guneba-ganwyobis (afeqturi)

aSliloba

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

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klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
`guneba-ganwyobis (afeqturi) aSliloba~ miRebulia klinikuri
praqtikis erovnuli rekomendaciebis (gaidlainebi) da
daavadebaTa marTvis saxelmwifo standartebis (protokolebi)
SemuSavebis, Sefasebis da danergvis erovnuli sabWos 2008 wlis
5 noembris #1 sxdomaze da damtkicebulia saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis ministris 2008 wlis 18
dekembris # 276/o brZanebiT.

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 guneba-ganwyobisA(afeqturi) aSliloba

1. daavadebis definicia, sinonimebi, klasifikacia da

terminologia (1, 3, 5, 8, 18)
guneba-ganwyoba _ adamianis mier gancdili emociuri mdgomareoba, romelic
damokidebulia garemoebaze da sixarulis da dardis monacvleobaSi
vlindeba.
guneba-ganwyobis (afeqturi) aSliloba xasiaTdeba daTrgunvis _ depresiis
an awevis _ eiforiis, maniis paTologiuri grZnobiT da erTmaneTisagan
gancalkevebuli afeqturi (depresiuli, maniakaluri, Sereuli da a. S)
epizodebis monacvleobiT.
depresiuli epizodis klinika upiratesad depresiuli, xolo maniakaluri
epizodis _ maniakaluri sindromiTaa warmodgenili.
depresiuli sindromi (sinonimebi: depresia, melanqolia) _ daTrgunuli
guneba_ganwyoba, ideatoruli da motoruli aqtivobis retadacia (e. w.
depresiuli triada) Serwymuli somato_vegetatiur aSlilobebTan.
tipiuri depresiuli sindromis mravalferovneba ZiriTadad depresiuli
triadis ama Tu im komponentis an calkeuli simptomis dominirebazea
damokidebuli, xolo mis struqturaSi heterogenuri fsiqopaTologiuri
simptomebis aRmoceneba afarTovebs depresiul sindromTa speqtrs da
ayalibebs atipiur depresiul sindromebs.
depresiuli sindromebia:
• klasikuri depresia (,,triadiT”);
• SfoTviani, aJitirebuli depresia, agznebis pikia depresiuli raptusi _
Raptus melancholicus;
• asTeniuri depresia;
• adinamiuri depresia;
• cremliani depresia;
• disforeuli (mowuwune, boRmiani) depresia;
• apaTiuri depresia, romlis kulminaciaa depresiuli stupori;
• anesTeziuri depresia _ garTulebis SemTxvevaSi viTardeba fsiqikuri
anesTezia _ Anaesthezia psychica dolorosa;
• depresia depersonalizaciiT da derealizaciiT;
• depresia akviatebebiT;
• ipoqondriuli depresia;
• SeniRbuli anu larvirebuli, latenturi, faruli, somatizirebuli,
daburuli depresia;
• depresiul _ bodviTi sindromi;
• depresiul-paranoiduli sindromi.
depresiuli sindromi aseve SeiZleba damZimdes cnobierebis oneroiduli
SecvliT, halucinaciebiT da fsevdohalucinaciebiT, fsiqikuri
avtomatizmebiT da sxva.

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maniakaluri sindromi (sin. mania) _ aweuli guneba-ganwyoba (hiperTimia,
eiforia), ideatoruli da motoruli hiperaqtivoba (e. w. maniakaluri
triada) Serwymuli somato_vegetatiur aSlilobebTan.
depresiuli sindromis msgavsad, tipiuri maniakaluri sindromis
mravalferovneba ZiriTadad maniakaluri triadis ama Tu im komponentis an
calkeuli simptomis dominirebazea damokidebuli, xolo mis struqturaSi
heterogenuri fsiqopaTologiuri simptomebis aRmoceneba ayalibebs atipiur
maniakalur sindroms.
maniakaluri sindromebia:
• mxiaruli mania;
• mrisxane mania;
• mania abneviT;
• araproduqtiuli mania;
• Sekavebuli mania; motoruli Sekaveba, zogjer stuporis
intensivobas aRwevs;
• mania oxunjobiT;
• eqspansiuri mania;
• maniakaluri agzneba _ furor maniakalis;
• maniakalur_bodviTi sindromi;
• maniakalur _ paranoiduli sindromi;
• oneroiduli maniakaluri mdgomareoba;
• moria;
• rauS _ mania;
• eqstazi.
afeqturi aSlilobis klasifikaciis momawesrigebeli RerZis rolSi
sxvadasxva parametri SeiZleba mogvevlinos: simZime _ msubuqi, saSualo da
mZime depresia an mania; mimdinareoba _ bipolaruli da unipolaruli anu
rekurentuli (Leonhard K., 1957); gamomwvev faqtorTan mimarTeba _ pirveladi
da meoradi (Robins E., Guse S.B., 1972; Lewis D.D., Smith S.E., 1983); warmomavloba _
ekzogenuri da endogenuri da sxva.
miuxedavad depresiis da maniis klasifikaciis mravalricxovnobis da
mravalferovnebisa _ struqturuli, etiopaTogenezuri, fenomenologiuri
da sxva _ srulyofilebaze pretenzias vercerTi ver acxadebs.
dReisaTvis fsiqikuri da qceviTi aSlilobis standartizebuli Sefasebisa
da diagnostirebisaTvis gamoiyeneba amerikis fsiqiatriuli asociaciis
diagnostikuri da statistikuri cnobaris me-4 gamocema _ DSM-IV da
msoflio jandacvis organizaciis mier mowodebuli, daavadebaTa
saerTaSoriso klasifikaciis me-10 gadasinjva _ dsk-10 (ICD-10; 1992);
saqarTveloSi klinikur praqtikaSi sargeblobisaTvis rekomendirebulia
dsk_10, romlis rubrikaSi ,,guneba-ganwyobis (afeqturi) aSlilobebi” (F30-
F39), mowodebuli operacionaluri kriteriumebis gamoyenebiT
diagnostirebisas, garda wamyvani afeqtisa, xdeba kidev ramdenime faqtoris
erTdrouli gaTvaliswineba: mimdinareoba, mdgomareobis simZimis xarisxi,
aSlilobis struqtura, RerZuli da gamWoli sindromebis
urTierTdamokidebuleba, rac aadvilebs afeqturi aSlilobisas erTiani

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fsiqiatriuli menejmentis SemuSavebas, mkurnalobas da SemTxvevis
prognozirebas.

2. guneba-ganwyobis aSlilobis epidemiologia (1, 3, 5, 6, 8)

• yoveli merve adamiani anu saerTo populaciaSi _ 15%, cxovrebaSi
erTxel mainc saWiroebs antidepresantebiT mkurnalobas, depresiis
gamo;
• aqedan mxolod 1/3 akiTxavs fsiqiatrs;
• aqedan mxolod 1/4¼-Si xdeba swori diagnostireba da iniSneba
adeqvaturi mkurnaloba;
• aqedan, 50% ama Tu im mizeziT wyvets mkurnalobas;
• didi depresiuli epizodis dros dasrulebuli suicidi 15-20%-ia,
rac 20-jer ufro maRalia vidre mTlian populaciaSi da 3-4-jer ufro
maRali, vidre sxva fsiqikuri aSlilobebis dros;
• SemTxvevaTa 60%-Si iRebs qronikul xasiaTs;
• pirveli depresiuli epizodis Semdeg, avdmyofebis 5-10% - Si viTardeba
maniakaluri mdgomareoba;
• genderuli Tanafardoba: SemTxvevaTa 2/3 qalia;
• srulfasovani cxovrebidan depresiis gamo dakarguli drois wili
aWarbebs Sizofreniisa da alchaimeris daavadebis gamo dakarguls
(DALY meTodi);
• depresia mosaxleobis dainvalidebis mxriv, 2020 wels daikavebs meore
adgils gul-sisxlZarRvTa daavadebebis Semdeg;
• depresias Tan axlavs SfoTva SemTxvevaTa 60_70%-Si, zogierTi
mkvlevaris azriT ki _ 42 -100% -Si (Dobson K S., Cheung E., 1990; Tollafson G.
D., et. Al. 1993));
• msoflioSi mosaxleobis 5% daavadebulia depresiiT; amavdroulad
sicocxlis manZilze depresiiT daavadebis riski daaxloebiT 20%-ia
(Costa e Silva J. A. 1993);
• depresiuli epizodi cxovrebaSi erTxel mainc gadaitana
_ 20-25%-ma qalma
_ 7-12% -ma mamakacma
• tipiuri SemTxvevebi, depresiuli avadmyofebis mxolod 10%-s Seadgenen.
ZiriTadad depresiuli aSliloba mimdinareobs waSlili, atipiuri,
ambulatoriuli e. w. SeniRbuli depresiis saxiT;
• atipiuri depresiis gavrceleba populaciaSi 0,7%-ia da misi
manifestaciis saSualo asakia 35 weli;
• atipiuri depresiis struqturaSi panikuri aSlilobis komorbidoba _
14,4%_s, xolo toqsikomaniis _ 28,8%_s Seadgens (Horwath E. et al. 1992);
• atipiuri depresiis xazebi SeimCneva rekurentuli depresiuli
aSlilobis mqone pacientebis 40%-Si; disTimiuris 60%-Si da
bipolarulis 50%-Si (Klein D.E., 1993);
• sicocxlis manZilze disTimiis ganviTarebis riski 3_6%-s Seadgens
(Angst J. et. al 1994; Shader R. I., 1994; DSM _IV, 1994;). Aavadoba 2_jer metia
qalebSi;

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 • disTimia ZiriTadad gvxvdeba zogad samedicino praqtikaSi _ 2,1 _ 3,7%
(Depression Guideline Panel, 1993). maT Soris, TiTqmis 50%-s uviTardebaT
tipiuri rekurentuli depresiuli aSliloba (Akiskal H.S. 1994).

3. guneba_ganwyobis aSlilobis eTiopaTogenezi (1, 3, 5, 6, 8)

A. biologiuri faqtorebi
genetikuri faqtorebi
kvlevebis umravlesoba miuTiTebs imaze, rom mZime depresiiT daavadebulTa
pirveli rigis naTesavebSi depresiuli aSlilobis ganviTarebis riski 10-
15%-ia, xolo zogadad populaciaSi 1-2%-s ar aRemateba.
monozigotur tyupebSi konkordantoba Seadgens 68%-s, xolo dizigotur
tyupebSi 23%-s (Price 1977); zogi avtoris azriTY es maCveneblebi Sesabamisad
74% da 43%-s aRwevs ( Angst 1966; Bertelsen et al. 1977).
memkvidreobiTobis albaToba ufro maRalia bipolaruli afeqturi
aSlilobisaTvis. bipolaruli aSliloba ufro xSirad gvxvdeba
bipolaruli aSlilobis mqone, vidre monopolaruli aSlilobebis mqone
probandebis ojaxebSi (Leonhard et al. 1962; Nurnberger, Gershon 1982). Tu erTi
mSobeli daavadebulia I tipis bipolaruli aSlilobiT, bavSvSi afeqturi
aSlilobis gamovlinebis albaToba 25%-s utoldeba. Tu orive mSobeli
daavadebulia I tipis bipolaruli aSlilobiT, bavSvSi aSlilobis
ganviTarebis albaToba 50_75%-mde izrdeba.

monoaminuri hipiTeza
monoaminuri hipoTezis Tanaxmad, adgili aqvs rogorc monoaminuri
receptorebis, aseve monoaminebis koncentraciis da aminebis cvlis
procesebis darRvevas. (Garver, Devis 1979).
monoaminuri hipoTezis mixedviT impulsis transmiterebis,
neiromediatorebis (noradrenalini, serotonini, dofamini) funqciuri
deficiti iwvevs depresias, siWarbe ki, manias. erTi monoaminuri sistemis
stimulireba iwvevs uSualo an mogvianebiT cvlilebebs meore monoaminur
sistemaSi. (Grahame_Smith D. G. 1992).
afeqturi impulsis gatarebaSi mniSvnelovani roli aqvs postsinafsuri
alfa_ da beta_adrenoreceptorebis (gvxvdeba Tavis tvinis sxvadasxva
struqturebSi) mgrZnobelobas, aseve neiromediatorebis destruqciasa da
maT ukumitacebaSi monawile agentis, MAO-s aqtiurobas.

neiroendokrinuli faqtorebi
endokrinuli cvlilebebi hipoTalamuri meqanizmebiT regulirdeba,
romelsac nawilobriv monoaminuri sistema akontrolebs. savaraudoa, rom
neiroendokrinuli darRvevebi hipoTalamusSi biogenuri aminebis miwodebis
regulirebis darRvevas gamoxataven. hipofizSi relizing-faqtoris

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gamomuSavebis regulireba kontrolirdeba garkveuli neiromediatorebiT
da maT Soris, depresiis paTogenezSi monawile neiromediatorebiT
(noradrenalini, serotonini, dofamini).
depresiis dros hipoTalamo_hipofizo_adrenalinuri sistema
hiperaqtiuria, rac iwvevs kortizolis sekreciis momatebas cirkaduli
riTmis darRvevasTan erTad, saRamos da Ramis saaTebSi sekreciis gazrdis
xarjze (normaSi kortizolis sekreciis piki dilis saaTebze modis). amis
garda, darRveulia ukukavSiris makontrolebeli meqanizmic, ris gamoc
deqsametazonis _ sinTezuri glukokortikosteroidis Seyvana ar axdens
endogenuri kortizolis gamomuSavebis daTrgunvas.
Carroll B. (1982)–is mier, am principze Seqmnili deqsametazonuri testis
dadebiTi Sedegi aReniSneba depresiul avdmyofTa 40-60%-s, didi depresiis
dros ki _ 80%-s. uaryofiTi deqsametazonuri testi ar SeiZleba
CaiTvalos didi depresiuli epizodis uaryofis safuZvlad, radgan yvela
avadyofSi ar xdeba kortizolis sekreciis daTrgunva, garda amisa,
deqsametazonis testi dadebiTi SeiZleba iyos sxva daavadebebis (mag.
kuSingis sindromi, nervuli bulimia, alcheimeris daavadeba, alkoholizmi,
mania) da aseve, orsulobis dros.
depresiis dros Semcirebulia Tireostimulirebadi, zrdis,
folikulostimulirebadi da luTeinizirebadi hormonis, aseve
testosteronis gamonTavisufleba. maniakaluri da depresiuli sindromebis
dros Senelebulia imunuri funqciebi.

Zilis faqtori
Zilis darRveva afeqturi aSlilobis mqone pacientebis 60-65%-s aReniSneba.
depresiis dros vlindeba swrafi Zilis fazis gazrda Zilis pirvel
periodSi da zogadad swrafi Zilis periodis gazrda (CaZinebisTanave
swrafi Zilis periodis dawyeba), Semoklebulia Zilis IV faza. maniakaluri
sindromis dros Cveulebrivi movlenaa xSiri gamoRviZebebi, zogadad Zilis
xangrZlobis Semcirebis fonze.

B. fsiqosocialuri faqtorebi
mowyvladobis faqtori
a. premorbiduli pirovnuli Taviseburebebi _ arsebobs mosazreba, rom
adamianebi piknikuri aRnagobiT da cikloTimiuri temperamentiT ufro
metad arian midrekilni bipolaruli afeqturi aSlilobisadmi, xolo
leptosomuri, fsiqasTeniuri _ unipolarulisadmi;
b. fsiqoanalitikuri faqtorebi _ fsiqoanalitikosebi amtkiceben, rom
dedis gardacvalebis an ganSorebis gamo bavSvobis asakSi dedis alersis
uqonloba, mozrdil asakSi depresiuli aSlilobebisadmi ganawyobs. mania
da aweuli guneb-ganwyoba ganixileba, rogorc dacva fonuri depresiisgan.
g. kognitiuri faqtorebi _ Beck-ma 1967 wels gamoTqva mosazreba, rom
,,depresiuli azrovneba” SeiZleba pirveladi aSliloba, an ukidures
SemTxvevaSi, am aSlilobis gamomwvevi da SemanarCunebeli Zlieri faqtori
iyos. depresiis kognituri hipoTezis sayrdenia bekis kognitiuri triada: a)
sakuTari Tavisadmi negatiuri damokidebuleba _ ,,saqmeebi cudad midis,

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 imitom rom me var cudi”; b) cxovrebiseuli gamocdilebis negatiuri
interpretacia _ ,,yovelTvis yvelaferi cudad iqneba”; g) momavlis
pesimisturi xedva _ marcxis molodini.

precipitirebadi faqtorebi
grZelvadiani, gaxangrZlivebuli da mwvave stresuli movlenebi _
mecnieruli kvlevebiT dasturdeba, rom stresuli movlenebidan eqvsi Tvis
ganmavlobaSi depresiis ganviTarebis riski 6–jer matulobs, suiciduri
mcdelobis riski ki _ 7-jer (Paykel et al. 1969, 1978; Brown, Harris 1978);
stres_faqtorebidan gansakuTrebuli mniSvneloba eniWeba danakliss
ganSorebis an sikvdilis gamo, faseulobaTa rRvevas, daucvelobis gancdas
da momavlis SiSs, mkveTr cxovrebiseul cvlilebebs.
mania mTlianad biologiuri faqtorebiT ganpirobebul aSlilobad
moiazreboda, magram klinikuri gamocdileba iZleva safuZvels davuSvaT,
rom mania provocirebulia, da zogjer iseTi stresuli movlenebiTac,
romelesac sxva pirovnebaSi SeiZleba depresia gamoewvia (mag. mZime
danaklisi).

C. depresiis (da maniis) zogadi samedicino da fsiqikuri komorbiduli

faqtorebi (1, 2)
cxrili 1

kardiovaskularuli autoimunuri aSliloba qirurgiuli

• miokardiumi infarqtis Semdeg • revmatoiduri • Tirkmlis
• CVA –s Semdeg arTriti transplantacia
• fitv-gulis ukmarisoba • sistemuri wiTeli • koronaluri arteriebis
mglura Suntireba

endokrinuli aSlilobebi virususuli infeqciebi kibo

• hipoTireoidizmi • pnevmonia • bronqebis
• Saqriani diabeti • martivi herpesi • pankreasis
• kuSingis daavadeba • Sidsi • ZuZus
• adisonis daavadeba • mononukleozi • nawlavebis
• hipopituitarizmi aravirusuli • sakvercxis
• akromegalia • brucelozi qimioTerapiis Semdgomi
• hipoparaTireoidizmi • tifi
• hiperparaTireoidizmi • neirosifilisi
• dismenorea • tubelkuliozi
metabolituri dermatologiuri ginekologia
• Tirkmlis qr. ukmarisoba • fsoriazi • histereqtomiis Semdgomi
• dializis Semdgomi • egzema • mSobiarobis Semdgomi
• B12 vitaminis deficiti

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hematologiuri nevrologiuri samedicino mizniT daniSnuli
• anemia aSlilobebi medikamentebi
• perniciozuri anemia • parkinsonis daavadeba • alfa_meTildofa
• foliumis deficiti • gafantuli • rezerpini
sklerozi • prednizoloni
• epilefsia • kontraceptivebi
• demencia • H2 antagonistebi_
• CV _ daavadebebi cimetidini, ranitidini,
• Tavis tvinis travma famotidini.
• ZilSi apnoes Seteva • haloperidoli
• hidrocefalia • amitriftilini
• hepatocerebruli • normoTimuli saSualeba
distrofia • sxva fsiqotropuli
preparatebi (mag.
bupropioni, risperidoni

arasamedicino mizniT moxmarebuli fsiqikuri faqtorebi

medikamentebi • disTimia
stimulirebadi prepaparatebis moxmarebis • panikuri aSliloba
ukuefeqti: • tikebi
• kokaini, kreki • fobiebi
• amfetaminebi • osesiur-kompulsiuri aSliloba
CNS_is depresantebis Sewyveta: • nervuli anoreqsia da bulimia
• alkoholi • personologiuri aSlilobebi
• benzodiazepini • impulsuri aSlilobebi
• somatoformulli aSlilobebi
• SfoTviTi aSlilobebi

fsiqologiuri, socialuri da biologiuri meqanizmebi ar SeiZleba

ganvixiloT, rogorc ueWveli urTierTgamomricxavi, radgan maT SeuZliaT
erTiani paTologiuri procesis gansxvavebuli doneebi warmoadginon.

4. guneba-ganwyobis aSlilobis klinikuri simptomatika (1, 3, 5,

6, 8)
afeqturi aSlilobis dros ZiriTadi darRveva mdgomareobs afeqtis anu
guneba_ganwyobis daTrgunvaSi (SfoTviT an mis gareSe) an awevaSi,
romelsac umetesad Tan axlavs zogadi aqtivobis donis Secvla, xolo
danarCeni simptomebis umravlesoba meoradia, iolad gasagebi xdeba guneba-
ganwyobisa da aqtivobis Secvlis konteqstSi. am aSlilobaTa umravlesoba
xasiaTdeba ganmeorebadobiT da fsiqosocialuri funqcionirebis
gauaresebiT, xolo calkeuli epizodis dasawyisi xSirad stresuli
movlenebiTaa provocirebuli.

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A. depresia (1, 3 – 6, 8)

depresiis klinikuri niSnebi, simptomebi, sindromebi

• garegnoba _ depresiuli avadmyofi gamoirCeva tipiuri garegnobiT.
mTlianad mouwesrigebeli, mouvlelia, Secvlilia gamometyveleba:
daSvebulia tuCis kuTxeebi, Subli SeWmuxnulia, mzera Camqrali,
quTuToebi damZimebuli, iSviaTad axamxamebs Tvalebs. mxrebi
Camovardnilia, TavCaqindruli da Tvalebdaxrilia, Jestikulacia
minimumamdea dayvanili, zogjer ki, sruli amimiaa. miuxedavad Rrma
depresiisa zogi avadyofi saxeze Rimils inarCunebs _ momRimari anu
ironiuli depresia;
• guneba-ganwyoba _ dominirebadia melanqoliuri afeqti, romelic
SeiZleba gamovlindes naRvliani, daTrguli, melanqoliuri guneba-
ganwyobiT. vitaluri komponenti SeiZleba sxvadasxva siZlieriT iyos
gamoxatuli, msubuqi modunebidan da sicocxlis tonusis daqveiTebidan
gaqvavebis da sruli umweobis gancdamde. vitaluri gancda _ ,,sulieri
tkivilis”, ,,gulze lodis”, ,,simZimis”, ,,sulis marwuxebSi moqcevis”
SegrZnebiT, romelsac zogjer Tan axlavs mosalodneli ubedurebis
dauZleveli gancda, vitaluri naRvelis gancdas ufro xSirad Tan
axlavs SfoTva da yalibdeba SfoTviT-naRvliani afeqti, xolo
emociuri gancdebis ukmarisobis, ganurCevoblobis arsebobis dros
yalibdeba apaTiuri afeqti;
• zogadi ideatoruli Sekaveba vlindeba asociaciuri procesebis
SenelebiT, yuradRebis koncentrirebis da abstragirebis unaris
daqveiTebiT, ukiduresi daurwmuneblobiT, sakuTari pirovnebis
ignorirebiT da pesimisturi SefasebiT. gamoxatulia e. w. pesimisturi,
,,depresiuli azrovneba”_ warsuli, awmyo da momavali Savbnel ferebSia.
gamoTqvams TviTdamcirebis, TviTbraldebis da TviTganadgurebis ideebs.
dakargulia emociuri rezonansi, ndoba adamianebisadmi, situacia
aRiqmeba permanentulad uimedod, yovelgvari gamonaTebisa da
gaumjobesebis gareSe. mTlianad kargavs momavalSi sakuTari Tavis
proecirebis unars. dro Senelebulia da zogjer gaCerebulic;
• motoruli Sekaveba an aJitacia _ avadmyofi uCivis sisustes, modunebas,
daRlilobas, moZraobs nela an umoZraodaa, umetesad zis an wevs,
naklebad icvlis pozas. avadmyofs didi Zalisxmeva Wirdeba nebismieri
martivi saqmis gasakeTeblad, uWirs dawyebuli saqmis bolomde miyvana.
aJitacia gamoixateba SeuCerebel motorul aqtivobaSi. msubuqi formebis
dros, avadmyofi ikvnets frCxilebs, ifSvnets xelebs, aqvs mousveneri
mzera da fexebis mousvenari moZraoba; mZime formisas ki, avadmyofi
wrialebs, dadis win da ukan, ver Cerdeba erT adgilze;
• metyveleba _ metyvelebis tempi Senelebulia, SekiTxvebze pasuxobs
mogvianebiT, xangrZlivi pauzebiT, uRimRamod, yru, daxSuli xmiT;
• anhedonia _ dakargulia interesi, sixarulis da siamovnebis miRebis
unari, interpersonaluri urTierTobebis da socialuri kontaqtebis
moTxovnileba;

10
• biologiuri anu somato-vegetatiuri simptomebi:
- guneba-ganwyobis cirkaduloba _ depresia diliT ufro mZimea;
- Zilis darRveva _ ufro xSirad iRviZebs dilaadrian, Cveulebrivze 2-3
saaTiT adre, gamouZineblobis grZnobiT, xSirad SfoTviT da
mousvenrobiT, Savbneli fiqrebiT warsulze da momavalze. SeiZleba
uWirdes CaZineba, an eZinos wyvetili ZiliT. zogjer ki piriqiT,
depresiul avadmyofs aqvs Warbi Zilianoba;
- anoreqsia da wonaSi dakleba an bulimia da simsuqne;
- Sinagani gamofitva, ioli daRla, anergia;
- libidos daqveiTeba;
- mravlobiTi somaturi Civilebi _ Tavis, saxsrebis, gulis areSi
tkivilebi, sisxlis mimoqcevis periferiuli moSla _ akrocianozi,
sicivis SegrZneba kidurebSi, arteriuli hipertenzia; intestinaluri
problemebi: hiposalivacia, kanis da lorwovanis simSrale, yabzoba;
dismenorea, mravlobiTi fsiqalgiebi, moklebuli saTanado substrats;
• asakobrivi Taviseburebebi:
- prepubertatuli periodi _ somaturi Civilebi, aJitacia, erTi da igive
xmiT warmoTqmuli smeniTi halucinaciebi, SfoTva, fobiebi;
- pubertatuli periodi _ fsiqoaqtiuri nivTierebebis Warbi moxmareba,
opoziciuri da antisocialuri qceva, daudevroba, siZneleebi
swavlaSi, skolis gacdena, SemTxveviTi nacnoboba, sibinZure, negatiuri
Sefasebisadmi aweuli mgrZnobeloba;
- sibere _ inteleqtualuri darRvevebi, yuradRebis ioli gadanacvleba,
mexsierebis daqveiTeba, dezorientireba, cnobierebis abneva,
fsevdodemencia an demencia Serwymuli depresiasTan, apaTia;
• suiciduri riski _ suiciduri azrebis, suiciduri tendenciebis da
dasrulebuli suicidis maRali sixSiris gamo aucilebelia suiciduri
riskis Sefaseba. motivacia SeiZleba iyos sruliad gansxvavebuli,
uxSiresad dauZleveli siZneleebis gadalaxvze uaris Tqma an
usasrulo, moCvenebiTi, mtanjveli suleri gancdebisaTvis wertilis
dasmis survili.
suicidis seriozul risk-faqtors warmoadgens:
- suicidis mcdeloba wina epizidis dros;
- suiciduri mcdeloba avadmyofis naTesavebs Soris;
- TviTmkvlelobis pirdapiri an arapirdapiri muqara da Semdgomi
,,avismomaswavebeli” dumili;
- suicidisaTvis mzadeba _ sucidisaTvis aucilebeli inventaris (Toki,
sawamlavi, iaraRi da a. S.) Zieba an suiciduri aqtis konstruirebis
mcdeloba da maTi letalurobis xarisxi;
- autodestruqciuli azrebi.
suicidur risks mniSvnelovnad zrdis:
- vitaluri naRveli da SfoTva;
- Zlis darRveva;
- emociuri da socialuri izolireba;
- gabrazeba agresiuli tendenciebiT;
- gamoxatuli damnaSveobis da arasrulfasovnebis gancda;
- fsiqozuri simptomebi;
11
 - azrebi ganukurnebel avadmyofobaze.
suiciduri riski maRalia:
- depresiuli epizodis dasawyisSi an bolos;
- Sereuli afeqtis dros;
- biologiur krizisul periodebSi _ pubertatuli an involuciuri
periodi, menopauzis dadgoma. (Poldinger, 1984; Deniker P., Olie J.P., 1990)

depresiuli sindromis struqturaSi ama Tu im simptomis dominireba

ganapirobebs sindromul Taviseburebas da Timoanalefsiuri mkurnalobis
taqtikas.

a. asTeniuri depresia (e. s. averbuxi, 1962) _ xasiaTdeba fsiqasTeniuri

xasiaTis Civilebis siWarbiT, emociuri labilobiT, asTeniuri tipis
azrovnebiT _ upiratesad dilis saaTebSi. misi ufro mZime formaa
gamofitvis depresia (Kielholz, 1970), romelic fsiqotravmirebadi
faqtorebis zemoqmedebiT viTardeba.
asTeniuri depresiis dros ufro efeqturia mkurnaloba gamoxatuli
mastimulirebeli efeqtis mqone antidepresantebiT.

b. apaTiuri depresiis dros dominirebs motivaciis, interesebis, emociuri

reagirebis, sasicocxlo tonusis daqveiTeba, ganurCevloba, anergia,
nebelobiTi funqciebis ukmarisoba, xolo sakuTriv melanqoliuri
afeqti, suiciduri tendenciebi, somato _ vegetatiuri simptomebi,
cirkadoba naklebadaa gamoxatuli. ukanasknel wlebSi gaxSirda
depresiebi apaTo_ abuliuri simptomebis upiratesobiT, rac zogierTi
avtoris azriT medikamentozur paTomorfozTan unda iyos
dakavSirebuli da xSirad isini farmakoTerapiisadmi torpidulobiT
gamoirCevian.
depresiis apaTo_anergiuli da adinamiuri variantebis mkurnalobisas
aqcenti unda gakeTdes mastimulirebeli moqmedebis mqone
antidepresantebze, aseve mao–s Seuqcevad inhipitorebze.

g. SfoTviTi depresia. klinikuri suraTi gamoirCeva foriaqis, aJitaciis,

somato_vegetatiuri simptomebis siWarbiT. saRamos mdgomareoba
SeiZleba damZimdes. xSiria TviTdanaSaulis, TviTbraldebis ideeebi,
aseve ipoqondriuli gancdebi da fobiebi.
mkurnalobisas ZiriTadi aqcenti unda gakeTdes Zlieri
Timoanaleptiuri da sedaciuri efeqtis mqone antidepresantebis
gamoyenebaze. Terapiuli efeqti, SfoTviani depresiis adeqvaturi
mkurnalobisas, daaxloebiT 60-70%-ia.
zogi avtori Tvlis, rom SfoTviTi depresia ufro moxucebuli
asakisTvisaa damaxsiaTebeli. zogierTi mkvlevaris azriT ki es aris
depresiuli avadmyofebis gansakuTrebuli qvejgufi, daavadebis
SedarebiT adreuli asakobrivi dasawyisiT, midrekilebiT xSiri
recidivebisa da gaxangrZlivebuli mimdinareobisadmi, ufro maRali

12
 suiciduri riskiT da naklebad keTilsaimedo Terapiuli da
socialuri prognoziT. (Gersh S., Fowles D. C., 1979; Fawcett J., 1988; Murphy J.
M., 1993; Cassano G. B. et al. 1993).

d. cremliani depresia _ xasiaTdeba sustsulovnebiT, afeqtis labilobiTa

da SeukaveblobiT, ususurobiTa da fsiqikuri hiperesTeziiT;

e. disforiuli anu buzRuna depresia, romlisTvisac damaxasiaTebelia

gandgoma, buzRuni, ioli gamRizianebloba, yvelafrisadmi zizRi,
pirquSi ganwyoba, zogjer Tanmxlebi vitaluri naRveliT. xasiaTdeba
mdgomareobis gaxangrZlivebiT da iSviaTi cvalebadobiT, Tumca
mdgomareoba uecrad SeiZleba Seicvalos agznebiT, braziT, agresiuli
da autoagresiuli tendenciebiT. es depresia, rogorc wesi organuli
ukmarisobis fonze viTardeba.

depresiis klinikuri suraTi, simZimis xarisxis mixedviT

depresiuli epizodi SeiZleba iyos msubuqi, saSualo (zomieri) da mZime.
msubuqi, hipoTimiuri depresia ufro xSirad daavadebis dasawyisSi
gvxvdeba, SemdegSi depresiuli epizodi ufro zomierad gamoxatul, tipiur
xasiaTs iRebs, an wina planze gamodis heteronomuri an somato
vegetatiuri simptomebi.
a. msubuqi depresiis dros avadmyofi garegnulad ar gamoiyureba
daTrgunulad. uCivis guneba-ganwyobis daqveiTebas, uRonobas, siamovnebis
miRebis unaris dakargvas, momatebul gamRizianeblobas, Zilis darRvevas
_ uWirs CaZineba, Rame uwydeba Zili da mxolod gamTeniisas iZinebs.
,,biologiuri” niSnebi, rogorc wesi ar vlindeba, Tumca guneba-ganwyoba
SeiZleba icvlebodes dRis ganmavlobaSi, saRamos Cveulebriv uaresia,
vidre diliT. msubuqi depresiis dros ufro xSirad gvxvdeba e. w.
,,nevrozuli” simptomebi: fobia, SfoTva obsesiuri da isTeriuli
simptomebi, ris gamoc zogi avtori msubuq depresias nevrozul
depresias uwodebs.
fsiqosocialuri funqcionireba gaZnelebulia.

b. zomieri depresia xasiaTdeba gamoxatuli simptomebis zomierebiT da

harmoniuli depresiuli triadiT _ guneba-ganwyobis daqveiTeba,
sixarulis gancdis unaris dakargva, pesimisturi azrovneba, energiis
daqveiTeba, rac fsiqosocialuri funqcionirebis gauaresebas da Sromis
unaris daqveiTebas iwvevs.

g. mZime depresias xSirad win uZRvis hipoTimiuri depresia.

fsiqopaTologia fenomenologiurad zomieri depresiisagan bevri
arafriT ar gansxvavdeba, depresiul simptomTa ufro meti intensivobis,
ufro farTe speqtris da mdgomareobis gansakuTrebuli mdgradobis
garda.

13
 DmZime depresiis dros:
• klinikur suraTSi dominirebs daTrgunuli melanqoliuri guneba-
ganwyoba (dardi, SfoTva, naRveli), interesebis dakargva,
ganurCevloba, anhedonia. darRveulia interpersonaluri
urTierTobebi da fsiqosocialuri funqcionireba. gamoxatulia
ideatoruli da motoruli Sekaveba. viTardeba adinamiuri anu
Sekavebuli depresia an zogjer fsiqikuri anesTezia;
• klinikur suraTSi aJitirebuli depresiis dominirebis dros
avadmyofi mousvenaria, wrialebs, kargavs mizanmimarTuli saqmianobis
unars. TviTbraldebis, codvianobis, TviTdanaSaulis da
ganukurneblobis zeRirebulovani ideebis fonze, msjelobs
sikvdilze, cxovrebis uazrobaze, gamoTqvams suicidur azrebs,
adgens TviTmkvlelobis gegmebs, eZebs saSualebebs.
mZime depresiuli aSlilobisaTvis damaxasiaebelia somato_vegetatiuri
gamovlinebebis mravavalferovneba da mdgradoba.
depresiis gaRrmavebis SemTxvevaSi viTardeba, ufro iSviaTi, depresiis
fsiqozuri formebi.
fsiqomotorulma Sekavebam SeiZleba miaRwios depresiuli stuporis
xarisxs _ sruli umoZraobiT, mkveTri bradifsiqizmiT, zogjer sruli
mutizmiT da cnobierebis abneviT. avadmyofi saWiroebs gansakuTrebul
mzrunvelobas da yuradRebas, mdgomareoba SeiZleba Seicvalos uecari
agznebiT an impulsuri suiciduri mcdelobiT.
mZime depresiis struqturaSi SfoTvis upiratesobisas, misi Semdgomi
gaZlirebis fonze, SesaZlebelia ganviTardes melanqoliuri raptusi an
fuga _avadmyofi oTaxSi wrialebs, oxravs, kvnesis, yviris, imtvrevs xelebs,
iyenebs travmebs, mosalodnelia suciduri mcdeloba.
zeRirebulovani depresiuli ideebi qmnis substrats damnaSaveobis,
TviTdamcirebis, codvianobis, TviTbraldebis, gaRatakebis, gansjis,
mosalodneli damsaxurebulad dasjis, ganukurneblobis da a.S. bodviTi
ideebis formirebisaTvis da yalibdeba bodviTi depresia anu bodviTi
melanqolia, roca bodviTi ideebi ZiriTadad wamyvani afeqtis Sesatyvisi _
kongruentulia. ufro iSviaTad viTardeba devnis bodva _ ,,melancholie de
persecution” _ am SemTxvevaSi laparakia depresiul_paranoidul sindromze.
gaSlili depresiul-paranoiduli sindromi xasiaTdeba depresiuli
derealizaciiT da depersonalizaciiT, mwvave grZnobadi,
intermetamorfozis da miniSnebis bodviT, mcdari SecnobebiT,
iluzorul_bodviTi aRqmiT. bodvis fabula, rogorc wesi, dakavSirebulia
danaSaulis, gansjis, dasjis moaxloebuli katastrofis ideebTan. am
simptomatikas SeiZleba Tan axldes verbaluri halucinaciebi.
halucinaciuri gancdebis dominirebis SemTxvevaSi calke gamoyofen
depresiis halucinaciur formas.
depresiuli afeqtis da bodviTi ideebis Semdgomi damZimeba iwvevs
melanqoliuri parafreniis anu fantastikuri melanqoliis ganviTarebas.
depresiis fsiqozuri formebis dros SesaZlebelia afeqtis
arakongruentuli bodvis da halucinaciis, anu heteronomuli
procesualuri simptomebis _ fsiqikuri avtomatizmebi,

14
katatonur_hebefrenuli simptomebi, devnis, zemoqmedebis bodva, azrovnebis
specifiuri darRvevebi da sxva _ aRmoceneba.

atipiuri depresia
garda martivi da bodviTi depresiebisa, bolo dros klinikur praqtikaSi
xSirad gvxvdeba depresiis gansakuTrebuli sindromaluri variantebi
waSlili, disharmoniuli, disociaciuri simptomatikiT.
a. anesTeziuri depresia, romelic ayalibebs depresias
depersonalizaciiTa da derealizaciiT, xasiaTdeba emociuri
gaucxovebis gancdiT, avadmyofebi uCivian ara imdenad guneba-ganwyobis
daqveiTebas, dards an SfoTvas, ramedenadac gancdis da emociis,
TanagrZnobis unaris uqonlobas. aRniSnaven, rom dakarges raRac kavSiri
samyarosTan, rom Seicvala samyaros aRqma, garemom dakarga Cveuli
feradovneba, umoZrao, usicocxlo da uRimRamo gaxda. xmebi daxSuli
da monotonuria. gamoxatulia anhedonia. ufro mkveTrad gamoxatuli
depresiuli derealizaciisas avadmyofebs euflebaT gancda, rom
imyofebian burusSi, samyaro Tejirs miRmaa, itanjebian emociuri
siClungis, garemosTan emociuri rezonansis dakargvis gamo. vitaluri
komponenti warmodgenilia gulis areSi da TavSi gaxevebis, gaqvavebis,
sicarielis gancdiT. fiqomotoruli Sekaveba sustadaa gamoxatuli an
saerTod ar arsebobs. sakmaod xSirad gvxvdeba somatofsiqikuri
depersonalizacia _ dakargulia Zilis, SimSilis, tkivilis da a.S.
SegrZneba. rTul SemTxvevebSi viTardeba anaesthesia psychica dolorosa.
zogjer SeiZleba ganviTardes uecari motoruli agzneba, rac zrdis
suicidis risks;
b. depresia akviatebebiT xasiaTdeba klinikur suraTSi obsesiuri,
kompulsiuri an fobikuri simptomebis upiratesobiT. ufro xSirad
akviatebebi uviTardebaT pirebs premorbiduli fsiqasTeniuri xazebiT
xasiaTSi. depresiis struqturaSi akviatebuli mdgomareoba SeiZleba
iyos ipoqondriuli fobiis (kancerofobia, kardiofobiis, nozofobiis
da sxva), kontrastuli akviatebis (pirovnebis Seusabamo
moralur_eTikuri faseulobebis), akviatebuli meryeobis da
indiferentuli Sinaarsis ideatoruli akviatebebis saxiT. iSviaTia
akviatebuli moqmedebebi da rTuli ritualebi. sakuTriv depresiuli
afeqti zomierd an sustad aris gamoxatuli;
g. SeniRbuli (larvirebuli, latenturi, faruli, somatizirebuli)
depresia xasiaTdeba klinikur suraTSi somaturi da vegetatiuri
simptomebis an sxva fsiqopaTologiuri registris aSlilobisaTvis
damaxasiaTebeli darRvevebis upiratesobiT, xolo tipiuri depresiuli
afeqti waSlilia an saerTod ar aris, am ukanasknels zogjer uwodeben
,,depresias depresiis gareSe” an ,,depresiul ekvivalents”.
bolo wlebSi SeniRbuli depresiis calke gamoyofa fenomenologiuri
fsiqiatriis erT_erT mniSvnelovan warmatebad unda CaiTvalos.
avtorTa umravlesoba (Kielholz P., 1973; Lopez-Ibor J., 1973; Less S., 1983; da sxv.)
SeniRbuli depresias viwro gansazRvrebas iZleva da mas miakuTvnebs,
mxolod endogenuri depresiis somatizirebul formebs. depresias

15
 mkveTrad gamoxatuli somato-vegetatiuri funqciuri darRvevebiT da
ipoqondriul depresias Cveulebriv ganixilavs SeniRbuli depresiis
farglebSi.
SeniRbuli depresiis klinikuri niSnebia:
• momatebuli SfoTva sakuTari janmrTelobis gamo;
• warmosaxvebi gansakuTrebiT mZime daavadebebze;
• mravlobiTi somaturi da vegetatiuri aSliloba _ taqikardia,
wnevis meryeoba, oflianoba, dismnezia, gulisreva, gulis areSi
SeteviTi xasiaTis tkivili, myari Tavbrusxveva, kuW-nawlavis
traqtis aSliloba, mravalricxvovani fsiqalgia da paresTezia,
SedarebiT iSviaTad, Civilebi sayrden_mamoZravebeli sistemis
da sunTqvis organoebis mxriv da sxva.
_ warmoadgens depresiis niRabs.
• ukiduresad ucnauri xasiaTis vitaluri gancda, dilis saaTebSi
somaturi Civilebis saxiT;
• dauzustebeli lokalizaciis senestopaTiebi;
• klinikur substrats moklebuli somaturi Civilebi;
• dausrulebeli vizitebi sxvadasxva profilis eqimebTan
damatebiTi gamokvlevebis moTxovniT, miuxedavad somaturi
darRvevebis ararsebobisa;
• guneba-ganwyobis umniSvnelo daqveiTeba. SesaZlebelia SesamCnevi
iyos depresiuli afeqtis niSnebi _ gaRaribebuli moZraobebi,
SeSfoTebuli mzera, damaxasiaTebeli mobuzuli poza da saxis
naRvliani gamometyveleba;
• depresiis somaturi niSnebi _ libidos, Zilisa da madis
darRveva, anhedonia an vitaluri gancdebi moWeris, dabuJebis,
simZimis SegrZnebiT gulis an epigastriumis areSi;
• umniSvnelo inteleqtualuri Sekaveba;
• ukmayofileba fsiqiatrTan gaSvebiT _ is daiRala ara marto
Tavis daavadebiT, aramed eqimebiTac;

am darRvevebis depresiisaTvis mikuTvneba SesaZlebelia:

• memkvidruli mowyvladobis;
• simptomebis sezonurobis da cirkadobis;
• anamnezSi ufro tipiuri afeqturi _ depresiuli da
ganasakuTrebiT hipomaniakaluri periodebis arsebobis;
• xSiri suiciduri tendenciebis;
• Timoanaleptiuri mkurnalobis kargi efeqtis gamo;

guneba-ganwyobis (afeqturi) qronikuli aSliloba

a. disTimia
disTima warmoadgens qronikul depresiul aSlilobas. gamoyofen pirvelad
da meorad disTimiebs, aseve disTimiebs adreuli da mogvianebiTi
dasawyisiT. pirveladi anu ,,sufTa” disTimia Cveulebriv viTardeba

16
TandaTanobiT, bavSvobis an pubertatul asakSi, swrafad iRebs qronikul
xasiaTs (21 w-mde) da ar aris dakavSirebuli raime winamorbed fsiqikur
aSlilobasTan. meoradi disTimia iwyeba mogvianebiT, ukve arsebuli
fsiqikuri an somaturi daavadebis fonze. disTimiis es forma pirvelad
aRwera H.Weitbrecht_ma (1954) endoreaqtiuli disTimiis saxeliT. misi azriT
aSliloba uviTardebaT emociurad arastabilur, sensitiur pirebs
fsiqotravmirebad situaciaSi. zogierT avadmyofs disTimiuri aSlilobis
fonze ufro mkveTrad gamoxatuli depresiuli epizodi e. w. ,,ormagi
depresia” uviTardeba (Keller M.B., Shapiro R.W., 1982; Keller M.B. 1994 da sxv.),
romelic aseve gamoirCeva qronikuli mimdinareobiT, didi depresiuli
epizodebis recidivebis sixSiriT da Timoanaleptiuri mkurnalobisadmi
rezistentobiT. DSM_IV–is monacemebiT, rekurentuli depresiuli
aSlilobis 20_25%-s Seadgens avadmyofebi ,,ormagi depresiiT”, aqedan
srulyofili remisia viTardeba avadmyofebis 3%_Si, sxva SemTxvevebSi
remisiebs Soris yovelTvis rCeba ama Tu im xarisxis disTimiuri
simptomebi.
disTimiis ZiriTadi maxasiaTebelia:
• aSlilobis TandaTanobiTi dasawyisi da qronikuli mimdinareoba;
• TiTqmis mudmivad arsebuli an remitirebadi ara Rrma depresiuli
simptomebi, romelic ar warmoadgens rezidualurs depresiuli
epizodis Semdeg;
• Tanmxlebi pirovnuli paTologia, romelic pirdapir ar monawileobs
simptomebis formirebaSi;
• socialuri funqcionirebis SedarebiTi stabiluroba;
• depresia ufro subieqturia, vidre obieqturi.

disTimiis ZiriTadi klinikuri simptomebia:

• madis daqveiTeba an gaumaZRroba;
• uZiliba an Warbi Zilianoba;
• anergiuloba an daRliloba;
• daqveiTebuli TviTSefaseba;
• yuradRebis koncentrirebis gaZneleba;
• gadawyvetilebis miRebis gaZneleba;
• uimedobis grZnoba.

ufro iSviaTad gvxvdeba:

• sakuTari ugergilobis grZnoba;
• anhedonia;
• interesebis dakargva;
• gulCaTxrobiloba;
• mwuxareba an danaSaulis gancda warsulis gamo;
• gamRizianebloba an brazi;
• aqtivobisa da produqtulobis daqveiTeba.

Zalze iSviaTia:
• tipiuri somato-vegetatiuri darRvevebi;

17
 • melanqoliuri depresiis cirkadul_vitaluri niSnebi;
• gamoxatuli fsiqomotoruli Sekaveba;
• suiciduri azrebi;
• bodviTi aSliloba.
G
b. cikloTimia
cikloTimia xasiaTdeba qronikuli fluqtuirebadi mimdinareobiT da
mravlobiTi hipomaniakaluri da msubuqad an zomierad gamoxatuli
depresiuli epizodebiT. cikloTimiis klinikaSi ar gvxvdeba fsiqozuri
simptomebi. qalebSi da mamakacebSi Tanabari sixSiriT viTardeba, rogorc
wesi mozardobis an ymawvilobis asakSi iwyeba da Tan axlavs alkoholis
da fsiqoaqtiuri nivTierebebis Warbi gamoyeneba. depresiuli aSliloba
ufro xSiria pirdapir naTesavebSi, vidre populaciaSi. emociuri
aSlilobis rekurentulobam SeiZleba gamoiwvios fsiqosocialuri
funqcionirebis gauareseba.

B. maniakaluri epizodis klinika (1, 3, 6, 8)

maniis klinikuri niSnebi, simptomebi da sindromebi

• garegnoba _ avdmyofi gamoiyureba gaaxlgazrdavebuli, gabrwyinebuli
TvalebiT da Sefakluli loyebiT, yovelmxriv cdilibs yuradRebis
centrSi moqcevas _ Warbad iyenebens kosmetikas, icvams gamomwvevad,
eqscentrulad, zedmetad mkveTr ferebSi, Seuxameblad;
• aweuli guneba-ganwyoba _ avadmyofi optimisturi, eqspansiuri da
eiforiulia, romlis realuri mizezi ara Tu ar arsebobs, aramed
SeiZleba avadmyofis cxovrebasTan groteskulad Seusabamoc ki iyos.
aweuli guneba-ganwyobis xarjze yvela movlens dadebiTad aRiqvams.
SeiZleba gamovlindes momatebuli gamRizianebloba, brazi, agresia;
• azrovnebis darRveva _ vlindeba tempis aCqarebaSi. asociaciuri
procesebis aCqarebuli da daukavSirebelia, viTardeba ,,ideaTa rbola”.
zogjer gvxvdeba Sinarsobrivi darRvevac _ avadmyofi axdens sakuTari
SesaZleblobebis gadafasebas, aRmocendeba gandidebis zeRirebulovani
ideebi. yuradRebis koncentrireba gaZnelebulia, SesaZlebelia
hipermnezia;
• motoruli aqtivoba _ momatebulia qmediToba _ erTdroulad iwyebs
uamrav saqmes, romelic bolomde ver mihyavs. saqmianoba xdeba umizno da
uSedego, vlindeba garTobisadmi, azartuli TamaSebisadmi, alkoholisa
da narkotikebis moxmarebisadmi midrekileba. avadmyofi flangavs fuls,
qonebas, xSirad debs wamgebian da moufiqrebel xelSekrulebebs;
• metyveleba _ avadmyofi laparakobs swrafad, xmamaRla, dramatulad,
Teatralurad, CaxleCili xmiT. asociaciuri procesebis Zlieri
aCqarebis gamo, metyveleba nakadis xasiaTs atarebs da SeiZleba
daukavSirebelic gaxdes;

18
• vegetatiuri funqciebi energia mozRvavebulia, pulsi aCqarebulia,
daqveiTebulia Zilis moTxovnileba. aweulia libido, rac xSirad
SemTxveviTi seqsuluri kavSirebis da arasasurveli orsulobis mizezi
xdeba. mada ufro xSirad momatebulia, magram motoruli agznebisa da
uZilobis gamo ikleben wonaSi. mkurnalobis gareSe, TandaTanobiT
viTardeba sruli gamofitva;
• adeqvaturi Sefasebis da daskvnis gakeTebis, racionaluri
gadawyvetilebis miRebis unari daqveiTebulia, xdeba sakuTari
avadmyofobis sruli uaryofa.

maniakaluri epizodis klinikur suraTSi, rogori simZimisac ar unda iyos

is, wamyvani yovelTvis aris afeqturi fonis da vitalur _ energetikuli
tonusis momateba. maniis struqturaSi am ori komponentis gamovlineba
faravs somatovegetatiur darRvevebs. ama Tu im simptomis dominirebis
mixedviT gamoyofen maniis sxvadasxva sindromul variantebs:
• mxiaruli mania _ optimisturi guneba-ganwyoba, zomieri metyvelebiTi da
motoruli agznebiT; es varianti Seesabameba K. Leonhard (1957)–is
aRweril ,,sufTa manias”, romelic xasiaTdeba eiforiuli guneba-
ganwyobiT, dadebiTi vitaluri TviTgrZnobiT da sakuTari
SesaZleblobebis gadafasebiT, aseTi qceva avadmyofs dabrkolebas ar
uqmnis socialuri funqcionirebisas;
• disforiuli mania _ aweuli guneba-ganwyoba ukmayofilebiT,
modaveobiTa da gamRizianeblobiT; xasiaTdeba fsiqikuri funqciebis
aCqarebiT, gandidebis zeRirebulovani ideebiT, fsiqomotoruli
agznebiT, braziT, rasac SesaZloa agresiuli qceva moyhves;
• eqspansiuri mania _ fsiqikuri procesebis aCqarebas Tan axlavs
gandidebis zeRirebulovani ideebi, saqmianobisadmi uzomo ltolva _
sistematurad problemebis mogvarebaSia, flangaven fuls da qonebas,
debs realurad Seusrulebel pirobebs da xelSekrulebebs, ris
Sedegadac xSirad gakotrebamde midis da kargavs socialur statuss;
• mania abneviT anu mania ,,ideaTa rboliT”_ aweuli guneba-ganwyobis
fonze, asociaciebis aCqareba, dawyveta, daukavSirebeli metyveleba da
uwesrgo motoruli agzneba;
• araproduqtiuli mania _aweuli guneba-ganwyoba da motoruli agzneba
araproduqtiul metyvelebasTan erTad;
• bodviTi mania _ aweuli guneba-ganwyoba, fobikur warmonaqmnebsa da
iSviaTad, interpretaciul bodvasTan erTad. xSiria gandidebis da
devnis bodva, iSviaTad _ damokidebulebis. SesaZlebelia
halucinaciebis CarTvac;
• Sekavebuli mania _ aweuli guneba-ganwyoba da metyvelebiTi agzneba
motoruli Sekavebis fonze, romelic zogjer stuporis intensivobas
aRwevs;
• mania oxunjobiT _ aweuli guneba-ganwyoba motoruli da metyvelebiTi
agznebiT, manerulobiT, bavSvurobiT, jambazobiT, briyvuli xumrobebiT;

19
• maniakaluri agzneba _ furor maniakalis _ mdgomareoba mkveTrad
gamoxatuli fsiqomotoruli agznebiT, braziT, agresiiTa da
damangreveli qmedebebiT;
• asakobrivi Tavisebureba _ mozardebSi maniis niSnebi vlindeba
fsiqoaqtiuri nivTierebebis Warbi moxmarebis da asocialuri qmedebebis
saxiT.

maniis klinikuri suraTi simZimis xarisxis mixedviT

maniakaluri aSlilobis simZimes tipiuri maniakaluri sindromis

gamovlinebis xarisxis garda, ganapirobebs klinikur suraTSi
heteronomuri siptomebis gamoCena da fsiqosocialuri funqcionirebis
done.
a. hipomania _ maniakaluri sindromis msubuqi formaa, xasiaTdeba fsiqo-
fizikuri tonusis momatebiT, sifxizlis, fizikuri da fsiqikuri
keTildReobis grZnobiT, aweuli guneba-ganwyobiT da optimizmiT. aweulia
TviTSefaseba. fsiqikuri funqcionireba _ aRqma, damaxsovreba, azrovneba _
gaiolebulia, aweulia saqmianobisadmi ltolva. avadmyofs sZinavs
xanmokle, magram Rrma ZiliT, dgeba fxizlad, swrafad energiulad,
damajereblad akeTebs misTvis Cveul saqmes, warmatebulia sawavlaSi,
samsaxurSi. miuxedavad didi raodenobiT energiis xarjvisa ver grZnobs
daRlas. gaZlierebulia mada, pulsi aCqarebulia, gamococxlebulia mimika
da metyveleba, gamoiyureba axalgazrdulad, energiuli moZraobebiT.
xSirad Znelia Seicno am mdgomareobis avadmyofuroba, axloblebis mier
igi aRiqmeba, rogorc saqmiani, yuradRebiani, mxiaruli, kontaqturi,
mixvedrili, xumara, iniciativiani da TviTdajerebuli adamiani. Cveuli
eiforia zogjer SeiZleba Seicvalos gaRizianebiT da uxeSobiT, magram es
ar iwvevs socialuri da SromiTi funqcionirebis darRvevas.
hipomania xSirad SeimCneva maniis dawyebis an maniidan gamosvli dros, misi
avadmyofurobis Secnoba mxolod gamoxatul maniakalur an depresiul
mdgomareobaSi gadasvlis Semdeg xdeba SesaZlebeli.

b. gamoxatuli maniakaluri sindromi _ avdmyofs damaxasiaTebeli

garegnuli ieri aqvs: Tvalebi gabrwyinebulia, saxe hiperemiuli, mimika
cocxali, mxiarul ganwyobazea, ganmsWvalulia optimizmiT, uzrnveli da
uproblemoa, araferi ar adrdebs da ar aRelvebs. dro da dro mxiaruli
da laRi ganwyoba, garegani faqtorebis zemoqmedebiT, icvleba eWviT,
gamRizianeblobiT da braziT, magram es afeTqebis xasiaTs atarebs da
swrafad qreba.
asociaciebi, azrovnebis tempi aCqarebulia, yuradReba gafantuli.
gamoTqvams zeoptimistur da eqspansiur zeRirebulovan azrebs. aweulia
sakuTari Rirsebis gancda, adgens grandiozul gegmebs da ver xedavs
veraviTar dabrkolebas. axdens sakuTari SesaZleblobebis gadafasebas.
avdmyofi laparakobs bevrs, swrafad, uwyvetad, afrqvevs nerwyvis Sxefebs,
xma exliCeba, gamoTqmebi araTanmimdevrulia, swrafad xteba erTi Temidan
meoreze, uxvevs ZiriTad Temas, yoveli wvrilmani ubiZgebs saubari axali
mimarTulabiT waiyvenos, ise rom veRar ubrundeba ZiriTads, azrovneba

20
wyvetili xdeba, viTardeba ,,ideaTa rbola” (fuga). xSirad iyenebs
kalamburebs, xumrobebs, citatebs, zogjer bilwsityvaobs, uadgilod
icinis, stvens, ukravs, mReris Txzavs leqsebs, yvelas siyvaruls eficeba,
saubarSi iniciativas iRebs da ugulebelhyofs SekiTxvebs. qmnis
erTdroulad mxiarul da daZabul atmosferos.
avadmyofi grZnobs energiis mozRvavebas, misTvis yvelaferi SesaZlebeli
da dasaSvebia, moZraobs swrafad, erT adgilze ver isvenebs, xSirad
icvlis pozas, wrialebs, dadis an darbis oTaxSi, yvalaferSi cxvirs yofs.
gaZlierebulia seqsualuri moTxovnileba da mada, Wams fexze mdgari,
swrafad, dauReWavad ylapavs. aRfrTovanebiT esalmeba yvelas. maniakaluri
agzneba saRamos kidev ufro Zlierdeba, Rame ver iZinebs, an Zinavs cota da
zedapiruli ZiliT. agznebis momatebisas xdeba cinikuri, gaSiSvlebuli,
seqsualuri uxeSobiT. hiperaqtiuroba da mizidulobebis gaZliereba
problemebs uqmnis mikro da makro socialur garemosTan urTierTobaSi.
mosalodnelia saxifaTo an kriminaluri qmedeba.
miuxedavad momatebuli aqtiurobisa da saqmianobisadmi ltolvisa,
daqveiTebulia produqtiuloba da darRveulia Cveuli fsiqosocialuri
funqcionireba.

g. fsiqozuri mania _ maniakaluri epizodis damZimeba xdeba fsiqozuri

simptomebis _ bodvis, halucinaciebis da cnobierebis abnevis damatebis
xarjze.
aweuli TviTSefasebisa da gandidebis zeRirebulovani ideebi gardaiqmneba
afeqtis kongruentul gandidebis, gansakuTrebuli warmoSobis eqspansiur
bodviT azrebad, xolo maniakaluri sindromis struqturaSi
gamRizianeblobis da eWvianobis dominirebis dros, viTardeba devnis bodva.
bodva Cveulebriv gamoirCeva mcire masStabiT, faqtis konstataciis xasiaTs
atarebs da ar xdeba misi inteleqtualuri gadamuSaveba. avadmyofis
cnobiereba ara aris koncentrirebuli bodviT produqciaze, TiTqos
mxolod keTilganwyobis, optimizmis, energiulobis gamoxatvas emsaxureba
da avadmyofi mas fizikuri da sulieri yovlisSemZleobis
damadastureblad ,,igonebs”, ris gamoc ,,gaTamaSebis” STabeWdilebas
tovebs. gansxvavebiT depresiuli mdgomareobisa, avadmyofi maniakaluri
parafreniis drosac ki, ar aris mocululi bodviTi gancdebiT. avadmyofis
gamoTqmebSi bevri fantaziaa, meryeobs, gadarwmunebis mcdelobisas am
ideebze iolad ambobs uars. fsiqikuri statusis damZimebisas ideaTa
rbola midis abnevamde. metyveleba gaugebari xdeba. piradi higienis,
sakvebis da siTxis miRebisadmi daudevarma damokidebulebam SeiZleba
gamoiwvios sicocxlisTvis saxifaTo mdgomareoba.
maniis struqturaSi ,,arakongruentuli” gulisxmobs afeqturad neitralur
bodviT da halucinaciur aSlilobas, mag. damokidebulebis bodva
damnaSaveobisa da braldebis gareSe, an xmebi, romlebic esaubrebian
avadmyofs misTvis emociurad neitralur Temaze.

C. Sereuli afeqturi aSliloba (1, 6, 8, 18)

afeqturi aSlilobis dros zogjer depresiuli da maniakaluri simptomebi
erTdroulad arsebobs, hiperaqtiur, sityvauxv pacients SeiZleba Rrma

21
depresiuli azrebi qondes, an aweul guneba-ganwyobasa da gandidebis
ideebs Tan axldes SfoTva, aJitireba, aqtivobis da libidos daqveiTeba, an
ideaTa rbola da hiperTimiuri afeqti iyos motoruli Sekavebis fonze,
rac SeZlebelia gadaizardos maniakalur stuporSi. sxva SemTxvevaSi
SesaZlebelia depresiuli, hipomaniakaluri an maniakaluri simptomebis
swrafi alternireba; mag. maniakaluri avadmyofi ramdenime saaTiT SeiZleba
mZime depresiam moicvas, Semdeg ki isev swrafad dabrundes maniakalur
mdgomareobaSi. (Griesinger 1867; Kotin, Guodwin 1972).

5. guneba-ganwyobis (afeqturi) aSlilobis diagnostireba (1, 7,

18, 19)

guneba-ganwyobis aSlilobis diagnostikuri kriteriumebi DSM-IV_is

mixedviT (1, 19)

a. didi depresiuli epizodis kriteriumebi (DSM-IV):

• daTrgunuli gunaba-ganwyoba, dRis umetes dros da TiTqmis
yoveldRiurad, subieqturi SefasebiT (mag. dardis da sicarielis
grZnoba) an obieqturi dakvirvebiT (mag pacienti tiris);
SeniSvna: bavSvebSi da mozardebSi SesaZlebelia iyos gamRizianebloba.
• gamoxatulia interesebis daqveiTeba an nebismieri tipis saqmianobidan
siamovnebis miRebis unaris dakargva dRis umetes dros da TiTqmis
yoveldRiurad (subieqturi SefasebiT an obieqturi dakvirvebiT);
• wonis mniSvnelovani dakleba, romelic ar ukavSirdeba dietas an
wonaSi momateba (mag. TveSi 5%-iT);
• uZiloba an Zilianoba, TiTqmis yoveldRiurad;
• fsiqomotoriuli agzneba an Sekaveba, TiTqmis yoveldRiurad,
obieqturi dakvirvebiT;
• daRliloba, Zalis dakargva TiTqmis yoveldRiurad;
• sakuTari uvargisobis da damnaSaveobis gazviadebuli grZnoba
(romelic SeiZleba bodviTi xasiaTis iyos), TiTqmis yoveldRiurad;
• azrovnebis da yuradRebis koncentrirebis unaris daqveiTeba,
daurwmunebloba TiTqmis yoveldRiurad (sibieqturi SefasebiT an
irgvlimyofebis azriT);
• perioduli fiqrebi sikvdilze da TviTmkvlelobaze, an
TviTmkvlelobis spontanuri mcdeloba an suicidi dagegmvis Sedegad.

diagnostikuri Sefaseba:
• xuTi an meti zemoT CamoTvlli simptomebi arsebobs 2 kviris manZilze
da iwvevs normaluri funqcionirebis daqveiTebas, aqedan erT-erTi
simptomi mainc unda iyos daqveiTebuli gunaba-ganwyoba an garemosadmi
interesis da siamovnebis miRebis unaris dakargva.

22
 SeniSvna: am simptomebSi ar igulisxmeba somaturi daavadebiT
ganpirobebuli simptomebi, aseve afeqtis Seusabamo bodvebi da
halucinaciebi;
• simptomebi ar Seesabameba Sereuli epizodis kriteriumebs;
• simptomebi iwveven klinikurad gamoxatul distress an funqcionirebis
darRvevas socialur, SromiT da sxva sferoSi;
• simptomebs ar aqvs pirdapiri paTofiziologiuri kavSiri fsiqoaqtiuri
nivTierebebis gamoyenebasTan da ar aris ganpirobebuli somaturi an
nevrologiuri daavadebiT;
• simptomebi ar aris gamowveuli mZime danaklisiT.

b. melanqoliis diagnostikuri kriteriumebi (DSM-IV):

a. nebismieri qvemoT CamoTvlili simptomi arsebobs mimdinare epizodis
ufro mZime periodis ganmavlobaSi:
• raime saxis saqmianobidan siamovnebis miRebis unaris dakargva;
• reaqciis uqonloba im stimulze, romelic Cveulebriv siamovnebas
aniWebda (sasixarulo movlenazec ki gunaba-ganwyoba ar umjobesdeba).
b. sami an meti qvemoT CamoTvlili simptomebidan:
• mkafiod gamoxatuli depresiuli guneb-ganwyoba;
• depresiis gamovlineba ufro gamoxatulia diliT;
• diliT adre gamoRviZeba (Cveulebrivze >2 sT);
• gamoxatuli fsiqomotoruli agzneba an Sekaveba;
• gamoxatuli umadoba an wonaSi dakleba;
• danaSaulis gadaWarbebuli an usafuZvlo gancda.

g. maniakaluri epizodis diagnostikuri kriteriumebi (DSM-IV):

• guneba-ganwyobis mdgradi aweva, eqspansiurobiT da gamRizianeblobiT,
romelic grZeldeba aranaklebi erTi kviris manZilze (an nebismieri
xangrZlivobiT, hospitalizaciis aucileblobis SemTxvevaSi);
• qvemoT CamoTvlili sami an meti simptomi am periodis ganmavlobaSi
mdgradia da gamoxatulia mniSvnelovnad (4 simptomi, Tu guneba-
ganwyoba gamRizianeblobiT xasiaTdeba):
- sakuTari pirovnebis gadafaseba da midrekileba grandiozuli
ideebisaken midrekilebiT;
- Zilis moTxovnilebis daqveiTeba (mag. dRe-RameSi 3 saaTi);
- Cveulebrivze ufro meti laparaki an laparakis moTxovnileba;
- azrovnebis tempis aCqareba an ideaTa rbolis subieqturi SegrZneba;
- paologiurad gamoxatuli yuradRebis gafantva (garegan nebismier
umniSvnelo stimulze yuradRebis gadanacvleba);
- momatebuli aqtiuroba, mimarTuli raime miznis (socialuri,
profesiuli, saganmaTleblo, seqsualuri) misaRwevad an
fsoqomotoruli agzneba;
- ukiduresi gataceba siamovnebis momtani saqmianobiT, romelmac
SeiZleba damRupveli Sedegi gamoiRos (mag. ukontrolo ltolva
garTobis mizniT sayidlebis keTebisadmi, SemTxveviTi seqsualuri
kavSirebi da kapitalis uazrod dabandeba).
• simptomebi ar Seesabameba Sereuli epizodis kriteriumebs;

23
 • gamoxatuli emociuri aSliloba iwvevs socialuri da SromiTi
funqcionirebis da interpersonaluri urTierTobebis mniSvnelovan
darRvevas; zogjer aucilebelia hospitalizeba, raTa SesaZlo
safrTxe aarido piradad mas da irgvlivmyofebs.
SeiZleba ganviTardes fsiqozuri mdgomareoba;
• simptomebs ar aqvs pirdapiri paTofiziologiuri kavSiri
fsiqoaqtiuri nivTierebebis gamoyenebasTan da ar aris ganpirobebuli
somaturi an nevrologiuri daavadebiT;
SeniSvna: maniakaluri epizodis msgavsi simptomebi, romelic depresiis
mkurnalobis dros ganviTarda, ar unda iyos gaTvaliswinebuli I
tipis bipolaruli aSlilobis diagnostirebis dros.

d. DSM-IV (1994)_Si guneba_ganwyobis aSlilobis sistematizebisTvis

gamoyofilia Semdegi diagnostikuri kategoriebi:

291. 8X guneba-ganwyobis aSliloba gamowveuli alkoholiT da

fsiqoaqtiuri nivTierebebis gamoyenebiT
293. 83 guneba-ganwyobis aSliloba gamowveuli somaturi daavadebiT
didi depresiuli epizodi:
296. 2X didi depresiuli aSliloba erTaderTi epizodi;
296. 3X didi depresiuli aSliloba, rekurentuli mimdinareoba;
bipolaruli aSliloba
296. XX bipolaruli I aSliloba
. 0X erTdaerTi maniakaluri epizodi
. * Sereuli xasiaTis
. 40 mimdinare hipomaniakaluri epizodi
. 4X mimdinare maniakaluri epizodi
. 5X mimdinare epizodi Sereuli xasiaTis
. 6X mimdinare depresiuli epizodi
. 7X mimdinare epizodi dauzustebeli
296. 89 bipolaruli II aSliloba
* mimdinare an bolo epizodi hipomaniakaluri/depresiuli
296. 80 bipolaruli aSliloba dauzustebeli
296. 90 guneba-ganwyobis aSliloba dauzustebeli
300. 4 disTimiuri aSliloba
301. 13 cikloTimiuri aSliloba
guneba_ganwyobis sxva aSlilobebi
311 depresiuli aSliloba dauzustebeli

Ab. guneba-ganwyobis (afeqturi) aSlilobis diagnostikuri kriteriumebi _

ICD_10; F30_F39; (7,18)

F30 _ maniakaluri epizodi

gamoyofilia simZimis sami xarisxi, romlisTvisac saerTo ZiriTadi
kriteriumia:

24
 • guneba-ganwyobis aweva;
• fsiqo-fizikuri aqtivobis tempis da moculobis gazrda.
am kategoriis qverubrikebi, SeiZleba gamoyenebuli iyos mxolod
erTaderTi maniakaluri epizodis dros.

F 30. 0 hipomania
kriterimebi:
• guneba-ganwyobis msubuqad aweva;
• momatebuli energiuloba da aqtivoba;
• fsiqo-fizikuri keTildReobis da produqtulobis gancda.
aseve:
• momatebuli socialuri aqtivoba;
• Warbsityvaoba;
• zedmeti familaroba;
• aweuli seqsualuri aqtivoba;
• Zilis moTxovnilebis daqveiTeba;
• yuradRebis koncentrirebis gaZneleba.
eiforiulobisa da momatebuli socialuri aqtivobis nacvlad SeiZleba
iyos:
• gamRizianebloba;
• momatebuli TviTSefaseba;
• uxeSi qceva.
diagnostirebisTvis aucilebeli pirobaa:
• aweuli an Secvlili guneba-ganwyobis zemoT moyvanili simptomidan
zogierTi mainc unda arsebobdes uwyvetad, aranaklebi ramdenime
dRisa, ramdenadme meti siZlieriT da meti mudmivobiT, vidre
cikloTimiis dros (F34.0);
• fsiqosocialuri funqcionireba SenarCunebulia, miuxedavad
nawilobrivi gaZnelebisa.

F30.1 mania fsiqozuri simptomebis gareSe

ZiriTadi kriteriumebia:
• aweuli guneba-ganwyoba, romelic Seusabamoa realobasTan (SeiZleba
varirebdes uzrunveli mxiarulebidan ukontrolo agznebamde);
• energiis siWarbe:
• hiperaqtivoba;
• metyvelebis aCqareba;
• Zilis moTxovnilebis daqveiTeba.
damatebiTi kriteriumebia:
• socialuri normebis ignorireba da aqedan gamomdinare ukontrolo
qcevebi;
• gaZnelebulia yuradRebis koncentrireba, iolad xdeba gadanacvleba;
• momatebulia TviTSefaseba;
• gamoTqvams ze-optimistur da gandidebis ideebs.

25
 SesaZlebelia iyos:
• aRqmis darRveva, subieqturi hiperakuzia;
• moufiqrebeli, mouridebeli da eqstravaganturi gadawyvetilebebi;
• gamRizianebloba da agresia;
dignostikuri miTiTeba:
• pirveli Seteva ufro xSirad 15-30 wlis askSi iwyeba (SesaZleblia
nebismier asakSi dawyeba);
• epizodi unda gagrZeldes aranaklebi erTi kvira;
• simptomebis simZimem unda gamoiwvios fsiqosocialuri funqconirebis
darRveva;
• gamoxatuli unda iyos aweuli guneba-ganwyoba
da
• momatebuli energiuloba;
• metyvelebis aCqareba;
• Zilis moTxovnis daqveiTeba;
• gandidebis azrebi;
• gadaWarbebuli optimizmi.

F30.2 mania fsiqozuri siptomebiT

diagnostikuri miTiTeba:
• F 30.1 –is klinikuri suraTi damZimebulia;
• gamoxatuli ideaTa rbola SesaZlebelia mivides abnevamde;
• metyveleba gaugebaria;
• maniakalur afeqts Tan erTvis fsiqozuri simptomebi _ bodva,
halucinacia, cnobierebis abneva, romelic SeiZleba iyos:
FXX.20 _ afeqtis kongruentuli. mag. gandidebis zeRirebulovani
ideebis da aweuli TviTSefasebis fonze viTardeba gansakuTrebuli
warmoSobis da gandidebis eqspansiuri bodva, xolo gamRizianeblobis
da eWvianobis dominirebis dros, viTardeba devnis bodva;
FXX.21 _ afeqtis arakongruentuli _ afeqturad neitraluri
halucinaciuri da bodviTi aSliloba. mag. damokidebulebis bodva
danaSaulis grZnobisa da braldebis gareSe an xmebi, romlebic
esaubrebian avadmyofs misTvis emociurad neitralur Temebze.
damatebiTi kriteriumebi:
• mosalodnelia agresia da Zaladoba aRgznebis gamo;
• SesaZlebelia dehidratacia da xelmiSvebuloba sakvebis, siTxis
miRebisa da piradi higienisadmi daudevari damokidebulebis gamo.

F31 bipolaruli afeqturi aSliloba

ZiriTadi dignostikuri kriteriumebi:
• ganmerebadi afeqturi epizodebi, romlis drosac guneba-ganwyoba da
fsiqo-fizikuri aqtivoba mniSvnelovnadaa darRveuli (depresia, mania,
hipomania an Sereuli afeqti);

26
 • epizodebs Soris Cveulebriv aris sruli gamojanmrTeleba;
• avadoba Tanabaria qalebsa da mamakacebs Soris.
damatebiTi diagostikuri kriteriumebia:
• manakaluri epizodi Cveulebriv iwyeba mwvaved da grZeldeba
saSualod 4 Tves (SesaZlebelia _ 2 kviridan 5 Tvemde);
• depresiuli epizodi grZeldeba saSualod 6 Tves, iSviaTad erT
wlamde (moxucebSi iRebs gaxangrZlivebul da qronikul
mimdinareobas);
• pirveli epizodi SeiZleba ganviTardes nebismier asakSi.

F31.0; F31.1; F31.2_bipolaruli afeqturi aSliloba mimdinare epizodi

<hipomaniakaluri epizodi>, M<maniakaluri epizodi fsiqozuri simptomebis
gareSe>, <maniakaluri epizodi fsiqozuri simptomebiT>
diagnostikuri miTiTeba:
• mimdinare epizodi pasuxobs saTanadod …<hipomaniakaluri epizodi (F
30.0) >, M<maniakaluri epizodi fsiqozuri simptomebis gareSe (F30.1) >,
<maniakaluri epizodi fsiqozuri simptomebiT (F30.2) > kriteriumebs;
• anamnezSi unda iyos sul mcire erTi afeqturi aSlilobis epizodi
mainc (hipomaniakaluri, maniakaluri, depresiuli an Sereuli
epizodi).

F31.3; F31.4; F31.5 _ bipolaruli afeqturi aSliloba mimdinare epizodi

<msubuqi an zomieri depresiis>, <mZime depresiis fsiqozuri simptomebis
gareSe>, <mZime depresiis fsiqozuri simptomebiT>
diagnostikuri miTiTeba:
• mimdinare epizodi pasuxobs saTanadod: <msubuqi an zomieri depresia
(F32. 0; F32. 1)>, <mZime depresiis fsiqozuri simptomebis gareSe (F32.
2)>, <mZime depresiis fsiqozuri simptomebiT (F32. 3)> kriteriumebs;
• anamnezSi unda iyos sul mcire erTi afeqturi aSlilobis epizodi
mainc (hipomaniakaluri, maniakaluri an Sereuli epizodi).

F31. 3 _ am rubrikaSi diagnostirebis dros SeiZleba gamoyenebuli iyos:

F31. 30 somaturi simptomebis gareSe;
F31. 31 somaturi simptomebiT.
• Tu gamoxatulia 4 an meti somaturi simptomi;
• an 2 an 3 sakmaod mkveTrad gamoxatuli somaturi simptomi.
F31. 2 da F31. 5 rubrikaSi diagnostirebis dros SesaZlebelia gamoyenebuli
iyos me-5 maCvenebeli fsiqozuri simptomebis kongruentulobis
aRsaniSnavad:
• FX. X0 _ wamyvani afeqtisadmi kongruantuli;
• FX. X1 _ wamyvani afeqtisadmi arakongruentuli.

27
F31. 6 bipolaruli afeturi aSliloba, mimdinare Sereuli epizodi
ZiriTadi diagnostikuri kriteriumia:
• anamnezSi unda iyos sul mcire erTi afeqturi aSlilobis epizodi
mainc (hipomaniakaluri, maniakaluri, depresiuli an Sereuli
epizodi);
• mimdinare epizodSi vlindeba hipomaniakaluri, maniakaluri an
depresiuli simptomebi Sereuli an alternirebadi saxiT (afeqtis
cvlileba SesaZlebelia dRegamoSvebiT an saaTobriv xdebodes);
• aucilebelia ori afeqtis Sereuli simptomebis arseboba Tanabari
siZlieriT, aranaklebi ori kviris manZilze.

F31. 7 bipolaruli afeqturi aSliloba, remisiis mdgomareoba

dignostikuri kriteriumebi:
• avadmyofs warsulSi unda hqondes erTi dadasturebuli
hipomaniakaluri maniakaluri an Sereuli tipis afeqturi epizodi
mainc;
• damatebiT, kidev erTi, hipomaniis, maniis, depresiis an Sereuli
afeqturi epizodi;
• mocemul periodSi ar unda iyos afeqturi aSliloba;
• dasaSvebia avadmyofi agrZelebdes profilaqtikur mkurnalobas
recidivis Tavidan acilebis mizniT.

F31. 8 sxva bipolaruli afeqturi aSlilobebi

• bipolaruli aSliloba II tipi;
• rekurentuli maniakaluri epizodebi.

F 32 depresiuli epizodi

F 32.0; F 32.1; F32.2; F32.3 rubrikaSi depresiuli epizodis dignostirebisas

aucilebeli pirobaa:
• depresiuli mdgomareobis xangrZlivoba unda iyos ara naklebi 2
kvirisa;
• anamnezSi ar undaiyos maniakaluri an hipomaniakaluri epizodebi;
• epizodi ar unda ukavSirdbodes fsiqoaqtiuri nivTierebis miRebas,
sxva fsiqikur an somatur aSlilobas.
ZiriTadi kriteriumebia:
• guneba-ganwyobis daqveiTeba;
• interesebis da siamovnebis miRebis unaris dakargva;
• energiis daqveiTeba aqtivobis daqveiTebiT da daRlilobis grZnoba.

28
 damatebiTi kriteriumebia:
• yuradRebis koncentrirebis unaris daqveiTeba;
• sakuTar TavSi rwmenis da TviTSefasebis daqveiTeba;
• TviTbraldebis da TviTdamcirebis dausabuTebeli ideebi;
• momavlis bundovani da pesimisturi xedva;
• xSiri, ganmeorebadi azri an qmedeba TviTdazianebisa da
TviTmkvlelobis mizniT;
• Zilis darRveva;
• madis daqveiTeba.
depresiis tipiuri simptomebi:
• daqveiebuli guneba-ganwyoba naklebad icvleba garegani faqtorebis
zegavleniT da ikavebs dRis umetes nawils;
• xasiaTdeba cirkadulobiT;
• SesaZlebelia SfoTva uimedoba da aJitacia ufro metad iyos
gamoxatuli, vidre depresia.
guneba-ganwyobis daqveiTeba SesaZlebelia SeniRbuli iyos damatebiTi
simptomebiT:
• gamRizianeblobiT;
• alkoholis Warbi moxmarebiT;
• isTeriulobiT;
• obsesiur-kompulsiuri simptomebiT;
* somato-vegetatiuri simptomebiT.

gansakuTrebuli klinikuri mniSvneloba aqvs depresiis somato-

vegetatiur anu “melanqoliis” niSnebs:
• Cveulebriv misTvis sasiamovno saqmianobisadmi interesis da
siamovnebis miRebis unaris dakargva _ anhedonia;
• emociuri reaqtiulobis dakargva garemosa da movlenebze;
• diliT Cveul droze adre gamoRviZeba ( >2 saaTiT);
• depresia ufro mZimea dilaobiT;
• madis mkveTri daqveiTeba;
• wonaSi dakleba_bolo erTi Tvis manZilze 5%-iT;
• fsiqomotoruli Sekaveba an aJitacia _ obieqturi monacemebi
mkveTrad gamoxatul Sekavebasa an aJitaciis Sesaxeb;
• libidos daqveiTeba;

F 32.0 msubuqi depresiuli epizodi

dignostikuri miTiTeba:
klinikur suraTSi warmodgenili unda iyos:
• depresiis minimum ori ZiriTadi kriteriumi
• da ori damatebiTi kriteriumi mainc
• arc erTi simptomi ar unda iyos gamoxatuli Rrma xarisxSi;
• depresiuli epizodis xangrZlivoba unda iyos aranaklebi 2 kvira.

29
 tipiuri simptomebia:
• guneba-ganwyobis daqveiTeba;
• interesebis dakargva da anhedonia;
• ioli daRla.

me-5 niSanis gamoyeneba SesaZlebelia somaturi sindromis

aRsaniSnavad:
FXX. X0 _ somaturi simptomebis gareSe;
FXX. X1 _ somaturi simptomebiT
• akmayofilebs msubuqi depresiuli epizodis kriteriumebs;
• da Tan axlavs 4 an meti somaturi simtomi an
• Tan axlavs 2 an sami mZime somaturi simptomi.
msubuqi depresiuli epizodis dros, miuxedavad siZneleebisa
fsiqosocialuri funqcionireba SenarCunebulia.

F32. 1 _ zomierad gamoxatuli depresiuli epizodi

diagnostikuri miTieba:
• ZiriTadi kriteriumebidan minimum oris arseboba;
• ZiriTad kriteriumebTan erTad 4-5 damatebiTi kriteriumis arseboba
me-5 niSanis gamoyeneba SesaZlebelia somaturi sindromis aRsaniSnavad:
FXX. X0 _ somaturi simptomebis gareSe;
FXX. X1 _ somaturi simptomebiT
• akmayofilebs zomieri depresiuli epizodis kriteriumebs;
• da Tan axlavs 4 an meti somaturi simtomi an
• Tan axlavs 2 an 3 mZime somaturi simptomi.
fsiqo-socialuri funqcionireba zomieri depresiuli epizodis dros
mniSvnelovnad gaZnelebulia.

F32. 2 mZime depresiuli epizodi fsiqozuri simptomebis gareSe

mniSvnelovnadaa gamoxatuli:
• mousvenroba da aJitacia an SesaZlebelia Sekaveba;
• sakuTari arasrulfasovnebis, TviTdanaSaulis da TviTbraldebis
azrebi;
• maRalia suiciduri riski;
• mudmivia somato-vegetatiuri simptomebi.
dignostikuri miTiTeba:
• saerTo sami ZiriTadi kriteriumidan samive arsebobs;

30
 • ZiriTad kriteriumebTan erTdroulad arsebobs aranaklebi 4
damatebiTi kriteriumi, romelTagan nawili mZime xarisxiT unda iyos
warmodgenili;
• depresiuli epizodi unda grZeldebodes aranaklebi 2 kvira;
• mwvave dasawyisis da simptomebis gansakuTrebuli simZimisas,
dasaSvebia mZime depresiuli epizodis diagnostireba 2 kviraze adre.
mZime depresiuli epizodis dros avadmyofis fsiqosocialuri
funqcionireba mkveTrad SezRudulia.

F32. 3 mZime depresiuli epizodi fsiqozuri simptomebiT

diagnostikuri miTiTeba:
• Seesabameba mZime depresiuli epizodis (F32. 2), kriteriumebs,
romelsac Tan erTvis:
• bodviTi ideebi, ufro xSirad TviTbraldebis, TviTdanaSaulis
codvianobis, danaklisis Sinaarsis;
• smeniTi an ynosviTi halucinaciebi _ xmebi, romlebic adanaSauleben
da Seuracxyofas ayeneben an gaxrwnili xorcis da sibinZuris suni;
• depresiuli stupori _ mZime motoruli Sekaveba SeiZleba stuporSi
gadaizardos.
Tu arsebobs amis saWiroeba, bodva da halucianacia SeiZleba
ganisazRvros, rogorc F
F32. 30 _ wamyvani afeqtis kongruentuli an
F32. 31 wamyvani afeqtis arakongruentuli

F33. rekurentuli depresiuli aSliloba

ZiriTadi diagnostikuri kriteriumebia:
• depresiis ganmeorebadi epizodebi (msubuqi _ F32.0; zomieri _ F32.1; an
mZime _ F32.2);
• maniakaluri epizodebis (F30.1 ; F30.2), ararseboba anamnezSi;
• dasSvebia anamnezSi hipomaniakaluri epizodis F30.0-is arseboba, Tu
is moyveba uSualod depresiul epizods da SesaZlebelia
Timoanaleptiuri mkurnalobis Sedegi iyos.
damatebiTi kriteriumebia:
• pirveli depresiuli epizodi viTardeba ufro gvian, vidre
bipolaruli depresiis dros, Sua xnis asakSi;
• epizodis xangrZlivoba aris 3 _12 Tve (saSualod 6 Tve);
• depresiuli epizodi umetesad gamojanmrTelebiT mTavrdeba;
• iSviaTad, gansakuTrebiT moxucebSi, iRebs qronikul xasiaTs;
• nebismieri siZlieris calkeuli epizodi, xSirad stresuli
situaciiT aris provocirebuli;
• 2-jer ufro xSiria qalebSi.
diagnostikuri miTiTeba:

31
 • unda akmayofilebdes rekurentuli depresiuli aSlilobis
kriteriumebs;
• mimdinare epizodi akmayofilebs depresiuli epizodis kriteriumebs
Sesabamisad: F33.0 _ F32.0; F33.1 _ F32.1; F33.2_ F32.2; F33.3 _ F32.3;
• warsulSi unda iyos, aranaklebi ori kviris xangrZlivobis, sul
mcire ori epizodi da maT Soris ramdenime Tve intervali, raime
mniSvnelovani darRvevis gareSe.

F34 guneba-ganwyobis qronikuli (afeqturi) aSliloba

am kategoriaSi Semavali afeqturi aSlilobebi:
• xasiaTdeba qronikuli an fluqtuirebadi mimdinareobiT;
• calkeuli epizodi Tavisi siRrmiT ver akmayofilebs hipomaniis an
msubuqi depresiis kriteriumebs;
• xangrZlivi mimdinareobis gamo daqveiTebulia fsiqosocialuri
funqcionireba;
• zogjer SeiZleba maniis an depresiis rekurentuli an erTeuli
epizodi zed daedos qronikul afeqtur aSlilobas;
• qronikuli afeqturi aSlilobis dros adgili aqvs afeqturi
paTologiiT memkvidrul datvirTvas;
• zogjer aseTi avadmyofebi dadebiTad reagireben igive
Timoanaleptiur mkurnalobaze, romelzec saerTod afeqturi
aSlilobis mqone avadmyofebi;
• SesaZlebelia iyo adreuli an mogvianebiTi dasawyisiT.

F34. 0 cikloTimia
ZiriTadi dignostikuri kriteriumebia:
• guneba-ganwyobis mudmivi, qronikuli meryeoba, msubuqi depresiis an
ganwyobis msubuqad awevis mravalricxvovani periodebi;
• afeqturi epizodebi xanmoklea da arasakmarisad gamoxatuli;
• arcerTi periodi ar akmayofilebs bipolaruli, rekurentuli,
maniakaluri an depresiuli epizodis kriteriumebs.

F34. 1 disTimia
ZiriTadi dignostikuri kriteriumebia:
• qronikuli depresiuli guneba-ganwyoba;
• mocemul momentSi depresia siZlieriT ver akmayofilebs
rekurentuli depresiuli aSlilobis kriteriumebs.

F34. 8 sxva qronikuli afeqturi aSlilobebi

am rezidualur kategorias miekuTvneba qronikuli afeqturi aSliloba,
romelic klinikurad mniSvnelovania, magram arasakmarisi simZimisa da
xangrZlivobis gamo ver akmayofilebs cikloTimiis (F34. 0) an disTimiis

32
(F34. 1); aseve, msubuqi (F32. 0) an zomieri (F32. 1) depresiuli epizodis
kriteriumebs.

F34. 9 guneba-ganwyobis (afeqturi) dauzustebeli qronikuli aSlilobebi;

F38 guneba-ganwyobis (afeqturi) sxva aSlilobebi
F38. 0 guneba-ganwyobis (afeqturi) erTeuli aSliloba
F38. 00 Sereuli afeqturi epizodi
afeqturi epizodi, romelic grZeldeba ara naklebi 2 kviris
ganmavlobaSi da xasiaTdeba hipomaniakaluri, maniakaluri da
depresiuli simptomebis swrafi monacvleobiT (Cveulebriv ramdenime
saaTis ganmavlobaSi) an Sereuli simptomebiT.

F38. 1 guneba-ganwyobis (afeqturi) sxva rekurentuli aSliloba

F38. 10 xanmokle rekurentuli depresiuli aSliloba
xanmokle depresiuli epizodebi, aRmocenebuli, bolo wlis
ganmavlobaSi, daaxloebiT TveSi erTxel. TiToeuli epizodis
xangrZlivoba aris 2 kviraze naklebi (tipiuria 2-3 dRe, sruli
gamojanmrTelebiT), magram pasuxobs msubuqi, zomieri an mZime
depresiuli epizodis kriteriumebs (F32.0; F32.1; F32.2)

F38. 8 guneba-ganwyobis (afeqturi) sxva dazustebuli aSliloba

es aris rezidualuri kategoria afeqturi aSlilobebisaTvis,
romelic ar pasuxobs F30. 0 _ F38. 1 kategoriis kriteriumebs.

F39 guneba-ganwyobis (afeqturi) dauzustebeli aSliloba

am kategoriis gamoyeneba xdeba roca sxva gansazRvreba ar arsebobs.

33
 B. guneba-ganwyobis aSlilobis diferencialur-diagnostikuri algoriTmi
ICD_10-is mixedviT (5)
cxrili #2
daqveiTebuli guneba-ganwyoba

organuli dazianebis Sedegad diax organuli afeqturi darRveva

(F 06.3)
ara
fsiqoaqtiuri preparatebis fsiqoaqtiuri nivTierebiT gamowveuli
zemoqmedebi Sedegad diax fsiqikuri aSliloba (F1)
ara

depresiis ramdenime gamoxatuli bolo 12 Tvis manZilze

Sizofreniis saerTo
simptomis arseboba (2 kvira) diax kriteriumebis arseboba, ara
ara romelTagan zogierTi isev
aris warmodgenili(F20)
diax

postSizofreniuli depresia
(F20.4) ara

Sizofreniis erTi an ori

kriteriumis arseboba (F20)
diax ara

depresiuli tipis
Sizoafeqturi aSliloba
(F25. 1)
diax
depresiuli epizodi
( de - F32)
anamnezSi maniakaluri,
hipomaniakaluri an Sereuli diax bipolaruli afeqturi
epizodis arseboba aSliloba (F31)
ara

anamnezSi de –s arseboba diax rekurentuli depresiuli

ara aSliloba (F33)

guneba-ganwyobis xangrZlivi daqveiTaba, diax

romelic ar pasuxobs de –s ( F32) disTimia (F34.1)
kriteriumebs
ara

guneba-ganwyobis xangrZlivi arastabiluroba

ganwyobis msubuqi awevis periodebiT diax cikloTimia (F34.0)
ara

stresiT gamowveuli tranzitoruli(<1 Tve) diax xanmokle depresiuli

msubuqi depresiuli mdgomareoba reaqcia (F43.20)
ara

stresuli situaciis xangrZlivi zemoqmedebiT diax prolongirebuli depresiuli

gamowveuli msubuqi depresiuli mdg-ba(< 2w.) reaqcia (F43.21)
ara

depresiuli simptomebi, romlebis ar pasuxoben diax guneba-ganwyobis (afeqturi)

guneba-ganwyobis romelime specifiur aSlilobas sxva aSliloba(F38.8)

34
C. afeqturi aSlilobis mimdinareoba da prognozi (1, 2, 5, 8)
afeqturi aSlilobis mimdinareoba da gamosavali iseve mravalferovania,
rogorc fsiqopaTologiuri suraTi.
afeqtur aSlilobas SeiZleba cxovrebaSi erTaderTi depresiuli (iSviaTad
maniakaluri) epizodis, unipolaruli (rekurentuli) an bipolaruli
(hipomaniakaluri, maniakaluri da depresiuli epizodebis monacvleoba)
mimdinareobis saxe hqondes. zog SemTxvevaSi epizodebs Soris
mravalwliani remisiebia, zojer aSliloba mimdinareobs xanmokle
depresiuli epizodebis seriebis saxiT. asakis matebasTan erTad iklebs
remisiis xangrZlivoba. epizodi SesaZlebelia Sereuli afeqtis saxiT iyos
warmodgenili.
Denner D.L. (1976) da Angst J. ( 1978) _ is Sromebidan moyolebuli, miRebulia
bipolaruli aSlilobis dayofa bipolarul _ I da bipilarul _ II tipad.
I gulisxmobs maniakalur depresiuli fsiqozis tipur mimdinareobas,
gaSlili maniakaluri da depresiuli fazebis an upiratesad maniakaluri
epizodebis monacvleobiT, II _ mimdinareobs gaSlili, upiratesad
depresiuli da calkeuli hipomaniakaluri epizodebis monacvleobiT
romelmac, SeiZleba miiRos kontinualuri saxe. am sistematikis mixedviT,
cikloTimia pirovnuli aSlilobis diagnostikuri kategoriidan kvlav
gamocalkevebulia da Setanilia mcire intensivobis afeqturi speqtris
bipolarul aSlilobebSi.
bipolaruli aSlilobis depresiuli epizodis kupirebisas SesaZlebelia
fazis Terapiuli inversia, maniakaluri simtomebis ganviTareba, rac
Terapiis ZiriTad problemas warmoadgens.
afeqturi aSlilobis mimdinareobis da prognozis statistikuri
parametrebi Semdegnairad gamoiyureba:
• unipolaruli aSliloba 25-45 wlis, xolo bipolaruli 15-25 wlis
asakSi manifestirdeba;
• populaciaSi rekurentuli depresiuli aSlilobis gavrceleba 4-5-jer
ufro metia, vidre bipolarulis;
• depresiuli epizodis spontanuri xangrZlioba: unipolarulis dros
saSualod 6-10 Tve, xolo bipolarulis dros 4 Tvea, SeiZleba
gaxangrZlivdes 6-12 Tve;
• depresiuli epizodebis raodenoba sicocxlis manZilze saSualod 5-s
udris;
• pirveli depresiuli epizodidan pirveli 6 Tvis ganmavlobaSi
avadmyofebis sul mcire 70-80%-s uviTardebaT;
• depresiuli aSlilobis unipolaruli mimdinareobisas prognozi
ZiriTadad keTilsaimedoa:
- gamojanmrTeldeba da ubrundeba socialuri funqcionirebis
premorbidul dones avadmyofebis 50%;
- reducirebuli rezidualuri simptomatika aReniSneba avadmyoebis
30%-s;
- daavadeba iRebs qronikul xasiaTs SemTxvevaTa 20%-Si, rasac xels
uwyobs komorbiduli faqtorebis arseboba.
• pirveli depresiuli epizodis Semdeg praqtikulad SeuZlebelia
iwinaswarmetyvelo aSlilobis Semdgomi mimdinareoba;

35
 • maniakaluri mdgomareobis ganviTarebis albaToba ufro maRalia
depresiis epizodis:
- adreul asakSi mwvaved manifestirebisas;
- simptomebis damZimebisas, gansakuTrebiT fsiqomotoruli SekavebiT da
fsiqozuri simptomebiT;
- pubertatul periodSi fsiqopaTologiuri darRvevebis ar
arsebobisas.
• disTimiuri aSlilobis mqone pacientebis 20-30%-Si viTardeba
depresiuli epizodi _ e. w. ormagi depresia;
• cikloTimiuri aSlilobis mqone pacientebis 1/3-Si viTardeba
ZiriTadad II tipis bipolaruli afeqturi aSliloba
• SemTxvevaTa 45%-Si maniakaluri epizodi meordeba;
• maniakaluri epizodis xangrZlivoba 4-6 Tvea, recidivis maRali
albaTobiT;
• maniakaluri epizodebiT mimdinare afeqturi aSlilobis dros, droTa
ganmavlobaSi, avadmyofebis 80-90%-Si depresiuli epizodic viTardeba.
• afeqturi aSlilobis prognozi sakmaod keTilsaimedoa:
- gamojanmrTeleba avadmyofTa 15% -Si;
- arasruli gamojanmrTeleba da mravlobiTi recidivebis ganviTareba
epizodebs Soris adaptaciis kargi maCveneblebiT 50-60%-Si;
- qronificirebis da socialuri dezadaptaciis albaTobaa SemTxvevaTa
1/3-Si.
• daavadebis simZimesa da qronikul xasiaTze, cxovrebis xarisxis
mniSvnelovan daqveiTebaze miuTiTebs Semdegi faqtebi:
- unipolaruli mimdinareobisas avadmyofebi Tavisi cxovrebis drois
30%-s depresiul mdgomareobaSi atareben, aqedan cxovrebis 10%-s
saavadmyofoSi;
- bipolaruli aSlilobis dros es cifrebi Sesabamisad 60% da 40% -
aRwevs (Levin S., 1986).
• SemTxvevaTa 5-10%-Si bipolaruli aSliloba prognozulad
arakeTilsaimedo swrafcikluri mimdinareobis xasiaTs iRebs, romlis
drosac weliwadSi 4 da meti afeqturi epizodi viTardeba, rac
socialur _ SromiTi adaptaciis donis seriozul daqveiTebas da
invalidizacias iwvevs;
• bipolaruli afeqturi aSlilobis dros ar aris genderuli sxvaoba.

6. gamokvlevis sqema _ laboratoriuli da fsiqologiuri

gamokvleva (1,8-12)

A. deqsametazonuri testi
hipoTalamo_hipofizur-adrenalinuri sistemis hiperaqtivobiT gamowveuli
kortizolis hipersekreciis daTrgunva ar xdeba deqsametazonis Seyvanis
Sedegad _ testze dadebiTi pasuxi. SezRudulia misi klinikuri gamoyeneba
testis sirTulisa da maRali cdomilebis gamo.

36
B. fsiqologiuri testebi
depresiis sakvlevi unificirebuli skalebi:
• bekis depresiis kiTxvari;
• hamiltonis depresiis Sefasebis Skala.

bekis depresiis kiTxvari (11,12)

(Beck Depression Inventory _ BDI)

A.
0. me ar var sevdiani
1. me sevdiani var
2. me mudam sevdiani var da unari ar Semwevs moviSoro es gancda
3. me imdenad sevdiani da ubeduri var, rom amis atana aRar SemiZlia
B.
0. me Cveulebriv uimedod ar vuyureb Cems momavals
1. me uimedoba meufleba Cemi momavlis gamo
2. me vgrZnob, rom momavalSi araferi ar maqvs saimedo
3. me vgrZnob, rom Cemi momavali sruliad uimedoa da amas araferi ar
eSveleba
C.
0. me ar vTvli Tavs warumatebel adamianad
1. me vgrZnob, rom sxva adamianebTan SedarebiT naklebad warmatebuli
var
2. me cxovrebaSi uamravi warumatebloba mqonda
3. me vgrZnob, rom sruliad warumatebeli adamiani var
D.
0. me iseTive siamovnebas viReb cxovrebidan, rogorc adre
1. me cxovrebidan iseT siamovnebas veRar viReb, rogorc adre
2. me Zalian miWirs raime siamovnebis miReba cxovrebidan
3. me saerTod veranair siamovnebas veRar viReb cxovrebidan
E.
0. me ara maqvs danaSaulis gancda
1. me zogjer maqvs danaSaulis gancda
2. me TiTqmis yovelTvis mawuxebs danaSaulis gancda
3. me mudmivad maqvs danaSaulis gancda
F.
0. me ar mawuxebs gancda, rom davisjebi
1. me vfiqrob, rom SeiZleba davisajo
2. me velodebi dasjas
3. me aucileblad davisjebi

37
G.
0. me ar var ukmayofilo sakuTari TaviT
1. me guli gamityda sakuTar Tavze
2. me mgonia, rom autaneli var
3. me mezizReba sakuTari Tavi
H.
0. me skuTari Tavi sxvebze nakleb adamianad ar mimaCnia
1. me Secdomebis gamo sakuTar Tavs xSirad vakritikeb
2. me mudmivad vsayvedurob sakuTar Tavs mravali naklis gamo
3. me yvelaferSi sakuTar Tavs vadanaSauleb
I.
0. me ara maqvs TviTmkvlelobis azrebi
1. me zogjer miCndeba TviTmkvlelobis azri, magram me maT ar vyvebi
2. me Tavis mokvla minda
3. me Tavs moviklav, rogorc ki amis SesaZlebloba meqneba
J.
0. me ar vtiri Cveulebrivze ufro mets
1. amJamad gacilebiT mets vtiri, vidre saerTod mCvevia
2. me axla sul vtiri
3. adre SemeZlo metira, axla ki tirilis unaric davkarge
K.
0. me ar vRiziandebi Cveulebrivze ufro metad.
1. me gacilebiT advilad vRiziandebi, Cveulebrivze ufro advilad
vgrZnob Tavs Suracxhyofilad.
2. mudmivad gaRizianebuli var
3. sul aRar maRizianebs is ambebi, rac adre maRizianebda
L.
0. sxva adamianebis mimarT interesi ar maqvs dakarguli
1. adrindelTan SedarebiT sxva adamianebi axla naklebad
mainteresebs
2. sxva adamianebis mimarT interesi umetesad dakarguli maqvs
3. absoluturad davkarge yovelgvari interesi adamianebis mimarT
M.
0. me Cveulebisamebr advilad viReb gadawyvetilebebs
1. me xSirad varideb Tavs raime gadawyvetilebis miRebas
2. me Zalian miWirs gadawyvetilebis miReba
3. me saerTod ver viReb veranair gadawyvetilebas
N.
0. me ara maqvs imis gancda, rom adrindelze uaresad gamoviyurebi
1. me ganvicdi rom moberebulad da dauZlurebulad gamoviyurebi
2. me vgrZnob, rom garegnoba Semecvala, Seuxedavi gavxdi
3. me vTvli, rom saSinlad gamoviyurebi

38
O.
0. me iseTive Sromisunariani var, rogorc adre
1. me zogjer Tavs Zalas vatan, rom Sevasrulo samuSao
2. me mudmivad mWirdeba Zaldataneba sakuTar Tavze, rom samuSao
Sevasrulo
3. me saerTod verafers veRar vakeTeb
P.
0. me Cveulebisamebr kargad mZinavs
1. me ise kargad aRar mZinavs, rogorc adre
2. me Cveulebrivze 1-2 saaTiT adre meRviZeba, Semdeg miWirs daZineba
3. me Cveulebrivze ramdenime saaTiT adre meRviZeba da veRar viZineb
Q.
0. me ar viRlebi adrindelze metad
1. me adrindelTan SedarebiT ufro advilad viRlebi
2. me yvelaferi mRlis
3. me iseTi daqanculi var, rom arafris gakeTeba ar SemiZlia
R.
0. me Cveulebriv cudi mada ar maqvs
1. me iseTi kargi mada aRar maqvs, rogorc adre
2. axla gacilebiT uaresi mada maqvs, vidre adre
3. saerTod ar maqvs Wamis mada
S.
0. wonaSi ar damiklia mniSvnelovnad
1. wonaSi davikeli 2,5 kiloramze meti
2. wonaSi davikeli 5 kg-ze meti
3. wonaSi davikeli 7,5 kg-ze meti
(daazusteT icavs Tu ara dietas: diax /ara)
T.
0. Cemi janmrTeloba ar mawuxebs Cveulebrivze metad
1. zogjer me mawuxebs sakuTari janmrTelobis mdgomareoba
2. mawuxebs sakuTari janmrTeloba da miWirs sxva rameze fiqri
3. imdenad var Sewuxebuli sakuTari janmrTelobiT, rom ar SemiZlia
sxva rameze fiqri
U.
0. bolo xanebSi ar SeminiSnavs raime cvlileba Cems seqsualur
SesaZleblobebSi
1. adrindelTan SedarebiT seqsiT naklebad var dainteresebuli
2. gacilebiT naklebad var dainteresebuli seqsiT
3. seqsis mimarT interesi sruliad davkarge

39
bekis kiTxvaris interpretacia
A. sevda
B. uimedoba
C. warumatebloba
D. daukmayofileba
E. danaSaulis gancda
F. sasjelis molodini
G. sakuTari pirovnebis miuRebloba
H. TviTdanaSauli
I. suiciduri azrebi
J. tirilis epizodebi
K. gamRizianebloba
L. socialuri gariyva
M. sakuTar TavSi daurwmunebloba
N. sxeulis xatis Secvla
O. Seneleba, Sekaveba
P. uZiloba
Q. daRliloba
R. madis daqveiTeba
S. wonis dakleba
T. wuxili somaturi Civilebis gamo
U. dabali energetikuli done

BDI Sedegebis Sesafaseba

A _ 0 1 2 3 H _ 0 1 2 3 O _ 0 1 2 3
B _ 0 1 2 3 I _ 0 1 2 3 P _ 0 1 2 3
C _ 0 1 2 3 J _ 0 1 2 3 Q _ 0 1 2 3
D _ 0 1 2 3 K _ 0 1 2 3 R _ 0 1 2 3
E _ 0 1 2 3 L _ 0 1 2 3 S _ 0 1 2 3
F _ 0 1 2 3 M _ 0 1 2 3 T _ 0 1 2 3
G _ 0 1 2 3 N _ 0 1 2 3 U _ 0 1 2 3
eqsperimentis Sedegi BDI =
depresiis simZimis xarisxi _

• BDI mowodebulia Aaron T. Beck_is mier 1961 wels;

• warmoadgens depresiis TviTSefasebis Skalas 17-80 wlis asakis
pirebSi;
• BDI gamoiyeneba depresiis simptomebis gamovlenis, simZimis xarisxis
gansazRvrisa da monitoringisaTvis klinikuri da eqsperimentuli
mizniT;
• eqsperimentatori SeiZleba iyos fsiqikuri janmrTelobis
specialisti, romelic trenirebulia am Skalis gamoyenebasa da
SefasebaSi;
• BDI testSi mocemulia 21 punqti, TiToeulSi 4 debuleba, romelic
dalagebulia simptomis simZimis xarisxis mixedviT _ 0, 1, 2, 3 _
neitraluridan maqsimalurad mZimemde;
• gamosakvlevi piri yovel punqtSi moniSnavs mxolod erT debulebas,
romelsac yvelaze metad eTanxmeba ,,amJamad“ da/an ,,bolo 7 dRis“
ganmavlobaSi;
40
• kiTxvaris Sesafaseblad eZleva 5-10 wuTi (ar aris mkacri SezRudva);
• testis 1 _13 punqtiT fasdeba fsiqologiuri bunebis, xolo 14 _ 21
punqtiT upiratesad fizikuri simptomebi _ fasdeba sakuTriv
depresiuli simptomebi da depresiis specifiuri bihevioruli
gamovlinebebi;
• testis saboloo jamuri maCvenebeli gansazRvravs depresiis simZimis
xarisxs;
• testis totaluri maCvenebeli fasdeba:
BDI =
0 _ 9 _ ar aqvs depresia (depresiis simptomebi minimaluria)
10 _ 16 _ msubuqi depresia
17 _ 29 _ zomieri depresia
30 _ 63 _ mZime depresia
• zogad populaciaSi depresiis maCvenebelia >21 jamuri maCvenebeli.B

41
 hamiltonis depresiis Sefasebis skala (9,10)
(Hamilton Depression Raiting Scale _ HDRS)

1 depresiuli guneba-ganwyoba 11 SfoTvis somaturi niSnebi

daTrgunvis, uimedobis, uZlurebis SfoTvis fiziologiuri gamovlineba:
uunarobis grZnoba gastrointestinaluri-piris simSrale, boyini,
0 = ar aris spazmebi, meteorizmi, diarea, dispepsia;
1 = aRniSnuli grZnoba vlindeba mxolod gul-sisxlZarRvTa_taqikardia, Tavis tkivili;
pirdapiri SekiTxvisas sasunTqi-qoSini, hiperventilacia;
2 = Civilebs spontanurad gamoTqvams gaxSirebuli Sardva; oflianoba;
3 = aRniSnuli grZnoba ganisazRvreba 0 = ar aris
araverbalurad: mimika, poza, xma, cremlebi 1 = susti
4 = pacienti gamoxatavs mxolod am grZnobebs, 2 = saSualo
rogorc spontanur gamoTqmebSi, 3 = Zlieri
aseve araverbalurad 4 = ukiduresad Zlieri
2 danaSaulis grZnoba 12 kuW-nawlavis somaturi
0 = ar aris simptomebi
1 = TviTbraldeba; Tvlis, rom damnaSavea 0 = ar aris
sxvebis mimarT 1 = umadoba, magram sakvebs iRebs zedmeti
2 = danaSaulis ideebi an gansja Zaldatanebis gareSe, mucelSi simZimis
warsul Secdomebsa da codvebze SegrZneba
3 = arsebuli daavadeba fasdeba rogorc 2 = sakvebs iRebs mxolod Zlieri
sasjeli; danaSaulis bodvTi ideebi Zaldatanebis Semdeg; saWiroebs
4 = verbaluri halucinaciebi braldebisa da gastroenterologiur problemebis
gansjis SinaarsiT da/an mxedvelobiTi kupirebas
halucinaciebi muqaris SinaarsiT
3 suiciduri ganzraxva 13 zogadi somaturi simptomebi
0 = ar aris 0 = ar aris
1 = gancda, rom sicocxle ar Rirs 1 = simZime kidurebSi, zurgSi an
2 = sikvdilis survili an fiqri sakuTari TavSi, tkivilebi kunTebSi;
sikvdilis SesaZleblobis Sesaxeb energiis dakargvis an uZlurebis
3 = suiciduri gamoTqmebi an Jestebi SegrZneba
4 = suiciduri mcdeloba (nebismieri 2 = nebismieri mkveTrad gamoxatuli
seriozuli mcdeloba fasdeba ,,4” quliT) simptomi fasdeba ,,2” quliT
4 adreuli uZiloba 14 genitaluri simptomebi
0 = CaZineba ar uWirs libidos dakargva, menstrualuri darRvevebi
1 = epizoduri Civilebi CaZinebis 0 = simptomebi ar arsebobs
gaZnelebaze (30wT-ze meti) 1 = sustad gamoxatuli
3 = yoveldRiuri Civilebi CaZinebis 2 = mkveTrad gamoxatuli
gaZnelebaze
5 Sualeduri uZiloba 15 ipoqondria
0 = ar aris 0. ar aris
1 = Civilebi mTeli Rame mousvenar Zilze 1. moculia sakuTari TaviT (fizikurad)
2 = mTeli Ramis ganmavlobaSi xSiri 2. gadaWarbebuli zrunva sakuTar
gamoRviZeba. sawolidan nebismieri janmrTelobaze
wamodgoma Sefasdeba rogorc ,,2” 3. xSiri Civilebi, daxmarebis moTxovna da
(fiziologiur moTxovnebis garda) sxva
4. ipoqondriuli bodva
6 gviani uZiloba 16. wonaSi dakleba
0 = ar aris am punqtis Sefaseba xdeba:
1 = dilaadrian gamoRviZeba Semdgomi CaZinebiT 16A anamnezis mixedviT:
2 = dilaadrian sruli gamoRviZeba 0 = ar aris wonaSi dakleba

42
7 Sromis unari da aqtivoba 1 = savaraudoa wonaSi dakleba am
0 = ar aris sirTuleebi daavadebis gamo
1 = ususurobis azri da SegrZneba, sisustis da 2 = aSkara dakleba wonaSi (avadmyofis
daRlilobis gancda saqmianobasTan sityvebiT)
(samsaxuri an hobi) dakavSirebiT 3 = Sefaseba SeuZlebelia
2 = saqmisadmi (samuSao an hobi) interesis 16B wonis yovelkvireuli SefasebiT
dakargva, gamxatuli uSualod CivilebiT an 0 = wonaSi dakleba kviraSi < 0,5kg-ze
apaTiurobiTa da meryeobiT (samuSaos 1 = kviraSi > 0,5kg-ze
dasawyebad an aqtiurobisaTvis 2 = kviraSi > 1 kg-ze
damatebiTi Zaldatanebis aucileblobiT) 3 = Sefaseba ar xerxdeba
3 = aqtiurobis gamovlenis realuri periodis
Semcireba an produqtiulobis daqveiTeba;
17 kritika daavadebis mimarT
_ stacionaris pirobebSi ,,3” Sefaseba
0 = acnobierebs, rom depresiul
gamoaqvT, Tu pacientis aqtiuroba grZeldeba
mdgomareobaSia da avadaa
aranaklebi 3saaTi; (samuSao an hobi).
1 = gacnobierebulia mdgomareobis
4 = arsebuli daavadebis gamo samuSaoze uaris
avadmyofuroba, magram amis mizezad
Tqma; stacionarSi Sefaseba ,,4” gamoaqvT, Tu
miiCnevs cud sakvebs, gadaRlas, virusul
pacienti saerTod ar aqtiurobs, an martiv
infeqcias da sxva
saqmianobasac ki ver axerxebs damoukideblad
2 = daavadebis gacnobierebis sruli
ararseboba
8 Sekaveba 18. sadReRamiso meryeoba
azrovnebis da metyvelebis Seneleba, yuradRebis 18A - daazusteT, aris Tu ara simptomebis
koncentrirebis unaris da motoruli aqtiurobis sadReRamiso meryeoba
daqveiTeba 0 = ar aris meryeoba
0 = normaluri azrovneba da metyveleba 1 = uaresdeba diliT
1 = msubuqi Sekaveba intervius dros 2 = uaresdeba saRamos
2 = gamoxatuli Sekaveba intervius dros 18B -Tu arsebobs sadReRamiso meryeoba
3 = mniSvnelovani gaZneleba intervius dros SeafaseT maTi gamoxatvis xarisxi;
4 = sruli stupori 0 = ar aris 1 = susti 2 = Zlieri
9 aJitacia (SfoTviTi aRgzneba) 19 depersonalizacia da derealizacia
0 = ar aris mag. garemos ararealurobis SegrZneba
1 = mousvenroba 0 = ar aris
2 = xelebis fSvneta, Tmebis wvaleba da sxva 1 = susti
3 = moZraoba, wriali 2 = zomieri
4 = mudmivi xelebis fSvneta, frCxilebis da 3 = Zlieri
tuCebis kvneta, Tmebis wiwkna 4 = autaneli
10 fsiqikuri SfoTva 20 paranoiduli simptomebi
0 = ar aris
1 = subieqturi daZabuloba da gamRizianebloba 0 = ar aris
2 = mousvenroba umniSvnelo sababiT 1 = eWvianoba
3 = gangaSi, romelic vlindeba metyvelebasa da 2 = damokidebulebis ideebi
saxis gamometyvelebaSi 3 = damokidebulebis da devnis bodva
4 = SiSi, gamoxatuli gamokiTxvis gareSec 21. obsesiur-kompulsuri simptomebi
0 = ar aris
1 = msubuqi
2 = mZime

HDRS Sedegebis Sesafaseba

1 __ 0 1 2 3 4
9 __ 0 1 2 3 4 16B __ 0 1 2 3 4
2 __ 0 1 2 3 4
10 __ 0 1 2 3 4 17 __ 0 1 2 3 4
3 __ 0 1 2 3 4
11 __ 0 1 2 3 4 18A __ 0 1 2 3 4
4 __ 0 1 2 3 4
12 __ 0 1 2 3 4 18B ---- 0 1 2 3 4
5 __ 0 1 2 3 4
13 __ 0 1 2 3 4 19 __ 0 1 2 3 4
6 __ 0 1 2 3 4
14 __ 0 1 2 3 4 20 __ 0 1 2 3 4
7 __ 0 1 2 3 4
15 __ 0 1 2 3 4 21 __ 0 1 2 3 4
8 __ 0 1 2 316A__ 0 1 2
4 3 4
eqsperimentis Sedegi HDRS =
depresiis simZime _

43
HDRS = 0 – depresia ar aris!
HDRS = 52-depresiuli sindromi ukiduresad mZimea!
• HDRS _mowodebulia M. Hamilton _is mier 1960 wels depresiis simZimis
xarisxis Sesafaseblad klinikuri da eqsperimentuli kvlevis mizniT;
• gasazomi maCveneblebia depresiis simptomebi;
• eqsperimentis dro=20-30wT;
• populacia _ depresiuli aSlilobis mqone mozrdili pirebi;
• eqsperimentatori SeiZleba iyos kvalificirebuli fsiqiatri an
klinikuri fsiqologi, romelsac gavlili aqvs specialuri trenireba;
• Sesafasebeli periodi ganisazRvreba, rogorc: ,,amJamad” an ,,bolo erTi
kviris ganmavlobaSi”;
• originaluri versia Sedgeba 21 punqtisagan, aqedan 2 punqti dayofiali 2
nawilad;
• HDRS Seicavs sam faqtors: ,,zogadi depresiuli faqtori”, ,,SfoTviTi
depresia” da arastabilurobis indeqsi. testis bolo 4 punqti ar
gansazRvravs sakuTriv depesias, aramed azustebs depresiis tips;
• qulebis mniSvneloba:
_ 9 punqti fasdeba raodenobrivad _ 0-dan 4-mde;
_ 6 punqtis maCvenebeli fasdeba Tvisobrivad, 0-dan 2 qulamde;
• ,,7” punqtis Sesafaseblad mkvlevarma SeiZleba informacia miiRos
axloblebis an samedicino personalisagan;
• ,,16” punqtze, pasuxi unda gaeces erT-erTs; 16A–punqtiT Sefaseba
mkurnalobis dasawyisSi xdeba, xolo mkurnalobis procesSi sasurvelia
obieqturi Sefaseba 16B–punqtiT;
• ,,18B” punqti mxolod im SemTxvevaSi fasdeba, Tu 18A punqtSi aRniSnulia
guneba-ganwyobis sadReRamiso meryeoba;
• eqsperimentis dros ar SeiZleba zewola pacientze;
• paciants sakmarisi dro unda daeTmos amomwuravi pasuxis gasacemad,
magram ar unda gadauxvios Temas, pirdapiri SekiTxvebi minimumamde unda
iyos dayvanili, varireba unda xdebodes dadebiTi da uaryofiTi
pasuxebis kombinaciiT; Sesafaseblad amorCeuli unda iyos is pasuxi,
romelic ufro zustad axasiaTebs pacientis mdgomareobas;
• ganmeorebiTi gamokvleva xdeba damoukideblad, cariel blankze,
mkvlevarma ar unda naxos wina eqsperimenti.

44
 roSaxis testi
10 feradi cxrilisagan (,,laqebi”) Semdgari standartuli krebuli,
romelsac Tavazoben pacients interpretaciisaTvis. rezultatis Sefasebas
axdens eqsperimentatori. depresiis dros vlindeba Raribi
asociaciur_inteleqtualuri funqcionireba da Senelebuli reagireba.

Tematuri apercefciis testi

30 suraTisagan Semdgari suraTebis seria, situaciebis gamosaxulebiT,
romelic uSvebs orazrovan axsnas. pacienti axdens calkeuli situaciis
Sefasebas. depresiuli pacientis monaTxrobi naRvliania, maniis dros ki,
amaRlebuli da dramatuli.

C. Tavis tvinis funqcionirebis vizualuri gamokvlevebi (1)

cvlilebebi Tavis tvinSi umniSvneloa. kompiuteruli tomografiis
meTodiT skanireba uCvenebs, rom maniis da fsiqozuri depresiis dros
gafarToebulia Tavis tvinis parkuWebi. zogierT avadmyofs didi
depresiuli epizodis simptomebiT aReniSnebaT bazalur birTvebSi sisxlis
nakadis Semcireba. MRI tomografiis Sedegad gamovlinda, rom pacientebs
didi depresiuli epizodis simptomebiT, kudiani birTvi da Sublis wilebi
ufro patara aqvT, vidre janmrTelebs. MRI speqtroskopiis meSveobiT I
tipis bipolaruli aSlilobis mqone pacientebiSi Catarebuli
gamokvlevebis Sedegebi Seesabameba hipoTezas imis Sesaxeb, rom aSlilobis
paTofiziologiuri Tavisebureba SeiZleba Seicavdes membranebSi
fosfolipiduri cvlis regulirebis darRvevas.

45
 7. mkurnalobis sqema

I. depresiuli epizodi (1, 3-5, 8, 13-15, 18, 152)

A. fsiqiatriuli menejmenti (13, 14, 152)

1. SeafaseT diagnostikurad (18)

gansazRvreT, aris Tu ara depresia (13, 14, 152, 153)

gansazRvreT fsiqikuri da zogadi samedicino komorbiduli

faqtorebis arseboba (13, 14, 152, 153)

• Tanmimdevruli diagnostikuri Sefasebisas gaiTvaliswineT

fsiqikuri aSlilobis, maT Soris, gadatanili maniakaluri
an depresiuli epizodis da warsulSi Catarebuli
mkurnalobis subieqturi da obieqturi istoria, aseve
mimdinare simptomebi da mkurnalobis efeqturoba (73, 148, 178.
A);
• zogadi samedicino istoria (148, 178. A);
• fsiqoaqtiuri nivTierebebis miRebiT gamowveuli
aSlilobebis istoria (101. D);
• personaluri istoria _ mag. genetikuri faqtori, adreuli
fsiqo-fizikuri ganviTareba, mniSvnelovan cxovrebiseul
clilebebze reagireba (94 D; 44 A);
• socialuri, profesiuli da ojaxuri istoria(173 C, 44 A );
• pacientis mkurnalobis gadasinjva (153);
• fsiqiatriuli daxmarebis Sesabamisi donis SerCeva(16);
• fsiqikuri statusis gamokvleva (1, 3, 5, 8) (24, 34, 36, 37 _ A);
• fizikuri statusis gamokvleva (1-4) (178 A):
_ sisxlis saerTo analizi;
_ Tirkmlis funqciuri sinjebi (Sardovanas da kreatininis
gansazRvra);
_ eleqtrolitebis koncentracia sisxlSi;
_ RviZlis funqciuri sinjebi;
_ farisebri jirkvlis funqciuri sinjebi;
_ ekg da eeg (38, 158 _ B );
• gamoiyene specialistebis konsultacia klinikuri da
paraklinikuri gamokvlevebis Sedegebis Sesabamisad
(178 A);
• gamoiyene depresiis sakvlevi unificirebuli skala
diagnozis dazustebis da mkurnalobis efeqturobis
Sefasebis mizniT:
_ bekis depresiis kiTxvari _ BDI (11, 12)
_ hamiltonis depresiis reitinguli skala _ HDRS (9, 10)

46
2. SeafaseT pacientis da sxva pirebis usafrTxoeba (1, 3, 13, 152, 153)

• gansakuTrebuli mniSvneloba aqvs suiciduri riskis

Sefasebas (ix. dafa 1.)
(29, 89 _ A);
• Tu pacienti avlens suicidur an homicidur ideebs,
intenciebs an gegmebs, saWiroa uSualo meTvalyureoba;
• Tu riski mniSvnelovania, SeiZleba mizanSewonili iyos
hospitalizeba(16).
• yuradReba!
suiciduri mcdelobis winaswari ganWvretis SesaZlebloba
Zalze mwiria!

dafa 1. suiciduri riskis Sefasebisas sayuradReboa (13, 152, 153):

• suiciduri an homociduri azrebis, intenciebis an gegmebis arseboba;
• suiciduri saSualebebis da am saSualebebis letalurobis
xarisxis Seafaseba;
• fsiqozuri simtomebis, imperatiuli halucinaciebis an Zlieri
SfoTvis da aJitaciis arseboba;
• komorbiduli faqtorebis, fsiqoaqtiuri nivTierebebis moxmarebis
arseboba;
• wina suciduri mcdelobis istoria da misi seriozuloba;
• ojaxis wevrTa Soris bolodroindeli gamJRavnebuli suicidis
istoria.
yuradReba!
aRniSnuli faqtorebis arsebobisas mdgomareoba fasdeba, rogorc
maRali suiciduri riskis mqone.

3. SeafaseT fsiqosocialuri funqcionirebis gauaresebis done

(13, 14, 152, 153)

• interpersonaluri urTierTobebis, samuSao da

sacxovrebeli pirobebis gauareseba, aseve
janmrTelobasTan dakavSirebul problemebis arseboba;
• gauaresebis miznobrivi Sefaseba (mag. samsaxuris gacdena,
samuSao gegmis uqonloba, mkurnalobis reJimis ararseboba
da sxva).
(164, 173, 174-C);

47
4. gansazRvreT fsiqiatriuli daxmarebis done (13, 14, 152, 153)

amorCevisas gaiTvaliswineT Semdegi:

• klinikuri mdgomareoba _ simptomebis simwvave,
komorbiduli faqtorebi, suiciduroba, homociduroba da
fsiqosocialuri funqcionirebis done;
• mxardamWeri sistemebis xelmisawvdomoba;
• pacientis unari, miiRos gacnobierebuli gadawyvetileba
SeTavazebuli fsiqiatriuli daxmarebis Sesabamisobis,
fsiqiatrTan saimedo ukukavSirisa da mkurnalobis dros
TanamSromlobis Sesaxeb.
(164-C; 29, 73, 89, 166, 178 - A);

ganmeorebiT SeafaseT fsiqiatriuli daxmarebis

optimaluroba fsiqo-fizikuri mdgomareobis dinamikis
gaTvaliswinebiT.

gaiTvaliswineT hospitalizaciis saWiroeba, Tu pacienti (16):

• seriozul saSiSroebas uqmnis Tavis Tavs an irgvlimyofebs
_ Tu pacienti uars acxadebs mkurnalobaze, SeiZleba misi
aranebayoflobiTi mkurnaloba (29, 89 _ A);
• agznebulia, ar aqvs Sesabamisi socialuri mxardaWera da
alternatiuli intensiuri mkurnalobis SesaZlebloba (mag.
dRis stacionari, stacionari binaze da sxva) (164, 173_C, 166-
A);
• gamoxatulia fsiqikuri an zogadi samedicino komorbiduli
faqtorebi (94, 101- D, 44-A);
• ar an ver miiRebs adekvatur ambulatoriul mkurnalobas,
fsiqiatriuli daxmarebis dayovneba ki safrTxes Seuqmnis
pacientis an sxva piris sicocxles da/an janmrTelobas.

5. Terapiuli aliansis Camoyalibeba da xelSewyoba(13, 14, 152, 153)

mniSvnelovani yuradReba unda miaqcioT pacientis da misi

ojaxis wevrebis problemebs
• gacnobierebuli unda gqondeT mosalodneli transferis
da ukutransferis SesaZlebloba. (92-eqspertTa mosazreba,
73, 166-A);

48
6. fsiqikuri statusis da usafrTxoebis monitoringi(13, 14, 152, 153)

monitoringi pacientebis, sakuTari Tavis an sxvebisadmi

destruqciuli impulsebis mosalodneli gamovlinebis gamo
(73-A);

monitoringi fsiqikuri statusis cvalebadobisas. iyavi

yuradRebiT rogorc depresiis, aseve SesaZlo komorbiduli
simptomebis mimarT (58-C, 73-A);

gaiTvaliswineT ganmeorebiTi diagnostikuri Sefaseba, Tu

siptomebi mniSvnelovnad Seicvala an aRmocenda axali
simptomebi (172-D, 57,73-A);

urgentul situaciaSi, romelic xSiria mZime depresiis dros,

eqimi moklebulia srulyofili gamokvlevis Catarebis
SesaZleblobas da gadaudebeli Terapiis aucileblobis dros
unda daeyrdnos mdgomareobis situaciur analizs da
ixelmZRvanelos sakuTari gamocdilebiT (5).

7. pacientis da, Tu SesaZlebelia, misi ojaxis wevrebis

fsiqoganaTleba (13, 14, 152, 153)

• gansakuTrebuli xazgasmiT auxseniT is, rom depresiuli

aSliloba realuri daavadebaa;
• miawodeT informacia SeTavazebuli fsiqiatriuli daxmarebis
da mkurnalobis Sesaxeb, rac daexmareba pacients
informirebuli gadawyvetilebis miRebaSi, mkurnalobis
efeqturobis, SesaZlo gverdiTi efeqtebis da sxva Tanmxlebi
movlenebis gacnobierebaSi.
(181, 182-A);

49
8. uzrunvelyaviT mkurnalobis reJimis mkacrad dacva(13, 14, 152, 153)

depresiis diagnozis dadgenisTanave aucilebelia mkurnalobis

Tanmimdevruli gegmis Sedgena, romelic sam periods mocavs:
• mwvave fazis mkurnaloba anu kupireba _ mwvave depresiuli
simptomebis swrafi alageba, avadmyofis tanjvis Semcirebisa
da suicidis Tavidan acilebis mizniT;
• SemanarCunebeli anu mastabilizebeli Terapia _ depresiuli
simptomebis sruli alageba da Terapiuli remisiis miRweva;
• damWeri anu profilaqtikuri Terapia _ gamwvavebis da axali
epizodis ganviTarebis riskis Semcireba da Tavidan acileba,
fsiqosocialuri reabilitacia, SromiTi adaptacia.
(4) (164-C, 73, 148, 178-A)

mkurnalobis reJimis mkacri dacvis mizniT, garkveviT auxseniT:

• rodis da ra sixSiriT miiRos medikamenti;
• rom dadebiTi Sedegi Cveulebriv 2-4 kviris Semdeg
gamovlindeba;
• rom aucilebelia mkurnalobis gagrZeleba, imis Semdegac,
roca pacienti Tavs kargad igrZnobs;
• rom mkurnaloba SeiZleba Sewyvitos mxolod mkurnal
eqimTan konsultaciis Semdeg;
• rogor unda moiqces, Tu problemebi warmoiqmneba.
(73, 76, 166, 181, 182-A);

mkurnalobis reJimis mkacri dacva moxuc pacientebSi

uzrunvelyaviT mkurnalobis reJimis gamartivebiT da
mkurnalobis Rirebulebis minimumamde dayvaniT
(71-B);

gaiTvaliswine fsiqoTerapiuli Careva Terapiuli aliansis

gaumjobesebis da mkurnalobis reJimis darRvevis Tavidan
acilebis mizniT (166, 181-A);

9. recidivis adreuli niSnebis marTva(13, 14, 152, 153)

moaxdineT pacientis (da ojaxis) informireba recidivis riskis

arsebobis Sesaxeb. (169-B, 76, 166, 181-A);

aswavleT pacients (da ojaxs) axali epizodis adreuli

niSnebis da simptomebis Secnoba.
(169-B, 76, 166, 181-A)

xazgasmiT auxseniT pacients, Tu vis mimarTos fsiqiatriuli

daxmarebis misaRebad recidivis pirvelive niSnebis da
simptomebis gamovlinebisas, raTa Tavidan aicilos daavadebis
sruli egzacerbacia. (169-B, 76, 166, 181-A);

50
 B. mwvave fazis mkurnaloba anu kupirebak(3, 4, 5, 13, 14, 152)upireba.

1. inicialuri mkurnalobis modelis arCeva (13) (ix. sur. 1; 2);

suraTi 1.

ar CarToT 1. saWiroa specifiuri fsiqoTerapia (sf)? CarTeT sf

sf ara • msubuqi depresia: upiratesoba eniWeba diax mkurnalobi
mkurnalobi monoTerapias an kombinacias medikamentebTan. s gegmaSi da
s gegmaSi da • zomieri da mZime depresia: kombinaciaSi gadadiT
gadadiT me-2 medikamentebTan an ekT-sTan, Tu mniSvnelovnadaa meore
skiTxze gauaresebuli fsiqosocialuri funqcionireba sakiTxze
da/an roca pacianti aniWebs upiratesobas

ar CarToT 2. saWiroa medikamenturi mkurnaloba? CarTeT

medikamenturi • msubuqi depresia: Tu arCeulia medikamenturi medikamenti
mk-ba monoTerapia mkurnalobis
mkurnalobis ara • zomieri da mZime depresia: medikamentis diax
gegmaSi da
gegmaSi da kombinacia sf-sTan, an mis gareSe, Tu ar aris gaagrZeleT
gadadiT dagegmili ekT sxva saxis
mesame • fsiqozuri depresia: antifsiqozuri da mkurnalobis
kiTxvaze antidepresiuli medikamenturi mkurnalobis ganxilva
kombinacia an ekT

ar CarToT 3. saWiroa medikamenturi mk-ba da sf kombinaciaSi? CarTeT

medikament • msubuqi depresia: medikamenti
uri da sf _ Tu arCeulia, rogorc kombinirebuli mkurnaloba da sf
mkurnalobis _ Tu aris monoTerapiis nawilobrivi efeqturoba mkurnalobis
gegmaSi da _ cudi komplaenturoba gegmaSi da
gadadiT me-4 • zomieri da mZime depresia gaagrZeleT
kiTxvaze _ darRveuli fsiqosocialuri funqcionireba mkurnalobis
_ interpersonaluri problemebi sxva
_ personologiuri aSlilobebi variantebis
_ cudi komplaenturoba ganxilva

ar CarToT 4. saWiroa Tu ara ekT-s gamoyeneba? CarTeT ekT

ekT • qronikuli, zomieri da mZime depresiis dros mkurnalobi
mkurnalobis kombinaciaSi sf_Tan an mis gareSe, rogorc s gegmaSi da
gegmaSi da
gaagrZeleT ara pacienti airCevs. diax gaagrZeleT
• mZime depresis dros da yvela Semdeg mkurnalo-
mkurnalobis SemTxvevaSi: bis sxva
saxva _ fsiqozuri simptomebiT variantebis
variantebis _ roca pacienti irCevs ganxilva
ganxilva _ warsulSi efeqturobis istoria.
_ swrafi antidepresiuli pasuxis saWiroeba
_ medikamentebisadmi intolerantoba

gadadiT mkurnalobis sxva variantebis ganxilvaze

51
suraTi 2. depresiuli aSlilobis mwvave fazis mkurnaloba (13)
mkurnalobis dawyeba monitoringi:
medikamenturi da/an fsiqoTerapia
• pacientis da sxva
pirebis
usafrTxoebis
Tu mk-ba araefeqturia da
xarisxi
klinikurad mZimea, gaiTvaliswineT:
(dafa 1)
• medikamentis dozis momateba
• fsiqoTerapiis intensivobis • fsiqikuri
momateba statusi
• ekT

4-8 kviris Semdeg SeafaseT • fsiqosocialuri

mkurnalobis efeqturoba statusi

• mkurnalobis
efeqti

araefeqturia nawilobrivi efeqti sruli efeqti • gverdiTi efeqti

(ix. sur 6; 7; .8;
1. medikamenturi 1. medikamenturi gadadiT 9.)
mkurnalo bisas: mkurnalobisas: SemanarCunebeli
• SecvaleT • SecvaleT doza mkurnalobis • maniis niSnebis
antidepresanti • daumateT meore fazaSi gamoCena
• daumateT antidepresanti’’
fsiqoTerapia • SecvaleT • komorbiduli
antidepresanti fsiqikuri
• daumateT aSlilobebi
fsiqoTerapia fsiqoaqtiuri
@2. fsiqoTera- • ekT nivTierebebis
piiT mkurnalo 2. fsiqoTerapiiT gamoyenebis
bisas: mkurnalobisas CaTvliT
* daumateT an
• gazardeT
SecvaleT • zogadi
fiqoTerapiis
medikamenturiT samedicini
intensivoba
• SecvaleT komorbiduli
fsiqoTerapiis faqtorebi
tipi
• daumateT an
SecvaleT
medikamentozur
iT

damatebiTi 4-8 kviris Semdeg ganmeorebiT SeafaseT

mkurnalobis efeqturoba
“airCieT meore antidepresanti igive klasidan, an wina ori mcdelobis dros am klasis
antidepresantis araefeqturobis SemTxvevaSi, airCieT sxva klasis antidepresanti.

52
2. inicialuri medikamenturi mkurnaloba (3-5, 13-15, 150,152)
(ix. sur. 1; sur. 2 dafa 2)

• inicialuri medikamenturi mkurnalobis upiratesobas

gansazRvravs warsulSi medikamentur mkurnalobaze
dadebiTi efeqtis istoria;
• fsiqikuri mdgomareobis simZime Zilis da madis
mniSvnelovani darRveva an aJitacia;
• savaraudoa damWeri Terapiis aucilebloba
• pacientis arCevani medikamentur mkurnalobaze
• alternatiuli adekvaturi mkurnalobis modelis deficiti.
(20, 22, 28, 67- eqspertTa mosazreba; 25, 33, 58-C, 24, 29, 32, 36 56,
57, 73, 80, 84, 178-A)
dafa 2.
depresiuli epizodis farmakoTerapia
simZimis xarisxi:

msubuqi antidepresanti, Tu pacienti mas aniWebs

upiratesobas
zomieri da mZime antidepresanti aris mkurnalobis arCevani, Tu
ar aris dagegmili eleqtrokonvulsiuri
Terapia (ekT)
mZime, fsiqozuri antidepresanti + antifsiqozuri preparati
simptomebiT an ekT

a. inicialuri antidepresantis amorCevis pricipi (3-5, 13-15, 150,152)

Timoanalefsiuri mkurnalobis dros gasaTvaliswinebelia (4):

• antideprasantebis klasifikacia xdeba qimiuri struqturis an
moqmedebis meqanizmis Sesabamisad (ix. sur. 3; sur. 10);
• antidepresantebi xanmokle Terapiisas sinafsur da xangrZlivi
Terapiis dros receptorul cvlilebebs iwvevs da yvela
antidepresanti ama Tu im doziT zemoqmedebas axdens
serotoninur da HT sistemaze (ix. sur. 6.). (46-49, 75, 87_ A)A
• Cveulebriv, sxvadasxva klasis antidepresantebs aqvT Tanabari
Timoanalefsiuri efeqti, Tumca, antidepresantebis klasebs
Soris da klasebs SigniT, arsebobs SedarebiTi efeqturoba
calkeul depresiuli simptomis mimarT (ix. sur. 4. da 5). (33-C,
32, 33, 36, 45, 56, 73, 178_ A)A
• antidepresantebi gansxvavdebian usafrTxoebis diapazoniT da
gverdiTi efeqtebis gamovlinebis xarisxiT (ix. sur. 6; 7; 8; 9;
10). (31, 32, 46, 56_ A)A
• antidepresantebis swori gamoyenebisas klinikuri efeqturoba
60_70%-ia (8). (57_ A)A
• mkurnalobis dawyebidan antidepresiuli efeqtis
gamovlinebamde SeiZleba 4-6 kvira gavides (3, 5, 14, 15)

53
antidepresantis inicialuri seleqciisas yuradReba unda mieqces
Semdeg faqtorebs:
• mosalodneli gverdiTi efeqtebi (sur. 6 7; 8; 9; 10)
(74-eqspertTa mosazreba);
• pacientis individualuri amtanoba
(20, 22, 28-eqspertTa mosazreba);
• Terapiuli usafrTxoebis diapazoni
(154,155-eqspertTa mosazreba; 46, 56, 31, 32_ A);
• pacientis arCevani (22, 92-eqspertTa mosazreba; 25_C. 77-79_ A);
• klinikuri gamokvlevis Sedegebi (49-55, 84_ A);
• Rirebuleba (20, 92-eqsperTTa mosazreba);
am faqtorebis gaTvaliswinebiT, pacientebis umravlesobis
mkurnalobisas efeqturi iqneba: serotoninis ukumitacebis
seleqtiuri inhibitori _ sumsi (48, 53, 54_ A), an dezipramini,
nefazadoni, nortriftilini, trazadoni, bupropioni (37, 39, 49 50,
51, 87_ A), venlafaqsini (53, 54_ A) da mirtazapini.®
• tricikluri antidepresantis (tca) pirveli rigis da
xangrZlivi moxmarebis preparatad arCeva SezRudulia Zlieri
qolinolizuri da kardiotoqsikuri gverdiTi efeqtis gamo
(62-qspertTa mosazreba; 40, 41, 45_B, 75_ A).

gasaTvaliswinebelia sxva faqtorebic:

• depresiuli sindromis Tavisebureba, misi calkeuli simptomis
gamoxatvis xarisxi
(35_C, 45_B, 31, 36, 37, 53-56_ A);
• warsulSi garkveuli antidepresantis maRali efeqturobis
istoria (45, 47_B, 24, 32, 36, 50, 57 77_ A);
• fsiqikuri an zogadi samedicino komorbiduli faqtorebi
(161-D, 24, 34, 36, 37_ A).

monoaminooqsidazas inhibitorebi (maoi) gamoiyeneT mxolod sxva

klasis antidepresantebis araefeqturobis SemTxvevaSi, radgan
maTi gamoyenebisas mosalodnelia seriozuli gverdiTi efeqtebi
da saWiroa Tiraminis Semcvel produqtebze mkacri dieturi
SezRudva.
• maoi SeiZleba gansakuTrebiT efeqturi iyos atipiuri
depresiuli epizodis dros (30, 31, 32, 34, 55, 56_ A), Tumca
klinikur praqtikaSi atipiuri depresiis mkurnalobisas
farTod gamoiyeneba sumsi, kargi Terapiuli indeqsis da
naklebi gverdiTi efeqtebis gamo (77_B; 39, 46_ A; 40, 41, 45_B,
75_ A).

54
b. damatebiTi informacia antidepresantebis Sesaxeb

antidepresantebis inicialuri seleqciisas gaiTvaliswineT

mowodebuli informacia _ antidepresantebis klasifikacia,
dozireba, moqmedebis meqanizmi, medikamentebTan urTierTqmedeba
gverdiTi efeqtebi.

suraTi #3
antidepresantebis klasifikacia, dozireba da naxevardaSlis periodi
(4, 13, 14, 15, 17)
generiuli dozireba naxevardaSlis
(saerTaSoriso) mg/dReSi periodi (sT-Si)
saxelwodeba inicialuri Terapiuli maqsimaluri
1. tricikluri antidepresantebi (tca)
amitriftilini* 25 75 - 150 300 27 _ 32 (18 _ 96)
klomipramini 25 100 _ 200 250 17 _ 28 (57 _ 77)
doqsepini 25 75 _ 150 300 8 _24 (28 _52)
imipramini* 25 50 _ 150 300 5_25
trimipramini 25 50 _ 150 200 _300 7 _ 23
dezipramini 25 100 _ 200 300 24
nortriftilini 10 _ 25 75 _ 150 300 36 (18 _96)
Tianeptini* 25 37, 5 50 3 _ 5
protriftilini 15 15 _ 40 60 74 (50 _200)
2. tetracikluri antidepresantebi _ tetca
amoqsapini 50 _ 75 200 _ 300 400 (600) 8 _ 24
maprotilini 25 75 _ 150 225 51
mianserini* 30 30 _ 90 120 10 _ 20
3. serotoninis ukumitacebis seleqtiuri inhibitorebi _ sumsi
citaloprami 20 20 _ 40 60 23 _ 45
fluoqsetini* 20 20 _ 40 80 48 _ 360
fluvoqsamini* 50 50 _ 200 300 9 _ 28
paroqsetini* 20 20 _ 40 50 24
sertralini* 50 50 _ 150 200 22 _ 36 (10 _109)
4. sxva qimiuri struqturis antidepresantebi
bupropioni 150 150 _ 300 450 10 _ 27
venlafaqsini 37,5 75 _ 225 375 3 _ 7 (9_13)
5. serotoninis modulatorebi
nefazadoni 200 300 _ 500 600 2 _ 4 (12)
trazodoni 150 300 _ 400 400 _ 600 3 _ 9
6. mao-s Seuqcevadi inhibitorebi
nialamidi 300 300 - 400 500 ?
fenelzini 45 45 _ 75 90 1,5 _ 3 (21 dRemde)
tranilcipromini 30 30_40 60 1,5_3 (21 dRemde)
7. mao-s Seqcevadi inhibitorebi
moklobemidi 150 300 _ 600 600 1 _ 4 (24)
pirazidoli 100 150 _ 400 500 ?

* saqarTveloSi registrirebuli preparatebi

55
 suraTi 4
antidepresantebis klnikuri klasifikacia (4)

antidepresantebi sedaciuri efeqtiT:

sedaciuri efeqti
ftoracizini
trimipramini
doqsepini
amitriftilini
mianserini
mirtazapini
fluvoqsamini
femoqsetini
trazodoni
medifoqsamini
nefazadoni

antidepresantebi mabalansirebadi efeqtiT:

venlafaqsini
triftofani
maprotilini
dosuleptini
Tianeptini
midalciprami
sertranili
paroqsiteni
pirazidoli
klomipramini
citaloprami

antidepresantebi mastimulirebeli efeqtiT:

viloqsazini
iprindoli
fluoqsetini
imipramini
nortriftilini
protriftilini
dezipramini
amineptini
bupropioni
moklobemidi
mastimulirebeli nialamidi
efeqti

56
 suraTi 5.
antidepresantebis efeqturoba depresiuli sindromis calkeuli
simptomis reducirebis tempis mixedviT (4)
moqmedebis Zala preparatebSi iklebs Semdegi TanmimdevrobiT

1. sakuTriv Timoanaleptiuri
klomipramini imipramini amitriftilini maprotilini
pirazidoli doqsepini nialamidi fluoqsetini fluvoqsamini
sertralini mianserini

2. antifobiuri
klomipramini fluvoqsamini sertralini fluoqsetini
imipramini nialamidi pirazidoli maprotilini
amitriftilini doqsepini mianserini

3. anqsiolituri
klomipramini fluvoqsamini amitriftilini sertranili
mianserini doqsepini maprotilini pirazidoli fluoqsetini
imipramini nialamidi

4. mastimulirebeli
nialamidi imipramini klomipramini pirazidoli
fluoqsetini fluvoqsamini sertranili maprotilini
mianserini doqsepini amitriftilini

5. sedaciuri da hipnoturi
doqsepini amitriftilini mianserini maprotilini
klomipramini sertralini pirazidoli fluvoqsamini
imipramini fluoqsetini nialamidi

57
 suraTi 6.
Tanamedrove antidepresantebis SedarebiTi farmakologiuri
aqtivoba, maoi-s garda (5)
preparatebi zemoqmedebis xasiaTi
ukumitacebis receptorebis blokada
blokada
NA SER DA H1 M. alfa1 alfa2 DA2 SER2 SER3
amitriftilini 3 3 4 2 1 1 2 4 3 3
amoqsapini 2 4 4 3 4 2 4 1 1 ?
bupropioni 5 6 3 5 6 5 6 6 6 ?
dezipramini 1 4 5 4 3 3 5 4 5 5
doqsepini 3 4 5 1 2 1 3 4 3 ?
imipramini 3 3 4 3 2 2 4 4 4 4
klomipramini 3 2 4 3 2 2 5 2 4 1
maprotilini 2 6 4 2 4 2 5 4 4 ?
mianserini 4 5 5 2 4 2 1 4 2 3
nortriftilini 2 4 4 3 2 2 4 4 3 4
paroqsetini 4 1 4 6 3 5 5 4 6 2
sertralini 5 2 3 6 5 4 4 5 6 1
trimipramini 4 5 4 1 2 1 3 3 3 ?
trazodoni 5 4 6 4 5 1 1 4 2 ?
fluvoqsamini 5 2 4 6 6 5 5 6 6 ?
fluoqsetini 4 2 4 5 5 5 5 6 5 2
citaloprami 6 2 6 4 5 4 6 6 6 ?

suraTi 6 -is axsna: preparatis gavlenis SedarebiTi Zala (erTi antidepresantis

meoresTan SedarebiT) gamosaxulia 6 baliani skaliT:
1- maqsimaluri efeqti 4 _ susti efeqti
2- gamoxatuli efeqti 5 _ ukiduresad susti an efeqti saeWvoa
3- zomieri efeqti 6 _ efeqti ar arsebobs
NA– noradrenalini; SER- serotonini; DA _Adofamini;

58
 suraTi 7.
antidepresantebis gverdiTi efeqtebi (4)

tca maoi sumsi

qolinerguli: igive, rc tca-s dros _
piris simSrale, yabzoba, Sardis Sekaveba,
peristaltikis da eakulaciis daTrgunva,
akomodaciis darRveva, deliriumi_xSirad
moxucebSi
kupireba:_dozebis Semcireba an moxsna,
detoqsikacia.
simptomuri Terapia _ prozerini an galantamini
1_4mg kanqveS; fizostigmini 0,5_2mg yovel saaTSi,
I/M an kanqveS; pilokarpini 1_2% (Tvalis
wveTebi);
kardio-vaskuluri: • taqikardia, • taqikardia,
• taqikardia, orTostatikuri hipotenzia; orTostatiuri TA-s momateba
saWiroa: _dozis Semcireba; kordiamini 2% hipotenzia; saWiroa:
_1,0mlI/M kupireba: dozebis Semcireba
• ekg-s darRveva: T kbilis daTrgunva an dozebis Semcireba
inversia, QRS segmentis gaxangrZliveba,
ariTmia, gamtareblobis darRveva.
(xangrZlivi miRebisas _ miokardiumis
infarqti da kardiomiopaTia);
saWiroa: mk-is Sewyveta; simptomuri Terapia;
gastro-enterologiuri: • siyviTle, hepatiti; gulisreva, kuWis
• gulisreva, Rebineba, pirSi mware gemo, kupireba: gadavsebis grZnoba,
nawlavebis peristaltikis darRveva; mkurnalobis Sewyveta Rebineba, buybuyi,
saWiroa: _ dozebis Semcireba; muclis kolika,
_medikamentis ufro danawevrebuli miReba; diarea, meteorizmi;
hematologiuri:
leikocitozi, leikopenia, eozinofilia,
Trombocitopenia; saWiroa: mkurnalobis Sewyveta
centraluri: sedacia, Zilianoba, sisuste, hipertonuli krizi;
Tavbrusxveva, nistagmi, ataqsia, dizarTria, koma, sxva
paroqsizmuli movlenebi, eqstrapiramiduli preparatebTan .
simptomebi, wvrilamplitudiani tremori, interaqtivobis gamo.
romelic ar reagirebs qolinolizur smenis da optikuri
preparatebze); nervis dazianeba
saWiroa: _ dozis Semcireba an mkurnalobis saWiroa mk-is moxsna
Sewyveta; dozis Semcireba+beta blokerebi;
fenobarbitali; maniakaluri mdg-is
ganviTarebisas
saWiroa_mk-is Sewyveta+liTiumi+neiroleptikebi
alergiuli: dermatovaskuliti
* qolestatikuri siyviTle, agranulocitozi, arTropaTia, arTriti,
(mk-is dawyebidan 1-2 TveSi), dermatovaskuliti, limfadenopaTia
WinWris cieba; saWiroa: mkurnalobis moxsna saWiroa: mk-is moxsna
sxvadasxva: priapizmi, libidos prolaqtinemia
• ,,moxsnis sindromi” _ saWiroa medikamentis daqveiTeba, anorgazmia, ,,serotoninuli
moxsna 4-6kviris ganmavlobaSi (ix. dafa 6.) ,,moxsnis sindromi” sindromi”.
• wonis momateba, libidos daqveiTeba, (ix. suraTi 8.)
prolaqtinemia, hipoglikemia

59
 suraTi 8.

serotoninuli sindromi (4, 14);

• kuWnawlavis mxriv _ muclis kolika da buybuyi, meteorizmi, gulisreva,

iSviaTad - Rebineba, diarea;
• cns-is mxriv: tremori, dizarTria, akatizia, hiperrefleqsia, kunTovani
hipertonusi, mioklonuri SekrTomebi (iwyeba terfSi da vrceldeba mTel
sxeulSi), SesaZloa ataqsia da kordinaciis darRveva;
• gul-sisxlZarRvTa sistema: TA-s arteriuli wnevis momateba, taqikardia
(serotononerguli antidepresantebi Cveulebriv, bradikardias iwveven);
• mdg-is damZimebisas: fsevdomaniakaluri sindromi, metyvelebis gaZneleba,
ideaTa rbola, Zilis darRveva, hiperaqtiuroba, abneva da dezorientacia;.
• terminaluri stadia Zalian waagavs avTvisebian neirolefsiur sindroms
_ maRali temperatura, profuzuli ofli, niRbiseburi, gapoxili saxe;
• simptomebi qreba sumsi-s dozis Semcirebis an moxsnis Semdeg.
mkurnaloba mZime SemTxvevebSi _ciproheptadini
16-32 mg dReSi; beta-blokerebi; detoqsikacia, simptomuri Terapia;
• sikvdili viTardeba mwvave kardio_vaskuluri ukmarisobiT.

60
 suraTi 9.
calkeuli antidepresantis gverdiTi efeqtis SedarebiTi daxasiaTeba
(4,14);
preparati gverdiTi efeqti
generiuli qoli- Zilia- uZiloba orTosta- gulis gastro- wonis sqeso
(saerTaSoriso) noli- noba, aJitacia tiuri riTmis -entero- momat brivi
zuri sedacia hipo- darRvev logiuri eba sfer
saxelwodeba tenzia a o
tricikluri antidepresantebi
amitriftilini ++++ ++++ _ ++++ +++ + ++++ ++
dezipramini ++ + +++ +++ ++ + ++ _
doqsepini +++ ++++ _ +++ +++ + ++ +
imipramini ++++ ++ ++ ++++ +++ ++ +++ ++
klomipramini ++++ ++ + ++++ +++ ++ +++ ++
nortriftilini ++ ++ + +++ +++ + ++ +
protriftilini +++ ++ ++ +++ +++ + + _
Tianeptini + + ++ _ + ++ _ _
trimipramini +++ ++++ _ +++ ++ _ +++ ++
tetracikluri antidepresantebi
amoqsapini ++ +++ _ +++ ++ ++ +++ ++
maprotilini ++ +++ + + ++ _ +++ +
mianserini + +++ _ + _ + ++ +
antidepresantebi sxva qimiuri struqturiT
bupropioni _ _ +++ _ ++ ++ _ _
venlafaqsini ++ ++ ++ _ _ +++ + ++
trazodoni
serotoninis ukumitacebis seleqtiuri inhibitorebi
paroqsetini ++ + ++ _ _ +++ _ +++
sertralini _ ++ ++ _ _ +++ _ +++
fluvoqsamini _ ++ ++ _ _ +++ _ +++
fluoqsetini _ _ +++ _ _ +++ _ +++
citaloprami _ + ++ _ _ +++ _ +++
mao-s Seuqcevadi inhibitorebi
nialamidi ++ ++ ++++ +++ _ ++ ++ +
mao-s Seqcevadi inhibitorebi
moklobemidi + _ ++ _ _ ++ + _
pirazidoli + + ++ _ _ ++ + _

SeniSvna _ gverdiTi efeqti: _ _ ar aris

+ _ Zalian iSviaTia
++ _ iSviaTia
+++ _ xSiria
++++ _ Zalian xSiria

61
 suraTi 10.
farmakokineturi interaqtivoba (14)
citoqromi P450IA2 citoqromi P4502C citoqromi P4502D6 citoqromi P4503A

genetikuri TeTri rasis 5-10%-s TeTri rasis 3-5%-s P450 Semcvelobis

polimorfizmi aqvs misi ukmarisoba aqvs misi ukarisoba 60%
inducireba: inducireba: inducireba: inducireba:

sigaretis moweva fenitoini karbamazepini karbamazepini

SeSis naxSiris rifampicini fenitoini fenitoini
boli prednizoloni
karbamazepini rifampicini
omeprazoli
fenobarbitali
fenitoini
inhibireba: inhibireba: inhibireba: inhibireba:

cimetidini cimetidini qlorpromazini eriTromicini

ciprofloqsacini fluoqsetini citaloprami fluoqsetini
eriTromicini fluvoqsamini duloqsetini fluvoqsamini
fluvoqsamini sertralini flufenazini ketokonazoli
paroqsetini haloperidoli paroqsetini
paroqsetini sertralini
sertralini triciklurebi
triciklurebi
metabolizmi: metabolizmi: metabolizmi: metabolizmi:

klozapini diazepami klozapini benzodiazepinebi

haloperidoli omeprazoli kodeini Ca++ blokatorebi
mirtazapini fenitoini donepezili karbamazepini
olanzapini tolbutamidi haloperidoli cimetidini
Teofilini triciklurebi fenoTiazini klozapini
triciklurebi varfarini risperidoni kodeini
varfarini tca meoradi donepezili
aminebi eriTromicini
tramadoli galantamini
trazodoni metadoni
venlafaqsini mirtazapini
risperidoni
steroidebi
terfenadini
triciklurebi
valproati
venlafaqsini
Z _ hipnoturebi

62
c. inicialuri mkurnaloba antidepresantebiT (3-5, 13-15, 150, 152)

antidepresantebis inicialuri dozebi mocemulia sur. 3.

Terapiuli dozis misaRwevad antidepresantis titraciis dros

gaiTvaliswineT:
• gverdiTi efeqtebi (ix. sur. 7; 8; 9; 10);
• pacientis asaki
mag. inicialuri da Terapiuli doza unda ganaxevrdes
moxucebsa da fizikurad dauZlurebul pacientebSi
• komorbiduli faqtorebi.
(20, 22, 28, 74, 150, 155-eqspertTa mosazreba; 67_B, A57, 58 73, 81 148,
178-A)

• monitorings da Sefasebas saWiroebs gverdii efeqtebi;

• klinikuri mdgomareoba;
• usafrTxoeba (mag. suicuduroba).
• Terapiis efeqturoba;
(73, 148-A)

monitoringis sixSire damokidebulia daavadebis simZimeze;

• suicidur riskze;
• mniSvnelovan gverdiT efeqtebze an wamlebis interaqtivobaze
(ix. sur. 6; sur. 10);
• pacientis mkurnalobisadmi damokidebulebaze;
• socialur mxardaWeraze da
• komorbiduli zogadi samedicino problemebis arsebobaze.
(73, 148-A):

monitoringis meTodebi gansazRvreT klinikuri konteqstis

Sesabamisad _ pirispir, telefoniT, eleqtronuli fostiT,
kontaqti pirveladi jandacvis eqimTan
(74, 155 – eqspertTa mosazreba)

mkurnalobis efeqturobis Sesafaseblad gamoiyeneT depresiis

Sesafasebeli unificirebuli skalebi _ hamiltonis, bekis da sxva

moaxdineT medikamenturi mkurnalobis gverdiTi efeqtebis marTva

(ix. sur.11)

63
 suraTi 11.
medikamenturi mkurnalobis gverdiTi efeqtebis
menejmenti (13-15, 150, 152) (74, 155-eqspertTa mosazreba)

miawodeT pacients informacia potenciuri gverdiTi

efeqtebis Sesaxeb, moTxoveT, gansakuTrebuli
yuradRebiT iyos maT mimarT.

moaxdineT gamovlenili gverdiTi efeqtebis

monitoringi

mniSvnelovani gverdiTi efeqtebis gamovlenisas:

• daakvirdiT da daicadeT _ Tu ar aris Terapiuli
riski;
• SecvaleT wamlebis doza, miRebis sixSire da dro;
• SecvaleT sxva, diferencirebuli klasis
medikamentiT;
• uzrunvelyaviT gverdiTi efeqtebis specialuri
mkurnaloba.

gaagrZeleT gverdiTi efeqtebis monitoringi,

gansakuTrebuli yuradReba miaqcieT:
• Terapiuli riskis arsebobas;
• pacientis mier mkurnalobis reJimis mkacrad dacvas;
• pacientis TviTgrZnobas.

64
d. inicialuri mkurnalobis warumatebloba (3-5, 13-15, 150,152)

Tu 4-8 kviris Semdeg pacientis mdgomareoba zomierad mainc ar

gaumjobesda, SecvaleT mkurnalobis reJimi (sur. 2.)
(73, 166-A);

• gaarkvieT, Tanmimdevrulad icavs Tu ara pacienti

mkurnalobis reJims (25-C, 72, 78-B, 23, 26, 77, 79-A)

gaiTvaliswineT farmakodinamikuri da farmakokineturi

faqtorebi (SeiZleba saWiro iyos sisxlis plazmaSi
antidepresantis koncentraciis gansazRvra)
(58- B, 57-A);

gadasinjeT mkurnalobis gegma

maqsimumamde gazardeT inicialuri Terapiuli doza
(46, 81-A):
_ nawilobri efeqtis miRebisas gaaxangrZliveT mkurnaloba
gazrdili doziT, mag. 2-4 kviriT
(58-C; 57-A):
_ saSualo dozebis araefeqturobis an sisxlis plazmaSi
dabali koncentraciisas gazardeT doza da daakvirdiT
gverdiT efeqtebs
(74, 155 - eqspertTa mosazreba; 58-C; 44, 45, 67-B; 46, 75, 81-A):
• daumateT, SecvaleT, an gazardeT fsiqoTerapiis
intensivoba (20, 69, 92- eqspertTa mosazreba; 25-C, 72, 78-B, 23,
26, 77, 79-A);
• gadadiT sxva, igive an gansxvavebuli klasis, ara maoi–s
jgufis antidepresantze (ix. sur. 3; dafa 3. da 4.)
(27-C; 24, 31, 48, 64-A);
• Tu nawilobrivi efeqti mainc gaqvT, daumateT:
_ ara maoi-s jgufis, sxva diferencirebuli klasis
antidepresanti (iyaviT fxizlad wamlebs Soris
interaqtiobis gamo)
(27-C; 24, 55, 56, 87-A); an
_ sxva damxmare medikamenti _ mag. liTiumi (59, 60-C; 106-B
donis mtkicebuleba); Tiroiduli hormoni, (61-eqspertTa
mosazreba 62-D), antikonvulsanti, (60, 63-C),
fsiqostimulatori (62-eqspertTa mosazreba);
• gadadiT maoi-s jgufis antidepresantze (62-eqspertTa
moszreba; 30, 32, 34, 56-A);
• daniSneT ekT (156, 43-eqspertTa moszreba; 25-C, 67-B, 66-A)

dafa 3.
aucilebeli intervali antidepresantebis Secvlis dros
(1, 13, 152)
antidepresantebis Secvla minimaluri intervali

65
1. xangrZlivi naxevardaSlis
periodis mqone preparatebis (mag. 5 kvira
fluoqsetini) Secvla maoi-s
preparatebiT
2. maoi-s preparatebis Secvla
xangrZlivi naxevardaSlis 2 kvira
periodis mqone preparatebiT (mag.
tca, paroqsetini, fluvoqsamini,
venlafaqsini) an maoi-s sxva
preparatiT;
3. maoi-s preparatebis Secvla 2 kvira
ara-maoi-s preparatebiT

rodesac erTi antidepresanti meore antidepresantiT

icvleba, mizanSewonilia araefeqturi an dabali
tolerantobis mqone antidepresantis dozebis Semcireba
garkveuli drois ganmavlobaSi da axali preparatiT
TandaTanobiTi Canacvleba (14).
garda zemoT, dafa 3 –ze gaTvaliswinebuli SezRudvebisa

dafa 4
magaliTi
pirveli meore mesame meoTxe
kvira kvira kvira kvira

doTiapinis 150mg 100 mg /dReSi 50mg/dReSi 25mg/dReSi araferi

moxsna
citalopramis araferi 10mg/dReSi 10mg/dReSi 20mg/dReSi 20mg/dReSi
daniSvna

• fsiqozuri simptomebiT mimdinare depresiuli epizodis dros

simptomebis marTvisaTvis gamoiyeneT antifsiqozuri
medikamentebi(3):
• mizanSewonilia 2-generaciis (atipiuri) antifsiqozuri
preparatebiT mkurnaloba, maTi zogadad ufro asatani
gverdiTi efeqtebis profilis gamo:
mag.
_ risperidoni 0,5 _ 8 mg/dReSi;
_ olanzapini 5 -20 mg/dReSi;
_ queTiapini 200_400 mg/dReSi;
(28- eqspertTa mosazreba; 96,161-D, 28, 29-A)

66
 e.antidepresantis SerCeva gaxangrZlivebuli araefeqturobisas
(3-5, 13-15, 150,152)

• gadaamowmeT diagnozis siwore da pacientis mier

mkurnalobis reJimis Tanmimdevruli dacva eqspertTa
moszreba; 25-C, 72, 78-B, 23, 26, 77, 79-A):

• Tu 4-8 kviris Semdeg pacientis mdgomareoba zomierad mainc

ar gaumjobesda, gamoikvlieT mkurnalobisaTvis xelis
SemSleli faqtorebi:
• zogadi samedicino komorbiduli faqtorebi;
• komorbiduli fsiqikuri faqtorebi, fsiqoaqtiuri
nivTierebebis moxmarebis CaTvliT;
• mniSvnelovani fsiqosocialuri problemebi.
(164-C, 40-B, 55, 35-37, 73-A)

Tu zemoT aRniSnuli RonisZiebebis gatarebisas araefeqturobis

mizezi ar gamoavlindeba gaiTvaliswineT konsultacia an ekT
(156-eqspertTa mosazreba; 67, 157-B, 42, 43, 65-A);

3. inicialuri fsiqoTerapiuli mkurnaloba (13, 14, 152, 153)

msubuqi an zomieri depresiis dros fsiqoTerapiis monoTerapiis

saxiT gamoyeneba xdeba pacientis arCevanis gaTvaliswinebiT
(20, 22, 155- eqspertTa mosazreba; 160-D, 21, 78, 154-B, 23, 26, 76,180,
181, 182-A)

fsiqoTerapiuli intervencia damokidebulia Semdeg

Taviseburebebze:
• mniSvnelovani fsiqosocialuri stresorebis arseboba;
• intrafsiqikuri konfliqti;
• interpersonaluri siZneleebi;
• komorbiduli personologiuri aSliloba;
• orsulobis da laqtaciis periodi an daorsulebis survili;
• pacientis arCevani.

67
a. fsiqoTerapiis SerCevis principi.

mkurnalobis modelis arCeva:

• kognitur-bihevioruli Terapis da interpersonaluri
Terapiis maRali efeqturoba dadasturebulia(70, 71, 72, 78, 85-
B, 77, 79.-A)
• fsiqodinamiuri fsiqoTerapia, romelzec miRweulia farTo
klinikuri konsensusi, orientirebulia rogorc depresiis,
aseve personologiuri aSlilobis simptomebze (20- eqspertTa
mosazreba; (159- eqspertTa mosazreba)

gaiTvaliswineT:
• pacientis arCevani;
• specifiur problemebze saTanadod trenirebuli
klinicistebis xelmisawvdomoba.

b. fsiqoTerapiuli mkurnalobis ganxorcieleba

gansazRvreT fsiqoTerapiis sixSire

fsiqoTerapiis intensivoba mwvave fazaSi (Cveulebriv, kviraSi
erTxel an ramdenimejer) damokidebulia:
• fsiqoTerapiis specifikaze da miznebze;
• Terapiuli aliansis Seqmnisa da xelSewyobis saWiroebaze;
• komplaenturobis miRwevis aucileblobaze;
• suicidurobis monitoringis da marTvis saWiroebaze.
(159, 167-eqspertTa mosazreba; 70, 71, 72, 78, 85-B, 77, 79, 180, 181,
182-A)

roca mkurnalobis procesSi erTze meti klinicisti

monawileobs, xeli SeuwyveT pacientis kontaqts sxva
klinicistebTan (13).

Tu 4-8 kviris Semdeg pacientis mdgomareoba, sul mcire,

zomierad mainc ar gaumjobesda, CaatareT srulyofili
ganmeorebiTi Sefaseba da gadadiT mkurnalobis sxva
variantebis ganxilvaze (ix. sur. 3.) (73 A)

68
4. farmakoTerapiis da fsiqoTerapiis kombinireba (13, 15, 152)

farmakoTerapiis da fsiqoTerapiis kombinirebas gansazRvravs

zomieri da mZime depresiuli epizodis simwvave,
fsiqosocialuri funqcionirebis mniSvnelovani gauareseba,
interpersonaluri problemebi an komorbiduli
personologiuri aSliloba (20, 22, 155, 159, 167- eqspertTa
mosazreba; 160-D, 21, 78, 154-B, 23, 26, 76, 179 -182-A)

kombinirebuli mkurnalobis ganmsazRvreli damatebiTi

faqtorebia:
• warsulSi monoTerapiis araefeqturobis istoria
• mkurnalobis Tanmimdevruli reJimis darRveva
(fsiqoTerapiuli intervencia orientirebulia
komplaenturobis miRwevaze)

5. eleqtrokonvulsiuri Terapia

eleqtrokonvulsiuri Terapiis ganxilva xdeba Semdegi

faqtorebis arsebobisas:
• depresiuli epizodis simZimis maRali xarisxi,
fsiqosocialuri funqcionirebis darRveviT;
• fsiqozuri simptomebi da katatonia;
• antidepresiuli efeqtis urgentuli saWiroeba (mag.
suiciduroba an uari sakvebis miRebaze).
(156, 74, 43-eqspertTa moszreba; 25-C, 157, 67-B, 66-A)

ekT SesaZlebelia upiratesi mkurnaloba iyos:

• antidepresantebiT mkurnalobis gamomricxavi zogadi
samedicino komorbiduli faqtorebis arsebobis dros;
• warsulSi ekT-s kargi efeqturobis dros;
• roca pacienti irCevs ekT-s.
(43-eqspertTa moszreba; 42-A)

6. mkurnalobis efeqtis adekvaturi Sefaseba (13, 152, 153)

ar Sewyvito mwvave fazis mkurnaloba arasruli efeqturobisas,

nawilobrivi efeqti cud fsiqosocialur gamosavalTan
asocirdeba (164, 174_C, 73, 178-A).

69
C. SemanarCunebeli anu mastabilizebeli mkurnalobis faza
(13, 14, 152, 153)
SemanarCunebeli anu mastabilizebeli mkurnalobis faza
ganisazRvreba mwvave fazis amowurvis da remisiis
Camoyalibebidan 16_20 kviris xangrZlivobis periodiT.
(82_B, 73-A)
recidivis prevenciis mizniT, gaagrZeleT antidepresantebiT
mkurnaloba igive doziT, rogorc mwvave fazis periodSi
(73, 80, 82, 84-A).

recidivis prevenciis mizniT, gaiTvaliswineT fsiqoTerapiis

gamoyeneba. (85_B, 166, 179, 180, 181-A)

recidivis prevenciis mizniT, gaiTvaliswineT ekT-s SeTavazeba,

Tu araefeqturi iyo medikamenturi an fsiqoTerapiuli
mkurnaloba. (86_B)

klinikuri mdgomarebasa da gamoyenebuli mkurnalobis

specifiurobis Sesabamisad gansazRvreT vizitebis sixSire.
sixSire SeiZleba meryeobdes kviraSi ramdenime vizitidan, 2-3
TveSi erTxel vizitamde.

70
D. damWeri anu profilaqtikuri Terapiis faza (3, 13, 14, 152, 153)

damWeri anu profilaqtikuri Terapiis mizania depresiuli

epizodis rekurentobis prevencia
(174_C, 73, 148, 178 -A)

damWeri anu profilaqtikuri Terapiis Sesaxeb gadawyvetilebis

miRebisas gaiTvaliswineT Semdegi faqtorebi:
faqtori
• ganmeorebis riski
• epizodebis simZime
• SemanarCunebeli
mkurnalobis periodSi
gverdiTi efeqtebi
komponenti
• wina epizodebis raodenoba,
epizodebis polaruloba,
komorbiduli problemebi,
epizodebs Soris
rezidualuri simptomebi;
• suiciduroba, fsiqozuri
simptomebi, fsiqosocialuri
funqcionirebis daqveiTebis
done;

• pacientis arCevani

gaagrZeleT mkurnaloba, romelic efeqturi iyo mwvave da

SemanarCunebeli mkurnalobis fazaSi (82, 85, 87,_B, 80-A).

gamoiyeneT antidepresantebis igive dozebi, romlebic efeqturi

iyo mkurnalobis wina fazaSi. (80, 81, 82, 84 _ A).

gansazRvreT vizitebis sixSire klinikuri mdgomarebis da

gamoyenebuli mkurnalobis specifikurobis Sesabamisad.
stabiluri pacientebisaTvis viziti SeiZleba daigegmos 2-3
TveSi erTxel, xolo Tu pacienti mkurnalobs fsiqodinamiuri
fsiqoTerapiiT _ kviraSi ramdenjerme (180, 181, 182- A)

gansazRvreT ekT-s gamoyenebis saWiroeba pacientebTan,

romlebic uars acxadeben ganmeorebadi zomieri an mZime
epizodis dros Sesabamis farmakologiur mkurnalobaze. (86-B).

71
E. aqtiuri mkurnalobis Sewyveta (3, 13, 14, 152, 153)

gaiTvaliswineT, rom mkurnalobis Sewyveta igive faqtorebzea

damokidebili, romlis mixedviTac gamogvaqvs daskvna damWeri
mkurnalobis dawyebaze
(44, 73, 80, 81, 82, 84 _ A donis mtkicebuleba).
• magaliTad, gaiTvaliswineT gameorebis SesaZlebloba,
sixSire da bolo epizodis simZime (ix. cxrili 4)
SeafaseT depresiuli epizodis rekurentulobis riski
(dafa 5. )

dafa 5.
depresiuli epizodis rekurentulobis risk_faqtorebi
(13, 14, 152):
• anamnezSi xSiri depresiuli epizodebi;
• bolo depresiuli epizodis simZime;
• ojaxuri uTanxmoeba, cudi emociuri da socialuri
maxardaWera;
• stres-faqtorebisadmi aweuli mgrZnobeloba;
• disTimiuri an sxva fsiqikuri aSlilobis komorbidoba;
• Tanmxlebi qronikuli somaturi daavadebis arseboba.

mkurnalobis Sewyvetisas fsiqoTerapiis meTodis arCeva

damokidebulia pacientis problemebze, fsiqoTerapiis tipze,
mkurnalobis xangrZlivobasa da intensivobaze.

eqvs kviriani an ufro xangrZlivi Timoanaleptiuri

mkurnalobis mkveTrad Sewyveta ar aris mizanSewonili,
SesaZlebelia ,,moxsnis sindromis” ganviTareba (ix. dafa 6.)
antidepresantebis moxsna xdeba TandaTanobiT, dozis
SemcirebiT, zogjer saWiroa preparatis datoveba kviraSi 2-3-
jer. kleba unda gagrZeldes oTxi kviris manZilze an ufro met
xans, rac mniSvnelovanwilad damokidebulia preparatis
naxevardaSlis periodze (14)

magaliTi antidepresantebis Sewyveta (14).

dozebis kleba (mg/dReSi)
preparati Terapiuli I kviris II kviris III kviris IV
doza Semdeg Semdeg Semdeg kviris
Semdeg
amitriftilini 150 100 50 25 arafe
ri
paroqsetini 30 20 10 10mg arafe
dRegamoSvebiT ri
trazodoni 450 300 150 75 arafe
ri

72
 gaiTvaliswineT, rom Timoanaleptiuri Terapiis mkveTri
Sewyvetisas, potenciurad nebismier andidepresants SeuZlia
gamoiwvios ,,moxsnis sindromi” (14).

dafa 6.
antidepresantebis ,,moxsnis sindromi” (14)
maoi tca sumsi
simptomebi aJitacia, ataqsia gripismagvari gripismagvari simptomebi,
gamRizianebloba, simptomebi _ ,,eleqtro Sokismagvari”
aSlilobis Semcivneba, mialgia, SegrZnebebi, insomnia, an
gamwvaveba, insomnia, hiperhidrozi, Tavis uzomo Zilianoba
somnolencia, tkivili, gulis Tavbrusxveva,
koSmaruli reva),DuZiloba an gamRizianebloba,
sizmrebi, mZafris sizmrebi. wamoyvirebebi.
kognituri * iSviaTad * iSviaTad _aSlilobis
darRvevebi, viTardeba mania da gamwvaveba, yuradRebis
gaugebari kardialuri koncentraciis da
metyveleba, ariTmia mexsierebis
* iSviaTad _ problemebi.
halucinacia, bodva
xSirad iwvevs tranilcipromini amitriftilini paroqsetini
xanmokle imipramini venlafaqsini
naxevardaSllis
peridis mqone
antidepresanti

• Tu gamovlinda ,,moxsnis” sindromi, wamlis Sewyveta ki

aucilebelia, gaaxangrZliveT moxsnis vadebi da SeamcireT
wamlis daklebis doza (14);
• Tu moxsnis simptomebi 1-2 kviraze met xans mainc rCeba,
xelaxla SeafaseT da gadawyviteT, ra ufro rekomendebulia,
moxsna Tu mkurnalobis gagrZeleba (14).

• Tu pacients aqvs mkurnalobis Sewvetis SemTxvevaSi recidivis

gamocdileba, aRadgineT adrindeli, Terapiulad efeqturi
mkurnaloba (14);
• depresiis simptomebis recidivis SemTxvevaSi ufro swrafad
daubrundiT srul Terapiul dozas;
• SeimuSaveT mkurnalebis ganaxlebis gegma recidivis
SemTxvevisaTvis(14).

73
II. bipolaruli aSlilobis mkurnaloba

A fsiqiatriuli menejmenti (13, 14, 151)

fsiqiatriuli menejmentis miznebi (13, 151):

• Terapiuli aliansis Camoyalibeba da xelSewyoba;
• pacientis fsiqikuri statusis monitoringi;
• bipolaruli aSlilobis Sesaxeb ganaTlebis gavrce
• leba;
• mkurnalobis Tanmimdevruli reJimis mkacri dacva;
• aqtiurobisa da Zilis bunebrivi riTmis xelSewyoba;
• winaswari sifrTxile stresorebis mimarT;
• axali epizodis adreuli identificireba;
• fsiqosocialuri funqcionirebis gauaresebis minimumamde
dayvana.

1. Seafase diagnostikurad (18)

SeafaseT fsiqoaqtiuri nivTierebebis moxmareba an sxva

komorbiduli faqtorebis arseboba, romelsac SeuZlia
gamoiwvios daavadeba, gavlena moaxdinos daavadebis
mimdinareobaze, an xeli SeuSalos mkurnalobis process

• gafantuli sklerozi da am daavadebaSi monawile, limbiur

sistemasTan mWidrod dakavSirebuli, marjvenamxrivi
subkortikaluri da kortikaluri zonebis organuli
dazianeba, Cveulebriv, meorad maniasTan asocirdeba;
• L–dofas preparatebiT da kortikosteroidebiT
mkurnalobisas Zalze xSirad viTardeba meoradi mania;
• fsiqoaqtiuri nivTierebebis gamoyeneba SesaZloa
gaxdesGguneb-ganwyobis aSlilobis epizodis maprovocire-
beli faqtori an, SesaZlebelia, pacienti aseTi epizodis
simptomebis Casaqrobad iRebdes am nivTierebebs.
(1, 2, 8) (103, 104, 171 C, da 101, 102, 172 D)

gamokiTxeT guneba-ganwyobis meryeobis da maniasTan

asocirebuli siptomebis labilurobis istoria, mag. Zilis
darRveva, gadaWarbebuli aqtiuroba da sxva.
(93, 94, 172 _D 178- A)
• bipolaruli aSliloba Cveulebriv warmodgenili unda
iyos depresiuli, hipomaniakaluri, maniakaluri an Sereuli
afeqturi epizodebis monacvleobiT (18) (178 - A)
• pacienti uCveulo xalisiT iZleva informacias maniakaluri
an hipomaniakaluri simptomebis Sesaxeb (18)

74
@2. uzrunvelyaviT pacientis da sxva pirebis usafrTxoeba.
gansazRvreT fsiqiatriuli daxmarebis done (13, 151)

usafrTxoebis Sefaseba
• gansakuTrebuli mniSvneloba aqvs suicidis riskis zust
Sefasebas (90-91 _ C);
• suicidur mcdelobaTa umravlesoba depresiul an Sereul
epizods ukavSirdeba (88-89-D);
• SeekiTxeT yvela pacients suiciduri azrebis, tendenciebis,
suicidis dagegmvis Sesaxeb da gansazRvre maTi intensivoba;
• SeagroveT damatebiTi informacia ojaxis wevrebisa da sxva
pirebisagan;
• SeafaseT im saSualebebis xelmisawvdomoba, romliTac
Caidina suicidi (mag medikamentebi, cecxlsasroli iaraRi
da sxva) da am saSualebebis letalurobis xarisxi;
• SeafaseT suiciduri riskis momatebasTan dakavSirebuli
komorbuli faqtorebi, rogoricaa aJitacia, Zilis
darRveva, impulsuroba, fsiqoaqtiuri nivTierebebis Warbi
moxmareba (101-102_D; 103-C), fsiqozuri simptomebi
(gansakuTrebiT imperatiuli halucinaciebi) da
personologiuri aSliloba (104-C);
• SeafaseT ojaxuri istoria suicidze da axali
gamJRavnebuli suicidis istoria (94- D);
• gansazRvreT nebismieri wina suiciduri mcdelobis arsi da
potenciuri letalurobis xarisxi;
• gansakuTrebuli zedamxedveloba gauwieT pacients,
romelic amJRavnebs suiciduri da Zaladobis Sinarsis
mqone azrebs an ganzraxvebs (100- D);
• iyaviT frTxili daskvnis gamotanis procesSi.

gaiTvaliswineT hospitalizaciis saWiroeba, Tu pacienti (13,16):

• seriozul saSiSroebas uqmnis Tavis Tavs an irgvlimyofebs;
• agresiulia da saavadmyofos gareT ar aqvs Sesabamisi
socialuri mxardaWera an aSkaraa gauaresebis
SesaZlebloba;
• aqvs garTulebuli fsiqikuri an zogadi samedicino
mdgomareoba;
• ar an ver miiRebs adekvatur ambulatoriul mkurnalobas,
fsiqiatriuli daxmarebis dayovneba ki safrTxes Seuqmnis
pacientis an sxva piris sicocxles da/an janmrTelobas.(16)

ganmeorebiT SeafaseT SeTavazebuli fsiqiatriuli daxmarebis

donis optimaloba (13, 151, 153)

gaiTvaliswineT, Tu ramdenad xelmisawvdomia avadmyofisaTvis

manqana, sakredito baraTi, sabanko angariSebi, telefoni da
sxva, radgan maniakaluri mdgomareobis dros qonebisadmi
daudevari mopyrobis maRali riskia
(13, 153; 164-C);

75
3. Terapiuli aliansis Seqmna da xelSewyoba (13; 151)

Terapiuli aliansis Seqmna:

• gadamwyvetia TiToeuli pacientisagan fsiqiatriul
daxmarebaze Tanxmobis miRebis da SemTxvevis marTvis
procesSi (16);
• pacientisa da avadmyofobis Sesaxeb ufro meti informaciis
miRebis, prodromuli simptomebis adreuli identificirebis
da axali epizodis adreuli Secnobis saSualebas iZleva
(92-eqspertTa mosazreba, 95, 181-A);.

4. pacientis fsiqikuri statusis monitoringi (13; 151, 153)

• gansakuTrebulad mniSvnelovania monitoringi maniakaluri

epizodis mimdinareobisas, roca pacients SezRuduli an
dakarguli aqvs sakuTari daavadebis gacnobierebis unari
(166-A);
• gaxsovdeT, rom qcevis an guneba-ganwyobis mciredi
cvlilebac ki SeiZleba epizodis dasawyisis mauwyebeli
iyos (95, 178- A);A

5. pacientis da misi ojaxis fsiqoganaTleba (13; 151)

• TandaTanobiT pacienti ufro kompetenturi xdeba, igebs da

imaxsovrebs miwodebul informacias, iRebs da egueba
daavadebis xangrZlivi mkurnalobis saWiroebas
fsiqoganaTleba unda iyos uwyveti procesi, romlis drosac
fsiqiatri TandaTanobiT awvdis cnobebs avadmyofobisa da
misi mkurnalobis Sesaxeb;
• SeiZleba gamoyenebuli iyos beWdviTi da/an internetis
masalebi;
• igive saganmanaTleblo meTodebi gamoiyene ojaxis wevrebisa
da mkurnalobaSi CarTuli sxva pirebisaTvis
(92-eqspertTa mosazreba; 95, 181- A);

6. gaaumjobeseT mkurnalobis reJimis mkacri dacva (13; 151)

• mkurnalobisadmi ambivalenturi damokidebuleba xSirad

rogorc medikamenturi, aseve sxva saxis mkurnalobis reJimis
darRvevis mizezi xdeba
• ambivalenturi damokidebulebis mizezebia:
_ sakuTari daavadebis seriozulobis mimarT
gacnobierebuli damokidebulebis ukmarisoba;
_ hipomaniis an maniis Sesaxeb miRebuli piradi
gamocdilebis ignorireba.
• pacientTan diskusiisas ganxiluli unda iyos medikamentebis
gverdiTi efeqtebi, Rirebuleba da sxva problemebi, romelic
xangrZlivi mkurnalobisas SeiZleba tvirTad daawves

76
 pacients;
• gverdiTi efeqtebis umetesobis koreqcia SeiZleba dozebis
frTxili SerCeviT, daniSnulebis reJimis da wamlis formis
SecvliT (mag. gaxangrZlivebuli moqmedebis, Txevadi
formis)(3).
(92-eqspertTa mosazreba; 166- A);

7. daexmareT, Seicnos stresogenuli faqtori. Seqmnas aqtiurobisa

da Zilis regularuli modeli (13; 151)

• stresogenuli faqtori ZiriTadad win uswrebs daavadebis

epizods
• socialuri riTmis darRveva, Zilis da aqtiurobis riTmis
darRvevasTan erTad, SeiZleba CaiTvalos maniakaluri
epizodisaTvis specifiur biZgis mimcem faqtorad; pacients
da misi ojaxis wevrebs unda hqondes informacia Zilis
darRvevis potenciur rolze maniakaluri epizodis
ganviTarebaSi
• xelSewyobili unda iyos dRis aqtiurobis regularuli
modeli (Zilis, kvebis, fizikuri aqtiurobis, socialuri da
emociuri stimulirebis CaTvliT).
(93, 94- D, 95, 181-A);

8. muSaoba pacientTan gamwvavebis adreuli niSnebis Secnobis da

marTvis mizniT(13; 151)

• fsiqiatri exmareba pacients, misi ojaxis wevrebs da

dainteresebul sxva pirebs maniakaluri an depresiuli
epizodis adreuli niSnebis da simptomebis winaswar
Secnobasa da marTvaSi
• epizodis Setevis adreuli markerebi xSirad TiToeuli
pacientisaTvis epizodis dawyebis mauwyebelia;
• fsiqiatris mWidro urTierToba, rogorc pacientTan, aseve
mis ojaxTan, aadvilebs prodromis adreul Secnobas.
(95, 181-A);

8. fsiqosocialuri funqcionirebis gauaresebis Sefaseba da

marTva (13; 151)

gansazRvre da warmarTe fsiqosocialuri funqcionirebis

gauareseba daexmareT pacients saqmianobis da sxva
movaleobebis ganrigis SedgenaSi;
• daexmareT pacients, Tavi aaridos mniSvnelovan
cxovrebiseul cvlilebebs maniakalur an depresiul
mdgomareobaSi;
• SeafaseT bipolaruli aSlilobis mqone pacientis
bavSvebis problemebi da daxmareba aRmouCineT maT.
(96-D; 97, 163, 164, 174-C)

77
B. mkurnalobis arCevani

1. mwvave maniakaluri an Sereuli epizodi (13, 14, 151)

mkurnalobis miznebi:
• simptomebis marTva, raTa pacientma SeZlos fsiqosocialuri
funqcionirebis Cveul doneze dabruneba
• aJitaciis, agresiis da impulsurobis swrafi marTva.
(163, 164-C, 178- A);

inicialuri mkurnalobis modelis arCeva

pirvelad pacientebSi:
mZime maniakaluri an Sereuli epizodis dros, rekomendebulia
mkurnalobis dawyeba (114-B da 162_C):
• liTiumiT, romelime antifsiqozur preparatTan
kombinaciaSi (111-112-A)
• an valproatiT* romelime antifsiqozur preparatTan
kombinaciaSi. (127-B da 129, 128, 140-A)
• naklebad mZime pacientebisaTvis rekomendebulia
monoTerapia liTiumiT (105-107, 109-B, 115, 147-A),
valproatiT* (124-B, 110 125-126-A), an romelime
antifsiqozuri preparatiT, mag. olanzapiniT* (111, 112, 136,
137, 138,-A);
• SeiZleba saWiro iyos, xanmokle periodis ganmavlobaSi
benzodiazepinebiT damatebiTi mkurnaloba (142-143-A);
• Sereuli epizodis dros SeiZleba, liTiumTan SedarebiT,
ufro efeqturi iyos valproati (110, 115-A);
• atipiur antifsiqozur preparatebs upiratesoba eniWeba
tipiurTan SedarebiT, ZiriTadad maTi ufro asatani
gverdiTi efeqtebi gamo (mag. olanzapini an risperidoni*)
(138-139-A);
• alternatiuli mkurnaloba gulisxmobs:
1) karbamazepini* an oqskarbamazepini, 132, 165_B da 108,
131,133, 138- A); liTiumis an valproatis nacvlad;
2) ziprazidoni an queTiapini sxva antifsiqozuri
preparatis nacvlad (13);

gaiTvaliswineT:
• mkurnalobis SerCeva damokidebulia daavadebis simZimis
xarisxze, rac swrafi ciklurobis an fsiqozis arsebobas
ukavSirdeba da, roca SesaZlebelia, pacientis arCevanze
(178-A);
• liTiumis aqtiuri moqmedebis dawyebamde latenturi
periodi 4-10 dRea, amitom, maniis simptomebis marTvis
mizniT, SeiZleba saWiro gaxdes antifsiqozuri
preparatebis damateba (3) (139, 140, 141-A);
• antidepresanti Semcirebuli an Sewyvetili unda iyos

78
 saWiroebis mixedviT (98 B da 146-A);
• rekomendebulia fsiqosocialuri da
fsiqofarmakologiuri Terapiis kombinireba
(164_C, 179, 180, 181- A)

* saqarTveloSi registrirebuli preparatebi

pacientebTan, romlebsac damWeri Terapiis fonze ewyebaT

maniakaluri an Sereuli epizodis Seteva, saWiroa
medikamentebis dozebis optimizeba
• darwmundiT, rom sisxlis SratSi medikamentis
koncentracia Terapiulis farglebSia. zogjer
aucilebelia, miaRwioT Terapiuli koncentraciis zeda
zRvars (175-D, 68, 123- B, 122-A);
• xSirad, kvlav saWiro xdeba antifsiqozuri preparatis
damateba (139-141-A);
• daavadebis simZimis an gamoxatuli aJitaciis dros
SesaZlebelia, saWiro gaxdes, pacients daeniSnos
benzodiazepiniT damatebiTi moklevadiani mkurnaloba,
mag. lorazepami an klonazepami* 2- 4 mg/dReSi (4) (142-143-
A);

Tu maniis simptomebi 10-14 dRis ganmavlobaSi pirveli rigis

medikamenturi mkurnalobis optimizebuli dozebiT
arasakmarisad kontrolirdeba, daumateT sxva pirveli rigis
medikamenti. (113, 114-C, 110-112, 115-A);
mkurnalobis alternatiuli variantebia:
• pirveli rigis medikamentebis (liTiumi, valproati,
antifsiqozuri praparati) damatebis nacvlad, daumateT
karbamazepini an oqskarbamazepini
(113-C, 116, 165-B, 108-A);
• daumateT antifsiqozuri preparati, an erTi antifsiqozuri
preparati SecvaleT meore antifsiqozuri preparatiT
(139-141_A);
• daavadebebis rezistentulobis dros SeiZleba nawilobriv
efeqturi iyos klozapini (149-B);
• eleqtrokonvulsiuri Terapia (ekT) mizanSewonilia:
_ pacientebSi mZime maniakaluri an medikamenturi
Terapiisadmi rezistentuli mdgomareobis dros;
_ pacientebSi, romlebic fsiqiatrTan konsultaciis
Semdeg airCeven ekT-s;
_ pacientebSi Sereuli epizodiT da
_ pacientebSi, romlebsac ganuviTardaT mZime mania
orsulobis periodSi
(43, 155, 156-eqspertTa mosazreba, 157- B)

79
 siqozuri simptomebiT mimdinare maniakaluri an Sereuli
epizodis dros simptomebis marTvisaTvis gamoiyeneT
antifsiqozuri medikamentebi:
mizanSewonilia meore Taobis (atipuri) antifsiqozuri
preparatebiT mkurnaloba, maTi zogadad ufro asatani gverdiTi
efeqtebis profilis gamo (3):
_ risperidoni 2-6 mg;
_ olanzapini 10-20 mg;
_ queTiapini 200_400 mg;
_ ziprazidoni 40_80 mg.
(127-B, 128, 136-141-A)
• arakomplaenturi, mZime maniakalur pacientebSi, oraluri
antifsiqozuri preparatebis nacvlad, mizanSewonilia
deponirebuli fenoTiazinis gamoyeneba, mag. Sol. Fluphenazine*
12,5 _25 mg. kunTebSi 3-4 kviraSi erTxel (3)
• aseve SeiZleba ganxiluli iyos ekT (156, 43-eqspertTa
mosazreba, 157- B);

80
2. bipolaruli mwvave depresia(13, 151)

mkurnalobis mizani:
• depresiis simptomebis alageba da pacientis fsiqosocialuri
funqcionirebis Cveul doneze dabruneba;
• maniakaluri an hipomaniakaluri epizodis maprovocirebeli
faqtoris Tavidan acileba
(97, 164-C, 98, 106, 154-B, 134, 145, 147, 66_A).

airCieT inicialuri mkurnalobis modeli

pacientebTan, romlebsac pirvelad utardebaT mkurnaloba

bipolaruli aSlilobis gamo, mkurnaloba daiwyeT liTiumiT (105-
107_B); an lamotrijiniT* (145- B, 99, 134, 135, 144-A).
• rogorc alternativa, gansakuTrebiT ufro mZime depresiis
dros _ mizanSewonilia mkurnaloba daiwyoT liTiumis da
antidepresantis erTdroulad micemiT(13, 3)
• antidepsantTan kombinirebuli mkurnalobis xangrZlivoba
SezRudulia _ saSualod 4-12 kvira (3);
• antidepresantebiT monoTerapia ar aris rekomendebuli (146_A,
98- B);
• gaiTvaliswineT ekT:
_ fizikurad dauZlurebul, suicidur an fsiqozur
pacientebTan;
_ pacientebTan, romlebsac orsulobis fonze
ganuviTardaT mZime depresia (155, 43-eqspertTa mosazreba,
160-D, 67, 86, 157-B da 66_A)
• mkurnalobis seleqciisas unda ixelmZRvaneloT daavadebis
simZimiT, romelic swraf ciklurobaSi an fsiqozuri
simptomebis arsebobaSi vlindeba da aseve, SesaZleblobis
farglebSi, unda gaiTvaliswinoT pacientis arCevani (96, 172-
D, 178-A);
• interpersonaluri da kognitur-bihevioruli fsiqoTerapia
SesaZlebelia sasargeblo iyos farmakoTerapiasTan
kombinaciaSi (167) (180, 181 A);
• bipolaruli aSlilobis dros fsiqodinamiuri fsiqo-
Terapiis efeqturoba ar aris mecnierulad Seswavlili,
magram klinikur praqtikaSi farTod gamoiyeneba
fsiqofarmakoTerapiasTan kombinaciaSi (159) (179 A);

pacientebTan, romlebsac damWeri Terapiis periodSi daewyo

depresiuli epizodis Seteva, saWiroa medikamentebis dozebis
optimizeba.
darwmundiT, rom sisxlis SratSi medikamentis koncentracia
Terapiulis farglebSia: zogjer saWiroa, miaRwioT
Terapiulad dasaSvebi koncentraciis zeda zRvars. (63, 175_ D,
123-B, 122-A).
Tu damWeri Terapiis optimizebis Semdeg pacientis

81
 mdgomareoba ar gaumjobesda, mizanSewonilia lamotrijinis
(134,135-A), bupropionis an paroqsitenis (98–B da 146-A) damateba.
• alternatiuli Semdegi nabijia sxva axali antidepresantis
damateba (mag. sumsi–is sxva preparati, an venlafaqsini an
monoaminoqsidazas inhibitori _maoi (13)
• tricikluri antidepresantebis daniSvna sariskoa, is
SeiZleba fazis inversiis precipitirebadi faqtori gaxdes,
ris gamoc ar aris rekomendirebuli (13);
• maoi-is gamoyeneba rTuli da SezRudulia sxva medikamentebsa
da sakvebTan interaqtivobis riskis gamo (13);
• fsiqozuri simptomebiT mimdinare depresia Cveulebriv
saWiroebs damatebiT adekvatur mkurnalobas antifsiqozuri
preparatebiT (127_B, 136-141-A);
• mizanSewonilia ekT _ mZime an Terapiisadmi rezistentuli
depresiis dros;
_ fsiqozuri simptomebiT mimdinare depresiisas;
_ katatonuri simptomebiT mimdinare depresiisas;
(156, 43-eqspertTa mosazreba; 86, 157- B)
• klinicistma SeiZleba airCios antidepresantis frTxili
gamoyeneba bipolarulis II depresiis SemTxvevaSi, am dros
ufro dabalia antidepresantebiT inducirebul maniaSi an
hipomaniaSi gadasvlis SesaZlebloba, vidre bipolarulis I
depresiisas. (1, 3, 14, 13)

3. swrafi cikluroba

gamoavlineT swrafi ciklurobis xelSemwyobi komorbiduli

faqtorebi, rogoricaa hipoTireodizmi (117_B, 118-C),
narkotikebis an alkoholis moxmareba (103_C, 102-D);
da CaatareT saTanado medikamenturi mkurnaloba.

• Tu SesaZlebelia, SezRudeT medikamentebi,

gansakuTrebiT, antidepresantebi, romlebsac SeuZliaT
xeli Seuwyon ciklurobas (98_B, 146-A);

guneba-ganwyobis mastabilizebeli pirveli rigis

preparatebiT, maT Soris liTiumiT an valproatiT
inicialuri mkurnalobis alternativaa:
• mkurnaloba lamotrijiniT (99-A);
• bevri pacientisaTvis mizanSewonilia medikamentebis
kombinacia, e.i kombinacia ori zemoT xsenebuli agentisa
(108, 110, 115 -A), an erT-erT maTgans damatebuli romelime
antifsiqozuri preparati (111, 112, 128, 129, 140, 141 -A);
• liTiumis antikonvulsantTan kombinaciisas
rekomendebulia orive preparatis Terapiuli doza
ganaxevrdes an Semcirdes 1/3-iT, sisxlis plazmaSi
Sesaferisi da usafrTxo koncentraciis dacvis mizniT. (3)

82
4. damWeri, anu profilaqtikuri Terapia (13, 14, 151)

mkurnalobis miznebi:
• recidivis da rekurentobis prevencia;
• rezidualuri simptomebis reducireba;
• suiciduri riskis reducireba;
• ciklurobis sixSiris an guneba-ganwyobis umniSvnelo
labilobis reducireba;
• zogadi funqcionirebis gaumjobeseba
(164, 174-C, 178- A);

gansazRvreT damWeri Terapiis Cveneba:

• damWeri Terapiis rekomendireba gamomdinareobs maniakaluri an
depresiuli epizodis mimdinareobidan;
• bipolaruli II aSlilobis dros, sul umniSvnelo daxmarebac
ki, gaazrebulad da mkacri meTvalyureobis garantiiT unda
gatardes.
(172-D, 178-A)

airCieT inicialuri mkurnalobis modeli

rekomendebuli arCevani:
• mkurnalobis arCevanSi didi upiratesoba eniWeba liTiums
(165-B, 147-A) an valproats (125-A); SesaZlo alternativaa
lamotrijinis (145_B da 144, 99-A), karbamazepinis an
oqskarbamazepinis (131, 133-A) CarTva;
• Tu erT-erTma zemoT aRniSnulma preparatma bolo
depresiuli an maniakaluri epizodis Semdgomi remisia
gamoiwvia, damWeri Terapiis dros igive preparati unda
gagrZeldes 6 Tve, Semdeg 1_3 Tvis ganmavlobaSi TandaTanobiT
Semcirdes da Sewydes (3)
• guneba-ganwyobis mastabilizebeli preparatis miReba unda
ganaxldes epizodis Semobrunebisas da SenarCundes, Tu
epizodi meordeba 3 welze nakleb droSi (3);
• profilaqtikuri mkurnaloba mizanSewonilia liTiumiT, Tu 2
tipiuri maniakaluri epizodis Seteva ganviTarda 3 welze
nakleb droSi (3);
• profilaqtikuri mkurnalobis mizniT antidepresantebis
gamoyenebam, Tundac normoTimul preparatebTan kombinaciaSi,
SesaZlebelia swrafi ciklurobis provocireba gamoiwvios (3)
(146_A, 98- B);
• ekT gamoyeneba damWeri Terapiis mizniT SeiZleba
mizanSewonili iyos pacientebisaTvis, romlebsac kargi efeqti
hqondaT ekT-ze mwvave epizodis dros
(86_B);
• damWeri Terapiis seleqciisas unda ixelmZRvaneloT
daavadebis simZimiT, rasac daavadebis swrafi cikluroba an
fsiqozuri simptomebis arseboba ganapirobebs da, roca
SesaZlebelia, unda gaiTvaliswinoT pacientis arCevani.
(96, 172-D, 178-A); 83
antifsiqozuri preparatebis roli
• antifsiqozuri preparatebiT mkurnaloba unda
Sewydes, Tu ki is persistentuli fsiqozis marTvis an
guneba-ganwyobis epizodis rekurentulobis
prevenciisaTvis ar aris saWiro (3);
• damWeri Terapiis dros atipiuri antifsiqozuri
preparatebis gamoyenebisas, gaiTvalisawineT, rom
damWeri Terapiisas maTi efeqturoba SefardebiTia;
sakiTxi sadaoa da jer ar aris sabolood
dadasturebuli, zogierTi moqmedi faqtori
ganxilulia zemoT (13).
(149-B, 139_A)

fsiqosocialuri intervenciis roli

• Tanmxlebi fsiqosocialuri intervencia mimarTulia
daavadebis marTvaze _ mkurnalobis reJimis
Tanmimdevrulobis mkacri dacva, cxovrebis stilis
Secvla, prodromuli simptomebis adreuli Secnoba
da, aseve, interpersonaluri problemebis mowesrigeba;
• medikamentebTan kombinaciaSi farTod gamoiyeneba
mxardamWeri da fsiqodinamiuri fsiqoTerapia;
• jgufuri da ojaxuri fsiqoTerapia daexmareba
pacients iseTi problemebis gadaWraSi, rogoricaa
Terapiuli gegmis Tanmimdevrulobis mkacri dacva,
qronikul daavadebasTan adaptireba, pirovnuli
Cvevebis regulireba, col-qmruli da sxva
fsiqosocialuri sadao sakiTxebis marTva
• jgufebi daexmareba pacients bipolaruli
aSlilobebis da misi mkurnalobis Sesaxeb saWiro
informaciis miRebaSi.
(159, 167-eqspertTa mosazreba; 164, 173-C 44, 166, 179, 180,
181 -A);

Tu pacienti arasakmarisad reagirebs, gamoxatulia qvemwvave

simptomebi an grZeldeba guneba-ganwyobis epizodis Seteva,
daumateT sxva medikamenti, romelime atipiuri neiroleptiki
an antidepresanti (146_A, 98- B);
• monacemebi arasakmarisia, preparatebis romelime erT-
erTi kombinaciis mxardasaWerad (13);
• ekT gamoyeneba damWeri Terapiis mizniT SeiZleba
mizanSewonili iyos pacientebisaTvis, romlebsac
kargi efeqti hqondaT ekT-ze mwvave epizodis dros.
(86_B);

84
C. damatebiTi informacia farmakoTerapiuli agentebis Sesaxeb.

1. liTiumi (1, 3, 4, 13, 14, 15)

liTiumis Terapiuli efeqturoba (3, 13, 14)
dadebiTi Terapiuli efeqtis prediqtorebia:
• maniakaluri sindromis tipiuroba;
• weliwadSi 2 _ze naklebi afeqturi epizodi;
• liTiumis dadebiTi Terapiuli efeqturobis
personaluri an ojaxuri istoria.
(105, 122, 123-B da 109, 147-A)
liTiumi araefeqturia:
• Sereuli epizodis dros
• bipolaruli aSlilobis swrafi ciklurobis dros
• SfoTvis komorbidobisas;
• fsiqoaqtiuri nivTierebebis Warbi moxmarebisas;
• nevrologiuri daavadebebis komorbidobisas.
(113-C, 172- D da 114, 116-B, 178-A);

gverdiTi efeqtebi (1, 3, 4, 13, 14, 15)

• gverdiTi efeqtebis umravlesoba aris umniSvnelo da
SesaZloa, reducirdes dozebis daklebiT an
daniSnulebis reJimis SecvliT;
• gverdiTi efeqtebi, romelic dakavSirebulia sisxlis
plazmaSi liTiumis koncentraciis pikTan (mag., tremori
dozis miRebidan 1-2 saaTis Semdeg), SesaZlebelia
reducirdes micemuli preparatis dozebis SemcirebiT
an daniSnulebis reJimis SecvliT _ dRis dozis
Semcirebis xarjze saRamos dozis gazrda;
• gverdiT efeqtebia: poliuria, polidifsia, wonis mateba,
kognituri problemebi, tremori, sedacia an leTargia,
kordinaciis darRveva, gastrointestinaluri distresi,
Tmebis cvena, keTilTvisebiani leikocitozi, akne da
SeSupeba;
• liTiumis miRebisas Zlierdeba organizmidan siTxis da
natriumis gamoyofa (3);
• xangrZlivi drois ganmavlobaSi liTiumiT
mkurnalobisas (>10 weli), pacientebis 10_20%-s
uviTardeba morfologiuri cvlilebebi TirkmelSi.
savaraudoa liTiumiT inducirebuli renaluri
ukmarisobis ganviTareba (119-D da 68, 120, 121-C);
• sisxlis plazmaSi 1,5 mEq/L -ze ufro maRali
koncentracia pacientebisaTvis ufro xSirad
toqsiuria, xolo 2,0 mEq/L –ze ufro maRali
koncentracia, Cveulebriv, sicocxlisaTvis saSiS
gverdiT movlenebTan asocirdeba. maRali
koncentraciisas toqsikurobis minimummde dayvanisTvis
SeiZleba saWiro gaxdes hemodializi (91-C);
• sisxlis plazmaSi liTiumis koncentraciis gansazRvra
unda moxdes liTiumis bolo dozis miRebidan 12 saaTis

85
 Semdeg, umjobesia diliT, uzmoze, preparatis pirveli
dozis miRebamde (14)
(105, 106, 123- B, 122- A);

mkurnalobis Tanmimdevroba (13)

inicialuri samuSao
zogadi rekomendaciebi liTiumiT mkurnalobis
dawyebamde:
• zogadi samedicino istoriis Seswavla da fizikuri
statusis gamokvleva (178-A);
• sisxlSi Sardovanas da kreatininis koncentraciis
gansazRvra (68, 120, 121-C);
• farisebri jirkvlis funqciuri sinjebis Catareba
(118-C da 117-B);
• eleqtrokardiografia;
• orsulobis testi (Svilosnobis asakis mqone qalebSi).

dozireba (1, 3, 4, 13, 14, 15)

• gverdiTi movlenebis minimumade dayvanis mizniT
liTiumis karbonatiT mkurnaloba daiwyeT dabali,
danawevrebuli dozebiT
mag. 300mg. 2-3-jer dReSi pacientis wonisa da asakis
gaTvaliswinebiT;
• dozebis mateba xdeba 7-10 dRis ganmavlobaSi, vidre
sisxlis plazmaSi liTiumis koncentracia ar miaRwevs
0,8 _ 1,0 mEq/L, rac Cveulebriv 450-900 mg. liTiumis
regularuli miiRebis Sedegad yalibdeba (4);
• dozebis titraciis mateba (sisxlis SratSi liTiumis
koncentracia Cveulebriv 0,5_1,2 mEq/L farglebSi unda
iyos SenarCunebuli) damokidebulia Terapiul
efeqtsa da gverdiT movlenebze;
• liTiumis efeqturi samkurnalo doza da Terapiuli
koncentracia sisxlis plazmaSi individualuria
TiToeuli pacientisaTvis;
• dozis yoveli matebis Semdeg gansazRvreT sisxlis
plazmaSi liTiumis koncentracia (koncetraciis
gawonasworeba dozis koregirebidan daaxloebiT 5
dRis vadaSi xdeba);
• mozardebSi renaluri funqciebis gaZlierebis gamo,
saWiroa liTiumis maRali Terapiuli dozebiT
mkurnaloba (3);
• moxucebSi saWiroa liTiumis dabali dozebiT
mkurnaloba (3);
• liTiumis doza da sisxlis plazmaSi koncentracia
mwvave fazis mkurnalobisas ufro maRali unda iyos,
vidre damWeri Terapiis dros (3).
(91-C,105, 123- B, 122- A);

86
laboratoriuli maCveneblebis grZelvadiani monitoringi
• sisxlis plazmaSi liTiumis koncentracia (119_ C, 109,
123_ B da 122 -A);
_ rogorc minimumi, kontroli xorcieldeba yovel 3-6
TveSi erTxel stabiluri pacientebisaTvis da yovelTvis
klinikuri statusis Secvlisas;
_ monitoringis sixSiris optimaloba damokidebulia
droTa gamavlobaSi liTiumis sisxlis plazmaSi
koncentraciis stabilurobaze da pacientis
mdgomareobaze, romelic SeiZleba Seicvalos
sayuradRebo da angariSgasawevi simptomebiT;
• renuli funqciebi _ mkurnalobis pirveli 6 Tvis
ganmavlobaSi
analizi yovel 2-3 TveSi erTxel.
_Semdgomi kontroli yovel 6-12 TveSi erTxel
stabiluri pacientebisaTvis da yovelTvis klinikuri
statusis Secvlisas;
(68, 120 da 121-C );
• farisebri jirkvlis funqciebi _ mkurnalobis pirveli
6 Tvis ganmavlobaSi erTi an ori testi.
_ Semdgomi kontroli 6-12 TveSi erTjer stabiluri
pacientebisaTvis da yovelTvis klinikuri statusis
Seicvlisas.
(118-C da 117-B);

87
 liTiumis gverdiTi efeqtebis menejmenti (183)
gverdiTi efeqti
postabsorfciuli sindromi G/I
diskomforti, gulisreva, sisuste,
Tavbrusxveva
• gamowveulia sisxlSi liTiumis
koncentraaciis swrafi momatebiT
• gaivlis droTa ganmavlobaSi
xelebis wvrilamplitudiani tremori,
romelic daRlilobisas vlindeba da
persistentulia
wyurvili, polidifsia, poliuria, Sardis
dabali xvedriTi wona
• medikamentiT inducirebuli
renaluri disfunqcia,
antidiuretikul hormonze
Tirkmlis sapasuxo reaqciis
Semcirebis gamo
• zogierT pacients SeiZleba
daqveiTebuli qondes koncentraciis
unari
• SesaZloa nefrogenuli uSaqro
diabeti gamovlindes
interstinaluri fibrozi, glomeruluri
sklerozi, auaresebs wylis reabsorbcias,
iwvevs sisxlSi kreatininis momatebas
• asocirebulia liTiumis
xangrZlivad gamoyenebasTan,
zogierT etapze
repolarizaciis darRveva ekg-ze _
gamtareblobis darRveva an zogjer
ariTmia
hipotireodizmi
• ufro xSiria qalebSi
• vlindeba pacientebis 1/3 -Si
liTiumiT mkurnalobisas
• SeiZleba gamovlindes pacientebSi
liTiumiT mkurnalobisas 6-18 Tvis
ganmavlobaSi
• arsebobs depresiis gamovlinebis
riski liTiumiT inducirebuli
hipoTireodizmis mqone pacientebSi
dermatologiuri cvlilebebi _ Cirqovani
gamonayari, fsoriazis eqsacerbacia an
precipitacia, antipsoriazuli mkurnalbis
inhibireba.
• sisxlis plazmaSi 1,5 mEq/L -ze ufro maRali koncentracia pacientebisaTvis ufro
xSirad toqsiuria, xolo 2,0 mEq/L –ze ufro maRali koncentracia Cveulebriv
sicocxlisaTvis saSiS gverdiT movlenebTan asocirdeba. maRali koncentraciisas
toqsiurobis minimizebisaTvis SeiZleba saWiro gaxdes hemodializi.
kupireba
• dozebis Semcireba an daniSnulebis
reJimis Secvala _ dRis dozis
Semcirebis xarjze saRamos dozis
gazrda;
• alternatiuli preparatis micema
• gazome koncentracia sisxlSi
• damoiyene propranololi an msgavsi
preparati
• poliuria SeiZleba mowesrigdes
medikamentis Zilis win erTjeradi
micemiT
• dozebis reducireba SeiZleba iqnes
gamoyenebuli simptomebis kontrolisTvis
• saTanado xsnarebis da eleqtrolitebis
gadasxma SeiZleba iqnes gamoyenebuli
• mwvave simptomebis dros SeiZleba
gamoyenebuli iqnes Tiaziduri
struqturis preparatebi, magram
eleqtolitebis monitoringia saWiro,
kaliumis micema SeiZleba iyos saWiro da
liTiumis doza unda Semcirdes.
• kaliumis damzogavi diuretiki SeiZleba
efeqturi iyos, romelic Cveulebriv ar
gaaZlierebs potasiumis eqskrecias da
liTiumis reabsorbcias
• Tirkmlis funqciis monitoringi
dasawyisSi da weliwadSi orjer
• ekg gamokvleva dasawyisSi da
individualurad 40 w < asakis zemoT
• levoTiroqsinis gamoyeneba pacientebSi,
romlebic moixmaren liTiums
• Tiroiduli hormonis CarTva
mkurnalobaSi da guneba-ganwyobis
stabilizebadi sxva preparatiT
Canacvleba SeiZleba iqnes gamyenebuli
roca swrafi cikluroba an depresiaa
gamoxatuli
• Tiroiduli hormonebis gamokvleva unda
moxdes inicialur etapze da
1-2-jer weliwadSi
• mkurnaloba empiriulad
88
2. valproati / valproatis mJava / divalproeqsi (1, 3, 4, 13, 14, 15)

• antikonvulsantebis Terapiuli upiratesoba

liTiumTan SedarebiT, maTi ufro farTo Terapiuli
indeqsiT da SedarebiT dabali renaluri
toqsikurobiT ganisazRvreba(3)
(63-D, 124, 127-B, 125, 126, 128, 176-A);

gverdiTi efeqtebi (1, 3, 4, 13, 14, 15, 74)

• valproatis sawyisi doziT gamovlenili gverdiTi
efeqtebia: gastointestinaluri distresi, RviZlis
transaminazas keTilTvisebiani momateba,
osteoporozi, tremori da sedacia;
• pacientebSi, RviZlis gadatanili an arsebuli
daavadebiT, mosalodnelia hepatotoqsikurobis
riskis momateba (130-B);
• SedarebiT iSviaTia asimptomuri leikopenia da
Trombocitopenia, romelic Seqcevadia wamlebis
Sewyvetis Semdeg. (175-D);
• sxva gverdiTi efeqtebia: Tmis cvena, gaZlierebuli
mada da wonis mateba(63-D);
• qalebSi arsebobs sakvercxis polikistozuri
sindromis ganviTarebis riski, rac saWiroebs
monitorings (63-D);
• iSviaTad idiosinkrazia, magram SesaZlo fataluri
gamosavaliT: RviZlis Seuqcevadi ukmarisoba,
hemoragiuli pankreatiti da agranulocitozi.
• pacienti gafrTxilebuli unda iyos, rom RviZlis da
hematologiuri disfunqciis niSnebis da simptomebis
gamovlinebisas aucileblad mimarTos Terapevts
(63, 175, 177-D,130-B);

mkurnalobis Tanmimdevroba (1, 3, 4, 13, 14, 15, 74, 151)

inicialuri samuSao (13)

zogadi rekomendaciebi valproatiT mkurnalobis dawyebis
win:
• SeiswavleT zogadi samedicino istoria,
gansakuTrebuli yuradReba miaqcieT RviZls,
hematologiur paTologias da sisxldenis
SemTxvevebs (175-D, 130-B);
• sasurvelia RviZlis funqciuri testebis da
homatologiuri maCveneblebis gansazRvra(63-D);

dozireba (1, 3, 4, 13, 14, 15)

• pacientebs mwvave maniiT, stacionaris pirobebSi
SeiZleba daeniSnos valproatis sawyisi doza 20-30
mg/kgGdReSi. valproatis Terapiulad efeqturi doza

89
 Seesabameba sisxlis plazmaSi 50 _ 125 mg/mL
valproatis koncentracias;
• dozis mateba xdeba TandaTanobiT, 250-500mg-iT, 2-3
dRis intervaliT, rac damokidebulia klinikur
efeqtsa da gverdiT movlenebze (4);
• Cveulebriv, mozrdilis maqsimaluri dRiuri doza 60
mg/kg–ze dReSi, iZleva sisxlis plazmaSi 50-125 mg/mL
preparatis koncentracias;
• pacientebs ambulatoriul pirobebSi, moxucebs an
pacientebs hipomaniiT da euTimiiT, eniSnebaT
valproatis sawyisi doza 250 mg 3-jer dReSi.
stabilur pacientebs SeiZleba daeniSnoT erTjeradi
an orjeradi dRiuri doza gamartivebulad, erTxel
dReSi;
• gaxangrZlivebuli moqmedebis preparatis, mag.
divalproeqsi ER_is biosargeblianoba, daaxloebiT
15%-iT ufro naklebia, vidre uSualo moqmedebis
preparatebis. amitom divalproeqs ER -is dozis
mateba unda moxdes proporciulad
(63-D, 125, 126, 128, 176-A);.

wamlebis urTierTqmedeba (4, 13, 14, 15)

• valproati gamodevnis cilebTan SekavSirebis maRali
unaris mqone preparatebs maTi SekavSirebis
adgilidan da saWiro xdeba dozis koregireba
• radgan valproati axdens lamotrijinis
metabolizmis inhibirebas, lamotrijiniT
mkurnalobis dawyeba unda moxdes ganaxevrebuli
doziT.

laboratoriuli monacemebis xangrZlivi monitoringi

(1, 3, 4, 13, 14, 15)
• saWiroa, pacients hqondes informacia RviZlis da
hematologiuri disfunqciis niSnebisa da
simptomebis Sesaxeb da am simptomebis gamoCenis
SemTxvevaSi acnobos eqims;
• stabilur pacientebSi, romlebic iReben valproats,
fsiqiatris mier hepatologiuri da hematologiuri
testebis pasuxis klinikuri Sefaseba saWiroa minimum
eqvs TveSi erTxel;
• sisxlis plazmaSi valproatis mJavas koncentracia
unda ganisazRvros klinikuri Cvenebis arsebobisas
(mag., roca valproatis mJavas metabolizmi SeiZleba
Secvalos sxva medikamentma).
(63-D, 125, 125, 126, 128, 176-A);

90
 valproatiT gamowveuli gverdiTi efeqtebis marTva (183)
gverdiTi efeqti kupireba
sedacia da GI distresi gamovlenili • wamlebiT gamowveuli GI distresis marTva
mkurnalobis dawyebisas xdeba dozebis SemcirebiT, valproatis
jgufis sxva preparatis daniSvniT da/an H2-
receptoris blokatoris daniSvniT
Tmebis cvena, wonaSi momateba, madis • urCie dieta da varjiSi
gaZliereba • ganixile wonis damklebi agentebi
msubuqi leikopenia, Trombocitopenia, • unda gakeTdes sixlis saerTo analizi
Trompocitebis funqciis gauareseba srulad;
• gansazRvre Trombocitebis analizi da
sisxlis Sededebis dro, Tu pacients
dagegmili aqvs operacia da roca pacients
aqvs Zlieri sisxlnaJRenTebi an hemoragia;
• Seqcevadia mkurnalobis Sewyvetis Semdeg.
SeiZleba gamovlindes tremori • mkurnaloba beta-blokerebiT
SeiZleba gazardos policistozuri • mkurnaloba oraluri kontraceptivebiT
ovariuli sindromis gamovlinebis
SemTxvevebi
RviZlis funqciis darRveva, • RviZlis funqciuri sinjebis monitori
hiperamonemiis mZime SemTxvevebis yovelTviurad mkurnalobis dasawyisSi da
gamovlineba zogierT pacientSi Semdeg weliwadSi orjer
hepatocelularuli nekrozi, • pacienti gafrTxilebuli unda iyos rom
hemoragiuli pankreatiti da dauyovnebliv mimarTos samedicino
agranulocitozi. daxmarebas abdominaluri tkivilis,
iSviaTad idiosinkraziuli reaqcia siyviTlis sicxiT mimdinare mwvave
faringitis, sisxldenis an purpuris
gamovlinebis SemTxvevaSi

3. karbamazepini

karbamazepinis Terapiuli efeqturoba (3, 4, 13, 14, 15)

• monoTerapia mwvave maniis kupirebisas (116-B, 131, 133-A
donis mtkicebuleba);
• kombinirebuli mkurnaloba antifsiqozur preparatebTan
mwvave maniis dros (127-B);
• monoTerapia bipolaruli depresiis dros;
• kombinirebuli mkurnaloba antidepresantebTan an sxva
guneba-ganwyobis mastabilizebel preparatTan
refraqteruli unipolaruli depresiis dros (108-A);
• bipolaruli aSlilobis profilaqtikuri mkurnaloba
liTiumisadmi rezistentuli SemTxvevebis dros
• swrafi ciklurobis dros (4 an meti Seteva weliwadSi).
(178-A);

gverdiTi efeqtebi (4, 13, 14, 15)

• karbamazepinis miRebisas gverdiTi efeqtebi gamovlindeba
SemTxvevaTa 50%-Si da meti;
• yvelaze xSiri gverdiTi efeqtebia: daRliloba,
gulisreva, nevrologiuri simptomebi _ diplopia, laqebi

91
 mxedvelobis velSi da ataqsia;
• naklebi sixSiris gverdiTi efeqtebia: kanze gamonayari,
zomieri leikopenia, RviZlis enzimebis zomieri momateba,
zomieri Trombocitopenia, hiponatremia (132-C, 177-D);
• iSviaTi, idiosinkraziuli, magram seriozuli da
potenciurad fataluri gverdiTi efeqtebia:
agranulocitozi, aplastiuri anemia, Trombocitopenia,
RviZlis ukmarisoba, eqsfoliatiuri dermatiti (mag
steven_jonsonis sindromi) da pankreatiti;
• damatebiTi sifrTxilea saWiro klinikuri statusis
monitoringis dros _ aucilebelia pacients aswavloT
RviZlis, hematologiuri da dermatologiuri reaqciebis
niSnebi da simptomebi, instruqtirebuli unda iyos, rom
am simptomebis gamovlenis SemTxvevaSi dauyovnebliv
Seatyobinos eqims;
• sxva iSviaTi gverdiTi efeqtebia: sistemuri
hipersenzitiuri reaqciebi, gulis gamtareblobis
darRveva, fsiqozebis sporadiul SemTxvevebi da Zalian
iSviaTia renaluri efeqti _ Tirkmlis ukmarisoba,
oliguria, hematuria da proteinuria;
• karbamazepinTan SedarebiT, oqskarbamazepins zomieri
efeqturoba da naklebi gverdiTi efeqtebi aqvs (3). (133-B);

mkurnalobis Tanmimdevroba (1, 3, 4, 13, 14, 15, 74)

inicialuri samuSao (13, 14, 151)

zogadi rekomendaciebi karbamazepiniT mkurnalobis
dawyebis win:
• aucilebelia hematologiuri, hepatologiuri da
renaluri funqciebis testebis Catareba da
gaanalizeba.
• sasurvelia SratSi eleqtrolitebis koncentraciis
gansazRvra, gansakuTrebiT, moxucebSi, sadac
hiponatremiis maRali riskia.
• zogadi samedicino istoriis da fizikuri statusis
gamokvleva unda gakeTdes wesisamebr, gansakuTrebuli
yuradReba unda mieqces warsulSi Zvlis tvinis
kompresiis da RviZlis daavadebis arsebobis istorias.

dozireba (3, 13, 14, 15)

• karbamazepinis Cveulebrivi sawyisi dRiuri doza aris
200 _600 mg/dRe-RameSi (3-4 miRebaze); (14, 15)
• pacientebSi mwvave maniiT, stacionarul pirobebeSi,
doza SeiZleba gaizardos 200-dan 800-1000mg-mde dReSi,
momateba xdeba TandaTanobiT, yovel kviraSi 200 mg-iT,
ganawilebuli dRis ganmavlobaSi, Sesabamisi Cvenebis
da gverdiTi movlenebis gaTvaliswinebiT (15);

92
 • daavadebis qvemwvave gamovlinebisas, ambulatoriul
pacientebSi doza TandaTan unda Semcirdes gverdiTi
efeqtebis minimumamde dayvanis mizniT(13);
• Terapiuli doza saSualod utoldeba 1000 mg-s dReSi,
magram SeiZleba meryeobdes klinikur praqtikaSi
dasaSvebis farglebSi 200_1600 mg. dReSi (13);
• aSlilobis kupirebisaTvis saWiroa bipolaruli
aSlilobis mqone pacientebis sisxlis plazmaSi
karbamazepinis Terapiuli koncentraciis miRweva.
(sisxlis plazmaSi preparatis Terapiuli
koncentracia 4-12 mg/mL farglebSi meryeobs); (13)
• sisxlis plazmaSi koncentraciis piki dgeba
preparatis miRebidan 4_10 saaTis Semdeg (3);
• sisxlis plazmaSi karbamazepinis koncentraciis
monitoringi unda gakeTdes diliT, dRis pirveli
dozis miRebamde (14);
• dedis rZeSi karbamazepinis koncentracia sisxlis
plazmaSi koncentraciis 25-60%-s Seadgens (3) (161_C);
• Sesabamisi Terapiuli koncentracia sisxlis
plazmaSi, dozis Secvlidan 5 dRis Semdeg yalibdeba
(13).

laboratoriuli maCveneblebis xangrZlivi monitoringi (13)

• karbamazepiniT mkurnalobis dawyebidan ori Tvis
ganmavlobaSi hematologiuri da hepatologiuri
funqciuri testebi unda Semowmdes or kviraSi
erTxel;
• amis Semdeg, Tu laboratoriuli testebi normis
farglebSi darCa, ar gamovlinda Zvlis tvinis
kompresiis da hepatitis simptomebi, sisxlis analizi
da RviZlis funqciuri testebi unda gakeTdes 3-6
TveSi erTxel. monitoringis intensivoba
hematologiuri an hepatologiuri darRvevebis
gamovlinebazea damokidebuli.

93
4. olanzapini (13)

gverdiTi efeqtebi (3, 13, 14, 15)

• SedarebiT xSiria: somnolencia, yabzoba, piris
simSrale, madis gaZliereba da wonaSi mateba;
• inicialuri dozis matebisas, olanzapinma SeiZleba
gamoiwvios hipotenzia, rac asocirdeba
TavbrusxvevasTan, taqikardiasTan da, zog pacientSi,
sinkopes ganviTarebasTan.

mkurnalobis Tanmimdevroba (1, 3, 4, 13, 14, 15)

• pacientisaTvis mwvave maniiT, stacionaris pirobebSi
inicialuri dozaa 15 mg/dReSi
• ambulatoriuli pacientisaTvis inicialuri doza ufro
dabalia, 5-10 mg/dReSi.
(136_139 A);

5. lamotrijini (1, 3, 13, 14, 15)

gverdiTi efeqtebi
• yvelaze xSiri gverdiTi efeqtia sedacia, Tavbrusxveva,
ataqsia, tremori, insomnia, Tavis tkivili, gulis reva,
infeqciebi da mxedvelobis dabindva an gaoreba,
daRliloba, gastro_intestinaluri disfunqcia,
gripismagvari simptomebi, cvlilebebi sisxlSi (15);
• lamotrijinis dozis swrafma titraciam SeiZleba
gamoiwvios gamonayari _ steven-jonsonis sindromi da
toqsiuri epidermaluri nekrolizi. mozrdilebSi riski
aris daaxloebiT 0,3%; bavSvebSi _ daaxloebiT 1%;
• pacienti informirebuli unda iyos gamonayaris
ganviTarebis riskis Sesaxeb, raTa saWiroebis
SemTxvevaSi droulad daukavSirdes fsiqiatrs an
pirveladi jandacvis Terapevts;
• gamonayari SeiZleba mkurnalobis nebismier periodSi
gamovlindes, magram ufro savaraudoa mkurnalobis
dasawyisSi;
• gamonayaris gamovlinebisas Zneli gasarCevia, ramdenad
seriozuli an keTilTvisebiania gamonayari;
• gansakuTrebiT SemaSfoTebelia, roca gamonayars Tan
erTvis cxeleba da yelis tkivili, gamonayaris
difuzuri gavrceleba da saxis da lorwovanis
SeSupeba. am SemTxvevaSi rogorc lamotrijini, aseve
valproati unda moixsnas;
• klinikuri dakvirvebiT, dabali dozebis titraciis
reJimis gamoyeneba (ix. qvemoT) amcirebs mniSvnelovani
gamonayaris risks mozrdilebSi 0,01%-iT (igivea sxva
antikonvulsantebis dozirebis dros);

94
 • ufro naklebada mosalodneli gamonayaris garTuleba
Tu vmarTavT lamotrijinis da valproatis gverdiT
movlenebs.
(134, 135, 144 _ A da !45_B)

mkurnalobis Tanmimdevroba (1, 3, 4, 13, 14, 15)

• lamotrijini unda dainiSnos 25 mg/dReSi pirveli ori

kviris ganmavlobaSi; Semdeg _ 50mg/dReSi, mesame da
meoTxe kviraSi

• amis Semdeg 50 mg/kviraSi SeiZleba moematos klinikuri

CvenebiT;
• valproatis mimReb pacientebSi gamonayaris potenciuri
riskis minimumamde dayvanis mizniT, lamotrijinis doza
unda ganaxevrdes da titraciis periodi 2-jer ufro
gaxangrZlivdes (mag. 12,5 mg/dReSi an 25 mg
dRegamoSvebiT 2 kviris ganZilze, xolo 25 mg/dReSi
mesame da meoTxe kviris ganmavlobaSi).
(134, 135, 144 _ A da !45_B)

95
 6. liTiumis karbonatis, valproatis da karbamazepinis
zogierTi SedarebiTi farmakokineturi parametri (4)
preparatebi
parametrebi liTiumi valproati karbamazepini

sadReRamiso dozis
Terapiuli 0,6 _ 1, 2 0,6 _ 1, 4 ^ 0,4 _1,0
intervali gramebSi
sisxlis plazmaSi
optimaluri 0,5_0,8 50 _100 6 _ 8
Terapiuli mmoli/l mkg/ml mkg/ml
koncentracia
sisxlSi preparatis + + + ?
konc-is Terapiul aSkara, pirdapiri arapirdapiri, (saeWvo)
efeqtTan kavSiri
toqsikuri konc.-ia 1,5 mmoli/l 200 mkg/ml 18 mkg/ml
Tirkmlis _ _ +
fermentebis
autoinduqcia
per - os miRebisas 1 – 3 sT_s Semdeg 1 _ 4 sT-s Semdeg 4_10 sT-s Semdeg
SratSi konc-is piki
sisxlis cilebTan 0 90 75
SekavSireba (%)
sisxlis plazmidan 8 _ 41 sT 30 _ 40 sT
naxevargamoyofis (saSualod 8 _ 17 sT (8_17 sT xangrZlivad
periodi 24sT) miRebisas fermentuli
autoinduqciis gamo)
sisxlis plazmaSi 2_6 dRis Semdeg (ar 2 dRis Semdeg 7_10 dRe dawyebidan,
stabiluri konc-is icvleba xangrZlivi (ar icvleba xangrZlivi xangrZlivi miRebisas,
fazis miRwevis dro miRebisas) miRebisas) dozis Secvlidan 3-
5dRe
80_90% SardiT 3% SardiT da ganavliT 2% SardiT da
organizmidan Seucvleli saxiT Seucvlelad, danarCenis ganavliT
gamoyofis ZiriTadi metabolizmi _ RviZlSi, Seucvlelad,
gzebi glukuronis mJavasTan danarCenis
mierTebiT metabolizmi xdeba
RviZlSi glukuronis
mJavasTan mierTebis
da hidroqsilirebis
gziT
zrdis liTiumis kompleqsuri zrdis cns-is mxriv
wamlebTan neirotoqsiurobas: interaqtivoba: sxva gverdiT efeqts:
urTierTmoqmedeba _antifsiqozuri antikonvulsantebTan liTiumi,
preparatebi, _saWiroa nevrologis antifsiqozuri
_Ca antagonistebi, konsultacia preparatebi,
_ACE inhibitorebi potencirebas axdens Ca++ antagonistebi;
koncentracias zrdis: aspirinis da varfarinis maoi-sTan_
alkoholi aqtivobis; aucilebelia 2 kvira
diuretikebi; SeuZlia gazardos maoi- intervali;
gamoyofas aZlierebs s da tca-s koncentracia. tca, neiroleptiki.
_ NaCl; toqsiuria gripis
sifrTxilea saWiro: vaqcinaciisas, efeqti
aspirini, ibuprofeni sxvadasxvaa
fenitoinTan da
oralur
kontraceptivebTan.

96
 7. normoTimuli Terapiis gverdiTi efeqtebis SedarebiTi speqtri (4)

gverdiTi efeqti liTiumis karbonati karbamazepini valproatis natriumi

adreuli _wyurvili _Zilianoba _gulisreva
(adaptaciuri _xSiri Sardva _gugis akomodaciis _kuWis wva, piris
periodis gverdiTi _tremori darRveva simware, gemos Secvla
efeqtebi) _gulis reva _Sekaveba _tkivilebi mucelSi
viTardeba, ufro _sisuste, moduneba _ataqsia _wonaSi momateba
xSirad, _msubuqi Sekaveba _Tavbrusxveva _tremori
mkurnalobis _libidos daqveiTeba _tremori _alopecia
pirveli Tvis _pirSi liTonis gemo _madis daqveiTeba _menstrualuri
ganmavlobaSi da ar _tkivilebi mucelSi _gulisreva ciklis darRveva
saWiroebs _kuWis wva _piris simSrale
prepatatis moxsnas _diarea _menstrualuri
ciklis darRveva

mogvianebiT _myari tremori _gulisreva _Civilebi RviZlis

gverdiTi efeqtebi _dizarTria _piris simSrale mxriv (RviZlis
viTardeba iSviaTad, _kunTovani sisuste, _oflianoba fermentebis momateba,
preparatis moduneba _kunTebis tkivili idiosinkraziuli
xangrZlivi _wonis momateba _Tavis tkivili hepatiti)
miRebisas da _hipoglikemia Sardis _Civilebi RviZlze _madis dakargva
saWiroebs gaZlierebuli (alergiuli _alopecia
specialur gamoyofiT da hepatiti) _mucelSi tkivilebi
koreqcias an Tirkmlis ukmarisobis _alergiuli _gulisreva
preparatis moxsnas simptomebi dermatiti _diarea
_ Civilebi mexsierebis _aweuli _ wonis momateba
daqveiTebasa da mgrZnobeloba _tremori
yuradRebis ultraiisfer _pankreatiti
koncentrirebis gamosxivebaze _Trombocitopenia
gaZnelebaze _leikopenia (sisxlis Sededebis
_libidos daqveiTeba periodis gazrda)
_ diarea an yabzoba
_ farisebri jirkvlis
funqciis daqveiTeba
_gulis riTmis
darRveva
_dermatiti, aknes da
fsoriazis gamwvaveba
_alopecia
_mravlobiTi kariesi
_neitrofilia
_eriTrocitozi

97
 8. normoTimuli preparatebis gamoyenebis ukuCveneba (4)

liTiumis karbamazepini valproatis natriumi

karbinati
sruli 1.Tirkmlis 1. gulis riTmis 1. valproatis mJavas
ukuCveneba daavadebebi funqciis darRveva preparatebisadmi
daqveiTebiT 2. krb-s an tca–s alergiuli reaqcia
(glomerulonefriti, mimarT alegiuli 2. RviZlis funqciis
pielonefriti da raqcia daqveiTeba(mwv. da qr.
sxva) 3. maoi-s hepatiti da sxv)
preparatebTan 3. hemoragiuli diaTezi
erTdrouli an maTi
moxsnidan 2 kviraze
adre daniSvna.
4. RviZlis
daavadebebi,
funqciis
daqveiTebiT
SedarebiTi 1. eu_ da 1. glaukoma 1. gulis ukmarisoba
ukuCveneba hiperTireoiduli 2. winamdebare 2. RviZlis da Tirkmlis
Ciyvi; jirkvlis daavadeba ukmarisoba
2. umarilo dieta (Sardis Sekaveba) 3. sisxlis daavadebebi
3. kataraqta 3. gulis ukmarisoba (gansakuTrebiT
4. Zvlis daavadebebi 4. RviZlis da Trombocitopenia
_ osteoporozi Tirkmlis 4. orsulobis I trimestri
5. heqtiuri T _ iT ukmarisoba da laqtaciis periodi
da Warbi 5. moxucebuli asaki (rZeSi gadadis sisxlis
oflianobiT 6. sisxlis daavadeba, Semcvelobis mxolod
mimdinare TeTri sisxlis 1-10%, amitom valproatis
daavadebebi warmoqmnis natriumis amorCeva
6. orsulobis daTrgunviT mizanSewonilia
pirveli 7. orsulobis I
trimestri da trimestri da
laqtaciis laqtaciis periodi
periodi (sisxlSi (sisxlSi
preparatis Semcvelobis 30-60%
koncentraciis gadadis rZeSi)
50% gadadis
dedis rZeSi)
gansakuTrebuli 1. Tirkmlis 1. kanis 1. alergiuli hepatiti
yuradreba unda anTebadi alergiulireaqcia 2. sisxlis Sededebis
mieqces anamnezSi daavadebebi 2. hepatitis unaris darRveva
2. farisebri 3. Zvlis tvinis
jirkvlis sisxlmbadi
funqciis funqciis daTrgunva
darRveva 4. gulis riTmis
darRveva

98
 9. liTiumis marilebiT mkurnalobis gverdiTi movlenebis kupireba (4)
adreuli gverdiTi liTiumis marilebiT
efeqti _ pirveli intoqsikacia (liTiumis
ori kvira koncentracia sisxlis
_ ar saWirobs plazmaSi > 1,5 _ 2,0
Terapiis srul mmol/l)
moxsnas, • liTiumis marilebis mogvianebiTi gverdiTi efeqti
dasaSvebia: miRebis saWiroebs:
• droebiT dozebis dauyovneblivi • specialur koreqcias an
Semcireba an Sewyveta • Terapiis moxsnas
• retardirebul • detoqsikaciuri
preparatebze Terapiis Catareba:
gadasvla an _ diuretikebi
• mkurnalobis _ natriumis
reJimis Secvla bikarbonati
_ dializi
_ simptomuri Terapia

1. kuW-nawlavis 1. kuW-nawlavis mxriv: 1. nevrologiuri; 6. paraTireoiduli

mxriv: gamoxatulia: • myari jirkvlis
• gulis reva • gulisreva msxvilamplitudiani hiperfunqcia
• madis daqveiTeba • Rebineba tremori, romelic ar 7. gul-
• pirSi liTonis • diarea reagirebs sixlZarRvTa
gemos SegrZneba 2. cns –is mxriv: qolinolitikebze, sistemis mxriv
• fascikularuli mcirdeba beta- • eqstrasistoli
• tkivilebi kunTovani blokerebis miRebisas a,
mucelSi SekrTomebi • dizarTria • nawilobrivi
• kuWis wva • hiperefleqsia • taqikinezia blokada
• kuWis xSiri • meningizmis • kunTovani sisuste da • T kbilis
moqmedeba movlenebi SekrTomebi inversia
2. renaluri 8. alergiuli
• motoruli Sekaveba
• uSaqro diabeti • qavana
2. cns –is mxriv: • Zilianiba
• Zil_RviZilis • ataqsia • wyurvili dermatitis
SegrZnebis • xSiri Sardva • ekzema
• dizarTria
dakargva • diurezis momateba • makulopapulo
• cnobierebis abneva
• daRliloba, • niqturia zuri
• mexsierebis gamonayari
moduneba
daqveiTeba • qronikuli renaluri
• Tavis tkivili ukmarisobis niSnebi • fsoriazi
intoqsikaciis 9. hematologiuri
• Tavbrusxveva momatebisas: 3. wonis momateba
• ioli tremori 4. kuWnawlavis mxriv • neitrofilia
• oliguria
3. Tirkmlis • diarea • eozinofilia
• gulsisxlZarRvTa
• wyurvili • sakvebis gemos myari • eriTrocitozi
sistemis daTrgunva
• xSiri Sardva dakargva 10. fsiqikuri
• krunCxviTi sind-mi
5. hipoTireoiduli • arsebobis
• cns-is kerovani ,,avtomaturobis
Ciyvi (hipertrofia,
simptomebi ” fenomeni
miqsedemuroba)
• sopori, koma • anesTeziuri
subdepresia
11. sxva
• libidos
daqveiTeba
• alopecia
• kbilebis
kariesi

99
8. gaidlainis gadasinjvisa da ganaxlebis vada – 2 weli.

9. gaidlainis miRebis xerxi/wyaro

• guneba-ganwyobis (afeqturi) aSlilobis Sesaxeb arsebobs
samecniero mtkicebulebis safuZvelze Seqmnil rekomendaciaTa
sakmarisi raodenoba. mocemuli gzamkvlevis Semqmnis procesSi
samuSao jgufma moiZia da Seafasa ukve arsebuli praqtikuli
gzamkvlevebi, ramdenime fundamenturi naSromi da eqspertTa
konsensusis jgufis mier mowodebuli rekomendaciebi.
bazisurad gamoyenebuli iqna Semdegi naSromebi:

1 KAPLAN & SADOCK’S SYNOPSIS OF PSYCHIATRY

Behavioral sciences/Clinical psychiatry. 9-th edition ; Virginia A. Sadock, M.D. and
Benjamin J. Sadock, M.D.(2003 by Lippincott Williams & Wilkins; Philadelphia. USA) (1)
2. ,,The Presentations of Clinical Psychiatry” Robert M. Cohen 2000;
(Printed in the UK Redwood Book, Trowbidge, Wilts, UK);(2)
3. ,,THE MERCK MANUAL” 18TH EDITION _ Published by MERCK RESEARCH
LABORATORIES _ 2006 (3)
4. ,,Основы Психофармакологии”. Мосолов С. Н. (г. Москва _1996) (4)
5. ,,Клиническое применение современных антидепрессантов”. Мосолов С. Н.
(г. Санкт-Петервург _1995) (5)
6. ,,Оксфордское руководство по психиатрии”. Маикл Гельдер, Деннис Гэт, Ричард
Мейо., (г. Киев 1997) (6)
7. ,,Классификациа психических и поведенческих расстройств”; MKБ -10; ВОЗ;
(г. Санкт-Петербург 1994) (7)
8. ,,Руководство по психиатрии”. Морозов Г. В. (г. Москва _1888) (8)
9. ,,Practice Guidelines for the Treatment of psychiatric Dizorder” QUICK REFERENCE
to The American Psychiatric Association (APA); COMPENDIUM 2004;
( APA, Arlington, Virginia); (13)
10. ,,PRESCRIBING GUIDELINES 2005-2006’’, 8th Edition; The South London and
Maudsley NHS Trust & Oxleas NHS Trust; David Taylor, Carol Paton, Robert Kerwin;
p. 135-190 (Published by Taylor & Francis Group, London and New york); (14)
11. ,, Essential Psychopharmacology _The Prescriber’s Guide”; Stephen M. Stahl, 2005;
(Published by Pres syndicate of the University of Cambridge); (15)
12. saqarTvelos kanoni ,,fsiqiatriuli daxmarebis Sesaxeb”_ 2006wlis
14 ivlisi (ssm #30 nawili I 27.07.06) (16)
13. The ICD-10 Classification of Mental and Behavioral Disorders; Diagnostic criteria for
research ; World Health Organization; Geneva, 1993; (18)
14. American Psychiatric Association Diagnostic and statistical Manual of Mental
disorders (DSM-IV & DSM-IV-TR) (19)
15. Agency for Healthcare Policy Research: Evidence Report on Treatment of
Depression—Newer Pharmacotherapies. San Antonio Evidence-Based Practice Center.
Washington, DC, AHCPR, Evidence-Based Practice Centers, 1999 (150)
16. American Psychiatric Association: Practice Guideline for the Treatment of Patients
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17. American Psychiatric Association: Practice Guideline for the Treatment of Patients
With Major depressive Disorder ; Second Edition (152)

100
18. American Psychiatric Association: Practice Guideline for Psychiatric Evaluation of
Adults. Am J Psychiatry 1995; 152(Nov suppl): (153)
• moxda fundamenturi naSromebisa da arsebuli rekomendaciebis
Targmna, Sejereba da adaptirebuli variantis SemuSaveba, romelic,
erTi mxriv, pasuxobs saerTaSoriso moTxovnebs, xolo, meore
mxriv, iTvaliswinebs saqarTvelos samedicino dawesebulebaTa
rogorc adamianur, ise teqnikur resursebs.
• rekomendaciaTa moZieba xorcieldeboda klinikuri rekomendaciebis
saerTaSoriso reestrebSi, eleqtronuli monacemebis bazebSi
internetis gamoyenebiT.

EDUCATIONAL SOURCES FOR DEPRESSION AND BIPOLAR

DISORDER

Internet Mental Health National Foundation for Depressive Illness,

Inc.

http://www.mentalhealth.org P.O. Box 2257

New York, NY 10116

National Alliance for the Mentally Ill (800) 239-1265

Colonial Place Three, 2107 Wilson Blvd. http://www.depression.org

Suite 300

Arlington, VA 22201 NIMH Public Inquiries

(703) 524-7600 Depression Information Program

NAMI HelpLine: (800) 950-NAMI [6264] 6001 Executive Blvd., Rm. 8184

http://www.nami.org MSC 9663

Bethesda, MD 20892-9663

National Depressive and Manic-Depressive (301) 443-4513 TTY Line: (301) 443-8431
Association

730 N. Franklin St., Suite 501 http://www.nimh.nih.gov

Chicago, IL 60610-7204

(312) 642-0049 National Mental Health Association

(800) 826-3632 1021 Prince St.

http://www.ndmda.org Alexandria, VA 22314-2971

(703) 684-7722

TTY Line: (800) 433-5959

http://www.nmha.org

101
klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi
wyaroebi da meTodebi
• Lifelong learning in Psychiatry _ Psychiatryonlain
• Wikipeia, the free encyclopedia _ www.en.wikipedia.org/wiki/.
• koxreinis biblioTeka - The Cochrane Library 2006, Issue 4
• amerikis samedicino biblioTekis mier Seqmnili eleqtronul
bibliografiul monacemTa baza - MEDLINE

publikaciebis CarTvis/gamoricxvis kriteriumebi

• kvlevebi Semdegi dizainiT: randomizirebuli sakontrolo kvlevebi,
sistematuri mimoxilvebi da meta-analizi, erTmomentiani, kohortuli
kvlevebi
• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 15
wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro adreuli
publikaciebi, romlebic dResac aqtualuria da safuZvlad udevs
sxva Tanamedrove mtkicebulebebs.
• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs
SesaZlebloba hqonda literaturis wyaroebi Seeswavla mxolod
inglisur da rusul enebze.

moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi

• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.

Catarebuli Ziebis Sedegad miRebuli iyo guneba-ganwyobis (afeqturi)
aSlilobisis arsebuli ramdenime meToduri rekomendacia, romlebic
Seicavda jgufis miznis Sesaferis saWiro informacias.
• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas
gamoyenebuli iyo saqarTvelos Sromis, janmrTelobisa da socialuri
dacvis saministros mier mowodebuli mtkicebulebebis donisa da
rekomendaciebis xarisxis sqema.

mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema

done mtkicebulebis siZlieris xarisxi rekomendaciis xarisxi
done (Muir Gray) (Cook et al)
I Zlieri mtkicebuleba, A eyrdnoba I donis
eyrdnoba minimum erT mtkicebulebas da
sistemur mimoxilvas, Sesabamisad mtkiced
romelic efuZneba swori rekomendebulia
dizainis mqone
randomizebul
kontrolirebad kvlevas
II Zlieri mtkicebuleba, B eyrdnoba II donis
eyrdnoba minimum erTi mtkicebulebas da
swori dizainis mqone Sesabamisad mtkiced
randomizebul rekomendebulia
kontrolirebad kvleva
III klinikuri kvleva C eyrdnoba III donis
randomizaciis gareSe, mtkicebulebas
kohortuli da SeiZleba CaiTvalos
SemTxveva-kontrolis Sesabamisad
kvlevebi

102
 IV araeqsperimentuli D eyrdnoba IV da V
multicentruli donis mtkicebulebas
kvlevebi saWiroebs konsesuss
Va avtoritetul
profesionalTa
mosazreba
Vb klinikuri gamocdileba,
aRwerilobiTi kvlevebi
an eqspertTa angariSi

10. alternatiuli gaidlaini ar arsebobs

11. gamoyenebuli literatura

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12. avtorTa jgufi

saqarTvelos fsiqikuri janmrTelobis asociacia

⇒ jgufis xelmZRvaneli _ manana bokuCava _ md, fsiqiatriis s/k

institutis konsultanti;
⇒ qeTevan gelaSvili _ wamebis, Zaladobisa da gamoxatuli
stresuli zemoqmedebis msxverplTa fsiqoreabilitaciis centri
`epaTia~; eqimi-fsiqiatri.

eqspertebi:
⇒ Temur silagaZe _ Tssu neiromedicinis departamentis
fsiqiatriis mimarTulebis xelmZRvaneli, asocirebuli
profesori;
⇒ q. gigolaSvili _ ss `m. asaTianis saxelobis fsiqiatriis s/k
institutis~ direqtori klinikis dargSi;
⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros janmrTelobis dacvis
departamenti;
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socialuri dacvis saministros janmrTelobis dacvis
departamenti.

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