S????ST???????S ?????????S

1
S????ST???????S ?????????S
2
Se p??e? pe??pt?se?? ?e????µe ??p??a s??a?s??µata
pa????????

• ?ta? ????? d?sa?????a p??? µe???? ??tas? ?a?
  d????e?a
• ?ta? s???p?????? d?s????e? ?a? ap? t?? s?µat???
  sfa??a (d?ata?a??? t?? ?p???, t?? ??e??? ?a? t??
  se???a????? ep???µ?a?)
• ?ta? e?a?t?a? t??? pa?eµp?d??eta? ? ??a??t?ta
  ep?t??es?? t?? ?a??µe????? as?????? (e??as?a,
  sp?t?, ?????????t?ta)
• ?ta? s???p?????? ????t??? s?µpt?µata
• ?ta? e?a?t?a? t?? µe????? t??? ??tas?? p????pte?
  ???d???? ??a t? ??? t?? at?µ?? ? ?a? ?????

3
?a????µ?s?

• ?????????? S????ST??????? ?????????
• ????p????? ?at??????
• ????p????? ?a??a
• ??s??µ??? ??ata?a??
• ???????? S????ST??????? ?????????
• ??p????? ??ata?a?? ?
• ??p????? ??ata?a?? ??
• ???????µ??? ??ata?a??

4
????p????? ?at??????
??s??µ??? ??ata?a??
????p????? ?a??a
???????µ??? ??ata?a??
??p????? ??ata?a??
5
(No Transcript)
6
???????? F?S??
Goodwin et al. Manic-depressive illness. Oxford
Oxford University Press, 1990
7
??????????G??
????T????
?????
8
G?O??S???? ??S ????T????SS????O???? G?? ?? ?????
?? ?ST????S ?????? ???T???

• ? as?e??? s?????? pa?ap??e?ta? a????? ??a ??a ?
  pe??ss?te?a s?µat??? e?????µata (??p?s?, p????,
  a?p??a)
• ?e?a?t??? ??e???? ap??a??pte? ?ata???pt???
  s??a?s??µa ? ap??e?a e?d?afe???t??
• S???? ? e?e?e??st?t?ta ? t? ????? e??a? t? ?????
  p??ß??µa ??a t? ?p??? pa?ap??e?ta? ? as?e???

9
G?O??S???? ??S ????T????S????a s?µpt?µata t??
?at???????

• ???????st?? d?? ap? ta pa?a??t?
• ?ata???pt??? ? ?s??µ? d???es? t? µe?a??te??
  d??st?µa t?? ?µ??a? ??a d?? t??????st?? eßd?µ?de?
  p?? de? ep??e??eta? ap? t?? pe??st?se??
• ?p??e?a e?d?afe???t?? ? ???e??? e??a??st?s?? se
  e?????ste? d?ast????t?te?
• ?e??s? t?? e?e???t???t?ta? ? a???µ??? ??p?s?
• ?????e?a t?? epe?s?d??? ???????st?? d?? eßd?µ?de?

10
G?O??S???? ??S ????T????S???a s?µpt?µata
?at???????

• ???????st?? t?sse?a ap? ta pa?a??t?
• ???e??? a?t?e?t?µ?s?? ? t?? eµp?st?s???? st??
  ea?t?
• ?d??a??????ta a?s??µata a?t?µ?µf?? ? e?????
• ?pa?e???µµ??e? s???e?? ?a??t?? ? a?t??t???a? ?
  a?t??atast??f??? s?µpe??f???
• ??s???e?a s????? ?a? s?????t??s??,
  a?ap?fas?st???t?ta ? a?aß??t???t?ta
• ?etaß???? t?? ????????t???t?ta? (ep?ß??d??s? ?
  a??s???a)
• ??ata?a??? t?? ?p??? (a?p??a, ?pe??p??a, ?a??
  p???t?ta ?p???)
• ?etaß??? t?? ??e??? (a???s? ? µe??s?) µe
  epa??????e? µetaß???? t?? s?µat???? ß?????

11
G?O??S???? ??S ????T????SS?µat??? s??d??µ?
?at???????

• ???????st?? t?sse?a ap? ta pa?a??t?
• ??t??? ap??e?a e?d?afe???t?? ? ???e???
  e??a??st?s?? se e?????ste? d?ast????t?te?
• ???e??? s??a?s??µat???? a?t?d??se?? se ?e????ta ?
  d?ast????t?te?
• ????µ? af?p??s? (2 ??e? t??????st?? ????te?a)
• ?e???t??e?s? t ?? ?at??????? ta p?????
• ?µfa??? ??????????? ep?ß??d??s? ? a??s???a
• ??t??? ???e??? ??e???
• ?e??s? t?? s?µat???? ß????? (5 se ??a µ??a)
• ??to?? ap??e?a t?? libido

12
???????S ???F?S ??S ????T????S

• ?e???? ?at?????? (sta p?a?s?a ????p?????? ?
  ??p?????? S??a?s??µat???? ??ata?a???)
• ?p?a ? ???ss?? ?at??????
• ??s??µ??? ??ata?a?? (?p?a gt2 ?????a)
• ????d?? ?at??????
• ??d??e??? ?at?????? ( µe????)
• ??t?d?ast??? ?at??????
• ????t??? ?at??????
• ?t?p? ?at??????
• ??a?e?a d?a?e?p??sa ?at??????
• ?e?a?????a
• ?p?st??f??? e?e???t??? ?at??????

13
???????G???? ????G????S????????G?????? ???????
??S ????T????S

• ????e?ta? ??a s?µp???? ?a? a????ep?d?as? p???????
  pa?a???t??, ?????te??? ap? t??? ?p????? e??a? ??
  pa?a??t?
• ?????????? (???????µ???t?ta, ????? se??t??????,
  ???ad?e?a????? ?a? ????? ?e???d?aß?ßast??,
  s?µat???? ??s??, fa?µa?e?t???? ?a? ????d?ast????
  ??s?e?)
• ???d?a?es???? (p???µa ????t?a?µat??? ?e????ta ?a?
  ste??se??, ?????????????? pa?????te?)
• ?e??ßa????t???? (???µa, ????????? pe??ß?????,
  f?s??? pe??ß?????)
• ?a?????te? p?? p???a???? t?? ?at?????? (?e????ta
  ????)
• ??????????? (p??s?p???t?ta, a???t???? t??p??
  s?????)

14
?????S ???????? G?? ??? ???????? ????T????S ?

• ?e????a ?e????ta ????
• p??sfat?? ap?????sµ??
• p??ß??µata s??se??
• a?e???a
• µe????e? µeta????se??
• e??as?a?? stress
• ??????µ??? p??ß??µata

15
?????S ???????? G?? ??? ???????? ????T????S ??

• ???a ?e????ta
• ?p??e?a s?µa?t???? p??s?p?? (????a) p??? t??
  ?????a t?? 11 et??
• ?????e?e?a?? ?st????? ?at???????
• ???et??
• ?µµ???pa?s?
• ?p???a??? µetaß????

16
?????S ???????? G?? ??? ???????? ????T????S ???

• S?µat???? pa??se??
• ???µ?de?? ??s??
• ???p?
• ?pat?t??
• ?????e? s?µat???? ??s??
• d?ata?a??? ?fe???µe?e? st? ???s? ????p?e?µat?d??
  ?a? ??s???

17
???F????? ???G?OS? ????T????S

• T????
• ??????
• ????de?? ??ata?a??? (F?ß?e?-OCD)
• S????f???e?a
• ??????? ?atast?se??
• ??p????? ??ata?a??
• ??ata?a??? ???s?p???t?ta?
• ???a????? ?atast?se?? (???µ??e??, F??µa?a,
  ??s?e?, ?p?s??s? fa?µ???? ? ??s???, ?????,
  ??d????????????? ??ata?a???, ?e??????????
  pa??se??)

18
????T???? S????S????????. ???e? ???????
d?ata?a???

• ?a??a (d?p????? d?ata?a??, µa???-?at??????)
• ????de?? d?ata?a??? (?e???e?µ??? ?????, d?ata?a??
  pa?????, f?ß???? d?ata?a???)
• ??ata?a??? ap? ???s? ????p?e?µat?d?? ? ??s???
• ????t???? d?ata?a???
• ????e?

19
????T???? S????S?????????. S?µat???? pa??se??
(?e??????????)

• ?e??????????
• ???e??e??efa????? ??s??
• ?p?????a
• ?d????fa???
• ???µ??e?? t?? ??S (p.?. S?f????, HIV)
• ?µ???a??e?
• S??????s? ?at? p???a?
• ?. Parkinson
• ?e?p??sµata e??ef????
• ??a?µat?sµ?? t?? ??S

20
????T???? S????S??????????. S?µat???? pa??se??
(???e?)

• ??d????????? ??s?? (?. Cushing, N. Addison,
  ?pe?a?d?ste????sµ??, d?ata?a??? t?? ???e?e?d???
  ?a? t?? pa?a???e?e?d??)
• ???µ?de?? ?a? f?e?µ???de?? ??s?? ( ?.
  ????p?????s?, ??e?µ???e?, F?µat??s??, ?.
  ?????t??, S. Sjogren, ???taf??? a?t???t?da,
  ?????µat?d?? ?????)
• ???e? pa??se?? (?. Wilson, ?a??????, p???f???e?,
  ???a?µ?a, aß?taµ???se??)

21
????T???? ??? F???????????S ??S??S

• ??a???t??? ?a? a?t?f?e?µ???d?
• ??t?ßa?t???a?? ?a? a?t?µ???t?as???
• ??t??pe?tas??? ?a? ?a?d???????? s?e??sµata
  (a-µe???-?t?pa, a?ast??e?? t?? ß-?p?d?????,
  ?????d???, ???a?e??d???, ??d??a???, ?ese?p???)
• ??t??e?p?asµat??? (a?a?e??p????, C-aspa?a????s?)
• ?e????????? ?a? ????at???? f??µa?a (aµa?tad???,
  a?t?????s???, ß??µ????pt???, ?a?ßaµa?ep???,
  ?eß??t?pa, fa???t????, ?atasta?t??? ?a? ?p??t???)
• Ste??e?d? ?a? ??µ??e? (???t???ste??e?d?,
  a?t?s????pt??? s?e??sµata)
• ???a f??µa?a (??p??eptad???, s?µet?d???,
  d?s???f???µ?, d?e?e?t???)

22
????????S ?????????S (DSM-IV)

• ???????? I
• 1 ? pe??ss?te?a µa??a?? ? µe??t? epe?s?d?a
• ?p????t?s? 0.41.6 (?s?d??aµa se ??d?e? ?a?
  ???a??e?)
• ?at? µ?s? ??? , s?µßa????? 4 epe?s?d?a µ?sa se
  10 ?????a
• ???????? II
• 1 ? pe??ss?te?a µe????a ?ata???pt??? epe?s?d?a
  s???de??µe?a ap? 1 t??????st? ?p?µa??a??
  epe?s?d??
• ?p????t?s? 0.5 ( s????te?? se ???a??e? ap ?t?
  se ??d?e? )

23
???????? ????????? S??S? ?? ?? ???????G???????

• ????t?? Antonin Arteaux, Charles Baudelaire,
  Robert Burns, Lord Byron, Emily Dickinson, T.S.
  Eliot, Friedrich Holderlin, Victor Hugo, Samuel
  Johnson, John Keats, Vladimir Mayakovsky, Boris
  Pasternak, Sylvia Plath, Cesare Pavese, Edgar
  Allan Poe, Ezra Pound, Alexander Pushkin, Lord
  Tennyson, Dylan Thomas,Walt Whitman
• S????afe?? Hans Christian Andersen, Honore de
  Balzac, Joseph Conrad, Charles Dickens, William
  Faulkner, Nikolai Gogol, Maxim Gorky, Graham
  Greene, Ernest Hemingway, Herman Hesse, Henrik
  Ibsen, Henry James, Herman Melville, Eugene O
  Neal, Mary Shelley, R. L. Stevenson, August
  Strinberg, Leo Tolstoy, Tennessee Williams,
  Virginia Woolf, Emile Zola, ?a??a??ta ?a?ap????
• S????te?-???s???? Hector Berlioz, Edward Elgar,
  G.F. Haendel, Gustav Mahler, Charles Mingus,
  Charlie Parker, Cole Porter, Sergey Rachmaninoff,
  G. Rosini, Robert Schumann, Peter Tchaikovsky
• ?????f?? Richard Dadd, Paul Gaugin, Vincent van
  Gogh, E.L. Kirchner, Michelangelo, Edvard Munch,
  Jackson Pollock

24
???????? ????????? ????? ????S????

• ?p?µa??a
• ?a??a ????? ????t??? s?µpt?µata
• ?a??a ????t??? s?µpt?µata
• ?at??????
• ?p?a
• ??t??a
• S?ßa?? ????? ????t??? s?µpt?µata
• S?ßa?? µe ????t??? s?µpt?µata
• ?e??t? epe?s?d??
• Se ap?d??µ? (???µ???µ?a)
• ??a??as?µe?a epe?s?d?a
• ?a???? ???????? µetaß????

25
????????S ?????????S (DSM-IV)

• ?????T????
• p???????µa epe?s?d?a ?p?µa??a? ?a? ?ata???pt????
  s?µpt?µ?t?? ( ??? t?? ßa??t?ta? µe??????
  ?ata???pt???? epe?s?d??? ) ??a 2 ?????a
  t??????st??
• ?p????t?s? 0.41
• 515 t?? d?p?????? as?e??? e??a? as?e?e?? µe
  ta?e?e? e?a????e? ( rapid cyclers ) µe 4 ?
  pe??ss?te?a epe?s?d?a a?? ?t??
• 60 t?? d?p?????? as?e??? ????? ?a? ????s???
  s?µpt?µata

26
???????S ?????OS??S ??S ????????S ?????????S

• ??p????? t?p?? I d?ata?a??
• ?ata???pt??? epe?s?d??
• µe ? ????? ????t???
  s?µpt?µata
• ?a??a?? epe?s?d??
• µe ? ????? ????t???
  s?µpt?µata
• ?e??t? epe?s?d??
• ??ata?a?? µe ta?e?a e?a??a?? f?se??
• ???e?t??? st? ?e?ape?a µ??f?
• ??p????? t?p?? ?I d?ata?a??

27
?????

• ??????? e????a - ??a???st??? ???t???a
• ??f?????, d?a??t??? s??a?s??µa
• ?d?e? ?pe?t?µ?s?? t?? ??? ?d?e? ?e?a?e???
• ?e??s? t?? a?????? ??a ?p??
• F??a??a
• F??? ?de??
• ??s????a ep????t??s?? t?? p??s????
• ????s? t?? ????????t???? d?ast????t?ta?

28
?????

• ??af????? ??????s?
• ???a????t?ta
• ??????sa ?e???? pa????s?, ????? t?? e??ef????,
  S??????s? ?at? p???a?, ?pe????e?e?d?sµ??, ???????
  ?atast?se??, ??????s?
• S????f???e?a

29
?????????????? S????O??????G??S ?????????S
S????ST?????S S?? S????F??????
30
?????????????? S????O??????G??S ???OS???
S????O???? S?? ???????? ?????????
31
???e?a ?a? ??????s? t?? S??a?s??µat????
??ata?a???

• ?a??? p??e?a µe s????? ?p?t??p??
• ?e??ss?te?? ?a????e?? ap? t?? S????f?e?????
  ????se??, a??? µe p???? p??ß??µata ?a? µe ßa??
  t?µ?µa
• ?? st?ess?????? pa?????te? fa??eta? ?a pa?????
  s?µa?t??? ???? µ???? t?? e?d???s? t?? p??t??
  epe?s?d???, µet? ? ????? t??? e??a? s?µa?t???
  µ????te???

32
????? ?????? G?? ??? ????T??????? ?ST??? ???S
?????S ???

• ? p?????s? t?? ?at??????? e??a? ?e???? ?a??
• ? ?at?????? e??a? µ?a s?????sµ??? a???st?a ?a?
  e??a? a?t?µet?p?s?µ?
• ?e? ?fe??eta? se, ??te e??a?, ad??aµ?a ?a?a?t??a
  ?a? ????s??
• ?e? e??a? teµpe???
• S?µa??e? ?t? p?s?ete ap? µ?a d?ata?a?? p??
  apa?te? ?e?ape?t??? a?t?µet?p?s? ?a? p?? µp??e?
  ?a a?t?µet?p?ste?

33
???e?a ?e?????? ?ata???pt???? ??ata?a???

• 1? epe?s?d??
• ??a p???µ? a?t?µet?p?s? ?p??? s?µpt?µ?t?? µp??e?
  ?a ap?t???e? t?? a??pt??? e??? p??????
  ?ata???pt???? epe?s?d???.
• S?????? de? ?p???e? p????s??? ?st????? d?ata?a???
  p??s?p???t?ta?
• gt50 t? 1? epe?s?d?? eµfa???eta? p??? ta 40
• ?????e?a
• ????? ?e?ape?a 6-13 µ??e?
• ?e ?e?ape?a 3 µ??e?
• ?e t?? ?????, ? s????t?ta? ? d????e?a?, ?.?.
  5-6/20 ?t?
• ?µf???s? µa??a??? epe?s?d???
• 5-10 µe a????? d?????s? µ???p????? ?at??????,
  6-10 ?t? µet?
• ???a?? ??s? ?????a 32 ?t?, µet? ap? 2-4
  epe?s?d?a

34
???e?a ??p?????? ??ata?a??? ?

• ???a? ?p?t??p?????sa
• ?µfa???eta? s?????? µe ?at?????? (75 G ?a? 67
  ?)
• ?? pe??ss?te??? as?e?e?? eµfa?????? ?a?
  ?ata???pt??? ?a? µa??a?? epe?s?d?a 10-20 µ????
  µa??a??
• ?????e?a epe?s?d??? µa??a? ????? ?e?ape?a 3
  µ??e?
• ?e t?? p???d? t?? ?????? ? s????t?ta t??
  epe?s?d??? a????eta? ?a? µe???eta? t?
  µes?d??st?µa
• ?et? ap? 5 epe?s?d?a, ?p???e? µ?a sta?e??p???s?
  t?? µes?d?ast?µat?? t?? t???? t?? 6-9 µ????
• ???sµ???? eµfa?????? ta?e?a e?a??a?? t??
  epe?s?d???

35
??????s? ?e?????? ?ata???pt???? ??ata?a??? ?

• ??????t?ta - ?p?t??p??
• ?et? t? ??s??e?a 50 p??a??t?ta ?a a?a??ß???
  st?? 1? ?????
• St?? 5? ????? 10-15 de? ????? a?a??ße?
• 25 ?p?t??p? st??? p??t??? 6 µ??e?, 30-50 sta 2
  p??ta ?????a ?a? 50-70 se 5 ?????a
• ?a??te?? p?????s? ??a ?s??? s??e??????
  p??f??a?t??? fa?µa?e?t??? ?e?ape?a ?a? ??a ?s???
  ????? µ???? 1 ? 2 ?ata???pt??? epe?s?d?a
• Tet???? ??????st???? de??te?
• ?p??t?ta epe?s?d???, ap??s?a ????t????
  s?µpt?µ?t??
• ?pa??? sta?e??? s??se?? ?at? t?? ef?ße?a
• Sta?e??t?ta st? ?e?t?????a t?? ???????e?a?
• Sta?e?? ?a?? ????????? ?e?t???????t?ta sta
  te?e?ta?a 5 ?????a
• ?p??s?a ??ata?a??? ???s?p???t?ta? ? ?????
  ????at????? ??ata?a???
• ???????µ??? ?????a p??t?? eµf???s??

36
??????s? ?e?????? ?ata???pt???? ??ata?a???

• T??s?µ?t?ta
• ?e??t?? T??s?µ?t?ta? 1.37-2.49 (normal
  population1.0)
• ??t??t???a, at???µata, ?a?d?a??e?a??? d?ata?a???,
  ???µ??e?? t?? a?ap?e?st????, de?te???e??? eµp????
  µe ???s? ??s???
• ?e??te? ??t??t???a? (normal population1.0)
• ??p????? ??ata?a?? 15.05
• ?e???? ?at?????? 20.35
• ??s??µ?a 12.12
• ??e? ?? d?a???st???? ?at?????e? 13.65

37
??????s? ??p?????? ??ata?a??? ?

• ?e???te?? ap? t?? µe????a ?ata???pt??? d?ata?a??
• 40-50 eµfa???e? ??a 2? epe?s?d?? µ?sa se 2
  ?????a
• 50-60 ep?t?????e? ??e??? µe ta sta?e??p???t???
  t?? d???es??
• 7 de? eµfa???e? de?te?? epe?s?d??
• 40 a?apt?sse? ?????a ?p?t??p?????sa p??e?a
• ????µ?? epe?s?d??? 2-30, µe ??9
• 40 eµfa???e? gt10 epe?s?d?a
• Se µa????????a pa?a???????s?
• 15 e??a? ?a??
• 45 ?a?? pa?? t?? p????? ?p?t??p??
• 30 µe???? ?fes?
• 10 ??????t?ta

38
??????s? ??p?????? ??ata?a??? ?

• Tet???? ??????st???? ?e??te?
• ??a?e?a d????e?a µa??a??? epe?s?d???
• 1? epe?s?d?? se a??et? µe???? ?????a
• ????te?e? a?t??t?????? s???e??
• ????te?a s???p?????ta ????at???? ?a? s?µat???
  p??ß??µata
• ????t???? ??????st???? ?e??te?
• ?a?? p????s??? epa??e?µat??? ?at?stas?
• ????t?s? ap? t? a?????
• ???e? f???
• ????t??? ?a?a?t???st???

39
T???????G?????S ????S

• ??af??a?? t?? asf??e?a? t?? as?e????
• ?????? d?a???st??? e?t?µ?s?
• S?ed?asµ?? ????? µa????????a? f???t?da?
• F???t?da-p??s??? sta st?ess????a ?e????ta,
  p?????? t??? ?p?? e??a? ef??t?

40
????T???? ??????????

• ?a?ap?µ?ete
• ?ta? ? ?at?????? e??a? p??? s?ßa??
• ?p?????? s????? ?p?t??p??
• ????stata? st? ?e?ape?a
• ?p?????? ep?µ??e? ?d?e? a?t??t???a? ?
  p??????µe?e? ap?pe??e?, ? ?????e?e?a?? ?st?????
  a?t??t???a?
• ?e? ?p???e? ?a?? s?µµ??f?s? st? ?e?ape?a
• ???s??? st? st?s? t?? as?e???? ap??a?t? st???
  ?????t???? ?a? st?? st??µat?sµ? p?? µp??e? ?a
  ????se? e?a?t?a? t?? pa?ap?µp??

41
??S??????
T???????

• ???d???? ??t??t???a? ? ?????p??t???a?
• ?????? ??a???st???? ????µas???
• ?e???? µe??s? t?? ??a??t?ta? ??a e?asf???s?
  t??f??, st???? ? ??d?s??, ???d???? ??a t?
  s?µat??? ??e?a
• ?st????? ta?e?a? eµf???s?? t?? s?µpt?µ?t??
• ?e???? ??pt?s? t?? e?a?s??s?a? ?a? t?? ???s??
• ?p??s?a ? ???? µe ta s????? ?p?st????t???
  s?st?µata

42
????T???? ??????S? ??? ???????? ??????????S

• ?p??????
• ???e??? e?d?af????t?? ??a t? ???
• ????? ?a??t??
• ?d?e? a?t??t???a?
• ?a??d????, fe??a??e?
• ?p?µ??e? a??? ??a ?????? ?????? t?? ap????pte?
• ?p?µ??e? a??? ????? ?d?a?te?? s??d??
• ?p?µ??e?, µe s??d??
• ?st????? p??????µ???? ap?pe????
• ?????e?e?a?? ?st????? ?at??????? ?a? ap?pe???? ?
  ep?t???µ???? a?t??t?????
• ?? ?? ?d?e? e??a? ep?µ??e?, ? ? ?at?????? e??a?
  s?ßa?? ? ?p???e? ?????e?e?a?? ?st?????,
  s?µß???e?te?te ????at?? ? pa?ap?µ?ete

43
F?????? ? ????T????????
T???????

• F??µa?a ?????? a??a?? st?? a?t?µet?p?s? t??
  d?ata?a??? t?? d???es??, ??aµat??? ep?pt?s? st??
  p??e?a t???, ?e???? µe??s? t?? ??st??? t??
  d?ata?a???
• ?????e?ape?e? S?µa?t??? ep?pt?s? ?a? µetaß???
  st?? a?t????? ?a? st?? t??p? µe t?? ?p???
  a?t?µet?p????ta? ?? d?ata?a??? t?? d???es??.
• ??? ?? ??at???
• Te????? ?t? µ???? ? ????d??aµ??? p??s????s? ??e?
  ????
• ? aµf???µ?a t??? se s??s? µe ta f??µa?a µp??e?
  ?a ?d???se? se ?a?? a?tap????s?, ft??? s?µµ??f?s?
  ?a? ?s?? a?epa??e?? d?se??
• ??????? t?? ?????????????? a????e? t?? at?µ??
• ? ??ßas? t?? fa?µa???e?ape?a? de? ?a e??a? ?
  a?aµe??µe??

44
????T???? G?????S ???G??S F??????T???????S ?

• ?p?te?esµat???t?ta ????? (60-70) ?a? ta??te??
• S?µµ??f?s? st?? a???? a?a??a?a
• ?d???e? ??a t?? as?e??
• ?a f??µa?a de? p???a???? e??sµ?
• ???pe? ?a ap?fe????ta? ta ????p?e?µat?d?
• ??tap????s? µet? 2-3 eßd?µ?de?
• ??ep???µ?te? e????e?e? ?a a?af????ta? st?
  ??at??, ße?t??s? s?????? µet? 7-10 ?µ??e?
• ????d??
• S?????s? t?? a?????, a??a?? µ??? ap? t?? ??at??
• ??a??p? µ??? ap? t?? ??at??
• ???a?? fa?µ???? ep? µ? ap?te?esµat???t?ta?
• ?????e?a ?e?ape?a? 6-9 µ??e? st? p??t? epe?s?d??
• S??e??? epa???e???? apa?a?t?t??

45
G?????S ?????T??S??S ??
T???????

• ???µ???s? - ??pa?de?s? t?? as?e????
• ?p????? ??t??ata???pt????
• ?st????? p??????µe??? ?a??? a?tap????s??
• ?st????? ?a??? a?tap????s?? µ????? t??
  ???????e??? t??
• S???? ? t?p?? t?? ?at??????? ?a? ? eµpe???a t??
  ??at???
• ??d?? pa?e?e??e???
• ?pa???? ??s?????a
• ??at???s? t?? µ???st?? ?e?ape?t???? d?s?? ??a 4
  eßd?µ?de? p??? s?eft??µe a??a??
• ???s??? t?? p??te? eßd?µ?de? t?? ????????
  ße?t??s??
• ???s??? ??a ?p?pte? ????se?? ?a? a?e????te?
  a??a??? t?? as?e????
• ??e???? fa?µ???? st? p??sµa (ap????f?s?,
  compliance)
• ??? ?p???e? ?p?t??p? µ?sa se 2,5 ?????a,
  d??a?????e?ta? p??f??a?t??? a???? ep? 5et?a.

46
H a??pt??? t?? a?t??ata???pt???? fa?µ????
NaSSA
MAOI
??t??ata???pt??? ???ad?e?a????? e?d????
?p?d????? t?? se??t??????
??ast??e?? t?? µ???-aµ?????d?s??
1950 1960 1970 1980 1990
2000
??ast??e?? epa?ap??s????? se??t??????
???ad?e?a?????
???e?t???? a?ast??e?? epa?ap??s?????
t?? se??t??????
??-e?d??? t????????? a?t??ata???pt???
SNRI
47
F??????T????????. ????T????
T???????
??t??ata???pt???
48
??t??ata???pt???
49
S????????S ???????G???S ?????????O?
????????T??????O?

• ??t??????e?????? ????st?µ?a, d?s??????t?ta, ????
  ??as?, ?ata???t?s? ?????, ???st??? d?ata?a??
  st??? ??????µ?????
• ??t??staµ?????? ?atast???, a???s? ß?????
• Se??t??e?????? Se???a???? d?s?e?t?????a
• a-?d?e?e?????? ????stat??? ?p?tas?, ????

50
??? ???S???

• ??????s? st???????, a????µ??? d?ata?a??? a?????
  ? ta???a?d?a?
• Ste?? ?e?ape?t??? f?sµa, ?aµ??? ?a?at?f??a d?s?
  (?a?d?a?? t?????t?ta)
• ?e??s? t?? ??d?? ep???pt???? spasµ??
• Se as?e?e?? µe p??ß??µata p??st?t?
• Se as?e?e?? µe ??a???µa ??e?st?? ????a?
• Se as?e?e?? µe d?p????? d?ata?a??

51
??? F???????????S ???????????S??S

• ????p?e?µat?d? a???s? ????????t???? d?ata?a???
• ??t??????e????? a???s? a?t??????e?????? d??s??
• ??t?p??t??? µe??s? t?? µetaß???sµ?? (a???s?
  d??s??) t?? ???a?fa?????
• ??t?????t??? a???s? ep?p?d?? ???
• ?a?ß?t?????? a???s? ep?p?d?? ???, ?atast??? ??S
• S?µet?d??? a???s? ep?p?d?? ???, a???s?
  a?t??????e?????? d??s??
• ?????d???, ???a?e??d??? a?ta????sµ??
  a?t??pe?tas???? d??s?? (?pe?tas??? ???s?)
• ?eß??t?pa µe??s? t?? ap????f?s?? t?? ???
• ??ast??e?? ??? S?ßa?? se??t??e????? s??d??µ?
• ???pe??d???, fa????e?a???e?, µe???fa???d?t?,
  a?t?s????pt??? µe??s? µetaß???sµ?? (a???s?
  d?as??) t?? ???
• Fa???t???? a???s? ep?p?d?? fa???t?????, µe??s?
  ep?p?d?? ???
• ????d??? a???s? ep?p?d?? ??? (µe??s?
  µetaß???sµ?? ), ep?p??s?et? d??s? st?? ?a?d?a??
  a????µ?t?ta
• SSRIs µe??s? µetaß???sµ?? (a???s? ep?p?d?? ?a?
  pa?e?e??e???) ???
• S?µpa??µ?µ?t???? aµ??e? e??s??s? a????µ???,
  ?pe?tas??, ta???a?d?a?

52
???? ????????T??????? ?????T?????S ????G???S

• SSRIs ????, ?p????a, t??µ??, ef?d??s?,
  ?efa?a???a, ????st?µ?a, d??????a, ?a?t?a, ?µet??,
  ????? a?p??a (f?????et???), se???a????
  d?s?e?t?????a, e?????µa (f?????et???),
  ?p?????a?µ?a (f?????et???)
• SNRI- ?e??afa???? ????, ?p????a, ef?d??s?,
  ?efa?a???a, a???e??a, ?a?t?a, ?µet??, ?????
  a?p??a, se???a???? d?s?e?t?????a, ?p?a a???s? ??
  ?a?d?a??? ???µ??, a???s? QT (XR)
• ?efa??d??? ????, ?p????a, ????st?µ?a, ?a?t?a,
  ????s? ??as??, d?s??????t?ta, ????stat??? ?p?tas?
  (µe µ? ?atasta?t??? a?t??staµ?????)

53
????T???? ????S SO??????S T???????S
T???????

• ??T?? (p??s????)
• ???s??t??? t?? a?t??ata???pt???? a????? se
  a???st?µe?? ??
• ??e?t??spasµ??e?ape?a (ECT)
• ?ta? ? as?e??? de? apa?t? st?? fa?µa???e?ape?a.
• ?ta? ? ?at?stas? e??a? ?d?a?te?a s?ßa??,
  ape??e?ta? ? ??? t?? ?a? de? ?p???e? ? d??at?t?ta
  a?aµ????.

54
F??????T?????????. ???????? ?????????
T???????
55
???????? ????????? ????????S G?? ???????OS???

• ??e?a f?s? µa??a , µe??t? d?ata?a??
• a?????? ??e???? s?µpe??f????
• a?t?µet?p?s? ????s???? s?µpt?µ?t??
• µa??a a??e?t??? st?? a????
• F?s? sta?e??p???s??
• p????? ap?te?esµat??? d?s? fa?µ???? ??a 4 - 12
  eßd?µ?de?
• ????? f?s?? s??t???s??
• p?????? epa?eµf???s?? ????s???? s?µpt?µ?t??
• ??a??p?
• p??? ßa?µ?a?a µe??s?
  (? a??pe??d??? µe???eta? ?at?
  12 mg /µ??a )

56
???SS??? ????????????

• ??e??e?t?µata
• ??tetaµ??? ??????? eµpe???a
• ?a?? a?t?µa??a?? ap?t??esµa
• ?p?te?esµat??? st??? ????t?????, d?e?e?t?????,
  ?a? ep??et????? as?e?e??
• ???a? d?a??s?µa se e??s?µ? µ??f? ?a? se µ??f?
  ß?ade?a? ap?d?sµe?s?? (depot)

57
???SS??? ????????????

• ?e???e?t?µata
• ?e? e??a? ap?te?esµat??? st?? p??f??a??
• ????? p?s?st? e?d???s?? ?.?.S.
• ?????? ???d???? e?d???s?? ???µ?? d?s????s?a? ?a?
  ?a??????? ?e?????pt???? s??d??µ??
• ??t??????e?????? pa?e????e?e? ?a? d?sµe??
  ep?pt?s? st?? ???st???? ?e?t?????e?
• ???a??? p???a???? ? ep?de??????? t?? ?at??????
• ????s? ß?????
• ????a???? ?pe?ß????? ?atast???
• ????? s?µµ??f?s? st? ?e?ape?a

58
????? ???????OS???

• ?p?te?esµat???t?ta st?? ??e??? t?? µa??a???
  s?µpt?µ?t??
• ?p?te?esµat???t?ta st?? ??e??? t?? ????s????
  s?µpt?µ?t?? ( p?? s?????? s???p?????? )
• ???????te?? p??f?? a.e. ( ??S - ?? )
• ?a??te?? s?µµ??f?s?

59
?????????? ??T???
T???????

• Te?ape?t??? ep?peda 0,7-1,2 mmol/L (1,5)
• ??ep???µ?te? e????e?e?
• ?e???µ???? s?µpt?µata (t??µ??, µ???? ad??aµ?a)
• ?a?t?a, ?µet??, d??????a
• ????s? s?µat???? ß?????
• ??ata?a?? µ??µ?? a??te??? ?e?t???????
• ????????a ?ef??t?? ?ef???? ??ep???e?a
• ?pe?- ? ?a? ?p?- ???e?e?d?sµ??
• ??????t?ta
• ??sa????a, ????, ??sta?µ??, ?µet??
• T???s? t?? ??as??, ??ata?a?? t?? s??e?d?s??
• ?a?a????µa, s????s?
• ?ef???? a?ep???e?a, spasµ??, ??µa, ???at??

60
????????O????S T???????S
T???????

• G??s?a?? ?????e?ape?a
• Te?ape?a ??ap??s?p???? S??se??
• ???a?a??t??? ???sa?at???sµ??? ?????e?ape?a
• ?????e?e?a?? ?????e?ape?a

61

?????e?ape?t???
?a??µßas?
st??
?ata???pt??? as?e?? Ge????? ?????

• ??t?µ?s? t?? ßa??t?ta? t?? d?ata?a???
• ??t?µ?s? t?? ???d???? a?t??t???a?
• ??t?µ?s? p??s?p???t?ta?
• ???at?stas? ?e?ape?t???? s??s??
• S???pe?a ?a? sta?e??t?ta
• ?p?st????? ??st??a?? e?p?da?
• ??µ??e?t??? (?p?? e?de????ta?)
• ?p????s? ?a? a????s? t?? d???? µa? s??a?s??µ?t??
  ?a? a?t?d??se??

62

?????e?ape?t???
?a??µßas?
st?? as?e?? p??
ß??s?eta? se ?a??a Ge????? ?????

• ??t?µ?s? t?? ßa??t?ta? t?? d?ata?a???
• ??t?µ?s? t?? d??at?t?t?? ??????t?s??
• ??t?µ?s? t?? ???d???? ß?a??? ? ep??et????
  s?µpe??f????
• ??t?µ?s? p??s?p???t?ta?
• ???sp??e?a e??at?stas?? ?e?ape?t???? s??s??
• ???a ????????e?a ?e???a?e? e?f??se??.
• Seßasµ?? t?? ?e?a??µa??a??? ?a?a????µat??
  ??te t? ap?de??µaste ??te t? ap????pt??µe
• ?p????s? ?a? a????s? t?? d???? µa? s??a?s??µ?t??
  ?a? a?t?d??se?? ?p?t??p??µe st?? ea?t? µa? ?a
  f?ß?ta?

63
G?OS???? ????T???????
T???????
?e? e??a? ta p???µata p?? e??????? t???
a????p???, a??? ?? ?d?e? p?? ????? ?? ?????p??
??a ta p???µata
?p??t?t??

• ?st???e? st?? a?t?µet?p?s? t?? ???s?a???
  pa?aµ??f?se?? t?? µe?????? ?ata???pt????
  d?ata?a???
• St????
• - ? e?t?p?s? ?a? ? ??e???? t?? a???t???? a?t??
  ???s???,
• - ? a??pt??? e?a??a?t????, e??aµpt?? ?a?
  ?et???? t??p?? s?????,
• - ????µ? ???? ???s?a??? ?a? s?µpe??fe??????????
  apa?t?se??

? d???es? ?a? ta s??a?s??µat? µa? ep??e????ta?
ap? t?? s???e?? µa? ?a? ?ts? a???t???? ?a?
?p?t?µ?t???? s???e?? ?a? a???t??? s??µata s?????
(???s?e?) p???a???? d?sf????? d???es? ?a?
?at??????
G??s?a?? t???da ????t???? ap??e?? t?? at?µ??
??a t?? ea?t? t??, t?? ??sµ? ?a? t? µ????? t??
64
??????SO???? T???????
T???????

• ?st???e? se ??a ? d?? t?????ta d?ap??s?p???
  p??ß??µata
• ???eta? p??
• - ta t?????ta p??ß??µata ????? t?? ???e? t???
  st?? p???µe?
• d?s?e?t???????? s??se??
• - ta t?????ta d?ap??s?p??? p??ß??µata
  s?et????ta? µe t??
• eµf???s? ?a? d?at???s? t?? t??????
  ?ata???pt???? s?µpt?µ?t??
• 3. 12-16 s??ed??e?, 1/eßd., ??e???t???
  ?e?ape?t??? p??s????s?

65
????T???? ???G??S S????????????S G?? ??? ?ST???

• ?a ??te?? µ??????, ef??t???, ?a??µe?????? st?????
  e?t??es?? e?????st?? d?ast????t?t??, ?a
  epa?e?et??e?? t?? p???d? t??? µe t??t???
• ?a p????aµµat??e?? ????? ??a d?ast????t?te? ?a?
  ?a t?? a????e?? p???de?t??? ???e eßd?µ?da
• ?a ???e?? ?ea??st??? s??d?a ??a t? µ?????
• ?a apas???e?sa? µe ??t?, a??µ? ?a? ?ta? e??a?
  d?s???? ?a ß?e?? ????t??
• ?a p??spa?e?? ?a e?sa? µe ???a µ??? t??
  ???????e??? s??

66
????T???? S????? ?????S?S ?????????O?

• S???t?s?
• ?a s???t?? ta p??ß??µat? s?? µe t??/t?? s??t??f?
  s??, ta µ??? t?? ???????e?a?, ??a? ?µp?st? f???,
  ? ??p???? e?d???
• ?p?stas??p???s?
• ???sp???se ?a ß??pe?? ta p???µata sa? pa?at???t??
• ?p??????
• ?a ep????e?? efa?µ?s?µe? ??se?? ??a ta p??ß??µat?
  s??
• ?p?? ?a? ?at?
• ?a e?et??e?? ta ?p?? ?a? ta ?at? ???e ep??????
• ?a????sµ?? ???????? p?a?s??? ?a? s??d??? d??s??
  ??a t?? stad?a?? ep???s? t?? p??ß??µ?t??
• ?pa???e????
• ?a epa?e?t?µ?? t?? p???d? p?? p?a?µat?p???se?
  st?? ep???s? t?? p??ß??µ?t??

67
????T???? ????G? S??S?O? ??? ?????? S????S

• ???ta ?a a?s????µa? ?ts?, ta p???µata de? ?a
  a??????? p?t?
• ??? fta?? ??a ??a. ?e? µp??? ?a ???? t?p?ta
  s?st?

• ?a s??a?s??µata a?t? e??a? pa??d???. ?e t?
  ?e?ape?a, ta p???µata ?a ?a??te?e?s??? se ???e?
  eßd?µ?de?
• ??t?? ?? a???t???? s???e?? e??a? ap?t??esµa
  t?? ?at???????. ?? ap?de??e?? ??? p?a?µat??? ??a
  t? fta???µ? µ??

68
???????????? ???S???????S???? ????T???????
T???????
?e? est???e? ?d?a?te?a sta s?µpt?µata. St???? -
?p????s? / ??µ??? ???a?? - ?e?t??s?
d?ap??s?p???? eµp?st?s???? - ?e?t??s? t??
d??at?t?ta? ??a s??se?? e???t?ta - ?e?t??s?
µ??a??sµ?? a?t?µet?p?s?? t?? p??ß??µ?t?? -
?e?t??s? t?? ??a??t?ta? ?a ß?????ta? ta ??t??a
?a? ßa??? s??a?s??µata, ?????? t? p?????
69
????G??????? ????T???????
T???????

• ? e?d??????e?e?a?? ?at?stas? (t? s?st?µa)
  e??d??e? ? ?a? s??t??e? t?? d?ata?a?? t??
  d???es??
• ??et??eta? ? ????? t?? a???st?? st? p?a?s?? t??
  s?st?µat?? t?? ???????e?a? ?a??? ?a? ? ?????
  ????????? t?? ???????e?a? st?? s??t???s? t??
  s?µpt?µ?t?? t?? a???st??.

70
??a?s?? p?? ?e?t????e? ??a p??? ap? 15 ?????a
?
G
?
?
71
(No Transcript)
72
(No Transcript)
73
(No Transcript)
74
??s? µ?sa ap? t? p?a?s??, ?p?? e??e µ??e? ??a ta
?????a, µe ßas??? ????a ?a µ?? a????e? t?
p?a?s?? a?t?, p?? ??e? d???µaste? ?a? ??e?
ap?de???e? ?t? ?e?t????e? ?a?? t?sa ?????a
1
75
2
??s? p?? a????e? t? p?a?s??
76
?
77
??µ??????a ???? p?a?s???
78
(No Transcript)