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    36 views916 pages

    DSM Iv TR

    Uploaded by

    Limota Chiralina

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 916

    DSM IV t.

    rIX
    GRUPUL OPERATIV PENTRU DSM-IV
    ALLEN FRANCES, M.D.
    Preedinte HAROLD
    ALN PINCUS, M.D.
    Vicepreedinte
    MICHAEL B. FIRST, M.D.
    Editor, Text si Criterii
    Nancy Coover Andreason, M.D., P.D.
    Dav!d H. Bar"o#, P.D.
    Ma$da Ca%&'e"", M.D.
    Den!s P. Can(#e"", M.D.
    E""en Fran), P.D.
    *+d!( H. ,o"d, M.D.
    *on ,+nderson, M.D.
    Ro'er( E. Ha"es, M.D.
    -enne( S. -end"er, M.D.
    Dav!d *. -+&.er, M.D.
    M!cae" R. L!e'o#!(/, M.D.
    *+an Enr!0+e Me//!c, M.D., P.D.
    Pe(er E. Na(an, P.D.
    Ro$er Pee"e, M.D.
    Darre" A. Re$!er, M.D., M.P.H.
    A. *on R+s,M.D.
    Ces(er 1. Sc%!d(, M.D. Marc A"an
    S+c)!(, M.D. Dav!d Sca..er, M.D.
    Ro'er( L. S&!(/er, M.D
    Consilier Special ,ary *. T+c)er,
    M. D B. T!%o(y 1a"s, M.D. To%as
    A. 1!d!$er, P.D.,
    Coordonator Cercetare *ane( B.
    1!""!a%s, D.S.1 *on C Ur'a!(!s,
    M.D.,
    Assembly Liaison 2 *a%es *.
    H+d/!a), M.D.
    Resident Fellow (!!"#!!$% *+n!+s
    ,on/a"es, M.D.,
    Resident Fellow (!&&#!!"%

    R+( Ross, M.A.,
    Redactor 'tiin(i)ic
    Nancy E. 3e((ore""o, M.U.P.,
    Coordonator Administrati* 1endy
    1a)e.!e"d Dav!s, Ed.M.,
    Coordonator Editare
    Nancy Sydnor4,reen'er$, M.A.,
    Asistent Administrati*
    Myr!a% -"!ne, M.S.,
    Foc+sed Field Trial, Coordinator
    ,
    *a%es 1. To%&son,, M.D., M.P.H.,
    Videotape Field Trial Coordinator
    $
    5
    Res!den( Fe""o# 6 '+rs!er c+ (!("+ acade%!c care e.ec(+ea/7 o ac(!v!(a(e de cerce(are8
    9
    Foc+sed F!e"d4Tr!a" Coord!na(or 6 Coordona(or a" cerce(7r!! :n (eren8
    ;
    3!deo(a&e F!e"d4Tr!a" Coord!na(or 6 coordona(or a" cerce(7r!! :n (eren :nre$!s(ra(e &e
    v!deocase(e.
    ,r+&+r!"e de L+cr+ &en(r+ DSM4I3 Te<( Rev!/+!( s+n( %en=!ona(e "a &a$. >34>3H
    ?1I
    H
    Grupul operativ pentru DSM-IV
    Grupul
    de
    Lucru
    pentru
    Tulbur
    rile
    Anxioa
    se
    M!c
    ae"
    R.L!
    e'o
    #!(/
    ,
    M.
    D.,
    *a%
    es
    C.
    Ba""
    en$
    er
    Pr
    e
    ed
    in
    te
    *o
    na
    (
    an
    D
    av
    !d
    so
    n,
    M
    .D
    .
    Dav
    !d
    H.
    Bar"
    o#,
    P.
    D.
    Edn
    a
    Foa,
    P.
    D.
    Vi
    ce
    pr
    e
    edinte A''y Feyer,M.D.
    Grupul de Lucru pentru Delirium,
    Demen, Tulburrile Amnestice si Alte
    Tulburri o!nitive
    ,ary *. T+c)er, M.D. Marsa"" Fo"s(e!n, M.D.
    Preedinte ,ary L"oyd ,o(("!e',
    M.D.
    M!ce" Po&)!n, M.D., I$or ,ran(, M.D.
    Vicepreedinte Ben@a%!n L!&(/!n,
    M.D.
    Er!c Do+$"as CA!ne, M.D.
    Grupul de Lucru pentru Tulburrile dia!nosticate
    de re!ul pentru prima dat "n #erioada de Su!ar,
    "n opilrie sau Adolescen
    Dav!d Sa..er, M.D., Race" -"e!n, P.D.
    Copreedinte Ben@a%!n Laey, P.D.
    Ma$da Ca%&'e"", M.D., Ro". Loe'er,P.D.
    Copreedinte Rea Pa+", P. D.
    S+san Brad!ey, M.D *+d!( H. L. Ra&o&or(,
    M.D.
    Den!s P. Can(#e"", M.D. B!r M!cae" R+((er,
    M.D.
    ,a'r!e""e A. Car"son, M.D. Fred 3o")%ar, M.D.
    Dona"d *ay Coen, M.D *on S.
    1erry, M.D.
    Barry ,ar.!n)e", M.D.
    Grupul de Lucru pentru
    Tulburrile de
    omportament
    Alimentar
    B. T!%o(y 1a"s, M.D., -a(er!ne A. Ha"%!,
    M.D.
    Preedinte *a%es M!(ce"", M.D.
    Pa+" ,ar.!n)eC, M.D.,. ,. Terence 1!"son,
    P.D.
    Grupul de Lucru pentru Tulburrile
    A$ective
    A. *on R+s, M.D., Dav!d D+nner, M.D.
    C-airperson E""en Fran), P. D.
    Mar(!n B. -e""er, M.D. Dona"d F. -"e!n, M.D.
    V
    icepre
    edint
    e
    Mar)
    S.
    Ba+er,
    M.D.
    Grupul operativ pentru DSM-IV
    XI
    Grupul de Lucru pentru #roblemele
    de odi$icare Multiaxial
    *ane( B. 1!""!a%s, D.S.1. *+an Enr!0+e Me//!c, M
    Preedinte Ro$er Pee"e, M.D.
    Ho#ard H. ,o"d%an, M.D., P.D. S(e&en Se((er'er$, M.D.
    Vicepreedinte Andre# Ed#ard S)odo" H, M.D.
    A""an M. ,r+en'er$, M.D.
    Grupul de Lucru pentru Tulburrile
    de #ersonalitate
    *on ,+nderson, M.D., Teodor M!"!on, P.D.
    Preedinte Br+ce P.o", M.D.
    Ro'er( M. A. H!rsc.e"d, M.D. Trac!e Sea, P.D.
    Vicepreedinte Lany S!ever, M.D.
    Ro$er B"as.!e"d, P.D. To%as A. 1!d!$er, P.D.
    S+san *ean F!es(er, M.D.
    Grupul de Lucru pentru Tulburarea Dis$oric
    #remenstrual
    *+d!( H. ,o"d, M.D., Sa""y Sever!no, M.D.
    Preedinte Nada Lo$an S(o("and, M.D.
    *ean End!co((, P.D. E""en Fran), P.D.
    Bar'ara Parry,, M.D. Cons+ltant
    Grupul de Lucru pentru Tulburrile de Inter$a ale
    Sistemelor #si%iatrice &Tulburrile de Adaptare, Disociative,
    'actice, ale ontrolului Impulsului si Somato$orme, si
    'actorii #si%olo!ici care a$ectea( ondiiile Medicale)
    Ro'er( E. Ha"es, M.D., S(even A. -!n$, M.D.
    Preedinte Rona"d L. Mar(!n, M.D. C. Ro'er(
    C"on!n$er, M.D. -a(ar!ne Anne P!""!&s, M.D.
    Vicepreedinte Dav!d A. S&!e$e", M.D.
    *ona(an F. Bor+s, M.D. A"an S(o+de%!re, M.D.
    *ac) Denn!n$ B+r)e, *r., M.D., M.P.H. *a%es *. S(r7!n, M.D.
    *oe P. Fa$an, M.D. M!cae" ,. 1!se, M.D.
    Grupul de Lucru pentru Sc%i(o$renie
    si Alte Tulburri #si%otice
    Nancy Coover Andreasen, M.D., P.D., Sa%+e" -e!(, M.D.
    Preedinte -enne( S. -end"er, M.D.
    *on M. -ane, M.D. To%as Mc,"asan, M.D.
    Vicepreedinte
    Xfl Grupul operativ pentru DSM-IV
    Grupul de Lucru pentru Tulburrile Sexuale
    Ces(er 1. Sc%!d(, M.D.,
    Preedinte RA+"
    Sc!av!, M.D.
    Les"!e Scover, P.D Tay"or
    Sea$raves, M.D. To%as Na(an
    1!se, M.D.
    Grupul de Lucru pentru Tulburrile de Somn
    Dav!d *. -+&.er, M.D., Ca!r&erson
    Preedinte Car"es E Re!no"ds El,
    M.D.,
    Vicepreedinte Dan!e"
    B+ysse, M.D.
    Ro$er Pee"e, M.D. D+en(!n
    Re$es(e!n, M.D. M!cae"
    Sa(e!a, M.D. M!cae" Tor&y,
    M.D
    Grupul de Lucru pentru Tulburrile
    "n le!tur cu o Substan
    Marc A"an Sc+c)!(, M.D.
    Preedinte *on E. He"/er,
    M.D.,
    Vicepreedinte L!nda B.
    Co(("er, P.D.
    L!nda B. Co(("er, P.D.
    To%as Cro#"ey, M.D. Pe(er
    E. Na(an, P.D. ,eor$e E.
    1oody, M.D
    omitetul pentru Dia!nostic si *valuare #si%iatric
    Lay(on McC+rdy, M.D.
    Preedinte E5FGH45FFIJ -enne( K.
    A"(s+"er, M.D. E5FGH45FF9J To%as F.
    Anders, M.D. E5FGG45FF5J S+san *ane
    B"+%en(a", M.D.E5FFL45FF;J *oan
    D!c)s(e!n, M.D. E5FGG45FFIJ Le#!s *.
    *+dd, M.D. E5FGG45FFIJ ,era"d L.
    -"er%an, M.D. Edeceda(J
    E5FGG45FF5J
    S(+ar( C. M+do.s)!, M.D. E5FF945FFIJ *ac)
    D. B"a!ne, M.D.,
    Cons+ltant E5FGH45FF9J
    *erry M. Le#!s, M.D.,
    Cons+ltant E5FGG45FFIJ
    Dan!e" *. L+c!ns, M.D.,
    Cons+ltant E5FGH45FF5J
    -a(ar!ne Ar%e P!""!&s, M.D., Lea
    Cons+ltant E5FF945FFIJ
    Cyn(!a Pear" Rose, M.D
    Cons+ltant E5FFL45FFIJ
    Lo+!s A"an Moenc, M.D.,
    Assembly Liaison E5FF545FFIJ
    S(even -. Do'sca, M.D.,
    Resident Fellow E5FFL45FF9 Mar)
    K!%%er%an, M.D.,
    Resident Fellow E5FF945FFIJ
    omitetul omun al onsiliului de Administraie
    si Adunrii 'ilialelor Districtuale pentru
    #roblemele ontroversate +e$eritoare la DSM-IV
    Rona"d A. Se""o#, M.D.
    Preedinte Harvey
    B"+es(one, M.D.
    Lea *oan D!c)s(e!n, M.D.
    Ar(+r *on Far"ey, M.D. Caro"
    Ann Berns(e!n, M.D.
    >III
    GRUPURILE DE LUCRU PENTRU DSM-IV
    TEXT REVIUIT
    MICHAEL B. FIRST, M.D.
    Copreedinte i Editor
    HAROLD ALAN PINCUS
    Copreedinte
    La+r!e E. McD+een, M.S.S. 1 Mos!e Sa(a)e, B.A.
    .ana/er Pproiect 0S. Coordonator Pro/ram 0S.
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor Anxioase
    M+rray B. S(e!n, M.D. M!ce""e Cras)e, P.D.
    Preedinte Edna Foa, P.D
    *ona(an A'ra%o#!(/, P.D. To%as Me""%an, M.D.
    Cordon As%+ndson, P.D. Ron Nor(on, P.D.
    *ean C. Bec)a%, P.D. Fran)"!n Scne!er, M.D.
    T!%o(y Bro#n, P.D, Psy.D. R!card K!n'ar$, P.D.
    Grupul de Lucru pentru revi(uirea textului Deliriumului,
    Demenei, Tulburrilor Amnestice si Altor Tulburri o!nitive
    si a textului Tulburrilor Mentale
    datorate unei ondiii Medicale Generale
    Er!c Do+$"as CA!ne, M.D. *esse Fann, M.D., M.P.H.
    Grupul de Lucru pentru revi(uirea textului Tulburrilor
    dia!nosticate de re!ul pentru prima dat "n
    #erioada de Su!ar, "n opilrie sau Adolescen
    Dav!d Sa..er, M.D. A%! -"!n, P.D.
    Preedinte Dan!e" P!ne
    Dona"d *. Coen, M.D. Mar) A. R!dd"e, M.D.
    S(e&en H(.!sa#, M.D. Fred R. 3o")%ar, M.D.
    Race" ,. -"e!n, P.D. Car"es Keana, M.D.
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor de omportament Alimentar
    -a(ar!ne L. Loe', P.D. B. T+no(y 1a"s, M.D.
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor de Mi,care induse de Medicamente
    ,erard Addon!/!o, M.D. A"an ,e"en'er$, M.D.
    Lenard Ad"er, M.D. *a%es *e..erson, M.D.
    B+r(on An$r!s(, M.D. D!"!& *es(e, M.D.
    Dan!e" Casey, M.D. Pe(er 1e!den, M.D.
    -IV Grupul operativ pentru DSM-IV
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor A$ective
    Mar) S. Ba+er, MD. M!cae" E. Tase, M.D.
    Pa(r!c!a S+&&es, M.D., P.D.
    Grupul de Lucru pentru revi(uirea textului
    Dia!nosticului Multiaxial
    A"an M. ,r+en'er$, M.D.
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor de #ersonalitate
    Br+ce P.o", M.D. To%as A, 1!d!$er, P.D.
    Grupul de Lucru pentru revi(uirea textului Tulburrilor de
    Inter$a ale Sistemului #si%iatric &Tulbur rile de Adaptare,
    Disociative, 'actice, de ontrol al Impulsului, Somato$orme
    ,i 'actorii #si%olo!ici care a$ectea( ondiia Medical)
    M!(ce"" Coen, M.D. R+sse"" Noyes, *r., M.D.
    Marc Fe"d%an, M.D. -a(ar!ne Anne P!""!&s, M.D.
    Er!c Ho""ander, M.D. Eya" Se%es, M.D.
    S(even A. -!n$, M.D. Dav!d A. S&!e$e", M.D.
    *a%es Levenson, M.D. *a%es *. S(r7!n, M.D.
    Rona"d L. Mar(!n, M.D. Sean H. M+(/y, M.D.
    *e..rey Ne#corn, M.D.
    Grupul de Lucru pentru revi(uirea textului Sc%i(o$reniei
    ,i Altor Tulburri #si%otice
    M!cae" F"a+%, M.D. >av!er A%ador, P.D.
    Preedinte
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor Sexuale si de Identitate Sexual
    Ces(er 1 Sc%!d(, M.D. To%as Na(an 1!se, M.D.
    R. Tay"or Se$raves, M.D. -enne( *. K+c)er, P.D.
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor de Somn
    Dan!e" B+ysse, M.D. Pe(er No#e"", M.D.
    Grupul de Lucru pentru revi(uirea textului
    Tulburrilor "n le!tur cu o Substan
    Marc A"an Sc+c)!((, M.D.
    Grupul operativ pentru DSM-IV
    XV
    omitetul Asociaiei Americane de #si%iatrie
    pentru Dia!nostic ,i *valuare #si%iatric
    Dav!d *. -+&.er, M.D. Lo+!s A"an Moenc, M.D.
    Preedinte Assembly Liaison
    *a%es Lec)%an, M.D. *ac) Barcas, M.D.
    .embr+ .embr+ Corespondent
    -a(ar!ne Anne P!""!&s, M.D Her'er( 1. Harr!s, M.D., P.D.
    .embr+ .embr+ Corespondent
    A. *on R+s, M.D. Car"es -ae"'er, M.D.
    .embr+ .embr+ Corespondent
    Dan!e" 1!ns(ead, M.D. *or$e A. Cos(a e S!"va, M.D.
    .embr+ .embr+ Corespondent
    Bonn!e K!%a, M.D., P.D. T. Bed!ran Us(+n, M.D.
    .embr+ .embr+ Corespondent
    Bar'ara -ennedy, M.D., P.D. Mes+scandra Da!'ar, M.D.
    Cons+ltant APA1 2laxo#3ellcome Fettaw
    *ane( B.1. 1!U!a%s, D.S.1.
    Cons+ltant

    Mulumiri pentru DSM-IV
    NN?SM4I3 es(e +n e.or( de ec!&7. Pes(e 5LLL de &ersoane Es! n+%eroase
    or$an!/a=!! &ro.es!ona"eJ ne4a+ a@+(a( "a e"a'orarea aces(+! doc+%en(. Me%'r!!
    ,r+&+"+! O&era(!v &en(r+ DSM4F3 O! S(a..4+" DSM4I3 s+n( %en=!ona=! "a &a$!na >I,
    %e%'r!! ,r+&+r!"or de L+cr+ a"e DSM4I3 s+n( %en=!ona=! "a &a$!n!"e >II4>I3, !ar o
    "!s(7 a ce"or"a"=! &ar(!c!&an=! es(e !nc"+s7 :n ane<a *.
    Res&onsa'!"!(a(ea %a@or7 &en(r+ con=!n+(+" DSM4I3 rev!ne ,r+&+"+! O&era(!v
    a" DSM4I3 s! %e%'r!"or ,r+&+r!"or de L+cr+ a"e DSM4I3. Aces(ea a+ "+cra(
    Eadesea, %+"( %a! $re+ decA( se aO(e&(a+J c+ +n devo(a%en( O! o '+n7 d!s&o/!=!e &e
    care n! "e4a+ !ns+."a( O! no+7. L+! Bo' S&!(/er :! %+"=+%!% :n %od s&ec!a" &en(r+
    e.or(+r!"e sa"e as!d+e O! v!/!+nea sa or!$!na"7. Mor%an Sar(or!+s, Darre" Re$!er,
    Le#!s *+dd, Fred ,ood#!n s! C+c) -ae"'er a+ con(r!'+!( cons!dera'!" "a
    .ac!"!(area +n+! sc!%' de &7rer!, rec!&roc .er(!", :n(re Asoc!a=!a A%er!can7 de
    Ps!!a(r!e EAPAJ O! Or$an!/a=!a Mond!a"7 a S7n7(7=!!, care a a%e"!ora( a(A( DSM4F3,
    cA( s! CIM45L, s! a cresc+( co%&a(!'!"!(a(ea "or. S+n(e% rec+nosc7(or! "+! Ro'er(
    Israe", S+e Meads O! A%y B"+% de "a Na(!ona" Cen(er .or Hea"( S(a(!s(!cs s! "+!
    Andrea A"'a+% Fe!ns(e!n de "a A%er!can Hea"( In.or%a(!on Mana$e%en(
    Assoc!a(!on &en(r+ s+$es(!!"e re.er!(oare "a s!s(e%+" de cod!.!care a" DSM4I3. Den!s
    Pra$er, Pe(er Na(an O! Dav!d -+&.er ne4a+ a@+(a( "a e"a'orarea +ne! no! s(ra(e$!!
    de reana"!/are a da(e"or, care a .os( s+s=!n+(7 c+ .ond+r! de "a *on D. and Ca(er!ne
    T. MacAr(+r Fo+nda(!on.
    De ase%enea, %+"(e &ersoane d!n Asoc!a=!a A%er!can7 de Ps!!a(r!e %er!(7
    $ra(!(+d!nea noas(r7. Sa$ac!(a(ea s! '+n7vo!n=a e<(raord!nar7 a "+! Me! Sa's!n
    a+ .7c+( ca s! ce"e %a! anos(e sarc!n! s7 &ar7 "+cr+r! !%&or(an(e. A%er!can
    Psyc!a(r!c Assoc!a(!on Co%!(ee on Psyc!a(r!c D!a$nos(!c and Assess%en(
    E&re/!da( de Lay(on Mc*K+rdyJ ne4a o.er!( o :ndr+%are s! cons!"!ere &re=!oas7.
    P!ne%, de ase%enea, s7 %+"=+%!% &reOed!n=!"or Asoc!a=!e! A%er!cane de
    Ps!!a(r!e EDoc(or!! F!n), Pardes, Benede), Har(%ann, En$"!s s! Mc"n(yreJ s!
    &+r(7(or!"or de c+vAn( a! Ad+n7r!! EDoc(or!! Coen, F"a%%, Han!n, P.ae"er s!
    Se""o#J care ne4a+ a@+(a( :n &"an!.!carea %+nc!! noas(re. Caro"yn Ro'!no#!(/ O!
    *ac) 1!(e O!, res&ec(!v, cadre"e "or de "a B!ro+" D!rec(or+"+! Med!ca" a" Asoc!a=!e!
    A%er!cane de Ps!!a(r!e s! de "a B+s!ness Ad%!n!s(ra(!on O..!ce ne4a+ acorda( o
    as!s(en=7 &re=!oas7 :n or$an!/area &ro!ec(+"+!.
    M+"(or a"(or &ersoane "e da(or7% :n(rea$a noas(r7 $ra(!(+d!neQ 1endy Dav!s,
    Nancy 3e((ore""o s! Nancy Sydnor4,reen'er$ a+ e"a'ora( O! !%&"e%en(a( o
    s(r+c(+r7 or$an!/a=!ona"7 care a .7c+( ca aces( &ro!ec( co%&"e< s7 n+ sca&e de s+'
    con(ro". No! a% .os(, de ase%enea, do(a=! c+ +n cons!"!+ ad%!n!s(ra(!v e<(re% de
    ca&a'!", care a !nc"+s &e E"!sa'e( F!(/+$, 1!""a Ha"!, -e""y Mc-!nney, ,"or!a
    M!e"e, He"en S(ayna, Sara T!""y, N!na Rosen(a", S+san Mann, *oana Mas s!, :n
    s&ec!a", &e C!ndy *ones. R+( Ross, !n.a(!$a'!"a noas(r7 redac(or O(!!n=!.!c, a
    r7s&+ns de a%e"!orarea c"ar!(7=! e<&res!e! s! or$an!/7r!! DSM4I3. Myr!a% -"!ne
    Ecoordona(oarea cerce(7r!! &en(r+ (es(7r!"e :n (eren, cen(ra(e &e DSM4F3, &en(r+
    NIH, *!% To%&son Ecoordona(or a" cerce(7r!! &en(r+ MacAr(+r Fo+nda(!on4
    .+nded 3!deo(a&e F!e"d Tr!a"J O! Sandy Ferr!s Ed!rec(or ad@+nc( a" B!ro+"+! de
    XVII
    XVIII Mul!u"iri pentru DSM-IV
    Cerce(areJ a+ ad+s %+"(e con(r!'+=!! &re=!oase. De ase%enea, =!ne% s7 %+"=+%!%
    &e aceas(7 ca"e (+(+ror ce"or"a"(e cadre de cond+cere a"e Asoc!a=!e! A%er!cane de
    Ps!!a(r!e care a+ a@+(a( "a aces( &ro!ec(. Ron McM!""en, C"a!re Re!n'+r$, Pa%
    Har"ey s! *ane Daven&or( de "a A%er!can Psyc!a(r!c Press a+ as!$+ra( o as!s(en=7
    (en!c7 de :na"(7 c"as7.
    A""en Frances, M.D.
    Preedinte, 2r+p+l 4perati* pentr+ 0S.#5V
    Haro"d A"an P!nc+s
    Vicepreedinte, 2r+p+l 4perati* pentr+ 0S.#5V
    M!cae" B. F!rs(, M.D. Editor
    Text si Criterii 0S.#5V
    To%as A. 1!d!$er, P.D
    Coordonator Cercetare
    Mulumiri pentru DSM-IV
    Text +evi(uit
    I.or(+" de a rev!/+! (e<(+" DSM4F3 a .os(, de ase%enea, +n e.or( de
    ec!&7. S+n(e% :nda(ora=! :n s&ec!a" e.or(+r!"or !n.a(!$a'!"e a"e
    $r+&+r!"or de L+cr+ &en(r+ rev!/+!rea (e<(+"+! DSM4I3 E%en=!ona=! "a
    &a$. <v4<v!!J, c7rora "e4a reven!( &ar(ea "e+"+! :n e.ec(+area aces(e!
    rev!/+!r!. 3re%, de ase%enea, s7 re%arc7% con(r!'+=!a d!verO!"or
    cons!"!er! a! ,r+&+r!"or de L+cr+ Eve/! ane<a -, &a$. F9FJ care s!4a+ e<&r!%a(
    o&!n!!"e :n "e$7(+r7 c+ .a&(+" dac7 %od!.!c7r!"e &ro&+se s+n( @+s(!.!ca(e sa+ n+. :n
    .!na" a% vrea s7 %+"=+%!% Co%!(e(+"+! Asoc!a=!e! A%er!cane de Ps!!a(r!e
    &en(r+ Eva"+are s! D!a$nos(!c Ps!!a(r!c E%en=!ona=! "a &a$. <v!!J care ne4a+ o.er!( o
    :ndr+%are s! s+&erv!/are +(!"7 :n c+rs+" &roces+"+! de e"a'orare, &rec+% s!
    a&ro'area doc+%en(+"+! .!na". M+"=+%!r! s&ec!a"e %er!(7 %e%'r!! co%!(e(+"+!,
    -a(ar!ne A. P!""!&s s! *ane( B.1. 1!""!a%s &en(r+ %e(!c+"o/!(a(ea c+ care a+
    rev7/+( (e<(+" rev!/+!(. Des!$+r, n!%!c d!n (oa(e aces(ea n+ ar .! .os( &os!'!"e .7r7
    va"oroasa as!s(en=7 or$an!/a(or!c7 s! ad%!n!s(ra(!v7 o.er!(7 de s(a..4+" DSM4F3,
    La+r!e McD+een s! Mos!e Sa(a)e s! as!s(en=a de &rod+c=!e o.er!(7 de Anne Barnes,
    Pa% Har"ey, ,re$ -+ny, C"a!re Re!n'+r$ s! Ron McM!""en de "a A%er!can
    Psyc!a(r!c Press.
    M!cae" B. F!rs(, M.D.
    Copreedinte si Editor
    Haro"d A"an P!nc+s
    Copreedinte
    XIX
    *

    .tili(area Manualului
    Pro#e$eele $e #o$i%i#are &i raportare
    odurile dia!nostice
    S!s(e%+" de cod!.!care o.!c!a" :n +/ :n S(a(e"e Un!(e, d+&7 &+'"!carea aces(+!
    %an+a", es(e Clasi)icarea 5nterna(ional6 a .aladiilor, cea de a No+a Rev!/+!re,
    Mod!.!carea C"!n!c7 EICD4F4CMJ. Ce"e %a! %+"(e (+"'+r7r! d!n DSM4I3 a+ +n cod
    n+%er!c ICD4F4CM care a&are de %a! %+"(e or!Q 5J &recedAnd den+%!rea (+"'+r7r!!
    :n c"as!.!care E&a$. 5;49RJ, 9J "a :nce&+(+" sec=!+n!! (e<(+"+! &en(r+ .!ecare (+"'+rare,
    s! ;J :nso=!nd se(+" de cr!(er!! &en(r+ .!ecare (+"'+rare. Pen(r+ +ne"e d!a$nos(!ce Ede
    e<., re(ardarea %en(a"7, (+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7J, cod+"
    cores&+n/7(or de&!nde de s&ec!.!ca=!a care +r%ea/7 s! es(e %en=!ona( d+&7 (e<(+" s!
    se(+" de cr!(er!! a" (+"'+r7r!!. Den+%!r!"e +nora d!n(re (+"'+r7r! s+n( +r%a(e de
    (er%en! a"(erna(!v! &+O! :n(re &aran(e/e, care, :n ce"e %a! %+"(e ca/+r!, s+n(
    den+%!r!"e DSM4III4R a"e (+"'+r7r!"or.
    U(!"!/area cod+r!"or d!a$nos(!ce es(e .+nda%en(a"7 &en(r+ s(ocarea
    :nre$!s(r7r!"or %ed!ca"e. Cod!.!carea d!a$nos(!ce"or +O+rea/7 s(rAn$erea de da(e,
    rec+&erarea O! co%&!"area !n.or%a=!e! s(a(!s(!ce. Cod+r!"e s+n(, de ase%enea,
    necesare &en(r+ a ra&or(a da(e d!a$nos(!ce care !n(eresea/7 (er=e &7r=!, !nc"+/And
    a$en=!!"e $+verna%en(a"e, soc!e(7=!"e de as!$+r7r! &r!va(e s! Or$an!/a=!a
    Mond!a"7 a S7n7(7=!!. De e<e%&"+, :n S(a(e"e Un!(e, +(!"!/area aces(or cod+r! a
    .os( %anda(a(7 de Hea"( Care F!nanc!n$ Ad%!n!s(ra(!on :n sco& de ra%'+rsare
    &r!n s!s(e%+" Med!care.
    S+'(!&+r!"e Ed!n(re care +ne"e s+n( cod!.!ca(e c+ o a c!ncea c!.r7J O! s&ec!.!can=!!
    s+n( &rev7/+=! &en(r+ a cres(e s&ec!.!c!(a(ea. S+btip+rile de.!nesc s+'$r+&7r!
    .eno%eno"o$!ce :n cadr+" +n+! d!a$nos(!c, care se e<c"+d rec!&roc s! s+n( e<a+s(!ve
    :%&re+n7 :n cadr+" +n+! d!a$nos(!c, O! s+n( !nd!ca(e &r!n !ns(r+c=!+nea Sde s&ec!.!ca(
    (!&+"T d!n se(+" de cr!(er!!. De e<e%&"+, (+"'+rarea de"!ran(7 es(e s+'(!&a(7 &e 'a/a
    con=!n+(+"+! !de!"or de"!ran(e :n Oa&(e s+'(!&+r!Q ero(o%an!e, de $randoare, de
    $e"o/!e, de &ersec+=!e, so%a(!c, %!<( O! nes&ec!.!ca(. D!n con(ra, speci)ican(ii n+ s+n(
    conce&+=! a .! e<c"+s!v! rec!&roc O! e<a+s(!v! :%&re+n7, O! s+n( !nd!ca=! &r!n
    !ns(r+c=!+nea Sde s&ec!.!ca( dac7T d!n ser+" de cr!(er!! Ede e<., &en(r+ .o'!a soc!a"7,
    !ns(r+c=+nea no(!.!c7 Sde s&ec!.!ca( dac7Q $enera"!/a(7TJ. S&ec!.!can=!! o.er7
    o&or(+n!(a(ea de a descr!e o s+'$r+&are %a! o%o$en7 de !nd!v!/! c+ (+"'+rarea, care
    a+ :n co%+n an+%!(e e"e%en(e Ede e<., (+"'+rare de&res!v7 %a@or7, c+ e"e%en(e
    %e"anco"!ceJ. DeO! o a c!ncea c!.r7 es(e des(!na(7 +neor! s7 cod!.!ce +n s+'(!& sa+
    s&ec!.!can( Ede e<., 9FI.55 De%en=7 de (!& A"/e!%er, c+ de'+( (ard!v, c+ !de!
    de"!ran(eJ sa+ sever!(a(ea E9FR.95 T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, +OorJ,
    %a@or!(a(ea s+'(!&+r!"or s! s&ec!.!can=!"or !nc"+O! :n DSM4I3 n+ &o( .! cod!.!ca=! :n
    cadr+" s!s(e%+"+! ICD4F4CM O! s+n( !nd!ca=! n+%a! &r!n !nc"+derea s+'(!&+"+! sa+
    s&ec!.!can(+"+! d+&7 n+%e"e (+"'+r7r!! Ede e<., .o'!e soc!a"7, $enera"!/a(7J.
    .tili(area manualului
    Speci$icanii de severitate ,i de evoluie
    Un d!a$nos(!c DSM4I3 es(e a&"!ca( de re$+"7 s(7r!! &re/en(e a !nd!v!d+"+! s! n+
    es(e +(!"!/a(, :n $enera", &en(r+ a !nd!ca d!a$nos(!ce"e an(er!oare d!n care !nd!v!d+"
    s4a rec+&era(. Ur%7(or!! s&ec!.!can=!, !nd!cAnd sever!(a(ea s! evo"+=!a, &o( .!
    %en=!ona=! d+&7 d!a$nos(!cQ +Ooar7, %odera(7, sever7, :n re%!s!+ne &ar=!a"7, :n
    re%!s!+ne co%&"e(7, S!s(or!c an(er!or de...T
    S&ec!.!can=!!, +Ooar7, %odera(7 s! sever7 (re'+!e +(!"!/a=! n+%a! cAnd cr!(er!!"e
    &en(r+ (+"'+rare s+n( ac(+a"%en(e !n(e$ra" sa(!s.7c+(e, :n a dec!de dac7 (a'"o+"
    c"!n!c (re'+!e descr!s ca +Oor, %odera( sa+ sever, c"!n!c!an+" (re'+!e s7 !a :n
    cons!dera=!e n+%7r+" s! !n(ens!(a(ea se%ne"or s! s!%&(o%e"or (+"'+r7r!! s! or!ce
    de(er!orare care re/+"(7 :n .+nc=!onarea &ro.es!ona"7 sa+ soc!a"7. Pen(r+ %a@or!(a(ea
    (+"'+r7r!"or &o( .! +(!"!/a(e +r%7(oare"e "!n!! d!rec(oareQ
    UOoar7. S+n( &re/en(e &+=!ne, dac7 n+ c!ar n!c! +n s!%&(o% :n e<ces .a=7
    de ce"e cer+(e &en(r+ a &+ne d!a$nos(!c+", !ar s!%&(o%e"e n+ d+c decA( "a o
    de(er!orare %!nor7 :n .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7.
    Modera(7. S+n( &re/en(e s!%&(o%e sa+ de(er!orare .+nc=!ona"7 :n(re
    S+Ooar7T s! Ssever7T.
    Sever7. S+n( &re/en(e %+"(e s!%&(o%e :n e<ces .a(7 de ce"e cer+(e &en(r+
    a &+ne d!a$nos(!c+" sa+ s+n( &re/en(e %a! %+"(e s!%&(o%e e<(re% de severe,
    or! s!%&(o%e"e cond+c "a o de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea soc!a"7
    sa+ &ro.es!ona"7.
    :n re%!s!+ne &ar=!a"7. Toa(e cr!(er!!"e &en(r+ (+"'+rare a+ .os( sa(!s.7c+(e
    an(er!or, dar ac(+a"%en(e a+ r7%as n+%a! cA(eva s!%&(o%e sa+ se%ne a"e
    (+"'+r7r!!.
    :n re%!s!+ne co%&"e(7. N+ %a! e<!s(7 n!c! +n .e" de s!%&(o%e sa+ se%ne
    a"e (+"'+r7r!!, dar c"!n!c es(e :nc7 !%&or(an( a se %en=!ona (+"'+rarea U de
    e<e%&"+, "a +n !nd!v!d c+ e&!soade an(er!oare de (+"'+rare '!&o"ar7 care s+'
    (ra(a%en( c+ "!(!+ n+ a %a! &re/en(a( n!c! +n .e" de s!%&(o%e :n +"(!%!! (re!
    an!. D+&7 o &er!oad7 de (!%& de re%!s!+ne co%&"e(7, c"!n!c!an+" &oa(e
    cons!dera !nd!v!d+" ca rec+&era(, O!, ca a(are, n+ va %a! cod!.!ca (+"'+rarea
    ca d!a$nos(!c c+ren(. D!.eren=!erea re%!s!+n!! co%&"e(e de rec+&erare
    neces!(7 "+area :n cons!dera=!e a %a! %+"(or .ac(or!, !nc"+/And evo"+=!a
    carac(er!s(!c7 a (+"'+r7r!!, (!%&+" sc+rs de "a +"(!%a &er!oad7 de &er(+r'are,
    d+ra(a (o(a"7 a &er(+r'7r!! s! neces!(a(ea de eva"+are con(!n+7 sa+ de
    (ra(a%en( &ro.!"ac(!c.
    Is(or!c an(er!or. Pen(r+ an+%!(e sco&+r!, &oa(e .! +(!"7 no(area !s(or!c+"+!
    cr!(er!!"or care a+ .os( sa(!s.7c+(e &en(r+ o (+"'+rare, c!ar cAnd se cons!der7
    c7 !nd!v!d+" s4a rec+&era( d!n ea. A(ar! d!a$nos(!ce de (+"'+rare %en(a"7 :n
    (rec+( vor .! !nd!ca(e &r!n +(!"!/area s&ec!.!can(+"+! de !s(or!c an(er!or Ede e<.,
    V An<!e(a(e de se&arare, !s(or!c an(er!or W, "a +n !nd!v!d c+ +n !s(or!c de
    an<!e(a(e de se&arare care n+ are n!c! o (+"'+rare c+ren(7 sa+ 2care
    ac(+a"%en(e sa(!s.ace cr!(er!!"e &en(r+ &an!c7J.
    Cr!(er!! s&ec!.!ce &en(r+ a de.!n! .or%e"e +Ooar7, %odera(7 O! sever7, a+ .os(
    &rev7/+(e &en(r+ +r%7(oare"e (+"'+r7r!Q re(ardarea %en(a"7, (+"'+rarea de
    cond+!(7, e&!sod+" %an!aca" O! e&!sod+" de&res!v %a@or. De ase%enea, a+ .os(
    &rev7/+(e cr!(er!! s&ec!.!ce &en(r+ de.!n!rea re%!s!+n!! &ar=!a"e s! co%&"e(e &en(r+
    +r%7(oare"e (+"'+r7r!Q e&!sod+" %an!aca", e&!sod+" de&res!v %a@or O! de&enden=a
    de o s+'s(an=7.
    Introducere
    * r 2 " ) c e
    ceas(a es(e cea de a &a(ra ed!=!e a Man+a"+"+! de D!a$nos(!c s! S(a(!s(!c7
    a T+"'+r7r!"or Men(a"e sa+ DSM4I3 a" Asoc!a=!e! A%er!cane de Ps!!a(r!e. U(!"!(a(ea
    s! cred!'!"!(a(ea DSM4I3 cer ca e" s7 se cen(re/e &e sco&+r!"e sa"e c"!n!ce, de cerce(are
    s! ed+ca=!ona"e s! s7 .!e s+s=!n+( de +n .+nda%en( e%&!r!c e<(!ns. S+&re%a noas(r7
    &reoc+&are a .os( aceea de a o.er! +n $!d +(!" &rac(!c!! c"!n!ce. No! a% dor!( s7
    .ace% DSM4I3 &rac(!c s! +(!" &en(r+ c"!n!c!en!, +r%7r!nd sc+r(area se(+r!"or de
    cr!(er!!, c"ar!(a(ea "!%'a@+"+! s! .or%+"7r! e<&"!c!(e a"e cons(r+c(e"or !nc"+se :n
    cr!(er!!"e de d!a$nos(!c. Un o'!ec(!v s+&"!%en(ar a .os( ace"a de a .ac!"!(a cerce(area
    s! de a a%e"!ora co%+n!carea d!n(re c"!n!c!en! s! cerce(7(or!. No! a% .os( conO(!en=!,
    de ase%enea, de +(!"!/area DSM4I3 &en(r+ a%e"!orarea co"ec(7r!! de !n.or%a=!!
    c"!n!ce s! ca !ns(r+%en( ed+ca=!ona" &en(r+ &redarea &s!o&a(o"o$!e!.
    O no%enc"a(+r7 o.!c!a"7 (re'+!e s7 .!e a&"!ca'!"7 :n(r4o "ar$7 d!vers!(a(e de
    con(e<(e. DSM4I3 es(e +(!"!/a( de c"!n!c!en! s! cerce(7(or! de ce"e %a! d!.er!(e
    or!en(7r! Ede e<., '!o"o$!c7, &s!od!na%!c7, co$n!(!v7, co%&or(a%en(a"7,
    !n(er&ersona"7, .a%!"!eXs!s(e%eJ. E" es(e +(!"!/a( de &s!!a(r!, de a"=! %ed!c!, de
    &s!o"o$!, as!s(en=! soc!a"!, s+ror! %ed!ca"e, (era&e+=! oc+&a=!ona"! s! de rec+&erare,
    cons!"!er! s! a"=! &ro.es!on!O(! d!n do%en!+" s7n7(7=!! s! s7n7(7=!! %en(a"e. DSM4I3
    (re'+!e s7 .!e +(!"!/a'!" :n d!verse s!(+a=!!4&ac!en( !n(erna( :n s&!(a", &ac!en(
    a%'+"a(or, s&!(a" &ar=!a", cons+"(a=!e de s&ec!a"!(a(e :n(r4o +n!(a(e de a"( &ro.!",
    c"!n!c7, &rac(!c7 &r!va(a s! &ro.!"a<!e &r!%ar7 s! :n co%+n!(7=! &o&+"a=!ona"e. De
    ase%enea, e" es(e +n !ns(r+%en( necesar &en(r+ co"ec(area s! co%+n!carea +nor da(e
    s(a(!s(!ce e<ac(e de s7n7(a(e &+'"!c7. D!n .er!c!re, (oa(e aces(e +(!"!/7r! %+"(!&"e s+n(
    co%&a(!'!"e +ne"e c+ a"(e"e.
    DSM4I3 es(e &rod+s+" ac(!v!(7=!! a 5; ,r+&+r! de L+cr+ Eve/! ane<a *J, .!ecare
    $r+& avAnd res&onsa'!"!(a(ea &r!nc!&a"7 &en(r+ cA(e o sec=!+ne a %an+a"+"+!.
    Aceas(7 or$an!/are a .os( des(!na(7 s7 creasc7 &ar(!c!&area de s&ec!a"!O(! :n .!ecare
    d!n do%en!!"e res&ec(!ve. A% "+a( +n n+%7r de &reca+=!! &en(r+ a avea $aran=!a c7
    reco%and7r!"e ,r+&+"+! de L+cr+ re."ec(7 %+"(!(+d!nea da(e"or s! o&!n!!"or
    e<!s(en(e s! n+ doar &+nc(e"e de vedere a"e an+%!(or %e%'r!. D+&7 cons+"(7r!
    a%&"e c+ e<&er=! s! c"!n!c!en! d!n .!ecare do%en!+, a% se"ec(a( ca %e%'r! a!
    ,r+&+"+! de L+cr+ &e ce! care &re/en(a+ +n s&ec(r+ "ar$ de &+nc(e de vedere s! de
    c+noO(!n=e. Me%'r!! ,r+&+"+! de L+cr+ a+ .os( !ns(r+!=! as+&ra .a&(+"+! c7 e! vor
    &ar(!c!&a :n ca"!(a(e de d!sc!&o"! a! consens+"+! s! n+ ca a&7r7(or! a! vec!"or &+nc(e
    de vedere, :n &"+s, a% s(a'!"!( ca ,r+&+r!"e de L+cr+ s7 +r%e/e o %e(od7 de "+cr+
    r!$+roas7, &e 'a/7 de da(e.
    ,r+&+r!"e de L+cr+ a+ ra&or(a( ac(!v!(a(ea ,r+&+"+! O&era(!v a" DSM4I3 Eve/!
    &a$ >IJ, care a .os( cons(!(+!( d!n 9H %e%'r!, d!n(re care %+"=! &re/!da+ cA(e +n
    ,r+& de L+cr+. F!ecare d!n(re ce"e 5; ,r+&+r! de L+cr+ a .os( co%&+s d!n Y Esa+
    c!ar %a! %+"=!J %e%'r! a"e c7ror s(+d!! a+ .os( ana"!/a(e de c7(re YL &An7 "a 5LL de
    cons!"!er!, a"eO! as(.e" :ncA( s7 re&re/!n(e d!verse co%&e(en=e, d!sc!&"!ne, .or%a=!! s!
    %ed!! c"!n!ce O! de cerce(are. I%&"!carea %+"(or e<&er=! !n(erna=!ona"! $aran(ea/7
    .a&(+" c7 DSM4I3 a d!s&+s de ce" %a! vas( .ond de !n.or%a=!! s! &oa(e .! a&"!ca( :n
    >>I
    --II Introducere
    ce"e %a! d!verse c+"(+r!. A+ .os( =!n+(e con.er!n=e s! a(e"!ere de "+cr+ s&re a o.er! o
    or!en(are conce&(+a"7 s! %e(odo"o$!c7 &en(r+ e"a'orarea DSM4I3. Aces(ea a+ !nc"+s
    +n n+%7r de cons+"(7r! :n(re a+(or!! DSM4I3 s! a+(or!! ICD45L or$an!/a(e :n sco&+"
    creO(er!! co%&a(!'!"!(7=!! d!n(re ce"e do+7 s!s(e%e. De ase%enea, s4a+ =!n+( %a!
    %+"(e con.er!n=e %e(od!ce, a<a(e &e .ac(or!! c+"(+ra"! :n d!a$nos(!c+" (+"'+r7r!!
    %en(a"e, &e d!a$nos(!c+" $er!a(r!e s! &e d!a$nos(!c+" &s!!a(r!c :n +n!(7=!"e de
    as!s(en=7 %ed!ca"7 &r!%ar7.
    Pen(r+ a %en=!ne "!n!! de co%+n!care desc!se s! e<(!nse, ,r+&+" O&era(!v a
    s(a'!"!( "e$7(+r! c+ %+"(e a"(e co%&onen(e d!n cadr+" Asoc!a=!e! A%er!cane de
    Ps!!a(r!e, &rec+% s! c+ &es(e RL de or$an!/a=!! s! asoc!a=!! !n(eresa(e :n e"a'orarea
    DSM4I3 Ede e<., A%er!can Hea"( In.or%a(!on Mana$e%en( Assoc!a(!on, A%er!can
    N+rses2 Assoc!a(!on, A%er!can Occ+&a(!ona" Tera&y Assoc!a(!on8 A%er!can
    Psycoana"y(!c Assoc!a(!on, A%er!can Psyco"o$!ca" Assoc!a(!on, A%er!can
    Psyco"o$!ca" Soc!e(y, Coa"!(!on .or (e Fa%!"y, ,ro+& .or (e Advance%en( o.
    Psyc!a(ry, Na(!ona" Assoc!a(!on o. Soc!a" 1or)er, Na(!ona" Cen(er .or Hea"(
    S(a(!s(!cs, Or$an!/a=!a Mond!a"7 a S7n7(7=!!J. A% :ncerca( s7 e<&+ne% s+'!ec(e"e s!
    da(e"e e%&!r!ce de "a :nce&+(+" ac=!+n!!, :n sco&+" !den(!.!c7r!! even(+a"e"or
    &ro'"e%e s! d!.eren=e de !n(er&re(are. Sc!%'+r!"e de !n.or%a=!! a+ .os(, de
    ase%enea, &os!'!"e &r!n d!s(r!'+!rea +n+! '+"e(!n '!an+a" E(e DSM4U&da(eJ,
    &+'"!carea +ne! co"oane re$+"a(e des&re DSM4I3 :n Hos&!(a" and Co%%+n!(y
    Psyc!a(ry, &re/en(7r! .recven(e "a con.er!n=e"e na=!ona"e s! !n(erna=!ona"e, &rec+%
    s! &r!n n+%eroase ar(!co"e a&7r+(e :n d!verse &+'"!ca=!!.
    C+ do! an! :na!n(e de &+'"!carea DSM4I3, ,r+&+" O&era(!v a &+'"!ca( s!
    d!s(r!'+!( "ar$ DSM4I3 O&(!ons Boo). Aces( vo"+% a &re/en(a( +n s+%ar
    c+&r!n/7(or de &ro&+ner! a"(erna(!ve care era+ av+(e :n vedere &en(r+ !nc"+derea :n
    DSM4I3, c+ sco&+" de a so"!c!(a o&!n!! s! da(e s+&"!%en(are &en(r+ de/'a(er!"e
    noas(re. A% &r!%!( o vas(7 cores&onden=7 de "a &ersoane"e !n(eresa(e, care ne4a+
    .+rn!/a( da(e s+&"!%en(are s! ne4a+ .7c+( reco%and7r! :n "e$7(+r7 c+ even(+a"+"
    !%&ac( a" &os!'!"e"or sc!%'7r! d!n DSM4I3 as+&ra &rac(!c!! "or c"!n!ce, &rec+% s!
    as+&ra :nv7=7%An(+"+!, cerce(7r!! s! ac(!v!(7=!! ad%!n!s(ra(!ve. Aceas(7 a%&"oare a
    d!sc+=!!"or ne4a a@+(a( s7 an(!c!&7% +ne"e &ro'"e%e s! s7 :ncerc7% s7 re&er7% cea
    %a! '+n7 so"+=!e d!n(re d!.er!(e"e o&=!+n!. C+ +n an :na!n(e de &+'"!carea DSM4I3,
    o sc!=7 a&roa&e .!na"7 a se(+r!"or de cr!(er!! &ro&+se a .os( d!s(r!'+!(7 &en(r+ a
    &er%!(e o +"(!%7 rev!/+!re cr!(!c7.
    S&re a a@+n$e "a dec!/!!"e .!na"e re.er!(oare "a DSM4I3, ,r+&+r!"e de L+cr+ s!
    ,r+&+" O&era(!v a+ ana"!/a( (oa(e da(e"e e%&!r!ce s! vas(a cores&onden=7 ad+na(7.
    Conv!n$erea noas(r7 es(e c7 !nova=!a %a@or7 a DSM4I3 cons(7, n+ :n %od!.!c7r!"e
    con=!n+(+"+! s&ec!.!c, c! :n &roces+" s!s(e%a(!c s! e<&"!c!( &r!n care e" a .os( cons(r+!(
    s! doc+%en(a(. Ma! %+"( decA( or!care a"(7 no%enc"a(+r7 a (+"'+r7r!"or %en(a"e,
    DSM4I3 es(e .onda( &e da(e e%&!r!ce.
    'un$a"entare i&tori#(
    Neces!(a(ea +ne! c"as!.!c7r! a (+"'+r7r!"or %en(a"e es(e ev!den(7 de4a "+n$+"
    :n(re$!! !s(or!! a %ed!c!n!!, dar a e<!s(a( &+=!n consens as+&ra (+"'+r7r!"or care ar
    (re'+! s7 .!e !nc"+se s! a %e(ode! o&(!%e &en(r+ or$an!/area "or. N+%eroase"e
    no%enc"a(+r! e"a'ora(e :n dec+rs+" +"(!%e"or do+7 %!"en!! d!.er7 :n(re e"e &r!n
    accen(+" re"a(!v &+s &e .eno%eno"o$!e, e(!o"o$!c s! evo"+=!e, ca e"e%en(e de.!n!(or!!.
    Une"e s!s(e%e !nc"+d n+%a! o %An7 de ca(e$or!! d!a$nos(!ce, &e cAnd a"(e"e !nc"+d %!!.
    Intro$u#ere XXIII
    :n a.ar7 de aceas(a, d!verse"e s!s(e%e de c"as!.!care a (+"'+r7r!"or %en(a"e se d!s(!n$
    :n(re e"e, d+&7 c+% o'!ec(!v+" "or &r!nc!&a" a .os( +(!"!/area :n c"!n!c7, :n cerce(are
    sa+ :n s(a(!s(!c7. Deoarece !s(or!a c"as!.!c7r!! es(e &rea vas(7 &en(r+ a &+(ea .!
    re/+%a(7 a!c!, ne vo% concen(ra, &e sc+r(, n+%a! as+&ra ace"or as&ec(e care a+ d+s
    :n %od d!rec( "a e"a'orarea Man+a"+"+! de D!a$nos(!c s! S(a(!s(!c7 a T+"'+r7r!"or
    Men(a"e EDSMJ O! "a sec=!+nea (+"'+r7r!"or %en(a"e d!n d!verse"e ed!=!! a"e
    C"as!.!c7r!! In(erna=(ona"e a Ma"ad!!"or ECIM sa+ ICDJ.
    :n S(a(e"e Un!(e, !%'o"d+" !n!=!a" &en(r+ e"a'orarea +ne! c"as!.!c7r! a (+"'+r7r!"or
    %en(a"e 54a cons(!(+!( neces!(a(ea s(rAn$er!! de !n.or%a=!! s(a(!s(!ce. Ceea ce ar &+(ea
    .! cons!dera( ca &r!%a (en(a(!v7 o.!c!a"7 de a s(rAn$e !n.or%a=!! des&re (+"'+r7r!"e
    %en(a"e :n S(a(e"e Un!(e ar .! :nre$!s(rarea .recven=e! +ne! ca(e$or!! U
    S!d!o=!aXne'+n!aT "a recens7%An(+" d!n 5GIL. La recens7%An(+" d!n 5GGL era+
    d!s(!nse Oa&(e ca(e$or!! de %a"ad!! %en(a"e U %an!a, %e"anco"!a, %ono%an!a,
    &are/a, de%en=a, d!&so%an!a s! e&!"e&s!a, :n 5F5H, Co%!(e(+" &en(r+ S(a(!s(!c7 a"
    Asoc!a=!e! A%er!cane de Ps!!a(r!e Eden+%!(7 :n ace" (!%& Asoc!a=!a Med!co4
    Ps!o"o$!c7 A%er!can7J Zden+%!rea a .os( sc!%'a(7 :n 5F95[, :%&re+n7 c+
    Co%!s!a Na=!ona"7 &en(r+ I$!ena Men(a"7, a+ .or%+"a( +n &"an care a .os( ado&(a(
    de B!ro+" de Recens7%An( &en(r+ s(rAn$erea de s(a(!s(!c! +n!.or%e d!n s&!(a"e"e de
    (+"'+r7r! %en(a"e. DeO! aces( s!s(e% acorda %a! %+"(7 a(en=!e +(!"!(7=!! c"!n!ce decA(
    ce" an(er!or, e" r7%Anea :n esen=7 o c"as!.!care s(a(!s(!c7. Asoc!a=!a A%er!can7 de
    Ps!!a(r!e a co"a'ora( d+&7 aceea c+ Acade%!a de Med!c!n7 d!n Ne# Mor) "a
    e"a'orarea +ne! no%enc"a(+r! &s!!a(r!ce acce&(a'!"e na=!ona", care (re'+!a s7 .!e
    :ncor&ora(7 :n &r!%a ed!=!e a "+! A%er!can Med!ca" Assoc!a(!on2s S(andard
    C"ass!.!ed No%enc"a(+re o. D!sease. Aceas(7 no%enc"a(+r7 era des(!na(7 :n &r!%+"
    rAnd &ac!en=!"or !n(erna=! c+ (+"'+r7r! &s!!a(r!ce s! ne+ro"o$!ce severe.
    O no%enc"a(+r7 %+"( %a! a%&"7 a .os( e"a'ora(7 %a! (Ar/!+ de US Ar%y Es!
    %od!.!ca(7 de 3e(eran Ad%!n!s(ra(!onJ c+ sco&+" de a :ncadra %a! '!ne (a'"o+r!"e
    c"!n!ce a"e &ac!en=!"or a%'+"a(or!, %!"!(ar! :n (er%en s! ve(eran! a! ce"+! de a" Do!"ea
    R7/'o! Mond!a" Ede e<., (+"'+r7r!"e &s!o.!/!o"o$!ce, de &ersona"!(a(e s! ac+(eJ, :n
    ace"aO! (!%&, Or$an!/a=!a Mond!a"7 a S7n7(7=!! EOMSJ a &+'"!ca( cea de a Oasea
    ed!=!e a ICD care, &en(r+ &r!%a da(7, !nc"+dea O! o sec=!+ne &en(r+ (+"'+r7r!"e
    %en(a"e. ICD4R a .os( !n."+en=a(7 cons!dera'!" de no%enc"a(+ra "+! 3e(eran
    Ad%!n!s(ra(!on O! !nc"+dea 5L ca(e$or!! &en(r+ &s!o/e, F &en(r+ &s!onevro/e O! H
    &en(r+ (+"'+r7r!"e de carac(er, de co%&or(a%en( s! de !n(e"!$en=7.
    Co%!(e(+" &en(r+ No%enc"a(+r7 O! S(a(!s(!c7 a" Asoc!a=!e! A%er!cane de
    Ps!!a(r!e a e"a'ora( o var!an(7 a CIM4R care a .os( &+'"!ca(7 :n 5FY9, ca &r!%7 ed!=!e
    a Man+a"+"+! de D!a$nos(!c s! S(a(!s(!c7 a T+"'+r7r!"or Men(a"e EDSM4IJ. DSM4I
    con=!nea +n $"osar de descr!er! a"e ca(e$or!!"or d!a$nos(!ce s! a .os( &r!%+" %an+a"
    o.!c!a" de (+"'+r7r! %en(a"e a<a( &e +(!"!(a(ea c"!n!c7. U/+" (er%en+"+! de reac=!e
    &es(e (o( :n DSM4I re."ec(7 !n."+en=a conce&=!e! &s!o'!o"o$!ce a "+! Ado". Meyer,
    con.or% c7re!a (+"'+r7r!"e %en(a"e re&re/!n(7 reac=!! a"e &ersona"!(7=!! "a .ac(or!!
    &s!o"o$!c!, soc!a"! s! '!o"o$!c!, :n &ar(e s! d!n ca+/a "!&se! de acce&(are "ar$7 a
    (a<ono%!e! (+"'+r7r!"or %en(a"e con=!n+(e :n ICD4R s! ICD4H, OMS a s&onsor!/a( o
    rev!/+!re c+&r!n/7(oare a en(!(7=!"or d!a$nos(!ce, care a .os( cond+s7 de &s!!a(r+"
    'r!(an!c S(en$e". Ra&or(+" s7+ &oa(e .! cred!(a( ca !ns&!rAnd %+"(e d!n(re &ro$rese"e
    recen(e :n %e(odo"o$!a d!a$nos(!c+"+!, :n s&ec!a" neces!(a(ea +nor de.!n!=!! e<&"!c!(e,
    ca %!@"oc de &ro%ovare a +nor d!a$nos(!ce c"!n!ce .!de"e. C+ (oa(e aces(ea :ns7,
    r+nda +r%7(oare de rev!/+!re d!a$nos(!c7, O! care a d+s "a DSM4II O! ICD4G, n+ a
    +r%a( reco%and7r!"e "+! S(en$e" :n &rea %are %7s+r7. DSM4II era ase%7n7(or c+
    DSM4I, dar a e"!%!na( (er%en+" de reac=!e.
    XXIV Introducere
    AOa c+% .os( ca/+" c+ DSM4I s! DSM4II, e"a'orarea DSM4III a .os( coordona(7
    c+ e"a'orarea +r%7(oare! vers!+n! Ea no+aJ a ICD, care a .os( &+'"!ca(7 :n 5FHY s!
    !%&"e%en(a(7 :n 5FHG. L+cr+" "a DSM4III a :nce&+( :n 5FHI, !ar :n 5FGL aces(a a .os(
    &+'"!ca(. DSM4III !n(rod+ce +n n+%7r !%&or(an( de !nova=!! %e(odo"o$!ce,
    !nc"+/And cr!(er!! de d!a$nos(!c e<&"!c!(e, +n s!s(e% %+"(!a<!a" s! o a'ordare
    descr!&(!v7 care :ncerca s7 .!e ne+(r7 .a=7 de (eor!!"e e(!o"o$!ce. Aces( e.or( a .os(
    +O+ra( de vas(a ac(!v!(a(e e%&!r!c7, a&o! de %od+" de cons(r+!re s! va"!dare a
    cr!(er!!"or de d!a$nos(!c e<&"!c!(e s! de e"a'orarea !n(erv!+r!"or se%!s(r+c(+ra(e.
    ICD4F n+ a !nc"+s cr!(er!! de d!a$nos(!c sa+ +n s!s(e% %+"(!a<!a" :n %are %7s+r7,
    deoarece &r!nc!&a"a .+nc=!e a aces(+! s!s(e% !n(erna=!ona" era aceea de a de"!%!(a
    ca(e$or!! s&re a .ac!"!(a s(rAn$erea de da(e s(a(!s(!ce des&re s7n7(a(ea de .ond. D!n
    con(ra, DSM4III a .os( e"a'ora( c+ sco&+" s+&"!%en(ar de a o.er! o no%enc"a(+r7
    %ed!ca"7 &en(r+ c"!n!c!en! s! cerce(7(or!. D!n ca+/a !nsa(!s.ac=!e!, (+(+ror
    s&ec!a"!(7=!"or %ed!ca"e .a=7 de "!&sa de s&ec!.!c!(a(e a ICD4F, a .os( "+a(7 dec!/!a
    de a o %od!.!ca &en(r+ a .! +(!"!/a(7 :n S(a(e"e Un!(e, re/+"(And as(.e" ICD4F4CM
    E&en(r+ %od!.!care c"!n!c7J.
    E<&er!en=a c+ DSM4III a reve"a( o ser!e de con(rad!c=!! :n s!s(e%, &rec+% s! +n
    n+%7r de ca/+r! :n care cr!(er!!"e n+ era+ :n :n(re$!%e c"are. De aceea, Asoc!a=!a
    A%er!can7 de Ps!!a(r!e a n+%!( +n ,r+& de L+cr+ &en(r+ a rev!/+! DSM4III, aces(a
    e.ec(+And rev!/+!r!"e s! corec(+r!"e care a+ d+s "a &+'"!carea DSM4III4R :n 5FGH.
    Pro#e&ul $e revi)uire a DSM-IV
    Cea de a (re!a ed!=!e a Man+a"+"+! de D!a$nos(!c s! S(a(!s(!c7 a T+"'+r7r!"or
    Men(a"e EDSM4IIIJ a re&re/en(a( +n !%&or(an( &ro$res :n d!a$nos(!carea
    (+"'+r7r!"or %en(a"e s! a .ac!"!(a( :n %are %7s+r7 cerce(area e%&!r!c7. E"a'orarea
    DSM4I3 a 'ene.!c!a( de creserea s+'s(an=!a"7 a cerce(7r!! re.er!(oare "a d!a$nos(!c,
    care a .os( $enera(7, :n &ar(e, de DSM4III s! de DSM4III4R. Ce"e %a! %+"(e
    d!a$nos(!ce a+ ac+% o "!(era(+r7 e%&!r!c7 sa+ ser+r! de da(e va"a'!"e care s+n(
    re"evan(e &en(r+ dec!/!!"e re.er!(oare "a rev!/+!rea %an+a"+"+! de d!a$nos(!c.
    ,r+&+" O&era(!v s! ,r+&+r!"e de L+cr+ a+ cond+s +n &roces e%&!r!c :n (re! e(a&e
    care a !nc"+sQ 5J rev!/+!r! s!s(e%a(!ce s! c+&r!n/7(oare a"e "!(era(+r!! &+'"!ca(e, 9J
    reana"!/area se(+r!"or de da(e de@a co"ec(a(e s! ;J (es(7r! e<(!nse :n (eren, a<a(e &e
    &ro'"e%e"e con(roversa(e.
    +evi(uirea literaturii
    A+ .os( s&onsor!/a(e do+7 con.er!n=e %e(od!ce &en(r+ a ar(!c+"a (oa(e ,r+&+r!"e
    de L+cr+ "a +n &rocede+ s!s(e%a(!c de re&erare, e<(ra$ere, s(rAn$ere s! !n(er&re(are
    a da(e"or :n(r4o %an!er7 c+&r!n/7(oare s! o'!ec(!v7. Sarc!n!"e !n!=!a"e a"e .!ec7r+!
    ,r+& de L+cr+ DSM4I3 a+ .os( ace"ea de a !den(!.!ca ce"e %a! re"evan(e &ro'"e%e
    con(roversa(e &en(r+ .!ecare d!a$nos(!c s! de a s(a'!"! (!&+r!"e de da(e e%&!r!ce
    adecva(e &en(r+ re/o"varea "or. Un+! %e%'r+ sa+ cons!"!er a" ,r+&+"+! de L+cr+
    !4a .os( re&ar(!/a(7 res&onsa'!"!(a(ea cond+cer!! +ne! (recer! :n rev!s(7 c+&r!n/7(oare
    a "!(era(+r!! re"evan(e care ar &+(ea o.er! !n.or%a=!! &en(r+ re/o"varea &ro'"e%e!
    con(roversa(e s! &en(r+ doc+%en(area (e<(+"+! DSM4I3. Do%en!!"e av+(e :n vedere
    :n "+area dec!/!!"or a+ !nc"+s +(!"!(a(ea c"!n!c7, re"!a'!"!(a(ea, va"!d!(a(ea descr!&(!v7,
    carac(er!s(!c!"e &er.or%an=e"or &s!o%e(r!ce a"e cr!(er!!"or !nd!v!d+a"e s! +n n+%7r
    de var!a'!"e va"!dan(e.
    Introducere
    --V
    F!ecare rev!/+!re a "!(era(+r!! a s&ec!.!ca(Q 5J &ro'"e%e"e s! as&ec(e"e
    Econ(roversa(eJ a"e (e<(+"+! O! cr!(er!!"or cons!dera(e O! se%n!.!ca=!a "or c+ re.er!re "a
    DSM4I38 9J %e(oda de eva"+are E!nc"+/And s+rse"e de !den(!.!care a s(+d!!"or
    re"evan(e, n+%7r+" s(+d!!"or "+a(e :n cons!dera=!e, cr!(er!!"e de !nc"+dere O! de
    e<c"+dere d!n eva"+are O! var!a'!"e"e :nre$!s(ra(e :n .!ecare s(+d!+8 ;J re/+"(a(e"e
    eva"+7r!! E!nc"+/And +n s+%ar descr!&(!v a" s(+d!!"or, re.er!(or "a %e(odo"o$!e, (!&,
    core"a(e"e esen=!a"e a"e da(e"or, da(e"e re"evan(e O! ana"!/e"e care a+ cond+s "a aces(e
    da(e O! IJ d!verse"e o&=!+n! &en(r+ re/o"varea &ro'"e%e"or con(roversa(e,
    avan(a@e"e s! de/avan(a@e"e .!ec7re! o&=!+n!, reco%and7r! O! s+$es(!! &en(r+ o
    cerce(are s+&"!%en(ar7 care va .! necesar7 &en(r+ a o.er! o re/o"vare %a!
    conc"+den(7 .
    Sco&+" eva"+7r!"or cr!(!ce a"e "!(era(+r!! DSM4F3 a .os( ace"a de a .+rn!/a
    !n.or%a=!! c+&r!n/7(oare s! !%&ar=!a"e O! de a $aran(a .a&(+" c7 DSM4I3 re."ec(7 cea
    %a! '+n7 "!(era(+r7 c"!n!c7 O! de cerce(are. Pen(r+ aces( %o(!v, no! a% +(!"!/a(
    e<&"or7r!"e s!s(e%a(!ce &e co%&+(er s! eva"+7r!"e cr!(!ce .7c+(e de +n %are n+%7r
    de cons!"!er! &en(r+ a .! s!$+r! c7 aco&er!rea :n "!(era(+r7 es(e cores&+n/7(oare s! c7
    !n(er&re(area re/+"(a(e"or es(e corec(7. Av!/+" a .os( cer+( :n s&ec!a" de "a ace"e
    &ersoane cons!dera(e a avea o a(!(+d!ne cr!(!c7 .a=7 de conc"+/!!"e eva"+7r!!.
    Eva"+7r!"e "!(era(+r!! a+ .os( rev!/+!(e de %a! %+"(e or! &en(r+ a o'=!ne +n re/+"(a(
    cA( %a! c+&r!n/7(or s! %a! ec!"!'ra( &os!'!". Tre'+!e %en=!ona( c7 &en(r+ +ne"e
    ces(!+n! con(roversa(e r!d!ca(e de c7(re ,r+&+r!"e de L+cr+ a"e DSM4I3, :n s&ec!a"
    &en(r+ ce"e care era+ de na(+r7 %a! (eore(!c7 sa+ &en(r+ care n+ e<!s(a+ da(e
    s+.!c!en(e, eva"+area cr!(!c7 a "!(era(+r!! a av+( o +(!"!(a(e "!%!(a(7. C+ (oa(e aces(e
    "!%!(e, eva"+7r!"e a+ .os( +(!"e :n doc+%en(area s+&or(+"+! ra=!ona" O! e%&!r!c a"
    dec!/!!"or "+a(e de ,r+&+r!"e de L+cr+ a"e DSM4I3.
    +eanali(area datelor
    CAnd o rev!/+!re a "!(era(+r!! a reve"a( o "!&s7 a &ro'e"or Esa+ &ro'e
    con(rad!c(or!!J &en(r+ re/o"varea +n+! as&ec(, a% .7c+( adesea +/ de do+7 s+rse
    ad!=!ona"e 4 reana"!/area da(e"or s! (es(7r!"e :n (eren &en(r+ a "+a dec!/!!"e .!na"e.
    Ana"!/e"e +nor se(+r! de da(e re"evan(e ne&+'"!ca(e a+ .os( s+&or(a(e de o '+rs7
    acorda(7 Asoc!a=!e! A%er!cane de Ps!!a(r!e de *on D. and Ca(er!ne T. MacAr(+r
    Fo+nda(!on. Ce"e %a! %+"(e d!n(re ce"e IL de reana"!/e a"e da(e"or e.ec(+a(e &en(r+
    DSM4I3 a+ !%&"!ca( co"a'orarea %a! %+"(or !nves(!$a(or! d!n d!.er!(e "oc+r!. AceO(!
    cerce(7(or! O!4a+ &re/en(a( :n co%+n da(e"e "or "a :n(re'7r!"e &+se de ,r+&+r!"e de
    L+cr+ re.er!(oare "a cr!(er!!"e !nc"+se :n DSM4III4R sa+ "a cr!(er!!"e care &+(ea+ .!
    !nc"+se :n DSM4I3. Reana"!/area da(e"or a .7c+(, de ase%enea, &os!'!" ca ,r+&+r!"e
    de L+cr+ s7 e"a'ore/e d!verse se(+r! de cr!(er!! care a+ .os( (es(a(e a&o! :n (r!a"+r!"e
    d!n (eren a"e DSM4I3. DeO!, :n cea %a! %are &ar(e, se(+r!"e de da(e +(!"!/a(e :n
    reana"!/7r! a+ .os( co"ec(a(e ca &ar(e a s(+d!!"or e&!de%!o"o$!ce sa+ a +nor s(+d!!
    re.er!(oare "a (ra(a%en( or! a a"(or s(+d!! c"!n!ce, aces(ea s4a+ ar7(a(, de ase%enea,
    a .! e<(re% de re"evan(e &en(r+ &ro'"e%e"e de ord!n noso"o$!c c+ care s4a+
    con.r+n(a( ,r+&+r!"e de L+cr+ a"e DSM4I3.
    Testrile "n teren
    Do+7s&re/ece (es(7r! :n (eren a"e DSM4I3 a+ .os( s&onsor!/a(e de Na(!ona"
    Ins(!(+(e o. Men(a" Hea"( ENIMHJ :n co"a'orare c+ Na(!ona" Ins(!(+(e on Dr+$
    A'+se ENIDAJ s! de Na(!ona" Ins(!(+(e on A"coo" A'+se and A"coo"!s% ENIAAAJ.
    Tes(7r!"e :n (eren a+ &er%!s ,r+&+r!"or de L+cr+ a"e DSM4I3 s7 co%&are o&=!+n!"e
    --V/ Introducere
    a"(erna(!ve s! s7 s(+d!e/e !%&ac(+" &os!'!" a" %od!.!c7r!"or s+$era(e. Tes(7r!"e :n
    (eren a+ co%&ara( DSM4III, DSM4III4R, ICD45L s! se(+r!"e de cr!(er!! &ro&+se &en(r+
    DSM4F3 :n Y45L "oc+r! d!.er!(e &en(r+ (es(area :n (eren, c+ a&ro<!%a(!v.5LL de
    s+'!ec=! &en(r+ .!ecare "oc. A+ .os( a"ese d!verse "oc+r!, c+ $r+&+r! re&re/en(a(!ve de
    s+'!ec=! de &roven!en=7 soc!oc+"(+ra"7 s! e(n!c7 d!.er!(7, &en(r+ a as!$+ra
    $enera"!/a'!"!(a(ea re/+"(a(e"or (es(7r!"or :n (eren s! a (es(a +ne"e d!n(re ce"e %a!
    d!.!c!"e &ro'"e%e de d!a$nos(!c d!.eren=!a". Ce"e 59 (es(7r! :n (eren a+ !nc"+s &es(e HL
    de "oc+r! s! a+ eva"+a( %a! %+"( de RLLL de s+'!ec=!. Tes(7r!"e :n (eren a+ co"ec(a(
    !n.or%a=!! des&re .!de"!(a(ea s! &er.or%an=a carac(er!s(!c!"or .!ec7r+! se( de cr!(er!! ca
    :n(re$, ca s! a !(e%!"or s&ec!.!c! d!n cadr+" .!ec7r+! se( de cr!(er!!. Tes(7r!"e :n (eren a+
    a@+(a(, de ase%enea, "a s(a'!"!rea de &+n=! :n(re cerce(area c"!n!c7 s! &rac(!ca c"!n!c7
    &r!n &rec!/area a cA( de '!ne s+$es(!!"e &en(r+ sc!%'are, der!va(e d!n cerce(area
    c"!n!c7, se a&"!c7 :n &rac(!ca c"!n!c7.
    riteriile pentru sc%imbare
    DeO! a .os( a&roa&e !%&os!'!" s7 se e"a'ore/e cr!(er!! a'so"+(e O! !n.a!"!'!"e &en(r+
    %o%en(+" cAnd (re'+!e .7c+(e sc!%'7r!, a+ e<!s(a( cA(eva &r!nc!&!! care a+ $!da(
    e.or(+r!"e noas(re. Pra$+" &en(r+ e.ec(+area rev!/+!r!"or DSM4I3 a .os( %a! :na"(
    decA( ce" &en(r+ DSM4III s! DSM4III4R. Dec!/!!"e a+ (re'+!( s7 .!e concre(!/a(e &r!n
    .or%+"7r! e<&"!c!(e a"e ra=!+n!! "or de a .! s! &r!n eva"+area cr!(!c7 s!s(e%a(!c7 a da(e"or
    e%&!r!ce re"evan(e. Pen(r+ a cres(e carac(er+" &rac(!c s! +(!"!(a(ea c"!n!c7 a DSM4I3,
    cr!(er!!"e a+ .os( s!%&"!.!ca(e s! c"ar!.!ca(e cAnd aceas(a a &+(+( .! @+s(!.!ca( de da(e"e
    e%&!r!ce. A .os( .7c+(7 :ncercarea de a $7s! +n ec!"!'r+ o&(!% :n DSM4I3 c+ &r!v!re
    "a (rad!=!a !s(or!c7 Eca :n(r+c!&a(7 de DSM4III s! DSM4III4RJ, co%&a(!'!"!(a(ea c+
    ICD45L, da(e"e d!n eva"+area cr!(!c7 a "!(era(+r!!, ana"!/e"e se(+r!"or de da(e
    ne&+'"!ca(e, re/+"(a(e"e (es(7r!! :n (eren s! consens+" (eren+"+!. DeO! n+%7r+" de da(e
    necesare &en(r+ a de(er%!na sc!%'7r! a .os( r!d!ca( "a ce" %a! :na"( &ra$, e" a var!a(
    :n %od necesar &e sec=!+ne (ransversa"7 &r!n d!verse"e (+"'+r7r!, &en(r+ c7 O!
    s+&or(+" e%&!r!c &en(r+ dec!/!!"e "+a(e :n DSM4HI si DSM4III4R a var!a(, de
    ase%enea, &e sec=!+ne (ransversa"7 &r!n aces(ea. Des!$+r, a .os( necesar '+n+" s!%=,
    !ar %od!.!c7r!"e %a@ore &en(r+ a re/o"va &ro'"e%e %!nore a+ neces!(a( %a! %+"(e
    da(e decA( %od!.!c7r!"e %!nore &en(r+ a re/o"va &ro'"e%e %a@ore.
    A% &r!%!( s+$es(!! de a !nc"+de n+%eroase d!a$nos(!ce no! :n DSM4I3.
    Pro&onen=!! ar$+%en(a+ c7 no!"e d!a$nos(!ce s+n( necesare &en(r+ a a%e"!ora
    aco&er!rea s!s(e%+"+! &r!n !nc"+derea +n+! $r+& de !nd!v!/! care era+
    ned!a$nos(!ca'!"! :n DSM4III4R sa+ d!a$nos(!ca'!"! n+%a! "a r+'r!ca )6r6 alt6
    speci)ica(ie7 No! a% dec!s :ns7 c7, :n $enera", no!"e d!a$nos(!ce (re'+!e !nc"+se :n s!s(e%
    n+%a! d+&7 ce cerce(area va s(a'!"! c7 aces(ea (re'+!e s7 .!e !nc"+se O! n+ s7 "e
    !nc"+de% &en(r+ a s(!%+"a cerce(area. D!a$nos(!ce"or de@a !nc"+se :n ICD45L "! s4a
    acorda( :ns7 %a! %+"(7 cons!dera=!e decA( ce"or care a+ .os( recen( &ro&+se &en(r+
    DSM4I3. U(!"!(a(ea %ar$!na"7 cresc+(7, c"ar!(a(ea s! aco&er!rea &rev7/+(e de .!ecare
    d!a$nos(!c no+ &ro&+s a+ (re'+!( s7 .!e con(ra&+se !nco%od!(7=!! c+%+"a(!ve !%&+se
    :n(re$+"+! s!s(e%, &a+c!(7=!! doc+%en(7r!! e%&!r!ce O! &os!'!"e"or eror! de d!a$nos(!c
    sa+ de +(!"!/are a'+/!v7 care ar &+(ea s+rven!. N!c! o c"as!.!care a (+"'+r7r!"or %en(a"e
    n+ &oa(e avea +n n+%7r s+.!c!en( de ca(e$or!! s&ec!.!ce &en(r+ a c+&r!nde or!ce
    (a'"o+ c"!n!c !%a$!na'!". Ca(e$or!!"e )6r6 alt6 speci)ica(ie s+n( &rev7/+(e &en(r+ a
    aco&er! n+ rare"e (a'"o+r! c"!n!ce care se a."7 "a "!%!(a de.!n!=!!"or ca(e$or!a"e s&ec!.!ce.
    Introducere
    --VII
    olecia de documente a DSM-IV
    Doc+%en(a=!a a .os( 'a/a esen=!a"7 a DSM4I3. 0S.#5V So+rceboo8 &+'"!ca(7 :n
    &a(r+ vo"+%e es(e conce&+(7 s7 o.ere +n doc+%en( (es(!%on!a" c+&r!n/7(or s!
    acces!'!" &en(r+ s+&or(+" c"!n!c s! de cerce(are a" d!verse"or dec!/!! "+a(e de
    ,r+&+r!"e de L+cr+ s! de ,r+&+" O&era(!v. Pr!%e"e (re! vo"+%e a"e "+! So+rce'oo)
    con=!n vers!+n!"e condensa(e a"e 5YL de rev!/+!r! a"e "!(era(+r!! DSM4I3. 3o"+%+" I3
    con=!ne ra&oar(e des&re reana"!/area da(e"or, ra&oar(e a"e (es(7r!"or :n (eren s! +n
    s+%ar ad%!n!s(ra(!v .!na" a" %o(!ve"or &en(r+ dec!/!!"e "+a(e de .!ecare ,r+& de
    L+cr+, :n &"+s, %+"(e ar(!co"e a+ .os( s(!%+"a(e de e.or(+r!"e &en(r+ o doc+%en(are
    e%&!r!c7 :n DSM4I3 s! aces(ea a+ .os( &+'"!ca(e :n rev!s(e"e Co"e$!+"+! Med!c!"or.
    Rela!ia #u ICD-*+
    Cea de a /ecea rev!/+!re a "+! 5nternational Statistical Classi)ication o) 0isease and
    Related 9ealt- Problems EICD45LJ e"a'ora(7 de OMS a .os( &+'"!ca(7 :n 5FF9. O
    %od!.!care c"!n!c7 a ICD45L EICD45L4CMJ es(e av+(7 :n vedere s&re a .!
    !%&"e%en(a(7 :n S(a(e"e Un!(e :n 9LLI. Ce! care a+ &re&ara( ICD45L O! DSM4I3 a+
    "+cra( c+ a(en=!e &en(r+ a4s! coordona e.or(+r!"e, ceea ce a d+s "a o %are !n."+en=7
    rec!&roc7 . ICD45L cons(7 d!n(r4+n s!s(e% de cod!.!care o.!c!a" s! d!n a"(e doc+%en(e
    O! !ns(r+%en(e c"!n!ce O! de cerce(are asoc!a(e. Cod+r!"e s! (er%en!! &rev7/+=! :n
    'SM4T3 s+n( &e de&"!n co%&a(!'!"! a(A( c+ ICD4F4CM, cA( s! c+ ICD45L Eve/! ane<a HJ.
    Sc!=e"e c"!n!ce O! de cerce(are a"e ICD45L a+ .os( e<a%!na(e :n de(a"!+ de ,r+&+r!"e
    de L+cr+ a"e DSM4I3 s! a+ s+$era( !%&or(an(e s+'!ec(e &en(r+ rev!/+!rea "!(era(+r!!
    s! reana"!/area da(e"or &en(r+ DSM4I3. 3ers!+n! a"e sc!=e"or cr!(er!!"or de
    d!a$nos(!c &en(r+ cerce(are a"e ICD45L a+ .os( !nc"+se ca a"(erna(!ve &en(r+ a .!
    co%&ara(e c+ se(+r!"e de cr!(er!! a"e DSM4n!, DSM4III4R s! c+ se(+r!"e de cr!(er!!
    s+$era(e &en(r+ DSM4I3 :n (es(7r!"e :n (eren a"e DSM4I3. M+"(e"e cons+"(7r! d!n(re
    redac(or!! DSM4I3 O! ICD45L Ecare a+ .os( .ac!"!(a(e de NIMH, NIDA s! NIAAAJ a+
    .os( e<(re% de +(!"e :n creO(erea con$r+en=e! O! red+cerea d!.eren=e"or
    nese%n!.!ca(!ve :n .or%+"are d!n(re ce"e do+7 s!s(e%e.
    Revi)uirea te,tului DSM-IV
    Una d!n(re ce"e %a! !%&or(an(e +(!"!/7r! a DSM4I3 a .os( aceea de !ns(r+%en(
    ed+ca=!ona". Aceas(a es(e va"a'!" :n s&ec!a" &en(r+ (e<(+" descr!&(!v care
    aco%&an!a/7 se(+r!"e de cr!(er!! a"e (+"'+r7r!"or DSM4I3. Da( .!!nd .a&(+" c7
    !n(erva"+" d!n(re DSM4I3 O! DSM43 va .! %a! e<(!ns :n co%&ara=!e c+ !n(erva"e"e
    d!n(re ed!=!!"e an(er!oare EH an! :n(re DSM4III s! DSM4III4R, !ar :n(re DSM4III4R s!
    DSM4I3 de ce" &+=!n 59 an!8 :n rea"!(a(e H an!, 5FGH45FFIJ !n.or%a=!!"e d!n (e<( Ecare
    a+ .os( redac(a(e &e 'a/a "!(era(+r!! de &An7 :n 5FF9J r!sc7 s7 .!e (o( %a! %+"(
    de&7O!(e de vo"+%+" %are de cerce(7r! &+'"!ca(e :n .!ecare an. :n sco&+" cons(r+!r!!
    +ne! &+n=! :n(re DSM4I3 s! DSM43 era de &res+&+s o rev!/+!re a (e<(+"+! DSM4I3.
    Sco&+r!"e aces(e! rev!/+!r! a (e<(+"+! s+n( %+"(!&"eQCJ s7 corec(e/e or!ce .e" de eror!
    .ac(+a"e !den(!.!ca(e :n (e<(+" DSM4I38 9J s7 revad7 (e<(+" DSM4I3 &en(r+ a avea
    $aran=!a c7 !n.or%a=!!"e de or!ce .e" s+n( :nc7 ac(+a"e8 ;J s7 .ac7 %od!.!c7r! a"e
    (e<(+"+! DSM4I3 as(.e" :ncA( aces(ea s7 re."ec(e no!"e !n.or%a=!! d!s&on!'!"e de "a
    rev!/+!rea "!(era(+r!! DSM4I3, care a .os( e.ec(+a(7 :n 5FF98 IJ s7 .ac7 :%'+n7(7=!r!
    care s7 creasc7 va"oarea ed+ca=!ona"7 a DSM4I3 s! YJ s7 ac(+a"!/e/e ace"e cod+r!
    --VIII Introducere
    ICD4F4CM care a+ .os( sc!%'a(e d+&7 ac(+a"!/area cod!.!c7r!! DSM4F3 :n 5FFR. Ca
    s! :n ca/+" DSM4I3 or!$!na", (oa(e %od!.!c7r!"e &ro&+se &en(r+ (e<( a (re'+!( s7 .!e
    s+s=!n+(e de da(e e%&!r!ce. Ma! %+"( decA( a(A(, (oa(e %od!.!c7r!"e &ro&+se a+ .os(
    "!%!(a(e "a an+%!(e sec=!+n! a"e (e<(+"+! Ede e<., e"e%en(e s! (+"'+r7r! asoc!a(e,
    &reva"en(7J. N+ a+ .os( av+(e :n vedere %od!.!c7r! a"e se(+r!"or de cr!(er!!, n+ a+ .os(
    &r!%!(e n!c! +n .e" de &ro&+ner! de !nc"+dere a +nor no! (+"'+r7r!, a +nor no!
    s+'(!&+r! sa+ de %od!.!c7r! a"e s(a(+s+"+! ca(e$or!!"or d!n ane<e"e DSM4I3.
    Proces+" de rev!/+!re a :nce&+( :n 5FFH &r!n n+%!rea ,r+&+r!"or de L+cr+ &en(r+
    rev!/+!rea (e<(+"+! DSM4I3, care cores&+nd s(r+c(+r!! ,r+&+r!"or de L+cr+ a"e DSM4I3
    or!$!na". PreOed!n=!! ,r+&+r!"or de L+cr+ a"e DSM4I3 or!$!na" a+ .os( cons+"(a=! %a!
    :n(A! c+ &r!v!re "a co%&o/!=!a aces(or ,r+&+r! de L+cr+ &en(r+ rev!/+!rea (e<(+"+!.
    F!ec7r+! ,r+& de L+cr+ &en(r+ rev!/+!rea (e<(+"+! ! s4a da( ca sarc!n7 &r!nc!&a"7
    ac(+a"!/area (e<(+"+! +ne! sec=!+n! a DSM4I3. Aceas(a !%&"!ca revederea a(en(7 a
    (e<(+"+! s&re a !den(!.!ca eror!"e s! o%!s!+n!"e s! a&o! cond+cerea +ne! rev!/+!r!
    c+&r!n/7(oare s! s!s(e%a(!ce a "!(era(+r!! care s4a cen(ra( &e +n %a(er!a" re"evan(
    &+'"!ca( :nce&And d!n 5FF9. Me%'r!! ,r+&+"+! de L+cr+ &en(r+ rev!/+!rea (e<(+"+!
    a+ .7c+( a&o! o sc!=7 a %od!.!c7r!"or &ro&+se, :nso=!(7 de @+s(!.!c7r! scr!se a"e
    %od!.!c7r!"or res&ec(!ve, :%&re+n7 c+ '!'"!o$ra.!a re"evan(7, :n c+rs+" a o ser!e de
    con.er!n=e (e"e.on!ce, %od!.!c7r!"e &ro&+se, @+s(!.!c7r!"e s! '!'"!o$ra.!a, a+ .os(
    &re/en(a(e de +n %e%'r+ a" ,r+&+"+! de L+cr+ &en(r+ rev!/+!rea (e<(+"+!, a"(or
    %e%'r! a! ,r+&+"+! de L+cr+ &en(r+ rev!/+!rea (e<(+"+! care O!4a+ s&+s c+vAn(+" :n
    "e$7(+r7 c+ .a&(+" dac7 %od!.!c7r!"e era+ @+s(!.!ca(e &e 'a/a doc+%en(a=!e! care "e
    s+s=!nea. Oda(7 ce sc!=e"e %od!.!c7r!"or &ro&+se era+ .!na"!/a(e de ,r+&+r!"e de
    L+cr+ &en(r+ rev!/+!rea (e<(+"+!, %od!.!c7r!"e a+ .os( "ar$ d!.+/a(e +n+! $r+& de
    cons!"!er! &en(r+ .!ecare sec=!+ne s&ec!.!c7 Econs(And d!n %e%'r! ,r+&+"+! de L+cr+
    or!$!na" &en(r+ DSM4I3, s+&"!%en(a( de cons!"!er! a+<!"!ar!J &en(r+ co%en(ar!+ s!
    rev!/+!re :n con(!n+are. Aces(or cons!"!er! "! s4a crea( o&or(+n!(a(ea de a s+$era
    %od!.!c7r! s+&"!%en(are dac7 e! &+(ea+ o.er! &ro'e s+.!c!en( de conv!n$7(oare s&re
    a @+s(!.!ca :nc"+derea :n (e<(. D+&7 (recerea :n rev!s(7 a co%en(ar!!"or cons!"!er!"or,
    sc!=e"e .!na"e a"e %od!.!c7r!"or &ro&+se a+ .os( s+&+se &en(r+ rev!/+!re .!na"7 s!
    a&ro'are Co%!(e(+"+! &en(r+ Eva"+are O! D!a$nos(!c :n Ps!!a(r!e a" APA EA%er!can
    Psyc!a(r!c Assoc!a(!on2s Co%%!((ee on Psyc!a(r!c D!a$nos!s and Assess%en(J.
    Ce"e %a! %+"(e d!n(re %od!.!c7r!"e 'a/a(e pe "!(era(+r7 &ro&+se a+ av+( "oc :n
    sec=!+n!"e e"e%en(e O! (+"'+r7r! asoc!a(e Ecare !nc"+de s! da(e"e de "a'ora(or
    asoc!a(eJ8 e"e%en(e s&ec!.!ce c+"(+r!!, e(7=!! O! se<+"+!8 &reva"en(78 evo"+=!e s! &a((ern
    .a%!"!a" a"e (e<(+"+!, :n ca/+" +nor (+"'+r7r!, a .os( e<(!ns7 sec=!+nea de d!a$nos(!c
    d!.eren=!a" s&re a o.er! d!.eren=!er! %a! c+&r!n/7(oare. Ane<a D Eve/! &a$. G9FJ o.er7
    o !%a$!ne $"o'a"7 a %od!.!c7r!"or !nc"+se :n aceas(7 rev!/+!re a (e<(+"+!.
    De%ini!ia Tulburrii Mentale
    DeO! aces( vo"+% es(e !n(!(+"a( .an+al de 0ia/nostic si Statistic6 a T+lb+r6rilor
    .entale, (er%en+" de t+lb+rare mental6 d!n ne.er!c!re !%&"!c7 o d!s(!nc=!e :n(re
    (+"'+r7r!"e S%en(a"eT s! (+"'+r7r!"e Sso%a(!ceT, care es(e +n anacron!s%
    red+c=!on!s( a" d+a"!s%+"+! %!n(eXcor&. O "!(era(+r7 r!$+roas7 de%ons(rea/7 c7
    e<!s(7 %+"( Sso%a(!cT :n (+"'+r7r!"e S%en(a"eTs! %+"( S%en(a"T :n (+"'+r7r!"e
    Sso%a(!ceT. Pro'"e%a r!d!ca(7 de (er%en+" de (+"'+r7r! S%en(a"eT a .os( %+"( %a!
    c"ar7 decA( re/o"varea sa s!, d!n ne.er!c!re, (er%en+" &ers!s(7 O! :n (!("+" DSM4I3,
    deoarece n+ a% $7s!( +n s+'s(!(+( cores&+n/7(or.
    Introducere XXIX
    De ase%enea, deO! aces( %an+a" o.er7 o c"as!.!care a (+"'+r7r!"or %en(a"e, (re'+!e
    ad%!s c7 n!c! o de.!n!=!e n+ s&ec!.!c7 :n %od adecva( "!%!(e &rec!se &en(r+ conce&(+"
    de S(+"'+rare %en(a"7 T. Conce&(+" de (+"'+rare %en(a"7, ca O! %+"(e a"(e conce&(e
    d!n %ed!c!n7 s! O(!!n=7, es(e "!&s!( de o de.!n!=!e o&era=!ona"7 adecva(7 care s7 aco&ere
    (oa(e s!(+a=!!"e. Toa(e cond!=!!"e %ed!ca"e s+n( de.!n!(e "a d!.er!(e n!ve"e de
    a's(rac(!/are 4 de e<., &a(o"o$!e s(r+c(+ra"7 Eco"!(a +"ceroas7J, &re/en(area de
    s!%&(o%e E%!$renaJ, dev!erea de "a o nor%7 .!/!o"o$!c7 E!&er(ens!+nea ar(er!a"7J O!
    e(!o"o$!e E&ne+%on!a &ne+%ococ!c7J. T+"'+r7r!"e %en(a"e a+ .os( de.!n!(e &r!n(r4o
    var!e(a(e de conce&(e Ede e<, de(res7, d!s.+nc=!e, d!scon(ro", de/avan(a@, !nca&ac!(a(e,
    !n."e<!'!"!(a(e, !ra=!ona"!(a(e, &ar(er n s!ndro%!c, e(!o"o$!e, s! dev!ere s(a(!s(!c7J. F!ecare
    d!n(re aces(ea es(e +n !nd!ca(or +(!" &en(r+ o (+"'+rare %en(a"7, dar n!c! +n+" n+ es(e
    ec!va"en( c+ conce&(+", !ar s!(+a=!! d!.er!(e rec"a%7 de.!n!=!! d!.er!(e.
    :n d!s&re=+" aces(or o's(aco"e, de.!n!=!a de t+lb+rare mental6 care a .os( !nc"+s7 :n
    DSM4III s! DSM4III4R es(e &re/en(a(7 a!c! deoarece es(e "a .e" de +(!"7 ca or!care a"(7
    de.!n!=!e d!s&on!'!"7 s! a a@+(a( "a $!darea dec!/!!"or re.er!(oare "a care cond!=!!
    s!(+a(e "a "!%!(a d!n(re nor%a"!(a(e s! &a(o"o$!e (re'+!e !nc"+se :n DSM4I3. :n DSM4I3
    .!ecare d!n(re (+"'+r7r!"e %en(a"e es(e conce&(+a"!/a(7 ca +n &a((ern sa+ s!ndro%
    &s!o"o$!c sa+ co%&or(a%en(a" se%n!.!ca(!v c"!n!c care a&are "a +n !nd!v!d s! care
    es(e asoc!a( c+ de(res7 &re/en(7 Ede e<., +n s!%&(o% s+&7r7(orJ sa+ !nca&ac!(a(e
    Ead!c7, de(er!orare :n(r4+n+" sa+ :n %a! %+"(e do%en!! de .+nc=!onareJ sa+ c+ +n
    r!sc cresc+( de a s+.er! %oar(ea, d+rerea, !n.!r%!(a(ea sa+ o &!erdere !%&or(an(7 a
    "!'er(7=!!, :n &"+s, &a((ern+" sa+ s!ndro%+" n+ (re'+!e s7 .!e &+r O! s!%&"+, +n
    r7s&+ns sanc=!ona( c+"(+ra" s! &rev!/!'!" "a +n an+%!( even!%en(, de e<e%&"+, "a
    %oar(ea +ne! .!!n=e !+'!(e. Ind!.eren( de ca+/a care 54a $enera(, e" (re'+!e cons!dera(
    :n %od +/+a" o %an!.es(are a +ne! d!s.+nc=!! '!o"o$!ce, &s!o"o$!ce sa+
    co%&or(a%en(a"e :n !nd!v!d. N!c! co%&or(a%en(+" dev!an( Ede e<., &o"!(!c, re"!$!os
    sa+ se<+a"J, n!c! con."!c(e"e care e<!s(7, :n &r!%+" rAnd :n(re !nd!v!d s! soc!e(a(e, n+
    s+n( (+"'+r7r! %en(a"e c+ e<ce&=!a .a&(+"+! cAnd dev!an=a sa+ con."!c(+" es(e +n
    s!%&(o% a" +ne! d!s.+nc=!! a !nd!v!d+"+!, aOa c+% es(e descr!s7 %a! s+s.
    O conce&=!e erona(7 co%+n7 es(e aceea c7 o c"as!.!care a (+"'+r7r!"or %en(a"e
    c"as!.!c7 !nd!v!/!, cAnd :n rea"!(a(e ceea ce es(e c"as!.!ca( s+n( (+"'+r7r!"e &e care "e
    a+ !nd!v!/!!. Pen(r+ aces( %o(!v, (e<(+" DSM4I3 EaOa c+% a .7c+( O! (e<(+" DSM4III4RJ
    ev!(7 +/+" +nor e<&res!! ca S+n sc!/o.ren!cT sa+ S+n a"coo"!cT s! +(!"!/ea/7
    e<&res!!"e %a! corec(e, dar %a! !nco%ode de S+n !nd!v!d c+ sc!/o.ren!eT sa+ de
    S+n !nd!v!d c+ de&enden=7 a"coo"!c7 T.
    Pro-le"e #ontrover&ate .n utili)area DSM-IV
    Limitele abordrii cate!oriale
    DSM4I3 es(e o c"as!.!care ca(e$or!a"7 care d!v!de (+"'+r7r!"e %en(a"e :n (!&+r! &e
    'a/a +nor se(+r! de cr!(er!! c+ e"e%en(e care "e de.!nesc. Aces( %od de !nd!care a
    ca(e$or!!"or es(e %e(oda (rad!=!ona"7 de or$an!/are s! de (rans%!(ere a !n.or%a=!!"or
    :n v!a=a de /! c+ /! s! a .os( a'ordarea .+nda%en(a"7 +(!"!/a(7 :n (oa(e s!s(e%e"e de
    d!a$nos(!c %ed!ca". O a'ordare ca(e$or!a"7 de c"as!.!care "+crea/7 %a! '!ne cAnd (o=!
    %e%'r!! +ne! c"ase d!a$nos(!ce s+n( o%o$en!, cAnd e<!s(7 "!%!(e c"are :n(re c"ase O!
    cAnd c"ase d!.er!(e s+n( %+(+a" e<c"+s!ve. C+ (oa(e aces(ea, (re'+!e rec+nosc+(e O!
    "!%!(e"e s!s(e%+"+! de c"as!.!care ca(e$or!a"7.
    XXX
    Introducere
    :n DSM4I3 n+ e<!s(7 n!c! o a.!r%a=!e c7 .!ecare ca(e$or!e de (+"'+rare %en(a"7
    es(e o en(!(a(e co%&"e( d!s(!nc(7, c+ "!%!(e a'so"+(e care o se&ar7 de a"(e (+"'+r7r!
    %en(a"e sa+ de n!c! o (+"'+rare %en(a"7. De ase%enea, n+ e<!s(7 n!c! o a.!r%a=!e c7
    (o=! !nd!v!/!! descr!O! ca avAnd aceeaO! (+"'+rare %en(a"7 s+n( !den(!c! s+' (oa(e
    as&ec(e"e !%&or(an(e. C"!n!c!an+" care +(!"!/ea/7 DSM4I3 (re'+!e, de aceea, s7 a!'7
    :n vedere .a&(+" c7 !nd!v!/!! care a+ ace"aO! d!a$nos(!c es(e &os!'!" s7 .!e e(ero$en!
    c!ar c+ &r!v!re "a e"e%en(e"e de.!n!(or!! a"e d!a$nos(!c+"+! s! c7 :n ca/+r!"e "!%!(7 va
    .! d!.!c!" de &+s d!a$nos(!c+" :n a"( %od decA( :n(r4o %an!er7 &ro'a'!"!s(7. Aces(
    &+nc( de vedere &er%!(e o %a! %are ."e<!'!"!(a(e :n +(!"!/area s!s(e%+"+!,
    :nc+ra@ea/7 acordarea de %a! %+"(7 a(en=!e ca/+r!"or "!%!(7 O! s+'"!n!a/7 neces!(a(ea
    &roc+r7r!! de !n.or%a=!! c"!n!ce s+&"!%en(are care s7 %ear$7 d!nco"o de d!a$nos(!c.
    Rec+noscAnd e(ero$en!(a(ea (a'"o+r!"or c"!n!ce, DSM4I3 !nc"+de adesea se(+r! de
    cr!(er!! &o"!(e(!ce, d!n care !nd!v!d+" neces!(7 &re/en(a n+%a! a +n+! s+'se( de !(e%!
    d!n(r4o "!s(7 %a! "+n$7 Ede e<., d!a$nos(!c+" de (+"'+rare de &ersona"!(a(e 'order"!ne
    cere &re/en=a a n+%a! c!nc! d!n(re ce! no+7 !(e%!J.
    S4a s+$era( ca :n DSM4I3, c"as!.!carea s7 .!e or$an!/a(7 con.or% +n+! %ode"
    d!%ens!ona" %a! c+rAnd decA( %ode"+"+! ca(e$or!a" +(!"!/a( :n DSM4III4R. Un
    s!s(e% d!%ens!ona" c"as!.!c7 (a'"o+r!"e c"!n!ce &e 'a/a c+an(!.!c7r!! a(r!'+(e"or %a!
    c+rAnd decA( &e 'a/a s(a'!"!r!! de ca(e$or!! s! "+crea/7 ce" %a! '!ne :n descr!erea
    .eno%ene"or care s+n( d!s(r!'+!(e con(!n++ O! care n+ a+ "!%!(e c"are. DeO! s!s(e%e"e
    d!%ens!ona"e cresc .!de"!(a(ea s! co%+n!c7 %a! %+"(7 !n.or%a=!e c"!n!c7 Edeoarece
    e"e descr!+ a(r!'+(e c"!n!ce care &o( .! s+'"!%!na"e :n(r4+n s!s(e% ca(e$or!a"J, e"e a+,
    de ase%enea, "!%!(e ser!oase s!, deoca%da(7, s+n( %a! &+=!n +(!"e dec:( s!s(e%e"e
    ca(e$or!a"e :n &rac(!ca c"!n!c7 s! :n s(!%+"area cerce(7r!!. Descr!er!"e d!%ens!ona"e
    n+%er!ce s+n( %+"( %a! &+=!n .a%!"!are O! v!! decA( s+n( d!%ens!+n!"e ca(e$or!a"e
    &en(r+ (+"'+r7r!"e %en(a"e, :n &"+s, n+ e<!s(7 :nc7 n!c! +n acord as+&ra a"e$er!!
    d!%ens!+n!"or o&(!%e care s7 .!e +(!"!/a(e &en(r+ sco&+r!"e c"as!.!c7r!!. C+ (oa(e
    aces(ea, es(e &os!'!" ca &r!n !n(ens!.!carea cerce(7r!"or as+&ra s!s(e%e"or
    d!%ens!ona"e s! &r!n .a%!"!ar!/area c+ e"e, s7 se a@+n$7 "a o %a! %are acce&(are a
    "or, a(A( ca %e(od7 de co%+n!care a !n.or%a=!e!, cA( s! ca !ns(r+%en( de cerce(are.
    .(ul 0udecii clinice
    DSM4I3 es(e o c"as!.!care a (+"'+r7r!"or %en(a"e care a .os( e"a'ora(7 &en(r+ a .!
    +(!"!/a(7 :n cond!=!! c"!n!ce, de :nv7=7%An( O! de cerce(are. Ca(e$or!!"e d!a$nos(!ce,
    cr!(er!!"e s! descr!er!"e d!n (e<( s+n( des(!na(e +(!"!/7r!! de c7(re &ersoane c+
    an(rena%en( c"!n!c cores&+n/7(or s! e<&er!en=7 :n d!a$nos(!c. Es(e !%&or(an( ca
    DSM4I3 s7 n+ .!e a&"!ca( %ecan!c de c7(re &ersoane nean(rena(e. Cr!(er!!"e de
    d!a$nos(!c s&ec!.!ce !nc"+se :n DSM4I3 s+n( des(!na(e s7 serveasc7 dre&( $!d s&re
    a .! !n.or%a( &r!n @+deca(a c"!n!c7 s! n+ s&re a .! +(!"!/a(e :n %an!era +ne! c7r=! de
    '+ca(e. De e<e%&"+, e<erc!(area @+dec7=!! c"!n!ce &oa(e @+s(!.!ca acordarea +n+!
    an+%!( d!a$nos(!c +n+! !nd!v!d c!ar dac7 (a'"o+" c"!n!c n+ sa(!s.ace cr!(er!!"e
    co%&"e(e &en(r+ d!a$nos(!c+" res&ec(!v, a(A( (!%& cA( s!%&(o%e"e &re/en(e s+n(
    &ers!s(en(e s! severe. Pe de a"(7 &ar(e, "!&sa de .a%!"!ar!/are c+ DSM4I3 sa+
    a&"!carea e<ces!v de ."e<!'!"7 s! !d!os!ncra(!c7 a cr!(er!!"or sa+ conven=!!"or DSM4I3
    red+ce s+'s(an=!a" +(!"!(a(ea sa ca "!%'a@ co%+n de co%+n!care.
    Pe "An$7 neces!(a(ea +n+! an(rena%en( s! a @+dec7=!! c"!n!ce, es(e, de ase%enea,
    !%&or(an(7 %e(oda co"ec(7r!! da(e"or. A&"!carea corec(7 a cr!(er!!"or de d!a$nos(!c
    !nc"+se :n aces( %an+a" neces!(7 o eva"+are care accesea/7 :n %od d!rec( !n.or%a=!a
    con=!n+(7 :n se(+r!"e de cr!(er!! Ede e<., dac7 +n s!ndro% a &ers!s(a( o &er!oad7
    Introducer
    e
    XXXI
    %!n!%7 de (!%&J. Eva"+7r!"e care se red+c n+%a! "a (es(area &s!o"o$!c7 s! n+
    aco&er7 con=!n+(+" cr!(er!!"or Ede e<., (es(area &ro!ec(!v7J n+ &o( .! +(!"!/a(e :n %od
    va"a'!" ca s+rs7 &r!%ar7 de !n.or%a=!e d!a$nos(!c7.
    .tili(area DSM-IV "n situaii medico-le!ale
    CAnd descr!er!"e (e<(+a"e, cr!(er!!"e s! d!a$nos(!ce"e DSM4I3 s+n( +(!"!/a(e :n
    sco&+r! %ed!co4"e$a"e, e<!s(7 r!sc+r! se%n!.!ca(!ve ca !n.or%a=!!"e d!a$nos(!ce s7 .!e
    +(!"!/a(e sa+ :n=e"ese :n %od erona(. Aces(e &er!co"e a&ar d!n ca+/a acord+"+!
    !%&er.ec( d!n(re &ro'"e%e"e de !n(eres esen=!a" &en(r+ "e$e s! !n.or%a=!a con=!n+(7
    :n(r4+n d!a$nos(!c c"!n!c, :n ce"e %a! %+"(e s!(+a=!!, d!a$nos(!c+" c"!n!c a" +ne!
    (+"'+r7r! %en(a"e a DSM4I3 n+ es(e s+.!c!en( &en(r+ a s(a'!"! e<!s(en=a :n sco& "e$a"
    a +ne! S(+"'+r7r! %en(a"eT, S!nca&ac!(7=! %en(a"eT, S%a"ad!! %en(a"eT sa+ Sde.ec(
    %en(a"T, :n a s(a'!"! dac7 +n !nd!v!d sa(!s.ace +n s(andard "e$a" s&ec!.!ca( Ede e<.,
    &en(r+ co%&e(en=7, res&onsa'!"!(a(e &ena"7 sa+ !nca&ac!(a(eJ s+n( necesare de
    re$+"7 !n.or%a=!! s+&"!%en(are, c+ %+"( &es(e ce"e con=!n+(e :n d!a$nos(!c+" DSM4
    I3. Aces(ea &o( !nc"+de !n.or%a=!! des&re de(er!or7r!"e .+nc=!ona"e a"e !nd!v!d+"+!
    O! des&re %od+" c+% aces(e de(er!or7r! a.ec(ea/7 ca&ac!(7=!"e s&ec!.!ce :n
    ces(!+ne. E<ac( &en(r+ .a&(+" c7 de(er!or7r!"e, ca&ac!(7=!"e s! !nca&ac!(7=!"e var!a/7
    "ar$ :n cadr+" .!ec7re! ca(e$or!! d!a$nos(!ce, s(a'!"!rea +n+! an+%!( d!a$2nos(!c n+
    !%&"!c7 +n n!ve" s&ec!.!c de de(er!orare sa+ !nca&ac!(a(e.
    Ce! care !a+ dec!/!! nonc"!n!ce (re'+!e s7 .!e a(en=! "a .a&(+" c7 +n d!a$nos(!c n+
    are n!c! +n .e" de !%&"!ca=!! o'"!$a(or!! re.er!(oare "a ca+/e"e (+"'+r7r!! %en(a"e a
    !nd!v!d+"+! sa+ "a de(er!or7r!"e asoc!a(e c+ aceas(a. Inc"+derea +ne! (+"'+r7r! :n
    c"as!.!care Eca :n %ed!c!n7, :n $enera"J n+ cere s7 .!e c+nosc+(7 s! e(!o"o$!a sa. De
    ase%enea, .a&(+" c7 (a'"o+" c"!n!c a" +n+! !nd!v!d sa(!s.ace cr!(er!!"e &en(r+ +n
    d!a$nos(!c DSM4I3 n+ co%&or(7 n!c! +n .e" de !%&"!ca=!! re.er!(oare "a $rad+" de
    con(ro" a" !nd!v!d+"+! as+&ra co%&or(a%en(+"+! care &oa(e .! asoc!a( c+ (+"'+rarea.
    C!ar cAnd con(ro"+" d!%!n+a( as+&ra &ro&r!+"+! co%&or(a%en( es(e +n e"e%en( a"
    (+"'+r7r!!, a avea d!a$nos(!c+" :n s!ne n+ de%ons(rea/7 c7 +n an+%!( !nd!v!d es(e
    Esa+ a .os(J !nca&a'!" s74s! con(ro"e/e co%&or(a%en(+" "a +n %o%en( da(.
    Tre'+!e no(a( c7 DSM4I3 re."ec(7 +n consens re.er!(or "a c"as!.!carea s!
    d!a$nos(!c+" (+"'+r7r!"or %en(a"e care &rov!ne :nc7 de "a &r!%a sa &+'"!care.
    C+noO(!n=e"e no! o'=!n+(e d!n cerce(are sa+ e<&er!en=a c"!n!c7 vor d+ce !nd+'!(a'!"
    "a o creO(ere a :n=e"e$er!! (+"'+r7r!"or !nc"+se :n DSM4I3, "a !den(!.!carea de no!
    (+"'+r7r! s! "a e<c"+derea +nor (+"'+r7r! d!n c"as!.!c7r!"e v!!(oare. Te<(+" s! se(+r!"e
    de cr!(er!! !nc"+se :n DSM4I3 vor neces!(a recons!derare :n "+%!na !n.or%a=!!"or no!
    care vor a&are.
    U(!"!/area DSM4I3 :n s!(+a=!! %ed!co4"e$a"e (re'+!e s7 .!e &7(r+ns7 de
    conO(!en(!/area r!sc+r!"or O! "!%!(e"or d!sc+(a(e %a! s+s. CAnd s+n( +(!"!/a(e
    cores&+n/7(or, d!a$nos(!ce"e s! !n.or%a=!!"e d!a$nos(!ce &o( a@+(a &e ce! care !a+
    dec!/!! :n re/o"+=!!"e "or. De e<e%&"+, cAnd &re/en(a +ne! (+"'+r7r! %en(a"e es(e
    !nvoca(7 &en(r+ o dec!/!e "e$a"7 +"(er!oar7 Ede e<., o'"!$a=!e c!v!"7 !nvo"+n(ar7J,
    +(!"!/area +n+! s!s(e% de d!a$nos(!c &res(a'!"!( creO(e va"oarea O! .!de"!(a(ea dec!/!e!.
    Pr!n o.er!rea +n+! co%&end!+% 'a/a( &e o (recere :n rev!s(7 a "!(era(+r!! c"!n!ce s! de
    cerce(are cores&+n/7(oare, DSM4I3 &oa(e &oa(e .ac!"!(a :n=e"e$erea de c7(re ce! care
    !a+ dec!/!! a carac(er!s(!c!"or re"evan(e a"e (+"'+r7r!"or %en(a"e. L!(era(+ra
    re.er!(oare "a d!a$nos(!c serveO(e, de ase%enea, dre&( .rAn7 :n ca"ea s&ec+"a=!!"or
    ne.onda(e des&re (+"'+r7r!"e %en(a"e s! des&re .+nc=!onarea +n+! an+%!( !nd!v!d,
    :n .!ne, !n.or%a=!!"e d!a$nos(!ce re.er!(oare "a evo"+=!a "on$!(+d!na"7 &o( a%e"!ora
    "+area dec!/!e! cAnd &ro'"e%a "e$a"7 !n(eresea/7 .+nc=!onarea %en(a"7 a +n+!
    !nd!v!d d!n(r4o &er!oad7 de (!%& (rec+(7 sa+ v!!(oare.
    XXXII Introducere

    onsideraiuni etnice si culturale
    :n &re&ararea DSM4I3 a+ .os( .7c+(e e.or(+r! s&ec!a"e &en(r+ a :ncor&ora
    conO(!en(!/area .a&(+"+! c7 %an+a"+" es(e +(!"!/a( :n &o&+"a=!! d!.er!(e c+"(+ra" :n
    S(a(e"e Un!(e O! :n a"(e =7r!. C"!n!c!en!! s+n( ce%a=! s7 eva"+e/e !nd!v!/! d!n
    n+%eroase .ond+r! c+"(+ra"e O! $r+&+r! e(n!ce d!.er!(e. Eva"+area d!a$nos(!c7 &oa(e
    .! e<(re% de !n(eresan(7 cAnd +n c"!n!c!an d!n(r4+n $r+& c+"(+ra" sa+ e(n!c +(!"!/ea/7
    c"as!.!carea DSM4I3 &en(r+ a eva"+a +n !nd!v!d d!n(r4+n a"( $r+& c+"(+ra" sa+ e(n!c.
    Un c"!n!c!an care n+ es(e .a%!"!ar!/a( c+ n+an=e"e cadr+"+! c+"(+ra" de re.er!n=7 a"
    !nd!v!d+"+! &oa(e cons!dera !ncorec( ca &s!o&a(o"o$!e ace"e var!a=!! :n
    co%&or(a%en(, cred!n=e sa+ e<&er!en=e care s+n( &ro&r!! c+"(+r!! !nd!v!d+"+!. De
    e<e%&"+, an+%!(e &rac(!c! re"!$!oase sa+ cred!n=e Ede e<., a+/!rea sa+ vederea +ne!
    r+de deceda(e :n c+rs+" do"!+"+!J &o( .! d!a$nos(!ca(e ca %an!.es(7r! a"e +ne!
    (+"'+r7r! &s!o(!ce. A&"!carea cr!(er!!"or (+"'+r7r!! de &ersona"!(a(e (ransversa" &r!n
    cond!=!! c+"(+ra"e &oa(e .! e<(re% de d!.!c!"7 d!n ca+/a "ar$!! var!a=!! c+"(+ra"e :n
    conce&(e"e de s!ne, s(!"+r!"e de co%+n!care s! %ecan!s%e"e de a .ace .a=7.
    DSM4I3 !nc"+de (re! (!&+r! de !n.or%a=!! care se re.er7 :n s&ec!a" "a as&ec(e"e
    c+"(+ra"eQ 5J d!sc+(area :n (e<( a var!a=!!"or c+"(+ra"e d!n (a'"o+" c"!n!c a" ace"or
    (+"'+r7r! care a+ .os( !nc"+se :n c"as!.!carea DSM4I38 9J descr!erea s!ndro%e"or
    c!rc+%scr!se c+"(+ra" care n+ a+ .os( !nd+se :n c"as!.!carea DSM4I3 Eaces(ea s+n(
    !nc"+se :n ane<a IJ s! ;J o sce%7 &en(r+ .or%+"area c+"(+ra"7 des(!na(7 s7 a@+(e
    c"!n!c!an+" :n eva"+area s!s(e%a(!c7 O! descr!erea !%&ac(+"+! con(e<(+"+! c+"(+ra" a"
    !nd!v!d+"+! Ede ase%enea, :n ane<a IJ.
    Lar$a acce&(are !n(erna=!ona"7 a DSM s+$erea/7 c7 aceas(7 c"as!.!care es(e +(!"7
    :n descr!erea (+"'+r7r!"or %en(a"e, aOa c+% s+n( e"e e<&er!en(a(e de !nd!v!/!! d!n
    :n(rea$a "+%e. C+ (oa(e aces(ea, ev!den=a s+$erea/7 c7 evo"+=!a O! s!%&(o%e"e +n+!
    n+%7r de (+"'+r7r! DSM4I3 s+n( !n."+en=a(e de .ac(or! c+"(+ra"! s! e(n!c!. Pen(r+ a
    .ac!"!(a a&"!carea sa "a !nd!v!/! d!n d!verse %ed!! c+"(+ra"e s! e(n!ce, DSM4I3 !nc"+de
    o sec=!+ne no+7 :n (e<(, &en(r+ a aco&er! e"e%en(e"e :n "e$7(+r7 c+ c+"(+ra. Aceas(7
    sec=!+ne descr!e %od+r!"e :n care d!verse"e .ond+r! c+"(+ra"e a.ec(ea/7 con=!n+(+" s!
    .or%a &re/en(7r!! s!%&(o%e"or Ede e<., (+"'+r7r!"e de&res!ve carac(er!/a(e &r!n
    &re&onderen=a s!%&(o%e"or so%a(!ce %a! c+rAnd decA( &r!n (r!s(e=e :n an+%!(e
    c+"(+r!J, e<&res!!"e &re.era(e &en(r+ descr!erea de(rese! O! !n.or%a=!! des&re
    &reva"en=7,cAnd aces(ea s+n( d!s&on!'!"e.
    A" do!"ea (!& de !n.or%a=!e c+"(+ra"7 o.er!(7 se re.er7 "a Ss!ndroa%e"e c!rc+%scr!se
    c+"(+ra"T care a+ .os( descr!se :n(r4+na sa+ :n cA(eva soc!e(7=! d!n "+%e. DSM4I3
    o.er7 do+7 %od+r! de creO(ere a rec+noaO(er!! s!ndroa%e"or c!rc+%scr!se c+"(+ra"Q
    5J +ne"e Ede e<., amo8, ata:+e de ner*ios% s+n( !nc"+se ca e<e%&"e se&ara(e :n ca(e$or!!"e
    de S.7r7 a"(7 s&ec!.!ca=!eT O! 9J o ane<7 a s!ndro%e"or c!rc+%scr!se c+"(+ra" Eane<a IJ
    a .os( !n(rod+s7 :n DSM4I3, aceas(a !nc"+/And n+%e"e cond!=!e!, c+"(+ra :n care a
    .os( descr!s7 &en(r+ &r!%a da(7 s! o sc+r(7 descr!ere a &s!o&a(o"o$!e!.
    Prevederea +ne! sec=!+n! s&ec!.!ce c+"(+r!! :n (e<(+" DSM4I3, !nc"+derea +n+!
    $"osar de s!ndroa%e c!rc+%scr!se c+"(+ra" s! &revedera +ne! sce%e &en(r+
    .or%+"area c+"(+ra"7 s+n( des(!na(e s7 creasc7 a&"!carea (ransc+"(+ra"7 a DSM4I3. Se
    s&er7 c7 aces(e no! e"e%en(e vor creO(e sens!'!"!(a(ea "a var!a=!!"e %od+"+! :n care
    (+"'+r7r!"e %en(a"e &o( .! e<&r!%a(e :n d!verse c+"(+r! s! vor red+ce e.ec(+" &os!'!"
    a" &re@+dec7=!"or !ns(!nc(!ve &roven!nd d!n &ro&r!+" %ed!+ c+"(+ra" a" c"!n!c!an+"+!.
    Introducer
    e
    XXXIII
    .tili(area DSM-IV "n plani$icarea tratamentului
    P+nerea +n+! d!a$nos(!c DSM4I3 es(e n+%a! &r!%+" &as a" +ne! eva"+7r!
    c+&r!n/7(oare. Pen(r+ a .or%+"a +n &"an de (ra(a%en( adecva(, c"!n!c!an+" va
    neces!(a :n %od cons(an( !n.or%a=!! s+&"!%en(are cons!dera'!"e des&re &ersoana
    eva"+a(7, :n a.ara ce"or cer+(e &en(r+ a &+ne +n d!a$nos(!c DSM4I3.
    Disticia dintre Tulburarea Mental si Condiia Medical General
    Ter%en!! de t+lb+rare mental6 s! de condi(ie medicala /eneral6 s+n( +(!"!/a=! &es(e
    (o( :n aces( %an+a". Ter%en+" de t+lb+rare mental6 a .os( e<&"!ca( %a! s+s. Ter%en+"
    de condi(ie medical6 /eneral6 es(e +(!"!/a( &+r O! s!%&"+ dre&( o &resc+r(are
    convena'!"7 &en(r+ re.er!rea "a cond!=!!"e s! (+"'+r7r!"e care s+n( "!s(a(e :n a.ara
    ca&!(o"+"+! de ST+"'+r7r! %en(a"e s! de co%&or(a%en(T a" ICD. Tre'+!e rec+nosc+(
    c7 aceO(!a s+n( &+r s! s!%&"+ (er%en! conven=!ona"! s! n+ (re'+!e "+a=! :n sens+" c7
    ar e<!s(a vreo d!s(!nc=!e .+nda%en(a"7 :n(re (+"'+r7r!"e %en(a"e O! cond!=!!"e
    %ed!ca"e $enera"e, c7 (+"'+r7r!"e %en(a"e n+ a+ n!c! o "e$7(+r7 c+ .ac(or!! sa+
    &rocese"e so%a(!ce sa+ '!o"o$!ce, sa+ c7 cond!=!!"e %ed!ca"e $enera"e n+ a+ n!c! o
    "e$7(+r7 c+ .ac(or!! sa+ &rocese"e &s!osoc!a"e sa+ co%&or(a%en(a"e.
    Or/ani)area Manualului
    Man+a"+" :nce&e c+ !ns(r+c=!+n! re.er!(oare "a +(!"!/area %an+a"+"+! E&a$. 5J,
    +r%a(7 de c"as!.!carea DSM4F34TR E&a$. 5;49RJ care &revede o "!s(are s!s(e%a(!c7 a
    ca(e$or!!"or s! cod+r!"or o.!c!a"e. Ur%7(oarea es(e descr!erea s!s(e%+"+! %+"(!a<!a" a"
    DSM4I3 &en(r+ eva"+are E&a$. 9H4;HJ. Aceas(a es(e +r%a(7 de cr!(er!!"e de
    d!a$nos(!c &en(r+ .!ecare d!n(re ca(e$or!!"e d!a$nos(!ce a"e DSM4I3 aco%&an!a(e de
    +n (e<( descr!&(!v E&a$. ;F4HI;J. :n .!na", DSM4I3 !nc"+de 55 ane<e.

    Avertisment
    r!(er!!"e de d!a$nos(!c s&ec!.!ca(e &en(r+ .!ecare (+"'+rare %en(a"7 s+n(
    o.er!(e ca re&ere &en(r+ e.ec(+area d!a$nos(!c+"+!, deoarece s4a
    de%ons(ra( c7 +(!"!/area +nor as(.e" de cr!(er!! cres(e acord+" :n(re
    c"!n!c!en! s! cerce(7(or!. U(!"!/area cores&+n/7(oare a aces(or cr!(er!!
    cere +n an(rena%en( c"!n!c s&ec!a"!/a( care &roc+r7, a(A( +n cor& de
    c+noO(!n=e, cA( s! a&(!(+d!n! c"!n!ce.
    Aces(e cr!(er!! de d!a$nos(!c s! c"as!.!carea DSM4F3 a (+"'+r7r!"or %en(a"e
    re."ec(7 +n consens as+&ra .or%+"7r!"or c+ren(e a"e c+noO(!n=e"or a&7r+(e :n
    do%en!+" nos(r+. E"e n+ c+&r!nd :ns7 (oa(e cond!=!!"e &en(r+ care &o( .! (ra(a=!
    oa%en!! sa+ care &o( .! (e%e adecva(e &en(r+ e.or(+r!"e cerce(7r!!.
    Sco&+" DSM4I3 es(e ace"a de a o.er! descr!er! c"are ca(e$or!!"or d!a$nos(!ce c+
    sco&+" de a &er%!(e c"!n!c!en!"or O! cerce(7(or!"or s7 d!a$nos(!ce/e, s7 co%+n!ce
    des&re aceas(a, s7 s(+d!e/e O! s7 (ra(e/e oa%en!! c+ d!verse (+"'+r7r! %en(a"e.
    Tre'+!e :n=e"es c7 !nc"+derea a!c!, :n sco&+r! c"!n!ce O! de cerce(are, a +nor ca(e$or!!
    d!a$nos(!ce c+% s+n( @oc+" de Oans7 &a(o"o$!c s! &edo.!"!a, n+ !%&"!c7 O! .a&(+" c7
    aces(e cond!=!! sa(!s.ac cr!(er!!"e "e$a"e sa+ non%ed!ca"e &en(r+ ceea ce cons(!(+!e
    %a"ad!e %en(a"7, (+"'+rare %en(a"7 sa+ !nca&ac!(a(e %en(a"7. Cons!dera=!+n!"e de
    ord!n c"!n!c O! O(!!n=!.!c !%&"!ca(e :n c"as!.!carea aces(or cond!=!! ca (+"'+r7r! %en(a"e
    n+ &o( .! &e de&"!n re"evan(e &en(r+ ra=!ona%en(e "e$a"e, de e<e%&"+, care !a+ :n
    cons!dera=!e as&ec(e c+% ar .! res&onsa'!"!(a(ea !nd!v!d+"+!, s(a'!"!rea !nca&ac!(7=!!
    s! co%&e(en=e!.
    XXXV

    ?DM(!

    .tili(area manualului
    +ecurena
    N+ rar :n &rac(!ca c"!n!c7, !nd!v!/!!, d+&7 o &er!oad7 de (!%& :n care cr!(er!!"e
    co%&"e(e &en(r+ (+"'+rare n+ %a! s+n( sa(!s.7c+(e Ead!c7, se a."7 :n re%!s!+ne
    &ar=!a"7 sa+ co%&"e(7, or! s+n( rec+&era=!J, &o( de/vo"(a s!%&(o%e care s+$erea/7 o
    rec+ren=7 a (+"'+r7r!! "or !n!=!a"e, dar care n+ sa(!s.ace co%&"e( &ra$+" &en(r+ acea
    (+"'+rare, d+&7 c+% es(e s&ec!.!ca( :n se(+" de cr!(er!!. Es(e o &ro'"e%7 de @+deca(7
    c"!n!c7, c+% ar .! %a! '!ne s7 se !nd!ce &re/en=a aces(or s!%&(o%e. S+n( a&"!ca'!"e
    +r%7(oare"e a"(erna(!veQ
    N Dac7 s!%&(o%e"e s+n( cons!dera(e a .! +n no+ e&!sod a" +ne! cond!=!! rec+ren(e,
    (+"'+rarea &oa(e .! d!a$nos(!ca(7 dre&( c+ren(7 Esa+ &rov!/or!eJ, c!ar :na!n(e ca
    (oa(e cr!(er!!"e s7 .!e sa(!s.7c+(e Ede e<., d+&7 sa(!s.acerea cr!(er!!"or &en(r+ +n
    e&!sod de&res!v %a@or, &en(r+ &+nerea d!a$nos(!c+"+! s+n( necesare n+%a! 5L
    /!"e d!n 5I cA(e s+n( cer+(e de re$+"7J.
    N Dac7 s!%&(o%e"e s+n( cons!dera(e a .! se%n!.!ca(!ve c"!n!c, dar n+ es(e c"ar dac7
    e"e cons(!(+!e o rec+ren=7 a (+"'+r7r!! !n!=!a"e, &oa(e .! &er%!s7 ca(e$or!a
    cores&+n/7(oare de S.7r7 a"(7 s&ec!.!ca=!eT.
    N Dac7 se cons!der7 c7 s!%&(o%e"e n+ s+n( se%n!.!ca(!ve c"!n!c, n+ se va &+ne n!c!
    +n d!a$nos(!c c+ren( sa+ &rov!/or!+, dar &oa(e .! no(a( S!s(or!c an(er!or de...T
    Eve/! &a$. 9J.
    Dia!nostic principal1motivul consultaiei
    CAnd +n+! !nd!v!d, :n s!(+a=!a de &ac!en( !n(erna( :n s&!(a", ! se &+n %a! %+"(e
    d!a$nos(!ce, dia/nostic+l principal es(e cond!=!a s(a'!"!(7 d+&7 e<a%en+" c"!n!c a .!
    &r!nc!&a"+" res&onsa'!" de !n(ernarea :n s&!(a" a !nd!v!d+"+!. CAnd +n+! !nd!v!d :!
    es(e &+s %a! %+"( decA( +n s!n$+r d!a$nos(!c, :n s!(+a=!a de &ac!en( a%'+"a(or!+,
    moti*+l cons+lta(iei es(e cond!=!a care es(e &r!nc!&a"+" res&onsa'!" &en(r+ serv!c!!"e
    de as!s(en=7 %ed!ca"7 a%'+"a(or!e &r!%!(e :n (!%&+" cons+"(a=!e!, :n ce"e %a! %+"(e
    ca/+r!, d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+" cons+"(a=!e! es(e, de ase%enea,
    &r!nc!&a"+" cen(r+ a" a(en=!e! sa+ (ra(a%en(+"+!. Adesea es(e d!.!c!" Es! oarec+%
    ar'!(rarJ s7 se &rec!/e/e care es(e d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+" cons+"(a=!e!, :n
    s&ec!a" :n s!(+a=!!"e de Sd!a$nos(!c d+'"+T E+n d!a$nos(!c :n "e$7(+r7 c+ o s+'s(an=7,
    c+% ar .! de&enden=a de a%.e(a%!na, :nso=!( de +n d!a$nos(!c .7r7 "e$7(+r7 c+ vreo
    s+'s(an=7, c+% ar .! sc!/o.ren!aJ. De e<e%&"+, &oa(e .! nec"ar care d!a$nos(!c
    (re'+!e s7 .!e cons!dera( S&r!nc!&a"T "a +n !nd!v!d s&!(a"!/a(, a(A( &en(r+
    sc!/o.ren!e, cA( s! &en(r+ o !n(o<!ca=!e c+ a%.e(a%!na, &en(r+ c7 se &oa(e ca .!ecare
    cond!=!e s7 .! con(r!'+!( :n e$a"7 %7s+r7 "a neces!(a(ea !n(ern7r!! s! (ra(a%en(+"+!.
    D!a$nos(!ce"e %+"(!&"e &o( .! ra&or(a(e :n %od %+"(!a<!a" Eve/! &a$. ;YJ sa+ :n
    %od nona<!a" Eve/! &a$. ;HJ. CAnd d!a$nos(!c+" &r!nc!&a" es(e o (+"'+rare de &e a<a
    I, aces( "+cr+ es(e !nd!ca( &r!n %en=!onarea sa, &r!%+". Res(+" (+"'+r7r!"or s+n(
    %en=!ona(e :n ord!nea !%&or(an=e! "or &en(r+ a(en=!e s! (ra(a%en(. CAnd o &ersoan7
    are, a(A( &e a<a I, cA( s! &e a<a II cA(e +n d!a$nos(!c, d!a$nos(!c+" &r!nc!&a" sa+
    %o(!v+" cons+"(a=!e! se cons!der7 a .! d!a$nos(!c+" de &e a<a I, e<ce&(And ca/+" :n
    care d!a$nos(!c+" de &e a<a II es(e +r%a( de e<&res!a ca"!.!ca(!v7 SEd!a$nos(!c
    &r!nc!&a"JT sa+ SE%o(!v &en(r+ cons+"(a=!eJT.
    Dia!nostic provi(oriu
    S&ec!.!can(+" de pro*i;ori+ &oa(e .! +(!"!/a( cAnd e<!s(7 &re/+%=!a .er%7 c7 :n ce"e
    d!n +r%7 cr!(er!!"e &en(r+ (+"'+rare vor .! sa(!s.7c+(e &e de&"!n, dar :n &re/en( n+
    .tili(area manualului
    es(e d!s&on!'!"7 s+.!c!en(7 !n.or%a=!e &en(r+ a &+ne +n d!a$nos(!c de cer(!(+d!ne.
    C"!n!c!an+" &oa(e !nd!ca !ncer(!(+d!nea d!a$nos(!c7 &r!n %en=!onarea e<&res!e!
    SE&rov!/or!+JT d+&7 d!a$nos(!c. De e<e%&"+, !nd!v!d+" &are a avea o (+"'+rare
    de&res!v7 %a@or7, dar es(e !nca&a'!" s7 &re/!n(e +n !s(or!c adecva( &en(r+ a se &+(ea
    s(a'!"! c7 (oa(e cr!(er!!"e s+n( sa(!s.7c+(e. O a"(7 +(!"!/are a (er%en+"+! de &rov!/or!+
    es(e cea &en(r+ s!(+a=!!"e :n care d!a$nos(!c+" d!.eren=!a" de&!nde e<c"+s!v de d+ra(a
    %a"ad!e!. De e<e%&"+, d!a$nos(!c+" de (+"'+rare sc!/o.ren!.or%7 neces!(7 o d+ra(7
    de %a! &+=!n de R "+n! s! &oa(e .! &+s n+%a! &rov!/or!+, dac7 es(e s(a'!"!( :na!n(e ca
    s7 s+rv!n7 re%!s!+nea.
    Utili)area #ate/oriilor 0'(r( Alt( Spe#i%i#a!ie1
    D!n ca+/a d!vers!(7=!! (a'"o+r!"or c"!n!ce, es(e !%&os!'!" &en(r+ no%enc"a(+ra
    d!a$nos(!c7 s7 aco&ere or!ce s!(+a=!e &os!'!"7. D!n aceas(7 ca+/7, .!ecare c"as7
    d!a$nos(!c7 are ce" &+=!n o ca(e$or!e .7r7 a"(7 s&ec!.!ca=!e EFSJ, !ar +ne"e c"ase a+
    %a! %+"(e ca(e$or!! FS. E<!s(7 &a(r+ s!(+a=!! :n care es(e o&or(+n +n d!a$nos(!c FSQ
    N Ta'"o+" c"!n!c se con.or%ea/7 "!n!!"or d!rec(oare $enera"e &en(r+ o (+"'+rare
    %en(a"7 d!n c"asa d!a$nos(!c7, dar (a'"o+" s!%&(o%a(o"o$!e n+ sa(!s.ace cr!(er!!"e
    &en(r+ n!c! +na d!n(re (+"'+r7r!"e s&ec!.!ce. Aceas(a se :n(A%&"7, .!e a(+nc! cAnd
    s!%&(o%e"e s+n( s+' &ra$+" d!a$nos(!c &en(r+ vre+na d!n(re (+"'+r7r!"e
    s&ec!.!ce, .!e cAnd e<!s(7 +n (a'"o+ c"!n!c a(!&!c sa+ %!<(.
    N Ta'"o+" c"!n!c se con.or%ea/7 +n+! &a((ern de s!%&(o%e care n+ es(e !nc"+s :n
    c"as!.!carea DSM4I3, dar care ca+/ea/7 o de(res7 sa+ de(er!orare se%n!.!ca(!v7
    c"!n!c. Cr!(er!!"e de cerce(are &en(r+ +ne"e d!n(re aces(e &a((ern+r! de s!%&(o%e
    a+ .os( !nc"+se :n ane<a B ESSe(+r! de cr!(er!! O! a<e &rev7/+(e &en(r+ s(+d!+
    s+&"!%en(arTJ, :n care ca/ es(e &rev7/+(7 o &a$!n7 de re.er!n=7 &en(r+ se(+" de
    cr!(er!! de cerce(are s+$era(e :n ane<a B.
    N E<!s(7 !ncer(!(+d!ne :n "e$7(+r7 c+ e(!o"o$!a Ead!c7, re.er!(or "a .a&(+" dac7
    (+"'+rarea es(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, es(e !nd+s7 de o
    s+'s(an=7, or! es(e &r!%ar7J.
    N E<!s(7 &+=!ne Oanse &en(r+ o s(rAn$ere de da(e co%&"e(e Ede e<., :n s!(+a=!! de +r
    $en=7J sa+ !n.or%a=!!"e s+n( !ncons!s(en(e sa+ con(rad!c(or!!, dar e<!s(7 s+.!c!en(e
    !n.or%a=!! &en(r+ a &"asa (+"'+rarea :n(r4o c"as7 d!a$nos(!c7 an+%e Ede e<.,
    c"!n!c!an+" s(a'!"eO(e c7 !nd!v!d+" &re/!n(7 s!%&(o%e &s!o(!ce, dar n+ d!s&+ne de
    s+.!c!en(e !n.or%a=!! &en(r+ a d!a$nos(!ca o (+"'+rare &s!o(!c7 s&ec!.!c7J.
    Mo$urile $e in$i#are a in#ertitu$inii $ia/no&ti#e
    Ta'e"+" +r%7(or &re/!n(7 d!verse"e %od+r! :n care c"!n!c!an+" &oa(e !nd!ca
    !ncer(!(+d!nea d!a$nos(!c7
    Ter"en E,e"ple $e &itua!ii #lini#e


    oduri V &#entru alte condiii care
    se pot a$la "n centrul ateniei clinice)
    Isu$icient in$ormaie pentru a ,ti dac
    sau nu problema pre(ent este atri-
    buibil unei tulburri mentale, de ex2,
    problem ,colar3 comportament
    antisocial al adultului2
    utili(area manualului

    Termen E,e"ple $e &itua!ii #lini#e

    In$ormaie inadecvat pentru a putea
    $ace vreo 0udecat dia!nostic "n
    le!tur cu un dia!nostic sau condiie
    de pe axa I2
    In$ormaie inadecvat pentru a putea
    $ace vreo 0udecat dia!nostic "n
    le!tur cu un dia!nostic sau condiie
    de pe axa II2
    45526 Tulburare mental nespeci$icat *ste disponibil su$icient in$ormaie
    &nonpsi%otic) pentru a exclude o tulburare psi%o-
    tic, dar alt speci$icaie "n plus nu
    este posibil2
    76826 Tulburare psi%otic $r alt
    speci$icaie
    9lasa tulburrilor: 'r alt
    speci$icaie, de ex2, Tulburare
    depresiv ';S
    <Dia!nostic speci$ic: &#rovi(oriu),
    de ex2, Tulburare sc%i(o$reni$orm
    p
    rovi(oriu)
    *ste disponibil su$icient in$ormaie
    pentru a stabili pre(ena unei tulburri
    psi%otice, dar alt speci$icaie "n plus
    nu este posibil2
    *ste disponibil su$icient in$ormaie
    pentru a indica clasa tulburrii pre(ente,
    dar alt speci$icaie "n plus nu este
    posibil, $ie pentru c nu exist
    su$icient in$ormaie pentru a pune
    un dia!nostic mai speci$ic, $ie pentru
    c elementele clinice ale tulburrii nu
    satis$ac criteriile pentru nici una din
    cate!oriile speci$ice din clasa respectiv2
    *ste disponibil su$icient in$ormaie
    pentru a pune un dia!nostic =de lucru>,
    dar clinicianul dore,te s indice un
    !rad semni$icativ de incertitudine2

    Criteriile utili)ate .n "o$ %re#vent
    riteriile utili(ate pentru a exclude alte dia!nostice si a su!era
    dia!nosticele di$ereniale
    Ce"e %a! %+"(e se(+r! de cr!(er!! &re/en(a(e :n aces( %an+a" !nc"+d cr!(er!! de
    e<c"+dere, necesare &en(r+ a s(a'!"! "!%!(e"e d!n(re (+"'+r7r! s! &en(r+ a c"ar!.!ca
    d!a$nos(!ce"e d!.eren=!a"e. M+"(e d!n(re d!verse"e .or%+"7r! a"e cr!(er!!"or de
    e<c"+dere d!n se(+r!"e de cr!(er!! a"e DSM4I3 re."ec(7 d!.er!(e"e (!&+r! de re"a=!!
    &os!'!"e d!n(re (+"'+r7r!Q
    N SCr!(er!!"e n4a+ .os( sa(!s.7c+(e n!c!oda(7 &en(r+...T Aces( cr!(er!+ de e<c"+dere
    es(e +(!"!/a( &en(r+ a de.!n! o !erar!e :n(re (+"'+r7r! &e (o( c+rs+" v!e=!!. De
    e<e%&"+, d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7 n+ %a! &oa(e .! &+s, oda(7
    ce a s+rven!( +n e&!sod %an!aca", s! (re'+!e s7 .!e sc!%'a( c+ d!a$nos(!c+" de
    (+"'+rare '!&o"ar7 I.
    ?6626 Dia!nostic sau condiie
    am@nat pe axa l
    >A626 Dia!nostic am@nat pe axa II
    .tili(area manualului
    N SCr!(er!!"e n+ s+n( sa(!s.7c+(e &en(r+...T. Aces( cr!(er!+ de e<c"+dere es(e
    +(!"!/a( &en(r+ a s(a'!"! o !erar!e :n(re (+"'+r7r! Esa+ s+'(!&+r!J, de.!n!(e &e
    sec=!+ne (ransversa"7. De e<e%&"+, s&ec!.!can(+" Sc+ e"e%en(e %e"anco"!ceT
    &r!%ea/7 .a=7 de ce" Sc+ e"e%en(e a(!&!ceT &en(r+ descr!erea e&!sod+"+!
    de&res!v %a@or c+ren(.
    N Sn+ s+rv!ne e<c"+s!v :n c+rs+"...T. Aces( cr!(er!+ de e<c"+dere &rev!ne
    d!a$nos(!carea +ne! (+"'+r7r! cAnd s!%&(o%e"e sa"e s+rv!n n+%a! :n c+rs+" a"(e!
    (+"'+r7r!. De e<e%&"+, de%en=a n+ es(e d!a$nos(!ca(7 se&ara( dac7 s+rv!ne
    n+%a! :n c+rs+" de"!r!+%+"+!8 (+"'+rarea de convers!e n+ es(e d!a$nos(!ca(7
    se&ara( dac7 s+rv!ne n+%a! :n c+rs+" (+"'+r7r!! de so%a(!/are8 '+"!%!a nervoas7
    n+ es(e d!a$nos(!ca(7 se&ara( dac7 s+rv!ne n+%a! :n c+rs+" e&!soade"or de
    anore<!e nervoas7. Aces( cr!(er!+ de e<c"+dere es(e +(!"!/a( de re$+"7 :n s!(+a=!!"e
    :n care s!%&(o%e a"e +ne! (+"'+r7r! s+n( e"e%en(e asoc!a(e sa+ +n s+'se( a"
    s!%&(o%e"or (+"'+r7r!! &r!or!(are. C"!n!c!an+" (re'+!e s7 cons!dere &er!oade"e de
    re%!s!+ne &ar=!a"7 ca &ar(e a Sc+rs+"+! a"(e! (+"'+r7r!T. Tre'+!e %en=!ona( c7
    d!a$nos(!c+" e<c"+s &oa(e .! &+s +neor!, cAnd (+"'+rarea s+rv!ne !nde&enden(
    Ede e<., cAnd (+"'+rarea care e<c"+de se a."7 :n re%!s!+ne co%&"e(7J.
    N Sn+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n
    dro$ de a'+/, +n %ed!ca%en(J sa+ a"e +ne! cond!=!! %ed!ca"e $enera"eT. Aces(
    cr!(er!+ de e<c"+dere es(e +(!"!/a( &en(r+ a !nd!ca .a&(+" c7 e(!o"o$!a re&re/en(a(7
    de o s+'s(an=7 sa+ de o cond!=!e %ed!ca"7 $enera"7 (re'+!e "+a(7 :n cons!dera=!e
    s! e<c"+s7 :na!n(e ca (+"'+rarea s7 &oa(7 .! d!a$nos(!ca(7 Ede e<., (+"'+rarea
    de&res!v7 %a@or7 &oa(e .! d!a$nos(!ca(7 n+%a! d+&7 ce e(!o"o$!!"e re&re/en(a(e
    de +/+" +ne! s+'s(an=e s! de o cond!=!e %ed!ca"7 $enera"7 a+ .os( e<c"+seJ.
    N Sn+ es(e e<&"!ca(7 %a! '!ne de...T A(es( cr!(er!+ de e<c"+dere es(e +(!"!/a(
    &en(r+ a !nd!ca .a&(+" c7 (+"'+r7r!"e %en=!ona(e :n cr!(er!+ (re'+!e "+a(e :n
    cons!dera=!e "a e.ec(+area d!a$nos(!c+"+! d!.eren=!a" a" &s!o&a(o"o$!e! &re/en(e
    s! c7, :n ca/+r!"e de "!%!(7, va .! necesar7 @+deca(a c"!n!c7 &en(r+ a &rec!/a care
    (+"'+rare re&re/!n(7 ce" %a! cores&+n/7(or d!a$nos(!c, :n as(.e" de ca/+r!,
    &en(r+ $!dare, (re'+!e cons+"(a(7 sec=!+nea Sd!a$nos(!c d!.eren=!a"T a (e<(+"+!
    &en(r+ (+"'+r7r!.
    Conven=!a $enera"7 :n DSM4I3 es(e aceea de a &er%!(e ca d!a$nos(!ce %+"(!&"e
    s7 .!e a(r!'+!(e ace"or (a'"o+r! c"!n!ce care sa(!s.ac cr!(er!!"e &en(r+ %a! %+"( decA( o
    s!n$+r7 (+"'+rare DSM4I3. E<!s(7 (re! s!(+a=!! :n care cr!(er!!"e de e<c"+dere %a! s+s
    %en=!ona(e a@+(7 "a s(a'!"!rea +ne! !erar!! d!a$nos(!ce Es! dec! &rev!n d!a$nos(!ce"e
    %+"(!&"eJ sa+ "a scoa(erea :n ev!den=7 a cons!dera=!+n!"or de d!a$nos(!c d!.eren=!a"
    Es! dec! desc+ra@ea/7 d!a$nos(!ce"e %+"(!&"eJQ
    N CAnd o (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e sa+ o
    (+"'+rare !nd+s7 de o s+'s(an=7 es(e r7s&+n/7(oare de s!%&(o%e, ea &r!%ea/7
    .a=7 de d!a$nos(!c+" (+"'+r7r!! &r!%are cores&+n/7(oare c+ ace"eaO! s!%&(o%e
    Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de coca!n7 &r!%ea/7 .a=7 de (+"'+rarea
    de&res!v7 %a@or7J, :n as(.e" de ca/+r!, +n cr!(er!+ de e<c"+dere con=!nAnd
    e<&res!a Sn+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e...T es(e !nc"+s :n se(+"
    de cr!(er!! &en(r+ (+"'+rarea &r!%ar7.
    N CAnd o (+"'+rare %a! &ervas!v7 Ede e<., sc!/o.ren!aJ are &r!n(re s!%&(o%e"e
    sa"e de.!n!(or!! Esa+ &r!n(re s!%&(o%e"e asoc!a(eJ, ceea ce s+n( s!%&(o%e"e
    de.!n!(or!! a"e +ne! (+"'+r7r! %a! &+=!n &ervas!ve Ede e<., d!s(!%!aJ, +n+" d!n
    +r%7(oare"e (re! cr!(er!! de e<c"+dere a&are :n se(+" de cr!(er!! &en(r+ (+"'+rarea
    .tili(area manualului
    %a! &+=!n &ervas!v7, !nd!cAnd .a&(+" c7 n+%a! (+"'+rarea %a! &ervas!v7 es(e
    d!a$nos(!ca(7Q SCr!(er!!"e n4a+ .os( n!c!oda(7 sa(!s.7c+(e &en(r+...T, SCr!(er!!"e n+
    s+n( sa(!s.7c+(e &en(r+...T, Sn+ s+rv!ne e<c"+s!v :n c+rs+"...T.
    N CAnd e<!s(7 de"!%!(7r! de d!a$nos(!c d!.eren=!a" e<(re% de d!.!c!"e, e<&res!a Sn+
    es(e e<&"!ca(7 %a! '!ne de...T es(e !nc"+s7 &en(r+ a !nd!ca .a&(+" c7 es(e necesar7
    @+deca(a c"!n!c7 &en(r+ a s(a'!"! care es(e d!a$nos(!c+" ce" %a! adecva(. De
    e<e%&"+, &an!ca c+ a$ora.o'!e !nc"+de cr!(er!+" Sn+ es(e e<&"!ca(7 %a! '!ne de
    .o'!a soc!a"7T, !ar .o'!a soc!a"7 !nc"+de cr!(er!+" Sn+ es(e e<&"!ca(7 %a! '!ne de
    &an!ca c+ a$ora.o'!eT, ca rec+noaO(ere a .a&(+"+! c7 es(e e<(re% de d!.!c!" de
    (rasa( o de"!%!(are, :n +ne"e ca/+r!, a%'e"e d!a$nos(!ce &o( .! adecva(e.
    riteriile pentru tulburrile induse de o substan
    Adesea es(e d!.!c!" de s(a'!"!( dac7 s!%&(o%a(o"o$!a &re/en(a(7 es(e !nd+s7 de o
    s+'s(an=7, ad!c7, dac7 es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! !n(o<!ca=!! sa+ :r4
    s(!nen=e de o s+'s(an=7, a +/+"+! +n+! %ed!ca%en( sa+ e<&+ner!! "a +n (o<!c, :n 48
    nn=a de a o.er! +n a@+(or :n a .ace aceas(7 &rec!/are, ce"e do+7 cr!(er!! %en=!ona(e
    \a. @os a+ .os( ad7+$a(e "a .!ecare d!n(re (+"'+r7r!"e !nd+se de o s+'s(an=7. Aces(e
    rr.rer!! s+n( %en!(e s7 o.ere "!n!! d!rec(oare $enera"e, dar :n ace"aO! (!%& !a+ :n cons!4
    # ora=!e @+deca(a c"!n!c7 :n a &rec!/a dac7 sa+ n+ s!%&(o%e"e &re/en(a(e s+n( ce" %a!
    r.re e<&"!ca(e de e.ec(e"e .!/!o"o$!ce d!rec(e a"e s+'s(an=e!. Pen(r+ o d!sc+=!e
    !]&"!%en(ar7 a aces(e! &ro'"e%e ve/! &a$. 9LF.
    B. Ev!den=a d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or, .!e a E5J, .!e a E9JQ
    (1) s!%&(o%e"e a+ a&7r+( :n (!%& or! :n dec+rs de o "+n7 de "a
    !n(o<!ca=!a sa+
    a's(!nen=a de o s+'s(an=78
    (2) +/+" +n+! %ed!ca%en( es(e e(!o"o$!c :n "e$7(+r7 c+ &er(+r'area.
    C Per(+r'area n+ es(e e<&"!ca(7 %a! '!ne de o (+"'+rare care n+ es(e !nd+s7 de
    o s+'s(an=7. Pro'a c7 s!%&(o%e"e s+n( e<&"!ca(e %a! '!ne de o (+"'+rare care
    n+ es(e !nd+s7 de o s+'s(an=7 &oa(e !nc"+de +r%7(oare"eQ s!%&(o%e"e &reced
    de'+(+" +/+"+! de s+'s(an=7 Esa+ %ed!ca%en(J8 s!%&(o%e"e &ers!s(7 o
    &er!oad7 cons!dera'!"7 de (!%& Ede e<., :n @+r de o "+n7J d+&7 :nce(area
    a's(!nen=e! ac+(e sa+ a !n(o<!ca=!e! severe, or! s+n( s+'s(an=!a" :n e<ces .a=7 de
    ceea ce ar .! de e<&ec(a(, da(e .!!nd "!&+", d+ra(a or! can(!(a(ea de s+'s(an=7
    +(!"!/a(78 or! e<!s(7 a"(e da(e care s+$erea/7 e<!s(en=a +ne! (+"'+r7r!
    !nde&enden(e, non!nd+se de o s+'s(an=7 Ede e<., +n !s(or!c de e&!soade
    rec+ren(e .7r7 "e$7(+r7 c+ o s+'s(an=7J.
    2rte-iile pentru o tulburare mental
    0BCaDorat unei condiii medicale !enerale
    9r.Qer!+" %en=!ona( %a! @os es(e necesar &en(r+ a s(a'!"! e<!$en=a e(!o"o$!c7 ^ &er
    TU .!ecare d!n(re (+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e 8_
    (+"'+rarea de&res!v7 da(ora(7 !&o(!ro!d!s%+"+!J. Pen(r+ o d!sc+=!e s+&"!4Er4ar7 a
    aces(e! &ro'"e%e, ve/! &a$. 5G5.
    Ev!den=a d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or, a .a&(+"+!
    c7 &er(+r'area es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e
    $enera"e.
    8 .tili(area manualului

    riteriile pentru semni$icaia clinic
    De.!n!=!a t+lb+r6rii mentale d!n !n(rod+cerea DSM4I3 cere s7 e<!s(e o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c. Pen(r+ a !"+s(ra !%&or(an=a "+7r!! :n cons!dera=!e a
    aces(+! as&ec(, se(+r!"e de cr!(er!! &en(r+ ce"e %a! %+"(e (+"'+r7r! !nc"+d +n cr!(er!+
    de se%n!.!ca=!e c"!n!c7 E.or%+"a( de re$+"7 aOa S...ca+/ea/7 de(res7 sa+ de(er!orare
    se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e
    de .+nc=!onareTJ. Aces( cr!(er!+ a@+(7 "a s(a'!"!rea &ra$+"+! &en(r+ d!a$nos(!c+" +ne!
    (+"'+r7r! :n ace"e s!(+a=!! :n care (a'"o+" c"!n!c :n s!ne E:n s&ec!a", :n .or%e"e sa"e
    +OoareJ n+ es(e :n %od !neren( &a(o"o$!c, s! &oa(e .! :n(A"n!( s! "a !nd!v!/!! &en(r+
    care +n d!a$nos(!c de S(+"'+rare %en(a"7T ar .! necores&+n/7(or. A a.!r%a c7 aces(
    cr!(er!+ es(e sa(!s.7c+(, :n s&ec!a" :n (er%en! de .+nc=!onare a ro"+"+!, es(e !neren( o
    @+deca(7 c"!n!c7 d!.!c!"7. U(!"!/area de !n.or%a=!! o'=!n+(e de "a %e%'r!! .a%!"!e! s!
    de "a (er=! E&e "An$7 ce"e .+rn!/a(e de !nsJ :n "e$7(+r7 c+ .+nc=!onarea !nd!v!d+"+!
    es(e adesea necesar7.
    Tipurile $e in%or"a!ii $in te,tul DSM-IV
    Te<(+" DSM4I3 descr!e s!s(e%a(!c .!ecare (+"'+rare s+' +r%7(oare"e r+'r!c!Q
    Se"e%en(e de d!a$nos(!cT, Ss+'(!&+r! s!Xsa+ s&ec!.!cAndT, S&rocedee de
    :nre$!s(rareT, Se"e%en(e s! (+"'+r7r! asoc!a(eT, Se"e%en(e s&ec!.!ce c+"(+r!!, e(7=!! s!
    se<+"+!T, S&reva"en(7T, Sevo"+=!eT, S&a((ern .a%!"!a"T s! Sd!a$nos(!c d!.eren=!a"T.
    CAnd, &en(r+ o sec=!+ne, n+ se d!s&+ne de n!c! o !n.or%a=!e, sec=!+nea res&ec(!v7 n+
    es(e !nc"+s7, :n +ne"e ca/+r!, cAnd %+"(e d!n(re (+"'+r7r!"e s&ec!.!ce d!n(r4+n $r+&
    de (+"'+r7r! a+ e"e%en(e co%+ne, aceas(7 !n.or%a=!e es(e !nc"+s7 :n !n(rod+cerea
    $enera"7 "a $r+&+" res&ec(!v.
    E"e%en(e de d!a$nos(!c. Aceas(7 sec=!+ne c"ar!.!c7 cr!(er!!"e de d!a$nos(!c s!
    adesea o.er7 e<e%&"e !"+s(ra(!ve.
    S+'(!&+r! O!Xsa+ s&ec!.!can=!. Aceas(7 sec=!+ne o.er7 de.!n!=!! s! sc+r(e
    co%en(ar!! :n "e$7(+r7 c+ s+'(!&+r!"e s!Xsa+ s&ec!.!can=!! a&"!ca'!"!.
    Procedee de :nre$!s(rare. Aceas(7 sec=!+ne o.er7 !nd!ca=!! &en(r+ ra&or(area
    den+%!r!! (+"'+r7r!! O! &en(r+ a"e$erea s! :nre$!s(rarea cod+"+! d!a$nos(!c ICD4F4
    CM cores&+n/7(or. Ea !nc"+de, de ase%enea, !ns(r+c=!+n! de a&"!care a or!c7ror
    s+'(!&+r! s!Xsa+ s&ec!.!can=! cores&+n/7(or!.
    E"e%en(e O! (+"'+r7r! asoc!a(e. Aceas(7 sec=!+ne es(e de re$+"7 s+'d!v!/a(7 :n
    (re! &7r=!Q
    N Elemente descripti*e si t+lb+r6ri mentale asociate7Aceast6 sec=!+ne !nc"+de e"e%en(e"e
    c"!n!ce care s+n( asoc!a(e :n %od .recven( c+ (+"'+rarea, dar care n+ s+n(
    cons!dera(e esen=!a"e &en(r+ &+nerea d!a$nos(!c+"+!, :n +ne"e ca/+r!, aces(e
    e"e%en(e a+ .os( av+(e :n vedere &en(r+ !nc"+derea "or dre&( cr!(er!! de
    d!a$nos(!c &os!'!"e, dar a+ .os( !ns+.!c!en( de sens!'!"e sa+ de s&ec!.!ce &en(r+ a
    .! !nc"+se :n se(+" de cr!(er!! .!na". De ase%enea, :n aceas(7 sec=!+ne s+n(
    %en=!ona(e O! a"(e (+"'+r7r! %en(a"e asoc!a(e c+ (+"'+rarea :n d!sc+=!e. Es(e
    s&ec!.!ca( EcAnd se c+noaO(eJ, dac7 aces(e (+"'+r7r! &reced, s+rv!n conco%!(en(
    c+, or! s+n( consec!n=e"e (+"'+r7r!! :n ces(!+ne Ede e<., de%en=a &ers!s(en(7
    !nd+s7 de a"coo" es(e consec!n=a de&enden=e! cron!ce de a"coo"J. Dac7 s+n(
    .tili(area manualului
    d!s&on!'!"e, !n.or%a=!!"e :n "e$7(+r7 c+ .ac(or!! &red!s&o/an=! s! co%&"!ca=!!"e
    s+n(, de ase%enea, !nc"+se :n aceas(7 sec=!+ne.
    N 0ate de laborator asociate7 Aceas(7 sec=!+ne .+rn!/ea/7 !n.or%a=!! des&re (re! (!&+r!
    de da(e de "a'ora(or care &0( .! asoc!a(e c+ (+"'+rareaQ 5J da(e"e de "a'ora(or
    asoc!a(e, care s+n( cons!dera(e a .! Sd!a$nos(!ceT &en(r+ (+"'+rare, de e<e%&"+
    da(e"e &o"!so%no$ra.!ce :n an+%!(e (+"'+r7r! de so%n8 9J da(e"e de "a'ora(or
    care n+ s+n( cons!dera(e a .! d!a$nos(!ce &en(r+ (+"'+rare, dar care a+ .os( no(a(e
    ca anor%a"e "a $r+&+" de !nd!v!/! c+ (+"'+rarea, :n co%&ara=!e c+ s+'!ec=!! de
    con(ro" 4 de e<e%&"+ d!%ens!+nea ven(r!c+"!"or "a (o%o$ra.!a co%&+(er!/a(7, ca
    va"!dan( a" conce&(+"+! de sc!/o.ren!e8 ;J da(e"e de "a'ora(or asoc!a(e c+
    co%&"!ca=!!"e +ne! (+"'+r7r!, de e<e%&"+, de/ec!"!'re"e e"ec(ro"!(!ce "a !nd!v!/!!
    c+ anore<!e nervoas7.
    N 0atele examin6rii somatice si condi(iile medicale /enerale asociate7 Aceas(7 sec=!+ne
    !nc"+de !n.or%a=!! :n "e$7(+r7 c+ s!%&(o%e"e, o'=!n+(e d!n !s(or!c, sa+ da(e"e
    no(a(e :n (!%&+" e<a%en+"+! so%a(!c, care &o( .! de !%&or(an=7 d!a$nos(!c7, dar
    care n+ s+n( esen=!a"e &en(r+ d!a$nos(!c, de e<e%&"+ ero/!+nea den(ar7 d!n
    '+"!%!a nervoas7. De ase%enea, s+n( !nc"+se ace"e (+"'+r7r! cod!.!ca(e :n a.ara
    ca&!(o"+"+! de ST+"'+r7r! %en(a"e s! de co%&or(a%en(T a" ICD, care s+n(
    asoc!a(e c+ (+"'+rarea :n d!sc+=!e. CA( des&re (+"'+r7r!"e %en(a"e asoc!a(e, (!&+"
    de asoc!a=!e Ead!c7, &recede, a&are conco%!(en( sa+ es(e consec!n=a aJ es(e
    s&ec!.!ca(, dac7 es(e c+nosc+( 4 de e<e%&"+ c7 c!ro/a es(e o consec!n=7 a
    de&enden=e! a"coo"!ce.
    E"e%en(e s&ec!.!ce c+"(+r!!, e(7=!! O! se<+"+!. Aceas(7 sec=!+ne o.er7 $!dare
    &en(r+ c"!n!c!an :n "e$7(+r7 c+ var!a=!!"e :n &re/en(area (+"'+r7r!!, care &o( .!
    a(r!'+!(e cond!=!e! c+"(+ra"e a !nd!v!d+"+!, s(ad!+"+! de de/vo"(are Ede e<., &er!oade!
    de s+$ar, co&!"7r!e!, ado"escen=e!, &er!oade! ad+"(e, &er!oade! (Ar/!! a v!e=!!J sa+
    se<+"+!. Aceas(7 sec=!+ne !nc"+de, de ase%enea, !n.or%a=!! des&re ra(e"e de
    &reva"en(7 d!.eren=!a"7 :n "e$7(+r7 c+ c+"(+ra, e(a(ea O! se<+" Ede e<., ra(a se<+"+!J.
    Preva"en(7. Aceas(7 sec=!+ne .+rn!/ea/7 da(e des&re &reva"en(a s! !nc!den=a "a
    +n %o%en( da( s! &e v!a=7, s! r!sc+" &e v!a=7. Aces(e da(e s+n( &rev7/+(e &en(r+
    d!.er!(e s!(+a=!! Ede e<., co%+n!(a(e, &ro.!"a<!e &r!%ar7, &ac!en( a%'+"a(or :n(r4o
    c"!n!c7 de s7n7(a(e %en(a"7, s! &ac!en( !n(erna( :n !ns(!(+=!! &s!!a(r!ceJ, cAnd aceas(7
    !n.or%a=!e es(e c+nosc+(7.
    Evo"+=!e. Aceas(7 sec=!+ne descr!e &a((ern+r!"e (!&!ce de &re/en(are s! de
    evo"+=!e &e v!a=7 a"e (+"'+r7r!!. Ea con=!ne !n.or%a=!! des&re etatea la deb+t s! mod+l
    de deb+t Ede e<., 'r+sc sa+ !ns!d!osJ a" (+"'+r7r!!8 e*ol+(ia episodic6 vers+s contin+6<
    episod +nic vers+s rec+rent< d+rat6, care carac(er!/ea/7 "+n$!%ea (!&!c7 a %a"ad!e! s!
    a e&!soade"or sa"e, s! pro/resi+nea, care descr!e (end!n=a $enera"7 a (+"'+r7r!! :n (!%&
    Ede e<., s(a'!"!(a(e, a$ravare, a%e"!orareJ.
    Pa((ern .a%!"!a". Aceas(7 sec=!+ne descr!e da(e des&re .recven=a (+"'+r7r!!
    &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e ce"or c+ (+"'+rarea, :n co%&ara=!e c+
    .recven=a :n &o&+"a=!a $enera"7. Ea !nd!c7, de ase%enea, a"(e (+"'+r7r! care (!nd s7
    s+rv!n7 %a! .recven( "a %e%'r!! .a%!"!e! ce"or c+ (+"'+rarea. In.or%a=!!"e re.er!(oare
    "a na(+ra ered!(ar7 a (+"'+r7r!! Ede e<., da(e d!n s(+d!!"e &e $e%en!, &a((ern+r! de
    (rans%!s!e $ene(!c7 c+nosc+(eJ s+n(, de ase%enea, !nd+se :n aceas(7 sec=!+ne.
    D!a$nos(!c d!.eren=!a". Aceas(7 sec=!+ne d!sc+(7 c+% s7 se d!.eren=!e/e
    (+"'+rarea res&ec(!v7 de a"(e (+"'+r7r! care a+ &re/en(e +ne"e carac(er!s(!c!
    s!%!"are.
    E5 .tili(area manualului
    Planul $e or/ani)are al DSM-IV
    T+"'+r7r!"e DSM4I3 s+n( $r+&a(e :n 5R c"ase d!a$nos(!ce %a@ore Ede e<.,
    (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7, (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e an<!oaseJ O!
    o sec=!+ne ad!=!ona"7, Sa"(e cond!=!! care &o( .! cen(r+" a(en=!e! c"!n!ceT.
    Pr!%a sec=!+ne es(e des(!na(7 ST+"'+r7r!"or d!a$nos(!ca(e de re$+"7 &en(r+
    &r!%a da(7 :n &er!oada de s+$ar, :n co&!"7r!e sa+ ado"escen=7T. Aceas(7 :%&7r=!re
    a c"as!.!c7r!! :n ra&or( c+ e(a(ea "a &re/en(are es(e .7c+(7 &en(r+ co%od!(a(e s! n+
    es(e a'so"+(7. C+ (oa(e c7 (+"'+r7r!"e d!n aceas(7 sec=!+ne s+n( de re$+"7 ev!den(e
    &en(r+ &r!%a da(7 :n co&!"7r!e s! ado"escen=7, +n!! !nd!v!/! d!a$nos(!ca=! c+
    (+"'+r7r! s!(+a(e :n aceas(7 sec=!+ne Ede e<, (+"'+rarea !&erac(!v!(a(eXde.!c!( de
    a(en=!eJ &o( s7 n+ .ac7 o'!ec(+" a(en=!e! c"!n!ce &An7 :n &er!oada ad+"(7, :n a.ar7
    de aceas(a, n+ es(e de"oc rar ca e(a(ea "a de'+( &en(r+ %+"(e (+"'+r7r! &"asa(e :n
    a"(e sec=!+n! s7 .!e :n co&!"7r!e sa+ ado"escen=7 Ede e<., (+"'+rarea de&res!v7
    %a@or7, sc!/o.ren!a, an<!e(a(ea $enera"!/a(7J. C"!n!c!en!! care "+crea/7 :n &r!%+"
    rAnd c+ co&!!! s! ado"escen=!!, (re'+!e, de aceea, s7 .!e .a%!"!ar!/a=! c+ :n(re$+"
    %an+a", !ar ce! care "+crea/7 :n &r!%+" rAnd c+ ad+"=!! (re'+!e s7 .!e .a%!"!ar!/a=!
    c+ aceas(7 sec=!+ne.
    Ur%7(oare"e (re! sec=!+n! U SDe"!r!+%+", de%en=a, (+"'+rarea a%nes(!c7 s! a"(e
    (+"'+r7r! co$n!(!veT, ST+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"eT s! ST+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7T U era+ $r+&a(e :%&re+n7 :n
    DSM4III4R s+' (!("+" +n!c de SS!ndro%e s! (+"'+r7r! %en(a"e or$an!ceT. Ter%en+" de
    S(+"'+rare %en(a"7 or$an!c7T n+ %a! es(e +(!"!/a( :n DSM4I3, deoarece e" !%&"!c7 :n
    %od !ncorec( .a&(+" c7 ce"e"a"(e (+"'+r7r! %en(a"e d!n %an+a" n+ a+ o 'a/7
    '!o"o$!c7. Ca O! :n DSM4III4R, aces(e sec=!+n! s+n( &"asa(e :n %an+a" :na!n(ea
    res(+"+! (+"'+r7r!"or d!n ca+/a &r!or!(7=!! "or :n d!a$nos(!c+" d!.eren=!a" Ede e<.,
    ca+/e"e de d!s&o/!=!e de&res!v7 :n "e$7(+r7 c+ o s+'s(an=7 (re'+!e s7 .!e e<c"+se
    :na!n(e de a &+ne +n d!a$nos(!c de (+"'+rare de&res!v7 %a@or7J. Pen(r+ a .ac!"!(a
    d!a$nos(!c+" d!.eren=!a", "!s(e co%&"e(e a"e (+"'+r7r!"or %en(a"e da(ora(e +ne!
    cond!=!! %ed!ca"e $enera"e s! a"e (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7 a&ar :n
    aces(e sec=!+n!, &e cAnd (e<(+" s! cr!(er!!"e &en(r+ aces(e (+"'+r7r! s+n( &"asa(e :n
    sec=!+n!"e d!a$nos(!ce c+ (+"'+r7r!"e c+ care e"e a+ co%+n7 .eno%eno"o$!a. De
    e<e%&"+, (e<(+" s! cr!(er!!"e &en(r+ (+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7 s!
    &en(r+ (+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s+n( !nc"+se :n
    sec=!+nea (+"'+r7r!"or a.ec(!ve.
    Pr!nc!&!+" or$an!/a(or &en(r+ (oa(e ce"e"a"(e sec=!+n! r7%ase Ec+ e<ce&=!a
    (+"'+r7r!"or de ada&(areJ es(e ace"a de a $r+&a (+"'+r7r!"e &e 'a/a e"e%en(e"or
    .eno%eno"o$!ce &e care "e a+ :n co%+n, c+ sco&+" de a .ac!"!(a d!a$nos(!c+"
    d!.eren=!a". Sec=!+nea ST+"'+r7r!"or de ada&(areT es(e or$an!/a(7 d!.er!(, &r!n aceea
    c7 aces(e (+"'+r7r! s+n( 'a/a(e &e e(!o"o$!a "or co%+n7 Ede e<., reac=!a de/ada&4
    (a(!v7 "a +n s(resorJ. De aceea, (+"'+r7r!"e de ada&(are !nc"+d o var!e(a(e de (a'"o+r!
    c"!n!ce e(ero$ene Ede e<., (+"'+rarea de ada&(are c+ d!s&o/!=!e de&res!v7,
    (+"'+rarea de ada&(are c+ an<!e(a(e, (+"'+rarea de ada&(are c+ &er(+r'area
    cond+!(e!J.
    :n .!na", DSM4I3 %a! !nc"+de o sec=!+ne &en(r+ SA"(e cond!=!! care &o( .! cen(r+"
    a(en=!e! c"!n!ceT.
    DSM4I3 !nc"+de 5L ane<eQ
    Ane<a AQ Ar'or!! de dec!/!e &en(r+ d!a$nos(!c+" d!.eren=!a". Aceas(7 ane<7
    con=!ne sase ar'or! de dec!/!e E&en(r+ (+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!!
    %ed!ca"e $enera"e, (+"'+r7r!"e !nd+se de o s+'s(an=7, (+"'+r7r!"e &s!o(!ce,
    .tili(area
    manualului
    EE
    (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e an<!oase s! (+"'+r7r!"e so%a(o.or%eJ. Sco&+" "or
    es(e ace"a de a a@+(a c"!n!c!an+" "a e.ec(+area d!a$nos(!c+"+! d!.eren=!a" s!
    :n=e"e$erea s(r+c(+r!! !erar!ce a c"as!.!c7r!! DSM4I3.
    Anexa B: Seturile de criterii si axele prevzute pentru studiu suplimentar.
    Aceas(7 ane<7 con=!ne +n n+%7r de &ro&+ner! care a+ .os( s+$era(e &en(r+ &os!'!"a
    !nc"+dere :n DSM4I3. Sc+r(e (e<(e s! se(+r! de cr!(er!! &en(r+ cerce(are s+n(
    &rev7/+(e &en(r+ +r%7(oare"e (+"'+r7r!Q (+"'+rarea &os(con(+/!ona"7, (+"'+rarea
    ne+roco$n!(!v7 +Ooar7, a's(!nen=a de ca.e!na, (+"'+rarea de&res!v7 &os( &s!o(!c7 a
    sc!/o.ren!e!, (+"'+rarea de(er!ora(!v7 s!%&"7, (+"'+rarea d!s.or!c7 &re%ens(r+a"7,
    (+"'+rarea de&res!v7 %!nor7, (+"'+rarea de&res!v7 rec+ren(7 sc+r(7, (+"'+rarea
    de&res!v4an<!oas7 %!<(7, (+"'+rarea .ac(!ce &r!n &roc+r7, (ransa d!soc!a(!v7,
    (+"'+rarea %Anca(+" co%&+"s!v, (+"'+rarea de &ersona"!(a(e de&res!v7, (+"'+rarea
    de &ersona"!(a(e &as!v4a$res!v7, &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce, s!ndro%+"
    ne+ro"e&(!c %a"!$n, d!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce, a)a(!s!a ac+(7 !nd+s7 de
    ne+ro"e&(!ce, d!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce s! (re%or+" &os(+ra" !nd+s
    de %ed!ca%en(e, :n &"+s, %a! s+n( !nc"+O! descr!&(or! d!%ens!ona"! a"(erna(!v!
    &en(r+ sc!/o.ren!e O! +n cr!(er!+ B a"(erna(!v &en(r+ (+"'+rarea d!s(!%!c7. :n .!na"
    s+n( &rev7/+(e (re! a<e &ro&+se Esca"a &en(r+ .+nc=!onarea a&7r7r!"or, sca"a de
    eva"+are $"o'a"7 a .+nc=!on7r!! re"a=!ona"e ZSE,FR[ O! sca"a de eva"+are a
    .+nc=!on7r!! soc!a"e O! &ro.es!ona"e ZSEFSP[J.
    Ane<a CQ ,"osar+" de (er%en! (en!c!. Aceas(7 ane<7 con=!ne de.!n!=!! de $"osar
    a"e +nor (er%en! se"ec(a=! &en(r+ a a@+(a &e ce! care .o"osesc %an+a"+" :n a&"!carea
    se(+r!"or de cr!(er!!.
    Ane<a DQ S+'"!n!erea %od!.!c7r!"or d!n DSM4I3 Te<( Rev!/+!( Aceas(7 ane<7
    o.er7 o vedere $enera"7 a %od!.!c7r!"or re/+"(a(e :n +r%a &roces+"+! de rev!/+!re a
    (e<(+"+! DSM4I3.
    Ane<a EQ L!s(a a".a'e(!c7 a d!a$nos(!ce"or s! cod+r!"or DSM4I34TR . Aceas(7
    ane<7 "!s(ea/7 (+"'+r7r!"e s! cond!=!!"e DSM4I3 Ec+ cod+r!"e "or ICD4F4CMJ :n ord!ne
    a".a'e(!c7. Ea a .os( !nc"+s7 &en(r+ a +O+ra se"ec(area cod+r!"or d!a$nos(!ce.
    Ane<a FQ L!s(a n+%er!c7 a d!a$nos(!ce"or s! cod+r!"or DSM4I34TR. Aceas(7
    ane<7 "!s(ea/7 (+"'+r7r!"e O! cond!=!!"e DSM4I3 Ec+ cod+r!"e "or ICD4F4CMJ, :n
    ord!nea n+%er!c7 a cod+r!"or. Ea a .os( !nc"+s7 &en(r+ a +O+ra :nre$!s(rarea
    (er%en!"or d!a$nos(!c!.
    Ane<a ,Q Cod+r!"e ICD4F4CM &en(r+ cond!=!!"e %ed!ca"e $enera"e O!
    (+"'+r7r!"e !nd+se de %ed!ca%en(e, se"ec(a(e. Aceas(7 ane<7 con=!ne o "!s(7 a
    cod+r!"or ICD4F4CM &en(r+ cond!=!!"e %ed!ca"e $enera"e se"ec(a(e s! a .os(
    &rev7/+(7 &en(r+ a +O+ra cod!.!carea &e a<a III. Aceas(7 ane<7 &revede, de
    ase%enea, cod+r!"e E d!n ICD4F4CM &en(r+ %ed!ca%en(e"e se"ec(a(e, &rescr!se :n
    do/e (era&e+(!ce O! care ca+/ea/7 (+"'+r7r! !nd+se de o s+'s(an=7. Cod+r!"e E &o( .!
    cod!.!ca(e o&=!ona" &e a<a I, !%ed!a( d+&7 (+"'+rarea c+ care s+n( :n "e$7(+r7 Ede
    e<., 9F9.;F T+"'+rare a.ec(!v7 !nd+s7 de an(!conce&=!ona"e ora"e, c+ e"e%en(e
    de&res!ve8 E F;9.9 An(!conce&=!ona"e ora"eJ.
    Ane<a HQ C"as!.!carea DSM4I3 c+ cod+r!"e ICD45L. Ca O! :na!n(e de &+'"!carea
    (e<(+"+! rev!/+!( E"a .!ne"e &r!%7ver!! an+"+! 9LLLJ, s!s(e%+" de cod!.!care o.!c!a" :n
    +/ :n S(a(e"e Un!(e es(e Clasi)icarea 5nterna(ional6 a .aladiilor, cea dea no+a
    rev!/+!re, Mod!.!carea C"!n!c7 EICD4F4CMJ. :n cea %a! %are &ar(e a "+%!!, s!s(e%+"
    o.!c!a"
    12 .tili(area manualului

    de cod!.!care es(e Clasi)icarea Statistic6 5nterna(ional6 a .aladiilor si Problemelor =n
    le/6t+r6 c+ S6n6tatea, cea de a > rev!/+!re EICD45LJ. Pen(r+ a .ac!"!(a +(!"!/area
    !n(erna=!ona"7 a DSM4I3, aceas(7 ane<7 con=!ne c"as!.!carea co%&"e(7 a DSM4I3 c+
    cod+r!"e d!a$nos(!ce a"e ICD45L.
    Ane<a IQ Sce%7 &en(r+ .or%+"area c+"(+ra"7 s! $"osar+" s!ndro%e"or
    c!rc+%scr!se c+"(+ra". Aceas(7 ane<7 es(e :%&7r=!(7 :n do+7 sec=!+n!. Pr!%a &revede
    o sce%7 &en(r+ .or%+"area c+"(+ra"7 des(!na(7 s7 a@+(e c"!n!c!an+" :n eva"+area
    s!s(e%a(!c7 s! :n descr!erea !%&ac(+"+! con(e<(+"+! c+"(+ra" a" !nd!v!d+"+!. A do+a
    es(e +n $"osar de s!ndro%e c!rc+%scr!se c+"(+ra".
    Ane<a *Q Co"a'ora(or!! "a DSM4I3. Aceas(7 ane<7 "!s(ea/7 n+%e"e cons!"!er!"or
    s! &ar(!c!&an=!"or "a (es(area :n (eren, s! a a"(or &ersoane s! or$an!/a=!! care a+
    con(r!'+!( "a e"a'orarea DSM4I3.
    Ane<a -Q Cons!"!er!! DSM4I3 Te<( Rev!/+!(. Aceas(7 ane<7 "!s(ea/7 n+%e"e
    cons!"!er!"or care a+ con(r!'+!( "a rev!/+!rea (e<(+"+! DSM4I3.
    lasi$icarea DSM-IV-T+
    FS 6 F7r7 a"(7 s&ec!.!ca=!e
    Un < a&7r+( :n(r4+n cod d!a$nos(!c
    !nd!c7 .a&(+" c7 es(e cer+( +n n+%7r de
    cod s&ec!.!c
    O e"!&s7 E...J es(e +(!"!/a(7 :n n+%e"e
    an+%!(or (+"'+r7r! &en(r+ a !nd!ca
    .a&(+" c7 n+%e"e +ne! an+%!(e (+"'+r7r!
    %en(a"e sa+ cond!=!! %ed!ca"e (re'+!e
    !nsera( cAnd se :nre$!s(rea/7
    d!a$nos(!c+" Ede e<., De"!r!+% da(ora(
    !&o(!ro!4d!s%+"+!J
    N+%ere"e d!n(re &aran(e/e s+n(
    n+%ere"e &a$!n!"or.
    Dac7 cr!(er!!"e s+n( sa(!s.7c+(e
    ac(+a"%en(e, +n+" d!n(re +r%7(or!!
    s&ec!.!4can=! de !n(ens!(a(e &o( .! no(a=!
    d+&7 d!a$nos(!cQ
    +Ooar7
    %odera(7
    sever
    Dac7 cr!(er!!"e n+ %a! s+n( sa(!s.7c+(e,
    &oa(e .! no(a( +n+" d!n(re +r%7(or!!
    s&ec!.!can=!Q
    :n re%!s!+ne &ar=!a"7
    :n re%!s!+ne co%&"e(7
    !s(or!c an(er!or
    Tul-ur(rile $ia/no&ti#ate $e
    re/ul( pentru pri"a $at( In
    Perioa$a $e Su/ar2 %n Copil(rie
    &au A$ole&#en!( 3456
    RETARDAREA MENTALA 37*6
    >ot6 ? Acestea s+nt codi)icate pe axa 557
    ;5H Re(ardare %en(a"7 +Ooar7 EI;J
    318.0 Re(ardare %en(a"7 %odera(7
    EI;J
    318.0 Re(ardare %en(a"7 sever7 EI;J
    318.1 Re(ardare %en(a"7 &ro.+nd7
    EIIJ
    ;5F Re(ardare %en(a"7, sever!(a(ea
    nes&ec!.!ca(7 EIIJ
    TUL8UR9RILE DE :NV9;ARE 3756
    315.0 D!s"e<!e ET+"'+rarea c!(!(+"+!J
    EY5J
    315.1 D!sca"c+"!e ET+"'+rare de ca"c+"J
    EY;J
    315.2 D!s$ra.!e ET+"'+rarea e<&res!e!
    $ra.!ceJ EYIJ
    ;5Y.F T+"'+rare de :nv7=are FS EYRJ
    TUL8URAREA APTITUDINILOR
    MOTORII 3<=6
    ;5Y.I T+"'+rare de de/vo"(are a
    coordon7r!! EYRJ
    TUL8UR9RILE DE COMUNICARE 3<>6
    315.31T+"'+rare de "!%'a@ e<&res!v
    EYGJ
    315.32T+"'+rare %!<(7 de "!%'a@ re
    ce&(!v s! e<&res!v ER9J
    ;5Y.;F T+"'+rare .ono"o$!c7 ERYJ
    ;LH.L Ba"'!s% ERHJ
    ;LH.F T+"'+rare de co%+n!care FS ERFJ
    E4
    5I
    lasi$icarea DSM-IV-T+

    TUL8UR9RILE DE DEVOLTARE
    PERVASIV9 3=56
    9FF.LL T+"'+rare a+(!s(7 EHLJ 9FF.GL
    T+"'+rare Re(( EHRJ 9FF.5L T+"'+rare
    de/!n(e$ra(!v7 a co&!"7r!e! EHHJ 9FF.GL
    T+"'+rare As&er$er EGLJ
    9FF.GL T+"'+rare de de/vo"(are &er4
    vas!v7 FS EGIJ
    TUL8UR9RILE DE DE'ICIT DE
    ATEN;IE ?l DE COMPORTAMENT
    DISRUPTIV 3><6
    ;5I.<< T+"'+rarea !&erac(!v!(a(eXde.!c!(
    de a(en=!e EGYJ .L5 (!&
    co%'!na( .LL (!& &redo%!nan(
    !na(en( .L5 (!& &redo%!nan(
    !%&+"s!v4!4
    &erac(!v
    Tul-urarea @ipera#tiv%tateA$e%i$t
    $e aten!ie 'BS 3546
    ;59.<< T+"'+rare de cond+!(7 EFIJ .
    G5 T!& c+ de'+( :n co&!"7r!e .
    G9 T!& c+ de'+( :n ado"escen=7 .
    GF De'+( nes&ec!.!ca(
    ;5;.G5 T+"'+rarea o&o/!=!on!s%+" &ro
    voca(or E5LLJ
    ;59.F T+"'+rare de co%&or(a%en(
    d!sr+&(!v FS E5L;J
    TUL8UR9RILE DE ELIMINARE 3**=6
    ]]].] Enco&re/!s E55RJ
    787.6 c+ cons(!&a=!e s! !ncon(!nen=7
    &r!n &rea&"!n
    307.6 .7r7 cons(!&a=!e s! !ncon(!nen=7
    &r!n &rea&"!n
    ;LH.R En+re/!s Eneda(ora( +ne!
    cond!=!! %ed!ca"e $enera"eJ
    E55GJ 0e speci)icat tip+l? n+%a!
    noc(+rnX n+%a! d!+rnXnoc(+rn s!
    d!+rn
    ALTE TUL8UR9RI ALE PERIOADEI
    DE SUGAR2 ALE COPIL9RIEI SAU
    ADOLESCENTEI 3*C*6
    ;LF.95 An<!e(a(e de se&arare E595J
    0e speci)icat dac6? de'+( &recoce
    ;5;.9; M+(!s% se"ec(!v E59YJ ;5;.GF
    T+"'+rarea de a(aOa%en( reac(!v7
    a &er!oade! de s+$ar sa+ a %!c!!
    co&!"7r!! E59HJ
    0e speci)icat tip+l? (!& !n!'a(X(!&
    de/!n!'a(
    ;LH.; T+"'+rarea de %!Ocare
    s(ereo(!&7 E5;5J
    0e speci)icat dac6? c+ co%&or(a%en(
    a+(o%+(!"an( ;5;.F T+"'+rare a
    &er!oade! de s+$ar,
    co&!"7r!e! sa+ ado"escen=e! FS
    E5;IJ

    TUL8UR9RILE
    DE COM--
    VIENTARE?I
    UIMENTAR
    SAR SAU
    54)
    Delirlu"ul2 De"en!a2 Tul-ur(rile
    A"ne&tDe Ei Alte Tul-ur(ri
    Co/nitive 3*4<6
    DEURIUMUL 3*4=6
    9F;.L De"!r!+% da(ora(.... @Se indic6 condi(ia medical6 /eneral6A (B%
    ]]]].] De"!r!+% &r!n !n(o<!ca=!e c+ o
    s+'s(an=7 Ea se cons+"(a (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 &en(r+
    cod+r!"e s&ec!.!ce .!ec7re! s+'s(an=eJ E5I;J
    ]]].] De"!r!+% &r!n a's(!nen=a de o
    s+'s(an=7 (a se cons+lta t+lb+r6rile =n le/6t+r6 c+ o s+bstan(6 pentr+ cod+rile
    speci)ice )ieec6rei s+bstan(e% (B$%
    lasi$icarea DSM-IV-
    T+
    5Y

    nen(are
    a !+ a
    %!c!!
    cron!c
    .
    !ren(

    ]]]].] De"!r!+% da(ora( +nor e(!o"o$!!
    %+"(!&"e (a se codi)ica )iecare
    etiolo/ie speci)ic6% E5IRJ
    HGL.LF De"!r!+% FS E5IHJ
    D*M*FGA &EH?)
    9FI. <<` De%en=7 de (!& A"/e!%er, c+
    de'+( &recoce (de asemenea, se
    codi)ic6 .aladie Al;-eimer, pe axa
    555% E5YIJ
    .5L .7r7 (+"'+r7r! de co%&or(a%en( .55
    c+ (+"'+r7r! de co%&or(a%en( 9FI.<<`
    De%en=7 de (!& A"/e!%er, c+
    de'+( (ard!v (de asemenea, se
    codi)ic6 .aladie Al;-eimer, pe axa
    555% E5YIJ
    .5L .7r7 (+"'+r7r! de co%&or(a%en( .55
    c+ (+"'+r7r! de co%&or(a%en( 9FL.<<
    De%en=7 vasc+"ar7 E5YGJ .IL
    neco%&"!ca(7 .I5 c+ de"!r!+% .I9 c+
    !de! de"!ran(e .I; c+ d!s&o/!=!e
    de&res!v7
    0e speci)icat dac6? c+ (+"'+rare de
    co%&or(a%en(
    A se codi)ica pre;en(a sa+ absen(a +nei
    t+lb+r6ri de comportament c+ cea de a
    cincea ci)r6 pentr+ de%en=a da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"eQ
    06 .7r7 (+"'+rare de co%&or(a%en(
    16 c+ (+"'+rare de co%&or(a%en(
    9FI.5<` De%en=7 da(ora(7 %a"ad!e!
    HI3 (de asemenea, se codi)ic6
    "B, 95V pe axa 555% E5R;J
    9FI.I<` De%en=7 da(ora(7
    (ra+%a(!s%+"+! cran!an (de
    asemenea, se codi)ic6 &CB7""
    Tra+matism cranian, pe axa 555%
    E5RIJ
    9FI.5<` De%en=7 da(ora(7 %a"ad!e!
    Par)!nson (de asemenea, se
    codi)ic6 $$,7" .aladie
    Par8inson, pe axa 555% E5RIJ
    5FI.I<` De%en=a da(ora(7 %a"ad!e!
    H+n(!n$(on (de asemenea, se
    codi)ic6 $$$7B .aladie
    9+ntin/ton, pe axa 555% E5RYJ
    9FI.5<` De%en=a da(ora(7 %a"ad!e! P!c)
    (de asemenea, se codi)ic6 $$7
    .aladie Pic8, pe axa E5% E5RYJ
    9FI.5<` De%en=a da(ora(7 %a"ad!e!
    Cre+(/.e"d(4*a)o' (de
    asemenea, se codi)ic6 "BD7
    .aladie Cre+t;)eldt#Ea8ob, pe axa
    E5% E5RRJ
    9FI. " <` De%en=7 da(ora(7... @Se indic6
    condi(ia medical6 /eneral6
    nemen(ionat6 mai s+sA (de
    asemenea, se codi)ic6 condi(ia
    medical6 /eneral6, pe axa 555%
    E5RHJ
    ]]].] De%en=7 &ers!s(en(7 !nd+s7 de
    o s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6 pentr+ cod+rile speci)ice
    )iec6rei s+bstan(e% E5RGJ
    ]]].] De%en=a da(ora(7 +ne! e(!o"o$!!
    %+"(!&"e (se codi)ic6 )iecare
    etiolo/ie speci)ic6% E5HLJ
    9FI.G De%en=7 FS E5H5J
    TUL8UR9RILE AMNESTICE &E?7)
    9FI.L T+"'+rare a%nes(!c7 da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A E5HYJ
    0e speci)icat dac6? (ran/!(or!eX
    cron!c7
    ]]].] T+"'+rare a%nes(!c7 &ers!s(en(7
    !nd+s7 de o s+'s(an=7 (a se
    cons+lta t+lb+r6rile =n le/6t+r6 c+
    o s+bstan(6 pentr+ cod+rile
    speci)ice )iec6rei s+bstan(e% E5HHJ
    9FI.G T+"'+rare a%nes(!c7 FS E5HFJ
    ALTE TUL8UR9RI COGNITIVE &E85)
    9FI.F T+"'+rare co$n!(!v7 FS E5GLJ
    Tul-ur(rile Mentale $atorate unei
    Con$i!ii Me$i#ale Generale
    Ne#la&i%i#ate .n Alt( Parte 3*>*6
    9F;.GF T+"'+rarea ca(a(on!c7 da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A E5GYJ
    ;5LQ5 Mod!.!care de &ersona"!(a(e
    da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A E5GHJ
    *= lasi$icarea DSM-IV-T+


    0e speci)icat tip+l? (!& "a'!"X(!& de4
    /%!'a(X(!& a$res!vX& a&acX(!&
    &arano!dXa"( &X& co%'!na(X(!&
    nes&ec!.!ca(
    9F;.F T+"'+rare %en(a"7 FS da(ora(7...
    l Se indic6 condi(ia medical6
    /eneral6 A E5FLJ.
    Tul-ur(rile .n le/(tur(
    #u o Su-&tan!( 3*5*6
    Frm6torii speci)ican(i se aplic6 dependen(ei
    de o s+bstan(6 d+p6 c+m +rmea;6 ?
    a
    c+ de&enden=7 .!/!o"o$!c7X.7r7
    de&enden=7 .!/!o"o$!c7
    '
    re%!s!+ne co%&"e(7 &recoceXre%!s!4
    +ne &ar=!a"7 &recoce re%!s!+ne
    co%&"e(7 &re"+n$!(7Xre%!s!+ne
    &ar=!a"7 &re"+n$!(7
    c
    :n %ed!+ con(ro"a(
    d

    s+' (era&!e a$on!s(7
    Frm6torii speci)ican(i se aplic6 t+lb+r6rilor
    ind+se de o s+bstan(6 ca nota(i?
    I c+ de'+( :n c+rs+" !n(o<!ca=!e! X A c+
    de'+( :n c+rs+" a's(!nen=e!
    TUL8UR9RILE :N LEG9TUR9
    CU ALCOOLUL 3C*C6
    Tulburrile uzului de alcool E95;J
    ;L;.FL De&enden=7 de a"coo" a,',c E95;J
    ;LY.L A'+/ de a"coo" E95IJ
    Tulburrile induse de alcool E95IJ
    ;L;.LL In(o<!ca=!e a"coo"!c7 E95IJ 9F5.G5
    A's(!nen=7 de a"coo" E95YJ
    0e speci)icat dac6 c+ (+"'+r7n de
    &erce&=!e
    9F5.L De"!r!+% &r!n !n(o<!ca=!e
    a"coo"!c7 E5I;J
    9F5.L De"!r!+% &r!n a's(!nen=7 de
    a"coo" E5I;J
    9F5.9 De%en=7 &ers!s(en(7 !nd+s7 de
    a"coo" E5RGJ
    9F5.5 T+"'+rare a%nes(!c7 &ers!s(en(7
    !nd+s7 de a"coo" E5HHJ
    9F5 .< T+"'+rare &s!o(!c7 !nd+s7 de
    a"coo" E;;GJ
    .Y c+ !de! de"!ran(e
    li

    A
    .; c+
    a"+c!na=!!
    l
    G
    A
    9F5.G T+"'+rare
    a.ec(!v7 !nd+s7 de
    a"coo" `2
    A
    EILYJ 9F5.G
    T+"'+rare an<!oas7 !nd+s7 de
    a"coo",
    l
    #
    A
    EIHFJ 9F5.G
    D!s.+nc=!e se<+a"7 !nd+s7 de
    a"coo"
    l
    EYR9J
    291.8 T+"'+rare de so%n !nd+s7 de
    a"coo"
    l
    G
    A
    ERYYJ
    291.9 T+"'+rare :n "e$7(+r7 c+ a"coo"+"
    FS E99;J
    TUL8UR9RILE :N LEG9TUR9
    CU AM'ETAMINA 3SAU CU O
    SU8STAN;9 SIMILAR9
    AM'ETAMINEI6 3CC46
    Tulburrile uzului de amfetamina E99IJ
    ;LI.IL De&enden=7 de a%.e(a%!na
    aX

    'X
    c
    E99IJ ;LY.HL A'+/ de
    a%.e(a%!na E99YJ
    Tulburrile induse de amfetamina E99RJ
    9F9.GF In(o<!ca=!e c+ a%.e(a%!na E99RJ
    0e speci)icat dac6? c+ (+"'+r7r! de
    &erce&=!e
    9F9.L A's(!nen=7 de a%.e(a%!na E99HJ
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+
    a%.e(a%!na E5I;J 9F9.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    a%.e(a%!na E;;GJ .55 c+ !de!
    de"!ran(e
    5
    .59 c+ a"+c!na=!!
    5
    9F9.GI
    T+"'+rare a.ec(!v7 !nd+s7 de
    a%.e(a%!na
    5
    2
    A
    EILYJ 9F9.GF
    T+"'+rare an<!oas7 !nd+s7 de
    a%.e(a%!na
    5
    EIHFJ 9F9.GF
    D!s.+nc=!e se<+a"7 !nd+s7 de
    a%.e(a%!na
    5
    EYR9J 9F9.F
    T+"'+rare de so%n !nd+s7 de
    a%.e(a%!na
    5
    2
    A
    ERYYJ 9F9.F T+"'+rare :n
    "e$7(+r7 c+ a%.e(a%!na FS E9;5J
    lasi$icarea DSM-IV-
    T+
    E?

    TUBU!"!#$ %& $'"TU!"
    (U (A)$#&A *2+1,
    Tulburrile induse de cafeina E9;9J
    ;LY.FL In(o<!ca=!e c+ ca.e!na E9;9J
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de
    ca.e!na
    5
    EIHFJ 9F9.GF T+"'+rare
    de so%n !nd+s7 de
    ca.e!na
    5
    ERYYJ 9F9.F T+"'+rare
    :n "e$7(+r7 c+ ca.e!na
    FS E9;IJ
    TUL8UR9RILE :N LEG9TUR9
    CU CANNA8ISUL 3C476
    Tulburrile uzului de cannabis E9;RJ
    ;LI.;L De&enden=7 de canna'!s
    a
    2
    '
    2
    c
    E9;RJ ;LY.9L A'+/ de
    canna'!s E9;RJ
    Tulburrile induse de cannabis E9;HJ
    9F9.GF In(o<!ca=!e c+ canna'!s E9;HJ
    0e speci)icat dac6? c+ (+"'+r7r! de
    &erce&=!e 9F9.G5. De"!r!+% &r!n
    !n(o<!ca=!e c+
    canna'!s E5I;J 9F9.<< T+"'+rare
    &s!o(!c7 !nd+s7 de
    canna'!s E;;GJ .55 c+ !de!
    de"!ran(e
    5
    .59 c+ a"+c!na=!!
    5
    9F9.GF
    T+"'+rare an<!oas7 !nd+s7 de
    canna'!s
    5
    EIHFJ 9F9.F
    T+"'+rare :n "e$7(+r7 c+
    canna'!s+" FS E9I5J
    TUL8UR9RILE :N LEG9TUR9 CU
    COCAINA 3C7*6
    Tulburrile uzului de cocain E9I5J
    ;LI.9L De&enden=7 de coca!n7
    a
    2
    '
    2
    c
    E9I9J ;LY.RL A'+/ de
    coca!n7 E9I;J
    Tulburrile induse de cocain E9IIJ
    9F9.GF In(o<!ca=!e c+ coca!n7 E9IIJ
    0e speci)icat dac6? c+ (+"'+r7r! de
    &erce&=!e
    9F9QL A's(!nen=7 de coca!n7 E9IYJ
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+
    coca!n7 E5I;J 9F9.<< T+"'+rare
    &s!o(!c7 !nd+s7 de
    coca!n7 E;;GJ .55
    c+ !de! de"!ran(e
    5
    .59
    c+ a"+c!na=!!
    5
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de
    coca!n7
    5
    2
    A
    EILYJ 9F9.GF
    T+"'+rare an<!oas7 !nd+s7 de
    coca!n7
    5
    2
    A
    EIHFJ 9F9.GF
    D!s.+nc=!e se<+a"7 !nd+s7 de
    coca!n7
    5
    EYR9J 9F9.GF T+"'+rare
    de so%n !nd+s7 de
    coca!n7
    5
    4
    A
    ERYYJ 9F9.F
    T+"'+rare :n "e$7(+r7 c+ coca!na
    FS E9YLJ
    TUL8UR9RILE :N LEG9TUR9
    CU FALUCINOGENELE 3C<+6
    Tuburrito uzului de -alucino.ene E9Y5J
    ;LI.YL De&enden(7 de a"+c!no$ene
    5
    T2
    c
    E9Y5J ;LY.;L A'+/ de
    a"+c!no$ene E9Y9J
    E9Y9
    J 9F9.GF In(o<!ca=!e c+ a"+c!no$ene
    E9Y9J
    9F9.GF T+"'+rare de &erce&=!e
    &ers!s(en(7 !nd+s7 de a"+c!no$ene
    EF"as'ac)sJ E9Y;J 9F9QG5 De"!r!+% &r!n
    !n(o<!ca=!e c+
    a"+c!no$ene E5I;J 9F9.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    a"+c!no$ene E;;GJ .55 c+ !de! de"!ran(e
    5
    .59 c+ a"+c!na=!!
    5
    9F9.GI T+"'+rare
    a.ec(!v7 !nd+s7 de a"+c!no$ene
    5
    EILYJ
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de
    a"+c!no$ene
    5
    EIHFJ
    9F9QGF T+"'+rare :n "e$7(+r7 c+
    a"+c!no$ene"e FS E9YHJ
    TUL8UR9RILE :N LEG9TUR9 CU
    INFALANTELE 3C<G6
    Tulburrile uzului de in-alante E9YGJ
    ;LIQRL De&enden=7 de !na"an(e
    '
    2
    c
    E9YGJ
    ;LY.FL A'+/ de !na"an(e E9YFJ
    Tulburrile induse de in-alante E9YFJ
    9F9.GF In(o<!ca=!e c+ !na"an(e E9YFJ
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+
    !na"an(e E5I;J
    *>
    lasi$icarea DSM-IV-T+

    9F9.G9 De%en=7 &ers!s(en(7 !nd+s7 de
    !na"an(e E5RGJ
    9F9.<< T+"'+rare &s!o(!c7 !nd+s7 de
    !na"an(e E;;GJ .
    55 c+ !de! de"!ran(e
    5
    .
    59 c+ a"+c!na=!!
    5
    9F9.G; T+"'+rare a.ec(!v7 !nd+s7 de
    !na"an(e
    5
    EILYJ
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de
    !na"an(e
    5
    EIHFJ 9F9.F
    T+"'+rare :n "e$7(+r7 c+
    !na"an(e"e FS E9R;J
    TUL8UR9RILE :N LEG9TURA CU
    NICOTIN9 3C=76
    Tulburarea uzului de nicotini E9RIJ
    ;LYQ5L De&enden=7 de n!co(!n7
    a
    2
    '
    E9RIJ
    Tulburarea indu/i de nicotini E9RYJ
    9F9.L A's(!nen=a de n!co(!n7 E9RYJ
    9F9.F T+"'+rare :n "e$7(+r7 c+
    n!co(!n7 FS E9RFJ
    TUL8UR9RILE :N LEG9TUR9
    CU OPIACEELE 3C=56
    Tulburrile uzului de opiacee E9HLJ
    ;LI.LL De&enden=7 de o&!acee
    a
    2
    '
    4
    c
    2
    d
    E9HLJ ;LY.YL A'+/ de
    o&!acee E9H5J
    Tulburrile induse de opiacee E9H5J
    9F9.GF In(o<!ca=!e c+ o&!acee E9H5J
    0e speci)icat dac6? c+ (+"'+r7r! de
    &erce&=!e
    9F9.L A's(!nen=7 de o&!acee E9H9J
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+
    o&!acee E5I;J 9F9.<< T+"'+rare
    &s!o(!c7 !nd+s7 de
    o&!acee E;;GJ .55
    c+ !de! de"!ran(e
    5
    .59
    c+ a"+c!na=!!
    5
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de
    o&!acee
    5
    EILYJ
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7 de
    o&!acee! EYR9J 9F9.GF
    T+"'+rare de so%n !nd+s7 de
    o&!acee
    l
    #
    A
    ERYYJ 9F9.L
    T+"'+rare :n "e$7(+r7 c+
    o&!acee"e FS E9HHJ
    TUL8UR9RILE :N LEG9TUR9 CU
    PFENCHOIDINA 3SAU CU O
    SU8STAN;9 SIMILARA
    PFENCHOIDINEI6 3CG>6
    Tufcurrite uzului de p-enc0d1fin E9HFJ
    ;LI.FL De&enden=7 de &encyc"!d!n7
    '
    2
    c
    E9HFJ ;LY.FL A'+/ de
    &encyc"!d!n7 E9HFJ
    Tufcurrile induse de p-enc0didini E9GLJ
    F9.GF In(o<!ca=!e c+ &encyc"!d!n7 E9GLJ
    0e speci)icat dac6? c+ (+"'+r7r! de
    &erce&=!e 9F9.G5 De"!r!+% &r!n
    !n(o<!ca=!e c+
    &encyc"!d!n7 E5I;J 9F9.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    &encyc"!d!n7 E;;GJ .55 c+ !de!
    de"!ran(e
    5
    .59 c+ a"+c!na=!!
    5
    9F9.GY
    T+"'+rare a.ec(!v7 !nd+s7 de
    &encyc"!d!n7
    l
    EILYJ 9F9.GF
    T+"'+rare an<!oas7 !nd+s7 de
    &encyc"!d!n7
    5
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    !n(o<!ca=!e!
    ;L9.HL D!s.+nc=!e se<+a"7 FS EYRRJ
    PARA'ILIILE 3<==6
    ;L9.I E<!'!=!on!s% EYRFJ
    ;L9.G5 Fe(!O!s% EYRFJ
    ;L9.GF Fro(e+r!s% EYHLJ
    ;L9.9 Pedo.!"!e EYH5J
    0e speci)8at dac6? es(e a(ras se<+a"
    de '7r'a=!Xes(e a(ras se<+a" de
    .e%e!Xes(e a(ras se<+a" de a%'e"e
    sexe
    0e speci)icat dac6? "!%!(a(7 "a !nces(
    0e speci)icat tip+l? de (!& e<c"+s!vXde
    (!& none<c"+s!v
    302.83Masoc!s% se<+a" EYH9J
    302.84Sad!s% se<+a" EYH;J
    ;L9.; Fe(!O!s% (ransves(!c EYHIJ
    0e speci)icat dac6? c+ d!s.or!e .a=7 de
    se<
    ;L9.G9 3oye+r!s% EYHYJ
    ;L9.F Para.!"!e FS EYHRJ
    TUL8UR9RILE DE IDENTITAE
    SEXUALA 3<G=6
    ;L94<< T+"'+rare de !den(!(a(e se<+a"7
    EYHRJ
    .R "a co&!! .GY "a ado"escen=!
    sa+ "a ad+"=!
    0e speci)icat dac6? es(e a(ras se<+a"
    de '7r'a=!X es(e a(ras se<+a" de
    .e%e!Xes(e a(ras se<+a", de a%'e"e
    se<eXn+ es(e a(ras se<+a" de n!c!
    +n+" d!n(re se<e
    ;L9.R T+"'+rare de !den(!(a(e se<+a"7
    FS EYG9J
    ;L9.F T+"'+rare se<+a"7 FS EYG9J
    Tul-ur(rile $e Co"porta"ent
    Ali"entar 3<>46
    ;LH.5 Anore<!e nervoas7 EYG;J
    0e speci)icat tip+l? de (!& res(r!c(!v8
    de (!& %Anca( e<ces!vXde (!&
    &+r$are ;LH.Y5 B+"!%!e
    nervoas7 EYGFJ
    0e speci)icat tip+l? de (!&
    &+r$areXde
    (!& non&+r$are ;LH.YL T+"'+rare
    de co%&or(a%en(
    a"!%en(ar FS EYFIJ
    Tul-ur(rile $e So"n 3<5G6
    TUL8UR9RILE DE SOMN PRIMARE
    EYFGJ
    Di&&o"niito &A68)
    ;LH.I9 Inso%n!e &r!%ar7 EYFFJ
    ;LH.II H!&erso%n!e &r!%ar7 ERLIJ
    0e speci)icat dac6? rec+ren(7
    ;IH Narco"e&s!e ERLFJ HGL.YF
    T+"'+rare de so%n :n "e$7(+r7 c+
    res&!ra=!a ER5YJ
    ;LH.IY T+"'+rare de r!(% c!rcad!an a
    so%n+"+! ER99J
    0e speci)icat tip+l? de .a/7 de so%n
    :n(Ar/!a(Xde deca"a@ de .+s orarXde
    "+cr+ :n (+re Xde (!& nes&ec!.!ca(
    ;LH.IR D!sso%n!e FS ER9FJ
    Para&o"niilJ &I45)
    ;LH.IH CoO%ar ER;5J
    ;LH.IR Teroare de so%n ER;IJ
    307.46So%na%'+"!s% ER;FJ
    307.47Paraso%n!e FS ERIIJ
    TUL8UR9RILE DE SOMN :N
    LEG9TURA CU ALTA
    TUL8URARE MENTALA 3=7<6
    ;LH.I9 Inso%n!e :n "e$7(+r7 c+... @Se
    indic6 t+lb+rarea de pe axa 5 sa+
    axa 55A ERIYJ ;LH.II
    H!&erso%n!e :n "e$7(+r7 c+...
    @Se indic6 t+lb+rarea de pe axa 5
    sa+ axa 55A ERIYJ
    C7
    lasi$icarea DSM-IV-T+


    AT$ TUBU!"!# 9$ S;<& ERY5J
    HGL.>> T+"'+rare de so%n da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6 A ERY5J
    .Y9 de (!& !nso%n!e
    .YI de (!& !&erso%n!e
    .YF de (!& &araso%n!e
    .YF de (!& %!<(
    ]]].]] T+"'+rare de so%n !nd+s7 de o
    s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6 pentr+ cod+rile speci)ice
    )iec6rei s+bstan(e% ERYYJ
    0e speci)icat tip+l? de (!&
    !nso%n!eXde (!& !&erso%n!eXde
    (!& &araso%n!eXde (!& %!<( 0e
    speci)icat dac6? c+ de'+( :n c+rs+"
    !n(o<!ca=!e!X c+ de'+( :n c+rs+"
    a's(!nen(e!
    Tul-ur(rile Controlului
    I"pul&ului Ne#la&i%i#ate
    .n Alt( Parte 3==46
    ;59.;I T+"'+rare e<&"o/!v7
    !n(er%!(en(7 ERR;J
    312.32-"e&(o%an!e ERRHJ
    312.33P!ro%an!e ERRFJ
    ;59.;5 *oc de Oans7 &a(o"o$!c ERH5J
    ;59.;F Tr!co(!"o%an!e ERHIJ ;59.;L
    T+"'+rare a con(ro"+"+! !%&+"s+"+! FS
    ERHHJ
    Tul-ur(rile $e A$aptare 3=G56
    ;LF4<< T+"'+rarea de ada&(are .L c+
    d!s&o/!=!e de&res!v7 .9I c+ an<!e(a(e
    .9G c+ d!s&o/!=!e %!<(7, de&res!v7 s!
    an<!oas7
    .; c+ &er(+r'are de cond+!(7 .I
    c+ &er(+r'are %!<(7 a e%o=!!"or
    s! cond+!(e! .F
    nes&ec!.!ca(7
    0e speci)icat dac6? acut sau cronic
    Tul-ur(rile $e Per&onalitate 3=><6
    >ot6? Acestea s+nt codi)icate pe axa 97
    ;L5.L T+"'+rare de &ersona"!(a(e &ara4
    no!d7 ERFLJ
    301.20T+"'+rare de &ersona"!(a(e sc!
    /o!d7 ERFIJ
    301.21T+"'+rare de &ersona"!(a(e sc!4
    /o(!&a"7 ERFHJ
    ;L5.H T+"'+rare de &ersona"!(a(e
    an(!soc!a"7 EHL5J
    ;L5.G; T+"'+rare de &ersona"!(a(e 'or4
    der"!ne EHLRJ
    ;L5.YL T+"'+rare de &ersona"!(a(e
    !s(r!on!c7 EH55J
    301.81T+"'+rare de &ersona"!(a(e nar4
    c!s!s(!c7 EH5IJ
    301.82T+"'+rare de &ersona"!(a(e ev!4
    (an(7 EH5GJ
    ;L5.R T+"'+rare de &ersona"!(a(e
    de&enden(7 EH95J
    ;L5.I T+"'+rare de &ersona"!(a(e o'se4
    s!vo co%&+"s!v7 EH9YJ
    ;L5.F T+"'+rare de &ersona"!(a(e FS
    EH9FJ
    Alte Con$i!ii #are &e pot a%la .n
    Centrul Aten!iei Clini#e 3G4*6
    'ACTORII PSIFOLOGICI CARE
    A'ECTEA9 CONDI;IA MEDICAL9
    EH;5J
    ;5R .. 7@0e speci)icat )actor+l psi-olo/ic
    care a)ectea;6777A @Se indic6
    condi(ia medical6 /eneral6A EH;5J
    A se ale/e den+mirea pe ba;a
    nat+rii Lactor 9or?
    T+"'+rare %en(a"7 care
    a.ec(ea/7 cond!=!a %ed!ca"7
    S!%&(o%e &s!o"o$!ce care
    a.ec(ea/7 cond!=!a %ed!ca"7
    lasi$icarea DSM-IV-
    T+
    C<

    Tr7s7(+r! de &ersona"!(a(e sa+
    s(!" de a .ace .a=7 care
    a.ec(ea/7 cond!=!a %e d!ca"7
    Co%&or(a%en(e de/ada&(a(!ve
    &en(r+ s7n7(a(e care a.ec(ea/7
    cond!=!a %ed!ca"7
    R7s&+ns .!/!o"o$!c :n "e$7(+r7
    c+ s(res+" care a.ec(ea/7
    cond!=!a %ed!ca"7
    A"=! .ac(or! &s!o"o$!c! sa+
    .ac(or! &s!o"o$!c!
    nes&ec!.!ca=! care a.ec(ea/7
    cond!=!a %ed!ca"7
    TUL8UR9RILE DE MI?CARE
    INDUSE DE MEDICAMENTE 3G476
    ;;9.5 Par)!nson!s% !nd+s de ne+ro4
    "e&(!ce EH;YJ ;;;.F9 S!ndro%
    ne+ro"e&(!c %a"!$n
    EH;YJ ;;;.H D!s(on!e ac+(7
    !nd+s7 de ne+ro4
    "e&(!ce EH;YJ ;;;.FF A)a(!s!e
    ac+(7 !nd+s7 de ne+ro4
    "e&(!ce EH;YJ ;;;.G9
    D!s)!ne/!e (ard!v7 !nd+s7 de
    ne+ro"e&(!ce EH;RJ
    ;;;.5 Tre%or &os(+ra" !nd+s de
    ne+ro"e&(!ce EH;RJ
    ;;;.FL T+"'+rare de %!Ocare !nd+s7 de
    ne+ro"e&(!ce FS EH;RJ
    ALT9 TUL8URARE INDUS9
    DE MEDICAMENTE 3G4=6
    FFY.9 E.ec(e"e adverse a"e %ed!ca
    %en(e"or FS EH;RJ
    PRO8LEME RELA;IONALE 3G4=6
    3R5.F Pro'"e%7 re"a=!ona"7 :n "e$7(+r7
    c+ o (+"'+rare %en(a"7 sa+ c+ o
    cond!=!e %ed!ca"7 $enera"7 EH;HJ
    3R5.9L Pro'"e%7 re"a=!ona"7 &7r!n(e4
    co&!" EH;HJ
    3R5.5 Pro'"e%7 re"a=!ona"7 c+
    &ar(ener+" EH;HJ
    3R5.G Pro'"e%7 re"a=!ona"7 :n(re .ra=!
    EH;HJ
    3R9.G5 Pro'"e%7 re"a=!ona"7 FS EH;HJ
    PRO8LEME :N LEG9TUR9 CU
    A8UUL SAU NEGLIIAREA 3G4>6
    3R5.95 Ma"(ra(are a co&!"+"+! EH;GJ
    (se codi)ic6 la !!C7C dac6 =n centr+l
    aten(iei se a)l6 *ictima% 3R5.95
    A'+/ se<+a" de +n co&!" EH;GJ
    (se codi)ic6 la !!C7C dac6 =n
    centr+l
    aten(iei se a)l6 *ictima%
    3R5.95 Ne$"!@are a co&!"+"+! EH;GJ
    (se codi)ic6 la !!C7C, dac6 =n centr+l
    aten(iei se a)l6 *ictima% 3R.5
    Ma"(ra(are a ad+"(+"+! EH;GJ
    (se codi)ic6 la !!C7&, dac6 =n
    centr+l aten(iei se a)l6 *ictima%
    3R5.5 A'+/ se<+a" de +n ad+"( EH;GJ
    (se codi)ic6 la !!C7&, dac6 =n
    centr+l aten(iei se a)l6 *ictima%
    CONDI;IILE ADI;IONALE CARE SE
    POT A'LA :N CENTRUL ATEN;IEI
    CLINICE 3G456
    3I Y.G5 Nonco%&"!an=7 "a (ra(a%en(
    EH;FJ
    3RY.9 S!%+"are EH;FJ
    3H5.L5 Co%&or(a%en( an(!soc!a" a"
    ad+"(+"+! EHILJ
    3H5.L9 Co%&or(a%en( an(!soc!a" a"
    co&!"+"+! sa+ ado"escen(+"+!
    EHILJ
    3R9.GF F+nc=!onare !n(e"ec(+a"7 "!%!4
    nar7 EHILJ >ot6? Aceasta este
    codi)icat6 pe axa 55
    HGL.F Dec"!n co$n!(!v :n "e$7(+r7 c+
    e(a(ea EHILJ
    3R9.G9 Do"!+ EHILJ
    3R9.; Pro'"e%7 Oco"ar7 EHI5J
    3R9.9 Pro'"e%7 &ro.es!ona"7 EHI5J
    ;5;.G9 Pro'"e%7 de !den(!(a(e EHI5J
    3R9.GF Pro'"e%7 re"!$!oas7 sa+
    s&!r!(+a"7 EHI5J
    3R9.I Pro'"e%7 de ac+"(+ra=!e EHI9J
    3R9.GF Pro'"e%7 de .a/7 de v!a(7 EHI9J
    9R Cla&i%i#area DSM-IV-T+

    Co$urile A$i!ionale 3G746
    ;LL.F T+"'+rare %en(a"7 nes&ec!.!ca(7
    Enon&s!o(!c7J EHI;J
    3H5.LF N!c! +n d!a$nos(!c sa+ cond!=!e
    &e a<a I EHI;J
    HFF.F D!a$nos(!c sa+ cond!=!e
    a%Ana(7 &e a<a I EHI;J
    3H5.LF N!c! +n d!a$nos(!c &e a<a II EHI;J
    HFF.F D!a$nos(!c a%Ana( &e a<a II
    EHI;J
    Si&te"ul Muttia,ial 3CG6
    A<a I T+"'+r7r!"e c"!n!ce
    A"(e cond!=!! care se &o( a."a :n
    cen(r+" a(en=!e! c"!n!ce A<a II
    T+"'+r7r!"e de &ersona"!(a(e
    Re(ardarea %en(a"7 A<a III
    Cond!=!!"e %ed!ca"e $enera"e A<a I3
    Pro'"e%e"e &s!osoc!a"e s! de
    %ed!+ A<a 3 Eva"+area
    $"o'a"7 a .+nc=!on7r!!
    *valuarea multiaxial
    2n s!s(e% %+"(!a<!a" !%&"!c7 o eva"+are &e %a! %+"(e a<e, .!ecare a<7
    re.e4r!nd+4se "a +n do%en!+ d!.er!( de !n.or%a=!! care &o( a@+(a
    c"!n!c!an+" :n e"a'orarea &"an+"+! de (ra(a%en( s! &o( &re/!ce
    de/nod7%An(+". E<!s(7 c!nc! a<e !nc"+se :n c"as!.!carea %+"(!a<!a"7 a
    DSM4I3Q
    A<a I T+"'+r7r!"e c"!n!ce
    A"(e cond!=!! care se &o( a."a :n cen(r+" a(en=!e! c"!n!ce
    A<a II T+"'+r7r!"e de &ersona"!(a(e
    Re(ardarea %en(a"7 A<a III Cond!=!!"e
    %ed!ca"e $enera"e A<a I3 Pro'"e%e"e
    &s!osoc!a"e s! de %ed!+ A<a 3 Eva"+area
    $"o'a"7 a .+nc=!on7r!!
    U(!"!/area s!s(e%+"+! %+"(!a<!a" .ac!"!(ea/7 o eva"+are c+&r!n/7(oare s!
    s!s(e%a(!c7, c+ acordarea de a(en=!e d!verse"or (+"'+r7r! %en(a"e s! cond!=!!
    %ed!ca"e $enera"e, &ro'"e%e"or &s!o4soc!a"e O! de %ed!+ s! n!ve"+"+! de
    .+nc=!onare, care &o( .! (rec+(e c+ vederea dac7 a(en=!a es(e concen(ra(7 &e
    eva"+area +ne! s!n$+re &ro'"e%e &re/en(a(e. Un s!s(e% %+"(!a<!a" &revede +n
    .or%a( convena'!" de or$an!/are s! co%+n!care a !n.or%a=!!"or c"!n!ce, de
    ca&(are a co%&"e<!(7=!! s!(+a=!!"or c"!n!ce O! de descr!ere a e(ero$en!(7=!!
    !nd!v!/!"or care &re/!n(7 ace"aO! d!a$nos(!c, :n a.ar7 de aceas(a, s!s(e%+"
    %+"(!a<!a" &ro%ovea/7 a&"!carea %ode"+"+! '!o&s!osoc!a" :n cond!=!!
    c"!n!ce, ed+ca=!ona"e O! de cerce(are.
    Res(+" aces(e! sec=!+n! &revede o descr!ere a .!ec7re!a d!n a<e"e DSM4F3. :n +ne"e
    cond!=!! sa+ s!(+a=!!, c"!n!c!an+" &oa(e &re.era s7 n+ +(!"!/e/e s!s(e%+" %+"(!a<!a".
    Pen(r+ aces( %o(!v, "a .!ne"e aces(e! sec=!+n! s+n( &rev7/+(e %ode"e &en(r+
    ra&or(area re/+"(a(e"or +ne! eva"+7r! DSM4I3 .7r7 a&"!carea s!s(e%+"+! %+"(!a<!a"
    o.!c!a".
    Axa ID Tulburrile clinice
    Alte condiii care se pot a$la "n centrul ateniei clinice
    A<a I es(e des(!na(7 ra&or(7r!! (+(+ror (+"'+r7r!"or s! cond!=!!"or d!n c"as!.!care,
    c+ e<ce&=!a (+"'+r7r!"or de &ersona"!(a(e O! a re(ard7r!! %en(a"e Ecare s+n( ra&or(a(e
    &e a<a IIJ. ,r+&e"e %a@ore de (+"'+r7r! de ra&or(a( &e a<a I s+n( %en=!ona(e :n
    case(a de %a! @os. De ase%enea, de ra&or(a( &e a<a I s+n( s! a"(e cond!=!! care se &o(
    a."a :n cen(r+" a(en=!e! c"!n!ce.
    CAnd +n !nd!v!d are %a! %+"( decA( o s!n$+r7 (+"'+rare de &e a<a I, (re'+!e
    ra&or(a(e (oa(e E&en(r+ e<e%&"!.!care ve/! &a$. ;YJ. Dac7 es(e &re/en(7 %a! %+"(
    decA( o s!n$+r7 (+"'+rare &e a<a I, d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+" cons+"(a=!e!
    Eve/! &a$. ;J (re'+!e s7 .!e !nd!ca( &r!n %en=!onarea sa, &r!%+". CAnd +n !nd!v!d are,
    a(A( &e a<a I, cA( s! &e a<a II, cA(e o (+"'+rare, d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+"
    9H
    2= *valuarea multiaxial
    cons+"(a=!e! va .! cons!dera( (+"'+rarea de &e a<a I, e<ce&(And ca/+" cAnd
    d!a$nos(!c+" de &e a<a II es(e +r%a( de e<&res!a ca"!.!ca(!v7 SEd!a$nos(!c &r!nc!&a"JT
    sa+ SE%o(!v+" cons+"(a=!e!JT. Dac7 &e a<a I n+ es(e &re/en(7 n!c! o (+"'+rare, aces(
    .a&( (re'+!e cod!.!ca( ca 3H5.LF. Dac7 +n d!a$nos(!c &e a<a I es(e a%Ana( &An7 "a
    s(rAn$erea de !n.or%a=!! s+&"!%en(are, aces( .a&( (re'+!e s7 .!e cod!.!ca( ca HFF.F.
    u
    A,a l
    Tul-ur(rile #lini#e Alte #on$i!ii #are &e
    pot a%la .n #entrul aten!iei #lini#e
    Tulburrile dia!nosticate de re!ul pentru prima dat "n perioada de su!ar "n
    copilrie sau adolescen (excluznd retardarea mental, care este
    diagnosticat pe axa II)
    Deliriumul, demena, tulburrile amnestice si alte tulburri co!nitive
    Tulburrile mentale datorate unei condiii medicale !enerale
    Tulburrile "n le!tur cu o substan
    Sc%i(o$renia si alte tulburri psi%otice
    Tulburrile a$ective
    Tulburrile anxioase
    Tulburrile somato$orme
    Tulburrile $actice
    Tulburrile disociative
    Tulburrile sexuale ,i de identitate sexual
    Tulburrile de comportament alimentar
    Tulburrile controlului impulsului neclasi$icate "n alt parte
    Tulburrile de adaptare
    Alte condiii care se pot a$la "n centrul ateniei clinice
    Axa IID Tulburrile de #ersonalitate
    +etardarea Mental
    A<a II es(e des(!na(7 ra&or(7r!! (+"'+r7r!"or de &ersona"!(a(e s! re(ard7r!!
    %en(a"e. Ea &oa(e .! +(!"!/a(7, de ase%enea, &en(r+ a no(a e"e%en(e"e
    de/ada&(a(!ve de &ersona"!(a(e re%arca'!"e s! %ecan!s%e"e de a&7rare.
    Men=!onarea (+"'+r7r!"or de &ersona"!(a(e s! a re(ard7r!! %en(a"e &e o a<7
    se&ara(7 as!$+r7 acordarea de cons!dera=!e &re/en=e! &os!'!"e a (+"'+r7r!"or de
    &ersona"!(a(e O! re(ard7r!! %en(a"e, care a"(.e" &o( .! (rec+(e c+ vederea cAnd
    a(en=!a es(e concen(ra(7 as+&ra +nor (+"'+r7r! de re$+"7 %a! ."or!de de &e a<a I.
    Cod!.!carea (+"'+r7r!"or de &ersona"!(a(e &e a<a II n+ (re'+!e s7 .!e cons!dera(7 ca
    !%&"!cAnd .a&(+" c7 &a(o$ene/a "or sa+ c7 a"e$erea (ra(a%en(+"+! adecva( s+n(
    .+nda%en(a" d!.er!(e de ce"e &en(r+ (+"'+r7r!"e cod!.!ca(e &e a<a I. T+"'+r7r!"e de
    cod!.!ca( &e a<a II s+n( %en=!ona(e :n case(a de %a! @os.
    :n s!(+a=!a co%+n7, :n care +n !nd!v!d are %a! %+"( decA( +n s!n$+r d!a$nos(!c
    &e a<a II, vor (re'+! ra&or(a(e (oa(e E&en(r+ e<e%&"!.!care, ve/! &a$. ;YJ. CAnd +n
    !nd!v!d are, a(A( &e a<a I, cA( s! &e a<a II cA(e +n d!a$nos(!c, !ar d!a$nos(!c+" de &e
    a<a II es(e d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+" cons+"(a=!e!, aces( "+cr+ (re'+!e
    !nd!ca( &r!n ad7+$area e<&res!e! ca"!.!ca(!ve de SEd!a$nos(!c &r!nc!&a"JT sa+ de
    SE%o(!v a" cons+"(a=!e!JT d+&7 d!a$nos(!c+" de &e a<a II. Dac7 n+ es(e &re/en(7 n!c!
    *valuarea
    multiaxial
    24

    o (+"'+rare &e a<a II, aceas(7 even(+a"!(a(e (re'+!e s7 .!e cod!.!ca(7 ca 3H5.LF. Dac7
    +n d!a$nos(!c de &e a<a II es(e a%Ana( &An7 "a s(rAn$erea de !n.or%a=!!
    s+&"!%en(are, aces( .a&( va .! cod!.!ca( ca HFF.F.
    A<a II &oa(e .!, de ase%enea, +(!"!/a(7 &en(r+ a !nd!ca e"e%en(e"e de/ada&(a(!ve
    de &ersona"!(a(e re%arca'!"e care n+ sa(!s.ac &ra$+" &en(r+ o (+"'+rare de
    &ersona"!(a(e E:n ase%enea ca/+r!, n+ (re'+!e +(!"!/a( n!c! +n n+%7r de cod 4 ve/!
    e<e%&"+" ; de "a &a$. ;HJ. U(!"!/area a'!(+a"7 a %ecan!s%e"or de a&7rare
    de/ada&(a(!ve &oa(e .!, de ase%enea, !nd!ca(7 &e a<a II Eve/! ane<a B, &a$. G55,
    &en(r+ de.!n!=!! s! e<e%&"+" " de "a &a$. ;HJ.
    A,a II
    Tul-ur(rile $e per&onalitate
    Retar$area "ental(
    Tulburarea de personalitate paranoid
    Tulburarea de personalitate sc%i(oid
    Tulburarea de personalitate
    sc%i(otipal Tulburarea de
    personalitate antisocial
    Tulburarea de personalitate borderline
    Tulburarea de personalitate %istrionic
    Tulburarea de personalitate
    narcisistic
    Tulburarea de personalitate evitant
    Tulburarea de personalitate dependent
    Tulburarea de personalitate
    obsesivo-compulsiv
    Tulburare de personalitate ';S
    +etardarea mental

    Axa IIID ondiiile Medicale Generale
    A<a III es(e des(!na(7 ra&or(7r!! cond!=!!"or %ed!ca"e $enera"e care s+n( &o(en=!a"
    re"evan(e &en(r+ :n=e"e$erea sa+ (ra(a%en(+" (+"'+r7r!! %en(a"e a !nd!v!d+"+!.
    Aces(e cond!=!! s+n( c"as!.!ca(e :n a.ara ca&!(o"+"+! de ST+"'+r7r! %en(a"eT a" ICD4F4
    CM Es! :n a.ara ca&!(o"+"+! 3 a" ICD45LJ. O "!s(7 a &r!nc!&a"e"or ca(e$or!! de
    cond!=!! %ed!ca"e $enera"e es(e da(7 :n case(a de %a! @os. EPen(r+ o "!s(7 %a!
    de(a"!a(7 !nc"+/And cod+r!"e s&ec!.!ce ICD4F4CM, a se cons+"(a ane<a ,.J.
    D+&7 c+% s4a %en=!ona( :n SIn(rod+cereT, d!s(!nc=!a %+"(!a<!a"7 d!n(re
    (+"'+r7r!"e de &e a<a I, II s! III n+ !%&"!c7 s! .a&(+" c7 e<!s(7 d!.eren=e .+nda%en(a"e
    :n conce&(+a"!/area "or, c7 (+"'+r7r!"e %en(a"e n+ a+ n!c! o "e$7(+r7 c+ .ac(or! sa+
    &rocese so%a(!ce sa+ '!o"o$!ce, sa+ c7 cond!=!!"e %ed!ca"e $enera"e n+ a+ n!c! o
    "e$7(+r7 c+ .ac(or! sa+ &rocese co%&or(a%en(a"e sa+ &s!osoc!a"e. Sco&+"
    d!s(!n$er!! cond!=!!"or %ed!ca"e $enera"e es(e ace"a de a :nc+ra@a a&ro.+ndarea :n
    eva"+are O! de a cres(e co%+n!carea d!n(re ce! care se oc+&7 de :n$r!@!rea s7n7(7=!!.
    Cond!=!!"e %ed!ca"e $enera"e &o( .! :n "e$7(+r7 c+ (+"'+r7r!"e %en(a"e :n(r4o
    var!e(a(e de %od+r!, :n +ne"e ca/+r! es(e ev!den( c7 cond!=!a %ed!ca"7 $enera"7 se
    a."7 :n re"a=!e e(!o"o$!c7 d!rec(7 c+ a&ar!=!a sa+ a$ravarea s!%&(o%e"or s! c7
    %ecan!s%+" &en(r+ aces( e.ec( es(e .!/!o"o$!c. CAnd o (+"'+rare %en(a"7 es(e
    cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a cond!=!e! %ed!ca"e $enera"e,
    (+"'+rarea %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e va (re'+! s7 .!e
    d!a$nos(!ca(7 &e a<a I, !ar cond!=!a %ed!ca"7 $enera"7 va (re'+! s7 .!e :nre$!s(ra(7,
    a(A( &e a<a I, cA( s! &e a<a III. De e<e%&"+, cAnd !&o(!ro!d!s%+" es(e ca+/a d!rec(7
    a s!%&(o%e"or de&res!ve, d!a$nos(!c+" de &e a<a I es(e 9F;.G;. T+"'+rare a.ec(!v7
    4+ *valuarea muttiaxial
    da(ora(7 !&o(!ro!d!s%+"+!, c+ e"e%en(e de&res!ve, !ar !&o(!ro!d!s%+" es(e
    %en=!ona( d!n no+ s! cod!.!ca( &e a<a III ca 9II.F Eve/! e<e%&"+" $, &a$. ;HJ. Pen(r+
    e<&"!ca=!! s+&"!%en(are ve/! &a$ 5G5.
    :n ace"e ca/+r!, :n care re"a=!a e(!o"o$!c7 d!n(re cond!=!a %ed!ca"7 $enera"7 M
    s!%&(o%e"e %en(a"e es(e !ns+.!c!en( de c"ar7 &en(r+ a @+s(!.!ca +n d!a$nos(!c de
    (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e &e a<a I, (+"'+rarea
    %en(a"7 res&ec(!v7 Ede e<., (+"'+rarea de&res!v7 %a@or7J (re'+!e s7 .!e %en=!ona(7
    s! cod!.!ca(7 &e a<a I8 cond!=!a %ed!ca"7 $enera"7 va .! cod!.!ca(7 n+%a! &e a<a III.
    E<!s(7 +ne"e s!(+a=!! :n care cond!=!!"e %ed!ca"e $enera"e s+n( :nre$!s(ra(e &e a<a
    III d!n ca+/a !%&or(an=e! "or &en(r+ :n=e"e$erea $"o'a"7 sa+ (ra(a%en(+" !nd!v!d+"+!
    c+ (+"'+rarea %en(a"7. O (+"'+rare de &e a<a I &oa(e .! o reac=!e &s!o"o$!c7 "a o
    cond!=!e %ed!ca"7 de &e a<a III Ede e<., ;LF.L T+"'+rare de ada&(are c+ d!s&o/!=!e
    de&res!v7, ca reac=!e "a d!a$nos(!c+" de carc!no% a" sAn+"+!J. Une"e cond!=!!
    %ed!ca"e $enera"e &o( s7 n+ .!e :n re"a=!e d!rec(7 c+ (+"'+rarea %en(a"7, dar c+ (oa(e
    aces(ea s7 a!'7 !%&or(an(e !%&"!ca=!! &ro$nos(!ce sa+ de (ra(a%en( Ede e<., cAnd
    d!a$nos(!c+" de &e a<a I es(e 9FR.9 T+"'+rare de&res!v7 %a@or7, !ar ce" de a<a III es(e
    I9H.F Ar!(%!e, a"e$erea .ar%aco(era&!e! es(e !n."+en=a(7 de cond!=!a %ed!ca"7
    $enera"78 "a .e", cAnd o &ersoan7 c+ d!a'e( /aara( es(e !n(erna(7 :n s&!(a" &en(r+ o
    e<acer'are a sc!/o.ren!e!, !ar (ra(a%en(+" c+ !ns+"!na (re'+!e %on!(or!/a(J.
    CAnd +n !nd!v!d are %a! %+"( decA( +n s!n$+r d!a$nos(!c re"evan( &e a<a III,
    (re'+!e ra&or(a(e (oa(e. Pen(r+ e<e%&"!.!care, ve/! &a$. ;Y. Dac7 n+ es(e &re/en(7
    n!c! o (+"'+rare &e a<a III, aces( .a&( (re'+!e !nd!ca( &r!n no(a=!a SA<a IIIQ N!c! +n
    d!a$nos(!cT. Dac7 +n d!a$nos(!c de &e a<a III es(e a%Ana( &An7 "a s(rAn$erea de
    !n.or%a=!! s+&"!%en(are, aces( .a&( (re'+!e !nd!ca( &r!n %en=!+nea SA<a IIIQ
    D!a$nos(!c a%Ana(T.
    A,a III Con$i!ii Me$i#ale
    Generale 3#u #o$urile ICD-5-CM6
    Maladii in$ecioase si para(itare &55E-746)
    Feoplasme &EH5-746)
    Maladii endocrine, de nutriie si metabolice ,i tulburri imunolo!ice &7H5-7?6)
    Maladii ale sistemului nervos ,i ale or!anelor de sim &475-486)
    Maladii ale sistemului circulator &465-HA6)
    Maladii ale sistemului respirator &HI5-AE6)
    Maladii ale sistemului di!estiv &A75-A?6)
    Maladii ale sistemului !enito-urinar &A85-I76)
    omplicaii ale sarcinii, na,terii ,i puerperiumului &I45-I?I)
    Maladii ale pielii ,i esutului subcutanat &I85-?56)
    Maladii ale sistemului osteo-muscular ,i esutului con0unctiv &?E5-?46)
    Anomalii con!enitale &?H5-?A6)
    Anumite condiii survenind "n perioada perinatal &?I5-??6)
    Simptome, semne si maladii ru de$inite &?85-?66)
    Traumatisme ,i otrviri &intoxicaii) &855-666)
    *valuarea
    multiaxial
    4E
    Axa IVD #robleme #si%osociale si de Mediu
    A<a I3 es(e des(!na(7 ra&or(7r!! &ro'"e%e"or &s!osoc!a"e s! de %ed!+ care &o(
    a.ec(a d!a$nos(!c+", (ra(a%en(+" O! &ro$nos(!c+" (+"'+r7r!"or %en(a"e Ea<e"e I s! E%7
    Pro'"e%a &s!osoc!a"7 sa+ de %ed!+ &oa(e .! +n even!%en( de v!a=7 ne$a(!v, o
    d!.!c+"(a(e sa+ de.!c!en(7 a%'!en(a"7, +n s(res .a%!"!a" sa+ +n a"( s(res !n(er&ersona",
    o !nadecvare a s+&or(+"+! soc!a" sa+ a res+rse"or &ersona"e or! a"(e &ro'"e%e :n
    "e$7(+r7 c+ con(e<(+" :n care a+ a&7r+( d!.!c+"(7=!"e &ersoane!. Asan+%!=!! s(resor!
    &o/!(!v!, c+% ar .! &ro%ovarea :n .+nc=!e, (re'+!e s7 .!e %en=!ona=! n+%a! dac7
    cons(!(+!e sa+ d+c "a o &ro'"e%7, ca a(+nc! cAnd o &ersoan7 are d!.!c+"(7=! :n a se
    ada&(a "a o s!(+a=!e no+7. Pe "An$7 .a&(+" de a @+ca +n ro" :n !n!=!erea sa+
    e<acer'area +ne! (+"'+r7r! %en(a"e, &ro'"e%e"e &s!osoc!a"e &o( a&are s! ca o
    consec!n=7 a &s!o&a(o"o$!e! &ersoane! sa+ &o( cons(!(+! &ro'"e%e care (re'+!e s7
    .!e "+a(e :n cons!dera=!e :n &"an+" $"o'a" de (ra(a%en(.
    CAnd +n !nd!v!d are %+"(!&"e &ro'"e%e &s!osoc!a"e sa+ de %ed!+, c"!n!c!an+"
    &oa(e no(a a(A(ea cA(e cons!der7 a .! re"evan(e, :n $enera", c"!n!c!an+" (re'+!e s7
    no(e/e n+%a! ace"e &ro'"e%e &s!osoc!a"e sa+ de %ed!+ care a+ .os( &re/en(e :n
    an+" &receden( eva"+7r!! ac(+a"e, :ns7, c"!n!c!an+" &oa(e s7 no(e/e s! &ro'"e%e"e
    &s!osoc!a"e sa+ de %ed!+ care a+ s+rven!( :na!n(ea an+"+! &receden(, dac7 aces(ea
    con(r!'+!e "a (+"'+rarea %en(a"7 sa+ a+ deven!( =!n(a (ra(a%en(+"+!, de e<e%&"+,
    e<&er!en=e"e de "+&(7 an(er!oare care a+ d+s "a s(res+" &os((ra+%a(!c.
    :n &rac(!c7, ce"e %a! %+"(e &ro'"e%e &s!osoc!a"e s! de %ed!+ vor .! !nd!ca(e &e
    a<a I3. :ns7, cAnd o &ro'"e%7 &s!osoc!a"7 sa+ de %ed!+ se a."7 :n cen(r+" a(en=!e!
    c"!n!ce, aceas(a (re'+!e, de ase%enea, s7 .!e :nre$!s(ra(7 &e a<a I, c+ +n cod &roven!(
    d!n sec=!+nea SA"(e cond!=!! care se &o( a."a :n cen(r+" a(en=!e! c"!n!ceT Eve/! &a$.
    H;5J.
    Pen(r+ co%od!(a(e, &ro'"e%e"e s+n( $r+&a(e :%&re+n7 :n +r%7(oare"e ca(e$or!!Q
    N Pro'"e%e c+ $r+&+" de s+&or( &r!%ar U de e<., %oar(ea +n+! %e%'r+ a"
    .a%!"!e!8 &ro'"e%e de s7n7(a(e :n .a%!"!e8 des(r7%area .a%!"!e! &r!n se&arare,
    d!vor= sa+ :ns(r7!nare8 &"ecarea de acas78 rec7s7(or!rea +n+! &7r!n(e8 a'+/+"
    se<+a" sa+ .!/!c8 !&er&ro(ec=!a &aren(a"78 ne$"!@area co&!"+"+!8 d!sc!&"!n7
    !nadecva(78 d!scord!e :n(re .ra=!!8 naO(erea +n+! .ra(e
    N Pro'"e%e :n "e$7(+r7 c+ %ed!+" soc!a" U de e<., %oar(ea sa+ &!erderea +n+!
    a%!c8 s+&or( soc!a" !nadecva(8 a (r7! s!n$+r8 d!.!c+"(7=! de ac+"(+ra=!e8
    d!scr!%!nare8 ada&(area "a (ran/!=!a "a a"(7 e(a&7 de v!a=7 Ec+% ar .! &ens!onareaJ
    N Pro'"e%e ed+ca=!ona"e U de e<., ana".a'e(!s%, &ro'"e%e Oco"are, ne:n=e"e$ere
    c+ &ro.esor!! sa+ c+ co"e$!!8 %ed!+ Oco"ar !nadecva(
    N Pro'"e%e &ro.es!ona"e U de e<., Oo%a@, a%en!n=area c+ &!erderea serv!c!+"+!,
    orar de "+cr+ s(resan(, cond!=!! de "+cr+ d!.!c!"e, !nsa(!s.ac=!e &ro.es!ona"7,
    sc!%'area &ro.es!e!, ne:n=e"e$ere c+ &a(ron+" sa+ c+ co"e$!! de serv!c!+
    N Pro'"e%e c+ "oc+!n=a U de e<., "!&sa "oc+!n=e!, "oc+!n=7 necores&+n/7(oare,
    vec!n7(a(e &er!c+"oas7, ne:n=e"e$er! c+ vec!n!! sa+ c+ &ro&r!e(ar+"
    N Pro'"e%e econo%!ce U de e<., &a+&er(a(e e<(re%7, .!nan=e !ns+.!c!en(e, a@+(or
    soc!a" !ns+.!c!en(
    N Pro'"e%e c+ acces+" "a serv!c!!"e de as!s(en=7 %ed!ca"7 U de e<., serv!c!! de
    as!s(en=7 %ed!ca"7 !nadecva(e, (rans&or( !nacces!'!" "a +n!(7=!"e de as!s(en=7
    %ed!ca"7, as!$+rare de s7n7(a(e !nadecva(7
    N Pro'"e%e :n "e$7(+ra c+ !n(erac=!+nea c+ s!s(e%+" "e$a"X&ena" U de e<., ares(,
    :nc!soare, "!(!$!+, v!c(!%7 a +n+! !n.rac=!+n!
    ;9 *valuarea multiaxial

    N A"(e &ro'"e%e &s!osoc!a"e s! de %ed!+ U de e<., e<&+nerea "a +n de/as(r+,
    r7/'o!, a"(e os(!"!(7=!, ne:n("e$ere c+ (+(or!! care n+ .ac &ar(e d!n .a%!"!e, c+% ar .!
    +n avoca(, as!s(en( soc!a" sa+ %ed!c, !nacces!'!"!(a(e "a a$en=!!"e de serv!c!! soc!a"e
    CAnd se +(!"!/ea/7 .or%+"ar+" de ra&or(are a eva"+7r!! %+"(!a<!a"e Eve/! &a$. ;RJ,
    c"!n!c!an+" (re'+!e s7 !den(!.!ce ca(e$or!!"e re"evan(e de &ro'"e%e &s!osoc!a"e s! de
    %ed!+, s! s7 !nd!ce .ac(or!! s&ec!.!c! !%&"!ca=!. Dac7 n+ se +(!"!/ea/7 +n .or%+"ar de
    :nre$!s(rare c+ o "!s(7 a ca(e$or!!"or de &ro'"e%e, c"!n!c!an+" &oa(e no(a &+r s!
    s!%&"+ &ro'"e%e"e s&ec!.!ce &e a<a 1 E3e/! e<e%&"e"e de "a &a$. ;YJ.
    A,a IV Pro-le"e p&i@o&o#iale Ei $e
    "e$iu
    #robleme cu !rupul de suport primar
    #robleme "n le!tur cu mediul social
    #robleme educaionale
    #robleme pro$esionale
    #robleme domestice
    #robleme economice
    #robleme cu accesul la serviciile de asisten medical
    #robleme "n le!tur cu interaciunea cu sistemul le!al1penal
    Alte probleme psi%osociale si de mediu
    Axa VD *valuarea Global a 'uncionrii
    A<a 3 es(e des(!na(7 ra&or(7r!! o&!n!e! c"!n!c!an+"+! as+&ra n!ve"+"+! $"o'a" de
    .+nc=!onare a" !nd!v!d+"+!. Aceas(7 !n.or%a=!e es(e +(!"7 &en(r+ &"an!.!carea
    (ra(a%en(+"+! s! %7s+rarea !%&ac(+"+! s7+ s! &red!c=!a de/nod7%An(+"+!.
    Ra&or(area .+nc=!on7r!! $"o'a"e &e a<a. 3 &oa(e .! .7c+(7 .o"os!nd ,"o'a"
    Assess%en( o. F+nc(!on!n$ E,AFJ ZSca"a de Eva"+are ,"o'a"7 a F+nc=!on7r!! EE,FJ[.
    Sca"a ,AF &oa(e .! e<(re% de +(!"7 :n +r%7r!rea &ro$res+"+! c"!n!c a" !nd!v!/!"or :n
    (er%en! $"o'a"!, +(!"!/And o s!n$+r7 %7s+rare. Sca"a ,AF es(e des(!na(7 n+%a!
    a&rec!er!"or re.er!(oare "a .+nc=!onarea &s!o"o$!c7, soc!a"7 s! &ro.es!ona"7.
    Ins(r+c=!+n!"e s&ec!.!c7 Sa n+ se !nc"+de de(er!orarea :n .+nc=!onare da(ora(7
    res(r!c=!!"or so%a(!ce Esa+ de %ed!+JT.
    Sca"a ,AF es(e d!v!/a(7 :n 5L ca(e$or!! de .+nc=!onare. A ca"c+"a +n scor ,AF
    !%&"!c7 a"e$erea +ne! s!n$+re va"or! care re."ec(7 ce" %a! '!ne n!ve"+" $"o'a" de
    .+nc=!onare a" !nd!v!d+"+!. Descr!erea .!ec7re! ca(e$or!! de 5L &+nc(e &e sca"a ,AF
    are do+7 co%&onen(eQ &r!%a &ar(e (ra(ea/7 sever!(a(ea s!%&(o%e"or, !ar cea de a
    do+a &ar(e (ra(ea/7 .+nc=!onarea. Scor+" ,AF se ca"c+"ea/7 :n cadr+" +ne! an+%!(e
    dec!"e dac7, .!e sever!(a(ea s!%&(o%e"or, .!e n!ve"+" de .+nc=!onare cad :n ca(e$or!a
    res&ec(!v7. De e<e%&"+, &r!%a &ar(e a ca(e$or!e! I54YL descr!e Ss!%&(o%e severe
    Ede e<., !dea=!e s+!c!da"7, r!(+a"+r! o'ses!ve severe, .+r(+r! .recven(e d!n
    %a$a/!neJT, !ar cea de a do+a &ar(e !nc"+de Sor!ce de(er!orare sever7 :n
    .+nc=!onarea soc!a"7, &ro.es!ona"7 sa+ Oco"ar7 Ede e<., n+ are a%!c!, es(e !nca&a'!" s7
    se =!n7 de serv!c!+JT. Tre'+!e re=!n+( c7 :n s!(+a=!!"e :n care sever!(a(ea s!%&(o%e"or
    s! sever!(a(ea n!ve"+"+! de .+nc=!onare s+n( d!scordan(e, scor+" ,AF .!na" re."ec(7
    (o(dea+na &e cea %a! rea d!n(re ce"e do+7. De e<e%&"+, scor+" ,AF a" +n+! !nd!v!d
    *valuarea
    multiaxial
    44

    care cons(!(+!e +n rea" &er!co" &en(r+ s!ne, dar care .+nc=!onea/7 '!ne, va .! s+' 9L.
    La .e", scor+" ,AF &en(r+ +n !nd!v!d c+ s!%&(o%a(o"o$!e &s!o"o$!c7 %!n!%7, dar
    c+ de(er!orare se%n!.!ca(!v7 :n .+nc=!onare Ede e<., +n !nd!v!d a c7r+! &reoc+&are
    e<ces!v7 &en(r+ +/+" de o s+'s(an=7 a d+s "a &!erderea sev!c!+"+! s! a a%!c!"or, dar
    .7r7 a"(7 &s!o&a(o"o$!eJ va .! s+' IL sa+ c!ar %a! @os.
    :n ce"e %a! %+"(e ca/+r!, scor+" &e sca"a ,AF (re'+!e ca"c+"a( &en(r+ &er!oada
    c+ren(7 Ead!c7, n!ve"+" .+nc=!ona" d!n %o%en(+" eva"+7r!!J, deoarece scor+"
    .+nc=!on7r!! ac(+a"e es(e ce" care re."ec(7 neces!(a(ea (ra(a%en(+"+! sa+ :n$r!@!r!!. In
    sco&+" e<&"!c7r!! var!a'!"!(7=!! de "a o /! "a a"(a a .+nc=!on7r!!, scor+" ,AF &en(r+
    S&er!oada c+ren(7T es(e o&era=!ona"!/a( dre&( ce" %a! sc7/+( n!ve" de .+nc=!onare
    d!n s7&(7%Ana (rec+(7, :n +ne"e ca/+r!, &oa(e .! +(!" s7 se conse%ne/e scor+" &e
    sca"a ,AF a(A( "a !n(ernare, cA( s! "a e<(ernare. Eva"+area &e sca"a ,AF &oa(e .!
    .7c+(7 s! &en(r+ a"(e &er!oade de (!%& Ede e<., ce" %a! :na"( n!ve" de .+nc=!onare
    &en(r+ cA(eva "+n! a"e an+"+! (rec+(J.
    Sca"a ,AF es(e :nre$!s(ra(7 &e a<a 3 d+&7 c+% +r%ea/7Q S,AF 6 T, +r%a( de
    scor+" ,AF de "a O "a 5LL s! de &er!oada de (!%& &en(r+ care a .os( ca"c+"a(, :n
    &aran(e/7 U de e<e%&"+, SEc+ren(JT, SEce" %a! :na"( n!ve" an+" (rec+(JT, SE"a
    e<(ernareJT. E3e/! e<e%&"e "a &a$. ;YJ.
    S&re a .! s!$+r! c7 n!c! +n e"e%en( a" sca"e! ,AF n+ a .os( o%!s cAnd se ca"c+"ea/7
    scor+" ,AF, &oa(e .! a&"!ca(7 +r%7(oarea %e(od7 de s(a'!"!re a scor+"+! ,AFQ
    PAS 5Q Se :nce&e de "a ce" %a! r!d!ca( n!ve" O! se eva"+ea/7 .!ecare ca(e$or!e
    &+nAnd+4se :n(re'areaQ S es(e .!e sever!(a(ea s!%&(o%e"or !nd!v!d+"+!, .!e n!ve"+"
    s7+ de .+nc=!onare %a! r7+ decA( ce" care es(e !nd!ca( :n descr!erea ca(e$or!e!cT
    PAS 9Q Se de&"asea/7 :n @os &e sca"7 &An7 es(e a(!ns scor+" care e<&r!%7 ce" %a! '!ne
    sever!(a(ea s!%&(o%e"or !nd!v!d+"+! sa+ a n!ve"+"+! de .+nc=!onare, !nd!.eren( de
    care es(e %a! r7+.
    PAS ;Q Se e<a%!nea/7 +r%7(oarea ca(e$or!e !n.er!oar7 s&re a ver!.!ca dac7 n+
    c+%va ne4a% o&r!( &re%a(+r. Aceas(7 ca(e$or!e (re'+!e s7 .!e %a! sever7 a(A( "a
    n!ve" de s!%&(o%e, cA( s! "a n!ve" de .+nc=!onare. Dac7 es(e aOa, ca(e$or!a
    cores&+n/7(oare a .os( a(!ns7 Ese con(!n+7 c+ &as+" IJ. Dac7 n+ es(e aOa, se rev!ne "a
    &as+" 9 O! se con(!n+7 de&"asarea :n @os &e sca"7.
    PAS IQ Pen(r+ a s(a'!"! scor+" ,AF s&ec!.!c :n cadr+" +ne! ca(e$or!! se"ec(a(e de 5L
    &+nc(e, (re'+!e s7 se !a !n cons!dera=!e .a&(+" dac7 !nd!v!d+" .+nc=!onea/7 "a ce" %a!
    :na"( sa+ "a ce" %a! sc7/+( &o" a" sca"e! de 5L &+nc(e. De e<e%&"+, s7 "+7% ca/+"
    +n+! !nd!v!d care a+de voc! care n+4! !n."+en=ea/7 co%&or(a%en(+" Ede e<., c!neva
    c+ sc!/o.ren!e d+rAnd de %+""( (!%&, care4s! acce&(7 a"+c!na=!!"e ca &ar(e a
    %a"ad!e! sa"eJ. Dac7 voc!"e s+rv!n re"a(!v rar Eoda(7 &e s7&(7%An7 sa+ c!ar %a!
    rarJ, +n scor de ;F sa+ IL &are a .! ce" %a! cores&+n/7(or. D!n con(ra, dac7 !nd!v!d+"
    a+de voc! a&roa&e con(!n++, +n scor de ;5 sa+ ;9 &are a .! %a! adecva(.
    In +ne"e ca/+r!, &oa(e .! +(!" s7 se eva"+e/e !nca&ac!(a(ea soc!a"7 O! &ro.es!ona"7
    O! s7 se +r%7reasc7 &ro$res+" :n rec+&erare !nde&enden( de sever!(a(ea
    s!%&(o%e"or &s!o&a(o"o$!ce, :n aces( sco& es(e !nc"+s7 :n ane<a B Eve/! &a$. G5HJ
    o sca"7 &ro&+s7 &en(r+ eva"+area .+nc=!on7r!! soc!a"e O! oc+&a=!ona"e ZSoc!a"
    and Occ+&a(!ona" F+nc(!on!n$ Assess%en( Sca"e4SOFAS[. :n ane<a B %a! s+n(
    !nc"+se do+7 sca"e &ro&+se O! care &o( .! +(!"e :n an+%!(e s!(+a=!! 4(e ,"o'a"
    Assess%en( o. Re"a=!ona". F+nc(!on!n$ Sca"e E,ARFSJ Eve/! &a$. G5IJ s!
    De.ens!ve F+nc(!on!n$ Sca"e Eve/! &a$. GLHJ.
    47
    *valuarea multiaxial
    S#ala $e Evaluare Glo-al( a 'un#!ion(rii 3EG'6
    KGlo-al A&&e&&"ent o% 'un#tionin/ S#ale 3GA'6L
    F+nc=!onarea &s!o"o$!c7, soc!a"7 s! &ro.es!ona"7 se cons!der7 &e +n con(!n++%
    !&o(e(!c de s7n7(a(e4%a"ad!e %en(a"7. N+ se !nc"+de de(er!orarea :n .+nc=!onare
    da(ora(7 res(r!c=!!"or so%a(!ce Esa+ de %ed!+J.
    Co$ 3Not(M A &e utili)a #o$uri inter"e$iare #Nn$ &unt #ore&pun)(toare2 $e e,.2 7<2=>2GC6
    E55 'un#!ionare &uperioar( .ntr-un lar/ $o"eniu $e a#tivit(!i2 pro-le"ele $e via!( nu
    O par a %i &#(pat vreo$at( $in "Nn(2 e&te #(utat $e al!ii pentru "ultele &ale #alit(!i.
    6E Ni#i un &i"pto".
    65 Si"pto"e a-&ente &au "ini"e &de ex2, anxietate u,oar "naintea unui examen),
    J %un#!ionare -un( .n toate $o"eniile2 intere&at Ei i"pli#at .ntr-o /a"( lar/( $e
    >* a#tivit(!i2 e%i#ient &o#ial2 &ati&%(#ut .n /eneral $e via!(2 nu "ai "ult $e#Nt pro-le"e
    &au preo#up(ri #oti$iene &de e,.2 o ceart oca(ional cu membrii $amiliei)2
    85 Da#( &unt pre)ente &i"pto"e2 a#e&tea &unt rea#!ii e,pe#ta-ile &i tran)itorii la
    O &tre&ori p&i@o&o#iali &de ex2, di$iculti "n concentrare dup o ceart "n $amilie)3 nu
    ?E "ai "ult $e#Nt o uEoar( $eteriorare .n %un#!ionarea &o#ial(2 pro%e&ional( &au
    E#olar( &de ex2, rm@nere "n urm temporar "n activitatea ,colar)2
    ?5 CNteva &i"pto"e uEoare &de ex2, dispo(iie depresiv ,i insomnie u,oar) SAU
    unele O $i%i#ult(!i .n %un#!ionarea &o#ial(2 pro%e&ional( &au E#olar( &de ex2, c%iul
    oca(ional IE ori $urt din cas) $ar2 .n /eneral2 %un#!ionare $e&tul $e -un(2 are
    #Nteva rela!ii interper&onale &e"ni%i#ative.
    I5 Si"pto"e "o$erate &de ex2, a$ect plat ,i limba0 circumstanial, atacuri de panic
    J oca(ionale) SAU $i%i#ult(!i "o$erate .n %un#!ionarea &o#ial(2 pro%e&ional( &au
    AE E#olar( 3$e ex2, puini amici, con$licte cu e!alii sau cu colaboratorii)2
    A5 Si"pto"e &evere 3$e ex2, ideaie suicidar, ritualuri obsesionale severe, $urturi din J
    ma!a(ine), SAU $eteriorare &ever( .n %un#!ionarea &o#ial(2 pro%e&ional( &au E#olar(
    HE &de ex2, nici un $el de amici, incapabil s menin un serviciu)2
    H5 O oare#are $eteriorare a &i"!ului #riti# 3realitP te&tin/6 &au .n #o"uni#are &de ex2, J
    limba0ul este uneori ilo!ic, obscur sau irelevant) SAU $eteriorare "aQor( .n "ulte
    4E $o"enii2 #u" ar %i &ervi#iul &au E#oala2 rela!iile $e %a"ilie2 Qu$e#ata2 /Nn$irea &au
    $i&po)i!ia &de ex2 omul depresiv evit amicii, ",i ne!li0ea( $amilia, este incapabil s
    munceasc3 copilul bate copiii mai mici ca el, este s$idtor acas, lipse,te de la ,coal)
    45 Co"porta"entul e&te #on&i$era-il in%luen!at $e i$ei $elirante &au $e @alu#ina!ii
    O SAU e,i&t( o $eteriorare &evera .n #o"uni#are &au .n Qu$e#at( &de ex2, uneori este
    7E incoerent, acionea( "n mod $la!rant inadecvat, are preocupri suicidare) SAU e&te
    in#apa-il &( %un#!ione)e .n aproape toate $o"eniile &de ex2, st "n pat toat (iua, nu
    are serviciu, locuin sau amici)2
    75 Un oare#are peri#ol $e a &e v(t("a pe &ine &au pe al!ii &de ex2, tentative de suicid J
    $r urmrirea clar a morii3 $recvent violent3 excitaie maniacal) SAU o#a)ional **
    in#apa-il &( "en!in( un "ini"u" $e i/ien( per&onal( &de ex2, miroase a $ecale) SAU
    $eteriorare %la/rant( .n #o"uni#are &de ex2, extrem de incoerent sau mut)2
    E5 Peri#ol per&i&tent $e v(t("are &ever( a &a &au a altora &de ex2, violen recurenta)
    J SAU in#apa#itatea $e a "en!ine o i/ien( per&onal( "ini"( SAU a#t &ui#i$ar &ever
    * #u $orin!a #lar( $e a "uri.
    O In%or"a!ie ina$e#vat(
    *stimarea $uncionrii psi%olo!ice !lobale pe scala 5-E55 a $ost operaionali(at de LuborsCK
    "n Lealt%-SicCness +atin! Scale &LuborsCK LD =liniciansMNud!ments o$ Mental Lealt%>2
    Arci!es o" Genera1 #s$ciatr$ ?D H5?-HE?, E6I7)2 Spit(er ,i cole!ii si au e$ectuat o revi(uire
    a Lealt%-SicCness +atin! Scale pe care au numit-o Global Assessment Scale &GAS) &*ndicott N,
    Spit(er +L, 'leiss NL, o%en ND =T%e Global Assessment ScaleD A #rocedure $or Measurin!
    Overall SeveritK o$ #sKc%iatric Disturbance2> Arci!es o" General #s$ciatr$ 44D ?II-??E,
    E6?I)2 O versiune modi$icat a GAS a $ost inclus "n DSM-III-+ ca Global Assessment o$
    'unctionin! &GA') Scale2
    *valuarea
    multiaxial
    4<
    E,e"ple $e "o$ul #u" tre-uie &( &e .nre/i&tre)e
    re)ultatele unei evalu(ri "ultia,iale DSM-IV
    Tulburare depresiv ma0or, episod unic, sever
    $r
    simptome
    psi%otice Abu( de alcool
    Tulburare de personalitate dependent2 .( $recvent de
    ne!are Fici un dia!nostic Ameninare de pierdere a
    serviciului
    GA' P 4A &curent)
    Axai 4552H
    4EA255
    Axa II V?E256
    Axa III 48726
    Axa IV
    Tulburare distimic Dislexie &Tulburare de citit)
    Fici un dia!nostic Otit medie, recurent
    Victim a ne!li0rii copilului
    GA' P A4 &curent)
    %xemplul &'
    Axa l
    Axa II
    Axa III
    Axa IV
    Axa V
    764284 Tulburare a$ectiv datorat %ipotiroidismului,
    cu simptome depresive V?E256 Fici un
    dia!nostic, elemente de personalitate
    %istrionic
    7HH26 Lipotiroidism
    4IA274 Glaucom cronic cu un!%i "nc%is
    Fici un dia!nostic GA' P HA
    &la internare) GA' P IA &la externare)

    %xemplul (' Axa
    l Axa II Axa II
    Axa IV Axa V
    VIE2E #roblem de relaie cu partenerul
    V?E256 Fici un dia!nostic
    Fici un dia!nostic
    Qomer *G' P 84 &cel mai "nalt nivel anul trecut)
    +>
    *valuarea muitiaxial

    'or"ular $e raportare a evalu(rii "ultia,.ale
    Ur%7(or+" .or%+"ar es(e o.er!( ca +na d!n &os!'!"!(7=!"e de ra&or(are a
    eva"+7r!"or %+"(!a<!a"e. :n +ne"e s!(+a=!! aces( .or%+"ar &oa(e .! +(!"!/a( aOa c+%
    es(e8 :n a"(e s!(+a=!! :ns7, &oa(e .! ada&(a( &en(r+ a sa(!s.ace neces!(7=! s&ec!a"e
    AXA IM Tul-ur(rile #lini#e
    Alte #on$i!ii #are &e pot a%la .n #entrul aten!iei #lini#e
    od dia!nostic Denumirea DSM-IV
    Axa II
    Axa III
    Axa IV
    Axa V
    %xemplul
    )'
    Axa V
    %xemplul *'
    Axa l
    45A25
    45E2I
    AXA IIM Tul-ur(rile $e per&onalitate
    Retar$area "ental(
    od dia!nostic Denumirea DSM-IV
    AXA IIIM Con$i!iile "e$i#ale /enerale
    od IM-6-M Denumirea IM-6-M
    AXA IVM Pro-le"ele p&i@o&o#iale Ei $e "e$iu.
    +ista'
    R Pro-le"e #u /rupul $e &uport prin#ipal. De speci"icat,
    R Pro-le"e .n le/(tur( #u "e$iul &o#ial. De sped"icat'-
    R Pro-le"e e$u#a!ionale. De speci"icat,MMMMMMMMMMMMMMMM
    R Pro-le"e pro%e&ionale. De speci"icat,MMMMMMMMMMMMMMMM
    R Pro-le"e #u lo#uin!a. De speci"icat'MMMMMMMMMMMMMMMMM
    R Pro-le"e e#ono"i#eM De speci"icat,MMMMMMMMMMMMMMMMMM
    Pro-le"e .n le/(tur( #u a##e&ul la &ervi#iile $e a&i&ten!( "e$i#al(.
    De speci"icat,MMMMMMMMMMMMMMMMMMMM
    R Pro-le"e le/ate $e intera#!iunea #u &i&te"ul le/alApenal. De speci"icat,
    R Alte pro-le"e p&i@o&o#iale Ei $e "e$iu. De speci"icat,MMMMMMMMMMMMMMMMMM
    AXA VM S#ala $e evaluare /lo-al( a %un#!ion(rii
    S#orM??????????????
    Perioa$a $e re%erin!(M
    *valuarea
    multiaxial
    4G
    'or"atul nona,ial
    C"!n!c!e%2Lcare n+ doresc s7 +(!"!/e/e .or%a(+" %+"(!a<!a" &o(, &+r s! s!%&"+,
    "!s(a doar d!a$nos(!ce"e cores&+n/7(oare. Ce! care o&(ea/7 &en(r+ aceas(7 var!an(7
    (re'+!e s7 +r%e/e re$+"a $enera"7 a :nre$!s(r7r!! a cA( %a! %+"(e (+"'+r7r! %en(a"e
    coe<!s(en(e, a cond!=!!"or %ed!ca"e $enera"e s! a a"(or .ac(or! care s+n( re"evan=!
    &en(r+ :n$r!@!rea s! (ra(a%en(+" !nd!v!d+"+!. D!a$nos(!c+" &r!nc!&a" sa+ %o(!v+"
    cons+"(a=!e! (re'+!e s7 .!e %en=!ona( &r!%+".
    E<e%&"e"e de %a! @os !"+s(rea/7 ra&or(area de d!a$nos(!ce :n(r4+n .or%a( care n+
    +(!"!/ea/7 s!s(e%+" %+"(!a<!a".
    %xemplul *'
    76ID74 Tulburare depresiv ma0or, episod unic, sever,
    $r simptome psi%otice 45A255 Abu( de alcool 45E2I
    Tulburare de personalitate dependent2 .( $recvent de ne!are
    %xemplul )'
    4552H Tulburare distimic 4EA255
    Dislexie &Tulburare de citit) 48726
    Otit medie recurent
    %xemplul &'
    764284 Tulburare a$ectiv datorat %ipotiroidismului, cu simptome depresive
    7HH26 Lipotiroidism
    4IA274 Glaucom cu un!%i "nc%is cronic
    *lemente de personalitate %istrionic
    %xemplul ('
    VIE2E #roblem de relaie cu partenerul

    Tulburrile dia!nosticate de
    re!ul pentru prima dat "n
    #erioada de Su!ar, "n opilrie
    sau "n Adolescent
    D
    N revederea +ne! sec=!+n! se&ara(e &en(r+ (+"'+r7r!"e care s+n( d!a$nos(!ca(e
    de re$+"7 &en(r+ &r!%a da(7 :n &er!oada de s+$ar, :n co&!"7r!e sa+ :n ado"escen=7
    es(e .7c+(7 n+%a! d!n co%od!(a(e O! n+ :nsea%n7 c7 e<!s(7 vreo d!s(!nc=!e c"ar7 :n(re
    (+"'+r7r!"e Sco&!"7r!e!T s! S&er!oade! ad+"(eT. DeO! ce! %a! %+"=! !nd!v!/! c+ aces(e
    (+"'+r7r! se &re/!n(7 &en(r+ a(en=!e c"!n!c7 :n co&!"7r!e sa+ :n ado"escen=7, +neor!
    (+"'+r7r!"e n+ s+n( d!a$nos(!ca(e &An7 :n &er!oada ad+"(7, :n a.ar7 de aceas(a,
    %+"(e (+"'+r7r! !nc"+se :n a"(e sec=!+n! a"e %an+a"+"+! de'+(ea/7 adesea :n c+rs+"
    co&!"7r!e! sa+ ado"escen=e!, :n eva"+area +n+! s+$ar, co&!" sa+ ado"escen(,
    c"!n!c!an+", (re'+!e s7 !a :n cons!dera=!e d!a$nos(!ce"e !nc"+se :n aceas(7 sec=!+ne s!,
    de ase%enea, s7 cons+"(e s! (+"'+r7r!"e descr!se :n a"(7 &ar(e :n aces( %an+a".
    Ad+"=!! &o( .!, de ase%enea, d!a$nos(!ca=! c+ (+"'+r7r! !nc"+se :n aceas(7 sec=!+ne a
    (+"'+r7r!"or d!a$nos(!ca(e de re$+"7 &en(r+ &r!%a da(7 :n &er!oada de s+$ar, :n
    co&!"7r!e sa+ :n ado"escen=7, dac7 (a'"o+" "or c"!n!c sa(!s.ace cr!(er!!"e de d!a$nos(!c
    re"evan(e Ede e<., 'a"'!s%+", &!caJ. De ase%enea, dac7 +n ad+"( a &re/en(a( :n
    co&!"7r!e s!%&(o%e care a+ sa(!s.7c+( co%&"e( cr!(er!!"e &en(r+ o (+"'+rare, !ar ac+%
    &re/!n(7 doar o .or%7 a(en+a(7 sa+ re/!d+a"7, &oa(e .! !nd!ca( s&ec!.!can(+" S:n
    re%!s!+ne &ar=!a"7T Ede e<., T+"'+rarea !&eracr!v!(a (eXde.!c!( de a(en=!e, (!&
    co%'!na(, :n re%!s!+ne &ar=!a"7J. Pen(r+ ce"e %a! %+"(e Edar n+ &en(r+ (oa(eJ
    (+"'+r7r!"e DSM4I3, es(e &rev7/+( +n s!n$+r se( de cr!(er!! care se a&"!c7 co&!!"or,
    ado"escen=!"or s! ad+"=!"or Ede e<., dac7 +n co&!" sa+ ado"escen( &re/!n(7 s!%&(o%e
    care sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de&res!v7 %a@or7, aces( d!a$nos(!c (re'+!e
    &+s !nd!.eren( de e(a(ea !nd!v!d+"+!J. 3ar!a=!!"e :n &re/en(area +ne! (+"'+r7r!,
    a(r!'+!'!"e +n+! s(ad!+ de de/vo"(are a !nd!v!d+"+!, s+n( descr!se :n(r4o sec=!+ne a
    (e<(+"+! !n(!(+"a(7 Se"e%en(e s&ec!.!ce c+"(+r!!, e(7=!! O! se<+"+!T. Pro'"e%e"e
    s&ec!.!ce :n "e$7(+r7 c+ d!a$nos(!c+" de (+"'+r7r! de &ersona"!(a(e "a co&!! sa+ "a
    ado"escen=! s+n( d!sc+(a(e "a &a$. RGH.
    :n aceas(7 sec=!+ne s+n( !nc"+se +r%7(oare"e (+"'+r7r!Q
    Re(ardarea %en(a"7. Aceas(7 (+"'+rare es(e carac(er!/a(7 &r!n(r4o .+nc=!onare
    !n(e"ec(+a"7 se%n!.!ca(!v s+' %ed!e E+n DI de a&ro<!%a(!v HL sa+ s+'J c+ de'+(
    :na!n(e de e(a(ea de 5G an! s! &r!n de.!c!(e sa+ de(er!or7r! conco%!(en(e :n
    .+nc=!onarea ada&(a(!v7. S+n( &rev7/+(e cod+r! se&ara(e &en(r+ re(ardarea %en(a"7
    +Ooar7, %odera(7, sever7 s! &ro.+nd7, &rec+% s! &en(r+ re(ardarea %en(a"7 de
    sever!(a(e nes&ec!.!ca(7.
    T+"'+r7r!"e de :nv7=are. Aces(e (+"'+r7r! se carac(er!/ea/7 &r!n(r4o .+nc=!onare
    Oco"ar7 s+'s(an=!a" s+' cea e<&ec(a(7, da(7 .!!nd e(a(ea crono"o$!c7 a &ersoane!,
    ;F
    Tulburrile dia!nosticate de re!ul pentru prima dat
    H5 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    !n(e"!$en=a %7s+ra(7 s! ed+ca=!a cores&+n/7(oare e(7=!!. T+"'+r7r!"e s&ec!.!ce !nd+se :n
    aceas(7 sec=!+ne s+n( dislexia *tulburarea de citit,2 discalculia *tulburarea de calcul,2
    dis.rafia *tulburarea expresiei .rafice, si tulburarea de @nv3are fr alt specifica3ie.
    Tulburarea aptitudinilor motorii. Aceas(a !nc"+de tulburarea de dezvoltare a
    coordonrii2 care es(e carac(er!/a(7 &r!n(r4o coordonare %o(or!e, s+'s(an=!a" s+' cea
    aO(e&(a(7, da(7 .!!nd e(a(ea crono"o$!c7 a &ersoane! s! !n(e"!$en=a %7s+ra(7.
    Tulburrile de comunicare. Aces(e (+"'+r7r! s+n( carac(er!/a(e &r!n d!.!c+"(7=! :n
    vor'!re sa+ "!%'a@, s! !nc"+d tulburarea de limbaA expresiv2 tulburarea mixt de
    limbaA receptiv s! expresiv2 tulburarea fonolo.ic2 balbismul /i tulburarea de
    comunicare fr alt specifica3ie.
    Tulburrile de dezvoltare pervasiv. Aces(e (+"'+r7r! s+n( carac(er!/a(e &r!n
    de.!c!(e severe s! de(er!orare &ervas!v7 :n %+"(!&"e do%en!! a"e de/vo"(7r!!. Aces(ea
    !nc"+d de(er!orarea :n !n(erac=!+nea soc!a"7 rec!&roc7, de(er!orarea :n co%+n!care s!
    &re/en=a de co%&or(a%en(e, &reoc+&7r! s! ac(!v!(7=! s(ereo(!&e. T+"'+r7r!"e s&ec!.!ce
    !nc"+se :n aceas(7 sec=!+ne s+n( tulburarea autist2 tulburarea !ett2 tulburarea
    dezinte.rativ a copilriei2 tulburarea Asper.er s! tulburarea de dezvoltare
    pervasiv fr alt specifica3ie.
    9eficitul de aten3ie si tulburrile de comportament disruptiv. Aceas(7 sec=!+ne
    !nc"+de (+"'+rarea !&eracr!v!(a(eXde.!c!( de a(en=!e, care es(e carac(er!/a(7 &r!n
    s!%&(o%e no(a'!"e de !na(en=!e s!Xsa+ de !&erac(!v!(a(e4!%&+"s!v!(a(e. S+n(
    &rev7/+(e s+'(!&+r! &en(r+ s&ec!.!carea &re/en=e! s!%&(o%+"+! &redo%!nan(Q tip
    predominant inatent2 tip predominant -iperactivBimpulsiv O! tip combinat2 :n
    aceas(7 sec=!+ne s+n( !nc"+se, de ase%enea, tulburrile de comportament
    disruptiv: tulburarea de conduit2 carac(er!/a(7 &r!n(r4+n &a((ern de
    co%&or(a%en( care v!o"ea/7 dre&(+r!"e .+nda%en(a"e a"e a"(ora sa+ nor%e"e or!
    re$+"!"e soc!a"e %a@ore cores&+n/7(oare e(7=!!8 tulburarea opozi3ionismul
    provocator2 carac(er!/a(7 &r!n(r4+n &a((ern de co%&or(a%en( ne$a(!v!s(, os(!" O!
    s.!d7(or. Aceas(7 sec=!+ne !nc"+de, de ase%enea, do+7 ca(e$or!! .7r7 a"(7
    s&ec!.!ca=!eQ tulburarea -iperactivitateCdeficit de aten3ie fr alt specifica3ie O!
    tulburarea de comportament disruptiv fr alt specifica3ie.
    Tulburrile de alimentare si de comportament alimentar ale perioadei de
    su.ar sau micii copilrii. Aces(e (+"'+r7r! s+n( carac(er!/a(e &r!n (+"'+r7r!
    &ers!s(en(e :n a"!%en(are s! :n co%&or(a%en(+" a"!%en(ar. T+"'+r7r!"e s&ec!.!ce
    !nc"+se s+n( pica2 rumina3ia s! tulburarea de alimentare a perioadei de su.ar sau
    a micii copilrii. De re=!n+( c7 anore<!a nervoas7 s! '+"!%!a nervoas7 s+n( !nc"+se
    :n sec=!+nea ST+"'+r7r!"e de co%&or(a%en( a"!%en(arT, &re/en(a(7 %a! de&ar(e :n
    %an+a" Eve/! &a$. YG;J.
    Ticurile. Aces(e (+"'+r7r! s+n( carac(er!/a(e &r!n (!c+r! %o(or!! s!Xsa+ voca"e.
    T+"'+r7r!"e s&ec!.!ce !nc"+d tulburarea Tourette2 ticul motor sau vocal cronic2 ticul
    tranzitor si ticul fr alt specifica3ie.
    Tulburrile de eliminare. Aceas(7 $r+&are !nc"+de enco&re/!s+", e"!%!narea de
    .eca"e :n "oc+r! !nadecva(e, s! en+re/!s+", e"!%!narea re&e(a(7 de +r!n7 :n "oc+r!
    !nadecva(e.
    Alte tulburri ale perioadei de su.ar2 ale copilriei sau adolescen3ei. Aceas(7
    $r+&are es(e re/erva(7 (+"'+r7r!"or care n+ s+n( !nc"+se :n sec=!+n!"e %a! s+s
    +etardarea Mental HE
    %en=!ona(e. An<!e(a(ea de se&arare es(e carac(er!/a(7 &r!n(r4o an<!e(a(e e<ces!v7 s!
    !nadecva(7 de/vo"(7r!!, :n "e$7(+r7 c+ se&ararea de cas7 sa+ de ce! de care co&!"+"
    es(e a(aOa(. M+(!s%+" se"ec(!v es(e carac(er!/a( &r!n !nca&ac!(a(ea cons(an(7 de a
    vor'! :n s!(+a=!! soc!a"e s&ec!.!ce, :n d!s&re=+" .a&(+"+! c7 vor'eO(e :n a"(e s!(+a=!!.
    T+"'+rarea reac(!v7 de a(aOa%en( a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!! es(e
    carac(er!/a(7 &r!n(r4o re"a=!e soc!a"7 !nadecva(7 de/vo"(7r!! s! &er(+r'a(7
    cons!dera'!", care a&are :n ce"e %a! %+"(e con(e<(e s! es(e asoc!a(7 c+ o :n$r!@!re
    ."a$ran( &a(o$en!c7. T+"'+rarea de %!Ocare s(ereo(!&7 es(e carac(er!/a(7 &r!n(r4+n
    co%&or(a%en( %o(or non.+nc=!ona", a&aren( !%&+"s!v O! re&e(!(!v, care !n(er.erea/7
    cons!dera'!" c+ ac(!v!(7=!"e nor%a"e O! +neor! &oa(e d+ce "a v7(7%are cor&ora"7.
    T+"'+rarea &er!oade! de s+$ar, a co&!"7r!e! sa+ ado"escen=e! .7r7 a"(7 s&ec!.!ca=!e
    es(e o ca(e$or!e re/!d+a"7 &en(r+ cod!.!carea (+"'+r7r!"or c+ de'+( :n &er!oada de
    s+$ar, :n co&!"7r!e sa+ ado"escen=7 care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare
    s&ec!.!c7 d!n c"as!.!care.
    Co&!!! sa+ ado"escen=!! se &o( &re/en(a c+ &ro'"e%e neces!(And a(en=!e c"!n!c7,
    dar care n+ s+n( de.!n!(e ca (+"'+r7r! %en(a"e Ede e<., &ro'"e%e re"a=!ona"e,
    &ro'"e%e asoc!a(e c+ a'+/+" sa+ ne$"!@area, do"!+", .+nc=!onarea !n(e"ec(+a"7 "!%!4
    nar7, &ro'"e%e Oco"are, co%&or(a%en(+" an(!soc!a" a" co&!"+"+! sa+ ado"escen(+"+!,
    &ro'"e%7 de !den(!(a(eJ. Aces(ea s+n( %en=!ona(e "a .!ne"e %an+a"+"+!, :n sec=!+nea
    SA"(e cond!=!! care se &o( a."a :n cen(r+" a(en=!e! c"!n!ceT Eve/! &a$. H;5J.
    DSM4III4R !nc"+dea do+7 (+"'+r7r! an<!oase s&ec!.!ce co&!!"or s! ado"escen=!"or,
    an<!e(a(ea e<ces!v7 a co&!"7r!e! O! (+"'+rarea ev!(an(7 a co&!"7r!e!, care a+ .os(
    s+'s+%a(e an<!e(7=!! $enera"!/a(e s!, res&ec(!v, .o'!e! soc!a"e, d!n ca+/a
    s!%!"!(+d!n!"or :n e"e%en(e"e "or esen=!a"e.
    Retar$area Mental(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" re(ard7r!! %en(a"e :" cons(!(+!e .+nc=!onarea !n(e"ec(+a"7
    $enera"7 se%n!.!ca(!v s+'%ed!e Ecr!(er!+" AJ, care es(e aco%&an!a(7 de res(r!c=!!
    se%n!.!ca(!ve :n .+nc=!onarea ada&(a(!v7 :n ce" &+=!n do+7 d!n +r%7(oare"e do%en!!
    de a&(!(+d!n!Q co%+n!care, a+(o:n$r!@!re, v!a=7 de .a%!"!e, a&(!(+d!n! soc!a"eX!n(er4
    &ersona"e, +/ de res+rse"e co%+n!(7=!!, a+(ocond+cere, a&(!(+d!n! Oco"are
    .+nc=!ona"e, oc+&a=!e, (!%& "!'er, s7n7(a(e s! sec+r!(a(e Ecr!(er!+" BJ. De'+(+" (re'+!e
    s7 s+rv!n7 :na!n(e de e(a(ea de 5G an! Ecr!(er!+" CJ. Re(ardarea %en(a"7 are %+"(e
    e(!o"o$!! d!.er!(e O! &oa(e .! v7/+(7 dre&( ca"e .!na"7 co%+n7 a d!verse"or &rocese
    &a(o"o$!ce care a.ec(ea/7 .+nc=!onarea s!s(e%+"+! nervos cen(ra".
    F+nc=!onarea !n(e"ec(+a"7 $enera"7 es(e de.!n!(7 &r!n coe.!c!en(+" de !n(e"!$en=7 EDI
    sa+ ec!va"en(+" DIJ o'=!n+( &r!n eva"+area c+ +n+" sa+ %a! %+"(e (es(e de !n(e"!$en=7
    s(andard!/a(e, ad%!n!s(ra(e !nd!v!d+a", Ede e<., sca"e"e de !n(e"!$en=7 1ecs"er &en(r+
    co&!!4rev!/+!(e, 'a(er!a de eva"+are &en(r+ co&!! S(an.ord4B!ne(, -a+.%anJ.
    F+nc=!onarea !n(e"ec(+a"7 se%n!.!ca(!v s+'%ed!e es(e de.!n!(7 ca +n DI de a&roa&e HL
    sa+ s+' Ea&ro<!%a(!v 9 dev!a=!! s(andard s+' %ed!eJ. Tre'+!e re=!n+( c7 e<!s(7 o eroare
    de %7s+rare de a&ro<!%a(!v Y &+nc(e :n eva"+area DI, deO! aceas(a &oa(e var!a de "a
    +n !ns(r+%en( "a a"(+" Ede e<., +n DI 1ecs"er de HL es(e cons!dera( a re&re/en(a +n
    Tulburrile dia!nosticate de re!ul pentru prima dat
    7C "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    do%en!+ de "a RY "a HY J. Pr!n +r%are, es(e &os!'!" s7 se d!a$nos(!ce/e re(ardarea
    %en(a"7 "a !nd!v!/!! c+ DI :n(re HL O! HY, care &re/!n(7 de.!c!(e se%n!.!ca(!ve :n
    co%&or(a%en(+" ada&(a(!v. Invers, re(ardarea %en(a"7 n+ va .! d!a$nos(!ca(7 "a +n
    !nd!v!d c+ +n DI %a! %!c de HL, dac7 n+ e<!s(7 de.!c!(e sa+ de(er!or7r! se%n!.!ca(!ve
    :n .+nc=!onarea ada&(a(!v7. La a"e$erea !ns(r+%en(e"or de (es(are s! "a !n(er&re(area
    re/+"(a(e"or, (re'+!e "+a=! :n cons!dera=!e .ac(or!! care &o( "!%!(a &er.or%an=a "a (es( Ede
    e<., .ond+" soc!oc+"(+ra" a" !nd!v!d+"+!, "!%'a %a(ern7, s! and!ca&+r!"e de
    co%+n!care, %o(or!! O! sen/or!a"e asoc!a(eJ. CAnd e<!s(7 o d!s&ers!e se%n!.!ca(!v7 :n
    scor+r!"e s+'(es(, %a! c+rAnd &ro.!"+" de .or=7 s! de de'!"!(a(e va re."ec(a %a! c+
    ac+ra(e=e a&(!(+d!n!"e de :nv7=are a"e &ersoane! decA( DI (o(a" o'=!n+( &e ca"e
    %a(e%a(!c7. CAnd e<!s(7 o d!scre&an=7 cons!dera'!"7 vers+s scor+r!"e ver'a"e O! de
    e<ec+=!e, ca"c+"+" de o'=!nere a scor+"+! DI (o(a" &oa(e !nd+ce :n eroare.
    De(er!or7r!"e :n .+nc=!onarea ada&(a(!v7, %a! c+rAnd decA( +n DI sc7/+(, s+n( de
    re$+"7 s!%&(o%e"e &e care "e &re/!n(7 !nd!v!/!! c+ re(ardare %en(a"7. F+nc=!onarea
    ada&(a(!v7 se re.er7 "a cA( de e.!c!en( .ac !nd!v!/!! .a=7 e<!$en=e"or co%+ne a"e v!e=!!
    s! "a cA( de '!ne sa(!s.ac e! s(andarde"e de !nde&enden=7 &ersona"7 e<&ec(a(e de "a
    c!neva d!n $r+&+" de e(a(e cores&+n/7(oare, .ond+" soc!oc+"(+ra" s! cond!=!a
    co%+n!(7=!! "or. F+nc=!onarea ada&(a(!v7 &oa(e .! !n."+en=a(7 de d!verO! .ac(or!
    !nc"+/And ed+ca=!a, %o(!va=!a, carac(er!s(!c!"e &ersona"!(7=!!, o&or(+n!(7=!"e soc!a"e s!
    &ro.es!ona"e, &rec+% s! (+"'+r7r!"e %en(a"e s! cond!=!!"e %ed!ca"e $enera"e care &o(
    coe<!s(a c+ re(ardarea %en(a"7. Es(e .oar(e &os!'!" ca &ro'"e%e"e de ada&(are s7 se
    a%e"!ore/e &r!n e.or(+r!"e re%ed!a(oare %a! %+"( decA( DI co$n!(!v, care (!nde s7
    r7%An7 +n a(r!'+( %a! s(a'!".
    Es(e reco%anda'!" s7 se s(rAn$7 da(e des&re de.!c!(e"e :n .+nc=!onarea
    ada&(a(!v7 de "a +na sa+ %a! %+"(e s+rse de :ncredere !nde&enden(e Ede e<.,
    eva"+area &ro.esor+"+! O! !s(or!c+" %ed!ca", a" de/vo"(7r!! s! ed+ca=!e!J. M+"(e sca"e
    a+ .os(, de ase%enea, des(!na(e s7 %7soare .+nc=!onarea sa+ co%&or(a%en(+"
    ada&(a(!v Ede e<., sca"a &en(r+ co%&or(a%en(+" ada&(a(!v 3!ne"and s! sca"a &en(r+
    co%&or(a%en(+" ada&(a(!v a Asoc!a(e! A%er!cane &en(r+ Re(ardarea Men(a"7J.
    Aces(e sca"e o.er7 :n $enera" +n scor de e<c"+dere c"!n!c, care es(e o %!<(+r7 de
    cond+!(e d!n(r4+n n+%7r de do%en!! de a&(!(+d!n! ada&(a(!ve. Tre'+!e re=!n+( c7
    scor+r!"e &en(r+ an+%!(e do%en!! !nd!v!d+a"e n+ s+n( !nc"+se :n +ne"e d!n(re aces(e
    !ns(r+%en(e O! c7 scor+r!"e do%en!+"+! !nd!v!d+a" &o( var!a cons!dera'!" ca
    re"!a'!"!(a(e. Ca O! :n eva"+area .+nc=!on7r!! !n(e"ec(+a"e, (re'+!e acorda(7 (oa(7
    a(en=!a adecv7r!! !ns(r+%en(+"+! "a .ond+" soc!oc+"(+ra", !ns(r+!rea, and!ca&+r!"e
    asoc!a(e, %o(!va=!a s! coo&erarea &ersoane!. De e<e%&"+, &re/en=a +nor
    and!ca&+r! !%&or(an(e !nva"!dea/7 %+"(e nor%e a"e sca"e! ada&(a'!"!(7=!!, :n a.ar7
    de aceas(a, co%&or(a%en(e, care :n %od nor%a" ar .! cons!dera(e de/ada&(a(!ve Ede
    e<. de&enden=a, &as!v!(a(eaJ &o( .! ev!den=a +ne! '+ne ada&(7r! :n con(e<(+" v!e=!!
    +n+! an+%!( !nd!v!d Ede e<., :n +ne"e s!(+a=!! !ns(!(+=!ona"eJ.
    Gradele de severitate ale retardrii mentale
    Po( .! s&ec!.!ca(e &a(r+ $rade de sever!(a(e, care re."ec(7 n!ve"+" de(er!or7r!!
    !n(e"ec(+a"eQ +Ooar7, %odera(7, sever7 O! &ro.+nd7.
    ;5H Re(ardare %en(a"7 +Ooar7 n!ve" DI de "a YL4YY &An7 "a a&ro<!%a(!v HL
    318.0Re(ardare %odera(7 n!ve" DI de "a ;Y4IL &An7 "a YL4YY
    318.1Re(ardare %en(a"7 sever7 n!ve" DI de "a 9L49Y &An7 "a ;Y4IL
    318.2Re(ardare %en(a"7 &ro.+nd7 n!ve" DI s+' 9L sa+ 9Y
    4E? +etardarea Mental .,oar H4
    ;5F Re(ardare %en(a"7 de sever!(a(e nes&ec!.!ca(7, &oa(e .! +(!"!/a(7 cAnd
    e<!s(7 o &+(ern!c7 &re/+%=!e de re(ardare %en(a"7, dar !n(e"!$en=a &ersoane! n+
    &oa(e .! (es(a(7 &r!n (es(e"e s(andard Ede e<., "a !nd!v!/!! &rea de(er!ora=! or!
    necoo&eran=! sa+ "a s+$ar!J.
    4*G Retar$area Mental( UEoar(
    Re(ardarea %en(a"7 +Ooar7 es(e, :n %are, ec!va"en(7 c+ ceea ce se .o"oseO(e
    &en(r+ a se .ace re.er!re "a ca(e$or!a ed+ca=!ona"7 de Sed+ca'!"T. Aces( $r+&
    cons(!(+!e ce" %a! :n(!ns se$%en( Ea&roa&e GYdJ a" ce"or c+ aceas(7 (+"'+rare.
    Cons!dera=! ca $r+&, oa%en!! c+ aces( n!ve" de re(ardare %en(a"7 de/vo"(7 de re$+"7
    a&(!(+d!n! soc!a"e s! de co%+n!care :n (!%&+" &er!oade! &reOco"are EL4Y an!J, a+ o
    de(er!orare %!n!%7 :n ar!!"e sen/or!o%o(or!!, !ar adesea n+ se d!s(!n$ de co&!!! .7r7
    re(ardare %en(a"7 &An7 %a! (Ar/!+. PAn7 "a .!ne"e ado"escen=e! "or, e! &o( ac!/!=!ona
    a&(!(+d!n! Oco"are cores&+n/7(oare a&ro<!%a(!v n!ve"+"+! c"ase! a Oasea, :n c+rs+"
    &er!oade! ad+"(e e! ac!/!=!onea/7 de re$+"7 a&(!(+d!n! soc!a"e s! &ro.es!ona"e
    adecva(e &en(r+ +n %!n!%+% de a+(o!n(re=!nere, dar &o( neces!(a s+&rave$ere,
    !ndr+%are O! as!s(en=7, :n s&ec!a" :n cond!=!! de s(res econo%!c sa+ soc!a" !na'!(+a".
    C+ s+&or( cores&+n/7(or, !nd!v!/!! c+ re(ardare %en(a"7 +Ooar7 &o(, de re$+"7, (r7!
    c+ s+cces :n co%+n!(a(e, .!e !nde&enden(, .!e :n cond!=!! de s+&rave$ere.
    4*>.+ Retar$area Mental( Mo$erat(
    Re(ardarea %en(a"7 %odera(7 es(e :n %are ec!va"en(7 c+ ceea ce se .o"oseO(e
    &en(r+ a se .ace re.er!re "a ca(e$or!a ed+ca=!ona"7 de San(rena'!"T. Aces( (er%en
    de&7O!( n+ (re'+!e s7 .!e +(!"!/a(, deoarece e" !%&"!c7 :n %od erona( .a&(+" c7
    oa%en!! c+ re(ardare %en(a"7 %odera(7 n+ &o( 'ene.!c!a de &ro$ra%e ed+ca=!ona"e.
    Aces( $r+& cons(!(+!e a&roa&e 5Ld d!n :n(rea$a &o&+"a=!e a oa%en!"or c+ re(ardare
    %en(a"7. Ce! %a! %+"=! !nd!v!/! c+ aces( n!ve" de re(ardare %en(a"7 ac!/!=!onea/7
    a&(!(+d!n! de co%+n!care, &recoce, :n %!ca co&!"7r!e. E! 'ene.!c!a/7 de an(rena%en(
    &ro.es!ona" O!, c+ s+&rave$ere %odera(7, &o( &ar(!c!&a "a &ro&r!a "or :n$r!@!re
    &ersona"7. De ase%enea, e! &o( 'ene.!c!a de an(rena%en( :n a&(!(+d!n!"e soc!a"e O!
    &ro.es!ona"e, dar s+n( !nca&a'!"! s7 &ro$rese/e d!nco"o de n!ve"+" c"ase! a do+a :n
    %a(er!e de scoa"7. Po( :nv7=a s7 c7"7(oreasc7 !nde&enden( &r!n "oc+r! .a%!"!are, :n
    c+rs+" ado"escen=e!, d!.!c+"(7=!"e "or :n rec+noaO(erea conven=!!"or soc!a"e &o(
    !n(er.era c+ re"a=!!"e c+ e$a"!!, :n &er!oada ad+"(7, %a@or!(a(ea s+n( ca&a'!"! s7
    &res(e/e o %+nc7 neca"!.!ca(7 sa+ se%!ca"!.!ca(7, s+' s+&rave$ere :n a(e"!ere
    &ro(e@a(e sa+ :n cadr+" .or=e! de %+nc7 $enera"e. E! se ada&(ea/7 '!ne "a v!a=a :n
    co%+n!(a(e, de re$+"7 :n cond!=!! de s+&rave$ere.
    4*>.* Retar$area Mental( Sever(
    ,r+&+" ce"or c+ re(ardare %en(a"7 sever7 cons(!r+e ;d4Id d!n (o(a"+" !nd!v!/!"or
    c+ re(ardare %en(a"7, :n %!ca co&!"7r!e e! ac!/!=!onea/7 .oar(e &+=!n sa+ de"oc
    "!%'a@+" co%+n!ca(!v, :n (!%&+" &er!oade! de Oco"ar!/are, e! &o( :nv7=a s7 vor'easc7
    O! &o( .! an(rena=! :n a&(!(+d!n! e"e%en(are de a+(o:n$r!@!re. Bene.!c!a/7 n+%a! :n
    %!c7 %7s+r7 de ed+ca=!e &e (e%e &reOco"are, c+% ar .! .a%!"!ar!/area c+ a".a'e(+" O!
    n+%7ra(+", dar :O! &o( :ns+O! a&(!(+d!n! ca :nv7=area c!(!(+"+! "a &r!%a vedere a +nor
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    r, "n opilrie sau "n Adolescent
    c+v!n(e de Ss+&rav!e=+!reT :n &er!oada ad+"(7 e! &o( .!
    ca&a'!"! s7 e.ec(+e/e sarc!n! s!%&"e, :n cond!=!! de
    s+&rave$ere s(r!c(7 Ce! %a! %+"=! se ada&(ea/7 '!ne "a
    v!a(a :n co%+n!(a(e, :n c7%!ne sa+ :n .a%!"!!"e "or,
    e<ce&(And ca/+" cAnd a+ asoc!a( +n and!ca& care
    neces!(7 +n n+rs!n$ s&ec!a"!/a( sa+ a"(7 :n$r!@!re
    4*>.C Retar$area Mental(
    Pro%un$(
    ,r+&+" ce"or c+ re(ardare %en(a"7 &ro.+nd7
    cons(!(+!e a&ro<!%a(!v "d49d d% (o(a"+" oa%en!"or c+
    re(ardare %en(a"7 Ce! %a! %+"=! !nd!v!/! c+ aces(
    d!a$nos(!c a+ o cond!=!e ne+ro"o$!c7 !den(!.!ca(7 care
    @+s(!.!c7 re(ardarea "or %en(a"7 :n c+rs+" %!c!! co&!"7r!!,
    e! &re/!n(7 de(er!or7r! cons!dera'!"e :n .+nc=!onarea
    sen/or!%o(one De/vo"(area o&(!%7 &oa(e s+rven! :n(r4
    +n %ed!+ :na"( s(r+c(+ra(, c+ a@+(or s! s+&rave$ere
    cons(an(7 s! o re"a=!e !nd!v!d+a"!/a(7 c+ +n !n.!r%!er
    De/vo"(area %o(or!e, a+(o:n$r!@!rea s! a&(!(+d!n!"e de
    co%+n!care se &o( a%e"!ora dac7 es(e o.er!( +n
    an(rena%en( cores&+n/7(or Un+ &o( e.ec(+a sarc!n!
    s!%&"e, :n cond!=!! de &ro(ec=!e s! s+&rave$ere s(r!c(7
    4*5 Retar$area
    Mental( $e
    Severitate
    Ne&pe#i%i#
    at(
    D!a$nos(!c+" de re(ardare %en(a"7 de sever!(a(e
    nes&ec!.!ca(7 (re'+!e s7 .!e +(!"!/a( cAnd e<!s(7 o
    &re/+%=!e .er%7 de re(ardare %en(a"7, dar &ersoana n+
    &oa(e .! (es(a(7 c+ s+cces c+ (es(e"e de !n(e"!$en(7
    s(andard Aces(a &oa(e .! ca/+" cAnd co&!!!, ado"escen=!!
    sa+ ad+"=!! s+n( &rea de(er!ora=! sa+ necoo&eran(! "a
    (es(are or! :n ca/+" s+$ar!"or, cAnd e<!s(7 @+deca(a
    c"!n!c7 de ac(!v!(a(e !n(e"ec(+a"7 se%n!.!ca(!v s+'%ed!e,
    dar (es(e"e n+ o.er7 va"on a"e DI Ede e<, sca"a Bay"ey
    de de/vo"(are a s+$ar+"+!, sca"e"e Ca((e"" de !n(e"!$en(7
    a s+$ar+"+! s! a"(e"eJ :n $enera", c+ cA( es(e %a! %!ca
    e(a(ea, c+ a(A( es(e %a! d!.!c!" s7 se a&rec!e/e &re/en(a
    re(ard7rn %en(a"e, e<ce&(And ca/+r!"e c+ de(er!orare
    &ro.+nd7
    #rocedee de "nre!istrare
    Cod+" d!a$nos(!c s&ec!.!c &en(r+ re(ardarea
    %en(a"7 es(e se"ec(a( &e 'a/a n!ve"+"+! de sever!(a(e,
    aOa c+% es(e !nd!ca( %a! s+s, s! es(e :nre$!s(ra( &e a<a
    II Dac7 re(ardarea %en(a"7 es(e asoc!a(7 c+ a"(7
    (+"'+rare %en(a"7 Ede e<, c+ (+"'+rarea a+(!s(7J,
    (+"'+rarea %en(a"7 ad!=!ona"7 es(e cod!.!ca(7 &e a<a I
    De ase%enea, dac7 re(ardarea %en(a"7 es(e asoc!a(7 c+
    o cond!=!e %ed!ca"7 $enera"7 Ede e< , c+ s!ndro%
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    a"7 $enera"7 es(e cod!.!ca(7 &e a<a III
    *lemente si tulburri asociate
    *lemente descriptive si tulburri mentale asociate2
    Fici un $el de elemente de
    &ersona"!(a(e sa+ de co%&or(a%en( s&ec!.!ce n+ s+n(
    asoc!a(e e<c"+sn c + re(ardarea %en(a"7 Un+ !nd!v!/! c+
    re(ardare %en(a"7 s+n( &as!v!, &"ac!/! s! de&enden=!, %
    (!%& ce a"=!! &o( .! a$res!v! s! !%&+"s!v! L!&sa
    a&(!(+d!n!"or de co%+n!care &oa(e &red!s&+ne "a
    co%&or(a%en(e d!sr+&(!ve s! a$res!ve care se
    s+'s(!r+2e "2%'a@+"+! co%+n!ca(!v Une"e cond!=!!
    %ed!ca"e $enera"e asoc!a(e c+ re(ardarea rren(a"7 se
    carac(er!/ea/7 &r!n an+%!(e s!%&(o%e
    co%&or(a%en(a"e Ede e< corr&or(a%en(+"
    a+(ov+"neran( !n(ra(a'!" asoc!a( c+ s!ndro%+" Lesc4
    NyanJ Ind!_ !/ 2 c+ re(ardare
    +etardarea Mental HA
    %en(a"7 s+n( v+"nera'!"! "a a .! e<&"oa(a=! de c7(re a"=!! Ede e<., de a se a'+/a .!/!c s!
    se<+a" de e!J sa+ "a a "! se ne$a dre&(+r!"e s! Oanse"e.
    Ind!v!/!! c+ re(ardare %en(a"7 a+ o &reva"en(7 de (+"'+r7r! %en(a"e co%or'!de
    es(!%a(7 "a a .! de (re!, &An7 "a &a(r+ or! %a! %are decA( &o&+"a=!a $enera"7, :n +ne"e
    ca/+r!, aceas(a &oa(e re/+"(a d!n aceeaO! e(!o"o$!c, care es(e co%+n7 re(ard7r!!
    %en(a"e O! (+"'+r7r!! %en(a"e asoc!a(e Ede e<., (ra+%a(!s%+" cran!an &oa(e d+ce "a
    re(ardare %en(a"7 s! "a %od!.!care de &ersona"!(a(e da(ora(7 (ra+%a(!s%+"+!
    cran!anJ. Po( .! :n(A"n!(e (oa(e (!&+r!"e de (+"'+r7r! %en(a"e, s! n+ e<!s(7 n!c! o &ro'7
    c7 na(+ra +ne! (+"'+r7r! %en(a"e da(e es(e d!.er!(7 "a !nd!v!/!! care a+ re(ardare
    %en(a"7. D!a$nos(!c+" (+"'+r7r!"or %en(a"e co%or'!de es(e :ns7 co%&"!ca( adesea
    de .a&(+" c7 (a'"o+" c"!n!c &oa(e .! %od!.!ca( de sever!(a(ea re(ard7r!! %en(a"e s! de
    and!ca&+r!"e asoc!a(e. De.!c!(e"e :n a&(!(+d!n!"e de co%+n!care &o( cond+ce "a
    !nca&ac!(a(ea de a .+rn!/a +n !s(or!c adecva( Ede e<., d!a$nos(!c+" de (+"'+rare
    de&res!v7 %a@or7 "a +n ad+"( %+( c+ re(ardare %en(a"7 es(e adesea 'a/a( :n &r!%+"
    rAnd &e %an!.es(7r!, &rec+% d!s&o/!=!a de&res!v7, !r!(a'!"!(a(ea, anore<!a sa+
    !nso%n!a, care s+n( o'serva(e de a"=!!J. Ma! des decA( es(e ca/+" "a !nd!v!/!! .7r7
    re(ardare %en(a"7, es(e .oar(e d!.!c!" s7 se a"ea$7 +n d!a$nos(!c s&ec!.!c, s! :n as(.e"
    de ca/+r! &oa(e .! +(!"!/a(7 ca(e$or!a cores&+n/7(oare de S.7r7 a"(7 s&ec!.!ca=!eT Ede
    e<., (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!eJ. Ce"e %a! .recven(e (+"'+r7r! %en(a"e
    asoc!a(e s+n( (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (+"'+r7r!"e a.ec(!ve,
    (+"'+r7r!"e de de/vo"(are &ervas!v7, (+"'+rarea de %!Ocare s(ereo(!&7 s! (+"'+r7r!"e
    %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e Ede e<., de%en=a da(ora(7 +n+!
    (ra+%a(!s% cran!anJ. Ind!v!/!! care a+ re(ardare %en(a"7 da(ora(7 +n+! s!ndro%
    Do#n s+n( e<&+O! ce"+! %a! :na"( r!sc de a de/vo"(a de%en=a A"/e!%er.
    Mod!.!c7r!"e &a(o"o$!ce cere'ra"e asoc!a(e c+ aceas(7 (+"'+rare se de/vo"(7 de re$+"7
    "a :nce&+(+" an!"or IL a! aces(or !nd!v!/!, deO! s!%&(o%e"e c"!n!ce de de%en=7 n+
    s+n( ev!den(e decA( %a! (Ar/!+.
    A+ .os( ra&or(a(e asoc!er! :n(re .ac(or! e(!o"o$!c! s&ec!.!c! s! an+%!(e s!%&(o%e
    co%or'!de s! (+"'+r7r! %en(a"e. De e<e%&"+, s!ndro%+" > .ra$!" &are a cres(e r!sc+"
    de %or'!d!(a(e &en(r+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e O! de .o'!e
    soc!a"78 !nd!v!/!! c+ s!ndro% Prader41!""! &o( &re/en(a !&er.a$!e s! co%&+"s!v!(a(e,
    !ar ce! c+ s!ndro% 1!""!a%s &o( &re/en(a +n r!sc cresc+( &en(r+ (+"'+r7r!"e an<!oase
    O! (+"'+rarea !&erac(!v!(eXde.!c!( de a(en=!e.
    Fac(or! &red!s&o/an=!. Fac(or!! e(!o"o$!c! &o( .! :n &r!nc!&a" '!o"o$!c!, :n &r!nc!&a"
    &s!osoc!a"! sa+ o co%'!na=!e a a%'e"or ca(e$or!!. La a&ro<!%a(!v ;L4ILd d!n(re
    !nd!v!/!! v7/+=! :n cond!=!! c"!n!ce, n+ &oa(e .! &rec!/a(7 o er!o"o$!e c"ar7 a re(ard7r!!
    %en(a"e, :n d!s&re=+" e.or(+r!"or de eva"+are e<(!nse. Es(e &os!'!" ca e(!o"o$!!"e
    s&ec!.!ce s7 .!e !den(!.!ca(e "a !nd!v!/!! c+ re(ardare %en(a"7 sever7 sa+
    &ro.+nd7.Fac(or!! &red!s&o/an=! %a@or! !nc"+dQ
    Ereditatea? AceO(! .ac(or! !nc"+d eror!"e :n7sc+(e de %e(a'o"!s%, %oO(en!(e ce"e
    %a! %+"(e &r!n %ecan!s%e a+(oso%a"e reces!ve Ede e<., %a"ad!a Tay4SacsJ, a"(e
    ano%a"!! %ono$en!ce c+ Trans%!(ere %ende"!an7 s! e<&res!e var!a'!"7 Ede e<.,
    sc"ero/a (+'eroas7J O! a'era=!!"e cro%o/o%!a"e Ede e<., s!ndro%+" de (rans"oca=!e
    Do#n, s!ndro%+" >4.ra$!"J. Pro$rese"e :n $ene(!c7 vor creO(e &ro'a'!" !den(!.!carea
    .or%e"or er!(a'!"e de re(ardare %en(a(7.
    Alter6rile precoce ale de;*olt6rii embrionare? AceO(! .ac(or! !nc"+d %od!.!c7r!"e
    cro%o/o%!a"e Ede e<., s!ndro%+" Do#n da(ora( (r!so%!e!J sa+ "e/!+n!"e &rena(a"e
    da(ora(e (o<!ce"or Ede e<., cons+%+" %a(ern de a"coo", !n.ec=!!"eJ.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    HI "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    5n)l+en(ele ambientale? AceO(! .ac(or! !nc"+d de&r!vare de :n$r!@!re a.ec(+oas7 s! de
    s(!%+"are soc!a"7, "!n$v!s(!c7 sa+ de a"( (!&.
    T+lb+r6rile mentale? AceO(! .ac(or! !nc"+d (+"'+rarea a+(!s(7 s! a"(e (+"'+r7r! de
    de/vo"(are &ervas!ve.
    Sarcina si problemele perinatale? AceO(! .ac(or! !nc"+d %a"n+(r!=!a .e(a"7,
    &re%a(+r!(a(ea, !&o<!a, !n.ec=!!"e v!ra"e O! a"(e !n.ec=!!, s! (ra+%a(!s%e"e.
    Condi(iile medicale /enerale c6p6tate =n perioada de s+/ar sa+ =n copil6rie? AceO(!
    .ac(or! !nc"+d !n.ec=!!"e, (ra+%a(!s%e"e s! !n(o<!ca=!!"e Ede e<., da(ora(e &"+%'+"+!J.
    9ate de laborator asociate2 :n a.ara re/+"(a(e"or "a (es(e"e &s!o"o$!ce s! de
    co%&or(a%en( ada&(a(!v, care s+n( necesare &en(r+ d!a$nos(!c+" re(ard7r!! %en(a"e,
    n+ e<!s(7 da(e de "a'ora(or care s7 .!e asoc!a(e e<c"+s!v c+ re(ardarea %en(a"7.
    Da(e"e d!a$nos(!ce de "a'ora(or &o( .! asoc!a(e c+ o cond!=!e %ed!ca"7 $enera"7
    s&ec!.!c7 de aco%&an!a%en( Ede e<., ano%a"!! cro%o/o%!a"e :n d!verse cond!=!!
    $ene(!ce, concen(ra=!e san$+!n7 cresc+(7 de .en!"a"an!n7 :n .en!"ce(on+r!e sa+
    ano%a"!! &e !%a$!s(!ca s!s(e%+"+! nervos cen(ra"J.
    9atele examinrii somatice si condi3iile medicale .enerale asociate. N+ e<!s(7
    e"e%en(e so%a(!ce s&ec!.!ce asoc!a(e c+ re(ardarea %en(a"7. CAnd re(ardarea
    %en(a"7 es(e &ar(e a +n+! s!ndro% s&ec!.!c, e"e%en(e"e c"!n!ce a"e ace"+! s!ndro%
    vor .! &re/en(e Ede e<., e"e%en(e"e so%a(!ce a"e s!ndro%+"+! Do#nJ. C+ cA( es(e %a!
    sever7 re(ardarea %en(a"7 E:n s&ec!a", dac7 es(e sever7 sa+ &ro.+nd7J, c+ a(A( es(e
    %a! %are &ro'a'!"!(a(ea cond!=!!"or ne+ro"o$!ce Ede e<., a cr!/e"or e&!"e&(!ceJ, a
    cond!=!!"or ne+ro%+sc+"are, v!/+a"e, a+d!(!ve, card!ovasc+"are O! a a"(or cond!=!!.
    *lemente speci$ice culturii, etii si sexului
    Tre'+!e "+a(e %7s+r! &en(r+ a ne as!$+ra c7 &rocedee"e de (es(are !n(e"ec(+a"7
    acord7 a(en=!a adecva(7 .ond+"+! e(n!c sa+ c+"(+ra" a" !nd!v!d+"+!. Aceas(a se
    rea"!/ea/7 de re$+"7 &r!n +(!"!/area de (es(e :n care carac(er!s(!c!"e re"evan(e a"e
    !nd!v!d+"+! s+n( re&re/en(a(e :n eOan(!on+" de s(andard!/are a" (es(+"+! or! &r!n
    +(!"!/area +n+! e<a%!na(or care es(e .a%!"!ar!/a( c+ as&ec(e"e .ond+"+! e(n!c sa+
    c+"(+ra" a" !nd!v!d+"+!. Tes(area !nd!v!d+a"!/a(7 es(e necesar7 (o(dea+na &en(r+ a
    &+ne d!a$nos(!c+" de re(ardare %en(a"7. Preva"en(a re(ard7r!! %en(a"e da(ora(e
    +nor .ac(or! '!o"o$!c! c+nosc+=! es(e s!%!"ar7 &r!n(re co&!!! d!n c"ase"e
    soc!oecono%!ce s+&er!oare O! !n.er!oare, c+ e<ce&=!a .a&(+"+! c7 an+%!=! .ac(or!
    e(!o"o$!c! s+n( "e$a=! de s(ar+s+" econo%!c !n.er!or Ede e<., !n(o<!ca=!a c+ &"+%' O!
    naO(er!"e &re%a(+reJ, :n ca/+r!"e :n care n+ &oa(e .! !den(!.!ca(7 n!c! o ca+/7
    '!o"o$!c7 s&ec!.!c7, c"ase"e soc!oecono%!ce !n.er!oare s+n( s+&rare&re/en(a(e, !ar
    re(ardarea %en(a"7 es(e de re$+"7 %a! +Ooar7, deO! (oa(e $rade"e de sever!(a(e s+n(
    re&re/en(a(e, :n eva"+area de(er!or7r!! a&(!(+d!n!"or ada&(a(!ve, (re'+!e =!n+( con(
    de co%&ensa=!!"e de/vo"(7r!!, &en(r+ c7 an+%!(e do%en!! a&(!(+d!na"e s+n( %a!
    &+=!n re"evan(e "a d!.er!(e e(7=! Ede e<., +/+" de res+rse"e co%+n!(7=!! sa+ serv!c!+" "a
    co&!! de e(a(e Oco"ar7J. Re(ardarea %en(a"7 es(e %a! .recven(7 &r!n(re '7r'a=!, c+ +n
    ra&or( '7r'a=!X.e%e! de a&ro<!%a(!v 5,YQ5.
    #revalent
    Ra(a de &reva"en(7 a re(ard7r!! %en(a"e a .os( es(!%a(7 "a a&ro<!%a(!v " d .
    D!.er!(e s(+d!! a+ ra&or(a( :ns7 ra(e d!.er!(e :n .+nc=!e de de.!n!=!a +(!"!/a(7, %e(ode"e
    de !den(!.!care O! &o&+"a=!a s(+d!a(7.
    +etardarea
    Mental
    7G

    *voluie
    D!a$nos(!c+" de re(ardare %en(a"7 cere ca de'+(+" (+"'+r7r!! s7 a!'7 "oc :na!n(e
    de e(a(ea de 5G an! E(a(ea s! %od+" de de'+( de&!nd de e(!o"o$!a O! sever!(a(ea
    re(ard7rn %en(a"e Re(ardarea %a! sever7, :n s&ec!a" cAnd es(e asoc!a(7 c+ +n
    s!ndro% c+ .eno(!& carac(er!s(!c, (!nde a .! rec+nosc+(7 &recoce Ede e< , s!ndro%+"
    Do#n es(e d!a$nos(!ca( de re$+"7 "a naO(ereJ D!n con(ra, re(ardarea +Ooar7 de
    or!$!ne nec+nosc+(7 es(e :n $enera" re%arca(7 %a! (Ar/!+ :n re(ardarea %a! sever7
    re/+"(And d!n(r4o ca+/7 c7&7(a(7, de(er!orarea !n(e"ec(+a"7 se va de/vo"(a %a!
    re&ede Ede e< , re(ardarea +r%And +ne! ence.a"!(eJ Evo"+=!a re(ard7% %en(a"e es(e
    !n."+en=a(7 de evo"+=!a cond!=!!"or %ed!ca"e $enera"e s+'!acen(e O! de .ae(on
    a%'!en(a"! Ede e< , de o&or(+n!(7=!"e de !ns(r+!re s! de a"(e o&or(+n!(7=!, s(!%+"area
    a%'!en(a"7 s! adecvarea %ana$e%en(+"+!J Dac7 o cond!=!e %ed!ca"7 $enera"7
    s+'!acen(7 es(e s(a'!"!/a(7, es(e .oar(e &ro'a'!" c7 evo"+=!a va .! var!a'!"7 O! va
    de&!nde de .ac(or!! a%'!en(a"! Re(ardarea %en(a"7 n+ es(e :n %od necesar o
    (+"'+rare &e (oa(7 d+ra(a v!e=!! Ind!v!/!! care a+ av+( re(ardare %en(a"7 +Ooar7 de
    (!%&+r!+ :n v!a(a "or, %an!.es(a(7 &r!n eOec :n sarc!n!"e de :nv7=are Oco"ar7, c+
    an(rena%en( O! o&or(+n!(7=! adecva(e, &o( s7 de/vo"(e a&(!(+d!n! ada&(a(!ve '+ne :n
    a"(e do%en!!, O! &o( s7 n+ %a! a!'7 n!ve"+" de de(enorare cer+( de d!a$nos(!c+" de
    re(ardare %en(a"7
    #attern $amilial
    D!n ca+/a e(!o"o$!e! sa"e e(ero$ene, n!c! +n &a((ern .a%!"!a" n+ es(e a&"!ca'!"
    re(ard7rn %en(a"e ca o ca(e$or!e $enera"7 En(a'!(a(ea re(ard7rn %en(a"e es(e
    d!sc+(a(7 "a SFac(or!! &red!s&o/an=!T Eve/! &a$ IY J
    Dia!nostic di$erenial
    Cr!(er!!"e de d!a$nos(!c &en(r+ re(ardarea %en(a"7 n+ !nc"+d s! +n cr!(er!+ de
    e<c"+dere, O! ca a(are, d!a$nos(!c+" (re'+!e &+s or! de cA(e or! cr!(er!!"e de d!a$nos(!c
    s+n( sa(!s.7c+(e, !nd!.eren( de &re/en(a +ne! a"(e (+"'+r7r! %en(a"e :n (+"'+r7r!"e de
    :nv7=are or! :n (+"'+r7r!"e de co%+n!care Eneasoc!a(e c+ re(ardare %en(a"7J,
    de/vo"(area :n(r4+n do%en!+ s&ec!.!c Ede e< , "e<!a, "!%'a@+" e<&res!vJ es(e de(er!ora(7,
    dar n+ e<!s(7 o de(enorare $enera"!/a(7 :n de/vo"(area !n(e"ec(+a"7 s! :n .+nc=!onarea
    ada&(a(!v7 O (+"'+rare de :nv7=are on de co%+n!care &oa(e .! d!a$nos(!ca(7 "a +n
    !nd!v!d c+ re(ardare %en(a"7, dac7 de.!c!(+" s&ec!.!c es(e d!s&ro&or=!ona( :n
    co%&ara=!e c+ sever!(a(ea re(ard7% %en(a"e :n (+"'+r7r!"e de de/vo"(are &ervas!v7,
    e<!s(7 o de(er!orare ca"!(a(!v7 :n de/vo"(area !n(erac=!+n!! soc!a"e rec!&roce O! :n
    de/vo"(area a&(!(+d!n!"or de co%+n!care soc!a"7 ver'a"7 s! nonver'a"7 Re(ardarea
    %en(a"7 aco%&an!a/7 adesea (+"'+r7r!"e de de/vo"(are &ervas!v7
    Une"e ca/+r! de re(ardare %en(a"7 :O! a+ de'+(+" d+&7 o &enoad7 de
    .+nc=!onare nor%a"7 s! &o( :ndre&(7=! d!a$nos(!c+" ad!=!ona" de de%en=7
    D!a$nos(!c+" de de%en(7 cere ca de(er!orarea %e%or!e! O! a"(e de.!c!(e co$n!(!ve s7
    re&re/!n(e +n dec"!n se%n!.!ca(!v de "a ce" %a! :na"( n!ve" de .+nc=!onare an(enor
    Deoarece es(e .oar(e d!.!c!" s7 se &rec!/e/e n!ve"+" an(er!or de .+nc=!onare "a co&!!!
    .oar(e %!c!, d!a$nos(!c+" de de%en(7 n+ es(e &+s &An7 cAnd co&!"+" n+ es(e :n e(a(e
    de I4R a% :n $enera", &en(r+ !nd!v!/!! s+' 5G a%, d!a$nos(!c+" de de%en(7 es(e
    &+s, n+%a! cAnd cond!=!a n+ es(e carac(er!/a(7 sa(!s.7c7(or n+%a! de d!a$nos(!c+"
    de re(ardare %en(a"7
    Tulburrile dia!nosticate de re!ul
    pentru prima dat
    H8 "n
    p
    erMoada de Su!ar, "n opilrie sau
    "n Adolescent
    F
    +nc=!
    onar
    ea
    !n(e"
    ec(+a"7 "!%!nar7 Eve/! &a$ HILJ descr!e +n do%en!+ a" DI, care
    es(e %a! :na"( decA( ce" a" re(ard7rn %en(a"e E:n $enera" H54GIJ
    D+&7 c+% s4a d!sc+(a( an(er!or, +n scor a" DI &oa(e !%&"!ca o
    eroare de %7s+rare de a&ro<!%a(!v Y &+nc(e, :n .+nc=!e de
    !ns(r+%en(+" de (es(are AOadar, es(e &os!'!" s7 se
    d!a$nos(!ce/e re(ardarea %en(a"7 s! "a !nd!v!/! c+ scor+r! DI :n(re
    H5 s! HY, dac7 e! &re/!n(7 de.!c!(e se%n!.!ca(!ve :n
    co%&or(a%en(+" ada&(a(!v care sa(!s.ac cr!(er!!"e &en(r+
    re(ardarea %en(a"7 D!.eren=!erea re(ard7rn %en(a"e +Ooare de
    .+nc=!onarea !n(e"ec(+a"7 "!%!nar7 neces!(7 ana"!/a a(en(7 a
    or!c7re! !n.or%a=!! acces!'!"e
    +elaia cu alte clasi$icri ale retardrii mentale
    S!s(e%+" de c"as!.!care a" Asoc!a=!e! A%er!cane &en(r+
    Re(ardarea Men(a"7 EAAMRJ !nc"+de ace"eaO! (re! cr!(er!! Ead!c7,
    .+nc=!onare !n(e"ec(+a"7 se%n!.!ca(!v s+'%ed!e, res(r!c=!! :n
    a&(!(+d!n!"e ada&(a(!ve s! de'+( an(enor e(7=!! de 5G an!J :n
    c"as!.!carea AAMR, cr!(er!+" .+nc=!on7% !n(e"ec(+a"e
    se%n!.!ca(!v s+'%edn se re.er7 "a +n scor s(andard de
    a&ro<!%a(!v HL4HY sa+ s+' Ecare !a :n cons!dera=!e o eroare de
    %7s+rare even(+a"7 de &"+s sa+ %!n+s Y &+nc(e "a (es(area DIJ :n
    (!%& ce DSM4I3 s&ec!.!c7 n!ve"e"e de sever!(a(e, s!s(e%+" de
    c"as!.!care AAMR d!n 5FF9 s&ec!.!c7 S&a((ern+n"e s! !n(ens!(a(ea
    neces!(7=!"or de s+&or(T Ead!c7, !n(er%!(en(7, "!%!(a(7, e<(!ns7 s!
    &ervas!v7J, care n+ s+n( co%&ara'!"e :n %od d!rec( c+ $rade"e de
    sever!(a(e a"e DSM4I3 De.!n!=!a !nca&ac!(7(!"or de de/vo"(are d!n
    P+'"!c La# ELe$ea P+'"!c7J FY4RL9 E5FHGJ n+ es(e "! %!(a(7 "a
    re(ardarea %en(a"7 s! se ba;ea;6 &e cr!(er!! .+nc=!ona"e Aceas(7 "e$e
    de.!neO(e !nca&ac!(a(ea de de/vo"(are ca &e o !nca&ac!(a(e
    a(n'+!'!"7 +ne! de(er!or7r! %en(a"e sa+ so%a(!ce care se %an!.es(7
    :na!n(e de e(a(ea de 99 de an! s! se con(!n+7 &ro'a'!" !nde.!n!(,
    d+cAnd "a res(r!c=!! s+'s(an=!a"e :n (re! sa+ %a! %+"(e do%en!! de
    .+nc=
    !onar
    e
    s&ec!
    .!ce
    s!
    nece
    s!(An
    d o
    as!s(
    en(7
    s&ec!
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    "+n$
    7
    d+ra
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    sa+
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    (oa(7
    v!a(a
    Tulburrile de "nvare
    &anterior Tulburrile Aptitudinilor
    Qcolare)
    IF

    Criteriile $e $ia/no&ti# pentru Retar$area Mental(
    A 'uncionare intelectual semni$icativ submedie un Rl de aproximativ ?5 sau
    sub la un test administrat individual &pentru copii, 0udecata clinic a unei
    $uncionri intelectuale semni$icativ submedii)
    S De$icite sau deteriorri concomitente "n activitatea adaptativ pre(ent
    &adic, e$icienta persoanei "n satis$acerea standardelor expectate la etatea
    sa de !rupul su cultural) "n cel puin dou din urmtoarele domenii
    comunicare, auto"n!n0ire, viat de $amilie, aptitudini sociale1mterpersonale,
    u( de resursele comunitii, autoconducere, aptitudini ,colar $uncionale,
    munc, timp liber, sntate si si!uran
    Debut "nainte de E8 ani
    Se codi"ic pe ba(a !radului de severitate care re$lect nivelul de deteriorare
    intelectual
    4E? +etardare mental u,oarD nivel Rl de la A5-AA p@n la aproximativ ?5
    318.0+etardare mental moderatD nivel Rl de la 4A-H5 p@n la A5-AA
    318.1+etardare mental severD nivel Rl de la 75-7A p@n la 4A-H5
    318.2+etardare mental pro$undD nivel Rl sub 75 sau 7A
    4E6 +etardare mental de severitate nespeci$icatD c@nd exist pre(umia
    $erm de retardare mental, dar inteli!enta persoanei nu poate $i
    testat prin testele standard
    Tul-ur(rile $e .nv(!are (anterior
    Tul-ur(rile Aptitu$inilor ?#olare6
    Aceas(7 sec=!+ne des&re (+"'+r7r!"e de :nv7=are !nc"+de d!s"e<!a E(+"'+rarea de
    c!(!(J, d!sca"c+"!a E(+"'+rarea de ca"c+"J, d!s$ra.!a E(+"'+rarea e<&res!e! $ra.!ceJ, s!
    (+"'+rarea de :nv7=are .7r7 a"(7 s&ec!.!ca=!e
    *lemente de dia!nostic
    T+"'+r7r!"e de :nv7=are s+n( d!a$nos(!ca(e cAnd &er.or%an(a !nd!v!d+"+! "a
    (es(e"e s(andard!/a(e ad%!n!s(ra(e !nd!v!d+a" re.er!(oare "a c!(!(, ca"c+" ar!(%e(!c
    sa+ e<&res!e $ra.!c7 es(e s+'s(an=!a" s+' ceea ce es(e e<&ec(a( "a e(a(ea,
    Oco"ar!/area s! n!ve"+" de !n(e"!$en(7 a" !ns+"+! Pro'"e%e"e de :nv7=are
    !n(er.erea/7 se%n!.!ca(!v c+ &er.or%an(a Oco"ar7 sa+ c+ ac(!v!(7=!"e co(!d!ene care
    neces!(7 a&(!(+d!n! "e<!ce, de ca"c+" ar!(%e(!c sa+ $ra.!ce O var!e(a(e de &rocedee
    s(a(!s(!ce &o( .! +(!"!/a(e &en(r+ a s(a'!"! c7 d!scre&an(a es(e se%n!.!ca(!v7
    S+btantial s+b es(e de.!n!( de re$+"7 ca o d!scre&an(7 de %a! %+"( de 9 dev!a=!!
    s(andard :n(re &er.or%an(7 s! D" O d!scre&an(7 %a! %!c7 :n(re &er.or%an(7 s! D"
    Ead!c7, :n(re " s! 9 dev!a=!! s(andardJ es(e +(!"!/a(7 +neor!, :n s&ec!a" :n ca/+r!"e :n
    care &er.or%an(a !nd!v!d+"+! "a +n (es( D" &oa(e .! co%&ro%!s7 de o (+"'+rare
    asoc!a(7 :n &rocesarea co$n!(!v7, de o (+"'+rare %en(a"7 co%or'!d7 sa+ de o
    cond!=!e %ed!ca"7 $enera"7 or! de .ond+" e(n!c sa+ c+"(+ra" a" !nd!v!d+"+! Dac7
    Tulburrile dia!nosticate de re!ul pentru prima dat
    <+ "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    es(e &re/en( +n de.!c!( sen/or!a", d!.!c+"(7=!"e de :nv7=are (re'+!e s7 .!e :n e<ces
    .a=7 de ce"e asoc!a(e de re$+"7 c+ de.!c!(+". T+"'+r7r!"e de :nv7=are &o( &ers!s(a :n
    &er!oada ad+"(7.
    *lemente si tulburri asociate
    De%ora"!/area, s(!%a de s!ne sc7/+(7 s! de.!c!(e"e :n a&(!(+d!n!"e soc!a"e &o( .!
    asoc!a(e c+ (+"'+r7r!"e de :nv7=are. Pro&or=!a de a'andon Oco"ar &r!n(re co&!!! sa+
    ado"escen=!! c+ (+"'+r7r! de :nv7=are se c!.rea/7 "a a&roa&e ILd Esa+ de a&ro<!%a(!v
    ", Y or! %ed!aJ. Ad+"=!! c+ (+"'+r7r! de :nv7=are &o( avea d!.!c+"(7=! se%n!.!ca(!ve :n
    serv!c!+ sa+ :n ada&(area soc!a"7. M+"=! !nd!v!/! E5Ld49YdJ c+ (+"'+rare de
    cond+!(7, o&o/!=!on!s% &rovoca(or, (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e,
    (+"'+rare de&res!v7 %a@or7 sa+ (+"'+rare d!s(!%!c7 a+ O! (+"'+r7r! de :nv7=are.
    E<!s(7 &ro'e c7 :n(Ar/!er!"e :n de/vo"(area "!%'a@+"+! &o( s+rven! :n asoc!ere c+
    (+"'+r7r!"e de :nv7=are E:n s&ec!a" c+ d!s"e<!aJ, :ns7 aces(e :n(Ar/!er! &o( s7 n+ .!e
    s+.!c!en( de severe &en(r+ a @+s(!.!ca +n d!a$nos(!c se&ara( de (+"'+rare de
    co%+n!care. T+"'+r7r!"e de :nv7=are &o( .!, de ase%enea, asoc!a(e c+ +n &rocen(
    r!d!ca( de (+"'+r7r! de de/vo"(are a coordon7r!!.
    Po( e<!s(a ano%a"!! s+'!acen(e :n &rocesarea co$n!(!v7 Ede e<., de.!c!(e :n
    &erce&=!a v!/+a"7, &rocese"e "!n$v!s(!ce, a(en=!e sa+ %e%or!e or! o co%'!na=!e a
    aces(oraJ care adesea &reced sa+ s+n( asoc!a(e c+ (+"'+r7r!"e de :nv7=are. Tes(e"e
    s(andard!/a(e &en(r+ %7s+rarea aces(or &rocese s+n( :n $enera" %a! &+=!n re"!a'!"e
    s! va"!de decA( a"(e (es(e &s!oed+ca=!ona"e. DeO! &red!s&o/!=!a $ene(!c7,
    (ra+%a(!s%e"e &er!na(a"e s! d!verse"e cond!=!! ne+ro"o$!ce sa+ a"(e cond!=!! %ed!ca"e
    $enera"e &o( .! asoc!a(e c+ de/vo"(area (+"'+r7r!"or de :nv7=are, &re/en=a +nor as(.e"
    de cond!=!! n+ &re/!ce !nvar!a'!" o (+"'+rare de :nv7=are, e<!s(And %+"=! !nd!v!/! c+
    (+"'+r7r! de :nv7=are care n+ a+ +n as(.e" de !s(or!c. T+"'+r7r!"e de :nv7=are s+n(
    :n(A"n!(e, :ns7, asoc!a(e .recven( c+ o var!e(a(e de cond!=!! %ed!ca"e $enera"e Ede e<.,
    !n(o<!ca=!a sa(+rn!n7, s!ndro%+" .e(a" a"coo"!c, s!ndro%+" >4.ra$!"J.
    *lemente speci$ice culturii
    Tre'+!e s7 ne as!$+r7% ca &rocedee"e de (es(are a !n(e"!$en=e! s7 acorde a(en=!a
    c+ven!(7 .ond+"+! e(n!c sa+ c+"(+ra" a" !nd!v!d+"+!. Aceas(a se rea"!/ea/7 de re$+"7
    &r!n +(!"!/area de (es(e :n care carac(er!s(!c!"e re"evan(e a"e !nd!v!d+"+! s+n(
    re&re/en(a(e :n eOan(!on+" de s(andard!/are a" (es(+"+! sa+ &r!n .o"os!rea +n+!
    e<a%!na(or care es(e .a%!"!ar!/a( c+ as&ec(e"e .ond+"+! e(n!c sa+ c+"(+ra" a"
    !nd!v!d+"+!. Tes(area !nd!v!d+a"!/a(7 es(e (o(dea+na necesar7 &en(r+ a &+ne
    d!a$nos(!c+" de (+"'+rare de :nv7=are.
    #revalent
    Es(!%7r!"e &reva"en(e! (+"'+r7r!"or de :nv7=are %er$ de "a 9d "a 5Ld ,4:n .+nc=!e
    de na(+ra cons(a(7r!! O! de.!n!=!!"e a&"!ca(e. A&ro<!%a(!v Yd d!n(re e"ev!! d!n Oco"!"e
    &+'"!ce d!n S(a(e"e Un!(e s+n( !den(!.!ca=! ca avAnd o (+"'+rare de :nv7=are.
    4EA 55 Dislexia &Tulburarea
    ititului)
    <*
    Dia!nostic di$erenial
    T+"'+r7r!"e de :nv7=are (re'+!e s7 .!e d!.eren=!a(e de varia3iile normale @n
    cuno/tin3ele /colare s! de d!.!c+"(7=!"e Oco"are da(ora(e lipsei de posibilit3i2
    modului defectuos de a preda al profesorului sa+ factorilor culturali. Bco"ar!/area
    !nadecva(7 &oa(e d+ce "a re/+"(a(e s"a'e "a (es(e"e de &er.or%an(7 s(andard!/a(e
    Co&!!! d!n %ed!! e(n!ce sa+ c+"(+ra"e d!.en(e de c+"(+ra care &reva"ea/7 :n scoa"7 or!
    d!n %ed!!"e :n care en$"e/a n+ es(e "!%'a %a(ern7, !ar co&% a+ .recven(a( sco"! :n
    care &redarea a .os( !nadecva(7, &o( o'=!ne scor+r! red+se "a (es(e"e de &er.or%an(7
    Co&!!! d!n aces(e %ed!! &o( .!, de ase%enea, e<&+O! +n+! r!sc %a! %are de a'sen(e!s%
    da(ora( %a"ad!!"or %a! .recven(e sa+ %ed!+"+! de v!a(7 ao(!c sa+ &en+nc
    9eteriorarea vederii sau auzului &oa(e a.ec(a ca&ac!(a(ea de :nv7=are s! (re'+!e
    s7 .!e !nves(!$a(7 &r% (es(e de screen!n$ v!/+a" sa+ a+d!o%ernc O (+"'+rare de
    :nv7=are &oa(e .! d!a$nos(!ca(7 :n &re/en(a +nor as(.e" de de.!c!(e sen/or!a"e n+%a!
    dac7 d!.!c+"(7=!"e de :nv7=are s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+
    aces(e de.!c!(e Cond!=!!"e ne+ro"o$!ce sa+ cond!=!!"e %ed!ca"e $enera"e de
    aco%&an!a%en( (re'+!e s7 .!e cod!.!ca(e &e a<a III
    @n retardarea mental2 d!.!c+"(7=!"e de :nv7=are s+n( &ro&or=!ona"e c+
    de(er!orarea $enera"7 a .+nc=!on7% !n(e"ec(+a"e C+ (oa(e aces(ea :ns7, :n +ne"e
    ca/+r! de re(ardare %en(a"7 +Ooar7, n!ve"+" a(!ns :n "e<!e, ca"c+" sa+ e<&res!e $ra.!c7
    es(e se%n!.!ca(!v s+' n!ve"e"e e<&ec(a(e, da(7 .+nd Oco"ar!/area &ersoane! s!
    sever!(a(ea re(ard7rn %en(a"e :n as(.e" de ca/+r!, (re'+!e s7 .!e &+s d!a$nos(!c+"
    ad!=!ona" de (+"'+rare de :nv7=are cores&+n/7(oare
    Un d!a$nos(!c ad!=!ona" de (+"'+rare de :nv7=are (re'+!e s7 .!e &+s :n con(e<(+"
    +ne! tulburri de dezvoltare pervasiv2 n+%a! cAnd de(er!orarea Oco"ar7 es(e
    se%n!.!ca(!v s+' n!ve"e"e e<&ec(a(e, da(7 .+nd .+nc=!onarea !n(e"ec(+a"7 s!
    Oco"ar!/area !nd!v!d+"+! La !nd!v!/a c+ tulburri de comunicare2 ac(!v!(a(ea
    !n(e"ec(+a"7 &oa(e .! eva"+a(7 +(!"!/And %7s+r7r! s(andard!/a(e a"e ca&ac!(7=!!
    !n(e"ec(+a"e nonver'a"e :n ca/+r!"e !n care &er.or%an(a Oco"ar7 es(e se%n!.!ca(!v
    s+' aceas(7 ca&ac!(a(e %7s+ra(7, (re'+!e &+s d!a$nos(!c+" de (+"'+rare de :nv7=are
    cores&+n/7(oare
    9iscalcu-a si dis.rafia s+rv!n ce! %a! .recven( :n co%'!na=!e c+ dislexia CAnd
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ %a! %+"( decA( o s!n$+r7 (+"'+rare de :nv7=are
    (re'+!e s7 .!e d!a$nos(!ca(e (oa(e
    4*<.++ Di&le,ia 3Tul-urarea Cititului6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" d!s"e<!e! :" cons(!(+!e .a&(+" c7 &er.or%an(a :n "e<!e Ead!c7,
    ac+ra(e=ea, v!(e/a sa+ co%&reens!+nea "e<!e!, %7s+ra(e &nn (es(e s(andard!/a(e
    ad%!n!s(ra(e !nd!v!d+a"J co'oar7 s+'s(an=!a" s+' ceea ce es(e e<&ec(a(, da(7 .+nd
    e(a(ea crono"o$!c7 a !nd!v!d+"+!, !n(e"!$en(a %7s+ra(7 s! ed+ca=!a cores&+n/7(oare
    e(7=!! Ecr!(er!+" AJ Per(+r'area "e<!e! !n(er.erea/7 se%n!.!ca(!v c+ &er.or%an(a
    Oco"ar7 sa+ c+ ac(!v!(7=!"e _ "e(n co(!d!ene care neces!(7 a&(!(+d!n! "e<!ce Ecn(en+" BJ
    Dac7 es(e &re/en( +n de.!c!( sen/or!a", d!.!c+"(7=!"e "e<!ce s+n( :n e<ces .a(7 de ce"e
    asoc!a(e de re$+"7 c+ aces(a Ecr!(er!+" CJ De ase%enea, dac7 e<!s(7 +n de.!c!(
    ne+ro"o$!c, +n de.!c!( sen/or!a" sa+ a"(7 cond!=!e %ed!ca"7 $enera"7, aces(ea (re'+!e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    A7 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    cod!.!ca(e &e a<a III La !nd!v!/!! c+ (+"'+rarea c!(!(+"+! Ecare a .os( den+%!(7
    Sd!s"e<!eTJ, "ec(+ra ora"7 se carac(er!/ea/7 &r!n d!s(ors!+n!, s+'s(!(+!r! sa+ o%!s!+n!,
    !ar a(A( c!(!(+" c+ voce (are, cA( s! c!(!(+" :n $And s+n( carac(er!/a(e &r!n "en(oare s!
    eror! :n co%&reens!+ne
    *lemente si tulburri asociate
    3e/! sec=!+nea SE"e%en(e s! (+"'+r7r! asoc!a(eT &en(r+ (+"'+r7r!"e de :nv7=are
    E&a$ YLJ D!sca"c+"!a s! d!s$ra.!a s+n( asoc!a(e .recven( c+ d!s"e<!a, .!ecare d!n
    aces(e (+"'+r7r! .+nd :n(A"n!(7 re"a(!v rar :n a'sen(a d!s"e<!e!
    *lemente speci$ice sexului
    A&ro<!%a(!v RLHo &An7 "a GLd d!n(re !nd!v!/!! d!a$nos(!ca=! c+ d!s"e<!e s+n(
    '7r'a=! Procedee"e de (r!%!(ere &o( .! adesea :nc"!na(e s&re !den(!.!carea '7r'a=!"or,
    &en(r+ c7 e! &re/!n(7 %a! .recven( co%&or(a%en(e d!sr+&(!ve :n asoc!ere c+
    (+"'+r7r!"e de :nv7=are S4a cons(a(a( :ns7, c7 (+"'+rarea s+rv!ne :n &ro&or=!!
    a&roa&e e$a"e "a '7r'a=! s! "a .e%e!, cAnd s+n( +(!"!/a(e o s(a'!"!re a(en(7 a
    d!a$nos(!c+"+! s! cr!(er!! s(r!c(e, %a! c+rAnd decA( (r!%!(er!"e de c7(re scoa"7 s!
    &rocedee"e de d!a$nos(!c (rad!=!ona"e
    #revalent
    Preva"en(a d!s"e<!e! es(e d!.!c!" de s(a'!"!(, deoarece %+"(e s(+d!! s4a+ concen(ra(
    as+&ra &reva"en(e! (+"'+r7r!"or de :nv7=are, .7r7 a .ace o se&arare cores&+n/7(oare
    :n d!s"e<!e, d!sca"c+e s! d!s$ra.!e D!s"e<!a, s!n$+r7 sa+ :n co%'!na=!e c+ d!sca"c+"!a
    sa+ d!s$ra.!a, re&re/!n(7 a&ro<!%a(!v &a(r+ d!n .!ecare c!nc! ca/+r! de (+"'+rare de
    :nv7=are Preva"en(a d!s"e<!e! :n S(a(e"e Un!(e es(e es(!%a(7 "a Id "a co&!!! de e(a(e
    Oco"ar7 :n a"(e =7r!, :n care s+n( +(!"!/a(e cr!(er!! %a! s(r!c(e, c!.re"e &en(r+ !nc!den=a
    s! &reva"en(a d!s"e<!e! s+n( %a! %!c!
    *voluie
    DeO! s!%&(o%e a"e d!.!c+"(7=!! "e<!ce Ede e<, !nca&ac!(a(ea de a d!s(!n$e "!(ere"e
    co%+ne, +ne"e de a"(e"e, sa+ de a asoc!a .one%e"e co%+ne c+ s!%'o"+r!"e "!(era"eJ
    &o( s+rven! :nc7 d% &r!%+" an de $r7d!n!=7, d!s"e<!a es(e rar d!a$nos(!ca(7 :na!n(e
    de (er%!narea $r7d!n!=e! sa+ de :nce&+(+" c"ase! a :n(A!a, deoarece !ns(r+!rea
    .or%a"7 &en(r+ c!(!( n+ :nce&e de re$+"7 &An7 :n aces( %o%en( :n ce"e %a! %+"(e
    sco"! :n s&ec!a" cAnd d!s"e<!a es(e asoc!a(7 c+ +n DI :na"(, co&!"+" &oa(e .+nc=!ona "a,
    sa+ a&roa&e "a, n!ve"+" c"ase!, :n &r!%e"e c"ase, d!s"e<!a nedeve%nd &e de&"!n
    ev!den(7 &An7 :n c"asa a &a(ra sa+ c!ar %a! (Ar/!+ C+ !den(!.!care s! !n(erven=!e
    &recoce, &ro$nos(!c+" es(e '+n :n(r4+n &rocen( se%n!.!ca(!v de ca/+r! D!s"e<!a
    &oa(e &ers!s(a :n v!a(a ad+"(7
    #attern $amilial
    D!s"e<!a se a$re$7 .a%!"!a" s! es(e %a! .recven(7 &r!n(re r+de"e '!o"o$!ce de
    $rad+" I a"e !nd!v!/!"or c+ d!s"e<!e
    4EA E Discalcu%a &Tulburarea de
    alcul)
    <4
    Dia!nostic di$erenial
    3e/! sec=!+nea SD!a$nos(!c d!.eren=!a"T &en(r+ (+"'+r7r!"e de :nv7=are E&a$ Y5J
    Criteriile $e $ia/no&ti# pentru 4*<.++ Di&le,ie
    A #er$ormanta "n lexie, msurat prin teste standardi(ate de corectitudine si
    "nele!ere a lecturii, administrate individual, este substanial sub cea
    expectat dat $und etatea cronolo!ic a persoanei, inteli!enta msurat si
    educaia corespun(toare etii
    S #erturbarea de la criteriul A inter$erea( semni$icativ cu2per$ormanta
    ,colar sau cu activitile vieii cotidiene care necesit aptitudini lexice
    Dac este pre(ent un de$icit sen(orial, di$icultile de lexie sunt "n exces $at
    de cele asociate de re!ul cu acesta
    Not( $e #o$i%i#are Dac este pre(ent o condiie medical !eneral &de ex,
    neurolo!ic) sau un de$icit sen(orial, condiia se codi$ic pe axa III
    4*<.* Di&#al#ulia 3Tul-urarea $e Cal#ul6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" d!sca"c+e! :" cons(!(+!e ca&ac!(a(ea %a(e%a(!c7 E%7s+ra(7
    &r!n (es(e s(andard!/a(e de ca"c+" sa+ ra=!ona%en( %a(e%a(!c, ad%!n!s(ra(e
    !nd!v!d+a"J s+'s(an=!a" s+' cea e<&ec(a(7 de "a e(a(ea crono"o$!c7 a !nd!v!d+"+!,
    !n(e"!$en(a %7s+ra(7 s! ed+ca=!a cores&+n/7(oare e(7=!! Ecr!(er!+" AJ T+"'+rarea de
    ca"c+" !n(er.erea/7 se%n!.!ca(!v c+ &er.or%an(a Oco"ar7 sa+ c+ ac(!v!(7=!"e v!e=!!
    co(!d!ene care neces!(7 a&(!(+d!n! %a(e%a(!ce Ecr!(er!+" BJ Dac7 es(e &re/en( +n
    de.!c!( sen/or!a", d!.!c+"(7=!"e :n ca&ac!(a(ea de a ca"c+"a s+n( !n e<ces .a(7 de ce"e
    asoc!a(e de re$+"7 c+ aces(a Ecr!(er!+" CJ Dac7 o cond!=!e ne+ro"o$!c7 sa+ o a"(7
    cond!=!e %ed!ca"7 $enera"7 or! +n de.!c!( sen/or!a" es(e &re/en(, aces(a va .! cod!.!ca(
    &e a<a III Un n+%7r de a"(e a&(!(+d!n! d!.er!(e &oa(e .! de(er!ora( :n d!sca"c+"!e,
    !nc"+/And a&(!(+d!n!"e S"!n$v!s(!ceT Ede e< , :n=e"e$erea sa+ den+%!rea (er%en!"or,
    o&era=!!"or sa+ conce&(e"or %a(e%a(!ce s! decodarea &ro'"e%e"or scr!se :n s!%'o"+r!
    %a(e%a(!ceJ, a&(!(+d!n!"e S&erce&(neT Ede e<, rec+noaO(erea sa+ c!(!rea
    s!%'o"+r!"or n+%er!ce or! a se%ne"or ar!(%e(!ce s! ad+narea o'!ec(e"or :n $r+&eJ,
    a&(!(+d!n!"e S&rose<!ceT Ede e<, co&!erea corec(7 a n+%ere"or sa+ c!.re"or, (!nerea
    %!n(e &en(r+ a .! ad+na(e a n+%ere"or de Sre&or(a(T s! o'servarea se%ne"or
    o&era=!ona"eJ s! a&(!(+d!n!"e S%a(e%a(!ceT Ede e<, +r%7r!rea secven=e"or
    &rocedee"or %a(e%a(!ce, n+%7rarea o'!ec(e"or, :nv7=area (a'"e! :n%+"=!%J
    *lemente si tulburri asociate
    3e/! sec=!+nea SE"e%en(e s! (+"'+r7r! asoc!a(eT &en(r+ (+"'+r7r!"e de :nv7=are
    E&a$ YLJ D!sca"c+a es(e :n(A"n!(7 .recven( :n co%'!na=!e c+ d!s"e<!a sa+ c+
    d!s$ra.!a
    Tulburrile dia!nosticate de re!ul pentru prima dat
    AH "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    #revalent
    Preva"en(a d!sca"c+"!e! es(e d!.!c!" de s(a'!"!(, deoarece %+"(e s(+d!! s4a+
    concen(ra( as+&ra &reva"en(e! (+"'+r7r!"or de :nv7=are, .7r7 se&ararea
    cores&+n/7(oare :n (+"'+r7r! s&ec!.!ce de "e<!e, de ca"c+" or! de e<&res!e $ra.!c7.
    Preva"en(a d!sca"c+"!e! n+%a! Ead!c7, a(+nc! cAnd n+ es(e :n(A"n!(7 :n asoc!ere c+ a"(e
    (+"'+r7r! de :nv7=areJ a .os( es(!%a(7 "a a&ro<!%a(!v +n+ d!n .!ecare c!nc! ca/+r! de
    (+"'+rare de :nv7=are. Se es(!%ea/7 c7 5d d!n(re co&!! de e(a(e Oco"ar7 a+
    d!sca"c+"!e.
    *voluie
    DeO! s!%&(o%e"e de d!.!c+"(a(e :n ca"c+" Ede e<., con.+/!e :n conce&(e"e de n+%7r
    sa+ !nca&ac!(a(ea de a n+%7ra corec(J &o( a&are :nc7 de "a $r7d!n!=7 sa+ d!n c"asa I4a,
    d!sca"c+"!a es(e rar d!a$nos(!ca(7 :na!n(e de .!ne"e c"ase! a I4a, deoarece &An7 "a
    aceas(7 da(7 !ns(r+!rea %a(e%a(!c7 o.!c!a"7 n+ a av+( de re$+"7 "oc :n ce"e %a! %+"(e
    sco"!. Ea dev!ne de re$+"7 ev!den(7 :n c+rs+" c"ase! a I"4a sa+ a I"I4a. :n s&ec!a" cAnd
    d!sca"c+"!a es(e asoc!a(7 c+ +n DI :na"(, co&!"+" &oa(e .! ca&a'!" s7 .+nc=!one/e "a, sa+
    a&roa&e "a, n!ve"+" c"ase!, :n &r!%e"e c"ase, !ar d!sca"c+"!a s7 n+ dev!n7 ev!den(7
    &An7 :n c"asa a 34a sa+ c!ar %a! (Ar/!+.
    Dia!nostic di$erenial
    3e/! sec=!+nea de SD!a$nos(!c d!.eren=!a"T &en(r+ (+"'+r7r!"e de :nv7=are E&a$. Y5J.
    Criteriile $e $ia/no&ti# pentru 4*<. Di&#al#ulie
    A2 apacitatea de calcul aritmetic, msurat prin teste standardi(ate, este
    substanial sub cea expectat, dat $iind etatea cronolo!ic a persoanei,
    inteli!ena msurat ,i educaia corespun(toare etii2
    S2 #erturbarea de la criteriul A, inter$erea( semni$icativ cu per$ormana
    ,colar sau cu activitile vieii cotidiene care necesit aptitudini
    matematice2
    2 Dac este pre(ent un de$icit sen(orial, di$icultile "n aptitudinea
    matematic sunt "n exces "n raport cu cele asociate de re!ul cu acesta2
    Fot de codi$icareD Dac este pre(ent o condiie medical !eneral &de ex2,
    neurolo!ic) sau un de$icit sen(orial, condiia se codi$ic pe axa III2
    4*<.C Di&/ra%ia 3Tul-urarea E,pre&iei Gra%i#e6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" d!s$ra.!e! E(+"'+rarea e<&res!e! $ra.!ceJ :" cons(!(+!e
    a&(!(+d!n!"e $ra.!ce E%7s+ra(e &r!n(r4+n (es( s(andard!/a(, ad%!n!s(ra( !nd!v!d+a"
    sa+ a&rec!erea .+nc=!ona"7 a a&(!(+d!n!"or $ra.!ceJ care s+n( s+'s(an=!a" s+' ce"e
    4EA7 Dis!ra$ia &Tulburarea *xpresiei
    Gra$ice)
    <<
    e<&ec(a(e, da(7 .+nd e(a(ea crono"o$!c7 a !nd!v!d+"+!, !n(e"!$en=a %7s+ra(7 O!
    ed+ca=!a cores&+n/7(oare e(7=!! Ecr!(er!+" AJ Per(+r'area :n e<&res!a $ra.!c7
    !n(er.erea/7 se%n!.!ca(!v c+ re+O!(a Oco"ar7 sa+ c+ ac(!v!(7=!"e v!e=!! co(!d!ene care
    neces!(7 a&(!(+d!n! $ra.!ce Ecr!(er!+" BJ Dac7 es(e &re/en( +n de.!c!( sen/or!a",
    d!.!c+"(7=!"e :n a&(!(+d!n!"e $ra.!ce s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7
    c+ aces(a Ecr!(er!+" CJ De ase%enea, dac7 es(e &re/en(7 o cond!=!e ne+ro"o$!c7 sa+
    a"(7 cond!=!e %ed!ca"7 $enera"7 or! +n de.!c!( sen/or!a", aces(a (re'+!e cod!.!ca( &e
    a<a III :n $enera", e<!s(7 o co%'!na=!e de d!.!c+"(7=! :n ca&ac!(a(ea !nd!v!d+"+! de
    a co%&+ne (e<(e scr!se, ev!den=!a(7 &r!n eron $ra%a(!ca"e sa+ de &+nc(+a=!e :n
    cadr+" &ro&o/!=!+n!"or, or$an!/are de.ec(+oas7 a &ara$ra.e"or, eron %+"(!&"e de
    or(o$ra.!e s! scr!s e<(re% de +rA( :n $enera", aces( d!a$nos(!c n+ es(e &+s, dac7
    e<!s(7 n+%a! eror! or(o$ra.!ce sa+ n+%a! scr!s +rA(, :n a'sen(a a"(e! de(er!or7r! a
    e<&res!e! $ra.!ce :n co%&ara=!e c+ a"(e (+"'+r7r! de :nv7=are, des&re (+"'+r7r!"e
    e<&res!e! $ra.!ce s! re%ed!erea "or se O(!e .oar(e &+=!n, :n s&ec!a" cAnd aces(ea
    s+rv!n :n a'sen=a d!s"e<!e! C+ e<ce&=!a or(o$ra.!e!, :n aces( do%en!+, (es(e"e
    s(andard!/a(e s+n( %a! &+=!n '!ne e"a'ora(e decA( (es(e"e &en(r+ a&(!(+d!nea de a
    c!(! sa+ de a ca"c+"a, !ar eva"+area de(er!or7% :n a&(!(+d!n!"e $ra.!ce &oa(e neces!(a
    o co%&ara=!e :n(re eOan(!oane :n(!nse de (e%e Oco"are scr!se a"e !nd!v!d+"+!,
    &er.or%an=a e<&ec(a(7 &en(r+ e(a(ea sa s! DI Aces(a es(e :n s&ec!a" ca/+" &en(r+
    co&!!! %!c! d!n &r!%e"e c"ase e"e%en(are Sarc!n!"e :n care co&!"+" es(e &+s s7
    co&!e/e +n (e<(, s7 scr!e s+' d!c(are s! scr!s+" s&on(an &o( .! (oa(e necesare &en(r+
    a s(a'!"! &re/en(a s! sever!(a(ea aces(e! (+"'+r7r!
    *lemente si tulburri asociate
    3e/! sec=!+nea SE"e%en(e s! (+"'+r7r! asoc!a(e2 &en(r+ (+"'+r7r!"e de :nv7=are
    E&a$ YLJ D!'$ra.!a es(e :n(A"n!(7 .recven( :n co%'!na=!e c+ d!'"e<!a s! d!sca"c+"!a
    E<!s(7 +ne"e &ro'e c7 de.!c!(e"e de "!%'a@ s! ce"e &erce&(!vo4%o(or+ &o( aco%&an!a
    aceas(7 (+"'+rare
    #revalent
    Preva"en(a d!s$ra.!e! es(e d!.!c!" de s(a'!"!(, deoarece %+"(e s(+d!! s4a+ concen(ra(
    as+&ra &reva"en(e! (+"'+r7r!"or de :nv7=are .7r7 a "e se&ara cores&+n/7(or :n
    (+"'+r7r! s&ec!.!ce de "e<!e, de ca"c+" sa+ de e<&res!e $ra.!c7 D!s$ra.!a es(e rar7,
    cAnd n+ es(e asoc!a(7 c+ a"(e (+"'+r7r! de :nv7=are
    *voluie
    DeO! d!.!c+"(a(ea $ra.!c7 Ede e< , scr!s+" e<(re% de +rA(, !nca&ac!(a(ea de a co&!a
    sa+ !nca&ac!(a(ea de a4s! a%!n(! secven=e"e de "!(ere :n c+v!n(e"e co%+neJ &oa(e
    a&are :nc7 d!n c+rs+" c"ase! a I4a, d!s$ra.!a es(e rar d!a$nos(!ca(7 :na!n(e de .!ne"e
    c"ase! a I4a, deoarece &An7 "a aceas(7 da(7 :n ce"e %a! %+"(e sco"! n+ s4a .7c+(
    s+.!c!en(7 !ns(r+!re o.!c!a"7 :n "e$7(+r7 c+ scr!s+" T+"'+rarea es(e ev!den(7 de re$+"7
    :n c"asa a I"4a D!s$ra.!a &oa(e .! v7/+(7 oca/!ona" s! "a co&!! %a! %ar! or! "a ad+"=!,
    !ar des&re &ro$nos(!c+" s7+ &e (er%en "+n$ se O(!e .oar(e &+=!n
    Tulburrile dia!nosticate de re!ul pentru prima dat
    AI "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    Dia!nostic di$erenial
    3e/! sec=!+nea SD!a$nos(!c d!.eren=!a"T &en(r+ (+"'+r7r!"e de :nv7=are E&a$ Y5J
    O (+"'+rare !n(eresAnd n+%a! or(o$ra.!a sa+ scr!s+", :n a'sen(a a"(or d!.!c+"(7=! a"e
    e<&res!e! $ra.!ce, n+ :ndre&(7=eO(e :n $enera" "a d!a$nos(!c+" de d!s$ra.!e Dac7
    scr!s+" +rA( se da(orea/7 +ne! de(er!or7r! a coordon7% %o(or!!, (re'+!e "+a( :n
    cons!dera=!e d!a$nos(!c+" de (+"'+rare de de/vo"(are a coordon7%
    Criteriile $e $ia/no&ti# pentru 4*<.C Di&/ra%ie
    A Aptitudinile !ra$ice, msurate prin teste standardi(ate administrate
    individual &sau evalurile $uncionale ale aptitudinilor !ra$ice), sunt
    substanial sub cele expectate, dat $und etatea cronolo!ic a persoanei si
    educaia corespun(toare etii
    S #erturbarea de la
    ,colar sau cu ac
    criteriul A inter$erea( semni$icativ cu per$ormanta
    tivittile vietn cotidiene care necesit compunerea de texte scrise &de ex,
    propo(itium sau para!ra$e or!ani(ate, scrise corect !ramatical)
    Dac este pre(ent un de$icit sen(orial, di$icultile "n aptitudinile !ra$ice
    sunt "n exces "n raport cu cele asociate de re!ul cu acesta
    Fot de codi$icareD Dac este pre(ent o condiie medical &de ex,
    neurolo!ic) sau un de$icit sen(orial, condiia se codi$ic pe axa III
    4*<.5 Tul-urare $e .nv(!are '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e re/erva(7 (+"'+r7r!"or de :nv7=are care n+ sa(!s.ac
    cr!(er!!"e &en(r+ n!c! o (+"'+rare de :nv7=are s&ec!.!c7 Aceas(7 ca(e$or!e &oa(e
    !nc"+de &ro'"e%e d!n (oa(e ce"e (re! do%en!!, "e<!e, ca"c+", $ra.!e, care, :%&re+n7,
    !n(er.erea/7 c+ &er.or%an(a Oco"ar7, c!ar dac7 re/+"(a(+" "a (es(e"e %7s+rAnd
    .!ecare a&(!(+d!ne !nd!v!d+a"7 n+ es(e s+'s(an=!a" s+' ce" e<&ec(a(, da(7 .+nd e(a(ea
    crono"o$!c7 a &ersoane!, !n(e"!$en=a %7s+ra(7 s! ed+ca=!a cores&+n/7(oare e(7(n
    Tul-urarea aptitu$inilor "otorii
    4*<.7 Tul-urarea $e De)voltare a Coor$on(rii
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de de/vo"(are a coordon7% :" cons(!(+!e o
    de(er!orare cons!dera'!"7 :n de/vo"(area coordon7r!! %o(or!! Ecr!(er!+" AJ
    D!a$nos(!c+" es(e &+s n+%a! dac7 de(er!orarea !n(er.erea/7 se%n!.!ca(!v c+
    &er.or%an(a Oco"ar7 sa+ c+ ac(!v!(7=!"e _!e(+ co(!d!ene Ecr!(er!+" BJ D!a$nos(!c+" se
    4EAH Tulburarea de De(voltare a
    oordonm
    A?
    &+ne n+%a! dac7 d!.!c+"(7=!"e de coordonare n+ se da(orea/7 +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<, &ara"!/!e cere'ra"7, e%!&"e$!e sa+ d!s(ro.!c %+sc+"ar7J, !ar
    cr!(er!!"e &en(r+ (+"'+rarea de de/vo"(are &ervas!v7 n+ s+n( sa(!s.7c+(e Ecr!(er!+" CJ
    Dac7 es(e &re/en(7 re(ardarea %en(a"7, d!.!c+"(7=!"e %o(or!! s+n( :n e<ces :n ra&or(
    c+ ce"e asoc!a(e de re$+"7 c+ aceas(a Ecr!(er!+" DJ Man!.es(an(e aces(e! (+"'+r7r!
    var!a/7 c+ e(a(ea s! c+ de/vo"(area De e<e%&"+, co&!! %a! %!c! &o( &re/en(a
    s(An$7c!e s! :n(Ar/!er! :n a(!n$erea @a"oane"or de de/vo"(are %o(one Ede e< , %ers,
    (ArA(, aOe/a(, :noda(+" s!re(+r("or "a &an(o.!, :nce!erea nas(+n"or "a c7%ase,
    :nce!erea .er%oar+"+! "a &an(a"on!J Co&!!! %a! %An &o( &re/en(a d!.!c+"(7=! :n
    as&ec(+" %o(or a" asa%'"7r!! +nor @oc+r!, a" cons(r+!r!! d+&7 %ode"e, a" @oc+"+! c+
    'a"on+", a" desena(+"+! sa+ scr!s+"+!
    *lemente si tulburri asociate
    Pro'"e%e"e asoc!a(e .recven( c+ (+"'+rarea de de/vo"(are a coordon7% !nc"+d
    :n(Ar/!er! s! :n a"(e @a"oane non%o(o% T+"'+r7r!"e asoc!a(e &o( !nc"+de (+"'+rarea
    .ono"o$!c7, (+"'+rarea de "!%'a@ e<&res!v s! (+"'+rarea %!<(7 de "!%'a@ rece&(n s!
    e<&res!v
    #revalent
    Preva"en(a (+"'+r7r!! de de/vo"(are a coordon7r!! a .os( es(!%a(7 a .! %a! %are
    de Rd &en(r+ co&!! d!n $r+&a de e(a(e Y455 a%
    *voluie
    Rec+noaO(erea (+"'+r7r!! de de/vo"(are a coordon7% s+rv!ne de re$+"7 cAnd
    co&!"+" :ncearc7 s7 e.ec(+e/e &en(r+ &r!%a da(7 sarc!n! &rec+% a"er$a(+", =!n+(+" :n
    %An7 a" c+=!(+"+! s! .+rc+"!=e!, :nce!erea nas(+n"or sa+ @oc+n c+ 'a"on+" Evo"+=!a
    es(e var!a'!"7 :n +ne"e ca/+r!, "!&sa de coordonare be con(!n+7 :n ado"escen(7 s! :n
    &er!oada ad+"(7
    Dia!nostic di$erenial
    T+"'+rarea de de/vo"(are a coordon7% (re'+!e s7 .!e d!s(!ns7 de de(er!or7r!"e
    %o(or!! da(ora(e +ne! cond!=!! %ed!ca"e $enera"e Pro'"e%e"e de coordonare &o( .!
    asoc!a(e c+ (+"'+r7r! ne+ro"o$!ce s&ec!.!ce Ede e<, &ara"!/!e cere'ra"7, "e/!+n!
    &ro$res!ve a"e cere'e"+"+!J, dar :n aces(e ca/+r! e<!s(7 o "e/!+ne nervoas7 &rec!s7 s!
    da(e anor%a"e "a e<a%en+" ne+ro"o$!c Dac7 es(e &re/en(7 re(ardarea %en(a"7,
    (+"'+rarea de de/vo"(are a coordon7% &oa(e .! d!a$nos(!ca(7 n+%a! dac7
    d!.!c+"(7=!"e %o(or!! s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ re(ardarea
    %en(a"7 D!a$nos(!c+" de (+"'+rare de de/vo"(are a coordon7% n+ es(e &+s dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ o (+"'+rare de de/vo"(are &ervas!v7 Ind!v!/!! c+
    (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e &o( c7dea, se &o( "ov! de, sa+ r7s(+rna,
    d!verse o'!ec(e, dar aceas(a se da(orea/7 de re$+"7 d!s(rac(!'!(7(n s! !%&+"s!v!(7=!!
    %a! c+rAnd decA( +ne! de(enor7n %o(or!! Dac7 s+n( sa(!s.7c+(e cn(en!"e &en(r+
    a%'e"e (+"'+r7r!, &o( .! &+se a%'e"e d!a$nos(!ce
    Tulburrile dia!nosticate de re!ul pentru prima dat
    <> "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    Criteriile $e $ia/no&ti# pentru
    4*<.7 Tul-urarea $e De)voltare a Coor$on(rii
    A #er$ormanta "n activitile cotidiene care cer coordonare motorie este
    substanial sub cea expectat, dat $und etatea cronolo!ic a persoanei si
    inteli!enta msurat Acesta se poate mani$esta prin "nt@r(ieri marcate "n
    atin!erea 0aloanelor motorii &de ex, mersul, t@r@tul, a,e(atul), scparea
    obiectelor din m@n, =st@n!cie>, per$ormante reduse "n sport, scris de
    m@n ur@t
    S #erturbarea de la criteriul A inter$erea( cu per$ormanta ,colar sau cu
    activitile vieii cotidiene
    #erturbarea nu se datorea( unei condiii medicale !enerale &de ex,
    parali(ie cerebral, %emiple!ie sau distro$ie muscular) si nu satis$ace
    criteriile pentru tulburarea de de(voltare pervasiv
    D Dac este pre(ent retardarea mental, di$icultile motorii sunt "n exces "n
    raport cu cele asociate de re!ul cu acesta
    Fot de codi$icareD Dac este pre(ent o condiie medical !eneral &de ex2,
    neurolo!ic) sau un de$icit sen(orial, condiia se codi$ic pe axa III
    Tul-ur(rile $e #o"uni#are
    :n aceas(7 sec=!+ne s+n( !nc"+se +r%7(oare"e (+"'+r7r! de co%+n!care (+"'+rarea
    de "!%'a@ e<&res!v, (+"'+rarea %!<(7 de "!%'a@ rece&(!v s! e<&res!v, (+"'+rarea
    .ono"o$!c7, 'a"'!s%+", (+"'+rarea de co%+n!care .7r7 a"(7 s&ec!.!ca=!e E"e s+n(
    !nc"+se :n aceas(7 c"as!.!care &en(r+ a .a%!"!ar!/a cn!c!en+ c+ %od+r!"e :n care se
    &re/!n(7 (+"'+r7r!"e de co%+n!care s! &en(r+ a .ac!"!(a d!a$nos(!c+" "or d!.eren=!a"
    4*<.4* Tul-urarea $e Li"-aQ E,pre&iv
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de "!%'a@ e<&res!v :" cons(!(+!e o de(er!orare :n
    de/vo"(area "!%'a@+"+! e<&res!v de%ons(ra(7 de scor+r!"e "a %7s+r7r!"e
    s(andard!/a(e, ad%!n!s(ra(e !nd!v!d+a", a"e de/vo"(7r!! "!%'a@+"+! e<&res!v, care
    s+n( s+'s(an=!a" s+' ce"e o'=!n+(e "a %7s+r7r!"e s(andard!/a(e, a(A( a"e ca&ac!(7=!!
    !n(e"ec(+a"e nonver'a"e, cA( s! a"e de/vo"(7% "!%'a@+"+! rece&(!v Ecr!(er!+" AJ CAnd
    !ns(r+%en(e"e s(andard!/a(e n+ s+n( d!s&on!'!"e sa+ n+ s+n( adecva(e, d!a$nos(!c+"
    se &oa(e 'a/a &e o eva"+are .+nc=!ona"7 de(a"!a(7 a a&(!(+d!n!! "%$_ !sce a
    !nd!v!d+"+! Po( s+rven! d!.!c+"7(! :n co%+n!care !%&"!cAnd a(A( "!%'a@+" ver'a", cA(
    s! se%ne"e "!n$v!s(!ce D!.!c+"(7=!"e "!n$v!s(!ce !n(er.erea/7 c+ &er.or%an(a Oco"ar7
    sa+ &ro.es!ona"7 or! c+ co%+n!carea soc!a"7 Ecr!(er!+" BJ S!%&(o%e"e n+ (re'+!e s7
    sa(!s.ac7 cr!(er!!"e &en(r+ (+"'+rarea %!<(7 de "!%'a@ e<&res!v s! rece&(!v or! &en(r+
    4EA24E Tulburarea de Limba0
    *xpresiv
    YF

    o (+"'+rare de de/vo"(are &ervas!v7 Ecr!(er!+" CJ. Dac7 es(e &re/en(7 re(ardarea
    %en(a"7, +n de.!c!( ver'o%o(or sa+ +n de.!c!( sen/or!a" or! de&r!varea a%'!en(a"7,
    d!.!c+"(7=!"e :n "!%'a@ s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ aces(e
    &ro'"e%e Ecr!(er!+" DJ. Dac7 es(e &re/en( +n de.!c!( ver'o%o(or sa+ sen/or!a" or! o
    cond!=!e ne+ro"o$!c7, aceas(a (re'+!e s7 .!e cod!.!ca(7 &e a<a III.
    E"e%en(e"e "!n$v!s(!ce a"e (+"'+r7r!! var!a/7 :n .+nc=!e de sever!(a(ea sa s! de
    e(a(ea co&!"+"+!. Aces(e e"e%en(e !nc"+d +n de'!( ver'a" red+s, +n voca'+"ar red+s,
    d!.!c+"(7=! :n ac!/!=!onarea de c+v!n(e no!, :n re&erarea c+v!n(e"or sa+ eror! de
    voca'+"ar, &ro&o/!=!+n! sc+r(e, s(r+c(+r! $ra%a(!ca"e s!%&"!.!ca(e, var!e(7=! red+se
    de s(r+c(+r! $ra%a(!ca"e Ede e<., .or%e ver'a"eJ, var!e(7=! red+se de (!&+r! de
    &ro&o/!=!+n! Ede e<., &ro&o/!=!+n! !%&era(!ve, !n(ero$a(!veJ, o%!s!+n! a"e &7r=!"or
    dec!s!ve a"e .ra/e"or, +(!"!/area +ne! ord!n! !nso"!(e a c+v!n(e"or s! r!(% "en( de
    de/vo"(are a "!%'a@+"+!. F+nc=!onarea non"!n$v!s(!c7 E%7s+ra(7 &r!n &er.or%an=a "a
    (es(e"e de !n(e"!$en=7 s! a&(!(+d!n!"e de :n=e"e$ere a "!%'a@+"+! s+n( de re$+"7 :n
    "!%!(e nor%a"e. T+"'+rarea de "!%'a@ e<&res!v &oa(e .!, .!e c7&7(a(7, .!e de
    de/vo"(are, :n (!&+" c7&7(a(, de(er!orarea :n "!%'a@+" e<&res!v s+rv!ne d+&7 o
    &er!oad7 de de/vo"(are nor%a"7, ca re/+"(a( a" +ne! cond!=!! ne+ro"o$!ce sa+ a" +ne!
    a"(e cond!=!! %ed!ca"e $enera"e Ede e<., ence.a"!(7, (ra+%a(!s% cran!ocere'ra",
    !rad!ereJ, :n (!&+" de de/vo"(are, e<!s(7 o de(er!orare :n "!%'a@+" e<&res!v care n+
    es(e asoc!a(7 c+ o a.ec=!+ne ne+ro"o$!c7 &os(na(a"7 de or!$!ne c+nosc+(7. Co&!!! c+
    aces( (!& de (+"'+rare :nce& s7 vor'easc7 adesea (Ar/!+ O! (rec %a! "en( decA( :n %od
    +/+a" &r!n d!verse"e s(ad!! de de/vo"(are a "!%'a@+"+! e<&res!v.
    *lemente si tulburri asociate
    Ce" %a! co%+n e"e%en( asoc!a( a" (+"'+r7r!! de "!%'a@ e<&res!v "a co&!!! %!c! es(e
    (+"'+rarea .ono"o$!c7. Poa(e e<!s(a, de ase%enea, o &er(+r'are :n ."+en=a s!
    .or%+"area "!%'a@+"+!, !%&"!cAnd +n c+rs anor%a" de ra&!d s! +n r!(% nere$+"a( a"
    vor'!r!!, s! &er(+r'7r! :n s(r+c(+ra "!%'a@+"+! ES(+%+"(+s ser%on!sTJ. CAnd
    (+"'+rarea de "!%'a@ e<&res!v es(e c7&7(a(7, d!.!c+"(7=! s+&"!%en(are :n vor'!re s+n(,
    de ase%enea, co%+ne s! &o( !nc"+de &ro'"e%e de ar(!c+"are %o(or!e, eror!
    .ono"o$!ce, "en(oare :n vor'!re, re&e(!=!! de s!"a'e, !n(ona=!e %ono(on7, &a((ern+r! de
    accen(+are. La co&!!! de e(a(e Oco"ar7, &ro'"e%e"e Oco"are s! de :nv7=are Ede e<.,
    scr!s+" d+&7 d!c(are, co&!erea de &ro&o/!=!+n!, or(o$ra.!aJ, care sa(!s.ac +neor!
    cr!(er!!"e &en(r+ (+"'+r7r!"e de :nv7=are, s+n( asoc!a(e adesea c+ (+"'+rarea de
    "!%'a@ e<&res!v. Ma! &oa(e e<!s(a, de ase%enea, o de(er!orare +Ooar7 a a&(!(+d!n!"or
    de "!%'a@ rece&(!v, !ar cAnd aceas(a es(e se%n!.!ca(!v7, &oa(e .! &+s d!a$nos(!c+" de
    (+"'+rare %!<(7 de "!%'a@ e<&res!v s! rece&(!v. Un !s(or!c de :n(Ar/!ere :n a(!n$erea
    @a"oane"or %o(or!!, de (+"'+rare de de/vo"(are a coordon7r!! s! de en+re/!s n+ s+n(
    rare. Re(ra$erea soc!a"7 s! +ne"e (+"'+r7r! %en(a"e, c+% ar .! (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e, s+n( des(+" de .recven( asoc!a(e. T+"'+rarea de
    "!%'a@ e<&res!v &oa(e .! aco%&an!a(7 de ano%a"!! EE,, da(e anor%a"e "a !%a$!s(!ca
    cere'ra"7, co%&or(a%en(e d!/ar(r!ce sa+ a&ra<!ce or! de a"(e se%ne ne+ro"o$!ce.
    *lemente speci$ice culturii si sexului
    Eva"+7r!"e de/vo"(7r!! a&(!(+d!n!"or de co%+n!care (re'+!e s7 =!n7 con( de
    con(e<(+" c+"(+ra" s! "!n$v!s(!c a" !nd!v!d+"+!, :n s&ec!a" "a !nd!v!/!! cresc+=! :n %ed!!
    '!"!n$ve. M7s+r7r!"e s(andard!/a(e a"e de/vo"(7r!! "!%'a@+"+! s! a"e ca&ac!(7=!!
    !n(e"ec(+a"e nonver'a"e (re'+!e s7 .!e re"evan(e &en(r+ $r+&+" c+"(+ra" s! "!n$v!s(!c
    Tulburrile dia!nosticate de re!ul pentru prima dat
    =+ "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Ede e<., (es(e"e e"a'ora(e s! s(andard!/a(e &en(r+ +n $r+& &o( s7 n+ o.ere nor%e
    cores&+n/7(oare &en(r+ +n $r+& d!.er!(J. T!&+" de de/vo"(are a" (+"'+r7r!! de "!%'a@
    e<&res!v es(e %a! .recven( "a '7r'a=! decA( "a .e%e!.
    #revalent
    Es(!%7r!"e &reva"en(e! var!a/7 c+ e(a(ea. La co&!! s+' ; an!, :n(Ar/!er!"e :n "!%'a@
    s+n( .oar(e .recven(e, s+rven!nd :n 5L45Yd d!n(re co&!!. La e(a(ea Oco"ar7 es(!%7r!"e
    &reva"en(e! %er$ de "a ;d "a NO7 T!&+" de de/vo"(are a" (+"'+r7r!! de "!%'a@
    e<&res!v es(e %a! .recven( decA( (!&+" c7&7(a(.
    *voluie
    T!&+" de de/vo"(are a" (+"'+r7r!! de "!%'a@ e<&res!v es(e rec+nosc+( de re$+"7 "a
    e(a(ea de ; an!, :ns7 .or%e"e +Ooare a"e (+"'+r7r!! &o( s7 n+ dev!n7 ev!den(e &An7 "a
    :nce&+(+" ado"escen=e!, cAnd "!%'a@+" dev!ne de re$+"7 %a! co%&"e<. T!&+" c7&7(a(
    de (+"'+rare de "!%'a@ e<&res!v da(ora( "e/!+n!"or cere'ra"e, (ra+%a(!s%e"or
    cran!ene, !c(+s+r!"or, &oa(e s+rven! "a or!ce e(a(e, !ar de'+(+" es(e 'r+sc.
    De/nod7%An(+" (!&+"+! de de/vo"(are a" (+"'+r7r!! de "!%'a@ e<&res!v es(e var!a'!".
    Ma@or!(a(ea co&!!"or c+ aces(a (+"'+rare se a%e"!orea/7 s+'s(an=!a", :ns7 :n(r4+n %!c
    &rocen( d!.!c+"(7=!"e &ers!s(7 O! :n &er!oada ad+"(7.
    Ce! %a! %+"=! co&!! ca&7(7, :n ce"e d!n +r%7, a&(!(+d!n! "!n$v!s(!ce %a! %+"( sa+
    %a! &+=!n nor%a"e, &An7 (Ar/!+ :n ado"escen=7, c+ (oa(e c7 &o( &ers!s(a de.!c!(e
    s+'(!"e, :n (!&+" c7&7(a( a" (+"'+r7r!! de "!%'a@ e<&res!v, evo"+=!a O! &ro$nos(!c+" s+n(
    :n ra&or( c+ sever!(a(ea s! "oca"!/area &a(o"o$!e! cere'ra"e, &rec+% O! c+ e(a(ea
    co&!"+"+! O! $rad+" de de/vo"(are a "!%'a@+"+! :n %o%en(+" c7&7(7r!! (+"'+r7r!!.
    A%e"!orarea c"!n!c7 a a&(!(+d!n!"or de "!%'a@ es(e +neor! ra&!d7 s! co%&"e(7, deO!
    &o( &ers!s(a de.!c!(e :n co%+n!care O! a&(!(+d!n!"e co$n!(!ve asoc!a(e, :n a"(e ca/+r!
    &oa(e e<!s(a +n de.!c!( &ro$res!v.
    #attern $amilial
    Se &are c7 (!&+" de de/vo"(are a" (+"'+r7r!! de "!%'a@ e<&res!v s+rv!ne %a!
    .recven( "a !nd!v!/!! care a+ +n !s(or!c .a%!"!a" de (+"'+r7r! de co%+n!care sa+ de
    (+"'+r7r! de :nv7=are. N+ e<!s(7 n!c! o &ro'7 de a$re$are .a%!"!a"7 :n (!&+" c7&7(a(.
    Dia!nostic di$erenial
    T+"'+rarea de "!%'a@ e<&res!v se d!s(!n$e de tulburarea mixt de limbaA
    receptiv si expresiv &r!n &re/en=a :n +"(!%a a +ne! de(er!or7r! se%n!.!ca(!ve a
    "!%'a@+"+! rece&(!v8 %+"=! !nd!v!/! c+ (+"'+rarea de "!%'a@ e<&res!v a+, de
    ase%enea, d!.!c+"(7=! s+'(!"e s! :n a&(!(+d!n!"e rece&(!ve.
    T+"'+rarea de "!%'a@ e<&res!v n+ va .! d!a$nos(!ca(7 dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ tulburarea autist sa+ &en(r+ o a"(7 tulburare de dezvoltare
    pervasiv. T+"'+rarea a+(!s(7 !%&"!c7, de ase%enea, o de(er!orare a "!%'a@+"+!
    e<&res!v, dar &oa(e .! d!s(!ns7 de (+"'+rarea de "!%'a@ e<&res!v O! de (+"'+rarea
    %!<(7 de "!%'a@ e<&res!v O! rece&(!v &r!n caracr(er!s(!c!"e de(er!or7r!! :n co%+n!care
    Ede e<., +(!"!/area s(ereo(!&7 a "!%'a@+"+!J s! &r!n &re/en=a +ne! de(er!or7r! ca"!(a(!ve
    :n !n(erac=!+nea soc!a"7 s! a +nor &a((ern+r! s(ereo(!&e, re&e(!(!ve O! res(rAnse de
    co%&or(a%en(. De/vo"(area "!%'a@+"+! rece&(!v s! e<&res!v &oa(e .! de(er!ora(7 d!n
    ca+/a retardrii mentale2 a +ne! deteriorri a auzului ori a altui deficit senzorial2
    Tulburrile dia!nosticate de re!ula pentru prima
    dat "n #erioada de Su!ar, "n opilrie sau "n
    Adolescent
    =*
    a +n+! de.!c!( ver'o%o(or on a +ne! de&r!v7n a%'!en(a"e severe Pre/en(a aces(or
    &ro'"e%e &oa(e .! s(a'!"!(7 &r!n (es(e de !n(e"!$en(7, (es(are a+d!o%e(nc7, (es(are
    ne+ro"o$!c7 s! !s(or!c Dac7 d!.!c+"(7=!"e de "!%'a[ s+n( :n e<ces :n ra&or( c+ ce"e
    asoc!a(e de re$+"7 c+ aces(e &ro'"e%e, &oa(e .! &+s d!a$nos(!c+" conco%!(en( de
    (+"'+rare a "!%'a@+"+! e<&res!v sa+ ce" de (+"'+rare %!<(7 de "!%'a[ e<&res!v s!
    rece&(!v Co&!!! c+ :n(Ar/!er! :n "!%'a@+" e<&res!v da(ora(e de&nv7r+ a%'!en(a"e &o(
    &re/en(a rec+&er7r! ra&!de, oda(7 ce &ro'"e%e"e a%'!en(a"e s4a+ a%e"!ora(
    :n d!s$ra.!e e<!s(7 o &er(+r'are :n a&(!(+d!n!"e $ra.!ce Dac7 s+n( &re/en(e, de
    ase%enea, s! de.!c!(e a"e e<&res!e! ora"e, +n d!a$nos(!c ad!=!ona" de (+"'+rare de
    "!%'a@ e<&res!v &oa(e .! adecva( M+(!s%+" se"ec(!v !%&"!c7 +n de'!( e<&res!v red+s
    care &oa(e %!%a (+"'+rarea de "!%'a@ e<&resn or! (+"'+rarea %!<(7 de "!%'a[
    e<&res!v s! rece&(!v, ca/ :n care +n !s(or!c s! o o'serva=!e a(en(7 s+n( necesare &en(r+
    a &rec!/a &re/en(a +n+! "!%'a@ nor%a" :n an+%!(e s!(+a=!! A.a/!a c7&7(a(7, asoc!a(7
    c+ o cond!=!e %ed!ca"7 $enera"7 :n co&!"7r!e es(e adesea (ran/!(or!e D!a$nos(!c+" de
    (+"'+rare de "!%'a@ e<&res!v es(e !nd!ca( n+%a! dac7 &er(+r'area "!%'a@+"+!
    &ers!s(7 s! d+&7 &er!oada de rec+&erare ac+(7 a cond!=!e! e(!o"o$!ce %ed!ca"e
    $enera"e Ede e< , +n (ra+%a(!s% cran!an, o !n.ec=!e v!ra"7J
    Criteriile $e $ia/no&ti# pentru 4*<.4*
    Tul-urarea $e Li"-aQ E,pre&iv
    A Scorurile obinute la msurrile standardi(ate ale de(voltm limba0ului
    expresiv administrate individual sunt substanial sub cele obinute la
    msurrile standardi(ate ale capacittMi intelectuale nonverbale si
    de(voltrii limba0ului receptiv #erturbarea se poate mani$esta clinic prin
    simptome care includ $aptul de a avea un vocabular considerabil redus, de
    a $ace erori "n con0u!area verbelor ori de a avea di$iculti "n evocarea
    cuvintelor sau "n crearea de propo(itiuni >ie lun!ime sau complexitate
    corespun(toare de(voltm
    S Di$icultile "n limba0ul expresiv inter$erea( cu per$ormanta ,colar sau
    pro$esional ori cu comunicarea social
    Fu sunt satis$cute criteriile pentru tulburarea mixt de limba0 expresiv si
    receptiv sau pentru o tulburare de de(voltare pervasiva
    D Dac este pre(ent retardarea mental, un de$icit verbomotor sau sen(orial
    ori deprivarea ambiental di$icultile de limba0 sunt "n exces "n raport cu
    cele asociate de re!ul cu aceste probleme
    Not( $e #o$i%i#areM Dac este pre(ent un de$icit verbomotor sau sen(orial ori o
    condiie neurolo!ic, condiia se codi$ic pe axa III
    Tulburrile dia!nosticate de re!ul pentru prima dat
    =C "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    4*<.4C Tul-urarea Mi,t( $e Li"-aQ E,pre&iv
    &i Re#eptiv
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! %!<(e de "!%'a@ e<&res!v s! rece&(!v :" cons(!(+!e
    o de(er!orare, a(A( :n de/vo"(area "!%'a@+"+! rece&(!v, cA( s! a ce"+! e<&res!v,
    de%ons(ra(7 &r!n scor+r!"e "a %7s+r7r!"e s(andard!/a(e, ad%!n!s(ra(e !nd!v!d+a",
    a"e de/vo"(7r!!, a(A( a "!%'a@+"+! rece&(!v, cA( s! a ce"+! e<&res!v, care s+n(
    s+'s(an=!a" s+' ce"e o'=!n+(e &r!n %7s+r7r!"e s(andard!/a(e a"e ca&ac!(7=!!
    !n(e"ec(+a"e nonver'a"e Ecr!(er!+" AJ. D!.!c+"(7=!"e care s+rv!n :n co%+n!care
    !%&"!c7, a(A( "!%'a@+" ver'a" cA( O! se%ne"e "!n$v!s(!ce. D!..c+"(7=!"e :n "!%'a@
    !n(er.erea/7 c+ &er.or%an=a Oco"ar7 sa+ &ro.es!ona"7, or! c+ co%+n!carea soc!a"7
    Ecr!(er!+" BJ, !ar s!%&(o%e"e n+ sa(!s.ac cr!(er!!"e &en(r+ o (+"'+rare &ervas!v7 de
    de/vo"(are Ecr!(er!+" CJ. Dac7 es(e &re/en(7 re(ardarea %en(a"7, +n de.!c!(
    ver'o%o(or sa+ sen/or!a", or! de&r!varea a%'!en(a"7, d!.!c+"(7=!"e :n "!%'a@ s+n( :n
    e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ aces(e &ro'"e%e Ecr!(er!+" DJ. Dac7 es(e
    &re/en( +n de.!c!( ver'o%o(or sa+ sen/or!a", or! o cond!=!e ne+ro"o$!c7, aces(ea vor
    .! cod!.!ca(e &e a<a III.
    Un !nd!v!d c+ aceas(7 (+"'+rare are d!.!c+"(7=!"e asoc!a(e c+ (+"'+rarea
    "!%'a@+"+! e<&res!v, Ede e<., voca'+"ar e<(re% de red+s, eror! :n co@+$area ver'e"or,
    d!.!c+"(7=! :n evocarea c+v!n(e"or sa+ :n crearea de &ro&o/!=!+n! de "+n$!%e sa+
    co%&"e<!(a(e cores&+n/7(oare de/vo"(7r!! s! d!.!c+"(a(e $enera"7 :n e<&r!%area
    !de!"orJ s!, de ase%enea, are d!.!c+"(7=! :n de/vo"(area "!%'a@+"+! rece&(!v Ede e<.
    d!.!c+"(7=! :n :n=e"e$erea c+v!n(e"or, &ro&o/!=!+n!"or or! a an+%!(or (!&+r! de c+v!n(e,
    :n ca/+r!"e +Ooare, &o( e<!s(a d!.!c+"(7=! n+%a! :n :n=e"e$erea an+%!(or (!&+r! de
    c+v!n(e Ede e<., a (er%en!"or s&a=!a"!J sa+ a an+%!(or s&ec!.!ca=!! Ede e<., a
    %a<!%e"or Sdac74a(+nc!TJ. In ca/+r!"e %a! severe, &o( e<!s(a !nca&ac!(7=! %+"(!&"e
    care !nc"+d !nca&ac!(a(ea de a :n=e"e$e voca'+"ar+" de 'a/7 sa+ &ro&o/!=!+n!"e
    s!%&"e, s! de.!c!(e :n d!verse do%en!! a"e &roces7r!! a+d!(!ve Ede e<., d!scr!%!narea
    s+ne(e"or, asoc!erea de s+ne(e O! s!%'o"+r!, conservarea, evocarea s! secven=!ereaJ.
    Deoarece de/vo"(area "!%'a@+"+! e<&res!v :n co&!"7r!e es(e :n ra&or( c+
    ac!/!=!onarea a&(!(+d!n!"or rece&(!ve, o (+"'+rare &+r7 de "!%'a@ rece&(!v Eana"o$7
    a.a/!e! 1ern!c)e de "a ad+"=!J n+ se :n(A"neO(e &rac(!c n!c!oda(7.
    T+"'+rarea %!<(7 de "!%'a@ e<&res!v s! rece&(!v &oa(e .!, .!e c7&7(a(7, .!e de
    de/vo"(are, :n (!&+" c7&7(a(, de(er!orarea :n "!%'a@+" rece&(!v s! :n "!%'a@+" e<&res!v
    s+rv!ne d+&7 o &er!oad7 de de/vo"(are nor%a"7, ca re/+"(a( a" +ne! cond!=!!
    ne+ro"o$!ce sa+ a" +ne! a"(e cond!=!! %ed!ca"e $enera"e Ede e<., ence.a"!(7,
    (ra+%a(!s% cran!an, !rad!ereJ, :n (!&+" de de/vo"(are e<!s(7 o de(er!orare :n "!%'a@+"
    rece&(!v O! :n ce" e<&res!v, care n+ es(e asoc!a(7 c+ o "e/!+ne ne+ro"o$!c7 de or!$!ne
    c+nosc+(7. Aces( (!& es(e carac(er!/a( &r!n(r4+n r!(% "en( de de/vo"(are a "!%'a@+"+!,
    :n care vor'!(+" :nce&e (Ar/!+ O! avansea/7 "en( &r!n s(ad!!"e de de/vo"(are a
    "!%'a@+"+!.
    *lemente si tulburri asociate
    E"e%en(e"e "!n$v!s(!ce a"e de(er!or7r!! &rod+cer!! "!%'a@+"+! :n (+"'+rarea %!<(7
    de "!%'a@ e<&res!v O! rece&(!v s+n( s!non!%e c+ ce"e care aco%&an!a/7 (+"'+rarea
    de "!%'a@ e<&res!v. De.!c!(+" de :n=e"e$ere es(e e"e%en(+" &r!nc!&a" care
    4EA 47 Tulburarea Mixt de Limba0 *xpresiv si +eceptiv =4
    d!.eren=!a/7 aceas(7 (+"'+rare de (+"'+rarea de "!%'a@ e<&res!v, !ar aceas(a &oa(e
    vana :n .+nc=!e de sever!(a(ea (+"'+r7r!! s! e(a(ea co&!"+"+! De(er!or7r!"e :n
    :n=e"e$erea "!%'a@+"+! &o( .! %a! &+=!n ev!den(e decA( ce"e :n &rod+cerea
    "!%'a@+"+!, deoarece e"e n+ s+n( (o( a(A( de +Oor de ses!/a( de c7(re o'serva(or s!
    &o( a&are n+%a! "a o eva"+are .or%a"7 Co&!"+" &oa(e &7rea, !n(er%!(en(, c7 n+
    a+de, c7 es(e con.+/ sa+ c7 n+ acord7 a(en=!e cAnd ! se vor'eO(e Co&!"+" &oa(e
    e.ec(+a !ncorec( co%en/!"e or! &oa(e s7 n+ "e e.ec(+e/e de"oc, s! s7 dea r7s&+ns+r!
    (an$en=!a"e sa+ !nadecva(e "a :n(re'7r! Co&!"+" &oa(e .! e<(re% de (7c+( sa+, d!n
    con(ra, .oar(e vor'7re= A&(!(+d!n!"e conversa=!ona"e Ede e<, sc!%'area,
    %en=!nerea +n+! s+'!ec( de d!sc+=!eJ s+n( adesea .oar(e red+se sa+ !nadecva(e
    De.!c!(e"e :n d!verse do%en!! a"e &roces7r!! !n.or%a=!e! sen/or!a"e s+n( .recven(e,
    :n s&ec!a" :n &rocesarea a+d!(!v7 (e%&ora"7 Ede e< , r!(%+" de &rocesare, asoc!erea
    de s+ne(e O! s!%'o"+r!, s+cces!+nea s+ne(e"or s! %e%or!a, a(en=!a acorda(7
    s+ne(e"or O! d!scr!%!narea "orJ D!.!c+"(a(ea :n &rod+cerea secven=e"or %o(or!! "!n s!
    ra&!d es(e, de ase%enea, carac(er!s(!c7 T+"'+rarea .ono"o$!c7, (+"'+r7r!"e de
    :nv7=are O! de.!c!(e"e :n &erce&erea "!%'a@+"+! s+n( adesea &re/en(e s! aco%&an!a(e
    de de(er!or7r! a" e %e%or!e! A"(e (+" '+r7r! asoc! a(e s+n( (+" '+rarea
    !&erac v! =a=eXde.!c!( de a(en=!e, (+"'+rarea de de/vo"(are a coordon7r!! s!
    en+re/!s+" T+"'+rarea %!<(7 de "!%'a@ e<&res!v O! rece&(!v &oa(e .! aco%&an!a(7
    de ano%a"!! EE,, da(e anor%a"e "a ne+ro!%a$!s(!c7 s! a"(e se%ne ne+ro"o$!ce O
    .or%7 de (+"'+rare %!<(7 de "!%'a@ e<&res!v s! rece&(!v c+ de'+( :n(re ; s! F a%, O!
    aco%&an!a(7 de conv+"s!! es(e den+%!(7 s!ndro% Landa+4-"e..ner
    *lemente speci$ice culturii si sexului
    Eva"+7r!"e de/vo"(7r!! a&(!(+d!n!"or de co%+n!care (re'+!e s7 =!n7 con( de
    con(e<(+" c+"(+ra" O! "!n$v!s(!c a" !nd!v!d+"+!, :n s&ec!a" "a !nd!v!/!! cresc+=! :n %ed!!
    '!"!n$ve M7s+r7r!"e s(andard!/a(e a"e de/vo"(7% "!n$v!s(!ce s! a"e ca&ac!(7=!!
    !n(e"ec(+a"e nonver'a"e (re'+!e s7 .!e re"evan(e &en(r+ $r+&+" c+"(+ra" O! "!n$v!s(!c
    T!&+" de de/vo"(are es(e %a! .recven( "a '7r'a=! decA( "a .e%e!
    #revalent
    Es(!%7r!"e &reva"en(e! var!a/7 c+ e(a(ea Se es(!%ea/7 c7 (!&+" de de/vo"(are a"
    (+"'+r7% %!<(e de "!%'a@ e<&res!v s! rece&(!v &oa(e s+rven! :n &An7 "a Yd d!n(re
    &rsco"an O! :n ;d d!n(re co&!! de e(a(e Oco"ar7 s! c7 es(e &ro'a'!" %a! &+=!n .recven(
    decA( (+"'+rarea de "!%'a@ e<&res!v S!ndro%+" Landa+4-"e..ner s! a"(e .or%e a"e
    (!&+"+! c7&7(a( a" (+"'+r7% s+n( %a! rare
    *voluie
    T!&+" de de/vo"(are a" (+"'+r7% %!<(e de "!%'a@ e<&res!v s! rece&(!v es(e de
    re$+"7 de(ec(a'!" :na!n(e de e(a(ea de I an! For%e"e severe a"e (+"'+r7% &o(
    ev!den(e :nc7 de "a e(a(ea de , an! For%e"e %a! +Ooare &o( s7 n+ .!e rec+nosc+(e
    &An7 ce co&!"+" n+ !n(r7 :n scoa"7 e"e%en(ar7, +nde de.!c!(e"e :n co%&reens!+ne
    dev!n %a! ev!den(e T!&+" c7&7(a( a" (+"'+r7% %!<(e de "!%'a@ e<&res!v s! rece&(!v
    da(ora( +nor "e/!+n! cere'ra"e, (ra+%a(!s% cran!an or! !cr+s &oa(e s+rven! "a once
    e(a(e T!&+" c7&7(a( da(ora( s!ndro%+"+! Landa+4-"e..ner Ea.a/!a e&!"e&(!c7
    c7&7(a(7J s+rv!ne de re$+"7 :n(re ; s! F a% M+"=! co&!! c+ (+"'+rarea %!<(7 de "!%'a@
    e<&res!v s! rece&(!v ac!/!=!onea/7 :n ce"e d!n +r%7 a&(!(+d!n! "!n$v!s(!ce nor%a"e,
    Tulburrile dia!nosticate de re!ul pentru prima dat
    IH "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    dar &ro$nos(!c+" es(e %a! r7+ decA( a" ce"or c+ (+"'+rare de "!%'a@ e<&res!v :n (!&+"
    c7&7(a( a" (+"'+r7% %!<(e de "!%'a@ e<&res!v s! rece&(!v, evo"+=!a s! &ro$nos(!c+"
    s+n( :n ra&or( c+ sever!(a(ea s! "oca"!/area &a(o"o$!e! cere'ra"e, &rec+% s! c+ e(a(ea
    co&!"+"+! s! $rad+" de de/vo"(are a "!%'a@+"+! :n %o%en(+" c7&7(7% (+"'+r7r!!.
    A%e"!orarea c"!n!c7 :n a&(!(+d!n!"e de "!%'a@ es(e +neor! co%&"e(7, &e cAnd :n a"(e
    ca/+r! rec+&erarea &oa(e .! !nco%&"e(7 sa+ de.!c!(+" &oa(e &ro$resa Co&!!! c+ .or%e
    %a! severe vor de/vo"(a &ro'a'!" (+"'+r7r! de :nv7=are
    #attern $amilial
    T!&+" de de/vo"(are a" (+"'+r7r!! %!<(e de "!%'a@ e<&res!v s! rece&(!v es(e %a!
    .recven( &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e ce"or c+ (+"'+rarea decA( :n
    &o&+"a=!a $enera"7 N+ e<!s(7 n!c! o &ro'7 de a$re$are .a%!"!a"7 :n (!&+" c7&7(a( a"
    (+"'+r7%
    Dia!nostic di$erenial
    3e/! sec=!+nea SD!a$nos(!c d!.eren=!a"T &en(r+ (+"'+rarea de "!%'a@ e<&res!v
    E&a$ RLJ
    Criteriile $e $ia/no&ti# pentru
    4*<.4C Tul-urarea Mi,t( $e Li"-aQ E,pre&iv &i Re#eptiv
    A Scorurile obinute prmtr-o baterie de msurri standardi(ate administrate
    individual ale de(voltm limba0ului receptiv c"t si expresiv sunt substanial
    sub cele obinute la msurrile standardi(ate ale capacitii intelectuale
    nonverbale Simptomele includ pe cele pentru tulburarea de limba0
    expresiv, precum si di$icultatea "n "nele!erea cuvintelor, propo(itiunilor ori
    a unor tipuri speci$ice de cuvinte, cum sunt termenii spaiali
    S Di$icultile "n limba0ul receptiv si expresiv inter$erea( semni$icativ cu
    per$ormanta ,colar sau pro$esional ori cu comunicarea social
    Fu sunt satis$cute criteriile pentru tulburarea de de(voltare pervasiv
    D Dac este pre(enta retardarea mental, un de$icit verbomotor sau sen(orial
    ori deprivarea ambiental, di$icultile de limba0 sunt "n exces "n raport cu
    cele asociate cu aceste probleme
    Not( $e #o$i%i#areM Dac este pre(ent un de$icit verbomotor sau sen(orial ori o
    condiie neurolo!ic, condiia se codi$ic pe axa III
    4EA246 Tulburarea 'onolo!ic
    &anterior Tulburarea de De(voltare a
    Articulrii)
    =<

    4*<.45 Tul-urarea 'onolo/i#( (anterior
    Tul-urarea $e De)voltare a Arti#ul(rii6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! .ono"o$!ce :" cons(!(+!e !nca&ac!(a(ea de a +(!"!/a
    s+ne(e" vor'!r!! e<&ec(a(e :n de/vo"(are s! care s+n( cores&+n/7(oare &en(r+ e(a(ea
    s! d!a"ec(+" !nd!v!d+"+! Ecr!(er!+" AJ. Aceas(a &oa(e !%&"!ca eror! :n &rod+cerea,
    +/+", re&re/en(area sa+ or$an!/area s+ne(e"or, c+% ar .! s+'s(!(+!r!"e +n+! s+ne( c+
    a"(+" E+(!"!/ea/7 s+ne(+" X(X :n "oc+" s+ne(+"+! X)XJ or! o%!s!+n! de s+ne(e Ede e<.,
    a"e consoane"or .!na"eJ, dar n+ se "!%!(ea/7 n+%a! "a aces(ea. D!.!c+"(7=!"e :n
    &rod+cerea s+ne(e"or vor'!r!! !n(er.erea/7 c+ &er.or%an=a Oco"ar7 sa+ &ro.es!ona"7
    or! c+ co%+n!carea soc!a"7 Ecr!(er!+" BJ. Dac7 es(e &re/en(7 re(ardarea %en(a"7, +n
    de.!c!( ver'o%o(or sa+ sen/or!a" or! de&r!varea a%'!en(a"7, d!.!c+"(7=!"e :n vor'!re
    s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ aces(e &ro'"e%e Ecr!(er!+" CJ.
    Dac7 es(e &re/en( +n de.!c!( ver'o%o(or sa+ sen/or!a" or! o cond!=!e ne+ro"o$!c7,
    aces(ea (re'+!e cod!.!ca(e &e a<a III.
    T+"'+rarea .ono"o$!c7 !nc"+de eror! :n &rod+c=!a .ono"o$!c7 Ead!c7 :n ar(!c+"areJ,
    care !%&"!c7 !nca&ac!(a(ea de a e%!(e corec( s+ne(e"e vor'!r!! s! .or%e"e 'a/a(e
    co$n!(!v a"e &ro'"e%e"or .ono"o$!ce care !%&"!c7 +n de.!c!( :n c"as!.!carea s+ne(e"or
    vor'!r!! Ede e<., d!.!c+"(a(e :n a a"e$e care s+ne(e :n "!%'a@ .ac s7 se d!.eren=!e/e
    sens+"J. Sever!(a(ea %er$e de "a +n .oar(e red+s sa+ de "a n!c! +n e.ec( as+&ra
    !n(e"!$!'!"!(7=!! vor'!r!! &An7 "a o vor'!re co%&"e( !n!n(e"!$!'!"7. O%!s!+n!"e de
    s+ne(e s+n( de re$+"7 v7/+(e ca %a! severe decA( s+n( s+'s(!(+!r!"e de s+ne(e, care
    :n sc!%' s+n( %a! severe decA( d!s(ors!+n!"e de s+ne(e. S+ne(e"e ce" %a! .recven(
    ar(!c+"a(e erona( s+n( ce"e c7&7(a(e %a! (Ar/!+ :n c+rs+" de/vo"(7r!! E", r, s, /, (, eJ,
    dar "a !nd!v!/!! %a! (!ner! Eco&!!! %a! %!c!J sa+ %a! sever a.ec(a=!, O! consoane"e s!
    voca"e"e care se de/vo"(7 %a! &recoce &o( .!, de ase%enea, a.ec(a(e. L!s&!n$+" Ead!c7
    ar(!c+"area de.ec(+oas7 a s!'!"an(e"orJ es(e e<(re% de co%+n. T+"'+rarea .ono"o$!c7
    &oa(e !%&"!ca, de ase%enea, eror! :n se"ec(area s! ordonarea s+ne(e"or :n s!"a'e O!
    c+v!n(e Ede e<., :n ". en$"e/7 a)s :n "oc de as)J.
    *lemente si tulburri asociate
    DeO! &oa(e e<!s(a o asoc!ere c+ .ac(or! ca+/a"! ev!den=!, c+% ar .! de(er!orarea
    a+/+"+!, de.ec(e s(r+c(+ra"e a"e %ecan!s%e"or ora"e a"e "!%'a@+"+! &er!.er!c Ede e<.,
    &a"a(osc!/!sJ, cond!=!! ne+ro"o$!ce Ede e<., &ara"!/!e cere'ra"7J, res(r!c=!! co$n!(!ve
    Ede e<., re(ardare %en(a"7J, or! &ro'"e%e &s!osoc!a"e, "a ce" &+=!n 9,Yd d!n(re co&!!!
    &reOco"ar! se cons(a(7 &re/en=a +nor (+"'+r7r! .ono"o$!ce de or!$!ne nec+nosc+(7
    sa+ &res+&+s7, care s+n( adesea den+%!(e dre&( )+nc(ionale sa+ de de;*oltare7 Poa(e
    e<!s(a, de ase%enea, o :n(Ar/!ere :n vor'!re. Une"e .or%e de (+"'+rare .ono"o$!c7
    !%&"!cAnd eror! !ncons(an(e, d!.!c+"(7=! :n secven=!erea s+ne(e"or :n "!%'a@+"
    :n"7n=+!( "o$!c O! d!s(ors!+n! a"e voca"e"or s+n( den+%!(e +neor! +neor! S d!s&ra<!e
    de de/vo"(are a "!%'a@+"+!T.
    *lemente speci$ice culturii si sexului
    Eva"+7r!"e de/vo"(7r!! a&(!(+d!n!"or de co%+n!care (re'+!e s7 =!n7 con( de
    con(e<(+" c+"(+ra" s! "!n$v!s(!c a" !nd!v!d+"+!, :n s&ec!a" "a !nd!v!/!! cresc+=! :n %ed!!
    '!"!n$ve. T+"'+rarea .ono"o$!c7 es(e %a! .recven(7 "a '7r'a=!. N
    Tulburrile dia!nosticate de re!ul pentru prima dat
    II "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    #revalent
    A&ro<!%a(!v 9d d!n(re co&!!! :n e(a(e de R s! H an! &re/!n(7 (+"'+rare .ono"o$!c7,
    %er$And de "a %odera(7 &An7 "a sever7, deO! &reva"en(a .or%e"or +Ooare a"e aces(e!
    (+"'+r7r! es(e %a! %are. Preva"en(a scade "a L,Yd "a e(a(ea de 5H an!.
    *voluie
    :n (+"'+rarea .ono"o$!c7 sever7, vor'!rea co&!"+"+! &oa(e .! re"a(!v !n!n(e"!$!'!"7
    c!ar &en(r+ %e%'r!! .a%!"!e!. For%e"e %a! &+=!n severe a"e (+"'+r7r!! &o( s7 n+ .!e
    rec+nosc+(e &An7 ce co&!"+" n+ !n(r7 :n %ed!+" &reOco"ar sa+ Oco"ar O! n+ are
    d!.!c+"(7=! :n a se .ace :n=e"es de ce! d!n a.ara .a%!"!e! !%ed!a(e. Evo"+=!a (+"'+r7r!!
    es(e var!a'!"7, de&!n/And de ca+/e"e asoc!a(e s! de sever!(a(e. La co&!! c+ &ro'"e%e
    .ono"o$!ce +Ooare s&re %odera(e neda(ora(e +ne! cond!=!! %ed!ca"e $enera"e
    a&roa&e (re! s.er(+r! &re/!n(7 o nor%a"!/are s&on(an7 "a e(a(ea de R an!.
    #attern $amilial
    A .os( de%ons(ra( +n &a((ern .a%!"!a" &en(r+ +ne"e .or%e de (+"'+rare .ono"o$!c7.
    Dia!nostic di$erenial
    D!.!c+"(7=!"e :n vor'!re &o( .! asoc!a(e c+ re(ardarea %en(a"7, de(er!orarea
    a+/+"+! sa+ +n a"( de.!c!( sen/or!a", c+ +n de.!c!( ver'o%o(or or! c+ de&r!varea
    a%'!en(a"7 sever7. Pre/en=a aces(or &ro'"e%e &oa(e .! s(a'!"!(7 &r!n (es(area
    !n(e"!$en=e!, (es(are a+d!o%e(r!c7, (es(are ne+ro"o$!c7 s! &r!n !s(or!c. Dac7
    d!.!c+"(7=!"e de vor'!re s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ aces(e
    &ro'"e%e, &oa(e .! &+s d!a$nos(!c+" conco%!(en( de (+"'+rare .ono"o$!c7.
    Pro'"e%e"e "!%!(a(e "a r!(%+" vor'!r!! sa+ voc!! n+ s+n( !nc"+se ca &ar(e a
    (+"'+r7r!! .ono"o$!ce, c! s+n( d!a$nos(!ca(e ca 'a"'!s% or! (+"'+rare de co%+n!care
    .7r7 a"(7 s&ec!.!ca=!e. Co&!!! c+ d!.!c+"(7=! de vor'!re da(ora(e de&r!v7r!!
    a%'!en(a"e &o( &re/en(a rec+&er7r! ra&!de, :nda(7 ce &ro'"e%e"e a%'!en(a"e s4a+
    a%e"!ora(.
    Criteriile $e $ia/no&ti# pentru
    4*<.45 Tul-urarea 'onolo/i#(
    A2 Incapacitatea de a utili(a sunetele vorbirii expectate evolutiv, care sunt cores
    pun(toare pentru etatea si dialectul copilului &de ex2, erori "n producerea,
    u(ul, repre(entarea sau or!ani(area sunetelor, cum ar $i, substituirile unui
    sunet cu altul &utili(ea( sunetul 1t1 "n loc de sunetul 1C1) ori omisiuni de
    sunete, cum ar $i consonantele $inale), dar nu se limitea( la acestea2
    S2 Di$icultile "n producerea sunetelor inter$erea( cu per$ormana ,colar sau
    pro$esional ori cu comunicarea social2
    2 Dac este pre(ent retardarea mental, un de$icit verbomotor sau sen(orial
    ori deprivarea ambiental, di$icultile "n vorbire sunt "n exces "n raport cu
    cele asociate de re!ul cu aceste probleme2
    Fot $e #o$i%i#areM Dac este pre(ent un de$icit verbomotor sau sen(orial ori o
    condiie neurolo!ic, condiia se codi$ic pe axa III2
    45?25 Salbismul =G
    4+G.+ 8al-i&"ul
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" 'a"'!s%+"+! :" cons(!(+!e o &er(+r'are :n ."+en=a nor%a"7 s!
    :n (!%&+" de s(r+c(+rare a vor'!r!!, care es(e !nadecva( &en(r+ e(a(ea !nd!v!d+"+!
    Ecr!(er!+" AJ. Aceas(7 &er(+r'are es(e carac(er!/a(7 &r!n re&e(!=!! .recven(e sa+
    &re"+n$!r! 4a"e s+ne(e"or sa+ s!"a'e"or Ecr!(er!!"e A" O! A9J. Po( .! !%&"!ca(e s! a"(e
    d!verse (!&+r! de d!s."+en=7 a vor'!r!! !nc"+/And !n(er@ec=!! Ecr!(er!+" A;J, c+v!n(e
    :n(rer+&(e Ede e<., &a+/e :n !n(er!or+" +n+! c+vAn(J Ecr!(er!+" AIJ, '"oca@ a+d!'!" sa+
    %+( E&a+/e co%&"e(e sa+ !nco%&"e(e :n vor'!reJ Ecr!(er!+" AYJ, c!rc+%"oc+=!+n!
    Ead!c7, s+'s(!(+!r! de c+v!n(e c+ sco&+" de a ev!(a c+v!n(e"e &ro'"e%a(!ceJ Ecr!(er!+"
    ARJ, c+v!n(e &rod+se c+ +n e<ces de (ens!+ne .!/!c7 Ecr!(er!+" AHJ s! re&e(area +nor
    :n(re$! c+v!n(e %onos!"a'!ce Ede e<., Se+, e+, e+, e+ :" v7dTJ Ecr!(er!+" AGJ.
    Per(+r'area ."+en=e! !n(er.erea/7 c+ &er.or%an=a Oco"ar7 sa+ &ro.es!ona"7 or! c+
    co%+n!carea soc!a"7 Ecr!(er!+" BJ. Dac7 es(e &re/en( +n de.!c!( ver'o%o(or sa+ +n
    de.!c!( sen/or!a", d!.!c+"(7=!"e :n vor'!re s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de
    re$+"7 c+ aces(e &ro'"e%e Ecr!(er!+" CJ. Dac7 es(e &re/en( +n de.!c!( ver'o%o(or sa+
    +n de.!c!( sen/or!a" or! o %a"ad!e ne+ro"o$!c7, cond!=!a va .! cod!.!ca(7 &e a<a III.
    In(ens!(a(ea &er(+r'7r!! var!a/7 de "a o s!(+a=!e "a a"(a s! adesea es(e %a! sever7 cAnd
    e<!s(7 o &res!+ne s&ec!a"7 de a co%+n!ca Ede e<., &re/en(area +n+! re.era( "a scoa"7,
    !n(erv!evarea &en(r+ an$a@area :n(r4+n serv!c!+J. Ba"'!s%+" es(e adesea a'sen( :n
    c+rs+" "ec(+r!! ora"e, a" cAn(a(+"+! or! a" vor'!(+"+! c+ o'!ec(e !nan!%a(e sa+ c+
    an!%a"e"e .avor!(e.
    *lemente si tulburri asociate
    La :nce&+(+" 'a"'!s%+"+!, vor'!(or+" &oa(e s7 n+ .!e conO(!en( de &ro'"e%7, :ns7
    conO(!en(!/area O! c!ar an(!c!&area an<!oas7 a &ro'"e%e! &o( a&are %a! (Ar/!+.
    3or'!(or+" &oa(e :ncerca s7 ev!(e 'A"'A!a"7 &r!n %ecan!s%e "!n$v!s(!ce Ede e<., &r!n
    %od!.!carea r!(%+"+! vor'!r!!, ev!(area an+%!(or s!(+a=!! s&ec!a"e de a vor'!, c+% ar
    .! (e"e.ona(+" sa+ vor'!(+" :n &+'"!c or! ev!(area an+%!(or c+v!n(e sa+ s+ne(eJ.
    Ba"'!s%+" &oa(e .! aco%&an!a( de %!Oc7r! %o(or!! Ede e<., c"!&!(, (!c+r!, (re%or a"
    '+/e"or sa+ a" .e=!!, n+(a=!a Ec"7(!nareaJ ca&+"+!, %!Oc7r! res&!ra(or!!, s(rAn$erea
    &+%n!"orJ. S(res+" sa+ an<!e(a(ea e<acer'ea/7 'a"'!s%+". De(er!orarea .+nc=!on7r!!
    soc!a"e &oa(e re/+"(a d!n an<!e(a(ea asoc!a(7, d!n .r+s(rare or! d!n s(!%a de s!ne
    sc7/+(7. La ad+"=!, 'a"'!s%+" &oa(e "!%!(a a"e$erea &ro.es!e! sa+ avansarea.
    T+"'+rarea .ono"o$!c7 O! (+"'+rarea "!%'a@+"+! e<&res!v s+rv!n %a! .recven( "a
    !nd!v!/!! c+ 'a"'!s% decA( :n &o&+"a=!a $enera"7.
    #revalent
    Preva"en(a 'a"'!s%+"+! "a co&!!! &re&+'er(ar! es(e de " d O! d!%!n+a "a L,Gd :n
    ado"escen=7. Ra&or(+" '7r'a=!X.e%e! es(e de a&ro<!%a(!v ;Q5.
    *voluie
    S(+d!!"e re(ros&ec(!ve &e !nd!v!/!! c+ 'a"'!s% descr!+ +n de'+( (!&!c :n(re
    e(7=!"e de 9 O! H an! Ec+ +n &!c a" de'+(+"+! :n @+r+" e(7=!! de Y an!J, :n FGd d!n
    ca/+r! de'+(+" s+rv!ne :na!n(e de e(a(ea de 5L an!. De'+(+" es(e de re$+"7
    Tulburrile dia!nosticate de re!ul pentru prima dat
    => "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    !ns!d!os, :n(%/And+4se &e %a! %+"(e "+n! :n c+rs+" c7rora d!s."+en=e"e :n
    vor'!re, neo'serva(e, e&!sod!ce, dev!n o &ro'"e%7 cron!c7 De re$+"7,
    &er(+r'area :nce&e $rad+a", c+ re&e(area consoane"or !n!=!a"e, a &r!%e"or
    c+v!n(e a"e +ne! e<&res!! or! a c+v!n(e"or "+n$! :n $enera", co&!"+" n+ es(e
    conO(!en( de 'a"'!s% Pe %7s+ra ce (+"'+rarea &ro$resea/7 :ns7, evo"+=!a
    &re/!n(7 a%e"!or7r! s! a$rav7r! D!s."+en=e"e de_ % %a! .rec_ en(e, !ar 'a"'!s%+"
    s+rv!ne "a &ron+n=!a ce"or %a! se%n!.!ca(!ve c+v!n(e sa+ e<&res!! Pe %7s+r7
    ce co&!"+" dev!ne conO(!en( de d!.!c+"(a(ea :n vor'!re, &o( a&are %ecan!s%e de
    ev!(are a d!s."+en4(e"or s! r7s&+ns+r! e%o=!ona"e Cerce(7r!"e s+$erea/7 c7 +n
    an+%!( &rocen( se rec+&erea/7, es(!%7r!"e %er$And de "a 9Ld &an7 "a GLd
    Un+ !nd!v!/! c+ 'a"'!s% se rec+&erea/7 s&on(an, de re$+"7 :na!n(e de e(a(ea
    de 5R an!
    #attern $amilial
    S(+d!!"e .a%!"!a"e s. &e $e%en! o.er7 &ro'a cer(7 a +n+! .ac(or $ene(!c :n e(!o"o$!a
    'a"':s%+"+! Pre/en(a +ne! (+"'+r7r! .ono"o$!ce or! a (!&+"+! de de/vo"(are a"
    (+"'+r7r!! de "!%'a@ e<&res!v sa+ a +n+! !s(or!c .a%!"!a" a" aces(ora, cres(e
    &ro'a'!"!(a(ea 'a"':s%+"+! R!sc+" de 'a"'!s% &r!n(re r+de"e '!o"o$!ce de $rad+" I
    es(e de (re! or! %a! %are decA( nsc+" :n &o&+"a=!a $enera"7 Pen(r+ '7r'a=!! c+ !s(or!c
    de 'a"'!s%, a&ro<!%a(!v 5Ld d!n(re .!!ce"e s! 9Ld d!n(re .% "or se vor 'A"'A!
    Dia!nostic di$erenial
    D!.!c+"(7=!"e :n vor'!re &o( .! asoc!a(e c+ de(er!orarea a+/+"+! sa+ c+ +n a"(
    de.!c!( sen/or!a" or! c+ +n de.!c!( ver'o%o(or :n ca/+r!"e :n care d!.!c+"(7=!"e :n
    _ or'!re s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ aces(e &ro'"e%e, &oa(e
    .! &+s M d!a$nos(!c+" conco%!(en( de 'a"'!s% Ba"'!s%+" (re'+!e s7 .!e d!s(!ns de
    d!s."+en=e"e nor%a"e care s+rv!n .recven( "a co&!! %!c! s! care !nc"+d re&e(area
    +nor c+v!n(e sa+ .ra/e :n(re$! Ede e< , e+ vrea+, e+ vrea+ :n$e=a(7TJ, .ra/e
    !nco%&"e(e, 2n(er@ec!, &a+/e v!de s! re%arc! &aran(e(!ce
    45? 6 Tulburare de omunicare 'r Alt
    Speci$icaie
    RF
    Criteriile $e $ia/no&ti# pentru 4+G.+ 8al-i&"
    A #erturbare "n $luenta normal si "n timpul de structurare a vorbim &inadecvat
    pentru etatea individului caracteri(at prin apariia $recvent a unuia sau a
    mai multora dintre urmtoarele
    (1) repetiii de sunete si silabe,
    (2) prelun!irea sunetelor,
    (3) inter0ecu,
    (4) cuvtnte "ntrerupte &de ex, pau(e "n cadrul unui cuv@nt),
    (5) bloca0 audibil sau mut &pau(e complete sau incomplete "n vorbire),
    (6) circumlocutiuni &substituiri de cuvinte pentru a evita cuvintele problematice),
    (7) cuvinte produse cu un exces de tensiune $i(ic,
    (8) repetarea unor "ntre!i cuvinte monosilabice &de ex , eu, eu, eu, "l vd)2
    S #erturbarea "n $luent inter$erea( cu per$ormanta ,colar sau pro$esional
    ori cu comunicarea
    Dac este pre(ent un de$icit verbomotor sau sen(orial, di$icultile "n
    vorbire sunt "n exces "n raport cu cele asociate de re!ul cu aceste probleme
    Not( $e #o$i%i#areM Dac este pre(ent un de$icit verbomotor sau sen(orial ori o
    condiie neurolo!ic, condiia se codi$ic pe axa III
    4+G.5 Tul-urare $e Co"uni#are '(r( Alt(
    Spe#i%i#a!ie
    Aces(a ca(e$or!e es(e des(!na(7 (+"'+r7r!"or de co%+n!care care n+ sa(!s.ac
    cr!(er!!"e &en(r+ n!c! +na d!n(re (+"'+r7r!"e de co%+n!care s&ec!.!ce, de e<e%&"+, o
    (+"'+rare a voc!! Eres&ec(!v, o ano%a"!e a :n7"=!%!!, !n(ens!(7=!!, ca"!(7=!!, (on+"+! sa+
    re/onan=e! voc!!J
    Tul-ur(rile $e De)voltare Perva&iv(
    T+"'+r7r!"e de de/vo"(are &ervas!v7 s+n( carac(er!/a(e &nn de(er!orare sever7
    O! &ervas!v7 :n d!verse do%en!! de de/vo"(are a&(!(+d!n! de !n(erac=!+ne soc!a"7
    rec!&roc7, a&(!(+d!n! de co%+n!care sa+ &re/en(a +n+! co%&or(a%en(, !n(erese s!
    ac(!v!(7=! s(ereo(!&e De(er!or7r!"e ca"!(a(!ve care de.!nesc aces(e cond!=!! s+n( c"ar
    dev!an(e :n ra&or( c+ n!ve"+" de de/vo"(are sa+ c+ e(a(ea %en(a"7 a !nd!v!d+"+!
    Aceas(7 sec=!+ne con=!ne (+"'+rarea a+(!s(7, (+"'+rarea Re((, (+"'+rarea
    de/!n(e$ra(!v7 a co&!"7r!e!, (+"'+rarea As&er$er s! (+"'+rarea de de/vo"(are
    &ervas!v7 .7r7 a"(7 s&ec!.!ca=!e Aces(e (+"'+r7r! s+n( de re$+"7 ev!den(e d!n &n%n
    an! de v!a(7 s! adesea s+n( asoc!a(e c+ +n an+%!( $rad de re(ardare %en(a"7 care,
    dac7 es(e &re/en(7, (re'+!e s7 .!e cod!.!ca(7 &e a<a II T+"'+r7r!"e de de/vo"(are
    &ervas!v7 s+n( o'serva(e +neor! :%&re+n7 c+ +n $r+& de a"(e cond!=!! %ed!ca"e
    $enera"e Ede e< , ano%a"!! cro%o/o%!a"e, !n.ec=!! con$en!(a"e, ano%a"!! s(r+c(+ra"e
    a"e s!s(e%+"+! nervos cen(ra"J Dac7 as(.e" de cond!=!! s+n( &re/en(e, e"e (re'+!e s7
    .!e no(a(e &e a<a III DeO! (er%en! ca S&s!o/7T s! Ssc!/o.ren!e a co&!"7r!e!T a+ .os(
    Tulburrile dia!nosticate de re!ul pentru prima dat
    ?5 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    +(!"!/a=! cAndva &en(r+ a den+%! aces(e cond!=!!, e<!s(7 s+.!c!en(e da(e care
    s+$erea/7 c7 (+"'+r7r!"e de de/vo"(are &ervas!v7 s+n( d!s(!nc(e de sc!/o.ren!e
    E:ns7, +n !nd!v!d c+ (+"'+rare de de/vo"(are &ervas!v7 &oa(e de/vo"(a oca/!ona"
    sc!/o.ren!e %a! (Ar/!+J.
    C55.++ Tul-urarea Auti&t(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! a+(!s(e "e cons(!(+!e &re/en=a +ne! de/vo"(7r!
    c"ar anor%a"e sa+ de(er!ora(e :n !n(erac=!+nea soc!a"7 s! :n co%+n!care s! +n
    re&er(or!+ res(rAns cons!dera'!" de ac(!v!(7=! s! !n(erese. Man!.es(7r!"e (+"'+r7r!!
    var!a/7 %+"( :n .+nc=!e de n!ve"+" de de/vo"(are O! e(a(ea crono"o$!c7 a !nd!v!d+"+!.
    T+"'+rarea a+(!s(7 es(e den+%!(7 +neor! a+tism in)antil precoce, a+tism+l copil6riei sa+
    a+tism Panner7
    De(er!orarea, :n !n(erac=!+nea soc!a"7 rec!&roc7 es(e ."a$ran(7 s! s+s=!n+(7. Poa(e
    e<!s(a o de(er!orare se%n!.!ca(!v7 :n +(!"!/area %+"(!&"e"or co%&or(a%en(e
    nonver'a"e Ede e<., &r!v!(+" :n .a=7, e<&res!a .ac!a"7, &os(+r!"e s! $es(+r!"e cor&ora"eJ
    &en(r+ a re$"a !n(erac=!+nea s! co%+n!carea soc!a"7 Ecr!(er!+" A"aJ. Poa(e e<!s(a o
    !nca&ac!(a(e :n a s(a'!"! re"a=!! c+ e$a"!!, cores&+n/7(oare n!ve"+"+! de de/vo"(are
    Ecr!(er!+" A"'J care &oa(e "+a d!.er!(e .or%e "a d!.er!(e e(7=!. Ind!v!/!! %a! (!ner! &o(
    avea .oa(e &+=!n sa+ n!c! +n !n(eres :n a s(a'!"! a%!c!=!!. Ind!v!/!! %a! :n e(a(e &o( .!
    !n(eresa=! :n s(a'!"!rea de a%!c!=!!, dar s+n( "!&s!=! de :n=e"e$erea conven=!!"or
    !n(erac=!+n!! soc!a"e. Poa(e e<!s(a o "!&s7 a c7+(7r!! s&on(ane de a :%&7r(7O! a"(ora
    '+c+r!a, !n(erese"e or! rea"!/7r!"e Ede e<., a n+ ar7(a, a n+ ad+ce or! a n+ s&ec!.!ca
    o'!ec(e"e &e care e! "e cons!der7 !n(eresan(e Ecr!(er!+" A"eJ. De ase%enea, &oa(e .!
    &re/en(7 o "!&s7 de rec!&roc!(a(e e%o=!ona"7 sa+ soc!a"7 Ede e<., n+ &ar(!c!&7 :n %od
    ac(!v "a @oc+r! soc!a"e s!%&"e, &re.er7 ac(!v!(7=!"e so"!(are, !%&"!c7 &e a"=!! :n ac(!v!(7=!
    n+%a! ca !ns(r+%en(e sa+ a@+(oare S%ecan!ceTJ Ecr!(er!+" A!dJ. Adesea conO(!!n=a
    de a"=!! a !nd!v!d+"+! es(e de(er!ora(7 cons!dera'!". Ind!v!/!! c+ aceas(7 (+"'+rare &o(
    +!(a de ce!"a"=! co&!! E!nc"+s!v de .ra=!J, &o( s7 n+ a!'7 n!c! o !dee des&re neces!(7=!"e
    a"(ora or! &o( s7 n+ o'serve de(resa a"(e! &ersoane.
    De(er!orarea :n co%+n!care es(e, de ase%enea, no(a'!"7 O! s+s=!n+(7, s! a.ec(ea/7
    a(A( a&(!(+d!n!"e ver'a"e, cA( O! nonver'a"e. Poa(e e<!s(a o :n(Ar/!ere sa+ o "!&s7
    (o(a"7 de de/vo"(are a "!%'a@+"+! vor'!( Ecr!(er!+" A9aJ. La !nd!v!/!! care vor'esc,
    &oa(e e<!s(a o de(er!orare cons!dera'!"7 :n ca&ac!(a(ea de a !n!=!a sa+ s+s=!ne o
    conversa=!e c+ a"=!! Ecr!(er!+" A9'J or! o +(!"!/are re&e(!(!v7 O! s(ereo(!&7 a "!%'a@+"+!
    sa+ +n "!%'a@ &ro&r!+ Ecr!(er!+" A9cJ. Poa(e e<!s(a, de ase%enea, o "!&s7 a @oc+"+!
    Sde4a...T s&on(an var!a( sa+ a @oc+"+! !%!(a(!v soc!a", cores&+n/7(or n!ve"+"+! de
    de/vo"(are Ecr!(er!+" A9dJ. CAnd "!%'a@+" se de/vo"(7, :n7"=!%ea voc!!, !n(ona=!a,
    de'!(+" s! r!(%+" vor'!r!! sa+ accen(+" &o( .! anor%a"e Ede e<., (on+" voc!! &oa(e .!
    %ono(on sa+ &oa(e con=!ne ascens!+n! !n(ero$a(!ve "a .!ne"e .ra/e"orJ. S(r+c(+r!"e
    $ra%a(!ca"e s+n( adesea !%a(+re s! !nc"+d +/+" re&e(!(!v O! s(ereo(!& a" "!%'a@+"+!
    Ede e<., re&e(area de c+v!n(e sa+ &ro&o/!=!+n! !nd!.eren( de sens8 re&e(area de
    vers+r! a"!(era(e or! de rec"a%e co%erc!a"eJ or! +n "!%'a@ &ro&r!+ Ead!c7, +n "!%'a@
    care &oa(e .! :n=e"es c"ar n+%a! de ce! .a%!"!ar!/a=! c+ s(!"+" de co%+n!care a"
    !nd!v!d+"+!J, :n=e"e$erea "!%'a@+"+! es(e adesea %+"( :n(Ar/!a(7, !nd!v!d+" .!!nd
    !nca&a'!" s7 :n=e"ea$7 :n(re'7r!"e sa+ ord!ne"e. O &er(+r'are :n +/+" &ra$%a(!c E+/+"
    766255 Tulburarea
    Autist
    81
    soc!a"J a" "!%'a@+"+! es(e adesea ev!den=!a(7 &r!n !nca&ac!(a(e de a !n(e$ra c+v!n(e"e
    c+ $es(+r!"e sa+ de a :n=e"e$e +%or+" sa+ as&ec(e"e non"!(era"e a"e "!%'a@+"+!, c+%
    ar .! !ron!!"e sa+ sens+" !%&"!c!(. *oc+" !%a$!na(!v es(e adesea a'sen( sa+
    cons!dera'!" de(er!ora(. AceO(! !nd!v!/! (!nd, de ase%enea, s7 n+ se an$a@e/e :n
    @oc+r!"e de !%!(a=!e s!%&"e or! :n r+(!ne"e &er!oade! de s+$ar sa+ a"e %!c!! co&!"7r!!
    sa+ o .ac n+%a! :n a.ara con(e<(+"+! or! :n %od %ecan!c.
    Ind!v!/!! c+ (+"'+rare a+(!s(7 a+ &a((ern+r! de co%&or(a%en(, !n(erese s!
    ac(!v!(7=! res(rAnse, re&e(!(!ve s! s(ereo(!&e. Poa(e e<!s(a o &reoc+&are c!rc+%scr!s7
    "a +n+" sa+ %a! %+"(e &a((ern+r! res(rAnse s! s(ereo(!&e de !n(eres care es(e anor%a",
    .!e ca !n(ens!(a(e, sa+ cen(rare Ecr!(er!+" A;aJ8 o aderen=7 !n."e<!'!"7 de an+%!(e
    r+(!ne sa+ r!(+a"+r! non.+nc=!ona"e Ecr!(er!+" A;'J8 %an!er!s%e %o(or!! re&e(!(!ve s!
    s(ereo(!&e Ecr!(er!+" A;cJ8 or! o &reoc+&are &ers!s(en(7 &en(r+ an+%!(e &7r=! a"e
    o'!ec(e"or Ecr!(er!+" A;dJ. Ind!v!/!! c+ (+"'+rare a+(!s(7 &re/!n(7 o $a%7 res(rAns7
    cons!dera'!" de !n(erese s! s+n( adesea &reoc+&a=! de ces(!+n! %7r+n(e Ede e<.,
    da(e, n+%ere de (e"e.on, a&e"+r! "!(era"e a"e s(a=!e! de rad!oJ. E! &o( a"!n!a +n n+%7r
    oarecare de &!ese de @oc e<ac( :n ace"aO! %od de re&e(a(e or! sa+ %!%ea/7 :n %od
    re&e(a( ac=!+n!"e +n+! ac(or v7/+( "a (e"ev!/or. De ase%enea, e! &o( !ns!s(a as+&ra
    +n!.or%!(7=!! s! %an!.es(7 re/!s(en=7 sa+ de(res7 "a %od!.!c7r! %!nore Ede e<., +n
    co&!" %!c &oa(e avea o reac=!e ca(as(ro.a"7 "a o sc!%'are %!nor7 :n a%'!an=7, c+%
    ar .! rearan@area %o'!"e! sa+ .o"os!rea +n+! serv!c!+ no+ "a %as7 J. E<!s(7 adesea o
    &reoc+&are &en(r+ r+(!ne sa+ r!(+a"+r! non.+nc=!ona"e or! !ns!s(en=7 !ra=!ona"7 de a
    +r%a r+(!ne"e Ede e<., de a &arc+r$e e<ac( aceeaO! r+(7 :n .!ecare /!, cAnd %er$e "a
    scoa"7J. M!Oc7r!"e s(ereo(!&e a"e cor&+"+! !n(eresea/7 %A!n!"e E'7(+(+" d!n &a"%e,
    .A".A!(+" de$e(e"orJ sa+ :n(re$+" cor& E"e$7na(+", :nc"!na(+" O! 'a"ansa(+"J. Po( .!
    &re/en(e ano%a"!! de &os(+r7 Ede e<., %ers+" &e &oan(e, %!Oc7r! a"e %A!n!"or O!
    &os(+r! cor&ora"e '!/areJ. AceO(! !nd!v!/! %an!.es(7 o &reoc+&are &ers!s(en(7 &en(r+
    &7r=! a"e o'!ec(e"or Ede e<., '+(on!, &7r=! a"e cor&+"+!J. De ase%enea, &oa(e e<!s(a o
    .asc!na=!e &en(r+ %!Ocare Ede e<., :nvAr(!rea ro=!"or @+c7r!!"or, desc!derea O!
    :nc!derea +O!"or, +n ven(!"a(or sa+ a"( o'!ec( care se :nvAr(eO(e ra&!dJ. Persoana
    &oa(e .! .oar(e a(aOa(7 de +ne"e o'!ec(e !nan!%a(e Ede e<., o '+ca(7 de s.oar7 sa+ o
    'and7 de ca+c!+cJ.
    Per(+r'area (re'+!e s7 se %an!.es(e &r!n :n(Ar/!er! sa+ .+nc=!onare anor%a"7 :n
    ce" &+=!n +n+" d!n +r%7(oare"e do%en!!, :na!n(e de e(a(ea de ; an!Q !n(erac=!+ne
    soc!a"7, "!%'a@, aOa c+% es(e +(!"!/a( :n co%+n!carea soc!a"7, or! @oc s!%'o"!c sa+
    !%a$!na(!v Ecr!(er!+" BJ, :n ce"e %a! %+"(e ca/+r!, n+ e<!s(7 o &er!oad7 de de/vo"(are
    nor%a"7 !nd+'!(a'!"7, deO! :n a&ro<!%a(!v 9Ld d!n ca/+r! &7r!n=!! re"a(ea/7 o
    de/vo"(are re"a(!v nor%a"7 :na!n(e de " sa+ 9 an!. :n as(.e" de ca/+r!, &7r!n=!! &o(
    re"a(a c7 co&!"+" a ac!/!=!ona( &+=!ne c+v!n(e s! "e4a sa+ c7 &are a s(a$na evo"+(!v.
    Pr!n de.!n!=!e, dac7 e<!s(a o &er!oad7 de de/vo"(are nor%a"7, ea n+ se &oa(e
    e<(!nde d!nco"o de e(a(ea de ; an!. Per(+r'area n+ (re'+!e s7 .!e e<&"!ca(7 %a! '!ne
    de (+"'+rarea Re(( sa+ de (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! Ecr!(er!+" CJ.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e, :n ce"e %a! %+"(e ca/+r!,
    e<!s(7 +n d!a$nos(!c asoc!a( de re(ardare %en(a"7 care &oa(e %er$e de "a +Ooar7 "a
    &ro.+nd7. Po( e<!s(a ano%a"!! :n de/vo"(area a&(!(+d!n!"or co$n!(!ve. Pro.!"+"
    a&(!(+d!n!"or co$n!(!ve es(e de re$+"7 !ne$a", !nd!.eren( de n!ve"+" $enera" a"
    !n(e"!$en=e!, c+ a&(!(+d!n! ver'a"e de re$+"7 %a! red+se decA( a&(!(+d!n!"e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    ?7 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    nonver'a"e Uneor! s+n( &re/en(e a&(!(+d!n! s&ec!a"e Ede e< , o .a(7 :n e(a(e de I an!
    s! @+%7(a(e, c+ (+"'+rare a+(!s(7, &oa(e .! ca&a'!"7 s7 Sdecode/eT %a(er!a"e scr!se c+
    %!n!%7 :n=e"e$ere a sens+"+! ce"or c!(!(e Z!&er"e<!e@ sa+ +n '7!a( de 5L a% &oa(e
    avea ca&ac!(7=! &rod!$!oase de a ca"c+"a da(e Zca"c+"a(or ca"endar!s(!c[ A&rec!er!"e
    d+&7 +n s!n$+r c+vAn( Erece&(!v sa+ e<&res!vJ d!n voca'+"ar n+ s+n( (o(dea+na
    a&rec!er! '+ne a"e n!ve"+"+! "!%'a@+"+! Ead!c7, a&(!(+d!n!"e "!nv!s(!ce rea"e &o( .!
    s!(+a(e "a nrv e"e %+"( %a! @oaseJ
    Ind!v!/+ c+ (+"'+rare a+(!s(7 &o( avea o $a%7 "ar$7 de s!%&(o%e
    co%&or(a%en(a"e !nc"+/And !&erac(!v!(a(ea, red+cerea vo"+%+"+! a(en=!e!,
    !%&+"sn !(a(ea, a$res!v!(a(ea, co%&or(a%en(e"e a+(ov+"neran(e s!, :n s&ec!a" "a
    co&!!! %!c!, accese"e de .+r!e Po( e<!s(a r7s&+ns+r! '!/are "a s(!%+"n sen/or!a"! Ede
    e< , +n &ra$ r!d!ca( "a d+rere, !&eres(e/!e "a s+ne(e sa+ "a a(!n$ere, reac=!! e<a$era(e
    "a "+%!n7 sa+ "a %!ros+r!, .asc!na=!e &en(r+ an+%!=! s(!%+"!J De ase%enea, &o(
    e<!s(a ano%a"!! de co%&or(a%en( a"!%en(ar Ede e< "!%!(area d!e(e! "a cA(eva
    a"!%en(e, &!caJ sa+ :n %od+" de a dor%! Ede e<, deO(e&(7r! re&e(a(e d% so%n :n
    c+rs+" no&=!!, c+ "e$7nareJ Po( .! &re/en(e ano%a"!! de d!s&o/!=!e sa+ a.ec( Ede e<,
    rAs s(+&!d sa+ &"Ans .7r7 +n %o(!v ev!den(, a'sen(a ev!den(7 a reac=!e! e%o=!ona"eJ
    Poa(e e<!s(a o "!&s7 a .r!c!! ca r7s&+ns "a &er!co"e rea"e s! o (ea%7 e<ces!v7 de o'!ec(e
    nev7(7%7(oare Poa(e .! &re/en(7 o var!e(a(e de co%&or(a%en(e a+(o%+(!"an(e Ede
    e<, "ov!(+" c+ ca&+" or! %+sca(+" de$e(e"or, %A!n!! sa+ :nce!e(+r!! %A!n!!J :n
    ado"escen(7 sa+ "a :nce&+(+" v!e=!! ad+"(e, !nd!v!/!! c+ (+"'+rare a+(!s(7, care a+
    ca&ac!(a(ea !n(e"ec(+a"7 &en(r+ a conO(!en(!/a %a"ad!a, &o( deven! de&res!v! ca
    r7s&+ns "a rea"!/area de(er!or7r!! "or severe
    9ate de laborator asociate. CAnd (+"'+rarea a+(!s(7 es(e asoc!a(7 c+ o
    cond!=!e %ed!ca"7 $enera"7, vor .! o'serva(e da(e de "a'ora(or con.or%e c+
    cond!=!a %ed!ca"7 $enera"7 E<!s(7 o sene de d!.eren(e "a +ne"e %7s+r7r! a"e
    ac(!v!(7=!! sero(on%er$!ce, dar aces(ea n+ a+ va"oare d!a$nos(!c7 &en(r+
    (+"'+rarea a+(!s(7 S(+d!!"e de !%a$!s(!c7 &o( .! anor%a"e :n +ne"e caX+n, dar n+
    a .os( !den(!.!ca( c"ar n!c! +n &a((ern s&ec!.!c Ano%a"!!"e EE, s+n( .recven(e, c!ar
    :n a'sen(a cr!/e"or e&!"e&(!ce
    9atele examinrii somatice si condi3iile medicale .enerale asociate. In
    (+"'+rarea a+(!s(7 &o( .! no(a(e d!verse s!%&(o%e s! se%ne ne+ro"o$!ce nes&ec!.!ce
    Ede e<, re."e<e &r!%!(!ve de/vo"(are (ard!v7 a do%!nan(e! %an+a"eJ T+"'+rarea
    es(e Q !=7 +neor! :n asoc!ere c+ o cond!=!e ne+ro"o$!c7 sa+ c+ a"(7 cond!=!e
    %ed!ca"7 Ede e< , s!ndro% >4.ra$!" s! sc"ero/7 (+'eroas7J
    &o( a&are cr!/e e&!"e&(!ce E:n s&ec!a", :n ado"escen(7J :n n+ %a! &+(% de
    +n CAnd s+n( &re/en(e a"(e cond!=!! %ed!ca"e $enera"e, aces(ea (re'+!e
    !e a<a III
    ci$ice etii si sexului
    an! :n %(erac(%nea soc!a"7 se &oa(e sc!%'a c+ (!%&+" %
    ooa(e vana :n .+nc=!e de n!ve"+" de de/vo"(are a" !nd!v!d+"+! a
    !nca&ac!(a(ea de a %er$e de4a '+s!"ea, !nd!.eren(7 sa+ +
    con(ac( .!/!c, "!&sa con(ac(+"+! v!/+a", a reac=!e! (ac"a"e or! T!a" s!
    !nca&ac!(a(ea de a r7s&+nde "a vocea &7r!n=!"or Ca (n &o(
    cons!dera, !n!=!a", c7 co&!"+" es(e s+rd Co&!! %!c!
    C55.++ Tul-urarea Auti&t(
    G4
    c+ aceas(7 (+"'+rare &o( (ra(a ad+"=!! ca !n(ersan@a'!"! sa+ se &o( a$7=a %ecan!c de o
    an+%!(7 &ersoan7 sa+ &o( +(!"!/a %ana +n+! &7r!n(e &en(r+ a o'=!ne o'!ec(+" dor!(
    .7r7 a rea"!/a con(ac(+" v!/+a" Eca s! c+% %Ana s! n+ &ersoana ar .! ceea ce es(e
    re"evan(J :n c+rs+" de/vo"(7%, co&!"+" &oa(e deven! %a! dorn!c de a .! an$a@a( &as!v
    :n(r4o !n(erac=!+ne soc!a"7 s! &oa(e de_e% c!ar %a! !n(eresa( de !n(erac=!+nea
    soc!a"7 C!ar :n aces(e ca/+r! !ns7, co&!"+" (!nde s7 (ra(e/e &e ce!"a"=! :n(r4o %an!er7
    !nso"!(7 Ede e<, se aO(ea&(7 ca ce!"a"=! s7 r7s&+nd7 +nor :n(re'7r! n(+a"!/a(e :n
    an+%!(e %od+r!, are .oar(e &+=!n sen(!%en(+" "!%!(e"or a"(+! o% s! es(e !no&or(+n
    de !n(r+s!v :n !n(erac=!+nea soc!a"7J La !nd+ !/n %a! :n e(a(e, sarc!n!"e !%&"!cAnd
    %e%or!a de "+n$7 d+ra(7 Ede e<, %ers+" (ren+r!"or, da(e"e !s(or!ce, .or%+"e"e
    c!%!ce sa+ evocarea e<ac(7 a c+v!n(e"or cAn(ece"or a+/!(e c+ an! :na!n(e &oa(e .!
    e<ce"en(7, dar !n.or%a=!a (!nde s7 .!e re&e(a(7 de nen+%7ra(e or!, !nd!.eren( de
    adecvarea e! "a con(e<(+" soc!a" Ra(e"e (+"'+r7r!! s+n( de &a(r+, c!nc! or! %a! %ar!
    "a '7r'a=! decA( "a .e%e! Es(e .oar(e &os!'!" !ns7, ca .e%e!"e c+ aceas(7 (+"'+rare s7
    &re/!n(e o re(ardare %en(a"7 %a! sever7
    #revalent
    Ra(a %ed!e a (+"'+r7 rn a+(!s(e !n s(+d!!"e e&!de%!o"o$!ce es(e de Y ca/+r! "a
    5LLLL de !nd!v!/!, c+ ra(e ra&or(a(e %er$And de "a 9 "a 9L ca/+n "a 5LLLL de
    !nd!v!/! R7%Ane nec"ar .a&(+" dac7 ra(e"e %a! !%&or(an(e ra&or(a(e re."ec(7
    d!.eren(e :n %e(odo"o$!e sa+ o creO(ere a .recven(e! cond!=!e!
    *voluie
    Pr!n de.!n!=!e, de'+(+" (+"'+r7r!! a+(!s(e s+rv!ne :na!n(e de e(a(ea de ; a% :n
    +ne"e ca/+r!, &7r!n=!! a.!r%7 c7 a+ .os( a"ar%a=! de co&!" :nc7 de "a naO(ere sa+ sc+r(
    (!%& d+&7 aceea, d!n ca+/a "!&se! de !n(eres a co&!"+"+! &en(r+ !n(erac=!+nea soc!a"7
    Man!.es(7r!"e (+"'+ra% :n &er!oada de s+$ar s+n( %a! s+'(!"e s! rra! d!.!c!" de
    de.!n!( decA( ce"e ses!/a(e d+&7 e(a(ea de 9 a% :n(r4+n n+%7r red+s de ca/+n,
    co&!"+" es(e descr!s a se .! de/vo"(a( nor%a" :n &r!%+" an de _ a=7 Esa+ c!ar :n &r!%!!
    9 a%J T+"'+rarea a+(!s(7 are o evo"+=!e con(!n+7 La co&!!! de e(a(e Oco"ar7 s! "a
    ado"escen=!, s+n( .recven(e cAO(!$+r! :n de/_ o"(are :n +ne"e do%en!! Ede e<,
    creO(erea !n(eres+"+! &en(r+ ac(!v!(a(ea soc!a"7, &e %7s+r7 ce co&!"+" a@+n$e "a e(a(ea
    Oco"ar7 J Un+ !nd!v!/! se de(er!orea/7 co%&or(a%en(a" :n c+rs+" ado"escen(e!, &e
    c:nd a"(n se a%e"!orea/7 A&(!(+d!n!"e "!n$v!s(!ce Ede e<, &re/en=a "!%'a@+"+!
    co%+n!ca(!vJ s! n!ve"+" !n(e"ec(+a" $enera" s+n( ce! %a! !%&or(an=! .ac(or! :n ra&or(
    c+ &ro$nos(!c+" .!na" S(+d!!"e ca(a%nes(!ce d!s&on!'!"e s+$erea/7 c7 n+%a! +n %!c
    &rocen(a@ de !nd!v!/! c+ (+"'+rarea a@+n$ s7 (r7!asc7 s! s7 %+nceasc7 !nde&enden(
    ca ad+"=! :n a&roa&e o (re!%e d!n ca/+r! es(e &os!'!" +n an+%!( $rad de
    !nde&enden(7 &ar=!a"7 Ad+"=!! c+ (+"'+rare a+(!s(7 c+ ce" %a! :na"( n!ve" de
    .+nc=!onare con(!n+7 de re$+"7 s7 &re/!n(e &ro'"e%e :n !n(erac=!+nea soc!a"7 s! :n
    co%+n!care, :%&re+n7 c+ o res(rAn$ere %arca(7 a &reoc+&7r!"or s! ac(!v!(7=!"or
    #attern $amilial
    E<!s(7 +n r!sc cresc+( de (+"'+rare a+(!s(7 &r!n(re .ra=!! !nd!v!/!"or c+ (+"'+rarea,
    c+ a&ro<!%a(!v Yd d!n(re .ra=! &re/en(And, de ase%enea, cond!=!a De ase%enea,
    &are a e<!s(a +n r!sc &en(r+ d+ erse d!.!c+"(7=! :n de/vo"(are "a .ra(n a.ec(a=!
    Tulburrile dia!nosticate de re!ul pentru prima dat
    ?H "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Dia!nostic di$erenial
    Per!oade de re$res!+ne :n de/vo"(are &o( .! o'serva(e s! :n de/vo"(area nor%a"7,
    dar aces(ea n+ s+n( n!c! a(A( de severe s! n!c! a(A( de &re"+n$!(e ca :n (+"'+rarea
    a+(!s(7. T+"'+rarea a+(!s(7 (re'+!e s7 .!e d!.eren=!a(7 de a"(e (+"'+r7r! de de/vo"(are
    &ervas!ve. T+"'+rarea Re(( d!.er7 de (+"'+rarea a+(!s(7 &r!n ra(a se<+"+! s!
    &a((ern+" de de.!c!(e carac(er!s(!ce. T+"'+rarea Re(( a .os( d!a$nos(!ca(7 n+%a! "a
    .e%e!, &e cAnd (+"'+rarea a+(!s(7 s+rv!ne %+"( %a! .recven( "a '7r'a=!, :n (+"'+rarea
    Re((, e<!s(7 +n &a((ern carac(er!s(!c de :nce(!n!re a creO(er!! ca&+"+!, de &!erdere a
    a&(!(+d!n!"or %an+a"e or!en(a(e s&re +n sco& c7&7(a(e an(er!or s! a&ar!=!a +n+! %ers
    sa+ %!Oc7r! a"e (r+nc!+"+! !ns+.!c!en( coordona(e, :n s&ec!a" :n (!%&+" an!"or
    &reOco"ar!, !nd!v!/!! c+ (+"'+rare Re(( &o( &re/en(a d!.!c+"(7=! :n !n(erac=!+nea
    soc!a"7 s!%!"are ce"or o'serva(e :n (+"'+rarea a+(!s(7, dar aces(ea (!nd a .! (ran/!(or!!.
    T+"'+rarea a+(!s(7 d!.er7 de (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e!, care are +n
    &a((ern d!s(!nc( de re$res!+ne a de/vo"(7r!!, aceas(a s+rven!nd d+&7 ce" &+=!n 9 an!
    de de/vo"(are nor%a"7, :n (+"'+rarea a+(!s(7, ano%a"!!"e de de/vo"(are s+n( ses!/a(e
    de re$+"7 :nc7 d!n &r!%+" an de v!a=7. CAnd n+ s+n( d!s&on!'!"e !n.or%a=!! des&re
    de/vo"(area &recoce or! cAnd n+ es(e &os!'!"7 doc+%en(area re.er!(oare "a &er!oada
    de de/vo"(are nor%a"7 necesar7, (re'+!e &+s d!a$nos(!c+" de (+"'+rare a+(!s(7.
    T+"'+rarea As&er$er &oa(e .! d!s(!ns7 de (+"'+rarea a+(!s(7 &r!n "!&sa :n(Ar/!er!! :n
    de/vo"(area "!%'a@+"+!. T+"'+rarea As&er$er n+ es(e d!a$nos(!ca(7 dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea a+(!s(7.
    Sc!/o.ren!a c+ de'+( :n co&!"7r!e s+rv!ne de re$+"7 d+&7 an! de de/vo"(are
    nor%a"7 sa+ a&roa&e nor%a"7. Un d!a$nos(!c ad!=!ona" de sc!/o.ren!e &oa(e .! &+s,
    dac7 +n !nd!v!d c+ (+"'+rare a+(!s(7 de/vo"(7 e"e%en(e"e carac(er!s(!ce de
    sc!/o.ren!e Eve/! &a$. 9FGJ c+ s!%&(o%e a"e .a/e! ac(!ve, c+% ar .! !de!"e de"!ran(e
    sa+ a"+c!na=!!"e &roe%!nen(e, care d+rea/7 ce" &+=!n o "+n7. :n %+(!s%+" se"ec(!v,
    co&!"+" &re/!n(7 de re$+"7 a&(!(+d!n! de co%+n!care cores&+n/7(oare :n an+%!(e
    con(e<(e s! n+ are de(er!orarea sever7 :n !n(erac=!+nea soc!a"7 s! &a((ern+r!"e
    res(r!c(!ve de co%&or(a%en( asoc!a(e c+ (+"'+rarea a+(!s(7, :n (+"'+rarea de "!%'a@
    e<&res!v O! :n (+"'+rarea %!<(7 de "!%'a@ rece&(!v O! e<&res!v e<!s(7 o de(er!orare
    a "!%'a@+"+!, dar ea n+ es(e asoc!a(7 c+ &re/en=a +ne! de(er!or7r! ca"!(a(!ve :n
    !n(erac=!+nea soc!a"7 O! c+ &a((ern+r! res(rAnse, re&e(!(!ve O! s(ereo(!&e de
    co%&or(a%en(. Uneor!, es(e d!.!c!" de &rec!/a( dac7 +n d!a$nos(!c ad!=!ona" de
    (+"'+rare a+(!s(7 es(e @+s(!.!ca( "a +n !nd!v!d c+ re(ardare %en(a"7, :n s&ec!a" dac7
    re(ardarea %en(a"7 es(e sever7 sa+ &ro.+nd7. Un d!a$nos(!c ad!=!ona" de (+"'+rare
    a+(!s(7 es(e re/erva( &en(r+ ace"e s!(+a=!! :n care e<!s(7 de.!c!(e ca"!(a(!ve :n
    a&(!(+d!n!"e de co%+n!care O! soc!a"e, !ar co%&or(a%en(e"e s&ec!.!ce, carac(er!s(!ce
    (+"'+r7r!! a+(!s(e, s+n( &re/en(e. S(ereo(!&!!"e %o(or!! s+n( carac(er!s(!ce (+"'+r7r!!
    a+(!s(e8 +n d!a$nos(!c ad!=!ona" de (+"'+rare de %!Ocare s(ereo(!&7 n+ es(e &+s cAnd
    aces(ea s+n( e<&"!ca(e %a! '!ne ca &ar(e a (a'"o+"+! c"!n!c a" (+"'+r7r!! a+(!s(e.
    S!%&(o%e"e de !&erac(!v!(a(e O! de !na(en=!e s+n( .recven(e :n (+"'+rarea a+(!s(7 ,
    :ns7 d!a$nos(!c+" de (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e n+ es(e &+s dac7
    es(e &re/en(7 (+"'+rarea a+(!s(7 .
    Tulburrile dia!nosticate de re!ul pentru prima
    dat "n #erioada de Su!ar, "n opilrie sau "n
    Adolescen
    G<

    Criteriile $e $ia/no&ti# pentru C55.+ Tul-urarea Auti&t(
    A2 .n total de ,ase &sau mai muli) itemi de la &E), &7) si &4), cu cel puin doi
    itemi de la &E) si c@te unul de la &7) si &4)D
    &E) deteriorare calitativ "n interaciunea social, mani$estat prin cel puin
    dou din urmtoareleD
    (a)deteriorare marcat "n u(ul a multiple comportamente nonverbale,
    cum ar $i privitul "n $a, expresia $acial, posturile corpului si
    !esturile, pentru re!larea interaciunii sociale3
    (b)incapacitatea de a promova relaii cu e!alii, corespun(toare nivelului
    de de(voltare3
    (c)lipsa cutrii spontane de a imprtsi bucuria, interesele sau reali
    (rile cu ali oameni &de ex2, prin lipsa de a arta, de a aduce ori de a
    speci$ica obiectele de interes)3
    (d)lipsa de reciprocitate emoional sau social3
    &7) deteriorri calitative "n comunicare, mani$estate prin cel puin unul din
    urmtoareleD
    (a)"nt@r(iere sau lips total a de(voltrii limba0ului vorbit &ne"nsoit de
    o "ncercare de a o compensa prin moduri alternative de comunicare,
    cum ar $i !estica sau mimica)3
    (b) la indivi(ii cu limba0 adecvat, deteriorarea semni$icativ "n
    capacitatea
    de a iniia sau susine o conversaie cu alii3
    (c)u( repetitiv si stereotip de limba0 ori un limba0 va!3
    (d) lipsa unui 0oc spontan si variat =de-a222> ori a unui 0oc imitativ
    social
    corespun(tor nivelului de de(voltare3
    &4) patternuri stereotipe si repetitive restr@nse de comportament, preo
    cupri si activiti, mani$estate printr-unul din urmtoareleD
    &a) preocupare circumscris la unul sau mai multe patternuri restr@nse si
    stereotipe de interese, care este anormal, $ie ca intensitate, $ie ca
    $ocali(are3
    &b)aderen in$lexibil evident de anumite rutine sau ritualuri
    non$uncionale3
    (c)manierisme motorii stereotipe si repetitive &de ex2, $luturatul sau rsu-
    citul de!etelor sau m@inilor ori mi,cri complexe ale "ntre!ului corp)3
    (d) preocupare persistent pentru pri ale obiectelor2
    S2 "nt@r(ieri sau $uncionare anormal "n cel puin unul din urmtoarele
    domenii, cu debut "nainte de etatea de 4 aniD &E) interaciune social, &7)
    limba0, a,a cum este utili(at "n comunicarea social, ori &4) 0oc ima!inativ sau
    simbolic2
    2 #erturbarea nu este explicat mai bine de tulburarea +ett sau de tulburarea
    de(inte!rativ a copilriei2
    Tulburrile dia!nosticate de re!ul pentru prima dat
    G= "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    C55.>+ Tul-urarea Rett
    _
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7% Re(( :" cons(!(+!e de/vo"(area +nor de.!c!(e
    s&ec!.!ce %+"(!&"e, +r%And +ne! &er!oade de .+nc=!onare nor%a"7 d+&7 naO(ere
    Ind!v!/!! a+, ev!den(, o &er!oad7 &rena(a"7 O! &enna(a"7 nor%a"7 Ecr!(er!+" A"J, c+
    de/vo"(are &s!o%o(one nor%a"7 :n &r!%e"e c!nc! "+n! de v!a=7 Ecr!(er!+" A9J
    C!rc+%.er!n=a ca&+"+! "a naO(ere es(e, de ase%enea, :n "!%!(e nor%a"e Ecr!(er!+" A;
    J :n(re e(a(ea de Y s! IG de "+n!, creO(erea ca&+"+! se :nce(!neO(e Ecr!(er!+" B"J E<!s(7
    o &!erdere a a&(!(+d!n!"or %an+a"e &rac(!ce c7&7(a(e an(er!or :n(re e(a(ea de Y O! ;L
    de "+n!, c+ a&ar!=!a consec+(!v7 a %!Oc7r!"or s(ereo(!&e carac(er!s(!ce a"e %A!n!!,
    ase%7n7(oare s(ors+"+! r+.e"or c+ %Ana or! s&7"a(+"+! &e %A!n! Ecr!(er!+" B9J.
    In(eres+" &en(r+ a%'!an(a soc!a"7 d!%!n+a :n &r!%!! cA=!va a% d+&7 de'+(+"
    (+"'+r7r!! Ecr!(er!+" B;J, deO! !n(erac=!+nea soc!a"7 se &oa(e de/vo"(a adesea %a!
    (Ar/!+ :n c+rs+" evo"+=!e!. A&ar &ro'"e%e :n coordonarea %ers+"+! or! a %!Oc7r!"or
    (r+nc!+"+! Ecr!(er!+" BIJ E<!s(7, de ase%enea, o de(enorare sever7 :n de/vo"(area
    "!%'a@+"+! e<&res!v O! rece&(!v, c+ re(ardare &s!o%o(one sever7 Ecr!(er!+" BYJ
    *lemente ,i tulburri asociate
    T+"'+rarea Re(( es(e asoc!a(7 de re$+"7 c+ re(ardare %en(a"7 sever7 sa+
    &ro.+nd7 care, dac7 es(e &re/en(7, (re'+!e s7 .!e cod!.!ca(7 &e a<a II. N+ e<!s(7 n!c!
    +n .e" de da(e de "a'ora(or s&ec!.!ce asoc!a(e c+ (+"'+rarea Poa(e e<!s(a o .recven=7
    cresc+(7 a ano%a"!!"or EE, s! a e&!"e&s!e! "a !nd!v!/!! c+ (+"'+rare Re(( A+ .os(
    descnse ano%a"!! nes&ec!.!ce "a !%a$!s(!ca cere'ra"7. Da(e &re"!%!nare s+$erea/7 c7
    o %+(a=!e $ene(!c7 es(e ca+/a +nor ca/+r! de (+"'+rare Re((
    #revalent
    Da(e"e s+n( "!%!(a(e :n $enera" "a cA(eva ser!! de ca/+r!, O! se &are c7 (+"'+rarea
    Re(( es(e %+"( %a! &+=!n .recven(7 decA( (+"'+rarea a+(!s(7 Aceas(7 (+"'+rare a .os(
    descr!s7 n+%a! "a .e%e!
    *voluie
    Pa((ern+" de re$res!+ne :n de/vo"(are es(e cA( se &oa(e de d!s(!nc( T+"'+rarea
    Re(( de'+(ea/7 :na!n(e de e(a(ea de I an!, de re$+"7 :n &r!%+" sa+ :n a" do!"ea an de
    v!a=7 T+"'+rarea d+rea/7 (oa(7 v!a=a, !ar &!erderea a&(!(+d!n!"or es(e :n $enera"
    &ers!s(en(7 s! &ro$res!v7 :n ce"e %a! %+"(e ca/+r!, rec+&erarea es(e e<(re% de
    red+s7, deO! &o( .! o'=!n+(e +ne"e cAO(!$+r! evo"+(!ve .oar(e %odes(e, O! &oa(e .!
    o'serva(7 o &reoc+&are &en(r+ !n(erac=!+nea soc!a"7, deoarece !nd!v!/!! !n(r7 %a!
    (Ar/!+ :n co&!"7r!e sa+ :n ado"escen(7 D!.!c+"(7=!"e de co%+n!care O! co%&or(a%en(
    r7%An de re$+"7 re"a(!v cons(an(e de4a "+n$+" v!e=!!
    Dia!nostic di$erenial
    Per!oade de re$res!+ne :n de/vo"(are &o( .! o'serva(e s! :n de/vo"(area nor%a"7,
    dar aces(ea n+ s+n( n!c! a(A( de severe s! n!c! a(A( de &re"+n$!(e ca :n (+"'+rarea Re((
    Pen(r+ d!a$nos(!c+" d!.eren=!a" :n(re (+"'+rarea Re(( s! (+"'+rarea a+(!s(7, ve/! &a$ HI
    766 E5 Tulburarea De(mte!rativ a opilriei ??

    T+"'+rarea Re(( d!.er7 de (+"'+rarea de/%(e$ra(!v7 a co&!"7r!e! s! de (+"'+rarea
    As&er$er &r!n ra(a se<+"+!, de'+( s! &a((ern+" de.!c!(e"or care4! s+n( carac(er!s(!ce T+"'+rarea Re(( a .os(
    d!a$nos(!ca(7 n+%a! "a .e%e!, &e cAnd :n (+"'+rarea de/%(e$ra(!v7 a co&!"7r!e! s! (+"'+rarea As&er$er &ar a .!
    %a! .recven(e "a '7r'a=! De'+(+" s!%&(o%e"or :n (+"'+rarea Re(( &oa(e s+rven! :nc7 de "a e(a(ea de Y "+n!, &e
    cAnd :n (+"'+rarea de/%(e$ra(!v7 a co&!"7r!e! &er!oada de de/vo"(are nor%a"7 es(e de "e$+"7 %a! &re"+n$!(7
    Ead!c7, ce" &+=!n &An7 "a e(a(ea de 9 a%J :n (+"'+rarea Re(( e<!s(7 +n &a((ern carac(er!s(!c de :nce(!n!re a creO(e%
    ca&+"+!, de &!erdere a a&(!(+d!n!"or %an+a"e c7&7(a(e an(er!or s! de a&ar!=!e a +n+! %ers s! %!Oc7r! a"e
    (r+nc!+"+! !ns+.!c!en( de coordona(e :n con(ras( c+ (+"'+rarea As&er$er, (+"'+rarea Re(( se carac(er!/ea/7
    &r%(r4o de(er!orare se_ er7 a de/vo"(7% "!%'a@+"+! rece&(!v s! e<&res!v
    Criteriile $e $ia/no&ti# pentru C55.>+ Tul-urarea Rett
    A Oricare din urmtorii itemi
    (1) de(voltare prenatala si permatal dup c@t se pare normal,
    (2) de(voltare psi%omotone dup cat se pare normal "n primele A luni dup
    na,tere,
    (3) circum$erina capului normal la na,tere
    S Debutul oricruia din urmtorii itemi dup o perioad de de(voltare normal
    (1) "ncetinirea cre,tem capului "ntre etatea de A si H8 de luni,
    (1) pierderea aptitudinilor manuale practicT cptate anterior "ntre etatea
    de A si 45 de luni, cu apariia consecutiv de mi,cri stereotipe ale
    m@inilor &de ex , storsul cu m@inile, splatul pe Taini),
    (2) pierderea an!a0m sociale, precoce "n cursul evoluiei &de,i adesea
    interaciunea social se de(volt mai t@r(iu
    E
    U
    (3) apariia unui mers sau a unor mi ,cri ale trunc%iului insu$i ci ent de
    coordonate,
    (4) de(voltarea limba0ului receptiv si expresiv deteriorat sever, cu retardare
    psi%omotone sever
    C55.*+ Tul-urarea De)inte/rativ( a Copil(riei
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7% de/%(e$ra(n e a co&!"7r!e! :" cons(!(+!e o re$res!+ne %arca(7 :n %+"(!&"e
    do%en!! de .+nc=!onare, care +r%ea/7 +ne! &er!oade de ce" &+=!n 9 an! de de/vo"(are ev!den( nor%a"7 Ecr!(er!+"
    AJ De/vo"(area ev!den( nor%a"7 es(e re."ec(a(7 de co%+n!carea ver'a"7 s! nonver'a"7, de re"a=!!"e soc!a"e, @oc+"
    s! co%&or(a%en(+" ada&(a(!v cores&+n/7(oare e(7(n D+&7 &r!%!! 9 an! de v!a=7 Edar :na!n(e de e(a(ea de 5L
    a%J, co&!"+" &re/!n(7 o &!erdere !%&or(an(7 a a&(!(+d!n!"or c7&7(a(e :n ce" &+(% do+7 d!n +r%7(oare"e do%en!!
    "!%'a@ rece&(!v sa+ e<&res!v, a&(!(+d!n! soc!a"e sa+ co%&or(a%en( ada&(a(!v, &!erderea con(ro"+"+!
    ?8 Tulburrile dia!nosticate de re!ul pentru prima dat "n #erioada de Su!ar,
    "n opilrie sau "n Adolescen
    s.!nc(er+"+! ana" sa+ a" ve/!c!! +r!nare, @oc sa+ a&(!(+d!n! %o(or!! Ecr!(er!+" BJ. Foar(e (!&!c es(e .a&(+" c7
    a&(!(+d!n!"e c7 &a =a=e s+n( &!erd+(e :n a&roa&re (oa(e do%en!!"e. Ind!v!/!! c+ aceas(7 (+"'+rare %an!.es(7 de.!c!(e
    de co%+n!care s! soc!a"e, s! e"e%en(e co%&or(a%en(a"e o'serva(e :n $enera" :n (+"'+rarea a+(!s(7 Eve/! &a$.
    HLJ. E<!s(7 o de(er!orare ca"!(a(!v7 :n !n(erac=!+nea soc!a"7 Ecr!(er!+" CIJ O! :n co%+n!care Ecr!(er!+" C9J O!
    &a((ern+r! s(ereo(!&e, re&e(!(!ve O! res(rAnse de co%&or(a%en(, !n(erese s! ac(!v!(7=! Ecr!(er!+" C;J. Per(+r'area
    n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de de/vo"(are &ervas!v7 sa+ de sc!/o.ren!e Ecr!(er!+" DJ. Aceas(7
    cond!=!e a .os( den+%!(7, de ase%enea, sindrom 9eller, demen(ia in)antilis sa+ psi-o;6 de;inte/rati*67
    *lemente si tulburri asociate
    T+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! es(e asoc!a(7 de re$+"7 c+ re(ardarea %en(a"7 sever7 care, dac7 es(e
    &re/en(7, (re'+!e s7 .!e cod!.!ca(7 &e a<a II. Po( .! no(a(e d!verse se%ne s! s!%&(o%e ne+ro"o$!ce nes&ec!.!ce. Se
    &are c7 e<!s(7 o .recven=7 cresc+(7 a ano%a"!!"or EE, O! a e&!"e&s!e!. DeO! se &are c7 aceas(7 cond!=!e es(e
    re/+"(a(+" +ne! no<e care a.ec(ea/7 de/vo"(area s!s(e%+"+! nervos cen(ra", n!c! +n %ecan!s% &rec!s n+ a .os(
    !den(!.!ca(. Cond!=!a es(e o'serva(7, oca/!ona", :n asoc!ere c+ o cond!=!e %ed!ca"7 $enera"7 Ede e<.,
    "e+cod!s(ro.!a %e(acro%a(!c7, %a"ad!a Sc!"derJ care &oa(e @+s(!.!ca re$res!+nea :n de/vo"(are, :n ce"e %a!
    %+"(e ca/+r! :ns7, !nves(!$a=!! e<(!nse n+ ev!den=!a/7 n!c! o as(.e" de cond!=!e. Dac7 o cond!=!e ne+ro"o$!c7 sa+
    o a"(7 cond!=!e %ed!ca"7 $enera"7 es(e asoc!a(7 c+ (+"'+rarea, aceas(a (re'+!e :nre$!s(ra(7 &e a<a III. Da(e"e de
    "a'ora(or vor re."ec(a or!ce cond!=!! %ed!ca"e $enera"e asoc!a(e.
    #revalent
    Da(e"e e&!de%!o"o$!ce s+n( red+se, dar (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! &are a .! .oar(e rar7 s! %+"(
    %a! &+=!n .recven(7 decA( (+"'+rarea a+(!s(7, c!ar dac7 cond!=!a es(e &ro'a'!" s+'d!a$nos(!ca(7. DeO! s(+d!!"e
    !n!=!a"e s+$era+ o ra(7 a se<+"+! e$a"7, da(e %a! recen(e !nd!c7 .a&(+" c7 (+"'+rarea es(e %a! .recven(7 "a
    '7r'a=!.
    *voluie
    Pr!n de.!n!=!e, (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! &oa(e .! d!a$nos(!ca(7 n+%a! dac7 s!%&(o%e"e s+n(
    &receda(e de ce" &+=!n 9 an! de de/vo"(are nor%a"7, !ar de'+(+" es(e an(er!or e(7=!! de 5L an!. CAnd &er!oada
    de de/vo"(are nor%a"7 a .os( .oar(e &re"+n$!(7 EY sa+ %a! %+"=! an!J, es(e e<(re% de !%&or(an( s7 se &rocede/e "a
    +n e<a%en so%a(!c sa+ ne+ro"o$!c &en(r+ a s(a'!"! &re/en(a +ne! cond!=!! %ed!ca"e $enera"e, :n ce"e %a! %+"(e
    ca/+r!, de'+(+" s+rv!ne :n(re e(7=!"e de ; s! I an!, s! &oa(e .! !ns!d!os sa+ 'r+sc. Se%ne"e &re%on!(or!! &o( !nc"+de
    n!ve"e de ac(!v!(a(e cresc+(e, !r!(a'!"!(a(ea s! an<!e(a(ea, +r%a(e de o &!erdere a a&(!(+d!n!"or "!n$v!s(!ce sa+ a a"(or
    a&(!(+d!n!. De re$+"7, &!erderea a&(!(+d!n!"or a(!n$e +n &"a(o+, d+&7 care &o( s+rven! +ne"e a%e"!or7r!
    "!%!(a(e, :ns7 a%e"!orarea es(e rar no(a'!"7, :n a"(e ca/+r!, :n s&ec!a" cAnd (+"'+rarea es(e asoc!a(7 c+ o cond!=!e
    ne+ro"o$!c7 &ro$res!v7, &!erderea a&(!(+d!n!"or es(e $rad+a"7. Aceas(7 (+"'+rare are o evo"+=!e con(!n+7 s! :n
    %a@or!(a(ea ca/+r!"or d+rea/7 (oa(7 v!a=a. D!.!c+"(7=!"e co%&or(a%en(a"e, co%+4n!ca=!ona"e O! soc!a"e r7%An
    re"a(!v cons(an(e de4a "+n$+" v!e=!!.
    7662E5 Tulburarea De(inte!rativ a opilriei ?6
    Dia!nostic di$erenial
    Per!oade de re$res!+ne &o( .! o'serva(e s! :n de/vo"(area nor%a"7, dar aces(ea n+
    s+n( n!c! a(A( de severe s! n!c! a(A( de &re"+n$!(e ca :n (+"'+rarea de/!n(e$ra(!v7 a
    co&!"7r!e!. T+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! (re'+!e s7 .!e d!.eren=!a(7 de a"(e
    (+"'+r7r! de de/vo"(are &ervas!ve. Pen(r+ d!a$nos(!c+" d!.eren=!a" c+ (+"'+rarea
    a+(!s(7, ve/! &a$. HR. Pen(r+ d!a$nos(!c+" d!.eren=!a" c+ (+"'+rarea Re((, ve/! &a$.
    HR. :n con(ras( c+ (+"'+rarea As&er$er, (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! es(e
    carac(er!/a(7 &r!n(r4o &!erdere se%n!.!ca(!v7 c"!n!c :n a&(!(+d!n!"e c7&7(a(e an(er!or
    s! &r!n(r4o %are &ro'a'!"!(a(e de re(ardare %en(a"7, :n (+"'+rarea As&er$er n+
    e<!s(7 :n(Ar/!ere :n de/vo"(area "!%'a@+"+! s! n!c! o &!erdere se%n!.!ca(!v7 a
    a&(!(+d!n!"or de de/vo"(are.
    T+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! (re'+!e s7 .!e d!.eren=!a(7 de de%en=a c+
    de'+( :n &er!oada de s+$ar sa+ :n co&!"7r!e. De%en=a s+rv!ne ca o consec!n=7 a
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<., (ra+%a(!s%,
    cran!anJ, &e cAnd (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! s+rv!ne de re$+"7 :n a'sen=a
    +ne! cond!=!! %ed!ca"e $enera"e asoc!a(e.
    Criteriile $e $ia/no&ti# pentru
    C55.*+ Tul-urarea De)inte/rativ( a Copil(riei
    A2 De(voltare evident normal pentru cel puin primii 7 ani dup na,tere
    mani$estat prin pre(ena comunicrii verbale ,i nonverbale, relaii sociale,
    0oc si comportament adaptativ corespun(toare etii2
    S2 #ierdere semni$icativ clinic a aptitudinilor ac%i(iionate anterior &"nainte
    de etatea de E5 ani) "n cel puin dou din urmtoarele domeniiD
    (1)limba0 receptiv ,i expresiv3
    (2)aptitudini sociale sau comportament adaptativ3
    (3)controlul s$incterului anal ,i ve(ica)3
    (4)0oc3
    (5)aptitudini motorii2
    2 Anomalii "n $uncionare "n cel puin dou din urmtoarele domeniiD
    &E) deteriorare calitativ "n interaciunea social &de ex2, deteriorare "n
    comportamentele nonverbale, incapacitatea de a promova relaii cu
    e!alii, lipsa reciprocitii emoionale sau sociale)3
    (2) deteriorare calitativ "n comunicare &de ex2Nnt@r(iere sau lipsa limba0ului
    vorbit, incapacitatea de a iniia sau susine o conversaie, uz repetitiv ,i
    stereotip de limba0, lipsa 0ocului =de-a222> variat)3
    (3) patternuri stereotipe, repetitive ,i restr@nse de comportament, interese
    si activiti, inclu(@nd stereotipii ,i manierisme motorii2
    D2 #erturbarea nu este explicat mai bine de o alt tulburare >de de(voltare
    pervasiv speci$ic ori de sc%i(o$renie2
    Tulburrile dia!nosticate de re!ul pentru prima dat
    85 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    C55.>+ Tul-urarea A&per/er
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! As&er$er "e cons(!(+!e de(er!orarea s+s=!n+(7
    s! sever7 :n !n(erac=!+nea soc!a"7 Ecr!(er!+" AJ s! de/vo"(area +nor &a((ern+n
    re&e(!(!ve, res(rAnse, de co%&or(a%en(, !n(erese s! ac(!v!(7=! Ecr!(er!+" BJ
    Per(+r'area (re'+!e s7 ca+/e/e o de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ :n ra&or( c+
    (+"'+rarea a+(!s(7, n+ e<!s(7 :n(Ar/!er! se%n!.!ca(!ve c"!n!c :n "!%'a@ Ede e< , c+v!n(e
    nonecoa(e s!n$+re s+n( +(!"!/a(e :n co%+n!care "a e(a(ea de do! an!, e<&res!!
    co%+n!ca(!ve "a e(a(ea de ; an!J Ecr!(er!+" DJ, deO! &o( .! a.ec(a(e as&ec(e %a! s+'(!"e
    a"e co%+n!c7 rn soc!a"e (de ex , sc-imb+l tipic =n con*ersa(ie% :n a.ar7 de aceas(a, :n
    c+rs+" &r!%!"or (re! a% de v!a(7 n+ e<!s(7 :n(Ar/!er! se%n!.!ca(!ve c"!n!c :n
    de/vo"(area co$n!(!v7 ca %an!.es(a(e &r!n e<&r!%area c+no/!(7 (n nor%a"e :n
    "e$7(+r7 c+ a%'!an(a sa+ :n ac!/!=!onarea a&(!(+d!n!"or de :nv7=are s! a
    co%&or(a%en(+"+! ada&(a(!v cores&+n/7(oare e(7=!! Ea"(e"e decA( :n !n(erac=!+nea
    soc!a"7 J Ecr!(er!+" EJ :n .!ne, n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a"(7 (+"'+rare de
    de/vo"(are &ervas!v7 sa+ &en(r+ sc!/o.ren!e Ecr!(er!+" FJ Aceas(7 cond!=!e es(e
    den+%!(7, de ase%enea, s!ndro% As&er$er
    De(er!orarea :n !n(erac=!+nea soc!a"7 rec!&roc7 es(e $"o'a"7 s! s+s=!n+(7 Poa(e
    e<!s(a de(er!orare %arca(7 :n +/+" a %+"(!&"e co%&or(a%en(e nonver'a"e de re$"are
    a co%+n!c7r!! s! !n(erac=!+n!! soc!a"e Ede e<, &r!v!(+" :n .a(7, e<&res!a .ac!a"7,
    $es(+r!"e s! &os(+r!"e cor&ora"eJ Ecr!(er!+" A"J De ase%enea, &oa(e e<!s(a
    !nca&ac!(a(ea de a s(a'!"! re"a=!! c+ e$a"!! cores&+n/7 (oare n!ve"+"+! de de/vo"(are
    Ecr!(er!+" A9J care &o( "+a d!.er!(e .or%e "a e(7=! d!.er!(e Ind!v!/!! %a! %!c! &o( avea
    &+=!n sa+ n!c! +n !n(eres :n a s(a'!"! a%!c!=!! Ind!v!/!! %a! %ar! &o( .! !n(eresa=! de
    a%!c!=!!, dar s+n( "!&s!=! de :n=e"e$erea conven=!!"or !n(erac=!+n!! soc!a"e Poa(e e<!s(a
    o "!&s7 a c7+(7% s&on(ane de a :%&7r(7O! c+ a"=!! sa(!s.ac=!a, !n(erese"e sa+
    rea"!/7r!"e Ede e<, n+ ara(7 , n+ ad+c sa+ n+ s&ec!.!c7 o'!ec(e"e care4! !n(eresea/7
    Ecr!(er!+" A;J Poa(e .! &re/en(7 "!&sa de rec!&roc!(a(e e%o=!ona"7 sa+ soc!a"7 Ede e< ,
    n+ &ar(!c!&7 ac(!v "a @oc+r!"e soc!a"e s!%&"e, &re.er7 ac(!v!(7=!"e so"!(are sa+ !%&"!c7
    &e a"=!! :n ac(!v!(7=! n+%a! ca !ns(r+%en(e sa+ a@+(oare S%ecan!ceT Ecr!(er!+" AIJ
    C!ar dac7 de.!c!(+" soc!a" !n (+"'+rarea As&er$er es(e sever s! es(e de.!n!( :n ace"aO!
    %od ca :n (+"'+rarea a+(!s(7, "!&sa de rec!&roc!(a(e soc!a"7 se %an!.es(7 %a! (!&!c
    &r%(r4o a'ordare soc!a"7 e<cen(r!c7 s! +n!"a(era"7 a a"(ora %a! c+rAnd decA( &r!n
    !nd!.eren(7 e%o=!ona"7 sa+ soc!a"7 Ede e<, +r%7reO(e +n s+'!ec( de conversa=!e
    !nd!.eren( de reac=!!"e ce"or"a"=!J
    Ca s! % (+"'+rarea a+(!s(7, s+n( &re/en(e &a((ern+n re&e(!(!ve, res(rAnse, de
    co%&or(a%en(, !n(erese s! ac(!v!(7=! Ecr!(er!+" BJ Adesea aces(ea se %an!.es(7 :n
    &r!%+" rAnd :n de/vo"(area de &reoc+&7r! c!rc+%scr!se "a +n an+%!( !n(eres sa+
    s+'!ec( des&re care !nd!v!d+" &oa(e ad+na +n %are vo"+% de .a&(e s! !n.or%a=!!
    Ecr!(er!+" B"J Aces(e !n(erese s! ac(!v!(7=! s+n( +r%7r!(e c+ %are !n(ens!(a(e,
    %er$And adesea &An7 "a e<c"+derea a"(or ac(!v!(7=!
    Per(+r'area &oa(e ca+/a o de(er!orare se%n!.!ca(!v7 c"!n!c :n ada&(area soc!a"7,
    care :n sc!%' &oa(e avea +n !%&ac( !%&or(an( as+&ra a+(ono%!e! sa+ .+nc=!on7%
    oc+&aona"e or! a a"(or do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ De.!c!(e"e
    soc!a"e s! &a((ern+r!"e res(r!nse de !n(erese, ac(!v!(7=! s! co%&or(a%en(e s+n( s+rsa
    +ne! !nca&ac!(7=! cons!dera'!"e
    766 85 Tulburarea
    Asper!er
    >*
    Con(rar (+"'+r7r!! a+(!s(e, n+ e<!s(7 :n(Ar/!en se%n!.!ca(!ve c"!n!c :n "!%'a@+"
    &recoce Ede e<, c+v!n(e !/o"a(e s+n( .o"os!(e :n @+r+" e(7=!! de 9 a%, !ar .ra/e
    co%+n!ca(!ve, :n @+r+" e(7(n de ; a%J Ecr!(er!+" DJ L!%'a@+" +"(er!or &oa(e .! !nso"!(
    :n (er%en!! &reoc+&7% !nd!v!d+"+! &en(r+ an+%!(e s+'!ec(e s! a "ocvac!(7=!! sa"e
    D!.!c+"(7=!"e :n co%+n!care &o( d+ce "a d!s.+nc(!e soc!a"7 s! "a !nca&ac!(a(ea de a
    rea"!/a s! +(!"!/a re$+"!"e conven=!ona"e a"e conversa=!e!, "a !nca&ac!(a(ea de a rea"!/a
    se%ne"e nonver'a"e s! "a ca&ac!(7=! red+se de a+(ocond+cere Ea+(o%on!(on/areJ
    Ind!v!/!! c+ (+"'+rare As&er$er n+ &re/!n(7 :n(Ar/!en se%n!.!ca(!ve c"!n!c :n
    de/vo"(area co$n!(!v7 sa+ :n a&(!(+d!n!"e de a+(oa@+(orare cores&+n/7(oare e(7(n, :n
    co%&or(a%en(+" ada&(a(!v Ea"(+" decA( :n !n(erac=!+nea soc!a"7J s! c+r!o/!(a(ea :n
    "e$7(+r7 c+ a%'!an(a :n co&!"7r!e Ecr!(er!+" EJ Deoarece "!%'a@+" &recoce s!
    a&(!(+d!n!"e co$n!(!ve s+n( :n "!%!(e nor%a"e :n &r!%!! ; a% de v!a(7, &7r!n=!! sa+
    !n.!r%!er!! n+ s+n( concen(ra=! de re$+"7 as+&ra de/vo"(7% co&!"+"+! :n aceas(7
    &er!oad7, deO! "a o ces(!onare %a! de(a"!a(7 aceO(!a &o( rec+noaO(e
    co%&or(a%en(e"e !nso"!(e Co&!"+" &oa(e .! descr!s ca vor'!nd :na!n(e de a %er$e,
    &7r!n=!! cre/And c7 co&!"!"+" es(e &recoce Ead!c7, are +n voca'+"ar 'o$a( sa+
    Sad+"(TJ C+ (oa(e c7 &o( e<!s(a &ro'"e%e soc!a"e s+'(!"e, &7r!n=!! sa+ !n.!r%!er!! n+
    s+n( &reoc+&a=! de aces(ea &An7 ce co&!"+" n+ :nce&e s7 %ear$7 "a $r7 d!n!(7 sa+
    es(e con.r+n(a( c+ +n co&!" de aceeaO! e(a(e, :n aces( %o%en( d!.!c+"(7=!"e soc!a"e a"e
    co&!"+"+! c+ e$a"!! Eco&!!J de aceeaO! e(a(e &o( deven! ev!den(e
    Pr!n de.!n!=!e, d!a$nos(!c+" n+ es(e &+s dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+
    or!care a"(7 (+"'+rare de de/vo"(are &ervas!v7 s&ec!.!c7 sa+ &en(r+ sc!/o.ren!e
    EdeO! d!a$nos(!ce"e de (+"'+rare As&er$er s! de sc!/o.ren!e &o( coe<!s(a, dac7
    de'+(+" (+"'+r7% As&er$er &recede c"ar de'+(+" sc!/o.ren!e! Ecr!(er!+" FJ
    *lemente si tulburri asociate
    Con(rar (+"'+r7% a+(!s(e, re(ardarea %en(a"7 n+ es(e o'serva(7 de re$+"7 :n
    (+"'+rarea As&er$er, deO!, oca/!ona", a+ .os( o'serva(e ca/+r! :n care es(e &re/en(7
    o re(ardare %en(a"7 +Ooar7 Ede e< , cAnd re(ardarea %en(a"7 dev!ne ev!den(7 n+%a!
    :n an!! de scoa"7, c+ n!c! o :n(Ar/!ere !n "!%'a@ sa+ :n c+noaO(ere :n &r!%!! an! de
    v!a(7 J Poa(e .! o'serva(7 vana'!(a(ea .+nc=!on7r!! co$n!(!ve, adesea c+
    !n(ens!.!c7r! :n do%en!!"e a&(!(+d!n!! v er'a"e Ede e<, :n voca'+"ar, %e%or!a
    a+d!(!v7 de r+(!n7J s! d!%!n+7r! :n ar!!"e nonver'a"e Eres&ec(!v, a&(!(+d!n!"e
    v!/+o%o(orn s! v!/+os&a(!a"eJ Po( .! &re/en(e !na'!(a(ea %o(or!e s! %a"adresa, dar
    de re$+"7 s+n( re"a(!v +Ooare, deO! d!.!c+"(7 (!"e %o(or!! &o( con(r!'+! "a res&!n$erea
    de c7 (re e$a"! s! "a !/o"area soc!a"7 Ede e< , !nca&ac!(a(ea de a &ar(!c!&a "a s&or(+r!"e
    de $r+&J S!%&(o%e"e de !&eracv!(a(e s! de %a(ene s+n( .recven(e :n (+"'+rarea
    As&er$er s! %a! %+"( decA( a(A(, %+"=! !nd!v!/! c+ aceas(7 cond!=!e &r!%esc +n
    d!a$nos(!c de (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e an(er!or s(a'!"!r!!
    d!a$nos(!c+"+! de (+"'+rare As&er$er T+"'+rarea As&er$er a .os( ra&or(a(7 a .!
    asoc!a(7 c+ +n n+%7r de a"(e (+"'+r7r! %en(a"e, !nc"+s!v (+"'+r7r!"e de&res!ve
    *lemente speci$ice etii si sexului
    Ta'"o+" c"!n!c se &oa(e &re/en(a d!.er!( "a d!.er!(e e(7=! Adesea, !nca&ac!(a(ea
    soc!a"7 a !nd!v!/!"or c+ (+"'+rarea dev!ne %a! .ra&an(7 :n (!%& :n ado"escen=7 +n+
    !nd!v!/! c+ (+"'+rarea &o( :nv7=a s7 .o"oseasc7 do%en!!"e de .or=7 Ede e<,
    ca&ac!(7=!"e ver'a"e de r+(!n7J &en(r+ a co%&ensa do%en!!"e de de'!"!(a(e Ind!v!/!!
    c+ (+"'+rarea As&er$er &o( .! &ersec+(a=! de a"(n, aceas(a s! sen(!%en(e"e de !/o"are
    Tulburrile dia!nosticate de re!ul pentru prima dat
    87 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    soc!a"7 s! ca&ac!(a(ea cresc+(7 de conO(!en(!/are &o( con(r!'+! "a a&ar!=!a de&res!e! s!
    an<!e(7=!! :n ado"escen=7 s! :n &er!oada de ad+"( (An7r. T+"'+rarea es(e d!a$nos(!ca(7
    %+"( %a! .recven( Ede ce" &+=!n c!nc! or!J "a '7r'a=! decA( "a .e%e!.
    #revalent
    L!&sesc da(e conc"+den(e des&re &reva"en(a (+"'+r7r!! As&er$er.
    Evo"+=!e
    T+"'+rarea As&er$er es(e o (+"'+rare con(!n+7 s! d+rea/7 (oa(7 v!a=a La co&!! de
    e(a(e Oco"ar7 ca&ac!(7=!"e ver'a"e '+ne &o(, :n(r4o an+%!(7 %7s+r7, %asca
    sever!(a(ea d!s.+nc=!e! soc!a"e s! &o(, de ase%enea, :nOe"a !n.!r%!er!! O! &ro.esor!!
    4ad!c7, !n.!r%!er!! O! &ro.esor!! se &o( concen(ra as+&ra a&(!(+d!n!"or ver'a"e '+ne a"e
    co&!"+"+! O! &o( .! !ns+.!c!en( de conO(!en=! de &ro'"e%e"e d!n a"(e do%en!! E:n s&ec!a"
    de ada&(area soc!a"7 J A&(!(+d!n!"e ver'a"e re"a(!v '+ne a"e co&!"+"+! &o( .ace &e
    &ro.esor! s! !n.!r%!er! s7 a(r!'+!e :n %od erona( d!.!c+"(7=!"e co%&or(a%en(a"e
    o's(!na=!e! sa+ :nd7r7(n!c!e! co&!"+"+! In(eres+" &en(r+ s(a'!"!rea de re"a=!! soc!a"e
    &oa(e creO(e :n ado"escen=7 &e %7s+r7 ce !nd!v!/!! :nva=7 cA(eva %oda"!(7=! de a
    r7s&+nde %a! ada&(a(!v "a d!.!c+"(7=!"e "or 4 de e<e%&"+ , !nd!v!d+", &oa(e :nv7=a s7
    a&"!ce r+(!ne sa+ re$+"! ver'a"e e<&"!c!(e :n an+%!(e s!(+a=!! s(resan(e. Ind!v!/!! %a!
    %ar! &o( .! !n(eresa=! :n a s(a'!"!! a%!c!=!!, dar "!&sa de :n=e"e$ere a conven=!!"or de
    !n(erac=!+ne soc!a"7 .ace %a! &ro'a'!"e re"a=!!"e c+ !nd!v!/! %a! :n e(a(e sa+ %a! %!c!
    decA( e! Pro$nos(!c+" &are a .! cons!dera'!" %a! '+n decA( ce" a" (+"'+r7% a+(!s(e,
    s(+d!!"e ca(a%nes(!ce s+$erAnd c7 %+"=! !nd!v!/!, ca ad+"=!, s+n( ca&a'!"! de an$a@are
    :n %+nc7 &ro.!(a'!"7 s! de !nde&enden=7 &ersona"7
    #attern $amilial
    DeO! da(e"e d!s&on!'!"e s+n( "!%!(a(e, se &are c7 e<!s(7 o .recven=7 cresc+(7 a
    (+"'+r7% As&er$er &r!n(re %e%'r+ .a%!"!!"or !nd!v!/!"or care a+ aceas(7 (+"'+rare
    Poa(e e<!s(a, de ase%enea, +n r!sc cresc+( &en(r+ (+"'+rarea a+(!s(7 ca s! &en(r+
    d!.!c+"(7 =! soc!a"e %a! $enera"e
    Dia!nostic di$erenial
    T+"'+rarea As&er$er (re'+!e d!s(!ns7 de a"(e (+"'+r7r! de de/vo"(are
    &ervas!v7, (oa(e aces(ea .+nd carac(er!/a(e &r!n &ro'"e%e :n !n(erac=!+nea soc!a"7
    T+"'+rarea As&er$er d!.er7 de (+"'+rarea a+(!s(7 :n d!verse %od+r! :n
    (+"'+rarea a+(!s(7 e<!s(7, &r!n de.!n!=!e, ano%a"!! se%n!.!ca(!ve :n do%en!!"e
    !n(erac=!+n!! soc!a"e, "!%'a@+"+! s! @oc+"+!, &e cAnd :n (+"'+rarea As&er$er
    a&(!(+d!n!"e "!n$v!s(!ce O! co$n!(!ve &recoce n+ s+n( :n(Ar/!a(e :n %od se%n!.!ca(!v
    :n a.ar7 de aceas(a, :n (+"'+rarea a+(!s(7, !n(erese"e O! ac(!v!(7=!"e, res(rAnse,
    re&e(!(!ve s! s(ereo(!&e s+n( adesea carac(er!/a(e &r!n &re/en=a %a%ens%e"or
    %o(or!!, a &reoc+&7% &en(r+ &7r=! a"e o'!ec(e"or, r!(+a"+r! s! de(res7 %arca(7, &e
    cAnd :n (+"'+rarea As&er$er, aces(ea s+n( o'serva(e :n &r!%+" rAnd :n
    +r%7r!rea a(o(c+&r!n/7(oare a !n(erese"or c!rc+%scr!se !nc"+/And +n s+'!ec(
    c7r+!a !nd!v!d+" :! ded!c7 .oar(e %+"( (!%& s(rAn$And !n.or%a=!! s! da(e
    D!.eren=!erea ce"or do+7 cond!=!! &oa(e .! &ro'"e%a(!c7 :n +ne"e ca/+r! :n
    (+"'+rarea a+(!s(7, &a((ern+r!"e de !n(erac=!+ne soc!a"7 (!&!c7 s+n( %arca(e de
    a+(o!/o"are sa+ de a'ord7r! soc!a"e %arca( r!$!de, &e cAnd :n (+"'+rarea
    As&er$er &are a e<!s(a o %o(!va=!e &en(r+
    766285 Tulburarea Asper!er 84
    a'ordarea ce"or"a"=!, c!ar dac7 aceas(a es(e .7c+(7 :n(r4o %an!er7 e<cen(r!c7,
    +n!"a(era"7, &ro"!<7 s! !nsens!'!"7
    T+"'+rarea As&er$er (re'+!e s7 .!e, de ase%enea, d!.eren=!a(7 de (+"'+r7r!"e de
    de/vo"(are &ervas!v7, a"(e"e decA( (+"'+rarea a+(!s(7 T+"'+rarea Re(( d!.er7 de
    (+"'+rarea As&er$er &r!n ra(a se<+"+! carac(er!s(!c7 s! &r!n &a((ern+" de de.!c!(e
    T+"'+rarea Re(( a .os( d!a$nos(!ca(7 n+%a! "a .e%e!, &e cAnd (+"'+rarea As&er$er
    s+rv!ne %+"( %a! .recven( "a '7r'a=! :n (+"'+rarea Re(( e<!s(7 +n &a((ern
    carac(er!s(!c de :nce(!n!re a creO(e% ca&+"+!, de &!erdere a a&(!(+d!n!"or %an+a"e
    !%&or(an(e c7&7(a(e an(er!or s! de a&ar!=!e a +nor %!Oc7r! &+=!n coordona(e a"e
    (r+nc!+"+! sa+ %ers+"+! T+"'+rarea Re(( es(e asoc!a(7, de ase%enea, c+ $rade
    %arca(e de re(ardare %en(a"7 s! de de(er!or7r! $roso"ane :n "!%'a@ s! co%+n!care
    T+"'+rarea As&er$er d!.er7 de (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! care are
    +n &a((ern d!s(!nc(!v de re$res!+ne a de/vo"(7% +r%And d+&7 ce" &+=!n 9 an! de
    de/vo"(are nor%a"7 Co&!! c+ (+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e! &re/!n(7, de
    ase%enea, $rade %arca(e de re(ardare %en(a"7 sa+ de :n(Ar/!er! :n "!%'a@
    Sc!/o.ren!a c+ de'+( :n co&!"7r!e a&are de re$+"7 d+&7 a% de de/vo"(are
    nor%a"7 sa+ a&roa&e nor%a"7 s! s+n( &re/en(e e"e%en(e"e carac(er!s(!ce a"e
    (+"'+r7r!!, !nc"+/And a"+c!na=!!"e, !de!"e de"!ran(e s! "!%'a@+" de/or$an!/a( :n
    %+(!s%+" se"ec(!v, co&!"+" &re/!n(7 de re$+"7 a&(!(+d!n! de co%+n!care
    cores&+n/7(oare :n an+%!(e con(e<(e s! n+ are de(er!orarea sever7 d!n !n(erac=!+nea
    soc!a"7 s! &a((ern+r!"e res(rAnse de co%&or(a%en( asoc!a(e c+ (+"'+rarea As&er$er
    D!n con(ra, !nd!v!/!! c+ (+"'+rare As&er$er s+n( de re$+"7 vor'7re=!, :n (+"'+rarea
    de "!%'a@ e<&res!v s! :n (+"'+rarea %!<(7 de "!%'a@ e<&res!v s! rece&(!v, e<!s(7
    de(er!orare :n "!%'a@, dar aceas(a n+ es(e asoc!a(7 c+ de(enorare ca"!(a(!v7 :n
    !n(erac=!+nea soc!a"7 s! c+ &a((ern+r! s(ereo(!&e, re&e(!(!ve O! res(rAnse de
    co%&or(a%en( Un+ !nd!v!/! c+ (+"'+rarea As&er$er &o( &re/en(a &a((ern+n de
    co%&or(a%en( s+$erAnd (+"'+rarea o'ses!vo4co%&+"s!v7, s! ca a(are (re'+!e
    acorda(7 o a(en=!e c"!n!c7 s&ec!a"7 d!.eren=!er!! &reoc+&7r!"or s! ac(!v!(7=!"or d!n
    (+"'+rarea As&er$er de o'ses!!"e s! co%&+"s!!"e d!n (+"'+rarea o'ses!vo4
    co%&+"s!v7 :n (+"'+rarea As&er$er aces(e !n(erese s+n( s+rsa +ne! oarecan &"7cer!
    sa+ con.or(, &e cAnd :n (+"'+rarea o'ses!vo4co%&+"s!v7 e"e s+n( s+rsa an<!e(7=!! :n
    a.ar7 de aceas(a, (+"'+rarea o'ses!vo4co%&+"s!v7 n+ es(e asoc!a(7 de re$+"7 c+
    n!ve"e"e de de(enorare :n !n(erac=!+nea soc!a"7 s! :n co%+n!care o'serva(e :n
    (+"'+rarea As&er$er
    Re"a=!a d!n(re (+"'+rarea As&er$er s! (+"'+rarea de &ersona"!(a(e sc!/o!d7 es(e
    nec"ar7 :n $enera", d!.!c+"(7=!"e soc!a"e d!n (+"'+rarea As&er$er s+n( %a! severe O!
    de'+(ea/7 %a! &recoce DeO! +n+ !nd!v!/! c+ (+"'+rare As&er$er &o( e<&enen(a o
    an<!e(a(e cresc+(7 s! de'!"!(an(7 :n cond!=!! soc!a"e, ca :n .o'!a soc!a"7 sa+ a"(e
    (+"'+r7r! an<!oase, aces(ea d!n +r%7 n+ se carac(er!/ea/7 &r!n de(er!or7r!
    &ervas!ve :n de/vo"(area soc!a"7 sa+ &r!n !n(erese"e c!rc+%scnse (!&!ce (+"'+r7r!!
    As&er$er. T+"'+rarea As&er$er (re'+!e d!s(!ns7 de @ena soc!a"7 nor%a"7 s! de
    o''!+r!"e O! !n(erese"e nor%a"e cores&+n/7(oare e(7=!!, :n (+"'+rarea As&er$er,
    de.!c!(e"e soc!a"e s+n( .oar(e severe !ar &reoc+&7r!"e s+n( a(o(c+&r!n/7(oare s!
    !n(er.erea/7 c+ ac!/!=!onarea a&(!(+d!n!"or .+nda%en(a"e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    8H "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Criteriile $e $ia/no&ti# pentru C55.>+ Tul-urarea A&per/er
    A2 Deteriorare calitativ "n interaciunea social mani$estat prin cel puin
    dou dintre urmtoareleD
    (1) deteriorare marcat "n u(ul a multiple comportamente nonverbale cum
    ar $i privitul "n $a, expresia $acial, posturile corporale si !esturile de
    re!lare a interaciunii sociale3
    (2) incapacitatea de a stabili relaii cu e!alii corespun(toare nivelului
    de
    de(voltare3
    (3) lipsa cutrii spontane de a "mprt,i satis$acia, interesele sau
    reali(rile
    cu ali oameni &de ex2, lipsa de a arta, de a aduce, de a speci$ica altor
    oameni obiectele de interes)3
    (4) lipsa de reciprocitate emoional sau social2
    S2 #atternuri stereotipe, repetitive ,i restr@nse de comportament, interese si
    activiti, mani$estate prin cel puin unul dintre urmtorii itemiD
    (1) preocupare circumscris la unul sau mai multe patternuri restr@nse si
    ste
    reotipe de interes, si care este anormal, $ie ca intensitate sau centrare3
    (2) aderen in$lexibil evident de rutine sau ritualuri speci$ice,
    non-
    $uncionale3
    (3) manierisme motorii repetitive si stereotipe &de ex,, $luturatul sau
    rsu-
    citul m@inilor sau de!etelor sau mi,cri complexe ale "ntre!ului corp)3
    (1) preocupare persistent pentru pri ale obiectelor2
    2 #erturbarea cau(ea( deteriorare semni$icativ clinic "n domeniul social,
    pro$esional ori "n alte domenii importante de $uncionare2
    D2 Fu exist o "nt@r(iere !eneral semni$icativ clinic "n 2limba0 &de ex2, utili(ea(
    cuvinte i(olate ctre etatea de 7 ani si $ra(e comunicative ctre etatea de 4 ani)2
    *2 Fu exist o "nt@r(iere semni$icativ clinic "n de(voltarea co!nitiv sau "n
    de(voltarea aptitudinilor de autoa0utorare corespun(toare etii, $n
    comportamentul adaptativ &altele dec@t "n interaciunea social) ,i "n
    curio(itatea pentru ambian "n copilrie2
    '2 Fu sunt satis$cute criteriile pentru o alt tulburare de de(voltare pervasiv
    speci$ic sau pentru sc%i(o$renie2
    C55.>+ Tul-urare $e De)voltare Perva&iv(
    '(r( Alt( Spe#i%i#a!ie 3in#lu&iv Auti&"ul Atipi#6
    Aceas(7 ca(e$or!e (re'+!e +(!"!/a(7 cAnd e<!s(7 o de(er!orare &ervas!v7 s! sever7
    :n de/vo"(area !n(erac=!+n!! soc!a"e rec!&roce sa+ a a&(!(+d!n!"or de co%+n!care
    nonver'a"7 sa+ ver'a"7 or! cAnd s+n( &re/en(e co%&or(a%en(e, !n(erese s! ac(!v!(7=!
    s(ereo(!&e, dar n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ o (+"'+rare de de/vo"(are
    &ervas!v7 s&ec!.!c7, &en(r+ sc!/o.ren!e, (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7
    or! &en(r+ (+"'+rarea de &ersona"!(a(e ev!(an(7. De e<., aceas(7 ca(e$or!e !nc"+de
    Sa+(!s%+" a(!&!cT U (a'"o+r! c"!n!ce care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea
    a+(!s(7 d!n ca+/a de'+(+"+! (ard!v, s!%&(o%a(o"o$!e! a(!&!ce, s!%&(o%a(o"o$!e!
    s+'"!%!na"e or! a (+(+ror aces(ora.
    Tulburrile de De$icit de Ateni
    e si de omportament
    Disruptiv ><
    Tul-ur(rile $e De%i#it $e Aten!ie
    Ei $e Co"porta"ent Di&ruptiv
    Tul-urarea Fipera#tivitateADe%i#it $e Aten!ie
    Ele"ente $e $ia/no&ti#
    E"e%en(+" esen=!a" a" (+"'+r7% !&erac(!v!(a(eXde.!c!( de a(en=!e :".consr!r+!e +n
    &a((ern &ers!s(en( de %a(en(!e s!, sa+ de !&erac(!v!(a(e4!%&+"s!v!(a(e, care es(e %a!
    .recven( s! %a! sever decA( es(e o'serva( de re$+"7 "a !nd!v!/!! c+ +n n!ve"
    co%&ara'!" de de/vo"(are Ecr!(er!+" AJ Une"e s!%&(o%e de !&erac(!v!(a(e4
    !%&+"s!v!(a(e sa+ de %a(en(!e care ca+/ea/7 de(er!orarea (re'+!e s7 .! .os( &re/en(e
    :na!n(e de e(a(ea de H an!, deO! %+"=! !nd!v!/! s+n( d!a$nos(!ca=! d+&7 ce s!%&(o%e"e
    a+ .os( &re/en(e (!%& de +n n+%7r de an!, :n s&ec!a" :n ca/+" !nd!v!/!"or c+ (!&+"
    &redo%!nan( %a(en( Ecr!(er!+" BJ O oarecare de(er!orare d!n ca+/a s!%&(o%e"or
    (re'+!e s7 .!e &re/en(7 :n ce" &+=!n do+7 s!(+a=!! Ede e<, acas7, s! "a scoa"7 sa+ "a
    serv!c!+J Ecr!(er!+" CJ Tre'+!e s7 .!e c"ar7 &ro'a !n(er.eren=e! c+ .+nc=!onarea soc!a"7,
    Oco"ar7 sa+ &ro.es!ona"7 cores&+n/7(oare d!n &+nc(+" de vedere a" de/vo"(7 n!
    Ecr!(er!+" DJ Per(+r'area n+ s+rv!ne e<c"+s!v :n c+rs+" evo"+=!e! +ne! (+"'+r7n de
    de/vo"(are &ervas!v7, a" sc!/o.ren!e! or! a" a"(e! (+"'+r7n &s!o(!ce s! n+ es(e
    e<&"!ca(7 %a! '!ne de vreo a"(7 (+"'+rare %en(a"7 Ede e<, o (+"'+rare a.ec(!v7,
    an<!oas7, d!soc!a(!v7 sa+ de &ersona"!(a(eJ Ecr!(er!+" EJ
    Ina(en(!a se &oa(e %an!.es(a % s!(+a=!! Oco"are, &ro.es!ona"e sa+ soc!a"e Ind!v!/!!
    c+ aceas(7 (+"'+rare &o( .! !nca&a'!"! s7 4s! concen(re/e a(en=!a as+&ra de(a"!!"or sa+
    &o( .ace eror! &r!n ne$"!@en(7 :n e.ec(+area (e%e"or Oco"are sa+ a a"(or sarc!n! Ecn(en+"
    A"aJ Ac(!v!(a(ea es(e adesea de/ordona(a, e.ec(+a(7 ne$"!@en( s! .7r7 +n &"an $And!(
    Ind!v!/!! a+ adesea d!.!c+"(7=! :n a4s! %en=!ne a(en=!a as+&ra +nor sarc!n! sa+
    ac(!v!(7=! de @oc s! cons!der7 c7 es(e $re+ s7 &ers!s(e :n e.ec(+area sarc!n!"or &An7 "a
    rea"!/area "or Ecr!(er!+" A"'J E! &ar adesea ca s! c+% ar c+ %!n(ea :n a"(7 &ar(e on
    ca s! c+% n+ ar asc+"(a sa+ n+ ar a+/! ceea ce se s&+ne Ecn(en+" A"eJ Po( e<!s(a
    (recer! .recven(e de "a o ac(!v!(a(e ne(er%!na(7 "a a"(a Ind!v!/!! d!a$nos(!ca=! c+
    aceas(7 (+"'+rare &o( :nce&e o sarc!n7, (rec "a a"(a, a&o! se :n(orc "a a"(ceva, :na!n(e de
    a (er%!na vre+na Adesea e! n+ +r%ea/7 e<ac( cerer!"e sa+ !ns(r+c=!+n!"e s! s+n(
    !nca&a'!"! s7 4s! e.ec(+e/e (e%e"e Oco"are, sarc!n!"e casn!ce sa+ a"(e :nda(onn Ecn(en+"
    A!dJ Inca&ac!(a(ea de a :nde&"!n! sarc!n!"e (re'+!e "+a(7 :n cons!dera=!e a(+nc! cAnd
    se &+ne aces( d!a$nos(!c, n+%a! dac7 ea se da(orea/7 %a(en=!e!, ca o&+s7 a"(or
    %o(!ve &os!'!"e Ede e< , !nca&ac!(a(ea de a :n=e"e$e !ns(r+c=!+n!"eJ AceO(! !nd!v!/! a+
    adesea d!.!c+"(7=! :n or$an!/area sarc!n!"or s! ac(!v!(7=!"or Ecn(en+" A"e J Sarc!n!"e
    care cer +n e.or( %en(a" s+s=!n+( s+n( e<&enen(a(e ca ne&"7c+(e s! %arca( avers!ve
    :n consec!n=7, aceO(! !nd!v!/! ev!(7 de re$+"7, on a+ o &+(ern!c7 avers!+ne .a(7 de
    ac(!v!(7=!"e care neces!(7 a+(oe<!$en=7 s! e.or( %en(a" sa+ care neces!(7 ca&ac!(7=!
    or$an!/a(or!ce on o concen(rare s+s=!n+(7 Ede e< , (e%e"e &en(r+ acas7 sa+ "+cr7n"e
    scr!seJ Ecr!(er!+" A".J Aceas(7 ev!(are (re'+!e s7 .!e da(ora(7 d!.!c+"(7=!"or :n
    concen(rare a"e &ersoane! s! n+ +ne! a(!(+d!n! o&o/!=!on!s(e &r!%are, deO! +n
    o&o/!(!on!s% sec+ndar &oa(e, de ase%enea, s+rven! De&r!nder!"e de a "+cra s+n(
    adesea de/or$an!/a(e, !ar %a(er!a"e"e necesare &en(r+ :nde&"!n!rea sarc!n!"or s+n(
    Tulburrile dia!nosticate de re!ul pentru prima dat
    >= "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    adesea :%&r7O(!a(e, &!erd+(e sa+ %An+!(e ne$"!@en( s! de(er!ora(e Ecr!(er!+" A" $J.
    Ind!v!/!! c+ aceas(7 (+"'+rare s+n( +Oor de d!s(ras de s(!%+"! !re"evan(! s! :n %od
    .recven( :n(rer+& sarc!n!"e :n c+rs de e.ec(+are &en(r+ a se oc+&a de /$o%o(e sa+
    even!%en(e 'ana"e, care s+n( +/+a"e s! +Oor de !$nora( de c7(re a"=!! Ede
    e<.,c"a<ona(+" +n+! a+(o(+r!s%, o conversa=!e d!n @+rJ Ecr!(er!+" A"J. E! s+n( adesea
    +!(+c! re.er!(or "a ac(!v!(7=!"e co(!d!ene Ede e<., "!&sesc de "a :n(A"n!r!, +!(7 s74O! !a
    de@+n+" Ecr!(er!+" A!!J, :n s!(+a=!! soc!a"e, !na(en=!a se &oa(e %an!.es(a &r!n (recer! de
    "a +n s+'!ec( "a a"(+" :n conversa=!e, &r!n a n+ asc+"(a "a ce!"a"=!, a n+4! .! %!n(ea "a
    conversa=!e O! a n+ res&ec(a de(a"!!"e sa+ re$+"!"e @oc+r!"or sa+ ac(!v!(7=!"or.
    H!&erac(!v!(a(ea se &oa(e %an!.es(a &r!n .o!( sa+ r7s+c!( Ecr!(er!+" A9aJ, &r!n a n+
    r7%Ane aOe/a( cAnd es(e de dor!( s4o .ac7 Ecr!(er!+" A9J, &r!n a"er$a( sa+ c7=7ra( :n
    s!(+a=!! :n care aces( "+cr+ es(e !nadecva( Ecr!(er!+" A9cJ, &r!n a avea d!.!c+"(7=! :n a se
    @+ca or! :n a se an$a@a "!n!O(!( :n ac(!v!(7=! d!s(rac(!ve Ecr!(er!+" A9dJ, &r!n a &7rea
    adesea c7 se a."7 S:n con(!n+7 %!OcareT or! ca s! c+% ar .! S:%&!ns de +n %o(orT
    Ecr!(er!+" A9eJ, sa+ &r!n a vor'! e<ces!v de %+"( Ecr!(er!+" A9.J. H!&erac(!v!(a(ea &oa(e
    var!a :n ra&or( c+ e(a(ea !nd!v!d+"+! O! c+ n!ve"+" de de/vo"(are, !ar d!a$nos(!c+"
    (re'+!e &+s c+ %+"(7 &reca+=!e "a co&!!! %!c!. Co&!!! care a'!a :nce& s7 %ear$7 O!
    &reOco"ar!! c+ aceas(7 (+"'+rare d!.er7 de co&!!! %!c! ac(!v! nor%a"! &r!n .a&(+" c7 se
    a."7 :n(r4o con(!n+7 %!Ocare O! &es(e (o(J, .+$ :na!n(e O! :na&o!, s+n( Ra)ar6 :na!n(ea
    a!ne"orT "or, sar &es(e %o'!"7 sa+ se +rc7 &e ea, a"ear$7 &r!n cas7 s! a+ d!.!c+"(7=! :n
    a &ar(!c!&a "a ac(!v!(7=! de $r+& seden(are :n c"ase"e &reOco"are Ede e<., s7 asc+"(e o
    &oves(eJ. Co&!!! de e(a(e Oco"ar7 &re/!n(7 co%&or(a%en(e s!%!"are, dar de re$+"7 c+
    o .recven=7 sa+ !n(ens!(a(e %a! red+s7 decA( co&!!! care :nva=7 s7 %ear$7 O! ca
    &reOco"ar!!. E! a+ d!.!c+"(7=! :n a r7%Ane aOe/a=!, se r!d!c7 .recven( :n &!c!oare, se
    r7s+cesc &e sca+n sa+ se a$a=7 de %ar$!nea aces(+!a. Se @oac7 c+ d!verse o'!ec(e, 'a(
    d!n &a"%e, :O! &end+"ea/7 &!c!oare"e :n %od e<ces!v. Adesea se r!d!c7 de "a %as7 :n
    (!%& ce %7nAnc7 sa+ se r!d!c7 :n (!%& ce &r!vesc "a (e"ev!/or or! :n (!%& ce4O! .ac
    (e%e"e &en(r+ acas7, vor'esc e<ces!v de %+"( O! .ac %+"( /$o%o( :n (!%&+" +nor
    ac(!v!(7=! care (re'+!e s7 se des.7Ooare :n "!n!O(e. La ado"escen=! sa+ "a ad+"=!,
    s!%&(o%e"e de !&erac(!v!(a(e !a+ .or%a +nor sen(!%en(e de ne"!n!O(e s! de
    d!.!c+"(a(e :n a se an$a@a :n ac(!v!(7=! seden(are care (re'+!e s7 se des.7Ooare :n "!n!O(e.
    I%&+"s!v!(a(ea se %an!.es(7 ca !%&ac!en=7, d!.!c+"(a(e :n a%Anarea
    r7s&+ns+r!"or, (rAn(!rea r7s&+ns+r!"or :na!n(e ca :n(re'7r!"e s7 .! .os( co%&"e(
    .or%+"a(e Ecr!(er!+" A9$J, d!.!c+"(7=! :n a4O! aO(e&(a rAnd+" Ecr!(er!+" A9J O!
    :n(rer+&erea sa+ deran@area a"(ora &An7 &e &+nc(+" de a ca+/a d!.!c+"(7=! :n s!(+a=!!
    &ro.es!ona"e, Oco"are sa+ soc!a"e Ecr!(er!+" A9!J. Ce!"a"=! se &o( &"An$e c7 e! n+ &o(
    scoa(e o vor'7. Ind!v!/!! c+ aceas(7 (+"'+rare .ac de re$+"7 co%en(ar!! :na!n(e de a
    "e .! ven!( rAnd+" s7 !n(erv!n7 :n d!sc+=!e, s+n( !nca&a'!"! s7 asc+"(e de !nd!ca=!!,
    !n!=!a/7 conversa=!! :n %o%en(e !no&or(+ne, :n(rer+& :n %od e<ces!v s! deran@ea/7
    &e a"=!!, s%+"$ d!verse o'!ec(e de "a a"=!!, a(!n$ "+cr+r! &e care n+ se crede c7 e! "e
    &o( a(!n$e O! .ac &e c"ovn!! :n .a=a ce"or d!n @+r. I%&+"s!v!(a(ea &oa(e d+ce "a
    acc!den(e Ede e<., se c!ocnesc de o'!ec(e"e d!n @+r, se "ovesc de d!verse &ersoane,
    a&+c7 o casero"7 .!er'!n(eJ s! se an$a@ea/7 :n ac(!v!(7=! &o(en=!a" &er!c+"oase .7r7 a
    "+a :n cons!dera=!e consec!n=e"e &os!'!"e Ede e<., a"ear$7 &e s)a(e'oard 4 scAnd+r7
    &e ro(!"e 4 &e +n (eren e<(re% de nere$+"a(J.
    Man!.es(7r!"e co%&or(a%en(a"e a&ar de re$+"7 :n %+"(!&"e con(e<(e !nc"+/And
    casa, Ocoa"a, serv!c!+" s! s!(+a=!!"e soc!a"e. Pen(r+ a &+ne d!a$nos(!c+", (re'+!e s7
    e<!s(e o oarecare de(er!orare :n ce" &+=!n do+7 s!(+a=!! Ecr!(er!+" CJ. Es(e e<(re% de
    rar ca/+" ca +n !nd!v!d s7 &re/!n(e ace"aO! n!ve" de d!s.+nc=!e :n (oa(e s!(+a=!!"e or!
    Tulburrile de De$icit de
    Atenie si de omportament
    Disruptiv
    >G
    :n aceeaO! s!(+a=!e (o( (!%&+" De re$+"7, s!%&(o%e"e se a$ravea/7 :n s!(+a=!! care
    neces!(7 a(en=!e sa+ e.or( %en(a" s+s=!n+( or! care s+n( "!&s!(e de a(rac(!v!(a(e sa+
    de no+a(e !n(r!nsec7 Ede e< , a+d!erea &ro.esor!"or :n c"as7, e.ec(+area (e%e"or :n
    c"as7, a+d!erea sa+ c!(!rea +nor %a(er!a"e %a! "+n$! or! "+cr+" "a sarc!n! re&e(!(!ve,
    %ono(oneJ Se%ne"e (+"'+r7% &o( .! %!n!%e sa+ a'sen(e cAnd &ersoana &r!%eO(e
    .recven( reco%&ense &en(r+ +n co%&or(a%en( cores&+n/7(or, se a."7 s+'
    s+&rave$ere s(r!c(7 , se a."7 :n(r4o s!(+a=!e no+7, es(e an$a@a(7 :n ac(!v!(7=! e<(re%
    de !n(eresan(e, or! se se a."a :n(r4o s!(+a=!e de +n+4"a4+n+ Ede e<, :n ca'!ne(+"
    c"!n!c!an+"+!J S!%&(o%e"e s+rv!n .oar(e &ro'a'!" :n s!(+a=!! de $r+& Ede e< , $r+&e
    de [oc, :n c"as7 or! "a "oc+" de %+nc7J C"!n!c!an+" (re'+!e, de aceea, s7 o'=!n7
    !n.or%a=!! d!n %a! %+"(e s+rse Ede e< , &7r!n=!, &ro.esor!J s! s7 se !n.or%e/e des&re
    co%&or(a%en(+" !nd!v!d+"+! :n(r4o var!e(a(e de s!(+a=!! :n .!ecare con(e<( Ede e<, .7
    c+(+" (e%e"or, "+a(+" %ese!J
    Subtipuri
    DeO! %+"=! !nd!v!/! &re/!n(7 a(A( s!%&(o%e de %a(en=!e, cA( O! de
    !&erac(!v!(a(eX!%&+"s!v!(a(e, e<!s(7 !nd!v!/! "a care &redo%!n7 +n+" d!n(re aces(e
    &a((ern+r! S+'(!&+" cores&+n/7(or E&en(r+ d!a$nos(!c+" c+ren(J (re'+!e s7 .!e
    !nd!ca( &e 'a/a &a((ern+"+! s!%&(o%+"+! &redo%!nan( :n c+rs+" +"(!%e"or R "+n!.
    ;5I.L5 T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (!& co%'!na(. Aces(
    s+'& (re'+!e s7 .!e +(!"!/a( dac7 sase Esa+ %a! %+"(eJ s!%&(o%e de %a(en=!e
    O! Oase Esa+ %a! %+"(eJ s!%&(o%e de !&erac(!v!(a(e4!%&+"s!v!(a(e a+
    &ers!s(a( ce" &+=!n R "+n! Ce! %a! %+"=! co&!! s! ado"escen=! c+ (+"'+rarea a+
    (!&+" co%'!na( N+ se O(!e dac7 ace"aO! "+cr+ es(e va"a'!" s! &en(r+ ad+"=!! c+
    aceas(7 (+"'+rare
    314.0 T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (!& &redo%!nan( de
    !na(en=!e Aces( s+'(!& (re'+!e +(!"!/a( dac7 sase Esa+ %a! %+"(eJ s!%&(o%e
    de %a(en=!e, dar %a! &+=!n de sase s!%&(o%e de !&erac(!v!(a(e4!%&+"s!v!(a(e
    a+ &ers!s(a( ce" &+=!n R "+n!
    314.1 T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (!& &redo%!nan(
    !&erac(!v4!%&+"s!vQ Aces( s+'(!& (re'+!e s7 .!e +(!"!/a( dac7 Oase Esa+ %a!
    %+"(eJ s!%&(o%e de !&erac(!v!(a(e4!%&+"s#!(a(e Edar %a! &+=!n de Oase
    s!%&(o%e de %a(en=!eJ a+ &ers!s(a( ce" &+=!n R "+n! Ina(en=!a &oa(e adesea
    +n e"e%en( c"!n!c se%n!.!ca(!v s! :n as(.e" de ca/+n
    #rocedee de "nre!istrare
    Ind!v!/!! care :n(r4+n s(ad!+ &recoce a" (+"'+r7% a+ av+( (!&+" &redo%!nan( de
    %a(en=!e or! (!&+" &redo%!nan( !&erac(!v4!%&+"s!v, &o( a@+n$e s7 de/vo"(e (!&+"
    co%'!na( s! v!ceversa T!&+" cores&+n/7(or E&en(r+ d!a$nos(!c+" c+ren(J (re'+!e s7
    .!e !nd!ca( &e 'a/a &a((ern+"+! s!%&(o%+"+! &redo%!nan( :n +"(!%e"e R "+n! Dac7
    r7%An s!%&(o%e se%n!.!ca(!ve c"!n!c, dar cr!(er!!"e &en(r+ n!c! +n s+'(!& n+ %a!
    s+n( sa(!s.7c+(e, d!a$nos(!c+" adecva( es(e ce" de (+"'+rare !&erac(!v!(a(eXde.!c!(
    de a(en=!e, :n re%!s%ne &ar=!a"7 CAnd s!%&(o%e"e +n+! !nd!v!d n+ sa(!s.ac
    ac(+a"%en(e co%&"e( cr!(er!!"e &en(r+ (+"'+rare s! n+ es(e c"ar dac7 cr!(er!!"e &en(r+
    (+"'+rare a+ .os( sa(!s.7c+(e an(er!or, (re'+!e &+s d!a$nos(!c+" de (+"'+rare
    !&erac(!v!(a(eXde.!c!( de a(en=!e .7r7 a"(7 s&ec!.!ca=!eJ
    Tulburrile dia!nosticate de re!ul pentru prima dat
    88 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. E"e%en(e"e asoc!a(e
    var!a/7 :n .+nc=!e de e(a(e s! s(ad!+" de de/vo"(are, s! &o( !nc"+de (o"eran=a sc7/+(7 "a
    .r+s(rare, accese co"eroase, (end!n=a "a do%!nare, o's(!na=!a, !ns!s(en=a .recven(7 s!
    e<ces!v7 de a4! .! sa(!s.7c+(e cerer!"e, "a'!"!(a(ea a.ec(!v7, de%ora"!/area, d!s.ona,
    res&!n$erea de c7(re e$a"! s! s(!%a de s!ne sc7/+(7 Per.or%an(a Oco"ar7 es(e adesea
    de(er!ora(7 s! deva"or!/a(7 s! d+ce de re$+"7 "a con."!c(e c+ .a%!"!a s! c+ a+(or!(7=!"e
    Oco"are. D!"!$en(a red+s7 &en(r+ e.ec(+area sarc!n!"or care neces!(7 +n e.or( s+s=!n+(
    es(e adesea !n(er&re(a(7 de a"=!! ca !nd!cAnd "ene, +n s!%= red+s a" res&onsa'!"!(7=!! O!
    +n co%&or(a%en( o&o/!=!o%s( Re"a=!!"e c+ .a%!"!a s+n( carac(er!/a(e adesea &r!n
    resen(!%en(e s! an(a$on!s%e, :n s&ec!a" d% ca+;a var!a'!"!(7=n :n s(a(+s+"
    s!%&(o%a(!c care .ace adesea &e &7r!n=! s7 cread7 c7 or!ce co%&or(a%en(
    !%&er(!nen( es(e vo!( D!scord!a .a%!"!a"7 s! !n(erac=!+n!"e &7nn(e4co&!" ne$a(!ve s+n(
    adesea &re/en(e As(.e" de !n(rerac=!+% ne$a(!ve d!%!n+a &nn(r4+n (ra(a%en( c+
    s+cces :n %ed!e, !nd!v!/!! c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e a+ %a!
    &+(!n7 scoa"7 decA( e$a"!! "or s!, de ase%enea, a+ o e.!c!en=7 &ro.es!ona"7 %a! red+s7
    De ase%enea, :n %ed!e, n!ve"+" !n(e"ec(+a", eva"+a( &r!n (es(e DI !nd!v!d+a"e es(e c+
    cA(eva &+nc(e %a! sc7/+( "a co&!! c+ aces(a (+"'+rare :n co%&ara=!e c+ e$a"!! :n
    ace"aO! (!%& es(e ev!den=!a(7 s! %area vana'!"!(a(e a DI, !nd!v!/!! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e &+(And &re/en(a de/vo"(are !n(e"ec(+a"7 deas+&ra
    %ed!e! sa+ .+nd do(a=! :n .or%a sa sever7, (+"'+rarea es(e %arca( de(enoran(7,
    a.ec(And ada&(area Oco"ar7, .a%!"!a"7 s! soc!a"7 Toa(e ce"e (re! s+'&+n s+n( asoc!a(e
    c+ o de(er!orare se%n!.!ca(!v7 De.!c!(e"e Oco"are s! &ro'"e%e"e :n "e$7(+r7 c+ Ocoa"a
    (!nd a .! %a! &ron+n=a(e "a (!&+r!"e %arca(e &r!n %a(en=!e E(!&+r!"e &redo%!nan(
    !%&+"s!v4!&erac(!v s! co%'!na(J Ind!v!/!! c+ (!&+" &redo%!nan( !na(en( (!nd a .!
    &as!v! soc!a", s! &ar a .! %a! c+rAnd ne$"!@a=! decA( re@ec(a=! de e$a"!
    O &ro&or=!e s+'s(an=!a"7 Ea&ro<!%a(!v @+%7(a(eJ de co&!! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e :ndr+%a=! c7(re c"!%e! a+, de ase%enea, s!
    (+"'+rarea o&o/!=!on!s% &rovoca(or sa+ (+"'+rare de cond+!(7 Ra(e"e de a&ar!=!e
    conco%!(en(7 a (+"'+r7 n! !&erac(!v!(a(eXde.!c!( de a(en=!e c+ aces(e a"(e (+"'+r7 n
    de co%&or(a%en( d!sr+&(!v s+n( %a! %An decA( ce"e c+ a"(e (+"'+r7r! %en(a"e, !ar
    aceas(7 coa&an(!e es(e .oar(e &ro'a'!"7 :n ce"e do+7 s+'(!&+n %arca(e de
    !&erac(!v!(a(e4!%&+"s!v!(a(e E(!&+r!"e !&erac(!v4!%&+"s!v O! co%'!na(J A"(e
    (+"'+r7 n asoc!a(e !nc"+d (+"'+r7r!"e a.ec(!ve, an<!oase, de :nv7=are O! de
    co%+n!care "a co&!! c+ (+"'+rarea !&erac(!v!(a(e Xde.!c!( de a(en=!e DeO! (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e es(e &re/en(7 :n ce" &+=!n YLd d!n(re !nd!v!/!! c+
    (+"'+rarea To+re((e (r!%!O! :n c"!n!c7, ce! %a! %+"=! !nd!v!/! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e n+ a+ O! (+"'+rarea To+re((e. CAnd ce"e do+7
    (+"'+r7r! coe<!s(7, de'+(+" (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e &recede
    de'+(+" (+"'+r7r!! To+re((e
    Poa(e e<!s(a +n !s(or!c de a'+/ sa+ de ne$"!@are a co&!"+"+!, de %+"(!&"e &"as7r!
    :n c7%!ne, e<&+nere "a ne+ro(o<!ce Ede e<., !n(o<!ca=!e c+ &"+%'J, !n.ec=!! Ede e<S
    ence.a"!(aJ, e<&+nere "a dro$+r! !n +(ero sa+ de re(ardare %en(a"7 DeO! $re+(a(ea
    %!c7 "a naO(ere &oa(e .! asoc!a(7 +neor! c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de
    a(en=!e, ce! %a! %+"=! co&!! c+ $re+(a(e %!c7 "a naO(ere n+ &re/!n(7 (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e, !ar ce! %a! %+"=! co&!! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e n+ &re/!n(7 +n !s(or!c de $re+(a(e %!c7 "a naO(ere
    Tulburrile de De$icit de Atenie
    si de omportament Disruptiv 86
    9ate de laborator asociate. N+ e<!s(7 (es(e de "a'ora(or, eva"+7r! ne+ro"o$!ce
    sa+ eva"+7r! &rose<!ce care s7 .! .os( s(a'!"!(e ca avAnd va"oare d!a$nos(!c7 :n
    eva"+area c"!n!c7 a (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e S4a o'serva( c7
    (es(e"e neces!(And o &rocesare %en(a"7 care cere e.or( s+n( anor%a"e "a !nd!v!/!! c+
    (+"'+rarea !&eracv!(a(eXde.!c!( de a(en=!e :n co%&ara=!e c+ e$a"!!, :ns7 aces(e
    (es(e n+ O!4a+ de%ons(ra( +(!"!(a(ea cAnd s4a :ncerca( s7 se s(a'!"easc7 dac7 +n
    an+%!( !nd!v!d are (+"'+rarea N+ se c+nosc :nc7 de.!c!(e"e co$n!(!ve .+nda%en(a"e
    care s+n( res&onsa'!"e de as(.e" de d!.eren(e de $r+&
    9atele examinrii somatice si condi3iile medicale .enerale asociate. N+ e<!s(7
    e"e%en(e so%a(!ce s&ec!.!ce asoc!a(e c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e,
    deO! ano%a"!! so%a(!ce %!nore Ede e< , !&er(e"ons%+", o$!va &a"a(!n7 :na"(7, +rec!"e
    @os :nsera(e J &o( s+rven! :n(r4o &ro&or=!e %a! %are decA( :n &o&+"a=!a $enera"7. De
    ase%enea, &oa(e e<!s(a o ra(7 %a! :na"(7 a (ra+%e"or so%a(!ce acc!den(a"e
    *lemente speci$ice culturii, etii si sexului
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e es(e c+nosc+(7 ca a&7rAnd :n d!verse
    c+"(+r!, c+ var!a=!! :n &reva"en(a ra&or(a(7 de =7r!"e ves(!ce, &roven!nd &ro'a'!" %a!
    %+"( d!n &rac(!c!"e d!a$nos(!ce d!.er!(e decA( d!n d!.eren(e"e :n &re/en(area c"!n!c7
    Es(e .oar(e $re+ s7 se s(a'!"easc7 aces( d!a$nos(!c "a co&!!! %a! %!c! de I4Y a%,
    deoarece co%&or(a%en(+" "or carac(er!s(!c es(e %+"( %a! var!a'!" decA( ce" a"
    co&!!"or %a! %ar! s! &oa(e !nc"+de e"e%en(e care s+n( s!%!"are c+ s!%&(o%e"e
    (+"'+r7% !&erac(!v!(a(eXde.!c!( de a(en=!e :n a.ar7 de aceas(a, s!%&(o%e"e de
    %a(en=!e, "a co&!!! %!c! sa+ "a co&!!! &reOco"ar!, adesea n+ s+n( +Oor de o'serva(,
    deoarece co&n! %!c! de re$+"7 e<&enen(ea/7 &+=!ne so"!c!(7r! de a(en=!e s+s=!n+(7
    C+ (oa(e aces(ea :ns7, a(en=!a co&!!"or %!c! &oa(e .! re=!n+(7 :n(r4o var!e(a(e de
    s!(+a=!! Ede e< , +n co&!" :n e(a(e de 94; an! &oa(e s(a de re$+"7 c+ +n ad+"( care
    r7s.o!eO(e c7r=! !"+s(ra(eJ D% con(ra, co&!!! %!c! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e se %!Oc7 e<ces!v de %+"( s! de re$+"7 s+n( d!.!c!"
    de as(A%&7ra( Ance(a re.er!(oare "a o "ar$7 var!e(a(e de co%&or(a%en(e "a +n co&!"
    %!c &oa(e .! +(!"7 :n a $aran(a .a&(+" c7 a .os( o'=!n+( +n (a'"o+ c"!n!c co%&"e( O
    de(er!orare s+'s(an=!a"7 a .os( de%ons(ra(7 "a co&!! &reOco"ar! c+
    !&erac(!v!(a(eXde.!c!( de a(en=!e La co&!! de e(a(e Oco"ar7 , s!%&(o%e"e de %a(en=!e
    a.ec(ea/7 ac(!v!(a(ea :n c"as7 s! &er.or%an=a Oco"ar7 S!%&(o%e"e de !%&+"s!v!(a(e
    &o( d+ce, de ase%enea, "a :nc7"carea nor%e"or ed+ca=!ona"e, %(er&ersona"e O!
    .a%!"!a"e S!%&(o%e"e (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e s+n( de re$+"7
    ce"e %a! &roe%!nen(e :n c+rs+" c"ase"or e"e%en(are Pe %7s+r7 ce co&!"+" creO(e,
    s!%&(o%e"e dev!n de re$+"7 %a! &+=!n ev!den(e. S&re .!ne"e co&!"7r!e! s! :nce&+(+"
    ado"escen=e!, se%ne"e ac(!v!(7=!! %o(or!! ."a$ran( e<ces!ve Ede e< a"er$a(+" s!
    c7=7ra(+" e<ces!v, a n+ s(a +n %o%en( "oc+"+!J s+n( %a! &+=!n .recven(e, !ar
    s!%&(o%e"e de !&erac(!v!(a(e &o( .! red+se "a neas(A%&7r or! "a sen(!%en(+" de
    (re%or sa+ ne"!n!O(e !n(er!oar7 In &er!oada ad+"(7, ne"!n!O(ea &oa(e d+ce "a
    d!.!c+"(7=! :n &ar(!c!&area "a ac(!v!(7=! seden(are O! "a ev!(area d!s(rac=!!"or sa+
    oc+&a=!!"or care o.er7 o&or(+n!(7=! "!%!(a(e &en(r+ %!Ocarea s&on(an7 Ede e<,
    ac(!v!(7=!"e de '!ro+J D!s.+nc(!a soc!a"7 "a ad+"=! &are a .! &ro'a'!"7 :n s&ec!a"
    "a ce! care a+ av+( d!a$nos(!ce conco%!(en(e :n co&!"7r!e Tre'+!e %an!.es(a(7
    &r+den(7 :n &+nerea d!a$nos(!c+"+! de (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e
    "a ad+"=! n+%a! &e 'a/a a%!n(!% !nd!v!d+"+! c7 a .os( !na(en( sa+ !&erac(!v :n
    co&!"7r!e, deoarece va"!d!(a(ea +nor as(.e" de da(e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    5+ "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    re(ros&ec(!ve es(e adesea &ro'"e%a(!c7. DeO! !n.or%a=!! a+<!"!are &o( s7 n+ .!e
    (o(dea+na d!s&on!'!"e, coro'orarea !n.or%a=!!"or de "a a"=! !n.or%a(or! E!nc"+s!v
    doc+%en(e"e Oco"are an(er!oareJ es(e +(!"7 &en(r+ a%e"!orarea ac+ra(e=e!
    d!a$nos(!c+"+!. T+"'+rarea es(e %a! .recven(7 "a '7r'a=! decA( "a .e%e!, c+
    ra&oar(e '7r'a=!X.e%e! %er$And de "a 9Q5 "a FQ5, :n .+nc=!e de (!& E(!&+"
    &redo%!nan( !na(en( &oa(e avea +n ra&or( '7 r'a=!X.e%e! %a! &+=!n &ron+n=a(J s!
    %ed!+ Ees(e &os!'!" ca co&!!! (r!%!O! :n c"!n!c7 s7 .!e '7r'a=!J.
    #revalent
    Preva"en(a (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e a .os( es(!%a(7 "a ;d4Hd
    d!n(re co&!! de e(a(e Oco"ar7. Aces(e &rocen(e ra&or(a(e var!a/7 :n .+nc=!e de na(+ra
    &o&+"a=!e! cerce(a(e O! de %e(oda de s(a'!"!re. Da(e"e des&re &reva"en(a (+"'+r7r!! :n
    ado"escen=7 O! :n &er!oada ad+"(7 s+n( "!%!(a(e. Ev!den=a s+$erea/7 c7 &reva"en(a
    (+"'+r7 r!! !&erac(!v!(a(eXde.!c!( de a(en=!e, aOa c+% es(e aceas(a de.!n!(7 :n DSM4I3,
    es(e &+=!n %a! %are decA( &reva"en(a (+"'+r7r!! 'a/a(e &e cr!(er!!"e DSM4III4R d!n
    ca+/a !nc"+der!! (!&+r!"or &redo%!nan( !&erac(!v4!%&+"s!v O! &redo%!nan( !na(en(
    Ecare era+ d!a$nos(!ca(e ca (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e .7r7 a"(7
    s&ec!.!ca=!e :n DSM4III4RJ.
    *voluie
    Ce! %a! %+"=! &7r!n=! o'serv7 &en(r+ &r!%a da(7 ac(!v!(a(ea %o(or!e e<ces!v7
    cAnd co&!!! :nce& s7 %ear$7, ceea ce co!nc!de .recven( c+ de/vo"(area "oco%o=!e!
    !nde&enden(e. Deoarece :ns7, %+"=! co&!! !&erac(!v! care :nce& s7 %ear$7 n+ vor
    de/vo"(a %a! (Ar/!+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (re'+!e
    %an!.es(a(7 o a(en=!e s&ec!a"7 :n d!.eren=!erea !&erac(!v!(7=!! nor%a"e de
    !&erac(!v!(a(ea carac(er!s(!c7 (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e :na!n(e de
    &+nerea aces(+! d!a$nos(!c :n &r!%!! an!. De re$+"7, (+"'+rarea es(e d!a$nos(!ca(7
    &en(r+ &r!%a da(7 :n an!! de scoa"7 e"e%en(ar7, cAnd ada&(area Oco"ar7 es(e
    co%&ro%!s7. Un!! co&!! c+ (!&+" &redo%!nan( !na(en( &o( s7 n+ !n(re :n a(en=!e
    c"!n!c7 &An7 s&re .!ne"e co&!"7r!e!, :n %a@or!(a(ea ca/+r!"or v7/+(e :n cond!=!! c"!n!ce,
    (+"'+rarea es(e re"a(!v s(a'!"7 "a :nce&+(+" ado"escen=e!. La ce! %a! %+"=! !nd!v!/!,
    s!%&(o%e"e E:n s&ec!a" !&erac(!v!(a(ea %o(or!eJ se a(en+ea/7 :n +"(!%a &ar(e a
    ado"escen=e! O! :n &er!oada ad+"(7, deO! +n n+%7r red+s de ca/+r! e<&er!en(ea/7
    :n(re$+" e.ec(!v de s!%&(o%e a" (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e &An7 "a
    %!@"oc+" v!e=!! ad+"(e. A"=! ad+"=! &o( re=!ne n+%a! cA(eva d!n(re s!%&(o%e, :n care
    ca/ (re'+!e .7c+( +/ de d!a$nos(!c+" de (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e,
    :n re%!s!+ne &ar=!a"7. Aces( d!n +r%7 d!a$nos(!c se a&"!c7, de ase%enea, !nd!v!/!"or
    care n+ %a! &re/!n(7 :n(re$+" (a'"o+ c"!n!c a" (+"'+r7r!!, dar re=!n :nc7 +ne"e
    s!%&(o%e care ca+;ea;6 de(er!orare .+nc=!ona"7.
    #attern $amilial
    S4a cons(a(a( c7 (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e es(e %a! .recven(7 "a
    r+de"e '!o"o$!ce de $rad+" I a"e co&!!"or c+ aceas(7 (+"'+rare decA( :n &o&+"a=!a
    $enera"7. Pro'e cons!dera'!"e a(es(7 !n."+en=a &+(ern!c7 a .ac(or!"or $ene(!c! as+&ra
    n!ve"e"or de !&erac(!v!(a(e, !%&+"s!v!(a(e s! !na(en=!e %7s+ra(e d!%ens!ona".
    In."+en=e"e .a%!"!are, Oco"are s! d!n &ar(ea e$a"!"or s+n( :ns7 cr+c!a"e :n de(er%!narea
    :n(!nder!! de(er!or7r!! s! co%or'!d!(7=!!. De ase%enea, s(+d!!"e s+$erea/7 c7 "a
    %e%'r!! de .a%!"!e a! !nd!v!/!"or c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e,
    Tulburrile dia!nosticate de re!ul pentru prima
    dat "n #erioada de Su!ar, "n opilrie sau "n
    Adolescent
    41
    e<!s(7 o &reva"en(7 %a! %are a (+"'+r7r!"or a.ec(!ve s! an<!oase, a (+"'+r7r!"or de
    :nv7=are, a (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7 s! a (+"'+r7% de &ersona"!(a(e
    an(!soc!a"7
    Dia!nostic di$erenial
    :n %!ca co&!"7r!e &oa(e - d!.!c!" de .7c+( d!s(!nc=!e :n(re s!%&(o%e"e (+"'+r7%
    !&erac(!v!(a(eXde.!c!( de a(en=!e s! co%&or(a%en(e"e cores&+n/7(oare e(7=!! "a
    co&!! ac(!v! Ede e< , a"er$ar+" de @+r :%&re@+r sa+ a .ace "ar%7J
    S!%&(o%e"e de %a(en(!e s+n( co%+ne &r!n(re co&!!! c+ DI red+s, &"asa=! :n
    cond!=!! de Oco"ar!/are !nadecva(e ca&ac!(7=!! "or !n(e"ec(+a"e Aces(e co%&or(a%en(e
    (re'+!e s7 .!e d!s(!nse de se%ne"e s!%!"are a"e co&!!"or c+ (+"'+rarea !&erac(!v!(a(eX
    de.!c!( de a(en=!e La co&!! c+ re(ardare %en(a"7, +n d!a$nos(!c ad!=!ona" de (+"'+rare
    !&erac(!v!(a(eXde.!c!( de a(en=!e (re'+!e &+s n+%a! dac7 s!%&(o%e"e de !na(en(!e
    sa+ de !&erac(!v!(a(e s+n( :n e<ces :n ra&or( c+ e(a(ea %en(a"7 a co&!"+"+! Ina(en(!a
    :n c"as7 &oa(e s+rven!, de ase%enea, cAnd co&!! .oar(e !n(e"!$en=! s+n( &"asa=! :n
    %ed!! Oco"are s+'s(!%+"an(e T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e (re'+!e,
    de ase%enea, s7 .!e d!s(!ns7 de d!.!c+"(a(ea :n co%&or(a%en(+" onen(a( s&re +n sco&
    "a co&!! d!n %ed!! !nadecva(e, de/or$an!/a(e sa+ ao(!ce Is(or!c+" &a((ern+"+! de
    s!%&(o%e o'=!n+( de "a %a! %+"=! !n.or%a(or! Ede e< , 'a'y4s!((ers, '+n!c! or! &7r!n=!
    a! co%&an!on!"or de @oac7J s+n( +(!"e :n .+rn!/area +ne! con."+en(e de o'serva=!!
    re.er!(oare "a %a(ena co&!"+"+!, !&erac(!v!(a(ea s! ca&ac!(a(ea de a+(ore$"are
    cores&+n/7(oare evo"+(!v :n d!verse s!(+a=!!
    Ind!v!/!! c+ co%&or(a%en( o&o/!(!on!s( se &o( o&+ne sarc!n!"or de serv!c!+ sa+
    Oco"are care neces!(7 &erseveren(7, d!n ca+/a ne&"7cer!! de a se con.or%a cerer!"or
    a"(ora Aces(e s!%&(o%e (re'+!e s7 .!e d!.eren=!a(e de ev!(area sarc!n!"or Oco"are
    o'serva(7 "a !nd!v!/!! c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e Co%&"!can(
    &en(r+ d!a$nos(!c+" d!.eren=!a" es(e .a&(+" c7 +n+ !nd!v!/! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e de/vo"(7 sec+ndar a(!(+d!n! o&o/!=!on!s(e .a(7 de
    as(.e" de sarc!n! s! deva"or!/ea/7 !%&or(an(a "or, adesea ca o conO(!en(!/are a
    !nca&ac!(7=!! "or
    Ac(!v!(a(ea %o(or!e cresc+(7 care &oa(e s+rven! :n (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e
    Tre'+!e s7 .!e d!s(!ns7 de co%&or(a%en(+" %o(or re&e(!(!v care carac(er!/ea/7
    (+"'+rarea de %!Ocare s(ereo(!&7 . :n (+"'+rarea de %!Ocare s(ereo(!&7 ,
    co%&or(a%en(+" %o(or es(e :n $enera" .oca"!/a( s! .!<a( Ede e< , 'a"ansa(+" cor&+"+!,
    a+(o%+scareaJ, &e cAnd neas(A%&7 r+" s! ne"!n!O(ea d!n (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e s+n( de re$+"7 %a! $enera"!/a(e :n a.ar7 de
    aceas(a, !nd!v!/!! c+ (+"'+rare de %!Ocare s(ereo(!&7 n+ s+n( :n $enera" !&erac(!v!,
    c+ e<ce&=!a s(ereo(!&+"or, e! &+(And .! !&oac(!v!
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e n+ es(e d!a$nos(!ca(7 dac7
    s!%&(o%e"e s+n( e<&"!ca(e %a! '!ne de c7(re o a"(7 (+"'+rare %en(a"7 Ede e<, o
    (+"'+rare a.ec(!v7, an<!oas7, d!soc!a(!v7, de &ersona"!(a(e, de o %od!.!care de
    &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e or! o (+"'+rare :n "e$7(+r7 c+
    o s+'s(an=7J :n (oa(e aces(e (+"'+r7r!, s!%&(o%e"e de %a(en(!e a+ de re$+"7 de'+(+"
    d+&7 e(a(ea de H an!, !ar !s(or!c+" d!n co&!"7r!e a" ada&(7% Oco"are n+ es(e
    carac(er!/a( :n $enera" &r!n co%&or(a%en( d!sr+&(!v or! &"An$er! a"e :nv7=7(or+"+!
    re.er!(oare "a co%&or(a%en(+" %a(en(, !&erac(!v sa+ !%&+"s!v CAnd o (+"'+rare
    a.ec(!v7 sa+ o (+"'+rare an<!oas7 s+rv!ne conco%!(en( c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e, (re'+!e s7 .!e d!a$nos(!ca(7 s! aceas(a T+"'+rarea
    Tulburrile dia!nosticate de re!ul pentru prima dat
    67 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    !&erac(!v!(a(eXde.!c!( de a(en=!e n+ es(e d!a$nos(!ca(7 dac7 s!%&(o%e"e de
    !na(en=!e s! !&erac(!v!(a(e s+rv!n e<c"+s!v :n c+rs+" +ne! (+"'+r7r! de de/vo"(are
    &ervas!v7 or! a" +ne! (+"'+r7r! &s!o(!ce. S!%&(o%e de !na(en=!e, !&erac(!v!(a(e or!
    !%&+"s!v!(a(e :n "e$7(+r7 c+ +/+" +n+! %ed!ca%en( Ede e<., 'ronod!"a(a(oare,
    !son!a/!d7, a)a(!s!e da(ora(7 ne+ro"e&(!ce"orJ "a co&!! :na!n(e de e(a(ea de H an! n+
    s+n( d!a$nos(!ca(e ca (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e, c! ca a"(7
    (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7 .7r7 a"(7 s&ec!.!ca=!e.
    T $uTnVi# WF.- XY Mi $ini .m/msmmrnrM i ii<mUUUUZ[Y33 \ t,0u nZMZ2OAiAroirii TOiioi$-Tini1 niMMMiv2uumYnioYiii-iMi0M iM$oiuZ n n nn n uri iniiii ii ILNM.NNT N -itr ntm000m1"$>2M2M2M2vr2r 23334I.Mfaami rMYnniMiMMriMmrimMi"nmiW YmOTimmii0$$i$$iimK0Yi<<
    Criteriile $e $ia/no&ti# pentru
    Tul-urarea Fipera#tivitateADe%i#it $e Aten!ie
    A2 'ie &E) sau &7)D
    &E),ase &sau mai multe) dintre urmtoarele simptome de inatenie au
    persistat cel puin I luni "ntr-un !rad care este de(adaptativ ,i discrepant
    "n raport cu nivelul de de(voltareD l
    l na ten ia
    (a)incapabil adesea de a da atenia cuvenit detaliilor ori $ace erori prin
    ne!li0en "n e$ectuarea temelor ,colare, la serviciu, sau "n alte activiti3
    (b) adesea are di$iculti "n susinerea ateniei asupra sarcinilor sau
    acti
    vitilor de 0oc3
    (a)adesea pare a nu asculta c@nd i se vorbe,te direct3
    (c)adesea nu se con$ormea( instrucunilor ,i este incapabil s-,i termine
    temele pentru acas, sarcinile casnice ori obli!aiile la locul de munc
    &nedatorate comportamentului opo(iionist sau incapacitii de a
    "nele!e instruciunile)3
    (b) adesea are di$iculti "n or!ani(area sarcinilor ,i activitilor3
    (d) adesea evit, are aversiune, nu este dispus s se an!a0e(e "n
    sarcini
    care necesit un e$ort mental susinut &cum ar $i e$ectuarea temelor
    "n clas sau acas)3
    (e)adesea pierde lucruri necesare pentru diverse sarcini sau activiti &de
    ex2, 0ucrii, teme pentru acas, creioane, cri, instrumente)3
    &%) adesea este u,or de distras de stimuli irelevani3 &i)
    adesea este uituc re$eritor la activitile cotidiene3
    &7) ,ase &sau mai multe) dintre urmtoarele simptome de %iperactivitate-impul-
    sivitate au persistat timp de cel puin I luni "ntr-un !rad care este
    de(adaptativ ,i "n contradicie cu nivelul de de(voltareD
    5iperacti!itatea
    &a) adesea se 0oac cu m@inile sau sau cu picioarele sau se $oie,te pe loc,
    &b)adesea ",i las locul "n clas sau "n alte situaii "n care este de dorit s
    rm@n a,e(at3
    (c)adesea alear! "n 0ur sau se car excesiv de mult, "n situaii "n care acest
    lucru este inadecvat &la adolesceni sau la aduli poate $i limitat la
    sentimentul subiectiv de nelini,te)3
    (d) adesea are di$iculti "n a se 0uca sau "n a se an!a0a "n activiti distractive
    "n lini,te3
    (e)adesea este ="n continu mi,care> sau acionea( ca si cum =ar $i "mpins
    de un motor>3
    (c)adesea vorbe,te excesiv de mult3
    4EH26 Tulburarea Liperactivitate1De$icit de Atenie 'r Alt
    Speci$icaie 4+
    Criteriile $e $ia/no&ti# pentru
    Tul-urarea Fipera#tivitateADe%i#it $e Aten!ie (continuare)
    Impulsi!itatea
    &!)adesea =tr@nte,te> rspunsuri "nainte ca "ntrebrile s $i $ost complet
    $ormulate,
    &%)adesea are di$iculti "n a-si a,tepta r@ndul, &i) adesea "ntrerupe sau deran0ea( pe altn &de
    ex , intervine "n conversaiile
    sau 0ocurile altora)
    S .nele simptome de matentie sau de %tperactivitate-impulsivitate care au cau(at deteriorarea
    erau pre(ente "nainte de etatea de ? ani
    2 O anumit deteriorare dm cau(a simptomelor este pre(ent "n dou sau mai multe situaii &de ex
    , la scoal 9sau la serviciu: si acas)
    D Trebuie s $ie clar proba deteriorm semni$icative clinic "n $uncionarea social, ,colar sau
    pro$esional
    * Simptomele nu survin exclusiv "n cursul unei tulburri de de(voltare pervasive, al
    sc%i(o$reniei ori al altei tulburri psi%otice si nu sunt explicate mai bine de alt tulburare
    mental &de ex, de o tulburare a$ectiv, anxioas, disociativ sau de personalitate)
    A se codi"ica pe ba( de tip
    4*7.+* Tul-urare @ipera#tivitateA$e%i#it $e aten!ie2 tip #o"-inat- dac ambele criterii AE
    si A7 sunt satis$cute pentru ultimele I luni
    314.0 Tul-urare @ipera#tivitateA$e%i#it $e aten!ie2 tip pre$o"inant
    $e inatentie dac criteriul AE este satis$cut, iar criteriul A7 nu,
    pentru ultimele I luni
    314.1 Tul-urare @ipera#tivitateA$e%i#it $e aten!ie2 tip pre$o"inant
    de %iperactivitate-impulsivitate daca criteriul A7 este satis$cut, iar criteriul AE nu este
    satis$cut pentru ultimele I luni
    Fot de codi$icare #entru indivi(ii &"n special pentru adolesceni si aduli) care "n mod curent au
    simptome care nu mai satis$ac "n "ntre!ime criteriile, trebuie speci$icat ="n remisiune parial>
    4*7.5 Tul-urarea Fipera#tivitateADe%i#it $e Aten!ie '(r(
    Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e des(!na(7 (+"'+r7r!"or c+ '!%&(o%e no(a'!"e de !na(en(!e sa+ !&erac(!v!(a(e4
    !%&+"s!v!(a(e care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea !&erac(!v!(a(eX de.!c!( de a(en=!e
    E<e%&"e"e !nc"+d
    1 Ind!v!/!! a"e c7ror s!%&(o%e s! de(er!orare sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e, (!&+" &redo%!nan( %a(en(, dar a c7ror e(a(e "a
    de'+( es(e de H a% sa+ %a! %+"(
    2 Ind!v!/!! c+ de(er!orare se%n!.!ca(!v7 c"!n!c care se &re/!n(7 c+ !na(en(!e s! a"
    c7ror &a((ern de s!%&(o%e n+ sa(!s.ace co%&"e( cr!(er!!"e &en(r+ (+"'+rare, dar
    are +n &a((ern co%&or(a%en(a" %arca( de "en(oare, rever!e O! !&oacr!v!(a(e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    6H "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Tul-urarea $e Con$uit(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de cond+!(7 :" cons(!(+!e +n &a((ern &ers!s(en( s!
    re&e(!(!v de co%&or(a%en(e :n care dre&(+r!"e .+nda%en(a"e a"e a"(ora, or! nor%e"e
    sa+ re$+"!"e soc!a"e %a@ore cores&+n/7(oare e(7=!! s+n( v!o"a(e Ecr!(er!+" AJ. Aces(e
    co%&or(a%en(e se :ncadrea/7 :n &a(r+ $r+&e &r!nc!&a"eQ cond+!(7 a$res!v7, care
    ca+/ea/7 sa+ a%en!n=7 c+ v7(7%area .!/!c7 a"=! oa%en! sa+ an!%a"e Ecr!(er!!"e
    A54AHJ, cond+!(7 nona$res!v7, care ca+;ea;6 &!erderea sa+ &re@+d!c!erea
    &ro&r!e(7=!! Ecr!(er!!"e AG4AFJ, .ra+d7 sa+ .+r( Ecr!(er!!"e A5L4A59J, s! v!o"7r! ser!oase
    a"e re$+"!"or Ecr!(er!!"e A5;4A5YJ. Tre! Esa+ %a! %+"(eJ co%&or(a%en(e carac(er!s(!ce
    (re'+!e s7 .! .os( &re/en(e :n (!%&+" +"(!%e"or 59 "+n!, c+ ce" &+=!n +n co%&or(a%en(
    &re/en( :n +"(!%e"e R "+n!. Per(+r'area :n co%&or(a%en( ca+/ea/7 o de(er!orare
    se%n!.!ca(!v7 c"!n!c :n .+nc=!onarea soc!a"7, Oco"ar7 sa+ &ro.es!ona"7 Ecr!(er!+" BJ.
    T+"'+rarea de cond+!(7 &oa(e .! d!a$nos(!ca(7 "a !nd!v!/!! :n e(a(e de &es(e 5G an!, dar
    n+%a! dac7 n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea de &esona"!(a(e
    an(!soc!a"7 Ecr!(er!+" CJ. Pa((ern+" de co%&or(a%en( es(e de re$+"7 &re/en( :n(r4o
    var!e(a(e de "oc+r! c+% ar .! casa, Ocoa"a sa+ co%+n!(a(ea. Deoarece !nd!v!/!! c+
    (+"'+rare de cond+!(7 :O! %!n!%a"!/ea/7, ev!den(, &ro'"e%e"e de cond+!(7,
    c"!n!c!an+" (re'+!e s7 rec+r$7 adesea "a !n.or%a(or! s+&"!%en(ar!, :ns7 c+noO(!n=e"e
    !n.or%a(or+"+! des&re &ro'"e%e"e de cond+!(7 a"e co&!"+"+! &o( .! "!%!(a(e &r!n
    s+&rave$ere !nadecva(7 or! &r!n .a&(+" c7 n+ a+ .os( reve"a(e de c7(re co&!".
    Co&!!! sa+ ado"escen=!! c+ aceas(7 (+"'+rare !n!=!a/7 adesea +n co%&or(a%en(
    a$res!v O! reac=!onea/7 a$res!v .a=7 de a"=!!. E! &o( &re/en(a +n co%&or(a%en(
    !nso"en(, a%en!n=7(or sa+ !n(!%!dan( Ecr!(er!+" A"J, &o( s7 !n!=!e/e .recven( '7(7!
    Ecr!(er!+" A9J8 +/ea/7 de o ar%7 care &oa(e ca+/a o v7(7%are cor&ora"7 ser!oas7 Ede
    e<., +n '7=, o c7r7%!d7, o '+(e"!e s&ar(7, +n c+=!( sa+ o ar%7 de .ocJ Ecr!(er!+" A;J8 &o(
    .! cr+/! c+ oa%en!! Ecr!(er!+" AIJ or! c+ an!%a"e"e Ecr!(er!+" AYJ8 .+r7 :n (!rn& ce se
    con.r+n(7 c+ v!c(!%a Ede e<., 'and!(!s%, .+r( d!n '+/+nare, e<(orcare sa+ .+r( c+ %Ana
    ar%a(7J Ecr!(er!+" ARJ, or! .or=ea/7 &e c!neva "a ac(!v!(a(e se<+a"7 Ecr!(er!+" AHJ.
    3!o"en=a .!/!c7 &oa(e "+a .or%a v!o"+"+!, a(ac+"+! sa+, :n ca/+r! %a! rare, a o%+c!der!!.
    D!s(r+$erea de"!'era(7 a &ro&r!e(7=!! a"(ora es(e e"e%en(+" carac(er!s(!c a" aces(e!
    (+"'+r7r! O! &oa(e !nc"+de !ncend!erea de"!'era(7, c+ !n(en=!a de a ca+/a +n &re@+d!c!+
    ser!os Ecr!(er!+" AGJ sa+ d!s(r+$erea de"!'era(7 a &ro&r!e(7=!! a"(ora :n a"(e %od+r! Ede
    e<., s&ar$erea .eres(re"or a+(o(+r!s%+"+!, vanda"!s% :n Ocoa"7J Ecr!(er!+" AFJ.
    Fra+da sa+ .+r(+" es(e co%+n O! &oa(e !nc"+de o s&ar$ere a case!, de&end!n=e"or
    sa+ a+(o(+r!s%+"+! c+!va Ecr!(er!+" A5LJ8 !nd!v!d+" %!n(e .recven( sa+ .ace
    &ro%!s!+n! s&re a o'=!ne '+n+r! sa+ .avor+r! or! &en(r+ a ev!(a da(or!! sa+ o'"!$a=!!
    Ede e<., S.ra!ereO(eT a"(e &ersoaneJ Ecr!(er!+" AIIJ sa+ .+r7 "+cr+r! de va"oare, .7r7
    con.r+n(are c+ v!c(!%a Ede e<., .+r( d!n %a$a/!ne, &"as(o$ra.!eJ Ecr!(er!+" A59J.
    Po( e<!s(a, de ase%enea, v!o"7r! ser!oase a"e re$+"!"or Ede e<., Oco"are, &aren(a"eJ
    de c7(re !nd!v!/!! c+ aceas(7 (+"'+rare, :nce&And :na!n(e de e(a(ea de 5; an!, co&!!!
    c+ aceas(7 (+"'+rare a+ adesea +n &a((ern, Ede co%&or(a%en(J care cons(7 :n a ven!
    acas7 noa&(ea (Ar/!+, :n d!s&re=+" !n(erd!c=!!"or &aren(a"e Ecr!(er!+" A5;J. Poa(e
    e<!s(a +n &a((ern de a .+$! de acas7 noa&(ea Ecr!(er!+" A5IJ. Pen(r+ a .! cons!dera(
    ca s!%&(o% a" (+"'+r7r!! de cond+!(7, .+$a de acas7 (re'+!e s7 .! s+rven!( de ce"
    &+=!n do+7 or! Eor! n+%a! oda(7, dac7 !nd!v!d+" se :n(oarce acas7 d+&7 o "+n$7
    &er!oad7 de (!%&J. E&!soade"e de .+$7 de acas7, care s+rv!n ca o consec!n=7 d!rec(7
    a a'+/+"+! .!/!c sa+ se<+a", n+ s+n( dese%na(e &en(r+ aces( cr!(er!+. Co&!!! c+
    aceas(7 (+"'+rare c!+"esc adesea de "a Ocoa"7, :nce&And :na!n(e de e(a(ea de 5; an!
    Tulburarea de
    onduit
    45

    Ecr!(er!+" A5YJ La !nd!v!/!! %a! :n e(a(e, aces( co%&or(a%en( se %an!.es(7 adesea
    &r!n a'sen=e de "a serv!c!+ .7r7 +n %o(!v '!ne @+s(!.!ca(
    Subtipuri
    Pe 'a/a e(7=!! "a de'+(+" (+"'+r7r!! se d!s(!n$ do+7 s+'(!&+r! de (+"'+rare de
    cond+!(7 Ead!c7, (!&+" c+ de'+( :n co&!"7r!e s! (!&+" c+ de'+( :n ado"escen(7J
    S+'(!&+r!"e d!.er7 :n(re e"e s+' ra&or(+" na(+r!! carac(er!s(!ce a &ro'"e%e"or de
    cond+!(7 &re/en(a(e, a" evo"+=!e! s! &ro$nos(!c+"+!, s! a" ra(e! se<+"+! A%'e"e
    s+'(!&+n &o( s+rven! :n(r4o .or%7 +Ooar7, %odera(7 sa+ sever7 Pen(r+ a&rec!erea
    e(7(n "a de'+(, (re'+!e o'=!n+(e !n.or%a=!! de "a (An7r sa+ de "a %.!r%!erE!J
    Deoarece %+"(e d!n(re co%&or(a%en(e &o( .! asc+nse, !n.!r%!er!! &o( s+'ra&or(a
    s!%&(o%e"e s! s+&raes(!%a e(a(ea "a de'+(
    312.81 T!& c+ de'+( :n co&!"7r!e Aces( s+'(!& es(e de.!n!( &nn de'+(+" a
    ce"
    &+=!n +n cr!(er!+ carac(er!s(!c (+"'+r7% de cond+!(7 :na!n(e de e(a(ea de I O
    a% Ind!v!/!! c+ (!&+" c+ de'+( :n co&!"7r!e s+n( de re$+"7 '7r'a=!, %an!.es(7
    .recven( a$res!v!(a(e .!/!c7 .a(7 de a"=!!, a+ &er(+r'a(e re"a=!!"e c+ e$a"!!, &o( s7
    .! av+( (+"'+rarea o&o/!(!o%s%+" &rovoca(or :n (!%&+" %!c!! co&!"7r!!, s! de
    re$+"7 a+ s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de cond+!(7,
    :na!n(e de &+'er(a(e M+"=! co&!! c+ aces( s+'(!& a+, de ase%enea,
    conco%!(en( s! (+"'+rarea !&er ac(!v!(a(eXde.!c!( de a(en=!e Ind!v!/!! c+ (!&+"
    c+ de'+( :n co&!"7r!e es(e .oar(e &os!'!" s7 a!'7 (+"'+rare de cond+!(7
    &ers!s(en(7 s! s7 &re/!n(e ca ad+"=! (+"'+rare de &ersona"!(a(e an(!soc!a"7 %a!
    %+"( decA( ce! c+ (!&+" c+ de'+( :n ado"escen(7
    312.82 T!&+" c+ de'+( :n ado"escen=7 Aces( s+'(!& es(e de.!n!( &r!n
    a'sen(a
    or!c7r+! cr!(er!+ carac(er!s(!c de (+"'+rare de cond+!(7, :na!n(e de e(a(ea de 5L
    an! Co%&ara(!v c+ ce! c+ (!&+" c+ de'+( :n co&!"7r!e, es(e &+(% &ro'a'!" c7
    aceO(! !nd!v!/! vor &re/en(a co%&or(a%en(e a$res!ve s! (!nd s7 a!'7 re"a=!! %a!
    nor%a(!ve c+ e$a"!! EdeO! e! a+ adesea &ro'"e%e de cond+!(7 :n co%&an!a
    a"(oraJ Es(e &+=!n &ro'a'!" c7 aceO(! !nd!v!/! vor avea (+"'+rare de cond+!(7
    &ers!s(en(7 sa+ c7 vor &re/en(a ca ad+"=! (+"'+rare de &ersona"!(a(e
    an(!soc!a"7 Ra&or(+" '7r'a=!X.e%e! c+ (+"'+rarea de cond+!(7 es(e %a! red+s
    &en(r+ (!&+" c+ de'+( :n ado"escen(7 decA( &en(r+ (!&+" c+ de'+( :n co&!"7r!e
    ;59.GF De'+( nes&ec!.!ca(. Aces( s+'(!& es(e +(!"!/a( dac7 e(a(ea "a de'+( a
    (+"'+r7% de cond+!(7 es(e nec+nosc+(7
    Speci$icantii de severitate
    UOoar7. S+n( &re/en(e &+=!ne, dac7 n+ n!c! +n .e" de &ro'"e%e de cond+!(7 :n
    e<ces :n ra&or( de ce"e cer+(e &en(r+ &+nerea d!a$nos(!c+"+!, !ar &ro'"e%e"e
    de cond+!(7 ca+/ea/7 +n &re@+d!c!+ re"a(!v %!nor a"(ora Ede e< , %!nc!+n7,
    c!+", .+$7 de acas7 d+&7 "7sarea :n(+ner!c+"+!, .7r7 &er%!s!+neJ Modera(7.
    N+%7r+" de &ro'"e%e de cond+!(7 s! e.ec(+" as+&ra a"(ora s+n(
    !n(er%ed!are :n(re S+Ooar72 s! Ssever7T Ede e<, .+r( .7r7 con.r+n(are c+
    v!c(!%a, vanda"!s%J
    Sever7. S+n( &re/en(e %+"(e &ro'"e%e de cond+!(7 :n e<ces :n ra&or( c+ ce"e
    cer+(e &en(r+ &+nerea d!a$nos(!c+"+!, or! &ro'"e%e"e de cond+!(7 ca+/ea/7
    +n &re@+d!c!+ cons!dera'!" a"(ora Ede e<, re"a=!! se<+a"e .or=a(e, cr+/!%e
    .!/!c7, +/ de ar%7, .+r( c+ con.r+n(are c+ v!c(!%a, .+r( &r!n e.rac=!eJ
    Tulburrile dia!nosticate de re!ul pentru prima dat
    6I "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Ind!v!/!! c+ (+"'+rare de
    cond+!(7 &o( avea &+=!n7 e%&a(!e s! &+=!n7 &reoc+&are &en(r+ sen(!%en(e"e, dor!n=e"e
    s! '+n7s(area a"(ora, :n s!(+a=!! a%'!$+e %a! a"es, !nd!v!/!! a$res!v! c+ aceas(7 (+"'+rare
    &erce& .recven( :n %od erona( !n(en=!!"e a"(ora ca %a! os(!"e s! %a! a%en!n=7(oare decA(
    es(e ca/+" O! r7s&+nd &r!n a$res!+ne, &e care e! o cons!der7 ra=!ona"7 s! @+s(!.!ca(7. E!
    &o( .! cr+/! s! "!&s!=! de sen(!%en(e"e cores&+n/7(oare de c+"&7 sa+ re%+scare. Poa(e .!
    d!.!c!" de a&rec!a( dac7 re%+scarea %an!.es(a(7 es(e $en+!n7, deoarece aceO(! !nd!v!/!
    :nva=7 c7 a.!r%area c+"&e!, &oa(e red+ce sa+ &reven! &ede&s!rea. Ind!v!/!! c+ aceas(7
    (+"'+rare &o( s74O! den+n=e +Oor co%&an!on!! s! &o( :ncerca s7 '"a%e/e &e a"=!! &en(r+
    &ro&!!"e "or de"!c(e. S(!%a de s!ne es(e de re$+"7 sc7/+(7, deO! &ersoana res&ec(!v7
    &oa(e &ro!ec(a o !%a$!ne de Sd+r!(a(eT. La a"=! !nd!v!/!, s(!%a de s!ne %7s+ra(7 &oa(e
    .! .oar(e e<a$era(7 . To"eran=a red+s7 "a .r+s(rare, !r!(a'!"!(a(ea, accese"e de .+r!e O!
    ne$"!@en=a s+n( e"e%en(e asoc!a(e .recven(e. Ra(a acc!den(e"or &are a .! %a! cresc+(7 "a
    !nd!v!/!! c+ (+"'+rare de cond+!(7 decA( "a ce! .7r7.
    T+"'+rarea de cond+!(7 es(e asoc!a(7 adesea c+ +n de'+( &recoce a"
    co%&or(a%en(+"+! se<+a", a" '7+(+"+!, .+%a(+"+!, +/+"+! de s+'s(an=e !"e$a"e s! a"
    ac(e"or !%&r+den(e s! r!scan(e. U/+" de dro$+r! !"e$a"e &oa(e cres(e r!sc+" ca (+"'+rarea
    de cond+!(7 s7 &ers!s(e. Co%&or(a%en(e"e (+"'+r7r!! de cond+!(7 &o( d+ce "a
    :n(rer+&erea sco"!! sa+ "a e<%a(r!c+"are, "a &ro'"e%e :n ada&(are "a %+nc7, "a d!.!c+"(7=!
    "e$a"e, %a"ad!! (rans%!se &e ca"e se<+a"7, sarc!n7 nedor!(7, "a "e/!+n! cor&ora"e &r!n
    acc!den(e sa+ '7(7!. Aces(e &ro'"e%e &o( :%&!ed!ca +r%area c+rs+r!"or +ne! sco"!
    nor%a"e sa+ conv!e=+!rea :n casa &aren(a"7 sa+ a &7r!n=!"or ado&(!v!. Idea=!a s+!c!dar7,
    (en(a(!ve"e de s+!c!d O! s+!c!d+" co%&"e( s+rv!n :n(r4+n &rocen( %a! %are decA( ce"
    e<&ec(a(. T+"'+rarea de cond+!(7 &oa(e .! asoc!a(7 c+ o !n(e"!$en=7 %a! @oas7 decA(
    %ed!a, !n(eresAnd :n s&ec!a" DI ver'a"7 . Per.or%an=a Oco"ar7, :n s&ec!a" "a c!(!( O! :n a"(e
    a&(!(+d!n! ver'a"e, es(e adesea s+' n!ve"+" e<&ec(a( &e 'a/a e(7=!! O! !n(e"!$en=e! s! &oa(e
    @+s(!.!ca d!a$nos(!c+" ad!=!ona" de (+"'+rare de :nv7=are sa+ de co%+n!care. T+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e es(e co%+n7 "a co&!!! c+ (+"'+rare de cond+!(7.
    T+"'+rarea de cond+!(7 &oa(e .!, de ase%enea, asoc!a(7 c+ +na sa+ %a! %+"(e d!n(re
    +r%7(oare"e (+"'+r7r! %en(a"eQ (+"'+r7r! de :nv7=are, an<!oase, a.ec(!ve s! :n "e$7(+r7
    c+ o s+'s(an=7. Ur%7(or!! .ac(or! &o( &red!s&+ne !nd!v!d+" "a de/vo"(area (+"'+r7r!! de
    cond+!(7Q res&!n$erea s! ne$"!@area &aren(a"7, (e%&era%en(+" !n.an(!" d!.!c!", %e(ode"e
    !nadecva(e de ed+care a co&!"+"+!, c+ d!sc!&"!n7 sever7, a'+/+" .!/!c sa+ se<+a", "!&sa
    de s+&rave$ere, v!a=a !ns(!(+=!ona"7 &recoce, sc!%'7r! .recven(e de !n.!r%!er, .a%!"!e
    %are, !s(or!c+" de .+%a( a" %a%e! :n c+rs+" sarc!n!!, res&!n$erea de c7(re e$a"!,
    asoc!erea c+ +n $r+& de e$a"! de"!ncven=!, or!en(area s&re v!o"en=7 a car(!er+"+! O!
    an+%!(e (!&+r! de &s!o&a(o"o$!e .a%!"!a"7 Ede e<., (+"'+rare de &ersona"!(a(e
    an(!soc!a"7, de&enden=a sa+ a'+/+" de o s+'s(an=7 ..
    9ate de laborator asociate2 :n +ne"e s(+d!!, "a !nd!v!/!! c+ (+"'+rare de
    cond+!(7, a+ .os( no(a(e +n r!(% card!ac s! o cond+c(an=7 c+(ana(7 %a! red+se :n
    co%&ara=!e c+ ce! .7r7 aceas(7 (+"'+rare. C+ (oa(e aces(ea :ns7, n!ve"e"e de e<c!(a=!e
    .!/!o"o$!c7 n+ s+n( s&ec!.!ce d!a$nos(!c &en(r+ (+"'+rare.
    *lemente speci$ice culturii, etii ,i sexului
    A+ cresc+( (e%er!"e c7 d!a$nos(!c+" de (+"'+rare de cond+!(7 &oa(e .! a&"!ca(
    +neor! :n %od erona( +nor !nd!v!/! :n s!(+a=!! :n care &a((ern+r!"e de co%&or(a%en(
    !nde/!ra'!" s+n( cons!dera(e +neor! ca &ro(ec(oare Ede e<., a%en!n=are, &a+&er(a(e,
    de"!c( $ravJ, :n con.or%!(a(e c+ de.!n!=!a DSM4I3 a (+"'+r7r!! %en(a"e, d!a$nos(!c+"
    Tulburarea de
    onduit
    48

    de (+"'+rare de cond+!(7 (re'+!e s7 .!e &+s n+%a! cAnd co%&or(a%en(+" :n ces(!+ne
    es(e s!%&(o%a(!c de o d!s.+nc(!e s+'!acen(7 :n !nd!v!d s! n+ &+r s! s!%&"+ o reac=!e
    "a con(e<(+" soc!a" !%ed!a( De ase%enea, (!ner!! !%!$ran=! d!n =7n"e devas(a(e de
    r7/'o! care a+ +n (rec+( de co%&or(a%en(e a$res!ve, care &ro'a'!" a+ .os( necesare
    &en(r+ s+&rav!e=+!rea "or :n ace" con(e<(, n+ @+s(!.!c7 :n %od necesar d!a$nos(!c+" de
    (+"'+rare de cond+!(7 Poa(e .! +(!" &en(r+ c"!n!c!an s7 !a :n cons!dera=!e con(e<(+"
    econo%!c s! soc!a" :n care a+ s+rven!( co%&or(a%en(e"e !nde/!ra'!"e
    S!%&(o%e"e (+"'+r7r!! var!a/7 c+ e(a(ea, &e %7s+r7 ce !nd!v!d+" d7 se%ne de
    .or=7 .!/!c7, a'!"!(7=! co$n!(!ve s! %a(+r!(a(e se<+a"7 cresc+(e Co%&or(a%en(e"e %a!
    &+=!n severe Ede e< , %!nc!+na, .+r(+" d!n %a$a/!ne, '7(7!"eJ (!nd s7 a&ar7 &r!%e"e,
    :n (!%& ce a"(e"e Ede e< , s&ar$er!"eJ (!nd s7 a&ar7 %a! (Ar/!+ De re$+"7 &ro'"e%e"e
    de cond+!(7 ce"e %a! severe Ede e< , v!o"+", .+r(+" c+ con.r+n(are c+ v!c(!%aJ nd s7
    a&ar7 +"(!%e"e E<!s(7 :ns7 %An d!.eren=e :n(re !nd!v!/!, +n!! an$a@And+4se :n ce"e
    %a! &re@+d!c!an(e co%&or(a%en(e "a o e(a(e %!c7 E&red!c(!v7 de +n &ro$nos(!c r7+J
    T+"'+rarea de cond+!(7, :n s&ec!a" (!&+" c+ de'+( :n co&!"7r!e, es(e %+"( %a!
    .recven(7 "a '7r'a=! D!.eren(e de se< s+n(, de ase%enea, re&era(e :n (!&+r!"e
    s&ec!.!ce de &ro'"e%e de cond+!(7 B7r'a=!! c+ d!a$nos(!c+" de (+"'+rare de
    cond+!(7 se %an!.es(7 .recven( &nn '7(7!, .+r(+n, vanda"!s% s! &ro'"e%e de
    d!sc!&"!n7 Oco"ar7 Fe%e!"e c+ d!a$nos(!c+" de (+"'+rare de cond+!(7 se %an!.es(7
    %a! c+rAnd &nn %!nc!+n7, c!+", .+$7, +/ de o s+'s(an=7 s! &ros(!(+=!e :n (!%& ce
    a$res!+nea con.r+n(a(!ona"7 es(e %a! .recven( %an!.es(a(7 de '7r'a=!, .e%e!"e (!nd
    s7 +/e/e %a! %+"( de co%&or(a%en(e noncon.r+n(a.aona"e.
    #revalent
    Preva"en(a (+"'+r7r!! de cond+!(7 &are a .! cresc+( %+"( :n +"(!%e"e decade s! es(e
    %a! %are :n %ed!+" +r'an decA( :n %ed!+" r+ra" Ra(e"e vana/7 "ar$ :n .+nc=!e de
    na(+ra &o&+"a=!e! esan(!ona(e s! %e(ode"e de s(a'!"!re S(+d!!"e &e &o&+"a=!a
    $enera"7 ra&or(ea/7 ra(e %er$And de "a %a! &+=!n de 5d &An7 "a %a! %+"( de 5Ld
    Ra(e"e de &reva"en(7 s+n( %a! %ar! "a '7r'a=! decA( "a .e%e! T+"'+rarea de cond+!(7
    es(e +na d!n(re cond!=!!"e ce"e %a! .recven( d!a$nos(!ca(e "a &ac!en=!! !n(erna=! O!
    a%'+"a(on a! +n!(7=!"or de s7n7(a(e %en(a"7 &en(r+ co&!!
    *voluie
    De'+(+" (+"'+r7% de cond+!(7 &oa(e s+rven! :nc7 d!n an!! &reOco"ar!, dar
    &r!%e"e s!%&(o%e se%n!.!ca(!ve s+rv!n de re$+"7 :n c+rs+" &enoade! d!n(re
    %!@"oc+" co&!"7ne! s! %!@"oc+" ado"escen(e! O&o/!(!o%s%+" &rovoca(or es(e +n
    &rec+rsor co%+n a" (!&+"+! de (+"'+rare de cond+!(7 c+ de'+( :n co&!"7r!e De'+(+"
    es(e rar d+&7 e(a(ea de 5R an! Evo"+=!a (+"'+r7r!! de cond+!(7 es(e var!a'!"7 La
    %a@or!(a(ea !nd!v!/!"or, (+"'+rarea se re%!(e :n &enoada ad+"(7 C+ (oa(e aces(ea
    :ns7, o &ro&or=!e s+'s(an=!a"7 con(!n+7 s7 &re/!n(e :n &er!oada ad+"(7
    co%&or(a%en(e care sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7 M+"=! !nd!v!/! c+ (+"'+rare de cond+!(7, :n s&ec!a" ce! c+ (!&+" c+ de'+(
    :n ado"escen(7 s! ce! c+ s!%&(o%e &+=!ne s! %a! +Ooare, rea"!/ea/7 o ada&(are
    &ro.es!ona"7 s! soc!a"7 adecva(7 ca ad+"=! De'+(+" &recoce &re/!ce +n &ro$nos(!c
    r7+ s! +n r!sc cresc+( :n v!a(a ad+"(7 de (+"'+rare de &ersona"!(a(e an(!soc!a"7 s! de
    (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 Ind!v!/!! c+ (+"'+rare de cond+!(7 r!sc7 &en(r+
    %a! (Ar/!+ (+"'+r7r! a.ec(!ve sa+ an<!oase, (+"'+r7r! so%a(o.or%e O! (+"'+r7n :n
    "e$7(+r7 c+ o s+'s(an=7
    Tulburrile dia!nosticate de re!ul pentru prima dat
    68 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    #attern $amilial
    Es(!%7r!"e d!n s(+d!!"e &e $e%en! s! ado&(a=! ara(7 c7 (+"'+rarea de cond+!(7 are
    a(A( co%&onen(e $ene(!ce, cA( O! de %ed!+. R!sc+" &en(r+ (+"'+rarea de cond+!(7
    es(e cresc+( "a co&!!! c+ +n &7r!n(e '!o"o$!c sa+ ado&(!v c+ (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 or! c+ +n .ra(e c+ (+"'+rare de cond+!(7. De ase%enea,
    (+"'+rarea &are a .! %a! .recven(7 "a co&!!! &7r!n=!"or '!o"o$!c! c+ de&enden=7
    a"coo"!c7, (+"'+r7r! a.ec(!ve sa+ sc!/o.ren!e or! a! &7r!n=!"or care a+ +n !s(or!c de
    (+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e sa+ de (+"'+rare de cond+!(7.
    Dia!nostic di$erenial
    C+ (oa(e c7 (+"'+rarea o&o/!=!on!s%+" &rovoca(or !nc"+de +ne"e d!n e"e%en(e"e
    o'serva(e :n (+"'+rarea de cond+!(7 Ede e<., d!so'ed!en=7 s! o&o/!=!e .a=7 de
    &ersoane"e re&re/en(And a+(or!(a(eaJ, ea n+ !nc"+de &a((ern+" &ers!s(en( a" .or%e"or
    %a! severe de co%&or(a%en( :n care, .!e dre&(+r!"e .+nda%en(a"e a"e a"(ora, or!
    nor%e"e soc!a"e cores&+n/7(oare e(7=!! s+n( v!o"a(e. CAnd &a((ern+" co%&or(a%en(a"
    a" !nd!v!d+"+! sa(!s.ace, a(A( cr!(er!!"e &en(r+ (+"'+rarea de cond+!(7, cA( s! &en(r+
    (+"'+rarea o&o/!=!on!s%+" &rovoca(or, d!a$nos(!c+" de (+"'+rare de cond+!(7 are
    &r!or!(a(e, !ar (+"'+rarea o&o/!=!on!s%+" &rovoca(or n+ se d!a$nos(!cea/7.
    DeO! co&!!! c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e &re/!n(7 adesea +n
    co%&or(a%en( !&erac(!v O! !%&+"s!v care &oa(e .! d!sr+&(!v, aces( co%&or(a%en(
    &r!n s!ne n+ v!o"ea/7 nor%e"e soc!a"e cores&+n/7(oare e(7=!! O! &r!n +r%are n+
    sa(!s.ace, de re$+"7, cr!(er!!"e &en(r+ (+"'+rarea de cond+!(7. CAnd s+n( sa(!s.7c+(e
    cr!(er!!"e a(A( &en(r+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, cA( s! &en(r+
    (+"'+rarea de cond+!(7, vor .! &+se a%'e"e d!a$nos(!ce.
    Ir!(a'!"!(a(ea s! &ro'"e%e"e de cond+!(7 s+rv!n adesea "a co&!!! sa+ ado"escen=!!
    c+ (+"'+rare a.ec(!v7 Aces(ea &oa(e .! de re$+"7 d!s(!nse de &a((ern+" &ro'"e%e"or
    de cond+!(7 :n(A"n!(e :n (+"'+rarea de cond+!(7 &e 'a/a evo"+=!e! e&!sod!ce s! a
    s!%&(o%e"or carac(er!s(!ce de aco%&an!a%en( a"e (+"'+r7r!! a.ec(!ve. Dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ a%'e"e, &oa(e .! &+s a(A( d!a$nos(!c+" de (+"'+rare de
    cond+!(7, cA( s! d!a$nos(!c+" de (+"'+rare a.ec(!v7 .
    D!a$nos(!c+" de (+"'+rare de ada&(are Ec+ &er(+r'are de cond+!(7 or! c+
    &er(+r'are %!<(7 de e%o=!! s! cond+!(7J (re'+!e "+a( :n cons!dera=!e, dac7 &ro'"e%e
    de cond+!(7 se%n!.!ca(!ve c"!n!c s! care n+ sa(!s.ac cr!(er!!"e &en(r+ o a"(7 (+"'+rare
    s&ec!.!c7 se de/vo"(7 :n asoc!ere c"ar7 c+ de'+(+" +n+! s(resor &s!osoc!a".
    Pro'"e%e"e !/o"a(e de cond+!(7, care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de
    cond+!(7 or! &en(r+ (+"'+rarea de ada&(are, &o( .! cod!.!ca(e dre&( co%&or(a%en(
    an(!soc!a" a" co&!"+"+! sa+ ado"escen(+"+! Eve/! SA"(e cond!=!! care se &o( a."a :n
    cen(r+" a(en=!e! c"!n!ceT, &a$. H;FJ. T+"'+rarea de cond+!(7 es(e d!a$nos(!ca(7,
    n+%a! dac7 &ro'"e%e"e de cond+!(7 re&re/!n(7 +n &a((ern re&e(!(!v O! &ers!s(en(,
    care es(e asoc!a( c+ de(er!orare :n .+nc=!onarea soc!a"7, Oco"ar7 sa+ &ro.es!ona"7.
    Criteriile $e $ia/no&ti# pentru Tul-urarea $e Con$uit(
    A2 .n pattern repetitiv si persistent de comportament "n care drepturile
    $undamentale ale altora ori normele sau re!ulile sociale corespun(toare
    etii sunt violate, mani$estat prin pre(ena a trei &sau a mai multe) dintre
    urmtoarele criterii "n ultimele E7 luni, cu cel puin un criteriu pre(ent "n
    ultimele I luniD
    A!resiune $a de oameni si animale
    &E) adesea tirani(ea(, amenin sau intimidea( pe alii3
    &7 iniia( adesea bti3
    &4) a $cut u( de o arm care poate cau(a o vtmare corporal serioas
    altora &de ex2, b, crmid, sticl spart, cuit, arm de $oc)3
    Tulburarea de
    onduit
    44
    Criteriile $e $ia/no&ti# pentru Tul-urarea $e Con$uit(
    (continuare)
    (4) a $ost crud $i(ic cu ali oameni,
    (5) a $ost crud $i(ic cu animalele,
    (6) a $urat cu con$runtare cu victima &de ex, banditism, $urt din
    po,ete,
    estorcare, atac cu m@na armat),
    (7) a $orat pe cineva la activitate sexual,
    Di&tru/erea propriet(!ii
    (8) s-a an!a0at deliberat "n incendieri cu intenia de a cau(a un pre0udiciu
    serios,
    (9) a distrus deliberat proprietatea altora &alt$el dec@t prin incendiere)
    'rau$( &au %urt
    (10)a intrat prin e$racie "n casa, dependinele sau autoturismul cuiva,
    (11)minte adesea pentru a obine bunuri sau $avoruri ori pentru a evita
    anumite obli!aii &adic, =escroc%ea(> pe alii),
    (12)a $urat lucruri de valoare mare $r con$runtare cu victima &de ex, $urt
    din ma!a(ine, dar $r e$racie, plasto!ra$ie),
    Viol(ri &erioa&e ale re/ulilor
    (13)adesea lipse,te de acas noaptea "n dispreul interdiciei prinilor,
    "ncep@nd "nainte de etatea de E4 ani,
    (14)a $u!it de acas &noaptea) de cel puin dou ori "n timp ce locuie,te "n
    casa printeasc sau a substitutului parental &sau odat, $r a reveni
    acas o lun! perioad de timp),
    (15)c%iule,te adesea de la scoal, "ncep@nd "nainte de etatea E4 am
    S #erturbarea "n comportament cau(ea( o deteriorare semni$icativ clinic "n
    $uncionarea social, ,colar sau pro$esional
    Dac individul este "n etate de E8 am sau mai mult, nu sunt satis$cute
    criteriile pentru tulburarea de personalitate antisocial
    De codi"icat pe ba(a ettn la debut
    312.81Tul-urare $e #on$uit( 2 tip #u $e-ut .n #opil(rieM debutul a cel puin
    un criteriu caracteristic tulburm de conduit "nainte de etatea de E5 am,
    312.82Tul-urare $e #on$uit(2 tip #u $e-ut .n a$ole&#ent(M absenta oricrui
    criteriu caracteristic tulburm de conduit "nainte de etatea de E5 ani,
    4*C.>5 Tul-urare $e #on$uit(2 $e-ut ne&pe#i%i#atM etatea la debut nu este
    cunoscut
    De speci"icat severitatea
    UEoar( puine, dac nu c%iar nici un $el de probleme de conduit "n exces
    "n raport cu cele cerute pentru a pune dia!nnsticul, iar problemele de
    conduit cau(ea( numai un pre0udiciu minor altora,
    Mo$erat(M numrul problemelor de conduit si e$ectul asupra altora,
    intermediar "ntre =u,oar> si =severa>,
    Sever( multe probleme de conduita "n exces "n raport cu cele cerute pentru
    a pune dia!nosticul ori problemele de conduit cau(ea( un pre0udiciu
    considerabil altora
    Pen(r+ !nd!v!/!! &es(e 5G an! d!a$nos(!c+" de (+"'+rare de cond+!(7 &oa(e .! &+s
    n+%a! dac7 n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ tulburarea de personalitate
    antisocial . D!a$nos(!c+" d& (+"'+rare de &ersona"!(a(e an(!soc!a"7 n+ &oa(e .! &+s
    !nd!v!/!"or s+' 5G a%
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E55 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    4*4.>* Tul-urarea Opo)i!ioni&"ul Provo#ator
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! o&o/!=!on!s%+" &rovoca(or :" cons(!(+!e +n
    &a((ern rec+ren( de co%&or(a%en( ne$a(!v!s(, s.!d7(or, d!so'ed!en( s! os(!" .a(7 de
    &ersoane"e re&re/en(And a+(or!(a(ea, care &ers!s(7 ce" &+=!n R "+n! Ecr!(er!+" AJ s!
    es(e carac(er!/a( &r!n a&ar!=!a .recven(7 a ce" &+=!n &a(r+ d!n +r%7(oare"e
    co%&or(a%en(e &!erderea c+%&7(+"+! Ecr!(er!+" A"J, cer(+r! c+ ad+"=!! Ecr!(er!+"
    A9J, s.!darea sa+ re.+/+" ac(!v de a se s+&+ne re$+"!"or ad+"=!"or Ecr!(er!+" A;J,
    co%!(erea de"!'era(7 a +nor "+cr+r! care vor s+&7ra a"=! oa%en! Ecr!(er!+" AIJ,
    '"a%area a"(ora &en(r+ &ro&r!!"e sa"e eror! sa+ &+r(are rea Ecr!(er!+" AYJ, a .!
    s+sce&(!'!" s! +Oor de a$asa( de c7(re a"=!! Ecr!(er!+" ARJ, a .! co"eros s! &"!n de
    resen(!%en(e Ecr!(er!+" AHJ or! a .! ranc!+nos s! v!nd!ca(!v Ecr!(er!+" AGJ Pen(r+ a .!
    dese%na(e &en(r+ (+"'+rarea o&o/!=!on!s%+" &rovoca(or, co%&or(a%en(e"e (re'+!e
    s7 s+rv%7 %a! .recven( decA( se o'serv7 de re$+"7 "a !nd!v!/!! de e(a(e s! n!ve" de
    de/vo"(are co%&ara'!"e s! (re'+!e s7 d+c7 "a o de(er!orare se%n!.!ca(!v7 !n
    .+nc=!onarea soc!a"7, Oco"ar7 sa+ &ro.es!ona"7 Ecr!(er!+" BJ D!a$nos(!c+" n+ es(e &+s
    dac7 &er(+r'area :n co%&or(a%en( s+rv!ne e<c"+s!v :n c+rs+" +ne! (+"'+r7r!
    &s!o(!ce sa+ a.ec(!ve Ecr!(er!+" CJ, or! dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+
    (+"'+rarea de cond+!(7 sa+ &en(r+ (+"'+rarea de &ersona"!(a(e an(!soc!a"7 E"a +n
    !nd!v!d :n e(a(e de &es(e 5G an!J
    Co%&or(a%en(e"e ne$a(n!s(e s! s.!d7(oare se %an!.es(7 &r!n o's(!na=!e
    &ers!s(en(7, re/!s(en(7 "a :ndr+%7r! s! re.+/+" de a .ace co%&ro%!s+r!, de a ceda or!
    de a ne$oc!a c+ ad+"=!! sa+ e$a"!! S.!darea &oa(e !nc"+de, de ase%enea, (es(area
    de"!'era(7 sa+ &ers!s(en(7 a "!%!(e"or (o"eran(e!, de re$+"7 &r!n !$norarea ord!ne"or,
    cear(7 s! !nca&ac!(a(ea de a acce&(a '"a%+" &en(r+ re"e"e corn!Oe Os(!"!(a(ea &oa(e (!
    :ndre&(a(7 s&re ad+"=! sa+ e$a"! s! es(e %an!.es(a(7 &r!n enervarea de"!'era(7 a a"(ora
    or! &r!n a$res!+ne ver'a"7 Ede re$+"7, .7r7 a$res!+nea .!/!c7 ser!oas7 _7/+(7 :n
    (+"'+rarea de cond+!(7J Man!.es(7r!"e (+"'+r7r!! s+n( a&roa&e cons(an( &re/en(e
    acas7 s! &o( s7 n+ .!e ev!den(e "a scoa"7 sa+ :n co%+n!(a(e S!%&(o%e"e (+"'+r7r!!
    s+n( de re$+"7 %a! ev!den(e :n !n(erac=!+n!"e c+ ad+"=!! sa+ c+ e$a"!! &e care
    !nd!v!d+" :! c+noaO(e '!ne s! ca a(are &o( s7 n+ .!e ev!den(e :n (!%&+" e<a%!n7r!!
    c"!n!ce. De re$+"7, !nd!v!/!! c+ aceas(7 (+"'+rare n+ se cons!der7 e! :nO!O! ca
    o&o/!=!on!s(! sa+ &rovoca(or! s! :O! @+s(!.!c7 co%&or(a%en(+" ca .+nd +n r7s&+ns "a
    cerer! sa+ c!rc+%s(an=e a's+rde
    *lemente si tulburri asociate
    E"e%en(e"e s! (+"'+r7r!"e asoc!a(e var!a/7 :n .+nc=!e de e(a(ea !nd!v!d+"+! s!
    sever!(a(ea (+"'+r7r!! o&o/!=!on!s%+" &rovoca(or La '7r'a=!, (+"'+rarea s4a ar7(a( a
    .! %a! .recven(7 &r!n(re ce! care :n an!! &reOco"ar! a+ av+( (e%&era%en(e
    &ro'"e%a(!ce Ede e< , reac(!v!(a(e cresc+(7, d!.!c+"(a(e :n a .! ca"%a=!J sa+ ac(!v!(a(e
    %o(or!e cresc+(7 :n (!%&+" an!"or de scoa"7, &oa(e e<!s(a o s(!%7 de s!ne sc7/+(7,
    "a'!"!(a(e a.ec(!v7, (o"eran=7 sc7/+(7 "a .r+s(rare, cen(!o/!(a(e, +/ &recoce de a"coo",
    de (a'ac or! de dro$+r! !"!c!(e Adesea e<!s(7 con."!c(e c+ &7r!n=!!, &ro.esor!! sa+ c+
    e$a"!! Poa(e e<!s(a +n cerc v!c!os :n care &7r!n(e"e s! co&!"+" ara(7 (o( ce es(e %a! r7+
    :n .!ecare T+"'+rarea o&o/!=!on!s%+" &rovoca(or es(e %a! .recven(7 :n .a%!"!!"e :n
    care :n$r!@!rea co&!"+"+! es(e .7rA%!=a(7 de o s+cces!+ne de !n.!r%!er! d!.er!=! sa+ :n
    4E4 8E Tulburarea Opo(itionismul
    #rovocator
    *+*
    .a%!"!!"e :n care %e(ode"e de ed+care a co&!"+"+!, as&re, !nadecva(e sa+ ne$"!@en(e,
    s+n( .recven(e T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e es(e co%+n7 "a co&!!! c+
    (+"'+rarea o&o/!(!on!s%+" &rovoca(or De ase%enea, (+"'+r7r!"e de :nv7=are s! de
    co%+n!care (!nd a .! asoc!a(e c+ (+"'+rarea o&o/!(!on!s%+" &rovoca(or
    *lementele speci$ice etii si sexului
    Deoarece co%&or(a%en(+" o&o/!(!on!s( (ran/!(or es(e .oar(e .recven( "a co&!!!
    &reOco"ar! s! "a ado"escen=!, se !%&+ne &reca+=!e :n &+nerea d!a$nos(!c+"+! de
    o&o/!o%s% &rovoca(or, %a! a"es :n c+rs+" aces(or &er!oade a"e de/vo"(7%
    N+%7r+" s!%&(o%e"or de o&o/!(!on!s% (!nde s7 creasc7 c+ e(a(ea T+"'+rarea es(e
    %a! .recven(7 "a '7r'a=! decA( "a .e%e! :na!n(e de &+'er(a(e, dar ra(e"e dev!n
    &ro'a'!" e$a"e d+&7 &+'er(a(e S!%&(o%e"e s+n( :n $enera" s!%!"are "a a%'e"e se<e,
    c+ e<ce&=!a .a&(+"+! c7 '7r'a=!! &o( avea +n co%&or(a%en( %a! con."!cr+a" s!
    s!%&(o%e %a! &ers!s(en(e
    #revalent
    A+ .os( ra&or(a(e ra(e a"e (+"'+r7% o&o/!(!on!s%+" &rovoca(or :n(re 9d s! 5Rd,
    :n .+nc=!e de na(+ra eOan(!on+"+! &o&+"a(!ona" s! %e(ode"e de s(a'!"!re
    *voluie
    T+"'+rarea o&o/!(!on!s%+" &rovoca(or dev!ne ev!den(7 de re$+"7 :na!n(e de
    e(a(ea de G an! s! :n %od +/+a" n+ %a! (Ar/!+ de :nce&+(+" ado"escen(e! S!%&(o%e"e
    de o&o/!(!on!s% a&ar adesea :n %ed!+" .a%!"!ar, dar c+ (!%&+" a&ar s! :n a"(e "oc+r!
    De'+(+" es(e de re$+"7 $rad+a", s+rve%nd a'!(+a" :n dec+rs de "+n! sa+ an! In(r4
    o &ro&or=!e se%n!.!ca(!v7 de ca/+r!, (+"'+rarea o&o/!(!on!s%+" &rovoca(or es(e +n
    an(eceden( evo"+(!v a" (+"'+r7nn! de cond+!(7 DeO! (+"'+rarea de cond+!(7, (!&+"
    c+ de'+( :n co&!"7r!e, es(e &receda(7 adesea de o&o/!(!on!s%+" &rovoca(or, %+"=!
    co&!! c+ o&o/!(!on!s% &rovoca(or n+ vor &re/en(a +"(er!or (+"'+rarea de cond+!(7
    #attern $amilial
    T+"'+rarea o&o/!(!on!s%+" &rovoca(or &are a .! %a! .recven(7 :n .a%!"!!"e :n care
    ce" &+=!n +n+" d!n(re &7r!n=! are +n !s(or!c de (+"'+rare a.ec(!v7, o&o/!o%s%
    &rovoca(or, !&erac(!v!(a(eXde.!c!( de a(en=!e, &ersona"!(a(e an(!soc!a"7 or! de
    (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 :n a.ar7 de aceas(a, +ne"e s(+d!! s+$erea/7 c7
    %a%e"e c+ (+"'+rare de&res!v7 s+n( %a! &red!s&+se "a a a_ea co&!! c+
    co%&or(a%en( o&o/!(!on!s(, :ns7 n+ es(e c"ar :n ce %7s+r7 de&res!a %a(ern7 re/+"(7
    d!n, or! ca+/ea/7 co%&or(a%en(+" o&o/!(!on!s( "a co&!! T+"'+rarea o&o/!(!on!s%+"
    &rovoca(or es(e, de ase%enea, %a! .recven(7 !n .a%!"!!"e :n care e<!s(7 o d!scord!e
    %ar!(a"7 ser!oas7
    Dia!nostic di$erenial
    Co%&or(a%en(e"e d!'r+&(!ve a"e !nd!v!/!"or c+ (+"'+rarea o&o/!(!on!s%+"
    &rovoca(or s+n( de na(+r7 %a! &+=!n sev er7 decA( ce"e a"e !nd!v!/!"or c+ (+"'+rare de
    cond+!(7, s! de re$+"a n+ !nc"+d a$res!+nea .a(7 de oa%en! sa+ an!%a"e, d!s(r+$erea
    &ro&r!e(7=!! on +n &a((ern 'n$an(esc sa+ de.ra+da(!v Deoarece (oa(e e"e%en(e"e
    (+"'+r7% o&o/!(!on!s%+" &rovoca(or s+n( de re$+"7 &re/en(e :n (+"'+rarea de
    Tulburrile dia!nosticate de re!ul pentru prima dat
    *+C "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    cond+!(7, (+"'+rarea o&o/!=!on!s%+" &rovoca(or n+ es(e d!a$nos(!ca(7, dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea de cond+!(7. Co%&or(a%en(+" o&o/!=!on!s(
    es(e +n e"e%en( asoc!a( co%+n a" (+"'+r7r!"or a.ec(!ve O! a" (+"'+r7r!"or &s!o(!ce
    &re/en(e "a co&!! s! "a ado"escen=! s! n+ (re'+!e d!a$nos(!ca( se&ara(, dac7 s!%&(o%e"e
    s+rv!n e<c"+s!v :n c+rs+" +ne! (+"'+r7r! a.ec(!ve sa+ &s!o(!ce. Co%&or(a%en(e"e
    o&o/!=!on!s(e (re'+!e, de ase%enea, d!s(!nse de co%&or(a%en(+" d!sr+&(!v care
    re/+"(7 d!n !na(en=!e s! !%&+"s!v!(a(e :n (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e.
    CAnd ce"e do+7 (+"'+r7r! s+rv!n conco%!(en(, (re'+!e &+se a%'e"e d!a$nos(!ce. La
    !nd!v!/!! c+ re(ardare %en(a"7, +n d!a$nos(!c de (+"'+rare o&o/!=!on!s% &rovoca(or
    es(e &+s n+%a! dac7 co%&or(a%en(+" o&o/!=!on!s( es(e c+ %+"( %a! ev!den( decA( se
    o'serv7 "a !nd!v!/!! de e(a(e, se< s! sever!(a(e a re(ard7r!! %en(a"e co%&ara'!"e.
    T+"'+rarea o&o/!=!on!s%+" &rovoca(or (re'+!e d!s(!ns7, de ase%enea, de
    !nca&ac!(a(ea de a e<ec+(a ord!ne"e da(e, care es(e re/+"(a(+" de(er!or7r!! :n=e"e$er!!
    "!%'a@+"+! Ede e<., &!erderea a+/+"+!, (+"'+rarea %!<(7 de "!%'a@ rece&(!v s!
    e<&res!vJ. Co%&or(a%en(+" o&o/!=!on!s( es(e +n e"e%en( (!&!c a" an+%!(or s(ad!! de
    de/vo"(are Ede e<., %!ca co&!"7r!e s! ado"escen=aJ. Un d!a$nos(!c de o&o/!=!on!s%
    &rovoca(or (re'+!e av+( :n vedere, n+%a! dac7 co%&or(a%en(e"e s+rv!n %a!
    .recven( s! a+ consec!n=e %a! ser!oase decA( se o'serv7 de re$+"7 "a a"=! !nd!v!/! c+
    s(ad!+ de de/vo"(are co%&ara'!" s! d+c "a o de(er!orare !%&or(an(7 :n .+nc=!onarea
    soc!a"7, Oco"ar7 sa+ &ro.es!ona"7. De'+(+" co%&or(a%en(e"or o&o/!=!on!s(e :n
    ado"escen=7 &oa(e .! da(ora( &roces+"+! de !nd!v!d+a=!e nor%a"7.
    Criteriile $e $ia/no&ti# pentru
    4*4.>* Opo)i!ioni&"ul Provo#ator
    A2 .n pattern de comportament ne!ativist, ostil ,i provocator care durea( cel
    puin I luni, "n timpul crora sunt pre(ente patru &sau mai multe) dintre
    urmtoareleD
    (1) adesea ",i pierde cumptul3
    (2) adesea se ceart cu adulii3
    (3) adesea s$idea( sau re$u( "n mod activ s se con$orme(e cererilor
    sau
    re!ulilor adulilor3
    (4) adesea enervea( "n mod deliberat pe alii3
    (5) adesea blamea( pe alii pentru propriile sale erori sau purtare rea3
    (6) adesea este susceptibil ori u,or de enervat de ctre alii3
    (7) adesea este coleros ,i plin de resentimente3
    (8) adesea este ranc%iunos ,i vindicativ2
    FotD .n criteriu se consider satis$cut, numai dac comportamentul
    survine mai $recvent dec@t se observ de re!ul la indivi(ii de etate ,i nivel
    de de(voltare comparabile2
    S2 #erturbarea "n comportament cau(ea( o deteriorare semni$icativ clinic "n
    $uncionarea social, ,colar si pro$esional2
    2 omportamentele nu survin exclusiv "n cursul evoluiei unei tulburri psi%o
    tice sau a$ective2
    D2 Fu sunt satis$cute criteriile pentru tulburarea de conduit, ,i dac individul
    este "n etate de E8 ani sau mai mult, nu sunt satis$cute criteriile pentru
    tulburarea de personalitate antisocial2
    4E7 6 Tulburarea de omportament
    Disruptiv 'r Alt Speci$icaie *+4
    4*C.5 Tul-urarea $e Co"porta"ent Di&ruptiv
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e des(!na(7 (+"'+r7r!"or carac(er!/a(e &nn cond+!(7 sa+
    co%&or(a%en(e o&o/!(!o%s( s.!da (oare care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea
    de cond+!(7 sa+ &en(r+ (+"'+rarea o&o/!on!s%+" &rovoca(or De e<e%&"+, !nc"+de
    (a'"o+r!"e c"!n!ce care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea o&o/!(!o%s%+"
    &rovaca(or or! &en(r+ (+"'+raraa de cond+!(7, dar :n care e<!s(7 o de(er!orare
    se%n!.!ca(!v7 c"!n!c
    Tul-ur(rile $e Ali"entare &i $e Co"porta"ent
    Ali"entar ale Perioa$ei $e Su/ar &au Mi#ii Copil(rii
    T+"'+r7r!"e de a"!%en(are s! de co%&or(a%en( a"!%en(ar a"e &er!oade! de s+$ar
    sa+ a"e %!ca co&!"7r!! se carac(er!/ea/7 &r!n &er(+r'7r! .recven(e de a"!%en(are s! de
    co%&or(a%en( a"!%en(ar T+"'+r7r!"e s&ec!.!ce !nc"+se s+n( &!ca, r+%%a(!a s!
    (+"'+rarea de a"!%en(are a &er!oade! de s+$ar s! a %!c!! co&!"7r!! De no(a( c7
    anore<!a nervoas7 s! '+"!%!a nervoas7 s+n( !nc"+se :n sec=!+nea ST+"'+r7r!"e de
    co%&or(a%en( a"!%en(arT Eve/! &a$ YG;J
    4+G.<C Pi#a
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" &!c!! :" cons(!(+!e %Anca(+" &ers!s(en( de s+'s(an=e
    nonn+(n(!ve o &er!oad7 de ce" &+=!n o "+r7 Ecn(en+" AJ S+'s(an=e"e !n$era(e de
    re$+"7 (!nd s7 var!e/e c+ e(a(ea S+$an! s! co&!!! %!c! %7nAnc7 de re$+"7 vo&sea,
    &"as(!c, s.oar7, &7r or! :%'r7c7%!n(e Co&!!! %a! %ar! &o( %Anca e<cre%en(e de
    an!%a"e, n!s!&, !nsec(e, .r+n/e, &!e(r!ce"e Ado"escen=!! sa+ ad+"=!! &o( cons+%a
    ar$!"7 sa+ "+( N+ e<!s(7 avers!+ne .a(7 de %Ancare Aces( co%&or(a%en( (re'+!e s7
    .!e !nadecva( evo"+(!v Ecr!(er!+" BJ, s! n+ o &ar(e a +ne! &rac(!c! sanc=!ona(e c+"(+ra"
    Ecr!(er!+" CJ MAncarea de s+'s(an=e nonn+(n(!ve es(e +n e"e%en( asoc!a( s! a"(or
    (+"'+r7r! %en(a"e Ede e<, (+"'+rarea de de/vo"(are &ervas!v7, re(ardarea %en(a"7J
    Dac7 co%&or(a%en(+" a"!%en(ar s+rv!ne e<c"+s!v :n c+rs+" a"(e! (+"'+r7r! %en(a"e,
    +n d!a$nos(!c se&ara( de &!ca (re'+!e &+s, n+%a! dac7 co%&or(a%en(+" a"!%en(ar
    es(e s+.!c!en( de sever &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 Ecr!(er!+" DJ
    *lemente si tulburri asociate
    P!ca es(e .recven( asoc!a(7 c+ re(ardarea %en(a"7 C+ (oa(e c7 % +ne"e ca/+r! a+
    .os( descr!se de.!c!en(e v!(a%%!ce sa+ %!nera"e, de re$+"7 n+ s+n( cons(a(a(e n!c!
    +n .e" de ano%a"!! '!o"o$!ce s&ec!.!ce :n +ne"e ca/+r!, &!ca a(ra$e a(en=!a c"!n!c7
    n+%a! cAnd !nd!v!d+" &re/!n(7 vre+na d!n d!verse"e co%&"!ca=!! %ed!ca"e $enera"e
    care &o( s+rven! Ede e< , !n(o<!ca=!a c+ &"+%', ca re/+"(a( a" %$es(!e! de vo&sea sa+
    de &"as(!c !%&r!%a( c+ vo&sea, &ro'"e%e !n(es(!na"e de na(+r7 %ecan!c7 oc"+/!e
    !n(es(!na"7 ca reH+"(a( a" +nor (+%or c+ $e%e de &ar, &er.ora=!e !n(es(!na"7 or!
    !n.ec=!!, &rec+% (o<o&"as%o/a s! (o<ocana/a, ca re/+"(a( a" %$es(!e! de .eca"e sa+
    Tulburrile dia!nosticate de re!ul pentru prima dat
    *+7 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    &7%An(J Pa+&er(a(ea, ne$"!@en=a, "!&sa de s+&rave$ere &aren(a"a s! :n(Ar/!erea :n
    de/vo"(are cresc r!sc+" &en(r+ aceas(7 cond!=!e
    *lemente speci$ice culturii, etii si sexului
    :n +ne"e c+"(+r!, a %Anca &7%An( sa+ a"(e s+'s(an=e nonn+(r!(!ve ase%7n7(oare
    es(e cons!dera(7 a .! o va"oare P!ca es(e %a! .recven(7 "a co&!!! %!c! s!, oca/!ona", "a
    .e%e!"e $rav!de
    #revalent
    Da(e"e e&!de%!o"o$!ce des&re &!ca s+n( "!%!(a(e Pr!n(re !nd!v!/!! c+ re(ardare
    %en(a"7, &reva"en(a (+"'+r7r!! &are a cres(e c+ sever!(a(ea re(ard7rn Ede e<, a .os(
    ra&or(a(7 a .! de &es(e 5Yd "a ad+"=!! c+ re(ardare %en(a"7 sever7J
    *voluie
    P!ca &oa(e de'+(a :n &er!oada de s+$ar :n ce"e %a! %+"(e ca/+r!, (+"'+rarea
    d+rea/7 &ro'a'!" %a! %+"(e "+n! s! a&o! se re%!(e Oca/!ona", se &oa(e con(!n+a :n
    ado"escen(7 or!, %a! rar, :n &er!oada ad+"(7 La !nd!v!/!! c+ re(ardare %en(a"7,
    co%&or(a%en(+" &oa(e d!%!n+a :n &er!oada ad+"(7
    Dia!nostic di$erenial
    :na!n(e de e(a(ea de 5G49I de "+n!, d+cerea "a $+r7 s! +neor! %Anca(+" de
    s+'s(an=e nonn+(r!(!ve s+n( re"a(!v .recven(e s! n+ !%&"!c7 &re/en(a &!c!! P!ca es(e
    d!a$nos(!ca(7 n+%a! cAnd co%&or(a%en(+" es(e cons!dera( a .! &ers!s(en( Ead!c7,
    &re/en( (!%& de ce" &+=!n o "+n7J s! !nadecva(, da( n%d n!ve"+" de de/vo"(are a"
    !nd!v!d+"+! MAnca(+" de s+'s(an=e nonn+(r!(!ve &oa(e s+rven! s! :n c+rs+" a"(or
    (+"'+r7r! %en(a"e Ede e< , :n (+"'+rarea de de/vo"(are &ervas!v7, :n sc!/o.ren!e,
    ca re/+"(a( a" conv!n$er!"or de"!ran(e, s! :n s!ndro%+" -"e!ne4Lev!nJ :n as(.e" de
    ca/+r!, +n d!a$nos(!c ad!=!ona" de &!ca (re'+!e &+s n+%a! dac7 co%&or(a%en(+"
    a"!%en(ar es(e s+.!c!en( de sever &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 P!ca
    &oa(e .! d!s(!ns7 de a"(e (+"'+r7r! de a"!%en(are Ede e<, r+%!na(!a, (+"'+rarea de
    a"!%en(are a &er!oade! de s+$ar s! a %!c!! co&!"7r!!, anore<!a nervoas7 s! '+"!%!a
    nervoas7J &r!n cons+%+" de s+'s(an=e nonn+(r!(!ve
    45? A4
    +ummatia
    5LY
    Criteriile $e $ia/no&ti# pentru 4+G.<C Pi#a
    A M@ncatul persistent de substane nonnutritive o perioada de cel puin o lun
    S M@ncatul de substane nonnutritive este inadecvat nivelului de de(voltare
    omportamentul alimentar nu este o parte a unei practici sancionate cultural
    D Dac comportamentul alimentar survine exclusiv "n cursul altei tulburri mentale
    &de ex, retardarea mental , tulburarea de de(voltare pervasiv , sc%i(o$renia)
    acesta este su$icient de sever pentru a 0usti$ica o atenie clinic separat
    4+G.<4 Ru"ina!ia
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" r+%%a(!e! es(e re$+r$!(area s! re%es(ecarea re&e(a(7 a
    a"!%en(e"or, care a&are "a +n s+$ar sa+ "a +n co&!", d+&7 o &er!oad7 de .+nc=!onare
    nor%a"7, s! d+rea/7 ce" &+=!n o "+n7 Ecr!(er!+" AJ MAncarea, &ar=!a" d!$era(7, es(e
    read+s7 :n $+r7 .7r7 $rea=7, e.or( de a vo%a, de/$+s( or! o (+"'+rare
    $as(ro%(es(%a"7 asoc!a(7 MAncarea es(e a&o!, .!e e@ec(a(7 d!n $+r7, .!e, %a!
    .recven(, %es(eca(7 s! re:n$!(7 S!%&(o%e"e n+ se da(orea/7 +ne! cond!=!!
    $as(ro!n(es(%a"e or! a"(e! cond!=!! %ed!ca"e $enera"e asoc!a(e Ede e<, s!ndro%
    Sand!.er, re."+< eso.a$!anJ +n(en+" BJ s! n+ s+rv!n e<c"+s!v :n c+rs+" anore<!e!
    nervoase or! a" '+%!e! nervoaseJ Dac7 s!%&(o%e"e s+rv!n e<c"+s!v :n c+rs+"
    re(ard7rn %en(a"e sa+ a" (+"'+rar7 de de/vo"(are &ervas!v7, e"e (re'+!e s7 .!e
    s+.!c!en( de severe &er(r+ a @+s(*!ca o a(en=!e cLn!c7 se&ara(7 Ecn(en+" CJ
    T+"'+rarea es(e o'serva(7 ce" %a! .rea en( "a s+$ar!, dar &oa(e .! :n(A"n!(7 s! "a
    !nd!v!/! %a! :n e(a(e, !n s&ec!a" "a ce! ca?e a+, de ase%enea, re(ardare %en(a"7
    S+$ar!! c+ aceas(7 (+"'+rare &re/!n(7 o &o/!=!e carac(er!s(!ca de :ncordare s! arc+!re
    a s&a(e"+!, c+ ca&+" da( &e s&a(e, .ac rr !sc7r! de s+c+ne s! da+ !%&res!a c7 o'=!n
    sa(!s.ac=!e d!n aceas(7 ac(!v!(a(e
    *lemente si tulburri asociate
    S+$ar!! c+ r+%!nae s+n( % $enera" !r!(a'!"! s! :n.o%e(a=! :n(re e&!soade"e de
    re$+r$!(a(!e C+ (oa(e c7 s+$ar+" es(e ev!den( :n.o%e(a( s! !n$er7 %An can(!(7=! de
    a"!%en(e, &oa(e s+rven! %a"n+(na, d!n ca+/a re$+r$!(a% care +r%ea/7 !%ed!a(
    d+&7 a"!%en(are Poa(e re/+"(a &!erdere !n $re+(a(e, !nca&ac!(a(ea de a "+a !n
    $re+(a(e a(A( cA( es(e e<&ec(a( s! c!ar %oar(ea Ec+ ra(e de %or(a"!(a(e ra&or(a(e de
    &es(e 9YdJ Ma"n+(r!(!a &are a .! %a! &+=!n &ro'a'!"7 "a co&!!! %a! %ar! s! "a ad+"=!,
    "a care (+"'+rarea &oa(e .!, .!e con(!n+7 .!e e&!sod!c7 Pro'"e%e"e &s!osoc!a"e, c+%
    ar .! "!&sa de s(!%+"are, ne$"!@area, s!(+a=!!"e s(resan(e de v!a(7 s! &ro'"e%e"e :n
    re"a=!a &7r!n(e co&!" &o( .! .ac(or! &red!s&o/an(! S+'s(!%+"area s+$ar+"+! &oa(e
    re/+"(a s! dac7 !n.!r%!er+" se desc+ra@ea/7 s! se :ns(r7!nea/7 de co&!" d!n ca+/a
    e<&er!en=e"or de a"!%en(are !n.r+c(+oase sa+ a %!ros+"+! ne&"7c+( a" %a(er!a"+"+!
    re$+r$!(a( :n +ne"e ca/+r! se &oa(e de/vo"(a, de ase%enea, (+"'+rarea de
    Tulburrile dia!nosticate de re!ul pentru prima dat
    *+= "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    a"!%en(are a &er!oade! de s+$ar O! a %!c!! co&!"7r!!. La co&!!! %a! %ar! s! "a ad+"=!,
    re(ardarea %en(a"7 es(e +n .ac(or &red!s&o/an(.
    #revalent
    R+%!na=!a &are a .! rar7. S+rv!ne %a! adesea "a '7r'a=! decA( "a .e%e!.
    Evo"+=!e
    De'+(+" r+%!na=!e! &oa(e s+rven! :n con(e<(+" :n(Ar/!er!"or :n de/vo"(are. E(a(ea
    "a de'+( es(e :n(re ; s! 59 "+n!, c+ e<ce&=!a !nd!v!/!"or c+ re(ardare %en(a"7 "a care
    (+"'+rarea &oa(e s+rven! :n(r4+n s(ad!+ evo"+(!v ceva %a! (ard!v. La s+$ar!,
    (+"'+rarea se re%!(e .recven( s&on(an, :n +ne"e ca/+r! %a! severe :ns7, evo"+=!a es(e
    con(!n+7.
    Dia!nostic di$erenial
    La s+$ar!, ano%a"!!"e con$en!(a"e Ede e<., s(eno/a &!"or!c7 sa+ re."+<+"
    $as(roeso.a$!anJ or! a"(7 cond!=!e %ed!ca"7 $enera"7 Ede e<., !n.ec=!! a"e s!s(e%+"+!
    $as(ro!n(es(!na"J &o( ca+/a re$+r$!(area a"!%en(e"or, s! (re'+!e s7 .!e e<c"+se &r!n
    e<a%ene so%a(!ce s! (es(e de "a'ora(or adecva(e. R+%!na=!a &oa(e .! d!s(!ns7 de
    v7rs7(+ra nor%a"7 a &er!oade! &recoce de s+$ar &r!n na(+ra ev!den( vo"+n(ar7 a
    r+%!na=!e! Ede e<., o'servarea %!Oc7r!"or &re&ara(or!! carac(er!s(!ce, +r%a(e de
    re$+r$!(are s! de %!Oc7r! de s+$ere or! de %as(!ca=!e, care &ar a .! &"7c+(eJ.
    R+%!na=!a n+ es(e d!a$nos(!ca(7, dac7 s!%&(o%e"e s+rv!n e<c"+s!v :n c+rs+"
    anore<!eC nervoase or! a" '+"!%!e! nervoase.
    Criteriile $e $ia/no&ti# pentru 4+G.<4 Ru"ina!ie
    A2 +e!ur!itarea ,i remestecarea repetat a alimentelor o perioad de cel puin
    o lun, urm@nd unei perioade de $uncionare normal2
    S2 omportamentul nu se datorea( unei condiii !astrointestinale sau altei
    condiii medicale !enerale asociate &de ex2, re$lux eso$a!ian)2
    2 omportamentul nu survine exclusiv "n cursul anorexie/ nervoase ori al
    bulimiei nervoase2 Dac simptomele survin exclusiv "n cursul retardrii
    mentale sau al tulburrii de de(voltare pervasiv , ele sunt su$icient de
    severe pentru a 0usti$ica o atenie clinic separat 2
    45? A6 Tulburarea de Alimentare a #erioadei de
    Su!ar si a MIII opilrii *+G

    4+G.<5 Tul-urarea $e Ali"entare a Perioa$ei $e
    Su/ar &i a Mi#ii Copil(rii
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7% de a"!%en(are a &er!oade! de s+$ar s! a %!c!!
    co&!"7r!! :" cons(!(+!e !nca&ac!(a(ea &ers!s(en(7 de a se a"!%en(a cores&+n/7(or, .a&(
    !"+s(ra( de !nca&ac!(a(ea de a "+a :n $re+(a(e or! de &!erderea &ondera"7
    se%n!.!ca(!v7, :n dec+rs de ce" &+=!n o "+n7 Ecr!(er!+" AJ N+ e<!s(7 n!c! o cond!=!e
    $as(ro%(es(%a"7 sa+ a"(7 cond!=!e %ed!ca"7 $enera"7 Ede e<, re."+< eso.a$!anJ
    s+.!c!en( de sever7 care s7 @+s(!.!ce &er(+r'area de a"!%en(are Ecr!(er!+" BJ De
    ase%enea, &er(+r'area de a"!%en(are n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare
    %en(a"7 Ede e< , r+%!na(!aJ or! de "!&sa de a"!%en(e Ecr!(er!+" BJ De'+(+" (+"'+r7r!!
    (re'+!e s7 a!'7 "oc :na!n(e de e(a(ea de R a% Ecr!(er!+" DJ
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. S+$ar!! c+ (+"'+rare de
    a"!%en(are s+n( adesea e<(re% de !r!(a'!"! s! d!.!c!" de conso"a( :n (!%&+"
    a"!%en(7% E! &o( &7rea a&a(!c! s! re(raO!, s! &o( &re/en(a, de ase%enea, :n(Ar/!er!
    :n de/vo"(are In +ne"e ca/+r!, &ro'"e%e"e :n "e$7(+r7 c+ !n(erac=!+nea &7r!n(e4
    co&!" &o( con(r!'+! "a sa+ &o( e<acer'a &ro'"e%a de a"!%en(are a s+$ar+"+! Ede e< ,
    &re/en(area :n %od !nadecva( a %Anc7r!! or! a r7s&+nde "a re.+/+" %Anc7% de
    c7(re s+$ar ca s! c+% ar .! +n ac( de a$res!+ne sa+ de re@ec=!eJ A&or(+" ca"or!c
    !nadecva( &oa(e e<acer'a e"e%en(e"e asoc!a(e Ede e<, !n(a'!(a(ea, :n(Ar/!er!"e :n
    de/vo"(areJ s!, :n consec!n=7, con(r!'+!e "a d!.!c+"(7=!"e de a"!%en(are Fac(or!!, care
    "a s+$ar &o( .! asoc!a=! c+ cond!=!a, !nc"+d d!.!c+"(7=! ne+rore$"a(orn Ede e<,
    d!.!c+"(7=! de so%n4v!$!"!(a(e, re$+r$!(a(!e .recven(7, &er!oade !%&rev!/!'!"e de
    v!$!"!(a(eJ s! de(er!or7r!"e :n de/vo"(are &ree<!s(en(e, care .ac s+$ar+" %a! &+=!n
    reac(!v A"=! .ac(or! care &o( .! asoc!a=! c+ cond!=!a !nc"+d &s!o&a(o"o$!a &aren(a"7
    s! a'+/+" sa+ ne$"!@area co&!"+"+!
    9ate de laborator asociate. Po( e<!s(a da(e nes&ec!.!ce asoc!a(e c+ %a"n+(n(!a,
    care es(e o'serva(7 +neor! :n (+"'+rarea de a"!%en(are a &er!oade! de s+$ar sa+ a
    %!c!! co&!"7r!! Ede e< , ane%!e, sc7derea a"'+%%e! ser!ce s! a &ro(e!ne"or (o(a"eJ
    Datele e,a"in(rii &o"ati#e &i #on$i!iile "e$i#ale /enerale a&o#iate2 .n
    (+"'+rarea de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!! &oa(e e<!s(a
    %a"n+(n(!e care, :n ca/+r!"e severe, &oa(e &er!c"!(a v!a(a
    *lemente speci$ice etii si sexului
    Un de'+( %a! (ard!v Ede e< , "a e(a(ea de 9 sa+ ; an!, %a! c+rAnd decA( :n
    &er!oada de s+$arJ es(e asoc!a( c+ $rade %a! &+=!n severe de :n(Ar/!ere :n
    de/vo"(are s! de %a"n+(n(!e, c+ (oa(e c7 &oa(e .! o'serva(7 o :n(Ar/!ere a creO(e%
    T+"'+rarea de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!! es(e "a .e" de
    .recven(7 "a '7r'a=! s! "a .e%e!
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E58 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    #revalent
    D!n (oa(e !n(ern7r!"e :n s&!(a"e"e &ed!a(r!ce, "d4Yd s+n( &en(r+ d!s(ro.!c s! &An7
    "a @+%7(a(e d!n(re aces(ea &o( re&re/en(a &er(+r'7r! de a"!%en(are, .7r7 vreo
    cond!=!e %ed!ca"7 $enera"7 &red!s&o/an(7 ev!den(7. Da(e d!n eOan(!oane
    co%+n!(are s+$erea/7 o &reva"en(7 &+nc(+a"7 :n @+r de ;d &en(r+ d!s(ro.!e.
    *voluie
    Frecven(, (+"'+rarea de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!! :O!
    are de'+(+" :n &r!%+" an de v!a=7, dar &oa(e s+rven! O! "a e(a(ea de 94; an!.
    Ma@or!(a(ea co&!!"or &re/!n(7 o a%e"!orare d+&7 &er!oade var!a'!"e de (!%&, deO! e!
    r7%An %a! sc+n/! s! %a! +Oor! &An7 :n ado"escen=7 :n co%&ara=!e c+ co&!! care n+
    a+ &re/en(a( d!s(ro.!e.
    Dia!nostic di$erenial
    Pro'"e%e %!nore :n a"!%en(are s+n( .recven(e :n &er!oada de s+$ar.
    D!a$nos(!c+" de (+"'+rare de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!
    (re'+!e s7 .!e &+s n+%a! dac7 &ro'"e%a de a"!%en(are d+ce "a o !nca&ac!(a(e
    se%n!.!ca(!v7 :n a "+a :n $re+(a(e or! "a &!erdere :n $re+(a(e. Aceas(7 (+"'+rare n+
    es(e d!a$nos(!ca(7, dac7 &er(+r'7r!"e de a"!%en(are s+n( e<&"!ca(e !n(e$ra" de o
    cond!=!e $as(ro!n(es(!na"7, endocr!no"o$!c7 sa+ ne+ro"o$!c7. Co&!!! c+ o cond!=!e
    %ed!ca"7 $enera"7 s+'!acen(7 &o( .! %a! d!.!c!" de a"!%en(a(, !ar d!a$nos(!c+" de
    (+"'+rare de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!! (re'+!e &+s :n
    as(.e" de ca/+r!, n+%a! dac7 $rad+" de &er(+r'are es(e de sever!(a(e %a! %are decA(
    ar .! de e<&ec(a( &e 'a/a cond!=!e! %ed!ca"e $enera"e, s!n$+re. D!a$nos(!c+" es(e
    s+$era( dac7 e<!s(7 o a%e"!orare :n a"!%en(are O! +n &"+s &ondera" ca r7s&+ns "a
    sc!%'area !n.!r%!er!"or.
    Criteriile $e $ia/no&ti# pentru 4+G.<5 Tul-urarea
    $e Ali"entare a Perioa$ei $e Su/ar &au a Mi#ii Copil(rii
    A2 #erturbare de alimentare mani$estat prin incapacitatea persistent de a
    m@nca adecvat, cu incapacitatea semni$icativ de a lua "n !reutate ori cu
    pierdere ponderal semni$icativ "n decurs de cel puin o lun2
    S2 #erturbarea nu se datorea( unei condiii !astrointestinale sau altei condiii
    medicale !enerale asociate &de ex2, re$lux eso$a!ian)2
    2 #erturbarea nu este explicat mai bine de o alt tulburare mental &de ex2,
    ruminaia) ori de lipsa de alimente adecvate2
    D2 Debutul survine "nainte de etatea de I ani2
    Tulburrile dia!nosticate de re!ul pentru prima dat
    "n #erioada de Su!ar, "n opilrie sau "n Adolescent E56
    Ti#urile
    :n aceas(7 sec=!+ne s+n( !nc"+se &a(r+ (+"'+r7r! (+"'+rarea To+re((e, (!c+" %o(or
    sa+ voca" cron!c, (!c+" (ran/!(or s! (!c+" .7r7 n!c! o a"(7 s&ec!.!ca=!e Un (!c es(e o
    %!Ocare %o(or!e sa+ voca"!/a(e, 'r+sc7, ra&!d7, rec+ren(7, nonr!(%!c7, s(ereo(!&7
    T!c+r!"e voca"e sa+ %o(or!! &o( (! s!%&"e E!%&"!cAnd n+%a! cA=!va %+Oc! sa+ s+ne(e
    s!%&"eJ sa+ co%&"e<e E!%&"!cAnd %a! %+"(e $r+&e de %+Oc! recr+(a=! :n accese
    orces(ra(e sa+ :n c+v!n(e s! &ro&o/!(!+% E<e%&"e de tic+ri motorii simple s+n(
    c"!&!(+", cor+$a(!a E:ncrereaJ nas+"+!, "ac(a(!a Esc+(+rareaJ ca&+"+!, r!d!ca(+" d!n
    +%er!, $r!%ase"e .ac!a"e s! re(raca a'do%en+"+! Aces(e (!c+r! d+rea/7 de re$+"7
    %a! &+(% de cA(eva s+(e de %!"!sec+nde Tic+rile motorii complexe !nc"+d $es(+r!
    %an+a"e, s7r!(+", a(!ns+", a&7sa(+", %ers+" c+ &aO! de dans, con(ors!+n!"e .ac!a"e,
    %!ros!rea re&e(a(7 a +n+! o'!ec(, $e%+!(+", %ers+" c+ &!c!oare"e :ndo!(e, %ers+"
    :na&o!, r7s+c!(+" :n c+rs+" %ers+"+!, "+area s! %en=!nerea +nor &os(+r! !n+/+a"e
    E!nc"+/And S(!c+r!"e d!s(o%ceT c+% ar .! (!nerea $A(+"+! :n(r4o an+%!(7 &o/!=!e
    r!$!d7 J Aces(e (!c+n a+ o d+ra(7 %a! %are, cA(eva sec+nde sa+ c!ar %a! %+"(
    Co&ro&ra<!a E+n (!c 'r+sc, s!%!"ar +n+! $es( v+"$ar, se<+a" sa+ o'scenJ s!
    .eno%ene"e :n o$"!nd7, c+% ar .! eco&ra<!a E!%!(are s&on(an7, !nvo"+n(ar7 a
    $es(+r!"or c+!vaJ s+n( (!c+r! %o(or!! co%&"e<e
    Tic+rile *ocale simple s+n( s+ne(e .7r7 sens c+% ar .! dres+" voa!, .orn7!(+",
    !ns&!ra(+" s! e<&!ra(+" .or=a( de aer &e nas s! O+!era(+" Tic+rile *ocale complete
    !n(eresea/7 vor'!rea s! "!%'a@+" s! !nc"+d &ron+n=area 'r+sc7 , s&on(an7 , a +n+!
    s!n$+r c+vAn( sa+ .ra/e, '"ocarea vor'!r!!, %od!.!c7r! 'r+O(e s! .7r7 sens a"e :n7"=!%!!
    voc!!, accen(+"+! sa+ vo"+%+"+! vor'!%, &a"a"!a Ere&e(area &ro&r!!"or s+ne(e sa+
    c+v!n(eJ s! eco"a"!a Ere&e(area +"(!%e"or s+ne(e, c+v!n(e sa+ .ra/e a+/!(eJ Co&ro"aa
    es(e &ron+n=area 'r+sc7, !nadecva(7, a +nor c+v!n(e sa+ .race !nacce&(a'!"e soc!a"
    s! &oa(e !nc"+de o'scen!(7=! ca s! !ns+"(e c+ s&ec!.!c e(n?c, ras!a" sa+ re"!$!os
    Co&ro"aa es(e cons(a(a(7 :n %a! &+=!n de 5"Sc d!n(re !nd+ !/n c+ +n (!c
    :n $enera", (!c+r!"e s+n( e<&enen(a(e ca !re/!s(!'!"e, dar &o( .! s+&r!%a(e &en(r+
    &er!oade var!a'!"e de (!%& Un+ co&!! Es! +n ad+"( oca/!ona"J n+ s+n( conO(!en=! de
    (!c+r!"e "or :ns7, oda(7 c+ de/vo"(area, %+"(e &eroane c+ (!c Edar n+ (oa(eJ
    e<&enen(ea/7 o !nc!(a=!e &re%on!(or!e 4 o (ens!+ne crescAnd7 sa+ o sen/a=!e
    so%a(!c7 :n(r4o &ar(e a cor&+"+! care &recede (+]+" _ oca" sa+ %o(or s! +n sen(!%en(
    de +O+rare sa+ de red+cere a (ens!+n!! d+&7 e.ec(+area (!c+"+! Ind!v!/!! c+ (!c+r!
    &o( s!%=! c7 (!c+" se a."7 :n(re Svo"+n(arT s! S!nvo"+n(arT &r!n aceea c7 adesea es(e
    e<&enen(a( ca .+nd an+n=a( de o (ens!+ne sa+ neces!(a(e cor&ora"7 crescAnd7,
    s!%!"ar7 c+ (ens!+nea care &recede +n s(r7n+( sa+ c+ neces!(a(ea a&roa&e !re/!s(!'!"7
    de sc7r&!na( :n sca'!e Un !nd!v!d &oa(e s!%=! neces!(a(ea de a e.ec(+a +n (!c
    co%&"e< :n(r4+n an+%!( %od sa+ :n %od re&e(a( &An7 ce are sen(!%en(+" c7 (!c+" a
    .os( .7c+( SaOa c+% (re'+!eT N+%a! d+&7 aceea !nd!v!d+" e<&enen(ea/7 o red+cere
    a an<!e(7=!! sa+ (ens!+n!!
    T!c+r!"e s+n( e.ec(+a(e adesea :n accese de +n+" sa+ %a! %+"(e a%, accese"e
    s+n( se&ara(e de &er!oade de non(!c d+rAnd de "a cA(eva sec+nde "a cA(eva ore In
    $enera", (!c+r!"e :O! %od!.!c7 sever!(a(ea :n dec+rs de cA(eva ore s! :n c+rs+" +ne! /!"e
    E.recven=a, .or=a s! $rad+" (!c+r!"or &er(+r'7 co%&or(a%en(e"e :n c+rs de des.7
    s+rareJ T!c+r!"e &o( vana ca .recven(7 s! d!sr+&(!v!(a(e :n d!verse con(e<(e De
    e<e%&"+, co&!! s! ad+"=!! s+n( %a! ca&a'!"! s74s! s+&r!%e c+n"e cAnd se a."7 "a scoa"7
    , "a serv!c!+ sa+ :n ca'!ne(+" %ed!c+"+! decA( acas7 :n $enera", c+n"e d!%!n+a sa+
    Tulburrile dia!nosticate de re!ul pentru prima dat
    EE5 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    :nce(ea/7 :n c+rs+" so%n+"+!, dar c+ (oa(e aces(ea, +ra! !nd!v!/! &re/!n(7 oca/!ona!
    (!c+r! :n (!%& ce dor% sa+ se deO(ea&(7 'r+sc d!n so%n c+ +n (!c T!c+r!"e s+n( adesea
    %a! .recven(e cAnd &ersoana se re"a<ea/7 acas7 Ede e<, &r!veO(e "a (e"ev!/orJ s! se
    red+c cAnd !nd!v!d+" se an$a@ea/7 :n(r4o ac(!v!(a(e d!r!@a(7 care cere e.or( Ede e< , c!(!(
    sa+ c+s+(J T!c+r!"e &o( .! e<acer'a(e :n c+rs+" &er!oade"or de s(res, c+% ar .! a(+nc!
    cAnd e<!s(7 &res!+n! %ar! "a serv!c!+ sa+ :n c+rs+" e<a%!n7r!"or
    Dia!nostic di$erenial
    T!c+r!"e (re'+!e s7 .!e d!s(!nse de a"(e (!&+r! de %!Oc7r! anor%a"e care &o(
    aco%&an!a cond!=!! %ed!ca"e $enera"e Ede e<, %a"ad!a H+n(!n$(on, !c(+s+",
    s!ndro%+" Lesc4Nyan, %a"ad!a 1!"son, coreea Sydena%, sc"ero/a %+"(!&"7,
    ence.a"!(a &os(v!ra"7, (ra+%a(!s%+" cran!anJ s! de %!Oc7r!"e care se da(orea/7
    e.ec(+"+! d!rec( a" +ne! s+'s(an=e Ede e< , +n %ed!ca%en( ne+ro"e&(!cJ L+area :n
    cons!dera=!e a !s(or!c+"+! %ed!ca" '! .a%!"!a", a %or.o"o$!e!, r!(%+"+! O! !n."+en=e"or
    %od!.!ca(oare a"e %!Oc7 rn &oa(e a@+(a "a e.ec(+area +n+! d!a$nos(!c corec( Coreea
    es(e de re$+"7 o %!Ocare s!%&"7, cas+a"7, nere$+"a(7 s! nons(ereo(!&7, s! care n+ are
    o co%&onen(7 &re%on!(or!e s! se accen(+ea/7 cAnd &ersoana es(e d!s(ras7
    M!Oc7r!"e d!s(on!ce s+n( %!Oc7r! "en(e, e<(!nse, de (ors!+ne, a%es(eca(e c+ s(an de
    (ens!+ne %+sc+"ar7 &re"+n$!(7 M!Oc7r!"e a(e(o!de s+n( %!Oc7r! de con(ors!+ne,
    nere$+"a(e, "en(e, "oca"!/a(e ce" %a! .recven( "a de$e(e"e %A!n!"or s! &!c!oare"or, dar
    care adesea &o( !n(eresa s! $A(+" M!Oc7r!"e %!oc"on!ce s+n( con(rac=!! %+sc+"are
    sc+r(e, ase%7n7(oare soc+"+!, care &o( a.ec(a &7r=! a"e %+Oc!"or sa+ $r+&e de
    %+Oc! Con(rar (!c+r!"or, %!Oc7 n"e %!oc"on!ce &o( con(!n+a :n c+rs+" so%n+"+!
    M!Oc7r!"e e%!'as(!ce s+n( %!Oc7r! +n!"a(era"e, de %are a%&"!(+d!ne, $ros!ere O!
    !n(er%!(en(e a"e %e%'re"or S&as%e"e s+n( %!Oc7r! &re"+n$!(e, s(ereo(!&e
    !%&"!cAnd ace"eaO! $r+&e de %+Oc! s! care de re$+"7 s+n( %a! "en(e, dar +neor! %a!
    ra&!de decA( (!c+r!"e S&a'!n+" e%!.ac!a" cons(7 d!n con(rac=!! nere$+"a(e,
    re&e(!(!ve, +n!"a(era"e a"e %+Oc!"or .ac!a"! S!n)!ne/!a es(e o %!Ocare !nvo"+n(ar7
    conco%!(en(7 c+ +n ac( vo"+n(ar s&ec!.!c Ede e< , %!Oc7r! a"e co%!s+r!! '+ca"e, cAnd
    &ersoana :ncearc7 s7 :nc!d7 oc!!J
    CAnd (!c+r!"e s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a +/+"+! +n+! %ed!ca%en(, va
    (re'+! s7 .!e d!a$nos(!ca(7 (+"'+rarea de %!Ocare !nd+s7 de +n %ed!ca%en( .7r7
    a"(7 s&ec!.!ca=!e, :n "oc de (!c Ede e< , :n ca/+r!"e .oar(e c"are (!c+r!"e s+rv!n oda(7 c+
    +/+" +n+! %ed!ca%en( s! :nce(ea/7 oda(7 c+ :n(rer+&erea %ed!ca%en(+"+!J :n
    +ne"e ca/+r!, an+%!(e %ed!ca%en(e Ede e<, s(!%+"an(e"eJ &o( e<acer'a +n (!c
    &ree<!s(en(, even(+a"!(a(e !n care n+ es(e necesar d!a$nos(!c+" ad!=!ona" de (+"'+rare
    !nd+s7 de +n %ed!ca%en(
    T!c+r!"e (re'+!e d!s(!nse, de ase%enea, de (+"'+rarea de %!Ocare s(ereo(!&7 s! de
    s(ereo(!&n"e d% (+"'+r7r!"e de de/vo"(are &ervas!v7 D!.eren=!erea (!c+r!"or s!%&"e
    Ede e< , c"!&!(+"J de %!Oc7r!"e co%&"e<e carac(er!s(!ce %!Oc7r!"or s(ereo(!&e es(e re"a(!v
    s!%&"7 D!s(!nc=!a d!n(re (!c+r!"e %o(or!! co%&"e<e s! %!Oc7r!"e s(ereo(!&e es(e %a!
    &+=!n ne(7 :n $enera", %!Oc7r!"e s(ereo(!&e &ar a .! %a! d!rec(!ona(e, r!(%!ce,
    a+(os(!%+"an(e 'a+ a"!n(7 (oc(re s! !n(en=!ona"e, &e cAnd (!c+r!"e a+ ca"!(a(ea de a .!
    %a! !nvo"+n(are EdeO! +n+ %drW !]! descr!+ (!c+r!"e ca avAnd o co%&onen(7 vo"+n(ar7
    J s! :n $enera" s+rv!n :n accese 'a+ $r+&+r! (e%&ora"e T!c+r!"e co%&"e<e &o( .! d!.!c!"
    de d!s(!ns de co%&+"s!! Eca % (+"'+rarea o'ses!vo4co%&+"'!v7J, e.ec(+area aces(e!
    d!s(!nc=!! es(e d!n(re roa(e cea %a! &rovoca(oare, deoarece (+"'+rarea o'ses!vo4
    co%&+"s!va es(e .recven(a Ia !rd!v!/!! c+ (!c+r! Co%&+"s+"e s+n( e.ec(+a(e ca
    r7s&+ns "a o o'ses!e Ede e_ s&7"a(+" %A!n!"or d!%!n+a &reoc+&area &en(r+ $er%en!J
    45? 74 Tulburarea
    Tourette
    ***
    sa+ con.or% +nor re$+"! care (re'+!e s7 .!e a&"!ca(e :n %od r!$!d Ede e< , neces!(a(ea
    de a a"!n!a "+cr+r!"e :n(r4o an+%!(7 ord!neJ Co%&+"sn"e s+n( de re$+"7 %a! e"a'ora(e
    decA( (!c+r!"e s! es(e .oar(e &os!'!" ca aces(ea s7 a%!n(easc7 co%&or(a%en(+"
    Snor%a"T, :n (!%& ce co%&+"s!!"e s+n( adesea, deO! n+ (o(dea+na, &receda(e de o
    a&reens!+ne sa+ ne"!n!O(e &ers!s(en(7, es(e .oar(e &os!'!" ca (!c+r!"e s7 .!e &receda(e
    de o (ens!+ne S.!/!c7 T (ran/!(or!e :n(r4o &ar(e a cor&+"+! Ede e<, :n %+Oc!! nas+"+!
    sa+ +%7r+"+! sa+ :n $A(J care es(e red+s7 de (!c CAnd !nd!v!/!! &re/!n(7 s!%&(o%e,
    a(A( de (+"'+rare o'ses!vo4co%&+"s!v7, cA( s! de (!c E:n s&ec!a" de (+"'+rare To+re((eJ,
    a%'e"e d!a$nos(!ce &o( .! @+s(!.!ca(e An+%!(e (!c+r! %o(on! sa+ voca"e Ede e<,
    "7(ra(+", eco"aa, &a"!"a"!aJ (re'+!e s7 .!e d!s(!nse de co%&or(a%en(+" de/or$an!/a(
    sa+ ca(a(o%c d!n sc!/o.ren!e.
    T!c+r!"e &o( .! d!s(!nse +ne"e de a"(e"e &e 'a/a d+ra(e! s! (!&+"+! Ede (!cJ, &rec+%
    O! a e(7=!! "a de'+( T!c+" (ran/!(or !nc"+de (!c+r! %o(or!! s!Xsa+ voca"e c+ o d+ra(7
    de ce" &+=!n I s7&(7%An! dar n+ %a! %+"( de 59 "+n! consec+(!ve T+"'+rarea
    To+re((e O! (!c+" voca" sa+ %o(or cron!c a+ .!ecare o d+ra(7 de &es(e 59 "+n!, dar
    (+"'+rarea To+re((e cere s7 e<!s(e (!c+r! %o(or!! %+"(!&"e s! ce" &+=!n +n (!c voca" :n
    c+rs+" +ne! &7r=! a aces(e! &er!oade Adesea, d!a$nos(!c+" se &oa(e sc!%'a c+
    (!%&+" :n c+rs+" !s(or!e! na(+ra"e a +n+! (!c De e<e%&"+, :n c+rs+" &r!%e"or "+n!, +n
    co&!" &oa(e .! d!a$nos(!ca( ca avAnd (!c (ran/!(or D+&7 +n an, d% ca+/a a&ar!=!e!
    a"(or (!c+r! s! a d+ra(e! %a! %ar! a aces(ora, d!a$nos(!c+" &oa(e deven! (+"'+rare
    To+re((e T!c .7r7 a"(7 s&ec!.!ca=!e ar &+(ea .! d!a$nos(!c+" !nd!ca( &en(r+ (a'"o+r!"e
    se%n!.!ca(!ve c"!n!c c+ o d+ra(7 de %a! &+=!n de I s7&(7%An!, &en(r+ (a'"o+r!"e
    c"!n!ce c+ o e(a(e "a de'+( de &es(e 5G an! s!, &en(r+ ca/+" e<(re% de rar, a" +n+!
    !nd!v!d c+ n+%a! +n s!n$+r (!c %o(or s! c+ n+%a! +n s!n$+r (!c voca"
    4+G.C4 Tul-urarea Tourette
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! To+re((e "e cons(!(+!e (!c+r!"e %o(on! %+"(!&"e
    s! +n+" sa+ %a! %+"(e (!c+r! voca"e Ecr!(er!+" AJ Aces(ea &o( a&are s!%+"(an sa+ "a
    !n(erva"e d!.er!(e de (!%& :n c+rs+" %a"ad!e! T!c+r!"e s+rv!n :n %od rec+ren( de %a!
    %+"(e or! &e /!, de4a "+n$+" +ne! &er!oade de %a! %+"( de " an :n c+rs+" aces(e!
    &er!oade, n+ e<!s(7 n!c! +n !n(erva" .7r7 (!c+r! c+ o d+ra(7 %a! %are de $ "+n!
    consec+(!ve Ecr!(er!+" BJ De'+(+" (+"'+r7% are "oc :na!n(e de e(a(ea de 5G a%
    Ecr!(er!+" CJ Aces(e (!c+r! n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne!
    s+'s(an=e Ede e<, s(!%+"an(e"orJ sa+ +ne! cond!=!! %ed!ca"e $enera"e Ede e<,
    %a"ad!e H+n(!n$(on, ence.a"!(7 &os(v!ra"7J Ecr!(er!+" DJ
    Loca"!/area ana(o%!c7, n+%7r+", .recven(a, co%&"e<!(a(ea s! sever!(a(ea (!c+r!"or
    se sc!%'7 c+ (!%&+" T!c+r!"e s!%&"e s! co%&"e<e &o( a.ec(a or!ce &ar(e a cor&+"+!,
    !nc"+s!v .a(a, ca&+", (r+nc!+" s! %e%'re"e s+&er!oare s! !n.er!oare T!c+r!"e %o(or!!
    s!%&"e s+n( con(rac=!! .7 r7 sens, ra&!de, a"e +n+!a sa+ a"e cA(orva %+Oc!, c+% ar .!
    c"!&!(+" T!c+r!"e %o(or!! co%&"e<e !%&"!c7 a(!ns+", $e%+!(+", %ers+" c+ $en+nc!!
    :ndo!=!, %ers+" :na&o! s! :nvAr(!(+" :n (!%&+" %ers+"+! T!c+r!"e voca"e !nc"+d
    d!verse c+v!n(e sa+ s+ne(e &rec+% c"!c+n:e, %+r%+re"e, +r"e(e"e, "7(r7(+r!"e,
    !ns&!rarea s! e<&!rarea .or=a(7 de aer &e nas s! (+s!(+" Co&ro"a"!a, +n (!c voca"
    co%&"e< !%&"!cAnd &ron+n=area de o'scen!(7=!, es(e &re/en(7 "a &+(!n! !nd!v!/! c+
    aceas(7 (+"'+rare E%a! &+=!n de 5LdJ s! n+ es(e cer+(7 &en(r+ d!a$nos(!c+" de
    (+"'+rare To+re((e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    EE7 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    La a&ro<!%a(!v @+%7(a(e d!n(re !nd!v!/!! c+ aceas(7 (+"'+rare, &r!%e"e s!%&(o%e
    care a&ar s+n( accese"e de +n s!n$+r .e" de (!c, ce" %a! adesea de c"!&!(. Ma! rar,
    (!c+r!"e !n!=!a"e !n(eresea/7 a"(e &7r=! a"e .e=!! sa+ cor&+"+!, c+% ar .! $r!%ase"e
    .ac!a"e, !ac(a=!a ca&+"+!, &ro(r+/!a "!%'!!, !ns&!rarea .or=a(7 de aer &e nas, s7r!(+",
    s7"(a(+", dres+" voc!!, '"oc7r! s!%!"are 'a"'!s%+"+! :n ."+en=a vor'!r!! sa+
    &ron+n=area de s+ne(e sa+ c+v!n(e. Uneor! (+"'+rarea :nce&e c+ s!%&(o%e
    %+"(!&"e, a&7rAnd (oa(e :n ace"aO! (!%&.
    *lemente si tulburri asociate
    Ce"e %a! co%+ne s!%&(o%e asoc!a(e a"e (+"'+r7r!! To+re((e s+n( o'ses!!"e O!
    co%&+"s!!"e. H!&erac(!v!(a(ea, d!s(rac(!'!"!(a(ea s! !%&+"s!v!(a(ea s+n(, de ase%enea,
    re"a(!v co%+ne.D!scon.or(+" soc!a", r+O!nea, (!%!d!(a(ea, de%ora"!/area s! (r!s(e=ea
    s+rv!n .recven(. T!c+r!"e voca"e O! %o(or!! &ers!s(en(e &o( ca+/a o $a%7 "ar$7 de
    de(res7 s! de(er!orare %er$And de "a n!c! +na &An7 "a sever7 . Co&!!! %a! %!c!, :n
    s&ec!a" &o( s7 n+ a!'7 conO(!!n=a (!c+r!"or "or, n+ s+n( de(resa=! O! n+ &re/!n(7
    de(er!orare :n n!c! o ar!e de .+nc=!onare. Un &rocen( %are de co&!!, ado"escen=! O!
    ad+"=! c+ (+"'+rarea n+ so"!c!(7 a(en=!e %ed!ca"7 &en(r+ (!c+r!"e "or. La ce"7"a"( ca&7(
    a" s&ec(r+"+!, e<!s(7 !nd!v!/! c+ (+"'+rare To+re((e care s+n( :%&ov7ra=! de (!c+r!
    voca"e s! %o(or!! !n(r+s!ve, rec+ren(e, !n(ense O! s(!$%a(!/an(e soc!a".
    F+nc=!onarea soc!a"7, Oco"ar7 sa+ &ro.es!ona"7 &oa(e .! de(er!ora(7 d!n ca+/a
    re@ec=!e! de c7(re a"=!! or! a an<!e(7=!! :n "e$7(+r7 c+ .a&(+" de a avea (!c+r! :n s!(+a=!!
    soc!a"e. S!%&(o%e"e de (!c cron!c &o( ca+/a o de(res7 cons!dera'!"7 s! &o( d+ce "a
    !/o"are soc!a"7 s! "a %od!.!c7r! de &ersona"!(a(e, :n ca/+r!"e severe de (+"'+rare
    To+re((e, (!c+r!"e &o( !n(er.era d!rec( c+ ac(!v!(7=!"e co(!d!ene Ede e<., c+ conversa=!a,
    c!(!(+" sa+ scr!s+"J. Co%&"!ca=!!"e rare a"e (+"'+r7r!! To+re((e !nc"+d v7(7%7r!"e
    cor&ora"e, c+% ar .! or'!rea da(ora(7 de/"!&!r!! re(!ne! E&r!n "ov!(+" c+ ca&+" or!
    &resarea oc!"or :n or'!(eJ, &ro'"e%e"e or(o&ed!ce E&r!n :ndo!rea $en+nc!"or,
    s%+c!rea $A(+"+! or! :n(oarcerea ca&+"+!J, &ro'"e%e"e c+(ana(e E&r!n &!Ocare sa+
    Un$erea '+/e"orJ s! sece"e"e ne+ro"o$!ce E&r!n (+"'+rare d!sca"7 re"a(a(7 "a %+"=!
    an! de %!Oc7r! .or=a(e a"e $A(+"+!J. Sever!(a(ea (!c+r!"or &oa(e .! e<acer'a(7 &r!n
    ad%!n!s(rarea de s(!%+"an(e a"e s!s(e%+"+! nervos cen(ra", c+% ar .! ce"e +(!"!/a(e :n
    (ra(a%en(+" (+"'+r7r!! !&erac(!v!(a(eXde.!c!( de a(en=!e, c+ (oa(e c7 +n!! !nd!v!/! &o(
    (o"era aces(e %ed!ca%en(e .7r7 o e<acer'are a (!c+r!"or "or sa+ &o( avea c!ar o
    red+cere a (!c+r!"or "or. T+"'+rarea o'ses!vo4co%&+"s!v7 s! (+"'+rarea !&erac(!v!4
    (a(eXde.!c!( de a(en=!e a&ar adesea conco%!(en( c+ (+"'+rarea To+re((e. Pro'"e%e"e
    de a(en=!e sa+ s!%&(o%a(o"o$!a o'ses!v7 &oa(e &receda sa+ +r%a de'+(+"+!
    (!c+r!"or. S!%&(o%e"e o'ses!vo4co%&+"s!ve o'serva(e "a !nd!v!/!! c+ (+"'+rarea
    To+re((e &o( cons(!(+! +n s+'(!& s&ec!.!c de (+"'+rare o'ses!vo4co%&+"s!v7. Aces(
    s+'(!& &are a .! carac(er!/a( &r!n(r4o e(a(e %a! %!c7 "a de'+(, &re&onderen=a "a
    '7r'a=!, .recven=a cresc+(7 a an+%!(or s!%&(o%e o'ses!vo4co%&+"s!ve Es!%&(o%e
    %a! a$res!ve O! o &reoc+&are %a! red+s7 &en(r+ con(a%!nare O! ac+%+"areJ O! +n
    r7s&+ns %a! red+s "a .ar%aco(era&!a c+ !n!'!(or! se"ec(!v! a! reca&(7r!! sero(on!ne!.
    Co%&or(a%en(+" d!sr+&(!v, !%&+"s!v!(a(ea s! !%a(+r!(a(ea soc!a"7 s+n( e"e%en(e
    &roe%!nen(e "a ace! co&!! O! ado"escen=! care a+, de ase%enea, (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e. Aces(e e"e%en(e c"!n!ce &o( !n(er.era c+
    &er.or%an=a Oco"ar7 O! re"a=!!"e !n(er&ersona"e s! d+c "a o de(er!orare %a! %are decA(
    cea ca+/a(7 de (+"'+rarea To+re((e.
    45?274 Tulburarea
    Tourette
    EE4

    *lemente speci$ice culturii ,i sexului
    T+"'+rarea To+re((e a .os( "ar$ descr!s7 :n d!verse $r+&+r! ras!a"e s! e(n!ce. DeO!
    :n cond!=!! c"!n!ce (+"'+rarea es(e d!a$nos(!ca(7 de (re! &An7 "a c!nc! or! %a! .recven(
    "a '7r'a=! decA( "a .e%e!, ra(a se<+"+! es(e &ro'a'!" %a! %!c7 de 9Q5 :n eOan(!oane"e
    co%+n!(are.
    #revalent
    Preva"en(a (+"'+r7r!! To+re((e es(e :n "e$7(+r7 c+ e(a(ea. S+n( a.ec(a=! %+"( %a!
    %+"=! co&!! EY4;L "a 5L.LLLJ decA( ad+"=!! E549 "a 5L.LLLJ.
    *voluie
    T+"'+rarea To+re((e &oa(e s+rven! c!ar "a e(a(ea de 9 an!, :ns7 de re$+"7 de'+(+"
    s7+ are "oc :n co&!"7r!e or! "a :nce&+(+" ado"escen=e! s!, &r!n de.!n!=!e, :na!n(e de
    e(a(ea de 5G an!. E(a(ea %ed!e "a de'+( &en(r+ (!c+r!"e %o(or!! es(e de R4H an!.
    T+"'+rarea d+rea/7 de re$+"7 (oa(7 v!a=a, dar &o( s+rven! &er!oade de re%!s!+ne,
    d+rAnd de "a cA(eva s7&(7%An! "a cA=!va an!. :n ce"e %a! %+"(e ca/+r!, sever!(a(ea,
    .recven=a, d!sr+&(!v!(a(ea s! var!a'!"!(a(ea s!%&(o%e"or d!%!n+a :n c+rs+"
    ado"escen=e! s! a" &er!oade! ad+"(e, :n a"(e ca/+r!, s!%&(o%e"e d!s&ar rea"%en(e :n
    :n(re$!%e, de re$+"7 "a :nce&+(+" &er!oade! ad+"(e, :n cA(eva ca/+r!, s!%&(o%e"e se
    &o( a$rava :n &er!oada ad+"(7 .
    #attern $amilial
    3+"nera'!"!(a(ea "a (+"'+rarea To+re((e s! "a (+"'+r7r!"e a.!ne es(e (rans%!s7 :n
    .a%!"!! O! &are a .! $ene(!c7. Mod+" de (rans%!s!e $ene(!c7 n+ es(e :ns7 c+nosc+(.
    S(+d!!"e &ed!$r!+r!"or s+$erea/7 c7 e<!s(7 $ene de e.ec( %a@or. DeO! +ne"e s(+d!! %a!
    vec! s+$era+ +n &a((ern de (rans%!s!e cores&+n/7(or +n+! &a((ern a+(oso%a"
    do%!nan(, a"(e s(+d!! s+$erea/7 +n %od de (rans%!s!e %a! co%&"e<.
    S3+"nera'!"!(a(eaT !%&"!c7 .a&(+" c7 co&!"+" &r!%eO(e 'a/a $ene(!c7 sa+
    cons(!(+=!ona"7 &en(r+ de/vo"(area +n+! (!c8 (!&+" e<ac( or! sever!(a(ea (+"'+r7r!! &o(
    .! d!.er!(e de "a o $enera=!e "a a"(a O! es(e %od!.!ca( de .ac(or! non$ene(!c!. :ns7, n+
    or!c!ne care %oO(eneO(e v+"nera'!"!(a(ea $ene(!c7 va &re/en(a s!%&(o%e"e +n+! (!c.
    ,a%a de .or%e :n care &oa(e .! e<&r!%a(7 v+"nera'!"!(a(ea !nc"+de (+"'+rarea
    To+re((e, (!c+" voca" sa+ %o(or cron!c s! +ne"e .or%e de (+"'+rare o'ses!vo4
    co%&+"s!v7. De ase%enea, se &are c7 !nd!v!/!! c+ (+"'+rarea To+re((e &re/!n(7 +n
    r!sc de %or'!d!(a(e %are &en(r+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e. La
    +n!! !nd!v!/! c+ (+"'+rare To+re((e n+ e<!s(7 n!c! o &ro'7 de &a((ern .a%!"!a".
    Dia!nostic di$erenial
    A se cons+"(a sec=!+nea Sd!a$nos(!c d!.eren=!a"T &en(r+ (!c+r! E&a$. 55LJ.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    EEH "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Criteriile $e $ia/no&ti# pentru 4+G.C4 Tul-urarea Tourette
    A2 At@t ticuri motorii multiple, c@t si unul sau mai multe ticuri vocale au $ost
    pre(ente la un moment dat "n cursul maladiei, de,i nu "n mod necesar
    concomitent2 &.n tic este o mi,care motorie ori o vocali(are brusc, rapid,
    recurent, nonritmic, stereotip)2
    S2 Ticurile survin de mai multe ori pe (i &de re!ul "n accese), aproape "n $iecare
    (i sau intermitent, de-a un!ul unei perioade de mai mult de E an, iar "n
    cursul acestei perioade nu a existat niciodat o perioad $r ticuri de mai
    mult de & luni consecutive2
    2 Debutul are loc "nainte de etatea de E8 ani2
    D2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, stimulante) ori unei condiii medicale !enerale &de ex2, maladia
    Luntin!ton ori ence$alita postviral)2
    4+G.CC Ti#ul Vo#al &au Motor Croni#
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (!c+"+! voca" sa+ %o(or cron!c :" cons(!(+!e &re/en=a, .!e a
    (!c+r!"or %o(or!!, )ie a (!c+r!"or voca"e, dar n+ a ambelor Ecr!(er!+" AJ. Aceas(7
    (+"'+rare d!.er7 de (+"'+rarea To+re((e :n care (re'+!e s7 e<!s(e (!c+r! %o(or!!
    %+"(!&"e s! +n+" sa+ %a! %+"(e (!c+r! voca"e. Ce"e"a"(e e"e%en(e esen=!a"e Ecr!(er!!"e
    B, C O! DJ s+n( ace"eaO! c+ ce"e &en(r+ (+"'+rarea To+re((e. D!a$nos(!c+" de (!c voca"
    sa+ %o(or cron!c n+ &oa(e .! &+s, dac7 a+ .os( sa(!s.7c+(e cr!(er!!"e s! &en(r+
    (+"'+rarea To+re((e Ecr!(er!+" EJ. Ce"e"a"(e carac(er!s(!c! a"e (!c+"+! voca" sa+ %o(or
    cron!c s+n( :n $enera" ace"eaO! c+ ce"e &en(r+ (+"'+rarea To+re((e Eve/! &a$. 555J, c+
    e<ce&=!a .a&(+"+! c7 s!%&(o%e"e O! de(er!orarea .+nc=!ona"7 s+n( de re$+"7 %a!
    red+se. Se &are c7 (!c+" voca" sa+ %o(or cron!c s! (+"'+rarea To+re((e s+n( :nr+d!(e
    $ene(!c, &en(r+ c7 e"e s+rv!n adesea :n ace"eaO! .a%!"!!.
    Dia!nostic di$erenial
    A se cons+"(a sec=!+nea de SD!a$nos(!c d!.eren=!a"T &en(r+ (!c+r! E&a$.55LJ.
    45?27E Ticul Tran(itor EEA
    Criteriile $e $ia/no&ti# pentru 4+G.CC
    Ti#ul Vo#al &au Motor Croni#
    A2 Ticuri vocale sau motorii unice sau multiple &adic, vocali(ri sau mi,cri
    motorii stereotipe, bru,te, rapide, recurente, nonritmice), dar nu ambele, au
    $ost pre(ente la un moment dat "n ncursul maladiei2
    S2 Ticurile survin de mai multe ori pe (i, aproape "n $iecare (i sau intermitent o
    perioad de mai mult de un an, iar "n cursul acestei perioade nu a existat nici
    o dat o perioad $r ticuri mai lun! de trei luni consecutive2
    2 Debutul are loc "nainte de etatea de E8 ani2
    D2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, stimulante) sau unei condiii medicale !enerale &de ex2, maladia
    Luntin!ton sau ence$alita postviral)2
    *2 Fu au $ost satis$cute niciodat criteriile pentru tulburarea TouretteD
    4+G.C* Ti#ul Tran)itor
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (!c+"+! (ran/!(or !! cons(!(+!e &re/en=a +nor (!c+r! voca"e
    s!Xsa+ %o(or!!, +n!ce sa+ %+"(!&"e Ecr!(er!+" AJ. T!c+r!"e s+rv!n de %a! %+"(e or! &e
    /!, a&roa&e :n .!ecare /!, (!%& de ce" &+=!n I s7&(7%An!, dar n+ %a! %+"( de 59 "+n!
    consec+(!ve Ecr!(er!+" BJ. Ce"e"a"(e e"e%en(e esen=!a"e Ecr!(er!!"e C s! DJ s+n( ace"eaO!
    c+ ce"e a"e (+"'+r7r!! To+re((e. T!c+" (ran/!(or n+ es(e d!a$nos(!ca(, dac7 a+ .os(
    sa(!s.7c+(e cAndva cr!(er!!"e &en(r+ (+"'+rarea To+re((e or! &en(r+ (!c+" voca" sa+
    %o(or cron!c Ea%'e"e cerAnd o d+ra(7 de ce" &+=!n " anJ Ecr!(er!+" EJ. Ce"e"a"(e
    carac(er!s(!c! a"e (+"'+r7r!! s+n( :n $enera" ace"eaO! c+ ce"e a"e (+"'+r7r!! To+re((e
    Eve/! &a$."""J, c+ e<ce&=!a .a&(+"+! c7 sever!(a(ea s!%&(o%e"or s! de(er!orarea
    .+nc=!ona"7 s+n( de re$+"7 %a! red+se.
    Speci$icani
    Evo"+=!a (!c+"+! (ran/!(or &oa(e .! !nd!ca(7 s&ec!.!cAnd e&!sod +n!c sa+ rec+ren(.
    Dia!nostic di$erenial
    A se cons+"(a sec=!+nea SD!a$nos(!c d!.eren=!a"T &en(r+ (!c+r! E&a$. 55LJ.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    **= "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    Criteriile $e $ia/no&ti# pentru 4+G.C* Ti#ul Tran)itor
    A Ticuri vocale sau1si motorii unice sau multiple &adic , vocali(ri sau mi,cri
    motorii stereotipa, bru,te, rapide, recurente, nonritmice)
    S Ticurile survin de mai multe ori pe (i, aproape "n $iecare (i, timp de cel puin
    patru sptm@ni, dar nu pentru mai mult de E7 luni consecutive
    Debutul survine "nainte de etatea de E8 ani
    D #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex, stimulante) sau unei condiii medicale !enerale &de ex, maladia
    Luntm!ton ori ence$alita postviral)
    * Fu au $ost niciodat satis$cute criteriile pentru tulburarea Tourette sau
    ticul motor sau vocal cronic
    De speci"icat dac
    Epi&o$ unic sau recurent
    4+G.C+ Ti# '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e des(!na(7 (+"'+r7r!"or carac(er!/a(e &r!n (!c+r! care n+
    sa(!s.ac cr!(er!!"e &en(r+ +n an+%!( (!c E<e%&"e"e !nc"+d (!c+r!"e d+rAnd %a! &+=!n
    de I s7&(7%An! sa+ (!c+r!"e c+ de'+( d+&7 e(a(ea de 5G a%
    Tul-ur(rile $e Eli"inare
    En#opre)i&ul
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" enco&re/!s+"+! :" cons(!(+!e e"!%!narea re&e(a(7 de .eca"e :n
    "oc+r! !nadecva(e Ede e<, :n &an(a"on! sa+ &e &sJ Ecr!(er!+" AJ Ce" %a! adesea,
    aceas(a es(e !nvo"+n(ar7, dar, oca/!ona", &oa(e .! s! !n(en=!ona(7. Even!%en(+"
    (re'+!e s7 s+rv%7 ce" &+=!n oda(7 &e "+n7, (!%& de ce" &+=!n ; "+n! Ecr!(er!+" BJ, !ar
    e(a(ea crono"o$!c7 a co&!"+"+! (re'+!e s7 .!e de ce" &+=!n I an! Esa+ &en(r+ co&!!! c+
    :n(Ar/!er! :n de/vo"(are, o e(a(e %en(a"7 de ce" &+=!n I a%J Ecr!(er!+" CJ Incon(!nen=a
    de .eca"e n+ (re'+!e s7 se da(ore/e e<c"+s!v de.ec(e"or .!/!o"o$!ce a"e +ne! s+'s(an=e
    Ede e< "a<a(!ve"orJ sa+ +ne! cond!=!! %ed!ca"e $enera"e, c+ e<ce&=!a ce"e! &r!n(r4+n
    %ecan!s% !%&"!cAnd cons(!&a(!a Ecn(en+" DJ
    CAnd e"!%!narea de .eca"e es(e %a! c+rAnd !nvo"+n(ar7 decA( !n(en=!ona"7, ea
    es(e adesea :n "e$7(+r7 c+ cons(!&a(!a, !%&ac(area s! re(en=!a c+ &rea&"!n consec+(!v
    Cons&a=!a &oa(e a&are d!n %o(!ve de ord!n &s!o"o$!c Ede e<, an<!e(a(e :n
    "e$7(+r7 c+ .a&(+" de a de.eca :n(r4+n an+%!( "oc on +n &a((ern %a! $enera" de
    co%&or(a%en( an<!os sa+ o&o/!=!on!s(J care d+c "a ev!(area de.ec7r!!
    Pred!s&o/!=!!"e
    *ncopre(isul EE?
    .!/!o"o$!ce "a cons(!&a=!e !nc"+d scre%+(+" !ne.!cace sa+ %!Oc7r!"e de de.eca=!e
    &arado<a"e, c+ con(rac=!a %a! c+rAnd decA( c+ re"a<area s.!nc(er+"+! e<(ern sa+ a
    &"anOe+"+! &e"v!n :n c+rs+" s.or=7r!! de a de.eca. Des!dra(area asoc!a(7 c+ o
    %a"ad!e .e'r!"7, !&o(!ro!d!s%+" sa+ e.ec(e"e sec+ndare a"e +n+! %ed!ca%en( &o(,
    de ase%enea, !nd+ce cons(!&a=!a. Oda(7 ce cons(!&a=!a a a&7r+(, aceas(a &oa(e .!
    co%&"!ca(7 de o .!s+r7 ana"7, de de.eca=!e d+reroas7 s! re(en=!e de .eca"e
    consec+(!v7. Cons!s(en=a sca+n+"+! &oa(e var!a. La +n!! !nd!v!/!, sca+n+" &oa(e .! de
    cons!s(en=7 nor%a"7 sa+ a&roa&e nor%a"7. La a"=! !nd!v!/!, care a+ !ncon(!nen=7 &r!n
    &rea&"!n, sec+ndar7 re(en=!e! de .eca"e, sca+n+" &oa(e .! "!c!d.
    Subtipuri
    Enco&re/!s+" se cod!.!c7 :n con.or%!(a(e c+ s+'(!&+" care carac(er!/ea/7 (a'"o+"
    c"!n!cQ
    HGH.R C+ cons(!&a(!e s! !ncon(!nen=7 &r!n &rea&"!n. E<!s(7 se%ne de
    cons(!&a(!e "a e<a%en+" so%a(!c Ead!c7 , &re/en=a +ne! %ar! %ase de .eca"e "a
    e<a%en+" a'do%!na" sa+ rec(a"J sa+ +n !s(or!c de .recven=7 a sca+ne"or de
    %a! &+=!n de (re! &e s7&(7%An7. Feca"e"e :n !ncon(!nen(a &r!n &rea &"!n s+n(
    de re$+"7 Edar n+ :n %od cons(an(J &+=!n .or%a(e, !ar &!erderea de .eca"e
    &oa(e %er$e de "a rar7, "a con(!n+7, s+rven!nd ce" %a! adesea :n c+rs+" /!"e!
    s! %a! rar :n so%n. N+%a! o %!c7 &ar(e d!n .eca"e es(e e"!%!na(7 &r!n %ers+"
    "a (oa"e(7, !ar !ncon(!nen=a se re/o"v7 d+&7 (ra(area cons(!&a=!e!.
    ;LH.H F7r7 cons(!&a(!e O! !ncon(!nen=7 &r!n &rea&"!n. N+ e<!s(7 &ro'e de
    cons(!&a(!e "a e<a%en+" so%a(!c sa+ d!n !s(or!c. Feca"e"e s+n(, d+&7 cA( se
    &are, nor%a"e ca .or%7 O! cons!s(en=7, !ar &!erderea de .eca"e es(e
    !n(er%!(en(7. Feca"e"e &o( .! de&o/!(a(e :n(r4+n "oc +Oor de re%arca(. Aces( (!&
    es(e asoc!a( de re$+"7 c+ &re/en=a (+"'+r7r!! o&o/!=!on!s%+" &rovoca(or sa+ a
    (+"'+r7r!! de cond+!(7, sa+ &oa(e .! consec!n=a %as(+r'7r!! ana"e. P!erderea
    de .eca"e .7r7 cons(!&a(!e &are a .! %a! &+=!n .recven(7 decA( &!erderea de
    .eca"e c+ cons(!&a(!e.
    *lemente si tulburri asociate
    Co&!"+" c+ enco&re/!s se s!%(e adesea r+O!na( O! &oa(e dor! s7 ev!(e s!(+a=!!"e
    care &o( d+ce "a &+nerea :n d!.!c+"(a(e Ede e<., %ers+" :n (a'7r7 or! "a Ocoa"7J.
    Sever!(a(ea de(er!or7r!! es(e :n .+nc=!e de e.ec(+" as+&ra s(!%e! de s!ne a co&!"+"+!,
    de $rad+" de os(rac!s% soc!a" d!n &ar(ea e$a"!"or, O! de !nd!$narea, &edea&sa O!
    re@ec=!a d!n &ar(ea !n.!r%!er!"or. P7(area c+ .eca"e &oa(e .! de"!'era(7 sa+
    acc!den(a"7, re/+"(And d!n :ncercarea co&!"+"+! de a se c+r7=a de .eca"e sa+ de a
    asc+nde .eca"e"e e"!%!na(e !nvo"+n(ar. CAnd !ncon(!nen=a es(e c"ar de"!'era(7, &o(
    .!, de ase%enea, &re/en(e e"e%en(e a"e (+"'+r7r!! o&o/!=!on!s%+" &rovoca(or sa+
    a"e (+"'+r7r!! de cond+!(7. M+"=! co&!! c+ enco&re/!s s! cons(!&a(!e cron!c7 s+n(
    en+re(!c! O! &o( avea asoc!a(e re."+<+" ve/!co4+re(era" O! !n.ec=!! cron!ce a"e (rac(+"+!
    +r!nar care se &o( re%!(e c+ (ra(a%en(.
    #revalent
    Se es(!%ea/7 c7 a&ro<!%a(!v " d d!n(re co&!!! :n e(a(e de Y an! a+ enco&re/!s, !ar
    (+"'+rarea es(e %a! .recven(7 "a '7r'a=! decA( "a .e%e!.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    EE8 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    *voluie
    Enco&re/!s+" n+ se d!a$nos(!cea/7 &An7 ce co&!"+" n+ a a(!ns e(a(ea crono"o$!c7
    de ce" &+=!n I an! E&en(r+ co&!!! c+ :n(Ar/!er! :n de/vo"(are, o e(a(e %en(a"7 de ce"
    &+=!n I an!J. An(rena%en(+" !nadecva( s! !nconsecven( a" %ers+"+! "a (oa"e(7 s!
    s(res+" &s!osoc!a" Ede e<., !n(rarea "a scoa"7 sa+ naO(erea +n+! .ra(eJ &o( .! .ac(or!
    &red!s&o/an=!. A+ .os( descr!se do+7 (!&+r! de evo"+=!eQ +n (!& S&r!%arT, :n care
    !nd!v!d+" n+ a s(a'!"!( n!c!oda(7 con(!nen=a de .eca"e, s! +n (!& Ssec+ndarT, :n care
    &er(+r'area se de/vo"(7 d+&7 o &er!oad7 de con(!nen=a de .eca"e s(a'!"!(7.
    Enco&re/!s+" &oa(e &ers!s(a c+ e<acer'7r! !n(er%!(en(e (!%& de an!.
    Dia!nostic di$erenial
    Un d!a$nos(!c de enco&re/!s, :n &re/en=a +ne! cond!=!! %ed!ca"e $enera"e, es(e
    @+s(!.!ca( n+%a! dac7 %ecan!s%+" !%&"!c7 cons(!&a=a. Incon(!nen=a de .eca"e :n
    "e$7(+r7 c+ a"(e cond!=!! %ed!ca"e $enera"e, Ede e<., d!areea cron!c7, s&!na '!.!da,
    s(eno/a ana"7 J n+ (re'+!e s7 @+s(!.!ce +n d!a$nos(!c DSM4I3 de enco&re/!s.
    Criteriile $e $ia/no&ti# pentru En#opre)i&
    A2 *liminarea repetat de $ecale "n locuri inadecvate &de ex2, "n pantaloni ori
    pe 0os), $ie c este involuntar sau intenional2
    S2 .n ast$el de eveniment cel puin odat pe lun, timp de cel puin 4 luni2
    2 *tatea cronol o!i c este de cel pui n H ani &sau ni vel ul de de(vol tare
    ec%ivalent)2
    D2 omportamentul nu se datorea( exclusiv e$ectelor $i(ilo!ice directe ale
    unei substane &de ex2, laxativelor) ori unei condiii medicale !enerale,
    except@nd ca(ul unui mecanism care implic constipaia2
    A se codi"ica dup cum urmea(D
    787.6Cu #on&tipa!ie &i in#ontinen!( prin preaplin
    307.6'(r( #on&tipa!ie &i in#ontinen!( prin preaplin
    4+G.= Enure)i&ul 3ne$atorat unei
    #on$i!ii "e$i#ale /enerale6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" en+re/!s+"+! :" cons(!(+!e e"!%!narea re&e(a(7 de +r!n7 :n
    (!%&+" /!"e! sa+ a" no&=!!, :n &a( sa+ :n &an(a"on! Ecr!(er!+" AJ. Ce" %a! adesea,
    aceas(a es(e !nvo"+n(ar7, dar, oca/!ona", &oa(e .! s! !n(en=!ona"7. Pen(r+ a dese%na
    &en(r+ d!a$nos(!c+" de en+re/!s, e"!%!narea de +r!n7 (re'+!e s7 s+rv!n7 de ce" &+=!n
    do+7 or! &e s7&(7%An7, (!%& de ce" &+=!n ; "+n!, or! (re'+!e s7 ca+/e/e o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", Oco"ar E&ro.es!ona"J or! :n a"(e
    do%en!! !%&or(an(e .+nc=!onare Ecr!(er!+" BJ. Ind!v!d+" (re'+!e s7 .! a(!ns o e(a(e "a
    care es(e de aO(e&(a( s7 .!e con(!nen( Ede e<., e(a(ea crono"o$!c7 a co&!"+"+! (re'+!e
    45?2I *nure(isul &nedatorat unei condiii medicale !enerale) EE6
    s7 .!e de ce" &+=!n Y an! or!, &en(r+ co&!!! c+ :n(Ar/!er! :n de/vo"(are, o e(a(e %en(a"7
    de ce" &+=!n Y an!J Ecr!(er!+" CJ. Incon(!nen=a +r!nar7 n+ se da(orea/7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., d!+re(!ce"orJ or! +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<., d!a'e(, s&!na '!.!da, e&!"e&s!eJ Ecr!(er!+" DJ.
    Subtipuri
    S!(+a=!a :n care s+rv!ne en+re/!s+" &oa(e .! no(a(7 &r!n(r4+n+" d!n +r%7(oare"e
    s+'(!&+r!Q
    E<c"+s!v noc(+rn. Aces(a es(e s+'(!&+" ce" %a! co%+n s! es(e de.!n!( ca e%!s!e
    de +r!n7 e<c"+s!v :n (!%&+" so%n+"+! noc(+rn. Even!%en(+" en+re(!c s+rv!ne
    de re$+"7 :n &r!%a (re!%e a no&=!!. Oca/!ona", e%!s!a de +r!n7 are "oc :n
    (!%&+" s(ad!+"+! de so%n c+ %!Oc7r! oc+"are ra&!de EREMJ, !ar co&!"+" :O!
    &oa(e a%!n(! +n v!s care !%&"!c7 acr+" %!c=!+n!!.
    E<c"+s!v d!+rn. Aces( s+'(!& es(e de.!n!( ca e"!%!nare de +r!n7 :n (!%&+"
    ore"or de v!$!"!(a(e. En+re/!s+" d!+rn es(e %a! .recven( "a .e%e! decA( "a
    '7r'a=! s! es(e .oar(e rar d+&7 e(a(ea de ! an!. Ind!v!/!! c+ en+re/!s d!+rn &o(
    .! :%&7r=!=! :n do+7 $r+&e.Un $r+& c+ S!ncon(!nen=7 co%&+"s!v7 Tare
    en+re/!s carac(er!/a( &r!n s!%&(o%e de !nc!(a=!e 'r+sc7 s! !ns(a'!"!(a(e a
    de(r+sor+"+! "a c!s(o%e(r!e. A"( $r+&, c+ Sevac+are a%Ana(7 T a%An7 :n %od
    conO(!en( !%&+"s!+n!"e de a +r!na &An7 re/+"(7 !ncon(!nen=a, c+ a%An7r!
    da(ora(e +neor! re.+/+"+! de a +(!"!/a (oa"e(a d!n ca+/a an<!e(7=!! soc!a"e sa+
    a +ne! &reoc+&7r! :n "e$7(+r7 c+ Ocoa"a sa+ c+ ac(!v!(a(ea de @oc. Aces( +"(!%
    $r+& are +n &rocen( %are de s!%&(o%e de co%&or(a%en( d!sr+&(!v.
    Even!%en(+" en+re(!c s+rv!ne ce" %a! .recven( "a :nce&+(+" d+&7 a%!e/!!, :n
    /!"e"e de scoa"7.
    Noc(+rn O! d!+rn. Aces( s+'(!& es(e de.!n!( ca o co%'!na=!e a ce"or do+7
    s+'(!&+r! de %a! s+s.
    *lemente si tulburri asociate
    Sever!(a(ea de(er!or7r!! asoc!a(e c+ en+re/!s+" es(e :n .+nc=!e de "!%!(area "a co&!"
    a ac(!v!(7=!"or soc!a"e Ede e<., n+ acce&(7 s7 doar%7 :n(r4+n ca%&!n$J or! de e.ec(+"
    s7+ as+&ra s(!%e! de s!ne a co&!"+"+!, $rad+" de os(rac!s% d!n &ar(ea e$a"!"or O!
    !nd!$narea, &edea&sa O! re@ec=!a d!n &ar(ea !n.!r%!er!"orJ. DeO! ce! %a! %+"=! co&!! c+
    en+re/!s n+ a+ O! o (+"'+rare %en(a"7 coe<!s(en(7, &reva"en(a s!%&(o%e"or
    co%&or(a%en(a"e coe<!s(en(e es(e %a! %are "a co&!! c+ en+re/!s decA( "a co&!! .7 r7
    en+re/!s. :n(Ar/!er!"e :n de/vo"(are, !nc"+/And vor'!rea s! "!%'a@+", :nv7 (area s!
    a&(!(+d!n!"e %o(or!!, s+n(, de ase%enea, &re/en(e "a +n n+%7r de co&!! c+ en+re/!s.
    Ma! &o( .! &re/en(e enco&re/!s+", so%na%'+"!s%+" O! (eroarea de so%n. In.ec=!!"e
    (rac(+"+! +r!nar s+n( %a! .recven(e "a co&!!! c+ en+re/!s, %a! a"es "a ce! c+ (!&+"
    d!+rn, decA( "a ce! care s+n( con(!nen=!. De re$+"7, en+re/!s+" &ers!s(7 d+&7
    (ra(a%en(+" adecva( a" +ne! !n.ec=!! asoc!a(e. A+ .os( s+$era=! +n n+%7r de .ac(or!
    &red!s&o/an=!, !nc"+/And an(rena%en(+" :n(Ar/!a( sa+ "a< a" %ers+"+! "a (oa"e(7,
    s(res+" &s!osoc!a", :n(Ar/!er!"e :n de/vo"(area r!(%+r!"or c!rcad!ene nor%a"e de
    &rod+cere a +r!n!! d+cAnd "a &o"!+r!e noc(+rn7 sa+ ano%a"!! a"e sens!'!"!(7 =!!
    rece&(or!"or cen(ra"! a! vaso&res!ne! O! ca&ac!(7=!"e .+nc=!ona"e red+se a"e ve/!c!!
    +r!nare c+ !&erreac(!v!(a(e ve/!ca"7 Es!ndro%+" de ve/!c7 !ns(a'!"7 J.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E75 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    #revalent
    Preva"en(a en+re/!s+"+! es(e :n @+r de Y45Ld &r!n(re co&!! de Y an!, de ;4Yd &r!n(re
    co&!! de 5L an!, s! :n @+r de 5d &r!n(re !nd!v!/!! :n e(a(e de 5Y an! sa+ %a! %ar!.
    *voluie
    A+ .os( descr!se do+7 (!&+r! de evo"+=!e &en(r+ en+re/!sQ +n (!& S&r!%arT, :n
    care !nd!v!d+" n+ a av+( n!c!oda(7 s(a'!"!(7 con(!nen=a +r!nar7 s! +n (!& Ssec+ndarT,
    :n care &er(+r'area se de/vo"(7 d+&7 o &er!oad7 de con(!nen=a +r!nar7 s(a'!"!(7.
    Pr!n de.!n!=!e, en+re/!s+" &r!%ar :nce&e "a e(a(ea Y an!. Cea %a! co%+n7 &er!oad7
    &en(r+ de'+(+" en+re/!s+"+! sec+ndar es(e cea d!n(re e(7=!"e de Y s! G an!, dar aces(a
    &oa(e s+rven! or!cAnd. D+&7 e(a(ea de Y an!, &rocen(+" de re%!s!+ne s&on(an7 es(e
    c+&r!ns :n(re Yd s! 5Ld &e an. Ce! %a! %+"=! co&!! c+ (+"'+rarea dev!n con(!nen=!
    "a ado"escen=7, dar :n a&ro<!%a(!v 5d d!n ca/+r! (+"'+rarea se con(!n+7 :n
    &er!oada ad+"(7.
    #attern $amilial
    A&ro<!%a(!v HYd d!n(re (o=! co&!!! c+ en+re/!s a+ o r+d7 '!o"o$!c7 de $rad+" I
    care a av+( aceas(7 (+"'+rare. R!sc+" de %or'!d!(a(e &en(r+ en+re/!s es(e de c!nc!
    &An7 "a Oa&(e or! %a! %are "a descenden=!! +n+! &7r!n(e care a av+( +n !s(or!c de
    en+re/!s. Concordan=a &en(r+ (+"'+rare es(e %a! %are "a $e%en!! %ono/!$o=! decA(
    "a ce! d!/!$o=!. C+ (oa(e c7 ana"!/e"e de $ene(!c7 %o"ec+"ar7 a+ de(ec(a( asoc!er! c+
    d!verO! cro%o/o%!, n+ a+ .os( !den(!.!ca(e n!c! +n .e" de asoc!er! :n(re "!n)a@+" "a
    !n(erva"+" +n+! cro%o/o% O! (!&+" de en+re/!s.
    Dia!nostic di$erenial
    D!a$nos(!c+" de en+re/!s n+ se &+ne :n &re/en=a +ne! ve/!c! ne+ro$en!ce or! :n
    &re/en=a +ne! cond!=!! %ed!ca"e $enera"e care ca+/ea/7 &o"!+r!e sa+ neces!(ea
    !%&er!oas7 de a +r!na Ede e<., d!a'e(+" /aara( sa+ d!a'e(+" !ns!&!d ne(ra(a(J or! :n
    c+rs+" +ne! !n.ec=!! ac+(e a (rac(+"+! +r!nar. C+ (oa(e aces(ea :ns7, +n d!a$nos(!c de
    en+re/!s es(e co%&a(!'!" c+ aces(e cond!=!!, dac7 !ncon(!nen=a de +r!n7 a .os(
    &re/en(7 :n %od re$+"a( :na!n(ea de/vo"(7r!! cond!=!e! %ed!ca"e $enera"e sa+ dac7
    en+re/!s+" &ers!s(7 d+&7 !ns(!(+!rea (ra(a%en(+"+! adecva(.
    Alte Tulburri ale #erioadei de Su!ar, opilriei sau
    Adolescenei
    595

    Criteriile $e $ia/no&ti# pentru 4+G.= Enure)i&
    A2 *misiune repetat de urin "n pat sau "n pantaloni &$ie involuntar, $ie
    intenionat)2 ,
    S2 omportamentul este semni$icativ clinic, mani$est@ndu-se printr-o $recven
    de dou ori pe sptm@na, timp de cel puin 4 luni consecutive, ori prin
    pre(ena unei detrese sau deteriorri semni$icative clinic "n domeniul social,
    ,colar &pro$esional) ori "n alte domenii importante de $uncionare2
    2 *tatea cronolo!ic este de cel puin A ani &sau nivelul de de(voltare
    ec%ivalent)2
    D2 omportamentul nu se datorea( exclusiv e$ectului $i(iolo!ic direct al unei
    substane, &de ex2, un diuretic) ori unei condiii medicale !enerale &de ex2,
    diabet, spina bi$ida, epilepsie)2
    De speci"icat tipulD
    E,#lu&iv no#turn
    E,#lu&iv $iurn
    No#turn &i $iurn
    Alte Tul-ur(ri ale Perioa$ei $e Su/ar2 Copil(riei
    &au A$ole&#en!ei
    4+5.C* An,ietatea $e Separare
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" an<!e(7=!! de se&arare :" cons(!(+!e an<!e(a(ea e<ces!v7 :n
    "e$7(+r7 c+ se&ararea de cas7 sa+ de ce! de care &ersoana es(e a(aOa(7 Ecr!(er!+" BJ.
    Aceas(7 an<!e(a(e de&7OeO(e ceea ce es(e e<&ec(a( de "a n!ve"+" de de/vo"(are a"
    !nd!v!d+"+!. Per(+r'area (re'+!e s7 d+re/e o &er!oad7 de ce" &+=!n I s7&(7%An!
    Ecr!(er!+" BJ, s7 :ncea&7 :na!n(e de e(a(ea de 5G an! Ecr!(er!+" CJ s! s7 ca+/e/e o
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", Oco"ar E&ro.es!ona"J
    or! :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" DJ. D!a$nos(!c+" n+ es(e &+s
    dac7 an<!e(a(ea s+rv!ne e<c"+s!v :n c+rs+" +ne! (+"'+r7r! de de/vo"(are &ervas!v7,
    a" sc!/o.ren!e! sa+ a" a"(or (+"'+r7r! &s!o(!ce, or!, "a ado"escen=! sa+ "a ad+"=!, dac7
    an<!e(a(ea de se&arare es(e e<&"!ca(7 %a! '!ne de &an!ca c+ a$ora.o'!e Ecr!(er!+" EJ.
    Ind!v!/!! c+ aceas(7 (+"'+rare &o( e<&er!en=a o de(res7 e<ces!v7 rec+ren(7 "a
    se&ararea de cas7 sa+ de &ersoana"e de a(aOa%en( %a@or Ecr!(er!+" A"J. CAnd s+n(
    se&ara=! de &ersoane"e de care s+n( a(aOa=!, e! vor adesea s7 O(!e +nde s4a+ d+s
    aces(ea s! vor s7 se a."e :n con(ac( c+ e"e Ede e<., &r!n (e"e.onJ. Un!! !nd!v!/! dev!n
    e<(re% de nos(a"$!c! O! de neconso"a=!, %er$And &An7 "a &+nc(+" de a .! ne.er!c!=!,
    cAnd s+n( de&ar(e de cas7. E! &o( dor! !n(ens s7 se :n(oarc7 acas7 s! &o( .! &reoc+&a=!
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E77 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    c+ .an(e/!! de re+n!re. CAnd s+n( se&ara=! de &ersoane"e de a(aOa%en( %a@or, aceO(!
    !nd!v!/! s+n( adesea &reoc+&a=! de (ea%a c7 &ersoane"or de care s+n( a(aOa=! sa+ "or
    :nO!O! "! se vor :n(A%&"a acc!den(e s! %a"ad!! Ecr!(er!+" A9J. Co&!!! c+ aceas(7
    (+"'+rare :O! e<&r!%7 adesea .r!ca de a n+ .! &!erd+=! O! de a n+ se %a! re+n!
    n!c!oda(7 c+ &7r!n=!! "or Ecr!(er!+" A;J. E! s+n( adesea !nco%oda=! cAnd c7"7(oresc
    s!n$+r! de&ar(e de cas7 sa+ de a"(e "oc+r! .a%!"!are O! &o( ev!(a s7 %ear$7 :n aces(e
    "oc+r! d!n &ro&r!e !n!=!a(!v7. De ase%enea, &o( .! re.rac(ar! sa+ &o( re.+/a s7 %ear$7
    "a scoa"7 sa+ :n(r4+n ca%&!n$, s7 v!/!(e/e sa+ s7 doar%7 :n casa a%!c!"or "or or! s7
    .ac7 co%!s!oane Ecr!(er!+" AIJ. AceO(! co&!! &o( .! !nca&a'!"! s7 s(ea sa+ s7 %ear$7
    s!n$+r! &r!n ca%er7 O! &o( &re/en(a +n co%&or(a%en( Sade/!vT, s(And s(rAns "!&!=!
    de &7r!n=! O! +r%7r!nd+4! ca o S+%'r7T :n @+r+" case! sa+ cerAnd c+!va s7 s(ea "An$7
    e! cAnd %er$ :n a"(7 ca%er7 d!n cas7 Ecr!(er!+" AYJ.
    Co&!!! c+ aceas(7 (+"'+rare a+ adesea d!.!c+"(7=! :n %ers+" "a c+"care O! &o( !ns!s(a
    ca s7 s(ea c!neva "An$7 e! &An7 ador% Ecr!(er!+" ARJ. :n c+rs+" no&=!!, :O! &o( .ace
    dr+% "a &a(+" &7r!n=!"or Eor! a" a"(e! &ersoane !%&or(an(e, c+% ar .! +n .ra(eJ8 dac7
    !n(rarea :n ca%era &7r!n=!"or es(e 'ara(7, e! &o( dor%! "An$7 +Oa ca%ere! aces(ora.
    Po( e<!s(a coO%ar+r! a" c7ror con=!n+( e<&r!%7 .r!c!"e !nd!v!d+"+! Ede e<.,
    d!s(r+$erea .a%!"!e! &r!n .oc, cr!%7 sa+ a"(7 ca(as(ro.7J Ecr!(er!+" AHJ. CAnd
    se&ararea s+rv!ne or! es(e n+%a! an(!c!&a(7, s+n( co%+ne d!verse ac+/e so%a(!ce,
    &rec+% d+rer!"e de s(o%ac, d+rer!"e de ca&, $re=+r!"e s! v7rs7(+r!"e Ecr!(er!+" AGJ.
    S!%&(o%e"e card!ovasc+"are, c+% ar .! &a"&!(a=!!"e, a%e=ea"a s! sen/a=!a de "eO!n,
    s+n( rare "a co&!!! %a! %!c!, dar &o( a&are "a !nd!v!/!! %a! :n e(a(e.
    Speci$icant
    De'+( &recoce. Aces( s&ec!.!can( &oa(e .! +(!"!/a( &en(r+ a !nd!ca de'+(+"
    (+"'+r7r!! :na!n(e de e(a(ea de R an!.
    *lemente ,i tulburri mentale asociate
    Co&!!! c+ an<!e(a(e de se&arare (!nd a &roven! d!n .a%!"!! s(rAns +n!(e. CAnd
    s+n( se&ara=! de cas7 sa+ de &ersoane"e de a(aOa%en( %a@or, e! &o( &re/en(a :n %od
    rec+ren( !/o"are soc!a"7, a&a(!e, (r!s(e=e or! d!.!c+"(a(e :n concen(rare :n ac(!v!(a(e
    sa+ :n @oc. :n .+nc=!e de e(a(ea "or, !nd!v!/!! &o( avea .r!c! de an!%a"e, de %onO(r!,
    de :n(+ner!c, de 'and!=!, de o=!, de r7&!(or!! de co&!!, de acc!den(e de c!rc+"a=!e, de
    c7"7(or!! c+ av!on+" or! de a"(e s!(+a=!! care s+n( &erce&+(e ca &re/en(And +n &er!co"
    &en(r+ !n(e$r!(a(ea .a%!"!e! sa+ a "or :nO!O!. S+n( co%+ne &reoc+&7r!"e :n "e$7(+r7
    c+ %oar(ea O! c+ .a&(+" de a %+r!. Re.+/+" de a %er$e "a scoa"7 &oa(e d+ce "a
    d!.!c+"(7=! Oco"are O! "a ev!(are soc!a"7. Co&!!! se &o( &"An$e de .a&(+" c7 n!%en! n+4!
    !+'eO(e O! n+ are $r!@7 de e!, s! c7 doresc s7 .!e %or=!. CAnd s+n( e<(re% de
    (+"'+ra=! de even(+a"!(a(ea se&ar7r!!, &o( deven! co"eroO! sa+, oca/!ona", "ovesc c+
    &+%n!! &e ce" care .or=ea/7 se&ararea. CAnd s+n( s!n$+r!, :n s&ec!a" seara, co&!!!
    %!c! re"a(ea/7 e<&er!en=e &erce&(!ve !nso"!(e Ede e<., v7d oa%en! a&7rAnd :n
    ca%era "or, crea(+r! or!'!"e re&e/!nd+4se "a e!, s!%( oc! care4! &r!vescJ. Co&!!! c+
    aceas(7 (+"'+rare s+n( descr!O! adesea ca &re(en=!oO!, !n(r+s!v! O! neces!(And
    &er%anen( a(en=!e. Cerer!"e e<ces!ve a"e co&!"+"+! dev!n adesea o s+rs7 de .r+s(rare
    &aren(a"7, d+cAnd "a resen(!%en(e s! con."!c(e :n .a%!"!e. Uneor! co&!!! c+ aceas(7
    (+"'+rare s+n( descr!O! ca .!!nd e<(re% de conO(!!nc!oO!, co%&"!an=!, dorn!c! s7
    &"ac7. Co&!!! &o( avea d!verse ac+/e so%a(!ce care d+c "a e<a%!n7r!Xso%a(!ce O!
    &roced+r! %ed!ca"e. D!s&o/!=!a de&res!v7 es(e .recven( &re/en(7 s! &oa(e deven!
    Tulburrile dia!nosticate de re!ul pentru prima dat
    "n #erioada de Su!ar, "n opilrie sau "n Adolescen E74
    &ers!s(en(7 c+ (!%&+", @+s(!.!cAnd +n d!a$nos(!c ad!=!ona" de (+"'+rare d!s(!%!c7
    sa+ de (+"'+rare de&res!v7 %a@or7. T+"'+rarea &oa(e &recede a&ar!=!a &an!c!! c+
    a$ora.o'!e. Co%or'!d!(a(ea c+ a"(e (+"'+r7r! an<!oase s+n( .recven(e, :n s&ec!a" :n
    cond!=!! c"!n!ce.
    *lemente speci$ice culturii, etii ,i sexului
    E<!s(7 var!a=!! c+"(+ra"e re.er!(oare "a $rad+" "a care es(e cons!dera(7 de/!4
    ra'!"7 (o"erarea se&ar7r!!. Es(e !%&or(an( de d!.eren=!a( an<!e(a(ea de se&arare de
    :na"(a va"oare &e care +ne"e c+"(+r! o &+n &e !n(erde&enden=a &+(ern!c7 d!n(re
    %e%'r!! .a%!"!e!.
    Man!.es(7r!"e (+"'+r7r!! &o( var!a c+ e(a(ea. Co&!!! %a! %!c! &o( s7 n+4s! e<&r!%e
    .r!c!"e s&ec!.!ce .a=7 de a%en!n=7r! &rec!se "a adresa &7r!n=!"or, a case! sa+ a "or :nO!O!.
    Pe %7s+r7 ce co&!"+" creO(e, (e%er!"e sa+ .r!c!"e s+n( adesea de an+%!(e &er!co"e Ede
    e<., r7&!re, a(ac 'and!(escJ. An<!e(a(ea s! an(!c!&area se&ar7r!! dev!n %an!.es(e :n
    &er!oada %ed!e a co&!"7r!e!. DeO! ado"escen=!! c+ aceas(7 (+"'+rare, :n s&ec!a"
    '7r'a=!!, &o( ne$a an<!e(a(ea :n "e$7(+r7 c+ se&ararea, aceas(a se &oa(e re."ec(a :n
    ac(!v!(a(ea "or !nde&enden(7 "!%!(a(7 s! :n re.+/+" de a &"eca de acas7. La !nd!v!/!!
    %a! :n e(a(e, (+"'+rarea &oa(e "!%!(a ca&ac!(a(ea &ersoane! de a re/o"va sc!%'7r!"e
    :n c!rc+%s(an=e"e sa"e de v!a=7 Ede e<., %+(are, c7s7(or!eJ. Ad+"=!! c+ aceas(7
    (+"'+rare s+n( de re$+"7 e<ces!v de concen(ra=! as+&ra co&!!"or s! so=+"+! Eso=!e!J O!
    e<&er!en(ea/7 +n d!scon.or( cons!dera'!" cAnd s+n( se&ara=! de e!. :n eOan(!oane"e
    c"!n!ce, (+"'+rarea es(e, d+&7 cA( se &are, "a .e" de .recven(7 "a '7r'a=! s! "a .e%e!, :n
    eOan(!oane"e e&!de%!o"o$!ce, (+"'+rarea es(e %a! .recven(7 "a .e%e!.
    #revalent
    An<!e(a(ea de se&arare n+ es(e rar78 &reva"en(a es(e es(!%a(7 :n %ed!e "a
    a&ro<!%a(!v Id "a co&!!! O! ado"escen=!! (!ner!. Preva"en(a an<!e(7=!! de se&arare
    d!%!n+a d!n co&!"7r!e s&re ado"escen=7 .
    *voluie
    An<!e(a(ea de se&arare &oa(e a&are d+&7 +ne"e even!%en(e s(resan(e Ede e<.,
    %oar(ea +ne! r+de sa+ a +n+! an!%a" .avor!(, %a"ad!a +n+! co&!" sa+ a +ne! r+de,
    sc!%'area sco"!!, %+(area :n(r4+n car(!er no+ sa+ !%!$rareaJ. De'+(+" &oa(e avea
    "oc :nc7 d!n &er!oada &reOco"ar7, dar &oa(e s+rven! or!cAnd :na!n(e de e(a(ea de 5G
    an!, :ns7 de'+(+" d+&7 ado"escen=7 es(e rar. De re$+"7, e<!s(7 &er!oade de
    e<acer'are s! de re%!s!+ne. :n +ne"e ca/+r!, a(A( an<!e(a(ea :n "e$7(+r7 c+ o &os!'!"7
    se&arare, cA( O! ev!(area s!(+a=!!"or !%&"!cAnd se&ararea Ede e<., a %er$e %a!
    de&ar(e "a co"e$!+J &o( &ers!s(a (!%& de %a! %+"=! an!. Ma@or!(a(ea co&!!"or c+
    an<!e(a(e de se&arare :ns7 n+ &re/!n(7 (+"'+r7r! an<!oase de(er!oran(e "a s(+d!!"e
    ca(a%nes(!ce e<(!nse.
    #attern $amilial
    An<!e(a(ea de se&arare es(e %a! .recven(7 "a r+de"e '!o"o$!ce de $rad+" I
    decA( :n &o&+"a=!a $enera"7 O! es(e re"a(!v %a! .recven(7 "a co&!!! %a%e"or c+
    a(ac+r! de &an!c7.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    *C7 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Dia!nostic di$erenial
    An<!e(a(ea de se&arare &oa(e .! +n e"e%en( asoc!a( a" tulburrii de dezvoltare
    pervasiv2 al sc-izofreniei sa+ a" altor tulburri psi-otice. Dac7 s!%&(o%e"e
    an<!e(7=!! de se&arare a&ar e<c"+s!v :n c+rs+" +ne!a d!n(re aces(e (+"'+r7r!, +n
    d!a$nos(!c se&ara( de an<!e(a(e de se&arare n+ es(e &+s. An<!e(a(ea de se&arare se
    d!s(!n$e de anxietatea .eneralizat &r!n aceea c7 an<!e(a(ea !n(eresea/7 :n %od
    &redo%!nan( se&ararea de cas7 s! de &ersoane"e de care es(e a(aOa(. La co&!!! sa+
    ado"escen=!! c+ an<!e(a(e de se&arare, a%en!n=area c+ se&ararea &oa(e d+ce "a
    an<!e(a(e e<(re%7 s! c!ar "a +n a(ac de &an!c7. Con(rar &an!c!!, an<!e(a(ea
    !n(eresea/7 se&ararea de &ersoane"e de a(aOa%en( or! de cas7 %a! c+rAnd decA( de
    a .! !nca&ac!(7=!! de +n a(ac de &an!c7 neaO(e&(a(. La ad+"=!, an<!e(a(ea de se&arare
    es(e rar7 s! n+ (re'+!e &+s7 ca d!a$nos(!c ad!=!ona", dac7 .r!c!"e de se&arare s+n(
    e<&"!ca(e %a! '!ne de a$ora.o'!a d!n panica cu a.orafobie or! de a.orafobia fr
    istoric de panic. C!+"+" es(e .recven( :n tulburarea de conduit2 dar an<!e(a(ea :n
    "e$7(+r7 c+ se&ararea n+ es(e res&onsa'!"7 de a'sen=e"e de "a scoa"7, !ar co&!"+" %a!
    c+rAnd &"eac7 de acas7 decA( se :n(oarce acas7. Une"e ca/+r! de re.+/ Oco"ar, %a!
    a"es :n ado"escen=7, se da(orea/7 %a! c+rAnd fobiei sociale sau tulburrilor
    afective decA( an<!e(7=!! de se&arare. Co&!! c+ an<!e(a(e de se&arare &o( .!
    o&o/!=!on!s(! :n s!(+a=!!"e :n care s+n( .or=a=! s7 se se&are de &ersoane"e de
    a(aOa%en(. ;pozitionismul provocator (re'+!e s7 .!e d!a$nos(!ca( n+%a! dac7
    e<!s(7 co%&or(a%en( o&o/!=!on!s( a"(eor! decA( a(+nc! cAnd e<!s(7 an<!e(a(e de
    se&arare sa+ cAnd se&ararea es(e an(!c!&a(7 . La .e", co&!! c+ an<!e(a(e de se&arare
    &o( deven! de&res!v! :n (!%& ce s+n( se&ara=! sa+ an(!c!&ea/7 se&ararea. O (+"'+rare
    de&res!v7 (re'+!e d!a$nos(!ca(7 n+%a! dac7 de&res!a s+rv!ne a"(eor! decA(
    an<!e(a(ea de se&arare.
    Con(rar a"+c!na=!!"or d!n tulburrile psi-otice2 e<&er!en=e"e &erce&(!ve
    !nso"!(e d!n an<!e(a(ea de se&arare se 'a/ea/7 de re$+"7 &e &erce&erea erona(7 a
    +n+! s(!%+" rea" s! a&ar n+%a! :n an+%!(e s!(+a=!! Ede e<., :n c+rs+" no&=!!J, O!
    d!s&ar :n &re/en=a +ne! &ersoane de care !ns+" es(e a(aOa(. Tre'+!e +(!"!/a(7
    @+deca(a c"!n!c7 :n d!s(!n$erea nivelelor de anxietate de separare corespunztoare
    dezvoltrii2 de &reoc+&7r!"e se%n!.!ca(!ve c"!n!c re.er!(oare "a se&arare, o'serva(e
    :n an<!e(a(ea de se&arare.
    4E4274 Mutismul Selectiv (anterior, Mutismul
    *lectiv)
    *C<
    Criteriile $e $ia/no&ti# pentru
    4+5.C* An,ietatea $e Separare
    A2 Anxietate excesiv si inadecvat evolutiv re$eritoare la separarea de cas sau
    de cei de care individul este ata,at, evideniat prin trei &sau mai multe) din
    urmtoareleD
    &E)detres excesiv recurent c@nd survine sau este anticipat separarea de
    cas sau de persoanele de ata,ament ma0or3
    (2) team excesiv si persistent "n le!tur cu pierderea sau
    posibila
    vtmare care s-ar putea "nt@mpla persoanelor de ata,ament ma0or3
    (3) teama excesiv ,i persistent c un eveniment ne$ericit va duce la
    separarea
    de o persoan de ata,ament ma0or &de ex2, a $i pierdut ori a $i rpit)3
    (4) opo(iie sau re$u( persistent de a mer!e la ,coal sau "n alt parte
    din
    cau(a $ricii de separare3
    (5) team sau opo(iie excesiv ,i persistent la a rm@ne acas, sin!ur sau
    $r
    persoanele de ata,ament ma0or, ori "n alte situaii, $r aduli importani3
    (6) opo(iie sau re$u( persistent de a mer!e la culcare, $r s $ie alturi
    o
    persoan de ata,ament ma0or ori de a adormi departe de cas3
    (2) co,maruri repetate implic@nd tema separrii3
    (7) acu(area repetat de simptome somatice &cum ar $i de durerile de
    cap,
    durerile de stomac, !reaa sau voma) c@nd survine sau este anticipat
    separarea de persoanele de ata,ament ma0or2
    S2 Durata perturbrii este de cel puin H sptm@ni2
    2 Debutul are loc "nainte de etatea de E8 ani2
    D2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    $uncionarea social, ,colar &pro$esional) sau "n alte domenii de
    $uncionare importante2
    *2 #erturbarea nu survine exclusiv "n cursul unei tulburri de de(voltare
    pervasiv, al sc%i(o$reniei ori al altei tulburri psi%otice ,i, la adolesceni ,i
    la aduli, nu este 0usti$icat mai bine de panica cu a!ora$obie2
    De speci"icat dacD
    De-ut pre#o#eM dac debutul survine "nainte de etatea de I ani2
    4*4.C4 Muti&"ul Sele#tiv
    (anterior, Muti&"ul Ele#tiv6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" %+(!s%+"+! se"ec(!v :" cons(!(+!e !nca&ac!(a(ea &ers!s(en(7
    de a vor'! :n an+%!(e s!(+a=!! soc!a"e, Ede e<., "a scoa"7, c+ &ar(ener!! de @ocJ, +nde
    es(e de aO(e&(a( s7 vor'easc7, :n d!s&re=+" .a&(+"+! c7 vor'eO(e :n a"(e s!(+a=!!
    Ecr!(er!+" A.J. Per(+r'area !n(er.erea/7 c+ &er.or%an=a ed+ca=!ona"7 sa+
    &ro.es!ona"7 or! c+ co%+n!carea soc!a"7 Ecr!(er!+" BJ. Per(+r'area (re'+!e s7 d+re/e
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E7I "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    ce" &+=!n " "+n7, s! n+ es(e "!%!(a(7 "a &r!%a "+n7 de scoa"7 E:n c+rs+" c7re!a %+"=!
    co&!! &o( .! (!%!/! s! re.+/7 s7 vor'easc7J Ecr!(er!+" CJ. M+(!s%+" se"ec(!v n+ (re'+!e
    d!a$nos(!ca(, dac7 !nca&ac!(a(ea !nd!v!d+"+! de a vor'! se da(orea/7 n+%a! +ne!
    "!&se de c+noO(!n=e sa+ aco%od7r!! c+ "!%'a@+" vor'!(, cer+( :n s!(+a=!a soc!a"7
    Ecr!(er!+" DJ. De ase%enea, aces(a n+ va .! d!a$nos(!ca(, dac7 &er(+r'area es(e
    e<&"!ca(7 %a! '!ne de @ena :n "e$7(+r7 c+ .a&(+" de a avea o (+"'+rare de co%+n!care
    Ede e<., 'a"'!s%J, or! dac7 &er(+r'area s+rv!ne e<c"+s!v :n c+rs+" +ne! (+"'+r7r! de
    de/vo"(are &ervas!v7, a" sc!/o.ren!e! sa+ a" a"(e! (+"'+r7r! &s!o(!ce Ecr!(er!+" EJ, :n
    "oc s7 co%+n!ce &r!n ver'a"!/area s(andard, co&!!! c+ aceas(7 (+"'+rare &o(
    co%+n!ca &r!n $es(+r!, :nc"!nAnd sa+ c"7(!nAnd ca&+", (r7$And sa+ :%&!n$And sa+,
    :n +ne"e ca/+r!, vor'!nd %onos!"a'!c, sc+r(, %ono(on or! c+ o voce sc!%'a(7.
    *lemente si tulburri asociate
    E"e%en(e"e asoc!a(e a"e %+(!s%+"+! se"ec(!v &o( !nc"+de (!%!d!(a(ea e<ces!v7,
    .r!ca de &+nere :n d!.!c+"(a(e :n soc!e(a(e, !/o"area s! re(ra$erea soc!a"7, ade/!v!(a(ea,
    (r7s7(+r!"e co%&+"s!ve, ne$a(!v!s%+", accese"e co"eroase, co%&or(a%en(+" de
    co%and7 sa+ o&o/!=!on!s(, %a! a"es acas7. Poa(e e<!s(a o de(er!orare sever7 :n
    ac(!v!(a(ea soc!a"7 sa+ Oco"ar7. Tac!narea sa+ &+nerea :n &os(+ra de =a& !s&7O!(or
    de c7(re e$a"! es(e co%+n7. DeO! co&!!! c+ aceas(7 (+"'+rare a+, :n $enera", a&(!(+d!n!
    "!n$v!s(!ce nor%a"e, oca/!ona", &oa(e .! asoc!a(7 o (+"'+rare de co%+n!care Ede e<.,
    (+"'+rarea .ono"o$!c7, (+"'+rarea "!%'a@+"+! e<&res!v or! (+"'+rarea %!<(7 de "!%'a@
    rece&(!v O! e<&res!vJ, or! o cond!=!e %ed!ca"7 $enera"7, care ca+/ea/7 ano%a"!! de
    ar(!c+"are. T+"'+r7r!"e an<!oase E:n s&ec!a" .o'!a soc!a"7J, re(ardarea %en(a"7,
    s&!(a"!/area sa+ s(resor!! &s!osoc!a"! e<(re%! &o( .! asoc!a=! c+ (+"'+rarea, :n &"+s,
    :n cond!=!! c"!n!ce, co&!!"or c+ %+(!s% se"ec(!v "! se &+ne a&roa&e (o(dea+na +n
    d!a$nos(!c ad!=!ona" de (+"'+rare an<!oas7 E:n s&ec!a" de .o'!e soc!a"7 J.
    *lemente speci$ice culturii si sexului
    Co&!!! !%!$ran=!, care s+n( ne.a%!"!ar!/a=! c+, or! !nco%oda=! de "!%'a o.!c!a"7
    d!n no+a "or =ar7, &o( re.+/a s7 vor'easc7 s(r7!n!"or :n no+" "or %ed!+. Aces(
    co%&or(a%en( n+ (re'+!e d!a$nos(!ca( ca %+(!s% se"ec(!v. M+(!s%+" se"ec(!v es(e c+
    &+=!n %a! .recven( "a .e%e! decA( "a '7r'a=!.
    #revalent
    M+(!s%+" se"ec(!v es(e d+&7 cA( se &are rar, .!!nd :n(A"n!( :n %a! &+=!n de 5d
    d!n(re !nd!v!/!! v7/+=! :n +n!(7=!"e de s7n7(a(e %en(a"7.
    *voluie
    De'+(+" %+(!s%+"+! se"ec(!v are "oc de re$+"7 :na!n(e de e(a(ea de Y an!, dar
    &er(+r'area &oa(e s7 n+ a(ra$7 a(en=!a c"!n!c7 &An7 "a !n(rarea "a scoa"7. DeO!
    &er(+r'area d+rea/7 de re$+"7 n+%a! cA(eva "+n!, ea &oa(e +neor! &ers!s(a %a! %+"(
    (!%& O! se &oa(e c!ar con(!n+a cA=!va an!. :n +ne"e ca/+r!, :n s&ec!a" :n ce"e c+ .o'!e
    soc!a"7 sever7 , s!%&(o%e"e an<!oase &o( deven! cron!ce.
    4E4286 Tulburarea +eactiv de Ata,ament a #erioadei de Su!ar
    sau a Micii opilrii E7?
    Dia!nostic di$erenial
    M+(!s%+" se"ec(!v (re'+!e s7 .!e d!s(!ns de &er(+r'7r!"e de vor'!re care s+n(
    e<&"!ca(e %a! '!ne de o (+"'+rare de co%+n!care, c+% ar .! (+"'+rarea .ono"o$!c7,
    (+"'+rarea de "!%'a@ e<&res!v, (+"'+rarea %!<(7 de "!%'a@ e<&res!v s! rece&(!v or!
    de 'a"'!s%. Con(rar %+(!s%+"+! se"ec(!v, &er(+r'area de "!%'a@ :n aces(e cond!=!!
    n+ es(e res(rAns7 "a o an+%!(7 s!(+a=!e soc!a"7. Co&!!! d!n .a%!"!!"e care a+ !%!$ra(
    :n(r4o =ar7 :n care es(e vor'!(7 o "!%'7 d.er!(7, &o( re.+/a s7 vor'easc7 no+a "!%'7
    d!n ca+/a "!&se! de c+noaO(ere a "!%'!!. Dac7 :n=e"e$erea no!! "!%'! es(e adecva(7,
    dar re.+/+" de a vor'! &ers!s(7, d!a$nos(!c+" de %+(!s% se"ec(!v &oa(e .! @+s(!.!ca(.
    Ind!v!/!! c+ o (+"'+rare de de/vo"(are &ervas!v7, sc!/o.ren!e sa+ a"(7 (+"'+rare
    &s!o(!c7 or! c+ re(ardare %en(a"7 sever7 &o( avea &ro'"e%e de co%+n!care soc!a"7
    s! &o( .! !nca&a'!"! s7 vor'easc7 :n %od cores&+n/7(or :n s!(+a=!! soc!a"e. D!n con(ra,
    %+(!s%+" se"ec(!v (re'+!e d!a$nos(!ca( n+%a! "a +n co&!" care are s(a'!"!(7
    ca&ac!(a(ea de a vor'! :n +ne"e s!(+a=!! soc!a"e Ede e<., acas7 J. An<!e(a(ea soc!a"7 s!
    ev!(area soc!a"7 d!n .o'!a soc!a"7 &o( .! asoc!a(e c+ %+(!s%+" se"ec(!v, :n as(.e" de
    ca/+r!, &o( .! &+se a%'e"e d!a$nos(!ce.
    Criteriile $e $ia/no&ti# pentru 4*4.C4 Muti&"ul Sele#tiv
    A2 Incapacitate considerabil de a vorbi "n anumite situaii sociale &"n care
    exist expectaia de a vorbi, de ex2, la scoal) "n dispreul $aptului c insul
    vorbe,te "n alte situaii2
    S2 #erturbarea inter$erea( cu per$ormanta educaional sau pro$esional ori
    cu comunicarea social2
    2 Durata perturbrii este de cel puin E lun &dar nu limitat la prima lun de
    ,coal)2
    D2 Incapaci tatea de a vorbi nu se datorea( l i psei de cunoa,tere ori de
    acomodare cu limba vorbit cerut "n situaia social2
    *2 #erturbarea nu este explicat mai bine de o tulburare de comunicare &de
    ex2, balbismul) si nu survine exclusiv "n cursul unei tulburri de de(voltare
    pervasiv, sc%i(o$reniei ori al altei tulburri psi%otice2
    4*4.>5 Tul-urarea Rea#tiv( $e AtaEa"ent a
    Perioa$ei $e Su/ar &au a Mi#ii Copil(rii
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! reac(!ve de a(aOa%en( :" cons(!(+!e re"a=!onarea
    soc!a"7 !nadecva(7 d!n &+nc( de vedere evo"+(!v O! %arca( &er(+r'a(7 :n ce"e %a!
    %+"(e con(e<(e, O! care :nce&e :na!n(e de e(a(ea de Y an! O! es(e asoc!a(7 c+ o :n$r!@!re
    ."a$ran( &a(o"o$!c7 Ecr!(er!+" AJ. E<!s(7 do+7 (!&+r! de (a'"o+r! c"!n!ce, :n (!&+"
    !n!'a(, co&!"+" es(e !nca&a'!" :n %od &ers!s(en( s7 !n!=!e/e O! s7 r7s&+nd7 "a ce"e %a!
    %+"(e !n(erac=!+n! :n(r4+n %od cores&+n/7(or evo"+(!v. Co&!"+" &re/!n(7 +n &a((ern
    de r7s&+ns+r! e<ces!v de !n!'a(e, !&erv!$!"en(e s! e<(re% de a%'!va"en=e Ede e<.,
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E78 "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    v!$!"en(a rece, re/!s(en(a "a conso"are or! +n a%es(ec de a&ro&!ere s! de ev!(areJ
    Ecr!(er!+" A"J :n (!&+" de/!n!'a(, e<!s(7 +n &a((ern de a(asa%en(e d!.+/e Co&%
    &re/!n(7 o soc!a'!"!(a(e %d!scr!%%a(!v7 sa+ o "!&s7 de se"ec(!v!(a(e :n a"e$erea
    &ersoane"or de a(aOa%en( Ecr!(er!+" A9J Per(+r'area n+ es(e e<&"!ca(7 e<c"+s!v de o
    :n(Ar/!ere :n de/vo"(are Eca :n re(ardarea %en(a"7J s! n+ sa(!s.ace cr!(er!!"e &en(r+
    (+"'+rarea de de/vo"(are &ervas!v7 Ecr!(er!+" BJ Pr!n de.!n!=!e, cond!=!a es(e asoc!a(7
    c+ o :n$r!@!re ."a$ran( &a(o"o$!c7, s! care &oa(e "+a .or%a +ne! descons!der7r!
    &ers!s(en(e a neces!(7=!"or e%o=!ona"e .+nda%en(a"e a"e co&!"+"+! &en(r+ conso"are,
    s(!%+"are s! a.ec=!+ne Ecr!(er!+" CIJ, descons!derarea &ers!s(en(7 a neces!(7=!"or
    cor&ora"e .+nda%en(a"e a"e co&!"+"+! Ecr!(er!+" C9J, or! sc!%'7r! re&e(a(e a"e
    !n.!r%!er+"+! &r!nc!&a", care &rev!n .or%area de a(asa%en(e s(a'!"e Ede e<,
    sc!%'7r! .recven(e de c7%!nJ Ecr!(er!+" C;J :n$r!@!rea &a(o"o$!c7 es(e cons!dera(7 a
    .! res&onsa'!"7 de re"a(!onarea soc!a"7 &er(+r'a(7 Ecr!(er!+" DJ
    Subtipuri
    T!&+" &redo%!nan( de &er(+r'are :n re"a(!onarea soc!a"7 &oa(e .! !nd!ca( &r!n
    s&ec!.!carea +n+!a d!n +r%7(oare"e s+'(!&+r! de (+"'+rare reac(!v7 de a(aOa%en(
    Tip in-ibat :n aces( s+'(!&, &er(+r'area &redo%!nan(7 es(e !nca&ac!(a(ea
    &ers!s(en(7 de a !n!=!a s! de a r7s&+nde "a ce"e %a! %+"(e !n(erac=!+n! soc!a"e
    :n(r4+n %od cores&+n/7(or evo"+(!v
    Tip dezin-ibat Aces( s+'(!& es(e +(!"!/a( dac7 &er(+r'area &redo%!nan(7 :n
    re"a(!onarea soc!a"7 o cons(!(+!e soc!a'!"!(a(ea !nd!scr!%%a(!v7 or! "!&sa de
    se"ec(!v!(a(e :n a"e$erea &ersoane"or de a(aOa%en(
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. An+%!(e s!(+a=!! Ede e<,
    s&!(a"!/area &re"+n$!(7 a co&!"+"+!, &en+r!a e<(re%7 sa+ "!&sa de e<&er!en=7
    &aren(a"7J &o( &red!s&+ne "a de/vo"(area :n$r!@!% &a(o"o$!ce :ns7, :n$r!@!rea
    ."a$ran( &a(o"o$!c7 n+ d+ce (o(dea+na "a de/vo"(area (+"'+r7r!! reac(!ve de
    a(aOa%en(, +n+ co&!! &o( .or%a a(asa%en(e s(a'!"e s! re"a=!! soc!a"e c!ar :n &re/en(a
    +ne! ne$"!@7r! sa+ a'+/ %arca( Ne$"!@area e<(re%7 Us! :n s&ec!a" :n$r!@!rea
    !ns(!(+=!ona"7, c+ o&or(+n!(7=! "!%!(a(e de a .or%a a(asa%en(e se"ec(!veUcres(e
    r!sc+" de a&ar!=!e a (+"'+r7r!! T+"'+rarea reac(!v7 de a(aOa%en( &oa(e .! asoc!a(7 c+
    :n(Ar/!er! :n de/vo"(are, c+ (+"'+rarea de a"!%en(are a &er!oade! de s+$ar sa+ a
    %!c!! co&!"7r!!, c+ &!ca or! c+ r+%!na(!a
    9ate de laborator asociate. Po( .! &re/en(e da(e de "a'ora(or concordan(e c+
    %a"n+(n(!a
    9atele examinrii somatice si condi3iile medicale .enerale asociate.
    E<a%!narea so%a(!c7 &oa(e doc+%en(a cond!=!! %ed!ca"e $enera"e asoc!a(e care
    s+n( asoc!a(e c+ ne$"!@area e<(re%7 Ede e<, :n(Ar/!ere :n creO(ere, &ro'e de a'+/
    .!/!c, %a"n+(n=!e, caren=e v!(a%!%ce sa+ %a"ad!! !n.ec=!oaseJ
    #revalent
    Da(e"e e&!de%!o"o$!ce s+n( red+se, dar (+"'+rarea reac(!v7 de a(aOa%en( &are a
    .! .oar(e rar7
    4E4286 Tulburarea +eactiv de Ata,ament a #erioadei de
    Su!ar sau a Micii opilrii 124
    *voluie
    De'+(+" (+"'+r7r!! reac(!ve de a(aOa%en( are "oc de re$+"7 :n &r!%!! cA=!va an! de
    v!a=7 s!, &r!n de.!n!=!e, :nce&e :na!n(e de e(a(ea de Y an!. Evo"+=!a &are a var!a :n
    .+nc=!e de .ac(or! !nd!v!d+a"! a&ar=!nAnd co&!"+"+! s! !n.!r%!er!"or, sever!(a(ea s!
    d+ra(a de&r!v7r!! &s!osoc!a"e asoc!a(e s! na(+ra !n(erven=!e!. O a%e"!orare sa+
    re%!s!+ne cons!dera'!"7 &oa(e s+rven!, dac7 es(e o.er!(7 o a%'!an=7 s+&or(!v7
    adecva(7. A"(.e", (+"'+rarea +r%ea/7 o evo"+=!e con(!n+7. Soc!a'!"!(a(ea !nd!scr!4
    %!na(!v7 &oa(e &ers!s(a c!ar d+&7 ce co&!"+" a de/vo"(a( a(asa%en(e se"ec(!ve.
    Dia!nostic di$erenial
    :n re(ardarea %en(a"7, a(asa%en(e"e adecva(e .a=7 de !n.!r%!er! se de/vo"(7 de
    re$+"7 :n concordan=7 c+ n!ve"+" de de/vo"(are $enera"7 a co&!"+"+!, !ar aces(e
    a(asa%en(e s+n( c"ar &re/en(e cAnd co&!"+" a a(!ns e(a(ea %en(a"7 de 5L "+n!. :ns7,
    +n!! s+$ar! s! co&!! %!c! c+ re(ardare %en(a"7 sever7 &o( &re/en(a &ro'"e%e s&ec!a"e
    &en(r+ !n.!r%!er! s! &o( &re/en(a s!%&(o%e carac(er!s(!ce de (+"'+rare reac(!v7 de
    a(aOa%en(. T+"'+rarea reac(!v7 de a(aOa%en( (re'+!e s7 .!e d!a$nos(!ca(7 n+%a!
    dac7 es(e c"ar c7 &ro'"e%e"e carac(er!s(!ce :n .or%area a(aOa%en(e"or se"ec(!ve n+
    s+n( o .+nc=!e a re(ard7r!!.
    T+"'+rarea reac(!v7 de a(aOa%en( (re'+!e s7 .!e d!.eren=!a(7 de (+"'+rarea
    a+(!s(7 O! de a"(e (+"'+r7r! de de/vo"(are &ervas!v7. :n (+"'+r7r!"e de de/vo"(are
    &ervas!v7, a(asa%en(e"e se"ec(!ve s+n(, .!e !nca&a'!"e s7 se de/vo"(e, or! s+n( e<(re%
    de dev!an(e, dar aceas(a s+rv!ne de re$+"7 :n cond!=!!"e +n+! %ed!+ &s!osoc!a"
    s+&or(!v re/ona'!". T+"'+rarea a+(!s(7 O! a"(e (+"'+r7r! &ervas!ve de de/vo"(are s+n(,
    de ase%enea, carac(er!/a(e &r!n &re/en=a +ne! de(er!or7r! ca"!(a(!ve :n co%+n!care
    O! &a((ern+r! de co%&or(a%en( res(r!c(!ve, re&e(!(!ve O! s(ereo(!&e. T+"'+rarea
    reac(!v7 de a(aOa%en( n+ es(e d!a$os(!ca(7, dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ o
    (+"'+rare &ervas!v7 de de/vo"(are.
    T!&+" !n!'a( de (+"'+rare reac(!v7 de a(aOa%en( (re'+!e s7 .!e d!s(!ns de .o'!a
    soc!a"7, :n .o'!a soc!a"7, !n!'!=!a soc!a"7 es(e ev!den(7 :n s!(+a=!! soc!a"e sa+ :n
    an(!c!&area :n(A"n!r!"or soc!a"e, dar n+ s+rv!ne c+ !n.!r%!er!! .a%!"!ar! :n s!(+a=!!
    .a%!"!are. Co%&or(a%en(+" dev!an( soc!a" :n (+"'+rarea de a(aOa%en( reac(!v,
    !nc"+s!v !n!'!=!a, es(e ev!den( d!nco"o de con(e<(e"e soc!a"e.
    T!&+" de/!n!'a( (re'+!e s7 .!e d!s(!ns de co%&or(a%en(+" !%&+"s!v sa+
    !&erac(!v carac(er!s(!c (+"'+r7 r!! !&eracr(!v!(a(eXde.!c!( de a(en=!e, :n con(ras( c+
    (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, co%&or(a%en(+" de/!n!'a( d!n
    (+"'+rarea reac(!v7 de a(aOa%en( es(e asoc!a( de re$+"7 c+ a .! .oar(e .a%!"!ar c+ sa+
    de a c7+(a conso"are de "a +n !n.!r%!er ad+"( non.a%!"!ar decA( c+ +n co%&or(a%en(
    !%&+"s!v :n $enera".
    T+"'+rarea reac(!v7 de a(aOa%en( (re'+!e s7 .!e d!.eren=!a(7 de (+"'+r7r!"e de
    co%&or(a%en( d!sr+&(!v, c+% ar .! (+"'+rarea de cond+!(7 s! (+"'+rarea
    o&o/!=!on!s%+" &rovoca(or. Ter%en+" de S&s!o&a( "!&s!( de a.ec=!+neT a .os(
    +(!"!/a( &en(r+ a descr!e co&!! cresc+=! :n cond!=!! de "!%!(are a o&or(+n!(7=!"or de a
    de/vo"(a a(asa%en(e se"ec(!ve Ede e<., :n !ns(!(+=!!J s! care a+ &re/en(a( +n &a((ern
    de co%&or(a%en( a$res!v O! an(!soc!a", !nca&ac!(a(ea de a s(a'!"! re"a=!! d+ra'!"e c+
    ad+"=!! s! d!verse s!%&(o%e, c+% s+n( en+re/!s+" O! s(ereo(!&!!"e. C+ (oa(e aces(ea,
    n+ a .os( s(a'!"!(7 o "e$7(+r7 d!rec(7 :n(re (+"'+rarea reac(!v7 de a(aOa%en( O!
    S&s!o&a(!a "!&s!(7 de a.ec=!+neT. T+"'+r7r!"e de a(aOa%en( d!n &r!%!! an! &o( creO(e
    r!sc+" de co%&or(a%en( an(!soc!a" :n +"(!%a &ar(e a co&!"7r!e! O! ado"escen=e!, dar
    Tulburrile dia!nosticate de re!ul pentru prima dat
    E45 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    co%&or(a%en(e"e an(!soc!a"e n+ s+n( :n %od necesar se%ne de (+"'+rare reac(!v7
    de a(aOa%en(, :n$r!@!rea ."a$ran( &a(o$en!c7 es(e +n e"e%en( de.!n!(or!+ a" (+"'+r7r!!
    reac(!ve de a(aOa%en(. O conse%nare ad!=!ona"7 a %a"(ra(7r!! co&!"+"+!, a ne$"!@7r!!
    co&!"+"+! or! a +ne! &ro'"e%e re"a=!ona"e &7r!n(e4co&!" &oa(e .! @+s(!.!ca(7. CAnd
    :n$r!@!rea ."a$ran( &a(o$en!c7 n+ d+ce "a o &er(+r'are %arca(7 :n re"a=!onarea
    soc!a"7 &oa(e .! no(a(7 %a! re&ede ne$"!@area co&!"+"+! or! o &ro'"e%7 &7r!n(e4co&!"
    decA( (+"'+rarea reac(!v7 de a(aOa%en(.
    Criteriile $e $ia/no&ti# pentru 4*4.>5 Tul-urarea Rea#tiv(
    $e AtaEa"ent a Perioa$ei $e Su/ar &au a Mi#ii Copil(rii
    A2 +elaionare social marcat perturbat si inadecvat evolutiv "n cele mai
    multe contexte, "ncep@nd "nainte de etatea de A ani, mani$estat, $ie prin
    &E), $ie prin &7)D
    (1) incapacitate persistent de a iniia sau de a rspunde "ntr-o
    manier
    adecvat evolutiv la cele mai multe interaciuni sociale, mani$estat prin
    rspunsuri excesiv de in%ibate, %ipervi!ilente ori extrem de ambivalene
    ,i contradictorii &de ex2, copilul poate rspunde in$irmierilor printr-o
    mixtur de apropiere, evitare ,i re(isten la consolare, ori poate
    mani$esta o vi!ilen rece)3
    (2) ata,amMente di$u(e mani$estate prin sociabilitate indiscriminativ
    cu
    incapacitate marcat de a mani$esta atasamente selective adecvate &de
    ex2, $amiliaritate excesiv cu rudele strine sau lips de selectivitate "n
    ale!erea persoanelor de ata,ament)2
    S2 #erturbarea de la criteriul A nu este explicat exclusiv prin "nt@r(iere "n de(
    voltare &ca "n retardarea mental) ,i nu satis$ace criteriile pentru o tulburare
    de de(voltare pervasiv2
    2 "n!ri0ire pato!enic evideniat prin cel puin unul din urmtoareleD
    (1) desconsiderare persistent a necesitilor emoionale $undamentale
    ale
    copilului pentru consolare, stimulare ,i a$eciune3
    (2) desconsiderare persistent a necesitilor corporale $undamentale
    ale
    copilului3
    (3) sc%imbri repetate ale "n!ri0itorului principal care previn $ormarea
    de
    atasamente stabile &de ex2, sc%imbarea $recvent de cmin)2
    D2 *xist pre(umia c "n!ri0irea de la criteriul este responsabil de compor
    tamentul perturbat de la criteriul A &de ex2, perturbrile de la criteriul A
    sunt consecina "n!ri0irii pato!enice de la criteriul )2
    De speci"icat tipulD
    Tip in@i-atM dac "n tabloul clinic predomin criteriul AE Tip
    $e)in@i-atM dac "n tabloul clinic predomin criteriul A7
    45?24 Tulburarea de Mi,care Stereotip
    (anterior Tulburarea Stereotipie1Labitudine) *4*
    4+G.4 Tul-urarea $e MiE#are Stereotip(
    (anterior Tul-urarea StereotipieAFa-itu$ine6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de %!Ocare s(ereo(!&7 :" cons(!(+!e
    co%&or(a%en(+" %o(or care es(e re&e(!(!v, adesea a&aren( d!rec=!ona(, s!
    non.+nc=!ona" Ecr!(er!+" AJ. Aces( co%&or(a%en( %o(or !n(erer.erea/7 cons!dera'!"
    c+ ac(!v!(7=!"e nor%a"e sa+ cond+ce "a v7(7%7r! cor&ora"e a+(o&rovoca(e care s+n(
    s+.!c!en( de se%n!.!ca(!ve &en(r+ a neces!(a (ra(a%en( %ed!ca" Eor! ar
    &+(ea d+ce "a as(.e" de v7(7%7r! dac7 n+ s+n( "+a(e %7s+r! de &ro(ec=!eJ
    Ecr!(er!+" BJ. Dac7 es(e &re/en(7 re(ardarea %en(a"7, co%&or(a%en(+" s(ereo(!& sa+
    a+(ov+"neran( es(e s+.!c!en( de sever &en(r+ a deven! =!n(a (ra(a%en(+"+! Ecr!(er!+"
    CJ. Co%&or(a%en(+" n+ es(e e<&"!ca( %a! '!ne de o co%&+"s!e Eca :n (+"'+rarea
    o'ses!vo4co%&+"s!v7J, de +n (!c Eca :n (!c+r!J, de o s(ereo(!&!e care es(e &ar(e a +ne!
    (+"'+r7r! de de/vo"(are &ervas!v7, or! de s%+"$erea &7r+"+! Eca :n (r!co(!"o%an!eJ
    Ecr!(er!+" DJ. De ase%enea, co%&or(a%en(+" n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! s+'s(an=e or! +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" EJ.
    Co%&or(a%en(e"e %o(or!! (re'+!e s7 &ers!s(e ce" &+=!n I s7&(7%An! Ecr!(er!+" FJ.
    M!Oc7r!"e s(ereo(!&e &o( !nc"+de .7c+(+" c+ %Ana, 'a"ansa(+", @+ca(+" c+ %A!n!"e,
    %!Ocarea nervoas7 a de$e(e"or, :nvAr(!(+" o'!ec(e"or, "ov!(+" c+ ca&+", %+Oc7(+r!"e
    a+(o&rovoca(e, &!scarea &!e"!! sa+ a or!.!c!!"or cor&+"+!, or! "ov!rea d!verse"or &7r=!
    a"e &ro&r!+"+! cor&. Uneor! !nd!v!d+" +(!"!/ea/7 +n o'!ec( :n e.ec(+area aces(or
    co%&or(a%en(e. Co%&or(a%en(e"e &o( ca+/a "e/!+n! (!s+"are &er%anen(e s!
    !nva"!dan(e, !ar +neor! &o( &er!c"!(a v!a=a. De e<., "ov!(+" sa+ '7(+(+" sever c+ ca&+"
    &oa(e d+ce "a (7!e(+r!, sAn$erare, !n.ec=!e, de(aOare a re(!ne! s! "a or'!re.
    Speci$icani
    C"!n!c!an+" &oa(e s&ec!.!ca Sc+ comportament autovulnerantD2 dac7
    co%&or(a%en(+" d+ce "a v7(7%are cor&ora"7 care neces!(7 +n an+%!( (ra(a%en( Esa+
    care ar .! &+(+( d+ce "a v7(7%are cor&ora"7, dac7 n+ s4ar .! "+a( %7s+r! de
    &ro(ec=!eJ.
    *lemente ,i tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Ind!v!d+" E:n s&ec!a" +n
    !nd!v!d c+ s!ndro% Lesc4NyanJ &oa(e e"a'ora %e(ode de a+(ocons(rAn$ere
    &en(r+ a :ncerca s74s! con(ro"e/e co%&or(a%en(e"e a+(ov+"neran(e Ede e<., =!ne
    %A!n!"e s+' c7%aO7, :n &an(a"on! sa+ :n '+/+nareJ. CAnd a+(ocons(rAn$erea es(e
    :%&!ed!ca(7, co%&or(a%en(e"e rev!n. Dac7 co%&or(a%en(e"e s+n( e<(re%e or!
    re&+"s!ve a"(ora, &o( e<!s(a co%&"!ca=!! &s!osoc!a"e da(ora(e e<c"+der!! !nd!v!d+"+!
    d!n ac(!v!(7=!"e soc!a"e s! a"e co%+n!(7=!!. T+"'+rarea de %!Ocare s(ereo(!&7 s+rv!ne
    ce" %a! adesea :n asoc!ere c+ re(ardarea %en(a"7. C+ cA( es(e %a! sever7 re(ardarea,
    c+ a(A( es(e %a! %are r!sc+" de co%&or(a%en(e a+(ov+"neran(e. T+"'+rarea &oa(e
    s+rven!, de ase%enea, "a !nd!v!/! .7r7 :n(Ar/!ere :n de/vo"(are Ede e<., "a !nd!v!/!! c+
    "e$7na(+" cor&+"+! asoc!a( c+ an<!e(a(ea $enera"!/a(7 J.
    Aceas(7 (+"'+rare &oa(e s+rven!, de ase%enea, :n asoc!ere c+ de.!c!(e sen/or!a"e
    severe Ecec!(a(e s! s+rd!(a(eJ O! &oa(e .! %a! .recven(7 :n %ed!!"e !ns(!(+=!ona"e :n care
    !nd!v!d+" &r!%eO(e !ns+.!c!en(7 s(!%+"are. Co%&or(a%en(e"e a+(ov+"neran(e s+rv!n
    :n an+%!(e cond!=!! %ed!ca"e $enera"e asoc!a(e c+ re(ardarea %en(a"7 Ede e<.,
    Tulburrile dia!nosticate de re!ul pentru prima dat
    *4C "n #erioada de Su!ar, "n opilrie sau "n Adolescent
    s!ndro% > .ra$!", s!ndro% Do#n, s!ndro% de Lan$e, s! :n s&ec!a" :n s!ndro%+"
    Lesc4Nyan, care es(e carac(er!/a( &r!n %+Oc7(+r! a+(o&rovoca(e severeJ
    Da(e de "a'ora(or asoc!a(e. Dac7 e<!s(7 a+(ov+"nerare, da(e"e de "a'ora(or vor
    re."ec(a na(+ra s! sever!(a(ea sa Ede e<, &oa(e .! &re/en(7 ane%!a, dac7 e<!s(7 o
    &!erdere cron!c7 de sAn$e &r%(r4o sAn$erare rec(a"7 a+(o&rovoca(7J
    Date de examinare somatic si condiii medicale !enerale asociate2 #ot $i
    &re/en(e se%ne a"e +nor "e/!+n! (!s+"are cron!ce Ede e<, con(+/!!, se%ne de
    %+Oc7(+r!, (7!e(+r!, escona(n, !n.ec=!! c+(ana(e, .!s+r! rec(a"e, cor&! s(r7!n! :n
    or!.!c!!"e cor&+"+!, de(er!orarea veder!! da(ora(7 a&7s7r!! e<erc!(a(e &e $"o'!! oc+"ar!
    sa+ ca(arac(e! (ra+%a(!ce s! .rac(+r! sa+ de.or%7r! osoaseJ :n ca/+r!"e %a! &+=!n
    severe, &oa(e e<!s(a o !n(a=!e cron!c7 a &!e"!! sa+ !nd+ra=!! &nn %+Oc7(+r!, &!Oc7(+r!,
    $ra(a@ or! %+rd7r!re c+ sa"!v7
    *lemente speci$ice etii si sexului
    Co%&or(a%en(e"e a+(ov+"neran(e s+rv!n "a !nd!v!/! de once e(a(e E<!s(7 +ne"e
    !nd!c!! c7 "ov!(+" c+ ca&+" es(e %a! .recven( "a '7r'a=! E:n &ro&or=!e de a&ro<!%a(!v
    ;5J, !ar %+Oc7(+ra a+(o&rovoca(7 es(e %a! .recven(7 "a .e%e!
    #revalent
    E<!s(7 &+=!ne !n.or%a=!! re.er!(oare "a &reva"en(a (+"'+r7r!! de %!Ocare
    s(ereo(!&7 Es(!%7r!"e &reva"en(e! co%&or(a%en(e"or a+(ov+"neran(e "a !nd!v!/!! c+
    re(ardare %en(a"7 var!a/7 de "a 9d s! ;d "a co&!!! s! ado"escen=!! (r7!nd :n
    co%+n!(a(e, "a a&ro<!%a(!v 9Yd "a ad+"=!! c+ re(ardare %en(a"7 sever7 sa+ &ro.+nd7
    (r7!nd :n !ns(!(+=!!
    *voluie
    N+ e<!s(7 o e(a(e sa+ +n &a((ern de de'+( carac(er!s(!c &en(r+ (+"'+rarea de
    %!Ocare s(ereo(!&7 De'+(+" &oa(e +r%a +n+! even!%en( s(resan( La !nd!v!/!! care
    n+ vor'esc, c+ re(ardare %en(a"7 sever7, %!Oc7r!"e s(ereo(!&e &o( .! dec"anOa(e de o
    cond!=!e %ed!ca"7 $enera"7 d+reroas7 Ede e< , o !n.ec=!e a +rec!! %ed!!, d+cAnd "a
    "ov!rea c+ ca&+"J M!Oc7r!"e s(ereo(!&e a(!n$ adesea a&o$e+" :n ado"escen(7 s! a&o!
    d!%!n+a &ro$res!v :ns7, %a! a"es "a !nd%/n c+ re(ardare %en(a"7 sever7 sa+
    &ro.+nd7, %!Oc7r!"e s(ereo(!&e &o( &ers!s(a a% de /!"e Focar+" aces(or
    co%&or(a%en(e se sc!%'7 adesea Ede e< , o &ersoan7 se &oa(e an$a@a :n %+sca(+"
    %A!n!"or care &oa(e d!%!n+a a&o!, s! s7 s+rv%7 "ov!(+" c+ ca&+"J
    Dia!nostic di$erenial
    M!Oc7r!"e s(ereo(!&e &o( .! asoc!a(e c+ re(ardarea %en(a"7, :n s&ec!a" "a !nd!v!/!!
    d!n %ed!! nons(!%+"an(e T+"'+rarea de %!Ocare s(ereo(!&7 (re'+!e s7 .!e
    d!a$nos(!ca(7, n+%a! "a !nd!v!/a "a care co%&or(a%en(+" s(ereo(!& sa+
    a+(ov+"neran( es(e s+.!c!en( de sever &en(r+ a deven! cen(r+" (ra(a%en(+"+!
    M!Oc7r!"e s(ereo(!&e re&e(!(!ve s+n( +n e"e%en( carac(er!s(!c a" (+"'+r7r!"or de
    de/vo"(are &ervas!v7 T+"'+rarea de %!Ocare s(ereo(!&7 n+ es(e d!a$nos(!ca(7, dac7
    s(ereo(!&+"e s+n( e<&"!ca(e %a! '!ne de o (+"'+rare de de/vo"(are &ervas!v7
    45?24 Tulburarea de Mi,care Stereotip
    (anterior Tulburarea
    Stereotipie1Labitudine)
    *44
    Co%&+"s!+n!"e d!n tulburarea obsesivoBcompulsiv s+n( :n $enera" %a! co%&"e<e
    s! %a! r!(+a"e, s! s+n( e.ec(+a(e ca r7s&+ns "a o o'ses!e or! con.or% +nor re$+"! care
    (re'+!e s7 .!e a&"!ca(e r!$!d. D!.eren=!erea %!Oc7r!"or co%&"e<e carac(er!s(!ce
    (+"'+r7r!! de %!Ocare s(ereo(!&7 de ticurile simple Ede e<., c"!&!(+"J es(e re"a(!v
    s!%&"7. D!a$nos(!c+" d!.eren=!a" c+ (!c+r!"e %o(or!! co%&"e<e &oa(e .! :ns7 .oar(e
    d!.!c!", da(e .!!nd s!%!"!(+d!n!"e :n(re ce"e do+7 (+"'+r7r! :n (er%en!! de
    !n(en=!ona"!(a(e, r!(%!c!(a(e s! d!rec=!onare.
    @n tricotilomanie2 &r!n de.!n!=!e, co%&or(a%en(+" re&e(!(!v es(e "!%!(a( "a
    s%+"$erea &7r+"+!. Le/!+n!"e a+(o&rovoca(e d!n (+"'+rarea de %!Ocare s(ereo(!&7
    (re'+!e s7 .!e d!s(!nse de tulburarea factice cu semne si simptome predominant
    somatice2 :n care %o(!va=!a a+(ov+"ner7r!! es(e as+%area ro"+"+! de &ac!en(.
    Automutilarea asociat cu anumite tulburri psi-otice O! tulburri de
    personalitate es(e &re%ed!(a(7, co%&"e<7 O! s&orad!c7 O! are +n sens &en(r+ !nd!v!d
    :n con(e<(+" (+"'+r7r!! %en(a"e severe s+'!acen(eEde e<., es(e re/+"(a(+" $And!r!!
    de"!ran(eJ. <i/crile involuntare asociate cu condi3ii neurolo.ice Ec+% ar .!
    %a"ad!a H+n(!n$(onJ +r%ea/7 de re$+"7 +n &a((ern (!&!c, !ar se%ne"e O! s!%&(o%e"e
    cond!=!e! ne+ro"o$!ce s+n( &re/en(e. 9is1inezia tardiv re/+"(7 de re$+"7 d!n +/+"
    cron!c de ne+ro"e&(!ce O! cons(7 d!n d!s)!ne/!! oro.ac!a"e carac(er!s(!ce sa+, %a!
    &+=!n .recven(, %!Oc7 r! nere$+"a(e a"e (r+nc!+"+! s! %e%'re"or, :n &"+s, aces(e
    (!&+r! de %!Oc7r! n+ d+c "a a+(ov7(7%are d!rec(7 .
    (omportamentele autostimulante corespunztoare evolu3iei ale copiilor mici
    Ede e<., s+$erea &o"!ce"+!, "e$7na(+" O! "ov!(+" c+ ca&+"J s+n( de re$+"7 a+(o"!%!(a(e
    O! d+c rar "a "e/!+n! (!s+"are care neces!(7 (ra(a%en(. (omportamentele
    autodirec3ionate la indivizii cu deficite senzoriale Ede e<., cec!(a(eJ s+n( s(ereo(!&e
    s! re&e(!(!ve, dar de re$+"7 n+ d+c "a d!s.+nc=!e sa+ "a a+(ov+"nerare.
    M+"=! oa%en! se an$a@ea/7 :n comportamente repetitive din diverse motive
    E:ncerc7r! de a a%e"!ora o a&(!(+d!ne %o(or!e, &rac(!c! sanc=!ona(e c+"(+ra"J. Con(rar
    (+"'+r7r!! de %!Ocare s(ereo(!&7, aces(e co%&or(a%en(e n+ !n(er.erea/7 c+
    ac(!v!(7=!"e nor%a"e s! n+ d+c "a a+(ov+"nerare.
    Tulburrile dia!nosticate de re!ul pentru prima dat
    *47 "n #erioada de Su!ar, "n opilrie sau "n Adolescen
    Criteriile $e $ia/no&ti# pentru
    4+G.4 Tul-urarea $e MiE#are Stereotip(
    A2 omportament motor repetitiv, aparent direcional ,i non$uncional &de
    ex2, str@n!erea sau $luturatul m@inilor, le!narea corpului, lovitul cu capul,
    apucarea obiectelor cu !ura, mu,cturile autoprovocate, pi,carea te!u
    mentelor sau a ori$iciilor corpului, lovirea propriului corp)2
    S2 omportamentul inter$erea( considerabil cu activitile normale ori duce
    la vtmri corporale autoprovocate care necesit tratament medical &sau
    ar duce la o vtmare, dac nu s-au luat msuri preventive)2
    2 Dac este pre(ent retardarea mental, comportamentul stereotip sau
    autovulnerant este de su$icient de sever pentru a deveni inta tratamen
    tului2
    D2 omportamentul nu este explicat mai bine de o compulsie &ca "n tulburarea
    obsesivocompulsiv), de un tic &ca "n tic), de o stereotipie, care este parte a
    unei tulburri de de(voltare pervasiv , ori de smul!erea prului &ca "n
    tricotilomanie)2
    *2 omportamentul nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    substane ori unei condiii medicale !enerale2
    '2 omportamentul persist H sptm@ni sau mai mult2
    De speci"icat dacD
    u comportament autovulnerantD dac comportamentul duce la o vtmare
    corporal care necesit un tratament speci$ic &ori care ar putea duce la o
    vtmare corporal, dac nu se iau msuri de protecie)2
    4*4.5 Tul-urare a Perioa$ei $e Su/ar2 a Copil(riei
    &au A$ole&#en!ei '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e o ca(e$or!e re/!d+a"7 &en(r+ (+"'+r7r!"e c+ de'+( :n
    &er!oada de s+$ar, :n co&!"7r!e sa+ ado"escen=7, care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c!
    o (+"'+rare s&ec!.!c7 d!n c"as!.!care.
    Deliriumul, Demena,
    Tulburrile Amnestice si
    Alte Tulburri o!nitive
    ceas(a sec=!+ne !nc"+de de"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce O!
    (+"'+r7r!"e co$n!(!ve .7r7 a"(7 s&ec!.!ca=!e. Per(+r'area &redo%!nan(7 es(e +n de.!c!(
    se%n!.!ca(!v c"!n!c :n c+noaO(ere care re&re/!n(7 o %od!.!care
    se%n!.!ca(!v7 de "a n!ve"+" an(er!or de .+nc=!onare. Pen(r+ .!ecare
    (+"'+rare d!n aceas(7 sec=!+ne, e(!o"o$!a o cons(!(+!e, .!e o cond!=!e
    %ed!ca"7 $enera"7 EdeO! cond!=!a %ed!ca"7 $enera"7 s&ec!.!c7 &oa(e s7
    n+ .!e !den(!.!ca'!"7J, .!e o s+'s(an=7 Ead!c7, +n dro$ de a'+/, +n
    %ed!ca%en( sa+ +n (o<!cJ or! o co%'!na=!e a aces(or .ac(or!.
    :n DSM4III4R, aces(e (+"'+r7r! era+ &"asa(e :n(r4o sec=!+ne !n(!(+"a(7 SS!ndro%e
    s! (+"'+r7r! %en(a"e or$an!ceT. Ter%en+" de t+lb+rare mental6 or/anic6 n+ %a! es(e
    +(!"!/a( :n DSM4I3, deoarece e" !%&"!c7 :n %od !ncorec( .a&(+" c7 (+"'+r7r!"e
    %en(a"e Snonor$an!ceT n+ a+ o 'a/7 '!o"o$!c7, :n DSM4F3, (+"'+r7r!"e den+%!(e
    an(er!or S(+"'+r7r! %en(a"e or$an!ceT a+ .os( $r+&a(e :n (re! sec=!+n!Q
    5J De"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce O! a"(e (+"'+r7r! co$n!(!ve8
    9J T+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e8 O! ;J T+"'+r7r!"e :n
    "e$7(+r7 c+ o s+'s(an=7.
    De"!r!+%+" es(e carac(er!/a( &r!n(r4o &er(+r'are a conO(!en(e! O! o %od!.!care :n
    c+noaO(ere care se de/vo"(7 :n c+rs+" +ne! sc+r(e &er!oade de (!%&. T+"'+r7r!"e
    !nc"+se :n sec=!+nea SDe"!r!+%+"T s+n( %en=!ona(e :n con.or%!(a(e c+ e(!o"o$!a
    &res+&+s7Q de"!r!+% da(ora( +ne! cond!=!! %ed!ca"e $enera"e, de"!r!+% !nd+s de o
    s+'s(an=7 Ead!c7, da(ora( +n+! dro$ de a'+/, +n+! %ed!ca%en( or! e<&+ner!! "a +n
    (o<!cJ, de"!r!+% da(ora( +nor e(!o"o$!! %+"(!&"e, or! de"!r!+% .7r7 a"(7 s&ec!.!ca=!e
    Edac7 e(!o"o$!a es(e ne&rec!/a(7J.
    De%en=a es(e carac(er!/a(7 &r!n de.!c!(e co$n!(!ve %+"(!&"e care !nc"+d
    de(er!orarea %e%or!e!. De%en=e"e s+n(, de ase%enea, %en=!ona(e :n con.or%!(a(e
    c+ e(!o"o$!a &res+&+s7Q de%en=7 de (!& A"/e!%er, de%en=7 vasc+"ar7, de%en=7
    da(ora(7 a"(or cond!=!! %ed!ca"e $enera"e Ede e<., %a"ad!a &rod+s7 de v!r+s+"
    !%+node.!c!en=e! +%ane ZHI3[, (ra+%a(!s%+" cran!an, %a"ad!a Par)!nson, %a"ad!a
    H+n(!n$(onJ, de%en=7 &ers!s(en(7 !nd+s7 de o s+'s(an=7 Ead!c7, da(ora(7 +n+! dro$
    de a'+/, +n+! %ed!ca%en( sa+ e<&+ner!! "a +n (o<!cJ, de%en=7 da(ora(7 +nor
    e(!o"o$!! %+"(!&"e or! de%en=a .7r7 a"(7 s&ec!.!ca=!e Edac7 e(!o"o$!a es(e ne&rec!/a(7J.
    T+"'+rare a%nes(!c7 es(e carac(er!/a(7 &r!n de(er!orarea %e%or!e! :n a'sen=a
    a"(or de(er!or7r! co$n!(!ve se%n!.!ca(!ve. T+"'+r7r!"e d!n sec=!+nea ST+"'+r7r!"e
    a%nes(!ceT s+n(, de ase%enea, %en=!ona(e :n con.or%!(a(e c+ e(!o"o$!a &res+&+s7Q
    (+"'+rare a%nes(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, (+"'+rare a%nes(!c7
    &ers!s(en(7 !nd+s7 de o s+'s(an=7 or! (+"'+rare a%nes(!c7 .7r7 a"(7 s&ec!.!ca=!e.
    T+"'+rarea co$n!(!v7 .7r7 a"(7 s&ec!.!ca=!e es(e re/erva(7 (a'"o+r!"or c"!n!ce care
    s+n( carac(er!/a(e &r!n(r4o d!s.+nc=!e co$n!(!v7 &res+&+s7 a .! da(ora(7, .!e +ne!
    *4<
    5;R Deliriumul, Dementa, Tulburrile Amnestice si Alte Tulburri

    cond!=!! %ed!ca"e $enera"e, .!e +/+"+! +ne! s+'s(an=e, s! care n+ sa(!s.ac cr!(er!!"e
    &en(r+ n!c! +na d!n(re (+"'+r7r!"e %en=!ona(e :n a"(7 &ar(e :n aceas(7 sec=!+ne
    A
    Es(e &rev7/+( +n (e<( !n(rod+c(!v care d!sc+(7 e"e%en(e"or $enera"e a"e .!ec7r+!
    $r+& de (+"'+r7r!, c+ e<ce&=!a e(!o"o$!c! Aces(a es(e +r%a( de (e<(+" s! cr!(er!!"e
    &en(r+ .!ecare (+"'+rare c+ e(!o"o$!c s&ec!.!c7
    Deliriu"ul
    T+"'+r7r!"e d!n sec=!+nea SDe"%+%+"T a+ :n co%+n &re/en(area de s!%&(o%e
    a"e +ne! &er(+r'7r! a conO(!en(e! s! c+noaO(e%, dar se d!.eren=!a/7 &e 'a/a e(!o"o$!e!
    de"!r!+% da(ora( +ne! cond!=!! %ed!ca"e $enera"e, de"!r!+% !nd+s de o s+'s(an=7
    E!nc"+s!v e.ec(e"e sec+ndare a"e +n+! %ed!ca%en(J s! de"!r!+% da(ora( +nor
    e(!o"o$!! %+"(!&"e Pe "An$7 aces(ea, :n aceas(7 sec=!+ne %a! es(e !nc"+s de"!r!+%+"
    .7r7 a"(7 s&ec!.!ca=!e, &en(r+ (a'"o+r!"e c"!n!ce :n care c"!n!c!an+" es(e !nca&a'!" s7
    &rec!/e/e o e(!o"o$!e s&ec!.!c7 &en(r+ de"!r!+%
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" de"!r!+%+"+! :" cons(!(+!e o &er(+r'are a conO(!en(e! care
    es(e aco%&an!a(7 de o %od!.!care :n c+noaO(ere care n+ &oa(e .! e<&"!ca(7 %a! '!ne
    de o de%en(7 &ree<!s(en(7 or! :n c+rs de de/vo"(are Per(+r'area se de/vo"(7 :n
    dec+rs+" +ne! sc+r(e &er!oade de (!%&, de re$+"7 :n cA(eva ore sa+ /!"e, s! (!nde s7
    ."+c(+e/e :n c+rs+" /!"e! D!n !s(or!c, e<a%en+" so%a(!c on (es(e"e de "a'ora(or
    re/+"(7 c7 de"!r!+%+" es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e
    $enera"e, a +ne! !n(o<!ca=!! sa+ a's(!nen(e de o s+'s(an=7, a +/+"+! +n+!
    %ed!ca%en( or! a e<&+ne% "a +n (o<!c sa+ a +ne! co%'!na=!! a aces(or .ac(or!
    Per(+r'area conO(!en(e! se %an!.es(7 &nn(r4o c"ar!(a(e red+s7 a conO(!en(e!
    a%'!an(e! Ca&ac!(a(ea de a .oca"!/a, s+s=!ne or! de&"asa a(en=!a es(e de(er!ora(7
    Ecr!(er!+" AJ :n(re'7r!"e (re'+!e re&e(a(e, deoarece a(en=!a !nd!v!d+"+! es(e era(!c7
    or! !nd!v!d+" &erseverea/7 :n r7s&+ns+" da( "a :n(re'area an(er!oar7, :n "oc s74s!
    de&"ase/e :n %od adecva( a(en=!a Persoana es(e +Oor de d!s(ras de s(!%+"!
    !re"evan(! D% ca+/a aces(or &ro'"e%e &oa(e .! d!.!c!" Esa+ !%&os!'!"J ca &ersoana s7
    &oa(7 .! an$a@a(7 :n(r4o conversa=!e
    E<!s(7 o %od!.!care aco%&a%an(7 :n c+noaO(ere Ecare &oa(e !nc"+de
    de(er!orarea %e%or!e!, de/or!en(area on &er(+r'area "!%'a@+"+!J or! de/vo"(area
    +ne! &er(+r'7r! de &erce&=!e Ecn(en+" BJ De(er!orarea %e%or!e! es(e ev!den(7 ce"
    %a! .recven( :n %e%or!a recen(7 s! &oa(e .! (es(a(7 cerAnd &ersoane! s7 re(!n7
    den+%!rea +nor o'!ec(e .7r7 "e$7(+r7 :n(re e"e or! o &ro&o/!=!+ne sc+r(7, s! a&o! s7
    "e re&e(e d+&7 cA(eva %!n+(e de d!s(ra$ere a a(en=!e! De/or!en(area se %an!.es(7
    de re$+"7 &r!n de/or!en(area :n (!%& a !nd!v!d+"+! Ede e< , crede c7 es(e d!%!nea=7,
    "a %!e/+" no&(nJ or! &r!n de/or!en(area :n "oc Es&a=!+J Ede e< , s+'!ec(+" crede c7 se
    a."7 acas7, %a! c+rAnd decA( :n s&!(a"J :n de"!r!+%+" +Oor, de/or!en(area :n (!%&
    &oa(e .! &r!%+" s!%&(o% care a&are De/or!en(area "a &ro&r!a &ersoan7 es(e %a!
    &+=!n .recven(7 Per(+r'area vor'!% sa+ a "!%'a@+"+! se &oa(e &re/en(a ca d!/ar(r!e
    Ead!c7, de(er!orarea ca&ac!(7=!! de ar(!c+"are a c+v!n(e"orJ, d!sno%!e Ead!c7,
    de(er!orarea ca&ac!(7=!! de a den+%! o'!ec(e"eJ, d!s$ra.!e Ead!c7, de(er!orarea
    ca&ac!(7=!! de a scr!eJ sa+ c!ar a.a/!e :n +ne"e ca/+r!, vor'!rea es(e d!va$an(7 s!
    !re"evan(7, :n a"(e"e, acce"era(7 s! !ncoeren(7, c+ (recer! !%&rev!/!'!"e de "a +n
    Delirium
    ul
    1+8
    s+'!ec( "a a"(+". Pen(r+ c"!n!c!an, &oa(e .! d!.!c!" s7 a&rec!e/e %od!.!c7r!"e :n
    ac(!v!(a(ea co$n!(!v7, deoarece !nd!v!d+" &oa(e .! !na(en( O! !ncoeren(, :n aces(e
    c!rc+%s(an=e, es(e +(!"] s7 se revad7 c+ a(en=!e !s(or!c+" !nd!v!d+"+! O! s7 se o'=!n7
    !n.or%a=!! de "a a"=! !n.or%a(or!, :n s&ec!a" de "a %e%'r! .a%!"!e!.
    Per(+r'7r!"e &erce&(!ve &o( !nc"+de !n(er&re(7r! erona(e, !"+/!! sa+ a"+c!na=!!.
    De e<e%&"+, '7(+(+" :n +O7 &oa(e .! "+a( :n %od erona( dre&( +n .oc de ar%7
    E!n(er&re(are erona(7J8 &"!+r!"e &7(+r!! de &e &a( &o( &are a .! o'!ec(e an!%a(e
    E!"+/!eJ8 or! &ersoana &oa(e SvedeaT +n $r+& de oa%en! &"+(!nd deas+&ra &ar+"+!,
    cAnd :n rea"!(a(e n+ e<!s(7 n!c! +n+" Ea"+c!na=!eJ. DeO! &erce&=!!"e sen/or!a"e erona(e
    s+n( ce" %a! .recven( v!/+a"e, e"e &o( s+rven! "a .e" de '!ne s! :n a"(e %oda"!(7=!
    sen/or!a"e, de e<e%&"+, a+d!(!v7, (ac(!"7, $+s(a(!v7 s! o".ac(!v7.. Perce&=!!"e erona(e
    %er$ de "a s!%&"e O! +n!.or%e "a e<(re% de co%&"e<e. Ind!v!d+" &oa(e avea
    conv!n$erea de"!ran(7 a rea"!(7=!! a"+c!na=!!"or s! &re/!n(7 r7s&+ns+r! e%o=!ona"e O!
    co%&or(a%en(a"e :n concordan=7 c+ con=!n+(+" aces(ora.
    Per(+r'area se de/vo"(7 :n dec+rs+" +ne! sc+r(e &er!oade de (!%& s! (!nde s7
    ."+c(+e/e :n c+rs+" /!"e! Ecr!(er!+" CJ. De e<., d!%!nea=a, :n (!%&+" v!/!(e"or, &ersoana
    &oa(e .! coeren(7 O! coo&eran(7, !ar noa&(ea &oa(e !ns!s(a s74s! s%+"$7 &er.+/or+" s!
    s7 %ear$7 acas7 "a &7r!n=!, care a+ deceda( c+ an! :n +r%7.
    *lemente si tulburri asociate
    De"!r!+%+" es(e asoc!a( adesea c+ o &er(+r'are a c!c"+"+! so%n4v!$!"!(a(e.
    Aceas(7 &er(+r'are &oa(e !nc"+de so%no"en(7 d!+rn7 sa+ a$!(a=!e noc(+rn7 s!
    d!.!c+"(a(e :n a ador%!, or! so%no"en=7 e<ces!v7 :n c+rs+" /!"e! sa+ v!$!"!(a(e :n
    c+rs+" no&=!!, :n +ne"e ca/+r!, &oa(e s+rven! !nversarea co%&"e(7 a c!c"+"+! so%n4
    v!$!"!(a(e, noa&(e4/!. De"!r!+%+" es(e aco%&an!a( .recven( de +n co%&or(a%en(
    &s!o%o(or &er(+r'a(. M+"=! !nd!v!/! c+ de"!r!+% s+n( ne"!n!O(!=! sa+ !&erac(!v!.
    Man!.es(7r!"e de ac(!v!(a(e &s!o%o(or!e cresc+(7 &o( !nc"+de &!&7!rea O! &!Ocarea
    "en@er!e! de &a(, :ncercarea de a se da @os d!n &a(, cAnd aceas(a es(e :nc7 &er!c+"os
    sa+ &re%a(+r, O! %!Oc7r! 'r+O(e. Pe de a"(7 &ar(e, !nd!v!d+" &oa(e &re/en(a o
    ac(!v!(a(e &s!o%o(or!e red+s7, c+ "en(oare O! "e(ar$!e, care se a&ro&!e de s(+&or.
    Ac(!v!(a(ea &s!o%o(or!e &oa(e (rece de "a o e<(re%7 "a a"(a :n c+rs+" +ne! /!"e. :n
    (!%& ce es(e !&erac(!v !nd!v!d+" &oa(e &re/en(a a"+c!na=!!, !de! de"!ran(e O!
    a$!(a=!e, &e cAnd :n s(7r!"e de !&oac(!v!(a(e es(e &+=!n &ro'a'!" c7 va &re/en(a aOa
    ceva. N!ve"e co%&ara'!"e de de(er!orare co$n!(!v7 a+ .os( o'serva(e a(A( :n s(7r!"e
    de !&erac(!v!(a(e, cA( O! :n ce"e de !&oac(!v!(a(e.
    Ind!v!d+" &oa(e &re/en(a &er(+r'7r! e%o=!ona"e, ca de e<., an<!e(a(e, .r!c7,
    de&res!e, !r!(a'!"!(a(e, .+r!e, e+.or!e O! a&a(!e. Po( e<!s(a (recer! ra&!de O!
    !%&rev!/!'!"e de "a o s(are e%o=!ona"7 "a a"(a, deO! +n!! !nd!v!/! c+ de"!r!+% a+ +n
    (on+s e%o=!ona" cons(an(. Fr!ca :nso=eO(e adesea a"+c!na=!!"e a%en!n=7(oare sa+
    !de!"e de"!ran(e (ran/!(or!!. Dac7 .r!ca es(e !n(ens7, &ersoana &oa(e a(aca &e ce! care
    s+n( .a"s &erce&+=! ca a%en!n=7(or!. Se &o( &rod+ce v7(7%7r! &r!n c7derea d!n &a(
    or! &r!n :ncercarea de a sc7&a, :n (!%& ce es(e a(aOa( "a &er.+/oare, (+'+r!
    res&!ra(or!!, ca(e(ere +r!nare or! a"( ec!&a%en( %ed!ca". S(area e%o=!ona"7
    &er(+r'a(7 se &oa(e ev!den=!a, de ase%enea, &r!n s(r!$7(e, va!e(e, :n@+r7(+r!,
    %+r%+re, $e%e(e or! a"(e s+ne(e. Aces(e co%&or(a%en(e s+n( &re/en(e %a!
    .recven( noa&(ea s! :n cond!=!!"e :n care "!&sesc s(!%+"area O! re&ere"e Ese%na"e"eJ
    a%'!en(a"e. De(er!orarea @+dec7=!! &oa(e !n(er.era c+ (ra(a%en(+" %ed!ca" s&ec!.!c,
    :n .+nc=!e de e(!o"o$!e, de"!r!+%+" &oa(e .! asoc!a( c+ +n n+%7r de ano%a"!!
    E48 Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    ne+ro"o$!ce nes&ec!.!ce, c+% ar .! (re%or+", %!oc"on+s+", as(er!<!s+" s! %od!.!c7r!"e
    de re."e<e s! (on+s %+sc+"ar.
    Pe "An$7 da(e"e de "a'ora(or care s+n( carac(er!s(!ce cond!=!!"or %ed!ca"e Eor!
    s(7r!"or de !n(o<!ca=!e sa+ de a's(!nen=7J e(!o"o$!ce sa+ asoc!a(e, EE, es(e de
    re$+"7 anor%a"7, &re/en(And o ac(!v!(a(e $enera"!/a(7 "en(7. Ac(!v!(a(ea ra&!d7
    es(e cons(a(a(7 oca/!ona", de e<e%&"+, :n +ne"e ca/+r! de de"!r!+% &r!n
    a's(!nen=7 a"coo"!c7.
    *lemente speci$ice culturii, etii si sexului
    Fond+" c+"(+ra" s! ed+ca=!ona" (re'+!e "+a(e :n cons!dera=!e :n eva"+area
    ca&ac!(7=!! %en(a"e a +n+! !nd!v!d. Ind!v!/!! d!n an+%!(e %ed!! &o( s7 n+ .!e
    .a%!"!ar!/a=! c+ !n.or%a=!a +(!"!/a(7 :n an+%!(e (es(e de c+noO(!n=e $enera"e Ede e<.,
    n+%e"e &reOed!n=!"or, c+noO(!n=e $eo$ra.!ceJ, de %e%or!e Ede e<., da(a naO(er!! :n
    c+"(+r!"e care n+ ce"e'rea/7 c+ren( da(a naO(er!!J, de or!en(are Ede e<., s!%=+" &"as7r!!
    O! "oca"!/7r!! &oa(e .! conce&+( d!.er!( :n +ne"e c+"(+r!J.
    Co&!!! &o( .! %a! s+sce&(!'!"! "a de"!r!+% decA( ad+"=!! Ea"=!! decA( '7(rAn!!J, :n
    s&ec!a" cAnd aces(a es(e :n "e$7(+r7 c+ o %a"ad!e .e'r!"7 O! c+ an+%!(e %ed!ca%en(e
    Ede e<., an(!co"!ner$!ce"eJ. Aceas(a se da(orea/7, &oa(e, de/vo"(7r!! !%a(+re a
    cre!er+"+! O! d!.eren=e"or .!/!o"o$!ce. La co&!!, de"!r!+%+" &oa(e .! "+a(, :n %od
    erona(, dre&( co%&or(a%en( necoo&eran(, !ar o'=!nerea se%ne"or co$n!(!ve
    d!s(!nc(!ve &oa(e .! d!.!c!"7. Dac7 &ersoane"e .a%!"!are n+ &o( ca"%a co&!"+", aces(
    .a&( &oa(e .! s+$es(!v de de"!r!+%. B7(rAn!! s+n(, de ase%enea, e<(re% de
    s+sce&(!'!"! "a de"!r!+% :n co%&ara=!e c+ ad+"=!! %a! (!ner!, &oa(e d!n ca+/a
    d!.eren=e"or .!/!o"o$!ce. Avansarea :n e(a(e "a ad+"=! es(e asoc!a(7 c+ ra(e :na"(e de
    de"!r!+%, c!ar d+&7 co%'a(erea .ac(or!"or de r!sc. Se<+" %asc+"!n &are a .! +n
    .ac(or de r!sc !nde&enden( &en(r+ de"!r!+% "a !nd!v!/!! %a! :n e(a(e.
    #revalent
    Preva"en(a &+nc(+a"7 a de"!r!+%+"+! :n &o&+"a=!a $enera"7 es(e de L,Id "a ad+"=!!
    :n e(a(e de 5G an! s! %a! %ar! O! de 5,5d "a ce! :n e(a(e de YY an! s! %a! %+"(.
    Preva"en(a &+nc(+a"7 a de"!r!+%+"+! "a &ac!en=!! s&!(a"!/a=! :n sec=!!"e de !n(erne
    var!a/7 :n(re 5Ld O! ;Ld. La '7(rAn!! s&!(a"!/a=! es(e ra&or(a( c7 5Ld45Yd &re/!n(7
    de"!r!+% "a !n(ernare, !ar 5Ld4ILd &o( .! d!a$nos(!ca=! c+ de"!r!+% :n (!%&+"
    s&!(a"!/7r!!. PAn7 "a RLd d!n(re re/!den=!! c7%!ne"or :n e(a(e de HY an! sa+ %a! %+"(
    se &o( a."a :n de"!r!+% :n or!ce %o%en(. N+ %a! &+=!n de 9Yd d!n(re &ac!en=!!
    s&!(a"!/a=! &en(r+ cancer O! ;Ld4ILd d!n(re &ac!en=!! s&!(a"!/a=! &en(r+ SIDA
    &re/!n(7 de"!r!+% :n c+rs+" s&!(a"!/7r!!. PAn7 "a GLd d!n(re ce! c+ s(7r! (er%!na"e
    &re/!n(7 de"!r!+% :n a&roa&e de %oar(e. Ra(a de"!r!+%+"+! "a aceO(! !nd!v!/!
    de&!nde :n %are %7s+r7 de na(+ra cond!=!e! "or %ed!ca"e $enera"e Easoc!a(eJ O! a
    &rocedee"or c!r+r$!ca"e asoc!a(e.
    *voluie
    S!%&(o%e"e de"!r!+%+"+! se de/vo"(7 de re$+"7 :n dec+rs de cA(eva ore &An7 "a
    cA(eva /!"e, deO! :n +ne"e ca/+r! Ede e<., d+&7 +n (ra+%a(!s% cran!anJ &oa(e :nce&e
    'r+sc. De re$+"7 s!%&(o%e"e &rodro%a"e, c+% ar .! ne"!n!O(ea, an<!e(a(ea,
    !r!(a'!"!(a(ea, de/or!en(area, d!s(rac(!'!"!(a(ea sa+ &er(+r'area so%n+"+!,
    &ro$resea/7 s&re de"!r!+%+" de&"!n cons(!(+!( :n dec+rs+" +ne! &er!oade de " &An7 "a
    ; /!"e.
    Delirium
    ul
    *45

    De"!r!+%+" se &oa(e re/o"va :n dec+rs de cA(eva ore &An7 "a cA(eva /!"e, sa+
    s!%&(o%e"e &o( &ers!s(a (!%& de s7&(7%An! sa+ "+n!, :n s&ec!a" "a !nd!v!/!! :n e(a(e
    c+ o de%en=7 coe<!s(en(7. Dac7 .ac(or+" e(!o"o$!c s+'!acen( es(e corec(a( &ro%&( sa+
    es(e a+(o"!%!(a(, es(e &os!'!" ca rec+&erarea s7 .!e co%&"e(7 s! %a! ra&!d7. Ind!v!/!!
    c+ o .+nc=!onare so%a(!c7 s! co$n!(!v7 &re%or'!d7 %a! '+n7 se rec+&erea/7 %a!
    '!ne d!n de"!r!+%. Ce! c+ e&!soade an(er!oare de de"!r!+% &o( &re/en(a +n r!sc
    cresc+( de s!%&(o%e rec+ren(e.
    :n (!%& ce %a@or!(a(ea !nd!v!/!"or se rec+&erea/7 co%&"e(, "a +n!! de"!r!+%+"
    &oa(e &ro$resa :n s(+&or, co%7, conv+"s!! sa+ %oar(e, :n s&ec!a" dac7 n+ es(e
    (ra(a(7 ca+/a s+'!acen(7. Rec+&erarea co%&"e(7 es(e &+=!n &ro'a'!"7 "a '7(rAn!, c+
    &rocen(e es(!%a(e de rec+&erare co%&"e(7 "a e<(ernare var!!nd de "a Id "a ILd.
    M+"(e s!%&(o%e n+ se re/o"v7 :n dec+rs de ;4R "+n! de "a e<(ernare. De.!c!(e"e
    co$n!(!ve &ers!s(en(e s+n(, de ase%enea, &re/en(e "a !nd!v!/!! %a! :n e(a(e care se
    rec+&erea/7 d!n de"!r!+%, :ns7 as(.e" de de.!c!(e se &o( da(ora +ne! de%en=e
    &re<!s(en(e care n+ a .os( a&rec!a(7 coerec(. Fa&(+" de a .! !n(erna( :n s&!(a" de acas7
    Eca o&+s !n(ern7r!! d!n(r4o +n!(a(e !ns(!(+=!ona"7J es(e core"a( c+ o ra(7 %a! %are de
    a%e"!orare a s(7r!! %en(a"e.
    De"!r!+%+" "a &ac!en=!! %ed!ca"! es(e asoc!a( c+ o %or'!d!(a(e se%n!.!ca(!v7.
    Pac!en=!! %ed!ca"! c+ de"!r!+%, :n s&ec!a" '7(rAn!!, a+ +n r!sc se%n!.!ca(!v cresc+( de
    co%&"!ca=!! %ed!ca"e, c+% ar .! &ne+%on!a O! +"cere"e de dec+'!(, care d+c "a
    !n(ern7r! de "+n$7 d+ra(7 :n s&!(a". De"!r!+%+" es(e asoc!a(, de ase%enea, c+ +n
    dec"!n .+nc=!ona" s! r!sc de &"asa%en( !ns(!(+=!ona" cresc+(. Pac!en=!! s&!(a"!/a=! c+
    de"!r!+%, :n e(a(e de RY an! sa+ %a! %+"(, &re/!n(7 +n r!sc de &"asa%en( :n c7%!ne
    s&!(a" O! +n dec"!n .+nc=!ona" de (re! or! %a! %are decA( &ac!en=!! s&!(a"!/a=! .7r7
    de"!r!+%, a(A( "a e<(ernare, cA( s! "a (re! "+n! d+&7 aceea. La &ac!en=!! &os(o&era(or!,
    de"!r!+%+" es(e +n !nd!c!+ de rec+&erare "!%!(a(7 O! de de/nod7%An( ne.avora'!" &e
    (er%en "+n$ O! es(e asoc!a( adesea c+ +n r!sc cresc+( de co%&"!ca=!! &os(o&era(or!!,
    c+ &er!oade de rec+&erare &os(o&era(or!e %a! "+n$!, c+ !n(ern7r! de d+ra(7 :n s&!(a"
    s! c+ o !nva"!d!(a(e &e (er%en "+n$ cresc+(7.
    De"!r!+%+" "a &ac!en=!! %ed!ca"! es(e asoc!a( c+ o %or(a"!(a(e cresc+(7. Ind!v!/!!
    :n e(a(e, care &re/!n(7 de"!r!+% :n c+rs+" +ne! s&!(a"!/7r! a+ o Oans7 de 9Ld4HYd de
    a deceda :n c+rs+" ace"e! s&!(a"!/7r!. Pac!en=!! care &re/!n(7 de"!r!+% :n c+rs+" +ne!
    s&!(a"!/7r! a+, de ase%enea, +n &rocen( de deces .oar(e cresc+( :n +r%7(oare"e "+n!
    d+&7 e<(ernare. PAn7 "a 5Yd d!n(re &ac!en=!! :n e(a(e c+ de"!r!+% decedea/7 :n
    dec+rs de o "+n7, !ar &An7 "a 9Yd :n dec+rs de Oase "+n! de "a e<(ernare. A"=! .ac(or!
    de r!sc, c+% ar .! (!&+" de %a"ad!e, sever!(a(ea aces(e!a, de(er!orarea co$n!(!v7
    &ree<!s(en(7 O! e(a(ea, con(r!'+!e se%n!.!ca(!v "a aceas(7 asoc!ere. Pac!en=!! c+
    neo&"as%e %a"!$ne O! c+ de"!r!+% &re/!n(7 o ra(7 e<(re% de :na"(7 de %or(a"!(a(e,
    a(A( :n s&!(a", cA( O! d+&7 e<(ernare, :n co%&ara=!e c+ &ac!en=!! c+ neo&"as%e
    %a"!$ne, dar .7r7 de"!r!+%.
    Dia!nostic di$erenial
    Cea %a! co%+n7 &ro'"e%7 de d!a$nos(!c d!.eren=!a" o cons(!(+!e s(a'!"!rea
    .a&(+"+! dac7 &ersoana res&ec(!v7 are o de%en=7 %a! c+rAnd decA( +n de"!r!+%, are
    n+%a! de"!r!+% or! are +n de"!r!+% s+&ra&+s &es(e o de%en=7 &ree<!s(en(7.
    De(er!orarea %e%or!e! es(e co%+n7, a(A( :n de"!r!+%, cA( s! :n de%en=7, dar
    &ersoana n+%a! c+ de%en=7 es(e a"er(7 O! n+ are &er(+r'area de conO(!en(7, care es(e
    carac(er!s(!c7 de"!r!+%+"+!. De'+(+" (e%&ora" s! evo"+=!a de(er!or7r!"or co$n!(!ve
    EH5 Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    s+n( +(!"e :n e.ec(+area +ne! d!s(!nc=!! :n(re de"!r!+% s! de%en=7, :n de"!r!+%,
    de'+(+" s!%&(o%e"or es(e %+"( %a! ra&!d Ede re$+"7, cA(eva ore sa+ /!"eJ, &e cAnd
    :n de%en=7 de'+(+" es(e de re$+"7 %a! $rad+a" sa+ !ns!d!os. Sever!(area
    s!%&(o%e"or :n de"!r!+% ."+c(+ea/7 :n dec+rs de 9I ore, &e cAnd :n de%en=7, de
    re$+"7, n+. CAnd s+n( &re/en(e s!%&(o%e"e +n+! de"!r!+%, !n.or%a=!!"e o'=!n+(e de
    "a %e%'r!! .a%!"!e!, de "a a"(e &ersoane care se oc+&7 de &ac!en( or! d!n
    doc+%en(e"e %ed!ca"e &o( .! +(!"e :n a s(a'!"! dac7 s!%&(o%e"e +ne! de%en=e era+
    &ree<!s(en(e. Cod!.!carea +n+! de"!r!+% s+&ra&+s &es(e d!.er!(e (!&+r! de de%en=e
    es(e d!sc+(a(7 "a SProcedee"e de :nre$!s(rareT &en(r+ .!ecare (!& de de"!r!+%.
    E(!o"o$!a &res+&+s7 de(er%!n7 d!a$nos(!carea +n+! an+%!( (!& de de"!r!+% E(e<(+"
    s! cr!(er!!"e &en(r+ d!a$nos(!c+" .!ec7r+! (!& de de"!r!+% s+n( &rev7/+(e se&ara(, :n
    .!na"+" aces(e! sec=!+n!J. Dac7 se cons!der7 c7 de"!r!+%+" es(e consec!n=a e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e, a(+nc! es(e &+s d!a$nos(!c+" de
    de"!r!+% da(ora( +ne! cond!=!! %ed!ca"e $enera"e. Dac7 de"!r!+%+" re/+"(7 d!n
    e.ec(e"e .!/!o"o$!ce d!rec(e a"e +n+! dro$ de a'+/, a(+nc! es(e &+s d!a$nos(!c+" de
    de"!r!+% &r!n !n(o<!ca=!e c+ o s+'s(an=7 or! de de"!r!+% &r!n a's(!nen=7 de o
    s+'s(an=7, :n .+nc=!e de .a&(+" dac7 de"!r!+%+" s+rv!ne :n asoc!ere c+ !n(o<!ca=!a c+ o
    s+'s(an=7, or! c+ a's(!nen=a de o s+'s(an=7. Dac7 de"!r!+%+" re/+"(7 d!n +/+" +n+!
    %ed!ca%en( sa+ e<&+nerea "a +n (o<!c, ar+nc! es(e &+s d!a$nos(!c+" de de"!r!+%
    !nd+s de o s+'s(an=7. N+ es(e rar .a&(+" ca de"!r!+%+" s7 se da(ore/e, a(A( +ne!
    cond!=!! %ed!ca"e $enera"e, cA( O! +/+"+! +ne! s+'s(an=e E!nc"+s!v a" +n+!
    %ed!ca%en(J. Aceas(a se &oa(e vedea, de e<e%&"+, "a +n !nd!v!d :n e(a(e, c+ o
    cond!=!e %ed!ca"7 sever7, care es(e (ra(a(7 c+ %+"(e %ed!ca%en(e. CAnd e<!s(7 %a!
    %+"( decA( o s!n$+r7 e(!o"o$!c Ede e<., a(A( o s+'s(an=7, cA( O! o cond!=!e %ed!ca"7
    $enera"7J es(e d!a$nos(!ca( de"!r!+%+" da(ora( +nor e(!o"o$!! %+"(!&"e. Dac7 n+ es(e
    &os!'!" s7 se s(a'!"easc7 o e(!o"o$!c s&ec!.!c7 Ead!c7, !nd+s de o s+'s(an=7 sa+ da(ora(
    +ne! cond!=!! %ed!ca"e $enera"eJ es(e d!a$nos(!ca( de"!r!+%+" .7r7 a"(7 s&ec!.!ca=!e.
    D!a$nos(!c+" de de"!r!+% &r!n !n(o<!ca=!e c+ o s+'s(an=7 or! de de"!r!+% &r!n
    a's(!nen=7 de o s+'s(an=7 es(e &+s :n "oc+" ce"+! de !n(o<!ca=!e c+ o s+'s(an=7 or! a
    ce"+! de a's(!nen=7 de o s+'s(an=7, n+%a! dac7 s!%&(o%e"e de"!r!+%+"+! s+n( :n
    e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e or! de a's(!nen=7 s!
    s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7. C!ar "a
    !nd!v!/!! c+ se%ne ev!den(e de !n(o<!ca=!e sa+ de a's(!nen=7, n+ (re'+!e (rec+(e c+
    vederea a"(e ca+/e &os!'!"e de de"!r!+% Ead!c7, de"!r!+% da(ora( +ne! cond!=!!
    %ed!ca"e $enera"eJ. De e<e%&"+, +n (ra+%a(!s% cran!an, care s+rv!ne ca re/+"(a( a"
    c7der!"or sa+ a" '7(7!"or d!n c+rs+" !n(o<!ca=!e!, &oa(e .! res&onsa'!" de de"!r!+%.
    De"!r!+%+" care es(e carac(er!/a( &r!n a"+c!na=!! v!!, !de! de"!ran(e, &er(+r'7r! de
    "!%'a@ s! a$!(a=!e, (re'+!e s7 .!e d!s(!ns de (+"'+rarea &s!o(!c7 sc+r(7, de
    sc!/o.ren!e, de (+"'+rarea sc!/o.ren!.or%7 s! de a"(e (+"'+r7r! &s!o(!ce, ca s!
    de (+"'+r7r!"e a.ec(!ve c+ e"e%en(e &s!o(!ce. :n de"!r!+%, s!%&(o%e"e &s!o(!ce
    s+n( .ra$%en(are O! nes!s(e%a(!/a(e. De"!r!+%+", care es(e carac(er!/a( &r!n
    %od!.!c7r! de d!s&o/!=!e s! an<!e(a(e (re'+!e, de ase%enea, d!s(!ns de (+"'+r7r!"e
    a.ec(!ve s! de (+"'+r7r!"e an<!oase, :n .!ne, de"!r!+%+" asoc!a( c+ .r!c7, an<!e(a(e O!
    s!%&(o%e d!soc!a(!ve, c+% ar .! de&ersona"!/area, (re'+!e s7 .!e d!s(!nse de s(res+"
    ac+(, care es(e &rec!&!(a( de e<&+nerea "a +n even!%en( (ra+%a(!c sever.
    S!%&(o%e"e &s!o(!ce, a.ec(!ve, an<!oase O! d!soc!a(!ve asoc!a(e c+ de"!r!+%+" de
    re$+"7 s+n( ."+c(+an(e, s+rv!n :n con(e<(+" +ne! ca&ac!(7=! red+se de a %en=!ne O!
    co%+(a :n %od cores&+n/7(or a(en=!a O! de re$+"7 s+n( asoc!a(e c+ ano%a"!! EE,.
    Adesea e<!s(7 o de(er!orare %e%or!e! O! de/or!en(are :n de"!r!+%, dar de re$+"7 n+
    76425 Deliriumul datorat unei ondiii Medicale
    Generale
    *7*
    s! :n aces(e a"(e (+"'+r7r!, :n .!ne, :n de"!n+%, :n $enera" &ersoana &re/!n(7 &ro'a
    +ne! cond!=!! %ed!ca"e $enera"e, a +ne! !n(o<!ca=!! sa+ a's(!nen=e de o s+'s(an=7 sa+
    a +/+"+! +n+! %ed!ca%en(.
    De"!r!+%+" (re'+!e d!s(!ns de s!%+"are s! de (+"'+rarea .ac(!ce. Aceas(7
    d!s(!nc=!e se .ace &e 'a/a (a'"o+"+! c"!n!c, a(!&!c adesea :n s!%+"are s! :n (+"'+rarea
    .ac(!ce, s! &e a'sen=a +ne! cond!=!! %ed!ca"e $enera"e or! a +ne! s+'s(an=e care s7 .!e
    e(!o"o$!c :n "e$7(+r7 c+ (+"'+rarea co$n!(!v7 ev!den(7.
    Ind!v!/!! &o( &re/en(a +ne"e, dar n+ (oa(e s!%&(o%e"e de"!r!+%+"+!. Ta'"o+r!"e
    c"!n!ce s+'s!ndro%a"e (re'+!e eva"+a(e c+ a(en=!e, &en(r+ c7 aces(ea &o( .! %esa$er!
    a! +n+! a+(en(!c de"!r!+% or! &o( se%na"a o cond!=!e %ed!ca"7 $enera"7 s+'!acen(7
    ned!a$nos(!ca(7 :nc7. As(.e" de (a'"o+r! c"!n!ce (re'+!e s7 .!e cod!.!ca(e ca (+"'+rare
    co$n!(!v7 .7r7 a"(7 s&ec!.!ca=!e.
    C54.+ Deliriu"ul $atorat
    unei Con$i!ii Me$i#ale Generale
    Dia!nostic ,i elemente asociate
    E"e%en(e"e descr!&(!ve a"e de"!r!+%+"+! da(ora( +ne! cond!=!! %ed!ca"e $enera"e
    Ecr!(er!!"e A4CJ s+n( d!sc+(a(e "a &a$. 5;R45;H. :n &"+s, &en(r+ a d!a$nos(!ca
    de"!r!+%+" da(ora( +ne! cond!=!! %ed!ca"e $enera"e, d!n !s(or!c, e<a%en+" so%a(!c
    sa+ da(e"e de "a'ora(or, (re'+!e s7 .!e ev!den( .a&(+" c7 &er(+r'area co$n!(!v7 es(e
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" DJ.
    :n &rec!/area .a&(+"+! c7 de"!r!+%+" es(e da(ora( +ne! cond!=!! %ed!ca"e $enera"e,
    c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en=a +ne! cond!=!! %ed!ca"e $enera"e.
    A&o!, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7 de"!r!+%+" es(e e(!o"o$!c :n "e$7(+r7
    c+ cond!=!a %ed!ca"7 $enera"7. Es(e necesar7 o eva"+are a(en(7 s! c+&r!n/7(oare a
    n+%eroO! .ac(or! &en(r+ a .ace aceas(7 @+deca(7. DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e,
    cA(eva cons!deren(e o.er7 +n oarecare $!da@ :n aces( do%en!+. Un &r!%
    cons!deren( :" cons(!(+!e &re/en(a +ne! asoc!er! (e%&ora"e :n(re de'+(+", e<acer'area
    sa+ re%!s!+nea cond!=!e! %ed!ca"e $enera"e s! cea a de"!r!+%+"+!. Da(e"e d!n
    "!(era(+r7, care s+$erea/7 c7 &oa(e e<!s(a o asoc!ere d!rec(7 :n(re cond!=!a %ed!ca"7
    $enera"7 :n ces(!+ne O! de/vo"(area +n+! de"!r!+%, &o( o.er! +n con(e<( +(!" :n
    eva"+area +n+! ca/ &ar(!c+"ar, :n &"+s, c"!n!c!an+" (re'+!e, de ase%enea, s7 @+dece
    .a&(+" dac7 &er(+r'area n+ es(e e<&"!ca(7 %a! '!ne de +n de"!r!+% !nd+s de o
    s+'s(an=7 or! de o (+"'+rare %en(a"7 &r!%ar7 Ede e<., +n e&!sod %an!aca"J. Aceas(7
    &rec!/are es(e e<&"!ca(7 %a! :n de(a"!+ :n sec=!+nea ST+"'+r7r!"e %en(a"e da(ora(e
    +ne! cond!=!! %ed!ca"e $enera"eT E&a$. 5G5J.
    De"!r!+%+" &oa(e .! asoc!a( c+ %+"(e s! d!.er!(e cond!=!! %ed!ca"e $enera"e, .!ecare
    avAnd da(e de e<a%!nare so%a(!c7 s! de "a'ora(or carac(er!s(!ce, :n %a"ad!!"e de
    s!s(e%, n+ s+n( de re$+"7 cons(a(a(e se%ne ne+ro"o$!ce de .ocar. Po( .! &re/en(e
    d!verse .or%e de (re%or. As(er!<!s+", o %!Ocare de .A".A!re a %A!n!"or !&ere<(!nse,
    a .os( descr!s !n!=!a" :n ence.a"o&a(!a e&a(!c7, dar &oa(e .! :n(A"n!( :n asoc!ere O! c+
    a"(e ca+/e de de"!r!+%. Se%ne"e de !&erac(!v!(a(e ve$e(a(!v7 Ede e<., (a!card!e,
    (rans&!ra=!!, .ac!es con$es(!v, &+&!"e d!"a(a(e O! &res!+ne san$+!n7 cresc+(7J s+rv!n
    .recven(. Pe "An$7 da(e"e de "a'ora(or, care s+n( carac(er!s(!ce cond!=!e! %ed!ca"e
    $enera"e e(!o"o$!ce Eor! s(7r!"or de !n(o<!ca=!e sa+ de a's(!nen=7J, EE, es(e :n $enera"
    anor%a"7, &re/en(And, .!e o ac(!v!(a(e $enera"!/a(7 "en(7, .!e +na ra&!d7.
    *7C
    Deliriumul, Demena, Tulburrile Amnestice si Alte Tulburri
    #rocedee de "nre!istrare
    La :nre$!s(rarea d!a$nos(!c+"+! de de"!r!+% da(ora( +ne! cond!=!! %ed!ca"e
    $enera"e, c"!n!c!an+" (re'+!e s7 no(e/e, a(A( de"!r!+%+", cA( s! cond!=!a %ed!ca"7
    $enera"7 !den(!.!ca(7, cons!dera(7 a .! ca+/a &er(+r'7r!!, &e a<a I Ede e<., 9F;.L
    De"!r!+% da(ora( !&o$"!ce%!e!J. Cod+" ICD4F4CM &en(r+ cond!=!a %ed!ca"7
    $enera"7 (re'+!e, de ase%enea, no(a( &e a<a III Ede e<., 9Y5.9 H!&o$"!ce%!eJ Eve/!
    ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce"or ICD4F4CM se"ec(a(e &en(r+ cond!=!!"e
    %ed!ca"e $enera"eJ. CAnd de"!r!+%+" es(e s+&ra&+s &es(e o de%en=7 &ree<!s(en(7,
    (re'+!e &+se a%'e"e d!a$nos(!ce Ede e<., 9FI.55 De%en=7 de (!& A"/e!%er, c+
    &er(+r'are de co%&or(a%en( s! 9F;.L De"!r!+% da(ora( n!&ona(re%!e!J. Deoarece
    de%en=a A"/e!%er n+ es(e o cond!=!e e(!o"o$!c7 &en(r+ de"!r!+% c! n+%a! +n .ac(or
    de r!sc, e(!o"o$!a or!c7r+! de"!r!+% s+&ra&+s &es(e %a"ad!a A"/e!%er (re'+!e
    &rec!/a(7. Pen(r+ c7 ICD4F4CM cod!.!c7 cond!=!!"e de 'a/7, de"!r!+%+" s+&ra&+s
    &es(e de%en=a vasc+"ar7 es(e no(a( &r!n cod!.!carea s+'(!&+"+! cores&+n/7(or de
    de%en=7 Ede e<
    v
    9FL.I5 de%en=7 vasc+"ar7, c+ de"!r!+%J. :n s!(+a=!!"e :n care es(e
    nec"ar dac7 de.!c!(e"e co$n!(!ve se da(orea/7 de"!r!+%+"+! sa+ de%en=e!, &oa(e .! +(!"
    s7 se &+n7 +n d!a$nos(!c &rov!/or!+ de de"!r!+% s! s7 se o'serve c+ a(en=!e &ersoana
    :n (!%& ce se con(!n+7 e.or(+r!"e de !den(!.!care a na(+r!! &er(+r'7r!!.
    ondiii medicale !enerale asociate
    Cond!=!!"e %ed!ca"e $enera"e asoc!a(e c+ de"!r!+%+" !nc"+d (+"'+r7r!"e
    s!s(e%+"+! nervos cen(ra" Ede e<., (ra+%a(!s%+" cran!an, s(7r!"e !c(a"e s! &os(!c(a"e,
    %a"ad!!"e vasc+"are, c+% ar .! a(ac+r!"e !sce%!ce (ran/!(or!! s! ence.a"o&a(!a
    !&er(ens!v7, %a"ad!!"e de$enera(!ve, ca de e<., %a"ad!a P!c), !n.ec=!!"e s! (+%or!"e
    cere'ra"eJ, (+"'+r7r!"e %e(a'o"!ce Ede e<., o %a"ad!e rena"7 sa+ e&a(!c7,
    de/ec!"!'re"e !dr!ce s! e"ec(ro"!(!ce, c+% ar .! des!dra(area, de/ec!"!'re"e
    sod!+"+! s! &o(as!+"+!, ane%!a, !&o<!a, !&ercar'!a, !&o$"!ce%!a, de.!c!en=a
    (!a%!n!c7, !&oa"'+%!ne%!a, endocr!no&a(!a, de/ec!"!'r+" ac!do'a/!cJ,
    (+"'+r7r!"e card!o&+"%onare E!n.arc(+" %!ocard!c, !ns+.!c!en=a card!ac7
    con$es(!v7, ar!(%!a card!ac7, Ooc+", !ns+.!c!en=a res&!ra(or!eJ s! %a"ad!!"e sa+
    e.ec(e"e s!s(e%!ce Ede e<., o !n.ec=!e, c+% ar .!, se&(!ce%!a, &ne+%on!a s! o !n.ec=!e
    a (rac(+"+! +r!nar, neo&"as%+", +n (ra+%a(!s% sever, de&r!varea sen/or!a"7
    v!/+a"7 sa+ a+d!(!v7, dere$"7r!"e (er%!ce, s(7r!"e &os(o&era(or!!J. An+%!(e "e/!+n!
    .oca"e a"e "o'+"+! &ar!e(a" dre&( s! .e=e! !n.ero%ed!a"e a "o'+"+! occ!&!(a" &o( d+ce,
    de ase%enea, "a de"!r!+%.
    Dia!nostic di$erenial
    3e/! &a$. 5;F &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a"
    de"!r!+%+"+!.
    Deliriumul indus de o
    Substan
    *74
    Criteriile $e $ia/no&ti# pentru C54.+ Deliriu" $atorat ...
    [Se indica Condiia Medical General]
    A2 #erturbare de con,tient &adic, reducerea claritii con,tientei ambianei),
    cu reducerea capacitii de a $ocali(a, susine sau deplasa atenia2
    S2 O modi$icare "n cunoa,tere &cum ar $i de$icitul de memorie, de(orientarea,
    perturbarea limba0ului) sau de(voltarea unei perturbri de percepie, care nu
    este explicat mai bine de o demen preexistent, stabili(at ori evolutiv2
    2 #erturbarea se de(volt "n decursul unei scurte perioade de timp &de re!ul,
    "n c@teva ore sau (ile) ,i tinde s $luctue(e "n cursul (ilei2
    D2 *xist proba, din istoric, examenul somatic sau datele de laborator, c
    perturbarea este cau(at de consecinele $i(iolo!ice directe ale unei condiii
    medicale !enerale2
    Not( $e #o$i%i#areM Dac deliriumul este suprapus peste o demen vascular,
    deliriumul este indicat codi$ic@nd 7652HE Demen vascular, cu delirium2
    Fot de codi$icareD A se include numele condiiei medicale !enerale pe axa l,
    de ex2, 76425 Delirium datorat ence$alopatiei %epatice3 de asemenea, a se
    codi$ica condiia medical !eneral pe axa III &ve(i anexa G pentru coduri)2
    Deliriu"ul in$u& $e o Su-&tan!(
    *lemente de dia!nostic ,i elemente asociate
    E"e%en(e"e descr!&(!ve a"e de"!r!+%+"+! !nd+s de o s+'s(an=7 Ecr!(er!!"e A4CJ
    s+n( d!sc+(a(e "a &a$. 5;R45;H. :n &"+s, &en(r+ a d!a$nos(!ca de"!r!+%+" !nd+s de o
    s+'s(an=7, d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or, (re'+!e s7 re/+"(e
    &ro'a !n(o<!ca=!e! sa+ a's(!nen(e! de o s+'s(an=7, &ro'a e.ec(e"or sec+ndare a"e +n+!
    %ed!ca%en( sa+ e<&+ner!! "a +n (o<!c, cons!dera( a .! e(!o"o$!c :n re"a=!e c+
    de"!r!+%+" Ecr!(er!+" DJ. Un de"!r!+% care s+rv!ne :n c+rs+" +ne! !n(o<!ca=!! c+ o
    s+'s(an=7, es(e d!a$nos(!ca( ca de"!r!+% &r!n !n(o<!ca=!e c+ o s+'s(an=78 +n de"!r!+%
    care s+rv!ne :n c+rs+" a's(!nen=e! de o s+'s(an=7 es(e d!a$nos(!ca( ca de"!r!+% &r!n
    a's(!nen=7 de o s+'s(an=78 !ar +n de"!r!+% care es(e asoc!a( c+ e.ec(e"e sec+ndare a"e
    +n+! %ed!ca%en( sa+ c+ e.ec(e"e e<&+ner!! "a +n (o<!c es(e d!a$nos(!ca( ca de"!r!+%
    !nd+s de o s+'s(an=7 Eve/! se(+" de cr!(er!! &en(r+ de"!r!+%+" &r!n !n(o<!ca=!e c+ o
    s+'s(an=7, &a$. 5IYJ.
    De"!r!+%+" care s+rv!ne :n c+rs+" !n(o<!ca=!e! c+ o s+'s(an=7 &oa(e a&are :n
    dec+rs de cA(eva %!n+(e sa+ ore de "a "+area +nor do/e re"a(!v %ar! de an+%!(e
    dro$+r!, c+% ar .! canna'!s+", coca!na s! a"+c!no$ene"e. De'+(+" &oa(e .! :ns7
    :n(Ar/!a( :n ca/+" +nor s+'s(an=e care se &o( ac+%+"a :n (!%&, deoarece a+ o
    se%!v!a=7 "+n$7 Ede e<., d!a/e&a%+"J. De re$+"7 de"!r!+%+" se re/o"v7 &e %7s+r7 ce
    d!s&are !n(o<!ca=!a sa+ :n dec+rs de cA(eva ore sa+ /!"e. D+ra(a &oa(e .! :ns7 %a!
    "+n$7 d+&7 !n(o<!ca=!a c+ &encyc"!d!n7 s! &oa(e &ers!s(a &er!oade %a! "+n$! de
    (!%& "a !nd!v!/!! c+ "e/!+n! cere'ra"e, "a '7(rAn! s! "a !nd!v!/!! care a+ .7c+( +/ de
    co%'!na=!! de s+'s(an=e. In(erva"+" de (!%& d!n(re "+area +ne! s+'s(an=e s! de'+(+"
    *77
    Delinumul, Dementa, Tulburrile Amnestice si Alte Tulburri

    de"!n+%+"+! &r!n !n(o<!ca=!e &oa(e .! %a! sc+r( "a !nd!v!/!! c+ +n c"earance red+s
    Eda(ora( +ne! %a"ad!! rena"e sa+ e&a(!ceJ
    De"!n+%+" asoc!a( c+ a's(!nen(a de o s+'s(an=7 se de/vo"(7 &e %7s+r7 ce
    concen(ra=!!"e s+'s(an=e! :n =es+(+r!"e s! ."+!de"e or$an!s%+"+! scad, d+&7 red+cerea
    sa+ (er%!narea +/+"+! s+s=!n+( s! de re$+"7 :n do/e %An a" a"coo"+"+! sa+
    seda(!ve"or, !&no(!ce"or sa+ an<!oce"or La !nd!v!/!! c+ c"earance red+s sa+ care
    .ac +/ de co%'!na=!! de s+'s(an=e, den+%+" &r!n a's(!nen(a de o s+'s(an=7 &oa(e
    s+rven! d+&7 red+cerea sa+ (er%!narea +nor do/e %a! %!c! D+ra(a de"!n+%+"+!
    (!nde a vana c+ se%!v!a(a s+'s(an=e! !%&"!ca(e s+'s(an=e"e c+ d+ra(a de ac(!v!(a(e
    %a! "+n$7 s+n( asoc!a(e de re$+"7 c+ o a's(!nen(7 %a! &re"+n$!(7 De"!n+%+" &r!n
    a's(!nen(a de o s+'s(an=7 se &oa(e con(!n+a &en(r+ cA(eva ore n+%a! or! &oa(e
    &ers!s(a %a! %+"( de 94I s7&(7%An!
    Aces( d!a$nos(!c (re'+!e &+s :n "oc+" d!a$nos(!c+"+! de !n(o<!ca=!e c+ o s+'s(an=7
    or! de a's(!nen(7 de o s+'s(an=7, n+%a! cAnd s!%&(o%e"e co$n!(!ve s+n( :n e<ces
    .a(7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen(7, s! cAnd
    s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7
    Pen(r+ o d!sc+=!e %a! de(a"!a(7 a e"e%en(e"or asoc!a(e c+ (+"'+r7r!"e :n "e$7(+r7 c+
    s+'s(an=e"e, ve/! &a$ 5F5
    #rocedee de "nre!istrare
    Un d!a$nos(!c de de"%+% !nd+s de o s+'s(an=7 :nce&e c+ n+%e"e s+'s(an=e!
    s&ec!.!ce E%a! c+rAnd decA( c+ ce" a" c"ase! de s+'s(an=eJ care es(e &res+&+s7 a .!
    ca+/a( de"!n+%+" Ede e< , Sd!a/e&a%T, %a! c+rAnd decA( Ssedave, !&no(!ce sa+
    an<!o"!ceTJ Cod+" d!a$nos(!c es(e se"ec(a( d% "!s(a de c"ase de s+'s(an=e &rev7/+(7
    :n se(+" de cr!(er!! Pen(r+ s+'s(an=e"e care n+ &o( .! !nc"+se :n n!c! +na d!n(re c"ase
    Ede e<, d!$!(a"aJ, (re'+!e +(!"!/a( cod+" &en(r+ Sa"(7 s+'s(an=7T :n &"+s, &en(r+
    %ed!ca%en(e"e &rescr!se :n do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!c &oa(e .! !nd!ca(
    &r!n %en=!onarea cod+"+! E cores&+n/7(or Eve/! ane<a ,J Pen(r+ s+'s(an=e"e care
    &rod+c !n(o<!ca=!e sa+ a's(!nen(7, den+%!rea s+'s(an=e! es(e +r%a(7 de con(e<(+" :n
    care a&ar s!%&(o%e"e Ede e<, 9F9 G5 Der!+% &r!n !n(o<!ca=!e c+ de<(roa%.e4
    (a%!n7, 9F5 O Der!+% &r!n a's(!nen(7 de a"coo"J Pen(r+ e.ec(e"e sec+ndare a"e
    +n+! %ed!ca%en( s! e<&+nerea "a +n (o<!c, es(e +(!"!/a( (er%en+" de S!nd+sT Ede e< ,
    9F9 G5 Der!+% !nd+s de d!$!(a"7J CAnd se cons!der7 c7 %a! %+"( decA( o s!n$+r7
    s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n a&ar!=!a de"!n+%+"+!, .!ecare s+'s(an=7
    (re'+!e s7 .!e %en=!ona(7 se&ara( Dac7 o s+'s(an=7 es(e cons!dera(7 a .! .ac(or+"
    e(!o"o$!c, dar s+'s(an=a s&ec!.!c7 sa+ c"asa de s+'s(an=e es(e nec+nosc+(7,
    d!a$nos(!c+" es(e 9F9 G5 De"%+% !nd+s de o s+'s(an=7 nec+nosc+(7
    Substane speci$ice
    De"!r!+%+" &r!n !n(o<!ca=!e c+ o s+'s(an=7 &oa(e s+rven! "a +r%7(oare"e c"ase
    de s+'s(an=e a"coo", a%.e(a%!ne s! s+'s(an=e a.!ne, canna'!s, coca!n7,
    a"+c!no$ene, !na"an(e, o&!acee, &encycd%7 s! s+'s(an=e a.!ne, sedave,
    !&no(!ce s! an<!o"!(!ce, s! a"(e s+'s(an=e sa+ s+'s(an=e nec+nosc+(e De"!n+%+" &r!n
    a's(!nen(7 de o s+'s(an=7 &oa(e s+rven! "a +r%7(oare"e c"ase de s+'s(an=e a"coo"
    Eadesea den+%!( Sde"%+% (re%ensTJ, seda(!ve, !&no(!ce s! an<!o"!(!ce, s! a"(e
    s+'s(an=e sa+ s+'s(an=e nec+nosc+(e
    Med!ca%en(e"e descr!se a ca+/a de"%+% !nc"+d anes(e/!ce"e, ana"$e/!ce"e,
    a$en=!! an(!as(%ac!, an(!conv+"s!van(e"e, an(!!s(a%%!ce"e, %ed!ca%en(e"e
    Deliriumul indus de o
    Substan
    5IY
    an(!!&er(ens!ve s! card!ovasc+"are, an(!%!cro'!ene"e, %ed!ca%en(e"e an(!&ar)!n4
    son!ene, cor(!cos(ero!/!!, %ed!ca%en(e"e $as(ro!n(es(!na"e, an(a$on!O(!! rece&(or!"or
    !s(a%!ner$!c! H9 Ede e<., c!%e(!d!naJ, a$en=!! !%+nos+&resor!, "!(!+%+", re"a<an(e"e
    %+sc+"are s! %ed!ca%en(e"e &s!o(ro&e c+ e.ec(e sec+ndare an(!co"!ner$!ce.
    To<!ce"e descr!se a ca+/a de"!r!+% !nc"+d !nsec(!c!de"e or$ano.os.ora(e
    Ean(!co"!nes(era/!ceJ, %ono<!d+" de car'on s! s+'s(an=e"e vo"a(!"e, c+% ar .!
    co%'+s(!'!"!! sa+ so"ven=!! o$an!c!.
    Dia!nostic di$erenial
    3e/! &a$. 5;F &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a"
    de"!r!+%+"+! s! &a$.9LH &en(r+ d!sc+(area d!a$nos(!c+"+! d!.eren=!a" a" !n(o<!ca=!e! s!
    a" de&enden=e! de o s+'s(an=7.
    Criteriile $e $ia/no&ti# pentru
    Deliriu"ul $atorat Into,i#a!iei #u o Su-&tan!(
    A2 #erturbare de con,tient &adic, reducerea claritii con,tientei ambianei)
    cu reducerea capacitii de a $ocali(a, susine ori deplasa atenia2
    S2 O modi$icare "n cunoa,tere &cum ar $i de$icitul de memorie, de(orientarea,
    perturbarea limba0ului) sau apariia unei perturbri de percepie, care nu
    este explicat mai bine de o demen preexistent, stabili(at sau "n curs de
    evoluie2
    2 #erturbarea se de(volt "n decursul unei scurte perioade de timp &de re!ul,
    "n c@teva ore sau (ile) ,i tinde s $luctue(e "n cursul (ilei2
    D2 Din istoric, examenul somatic ori datele de laborator re(ult proba, $ie a &E),
    $ie a &7)D
    &l)simptomele de la criteriile A ,i S apar "n cursul unei intoxicaii cu o
    substan3 &7) perturbarea este, etiolo!ic, "n le!tur cu u(ul unui
    medicamentU2
    FotD Acest dia!nostic trebuie pus "n locul unui dia!nostic de intoxicaie cu
    o substan, numai c@nd simptomele co!nitive sunt "n exces "n raport cu cele
    asociate de re!ul cu sindromul de intoxicaie ,i c@nd simptomele sunt
    su$icient de severe pentru a 0usti$ica o atenie clinic separat2
    UFotD Dia!nosticul trebuie s $ie "nre!istrat ca delirium indus de o
    substan, dac este "n le!tur cu u(ul unui medicament2 A se consulta
    anexa G, pentru codurile * care indic medicamentele speci$ice2
    odul &substana speci$ic) pentru deliriumul prin intoxicaieD
    &76E25 alcool3 76728E am$etamina &ori o substan similar am$etaminei)3
    76728E cannabis3 76728 cocain3 76728E %alucino!ene3 76728E in%alante3
    76728E opiacee3 76728E p%encKclidin &sau o substan similar p%encKclidinei)3
    76728E sedative, %ipnotice sau anxiolitice3 76728E alt substan 9sau o substan
    necunoscut:, 9de ex2, cimetidina, di!itala, ben(tropina:)2
    EHI Delinumul, Dementa, Tulburrile Amnestice si Alte Tulburri
    Criteriile $e $ia/no&ti# pentru Deliriu"ui prin
    A-&tinen!( $e o Su-&tan!(
    A #erturbare de con,tient &adic, reducerea claritii con,tientei ambiantei),
    cu reducerea capacitii de a $ocali(a, susine sau deplasa atenia
    S O modi$icare "n cunoa,tere &cum ar $i de$icitul de memorie, de(orientarea,
    perturbarea de limba0) sau de(voltarea unei perturbri de percepie, care nu
    este explicat mai bine de o dement preexistent, stabili(at sau evolutiv
    #erturbarea se de(volt "n decursul unei scurte perioade de timp &de re!ul,
    "n c@teva ore sau (ile) si tinde s $luctue(e "n cursul (ilei
    D Din istoric, examenul somatic ori datele de laborator, re(ult proba c
    simptomele de la criteriul A si S au aprut "n cursul ori la scurt timp dup un
    sindrom de abstinent
    FotD Acest dia!nostic trebuie s $ie pus "n locul dia!nosticului de abstinent
    de o substan, numai c@nd simptomele co!nitive sunt "n exces "n raport cu cele
    asociate de re!ul cu sindromul de abstinent si c@nd simptomele sunt
    su$icient de severe pentru a 0usti$ica o atenie clinic separat
    Codul &substana speci$ic) pentru delinumul prin abstinent
    &76E O alcool, 767 8E sedative, %ipnotice sau anxio%tice, 767 8E alt
    substan &sau o substan necunoscut)
    Deliriu"ui $atorat unor Etiolo/ii Multiple
    Ca(e$or!a de der!+% da(ora( +nor e(!o"o$+ %+"(!&"e es(e !nc"+s7 &en(r+ a a"er(a
    c"!n!c!an+" as+&ra s!(+a=!e! co%+ne :n care de"!n+%+" are %a! %+"( decA( o s!n$+r7
    e(!o"o$!e Poa(e e<!s(a %a! %+"( decA( o s!n$+ra cond!=!e %ed!ca"7 $enera"7 :n
    re"a=!e e(!o"o$!c7 c+ de"!n+%+" Ede e<, den+% da(ora( ence.a"o&a(!e! e&a(!ce,
    de"!n+% da(ora( (ra+%a(!s%+"+! cran!anJ or! de"!n+%+" &oa(e n da(ora( e.ec(e"or
    co%'!na(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<, ence.a"!(7 v!ra"7J s! +/+"+!
    +ne! s+'s(an=e Ede e< , a's(!nen(a a"coo"!c7J
    Procedee de :nre$!s(rare
    De"!r!+%+! da(ora( +nor e(!o"o$n %+"(!&"e n+ are +n cod &ro&r!+ se&ara( s! n+
    (re'+!e s7 .!e :nre$!s(ra( ca d!a$nos(!c De e<e%&"+, &en(r+ a cod!.!ca +n der!+%
    da(ora(, a(A( ence.a"o&a(!e! e&a(!ce, ca( s! a's(!nen(e! de a"coo", c"!n!c!an+" va
    %en=!ona, a(A( 9F; O Der!+% da(ora( ence.a"o&a(!e! e&a(!ce, cA( s! 9F5 O Der!+%
    &r!n a's(!nen(7 de a"coo", &e a<a I, !ar YH9 9 Ence.a"o&a(!e e&a(!c7, &e a<a III
    ?85265 Delirium 'r Alt
    Speci$icaie
    5IH
    Criteriile $e $ia/no&ti# pentru Deliriu"ul
    $atorat unor Etiolo/ii Multiple
    A2 #erturbare a con,tientei &adic, reducerea claritii con,tiensei ambiantei),
    cu reducerea capacitii de a $ocali(a, susine sau comuta atenia2
    S2 O modi$icare "n cunoa,tere &cum ar $i de$icitul de memorie, de(orientarea,
    perturbarea limba0ului) sau apariia unei perturbri de percepie, care nu
    este explicat mai bine de o demen preexistent, stabili(at sau evolutiv2
    2 #erturbarea se de(volta "n decursul unei scurte perioade de timp &de re!ul,
    "n c@teva ore sau (ile) si tinde s $luctue(e "n cursul (ilei2
    *2 Din istoric, examenul somatic ori datele de laborator re(ult proba c
    deliriumul are mai mult dec@t o sin!ur etiolo!ie &de ex2, mai mult dec@t o
    sin!ur condiie medical !eneral etiolo!ic, o condiie medical !eneral
    plus o intoxicaie cu o substan sau e$ectele secundare ale unui medicament)2
    Fot de codi$icareD A se utili(a coduri multiple care s re$lecte deliriumul
    speci$ic ,i etiolo!iile speci$ice, de ex2, 76425 Delirium datorat ence$alitei virale3
    76E25 Delirium prin abstinen alcoolic2
    G>+.5+ Deliriu" '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 &en(r+ a d!a$nos(!ca +n de"!r!+% care
    n+ sa(!s.ace cr!(er!!"e &en(r+ n!c! +n+" d!n (!&+r!"e s&ec!.!ce de de"!r!+% descr!se :n
    aces(a sec=!+ne.
    E<e%&"e"e !nc"+dQ
    1. Un (a'"o+ c"!n!c de de"!r!+%, care es(e s+s&ec(a( a se da(ora +ne! cond!=!!
    %ed!ca"e $enera"e or! +/+"+! +ne! s+'s(an=e, dar &en(r+ care n+ e<!s(7 s+.!c!en(e
    da(e &en(r+ a s(a'!"! o e(!o"o$!e s&ec!.!c7.
    2. De"!r!+% da(ora( +nor ca+/e ne%en=!ona(e :n aceas(7 sec=!+ne Ede e<.,
    de&r!varea sen/or!a"7J.
    De"en!a
    T+"'+r7r!"e d!n sec=!+nea SDe%en=aT se carac(er!/ea/7 &r!n de/vo"(area a
    n+%eroase de.!c!(e co$n!(!ve E!nc"+/And de(er!orarea %e%or!e!J care se da(orea/7
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e, e.ec(e"or &ers!s(en(e
    a"e +ne! s+'s(an=e or! +nor e(!o"o$!! %+"(!&"e Ede e<., e.ec(e"or co%'!na(e a"e +ne!
    %a"ad!! cere'rovasc+"are O! %a"ad!e! A"/e!%erJ. T+"'+r7r!"e d!n aceas(7 sec=!+ne
    a+ :n co%+n s!%&(o%a(o"o$!a, dar se d!.eren=!a/7 &e 'a/a e(!o"o$!e!. E"e%en(e"e de
    d!a$nos(!c %en=!ona(e :n sec=!+nea +r%7(oare a&ar=!n de%en=e! de (!& A"/e!%er,
    de%en=e! vasc+"are, de%en=e! da(ora(e %a"ad!e! HI3, de%en=e! da(ora(e
    (ra+%a(!s%+"+! cran!an, de%en=e! da(ora(e %a"ad!e! Par)!nson, de%en=e!
    da(ora(e %a"ad!e! H+n(!n$(on, de%en=e! da(ora(e %a"ad!e! P!c), de%en=e!
    da(ora(e %a"ad!e! Cre+(/.e"d(4*a)o', de%en=e! da(ora(e a"(or cond!=!! %ed!ca"e
    $enera"e, de%en=e! &ers!s(en(e !nd+se de o s+'s(an=7 s! de%en=e! da(ora(e +nor
    *7>
    Delinumul, Dementa, Tulburrile Amnestice si Alte Tulburri

    e(!o"o$!! %+"(!&"e Pe "An$7 aces(ea, :n aceas(7 sec=!+ne es(e !nc"+s7 s! de%en=a .7r7
    a"(7 s&ec!.!ca=!e, &en(r+ (a'"o+r!"e c"!n!ce :n care c"!n!c!an+" es(e !nca&a'!" s7
    &rec!/e/e o e(!o"o$!c s&ec!.!c7 &en(r+ de.!c!(e"e co$n!(!ve %+"(!&"e.
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" de%en=e! :" cons(!(+!e de/vo"(area +nor de.!c!(e co$n!(!ve
    %+"(!&"e care !nc"+d de(er!orarea %e%or!e! s! ce" &+=!n +na d!n(re +r%7(oare"e
    &er(+r'7r! co$n!(!ve a)a;ie, a&ra<!e, a$no/!e or! o &er(+r'are :n .+nc=!a de e<ec+=!e
    De.!c!(e"e co$n!(!ve (re'+!e s7 .!e s+.!c!en( de severe &en(r+ a ca+/a o de(er!orare :n
    .+nc=!onarea &ro.es!ona"7 sa+ soc!a"7 O! (re'+!e s7 re&re/!n(e +n dec"!n de "a ce" %a!
    :na"( n!ve" an(er!or de .+nc=!onare D!a$nos(!c+" de de%en=7 n+ (re'+!e &+s dac7
    de.!c!(e"e co$n!(!ve s+rv!n e<c"+s!v :n c+rs+" +n+! de"!r!+% :ns7, de%en=a s!
    den+%+" &o( .! a%'e"e d!a$nos(!ca(e, dac7 de%en(a es(e &re/en(7 +neor! s! cAnd
    de"!n+%+" "!&seO(e De%en=a &oa(e .! e(!o"o$!c :n "e$7(+r7 c+ o cond!=!e %ed!ca"7
    $enera"7, c+ e.ec(e"e &ers!s(en(e a"e +/+"+! +ne! s+'s(an=e E!nc"+s!v e<&+nerea "a +n
    (o<!cJ or! c+ o co%'!na=!e a aces(or .ac(or!
    De(er!orarea %e%or!e! es(e necesar7 &en(r+ a &+ne d!a$nos(!c+" de de%en=7 s!
    es(e +n s!%&(o% &recoce Ecr!(er!+" AJ Ind!v!/!! c+ de%en=7 a+ de(er!ora(7
    ca&ac!(a(ea de a :nv7=a +n %a(er!a" no+ or! +!(7 +n %a(er!a" :nv7=a( an(er!or Ce! %a!
    %+"=! !nd!v!/! c+ de%en(7 a+ a%'e"e .or%e de de(er!orare a %e%or!e!, c+ (oa(e c7
    +neor! es(e d!.!c!" s7 se de%ons(re/e &!erderea %a(er!a"+"+! :nv7=a( an(er!or,
    &recoce, :n c+rs+" (+"'+r7r!! E! &o( &!erde '+n+r!, c+% ar .! &or(%one!e O! ce!, +!(7
    %Ancarea de &re&ara( &e &"!(7 s! se &!erd :n car(!ere non.a%!are :n s(ad!!"e
    avansa(e de de%en=7, de(er!orarea %e%or!e! es(e a(A( de sever7, c7 &ersoana :O! +!(7
    &ro.es!a, s(+d!!"e, /!+a naO(er!!, %e%'r!! .a%!"!e! O! +neor! c!ar n+%e"e
    Me%or!a &oa(e .! (es(a(7 .or%a" cerAnd &ersoane! s7 :nre$!s(re/e, s7 re(!n7, s7
    evoce s! s7 rec+noasc7 o !n.or%a=!e Ca&ac!(a(ea de a :nv7=a o !n.or%a=!e no+7
    &oa(e .! eva"+a(7 cerAnd !nd!v!d+"+! s7 :nve=e o "!s(7 de c+v!n(e Ind!v!d+"+! ! se cere
    s7 re&e(e c+v!n(e"e E:nre$!s(rareJ, s7 re&rod+c7 !n.or%a=!a d+&7 +n !n(erva" de
    cA(eva %!n+(e Ere(en(!e, evocareJ s! s7 rec+noasc7 c+v!n(e"e d%(r4o "!s(7 %+"(!&"7
    Erec+noaO(ereJ Ind!v!/!! c+ d!.!c+"(a(e de :nv7=are a +ne! !n.or%a=!! no! n+ s+n(
    a@+(a=! de !nd!c!! sa+ &+nc(e de re&er Ede e<, &ro'"e%e"e c+ a"e$ere %+"(!&"7J,
    &en(r+ c7 e! n+ a+ :nv7=a( !n!=!a" %a(er!a"+" D!n con(ra, !nd!v!/!! c+ de.!c!(e :n
    &r!%+" rAnd de evocare &o( .! a@+(a=! &r!n !nd!c!! M &+nc(e de re&er, deoarece
    de(er!orarea "or se a."7 :n ca&ac!(a(ea de a accede "a %e%or!!"e "or Me%or!a
    :nde&7r(a(7 &oa(e .! (es(a(7 cerAnd !nd!v!d+"+! s7 evoce !n.or%a=!! &ersona"e sa+ +n
    %a(er!a" vec! &e care !nd!v!d+" :" cons!der7 !n(eresan( Ede e<, &o"!(!c7, s&or(,
    s&ec(aco"eJ De ase%enea, es(e +(!" s7 se &rec!/e/e Ede "a !nd!v!d+" :n ca+/7 s! de "a
    !n.or%a(or!J !%&ac(+" &er(+r'7r!"or de %e%or!e as+&ra .+nc=!on7r!! !nd!v!d+"+! Ede
    e< , ca&ac!(a(ea de a %+nc!, de a c+%&7ra, de a &re&ara %Ancarea, de a ac!(a no(e"e
    de &"a(7, de a ven! acas7 .7r7 s7 se &!ard7J
    De(er!orarea .+nc=!e! "!%'a@+"+! Ea.a/!aJ se &oa(e %an!.es(a &r!n d!.!c+"(a(e :n
    &ron+n=area n+%e"or de &ersoane s! de o'!ec(e Ecr!(er!+" A9aJ L!%'a@+" !nd!v!/!"or
    c+ a.a/!e &oa(e deven! va$ sa+ van, c+ "+n$! e<&res!! c!rc+%"oc+(o% s! c+ +/
    e<ces!v de (er%en! de re.er!re !nde.!n!(7, c+% ar .! S"+cr+T s! Sas(aT :n=e"e$erea
    "!%'a@+"+! vor'!( s! scr!s, s! vor'!rea re&e(a(7 &o( .!, de ase%enea, co%&ro%!se :n
    s(ad!!"e de de%en=7 avansa(7, !nd!v!d+" &oa(e .! %+( sa+ &oa(e avea +n &a((ern de
    vor'!re de(er!ora(, carac(er!/a( &r!n eco"a"!e Ead!c7, re&e(area a ceea ce es(e a+/!(J or!
    &a"a"!e Ead!c7, re&e(area :n(r4+na a s+ne(e"or sa+ c+v!n(e"or &ro&r!!J L!%'a@+" es(e
    Demen
    a
    EH6
    (es(a( cerAnd !nd!v!d+"+! s7 den+%easc7 o'!ec(e"e d!n ca%er7 Ede e<., crava(a,
    roc!a, %asa, "a%&aJ or! &7r=! a"e cor&+"+! Ede e<., nas+", '7r'!a, +%7r+"J, s7 e<ec+(e
    co%en/! ESar7(a=! +Oa O! a&o! %asaTJ or! s7 re&e(e +ne"e e<&res!! ESn!c! +n .e" de
    dac74+r!, s!4+r! or! dar4+r!TJ.
    Ind!v!/!! c+ de%en=7 &o( &re/en(a a&ra<!e Ead!c7, de(er!orarea ca&ac!(7=!! de a
    e.ec(+a ac(!v!(7=! %o(or!! :n d!s&re=+" a&(!(+d!n!"or %o(or!!, .+nc=!e! sen/or!a"e s!
    :n=e"e$er!! sarc!n!"or cer+(e, care s+n( !n(ac(eJ Ecr!(er!+" A9'J. E! s+n( de(er!ora=! :n
    ca&ac!(a(ea "or de a &an(o%!%a +/+" d!verse"or o'!ec(e Ede e<., &!e&(7na(+" &7r+"+!J
    or! de a e<ec+(a ac(e %o(or!! c+nosc+(e Ede e<., $es(+" de S"a revedereTJ. A&ra<!a
    &oa(e con(r!'+! "a d!.!c+"(7=!"e :n &re&ararea %Anc7r!!, "a :%'r7ca( s! desena(.
    Per(+r'7r!"e a&(!(+d!n!"or %o(or!! &o( .! (es(a(e cerAnd !nd!v!d+"+! s7 e<ec+(e d!verse
    ac(!v!(7=! %o(or!! Ede e<., s7 ara(e c+% se s&a"7 &e d!n=!, s7 co&!e/e do+7 &en(a$oane
    care se !n(ersec(ea/7, s7 asa%'"e/e c+'+r! or! s7 aran@e/e 'e=e :n an+%!(e deseneJ.
    Ind!v!/!! c+ de%en=7 &o( &re/en(a a$no/!e Ead!c7, !nca&ac!(a(ea de a rec+noaO(e
    sa+ !den(!.!ca o'!ec(e"e, :n d!s&re=+" .+nc=!e! sen/or!a"e !n(ac(eJ Ecr!(er!+" A9cJ. De
    e<e%&"+, !nd!v!d+" &oa(e avea ac+!(a(ea v!/+a"7 nor%a"7, dar a &!erd+( ca&ac!(a(ea
    de a rec+noaO(e o'!ec(e c+% s+n( sca+ne"e sa+ cre!oane"e, :n ce"e d!n +r%7, e! &o(
    .! !nca&a'!"! s74O! rec+noasc7 %e%'r!! .a%!"!e! or! &ro&r!a "or !%a$!ne :n o$"!nd7.
    De ase%enea, e! &o( avea sen/a=!a (ac(!"7 nor%a"7, dar &o( .! !nca&a'!"! s7 !den(!.!ce
    o'!ec(e"e &+se :n %An7, n+%a! &r!n (ac( Ede e<., o %oned7 sa+ o ce!eJ.
    Per(+r'7r!"e :n .+nc=!a de e<ec+=!e s+n( o %an!.es(are co%+n7 a de%en=e! Ecr!(er!+"
    A9dJ s! &o( .! re"a=!ona"e :n s&ec!a" c+ (+"'+r7r!"e "o'+"+! .ron(a" sa+ a"e c7!"or de
    asoc!a=!e s+'cor(!ca"e. F+nc=!a de e<ec+=!e !%&"!c7 ca&ac!(a(ea de a $And! a's(rac(, de
    a &"an!.!ca, secven=!a, %on!(or!/a O! s(o&a co%&or(a%en(+" co%&"e<. De(er!orarea
    $And!r!! a's(rac(e se &oa(e %an!.es(a &r!n d!.!c+"(7=!"e &e care "e are !nd!v!d+" :n a .ace
    .a=7 +nor sarc!n! no! O! &r!n ev!(area s!(+a=!!"or care cer &rocesarea de !n.or%a=!e no+7
    O! co%&"e<7. Ca&ac!(a(ea de a's(rac(!/are &oa(e .! eva"+a(7 .or%a" cerAnd &ersoane!
    s7 $7seasc7 s!%!"!(+d!n! sa+ d!.eren=e :n(re c+v!n(e :nr+d!(e. D!s.+nc=!a e<ec+(!v7 es(e,
    de ase%enea, ev!den=!a(7 &r!n ca&ac!(a(ea red+s7 de a sc!%'a se(+r!"e %en(a"e, de a
    crea o no+7 !n.or%a=!e ver'a"7 O! nonver'a"7 s! de a e<ec+(a ac(!v!(7=! %o(or!! de ser!e.
    Tes(e"e &en(r+ .+nc=!a de e<ec+=!e !nc"+d a cere !nd!v!d+"+! s7 n+%ere &An7 "a 5L, s7
    rec!(e a".a'e(+", s7 scad7 d!n H :n H, s7 en+%ere &e cA( es(e &os!'!" cA( %a! %+"(e
    an!%a"e :n(r4+n %!n+(, or! s7 (rase/e o "!n!e con(!n+7 cons(And a"(erna(!v d!n % O! n.
    Es(e, de ase%enea, +(!" s7 se s(a'!"easc7 Ede "a !nd!v!d O! de "a !n.or%a(or!J !%&ac(+"
    &er(+r'7r!"or d!n .+nc=!a de e<ec+=!e as+&ra v!e=!! co(!d!ene a !nd!v!d+"+! Ede e<.,
    ca&ac!(a(ea de a %+nc!, ac(!v!(7=!"e de &"an!.!care, '+$e(+"J.
    A(A( !(e%!! de "a cr!(er!+" A" Ede(er!orarea %e%or!e!J, cA( O! ce! de "a cr!(er!+" A9
    Ea.a/!a, a&ra<!a, a$no/!a sa+ &er(+r'area .+nc=!e! de e<ec+=!eJ (re'+!e s7 .!e
    s+.!c!en( de sever! &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea
    soc!a"7 sa+ &ro.es!ona"7 Ede e<., %ers+" "a Ocoa"7, "a "+cr+, "a c+%&7r7(+r!,
    :%'r7ca(+", :%'7!a(+", %An+!rea .!nan=e"or s! a"(e ac(!v!(7=! a"e v!e=!! co(!d!eneJ s!
    (re'+!e s7 re&re/!n(e +n dec"!n de "a n!ve"+" an(er!or de .+nc=!onare Ecr!(er!+" BJ.
    Na(+ra O! $rad+" de de(er!orare s+n( var!a'!"e O! de&!nd adesea de cond!=!a soc!a"7
    &ar(!c+"ar7 a !nd!v!d+"+!. Ace"aO! n!ve" de de(er!orare co$n!(!v7 &oa(e a"(era
    se%n!.!ca(!v ca&ac!(a(ea !nd!v!d+"+! de a :nde&"!n! o sarc!n7 co%&"e<7, dar n+ O! o
    sarc!n7 care es(e %a! &+=!n &re(en=!oas7. Sca"e"e de eva"+are s(andard!/a(e &+'"!ca(e
    care %7soar7 :n(re=!nerea cor&ora"7 Ede e<., !$!ena &ersona"7J, .+nc=!onarea
    !n(e"ec(+a"7 s! ca&ac!(a(ea de a +(!"!/a +ne"(e sa+ !ns(r+%en(e Ede e<., (e"e.on+",
    %aO!na de s&7"a(J, &o( .! +(!"!/a(e &en(r+ a %7s+ra sever!(a(ea de(er!or7r!!.
    EA5
    Deliriumul, Demena, Tulburrile Amnestice si Alte Tulburri
    De%en=a n+ es(e d!a$nos(!ca(7, dac7 aces(e s!%&(o%e s+rv!n e<c"+s!v :n c+rs+"
    +n+! de"!r!+%. Un de"!r!+% &oa(e .! :ns7, s+&ra&+s &es(e o de%en=7 &ree<!s(en(7,
    ca/ :n care (re'+!e &+se a%'e"e d!a$nos(!ce.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. Ind!v!/!! c+ de%en=7 &o(
    deven! de/or!en(a=! :n s&a=!+ s! &o( avea d!.!c+"(7=! c+ sarc!n!"e s&a=!a"e.
    F+nc=!onarea v!/+os&a=!a"7 &oa(e .! eva"+a(7 cerAnd !nd!v!d+"+! s7 co&!e/e desene,
    de e<e%&"+, +n cerc, &en(a$oane s+&ra&+se s! +n c+'. *+deca(a &recar7 s! conO(!!n=a
    %a"ad!e! red+s7 s+n( co%+ne :n de%en=7. Ind!v!/!! &o( avea .oar(e &+=!n sa+ de"oc
    conO(!!n=a &!erder!! %e%or!e! sa+ a a"(or ano%a"!! co$n!(!ve. Po( .ace a&rec!er!
    nerea"!s(e as+&ra ca&ac!(7=!"or "or O! .ac &"an+r! care n+ s+n( con$r+en(e c+
    de.!c!(e"e s! c+ &ro$nos(!c+" "or Ede e<., !n(en=!onea/7 s7 :ncea&7 o no+7 a.acereJ. De
    ase%enea, &o( s+'es(!%a r!sc+r!"e !%&"!ca(e de +ne"e ac(!v!(7=! Ede e<., de cond+sJ.
    Oca/!ona", deven!nd v!o"en=!, &o( v7(7%a &e a"=!!. Poa(e s+rven! +n co%&or(a%en(
    s+!c!dar, :n s&ec!a" :n s(ad!!"e !n!=!a"e, cAnd !nd!v!d+" %a! es(e ca&a'!" s7 e<ec+(e
    &"an+" +ne! ac=!+n!. De%en=a es(e aco%&an!a(7 +neor! de &er(+r'7r! %o(or!! a"e
    %ers+"+!, care d+c "a c7der!. Un!! !nd!v!/! c+ de%en=7 &re/!n(7 +n co%&or(a%en(
    de/!n!'a(, !nc"+/And s&!r!(e"e !nadecva(e, ne$"!@area !$!ene! &ersona"e,
    %an!.es(area +ne! .a%!"!ar!(7=! deran@an(e c+ s(r7!n!! or! descons!derarea re$+"!"or
    conven=!ona"e de cond+!(7 soc!a"7. 3or'!rea d!/ar(r!c7 &oa(e s+rven! :n de%en=a
    asoc!a(7 c+ o &a(o"o$!e s+'cor(!ca"7, c+% ar .! %a"ad!a Par)!nson, %a"ad!a
    H+n(!n$(on s! +ne"e ca/+r! de de%en=7 vasc+"ar7. M+"(!&"e"e de(er!or7r! co$n!(!ve
    a"e de%en=e! s+n( asoc!a(e adesea c+ &er(+r'7r! an<!oase, a.ec(!ve s! de so%n. Ide!"e
    de"!ran(e s+n( .recven(e, :n s&ec!a" ce"e care !%&"!c7 (e%e de &ersec+=!e Ede e<., c7
    '+n+r!"e, r7+ &+se, !4a+ .os( .+ra(eJ. Ha"+c!na=!!"e &o( s+rven! :n (oa(e %oda"!(7=!"e
    sen/or!a"e, dar a"+c!na=!!"e v!/+a"e s! a+d!(!ve s+n( ce"e %a! .recven(e. De"!r!+%+"
    es(e s+&ra&+s .recven( &es(e de%en=7, deoarece %a"ad!a cere'ra"7 s+'!acen(7 &oa(e
    cres(e s+sce&(!'!"!(a(ea "a s(7r! con.+/!ona"e, care &o( .! &rod+se de %ed!ca%en(e
    sa+ de a"(e cond!=!! %ed!ca"e $enera"e conco%!(en(e. Ind!v!/!! c+ de%en=7 &o( .!
    e<(re% de v+"nera'!"! "a s(resor!! .!/!c! Ede e<., o %a"ad!e sa+ o !n(erven=!e
    c!r+r$!ca"7 %!nor7J s! "a s(resor!! &s!osoc!a"! Ede e<., a %er$e "a s&!(a", do"!+"J care
    "e &o( e<acer'a de.!c!(e"e !n(e"ec(+a"e O! a"(e &ro'"e%e asoc!a(e.
    Da(e de "a'ora(or asoc!a(e. O d!sc+(are a da(e"or de "a'ora(or asoc!a(e,
    s&ec!.!ce d!verse"or (!&+r! de de%en=7, es(e !nc"+s7 :n (e<(+" &en(r+ .!ecare de%en=7,
    :n %od cons(an(, e<!s(7 ano%a"!! :n .+nc=!onarea co$n!(!v7 s! %ne/!c7, ano%a"!! care
    &o( .! eva"+a(e &r!n e<a%!n7r! a"e s(a(+s+"+! %en(a" s! (es(are ne+ro&s!o"o$!c7.
    Ne+ro!%a$!s(!ca &oa(e a@+(a "a e.ec(+area d!a$nos(!c+"+! d!.eren=!a" a" de%en=e!.
    To%o$ra.!a co%&+(er!/a(7 ETCJ or! !%a$!s(!ca &r!n re/onan=7 %a$ne(!c7 ERMNJ
    &oa(e re"eva o a(ro.!e cere'ra"7, "e/!+n! cere'ra"e .oca"e E!c(+s+r! cor(!ca"e, (+%or!,
    e%a(oa%e s+'d+ra"eJ, !droce.a"!e or! "e/!+n! cere'ra"e !sce%!ce &er!ven(r!4
    c+"are. I%a$!s(!ca .+nc=!ona"7, c+% ar .! (o%o$ra.!a &r!n e%!s!+ne de &o/!(ron!
    EPETJ or! (o%o$ra.!a co%&+(er!/a(7 &r!n e%!s!+nea +n+! s!n$+r .o(on ESPECTJ, n+
    es(e +(!"!/a(7 c+ren( :n eva"+area de%en=e!, dar &oa(e .+rn!/a !n.or%a=!! +(!"e
    &en(r+ d!a$nos(!c+" d!.eren=!a" Ede e<., %od!.!c7r!"e d!n "o'+" &ar!e(a" :n %a"ad!a
    A"/e!%er or! a"(er7r!"e d!n "o'+" .ron(a" :n de$enerescen(e"e "o'+"+! .ron(a"J "a
    !nd!v!/!! .7r7 &ro'a +nor %od!.!c7r! s(r+c(+ra"e "a scan7r!"e &r!n (o%o$ra.!e
    co%&+(er!/a(7 or! re/onan=7 %a$ne(!c7.
    Demen
    a
    *<*

    9atele examinrilor somatice si condi3iile medicale .enerale asociate. Da(e"e
    e<a%!n7r!"or so%a(!ce asoc!a(e a"e de%en=e! de&!nd de na(+ra, "oca"!/area s! s(ad!+"
    de evo"+=!e a" &a(o"o$!e! s+'!acen(e. Cea %a! .recven(7 ca+/7 a de%en=e! es(e
    %a"ad!a A"/e!%er, +r%a(7 de %a"ad!a vasc+"ar7 s! a&o! de e(!o"o$!!"e %+"(!&"e.
    A"(e .or%e .recven(e !nc"+d de%en=a vasc+"ar7 s! de%en=a da(ora(7 a"(or &rocese
    ne+rode$enera(!ve, c+% ar .! %a"ad!a c+ cor&+sc+"! Le#y E!nc"+/And de%en=a
    da(ora(7 %a"ad!e! Par)!nsonJ O! de$enerescen(a .ron(o(e%&ora"7 E!nc"+/And
    %a"ad!a P!c)J. A"(e ca+/e s+n( %a! &+=!n .recven(e s! !nc"+d !droce.a"!a c+
    &res!+ne nor%a"7, %a"ad!a H+n(!n$(on, "e/!+n!"e cere'ra"e (ra+%a(!ce, (+%or!"e
    cere'ra"e, ano<!a, (+"'+r7r!"e !n.ec=!oase Ede e<., v!r+s+" !%+node.!c!en=e! +%ane
    EHI3J, s!.!"!s+"J, %a"ad!!"e &r!on!ce Ede e<., %a"ad!a Cre+(/.e"d(4*a)o'J, cond!=!!"e
    endocr!ne Ede e<., !&o(!ro!d!s%+", !&erca"ce%!a, !&o$"!ce%!aJ, de.!c!en(e"e
    v!(a%!n!ce Ede e<., de.!c!en=e"e de (!a%!n7, n!ac!n7J, (+"'+r7r!"e !%+no"o$!ce Ede e<.,
    ar(er!(a (e%o&ora"7, "+&+s+" er!(e%a(os s!s(e%!cJ, cond!=!!"e e&a(!ce, cond!=!!"e
    %e(a'o"!ce Ede e<., %a"ad!a -+.s, adreno"e+cod!s(ro.!a, "e+cod!s(ro.!a %e(acro4
    %a(!c7 O! a"(e %a"ad!! de s(oca@ a"e &er!oade! ad+"(e O! co&!"7r!e!J s! a"(e cond!=!!
    ne+ro"o$!ce Ede e<., sc"ero/a %+"(!&"7J.
    *lemente speci$ice culturii si etii
    Fond+" c+"(+ra" O! ed+ca=!ona" (re'+!e s7 .!e "+a( :n cons!dera=!e :n eva"+area
    ca&ac!(7=!! %en(a"e a !nd!v!d+"+!. Ind!v!/!! d!n an+%!(e .ond+r! &o( s7 n+ .!e
    .a%!"!ar!/a=! c+ !n.or%a=!!"e +(!"!/a(e :n an+%!(e (es(e de c+noO(!n=e $enera"e Ede e<.,
    n+%e"e &reOed!n=!"or, c+noO(!n=e"e $eo$ra.!ceJ, de %e%or!e Ede e<., da(a naO(er!! :n
    c+"(+r!"e care n+ ce"e'rea/7 :n %od r+(!n!er da(a naO(er!!J O! de or!en(are Ede e<.,
    sen(!%en(+" de "oc O! de s&a=!+ &oa(e .! conce&(+a"!/a( d!.er!( :n +ne"e c+"(+r!J.
    Preva"en(a d!.er!(e"or ca+/e de de%en=7 Ede e<., !n.ec=!!, de.!c!en=e n+(r!=!ona"e,
    "e/!+n! cere'ra"e (ra+%a(!ce, cond!=!! endocr!ne, %a"ad!! cere'rovasc+"are,
    e&!"e&s!!, (+%or! cere'ra"e, a'+/+" de o s+'s(an=7J var!a/7 s+'s(an=!a" :n ra&or( c+
    $r+&+r!"e c+"(+ra"e.
    E(a(ea "a de'+(+" de%en=e! de&!nde de e(!o"o$!e, dar de re$+"7 de'+(+" are "oc
    (ard!v :n v!a=7, c+ cea %a! %are &reva"en(7 :n @+r+" e(7=!! de GY an!. O de(er!orare
    se%n!.!ca(!v7 a %e%or!e! s! a %+"(!&"e a&(!(+d!n! co$n!(!ve, care es(e necesar7
    &en(r+ d!a$nos(!c+" de%en=e!, &oa(e .! d!.!c!" de doc+%en(a( "a co&!!! .oar(e %!c!.
    Ca a(are, d!a$nos(!c+" de de%en=7 n+ &oa(e .! &rac(!c &+s &An7 cAnd co&!"+" n+
    dev!ne %a! %are Ede re$+"7, :n(re I O! R an!J. La !nd!v!/!! s+' e(a(ea de 5G an! c+
    re(ardare %en(a"7, +n d!a$nos(!c ad!=!ona" de de%en=7 (re'+!e &+s, n+%a! dac7
    cond!=!a n+ es(e carac(er!/a(7 :n %od sa(!s.7c7(or de d!a$nos(!c+" de re(ardare
    %en(a"7, s!n$+r. De%en=a es(e rar7 "a co&!! O! ado"escen=!, dar &oa(e s+rven! ca
    re/+"(a( a" +nor cond!=!! %ed!ca"e $enera"e Ede e<., (ra+%a(!s%e cran!ene, (+%or!
    cere'ra"e, !n.ec=!e c+ HI3, !c(+s+r!, adreno"e+cod!s(ro.!!J. De%en=a "a co&!! se &oa(e
    &re/en(a ca o de(er!orare :n .+nc=!onare Eca "a ad+"=!J or! ca o :n(Ar/!ere
    se%n!.!ca(!v7 sa+ dev!a=!e :n de/vo"(area nor%a"7. De(er!orarea e.!c!en=e! Oco"are
    &oa(e .! +n se%n &recoce.
    #revalent
    Preva"en(a ra&or(a(7 a de%en(e! var!a/7 :n s(+d!!"e e&!de%!o"o$!ce, :n .+nc=!e de
    e(a(ea s+'!ec=!"or esan(!ona=!, de %e(ode"e de de(er%!nare a &re/en=e!, sever!(7=!! s!
    (!&+"+! de de(er!orare co$n!(!v7, &rec+% s! de re$!+n!"e sa+ =7r!"e s(+d!a(e. S(+d!!"e
    *<C
    Delinumul, Dementa, Tulburrile Amnestice si Alte Tulburri

    co%+n!(are es(!%ea/7 &reva"en(a &os!'!"7 &e " an "a a&ro<!%a(!v ; d, c+ de(er!orare
    co$n!(!v7 sever7 :n &o&+"a=!a ad+"(7 S(+d!+" a eva"+a( !nd!v!/!! c+ +n ces(!onar
    sc+r( care s(a'!"eO(e s(a(+s+" co$n!(!v c+ren( E(e M%!4Men(a" S(a(e E<a%J, dar care
    n+ !den(!.!c7 d!a$nos(!ce s&ec!.!ce O %+"=!%e de s(+d!! e&!de%!o"o$!ce a+ ar7(a( c7
    &reva"en(a de%en=e!, :n s&ec!a" a de%en(e! de (!& A"/e!%er, cres(e oda(7 c+
    avansarea :n e(a(e 3a"or!"e &reva"en(e! cresc de "a 5,Id "a 5,Rd "a !nd!v!/!! :n e(a(e
    de RY4RF an! s! de "a 5Rd "a 9Yd "a ce! :n e(a(e de &es(e GY a%
    *voluie
    Is(or!c, (er%en+" de demen(6 !%&"!c7 o evo"+=!e &ro$red!en(7 sa+ !revers!'!"7
    De.!n!=!a DSM4I3 a de%en=e! es(e 'a/a(7 :ns7, &e &a((ern+" de.!c!(e"or co$n!(!ve s!
    n+ &oar(7 n!c! o cono(a=!e re.er!(oare "a &ro$nos(!c De%en=a &oa(e .! &ro$res!v7,
    s(a=!onar7 or! re%!(en(7 Revers!'!"!(a(ea +ne! de%en=e es(e :n .+nc=!e de &a(o"o$!a
    s+'!acen(7 s! de d!s&on!'!"!(a(ea O! a&"!carea o&or(+n7 a +n+! (ra(a%en( e.!c!en(
    Mod+" de de'+( s! evo"+=!a +"(er!oar7 a de%en=e! de&!nd, de ase%enea, de e(!o"o$!a
    s+'!acen(7 N!ve"+" de !nca&ac!(a(e de&!nde n+ n+%a! de sever!(a(ea de(er!or7r!"or
    co$n!(!ve a"e !nd!v!d+"+! dar s! de s+&or(+" soc!a" d!s&on!'!" :n de%en=a avansa(7,
    !nd!v!d+" &oa(e deven! (o(a" !nconO(!en( .a=7 de a%'!an=a sa s! neces!(7 :n$r!@!re
    &er%anen(7 Ind!v!/!! c+ de%en=7 sever7 s+n( s+sce&(!'!"! de acc!den(e O! %a"ad!!
    !n.ec=!oase, care adesea se dovedesc a .! .a(a"e
    Dia!nostic di$erenial
    De(er!orarea %e%or!e! s+rv!ne a(A( :n de"!r!+%, cA( s!4n de%en=7 Den+%+"
    es(e carac(er!/a(, de ase%enea, &nn(r4o ca&ac!(a(e red+s7 de a %en=!ne O! de&"asa :n
    %od cores&+n/7(or a(en=!a Evo"+=!a c"!n!c7 &oa(e a@+(a "a d!.eren=!erea
    der!+%+"+! de de%en(7 De re$+"7, s!%&(o%e"e :n de"!r!+% ."+c(+ea/7, &e cAnd :n
    de%en=7 s+n( re"a(!v s(a'!"e De(er!or7r!"e co$n!(!ve %+"(!&"e, care &ers!s(7 :n(r4o
    .or%7 nesc!%'a(7 %a! %+"( de cA(eva "+n!, s+$erea/7 %a! c+rAnd de%en=a decA(
    der!+%+" Den+%+" &oa(e .! s+&ra&+s &es(e o de%en(7, :n care ca/ a%'e"e
    (+"'+r7r! s+n( d!a$nos(!ca(e :n s!(+a=!!"e :n care n+ es(e c"ar dac7 de.!c!(e"e
    co$n!(!ve se da(orea/7 der!+%+"+! sa+ de%en(e!, &oa(e .! +(!" s7 se &+n7 +n
    d!a$nos(!c de de"!r!+% s! s7 se o'serve a(en( &ersoana :n (!%& ce se con(!n+7
    e.or(+r!"e &en(r+ a !den(!.!ca na(+ra &er(+r'7r!!
    T+"'+rarea a%nes(!c7 es(e carac(er!/a(7 &nn(r4o de(er!orare sever7 de %e%or!e,
    .7r7 a"(e de(er!or7r! se%n!.!ca(!ve a"e ac(!v!(7=!! co$n!(!ve Ead!c7, .7r7 a.a/!e, a&ra<!e,
    a$no/!e or! &er(+r'7r! :n ac(!v!(a(ea de e<ec+=!eJ
    E(!o"o$!a &res+&+s7 de(er%!n7 d!a$nos(!c+" de de%en=7 s&ec!.!c7 Dac7
    c"!n!c!an+" a s(a'!"!( c7 de%en(a es(e da(ora(7 +nor e(!o"o$!! %+"(!&"e, (re'+!e s7 .!e
    +(!"!/a(e cod+r! %+"(!&"e 'a/a(e &e de%en(e"e s&ec!.!ce s! e(!o"o$n!e "or Eve/!
    de%en(a da(ora(7 +nor e(!o"o$!! %+"(!&"e, &a$ 5HLJ :n de%en(a vasc+"ar7, s+n(
    &re/en(e se%ne ne+ro"o$!ce de .ocar Ede e< , e<a$erarea re."e<e"or os(eo(end%oase,
    se%n+" Ba'%s)! s! &ro'a de "a'ora(or a +ne! %a"ad!! vasc+"are, cons!dera(e a .! :n
    re"a=!e c+ de%en(a Evo"+=!a c"!n!c7 a de%en(e! vasc+"are es(e var!a'!"7 s! de re$+"7
    &ro$resea/7 :n %od (re&(a( Pre/en(a de%en(e! da(ora(e a"(or cond!=!! %ed!ca"e
    $enera"e Ede e<, %a"ad!a P!c), HI3J neces!(7 &ro'area d!n !s(or!c, e<a%en+"
    so%a(!c s! (es(e"e de "a'ora(or adecva(e, a .a&(+"+! c7 o cond!=!e %ed!ca"7 $enera"7
    es(e e(!o"o$!c :n re"a=!e c+ de%en(a De'+(+" de(er!or7r!! E$rad+a" sa+ 'r+scJ s!
    evo"+=!a sa Eac+(7, s+'ac+(7 sa+ cron!c7J &o( .! +(!"e :n s+$erarea e(!o"o$!e!
    Demen
    ta
    5Y;
    De e<e%&"+, sever!(a(ea de(er!or7% :n ac(!v!(a(ea co$n!(!v7 r7%Ane adesea
    s(a=!onar7 d+&7 +n (ra+%a(!s% cran!an, ence.a"!(7 sa+ !c(+s
    De.!c!(e"e co$n!(!ve %+"(!&"e care s+rv!n n+%a! :n con(e<(+" +/+"+! +ne!
    s+'s(an=e s+n( d!a$nos(!ca(e ca !n(o<!ca=!e c+ o s+'s(an=7 on ca a's(!nen=7 de o
    s+'s(an=7 Dac7 de%en=a re/+"(7 d!n e.ec(e"e &ers!s(en(e a"e +ne! s+'s(an=e Ead!c7,
    +n dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea "a +n (o<!cJ, a(+nc! es(e
    d!a$nos(!ca(7 de%en=a &ers!s(en(7 !nd+s7 de o s+'s(an=7 A"(e ca+/e de de%en=7
    Ede e<, de%en=a da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eJ (re'+!e (o(dea+na "+a(e
    :n cons!dera=!e, c!ar "a o &ersoan7 c+ de&enden=7 de o s+'s(an=7. De e<e%&"+, +n
    (ra+%a(!s% cran!an n+ es(e rar :n c+rs+" +/+"+! +ne! s+'s(an=e O! &oa(e s7 se a."e "a
    'a/a de%en=e! De%en=a de (!& A"/e!%er es(e :n %od c+ren( +n d!a$nos(!c de
    e<c"+dere, %a! :n(A! (re'+!nd s7 .!e e<c"+se a"(e ca+/e de de.!c!(e co$n!(!ve Eve/! %a!
    s+sJ :n &"+s, evo"+=!a es(e carac(er!/a(7 &nn(r4+n de'+( $rad+a" s! dec"!n co$n!(!v
    con(!n++ :n ace"e ca/+n, :n care n+ e<!s(7 s+.!c!en(e da(e &en(r+ a s(a'!"! dac7
    de%en=a es(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e sa+ es(e !nd+s7 de o
    s+'s(an=7, (re'+!e cod!.!ca(7 de%en=a .7r7 a"(7 s&ec!.!ca=!e. Ind!v!/!! &o( &re/en(a
    n+%a! +ne"e, dar n+ (oa(e s!%&(o%e"e de%en=e! As(.e" de (a'"o+r! c"!n!ce (re'+!e
    s7 .!e cod!.!ca(e ca (+"'+rare co$n!(!v7 .7r7 a"(7 s&ec!.!ca=!e
    Re(ardarea %en(a"7 es(e carac(er!/a(7 &nn(r4o .+nc=!onare !n(e"ec(+a"7 $enera"7
    c+ren(7 se%n!.!ca(!v s+' %ed!e, c+ de(er!or7n conco%!(en(e :n .+nc=!onarea
    ada&(a(!v7 s! c+ de'+( :na!n(e de e(a(ea de 5G a% Re(ardarea %en(a"7 n+ es(e
    asoc!a(7 necesar%en(e c+ de(er!orarea %ne/!c7 D!n con(ra, de'+(+" :n de%en=7
    s+rv!ne de re$+"7 %a! (Ar/!+ :n v!a(7 Dac7 de'+(+" de%en(e! are "oc :na!n(e de
    e(a(ea de 5G a%, a(A( de%en(a, cA( s! re(ardarea %en(a"7 &o( .! d!a$nos(!ca(e, dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a%'e"e (+"'+r7r! Doc+%en(area +ne! de(er!or7r!
    se%n!.!ca(!ve de %e%one s! a a"(or a&(!(+d!n! co$n!(!ve &oa(e .! d!.!c!"7 "a o
    &ersoan7 s+' e(a(ea de I a% La !nd!v!/!! s+' e(a(ea de 5G an!, d!a$nos(!c+" de
    de%en=7 (re'+!e &+s n+%a! dac7 cond!=!a n+ es(e carac(er!/a(7 sa(!s.7c7(or doar de
    d!a$nos(!c+" de re(ardare %en(a"7, s!n$+r
    Sc!/o.ren!a &oa(e .!, de ase%enea, asoc!a(7 c+ %+"(!&"e de(er!or7r! co$n!(!ve s!
    dec"!n :n .+nc=!onare, dar sc!/o.ren!a es(e con(rar!+" de%en=e!, &nn e(a(ea :n
    $enera" %a! %!c7 "a de'+(, &r!n &a((ern+" s7+ carac(er!s(!c de s!%&(o%e O! &r!n
    a'sen=a +ne! cond!=!! %ed!ca"e $enera"e on a +ne! s+'s(an=e s&ec!.!ce e(!o"o$!c De
    re$+"7, de(er!orarea co$n!(!v7 asoc!a(7 c+ sc!/o.ren!a es(e %a! &+=!n sever7 decA(
    cea o'serva(7 :n de%en(7
    T+"'+rarea de&res!v7 %a@or7 &oa(e .! asoc!a(7 c+ ac+/e de de(enorare a
    %e%or!e!, d!.!c+"(a(e :n $And!re s! :n concen(rare s! o red+cere $"o'a"7 a
    ca&ac!(7=!"or !n(e"ec(+a"e Uneor! !nd!v!/!! Ec+ (+"'+rare de&res!v7 %a@or7J o'=!n
    re/+"(a(e %odes(e "a e<a%!n7r!"e s(a(+(+"+! %en(a" s! "a (es(area ne+ro&s!o"o$!c7
    :n s&ec!a" "a &ersoane"e :n e(a(e, adesea es(e d!.!c!" s7 se &rec!/e/e dac7 s!%&(o%e"e
    co$n!(!ve s+n( e<&"!ca(e %a! '!ne de o de%en(7 on de +n e&!sod de&res!v %a@or
    Aces( d!a$nos(!c d!.eren=!a" &oa(e .! c"ar!.!ca( &nn(r4o eva"+are %ed!ca"7 de(a"!a(7 s!
    o eva"+are a de'+(+"+! &er(+r'7%, s+cces!+nea (e%&ora"7 a s!%&(o%e"or de&res!ve
    s! co$n!(!ve, evo"+=!a %a"ad!e!, !s(or!c+" .a%!"!a" s! r7s&+ns+" "a (ra(a%en( S(area
    &re%or'!d7 a !nd!v!d+"+! &oa(e a@+(a "a d!.eren=!erea S&se+dode%en(e!T Ead!c7, a
    de(er!or7r!"or co$n!(!ve da(ora(e e&!sod+"+! de&res!v %a@orJ de de%en=7 :n
    de%en(7 e<!s(7 de re$+"7 +n !s(or!c &re%or'!d de dec"!n a" ac(!v!(7=!! co$n!(!ve, &e
    cAnd !nd!v!d+" c+ +n e&!sod de&res!v %a@or are %+"( %a! &ro'a'!" o s(are
    &re%or'!d7 re"a(!v nor%a"7, !ar dec"!n+" co$n!(!v a'r+&( es(e asoc!a( c+ de&res!a
    EAH Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    Dac7 c"!n!c!an+" s(a'!"eO(e c7, a(A( de%en=a, cA( s! (+"'+rarea de&res!v7 %a@or7 s+n(
    &re/en(e, c+ e(!o"o$!! !nde&enden(e, (re'+!e d!a$nos(!ca(e a%'e"e.
    De%en=a (re'+!e s7 .!e d!s(!ns7 de s!%+"are s! de (+"'+rarea .ac(!ce. Pa((ern+r!"e
    de de.!c!(e co$n!(!ve &re/en(a(e de s!%+"are s! de (+"'+rarea .ac(!ce n+ s+n( de re$+"7
    cons(an(e :n (!%& s! n+ s+n( carac(er!s(!ce ce"or (!&!ce o'serva(e :n de%en=7. De
    e<e%&"+, !nd!v!/!! c+ (+"'+rare .ac(!ce sa+ c+ s!%+"are %an!.es(a(7 ca de%en=7 &o(
    e.ec(+a ca"c+"e :n (!%& ce =!n scor+" :n c+rs+" +n+! @oc de c7r=!, dar se &"An$ a&o! c7
    s+n( !nca&a'!"! s7 e.ec(+e/e ca"c+"e s!%!"are :n c+rs+" e<a%!n7r!! s(a(+s+"+! %en(a".
    De%en(a (re'+!e s7 .!e d!s(!ns7 de dec"!n+" nor%a" :n .+nc=!onarea co$n!(!v7 care
    s+rv!ne oda(7 c+ :%'7(rAn!rea Eca :n dec"!n+" co$n!(!v :n "e$7(+r7 c+ e(a(eaJ.
    D!a$nos(!c+" de de%en=7 es(e @+s(!.!ca(, n+%a! dac7 e<!s(7 &ro'a de%ons(ra'!"7 a
    +ne! de(er!or7r! %a! %ar! a %e%or!e! O! a"(7 de(er!orare co$n!(!v7 decA( ar .! de
    e<&ec(a( da(or!(7 &rocese"or de :%'7(rAn!re nor%a"e !ar s!%&(o%e"e ca+/ea/7
    de(er!orare :n .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7.
    C57.*J De"en!a $e tip Al)@ei"er
    *lemente de dia!nostic
    De.!c!(e"e co$n!(!ve Ecr!(er!+" AJ s! de(er!orarea cer+(7 Ecr!(er!+" BJ s+n( d!sc+(a(e
    "a &a$. 5IH45YLJ. De'+(+" de%en=e! de (!& A"/e!%er es(e $rad+a" s! !%&"!c7 +n
    dec"!n co$n!(!v con(!n++ Ecr!(er!+" CJ. D!n ca+/a d!.!c+"(7=!! de a o'=!ne &ro'a
    &a(o"o$!c7 d!rec(7 a &re/en=e! %a"ad!e! A"/e!%er, d!a$nos(!c+" &oa(e .! &+s n+%a!
    d+&7 e<c"+derea a"(or e(!o"o$!! &en(r+ de%en=7. 0e re$+"7, de.!c!(e"e co$n!(!ve n+
    se da(orea/7 a"(or cond!=!! a"e s!s(e%+"+! nervos cen(ra" care ca+/ea/7 de.!c!(e
    &ro$res!ve de %e%or!e sa+ c+noaO(ere Ede e<., %a"ad!e cere'rovasc+"ar7, %a"ad!e
    Par)!nson, %a"ad!e H+n(!n$(onJ, +nor cond!=!! s!s(e%!ce c+nosc+(e a ca+/a
    de%en=7 Ede e<., !&o(!ro!d!s%+", de.!c!en=a de v!(a%!n7 B59, !n.ec=!a HI3J or!
    e.ec(e"or &ers!s(en(e a"e +ne! s+'s(an=e Ede e<., a"coo"+"J Ecr!(er!+" DJ. Dac7 e<!s(7 o
    e(!o"o$!c ad!=!ona"7 Ede e<., +n (ra+%a(!s% cran!an care a$ravea/7 o de%en=7 de (!&
    A"/e!%erJ, a%'e"e (!&+r! de de%en=7 (re'+!e s7 .!e cod!.!ca(e Eve/! de%en=a
    da(ora(7 +nor e(!o"o$!! %+"(!&"e, &a$. 5HLJ. De%en=a de (!& A"/e!%er n+ (re'+!e
    d!a$nos(!ca(7, dac7 s!%&(o%e"e s+rv!n e<c"+s!v :n c+rs+" de"!r!+%+"+! Ecr!(er!+" EJ,
    :ns7, de"!r!+%+" &oa(e .! s+&ra&+s &es(e o de%en=7 de (!& A"/e!%er &ree<!s(en(7,
    :n care ca/ es(e !nd!ca( s+'(!&+" Sc+ de"!r!+%T. :n .!ne, de.!c!(e"e co$n!(!ve n+ s+n(
    e<&"!ca(e %a! '!ne de c7(re o a"(7 (+"'+rare de &e a<a I Ede e<., (+"'+rare de&res!v7
    %a@or7 or! sc!/o.ren!eJ Ecr!(er!+" FJ.
    Subtipuri
    E(a(ea "a de'+( a de%en=e! de (!& A"/e!%er &oa(e .! !nd!ca(7 &r!n +(!"!/area
    +n+!a d!n(re +r%7(oare"e s+'(!&+r!Q
    76H2EU Demena de tip
    Al(%eimer
    *<<
    C+ de'+( &recoce. Aces( s+'(!& es(e +(!"!/a( dac7 de'+(+" de%en=e! s+rv!ne
    "a e(a(ea de RY an! sa+ s+'.
    C+ de'+( (ard!v. Aces( s+'(!& es(e +(!"!/a( dac7 de'+(+" de%en=e! s+rv!ne
    d+&7 e(a(ea de RY an!.
    Pre/en=a sa+ a'sen=a +ne! &er(+r'7r! de co%&or(a%en( se%n!.!ca(!ve c"!n!c es(e
    !nd!ca(7 &r!n +(!"!/area +n+!a d!n(re +r%7(oare"e s+'(!&+r! cod!.!ca(eQ
    .5L F7r7 &er(+r'are de co%&or(a%en(. Aces( s+'(!& es(e +(!"!/a( dac7
    &er(+r'area co$n!(!v7 n+ es(e aco%&an!a(7 de n!c! o &er(+r'are de
    co%&or(a%en( se%n!.!ca(!v7 c"!n!c.
    .55 C+ &er(+r'are de co%&or(a%en(. Aces( s+'(!& es(e +(!"!/a( dac7
    &er(+r'area de co%&or(a%en( es(e aco%&an!a(7 de o &er(+r'are de
    co%&or(a%en( se%n!.!ca(!v7 c"!n!c Ede e<., va$a'onda@, a$!(a=!eJ.
    #rocedee de "nre!istrare
    Cod+" d!a$nos(!c de&!nde de &re/en=a sa+ a'sen=a +ne! &er(+r'7r! de
    co%&or(a%en( se%n!.!ca(!ve c"!n!c s! n+ de .a&(+" dac7 de'+(+" de%en=e! es(e
    &recoce sa+ (ard!v. As(.e", cod+" d!a$nos(!c es(e 9FI.5L &en(r+ de%en=a de (!&
    A"/e!%er, c+ de'+( &recoce, .7r7 &er(+r'are de co%&or(a%en(8 9FI.5L &en(r+
    de%en=a de (!& A"/e!%er, c+ de'+( (ard!v, .7r7 &er(+r'are de co%&or(a%en(8
    9FI.55 &en(r+ de%en=a de (!& A"/e!%er, c+ de'+( &recoce, c+ &er(+r'are de
    co%&or(a%en( O! 9FI.55 &en(r+ de%en=a de (!& A"/e!%er, c+ de'+( (ard!v, c+
    &er(+r'are de co%&or(a%en(, :n &"+s, ;;5.L %a"ad!e A"/e!%er (re'+!e cod!.!ca(
    &e a<a III.
    A"(e e"e%en(e c"!n!ce &roe%!nen(e re.er!(oare "a %a"ad!a A"/e!%er &o( .!
    !nd!ca(e &r!n cod!.!carea (+"'+r7r!"or %en(a"e ad!=!ona"e s&ec!.!ce da(ora(e %a"ad!e!
    A"/e!%er &e a<a I. De e<., &en(r+ a !nd!ca &re/en=a !de!"or de"!ran(e &roe%!nen(e,
    d!s&o/!=!a de&res!v7 se%n!.!ca(!v7 c"!n!c s! de/vo"(area +n+! co%&or(a%en( a$res!v
    &ers!s(en(, 9F;.G5 T+"'+rare &s!o(!c7 da(ora(7 %a"ad!e! A"/e!%er, c+ !de!
    de"!ran(e8 9F;.G;. T+"'+rare a.ec(!v7 da(ora(7 %a"ad!e! A"/e!%er, c+ e"e%en(e
    de&res!ves! ;5L.5 Mod!.!care de &ersona"!(a(e da(ora(7 %a"ad!e! A"/e!%er, (!&
    a$res!v, (re'+!e, de ase%enea, cod!.!ca(e &e a<a I.
    *lemente ,i tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. 3e/! &a$. 5YL &en(r+ o
    d!sc+=!e $enera"7 a e"e%en(e"or s! (+"'+r7r!"or asoc!a(e c+ de%en=a. Preva"en(a
    de%en=e! de (!& A"/e!%er es(e cresc+(7 "a !nd!v!/!! c+ s!ndro% Do#n s! "a !nd!v!/!!
    c+ !s(or!c de (ra+%a(!s% cran!an. Mod!.!c7r!"e &a(o"o$!ce carac(er!s(!ce %a"ad!e!
    A"/e!%er s+n( &re/en(e :n cre!er+" !nd!v!/!"or c+ s!ndro% Do#n :nc7 de "a
    :nce&+(+" ce"+! de a" &a(r+"ea decen!+, deO! s!%&(o%e"e c"!n!ce a"e de%en=e! n+ s+n(
    de re$+"7 ev!den(e decA( %a! (Ar/!+.
    Da(e de "a'ora(or asoc!a(e. N!c! +n+" d!n(re %ar)er!! '!o"o$!c! s&ec!.!c! s!
    sens!'!"! "ar$ acce&(a=!, n+ es(e acce&(a( +n!versa" ca d!a$nos(!c &en(r+ de%en=a de
    (!& A"/e!%er "a +n !nd!v!d :n v!a=7, :n %a@or!(a(ea ca/+r!"or, a(ro.!a cere'ra"7 es(e
    &re/en(7 :n de%en=a de (!& A"/e!%er, c+ s+"c!! cor(!ca"! O! ven(r!c+"!! cere'ra"! %a!
    "ar$! decA( es(e de aO(e&(a(, da( .!!nd &roces+" nor%a" de :%'7(rAn!re. Aceas(7
    5YR
    Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri

    a(ro.!e &oa(e .! de%ons(ra(7 &r!n (o%o$ra.!e co%&+(er!/a(7 ETCJ or! &r!n
    !%a$!s(!ca c+ re/onan=7 %a$ne(!c7 ERMNJ. E<a%!narea %!crosco&!c7 reve"ea/7 de
    re$+"7 %od!.!c7r! !s(o&a(o"o$!ce, !nc"+/And &"7c!"e sen!"e, (or(+o/!(7=!"e
    ne+ro.!'r!"are, de$enerarea $ran+"ovac+o"ar7, &!erder!"e ne+rona"e, $"!o/a
    as(roc!(ar7 s! an$!o&a(!a a%!"o!d7. Cor&+sc+"!! Le#y s+n( o'serva=! +neor! :n
    ne+ron!! cor(!ca"!.
    9atele examinrilor somatice si condi3iile medicale .enerale2 :n &r!%!! an! a!
    %a"ad!e!, c+ de%en=a de (!& A"/er%er s+n( asoc!a(e &+=!ne se%ne %o(or!! s!
    sen/or!a"e. Ma! (Ar/!+, :n c+rs+" evo"+=!e! &o( a&are %!oc"on+s s! (+"'+r7r! de %ers.
    La a&ro<!%a(!v 5Ld d!n(re !nd!v!/!! c+ aceas(7 (+"'+rare, s+rv!n cr!/e e&!"e&(!ce.
    *lemente speci$ice culturii, etii si sexului
    3e/! &a$. 5Y5 &en(r+ o d!sc+=!e $enera"7 a e"e%en(e"or s&ec!.!ce c+"(+r!! s! e(7=!!
    asoc!a(e c+ de%en=a. De'+(+" (ard!v Ed+&7 e(a(ea de RY de an!J a" de%en(e! de (!&
    A"/e!%er es(e %+"( %a! .recven( decA( de'+(+" &recoce. P+=!ne ca/+r! a&ar
    :na!n(e de e(a(ea de YL de an!. T+"'+rarea es(e c+ &+=!n %a! .recven(7 "a .e%e!
    decA( "a '7r'a=!.
    #revalent
    Preva"en(a de%en=e! de (!& A"/e!%er cres(e dra%a(!c oda(7 c+ :na!n(area :n
    e(a(e, %er$And de "a L,Rd "a '7r'a=! O! L,Gd "a .e%e! "a e(a(ea de RY an! E(oa(e
    n!ve"e"e de sever!(a(eJ "a 55d "a '7r'a=! O! 5Id "a .e%e! "a e(a(ea de GY an!. La e(a(ea
    de FL an!, &reva"en(a cres(e "a 95d "a '7r'a=! O! 9Yd "a .e%e!, !ar "a e(a(ea de FY an!
    &reva"en(a es(e de ;Rd "a '7r'a=! O! de I5d "a .e%e!. Ca/+r!"e %odera(e s&re severe
    re&re/!n(7 ILd4RLd d!n aces(e ra(e de &reva"en(7 es(!%a(7.
    *voluie
    3e/! &a$. 5Y9 &en(r+ o d!sc+=!e $enera"7 as+&ra evo"+=!e! de%en=e!. Evo"+=!a
    de%en=e! de (!& A"/e!%er (!nde a .! "en( &ro$res!v7, c+ %a! &+=!n de ;4I &+nc(e &e
    an "a +n !ns(r+%en( de eva"+are s(andard, c+% es(e M!n!4Men(a" S(a(e E<a%. S+n(
    o'serva(e d!verse &a((ern+r! de de.!c!(e. Un &a((ern .recven( es(e ce" c+ de'+(
    !ns!d!os, c+ de.!c!(e &recoce :n %e%or!a recen(7, +r%a(e d+&7 cA=!va an! de a&ar!=!a
    a.a/!e!, a&ra<!e! O! a$no/!e!. Un!! !nd!v!/! &o( &re/en(a %od!.!c7r! de &ersona"!(a(e,
    !r!(a'!"!(a(e cresc+(7 s! a"(e se%ne O! s!%&(o%e :nce&And d!n s(ad!!"e !n!=!a"e O!
    deven!nd %a! &ron+n=a(e :n s(ad!!"e de %!@"oc a"e %a"ad!e!, :n s(ad!!"e (ard!ve a"e
    %a"ad!e!, !nd!v!/!! &o( &re/en(a &er(+r'7r! %o(or!! O! de %ers, !ar :n ce"e d!n +r%7
    dev!n %+=! O! "ec(+ar!. D+ra(a %ed!e a %a"ad!e! de "a de'+(+" s!%&(o%e"or &An7 "a
    %oar(e es(e de G45L an!.
    #attern $amilial
    Co%&ara(!v c+ &o&+"a=!a $enera"7, r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or
    c+ de%en=7 de (!& A"/e!%er c+ de'+( &recoce es(e .oar(e &ro'a'!" c7 vor &re(en(a
    (+"'+rarea. Ca/+r!"e c+ de'+( (ard!v &o( avea, de ase%enea, o co%&onen(7
    $ene(!c7, :n +ne"e .a%!"!!, de%en=a de (!& A"/e!%er s4a de%ons(ra( a .! %oO(en!(7
    ca (r7s7(+r7 do%!nan(7 c+ "!n)a$e &e %a! %+"=! cro%o/o%! !nc"+/And cro%o/o%!!
    ", 5I O! 95. C+ (oa(e aces(ea, &ro&or=!a ca/+r!"or care s+n( :n "e$7(+r7 c+ ano%a"!!
    76H2EU Demena de tip
    Al(%eimer
    *<G
    ered!(are s&ec!.!ce n+ es(e c+nosc+(7. Ind!v!/!! &+r(7(or! a! +ne!a sa+ a! a%'e"or
    a"e"e care cod!.!c7 a&o"!&o&ro(e!na E4I EAPOE4IJ &e cro%o/o%+" 5F &re/!n(7 +n r!sc
    cresc+( &en(r+ %a"ad!a A"/e!%er c+ de'+( (ard!v, deO! aceas(7 $en7 n+ es(e :n s!ne
    o ca+/7 a (+"'+r7r!!.
    Dia!nostic di$erenial
    3e/! &a$. 5Y9 &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" de%en=e!.
    Criteriile $e $ia/no&ti# pentru C57.*
    , De"en!a $e Tip Al)@ei"er
    A2 De(voltarea de de$icite co!nitive multiple, mani$estate prin ambeleD
    (1)deteriorarea memoriei &deteriorarea capacitii de a "nva o in$ormaie
    nou ori de a evoca o in$ormaie "nvat anterior)3
    (2)una &sau mai multe) din urmtoarele perturbri co!nitiveD
    &a) a$a(ie &perturbare de limba0)3
    &b)apraxie &deteriorarea capacitii de a reali(a activiti motorii, "n
    dispreul $unciei motorii intacte)3
    (c)a!no(ie &incapacitatea de a recunoa,te sau identi$ica obiectele, "n
    dispreul $unciei sen(oriale intacte)3
    (d) perturbare "n $uncia de execuie &adic, "n plani$icare,
    or!ani(are,
    secveniere, abstracti(are)2
    S2 De$icitele co!nitive de la criteriile AE ,i A7 cau(ea(, $iecare, o deteriorare
    semni$icativ "n $uncionarea social sau pro$esional ,i repre(int un declin
    semni$icativ de la nivelul anterior de $uncionare2
    2 *voluia este caracteri(at prin debut !radual si declin co!nitiv continuu2
    D2 De$icitele co!nitive de la criteriile AE ,i A7 nu se datorea( nici uneia din
    urmtoareleD
    &E) altor condiii ale sistemului nervos central care cau(ea( de$icite
    pro!resive de memorie ,i cunoa,tere &de ex2, maladie cerebrovascular,
    maladie #arCinson, maladie Luntin!ton, %ematom subdural, %idroce$alie
    cu presiune normal, tumor cerebral)3
    (2) condiiilor sistemice, cunoscute a cau(a demen &de ex2,
    %ipotiroidismul,
    de$iciena de vitamin SE7 sau de acid $olie, de$iciena de niacin,
    %ipercalcemia, neurosi$ilisul, in$ecia cu LIV)3
    (3) condiiile induse de o substan2
    *2 De$icitele nu survin exclusiv "n cursul unui delirium2
    '2 #erturbarea nu este explicat mai bine de alt tulburare de pe axa l &de ex2,
    tulburarea depresiv ma0or, sc%i(o$renia)2
    Se codi"ic pe ba(a pre(enei sau absenei unei perturbri de comportament
    semni$icative clinicD
    76H2E5 'r perturbare de comportamentD dac perturbarea co!nitiv nu este
    acompaniat de nici o perturbare de comportament semni$icativ clinic2
    *<> Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    Criteriile $e $ia/no&ti# pentru
    C57.* , De"en!a $e Tip Al)@ei"er
    76H2EE u perturbare de comportamentD dac perturbarea co!nitiv este
    acompaniat de o perturbare de comportament semni$icativ clinic &de
    ex2, va!abonda0, a!itaie)2
    De speci"icat subtipul'
    u debut precoceD dac debutul survine la etatea de IA ani sau sub u
    debut tardivD dac debutul are loc dup etatea de IA de ani
    Fot de codi$icareD Se codi$ic, de asemenea, 44E25 Maladie Al(%eimer pe axa III2
    Alte elemente clinice proeminente "n le!tur cu maladia Al(%eimer se
    menionea( pe axa l &de ex2, 764284 Tulburare a$ectiv datorat maladiei
    Al(%eimer, cu elemente depresive si 45E2E Modi$icare de personalitate de tip
    a!resiv, datorat maladiei Al(%eimer)2
    C5+.7, De"en!a Va&#ular(
    (anterior, De"en!a Mul!i in%ar#t6
    *lemente de dia!nostic
    De.!c!(e"e co$n!(!ve Ecr!(er!+" AJ s! de(er!orarea cer+(7 Ecr!(er!+" BJ d!n de%en=a
    vasc+"ar7 s+n( d!sc+(a(e "a &a$. 5IH45YL. Tre'+!e s7 e<!s(e &ro'a +ne! %a"ad!!
    cere'rovasc+"are Ead!c7, se%ne s! s!%&(o%e ne+ro"o$!ce de .ocar sa+ da(e de
    "a'ora(orJ, care es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+ de%en=a Ecr!(er!+" CJ.
    Se%ne"e s! s!%&(o%e"e ne+ro"o$!ce de .ocar !nc"+d se%n+" Ba'!ns)!, &ara"!/!a
    &se+do'+"'ar7, (+"'+r7r!"e de %ers, e<a$erarea re."e<e"or os(eo(end!noase or! "!&sa
    de .or=7 %+sc+"ar7 :n(r4o e<(re%!(a(e. To%o$ra.!a co%&+(er!/a(7 ECTJ a ca&+"+! s!
    !%a$!s(!ca &r!n re/onan=7 %a$ne(!c7 ERMNJ de%ons(rea/7 de re$+"7 &re/en=a +nor
    "e/!+n! vasc+"are %+"(!&"e :n cor(e<(+" cere'ra" s! :n s(r+c(+r!"e s+'cor(!ca"e.
    De%en=a vasc+"ar7 n+ es(e d!a$nos(!ca(7 dac7 s!%&(o%e"e s+rv!n e<c"+s!v :n c+rs+"
    de"!r!+%+"+! Ecr!(er!+" DJ. De"!r!+%+" &oa(e .! s+&ra&+s :ns7, &es(e o de%en=7
    vasc+"ar7 &ree<!s(en(7, :n care ca/ es(e !nd!ca( s+'(!&+" c+ de"!r!+%.
    Subtipuri
    Pr!n conven=!a ICD4F4CM, de%en=a vasc+"ar7 es(e s!n$+r+" (!& de de%en=7 care
    .ace +/ de s+'(!&+r! &en(r+ a !nd!ca &re/en=a de s!%(o%e asoc!a(e se%n!.!ca(!ve.
    Ur%7(oare"e s+'(!&+r! (re'+!e s7 .!e +(!"!/a(e &en(r+ a !nd!ca e"e%en(e"e
    &redo%!nan(e a"e (a'"o+"+! c"!n!c c+ren(Q
    C+ de"!r!+%. Aces( s+'(!& es(e +(!"!/a( dac7 de"!r!+%+" es(e s+&ra&+s &es(e
    de%en=7.
    C+ !de! de"!ran(e. Aces( s+'(!& es(e +(!"!/a( dac7 !de!"e de"!ran(e s+n(
    e"e%en(+" &redo%!nan(
    7652Hx Demena Vascular (anterior, Demena
    Multiin$arct)
    154
    C+ d!s&o/!=!e de&res!v7. Aces( s+'r!& es(e +(!"!/a( dac7 d!s&o/!=!a de&res!v7
    E!nc"+/And (a'"o+r! c"!n!ce care sa(!s.ac cr!(er!!"e s!%&(o%a(o"o$!ce &en(r+
    e&!sod+" de&res!v %a@orJ es(e e"e%en(+" &redo%!nan(. Un d!a$nos(!c se&ara(
    de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e n+ es(e &+s.
    Neco%&"!ca(. Aces( s+'(!& es(e +(!"!/a( dac7 n!c! +n+" d!n e"e%en(e"e de %a!
    s+s n+ &redo%!n7 :n (a'"o+" c"!n!c c+ren(.
    S&ec!.!can(+" C+ &er(+r'are de co%&or(a%en( Ecare n+ &oa(e .! cod!.!ca(J &oa(e
    .!, de ase%enea, +(!"!/a( &en(r+ a !nd!ca &er(+r'7r!"e de co%&or(a%en(
    se%n!.!ca(!ve c"!n!c Ede e<., va$a'onda@+"J.
    #rocedee de "nre!istrare
    Pr!n conven=!a ICD4F4CM, n+%a! de%en=a vasc+"ar7 s! de%en=a de (!&
    A"/e!%er a+ s+'(!&+r! cond!.!ca'!"e. Cod+r!"e d!a$nos(!ce &en(r+ de%en=a
    vasc+"ar7 de&!nd de s+'(!&+" &en(r+ e"e%en(e"e &redo%!nan(eQ 9FL.I5 &en(r+ Sc+
    de"!r!+%T, 9FL.I9 &en(r+ Sc+ !de! de"!ran(eT, 9FL.I; &en(r+ Sc+ d!s&o/!=!e
    de&res!v7T, 9FL.IL &en(r+ Sneco%&"!ca(T. S&ec!.!can(+" Sc+ &er(+r'are de
    co%&or(a%en(T n+ es(e cod!.!ca( s! &oa(e .! a&"!ca( "a .!ecare d!n s+'(!&+r!"e de %a!
    s+s Ede e<., 9FL.I; De%en=7 vasc+"ar7, c+ d!s&o/!=!e de&res!v7 s! c+ &er(+r'are de
    co%&or(a%en(J. Pe "An$7 aceas(a, cond!=!a cere'rovasc+"ar7 (re'+!e s7 .!e cod!.!ca(7
    &e a<a III Ede e<., I;R Ic(+sJ.
    *lemente ,i tulburri asociate
    E"e%e(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. 3e/! &a$ 5YL, &en(r+ o
    d!sc+=!e $enera"7 a e"e%en(e"or s! (+"'+r7r!"e asoc!a(e c+ de%en=a.
    Da(e de "a'ora(or asoc!a(e, :n(!nderea "e/!+n!"or s!s(e%+"+! nervos cen(ra",
    de(ec(a(e &r!n (o%o$ra.!a co%&+(er!/a(7 s! !%a$!s(!ca &r!n re/onan=7 %a$ne(!c7,
    de&7OeO(e de re$+"7 :n(!nderea %od!.!c7r!"or de(ec(a(e :n cre!er+" &ersoane"or :n
    e(a(e s7n7(oase Ede e<., !&er!n(ens!(7(!"e &enven(r!c+"are s! d!n s+'s(an=a a"'7
    o'serva(e &e !%a$!n!"e RMNJ. Le/!+n!"e a&ar adesea, a(A( :n s+'s(an=a a"'7, cA( O!
    :n s(r+c(+r!"e s+'s(an=e! cen+O!!, !nc"+s!v :n re$!+n!"e s! n+c"e+ s+'cor(!ca"!. Poa(e .!
    de(ec(a(7 &re/en=a +nor !n.arc(e vec! Ede e<., a(ro.!e .oca"7J &rec+% O! da(e a"e +ne!
    %a"ad!! %a! recen(e. Da(e"e EE, &o( re."ec(a "e/!+n! .oca"e :n cre!er, :n &"+s, %a!
    &oa(e e<!s(a &ro'a de "a'ora(or a cond!=!!"or card!ace s! vasc+"are s!s(e%!ce asoc!a(e
    Ede e<., ano%a"!! EC,, &ro'a de "a'ora(or a !ns+.!c!en(e! rena"eJ.
    Da(e"e e<a%!n7r!! so%a(!ce O! cond!=!!"e %ed!ca"e $enera"e asoc!a(e. Se%ne"e
    ne+ro"o$!ce co%+ne Ede e<, re."e<e anor%a"e, sc7derea (or(e! %+sc+"are :nrr4o
    e<(re%!(a(e, &er(+r'area %ers+"+!J s+n( d!sc+(a(e :n sec=!+nea SE"e%en(e de
    d!a$nos(!cT. Adesea e<!s(7 &ro'a +ne! !&er(ens!+n! ar(er!a"e .oar(e vec! Ede e<.,
    ano%a"!! de .+nd de oc!, cord %7r!(J, a +ne! %a"ad!! card!ace va"v+"are Ede e<.,
    /$o%o(e card!ace anor%a"eJ or! a +ne! %a"ad!! vasc+"are e<(racra%ene, care &oa(e .!
    s+rs7 de e%'o cere'ra"! Un s!n$+r !c(+s &oa(e ca+/a o %od!.!care re"a(!v
    c!rc+%scr!s7 :n s(area %en(a"7 Ede e<, o a.a/!e +r%And +ne! "e/!+n! a e%!s.ere!
    cere'ra"e s(An$! or! o (+"'+rare a%nes(!c7 &r!n %.arcr!/are :n (er!(or!+" de d!s(r!'+=!e
    a" ar(ere"or cere'ra"e &os(er!oareJ, dar !n $enera" n+ ca+/ea/7 de%en(7 vasc+"ar7,
    care re/+"(7 (!&!c d!n s+rven!rea +nor !c(+s+n %+"(!&"e, de re$+"7 "a da(e d!.er!(e.
    EI5 Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    *lemente speci$ice culturii, etii ,i sexului
    3e/! &a$. 5Y5 &en(r+ o d!sc+=!e $enera"7 a e"e%en(e"or c+"(+r!! s! e(7=!! :n de%en=7.
    De'+(+" de%en=e! vasc+"are s+rv!ne :n %od (!&!c %a! &recoce decA( ce" a"
    de%en=e! de (!& A"/e!%er. T+"'+rarea es(e, d+&7 cA( se &are, %a! .recven(7 "a
    '7r'a=! decA( "a .e%e!.
    #revalent
    De%en=a vasc+"ar7 es(e ra&or(a(7 %+"( %a! &+=!n .recven( decA( de%en=a de (!&
    A"/e!%er.
    *voluie
    3e/! &a$. 5Y9 &en(r+ o d!sc+=!e $enera"7 a evo"+=!e! de%en=e!. De'+(+" de%en=e!
    vasc+"are es(e de re$+"7 'r+sc O! es(e +r%a( de o evo"+=!e :n (re&(e O! ."+c(+an(7,
    carac(er!/a(7 %a! c+rAnd &r!n %od!.!c7r! ra&!de :n .+nc=!onare decA( &r!n(r4o
    &ro$res!+ne "en(7. Evo"+=!a &oa(e .! e<(re% de var!a'!"7 :ns7, !ar +n de'+( !ns!d!os
    c+ dec"!n $rad+a" es(e, de ase%enea, :n(A"n!(. De re$+"7, &a((ern+" de de.!c!(e es(e
    S&arce"arT, de&!n/And de care re$!+n! a"e cre!er+"+! a+ .os( d!s(r+se. An+%!(e
    .+nc=!! co$n!(!ve &o( .! a.ec(a(e &recoce, :n (!%& ce a"(e"e r7%An re"a(!v !nde%ne.
    Tra(a%en(+" &recoce a" !&er(ens!+n!! O! %a"ad!e! vasc+"are &oa(e &reven!
    &ro$res!+nea +"(er!oar7.
    Dia!nostic di$erenial
    3e/! &a$. 5Y9 &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" de%en=e!.
    7652Hx Demena Vascular (anterior, Demena
    Multiin$arct)
    EIE
    Criteriile $e $ia/no&ti# pentru C5+.7, De"en!a Va&#ular(
    A2 De(voltarea de de$icite co!nitive multiple mani$estat prin ambele
    (1)deteriorarea memoriei &deteriorarea capacitii de a "nva in$ormaii
    noi sau de a evoca in$ormaii "nvate anterior),
    (2)una &sau mai multe) dintre urmtoarele perturbri co!nitiveD
    &a) a$a(ie &perturbare de limba0)3
    &b)apraxie &deteriorarea capacitii de a e$ectua activiti motorii, "n
    dispreul $unciei motorii intacte)3
    (c)a!no(ie &incapacitatea de a recunoa,te sau identi$ica obiectele "n
    dispreul $unciei sen(oriale intacte)3
    (d) perturbare "n $uncia de execuie &adic, "n plani$icare,
    or!ani(are,
    secveniere, abstracti(are)2
    S2 De$icitele co!nitive de la criteriile AE si A7 cau(ea( $iecare o deteriorare
    semni$icativ "n $uncionarea social sau pro$esional si repre(int un declin
    semni$icativ de la nivelul anterior de $uncionare2
    2 Semne si simptome neurolo!ice de $ocar &de ex2, exa!erarea re$lexelor
    osteotendinoase, semnul SabinsCi, parali(ie pseudobulbar, tulburri de
    mers, scderea $orei musculare "ntr-o extremitate) ori date de laborator
    indic@nd o maladie cerebrovascular &de ex2, in$arcte multiple implic@nd
    cortexul ,i substana alb subiacent) care sunt considerate a $i etiolo!ic "n
    relaie cu perturbarea2
    D2 De$icitele nu survin exclusiv "n cursul deliriumului2
    Se codi"ic pe ba(a elementelor predominanteD
    290.41u deliriumD dac deliriumul este suprapus peste demen
    290.42u idei deliranteD dac ideile delirante sunt elementul predominant
    290.43u dispo(iie depresivD dac dispo(iia depresiv &inclu(@nd tablouri
    clinice care satis$ac criteriile simptomatolo!ice complete pentru un episod
    depresiv ma0or) este elementul predominant2 .n dia!nostic separat de
    tulburare a$ectiv datorat unei condiii medicale !enerale nu este pus
    7652H5 Fecompli catD dac nici unul di ntre elementele de mai sus nu
    predomin "n tabloul clinic curent
    De speci"icat dacD
    u perturbare de comportament
    Fot de codi$icareD A se codi$ica, de asemenea, condiia cerebrovascular pe
    axa III2
    EI7 Deliriumul, Demena, Tulburrile Amnestice si Alte Tulburri
    De"en!ele $atorate altor
    Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    De.!c!(e"e co$n!(!ve Ecr!(er!+" AJ s! de(er!orarea cer+(7 Ecr!(er!+" BJ a"e de%en=e!
    da(ora(e a"(or cond!=!! %ed!ca"e $enera"e s+n( d!sc+(a(e "a &a$. 5IH45YL. D!n !s(or!c,
    e<a%en+" so%a(!c or! da(e"e de "a'ora(or, (re'+!e s7 re/+"(e c7 cond!=!a %ed!ca"7
    $enera"7 es(e e(!o"o$!c :n re"a=!e c+ de%en=a Ede e<., !n.ec=!e c+ v!r+s+"
    !%+node.!c!en=e! +%ane EHI3J, "e/!+n! cere'ra"e (ra+%a(!ce, %a"ad!e Par)!nson,
    %a"ad!e H+n(!n$(on, %a"ad!e P!c), %a"ad!e Cre+(/.e"d(4*a)o', !droce.a"!e c+
    &res!+ne nor%a"7, !&o(!ro!d!s%, (+%or7 cere'ra"7 sa+ de.!c!en=7 de v!(a%!n7 B59J
    Ecr!(er!+" CJ. De%en=a da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e n+ es(e
    d!a$nos(!ca(7, dac7 s!%&(o%e"e s+rv!n e<c"+s!v :n c+rs+" de"!r!+%+"+! Ecr!(er!+" DJ.
    De"!r!+%+" :ns7, &oa(e .! s+&ra&+s &es(e o de%en=7 &ree<!s(en(7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, ca/ :n care (re'+!e &+se a%'e"e d!a$nos(!ce.
    :n a &rec!/a dac7 de%en=a es(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en=a +ne! cond!=!! %ed!ca"e $enera"e.
    A&o!, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7 de%en=a es(e re"a=!ona(7 e(!o"o$!c
    c+ cond!=!a %ed!ca"7 $enera"7 &r!n(r4+n %ecan!s% .!/!o"o$!c. Pen(r+ a .ace aceas(7
    @+deca(7, es(e necesar7 o eva"+are a(en(7 s! c+&r!n/7(oare a n+%eroO! .ac(or!. C+
    (oa(e c7 n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a s(a'!"! dac7 re"a=!a d!n(re de%en=7 s!
    cond!=!a %ed!ca"7 es(e e(!o"o$!c7, cA(eva cons!deren(e o.er7 o oarecare $!dare :n
    aces( do%en!+. Un cons!deren( :n aces( sens :" cons(!(+!e &re/en=a +ne! asoc!er!
    (e%&ora"e :n(re de'+(+" sa+ e<acer'area cond!=!e! %ed!ca"e $enera"e :n d!sc+=!e O!
    ce" a" de.!c!(e"or co$n!(!ve. Da(e"e d!n "!(era(+r7, care s+$erea/7 c7 &oa(e e<!s(a o
    asoc!ere d!rec(7 :n(re cond!=!a %ed!ca"7 $enera"7 :n d!sc+=!e s! a&ar!=!a +ne!
    de%en=e, &o( o.er! +n con(e<( +(!" :n eva"+area +ne! an+%!(e s!(+a=!!, :n a.ar7 de
    aceas(a, c"!n!c!an+" (re'+!e s7 a&rec!e/e, de ase%enea, dac7 &er(+r'area n+ es(e
    e<&"!ca(7 %a! '!ne de de%en=a de (!& A"/e!%er, de de%en=a vasc+"ar7, de de%en=a
    &ers!s(en(7 !nd+s7 de o s+'s(an=7 or! de o a"(7 (+"'+rare %en(a"7 Ede e<., (+"'+rarea
    de&res!v7 %a@or7J. Aces(e &rec!/7r! s+n( e<&"!ca(e %a! :n de(a"!+ :n sec=!+nea
    ST+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"eT E&a$. 5G5J.
    3e/! &a$. 5YL &en(r+ o d!sc+=!e $enera"7 a e"e%en(e"or s! (+"'+r7r!"or asoc!a(e c+
    de%en=a.
    Subtipuri
    Pre/en=a sa+ a'sen=a +ne! &er(+r'7r! de co%&or(a%en( se%n!.!ca(!ve c"!n!c
    &oa(e .! !nd!ca(7 &r!n +(!"!/area +n+!a d!n(re +r%7(oare"e s+'(!&+r! cod!.!ca(eQ
    .5L F7r7 &er(+r'are de co%&or(a%en(. Aces( s+'(!& es(e +(!"!/a( dac7
    &er(r'area co$n!(!v7 n+ es(e aco%&an!a(7 de n!c! o &er(+r'are de
    co%&or(a%en( se%n!.!ca(!v7 c"!n!c.
    .55 C+ &er(+r'are de co%&or(a%en(. Aces( s+'(!& es(e +(!"!/a( dac7
    &er(+r'area co$n!(!v7 es(e aco%&an!a(7 de o &er(+r'are de co%&or(a%en(
    Ede e<., va$a'onda@, a$!(a=!eJ.
    76H2ExU Dementa datorat Maladiei
    LIV
    5R;

    #rocedee de "nre!istrare
    Cod+r!"e d!a$nos(!ce s+n( se"ec(a(e :n .+nc=!e de e<!s(en=a +ne! &er(+r'7r! de
    co%&or(a%en( se%n!.!ca(!ve c"!n!c Ead!c7, cod+" d!a$nos(!c 9FI.5L se a&"!c7 a(+nc!
    cAnd n+ e<!s(7 n!c! o &er(+r'are de co%&or(a%en( se%n!.!ca(!v7 c"!n!c, !ar 9FI.55 se
    a&"!c7 a(+nc! cAnd e<!s(7 o &er(+r'are de co%&or(a%en( se%n!.!ca(!v7 c"!n!c care
    aco%&an!a/7 de.!c!(e"e co$n!(!veJ. Cod+" ICD4F4CM
    Pen(r+ cond!=!a e(!o"o$!c7 (re'!e, de ase%enea, no(a( &e a<a III Ede e<.,;;9.L
    Ma"ad!e Par)!nson, ;;5.5 Ma"ad!e P!c), 9II.F H!&o(!ro!d!s%J. E3e/! ane<a , &en(r+
    "!s(a cod+r!"or d!a$nos(!ce ICD4F4CM a"e cond!=!!"or %ed!ca"e $enera"eJ.
    La +n !nd!v!d c+ +n !s(or!c de de%en=7 s(a'!"!(, +n de"!r!+% s+&ra&+s, da(ora(
    +ne! cond!=!! %ed!ca"e $enera"e, (re'+!e s7 .!e no(a( &r!n cod!.!carea, a(A( a
    de%en=e!, cA( s! a de"!r!+%+"+! &e a<a I Ede e<., 9FI.5 De%en=7 da(ora(7 %a"ad!e!
    Par)!nson s! 9F;.L De"!r!+% da(ora( ence.a"o&a(!e! e&a(!ceJ. Aceas(a es(e :n
    con(rad!c=!e c+ de%en=a vasc+"ar7, :n care es(e s&ec!.!ca( s+'(!&+" Sc+ de"!r!+%T.
    A"(e e"e%en(e c"!n!ce &roe%!nen(e :n "e$7(+r7 c+ cond!=!a %ed!ca"7 $enera"7
    e(!o"o$!c7 &o( .! !nd!ca(e &r!n cod!.!carea (+"'+r7r!! %en(a"e ad!=!ona"e s&ec!.!ce
    da(ora(e cond!=!e! %ed!ca"e $enera"e &e a<a I. De e<e%&"+, &en(r+ a !nd!ca &re/en=a
    !de!"or de"!ran(e &roe%!nen(e, a d!s&o/!=!e! de&res!ve se%n!.!ca(!ve c"!n!c s! a +ne!
    %od!.!c7r! s&re o &ersona"!(a(e "a'!"7, "a +n !nd!v!d c+ o de%en=7 da(ora(7 %a"ad!e!
    Par)!nson, (re'+!e cod!.!ca( &e a<a I 9F;. G5 T+"'+rare &s!o(!c7 da(ora(7 %a"ad!e!
    Par)!nson, c+ !de! de"!ran(e8 9F;.G; T+"'+rare a.ec(!v7 da(ora(7 %a"ad!e! Par)!nson,
    c+ e"e%en(e de&res!ve O! ;5L.5 Mod!.!care de &ersona"!(a(e da(ora(7 %a"ad!e!
    Par)!nson, (!& "a'!".
    C57.*,J De"en!a $atorat( Mala$iei FIV
    E"e%en(+" esen=!a" a" de%en=e! da(ora(e %a"ad!e! HI3 :" cons(!(+!e &re/en=a +ne!
    de%en=e cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a %a"ad!e! &rod+se de
    v!r+s+" !%+node.!c!en=e! +%ane EHI3J. Da(e"e ne+ro&a(o"o$!ce !%&"!c7 ce" %a!
    .recven( d!s(r+c=!a %+"(!.oca"7, d!.+/7, a s+'s(an=e! a"'e O! a s(r+c(+r!"or
    s+'cor(!ca"e. L!c!d+" ce.a"ora!d!an &oa(e &re/en(a o &ro(e!nora!e nor%a"7 sa+
    +Oor cresc+(7 s! o "!%.oc!(o/7 +Ooar7, !ar HI3 &oa(e .! !/o"a( de re$+"7 d!rec( d!n
    "!c!d+" ce.a"ora!d!an. De%en=a asoc!a(7 c+ !n.ec=!a HI3 d!rec(7 a s!s(e%+"+!
    nervos cen(ra" se carac(er!/ea/7 de re$+"7 &r!n +!(are, "en(oare, concen(rare red+s7
    s! d!.!c+"(7=! :n re/o"varea de &ro'"e%e. Man!.es(7r!"e co%&or(a%en(a"e ce"e %a!
    .recven(e !nc"+d a&a(!a O! re(ra$erea soc!a"7, !ar oca/!ona" aces(ea &o( .!
    aco%&an!a(e de de"!r!+%, !de! de"!ran(e sa+ de a"+c!na=!!. La e<a%en+" so%a(!c
    &o( .! &re/en(e (re%or+", a"(erarea %!Oc7r!"or re&e(!(!ve ra&!de, de/ec!"!'r+", a(a<!a,
    !&er(on!a, !&erre."e<!a $enera"!/a(7, se%ne"e &o/!(!ve de e"!'erare .ron(a"7,
    a"(erarea %!Oc7r!"or oc+"are de +r%7r!re s! sacad!ce. De ase%enea, O! co&!!! &o(
    de/vo"(a o de%en=7 da(ora(7 HI3, care se %an!.es(7 de re$+"7 &r!n :n(Ar/!er! :n
    de/vo"(are, !&er(on!e, %!croce.a"!e s! ca"c!.!carea $an$"!on!"or 'a/a"!. De%en=a
    asoc!a(7 c+ HI3 &oa(e re/+"(a, de ase%enea, d!n (+%or! a"e s!s(e%+"+! nervos
    cen(ra" Ede e<., +n "!%.o% &r!%!(!v a" s!s(e%+"+! nervos cen(ra"J s! d!n !n.ec=!!
    o&or(+n!s(e Ede e<., (o<o&"as%o/a, !n.ec=!a c+ c!(o%e$a"ov!r+s, cr!&(ococo/a,
    (+'erc+"o/a s! s!.!"!s+"J, :n care ca/ (re'+!e s7 .!e d!a$nos(!ca( (!&+" cores&+n/7(or de
    EIH
    De%riumul, Dementa, Tulburrile Amnestice si Alte Tulburri
    de%en(7 Ede e<, 9FI " De%en(7 da(ora(7 (o<o&"as%o/e!J Po( -, de ase%enea,
    &re/en(e !n.ec=!! s!s(e%!ce rare Ede e<, &ne+%on!a c+ pne+mocystis cTrmii% or!
    neo&"as%e rare Ede e< , sarco%+" -a&os!J
    C57.*J De"en!a $atorat( Trau"ati&"ului Cranian
    E"e%en(+" esen=!a" a" de%en(e! da(ora(e (ra+%a(!s%+"+! cran!an :" cons(!(+!e
    &re/en(a +ne! de%en(e cons!dera(e a .! consec!n=a .!/!o&a(o"o$!c7 d!rec(7 a
    (ra+%a(!s%+"+! cran!an ,rad+" s! (!&+" de de(er!or7r! co$n!(!ve s! de &er(+r'7r! de
    co%&or(a%en( de&!nde de "oca"!/area s! :n(!nderea "e/!+n!! cere'ra"e A%ne/!a
    &os((ra+%a(!c7 es(e .recven( &re/en(7 :%&re+n7 c+ de(er!orarea &ers!s(en(7 de
    %e%or!e Poa(e (! ev!den(7 o var!e(a(e de a"(e s!%&(o%e co%&or(a%en(a"e, c+ sa+
    .7r7 &re/en(a de de.!c!(e %o(or!! sa+ sen/or!a"e Aces(e s!%&(o%e !nc"+d a.a/!a,
    &ro'"e%e"e de a(en=!e, !n(a'!(a(ea, an<!e(a(ea, de&res!a sa+ "a'!"!(a(ea a.ec(!v7,
    a&a(!a, a$res!v!(a(ea cresc+(7 or! a"(e %od!.!c7r! de &ersona"!(a(e In(o<!ca=!a c+
    a"coo" or! c+ a"(7 s+'s(an=7 es(e adesea &re/en(7 "a !nd!v!/!! c+ (ra+%a(!s%e ac+(e
    a"e cran!+"+!, !ar a'+/+" sa+ de&enden(a conco%!(en(7 de o s+'s(an=7 &o( .!, de
    ase%enea, &re/en(e Tra+%a(!s%e"e cran!ene s+rv!n ce" %a! adesea "a '7r'a=!!
    (!ner! s! s+n( asoc!a(e c+ co%&or(a%en(e de as+%are a r!sc+"+! CAnd aceas(a
    s+rv!ne :n con(e<(+" +n+! s!n$+r (ra+%a(!s%, de%en(a da(ora(7 (ra+%a(!s%+"+!
    cran!an n+ es(e de re$+"7 &ro$res!v7, dar (ra+%a(!s%e cran!ene re&e(a(e Ede e<,
    &r!n 'o<J &o( d+ce "a o de%en(7 &ro$res!v7 EaOa n+%!(a de%en(!a &+$!s(!caJ Un
    (ra+%a(!s% cran!an +n!c, +r%a( de +n dec"!n &ro$res!v :n .+nc=!onarea co$n!(!v7,
    &oa(e cres(e &os!'!"!(a(ea +n+! a"( &roces s+&ra&+s, c+% ar .! !droce.a"!a or! +n
    e&!sod de&res!v %a@or
    C57.*,J De"en!a $atorat( Mala$iei ParDin&on
    E"e%en(+" esen=!a" a" de%en(e! da(ora(e %a"ad!e! Par)!nson :" cons(!(+!e &re/en(a
    +ne! de%en(e cons!dera(e a .! consec!n=a .!/!o&a(o"o$!c7 d!rec(7 a %a"ad!e!
    Par)!nson Ma"ad!a Par)!nson es(e o cond!=!e ne+ro"o$!c7 "en( &ro$res!v7,
    carac(er!/a(7 &r!n (re%or, r!$!d!(a(e, 'rad!)!ne/!e s! !ns(a'!"!(a(e &os(+ra"7 De%en(a
    a .os( ra&or(a(7 ca a&7rAnd "a a&ro<!%a(!v 9Ld4RLd d!n(re !nd!v!/!! c+ %a"ad!e
    Par)!nson s! es(e .oar(e &os!'!" s7 .!e &re/en(7 "a !nd!v!/!! %a! :n e(a(e or! "a ce! c+ o
    .or%7 de %a"ad!e %a! sever7 sa+ %a! avansa(7 De%en(a asoc!a(7 c+ %a"ad!a
    Par)!nson es(e carac(er!/a(7 &r!n "en(oare %o(or!e s! co$n!(!v7, d!s.+nc(!e :n e<ec+=!e
    s! de(er!orare :n evocarea %ne/!c7 Dec"!n+" &er.or%an(e! co$n!(!ve "a !nd!v!/!! c+
    %a"ad!e Par)!nson es(e e<acer'a( .recven( de de&res!e Da(e"e e<a%!n7% so%a(!ce
    !nc"+d se%ne"e %o(or!! anor%a"e carac(er!s(!ce de (re%or de re&a+s, &re/en=a
    "en(orn s! de.!c!(+"+! de %!Ocare Ec+% ar .! %!cro$ra.!aJ sa+ r!$!d!(a(ea %+sc+"ar7 s!
    &!erderea %!Oc7r!"or asoc!a(e La a+(o&s!e, se cons(a(7 &!erder! ne+rona"e s!
    cor&+sc+L Le#y :n s+'s(an(!a %$ra E<!s(7 o sene de s!ndro%e care se &o( %an!.es(a
    &r!n de%en(7, (+"'+r7r! de %!Ocare &ar)!nso%ene s! e"e%en(e ne+ro"o$!ce
    s+&"!%en(are Ede e<, &ara"!/!a s+&ran+c"ear7 &ro$res!v7, de$enerescen(a
    ovo&on(ocere'e"oas7 s! de%en(a vasc+"ar7J La +n+ !nd!v!/! c+ %a"ad!e Par)!nson
    s! de%en(7 se cons(a(7 "a a+(o&s!e c7 a+ o ne+ro&a(o"o$!e coe<!s(en(7 s+$es(!v7 de
    %a"ad!e A"/e!%er or! de %a"ad!e c+ cor&+sc+"! Le#v d!.+/!
    76H2E Dementa datorat Maladiei
    Luntm!ton
    5RY
    De%en=a da(ora(7 %a"ad!e! c+ cor&+sc+"! Le#y :n a'sen=a %an!.es(7r!"or
    &ar)%so%ene Ec+% ar .!, (re%or+" sa+ r!$!d!(a(ea &"as(!c7J (re'+!e s7 .!e
    d!a$nos(!ca(7 ca de%en=7 da(ora(7 %a"ad!e! c+ cor&+sc+"! Le#y, +na d!n(re
    de%en(e"e da(ora(e a"(or cond!=!! %ed!ca"e $enera"e Eve/! &a$ 5RHJ
    C57.* De"en!a $atorat( Mala$iei Funt"/ton
    E"e%en(+" esen=!a" a" de%en(e! da(ora(e %a"ad!e! H+n(%$(on :" cons(!(+!e
    &re/en=a +ne! de%en=e cons!dera(e a .! consec!n=a .!/!o&a(o"o$!c7 d!rec(7 a %a"ad!e!
    H+n(%$(on. Ma"ad!a H+n(%$(on es(e o %a"ad!e de$enera(!v7 &ro$res!v7 %oO(en!(7
    a c+noaO(e%, e%o=!e! Ea.ec(!v!(7=!!J s! %!Oc7% Ma"ad!a a.ec(ea/7 '7r'a=!! O! .e%e!"e
    :n e$a"7 %7s+r7 O! es(e (rans%!s7 de o $en7 do%!nan(7 a+(oso%a"7 +n!c7 de &e
    'ra=+" sc+r( a" cro%o/o%+"+! I Ma"ad!a es(e de re$+"7 d!a$nos(!ca(7 s&re .!ne"e
    an!"or ;L O! :nce&+(+" an!"or IL, dar &oa(e de'+(a c!ar de "a e(a(ea de I an!, :n .or%a
    sa @+ven!"7 E!n.an(!"7J or! d+&7 e(a(ea de GY de a%, :n .or%a c+ de'+( (ard!v De'+(+"
    %a"ad!e! H+n(%$(on es(e adesea !na+$+ra( de %od!.!c7r! !ns!d!oase :n
    co%&or(a%en( O! &ersona"!(a(e, !nc"+/And de&res!a, !n(a'!"!(a(ea O! an<!e(a(ea Un+
    !nd!v!/! se &re/!n(7 c+ ano%a"!! de %!Ocare care a%!n(esc o ne"!n!O(e cresc+(7 s! care
    %a! (Ar/!+ &ro$resea/7 s&re coreoa(e(o/a $enera"!/a(7 carac(er!s(!c7 D!.!c+"(7=!"e :n
    evocarea %ne/!c7, :n .+nc=!a de e<ec+=!e s! :n @+deca(7 s+n( de re$+"7 &recoce :n
    c+rs+" evo"+=!e!, c+ de.!c!(e de %e%or!e %a! severe care s+rv!n &e %7s+r7 ce
    %a"ad!a &ro$resea/7 L!%'a@+" de/or$an!/a( O! e"e%en(e"e &s!o(!ce s+n( +neon
    &re/en(e. TAr/!+, :n c+rs+" evo"+=!e!, Sven(nc+"! .+r$onT da(ora=! a(ro.!e! s(r!a(+"+!
    &o( .! v7/+=! &e !%a$!s(!ca cere'ra"7 s(r+c(+ra"7 To%o$ra.!a &r!n e%!s!+ne de
    &o/!(ro% ETEPJ &oa(e ar7(a +n !&o%e(a'o"!s% s(na(a" &recoce :n c+rs+" %a"ad!e!
    Descenden=!! !nd!v!/!"or c+ %a"ad!e H+n(%$(on a+ YLd Oans7 de a de/vo"(a
    %a"ad!a Es(e d!s&on!'!" +n (es( $ene(!c &en(r+ a de(er%!na c+ re"a(!v7 cer(!(+d!ne
    dac7 es(e &os!'!" ca +n !nd!v!d da(, :n &er!oada de r!sc, s7 &re/!n(e %a"ad!a, as(.e" de
    (es(e &o( .! ad%!n!s(ra(e ce" %a! '!ne :ns7 de c7(re cen(re c+ e<&er!en=7 :n cons!"!erea
    O! +r%7r!rea !nd!v!/!"or c+ r!sc de %a"ad!e H+n(%$(on
    C57.* ,J De"en!a $atorat( Mala$iei Pi#D
    E"e%en(+" esen=!a" a" de%en(e! da(ora(e %a"ad!e! P!c) :" cons(!(+!e &re/en=a +ne!
    de%en=e cons!dera(e a .! consec!n=a .!/!o&a(o"o$!c7 d!rec(7 a %a"ad!e! P!c) Ma"ad!a
    P!c) es(e o %a"ad!e de$enera(!v7 a cre!er+"+! care a.ec(ea/7 :n s&ec!a" "o'!! .ron(a"
    s! (e%&ora" Ca O! a"(e de%en(e a"e "o'+"+! .ron(a", %a"ad!a P!c) es(e carac(er!/a(7
    c"!n!c &r!n %od!.!c7r! de &ersona"!(a(e "a :nce&+(+" evo"+=!e!, de(er!orarea
    a&(!(+d!n!"or soc!a"e, a&"a(!/are e%o=!ona"7, de/!n!'!=!e co%&or(a%en(a"7 O!
    ano%a"!! no(a'!"e de "!%'a@ D!.!c+"(7=!"e :n "e$7(+r7 c+ %e%or!a, a&ra<!a O! a"(e
    e"e%en(e a"e de%en(e! a&ar de re$+"7 %a! (Ar/!+ :n c+rs+" evo"+=!e! Po( &re/en(e
    re."e<e &r!%!(!ve re%arca'!"e Enaso4"a'!a", de s+$ere, de a&+careJ Pe %7s+r7 ce
    de%en=a &ro$resea/7, &oa(e .! :nso=!(7, .!e de a&a(!e, .!e de a$!(a=!e e<(re%7
    Ind!v!/!! &o( de/vo"(a as(.e" de &ro'"e%e severe :n "!%'a@, a(en=!e sa+
    co%&or(a%en(, :ncA( &oa(e .! d!.!c!" de eva"+a( $rad+" "or de de(er!orare co$n!(!v7
    I%a$!s(!ca cere'ra"7 s(r+c(+ra"7 re"ev7 de re$+"7 o a(ro.!e .ron(a"7 s!Xsa+ (e%&ora"7
    no(a'!"7, !ar !%a$!s(!ca cere'ra"7 .+nc=!ona"7 &oa(e "oca"!/a !&o%e(a'os%+"
    EII Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    .ron(o(e%&ora", c!ar :n a'sen=a +ne! a(ro.!! s(r+c(+ra"e c"are. T+"'+rarea se
    %an!.es(7 ce" %a! .recven( "a !nd!v!/!! :n(re YL s! RL de an!, deO! &oa(e a&are s! "a
    !nd!v!/! %a! '7(rAn!. Ma"ad!a P!c) es(e +na d!n(re e(!o"o$!!"e d!s(!nc(e &a(o"o$!c d!n
    $r+&+" e(ero$en a" &rocese"or de%en=!a"e care s+n( asoc!a(e c+ a(ro.!e cere'ra"7
    .ron(o(e%&ora"7. D!a$nos(!c+" s&ec!.!c de de%en=7 de "o' .ron(a", c+% es(e %a"ad!a
    P!c), es(e s(a'!"!( de re$+"7 "a a+(o&s!e &r!n ev!den=!erea de cor&! carac(er!s(!c!
    !nc"+/!+n!"or !n(rane+rona"e ar$en(o.!"e P!c) &a(o"o$!ce. D!n &+nc( de vedere c"!n!c,
    %a"ad!a P!c) adesea n+ &oa(e .! d!s(!ns7 c+ cer(!(+d!ne de ca/+r!"e a(!&!ce de
    %a"ad!e A"/e!%er or! de a"(e de%en=e care a.ec(ea/7 "o'!! .ron(a"!. De%en=a
    da(ora(7 a"(e! de$enerescen(e .ron(o(e%&ora"e decA( %a"ad!a P!c) (re'+!e
    d!a$nos(!ca(7 ca de%en=7 da(ora(7 de$enerescen(e! .ron(o(e%&ora"e, +na d!n(re
    de%en=e"e da(ora(e a"(or cond!=!! %ed!ca"e $enera"e Eve/! &a$. 5RHJ.
    C5+.*,J De"en!a $atorat(
    Mala$iei Creut)%el$t-IaDo-
    E"e%en(+" esen=!a" a" de%en=e! da(ora(e %a"ad!e! Cre+(/.e"d(4*a)o' :"
    cons(!(+!e &re/en=a +ne! de%en=e cons!dera(e a .! consec!n=a .!/!o&a(o"o$!c7
    d!rec(7 a %a"ad!e! Cre+(/.e"d(4*a)o'. Ma"ad!a Cre+(/.e"d(4*a)o' es(e +na d!n(re
    ence.a"o&a(!!"e s&on$!.or%e s+'ac+(e, +n $r+& de %a"ad!! a"e s!s(e%+"+! nervos
    cen(ra" ca+/a(e de a$en=! (rans%!s!'!"! c+nosc+=! ca Sv!r+s+r! "en(eT sa+ &r!on!. De
    re$+"7, !nd!v!/!! c+ %a"ad!e Cre+(/.e"d(4*a)o' &re/!n(7 (r!ada c"!n!c7 de de%en=7,
    %!Oc7r! !nvo"+n(are E:n s&ec!a" %!oc"on+sJ s! ac(!v!(a(e EE, &er!od!c7. PAn7 "a 9Yd
    d!n(re !nd!v!/!! c+ aceas(7 (+"'+rare :ns7 &o( &re/en(a (a'"o+r! c"!n!ce a(!&!ce, !ar
    %a"ad!a &oa(e .! con.!r%a(7 n+%a! &r!n '!o&s!e or! "a a+(o&s!e, &r!n de%ons(rarea
    %od!.!c7r!"or ne+ro&a(o"o$!ce s&on$!.or%e. Ma"ad!a Cre+(/.e"d(4*a)o' &oa(e
    a&are "a or!ce e(a(e "a ad+"=!, dar ce" %a! .recven( cAnd aceO(!a s+n( :n e(a(e de IL4
    RL de an!. :n Yd &An7 "a 5Yd d!n(re ca/+r! &oa(e e<!s(a o co%&onen(7 .a%!"!a"7.
    S!%&(o%e"e &rodro%a"e a"e %a"ad!e! Cre+(/.e"d(4*a)o' &o( !nc"+de .a(!$a'!"!(a(ea,
    an<!e(a(ea or! &ro'"e%e c+ a&e(!(+", so%no"en=a or! concen(rarea, O! &o( .! +r%a(e
    d+&7 cA(eva s7&(7%An! de !ncoordonare, a"(erarea veder!! sa+ %ers anor%a" or!
    a"(e %!Oc7r! care &o( .! %!oc"on!ce, coreoa(e(o!de or! 'a"!s(!ce, asoc!a(e c+ o
    de%en=7 ra&!d &ro$res!v7. Ma"ad!a &ro$resea/7 de re$+"7 .oar(e re&ede, :n dec+rs
    de cA(eva "+n!, c+ (oa(e c7, %a! rar, &oa(e evo"+a O! (!%& de an!, s! &oa(e &7rea, :n
    evo"+=!a sa, s!%!"ar7 a"(or de%en=e. N+ e<!s(7 da(e d!s(!nc(!ve "a ana"!/a "!c!d+"+!
    ce.a"ora!d!an, dar a+ .os( desco&er!=! o ser!e de '!o%ar)er! re"!a'!"!. O a(ro.!e
    nes&ec!.!c7 &oa(e .! ev!den=!a(7 "a ne+ro!%a$!s(!c7. La ce! %a! %+"=! !nd!v!/!, EE,
    re"ev7 de re$+"7 &!c+r! &er!od!ce, adesea (r!.a/!ce O! desc7rc7r! s!ncrone c+ o
    .recven=7 de L,Y49 H/ "a +n %o%en( da( :n c+rs+" (+"'+r7r!!. A$en(+" (rans%!s!'!"
    cons!dera( a .! res&onsa'!" de %a"ad!a Cre+(/.e"d(4*a)o' es(e re/!s(en( "a .!er'ere,
    .or%a"!n7, a"coo" s! rad!a=!a +"(rav!o"e(7, dar &oa(e .! !nac(!va( &r!n a+(oc"avare s+'
    &res!+ne or! c+ a&a o<!$ena(7. A .os( con.!r%a(7 (rans%!s!a &r!n (rans&"an(area
    cornee! s! &r!n !n@ec(area c+ .ac(or +%an de creO(ere, &rec+% O! ca/+r! anecdo(!ce
    de (rans%!s!e "a &ersona"+" %ed!co4san!(ar. Pr!n +r%are, cAnd se &rac(!c7 o
    !n(erven=!e ne+roc!r+r$!ca"7, o '!o&s!e cere'ra"7 or! o a+(o&s!e a cre!er+"+!,
    (re'+!e "+a(e &reca+=!! +n!versa" va"a'!"e, a(A( c+ =es+(+", cA( s! c+ ec!&a%en(+"
    76H2ExU Demena datorat altor ondiii Medicale
    Generale
    1>8
    care v!ne :n con(ac( c+ aces(a. Trans%!s!a !n(ers&ec!! a !n.ec=!!"or &r!on!ce, c+ a$en=!
    s(rAns :nr+d!=! c+ .or%a +%an7, a .os( de%ons(ra(7 Ede e<., e&!de%!a de
    ence.a"o&a(!e s&on$!.or%7 'ov!n7 Z%a"ad!a vac!! ne'+ne[, var!an(a +%an7 a
    %a"ad!e! Cre+(/.e"d(4*a)o' :n Re$a(+" Un!( de "a %!@"oc+" an!"or 2FLJ.
    C57.* ,J De"en!a $atorat(
    altor Con$i!ii Me$i#ale Generale
    Pe "An$7 ca(e$or!!"e s&ec!.!ce %a! s+s descr!se, +n n+%7r de a"(e cond!=!!
    %ed!ca"e $enera"e &o( ca+/a de%en=7. Do+7 d!n(re ce"e %a! c+nosc+(e s+n(
    da(ora(e cor&+sc+"!"or Le#y 4 :n "e$7(+r7 c+ de$enerarea ESde%en=a c+ cor&+sc+"!
    Le#y SJ s! de$enerescen(a .oca"7 d!n "o'!! .ron(a"! s! (e%&ora"! ESde%en=a
    .ron(o(e%&ora"7TJ. De%en=a Par)!nson es(e +n e<e%&"+ de &r!%a Eve/! &a$. 5RIJ,
    !ar de%en=a da(ora(7 %a"ad!e! P!c), +n e<e%&"+ de +"(!%a Eve/! &a$. 5RYJ.
    E"e%en(e"e descr!&(!ve, evo"+=!a s! e(!o"o$!a de%en=e"or da(ora(e %a"ad!e! c+
    cor&+sc+"! Le#y d!.+/! .7r7 %a"ad!e Par)!nson s! de%en=a da(ora(7
    de$enerescen(e! .ron(o(e%&ora"e, a"(a decA( %a"ad!a P!c), neces!(7 cerce(7r!
    +"(er!oare. A"(e cond!=!! asoc!a(e c+ de%en=7 !nc"+d "e/!+n!"e s(r+c(+ra"e Ea"e
    s!s(e%+"+! nervos cen(ra"J E(+%or!"e cere'ra"e &r!%are sa+ sec+ndare, e%a(o%+"
    s+'d+ra", !droce.a"!a "en( &ro$res!v7 or! c+ &res!+ne nor%a"7J, cond!=!!"e
    endocr!ne E!&o(!ro!d!s%+", !&erca"ce%!a, !&o$"!ce%!aJ, cond!=!!"e n+(r!=!ona"e
    Ede.!c!en=e"e de (!a%!n7 sa+ de n!ac!n7J, a"(e cond!=!! !n.ec=!oase Ene+ros!.!"!s+",
    cr!&(ococo/aJ, (+"'+r7r!"e !%+no"o$!ce Ede e<., ar(er!(a (e%&ora"7, "+&+s+"
    er!(e%a(os s!s(e%!cJ, deran@a%en(e"e .+nc=!!"or rena"7 s! e&a(!c7, cond!=!!"e
    %e(a'o"!ce Ede e<., %a"ad!a -+.s, adreno"e+cod!s(ro.!a, "e+cod!s(ro.!a
    %e(acro%a(!c7 s! a"(e %a"ad!! de s(oca@ a"e &er!oade! ad+"(e O! co&!"7r!e!J s! a"(e
    cond!=!! ne+ro"o$!ce, c+% ar .! sc"ero/a %+"(!&"7. Ca+/e !nso"!(e de "e/!+n! a"e
    s!s(e%+"+! nervos cen(ra", c+% ar .! soc+" e"ec(r!c sa+ !rad!erea cran!an7, s+n( :n
    $enera" ev!den(e d!n !s(or!c. T+"'+r7r!"e rare, c+% ar .! %a"ad!!"e de s(oca@ a"e
    co&!"7r!e! s! &er!oade! ad+"(e, a+ +n !s(or!c .a%!"!a" or! +n (a'"o+ c"!n!c d!s(!nc(.
    E<a%en+" so%a(!c O! da(e"e de "a'ora(or asoc!a(e, &rec+% O! a"(e e"e%en(e c"!n!ce,
    de&!nd de na(+ra s! sever!(a(ea cond!=!e! %ed!ca"e $enera"e.
    Dia!nostic di$erenial
    3e/! &a$. 5Y9 &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" de%en=e!.
    5RG
    De%numul, Dementa, Tulburrile Amnestice si Alte Tulburri

    Criteriile $e $ia/no&ti# pentru C57.*,J De"en!a $atorat(
    Altor Con$i!ii Me$i#ale Generale
    A De(voltarea a multiple de$icite co!nitive mani$estate prin ambele
    (1) deteriorarea memoriei &deteriorarea capacitii de a "nva
    in$ormaii
    noi sau de a evoca in$ormaii "nvate anterior),
    (1) una &sau mai multe) dintre urmtoarele perturbri co!nitive
    &a) a$a(ie &perturbare de limba0),
    &b)apraxie &deteriorarea capacitii de a e$ectua activiti motorii, "n
    dispreul $unciei motorii intacte),
    (c)a!no(ie &incapacitatea de a recunoa,te sau de a identi$ica obiectele,
    "n dispreul $unciei sen(oriale intacte,
    (d) perturbare "n $uncia de execuie &adic, "n plani$icare,
    or!ani(are,
    secventiere, abstracti(are)
    S De$icitele co!nitive de la criteriile AE si A7 cau(ea( $iecare o deteriorare
    semni$icativ "n $uncionarea social sau pro$esional si repre(int un declin
    semni$icativ de la nivelul anterior de $uncionare
    Din istoric, examenul somatic sau datele de laborator re(ult c perturbarea
    este consecina $i(iolo!ic direct a unei condiii medicale !enerale, alta
    dec@t maladia Al(%eimer sau maladia cerebrovascular &de ex , in$ecie LIV,
    traumatism cramo-cerebral, maladie #arCmson, maladie Luntin!ton,
    maladie #icC, maladie reut($eldt-NaCob, %idroce$alie cu presiune normal,
    %ipotiroidism, tumora cerebrala sau de$icit de vitamina SE7)
    D De$icitele nu survin exclusiv "n cursul unui delinum
    A se codi"ica pe ba(a pre(entei sau absentei unei perturbri de ccomportament
    semni$icative clinic
    294.10 '(r( pertur-are $e #o"porta"ent dac perturbarea co!nitiv nu
    este acompaniat de nici o perturbare de comportament semni$icativ clinic
    294.11 Cu pertur-are $e #o"porta"ent dac perturbarea co!nitiv este
    acompaniat de o perturbare de comportament semni$icativ clinic &de ex
    va!abonda0, a!itaie)
    Not( $e #o$i%i#areM A se codi$ica, de asemenea, condiia medical !eneral pe
    axa III &de ex, 5H7 In$ecie LIV, 8AH55 Traumatism cranian, 4475 Maladie
    #arCmson, 444 H Maladie Luntin!ton, 44E E Maladie #icC, 5HI E Maladie
    reut($eldt-NaCob, ve(i anexa G pentru codurile adiionale)
    De"en!a Per&i&tent( in$u&( $e o Su-&tan!(
    *lemente de dia!nostic si elemente asociate
    De.!c!(e"e co$n!(!ve Ecr!(er!+" AJ s! de(er!orarea cer+(7 Ecr!(er!+" BJ s+n( d!sc+(a(e
    "a &a$ 5IH45YL De%en(a &ers!s(en(7 !nd+s7 de o s+'s(an=7 es(e d!a$nos(!ca(7, dac7
    s!%&(o%e"e &ers!s(7 d!nco"o de d+ra(a +/+a"7 a !n(o<!ca=!e! sa+ a's(!nen(e! de o
    s+'s(an=7 sa+ dac7 e"e s+rv!n e<c"+s!v :n c+rs+" +n+! de"!n+% Ecr!(er!+" CJ
    Demena #ersistent indus-de o
    Substan
    1>4
    :ns7, de"!r!+%+" &oa(e .! s+&ra&+s &es(e o de%en=7 &ers!s(en(7 &ree<!s(en(7 !nd+s7
    de o s+'s(an=7, :n care ca/ (re'+!e s7 .!e &+se a%'e"e d!a$nos(!ce. D!n !s(or!c,
    e<a%en+" so%a(!c s! da(e"e de "a'ora(or, (re'+!e s7 re/+"(e &ro'a c7 de.!c!(e"e s+n(
    e(!o"o$!c :n re"a=!e c+ e.ec(e"e &ers!s(en(e a"e +/+"+! +ne! s+'s(an=e Ede e<., +n dro$
    de a'+/, +n %ed!ca%en(, e<&+nerea "a +n (o<!cJ Ecr!(er!+" DJ. Aceas(7 (+"'+rare es(e
    den+%!(7 S&ers!s(en(7T, deoarece de%en=a &ers!s(7 %+"( (!%& d+&7 ce !nd!v!d+" a
    e<&er!en(a( e.ec(e"e !n(o<!ca=!e! or! a's(!nen=e! de o s+'s(an=7.
    E"e%en(e"e asoc!a(e c+ de%en(a &ers!s(en(7 !nd+s7 de o s+'s(an=7 s+n( ce"e
    asoc!a(e c+ de%en=e"e :n $enera" Eve/! &a$. 5IHJ. C!ar dac7 ac(+a"%en(e se a'=!n de
    "a +/+" de s+'s(an=7, ce! %a! %+"=! !nd!v!/! c+ aceas(7 (+"'+rare a+ av+( an(er!or +n
    &a((ern de +/ &re"+n$!( s! e<ces!v de s+'s(an=7 care a sa(!s.7c+( cr!(er!!"e &en(r+
    de&enden=a de o s+'s(an=7. Deoarece aces(e (+"'+r7r! &ers!s(7 %+"( (!%& d+&7
    s(o&area +/+"+! de s+'s(an=7, e<a%ene"e sAn$e"+! s! +r!n!! &o( .! ne$a(!ve &en(r+
    s+'s(an=a e(!o"o$!c7. E(a(ea "a de'+( a de%en=e! &ers!s(en(e !nd+se de o s+'s(an=7
    es(e rar s+' e(a(ea de 9L de an!. Aceas(7 (+"'+rare are de re$+"7 +n de'+( !ns!d!os
    s! o &ro$res!+ne "en(7, de re$+"7 :n &er!oada cAnd &ersoana @+s(!.!c7 d!a$nos(!c+" de
    de&enden=7 de o s+'s(an=7. De.!c!(e"e s+n( de re$+"7 &er%anen(e O! se &o( a$rava,
    c!ar dac7 :nce(ea/7 +/+" de s+'s(an=7, deO! +ne"e ca/+r! &re/!n(7 a%e"!or7r!.
    Pen(r+ o d!sc+=!e %a! de(a"!a(7 a e"e%en(e"or asoc!a(e c+ (+"'+r7r!"e :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$. 5F5.
    #rocedee de "nre!istrare
    Den+%!rea d!a$nos(!c+"+! :nce&e c+ cea a s+'s(an=e! s&ec!.!ce care es(e
    &res+&+s7 a .! ca+/a( de%en=a Ede e<., a"coo"+"J. Cod+" d!a$nos(!c es(e se"ec(a(
    d!n "!s(a c"ase"or de s+'s(an=e &rev7/+(e :n se(+" de cr!(er!!. Pen(r+ s+'s(an=e"e
    care n+ !n(r7 :n n!c! +na d!n c"ase, (re'+!e +(!"!/a( cod+" &en(r+ Sa"(7 s+'s(an=7T,
    :n a.ar7 de aces(a, &en(r+ %ed!ca%en(e"e &rescr!se :n do/e (era&e+(!ce,
    %ed!ca%en(+" s&ec!.!c &oa(e .! !nd!ca( &r!n %en=!onarea cod+"+! E cores&+n/7(or
    Eve/! ane<a ,J. CAnd se cons!der7 c7 %a! %+"( decA( o s!n$+r7 s+'s(an=7 @oac7
    +n ro" !%&or(an( :n de/vo"(area de%en=e! &ers!s(en(e, .!ecare s+'s(an=7 (re'+!e
    s7 .!e %en=!ona(7 se&ara( Ede e<., 9F5.9 De%en=7 &ers!s(en(7 !nd+s7 de a"coo"8
    9F9.G9 De%en=7 &ers!s(en(7 !nd+s7 de !na"an(eJ. Dac7 o s+'s(an=7 es(e
    cons!dera(7 a .! .ac(or+" e(!o"o$!c, dar s+'s(an=a s&ec!.!c7 or! c"asa de
    s+'s(an=e es(e nec+nosc+(7, d!a$nos(!c+" es(e 9F9.G9 De%en=7 &ers!s(en(7
    !nd+s7 de o s+'s(an=7 nec+nosc+(7.
    Substanele speci$ice
    De%en=a &ers!s(en(7 !nd+s7 de o s+'s(an=7 &oa(e a&are :n asoc!a=!e c+
    +r%7(oare"e c"ase de s+'s(an=eQ a"coo", !na"an(e, seda(!ve, !&no(!ce O! an<!o"!(!ce,
    or! a"(e s+'s(an=e sa+ s+'s(an=e nec+nosc+(e. Med!ca%en(e"e ra&or(a(e a ca+/a
    de%en=a !nc"+d an(!conv+"s!van(e"e s! %e(o(re<a(+" !n(ra(eca". To<!ce"e descr!se a
    evoca s!%&(o%e"e de%en=e! !nc"+d &"+%'+", %erc+r+", %ono<!d+" de car'on,
    !nsec(!c!de"e or$ano.os.ora(e s! so"ven=!! !nd+s(r!a"!.
    Dia!nostic di$erenial
    3e/! &a$. 5Y9 &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" de%en=e!.
    L2LRK *H
    R
    B+o&+a+! BA !r+!e&!+!& 2n@d+!a<a *SSDE +U 4BA!==+SoD UT
    A&ED!!!++!as A&nDas+cn +!&a& +n =e=@OA/a& B 2+nsn&! a"!n+" PBUI B @ns@rnD +!
    2a!BD 2=+a+!E=!od+!co a& a@B0anyad E*BI 2A!&!Ee 8n0a& no 2@a+na!=/=v d!e a& O!+a+!a&
    HD &!A!&+! +n B* a8BD&so+fB=& a!! ES a%0a!e B*E?DSEA Be+a+!a& :s e=& 2."a+na!!?v
    d!e a& E@+a+!a& eEeE 2n@d+!a<a a$ o&so+SE=& +n BD B=B>!s!Sa@+! a=@ BS a(n0an
    n+ :s =B*Bdas nes @e &oD +n a@B n+ a=d&@n+! +So&&a @o+n B=
    a0SNls0Ia0ui sp
    NE*OOD*B a& Bsn&+! B=+a?s=s@ad B?+a+!a& 24<a a&J ae+Ees0ns (7+n
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    aIE+!0+!oD @o=a&a@a B?E*O?BP !@ a=sod E?+a+!a& +o EUEIUB*D %=n+!s&E+%E<! Be
    B!+a+!a& :s @a+na!=/&? d& a& B=+a+!a&
    X4
    <a a&J E=+a+!a& no a!=E=a! +! !! a=Bod
    B=B*a+aS B=ED!&a+! a&!&+oD B!nS+!s o =&a& ==n+! IE*AI 2a!So=o!=a E4!nS+!s o =EDa&
    I@n+! IEUI a!B B=+a+!a& aaED +! a+n+!oD !a!eBr+=s $@dnsB @n+B&!+!& B "+!+ad
    Bsn[DU= a8sa a@d&=n+! nSo@o&a @o+n a?B*O=E& "a=+a+!a&
    Qoun

    nes eiueis]ns o uo eiueis]ns eiJS
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    76H28 Demena 'r Alt
    Speci$icaie
    181

    de (!& A"/e!%er, c+ de'+( (ard!v, .7r7 &er(+r'are de co%&or(a%en( s! 9FL.IL
    De%en=7 vasc+"ar7, neco%&"!ca(7, &e a<a I, cA( s! ;;5.L Ma"ad!e A"/e!%er s! I;R
    Ic(+s, &e a<a III.
    Criteriile $e $ia/no&ti# pentru
    De"en!a $atorat( unor Etiolo/.i Multiple
    A2 De(voltarea de de$icite co!nitive multiple mani$estate prin ambeleD
    (1) deteriorarea memoriei &deteriorarea capacitii de a "nva
    in$ormaii
    noi sau de a evoca in$ormaii "nvate anterior)3
    (2) una &sau mai multe) dintre urmtoarele perturbri co!nitiveD
    &a) a$a(ie &perturbare de limba0)3
    &b)apraxie &deteriorarea capacitii de a e$ectua activiti motorii, "n
    dispreul $unciei motorii intacte)3
    (c)a!no(ie &incapacitatea de a recunoa,te sau identi$ica obiectele, "n
    dispreul $unciei sen(oriale intacte)3
    (d) perturbare "n $uncia de execuie &adic, "n plani$icare,
    or!ani(are,
    secveniere, abstracti(are)2
    S2 De$icitele co!nitive de la criteriile AE ,i A7 cau(ea( $iecare deteriorare sem
    ni$icativ "n $uncionarea social sau pro$esional ,i repre(int un declin
    semni$icativ de la nivelul anterior de $uncionare2
    2 Din istoric, examenul somatic ori datele de laborator, re(ult proba c
    perturbarea are mai mult dec@t o sin!ur etiolo!ie &de ex2, un traumatism
    cranian plus u(ul cronic de alcool, demen de tip Al(%eimer cu de(voltarea
    ulterioar a unei demene vasculare)2
    D2 De$icitele nu survin exclusiv "n cursul unui delirium2
    Fot de codi$icareD A se utili(a coduri multiple ba(ate pe demene speci$ice ,i
    pe etiolo!ii speci$ice, de ex2, 76H2E5 Demen de tip Al(%eimer, cu debut tardiv,
    $r perturbare de comportament3 7652H5 Demen vascular, necomplicat2
    C57.> De"en!a '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 &en(r+ a d!a$nos(!ca o de%en=7 care n+
    sa(!s.ace cr!(er!!"e &en(r+ n!c! +n+" d!n (!&+r!"e s&ec!.!ce descr!se :n aceas(7 sec=!+ne.
    Un e<e%&"+ :n aces( sens es(e +n (a'"o+ c"!n!c de de%en=7 &en(r+ care n+ e<!s(7
    s+.!c!en(e &ro'e &en(r+ a s(a'!"! o e(!o"o$!e s&ec!.!c7.
    5H9 De%riumul, Dementa, Tulburrile Amnestice si Alte Tulburri
    Tul-ur(rile A"ne&ti#e
    T+"'+r7r!"e d!n sec=!+nea ST+"'+r7r!"e A%nes(!ceT se carac(er!/ea/7 &nn(r4o
    &er(+r'are de %e%or!e care es(e da(ora(7, .!e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne!
    cond!=!! %ed!ca"e $enera"e, .!e e.ec(e"or &ers!s(en(e a"e +ne! s+'s(an=e Ead!c7, +n
    dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea "a +n (o<!cJ T+"'+r7r!"e d!n aceas(7
    sec=!+ne a+ :n co%+n s!%&(o%+" de de(er!orare a %e%or!e!, dar se d!.eren=!a/7
    :n(re e"e &e 'a/7 de e(!o"o$!c E"e%en(e"e de d!a$nos(!c %en=!ona(e %a! @os a&ar=!n
    (+"'+r7r!! a%nes(!ce &ers!s(en(e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e Ede e< ,
    +n (ra+%a(!s% .!/!c s! de.!c!en=7 v!(a%!n!c7J s! (+"'+r7r!! a%nes(!ce &ers!s(en(e
    !nd+se de o s+'s(an=7 E!nc"+s!v e.ec(e"e sec+ndare a"e +n+! %ed!ca%en(J In &"+s,
    :n aceas(7 sec=!+ne es(e !nc"+s7 (+"'+rarea a%nes(!c7 .7r7 a"(7 s&ec!.!ca=!e, &en(r+
    ace"e (a'"o+r! c"!n!ce :n care c"!n!c!an+" es(e !nca&a'!" s7 &rec!/e/e o e(!o"o$!c
    s&ec!.!c7 &en(r+ &er(+r'area de %e%or!e Te<(+" s! cr!(er!!"e &en(r+ (+"'+r7r!"e
    d!soc!a(!ve !%&"!cAnd &!erderea %e%or!e! n+ s+n( !nc"+se a!c!, c! :n sec=!+nea
    (+"'+r7r!"or d!soc!a(!ve Eve/! &a$ Y5FJ
    *lemente de dia!nostic
    Ind!v!/!! c+ o (+"'+rare a%nes(!c7 s+n( de(er!ora=! :n ca&ac!(a(ea "or de a :nv7=a
    !n.or%a=!! no! sa+ de a evoca !n.or%a=!! :nv7=a(e an(er!or sa+ even!%en(e (rec+(e
    Ecr!(er!+" AJ Per(+r'area de %e%or!e (re'+!e s7 .!e s+.!c!en( de sever7 &en(r+ a
    ca+/a o de(er!orare %arca(7 :n .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7 s! (re'+!e s7
    re&re/!n(e +n dec"!n se%n!.!ca(!v de "a n!ve"+" an(er!or de .+nc=!onare Ecr!(er!+" BJ
    Per(+r'area de %e%or!e n+ (re'+!e s7 s+rv!n7 e<c"+s!v :n c+rs+" +n+! der!+% sa+
    a" +ne! de%en(e Ecr!(er!+" CJ Ca&ac!(a(ea de a :nv7=a s! de a evoca o !n.or%a=!e
    no+7 es(e a.ec(a(7 (o(dea+na :n(r4o (+"'+rare a%nes(!c7, :n (!%& ce &ro'"e%e"e
    a%!n(!nd !n.or%a=!a :nv7=a(7 an(er!or s+rv!n !ncons(an(, :n .+nc=!e de "oca"!/area s!
    sever!(a(ea "e/!+n!! cere'ra"e De.!c!(+" de %e%or!e es(e %a! ev!den( "a sarc!n!"e care
    neces!(7 o evocare s&on(an7 s!, de ase%enea, cAnd e<a%!na(or+" o.er7 re&ere
    &ersoane! &en(r+ ca aceas(a s74s! rea%!n(easc7 o &er!oad7 de (!%& %a! recen(7 :n
    .+nc=!e de ar!a cere'ra"7 s&ec!.!c7 a.ec(a(7, de.!c!(e"e &o( .! &redo%!nan( :n "e$7(+r7
    c+ s(!%+"! ver'a"! sa+ v!/+a"! :n +ne"e .or%e de (+"'+rare a%nes(!c7, !nd!v!d+" :O!
    &oa(e a%!n(! "+cr+r! d!n (rec+(+" .oar(e :nde&7r(a( %a! '!ne decA( even!%en(e %a!
    recen(e Ede e< , o &ersoan7 :O! &oa(e a%!n(! :n de(a"!! v!! o Oedere :n s&!(a" care a av+(
    "oc c+ o decad7 :na!n(ea e<a%!n7% ac(+a"e, dar &oa(e s7 n+ a!'7 n!c! o !dee des&re
    .a&(+" c7 ac(+a"%en(e se a."7 :n s&!(a"J
    D!a$nos(!c+" n+ es(e &+s, dac7 de(er!orarea %e%or!e! s+rv!ne e<c"+s!v :n c+rs+"
    +n+! der!+% Ede e< , s+rv!ne n+%a! :n con(e<(+" ca&ac!(7=!! red+se de a %en=!ne s!
    de&"asa a(en=!aJ Ca&ac!(a(ea de a re&e(a !%ed!a( +n .ra$%en( secven=!a" de
    !n.or%a=!e Ede e< , +n n+%7rJ n+ es(e a.ec(a(7 de re$+"7 :n(r4o (+"'+rare a%nes(!c7
    CAnd o as(.e" de de(er!orare es(e ev!den(7, aceas(a s+$erea/7 &re/en(a +ne!
    &er(+r'7r! de a(en=!e care &oa(e !nd!ca +n der!+% D!a$nos(!c+" n+ es(e &+s, de
    ase%enea, :n &re/en(a a"(or de.!c!(e co$n!(!ve Ede e<, a.a/!e, a&ra<!e, a$no/!e,
    &er(+r'are :n .+nc=!a de e<ec+=!eJ care s+n( carac(er!s(!ce de%en(e! Ind!v!/!! c+ o
    (+"'+rare a%nes(!c7 &o( e<&er!en=a o de(er!orare %a@or7 :n .+nc=!onarea "or soc!a"7
    s! &ro.es!ona"7 ca re/+"(a( a" de.!c!(e"or "or %ne/!ce, care, :n .or%e"e sa"e e<(re%e,
    &oa(e neces!(a s+&rave$erea s!(+a=!!"or de v!a(7 a"e aces(ora, &en(r+ a se as!$+ra
    a"!%en(area s! :n$r!@!rea cores&+n/7(oare
    Tulburrile
    Amnestice
    E?4
    *lemente si tulburri asociate
    O (+"'+rare a%ne'(!c7 es(e adesea &receda(7 de +n (a'"o+ c"!n!c evo"+(!v care
    !nc"+de con.+/!e s! de/or!en(are s!, oca/!ona", &ro'"e%e de a(en=!e, care s+$erea/7
    +n de"%+% Ede e<, (+"'+rarea a%nes(!c7 da(ora(7 de.!c!en(e! de (!a%!n7J
    Con.a'+"a(!a, ev!den=!a(7 adesea &r!n re"a(area de even!%en(e !%a$!nare &en(r+ a
    +%&"e "ac+ne"e %ne/!ce, &oa(e .! no(a(7 :n s(ad!!"e &recoce a"e (+"'+r7% a%nes(!ce,
    dar (!nde s7 d!s&ar7 c+ (!%&+" De aceea, &oa(e .! !%&or(an( s7 se o'=!n7 o
    !n.or%a=!e coro'ora(7 de "a %e%'r!! .a%!"!e! or! de "a a"=! !n.or%a(or! A%ne/!a
    &ro.+nd7 &oa(e d+ce "a de/or!en(are :n "oc s! (!%&, dar %a! rar "a &ro&r!a &ersoan7
    De/or!en(area "a &ro&r!a &ersoan7 &oa(e .! :n(A"n!(7 "a !nd!v!/!! c+ de%en(7, dar es(e
    e<ce&=!ona"7 :n(r4o (+"'+rare a%nes(!c7 Ce! %a! %+"=! !nd!v!/! c+ o (+"'+rare
    a%nes(!c7 sever7 n+ a+ conO(!!n=a de.!c!(e"or "or %ne/!ce s! &o( ne$a :n %od e<&"!c!(
    &re/en=a de(er!or7% severe a %e%or!e!, :n d!s&re=+" ev!den(e! de con(rar!+ L!&sa
    conO(!!n=e! (+"'+r7% &oa(e d+ce "a ac+/a=!! "a adresa a"(ora sa+, :n ca/+r! rare, "a
    a$!(a=!e Un+ !nd!v!/! &o( rec+noaO(e c7 a+ &ro'"e%e, dar s+n( !nd!.eren=! Po( .!
    :n(A"n!(e a&a(!a, "!&sa de !n!=!a(!v7, a&"a(!/area e%o=!ona"7 on a"(e %od!.!c7r!
    s+$es(!ve de a"(erare a .+nc=!e! &ersona"!(7=!! Ind!v!/!! &o( .! "a &r!%a vedere
    a%a'!"! s! a$rea'!"!, dar &o( avea +n $rad s+&er.!c!a" sa+ d!%!n+a( de e<&res!e
    a.ec(!v7 Ind!v!/!! c+ a%ne/!e $"o'a"7 (ran/!(or!e &ar adesea a .! &er&"ecs! sa+
    con.+/! Po( .! no(a(e de.!c!(e s+'(!"e % a"(e .+nc=!! co$n!(!ve, dar, &r!n de.!n!=!e,
    aces(ea n+ s+n( s+.!c!en( de severe &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 c"!n!c
    Tes(7r!"e ne+ro&s!o"o$!ce can(!(a(!ve ev!den=!a/7 adesea de.!c!(e de %e%or!e
    s&ec!.!ce, :n a'sen(a a"(or &er(+r'7r! co$n!(!ve Per.or%an(a "a (e<(e"e s(andard!/a(e
    care eva"+ea/7 evocarea +nor even!%en(e !s(or!ce or! &ersona"!(7=! &+'"!ce
    '!nec+nosc+(e &oa(e .! var!a'!"7 "a !nd!v!/!! c+ (+"'+rare a%nes(!c7, :n .+nc=!e de
    na(+ra s! :n(!nderea de.!c!(+"+!
    *lemente speci$ice culturii
    Fond+" c+"(+ra" s! ed+ca=!ona" (re'+!e s7 .!e "+a( :n cons!dera=!e :n eva"+area
    %e%or!e! Ind!v!/!! d!n an+%!(e .ond+r! n+ s+n( .a%!"!ar!/a=! c+ !n.or%a=!!"e
    +(!"!/a(e :n an+%!(e (es(e de %e%or!e Ede e_, da(a naO(er!!, :n c+"(+r!"e care n+
    ce"e'rea/7 :n %od c+ren( da(a naO(er!!J
    *voluie
    E(a(ea "a de'+( s! evo"+=!a +"(er!oar7 a (+"'+r7r!"or a%nes(!ce &o( .! .oar(e
    d!.er!(e, :n .+nc=!e de &roces+" &a(o"o$!c &r!%ar care ca+/ea/7 (+"'+rarea
    a%nes(!c7 Le/!+n!"e (ra+%a(!ce a"e cre!er+"+!, !c(+s+" sa+ a"(e even!%en(e
    cere'rovasc+"are, on (!&+r! s&ec!.!ce de e<&+nere "a s+'s(an=e ne+ro(o<!ce Ede
    e< , !n(o<!ca=!a c+ %ono<!d de car'onJ &o( d+ce "a +n de'+( ac+( a" (+"'+r7%
    a%nes(!ce A"(e cond!=!!, c+% ar .! a'+/+" &re"+n$!( de o s+'s(an=7, e<&+nerea
    cron!ca "a ne+ro(o<!ce or! de.!c!en(a n+(r!=!ona"7 s+s=!n+(7, &o( d+ce "a +n
    de'+( !ns!d!os A%ne/!a (ran/!(or!e da(ora(7 +ne2 e(!o"o$n cere'rovasc+"are
    &oa(e .! rec+ren(7, c+ e&!soade d+rAnd de "a cA(eva ore "a cA(eva /!"e
    T+"'+r7r!"e a%nes(!ce da(ora(e (ra+%a(!s%+"+! cran!an &o( d+ra &er!oade de
    (!%& d!.er!(e, c+ +n &a((ern carac(er!s(!c de de.!c!(e .oar(e %ar!, !%ed!a( d+&7
    (ra+%a(!s% s! a%e"!orare :n +r%7(or!! 9 a% Ea .os( no(a(7 s! o a%e"!orare
    +"(er!oar7 d+&7 9I de "+n!, dar es(e %a! &+=!n .recven(7J T+"'+r7r!"e da(ora(e
    E?H
    Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri

    d!s(r+$er!! s(r+c(+r!"or "o'+"+! %ed!o(e%&ora" Ede e<., &r!n !n.arc(!/are, a'"a=!e
    c!r+r$!ca"7 or! %a"n+(r!=!e, s+rven!nd :n con(e<(+" de&enden=e! a"coo"!ceJ &o(
    ca+/a de(er!or7r! &ers!s(en(e.
    Dia!nostic di$erenial
    De(er!orarea %e%or!e! es(e, de ase%enea, +n e"e%en( a" de"!r!+%+"+! s!
    de%en=e!, :n de"!r!+%, d!s.+nc=!a %e%or!e! s+rv!ne :n asoc!ere c+ de(er!orarea
    conO(!en(e!, c+ red+cerea ca&ac!(7=!! de a .oca"!/a, s+s=!ne sa+ de&"asa a(en=!a, :n
    de%en=7, de(er!orarea %e%or!e! (re'+!e s7 .!e aco%&an!a(7 de de.!c!(e co$n!(!ve
    %+"(!&"e Ead!c7, de a.a/!e, a&ra<!e, a$no/!e or! o &er(+r'are :n .+nc=!a de e<ec+=!eJ
    care d+c "a o de(er!orare se%n!.!ca(!v7 c"!n!c.
    T+"'+rarea a%nes(!c7 (re'+!e s7 .!e d!s(!ns7 de a%ne/!a d!soc!a(!v7 s! de
    a%ne/!a s+rven!nd :n con(e<(+" a"(or (+"'+r7r! d!soc!a(!ve Ede e<., (+"'+rarea de
    !den(!(a(e d!soc!a(!v7J. Pr!n de.!n!=!e, o (+"'+rare a%nes(!c7 es(e da(ora(7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e or! +/+"+! +ne! s+'s(an=e, :n
    a.ar7 de aceas(a, a%ne/!a d!n (+"'+r7r!"e d!soc!a(!ve n+ !%&"!c7 de re$+"7 de.!c!(e
    :n :nv7=area s! re&rod+cerea !n.or%a=!!"or no!, !nd!v!/!! &re/en(And %a! c+rAnd o
    !nca&ac!(a(e c!rc+%scr!s7 de a evoca even!%en(e an(er!oare, de re$+"7 de na(+r7
    (ra+%a(!c7 sa+ s(resan(7.
    Pen(r+ &er(+r'7r!"e de %e%or!e Ede e<., '"ac)o+(sJ care s+rv!n n+%a! :n c+rs+"
    !n(o<!ca=!e! sa+ a's(!nen=e! de +n dro$ de a'+/, (re'+!e &+s d!a$nos(!c+"
    cores&+n/7(or de !n(o<!ca=!e c+ o s+'s(an=7 or! de a's(!nen=7 de o s+'s(an=7 s! n+
    d!a$nos(!c+" se&ara( de (+"'+rare a%nes(!c7. Pen(r+ &er(+r'7r!"e de %e%or!e care
    s+n( asoc!a(e c+ +/+" +n+! %ed!ca%en( (re'+!e s7 .!e no(a( Se.ec(e adverse a"e +n+!
    %ed!ca%en( .7r7 a"(7 s&ec!.!ca=!eT E&a$. H;RJ, c+ !nd!carea %ed!ca%en(+"+!
    res&ec(!v &r!n +(!"!/area +n+! cod E Eve/! ane<a ,J.
    E(!o"o$!a &res+&+s7 a (+"'+r7r!! a%nes(!ce de(er%!n7 d!a$nos(!c+" E(e<(+" s!
    cr!(er!!"e &en(r+ .!ecare d!a$nos(!c de (+"'+rare a%nes(!c7 s+n( &rev7/+(e se&ara(,
    &+=!n %a! de&ar(e :n aceas(7 sec=!+neJ. Dac7 se cons!der7 c7 &er(+r'area de
    %e%or!e es(e consec!n=a e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e
    $enera"e E!nc"+s!v (ra+%a(!s%+" cran!anJ, ar+nc! es(e &+s d!a$nos(!c+" de (+"'+rare
    a%nes(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Dac7 &er(+r'area de %e%or!e
    es(e re/+"(a(+" e.ec(e"or &ers!s(en(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n
    %ed!ca%en( or! e<&+nerea "a +n (o<!cJ, ar+nc! es(e &+s d!a$nos(!c+" de (+"'+rare
    a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7. CAnd, a(A( o s+'s(an=7 Ede e<.,
    a"coo"+"J, cA( s! o cond!=!e %ed!ca"7 $enera"7 Ede e<., +n (ra+%a(!s% cran!anJ a+
    av+( +n ro" :n de/vo"(area &er(+r'7r!! de %e%or!e, s+n( &+se a%'e"e d!a$nos(!ce.
    Dac7 n+ es(e &os!'!" s7 se s(a'!"easc7 o e(!o"o$!c s&ec!.!c7 Ead!c7, d!soc!a(!v7, !nd+s7
    de o s+'s(an=7 or! da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eJ es(e d!a$nos(!ca(7
    (+"'+rarea a%nes(!c7 .7r7 a"(7 s&ec!.!ca=!e.
    T+"'+rarea a%nes(!c7 (re'+!e s7 .!e d!s(!ns7 de s!%+"are s! de (+"'+rarea .ac(!ce.
    Aceas(7 d!s(!nc=!e &oa(e .! e.ec(+a(7 c+ a@+(or+" +ne! (es(7r! s!s(e%a(!ce a %e%or!e!
    Ecare adesea d7 re/+"(a(e !ncons(an(e :n (+"'+rarea .ac(!ce s! :n s!%+"areJ O! &r!n
    a'sen=a +ne! cond!=!! %ed!ca"e $enera"e or! a +/+"+! +ne! s+'s(an=e care es(e
    e(!o"o$!c :n re"a=!e c+ de(er!orarea %e%or!e!.
    T+"'+rarea a%nes(!c7 (re'+!e s7 .!e d!s(!ns7 de %e%or!a %a! &+=!n e.!c!en(7 a
    dec"!n+"+! co$n!(!v :n "e$7(+r7 c+ e(a(ea, care se s!(+ea/7 :n cadr+" $a%e! nor%a(!ve
    ada&(a(e "a e(a(e, e<&ec(a(7 &en(r+ !nd!v!d.
    76H25 Tulburarea Amnestic datorat
    unei ondiii Medicale Generale 5HY
    C57.+ Tul-urarea A"ne&ti#( $atorat( unei
    Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic si elemente asociate
    E"e%en(e"e descr!&(!ve a"e (+"'+r7r!! a%nes(!ce da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e Ecr!(er!!"e A4C s+n( d!sc+(a(e "a &a$. 5H9J. :n &"+s, d!a$nos(!c+" cere ca d!n
    !s(or!c, e<a%en+" so%a(!c or! da(e"e de "a'ora(or, s7 .!e ev!den( .a&(+" c7
    &er(+r'area de %e%or!e es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e
    $enera"e E!nc"+s!v (ra+%a(!s%+" .!/!cJ Ecr!(er!+" DJ.
    :n &rec!/area .a&(+"+! c7 &er(+r'area a%nes(!c7 es(e da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en=a +ne!
    cond!=!! %ed!ca"e $enera"e. A&o!, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7
    &er(+r'area a%nes(!c7 es(e e(!o"o$!c :n re"a=!e c+ cond!=!a %ed!ca"7 $enera"7 &r!n(r4
    +n %ecan!s% .!/!o"o$!c. O eva"+are a(en(7 s! c+&r!n/7(oare a n+%eroO! .ac(or! es(e
    necesar7 &en(r+ a .ace aces( ra=!ona%en(. DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a
    &rec!/a dac7 re"a=!a d!n(re &er(+r'area a%nes(!c7 s! cond!=!a %ed!ca"7 $enera"7
    es(e e(!o"o$!c7, +ne"e cons!deren(e o.er7 o oarecare $!dare :n aces( do%en!+. Un
    &r!% cons!deren( :" cons(!(+!e &re/en=a +ne! asoc!er! (e%&ora"e :n(re de'+(+",
    e<acer'area sa+ re%!s!+nea cond!=!e! %ed!ca"e $enera"e s! cea a &er(+r'7r!!
    a%nes(!ce. A" do!"ea cons!deren( :" cons(!(+!e &re/en=a de e"e%en(e care s+n(
    a(!&!ce de(er!or7r!! %e%or!e! :n con(e<(+" +ne! (+"'+r7r! d!soc!a(!ve sa+ a" a"(e!
    (+"'+r7r! %en(a"e Ede e<., e(a(ea "a de'+( or! evo"+=!a a(!&!c7J. Da(e"e d!n "!(era(+r7,
    care s+$erea/7 c7 &oa(e e<!s(a o asoc!ere d!rec(7 :n(re cond!=!a %ed!ca"7 $enera"7
    :n ces(!+ne s! a&ar!=!a de(er!or7r!! %e%or!e!, &o( o.er! +n con(e<( +(!" :n eva"+area
    +ne! an+%!(e s!(+a=!!. Pe "An$7 aceas(a, c"!n!c!an+" (re'+!e s7 a&rec!e/e, de
    ase%enea, dac7 &er(+r'area n+ es(e e<&"!ca(7 %a! '!ne de o (+"'+rare d!soc!a(!v7,
    o (+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7 or! de o a"(7 (+"'+rare
    %en(a"7 &r!%ar7 Ede e<., (+"'+rarea de&res!v7 %a@or7J. Aces(e &rec!/7r! s+n(
    e<&"!ca(e %a! :n de(a"!+ :n sec=!+nea ST+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!!
    %ed!ca"e $enera"eT E&a$. 5G5J.
    Ind!v!/!! c+ (+"'+rare a%nes(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e
    &re/!n(7 adesea s! a"(e e"e%en(e a"e %a"ad!e! s!s(e%!ce sa+ cere'ra"e &r!%are care
    a ca+/a( de(er!orarea %e%or!e!. C+ (oa(e aces(ea :ns7, s(a(+s+" %en(a" (+"'+ra(
    &oa(e .! +n!c+" e"e%en( &re/en(. N+ e<!s(7 n!c! +n .e" de e"e%en(e s&ec!.!ce sa+ de
    d!a$nos(!c de(ec(a'!"e &r!n &rocedee c+% ar .! !%a$!s(!ca &r!n re/onan=7
    %a$ne(!c7 ERMNJ or! &r!n (o%o$ra.!a co%&+(er!/a(7 ETCJ. Le/area s(r+c(+r!"or
    "o'+"+! %ed!o(e%&ora" es(e :ns7 .recven(7 s! &oa(e .! o'!ec(!va(7 de "7r$!rea ce"+!
    de a" (re!"ea ven(r!c+" or! a coarne"or (e%&ora"e sa+ de a(ro.!a s(r+c(+ra"7
    de(ec(a(7 &r!n RMN.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! (re'+!e s7 .!e no(a=! &en(r+ a !nd!ca d+ra(a &er(+r'7r!!Q
    Tran/!(or!e. Aces( s&ec!.!can( es(e +(!"!/a( &en(r+ a !nd!ca d+ra(e %er$And de
    re$+"7 de "a cA(eva ore "a cA(eva /!"e, dar n+ %a! %+"( decA( o "+n7. CAnd
    d!a$nos(!c+" es(e &+s :n c+rs+" &r!%e! "+n!, .7r7 a se aO(e&(a rec+&erarea,
    &oa(e .! ad7+$a( (er%en+" de S&rov!/or!+T. SA%ne/!a (ran/!(or!e $"o'a"7T
    E?I Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    es(e o .or%7 s&ec!.!c7 de (+"'+rare a%nes(!c7 (ran/!(or!e, carac(er!/a(7
    &r!n(r4o !nca&ac!(a(e (ran/!(or!e cons!dera'!"7 de a :nv7=a !n.or%a=!! no! s! o
    ca&ac!(a(e var!a'!" de(er!ora(7 de a evoca even!%en(e"e care a+ av+( "oc c!ar
    :na!n(ea sa+ "a %!@"oc+" &ro'"e%e! e(!o"o$!ce cere'rovasc+"are. Cron!c7.
    Aces( s&ec!.!can( es(e +(!"!/a( &en(r+ &er(+r'7r!"e care d+rea/7 %a! %+"( de o
    "+n7.
    #rocedee de "nre!istrare
    La :nre$!s(rarea d!a$nos(!c+"+! de (+"'+rare a%nes(!c7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 no(e/e cond!=!a %ed!ca"7 $enera"7
    cons!dera(7 a .! ca+/a( &er(+r'area de &e a<a I Ede e<., 9FI.L T+"'+rare a%nes(!c7
    da(ora(7 !c(+s+"+!J. Cod+" CIM4F4CM &en(r+ cond!=!a %ed!ca"7 $enera"7 (re'+!e, de
    ase%enea, s7 .!e no(a( &e a<a III Ede e<., I;R !c(+sJ. E3e/! ane<a , &en(r+ "!s(a
    cod+r!"or d!a$nos(!ce ICD4F4CM se"ec(a(e &en(r+ cond!=!!"e %ed!ca"e $enera"eJ.
    ondiii medicale !enerale asociate
    O (+"'+rare a%nes(!c7 s+rv!ne adesea ca re/+"(a( a" +nor &rocese &a(o"o$!ce Ede
    e<., (ra+%a(!s% cran!an :nc!s, &"a$7 &ene(ran(7 &r!n &ro!ec(!", !n(erven=!e
    c!r+r$!ca"7, !&o<!e, !n.arc( a" (er!(or!+"+! de d!s(r!'+=!e a" ar(ere! cere'ra"e
    &os(er!oare s! ence.a"!(7 c+ er&es s!%&"e<J care ca+/ea/7 "e/area s(r+c(+r!"or
    d!ence.a"!ce s&ec!.!ce s! a s(r+c(+r!"or "o'+"+! %ed!o(e%&ora" Ede e<., cor&!!
    %a%!"ar!, !&oca%&+", .orn!<+"J. Pa(o"o$!a es(e ce" %a! adesea '!"a(era"7, dar
    de.!c!(e"e &o( &roven! O! d!n "e/!+n! +n!"a(era"e. T+"'+rarea a%nes(!c7 (ran/!(or!e,
    cAnd es(e :n(A"n!(7 ca Sa%ne/!e $"o'a"7 (ran/!(or!eT, es(e asoc!a(7 de re$+"7 c+ o
    %a"ad!e cere'rovasc+"ar7 s! &a(o"o$!e :n s!s(e%+" ver(e'ro4'a/!"ar. T+"'+rarea
    a%nes(!c7 (ran/!(or!e &oa(e &roven!, de ase%enea, d!n cond!=!! %e(a'o"!ce sa+
    cr!/e e&!"e&(!ceJ.
    Dia!nostic di$erenial
    3e/! &a$. 5HI &en(r+ o d!sc+=!e a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or
    a%nes(!ce.
    Tulburarea Amnestic #ersistent indus de o
    Substan
    *GG

    Criteriile $e $ia/no&ti# pentru C57.+ Tul-urarea
    A"ne&ti#( $atorat(.....
    [Se indic Condiia Medical General]
    A2 De(voltarea unei deteriorri a memoriei, mani$estat prin perturbarea
    capacitii de a "nva in$ormaii noi ori incapacitatea de a evoca in$ormaii
    "nvate anterior2
    S2 #erturbarea memoriei cau(ea( o deteriorare semni$icativ "n $uncionarea
    social sau pro$esional ,i repre(int un declin semni$icativ de la nivelul
    anterior de $uncionare2
    2 #erturbarea memoriei nu survine exclusiv "n cursul unui delirium sau
    demene2
    D2 Din istoric, examenul somatic sau datele de laborator, re(ult proba c
    perturbarea este consecina $i(iolo!ic direct a unei condiii medicale
    !enerale &inclusiv traumatismul $i(ic)2
    De speci"icat dac esteD
    Tran)itorieM dac deteriorarea memoriei durea( o lun sau mai puin2
    Croni#(M dac deteriorarea memoriei durea( mai mult de o lun2
    Not( $e #o$i%i#areM Fumele condiiei medicale !enerale se include pe axa l, de ex2,
    76H25 Tulburare amnestic datorat unui traumatism cranian3 de asemenea,
    condiia medical !eneral se codi$ica pe axa III &ve(i anexa G pentru coduri)2
    Tul-urarea A"ne&ti#( Per&i&tent(
    in$u&( $e o Su-&tan!(
    *lemente de dia!nostic si elemente asociate
    E"e%en(e"e descr!&(!ve a"e (+"'+r7r!! a%nes(!ce &ers!s(en(e !nd+se de o
    s+'s(an=7 Ecr!(er!!"e A s! BJ s+n( d!sc+(a(e "a &a$. 5H9. Per(+r'area de %e%or!e n+
    s+rv!ne e<c"+s!v :n c+rs+" de"!r!+%+"+! sa+ de%en=e! s! &ers!s(7 &es(e d+ra(a
    +/+a"7 a !n(o<!ca=!e! sa+ a's(!nen=e! de o s+'s(an=7 Ecr!(er!+" CJ, :n a.ar7 de aceas(a,
    &en(r+ a d!a$nos(!ca (+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7, d!n
    !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or, (re'+!e s7 re/+"(e .a&(+" c7
    &er(+r'area %e%or!e! es(e e(!o"o$!c :n re"a=!e c+ e.ec(e"e &ers!s(en(e a"e +/+"+! +ne!
    s+'s(an=e Ede e<., +n dro$ de a'+/, +n %ed!ca%en(, e<&+nerea "a +n (o<!cJ Ecr!(er!+"
    DJ. Aceas(7 (+"'+rare es(e e(!ce(a(7 ca S&ers!s(en(7T, deoarece &er(+r'area de
    %e%or!e &ers!s(7 %+"( (!%& d+&7 ce !nd!v!d+" n+ %a! e<&er!en(ea/7 e.ec(e"e
    !n(o<!ca=!e! sa+ a's(!nen=e! de o s+'s(an=7.
    E"e%en(e"e asoc!a(e c+ (+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7
    s+n( ce"e asoc!a(e c+ (+"'+rarea a%nes(!c7 :n $enera" Eve/! &a$. 5H;J. C!ar dac7
    ac(+a"%en(e s+n( a's(!nen=! de s+'s(an=7, ce! %a! %+"=! !nd!v!/! c+ aceas(7
    (+"'+rare a+ av+( an(er!or +n &a((ern de +/ &re"+n$!( O! e<ces!v de s+'s(an=7 care a
    sa(!s.7c+( cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7. Deoarece aces(e (+"'+r7r!
    *G>
    De%riumul, Dementa, Tulburrile Amnestice si Alte Tulburri

    &ers!s(7 %+"( (!%& d+&7 ce a :nce(a( +/+" de o s+'s(an=7, e<a%en+" sAn$e"+! s!
    +r%!! &oa(e .! ne$a(!v &en(r+ s+'s(an=a e(!o"o$!c7 De'+(+" s+rv!ne rar :na!n(e de
    e(a(ea de 9L de a%. De(er!orarea re/+"(a(7 &oa(e r7%Ane s(a'!"7 sa+ se &oa(e a$rava,
    c!ar dac7 +/+" de s+'s(an=7 :nce(ea/7
    Pen(r+ o d!sc+=!e %a! de(a"!a(7 a e"e%en(e"or asoc!a(e c+ (+"'+r7r!"e :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$ 5F5
    #rocedee de "nre!istrare
    Den+%!rea d!a$nos(!c+"+! :nce&e c+ s+'s(an=a s&ec!.!c7 Ede e< , a"coo",
    seco'ar'!(a"J &res+&+s7 a .! ca+/a( &er(+r'area %e%one! Cod+" d!a$nos(!c es(e
    se"ec(a( d!n "!s(a c"ase"or de s+'s(an=e &rev7/+(e :n se(+" de cr!(er!! Pen(r+
    s+'s(an=e"e care n+ s+n( !nc"+se :n n!c! +na d!n(re c"ase, (re'+!e s7 .!e +(!"!/a( cod+"
    &en(r+ SA"(7 s+'s(an=7T :n a.ar7 de aceas(a, &en(r+ %ed!ca%en(e"e &rescr!se :n
    do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!c &oa(e .! !nd!ca( &r!n %en=!onarea cod+"+!
    E cores&+n/7(or Eve/! ane<a ,J CAnd se cons!der7 c7 %a! %+"( decA( o s!n$+r7
    s+'s(an=7 @oac7 +n ro" !%&or(an( :n de/vo"(area &er(+r'7r!! de %e%or!e, .!ecare
    d!n(re aces(ea (re'+!e s7 .!e %en=!ona(7 se&ara( Ede e< , 9F5 " T+"'+rare a%nes(!c7
    &ers!s(en(7 !nd+s7 de a"coo", 9F9 G; T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de
    seco'ar'!(a"J Dac7 o s+'s(an=7 es(e cons!dera(7 a .! .ac(or+" e(!o"o$!c, dar s+'s(an=a
    s&ec!.!c7 sa+ c"asa de s+'s(an=e es(e nec+nosc+(7, d!a$nos(!c+" es(e 9F9 G;
    T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7 nec+nosc+(7
    Substanele speci$ice
    T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7 &oa(e s+rven! :n
    asoc!ere c+ +r%7(oare"e c"ase de s+'s(an=e a"coo", seda(!ve, !&no(!ce s! an<!o"!(!ce,
    a"(e s+'s(an=e sa+ s+'s(an=e nec+nosc+(e
    T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de a"coo" es(e da(ora(7, ev!den(,
    de.!c!en(e! v!(a%%!ce care es(e asoc!a(7 c+ !n$es(!a &re"+n$!(7 '! e<ces!v7 de a"coo"
    Per(+r'7r!"e ne+ro"o$!ce, c+% ar .! ne+ro&a(!a &er!.er!c7, a(a<!a cere'e"oas7 s!
    %!o&a(!a, se a."7 &r!n(re e"e%en(e"e asoc!a(e T+"'+rarea a%nes(!c7 &ers!s(en(7
    !nd+s7 de a"coo" da(ora(7 de.!c!en(e! de (!a%!n7 Es!ndro%+" -orsa)ovJ +r%ea/7
    adesea +n+! e&!sod ac+( de ence.a"o&a(!e 1er%c)e, o cond!=!e ne+ro"o$!c7
    %an!.es(a(7 &r!n con.+/!e, a(a<!e, ano%a"!! a"e %!Oc7r!"or $"o'!"or oc+"ar! E&ara"!/!!
    a"e &r!v!r!!, n!s(a$%+sJ s! a"(e se%ne ne+ro"o$!ce Tre&(a(, aces(e %an!.es(7r! d!s&ar,
    dar de(er!orarea %a@or7 a %e%or!e! r7%Ane Dac7 ence.a"o&a(!a 1er%c)e es(e
    (ra(a(7 &recoce c+ do/e %ar! de (!a%!n7, (+"'+rarea a%nes(!c7 &ers!s(en(7 da(ora(7
    a"coo"+"+! &oa(e s7 n+ a&ar7 DeO! e(a(ea n+ es(e +n .ac(or e(!o"o$!c s&ec!.!c :n
    cond!=!e, !nd!v!/!! care de/vo"(7 (+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de a"coo"
    a+, :n $enera", +n (rec+( de %+"=! a% de +/ de a"coo" s! s+n( ce" %a! adesea :n e(a(e
    de &es(e IL de a% DeO! %od+" de de'+( es(e de re$+"7 'r+sc, +n+ !nd!v!/! &o(
    de/vo"(a de.!c!(e, !ns!d!os, :n dec+rs de %+"=! an!, d% ca+/a !ns+"(e"or (o<!ce s!
    n+(r!=!ona"e re&e(a(e, :na!n(ea a&ar!=!e! +n+! e&!sod de(enora(!v .!na" %a! dra%a(!c,
    ev!den(, :n "e$7(+r7 c+ de.!c!en(a (!a%%!c7 Oda(7 s(a'!"!/a(7, (+"'+rarea a%nes(!c7
    &ers!s(en(7 !nd+s7 de a"coo" &ers!s(7 !nde.!n!(, deO! &oa(e e<!s(a o +Ooar7 a%e"!orare
    :n dec+rs+" (!%&+"+!, !ar :n(r4+n %!c n+%7r de ca/+r! cond!=!a se &oa(e re%!(e
    De(er!orarea es(e de re$+"7 .oar(e sever7 s! &oa(e .! necesar7 o :n$r!@!re c+s(od!a"7
    &e (oa(7 v!a(a T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce &oa(e +r%a +n+! +/ &re"+n$!( s! e<ces!v de dro$+r! d!n aceas(7 c"as7
    76H28 Tulburarea Amnestic 'r Alt
    Speci$icaie
    *G5

    Evo"+=!a es(e var!a'!"7 O!, con(rar (+"'+r7r!! a%nes(!ce &ers!s(en(e !nd+se de a"coo",
    rec+&erarea co%&"e(7 &oa(e s+rven!. Med!ca%en(e"e descr!se a ca+/a (+"'+r7r!
    a%nes(!ce !nc"+d an(!conv+"s!van(e"e sa+ %e(o(re<a(+" !n(ra(eca". To<!ce"e
    ra&or(a(e a evoca s!%&(o%e de a%ne/!e !nc"+d &"+%'+", %erc+r+", %ono<!d+" de
    car'on, !nsec(!c!de"e or$ano.os.ora(e s! so"ven=!! !nd+s(r!a"!.
    Dia!nostic di$erenial
    3e/! &a$. 5HI &en(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a"
    (+"'+r7r!"or a%nes(!ce.
    Criteriile $e $ia/no&ti# pentru Tul-urarea A"ne&ti#(
    Per&i&tent( in$u&( $e o Su-&tan!(
    A2 De(voltarea unei deteriorri a memoriei, mani$estat prin perturbarea
    capacitii de a "nva in$ormaii noi sau prin incapacitatea de evoca
    in$ormaii "nvate anterior2
    S2 #erturbarea memoriei cau(ea( o deteriorare semni$icativ "n $uncionarea
    social sau pro$esional ,i repre(int un declin semni$icativ de la nivelul
    anterior de $uncionare2
    2 #erturbarea de memorie nu survine exclusiv "n cursul unui delirium sau
    demene ,i persist peste durata u(ual a intoxicaiei sau abstinenei de o
    substan2
    D2 Din istoric, examenul somatic sau datele de laborator, re(ult proba ca
    perturbarea este etiolo!ic "n relaie cu e$ectele persistente ale u(ului unei
    substane &de ex2, un dro! de abu(, un medicament)2
    Tulburarea amnestic persistent indus de o substan speci$ic se codi"ic ast$elD
    &76E2E Alcool3 767284 Sedative, %ipnotice sau anxiolitice3 767284 Alt substan
    sau o substan necunoscut)
    C57.> Tul-urarea A"ne&ti#( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 "a d!a$nos(!carea +ne! (+"'+r7r!
    a%nes(!ce care n+ sa(!s.ace cr!(er!!"e &en(r+ n!c! +n+" d!n (!&+r!"e s&ec!.!ce descr!se
    :n aceas(7 sec=!+ne.
    Un e<e%&"+ :n aces( sens es(e +n (a'"o+ c"!n!c de a%ne/!e &en(r+ care e<!s(7
    !ns+.!c!en(e da(e &en(r+ a s(a'!"! o e(!o"o$!c s&ec!.!c7 Ead!c7, d!soc!a(!v7, !nd+s7 de
    o s+'s(an=7, or! da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eJ.
    E85 Deliriumul, Demena, Tulburrile Amnestice ,i Alte Tulburri
    Alte Tul-ur(ri Co/nitive
    C57.5 Tul-urarea Co/nitiv( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e des(!na(7 (+"'+r7r!"or carac(er!/a(e &r!n d!s.+nc=!e
    co$n!(!v7 &res+&+s a .! da(ora(7 e.ec(+"+! .!/!o"o$!c d!rec( a" +ne! cond!=!! %ed!ca"e
    $enera"e, care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! +n+" d!n(re (!&+r!"e de de"!r!+%,
    de%en=7 sa+ (+"'+rare a%nes(!c7 %en=!ona(e :n aces(a sec=!+ne s! care, de
    ase%enea, n+ &o( .! c"as!.!ca(e %a! '!ne ca de"!r!+% .7r7 a"(7 s&ec!.!ca=!e, de%en=7
    .7r7 a"(7 s&ec!.!ca=!e or! (+"'+rare a%nes(!c7 .7r7 a"(7 s&ec!.!ca=!e. Pen(r+ d!s.+nc=!a
    co$n!(!v7 da(ora(7 +ne! s+'s(an=e s&ec!.!ce or! nec+nosc+(e (re'+!e s7 .!e +(!"!/a(7
    ca(e$or!a de ST+"'+rare :n "e$7(+r7 c+ o s+'s(an=7 .7r7 a"(7 s&ec!.!ca=!eT.
    E<e%&"e"e :n aces( sens !nc"+dQ
    1. T+"'+rarea ne+roco$n!(!v7 +Ooar7Q de(er!orare :n ac(!v!(a(ea co$n!(!v7 ev!den
    =!a(7 &r!n (es(are ne+ro&s!o"o$!c7 or! eva"+are c"!n!c7 c+an(!.!ca(7, :nso=!(7 de
    &ro'a o'!ec(!v7 a +ne! cond!=!! %ed!ca"e $enera"e or! de o d!s.+nc=!e a s!s(e%+"+!
    nervos cen(ra" Eve/! &a$. HR9 &en(r+ cr!(er!!"e de cerce(are s+$era(eJ.
    2. T+"'+rarea &os(con(+/!ona"7Q de(er!orare a %e%or!e! sa+ a(en=!e! c+ s!%&(o%e
    asoc!a(e, consec+(!v7 +n+! (ra+%a(!s% cran!an Eve/! &a$. HRL &en(r+ cr!(er!!"e de
    cerce(are s+$era(eJ.
    Tulburrile Mentale datorate
    unei ondiii Medicale Generale
    (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e es(e
    carac(er!/a(7 &r!n &re/en(a de s!%&(o%e %en(a"e cons!dera(e a .!
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ter%en+" de
    condi(ie medicala /eneral6 se re.er7 "a cond!=!!"e care s+n( cod!.!ca(e &e a<a
    III s! care s+n( %en=!ona(e :n a.ara ca&!(o"+"+! ST+"'+r7r!"e %en(a"eT a"
    ICD E3e/! ane<a , &en(r+ "!s(a condensa(7 a aces(or cond!=!!J D+&7 c+%
    s4a d!sc+(a( :n SIn(rod+cereaT "a aces( %an+a", %en=!nerea d!s(!nc=!e!
    d!n(re (+"'+r7r!"e %en(a"e s! cond!=!!"e %ed!ca"e $enera"e n+ !%&"!c7 .a&(+" c7
    e<!s(7 d!.eren=e .+nda%en(a"e :n conce&(+a"!/area "or, c7 (+"'+r7r!"e %en(a"e n+
    s+n( :n re"a=!e c+ .ac(or! sa+ &rocese so%a(!ce sa+ '!o"o$!ce or! c7 cond!=!!"e
    %ed!ca"e $enera"e n+ a+ n!c! o re"a=!e c+ .ac(or! sa+ &rocese co%&or(a%en(a"e sa+
    &s!osoc!a"e Sco&+" d!s(!n$er!! cond!=!!"or %ed!ca"e $enera"e de (+"'+r7r!"e %en(a"e
    es(e ace"a de a :nc+ra@a a&ro.+ndarea :n eva"+are s! de a o.er! +n (er%en conc!s care
    s7 creasc7 co%+n!carea d!n(re ce! care se oc+&7 de :n$r!@!rea s7n7(7=!! :ns7, :n
    &rac(!ca c"!n!c7, es(e de dor!( s7 .!e +(!"!/a(7 o (er%!no"o$!e %a! adecva(7 &en(r+
    a !den(!.!ca cond!=!a s&ec!.!c7 !%&"!ca(7 :n DSM4III4R, (+"'+r7r!"e %en(a"e da(ora(e
    +ne! cond!=!! %ed!ca"e $enera"e s! (+"'+r7r!"e !nd+se de o s+'s(an=7 era+ den+%!(e
    Sor$an!ceT s! era+ %en=!ona(e :%&re+n7 :n(r4o s!n$+r7 sec=!+ne Aceas(7
    d!.eren=!ere a (+"'+r7r!"or %en(a"e Sor$an!ceT ca o c"as7 se&ara(7 !%&"!c7 .a&(+" c7
    (+"'+r7r!"e %en(a"e Snonor$an!ceT sa+ S.+nc=!ona"eT s+n( ca% .7r7 "e$7(+r7 c+
    .ac(or!! sa+ &rocese"e so%a(!ce sa+ '!o"o$!ce DSM4I3 e"!%!n7 (er%en+" de or$an!c
    s! d!s(!n$e (+"'+r7r!"e %en(a"e care se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e de
    ce"e !nd+se de o s+'s(an=7 s! de ce"e care n+ a+ s&ec!.!ca(7 e(!o"o$!a Ter%en+" de
    t+lb+rare mental6 primar6 es(e +(!"!/a( ca o a'rev!ere &en(r+ a !nd!ca ace"e
    (+"'+r7r! %en(a"e care n+ se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e s! care n+
    s+n( !nd+se de o s+'s(an=7 Te<(+" s! cr!(er!!"e &en(r+ (re! d% ace'(e (+"'+r7r!
    Ead!c7, (+"'+rarea ca(a(on!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    %od!.!carea de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s!
    (+"'+rarea %en(a"7 .7r7 a"(7 s&ec!.!ca=!e da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"eJ s+n( !nc"+se :n aceas(7 sec=!+ne Te<(+" s! cr!(er!!"e &en(r+ cond!=!!"e
    %en=!ona(e %a! @os s+n( &"asa(e :n a"(e sec=!+n! a"e %an+a"+"+! :%&re+n7 c+
    (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Man+a"+" a .os( or$an!/a( de o
    ase%enea %an!er7 :ncA( s7 a(en=!one/e c"!%c!enn s7 !a :n cons!dera=!e aces(e
    (+"'+r7r! :n e.ec(+area d!a$nos(!c+"+! d!.eren=!a"
    9F;.L De"!r!+%+" da(ora( +ne! cond!=!! %ed!ca"e $enera"e Te<(+" s! cr!(er!!"e s+n(
    !nc"+se :n sec=!+nea SDe"!r!+%+", de%en(a, (+"'+r7r!"e a%nesce s! a"(e (+"'+r7r!"e
    co$n!(!veT, &a$ 5I5
    E8E
    1=2
    Tulburrile Mentale datorate unei ondiii Medicale Generale
    U.4 De%en=a da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" s! cr!(er!!"e s+n(
    !nc"+se :n sec=!+nea SDe"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce s! a"(e (+"'+r7r!
    co$n!(!ve, &a$. 5R9.
    9FI.L T+"'+rarea a%nes(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" s!
    cr!(er!!"e s+n( !nc"+se :n sec=!+nea SDe"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce s!
    a"(e (+"'+r7r! co$n!(!veT, &a$. 5HY.
    o
    9F;.G< T+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" s!
    cr!(er!!"e s+n( !nc"+se :n sec=!+nea SSc!/o.ren!a s! a"(e (+"'+r7r! &s!o(!ce, &a$. ;;I.
    9F;.G; T+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" O!
    cr!(er!!"e s+n( !nc"+se :n sec=!+nea ST+"'+r7r!"e a.ec(!veT, &a$. IL5.
    9F;.GF T+"'+rarea an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" s!
    cr!(er!!"e s+n( !nc"+se :n sec=!+nea ST+"'+r7r!"e an<!oaseT, &a$. IHR.
    U.4 D!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" s!
    cr!(er!!"e s+n( !nc"+se :n sec=!+nea ST+"'+r7r!"e se<+a"e s! de !den(!(a(e se<+a"7T,
    &a$. YYG.
    HGL.Y< T+"'+r7r!"e de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e. Te<(+" s!
    cr!(er!!"e s+n( !nc"+se :n sec=!+nea ST+"'+r7r!"e de so%nT, &a$. RY5.
    *lemente de dia!nostic
    :n se(+" de cr!(er!! a" .!ec7re! (+"'+r7r! %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e a&ar (re! cr!(er!!Q
    B. $viden3a din istoric2 examenul somatic /i datele de laborator a faptului c
    perturbarea este consecin3a fiziolo.ic direct a unei condi3ii medicale
    .enerale.
    A&"!carea aces(+! cr!(er!+ neces!(7 do+7 @+dec7=! se&ara(eQ c7 es(e &re/en(7 o
    cond!=!e %ed!ca"7 $enera"7 Es(a'!"!(7 &r!n !s(or!c, e<a%en+" so%a(!c O! da(e"e de
    "a'ora(or O! c7 &er(+r'area Ede e<., s!%&(o%e"e &s!o(!ce, a.ec(!ve sa+ an<!oaseJ es(e
    e(!o"o$!c :n re"a=!e c+ cond!=!a %ed!ca"7 $enera"7 &r!n(r4+n %ecan!s% .!/!o"o$!c.
    Tre'+!e rec+nosc+( c7 dac7 sa+ n+ o &er(+r'are este sa+ n+ este da(ora(7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e re&re/!n(7 adesea o
    d!o(o%!e .a"s7, ad!c7 o cond!=!e %ed!ca"7 $enera"7 &oa(e .! &ar(e, dar n+ s!n$+ra
    e(!o"o$!e a (+"'+r7r!! DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a &rec!/a dac7 re"a=!a
    d!n(re &er(+r'are s! cond!=!a %ed!ca"7 $enera"7 es(e e(!o"o$!c7, cA(eva cons!deren(e
    o.er7 (o(+O! o $!dare :n aces( do%en!+. Un &r!% cons!deren( :" cons(!(+!e &re/en=a
    +ne! re"a=!! (e%&ora"e :n(re de'+(+", e<acer'area sa+ re%!s!+nea cond!=!e! %ed!ca"e
    $enera"e O! ce"e a"e (+"'+r7r!! %en(a"e Ede e<., s!%&(o%e"e an<!oase "a +n !nd!v!d c+
    +n adeno% &ara(!r!o!d!an care se re/o"v7 d+&7 ce e<c!/!a c!r+r$!ca"7 res(a+rea/7
    n!ve"+" nor%a" a" ca"c!+"+! ser!cJ. DeO! X&ro'a +ne! re"a=!! (e%&ora"e s(rAnse es(e
    adesea +(!"7, :n e%!(erea +ne! @+dec7=! re.er!(oare "a e(!o"o$!e e<!s(7 %+"(e e<ce&=!!.
    De e<e%&"+, (+"'+rarea &s!o(!c7 da(ora(7 e&!"e&s!e! &oa(e s+rven! "a %+"=! an!
    d+&7 de'+(+" accese"or, :n sc!%', s!%&(o%e O! se%ne a"e +ne! (+"'+r7r! %en(a"e
    se &o( a."a &r!n(re &r!%e"e %an!.es(7r! a"e +ne! %a"ad!! s!s(e%!ce sa+ cere'ra"e,
    Tulburrile Mentale datorate unei ondiii Medicale
    Generale
    *>4
    a&7rAnd c+ "+n! sa+ c!ar %a! %+"( :na!n(ea de(ec(7r!! &roces+"+! &a(o"o$!c
    s+'!acen( Ede e<., d!s&o/!=!a de&res!v7 care &recede %!Oc7r!"e core!.or%e :n %a"ad!a
    H+n(!n$(onJ. De ase%enea, (+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e &o( &ers!s(a d+&7 ce cond!=!a %ed!ca"7 $enera"7 s4a re/o"va( Ede e<.,
    d!s&o/!=!a de&res!v7 care &ers!s(7 d+&7 s+'s(!(+!rea or%on+"+! (!ro!d!anJ. Ma!
    %+"( decA( a(A(, o (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e &oa(e
    .! s+sce&(!'!"7 de (ra(a%en( s!%&(o%a(!c, c!ar dac7 cond!=!a %ed!ca"7 $enera"7
    r7%Ane ac(!v7 Ede e<., de&res!a d!n e&!"e&s!eJ. Tra(a%en(+" =!n(!( a" cond!=!e!
    %ed!ca"e $enera"e, care a%e"!orea/7 a(A( s!%&(o%e"e cond!=!e! %ed!ca"e $enera"e,
    cA( O! &er(+r'area %en(a"7, &oa(e .+rn!/a +n ar$+%en( &+(ern!c de re"a=!e e(!o"o$!c7.
    Un a" do!"ea cons!deren( !%&or(an( :" cons(!(+!e &re/en=a +nor e"e%en(e care
    s+n( a(!&!ce &en(r+ (+"'+rarea %en(a"7 &r!%ar7. Ce" %a! co%+n e<e%&"+ :"
    cons(!(+!e o e(a(e "a de'+( sa+ o evo"+=!e a(!&!c7 Ede e<., a&ar!=!a &en(r+ &r!%a da(7
    a +nor s!%&(o%e s!%!"are sc!/o.ren!e! "a +n !nd!v!d :n e(a(e de HY an!J. Po( e<!s(a
    e"e%en(e asoc!a(e !nso"!(e Ede e<., a"+c!na=!! v!/+a"e :nso=!nd e&!soade
    ase%7n7(oare e&!soade"or de&res!ve %a@oreJ sa+ e"e%en(e de d!a$nos(!c
    d!s&ro&or=!ona( %a! severe decA( ar .! de aO(e&(a(, da(7 .!!nd &re/en(area $enera"7
    Ede e<., o &!erdere :n $re+(a(e de YL de &.+n/! "a +n !nd!v!d c+ s!%&(o%e
    de&res!ve, de a"(.e" +Ooare, &oa(e s+$era &re/en=a +ne! cond!=!! %ed!ca"e $enera"e
    s+'!acen(eJ. C"!n!c!an+" (re'+!e s7 .!e a"er(a( :n s&ec!a" de &re/en=a +nor de.!c!(e
    co$n!(!ve se%n!.!ca(!ve d!s&ro&or=!ona(e .a=7 de ce"e :n(A"n!(e de re$+"7 :n
    (+"'+rarea %en(a"7 &r!%ar7.
    Ev!den=a d!n "!(era(+r7 a +ne! asoc!er! '!ne s(a'!"!(e sa+ .recven( :n(A"n!(e :n(re
    cond!=!a %ed!ca"7 $enera"7 O! .eno%eno"o$!a +ne! (+"'+r7r! %en(a"e s&ec!.!ce &oa(e
    .! +(!"7 :n eva"+area +ne! an+%!(e s!(+a=!!. As(.e" de s(+d!! &o( o.er! &ro'a +ne!
    asoc!er! e(!o"o$!ce &"a+/!'!"e :n(re s!%&(o%e"e %en(a"e O! cond!=!a %ed!ca"7
    $enera"7 Ede e<., sed!+" "e/!+n!! sa+ +n %ecan!s% .!/!o&a(o"o$!c c+nosc+(, :n s(are
    s7 a.ec(e/e .+nc=!a cre!er+"+!J O! a +ne! ra(e de &reva"en(7 cresc+(e a s!%&(o%e"or
    %en(a"e Ead!c7, deas+&ra ra(e! de 'a/7 "a +n con(ro" &o&+"a=!ona" adecva(J "a
    !nd!v!/!! c+ cond!=!a %ed!ca"7 $enera"7. DeO! as(.e" de da(e s+$erea/7 o &os!'!"7
    re"a=!e ca+/a"7 :n(re o (+"'+rare %en(a"7 s! o an+%!(7 cond!=!e %ed!ca"7 $enera"7,
    aceas(a n+ es(e s+.!c!en( &en(r+ a .ace o &rec!/are :n(r4+n ca/ !nd!v!d+a", &en(r+ c7
    s(+d!!"e de cerce(are re."ec(7 %ed!a $r+&+"+!, &e cAnd c"!n!c!an+" ca+(7 s7 !a o
    dec!/!e re.er!(oare "a +n !nd!v!d. Te<(+" &en(r+ .!ecare d!n (+"'+r7r!"e %en(a"e
    s&ec!.!ce da(ora(e +ne! cond!=!! %ed!ca"e $enera"e con=!ne o "!s(7 a +nora d!n(re
    cond!=!!"e %ed!ca"e $enera"e %en=!ona(e :n "!(era(+r7 a .! asoc!a(e c+ (+"'+rarea
    %en(a"7 s&ec!.!c7 res&ec(!v7.
    (. 6erturbarea nu este explicat mai bine de alt tulburare mental
    :n &+nerea d!a$nos(!c+"+! +ne! (+"'+r7r! %en(a"e da(ora(e +ne! cond!=!!
    %ed!ca"e $enera"e, es(e necesar s7 se e<c"+d7 (+"'+r7r!"e %en(a"e &r!%are O!
    (+"'+r7r!"e %en(a"e !nd+se de o s+'s(an=7. E<c"+derea (+"'+r7r!"or %en(a"e
    &r!%are es(e adesea d!.!c!"7, deoarece !nd!v!/!! c+ (+"'+r7r! %en(a"e &r!%are a+
    .recven( cond!=!! %ed!ca"e $enera"e conco%!(en(e, dar care n+ ca+/ea/7
    s!%&(o%e"e %en(a"e &r!n %ecan!s% .!/!o"o$!c d!rec(. Poa(e e<!s(a +n n+%7r de a"(e
    re"a=!! :n(re o (+"'+rare %en(a"7 s! o cond!=!e %ed!ca"7 $enera"7Q cond!=!a %ed!ca"7
    $enera"7 &oa(e e<acer'a s!%&(o%e"e sa+ co%&"!ca (ra(a%en(+" (+"'+r7r!! %en(a"e8
    5GI
    Tulburrile Mentale datorate unei ondiii Medicale Generale

    ce"e do+7 &o( .! :n "e$7(+r7 &r!n %ecan!s%e non.!/!o"o$!ce sa+ conco%!(en(a &oa(e
    .! co!nc!den(a"7 De e<e%&"+, cAnd s!%&(o%e"e de&res!ve s+n( &rec!&!(a(e de
    cond!=!a %ed!ca"7 $enera"7 care ac=!onea/7 ca +n srresor &s!o"o$!c, %a! c+rAnd
    decA( s7 re/+"(e d!n e.ec(e"e .!/!o"o$!ce d!rec(e a"e cond!=!e! %ed!ca"e $enera"e,
    d!a$nos(!c+" va .! ce" de (+"'+rare de&res!v7 %a@or7 or! de (+"'+rare de ada&(are
    c+ d!s&o/!=!e de&res!v7 La +n !nd!v!d c+ s!%&(o%e de&res!ve care a&ar
    conco%!(en( c+ o cond!=!e %ed!ca"7 $enera"7, +n !s(or!c de %+"(e e&!soade
    de&res!ve %a@ore or! +n !s(or!c .a%!"!a" de de&res!e vor s+$era %a! c+rAnd
    d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7 decA( &e ce" de (+"'+rare a.ec(!v7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e :n ce"e d!n +r%7, c"!n!c!an+" (re'+!e s7
    !a :n cons!dera=!e, de ase%enea, .a&(+" c7 s4ar &+(ea ca s!%&(o%e"e %en(a"e s7 .!e
    ca+/a(e de +n dro$ de a'+/, de +n %ed!ca%en(, or! de e<&+nerea "a +n (o<!c
    Eve/! &a$ 9LF &en(r+ "!n!!"e d!rec(oareJ Aceas(a es(e e<(re% de !%&or(an(,
    deoarece %+"=! !nd!v!/! c+ cond!=!! %ed!ca"e $enera"e &r!%esc %ed!ca%en(e care
    a+ ca&ac!(a(ea de a ca+/a o (+"'+rare %en(a"7 !nd+s7 de o s+'s(an=7
    D. Per(+r'area n+ s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+%
    Dac7 s!%&(o%e"e Ede e<, &s!o(!ce, a.ec(!ve, an<!oaseJ s+rv!n n+%a! :n c+rs+"
    &er!oade"or de de"%+%, e"e s+n( cons!dera(e a .! e"e%en(e asoc!a(e a"e de"!n+%+"+!
    s! n+ @+s(!.!c7 +n d!a$nos(!c se&ara( Aces(e cond!=!! Ede e<, (+"'+rarea a.ec(!v7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eJ &o( .! d!a$nos(!ca(e se&ara(, n+%a! dac7
    s+rv!n s! a"(e or! decA( :n c+rs+" de"!n+%+"+!
    #rocedee de "nre!istrare
    :n :nre$!s(rarea +ne! (+"'+r7r! %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e,
    c"!n!c!an+" (re'+!e s7 %en=!one/e a(A( (!&+" de &er(+r'are %en(a"7, cA( s! cond!=!a
    %ed!ca"7 $enera"7 e(!o"o$!c7 &e a<a I Ede e<, 9F; G; T+"'+rare a.ec(!v7 da(ora(7
    !&o(!ro!d!s%+"+!, c+ e"e%en(e de&res!veJ Cod+" ICD4F4CM &en(r+ cond!=!a
    %ed!ca"7 $enera"7 Ede e< , 9II F H!&o(!ro!d!s%J, de ase%enea, (re'+!e no(a( &e a<a
    III :n s!(+a=!!"e :n care c"!n!c!an+" a s(a'!"!( c7 s!%&(o%e"e %en(a"e n+ s+n(
    consec!n=a .!/!o"o$!c7 d!rec(7 a cond!=!e! %ed!ca"e $enera"e, (+"'+rarea %en(a"7
    &r!%ar7 (re'+!e s7 .!e cod!.!ca(7 &e a<a I, !ar cond!=!a %ed!ca"7 $enera"7 &e a<a III
    E3e/! ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce"or ICD4F4CM se"ec(a(e &en(r+
    cond!=!!"e %ed!ca"e $enera"eJ
    Dia!nostic di$erenial
    O (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e se d!s(!n$e de o
    (+"'+rare %en(a"7 &r!%ar7 &r!n a&"!carea cr!(er!!"or d!sc+(a(e an(er!or :n aceas(7
    sec=!+ne "a SE"e%en(e de d!a$nos(!cT CAnd s!%&(o%e"e +ne! (+"'+r7r! %en(a"e s!
    a"e +ne! cond!=!! %ed!ca"e $enera"e a&ar conco%!(en( es(e e<(re% de !%&or(an( s7 se
    &rec!/e/e, daca re"a=!a e(!o"o$!c7, dac7 e<!s(7, es(e d!rec( .!/!o"o$!c7 E:n care ca/
    d!a$nos(!c+" es(e ce" de (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eJ
    or! &r!n a"( %ecan!s% E:n care ca/ d!a$nos(!c+" es(e ce" de (+"'+rare %en(a"7
    &r!%ar7J :n +ne"e ca/+r!, de/vo"(area +ne! cond!=!! %ed!ca"e $enera"e sa+ &re/en(a
    +ne! !nva"!d!(7=! asoc!a(e, &oa(e &rec!&!(a sa+ e<acer'a o (+"'+rare %en(a"7 .7r7 n!c!
    o "e$7(+r7 .!/!o"o$!c7 c+nosc+(7 Ede e< , !nva"!d!(a(ea asoc!a(7 c+ os(eoar(n(a &oa(e
    Tulburrile Mentale datorate unei ondiii Medicale
    Generale
    E8A

    @+ca +n ro" :n a&ar!=!a +nor s)n&(o%e de&res!ve or! a +n+! e&!sod de&res!v %a@or,
    dar n+ e<!s(7 n!c! +n %ecan!s% .!/!o"o$!c c+nosc+( "a 'a/a re"a=!e! e(!o"o$!ce d!n(re
    ar(r!(7 s! s!%&(o%e"e de&res!veJ, :n aceas(7 s!(+a=!e, (+"'+rarea %en(a"7 &r!%ar7
    Ead!c7, (+"'+rarea de ada&(are sa+ (+"'+rarea de&res!v7 %a@or7J (re'+!e s7 .!e
    d!a$nos(!ca(e &e a<a I, !ar cond!=!a %ed!ca"7 $enera"7 Ead!c7, os(eoar(r!(aJ (re'+!e s7
    .!e %en=!ona(7 &e a<a III.
    O (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e (re'+!e s7 .!e
    d!s(!ns7, de ase%enea, de o (+"'+rare !nd+s7 de o s+'s(an=7. Dac7 e<!s(7 &ro'a
    +n+! +/ recen( sa+ &re"+n$!( de o s+'s(an=7 or! de e<&+nere "a +n (o<!c, (re'+!e
    "+a(7 :n cons!dera=!e o (+"'+rare !nd+s7 de o s+'s(an=7. Poa(e .! +(!" s7 se o'=!n7
    +n screen!n$ &en(r+ dro$+r! a" +r!n!! s! sAn$e"+! sa+ a"( e<a%en de "a'ora(or
    adecva(. S!%&(o%e"e care s+rv!n :n c+rs+" +ne! !n(o<!ca=!! sa+ a's(!nen=e de o
    s+'s(an=7, or! :n c+rs+" +/+"+! de +n %ed!ca%en( sa+ "a sc+r( (!%& d+&7 aceea Ede
    e<., :n dec+rs de I s7&(7%An!J &o( .! e<(re% de evoca(oare &en(r+ o (+"'+rare
    !nd+s7 de o s+'s(an=7, :n .+nc=!e de (!&+" O! de can(!(a(ea de s+'s(an=7 +(!"!/a(7
    sa+ de d+ra(a +/+"+!.
    S!%&(o%e"e de"!r!+%+"+!, de%en=e!, s!%&(o%e"e &s!o(!ce, a.ec(!ve, an<!oase
    sa+ s!%&(o%e"e (+"'+r7r!"or de so%n or! o d!s.+nc=!e se<+a"7 &o( .! ca+/a(e de
    e.ec(e"e co%'!na(e a"e +ne! cond!=!! %ed!ca"e $enera"e O! de +/+" de o s+'s(an=7
    E!nc"+s!v de %ed!ca%en(eJ, :n as(.e" de s!(+a=!! (re'+!e s7 .!e %en=!ona(e a%'e"e
    d!a$nos(!ce Ede e<., (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s!
    (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7J. Dac7 n+ es(e &os!'!" s7 se &rec!/e/e c7
    s!%&(o%e"e %en(a"e se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e or! c7 s+n( !nd+se
    de o s+'s(an=7, &oa(e .! +(!"!/a(7 ca(e$or!a de S.7r7 a"(7 s&ec!.!ca=!eT Eve/!
    co%en(ar!+" de %a! @osJ.
    CAnd, aOa c+% se :n(A%&"7 adesea, (a'"o+" c"!n!c a" +ne! (+"'+r7r! %en(a"e
    da(ora(e +ne! cond!=!! %ed!ca"e $enera"e con=!ne +n a%es(ec de s!%&(o%e d!.er!(e
    Ede e<., de d!s&o/!=!e s! an<!oaseJ, es(e de dor!(, :n $enera", s7 se conse%ne/e +n
    s!n$+r d!a$nos(!c, &e 'a/a s!%&(o%e"or care &redo%!n7 :n (a'"o+" c"!n!c, :n +ne"e
    s!(+a=!!, n+ es(e &os!'!" s7 se &rec!/e/e dac7 s!%&(o%e"e %en(a"e s+n( &r!%are, se
    da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e or! s+n( !nd+se de o s+'s(an=7, :n as(.e"
    de s!(+a=!!, (re'+!e s7 .!e +(!"!/a(7 ca(e$or!a de SF7r7 a"(7 s&ec!.!ca=!eT.
    C54.>5 Tul-urarea Catatoni#( $atorat( unei
    Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! ca(a(on!ce da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e :" cons(!(+!e &re/en=a ca(a(on!e!, care es(e cons!dera(7 a .! da(ora(7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e. Ca(a(on!a se %an!.es(7 &r!n
    or!care d!n(re +r%7(oare"eQ !%o'!"!(a(e %o(or!e, ac(!v!(a(e %o(or!e e<ces!v7,
    ne$a(!v!s% sa+ %+(!s% e<(re%, '!/arer!! a"e %!Oc7r!"or vo"+n(are, eco"a"!e sa+
    eco&ra<!e Ecr!(er!+" AJ. D!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or, (re'+!e
    s7 re/+"(e .a&(+" c7 aceas(a Eca(a(on!aJ es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne!
    cond!=!! %ed!ca"e $enera"e Ecr!(er!+" BJ. D!a$nos(!c+" n+ es(e &+s, dac7 ca(a(on!a es(e
    e<&"!ca(7 %a! '!ne de o a"(7 (+"'+rare %en(a"7 Ede e<., e&!sod+" %an!aca"J Ecr!(er!+"
    CJ or! dac7 s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+% Ecr!(er!+" DJ.
    *>=
    Tulburrile Mentale datorate unei ondiii Medicale Generale
    I%o'!"!(a(ea %o(or!e se &oa(e %an!.es(a &r!n ca(a"e&s!e E."e<!'!"!(a(e ceroas7J sa+
    s(+&or. Ac(!v!(a(ea %o(or!e e<ces!v7 es(e, ev!den(, "!&s!(7 de sco& s! n+ es(e
    !n."+en=a(7 de s(!%+"! e<(ern!. Ma! &oa(e e<!s(a +n ne$a(!v!s% e<(re% %an!.es(a(
    &r!n re/!s(en=7 "a or!ce .e" de !ns(r+c=!+n! sa+ %en=!nerea +ne! &os(+r! r!$!de con(ra
    :ncerc7r!"or de a .! %o'!"!/a(. S(ran!e(a(ea %!Oc7r!"or vo"+n(are se %an!.es(7 &r!n
    as+%area vo"+n(ar7 a +nor &os(+r! !nadecva(e sa+ '!/are or! &r!n(r4o $r!%asare
    !eO!(7 d!n co%+n. Eco"a"!a es(e re&e(area &a(o"o$!c7, ase%7n7(oare &s!(ac!s%+"+!, s!
    ev!den( .7r7 sens a +n+! c+vAn( sa+ e<&res!! a'!a s&+se de a"(7 &ersoan7. Eco&ra<!a
    es(e !%!(area re&e(a(!v7 a %!Oc7r!"or a"(e! &ersoane.
    #rocedee de "nre!istrare
    :n :nre$!s(rarea (+"'+r7r!! ca(a(on!ce da(ora(e +ne! cond!=!! %ed!ca"e $enera"e,
    c"!n!c!an+" (re'+!e s7 no(e/e a(A( .eno%eno"o$!a s&ec!.!c7 a &er(+r'7r!!, cA( s!
    cond!=!a %ed!ca"7 $enera"7 !den(!.!ca(7 a .! ca+/a( &er(+r'area de &e a<a I Ede e<.,
    9F;.GF T+"'+rare ca(a(on!c7 da(ora(7 +n+! neo&"as% cere'ra" %a"!$nJ. Cod+" ICD4
    F4CM &en(r+ cond!=!a %ed!ca"7 $enera"7 Ede e<., 5F5.F Neo&"as% cere'ra" %a"!$nJ
    (re'+!e, de ase%enea, no(a( &e a<a III. E3e/! ane<a , &en(r+ "!s(a cod+r!"or
    d!a$nos(!ce ICD4F4CM se"ec(a(e &en(r+ cond!=!!"e %ed!ca"e $enera"eJ.
    ondiii medicale !enerale asociate
    O var!e(a(e de cond!=!! %ed!ca"e $enera"e &oa(e ca+/a ca(a(on!a, dar :n s&ec!a"
    cond!=!!"e ne+ro"o$!ce Ede e<., neo&"as%e"e, (ra+%a(!s%e"e cran!ene, %a"ad!a
    cere'rovasc+"ar7, ence.a"!(aJ s! cond!=!!"e %e(a'o"!ce Ede e<., !&erca"ce%!a,
    ence.a"o&a(!a e&a(!c7, o%ocys(!n+r!a, ce(oac!do/a d!a'e(!caJ. Da(e"e e<a%!n7r!!
    so%a(!ce asoc!a(e, da(e"e de "a'ora(or s! &a((ern+r!"e de &reva"en(7 s! de'+( re."ec(7
    &e ce"e a"e cond!=!e! %ed!ca"e $enera"e e(!o"o$!ce.
    Dia!nostic di$erenial
    D!a$nos(!c+" se&ara( de (+"'+rare ca(a(on!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e n+ es(e &+s, dac7 ca(a(on!a s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+%.
    Dac7 !nd!v!d+" !a ac(+a"%en(e +n %ed!ca%en( ne+ro"e&(!c, (re'+!e s7 .!e "+a(e
    :n cons!dera=!e (+"'+r7r!"e de %!Ocare !nd+se de %ed!ca%en(e Ede e<., &o/!=!a
    anor%a"7 &oa(e .! da(ora(7 d!s(on!e! ac+(e !nd+se de ne+ro"e&(!ceJ. De
    ase%enea, s!%&(o%e ca(a(on!ce &o( .! &re/en(e :n sc!/o.ren!e s! :n (+"'+r7r!"e
    a.ec(!ve. Sc!/o.ren!a, (!&+" ca(a(on!c, se d!s(!n$e &r!n a'sen=a ev!den=e! +ne!
    cond!=!! %ed!ca"e $enera"e care s7 .!e e(!o"o$!c :n re"a=!e c+ ca(a(on!a s! &r!n
    &re/en=a a"(or s!%&(o%e carac(er!s(!ce de sc!/o.ren!e Ede e<., !de! de"!ran(e,
    a"+c!na=!!, "!%'a@ de/or$an!/a(, s!%&(o%e ne$a(!veJ. O (+"'+rare a.ec(!v7 c+
    e"e%en(e ca(a(on!ce es(e, :n %od ase%7n7(or, d!.eren=!a(7 &r!n a'sen=a
    eT3_de:__e_ U:_e_ cc%d!=n !rveoAca_e $enera"e care s7 .!e e(!o"o$!c :n re"a=!e c+
    ca(a(on!a s! &r!n &re/en=a de s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ o de&res!e
    %a@or7 sa+ +n e&!sod %an!aca".
    4E52E Modi$icarea de #ersonalitate
    datorat unei ondiii Medicale Generale E8?

    Criteriile $e $ia/no&ti# pentru C54.>5 Tul-urarea Catatoni#(
    $atorat( ... KSe in$i#( Con$i!ia Me$i#al( General( L
    A2 #re(ena catatoniei mani$estat prin imobilitate motorie, activitate motorie
    excesiv &care este evident lipsit de scop si nein$luenat de stimuli
    externi), ne!ativism sau mutism extrem, bi(arerii ale mi,crilor voluntare,
    ecolalie sau ecopraxie2
    S2 Din istoric, examenul somatic sau datele de laborator re(ult proba c
    perturbarea este consecina $i(iolo!ic direct a unei condiii medicale
    !enerale2
    #erturbarea nu este explicat mai bine de alt tulburare mental &de ex2, de
    un episod maniacal)
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    Fot de codi$icareD A se include numele condiiei medicale !enerale pe axa l,
    de ex2, 764286 Tulburare atatonic datorat ence$alopatiei %epatice3 de
    asemenea, condiia medical !eneral se codi$ic pe axa III &ve(i anexa G
    pentru coduri)2
    4*+.* Mo$i%i#area $e Per&onalitate $atorat( unei
    Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" %od!.!c7r!! de &ersona"!(a(e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e :" cons(!(+!e o &er(+r'are &ers!s(en(7 de &ersona"!(a(e care es(e cons!dera(7
    a .! da(ora(7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e.
    Per(+r'area de &ersona"!(a(e re&re/!n(7 o %od!.!care a &a((ern+"+! carac(er!s(!c de
    &ersona"!(a(e an(er!or a" !nd!v!d+"+!. La co&!!, aceas(7 cond!=!e se &oa(e %an!.es(a
    %a! c+rAnd ca o dev!ere %arca(7 de "a de/vo"(area nor%a"7, decA( ca o sc!%'are
    :n(r4+n &a((ern de &ersona"!(a(e s(a'!" Ecr!(er!+" AJ. D!n !s(or!c, e<a%en+" so%a(!c or!
    da(e"e de "a'ora(or (re'+!e s7 .!e ev!den( .a&(+" c7 %od!.!carea de &ersona"!(a(e es(e
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" BJ.
    D!a$nos(!c+" n+ es(e &+s dac7 &er(+r'area es(e e<&"!ca(7 %a! '!ne de o a"(7 (+"'+rare
    %en(a"7 Ecr!(er!+" CJ. De ase%enea, d!a$nos(!c+" n+ es(e &+s dac7 &er(+r'area
    s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+% or! dac7 s!%&(o%e"e sa(!s.ac cr!(er!!"e
    &en(r+ de%en=7 Ecr!(er!+" DJ. Per(+r'area (re'+!e, de ase%enea, s7 ca+/e/e o de(res7
    6a+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" or! :n a"(e
    do%en!! de .+nc=!onare !%&or(an(e Ecr!(er!+" EJ.
    Man!.es(7r!"e co%+ne a"e %od!.!c7r!! de &ersona"!(a(e !nc"+d !ns(a'!"!(a(ea
    a.ec(!v7, con(ro"+" red+s a" !%&+"s+"+!, accese"e de a$res!v!(a(e sa+ de .+r!e,
    ."a$ran( de d!s&ro&or=!ona(e "a or!ce s(resor &s!osoc!a" &rec!&!(an(, a&a(!a %arca(7,
    y+s&!c!o/!(a(ea sa+ !dea=!a &arano!d7. Feno%eno"o$!a %od!.!c7r!! es(e !nd!ca(7 &r!n
    +(!"!/area s+'(!&+r!"or c!(a(e %a! @os. Un !nd!v!d c+ aceas(7 (+"'+rare es(e
    carac(er!/a( adesea de a"=!! ca Sne %a! .!!nd e" EeaJT. DeO! are :n co%+n c+ (+"'+r7r!"e
    *>>
    Tulburrile Mentale datorate unei ondiii Medicale Generale

    de &ersona"!(a(e de &e a<a II (er%en+" de S&ersona"!(a(eT, aces( d!a$nos(!c es(e
    cod!.!ca( &e a<a I s! es(e d!s(!nc( de (+"'+r7r!"e de &ersona"!(a(e :n v!r(+(ea e(!o"o$!c!
    sa"e s&ec!.!ce, a .eno%eno"o$!e! d!.er!(e O! a de'+(+"+! s! evo"+=!e! %a! var!a'!"e.
    Ta'"o+" c"!n!c "a +n !nd!v!d da( de&!nde de na(+ra s! "oca"!/area &roces+"+!
    &a(o"o$!c. De e<e%&"+, "e/!+n!"e "o'!"or .ron(a"! se &o( a."a "a 'a/a +nor s!%&(o%e,
    c+% ar .! "!&sa de @+deca(7 sa+ de &rev!/!+ne, (end!n=a "a $"+%e E.ace(!o+snessJ,
    de/!n!'!=!a s! e+.or!a. Ic(+s+r!"e e%!s.ere! cere'ra"e dre&(e a+ .os( o'serva(e
    adesea evocAnd %od!.!c7r!"e de &ersona"!(a(e :n asoc!ere c+ ne$"!@area s&a=!+"+!
    +n!"a(era", anoso$no/!e E!nca&ac!(a(ea !nd!v!d+"+! de a rec+noaO(e +n de.!c!(
    cor&ora" sa+ .+nc=!ona", c+% ar .! e<!s(en=a +ne! e%!&are/eJ, !%&ers!s(en=a %o(or!e
    O! a"(e de.!c!(e ne+ro"o$!ce.
    Subtipuri
    O an+%!(7 %od!.!care de &ersona"!(a(e &oa(e .! s&ec!.!ca(7 &r!n !nd!carea
    &re/en=e! s!%&(o%e"or care &redo%!n7 :n (a'"o+" c"!n!cQ
    T!&+" "a'!". Aces( s+'(!& es(e +(!"!/a( dac7 e"e%en(+" &redo%!nan( es(e
    "a'!"!(a(ea a.ec(!v7.
    T!&+" de/!n!'a(. Aces( s+'(!& es(e +(!"!/a( dac7 e"e%en(+" &redo%!nan( es(e
    red+cerea con(ro"+"+! !%&+"s+"+! Eev!den=!a(7, de e<., &r!n !nd!scre=!!
    se<+a"eJ.
    T!&+" a$res!v. Aces( s+'(!& es(e +(!"!/a( dac7 e"e%en(+" &redo%!nan( es(e
    co%&or(a%en(+" a$res!v.
    T!&+" a&a(!c. Aces( s+'(!& es(e +(!"!/a( dac7 e"e%en(+" &redo%!nan( es(e
    a&a(!a %arca(7 O! !nd!.eren=a.
    T!&+" &arano!d. Aces( s+'(!& es(e +(!"!/a( dac7 e"e%en(+" &redo%!nan( es(e
    s+s&!c!o/@(a(ea sa+ !dea=!a &arano!d7.
    A"( (!&. Aces( s+'(!& va .! +(!"!/a(, de e<., &en(r+ o %od!.!care de &ersona"!(a(e
    asoc!a(7 c+ e&!"e&s!a.
    T!&+" co%'!na(. Aces( s+'(!& es(e +(!"!/a( dac7 %a! %+"( decA( +n s!n$+r
    e"e%en( &redo%!n7 :n (a'"o+" c"!n!c.
    #rocedee de "nre!istrare
    :n :nre$!s(rarea %od!.!c7r!! de &ersona"!(a(e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e, c"!n!c!an+" (re'+!e s7 no(e/e, a(A( .eno%eno"o$!a s&ec!.!c7 a &er(+r'7r!!,
    !nc"+/And s+'(!&+" cores&+n/7(or, cA( O! cond!=!a %ed!ca"7 $enera"7 cons!dera(7 a .!
    ca+/a &er(+r'7r!!, &e a<a I Ede e<., ;5L.5 Mod!.!care de &ersona"!(a(e da(ora(7
    "+&+s+"+! er!(e%a(os s!s(e%!c, de (!& &arano!dJ. Cod+" ICD4F4CM &en(r+ cond!=!a
    %ed!ca"7 $enera"7 (re'+!e, de ase%enea, no(a( &e a<a III. E3e/! ane<a , &en(r+ "!s(a
    cod+r!"or d!a$nos(!ce"or ICD4F4CM se"ec(a(e &en(r+ cond!=!!"e %ed!ca"e $enera"eJ.
    ondiii medicale !enerale asociate
    O var!e(a(e de cond!=!! ne+ro"o$!ce O! de a"(e cond!=!! %ed!ca"e $enera"e &o(
    ca+/a %od!.!c7r! de &ersona"!(a(e, !nc"+/And neo&"as%e"e s!s(e%+"+! nervos
    cen(ra", (ra+%a(!s%e"e cran!ene, %a"ad!!"e card!ovasc+"are, %a"ad!a H+n(!n$(on,
    e&!"e&s!a, cond!=!!"e !n.ec=!oase c+ !%&"!carea s!s(e%+"+! nervos cen(ra" Ede e<.,
    v!r+s+" !%+node.!c!en=e! +%aneJ, cond!=!!"e endocr!ne Ede e<., !&o(!ro!d!s%+",
    !&oO! !&eradrenocor(!c!s%+"J, cond!=!!"e a+(o!%+ne c+ !%&"!carea s!s(e%+"+!
    4E52E Modi$icarea de #ersonalitate
    datorat unei ondiii Medicale Generale *>5
    nervos cen(ra" Ede e<., "+&+s+" er!(e%a(os s!s(e%!cJ. Da(e"e asoc!a(e a"e e<a%!n7r!!
    so%a(!ce, da(e"e de "a'ora(or s! &a((ern+r!"e de &reva"en(7 s! de'+( re."ec(7 &e ce"e
    a"e cond!=!e! ne+ro"o$!ce sa+ &e ce"e a"e a"(e! cond!=!! %ed!ca"e $enera"e !%&"!ca(e.
    Dia!nostic di$erenial
    Cond!=!!"e %ed!ca"e $enera"e cron!ce asoc!a(e c+ d+rere O! !nva"!d!(a(e &o( .!, de
    ase%enea, asoc!a(e c+ %od!.!c7r! de &ersona"!(a(e. D!a$nos(!c+" de %od!.!care de
    &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e es(e &+s, n+%a! dac7 &oa(e
    .! s(a'!"!( +n %ecan!s% .!/!o&a(o"o$!c d!rec(. Aces( d!a$nos(!c n+ es(e &+s dac7
    %od!.!carea de &ersona"!(a(e es(e da(ora(7 ada&(7r!! co%&or(a%en(a"e sa+
    &s!o"o$!ce sa+ ca r7s&+ns "a o cond!=!e %ed!ca"7 $enera"7 Ede e<.,
    co%&or(a%en(e"e de de&enden=7 care re/+"(7 d!n neces!(a(ea de as!s(en=7 d!n
    &ar(ea a"(ora +r%And +n+! (ra+%a(!s% cran!an sever, %a"ad!! card!ovasc+"are sa+
    de%en=eJ. Mod!.!carea de &ersona"!(a(e es(e +n e"e%en( asoc!a( .recven( a"
    de"!r!+%+"+! sa+ de%en=e!. Un d!a$nos(!c se&ara( de %od!.!care de &ersona"!(a(e
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e n+ es(e &+s dac7 %od!.!carea s+rv!ne
    e<c"+s!v :n c+rs+" +n+! de"!r!+%. D!a$nos(!c+" de %od!.!care de &ersona"!(a(e
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e &oa(e .! &+s :ns7 ad!=!ona" d!a$nos(!c+"+!
    de de%en=7 dac7 %od!.!carea de &ersona"!(a(e es(e o &ar(e &roe%!nen(7 a (a'"o+"+!
    c"!n!c. Ma! %+"( decA( a(A(, d!a$nos(!c+" de %od!.!care de &ersona"!(a(e da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e n+ es(e &+s dac7 &er(+r'area es(e e<&"!ca(7 %a!
    '!ne de o a"(7 (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    (+"'+rarea a.ec(!v7 da(ora(7 +ne! (+%or! cere'ra"e, c+ e"e%en(e de&res!veJ.
    Mod!.!c7r!"e de &ersona"!(a(e &o( s+rven!, de ase%enea, :n con(e<(+"
    de&enden=e! de o s+'s(an=7, :n s&ec!a" dac7 de&enden=a es(e de "+n$7 d+ra(7.
    C"!n!c!an+" (re'+!e s7 cerce(e/e c+ a(en=!e na(+ra O! :n(!nderea +/+"+! de s+'s(an=7.
    Dac7 c"!n!c!an+" doreO(e s7 !nd!ce o re"a=!e e(!o"o$!c7 :n(re %od!.!carea de
    &ersona"!(a(e s! +/+" de o s+'s(an=7, &oa(e s7 +(!"!/e/e ca(e$or!a de S.7r7 a"(7
    s&ec!.!ca=!eT &en(r+ o an+%!(7 s+'s(an=7 Ede e<., (+"'+rare :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ.
    Mod!.!c7r!"e no(a'!"e de &ersona"!(a(e &o( .!, de ase%enea, +n e"e%en( asoc!a(
    a" a"(or (+"'+r7r! %en(a"e Ede e<., sc!/o.ren!a, (+"'+rarea de"!ran(7, (+"'+r7r!"e
    a.ec(!ve, (+"'+r7r!"e con(ro"+"+! !%&+"s+"+! .7r7 a"(7 s&ec!.!ca=!e, &an!caJ, :n
    aces(e (+"'+r7r!, :ns7, n!c! +n .ac(or .!/!o"o$!c s&ec!.!c n+ es(e cons!dera( a .! :n
    re"a=!e e(!o"o$!c7 c+ %od!.!carea de &ersona"!(a(e. Mod!.!carea de &ersona"!(a(e
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e &oa(e .! d!s(!ns7 de o (+"'+rare de
    &ersona"!(a(e &r!n neces!(a(ea +ne! %od!.!c7r! se%n!.!ca(!ve c"!n!c :n ra&or( c+
    "!n!a de 'a/7 a .+nc=!on7r!! &ersona"!(7=!! O! &re/en=a +ne! cond!=!! %ed!ca"e
    $enera"e s&ec!.!ce e(!o"o$!ce.
    E65 Tulburrile Mentale datorate unei ondiii Medicale Generale
    Criteriile $e $ia/no&ti# pentru
    4*+.* Mo$i%i#area $e Per&onalitate $atorat( ...
    [Se indic Condiia Medical General J
    A2 O perturbare de personalitate persistent repre(ent@nd o modi$icare a
    patternului de personalitate caracteristic anterior al individului2 &La copii
    perturbarea implic o deviaie marcat de la de(voltarea normal sau o
    modi$icare semni$icativ "n patternurile de comportament u(uale ale
    copilului dur@nd cel puin un an)2
    S2 Din istoric, examenul somatic sau datele de laborator re(ult proba c pertur
    barea este consecina $i(iolo!ic direct a unei condiii medicale !enerale2
    2 #erturbarea nu este explicat mai bine de alt tulburare mental) inclusiv
    de alt tulburare mental datorat unei condiii medicale !enerale)2
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    $uncionarea social, pro$esional sau "n alte domenii importante de
    $uncionare2
    De speci"icat tipulD
    Tip labilD dac elementul predominant este labilitatea a$ectiv2
    Tip de(in%ibatD dac elementul predominant este controlul redus al
    impulsului, dup cum demonstrea( indiscreiile sexuale2
    Tip a!resivD dac elementul predominant este comportamentul a!resiv2
    Tip apaticD dac elementul predominant este apatia si indi$erena marcat 2
    Tip paranoidD dac elementul predominant este suspicio(itatea sau ideaia
    paranoid2
    Alt tipD dac tabloul clinic nu este caracteri(at prin nici unul dintre subti-
    purile de mai sus2
    Tip combinatD dac mai mult dec@t un element predomin "n tabloul clinic2
    Tip ne&pe#i%i#at
    Fot de codi$icareD A se include numele condiiei medicale !enerale pe axa l,
    de ex2, 4E52E Modi$icare de personalitate datorat epilepsiei de lob temporal3
    de asemenea, a se codi$ica condiia medical !eneral pe axa III &ve(i anexa G
    pentru coduri)2
    C54.5 Tul-urare Mental( '(r( Alt( Spe#i%i#a!ie
    $atorat( unei Con$i!ii Me$i#ale Generale
    Aceas(7 ca(e$or!e re/!d+a"7 (re'+!e s7 .!e +(!"!/a(7 &en(r+ s!(+a=!!"e :n care a .os(
    s(a'!"!( c7 &er(+r'area es(e ca+/a(7 de e.ec(e"e .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    %ed!ca"e $enera"e, dar n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ o (+"'+rare %en(a"7
    s&ec!.!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e Ede e<., s!%&(o%e d!soc!a(!ve
    da(ora(e cr!/e"or &ar=!a"e co%&"e<eJ.
    No(7 de cod!.!careQ N+%e"e cond!=!e! %ed!ca"e $enera"e se !nc"+de &e a<a I, de e<.,
    9F;.F T+"'+rare %en(a"7 .7r7 a"(7 s&ec!.!ca=!e da(ora(7 %a"ad!e! HI38 de ase%enea,
    cond!=!a %ed!ca"7 $enera"7 se cod!.!c7 &e a<a III Eve/! ane<a , &en(r+ cod+r!J.
    Tulburrile "n le!tur
    cu o Substan
    +"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 !nc"+d (+"'+r7r!"e :n "e$7(+r7 c+
    "+area +n+! dro$ de a'+/ E!nc"+s!v a"coo"+"J, c+ e.ec(e"e sec+ndare a"e
    +n+! %ed!ca%en( s! c+ e<&+nerea "a +n (o<!c, :n aces( %an+a", (er%en+"
    de s+bstan(6 se &oa(e re.er! "a +n dro$ de a'+/, "a +n %ed!ca%en( sa+ "a
    +n (o<!c. S+'s(an=e"e d!sc+(a(e :n aceas(7 sec=!+ne s+n( $r+&a(e :n 55
    c"aseQ a"coo"8 a%.e(a%!na sa+ s!%&a(o%!%e(!ce c+ ac=!+ne s!%!"ar78 ca.e!na8
    canna'!s8 coca!n78 a"+c!no$ene8 !na"an(e8 n!co(!n78 o&!acee8 &encyc"!d!n7
    EPCPJ sa+ ary"cydoe<y"a%!ne c+ ac=!+ne s!%!"ar78 seda(!ve, !&no(!ce sa+
    an<!o"!(!ce. C+ (oa(e c7 aces(e s+'s(an=e a&ar :n ord!ne a".a'e(!c7, +r%7(oare"e
    c"ase a+ e"e%en(e s!%!"are co%+neQ a"coo"+" are e"e%en(e co%+ne c+ seda(!ve"e,
    !&no(!ce"e sa+ an<!o"!(!ce"e, !ar coca!na are e"e%en(e co%+ne c+ a%.e(a%!na sa+
    s!%&a(o%!%e(!ce"e c+ ac=!+ne s!%!"ar7, :n aceas(7 sec=!+ne s+n( !nc"+se, de
    ase%enea, de&enden=a de &o"!s+'s(an=7 s! (+"'+r7r!"e :n "e$7(+r7 c+ a"(7 s+'s(an=7
    sa+ c+ o s+'s(an=7 nec+nosc+(7 Ecare !nc"+d ce"e %a! %+"(e (+"'+r7r! :n "e$7(+r7 c+
    %ed!ca%en(e"e sa+ (o<!ce"eJ.
    M+"(e %ed!ca%en(e &rescr!se s! vAnd+(e "a "!'er &o( ca+/a, de ase%enea,
    (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7. S!%&(o%e"e s+rv!n :n $enera" "a do/e %ar! de
    %ed!ca%en( s! de re$+"7 d!s&ar cAnd es(e sc7/+(7 do/a sa+ :nce(ea/7 ad%!n!s(rarea
    %ed!ca%en(+"+!. Med!ca%en(e"e care &o( ca+/a (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7
    !nc"+d, dar n+ s+n( "!%!(a(e n+%a! "a aces(ea, anes(e/!ce"e s! ana"$e/!ce"e, a$en=!!
    an(!co"!ner$!c!, an(!conv+"s!van(e"e, an(!!s(a%!n!ce"e, an(!!&er(ens!ve"e s!
    %ed!ca%en(e"e card!ovasc+"are, %ed!ca%en(e"e an(!%!cro'!ene, %ed!ca%en(e"e
    an(!&ar)!nson!ene, a$en=!! c!%!o(era&e+(!c!, cor(!cos(ero!/!!, %ed!ca%en(e"e
    an(!!n."a%a(or!! nons(ero!d!ce, %ed!ca%en(e"e vAnd+(e .7r7 re=e(7, %ed!ca%en(e"e
    an(!de&res!ve s! d!s+".!ra%+".
    E<&+nerea "a o $a%7 "ar$7 de a"(e s+'s(an=e c!%!ce &oa(e d+ce, de ase%enea,
    "a de/vo"(area de (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7. S+'s(an=e"e (o<!ce care &o(
    ca+/a (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 !nc"+d, dar n+ se "!%!(ea/7 "a aces(ea,
    %e(a"e"e $re"e Ede e<., &"+%'+" sa+ a"+%!n!+"J, ra(!c!de"e con=!nAnd s(r!cn!na,
    &es(!c!de"e con=!nAnd !n!'!(or! a! ace(!"co"!nes(era/e!, $a/e"e ne+ro&ara"!/an(e,
    e(!"en$"!co"+" Ean(!$e"+"J, %ono<!d+" de car'on s! '!o<!d+" de car'on. S+'s(an=e"e
    vo"a(!"e Ede e<., car'+ran=!! s! vo&se"e"eJ s+n( c"as!.!ca(e ca S!na"an(eT Eve/! &a$.
    9YHJ, dac7 s+n( +(!"!/a(e :n sco&+" &rovoc7r!! !n(o<!ca=!e!8 e"e s+n( cons!dera(e :ns7
    S(o<!ceT, dac7 e<&+nerea es(e acc!den(a"7 sa+ &ar(e a +ne! !n(o<!ca=!! !n(en=!ona"e.
    De(er!or7r!"e co$n!(!ve sa+ a.ec(!ve s+n( ce"e %a! .recven(e s!%&(o%e asoc!a(e c+
    s+'s(an=e"e (o<!ce, deO! &o( a&are, de ase%enea, an<!e(a(e, a"+c!na=!!, !de! de"!ran(e
    sa+ cr!/e e&!"e&(!ce. S!%&(o%e"e d!s&ar de re$+"7 cAnd !nd!v!d+" n+ %a! es(e e<&+s
    s+'s(an=e!, dar re/o"varea s!%&(o%e"or &oa(e "+a s7&(7%An! sa+ "+n! O! &oa(e
    neces!(a (ra(a%en(.
    E6E
    5F9
    Tulburrile "n le!tur cu o Substan

    T+"'+r7r!"e :n "e$7(+ra c+ o s+'s(an=7 s+n( :%&7r=!(e :n do+7 $r+&e (+"'+r7r! a"e
    +/+"+! de o s+'s(an=7 Ede&enden(a de o s+'s(an=7 s! a'+/+" de o s+'s(an=7J s!
    (+"'+r7r! !nd+se de o s+'s(an=7 E!n(o<!ca=!a c+ o s+'s(an=7, a's(!nen(a de o
    s+'s(an=7, de"%+%+" !nd+s de o s+'s(an=7, de%en=a &ers!s(en(7 !nd+s7 de o
    T,
    s+'s(an=7, (+"'+rarea a%nes(!c7 !nd+s7 de o s+'s(an=7, (+"'+rarea &s!oc7 !nd+s7
    de o s+'s(an=7, (+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7, (+"'+rarea an<!oas7
    !nd+s7 de o s+'s(an=7, d!s.+nc(!a se<+a"7 !nd+s7 de o s+'s(an=7 s! (+"'+rarea de
    so%n !nd+s7 de o s+'s(an=7J Sec=!+nea :nce&e c+ (e<(+" s! se(+r!"e de cr!(er!! &en(r+
    de&enden(a, a'+/+", !n(o<!ca=!a s! a's(!nen(a de o s+'s(an=7, care s+n( a&"!ca'!"e
    d!verse"or c"ase de s+'s(an=e Aceas(a es(e +r%a(7 de co%en(a% $enera"e
    re.er!(oare "a e"e%en(e"e asoc!a(e, e"e%en(e"e :n "e$7(+r7 c+ c+"(+ra, e(a(ea s! se<+",
    "a evo"+=!e, de(er!orare s! co%&"!ca=!!, &a((ern .a%!"!a", d!a$nos(!c d!.eren=!a" s!
    &rocedee de :nre$!s(rare, care se a&"!c7 (+(+ror c"ase"or de s+'s(an=e Res(+"
    sec=!+n!! es(e or$an!/a( &e c"ase de s+'s(an=e s! descr!e as&ec(e"e s&ec!.!ce a"e
    de&enden(e!, a'+/+"+!, !n(o<!ca=!e! s! a's(!nen(e! &en(r+ .!ecare d!n ce"e 55 c"ase de
    s+'s(an=e Pen(r+ a .ac!"!(a d!a$nos(!c+" d!.eren=!a", (e<(+" s! cr!(er!!"e &en(r+ res(+"
    (+"'+r7r!"or !nd+se de o s+'s(an=7 s+n( !nc"+se :n sec=!+n!"e %an+a"+"+! :%&re+n7
    c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e< , (+"'+rarea a.ec(!v7 !nd+s7
    de o s+'s(an=7 es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e a.ec(!veTJ D!a$nos(!ce"e
    asoc!a(e c+ .!ecare $r+& s&ec!.!c de s+'s(an=e s+n( &re/en(a(e :n (a'e"+" "
    Tul-ur(rile U)ului $e o Su-&tan!(
    Depen$en!a $e o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" de&enden(e! de o s+'s(an=7 :" cons(!(+!e +n $r+& de
    '!%&(o%e co$n!(!ve, co%&or(a%en(a"e s! .!/!o"o$!ce !nd!cAnd c7 !nd!v!d+" con(!n+7
    +/+" s+'s(an=e! :n d!s&re=+" +nor &ro'"e%e !%&or(an(e :n "e$7(+r7 c+ s+'s(an=a
    E<!s(7 +n &a((ern de a+(oad%%!s(rare re&e(a(7 care d+ce de re$+"7 "a (o"eran(7,
    a's(!nen(7 s! "a +n co%&or(a%en( de "+are co%&+"s!v7 a dro$+"+! D!a$nos(!c+" de
    de&enden(7 de o s+'s(an=7 &oa(e .! a&"!ca( .!ec7re! c"ase de s+'s(an=e c+ e<ce&=!a
    ca.e%e! S!%&(o%e"e de de&enden(7 s+n( s!%!"are :n ra&or( c+ d!verse"e ca(e$or!!
    de s+'s(an=e, :ns7 &en(r+ an+%!(e c"ase +ne"e s!%&(o%e s+n( %a! &+=!n ev!den(e,
    !ar :n cA(eva ca/+r! n+ (oa(e s!%&(o%e"e s+n( &re/en(e Ede e<, &en(r+ de&enden(a
    de a"+?!o$ene n+ s+n( s&ec!.!ca(e s!%&(o%e de a's(!nen(7J DeO! n+ es(e
    %en=!ona(7 ca a(are dre&( +n !(e% cr!(er!+, Sdor!n=a arden(7T Ecrav!n$J Eo
    !%&+"s%ne s+'!ec(!v7 &+(ern!c7 de a .ace +/ de o s+'s(an=7J es(e &os!'!" s7 .!e
    e<&enen(a(7 de ce! %a! %+"=! !nd!v!/! c+ de&enden(7 de o s+'s(an=7 Edac7 n+ de
    (o=!J De&enden(a es(e de.!n!(7 ca +n $r+& de (re! sa+ %a! %+"(e d!n(re s!%&(o%e"e
    %en=!ona(e %a! @os, s+rven!nd or!cAnd :n c+rs+" ace"e!aO! &er!oade de 59 "+n!
    To"eran(a Ecr!(er!+" 5J es(e neces!(a(ea de can(!(7=! (o( %a! %ar! de s+'s(an=7
    &en(r+ a a@+n$e "a !n(o<!ca=!e Esa+ "a e.ec(+" dor!(J or! +n e.ec( d!%!n+a(
    cons!dera'!" &r!n con(!n+area +/+"+! ace"e!aO! can(!(7=! de s+'s(an=7 ,rad+" "a care
    se de/vo"(7 (o"era2(a var!a/7 %+"( :n ra&or( c+ d!verse"e c"ase de s+'s(an=e :n &"+s,
    Tabelul E2 Dia!nosticele asociate cu clasa de substane
    Delirium Delirium
    Depen- Intoxi- Absti- prin into- prin abs- Tulburare Tulburri Tulburri Tulburri Dis$uncii Tulburri
    den Abu( caie nen xicaie tinen Demen amnestic psi%otice a$ectivre anxioase sexuale de somn
    Alcool - - - - l A # # I1A I1A l1A
    Am$etamine - - - - l l l1A l
    a$eina - l
    annabis - - - l l l
    ocain - - - - l l l1A I1A
    Lalucino!ene - - - l lU l l
    In%alante - - - l # l l l
    Ficotin
    W
    -
    -
    Opiacee
    x x
    - - l l l
    #%encKclidina
    x x
    - l l l l
    Sedative,
    x x
    - - l A # # I1A I1A A
    Lipnotice,
    Anxiolitice
    #olisubstan
    x
    Alta
    x x
    - - l A # # I1A I1A I1A
    U Qi tulburarea de percepie persistent %alucino!en &'las%bacCs)
    FotD -, l, A, I1A sau # indic $aptul c respectiva cate!orie este recunoscut "n DSM-IV2 In a$ar de aceasta, l indic $aptul c speci$icantul =u
    debut "n cursul intoxicaiei> poate $i notat pentru cate!oria respectiv &cu excepia deliriumului prin intoxicaie)3 A indic $aptul c
    =cu debut "n cursul abstinenei> poate $i notat pentru cate!oriarespectiv &cu excepia deliriumului prin abstinen), iar I1A indic
    speci$icantul =cu debut "n cursul intoxicaiei, $ie speci$icantul =cu debut "n cursul abstinenei> poate $ notat pentru cate!oria respectiv2 # indic
    $aptul c respectiva cate!orie este persistent2
    *57
    Tulburrile "n le!tur cu o Substan

    &en(r+ +n an+%!( dro$, se &o( de/vo"(a d!verse $rade de (o"eran=7 "a d!.er!(e"e sa"e
    e.ec(e as+&ra s!s(e%+"+! nervos cen(ra". De e<e%&"+, &en(r+ o&!acee (o"eran(a "a
    de&r!%area res&!ra(or!e s! (o"eran(a "a ana"$e/!c a&ar "a concen(ra=!! d!.er!(e.
    Ind!v!/!! care +;ea;6 de can(!(7=! %ar! de o&!acee sa+ de s(!%+"an(e &o( &re/en(a
    n!ve"e de (o"eran=7 cons!dera'!"e Ede e<., de /ece or! %a! %ar!J, a@+n$And adesea "a
    o do/7 care ar &+(ea .! "e(a"7 &en(r+ +n non+se+r. To"eran=a "a a"coo" &oa(e .!, de
    ase%enea, &ron+n=a(7, dar de re$+"7 es(e c+ %+"( %a! %!c7 decA( (o"eran=a &en(r+
    a%.e(a%!na. M+"=! !nd!v!/! care .+%ea/7 =!$are(e, .+%ea/7 &es(e 9L de =!$are(e &e
    /!, o can(!(a(e care "e4ar .! &rod+s s!%&(o%e de (o<!c!(a(e "a :nce&+(+" .+%a(+"+!.
    Ind!v!/!! care +/ea/7 de %ar! can(!(7=! de canna'!s n+ rea"!/ea/7 :n $enera" c7 a+
    de/vo"(a( (o"eran=7 EdeO! aceas(a a .os( de%ons(ra(7 de s(+d!!"e &e an!%a"e s! "a +n!!
    !nd!v!/!J. To"eran(a es(e d!.!c!" de s(a'!"!( n+%a! d!n !s(or!c, cAnd s+'s(an=a +(!"!/a(7
    es(e !"e$a"7 s! a%es(eca(7 &ro'a'!" c+ d!verO! d!"+an=! sa+ c+ a"(e s+'s(an=e, :n as(.e"
    de s!(+a=!!, &o( .! +(!"e (es(e"e de "a'ora(or Ede e<., concen(ra=!!"e san$+!ne %ar! de o
    s+'s(an=7 c+&"a(e c+ o !n(o<!ca=!e &+=!n ev!den(7 s+$erea/7 c7 es(e &os!'!"7
    (o"eran=aJ. To"eran=a (re'+!e s7 .!e d!s(!ns7, de ase%enea, de var!a'!"!(a(ea
    E!nd!v!d+a"7 :n sens!'!"!(a(ea !n!=!a"7 "a e.ec(e"e an+%!(or s+'s(an=e. De e<., +n!!
    !nd!v!/! care 'ea+ &en(r+ &r!%a da(7 &re/!n(7 .oar(e &+=!ne se%ne de !n(o<!ca=!e "a
    (re!, &a(r+ &aare, :n (!%& ce a"=!!, de $re+(a(e s! !s(or!c de '7+(or! s!%!"are, &re/!n(7
    d!/ar(r!e s! !ncoordonare.
    A's(!nen=a Ecr!(er!+" 9aJ es(e o %od!.!care de/ada&(a(!v7 de co%&or(a%en(, c+
    conco%!(en(e .!/!o"o$!ce s! co$n!(!ve, care s+rv!ne cAnd concen(ra=!!"e san$+!ne sa+
    (!s+"are a"e +ne! s+'s(an=e d!%!n+a "a +n !nd!v!d care a %en=!n+( +n +/ &re"+n$!(
    de can(!(7=! %ar! de s+'s(an=7. D+&7 de/vo"(area s!%&(o%e"or ne&"7c+(e de
    a's(!nen=7, es(e &os!'!" ca &ersoana s7 !a s+'s(an=a &en(r+ a4s! +O+ra s!%&(o%e"e
    sa+ &en(r+ a "e ev!(a Ecr!(er!+" 9'J, .7cAnd de re$+"7 +/ de s+'s(an=7 (oa(7 /!+a,
    :nce&And c+rAnd d+&7 deO(e&(are. S!%&(o%e"e de a's(!nen=7 var!a/7 %+"( :n ra&or(
    c+ c"ase"e de s+'s(an=e s!, :n consec!n=7, s+n( &rev7/+(e se(+r! de cr!(er!! &en(r+
    a's(!nen=7 se&ara(e &en(r+ ce"e %a! %+"(e c"ase de s+'s(an=e. Se%ne .!/!o"o$!ce de
    a's(!nen=7 no(a'!"e O! :n $enera" +Oor de eva"+a( s+n( co%+ne &en(r+ a"coo", o&!acee
    O! seda(!ve, !&no(!ce O! an<!o"!(!ce. Se%ne O! s!%&(o%e de a's(!nen=7 s+n( adesea
    &re/en(e, dar %a! &+=!n ev!den(e, :n ca/+" s(!%+"an(e"or, c+% ar .! a%.e(a%!ne"e O!
    coca!na, &rec+% O! :n ca/+" n!co(!ne! O! canna'!s+"+!.. D+&7 +/+" re&e(a( de
    a"+c!no$ene n+ se o'serv7 n!c! o a's(!nen=7 se%n!.!ca(!v7. A's(!nen=a de
    &encyc"!@(a7 s! de s+'s(an=e"e a.!ne n+ a .os( :nc7 descr!s7 "a oa%en! EdeO! a .os(
    de%ons(ra(7 "a an!%a"eJ. N!c! (o"eran=a s! n!c! a's(!nen=a n+ s+n( necesare O! n!c!
    s+.!c!en(e &en(r+ d!a$nos(!c+" de a's(!nen=7 de o s+'s(an=7. Un!! !nd!v!/! Ede e<., ce!
    c+ de&enden=7 de canna'!sJ &re/!n(7 +n &a((ern de +/ co%&+"s!v, .7r7 n!c! +n se%n
    de (o"eran=7 sa+ de a's(!nen=7. Invers, +n!! &ac!en=! &os(c!r+r$!ca"! .7r7
    de&enden=7 de o&!acee &o( de/vo"(a (o"eran=7 "a o&!acee"e &rescr!se, e<&er!en(And
    s!%&(o%e de a's(!nen=7 .7r7 s7 %an!.es(e n!c! +n .e" de se%ne de +/ co%&+"s!v.
    S&ec!.!can=!! Sc+ de&enden=7 .!/!o"o$!c7T O! S.7r7 de&enden=7 .!/!o"o$!c7T s+n(
    &rev7/+=! &en(r+ a !nd!ca &re/en=a sa+ a'sen=a (o"eran=e! sa+ a's(!nen=e!.
    I(e%!! +r%7(or! descr!+ &a((ern+" de +/ co%&+"s!v a" +ne! s+'s(an=e care es(e
    carac(er!s(!c de&enden=e!. Ind!v!d+" &oa(e "+a s+'s(an=a :n can(!(7=! %ar! sa+ o
    &er!oad7 %a! "+n$7 de (!%& decA( !n(en=!ona !n!=!a" Ede e<., con(!n+7 s7 'ea &An7 ce
    se !n(o<!c7 sever, :n d!s&re=+" .a&(+"+! c7 O!4a &ro&+s ca "!%!(7 n+%a! +n &aarJ
    Ecr!(er!+" ;J. Ind!v!d+" :O! &oa(e e<&r!%a dor!n=a &ers!s(en(7 de a s+&r!%a sa+ re$"a
    +/+" de s+'s(an=7. Adesea e<!s(7 %+"(e e.or(+r! !n.r+c(+oase de a red+ce sa+
    Dependenta de o
    Substan
    145
    s+&r!%a +/+" Ecr!(er!+" IJ Ind!v!d+" &oa(e &!erde .oar(e %+"( (!%& &en(r+ a o'=!ne
    s+'s(an=a, a o cons+%a or! &en(r+ a se rec+&era d!n e.ec(e"e e! Ecr!(er!+" YJ :n +ne"e
    ca/+r! de de&enden(7 de s+'s(an=7, v!r(+a", (oa(e ac(!v!(7=!"e co(!d!ene a"e &ersoane!
    se :nvAr( :n @+r+" s+'s(an=e! Ac(!v!(7=! soc!a"e, &ro.es!ona"e sa+ recrea=!ona"e
    !%&or(an(e &o( .! a'andona(e sa+ red+se d!n ca+/a +/+"+! +ne! s+'s(an=e Ecr!(er!+"
    RJ Ind!v!d+" se &oa(e re(ra$e d!n ac(!v!(7=!"e de .a%!"!e O! d!n o''y4+n s&re a +/a
    de s+'s(an=7 :n %od &r!va( sa+ &en(r+ a &e(rece %a! %+"( (!%& c+ a%!c!!, +se+n de
    s+'s(an=7 :n d!s&re=+" rec+noaO(er!! ro"+"+! con(r!'+an( a" s+'s(an=e! "a o &ro'"e%7
    &s!o"o$!c7 sa+ so%a(!c7 Ede e<, s!%&(o%e de&res!ve severe or! "e/!+n! a"e
    d!verse"or or$aneJ, &ersoana con(!n+7 s7 .ac7 +/ de s+'s(an=7 Ecr!(er!+" HJ Te%a
    ce!e :n eva"+area aces(+! cr!(er!+ n+ es(e e<!s(en(a &ro'"e%e!, c! %a! c+rAnd
    !nca&ac!(a(ea !nd!v!d+"+! de a se a'(%e de "a +/+" de s+'s(an=7, :n d!s&re=+"
    .a&(+"+! c7 are &ro'a d!.!c+"(7=!! &e care aceas(a !4o &rovoac7
    Speci$icanti
    To"eran(a s! a's(!nen(a &o( .! asoc!a(e c+ +n r!sc %a! %are de &ro'"e%e %ed!ca"e
    $enera"e !%ed!a(e s! +n &rocen( %a! %are de rec7der! S&ec!can(n s+n( &rev7/+=!
    &en(r+ a no(a &re/en(a sa+ a'sen(a "or
    C+ de&enden=7 .!/!o"o$!c7. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( cAnd
    de&enden(a de o s+'s(an=7 es(e :nso=!(7 !n %od ev!den( de (o"eran(7 Ecr!(er!+"
    5J or! de a's(!nen=7 Ecr!(er!+" 9J
    )r de&enden=7 .!/!o"o$!c7 Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( cAnd n+
    e<!s(7 n!c! o &ro'7 de (o"eran(7 Ecr!(er!+" 5J sa+ de a's(!nen(7 Ecr!(er!+" 9J La
    aceO(! !nd!v!/!, de&enden(a de o s+'s(an=7 es(e carac(er!/a(7 &r%(r4+n
    &a((ern de +/ co%&+"s!v Ece" &+=!n (re! !(e%! de "a cr!(er!!"e ;4HJ
    Speci$icantii evoluiei
    Pen(r+ de&enden(a de o s+'s(an=7 s+n( d!s&on!'!"! saWe W&ec!.!!]an(! de
    evo"+=!e Ce! &a(r+ s&eo.!can(! de re%!s!+ne &o( .! a&"!ca=!, n+%a! d+&7 ce n!c!
    +n+" d!n(re cr!(er!!"e &en(r+ de&enden(a de o s+'s(an=7 sa+ a'+/+" de o s+'s(an=7
    n+ a .os( &re/en( (!%!de ce" &+(!r o "+n7 De.!n!=!a aces(or &a(r+ (!&+r! de
    re%!s!+ne se 'a/ea/7 &e !n(erva"+" care a (rec+( de "a :nce(area de&enden(e!
    Ere%!s!+ne &recoce vers+s re%!s!+n( &re"+n$!(7J s! dac7 e<!s(7 &re/en=a con(!n+7
    a +n+!a sa+ a %a! %+"(ora d!n(re !(e%n !nc"+O! !n se(+r!"e de cr!(er!! &en(r+
    de&enden(7 sa+ a'+/ Ere%!s!+ne &ar=!a"7 vers+s re%!s!+ne co%&"e(7J Deoarece
    &r!%e"e 59 "+n! d+&7 de&enden(a s+n( o &er!oad7 de r!sc de rec7dere .oar(e %are,
    aceas(7 &er!oad7 es(e den+%!(7 de Sre%!s!+ne &recoceT D+&7 ce a+ (rec+( ce"e 59
    "+n! de re%!s!+ne &recoce .7r7 rec7dere % de&enden(7, &ersoana !n(r7 !n
    Sre%!s!+ne &re"+n$!(72 A(A( &en(r+ re%!s!+nea &recoce, cA( s! &en(r+ re%!s!+nea
    &re"+n$!(7 es(e da(7 den+%!rea de ,co%&"e(7T, dac7 % &er!oada de re%!s!+ne n+
    a .os( sa(!s.7c+( n!c! +n cr!(er!+ de de&enden(7 sa+ a'+/, den+%!rea de S&ar=!a"7T
    es(e da(7, dac7 :n (!%&+" &er!oade! de re%!s!+ne a .os( sa(!s.7c+(, !n(er%!(en( sa+
    con(!n++, ce" &+=!n +n+" d!n(re cr!(er!!"e &en(r+ de&enden(7 sa+ a'+/
    D!.eren=!erea re%!s!+% co%&"e(e &re"+n$!(e de rec+&erare Eac(+a"%en(e, n!c! o
    (+"'+rare de +/ de o s+'s(an=7J neces!(7 "+area :n cons!dera=!e a !n(erva"+"+! de
    (!%& de "a +"(!%a &er!oad7 de &er(+r'are, d+ra(a (o(a"7 a &er(+r'7r!! s! neces!(a(ea
    de eva"+are con(!n+7
    5FR
    Tulburrile "n le!tur cu o Substan

    Dac7, d+&7 o &er!oad7 de re%!s%ne sa+ de rec+&erare, !nd!v!d+" dev!ne !ar7O!
    de&enden(, a&"!carea s&ec!.!can(+"+! de Sre%!s%ne &recoceT neces!(7 d!n no+
    e<!s(en(a +ne! &er!oade de o "+n7 :n care s7 n+ .!e sa(!s.7c+(e cr!(er!!"e &en(r+
    de&enden(7 sa+ a'+/ Ma! s+n( &rev7/+=! do! s&ec!.!can(! s+&"!%en(ar! SS+'
    (era&!e a$on!s(7T s! S:n(r4+n %ed!+ con(ro"a(T Pen(r+ ca +n !nd!v!d s7 .!e dese%na(
    &en(r+ re%!s!+ne &recoce, d+&7 :nce(area +ne! (era&!! a$o%s(e or! e"!'erarea d!n(r4
    +n %ed!+ con(ro"a(, (re'+!e s7 e<!s(e o &er!oad7 de o "+n7 :n care s7 n+ .!e sa(!s.7c+(
    n!c! +n cr!(er!+ &en(r+ de&enden(7 sa+ a'+/
    Ur%7(or!! s&ec!.!can(! de re%!s!+ne &o( .! a&"!ca=!, n+%a! d+&7 ce n!c! +n cr!(er!+
    &en(r+ de&enden(7 sa+ a'+/ n+ a .os( sa(!s.7c+( (!%& de ce" &+=!n o "+n7 De no(a(
    c7 aceO(! s&ec!.!can(! n+ se a&"!c7, dac7 !nd!v!d+" es(e s+' (era&!e a$on!s(7 or! se a."7
    :n(r4+n %ed!+ con(ro"a( Eve/! %a! @osJ
    Re%!s!+ne co%&"e(7 &recoce. Aces( s&ec!.!can( es(e +(!"!/a( dac7 &en(r+ ce"
    &+=!n o "+n7, dar &en(r+ %a! &+=!n de 59 "+n!, n+ a .os( sa(!s.7c+( n!c! +n
    cr!(er!+ &en(r+ de&enden(7 sa+ a'+/
    lun
    Re%!s!+ne &ar=!a"7 &recoce. Aces( s&ec!.!can( es(e +(!"!/a( dac7 &en(r+ ce"
    &+=!n o "+n7, dar %a! &+(% de 59 "+n!, +n+" sa+ %a! %+"(e cr!(er!! &en(r+
    de&enden(7 sa(!s.7c+(e, Edar n+ a+ .os( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+
    de&enden(7J
    lun
    Re%!s!+ne co%&"e(7 &re"+n$!(7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 n!c!
    +n+" d!n(re cr!(er!!"e &en(r+ de&enden(7 sa+ a'+/ n+ a .os( sa(!s.7c+(
    n!c!oda(7 :n c+rs+" +ne! &er!oade de 59 "+n! sa+ %a! %+"(
    EaU lun
    EE b luni
    Re%!s!+ne &ar=!a"7 s+s=!n+(7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 cr!(er!!"e
    co%&"e(e &en(r+ de&enden(7 n+ a+ .os( sa(!s.7c+(e o &er!oad7 de 59 "+n! sa+
    %a! %+"(, dar a+ .os( sa(!s.7c+(e +n+" sa+ %a! %+"(e cr!(er!! &en(r+
    de&enden(7 sa+ a'+/
    lun
    Dependenta de o
    Substan
    E6?
    Ur%7(or!! s&ec!.!can(! se a&"!c7 dac7 !nd!v!d+" se a."7 s+' (era&!e a$o%s(7 sa+
    :n(r4+n %ed!+ con(ro"a(
    S+' (era&!e a$on!s(7 Aces( s&ec!.!can( es(e +(!"!/a( dac7 !nd!v!d+" se a."7 :n
    (ra(a%en( c+ +n %ed!ca%en( a$on!s( &rescr!s, c+% ar .! %e(adona, s! n+ a
    .os( sa(!s.7c+( n!c! +n cr!(er!+ &en(r+ de&enden(7 sa+ a'+/ &en(r+ c"asa d!n
    care .ace &ar(e %ed!ca%en(+", ce" &+=!n "+na (rec+(7 Ec+ e<ce&=!a (o"eran(e!
    JUaDependen
    JBaDependent
    JUaDependent
    EE b luni
    sa+ a's(!nen(e! de a$on!s(J Aceas(7 ca(e$or!e se a&"!c7, de ase%enea, ce"or
    care, .+nd (ra(a=! &en(r+ de&enden(7, .ac +/ de +n a$on!s( &ar=!a" or! de +n
    a$on!s(Xan(a$on!s(
    :n(r4+n %ed!+ con(ro"a(. Aces( s&ec!.!can( es(e +(!"!/a( dac7 !nd!v!d+" se a."7
    :n(r4+n %ed!+ :n care acces+" "a a"coo" s! "a s+'s(an=e"e con(ro"a(e es(e "!%!(a(,
    s! n!c! +n cr!(er!+ &en(r+ de&enden(7 sa+ a'+/ n+ a .os( sa(!s.7c+(, ce" &+=!n
    "+na (rec+(7 E<e%&"e de aces(e %ed!! s+n( :nc!sor!"e s+&rave$ea(e s(r!c( s!
    .7r7 s+'s(an=e, co%+n!(7=!"e (era&e+(!ce sa+ +n!(7=!"e s&!(a"!ceO(! :nc!se
    Criteriile pentru Depen$en!a $e o Su-&tan!(
    .n pattern de(adaptativ de u( de o substan care duce la deteriorare sau
    detres semni$icativ clinic mani$estat prin trei sau mai multe din
    urmtoarele si care survin oric@nd "n cursul aceleia,i perioade de E7 luni
    &E) tolerant, a,a cum este de$inita de oricare dintre urmtoarele
    (a)necesitatea de cantiti considerabil crescute de substan pentru a
    a0un!e la intoxicaie sau la e$ectul dorit,
    (b) e$ect redus considerabil prin continuarea u(ului aceleia,i
    cantiti de
    substan,
    &7) abstinent, mani$estat prin oricare dintre urmtoarele
    (a)sindromul de absment caracteristic substanei &se re$er la criteriile A
    si S ale setului de criterii pentru abstinenta de substanele speci$ice),
    (b) aceea,i substan &sau o substan str@ns "nrudit) este luat
    pentru a
    u,ura sau evita simptomele de abstinent,
    (3) substana este luat adesea "n cantiti mai mari sau o perioad
    mai
    lun! de timp dec@t era preconi(at,
    (4) exist o dorin persistent sau e$orturi in$ructuoase de a suprima
    sau
    controla u(ul de substan,
    (5) o mare parte a timpului este ri sipit "n acti vi ti necesare
    obinem
    substanei &de ex, vi(itarea mai multor doctori sau condus pe distante
    mari), u(ul ui substanei &de ex, $umatul "n l an) sau recuperm din
    e$ectele acesteia,
    (6) activiti sociale, pro$esionale sau recreaionale sunt abandonate
    sau
    reduse din cau(a u(ului de substana,
    (7) u(ul de substan este continuat "n dispreul $aptului c ,tie c are
    o
    problem somatic sau psi%olo!ic, persistent sau recurent, care este
    posibil s $i $ost cau(ata sau exacerbat de substan &de ex, u( curent
    de cocain de,i ,tie c aceasta induce depresie, sau but continuu de,i
    ,tie c un ulcer este a!ravat de consumul de alcool)
    *5> Tul-ur(rile .n le/(tur( #u o Su-&tan!(
    Criteriile pentru Depen$en!a $e o Su-&tan!( (continuare)
    De secificat $a#(M
    Cu $epen$en!( %i)iolo/i#(M pro-a toleran!ei &au a-&tinen!ei 3a$i#( e&te
    pre)ent ite"ul * &au C6S
    '(r( $epen$en!( %i)iolo/i#(M ni#i o pro-( $e toleran!( &au $e a-&tinen!(
    3a$i#( nu e&te pre)ent ni#i ite"ul * &i ni#i ite"ul C6.
    Secificanii de curs 3ve)i te,tul pentru $e%ini!ii6M
    Re"i&iune #o"plet( pre#o#e Re"i&iune
    par!ial( pre#o#e Re"i&iune #o"plet(
    per&i&tent( Re"i&iune par!ial( per&i&tent( Su-
    terapie a/oni&t( .n "e$iu #ontrolat
    A-u)ul $e o Su-&tan!(
    *lemente caracteristice
    E"e%en(+" esen=!a" a" a'+/+"+! de o s+'s(an=7 :" cons(!(+!e +n &a((ern
    de/ada&(a(!v de +/ de o s+'s(an=7, %an!.es(a( &r!n consec!n=e adverse rec+ren(e s!
    se%n!.!ca(!ve :n "e$7(+r7 c+ +/+" re&e(a( de s+'s(an=e. Pen(r+ a sa(!s.ace +n cr!(er!+
    &en(r+ a'+/, &ro'"e%a :n "e$7(+r7 c+ s+'s(an=a (re'+!e s7 .! s+rven!( :n %od re&e(a(
    :n c+rs+" ace"e!aO! &er!oade de 59 "+n! sa+ s7 .!e &ers!s(en(7. Po( e<!s(a eOec+r!
    re&e(a(e :n :nde&"!n!rea o'"!$a=!!"or %a@ore a"e ro"+"+!, +/ re&e(a( :n s!(+a=!! :n care
    aces( "+cr+ es(e &er!c+"os .!/!c, %+"(!&"e &ro'"e%e "e$a"e O! &ro'"e%e soc!a"e O!
    !n(er&ersona"e rec+ren(e Ecr!(er!+" AJ. Con(rar cr!(er!!"or &en(r+ de&enden=a de o
    s+'s(an=7, cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 n+ !nc"+d (o"eran=a, a's(!nen=a or!
    +n &a((ern de +/ co%&+"s!v, dar !nc"+d, :n sc!%', n+%a! consec!n=e"e noc!ve a"e
    +/+"+! re&e(a(. D!a$nos(!c+" de a'+/ de o s+'s(an=7 &r!%ea/7 .a=7 de d!a$nos(!c+"
    de de&enden=7 de o s+'s(an=7, dac7 &a((ern+" de +/ de o s+'s(an=7 a" !nd!v!d+"+!
    n+ a sa(!s.7c+( n!c!oda(7 cr!(er!!"e &en(r+ de&enden=a de acea c"as7 de s+'s(an=e
    Ecr!(er!+" BJ. DeO! +n d!a$nos(!c de a'+/ de s+'s(an=7 es(e %a! &ro'a'!" "a !nd!v!/!!
    care a+ :nce&+( n+%a! recen( s7 !a s+'s(an=a, +n!! !nd!v!/! con(!n+7 s7 a!'7
    consec!n=e soc!a"e adverse :n "e$7(+r7 c+ o s+'s(an=7 o "+n$7 &er!oad7 de (!%&, .7r7
    a de/vo"(a vreo %an!.es(are de de&enden=7 de s+'s(an=7. Ca(e$or!a de a'+/ de o
    s+'s(an=7 n+ se a&"!c7 ca.e!ne! s! n!co(!ne!. Ter%en+" de ab+; (re'+!e a&"!ca( n+%a!
    +n+! &a((ern de +/ de o s+'s(an=7 care sa(!s.ace cr!(er!!"e &en(r+ aceas(7 (+"'+rare8
    (er%en+" n+ (re'+!e s7 .!e +(!"!/a( ca s!non!% &en(r+ S+/T, S+/ de/ada&(a(!vTsa+
    S+/ &er!c+"osT.
    Ind!v!d+" &oa(e &re/en(a :n %od re&e(a( !n(o<!ca=!e sa+ a"(e s!%&(o%e :n
    "e$7(+r7 c+ o s+'s(an=7, cAnd es(e de aO(e&(a( ca e" s7 O! :nde&"!neasc7 o'"!$a=!!"e
    ro"+"+! %a@or "a serv!c!+, "a scoa"7 sa+ acas7 Ecr!(er!+" A"J. Po( e<!s(a a'sen=e
    re&e(a(e sa+ o e.!c!en=7 red+s7 :n %+nc7 :n "e$7(+r7 c+ %a%+re"!"e rec+ren(e. Un
    e"ev &oa(e avea a'sen=e, e"!%!n7r! sa+ e<%a(r!c+"7r! d!n scoa"7 :n "e$7(+r7 c+ o
    s+'s(an=7, :n (!%& ce es(e !n(o<!ca(, !nd!v!d+" &oa(e ne$"!@a co&!!! sa+ o'"!$a=!!"e
    .a%!"!a"e. Persoana &oa(e .! !n(o<!ca(7 :n %od re&e(a(, :n s!(+a=!! care s+n(
    Tulburrile induse de o
    Substan
    144
    &er!c+"oase .!/!c Ede e<
    v
    :n (!%& ce cond+ce +n a+(o%o'!", "+crea/7 c+ +(!"a@e sa+ se
    an$a@ea/7 :n(r4+n co%&or(a%en( recrea=!ona" r!scan(, c+% ar .! :no(+" sa+
    ascens!+nea %on(an7J Ecr!(er!+" A9J. Po( e<!s(a &ro'"e%e "e$a"e re&e(a(e :n "e$7(+r7
    c+ o s+'s(an=7 Ede e<., ares(are &en(r+ cond+!(7 scanda"oas7, a(ac s! %o"es(are,
    cond+cere a +n+! ve!c+" s+' !n."+en=a +ne! s+'s(an=eJ Ecr!(er!+" A;J. Persoana
    &oa(e con(!n+a s7 .ac7 +/ de o s+'s(an=7, :n d!s&re=+" +n+! !s(or!c de consec!n=e
    !n(er&ersona"e sa+ soc!a"e ne&"7c+(e, re&e(a(e sa+ &ers!s(en(e Ede e<., d!.!c+"(7=!
    %ar!(a"e sa+ d!vor=, d!s&+(e ver'a"e sa+ .!/!ceJ Ecr!(er!+" AIJ.
    Criteriile pentru A-u)ul $e o Su-&tan!(
    A2 .n pattern de(adaptativ de u( de o substan care duce la deteriorare sau
    detres semni$icativ clinic mani$estat prin unul &sau mai multe) dintre
    urmtoarele si care survin "n decursul unei perioade de E7 luniD
    (1) u( recurent de o substan duc@nd la incapacitatea de a "ndeplini obli!a
    iile rolului ma0or la serviciu, la scoal sau acas &de ex2, absene repetate
    sau per$orman redus "n munc "n le!tur cu u(ul de substan3
    absene, eliminri sau exmatriculri din ,coal3 ne!li0area copiilor sau a
    casei)3
    (2) u( recurent de o substan "n situaii "n care acesta este periculos $i(ic
    &de
    ex2, condusul unui automobil sau manipularea unui utila0 atunci c@nd
    este deteriorat de u(ul de o substan)3
    (3) probleme le!ale repetate "n le!tur cu u(ul de o substan &de
    ex2,
    arestri pentru tulburri de conduit "n le!tur cu o substan)3
    (4) u( continuu de o substan "n dispreul $aptului c are probleme
    sociale
    sau interpersonale, persistente sau repetate, cau(ate sau exacerbate de
    e$ectele substanei &de ex2, certuri cu soia &soul) re$eritoare la consecin
    ele intoxicaiei, bti)2
    S2 Simptomele nu au satis$cut niciodat criteriile pentru dependena de o
    substan pentru aceast clas de substan2
    Tul-ur(rile in$u&e $e o Su-&tan!(
    Into,i#a!ia #u o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ o s+'s(an=7 :" cons(!(+!e a&ar!=!a +n+!
    s!ndro% revers!'!", s&ec!.!c s+'s(an=e!, da(ora( !n$es(!e! +ne! s+'s(an=e Esa+
    e<&+ner!! "a o s+'s(an=7J Ecr!(er!+" AJ. Mod!.!c7r!"e &s!o"o$!ce sa+
    co%&or(a%en(e"e de/ada&(a(!ve se%n!.!ca(!ve c"!n!c asoc!a(e c+ !n(o<!ca=!a Ede
    e<., 'e"!$eran(7, "a'!"!(a(ea a.ec(!v7, de(er!orarea co$n!(!v7, de(er!orarea
    @+dec7=!!, a .+nc=!on7% soc!a"e sa+ &ro.es!ona"eJ s+n( da(ora(e e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e s+'s(an=e! as+&ra s!s(e%+"+! nervos cen(ra" O! se a&ar :n
    c+rs+" sa+ "a sc+r( (!%& d+&7 +/+"
    9LL
    Tulburrile "n le!tur cu o Substan

    s+'s(an=e! Ecr!(er!+" BJ S!%&(o%e"e n+ se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e
    s! n+ s+n( e<&"!ca(e %a! '!ne de o a"(7 (+"'+rare %en(a"7 Ecr!(er!+" CJ In(o<!ca=!a c+
    o s+'s(an=7 es(e asoc!a(7 adesea c+ a'+/+" sa+ c+ de&enden=a de o s+'s(an=7
    Aceas(7 ca(e$or!e n+ se a&"!c7 %co(%e! Pro'a ad%!n!s(r7% recen(e de s+'s(an=7
    &oa(e .! o'=!n+(7 d!n !s(or!c, e<a%en+" so%a(!c Ede e< , a"ena a"coo"!c7J sa+ ana"!/a
    (o<!co"o$!c7 a ."+!de"or or$an!s%+"+! Ede e< , a +r%!! sa+ a sAn$e"+!J
    Ce"e %a! co%+ne %od!.!c7r! !%&"!c7 &er(+r'7r! de &erce&=!e, v!$!(a(e, a(en=!e,
    $And!re, @+deca(7, co%&or(a%en( &s!o%o(or s! co%&or(a%en( %(er&ersona"
    Ta'"o+" c"!n!c s&ec!.!c :n !n(o<!ca=!a c+ o s+'s(an=7 var!a/7 :n %od dra%a(!c &r!n(re
    !nd!v!/! s! de&!nde, de ase%enea, de care s+'s(an=7 es(e !%&"!ca(7, de do/a, d+ra(a
    sa+ cron!c!(a(ea +/+"+!, (o"eran=a &ersoane! "a s+'s(an=7, &er!oada de (!%& de "a
    +"(!%a do/7, e<&ec(a(n"e?!ersoane! de "a e.ec(e"e s+'s(an=e! s! a%'!an=a sa+
    c!rc+%s(an=e"e :n care es(e "+a(7 s+'s(an=a In(o<!ca=!!"e de sc+r(7 d+ra(7 sa+
    Sac+(eT &o( avea se%ne sa+ s!%&(o%e d!.er!(e, :n co%&ara=!e c+ !n(o<!ca=!!"e de
    "+n$7 d+ra(7 sa+ Scron!ceT De e<e%&"+, do/e"e %odera(e de coca!n7 &o( &rod+ce
    !n!=!a" $re$an(a(e, dar &oa(e a&are !/o"area soc!a"7 dac7 as(.e" de do/e s+n( re&e(a(e
    .recven(, (!%& de /!"e sa+ s7&(7%An!
    S+'s(an=e d!.er!(e E+neor! c!ar c"ase de s+'s(an=e d!.er!(eJ &o( &rod+ce
    s!%&(o%e !den(!ce De e<e%&"+, !n(o<!ca=!a c+ a%.e(a%!na s! !n(o<!ca=!a c+ coca!n7
    se &o( &re/en(a a%'e"e c+ $randoare s! !&erac(!v!(a(e, aco%&an!a(e de (a!card!e,
    d!"a(a=!e &+&!"ar7, &res!+ne san$+!n7 cresc+(7, (rans&!ra=!e sa+ sen/a=!e de .r!$. De
    ase%enea, a"coo"+" s! s+'s(an=e"e d!n c"asa seda(!ve"or, !&no(!ce"or sa+
    an<!o"!(!ce"or &rod+c s!%&(o%e de !n(o<!ca=!e s!%!"are
    CAnd es(e +(!"!/a( :n sens .!/!o"o$!c, (er%en+" de intoxica(ie es(e %a! "ar$
    decA( ce" de S!n(o<!ca=!e c+ o s+'s(an=7T, aOa c+% es(e de.!n!( a!c! M+"(e
    s+'s(an=e &o( &rod+ce %od!.!c7r! .!/!o"o$!ce sa+ &s!o"o$!ce care n+ s+n( :n
    %od necesar de/ada&(a(!ve De e<e%&"+, +n !nd!v!d c+ (a!card!e &r!n +/
    e<ces!v de co.e!n7 are !n(o<!ca=!e .!/!o"o$!c7, dar dac7 aceas(a es(e s!n$+r+"
    s!%&(o% :n a'sen(a co%&or(a%en(+"+! de/ada&(a(!v, d!a$nos(!c+" de !n(o<!ca=!e
    c+ ca.e!na n+ se a&"!c7 Na(+ra de/ada&(a(!v7 a %od!.!c7% :n co%&or(a%en(
    !nd+s7 de o s+'s(an=7 de&!nde de con(e<(+" soc!a" s! a%'!en(a"
    Co%&or(a%en(+" de/ada&(a(!v, :n $enera", e<&+ne !nd!v!d+" "a +n r!sc
    se%n!.!ca(!v de e.ec(e adverse Ede e< , acc!den(e, co%&"!ca=!! %ed!ca"e $enera"e,
    r+&(+r7 :n re"a=!!"e soc!a"e s! de .a%!"!e, d!.!c+"(7=! &ro.es!ona"e sa+ .!nanc!are,
    &ro'"e%e "e$a"eJ Se%ne"e s! s!%&(o%e"e de !n(o<!ca=!e &o( &ers!s(a +neor! ore
    sa+ /!"e, &es(e (!%&+" cA( s+'s(an=a es(e de(ec(a'!"7 :n ."+!de"e or$an!s%+"+!
    Aceas(a se &oa(e da(ora concen(ra=!!"or %!c!, con(!n+e, de s+'s(an=7 :n an+%!(e
    /one a"e cre!er+"+! or! +n+! e.ec( S"oveO(e s! .+$!T :n care s+'s(an=a a"(erea/7 +n
    &roces .!/!o"o$!c a c7r+! rec+&erare !a %a! %+"( (!%& decA( (!%&+" de e"!%!nare
    a" s+'s(an=e! Aces(e e.ec(e &e (er%en "+n$ a"e !n(o<!ca=!e! (re'+!e s7 .!e d!s(!nse
    de a's(!nen(7 Ead!c7, de s!%&(o%e"e !n!=!a(e de dec"!n+" concen(ra=!!"or +ne!
    s+'s(an=e :n sAn$e sa+ :n =es+(+r!J
    44
    edn& 2E+n/BO s@a+n +@ ZBn&s@SJ =/ea@o!@o+!e as ;5IRL5<LI555 a& a@a!+c0d+!!s :s a@a++!as
    &+=& ad 2aIBdoIS nes asn&a@ I+ns a@a/o& &+& a!edv ?+a+!=s0y ?+a+0s0e a&
    a@a+!o?d+!!s BKBa&a@E 2Ba+a+!asB a& 2a@BUo0(&B +&B.B+! @o+n !?+as0e n+s %+a/a!d !@
    i* +%o 2ULI;B* +@e :s +%oa@d 2/n a& BIBan& !aa HKOD yIUBIs0n28 !s+aaoH na +!
    ;IeA!as0o @o&D @nsndo &+!!8 eo a+!o@d!%s ;I@n!+ IHLU a&o no 2-Ie/!@!In a& a0o+ry +!
    ,KEUBA !aI+a+0s0e a@a+!oId+((s :s a@a+a!a$ a!0!@o!<++ nes 2aA0e&as 2aaoe!do
    2e+0oo!+ 2BUIBOOD 2a+!@y ;IU(cIs0ns aIZB :s a+!!+?a@+ ;IUBIs0ns a& adr+S
    a@aaeoIe+@!n n?+ad IBIda!oe ;IY; BI+a+!Is0B a& a@a+!oId+!!s B*OI*BUIB B a!ds
    !aIUBIs0ns B a@BaI4!!+!!+&Baa ;& BIU;&*B BI++o& ne E5ILI @B!!& aIBodJ BI!!a+!Is0B no
    !/! _!&+! +@n!+ IBUI !a? E QD f
    BC
    ` IKBAJ BIUBIs0ns o a& BI+a&+ada& no 2B+nBa&IOI n+ *B&
    2B@nSaa o& BIB!oosB LIS; BIU;U!Is0v EO @n+;I+oJ B*BIU;UI a@B!n0@nI BIZB a& a+!0
    IBUI ;IBO![d<; I+ns n+ :s a@B*S+aS a@eo!&a+! !0!&+oo "a+n BKBF*OIB& as n+
    a@;+!LId+!!$ E$ @n+aI+oJ ;IUBI*od!+! aaB+o0o+n@ a& n+a+!o& ;I@B +! +o .BUo!sa@o!d
    2ZB!oos @%+a+!o& +! o!+!& BA!IBO!@!++!as a@BO!?a& nBS Bsa?a& BKBa/nso
    !aIUBIS0ns o!@!oads @n+!o@&+!$ Ev !n@n+aI+oJ BIUBIs0ns o a& A!sao<a :s I!f+n@a@d
    /n %+n !naon&a! nBS !+BIao+! BHB;*OIB& as a@BO aA0!+Soo :s ao!So@o!/!@
    ;I+aI!+!oo+oo no 2!aIUBIs0ns ao!@!oads I+a!UBI!od!+oo a& ;A!IBIdB&B/a& UBO!@!&o+!
    !s+n B!IUBdB ;!nI(Is+oo @! BIUBIs0ns o ;&
    DXi3souIeip ap
    o ap
    a3eDiJdxa
    e0Je ap aui]
    luns nu "s aJe0au4I 8JeDipaai iiiipuoD laun e(ea0oiep as nu
    ot2ueA2s]ns Jn(n ednp du0ii 30nDs eJ nes ILSNLD ui 0ede
    "s &a0euoisap0d nes aJeoos n0euoipun2)2 ee0e0oua0ap Mn0eDapn$
    MeAi3iuIco a0e0oua3ap MeAipa02e a"2e3iJi]eJ MaH2eiiJenpiJ2)2uoD M xa ap) mJ
    nu0ai2sis e0dnse aiue3s]ns laun 0oiapap e(ea0o0ep as SNSD
    aAi0eDi02iuaias MaAi3eidepe(ap
    nes aDiIoJo]isd upi0MpoiAl a
    nes a0eJiu0is aoio0puis
    e0ueis]ns o eJ auaDa0 &luaundxa J
    i]is0aAa0 oio0puis mun ei0uedv V
    nQ!ua$
    "
    eiue0s]ns o ap e3uaui3s]v
    9L9 Tulburrile "n le!tur cu o Substan

    Criteriile pentru A-&tinen!a $e o Su-&tan!(
    A Apariia unui sindrom speci$ic substanei datorat "ncetm &sau reducem)
    u(ului excesiv si prelun!it al unei substane2
    S Sindromul speci$ic substanei cau(ea( o detres sau deteriorare
    eJS0uau0
    iod a3ua2)2ip aiueis]n! nes)
    #ci^saIui e0oiep a0ueis]ns laun Di
    ei!ue!&Tn& o na
    semni$icativ clinic "n $uncionarea social, pro$esional sau "n alte domenii
    de $uncionare importante
    Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental
    *lemente asociate Dependenei, Abu(ului,
    Intoxicaiei si Abstinentei de o Substan
    6robleme de evaluare. D!a$nos(!c+" de de&enden(7 de o s+'s(an=7 neces!(7
    o'=!nerea +n+! !s(or!c de(a"!a( de "a !nd!v!d s!, or! de cA(e or! es(e &os!'!", d% s+rse
    s+&"!%en(are de !n.or%a=!! Ede e<, doc+%en(e %ed!ca"e, so(E!eJ, o r+d7 sa+ +n
    a%!c a&ro&!a(J Pe "An$7 aces(ea, &o( .! +(!"e da(e"e e<a%!n7% so%a(!ce s! (es(e"e
    de "a'ora(or
    (alea de administrare. Ca"ea de ad%!n!s(rare a +ne! s+'s(an=e es(e +n .ac(or
    !%&or(an( :n de(er%!narea e.ec(e"or sa"e E!nc"+/And (!%&+" de de/vo"(are a"
    !n(o<!ca=!e!, &ro'a'!"!(a(ea c+ care +/+" s7+ va &rod+ce %od!.!c7r!"e .!/!o"o$!ce
    asoc!a(e c+ a's(!nen(a, or! va d+ce "a de&enden(7 sa+ a'+/J C7!"e de ad%!n!s(rare
    care &rod+c o a'sor'=!e %a! ra&!d7 s! %a! e.!c!en(7 :n c+ren(+" san$+!n Ede e< ,
    ad%!n!s(rarea !n(ra venoas7, (+rna(+" sa+ S&n/a(+"TJ (!nd s7 d+c7 "a o !n(o<!ca=!e
    %a! !n(ens7 s! "a &ro'a'!"!(a(ea cresc+(7 a +n+! &a((ern esca"adan( de +/ de
    s+'s(an=7 care d+ce "a de&enden(7 C7!"e de ad%!n!s(rare care e"!'erea/7 ra&!d o
    %are can(!(a(e de s+'s(an=7 cre!er+"+! s+n( asoc!a(e, de ase%enea, c+ n!ve"e %a!
    %ar! de cons+% de s+'s(an=7 s! c+ o &ro'a'!"!(a(e cresc+(7 de e.ec(e (o<!ce De
    e<e%&"+, o &ersoan7 care +/ea/7 de a%.e(a%!na ad%!n!s(ra(7 !n(ravenos es(e
    .oar(e &os!'!" s7 cons+%e %ar! can(!(7=! de s+'s(an=7 s! s7 r!O(e as(.e" o s+&rado/are
    :n co%&ara=!e c+ o &ersoan7 care !a a%.e(a%!na ora"
    !apiditatea debutului @n cadrul unei clase de substan3e. Es(e .oar(e &os!'!" ca
    s+'s(an=e"e c+ ac=!+ne ra&!d7 s7 &rod+c7 !%ed!a( !n(o<!ca=!e s! s7 d+c7 "a
    de&enden(7 sa+ a'+/, :n co%&ara=!e c+ s+'s(an=e"e c+ ac=!+ne %a! "en(7 De
    e<e%&"+, deoarece *!aXe&a%+" s! a"&ra/o"a%+" a+ +n de'+( a" ac=!+n!! %a! ra&!d
    decA( o<a/e&a%+", es(e .oar(e &os!'!" ca aces(ea s7 d+c7, &r!n +r%are, "a
    de&enden(7 sa+ a'+/ de o s+'s(an=7
    9urata e.ec(e"or. D+ra(a e.ec(e"or asoc!a(e c+ o an+%!(7 s+'s(an=7 es(e, de
    ase%enea, !%&or(an(7 :n de(er%!narea &er!oade! de des.7O+rare a !n(o<!ca=!e! s! a
    .a&(+"+! dac7 +/+" de o s+'s(an=a va d+ce "a de&enden(7 sa+ a'+X S+'s(an=e"e c+
    d+ra(7 de ac=!+ne re"a(!v sc+r(7 Ede e< , an+%!(e an<!o"!(!ceJ (!nd s7 a!'7 +n
    &o(en=!a" %a! %are de a de/vo"(a de&enden(7 sa+ a'+/, :n co%&ara=!e c+
    s+'s(an=e"e c+ e.ec(e s!%!"are, dar care a+ o d+ra(7 de ac=!+ne %a! "+n$a Ede e<,
    .eno'ar'!(a"+"J Se%!v!a(a s+'s(an=e! %er$e &ara"e" c+ as&ec(e"e a's(!nen(e! c+ cA(
    Tulburrile "n le!tur cu o
    Substan
    C+4
    d+ra(a de ac=!+ne es(e %a! "+n$7, c+ a(A( es(e %a! "+n$ (!%&+" d!n(re :nce(area
    ad%!n!s(r7r!! s! de'+(+" s!%&(o%e"or de a's(!nen=7, s! %a! "+n$7 d+ra(a a's(!nen=e!.
    De e<e%&"+, &en(r+ ero!n7, de'+(+" s!%&(o%e"or de a's(!nen=7 ac+(7 es(e %a!
    ra&!d dar s!ndro%+" de a's(!nen=7 es(e %a! &+=!n &ers!s(en( decA( ce" &en(r+
    %e(adon7. :n $enera", c+ cA( es(e %a! "+n$7 &er!oada de a's(!nen=7 ac+(7, c+ a(A(
    s!ndro%+" de a's(!nen=7 (!nde a .! %a! &+=!n !n(ens.
    Uzul mai multor substan3e. De&enden=a, a'+/+", !n(o<!ca=!a s! a's(!nen=a de o
    s+'s(an=7 !%&"!c7 adesea +/+" %a! %+"(or s+'s(an=e, conco%!(en( sa+ s+cces!v. De
    e<e%&"+, !nd!v!/!! c+ de&enden=7 de coca!n7 +;ea;6, de ase%enea, de a"coo",
    an<!o"!(!ce sa+ o&!acee, adesea &en(r+ a con(racara s!%&(o%e"e an<!oase &ers!s(en(e
    !nd+se de coca!n7. La .e", !nd!v!/!! c+ de&enden=7 de o&!acee sa+ c+ de&enden=7 de
    canna'!s a+ de re$+"7 %+"(e a"(e (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7, ce" %a! adesea
    !%&"!cAnd a"coo"+", an<!o"!(!ce"e, a%.e(a%!na sa+ coca!na. CAnd s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ %a! %+"( decA( o s!n$+r7 (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7, n+
    (re'+!e &+s d!a$nos(!c+" de de&enden=7 de &o"!s+'s(an=7. Aces( d!a$nos(!c es(e &+s
    n+%a! :n ace"e s!(+a=!! :n care &a((ern+" +/+"+! de %a! %+"(e s+'s(an=e n+ sa(!s.ace
    cr!(er!!"e &en(r+ de&enden=a sa+ a'+/+" de n!c! o s+'s(an=7 s&ec!.!c7, dar "e sa(!s.ace
    &en(r+ $r+&+" de s+'s(an=e "+a( ca :n(re$. S!(+a=!!"e :n care (re'+!e &+s +n
    d!a$nos(!c de de&enden=7 de &o"!s+'s(an=7 s+n( descr!se "a &a$. 9F;.
    9ate de laborator asociate. Ana"!/e"e de "a'ora(or a"e esan(!oane"or de sAn$e s!
    +r!n7 &o( a@+(a "a s(a'!"!rea +/+"+! recen( a" +ne! s+'s(an=e. Concen(ra=!!"e san$+!ne
    o.er7 !n.or%a=!! s+&"!%en(are des&re can(!(a(ea de s+'s(an=7 &re/en(7 :nc7 :n
    or$an!s%. Tre'+!e re=!n+( c7 +n (es( san$+!n sa+ de +r!n7 &o/!(!v n+ !nd!c7 &r!n s!ne
    c7 !nd!v!d+" are +n &a((ern de +/ de s+'s(an=7 care sa(!s.ace cr!(er!!"e &en(r+ o
    (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7 s! c7 (es(e"e san$+!ne O! de +r!n7 ne$a(!ve n+
    e<c"+d &r!n e"e :nse"e +n d!a$nos(!c de (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7.
    :n ca/+" !n(o<!ca=!e!, (es(e"e san$+!ne s! de +r!n7 &o( a@+(a "a s(a'!"!rea s+'s(an=e!
    sa+ s+'s(an=e"or re"evan(e !%&"!ca(e. Con.!r%area s&ec!.!c7 a s+'s(an=e! s+s&ec(a(e
    &oa(e neces!(a ana"!/e (o<!co"o$!ce, deoarece s+'s(an=e d!.er!(e a+ s!ndro%e de
    !n(o<!ca=!e s!%!"are8 !nd!v!/!! !a+ adesea +n n+%7r de s+'s(an=e d!.er!(e, s! &en(r+
    c7 s+'s(!(+!rea s! con(a%!narea dro$+r!"or s(r7/!! s+n( .recven(e, ce! care o'=!n :n
    %od !"!c!( s+'s(an=e"e, adesea n+ O(!+ con=!n+(+" e<ac( a ceea ce !a+. Tes(e"e
    (o<!co"o$!ce &o( .!, de ase%enea, +(!"e :n d!a$nos(!c+" d!.eren=!a" &en(r+ &rec!/area
    ro"+"+! !n(o<!ca=!e! sa+ a's(!nen=e! de o s+'s(an=7 :n e(!o"o$!a Esa+ e<acer'areaJ
    s!%&(o%e"or +ne! var!e(7=! de (+"'+r7r! %en(a"e Ede e<., (+"'+r7r! a.ec(!ve, (+"'+r7r!
    &s!o(!ceJ. :n a.ar7 de aceas(a, concen(ra=!!"e san$+!ne ser!a(e a@+(7 "a d!.eren=!erea
    !n(o<!ca=!e! de a's(!nen=7.
    Concen(ra=!a san$+!n7 a +ne! s+'s(an=e &oa(e .! +n !nd!c!+ +(!" :n &rec!/area
    .a&(+"+! dac7 &ersoana res&ec(!v7 are o (o"eran=7 cresc+(7 "a +n $r+& da( de
    s+'s(an=e Ede e<., o &ersoan7 &re/en(And o a"coo"e%!e de &es(e 5YL %$Xd", .7r7
    se%ne de !n(o<!ca=!e a"coo"!c7, are o (o"eran=7 se%n!.!ca(!v7 "a a"coo" O! es(e &os!'!"
    s7 .!e +n +se+r cron!c, .!e de a"coo", .!e de seda(!ve, !&no(!ce sa+ an<!o"!(!ceJ. A"(7
    %e(od7 de eva"+are a (o"eran=e! es(e aceea de a s(a'!"! r7s&+ns+" !nd!v!d+"+! "a +n
    %ed!ca%en( a$on!s(. De e<e%&"+, o &ersoan7, care n+ %an!.es(7 n!c! +n .e" de
    se%ne de !n(o<!ca=!e "a o do/7 de 9LL %$ sa+ %a! %+"( de &en(o'ar'!(a", are o
    (o"eran=7 se%n!.!ca(!v7 "a seda(!ve, !&no(!ce sa+ an<!o"!(!ce s! &oa(e neces!(a
    (ra(a%en( &en(r+ a &reven! de/vo"(area de&enden=e!.
    9LI
    Tulburrile "n le!tur cu o Substan
    Tes(e"e de "a'ora(or &o( n +(!"e :n !den(!.!carea a's(!nen=e! "a !nd!v!/!! c+
    de&enden(7 de o s+'s(an=7 Pro'a :nce(7r!! +/+"+! sa+ red+ce% do/e! &oa(e - o'=!n+(7
    d!n !s(or!c sa+ &r!n ana"!/a (o<!co"o$!c7 a ."+!de"or or$an!s%+"+! Ede e<, +r!n7 sa+
    sAn$eJ DeO! ce"e %a! %+"(e s+'s(an=e s! %e(a'o"!=!! "or se e"!%!n7 &r!n +r!n7 :n dec+rs
    de IG ore de "a %$es(!e, an+%!=! %e(a'o"!=! &o( .! &re/en=! o &enoad7 %a! "+n$7 de
    (!%& "a ce! care .ac +/ de o s+'s(an=7 :n %od cron!c Dac7 &ersoana &re/!n(7 a's(!nen=7
    de o s+'s(an=7 nec+nosc+(7, (es(e"e +r%are &o( a@+(a "a !den(!.!carea s+'s(an=e! de care
    es(e a's(!nen(7 &ersoana s! .ac &os!'!"7 !n!=!erea (ra(a%en(+"+! adecva(. Tes(e"e +r!nare
    &o( .!, de ase%enea, +(!"e "a d!.eren=!erea a's(!nen=e! de a"(e (+"'+r7r! %en(a"e,
    deoarece s!%&(o%e"e de a's(!nen(7 &o( %!%a s!%&(o%e"e +ne! (+"'+r7r! %en(a"e .7r7
    "e$7(+r7 c+ +/+" +ne! s+'s(an=e :n ca/+" :n care de&enden=a de o&!acee n+ &oa(e .!
    con.!r%a(7 c"ar d!n !s(or!c, +/+" +n+! an(a$on!s( Ede e<, na"o<onaJ &oa(e .! ed!.!ca(or
    :n a de%ons(ra dac7 s!%&(o%e"e de a's(!nen=7 s+n( !nd+se
    9atele examinrii somatice si condi3iile medicale .enerale asociate. D+&7
    c+% es(e &re/en(a( :n sec=!+nea s&ec!.!c7 a .!ec7re!a d!n(re ce"e 55 c"ase de s+'s(an=e,
    es(e &os!'!" ca s(7r!"e de !n(o<!ca=!e s! de a's(!nen=7 s7 !nc"+d7 se%ne s! s!%&(o%e
    so%a(!ce care s+n( adesea &r!%+" !nd!c!+ de s(are :n "e$7(+r7 c+ o s+'s(an=7 :n
    $enera", !n(o<!ca=!a c+ a%.e(a%!na sa+ c+ coca!n7 se :nso=eO(e de creO(erea &res!+n!!
    san$+!ne, r!(%+"+! res&!ra(or, &+"s+"+! s! (e%&era(+r!! cor&+"+! In(o<!ca=!a c+
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce or! c+ +n %ed!ca%en( o&!ace+ !%&"!c7 adesea
    &a((ern+" o&+s De&enden=a O! a'+/+" de o s+'s(an=7 s+n( asoc!a(e adesea c+ cond!=!!
    %ed!ca"e $enera"e, .recven( :n "e$7(+r7 c+ e.ec(e"e (o<!ce a"e s+'s(an=e"or as+&ra
    an+%!(or or$ane Ede e< , c!ro/a, :n de&enden=a a"coo"!c7J or! c+ c7!"e de ad%!n!s(rare
    Ede e<, !n.ec=!a c+ v!r+s+" !%+node.!c!en=e! +%ane ZHI3[ &r!n ace co%+neJ
    Tulburrile mentale asociate. U/+" de o s+'s(an=7 es(e adesea o co%&onen(7 a
    (a'"o+"+! c"!n!c a" (+"'+r7r!"or %en(a"e CAnd s!%&(o%e"e s+n( cons!dera(e a .!
    consec!n=a .!/!o"o$!c7 a +ne! s+'s(an=e, es(e d!a$nos(!ca(7 o (+"'+rare !nd+s7 de o
    s+'s(an=7 Eve/! &a$ 9LFJ T+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 s+n(, de ase%enea,
    .recven( co%or'!de c+ a"(e (+"'+r7r! %en(a"e, c7rora "e co%&"!c7 evo"+=!a O!
    (ra(a%en(+" Ede e<, (+"'+rarea de cond+!(7 "a ado"escen=!, (+"'+r7r!"e de
    &ersona"!(a(e an(!soc!a"7 s! 'order"%e, sc!/o.ren!a, (+"'+r7r!"e a.ec(!veJ
    #rocedee de "nre!istrare pentru dependen, abu(,
    intoxicaie si abstinent
    6entru dro.urile de abuz. C"!n!c!an+" (re'+!e s7 +(!"!/e/e cod+" care se a&"!c7
    c"ase! de s+'s(an=e, dar s7 :nre$!s(re/e n+%e"e s+'s(an=e! s&ec!.!ce O! n+ n+%e"e
    c"ase! De e<e%&"+, c"!n!c!an+" va :nre$!s(ra 9F9 O A's(!nen(7 de seco'ar'!(a" E%a!
    c+rAnd decA( a's(!nen(7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ceJ, sa+ ;LY HL A'+/ de
    %e(a%.e(a%!n7 E%a! c+rAnd decA( a'+/ de a%.e(a%!neJ Pen(r+ s+'s(an=e"e care
    n+ .ac &ar(e d!n n!c! +na d!n(re aces(e c"ase Ede e< , %(n(+" de a%y"J, (re'+!e s7 .!e
    +(!"!/a(e cod+r!"e cores&+n/7(oare &en(r+ Sde&enden=a de a"(7 s+'s(an=7T or!
    Sa's(!nen=a de a"(7 s+'s(an=7T s! !nd!ca(7 s+'s(an=a s&ec!.!c7 Ede e< , ;LY FL A'+/
    de n!(r!( de a%y"J Dac7 s+'s(an=a "+a(7 de !nd!v!d es(e nec+nosc+(7, (re'+!e s7 .!e
    +(!"!/a( cod+" &en(r+ c"asa de Sa"(7 s+'s(an=7, sa+ s+'s(an=7 nec+nosc+(7T Ede e< ,
    9F9 GF In(o<!ca=!e c+ s+'s(an=7 nec+nosc+(7J Pen(r+ o an+%!(7 s+'s(an=7, dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ %a! %+"( decA( o s!n$+r7 (+"'+rare :n "e$7(+r7 c+
    Tulburrile "n le!tur cu o
    Substana
    9LY
    o s+'s(an=7, vor .! d!a$nos(!ca(e (oa(e Ede e< , 9F9 O A's(!nen(7 de ero!n7, ;LI 5L
    De&enden(7 de ero!n7J Dac7 e<!s(7 s!%&(o%e sa+ &ro'"e%e asoc!a(e c+ o an+%!(7
    s+'s(an=7, dar n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ n!c! +na d!n(re (+"'+r7r!"e
    s&ec!.!ce s+'s(an=e!, (re'+!e s7 .!e +(!"!/a(7 ca(e$or!a S.7r7 a"(7 s&ec!.!ca=!eT Ede e< ,
    9F9 F T+"'+rare :n "e$7(+r7 c+ canna'!s+" .7r7 a"(7 s&ec!.!ca=!eJ Daca se .ace +/ de
    %a! %+"(e s+'s(an=e, (re'+!e s7 .!e d!a$nos(!ca(e (oa(e (+"'+r7r!"e re"evan(e :n
    "e$7(+r7 c+ s+'s(an=e"e Ede e< , 9F9 GF In(o<!ca=!e c+ %escan7, ;LI 9L De&enden(7
    de coca!n7J S!(+a=!!"e :n care (re'+!e &+s d!a$nos(!c+" de ;LI GL De&enden(7 de
    &o"!s+'s(an(7 s+n( descr!se "a &a$ 9F;
    6entru medicamente si toxice. Pen(r+ %ed!ca%en(e"e ne%c"+se %a! s+s Eca s!
    &en(r+ (o<!ceJ, (re'+!e +(!"!/a( cod+" &en(r+ Sa"(7 s+'s(an=72 Un an+%!( %ed!ca%en(
    &oa(e .!, de ase%enea, cod!.!ca( &r!n %en=!onarea cod+"+! E cores&+n/7(or &e a<a I
    Eve/! ane<a ,J Ede e<, 9F9 GF In(o<!ca=!e c+ 'en/(ro&%7, E FI5 " Ben/(ro&%7J
    Cod+r!"e E (re'+!e, de ase%enea, s7 .!e +(!"!/a(e &en(r+ c"ase"e de s+'s(an=e
    %en=!ona(e %a! s+s, cAnd aces(ea s+n( &rescr!se ca %ed!ca%en(e Ede e< , o&!acee"eJ
    *lemente speci$ice culturii, etii si sexului
    E<!s(7 "ar$! var!a=!! :n a(!(+d!nea .a(7 de cons+%+" de o s+'s(an=7, &a((ern+n"e
    de +/ de o s+'s(an=7, acces!'!"!(a(ea s+'s(an=e"or, reac=!!"e .!/!o"o$!ce "a s+'s(an=e s!
    &reva"en(a (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7 Une"e $r+&+r! !n(er/!c +/+" de
    a"coo", &e cAnd :n a"(e"e, +/+" a d!verse s+'s(an=e, &en(r+ e.ec(e"e "or de %od!.!care
    a d!s&o/!=!e!, es(e "ar$ acce&(a( Eva"+area or!c7r+! &a((ern de +/ de o s+'s(an=7 a"
    !nd!v!d+"+! (re'+!e s7 (!n7 con( de aceO(! .ac(or! Pa((ern+n"e de +/ de %ed!ca%en(e
    s! de e<&+nere "a (o<!ce var!a/7, de ase%enea, "ar$ :n cadr+" ace"e!aO! =7r!, cA( s!
    :n(re =7r! d!.er!(e
    Ind!v!/!! :n(re 5G s! 9I an! a+ ra(e de &reva"en(7 re"a(!v :na"(e &en(r+ +/+" e.ec(!v
    a" .!ec7re! s+'s(an=e, !nc"+s!v a"coo"+" Pen(r+ dro$+r *e de a'+/, !n(o<!ca=!a es(e de
    re$+"7 (+"'+rarea !n!=!a"7 :n "e$7(+r7 c+ o s+'s(an=7 s! :nce&e ce" %a! adesea :n
    ado"escen(7 A's(!nen(a &oa(e s+rven! "a or!ce e(a(e, ca cond!=!a ca dro$+" re"evan(
    s7 .! .os( "+a( :n do/e s+.!c!en( de %ar!, % dec+rs+" +ne! &er!oade de (!%& s+.!c!en(
    de "+n$! De&enden(a &oa(e s+rven!, de ase%enea, "a or!ce e(a(e, dar de re$+"7,
    &en(r+ ce"e %a! %+"(e dro$+r! de a'+/, % an!! 9L, ;L s! IL CAnd o (+"'+rare :n
    "e$7(+r7 c+ o s+'s(an=7, a"(a decA( !n(o<!ca=!a, :nce&e de (!%&+r!+ :n ado"escen(7, ea
    es(e asoc!a(7 adesea c+ (+"'+rarea de cond+!(7 s! c+ !nca&ac!(a(ea de a (er%!na
    scoa"7 Pen(r+ dro$+r!"e de a'+/, (+"'+r7r!"e !n "e$7(+r7 c+ o s+'s(an=7 s+n(
    d!a$nos(!ca(e de re$+"7 %a! .recven( "a '7r'a=! decA( "a .e%e!, dar ra(e"e se<+"+!
    _ ana/7 c+ c"asa de s+'s(an=7
    *voluie
    Evo"+=!a de&enden(e!, a'+/+"+!, !n(o<!ca=!e! s! a's(!nen(e! vana/7 c+ c"asa de
    4@'s(an(7, ca"ea de ad%!n!s(rare s! a"=! .ac(or! Sec=!+n!"e de Sevo"+=!eT a"e
    dn erse"or c"ase de s+'s(an=e !nd!c7 e"e%en(e"e s&ec!.!ce carac(er!s(!ce .!ec7re!a
    Po(
    r
    .7c+(e, :ns7, +ne"e $enera"!/7r! .a(7 de s+'s(an=e
    In(o<!ca=!a a&are de re$+"7 :n dec+rs de cA(eva %!n+(e &An7 "a cA(eva ore, d+&7
    @ s!n$+r7 do/7 s+.!c!en( de %are, s! se con(!n+7 sa+ se !n(ens!.!c7 "a do/e re&e(a(e
    Tecven( In(o<!ca=!a :nce&e de re$+"7 s7 d!%!n+e &e %7s+r7 ce concen(ra=!!"e
    \an$+%e sa+ (!s+"are a"e s+'s(an=e! scad, !ns7 se%ne"e s! s!%&(o%e"e d!s&ar "en(
    2E>
    Tulburrile "n le!tur cu o Substan
    De'+(+" !n(o<!ca=!e! &oa(e .! :n(Ar/!a( :n ca/+" a'sor'=!e! "en(e a s+'s(an=e"or sa+ a"
    ce"or care (re'+!e s7 .!e %e(a'o"!/a(e Ia co%&+O! ac(!v! S+'s(an=e"e c+ ac=!+ne de
    "+n$7 d+ra(7 &o( &rod+ce !n(o<!ca=!! &re"+n$!(e
    A's(!nen(a se de/vo"(7 oda(7 c+ dec"!n+" s+'s(an=e! :n s!s(e%+" nervos cen(ra"
    S!%&(o%e"e &recoce a"e a's(!nen=e! a&ar de re$+"7 :n cA(eva ore d+&7 :nce(area
    ad%!n!s(r7%, "a s+'s(an=e"e c+ se%!v!e=! de e"!%!nare sc+r(e Ede e< , a"coo"+",
    "ora/e&a%+" sa+ ero!naJ, &e cAnd cr!/e"e e&!"e&(!ce de a's(!nen=7 &o( a&are "a %a!
    %+"(e s7&(7%An! d+&7 (er%!narea do/e"or %ar! de s+'s(an=e an<!o"!(!ce c+
    se%!v!a(7 "+n$7 Ce"e %a! !n(ense se%ne de a's(!nen=7 d!s&ar de re$+"7 :n dec+rs
    de cA(eva /!"e sa+ s7&(7%An! d+&7 :nce(area +/+"+! de s+'s(an=7, deO! +ne"e se%ne
    .!/!o"o$!ce s+'(!"e %a! &o( .! :nc7 de(ec(a(e (!%& de %+"(e s7&(7%An! sa+ c!ar "+n!,
    ca &ar(e a +n+! s!ndro% de a's(!nen(7 &re"+n$!(
    Un d!a$nos(!c de a'+/ de s+'s(an=7 es(e .oar(e &ro'a'!" "a !nd!v!/!! care a+ :nce&+(
    n+%a! recen( s7 +/e/e de s+'s(an=7 Pen(r+ %+"=! !nd!v!/!, a'+/+" de o s+'s(an=7
    d%(r4o an+%!(7 c"as7 de s+'s(an=e evo"+ea/7 s&re de&enden(a de o s+'s(an=7 d!n
    c"asa res&ec(!v7 de s+'s(an=e Aceas(a es(e adev7ra( :n s&ec!a" &en(r+ ace"e s+'s(an=e
    care a+ +n :na"( &o(en=!a" de de/vo"(are a (o"eran(e!, a's(!nen(e! s! &a((ern+n"or de +/
    co%&+"s!v Un+ !nd!v!/! a+ e&!soade de a'+/ de o s+'s(an=7 care s+rv!n d+&7 o "+n$7
    &er!oad7 de (!%&, c!ar .7r7 s7 de/vo"(e de&enden(7 de s+'s(an=7 Aceas(a es(e .oar(e
    adev7ra( &en(r+ ace"e s+'s(an=e care a+ +n &o(en=!a" %a! red+s de de/vo"(are a
    (o"eran(e!, a's(!nen(e! s! &a((ern+r!"or co%&+"s!ve de +/ Oda(7 ce cr!(er!!"e &en(r+
    de&enden(a de o s+'s(an=7 a+ !os( sa(!s.7c+(e, +n d!a$nos(!c +"(er!or de a'+/ de o
    s+'s(an=7 n+ %a! &oa(e - &+s &en(r+ n!c! o s+'s(an=7 d!n c"asa res&ec(!v7 Pen(r+ o
    &ersoan7 c+ de&enden(7 de o s+'s(an=7 :n re%!s%ne co%&"e(7, once rec7der! care
    sa(!s.ac cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 (re'+!e s7 .!e cons!dera(e de&enden(7
    :n re%!s!+ne &ar=!a"7 Eve/! s&ec!.!c?n(n de evo"+=!e, &a$ 5FYJ
    Evo"+=!a de&enden(e! de o s+'s(an=7 es(e var!a'!"7 DeO! &o( s+rven! e&!soade
    sc+r(e s! a+(o%!(a(e E%a! aleQ :n c+rs+" &er!oade"or de s(res &s!osoc!a"J, evo"+=!a
    es(e de re$+"7 cron!c7, &+(And a+ra a% de /!"e, c+ &er!oade de e<acer'are s! de
    re%!s!+ne &ar=!a"7 ?a+ co%&"e(7 Po( e<!s(a &er!oade de ad%!n!s(rare e<ces!v7 s! de
    &ro'"e%e severe, &er!oade de a's(!nen(7 (o(a"7 s! &er!oade de +/ de s+'s(an=7 .7r7
    &ro'"e%e, d+rAnd +neon "+n! De&enden(a de o s+'s(an=7 es(e asoc!a(7 +neor! c+
    re%!s!+% s&on(ane de "+ng87 d+ra(7 De e<e%&"+, s(+d!!"e ca(a%nes(!ce re"ev7 c7 9L
    d Esa+ %a! %+"(J d!nQ
    r
    e !nd+v!! c+ de&enden(7 de a"coo" dev!n a's(!nen=!
    &er%anen=!, aceas(a +r%And de re$+"7 +n+! s(res de v!a(7 sever Ede e< , a%en!n=area
    sa+ !%&+nerea +nor sanc=!+n! soc!a"e sa+ "e$a"e, desco&er!rea +ne! co%&"!ca=!!
    %ed!ca"e care &+ne !n &er!co" v!a(aJ :n c+rs+" &r!%e"or 59 "+n! d+&7 de'+(+"
    rerr!s!+nn, %d!_!d+" es(e e<(re% de _+"nera'!" "a a a_ea o rec7dere M+"=! !nd!v!/!
    s+'es(!%ea/7 _+"nera'!"!(a(ea "o! "a de/_o"(area +n+! &a((ern de de&enden(7 CAnd
    s+n( :n(r4o &enoad7 de re%!s!+ne, e! se a+(oas!$+r7 :n %od !ncorec( c7 n+ vor %a!
    avea n!c! o &ro'"e%7 c+ re$"area +/+"+! de s+'s(an=7 s! &o( e<&er!%en(a (re&(a(
    re$+"! %a! &+=!n res(n?( v e re$"And +/+" de s+'s(an=7, n+%a! &en(r+ a e<&er!%en(a
    o reven!re "a de&enden(7 Pre/en(a +nor (+"'+r7r! %en(a"e a&7rAnd conco%!(en( Ede
    e<, (+"'+rarea de &ersona"!(a(e !n(!soc!a"7, (+"'+rarea de&res!v7 %a@or7 ne(ra(a(7,
    (+"'+rarea '!&o"ar7J cresc adesea r!sc+" de co%&"!ca=!! s! de de/nod7%An( r7+
    Deteriorare si complicaii
    DeO! %+"=! !nd!v!/! c+ &ro'"e%e :n "e$7(+r7 c+ s+'s(an=e"e a+ o .+nc=!onare '+n7
    Ede e<, :n re"a=!!"e &ersona"e, e.!c!en(a "a serv!c!+, a&(!(+d!n!"e de cAO(!$J, aces(e
    Tulburrile "n le!tur cu o
    Substan
    2E8

    (+"'+r7r! ca+/ea/7 adesea o de(er!orare %arca(7 s! co%&"!ca=!! severe Ind!v!/!! c+
    (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 e<&enen(ea/7 .recven( o de(enorare a s7n7(7=!! "or
    $enera"e D% d!e(a necores&+n/7(oare s! !$!ena &ersona"7 !nadecva(7 &o( re/+"(a
    %a"n+(n=!a s! a"(e cond!=!! %ed!ca"e $enera"e In(o<!ca=!a sa+ a's(!nen=a &o( .!
    co%&"!ca(e de (ra+%a(!s%e :n "e$7(+r7 c+ coordonarea %o(one de(er!ora(7 sa+ c+
    @+deca(a erona(7 Ma(er!a"e"e +(!"!/a(e "a S'o(e/areaT an+%!(or s+'s(an=e &o( &rod+ce
    reac=!! (o<!ce sa+ a"er$!ce Ad%!n!s(rarea !n(rana/a"7 a s+'s(an=e"or ES&r!/a(+"TJ &oa(e
    ca+/a ero/!+nea se&(+"+! na/a" U/+" de s(!%+"an(e &oa(e d+ce "a %oar(e s+'!(7 &nn
    ar!(%!! card!ace, !n.arc( %!ocard!c, acc!den( cere'rovasc+"ar sa+ s(o& res&!ra(or
    U(!"!/area de ace con(a%!na(e :n (!%&+" ad%!n!s(r7% !n(ravenoase a s+'s(an=e"or
    &oa(e ca+/a o !n.ec=!e c+ v!r+s+" !%+nodec!en=e! +%ane EHI3J, e&a(!(7, (e(anos,
    vasc+"!(7, se&(!ce%!e, endocard!(7 'ac(enan7 '+'ac+(7, .eno%ene e%'o"!ce s! %a"ar!e
    U/+" de o s+'s(an=7 &oa(e .! asoc!a( c+ +n co%&or(a%en( v!o"en( sa+ a$res!v care se
    &oa(e %an!.es(a &r!n '7(7! sa+ ac(!v!(a(e !n.rac=!ona"7 s! &oa(e d+ce "a v7(7%area
    &ersoane! care +/ea/7 de s+'s(an=7 sa+ a a"(ora Acc!den(e"e de a+(o%o'!", casn!ce
    s! de %+nc7 s+n( o co%&"!ca=!e %a@or7 a !n(o<!ca=!e! c+ o s+'s(an=7 s! &o( d+ce "a o
    ra(7 a&rec!a'!"7 de %or'!d!(a(e s! %or(a"!(a(e A&ro<!%a(!v @+%7(a(e d!n (oa(e
    acc!den(e"e de &e a+(os(rad7 !%&"!c7 .!e +n cond+c7(or a+(o, .!e +n &!e(on !n(o<!ca(
    :n a.ar7 de aceas(a, a&ro<!%a(!v 5Ld d!n(re !nd!v!/!! c+ de&enden(7 de o s+'s(an=7
    se s!n+c!d, adesea :n con(e<(+" +ne! (+"'+r7r! a.ec(!ve !nd+se de s+'s(an=7 :n .!ne,
    deoarece %+"(e, dac7 n+ c!ar (oa(e s+'s(an=e"e descr!se :n aceas(7 sec=!+ne (rec &nn
    &"acen(7, e"e &o( avea e.ec(e adverse !neren(e as+&ra de/vo"(7% .7(+"+! Ede e<,
    s!ndro%+" a"coo"!c .e(a"J CAnd s+n( "+a(e re&e(a( s! :n do/e %ar! de c7(re %a%7, +n
    n+%7r de s+'s(an=e Ede e< , coca!na, o&!acee"e, a"coo"+" s! seda(!ve"e, !&no(!ce"e s!
    an<!o(!ce"eJ s+n( ca&a'!"e s7 ca+/e/e de&enden(7 .!/!o"o$!c7 "a .e(+s s! +n s!ndro%
    de a's(!nen(7 "a no+ n7sc+(
    #attern $amilial
    In.or%a=!!"e re.er!(oare "a a$re$7r!"e .a%!"!a"e a+ .os( s(+d!a(e ce" %a! '!ne
    &en(r+ (+"'+r7r!"e :n "e$7(+r7 c+ a"coo"+" Eve/! d!sc+=!a de(a"!a(7 de "a &a$ 995J
    E<!s(7 +ne"e da(e des&re d!.eren(e"e de(er%!na(e $ene(!c :n(re !nd!v!/!, re.er!(oare "a
    do/e"e necesare &en(r+ a &rod+ce !n(o<!ca=!a a"coo"!c7 DeO! a'+/+" s! de&enden=a
    de o s+'s(an=7 &ar a se a$re$a :n an+%!(e .a%!"!!, +ne"e d!n(re aces(e e.ec(e &o( .!
    e<&"!ca(e &r!n d!s(r!'+=!a .a%!"!a"7 conver$en(7 a (+"'+r7% de &ersona"!(a(e
    an(!soc!a"7, care &oa(e &red!s&+ne !nd!v!/!! "a de/vo"(area a'+/+"+! sa+
    de&enden=e! de o s+'s(an=7 :n a.ar7 de aces(a, co&!! !nd!v!/!"or c+ de&enden(7
    a"coo"!c7 Edar n+ s! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7J n+ a+ &red!s&o/!=!a
    de a de/vo"(a de&enden(a de o s+'s(an=7 de (oa(e s+'s(an=e"e, e! &re/en(And +n
    r!sc %a! cresc+( doar &en(r+ de&enden(a a)ooc7
    Dia!nostic di$erenial
    T+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 se d!s(!n$ de +/+" non&a(o"o$!c de
    s+'s(an=7 Ede e<, S'7+(+" soc!a"TJ s! de +/+" de %ed!ca%en(e :n sco& %ed!ca"
    &r!n &re/en(a +n+! &a((ern de %a! %+"(e s!%&(o%e s+rven%d d+&7 o &er!oad7 %a!
    "+n$7 de (!%& Ede e<, (o"eran(a, a's(!nen(a, +/+" co%&+"s!vJ sa+ &re/en=a
    &ro'"e%e"or :n "e$7(+r7 c+ o s+'s(an=7 Ede e<, co%&"!ca=!! %ed!ca"e, r+&(+r7 :n
    re"a=!!"e soc!a"e s! de .a%!"!e, d!.!c+"(7=! &ro.es!ona"e sa+ .!nanc!are, &ro'"e%e
    "e$a"eJ E&!soade"e re&e(a(e de !n(o<!ca=!e c+ o s+'s(an=7 s+n( a&roa&e !nvar!a'!"
    9LG
    Tulburrile "n le!tur cu o Substan
    e"e%en(e &roe%!nen(e a"e abuzului sau dependentei de o substan32 :ns7, +n+"
    sa+ %a! %+"(e e&!soade de !n(o<!ca=!e, s!n$+re, n+ s+n( s+.!c!en(e &en(r+
    d!a$nos(!c+", .!e a" de&enden(e!, .!e a" a'+/+"+! de o s+'s(an=7
    Uneor! &oa(e .! d!.!c!" de d!s(!ns :n(re intoxica3ia cu o substan3 si abstinen3a de
    o substan3 Dac7 +n s!%&(o% a&are :n c+rs+" ad%!n!s(r7r!! s! a&o! d!%!n+a (re&(a(,
    d+&7 ce ad%!n!s(rarea a :nce(a(, e" es(e &ro'a'!" &ar(e a !n(o<!ca=!e!. Dac7
    s!%&(o%+" s+rv!ne d+&7 s(o&area s+'s(an=e! sa+ red+cerea +/+"+! s7+, e" es(e
    &ro'a'!" &ar(e a a's(!nen(e! Ind!v!/!! c+ (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 !a+
    adesea %a! %+"( decA( o s!n$+r7 s+'s(an=7, s! &o( .! !n(o<!ca=! c+ o s+'s(an=7 Ede e<.,
    c+ ero!n7J :n (!%& ce s+n( a's(!nen=! de a"(a Ede e< , de d!a/e&a%J D!.eren=!erea
    es(e a&o! co%&"!ca(7 de .a&(+" c7 se%ne"e s! s!%&(o%e"e de a's(!nen=7 de +ne"e
    s+'s(an=e Ede e< , de seda(!veJ &o( %!%a &ar=!a" !n(o<!ca=!a c+ a"(e s+'s(an=e Ede e<.,
    c+ a%.e(a%!neJ In(o<!ca=!a c+ s+'s(an=7 es(e d!.eren=!a(7 de deliriumul prin
    intoxica3ia cu o substan3 E&a$ 5I;J, tulburarea psi-otic indus de o substan32
    cu debut @n cursul intoxica3iei E&a$ ;;GJ, tulburarea afectiv indus de o
    substan32 cu debut @n cursul intoxica3iei E&a$ ILYJ, tulburarea anxioas indus
    de o substan32 cu debut @n cursul intoxica3iei E&a$ IHFJ, disfunc3ia sexual
    indus de o substan32 cu debut @n cursul intoxica3iei E&a$ YR9J s! de tulburarea
    de somn indus de o substan32 cu debut @n cursul intoxica3iei E&a$. RYYJ, &r!n
    .a&(+" c7 s!%&(o%e"e d!n aces(e d!n +r%7 (+"'+r7r! s+n( :n e<ces .a=7 de ce"e
    asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+ o s+'s(an=7 s! s+n( s+.!c!en( de severe &en(r+ a
    @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 A's(!nen=a de o s+'s(an=7 se d!s(!n$e de
    deliriumul prin abstinen3 de o substan3 E&a$ 5I;J, tulburarea psi-otic indus
    de o substan32 cu debut @n cursul abstinen3ei E&a$. ;;GJ, tulburarea afectiv
    indus de o substan32 cu debut @n cursul abstinen3ei E&a$. ILYJ, tulburarea
    anxioas indus de o substan32 cu debut @n cursul abstinen3ei E&a$. IHFJ s!
    tulburarea de somn indusa de o substan32 cu debut @n cursul abstinen3iei E&a$
    RYYJ &r!n .a&(+" c7 s!%&(o%e"e :n aces(e d!n +r%7 (+"'+r7r! s+n( :n e<ces .a=7 de
    ce"e asoc!a(e de re$+"7 c+ a's(!nen(a de o s+'s(an=7 s! s+n( s+.!c!en( de severe
    &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7
    T+"'+r7r!"e ad!=!ona"e %d+se de o s+'s(an=7 %en=!ona(e %a! s+s se &re/!n(7 c+
    s!%&(o%e care a%!n(esc tulburrile mentale neinduse de o substan3 Ead!c7,
    primare, 3e/! &a$ 9LF &en(r+ d!sc+(area aces(+! !%&or(an(, dar adesea d!.!c!"
    d!a$nos(!c d!.eren=!a"
    Un d!a$nos(!c ad!=!ona" de (+"'+rare !nd+s7 de o s+'s(an=7 n+ es(e &+s de re$+"7
    cAnd simptome ale unor tulburri mentale preexistente sunt exacerbate de
    intoxica3ia cu o substan3 sau de abstinen3a de o substan3 EdeO! +n d!a$nos(!c de
    !n(o<!ca=!e sa+ de a's(!nen(7 de o s+'s(an=7 ar .! &oa(e adecva(J De e<e%&"+, !n(o<!ca=!a
    c+ +ne"e s+'s(an=e &oa(e e<acer'a osc!"a=!!"e de d!s&o/!=!e d!n (+"'+rarea '!&o"ar7,
    a"+c!na=!!"e a+d!(!ve s! !de!"e de"!ran(e &arano!de d!n sc!/o.ren!e, $And+r!"e
    !n(r+s!ve s! v!se"e (er!.!an(e d% s(res+" &os((ra+%anc O! s!%&(o%e"e an<!oase d!n
    &an!c7, an<!e(a(ea $enera"!/a(7, .o'!a soc!a"7 s! a$ora.o'!e In(o<!ca=!a sa+ a's(!nen=a
    &o( cres(e, de ase%enea, r!sc+" de s+!c!d, de v!o"en=7 s! co%&or(a%en( !%&+"s!v "a
    !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 sa+ 'order"%e &ree<!s(en(7
    M+"(e (+"'+r7r! ne+ro"o$!ce Ede e<, (ra+%a(!s%e"e cran!eneJ sa+ cond!=!!
    %e(a'o"!ce &rod+c s!%&(o%e care sea%7n7 c+ ce"e a"e !n(o<!ca=!e! sa+ a's(!nen=e!,
    !ar +neor! s+n( a(r!'+!(e :n %od erona( aces(ora Ede e< , ."+c(+a=!a n!ve"e"or de
    conO(!en(7, d!/ar(na O! %coordonareaJ S!%&(o%e"e %a"ad!!"or !n.ec=!oase &o(, de
    ase%enea, a%!n(! a's(!nen(a de +ne"e s+'s(an=e Ede e< , $as(roen(en(a v!ra"7 &oa(e
    .! s!%!"ar7 a's(!nen(e! de o&!aceeJ Dac7 s!%&(o%e"e s+n( cons!dera(e a .! consec!n=a
    .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e, (re'+!e s7 .!e d!a$nos(!ca(7
    Tulburrile mentale induse de o
    substan incluse "n alt parte "n
    manual
    2E4
    tulburarea mental corespunztoare datorat unei condi3ii medicale .enerale.
    Dac7 s!%&(o%e"e s+n( cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +/+"+! +ne!
    s+'s(an=e cA( s! a +ne! cond!=!! %ed!ca"e $enera"e, &o( .! d!a$nos(!ca(e a(A( o
    (+"'+rare :n "e$7(+r7 c+ o s+'s(an=a, cA( s! o (+"'+rare %en(a"7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e. Dac7 c"!n!c!an+" n+ &oa(e &rec!/a dac7 s!%&(o%e"e
    &re/en(a(e s+n( !nd+se de o s+'s(an=7, se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e
    sa+ s+n( &r!%are, (re'+!e s7 .!e d!a$nos(!ca(7 ca(e$or!a cores&+n/7(oare de fr alt
    specifica3ie Ede e<., s!%&(o%e"e &s!o(!ce de e(!o"o$!c ne&rec!/a(7 vor .!
    d!a$nos(!ca(e ca (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!eJ.
    Tul-ur(rile "entale in$u&e $e o &u-&tan!(
    in#lu&e .n alt( parte .n "anual
    T+"'+r7r!"e !nd+se de o s+'s(an=7 ca+/ea/7 o var!e(a(e de s!%&(o%e care s+n(
    carac(er!s(!ce a"(or (+"'+r7r! %en(a"e Eve/! (a'e"+" ", &a$. 5F;J. Pen(r+ a .ac!"!(a
    d!a$nos(!c+" d!.eren=!a", (e<(+" s! cr!(er!!"e &en(r+ aces(e (+"'+r7r! !nd+se de o
    s+'s(an=7 s+n( !nc"+se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+
    :n co%+n .eno%eno"o$!aQ
    De"!r!+%+" !nd+s de o s+'s(an=7 Eve/! &a$. 5I;J es(e !nc"+s :n sec=!+nea
    SDe"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce s! a"(e (+"'+r7r! co$n!(!veT8
    De%en=a &ers!s(en(7 !nd+s7 de o s+'s(an=7 Eve/! &a$. 5RGJ es(e !nc"+s7 :n
    sec=!+nea SDe"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce O! a"(e (+"'+r7r! co$n!(!veT8
    T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7 Eve/! &a$. 5HHJ es(e
    !nc"+s7 :n sec=!+nea SDe"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce s! a"(e (+"'+r7r!
    co$n!(!veT8
    T+"'+rarea &s!o(!c7 !nd+s7 de o s+'s(an=7 Eve/! &a$. ;;GJ es(e !nc"+s7 :n
    sec=!+nea SSc!/o.ren!a s! a"(e (+"'+r7r! &s!o(!ceT. E:n DSM4III4R aces(e (+"'+r7r!
    era+ c"as!.!ca(e ca Sa"+c!no/7 or$an!c7T s! S(+"'+rare de"!ran(7 or$an!c7T8
    T+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7 Eve/! &a$. ILYJ es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e a.ec(!veT8
    T+"'+rarea an<!oas7 !nd+s7 de o s+'s(an=7 Eve/! &a$. IHFJ es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e an<!oaseT8
    D!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7 Eve/! &a$. YR9J es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e se<+a"e s! de !den(!(a(e se<+a"7T8
    T+"'+rarea de so%n !nd+s7 de o s+'s(an=7 Eve/! &a$. RYYJ es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e de so%nT8
    :n a.ar7 de aceas(a, (+"'+rarea de &erce&=!e &ers!s(en(7 a"+c!no$en7
    E."as'ac)sJ E&a$. 9Y;J es(e !nc"+s7 :n aceas(7 sec=!+ne "a ST+"'+r7r!"e :n "e$7(+r7 c+
    a"+c!no$ene"eT.
    :n DSM4III4R, (+"'+r7r!"e !nd+se de o s+'s(an=7 s! (+"'+r7r!"e %en(a"e da(ora(e
    +ne! cond!=!! %ed!ca"e $enera"e era+ n+%!(e (+"'+r7r! Sor$an!ceT s! era+ %en=!ona(e
    :%&re+n7 :n(r4o s!n$+r7 sec=!+ne. Aceas(7 d!.eren=!ere a (+"'+r7r!"or %en(a"e
    Sor$an!ceT ca o c"as7 se&ara(7 !%&"!c7 .a&(+" c7 (+"'+r7r!"e %en(a"e Snonor$an!ceT
    sa+ S.+nc=!ona"eT s+n( oarec+% .7r7 "e$7(+r7 c+ .ac(or!! sa+ &rocese"e so%a(!ce sa+
    '!o"o$!ce. DSM4I3 e"!%!n7 (er%en+" de or$an!c s! d!s(!n$e (+"'+r7r!"e %en(a"e
    !nd+se de o s+'s(an=7 de ce"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e, &rec+% s! de
    ce"e care n+ a+ o e(!o"o$!e s&ec!.!ca(7. Ter%en+" de t+lb+rare mental6 primar6 es(e
    +(!"!/a( ca a'rev!ere &en(r+ a !nd!ca ace"e (+"'+r7r! %en(a"e care n+ s+n( !nd+se de
    o s+'s(an=7 s! care n+ se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e.
    C*+
    Tulburrile "n le!tur cu o Substan

    Con(e<(+" :n care a&are o (+"'+rare !nd+s7 de o s+'s(an=7 &oa(e avea !%&"!ca=!!
    de %ana$e%en( !%&or(an(e T+"'+r7r!"e !nd+se de o s+'s(an=7 &o( a&are :n
    con(e<(+" +ne! !n(o<!ca=!! sa+ a's(!nen(e de o s+'s(an=7 or! &o( &ers!s(a %+"( (!%&
    d+&7 ce s+'s(an=a a .os( e"!%!na(7 d!n or$an!s% E(+"'+r7r!"e &ers!s(en(e !nd+se de
    s+'s(an=7J Ta'"o+r!"e c"!n!ce !nd+se de o s+'s(an=7 care a&ar :n con(e<(+"
    !n(o<!ca=!e! c+ o s+'s(an=7 &o( .! !nd!ca(e &r!n +(!"!/area s&ec!.!can(+"+! Sc+ de'+(
    :n c+rs+" !n(o<!ca=!e!T Ta'"o+r!"e c"!n!ce care a&ar :n con(e<(+" a's(!nen(e! de o
    s+'s(an=7 &o( .! !nd!ca(e &r!n s&ec!.!can(+" Sc+ de'+( :n c+rs+" a's(!nen(e!T
    Tre'+!e re=!n+( .a&(+" c7 +n d!a$nos(!c de (+"'+rare !nd+s7 de s+'s(an=7, c+ de'+(
    :n c+rs+" !n(o<!ca=!e! sa+ a's(!nen(e!, (re'+!e &+s :n "oc+" +n+! d!a$nos(!c de
    !n(o<!ca=!e c+ o s+'s(an=7 sa+ de a's(!nen(7 de o s+'s(an=7, n+%a! cAnd
    s!%&(o%e"e s+n( :n e<ces .a(7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de
    !n(o<!ca=!e sa+ de a's(!nen(7 carac(er!s(!c +ne! an+%!(e s+'s(an=e s! cAnd
    s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7
    S+n( !nc"+se (re! (+"'+r7r! &ers!s(en(e !nd+se de o s+'s(an=7 de%en(a &ers!s(en(7
    !nd+s7 de o s+'s(an=7 Eve/! &a$ 5RGJ s! (+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de
    o s+'s(an=7 Eve/! &a$ 5HHJ :n sec=!+nea SDer!+%+", de%en(a, (+"'+r7r!"e
    a%nes(!ce s! a"(e (+"'+r7r! co$n!(!veT, !ar (+"'+rarea de &erce&=!e &ers!s(en(7
    a"+c!no$en7 "a ST+"'+r7r!"e :n "e$7(+r7 c+ a"+c!no$ene"eT d!n aceas(7 sec=!+ne
    Eve/! &a$ 9Y;J E"e%en(+" esen=!a" a" (+"'+r7r!! &ers!s(en(e !nd+se de s+'s(an=7 :"
    cons(!(+!e &ers!s(en(a &re"+n$!(7 sa+ &er%anen(7 a '!%&(o%e"or :n "e$7(+r7 c+
    s+'s(an=a, care con(!n+7 s7 e<!s(e %+"( (!%& d+&7 ce evo"+=!a +/+a"7 a !n(o<!ca=!e!
    sa+ a's(!nen(e! s4a (er%!na(
    Pen(r+ dro$+r!"e de a'+/, +n d!a$nos(!c de (+"'+rare %en(a"7 !nd+s7 de
    s+'s(an=7 neces!(7 ev!den(a d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de
    "a'ora(or a !n(o<!ca=!e! c+ o s+'s(an=7 sa+ a de&enden(e! de o s+'s(an=7 :n
    s(a'!"!rea .a&(+"+! dac7 s!%&(o%e"e +ne! (+"'+r7r! %en(a"e s+n( e.ec(+"
    .!/!o"o$!c d!rec( a" +/+"+! +ne! s+'s(an=e, es(e !%&or(an( s7 se re(!n7 re"a=!a
    (e%&ora"7 d!n(re :nce&+(+" s! :nce(area +/+"+! s+'s(an=e! s! de'+(+" s! d!s&ar!=!a
    s!%&(o%e"or Dac7 s!%&(o%e"e &reced :nce&+(+" +/+"+! s+'s(an=e! sa+ &ers!s(7
    :n c+rs+" +nor :n(!nse &er!oade de a's(!nen(7 de s+'s(an=7, es(e &os!'!" ca
    s!%&(o%e"e s7 n+ .!e !nd+se de s+'s(an=a res&ec(!v7 :n %od e%&!r!c,
    s!%&(o%e"e care &ers!s(7 %a! %+"( de I s7&(7%An! d+&7 :nce(area !n(o<!ca=!e!
    ac+(e sa+ a a's(!nen(e!, (re'+!e s7 .!e cons!dera(e dre&( %an!.es(7r! a"e +ne!
    (+"'+r7r! %en(a"e !nde&enden(e, ne%d+se de o s+'s(an=7 or! a"e +ne! (+"'+r7r!
    &ers!s(en(e !nd+se de o s+'s(an=7 In e.ec(+area aces(e! d!s(!nc=!! es(e necesar7
    @+deca(a c"!n!c7, %a! a"es &en(r+ c7 s+'s(an=e d!.er!(e a+ d+ra(e carac(er!s(!ce
    d!.er!(e de !n(o<!ca=!e s! de a's(!nen(7 s! re"a=!! d!.er!(e c+ s!%&(o%e"e
    (+"'+r7r!"or %en(a"e Deoarece s(area de a's(!nen(7 &en(r+ +ne"e s+'s(an=e
    &oa(e .! (rasa(a re"a(!v, es(e +(!" s7 se o'serve evo"+=!a s!%&(o%e"or o &er!oad7
    %a! "+n$7 de (!%& Ede e< , I s7&(7%An! sa+ %a! %+"(J d+&7 :nce(area
    !n(o<!ca=!e! ac+(e sa+ a a's(!nen(e!, .7cAnd (oa(e e.or(+r!"e &os!'!"e &en(r+ a
    %en=!ne a's(!nen(a !nd!v!d+"+! Aceas(a &oa(e .! rea"!/a(7 :n d!verse %od+r!,
    !nc"+/And !n(ernarea :n s&!(a" sa+ (ra(a%en(+" "a do%!c!"!+, care cere v!/!(e
    .recven(e de +r%7r!re, %o'!"!/area a%!c!"or s! a %e%'r!"or .a%!"!e! &en(r+ a
    a@+(a "a (!nerea &ersoane! % s(are de so'r!e(a(e, e<a%!narea c+ re$+"ar!(a(e a
    +r%!! sa+ a sAn$e"+! &en(r+ &re/en(a de s+'s(an=e s!, dac7 es(e !%&"!ca(
    a"coo"+", e<a%!narea de r+(!n7 a %od!.!c7r!"or :n s(area %ar)en"or '7+(+"+!
    e<ces!v, c+% ar .! $a%%a4$"+(a%!"(rans.era/a E,,TJ
    Tulburrile mentale induse de o
    substan incluse "n alt parte "n
    manual
    955
    Un a"( cons!deren( :n d!.eren=!erea +ne! (+"'+r7r! %en(a"e &r!%are de o (+"'+rare
    !nd+s7 de o s+'s(an=7 :" cons(!(+!e &re/en(a +nor e"e%en(e care s+n( a(!&!ce &en(r+
    (+"'+rarea &r!%ar7 Ede e<., e(a(ea "a de'+( sa+ evo"+=!a a(!&!c7J. De e<e%&"+,
    de'+(+" +n+! e&!sod %an!aca" d+&7 e(a(ea de IY de an! &oa(e s+$era o e(!o"o$!c
    !nd+s7 de o s+'s(an=7. D!n con(ra, .ac(or!! care s+$erea/7 c7 s!%&(o%e"e s+n(
    e<&"!ca(e %a! '!ne de o (+"'+rare %en(a"7 &r!%ar7 !nc"+d +n !s(or!c de e&!soade
    an(er!oare de &er(+r'are care n+ a+ .os( !nd+se de o s+'s(an=7, :n .!ne, (re'+!e "+a(7
    :n cons!dera=!e &re/en=a sa+ a'sen=a e"e%en(e"or .!/!o"o$!ce s! co%&or(a%en(a"e de
    !n(o<!ca=!e sa+ de a's(!nen=7 s&ec!.!ce s+'s(an=e!. De e<e%&"+, &re/en=a de !de!
    de"!ran(e &arano!de n+ (re'+!e s7 s+r&r!nd7 :n con(e<(+" !n(o<!ca=!e! c+
    &encyc"!d!n7, dar es(e !nso"!(7 :n !n(o<!ca=!a c+ seda(!ve, crescAnd &ro'a'!"!(a(ea ca
    o (+"'+rare &s!o(!c7 &r!%ar7 s7 e<&"!ce s!%&(o%e"e. :n a.ar7 de aceas(a, (re'+!e
    =!n+( con( s! de do/a de s+'s(an=7 +(!"!/a(7. De e<e%&"+, &re/en=a de !de! de"!ran(e
    &arano!de ar .! !nso"!(7 d+&7 +n s!n$+r &+.. de %ar!+ana, dar &oa(e .! co%&a(!'!"7
    c+ do/e %ar! de aO!O.
    T+"'+r7r!"e !nd+se de o s+'s(an=7 &o( s+rven!, de ase%enea, ca e.ec( sec+ndar a"
    +n+! %ed!ca%en( sa+ a" e<&+ner!! "a +n (o<!c. T+"'+r7r!"e !nd+se de o s+'s(an=7,
    da(ora(e +n+! (ra(a%en( &rescr!s &en(r+ o (+"'+rare %en(a"7 sa+ &en(r+ o cond!=!e
    %ed!ca"7 $enera"7 (re'+!e s7 a!'7 de'+(+" :n (!%& ce &ersoana &r!%eO(e
    %ed!ca%en(+" Esa+ :n c+rs+" a's(!nen=e!, dac7 %ed!ca%en(+" es(e asoc!a( c+ +n
    s!ndro% de a's(!nen=7J. Oda(7 ce (ra(a%en(+" es(e :n(rer+&(, s!%&(o%e"e se vor
    re%!(e :n dec+rs de cA(eva /!"e &An7 "a cA(eva s7&(7%An! E:n .+nc=!e de se%!v!a=a
    s+'s(an=e!, &re/en=a +n+! s!ndro% de a's(!nen=7 s! var!a'!"!(a(ea !nd!v!d+a"7J. Dac7
    s!%&(o%e"e &ers!s(7, (re'+!e "+a(7 :n cons!dera=!e o (+"'+rare %en(a"7 &r!%ar7 E.7r7
    "e$7(+r7 c+ vre+n %ed!ca%en(J. Deoarece !nd!v!/!! c+ cond!=!! %ed!ca"e $enera"e
    !a+ adesea %ed!ca%en(e &en(r+ aces(e cond!=!!, c"!n!c!an+" (re'+!e s7 !a :n
    cons!dera=!e even(+a"!(a(ea c7 s!%&(o%e"e s+n( ca+/a(e de consec!n=e"e .!/!o"o$!ce
    a"e cond!=!e! %ed!ca"e $enera"e %a! c+rAnd decA( de %ed!ca%en(, :n care ca/ es(e
    d!a$nos(!ca(7 (+"'+rarea %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Is(or!c+"
    &oa(e o.er! o 'a/7 &en(r+ a .ace aceas(7 @+deca(7, dar o sc!%'are a (ra(a%en(+"+!
    cond!=!e! %ed!ca"e $enera"e Ede e<., s+'s(!(+!rea %ed!ca%en(+"+! sa+ :n(rer+&erea
    ad%!n!s(r7r!! "+!J &oa(e .! necesar7 &en(r+ a s(a'!"! :n %od e%&!r!c &en(r+ &ersoana
    res&ec(!v7 dac7 %ed!ca%en(+" es(e sa+ n+ a$en(+" ca+/a".
    #rocedee de "nre!istrare pentru tulburrile mentale
    induse de o substan incluse "n alt parte "n manual
    N+%e"e d!a$nos(!c+"+! :nce&e c+ ce" a" s+'s(an=e! s&ec!.!ce E:n "!%'a en$"e/7J
    Ede e<., coca!n7, d!a/e&a%, de<a%e(a/on7J &res+&+s7 a .! ca+/a s!%&(o%e"or.
    Cod+" d!a$nos(!c es(e se"ec(a( d!n "!s(a c"ase"or de s+'s(an=e &rev7/+(e :n se(+r!"e de
    cr!(er!! &en(r+ o an+%!(7 (+"'+rare !nd+s7 de o s+'s(an=7. Pen(r+ s+'s(an=e"e care
    n+ s+n( !nc"+se :n n!c! +na d!n(re c"ase Ede e<., de<a%e(a/on7J (re'+!e s7 .!e +(!"!/a(
    cod+" &en(r+ Sa"(7 s+'s(an=7T, :n a.ar7 de aceas(a, &en(r+ %ed!ca%en(e"e &rescr!se
    :n do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!c &oa(e .! !nd!ca( &r!n %en=!onarea
    cod+"+! E cores&+n/7(or &e a<a I Eve/! ane<a ,J. Den+%!rea (+"'+r7r!! Ede e<.,
    (+"'+rare &s!o(!c7 !nd+s7 de coca!n78 (+"'+rare an<!oas7 !nd+s7 de d!a/e&a%J es(e
    +r%a(7 de s&ec!.!carea s!%&(o%+"+! &redo%!nan( :n (a'"o+" c"!n!c O! de con(e<(+" :n
    care a+ a&7r+( s!%&(o%e"e Ede e<., 9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de coca!n7, c+
    !de! de"!ran(e, c+ de'+( :n c+rs+" !n(o<!ca=!e!8 9F9.GF T+"'+rare an<!oas7 !nd+s7 de
    7E7
    Tulburrile "n le!tur cu o Substan
    d!a/e&an, c+ de'+( :n c+rs+" a's(!nen(e!J CAnd se cons!der7 c7 %a! %+"( decA( o
    s!n$+r7 s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n a&ar!=!a s!%&(o%e"or, .!ecare
    s+'s(an=7 (re'+!e s7 .!e %en=!ona(7 se&ara( Dac7 o s+'s(an=7 es(e cons!dera(7 a .!
    .ac(or+" e(!o"o$!c, dar s+'s(an=a res&ec(!v7 sa+ c"asa de s+'s(an=e es(e nec+nosc+(7,
    (re'+!e s7 .!e +(!"!/a(7 c"asa de Ss+'s(an=7 nec+nosc+(7T
    Tul-ur(rile .n le/(tur( #u Al#oolul
    :n ce"e %a! %+"(e c+"(+r!, a"coo"+" es(e de&r!%an(+" cere'ra" ce" %a! .recven(
    +(!"!/a( s! ca+/a +ne! %or'!d!(7=! s! %or(a"!(7=! cons!dera'!"e La +n %o%en( da( :n
    v!a(a "or, %a! %+"( de FLd d!n(re ad+"=!! d!n S(a(e"e Un!(e a+ av+( o e<&er!en=7
    oarecare c+ a"coo"+", s! +n n+%7r s+'s(an=!a" ERLd d!n(re '7r'a=! s! ;Ld d!n(re .e%e!J
    a+ av+( +n+" sa+ %a! %+"(e even!%en(e de v!a(7 adverse :n "e$7(+r7 c+ a"coo"+" Ede
    e<, cond+s+" d+&7 cons+%area a &rea %+"( a"coo", a'sen(e de "a scoa"7 sa+ de "a
    serv!c!+ d!n ca+/a %a%+re"!!J D!n .er!c!re, ce! %a! %+"=! !nd!v!/! :nva=7 d!n aces(e
    e<&er!en=e s74s! %odere/e '7+(+" s! n+ de/vo"(7 de&enden(7 sa+ a'+/ de a"coo"
    Aceas(7 sec=!+ne con=!ne co%en(ar!! s&ec!.!ce re.er!(oare "a (+"'+r7r!"e :n
    "e$7(+r7 c+ a"coo"+" Te<(e"e s! se(+r!"e de cr!(er!! a+ .os( de@a &re/en(a(e %a! :na!n(e
    "a as&ec(e"e $enera"e a"e de&enden(e! de o s+'s(an=7 E&a$ 5F9J s! a'+/+"+! de o
    s+'s(an=7 E&a$ 5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or Te<(e"e s&ec!.!ce
    de&enden(e! s! a'+/+"+! de a"coo" s+n( &re/en(a(e %a! @os, n+ e<!s(7 :ns7 se(+r! de
    cr!(er!! s&ec!.!ce s+&"!%en(are &en(r+ de&enden(a a"coo"!c7 sa+ a'+/+" de a"coo"
    Te<(e"e s! se(+r!"e de cr!(er!! &en(r+ !n(o<!ca=!a a"coo"!c7 s! a's(!nen(a de a"coo" s+n(,
    de ase%enea, &re/en(a(e %a! @os T+"'+r7r!"e !nd+se de a"coo" Ea"(e"e decA(
    !n(o<!ca=!a s! a's(!nen(aJ s+n( descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+
    (+"'+r7r!"e c+ care a+ :n co%+n .eno%eno"o$!a Ede e<, (+"'+rarea a.ec(!v7 !nd+s7
    de a"coo" es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e a.ec(!ve J Ma! @os s+n( %en=!ona(e
    (+"'+r7r!"e +/+"+! de a"coo" s! (+"'+r7r!"e !nd+se de a"coo"
    Tulburrile u(ului de alcool
    ;L;.FL De&enden(a de a"coo" Eve/! &a$ 95;J
    ;LY.LL A'+/+" de a"coo" Eve/! &a$ 95IJ
    Tulburrile induse de alcool
    ;L;.LL In(o<!ca=!a a"coo"!c7 Eve/! &a$ 95IJ
    9F5. G5 A's(!nen(a de a"coo" Eve/! &a$ 95YJ De speci)icat dac6 C+ &er(+r
    '7r! de &erce&=!e
    9F5.L De"!n+%+" &r!n !n(o<!ca=!e c+ a"coo" Eve/! &a$ 5I;J
    291.0 De"!n+%+" &r!n a's(!nen(7 de a"coo" Eve/! &a$ 5I;J
    9F5 9 De%en(a &ers!s(en(7 !nd+s7 de a"coo" Eve/! &a$ 5RGJ
    291.1 T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de a"coo" Eve/! &a$ 5HHJ
    9F5.Y T+"'+rarea &s!o(!c7 !nd+s7 de a"coo", c+ !de! de"!ran(e Eve/! &a$ ;;GJ
    0e speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+"
    a's(!nen(e!
    454265 Dependena de
    Alcool
    21+
    9F5.;. T+"'+rarea &s!o(!c7 !nd+s7 de a"coo", c+ a"+c!na=!! Eve/! &a$. ;;GJ.
    0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+"
    a's(!nen=e! 9F5.G T+"'+rarea a.ec(!v7 !nd+s7 de a"coo" Eve/!
    &a$. ILYJ. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F5.G T+"'+rarea an<!oas7 !nd+s7 de a"coo" Eve/! &a$. IHFJ. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F5.G D!s.+nc=!a se<+a"7 !nd+s7 de a"coo" Eve/! &a$. YR9J. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F5.G T+"'+rarea de so%n
    !nd+s7 de a"coo" Eve/! &a$. RYYJ.De speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F5.G T+"'+rare :n "e$7(+r7 c+ a"coo"+" .7r7 a"(7 s&ec!.!ca=!e Eve/! &a$. 99;J.
    Tulburrile !"ului de #lcool
    4+4.5+ Depen$en!a $e Al#ool
    A se cons+"(a (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7 Eve/! &a$.
    5F9J. De&enden=a .!/!o"o$!c7 de a"coo" es(e !nd!ca(7 de &re/en=a s!%&(o%e"or de
    (o"eran=7 sa+ de a's(!nen=7, :n s&ec!a" dac7 es(e asoc!a(7 c+ +n !s(or!c de a's(!nen=7,
    de&enden=a .!/!o"o$!c7 es(e :n $enera" +n !nd!c!+ de evo"+=!e c"!n!c7 %a! sever7
    Ead!c7, de'+( %a! &recoce, '7+( :n can(!(7=! %a! %ar!, %a! %+"(e &ro'"e%e :n
    "e$7(+r7 c+ a"coo"+"J.
    A's(!nen=a de a"coo" Eve/! &a$. 95YJ se carac(er!/ea/7 &r!n de/vo"(area de
    s!%&(o%e de a's(!nen=7 :n dec+rs de 59 ore sa+ %a! %+"( d+&7 red+cerea a&or(+"+!,
    +r%And +ne! !n$es(!! &re"+n$!(e s! e<ces!ve de a"coo". Deoarece a's(!nen=a de a"coo"
    &oa(e .! ne&"7c+(7 s! !n(ens7, !nd!v!/!! c+ de&enden=7 de a"coo" &o( con(!n+a s7
    cons+%e a"coo" :n d!s&re=+" consec!n=e"or adverse, adesea &en(r+ a ev!(a sa+ +O+ra
    s!%&(o%e"e de a's(!nen=7. Une"e s!%&(o%e de a's(!nen=7 Ede e<. &ro'"e%e"e c+
    so%n+"J &o( &ers!s(a, c+ o !n(ens!(a(e %a! %!c7, (!%& de "+n!. O %!nor!(a(e
    s+'s(an=!a"7 de !nd!v!/! care a+ de&enden=7 a"coo"!c7 n+ a+ e<&er!en(a( n!c!oda(7
    n!ve"e re"evan(e c"!n!c de a's(!nen=7, s! n+%a! a&ro<!%a(!v Yd d!n(re !nd!v!/!! c+
    a's(!nen=7 de a"coo" vor e<&er!en=a vreoda(7 co%&"!ca=!!"e severe a"e a's(!nen=e! Ede
    e<., de"!r!+%, cr!/e de $rad %a"J. Oda(7 ce se de/vo"(7 +n &a((ern de +/ co%&+"s!v,
    !nd!v!/!! c+ de&enden=7 &o( ded!ca &er!oade s+'s(an=!a"e de (!%& o'=!ner!! s!
    cons+%7r!! '7+(+r!"or a"coo"!ce. AceO(! !nd!v!/! con(!n+7 adesea s7 .ac7 +/ de a"coo"
    :n d!s&re=+" ev!den=e! de consec!n=e adverse &s!o"o$!ce sa+ so%a(!ce Ede e<.,
    de&res!e, '"ac)o+(s, %a"ad!e e&a(!c7 sa+ a"(e sece"eJ.
    C*7
    Tulburrile "n le!tur cu o Substan
    Speci$icani
    Ur%7(or!! s&ec!.!can &o( .! a&"!ca=! d!a$nos(!c+"+! de de&enden(7 de a"coo"
    Eve/! &a$ 5FY &en(r+ %a! %+"(e de(a"!!J
    (u dependent fiziolo.ic
    )r dependen3 fiziolo.ic
    !emisiune complet precoce
    !emisiune par3ial precoce
    !emisiune complet prelun.it
    !emisune par3ial prelun.it
    #ntrBun mediu controlat
    4+<.++ A-u)ul $e Al#ool
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$ 5FGJ A'+/+" de a"coo" cere %a! &+(%e s!%&(o%e s! de aceea &oa(e .! %a! &+=!n
    sever decA( de&enden(a s! es(e d!a$nos(!ca( n+%a! d+&7 ce a .os( s(a'!"!(7 a'sen(a
    de&enden(e! Per.or%an(a Oco"ar7 s! cea &ro.es!ona"7 &o( s+.er!, .!e d!n ca+/a
    &os(e.ec(e"or '7+(+r!!, .!e d!n ca+/a !n(o<!ca=!e! e.ec(!ve "a scoa"7 sa+ "a serv!c!+,
    :n$r!@!rea co&!"+"+! sa+ res&onsa'!"!(7=!"e do%es(!ce &o( .! ne$"!@a(e s! &o( s+rven!
    a'sen=e de "a scoa"7 sa+ de "a serv!c!+ :n "e$7(+r7 c+ a"coo"+" Persoana &oa(e +/a
    de a"coo" :n c!rc+%s(an=e &er!c+"oase d!n &+nc( de vedere .!/!c Ede e< , cond+cerea
    a+(o%o'!"+"+! sa+ %an!&+"area +n+! +(!"a@ :n (!%& ce es(e 'ea(J Po( s+rven!
    d!.!c+"(7=! "e$a"e d!n ca+/a +/+"+! de a"coo" Ede e< , ares(7r! &en(r+ co%&or(a%en(+"
    d!n s(area de e'r!e(a(e or! &en(r+ cond+s s+' !n."+en=a a"coo"+"+!J :n .!ne, !nd!v!/!!
    c+ a'+/ de a"coo" &o( con(!n+a s7 cons+%e a"coo", :n d!s&re=+" c+noaO(er!! .a&(+"+!
    c7 aces(a &+ne &en(r+ e! &ro'"e%e soc!a"e sa+ !n(er&ersona"e !%&or(an(e Ede e<,
    cer(+r! v!o"en(e c+ so=!a Xso=+"X :n (!%& ce es(e 'ea(X7X, %a"(ra(area co&!"+"+!J
    CAnd aces(e &ro'"e%e s+n( aco%&an!a(e de &ro'a (o"eran=e!, a's(!nen=e! sa+ de
    co%&or(a%en( co%&+"s!v :n "e$7(+r7 c+ a"coo"+", (re'+!e "+a( :n cons!dera=!e %a!
    c+rAnd d!a$nos(!c+" de de&enden(7 de a"coo" decA( ce" de a'+/ de a"coo" Deoarece
    +ne"e s!%&(o%e de (o"eran(7, de a's(!nen(7 sa+ de +/ co%&+"s!v &o( s+rven! "a
    !nd!v!/!! c+ a'+/ dar n+ s! c+ de&enden(7, es(e !%&or(an( de s(a'!"!( :ns7 dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ de&enden=7
    Tulburrile induse de #lcool
    4+4.++ Into,i#a!ia Al#ooli#(
    A se cons+"(a (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7 Eve/! &a$ 5FFJ
    E"e%en(+" esen=!a" a" !n(o<!ca=!e! a"coo"!ce :" cons(!(+!e &re/en(a de %od!.!c7r!
    co%&or(a%en(a"e sa+ &s!o"o$!ce de/ada&(a(!ve se%n!.!ca(!ve c"!n!c Ede e<,
    co%&or(a%en( se<+a" sa+ a$res!v !nadecva(, "a'!"!(a(e a.ec(!v7, de(er!orarea
    @+dec7=!!, de(er!orarea .+nc=!on7% soc!a"e sa+ &ro.es!ona"eJ care a&ar :n c+rs+" sa+
    "a sc+r( (!%& d+&7 !n$es(!a de a"coo" Ecr!(er!!"e A s! BJ Aces(e %od!.!c7r! s+n(
    aco%&an!a(e de d!/ar(ne, %coordonare, %ers nes!$+r, n!s(a$%+s, de(er!orarea
    a(en=!e! sa+ %e%or!e!, or! s(+&or sa+ co%7 Ecr!(er!+" CJ S!%&(o%e"e n+ (re'+!e s7
    76E28E Abstinenta
    Alcoolic
    7EA
    se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e O! n!c! s7 .!e e<&"!ca(e %a! '!ne de a"(7
    (+"'+rare %en(a"7 Ecr!(er!+" DJ. Ta'"o+" c"!n!c re/+"(a( es(e s!%!"ar c+ ce" o'serva( :n
    c+rs+" !n(o<!ca=!e! c+ 'en/od!a/e&!ne sa+ 'ar'!(+r!ce. ,rade"e de !ncoordonare &o(
    !n(er.era c+ ca&ac!(a(ea de a cond+ce s! c+ e.ec(+area ac(!v!(7=!"or +/+a"e, &An7 "a
    &+nc(+" de a ca+/a acc!den(e. Pro'a +/+"+! de a"coo" &oa(e .! o'=!n+(7 d!n a"ena
    a"coo"!c7 a res&!ra=!e! !nd!v!d+"+!, d!n o'=!nerea +n+! !s(or!c de "a !nd!v!d sa+ de "a
    a"( o'serva(or s!, cAnd es(e necesar, avAnd acord+" !nd!v!d+"+!, d!n ana"!/a
    (o<!co"o$!c7 a aer+"+! e<&!ra(, a sAn$e"+! s! a +r!n!!.
    Criteriile $e $ia/no&ti# pentru 4+4.++ Into,i#a!ia Al#ooli#(
    A2 In!estie recent de alcool2
    S2 Modi$icri de comportament sau psi%olo!ice de(adaptative, semni$icative
    clinic &adic, comportament a!resiv sau sexual inadecvat, labilitate a$ectiv,
    deteriorarea 0udecii, deteriorarea $uncionrii sociale sau pro$esionale)
    care apar "n cursul sau la scurt timp dup in!estia de alcool2
    2 .nul &sau mai multe) dintre urmtoarele semne apr@nd "n cursul sau la scurt
    timp dup u(ul de alcoolD
    &l)di(artrie,
    (2)incoordonare,
    (3)mers titubant,
    (4)nista!mus,
    &S)deterioarea ateniei si memoriei,
    &I)stupor sau com2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale ,i nu sunt
    explicate mai bine de alt tulburare mental2
    C5*.>* A-&tinen!a Al#ooli#(
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ a's(!nen=a de o s+'s(an=7
    Eve/! &a$. 9L5J. E"e%en(+" esen=!a" a" a's(!nen=e! de a"coo" :" cons(!(+!e &re/en=a +n+!
    s!ndro% de a's(!nen=7 carac(er!s(!c care a&are d+&7 :nce(area Esa+ red+cereaJ +/+"+!
    e<ces!v s! &re"+n$!( de a"coo" Ecr!(er!!"e A s! BJ. S!ndro%+" de a's(!nen=7 !nc"+de do+7
    sa+ %a! %+"(e d!n(re +r%7(oare"e s!%&(o%eQ !&erac(!v!(a(e ve$e(a(!v7 Ede e<.,
    (rans&!ra=!e sa+ &+"s %a! %are de 5LLJ, (re%or %arca( a" %A!n!"or, !nso%n!e, a$!(a=!e
    &s!o%o(or!e, an<!e(a(e, $rea=7 sa+ vo%7, s! %a! rar, cr!/e de $rand %a" sa+ a"+c!na=!!
    sa+ !"+/!! v!/+a"e, (ac(!"e sa+ a+d!(!ve (ran/!(or!!. CAnd s+n( o'serva(e a"+c!na=!! sa+
    !"+/!!, c"!n!c!an+" &oa(e s&ec!.!ca Sc+ &er(+r'7r! de &erce&=!eT Eve/! %a! @osJ.
    S!%&(o%e"e de a's(!nen=7 ca+/ea/7 o de(er!orare sa+ de(res7 se%n!.!ca(!v7
    c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare
    Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e
    s! s7 n+ .!e e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7 Ede e<., de a's(!nen=a de
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce or! de an<!e(a(ea $enera"!/a(7J Ecr!(er!+" DJ.
    S!%&(o%e"e &o( .! +O+ra(e &r!n ad%!n!s(rarea de a"coo" sa+ de a"( de&r!%an(
    cere'ra". S!%&(o%e"e de a's(!nen=7 :nce& de re$+"7 cAnd concen(ra=!!"e san$+!ne a"e
    a"coo"+"+! d!%!n+a 'r+sc Ead!c7, :n dec+rs de I459 oreJ d+&7 :nce(area sa+ red+cerea
    7EI
    Tulburrile "n le!tur cu o Substan
    +/+"+! de a"coo" D!n ca+/a se%!v!e(n sc+r(e a a"coo"+"+!, s!%&(o%e"e de a's(!nen(7
    a"coo"!c7 a(!n$ %a<!%+%+" de !n(ens!(a(e :n c+rs+" ce"e! de a do+a /!"e de a's(!nen(7
    s! es(e &os!'!" s7 se a%e"!ore/e cons!dera'!" :n cea de a &a(ra sa+ a c%cea /! D+&7
    a's(!nen(a ac+(7 :ns7, s!%&(o%e"e de an<!e(a(e, !nso%n!e s! d!s.+nce ve$e(a(!v7 &o(
    &ers!s(a (!%& de ;4R "+n!, "a n!ve"e de !n(ens!(a(e %a! red+se
    Ma! &+=!n de 5Ld d!n(re !nd!v!/!! care de/vo"(7 de&enden(7 a"coo"!c7 vor
    &re/en(a s!%&(o%e dra%a(!ce Ede e< , !&erac(!v!(a(e ve$e(a(!v7 sever7, (re%+r7(+n
    s! de"!n+% &r!n a's(!nen(7 a"coo"!c7J Cr!/e de $rand %a" s+rv!n "a %a! &+=!n de ;d
    d!n(re !nd!v!/! De"!n+%+" &r!n a's(!nen(7 de a"coo" E&a$ 5I;J !nc"+de &er(+r'7r! de
    conO(!en(7 s! co$n!(!ve s! a"+c!na=!! v!/+a"e, (ac(!"e sa+ a+d!(!ve ESde"!n+% (re%ensT
    sa+ ,,DTs2J CAnd a&are de"!r!+%+" &r!n a's(!nen(7 de a"coo", es(e &os!'!" s7 .!e
    &re/en(7 o cond!=!e %ed!ca"7 $enera"7 re"evan(7 c"!n!c Ede e< , !ns+.!c!en(7 e&a(!c7,
    &ne+%on!e, sAn$erare $as(ro%(es(%a"7, sece"e de (ra+%a(!s% cra%ocere'ra",
    !&o$"!ce%!e, +n de/ec!"!'r+ !droe"ec(ro"!(!c or! s(a(+s &os(o&era(orJ
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( d!a$nos(!c+"+! de a's(!nen(7 de a"coo"
    C+ &er(+r'7r! de &erce&=!e Aces( s&ec!.!can( &oa(e .! %en=!ona( cAnd
    a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 sa+ !"+/!! a+d!(!ve, v!/+a"e sa+ (ac(!"e
    s+rv!n :n a'sen(a den+%+"+! Testarea realit6(ii Intact6 :nsea%n7 c7 &ersoana
    O(!e c7 a"+c!na=!!"e s+n( !nd+se de s+'s(an=7 s! c7 n+ re&re/!n(7 rea"!(a(ea
    e<(ern7 CAnd a"+c!na=!!"e s+rv!n :n a'sen(a +ne! (es(7r! a rea"!(7=!! !n(ac(e,
    (re'+!e "+a( :n cons!dera=!e d!a$nos(!c+" de (+"'+rare &s!oc7 !nd+s7 de o
    s+'s(an=7, c+ a"+c!na=!!
    Criteriile $e $ia/no&ti# pentru C5*.>* A-&tinen!a Al#ooli#(
    A "ncetarea &sau reducerea) u(ului excesiv si prelun!it de alcool
    S Dou &sau mai multe) dintre urmtoarele simptome, survenmd "n decurs de
    c@teva ore sau (ile dup criteriul A
    &E) %iperactivitate ve!etativ &de ex , transpiraie sau puls peste E55),
    &7)tremor marcat al extremitilor,
    (3) insomnie,
    (4) !reuri sau vrsturi,
    (5) ilu(ii sau %alucinaii vi(uale, tactile sau auditive tran(itorii,
    (6) a!itaie psi%omotone,
    (7) anxietate,
    (8) cri(e de !rand mal
    S Simptomele de la criteriul S cau(ea( detres sau deteriorare semni$icativ
    clinic "n $uncionarea social, pro$esionala sau "n alte domenii de
    $uncionare importante
    D Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental
    De speci"icat dac
    Cu pertur-(ri $e per#ep!ie
    Alte Tulburri induse de
    Alcool
    C*G

    Alte Tul-ur(ri in$u&e $e Al#ool
    Ur%7(oare"e (+"'+r7r! !nd+se de a"coo" s+n( descr!se :n sec=!+n!"e %an+a"+"+!
    :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ deliriumul prin
    intoxica3ie alcoolic E&a$. 5I;J, deliriumul prin abstinen3 de alcool E&a$.5I;J,
    demen3a persistent indus de alcool E&a$. 5RGJ, tulburarea amnestic persistent
    indus de alcool E&a$.5HHJ, tulburarea psi-otic indus de alcool E&a$. ;;GJ,
    tulburarea afectiv indus de alcool E&a$. ILYJ, tulburarea anxioas indus de
    alcool E&a$. IHFJ, disfunc3ia sexual indus de alcool E&a$. YR9J s! tulburarea de
    somn indus de alcool E&a$. RYYJ. Aces(e (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+"
    !n(o<!ca=!e! a"coo"!ce sa+ a" a's(!nen=e! de a"coo", n+%a! cAnd s!%&(o%e"e s+n( :n
    e<ces vers+s ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e a"coo"!c7 sa+ de
    a's(!nen=7 de a"coo" s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o
    a(en=!e c"!n!c7 se&ara(7.
    $nformaii sulimentare desre Tulburrile %n
    le&tur cu #lcoolul
    *lemente ,i tulburri asociate
    $lemente descriptive si tulburri mentale asociate. De&enden=a s! a'+/+" de
    a"coo" s+n( asoc!a(e adesea c+ de&enden=a sa+ a'+/+" de a"(e s+'s(an=e Ede e<.,
    canna'!s, coca!n7, ero!n7, a%.e(a%!ne, seda(!ve, !&no(!ce s! an<!o"!(!ce, s!
    n!co(!n7J. A"coo"+" &oa(e .! +(!"!/a( &en(r+ a +O+ra e.ec(e"e nedor!(e a"e aces(or a"(e
    s+'s(an=e or! &en(r+ a "! se s+'s(!(+!, cAnd aces(ea n+ s+n( d!s&on!'!"e. S!%&(o%e
    de de&res!e, an<!e(a(e s! !nso%n!a aco%&an!a/7 .recven( de&enden=a a"coo"!c7 s!
    +neor! o &reced. In(o<!ca=!a a"coo"!c7 se asoc!a/7 +neor! c+ a%ne/!e &en(r+
    even!%en(e"e care a+ av+( "oc :n c+rs+" !n(o<!ca=!e! ES'"ac)o+(sTJ. Aces( .eno%en
    &oa(e .! :n "e$7(+r7 c+ &re/en=a +ne! concen(ra=!! %ar! de a"coo" :n sAn$e O!, &oa(e,
    c+ ra&!d!(a(ea c+ care aceas(7 concen(ra=!e es(e a(!ns7.
    T+"'+r7r!"e :n "e$7(+r7 c+ a"coo"+" s+n( asoc!a(e c+ o creO(ere se%n!.!ca(!v7 a
    r!sc+"+! de acc!den(e, v!o"en=7 s! s+!c!d. Se es(!%ea/7 c7 +na d!n c!nc! !n(ern7r! :n
    +n!(7=!"e de (era&!e !n(ens!v7 d!n +ne"e s&!(a"e +r'ane es(e :n "e$7(+r7 c+ a"coo"+" s!
    c7 ILd d!n(re !nd!v!/! :n S(a(e"e Un!(e e<&er!en(e/7 +n acc!den( :n "e$7(+r7 c+
    a"coo"+" "a +n %o%en( da( :n v!a=a "or, &rec+% s! c7 a"coo"+" es(e res&onsa'!" de YYd
    d!n(re decese"e d!n c+rs+" cond+s+"+! +n+! ve!c+". In(o<!ca=!a a"coo"!c7 sever7, %a!
    a"es "a !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7, es(e asoc!a(7 c+ co%!(erea
    de ac(e !n.rac=!ona"e. De e<e%&"+, %a! %+"( de @+%7(a(e d!n(re (o=! cr!%!na"!! O!
    v!c(!%e"e "or se crede c7 era+ !n(o<!ca=! c+ a"coo" :n %o%en(+" cr!%e!. In(o<!ca=!a
    a"coo"!c7 sever7 con(r!'+!e, de ase%enea, "a de/!n!'!=!a O! "a sen(!%en(e"e de
    (r!s(e=e O! de !r!(a'!"!(a(e, care con(r!'+!e "a (en(a(!ve"e de s+!c!d O! s+!c!d co%&"e(.
    T+"'+r7r!"e :n "e$7(+r7 c+ a"coo"+" con(r!'+!e "a a'sen(e!s% de "a serv!c!+, "a
    acc!den(e :n "e$7(+r7 c+ serv!c!+" O! "a &rod+c(!v!(a(ea sc7/+(7 a an$a@a(+"+!. A'+/+"
    O! de&enden=a de a"coo", :%&re+n7 c+ a'+/+" O! de&enden=a de a"(e s+'s(an=e s+n(
    &re/en(e "a !nd!v!/! de or!ce n!ve" de ed+ca=!e s! s(a(+s soc!oecono%!c. Ra(e"e de
    (+"'+r7r! :n "e$7(+r7 c+ a"coo"+" &ar a .! %a! cresc+(e "a !nd!v!/!! .7r7 "oc+!n=7
    re."ec(And, &oa(e, o de&"asare :n @os s+' as&ec(+" .+nc=!on7r!! soc!a"e s! &ro.es!ona"e,
    deO! %+"=! oa%en! c+ de&enden=7 sa+ a'+/ con(!n+7 s74s! %en=!n7 re"a=!!"e c+
    C*>
    Tulburrile "n le!tur cu o Substan
    .a%!"!!"e "or s! .+nc=!a :n cadr+" serv!c!+"+! "or T+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e
    an<!oase, sc!/o.ren!a s! (+"'+rarea de &ersona"!(a(e an(!soc!a"7 &o( .!, de ase%enea,
    asoc!a(e c+ de&enden(a de a"coo" De re=!n+( c7 +ne"e &ro'e s+$erea/7 c7 ce" &+=!n
    o &ar(e a asoc!er!"or ra&or(a(e d!n(re de&res!e s! de&enden=a de a"coo" &o( .!
    a(r!'+!(e +nor s!%&(o%e de&res!ve co%or'!de re/+"(And d!n e.ec(e"e ac+(e a"e
    !n(o<!ca=!e! sa+ a's(!nen(e!
    9ate de laborator asociate. Un !nd!ca(or de "a'ora(or sens!'!" a" '7+(+"+!
    e<ces!v es(e creO(erea $a%%a4$"+(a%!"(rans.era/e! E,,TJ Eh;L +n!(7=!J Ce" &+=!n
    HLd d!n(re !nd!v!/!! c+ +n n!ve" cresc+( a" ,,T s+n( '7+(or! e<ces!v! &ers!s(en=!
    Ead!c7 'ea+ :n %od re$+"a( o&( sa+ %a! %+"(e &aare /!"n!cJ Un a" do!"ea (es( c+
    n!ve"e de sens!'!"!(a(e s! s&ec!.!c!(a(e co%&ara'!"e sa+ c!ar %a! %ar! es(e
    car'oydra(e de.!c!en( (rans.er% ECDTJ c+ n!ve"e de 9L +n!(7=! sa+ %a! %ar!, +(!" :n
    !den(!.!carea !nd!v!/!"or care 'ea+ :n %od re$+"a( o&( sa+ %a! %+"(e &aare &e /!
    Deoarece a(A( n!ve"e"e C,T, cA( s! ce"e a"e CDT rev!n "a nor%a" :n dec+rs de cA(eva
    /!"e sa+ s7&(7%An! de "a s(o&area '7+(+"+!, a%'!! %ar)en de s(are s+n( +(!"! :n
    %on!(or!/area a's(!nen(e!, :n s&ec!a" cAnd c"!n!c!an+" o'serv7 creO(er!, %a! c+rAnd
    decA( descreO(er! a"e aces(or va"on :n (!%& Co%'!narea CDT s! C,T &oa(e avea
    c!ar n!ve"e %a! %ar! de sens!'!"!(a(e s! de s&ec!.!c!(a(e decA( .!ecare d!n(re aces(e
    (es(e +(!"!/a( s!n$+r Tes(e"e +(!"e s+&"!%en(ar !nc"+d vo"+%+" cor&+sc+"ar %ed!+
    EMC3J care &oa(e .! cresc+( "a va"or! c+ %+"( &es(e nor%a" "a !nd!v!/!! care 'ea+
    e<ces!v de %+"(U%od!.!care da(ora(7 e.ec(e"or (o<!ce d!rec(e a"e a"coo"+"+! as+&ra
    en(ro&o!e/e!
    DeO! M3C &oa(e .! +(!"!/a( "a !den(!.!carea ce"or care 'ea+ e<ces!v, aceas(a es(e o
    %e(od7 !n.er!oar7 de %on!(or!/are a a's(!nen(e! d!n ca+/a se%!v!e=n "+n$! a
    e%a(!!"or Tes(e"e .+nc=!ona"e e&a(!ce Ede e<, a"a%n4a%!no(rans.era/a ZALT[ O!
    .os.a(a/a a"ca"!n7J &o( re"eva o "e/!+ne e&a(!c7 care es(e consec!n=a '7+(+"+!
    e<ces!v Poa(e .! o'serva(7 o creO(ere a n!ve"+"+! "!&!de"or :n sAn$e Ede e< , a (r!$ce4
    nde"or O! co"es(ero"+"+! "!&o&ro(e!cJ, care re/+"(7 d!n sc7derea neo$"+co$ene/e!
    asoc!a(e c+ '7+(+" e<ces!v Con=!n+(+" r!d!ca( :n "!&!de a" sAn$e"+! con(r!'+!e, de
    ase%enea, "a a&ar!=!a .!ca(+"+! $ras Po( a&are cocen(ra=n &es(e nor%a" a"e ac!d+"+!
    +nc :n '7+(+" e<ces!v, dar aces(ea s+n( re"a(!v nes&ec!.!ce Ce" %a! va"a'!" (es( d!rec(
    de %7s+rare a cons+%+"+! de a"coo" &e sec=!+ne (ransversa"7 es(e concen(ra=!a de
    a"coo" d!n sAn$e, care &oa(e .! +(!"!/a(7, de ase%enea, "a a&rec!erea (o"eran=e! "a
    a"coo" Un !nd!v!d c+ o concen(ra=!e de 5LL %$ e(ano" &e dec!"!(r+" de sAn$e s! care
    n+ &re/!n(7 se%ne de !n(o<!ca=!e, &oa(e .! de &res+&+s c7 a c7&7(a( ce" &+=!n +n $rad
    oarecare de (o"eran(7 "a a"coo" La 9LL %"Xd", ce! %a! %+"=! !nd!v!/! non(o"eran(!
    &re/!n(7 !n(o<!ca=!e sever7
    9atele examinrii somatice si condi3iile medicale .enerale asociate. In$es(!a
    re&e(a(7 de do/e %ar! de a"coo" &oa(e a.ec(a a&roa&e .!ecare or$an, :n s&ec!a" (rac(+"
    $as(ro!n(es(%a", s!s(e%+" card!ovasc+"ar s! s!s(e%+" nervos cen(ra" O! &er!.er!c
    E.ec(e"e $as(ro!n(es(%a"e !nc"+d $as(n(a, +"cere"e $as(r!c O! d+odena", s!, "a
    a&ro<!%a(!v 5Yd d!n(re +e! care +/ea/7 e<ces!v de a"coo", c!ro/a e&a(!c7 O!
    &ancrea(!(a E<!s(7, de ase%enea, o ra(7 cresc+(7 a cancer+"+! eso.a$!an, $as(r!c s! a"
    a"(or &7r=! a"e (rac(+"+! $as(ro!n(es(%a" Una d!n(re cond!=!!"e %ed!ca"e $enera"e ce"
    %a" .recven( asoc!a(e es(e !&er(ens!+nea c+ va"on %!c! Card!o%!o&a(!a s! a"(e
    %!o&a(+ s+n( %a! &+=!n .recven(e, dar a&ar :n(r4+n &rocen( cresc+( &r!n(re ce! care
    'ea+ e<ces!v de %+"( AceO(! .ac(or!, :%&re+n7 c+ creO(erea se%n!.!ca(!v7 a n!ve"+"+!
    Tulburri induse de
    Alcool
    214
    (n$cende"or s! co"es(ero"+"+! "!&o&ro(e!c c+ dens!(a(e %!c7, con(r!'+!e "a +n nsc
    cresc+( de %a"ad!e card!ac7 Ne+ro&a(!a &er!.er!c7 &oa(e .! ev!den=!a(7 &r!n
    sc7derea .or=e! %+sc+"are, &ares(e/+ s! d!%!n+area d!s(a"7 a sens!'!"!(7=!! E.ec(e"e
    %a! &ers!s(en(e as+&ra s!s(e%+"+! nervos !nc"+d de.!c!(e"e co$n!(!ve, de(er!orarea
    sever7 a %e%or!e! s! %od!.!c7r!"e de$enera(!ve d!n cere'e" Aces(e e.ec(e s+n( :n
    "e$7(+r7 c+ ac=!+nea d!rec(7 a a"coo"+"+! sa+ a +n+! (ra+%a(!s%, a de.!c!en=e"or
    v!(a%%!ce E:n s&ec!a" de v!(a%!ne B, !nc"+s!v (!a%!naJ Ce" %a! devas(a(or e.ec(
    as+&ra s!s(e%+"+! nervos cen(ra" :" cons(!(+!e re"a(!v rara (+"'+rare a%nes(!c7
    &ers!s(en(7 !nd+s7 de a"coo" E&a$ 5HHJ Es!ndro%+" 1er%c)e4-orsa)ovJ, :n care
    ca&ac!(a(ea de a encoda !n.or%a=!a no+7 es(e de(er!ora(7 sever
    M+"(e d!n(re s!%&(o%e"e s! da(e"e so%a(!ce asoc!a(e c+ (+"'+r7r!"e :n "e$7(+r7 c+
    a"coo"+" s+n( o consec!n=7 a s(7r!"or %or'!de %a! s+s %en=!ona(e E<e%&"e s+n(
    d!s&e&s!a, $rea=a s! ."a(+"en=a care aco%&an!a/7 $as(n(a s! e&a(o%e$aa, vance"e
    eso.a$!ene s! e%oro!/!! care aco%&an!a/7 %od!.!c7r!"e e&a(!ce !nd+se de a"coo"
    A"(e se%ne so%a(!ce !nc"+d (re%or+", %ers+" nes!$+r, !nso%n!a s! d!s.+nc=!a
    erec(!"7 Ind!v!/!! c+ de&enden(7 cron!c7 de a"coo" &o( &re/en(a o d!%!n+are a
    d!%ens!+n!"or (es(!c+"e"or s! e.ec(e .e%%!/an(e asoc!a(e c+ n!ve"e"e red+se de
    (es(os(eron. B7+(+" e<ces!v re&e(a( :n c+rs+" sarc!n!! es(e asoc!a( c+ avor( s&on(an s!
    c+ s!ndro% a"coo"!c .e(a" Ind!v!/!! c+ !s(or!c de e&!"e&s!e sa+ de (ra+%a(!s% cran!an
    sever &ree<!s(en( es(e .oar(e &os!'!" s7 &re/!n(e cr!/e e&!"e&(!ce :n "e$7(+r7 c+
    a"coo"+" A's(!nen(a de a"coo" &oa(e .! asoc!a(7 c+ $rea=7, vo%7, $as(n(7,
    e%a(e%e/7, $+r7 +sca(7, .ac!es (+%e.!a( s! c+&eros, s! ede%e &er!.er!ce d!scre(e
    In(o<!ca=!a a"coo"!c7 &oa(e d+ce "a c7der! s! "a acc!den(e care &o( ca+/a .rac(+r!,
    e%a(oa%e s+'d+ra"e s! a"(e .or%e de (ra+%a(!s%e cran!ene In(o<!ca=!a a"coo"!c7
    sever7 re&e(a(7 &oa(e s+&r!%a, de ase%enea, %ecan!s%e"e !%+%(are s! &oa(e
    &red!s&+ne !nd!v!/!! "a !n.ec=!! s! "a creO(erea r!sc+"+! de cancer :n .!ne, a's(!nen(a
    a"coo"!c7 nean(!c!&a(7 "a &ac!en=!! s&!(a"!/a=!, &en(r+ care +n d!a$nos(!c de
    a's(!nen=7 de a"coo" a .os( (rec+( c+ vederea, se &oa(e ad7+$a "a r!sc+r!"e s! cos(+r!"e
    s&!(a"!/7r!! O! "a (!%&+" &e(rec+( :n s&!(a"
    *lemente speci$ice culturii, etii si sexului
    Trad!=!!"e c+"(+ra"e, care "!%!(ea/7 +/+" de a"coo" :n s!(+a=!! .a%!"!are, re"!$!oase s!
    soc!a"e, :n s&ec!a" :n c+rs+" co&!"7r!e!, &o( a.ec(a a(A( &a((ern+r!"e de +/, cA( s!
    &ro'a'!"!(a(ea a&ar!=!e! de &ro'"e%e :n "e$7(+r7 c+ a"coo"+" D!.eren(e no(a'!"e
    carac(er!/ea/7 can(!(a(ea, .recven=a s! &a((ern+r!"e de cons+% de a"coo" :n =7n"e
    "+%!! :n ce"e %a! %+"(e c+"(+r! as!a(!ce, &reva"en(a $"o'a"7 a (+"'+r7r!"or :n "e$7(+r7
    c+ a"coo"+" es(e re"a(!v red+s7, !ar ra(a '7r'a=!X.e%e! %are Ra(e"e de &reva"en(7
    red+se "a as!a(!c! &ar a .! :n "e$7(+r7 c+ a'sen(a "a a&ro<!%a(!v YLd d!n(re @a&one/!,
    c!ne/! s! coreen!, a .or%e! de a"de!d4de!dro$ene/7 care e"!%!n7 n!ve"e"e sc7/+(e
    a"e &r!%+"+! &rod+s de de$radare a a"coo"+"+!, ace(a"de!da CAnd ce! 5Ld de
    !nd!v!/! es(!%a=! a avea a'sen(a co%&"e(7 a en/!%e! cons+%7 a"coo", e! &re/!n(7
    .ac!es v+"(+os s! &a"&!(a=!!, care &o( .! a(A( de severe c7 %+"=! n+ vor %a! 'ea de"oc :n
    con(!n+are Ce! ILd d!n(re !nd!v!/!! c+ o de.!c!en(7 re"a(!v7 a en/!%e! e<&enen(ea/7
    o con$es(!e .ac!a"7 %a! &+=!n !n(ens7 s! a+ +n r!sc sc7/+( de a &re/en(a o (+"'+rare a
    +/+"+! de a"coo" :n S(a(e"e Un!(e, a"'!! s! a.roa%encann a+ ra(e s!%!"are de a'+/ s!
    de&enden=7 de a"coo" B7r'a=!! "a(!no a+ ra(e ceva %a! %ar!, :ns7 &reva"en(a es(e %a!
    %!c7 &r!n(re .e%e!"e "a(!no, decA( &r!n(re .e%e!"e d!n a"(e $r+&+r! e(n!ce N!ve"+"
    ed+ca=!ona" sc7/+(, Oo%a@+" s! s(a(+s+" soc!oecono%!c %a! red+s s+n( asoc!a(e c+
    (+"'+r7r!"e :n "e$7(+r7 c+ a"coo"+", deO! adesea es(e d!.!c!" de se&ara( ca+/a de e.ec(
    99L
    Tulburrile "n le!tur cu o Substan
    An!! de scoa"7 &o( s7 n+ .!e "a .e" de !%&or(an=! :n de(er%!narea r!sc+"+! ca a(!n$erea
    sco&+"+! ed+ca=!ona" !%ed!a( Ead!c7, ce! care a+ ren+n=a( "a "!ce+ sa+ "a co"e$!+ a+
    ra(e e<(re% de r!d!ca(e de (+"'+r7r! :n "e$7(+r7 c+ a"coo"+"J
    Pr!n(re ado"escen=!, (+"'+rarea de cond+!(7 s! co%&or(a%en(+" an(!soc!a" re&e(a(
    a&ar adesea conco%!(en( c+ a'+/+" sa+ de&enden=a de a"coo" or! c+ a"(e (+"'+r7r!
    :n "e$7(+r7 c+ o s+'s(an=7 Mod!.!c7r!"e so%a(!ce :n ra&or( c+ e(a(ea "a '7(rAn!
    d+c "a o creO(ere a s+sce&(!'!"!(7=!! cre!er+"+! "a e.ec(e"e de&r!%an(e a"e a"coo"+"+!,
    "a d!%!n+area ra(e"or %e(a'o"!s%+"+! e&a(!c a d!verse s+'s(an=e, !nc"+s!v a
    a"coo"+"+!, s! scad &rocen(a@+" de a&7 a" cor&+"+! Aces(e %od!.!c7r! &o( ca+/a "a
    '7(rAn! a&ar!=!a +ne! !n(o<!ca=!! %a! severe s!, :n consec!n=7, &ro'"e%e "a n!ve"e %a!
    red+se de cons+% Pro'"e%e"e :n "e$7(+r7 c+ a"coo"+" "a '7(rAn! es(e .oar(e &os!'!"
    s7 .!e asoc!a(e c+ a"(e co%&"!ca=!! %ed!ca"e
    Fe%e!"e (!nd a &re/en(a concen(ra=!! de a"coo" :n sAn$e %a! %ar! decA( '7r'a=!!
    "a o an+%!(7 do/7 de a"coo" &er )!"o$ra% d!n ca+/a &rocen(+"+! "or %a! red+s de
    a&7 :n cor&, a &rocen(+"+! "or %a! r!d!ca( de "!&!de :n cor&, &rec+% s! a .a&(+"+! c7
    e"e (!nd a %e(a'o"!/a a"coo"+" %a! "en( E:n &ar(e d!n ca+/a n!ve"e"or %a! red+se de
    a"coo" de!dro$ena/7 :n &"!+r!"e %+coase! $as(r!ceJ D!n ca+/a aces(or concen(ra=!!
    cresc+(e de a"coo", .e%e!"e &re/!n(7 +n nsc %a! %are decA( '7r'a=!! &en(r+ +ne"e
    d!n(re consec!n=e"e :n "e$7(+r7 c+ s7n7(a(ea a"e +n+! a&or( e<ces!v de a"coo" Ede e<,
    "e/!+n!"e e&a(!ceJ A'+/+" s! de&enden(a de a"coo" s+n( %a! .recven(e "a '7r'a=!
    decA( "a .e%e!, c+ +n ra&or( '7r'a=!X.e%e! de &es(e Y ", dar aces( ra&or( var!a/7,
    :ns7, cons!dera'!" :n .+nc=!e de $r+&a de e(a(e :n $enera", .e%e!"e :nce& s7 'ea c+
    cA=!va a% %a! (Ar/!+ decA( '7r'a=!!, dar oda(7 ce a'+/+" sa+ de&enden(a de a"coo"
    a+ s+rven!(, "a .e%e! aces(ea &ar a &ro$resa ceva %a! ra&!d C+ (oa(e aces(ea,
    evo"+=!a c"!n!c7 a de&enden=e! a"coo"!ce "a '7r'a=! s! "a .e%e! es(e %a! %+"( s!%!"ar7
    decA( d!.er!(7
    #revalent
    U/+" de a"coo" es(e .oar(e r7s&And!( :n ce"e %a! %+"(e =7r! ves(!ce, c+ +n cons+%
    &er c7&!=a "a ad+"=! :n S(a(e"e Un!(e es(!%a( "a H,9I "!(r! de a"coo" a'so"+(, :n 5FFI :n
    S(a(e"e Un!(e, :n(re do+7 (re!%! s! FLd d!n(re ad+"=! a+ cons+%a( vreoda(7 a"coo", :n
    .+nc=!e de ance(7 s! de %e(oda +(!"!/a(7, c+ c!.re %a! %An &en(r+ '7r'a=! decA(
    &en(r+ .e%e! O ance(7 na=!ona"7 e.ec(+a(7 :n 5FFR ara(7 c7 a&ro<!%a(!v HLd d!n(re
    '7r'a=! s! RLd d!n(re .e%e! a+ cons+%a( a"coo", c!.re"e var!!nd :n ra&or( c+ e(a(ea,
    cea %a! %are &reva"en(7 EHHdJ cons(a(And+4se "a ce! :n e(a(e de 9R4;I an! Procen(e
    %a! %ar! de '7+(or! a+ .os( ra&or(a(e :n %ed!+" +r'an s! :n /one"e de coas(7 a"e
    S(a(e"or Un!(e, c+ d!.eren(e %odes(e :n(re $r+&+r!"e ras!a"e Tre'+!e no(a( c7
    deoarece aces(e ance(e a+ eva"+a( %a! %+"( &a((ern+n"e de +/ decA( &e ce"e de
    (+"'+r7r!, n+ se O(!e cA=! d!n(re ce! !n(ero$a=! care a+ +/a( de a"coo" a+ av+(
    s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ de&enden=7 sa+ a'+/
    Re."ec(And, &oa(e, d!.eren(e"e :n %e(odo"o$!a de cerce(are s! %od!.!c7r!"e
    cr!(er!!"or de d!a$nos(!c d!n dec+rs+" an!"or, es(!%7r!"e &reva"en(e! a'+/+"+! s!
    de&enden(e! de a"coo" var!a/7 cons!dera'!" :n(re d!verse"e s(+d!! C+ (oa(e
    aces(ea :ns7, cAnd s+n( +(!"!/a(e cr!(er!!"e DSM4III4R s! DSM4I3, a&are c7 "a
    %!@"oc+" an!"or FL r!sc+" de %or'!d!(a(e &e v!a=a &en(r+ de&enden=a de a"coo" era
    de a&ro<!%a(!v 5Yd :n &o&+"a=!a $enera"7 Procen(+" $enera" de de&enden=7
    a"coo"!c7 rea"7 Econs!dera(7 ca .+nd n+%7r+" de !nd!v!/!! a" c7ror &a((ern de +/
    de a"coo" a sa(!s.7c+( cr!(er!!"e &en(r+ aces(a :n c+rs+" an+"+! &receden(J se
    a&ro&!e &ro'a'!" de Yd
    Tulburri induse de
    Alcool
    221
    Evo"+=!e
    Pr!%+" e&!sod de !n(o<!ca=!e a"coo"!c7 es(e &os!'!" s7 s+rv%7 "a %!@"oc+"
    ado"escen(e!, c+ e(a(ea "a de'+(+" de&enden(e! de a"coo" a(!n$And &!c+" :n an!! 9L s!
    @+%7(a(ea an!"or ;L Marea %a@or!(a(e a ce"or care &re/!n(7 (+"'+r7r! :n "e$7(+r7 c+
    a"coo"+" o .ac "a .!ne"e an!"or "or ;L Pr!%a &ro'7 de a's(!nen(7 es(e &os!'!" s7 n+
    s+rv%7 decA( d+&7 ce %+"(e a"(e as&ec(e a"e de&enden(e! a+ a&7r+( de@a A'+/+" s!
    de&enden(a de a"coo" a+ o evo"+=!e var!a'!"7, carac(er!/a(7 .recven( &r!n &er!oade
    de re%!s%ne s! de rec7dere O dec!/!e de a s(o&a '7+(+", adesea ca r7s&+ns "a o
    cr!/7, es(e &os!'!" s7 .!e +r%a(7 de cA(eva s7&(7%An! sa+ c!ar %a! %+"( de
    a's(!nen(7, care es(e +r%a(7 adesea de &er!oade "!%!(a(e de '7+( con(ro"a( sa+ .7r7
    &ro'"e%e :ns7, oda(7 ce !n$es(!a de a"coo" es(e re"+a(7, es(e e<(re% de &ro'a'!" c7
    cons+%+" va esca"ada ra&!d, s! d!n no+ vor a&are &ro'"e%e ser!oase C"!n!ae%! a+
    adesea !%&res!a erona(7 c7 de&enden(a s! a'+/+" de a"coo" s+n( (+"'+r7r!
    !n(ra(a'!"e, 'a/And+4se &e .a&(+" c7 (o=! ce! care se &re/!n(7 &en(r+ (ra(a%en( a+ de
    re$+"7 +n !s(or!c de %+"=! an! de &ro'"e%e severe :n "e$7(+r7 c+ a"coo"+" :ns7,
    aces(e ce"e %a! severe ca/+r! re&re/!n(7 n+%a! +n %!c &rocen( de !nd!v!/! c+
    de&enden(7 sa+ a'+/ de a"coo", &ersoana (!&!c7 c+ (+"'+rare da(ora(7 +/+"+! de
    a"coo" avAnd +n &ro$nos(!c %+"( %a! &ro%!=7(or S(+d!!"e ca(a%nesce e.ec(+a(e &e
    !nd!v!/! c+ +n :na"( n!ve" de .+nconare !nd!c7 +n &rocen( de a's(!nen(7 de " an de
    &es(e RYd d+&7 (ra(a%en( C!ar &r!n(re !nd!v!/!! %a! &+=!n ac(!v! s! .7r7 "oc+!n=7
    c+ de&enden(7 a"ccoo"!c7 s! care +r%ea/7 +n &ro$ra% de (ra(a%en( n+ %a! &+=!n
    de RLd s+n( a's(!nen=! "a (re! "+n! s! IYd "a +n an Un+ !nd!v!/! E&oa(e 9Ld sa+ %a!
    %+"(J c+ de&enden(7 de a"coo" ca&7(7 o so'r!e(a(e de "+n$7 d+ra(7, c!ar .7r7
    (ra(a%en( ac(!v
    C!ar :n c+rs+" +ne! !n(o<!ca=!! +Ooare c+ a"coo", es(e &os!'!" s7 .!e o'serva(e
    d!verse s!%&(o%e :n d!.er!(e &er!oade de (!%& La :nce&+(+" &er!oade! de '7+(,
    cAnd concen(ra=!!"e de a"coo" d!n sAn$e s+n( cresc+(e s!%&(o%e"e !nc"+d adesea,
    "ocvac!(a(ea, sen/a=!a de '!ne s! o d!s&o/!=!e e+.or!c7, e<&ans!v7 Ma! (Ar/!+, :n
    s&ec!a" cAnd concen(ra=!!"e de a"coo" d!n sAn$e scad, !nd!v!d+" dev!ne &ro$res!v %a!
    de&res!v, re(ras s! de(er!ora( co$n!(!v La concen(ra=!! .oar(e %An de a"coo" :n sAn$e
    Ede e< , 9LL4;LL %$Xd"J es(e .oar(e &os!'!" ca +n !nd!v!d non(o"eran( s7 adoar%7 s!
    s7 !n(re :n &r!%+" s(ad!+ de anes(e/!e Concen(ra=!!"e s! %a! %An de a"coo" :n sAn$e
    Ede e< , de &es(e ;LL4ILL %$Xd"J &o( ca+/a !n!'area res&!ra=!e! s! &+"s+"+!, s! c!ar
    %oar(ea, "a !nd!v!/!! non(o"eran(! D+ra(a !n(o<!ca=!e! de&!nde de ca( de %+"( a"coo"
    a .os( cons+%a( s! :n ce &er!oad7 de (!%& In $enera", cor&+" es(e ca&a'!" s7
    %e(a'o/e/e a&ro<!%a(!v +n &aar &e or7 as(.e" c7 concen(ra=!a de a"coo" d!n
    sAn$e scade :n(r4+n r!(% de 5Y49L %$X%" &e or7 Se%ne"e s! s!%&(o%e"e !n(o<!ca=!e!
    es(e &os!'!" s7 .!e %a! !n(ense cAnd concen(ra=!a de a"coo" :n sAn$e cres(e, decA(
    a(+nc! cAnd scade
    #attern $amilial
    De&enden(a de a"coo" are adesea +n &a((ern .a%!"!a", s! se es(!%ea/7 c7 IL4RLd
    d!n var!an(a r!sc+"+! es(e e<&"!ca(7 &r!n !n."+en(e $ene(!ce R!sc+" de de&enden(7
    a"coo"!c7 es(e de (re! &An7 "a &a(r+ or! %a! %are "a r+de"e a&ro&!a(e a"e oa%en!"or
    c+ de&enden(7 a"coo"!c7 R!sc+" %a! %are es(e asoc!a( c+ +n n+%7r %a! %are de
    r+de a.ec(a(e, c+ re"a=!! $ene(!ce %a! s(rAnse s! c+ sever!(a(ea &ro'"e%e"or :n
    "e$7(+r7 c+ a"coo"+" "a r+de"e a.ec(a(e Ce"e %a! %+"(e s(+d!! a+ cons(a(a( +n r!sc
    se%n!.!ca(!v %a! %are de de&enden(7 a"coo"!c7 "a $e%en+" %ono/!$o( decA( "a ce"
    999
    Tulburrile "n le!tur cu o Substan
    d!/!$o( a" +ne! &ersoane c+ de&enden(7 de a"coo" S(+d!!"e &e ado&(a=! a+ reve"a( o
    creO(ere a r!sc+"+! de de&enden(7 de a"coo" de (re!, &a(r+ or! "a co&!!! !nd!v!/!"or c+
    de&enden(7 de a"coo", cAnd aceO(! co&!! a+ .os( ado&(a=! de "a naO(ere s! cresc+=! de
    &7r!n=! care n+ a+ aceas(7 (+"'+rare C+ (oa(e aces(ea :ns7, .ac(or!! $ene(!c! e<&"!c7
    n+%a! o &ar(e a r!sc+"+! de de&enden(7 a"coo"!c7, o &ar(e se%n!.!ca(!v7 a r!sc+"+!
    ven!nd d!n .ac(or!! a%'!en(a"! sa+ !n(er&ersona, care &o( !nc"+de a(!(+d!n!"e
    c+"(+ra"e .a(7 de '7+( s! 'e=!e, acces!'!"!(a(ea a"coo"+"+! E!nc"+s!v &re=+"J, e<&ec(a(n"e
    de "a e.ec(+" a"coo"+"+! as+&ra d!s&o/!=!e! s! co%&or(a%en(+"+!, e<&er!en=e"e
    &ersona"e c7&7(a(e c+ a"coo"+", s! s(res+"
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$ 9LH T+"'+r7r!"e !nd+se de a"coo" &o( .! carac(er!/a(e &r!n
    s!%&(o%e Ede e<, d!s&o/!=!e de&res!v7J care sea%7n7 c+ (+"'+r7r!"e %en(a"e
    &r!%are Ede e<, (+"'+rarea de&res!v7 %a@or7 vers+s (+"'+rarea a.ec(!v7 !nd+s7 de
    a"coo", c+ e"e%en(e de&res!ve, c+ de'+( :n c+rs+" !n(o<!ca=!e!J 3e/! &a$ 95L &en(r+
    d!sc+(area d!a$nos(!c+"+! d!.eren=!a"
    Incoordonarea s! de(er!orarea @+dec7=!! asoc!a(e c+ !n(o<!ca=!a a"coo"!c7 sea%7n7
    c+ s!%&(o%e"e an+%!(or cond!=!! %ed!ca"e $enera"e Ede e<, ac!do/a d!a'e(!c7,
    a(a<n"e cere'e"oase s! a"(e cond!=!! ne+ro"o$!ce, c+% ar .! sc"ero/a %+"(!&"7J :n %od
    s!%!"ar, s!%&(o%e"e a's(!nen(e! a"coo"!ce &o( .! %!%a(e de an+%!(e cond!=!!
    %ed!ca"e $enera"e Ede e<, de !&o$"!ce%!e s! ce(oac!do/a d!a'e(!c7J Tre%or+"
    esen=!a", o (+"'+rare care c!rc+"7 .recven( &r!n +ne"e .a%!"!!, &oa(e s+$era (re%or+"
    asoc!a( c+ a's(!nen(a de a"coo"
    In(o<!ca=!a a"coo"!c7 Ec+ e<ce&=!a a"ene! a"coo"!ceJ sea%7n7 %+"( c+ !n(o<!ca=!a
    c+ seda(!ve, !&no(!ce sa+ an<!o(!ce. Pre/en(a a"coo"+"+! :n aer+" e<&!ra( n+
    e<c"+de &r!n s!ne !n(o<!ca=!!"e c+ a"(e s+'s(an=e, deoarece %+"(e s+'s(an=e n+ de
    &+=!ne or! s+n( +(!"!/a(e conco%!(en( DeO! !n(o<!ca=!a, "a +n %o%en( da( :n c+rs+"
    v!e=!!, es(e &os!'!" s7 .!e o &ar(e a !s(or!c+"+! ce"or %a! %+"=! !nd!v!/! care 'ea+
    a"coo", cAnd aces( .eno%en s+rv!ne re$+"a( sa+ ca+;ea;6 de(er!orare, es(e !%&or(an(
    de "+a( :n cons!dera=!e &os!'!"!(a(ea +n+! d!a$nos(!c de de&enden=7 sa+ a'+/ de
    a"coo" A's(!nen=a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce &rod+ce +n s!ndro%
    .oar(e ase%7n7(or c+ a's(!nen(a de a"coo"
    In(o<!ca=!a a"coo"!c7 s! a's(!nen(a a"coo"!c7 se d!s(!n$ de a"(e (+"'+r7r! !nd+se de
    a"coo" Ede e<, de (+"'+rarea an<!oas7 !nd+s7 de a"coo", c+ de'+( :n c+rs+"
    a's(!nen(e!J, deoarece s!%&(o%e"e d!n aces(e d!n +r%7 (+"'+r7r! s+n( :n e<ces .a=7
    de ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a a"coo"!c7 sa+ c+ a's(!nen(a a"coo"!c7 s! s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 In(o<!ca=!a a"coo"!c7
    !d!os!ncra(!c7, de.!n!(7 ca o %od!.!care co%&or(a%en(a"7 %arca(7, de re$+"7
    a$res!v!(a(e, +r%And !n$es(!e! +ne! %!c! can(!(7=! de a"coo", era !nc"+s7 :n DSM4III4R
    D!n ca+/a s+&or(+"+! "!%!(a( d!n "!(era(+r7 &en(r+ va"!d!(a(ea aces(e! cond!=!!, ea n+
    %a! es(e !nc"+s7 ca +n d!a$nos(!c se&ara( :n DSM4I3 As(.e" de (a'"o+r! c"!n!ce
    (re'+!e s7 .!e d!a$nos(!ca(e ce" %a! &ro'a'!" ca !n(o<!ca=!e a"coo"!c7 or! ca (+"'+rare
    :n "e$7(+r7 c+ a"coo"+" .7r7 a"(7 s&ec!.!ca=!e
    76E 87 Tulburare "n le!tura cu Alcoolul 'r Alt Speci$icaie 774
    C5*.>C Tul-urare .n le/(tur( #u Al#oolul
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ a"coo"+" .7r7 a"(7 s&ec!.!ca=!e es(e re/erva(7
    (+"'+r7r!"or asoc!a(e c+ +/+" de a"coo" care n+ &o( .! c"as!.!ca(e ca de&enden(7 de
    a"coo", a'+/ de a"coo", !n(o<!ca=!e a"coo"!c7, a's(!nen(7 a"coo"!c7, de"!n+% &r!n
    !n(o<!ca=!e a"coo"!c7, de"!n+% &r!n a's(!nen(7 de a"coo", de%en(7 &ers!s(en(7 !nd+s7
    de a"coo", (+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de a"coo", (+"'+rare &s!o(!c7
    !nd+s7 de a"coo", (+"'+rare a.ec(!v7 !nd+s7 de a"coo", (+"'+rare an<!oas7 !nd+s7 de
    a"coo", d!s.+nc(!e se<+a"7 !nd+s7 de a"coo" sa+ (+"'+rare de so%n !nd+s7 de a"coo"
    Tul-ur(rile .n le/(tur( #u A"%eta"ina
    3&au #u Su-&tan!e Si"ilare6
    C"asa a%.e(a%%e! s! a s+'s(an=e"or s!%!"are a%.e(a%%e! !nc"+de (oa(e
    s+'s(an=e"e c+ s(r+c(+r7 .en!"e(!"a%%!c7 s+'s(!(+!(7, c+% ar .! a%.e(a%!na,
    de<(roa%.e(a%!na s! %e(a%.e(a%%a ESs&eedTJ Ev!(e/7J De ase%enea, %a! s+n(
    !nc"+se ace"e s+'s(an=e care s+n( d!.er!(e s(r+c(+ra", dar care a+ o ac=!+ne s!%!"ar7
    a%.e(a%%e!, c+% ar .! %e(!".e%da(+" s! a"=! a$en=! +(!"!/a=! ca s+&r!%an a!
    a&e(!(+"+! ES&!"+"e de d!e(7 J Aces(e s+'s(an=e s+n( "+a(e de re$+"7 ora" sa+
    ad%!n!s(ra(e !n(ravenos, deO! %e(a%.e(a%!na es(e "+a(7, de ase%enea, s! &e ca"e
    nasa"7 ES&r!/a(TJ O .or%7 .oar(e &+r7 de %e(a%.e(a%%a es(e den+%!(7 S!ceT
    E$!a(7J d!n ca+/a as&ec(+"+! cr!s(a"e"or sa"e cAnd s+n( v7/+(e %7r!(e s+' "+&7
    Da(or!(7 %an! sa"e &+r!(7=! s! &+nc(+"+! de _a&or!/are re"av sc7/+(, ,,!ce2 &oa(e .!
    .+%a(7 &en(r+ a &rod+ce +n e.ec( s(!%+"an( &+(ern!c s! !%ed!a( EaOa c+% se .ace c+
    coca!na Scrac)T E(r7sne(JJ Pe "An$7 co%&+O!! s!n(e(!c! s!%!"ar! a%.e(a%!ne!, e<!s(7
    s(!%+"an(e na(+ra"e der!va(e d% &"an(e, c+% ar .! )a(+" E.r+n/e"e &"an(e!J, care
    &oa(e &rod+ce a'+/ sa+ de&enden(7 Con(rar coca!ne!, care es(e a&roa&e (o(dea+na
    &roc+ra(7 de &e &!a=a !"e$a"7, a%.e(a%!na s! a"(e s(!%+"an(e &o( .! o'=!n+(e &e 'a/7
    de &rescr!&=!e %ed!ca"7 &en(r+ (ra(a%en(+" o'e/!(7=!!, (+"'+r7% !&erac(!4
    v!(a(eXde.!c!( de a(en=!e s! narco"e&s!e! S(!%+"an(e"e &rescr!se a+ .os( cAndva
    dev!a(e &e &!a=a !"e$a"7, adesea :n con(e<(+" +nor &ro$ra%e de con(ro" a" $re+(7=!!
    Ce"e %a! %+"(e e.ec(e a"e a%.e(a%%e"or s! dro$+r!"or s!%!"are a%.e(a%%e! s+n(
    ase%7n7(oare c+ ce"e a"e coca!ne! :ns7, con(rar coca!ne!, aces(e s+'s(an=e n+ a+
    ac(!v!(a(e anes(e/!c7 "oca"7 Erec(e, cana" !on!c de %e%'ran7J, de aceea, nsc+" "or de
    a !nd+ce an+%!(e cond!=!! %ed!ca"e $enera"e Ede e<, an(%n card!ace s! cr!/e
    e&!"e&(!ceJ &oa(e .! %a! red+s E.ec(e"e &s!oac(!ve a"e ce"or %a! %+"(e s+'s(an=e
    s!%!"are a%.e(a%%e! d+rea/7 %a! %+"( decA( ce"e a"e coca!ne!, !ar e.ec(e"e
    s!%&a(o%!%e(!ce &er!.er!ce &o( .! %a! &+(ern!ce
    Aceas(7 sec=!+ne con=!ne d!sc+=!! care s+n( s&ec!.!ce (+"'+r7r!"or :n "e$7(+r7 c+
    a%.e(a%!na Te<(+" s! se(+r!"e de cr!(er!! a+ .os( de@a &re/en(a(e "a as&ec(e"e
    $enera"e a"e de&enden(e! de o s+'s(an=7 E&a$ 5F9J s! a'+/+"+! de o s+'s(an=7
    E&a$ 5FGJ, care se a&"!c7 (+(+ror s+'s(an=e"or Te<(e"e s&ec!.!ce de&enden(e! s!
    a'+/+"+! de a%.e(a%!na s+n( &re/en(a(e %a! @os, n+ e<!s(7 :ns7 se(+r! de cr!(er!!
    s&ec!.!ce s+&"!%en(are &en(r+ de&enden(a de a%.e(a%!na sa+ &en(r+ a'+/+" de
    a%.e(a%!na Te<(e"e s! se(+r!"e de cr!(er!! s&ec!.!ce &en(r+ !n(o<!ca=!a c+ a%.e(a%!na
    s! &en(r+ a's(!nen(a de a%.e(a%!na s+n( &rev7/+(e, de ase%enea, %a! @os
    99I
    Tulburrile "n le!tur cu o Substan

    T+"'+r7r!"e !nd+se de a%.e(a%!na Ea"(e"e decA( !n(o<!ca=!a s! a's(!nen=a de
    a%.e(a%!naJ s+n( descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care
    a+ co%+n7 .eno%eno"o$!a Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de a%.e(a%!na es(e
    !nc"+s7 :n sec=!+nea ST+"'+r7r!"e a.ec(!veTJ. Ma! @os s+n( %en=!ona(e (+"'+r7r!"e
    +/+"+! de a%.e(a%!na s! (+"'+r7r!"e !nd+se de a%.e(a%!na.
    Tulburrile u(ului de am$etamina
    ;LI.IL De&enden=a de a%.e(a%!na Eve/! &a$. 99IJ
    ;LY.HL A'+/+" de a%.e(a%!na Eve/! &a$. 99YJ
    Tulburrile induse de am$etamina
    9F9.GF In(o<!ca=!a c+ a%.e(a%!na Eve/! &a$. 99RJ. 0e speci)icat dac6? C+
    &er(+r'7r! de &erce&=!e
    9F9.LL A's(!nen=a de a%.e(a%!na Eve/! &a$. 99HJ 9F9.G5
    De"!r!+%+" &r!n !n(o<!ca=!e c+ a%.e(a%!na Eve/! &a$. 5I;J
    292.11 T+"'+rarea &s!o(!c7 !nd+s7 de a%.e(a%!na, c+ !de! de"!ran(e Eve/!
    &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    292.12 T+"'+rarea &s!o(!c7 !nd+s7 de a%.e(a%!na, c+ a"+c!na=!! Eve/!
    &a$. ;;GJ 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GI T+"'+rarea a.ec(!v7 !nd+s7 de a%.e(a%!na Eve/! &a$. ;;GJ. 0e
    speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+"
    a's(!nen=e!
    F9.GF T+"'+rarea an<!oas7 !nd+s7 de a%.e(a%!na Eve/! &a$. IHFJ. 0e
    speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GF D!s.+nc=!a se<+a"7 !nd+s7 de a%.e(a%!na Eve/! &a$. YR9J. 0e
    speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GF T+"'+rarea de so%n !nd+s7 de a%.e(a%!na Eve/! &a$. RYYJ. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.F T+"'+rare :n "e$7(+r7 c+ a%.e(a%!na .7r7 a"(7 s&ec!.!ca=!e Eve/!
    &a$. 9;5J
    Tulburrile !"ului #Ae #mfetamina
    4+7.7+ Depen$en!a $e A"%eta"ina
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7
    Eve/! &a$. 5F9J. Pa((ern+r!"e de +/ O! de evo"+=!e a"e de&enden=e! de a%.e(a%!na
    s+n( s!%!"are c+ ce"e a"e de&enden=e! de coca!n7, deoarece a%'e"e s+'s(an=e s+n(
    s(!%+"an(e &+(ern!ce a"e s!s(e%+"+! nervos cen(ra", c+ e.ec(e &s!oac(!ve s!
    s!%&a(o%!%e(!ce s!%!"are, :ns7, a%.e(a%!ne"e a+ o d+ra(7 de ac=!+ne %a! %are
    decA( coca!na s!, ca a(are, s+n( a+(oad%!n!s(ra(e %a! &+=!n .recven(. Ca s! :n
    de&enden=a de coca!n7, +/+" &oa(e .! cron!c sa+ e&!sod!c, c+ e<cese ESs&eed r+nsTJ
    &+nc(a(e de sc+r(e &er!oade de so'r!e(a(e. Co%&or(a%en(+" a$res!v sa+ v!o"en( es(e
    asoc!a( c+ de&enden=a de a%.e(a%!na, :n s&ec!a" cAnd do/e %ar! s+n( .+%a(e Ede
    e<., S!ceTJ sa+ ad%!n!s(ra(e !n(ravenos. Ca s! :n ca/+" coca!ne!, adesea es(e
    o'serva(7 o an<!e(a(e !n(ens7, dar (e%&orar7, se%7nAnd c+ &an!ca sa+ c+
    an<!e(a(ea
    45A2?5 Abu(ul de
    Am$etamina
    99Y
    $enera"!/a(7, &rec+% s! o !dea(!c &arano!d7 O! e&!soade &s!o(!ce care sea%7n7 c+
    sc!/o.ren!a, (!&+" &arano!d, :n s&ec!a" :n asoc!ere c+ +/+" :n do/7 %are. S(7r!"e de
    a's(!nen=7 s+n( asoc!a(e adesea c+ s!%&(o%e de&res!ve (e%&orare, dar !n(ense, care
    &o( se%7na c+ +n e&!sod de&res!v %a@or. To"eran=a "a a%.e(a%!ne se de/vo"(7
    adesea, d+cAnd "a esca"adarea s+'s(an=!a"7 a do/e!. Invers, +n!! !nd!v!/! c+
    de&enden=7 de a%.e(a%!na, de/vo"(7 sens!'!"!/are, care es(e carac(er!/a(7 &r!n
    creO(erea cons!dera'!"7 a e.ec(e"or +r%And ad%!n!s(r7r!"or re&e(a(e, :n aces(e
    ca/+r!, do/e %!c! &o( &rod+ce e.ec(e s(!%+"an(e %arca(e, &rec+% s! a"(e e.ec(e
    %en(a"e O! ne+ro"o$!ce adverse.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! a&"!ca=! d!a$nos(!c+"+! de
    de&enden=7 a%.e(a%!na Eve/! &a$. 5FY &en(r+ %a! %+"(e de(a"!!JQ C+
    de&enden=7 .!/!o"o$!c7 F7r7 de&enden=7 .!/!o"o$!c7
    Re%!s!+ne co%&"e(7 &recoce
    Re%!s!+ne &ar=!a"7 &recoce
    Re%!s!+ne co%&"e(7
    &re"+n$!(7 Re%!s!+ne &ar=!a"7
    &re"+n$!(7 :n(r4+n %ed!+
    con(ro"a(
    de
    4+<.G+ A-u)ul $e A"%eta"ina
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7
    Eve/! &a$. 5FGJ. C!ar O! !nd!v!/!! a" c7ror &a((ern de +/ n+ sa(!s.ace cr!(er!!"e
    &en(r+ de&enden(7 &o( &re/en(a n+%eroase &ro'"e%e :n "e$7(+r7 c+ aces(e
    s+'s(an=e. D!.!c+"(7=!"e "e$a"e a&ar de re$+"7 ca re/+"(a( a" co%&or(a%en(+"+!
    d!n (!%&+" cA( !nd!v!d+" es(e !n(o<!ca( c+ a%.e(a%!ne E:n s&ec!a",
    co%&or(a%en(+" a$res!vJ, ca o consec!n=7 a o'=!ner!! dro$+"+! &e &!a=a !"e$a"7
    sa+ ca re/+"(a( a" &osed7r!! sa+ +/+"+! de dro$. Oca/!ona", !nd!v!/!! c+ a'+/ de
    a%.e(a%!na se an$a@ea/7 :n ac(e !"e$a"e Ede e<., &rod+cerea de a%.e(a%!na, .+r(J
    &en(r+ a o'=!ne dro$+"8 aces( co%&or(a%en( es(e %a! .recven( :ns7 "a ce! c+
    de&enden=7. Ind!v!/!! &o( con(!n+a s7 .ac7 +/ de s+'s(an=7 :n d!s&re=+" .a&(+"+!
    c7 O(!+ c7 aces(a d+ce "a cer(+r! c+ %e%'r!! .a%!"!e! :n (!%& ce !nd!v!d+" es(e
    !n(o<!ca( sa+ &re/!n(7 +n e<e%&"+ ne$a(!v co&!!"or sa+ a"(or %e%'r!! de .a%!"!e
    a&ro&!a=!. CAnd aces(e &ro'"e%e s+n( :nso=!(e de &ro'a (o"eran=e!, a's(!nen=e!
    sa+ co%&or(a%en(+"+! co%&+"s!v, (re'+!e "+a( :n cons!dera=!e %a! c+rAnd
    d!a$nos(!c+" de de&enden=7 de a%.e(a%!na decA( ce" de a'+/. Deoarece +ne"e
    s!%&(o%e de (o"en=7, de a's(!nen=7 sa+ a'+/ &o( s+rven! "a !nd!v!/!! c+ a'+/,
    dar n+ c+ de&enden=7, es(e !%&or(an( s7 se &rec!/e/e dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e co%&"e(e &en(r+ de&enden=7.
    99R
    Tulburrile "n le!tur cu o Substan

    Tulburrile induse de #mfetamina
    C5C.>5 Into,i#a!ia #u A"%eta"ina
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ a%.e(a%!na :" cons(!(+!e
    &re/en=a de %od!.!c7r! de/ada&(a(!ve co%&or(a%en(a"e s! &s!o"o$!ce
    se%n!.!ca(!ve c"!n!c, care a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7 +/+" de
    a%.e(a%!na sa+ de o s+'s(an=7 s!%!"ar7 E cr!(er!!"e A s! BJ. In(o<!ca=!a c+
    a%.e(a%!na :nce&e de re$+"7 c+ sen/a=!a de Se<a"(areT +r%a(7 de a&ar!=!a de
    s!%&(o%e, &rec+% e+.or!a c+ v!$oare cresc+(7, $re$ar!(a(ea, !&erac(!v!(a(ea,
    ne"!n!O(ea, !&erv!$!"!(a(ea, s+sce&(!'!"!(a(ea !n(er&ersona"7, "ocvac!(a(ea,
    an<!e(a(ea, (ens!+nea, a"er(a, $randoarea, co%&or(a%en(+" s(ereo(!& O! re&e(!(!v,
    s(area co"eroas7, :nc7!er7r!"e s! de(er!orarea @+dec7=!!, :n ca/+" !n(o<!ca=!e! cron!ce,
    &oa(e e<!s(a a&"a(!/are a.ec(!v7 c+ .a(!$a'!"!(a(e sa+ (r!s(e=e s! re(ra$ere soc!a"7.
    Aces(e %od!.!c7r! co%&o(a%en(a"e O! &s!o"o$!ce s+n( aco%&an!a(e de do+7 sa+
    %a! %+"(e d!n(re +r%7(oare"e se%ne s! s!%&(o%eQ (a!card!e sa+ 'rad!card!e,
    d!"a(a=!e &+&!"ar7, creO(erea sa+ sc7derea &res!+n!! san$+!ne, (rans&!ra=!e sa+
    sen/a=!e de .r!$, $rea=7 sa+ vo%7, &!erdere ev!den(7 :n $re+(a(e, a$!(a=!e sa+
    "en(oare &s!o%o(or!e, sc7derea .or=e! %+sc+"are, de&r!%are res&!ra(or!e,
    &record!a"$!! sa+ ar!(%!! card!ace, con.+/!e, cr!/e e&!"e&(!ce, d!s)!ne/!!, d!s(on!! sa+
    co%7 Ecr!(er!+" CJ. In(o<!ca=!a c+ a%.e(a%!na, .!e ac+(7 sa+ cron!c7, se asoc!a/7
    adesea c+ de(er!orarea .+nc=!on7r!! soc!a"e sa+ &ro.es!ona"e. S!%&(o%e"e n+
    (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e s! s7 n+ .!e e<&"!ca(e %a!
    '!ne de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" DJ. Ma$n!(+d!nea s! %an!.es(7r!"e
    %od!.!c7r!"or co%&or(a%en(a"e O! .!/!o"o$!ce de&!nd de do/a +(!"!/a(7 s! de
    carac(er!s(!c!"e !nd!v!d+a"e a"e &ersoane! care +/ea/7 de s+'s(an=7 Ede e<.,
    (o"eran=a, r!(%+" de a'sor'=!e, cron!c!(a(ea +/+"+!J. Mod!.!c7r!"e asoc!a(e c+
    !n(o<!ca=!a :nce& de re$+"7 :n dec+rs de cA(eva %!n+(e E+neor! c!ar :n dec+rs de
    cA(eva sec+ndeJ, dar &o( s+rven! s! :n dec+rs de &An7 "a o or7, :n .+nc=!e de dro$+"
    s&ec!.!c s! de %e(oda de ad%!n!s(rare.
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( +n+! d!a$nos(!c de !n(o<!ca=!e c+
    a%.e(a%!naQ
    C+ &er(+r'are de &erce&=!e. Aces( s&ec!.!can( &oa(e .! %en=!ona( cAnd
    a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 sa+ !"+/!! v!/+a"e, a+d!(!ve or! (ac(!"e
    s+rv!n :n a'sen=a +n+! de"!r!+%. Testarea realit6(ii intact6 :nsea%n7 c7
    &ersoana O(!e c7 a"+c!na=!!"e s+n( !nd+se de s+'s(an=7 s! n+ re&re/!n(7
    rea"!(a(ea e<(ern7. CAnd a"+c!na=!!"e s+rv!n :n a'sen=a +ne! test6ri a realit6(ii
    !n(ac(e, (re'+!e "+a( :n cons!dera=!e d!a$nos(!c+" de (+"'+rare &s!o(!c7
    !nd+s7 de o s+'s(an=7, c+ a"+c!na=!!.
    767255 Abstinenta de
    Am$etamina
    99H
    Criteriile $e $ia/no&ti# pentru C5C.
    >5 Into,i#a!ia #u A"%eta"ina
    A2 .( recent de am$etamina sau de o substan a$in &de ex2 metil$enidat)2
    S2 Modi$icri psi%olo!ice sau comportamentale de(adaptative semni$icative
    clinic &de ex2 eu$orie sau aplati(are a$ectiv, modi$icare de sociabilitate,
    %ipervi!ilitate, sensibilitate interpersonal, anxietate, tensiune sau m@nie,
    comportamente stereotipe, deteriorarea 0udecii sau deteriorarea $uncio
    nrii sociale sau pro$esionale) care apar "n cursul sau scurt timp dup u(ul
    de am$etamina sau de o substan a$in2
    2 Dou &sau mai multe) dintre urmtoarele apr@nd "n cursul sau la scurt timp
    dup u(ul de am$etamina sau de o substan a$inD
    &E) ta%icardie sau bradicardie3
    &7)dilataie pupilar3
    &4) cre,terea sau scderea presiunii san!uine3
    &H)transpiraii sau $risoane3
    (5) !rea sau vom3
    (6) pierdere evident "n !reutate3
    (7) a!itaie sau lentoare psi%omotorie3
    (5) scderea $orei musculare, depresie respiratorie, precordial!ie sau
    aritmii
    cardiace3
    (8) con$u(ie, convulsii, disCine(ii, distonii sau com2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental2
    De speci"icat dac'
    u perturbri de percepie
    C5C.++ A-&tinen!a $e A"%eta"ina
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a's(!nen(a de o s+'s(an=7
    Eve/! &a$. 9L5J. E"e%en(+" esen=!a" a" a's(!nen=e! de a%.e(a%!na :" cons(!(+!e
    &re/en=a +n+! s!ndro% de a's(!nen=7 carac(er!s(!c care a&are :n dec+rs de cA(eva ore
    &An7 "a cA(eva /!"e d+&7 :nce(area Esa+ red+cereaJ +/+"+! e<ces!v s! &re"+n$!( de
    a%.e(a%!na Ecr!(er!!"e A O! BJ. S!%&(o%e"e de a's(!nen=7 s+n( :n $enera" o&+s+"
    ce"or v7/+(e :n c+rs+" !n(o<!ca=!e!. S!ndro%+" de a's(!nen=7 es(e carac(er!/a( &r!n
    a&ar!=!a +ne! d!s&o/!=!! d!s.or!ce s! a do+7 sa+ %a! %+"(e d!n(re +r%7(oare"e
    %od!.!c7r! .!/!o"o$!ceQ .a(!$a'!"!(a(e, v!se v!! O! ne&"7c+(e, !nso%n!e sa+
    !&erso%n!e, creO(erea a&e(!(+"+! O! a$!(a=!e sa+ "en(oare &s!o%o(or!e. Anedon!a
    s! dor!n=a arden(7 de dro$ &o( .! &re/en(e, dar n+ s+n( &ar(e a cr!(er!!"or de
    d!a$nos(!c. S!%&(o%e"e ca+/ea/7 de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n
    do%en!+" soc!a" or! &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare
    Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e
    s! s7 n+ .!e e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7.
    S!%&(o%e"e de a's(!nen=7 %arca(7 EScras!n$TJ +r%ea/7 adesea d+&7 +n e&!sod
    de +/ !n(ens de do/e %ar! Eo Ss&eed r+nTJ. Aces(e &er!oade s+n( carac(er!/a(e &r!n
    sen(!%en(e !n(ense s! ne&"7c+(e de "as!(+d!ne s! de&res!e, care cer :n $enera" %a!
    22= Tulburrile "n le!tur cu o Substan

    %+"(e /!"e de re&a+s s! rec+&erare. P!erderea :n $re+(a(e s+rv!ne .recven( :n c+rs+"
    +/+"+! e<ces!v de s(!%+"an(e, &e cAnd o creO(ere %arca(7 a a&e(!(+"+! c+ &"+s
    &ondera" ra&!d es(e o'serva(7 adesea :n c+rs+" a's(!nen=e!. S!%&(o%e"e de&res!ve
    &o( d+ra %a! %+"(e /!"e O! &o( .! aco%&an!a(e de !dea=!e s+!c!d!ar7. I%ensa
    %a@or!(a(e a !nd!v!/!"or c+ de&enden=7 de a%.e(a%!ne a+ e<&er!en(a( +n s!ndro%
    de a's(!nen=7 "a +n %o%en( da( :n v!a=a "or s! ca a(are (o=! re"a(ea/7 (o"eran=a.
    Criteriile $e $ia/no&ti# pentru
    C5C.+ A-&tinen!a $e A"%eta"ina
    A2 "ncetarea &sau reducerea) u(ului de am$etamina &sau de o substan a$in),
    u( care a $ost excesiv si prelun!it2
    S2 Dispo(iie dis$oric ,i dou &sau mai multe) dintre urmtoarele modi$icri
    psi%olo!ice apr@nd "n decurs de c@teva ore sau (ile dup criteriul AD
    &l)$ati!abilitate3
    (2) vise vii, neplcute3
    (3) insomnie sau %ipersomnie3
    (4) cre,terea apetitului3
    (5) lentoare sau a!itaie psi%omotorie2
    2 Simptomele de la criteriul S cau(ea( o detres sau deteriorare semni$icativ
    clinic "n $uncionarea social sau pro$esional sau "n alte domenii impor
    tante de $uncionare2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental2
    Alte Tul-ur(ri in$u&e $e A"%eta"ina
    Ur%7(oare"e (+"'+r7r! !nd+se de a%.e(a%!na s+n( descr!se :n sec=!+n!"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ de"!r!+%+"
    &r!n !n(o<!ca=!e c+ a%.e(a%!na E&a$. 5I;J, (+"'+rarea &s!o(!c7 !nd+s7 de
    a%.e(a%!na E&a$. ;;GJ, (+"'+rarea a.ec(!v7 !nd+s7 de a%.e(a%!na E&a$. ILYJ,
    (+"'+rarea an<!oas7 !nd+s7 de a%.e(a%!na E&a$. IHFJ, d!s.+nc=!a se<+a"7 !nd+s7
    de a%.e(a%!na E&a$. YR9J, (+"'+rarea de so%n !nd+s7 de a%.e(a%!na E&a$. RYYJ.
    Aces(e (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ a%.e(a%!na sa+ a"
    a's(!nen=e! de a%.e(a%!na, n+%a! cAnd s!%&(o%e"e s+n( :n e<ces :n ra&or( c+ ce"e
    asoc!a(e de re$+"7 c+ !n(o<!ca=!a sa+ a's(!nen=a de a%.e(a%!na O! cAnd s!%&(o%e"e
    s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    $nformaii sulimentare desre Tulburrile %n
    le&tur cu #mfetamina
    *lemente si tulburri asociate
    In(o<!ca=!a ac+(7 c+ a%.e(a%!na es(e asoc!a(7 +neor! c+ "!%'a@ d!va$an(, !de! de
    re.er!n=7 (ran/!(or!! s! (!n!(+s. :n c+rs+" !n(o<!ca=!e! !n(ense c+ a%.e(a%!na &o( .!
    Tulburrile "n le!tur cu
    Am$etamina
    224
    e<&enen(a(e !dea(!e &arano!d7, a"+c!na=!! a+d!(!ve &e .ond+" +n+! senson+% c"ar s!
    a"+c!na=!! (ac(!"e Ede e< .+rn!c7(+r! s! sen/a=!a de $Andac! s+' &!e"eJ Frecven(,
    &ersoana care +/ea/7 de s+'s(an=7 rec+noaO(e c7 aces(e s!%&(o%e s+n( re/+"(a(+"
    s(!%+"an(e"or Poa(e s+rven! o s(are co"eroas7 e<(re%7 c+ a%en!n=7r! sa+ (recere "a
    ac=!+ne &r%(r4+n co%&or(a%en( a$res!v Mod!.!c7r!"e de d!s&o/!=!e, c+% ar .!
    de&res!a c+ !de! de s+!c!d, !n(a'!"!(a(ea, anedon!a, "a'!"!(a(ea e%o=!ona"7 sa+
    (+"'+r7r!"e de a(en=!e s! de concen(rare s+n( co%+ne, :n s&ec!a" :n c+rs+" a's(!nen(e!
    P!erderea :n $re+(a(e, ane%!a s! a"(e se%ne de %a"n+(n(!e s! de de(enorare a !$!ene!
    &ersona"e s+n( adesea v7/+(e :n de&enden(a &re"+n$!(7 de a%.e(a%!na
    T+"'+r7r!"e :n "e$7(+r7 c+ a%.e(a%!na s! (+"'+r7r!"e :n "e$7(+r7 c+ a"(e
    s(!%+"an(e s+n( asoc!a(e adesea c+ de&enden(a sa+ a'+/+" de a"(e s+'s(an=e, :n
    s&ec!a" de ce"e c+ &ro&r!e(7=! seda(!ve Ec+% ar .! a"coo"+" sa+ 'en/od!a/e&%e"eJ,
    care s+n( "+a(e de re$+"7 &en(r+ a red+ce sen/a=!!"e ne&"7c+(e de Snervo/!(a(eT
    re/+"(And d% e.ec(e"e dro$+r!"or s(!%+"an(e
    Da(e"e de "a'ora(or s! da(e"e e<a%!n7% so%a(!ce, &rec+% s! (+"'+r7r!"e %en(a"e
    s! cond!=!!"e %ed!ca"e $enera"e care s+n( asoc!a(e c+ (+"'+r7r!"e :n "e$7(+r7 c+
    a%.e(a%!na s+n( :n $enera" s!%!"are c+ ce"e asoc!a(e c+ (+"'+r7r!"e :n "e$7(+r7 c+
    coca!na Eve/! &a$ 9IRJ Tes(e"e de +r!n7 &en(r+ s+'s(an=e"e d!n aceas(7 c"as7 r7%An
    de re$+"7 &o/!(!ve n+%a! (!%& de 54; /!"e, c!ar d+&7 +n Sce.T E.ec(e"e adverse
    &+"%onare s+n( v7/+(e %a! rar decA( :n ca/+" coca!ne!, deoarece s+'s(an=e"e d!n
    aceas(7 c"as7 s+n( !na"a(e de %a! &+=!ne or! &e /! Cr!/e"e e&!"e&(!ce, !n.ec=!a c+
    HI3, %a"n+(r!(!a, &"7$!"e &r!n ar%e de .oc sa+ de c+=!(, e&!s(a<!s+n"e s! &ro'"e%e"e
    card!ovasc+"are s+n( v7/+(e adesea ca ac+/e &e care "e &re/!n(7 !nd!v!/!! c+
    (+"'+r7r! :n "e$7(+r7 c+ a%.e(a%!na Un !s(or!c de (+"'+rare de cond+!(7 :n
    co&!"7r!e, de (+"'+rare de &ersona"!(a(e an(!soc!a"7 s! de (+"'+rare !&erac(!4
    v!(a(eXde.!c!( de a(en=!e &oa(e .! asoc!a( c+ a&ar!=!a +"(er!oar7 a (+"'+r7r!"or :n
    "e$7(+r7 c+ a%.e(a%!na
    *lemente speci$ice culturii, etii si sexului
    De&enden(a s! a'+/+" de a%.e(a%!na s+n( :n(A"n!(e "a (oa(e n!ve"e"e soc!e(7=!! s!
    s+n( %a! .recven(e &r!n(re &ersoane"e :n e(a(e de 5G4;L a% Ad%!n!s(rarea
    !n(ravenoas7 es(e %a! .recven(7 &r!n(re &ersoane"e d!n $r+&e"e soc!o4econo%!ce
    !n.er!oare s! are +n ra&or( 'ar'a (!X.e%e! de ; sa+ I " Ra&or(+" '7r'a=!X.e%e! es(e
    %a! +n!.or% d!s(r!'+!( &r!n(re ce! c+ +/ no%n(ravenos
    #revalent
    Pa((ern+" de +/ de a%.e(a%!ne :n &o&+"a=!a $enera"7 d!.er7 :n(re "oca"!(7=! Ede
    e<, c+ &rocen(e %a! %ar! :n s+d+" Ca"!.orn!e!J s! a ."+c(+a( cons!dera'!" :n (!%& :n
    S(a(e"e Un!(e, &a((ern+r!"e de +/ $enera"e a+ a(!ns ce" %a! :na"( n!ve" "a :nce&+(+"
    an!"or 2GL, cAnd %a! %+"( de 9Yd d!n(re ad+"=! re"a(a+ c7 a+ .7c+( cAndva +/ de +n+"
    d!n(re aces(e dro$+r!
    Re.er!(or "a +/+" %a! recen(, o ance(7 na=!ona"7 :n "e$7(+r7 c+ +/+" de dro$ a
    ra&or(a( c7 :n @+r de Yd d!n(re ad+"=! a+ rec+nosc+( c7 a+ .7c+( cAndva +/ de
    dro$+r! Ss(!%+"an(eT &en(r+ a a@+n$e "a Se<a"(areT A&ro<!%a(!v " d a+ rec+nosc+(
    c7 a+ "+a( a%.e(a%!ne cAndva :n c+rs+" an+"+! (rec+( s! O Id c7 a+ "+a( a%.e(a%!ne
    "+na (rec+(7 P!c+" &reva"en(e! ce"or care a+ .7c+( +/ cAndva de a%.e(a%!na se s!(+a
    :n(re e(7=!"e de 9R s! ;I a% ERdJ, :n (!%& ce +/+" :n c+rs+" +"(!%+"+! an a .os( ce" %a!
    r!d!ca( &r!n(re ce! :n e(a(e de 5G49Y an! E9dJ Une"e ance(e a+ ra&or(a( &a((ern+n +/
    2+E
    Tulburrile "n le!tur cu o Substan
    c!ar %a! %ar! "a +ne"e coor(e de (!ner!. O ance(7 d!n 5FFH &r!n(re e"ev!! d!n
    c"ase"e s+&er!oare de "!ce+ a ra&or(a( c7 DO d!n(re a+ .7c+( cAndva +/ de dro$+r!
    s!%!"are a%.e(a%!ne!, !ar 5Ld a+ .7c+( +/ an+" (rec+(. Tre'+!e re=!n+( c7, deoarece
    aces(e ance(e a+ eva"+a( %a! c+rAnd &a((ern+r!"e de +/ decA( (+"'+r7r!"e, n+ se O(!e
    cA=! d!n(re ce! care a+ .7c+( +/ de a%.e(a%!na ces(!ona=! a+ av+( s!%&(o%e care
    sa(!s.7cea+ cr!(er!!"e &en(r+ de&enden=7 sa+ a'+/.
    Procen(e"e de de&enden=7 s! a'+/ de a%.e(a%!ne s+n( d!.!c!" de doc+%en(a(. Un
    s(+d!+ e&!de%!"o$!c na=!ona" e.ec(+a( :n S(a(e"e Un!(e "a :nce&+(+" an!"or 2FL a
    ra&or(a( o &reva"en(7 &e v!a=7 de 5,Yd a aces(or (+"'+r7r! a"e +/+"+! de a%.e(a%!na,
    !nc"+s!v &reva"en(a de L,5Id d!n +"(!%e"e 59 "+n!.
    *voluie
    Un!! !nd!v!/!, care &re/!n(7 a'+/ sa+ de&enden=7 de a%.e(a%!ne sa+ de
    s+'s(an=e s!%!"are a%.e(a%!ne!, :nce& s7 .ac7 +/ de aces(e s+'s(an=e :n (en(a(!va de
    a4s! con(ro"a $re+(a(ea. A"=!! .ac c+noO(!n=7 c+ aces(e s+'s(an=e &r!n &!a=a !"e$a"7.
    De&enden=a &oa(e s+rven! ra&!d cAnd s+'s(an=a es(e ad%!n!s(ra(7 !n(ravenos sa+
    .+%a(7. Ad%!n!s(rarea ora"7 d+ce de re$+"7 "a o &ro$res!+ne %a! "en(7 de "a +/ "a
    de&enden=7. De&enden=a de a%.e(a%!na es(e asoc!a(7 c+ do+7 &a((ern+r! de
    ad%!n!s(rareQ +/ e&!sod!c sa+ +/ /!"n!c Esa+ a&roa&e /!"n!cJ, :n &a((ern+" e&!sod!c,
    +/+" de s+'s(an=7 es(e se&ara( &r!n /!"e de non+/ Ede e<., +/ !n(ens :n c+rs+" #ee)4
    end+"+! or! :n(r4+na sa+ %a! %+"(e /!"e a"e s7&(7%An!!J. Aces(e &er!oade de +/
    !n(ens!v de do/e %ar! En+%!(e adesea Ss&eed r+nsT sa+ Sor$!!TJ s+n( adesea
    asoc!a(e c+ +/+" !n(ravenos. S3o!a@e"eT (!nd a se (er%!na n+%a! cAnd s(oc+" de dro$
    es(e e&+!/a(. U/+" cron!c /!"n!c &oa(e !%&"!ca do/e %ar! sa+ %!c!, s! &oa(e avea "oc
    (o( (!%&+" /!"e! sa+ &oa(e .! red+s "a doar cA(eva ore. :n +/+" cron!c /!"n!c, :n $enera",
    n+ e<!s(7 ."+c(+a=!! %ar! de do/7, /!"e :n O!r, dar +neor! e<!s(7 o creO(ere a do/e! c+
    (!%&+". U/+" cron!c de do/e %ar! dev!ne adesea ne&"7c+( d!n ca+/a sens!'!"!(7=!! s!
    a&ar!=!e! d!s.or!e! O! a a"(or e.ec(e ne$a(!ve a"e dro$+"+!. P+=!ne"e da(e &e (er%en
    "+n$ d!s&on!'!"e !nd!c7 .a&(+" c7 "a &ersoane"e care a+ deven!( de&enden(e de
    a%.e(a%!ne e<!s(7 (end!n=a de a red+ce sa+ de a s(o&a +/+" d+&7 G45L an!. Aceas(a
    &are a re/+"(a d!n a&ar!=!a e.ec(e"or adverse %en(a"e s! so%a(!ce care s+rv!n :n
    asoc!a=!e c+ de&enden=a de "+n$7 d+ra(7. N+ e<!s(7 n!c! +n .e" de da(e d!s&on!'!"e
    sa+ doar .oar(e &+=!ne des&re evo"+=!a &e (er%en "+n$ a a'+/+"+!.
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.en=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$. 9LH. T+"'+r7r!"e !nd+se de a%.e(a%!na &o( .! carac(er!/a(e
    &r!n s!%&(o%e Ede e<., !de! de"!ran(eJ care sea%7n7 c+ tulburrile mentale primare
    Ede e<., (+"'+rarea sc!/o.ren!.or%7 vers+s (+"'+rarea &s!o(!c7 !nd+s7 de
    a%.e(a%!na, c+ !de! de"!ran(e, c+ de'+( :n c+rs+" !n(o<!ca=!e!J. 3e/! &a$. 95L &en(r+
    d!sc+(area aces(+! d!a$nos(!c d!.eren=!a".
    #ntoxica3ia cu cocain2 intoxica3ia cu -alucino.ene s! intoxica3ia cu
    p-enc0clidin &o( ca+/a +n (a'"o+ c"!n!c s!%!"ar s!, +neor!, &o( .! d!s(!nse de
    !n(o<!ca=!a c+ a%.e(a%!na n+%a! &r!n &re/en=a %e(a'o"!=!"or a%.e(a%!ne! :n +r!n7
    sa+ a a%.e(a%!ne! :n &"as%7. De&enden=a s! a'+/+" de a%.e(a%!na (re'+!e s7 .!e
    d!s(!nse de dependen3a si abuzul de cocain2 p-enc0clidin O! -alucino.ene.
    In(o<!ca=!a c+ a%.e(a%!na s! a's(!nen=a de a%.e(a%!na se d!s(!n$ de alte tulburri
    induse de amfetamina Ede e<., (+"'+rarea an<!oas7 !nd+s7 de a%.e(a%!na, c+
    76726 Tulburare "n le!tur cu Am$etamina 'r Alt Speci$icaie 74E
    de'+( :n c+rs+" !n(o<!ca=!e!J, deoarece s!%&(o%e"e :n aces(e d!n +r%7 (+"'+r7r! s+n(
    :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+ a%.e(a%!na or! c+
    a's(!nen=a de a%.e(a%!na s! s+n( s+.!c!en( de severe &en(r+ a @+s(.!ca o a(en=!e
    c"!n!c7 se&ara(7.
    C5C.5 Tul-urare .n le/(tur( #u A"%eta"ina
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ a%.e(a%!na .7r7 a"(7 s&ec!.!ca=!e es(e
    re/erva(7 (+"'+r7r!"or asoc!a(e c+ +/+" de a%.e(a%!na Esa+ de o a"(7 s+'s(an=7
    a.!n7J care n+ s+n( c"as!.!ca'!"e ca de&enden=7 de a%.e(a%!na, ab+; de a%.e(a%!na,
    !n(o<!ca=!e c+ a%.e(a%!na, a's(!nen=a de a%.e(a%!na, de"!r!+% &r!n !n(o<!ca=!e c+
    a%.e(a%!na, (+"'+rare &s!o(!c7 !nd+s7 de a%.e(a%!na, (+"'+rare a.ec(!v7 !nd+s7
    de a%.e(a%!na, (+"'+rare an<!oas7 !nd+s7 de a%.e(a%!na, d!s.+nc=!e se<+a"7
    !nd+s7 de a%.e(a%!na sa+ (+"'+rare de so%n !nd+s7 de a%.e(a%!na.
    Tul-ur(rile .n le/(tur( #u Ca%eina
    Ca.e!na &oa(e .! cons+%a(7 d!n(r4+n n+%7r d!.er!( de s+rse, !nc"+/And ca.ea+a
    E.!ar(7 6 5LL5IL %$XG +nc!!, !ns(an( nes 6 RY %$45LL %$XG +nc!!J, cea!+" EIL45LL
    %$XG +nc!!J, a&a $a/oas7 ca.e!n!/a(7 EIY %$X59 +nc!!J, ana"$e/!ce"e vAnd+(e .7r7
    &rescr!&=!e s! %ed!ca%en(e"e con(ra r7ce"!! E9Y4YL %$X(a'"e(7J, s(!%+"an(e"e E5LL4
    9LL %$X(a'"e(7J s! a+<!"!are"e &en(r+ &!erderea :n $re+(a(e EHY49LL %$X(a'"e(7J.
    C!oco"a(a s! cacao a+ concen(ra=!! %+"( %a! red+se de ca.e!na Ede e<., Y %$X'a(on+"
    de c!oco"a(7J. Cons+%+" de ca.e!na es(e +'!c+!(ar :n %+"(e d!n s(a(e ES(a(e"e Un!(eJ
    c+ +n a&or( %ed!+ de ca.e!na de a&ro<!%a(!v 9LL %$ &e /! O! &An7 "a ;Ld d!n(re
    a%er!can! cons+%7 YLL %$ sa+ %a! %+"( &e /!. Un!! !nd!v!/! care 'ea+ %ar!
    can(!(7=! de ca.ea, %an!.es(7 +ne"e se%ne de de&enden=7 de ca.e!na s! &re/!n(7
    (o"eran=7, s! &oa(e c!ar a's(!nen=7, :ns7, "a ora ac(+a"7 e<!s(7 !ns+.!c!en(e da(e
    &en(r+ a &rec!/a dac7 aces(e s!%&(o%e s+n( asoc!a(e c+ o de(er!orare se%n!.!ca(!v7
    c"!n!c care sa(!s.ace cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7 or! a'+/+" de o
    s+'s(an=7. D!n con(ra, e<!s(7 da(e con.or% c7rora !n(o<!ca=!a c+ ca.e!na &oa(e .!
    se%n!.!ca(!v7 c"!n!c, !ar (e<(+" s! cr!(er!!"e s&ec!.!ce s+n( &re/en(a(e %a! @os. De
    ase%enea, da(e recen(e s+$erea/7 &os!'!"a re"evan=7 c"!n!c7 a a's(!nen=e! de ca.e!na8
    +n se( de cr!(er!! de cerce(are es(e !nc"+s "a &a$. HRY. T+"'+r7r!"e !nd+se de ca.e!na
    Ea"(e"e decA( !n(o<!ca=!a c+ ca.e!naJ s+n( descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7
    c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e<., (+"'+rarea an<!oas7
    !nd+s7 de ca.e!na es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e An<!oaseTJ4 Ma! @os s+n(
    %en=!ona(e (+"'+r7r!"e !nd+se de ca.e!na.
    Tulburrile induse de ca$eina
    ;LY.FL In(o<!ca=!a c+ ca.e!na Eve/!. &a$. 9;9J
    9F9.GF T+"'+rarea an<!oas7 !nd+s7 de ca.e!na Eve/!. &a$. IHFJ
    0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GF
    T+"'+rarea de so%n !nd+s7 de ca.e!na Eve/!. &a$. RYYJ
    0e speci)8at dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.F
    T+"'+rarea :n "e$7(+r7 c+ ca.e!na .7r7 a"(7 s&ec!.!ca=!e Eve/!. &a$. 9;IJ
    9;9
    Tulburrile "n le!tur cu o Substan
    Tulburrile induse de Cafeina
    4+<.5+ Into,i#a!ia #u Ca%eina
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ ca.e!na :" cons(!(+!e cons+%+"
    recen( de ca.e!na s! c!nc! sa+ %a! %+"(e s!%&(o%e care se de/vo"(7 :n c+rs+" sa+ "a
    sc+r( (!%& d+&7 +/+" de ca.e!na Ecr!(er!!"e A O! BJ. S!%&(o%e"e care &o( a&are d+&7
    !n$es(!a a n+ %a! &+=!n de 5LL %$ de ca.e!na &e /! !nc"+d ne"!n!O(ea, nervo/!(a(ea,
    e<c!(a=!a, !nso%n!a, .ac!es+" con$es(!v, d!+re/a Ecresc+(7J s! ac+/e $as(ro!n(es(!na"e.
    S!%&(o%e"e care a&ar :n $enera" "a n!ve"e"e de %a! %+"( de " $X/! !nc"+d
    .asc!c+"a=!a %+sc+"ar7, dev!erea c+rs+"+! $And!r!! O! vor'!r!!, (a!card!e sa+ ar!(%!!
    card!ace, &er!oade de !n.a(!$a'!"!(a(e s! a$!(a=!a &soo%o(or!e. In(o<!ca=!a c+ ca.e!na
    &oa(e s7 n+ a&ar7, :n d!s&re=+" can(!(7=!! %ar! de ca.e!na ad%!n!s(ra(e, d!n ca+/a
    de/vo"(7r!! (o"eran=e!. S!%&(o%e"e (re'+!e s7 ca+/e/e de(res7 sa+ de(er!orare c"!n!c7
    se%n!.!ca(!v7 :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de
    .+nc=!onare Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e s7 se da(ore/e +ne! cond!=!!
    %ed!ca"e $enera"e s! n+ (re'+!e s7 .!e e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7
    Ede e<., (+"'+rarea an<!oas7J Ecr!(er!+" DJ.
    Criteriile $e $ia/no&ti# pentru
    4+<.5+ Into,i#a!ia #u Ca%eina
    A2 onsum recent de ca$eina, de re!ul de mai mult de 7A5 m! &de ex2, mai
    mult de 7-4 ce,ti de ca$ea $iart)2
    S2 inci &sau mai multe) dintre urmtoarele semne, apr@nd "n cursul u(ului de
    ca$eina sau la scurt timp dup aceeaD
    (1)nelini,te3
    (2)anxietate3
    (3)excitaie3
    (4)insomnie3
    (5)$acies con!estiv3
    (6)diure(a3
    (7)perturbare !astrointestinal3
    (8)crampe musculare3
    (9)deraierea $luxului !@ndirii ,i vorbirii3
    (10)ta%icardie sau aritmii cardiace3
    (11)perioade de in$ati!abilitate3
    (12)a!itaie psi%omotorie2
    2 Simptomele de la criteriul S cau(ea( detres sau deteriorare semni$icativ
    clinic "n domeniul social, pro$esional sau "n alte domenii importante de
    $uncionare2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental &de ex2, o tulburare anxioas)2
    Alte Tulburri induse de
    a$eina
    2++
    Alte Tul-ur(ri in$u&e $e Ca%eina
    Ur%7(oare"e (+"'+r7r! !nd+se de ca.e!na s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ (+"'+rarea
    an<!oas7 !nd+s7 de ca.e!na E&a$. IHFJ O! (+"'+rarea de so%n !nd+s7 de ca.e!na E&a$.
    RYYJ. Aces(e (+"'+r7r! se d!a$nos(!cea/7 :n "oc+" !n(o<!ca=!e! c+ ca.e!na, n+%a!
    cAnd s!%&(o%e"e s+n( :n e<ces vers+s ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+
    ca.e!na s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7.
    $nformaii sulimentare desre
    Tulburrile %n le&tur cu Cafeina
    *lemente si tulburri asociate
    Per(+r'7r! sen/or!a"e +Ooare Ede e<., (!n!(+s :n +rec! s! ."aO+r! de "+%!n7J a+
    .os( descr!se "a do/e %ar!. DeO! do/e"e %ar! de ca.e!na &o( cres(e r!(%+" card!ac,
    do/e"e %a! %!c! &o( :nce(!n! &+"s+". Fa&(+" dac7 e<ces+" de ca.e!na &oa(e ca+/a
    ce.a"eea es(e nec"ar. La e<a%en+" so%a(!c &o( .! o'serva(e, a$!(a=!e, ne"!n!O(e,
    (rans&!ra=!!, (a!card!e, .ac!es con$es(!v s! creO(erea %o(!"!(7=!! !n(es(!n+"+! $ros.
    Pa((ern+r!"e (!&!ce de ad%!n!s(rare a ca.e!ne! n+ s+n( asoc!a(e cons(an( c+ a"(e
    &ro'"e%e %ed!ca"e. U/+" e<ces!v se asoc!a/7 :ns7, c+ a&ar!=!a sa+ e<acer'area
    an<!e(7=!! s! s!%&(o%e"or so%a(!ce, c+% ar .! ar!(%!!"e card!ace s! d+rerea
    $as(ro!n(es(!na"7 or! d!areea. La do/e ac+(e de&7O!nd "O$ de ca.e!na, cr!/e"e de
    $rand %a" s! !ns+.!c!en=a res&!ra(or!e &o( d+ce "a %oar(e. U/+" e<ces!v de ca.e!na
    se asoc!a/7 c+ (+"'+r7r!"e a.ec(!ve, de co%&or(a%en( a"!%en(ar, &s!o(!ce, de so%n
    O! :n "e$7(+r7 c+ o s+'s(an=7, d!n care ca+/7 !nd!v!/!! c+ (+"'+r7r! an<!oase es(e
    &os!'!" s7 ev!(e aceas(7 s+'s(an=7.
    *lemente speci$ice culturii, etii si sexului
    U/+" de ca.e!na s! s+rse"e d!n care es(e cons+%a(7 ca.e!na var!a/7 .oar(e %+"( :n
    d!verse c+"(+r!. Med!a can(!(7=!! de ca.e!na cons+%a(7 :n ce"e %a! %+"(e d!n(re =7r!"e
    :n c+rs de de/vo"(are es(e de %a! &+=!n de YL %$ &e /! :n co%&ara=!e c+ ILL %$ &e
    /! sa+ %a! %+"( :n S+ed!a, Re$a(+" Un!( O! a"(e na=!+n! e+ro&ene. Cons+%+" de
    ca.e!na creO(e :n c+rs+" an!"or 9L O! adesea scade d+&7 e(a(ea de RY an!. Cons+%+"
    de ca.e!na es(e %a! %are "a '7r'a=! decA( "a .e%e!. Oda(7 c+ avansarea :n e(a(e, es(e
    &os!'!" ca oa%en!! s7 &re/!n(e reac=!! (o( %a! !n(ense "a ca.e!na, c+ o %+"=!%e de
    ac+/e de !n(er.eren=7 c+ so%n+" sa+ sen/a=!! de e<c!(a=!e e<ces!v7
    #revalent
    Pa((ern+" de +/ de ca.e!na ."+c(+ea/7 :n c+rs+" v!e=!!, c+ GL4GYd d!n(re ad+=!
    cons+%And ca.e!na :n .!ecare an. D!n(re !nd!v!/!! care cons+%7 ca.e!na, GYd sa+
    %a! %+"( +/ea/7 de '7+(+r! con=!nAnd ca.e!na ce" &+=!n oda(7 &e s7&(7%An7, 'And
    :n %ed!e a&roa&e 9LL %$X/!. A&or(+" de ca.e!na es(e cresc+( &ro'a'!" &r!n(re
    !nd!v!/!! care .+%ea/7 O!, &oa(e, &r!n(re ce! care +/ea/7 de a"coo" O! de a"(e
    s+'s(an=e. Preva"en(a (+"'+r7r!"or :n "e$7(+r7 c+ ca.e!na es(e nec+nosc+(7.
    9;I
    Tulburrile "n le!tur cu o Substan

    *voluie
    Cons+%+" de ca.e!na :nce&e de re$+"7 :n ado"escen=7, creO(e :n an!! 29L s! 2;L
    a&o! n!ve"+" +/+"+! s(a$nea/7 s!, &oa(e, :nce&e s7 scad7. D!n(re ce! a&ro<!%a(!v ILd
    de !nd!v!/!! care a+ s(o&a( cons+%+" or!c7re! .or%e de ca.e!na, ce! %a! %+"=! a.!r%7
    c7 s!4a+ sc!%'a( &a((ern+" ca r7s&+ns "a e.ec(e"e sec+ndare a"e aces(e!a sa+ a
    &reoc+&7r!"or "or &en(r+ s7n7(a(e. Aces(ea d!n +r%7 !nc"+d ar!(%!!"e card!ace, a"(e
    &ro'"e%e card!ace, creO(erea &res!+n!! san$+!ne, %a"ad!a .!'roc!s(!c7 a sAn+"+!,
    !nso%n!a sa+ an<!e(a(ea. Deoarece a&are (o"eran=7 "a e.ec(e"e co%&or(a%en(a"e a"e
    ca.e!ne!, !n(o<!ca=!a c+ ca.e!na es(e o'serva(7 adesea "a ce! care +;ea;6 de ca.e!na
    %a! &+=!n .recven( sa+ "a ce! care a+ cresc+( recen( cons+%+" "or de ca.e!na "a o
    can(!(a(e a&rec!a'!"7.
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$. 9LH. T+"'+r7r!"e !nd+se de ca.e!na &o( .! carac(er!/a(e &r!n
    s!%&(o%e Ede e<., a(ac+r! de &an!c7J a%!n(!nd de (+"'+r7r!"e %en(a"e &r!%are Ede
    e<., &an!ca vers+s (+"'+rarea an<!oas7 !nd+s7 de ca.e!na, c+ a(ac+r! de &an!c7, c+
    de'+( :n c+rs+" !n(o<!ca=!e!J. 3e/! &a$. 95L &en(r+ d!sc+(area aces(+! d!a$nos(!c
    d!.eren=!a".
    Pen(r+ a sa(!s.ace cr!(er!!"e &en(r+ !n(o<!ca=!a c+ ca.e!na, s!%&(o%e"e n+ (re'+!e
    s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e or! a"(e! (+"'+r7r! %en(a"e, c+% ar .!
    (+"'+rarea an<!oas7, care "e4ar &+(ea e<&"!ca %a! '!ne. E&!soade"e %an!aca"e,
    &an!ca, an<!e(a(ea $enera"!/a(7, !n(o<!ca=!a c+ a%.e(a%!na, a's(!nen=a de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce or! a's(!nen=a de n!co(!n7, (+"'+r7r!"e de so%n s! e.ec(e"e
    sec+ndare !nd+se de %ed!ca%en(e Ede e<., a)a(!s!aJ &o( ca+/a +n (a'"o+ c"!n!c
    s!%!"ar c+ ce" a" !n(o<!ca=!e! c+ ca.e!na. Re"a=!a (e%&ora"7 a s!%&(o%e"or c+ creO(erea
    cons+%+"+! de ca.e!na or! c+ a's(!nen=a de ca.e!na a@+(7 "a s(a'!"!rea d!a$nos(!c+"+!.
    In(o<!ca=!a c+ ca.e!na se d!s(!n$e de (+"'+rarea an<!oas7 !nd+s7 de ca.e!na, c+
    de'+( :n c+rs+" !n(o<!ca=!e! E&a$. IHFJ O! de (+"'+rarea de so%n !nd+s7 de ca.e!na,
    c+ de'+( :n c+rs+" !n(o<!ca=!e! E&a$. RYYJ &r!n .a&(+" c7 s!%&(o%e"e :n aces(e d!n
    +r%7 (+"'+r7r! s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+
    ca.e!na O! s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    C5C.5 Tul-urare .n le/(tur( #u Ca%eina
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a (+"'+r7r!! :n "e$7(+r7 c+ ca.e!na .7r7 a"(7 s&ec!.!ca=!e es(e re/erva(7
    (+"'+r7r!"or asoc!a(e c+ +/+" de ca.e!na care n+ s+n( c"as!.!ca'!"e ca !n(o<!ca=!e c+
    ca.e!na, (+"'+rare an<!oas7 !nd+s7 de ca.e!na or! (+"'+rare de so%n !nd+s7 de
    ca.e!na. Un e<e%&"+ :n aces( sens es(e a's(!nen=a de ca.e!na Eve/! &a$. HRI &en(r+
    cr!(er!!"e de cerce(are s+$era(eJ.
    Tul-ur(rile .n le/(tur( #u Canna-i&ul
    Aceas(7 sec=!+ne !nc"+de &ro'"e%e"e care s+n( asoc!a(e c+ s+'s(an=e"e der!va(e
    d!n &"an(a canna'!s Ecanna'!no!/!!J s! co%&+O!! s!n(e(!c! s!%!"ar! c!%!c. CAnd
    Tulburrile "n le!tur cu
    annabisul
    2+5
    .r+n/e"e s+&er!oare, vAr.+r!"e s! (+"&!n!"e &"an(e! s+n( (7!a(e, +sca(e s! r+"a(e :n
    =!$are(e, &rod+s+" es(e den+%!( de re$+"7 %ar!+ana. HaO!O+" es(e e<+da(+"
    r7O!nos, +sca(, care se &re"!n$e d!n vAr.+r!"e s! &ar(ea !n.er!oar7 a .r+n/e"or de
    canna'!s8 +"e!+" de canna'!s es(e +n d!s(!"a( concen(ra( de aO!O, :n +"(!%!! an!, :n
    As!a, Ha#a!! O! Ca"!.orn!a a .os( &rod+s7 o .or%7 .oar(e &+(ern!c7 de canna'!s,
    sens!%!""a. De re$+"7, canna'!no!/!! s+n( .+%a=!, dar &o( .! "+a=! O! ora", a%es(eca=!
    c+ cea! sa+ c+ %Ancare. Canna'!no!d+" care a .os( !den(!.!ca( ca &r!nc!&a"+"
    res&onsa'!" &en(r+ e.ec(e"e &s!oac(!ve a"e canna'!s+"+! es(e de"(a4F4(e(ra4
    !drocanna'!no"+" Ec+nosc+(, de ase%enea, ca THC sa+ de"(a4F4THCJ, s+'s(an=7
    care es(e rar d!s&on!'!"7 :n .or%7 &+r7. Canna'!no!/!! a+ d!verse e.ec(e as+&ra
    cre!er+"+! d!n(re care ce"e %a! &roe%!nen(e s+n( e.ec(e"e as+&ra rece&(or!"or
    canna'!no!/! CB5 s! CB9, care s+n( re&era=! &es(e (o( :n s!s(e%+" nervos cen(ra".
    L!$an/!! endo$en! &en(r+ aceO(! rece&(or!, ananda%!da s! N4&a"%!(oe(ano"a%!da se
    co%&or(7 :n esen=7 ca n!O(e ne+ro(rans%!=7(or!. Con=!n+(+" :n THC a" %ar!+ane!
    d!s&on!'!"e var!a/7 .oar(e %+"(. Con=!n+(+" :n THC a" %ar!+ane! !"!c!(e a cresc+(
    cons!dera'!", :nce&And d!n +"(!%a &ar(e a an!"or 5FRL de "a "d4Yd "a %a! %+"( de
    5Ld45Yd. De"(a4F4THC s!n(e(!c a .os( +(!"!/a( :n an+%!(e cond!=!! %ed!ca"e
    $enera"e Ede e<., &en(r+ co%'a(erea $re=!! O! vo%e! ca+/a(e de c!%!o(era&!e,
    &en(r+ (ra(area anore<!e! O! &!erder!! :n $re+(a(e "a !nd!v!/!! c+ s!ndro%+" !%+no4
    de.!c!en=e! cAO(!$a(e ZSIDA[J.
    Aceas(7 sec=!+ne con=!ne co%en(ar!! s&ec!.!ce re.er!(oare "a (+"'+r7r!"e :n
    "e$7(+r7 c+ canna'!s+". Te<(e"e s! se(+r!"e de cr!(er!! a+ .os( de@a &re/en(a(e "a
    de.!n!rea as&ec(e"or $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J s! a'+/+"+!
    de o s+'s(an=7 E&a$. 5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or. A&"!carea aces(or
    cr!(er!! $enera"e "a de&enden=a de canna'!s s! "a a'+/+" de canna'!s s+n( &re/en(a(e
    %a! @os. N+ e<!s(7, :ns7, se(+r! de cr!(er!! s&ec!.!ce &en(r+ de&enden=a O! a'+/+" de
    canna'!s. De ase%enea, es(e &rev7/+( %a! @os +n +n (e<( s! +n se( de cr!(er!!
    s&ec!.!ce &en(r+ !n(o<!ca=!a c+ canna'!s. S!%&(o%e a"e +ne! &os!'!"e a's(!nen=e de
    canna'!s Ede e<., d!s&o/!=!e !r!(a'!"7 sa+ an<!oas7, aco%&an!a(7 de %od!.!c7r!
    .!/!o"o$!ce, c+% ar .! (re%or+", (rans&!ra=!a, $rea=a, %od!.!carea a&e(!(+"+! s!
    (+"'+r7r!"e de so%nJ a+ .os( descr!se :n asoc!ere c+ +/+" +nor do/e .oar(e %ar!, dar
    se%n!.!ca=!a "or c"!n!c7 es(e !ncer(7. Pen(r+ aces(e %o(!ve, d!a$nos(!c+" de a's(!nen=7
    de canna'!s n+ es(e !nc"+s :n aces( %an+a". T+"'+r7r!"e !nd+se de canna'!s Ea"(e"e
    decA( !n(o<!ca=!a c+ canna'!sJ s+n( descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+
    (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de
    canna'!s es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e a.ec(!veTJ. Ma! @os s+n( %en=!ona(e
    (+"'+r7r!"e +/+"+! de canna'!s s! (+"'+r7r!"e !nd+se de canna'!s.
    Tulburrile u(ului de cannabis
    ;LI.;L De&enden=a de canna'!s Eve/! &a$. 9;RJ
    ;LY.9L A'+/+" de canna'!s Eve/! &a$. 9;RJ
    Tulburrile induse de cannabis
    9F9.GF In(o<!ca=!a c+ canna'!s Eve/! &a$. 9;HJ. 0e speci)icat dac6? C+
    &er(+r'7r! de &erce&=!e
    9F9.G5 De"!r!+%+" &r!n !n(o<!ca=!e c+ canna'!s Eve/! &a$. 5I;J 9F9.55
    T+"'+rarea &s!o(!c7 !nd+s7 de canna'!s, c+ !de! de"!ran(e Eve/! &a$. ;;GJ.
    0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9;R
    Tulburrile "n le!tur cu o Substan
    242.12 Tulburarea psi-otic indus de cannabis2 cu -alucina3ii Eve/! &a$ ;;GJ
    0e speci)icat dac67 C+ de'+( :n c+rs+" !n(o<!ca=!e!
    242.=4 Tulburarea anxioas indus de cannabis Eve/! &a$ IHFJ. 0e
    speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e!
    242.4 Tulburare @n le.tur cu cannabisul fr alt specifica3ie Eve/!
    &a$ 9I5J
    Tulburrile !"ului $e Cannabis
    4+7.4+ Depen$en!a $e Canna-i&
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7
    Eve/! &a$. 5F9J Ind!v!/!! c+ de&enden=7 de canna'!s a+ +n +/ co%&+"s!v s!
    &ro'"e%e asoc!a(e A .os( descr!s7 (o"eran=a "a ce"e %a! %+"(e d!n(re e.ec(e"e
    canna'!s+"+!, "a !nd!v!/!! care +/ea/7 de canna'!s :n %od cron!c A+ e<!s(a(, de
    ase%enea, cA(eva co%+n!c7r! de a's(!nen=7, dar se%n!.!ca=!a "or c"!n!c7 es(e !ncer(7.
    E<!s(7 +ne"e &ro'e re.er!(oare "a .a&(+" c7 %a@or!(a(ea +/e+n"or cron!c! de
    canna'!no!/! re"a(ea/7 !s(or!ce de (o"eran(7 sa+ de a's(!nen=7 s! c7 aceO(! !nd!v!/!
    &re/!n(7 :n $enera" &ro'"e%e %a! severe :n "e$7(+r7 c+ dro$+" Ind!v!/!! c+
    de&enden=7 de canna'!s &o( +/a de +n canna'!s .oar(e &+(ern!c :n (o( c+rs+" /!"e!,
    o &er!oad7 de "+n! sa+ a%, s! &o( &!erde cA(eva ore &e /! &en(r+ a o'=!ne s+'s(an=a
    s! a +/a de ea Aces(ea !n(er.erea/7 adesea c+ ac(!v!(7=!"e de .a%!"!e, Oco"are, de
    serv!c!+ sa+ recrea=!ona"e Ind!v!/!! c+ de&enden=7 de canna'!s &o(, de ase%enea,
    &ers!s(a :n +/+" "or, :n d!s&re=+" c+noaO(e% &ro'"e%e"or so%a(!ce Ede e<., (+se
    cron!c7 :n "e$7(+r7 c+ .+%a(+"J sa+ a &ro'"e%e"or &s!o"o$!ce Ede e<., sedare
    e<ces!v7, re/+"(And d!n +/+" re&e(a( de do/e %ar!J
    Speci$icanti
    Ur%7(or!! s&ec!.!can &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden(7 de canna'!s
    Eve/! &a$ 5FY &en(r+ %a! %+"(e de(a"!!J (u dependen3 fiziolo.ic )r
    dependen3 fiziolo.ic
    !emisiune complet precoce
    !emisiune par3ial precoce
    !emisiune complet prelun.it
    !emisiune par3ial prelun.it @ntrB
    un mediu controlat
    4+<.C+ A-u)ul $e Canna-i&
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$. 5FGJ U/+" s! !n(o<!ca=!a &er!od!c7 c+ canna'!s &o( !n(er.era c+ &er.or%an=a :n
    %+nc7 sa+ Oco"ar7 s! &o( .! &er!c+"oase cor&ora" :n s!(+a=!!, c+% ar .! cond+cerea
    +n+! a+(o%o'!" Po( a&are &ro'"e%e "e$a"e ca o consec!n=7 a ares(7r!"or &en(r+
    de=!nerea de canna'!s Po( e<!s(a cer(+r! c+ so=!a Eso=+"J sa+ c+ &7r!n=!! re.er!(oare "a
    de=!nerea de canna'!s :n cas7 sa+ "a +/+" s7+ :n &re/en=a co&!!"or CAnd cAnd
    &ro'"e%e"e &s!o"o$!ce sa+ so%a(!ce s+n( asoc!a(e c+ canna'!s+", :n con(e<(+"
    767286 Intoxicaia cu
    annabis
    2+8
    +/+"+! co%&+"s!v, (re'+!e "+a( :n cons!dera=!e %a! c+rAnd d!a$nos(!c+" de
    de&enden=7 de canna'!s decA( ce" de a'+/ de canna'!s.
    Tulburrile induse de Cannabis
    C5C.>5 Into,i#a!ia #u Canna-i&
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ canna'!s :" cons(!(+!e &re/en=a
    +nor %od!.!c7r! co%&or(a%en(a"e sa+ &s!o"o$!ce de/ada&(a(!ve se%n!.!ca(!ve
    c"!n!c care a&ar :n c+rs+" sa+ sc+r( (!%& d+&7 +/+" de canna'!s Ecr!(er!!"e A s! BJ.
    In(o<!ca=!a :nce&e de re$+"7 c+ o sen/a=!e de Se<a"(areT +r%a(7 de s!%&(o%e care
    !nc"+d e+.or!a, c+ rAs !nadecva( s! $randoare, sedarea, "e(ar$!a, de(er!orarea
    %e%or!e! de sc+r(7 d+ra(7, d!.!c+"(a(e :n e.ec(+area &rocese"or %en(a"e co%&"e<e,
    de(er!orarea @+dec7=!!, d!s(ors!onarea &erce&=!!"or sen/or!a"e, de(er!orarea e<ec+=!e!
    %o(or!! s! sen/a=!a c7 (!%&+" (rece :nce(. Oca/!ona", s+rv!n an<!e(a(ea Ecare &oa(e .!
    sever7J, d!s.or!a sa+ re(ra$erea soc!a"7. Aces(e e.ec(e &s!oac(!ve s+n( aco%&an!a(e
    de do+7 sa+ %a! %+"(e d!n(re +r%7(oare"e se%ne care a&ar :n dec+rs de 9 ore de "a
    +/+" de canna'!sQ !n@ec(are con@+nc(!va"7, a&e(!( cresc+(, $+r7 +sca(7 s! (a!card!e
    Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e
    s! n+ s+n( e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" DJ.
    In(o<!ca=!a s+rv!ne :n dec+rs de cA(eva %!n+(e dac7 canna'!s+" es(e .+%a(, dar
    a&ar!=!a sa &oa(e "+a cA(eva ore, dac7 s+'s(an=a es(e !n$era(7. E.ec(e"e d+rea/7 de
    re$+"7 ;4I ore, d+ra(a .!!nd ceva %a! "+n$7 a(+nc! cAnd s+'s(an=a es(e !n$era(7.
    Ma$n!(+d!nea %od!.!c7r!"or co%&or(a%en(a"e O! .!/!o"o$!ce de&!nde de do/7,
    %od+" de ad%!n!s(rare O! carac(er!s(!c!"e !nd!v!d+a"e a"e &ersoane! care +;ea;6 de
    s+'s(an=7, c+% ar .! r!(%+" de a'sor'=!e, (o"eran=a O! sens!'!"!(a(ea "a e.ec(e"e
    s+'s(an=e!. Deoarece ce! %a! %+"=! canna'!no!/!, !nc"+s!v de"(a4F4THC, s+n(
    so"+'!"! :n $r7s!%!, e.ec(e"e canna'!s+"+! sa+ aO!O+"+! &o( &ers!s(a oca/!ona" sa+
    rea&are &en(r+ 5949I de ore, d!n ca+/a e"!'er7r!! "en(e a s+'s(an=e"or &s!oac(!ve
    d!n =es+(+" ad!&os sa+ c!rc+"a=!a en(eroe&a(!c7.
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( +n+! d!a$nos(!c de !n(o<!ca=!e c+ canna'!sQ
    C+ &er(+r'7r! de &erce&=!e. Aces( s&ec!.!can( &oa(e .! %en=!ona( cAnd
    a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 or! !"+/!! a+d!(!ve, v!/+a"e sa+ (ac(!"e
    s+rv!n :n a'sen=a +n+! de"!r!+%. Testarea realit6(ii intact6 :nsea%7 c7 &ersoana
    O(!e c7 a"+c!na=!!"e s+n( !nd+se de s+'s(an=7 s! n+ re&re/!n(7 rea"!(a(ea
    e<(ern7. CAnd a"+c!na=!!"e s+rv!n :n a'sen=a +ne! (es(7r! a rea"!(7=!! !n(ac(e
    (re'+!e s7 .!e "+a( :n cons!dera=!e d!a$nos(!c+" de (+"'+rare &s!o(!c7 !nd+s7
    de o s+'s(an=7, c+ a"+c!na=!!.
    C4> Tulburrile "n le!tur cu o Substan

    Criteriile $e $ia/no&ti# pentru
    C5C.>5. Into,i#a!ia #u Canna-i&
    A2 .( recent de cannabis2
    S2 Modi$icri comportamentale sau psi%olo!ice de(adaptative semni$icative
    clinic &de ex2, deteriorarea coordonrii motorii, eu$orie, anxietate, sen(aie
    de "ncetinire a timpului, deteriorarea 0udecii, retra!ere social) care apar
    "n cursul sau la scurt timp dup u(ul de canabis2
    2 Dou &sau mai multe) dintre urmtoarele semne care apar "n decurs de 7 ore
    de la u(ul de cannabisD
    (1)in0ectare con0unctival3
    (2)apetit crescut3
    (3)!ur uscat3
    (4)ta%icardie2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale ,i nu sunt
    explicate mai bine de alt tulburare mental2
    De speci"icat dac'
    Cu perur-(ri $e per#ep!ie
    Alte Tul-ur(ri in$u&e $e Canna-i&
    Ur%7(oare"e (+"'+r7r! !nd+se de canna'!s s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care aces(ea a+ co%+n7 .eno%eno"o$!aQ
    de"!r+%+" &r!n !n(o<!ca=!e c+ canna'!s E&a$. 5I;J, (+"'+rarea &s!o(!c7 !nd+s7 de
    canna'!s E&a$. ;;GJ O! (+"'+rarea an<!oas7 !nd+s7 de canna'!s E&a$. IHFJ. Aces(e
    (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ canna'!s, n+%a! cAnd
    s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    $nformaii sulimentare desre Tulburrile %n
    le&tur cu Cannabisul
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Canna'!s+" es(e +(!"!/a(
    adesea :%&re+n7 c+ a"(e s+'s(an=e, :n s&ec!a" c+ n!co(!n7, a"coo"+" s! coca!na.
    Canna'!s+" E:n s&ec!a", %ar!+anaJ &oa(e .! a%es(eca( O! .+%a( :%&re+n7 c+
    o&!acee, &encyc"!d!n7 ZPCP[ sa+ a"(e dro$+r! a"+c!no$ene. Ind!v!/!! care +/ea/7
    :n %od re$+"a( de canna'!s &re/!n(7 adesea a(A( !ner=!e .!/!c7 O! %en(a"7, cA( s!
    anedon!e. For%e +Ooare de de&res!e, an<!e(a(e sa+ !r!(a'!"!(a(e s+n( v7/+(e adesea
    "a o (re!%e d!n(re ce! care +/ea/7 :n %od re$+"a( de canna'!s E/!"n!c sa+ a&roa&e
    /!"n!cJ. CAnd s+n( "+a=! :n do/e %ar!, canna'!no!/!! a+ e.ec(e &s!oac(!ve care &o( .!
    s!%!"are ce"or a"e a"+c!no$ene"or Ede e<., d!e(!"a%!da ac!d+"+! "!ser$!c ZLSD[J, !ar
    !nd!v!/!! care +/ea/7 de canna'!no!/! &o( e<&er!en=a e.ec(e %en(a"e adverse care
    Tulburrile "n le!tur cu
    annabisul
    2+4
    a%!n(esc de S'ad (r!&sT. Aces(ea %er$ de "a n!ve"e de an<!e(a(e +Ooare s&re
    %odera(e Ede e<., (ea%7 c7 &o"!=!a va desco&er! +/+" de s+'s(an=7J &An7 "a reac=!!
    severe a%!n(!nd a(ac+r!"e de &an!c7. Poa(e e<!s(a, de ase%enea, !dea=!e &arano!d7
    %er$And de "a s+s&!c!o/!(a(e "a !de! de"!ran(e s! a"+c!na=!! c"are. A+ .os( descr!se,
    de ase%enea, e&!soade de de&ersona"!/are s! derea"!/are. S4a cons(a(a( c7
    acc!den(e"e de (ra.!c .a(a"e s+rv!n %a! .recven( "a !nd!v!/!! &o/!(!v! &en(r+
    canna'!no!/! decA( :n &o&+"a=!a $enera"7. Se%n!.!ca=!a aces(or da(e es(e :ns7
    nec"ar7, deoarece a"coo"+" s! a"(e s+'s(an=e s+n( adesea &re/en(e.
    Da(e de "a'ora(or asoc!a(e. Tes(e"e +r!nare !den(!.!c7 :n $enera" %e(a'o"!=!!
    canna'!no!/!"or. Deoarece aces(e s+'s(an=e s+n( so"+'!"e :n "!&!de, e"e &ers!s(7 :n
    ."+!de"e or$an!s%+"+! &er!oade "+n$! de (!%& s! s+n( e<cre(a(e "en(, !ar (es(e"e
    +r!nare de r+(!n7 &en(r+ canna'!no!/! "a !nd!v!/!! care +/ea/7 de canna'!s &o( .!
    &o/!(!ve oca/!ona" (!%& de H45L /!"e8 +r!na !nd!v!/!"or c+ +/ e<ces!v de canna'!s
    &oa(e (es(a &o/!(!v (!%& de 94I s7&(7%An!. Un (es( +r!nar &o/!(!v es(e concordan(
    n+%a! c+ +/+" (rec+( s! n+ s(a'!"eO(e .a&(+" dac7 es(e vor'a de !n(o<!ca=!e,
    de&enden=7 sa+ a'+/. A"(er7r!"e '!o"o$!ce !nc"+d s+&r!%area (e%&orar7 E&ro'a'!"
    :n "e$7(+r7 c+ do/aJ a .+nc=!e! !%+no"o$!ce O! a secre=!e! de (es(os(eron s! de or%on
    "+(e!n!/an( ELHJ, :ns7 se%n!.!ca=!a c"!n!c7 a aces(or a"(er7r! es(e nec"ar7. U/+" ac+(
    de canna'!no!/! ca+/ea/7, de ase%enea, o :nce(!n!re d!.+/7 a ac(!v!(7=!! de .ond &e
    EE, s! s+&r!%area %!Oc7r!"or oc+"are ra&!de EREMJ.
    Da(e"e e<a%!n7r!! so%a(!ce s! cond!=!!"e %ed!ca"e $enera"e asoc!a(e. F+%+"
    de canna'!s es(e e<(re% de !r!(an( &en(r+ na/o.ar!n$e O! c7!"e 'ronO!ce O! dec!, cres(e
    r!sc+" (+se! cron!ce O! &e ce" a" se%ne"or O! s!%&(o%e"or de &a(o"o$!e
    na/o.ar!n$!an7. U/+" cron!c de canna'!s es(e asoc!a( +neor! c+ "+a(+" :n $re+(a(e,
    care re/+"(7 &ro'a'!" d!n %Anca(+" e<ces!v O! d!n red+cerea ac(!v!(7=!! .!/!ce.
    S!n+/!(a, .ar!n$!(a, 'ronO!(a c+ (+se &ers!s(en(7, e%.!/e%+" s! d!s&"a/!a &+"%onar7
    &o( s+rven! :n +/+" cron!c e<ces!v. F+%+" de %ar!+ana con=!ne c!ar can(!(7=! %a!
    %ar! de cancer!$ene c+nosc+(e decA( (a'ac+".
    *lemente speci$ice culturii, etii si sexului
    Cana'!s+" es(e &ro'a'!" s+'s(an=a !"!c!(7 cea %a! .recven( +(!"!/a(7 :n "+%e. E"
    es(e "+a( d!n ce"e %a! vec! (!%&+r! &en(r+ e.ec(e"e sa"e &s!oac(!ve O! ca re%ed!+
    &en(r+ o ser!e :n(rea$7 de cond!=!! %ed!ca"e. Canna'!s+" se a."7 &r!n(re &r!%e"e
    dro$+r! de e<&er!%en(are Eadesea :n ado"escen=7J de c7(re (oa(e $r+&+r!"e c+"(+ra"e
    d!n S(a(e"e Un!(e. Ca O! :n ca/+" ce"or"a"(e dro$+r! !"!c!(e, (+"'+r7r!"e +/+"+! de
    canna'!s a&ar %a! .ercven( "a '7r'a=!, !ar &reva"en(a es(e %a! r!d!ca(7 "a &ersoane"e
    :n e(a(e de 5G &An7 "a ;L de an!.
    #revalent
    Cana'!no!/!!, :n s&ec!a" canna'!s+", s+n(, de ase%enea, ce"e %a! "ar$ +(!"!/a(e
    s+'s(an=e &s!oac(!ve !"!c!(e d!n S(a(e"e Un!(e. DeO! c!.re"e &reva"en(e! &e v!a=7 a+
    sc7/+( "en( :n an!! 2GL, creO(er! %odes(e a+ .os( ra&or(a(e :n(re 5FF5 s! 5FFH, :n s&ec!a"
    &r!n(re (!ner!. O ance(7 na=!ona"7 d!n 5FFR re.er!(oare "a +/+" de dro$ a s(a'!"!( c7
    ;9d d!n &o&+"a=!a SUA a re"a(a( c7 a .7c+( cAndva +/ de +n canna'!no!d. A&roa&e
    " d!n 55 !nd!v!/! a .Ac+( +/ de +n canna'!no!d an+" (rec+(, !ar :n @+r de Yd a+ .7c+(
    +/ "+na (rec+(7. Per!oada de e(a(e c+ cea %a! %are &reva"en(7 &e v!a=7 a .os( cea
    9IL
    Tulburrile "n le!tur cu o Substan

    d!n(re ,D s! ;I a% EYLdJ, dar +/+" :n +"(!%+" an E9IdJ s! :n +"(!%a "+n7 E5;dJ a .os(
    %a! .recven( "a ce! :n e(a(e de 5G &An7 "a 9Y a% D!n(re ce! care a+ .7c+( +/ de dro$
    an+" (rec+(, Yd a+ "+a( +n canna'%o!d de ce" &+=!n 59 or!, !ar ;d, oda(7 "a &es(e YL
    /!"e Re.er!(or "a +/+" de canna'!s "a ado"escen=! s! "a ad+"=!! (!ner!, o ance(7 d!n
    5FFY a cons(a(a( c7 I9d d!n(re e"ev!! c"ase"or s+&er!oare de "!ce+ a+ .7c+( cAndva +/
    de +n canna'%o!d, !nc"+/And s! &e ce! ;Yd care a+ .7c+( +/ de +n canna'%o!d an+"
    (rec+( Pen(r+ c7 ance(e"e a+ eva"+a( %a! c+rAnd &a((ern+n de +/ decA(
    d!a$nos(!ce, n+ se O(!e cA=! d!n(re ce! care a+ +/a( de %ar!+ana a+ av+( s!%&(o%e
    care sa(!s.ac cr!(er!!"e &en(r+ de&enden(7 sa+ a'+/
    O ance(7 na=!ona"7 e.ec(+a(7 :n S(a(e"e Un!(e :n 5FF9 a ra&or(a( ra(e &e v!a(7 de
    a'+/ sa+ de&enden(7 de canna'!s de a&roa&e Yd, !nc"+s!v de 5,9d :n an+" an(er!or
    *voluie
    De&enden(a s! a'+/+" de canna'!s a&ar de re$+"7 d+&7 o "+n$7 &er!oad7 de
    (!%&, deO! &ro$res!+nea &oa(e .! %a! ra&!d7 "a oa%en!! (!ner! c+ &ro'"e%e de
    cond+!(7 &ervas!v7 Ce! %a! %+"=! oa%en! care dev!n de&enden=! s(a'!"esc de
    re$+"7 +n &a((ern de +/ cron!c care cres(e &ro$res!v, a(A( :n .recven(7, cA( s! :n
    can(!(a(e :n +/+" cron!c e<ces!v, e<!s(7 +neor! o d!%!n+are sa+ &!erdere a e.ec(e"or
    &"7c+(e a"e s+'s(an=e! DeO! &oa(e e<!s(a, de ase%enea, o creO(ere cores&+n/7(oare
    a e.ec(e"or d!s.once, aces(ea n+ s+n( o'serva(e (o( a(A( de .recven( ca :n +/+" cron!c
    a" a"(or s+'s(an=e, c+% ar .! a"coo"+", coca!na sa+ a%.e(a%%e"e Un !s(or!c de
    (+"'+rare de cond+!(7 :n co&!"7r!e sa+ !n ado"escen(7 s! (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7 s+n( .ac(or! de r!sc &en(r+ a&ar!=!a %+"(or (+"'+r7r! :n "e$7(+r7 c+ o
    s+'s(an=7, !nc"+s!v a (+"'+r7r!"or :n "e$7(+r7 c+ canna'!s+" E<!s(7 &+=!ne da(e
    d!s&on!'!"e des&re evo"+=!a &e (er%en "+n$ a de&enden(e! sa+ a'+/+"+! de
    canna'!s Ca s! :n ca/+" a"coo"+"+!, ca.e%e! s! %co(%e!, +/+" de canna'!%od a&are
    &recoce :n c+rs+" +/+"+! de o s+'s(an=7 "a %+"=! oa%en! care %a! (Ar/!+ vor a@+n$e
    s7 &re/!n(e de&enden(a de a"(e s+'s(an=e 4 aceas(7 o'serva=!e d+cAnd "a !&o(e/a c7
    aces(a Ecanna'!s+"J &oa(e .! +n Sdro$ de desc!dereT Ba/e"e ne+roc!%!ce,
    &s!o"o$!ce s! soc!a"e a"e aces(e! &os!'!"e &ro$res!+% n+ s+n( '!ne c+nosc+(e s! n+
    es(e c"ar dac7 :n rea"!(a(e %ar!+ana de(er%!n7 !nd!v!/!! s7 (reac7 "a +/+" a"(or
    (!&+r! de s+'s(an=e
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$ 9LH T+"'+r7r!"e !nd+se de canna'!s &o( .! carac(er!/a(e &r!n
    s!%&(o%e Ede e<, an<!e(a(eaJ care a%!n(esc (+"'+r7r!"e %en(a"e &r!%are Ede e<,
    an<!e(a(ea $enera"!/a(7 vers+s (+"'+rarea an<!oas7 !nd+s7 de canna'!s, c+ an<!e(a(e
    $enera"!/a(7, c+ de'+( :n c+rs+" !n(o<!ca=!e!J 3e/! &a$ 9LF &en(r+ d!sc+(area aces(+!
    d!a$nos(!c d!.eren=!a" Ad%!n!s(rarea cron!c7 de canna'!s &oa(e &rod+ce s!%&(o%e
    care a%!n(esc (+"'+rarea d!s(!%!c7. Reac=!!"e adverse ac+(e "a canna'!s (re'+!e s7 .!e
    d!.eren=!a(e de s!%&(o%e"e &an!c!!, (+"'+r7r!! de&res!ve %a@ore, (+"'+r7r!!
    de"!ran(e, (+"'+r7% '!&o"are sa+ sc!/o.ren!e!, (!&+" &arano!d. E<a%en+" so%a(!c
    va ev!den=!a de re$+"7 o creO(ere a &+"s+"+! s! !n@ec(area con@+nc(!ve"or Tes(area
    (o<!co"o$!c7 a +r%!! &oa(e .! +(!"7 :n e.ec(+area d!a$nos(!c+"+!
    :n con(ras( c+ !n(o<!ca=!a c+ canna'!s, !n(o<!ca=!a a"co"!c7 s! !n(o<!ca=!a c+
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce scad .recven( a&e(!(+", cresc co%&or(a%en(+"
    a$res!v s! &rod+c n!s(a$%+s sa+ a(a<!e Ha"+c!no$ene"e :n do/e %!c! &o( ca+/a +n
    76726 Tulburare "n le!tur cu annabisul 'r Alt Speci$icaie 7HE
    (a'"o+ c"!n!c ase%7n7(or c+ !n(o<!ca=!a canna'!c7 6-enc0clidina *6(6,2 ca s!
    canna'!s+", &oa(e .! .+%a(7 s! are, de ase%enea, e.ec(e a"+c!no$ene, dar intoxica3ia
    cu p-enc0clidin ca+/ea/7 %+"( %a! &ro'a'!" a(a<!e s! co%&or(a%en( a$res!v
    In(o<!ca=!a c+ canna'!s se d!s(!n$e de alte tulburri induse de cannabis Ede ex,
    (+"'+rarea an<!oas7 !nd+s7 de canna'!s, c+ de'+( :n c+rs+" !n(o<!ca=!e!J, deoarece
    s!%&(o%e"e d!n aces(e +"(!%e (+"'+r7r! s+n( :n e<ces :n ra&or( c+ ce"e asoc!a(e de
    re$+"7 c+ !n(o<!ca=!a c+ canna'!s s! s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o
    a(en=!e c"!n!c7 se&ara(7
    D!s(!nc=!a :n(re uzul ocazional de cannabis s! de&enden=a sa+ a'+/+" de
    canna'!s es(e d!.!c!" de .7c+(, deoarece &ro'"e%e"e soc!a"e, co%&or(a%en(a"e sa+
    &s!o"o$!ce &o( .! d!.!c!" de a(r!'+!( canna'!s+"+!, :n s&ec!a" :n con(e<(+" +/+"+! a"(or
    s+'s(an=e Ne$area +/+"+! e<ces!v es(e .recven(7, !ar oa%en!! &ar a so"!c!(a
    (ra(a%en( &en(r+ de&enden(a sa+ a'+/+" de canna'!s %a! &+=!n .recven( decA(
    &en(r+ a"(e (!&+r! de (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7
    C5C.5 Tul-urare .n le/(tur( #u Canna-i&ul
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ canna'!s+" .7r7 a"(7 s&ec!.!ca=!e es(e
    re/erva(7 (+"'+r7r!"or asoc!a(e c+ +/+" de canna'!s, care n+ s+n( c"as!.!ca'!"e ca
    de&enden(7 de canna'!s a'+/ de canna'!s, den+% &r!n !n(o<!ca=!e c+ canna'!s,
    (+"'+rare &s!o(!c7 !nd+s7 de canna'!s sa+ (+"'+rare an<!oas7 !nd+s7 de canna'!s
    Tul-ur(rile .n le/(tur( #u Co#aina
    Coca!na, o s+'s(an=7 na(+ra"7 &rod+s7 de &"an(a coca, es(e cons+%a(7 s+' .or%a
    a d!verse &re&ara(e Ede e< , .r+n/e de coca, &as(7 de coca, c"or!dra( de coca!n7 s!
    coca!n7 a"ca"o!d, c+% ar .! 'a/a "!'er7 s! crac)+"J care d!.er7 :n(re e"e ca &+(ere,
    da(or!(7 n!ve"e"or d!.er!(e de &+r!(a(e s! ra&!d!(a(e a de'+(+"+! :n (oa(e aces(e .or%e
    :ns7, coca!na es(e !n$red!en(+" ac(!v Mes(eca(+" .r+n/e"or de coca es(e o &rac(!c7
    "!%!(a(7 :n $enera" "a &o&+"a=!!"e na(!ve d!n A%er!ca Cen(ra"7 s! de S+d, +nde es(e
    c+"(!va(7 &"an(a U/+" de &as(7 de coca, +n e<(rac( 'r+( d!n &"an(a coca, es(e "!%!(a(
    a&roa&e e<c"+s!v "a =7r!"e &rod+c7(oare de coca!n7 d!n A%er!ca Cen(ra"7 s! de S+d,
    +nde co$no%en+" s7+ es(e S'as+"caT So"v en(n +(!"!/a=! "a &re&ararea &as(e! de coca
    con(a%!nea/7 adesea &as(a s! &o( ca+/a e.ec(e (o<!ce "a n!ve"+" s!s(e%+"+! nervos
    cen(ra" s! a" a"(or or$ane cAnd &as(a es(e .+%a(7 P+dra de c"or!dra( de coca!n7 es(e
    de re$+"7 S&r!/a(7T &e n7r! ESsnor(!n$TJ sa+ d!/o"va(7 :n a&7 s! !n@ec(a(7 !n(ravenos
    Ea es(e +neor! a%es(eca(7 c+ ero!n7, &rod+cAnd o co%'!na=!e de dro$+r!
    c+nosc+(7 s+' n+%e"e de Ss&eed'a""T
    O .or%7 de coca!n7 +(!"!/a(7 .recven( :n S(a(e"e Un!(e es(e Scrac)T+", +n a"ca"o!d
    de coca!n7 e<(ras d% &+"'erea s7rn sa"e !droc"once &r!n a%es(ecarea c+
    '!car'ona( de sod!+ s! &or(!onarea s&re +scare :n %!c! Sroc)sT Crac)+" d!.er7 de
    a"(e .or%e de coca!n7, :n s&ec!a" &r!n aceea c7 es(e +Oor de va&on/a( s! de !na"a( s!,
    ca a(are, e.ec(e"e sa"e a+ +n de'+( e<(re% de ra&!d S!ndro%+" c"!n!c s! e.ec(e"e
    adverse asoc!a(e c+ +/+" de crac) s+n( !den(!ce c+ ce"e &rod+se de do/e
    co%&ara'!"e de a"(e &re&ara(e de coca!n7 :na!n(e de a&ar!=!a crac)+"+!, coca!na era
    se&ara(7 d!n 'a/a sa !droc"or!c7 &r!n :nc7"/!re :%&re+n7 c+ e(er, a%on!ac sa+ a"(
    9I9
    Tulburrile "n le!tur cu o Substan
    so"ven( vo"a(!". Coca!na S.ree 'aseT era a&o! .+%a(7. Aces( &roces era &er!c+"os d!n
    ca+/a r!sc+"+! ca so"ven=!! s7 se a&r!nd7 s! s7 va(e%e +se+r+".
    Aceas(7 sec=!+ne con=!ne co%en(ar!! s&ec!.!ce re.er!(oare "a (+"'+r7r!"e :n
    "e$7(+r7 c+ coca!na. A+ .os( de@a &re/en(a(e (e<(e"e s! se(+r!"e de cr!(er!! &en(r+ a
    de.!n! as&ec(e"e $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J s! a'+/+"+! de o
    s+'s(an=7 E&a$. 5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or. A&"!carea aces(or cr!(er!!
    $enera"e "a de&enden=a s! a'+/+" de coca!n7 es(e &re/en(a(7 %a! @os. N+ e<!s(7 :ns7,
    se(+r! de cr!(er!! s&ec!.!ce s+&"!%en(are &en(r+ de&enden=a de coca!n7 sa+ a'+/+"
    de coca!n7. Te<(e"e s! se(+r!"e de cr!(er!! s&ec!.!ce &en(r+ !n(o<!ca=!a c+ coca!n7 s!
    a's(!nen=a de coca!n7 s+n(, de ase%enea, &re/en(a(e %a! @os. T+"'+r7r!"e !nd+se de
    coca!n7 Ea"(e"e decA( !n(o<!ca=!a s! a's(!nen=a de coca!n7J s+n( descr!se :n sec=!+n!"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e<.,
    (+"'+rarea a.ec(!v7 !nd+s7 de coca!n7 es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e
    a.ec(!veTJ. Ma! @os s+n( %en=!ona(e (+"'+r7r!"e +/+"+! de coca!n7 O! (+"'+r7r!"e
    !nd+se de coca!n7.
    Tulburrile u(ului de cocain
    ;LI.9L De&enden=a de coca!n7 Eve/! &a$. 9I9J
    ;LY. RL A'+/+" de coca!n7 Eve/! &a$. 9I;J
    Tulburrile induse de cocain
    9F9. GF In(o<!ca=!a c+ coca!n7 Eve/! &a$. 9IIJ. 0e speci)icat dac6? C+ &er(+r'7r!
    de &erce&=!e
    9F9. O A's(!nen=a de coca!n7 Eve/! &a$. 9IYJ 9F9.G5
    De"!r+%+" &r!n !n(o<!ca=!e c+ coca!n7 Eve/! &a$. 5I;J
    292.10 T+"'+rarea &s!o(!c7 !nd+s7 de coca!n7, c+ !de! de"!ran(e Eve/!
    &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    292.11 T+"'+rarea &s!o(!c7 !nd+s7 de coca!n7, c+ a"+c!na=!! Eve/! &a$.
    ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GI T+"'+rarea a.ec(!v7 !nd+s7 de coca!n7 Eve/! &a$. ILYJ. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GF T+"'+rarea an<!oas7 !nd+s7 de coca!n7 Eve/! &a$. IHFJ. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen(e!
    9F9.GF D!s.+nc=!a se<+a"7 !nd+s7 de coca!n7 Eve/! &a$. YR9J. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GF T+"'+rarea de so%n
    !nd+s7 de coca!n7 Eve/! &a$. RYYJ. 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.F T+"'+rare :n "e$7(+r7 c+ coca!na .7r7 a"(7 s&ec!.!ca=!e Eve/! &a$. 9YLJ.
    Tulburrile !"ului #Ae Cocain
    4+7.C+ Depen$en!a $e Co#ain(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7
    Eve/! &a$. 5F9J. Coca!na are e.ec(e e+.or!ce e<(re% de &+(ern!ce, !ar !nd!v!/!!! e<&+O!
    "a aceas(a &o( de/vo"(a de&enden=7 d+&7 +/+" de coca!n7 &e &er!oade .oar(e sc+r(e de
    (!%&. Un se%n &recoce a" de&enden=e! de coca!n7 :" cons(!(+!e .a&(+" c7 !nd!v!d+"
    45A2I5 Abu(ul de
    ocain
    9I;
    cons(a(7 c7 :! es(e (o( %a! d!.!c!" s7 re/!s(e +/+"+! de coca!n7, or! de cA(e or! aceas(a es(e
    d!s&on!'!"7. D!n ca+/a se%!v!e=!! sa"e sc+r(e de a&roa&e ;L4YL %!n+(e, e<!s(7
    neces!(a(ea +ne! ad%!n!s(r7r! .recven(e &en(r+ a %en=!ne o s(are de Se<a"(areT.
    Persoane"e c+ de&enden=7 de coca!n7 &o( ce"(+! s+%e e<(re% de %ar! de 'an! &e
    dro$ :n dec+rs+" +ne! sc+r(e &er!oade de (!%&. :n consec!n=7, &ersoana care +/ea/7
    de s+'s(an=7 &oa(e .! !%&"!ca(7 :n .+r(+r!, &ros(!(+=!e, v!nderea de dro$+r! or! &oa(e
    cere avans+r! de sa"ar!+ &en(r+ a o'=!ne .ond+r!"e necesare &roc+r7r!! dro$+"+!.
    Ind!v!/!! c+ de&enden=7 de coca!n7 dec!d adesea c7 es(e necesar s7 :n(rer+&7 +/+"
    &en(r+ cA(eva /!"e &en(r+ a se rec+&era sa+ &en(r+ a o'=!ne .ond+r! s+&"!%en(are.
    Res&onsa'!"!(7=! !%&or(an(e, c+% ar .! serv!c!+" sa+ :n$r!@!rea co&!"+"+!, &o( .! ."a$ran(
    ne$"!@a(e &en(r+ a o'=!ne coca!n7 sa+ a +/a de aceas(a. Co%&"!ca=!!"e %en(a"e sa+
    so%a(!ce a"e +/+"+! cron!c de coca!n7, c+% ar .! !dea=!a &arano!d7, co%&or(a%en(+"
    a$res!v, an<!e(a(ea, de&res!a O! &!erderea :n $re+(a(e s+n( .recven(e. Ind!.eren( de
    ca"ea de ad%!n!s(rare, :n ca/ de +/ re&e(a( s+rv!ne (o"eran=a. Po( .! o'serva(e
    s!%&(o%e de a's(!nen=7, :n s&ec!a" !&erso%n!a,, a&e(!(+" cresc+( s! d!s&o/!=!a
    d!s.or!c7, O! es(e &os!'!" s7 creasc7 dor!n=a arden(7 de dro$ s! &ro'a'!"!(a(ea rec7der!!.
    I%ensa %a@or!(a(e a !nd!v!/!"or c+ de&enden=7 de coca!n7 a+ &re/en(a( O! se%ne de
    de&enden=7 .!/!o"o$!c7 de coca!n7 E(o"eran=7 sa+ a's(!nen=7J "a +n %o%en( da( :n
    c+rs+" +/+"+! "or de s+'s(an=7. Ind!ca=!a S c+ de&enden=7 .!/!o"o$!c7T es(e asoc!a(7 c+
    +n de'+( %a! &recoce a" de&enden=e! s! c+ %a! %+"(e &ro'"e%e :n "e$7(+r7 c+ coca!na.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden=7 de coca!n7
    Eve/! &a$. 5FY &en(r+ %a! %+"(e de(a"!!JQ C+ de&enden=7 .!/!o"o$!c7 F7r7
    de&enden=7 .!/!o"o$!c7
    Re%!s!+ne co%&"e(7 &recoce
    Re%!s!+ne &ar=!a"7 &recoce
    Re%!s!+ne co%&"e(7 &re"+n$!(7
    Re%!s!+ne &ar=!a"7 &re"+n$!(7
    In(r4+n %ed!+ con(ro"a(
    4+<.=+ A-u)ul $e Co#ain(
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$. 5FGJ. In(ens!(a(ea O! .recven=a ad%!n!s(r7r!! de coca!n7 s+n( %a! red+se :n
    a'+/+" de coca!n7, :n co%&ara=!e c+ de&enden=a. E&!soade"e de +/ &ro'"e%a(!c, de
    ne$"!@are a res&onsa'!"!(7=!"or s! de con."!c(e !n(er&ersona"e s+rv!n adesea :n
    a&ro&!erea /!"e"or de &"a(7 sa+ :n oca/!! s&ec!a"e O! d+c "a +n &a((ern de sc+r(e
    &er!oade Ede cA(eva ore sa+ /!"eJ de +/ de do/e %ar!, +r%a( de &er!oade %+"( %a!
    "+n$! Es7&(7%An! sa+ "+n!J de +/ oca/!ona", non&ro'"e%a(!c sa+ de a's(!nen=7. Po(
    re/+"(a d!.!c+"(7=! "e$a"e, d!n de=!nerea sa+ +/+" de dro$. CAnd &ro'"e%e"e asoc!a(e
    c+ +/+" s+n( aco%&an!a(e de &ro'a (o"eran=e!, a's(!nen=e! sa+ co%&or(a%en(+"+!
    co%&+"s!v :n "e$7(+r7 c+ o'=!nerea s! ad%!n!s(rarea coca!ne!, (re'+!e "+a( :n
    cons!dera=!e %a! c+rAnd d!a$nos(!c+" de de&enden=7 de coca!n7 decA( ce" de a'+/
    de coca!n7. Deoarece :ns7, +ne"e s!%&(o%e de (o"eran=7, a's(!nen=7 sa+ +/
    co%&+"s!v &o( s+rven! "a !nd!v!/!! c+ a'+/ dar n+ c+ de&enden=7, es(e !%&or(an( s7
    se s(a'!"easc7 dac7 s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ de&enden=7.
    9II
    Tulburrile "n le!tur cu o Substan
    Tulburrile induse de Cocain
    C5C.>5 Into,i#a!ia #u Co#ain(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$ 5FFJ E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ coca!n7 :" cons(!(+!e &re/en=a
    %od!.!c7r!"or &s!o"o$!ce sa+ co%&or(a%en(a"e de/ada&(a(!ve se%n!.!ca(!ve c"!n!c
    care a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7 +/+" de coca!n7 Ecr!(er!+" A s! BJ
    In(o<!ca=!a c+ coca!n7 :nce&e de re$+"7 c+ o sen/a=!e de Se<a"(areT s! !nc"+de +n+"
    sa+ %a! %+"(e d% +r%7(oare"e s!%&(o%e. e+.or!e c+ creO(erea v!$or!!, soc!a'!"!(a(e,
    !&erac(!v!(a(e, ne"!n!O(e %o(or!e, !&erv!$!(a(e, s+sce&(!'!"!(a(e !n(er&ersona"7,
    "ocvac!(a(e, an<!e(a(e, (ens!+ne, a"er(7, $randoare, co%&or(a%en( re&e(!(!v s!
    s(ereo(!&, s(are co"eroas7 s! de(er!orarea @+dec7=!!, !ar :n ca/+" !n(o<!ca=!e! cron!ce,
    a&"a(!/are a.ec(!v7 c+ .a(!$a'!(a(e sa+ (r!s(e=e s! re(ra$ere soc!a"7 Aces(e %od!.!c7r!
    co%&or(a%en(a"e s! &s!o"o$!ce s+n( aco%&an!a(e de do+7 sa+ %a! %+"(e d!n(re
    +r%7(oare"e se%ne s! s!%&(o%e care a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7 +/+" de
    coca!n7 (a!card!e sa+ 'rad!card!e, d!"a(ae &+&!"ar7, creO(erea sa+ sc7derea
    &res!+n!! san$+!ne, (rans&!ra=!e sa+ .r!soane, $rea=7 sa+ vo%7, &!erdere :n $re+(a(e,
    a$!(a=!e sa+ "en(oare &s!o%o(one, sc7derea .or=e! %+sc+"are, de&r!%are
    res&!ra(or!e, &record!a"$!e sa+ ar!(%!! card!ace s! con.+/!e, cr!/e e&!"e&(!ce,
    d!s)%e/n, d!s(onn sa+ co%7 Ecr!(er!+" CJ In(o<ca(!a, .!e ac+(7 sa+ cron!c7, es(e
    adesea asoc!a(7 c+ de(er!orarea .+nc=!on7r!! soc!a"e sa+ &ro.es!ona"e In(o<!ca=!a
    sever7 &oa(e d+ce "a conv+"s!!, ar!(%!! card!ace, .e'ra s! %oar(e Pen(r+ a &+ne
    d!a$nos(!c+" de !n(o<!ca=!e c+ coca!n7, s!%&(o%e"e n+ (re'+!e s7 se da(ore/e +ne!
    cond!=!! %ed!ca"e $enera"e s! sa n+ .!e e<&"!ca(e %a! '!ne de a"(7 (+'+rare %en(a"7
    Ecr!(er!+" DJ
    Ma$n!(+d!nea s! d!rec=!a %od!.!c7r!"or .!/!o"o$!ce s! co%&or(a%en(a"e de&!nd de
    %+"(e var!a'!"e, !nc"+s!v de do/a +(!"!/a(7 s! de carac(er!s(!c!"e &ersoane! care
    +/ea/7 de s+'s(an=7 Ede e<, (o"eran(a, r!(%+" de a'sor'=!e, cro%c!(a(ea +/+"+!,
    con(e<(+" :n care es(e "+a(7 s+'s(an=aJ E.ec(e"e s(!%+"an(e, c+% ar .! e+.or!a,
    creO(erea &+"s+"+!, &res!+n!! san$+!ne s! a ac(!v!(7=!! &s!o%o(orn s+n( ce" %a!
    .recven( o'serva(e E.ec(e"e de&r!%an(e, c+% ar .! (r!s(e=ea, 'rad!card!a, sc7derea
    &res!+n!! san$+!ne s! red+cerea ac(!v!(7=!! &s!o%o(orn s+n( %a! &+=!n .recven(e s!
    a&ar :n $enera" n+%a! :n +/+" cron!c de do/e %ar!
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( +n+! d!a$nos(!c de !n(o<!ca=!e c+ coca!n7
    C+ &er(+r'7r! de &erce&=!e. Aces( s&ec!.!can( &oa(e (! %en=!ona( cAnd s+rv!n
    a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 or! !"+/!! a+d!(!ve, v!/+a"e sa+ (ac(!"e,
    % a'sen(a +n+! de"!n+% Testarea lealit6(ii intac(ii :nsea%n7 c7 &ersoana O(!e c7
    a"+c!na=!!"e s+n( !nd+se de s+'s(an=7 s! n+ re&re/!n(7 rea"!(a(ea e<(ern7
    CAnd a"+c!na=!!"e s+rv!n !n a'sen(a (es(7% rea"!(7=!! !n(ac(e, (re'+!e "+a( :n
    cons!dera=!e d!a$nos(!c+" de (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7, c+
    a"+c!na=!!
    767 O Abstinenta de
    ocain
    2F5
    Criteriile $e $ia/no&ti# pentru
    C5C.>5 Into,i#a!ia #u Co#ain(
    A2 .( recent de cocain2
    S2 Modi$icri comportamentale sau psi%olo!ice de(adaptative semni$icative
    clinic &de ex, eu$orie sau aplati(are a$ectiv, modi$icri de sociabilitate,
    %ipervi!ilitate, susceptibilitate mterpersonal, anxietate, tensiune sau stare
    coleroas, comportamente stereotipe, deteriorarea 0udecii sau dete
    riorare "n $uncionarea social sau pro$esional) care apar "n cursul sau la
    scurt timp dup u(ul de cocain
    Dou &sau mai multe) din urmtoarele simptome apr@nd "n cursul sau la
    scurt timp dup u(ul de cocain
    (1) ta%icardie sau bradicardie,
    (2) dilatatie pupilar,
    (3) presiune san!uin crescut sau sc(ut,
    (4) transpiraie sau $risoane,
    (5) !rea sau vom,
    (6) proba pierderii "n !reutate,
    (7) a!itaie sau lentoare psi%omotone,
    (8) scderea $orei musculare, depresie respiratorie, precordial!ie sau aritmii
    cardiace,
    (9) con$u(ie, cri(e epileptice, disCine(u, distonn sau com
    D2 Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental
    De speci"icat dac
    Cu pertur-(ri $e per#ep!ie
    C5C.+ A-&tinen!a $e Co#ain(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a's(!nen(a de o s+'s(an=7
    Eve/! &a$ 9L5J E"e%en(+" esen=!a" a" a's(!nen(e! de coca!n7 :" cons(!(+!e &re/en(a
    +n+! s!ndro% de a's(!nen(7 carac(er!s(!c care a&are :n dec+rs de cA(e_a ore d+&7
    :nce(area Esa+ red+cereaJ +/+"+! de coca!na, care a .os( e<ces!v s! &re"+n$!( Ecr!(er!!"e
    A s! BJ S!ndro%+" de a's(!nen(7 se carac(er!/ea/7 &r!n a&ar!=!a +ne! d!s&o/!=!!
    d!s.once aco%&an!a(e de do+7 sa+ %a! %+"(e d!n(re +r%7(oare"e %od!.!c7r!
    .!/!o"o$!ce .a(!$a'!(a(e, v!se v!! s! ne&"7c+(e, !nso%n!e sa+ !&erso%n!e, creO(erea
    a&e(!(+"+! s! "en(oare sa+ a$!(a=!e &s!o%o(one Anedon!a s! dor!n=a arden(7 de
    dro$ &o( .! adesea &re/en(e, dar n+ .ac &ar(e d!n cr!(er!!"e de d!a$nos(!c Aces(e
    s!%&(o%e ca+/ea/7 de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ S!%&(o%e"e
    n+ (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e s! n+ s+n( e<&"!ca(e %a!
    '!ne de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" DJ
    S!%&(o%e"e de a's(!nen(7 ac+(7 ESa crasTJ Es+n( o'serva(e adesea, d+&7
    &er!oade de +/ re&e(a( de do/e %ar! ES(+reT sa+ Sor$!!TJ Aces(e &er!oade s+n(
    9IR
    Tulburrile "n le!tur cu o Substan

    carac(er!/a(e &r!n sen(!%en(e de "as!(+d!ne O! de&res!e, !n(ense s! ne&"7c+(e, care
    neces!(7 :n $enera" cA(eva /!"e de re&a+s s! rec+&erare. S!%&(o%e de&res!ve c+ !de!
    sa+ co%&or(a%en( s+!c!dar &o( s+rven! s! s+n( :n $enera" ce"e %a! ser!oase
    &ro'"e%e o'serva(e :n c+rs+" +ne! Scras!n$TEs(7r! de&res!veJ sa+ a a"(or .or%e de
    a's(!nen=7 de coca!n7. Un n+%7r cons!dera'!" de !nd!v!/! c+ de&enden=7 de coca!n7
    a+ &+=!ne sa+ c!ar n!c! +n .e" de s!%&(o%e de a's(!nen=7 "a :nce(area +/+"+!.
    Criteriile $e $ia/no&ti# pentru C5C.+ A-&tinen!a $e Co#ain(
    A2 "ncetarea &sau reducerea) u(ului de cocain, care a $ost excesiv ,i prelun!it2
    S2 Dispo(iie dis$oric ,i dou &sau mai multe) dintre urmtoarele modi$icri $i(io-
    lo!ice, apr@nd "n decurs de c@teva ore p@n la c@teva (ile dup criteriul AD
    (1)$ati!abilitate,
    (2)vise vii, neplcute,
    (3)insomnie sau %ipersomnie,
    (4)apetit crescut,
    (5)lentoare sau a!itaie psi%omotorie2
    2 Simptomele de la criteriul S cau(ea( o detres sau deteriorare semni$icativ clinic
    "n domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale ,i nu sunt
    explicate mai bine de alt tulburare mental2
    Alte Tul-ur(ri in$u&e $e Co#ain(
    Ur%7(oare"e (+"'+r7r! !nd+se de coca!n7 s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ de"!r!+%
    &r!n !n(o<!ca=!e c+ coca!n7 E&a$. 5I;J, (+"'+rarea &s!o(!c7 !nd+s7 de coca!n7
    E&a$. ;;GJ, (+"'+rarea a.ec(!v7 !nd+s7 de coca!n7 E&a$. ILYJ, (+"'+rarea an<!oas7
    !nd+s7 de coca!n7 E&a$. IHFJ, d!s.+nc=!a se<+a"7 !nd+s7 de coca!n7 E&a$. YR9J,
    (+"'+rarea de so%n !nd+s7 de coca!n7 E&a$. RYYJ. Aces(e (+"'+r7r! s+n(
    d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ coca!n7 sa+ a" a's(!nen=e! de coca!n7, n+%a!
    cAnd s!%&(o%e"e s+n( :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de
    !n(o<!ca=!e sa+ de a's(!nen=7 de coca!n7 s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe
    &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    $nformaii sulimentare desre
    Tulburrile %n le&tur cu Cocaina
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. Coca!na es(e +n dro$ c+
    ac=!+ne de sc+r(7 d+ra(7 care &rod+ce e.ec(e ra&!de s! &+(ern!ce as+&ra s!s(e%+"+!
    nervos cen(ra", :n s&ec!a" cAnd es(e ad%!n!s(ra(7 !n(ravenos sa+ .+%a(7. CAnd es(e
    !n@ec(a(7 sa+ .+%a(7, coca!na &rod+ce de re$+"7 o sen/a=!e !%ed!a(7 de '!ne, de
    :ncredere s! e+.or!e. Mod!.!c7r! co%&or(a%en(a"e dra%a(!ce &o( a&are ra&!d, :n
    Tulburrile "n le!tur cu
    ocaina
    2F8

    s&ec!a" :n asoc!ere c+ de&enden=a. Ind!v!/!! c+ de&enden=7 de coca!n7 s+n(
    c+nosc+=! a ce"(+! %!! de do"ar! &e s+'s(an=7 :n dec+rs+" +nor sc+r(e &er!oade de
    (!%&, d!n care ca+/7 a@+n$ "a ca(as(ro.e .!nanc!are :n care econo%!! sa+ case se
    &!erd. Ind!v!/!! se &o( an$a@a :n ac(!v!(7=! !n.rac=!ona"e s&re a o'=!ne 'an!! &en(r+
    coca!n7. Co%&or(a%en(+" ao(!c, !/o"area soc!a"7 s! d!s.+nc=!a se<+a"7 s+n(
    o'serva(e adesea :n con(e<(+" +ne! de&enden=e de coca!n7 de "+n$7 d+ra(7. D!n
    e.ec(e"e coca!ne! &oa(e re/+"(a +n e.ec( a$res!v8 v!o"en=a es(e, de ase%enea, asoc!a(7
    c+ Sco%er=+"T c+ coca!n7. Co%&or(a%en(+" se<+a" &ro%!sc++, .!e ca re/+"(a( a"
    dor!n=e! cresc+(e, .!e a" +(!"!/7r!! se<+"+! :n sco&+" o'=!ner!! coca!ne! Esa+ &en(r+
    'an! s&re a c+%&7ra coca!n7J a deven!( +n .ac(or :n r7s&And!rea %a"ad!!"or
    (rans%!se se<+a", !nc"+s!v a v!r+s+"+! !%+node.!c!en=e! +%ane EHI3J.
    In(o<!ca=!a ac+(7 c+ do/e %ar! de coca!n7 &oa(e .! asoc!a(7 c+ "!%'a@ d!va$an(,
    ce.a"ee, !de! (ran/!(or!! de re.er!n=7 s! (!n!(+s. Po( e<!s(a, de ase%enea, !dea=!e
    &arano!d7, a"+c!na=!! a+d!(!ve &e .ond+" +ne! conO(!!n=e c"are s! a"+c!na=!! (ac(!"e
    ES!nsec(e"e coca!ne!TJ, &e care +se+r+" "e rec+noaO(e de re$+"7, ca e.ec(e a"e coca!ne!.
    Poa(e s+rven! o .+r!e e<(re%7, c+ a%en!n=7r! sa+ co%&or(a%en( a$res!v.
    Mod!.!c7r!"e de d!s&o/!=!e, c+% ar .! de&res!a, !de!"e de s+!c!d, !r!(a'!"!(a(ea,
    anedon!a, "a'!"!(a(ea e%o=!ona"7 sa+ &er(+r'7r!"e de a(en=!e O! concen(rare s+n(
    .recven(e, :n s&ec!a" :n c+rs+" a's(!nen=e! de coca!n7.
    Ind!v!/!! c+ de&enden=7 de coca!n7 &re/!n(7 adesea s!%&(o%e de&res!ve
    (e%&orare care sa(!s.ac cr!(er!!"e s!%&(o%a(o"o$!ce O! de d+ra(7 &en(r+ (+"'+rarea
    de&res!v7 %a@or7 Eve/! (+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7, &a$. ILYJ. Is(or!ce
    concordan(e c+ a(ac+r! de &an!c7 re&e(a(e, co%&or(a%en( ase%7n7(or .o'!e! soc!a"e
    O! s!ndro%e ase%7n7(oare an<!e(7=!! $enera"!/a(e n+ s+n( rare Eve/! (+"'+rarea
    an<!oas7 !nd+s7 de o s+'s(an=7, &a$. IHFJ. T+"'+r7r!"e de co%&or(a%en( a"!%en(ar
    &o( .!, de ase%enea, asoc!a(e c+ aceas(7 s+'s(an=7. Un+" d!n ce"e %a! e<(re%e ca/+r!
    de (o<!c!(a(e a coca!ne! es(e (+"'+rarea &s!o(!c7 !nd+s7 de coca!n7 Eve/! &a$. ;;GJ,
    o (+"'+rare c+ !de! de"!ran(e s! a"+c!nan=!! care a%!n(esc sc!/o.ren!a, (!&+"
    &arano!d. Per(+r'7r!"e %en(a"e care s+rv!n :n asoc!a=!e c+ +/+" de coca!n7, se
    re/o"v7 de re$+"7 :n dec+rs de cA(eva ore &An7 "a cA(eva /!"e, d+&7 :nce(area +/+"+!,
    deO! &o( &ers!s(a O! (!%& de o "+n7.
    Ind!v!/!! c+ de&enden=7 de coca!n7 de/vo"(7 adesea r7s&+ns+r! cond!=!ona(e "a
    s(!%+"! :n "e$7(+r7 c+ coca!na Ede e<., dor!n=a arden(7 de dro$, "a vederea or!c7re!
    s+'s(an=e ase%7n7(oare c+ &+dra a"'7J. Aces(e r7s&+ns+r! con(r!'+!e &ro'a'!" "a
    rec7dere, s+n( d!.!c!" de s(!ns, O! de re$+"7 &ers!s(7 %+"( (!%& d+&7 ce de/!n(o<!carea
    sa (er%!na(. T+"'+r7r!"e +/+"+! de coca!n7 s+n( asoc!a(e adesea c+ de&enden=a sa+
    a'+/+" de a"(7 s+'s(an=7, :n s&ec!a" de a"coo", %ar!+ana O! 'en/od!a/e&!ne, care
    s+n( "+a(e adesea &en(r+ a red+ce an<!e(a(ea O! a"(e e.ec(e s(!%+"an(e ne&"7c+(e a"e
    coca!ne!. De&enden=a de coca!n7 &oa(e .! asoc!a(7 c+ s(res+" &os((ra+%a(!c,
    (+"'+rarea de &ersona"!(a(e an(!soc!a"7, (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e
    O! c+ @oc+" de Oans7 &a(o"o$!c.
    Da(e de "a'ora(or asoc!a(e. Ce"e %a! %+"(e (es(e de "a'ora(or &en(r+
    'en/oy"e$on!n7, +n %e(a'o"!( a" coca!ne!, care &ers!s(7 :n +r!n7 54; /!"e d+&7 o
    s!n$+r7 do/7, &oa(e .! &re/en( (!%& de H459 /!"e "a ce! ce +/ea/7 :n %od re&e(a( de
    do/e %ar!. Tes(e .+nc=!ona"e e&a(!ce +Oor cresc+(e &o( .! v7/+(e "a !nd!v!/!! care4O!
    !n@ec(ea/7 coca!na sa+ +/ea/7 e<ces!v de a"coo" :n asoc!ere c+ coca!na. Pne+%on!!
    sa+ &ne+%o(ora< se o'serv7 oca/!ona" "a e<a%en+" rad!o"o$!e &+"%onar, :nce(area
    +/+"+! cron!c de coca!n7 se asoc!a/7 adesea c+ %od!.!c7r! EE,, a"(er7r! :n &a((ern+"
    de secre=!e a &ro"ac(%e! s! re$"area @oas7 a rece&(or!"or do&a%!ne!.
    2F=
    Tulburrile "n le!tur cu o Substan
    9atele examinrii somatice si condi3iile medicale .enerale asociate. Poa(e
    s+rven! o "+n$7 sene de cond!=!! %ed!ca"e $enera"e, s&ec!.!ce c7!! de ad%!n!s(rare a
    coca!ne! Persoane"e care +;ea;6 de coca!n7 !n(rana/a" ES&r!/areTJ &re/!n(7 adesea
    s%+/!(7, !n(a=!e s! sAn$erare a %+coase! na/a"e s! &er.orarea se&(+"+! na/a" Ce!
    care .+%ea/7 coca!n7 s+n( s+&+O! +n+! r!sc cresc+( de &ro'"e%e res&!ra(or!! Ede e<,
    (+se, 'ronO!(7 s! &ne+%on!e da(or!(7 !r!(7% s! !n."a%7r!! =es+(+r!"or %+coase!
    (rac(+"+! res&!ra(orJ Persoane"e care4s! !n@ec(ea/7 coca!n7 a+ se%ne s! S+r%eT de
    :n=e&7(+r!, ce"e %a! %+"(e &e an(e'ra=e, aOa c+% se v7d "a ce! c+ de&enden(7 de
    o&!acee In.ec=!a c+ HI3 es(e asoc!a(7 c+ de&enden(a de coca!n7 d!n ca+/a
    .recven(e"or !n@ec=!! %(ravenoase s! a co%&or(a%en(+"+! se<+a" &ro%!sc++ cresc+(
    A"(e %a"ad!! (rans%!se se<+a", e&a(!(a s! (+'erc+"o/a, &rec+% s! a"(e !n.ec=!!
    &+"%onare s+n(, de ase%enea, o'serva(e De&enden(a de coca!n7 E!nd!.eren( de
    ca"ea de ad%!n!s(rareJ se asoc!a/7 .recven( c+ se%ne de &!erdere :n $re+(a(e s! de
    %a"n+(n(!e, d!n ca+/a e.ec(e"or sa"e de s+&r!%are a a&e(!(+"+! Pne+%o(ora<+"
    &oa(e re/+"(a &r!n e.ec(+area +nor %anevre ase%7n7(oare %anevre! 3a"sa"va,
    .7c+(e s&re a a'sor'! %a! '!ne coca!na !na"a(7 In.arc(+" %!ocard!c, &a"&!(a=!!"e s!
    ar!(%+"e, %oar(ea s+'!(7 &r!n s(o& res&!ra(or sa+ card!ac or! !c(+s+" a+ .os( asoc!a(e
    c+ +/+" de coca!n7 "a &ersoane (!nere, de a"(.e", s7n7(oase Aces(e !nc!den(e s+n(
    ca+/a(e &ro'a'!" de ca&ac!(a(ea coca!ne! de a cres(e &res!+nea san$+!n7, de a ca+/a
    vasocons(r!ce or! de a a"(era ac(!v!(a(ea e"ec(nc7 a !n!%!! A+ .os( o'serva(e cr!/e
    e&!"e&(!ce :n asoc!a=!e c+ +/+" de coca!n7 Le/!+n!"e (ra+%a(!ce da(ora(e d!s&+(e"or
    care d+c "a +n co%&or(a%en( v!o"en( s+n( .recven(e, :n s&ec!a" &r!n(re &ersoane"e
    care vAnd coca!n7 Pr!n(re .e%e!"e $rav!de, +/+" de coca!n7 es(e asoc!a( c+ (+"'+r7r!
    :n ."+<+" san$+!n &"acen(ar, a'r+&(!o &"acen(ae, (rava"!+ s! naO(ere &re%a(+r7 s! o
    &reva"en(7 cresc+(7 a co&!!"or c+ $re+(a(e .oar(e %!c7 "a naO(ere
    *lemente speci$ice culturii, etii si sexului
    U/+" de coca!n7 s! (+"'+r7r!"e care45 :nso=esc a.ec(ea/7 (oa(e rase"e, (oa(e
    $r+&+r!"e, soc!oecono%!ce, de e(a(e s! se< d!n S(a(e"e Un!(e T+"'+r7r!"e :n "e$7(+r7
    c+ coca!na s+n( cons(a(a(e %a! .rec_en( "a &ersoane"e :n(re 5G s! ;L de a% DeO!
    e&!de%!a ac(+a"7 de coca!n7 a :nce&+( :n an!! 5FHL &r!n(re !nd!v!/!! %a! av+=!, ea a
    (rec+( "a c+&r!nderea $r+&+r!"or soc!oecono%!ce !n.er!oare (r7!nd :n %an!e an!
    %e(ro&o"!(ane Kone"e r+ra"e, care %a! :na!n(e a+ .os( cr+=a(e de &ro'"e%e"e asoc!a(e
    c+ +/+" de dro$+r! !"!c!(e, a+ .os(, de ase%enea, a.ec(a(e Con(rar ce"or %a! %+"(e
    (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 :n care '7r'a=!! s+n( %a! a.ec(a=! decA( .e%e!"e,
    (+"'+r7r!"e +/+"+! de coca!n7 s+n( a&roa&e e$a" d!s(r!'+!(e &r!n(re '7r'a=! s! .e%e!
    #revalent
    Ca s! !n ca/+" ce"or %a! %+"(e d!n(re ce"e"a(e dro$+r!, &reva"en(a +/+"+! de
    coca!n7 !n S(a(e"e Un!(e a ."+c(+a( %+"( de4a "+n$+" an!"or D+&7 +n &!c :n an!! HL,
    &ro&or=!a &o&+"a=!e! care a .7c+( +/ de coca!n7 :n or!care d!n(re .or%e"e e!, a sc7/+(
    &ro$res!v &An7 "a :nce&+(+" an!"or 2FL, d+&7 care d!%!n+area a con(!n+a(, dar :n(r4
    +n r!(% %a! "en( O ance(7 na=!ona"7 d!n 5FFR re.er!(oare "a +/+" de dro$ re"a(ea/7
    c7 5LHc d!n &o&+"a=!e a .7c+( cand_a +/ de coca!na, c7 9d a ra&or(a( +/ :n +"(!%+"
    an, !ar O Gd, :n +"(!%a "+n7 U/+" de crac) es(e ce" %a! red+s, 9d d!n &o&+"a=!e
    re"a(And c7 a .Ac+( +/ de e" cAndva :n c+rs+" v!e=!!, L,Rd c7 a .7c+( +/ an+" (rec+(,
    !ar L,;d, c7 a .7c+( +/ "+na (rec+(7 Ind!v!/!! :n e(a(e de 9I4;R an! a+ re"a(a( ce"e %a!
    %ar! &rocen(e de +V :n c+rs+" v!e(n E95 d &en(r+ coca!n7 s! Id &en(r+ crac)J Pe de
    Tul-ur(rile .n le/(tur( #u
    Co#aina
    2F4
    a"(7 &ar(e :ns7 $r+&+" de e(a(e c+ ce" %a! r!d!ca( &rocen( :n c+rs+" an+"+! (rec+( EYd
    &en(r+ coca!n7 s! 5d &en(r+ crac)J a .os( ce" a" !nd!v!/!"or :n e(a(e de 5G49Y a%.
    Tre'+!e %en=!ona( :ns7 c7 :n(r+cA( aces(e ance(e a+ eva"+a( %a! c+rAnd &a((ern+n
    de +/ decA( (+"'+r7r!, n+ se O(!e cA=! d!n(re ce! ance(a=! care a+ .7c+( +/ de coca!n7
    a+ av+( s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ de&enden=7 sa+ a'+/
    Procen(+" de de&enden(7 sa+ a'+/ de coca!n7 &e v!a=7 a .os( ra&or(a( a .! de
    a&roa&e 9d :n(r4o ance(7 co%+n!(ar7 d!n 5FF9 e.ec(+a(7 :n S(a(e"e Un!(e, c+ o
    &reva"en(7 de a&ro<!%a(!v 9d &e ce"e 59 "+n! an(er!oare
    *voluie
    Ca s! :n ca/+" a%.e(a%%e"or, de&enden(a de coca!n7 es(e asoc!a(7 c+ o vane(a(e de
    &a((ern+n de a+(oad%!n!s(rare, !nc"+/And +/+" e&!sod!c sa+ /!"n!c Eor! a&roa&e /!"n!cJ
    :n &a((ern+" e&!sod!c, +/+" de coca!n7 (!nde a .! se&ara( &nn do+7 sa+ %a! %+"(e /!"e
    de non+/ Ede e<, +/ !n(ens :n c+rs+" #ee)end+"+! or! :n(r+na sa+ %a! %+"(e /!"e :n
    c+rs+" s7&(7%An!! SOr$!!"eT s+n( o .or%7 de +/ e&!sod!c care !%&"!c7 +n +/ con(!n++
    de do/e %An :n dec+rs de ore sa+ /!"e s! s+n( asoc!a(e adesea c+ de&enden(a Or$!!"e
    se (er%!n7 de re$+"7, n+%a! cAnd &rov!/!!"e de coca!n7 sa+ e&+!/a( U/+" cron!c /!"n!c
    &oa(e co%&or(a do/e %ar! sa+ %!c! s! &oa(e avea "oc :n (o( c+rs+" /!"e! on es(e res(rAns
    "a cA(eva ore doar In +c+" cron!c /!"n!c, n+ e<!s(7 :n $enera" %An ."+c(+a=!! :n do/7, /!"e
    "a rAnd, dar adesea e<!s(7 o creO(ere a do/e! c+ (!%&+"
    F+%a(+" s! ad%!n!s(rarea !n(ravenoas7 a coca!ne! (!nd a .! asoc!a(e c+
    &ro$res!+nea ra&!d7 de "a +/ "a a'+/ sa+ de&enden(7, aceas(a s+rve%nd adesea :n
    dec+rs de cA(eva s7&(7%An! sa+ "+n! U/+" %(rana/a" es(e asoc!a( c+ o &ro$res!+ne
    %a! "en(7, d+rAnd de re$+"7 "+n! sa+ an! De&enden(a es(e asoc!a(7 .recven( c+ o
    (o"eran(7 &ro$res!v7 "a e.ec(e"e de/!ra'!"e a"e coca!ne!, ceea ce d+ce "a creO(erea
    do/e"or Pr!n con(!n+area +/+"+! a&are o d!%!n+are a e.ec(e"or &"7c+(e da(ora(7
    (o"eran(e! s! o creO(ere a e.ec(e"or d!s.once S+n( d!s&on!'!"e &+=!ne da(e des&re
    evo"+=!a &e (er%en "+n$ a (+"'+r7r!"or +/+"+! de coca!n7
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or !n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$ 9LH T+"'+r7r!"e !nd+se de coca!n7 &o( .! carac(er!/a(e &r!n
    s!%&(o%e Ede e< , d!s&o/!=!e de&res!v7J care a%!n(esc (+"'+r7r!"e %en(a"e &r!%are
    Ede e< , (+"'+rarea de&resn 7 %a@ora _ ers+s (+"'+rarea a.ec(!v7 !nd+s7 de coca!n7,
    c+ e"e%en(e de&res!ve, c+ de'+( :n c+rs+" a's(!nen(e!J _e/! &a$ 9LF &en(r+
    d!sc+(area aces(+! d!a$nos(!c d!.eren=!a" Per(+r'7r!"e %en(a"e se%n!.!ca(!ve, care
    &o( re/+"(a d!n e.ec(e"e coca!ne!, (re'+!e s7 =!e d!sLnse de s!%&(o%e"e sc!/o.ren!e!,
    (!&+" &arano!d, de ce"e a"e (+"'+r7% '!&o"are s! a"e a"(or (+"'+r7r! a.ec(!ve,
    an<!e(7=!! $enera"!/a(e s! &an!c!!.
    In(o<!ca=!a c+ a%.e(a%!na s! !n(o<!ca=!a c+ &encyc"!d!n7 &o( ca+/a +n (a'"o+
    c"!n!c s!%!"ar s! adesea &o( "! d!s(!nse de !n(o<!ca=!a c+ coca!n7 n+%a! &r!n &re/en(a
    %e(a'o(!"or coca!ne! !n(r+n eOan(!on de +r!n7 or! a coca!ne! :n &"as%7 In(o<!ca=!a
    c+ coca!n7 s! a's(!nen(a de coco!na se d!s(!n$ de a"(e (+"'+r7r! !nd+se de coca!n7
    Ede e<, (+"'+rarea an<!oas7 %d+?a de coca!n7 c+ de'+( :n c+rs+" !n(o<!ca=!e!J,
    deoarece :n aces(ea d!n +r%7 s!%&(o%e"e s+n( !n e<eces .a(7 de ce"e asoc!a(e de
    re$+"7 c+ !n(o<!ca=!a c+ coca!na on c+ a's(!nen(a de coca!n7 s! s+n( s+.!c!en( de
    severe &en(r+ a @+s(!.!ca o a(en=!e c"!n-a ss&ara(a
    9YL Tulburrile "n le!tur cu o Substan

    C5C.5 Tul-urare .n le/(tur( #u Co#aina
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ coca!na .7r7 a"(7 s&ec!.!ca=!e es(e re/erva(7
    (+"'+r7r!"or asoc!a(e c+ +/+" de coca!n7 care n+ s+n( c"as!.!ca'!"e ca de&enden=7 de
    coca!n7, a'+/ de coca!n7, !n(o<!ca=!e c+ coca!n7, a's(!nen=7 de coca!n7, de"!r!+%
    &r!n !n(o<!ca=!e c+ coca!n7, (+"'+rare &s!o(!c7 !nd+s7 de coca!n7, (+"'+rare
    an<!oas7 !nd+s7 de coca!n7, d!s.+nc=!e se<+a"7 !nd+s7 de coca!n7 sa+ (+"'+rare de
    so%n !nd+s7 de coca!n7.
    Tul-ur(rile .n le/(tur( #u Falu#ino/enele
    Aces( $r+& d!vers de s+'s(an=e !nc"+de er$or+" s! co%&+O!! :nr+d!=! Ed!e(!"a%!da
    ac!d+"+! "!ser$!c ZLSD[, se%!n=e"e de /ore"eJ, .en!"a")!"a%!de"e E%esca"!na, SSTP
    Z9,Y,d!%e(o<!4I4%e(!" a%.e(a%!na[ s! MDA Z;,I4%e(!"end!o<!%e(a%.e(a%!na,
    n+%!(7, de ase%enea, s! Sics(asyT[J, a"ca"o!/! !ndo"!c! E&s!"oc!'!na, DMT Zd!%e(!"4
    (r!&(a%!na[J s! d!verO! a"=! co%&+O!. D!n aces( $r+& s+n( e<c"+se &encyc"!d!na
    EPCPJ E&a$. 9HGJ s! canna'!s+", s! co%&+s+" s7+ ac(!v, de"(a4F4(e(ra!dro4
    canna'!no"+" ETHCJ E&a$.9;I J. DeO! aces(e s+'s(an=e &o( avea e.ec(e a"+c!no4
    $en!ce, e"e s+n( d!sc+(a(e se&ara( d!n ca+/a d!.eren=e"or se%n!.!ca(!ve :n a"(e e.ec(e
    &s!o"o$!ce O! co%&or(a%en(a"e. Ha"+c!no$ene"e s+n( "+a(e de re$+"7 &e ca"e ora"7,
    deO! DMT &oa(e .! .+%a(, !ar +/+" &r!n !n@ec(are &oa(e s+rven!.
    Aceas(7 sec=!+ne con=!ne d!sc+=!! e<&"!c!(e des&re (+"'+r7r!"e :n "e$7(+r7 c+
    a"+c!no$ene"e. A+ .os( &re/en(a(e de@a (e<(e"e O! se(+r!"e de cr!(er!! &en(r+
    de.!n!rea as&ec(e"or $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J s! a'+/+"+!
    de o s+'s(an=7 E&a$. 5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or. A&"!carea aces(or
    cr!(er!! $enera"e "a de&enden=a s! a'+/+" de a"+c!no$ene s+n( &re/en(a(e %a! @os.
    N+ e<!s(7 :ns7, se(+r! de cr!(er!! s&ec!.!ce &en(r+ de&enden=a de a"+c!no$ene sa+
    a'+/+" de a"+c!no$ene. Un (e<( O! +n se( de cr!(er!! s&ec!.!ce &en(r+ !n(o<!ca=!a c+
    a"+c!no$ene s+n(, de ase%enea, &re/en(a(e %a! @os. To"eran=a se de/vo"(7 d+&7 +/
    re&e(a(, :ns7 a's(!nen=a de aces(e s+'s(an=e n+ es(e '!ne doc+%en(a(7. Pen(r+ aces(
    %o(!v, d!a$nos(!c+" de a's(!nen=7 "a a"+c!no$ene n+ es(e !nc"+s :n aces( %an+a".
    T+"'+r7r!"e !nd+se de a"+c!no$ene Ea"(e"e decA( !n(o<!ca=!a c+ a"+c!no$eneJ s+n(
    descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7
    .eno%eno"o$!a Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de a"+c!no$ene es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e A.ec(!veTJ. Ma! @os s+n( %en=!ona(e (+"'+r7r!"e +/+"+! de
    a"+c!no$ene O! (+"'+r7r!"e !nd+se de a"+c!no$ene.
    Tulburrile u(ului de %alucino!ene
    ;LI.YL De&enden=a de a"+c!no$ene Eve/! &a$. 9Y5J
    ;LY.;L A'+/+" de a"+c!no$ene Eve/! &a$. 9Y9J
    Tulburrile induse de %alucino!ene
    9F9.GF In(o<!ca=!a c+ a"+c!no$ene Eve/! &a$. 9Y9J
    9F9.GF T+"'+rarea de &erce&=!e &ers!s(en(7 a"+c!no$en7 EF"as'ac)sJ
    Eve/! &a$. 9Y;J
    N HHHBB!

    45H2A5 Dependena de
    Lalucino!ene
    9Y5
    9F9.G5 De"!r!+%+" &r!n !n(o<!ca=!e c+ a"+c!no$ene Eve/! &a$. 5I;J
    9F9.59 T+"'+r7r!"e &s!o(!ce !nd+se de a"+c!no$ene, c+ !de! de"!ran(e
    Eve/! &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.59 T+"'+rarea &s!o(!c7 !nd+s7 de a"+c!no$ene, c+ a"+c!na=!!
    Eve/! &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GI T+"'+rarea a.ec(!v7 !nd+s7 de a"+c!no$ene Eve/! &a$. ILYJ.De
    speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GF T+"'+rarea
    an<!oas7 !nd+s7 de a"+c!no$ene Eve/! &a$. IHFJ.De
    speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.F T+"'+rare :n
    "e$7(+r7 c+ a"+c!no$er(e"e .7r7 a"(7 s&ec!.!ca=!e Eve/!
    &a$. 9YHJ
    Tulburrile !"ului de 'alucino&ene
    4+7.<+ Depen$en!a $e Falu#ino/ene
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o
    s+'s(an=7 Eve/! &a$. 5F9J. Un+" d!n(re cr!(er!!"e $enera"e a"e de&enden=e! Ede e<.,
    a's(!nen=aJ n+ se a&"!c7 "a a"+c!no$ene, !ar a"(e"e neces!(7 c"ar!.!c7r!
    s+&"!%en(are. A .os( descr!s .a&(+" c7 (o"eran=a se de/vo"(7 .oar(e ra&!d "a e.ec(e"e
    e+.or!ce s! &s!ede"!ce a"e a"+c!no$ene"or, dar n+ s! "a e.ec(e"e ve$e(a(!ve, c+% ar
    .! d!"a(a=!a &+&!"ar7, !&erre."e<!a, creO(erea &res!+n!! san$+!ne, creO(erea
    (e%&era(+r!! cor&+"+!, &!"oerec=!a s! (a!card!a. E<!s(7 (o"eran=7 :ncr+c!=a(7 :n(re
    LSD s! a"(e a"+c!no$ene Ede e<., &s!"oc!'!na s! %esca"!naJ, dar aceas(a n+ se
    e<(!nde "a %+"(e a"(e ca(e$or!! de dro$+r! c+% ar .! PCP s! canna'!s+". U/+" de
    a"+c!no$ene, c!ar &r!n(re !nd!v!/!! c+ (a'"o+r! c"!n!ce care sa(!s.ac !n(e$ra"
    cr!(er!!"e &en(r+ de&enden=7, es(e adesea "!%!(a( "a n+%a! cA(eva or! &e
    s7&(7%An7. C+ (oa(e c7 a's(!nen=a a .os( o'serva(7 "a an!%a"e, E"a o%J re"a(7r!
    c"are de Sdor!n=7 arden(7T de dro$ d+&7 s(o&area a"+c!no$ene"or n+ se c+nosc.
    Da(or!(7 se%!v!e=!! "+n$! s! d+ra(e! de ac=!+ne e<(!nse a ce"or %a! %+"(e
    a"+c!no$ene, !nd!v!/!! c+ de&enden=7 de a"+c!no$ene re/erv7 adesea ore s! /!"e
    +/+"+! de s+'s(an=7 O! rec+&er7r!! d!n e.ec(e"e "or. D!n con(ra, +ne"e a"+c!no$ene
    Sdro$+r! s!n(e(!ceT Ede e<., DMTJ a+ o d+ra(7 de ac=!ne .oar(e sc+r(7.
    Ha"+c!no$ene"e &o( con(!n+a s7 .!e +(!"!/a(e :n d!s&re=+" c+noaO(er!! e.ec(e"or
    adverse Ede e<., de(er!orarea %e%or!e! :n (!%& ce es(e !n(o<!ca(, S'ad (r!&sT, care
    s+n( de re$+"7 reac=!! de &an!c7 sa+ ."as'ac)s4+r!J. Un!! !nd!v!/!, care +/ea/7 de
    MDMA E+n dro$ s!%!"ar a%.e(a%!ne! c+ e.ec(e a"+$!no$en!ceJ descr!+ o s(are de
    S%a%+rea"7T a do+a /! d+&7 +/, carac(er!/a(7 &r!n !nso%n!e, .a(!$a'!"!(a(e,
    a%e=ea"7, d+rere :n %+Oc!! %and!'+"e! "a s(rAn$erea d!n d!n=!, &!erderea
    ec!"!'r+"+! s! ce.a"ee. Deoarece con(ra.acer!"e sa+ s+'s(!(+!en=!! s+n( vAnd+=!
    adesea ca a"+c!no$ene Sac!deT sa+ ca a"( (!& de a"+c!no$ene, +ne"e d!n e.ec(e"e
    adverse descr!se &o( .! da(ora(e +nor ase%enea s+'s(an=e ca s(r!cn!na, &ency4
    c"!d!na sa+ a%.e(a%!na. Un!! !nd!v!/! &o( &re/en(a reac=!! co%&or(a%en(a"e
    &er!c+"oase Ede e<., s7r!(+" &e .ereas(r7, .!!nd conv!nO! c7 &o( S/'+raTJ d!n ca+/a
    "!&se! conO(!!n=e! %a"ad!e! O! @+dec7=!! :n (!%& ce s+n( !n(o<!ca=!. Aces(e e.ec(e
    adverse &ar a .! %a! .recven(e &r!n(re ce! care a+ (+"'+r7r! %en(a"e &ree<!s(en(e.
    9Y9
    Tulburrile "n le!tur cu o Substan

    Speci$icanti
    Ur%7(or!! s&ec!.!can(! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden(7 de
    a"+c!no$ene Eve/! &a$ 5FY &en(r+ %a! %+"(e de(a"!!J
    Re%!s%ne co%&"e(7 &recoce
    Re%!s!+ne &ar=!a"7 &recoce
    Re%!s!+ne co%&"e(7 &re"+n$!(7
    Re%!s!+ne &ar=!a"7 &re"+n$!(7
    :n(r4+n %ed!+ con(ro"a(
    4+<.4+ A-u)ul $e Falu#ino/ene
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$ 5FGJ Persoane"e care a'+/ea/7 de a"+c!no$ene +;ea;6 de aces(ea %+"( %a!
    rar decA( o .ac ce! c+ de&enden(7 C+ (oa(e aces(ea, e! &o( eO+a :n %od re&e(a( :n
    :nde&"!n!rea o'"!$a=!!"or ro"+"+! %a@or "a scoa"7, "a serv!c!+ sa+ acas7 d!n ca+/a
    de(er!or7r!! co%&or(a%en(a"e &rovoca(e de !n(o<!ca=!a c+ a"+c!no$ene Ind!v!d+"
    &oa(e +/a de a"+c!no$ene !n s!(+a=!a :n care aces( "+cr+ es(e &er!c+"os Ede e<, :n
    (!%& ce cond+ce o %o(oc!c"e(7 sa+ +n a+(o%o'!"J, s! &o( a&are d!.!c+"(7=! "e$a"e d!n
    ca+/a co%&or(a%en(e"or care re/+"(7 d% !n(o<!ca=!e sa+ &osedarea de
    a"+c!no$ene Po( e<!s(a &ro'"e%e soc!a"e sa+ %(er&ersona"e da(ora(e
    co%&or(a%en(+"+! !nd!v!d+"+! :n (!%& ce es(e !n(o<!ca(, s(!"+"+! de v!a(7 !/o"a( sa+
    cer(+r!"or c+ a"(e &ersoane !%&or(an(e
    Tulburrile induse de 'alucino&ene
    C5C.>5 Into,i#a!ia #u Falu#ino/ene
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$ 5FFJ E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ a"+c!no$ene :" cons(!(+!e &re/en(a
    +nor %od!.!c7r! &s!o"o$!ce s! co%&or(a%en(a"e de/ada&(a(!ve se%n!.!ca(!ve c"!%e Ede
    e<, an<!e(a(e sa+ de&res!e %arca(7, !de! de re.er!n=7, .r!ca de a n+4s! &!erde %!n=!"e,
    !dea(!e &arano!d7 de(er!orarea @+dec7r!! sa+ de(enorarea .+nc=!on7% soc!a"e or!
    &ro.es!ona"eJ care a&ar !n c+rs+" +/+"+! de a"+c!no$ene sa+ "a sc+r( (!%& d+&7 aceea
    E:n dec+rs de cA(eva %!n+(e &An7 "a cA(eva oreJ Ecr!(er!!"e A s! BJ Mod!.!c7r!"e de
    &erce&=!e a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7 +/+" de a"+c!no$ene s! s+rv!n :n s(are
    de v!$!"!(a(e co%&"e(7 s! de a"er(7 Ecr!(er!+" CJ Aces(e %od!.!c7r! !nc"+d !n(ens!.!carea
    s+'!ec(!v7 a &erce&=!!"or de&ersona"!/area derea/area, !"+/!!"e, a"+c!na=!!"e s!
    s!nes(e/!!"e :n a.ar7 de aceas(a, d!a$nos(!c+" cere ca do+7 d!n(re +r%7(oare"e se%ne
    .!/!o"o$!ce s7 .!e, de ase%enea, &re/en(e d!"a(ae &+&!"ar7, (a!card!e, (rans&!ra=!!,
    &a"&!(a=!!, o'n+'!"area vede%, (re%+r7(+r! s! %coordonare Ecr!(er!+" DJ S!%&(o%e"e
    n+ (re'+!e s7 .!e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e s! s7 n+ .!e e<&"!ca(e %a! '!ne
    de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" EJ
    In(o<!ca=!a c+ a"+c!no$ene :nce&e de re$+"7 c+ +ne"e e.ec(e s(!%+"an(e, c+% ar
    .! ne"!n!O(ea s! ac(!varea ve$e(a(!v7 Poa(e a&are s! $rea=7 Ur%ea/7 a&o! +n O!r de
    e<&er!en=e, do/e"e %a! %ar! &rod+cAnd s!%&(o%e %a! !n(ense Sen(!%en(e de
    e+.or!e &o( a"(erna ra&!d c+ de&res!e sa+ an<!e(a(e I"+/!!"e v!/+a"e !n!=!a"e sa+
    e<&er!en=e"e sen/or!a"e !n(ens!.!ca(e &o( desc!de ca"ea a"+c!na=!!"or La do/e %!c!,
    767286 Tulburarea de #ercepie
    #ersistent Lalucino!en
    &'las%bacCs)
    C<4
    .recven(, %od!.!c7r!"e de &erce&=!e n+ !nc"+d a"+c!na=!!. Po( a&are s!nes(e/!! Eo
    co%'!na=!e a s!%=+r!"orJ, de e<e%&"+, Svederea s+ne(e"orT. Ha"+c!na=!!"e s+n( de
    re$+"7 v!/+a"e O! cons(a+ adesea d!n .or%e sa+ .!$+r! $eo%e(r!ce, !ar +neor! d!n
    &ersoane s! o'!ec(e. Ma! rar, s+n( e<&er!ena(e a"+c!na=!! a+d!(!ve s! (ac(!"e, :n ce"e
    %a! %+"(e ca/+r!, (es(area rea"!(7=!! es(e &re/erva(7 Ead!c7, !nd!v!d+" O(!e c7 e.ec(e"e
    s+n( !nd+se de s+'s(an=7J.
    Criteriile $e $ia/no&ti# pentru C5C.>5
    Into,i#a!ia #u Falu#ino/ene
    A2 .( recent de un %alucino!en2
    S2 Modi$icri ps%i%olo!ice sau comportamentale de(adaptative semni$icative
    clinic &de ex2, anxietate sau depresie marcat, idei de re$erin, $rica de a nu-
    ,i pierde minile, ideaie paranoid, deteriorarea 0udecii sau deteriorarea
    $uncionarii sociale sau pro$esionale), care apar "n cursul sau la scurt timp
    dup u(ul de %alucino!en2
    2 Modi$icrile perceptive survin "n stare de vi!ilitate si de alert deplin &de ex2,
    intensi$icarea subiectiv a percepiilor, depersonali(are, dereali(are, ilu(ii,
    %alucinaii, sineste(ii) si apar "n cursul sau la scurt timp dup u(ul de %alucino!en2
    D2 Dou &sau mai multe) dintre urmtoarele semne care apar "n cursul sau la
    scurt timp dup u(ul de %alucino!enD
    (1)dilataie pupilar@3
    (2)ta%icardie3
    (3)transpiraie3
    (4)palpitaii3
    (5)obnubilarea vederii3
    (6)tremurturi3
    (7)incoordonare2
    *2 Simptomele nu se datorea( unei condiii medicale !enerale
    C5C.>5 Tul-urarea $e Per#ep!ie Per&i&tent
    Falu#ino/en( 3'la&@-a#D&6
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &erce&=!e &ers!s(en(e a"+c!no$ene
    E."as'ac)sJ :" cons(!(+!e rec+ren(a (ran/!(or!e de &er(+r'7r! de &erce&=!e, care s+n(
    re%!n!scen=e a"e ce"or e<&er!en(a(e :n c+rs+" +ne!a sa+ a" %a! %+"(or !n(o<!ca=!!
    an(er!oare c+ +n a"+c!no$en. Persoana (re'+!e s7 n+ .! av+( n!c! o !n(o<!ca=!e
    recen(7 c+ a"+c!no$ene O! (re'+!e s7 n+ &re/!n(e ac(+a"%en(e n!c! +n .e" de e.ec(e
    (o<!ce a"e dro$+"+! Ecr!(er!+" AJ. Aceas(7 ree<&enen(are a s!%&(o%e"or &erce&(+a"e
    ca+/ea/7 o de(res7 sa+ o de(er!orare :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e
    do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" BJ. S!%&(o%e"e n+ se da(orea/7 +ne!
    cond!=!! %ed!ca"e $enera"e Ede e<., "e/!+n! ana(o%!ce M !n.ec=!! a"e cre!er+"+! or!
    e&!"e&s!! v!/+a"eJ s! n+ s+n( e<&"!ca(e %a! '!ne de a2(7 (+"'+rare %en(a"7 Ede e<.,
    de"!r+%, de%en=7 sa+ sc!/o.ren!eJ or! de a"+c!na=!! !&no&o%&!ce Ecr!(er!+" CJ.
    Per(+r'7r!"e de &erce&=!e &o( !nc"+de .or%e $eo%e(r!ce, !%a$!n! de cA%& &er!.er!c,
    NM i$illtl,/M
    9YI
    Tulburrile "n le!tur cu o Substan

    ."as4+r! de c+"oare, c+"or! !n(ens!.!ca(e, !%a$!n! (renan(e E!%a$!n! r7%ase
    s+s&enda(e :n ca"ea +n+! o'!ec( care se %!Oc7, aOa c+% se vede :n(r4o .o(o$ra.!e
    s(ro'osco&!c7J, &erce&=!! de o'!ec(e :n(re$!, &os(!%a$!n! ES+%'reT a"e +n+! o'!ec(,
    co"ora(e !den(!c sa+ co%&"e%en(ar, care r7%An d+&7 :nde&7r(area o'!ec(+"+!J,
    a"o+r! :n @+r+" o'!ec(e"or, %acro&s!e s! %!cro&s!e. Perce&=!!"e anor%a"e care s+n(
    asoc!a(e c+ &er(+r'area de &erce&=!e &ers!s(en(7 a"+c!no$en7 a&ar e&!sod!c s! &o(
    .! a+(o!nd+se Ede e<., &r!n $And!(+" "a e"eJ sa+ dec"anOa(e de !n(rarea :n(r4+n %ed!+
    :n(+necos, de d!verse dro$+r!, de an<!e(a(e sa+ .a(!$a'!"!(a(e or! de a"=! s(resor!.
    E&!soade"e &o( d!s&are d+&7 cA(eva "+n!, :ns7 %+"(e &ersoane re"a(ea/7 e&!soade
    &ers!s(en(e (!%& de Y an! sa+ c!ar %a! %+"(. Tes(area rea"!(7=!! r7%Ane !n(ac(7
    Ead!c7, &ersoana rec+noaO(e c7 &erce&=!a es(e e.ec(+" dro$+"+! s! n+ re&re/!n(7
    rea"!(a(ea e<(ern7J. D!n con(r7, dac7 &ersoana &re/!n(7 o !n(er&re(are de"!ran(7
    re.er!(oare "a e(!o"o$!a &er(+r'7r!! de &erce&=!e, d!a$nos(!c+" adecva( va .! ce" de
    (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e.
    Criteriile $e $ia/no&ti# pentru C5C.>5 Tul-urare $e
    Per#ep!ie Per&i&tent( Falu#ino/en( 3'la&@-a#D&6
    A2 +eexperientarea, urm@nd "ncetrii u(ului unui %alucino!en, a unuia sau a
    mai multor simptome perceptuale care au $ost experientate "n timp ce era
    intoxicat cu %alucino!enul &de ex2, %alucinaii !eometrice, $alse percepii de
    mi,care "n c@mpul vi(ual peri$eric, $las%uri de culoare, culori intensi$icate,
    trenuri de ima!ini de obiecte "n mi,care, postima!ini po(itive, %alouri "n
    0urul obiectelor, macropsie ,i micropsie)2
    S2 Simptomele de la criteriul A cau(ea( o detres sau deteriorare semni$i
    cativ clinic "n domeniul social, pro$esional sau "n alte domenii importante
    de $uncionare2
    2 Simptomele nu se datorea( unei condiii medicale !enerale &de ex2, le(iuni
    anatomice ,i in$ecii ale creierului, epilepsii vi(uale) si nu sunt explicate mai
    bine de alt tulburare mental &de ex2, delirium, demen, sc%i(o$renie) sau
    de %alucinaiile %ipnopompice2
    Alte Tul-ur(ri in$u&e $e Falu#ino/ene
    Ur%7(oare"e (+"'+r7r! !nd+se de a"+c!no$ene s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+!, :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ
    de"!r!+%+" &r!n !n(o<!ca=!e c+ a"+c!no$ene E&a$. 5I;J, (+"'+rarea &s!o(!c7
    !nd+s7 de a"+c!no$ene E&a$. ;;GJ, (+"'+rarea a.ec(!v7 !nd+s7 de a"+c!no$ene
    E&a$. ILYJ O! (+"'+rarea an<!oas7 !nd+s7 de a"+c!no$ene E &a$. IHFJ. Aces(e
    (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ a"+c!no$ene, n+%a! cAnd
    s!%&(o%e"e s+n( :n e<ces .a(7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e
    c+ a"+c!no$ene s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o
    a(en=!e c"!n!c7 se&ara(7.
    Tulburrile "n le!tur cu Lalucino!enele 7AA
    $nformaii sulimentare desre
    Tulburrile %n le&tur cu 'alucino&enele
    *lemente si tulburri asociate
    CAnd s+n( !n(o<!ca=! c+ +n a"+c!no$en, !nd!v!/!! &o( .! vo"+'!"! s! "ocvace s!
    &re/!n(7 %od!.!c7r! ra&!de de d!s&o/!=!e. Fr!ca s! an<!e(a(ea &o( deven! !n(ense, c+
    (ea%a de ne'+n!e sa+ de %oar(e. M+"(e s+'s(an=e a"+c!no$ene a+ e.ec(e
    s(!%+"an(e Ede e<., (a!card!e, !&er(ens!+ne +Ooar7, !&er(er%!e s! d!"a(a=!e
    &+&!"ar7J O! &o( ca+/a +ne"e d!n(re e"e%en(e"e !n(o<!ca=!e! c+ a%.e(a%!na.
    Per(+r'7r!"e de &erce&=!e O! de(er!orarea @+dec7=!! asoc!a(e c+ !n(o<!ca=!a c+
    a"+c!no$ene, &o( d+ce "a v7(7%7r! sa+ %oar(e &r!n acc!den(e de a+(o%o'!",
    :nc7!er7r! sa+ :ncerc7r! de a S/'+raT d!n "oc+r! :na"(e. Fac(or!! a%'!en(a"!,
    &ersona"!(a(ea O! e<&ec(a=!!"e !nd!v!d+"+! care +;ea;6 de a"+c!no$ene &o( con(r!'+!
    "a na(+ra s! sever!(a(ea !n(o<!ca=!e! c+ a"+c!no$ene. In(o<!ca=!a &oa(e .! asoc!a(7, de
    ase%enea, c+ %od!.!c7r! .!/!o"o$!ce !nc"+/And creO(erea concen(ra=!e! san$+!ne a
    $"+co/e!, cor(!/o"+"+!, ACTH O! &ro"ac(!ne!. T+"'+rarea de &erce&=!e &ers!s(en(7
    a"+c!no$en7 &oa(e &rod+ce an<!e(a(e s! &reoc+&are cons!dera'!"7 O! &oa(e .! %a!
    .recven(7 "a &ersoane"e %a! s+$es(!ona'!"e. R7%Ane con(roversa( .a&(+" dac7 +/+"
    cron!c de a"+c!no$ene &rod+ce o (+"'+rare &s!o(!c7 de novo, dec"anOea/7
    s!%&(o%e &s!o(!ce n+%a! "a &ersoane"e v+"nera'!"e sa+ es(e doar +n se%n &recoce
    a" +n+! &roces &s!o(!c evo"+(!v. A'+/+" s! de&enden=a de a"+c!no$ene s+rv!n, de
    ase%enea, .recven( "a &ersoane"e c+ (+"'+rare de cond+!(7 &ree<!s(en(7 d!n
    ado"escen=7 or! "a &ersoane"e c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 :n &er!oada
    ad+"(7. In(o<!ca=!a c+ LSD &oa(e .! con.!r%a(7 &r!n e<a%en+" (o<!co"o$!c a" +r!n!!.
    *lemente speci$ice culturii, etii si sexului
    Ha"+c!no$ene"e &o( .! +(!"!/a(e ca &ar(e a +nor &rac(!c! re"!$!oase s(a'!"!(e, c+%
    ar .! &eyo("+" :n B!ser!ca A%er!can7 a Na(!v!(7=!!. :n S(a(e"e Un!(e e<!s(7 d!.eren=e
    re$!ona"e :n +/+" "or :n dec+rs+" (!%&+"+!. In(o<!ca=!a c+ a"+c!no$ene s+rv!ne de
    re$+"7 &en(r+ &r!%a da(7 :n ado"escen=7, !ar +se+r!! %a! (!ner! &o( (!nde s7
    e<&er!en(e/e e%o=!! %a! &er(+r'an(e. U/+" O! !n(o<!ca=!a c+ a"+c!no$ene &ar a .! de
    (re! or! %a! .recven(e &r!n(re '7r'a=! decA( &r!n(re .e%e!.
    #revalent
    Ha"+c!no$ene"e a+ deven!( o %od7 :n S(a(e"e Un!(e &r!n an!! 2RL. T!%& de an!, o
    var!e(a(e a aces(or a$en=! a .os( .oar(e &o&+"ar7, dar :n an!! 2FL ce"e %a! .recven(
    +(!"!/a(e do+7 dro$+r! d!n aceas(7 c"as7 a+ .os( LSD s! MDMA. Se es(!%ea/7 c7
    &!c+" &reva"en(e! cons+%+"+! de a"+c!no$ene :n S(a(e"e Un!(e a .os( :n(re 5FRR s!
    5FHL, c+ +n dec"!n consec+(!v, dar e<!s(7 &ro'e a"e +ne! %odes(e creO(er! :nce&:nd
    a&ro<!%a(!v d!n an!! 5FFL.
    Con.or% +ne! ance(e na=!ona"e d!n 5FFR re.er!(oare "a +/+" de dro$+r!, 5Ld
    d!n(re !nd!v!/!! :n e(a(e de 59 an! s! &es(e a+ rec+nosc+( c7 a+ .7c+( cAndva +/ de +n
    a"+c!no$en. E(a(ea $r+&+"+! "a care s4a ra&or(a( ce" %a! %are &rocen( a" ce"or care
    a+ .7c+( cAndva +/ de +n+" d!n(re aces(e dro$+r! a .os( de 5G49Y an! E5RdJ, c+ Hd
    .7cAnd +/ de dro$ :n +"(!%+" an O! c+ 9d .7cAnd +/ de dro$ :n "+na (rec+(7. D!n
    da(e"e +ne! ance(e na=!ona"e e.ec(+a(e :n 5FFH &r!n(re e"ev!! de "!ce+ d!n c"ase"e
    s+&er!oare re/+"(7 c7 5Yd a+ rec+nosc+( c7 a+ "+a( cAndva +n a"+c!no$en, !ar 5Ld
    25>
    Tulburrile "n le!tur cu o Substan

    c7 a+ "+a( +n a"+c!no$en an+" (rec+( Tre'+!e re=!n+( c7 deoarece aces(e ance(e a+
    eva"+a( %a! c+rAnd &a((ern+n"e de +/ decA( (+"'+r7r!"e, n+ se O(!e cA( de %+"=!
    d!n(re ce! care a+ &ar(!c!&a( "a ance(7 s! care a+ .7c+( +/ de a"+c!no$ene a+
    &re/en(a( s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ de&enden(7 sa+ a'+/
    O ance(7 co%+n!(ar7 e.ec(+a(7 :n S(a(e"e Ura(e :n 5FF9 ra&or(ea/7 c7 ra(e"e &e
    v!a=7 a"e a'+/+"+! sa+ de&enden(e! de a"+c!no$ene &ar a .! :n @+r de L,R d, c+ o
    ra(7 de &reva"en(7 &e 59 "+n! :n @+r de L,5d
    *voluie
    In(o<!ca=!a c+ a"+c!no$ene &oa(e .! +n even!%en( sc+r( s! !/o"a( sa+ &oa(e
    s+rven! :n %od re&e(a( In(o<!ca=!a &oa(e .! &re"+n$!(7, dac7 do/e"e s+n( re&e(a(e
    .recven( :n c+rs+" +n+! e&!sod Ad%!n!s(rarea .recven(7 (!nde :ns7 s7 red+c7
    e.ec(e"e !n(o<!ca=!e! d!n ca+/a de/vo"(7% (o"eran(e! :n .+nc=!e de dro$ s! de ca"ea sa
    de ad%!n!s(rare, e.ec(e"e a(!n$ &+nc(+" %a<!% :n dec+rs de cA(eva %!n+(e &An7 "a
    cA(eva ore, !ar !n(o<!ca=!a se re/o"v7 :n dec+rs de cA(eva ore &An7 "a cA(eva /!"e d+&7
    :nce(area ad%!n!s(r7% Preva"en(a cresc+(7 a ce"or care Sa+ +/a( cAndvaT de
    a"+c!no$ene &r!n(re ce! :n e(a(e de 9R4;I an! s! &reva"en(a sc7/+(7 a +/+"+! recen(
    "a aces( $r+& s+$erea/7 c7 %+"=! &o( :nce(a s7 %a! .ac7 +/ de a"+c!no$ene &e
    %7s+r7 ce avansea/7 :n e(a(e Un+ !nd!v!/! care +/ea/7 de a"+c!no$ene descr!+
    ,,."as'ac)4+n2 care n+ s+n( asoc!a(e c+ n!c! +n .e" de de(er!orare sa+ de(res7 Pe de
    a"(7 &ar(e, ."as'ac)4+n"e &o( ca+/a de(er!orare sa+ de(res7 "a +n+ !nd!v!/! E ve/!
    %a! s+s, (+"'+rarea de &erce&=!e &ers!s(en(7 a"+c!no$en7J
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7 ve/! &a$ 9LH T+"'+r7r!"e !nd+se de a"+c!no$ene &o( .!
    carac(er!/a(e &r!n s!%&(o%e Ede e<, !de! de"!ran(eJ care a%!n(esc de (+"'+r7r!"e
    %en(a"e &r!%are Ede e< , (+"'+rarea sc!/o.re%.or%7 vers+s (+"'+rarea &s!o(!c7
    !nd+s7 de a"+c!no$ene, c+ !de! de"!ran(e, c+ de'+( :n c+rs+" !n(o<!ca=!e!J 3e/! &a$
    95L &en(r+ d!sc+(area aces(+! d!a$nos(!c d!.eren=!a"
    In(o<!ca=!a c+ a"+c!no$ene (re'+!e s7 .!e d!s(!ns7 de !n(o<!ca=!a c+ a%.e(a%!na
    sa+ c+ &encycd!n7. Tes(e"e (o<!co"o$!ce s+n( +(!"e :n e.ec(+area aces(e! d!s(!nc=!!
    In(o<!ca=!a c+ an(!co"%er$!ce &oa(e, de ase%enea, &rod+ce a"+c!na=!!, dar aces(ea
    s+n( asoc!a(e adesea c+ da(e so%a(!ce &rec+% d!"a(a(!e &+&!"ar7, .e'r7, $+r7 s!
    (e$+%en(e +sca(e, .ac!es con$es(!_ s! &er(+r'7r! _ !/+a"e In(o<!ca=!a c+ a"+c!no$ene
    se d!s(!n$e de a"(e (+"'+r7r! !nd+se de a"+c!no$ene Ede e<, (+"'+rarea an<!oas7
    !nd+s7 de a"+c!no$ene, c+ de'+( !n c+rs+" !n(o<!ca=!e!J, deoarece :n aces(e d!n
    +r%7 (+"'+r7r!, s!%&(o%e"e s+n( :n e<ces co%&ara(!v c+ ce"e asoc!a(e de re$+"7 c+
    !n(o<!ca=!a c+ a"+c!no$ene s! s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7
    In(o<!ca=!a c+ a"+c!no$ene se d!s(!n$e de (+"'+rarea de &erce&=!e &ers!s(en(7
    a"+c!no$en7 E."as'ac)sJ &r!n .a&(+" c7 +"(!%a se con(!n+7 e&!sod!c (!%& de
    s7&(7%An! Esa+ %a! %+"(J d+&7 cea %a! recen(7 !n(o<!ca=!e :n (+"'+rarea de
    &erce&=!e &ers!s(en(7 a"+c!no$en7, !nd!v!d+" n+ crede c7 &erce&=!a re&re/!n(7
    rea"!(a(ea e<(ern7, &e cAnd o &ersoan7 c+ o (+"'+rare &s!o(!c7 crede adesea c7
    &erce&=!a es(e rea"7 T+"'+rarea de &erce&=!e &ers!s(en(7 a"+c!no$en7 &oa(e .!
    d!s(!ns7 de %!$ren7, de e&!"e&s!e or! de o cond!=!e ne+ro"o$!c7 &r!n !s(or!c+"
    ne+roo.(a"%"o$!c, e<a%en+" so%a(!c s! o eva"+are de "a'ora(or adecva(7
    Tulburrile "n le!tur cu
    In%alantele
    258
    C5C.5 Tul-urare .n le/(tur( #u Falu#ino/enele
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ a"+c!no$ene"e .7r7 a"(7 s&ec!.!ca=!e es(e
    re/erva(7 (+"'+r7r!"or asoc!a(e c+ +/+" de a"+c!no$ene care n+ s+n( c"as!.!ca'!"e ca
    de&enden=7 de a"+c!no$ene, (+"'+rare de &erce&=!e &ers!s(en(7 a"+c!no$en7,
    de"!r!+% &r!n !n(o<!ca=!e c+ a"+c!no$ene, (+"'+rare &s!o(!c7 !nd+s7 de
    a"+c!no$ene, (+"'+rare a.ec(!v7 !nd+s7 de a"+c!no$ene sa+ (+"'+rare an<!oas7
    !nd+s7 de a"+c!no$ene.
    Tul-ur(rile .n le/(tur( #u In@alantele
    Aceas(7 sec=!+ne !nc"+de (+"'+r7r!"e !nd+se &r!n !na"area !drocar'+r!"or
    a"!.a(!ce s! aro%a(!ce a."a(e :n s+'s(an=e &rec+% $a/o"!na, ade/!v!!, d!"+an=!! &en(r+
    vo&se"e s! vo&se"e"e s&ray. Ma! &+=!n +(!"!/a(e s+n( !drocar'+r!"e a"o$ena(e
    Ea."a(e :n e&+ra(or!, "!c!d+" de corec=!e &en(r+ %aO!na de scr!s, aeroso"!! &ro&+"s!v!J
    O! a"=! co%&+O! vo"a(!"! care con=!n es(er!, ce(one s! $"!co"!. In$red!en(e"e ac(!ve
    !nc"+de (o"+en+", 'en/en+", ace(ona, (e(rac"ore(!"ena, %e(ano"+" s! a"(e s+'s(an=e.
    Re."ec(And d!verse"e %od+r! de ac=!+ne O! &ro.!"e de &ro'"e%e asoc!a(e, (+"'+r7r!"e
    care re/+"(7 d!n +/+" $a/e"or anes(e/!ce Ede e<., o<!d+" de a/o(, e(er+"J sa+ ce" a"
    vasod!"a(a(oare"or c+ d+ra(7 sc+r(7 de ac=!+ne Ede e<., n!(r!(+" de a%y" s! n!(r!(+" de
    '+(y" ZT&o&&ersT[ s+n( descr!se :n sc!%' "a (+"'+r7r!"e :n "e$7(+r7 c+ a"(e
    s+'s(an=e sa+ s+'s(an=e nec+nosc+(e "a &a$. 9FI. Ce! %a! %+"=! co%&+O! care s+n(
    !na"a=! s+n( o %!<(+r7 de d!verse s+'s(an=e care &o( &rod+ce e.ec(e &s!oac(!ve,
    !ar adesea es(e d!.!c!" de s(a'!"!( e<ac( s+'s(an=a res&onsa'!"7 de (+"'+rare.
    E<ce&(And ca/+" cAnd e<!s(7 &ro'a c"ar7 c7 o s!n$+r7 s+'s(an=7 &+r7 a .os( +(!"!/a(7,
    (er%en+" $enera" de in-alant (re'+!e s7 .!e +(!"!/a( "a :nre$!s(rarea d!a$nos(!c+"+!.
    Aces(e s+'s(an=e vo"a(!"e s+n( acces!'!"e :n(r4o $a%7 "ar$7 de &rod+se co%erc!a"e s!
    &o( .! +(!"!/a(e !n(erOan@a'!", :n .+nc=!e de d!s&on!'!"!(a(e O! de &re.er!n=a &ersona"7.
    DeO! &o( e<!s(a d!.eren=e s+'(!"e :n e.ec(e"e &s!oac(!ve O! so%a(!ce a"e d!.er!=!"or
    co%&+O!, n+ se O(!e s+.!c!en( des&re e.ec(e"e "or d!.eren=!a"e &en(r+ a "e &+(ea
    d!s(!n$e :n(re e"e. Toa(e s+n( ca&a'!"e s7 &rod+c7 de&enden=7, a'+/ O! !n(o<!ca=!e.
    Pen(r+ !na"area va&or!"or !n(o<!can=! s+n( +(!"!/a(e d!verse %e(ode. Ce" %a!
    .recven(, o 'a(!s(7 :%'!'a(7 :n s+'s(an=7 es(e a&"!ca(7 &e $+r7 O! &e nas, !ar va&or!!
    s+n( res&!ra=!, &roces n+%!( T+..!n$T Ea .AsA!J. S+'s(an=a, &oa(e .!, de ase%enea,
    &+s7 :n(r4o &+n$7 de Ar(!e sa+ de &"as(!c, !ar $a/e"e d!n &+n$7 !na"a(e, &rocede+
    n+%!( T'a$$!n$T E&rAn/ "a &ace(J. De ase%enea, s+'s(an=e"e &o( .! !na"a(e d!rec(
    d!n con(a!nere sa+ d!n aeroso"!! s&re!a=! :n $+r7 sa+ nas. E<!s(7 re"a(7r! des&re
    !nd!v!/! care :nc7"/esc aceO(! co%&+O! &en(r+ a acce"era va&or!/area. Ina"an(e"e
    a@+n$ :n &+"%on!, :n c+ren(+" san$+!n O! :n "oc+r!"e =!n(7, .oar(e ra&!d.
    Aceas(7 sec=!+ne con=!ne d!sc+=!! e<&"!c!(e des&re (+"'+r7r!"e :n "e$7(+r7 c+
    !na"an(e"e. A+ .os( de@a &re/en(a(e (e<(e"e O! se(+r!"e de cr!(er!! &en(r+ as&ec(e"e
    $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J O! a'+/+"+! de o s+'s(an=7 E&a$.
    5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or. Te<(e"e s&ec!.!ce de&enden=e! s! a'+/+"+! de
    !na"an(e s+n( &re/en(a(e %a! @os. N+ e<!s(7 :ns7 se(+r! de cr!(er!! e<c"+s!v &en(r+
    de&enden=a de !na"an(e sa+ a'+/+" de !na"an(e. Te<(+" O! se(+" de cr!(er!! s&ec!.!ce
    &en(r+ !n(o<!ca=!a c+ !na"an(e s+n(, de ase%enea, &re/en(a(e %a! @os. To"eran=a a
    C<>
    Tulburrile "n le!tur cu o Substan

    .os( ra&or(a(7 &r!n(re !nd!v!/!! c+ +/ e<ces!v. DeO! s!%&(o%e s!%!"are ce"or de
    a's(!nen=7 a+ .os( ra&or(a(e "a an!%a"e d+&7 e<&+ner! re&e(a(e "a (r!c"ore(an, n+ a
    .os( :nc7 s(a'!"!( c7 +n s!ndro% de a's(!nen=7 se%n!.!ca(!v c"!n!c a&are "a oa%en!.
    Pen(r+ aces( %o(!v, d!a$nos(!c+" de a's(!nen=7 de !na"an(e n+ es(e !nc"+s :n aces(
    %an+a". T+"'+r7r!"e !nd+se de !na"an(e Ea"(e"e decA( !n(o<!ca=!a c+ !na"an(eJ s+n(
    descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7
    .eno%eno"o$!a Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de !na"an(e es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e A.ec(!veTJ. Ma! @os, s+n( %en=!ona(e (+"'+r7r!"e +/+"+! de
    !na"an(e s! (+"'+r7r!"e !nd+se de !na"an(e.
    Tulburrile u(ului de in%alante
    ;LI.RL De&enden=a de !na"an(e Eve/! &a$. 9YGJ
    ;LY.FL A'+/+" de !na"an(e Eve/! &a$. 9YFJ
    Tulburrile induse de in%alante
    9F9.GF In(o<!ca=!a c+ !na"an(e Eve/! &a$. 9YFJ
    292.81 De"!r!+%+" &r!n !n(o<!ca=!e c+ !na"an(e Eve/! &a$. 5I;J
    292.82 De%en=a &ers!s(en(7 !nd+s7 de !na"an(e Eve/! &a$. 5RGJ
    292.11 T+"'+rarea &s!o(!c7, !nd+s7 de !na"an(e, c+ !de! de"!ran(e Eve/!
    &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    292.12 T+"'+rarea &s!o(!c7, !nd+s7 de !na"an(e, c+ a"+c!na=!! Eve/!
    &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.59 T+"'+rarea a.ec(!v7 !nd+s7 de !na"an(e Eve/! &a$. ILYJ
    0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GF T+"'+rarea an<!oas7 !nd+s7 de !na"an(e Eve/! &a$. IHFJ
    0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.F T+"'+rare :n "e$7(+r7 c+ !na"an(e"e .7r7 a"(7 s&ec!.!ca=!e Eve/!
    &a$. 9R;J
    Tulburrile !"ului de $n(alante
    4+7.=+ Depen$en!a $e In@alante
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7
    Eve/! &a$. 5F9J. Une"e d!n cr!(er!!"e $enera"e a"e de&enden=e! n+ se a&"!c7
    !na"an(e"or, :n (!%& ce a"(e"e neces!(7 c"ar!.!c7r! s+&"!%en(are. To"eran=a "a e.ec(e"e
    !na"an(e"or a .os( descr!s7 &r!n(re !nd!v!/!! c+ +/ e<ces!v, :ns7 &reva"en(a s!
    se%n!.!ca=!a sa c"!n!c7 n+ s+n( c+nosc+(e. A .os( descr!s +n &os!'!" s!ndro% +Oor de
    a's(!nen=7, dar n+ a .os( '!ne doc+%en(a( s! n+ &are a .! se%n!.!ca(!v c"!n!c. Ca
    a(are, de&enden=a de !na"an(e n+ !nc"+de n!c! +n s!ndro% de a's(!nen=7
    carac(er!s(!c O! n!c! &ro'a +/+"+! de !na"an(e &en(r+ a +O+ra sa+ ev!(a s!%&(o%e"e
    de a's(!nen=7, :ns7, !na"an(e"e &o( .! ad%!n!s(ra(e :n dec+rs+" +nor &er!oade de
    (!%& %a! "+n$! sa+ :n can(!(7=! %a! %ar! decA( se !n(en=!ona !n!=!a", !ar !nd!v!/!! care
    +/ea/7 de e"e &o( cons(a(a c7 es(e d!.!c!" s7 s+&r!%e sa+ s7 re$"e/e +/+" de
    !na"an(e. Pen(r+ c7 !na"an(e"e s+n( !e.(!ne, "e$a"e s! +Oor acces!'!"e, &!erderea
    (!%&+"+! :n :ncercarea de a "e &roc+ra es(e rar7. Se &!erde :ns7 %+"( (!%& c+
    ad%!n!s(rarea "or s! c+ rec+&erarea d!n e.ec(e"e +/+"+! de !na"an(e. U/+" rec+ren(
    45A265 Abu(ul de
    In%alante
    9YF
    de !na"an(e &oa(e de(er%!na !nd!v!d+" s7 a'andone/e sa+ s7 red+c7 !%&or(an(e
    ac(!v!(7=! soc!a"e, &ro.es!ona"e sa+ recrea=!ona"e, !ar +/+" de s+'s(an=7 &oa(e
    con(!n+a :n d!s&re=+" c+noaO(er!! de c7(re !nd!v!d a &ro'"e%e"or so%a(!ce Ede e<.,
    %a"ad!e e&a(!c7 or! "e/are a s!s(e%+"+! nervos cen(ra" sa+ &er!.er!cJ or! a
    &ro'"e%e"or &s!o"o$!ce Ede e<., de&res!e sever7J ca+/a(e de +/.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden=7 de !na"an(e
    Eve/! &a$. 5FY &en(r+ %a! %+"(e de(a"!!JQ
    Re%!s!+ne co%&"e(7 &recoce
    Re%!s!+ne &ar=!a"7 &recoce
    Re%!s!+ne co%&"e(7 &re"+n$!(7
    Re%!s!+ne &ar=!a"7 &re"+n$!(7
    :n(r4+n %ed!+ con(ro"a(
    4+<.5+ A-u)ul $e In@alante
    A se cons+"(a de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FGJ. Ind!v!/!! care a'+/ea/7 de !na"an(e &o( +/a de aces(ea :n
    c!rc+%s(an=e &er!c+"oase Ede e<., a" cond+cer!! +n+! a+(o%o'!" or! %an!&+"7r!! +ne!
    %aO!n!, cAnd @+deca(a O! coordonarea s+n( de(er!ora(e &r!n !n(o<!ca=!e c+ !na"an(eJ.
    Use+r!! &o( deven!, de ase%enea, a$!(a=! O! c!ar v!o"en=! :n c+rs+" !n(o<!ca=!e!, c+
    &ro'"e%e"e !n(er&ersona"e O! "e$a"e de r!$oare. As&!rarea re&e(a(7 de !na"an(e
    &oa(e .! asoc!a(7 c+ con."!c(e .a%!"!a"e s! c+ &ro'"e%e Oco"are Ede e<., c!+", no(e re"e,
    e"!%!nare d!n scoa"7J sa+ d!.!c+"(7=! "a "oc+" de %+nc7.
    Tulburrile induse de $n(alante
    C5C.>5 Into,i#a!ia #u In@alante
    A se cons+"(a de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ !na"an(e :" cons(!(+!e &re/en=a
    +nor %od!.!c7r! &s!o"o$!ce sa+ co%&or(a%en(a"e de/ada&(a(!ve se%n!.!ca(!ve
    c"!n!c Ede e<., con.+/!e, con."!c(+a"!(a(e, a$res!v!(a(e, a&a(!e, de(er!orarea @+dec7=!!,
    de(er!orarea .+nc=!on7r!! soc!a"e sa+ &ro.es!ona"eJ care a&ar :n c+rs+" sa+ "a sc+r(
    (!%& d+&7 +/+" !n(en=!ona", e<&+nerea &en(r+ sc+r( (!%& "a do/e %ar! de !na"an(e
    vo"a(!"e Ecr!(er!!"e A O! BJ. Mod!.!c7r!"e de/ada&(a(!ve s+n( asoc!a(e c+ se%ne care
    !nc"+d a%e=ea"7 sa+ &er(+'7r! v!/+a"e Eo'n+'!"area veder!! sa+ d!&"o&!aJ,
    n!s(a$%+s, !ncoordonare, d!/ar(r!e, %ers nes!$+r, (re%or O! e+.or!e. Do/e"e %a!
    %ar! de !na"an(e &o( d+ce "a de/vo"(area "e(ar$!c! s! "en(or!! &s!o%o(or!!,
    red+cerea $enera"!/a(7 a .or=e! %+sc+"are, d!%!n+area re."e<e"or, s(+&or sa+ co%7
    Ecr!(er!+" CJ. Per(+r'area n+ (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e
    O! n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" DJ.
    9RL Tulburrile "n le!tur cu o Substan

    Criteriile $e $ia/no&ti# pentru
    C5C.>5 Into,i#a!ia #u In@alante
    A2 .( intenional recent sau expunere de scurt durat la do(e mari de
    in%alante volatile &exclu(@nd !a(ele aneste(ice ,i vasodilatatoarele cu
    durat scurt de aciune)2
    S2 Modi$icri ps%i%olo!ice sau comportamentale de(adaptative semni$icative
    clinic &de ex2, beli!erant, a!resivitate, apatie, deteriorarea 0udecii, dete
    riorarea $uncionrii sociale sau pro$esionale) care apar "n cursul sau la scurt
    timp dup u(ul sau expunerea la in%alante volatile2
    2 Dou &sau mai multe) din urmtoarele semne care apar "n cursul sau la scurt
    timp dup u(ul sau expunerea la in%alanteD
    (1)ameeal3
    (2)nista!mus3
    (3)incoordonare3
    (4)di(artrie3
    (5)mers nesi!ur3
    (6)letar!ie3
    (7)diminuarea re$lexelor3
    (8)lentoare ps%i%omotorie3
    (9)tremor3
    (10)scdere !enerali(at a $orei musculare3
    (11)obnubilarea vederii sau diplopie3
    (12)stupor sau com3
    (13)eu$orie2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale ,i nu sunt
    explicate mai bine de alt tulburare mental2
    Alte Tul-ur(ri in$u&e $e In@alante
    Ur%7(oare"e (+"'+r7r! !nd+se de !na"an(e s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ de"!r!+%+"
    &r!n !n(o<!ca=!e c+ !na"an(e E&a$. 5I;J, de%en=a &ers!s(en(7 !nd+s7 de !na"an(e
    E&a$. 5RGJ, (+"'+rarea &s!o(!c7 !nd+s7 de !na"an(e E&a$. ;;GJ, (+"'+rarea
    a.ec(!v7 !nd+s7 de !na"an(e E&a$. ILYJ O! (+"'+rarea an<!oas7 !nd+s7 de !na"an(e
    E&a$. IHFJ. Aces(e (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ !na"an(e
    n+%a! cAnd s!%&(o%e"e s+n( :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a
    c+ !na"an(e s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7.
    Tulburrile "n le!tur cu
    In%alantele
    C=*

    $nformaii sulimentare desre
    Tulburrile %n le&tur cu $n(alantele
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. Ind!v!/!! c+ !n(o<!ca=!e c+
    %a"an(e &o( &re/en(a a"+c!na=!! a+d!(!ve, v!/+a"e sa+ (ac(!"e or! a"(e &er(+r'7r! de
    &erce&=!e E%acro&s!e, %!cro&s!e, !"+/!!, a"(er7r! :n &erce&erea (!%&+"+!J Ide!
    de"!ran(e Ec+% ar .! conv!n$erea c7 &oa(e /'+raJ &o( a&are :n c+rs+" &er!oade"or de
    !n(o<!ca=!e c+ %aa"an(e, !n s&ec!a" a" ce"or carac(er!/a(e &r!n con.+/!e %arca(7, :n
    +ne"e ca/+r!, aces(or !de! de"!ran(e se &oa(e da c+rs, c+ "e/!+n!"e re/+"(an(e de
    r!$oare An<!e(a(ea &oa(e .!, de ase%enea, &re/en(7 Ad%!n!s(r7r!"e e&!sod!ce, dar
    re&e(a(e de %a"an(e &o( .! asoc!a(e :n &r!%+" rAnd c+ &ro'"e%e Oco"are Ede e<,
    c!+", no(e re"e, e"!%!nare d!n scoa"7J, &rec+% s! c+ con."!c(e c+ .a%!"!a U/+" de
    c7(re ado"escen=!! %a! %ar! s! ad+"=!! (!ner! es(e asoc!a( adesea c+ &ro'"e%e soc!a"e
    s! de %+nc7 Ede e< , de"!ncven(7, Oo%a@J Ce" %a! .recven(, !na"an(e"e s+n( +(!"!/a(e
    de ado"escen=! :n cond!=!! de $r+& U/+" so"!(ar (!nde a .! (!&!c ce"or c+ +; de "+n$7
    d+ra(7 s! e<ces!v U/+" de %a"an(e, ca s+'s(an=7 &redo%!nan(7 &en(r+ ce! ce ca+(7
    a@+(or &en(r+ de&enden(a de o s+'s(an=7, &are a .! rar, dar !na"an(e"e &o( .! +n dro$
    sec+ndar +(!"!/a( de !nd!v!/!! c+ de&enden(a de a"(7 s+'s(an=7 La +n+ !nd!v!/!,
    &oa(e e<!s(a o &ro$res!+ne &an7 "a s(ad!+" "a care %a"an(e"e dev!n s+'s(an=a
    &re.era(7, :n s&ec!a" &r!n(re !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7
    9atele de laborator asociate. Ana"!/a d!rec(7 &en(r+ %a"an(e n+ es(e :n
    $enera" d!s&on!'!"7 s! !n $enera" n+ .ace &ar(e d!n e<a%ene"e de r+(!n7 &en(r+
    dro$+r!"e de a'+/ Un %e(a'o"!( a" (o"+en+"+!, ac!d+" !&+r!c, es(e e<cre(a( :ns7 :n
    +r%7 s! :n(r4+n ra&or( s+&ra+n!(ar co%&ara(!v c+ crea(!%na, ceea ce &oa(e s+$era
    +/+" de (o"+en Le/!+n!"e %+sc+"are, rena"e, e&a(!ce s! a"e a"(or or$ane &o( avea
    dre&( re/+"(a( (es(e de "a'ora(or !nd!ca(oare a"e aces(or cond!=!! &a(o"o$!ce
    9atele examinrilor somatice si condi3iile medicale .enerale asociate M!ros+"
    de vo&sea sa+ de so"ven=! &oa(e .! &re/en( :n res&!ra=!a sa+ :%'r7c7%!n(ea
    !nd!v!/!"or care +/ea/7 de %a"an(e sa+ &oa(e e<!s(a +n re/!d++ de s+'s(an=7 &e
    :%'r7c7%!n(e sa+ (e$+%en(e Un Sras a" ce"or care (ra$ &e nas ade/!v!T &oa(e n
    ev!den( :n @+r+" nas+"+! s! a" $+r!! s!, de ase%enea, &oa(e .! re%arca(7 o !n(ae
    con@+nc(!va"7 Poa(e e<!s(a &ro'a +n+! (ra+%a(!s% da(ora( co%&or(a%en(+"+!
    de/%!'a( sa+ ars+r!"or da(ora(e na(+r!! !n."a%a'!"e a aces(or co%&+O! Da(e"e
    res&!ra(or!! nes&ec!.!ce !nc"+d &ro'a !n(a(!e! c7!"or aer!ene s+&er!oare s! !n.er!oare,
    !nc"+s!v (+Oea, sc+r$erea Ede secre=!eJ s%+sa"7, d!s&neea, ra"+r! sa+ ronc+s+n, %a!
    rar, &oa(e re/+"(a c!ano/7 &r% &ne+%on!e sa+ as.!<!e De ase%enea, &oa(e e<!s(a
    ce.a"ee, de'!"!(a(e $enera"!/a(7, d+rere a'do%!na"7, $rea=7 s! vo%7
    Ina"an(e"e &o( ca+/a "e/!+n!, a(A( a"e s!s(e%+"+! nervos cen(ra", cA( s! &er!.er!c,
    care &o( .! &er%anen(e E<a%!narea +n+! !nd!v!d care +/ea/7 :n %od cron!c de
    !na"an(e &oa(e reve"a +n n+%7r de de.!c!(e ne+ro"o$!ce, !nc"+/And de'!"!(a(ea
    $enera"!/a(7 s! ne+ro&a(n"e &er!.er!ce La !nd!v!/!! c+ +/ e<ces!v a+ .os( descr!se
    a(ro.!a cere'ra"7, de$enerarea cere'e"oas7 s! "e/!+n! a"e s+'s(an=e! a"'e, care a+ ca
    re/+"(a( se%ne d!n &ar(ea nerv!"or cran!e% sa+ (rac(+"+! &!ra%!da" U/+" rec+ren(
    &oa(e d+ce "a a&ar!=!a +ne! e&a(!(e Ecare &oa(e &ro$resa s&re c!ro/7J sa+ a +ne!
    ac!do/e %e(a'o"!ce co%&ara'!"e c+ ac!do/a (+'+"ar7 rena"7 d!s(a"7 Ins+.!c!en(a
    9R9
    Tulburrile "n le!tur cu o Substan
    rena"7 cron!c7, s!ndro%+" e&a(orena" s! ac!do/a e&a(orena"7 &ro<!%a"7 a+ .os(,
    de ase%enea, descr!se, ca s! s+&r!%area .+nc=!e! %7d+ve! osoase, :n s&ec!a" "a
    'en/en s! (r!c"ore(!"en7, &r!%+" crescAnd &ro'a'!" r!sc+" &en(r+ "e+ce%!a
    %!e"oc!(ar7 ac+(7 Une"e !na"an(e Ede e<., c"or+ra de %e(!"J &o( .! %e(a'o"!/a(e "a
    o<!d de car'on. Moar(ea &oa(e s+rven! &r!n de&res!e res&!ra(or!e sa+
    card!ovasc+"ar78 :n %od s&ec!a", S%oar(ea s+'!(7 a ce"or care (ra$ &e nasT &oa(e
    re/+"(a &r!n ar!(%!e ac+(7, !&o<!e sa+ ano%a"!! e"ec(ro"!(!ce.
    *lemente speci$ice culturii, etii si sexului
    :n (!%& ce ce"e %a! %+"(e ance(e ra&or(ea/7 &+=!ne d!.eren=e n+%a! :n .+nc=!e
    de $r+&+" e(n!c sa+ ras!a", +n s(+d!+ e.ec(+a( &e co&!! :n A"as)a r+ra"7, %en=!onea/7
    c7 a&roa&e YLd d!n(re co&!!! !nd!$en! d!n A"as)a d!n sa(e"e !/o"a(e a+ .7c+( +/ "a +n
    %o%en( da( de !na"an(e &en(r+ a se s!%=! '!ne.D!n ca+/a cos(+"+! "or red+s s!
    acces!'!"!(7=!! +Ooare, !na"an(e"e s+n( adesea &r!%e"e dro$+r! de e<&er!%en(are
    &en(r+ (!ner! s! E(o( d!n ace"eaO! %o(!veJ &oa(e e<!s(a o !nc!den=7 %a! %are &r!n(re
    ce! care (r7!esc :n /one de.avor!/a(e econo%!c. U/+" de !na"an(e &oa(e :nce&e de "a
    e(a(ea de F459 an!, &are a a(!n$e c+"%ea :n ado"escen=7 s! es(e %a! &+=!n .recven(
    d+&7 e(a(ea de ;Y an!. B7r'a=!! s+n( r7s&+n/7(or! de HL4GLd d!n(re cons+"(a=!!"e
    acorda(e :n ca%ere"e de $ard7 &en(r+ +r$en=e"e :n "e$7(+r7 c+ !na"an(e"e.
    #revalent
    Es(e d!.!c!" de s(a'!"!( &reva"en(a rea"7 a +/+"+! de !na"an(e, deoarece aces(e
    dro$+r! s+n( +Oor de o'=!n+( "e$a", !ar !%&or(an=a "or &oa(e .! s+'es(!%a(7 :n
    ance(e. In a.ar7 de aceas(a, &o&+"ar!(a(ea d!verO!"or !na"an=! se sc!%'7 c+
    (!%&+", de e<., :n c+rs+" +"(!%+"+! decen!+ sc7/And &rocen(+" +se+r!"or de co"an=! s!
    aeroso"! s! crescAnd ce" a" +se+r!"or de "!c!de !n."a%a'!"e.
    O ance(7 na=!ona"7 d!n 5FFR re.er!(oare "a +/+" de dro$+r! a ra&or(a( c7
    a&ro<!%a(!v Rd d!n &o&+"a=!a S(a(e"or Un!(e a rec+nosc+( c7 a .7c+( cAndva +/ de
    !na"an(e, 5d c7 a .7c+( +/ an+" (rec+(, !ar L,Id :n +"(!%a "+n7. Cea %a! %are
    &reva"en(7 &e v!a=7 a .os( o'serva(7 "a ce! :n e(a(e de 5G49Y an! E55dJ, &e cAnd ce! :n
    e(a(e de 5945H an! &redo%!n7 &r!n(re ce! care a+ .7c+( +/ an+" (rec+( EIdJ sa+ "+na
    (rec+(7 E9dJ. Procen(e %ar! s+n( ra&or(a(e "a o d!vers!(a(e de s+'$r+&+r!,
    a&ro<!%a(!v ;Ld d!n(re ce! a."a=! :n :nc!sor! re"a(And c7 a+ .7c+( cAndva +/ de
    aces(e s+'s(an=e.
    Procen(e"e de +/ s+n(, de ase%enea, %ar! &r!n(re !nd!v!/!! care (r7esc :n s7r7c!e,
    :n s&ec!a" &r!n(re co&!! s! ad+"=!! (!ner!..Tre'+!e no(a( :ns7 .a&(+" c7 deoarece aces(e
    ance(e eva"+ea/7 %a! c+rAnd &a((ern+r! de +/ decA( (+"'+r7r!, n+ se O(!e cA=! d!n(re
    ce! !nc"+O! :n ance(7 ca .7cAnd +/ de !na"an(e a+ &re/en(a( s!%&(o%e care sa(!s.ac
    cr!(er!!"e &en(r+ de&enden=7 sa+ a'+/. Preva"en(a a'+/+"+! sa+ de&enden(e! de
    !na"an(e :n &o&+"a=!a $enera"7 es(e nec+nosc+(7.
    *voluie
    Es(e .oar(e d!.!c!" de s(a'!"!( do/a de !na"an( :n .+nc=!e de e.ec(, d!n ca+/a
    d!.er!(e"or %e(ode de ad%!n!s(rare, !ar concen(ra=!!"e d!.er!(e de !na"an(e :n
    &rod+se"e +(!"!/a(e de(er%!n7 concen(ra=!! e<(re% de var!a'!"e :n or$an!s%. D+ra(a
    !n(o<!ca=!e! c+ !na"an(e es(e :n re"a=!e c+ carac(er!s(!c!"e .ar%aco"o$!ce a"e
    s+'s(an=e"or s&ec!.!ce +(!"!/a(e, dar de re$+"7 es(e sc+r(7, d+rAnd de "a cA(eva %!n+(e
    &An7 "a o or7. De'+(+" es(e ra&!d, c+"%ea .!!nd a(!ns7 :n dec+rs de cA(eva %!n+(e
    d+&7 !na"are. Co&!! %a!
    76726 Tulburare "n le!tur cu In%alantele 'r Alt Speci$icaie 7I4
    %!c!, d!a$nos(!ca=! ca avAnd de&enden=7 de !na"an(e, &o( +/a de !na"an(e de %a!
    %+"(e or! &e s7&(7%An7, adesea :n #ee)4end+r! s! d+&7 ore"e de c"as7. De&enden=a
    sever7 "a ad+"=! &oa(e !%&"!ca d!verse &er!oade de !n(o<!ca=!e, :n c+rs+" .!ec7re! /!"e O!
    &er!oade oca/!ona"e de +/ e<ces!v care &o( d+ra %a! %+"(e /!"e. Aces( &a((ern &oa(e
    &ers!s(a (!%& de an! de /!"e, c+ neces!(a(ea rec+ren(7 de (ra(a%en(. Ind!v!/!! care
    +/ea/7 de !na"an(e &o( avea +n n!ve" sa+ $rad &re.era( de !n(o<!ca=!e, !ar %e(oda de
    ad%!n!s(rare Ede re$+"7 as&!rarea d!n(r4+n con(e!ner sa+ res&!rarea &r!n(r4o 'a(!s(7
    %+!a(7 :n s+'s(an=7J &oa(e &er%!(e !nd!v!d+"+! s7 %en=!n7 ace" n!ve" (!%& de %a!
    %+"(e ore. De ase%enea, a+ .os( descr!se ca/+r! de a&ar!=!e "a %+nc!(or!! !nd+s(r!a"!
    care a+ o e<&+nere &ro.es!ona"7 de "+n$7 d+ra(7 O! acces "a !na"an(e. Un %+nc!(or
    &oa(e :nce&e s7 +(!"!/e/e co%&+s+" &en(r+ e.ec(e"e sa"e &s!oac(!ve s! s7 de/vo"(e
    +"(er!or +n &a((ern de de&enden=7. U/+" care d+ce "a de&enden=7 &oa(e s+rven!, de
    ase%enea, "a oa%en!! care n+ a+ acces "a a"(e s+'s(an=e Ede e<., &r!/on!er!, &ersona"
    %!"!(ar !/o"a( O! ado"escen=! sa+ ad+"=! (!ner! d!n /one"e r+ra"e !/o"a(eJ.
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$. 9LH. T+"'+r7r!"e !nd+se de !na"an(e &o( .! carac(er!/a(e
    &r!n s!%&(o%e Ede e<., d!s&o/!=!e de&res!v7J care sea%7n7 c+ (+"'+r7r!"e %en(a"e
    &r!%are Ede e<., (+"'+rarea de&res!v7 %a@or7 vers+s (+"'+rarea a.ec(!v7 !nd+s7 de
    !na"an(e, c+ e"e%en(e de&res!ve, c+ de'+( :n c+rs+" !n(o<!ca=!e!J. 3e/! &a$. 95L
    &en(r+ d!sc+(area aces(+! d!a$nos(!c d!.eren=!a".
    S!%&(o%e"e !n(o<!ca=!e! c+ !na"an(e, de "a +Ooar7 &An7 "a %odera(7, &o( .!
    s!%!"are c+ ce"e a"e !n(o<!ca=!e! c+ a"coo" s! a"e !n(o<!ca=!e! c+ seda(!ve, !&no(!ce
    Sa+ an<!o"!(!ce. Ha"ena res&!ra=!e! sa+ re/!d++r!"e de &e cor& or! de &e
    :%'r7c7%!n(e &o( .! !nd!c!! d!.eren=!a(oare !%&or(an(e, dar n+ (re'+!e av+(
    :ncredere :n e"e e<c"+s!v. Ind!v!/!!, care +/ea/7 :n %od cron!c de !na"an(e, es(e
    &os!'!" s7 +/e/e .recven( O! e<ces!v s! de a"(e s+'s(an=e, co%&"!cAnd O! %a! %+"(
    (a'"o+" d!a$nos(!c. U/+" conco%!(en( de a"coo" &oa(e .ace, de ase%enea, d!.!c!"7
    d!.eren=!erea. Is(or!c+" +/+"+! de dro$ O! cons(a(7r!"e carac(er!s(!ce E!nc"+s!v %!ros+"
    de so"ven( sa+ res(+r!"e de vo&seaJ &o( d!.eren=!a !n(o<!ca=!a de !na"an(e de
    !n(o<!ca=!a c+ a"(e s+'s(an=e8 :n &"+s, s!%&(o%e"e se &o( a%e"!ora %a! re&ede :n
    !n(o<!ca=!a c+ !na"an(e decA( :n !n(o<!ca=!!"e c+ a"(e s+'s(an=e. De'+(+" s! re/o"+=!a
    ra&!d7 &o(, de ase%enea, d!.eren=!a !n(o<!ca=!a c+ !na"an(e de a"(e (+"'+r7r!
    %en(a"e O! cond!=!! ne+ro"o$!ce. In(o<!ca=!a c+ !na"an(e se d!s(!n$e de a"(e (+"'+r7r!
    !nd+se de !na"an(e Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de !na"an(e, c+ de'+( :n
    c+rs+" !n(o<!ca=!e!J &r!n .a&(+" c7 s!%&(o%e"e :n aces(e d!n +r%7 (+"'+r7r! s+n( :n
    e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+ !na"an(e O! s+n( s+.!c!en( de
    severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    M+nc!(or!! !nd+s(r!a"! &o( .!, oca/!ona", e<&+O! acc!den(a" "a c!%!ca"e vo"a(!"e
    O! s+.er! o !n(o<!ca=!e .!/!o"o$!c7. Pen(r+ e<&+nerea "a as(.e" de (o<!ce (re'+!e
    +(!"!/a(7 ca(e$or!a de ST+"'+r7r! :n "e$7(+r7 c+ a"(7 s+'s(an=7T.
    C5C.5 Tul-urare .n le/(tur( #u In@alantele
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ !na"an(e"e .7r7 a"(7 s&ec!.!ca=!e es(e
    des(!na(7 (+"'+r7r!"or asoc!a(e c+ +/+" de !na"an(e care n+ s+n( c"as!.!ca'!"e ca
    9RI Tulburrile "n le!tur cu o Substan

    de&enden=7 de !na"an(e, a'+/ de !na"an(e, !n(o<!ca=!e c+ !na"an(e, de"!r!+% &r!n
    !n(o<!ca=!e c+ !na"an(e, de%en=7 &ers!s(en(7 !nd+s7 de !na"an(e, (+"'+rare
    &s!o(!c7 !nd+s7 de !na"an(e, (+"'+rare a.ec(!v7 !nd+s7 de !na"an(e sa+ (+"'+rare
    an<!oas7 !nd+s7 de !na"an(e.
    Tul-ur(rile .n le/(tur( #u Ni#otin(
    De&enden=a s! a's(!nen=a de n!co(!n7 &o( a&are :n (oa(e .or%e"e de +/ de (a'ac
    E=!$are(e, (a'ac de %es(eca(, (a'ac de &r!/a(, &!&e s! =!$7r! avaneJ s! :n &rescr!&=!!
    de %ed!ca%en(e E$+%7 sa+ &"as(+re c+ n!co(!n7J. Ca&ac!(a(ea re"a(!v7 a aces(or
    &rod+se de a &rod+ce de&enden=7 sa+ de a !nd+ce a's(!nen=7 es(e asoc!a(7 c+
    ra&!d!(a(ea carac(er!s(!c7 a c7!! de ad%!n!s(rare E.+%a( vers+s ora"7, ora"7 vers+s
    (ransder%a"7J s! con=!n+(+" :n n!co(!n7 a" &rod+s+"+!.
    Aceas(7 sec=!+ne con=!ne co%en(ar!! s&ec!.!ce re.er!(oare "a (+"'+r7r!"e :n
    "e$7(+r7 c+ n!co(!n7. A+ .os( &re/en(a(e de@a (e<(e"e O! se(+r!"e de cr!(er!! &en(r+ a
    de.!n! as&ec(e"e $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J care se a&"!c7
    (+(+ror s+'s(an=e"or. A&"!carea aces(or cr!(er!! $enera"e "a de&enden=a de n!co(!n7
    es(e &re/en(a(7 %a! @os. Re."ec(And &+=!n7(a(ea da(e"or re"evan(e c"!n!c, !n(o<!ca=!a
    c+ n!co(!n7 s! a'+/+" de n!co(!n7 n+ s+n( !nc"+se :n DSM4I3. Un (e<( s! +n se( de
    cr!(er!! s&ec!.!ce &en(r+ a's(!nen=a de n!co(!n7 s+n(, de ase%enea, &re/en(a(e %a!
    @os. Ma! @os s+n( "!s(a(e (+"'+r7r!"e :n "e$7(+r7 c+ n!co(!n7.
    Tulburrile u(ului de nicotin
    ;LY.5L De&enden=a de n!co(!n7 Eve/! &a$. 9RIJ.
    Tulburrile induse de nicotin
    9F9.L A's(!nen(a de n!co(!n7 Eve/! &a$. 9RYJ
    9F9.F T+"'+rare :n "e$7(+r7 c+ n!co(!n7 .7r7 a"(7 s&ec!.!ca=!e Eve/! &a$. 9RFJ
    Tulburarea !"ului de )icotin
    4+<.*+ Depen$en!a $e Ni#otin(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7
    Eve/! &a$. 5F9J. Une"e d!n(re cr!(er!!"e $ener!ce a"e de&enden=e! n+ &ar a se a&"!ca
    n!co(!ne!, !ar a"(e"e neces!(7 c"ar!.!c7r! s+&"!%en(are. To"eran=a "a n!co(!n7 se
    %an!.es(7 &r!n(r4+n e.ec( %a! !n(ens a" n!co(!ne! cAnd es(e +(!"!/a(7 &en(r+ &r!%a
    da(7 :n c+rs+" /!"e! s! &r!n a'sen=a $re=!! s! a%e=e"!! :n d!s&re=+" +(!"!/7r!! re$+"a(e a
    +nor can!(7=! %ar! de n!co(!n7, :nce(area +/+"+! de n!co(!n7 &rod+ce +n
    '!nec+nosc+( s!ndro% de a's(!nen=7 care es(e descr!s %a! @os. M+"=! !nd!v!/! care .ac
    +/ de n!co(!n7, !a+ n!co(!n7 &en(r+ a4s! +O+ra sa+ &en(r+ a ev!(a s!%&(o%e"e de
    a's(!nen=7, cAnd se deO(ea&(7 d!%!nea=a d!n so%n sa+ d+&7 ce s4a+ a."a( :n s!(+a=!!
    :n care +/+" es(e !n(er/!s Ede e<., "a serv!c!+ sa+ :n av!onJ. Ind!v!/!! care .+%ea/7 s!
    ce! care +/ea/7 de n!co(!n7 es(e &os!'!" s7 cons(a(e c7 s!4a+ cons+%a( re/erva de
    =!$are(e sa+ de a"(e &rod+se con=!nAnd n!co(!n7, %a! re&ede decA( !n(en=!ona+
    !n!=!a". DeO! &es(e GLd d!n(re !nd!v!/!! care .+%ea/7 :O! e<&r!%7 dor!n=a de a s(o&a
    76725 Abstinena de Ficotin 7IA
    .+%a(+", !ar ;Yd :ncearc7 s745 s(o&e/e :n .!ecare an, %a! &+=!n de Yd re+Oesc,
    nea@+(a=!, :n :ncerc7r!"e "or de a45 a'andona. P!erderea de .oar(e %+"( (!%& c+
    cons+%area s+'s(an=e! es(e ce" %a! '!ne e<e%&"!.!ca(7 de .+%a(+" :n "an=. Deoarece
    s+rse"e de n!co(!n7 s+n( +Oor acces!'!"e s! "e$a"e, &!erderea de %+"( (!%& :n
    :ncercarea de a &roc+ra n!co(!n7 es(e rar7. A'andonarea +nor ac(!v!(7=! soc!a"e,
    &ro.es!ona"e sa+ recrea=!ona"e &oa(e s+rven! cAnd +n !nd!v!d ren+n=7 "a o ac(!v!(a(e
    &en(r+ c7 aceas(a se des.7Ooar7 :n /one :n care .+%a(+" es(e !n(er/!s. Con(!n+area
    +/+"+!, :n d!s&re=+" c+noaO(er!! &ro'"e%e"or %ed!ca"e :n "e$7(+r7 c+ .+%a(+", es(e o
    &ro'"e%7 de s7n7(a(e e<(re% de !%&or(an(7 Ede e<., +n !nd!v!d care con(!n+7 s7
    .+%e/e :n d!s&re=+" .a&(+"+! c7 are o cond!=!e %ed!ca"7 $enera"7 !nd+s7 de (a'ac,
    c+% ar .! o 'ronO!(7 sa+ o %a"ad!e &+"%onar7 o's(r+c(!v7 cron!c7J.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden=7 de n!co(!n7
    Eve/! &a$. 5FY &en(r+ %a! %+"(e de(a"!!JQ C+ de&enden=7 .!/!o"o$!c7 F7r7
    de&enden=7 .!/!o"o$!c7
    Re%!s!+ne co%&"e(7 &recoce
    Re%!s!+ne &ar=!a"7 &recoce
    Re%!s!+ne co%&"e(7 &re"+n$!(7
    Re%!s!+ne &ar=!a"7 &re"+n$!(7
    Tulburarea indus de
    )icotin C5C.+ A-&tinen!a $e
    Ni#otin(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a's(!nen=a de o s+'s(an=7
    Eve/! &a$. 9L5J. E"e%en(+" esen=!a" a" a's(!nen=e! de n!co(!n7 :" cons(!(+!e &re/en=a
    +n+! s!ndro% de a's(!nen=7 carac(er!s(!c care a&are d+&7 :nce(area 'r+sc7 sa+
    red+cerea +/+"+! de &rod+se con=!nAnd n!co(!n7, +r%And +ne! "+n$! &er!oade Ede
    ce" &+=!n cA(eva s7&(7%An!J de +/ /!"n!c Ecr!(er!!"e A O! BJ. S!ndro%+" de a's(!nen=7
    c+&r!nde &a(r+ sa+ %a! %+"(e d!n(re +r%7(oare"eQ d!s&o/!=!e de&res!v7 sa+
    d!s.or!c7, !nso%n!e, !r!(a'!"!(a(e, .r+s(rare sa+ s(are co"eroas7, an<!e(a(e, d!.!c+"(a(e
    :n concen(rare, ne"!n!O(e sa+ !%&ac!en=7, d!%!n+area r!(%+"+! card!ac O! creO(erea
    a&e(!(+"+! sa+ &"+s &ondera". S!%&(o%e"e de a's(!nen=7 ca+/ea/7 o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!!
    !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ.S!%&(o%e"e n+ (re'+!e s7 .!e da(ora(e +ne!
    cond!=!! %ed!ca"e $enera"e O! n+ s+n( e<&"!ca(e %a! '!ne de o a"(7 (+"'+rare %en(a"7
    Ecr!(er!+" DJ.
    Aces(e s!%&(o%e s+n( da(ora(e :n %are &ar(e de&r!v7r!! de n!co(!n7 O! s+n( de
    re$+"7 %a! !n(ense &r!n(re !nd!v!/!! care .+%ea/7 =!$are(e decA( &r!n(re ce! care .ac
    +/ de a"(e &rod+se con=!nAnd n!co(!n7. De'+(+" %a! ra&!d a" e.ec(e"or n!co(!ne! :n
    .+%a(+" de =!$are(e d+ce "a +n &a((ern de +/ %a! !n(ens care es(e %a! d!.!c!" de
    :n(rer+&( d!n ca+/a .recven=e! s! ra&!d!(7=!! re:n(7r!r!! O! a de&enden=e! .!/!ce %a!
    %ar! de n!co(!n7. La !nd!v!/!! care .+%ea/7 =!$are(e, r!(%+" card!ac scade c+ Y &An7
    "a 59 '7(7! &e %!n+( :n &r!%e"e cA(eva /!"e de "a :nce(area .+%a(+"+!, !ar $re+(a(ea
    cres(e :n %ed!e c+ 94; )$ :n c+rs+" &r!%+"+! an d+&7 :nce(area .+%a(+"+!.
    9RR
    Tulburrile "n le!tur cu o Substan

    S!%&(o%e +Ooare de a's(!nen=7 &o( a&are d+&7 (recerea "a =!$are(e c+ con=!n+(
    red+s :n $+dronXn!co(!n7 s! d+&7 s(o&area +/+"+! de (a'ac !n.+%a'!", $+%7 c+
    n!co(!n7 sa+ &"as(+r! c+ n!co(!n7.
    Criteriile $e $ia/no&ti#
    pentru C5C.+ A-&tinen!a $e Ni#otin(
    A2 .( (ilnic de nicotin, timp de cel puin c@teva sptm@ni2
    S2 "ncetarea brusc a u(ului de nicotin sau reducere a cantitii de nicotin
    utili(at, urmat "n decurs de 7H ore de patru &sau mai multe) dintre
    urmtoarele semneD
    (1)dispo(iie depresiv sau dis$oric3
    (2)insomnie3
    (3)iritabilitate, $rustrare sau stare coleroas3
    (4)anxietate3
    (5)di$icultate "n concentrare3
    (6)nelini,te3
    (7)scderea ritmului cardiac3
    (8)apetit crescut sau plus ponderal2
    2 Simptomele de la criteriul S cau(ea( o detres sau o deteriorare "n dome
    niul social, pro$esional sau "n alte domenii importante de $uncionare2
    D2 Simptomele nu se datore( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental2
    $nformaii sulimentare desre
    Tulburrile %n le&tur cu )icotin
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Dor!n=a arden(7 es(e +n
    e"e%en( !%&or(an( a" a's(!nen=e! de n!co(!n7 O! &oa(e e<&"!ca d!.!c+"(7=!"e &e care "e
    a+ !nd!v!/!! :n a ren+n=a "a &rod+se"e con=!nAnd n!co(!n7. A"(e s!%&(o%e asoc!a(e c+
    a's(!nen=a de n!co(!n7 !nc"+d dor!n=a de d+"c!+r! s! de(er!orarea &er.or%an=e! "a
    sarc!n!"e neces!(And a(en=!e. Ma! %+"(e e"e%en(e asoc!a(e c+ de&enden(a de n!co(!n7
    &ar a &re/!ce +n $rad %a! %are de d!.!c+"(a(e :n s(o&area +/+"+! de n!co(!n7Q
    .+%a(+" !%ed!a( d+&7 deO(e&(area d!n so%n, .+%a(+" cAnd es(e s+.er!nd, d!.!c+"(a(e
    :n a se a'=!ne s7 n+ .+%e/e, re"a(area c7 &r!%a =!$are(7 a /!"e! es(e +na d!n(re ce"e
    %a! d!.!c!" de ceda( O! .+%a(+" %a! %+"( d!%!nea=a decA( d+&7 a%!a/a. N+%7r+"
    =!$are(e"or .+%a(e &e /!, con=!n+(+" :n n!co(!n7 a" =!$are(e! s! n+%7r+" de &ace(e
    .+%a(e &e an s+n(, de ase%enea, :n "e$7(+r7 c+ &ro'a'!"!(a(ea ca +n !nd!v!d s7
    s(o&e/e .+%a(+". De&enden(a de n!co(!n7 es(e %a! .recven(7 &r!n(re !nd!v!/!! c+ a"(e
    (+"'+r7r! %en(a"e, ca de e<., sc!/o.ren!a, :n .+nc=!e de &o&+"a=!a s(+d!a(7, :n(re
    YY4FLd d!n(re !nd!v!/!! c+ (+"'+r7r! %en(a"e .+%ea/7, :n co%&ara=!e c+ ;Ld d!n
    &o&+"a=!a $enera"7. T+"'+r7r!"e a.ec(!ve, an<!oase O! a"(e (+"'+r7r! :n "e$7(+r7 c+ o
    s+'s(an=7 &o( .! %a! .recven(e "a !nd!v!/!! care .+%ea/7 decA( "a .oO(!! .+%7(or! sa+
    "a ce! care n+ a+ .+%a( n!c!oda(7.
    Tulburrile "n le!tur cu
    Ficotin
    7I?

    9ate de laborator asociate. S!%&(o%e"e de a's(!nen(7 s+n( asoc!a(e c+ r!(%
    "en( &e EE,, red+cerea concen(ra=!!"or de ca(eco"a%%e s! de cor(!/o", %od!.!c7r! a"e
    %!Oc7r!"or oc+"are ra&!de EREMJ, de(er!orare "a (es(area ne+ro&s%o"o$!c7 s!
    sc7derea n(%+"+! %e(a'o"!c F+%a(+" cres(e %e(a'o"!s%+" %+"(or %ed!ca%en(e
    &rescr!se &en(r+ (ra(a%en(+" (+"'+r7r!"or %en(a"e, &rec+% s! &e ce" a" a"(or
    s+'s(an=e Dec!, :nce(area .+%a(+"+! &oa(e cres(e concen(ra=!!"e san$+!ne a"e aces(or
    %ed!ca%en(e, &rec+% s! &e ce"e a"e a"(or s+'s(an=e, +neor! :n(r4o %7s+r7
    se%n!.!ca(!v7 Aces( e.ec( n+ &are a se da(ora %co(%e!, c! %a! c+rAnd a"(or co%&+O!
    a! (a'ac+"+! N!co(!n7 s! %e(a'o"!c+" s7+ co(!%na &o( .! %7s+ra(e :n sAn$e, sa"!v7 sa+
    +r!n7 Persoane"e care .+%ea/7 a+, de ase%enea, d!%!n+a(e (es(e"e .+nc=!ona"e
    &+"%onare s! a+ cresc+( vo"+%+" cor&+sc+"ar %ed!+ EM3CJ
    9atele examinrii somatice si condi3iile medicale asociate. A's(!nen(a de
    n!co(!n7 &oa(e .! asoc!a(7 c+ o (+se +sca(7 sa+ &rod+c(!v7, sc7derea r!(%+"+!
    card!ac, a&e(!( cresc+( sa+ &"+s &ondera" s! o de&r!%are a r7s&+ns+"+! or(os(a(!c
    Ce"e %a! co%+ne se%ne a"e de&enden(e! de n!co(!n7 s+n( %!ros+" de (a'ac, (+Oea,
    ev!den(a +ne! %a"ad!! &+"%onare o's(r+c(!ve cron!ce s! ndarea e<ces!v7 a &!e"!!
    Pe(e de (a'ac &o( a&are &e de$e(e, dar s+n( rare U/+" de (a'ac &oa(e cres(e
    cons!dera'!" r!sc+" de cancer &+"%onar sa+ '+ca", &rec+% s! de a"(e cancere, de
    ase%enea, cres(e r!sc+" de cond!=!! card!ovasc+"are s! cere'rovasc+"are, de %a"ad!!
    &+"%onare o's(r+c(!ve cron!ce s! de a"(e %a"ad!! &+"%onare, de +"cer, de
    co%&"!ca=!! %a(erne s! .e(a"e, &rec+% s! de a"(e cond!=!! DeO! ce"e %a! %+"(e d!n(re
    aces(e &ro'"e%e &ar a .! ca+/a(e de cancer!$ene"e s! o<!d+" de car'on d!n (a'ac+"
    .+%a( %a! c+rAnd decA( de n!co(!n7 :ns7O!, n!co(!n7 &oa(e cres(e r!sc+" de
    even!%en(e card!ovasc+"are Ce! care n4a+ .+%a( n!c!oda(7, dar care s+n( e<&+O!
    cron!c "a .+%+" de (a'ac &ar a &re/en(a +n r!sc cresc+( &en(r+ cond!=!!, &rec+%
    cancer+" &+"%onar s! %a"ad!!"e card!ace
    *lemente speci$ice culturii, etii si sexului
    Preva"en(a .+%a(+"+! es(e :n sc7dere :n ce"e %a! %+"(e na=!+n! !nd+s(r!a"!/a(e,
    dar es(e :n creO(ere :n /one"e :n c+rs de de/vo"(are A.roa%enca%! (!nd a &re/en(a
    n!ve"e san$+!ne %a! r!d!ca(e de n!co(!n7 "a ace"aO! n+%7r n+%7r de (!$are :n
    co%&ara=!e c+ a"(e $r+&+r! ras!a"e, ceea ce &oa(e con(r!'+! "a d!.!c+"(a(ea %a! %are
    :n a se "7sa de .+%a( Cea %a! %are &reva"en(7 &e v!a(7 a +/+"+! de n!co(!n7 se
    cons(a(7 "a !nd!v!/!! %a! '7(rAn! :n S(a(e"e Un!(e, &reva"en(a .+%a(+"+! es(e +Oor
    %a! cresc+(7 "a '7r'a=! decA( "a .e%e!, &reva"en(a .+%a(+"+! es(e :ns7, :n sc7dere %a!
    ra&!d7 "a '7r'a=! decA( "a .e%e! :n a"(e =7r!, .+%a(+" es(e adesea %a! .recven( &r!n(re
    '7r'a=! U/+" de (a'ac !n.+%a'!" es(e %+"( %a! %are "a '7r'a=! decA( "a .e%e!, c+ +n
    ra&or( '7r'a=!X.e%e! de G " sa+ %a! %+"(
    #revalent
    E<!s(a o red+cere s+'s(an=!a"7 a .+%a(+"+! re$+"a( s! a de&enden(e! de n!co(!n7
    "a ce"e %a! %+"(e $r+&+r! &r!n an!! 2GL, +r%a(7 de o n!ve"are a aces(e! ra(e de dec"!n,
    es(!%a(7 "a a .! de n+%a! ,O sa+ %a! &+=!n % +"(!%a &ar(e a an!"or 2FL N!ve"e %a!
    %ar! de sc7dere a+ .os( o'sen a=e %a! %+"( "a '7r'a=! decA( "a .e%e!, s! %a! %+"( "a
    ca+ca/!en! decA( "a ce! de or!$!ne a.roa%encan7 sa+ !s&an!c7 D!verse $r+&+r! a+
    &re/en(a( o creO(ere rea"7 a &re_ a"en(e! .+%a(+"+! re$+"a( "a %!@"oc+" an!"or 2FL, :n
    s&ec!a" .e%e!"e care a+ %a! &+=!n decA( s(+d!! %ed!!
    2>=
    Tul-ur(rile .n le/(tur( #u o Su-&tan!(

    O ance(7 na=!ona"7 re.er!(oare "a +/+" de dro$, e.ec(+a(7 :n 5FFR, cons(a(a c7
    H9d d!n &o&+"a=!a ad+"(7 a S(a(e"or Un!(e a .7c+( cAndva +/ de =!$are(e, c+ ;9d
    ra&or(And +/ an+" (rec+(, s! 9Fd, +/ "+na (rec+(7 Preva"en(a &e v!a=7 :n S(a(e"e
    Un!(e era %a! %are &r!n(re !nd!v!/!! :n e(a(e de ;Y an! s! &es(e EHGdJ, deO! +/+" an+"
    (rec+( s! "+na (rec+(7 era %a! %are &r!n(re oa%en!! :n e(a(e de 5G s! 9Y an! EIYd s!
    res&ec(!v, ;GdJ Ance(a d!n 5FFR a %en=!ona(, de ase%enea, &rocen(e s+'s(an=!a"e
    de +/ de (a'ac %.+%a'!", 5Hd d!n &o&+"a=!a S(a(e"or Un!(e rec+noscAnd c7 a .7c+(
    cAndva +/ de aces(e &rod+se, !ar Yd c7 a .7c+( +/ "+na (rec+(7 Ance(e"e re.er!(oare
    "a +/+" de dro$ "a e"ev!! de "!ce+ %en=!ona+ c7 +/+" de (a'ac "a &o&+"a=!a (An7r7 es(e
    :n creO(ere Con.or% +ne! ance(e d!n 5FFH &r!n(re e"ev!! d!n c"asa a >H4a, RYd a+
    re"a(a( c7 a+ .7c+( cAndva +/ de =!$are(e 4 o creO(ere &es(e &rocen(+" de R9d d!n 5FFI
    Edar n+ (o( a(A( de %are ca &!c+" &reva"en(e! &e v!a(7 de HHd d!n 5FHHJ
    Deoarece se es(!%ea/7 c7 !n(re GLd s! FLd d!n(re .+%7(or!! re$+"a=! a+ de&enden(7
    de n!co(!n7, &An7 "a 9Yd d!n &o&+"a=!a S(a(e"or Un!(e &oa(e avea de&enden(7 de
    n!co(!n7 S4a cons(a(a( c7 &rocen(+" de&enden(e! de n!co(!n7 es(e %a! %are "a !nd!v!/!!
    c+ sc!/o.ren!e sa+ c+ de&enden(7 de a"coo" decA( :n &o&+"a=!a $enera"7
    *voluie
    Cons+%+" de n!co(!n7 :nce&e de re$+"7 de (!%&+r!+ :n ado"escen(7, FYd d!n(re
    ce! care con(!n+7 s7 .+%e/e "a e(a(ea de 9L an! deven!nd .+%7(or! /!"n!c!
    &er%anen=! Ma! %+"( de GLd d!n(re .+%7(or! re"a(ea/7 c7 a+ :ncerca( s7 se "ase de
    .+%a(, dar :n c+rs+" &r!%e! (en(a(!ve %a! &+=!n de 9Yd d!n(re ce! care a+ re+O!( s4o
    .ac7 r7%An a's(!nen=! &en(r+ &er!oade "+n$! de (!%& :n +"(!%7 !ns(an=7,
    a&ro<!%a(!v IYd d!n(re ce! care cons+%7 n!co(!n7 :n %od re$+"a( s+n( ca&a'!"! s7
    s(o&e/e .+%a(+" :n ce"e d!n +r%7 La %area %a@or!(a(e a .+%7(or!"or care a+
    de&enden(7 de n!co(!n7 :nce(area .+%a(+"+! de =!$are(e d+ce "a a&ar!=!a
    s!%&(o%e"or de a's(!nen(7 care :nce& "a cA(eva ore de "a :nce(are s! a(!n$ %a<!%+%
    de !n(ens!(a(e :n(re &r!%a s! cea de a &a(ra /!, c+ ce"e %a! %+"(e s!%&(o%e re/!d+a"e
    a%eorAnd+4se cons!dera'!" :n ;4I s7&(7%An!, .oa%ea s! &"+s+" &ondera"
    &ers!s(And (!%& de sase "+n! sa+ %a! %+"( Aceas(7 evo"+=!e cons(And d% "7sarea s!
    re"+area .+%a(+"+! s! dor!n=a re&e(a(7 de a se a'=!ne es(e &ro'a'!" a&"!ca'!"7 :n e$a"7
    %7s+r7 s! cons+%+"+! a"(or .or%e de n!co(!n7, :nc"+s!v $+%e! de %es(eca( c+ (a'ac
    #attern $amilial
    R!sc+" &en(r+ .+%a( cres(e de (re! or! dac7 o r+d7 '!o"o$!c7 de $rad+" I .+%ea/7
    S(+d!!"e &e $e%en! s! &e ado&(a=! !nd!c7 .a&(+" c7 .ac(or!! $ene(!c! con(r!'+!e "a
    de'+(+" s! con(!n+area .+%a(+"+!, c+ $rade de en(a'!(a(e ec!va"en(e c+ ce"e
    o'serva(e :n de&enden(a de a"coo"
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$ 9LH
    S!%&(o%e"e de a's(!nen(7 de n!co(!n7 se s+&ra&+n &es(e ce"e a"e a"(or s!ndroa%e
    de a's(!nen(7 de o s+'s(an=7, &es(e ce"e a"e !n(o<!ca=!e! c+ ca.e!na, (+"'+r7r!"or
    an<!oase, a.ec(!ve s! de so%n, &rec+% s! &es(e a)a(!s!a !nd+s7 de %ed!ca%en(e
    In(ernarea :n +n!(7=! san!(are :n care n+ se .+%ea/7, &oa(e !nd+ce s!%&(o%e de
    a's(!nen(7 care &o( %!%a, !n(ens!.!ca sa+ %asca a"(e d!a$nos(!ce Red+cerea
    76726 Tulburare "n le!tur cu Ficotin 'r Alt
    Speci$icaie
    9RF

    s!%&(o%e"or asoc!a(e &r!n re"+area .+%a(+"+! sa+ &r!n (era&!e de s+'s(!(+=!e a
    n!co(!ne! con.!r%7 d!a$nos(!c+".
    Pen(r+ c7 +/+" re$+"a( de n!co(!n7 n+ &are a de(er!ora .+nc=!onarea %en(a"7,
    de&enden=a de n!co(!n7 n+ es(e con.+nda(7 +Oor c+ a"(e (+"'+r7r! :n "e$7(+r7 c+ o
    s+'s(an=7 s! c+ a"(e (+"'+r7r! %en(a"e.
    C5C.5 Tul-urare .n le/(tur( #u Ni#otin(
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ n!co(!n7 .7r7 a"(7 s&ec!.!ca=!e es(e des(!na(7
    (+"'+r7r!"or asoc!a(e c+ +/+" de n!co(!n7 care n+ s+n( c"as!.!ca'!"e ca de&enden=7 de
    n!co(!n7 sa+ a's(!nen(7 de n!co(!n7.
    Tul-ur(rile .n le/(tur( #u Opia#eele
    O&!acee"e !nc"+d o&!acee"e na(+ra"e Ede e<., %or.!naJ, se%!s!n(e(!ce Ede e<.,
    ero!naJ s! s!n(e(!ce c+ ac=!+ne s!%!"ar7 %or.!ne! Ede e<., code!na, !dro%or.on+",
    %e(adona, o<!codona, %e&er!d!na, .en(any"+"J. Med!ca%en(e ca &en(a/oc!na s!
    '+&renor.!na, care a+ a(A( e.ec(e a$on!s(e, cA( O! an(a$on!s(e c+ o&!acee"e, s+n(, de
    ase%enea, !nc"+se :n aceas(7 c"as7, deoarece, :n s&ec!a" :n do/e %!c!, &ro&r!e(7=!"e
    "or a$on!s(e &rod+c e.ec(e .!/!o"o$!ce O! co%&or(a%en(a"e s!%!"are c+ ce"e a"e
    a$on!O(!"or o&!ace! c"as!c!. O&!acee"e s+n( &rescr!se ca ana"$e/!ce, anes(e/!ce, a$en=!
    an(!d!are!c! sa+ ca an(!(+s!ve. Hero!na es(e +n+" d!n dro$+r!"e d!n aceas(7 c"as7 de
    care se .ace a'+/ ce" %a! .recven( s! es(e ad%!n!s(ra(7 de re$+"7 &r!n !n@ec=!!, deO!
    &oa(e .! s! .+%a(7 s! S&r!/a(7T, cAnd es(e d!s&on!'!"7 :n s(are .oar(e &+r7. Fen(any"+"
    es(e !n@ec(a(, &e cAnd an(!(+s!ve"e s! a$en=!! an(!d!are!c! s+n( "+a(e ora". A"(e o&!acee
    s+n( ad%!n!s(ra(e, a(A( &r!n !n@ec=!!, cA( O! &e ca"e ora"7.
    Aceas(7 sec=!+ne con=!ne co%en(ar!! e<&"!c!(e re.er!(oare "a (+"'+r7r!"e :n
    "e$7(+r7 c+ o&!acee"e. Te<(e"e O! se(+r!"e de cr!(er!! a+ .os( de@a &re/en(a(e "a
    as&ec(e"e $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J O! a'+/+"+! de o
    s+'s(an=7 E&a$. 5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or. A&"!carea aces(or cr!(er!!
    $enera"e de&enden=e! O! a'+/+"+! de o&!acee es(e &rev7/+(7 %a! @os. N+ e<!s(7 :ns7,
    se(+r! de cr!(er!! e<c"+s!v &en(r+ de&enden=a de o&!acee s! a'+/+" de o&!acee. Te<(+"
    O! se(+r!"e de cr!(er!! s&ec!.!ce &en(r+ !n(o<!ca=!a c+ o&!acee O! a's(!nen=a de o&!acee
    s+n(, de ase%enea, &re/en(a(e %a! @os. T+"'+r7r!"e !nd+se de o&!acee Ea"(e"e dec:(
    !n(o<!ca=!a O! a's(!nen=a de o&!aceeJ s+n( descr!se :n sec=!+n!"e %an+a"+"+!
    :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e<., (+"'+rarea
    a.ec(!v7 !nd+s7 de o&!acee es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e A.ec(!veTJ. Ma! @os
    s+n( %en=!ona(e (+"'+r7r!"e +/+"+! de o&!acee s! (+"'+r7r!"e !nd+se de o&!acee.
    Tulburrile u(ului de opiacee
    ;LI.LL De&enden=a de o&!acee Eve/! &a$. 9HLJ
    ;LY.YL A'+/+" de o&!acee Eve/! &a$. 9H5J
    9HL
    Tulburrile "n le!tur cu o Substan
    Tulburrile induse de opiacee
    9F9.GF In(o<!ca=!a c+ o&!acee Eve/! &a$ 9H5J 0e speci)icat dac6 C+ de'+( :n
    c+rs+" !n(o<!ca=!e!
    9F9.L A's(!nen=a de o&!acee Eve/! &a$ 9H9J 9F9.G5 De"!r!+%+" &r!n
    !n(o<!ca=!e c+ o&!acee Eve/! &a$ 5I;J 9F9.5L T+"'+rarea &s!o(!c7 !nd+s7
    de o&!acee c+ !de! de"!ran(e Eve/! &a$
    ;;GJ 0e speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.59
    T+"'+rarea &s!o(!c7 !nd+s7 de o&!acee, c+ a"+c!na=!! Eve/! &a$
    ;;GJ 0e speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GI
    T+"'+rarea a.ec(!v7 !nd+s7 de o&!acee Eve/! &a$ ILYJ 0e speci)icat
    dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GF D!s.+nc(!a se<+a"7
    !nd+s7 de o&!acee Eve/! &a$ YR9J 0e speci)icat
    dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GF T+"'+rarea de so%n
    !nd+s7 de o&!acee Eve/! &a$ RYYJ 0e speci)icat
    dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.F T+"'+rare :n "e$7(+r7 c+ o&!acee"e .7r7 a"(7 s&ec!.!ca=!e Eve/! &a$
    9HHJ
    Tulburrile !"ului de *iacee
    4+7.++ Depen$en!a $e Opia#ee
    A se cons+"(a, de ase%enea (e<(+" s! cr!(er!!"e &en(r+ de&enden=a de o
    s+'s(an=7 Eve/! &a$ 5F9J Ce! %a! %+"=! !nd!v!/! c+ de&enden=7 de o&!acee a+
    n!ve"e de (o"eran(7 se%n!.!ca(!ve s! vor e<&er!en=a a's(!nen=7 "a :n(er+&erea
    'r+sc7 a s+'s(an=e"or o&!acee De&enden(a de o&!acee !nc"+de se%ne s! s!%&(o%e
    care re."ec(7 a+(oad%!%s(rarea &re"+n$!(7 s! co%&+"s!v7 a s+'s(an=e"or o&!acee
    care n+ s+n( +(!"!/a(e :n sco&+r! %ed!ca"e "e$!(!%e or!, dac7 es(e &re/en(7 o
    cond!=!e %ed!ca"7 $enera"7 care neces!(7 (ra(a%en( c+ o&!acee, aces(ea s+n(
    +(!"!/a(e :n do/e care s+n( c+ %+"( :n e<ces .a(7 de can(!(7=!"e necesare &en(r+
    +O+rarea d+re% Persoane"e c+ de&enden(7 de o&!acee (!nd a de/vo"(a as(.e" de
    &a((ern+n re$+"a(e de +/ co%&+"s!v de dro$, c7 ac(!v!(7=!"e /!"n!ce s+n( de re$+"7
    &"an!.!ca(e :n @+r+" o'=!ner!! s! ad%!n!s(r7r!! o&!acee"or O&!acee"e s+n( &roc+ra(e
    de re$+"7 de &e &!a=a !"e$a"7, dar &o( .! o'=!n+(e, de ase%enea de "a %ed!c! &r!n
    s!%+"area sa+ e<a$erarea &ro'"e%e"or %ed!ca"e $enera"e sa+ &r!n o'=!nerea de
    &rescr!&=!! s!%+"(ane de "a d!verO! %ed!c! Pro.es!on!O(!! :n as!s(en=7 %ed!ca"7 c+
    de&enden(7 de o&!a(.ee o'=!n adesea o&!acee &r!n scr!erea &rescr!&=!!"or &en(r+ e!
    :nO!O! sa+ &r!n s+s(ra$erea o&!acee"or care a+ (os( &rescr!se &en(r+ &ac!en=! or! d!n
    s(oc+r!"e .ar%ac!e!
    4+<.<+ A-u)ul $e
    Opia#ee
    CG*
    Speci$icani
    Ur%7(or!! S&ec!.!can=! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden=7 de o&!acee
    Eve/! &a$. 5FY &en(r+ %a! %+"(e de(a"!!JQ
    (u dependen3 fiziolo.ic )r
    dependen3 fiziolo.ic
    !emisiune complet precoce
    !emisiune par3ial precoce
    !emisiune complet prelun.it
    !emisiune par3ial prelun.it
    Sub terapie a.onist @ntrBun
    mediu controlat
    4+<.<+ A-u)ul $e Opia#ee
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$. 5FGJ. Po( a&are d!.!c+"(7=! "e$a"e, ca +r%are a co%&or(a%en(+"+! d!n (!%&+"
    !n(o<!ca=!e! c+ o&!acee sa+ d!n ca+/a .a&(+"+! c7 !nd!v!d+" a rec+rs "a s+rse de
    a&rov!/!onare !"e$a"e. De re$+"7, &ersoane"e care a'+/ea/7 de o&!acee +/ea/7 de
    aces(e s+'s(an=e %+"( %a! rar decA( o .ac ce! c+ de&enden=7 O! n+ de/vo"(7 s!%&(o%e
    se%n!.!ca(!ve de a's(!nen=7. C:nd &ro'"e%e"e :n "e$7(+r7 c+ +/+" de o&!acee s+n(
    aco%&an!a(e de &ro'a a's(!nen=e! sa+ a co%&or(a%en(+"+! co%&+"s!v :n "e$7(+r7 c+
    +/+" de o&!acee, (re'+!e c+"ese !n.or%a=!! s&re a vedea dac7 n+ es(e %a! adecva(
    d!a$nos(!c+" de de&enden=7 de o&!acee, %a! c+rAnd decA( ce" de a'+/ de o&!acee.
    Tulburrile incluse de *iacee
    C5C.>5 Into,i#a!ia #u Opia#ee
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ o&!acee :" cons(!(+!e &re/en=a
    +nor %od!.!c7r! de/ada&(a(!ve &s!o"o$!ce sa+ co%&or(a%en(a"e se%n!.!ca(!ve
    c"!n!c Ede e<., e+.or!e !n!=!a"7 +r%a(7 de a&a(!e, d!s.or!e, a$!(a=!e sa+ "en(oare
    &s!o%o(or!e, de(er!orarea @+dec7=!! sa+ de(er!orarea .+nc=!on7r!! soc!a"e or!
    &ro.es!ona"eJ care a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7 +/+" de o&!acee Ecr!(er!!"e
    A O! BJ. In(o<!ca=!a es(e aco%&an!a(7 de cons(r!c=!e &+&!"ar7 Ee<ce&(And ca/+" cAnd
    es(e vor'a de o s+&rado/are sever7, c+ ano<!e s! d!"a(a=!e &+&!"ar7 consec+(!v7J O!
    +n+" sa+ %a! %+"(e d!n(re +r%7(oare"e se%neQ (or&oare Edescr!s7 ca .!!nd S&e
    a=!&!(eTJ sa+ c!ar co%7, d!/ar(r!e s! de(er!orarea a(en=!e! sa+ %e%or!e! Ecr!(er!+" CJ.
    Ind!v!/!! c+ !n(o<!ca=!e c+ o&!acee &o( &re/en(a !na(en=!e .a=7 de a%'!an=7, c!ar
    &An7 "a &+nc(+" de a !$nora even!%en(e &o(en=!a" &er!c+"oase. S!%&(o%e"e n+
    (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e s! n+ s+n( e<&"!ca(e %a! '!ne
    de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" DJ.
    Ma$n!(+d!nea %od!.!c7r!"or &s!o"o$!ce s! co%&or(a%en(a"e care re/+"(7 d!n
    +/+" de o&!acee de&!nde de do/7, &rec+% s! de carac(er!s(!c!"e !nd!v!d+"+! care
    +;ea;6 de s+'s(an=7 Ede e<., (o"eran=a, r!(%+" de a'sor'=!e, cron!c!(a(ea +/+"+!J.
    S!%&(o%e"e !n(o<!ca=!e! c+ o&!acee d+rea/7 de re$+"7 cA(eva ore, !n(erva" de (!%&
    care concord7 c+ se%!v!a=a ce"or %a! %+"(e dro$+r! o&!acee. In(o<!ca=!a sever7
    9H9
    Tulburrile "n le!tur cu o Substan

    +r%And +ne! s+&rado/e de o&!acee &oa(e d+ce "a co%7, de&res!e res&!ra(or!e,
    d!"a(a(!e &+&!"ar7, &!erderea c+noO(!n=e! s! c!ar %oar(e
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( +n+! d!a$nos(!c de !n(o<!ca=!e c+ o&!acee
    C+ &er(+r'7r! de &erce&=!e Aces( s&ec!.!can( &oa(e .! %en=!ona( :n rare"e
    ca/+r! cAnd a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 sa+ !"+/!! a+d!(!ve,
    v!/+a"e or! (ac(!"e s+rv!n :n a'sen(a +n+! de"!n+% Testarea realit6(ii intact6
    :nsea%n7 c7 &ersoana O(!e c7 a"+c!na=!!"e s+n( !nd+se de o s+'s(an=7 s! n+
    re&re/!n(7 rea"!(a(ea e<(ern7 CAnd a"+c!na=!!"e s+rv!n :n a'sen(a +ne! (es(7r!
    a rea"!(7=!! !n(ac(e, (re'+!e "+a( :n cons!dera=!e d!a$nos(!c+" de (+"'+rare
    &s!o(!c7 !nd+s7 de o s+'s(an=7, c+ a"+c!na=!!
    Criteriile $e $ia/no&ti# pentru C5C.>5 Into,i#a!ia #u Opia#ee
    A .( recent de un opiaceu
    S Modi$icri psi%olo!ice si comportamentale de(adaptative semni$icative clinic
    &de ex, eu$orie iniial urmat de apatie, dis$one, a!itaie sau lentoare
    psi%omotone, deteriorarea 0udecaii sau deteriorarea $uncionm sociale sau
    pro$esionale), care apar "n cursul ori la scurt timp dup u(ul de opiacee
    onstricie pupilar &sau dilatatie pupilar datorat anoxiei prin suprado(
    sever) si unul &sau mai multe) dintre urmtoarele semne, apr@nd "n cursul
    ori la scurt timp dup u(ul de opiacee
    (1)torpoare sau com,
    (2)di(artrie,
    (3)deteriorarea ateniei sau memoriei
    D Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alta tulburare mental
    De speci"icat dac
    u perturbri de percepie
    C5C.+ A-&tinen!a $e Opia#ee
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a's(!nen(a de o s+'s(an=7
    Eve/! &a$ 9L5J E"e%en(+" esen=!a" a" a's(!nen(e! de o&!acee :" cons(!(+!e &re/en(a
    +n+! s!ndro% de a's(!nen(7 carac(er!s(!c care a&are d+&7 :nce(area Esa+ red+cereaJ
    +/+"+! de o&!acee care a .os( %as!v s! &re"+n$!( Ecr!(er!+" A"J S!ndro%+" de
    a's(!nen(7 &oa(e .!, de ase%enea, &rec!&!(a( de ad%!n!s(rarea +n+! o&!ace+
    an(a$on!s( Ede e<, na"o<on7 sa+ na"(re<on7J d+&7 o &er!oad7 de +/ de o&!acee
    Ecr!(er!+" A9J A's(!nen(a de o&!acee se carac(er!/ea/7 &r%(r4+n &a((ern de se%ne s!
    s!%&(o%e care s+n( o&+s+" e.ec(e"or a$o%s(e ac+(e Pr!%e"e d!n(re aces(ea s+n(
    s+'!ec(!ve s! cons(a+ d!n ac+/e de an<!e(a(e, ne"!n!O(e s! d%(r4o Ssen/a=!e de
    d+rereT "oca"!/a(7 adesea :n s&a(e s! :n &!c!oare, aco%&an!a(7 de dor!n=a de a o'=!ne
    76725 Abstinena de
    Opiacee
    9H;
    o&!acee EScrav!n$TJ s! co%&or(a%en(+" de c7+(are a dro$+"+!, :%&re+n7 c+
    !r!(a'!"!(a(ea O! creO(erea sens!'!"!(7=!! "a d+rere. Tre! sa+ %a! %+"(e d!n(re
    +r%7(oare"e s!%&(o%e (re'+!e s7 .!e &re/en(e &en(r+ a &+ne d!a$nos(!c+" de
    a's(!nen=7 de o&!aceeQ d!s&o/!=!e d!s.or!c7, $rea=7 sa+ vo%7, %!a"$!!, "7cr!%are sa+
    r!noree, d!"a(a=!e &+&!"ar7, &!"oerec=!e sa+ (rans&!ra=!e a'+nden(7, d!aree, c7sca(,
    .e'r7 s! !nso%n!e Ecr!(er!+" BJ. P!"oerec=!a s! .e'ra s+n( asoc!a(e c+ o a's(!nen=7 %a!
    sever7 s! adesea n+ s+n( v7/+(e :n &rac(!ca c"!n!c7 de r+(!n7, deoarece !nd!v!/!! c+
    de&enden=7 de o&!acee o'=!n de re$+"7 s+'s(an=e :na!n(e ca de&enden=a s7 dev!n7
    e<(re% de avansa(7. Aces(e s!%&(o%e a"e a's(!nen=e! de o&!acee (re'+!e s7 ca+/e/e
    o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n
    a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e s7 se
    da(ore/e +ne! cond!=!! %ed!ca"e $enera"e O! n+ s+n( e<&"!ca(e %a! '!ne de a"(7
    (+"'+rare %en(a"7 Ecr!(er!+" DJ.
    La ce! %a! %+"=! !nd!v!/! de&enden=! de dro$+r! c+ d+ra(7 sc+r(7 de ac=!+ne,
    c+% ar .! ero!na, s!%&(o%e"e de a's(!nen=7 s+rv!n :n dec+rs de R459 ore d+&7
    +"(!%a do/7. :n ca/+" dro$+r!"or c+ d+ra(7 %a! "+n$7 de ac=!+ne, c+% s+n(
    %e(adona sa+ LAAM E54a".aace(!"%e(ado"J, a&ar!=!a s!%&(o%e"or &oa(e neces!(a
    94I /!"e. S!%&(o%e"e de a's(!nen=7 ac+(7 de +n o&!ace+ c+ d+ra(7 sc+r(7 de ac=!+ne,
    c+% es(e ero!na, a(!n$ de re$+"7 &!c+" :n dec+rs de 54; /!"e O! d!%!n+a &ro$res!v
    :n dec+rs+" +ne! &er!oade de Y4H /!"e. S!%&(o%e"e de a's(!nen=7 %a! &+=!n ac+(e
    &o( d+ra s7&(7%An! sa+ "+n!. Aces(e s!%&(o%e %a! cron!ce !nc"+d an<!e(a(ea,
    d!s.or!a, anedon!a, !nso%n!a O! dor!n=a arden(7 de dro$. De .a&(, (o=! !nd!v!/!! c+
    de&enden=7 de o&!acee re"a(ea/7 o co%&onen(7 .!/!o"o$!c7, !nc"+/And YLd d!n(re
    ce! care a+ &re/en(a( a's(!nen=7.
    Criteriile $e $ia/no&ti# pentru C5C.+ A-&tinen!a $e Opia#ee
    A2 Oricare dintre urmtoareleD
    (1) "ncetarea &sau reducerea) u(ului de opiacee, care a $ost excesiv
    si
    prelun!it &mai multe sptm@ni sau c%iar mai mult),
    (2) administrarea unui anta!onist opiaceu dup o perioad de u( de opiacee2
    S2 Trei &sau mai multe) dintre urmtoarele simptome apr@nd "n decurs de
    c@teva minute sau (ile dup criteriul AD
    (1)dispo(iie dis$oric3
    (2)!rea sau vom3
    (3)mial!ii3
    (4)lcrimare sau rinoree3
    (5)dilataie pupilar, piloerecie sau transpiraie3
    (6)diaree3
    (7)cscat3
    (8)$ebr3
    (9)insomnie2
    2 Simptomele de la criteriul S cau(ea( o detres sau deteriorare semni$icativ
    clinic "n domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale ,i nu sunt
    explicate mai bine de alt tulburare mental2
    9HI
    Tul-ur(rile .n le/(tur( #u o Su-&tan!(
    Alte Tul-ur(ri in$u&e $e Opia#ee
    Ur%7(oare"e (+"'+r7r! !nd+se de o&!acee s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ deliriumul
    prin intoxica3ie cu opiacee E&a$. 5I;J, tulburarea psi-otic indus de opiacee
    E&a$ ;;GJ, tulburarea afectiv indus de opiacee E&a$. ILYJ, disfunc3ia sexual
    indus de opiacee E&a$ YR9J M tulburarea de somn indus de opiacee E&a$. RYYJ.
    Aces(e (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ o&!acee sa+ a" a's(!nen=e!
    de o&!acee n+%a! cAnd s!%&(o%e"e s+n( :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+
    s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen=7 de o&!acee O! cAnd s!%&(o%e"e s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    $nformaii sulimentare desre
    Tulburrile %n le&tur cu *iaceele
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. De&enden(a de o&!acee
    es(e asoc!a(7 .recven( c+ +n !s(or!c de !n.rac=!+n! :n "e$7(+r7 c+ dro$+" Ede e<,
    &osedarea sa+ d!s(r!'+!rea de dro$+r!, .a"s, .+r( &r!n e.rac=!e, 'and!(!s%, .+r( sa+
    &r!%!rea de '+n+r! .+ra(eJ La &ro.es!on!O(!! :n :n$r!@!rea s7n7(7=!! s! "a !nd!v!/!! care
    a+ +Oor acces "a s+'s(an=e"e =!n+(e s+' con(ro", e<!s(7 adesea +n &a((ern d!.er!( de
    ac(!v!(7=! !"e$a"e !%&"!cAnd &ro'"e%e c+ de&ar(a%en(e"e s(a(+"+! care e"!'erea/7
    a+(or!/a=!!, c+ cond+cer!"e &ro.es!ona"e a"e s&!(a"e"or or! c+ a"(e a$en=!!
    ad%!n!s(ra(!ve D!vor=+", Oo%a@+" sa+ an$a@area (e%&orar7 s+n( adesea asoc!a(e c+
    de&enden(a de o&!acee "a (oa(e n!ve"e"e soc!oecono%!ce
    Pen(r+ %+"=! !nd!v!/!, e.ec(+" "+7r!! &en(r+ &r!%a da(7 a +n+! o&!ace+ es(e %a!
    c+rAnd d!s.onc decA( e+.or!c, &+(And a&are $rea=7 s! vo%7 Ind!v!/!! c+ de&enden(7
    de o&!acee s+n( e<&+O! r!sc+"+! de a de/vo"(a o de&res!e +Ooar7 s&re %odera(7 care
    sa(!s.ace cr!(er!!"e s!%&(o%a(o"o$!ce s! de d+ra(7 &en(r+ (+"'+rarea d!s(!%!c7 s! +neor!
    &en(r+ (+"'+rarea de&res!v7 %a@or7 Aces(e s!%&(o%e &o( re&re/en(a o (+"'+rare
    a.ec(!v7 !nd+s7 de o&!acee E_ e/! &a$ ILYJ sa+ e<acer'area +ne! (+"'+r7r! de&res!ve
    &r!%are &ree<!s(en(e Per!oade"e de de&res!e s+n( e<(re% de .recven(e :n c+rs+"
    !n(o<!ca=!e! cron!ce or! :n asoc!ere c+ s(resorn &s!osoc!a"! care s+n( :n "e$7(+r7 c+
    de&enden(a de o&!acee Inso%n!a es(e co%+n7, :n s&ec!a" :n c+rs+" a's(!nen(e!
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7 es(e %+"( %a! .recven(7 "a !nd!v!/!! c+
    de&enden(7 de o&!acee decA( "a &o&+"a=!a $enera"7 S(res+" &os((ra+%a(!c es(e, de
    ase%enea, :n(:"%( .!ecven( Is(or!c+" de (+"'+rare de cond+!(7 :n co&!"7r!e sa+ :n
    ado"escen(7 a .os( !den(!.!ca( dre&( +n .ac(or de r!sc se%n!.!ca(!v &en(r+ (+"'+r7r!"e :n
    "e$7(+r7 c+ o s+'s(an=7, % s&ec+" &en(r+ de&enden(a de o&!acee
    9ate de laborator asoc!a(e. Tes(e"e (o<!co"o$!ce +r%are de r+(!n7 s+n( adesea
    &o/!(!ve &en(r+ dro$+r!"e o&!acee "a !nd!v!/!! c+ de&enden(7 de o&!acee Tes(e"e +r!nare
    r7%An &o/!(!ve &en(r+ ce"e %a! %+"(e o&!acee (!%& de 594;R ore d+&7 ad%!n!s(rare
    O&!acee"e c+ d+ra(7 de ac=!+ne %a! "+n$7 Ede e<, %e(adona s! LAAMJ &o( .!
    !den(!.!ca(e :n +r%7 (!%& de %a! %+"(e /!"e Fen(any"+" n+ es(e de(ec(a( &r!n (es(e"e
    +r!nare s(andard, dar &oa(e (! !den(!.!ca( &r!n %e(ode %a! s&ec!a"!/a(e Ev!den=!erea
    &r!n &ro'e de "a'ora(or a &re/en(e! a"(or s+'s(an=e Ede e< , coca!n7, %an+ana, a"coo",
    a%.e(a%!ne, 'c!vod!a/e&%cJ es(e .recven(7 Tes(e"e de e<&"orare &en(r+ e&a(!(a A, B
    Tulburrile "n le!tur cu
    Opiaceele
    285

    s! C s+n( &o/!(!ve &en(r+ n+ %a! &+=!n de GLd4FLd d!n(re +/e+% !n(ravenos, .!e &en(r+
    an$en+" e&a(!(e! Ese%n!.!cAnd o !n.ec=!e ac(!v7J, .!e &en(r+ an(!cor&+" e&a(!(e!
    Ese%n!.!cAnd o !n.ec=!e :n (rec+(J Pro'e .+nc=!ona"e e&a(!ce +Oor cresc+(e s+n(
    .recven(e, .!e ca re/+"(a( a" +ne! e&a(!(e &e ca"e de re/o"vare, .!e &nn "e/!+n! (o<!ce a"e
    .!ca(+"+! da(ora(e con(a%!nan=!"or care a+ .os( a%es(eca=! c+ o&!ace+" !n@ec(a(
    Mod!.!c7r! s+'(!"e :n &a((ern+n"e de secre=!e a cor(!/o"+"+! s! re$"7% (e%&era(+r!!
    cor&+"+! a+ .os( o'serva(e :n &An7 "a R "+n! d+&7 de/!n(o<!carea de o&!acee
    9atele examinrii somatice /i condi3iile medicale .enerale asociate. U/+"
    ac+( s! +/+" cron!c de o&!acee s+n( asoc!a(e c+ "!&sa secre=!!"or, ca+/And +scarea
    $+r!! s! nas+"+!, :nce(!n!rea ac(!v!(7=!! $as(ro%(es(%a"e s! cons(!&a=!e Ac+!(a(ea
    v!/+a"7 &oa(e .! de(er!ora(7 ca re/+"(a( a" cons(r!c=!e! &+&!"are La !nd!v!/!! care
    +/ea/7 de o&!acee !n(ravenos, vene"e sc"ero/a(e ET(rac)sTJ s! se%ne"e :n=e&7(+r!"or
    de &e &7r=!"e !n.er!oare a"e e<(re%!(7=!"or s+&er!oare s+n( .recven(e Uneon vene"e
    s+n( aOa de r7+ sc"ero/a(e c7 a&ar ede%e &er!.er!ce, !ar !nd!v!/!! (rec "a vene"e
    &!c!oare"or, $A(+"+! sa+ re$!+n!! !n$!na"e CAnd s! aces(e vene dev!n !n+(!"!/a'!"e
    or! !nacces!'!"e, !nd!v!/!! se !n@ec(ea/7 adesea d!rec( :n =es+(+" s+'c+(ana( ESs)!n4
    &o&&%$TJ d+cAnd "a a&ar!=!a de ce"+"!(e, a'cese, c!ca(r!c! c!rc+"are d+&7 v!ndecarea
    "e/!+n!"or c+(ana(e Te(an+s+" s! !n.ec=!a c+ Clostndi+m bot+-n+m s+n( co%&"!ca=!!
    re"a(!v rare, dar e<(re% de severe a"e !n@ec(7% de o&!acee, :n s&ec!a" c+ ace
    con(a%!na(e De ase%enea, &o( s+rven! !n.ec=!! s! :n a"(e or$ane s! !nc"+d
    endocard!(a, e&a(!(a s! !n.ec=!a c+ v!r+s+" !%+node.!c!en(e! +%ane EHI3J
    T+'erc+"o/a es(e o &ro'"e%7 e<(re% de ser!oas7 &r!n(re !nd!v!/!! care +/ea/7 de
    dro$+r! &e ca"e !n(ravenoas7, :n s&ec!a" "a ce! de&enden=! de ero!n7 In.ec=!a c+
    'ac!"+" (+'erc+"o/e! es(e de re$+"7 as!%&(o%a(!c7 s! se ev!den=!a/7 n+%a! &r!n
    &re/en(a +n+! (es( c+(ana( &o/!(!v "a (+'erc+"%7 Or!c+%, %+"(e ca/+r! de
    (+'erc+"o/7 ac(!v7 a+ .os( cons(a(a(e, :n s&ec!a" "a ce! care s+n( !n.ec(a=! c+ HI3
    AceO(! !nd!v!/! a+ adesea o !n.ec=!e c7&7(a(7 de c+rAnd, dar, de ase%enea, es(e
    &os!'!" s7 &re/!n(e o reac(!vare a +ne! !n.ec=!! an(enoare d!n ca+/a de(er!or7%
    .+nc=!e! !%+%(are Persoane"e care &r!/ea/7 ero!n7 sa+ a"(e o&!acee ESsnor(!n$TJ
    &re/!n(7 adesea o !n(a(!e a %+coase! nasa"e, asoc!a(7 +neor! c+ &er.orarea se&(+"+!
    na/a" D!.!c+"(7=!"e :n .+nc=!onarea se<+a"7 s+n( .recven(e B7r'a=!! &re/!n(7 adesea
    o d!s.+nce erec(!"7 !n c+rs+" !n(o<!ca=!e! sa+ +/+"+! cron!c Fe%e!"e a+ :n %od
    .recven( &er(+r'7r! a"e .+nc=!e! de re&rod+cere s! %ens(r+a=!! nere$+"a(e
    Inc!den=a !n.ec=!e! HI3 es(e %are &r!n(re !nd!v!/!! care +/ea/7 de dro$+r!
    !n(ravenos, +n %are &rocen( d!n(re aceO(!a .+nd !nd!v!/! c+ de&enden=7 de o&!acee
    As(.e", s4a cons(a(a( c7 &rocen(e"e !n.ec=!e! c+ HI3 s+n( de &es(e RLd &r!n(re
    &ersoane"e de&enden(e de ero!n7 d!n +ne"e /one a"e S(a(e"or Un!(e
    Pe "An$7 !n.ec=!!, c+% ar .! ce"+"!(a, e&a(!(a, HI3, (+'erc+"o/a, endocard!(a,
    de&enden(a de o&!acee es(e asoc!a(7 c+ o ra(7 de %or(a"!(a(e .oar(e %are, de &es(e
    ",Yd49d &e an Moar(ea s+rv!ne ce" %a! adesea &r!n s+&rado/are, acc!den(e,
    (ra+%a(!s%e sa+ a"(e co%&"!ca=!! %ed!ca"e Acc!den(e"e s! v7(7%7r!"e da(ora(e
    v!o"en(e! c+ care es(e asoc!a(a c+%&7rarea s! _ !nderea de dro$+r! s+n( .recven(e In
    +ne"e /one v!o"en(a e<&"!ca %a! %+"(e %or=! :n "e$7(+r7 c+ o&!acee"e decA(
    s+&rado/area sa+ !n.ec=!a c+ HI3 De&enden(a .!/!o"o$!c7 de o&!acee &oa(e s+rven!
    "a a&roa&e @+%7(a(e d!n(re s+$ar!! n7sc+=! d!n .e%e!"e c+ de&enden(7 de o&!acee,
    aceas(a &oa(e &rod+ce +n s!ndro% de a's(!nen(7 sever7 neces!(And (ra(a%en(
    %ed!ca" DeO! $re+(a(ea sc7/+(7 "a naO(ere es(e, de ase%enea, o'serva(7 "a co&!!
    %a%e"or c+ de&enden(7 de o&!acee, aceas(a n+ es(e de re$+"7 %arca(7 s! :n $enera"
    n+ es(e asoc!a(7 c+ consec!n=e adverse ser!oase
    28>
    Tulburrile "n le!tur cu o Substan
    *lemente speci$ice culturii, etii si sexului
    :nce&And d!n 5F9L, :n S(a(e"e Un!(e, %e%'r!! +nor $r+&+r! %!nor!(are (r7!nd :n
    /one de&r!va(e econo%!c s+n( s+&rare&re/en(a=! &r!n(re &ersoane"e c+ de&enden=7
    de o&!acee. C+ (oa(e aces(ea, :n +"(!%a &ar(e a an!"or 5GLL s! :nce&+(+" an!"or 5FLL,
    de&enden=a de o&!acee era :n(A"n!(7 %a! .recven( &r!n(re !nd!v!/!! a"'! d!n c"asa de
    %!@"oc, :n s&ec!a" &r!n(re .e%e!, s+$erAnd c7 d!.eren=a :n +/ re."ec(7 d!s&on!'!"!(a(ea
    de dro$+r! o&!acee s! a"=! .ac(or! soc!a"!. Persona"+" %ed!ca" care are acces +Oor "a
    o&!acee &oa(e &re/en(a +n r!sc cresc+( &en(r+ a'+/+" s! de&enden=a de o&!acee.
    :na!n(area :n e(a(e &are a .! asoc!a(7 c+ o sc7dere a &reva"en(e!. Aceas(7 (end!n=7
    a de&enden=e! de a se re%!(e :nce&e :n $enera" d+&7 e(a(ea de IL de an! s! a .os(
    den+%!(7 S(er%!narea %a(+r!/7r!!T E%a(+r!n$ o+(J. C+ (oa(e aces(ea, %+"(e
    &ersoane a+ r7%as de&enden(e de o&!acee (!%& de YL de an! sa+ %a! %+"(. B7r'a=!!
    s+n( a.ec(a=! %a! .recven(, ra&or(+" '7r'a=!X.e%e! .!!nd de re$+"7 de 5,YQ5 &en(r+
    a"(e o&!acee decA( ero!na Ead!c7, acces!'!"e &e 'a/7 de &rescr!&=!e %ed!ca"7J s! de
    ;Q5 &en(r+ ero!n7.
    #revalent
    O ance(7 na=!ona"7 d!n an+" 5FFR re.er!(oare "a +/+" de dro$+r! ra&or(a c7 R,Hd
    d!n(re '7r'a=!! s! I,Yd d!n(re .e%e!"e d!n S(a(e"e Un!(e rec+nosc c7 a+ .7c+( cAndva
    +/ de +n a%ed!ca%en( ana"$e/!c :n(r4a"( %od decA( :n ce" :n care a .os( &rescr!s
    aces(a, !nc"+O! .!!nd 9d care a+ .7c+( +/ de aces(e dro$+r! an+" (rec+(, O! a&ro<!%a(!v
    5d care a+ .7c+( +/ de aces(e dro$+r! "+na (rec+(7. U/+" !nadecva( d!n &+nc( de
    vedere %ed!ca" a" ana"$e/!ce"or are cea %a! %are &reva"en(7 &e v!a=7 a sa &r!n(re
    !nd!v!/!! :n e(a(e de 5G s! 9Y an! EFdJ, c+ Yd d!n aces( $r+& de e(a(e rec+noscAnd c7
    a+ .7c+( cAndva +/ de dro$ :n c+rs+" an+"+! (rec+( s! c+ 9d rec+noscAnd c7 a+ .7c+(
    +/ de dro$ "+na (rec+(7. Preva"en(a &e v!a=7 &en(r+ ero!n7 a .os( :n @+r de 5d, c+
    L,9d "+And dro$ :n c+rs+" an+"+! (rec+(. O ance(7 d!n 5FFH re.er!(oare "a +/+" de
    dro$ &r!n(re e"ev!! de "!ce+ a ra&or(a( c7 :n @+r de 9d d!n(re e"ev!! d!n +"(!%+" an a+
    "+a( cAndva ero!n7, !ar 5Ld c7 a+ .7c+( +/ :n %od !nadecva( de a"(e Sana"$e/!ceT.
    Aces(e &rocen(e &e v!a=7 a"e ero!ne! &r!n(re e"ev!! d!n +"(!%+" an de "!ce+ s+n( %a!
    %ar! decA( &rocen(e"e d!n an!! 5FFL O! 5FFI E5,;d s! res&ec(!v, 5,9dJ s! re&re/!n(7 ce"e
    %a! %ar! c!.re de "a &rocen(+" de &es(e 9d d!n 5FHY.
    Deoarece ance(e"e a+ eva"+a( %a! c+rAnd &a((ern+r! de +/ decA( (+"'+r7r!, n+
    se O(!e cA=! d!n(re ce! care a+ .7c+( +/ de ana"$e/!ce sa+ de ero!n7 a+ av+(
    s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ de&enden=7 sa+ a'+/. Un s(+d!+ co%+n!(ar
    e.ec(+a( :n S(a(e"e Un!(e d!n 5FGL &An7 :n 5FGY O! care a +(!"!/a( cr!(er!!"e %a! s(r!c(
    de.!n!(e a"e DSM4III cons(a(7 c7 L,Hd d!n &o&+"a=!a ad+"(7 a &re/en(a( "a +n
    %o%en( da( :n v!a=7 de&enden=7 sa+ a'+/ de o&!acee. D!n(re !nd!v!/!! c+
    de&enden=7 sa+ a'+/, 5Gd a+ re"a(a( +/ :n +"(!%a "+n7, !ar I9d a+ re"a(a( c7 a+ av+(
    o &ro'"e%7 c+ o&!acee"e :n +"(!%+" an.
    *voluie
    De&enden=a de o&!acee &oa(e :nce&e "a or!ce e(a(e, dar &ro'"e%e"e asoc!a(e c+
    +/+" de o&!acee s+n( o'serva(e &en(r+ &r!%a da(7 ce" %a! .recven( :n +"(!%a &ar(e
    a ado"escen=e! sa+ "a :nce&+(+" ce"e! de4a (re!a decade. Oda(7 a&7r+(7, de&enden=a
    se con(!n+7 o &er!oad7 de %+"=! an!, c!ar dac7 s+n( .recven(e sc+r(e &er!oade de
    a's(!nen=7. Rec7derea d+&7 a's(!nen=7 es(e .recven(7. DeO! s+rv!n rec7der!, !ar
    +ne"e &rocen(e de %or(a"!(a(e &e (er%en "+n$ a+ .os( ra&or(a(e ca .!!nd de &es(e 9d
    767 6 Tulburare "n le!tur cu Opiaceele 'r Alt
    Speci$icaie
    288

    &e an, a&ro<!%a(!v 9L4;Ld d!n(re !nd!v!/!! c+ de&enden(7 de o&!acee dev!n
    a's(!nen=! &e (er%en "+n$ O e<ce&=!e de "a c+rs+" cron!c carac(er!s(!c a"
    de&enden(e! de o&!acee a .os( o'serva(7 "a %!"!(a% care a+ deven!( de&enden=! de
    o&!acee :n 3!e(na% La :n(oarcerea :n S(a(e"e Un!(e, %a! &+=!n de 5Ld d!n(re ce! care
    era+ de&enden=! de o&!acee a+ rec7/+(, deO! e! &re/en(a+ &rocen(e cresc+(e de
    de&enden(7 de a"coo" sa+ de a%.e(a%!ne E<!s(7 &+=!ne da(e d!s&on!'!"e des&re
    evo"+=!a a'+/+"+! de o&!acee
    #attern $amilial
    Me%'r+ de .a%!"!e a! !nd!v!/!"or c+ de&enden(7 de o&!acee es(e &os!'!" s7 a!'7
    n!ve"e %a! %ar! de &s!o&a(o"o$!e, :n s&ec!a" o !nc!den=7 cresc+(7 a a"(or (+"'+r7r!
    :n "e$7(+r7 c+ o s+'s(an=7 s! a &ersona"!(7=!! an(!soc!a"e
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$ 9LH T+"'+r7r!"e !nd+se de o&!acee &o( .! carac(er!/a(e &r!n
    s!%&(o%e Ede e<, d!s&o/!=!e de&resn 7J care a%!n(esc de (+"'+r7r!"e %en(a"e
    &r!%are Ede e< , d!s%!e vers+s (+"'+rarea a.ec(+ 7 !nd+s7 de o&!acee, c+ e"e%en(e
    de&res!ve, c+ de'+( :n c+rs+" !n(o<!ca=!e!J _e/! &a$ 95L &en(r+ d!sc+(area aces(+!
    d!a$nos(!c d!.eren=!a" Es(e &+=!n &ro'a'!" ca o&!acee"e s7 &rod+c7 a"(e s!%&(o%e de
    &er(+r'are %en(a"7 decA( ce"e %a! %+"(e dro$+r! de a'+/ In(o<!ca=!a a"coo"!c7 s!
    !n(o<!ca=!a c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce &o( ca+/a +n (a'"o+ c"!n!c
    ase%7n7(or !n(o<!ca=!e! c+ o&!acee L n d!a$nos(!c de !n(o<!ca=!e a"coo"!c7 sa+ de
    !n(o<!ca=!e c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce &oa(e .! .7c+( &e 'a/a a'sen(e!
    cons(r!c=!e! &+&!"are sa+ &e "!&sa de r7s&+ns "a &rovocarea c+ na"o<on7 :n +ne"e
    ca/+r!, !n(o<!ca=!a se &oa(e da(ora a(A( o&!acee"or ca( s! a"coo"+"+! sa+ a"(or
    seda(!ve :n aces(e ca/+r! &ro_oc7rea c+ na"o<on7 n+ va an+"a (oa(e e.ec(e"e
    seda(!ve An<!e(a(ea s! ne"!n!O(ea asoc!a(e c+ a's(!nen(a de o&!acee sea%7n7 c+
    s!%&(o%e"e :n(A"n!(e :n a's(!nen(a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce :ns7,
    a's(!nen(a de o&!acee es(e aco%&an!a(7, de ase%enea, de r%oree, "7cr!%are s!
    d!"a(a(!e &+&!"ar7 care n+ se o'sen 7 !n a's(!nen(a (!& de seda(!ve P+&!"e d!"a(a(e se
    o'serv7, de ase%enea, % !n(o<!ca=!a c+ a"+c!no$ene, !n(o<!ca=!a c+ a%.e(a%!na
    s! !n(o<!ca=!a c+ coca!n7 A"(e se%ne sa+ s!%&(o%e a"e a's(!nen(e! de o&!acee, c+%
    ar .! $rea=a, vo%a, d!areea cra%&e"e a'do%!na"e sa+ "7cr!%area n+ s+n( :ns7
    &re/en(e In(o<!ca=!a c+ o&!acee s! a's(!nen(a de o&!acee se d!s(!n$ de a"(e (+"'+r7r!
    !nd+se de o&!acee Ede e< , (+"'+rarea a.ec(n 7 !nd+s7 de o&!acee, c+ de'+( :n c+rs+"
    !n(o<!ca=!e!J, deoarece s!%&(o%e"e d!n aces(ea d!n +r%7 s+n( :n e<ces .a(7 de ce"e
    asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+ o&!acee sa+ c+ a's(!nen(a de o&!acee s! s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7
    C5C.5 Tul-urare .n le/(tur( #u Opia#eele
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ o&!acee"e .7r7 a"(7 s&ec!.!ca=!e es(e
    re/erva(7 (+"'+r7r!"or asoc!a(e c+ +/+" de o&!acee care n+ s+n( c"as!ca'!"e ca
    de&enden(7 de o&!acee, a'+/ de o&!acee, !n(o<!ca=!e c+ o&!acee, a's(!nen(7 de
    o&!acee, der!+% &r!n !n(o<!ca=!e c+ o&!acee, (+"'+rare &s!o(!c7 !nd+s7 de o&!acee
    sa+ (+"'+rare de so%n !nd+s7 de o&!acee
    9HG Tulburrile "n le!tur cu o Substan
    Tul-ur(rile .n le/(tur( #u P@en#P#li$ina
    3&au #u &u-&tan!e &i"ilare P@en#P#li$inei6
    Pencycd!ne"e Esa+ s+'s(an=e"e s!%!"are &encycd!ne!J !nc"+d &encyc"!d%a
    EPCP, Serny"anJ s! co%&+O!! c+ ac=!+ne s!%!"ar7, dar %a! &+=!n &o(en=!, c+% es(e
    )e(a%!na E)e(a"ar, )e(a@ec(J, cyc"oe<a%%a s! d!/oc!"&!na Aces(e s+'s(an=e a+
    a&7r+( !n!=!a" ca anes(e/!ce d!soc!a(!ve :n an!! 2YL s! a+ deven!( dro$+r! de s(rad7 :n
    an!! 2RL E"e &o( .! "+a(e ora" sa+ ad%!n!s(ra(e !n(ravenos, or! &o( .! .+%a(e
    Pencyc"!d!na EvAnd+(7 !"!c!( s+' d!verse n+%e &rec+% PCP, o$, (ran0, an$e" d+s(,
    PeaCe P!"!J es(e s+'s(an=a d!n aceas(7 c"as7 de care se a'+/ea/7 ce" %a! %+"(
    Aceas(7 sec=!+ne con=!ne d!sc+=!!"e s&ec!.!ce (+"'+r7r!"or :n "e$7(+r7 c+
    &encyc"!d%a Te<(e"e s! se(+r!"e de cr!(er!! &en(r+ as&ec(e"e $enera"e a"e
    de&enden(e! de o s+'s(an=7 E&a$ 5F9J s! a'+/+"+! de o s+'s(an=7 E&a$ 5FGJ a+ .os(
    de@a &re/en(a(e s! se a&"!c7 (+(+ror s+'s(an=e"or A&"!carea aces(or cr!(er!! $enera"e
    "a de&enden(a s! a'+/+" de &encvc"!d%7 es(e &re/en(a(7 %a! &s N+ e<!s(7 :ns7
    se(+r! de cr!(er!! e<c"+s!v &en(r+ de&enden(a s! a'+/+" de &encyc"!d%a Un (e<( s!
    +n se( de cr!(er!! s&ec!.!ce &en(r+ !n(o<!ca=!a c+ &encvc"!d%7 es(e, de ase%enea,
    &re/en(a( %a! @os DeO! &o( a&are s!%&(o%e de a's(!nen(7 de &encyc"!d%a,
    se%n!.!ca=!a "or c"!n!c7 es(e !ncer(7, !ar +n d!a$nos(!c de a's(!nen(7 de
    &encyc"!d%a n+ es(e !nc"+s :n aces( %an+a" T+"'+r7r!"e !nd+se de &encyc"!d%a
    Ea"(e"e decA( !n(o<!ca=!a c+ &encycd%7J s+n( descr!se :n sec=!+n!"e %an+a"+"+!
    :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e<, (+"'+rarea
    &s!oc7 !nd+s7 de &encvc"!d%7 es(e !nc"+s7 !n sec=!+nea SSc!/o.ren!a s! a"(e
    (+"'+r7r! &s!o(!ce 2J Ma! @os s+n( %en=!ona(e (+"'+r7r!"e +/+"+! de &encyc"!d%a
    s! (+"'+r7r!"e !nd+se de &encvc"!d%7
    Tulburrile u(ului de p%encKdidin
    ;LI.FL De&enden=a de &encyc"!d%a Eve/! &a$ 9HFJ
    ;LY.FL A'+/+" de &encycd%7 Eve/! &a$ 9HFJ
    Tulburrile induse de p%encKdidin
    9F9.GF In(o<!ca=!a c+ &encyd!d!n7 Eve/! &a$. 9GLJ. 0e speci)icat dac6 C+
    &er(+r'7r! de &erce&=!e
    9F9.G5 De"!r!+%+" &r!n !n(o<!ca=!e c+ &encyd!d!n7 Eve/! &a$ 5I;J
    9F9.55 T+"'+rarea &s!o(!c7 !nd+s7 de &encyd!d!n7, c+ !de! de"!ran(e
    Eve/! &a$ ;;GJ 0e speci)icat daca C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.5; T+"'+rarea &s!o(!c7 !nd+s7 de &encyd!d!n7, c+ a"+c!na=!! Eve/!
    &a$ ;;GJ 0e speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GI T+"'+rarea a.ec(!v7 !nd+s7 de &encyd!d!n7 Eve/! &a$ ILYJ
    0e speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.GF
    T+"'+rarea an<!oas7 !nd+s7 de &encyd!d!n7 Eve/! &a$ IHFJ
    0t speci)icat dac6 C+ de'+( :n c+rs+" !n(o<!ca=!e! 9F9.F T+"'+rare
    :n "e$7(+r7 c+ &encyd!d!n7 .7r7 a"(7 s&ec!.!ca=!e Eve/!
    &a$ 9G;J
    45H2I5 Dependena de
    #%encKclidin
    284
    Tulburrile !"ului de +(enc,clidin
    4+7.=+ Depen$en!a $e P@en#P#li$in(
    A se cons+"(a, de ase%enea, (e<(+" O! se(+" de cr!(er!! &en(r+ de&enden=a de o
    s+'s(an=7 Eve/! &a$. 5F9J. Une"e d!n(re cr!(er!!"e $enera"e a"e de&enden=e! de o
    s+'s(an=7 n+ se a&"!c7 "a &encyc"!d!n7. DeO! Sdor!n=a arden(7 de dro$T a .os(
    re"a(a(7 de !nd!v!/!! c+ +/ e<ces!v, n!c! (o"eran=a O! n!c! s!%&(o%e"e de a's(!nen=7 n+
    a+ .os( de%ons(ra(e c"ar "a oa%en! EdeO! a%'e"e a+ .os( o'serva(e ca a&7rAnd :n
    s(+d!!"e &e an!%a"eJ. De re$+"7, &encyc"!d!n7 n+ es(e d!.!c!" de o'=!n+(, !ar !nd!v!/!!
    c+ de&enden=7 de &encyc"!d!n7 o .+%ea/7 adesea de ce" &+=!n 94; or! &e /!, dec!
    &!erd des(+" de %+"( (!%& +/And de s+'s(an=7 O! e<&er!en(And+4! e.ec(e"e. U/+" de
    &encyc"!d!n7 &oa(e con(!n+a :n d!s&re=+" &re/en=e! &ro'"e%e"or de ord!n
    &s!o"o$!c Ede e<., de/!n!'!(!e, an<!e(a(e, .+r!e, a$res!+ne, &an!c7, ."as'ac)s4+r!J
    sa+ %ed!ca" Ede e<., !&er(er%!e, !&er(ens!+ne, cr!/e e&!"e&(!ceJ &e care !nd!v!d+"
    O(!e c7 s+n( &rovoca(e de s+'s(an=7. Ind!v!/!! c+ de&enden=7 de &encyc"!d!n7 &o(
    &re/en(a reac=!! co%&or(a%en(a"e &er!c+"oase da(ora(e "!&se! conO(!!n=e! %a"ad!e! s!
    @+dec7=!! :n (!%& ce s+n( !n(o<!ca=!. Co%&or(a%en(+" a$res!v !%&"!cAnd '7(a!a a .os(
    !den(!.!ca( ca +n e.ec( advers e<(re% de &ro'"e%a(!c a" &encyc"!d!ne!. Ca O! :n ca/+"
    a"+c!no$ene"or, reac=!!"e adverse "a &encyc"!d!n7 &o( .! %a! .recven(e &r!n(re
    !nd!v!/!! c+ (+"'+r7r! %en(a"e &ree<!s(en(e.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden=7 Eve/! &a$.
    5FY &en(r+ %a! %+"(e de(a"!!JQ
    !emisiune complet precoce
    !emisiune par3ial precoce
    !emisiune complet prelun.it
    !emisiune par3ial prelun.it
    #ntrBun mediu controlat
    4+<.5+ A-u)ul $e P@en#P#li$in(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$. 5FGJ. DeO! !nd!v!/!! care a'+/ea/7 de &encyc"!d!n7 .ac +/ de s+'s(an=7 %+"(
    %a! rar decA( ce! c+ de&enden=7, e! &o( eO+a :n %od re&e(a( :n :nde&"!n!rea
    o'"!$a=!!"or ro"+"+! %a@or "a Ocoa"7, "a serv!c!+ or! acas7, d!n ca+/a !n(o<!ca=!e! c+
    &encyc"!d!n7. Ind!v!/!! &o( +(!"!/a &encyc"!d!n7 :n s!(+a=!! :n care aces( "+cr+ es(e
    &er!c+"os .!/!c Ede e<., :n (!%& ce %an!&+"ea/7 +n +(!"a@ sa+ cond+c o %o(oc!c"e(7 or!
    +n a+(o%o'!"J. Po( a&are d!.!c+"(7=! "e$a"e da(or!(7 &osed7r!! de &encyc"!d!n7 sa+
    co%&or(a%en(e"or re/+"(And d!n !n(o<!ca=!e Ede e<., :nc7!er7r!J. Po( e<!s(a &ro'"e%e
    soc!a"e sa+ !n(er&ersona"e rec+ren(e d!n ca+/a co%&or(a%en(+"+! !nd!v!d+"+! :n
    (!%& ce es(e !n(o<!ca( sa+ da(or!(7 s(!"+"+! de v!a=7 ao(!c, &ro'"e%e"or "e$a"e
    %+"(!&"e or! cer(+r!"or c+ &ersoane !%&or(an(e.
    9GL
    Tulburrile "n le!tur cu o Substan

    Tulburrile induse de +(enc,clid%n
    C5C.>5 Into,i#a!ia #u P@en#P#li$in(
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7
    Eve/! &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ &encyc"!d!n7 :" cons(!(+!e
    &re/en=a +nor %od!.!c7r! co%&or(a%en(a"e de/ada&(!ve se%n!.!ca(!ve c"!n!c Ede
    e<., con."!c(+a"!(a(e, a$res!v!(a(e, !%&+"s!v!(a(e, !%&rev!/!'!"!(a(e, a$!(a=!e &s!o%o4
    (or!e, de(er!orarea @+dec7=!! sa+ de(er!orarea .+nc=!on7r!! soc!a"e sa+ &ro.es!ona"eJ
    care a&ar :n c+rs+" or! "a sc+r( (!%& d+&7 +/+" de &encyc"!d!n7 Eor! de o s+'s(an=7
    s!%!"ar7J Ecr!(er!!"e A O! BJ. Aces(e %od!.!c7r! s+n( aco%&an!a(e de do+7 sa+ %a!
    %+"(e d!n(re +r%7(oare"e se%ne care a&ar :n dec+rs de o or7 de "a +/+" de
    s+'s(an=7 Esa+ %a! &+=!n, cAnd es(e .+%a(7, S&r!/a(7T sa+ ad%!n!s(ra(7
    !n(ravenosJQ n!s(a$%+s ver(!ca" sa+ or!/on(a", !&er(ens!+ne sa+ (ra!card!e,
    anes(e/!e sa+ d!%!n+area reac(!v!(7=!! "a d+rere, a(a<!e, d!/ar(r!e, r!$!d!(a(e
    %+sc+"ar7, conv+"s!! sa+ co%7 O! !&erac+/!e Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e
    s7 .!e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e s! n+ s+n( e<&"!ca(e %a! '!ne de a"(7
    (+"'+rare %en(a"7 Ecr!(er!+" DJ.
    Se%ne"e s! s!%&(o%e"e s&ec!.!ce s+n( :n ra&or( c+ do/a. Do/e"e %a! %!c! de
    &encyc"!d!n7 &rod+c ver(!@, a(a<!e, n!s(a$%+s, !&er(ens!+ne +Ooar7, %!Oc7r!
    !nvo"+n(are anor%a"e, d!/ar(r!e, $rea=7, as(en!e, (!%&! de reac=!e :nce(!n!=!,
    e+.or!e sa+ a&"a(!/are a.ec(!v7, "ocvac!(a(e s! "!&s7 de !n(eres. De/or$an!/area
    $:nd!r!!, %od!.!carea !%a$!n!! cor&ora"e s! a &erce&=!e! sen/or!a"e,
    de&ersona"!/area O! sen(!%en(e"e de !rea"!(a(e s+rv!n "a do/e !n(er%ed!are.
    Do/e"e %a! %ar! &rod+c a%ne/!e s! co%7 c+ ana"$e/!e s+.!c!en(7 &en(r+ o
    !n(erven=!e c!r+r$!ca"7, !ar conv+"s!!"e c+ de&res!e res&!ra(or!e s+rv!n "a do/e"e
    ce"e %a! %ar!. E.ec(e"e :nce& a&roa&e !%ed!a( d+&7 ad%!n!s(rarea !n(ravenoas7
    sa+ .+%a( s! a(!n$ &!c+" :n dec+rs de cA(eva %!n+(e. D+&7 ad%!n!s(rarea ora"7
    &!c+" e.ec(e"or es(e a(!ns :n dec+rs de a&ro<!%a(!v do+7 ore. :n !n(o<!ca=!!"e %a!
    +Ooare, e.ec(e"e d!s&ar d+&7 G49L de ore, &e cAnd se%ne"e !n(o<!ca=!!"or severe
    &o( &ers!s(a %a! %+"(e /!"e. T+"'+rarea &s!o(!c7 !nd+s7 de &encyc"!d!n7 E&a$.
    ;;GJ &oa(e &ers!s(a (!%& de s7&(7%An!.
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( d!a$nos(!c+"+! de !n(o<!ca=!e c+
    &encyc"!d!n7Q
    C+ &er(+r'7r! de &erce&=!e. Aces( s&ec!.!can( &oa(e .! no(a( cAnd a&ar
    a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 or! !"+/!! a+d!(!ve, v!/+a"e sa+ (ac(!"e
    :n a'sen=a de"!r!%+"+!. Testarea realit6(ii intact6 :nsea%n7 c7 &ersoana O(!e c7
    a"+c!na=!!"e s+n( !nd+se de s+'s(an=7 O! n+ re&re/!n(7 rea"!(a(ea e<(ern7.
    CAnd a"+c!na=!!"e s+rv!n :n a'sen=a +ne! test6ri a realit6(ii intacte, (re'+!e "+a(
    :n cons!derare d!a$nos(!c+" de (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7, c+
    a"+c!na=!!.
    Alte Tulburri induse de
    #%encKclidin
    2=1

    Criteriile $e $ia/no&ti# pentru
    C5C.>5 Into,i#a!ia #u P@en#P#li$in(
    A2 .( recent de p%encKclidin &ori de o substan a$in)2
    S2 Modi$icri comportamentale de(adaptive semni$icative clinic &de ex2,
    beli!erant, a!resivitate, impulsivitate, imprevi(ibilitate, a!itaie psi%o-
    motorie, deteriorarea 0udecii sau a $uncionri sociale sau pro$esionale)
    care apar "n cursul sau la puin timp dup u(ul de p%encKclidin2
    2 "n decurs de o or &sau mai puin c@nd substana este $umat, =pri(at> sau
    administrat intravenos), dou &sau mai multe) dintre urmtoarele semneD
    (1) nista!mus vertical sau ori(ontal3
    (2) %ipertensiune sau ta%icardie3
    (3) aneste(ie sau diminuarea reactivitii la durere3
    (4) ataxie3
    (5) di(artrie3
    (6) ri!iditate muscular3
    (7) cri(e epileptice sau com3
    (8) %iperacu(ie2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale ,i nu sunt
    explicate mai bine de alt tulburare mental2
    De speci"icat dac'
    Cu pertur-(ri $e per#ep!ie
    Alte Tul-ur(ri in$u&e $e P@en#P#li$in(
    Ur%7(oare"e (+"'+r7r! !nd+se de &encyc"!d!n7 s+n( descr!se :n a"(e sec=!+n! a"e
    %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!aQ
    de"!r!+%+" !nd+s de !n(o<!ca=!a c+ &encyc"!d!n7 E&a$. 5I;J, (+"'+rarea &s!o(!c7
    !nd+s7 de &encyc"!d!n7 E&a$. ;;GJ, (+"'+rarea a.ec(!v7 !nd+s7 de &encyc"!d!n7
    E&a$. ILYJ, (+"'+rarea an<!oas7 !nd+s7 de &encyc"!d!n7 E&a$. IHFJ. Aces(e
    (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ &encyc"!d!n7 n+%a! cAnd
    s!%&(o%e"e s+n( :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de
    !n(o<!ca=!e c+ &encyc"!d!n7 O! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a
    @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    $nformaii sulimentare desre
    Tulburrile %n le&tur cu +(enc,clidin
    *lemente ,i tulburri asociate
    $lemente descriptive si tulburri mentale asociate. DeO! !nd!v!/!! c+ !n(o<!ca=!e
    c+ &encyc"!d!n7 &o( r7%Ane a"er=! O! or!en(a=!, e! &o( &re/en(a de"!r!+%, co%7,
    s!%&(o%e &s!o(!ce sa+ %+(!s% c+ a(!(+d!n! ca(a(on!ce. In(o<!ca=!!"e re&e(a(e &o( d+ce
    "a &ro'"e%e :n "e$7(+r7 c+ serv!c!+", c+ .a%!"!a sa+ "a &ro'"e%e soc!a"e or! "e$a"e. Po(
    2=2
    Tulburrile "n le!tur cu o Substan

    s+rven! v!o"en=a, a$!(a=!a s! co%&or(a%en(+" '!/ar Ede e<., va$a'onda@+" con.+/J.
    Ind!v!/!! c+ de&enden=7 sa+ a'+/ de &encyc"!d!n7 &o( re"a(a s&!(a"!/7r! re&e(a(e
    de(er%!na(e de !n(o<!ca=!e, cons+"(a=!! "a ca%ere"e de $ard7 s! ares(7r! &en(r+
    co%&or(a%en( con.+/ sa+ '!/ar, sa+ &en(r+ :nc7!er7r!. T+"'+rarea de cond+!(7 "a
    ado"escen=! s! (+"'+rarea de &ersona"!(a(e an(!soc!a"7 "a ad+"=! &o( .! asoc!a(e c+ +/+"
    de &encyc"!d!n7. De&enden=a de a"(e s+'s(an=e E:n s&ec!a" de coca!n7, a"coo" s!
    a%.e(a%!neJ es(e .recven(7 &r!n(re ce! care a+ de&enden=7 de &encyc"!d!n7.
    9ate de laborator asociate. Pencyc"!d!n7 Esa+ o s+'s(an=7 a.!n7J es(e &re/en(7
    :n +r!na !nd!v!/!"or care s+n( !n(o<!ca=! ac+( c+ +na d!n(re aces(e s+'s(an=e.
    S+'s(an=a &oa(e .! de(ec(a(7 :n +r!n7 (!%& de %a! %+"(e s7&(7%An! d+&7 :nce(area
    +n+! +/ &re"+n$!( sa+ c+ do/e .oar(e %ar!, d!n ca+/a so"+'!"!(7=!! sa"e %ar! :n "!&!de.
    Pencyc"!d!n7 &oa(e .! de(ec(a(7 %a! +Oor :n +r!na ac!d7. Crea(!n.os.o)!na/a ECP-J
    s! (ransa%!na/a $"+(a%!c4o<a"ace(!c7 ser!c7 ET,OSJ s+n( adesea cresc+(e,
    re."ec(And a.ec(area %+Oc!"or.
    9atele examenului somatic si condi3iile medicale .enerale asociate.
    In(o<!ca=!a c+ &encyc"!d!n7 &rod+ce o (o<!c!(a(e card!ovasc+"ar7 s! ne+ro"o$!c7
    %arca(7 Ede e<., cr!/e e&!"e&(!ce, d!s(on!!, d!s)!ne/!!, ca(a"e&s!e s! !&o(er%!e
    sa+ !&er(er%!eJ. Deoarece a&roa&e @+%7(a(e d!n(re !nd!v!/!! c+ !n(o<!ca=!e c+
    &encyc"!d!n7 &re/!n(7 n!s(a$%+s sa+ &res!+ne san$+!n7 cresc+(7, aces(e se%ne
    so%a(!ce &o( .! +(!"e :n de&!s(area +se+r!"or de &encyc"!d!n7 La ce! c+ de&enden=7
    sa+ a'+/ de &encyc"!d!n7 &oa(e e<!s(a &ro'a cor&ora"7 a "e/!+n!"or &rod+se &r!n
    acc!den(e, '7(7! s! c7der!. Ur%e"e ace"or E&+nc=!!"or venoaseJ, e&a(!(a, %a"ad!a c+
    v!r+s+" !%+node.!c!en(e! +%ane EHI3J O! endocard!(a 'ac(er!an7 &o( .! cons(a(a(e
    &r!n(re &+=!n!! !nd!v!/! care4s! ad%!n!s(rea/7 &encyc"!d!n7 !n(ravenos. A .os(
    descr!s7, de ase%enea, :necarea, c!ar c+ can(!(7=! %!c! de a&7. Pro'"e%e"e
    res&!ra(or!! a&ar oda(7 c+ a&neea, 'ronos&as%+", 'ronoreea, as&!ra=!a d!n (!%&+"
    co%e! s! !&ersa"!va=!e!. Ra'do%!o"!/a c+ de(er!orare rena"7 es(e :n(A"n!(7 :n
    a&ro<!%a(!v ,O d!n(re !nd!v!/!! care so"!c!(7 as!s(en=7 %ed!ca"7 de +r$en=7. S(o&+"
    card!ac es(e o even(+a"!(a(e rar7.
    *lemente speci$ice culturii, etii si sexului
    Preva"en(a &ro'"e%e"or :n "e$7(+r7 c+ &encyc"!d!n7 &are a .! %a! %are &r!n(re
    '7r'a=! Ea&ro<!%a(!v de do+7 or!J, &r!n(re ce! :n e(a(e de 9L &An7 "a IL an! O! &r!n(re
    %!nor!(7=!"e e(n!ce Ea&ro<!%a(!v de do+7 or!J. B7r'a=!! cons(!(+!e a&ro<!%a(!v (re!
    &7(r!%! d!n(re ce! cons+"(a=! "a ca%era de $ard7 :n "e$7(+r7 c+ &encyc"!d!n7.
    #revalent
    Med!c!! "e$!s(! re"a(ea/7 c7 "a scar7 na=!ona"7 &encyc"!d!n7 es(e !%&"!ca(7 :n
    a&ro<!%a(!v $O d!n(re decese"e asoc!a(e c+ +/+" de o s+'s(an=7. Pencyc"!d!n7 es(e
    %en=!ona(7 ca &ro'"e%7 :n a&ro<!%a(!v ;d d!n(re cons+"(a=!!"e de "a ca%era de
    $ard7 :n "e$7(+r7 c+ o s+'s(an=7. Con.or% +ne! ance(e na=!ona"e d!n 5FFR
    re.er!(oare "a +/+" de dro$ :n S(a(e"e Un!(e, %a! %+"( de ;d d!n(re ce! :n e(a(e de 59
    an! s! &es(e a+ rec+nosc+( c7 a+ .7c+( cAndva +/ de &encyc"!d!n7, !ar L,9d, c7 a+
    .7c+( +/ an+" (rec+(. Cea %a! :na"(7 &reva"en(7 &e v!a=7 a .os( cons(a(a(7 "a ce! :n
    e(a(e de 9R4;I an! EIdJ, &e cAnd ce" %a! %are &rocen( de +se+r! de &encyc"!d!n7
    an+" (rec+( EL,HdJ a .os( cons(a(a( "a ce! :n e(a(e de 5945H an!. Tre'+!e re=!n+( c7
    76726 Tulburare "n le!tur cu #%encKclidina 'r Alt
    Speci$icaie
    2=+
    deoarece aces(e ance(e a+ %7s+ra( &a((ern+r! de +/ s! n+ (+"'+r7r!, n+ se O(!e cA=!
    d!n(re +se+r!! de &encyc"!d!n7 !nc"+O! :n ance(7 a+ sa(!s.7c+( cr!(er!!"e &en(r+
    de&enden=7 sa+ a'+/. Preva"en(a de&enden=e! sa+ a'+/+"+! de &encyc"!d!n7 :n
    &o&+"a=!a $enera"7 es(e nec+nosc+(7.
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$. 9LH. T+"'+r7r!"e !nd+se de &encyc"!d!n7 &o( .!
    carac(er!/a(e &r!n s!%&(o%e Ede e<., d!s&o/!=!e de&res!v7J care a%!n(esc de
    (+"'+r7r!"e %en(a"e &r!%are Ede e<., (+"'+rarea de&res!v7 %a@or7 vers+s
    (+"'+rarea a.ec(!v7 !nd+s7 de &encyc"!d!n7, c+ e"e%en(e de&res!ve, c+ de'+( :n
    c+rs+" !n(o<!ca=!e!J. 3e/! &a$. 95L &en(r+ d!sc+(area aces(+! d!a$nos(!c d!.eren=!a".
    E&!soade"e rec+ren(e de s!%&(o%e &s!o(!ce sa+ a.ec(!ve da(ora(e !n(o<!ca=!e! c+
    &encyc"!d!n7 &o( %!%a sc!/o.ren!a sa+ (+"'+r7r!"e a.ec(!ve. Is(or!c+" s! &ro'e"e de
    "a'ora(or a"e +/+"+! de &encyc"!d!n7 s(a'!"esc ro"+" s+'s(an=e!, dar n+ e<c"+d
    a&ar!=!a conco%!(en(7 a a"(or (+"'+r7r! %en(a"e &r!%are. De'+(+" ra&!d a"
    s!%&(o%e"or, &re/en=a de"!r!+%+"+! sa+ o'servarea n!s(a$%+s+"+! sa+
    !&er(ens!+n!! s+$erea/7, de ase%enea, %a! c+rAnd !n(o<!ca=!a c+ &encyc"!d!n7
    decA( sc!/o.ren!a, dar +/+" de &encyc"!d!n7 &oa(e !nd+ce e&!soade &s!o(!ce
    ac+(e "a !nd!v!/!! c+ sc!/o.ren!e &ree<!s(en(7. Re/o"+=!a ra&!d7 a s!%&(o%e"or s!
    a'sen=a +n+! !s(or!c de sc!/o.ren!e &o( a@+(a "a aceas(7 d!.eren=!ere. 3!o"en=a :n
    "e$7(+r7 c+ dro$+" sa+ de(er!orarea @+dec7=!! &o( a&are conco%!(en( c+, sa+ &o(
    %!%a as&ec(e a"e (+"'+r7r!! de cond+!(7 or! a"e (+"'+r7r!! de &ersona"!(a(e
    an(!soc!a"7. A'sen=a &ro'"e%e"or co%&or(a%en(a"e :na!n(ea de'+(+"+! +/+"+! de
    s+'s(an=7 sa+ :n c+rs+" a's(!nen=e!, &oa(e a@+(a "a c"ar!.!carea aces(e! d!.eren=!er!.
    Pency"!d!na s! s+'s(an=e"e a.!ne &o( &rod+ce &er(+r'7r! de &erce&=!e Ede e<.,
    "+%!n! sc!n(!"an(e, &erce&erea de s+ne(e, !"+/!! sa+ !%a$!n! v!/+a"e or$an!/a(eJ &e
    care &ersoana "e rec+noaO(e de re$+"7 ca re/+"(And d!n +/+" de dro$. Dac7 (es(area
    rea"!(7=!! r7%Ane !n(ac(7, !ar &ersoana n+ crede c7 &erce&=!!"e s+n( rea"e O! n!c! n+
    ac=!onea/7 con.or% "or, es(e %en=!ona( s&ec!.!can(+" Sc+ &er(+r'7r! de &erce&=!eT
    &en(r+ !n(o<!ca=!a c+ &encyc"!d!n7. Dac7 (es(area rea"!(7=!! es(e de(er!ora(7, (re'+!e
    "+a( :n cons!dera=!e d!a$nos(!c+" de (+"'+rare &s!o(!c7 !nd+s7 de &encyc"!d!n7.
    D!.eren=!erea !n(o<!ca=!e! c+ &encyc"!d!n7 de !n(o<!ca=!!"e c+ a"(e s+'s(an=e Ec+
    care adesea coe<!s(7J de&!nde de !s(or!c+" "+7r!! s+'s(an=e!, de &re/en=a !(e%!"or
    carac(er!s(!c! Ede e<., n!s(a$%+s s! !&er(ens!+ne +Ooar7J O! de (es(e"e (o<!co"o$!ce
    &o/!(!ve :n +r!n7. Ind!v!/!! care +/ea/7 de &encyc"!d!n7, +/ea/7 "a .e" de '!ne s! de
    a"(e dro$+r!, O! de aceea a'+/+" O! de&enden=a co%or'!d7 de a"(e dro$+r! (re'+!e
    "+a(7 :n cons!dera=!e. In(o<!ca=!a c+ &encyc"!d!n7 se d!s(!n$e de a"(e (+"'+r7r!
    !nd+se de &encyc"!d!n7 Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de &encyc"!d!n7 c+
    de'+( :n c+rs+" !n(o<!ca=!e!J, &r!n aceea c7 :n aces(e d!n +r%7 (+"'+r7r!, s!%&(o%e"e
    s+n( :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ !n(o<!ca=!a c+ &encyc"!d!n7 O! s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    C5C.5 Tul-urare .n le/(tur( #u P@en#P#li$ina
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ &encyc"!d!n7 .7r7 a"(7 s&ec!.!ca=!e es(e
    re/erva(7 (+"'+r7r!"or asoc!a(e c+ +/+" de &encyc"!d!n7 care n+ s+n( c"as!.!ca'!"e
    2=F Tulburrile "n le!tur cu o Substan
    ca de&enden=7 de &encyc"!d!n7, a'+/ de &encyc"!d!n7, !n(o<!ca=!e c+
    &encyc"!d!n7, de"!r!+% &r!n !n(o<!ca=!e c+ &encyc"!d!n7, (+"'+rare &s!o(!c7
    !nd+s7 de &encyc"!d!n7, (+"'+rare a.ec(!v7 !nd+s7 de &encyc"!d!n7 sa+ (+"'+rare
    an<!oas7 !nd+s7 de &encyc"!d!n7.
    Tul-ur(rile .n le/(tur( #u Se$ativele2 Fipnoti#ele
    &au An,ioliti#ele
    S+'s(an=e"e seda(!ve, !&no(!ce s! an<!o"!(!ce Ean(!an<!oaseJ !nc"+d
    'en/od!a/e&!ne"e, %ed!ca%en(e"e s!%!"are 'en/od!a/e&!ne"or, c+% ar .!
    /o"&!de%+" s! /a"e&"on+", car'a%a=!! Ede e<., $"+(e(!%!da, %e&ro'a%a(+"J,
    'ar'!(+r!ce"e Ede e<., seco'ar'!(a"+"J s! !&no(!ce"e s!%!"are 'ar'!(+r!ce"or Ede e<.,
    $"+(e(!%!da, %e(a0+a"onaJ. Aceas(7 c"as7 de s+'s(an=e !nc"+de %ed!ca%en(e"e
    &rescr!se &en(r+ so%n s! a&roa&e (oa(e %ed!ca%en(e"e &rescr!se ca an<!o"!(!ce.
    A$en=!! an<!o"!(!c! nond!a/e&!n!c! Ede e<., '+s&!rona, $e&!ronaJ n+ s+n( !nc"+O! :n
    aceas(7 c"as7. Une"e %ed!ca%en(e d!n aceas(7 c"as7 a+ s! a"(e +(!"!/7r! c"!n!ce
    !%&or(an(e Ede e<., ca an(!conv+"s!van(eJ. Ca s! a"coo"+", aceO(! a$en=! s+n(
    de&r!%an(e cere'ra"e O! &o( &rod+ce (+"'+r7r! s!%!"are ce"or !nd+se de o s+'s(an=7
    sa+ da(ora(e +/+"+! de o s+'s(an=7, :n do/e %ar!, seda(!ve"e, !&no(!ce"e O!
    an<!o"!(!ce"e &o( .! "e(a"e, :n s&ec!a" cAnd s+n( co%'!na(e c+ a"coo"+". Seda(!ve"e,
    !&no(!ce"e O! an<!o"!(!ce"e s+n( acces!'!"e, a(A( &e 'a/7 de &rescr!&=!e %ed!ca"7, cA(
    O! d!n s+rse !"e$a"e. Oca/!ona", !nd!v!/!! care o'=!n aces(e s+'s(an=e &e 'a/7 de
    &rescr!&=!e %ed!ca"7 vor a'+/a de e"e8 d!n con(ra, +n!! d!n(re ce! care4s! &roc+r7
    s+'s(an=e"e d!n aceas(7 c"as7 Sde &e s(rad7T n+ de/vo"(7 de&enden=7 sa+ a'+/.
    Med!ca%en(e"e c+ de'+( ra&!d a" ac=!+n!! "or O!Xsa+ c+ d+ra(7 de ac=!+ne sc+r(7 or!
    !n(er%ed!ar7 &o( .! e<(re% de v+"nera'!"e :n a se a'+/a de e"e.
    Aceas(7 sec=!+ne con=!ne co%en(ar!! s&ec!.!ce re.er!(oare "a (+"'+r7r!"e :n
    "e$7(+r7 c+ seda(!ve"e, !&no(!ce"e sa+ an<!o"!(!ce"e. Te<(e"e s! se(+r!"e de cr!(er!!
    &en(r+ de.!n!rea as&ec(e"or $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J O!
    a'+/+"+! de o s+'s(an=7 E&a$. 5FGJ care se a&"!c7 (+(+ror s+'s(an=e"or a+ .os( de@a
    &re/en(a(e. Te<(e"e s&ec!.!ce de&enden=e! O! a'+/+"+! de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce s+n( &rev7/+(e %a! @os8 n+ e<!s(7 :ns7 cr!(er!! s&ec!.!ce e<c"+s!v &en(r+
    de&enden=a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce or! &en(r+ a'+/+" de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce. Te<(e s! se(+r! de cr!(er!! s&ec!.!ce &en(r+ !n(o<!ca=!a c+
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce O! &en(r+ a's(!nen=a de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce s+n(, de ase%enea, &rev7/+(e %a! @os. T+"'+r7r!"e !nd+se de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce Ea"(e"e decA( !n(o<!ca=!a O! a's(!nen=a de seda(!ve, !&no(!ce
    sa+ an<!o"!(!ceJ s+n( descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+
    care a+ :n co%+n .eno%eno"o$!a Ede e<., (+"'+rarea an<!oas7 !nd+s7 de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e An<!oaseTJ. Ma! @os,
    s+n( "!s(a(e (+"'+r7r!"e +/+"+! de seda(!ve, !&no(!ce sa+ an<!o"!(!ce s! (+"'+r7r!"e
    !nd+se de seda(!ve, !&no(!ce sa+ an<!o"!(!ce.
    Tulburrile u(ului de sedative, %ipnotice sau anxiolitice
    ;LI.5L De&enden=a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce Eve/! &a$. 9GYJ
    ;LI.5L A'+/+" de seda(!ve, !&no(!ce sa+ an<!o"!(!ce Eve/! &a$. 9GRJ
    45H2E5 Dependena de Sedative, Lipnotice sau Anxiolitice 78A
    Tulburrile induse de sedative, %ipnotice sau anxiolitice
    9F9.GF In(o<!ca=!a c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce Eve/! &a$. 9GRJ
    9F9.L A's(!nen=a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce Eve/! &a$. 9GHJ
    0e speci)icat dac6? C+ &er(+r'7r! de &erce&=!e 9F9.G5 De"!r!+%+"
    &r!n !n(o<!ca=!e c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. 5I;J
    292.81 De"!r!+%+" &r!n a's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. 5I;J
    292.82 De%en=a &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. 5RGJ
    292.83 T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce
    sa+ an<!o"!(!ce Eve/! &a$. 5HHJ
    292.10 T+"'+rarea &s!o(!c7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o
    "!(!ce, c+ !de! de"!ran(e Eve/! &a$. ;;GJ. 0e speci)icat dac6? C+ de'+(
    :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    292.11 T+"'+rarea &s!o(!c7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o
    "!(!ce, c+ a"+c!na=!! Eve/! &a$. ;;GJ. 0e speci)icat dac6? C+ de'+( :n
    c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GI T+"'+rarea a.ec(!v7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. ILYJ 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+
    de'+( :n c+rs+" a's(!nen=e!
    9F9.GF T+"'+rarea an<!oas7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. IHFJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GF D!s.+nc=!a se<+a"7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. YR9J 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!
    9F9.GF T+"'+rarea de so%n !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    Eve/! &a$. RYYJ. 0e speci)icat dac6? C+ de'+( :n c+rs+" !n(o<!ca=!e!XC+
    de'+( :n c+rs+" a's(!nen=e! 9F9.GF T+"'+rare :n "e$7(+r7 c+
    seda(!ve"e, !&no(!ce"e sa+ an<!o"!(!ce"e
    .7r7 a"(7 s&ec!.!ca=!e Eve/! &a$. 9F;J
    Tulburrile !"ului de Sedati-e, 'inotice
    sau #n.iolitice
    4+7.*+ Depen$en!a $e Se$ative2 Fipnoti#e
    &au An,ioliti#e
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ de&enden=a de o s+'s(an=7
    Eve/! &a$. 5F9J O! (+"'+r7r!"e :n "e$7(+r7 c+ a"coo"+" Eve/! &a$. 959J. La seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce se &o( de/vo"(a n!ve"e .oar(e se%n!.!ca(!ve de de&enden=7
    .!/!o"o$!c7 %arca(7, a(A( &r!n (o"eran=7, cA( O! &r!n a's(!nen=7. De'+(+" s! sever!(a(ea
    s!ndro%+"+! de a's(!nen=7 va d!.er! :n .+nc=!e de s+'s(an=a s&ec!.!c7 s!
    .ar%acoc!ne(!ca s! .ar%acod!na%!ca sa. De e<e%&"+, a's(!nen=a de s+'s(an=e"e c+
    ac=!+ne %a! sc+r(7, care s+n( ra&!d a'sor'!(e s! care n+ a+ %e(a'o"!=! ac(!v! Ede e<.,
    (r!a/o"a%+"J, &oa(e :nce&e :n dec+rs de cA(eva ore d+&7 ce s+'s(an=a a .os( s(o&a(78
    a's(!nen=a de s+'s(an=e"e c+ %e(a'o"!=! c+ d+ra(7 "+n$7 de ac=!+ne Ede e<.,
    d!a/e&a%+"J &oa(e s7 n+ :ncea&7 (!%& de 549 /!"e sa+ %a! %+"(. S!ndro%+" de
    9GR Tulburrile "n le!tur cu o Substan

    a's(!nen=7 &rod+s de s+'s(an=e"e d!n aceas(7 c"as7 &oa(e .! carac(er!/a( &r!n a&ar!=!a
    +n+! de"!r!+% care &oa(e .! a%en!n=7(or &en(r+ v!a=7. Poa(e e<!s(a &ro'a (o"eran=e! s!
    a's(!nen=e! :n a'sen=a +n+! d!a$nos(!c de de&enden=7 de s+'s(an=7 "a +n !nd!v!d care
    :n(rer+&e 'r+sc 'en/od!a/e&!ne"e care era+ "+a(e de %+"( (!%& :n do/e"e (era&e+(!ce
    &rescr!se. Un d!a$nos(!c de de&enden=7 de s+'s(an=7 (re'+!e s7 .!e "+a( :n
    cons!dera=!e n+%a! cAnd, &e "An$7 .a&(+" c7 are de&enden=7 .!/!o"o$!c7, !nd!v!d+"
    care +/ea/7 de s+'s(an=7 &re/!n(7 &ro'a +ne! ser!! de &ro'"e%e Ede e<., +n !nd!v!d
    care a de/vo"(a( +n co%&or(a%en( de c7+(are a dro$+"+! :n(r4o aOa %7s+r7, c7
    ac(!v!(7=! !%&or(an(e s+n( a'andona(e sa+ red+se s&re a o'=!ne s+'s(an=aJ.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! a&"!ca=! +n+! d!a$nos(!c de de&enden=7 de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce Eve/! &a$. 5FY &en(r+ %a! %+"(e de(a"!!JQ
    C+ de&enden=7 .!/!o"o$!c7
    F7r7 de&enden=7 .!/!o"o$!c7
    Re%!s!+ne co%&"e(7 &recoce
    Re%!s!+ne &ar=!a"7 &recoce
    Re%!s!+ne co%&"e(7 &re"+n$!(7
    Re%!s!+ne &ar=!a"7 &re"+n$!(7
    :n(r4+n %ed!+ con(ro"a(
    4+<.7+ A-u)ul $e Se$ative2 Fipnoti#e &au
    An,iol.t.#e
    A se cons+"(a, de ase%enea, (e<(+" s! cr!(er!!"e &en(r+ a'+/+" de o s+'s(an=7 Eve/!
    &a$. 5FGJ. A'+/+" de s+'s(an=e"e d!n aceas(7 c"as7 &oa(e s+rven! n+%a! "a e"e sa+
    :n co%'!na=!e c+ +/+" a"(or s+'s(an=e. De e<e%&"+, !nd!v!/!! &o( +(!"!/a do/e
    !n(o<!can(e de seda(!ve sa+ de 'en/od!a/e&!ne &en(r+ Sa4s! reven!T d!n e.ec(e"e
    coca!ne! sa+ a%.e(a%!ne!, or! +;ea;6 de do/e %ar! de 'en/od!a/e&!ne :n
    co%'!na=!e c+ %e(adon7 &en(r+ a4! S!n(ens!.!caT e.ec(e"e. A'+/+" de s+'s(an=e d!n
    aceas(7 c"as7 &oa(e d+ce "a +/ :n s!(+a=!! &er!c+"oase, c+% ar .! o'=!nerea s(7r!! de
    Se<a"(areT a(+nc! cAnd cond+ce. Ind!v!d+" &oa(e a'sen(a de "a serv!c!+ sa+ de "a
    Ocoa"7, or! :O! ne$"!@ea/7 o'"!$a=!!"e de .a%!"!e sa+ a@+n$e "a cer(+r! c+ so=!a or! c+
    &7r!n=!! :n "e$7(+r7 c+ e&!soade"e de +/ de s+'s(an=7. CAnd aces(e &ro'"e%e s+n(
    :nso=!(e de &ro'a (o"eran=e!, a's(!nen=e! sa+ co%&or(a%en(+"+! co%&+"s!v :n
    "e$7(+r7 c+ +/+" de seda(!ve, !&no(!ce sa+ an<!o"!(!ce, (re'+!e "+a( :n cons!dera=!e
    d!a$nos(!c+" de de&enden=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce.
    Tulburrile induse de Sedati-e, 'inotice
    sau #n.iolitice
    C5C.>5 Into,i#a!ia #u Se$ative2 Fipnoti#e
    &au An,ioliti#e
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e !n(o<!ca=!e! c+ o s+'s(an=7 Eve/!
    &a$. 5FFJ. E"e%en(+" esen=!a" a" !n(o<!ca=!e! c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce :"
    76725 Abstinena de Sedative, Lipnotice sau
    Anxiolitice
    2=8

    cons(!(+!e &re/en=a +nor %od!.!c7r! co%&or(a%en(a"e sa+ &s!o"o$!ce de/ada&(!ve
    se%n!.!ca(!ve c"!n!c Ede e<., co%&or(a%en( se<+a" !nadecva( sa+ a$res!v, "a'!"!(a(ea
    d!s&o/!=!e!, de(er!orarea @+dec7=!!, de(er!orarea .+nc=!on7r!! soc!a"e sa+ &ro.es!ona"eJ
    care a&ar :n c+rs+" or! "a sc+r( (!%& d+&7 +/+" +ne! s+'s(an=e seda(!ve, !&no(!ce sa+
    an<!o"!(!ce Ecr!(er!!"e A s! BJ. Ca s! :n ca/+" a"(or de&r!%an(e cere'ra"e, aces(e
    co%&or(a%en(e &o( .! aco%&an!a(e de d!/ar(r!e, %ers nes!$+r, n!s(a$%+s, &ro'"e%e
    de %e%or!e sa+ de a(en=!e, n!ve"e de !ncoordonare, care &o( !n(er.era c+ ca&ac!(a(ea
    de a cond+ce s! c+ e.ec(+area ac(!v!(7=!"or +/+a"e &An7 "a &+nc(+" de a ca+/a c7der!
    sa+ acc!den(e de a+(o%o'!", s! s(+&or sa+ co%7 Ecr!(er!+" CJ. De(er!orarea %e%or!e!
    es(e +n e"e%en( no(a'!" a" !n(o<!ca=!e! c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce s! es(e
    carac(er!/a(7 ce" %a! .recven( &r!n(r4o a%ne/!e an(ero$rad7 care a%!n(eO(e de
    S'"ac)o+(s4+r!"e a"coo"!ceT, care &oa(e .! .oar(e d!s(+r'an(7 &en(r+ !nd!v!d.
    S!%&(o%e"e n+ (re'+!e s7 se da(ore/e +ne! cond!=!! %ed!ca"e $enera"e O! n+ s+n(
    e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" DJ. In(o<!ca=!a &oa(e s+rven! "a
    !nd!v!/! care &r!%esc aces(e s+'s(an=e &e 'a/7 de &rescr!&=!e %ed!ca"7 sa+ care "e
    :%&r+%+(7 de "a a%!c! sa+ r+de, or! !a+ :n %od de"!'era( s+'s(an=a s&re a se !n(o<!ca.
    Criteriile $e $ia/no&ti# pentru
    C5C.>5 Into,i#a!ia #u Se$ative2 Fipnoti#e &au An,ioliti#e
    A2 .( recent de un sedativ, %ipnotic sau anxiolitic2
    S2 Modi$icri comportamentale sau psi%olo!ice de(adaptive, semni$icative
    clinic &de ex2, comportament sexual inadecvat sau a!resiv, labilitatea
    dispo(iiei, deteriorarea 0udecii, deteriorarea $uncionrii sociale sau
    pro$esionale) care apar "n cursul sau la scurt timp dup u(ul de sedative,
    %ipnotice sau anxiolitice2
    2 .nul &sau mai multe) dintre urmtoarele semne care apar "n cursul sau la
    scurt timp dup u(ul de sedative, %ipnotice sau anxioliticeD
    (1) di(artrie3
    (2) incoordonare3
    (3) mers nesi!ur3
    (4) nista!mus3
    (5) deteriorarea ateniei si memoriei3
    (6) stupor sau com2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de alt tulburare mental2
    C5C.+ A-&tinen!a $e Se$ative2 Fipnoti#e
    &au An,ioliti#e
    A se cons+"(a, de ase%enea, (e<(+" O! cr!(er!!"e &en(r+ a's(!nen=a de o s+'s(an=7 Eve/!
    &a$. 9L5J. E"e%en(+" esen=!a" a" a's(!nen=e! de seda(!ve, !&no(!ce sa+ an<!o"!(!ce :"
    cons(!(+!e &re/en=a +n+! s!ndro% carac(er!s(!c care a&are d+&7 o red+cere %arca(7 sa+
    :nce(are a ad%!n!s(r7r!!, d+&7 cA(eva s7&(7%An! sa+ %a! %+"( de +/ re$+"a( Ecr!(er!!"e A
    O! BJ. Aces( s!ndro% de a's(!nen=7 es(e carac(er!/a( &r!n do+7 sa+ %a! %+"(e s!%&(o%e
    2==
    Tulburrile "n le!tur cu o Substan
    Es!%!"are a's(!nen=e! a"coo"!ceJ care !nc"+d !&eracv!(a(ea ve$e(a(!v7 Ede e<, creO(erea
    r!(%+"+! card!ac, r!(%+"+! res&!ra(or, &res!+n!! san$+!ne sa+ (e%&era(+ra cor&+"+!,
    :%&re+n7 c+ (rans&!ra=!aJ, (re%or+" %A!n!"or, !nso%n!a, an<!e(a(ea s! $rea=a,
    aco%&an!a(7 +neor! de vo%7, s! a$!(a=!a &s!o%o(one O cr!/7 de $rand %a" &oa(e
    s+rven! &ro'a'!" "a n+ %a! &+=!n de 9Ld4;Ld d!n(re !nd!v!/!! care s+.er7 de a's(!nen=7
    ne(ra(a(7 de aces(e s+'s(an=e :n a's(!nen(a sever7, &o( s+rven! a"+c!na=!! sa+ !"+/!!
    v!/+a"e, (ac(!"e sa+ a+d!(!ve, dar s+n( +/+a"e :n con(e<(+" +n+! den+% Dac7 &ersoana
    are (es(area rea"!(7=!! !n(ac(7 Ead!c7, O(!e c7 s+'s(an=a es(e aceea care ca+/ea/7
    a"+c!na=!!"eJ, !ar !"+/!!"e a&ar &e .ond+" +ne! cons(an(e c"are, &oa(e .! %en=!ona(
    s&ec!ncan(+" Sc+ &er(+r'7r! de &erce&=!eT Eve/! %a! &sJ S!%&(o%e"e ca+/ea/7 o
    de(res7 sa+ de(enorare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e
    do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ S!%&(o%e"e n+ (re'+!e s7 se da(ore/e
    +ne! cond!=!! %ed!ca"e $enera"e s! n+ s+n( e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7
    Ede e<, a's(!nen(a de a"coo" sa+ an<!e(a(ea $enera"!/a(7J Ecr!(er!+" DJ A%e"!orarea
    s!%&(o%e"or de a's(!nen(7 &r!n ad%!n!s(rarea or!c7r+! a$en( seda(!v4!&noc va
    s+s=!ne d!a$nos(!c+" de a's(!nen(7 de seda(!ve, !&no(!ce sa+ an<!oce
    S!ndro%+" de a's(!nen(7 se carac(er!/ea/7 &r!n se%ne s! s!%&(o%e care s+n( :n
    $enera" o&+s+" e.ec(e"or ac+(e, care es(e &os!'!" s7 .!e o'serva(e "a +n+" care .ace &en(r+
    &r!%a da(7 +/ de aceO(! a$en=! D+ra(a evo"+=!e! s!ndro%+"+! de a's(!nen(7 es(e :n
    $enera" &rev!/!'!"7 d!n se%!v!a(a '+'s(an(e! Med!ca%en(e"e a c7ror ac=!+ne d+rea/7
    de re$+"7 a&roa&e /ece ore sa+ %a! &+=!n Ede e<, "ora/e&a%+", o<a/e&a%+" s!
    (e%a/e&a%+"J &rod+c s!%&(o%e de a's(!nen(7 :n dec+rs de R4G ore de "a sc7derea
    concen(ra=!!"or san$+!ne, s!%&(o%e care cresc :n !n(ens!(a(e a do+a /! s! se a%e"!orea/7
    cons!dera'!" :n a &a(ra sa+ a c%cea /! Pen(r+ s+'s(an=e"e c+ se%!v!a(7 "+n$7 Ede e<,
    d!a/e&a%+"J S!%&(o%e"e &o( s7 n+ a&ar7 decA( d+&7 %a! %+"( de o s7&(7%An7, cresc
    :n !n(ens!(a(e % c+rs+" ce"e! de a do+a s7&(7%An! s! d!%!n+a cons!dera'!" :n c+rs+"
    ce"e! de a (re!a sa+ a &a(ra s7&(7%An! Po( e<!s(a s!%&(o%e s+&"!%en(are &e (er%en
    "+n$ "a n!ve"e de !n(ens!(a(e %+"( %a! red+se care &ers!s(7 %a! %+"(e "+n! Ca s! :n
    ca/+" a"coo"+"+!, aces(e s!%&(o%e de a's(!nen(7 care d+rea/7 %+"( Ede e<, an<!e(a(ea,
    !n(a'!"!(a(ea s! (+"'+r7r!"e de so%nJ &o( .! "+a(e :n %od erona( dre&( r+"'+r7n an<!oase
    sa+ de&res!ve no%nd+se de o s+'s(an=7 Ede e< , an<!e(a(ea $enera"!/a(7J
    C+ cA( s+'s(an=a a .os( "+a(7 %a! %+"( (!%& s! c+ cA( a .os( %a! %are do/a@+"
    +(!"!/a(, c+ a(A( es(e %a! &ro'a'!" ca a's(!nen(a s7 .!e %a! sever7 C+ (oa(e aces(ea,
    a .os( descr!s7 a's(!nen(a "a %a! &+=!n de 5Y %$ de d!a/e&a% Esa+ ec!va"en(+" s7+
    :n a"(e 'en/od!a/e&!neJ cAnd es(e "+a( /!"n!c (!%& de %a! %+"(e "+n! Do/e de
    a&ro<!%a(!v IL %$ de d!a/e&a% Esa+ ec!va"en(+" s7+J, /!"n!c, es(e .oar(e &os!'!" s7
    &rod+c7 s!%&(o%e de a's(!nen(7 re"evan(e c"!n!c, !ar do/e %a! %ar! Ede e< , 5LL %$
    de d!a/e&a%J es(e .oar(e &os!'!" s7 .!e +r%a(e de cr!/e e&!"e&(!ce sa+ de"!n+% &r!n
    a's(!nen(7 De"!n+%+" &r!n a's(!nen(7 de seda(!ve, !&no(!ce sa+ an<!o(!ce Eve/!
    &a$ 5I;J es(e carac(er!/a( &r!n &er(+r'7r! de conO(!!n=7 s! co$n!(!ve, c+ a"+c!na=!!
    v!/+a"e, (ac(!"e sa+ a+d!(!ve CAnd es(e &re/en(, den+%+" &r!n a's(!nen(7 de
    seda(!ve, !&no(!ce sa+ an<!o(!ce (re'+!e s7 .!e d!a$nos(!ca( :n "oc+" a's(!nen(e!
    Speci$icant
    Ur%7(or+" s&ec!.!can( &oa(e .! a&"!ca( +n+! d!a$nos(!c de a's(!nen(7 de seda(!ve,
    !&no(!ce sa+ an<!o(!ce
    C+ &er(+r'7r! de &erce&=!e S&ec!.!can(+" &oa(e .! no(a( cAnd :n a'sen(a
    de"!n+%+"+!, s+rv!n a"+c!na=!! c+ (es(area rea"!(7=!! !n(ac(7 sa+ !"+/!!
    Alte Tulburri induse de Sedative, Lipnotice sau
    Anxiolitice
    2=4

    a+d!(!ve, v!/+a"e sa+ (ac(!"e. Testarea realit6(ii intact6 :nsea%n7 c7 &ersoana
    O(!e c7 a"+c!na=!!"e s+n( !nd+se de s+'s(an=7 s! n+ re&re/!n(7 rea"!(a(ea
    e<(ern7. CAnd a"+c!na=!!"e a&ar :n a'sen=a +ne! (es(7r! a rea"!(7=!! !n(ac(e, +n
    d!a$nos(!c de (+"'+rare &s!o(!c7 !nd+s7 de s+'s(an=7, c+ a"+c!na=!!, (re'+!e
    s7 .!e "+a( :n cons!dera=!e.
    Criteriile $e $ia/no&ti# pentru
    C5C.>5 A-&tinen!a $e Se$ative2 Fipnoti#e &au An,ioliti#e
    A2 "ncetarea &sau reducerea) u(ului de sedative, %ipnotice sau anxiolitice, care
    a $ost excesiv ,i prelun!it2
    S2 Dou &sau mai multe) dintre urmtoarele simptome care apar "n decurs de
    c@teva ore p@n la c@teva (ile dup criteriul AD
    (1)%iperactivitate ve!etativ &de ex2, transpiraie sau $recvena pulsului mai
    mare delOO)3
    (2)tremor intens al m@inilor3
    (3)insomnie3
    (4)!rea sau vom3
    (5)%alucinaii sau ilu(ii vi(uale, tactile sau auditive tran(itorii3
    (6)a!itaie psi%omotorie3
    (7)anxietate3
    (8)cri(e de !rand mal2
    2 Simptomele de la criteriul S cau(ea( o detres sau deteriorare semni$icativ
    clinic "n domeniul social, pro$esional sau "n alte domenii importante de
    $uncionare2
    D2 Simptomele nu se datorea( unei condiii medicale !enerale si nu sunt
    explicate mai bine de o alt tulburare mental2
    De speci"icat dac'
    Cu pertur-(ri $e per#ep!ie
    Alte Tul-ur(ri in$u&e $e Se$ative2 Fipnoti#e
    &au An,ioliti#e
    Ur%7(oare"e (+"'+r7r! !nd+se de seda(!ve, !&no(!ce sa+ an<!o"!(!ce s+n( descr!se
    :n a"(e sec=!+n! a"e %an+a"+"+! :%&re+n7 c+ (+"'+r7r!"e c+ care a+ co%+n7
    .eno%eno"o$!aQ de"!r!+%+" &r!n !n(o<!ca=!e c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    E&a$. 5I;J, de"!r!+%+" &r!n a's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$.
    5I;J, de%en=a &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$. 5RGJ,
    (+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    E&a$. 5HHJ, (+"'+rarea &s!o(!c7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$.
    ;;GJ, (+"'+rarea a.ec(!v7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$.ILYJ,
    (+"'+rarea an<!oas7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$. IHFJ,
    d!s.+nc=!a se<+a"7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$. YR9J, s!
    (+"'+rarea de so%n !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce E&a$. RYYJ.
    765 Tulburrile "n le!tur cu o Substan
    Aces(e (+"'+r7r! s+n( d!a$nos(!ca(e :n "oc+" !n(o<!ca=!e! c+ seda(!ve, !&no(!ce sa+
    an<!o(!ce or! a" a's(!nen=e! de seda(!ve, !&no(!ce sa+ an<!o(!ce, n+%a! cAnd
    s!%&(o%e"e s+n( :n e<ces .a=7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e
    sa+ de a's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o(!ce s! cAnd s!%&(o%e"e s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7
    $nformaii sulimentare referitoare
    la Tulburrile %n le&tur cu Sedati-ele,
    'inoticele sau #n.ioliticele
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. De&enden=a s! a'+/+" de
    seda(!ve, !&no(!ce sa+ an<!o(!ce &o( .! asoc!a(e adesea c+ de&enden=a sa+ a'+/+"
    de a"(e s+'s(an=e Ede e<, de a"coo", canna'!s, coca!n7, ero!n7, %e(adon7,
    a%.e(a%!neJ Seda(!ve"e s+n( +(!"!/a(e adesea &en(r+ a +O+ra e.ec(e"e nedon(e a"e
    aces(or a"(e s+'s(an=e In(o<!ca=!a ac+(7 &oa(e avea dre&( consec!n=7 v7(7%area
    acc!den(a"7 &r!n c7der! s! acc!den(e de a+(o%o'!" La !nd!v!/!! %a! :n e(a(e, c!ar
    +/+" &e (er%en sc+r( a" aces(or %ed!ca%en(e seda(!ve :n do/e"e &rescr!se &oa(e .!
    asoc!a( c+ o creO(ere a r!sc+"+! de &ro'"e%e co$n!(!ve s! de c7der! Une"e da(e !nd!c7
    .a&(+" c7 e.ec(e"e de/%!'an(e a"e aces(or a$en=! &o( con(r!'+! de .a&(, ca s! a"coo"+",
    "a co%&or(a%en(e e<ces!v de a$res!ve, c+ &ro'"e%e"e %(er&ersona"e s! "e$a"e
    consec+(!ve In(o<!ca=!a !n(ens7 sa+ re&e(a(7 c+ seda(!ve, !&no(!ce sa+ an<!o(!ce
    &oa(e .! asoc!a(7 c+ de&res!! severe care, deO! (e%&orare, &o( .! s+.!c!en( de !n(ense
    &en(r+ a d+ce "a (en(a(!ve de s+!c!d sa+ "a s+!c!d co%&"e( Po( s+rven! s+&rado/7n
    acc!den(a"e sa+ de"!'era(e, s!%!"are ce"or o'serva(e :n a'+/+" sa+ de&enden(a de
    a"coo" or! :n !n(o<!ca=!a a"coo"!c7 re&e(a(7 :n con(ras( c+ "ar$a "or %ar$!ne de
    s!$+ran=7 cAnd s+n( +(!"!/a(e s!n$+re, 'en/od!a/e&!ne"e "+a(e :%&re+n7 c+ a"coo"
    &ar a .! e<(re% de &er!c+"oase, !ar s+&rado/7n acc!den(a"e a+ .os( descr!se
    S+&rado/7n acc!den(a"e a+ .os( descr!se, 4de ase%enea, "a !nd!v!/!! care a'+/ea/7
    de"!'era( de 'ar'!(+nce s! de a"(e seda(!ve nond!a/e&!n!ce Ede e<, de
    %e(a0+a"onaJ Pr!n +/ re&e(a( :n c7+(area e+.or!e!, a&are (o"eran=a "a e.ec(e"e
    seda(!ve, s! &ro$res!v, s+n( +(!"!/a(e do/e (o( %a! %An :ns7, (o"eran=a "a e.ec(e"e
    de&resoare as+&ra (r+nc!+"+! cere'ra" se de/vo"(7 %+"( %a! "en(, !ar &ersoana !a
    (o( %a! %+"(7 s+'s(an=7 &en(r+ a deven! e+.or!c7, s! &oa(e s+rven! s+'!( o de&res!e
    res&!ra(or!e s! o !&o(ens!+ne care &o( d+ce "a %oar(e Co%&or(a%en(+" an(!soc!a"
    s! (+"'+rarea de &ersona"!(a(e an(!soc!a"7 se asoc!a/7 c+ de&enden(a s! a'+/+" de
    seda(!ve, !&no(!ce sa+ an<!o(!ce, :n s&ec!a" cAnd s+'s(an=e"e s+n( o'=!n+(e !"e$a"
    Da(e de "a'ora(or asoc!a(e. A&roa&e (oa(e aces(e s+'s(an=e &o( .! !den(!.!ca(e
    &r!n e<a%ene"e de "a'ora(or a"e +r%!! sa+ sAn$e"+! E+"(!%e"e &+(And c+an(!.!ca
    concen(ra=!!"e aces(or a$en=! :n or$an!s%J Es(e &os!'!" ca (es(e"e +r!nare s7 r7%An7
    &o/!(!ve (!%& de &An7 "a o s7&(7%An7 sa+ %a! %+"( d+&7 +/+" +nor s+'s(an=e c+
    d+ra(7 "+n$7 de ac=!+ne Ede e<, ."+ra/e&a%+"J
    Da(e"e e<a%en+"+! so%a(!c s! cond!=!!"e %ed!ca"e asoc!a(e. Es(e &os!'!" ca
    e<a%en+" so%a(!c s7 reve"e/e e<!s(en(a +ne! red+cen +Ooare :n ce"e %a! %+"(e
    as&ec(e a"e .+nc=!on7r!! s!s(e%+"+! nervos ve$e(a(!v, !nc"+/And +n &+"s %a! "en(, o
    Tulburrile "n le!tur cu Sedativele, Lipnoticele sau
    Anxioliticele
    241

    d!%!n+are +Ooar7 a .recven=e! res&!ra(or!! s! o sc7dere +Ooar7 a &res!+n!! san$+!ne
    Ecare a&are ce" %a! &ro'a'!" "a sc!%'7r!"e &os(+ra"eJ. Do/e"e e<ces!ve de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce &o( .! asoc!a(e c+ o de(er!orare a se%ne"or v!(a"e care &o(
    se%na"a o +r$en=7 %ed!ca"7 !%!nen(7 Ede e<., s(o& res&!ra(or &r!n 'ar'!(+r!ceJ. Ma!
    &o( e<!s(a consec!n=e a"e (ra+%a(!s%e"or Ede e<., e%ora$!e !n(ern7 sa+ e%a(o%
    s+'d+ra"J d!n ca+/a acc!den(e"or care s+rv!n :n (!%& ce !nd!v!d+" es(e !n(o<!ca(.
    U/+" !n(ravenos a" aces(or s+'s(an=e &oa(e d+ce "a co%&"!ca=!! %ed!ca"e :n "e$7(+r7
    c+ +(!"!/area de ace con(a%!na(e Ede e<
    v
    e&a(!(a s! !n.ec=!a c+ v!r+s+"
    !%+node.!c!en=e! +%ane ZHI3[J.
    *lemente speci$ice culturii, etii si sexului
    E<!s(7 d!.eren=e cons!dera'!"e :n &a((ern+r!"e de &rescr!ere Es! d!s&on!'!"!(a(eJ a"e
    aces(e! c"ase de s+'s(an=e :n d!.er!(e =7r!, care &o( d+ce "a d!.eren=e :n &reva"en(a
    (+"'+r7r!"or :n "e$7(+r7 c+ seda(!ve"e, !&no(!ce"e sa+ an<!o"!(!ce"e. In(o<!ca=!a
    de"!'era(7 :n sco&+" o'=!ner!! Se<a"(7r!!T es(e &os!'!" s7 .!e o'serva(7 "a ado"escen=!
    s! "a !nd!v!/!! :n e(a(e de 9L4;L an!. A's(!nen=a, de&enden=a s! a'+/+" s+n(, de
    ase%enea, o'serva(e "a !nd!v!/!! :n e(a(e de IL4YL an! s! c!ar %a! %+"(, care %7resc
    do/a %ed!ca%en(e"or &rescr!se. A(A( e.ec(e"e (o<!ce ac+(e, cA( s! ce"e cron!ce a"e
    aces(or s+'s(an=e, :n s&ec!a" e.ec(e"e as+&ra c+noaO(er!!, %e%or!e! s! coordon7r!!
    %o(or!!, es(e &os!'!" s7 creasc7 c+ e(a(ea ca +r%are a %od!.!c7r!"or .ar%acod!na%!ce
    s! .ar%aco)!ne(!ce :n ra&or( c+ e(a(ea. La !nd!v!/!! c+ de%en=7 es(e .oar(e &ro'a'!"
    ca !n(o<!ca=!a s! de(er!orarea .+nc=!on7r!! .!/!o"o$!ce s7 a&ar7 "a do/e %a! %!c!.
    Fe%e!"e &o( .! %a! e<&+se r!sc+"+! de a'+/ de dro$ re&re/en(a( de s+'s(an=e"e d!n
    aceas(7 c"as7, &e 'a/7 de &rescr!&=!e %ed!ca"7.
    #revalent
    :n S(a(e"e Un!(e, &An7 "a FLd d!n(re !nd!v!/!! s&!(a"!/a=! &en(r+ (ra(a%en(
    %ed!ca" sa+ !n(erven=!e c!r+r$!ca"7 &r!%esc &rescr!&=!! &en(r+ %ed!ca%en(e
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce :n (!%&+" !n(ern7r!! "or s! %a! %+"( de 5Yd d!n(re
    a%er!can!! ad+"=! .ac +/ de aces(e %ed!ca%en(e Ede re$+"7 &e 'a/7 de &rescr!&=!eJ
    :n c+rs+" .!ec7r+! an. Ce! %a! %+"=! d!n(re aceO(! !nd!v!/! !a+ %ed!ca%en(e"e aOa
    c+% "! se reco%and7, .7r7 se%ne de a'+/. D!n(re %ed!ca%en(e"e d!n aceas(7 c"as7,
    'en/od!a/e&!ne"e s+n( ce"e %a! %+"( +(!"!/a(e, a&ro<!%a(!v 5Ld d!n(re ad+"=! "+And
    'en/od!a/e&!ne (!%& de ce" &+=!n o "+n7 :n c+rs+" an+"+! (rec+(. A(A( :n S(a(e"e
    Un!(e cA( s! :n a"(e =7r!, aces(e %ed!ca%en(e s+n( &rescr!se de re$+"7 de ce! care o.er7
    as!s(en=7 %ed!ca"7 &r!%ar7, +/+" aces(or %ed!ca%en(e &rescr!se es(e %a! %are "a
    .e%e! s! cres(e c+ avansarea :n e(a(e.
    O ance(7 na=!ona"7 e.ec(+a(7 :n 5FFR re.er!(oare "a +/+" de dro$+r! !nd!ca .a&(+" c7
    :n@+r de Rd d!n(re !nd!v!/! a+ rec+nosc+( c7 a+ +(!"!/a( .!e seda(!ve, .!e S(ranc!"!/an(eT
    !"!c!(e, !nc"+O! .!!nd L,;d care a+ re"a(a( +/ de seda(!ve !"!c!(e an+" (rec+( s! L,5d care a+
    re"a(a( +/ de seda(!ve, "+na (rec+(7. ,r+&+" de e(a(e c+ cea %a! %are &reva"en(7 &e
    v!a=7 a seda(!ve"or EL;dJ sa+ S(ranc!"!/an(e"orT (DO% a .os( ce" :n(re 9R4;I an!, &e c:nd
    ce! :n e(a(e de 5G49Y an! &redo%!n7 &r!n(re ce! care a+ .7c+( +/ an+" (rec+(.
    Deoarece ce"e %a! %+"(e ance(e a+ eva"+a( %a! c+rAnd &a(ern+r! de +/ decA(
    (+"'+r7r!, n+ se O(!e cA( de %+"=! d!n(re ce! care a+ .7c+( +/ de s+'s(an=e d!n aceas(7
    c"as7 a+ av+( s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ de&enden=7 sa+ a'+/. O ance(7
    na=!ona"7 e.ec(+a(7 :n 5FF9 :n SUA a ra&or(a( o &reva"en(7 &e v!a=7 &en(r+ a'+/ O!
    de&enden(7 de %a! &+=!n de " d, !nc"+s!v o &reva"en(7 de %a! &+=!n de L,5d &e 59 "+n!.
    242
    Tulburrile "n le!tur cu o Substan

    *voluie
    Ce" %a! +/+a" c+rs !%&"!c7 oa%en!! (!ner! :n cea de a do+a sa+ cea de a (re!a
    decad7 a v!e=!! "or, care4s! &o( cres(e +/+" oca/!ona" de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce &An7 "a &+nc(+" "a care e! de/vo"(7 &ro'"e%e care4! &o( dese%na &en(r+
    +n d!a$nos(!c de de&enden=7 sa+ a'+/. Aces( &a((ern &oa(e .! e<(re% de &ro'a'!"
    &r!n(re !nd!v!/!! care a+ (+"'+r7r! a"e +/+"+! a"(or s+'s(an=e Ede e<., :n "e$7(+r7 c+
    a"coo"+", o&!acee"e, coca!na, a%.e(a%!naJ. Un &a((ern !n!=!a" de +/ !n(er%!(en( "a
    &ar(y+r! &oa(e d+ce "a +/ /!"n!c s! "a n!ve"e r!d!ca(e de (o"eran=7. Oda(7 ce aceas(a
    s+rv!ne, es(e de aO(e&(a( s7 a&ar7 o creO(ere a n!ve"+"+! de d!.!c+"(7=! !n(er&ersona"e,
    de d!.!c+"(7=! "a serv!c!+ s! "e$a"e, &rec+% s! a +nor e&!soade d!n ce :n ce %a! severe
    de de(er!orare a %e%or!e! s! de a's(!nen=7 .!/!o"o$!c7.
    A" do!"ea c+rs c"!n!c, %a! &+=!n .recven( o'serva(, :nce&e c+ +n !nd!v!d care o'=!ne
    !n!=!a" %ed!ca%en(+" &e 'a/a &rescr!&=!e! +n+! %ed!c, de re$+"7 &en(r+ (ra(a%en(+"
    an<!e(7=!!, !nso%n!e! sa+ ac+/e"or so%a(!ce. DeO! %area %a@or!(a(e a ce"or care a+
    &rescr!s +n %ed!ca%en( d!n aceas(7 c"as7 n+ &re/!n(7 &ro'"e%e, +n %!c n+%7r o .ace.
    La aceO(! !nd!v!/!, &e %7s+r7 ce a&are (o"eran=a sa+ neces!(a(ea de do/e (o( %a! %ar!
    de %ed!ca%en(, e<!s(7 o creO(ere $rad+a"7 a do/e! O! .recven=e! de a+(oad%!n!s(rare.
    Es(e &os!'!" ca &ersoana s7 con(!n+!e s7 @+s(!.!ce +/+" &e 'a/a s!%&(o%e"or !n!=!a"e de
    an<!e(a(e sa+ de !nso%n!e, dar co%&or(a%en(+" de c7+(are a s+'s(an=e! &oa(e deven!
    (o( %a! ev!den(, !ar &ersoana &oa(e v!/!(a n+%eroO! %ed!c! s&re a o'=!ne can(!(7=!
    s+.!c!en(e de %ed!ca%en(. To"eran=a &oa(e a(!n$e n!ve"e r!d!ca(e, s! &oa(e s+rven!
    a's(!nen=a E!nc"+/And cr!/e"e e&!"e&(!ce O! de"!r!+%+" &r!n a's(!nen=7J. A"=! !nd!v!/! c+
    r!sc %a<!% !nc"+d &e ce! c+ de&enden=7 de a"coo" care &o( &r!%! &rescr!&=!! re&e(a(e
    ca r7s&+ns "a ac+/e"e "or de an<!e(a(e s! !nso%n!e :n "e$7(+r7 c+ a"coo"+".
    Dia!nostic di$erenial
    Pen(r+ o d!sc+=!e $enera"7 a d!a$nos(!c+"+! d!.eren=!a" a" (+"'+r7r!"or :n "e$7(+r7
    c+ o s+'s(an=7, ve/! &a$. 9LH. T+"'+r7r!"e !nd+se de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce &o( &re/en(a s!%&(o%e Ede e<., an<!e(a(eJ care a%!n(esc de (+"'+r7r!"e
    %en(a"e &r!%are Ede e<., an<!e(a(ea $enera"!/a(7 vers+s (+"'+rarea an<!oas7
    !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce, c+ de'+( :n c+rs+" a's(!nen=e!J. 3e/!
    &a$. 95L &en(r+ d!sc+(area aces(+! d!a$nos(!c d!.eren=!a".
    In(o<!ca=!a c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce sea%7n7 .oar(e %+"( c+
    !n(o<!ca=!a a"coo"!c7, e<ce&(And a"ena a"coo"!c7. La &ersoane"e %a! :n e(a(e,
    (a'"o+" c"!n!c a" !n(o<!ca=!e! &oa(e se%7na c+ o de%en=7 &ro$res!v7, :n a.ar7 de
    aceas(a, d!/ar(r!a, !ncoordonarea O! a"(e e"e%en(e carac(er!s(!ce asoc!a(e a"e
    !n(o<!ca=!e! c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce &o( .! re/+"(a(+" +ne! cond!=!!
    %ed!ca"e $enera"e Ede e<., sc"ero/a %+"(!&"7J sa+ a +n+! (ra+%a(!s% cran!an
    an(er!or Ede e<., +n e%a(o% s+'d+ra"J.
    A's(!nen=a a"coo"!c7 &rod+ce +n s!ndro% .oar(e ase%7n7(or ce"+! de a's(!nen=7
    de seda(!ve, !&no(!ce sa+ an<!o"!(!ce. An<!e(a(ea, !nso%n!a O! !&erac(!v!(a(ea
    s!s(e%+"+! nervos ve$e(a(!v care s+n( o consec!n=7 a !n(o<!ca=!e! c+ a"(e dro$+r! Ede
    e<., s(!%+"an(e ca a%.e(a%!na sa+ coca!naJ O! care s+n( consec!n=e a"e +nor cond!=!!
    .!/!o"o$!ce Ede e<., !&er(!ro!d!s%+"J, sa+ care s+n( :n ra&or( c+ (+"'+r7r!"e an<!oase
    &r!%are Ede e<., &an!ca sa+ an<!e(a(ea $enera"!/a(7J &o( se%7na c+ +ne"e as&ec(e
    a"e a's(!nen=e! de seda(!ve, !&no(!ce sa+ an<!o"!(!ce.
    In(o<!ca=!a O! a's(!nen=a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce se d!s(!n$ de a"(e
    (+"'+r7r! !nd+se de seda(!ve, !&no(!ce sa+ an<!o"!(!ce Ede e<., (+"'+rarea an<!oas7
    76726 Tulburarea "n le!tur cu Sedativele,
    Lipnoticele sau Anxioliticele 'r Alt Speci$icaie 24+

    !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce, c+ de'+( :n c+rs+" a's(!nen=e!J,
    deoarece s!%&(o%e"e :n aces(ea d!n +r%7 s+n( :n e<ces .a(7 de ce"e asoc!a(e de
    re$+"7 c+ !n(o<!ca=!a sa+ a's(!nen=a de seda(!ve, !&no(!ce sa+ an<!o"!(!ce s! s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    Tre'+!e s&+s c7 e<!s(7 !nd!v!/! care con(!n+7 s7 !a +n %ed!ca%en( 'en/o4
    d!a/e&!n!c con.or% reco%and7r!! %ed!c+"+! &en(r+ o !nd!ca=!e %ed!ca"7 "e$!(!%7,
    "+n$! &er!oade de (!%&. C!ar dac7 s+n( de&enden=! .!/!o"o$!c de %ed!ca%en(,
    %+"=! d!n(re aceO(! !nd!v!/! n+ de/vo"(7 s!%&(o%e care s7 sa(!s.ac7 cr!(er!!"e &en(r+
    de&enden=7, deoarece e! n+ s+n( &reoc+&a=! de o'=!nerea s+'s(an=e!, !ar +/+" s7+ n+
    !n(er.erea/7 c+ :nde&"!n!rea ro"+r!"or "or soc!a"e sa+ &ro.es!ona"e +/+a"e.
    C5C.5 Tul-urarea .n le/(tur( #u Se$ativele2
    Fipnoti#ele &au An,ioliti#ele '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare :n "e$7(+r7 c+ seda(!ve"e, !&no(!ce"e sa+ an<!o"!(!ce"e
    .7r7 a"(7 s&ec!.!ca=!e es(e des(!na(7 (+"'+r7r!"or asoc!a(e c+ +/+" de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce care n+ s+n( c"as!.!ca'!"e ca de&enden=7 de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce8 a'+/ de seda(!ve, !&no(!ce sa+ an<!o"!(!ce8 !n(o<!ca=!e c+
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce8 a's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce8
    de"!r!+% &r!n !n(o<!ca=!e c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce8 de"!r!+.n &r!n
    a's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce8 de%en=7 &ers!s(en(7 !nd+s7 de
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce8 (+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce8 (+"'+rare &s!o(!c7 !nd+s7 de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce8 (+"'+rare a.ec(!v7 !nd+s7 de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce8 (+"'+rare an<!oas7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce8
    d!s.+nc=!e se<+a"7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce or! (+"'+rare de
    so%n !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce.
    Tul-ur(rile .n le/(tur( #u Poli&u-&tan!a
    4+7.>+ Depen$en!a $e Poli&u-&tan!a
    Aces( d!a$nos(!c es(e re/erva( &en(r+ co%&or(a%en(+" d!n c+rs+" +ne! &er!oade
    de 59 "+n!, :n care &ersoana a .7c+( +/ :n %od re&e(a( de ce" &+=!n (re! $r+&e de
    s+'s(an=e Ene!nc"+/And ca.e!na s! n!co(!n7J, dar n+ a &redo%!na( +/+" +ne! s!n$+re
    s+'s(an=e, :n a.ar7 de aceas(a, :n c+rs+" aces(e! &er!oade, cr!(er!!"e &en(r+
    de&enden=7 a+ .os( sa(!s.7c+(e &en(r+ s+'s(an=e ca $r+& O! n+ &en(r+ vreo an+%!(7
    s+'s(an=7. De e<e%&"+, +n d!a$nos(!c de de&enden=7 de &o"!s+'s(an=7 va .! a&"!ca(
    +n+! !nd!v!d care :n c+rs+" ace"e!aO! &er!oade de 59 "+n! a a'sen(a( de "a serv!c!+ d!n
    ca+/a +/+"+! e<ces!v de a"coo", a +/+"+! con(!n++ de coca!n7 :n d!s&re=+"
    e<&er!en(7r!! +nor de&res!! severe d+&7 no&=! de +/ e<ces!v s! a .os( :n %od re&e(a(
    !nca&a'!" s7 se :r(cadre/e :n "!%!(e"e a+(o!%&+se re.er!(oare "a +/+" s7+ de code!n7.
    :n aces( ca/, deO! &ro'"e%e"e asoc!a(e c+ +/+" .!ec7re! s+'s(an=e n+ s+n( s+.!c!en( de
    &ervas!ve &en(r+ a @+s(!.!ca d!a$nos(!c+" de de&enden=7, +/+" s7+ $enera" de
    s+'s(an=e :! de(er!orea/7 se%n!.!ca(!v .+nc=!onarea O! ca a(are @+s(!.!c7 d!a$nos(!c+"
    de de&enden=7 de s+'s(an=e ca $r+&. Un as(.e" de &a((ern &oa(e .! o'serva(, de
    24F Tulburrile "n le!tur cu o Substan

    e<e%&"+, :n cond!=!!"e :n care +/+" es(e .oar(e .recven( dar :n care dro$+" de e"ec=!e
    se sc!%'7 des. Pen(r+ ace"e s!(+a=!! :n care e<!s(7 +n &a((ern de &ro'"e%e asoc!a(e
    c+ %a! %+"(e dro$+r!, !ar cr!(er!!"e s+n( sa(!s.7c+(e &en(r+ %a! %+"( decA( o s!n$+r7
    (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7 s&ec!.!c7 Ede e<., de&enden=7 de coca!n7,
    de&enden=7 de a"coo" s! de&enden=7 de canna'!sJ, (re'+!e &+s .!ecare d!a$nos(!c.
    Tul-ur(rile .n le/(tur( #u Alt( Su-&tan!(
    3&au #u o Su-&tan!( Ne#uno&#ut(6
    Ca(e$or!a de (+"'+r7r! :n "e$7(+r7 c+ a"(7 s+'s(an=7 Esa+ c+ o s+'s(an=7
    nec+nosc+(7J es(e re/erva(7 c"as!.!c7r!! (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7
    asoc!a(e c+ s+'s(an=e care n+ a+ .os( "!s(a(e %a! s+s. E<e%&"e"e de aces(e s+'s(an=e,
    care s+n( descr!se %a! :n de(a"!+ %a! @os, !nc"+d s(ero!/!! ana'o"!/an=!, !na"an(e"e
    n!(r!(!ce ES&o&&ersTJ, o<!d+" de a/o(, %ed!ca%en(e"e vAnd+(e .7r7 &rescr!&=!e
    %ed!ca"7 sa+ %ed!ca%en(e &rescr!se, dar care n+ s+n( c+&r!nse :n ce"e 55 ca(e$or!!
    Ede e<., cor(!/o"+", an(!!s(a%!n!ce"e, 'en/(ro&!naJ s! a"(e s+'s(an=e care a+ e.ec(e
    &s!oac(!ve. :n a.ar7 de aceas(a, aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 a(+nc! cAnd
    s+'s(an=a s&ec!.!c7 es(e nec+nosc+(7 Ede e<., o !n(o<!ca=!e d+&7 "+area +n+! ."acon
    de &!"+"e nee(!ce(a(J.
    S(ero!/!! ana'o"!/an=! &rod+c !n!=!a" o sen/a=!e de '!ne crescAnd7 Esa+ c!ar
    e+.or!eJ care es(e :n"oc+!(7 d+&7 +/ re&e(a( de "!&sa de ener$!e, !r!(a'!"!(a(e O! a"(e
    .or%e de d!s.or!e. Con(!n+area +/+"+! aces(or s+'s(an=e &oa(e d+ce "a a&ar!=!a +nor
    s!%&(o%e %a! severe Ede e<., o s!%&(o%a(o"o$!e de&res!v7J O! "a cond!=!! %ed!ca"e
    $enera"e E%a"ad!e e&a(!c7J.
    Ina"an(e"e n!(r!(!ce ES&o&&ers T4.or%e de n!(r!( de a%!", '+(!! s! !/o'+(!"J &rod+c
    o !n(o<!ca=!e carac(er!/a(7 &r!n sen/a=!a de ca& &"!n, +Ooar7 e+.or!e, %od!.!care :n
    &erce&=!a (!%&+"+!, re"a<area %+sc+"a(+r!! ne(ede s! o &os!'!"7 creO(ere a sen/a=!!"or
    se<+a"e. Pe "An$7 &os!'!"+" +/ co%&+"s!v, aces(e s+'s(an=e &oar(7 &er!co"+"
    de(er!or7r!! .+nc=!e! !%+n!(are, !r!(7r!! c7!"or res&!ra(or!!, sc7der!! ca&ac!(7=!! de
    (rans&or( a o<!$en+"+! de c7(re sAn$e O! a" +ne! reac=!! (o<!ce care &oa(e !nc"+de
    vo%7, ce.a"ee sever7, !&o(ens!+ne O! a%e=ea"7.
    O<!d+" de a/o( ES$a/+" !"ar!an(TJ de(er%!n7 o !n(o<!ca=!e c+ de'+( ra&!d,
    carac(er!/a(7 &r!n ver(!@ O! o sen/a=!e de &"+(!re, care se c"ar!.!c7 :n dec+rs de cA(eva
    %!n+(e d+&7 s(o&area ad%!n!s(r7r!!. E<!s(7 descr!er! de con.+/!e re"evan(7 c"!n!c,
    dar (e%&orar7, O! de s(7r! &arano!de, cAnd o<!d+" de a/o( es(e +(!"!/a( :n %od
    re$+"a(.
    A"(e s+'s(an=e care s+n( ca&a'!"e s7 &rod+c7 !n(o<!ca=!! +Ooare s+n( ca(n!&+",
    care &oa(e &rod+ce s(7r! s!%!"are ce"or o'serva(e :n ca/+" %ar!+ane! s! care, :n
    do/e %ar!, s4a re"a(a( c7 d+ce "a &erce&=!! de (!& LSD8 n+ca de 'e(e", care es(e
    %es(eca(7 :n %+"(e c+"(+r! s&re a &rod+ce o e+.or!e +Ooar7 O! sen/a=!a de &"+(!re8 O!
    )ava Eo s+'s(an=7 e<(ras7 d!n &"an(a &!&er d!n Pac!.!c+" de S+dJ care &rod+ce
    sedare, !ncoordonare, &!erdere :n $re+(a(e, .or%e +Ooare de e&a(!(7 O! ano%a"!!
    &+"%onare E(+"'+r7r! res&!ra(or!!J, :n a.ar7 de aces(ea, !nd!v!/!! &o( de/vo"(a
    de&enden=7 O! de(er!orare &r!n ad%!n!s(rarea +nor %ed!ca%en(e vAnd+(e c+ sa+
    .7r7 &rescr!&=!e !nc"+/And cor(!/o"+", a$en=!! an(!&ar)!nson!en! care a+ &ro&r!e(7=!
    an(!co"!ner$!ce s! an(!!s(a%!n!ce"e. O d!sc+=!e des&re %od+" c+% se cod!.!c7
    (+"'+r7r!"e :n "e$7(+r7 c+ %ed!ca%en(e"e se a."7 "a &a$. 9LY.
    Tulburrile "n le!tur cu Alt
    Substan &sau cu o Substan
    Fecunoscut)
    9FY

    A+ .os( de@a &re/en(a(e (e<(e"e s! se(+r!"e de cr!(er!! &en(r+ de.!n!rea as&ec(e"or
    $enera"e a"e de&enden=e! de o s+'s(an=7 E&a$. 5F9J, a'+/+"+! de o s+'s(an=7 E&a$.
    5FGJ, !n(o<!ca=!e! c+ o s+'s(an=7 E&a$. 5FFJ O! a's(!nen=e! de o s+'s(an=7 care s+n(
    a&"!ca'!"e (+(+ror c"ase"or de s+'s(an=e. T+"'+r7r!"e !nd+se de a"(7 s+'s(an=7 Esa+ de
    o s+'s(an=7 nec+nosc+(7J s+n( descr!se :n sec=!+n!"e %an+a"+"+! :%&re+n7 c+
    (+"'+r7r!"e c+ care a+ co%+n7 .eno%eno"o$!a Ede e<., (+"'+rarea a.ec(!v7 !nd+s7 de
    a"(7 s+'s(an=7 Zsa+ de o s+'s(an=7 nec+nosc+(7[J es(e !nd+s7 :n sec=!+nea ST+"'+r7r!"e
    A.ec(!veT. Ma! @os, s+n( "!s(a(e (+"'+r7r!"e +/+"+! de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J s! (+"'+r7r!"e !nd+se de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J.
    Tulburrile u(ului de alt substan
    &sau de o substan necunoscut)
    ;LI.FL De&enden=a de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7
    Eve/! &a$. 5F9J ;LY.FL A'+/+" de a"(7 s+'s(an=7 Esa+ de o
    s+'s(an=7 nec+nosc+(7 Eve/!
    &a$. 5FGJ
    Tulburrile induse de alt substan
    &sau de o substan necunoscut)
    9F9.GF In(o<!ca=!a c+ a"(7 s+'s(an=7 Esa+ c+ o s+'s(an=7 nec+nosc+(7J
    Eve/! &a$. 5FFJ. 0e speci)icat dac6? C+ &er(+r'7r! de &erce&=!e 9F9.L
    A's(!nen=a de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J Eve/! &a$.
    9L5J. De speci)icat dac6? C+ &er(+r'7r! de &erce&=!e
    292.81 De"!r!+%+" !nd+s de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+
    nosc+(7J Eve/! &a$. 5I;J
    292.82 De%en=a &ers!s(en(7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J Eve/! &a$. 5RGJ
    292.83 T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de
    o s+'s(an=7 nec+nosc+(7J Eve/! &a$. 5HHJ
    292.11 T+"'+rarea &s!o(!c7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J, c+ !de! de"!ran(e Eve/! &a$. ;;GJ. 0e speci)icat dac6? C+
    de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    292.12 T+"'+rarea &s!o(!c7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J, c+ a"+c!na=!! Eve/! &a$. ;;GJ. 0e speci)icat dac6? C+
    de'+( :n c+rs+" !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GI T+"'+rarea a.ec(!v7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J Eve/! &a$. ILYJ. 0e speci)icat dac6? C+ de'+( :n c+rs+"
    !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GF T+"'+rarea an<!oas7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J Eve/! &a$. IHFJ. 0e speci)icat dac6? C+ de'+( :n c+rs+"
    !n(o<!ca=!e!X C+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GF D!s.+nc=!a se<+a"7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J Eve/! &a$. YR9J. 0e speci)icat dac6? C+ de'+( :n c+rs+"
    !n(o<!ca=!e!XC+ de'+( :n c+rs+" a's(!nen=e!
    9F9.GF T+"'+rarea de so%n !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J Eve/! &a$. RYYJ. 0e speci)icat dac6? C+ de'+( :n c+rs+"
    !n(o<!ca=!e!X C+ de'+( :n c+rs+" a's(!nen=e!
    9F9.F T+"'+rare :n "e$7(+r7 c+ a"(7 s+'s(an=7 Esa+ c+ o s+'s(an=7
    nec+nosc+(7J .7r7 a"(7 s&ec!.!ca=!e

    Sc%i(o$renia
    si Alte Tulburri #si%otice
    +"'+r7r!"e d!n aceas(7 sec=!+ne !nc"+d sc!/o.ren!a, (+"'+rarea
    sc!/o.ren!4.or%7, (+"'+rarea sc!/oa.ec(!v7, (+"'+rarea de"!ran(7,
    (+"'+rarea &s!o(!c7 sc+r(7, (+"'+rarea &s!o(!c7 !nd+s7, (+"'+rarea
    &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, (+"'+rarea
    &s!o(!c7 !nd+s7 de o s+'s(an=7 O! (+"'+rarea &s!o(!c7 .7r7 a"(7
    s&ec!.!ca=!e. Aces(e (+"'+r7r! a+ .os( $r+&a(e :%&re+n7 s&e a .ac!"!(a
    d!a$nos(!c+" d!.eren=!a" a" (+"'+r7r!"or care !nc"+d s!%&(o%e &s!o(!ce ca as&ec(
    &roe%!nen( a" (a'"o+"+! "or c"!n!c. A"(e (+"'+r7r! care se &o( &re/en(a c+ s!%&(o%e
    &s!o(!ce ca e"e%en(e asoc!a(e s+n( !nc"+se :n a"(7 &ar(e :n %an+a" Ede e<., de%en=a
    de (!& A"/e!%er s! de"!r!+%+" !nd+s de o s+'s(an=7 s+n( !nc"+se :n sec=!+nea
    SDe"!r!+%+", De%en=a, T+"'+r7r!"e A%nesr!ce s! A"(e T+"'+r7r! Co$n!(!veT8
    (+"'+rarea de&res!v7 %a@or7, c+ e"e%en(e &s!o(!ce, es(e !nc"+s7 :n sec=!+nea
    ST+"'+r7r!"e A.ec(!veTJ. In d!s&re=+" .a&(+"+! c7 aces(e (+"'+r7r! s+n( $r+&a(e
    :%&re+n7 :n aces( ca&!(o", (re'+!e re=!n+( c7 s!%&(o%e"e &s!o(!ce n+ s+n(
    cons!dera(e :n %od necesar a .! n+c"e+" sa+ e"e%en(e"e .+nda%en(a"e a"e aces(or
    (+"'+r7r! s! n!c! c7 (+"'+r7r!"e !nc"+se :n aceas(7 sec=!+ne a+ :n %od necesar o
    e(!o"o$!e co%+n7. De .a&(, +n n+%7r de s(+d!! s+$erea/7 asoc!er! e(!o"o$!ce s(rAnse
    :n(re sc!/o.ren!e s! a"(e (+"'+r7r! care, &r!n de.!n!=!e, n+ &re/!n(7 s!%&(o%e
    &s!o(!ce Ede e<., (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7J
    Ter%en+" de psi-otic a &r!%!(, !s(or!c, +n n+%7r de de.!n!=!! d!.er!(e d!n(re care
    n!c! +na n+ a .os( +n!versa" acce&(a(7. Cea %a! :n$+s(7 de.!n!=!e a (er%en+"+! de
    psi-otic es(e res(rAns7 "a !de! de"!ran(e sa+ "a a"+c!na=!! &roe%!nen(e, c+ a"+c!na=!!
    s+rven!nd :n a'sen=a conO(!en(!/7r!! na(+r!! "or &a(o"o$!ce. O de.!n!=!e +Oor %a! &+=!n
    res(r!c(!v7 ar !nc"+de, de ase%enea, a"+c!na=!!"e &roe%!nen(e &e care !nd!v!d+" "e
    rea"!/ea/7 ca .!!nd e<&er!en=e a"+c!na(or!!. Ma! "ar$7 :nc7, es(e de.!n!=!a care !nc"+de
    s! a"(e s!%&(o%e &o/!(!ve de sc!/o.ren!e Ede e<., de/or$an!/area "!%'a@+"+!,
    co%&or(a%en(+" ."a$ran( de/or$an!/a( sa+ ca(a(on!cJ. Con(rar aces(or de.!n!=!!
    'a/a(e &e s!%&(o%e, de.!n!=!!"e +(!"!/a(e :n c"as!.!c7r!"e an(er!oare Ede e<., DSM4II s!
    ICD4FJ era+ &ro'a'!" de de&ar(e &rea !nc"+s!ve s! cen(ra(e &e sever!(a(ea de(er!or7r!!
    .+nc=!ona"e, :n ace" con(e<(, o (+"'+rare %en(a"7 era den+%!(7 S&s!o(!c7T dac7
    d+cea "a So de(er!orare care !n(er.era ."a$ran( c+ ca&ac!(a(ea de a sa(!s.ace cer!n=e"e
    +/+a"e a"e v!e=!!T. De ase%enea, (er%en+" .+sese de.!n!( an(er!or, ca So &!erdere a
    "!%!(e"or e+"+!T or! ca o de(er!orare ."a$ran(7 a (es(7r!! rea"!(7=!!T.
    :n aces( %an+a", (er%en+" de ps)liotic se re.er7 "a &re/en=a an+%!(or s!%&(o%e.
    Cons(e"a=!a s&ec!.!c7 de s!%&(o%e "a care se re.er7 (er%en+" var!a/7 :ns7 :n(r4o
    an+%!(7 %7s+r7 e< (ransverso &r!n ca(e$or!!"e d!a$nos(!ce, :n sc!/o.ren!e,
    (+"'+rarea sc!/o.ren!.or%7, (+"'+rarea sc!/oa.ec(!v7 s! (+"'+rarea &s!o(!c7 sc+r(7,
    (er%en+" de psi-otic se re.er7 "a !de! de"!ran(e O! a"+c!na=!! &roe%!nen(e, "!%'a@
    de/or$an!/a(, sa+ co%&or(a%en( ca(a(on!c sa+ de/or$an!/a(, :n (+"'+rarea &s!or!c7
    da(o(a(7 +ne! cond!=!! %ed!ca"e $enera"e s! :n (+"'+rarea &s!or!c7 !nd+s7 de o
    s+'s(an=7, (er%en+" de psi-otic se re.er7 "a !de! de"!ran(e O! n+%a! "a a"+c!na=!!"e
    care n+ s+n( aco%&an!a(e de conO(!!n=a %a"ad!e!, :n .!ne, :n (+"'+rarea de"!ran(7 s! :n
    (+"'+rarea &s!o(!c7 !nd+s7 sa+ :%&7r(7O!(7, psi-otic es(e ec!va"en( c+ de"!ran(.
    9FH
    24=
    Sc%i(o$renia ,i Alte Tulburri #si%otice
    In aceas(7 sec=!+ne s+n( !nc"+se +r%7(oare"e (+"'+r7r!Q
    Sc!/o.ren!a es(e o (+"'+rare care d+rea/7 ce" &+=!n R "+n! s! !nc"+de ce" &+=!n o
    "+n7 de s!%&(o%e a"e .a/e! ac(!ve Ead!c7, do+7 sa+ %a! %+"(e d!n(re +r%7(oare"eQ
    !de! de"!ran(e, a"+c!na=!!, "!%'a@ de/or$an!/a(, co%&or(a%en( ca(a(on!c sa+
    ."a$ran( de/or$an!/a(, s!%&(o%e ne$a(!veJ. In aceas(7 sec=!+ne s+n( !nc"+se, de
    ase%enea, de.!n!=!! &en(r+ s+'(!&+r!"e de sc!/o.ren!e E&arano!d, de/or$an!/a(,
    T2
    ca(a(on!c, ned!.eren=!a( s! re/!d+a"J.
    T+"'+rarea sc!/o.ren!.or%7 es(e carac(er!/a(7 &r!n(r4o &re/en(are s!%&(o%a4
    (o"o$!c7 ec!va"en(7 c+ cea a sc!/o.ren!e! c+ e<ce&=!a d+ra(e! sa"e Ead!c7, &er(+r'area
    d+rea/7 de "a " "a R "+n!J s! a'sen=a cer!n=e! ca s7 e<!s(e +n dec"!n :n .+nc=!onare.
    T+"'+rarea sc!/oa.ec(!v7 es(e o &er(+r'are :n care +n e&!sod a.ec(!v s!
    s!%&(o%e carac(er!s(!ce .a/e! ac(!ve a sc!/o.ren!e! a&ar :%&re+n7 s! s+n( &receda(e
    sa+ s+n( +r%a(e de ce" &+=!n 9 s7&(7%An! de !de! de"!ran(e sa+ a"+c!na=!!, .7r7
    s!%&(o%e a.ec(!ve no(a'!"e.
    T+"'+rarea de"!ran(7 es(e carac(er!/a(7 &r!n ce" &+=!n " "+n7 de !de! de"!ran(e
    non'!/are, .7r7 a"(e s!%&(o%e carac(er!s(!ce .a/e! ac(!ve a sc!/o.ren!e!.
    T+"'+rarea &s!o(!c7 sc+r(7 es(e o &er(+r'are &s!o(!c7 d+rAnd %a! %+"( decA(
    o s!n$+r7 /! s! care se re%!(e &An7 :n(r4o "+n7.
    T+"'+rarea &s!o(!c7 !nd+s7 E:%&7r(7O!(7J es(e carac(er!/a(7 &r!n &re/en=a +ne!
    !de! de"!ran(e "a +n !nd!v!d !n."+en=a( de c!neva care are +n de"!r e<!s(en( de %a!
    %+"( (!%&, c+ con=!n+( s!%!"ar.
    In (+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, s!%&(o%e"e
    &s!o(!ce s+n( cons!dera(e a .! consec!n=a .!/!o"o$!c7 a +ne! cond!=!! %ed!ca"e
    $enera"e.
    In (+"'+rarea &s!o(!c7 !nd+s7 de o s+'s(an=7, s!%&(o%e"e &s!o(!ce s+n(
    cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +n+! dro$ de a'+/, a +n+!
    %ed!ca%en( or! a e<&+ner!! "a +n (o<!c.
    T+"'+rarea &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ c"as!.!carea
    (a'"o+r!"or c"!n!ce &s!o(!ce care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! +na d!n(re
    (+"'+r7r!"e &s!o(!ce s&ec!.!ce de.!n!(e :n aceas(7 sec=!+ne or! &en(r+
    s!%&(o%a(o"o$!a &s!o(!c7 :n ra&or( c+ care e<!s(7 !n.or%a=!! !nadecva(e sa+
    con(rad!c(or!!.
    S#@i)o%renia
    E"e%en(e"e esen=!a"e a"e sc!/o.ren!e! "e cons(!(+!e o %!<(+r7 de se%ne s!
    s!%&(o%e carac(er!s(!ce Ea(A( &o/!(!ve, cA( s! ne$a(!veJ care a+ .os( &re/en(e o
    &or=!+ne se%n!.!ca(!v7 de (!%&, :n c+rs+" +ne! &er!oade de o "+n7 Eor! +n (!%& %a!
    sc+r(, dac7 a+ .os( (ra(a(e c+ s+ccesJ, c+ +ne"e se%ne a"e (+"'+r7r!! &ers!s(And (!%&
    de ce" &+=!n R "+n! Ecr!(er!!"e A O! CJ. Aces(e se%ne s! s!%&(o%e s+n( asoc!a(e c+ o
    d!s.+nc=!e soc!a"7 sa+ &ro.es!ona"7 %arca(7 Ecr!(er!+" BJ. Per(+r'area n+ es(e
    e<&"!ca(7 %a! '!ne de (+"'+rarea sc!/oa.ec(!v7 sa+ de o (+"'+rare a.ec(!v7 c+
    e"e%en(e &s!o(!ce s! n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e
    sa+ a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!!"e D s! EJ. La !nd!v!/!! c+ +n
    d!a$nos(!c an(er!or de (+"'+rare a+(!s(7 Eor! de a"(7 (+"'+rare de de/vo"(are
    &ervas!v7J, d!a$nos(!c+" ad!=!ona" de sc!/o.ren!e es(e @+s(!.!ca(, n+%a! dac7 !de!
    de"!ran(e sa+ a"+c!na=!! no(a'!"e s+n( &re/en(e (!%& de ce" &+=!n o "+n7 Ecr!(er!+"
    FJ. S!%&(o%e"e carac(er!s(!ce a"e sc!/o.ren!e! c+&r!nd o ser!e de d!s.+nc(!!
    co$n!(!ve s! e%o=!ona"e care !nc"+d &erce&=!a, $And!rea !n.eren=!a"7, "!%'a@+" s!
    l
    Sc%i(o$renia
    244
    co%+n!carea, con(ro"+" co%&or(a%en(+"+!, a.ec(+",
    ."+en=a s! &rod+c(!v!(a(ea $And!r!! s! "!%'a@+"+!,
    ca&ac!(a(ea edon!c7, vo!n=a s! !%&+"s+", s! a(en=!a. N!c! +n
    s!n$+r s!%&(o% n+ es(e &a(o$no%on!c sc!/o.ren!e!8
    d!a$nos(!c+" !%&"!c7 rec+noaO(erea +ne! cons(e"a=!! de
    se%ne s! s!%&(o%e asoc!a(e c+ de(er!orarea .+nc=!on7r!!
    soc!a"e sa+ &ro.es!ona"e.
    S!%&(o%e"e carac(er!s(!ce Ecr!(er!+" AJ &o( .!
    conce&(+a"!/a(e ca :%&7r=!nd+4se :n do+7 %ar! ca(e$or!! U
    &o/!(!ve s! ne$a(!ve. S!%&(o%e"e &o/!(!ve &ar a re."ec(a +n
    e<ces sa+ d!s(ors!onare a .+nc=!!"or nor%a"e, &e cAnd ce"e
    ne$a(!ve &ar a re."ec(a d!%!n+area sa+ &!erderea .+nc=!!"or
    nor%a"e. S!%&(o%e"e &o/!(!ve Ecr!(er!!"e A54AIJ !nc"+d
    d!s(ors!+n!"e d!n con=!n+(+" $And!r!! E!de!"e de"!ran(eJ,
    &erce&=!e! Ea"+c!na=!!"eJ, "!%'a@+"+! O! &roces+"+! $And!r!!
    Ede/or$an!/area "!%'a@+"+!J s! a+(ocon(ro"+"+!
    co%&or(a%en(+"+! Eco%&or(a%en(+" ca(a(on!c sa+
    ."a$ran( de/or$an!/a(J. Aces(e s!%&(o%e &o/!(!ve &o(
    co%&or(a do+7 d!%ens!+n! d!s(!nc(e care &o( .!, :n sc!%',
    :n ra&or( c+ %ecan!s%e ne+ra"e s+'!acen(e O! core"a(e c"!n!ce
    d!.er!(eQ Sd!%ens!+nea &s!or!c7T !nc"+de !de!"e de"!ran(e O!
    a"+c!na=!!"e, &e cAnd Sd!%ens!+nea de/or$an!/7r!!T
    !nc"+de de/or$an!/area "!%'a@+"+! s! co%&or(a%en(+"+!.
    S!%&(o%e"e ne$a(!ve Ecr!(er!+" AYJ !nc"+d o res(rAn$ere :n
    $a%a O! !n(ens!(a(ea e<&res!e! e%o=!ona"e Ea&"a(!/area
    a.ec(!v7J, :n ."+en=a O! &rod+c(!v!(a(ea $And!r!! s! "!%'a@+"+!
    Ea"o$!aJ O! :n !n!=!erea +ne! ac(!v!(7=! or!en(a(e s&re +n sco&
    Eavo"!=!aJ.
    Ide!"e de"!ran(e Ecr!(er!+" AJ s+n( conv!n$er! erona(e care
    !%&"!c7 de re$+"7 o !n(er&re(are .a"s7 a &erce&=!!"or sa+
    e<&er!en=e"or. Con=!n+(+" "or &oa(e !nc"+de o var!e(a(e de
    (e%e Ede e<., de &ersec+=!e, de re.er!n=7, so%a(!ce,
    re"!$!oase sa+ de $randoareJ. Ide!"e de"!ran(e de &ersec+=!e
    s+n( ce"e %a! .recven(e8 &ersoana res&ec(!v7 crede c7 es(e
    ve<a(7, +r%7r!(7, :nOe"a(7, s&!ona(7 sa+ r!d!c+"!/a(7. Ide!"e
    de"!ran(e de re.er!n=7 s+n(, de ase%enea, .recven(e, &ersoana
    res&ec(!v7 cre/And c7 an+%!(e $es(+r!, co%en(ar!!, &asa@e
    d!n c7r=!, /!are, cAn(ece "!r!ce or! a"e se%na"e a%'!en(a"e :!
    s+n( adresa(e! :n %od s&ec!a". D!s(!nc=!a :n(re o !dee de"!ran(7
    O! o !dee s+s=!n+(7 c+ .er%!(a(e es(e d!.!c!" de .7c+( O!
    de&!nde de $rad+" conv!n$er!! c+ care es(e s+s=!n+(7
    cred!n=a, :n d!s&re=+" ev!den=e! de con(rar!+.
    DeO! !de!"e de"!ran(e '!/are s+n( cons!dera(e a .! e<(re%
    de carac(er!s(!ce sc!/o.ren!e!, S'!/arer!aT &oa(e .! d!.!c!"
    de a&rec!a(, :n s&ec!a" e< (ransverso &r!n d!verse c+"(+r!.
    Ide!"e de"!ran(e s+n( cons!dera(e '!/are, dac7 s+n( c"ar
    !%&"a+/!'!"e s! !nco%&reens!'!"e s! n+ der!v7 d!n
    e<&enen=e"e de v!a=7 co%+ne. Un e<e%&"+ de !de! de"!ran(e
    '!/are :" cons(!(+!e conv!n$erea +ne! &ersoane, c+% c7 +n
    s(r7!n !4a :nde&7r(a( or$ane"e !n(erne s! ! "e4a :n"oc+!( c+
    or$ane"e a"(c+!va, .7r7 s7 "ase vreo &"a$7 sa+ c!ca(r!ce. Un
    e<e%&"+ de !dee de"!ran(7 non'!/ar7 :" cons(!(+!e
    conv!n$erea .a"s7 a +ne! &ersoane, c+% c7 se a."7 s+'
    s+&rave$erea &o"!=!e!. Ide!"e de"!ran(e care e<&r!%7 o
    &!erdere a con(ro"+"+! as+&ra %!n=!! sa+ cor&+"+! Ead!c7,
    ce"e !nc"+se &r!n(re Ss!%&(o%e"e de ran$+" IT d!n "!s(a "+!
    Scne!derJ s+n( cons!dera(e :n $enera" a .! '!/are8 aces(ea
    !nc"+d conv!n$erea +ne! &ersoane c7 !4a+ .os( s+s(rase
    $And+r!"e de o .or=7 e<(er!oar7 ESs+s(ra$erea $And!r!!TJ, c7
    $And+r!"e +n+! s(r7!n a+ .os( !n(rod+se :n %!n(ea sa
    ES!nser=!a $And!r!!TJ or! c7 ac=!+n!"e sa"e sa+ cor&+" s7+ s+n(
    !n."+en=a(e or! %an!&+"a(e de o .or=7 e<(er!oar7 ES!de!
    de"!ran(e de con(ro"TJ. Dac7 !de!"e de"!ran(e s+n(
    cons!dera(e a .! '!/are, n+%a! aces( s!n$+r s!%&(o% es(e
    s+.!c!en( &en(r+ a sa(!s.ace cr!(er!+" A &en(r+ sc!/o.ren!e.
    Ha"+c!na=!!"e Ecr!(er!+" A9J &o( s+rven! :n or!ce %oda"!(a(e
    sen/or!a"7 Ede e<., &o( .! a+d!(!ve, v!/+a"e, o".ac(!ve,
    $+s(a(!ve s! (ac(!"eJ, dar a"+c!na=!!"e a+d!(!ve s+n( de
    de&ar(e ce"e %a! .recven(e s! %a! carac(er!s(!ce &en(r+
    sc!/o.ren!e. Ha"+c!na=!!"e
    455 Sc%i(o$renia ,i Alte Tulburri #si%otice
    a+d!(!ve s+n( de re$+"7 e<&er!en(a(e ca voc!, .a%!"!are sa+ non.a%!"!are, care s+n(
    &erce&+(e ca d!s(!nc(e de &ro&r!!"e $And+r! de c7(re &ersoana res&ec(!v7.
    Ha"+c!na=!!"e (re'+!e s7 s+rv!n7 :n con(e<(+" +n+! sensor!+% c"ar8 ce"e care a&ar :n
    c+rs+" ador%!r!! Ea"+c!na=!!"e !&na$o$!ceJ sa+ a" deO(e&(7r!! d!n so%n
    Ea"+c!na=!!"e !&no&o%&!ceJ s+n( cons!dera(e a .! :n cadr+" ca(e$or!e! de e<&er!en=7
    nor%a"7. E<&er!en=e"e !/o"a(e de a se a+/! ce%a( &e n+%e or! e<&er!en=e"e "!&s!(e
    de ca"!(a(ea +ne! &erce&=!! e<(erne Ede e<., %+r%+ra( :n &ro&r!+" ca&J, de ase%enea,
    n+ s+n( cons!dera(e ca .!!nd s!%&(o%a(!ce de sc!/o.ren!e sa+ de a"(7 (+"'+rare
    &s!o(!c7. Ha"+c!na=!!"e &o( .!, de ase%enea, o &ar(e nor%a"7 a +ne! e<&er!en=e
    re"!$!oase :n an+%!(e con(e<(e c+"(+ra"e. An+%!(e (!&+r! de a"+c!na=!! a+d!(!ve Ede
    e<., do+7 sa+ %a! %+"(e voc! conversAnd :n(re e"e sa+ voc! co%en(And con(!n++
    $And+r!"e sa+ co%&or(a%en(+" &ersoane!J a+ .os( cons!dera(e ca .!!nd e<(re% de
    carac(er!s(!ce sc!/o.ren!e!. Dac7 s+n( &re/en(e n+%a! aces(e (!&+r! de a"+c!na=!!,
    aces( s!%&(o% s!n$+r es(e s+.!c!en( &en(r+ a sa(!s.ace cr!(er!+" A.
    De/or$an!/area $And!r!! ES(+"'+rarea .or%a"7 de $And!reTJ a .os( &os(+"a(7 de
    c7(re +n!! a .! ce" %a! !%&or(an( e"e%en( a" sc!/o.ren!e!. D!n ca+/a d!.!c+"(7=!!
    !neren(e :n e"a'orarea +ne! de.!n!=!! o'!ec(!ve a S(+"'+r7r!! de $And!reT s! &en(r+ c7,
    :n cond!=!! c"!n!ce, !n.eren=e"e re.er!(oare "a $And!re se ba;ea;6 :n &r!%+" rAnd &e
    "!%'a@+" !nd!v!d+"+!, conce&(+" de "!%'a@ de/or$an!/a( Ecr!(er!+" A;J a .os(
    accen(+a( :n de.!n!=!a sc!/o.ren!e! +(!"!/a(e :n aces( %an+a". L!%'a@+" !nd!v!/!"or c+
    sc!/o.ren!e &oa(e .! de/or$an!/a( :n d!verse %od+r!. Persoana &oa(e Sa"+necaT de
    "a +n s+'!ec( "a a"(+" ESdera!ereaT sa+ Sre"a<area asoc!a=!!"orTJ8 r7s&+ns+r!"e "a
    :n(re'7r! &o( .! doar !nd!rec( :n "e$7(+r7 c+ aces(ea sa+ co%&"e( .7r7 n!c! o "e$7(+r7
    ES(an$en=!a"!(a(eTJ8 %a! rar, "!%'a@+" &oa(e .! de/or$an!/a( a(A( de sever, c7 dev!ne
    a&roa&e !nco%&reens!'!", se%7nAnd c+ a)a;ia rece&(!v7 :n de/or$an!/area sa
    "!n$v!s(!c7 ES!ncoeren=aT sa+ Ssa"a(a de c+v!n(eTJ. Deoarece "!%'a@+" +Oor
    de/or$an!/a( es(e .recven( s! nes&ec!.!c, s!%&(o%+" (re'+!e s7 .!e s+.!c!en( de sever
    &en(r+ a de(er!ora s+'s(an=!a" co%+n!carea e.ec(!v7. ,And!rea sa+ "!%'a@+" %a!
    &+=!n sever de/or$an!/a(e &o( s+rven! :n c+rs+" &er!oade"or &rodro%a"7 s!
    re/!d+a"7 a"e sc!/o.ren!e! Eve/! cr!(er!+" CJ.
    Co%&or(a%en(+" ."a$ran( de/or$an!/a( Ecr!(er!+" AIJ se &oa(e %an!.es(a :n(r4o
    var!e(a(e de %od+r!, %er$And de "a (on(er!! !n.an(!"e "a a$!(a=!e !%&rev!/!'!"7. Po( .!
    no(a(e &ro'"e%e :n or!ce .e" de co%&or(a%en( or!en(a( s&re +n sco&, aces(ea d+cAnd
    "a d!.!c+"(7=! :n :nde&"!n!rea ac(!v!(7=!"or v!e=!! co(!d!ene, c+% ar .! &re&ararea
    %Anc7r!! sa+ %en=!nerea !$!ene!. Persoana &oa(e &7rea a .! e<(re% de de/ordona(7,
    se &oa(e :%'rc7ca de o %an!er7 !nso"!(7 Ede e<., :%'rac7 %a! %+"(e &a"(oane, &oar(7
    eOar.e O! %7n+O! :n(r4o /! c7"d+roas7J or! &oa(e %an!.es(a +n co%&or(a%en( se<+a"
    c"ar !nadecva( Ede e<., se %as(+r'ea/7 :n &+'"!cJ sa+ a$!(a=!e nedec"ansa(7 de ceva
    s! !%&rev!/!'!"7 Ede e<., s(r!$7(e sa+ :n@+r7(+r!J. A(en=!e "a a n+ se a&"!ca aces(
    cr!(er!+ :n %od &rea "ar$. De e<e%&"+, cA(eva %o%en(e de ne"!n!O(e, de %An!e or!
    de a$!(a=!e n+ (re'+!e s7 .!e cons!dera(e dre&( &ro'7 de sc!/o.ren!e, :n s&ec!a" dac7
    %o(!va=!a es(e !n(e"!$!'!"7.
    Co%&or(a%en(e"e %o(or!! ca(a(on!ce Ecr!(er!+" AIJ !nc"+d o red+cere %arca(7 a
    reac(!v!(7=!! "a a%'!an=7, +neor! a(!n$And $rad+" e<(re% de !nconO(!en=7 co%&"e(7
    Es(+&or ca(a(on!cJ, %en=!nerea +ne! &os(+r! r!$!de s! re/!s(en=7 "a e.or(+r!"e de a .!
    %o'!"!/a( Er!$!d!(a(e ca(a(on!c7J, re/!s(en=a ac(!v7 "a !ns(r+c=!+n! or! "a (en(a(!ve"e de
    a .! %o'!"!/a( Ene$a(!v!s% ca(a(on!cJ, "+area +nor &os(+r! !nadecva(e sa+ '!/are
    E&os(+r7 ca(a(on!c7J or! ac(!v!(a(e %o(or!e e<ces!v7, .7r7 sco& s! .7r7 s(!%+"
    dec"anOa(or Ee<c!(a=!e ca(a(on!c7J. DeO! ca(a(on!a a .os( asoc!a(7, !s(or!c, c+
    sc!/o.ren!a,
    Sc%i(o$ren
    ia
    +E1

    c"!n!c!an+" (re'+!e s7 re=!n7 .a&(+" c7 s!%&(o%e"e ca(a(on!ce n+ s+n( s&ec!.!ce,
    &+(And a&are O! :n a"(e (+"'+r7r! %en(a"e Eve/! (+"'+r7r!"e a.ec(!ve c+ e"e%en(e
    ca(a(on!ce, &a$. I5GJ, :n cond!=!! %ed!ca"e $enera"e Eve/! (+"'+rarea ca(a(on!c7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, &a$. 5GYJ s! :n (+"'+r7r!"e de %!Ocare
    !nd+se de %ed!ca%en(e Eve/! &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce, &a$. HF9J.
    S!%&(o%e"e ne$a(!ve a"e sc!/o.ren!e! Ecr!(er!+" AYJ e<&"!c7 +n s+'s(an=!a" $rad de
    %or'!d!(a(e asoc!a( c+ (+"'+rarea. Tre! s!%&(o%e ne$a(!ve U a&"a(!/area a.ec(!v7,
    a"o$!a s! avo"!=!a U s+n( !nd+se :n de.!n!=!a sc!/o.ren!e!8 a"(e s!%&(o%e ne$a(!ve Ede
    e<., anedon!aJ s+n( %en=!ona(e %a! @os, :n sec=!+nea SE"e%en(e s! (+"'+r7r! asoc!a(eT.
    A&"a(!/area a.ec(!v7 es(e e<(re% de .recven(7 O! es(e carac(er!/a(7 &r!n .a&(+" c7 .ac!es+"
    &ersoane! &are a .! !%o'!" O! !nd!.eren(, c+ con(ac( v!/+a" red+s O! red+cerea "!%'a@+"+!
    cor&ora". DeO! o &ersoan7 c+ a&"a(!/are a.ec(!v7 &oa(e /A%'! O! deven! %a! ca"d7
    oca/!ona", $a%a e<&res!v!(7=!! sa"e e%o=!ona"e es(e ev!den( d!%!n+a(7 cea %a! %are
    &ar(e a (!%&+"+!. Poa(e .! +(!" s7 se o'serve !n(erac=!+nea &ersoane! c+ e$a"!! &en(r+ a
    s(a'!"! dac7 a&"a(!/area a.ec(!v7 es(e s+.!c!en( de &ers!s(en(7 &en(r+ a sa(!s.ace cr!(er!+".
    A"o$!a Es7r7c!rea "!%'a@+"+!J se %an!.es(7 &r!n r7s&+ns+r! sc+r(e, "acon!ce, sec!.
    Ind!v!d+" c+ a"o$!e &are a avea o d!%!n+are a s(oc+"+! de !de!, care se re."ec(7 :n
    sc7derea ."+en=e! s! &rod+c(!v!(7=!! "!%'a@+"+!. Aceas(a (re'+!e d!s(!ns7 de re.+/+" de a
    vor'!, @+deca(a c"!n!c7 neces!(And o'servarea :n (!%& O! :n d!verse s!(+a=!!. Avo"!=!a se
    carac(er!/ea/7 &r!n !nca&ac!(a(ea de a !n!=!a O! &ersevera :n ac(!v!(7=! or!en(a(e s&re +n
    sco&. Persoana &oa(e s(a aOe/a(7 "+n$! &er!oade de (!%& s! %an!.es(a &+=!n !n(eres :n a
    &ar(!c!&a "a %+nc7 sa+ "a ac(!v!(7=! soc!a"e.
    DeO! +'!c+!(are :n sc!/o.ren!e, s!%&(o%e"e ne$a(!ve s+n( d!.!c!" de eva"+a(,
    deoarece e"e a&ar &e +n con(!n++% c+ nor%a"!(a(ea, s+n( nes&ec!.!ce s! &o( .!
    da(ora(e +ne! d!vers!(7=! de a"=! .ac(or! E!nc"+/And s!%&(o%e"e &o/!(!ve, e.ec(e"e
    sec+ndare a"e %ed!ca=!e!, de&res!a, s+'s(!%+"area a%'!en(a"7 or! de%ora"!/areaJ.
    Dac7 +n s!%&(o% ne$a(!v es(e cons!dera( a .! a(r!'+!'!" :n %od dar or!c7r+!a d!n(re
    aceO(! .ac(or!, aces(a n+ (re'+!e av+( :n vedere "a s(a'!"!rea d!a$nos(!c+"+! de
    sc!/o.ren!e. De e<e%&"+, co%&or(a%en(+" +n+! !nd!v!d care are conv!n$erea
    de"!ran(7 c7 e" se va a."a :n &er!co" dac7 !ese d!n ca%era sa sa+ vor'eO(e c+ c!neva,
    &oa(e %!%a !/o"area soc!a"7, avo"!=!a O! a"o$!a. An+%!(e %ed!ca%en(e ne+ro"e&(!ce
    &rod+c adesea e.ec(e e<(ra&!ra%!da"e adverse, c+% ar .! 'rad!)!ne/!a, care &o(
    %!%a a&"a(!/area a.ec(!v7. D!s(!nc=!a :n(re adev7ra(e"e s!%&(o%e ne$a(!ve O!
    e.ec(e"e adverse a"e +n+! %ed!ca%en( de&!nde de @+deca(a c"!n!c7 re.er!(oare "a
    sever!(a(ea s!%&(o%e"or ne$a(!ve, na(+ra O! (!&+" %ed!ca%en(+"+! ne+ro"e&(!c,
    e.ec(e"e ada&(7r!! do/e! O! e.ec(e"e %ed!ca%en(e"or an(!co"!ner$!ce. D!s(!nc=!a
    d!.!c!"7 d!n(re s!%&(o%e"e ne$a(!ve O! s!%&(o%e"e de&res!ve &oa(e .! (ranOa(7 de a"(e
    s!%&(o%e de aco%&an!a%en( care s+n( &re/en(e O! de .a&(+" c7 !nd!v!/!! c+
    s!%&(o%e de&res!ve e<&er!en(ea/7 de re$+"7 +n a.ec( d+reros !n(ens, &e cAnd ce! c+
    sc!/o.ren!e &re/!n(7 o d!%!n+are sa+ "!&s7 a a.ec(+"+!. In .!ne, s+'s(!%+"area
    a%'!en(a"7 cron!c7 sa+ de%ora"!/area &o( d+ce "a a&a(!e s! avo"!=!e :nv7=a(7. In
    s(a'!"!rea &re/en=e! s!%&(o%e"or ne$a(!ve care (re'+!e +(!"!/a(e s(a'!"!rea
    d!a$nos(!c+"+! de sc!/o.ren!e, ce" %a! '+n (es( es(e, &oa(e, &ers!s(en=a "or o
    &er!oad7 cons!dera'!"7 de (!%& :n d!s&re=+" e.or(+r!"or or!en(a(e s&re re/o"varea
    .!ec7re!a d!n(re even(+a"e"e ca+/e descr!se %a! s+s. S4a s+$era( ca s!%&(o%e"e
    ne$a(!ve d+ra'!"e, care n+ s+n( a(r!'+!'!"e ca+/e"or sec+ndare %a! s+s descr!se, s7
    .!e de.!n!(e ca s!%&(o%e de Sde.!c!(T.
    Cr!(er!+" A &en(r+ sc!/o.ren!e cere ca ce" &+=!n do! d!n(re ce! c!nc! !(e%! s7 .!e
    &re/en=! conco%!(en( &en(r+ %a! %+"( de o "+n7. Dac7 :ns7, !de!"e de"!ran(e s+n(
    4+C
    Sc%i(o$renia ,i Alte Tulburri #si%otice
    '!/are sa+ a"+c!na=!!"e co%&or(7 Svoc! care co%en(ea/7T sa+ Svoc! care
    conversea/7T, a(+nc! es(e necesar7 &re/en(a n+%a! a +n+! s!n$+r !(e%. Pre/en=a
    aces(e! re"a(!v severe cons(e"a=!! de se%ne s! s!%&(o%e es(e den+%!(7 S.a/a ac(!v7T,
    :n ace"e s!(+a=!!, :n care s!%&(o%e"e .a/e! ac(!ve se re%!( :n dec+rs de o "+n7 ca
    r7s&+ns "a (ra(a%en(, cr!(er!+" A &oa(e .! :nc7 cons!dera( ca sa(!s.7c+(, dac7
    c"!n!c!an+" a&rec!a/7 c7 s!%&(o%e"e ar .! &ers!s(a( (!%& de o "+n7 :n a'sen=a +n+!
    (ra(a%en( e.!cace. La co&!!, eva"+area s!%&(o%e"or carac(er!s(!ce (re'+!e s7 !nc"+d7
    cons!dera=!a c+ven!(7 &re/en=e! a"(or (+"'+r7r! sa+ d!.!c+"(7=! de de/vo"(are. De
    e<e%&"+, de/or$an!/area "!%'a@+"+! "a +n co&!" c+ o (+"'+rare de co%+n!care n+ va
    (re'+! s7 .!e "+a(7 :n ca"c+" &en(r+ d!a$nos(!c+" de sc!/o.ren!e, decA( :n ca/+" :n
    care $rad+" de de/or$an!/are es(e se%n!.!ca(!v %a! %are decA( ar .! de aO(e&(a( &e
    'a/a (+"'+r7r!! de co%+n!care s!n$+re.
    Sc!/o.ren!a !%&"!c7 d!s.+nc=!! :n(r4+n+" sa+ %a! %+"(e do%en!! %a@ore de
    .+nc=!onare Ede e<., re"a=!!"e !n(er&ersona"e, %+nca sa+ ed+ca=!a or! a+(o:n$r!@!reaJ
    Ecr!(er!+" BJ. De re$+"7, .+nc=!onarea es(e ne( s+' cea care a .os( a(!ns7 an(er!or
    de'+(+"+! s!%&(o%e"or. Dac7 &er(+r'area :nce&e :n co&!"7r!e sa+ :n ado"escen=7,
    &oa(e e<!s(a !nca&ac!(a(ea de a a(!n$e ceea ce ar .! .os( de aO(e&(a( de "a !nd!v!d, %a!
    c+rAnd decA( o de(er!orare a .+nc=!on7r!!. Co%&ararea !nd!v!d+"+! c+ .ra=!!
    nea.ec(a=! &oa(e .! +(!"7 :n a .ace aceas(7 &rec!/are. Pro$res+" ed+ca=!ona" es(e
    .recven( :n(rer+&(, !ar !nd!v!d+" &oa(e .! !nca&a'!" s7 (er%!ne Ocoa"a. M+"=! !nd!v!/!
    s+n( !nca&a'!"! s7 =!n7 +n serv!c!+ &er!oade %a! "+n$! de (!%& O! s+n( an$a@a=! "a
    n!ve"e !n.er!oare ce"or a"e &7r!n=!"or "or ES(end!n=a "a c7dereTJ. Ma@or!(a(ea
    !nd!v!/!"or c+ sc!/o.ren!e ERLd4HLdJ2n+ se c7s7(oresc, !ar ce! %a! %+"=! a+ con(ac(e
    soc!a"e re"a(!v red+se. D!s.+nc=!a &ers!s(7 o &er!oad7 cons!dera'!"7 de (!%& :n c+rs+"
    (+"'+r7r!!, s! n+ &are a .! re/+"(a(+" d!rec( a" +n+! s!n$+r e"e%en(. De e<e%&"+, dac7
    o .e%e!e :O! a'andonea/7 serv!c!+" d!n ca+/a !de!! de"!ran(e c!rc+%scr!se, c+% c7
    &a(ron+" e! :ncearc7 s4o o%oare, aceas(a s!n$+r7 n+ es(e o &ro'7 s+.!c!en(7 &en(r+
    aces( cr!(er!+, c+ e<ce&=!a .a&(+"+! dac7 n+ e<!s(7 +n &a((ern %a! &ervas!v de
    d!.!c+"(7=! Ede re$+"7, :n %+"(!&"e do%en!! de .+nc=!onareJ.
    Une"e se%ne a"e &er(+r'7r!! (re'+!e s7 &ers!s(e o &er!oad7 con(!n+7 de ce" &+=!n
    R "+n! Ecr!(er!+" CJ, :n c+rs+" aces(e! &er!oade de (!%&, (re'+!e s7 e<!s(e ce" &+=!n o
    "+n7 de s!%&(o%e Esa+ %a! &+=!n de o "+n7, dac7 s!%&(o%e"e s+n( (ra(a(e c+ s+ccesJ
    care sa(!s.ac cr!(er!+" A a" sc!/o.ren!e! E.a/a ac(!v7J. S!%&(o%e"e &rodro%a"e s+n(
    adesea &re/en(e :na!n(ea .a/e! ac(!ve, !ar s!%&(o%e"e re/!d+a"e :! &o( +r%a. Une"e
    s!%&(o%e &rodro%a"e s! re/!d+a"e s+n( .or%e re"a(!v +Ooare sa+ s+'"!%!na"e a"e
    s!%&(o%e"or &o/!(!ve s&ec!.!ca(e "a cr!(er!+" A. Ind!v!/!! &o( &re/en(a o var!e(a(e de
    conv!n$er! '!/are sa+ !nso"!(e care n+ s+n( de &ro&or=!! de"!ran(e Ede e<., !de! de
    re.er!n=7 sa+ $And!re %a$!c7J8 e! &o( &re/en(a e<&er!en=e &erce&(!ve !nso"!(e Ede e<.,
    s!%=!rea &re/en=e! +ne! &ersoane sa+ .or=e !nv!/!'!"e :n a'sen(a a"+c!na=!!"or
    ca(e$or!ceJ8 "!%'a@+" "or &oa(e .! :n $enera" :n=e"es, dar es(e d!$res!v, va$ or! e<(re%
    de a's(rac( sa+ de concre(8 co%&or(a%en(+" "or &oa(e .! !nso"!(, dar n+ ."a$ran(
    de/or$an!/a( Ede e<., %+r%+ra(+" &en(r+ s!ne :ns+O!, co"ec(area de o'!ec(e '!/are O!,
    ev!den(, !n+(!"eJ. Pe "An$7 aces(e s!%&(o%e s!%!"are ce"or &o/!(!ve, s!%&(o%e"e
    ne$a(!ve s+n( e<(re% de co%+ne :n .a/e"e &rodro%a"7 s! re/!d+a"7, O! +neor! &o( .!
    .oar(e severe. Ind!v!/!! care era+ ac(!v! soc!a" &o( deven! re(raO!8 e! :O! &!erd !n(eres+"
    &en(r+ ac(!v!(7=!"e &"7c+(e an(er!or, &o( deven! %a! &+=!n vor'7re=! O! c+r!oO!, O! :O!
    &o( &e(rece %a@or!(a(ea (!%&+"+! :n &a(. As(.e" de s!%&(o%e s+n( adesea &r!%e"e
    care se%na"ea/7 .a%!"!e! .a&(+" c7 ceva es(e :n nere$+"78 %e%'r!! .a%!"!e! &o( re"a(a,
    :n ce"e d!n +r%7, c7 e! a+ s!%=!( !nd!v!d+" ca S&!er/And+4se &ro$res!vT.
    Sc%i(o$ren
    ia
    4+4

    Subtipuri si speci$icani de evoluie
    D!a$nos(!c+" +n+! an+%!( s+'(!& se ba;ea;6 &e (a'"o+" c"!n!c care a oca/!ona( cea
    %a! recen(7 e<a%!nare sa+ !n(ernare :n s&!(a", dar &oa(e .! sc!%'a( :n dec+rs+"
    (!%&+"+!. Un (e<( s! cr!(er!! se&ara(e s+n( &rev7/+(e &en(r+ .!ecare d!n(re
    +r%7(oare"e s+'&+nQ
    9FY.;L T!&+" &arano!d Eve/! &a$ ;5;J
    9FY.5L T!&+" de/or$an!/a( Eve/! &a$ ;5IJ
    9FY.9L T!&+" ca(a(on!c Eve/! &a$ ;5YJ
    9FY.FL T!&+" ned!.eren=!a( Eve/! &a$ ;5RJ
    9FY.RL T!&+" re/!d+a" Eve/! &a$ ;5RJ
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a !nd!ca evo"+=!a carac(er!s(!c7 a
    s!%&(o%e"or sc!/o.ren!e! :n dec+rs+" (!%&+"+! AceO(! s&ec!.!can=! &o( .! a&"!ca=!
    n+%a! d+&7 ce" &+=!n +n an de "a de'+(+" !n!=!a" a" s!%&(o%e"or .a/e! ac(!ve :n
    c+rs+" aces(e! &er!oade de +n an, n+ &oa(e .! a&"!ca( n!c! +n s&ec!.!can( de c+rs
    E&!sod!c, c+ s!%&(o%e re/!d+a"e :n(re e&!soade. Aces( s&ec!.!can( se a&"!c7
    a(+nc! cAnd evo"+=!a es(e carac(er!/a(7 &nn e&!soade :n care cn(en+" A &en(r+
    sc!/o.ren!e es(e sa(!s.7c+(, !ar :n(re e&!soade e<!s(7 s!%&(o%e re/!d+a"e
    se%n!.!ca(!ve c"!n!c C+ s!%&(o%e ne$a(!ve &roe%!nen(e &oa(e .! ad7+$a( dac7
    s!%&(o%e ne$a(!ve no(a'!"e s+n( &re/en(e :n c+rs+" aces(or &er!oade re/!d+a"e
    E&!sod!c, .7r7 s!%&(o%e re/!d+a"e :n(re e&!soade. Aces( s&ec!.!can( se
    a&"!c7 a(+nc! cAnd evo"+=!a es(e carac(er!/a(7 &r!n e&!soade :n care cr!(er!+" A
    &en(r+ sc!/o.ren!e es(e sa(!s.7c+(, !ar :n(re e&!soade n+ e<!s(7 s!%&(o%e
    re/!d+a"e se%n!.!ca(!ve c"!n!c
    Con(!n++. Aces( s&ec!.!can( se a&"!c7 a(+nc! cAnd s!%&(o%e"e carac(er!s(!ce
    de "a cr!(er!+" A s+n( sa(!s.7c+(e (oa(e Esa+ a&roa&e (oa(eJ &e d+ra(a evo"+=!e!
    C+ s!%&(o%e ne$a(!ve &roe%!nen(e &oa(e .! ad7+$a( dac7 s!%&(o%e
    ne$a(!ve no(a'!"e s+n(, de ase%enea, &re/en(e
    E&!sod +n!c, :n re%!s!+ne &ar=!a"7 Aces( s&ec!.!can( se a&"!c7 ar+nc! cAnd a
    e<!s(a( +n s!n$+r e&!sod :n care cn(en+" A &en(r+ sc!/o.ren!e a .os(
    sa(!s.7c+( (.5 a+ r7%as +ne"e s!%&(o%e re/!d+a"e se%n!.!ca(!ve c"!n!c C+
    s!%&(o%e ne$a(!ve &roe%!nen(e &oa(e .! ad7+$a( dac7 aces(e s!%&(o%e
    re/!d+a"e !nc"+d s!%&(o%e ne$a(!ve no(a'!"e
    E&!sod +n!c, :n re%!s!+ne co%&"e(7. Aces( s&ec!.!can( se a&"!c7 a(+nc! cAnd
    a e<!s(a( +n s!n$+r e&!sod :n care cr!(er!+" A &en(r+ sc!/o.ren!e a .os(
    sa(!s.7c+( s! n+ a+ r7%as s!%&(o%e re/!d+a"e se%n!.!ca(!ve c"!n!c
    A"( &a((ern sa+ &a((ern nes&ec!.!ca( Aces( s&ec!.!can( es(e +(!"!/a( a(+nc!
    cAnd a .os( &re/en( +n a"( &a((ern de evo"+=!e sa+ +n &a((ern nes&ec!.!ca(
    #rocedee de "nre!istrare
    Cod+" d!a$nos(!c &en(r+ sc!/o.ren!e es(e se"ec(a( &e 'a/a s+'(!&+"+!
    cores&+n/7(or 9FY;L &en(r+ (!&+" &arano!d, 9FY5L &en(r+ (!&+" de/or$an!/a(,
    9FY 9L &en(r+ (!&+" ca(a(on!c, 9FY FL &en(r+ (!&+" ned!.eren=!a(, 9FY RL &en(r+ (!&+"
    re/!d+a" N+ e<!s(7 cod+n c+ cea de a c%cea c!.r7 d!s&on!'!"7 &en(r+ s&ec!.!can=n
    evo"+=!e! La :nre$!s(rarea n+%e"+! (+"'+r7%, s&ec!.!can(n evo"+=!e! s+n( no(a=!
    d+&7 s+'&+" cores&+n/7(or Ede e< , 9FY ;L Sc!/o.ren!e, (!& &arano!d, e&!sod!c7,
    c+ s!%&(o%e re/!d+a"e %(ere&!sod!c, c+ s!%&(o%e ne$a(!ve no(a'!"eJ
    4+7
    Sc%i(o$renia si Alte Tulburri #si%otice
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. Ind!v!/!! c+ sc!/o.ren!e
    &o( &re/en(a +n a.ec( !nadecva( Ede e<., /A%'e(, rAs, or! o e<&res!e .ac!a"7 de .er!c!re
    :n a'sen=a +n+! s(!%+" adecva(J care es(e +n+" d!n(re e"e%en(e"e de.!n!(or!! a"e
    (!&+"+! de/or$an!/a(. Anedon!a es(e .recven(7 s! se %an!.es(7 &r!n &!erderea
    !n(eres+"+! sa+ &"7cer!!. D!s&o/!=!a d!s.or!c7 &oa(e "+a .or%a de&res!e!, an<!e(7=!!
    sa+ s(7r!! co"eroase. Po( e<!s(a &er(+r'7r! :n &a((ern+" de so%n Ede e<., so%no"en=7
    d!+rn7 s! ac(!v!(a(e sa+ ne"!n!O(e :n (!%&+" no&=!!J. Ind!v!d+" &oa(e &re/en(a "!&s7 de
    !n(eres &en(r+ %Ancare sa+ re.+/7 %Ancarea, ca +r%are a conv!n$er!"or de"!ran(e.
    Adesea e<!s(7 ano%a"!! a"e ac(!v!(7=!! &s!o%o(or!! Ede e<., %ers+" de co"o &An7 co"o,
    'a"ansa(+" sa+ !%o'!"!(a(ea a&a(!c7J. D!.!c+"(a(ea :n concen(rare, a(en=!e O! %e%or!e
    es(e ev!den(7 .recven(.
    La %a@or!(a(ea !nd!v!/!"or c+ sc!/o.ren!e e<!s(7 o conO(!!n=7 red+s7 a .a&(+"+! c7
    e! a+ o %a"ad!e &s!o(!c7. Da(e"e s+$erea/7 c7 red+cerea conO(!!n=e! %a"ad!e! es(e o
    %an!.es(are a %a"ad!e! :ns7O! s! n+ o s(ra(e$!e de ada&(are. Aceas(a &oa(e .!
    co%&ara(7 c+ "!&sa conO(!!n=e! &en(r+ de.!c!(e"e ne+ro"o$!ce o'serva(7 :n !c(+s O!
    n+%!(7 anoso/no;ie7 Aces( s!%&(o% &red!s&+ne !nd!v!d+" "a nonco%&"!an=7 "a
    (ra(a%en( s! s4a cons(a(a( c7 &red!c(ea/7 +n &rocen( r!d!ca( de rec7der!, +n n+%7r
    %are de !n(ern7r! nevo"+n(are :n s&!(a", o .+nc=!onare soc!a"7 red+s7 s! o evo"+=!e
    de.avora'!"7 a %a"ad!e!.
    De&ersona"!/area, derea"!/area O! &reoc+&7r!"e so%a(!ce &o( s+rven!, O! a(!n$
    +neor! &ro&or=!! de"!ran(e. An<!e(a(ea O! .o'!!"e s+n( .recven(e :n sc!/o.ren!e.
    Uneor! s+n( &re/en(e ano%a"!! %o(or!! Ede e<., $r!%ase, &os(+r!, %an!er!s%e '!/are,
    co%&or(a%en( r!(+a" sa+ s(ereo(!&J. S&eran=a de v!a=7 a !nd!v!/!"or c+ sc!/o.ren!e
    es(e %a! sc+r(7 decA( cea a &o&+"a=!e! $enera"e &en(r+ o d!ves!(a(e de %o(!ve.
    S+!c!d+" es(e +n .ac(or !%&or(an(, deoarece a&ro<!%a(!v 5Ld d!n(re !nd!v!/!! c+
    sc!/o.ren!e se s!n+c!d, !ar :n(re 9Ld s! ILd .ac ce" &+=!n o (en(a(!v7 :n c+rs+"
    %a"ad!e!. DeO! r!sc+" Ede s+!c!dJ r7%Ane cresc+( (oa(7 v!a=a, .ac(or!! de r!sc s&ec!.!c!
    &en(r+ s+!c!d !nc"+d se<+" %asc+"!n, a .! :n e(a(e de %a! &+=!n de IY an!, s!%&(o%e"e
    de&res!ve, sen(!%en(+" de d!s&erare, Oo%a@+" O! e<(ernarea recen(7 d!n s&!(a".
    B7r'a=!! rea"!/ea/7 s+!c!d+" co%&"e( %a! .recven( decA( .e%e!"e, dar "a a%'e"e se<e
    r!sc+" de s+!c!d es(e %a! cresc+( co%&ara(!v c+ &o&+"a=!a $enera"7.
    M+"(e s(+d!! a+ ra&or(a( c7 s+'$r+&+r! de !nd!v!/! d!a$nos(!ca=! c+ sc!/o.ren!e
    a+ o !nc!den=7 cresc+(7 a co%&or(a%en(+"+! a$res!v s! v!o"en(. Pred!c(or!! %a@or! a!
    co%&or(a%en(+"+! v!o"en( s+n( se<+" %asc+"!n, (!nere=ea, !s(or!c+" de v!o"en=7 :n
    (rec+(, nonco%&"!an=7 "a (ra(a%en(+" c+ an(!&s!o(!ce s! +/+" e<ces!v de s+'s(an=7.
    Tre'+!e re=!n+( :ns7 c7 ce! %a! %+"=! !nd!v!/! c+ sc!/o.ren!e n+ s+n( %a! &er!c+"oO!
    decA( ce! d!n &o&+"a=!a $enera"7.
    Procen(+" de co%or'!d!(a(e c+ (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 es(e %are.
    De&enden=a de n!co(!n7 es(e e<(re% de r!d!ca(7, c+ es(!%7r! %er$And de "a GLd "a
    FLd "a !nd!v!/!! c+ sc!/o.ren!e care s+n( .+%7(or! +/+a"! de =!$are(e, :n &"+s, aceO(!
    !nd!v!/! (!nd a .+%a e<ces!v de %+"( O! de a &re.era =!$are(e"e c+ con=!n+( cresc+( de
    n!co(!n7. Co%or'!d!(a(ea c+ (+"'+r7r!"e an<!oase s4a cons(a(a(, de ase%enea, c7 es(e
    cresc+(7 :n sc!/o.ren!e, :n s&ec!a", &rocen(e"e de (+"'+rare o'ses!vo4co%&+"s!v7 s!
    de &an!c7 s+n( %a! cresc+(e "a !nd!v!/!! c+ sc!/o.ren!e co%&ara(!v c+ &o&+"a=!a
    $enera"7. T+"'+rarea de &ersona"!(a(e &arano!d7, sc!/o!d7 sa+ sc!/o(!&a"7 &oa(e
    &recede +neor! de'+(+" sc!/o.ren!e!. N+ es(e c"ar dac7 aces(e (+"'+r7r! de
    &ersona"!(a(e s+n( n+%a! &rodro%e a"e sc!/o.ren!e! sa+ dac7 s+n( (+"'+r7r!
    an(er!oare se&ara(e.
    Sc%i(o$ren
    ia
    4+<
    Un r!sc cresc+( de sc!/o.ren!e a .os( cons(a(a( :n asoc!ere c+ .ac(or!! &rena(a"! s!
    d!n co&!"7r!e Ede e<., e<&+nerea &rena(a"7 "a $r!&7, "a .oa%e, co%&"!ca=!!"e
    o's(e(r!ca"e, !n.ec=!!"e s!s(e%+"+! nervos :n %!ca co&!"7r!eJ.
    9ate de laborator asociate. N+ a+ .os( !den(!.!ca(e n!c! +n .e" de da(e de
    "a'ora(or ca .!!nd d!a$nos(!ce &en(r+ sc!/o.ren!e. O d!vers!(a(e de da(e d!n s(+d!!"e
    de ne+ro!%a$!s(!c7, ne+ro&s!o"o$!e O! ne+ro.!/!o"o$!e a+ ar7(a( e<!s(en=a +nor
    d!.eren=e :n(re $r+&+r!"e de !nd!v!/! c+ sc!/o.ren!e s! s+'!ec=!! de con(ro", :n
    "!(era(+ra de ne+ro!%a$!s(!c7 s(r+c(+ra"7, cea %a! %+"( s(+d!a(7 O! cea %a!
    concordan(7 cons(a(are re&rod+s7 con(!n+7 s7 .!e "7r$!rea ven(r!c+"!"or "a(era"!.
    M+"(e s(+d!! a+ de%ons(ra(, de ase%enea, red+cerea =es+(+"+! cere'ra" ev!den=!a(7
    &r!n "7r$!rea s+"c!"or cor(!ca"! s! d!%!n+area vo"+%+"+! s+'s(an=e! cen+O!! O! a"'e.
    E<!s(7 :ns7 o con(rovers7 crescAnd7 re.er!(oare "a .a&(+" dac7 red+cerea a&aren(7 a
    =es+(+"+! cere'ra" es(e +n &roces .oca" sa+ +n &roces %a! d!.+/, :n e<a%!narea &e
    re$!+n! Ea cre!er+"+!J, s4a cons(a(a( c7 "o'+" (e%&ora" es(e re&era( :n %od cons(an(
    ca .!!nd red+s ca vo"+%, :n (!%& ce "o'+" .ron(a" es(e !%&"!ca( %a! &+=!n, :n cadr+"
    "o'+"+! (e%&ora", e<!s(7 &ro'a +nor ano%a"!! .oca"e :n s(r+c(+r!"e (e%&ora"e
    %ed!a"e E!&oca%&, a%!$da"a s! cor(e<+" en(or!na"J, &rec+% s! :n $!r+s+" (e%&ora"
    s+&er!or O! &"an+% (e%&ora"e care a+ .os( cons(a(a(e :n %od cons(an( a .! red+se ca
    vo"+%. Red+cerea vo"+%+"+! (a"a%+s+"+! a .os( o'serva(7, de ase%enea, a(A( "a
    !nd!v!/!! c+ sc!/o.ren!e, cA( O! "a r+de"e "or de $rad+" I nea.ec(a(e, dar e<!s(7 &+=!ne
    s(+d!! re.er!(oare "a aces(a. A"(7 cons(a(are care a .os( :n %od cons(an( re&rod+s7
    es(e aceea a d!%ens!+n!! cresc+(e a $an$"!on!"or 'a/a"!, dar e<!s(7 (o( %a! %+"(e
    &ro'e c7 aceas(a es(e +n e&!.eno%en a" (ra(a%en(+"+! c+ ne+ro"e&(!ce (!&!ce. La
    !nd!v!/!! c+ sc!/o.ren!e a .os( de%ons(ra(7, de ase%enea, o !nc!den=7 cresc+(7 a
    +n+! cav+% se&(+% &e""+c!d! %are. Aces(a &oa(e avea !%&"!ca=!! .!/!o&a(o"o$!ce
    !%&or(an(e, deoarece es(e s+$es(!v7 de o ano%a"!e &recoce Ead!c7 &rena(a"7J
    !%&"!cAnd de/vo"(area .or%a=!+n!"or "!n!e! %ed!ane a cre!er+"+!, "a ce" &+=!n +n
    s+'$r+& de !nd!v!/! c+ sc!/o.ren!e.
    :n (er%en!! s(+d!!"or de !%a$!s(!c7 cere'ra"7 .+nc=!ona"7, !&o.rona"!(a(ea Ead!c7,
    red+cerea re"a(!v7 a ."+<+"+! san$+!n cere'ra", a %e(a'o"!s%+"+! sa+ a a"(or
    re&re/en(an=! a! ac(!v!(7=!! ne+rona"eJ con(!n+7 s7 .!e cea %a! cons(an(7 cons(a(are
    re&"!ca(7. E<!s(7 :ns7 o rec+noaO(ere crescAnd7 a .a&(+"+! c7 n+ es(e &os!'!" ca
    ano%a"!!"e .+nc=!ona"e s7 .!e "!%!(a(e "a o an+%!(7 re$!+ne cere'ra"7, ce"e %a! %+"(e
    d!n(re s(+d!!"e recen(e s+$erAnd ano%a"!! d!.+/e !%&"!cAnd s! c!rc+!(e"e cor(!co4
    s+'cor(!ca"e.
    De.!c!(e"e ne+ro &sd!o"o$!ce s+n( o cons(a(are cons(an(7 "a $r+&+r!"e de
    !nd!v!/! c+ sc!/o.ren!e. De.!c!(e"e s+n( ev!den(e &e sec=!+ne (ransversa"7 &r!n(r4o
    ser!e de a'!"!(7=! co$n!(!ve !nc"+/And %e%or!a, a'!"!(7=!"e &s!o%o(or!!, a(en=!a O!
    d!.!c+"(a(ea :n sc!%'area se(+"+! de r7s&+ns. Pe "An$7 &re/en=a aces(or de.!c!(e "a
    !nd!v!/!! s+.er!nd cron!c de sc!/o.ren!e, e<!s(7 (o( %a! %+"(e &ro'e c7 %+"(e d!n(re
    aces(e de.!c!(e se cons(a(7 "a !nd!v!/! :n c+rs+" &r!%+"+! "or e&!sod &s!o(!c O!
    an(er!or (ra(a%en(+"+! c+ %ed!ca%en(e an(!&s!o(!ce, "a !nd!v!/!! c+ sc!/o.ren!e
    care se a."7 :n re%!s!+ne c"!n!c7, &rec+% s! "a r+de"e de $rad+" I !nde%ne. Pen(r+
    aces(e %o(!ve, +ne"e d!n(re de.!c!(e"e ne+ro&s!o"o$!ce s+n( cons!dera(e a re."ec(a
    e"e%en(e %a! .+nda%en(a"e a"e %a"ad!e! O!, &oa(e, a reve"a .ac(or!! de
    v+"nera'!"!(a(e &en(r+ sc!/o.ren!e. Aces(e de.!c!(e s+n( !%&or(an(e c"!n!c &r!n aceea
    c7 s+n( :n "e$7(+r7 c+ $rad+" de d!.!c+"(a(e &e care an+%!=! !nd!v!/! c+ sc!/o.ren!e
    :" a+ :n ac(!v!(7=!"e co(!d!ene, &rec+% s! :n a'!"!(a(ea de a c7&7(a a&(!(+d!n! :n
    ;LR
    Sc%i(o$renia ,i Alte Tulburri #si%otice

    rea'!"!(area soc!a"7, :n consec!n=7, sever!(a(ea de.!c!(e"or ne+ro&s!o"o$!ce es(e +n
    re"a(!v &+(ern!c &red!c(or a" de/nod7%An(+"+! soc!a" s! &ro.es!ona".
    La $r+&+r!"e de !nd!v!/! c+ sc!/o.ren!e a+ .os( &+se :n ev!den=7 d!verse
    ano%a"!! ne+ro.!/!o"o$!ce. Pr!n(re ce"e %a! c+nosc+(e s+n( de.!c!(e"e :n &erce&=!a s!
    &rocesarea s(!%+"!"or sensor!a"! Ede e<., de(er!orarea .eno%en+"+! de &oar(7
    sen/or!a"7J, %!Oc7r!"e oc+"are "en(e s! %!Oc7r!"e oc+"are sacad!ce anor%a"e,
    :nce(!n!rea (!%&+"+! de reac=!e, a"(er7r!"e "a(era"!(7=!! cere'ra"e s! ano%a"!!"e
    &o(en=!a"e"or evoca(e &e e"ec(roence.a"o$ra%7.
    De ase%enea, &o( .! no(a(e da(e de "a'ora(or anor%a"e, .!e ca o co%&"!ca=!e a
    sc!/o.ren!e!, .!e a (ra(a%en(+"+! s7+. Un!! !nd!v!/! c+ sc!/o.ren!e 'ea+ can(!(7=!
    %ar! de "!c!de ES!n(o<!ca=!a c+ a&7TJ s! &re/!n(7 ano%a"!! a"e dens!(7=!! s&ec!.!ce a
    +r!n!! sa+ de/ec!"!'re e"ec(ro"!(!ce. N!ve"e cresc+(e a"e crea(!n.os.o)!na/e! ECP-J
    &o( re/+"(a d!n s!ndro%+" ne+ro"e&(!c %a"!$n Eve/! &a$, HFYJ
    9atele examinrii somatice /i condi3iile medicale .enerale. Ind!v!/!! c+
    sc!/o.ren!e s+n( +neor! d!s&"as(!c! .!/!c s! &o( &re/en(a se%ne ne+ro"o$!ce
    Sd!scre(eT Eso.(J c+% ar .! con.+/!a s(An$aXdrea&(a, coordonarea red+s7 sa+ se%n+"
    o$"!n/!!. Une"e ano%a"!! so%a(!ce %!nore Ede e<., 'o"(7 &a"a(!n7 e<(re% de arc+!(7,
    .an(e &a"&e'ra"e :n$+s(e sa+ "ar$!, or! %a".or%a=!! d!scre(e a"e +rec!"orJ &o( .! %a!
    .recven(e &r!n(re !nd!v!/!! c+ sc!/o.ren!e. Ce"e %a! .recven(e cons(a(7r! so%a(!ce
    asoc!a(e s+n(, &oa(e, ano%a"!!"e %o(or!!. Ce"e %a! %+"(e d!n(re aces(ea s+n( &ro'a'!"
    :n "e$7(+r7 c+ e.ec(e"e adverse a"e (ra(a%en(+"+! c+ %ed!ca%en(e an(!&s!o(!ce.
    Ano%a"!!"e %o(or!! sec+ndare (ra(a%en(+"+! ne+ro"e&(!c !nc"+d d!s)!ne/!a (ard!v7
    !nd+s7 de ne+ro"e&(!ce Eve/! &a$. GL;J, &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce Eve/!
    &a$. HF9J, .a)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce Eve/! &a$. GLLJ, d!s(on!a ac+(7
    !nd+s7 de ne+ro"e&(!ce Eve/! &a$. HFGJ s! s!ndro%+" ne+ro"e&(!c %a"!$n Eve/! &a$.
    HFYJ. Ano%a"!!"e %o(or!! s&on(ane s+n( ase%7n7(oare ce"or care &o( .! !nd+se de
    ne+ro"e&(!ce Ede e<., &+.n!(+", c"onc7n!(+" Z$"oc!(a=!a "!%'!![, %+r%+ra(+"J a+ .os(
    descr!se :n era &rene+ro"e&(!c7 O! s+n( :nc7 o'serva(e, deO! e"e &o( .! d!.!c!" de d!s(!ns
    de e.ec(e"e ne+ro"e&(!ce. A"(e cons(a(7r! so%a(!ce &o( .! :n ra&or( c+ (+"'+r7r!"e
    asoc!a(e :n %od .recven(. De e<e%&"+, deoarece de&enden(a de n!co(!n7 es(e a(A( de
    .recven(7 :n sc!/o.ren!e, es(e .oar(e &os!'!" ca aceO(! !nd!v!/! s7 de/vo"(e o &a(o"o$!e
    :n "e$7(+r7 c+ .+%a(+" Ede e<., e%.!/e% O! a"(e &ro'"e%e &+"%onare s! card!aceJ.
    *lemente speci$ice culturii, etii si sexului
    C"!n!c!en!!, care eva"+ea/7 s!%&(o%e"e sc!/o.ren!e! :n s!(+a=!! soc!oecono%!ce
    sa+ c+"(+ra"e d!.er!(e de ce"e a"e "or, (re'+!e s7 !a :n cons!dera=!e d!.eren=e"e
    c+"(+ra"e. Ide! care &o( &are a .! de"!ran(e :n(r4o c+"(+r7 Ede e<., %a$!a nea$r7 s!
    .ar%ece"eJ &o( .! cons!dera(e ca nor%a"e :n a"(a. :n +ne"e c+"(+r!, a"+c!na=!!"e
    v!/+a"e sa+ a+d!(!ve c+ con=!n+( re"!$!os &o( .! o &ar(e nor%a"7 a e<&er!en=e!
    re"!$!oase Ede e<., vederea Fec!oare! M7r!a sa+ a+/!rea voc!! "+! D+%ne/e+J, :n &"+s,
    eva"+area "!%'a@+"+! de/or$an!/a( &oa(e .! d!.!c!"7 d!n ca+;a d!vers!(7=!! "!n$v!s(!ce
    :n s(!"+r!"e nara(!ve a (ransverso &r!n d!verse"e c+"(+r!, ceea ce a.ec(ea/7 .or%a
    "o$!c7 a &re/en(7r!! ver'a"e. Eva"+area a.ec(+"+! neces!(7 sens!'!"!(a(e "a d!.eren=e"e
    :n s(!"+r!"e e<&res!e! e%o=!ona"e, con(ac(+" v!/+a" s! "!%'a@+" cor&ora", care d!.er7 :n
    d!verse"e c+"(+r!. Dac7 eva"+area es(e .7c+(7 :n(r4+n "!%'a@ d!.er!( de "!%'a@+"
    &r!%ar a" !nd!v!d+"+!, (re'+!e as!$+ra( .a&(+" c7 a"o$!a n+ es(e :n ra&or( c+ 'ar!ere"e
    "!n$v!s(!ce. Deoarece se%n!.!ca=!a c+"(+ra"7 a ac(!v!(7=!! a+(o!n!=!a(e s! or!en(a(e s&re
    Sc%i(o$ren
    ia
    4+G

    +n sco& es(e de aO(e&(a( s7 var!e/e :n d!verse s!(+a=!!, (+"'+r7r!"e de vo!n=7 (re'+!e,
    de ase%enea, s7 .!e eva"+a(e c+ a(en=!e.
    E<!s(7 +ne"e !nd!c!!, c+% c7 c"!n!c!en!! a+ (end!n=a de a s+&rad!a$nos(!ca
    sc!/o.ren!a "a +ne"e $r+&+r! e(n!ce. S(+d!!"e e.ec(+a(e :n Re$a(+" Un!( O! S(a(e"e
    Un!(e s+$erea/7 c7 sc!/o.ren!a &oa(e .! d!a$nos(!ca(7 %a! .recven( "a !nd!v!/!!
    a.roa%er!can! O! as!oa%er!can! decA( "a a"(e $r+&+r! ras!a"e. N+ es(e c"ar :ns7, dac7
    aces(e da(e re&re/!n(7 d!.eren=e rea"e :n(re $r+&+r!"e ras!a"e sa+ dac7 s+n( re/+"(a(+"
    &re@+dec7=!! c"!n!c!an+"+! sa+ !nsens!'!"!(7=!! c+"(+ra"e. D!.eren=e c+"(+ra"e a+ .os(
    no(a(e s! :n (a'"o+" c"!n!c, evo"+=!a s! de/nod7%An(+" sc!/o.ren!e!.
    Co%&or(a%en(+" ca(a(on!c a .os( descr!s re"a(!v rar &r!n(re !nd!v!/!! c+ sc!/o.ren!e
    d!n S(a(e"e Un!(e, dar es(e %a! .recven( :n =7r!"e nonves(!ce. Ind!v!/!! c+
    sc!/o.ren!e d!n =7r!"e :n c+rs de de/vo"(are (!nd a avea o evo"+=!e %a! ac+(7 O! +n
    de/nod7%An( %a! '+n decA( !nd!v!/!! d!n =7r!"e !nd+s(r!a"!/a(e.
    De'+(+" sc!/o.ren!e! are "oc de re$+"7 :n(re +"(!%a &ar(e a ado"escen=e! O!
    %!@"oc+" an!"or ;L, de'+(+" an(er!or ado"escen=e! .!!nd rar EdeO! a+ .os( ra&or(a(e
    ca/+r! c+ de'+( "a e(a(ea de Y4R an!J. E"e%en(e"e esen=!a"e a"e cond!=!e! s+n( ace"eaO!
    O! "a co&!!, :ns7 &oa(e .! e<(re% de d!.!c!" s7 se &+n7 d!a$nos(!c+" "a aceas(7 $r+&7 de
    e(a(e. La co&!!, !de!"e de"!ran(e s! a"+c!na=!!"e &o( .! %a! &+=!n e"a'ora(e decA( "a
    ad+"=!, !ar a"+c!na=!!"e v!/+a"e &o( .! %a! .recven(e. L!%'a@+" de/or$an!/a( es(e
    o'serva( :n(r4+n n+%7r de (+"'+r7r! c+ de'+( :n co&!"7r!e Ede e<., (+"'+r7r!"e de
    co%+n!care, (+"'+r7r!"e de de/vo"(are &ervas!v7J, d+&7 c+% es(e o'serva( O!
    co%&or(a%en(+" de/or$an!/a( Ede e<., (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e,
    %!Ocarea s(ereo(!&7J. Aces(e s!%&(o%e n+ (re'+!e s7 .!e a(r!'+!(e sc!/o.ren!e!, .7r7
    a se "+a :n cons!dera=!e .a&(+" c7 aces(e (+"'+r7r! s+n( %a! .recven(e :n co&!"7r!e.
    Sc!/o.ren!a &oa(e de'+(a, de ase%enea, %a! (Ar/!+ :n v!a=7 Ede e<., d+&7 e(a(ea de
    IY de an!J. Ca/+r!"e de sc!/o.ren!e c+ de'+( (ard!v (!nd a .! s!%!"are c+ sc!/o.ren!a
    c+ de'+( &recoce, deO! a+ .os( o'serva(e +n n+%7r de d!.eren=e. De e<e%&"+,
    &rocen(+" de .e%e! es(e %a! %are, !ar &rocen(+" de !nd!v!/! c+ de'+( (ard!v care a+
    .os( c7s7(or!=! es(e &os!'!" s7 .!e %a! %are decA( :n ca/+" !nd!v!/!"or c+ de'+(
    &recoce8 c+ (oa(e c7 de'+(+" s+rv!ne (ard!v, aceO(! !nd!v!/! s+n( %a! !/o"a=! soc!a" O!
    %a! de(er!ora=! co%&ara(!v c+ &o&+"a=!a $enera"7. Fac(or! c"!n!c!, c+% ar .! s(area de
    &os(%eno&a+/7, s+'(!&+r!"e de an(!$en "e+coc!(ar +%an O! %a"ad!a
    cere'rovasc+"ar7 s+n( .ac(or! de r!sc &os!'!"!. Es(e .oar(e &ro'a'!" ca (a'"o+" c"!n!c s7
    !nc"+d7 !de! de"!ran(e de &ersec+=!e O! a"+c!na=!!, s! %a! &+=!n &ro'a'!" s7 !nc"+d7
    s!%&(o%e de de/or$an!/are O! s!%&(o%e ne$a(!ve. Adesea evo"+=!a es(e
    carac(er!/a(7 &r!n(r4o &redo%!nare a s!%&(o%e"or &o/!(!ve c+ &re/ervarea a.ec(+"+!
    O! .+nc=!on7r!! soc!a"e. Evo"+=!a es(e de re$+"7 cron!c7, deO! !nd!v!/!! &o( r7s&+nde
    .oar(e '!ne "a %ed!ca=!a an(!&s!o(!c7 :n do/e %!c!. Pr!n(re ce! c+ e(a(e %a! avansa(7
    "a de'+( Ead!c7, &es(e e(a(ea de RL an! "a de'+(J de.!c!(e"e sen/or!a"e Ede e<.,
    &!erderea a+/+"+! sa+ a veder!!J s+rv!n %a! .recven( decA( :n &o&+"a=!a $enera"7,
    :ns7 ro"+" s&ec!.!c a" aces(or de.!c!(e :n &a(o$ene/7 r7%Ane nec+nosc+(. De
    ase%enea, e<!s(7 &ro'e &rec+% c7 de(er!orarea co$n!(!v7 aco%&an!a/7 (a'"o+"
    c"!n!c. Pro'"e%a dac7 &a(o"o$!a cere'ra"7 !den(!.!ca'!"7 carac(er!/ea/7 %a"ad!a c+
    de'+( (ard!v r7%Ane nec"ar7.
    Pro'e d!n(r4+n "ar$ cor& de "!(era(+r7 de%ons(rea/7 c7 sc!/o.ren!a se %an!.es(7
    d!.er!( "a '7r'a=! O! "a .e%e!. E(a(ea .or%a"7 "a de'+( &en(r+ '7r'a=! es(e c+&r!ns7
    :n(re 5G s! 9Y an!, !ar &en(r+ .e%e! :n(re 9Y an! s! @+%7(a(ea an!"or ;L. D!s(r!'+=!a e(7=!!
    "a de'+( es(e '!%oda"7 "a .e%e!, c+ +n a" do!"ea &!c s+rven!nd (Ar/!+ :n v!a=7, dar
    +n!%oda"7 "a '7r'a=!. A&ro<!%a(!v ;d45Ld d!n(re .e%e! a+ o e(a(e "a de'+( de &es(e
    4+>
    Sc%i(o$renia ,i Alte Tulburri #si%otice

    IL an!, &e cAnd "a '7r'a=! de'+(+" (ard!v es(e %+"( %a! &+=!n .recven(. De ase%enea,
    .e%e!"e a+ o .+nc=!onare &re%or'!d7 %a! '+n7 decA( '7r'a=!!. Fe%e!"e (!nd s7
    &re/!n(e o s!%&(o%a(o"o$!e %a! a.ec(!v7, !de! de"!ran(e E&arano!deJ s! a"+c!na=!!, &e
    cAnd '7r'a=!! (!nd s7 &re/!n(e %a! %+"( s!%&(o%e ne$a(!ve Ea.ec( &"a(, avo"!=!e,
    re(ra$ere soc!a"7J. Re.er!(or "a evo"+=!a sc!/o.ren!e!, .e%e!"e a+ +n &ro$nos(!c %a!
    '+n decA( '7r'a=!!, d+&7 c+% !nd!c7 n+%7r+" re!n(ern7r!"or, "+n$!%ea Oeder!"or :n
    s&!(a", d+ra(a $"o'a"7 a %a"ad!e!, &er!oade"e de rec7dere, r7s&+ns+" "a ne+ro"e&(!ce
    s! .+nc=!onarea &ro.es!ona"7 s! soc!a"7. C+ (oa(e aces(ea, avan(a@+" se<+"+! :n aceO(!
    &ara%e(r!! &are a se a(en+a :n(r4o an+%!(7 %7s+r7 oda(7 c+ avansarea :n e(a(e Ede
    e<., de/nod7%An(+" &e (er%en sc+r( O! &e (er%en %ed!+ es(e %a! '+n "a .e%e!, dar
    de/nod7%An(+" &e (er%en "+n$ "a .e%e!, :n s&ec!a" :n &er!oada &os(%eno&a+/7
    dev!ne s!%!"ar c+ ce" a" '7r'a=!"or. O !nc!den=7 +Oor cresc+(7 a sc!/o.ren!e! a .os(
    o'serva(7 "a '7r'a=! co%&ara(!v c+ .e%e!"e, :n a.ar7 de aceas(a, o ser!e de s(+d!! a+
    de%ons(ra( e<!s(en=a +nor d!.eren=e :n(re se<e re.er!(oare "a (rans%!s!a $ene(!c7 a
    sc!/o.ren!e!. Procen(+" de sc!/o.ren!e "a %e%'r!! de .a%!"!e a! .e%e!"or c+
    sc!/o.ren!e es(e %a! %are decA( ce" a" %e%'r!"or de .a%!"!e a! '7r'a=!"or sc!/o.ren!,
    &e cAnd r+de"e '7r'a=!"or &re/!n(7 o !nc!den=7 %a! %are a (r7s7(+r!"or de
    &ersona"!(a(e sc!/o!d7 O! sc!/o(!&a"7 decA( r+de"e .e%e!"or.
    #revalent
    Sc!/o.ren!a a .os( o'serva(7 :n :n(rea$a "+%e. Preva"en(a &r!n(re ad+"=! es(e
    ra&or(a(7 adesea a se s!(+a :n(re L,Yd O! 5,Yd. Inc!den=a an+a"7 se s!(+ea/7 ce" %a!
    .recven( :n(re L,Y s! Y "a 5L.LLL. Es(!%7r! a"e !nc!den=e! &es(e aces( do%en!+ a+ .os(
    ra&or(a(e &en(r+ +ne"e $r+&+r! &o&+"a=!ona"e 4 de e<., o !nc!den=7 .oar(e r!d!ca(7 "a
    cea de a do+a $enera=!e de a.rocara!'!en! s(a'!"!=! :n Re$a(+" Un!(.
    S(+d!!"e e.ec(+a(e &e coor(a naO(er!! s+$erea/7 +ne"e var!a=!! $eo$ra.!ce O!
    !s(or!ce :n !nc!den=7. De e<e%&"+, +n r!sc cresc+( a .os( cons(a(a( &r!n(re !nd!v!/!!
    n7sc+=! :n %ed!+" +r'an co%&ara(!v c+ ce! n7sc+=! :n %ed!+" r+ra", &rec+% O! +n
    dec"!n $rad+a" a" !nc!den=e! "a ce! d!n coor(e"e de naO(ere %a! recen(e.
    *voluie
    E(a(ea %ed!e "a de'+( &en(r+ &r!%+" e&!sod &s!o(!c de sc!/o.ren!e se s!(+ea/7
    :n(re :nce&+(+" s! %!@"oc+" an!"or 9L &en(r+ '7r'a=!, s! :n +"(!%a &ar(e a an!"or 9L
    &en(r+ .e%e!. De'+(+" &oa(e .! 'r+sc sa+ !ns!d!os, dar %a@or!(a(ea !nd!v!/!"or
    &re/!n(7 +n (!& de .a/7 &rodro%a"7 cons(And d!n de/vo"(area "en(7 s! &ro$res!v7 a
    +ne! d!vers!(7=! de se%ne O! s!%&(o%e Ede e<., re(ra$ere soc!a"7, &!erderea
    !n(eres+"+! &en(r+ Ocoa"7 sa+ serv!c!+, de(er!orarea !$!ene! O! =!n+(e!, co%&or(a%en(
    !nso"!(, accese co"eroaseJ. Me%'r!! .a%!"!e! &o( cons!dera aces( co%&or(a%en( d!.!c!"
    de !n(er&re(a( s! &res+&+n c7 &ersoana res&ec(!v7 S(rece &r!n(r4o )a;6S, :n ce"e d!n
    +r%7, :ns7, a&ar!=!a +n+! s!%&(o% a" .a/e! ac(!ve %arcea/7 &er(+r'area ca
    sc!/o.ren!e. E(a(ea "a de'+( &oa(e avea, a(A( se%n!.!ca=!e .!/!o&a(o"o$!c7, cA( O!
    &ro$nos(!c7. Ind!v!/!! c+ o e(a(e %a! %!c7 "a de'+( s+n( ce" %a! adesea '7r'a=! O! a+
    o ada&(are &re%or'!d7 %a! rea, &er.or%an=7 ed+ca=!ona"7 %a! sc7/+(7, ano%a"!!
    s(r+c(+ra"e cere'ra"e %a! ev!den(e, se%ne s! s!%&(o%e ne$a(!ve %a! &roe%!nen(e,
    de(er!orare co$n!(!v7 %a! ev!den(7, d+&7 c+% re!ese "a (es(area ne+ro&s!o"o$!c7, s!
    +n de/nod7%An( %a! r7+. Invers, !nd!v!/!! c+ de'+( %a! (ard!v s+n( ce" %a! adesea
    .e%e!, a+ ano%a"!! s(r+c(+ra"e cere'ra"e sa+ de(er!orare co$n!(!v7 %a! &+=!n
    ev!den(e, O! a+, de ase%enea, +n de/nod7%An( %a! '+n.
    Sc%i(o$ren
    ia
    +E4
    Ce"e %a! %+"(e s(+d!! des&re evo"+=!a s! de/nod7%An(+" sc!/o.ren!e!, s+$erea/7
    c7 evo"+=!a &oa(e .! var!a'!"7, +n!! !nd!v!/! &re/en(And e<acer'7r! s! re%!s!+n!, &e
    cAnd a"=!! r7%An s+.er!n/! cron!c!. D!n ca+/a d!vers!(7=!! :n de.!n!re s! s(a'!"!re, o
    e<&+nere e<ac(7 a de/nod7%An(+"+! sc!/o.ren!e! &e (er%en "+n$ n+ es(e &os!'!"7.
    Re%!s!+nea co%&"e(7 Ead!c7, o reven!re "a n!ve"+" &re%or'!d de ac(!v!(a(eJ es(e
    &ro'a'!" rar7 :n aceas(7 (+"'+rare. D!n(re ce! care r7%An s+.er!n/!, +n!! &ar a avea o
    evo"+=!e re"a(!v s(a'!"7, &e cAnd a"=!! &re/!n(7 o :nr7+(7=!re &ro$res!v7 asoc!a(7 c+ o
    !nca&ac!(a(e sever7. La :nce&+(+" %a"ad!e!, s!%&(o%e"e ne$a(!ve &o( .! &ron+n=a(e,
    a&7rAnd !n!=!a" ca e"e%en(e &rodro%a"e. U"(er!or a&ar O! s!%&(o%e"e &o/!(!ve.
    Pen(r+ c7 aces(e s!%&(o%e &o/!(!ve s+n( e<(re% de sens!'!"e "a (ra(a%en(, e"e, de
    re$+"7, d!%!n+a, :ns7 "a %+"=! !nd!v!/!, s!%&(o%e"e ne$a(!ve &ers!s(7 :n(re
    e&!soade"e de s!%&(o%e &o/!(!ve. E<!s(7 +ne"e !nd!c!! c7 s!%&(o%e"e ne$a(!ve &o(
    deven! c+ cer(!(+d!ne %a! &ron+n=a(e "a +n!! !nd!v!/! :n c+rs+" %a"ad!e!. N+%eroase
    s(+d!! a+ !nd!ca( +n $r+& de .ac(or! care s+n( asoc!a=! c+ +n &ro$nos(!c %a! '+n.
    AceO(!a !nc"+d ada&(area &re%or'!d7 '+n7, de'+(+" ac+(, e(a(ea %a! %are "a de'+(,
    a'sen=a anoso$no/!e! E"!&sa conO(!!n=e! (+"'+r7r!!J, a .! .e%e!e, even!%en(e"e
    &rec!&!(an(e, &er(+r'area a.ec(!v7 asoc!a(7, (ra(a%en(+" c+ an(!&s!o(!ce :nda(7 d+&7
    de'+(+" (+"'+r7r!!, co%&"!an=a con(!n+7 "a (ra(a%en( Ead!c7, (ra(a%en(+" &recoce O!
    con(!n++ &red!c(ea/7 +n r7s&+ns %a! '+n "a (ra(a%en(+" c+ %ed!ca%en(e
    an(!&s!o(!ce de %a! (Ar/!+J, d+ra(a sc+r(7 a s!%&(o%e"or .a/e! ac(!ve, .+nc=!onarea
    !n(ere&!sod!c7 '+n7, s!%&(o%e re/!d+a"e %!n!%e, a'sen=a ano%a"!!"or s(r+c(+ra"e
    cere'ra"e, .+nc=!onarea ne+ro"o$!c7 nor%a"7, +n !s(or!c .a%!"!a" de (+"'+rare a.ec(!v7
    s! n!c! +n !s(or!c .a%!"!a" de sc!/o.ren!e.
    #attern $amilial
    R+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ sc!/o.ren!e a+ +n r!sc de
    sc!/o.ren!e care es(e de a&roa&e /ece or! %a! %are decA( ce" a" &o&+"a=!e! $enera"e.
    Ra(e"e de concordan=7 &en(r+ sc!/o.ren!e s+n( %a! %ar! "a $e%en!! %ono/!$o(!
    decA( "a $e%en!! d!/!$o=!. S(+d!!"e &e ado&(a=! a+ ar7(a( c7 r+de"e '!o"o$!ce a"e
    !nd!v!/!"or c+ sc!/o.ren!e a+ +n r!sc cresc+( &en(r+ sc!/o.ren!e, &e cAnd r+de"e
    ado&(!ve n+. DeO! %+"(e da(e s+$erea/7 !%&or(an=a .ac(or!"or $ene(!c! :n e(!o"o$!a
    sc!/o.ren!e!, e<!s(en=a +ne! ra(e d!scordan(e cons!dera'!"e :n(re $e%en!! %ono/!$o(!
    !nd!c7, de ase%enea, !%&or(an=a .ac(or!"or de %ed!+. Une"e r+de a"e !nd!v!/!"or c+
    sc!/o.ren!e &o( avea, de ase%enea, +n r!sc cresc+( &en(r+ +n $r+& de (+"'+r7r!
    %en(a"e, den+%!( c+ (er%en+" de spectr+ al sc-i;o)reniei7 DeO! "!%!(e"e e<ac(e a"e
    s&ec(r+"+! r7%An nec"are, s(+d!!"e .a%!"!a"e O! &e ado&(a=! s+$erea/7 c7 aces(a
    !nc"+de &ro'a'!" (+"'+rarea sc!/oa.ec(!v7 O! (+"'+rarea sc!/o(!&a"7. A"(e (+"'+r7r!
    &s!o(!ce O! (+"'+r7r!"e de &ersona"!(a(e &arano!d7, sc!/o!d7 O! ev!(an(7 &o( a&ar=!ne,
    de ase%enea, s&ec(r+"+! sc!/o.ren!e!, dar e<!s(7 &+=!ne &ro'e :n aces( sens.
    Dia!nostic di$erenial
    O %are var!e(a(e de cond!=!! %ed!ca"e $enera"e se &oa(e &re/en(a c+ s!%&(o%e
    &s!o(!ce. T+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    de"!r!+%+" sa+ de%en=a s+n( d!a$nos(!ca(e cAnd e<!s(7 da(e d!n !s(or!c, e<a%en+"
    so%a(!c sa+ (es(e"e de "a'ora(or care !nd!c7 .a&(+" c7 !de!"e de"!ran(e sa+ a"+c!na=!!"e
    s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ede e<., s!ndro%
    C+s!n$, (+%or7 cere'ra"7J Eve/! &a$. ;;IJ. T+"'+rarea &s!o(!c7 !nd+s7 de o
    s+'s(an=7, de"!r!+%+" !nd+s de o s+'s(an=7 O! de%en=a &ers!s(en(7 !nd+s7 de o
    4*+
    Sc%i(o$renia si Alte Tulburri #si%otice
    s+'s(an=7 se d!s(!n$ de sc!/o.ren!e &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n dro$ de
    a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n
    "e$7(+r7 c+ !de!"e de"!ran(e sa+ c+ a"+c!na=!!"e Eve/! &a$. ;;GJ. M+"(e (!&+r! d!.er!(e
    de (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 &o( &rod+ce s!%&(o%e s!%!"are ce"or a"e
    sc!/o.ren!e! Ede e<., +/+" &re"+n$!( de a%.e(a%!na sa+ de coca!n7 &oa(e &rod+ce
    !de! de"!ran(e sa+ a"+c!na=!!8 +/+" de &encyc"!d!n7 &oa(e &rod+ce o %!<(+r7 de
    s!%&(o%e &o/!(!ve sa+ ne$a(!veJ. Pe 'a/a d!vers!(7=!! e"e%en(e"or care
    carac(er!/ea/7 evo"+=!a sc!/o.ren!e! s! a (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7,
    c"!n!c!an+" (re'+!e s7 &rec!/e/e dac7 s!%&(o%e"e &s!o(!ce a+ .os( !n!=!a(e s!
    %en=!n+(e de +/+" de o s+'s(an=7, :n %od !dea", c"!n!c!an+" (re'+!e s7 :ncerce s7
    o'serve !nd!v!d+" :n c+rs+" +ne! &er!oade &re"+n$!(e de a's(!nen=7 Ede e<., I
    s7&(7%An!J. Deoarece as(.e" de &er!oade &re"+n$!(e de a's(!nen=7 s+n( adesea d!.!c!"
    de rea"!/a(, c"!n!c!an+" &oa(e .! o'"!$a( s7 !a :n cons!dera=!e a"(e da(e, c+% ar .! .a&(+"
    dac7 s!%&(o%e"e &s!o(!ce &ar a .! e<acer'a(e de o s+'s(an=7 s! d!%!n+a cAnd aceas(a
    es(e :n(rer+&(7, re"a(!va sever!(a(e a s!%&(o%e"or &s!o(!ce :n ra&or( c+ can(!(a(ea s!
    d+ra(a +/+"+! de s+'s(an=7 O! c+noaO(erea s!%&(o%e"or carac(er!s(!ce &rod+se de o
    an+%!(7 s+'s(an=7 Ede e<., a%.e(a%!na &rod+ce de re$+"7 !de! de"!ran(e s!
    s(ereo(!&!!, dar n+ s! a&"a(!/are a.ec(!v7 sa+ s!%&(o%e ne$a(!ve &roe%!nen(eJ.
    D!s(!n$erea sc!/o.ren!e! de (+"'+rarea a.ec(!v7 c+ e"e%en(e &s!o(!ce s! de
    (+"'+rarea sc!/oa.ec(!v7 es(e d!.!c!"7 d!n ca+/a .a&(+"+! c7 &er(+r'area a.ec(!v7
    es(e .recven(7 :n c+rs+" .a/e"or &rodro%a"7, ac(!v7 s! re/!d+a"7 a"e sc!/o.ren!e!.
    Dac7 s!%&(o%e"e &s!o(!ce s+rv!n e<c"+s!v :n c+rs+" &er!oade"or de &er(+r'are
    a.ec(!v7, d!a$nos(!c+" va .! ce" de (+"'+rare a.ec(!v7 c+ e"e%en(e &s!o(!ce. :n
    (+"'+rarea sc!/oa.ec(!v7, (re'+!e s7 e<!s(e +n e&!sod a.ec(!v care es(e conco%!(en(
    c+ s!%&(o%e"e .a/e! ac(!ve a sc!/o.ren!e!, s!%&(o%e"e a.ec(!ve (re'+!e s7 .!e &re4
    en(e o &or=!+ne cons!dera'!"7 d!n d+ra(a (o(a"7 a &er(+r'7r!!, !ar !de!"e de"!ran(e sa+
    a"+c!na=!"e (re'+!e s7 .!e &re/en(e (!%& de ce" &+=n 9 s7&(7%An!, :n a'sen=a +nor
    s!%&(o%e a.ec(!ve &roe%!nen(e. D!n con(ra, s!%&(o%e"e a.ec(!ve d!n sc!/o.ren!e
    a+, .!e o d+ra(7 sc+r(7 :n ra&or( c+ d+ra(a (o(a"7 a &er(+r'7r!!, s+rv!n n+%a! :n
    .a/e"e &rodro%a"7 sa+ re/!d+a"7, or! n+ sa(!s.ac co%&"e( cr!(er!!"e &en(r+ +n e&!sod
    de&res!v. CAnd s!%&(o%e"e a.ec(!ve care sa(!s.ac co%&"e( cr!(er!!"e &en(r+ +n e&!sod
    a.ec(!v s+n( s+&ra&+se &es(e sc!/o.ren!e s! s+n( de o se%n!.!ca=!e c"!n!c7 s&ec!a"7,
    &oa(e .! &+s d!a$nos(!c+" ad!=!ona" de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e sa+
    de (+"'+rare '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e. Sc!/o.ren!a de (!& ca(a(on!c &oa(e .!
    d!.!c!" de d!s(!ns de (+"'+rarea a.ec(!v7 c+ e"e%en(e ca(a(on!ce.
    Pr!n de.!n!=!e, sc!/o.ren!a d!.er7 de (+"'+rarea sc!/o.ren!.or%7 &e 'a/a
    d+ra(e!. Sc!/o.ren!a !%&"!c7 &re/en=a de s!%&(o%e E!nc"+s!v s!%&(o%e"e
    &rodro%a"e sa+ re/!d+a"eJ (!%& de ce" &+=!n R "+n!, &e cAnd d+ra(a (o(a"7 a
    s!%&(o%e"or :n (+"'+rarea sc!/o.ren!.or%7 (re'+!e s7 .!e de ce" &+=!n o "+n7 s! de
    %a! &+=!n de R "+n!. T+"'+rarea sc!/o.ren!.or%7, de ase%enea, n+ cere +n dec"!n
    :n ac(!v!(a(e. T+"'+rarea &s!o(!c7 sc+r(7 es(e de.!n!(7 &r!n &re/en=a de !de!
    de"!ran(e, a"+c!na=!!, "!%'a@ de/or$an!/a( sa+ co%&or(a%en( ca(a(on!c or! ."a$ran(
    de/or$an!/a( d+rAnd ce" &+=!n o /!, dar %a! &+=!n de o "+n7.
    D!a$nos(!c+" d!.eren=!a" d!n(re sc!/o.ren!e O! (+"'+rarea de"!ran(7 se 'a/ea/7
    &e na(+ra !de!"or de"!ran(e E!de! de"!ran(e non'!/areJ O! &e a'sen=a a"(or s!%&(o%e
    carac(er!s(!ce de sc!/o.ren!e Ede e<., a"+c!na=!!, "!%'a@ sa+ co%&or(a%en(
    de/or$an!/a( sa+ s!%&(o%e ne$a(!ve no(a'!"eJ. T+"'+rarea de"!ran(7 es(e e<(re% de
    d!.!c!" de d!.eren=!a( de (!&+" &arano!d de sc!/o.ren!e, deoarece aces( s+'(!& n+
    !nc"+de "!%'a@+" de/or$an!/a( %arcan(, co%&or(a%en(+" de/or$an!/a( or! a.ec(+"
    Sc%i(o$ren
    ia
    4**

    &"a( sa+ !nadecva( s! adesea es(e asoc!a(7 c+ %a! &+=!n dec"!n :n .+nc=!onare decA(
    es(e carac(er!s(!c ce"or"a"(e s+'(!&+r! de sc!/o.ren!e. CAnd es(e &re/en(7 o
    .+nc=!onare &s!osoc!a"7 red+s7 :n (+"'+rarea de"!ran(7, aceas(a &rov!ne d!rec( d!n
    :nseO! conv!n$er!"e de"!ran(e.
    Un d!a$nos(!c de (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e &oa(e .! &+s dac7 n+
    s+n( d!s&on!'!"e s+.!c!en(e !n.or%a=!! &en(r+ a &+(ea a"e$e :n(re sc!/o.ren!e s! a"(e
    (+"'+r7r! &s!o(!ce Ede e<., (+"'+rarea sc!/oa.ec(!v7J or! &en(r+ a s(a'!"! dac7
    s!%&(o%e"e &re/en(a(e s+n( !nd+se de o s+'s(an=7 or! s+n( re/+"(a(+" +ne! cond!=!!
    %ed!ca"e $enera"e. O as(.e" de !ncer(!(+d!ne es(e .oar(e &os!'!" s7 s+rv!n7 &recoce :n
    evo"+=!a (+"'+r7r!!.
    DeO! sc!/o.ren!a s! (+"'+r7r!"e de de/vo"(are &ervas!v7 Ede e<., (+"'+rarea
    a+(!s(7J a+ :n co%+n &er(+r'7r! de "!%'a@, a.ec( s! re"a=!onare !n(er&ersona"7, e"e &o(
    .! d!s(!nse &r!n(r4o ser!e de &ar(!c+"ar!(7=!. T+"'+r7r!"e de de/vo"(are &ervas!v7 s+n(
    :n %od carac(er!s(!c rec+nosc+(e d!n &er!oada de s+$ar sa+ d!n %!ca co&!"7r!e Ede
    re$+"7 :na!n(e de e(a(ea de ; an!J, :n (!%& ce +n as(.e" de de'+( &recoce es(e rar :n
    sc!/o.ren!e. Ma! %+"( decA( a(A(, :n (+"'+r7r!"e de de/vo"(are &ervas!v7 s+n(
    a'sen(e !de!"e de"!ran(e s! a"+c!na=!!"e &roe%!nen(e, ano%a"!!"e a.ec(!ve s+n( %a!
    &ron+n=a(e, !ar "!%'a@+" es(e a'sen( sa+ %!n!% O! carac(er!/a( &r!n s(ereo(!&!! O!
    ano%a"!! :n &ro/od!e. Sc!/o.ren!a &oa(e a&are oca/!ona" "a !nd!v!/!! c+ (+"'+rare
    de de/vo"(are &ervas!v78 d!a$nos(!c+" de sc!/o.ren!e es(e @+s(!.!ca( "a !nd!v!/!! c+
    +n d!a$nos(!c &ree<!s(en( de (+"'+rare a+(!s(7 or! de a"(7 (+"'+rare de de/vo"(are
    &ervas!v7, n+%a! dac7 a"+c!na=!! sa+ !de! de"!ran(e &roe%!nen(e a+ .os( &re/en(e
    (!%& de ce" &+=!n o "+n7. Sc!/o.ren!a c+ de'+( :n co&!"7r!e (re'+!e s7 .!e d!s(!ns7 de
    (a'"o+r!"e c"!n!ce d!n co&!"7r!e care co%'!n7 "!%'a@+" de/or$an!/a( Ed!n(r4o
    (+"'+rare de co%+n!careJ s! co%&or(a%en(+" de/or$an!/a( Ed!n (+"'+rarea
    !&erac(!v!(a(eX de.!c!( de a(en=!eJ.
    Sc!/o.ren!a are e"e%en(e co%+ne Ede e<., !dea=!e &arano!d7, $And!re %a$!c7,
    ev!(are soc!a"7 s! "!%'a@ d!$res!v s! va$J c+ (+"'+r7r!"e de &ersona"!(a(e
    sc!/o(!&a"7, sc!/o!d7 sa+ &arano!d7 s! &oa(e .! &receda(7 de aces(ea. Un
    d!a$nos(!c ad!=!ona" de sc!/o.ren!e es(e o&or(+n a(+nc! cAnd s!%&(o%e"e s+n(
    s+.!c!en( de severe &en(r+ a sa(!s.ace cr!(er!+" A a" sc!/o.ren!e!. T+"'+rarea de
    &ersona"!(a(e &ree<!s(en(7 &oa(e .! no(a(7 &e a<a II +r%a(7 de S&re%or'!d7T :n
    &aran(e/7 Ede e<., (+"'+rare de &ersona"!(a(e sc!/o(!&a"7 Z&re%or'!d7[J.
    4E7
    Sc%i(o$renia si Alte Tulburri #si%otice
    Criteriile $e $ia/no&ti# pentru S#@i)o%renie
    A 6imptome caracteristice dou &sau mai multe) dintre urmtoarele simptome,
    $iecare pre(ent o poriune semni$icativ de timp "n cursul unei perioade de
    o lun &sau mai puin, dac sunt tratate cu succes)
    (1)idei delirante,
    (2)%alucinaii,
    (3)limba0 de(or!ani(at &de ex2, deraieri $recvente sau incoerent)3
    (4)comportament catatomc sau $la!rant de(or!ani(at,
    (5)simptome ne!ative, adic aplati(are a$ectiv, alo!ie sau avo%tie2
    FotD *ste necesar numai un sin!ur simptom de la criteriul A, dac ideile
    delirante sunt bi(are ori %alucinaiile constau dmtr-o voce care comentea(
    continuu comportamentul sau !@ndurile persoanei, ori dou sau mai multe
    voci care conversea( "ntre ele
    S 7is"unctie social8pro"esional, O poriune semni$icativ de timp de la
    debutul perturbm, unul sau mai multe domenii ma0ore de $uncionare,
    cum ar $i serviciul, relai il e mterpersonal e ori auto"n!n0 i rea, sunt
    considerabil sub nivelul atins anterior debutului &sau c@nd debutul are loc "n
    copilrie ori "n adolescent, incapacitatea de a atin!e nivelul a,teptat de
    reali(are mterpersonal, ,colar sau pro$esional)
    7urata Semne continue ale perturbm persist@nd timp de cel puin I luni2
    Aceast perioad de I luni trebuie s includ cel puin o lun &sau mai puin,
    dac sunt tratate cu succes) de simptome care satis$ac criteriul A &adic,
    simptome ale $a(ei active) si poate include perioade de simptome prodromale
    sau re(iduale "n cursul acestor perioade prodromale sau re(iduale, semnele
    perturbm se pot mani$esta numai prin simptome ne!ative ori dou sau mai
    multe simptome menionate la criteriul A, pre(ente "ntr-o $orm atenuat &de
    ex, convin!eri stranii, experiene perceptuale insolite)
    D %xcluderea tulburm scizoa"ecti!e 9i a tulburm a"ecti!e Tulburarea
    sc%i(oa$ectiv si tulburarea a$ectiv cu elemente psi%otice au $ost excluse,
    deoarece $ie &E) nici un $el de episoade depresive ma0ore, maniacale sau
    mixte nu au survenit concomitent cu simptomele $a(ei active, ori &7) dac
    episoadele au survenit "n timpul simptomelor $a(ei active, durata lor total
    a $ost mai scurt "n raport cu durata perioadelor, activ si re(idual
    * %xcluderea unei substane8condiii medicale generale #erturbarea nu se
    datorea( e$ectelor $i(iolo!ice directe ale unei substane &de ex , un dro! de
    abu(, un medicament) sau unei condiii medicale !enerale
    ' :elaia cu o tulburare de dez!oltare per!asi! Dac exist un istoric de
    tulburare autist sau de alt tulburare de de(voltare pervasiv, dia!nosticul
    adiional de sc%i(o$renie este pus, numai dac idei delirante sau %alucinaii
    proeminente sunt, de asemenea, pre(ente timp de cel puin o lun &sau mai
    puin, dac sunt tratate cu succes)
    76A 45 Tipul
    #aranoid
    4*4

    Clasi"icarea longitudinal a e!oluiei &poate $i aplicat numai dup trecerea a
    cel puin E an de la debutul iniial al simptomelor $a(ei active)
    Epi&o$i#(2 #u &i"pto"e re)i$uale interepi&o$i#e &episoadele sunt de$inite
    prin reapariia de simptome psi%otice proeminente), de asemenea, de
    speci"icat dac u simptome ne!ative proe"inente Epi&o$i#(2 %(r( ni#i
    un %el $e &i"pto"e interepi&o$i#e Continu( &simptome psi%otice
    proeminente sunt pre(ente pe toat durata
    perioadei de observaie), de asemenea, de speci"icat dac. Cu &i"pto"e
    ne/ative proe"inente *pisod unic "n remisiune parial, de asemenea, de
    speci"icat dac Cu &i"pto"e
    ne/ative proeminente Epi&o$ uni#
    .n re"i&iune #o"plet( Alt pattern &au
    pattern ne&pe#i%i#at
    Subtiurile de Sc(i"ofrenie
    S+'(!&+r!"e de sc!/o.ren!e s+n( de.!n!(e &r!n s!%&(o%a(o"o$!a &redo%!nan(7 :n
    (!%&+" eva"+7% C+ (oa(e c7 !%&"!ca=!!"e &ro$nos(!ce s! de (ra(a%en( a"e s+'(!&+r!"or
    s+n( d!.en(e, (!&+r!"e &arano!d s! de/or$an!/a( (!nd a .! ce" %a! &+=!n sever s!,
    res&ec(!v, ce" %a! sever D!a$nos(!c+" +n+! an+%!( s+'(!& se 'a/ea/7 &e (a'"o+" c"!n!c
    care a oca/!ona( cea %a! recen(7 eva"+are sa+ !n(ernare &en(r+ as!s(en(7 %ed!ca"7 s!,
    dec!, &oa(e .! sc!%'a( :n dec+rs+" (!%&+"+! Des(+" de des, (a'"o+" c"!n!c &oa(e
    !nc"+de s!%&(o%e care s+n( carac(er!s(!ce &en(r+ %a! %+"( decA( +n s!n$+r s+'(!&
    A"e$erea :n(re s+'(!&+r! de&!nde de +r%7(or+" a"$or!(% (!&+" ca(a(on!c es(e
    dese%na( on de cA(e or! s+n( &re/en(e s!%&(o%e ca(a(on!ce &roe%!nen(e Ec+
    e<ce&=!a &re/en(e! a"(or s!%&(o%eJ, (!&+" de/or$an!/a( es(e dese%na( or! de cA(e on
    "!%'a@+" s! co%&or(a%en(+" de/or$an!/a( s! a.ec(+" &"a( sa+ !nadecva( s+n(
    &roe%!nen(e Ee<ce&(And ca/+" cAnd (!&+" ca(a(on!c es(e, de ase%enea, &re/en(, (!&+"
    &arano!d es(e dese%na( or! de cA(e or! e<!s(7 o &reoc+&are :n "e$7(+r7 c+ !de!
    de"!ran(e, or! a"+c!na=!! .recven(e s+n( &roe%!nen(e Ee<ce&(And ca/+" cAnd (!&+"
    ca(a(on!c sa+ de/or$an!/a( es(e &re/en(J T!&+" ned!.eren(!a( es(e o ca(e$or!e
    re/!d+a"7 care descr!e (a'"o+r!"e c"!n!ce care !nc"+d s!%&(o%e &roe%!nen(e a"e .a/e!
    ac(!ve care n+ sa(!s.ac cr!(er!!"e &en(r+ (!&+" ca(a(on!c, de/or$an!/a( sa+ &arano!d,
    (!&+" re/!d+a" es(e des(!na( (a'"o+r!"or c"!n!ce :n care es(e ev!den(7 con(!n+!(a(ea
    &er(+r'7r!!, dar cr!(er!!"e &en(r+ s!%&(o%e"e .a/e! ac(!ve n+ %a! s+n( sa(!s.7c+(e
    D!n ca+/a va"on! "!%!(a(e a s+'(!&+r!"or de sc!/o.ren!e :n cond!=!! c"!n!ce s! de
    cerce(are Ede e< , &red!c(!a evo"+=!e!, r7s&+ns+"+! "a (ra(a%en(, core"a(e"or %a"ad!e!J
    s+n( !nves(!$a(e ac(!v sce%e de s+'(!&are a"(erna(!v7 A"(erna(!va c+ ce" %a! "ar$
    s+&&or( "a ora ac(+a"7 &ro&+ne c7 (re! d!%ens!+n! de &s!o&a(o"o$!e E&s!oc7,
    de/or$an!/a(7 s! ne$a(!v7J &o( s+rven! :%&re+n7 :n d!verse %od+r! "a !nd!v!/!! c+
    sc!/o.ren!e Aceas(7 a"(erna(!v7 d!%ens!ona"7 es(e descr!s7 :n ane<a B E&a$ HRYJ
    C5<.4+ Tipul Paranoi$
    E"e%en(+" esen=!a" a" (!&+"+! &arano!d de sc!/o.ren!e :" cons(!(+!e &re/en(a de
    !de! de"!ran(e sa+ de a"+c!na=!! a+d!(!ve &roe%!nen(e :n con(e<(+" +ne! &re/erv7n
    4EH
    Sc%i(o$renia ,i Alte Tulburri #si%otice
    re"a(!ve a .+nc=!on7r!! co$n!(!ve s! a a.ec(+"+!. S!%&(o%e"e carac(er!s(!ce (!&+r!"or
    de/or$an!/a( s! ca(a(on!c Ede e<., "!%'a@+" de/or$an!/a(, a.ec(+" &"a( sa+ !nadecva(,
    co%&or(a%en(+" ca(a(on!c sa+ de/or$an!/a(J n+ s+n( &roe%!nen(e. Ide!"e de"!ran(e
    s+n( de re$+"7 de &ersec+=!e sa+ de $randoare or! %!<(e, dar &o( s+rven!, de
    ase%enea, O! !de! de"!ran(e c+ a"(e (e%e Ede e<., de $e"o/!e, re"!$!os!(a(e sa+
    so%a(!/areJ. Ide!"e de"!ran(e &o( .! %+"(!&"e, dar de re$+"7 s+n( or$an!/a(e :n @+r+"
    +ne! (e%e coeren(e. Ha"+c!na=!!"e s+n( de re$+"7 :n ra&or( c+ con=!n+(+" (e%e!
    de"!ran(e. E"e%en(e"e asoc!a(e !nc"+d an<!e(a(ea, .+r!a, r7cea"a s! cear(a. Ind!v!d+"
    &oa(e avea o %an!er7 de a .! s+&er!or s! &ro(ec(or, s!, .!e o ca"!(a(e .or%a"7, e%.a(!c7,
    .!e !n(ens!(a(e e<(re%7 :n !n(erac=!+n!"e !n(er&ersona"e. Te%e"e de &ersec+=!e &o(
    &red!s&+ne !nd!v!d+" "a co%&or(a%en( s+!c!dar, !ar co%'!narea !de!"or de"!ran(e de
    &ersec+=!e s! de $randoare c+ .+r!a &oa(e &red!s&+ne !nd!v!d+" "a v!o"en=7. De'+(+"
    (!nde a .! %a! (ard!v :n v!a=7 decA( :n ce"e"a"(e (!&+r! de sc!/o.ren!e, !ar
    carac(er!s(!c!"e sa"e d!s(!nc(!ve &o( .! %a! s(a'!"e :n dec+rs+" (!%&+"+!. AceO(!
    !nd!v!/! &re/!n(7 de re$+"7 doar &+=!n7 sa+ n!c! +n .e" de de(er!orare "a (es(area
    ne+ro&s!o"o$!c7 sa+ "a a"(7 (es(are co$n!(!v7. Une"e da(e s+$erea/7 c7 &ro$nos(!c+"
    &en(r+ (!&+" &arano!d &oa(e .! cons!dera'!" %a! '+n decA( a" ce"or"a"(e (!&+r! de
    sc!/o.ren!e, :n s&ec!a" :n ceea ce &r!veO(e .+nc=!onarea &ro.es!ona"7 s! ca&ac!(a(ea
    de a d+ce o v!a=7 !nde&enden(7.
    Criteriile $e $ia/no&ti# pentru C5<.4+ Tipul Paranoi$
    .n tip de sc%i(o$renie "n care sunt satis$cute urmtoarele criteriiD
    A2 #reocupare pentru una sau mai multe idei delirante sau %alucinaii auditive
    $recvente2
    S2 Fici unul dintre urmtoarele simptome nu este proeminentD limba0 de(or!a
    ni(at, comportament catatonic sau de(or!ani(at, sau a$ect plat ori inadecvat2
    C5<.*+ Tipul De)or/ani)at
    E"e%en(e"e esen=!a"e a"e (!&+"+! de/or$an!/a( de sc!/o.ren!e s+n( cons(!(+!(e de
    "!%'a@+" de/or$an!/a(, co%&or(a%en(+" de/or$an!/a( s! a.ec(+" &"a( sa+ !nadecva(.
    L!%'a@+" de/or$an!/a( &oa(e .! aco%&an!a( de (on(er!e s! rAs, care n+ s+n( :n s(rAns7
    "e$7(+r7 c+ con=!n+(+" "!%'a@+"+!. De/or$an!/area co%&or(a%en(+"+! Ead!c7, "!&sa
    de or!en(are s&re +n sco&J &oa(e d+ce "a o r+&(+r7 sever7 :n ca&ac!(a(ea de a e.ec(+a
    ac(!v!(7=!"e v!e=!! co(!d!ene Ede e<., d+O+", :%'r7ca(+" sa+ &re&ararea %Anc7r!!J. N+
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ (!&+" ca(a(on!c de sc!/o.ren!e, !ar !de!"e de"!ran(e
    sa+ a"+c!na=!!"e, dac7 s+n( &re/en(e, s+n( .ra$%en(are O! neor$an!/a(e :n(r4o (e%7
    coeren(7. E"e%en(e"e asoc!a(e !nc"+d $r!%ase"e, %an!er!s%e"e s! a"(e '!/arer!! de
    co%&or(a%en(. De(er!orarea &er.or%an=e! &oa(e .! no(a(7 "a d!verse (es(e
    ne+ro&s!o"o$!ce sa+ co$n!(!ve. Aces( s+'(!& es(e, de ase%enea, asoc!a( de re$+"7
    c+ o &ersona"!(a(e &re%or'!d7 s7rac7, de'+( &recoce s! !ns!d!os, s! o evo"+=!e
    con(!n+7, .7r7 re%!s!+n! se%n!.!ca(!ve. Is(or!c, O! :n a"(e s!s(e%e de c"as!.!care, aces(
    (!& es(e den+%!( e'e.ren!c.
    76A275 Tipul
    atatonic
    4*<

    Criteriile $e $ia/no&ti# pentru C5<.*+ Tipul De)or/ani)at
    .n tip de sc%i(o$renie "n care sunt satis$cute urmtoarele criteriiD
    A2 Oricare dintre urmtoarele sunt proeminenteD
    (1)limba0 de(or!ani(at3
    (2)comportament de(or!ani(at3
    (3)a$ect plat sau inadecvat2
    S2 Fu sunt satis$cute criteriile pentru tipul catatonic2
    C5<.C+ Tipul CatatonQ#
    E"e%en(+" esen=!a" a" (!&+"+! ca(a(on!c de sc!/o.ren!e :" cons(!(+!e o &er(+r'are
    &s!o%o(or!e %arca(7 care &oa(e !%&"!ca !%o'!"!(a(e %o(or!e, ac(!v!(a(e %o(or!e
    e<ces!v7, ne$a(!v!s% e<(re%, %+(!s%, '!/arer!! a"e %!Oc7r!"or vo"+n(are, eco"a"!e sa+
    eco&ra<!e. I%o'!"!(a(ea %o(or!e se &oa(e %an!.es(a &r!n ca(a"e&s!e E."e<!'!"!(a(e
    ceroas7J sa+ s(+&or. Ac(!v!(a(ea %o(or!e e<ces!v7 es(e ev!den( "!&s!(7 de sco& O! n+
    es(e !n."+en=a(7 de s(!%+"! e<(ern!. Poa(e e<!s(a +n ne$a(!v!s% e<(re% care se
    %an!.es(7 &r!n %en=!nerea +ne! &os(+r! r!$!de con(ra (+(+ror :ncerc7r!"or de a .!
    %!Oca( sa+ &r!n re/!s(en=7 "a (oa(e !ns(r+c=!+n!"e. B!/arer!!"e %!Oc7r!"or vo"+n(are se
    %an!.es(7 &r!n as+%area vo"+n(ar7 a +nor &os(+r! '!/are or! &r!n $r!%ase
    &roe%!nen(e. Eco"a"!a es(e re&e(area &a(o"o$!c7, ase%enea +n+! &a&a$a" s! ev!den(
    .7r7 sens, a +n+! c+vAn( sa+ e<&res!! a'!a &ron+n=a(e de a"(7 &ersoan7. Eco&ra<!a
    es(e !%!(a=!a re&e(!(!v7 a %!Oc7r!"or a"(e! &ersoane. E"e%en(e"e accesor!! !nc"+d
    s(ereo(!&!!"e, %an!er!s%e"e s! s+&+nerea a+(o%a(7 sa+ %!%area, :n c+rs+"
    s(+&or+"+! sa+ e<c!(a=!e! ca(a(on!ce severe, &ersoana res&ec(!v7 &oa(e neces!(a o
    s+&rave$ere a(en(7 s&re a se ev!(a a+(ov7(7%area sa+ v7(7%area a"(ora. E<!s(7
    r!sc+r! &o(en=!a"e &en(r+ s+'n+(r!re, e&+!/are, .e'r7 sa+ "e/!+n! a+(o&rovoca(e.
    Pen(r+ a d!a$nos(!ca aces( s+'(!&, (a'"o+" c"!n!c a" !nd!v!d+"+! (re'+!e s7 sa(!s.ac7
    %a! :n(A! co%&"e( cr!(er!!"e &en(r+ sc!/o.ren!e O! s7 n+ .!e e<&"!ca( %a! '!ne de o
    a"(7 e(!o"o$!cQ !nd+s de o s+'s(an=7 Ede e<., &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce,
    ve/! &a$. HF9J, ca+/a( de o cond!=!e %ed!ca"7 $enera"7 Eve/! &a$. 5GYJ sa+ a&7rAnd
    :n c+rs+" +n+! e&!sod %an!aca" or! de&res!v %a@or Eve/! &a$. I5GJ.
    4EI
    Sc%i(o$renia si Alte Tulburri #si%otice
    Criteriile $e $ia/no&ti# pentru C5<.C+ Tipul Catatoni#
    .n tip de sc%i(o$renie "n care tabloul clinic este dominat de cel puin dou
    dintre urmtoarele
    (1) imobilitate motorie evideniat prin catalepsie &inclu(@nd
    $lexibilitatea
    ceroas) sau stupor,
    (2) activitate motorie excesiv &care este evident lipsit de sens si nu
    este
    in$luenat de stimu% externi),
    (3) ne!ativism extrem &o re(istent evident nemotivat la toate
    instruciunile
    ori meninerea unei posturi ri!ide la "ncercrile de a $i mi,cat) sau mutism3
    (4) bi(arerii ale mi,crii voluntare evideniate prin posturi &asumarea
    voluntar
    a unor posturi inadecvate sau bi(are), mi,cri stereotipe, mamerisme sau
    !rimase proeminente,
    (1) ecola%e sau ecopraxie
    C5<.5+ Tipul Ne$i%eren!iat
    E"e%en(+" esen=!a" a" (!&+"+! ned!.eren=!a( de sc!/o.ren!e :" cons(!(+!e &re/en=a
    de s!%&(o%e care sa(!s.ac cr!(er!+" A a" sc!/o.ren!e!, dar care n+ sa(!s.ac cr!(er!!"e
    &en(r+ (!&+" &arano!d, de/or$an!/a( sa+ ca(a(on!c
    Criteriile $e $ia/no&ti# pentru C5<.5+ Tipul Ne$i%eren!iat
    .n tip de sc%i(o$renie "n care sunt pre(ente simptome care satis$ac criteriul A, dar
    nu sunt satis$cute criteriile pentru tipurile paranoid, de(or!ani(at sau catatonic2
    C5<.=+ Tipul Re)i$ual
    T!&+" re/!d+a" de sc!/o.ren!e (re'+!e s7 .!e +(!"!/a( cAnd a e<!s(a( ce" &+=!n +n
    e&!sod de sc!/o.ren!e, dar (a'"o+" c"!n!c ac(+a" n+ &re/!n(7 s!%&(o%e &s!o(!ce
    &o/!(!ve &roe%!nen(e Ede e<, !de! de"!ran(e, a"+c!na=!!, "!%'a@ sa+ co%&or(a%en(
    de/or$an!/a(J E<!s(7 &ro'a +ne! con(!n+!(7=! a &er(+r'7%, d+&7 c+% es(e !nd!ca(
    de &re/en=a s!%&(o%e"or ne$a(!ve Ede e<., a.ec(+" &"a(, !nd!$en=7 "!%'a@+"+! sa+
    avo=!aJ or! do+7 sa+ %a! %+"(e s!%&(o%e &o/!(!ve a(en+a(e Ede e<., co%&or(a%en(
    e<cen(r!c, "!%'a@ +Oor de/or$an!/a( sa+ conv!n$er! '!/areJ Dac7 s+n( &re/en(e !de!
    de"!ran(e sa+ a"+c!na=!!, e"e n+ s+n( &roe%!nen(e s! n+ s+n( aco%&an!a(e de +n
    a.ec( &+(ern!c. Evo"+=!a (!&+"+! re/!d+a" &oa(e .! "!%!(a(7 :n (!%& O! re&re/!n(7 o
    (ran/!=!e :n(re +n e&!sod &e de&"!n de/vo"(a( s! re%!s!+nea co%&"e(7, :ns7, e" &oa(e
    .!, de ase%enea, &re/en( con(!n++ (!%& de %+"=! an!, c+ sa+ .7r7 e<acer'7r! ac+(e.
    76A H5 Tulburarea
    Sc%i(o$reni$orm
    ;5H
    Criteriile $e $ia/no&ti# pentru C5<.=+ Tipul Re)i$ual
    .n tip de sc%i(o$renie "n care sunt satis$cute urmtoarele criterii
    A Absenta ideilor delirante, a %alucinaiilor, limba0ului de(or!ani(at si a
    comportamentului catatonic sau $la!rant de(or!ani(at, proeminente
    S *xist proba continuitii perturbm, indicat de pre(enta de simptome
    ne!ative ori a dou sau mai multe simptome menionate la criteriul A
    pentru sc%i(o$renie, pre(ente "ntr-o $orm atenuat &de ex, convin!eri
    bi(are, experiene perceptive insolite)
    C5<.7+ Tul-urarea S#@i)o%reni%or"(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7% sc!/o.re%.or%e s+n( !den(!ce c+ ce"e a"e
    sc!/o.ren!e! Ecr!(er!+" AJ, c+ e<ce&=!a a do+7 d!.eren(e d+ra(a (o(a"7 a %a"ad!e!
    E!nc"+/And .a/e"e &rodro%a"7, ac(!v7 s! re/!d+a"7J es(e de ce" &+=!n o "+n7, dar de
    %a! &+=!n de R "+n! Ecr!(er!+" BJ, !ar de(er!orarea ac(!v!(7=!! soc!a"e sa+ &ro.es!ona"e
    :n c+rs+" +ne! &7r=! a %a"ad!e! n+ es(e necesara EdeO! ea &oa(e s+rven!J D+ra(a
    cer+(7 &en(r+ (+"'+rarea Sc!/o.ren!.or%7 es(e !n(er%ed!ar7 :n(re cea &en(r+
    (+"'+rarea &s!o(!c7 sc+r(7 E:n care s!%&(o%e"e d+rea/7 ce" &+=!n o /!, dar %a!
    &+=!n de o "+n7J s! sc!/o.ren!e E:n care s!%&(o%e"e &ers!s(7 (!%& de ce" &+=!n R
    "+n!J D!a$nos(!c+" de (+"'+rare Sc!/o.ren!.or%7 se &+ne :n do+7 s!(+a=!! :n &r!%a,
    d!a$nos(!c+" se a&"!c7 .7r7 n!c! o n+an=are +n+! e&!sod de %a"ad!e c+ o d+ra(7 :n(re "
    s! R "+n! d!n care !nd!v!d+" s4a rec+&era( de@a :n ceade a do+a s!(+a=!e,
    d!a$nos(!c+" se a&"!c7 a(+nc! cAnd o &ersoan7 care deO! s!%&(o%a(!c7, es(e aOa
    &en(r+ %a! &+=!n decA( ce"e R "+n! cer+(e &en(r+ d!a$nos(!c+" de sc!/o.ren!e :n
    aces( ca/, d!a$nos(!c+" de (+"'+rare Sc!/o.ren!.or%7 (re'+!e s7 .!e e(!ce(a( ca
    S&rov!/or!+T, deoarece n+ e<!s(7 n!c! o cer(!(+d!ne c7 %d!_ !d+" se va rec+&era d!n
    (+"'+rare :n dec+rs+" +ne! &er!oade de R "+n! Dac7 &er(+r'area &ers!s!(7 &es(e R
    "+n!, d!a$nos(!c+" va .! sc!%'a( c+ ce" de sc!/o.ren!e
    Speci$icanti
    Ur%7(or!! s&ec!.!can(! &en(r+ (+"'+rarea Sc!/o.ren!.or%7 &o( .! +(!"!/a=! &en(r+ a
    !nd!ca &re/en(a sa+ a'sen(a e"e%en(e"or care &o( .! asoc!a(e c+ +n &ro$nos(!c %a! '+n
    C+ e"e%en(e de &ro$nos(!c '+n Aces( s&ec!ean( es(e +(!"!/a( dac7 ce" &+=!n
    do+7 d!n(re +r%7(oare"e e"e%en(e s+n( &re/en(e de'+( a" s!%&(o%e"or
    &s!o(!ce &roe%!nen(e :n dec+rs de I s7&(7%An! de "a &r!%a sc!%'are
    no(a'!"7 :n co%&or(a%en(+" sa+ .+nc=!onarea +/+a"7, con.+/!e sa+
    &er&"e<!(a(e :n %o%en(+" c+"%!nan( a" e&!sod+"+! &s!o(!c, .+nc=!onarea
    soc!a"7 sa+ &ro.es!ona"7 &re%or'!d7 '+n7 s! a'sen(a a.ec(+"+! o'(+/ sa+ &"a(
    F7r7 e"e%en(e de &ro$nos(!c '+n Aces( s&ec!ean( es(e +(!"!/a( dac7 do+7
    sa+ %a!%+"(e d!n(re e"e%en(e"e de %a! s+s n+ a+ .os( &re/en(e
    4E8
    Sc%i(o$renia si Alte Tulburri #si%otice
    *lemente ,i tulburri asociate
    A se vedea, de ase%enea, d!sc+=!a d!n sec=!+nea SE"e%en(e s! (+"'+r7r! asoc!a(eT
    &en(r+ sc!/o.ren!e, &a$. ;LI. Con(rar sc!/o.ren!e!, de(er!orarea :n .+nc=!onarea
    soc!a"7 s! &ro.es!ona"7 n+ es(e cer+(7 &en(r+ d!a$nos(!c+" de (+"'+rare
    sc!/o.ren!.or%7. C+ (oa(e aces(ea :ns7, ce! %a! %+"=! !nd!v!/! &re/!n(7 d!s.+nc=!! :n
    d!verse"e do%en!! a"e .+nc=!on7r!! co(!d!ene Ede e<., "a serv!c!+ sa+ "a scoa"7, :n
    re"a=!!"e !n(er&ersona"e s! :n a+(o:n$r!@!reJ.
    *lemente speci$ice culturii, etii si sexului
    Pen(r+ o d!sc+=!e s+&"!%en(ar7 des&re .ac(or!!, c+"(+r7, e(a(e s! se<, re"evan=!
    &en(r+ d!a$nos(!c+" de (+"'+rare sc!/o.ren!.or%7, ve/! sec=!+nea SE"e%en(e
    s&ec!.!ce c+"(+r!!, e(7=!! s! se<+"+!T &en(r+ sc!/o.ren!e E&a$. ;LRJ. E<!s(7 da(e,
    con.or% c7rora :n =7r!"e :n c+rs de de/vo"(are rec+&erarea d!n (+"'+r7r!"e &s!o(!ce
    &oa(e .! %a! ra&!d7, ceea ce d+ce "a &rocen(e %a! r!d!ca(e de (+"'+rare
    sc!/o.ren!.or%7 decA( de sc!/o.ren!e.
    #revalent
    Pro'e"e d!s&on!'!"e s+$erea/7 var!a=!! :n !nc!den=7 &e sec=!+ne (ransversa"7 &r!n
    cond!=!!"e soc!oc+"(+ra"e, :n S(a(e"e Un!(e s! :n a"(e =7r! de/vo"(a(e, !nc!den=a es(e
    red+s7, &os!'!" de &An7 "a c!nc! or! %a! %!c7 decA( cea a sc!/o.ren!e!, :n =7r!"e :n
    c+rs de de/vo"(are, !nc!den=a es(e s+'s(an=!a" %a! %are, :n s&ec!a" &en(r+ s+'(!&+"
    c+ SC+ e"e%en(e de &ro$nos(!c '+nT, :n +ne"e d!n(re aces(e cond!=!!, (+"'+rarea
    sc!/o.ren!.or%7 &oa(e .! "a .e" de .recven(7 ca O! sc!/o.ren!a.
    *voluie
    E<!s(7 &+=!ne !n.or%a=!! d!s&on!'!"e des&re evo"+=!a (+"'+r7r!! sc!/o.ren!.or%e.
    A&ro<!%a(!v o (re!%e d!n(re !nd!v!/!! c+ d!a$nos(!c+" !n!=!a" de (+"'+rare
    sc!/o.ren!.or%7 E&rov!/or!+J se rec+&erea/7 :n dec+rs+" &er!oade! de R "+n! s!
    &r!%esc ca d!a$nos(!c .!na", d!a$nos(!c+" de (+"'+rare sc!/o.ren!.or%7. D!n res(+"
    de do+7 (re!%!, %a@or!(a(ea vor &ro$resa s&re d!a$nos(!c+" de sc!/o.ren!e sa+ de
    (+"'+rare sc!/oa.ec(!v7.
    #attern $amilial
    P+=!ne s(+d!! .a%!"!a"e a+ .os( cen(ra(e &e (+"'+rarea sc!/o.ren!.or%7. Pro'e"e
    d!s&on!'!"e s+$erea/7 c7 r+de"e !nd!v!/!"or c+ (+"'+rare sc!/o.ren!.or%7 a+ +n r!sc
    cresc+( &en(r+ sc!/o.ren!e.
    Dia!nostic di$erenial
    Deoarece cr!(er!!"e de d!a$nos(!c &en(r+ sc!/o.ren!e s! (+"'+rarea
    sc!/o.ren!.or%7 d!.er7 :n &r!%+" rAnd :n (er%en! de d+ra(7 a %a"ad!e!, d!sc+(area
    d!a$nos(!c+"+! d!.eren=!a" a" sc!/o.ren!e! E&a$. ;LFJ se a&"!c7, de ase%enea, O! "a
    (+"'+rarea sc!/o.ren!.or%7. T+"'+rarea sc!/o.ren!.or%7 d!.er7 de (+"'+rarea
    &s!o(!c7 sc+r(7 care are o d+ra(7 de %a! &+=!n de o "+n7.
    76A2?5 Tulburarea
    Sc%i(oa$ectiv
    +14

    Criteriile $e $ia/no&ti# pentru C5<.7+ Tul-urarea
    S#@i)o%reni%or"(
    A2 Sunt satis$cute criteriile A, D si * ale sc%i(o$reniei2
    S2 .n episod al tulburrii &inclu(@nd $a(ele prodromal, activ si re(idual) durea(
    cel puin o lun, dar mai puin de I luni2 &@nd trebuie pus dia!nosticul $r
    a se a,tepta recuperarea, dia!nosticul trebuie etic%etat ca =provi(oriu>)2
    De speci"icat dac'
    '(r( ele"ente $e pro/no&ti# -un
    Cu ele"ente $e pro/no&ti# -un2 ca evideniat de dou &sau mai multe)
    dintre urmtoareleD
    (1)debut al simptomelor psi%otice proeminente "n decurs de H sptm@ni de
    la prima modi$icare notabil "n comportamentul sau $uncionarea u(ual,
    (2)con$u(ie sau perplexitate la apo!eul episodului psi%otic3
    (3)$uncionare social sau pro$esional premorbid bun3
    (4)absena a$ectului plat sau obtu(2
    C5<.G+ Tul-urarea S#@i)oa%e#tiv(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! sc!/oa.ec(!ve :" cons(!(+!e o &er!oad7
    ne:n(rer+&(7 de %a"ad!e :n c+rs+" c7re!a, "a +n %o%en( da(, e<!s(7 +n e&!sod
    de&res!v %a@or, %an!aca" sa+ %!<(, conco%!(en( c+ s!%&(o%e care sa(!s.ac cr!(er!+"
    A &en(r+ sc!/o.ren!e Ecr!(er!+" AJ. Pe "An$7 aceas(a, :n c+rs+" ace"e!aO! &er!oade de
    %a"ad!e, e<!s(7 !de! de"!ran(e sa+ a"+c!na=!! (!%& de ce" &+=!n 9 s7&(7%An!, :n
    a'sen=a +nor s!%&(o%e a.ec(!ve &roe%!nen(e Ecr!(er!+" BJ, :n .!ne, s!%&(o%e"e
    a.ec(!ve s+n( &re/en(e o &or=!+ne s+'s(an=!a"7 de (!%& d!n d+ra(a (o(a"7 a %a"ad!e!
    Ecr!(er!+" CJ. S!%&(o%e"e n+ (re'+!e s7 se da(ore/e e.ec(e"or .!/!o"o$!ce d!rec(e a"e
    +ne! s+'s(an=e Ede e<., coca!ne!J sa+ +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    !&er(!ro!d!s%+"+! sa+ e&!"e&s!e! "o'+"+! (e%&ora"J Ecr!(er!+" DJ. S&re a sa(!s.ace
    cr!(er!!"e &en(r+ (+"'+rarea Sc!/oa.ec(!v7, e"e%en(e"e esen=!a"e (re'+!e s7 a&ar7 :n
    c+rs+" +ne! s!n$+re &er!oade ne:n(rer+&(e de %a"ad!e. E<&res!a S&er!oad7 de
    %a"ad!eT, aOa c+% es(e +(!"!/a(7 a!c!, se re.er7 "a &er!oada de (!%& :n c+rs+" c7re!a
    !nd!v!d+" con(!n+7 s7 &re/!n(e s!%&(o%e ac(!ve sa+ re/!d+a"e de %a"ad!e &s!o(!c7.
    Pen(r+ +n!! !nd!v!/!, &er!oada de %a"ad!e &oa(e d+ra an! sa+ c!ar /ec! de an!. O
    &er!oad7 de %a"ad!e se cons!der7 ca (er%!na(7, a(+nc! cAnd !nd!v!d+" s4a rec+&era(
    &en(r+ +n !n(erva" cons!dera'!" de (!%& s! n+ %a! &re/!n(7 n!c! +n s!%&(o%
    se%n!.!ca(!v a" (+"'+r7r!!.
    Fa/a %a"ad!e! c+ s!%&(o%e a.ec(!ve s! &s!o(!ce conco%!(en(e se carac(er!/ea/7
    &r!n .a&(+" c7 s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e, a(A( &en(r+ .a/a ac(!v7 a
    sc!/o.ren!e! Ead!c7, cr!(er!+" AJ Eve/! &a$. 9FGJ, cA( s! &en(r+ e&!sod+" de&res!v
    %a@or E&a$. ;IFJ, e&!sod+" %an!aca" E&a$. ;YHJ sa+ %!<( E&a$. ;R9J. D+ra(a
    ;9L
    Sc%i(o$renia si Alte Tulburri #si%otice
    e&!sod+"+! de&res!v %a@or (re'+!e s7 .!e de ce" &+=!n , s7&(7%An!, d+ra(a e&!sod+"+!
    %an!aca" sa+ %!<( (re'+!e '7 .!e de ce" &+=!n o s7&(7%An7 Deoarece s!%&(o%e"e
    &s!o(!ce (re'+!e s7 a!'7 o d+ra(7 (o(a"7 de ce" &+=!n o "+n7 &en(r+ a sa(!s.ace
    cr!(er!+" A &en(r+ sc!/o.ren!e, d+ra(a %!n!%7 a +n+! e&!sod sc!/oa.ec(!v es(e, de
    ase%enea, de o "+n7 Un e"e%en( esen=!a" a" e&!sod+"+! de&res!v %a&r :" cons(!(+!e
    &re/en=a, .!e a d!s&o/!=!e! de&res!ve, .!e a +ne! d!%!n+7r! %arca(e a !n(eres+"+! sa+
    &"7ce% Pen(r+ c7 &!erderea !n(eres+"+! sa+ &"7cer!! es(e a(A( de .recven(7 :n
    (+"'+r7r!"e &s!o(!ce nona.ec(!ve, &en(r+ a sa(!s.ace cr!(er!+" A a" (+"'+r7r!!
    sc!/oa.ec(!ve, e&!sod+" de&resn %a@or (re'+!e s7 !nc"+d7 d!s&o/!=!a de&res!v7
    &ervas!v7 Ead!c7, &re/en(a d!%!n+7r!! %arca(e a !n(eres+"+! sa+ &"7cer!! n+ es(e
    s+.!c!en(7J Fa/a (+"'+r7r!! n+%a! c+ s!%&(o%e &s!o(!ce s!n$+re es(e carac(er!/a(7
    &r!n !de! de"!ran(e sa+ a"+c!na=!! care d+rea/7 ce" &+=!n 9 s7&(7%An! DeO! +ne"e
    s!%&(o%e a.ec(!ve &o( .! &re/en(e :n c+rs+" aces(e! .a/e, e"e n+ s+n( &roe%!nen(e
    Aceas(7 &rec!/are &oa(e .! d!.!c!" de .7c+( s! &oa(e neces!(a o o'serva=!e
    "on$!(+d!na"7 s! %+"(!&"e s+rse de !n.or%a=!!
    S!%&(o%e"e (+"'+r7% sc!/oa.ec(!ve &o( s+rven! :n(r4o var!e(a(e de &a((ern+n
    (e%&ora"e Ur%7(or+" es(e +n &a((ern (!&!c +n !nd!v!d &oa(e avea a"+c!na=!!
    a+d!(!ve s! !de! de"!ran(e de &ersec+=!e &ron+n=a(e (!%& de 9 "+n!, :na!n(ea
    e&!sod+"+! de&res!v %a&r S!%&(o%e"e &s!o(!ce s! e&!sod+" de&res!v %a@or
    co%&"e( s+n( &re/en(e (!%& de ; "+n! A&o!, &ersoana se rec+&erea/7 co%&"e( d!n
    e&!sod+" de&res!v %a@or, dar s!%&(o%e"e &s!o(!ce %a! &ers!s(7 :nc7 o "+n7, :na!n(e
    de a d!s&are :n c+rs+" aces(e! &er!oade de %a"ad!e, s!%&(o%e"e !nd!v!d+"+! sa(!s.ac
    conco%!(en( cr!(er!!"e &en(r+ e&!sod+" de&res!v %a@or s! cr!(er!+" A &en(r+
    sc!/o.ren!e, s! :n c+rs+" aces(e! &er!oade de %a"ad!e s+n( &re/en(e a"+c!na=!!
    a+d!(!ve s! !de! de"!ran(e, a(A( :na!n(e, cA( s! d+&7 .a/a de&res!v7 Per!oada (o(a"7 de
    %a"ad!e d+rea/7 (!%& de a&roa&e R "+n!, c+ s!%&(o%e &s!o(!ce s!n$+re &re/en(e
    :n c+rs+" &r!%e"or 9 "+n!, a(A( c+ s!%&(o%e de&res!ve, cA( s! &s!o(!ce &re/en(e :n
    c+rs+" +r%7(oare"or ; "+n!, s! c+ s!%&(o%e &s!o(!ce s!n$+re &re/en(e :n c+rs+"
    +"(!%e! "+n! :n aces( ca/, d+ra(a e&!sod+"+! de&res!v n+ a .os( sc+r(7 :n ra&or( c+
    d+ra(a (o(a"7 a &er(+r'7r!! &s!o(!ce, s! ca a(are (a'"o+" c"!n!c se &re(ea/7 "a
    d!a$nos(!c+" de (+"'+rare sc!/oa.ec(!v7
    Cr!(er!+" C &en(r+ (+"'+rarea sc!/oa.ec(!v7 s&ec!.!c7 .a&(+" c7 s!%&(o%e"e
    a.ec(!ve care sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod de&res!v (re'+!e s7 .!e &re/en(e o
    &or=!+ne s+'s(an=!a"7 de (!%& d!n :n(rea$a &er!oad7 de %a"ad!e Dac7 s!%&(o%e"e
    a.ec(!ve s+n( &re/en(e n+%a! o sc+r(7 &er!oad7 de (!%&, d!a$nos(!c+" es(e ce" de
    sc!/o.ren!e s! n+ de (+"'+rare sc!/oa.ec(!v7 :n eva"+area aces(+! cr!(er!+,
    c"!n!c!an+" (re'+!e s7 s(a'!"easc7 !n(erva"+" de (!%& d!n c+rs+" &er!oade! con(!n+e
    de %a"ad!e &s!o(!c7 Ead!c7, a(A( s!%&(o%e ac(!ve, cA( s! re/!d+a"eJ, :n care a+
    e<!s(a( s!%&(o%e a.ec(!ve se%n!.!ca(!ve aco%&an!!nd s!%&(o%e"e &s!o(!ce
    O&era=!ona/area a ceea ce se :n=e"e$e &r!n So &or=!+ne s+'s(an=!a"7 de (!%&T
    neces!(7 @+deca(a c"!n!c7 De e<e%&"+, +n !nd!v!d, c+ +n !s(or!c de I a% de
    s!%&(o%e ac(!ve s! re/!d+a"e de sc!/o.ren!e de/vo"(7 +n e&!sod de&res!v %a@or
    s+&ra&+s care d+rea/7 (!%& de Y s7&(7%An!, :n c+rs+" c7r+!a s!%&(o%e"e &s!o(!ce
    &ers!s(7 Aces( (a'"o+ c"!n!c n+ sa(!s.ace cr!(er!+" &en(r+ So &or=!+ne s+'s(an=!a"7
    d% d+ra(a (o(a"7T, deoarece s!%&(o%e"e care sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod
    de&res!v a+ a&7r+( n+%a! &en(r+ Y s7&(7%An! d!n (o(a"+" de I an! de &er(+r'are :n
    aces( e<e%&"+, d!a$nos(!c+" r7%Ane ce" de sc!/o.ren!e, c+ d!a$nos(!c+" ad!=!ona"
    de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e, &en(r+ a !nd!ca e&!sod+" de&res!v
    %a@or s+&ra&+s
    76A2?5 Tulburarea
    Sc%i(oa$ectiv
    4C*

    Subtipuri
    Pe 'a/a co%&onen(e! a.ec(!ve a (+"'+r7% &o( .! %en=!ona(e do+7 s+'(!&+n de
    (+"'+rare sc!/oa.ec(!v7
    Tipul bipolar. Aces( s+'(!& se a&"!c7 dac7 +n e&!sod %an!aca" sa+ +n e&!sod
    %!<( es(e &ar(e a (a'"o+"+! c"!n!c Po( s+rven!, de ase%enea, e&!soade
    de&res!ve %a@ore
    Tipul depresiv Aces( s+'(!& se a&"!c7 n+%a! dac7 doar e&!soade de&res!ve
    s+n( &ar(e a (a'"o+"+! c"!n!c
    *lemente si tulburri asociate
    Po( e<!s(a o red+cere a ac(!v!(7=!! &ro.es!ona"e, o res(rAn$ere a s.ere! con(ac(e"or
    soc!a"e, &rec+% s! d!.!c+"(7=! :n a+(o:n$n@!re s! o creO(ere a r!sc+"+! de s+!c!d asoc!a(e
    c+ (+"'+rarea sc!/oa.ec(!v7 S!%&(o%e"e ne$a(!ve s! re/!d+a"e s+n( de re$+"7 %a!
    &+=!n severe s! %a! &+(% cron!ce decA( ce"e o'serva(e :n sc!/o.ren!e Ind!v!/!! c+
    (+"'+rare sc!/oa.ec(!v7 s+n( s+&+O! +n+! r!sc cresc+( de a de/vo"(a %a! (Ar/!+
    e&!soade de (+"'+rare a.ec(!v7 &+r7 Ede e<, (+"'+rare de&res!v7 %a@or7 sa+
    (+"'+rare '!&o"ar7J, de sc!/o.ren!e sa+ de (+"'+rare sc!/o.ren!.or%7 Po( .!
    asoc!a(e (+"'+r7r! :n "e$7(+r7 c+ a"coo"+" s! a"(e s+'s(an=e Da(e c"!n!ce "!%!(a(e
    s+$erea/7 .a&(+" c7 (+"'+rarea sc!/oa.ec(!v7 &oa(e .! &receda(7 de (+"'+rarea de
    &ersona"!(a(e sc!/o!d7, sc!/o(!&a"7, 'order"%e sa+ &arano!d7
    *lemente speci$ice culturii, etii si sexului
    Pen(r+ o d!sc+=!e s+&"!%en(ar7 a .ac(or!"or c+"(+r7, e(a(e s! se<, re"evan=! &en(r+
    eva"+area s!%&(o%e"or &s!o(!ce, ve/! (e<(+" &en(r+ sc!/o.ren!e E&a$ ;LRJ, !ar
    &en(r+ d!sc+(area +nor as(.e" de .ac(or! re"e_ an(! &en(r+ d!a$nos(!c+" (+"'+r7r!"or
    a.ec(!ve, ve/! &a$ ;H9 s! &a$ ;GY T+"'+rarea sc!/oa.ec(!v7, (!&+" '!&o"ar, &oa(e .!
    %a! .recven(7 "a ad+"=!! (!ner!, &e cAnd (+"'+rarea sc!/oa.ec(!v7, (!&+" de&res!v,
    &oa(e .! %a! .recven(7 "a ad+"=!! %a! :n e(a(e :n co%&ara=!e c+ sc!/o.ren!a,
    (+"'+rarea sc!/oa.ec(!v7 s+rv!ne &ro'a'!" %a! .recven( "a (e%e!
    #revalent
    In.or%a(a de(a"!a(e "!&sesc, dar (+"'+rarea sc!/oa.ec(!v7 &are a .! %a! &+=!n
    .recven(7 decA( sc!/o.ren!a
    *voluie
    E(a(ea (!&!c7 "a de'+( a (+"'+r7r!! sc!/oa.ec(!ve se s!(+ea/7 &ro'a'!" "a :nce&+(+"
    &er!oade! ad+"(e, deO! de'+(+" &oa(e s+rven! or!cAnd d!n ado"escen(7 &An7 (Ar/!+ :n
    v!a(7 Pro$nos(!c+" (+"'+r7% sc!/oa.ec(!ve es(e :n(r4o an+%!(7 %7s+r7 %a! '+n
    decA( &ro$nos(!c+" sc!/o.ren!e!, dar cons!dera'!" %a! r7+ decA( &ro$nos(!c+"
    (+"'+r7r!"or a.ec(!ve S+n( .recven(e d!s.+nc(n s+'s(an=!a"e :n .+nc=!onarea soc!a"7
    sa+ &ro.es!ona"7 Pre/en(a even!%en(e"or sa+ a s(resor!"or &rec!&!(an(! es(e asoc!a(7
    c+ +n &ro$nos(!c %a! '+n De/nod7%An(+" (+"'+r7% sc!/oa.ec(!ve, (!&+" '!&o"ar,
    &oa(e .! %a! '+n decA( ce" a" (+"'+r7% sc!/oa.ec(!ve, (!&+" de&res!v
    +22
    Sc%i(o$renia si Alte Tulburri #si%otice

    #attern $amilial
    E<!s(7 da(e s+'s(an=!a"e re.er!(oare "a r!sc+" cresc+( de sc!/o.ren!e a" r+de"or
    '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare sc!/oa.ec(!v7 De ase%enea, ce"e
    %a! %+"(e s(+d!! ara(7 c7 r+de"e !nd!v!/!"or c+ (+"'+rare sc!/oa.ec(!v7 &re/!n(7 +n
    r!sc cresc+( de (+"'+r7r! a.ec(!ve
    Dia!nostic di$erenial
    Cond!=!!"e %ed!ca"e $enera"e s! +/+" +ne! s+'s(an=e se &o( &re/en(a c+ o
    co%'!na=!e de s!%&(o%e &s!o(!ce s! a.ec(!ve T+"'+rarea &s!o(!c7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, +n de"!r!+% sa+ o de%en=7 s+n( d!a$nos(!ca(e cAnd,
    d!n !s(or!c, e<a%en+" so%a(!c sa+ (es(e"e de "a'ora(or, re/+"(7 &ro'e care !nd!c7
    .a&(+" c7 s!%&(o%e"e s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!!
    %ed!ca"e $enera"e Eve/! &a$ ;;IJ T+"'+rarea &s!o(!c7 !nd+s7 de o s+'s(an=7 s!
    der!+%+" !nd+s de o s+'s(an=7 se d!s(!n$ de (+"'+rarea sc!/oa.ec(!v7 &r!n .a&(+"
    c7 o s+'s(an=7 Ede e< , +n dro$ de a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ
    es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+ s!%&(o%e"e Eve/! &a$ ;;GJ
    D!s(!n$erea (+"'+r7r!! sc!/oa.ec(!ve de sc!/o.ren!e s! de (+"'+rarea a.ec(!v7
    c+ e"e%en(e &s!o(!ce es(e adesea d!.!c!"7 :n (+"'+rarea sc!/oa.ec(!v7, (re'+!e s7
    e<!s(e +n e&!sod a.ec(!v conco%!(en( c+ s!%&(o%e"e .a/e! ac(!ve a sc!/o.ren!e!,
    s!%&(o%e"e a.ec(!ve (re'+!e s7 .!e &re/en(e o &or=!+ne s+'s(an=!a"7 d!n d+ra(a (o(a"7
    a &er(+r'7%, !ar !de!"e de"!ran(e s! a"+c!na=!!"e (re'+!e s7 .!e &re/en(e (!%& de ce"
    &+=!n 9 s7&(7%An!, :n a'sen(a +nor s!%&(o%e a.ec(!ve no(a'!"e D% con(ra,
    s!%&(o%e"e a.ec(!ve :n sc!/o.ren!e a+ .!e o d+ra(7 %a! sc+r(7 decA( d+ra(a (o(a"7 a
    &er(+r'7r!!, s+rv!n n+%a! :n c+rs+" .a/e"or &rodro%a"7 sa+ re/!d+a"7, .!e c7 n+
    sa(!s.ac co%&"e( cr!(er!!"e &en(r+ +n e&!sod a.ec(!v Dac7 s!%&(o%e"e &s!o(!ce
    s+rv!n e<c"+s!v :n c+rs+" &er!oade"or de &er(+r'are a.ec(!v7, d!a$nos(!c+" es(e ce" de
    (+"'+rare a.ec(!v7 c+ e"e%en(e &s!o(!ce :n (+"'+rarea sc!/oa.ec(!v7, s!%&(o%e"e
    n+ (re'+!e s7 con(e/e &en(r+ +n e&!sod a.ec(!v dac7 e"e s+n( :n %od c"ar re/+"(a(+"
    s!%&(o%e"or sc!/o.ren!e! Ede e<, d!.!c+"(a(e :n a ador%! d!n ca+/a a"+c!na=!!"or
    a+d!(!ve d!s(+r'an(e, &!erdere :n $re+(a(e &en(r+ c7 %Ancarea es(e cons!dera(7
    o(r7v!(7, d!.!c+"(a(e :n concen(rare d!n ca+/a de/or$an!/7% &s!o(!ceJ P!erderea
    !n(eres+"+! sa+ &"7ce% es(e .recven(7 :n (+"'+r7r!"e &s!o(!ce nona.ec(!ve s! de
    aceea, &en(r+ a sa(!s.ace cr!(er!+" A a" (+"'+r7% sc!/oa.ec(!ve, e&!sod+" de&res!v
    %a@or (re'+!e s7 !nc"+d7 d!s&o/!=!a de&res!v7 &ervas!v7
    Deoarece &ro&or=!a re"a(!v7 de s!%&(o%e a.ec(!ve vers+s s!%&(o%e &s!o(!ce se
    &oa(e sc!%'a :n dec+rs+" &er(+r'7r!!, d!a$nos(!c+" cores&+n/7(or &en(r+ +n e&!sod
    !nd!v!d+a" de %a"ad!e se &oa(e sc!%'a d!n (+"'+rare sc!/oa.ec(!v7 :n sc!/o.ren!e
    Ede e<, +n d!a$nos(!c de (+"'+rare sc!/oa.ec(!v7, &en(r+ +n e&!sod de&res!v %a@or
    &roe%!nen( s! sever d+rAnd ; "+n! :n c+rs+" &r!%e"or R "+n! a"e +ne! %a"ad!! &s!o(!ce
    cron!ce, va .! sc!%'a( c+ ce" de sc!/o.ren!e, dac7 s!%&(o%e &s!o(!ce ac(!ve sa+
    s!%&(o%e re/!d+a"e no(a'!"e &ers!s(7 (!%& de %a! %+"=! a%, .7r7 rec+ren(a +n+! a"(
    e&!sod a.ec(!vJ D!a$nos(!c+" se &oa(e sc!%'a, de ase%enea, &en(r+ d!.er!(e e&!soade
    de %a"ad!e se&ara(e &nn(r4o &er!oad7 de rec+&erare De e<e%&"+, +n !nd!v!d &oa(e
    avea +n e&!sod de s!%&(o%e &s!o(!ce care sa(!s.ac cr!(er!+" A &en(r+ sc!/o.ren!e :n
    c+rs+" +n+! e&!sod de&res!v %a@or, se rec+&erea/7 co%&"e( d!n aces( e&!sod, !ar %a!
    (Ar/!+ de/vo"(7 R s7&(7%An! de !de! de"!ran(e s! de a"+c!na=!!, .7r7 s!%&(o%e a.ec(!ve
    no(a'!"e D!a$nos(!c+" :n aces( ca/ n+ va .! ce" de (+"'+rare sc!/oa.ec(!v7, deoarece
    &er!oada de !de! de"!ran(e s! de a"+c!na=!! n+ s4a con(!n+a( c+ &er!oada !n!=!a"7 a
    76?2E Tulburarea
    Delirant
    +2+

    &er(+r'7r!!. Ca a(are, d!a$nos(!c+" cores&+n/7(or &en(r+ &r!%+" e&!sod va .! ce" de
    (+"'+rare a.ec(!v7 c+ e"e%en(e &s!o(!ce, :n re%!s!+ne co%&"e(7 O! de (+"'+rare
    sc!/o.ren!.or%7 E&rov!/or!+J &en(r+ e&!sod+" ac(+a".
    Per(+r'7r! a.ec(!ve, :n s&ec!a" de&res!e, a&ar .recven( :n c+rs+" (+"'+r7r!! de"!ran(e,
    :ns7, aces(e (a'"o+r! c"!n!ce n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea sc!/oa.ec(!v7,
    deoarece :n (+"'+rarea de"!ran(7 s!%&(o%e"e &s!o(!ce s+n( red+se "a !de! de"!ran(e
    non'!/are s!, dec!, n+ sa(!s.ac cr!(er!+" A &en(r+ (+"'+rarea sc!/oa.ec(!v7.
    Dac7 e<!s(7 !n.or%a=!! !ns+.!c!en(e re.er!(oare "a re"a=!!"e d!n(re s!%&(o%e"e
    &s!o(!ce s! ce"e a.ec(!ve, d!a$nos(!c+" ce" %a! adecva( &oa(e .! ce" de (+"'+rare
    &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e.
    Criteriile $e $ia/no&ti# pentru C5<.G+ Tul-urarea
    S#@i)oa%e#tiv(
    A2 O perioad ne"ntrerupt de maladie "n cursul creia, la un moment dat
    exist, $ie un episod depresiv ma0or, un episod maniacal, ori un episod mixt,
    concomitent cu simptome care satis$ac criteriul A pentru sc%i(o$renie2
    Not(M *pisodul depresiv ma0or trebuie s includ criteriul AED dispo(iie
    depresiv2
    S2 "n cursul aceleia,i perioade de maladie, au existat idei delirante sau %aluci
    naii timp de cel puin 7 sptm@ni "n absena unor simptome a$ective
    proeminente2
    Simptomele care satis$ac criteriile pentru un episod a$ectiv sunt pre(ente o
    poriune substanial din durata total a perioadelor activ ,i re(idual ale
    maladiei2
    D2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) ori unei condiii medicale !enerale2
    7e speci"icat tipul'
    Tip -ipolarM dac perturbarea include un episod maniacal sau mixt &ori un
    episod maniacal sau un episod mixt ,i episoade depresive ma0ore)2
    Tip $epre&ivM dac perturbarea include numai episoade depresive ma0ore2
    C5G.* Tul-urarea Delirant(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de"!ran(e :" cons(!(+!e &re/en=a +ne!a sa+ a %a!
    %+"(or !de! de"!ran(e non'!/are care &ers!s(7 ce" &+=!n o "+n7 Ecr!(er!+" AJ.
    D!a$nos(!c+" de (+"'+rare de"!ran(7 n+ se &+ne dac7 !nd!v!d+" a av+( cAndva +n
    (a'"o+ c"!n!c care a sa(!s.7c+( cr!(er!+" A &en(r+ sc!/o.ren!e Ecr!(er!+" BJ.
    Ha"+c!na=!!"e a+d!(!ve sa+ v!/+a"e, dac7 s+n( &re/en(e, n+ s+n( &roe%!nen(e.
    Ha"+c!na=!!"e (ac(!"e sa+ o".ac(!ve &o( .! &re/en(e Es! &roe%!nen(eJ dac7 s+n( :n
    "e$7(+r7 c+ (e%a de"!ran(7 Ede e<., sen/a=!a c7 es(e !n.es(a( c+ !nsec(e, asoc!a(7 c+
    !de!"e de"!ran(e de !n.es(are, sa+ &erce&=!a c7 s+'!ec(+" e%!(e +n %!ros +rA( &r!n(r4+n
    47H
    Sc%i(o$renia si Alte Tulburri #si%otice
    or!.!c!+ a" cor&+"+!, asoc!a(7 c+ !de! de"!ran(e de re.er!n=7J. Ind!.eren( de !%&ac(+"
    d!rec( a" !de!"or de"!ran(e, .+nc=!onarea &s!osoc!a"7 n+ es(e %arca( de(er!ora(7, !ar
    co%&or(a%en(+" n+ es(e, n!c! s(ran!+ s! n!c! '!/ar Ecr!(er!+" CJ. Dac7, conco%!(en( c+
    !de!"e de"!ran(e, s+rv!n e&!soade de&res!ve, d+ra(a (o(a"7 a aces(or e&!soade a.ec(!ve
    es(e re"a(!v sc+r(7 co%&ara(!v c+ d+ra(a (o(a"7 a &er!oade"or de"!ran(e Ecr!(er!+" DJ.
    Ide!"e de"!ran(e n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede
    e<., coca!naJ sa+ +ne! cond!=!! %ed!ca"e $enera"e Ede e<., %a"ad!a A"/e!%er,
    "+&+s+" er!(e%a(os s!s(e%!cJ Ecr!(er!+" EJ.
    DeO! &rec!/area .a&(+"+! dac7 !de!"e de"!ran(e s+n( Esa+ n+J '!/are es(e
    cons!dera(7 a .! e<(re% de !%&or(an(7 :n a d!s(!n$e :n(re (+"'+rarea de"!ran(7 s!
    sc!/o.ren!e, S'!/arer!aT &oa(e .! d!.!c!" de @+deca(, :n s&ec!a" &e sec=!+ne
    (ransversa"7 &r!n d!verse c+"(+r!. Ide!"e de"!ran(e s+n( cons!dera(e '!/are dac7 s+n(
    ne( !n&"a+/!'!"e, !n!n(e"!$!'!"e s! n+ &rov!n d!n e<&er!en=e"e v!e=!! co(!d!ene Ede e<.,
    conv!n$erea +n+! !nd!v!d, c+% c7 +n s(r7!n !4a :nde&7r(a( or$ane"e !n(erne O! ! "e4a
    :n"oc+!( c+ or$ane"e a"(c+!va, .7r7 s7 "ase n!c! +n .e" de &"7$! sa+ c!ca(r!c!J. D!n
    con(ra, !de!"e de"!ran(e non'!/are !%&"!c7 s!(+a=!! care &o( .! conce&+(e ca s+rven!nd
    :n v!a=a rea"7 Zde e<., .a&(+" de a .! +r%7r!(, o(r7v!(, !n.ec(a(, !+'!( de "a d!s(an=7 or!
    :nOe"a(E7J de so=E!eJ sa+ de a%an(E7J[.
    F+nc=!onarea &s!osoc!a"7 es(e var!a'!"7. Un!! !nd!v!/! &ar a .! re"a(!v !nde%n! :n
    ro"+r!"e "or !n(er&ersona"e s! &ro.es!ona"e. La a"=!!, de(er!orarea &oa(e .! s+'s(an=!a"7
    s! !nc"+de o .+nc=!onare &ro.es!ona"7 red+s7 sa+ a'sen(7 s! !/o"are soc!a"7. CAnd :n
    (+"'+rarea de"!ran(7 es(e &re/en(7 red+cerea .+nc=!on7r!! &s!osoc!a"e, aceas(a es(e
    consec!n=a d!rec(7 a conv!n$er!"or de"!ran(e :nseO!. De e<e%&"+, +n !nd!v!d, care es(e
    conv!ns c7 va .! +c!s de S%a.!a +c!$aO!"or &"7(!=!T, :O! va "7sa serv!c!+" O! va re.+/a s7
    %a! !as7 d!n cas7 decA(, &oa(e, noa&(ea (Ar/!+ O! :%'r7ca( c+ (o(+" d!.er!( de
    ves(!%en(a=!a sa nor%a"7. Toa(e aces(e co%&or(a%en(e re&re/!n(7 o co%&or(are
    !n(e"!$!'!"7 de a &reven! !den(!.!carea s! +c!derea sa de c7(re &res+&+O!! asas!n!. D!n
    con(ra, .+nc=!onarea !nadecva(7 d!n sc!/o.ren!e se &oa(e da(ora, a(A( s!%&(o%e"or
    &o/!(!ve, cA( O! ce"or ne$a(!ve E:n s&ec!a" avo"!=!e!J. De ase%enea, o carac(er!s(!c7
    co%+n7 a !nd!v!/!"or c+ (+"'+rare de"!ran(7 o cons(!(+!e nor%a"!(a(ea a&aren(7 a
    co%&or(a%en(+"+! O! as&ec(+"+! "or, a(+nc! cAnd n+ s+n( d!sc+(a(e !de!"e "or de"!ran(e
    or! e! n+ (rec "a ac=!+ne con.or% aces(ora, :n $enera", .+nc=!onarea soc!a"7 O! %ar!(a"7
    es(e &os!'!" s7 .!e %a! a.ec(a(7 decA( .+nc=!onarea !n(e"ec(+a"7 O! &ro.es!ona"7.
    Subtipuri
    T!&+r!"e de (+"'+rare de"!ran(7 &o( .! s&ec!.!ca(e &e 'a/a (e%e! de"!ran(e
    &redo%!nan(eQ
    T!&+" ero(o%an. Aces( s+'(!& se a&"!c7 a(+nc! cAnd (e%a cen(ra"7 a de"!r+"+!
    o cons(!(+!e .a&(+" c7 o a"(7 &ersoan7 es(e a%ore/a(7 de !nd!v!dE7J. Ideea
    de"!ran(7 se re.er7 adesea %a! c+rAnd "a +n a%or ro%an(!c, !dea"!/a(, s! "a o
    +n!+ne s&!r!(+a"7 decA( "a a(rac=!a se<+a"7. Persoana, :n ra&or( c+ care se are
    aceas(7 conv!n$ere, are de re$+"7 +n s(a(+( %a! :na"( Ede e<., o &ersoan7
    .a!%oas7 or! +n s+&er!or "a serv!c!+J, dar &oa(e .! O! +na co%&"e( s(r7!n7.
    E.or(+r!"e de a con(ac(a o'!ec(+" !de!! de"!ran(e E&r!n a&e"+r! (e"e.on!ce,
    scr!sor!, cado+r!, v!/!(e O! c!ar s+&rave$ere s! !ns!d!ere s+n( .recven(e, deO!,
    oca/!ona", &ersoana res&ec(!v7 &oa(e =!ne secre(7 !deea de"!ran(7. Ce! %a!
    %+"=! !nd!v!/! c+ aces( s+'(!& :n esan(!oane"e c"!n!ce s+n( .e%e!, &e cAnd :n
    esan(!oane"e %ed!co"e$a"e ce! %a! %+"=! !nd!v!/! s+n( '7r'a=!. Un!! !nd!v!/!
    C5G * Tul-urarea
    Delirant(
    +25
    c+ aces( s+'(!&, :n s&ec!a" '7r'a=!!, v!n :n con."!c( c+ "e$ea :n e.or(+r!"e "or de
    a +r%7r! o'!ec(+" !de!! "or de"!ran(e sa+ :n e.or(+" "or nec+$e(a( de a45 Ssa"vaT
    de "a +n &er!co" !%a$!nar
    Tipul de .randoare Aces( s+'(!& se a&"!c7 a(+nc! cAnd (e%a cen(ra"7 a
    de"!r+"+! o cons(!(+!e conv!n$erea c7 are +n %are Edar nerec+nosc+(J (a"en(
    sa+ &ers&!cac!(a(e or! c7 a .7c+( o %are desco&er!re Ma! rar, !nd!v!d+" &oa(e
    &re/en(a !deea de"!ran(7 c7 ar avea o re"a=!e s&ec!a"7 c+ o &ersoan7 %arcan(7
    Ede e< , c+ +n cons!"!er a" &reOed!n(e"+!J or! c7 ar .! o &ersoan7 %arcan(7 E:n
    care ca/, res&ec(!v+" &oa(e .! cons!dera( dre&( !%&os(orJ Ide!"e de"!ran(e de
    $randoare &o( avea s! con=!n+( re"!$!os Ede e<, &ersoana crede c7 are +n
    %esa@ s&ec!a" de "a o d!v!n!(a(eJ
    Tipul de .elozie. Aces( s+'(!& se a&"!c7 a(+nc! cAnd (e%a cen(ra"7 a de"!r+"+!
    &ersoane! o cons(!(+!e .a&(+" c7 so=!a Eso=+"J sa+ a%an(a Ea%an(+"J &ersoane!
    es(e %.!de"E7J La aceas(7 conv!n$ere se a@+n$e .7r7 ca+/a c+ven!(7 s! se
    'a/ea/7 &e !n.eren=e !ncorec(e s+s=!n+(e de %!c! .7rA%e de S&ro'eT Ede e< ,
    ne$"!@en(a ves(!%en(ar7 sa+ &e(e &e cearcea.J care s+n( co"ec(a(e s! +(!"!/a(e
    s&re a @+s(!.!ca de"!r+" Ind!v!d+" c+ de"!r :O! con.r+n(7 de re$+"7 so=!a Eso=+"J
    sa+ a%an(a Ea%an(+"J s! :ncearc7 s7 !n(erv!n7 :n &res+&+sa !n.!de"!(a(e Ede
    e<, res(rAn$e a+(ono%!a so=!e! Eso=+"+!J, o E:"J +r%7reO(e !n secre(,
    !nves(!$ea/7 a%an(+" 2Ea%an(aJ &res+&+sE7J, a(ac7 so=!a Eso=+"J Tipul de
    persecu3ie Aces( s+'(!& se a&"!c7 a(+nc! cAnd (e%a cen(ra"7 a de"!r+"+!
    !%&"!c7 conv!n$erea &ersoane! c7 se cons&!r7 con(ra sa, c7 es(e s&!ona(7,
    :nOe"a(7, +r%7r!(7, o(r7v!(7 sa+ dro$a(7, (ra(a(7 c+ r7+(a(e, ve<a(7 sa+
    o's(r+c(!ona(7 :n +r%7r!rea o'!ec(!ve"or sa"e &e (er%en "+n$ M!c!
    +%!"!n=e &o( .! e<a$era(e s! deven! n+c"e+" +n+! s!s(e% de"!ran( N+c"e+"
    de"!r+"+! :" cons(!(+!e adesea o !n@+s(!=!e oarecare care (re'+!e re%ed!a(7 &r!n
    ac=!+ne "e$a"7 ES&arano!a ev er+"en(7 J, !ar &ersoana a.ec(a(7 se &oa(e an$a@a
    :n (en(a(!ve re&e(a(e de o'=!nere a sa(!s.ac=!e! &r!n a&e" "a (r!'+na"e s! "a a"(e
    a$en=!! $+verna%en(a"e Ind!v!/!! c+ !de! de"!ran(e de &ersec+=!e s+n( adesea
    &"!n! de resen(!%en(e s! co"eros!, s! &o( rec+r$e adesea "a v!o"en(7 con(ra ce"or
    care cred e! c6 !4a+ o.ensa(
    Tipul somatic Aces( s+'(!& se a&"!c7 a(+nc! cAnd (e%a cen(ra"7 a de"!r+"+!
    !%&"!c7 .+nc=!! sa+ sen/a=!! cor&ora"e Ide!"e de"!ran(e so%a(!ce &o( s+rven! :n
    d!verse .or%e Ce"e %a! .recv en(e cons(a+ d!n conv %$erea &ersoane! c7 ea
    e%!(e +n %!ros +ra( d!n &!e"e, $+r7, rec( sa+ va$!n, c7 es(e !n.es(a(7 c+ !nsec(e
    &e, sa+ s+' (e$+%en(e, c7 are &ara/!=! !n(ern!, c7 an+%!(e &7r=! a"e cor&+"+!
    s7+ s+n( d!.or%e sa+ !doase Econ(rar or!c7re! ev!den(eJ or! c7 &7r=! a"e
    cor&+"+! e! Ede e< , !n(es(!n+" $rosJ n+ .+nc=!onea/7
    Tipul mixt Aces( s+'(!& se a&"!c7 a(+nc! cAnd n+ &redo%!n7 n!c! o (e%7
    de"!ran(7
    Tipul nespecificat Aces( s+'(!& se a&"!c7 a(+nc! cAnd conv!n$erea de"!ran(7
    do%!nan(7 n+ &oa(e .! c"ar s(a'!"!(7 sa+ n+ se :nscr!e !n (!&+r!"e s&ec!.!ce Ede
    e<, !de! de"!ran(e de re.er!n=7, .7r7 o co%&onen(7 de &ersec+=!e sa+ de
    $randoare no(a'!"7J
    *lemente si tulburri asociate
    D!n conv!n$er!"e de"!ran(e a"e (+"'+r7% de"!ran(e &o( re/+"(a &ro'"e%e soc!a"e,
    %ar!(a"e sa+ de serv!c!+ Ide!"e de re.er!n=7 Ede e<, c7 even!%en(e .or(+!(e a+ o
    se%n!.!ca=!e s&ec!a"7J s+n( .recven(e "a !nd!v!/!! c+ aceas(7 (+"'+rare In(er&re(area
    +2>
    Sc%i(o$renia si Alte Tulburri #si%otice
    de c7(re e! a aces(or even!%en(e es(e concordan(7 c+ con=!n+(+" conv!n$er!"or "or
    de"!ran(e. M+"=! !nd!v!/! c+ (+"'+rare de"!ran(7 &re/!n(7 d!s&o/!=!e d!s.or!c7 sa+
    !r!(a'!"7 care de re$+"7 &oa(e .! :n=e"eas7 ca o reac=!e "a conv!n$er!"e "or de"!ran(e, :n
    s&ec!a", :n (!&+r!"e de &ersec+=!e O! de $e"o/!e &oa(e a&are o s(are co"eroas7
    re%arca'!"7 s! +n co%&or(a%en( v!o"en(. Ind!v!d+" se &oa(e an$a@a :n(r4+n
    co%&or(a%en( "!(!$!os, d+cAnd +neor! "a scr!erea a s+(e de scr!sor! de &ro(es(
    adresa(e o.!c!a"!(7=!"or $+verna%en(a"e s! @+d!c!are s! "a %+"(e a&ar!=!! :n .a=a
    co%&"e(e"or de @+deca(7. D!.!c+"(7=! "e$a"e &o( s+rven! :n (+"'+rarea de"!ran(7,
    (!&+r!"e de $e"o/!e s! ero(o%an. Ind!v!/!! c+ (+"'+rare de"!ran(7, (!&+" so%a(!c, &o( .!
    s+'!ec(+" +nor (es(e O! &roced+r! %ed!ca"e !n+(!"e. De.!c!en=e"e de a+/, s(resor!!
    &s!osoc!a"! sever! Ede e<., !%!$rareaJ O! s(a(+s+" soc!oecono%!c !n.er!or &o(
    &red!s&+ne +n !nd!v!d "a de/vo"(area an+%!(or (!&+r! de (+"'+rare de"!ran(7 Ede e<.,
    "a (!&+" &arano!dJ. E&!soade de&res!ve %a@ore s+rv!n &ro'a'!" "a !nd!v!/!! c+
    (+"'+rare de"!ran(7 %a! .recven( decA( :n &o&+"a=!a $enera"7. T+"'+rarea de"!ran(7
    &oa(e .! asoc!a(7 c+ (+"'+rarea o'ses!vo4co%&+"s!v7, (+"'+rarea d!s%or.!c7
    cor&ora"7 s! c+ (+"'+r7r!"e de &ersona"!(a(e &arano!d7, sc!/o!d7 sa+ ev!(an(7.
    *lemente speci$ice culturii si sexului
    Fond+" c+"(+ra" O! re"!$!os a" !nd!v!d+"+! (re'+!e "+a( :n cons!dera=!e :n eva"+area
    &re/en=e! &os!'!"e a (+"'+r7r!! de"!ran(e. Une"e c+"(+r! a+ conv!n$er! "ar$ s+s=!n+(e
    s! sanc=!ona(e c+"(+ra" care &o( .! cons!dera(e de"!ran(e :n a"(e c+"(+r!. Con=!n+(+"
    !de!"or de"!ran(e var!a/7, de ase%enea, :n d!verse c+"(+r! O! s+'c+"(+r!. T+"'+rarea
    de"!ran(7, (!&+" de $e"o/!e, es(e &ro'a'!" %a! .recven(7 "a '7r'a=! decA( "a .e%e!, dar
    se &are c7 n+ e<!s(7 d!.eren=e %a@ore :n ra&or( c+ se<+" :n .recven=a $enera"7 a
    (+"'+r7r!! de"!ran(e.
    #revalent
    T+"'+rarea de"!ran(7 es(e re"a(!v rar7 :n %ed!!"e c"!n!ce, ce"e %a! %+"(e s(+d!!
    c"!n!ce s+$erAnd c7 (+"'+rarea es(e res&onsa'!"7 de "d49d d!n !n(ern7r!"e :n
    +n!(7=!"e de s7n7(a(e %en(a"7. In.or%a=!! &rec!se c+ &r!v!re "a .recven=a :n &o&+"a=!e
    a aces(e! (+"'+r7r! "!&sesc, dar cea %a! '+n7 es(!%are es(e :n @+r de L,L;d. D!n ca+/a
    e(7=!! sa"e de re$+"7 (Ar/!! "a de'+(, r!sc+" de %or'!d!(a(e &e d+ra(a v!e=!! &oa(e .! de
    L,LYd4L,5d.
    *voluie
    E(a(ea "a de'+( a (+"'+r7r!! de"!ran(e es(e var!a'!"7, %er$And d!n ado"escen=7
    &An7 (Ar/!+ :n v!a=7. T!&+" de &ersec+=!e es(e ce" %a! .recven( s+'&. Evo"+=!a es(e
    .oar(e var!a'!"7, :n s&ec!a", :n (!&+" de &ersec+=!e (+"'+rarea es(e cron!c7, :ns7
    !n(ens!.!c7r! s! d!%!n+7r! a"e &reoc+&7r!! re.er!(oare "a conv!n$er!"e de"!ran(e
    s+rv!n adesea, :n a"(e ca/+r!, &er!oade de re%!s!+ne co%&"e(e &o( .! +r%a(e de
    rec7der! consec+(!ve, :n .!ne, :n a"(e ca/+r!, (+"'+rarea se re%!(e :n dec+rs de
    cA(eva "+n!, adesea .7r7 rec7dere +"(er!oar7. Une"e da(e s+$erea/7 c7 (!&+" de
    $e"o/!e &oa(e avea +n &ro$nos(!c %a! '+n decA( (!&+" de &ersec+=!e. CAnd (!&+" de
    &ersec+=!e es(e asoc!a( c+ +n even!%en( sa+ s(resor &rec!&!(an(, e" &oa(e avea +n
    &ro$nos(!c %a! '+n.
    76?2E Tulburarea
    Delirant
    +28

    #attern $amilial
    Une"e s(+d!! a+ cons(a(a( c7 (+"'+rarea de"!ran(7 es(e %a! .recven(7 &r!n(re
    r+de"e !nd!v!/!"or c+ sc!/o.ren!e decA( ar .! de aO(e&(a( &r!n Oans7, &e cAnd a"(e
    s(+d!! n+ a+ re%arca( n!c! o re"a=!e .a%!"!a"7 :n(re (+"'+rarea de"!ran(7 O!
    sc!/o.ren!e. E<!s(7 &+=!ne da(e :n "e$7(+r7 c+ .a&(+" c7 (+"'+r7r!"e de
    &ersona"!(a(e ev!(an(7 s! &arano!d7 &o( .! e<(re% de .recven(e &r!n(re r+de"e
    '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare de"!ran(7.
    Dia!nostic di$erenial
    D!a$nos(!c+" de (+"'+rare de"!ran(7 es(e &+s n+%a! cAnd !deea de"!ran(7 n+ es(e
    da(ora(7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ +ne! cond!=!! %ed!ca"e
    $enera"e. Un de"!r!+%, o de%en=7 s! (+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e se &o( &re/en(a c+ s!%&(o%e care s+$erea/7 (+"'+rarea
    de"!ran(7. De e<e%&"+, !de!"e de"!ran(e de &ersec+=!e s!%&"e Ede e<., Sc!neva !n(r7
    noa&(ea :n ca%era %ea O!4%! .+r7 a!ne"eTJ :n .a/a &recoce a de%en=e! de (!&
    A"/e!%er (re'+!e s7 .!e d!a$nos(!ca(e ca de%en=7 de (!& A"/e!%er, c+ !de!
    de"!ran(e. O (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7, da(ora(7 :n s&ec!a"
    s(!%+"an(e"or, c+% ar .! a%.e(a%!ne"e sa+ coca!na, &e sec=!+ne (ransversa"7 &oa(e .!
    !den(!c7 :n s!%&(o%a(o"o$!e c+ (+"'+rarea de"!ran(7, dar de re$+"7 &o( .! d!s(!nse
    &r!n re"a=!a crono"o$!c7 a +/+"+! de s+'s(an=7 c+ de'+(+" s! re%!s!+nea
    conv!n$er!"or de"!ran(e.
    T+"'+rarea de"!ran(7 &oa(e .! d!s(!ns7 de sc!/o.ren!e s! de (+"'+rarea
    sc!/o.ren!.or%7 &r!n a'sen=a a"(or s!%&(o%e carac(er!s(!ce a"e .a/e! ac(!ve a
    sc!/o.ren!e! Ede e<., a"+c!na=!! a+d!(!ve sa+ v!/+a"e &roe%!nen(e, !de! de"!ran(e
    '!/are, "!%'a@ de/or$an!/a(, co%&or(a%en( ."a$ran( de/or$an!/a( sa+ ca(a(on!c,
    s!%&(o%e ne$a(!veJ, :n co%&ara=!e c+ sc!/o.ren!a, (+"'+rarea de"!ran(7 &rod+ce de
    re$+"7 %a! &+=!n7 de(er!orare :n .+nc=!onarea &ro.es!ona"7 sa+ soc!a"7.
    Poa(e .! e<(re% de d!.!c!" s7 se d!.eren=!e/e (+"'+r7r!"e a.ec(!ve c+ e"e%en(e
    &s!o(!ce de (+"'+rarea de"!ran(7, deoarece e"e%en(e"e &s!o(!ce asoc!a(e c+
    (+"'+r7r!"e a.ec(!ve !%&"!c7 de re$+"7 !de! de"!ran(e non'!/are .7r7 a"+c!na=!!
    &roe%!nen(e, !ar (+"'+rarea de"!ran(7 are asoc!a(e .recven( s!%&(o%e a.ec(!ve.
    D!s(!nc=!a de&!nde de re"a=!a (e%&ora"7 d!n(re &er(+r'area a.ec(!v7 O! !de!"e
    de"!ran(e s! de sever!(a(ea s!%&(o%e"or a.ec(!ve. Dac7 !de!"e de"!ran(e s+rv!n
    e<c"+s!v :n c+rs+" e&!soade"or a.ec(!ve, d!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7
    c+ e"e%en(e &s!o(!ce. DeO! s!%&(o%e"e de&res!ve s+n( co%+ne :n (+"'+rarea
    de"!ran(7, e"e s+n( de re$+"7 +Ooare s! se re%!(, &e cAnd s!%&(o%e"e de"!ran(e
    &ers!s(7, O! n+ @+s(!.!c7 +n d!a$nos(!c se&ara( de (+"'+rare a.ec(!v7. Oca/!ona",
    s!%&(o%e a.ec(!ve care sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod a.ec(!v se s+&ra&+n
    &es(e o &er(+r'are de"!ran(7. T+"'+rarea de"!ran(7 &oa(e .! d!a$nos(!ca(7, n+%a!
    dac7 d+ra(a (o(a"7 a (+(+ror e&!soade"or a.ec(!ve es(e co%&ara(!v %a! sc+r(7 :n
    ra&or( c+ d+ra(a (o(a"7 a &er(+r'7r!! de"!ran(e. Dac7 s!%&(o%e"e care sa(!s.ac
    cr!(er!!"e &en(r+ +n e&!sod a.ec(!v s+n( &re/en(e o &or=!+ne s+'s(an=!a"7 a
    &er(+r'7r!! de"!ran(e Ead!c7, a ec!va"en(+"+! de"!ran( a" (+"'+r7r!! sc!/oa.ec(!veJ,
    a(+nc! es(e !nd!ca( +n d!a$nos(!c de (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e
    aco%&an!a(, .!e de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e, .!e de (+"'+rare
    '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e.
    ;9G
    Sc%i(o$renia ,i Alte Tulburri #si%otice
    Ind!v!/!! c+ (+"'+rare &s!o(!c7 !nd+s7 &o( &re/en(a s!%&(o%e s!%!"are ce"or
    o'serva(e :n (+"'+rarea de"!ran(7, dar &er(+r'area are o e(!o"o$!c O! evo"+=!e
    carac(er!s(!c7, :n (+"'+rarea de"!ran(7 !nd+s7, !de!"e de"!ran(e a&ar :n con(e<(+" +ne!
    re"a=!! s(rAnse c+ o a"(7 &ersoan7, s+n( !den(!ce ca .or%7 c+ !de!"e de"!ran(e a"e ace"e!
    &ersoane s! d!%!n+a sa+ d!s&ar cAnd !nd!v!d+" c+ (+"'+rarea &s!o(!c7 !nd+s7 es(e
    se&ara( de !nd!v!d+" c+ (+"'+rarea &s!o(!c7 &r!%ar7. T+"'+rarea &s!o(!c7 sc+r(7
    se d!.eren=!a/7 de (+"'+rarea de"!ran(7 &r!n .a&(+" c7 s!%&(o%e"e de"!ran(e d+rea/7
    %a! &+=!n de o "+n7. Un d!a$nos(!c de (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e &oa(e
    .! &+s, dac7 n+ se d!s&+ne de s+.!c!en(e !n.or%a=!! &en(r+ a a"e$e :n(re (+"'+rarea
    de"!ran(7 s! a"(e (+"'+r7r! &s!o(!ce sa+ &en(r+ a s(a'!"! dac7 s!%&(o%e"e &re/en(a(e
    s+n( !nd+se de o s+'s(an=7 sa+ s+n( re/+"(a(+" +ne! cond!=!! %ed!ca"e $enera"e.
    H!&ocondr!a E:n s&ec!a" c+ conO(!!n=a %a"ad!e! red+s7J &oa(e .! d!.!c!" de
    d!.eren=!a( de (+"'+rarea de"!ran(7, :n !&ocondr!e, (e%er!"e :n "e$7(+r7 c+ .a&(+"
    de a avea o %a"ad!e sever7 or! c+ &reoc+&area c7 o are de@a s+n( s+s=!n+(e c+ %a!
    &+=!n7 !n(ens!(a(e decA( cea de"!ran(7 Ead!c7, !nd!v!d+" &oa(e acce&(a !deea c7
    %a"ad!a (e%+(7 n+ es(e &re/en(7J. T+"'+rarea d!s%or.!c7 cor&ora"7 !%&"!c7 o
    &reoc+&are re.er!(oare "a +n de.ec( !%a$!nar :n as&ec(. M+"=! !nd!v!/! c+ aceas(7
    (+"'+rare :O! s+s=!n conv!n$er!"e c+ o !n(ens!(a(e %a! red+s7 decA( cea de"!ran(7 s!
    rec+nosc c7 &7rerea "or re.er!(oare "a &ro&r!+" as&ec( es(e d!s(ors!ona(7. Un
    &rocen( se%n!.!ca(!v de !nd!v!/! a"e c7ror s!%&(o%e sa(!s.ac cr!(er!!"e &en(r+
    (+"'+rarea d!s%or.!c7 cor&ora"7 :O! s+s=!n :ns7 conv!n$er!"e c+ o !n(ens!(a(e
    de"!ran(7. CAnd s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a%'e"e (+"'+r7r!, &o( .!
    d!a$nos(!ca(e a(A( (+"'+rarea d!s%or.!c7 cor&ora"7, cA( O! (+"'+rarea de"!ran(7,
    (!&+" so%a(!c. L!%!(e"e d!n(re (+"'+rarea o'ses!vo4co%&+"s!v7 E:n s&ec!a" c+
    conO(!!n=a %a"ad!e! red+s7J O! (+"'+rarea de"!ran(7 &o( .! +neor! d!.!c!" de s(a'!"!(.
    Ca&ac!(a(ea !nd!v!/!"or c+ (+"'+rare o'ses!vo4co%&+"s!v7 de a rec+noaO(e c7
    o'ses!!"e sa+ co%&+"s!!"e s+n( e<ces!ve sa+ ne@+s(!.!ca(e s+rv!ne &e +n con(!n++%.
    La +n!! !nd!v!/!, (es(area rea"!(7=!! &oa(e .! &!erd+(7, !ar o'ses!a &oa(e a(!n$e
    &ro&or=!! de"!ran(e Ede e<., conv!n$erea c7 c!neva a ca+/a( %oar(ea a"(e! &ersoane
    &r!n .a&(+" c7 !4a dor!(4oJ. Dac7 o'ses!!"e evo"+ea/7 :n conv!n$er! de"!ran(e
    s+s=!n+(e, care re&re/!n(7 &ar(ea %a@or7 a (a'"o+"+! c"!n!c, &oa(e .! !nd!ca(
    d!a$nos(!c+" ad!=!ona" de (+"'+rare de"!ran(7.
    :n con(ras( c+ (+"'+rarea de"!ran(7, :n (+"'+rarea de &ersona"!(a(e &arano!d7 n+
    e<!s(7 conv!n$er! de"!ran(e c"are sa+ &ers!s(en(e. Or! de cA(e or! o &ersoan7 c+
    (+"'+rare de"!ran(7 are o (+"'+rare de &ersona"!(a(e &ree<!s(en(7, (+"'+rarea de
    &ersona"!(a(e (re'+!e s7 .!e %en=!ona(7 &e a<a II, +r%a(7 de e<&res!a S&re%or'!d7T
    :n &aran(e/7.
    76828 Tulburarea #si%otic
    Scurt
    +24
    Criteriile $e $ia/no&ti# pentru C5G.* Tul-urarea Delirant(
    A2 Idei delirante nonbi(are 9adic, implic@nd situaii care survin "n viaa real,
    cum ar $i $aptul de a $i urmrit&), otrvit&), in$ectat&), iubit&) de la
    distan, "n,elat&) de so&ie) sau amant&) ori de a avea o maladie: cu o
    durat de cel puin o lun2
    S2 riteriul A pentru sc%i(o$renie nu a $ost satis$cut niciodat2
    Not(M Lalucinaii tactile ,i ol$active pot $i pre(ente "n tulburarea delirant,
    dac sunt "n raport cu tema delirant2
    2 "n a$ara impactului ideii &ideilor) delirante ori a rami$icaiilor sale &lor),
    $uncionarea nu este deteriorat semni$icativ, iar comportamentul nu este
    "n mod evident straniu sau bi(ar2
    D2 Dac episoadele a$ective au survenit concomitent cu ideile delirante, durata
    lor total a $ost scurt "n raport cu durata perioadelor delirante2
    *2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) ori, ale unei condiii medicale
    !enerale2
    De speci"icat tipul &urmtoarele tipuri sunt stabilite pe ba(a temei delirante
    predominante)D
    Tip eroto"anM idei delirante, cum c o alt persoan, de re!ul de condiie
    social mai "nalt se a$l "n relaii amoroase cu individul &a)
    Tip $e /ran$oareM idei delirante de valoare, putere, cuno,tine, identitate,
    sau o relaie special cu o divinitate sau persoan $aimoas
    Tip $e /elo)ieM idei delirante cum c partenera &partenerul) sexual&) al
    individului &individei) este in$idel&)
    Tip $e per&e#u!ieM idei delirante, cum c persoana respectiv &ori cineva de
    care persoana este apropiat) este tratat cu rutate "ntr-un anumit mod
    Tip &o"ati#M idei delirante, cum c persoana are un de$ect $i(ic sau o
    condiie medical !eneral
    Tip "i,tM idei delirante caracteristice pentru mai mult dec@t unul dintre
    tipurile de mai sus, dar nici una dintre ele nu predomin
    Tip ne$i%eren!iat
    C5>.> Tul-urarea P&i@oti#( S#urt(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! &s!o(!ce sc+r(e :" cons(!(+!e o &er(+r'are care
    !%&"!c7 de'+(+" 'r+sc a ce" &+=!n +n+" d!n(re +r%7(oare"e s!%&(o%e &s!o(!ce
    &o/!(!veQ !de! de"!ran(e, a"+c!na=!!, "!%'a@ de/or$an!/a( Ede e<., dera!ere .recven(7
    sa+ !ncoeren=7J or! co%&or(a%en( ca(a(on!c sa+ ."a$ran( de/or$an!/a( Ecr!(er!+" AJ.
    Un e&!sod a" &er(+r'7r!! d+rea/7 ce" &+=!n o /!, dar %a! &+=!n de o "+n7, !ar :n .!na"
    !nd!v!d+" rev!ne "a n!ve"+" an(er!or de .+nc=!onare Ecr!(er!+" BJ. Per(+r'area n+ es(e
    e<&"!ca(7 %a! '!ne de o (+"'+rare a.ec(!v7 c+ e"e%en(e &s!o(!ce, de (+"'+rarea
    44+
    Sc%i(o$renia ,i Alte Tulburri #si%otice

    sc!/oa.ec(!v7 or! de sc!/o.ren!e, s! n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e
    +ne! s+'s(an=e Ede e<., +n a"+c!no$enJ or! +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    e%a(o% s+'d+ra"J Ecr!(er!+" CJ.
    Speci$icani
    Ur%7(or!! s&ec!.!cAnd &en(r+ (+"'+rarea &s!o(!c7 sc+r(7 &o( .! no(a=! &e 'a/a
    &re/en=e! sa+ a'sen=e! de s(resor! &rec!&!(an=!Q
    C+ s(resorE!J %arcan(E!J. Aces( s&ec!.!can( &oa(e .! no(a( dac7 s!%&(o%e"e
    &s!o(!ce a&ar "a sc+r( (!%& d+&7, s! ev!den(, ca r7s&+ns "a +n+" sa+ %a!
    %+"(e even!%en(e care, s!n$+re sa+ :%&re+n7, ar .! %arca( s(resan(e &en(r+
    a&roa&e or!c!ne :n c!rc+%s(an=e s!%!"are :n c+"(+ra &ersoane!. Aces( (!& de
    (+"'+rare &s!o(!c7 sc+r(7 era n+%!( S&s!o/7 reac(!v7 sc+r(7T :n DSM4III4R.
    Even!%en(EeJ &rec!&!(an(EeJ &oa(e .! or!ce s(res %a@or, c+% ar .! &!erderea
    c+!va !+'!( or! (ra+%a &s!o"o$!c7 a "+&(e!. Prec!/area .a&(+"+! dac7 +n
    an+%!( s(resor a .os( &rec!&!(an( sa+ es(e consec!n=a %a"ad!e! &oa(e .! +neor!
    d!.!c!"7 c"!n!c, :n as(.e" de ca/+r!, dec!/!a va de&!nde de .ac(or!! asoc!a=!, c+%
    ar .! re"a=!a (e%&ora"7 d!n(re s(resor s! de'+(+" s!%&(o%e"or, !n.or%a=!!"e
    s+&"!%en(are de "a so= Eso=!eJ or! de "a +n EoJ a%!cE7J re.er!(oare "a n!ve"+" de
    .+nc=!onare an(er!or s(resor+"+! s! +n !s(or!c de r7s&+ns+r! s!%!"are "a
    even!%en(e s(resan(e :n (rec+(.
    F7r7 s(resorE!J %arcan(E!J. Aces( s&ec!.!can( &oa(e .! no(a(, dac7 s!%&(o%e"e
    &s!o(!ce n+ s+n(, ev!den(, +n r7s&+ns "a even!%en(e care ar .! %arca(
    s(resan(e &en(r+ a&roa&e or!c!ne, :n c!rc+%s(an=e s!%!"are :n c+"(+ra
    &ersoane!. C+ de'+( &os(&ar(+%. Aces( s&ec!.!can( va .! no(a( dac7
    de'+(+" s!%&(o%e"or are "oc :n dec+rs de I s7&(7%An! &os(&ar(+%.
    *lemente si tulburri asociate
    Ind!v!/!! c+ (+"'+rare &s!o(!c7 sc+r(7 e<&er!en(ea/7 de re$+"7 o '+"versare
    e%o=!ona"7 sa+ con.+/!e !n(ens7. Po( e<!s(a (recer! ra&!de de "a +n a.ec( !n(ens "a
    a"(+". DeO! de sc+r(7 d+ra(7, n!ve"+" de de(er!orare &oa(e .! sever s! &oa(e .! necesar7
    s+&rave$erea &en(r+ a ne as!$+ra c7 neces!(7=!"e n+(r!=!ona"e s! !$!en!ce s+n(
    sa(!s.7c+(e s! c7 !nd!v!d+" es(e &ro(e@a( con(ra consec!n=e"or @+dec7=!! de.!c!(are,
    de(er!or7r!! co$n!(!ve sa+ ac=!on7r!! con.or% !de!"or de"!ran(e. D+&7 cA( se &are,
    e<!s(7 +n r!sc cresc+( de %or(a"!(a(e Ec+ +n r!sc de s+!c!d e<(re% de %areJ, :n s&ec!a"
    "a !nd!v!/!! (!ner!. T+"'+r7r!"e de &ersona"!(a(e &ree<!s(en(e Ede e<., (+"'+rarea de
    &ersona"!(a(e &arano!d7, !s(r!on!c7, narc!s!s(!c7, sc!/o(!&a"7 sa+ 'order"!neJ &o(
    &red!s&+ne !nd!v!d+" "a de/vo"(area (+"'+r7r!!.
    *lemente speci$ice culturii
    Es(e !%&or(an( s7 se d!s(!n$7 s!%&(o%e"e (+"'+r7r!! &s!o(!ce sc+r(e de &a((ern+r!"e
    de r7s&+ns sanc=!ona(e c+"(+ra". De e<e%&"+, :n +ne"e cere%on!! re"!$!oase, +n !nd!v!d
    &oa(e re"a(a c7 a+de voc!, dar :n $enera" aces(ea n+ &ers!s(7 s! n+ s+n( &erce&+(e ca
    anor%a"e de c7(re ce! %a! %+"=! %e%'r! a! co%+n!(7=!! &ersoane!.
    #revalent
    Ca/+r! de (+"'+rare &s!o(!c7 sc+r(7 s+n( rar v7/+(e :n cond!=!! c"!n!ce :n s(a(e"e
    Un!(e s! :n a"(e =7r! de/vo"(a(e. Inc!den=a s! &reva"en(a ca/+r!"or care n+ se &re/!n(7
    76828 Tulburarea #si%otic
    Scurt
    44*

    &en(r+ (ra(a%en( s+n( nec+nosc+(e. T+"'+r7r!"e &s!o(!ce care sa(!s.ac cr!(er!!"e A s!
    C &en(r+ (+"'+rarea &s!o(!c7 sc+r(7, dar n+ s! cr!(er!+" B Ead!c7, d+ra(a
    s!%&(o%e"or ac(!ve es(e de 54R "+n!, ca o&+se ce"or care se re%!( :n(r4o "+n7J s+n(
    %a! .recven(e :n =7r!"e :n c+rs de de/vo"(are decA( :n =7r!"e de/vo"(a(e.
    *voluie
    T+"'+rarea &s!o(!c7 sc+r(7 &oa(e a&are :n ado"escen=7 sa+ &recoce :n &er!oada
    ad+"(7, e(a(ea %ed!e "a de'+( s!(+And+4se :n +"(!%a &ar(e a an!"or 9L O! :nce&+(+"
    an!"or ;L. Pr!n de.!n!=!e, d!a$nos(!c+" de (+"'+rare &s!o(!c7 sc+r(7 cere re%!s!+nea
    co%&"e(7 a (+(+ror s!%&(o%e"or s! reven!rea "a n!ve"+" &re%or'!d de .+nc=!onare :n
    dec+rs de o "+n7 de "a de'+(+" &er(+r'7r!!. La +n!! !nd!v!/!, d+ra(a s!%&(o%e"or
    &s!o(!ce &oa(e .! .oar(e sc+r(7 Ede e<., cA(eva /!"eJ.
    #attern $amilial
    Une"e da(e s+$erea/7 c7 (+"'+rarea &s!o(!c7 sc+r(7 &oa(e .! :n re"a=!e c+
    (+"'+r7r!"e a.ec(!ve, :n (!%& ce a"(e da(e s+$erea/7 c7 (+"'+rarea &oa(e .! d!s(!nc(7,
    a(A( de sc!/o.ren!e, cA( s! de (+"'+r7r!"e a.ec(!ve.
    Dia!nostic di$erenial
    O %are d!vers!(a(e de cond!=!! %ed!ca"e $enera"e se &oa(e &re/en(a c+ s!%&(o%e
    &s!o(!ce de sc+r(7 d+ra(7. T+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e sa+ de"!r!+%+" s+n( d!a$nos(!ca(e cAnd e<!s(7 da(e d!n !s(or!c, e<a%en+"
    so%a(!c sa+ (es(e"e de "a'ora(or care !nd!c7 .a&(+" c7 !de!"e de"!ran(e sa+
    a"+c!na=!!"e s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e
    s&ec!.!ce Ede e<., s!ndro% C+s!n$, (+%or7 cere'ra"7J Eve/! &a$. ;;IJ. T+"'+rarea
    &s!o(!c7 !nd+s7 de o s+'s(an=7, de"!r!+%+" !nd+s de o s+'s(an=7 s! !n(o<!ca=!a c+
    o s+'s(an=7 se d!s(!n$ de (+"'+rarea &s!o(!c7 sc+r(7 &r!n .a&(+" c7 o s+'s(an=7 Ede
    e<., +n dro$ de a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a
    .! e(!o"o$!c :n re"a=!e c+ s!%&(o%e"e &s!o(!ce Eve/! &a$. ;;GJ. Tes(e"e de "a'ora(or,
    c+% ar .! de(ec(area :n +r!n7 a +n+! dro$ sa+ n!ve"+" san$+!n a" a"coo"+"+!, &o( .!
    +(!"e :n e.ec(+area aces(e! &rec!/7r!, "a .e" ca s! +n !s(or!c de(a"!a( a" +/+"+! de o
    s+'s(an=7, c+ accen( &e re"a=!!"e (e%&ora"e d!n(re ad%!n!s(rarea s+'s(an=e! O!
    de'+(+" s!%&(o%e"or O! na(+ra s+'s(an=e! +(!"!/a(e.
    D!a$nos(!c+" de (+"'+rare &s!o(!c7 sc+r(7 n+ &oa(e .! &+s dac7 s!%&(o%e"e
    &s!o(!ce s+n( e<&"!ca(e %a! '!ne de +n e&!sod de&res!v Ead!c7, s!%&(o%e"e
    &s!o(!ce s+rv!n e<c"+s!v :n c+rs+" +n+! e&!sod de&res!v %a@or, %an!aca" sa+ %!<(J.
    Dac7 s!%&(o%e"e &s!o(!ce &ers!s(7 (!%& de o "+n7 sa+ %a! %+"(, d!a$nos(!c+" es(e,
    .!e ce" de (+"'+rare sc!/o.ren!.or%7, (+"'+rare de"!ran(7, (+"'+rare a.ec(!v7 c+
    e"e%en(e &s!o(!ce, .!e ce" de (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e, :n .+nc=!e
    de &re/en=a a"(or s!%&(o%e :n (a'"o+" c"!n!c. D!a$nos(!c+" d!.eren=!a" :n(re
    (+"'+rarea &s!o(!c7 sc+r(7 s! (+"'+rarea sc!/o.ren!.or%7 es(e d!.!c!" cAnd
    s!%&(o%e"e &s!o(!ce s4a+ re%!s :na!n(e de o "+n7, ca r7s&+ns "a (ra(a%en(+" c+
    %ed!ca%en(e :nc+n+na( de s+cces. Deoarece e&!soade"e rec+ren(e de (+"'+rare
    &s!o(!c7 sc+r(7 s+n( rare, (re'+!e acorda(7 o a(en=!e s&ec!a"7T &os!'!"!(7=!! ca o
    (+"'+rare rec+ren(7 Ede e<., (+"'+rarea '!&o"ar7, e<acer'7r!"e ac+(e rec+ren(e a"e
    sc!/o.ren!e!J sa .!e res&onsa'!"7 de or!ce e&!soade &s!o(!ce rec+ren(e.
    Un e&!sod de (+"'+rare .ac(!ce, c+ s!%&(o%e s! se%ne &redo%!nan(
    &s!o"o$!ce, &oa(e avea as&ec(+" +ne! (+"'+r7r! &s!o(!ce sc+r(e, dar :n as(.e" de
    447
    Sc%i(o$renia si Alte Tulburri #si%otice

    ca/+r! e<!s(7 &ro'a c7 s!%&(o%e"e s+n( &rod+se :n %od !n(en=!ona( CAnd
    s!%+"area !%&"!c7 s!%&(o%e a&aren( &s!o(!ce, de re$+"7 e<!s(7 &ro'a c7 %a"ad!a a
    .os( !nven(a(7 &en(r+ +n sco& !n(e"!$!'!"
    La an+%!=! !nd!v!/! c+ (+"'+r7r! de &ersona"!(a(e, s(resorn &s!osoc!a"! &o(
    &rec!&!(a sc+r(e e&!soade de s!%&(o%e &s!o(!ce Aces(ea s+n( de re$+"7 (ran/!(or!!
    s! n+ @+s(!.!c7 +n d!a$nos(!c se&ara( Dac7 s!%&(o%e"e &s!o(!ce &ers!s(7 ce" &+=!n o
    /!, +n d!a$nos(!c ad!=!ona" de (+"'+rare &s!o(!c7 sc+r(7 &oa(e .! o&or(+n
    Criteriile $e $ia/no&ti# pentru
    C5>.> Tul-urarea P&i@oti#( S#urt(
    A #re(enta unuia &sau a mai multora) dintre urmtoarele simptomeM
    (1) idei delirante,
    (2) %alucinaii,
    (3) limba0 de(or!ani(at &de ex , deraieri $recvente sau incoerent)3
    (4) comportament $la!rant de(or!ani(at sau catatonic
    FotD A nu se include un simptom dac acesta este un pattern de rspuns
    sancionat cultural
    S Durata unui episod al perturbrii este de cel puin o (i, dar de mai puin de
    o lun, cu eventuala revenire complet ia nivelul premorbid de $uncionare
    #erturbarea nu este explicat mai bine de o tulburare a$ectiv cu elemente
    psi%otice, de tulburarea sc%i(oa$ectiv@ sau de sc%i(o$renie, si nu se
    datorea( e$ectelor $i(iolo!ice directe ale unei substane &de ex , un dro! de
    abu(, un medicament) ori ale unei condiii medicale !enerale
    De speci"icat dac
    u stresor&i) marcant&i) &psi%o(a reactiv scurt) dac simptomele survin la
    scurt timp dup, si evident, ca rspuns la evenimente care, sin!ure sau
    "mpreuna, ar $i marcat stresante pentru aproape oricine, "n circumstane
    similare "n cultura persoanei
    'r stresor&i) marcant&i)D dac simptomele psi%otice nu survin la scurt timp
    dup, sau nu sunt, evident, un rspuns la evenimente care, sin!ure sau
    "mpreun, ar $i marcat stresante pentru aproape oricine "n circumstane
    similare "n cultura persoanei
    u debut postpartum dac debutul survine "n decurs de H sptm@ni
    postpartum
    C5G.4 Tul-urarea p&i@oti#( in$u&( 3'olie a Deu,6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! &s!o(!ce !nd+se E:%&7r(7O!(eJ E.o"!e a de+<J :"
    cons(!(+!e o !dee de"!ran(7 care a&are "a +n !nd!v!d care se a."7 :n(r4o re"a=!e s(rAns7 c+
    o a"(7 &ersoan7 Eden+%!(7 +neon S!nd+c(orT sa+ Sca/ &r!%arTJ care are de@a o
    (+"'+rare &s!o(!c7 c+ !de! de"!ran(e &roe%!nen(e Ecr!(er!+" AJ Ind!v!d+" a@+n$e s7
    76? 4 Tulburarea psi%otic indus &'olie a
    Deux)
    444

    :%&7r(7Oeasc7 conv!n$er!"e de"!ran(e a"e ca/+"+! &r!%ar !n (o(a"!(a(e sa+ :n &ar(e
    Ecr!(er!+" BJ Ideea de"!ran(7 n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare &s!o(!c7 Ede
    e<, sc!/o.ren!aJ sa+ de o (+"'+rare a.ec(!v7 c+ e"e%en(e &s!oce s! n+ se da(orea/7
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<, a%.e(a%!naJ or! a"e +ne!
    cond!=!! %ed!ca"e $enera"e Ede e< , (+%or7 cere'ra"7J Ecr!(er!+" CJ Sc!/o.ren!a es(e
    &ro'a'!" ce" %a! .recven( d!a$nos(!c a" ca/+"+! &r!%ar, :ns7 &o( n !nc"+se s! a"(e
    d!a$nos(!ce, &rec+% (+"'+rarea de"!ran(7 sa+ (+"'+rarea a.ec(!v7 c+ e"e%en(e
    &s!o(!ce Con=!n+(+" conv!n$er!"or de"!ran(e !nd+se &oa(e .! de&enden( de
    d!a$nos(!c+" ca/+"+! &r!%ar s! &oa(e !nc"+de !de! de"!ran(e re"a(!v '!/are Ede e<, c7 o
    &+(ere s(r7!n7 os(!"7 :! (rans%!(e :n a&ar(a%en( rad!a=!! care :! &rovoac7 !nd!$es(!e s!
    d!areeJ, !de! de"!ran(e con$r+en(e c+ d!s&o/!=!a Ede e< , ca/+" &r!%ar va &r!%! c+rAnd
    +n con(rac( &en(r+ +n .!"% :n va"oare de 9 %!"!oane do"an, &er%!=And as(.e" .a%!"!e!
    s74s! c+%&ere o cas7 %+"( %a! %are c+ &!sc!n7J or! !de! de"!ran(e non'!/are,
    carac(er!s(!ce (+"'+r7% de"!ran(e Ede e<, FBI4+" :nre$!s(rea/7 (e"e.on+" .a%!"!e! s!
    de&"as7r!"e %e%'r!"or .a%!"!e!, cAnd aceO(!a &"eac7 de acas7J De re$+"7, :n (+"'+rarea
    &s!o(!c7 !nd+s7, ca/+" &r!%ar es(e do%!nan( :n re"a=!e s!, (re&(a(, jM !%&+ne s!s(e%+"
    de"!ran( +ne! a do+a &ersoane, !n!=!a" s7n7(oas7 s! %a! &as!v7 Ind!v!/!! care a@+n$ s7
    :%&7r(7Oeasc7 conv!n$er!"e de"!ran(e s+n( adesea :nr+d!=! Ec+ ca/+" &r!%arJ &r!n
    "e$7(+r! de sAn$e sa+ %ar!a@, a+ (r7!( :%&re+n7 %+"( (!%&, +neor! :n(r4o !/o"are soc!a"7
    re"a(!v7 Dac7 re"a=!a c+ ca/+" &n%ar es(e :n(rer+&(7, conv!n$er!"e de"!ran(e a"e
    ce"+!"a"( !nd!v!d de re$+"7 d!%!n+a s! d!s&ar DeO! ce" %a! .recven( es(e o'serva(7 :n
    re"a=!!"e a n+%a! do! oa%en!, (+"'+rarea &s!o(!c7 !nd+s7 &oa(e s+rven! s! "a +n
    n+%7r %a! %are de !nd!v!/!, :n s&ec!a" :n s!(+a=!!"e de .a%!"!e :n care +n &7r!n(e es(e
    ca/+" &r!%ar, !ar co&!!!, +neor! :n $rade d!.er!(e, ado&(7 conv!n$er!"e de"!ran(e a"e
    &7r!n(e"+! Ind!v!/!! c+ aceas(7 (+"'+rare so"!c!(7 rar (ra(a%en(, s! de re$+"7 s+n(
    conv!nO! s7 .!e e<a%!na=! c"!n!c cAnd ca/+" &n%ar es(e s+&+s (ra(a%en(+"+!
    *lemente si tulburri asociate
    C+ e<ce&=!a conv!n$er!"or de"!ran(e, :n (+"'+rarea &s!o(!c7 !nd+s7
    co%&or(a%en(+" n+ es(e de re$+"7 '!/ar sa+ s(ran!+ De(er!orarea es(e adesea
    %a! &+=!n sever7 "a !nd!v!d+" c+ (+"'+rare &s!o(!c7 !nd+s7 decA( "a ca/+" &r!%ar
    #revalent
    Re.er!(or "a &reva"en(a (+"'+r7% &s!o(!ce !nd+se d!s&+ne% de &+(%e
    !n.or%a=!! s!s(e%a(!ce T+"'+rarea es(e rar7 :n cond!=!! c"!n!ce, deO! s4a ar$+%en(a(
    c7 +ne"e ca/+r! n+ s+n( rec+nosc+(e Eca a(areJ Da(e "!%!(a(e s+$erea/7 c7
    (+"'+rarea &s!o(!c7 !nd+s7 es(e :n(r+cA(va %a! .recven(7 "a .e%e! decA( "a '7r'a=!
    *voluie
    Se O(!e &+=!n des&re e(a(ea "a de'+( a (+"'+r7r!! &s!oce !nd+se, dar se &are c7
    es(e var!a'!"7 F7r7 !n(erven=!e, evo"+=!a es(e de re$+"7 cron!c7, deoarece aceas(7
    (+"'+rare s+rv!ne ce" %a! .recven( :n re"a=!! care d+rea/7 de %+"( (!%& O! s+n(
    re/!s(en(e "a sc!%'are Pr!n se&ararea de ca/+" &n%ar, conv!n$er!"e de"!ran(e a"e
    !nd!v!d+"+! d!s&ar +neor! ra&!d, !ar a"(eor! .oar(e "en(
    Dia!nostic di$erenial
    D!a$nos(!c+" de (+"'+rare &s!o(!c7 !nd+s7 se &+ne n+%a! cAnd !deea de"!ran(7
    n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e on +ne! cond!=!!
    %ed!ca"e $enera"e D!a$nos(!c+" d!.eren=!a" cons(!(+!e rar o &ro'"e%7, deoarece
    44H
    Sc%i(o$renia si Alte Tulburri #si%otice

    !s(or!c+" de asoc!ere s(rAns7 c+ ca/+" &r!%ar s! s!%!"!(+d!nea !de!"or de"!ran(e d!n(re
    ce! do! !nd!v!/! es(e carac(er!s(!c7 (+"'+r7r!! &s!o(!ce !nd+se, :n sc!/o.ren!e,
    (+"'+rarea de"!ran(7, (+"'+rarea sc!/oa.ec(!v7 O! (+"'+rarea a.ec(!v7 c+ e"e%en(e
    &s!o(!ce n+ e<!s(7 n!c! o re"a=!e s(rAns7 c+ o &ersoan7 do%!nan(7 care s7 a!'7 o
    (+"'+rare &s!o(!c7 s! care s7 !nd+c7 conv!n$er! de"!ran(e s!%!"are, or!, dac7 e<!s(7 o
    as(.e" de &ersoan7, s!%&(o%e"e &s!o(!ce &reced de re$+"7 de'+(+" or!c7re! !de!
    de"!ran(e !nd+se, :n rare ca/+r!, +n !nd!v!d se &oa(e &re/en(a c+ ceea ce &are a . ! o
    (+"'+rare &s!o(!c7 !nd+s7, dar !de!"e de"!ran(e n+ d!s&ar cAnd !nd!v!d+" es(e
    se&ara( de ca/+" &r!%ar, :n(r4o as(.e" de s!(+a=!e, es(e &os!'!" s7 se !a :n cons!dera=!e
    d!a$nos(!c+" +ne! a"(e (+"'+r7r! &s!o(!ce.
    Criteriile $e $ia/no&ti# pentru
    C5G.4 Tul-urarea P&i@oti#( In$u&(
    A2 .n delir care apare la un individ "n contextul unei relaii str@nse cu o alt
    persoan &saupersoane), care are &au) un delir de0a existent2
    S2 Delirul este similar "n coninut cu cel al persoanei care are de0a existent
    delirul2
    2 #erturbarea nu este explicat mai bine de o alt tulburare psi%otic &de ex2,
    sc%i(o$renia) ori de o tulburare a$ectiv cu elemente psi%otice si nu se
    datorea( e$ectelor $i(iolo!ice directe ale unei substane &de ex2, un dro! de
    abu(, un medicament) ori ale unei condiii medicale !enerale2
    Tul-urarea P&i@oti#( $atorat(
    unei Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! &s!o(!ce da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e "e cons(!(+!e a"+c!na=!!"e sa+ !de!"e de"!ran(e &roe%!nen(e, cons!dera(e a .!
    da(ora(e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+"
    AJ. D!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or, (re'+!e s7 .!e ev!den(
    .a&(+" c7 !de!"e de"!ran(e sa+ a"+c!na=!!"e s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a +ne!
    cond!=!! %ed!ca"e $enera"e Ecr!(er!+" BJ. Per(+r'area &s!o(!c7 n+ es(e e<&"!ca(7 %a!
    '!ne de o a"(7 (+"'+rare %en(a"7 Ede e<., s!%&(o%e"e n+ s+n( r7s&+ns+" %ed!a(
    &s!o"o$!c "a o cond!=!e %ed!ca"7 sever7, :n care ca/ es(e %a! !nd!ca( d!a$nos(!c+" de
    (+"'+rare &s!o(!c7 sc+r(7, c+ s(resor %arcan(J Ecr!(er!+" CJ. D!a$nos(!c+" n+ es(e
    &+s dac7 &er(+r'area s+rv!ne n+%a! :n c+rs+" +n+! de"!r!+% Ecr!(er!+" DJ. De
    ase%enea, +n d!a$nos(!c se&ara( de (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e n+ se &+ne dac7 !de!"e de"!ran(e s+rv!n n+%a! :n c+rs+"
    de%en=e! de (!& A"/e!%er sa+ de%en=e! vasc+"are8 :n sc!%', se &oa(e &+ne
    d!a$nos(!c+" de de%en=7 de (!& A"/e!%er or! de de%en=7 vasc+"ar7, c+ s+'(!&+"
    Sc+ !de! de"!ran(eT.
    Ha"+c!na=!!"e &o( s+rven! :n or!ce %oda"!(a(e sen/or!a"7 Ead!c7, a"+c!na=!!
    v!/+a"e, o".ac(!ve, $+s(a(!ve sa+ a+d!(!veJ, dar an+%!=! .ac(or! e(!o"o$!c! es(e &os!'!"
    Tulburarea #si%otic datorat unei ondiii Medicale
    Generale
    44<
    s7 evoce an+%!(e .eno%ene a"+c!na(orn Ha"+c!na=!!"e o".ac(!ve, :n s&ec!a" ce"e
    !%&"!cAnd %!ros+" de ca+c!+c ars or! a"(e %!ros+r! ne&"7c+(e, s+n( e<(re% de
    s+$es(!ve de e&!"e&s!e de "o' (e%&ora" Ha"+c!na=!!"e &o( var!a, de "a s!%&"e s!
    !n.or%e &An7 "a e<(re% de co%&"e<e s! or$an!/a(e, :n .+nc=!e de .ac(or!! e(!o"o$!c!,
    c!rc+%s(an=e"e a%'!en(a"e, na(+ra s! sed!+" "e/!+n!! a(r!'+!(e s!s(e%+"+! nervos
    cen(ra" s! r7s&+ns+" reac(!v "a de(er!orare D!a$nos(!c+" de (+"'+rare &s!o(!c7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e n+ se &+ne :n $enera", dac7 !nd!v!d+" are
    conserva(7 (es(area rea"!(7=!! &en(r+ a"+c!na=!! s! a&rec!a/7 c7 e<&er!en=e"e
    &erce&(!ve re/+"(7 d!n cond!=!a %ed!ca"7 $enera"7 Ide!"e de"!ran(e &o( e<&r!%a o
    var!e(a(e de (e%e, !nc"+s!v so%a(!ce, de $randoare, re"!$!oase s!, ce" %a! .recven(, de
    &ersec+=!e Ide!"e de"!ran(e re"!$!oase s+n( asoc!a(e :n %od e<&res :n +ne"e ca/+n c+
    e&!"e&s!a "o'+"+! (e%&ora" Ind!v!/!! c+ "e/!+n! cere'ra"e &ar!e(a"e dre&(e &o(
    de/vo"(a +n s!ndro% de ne$"!@en(7 con(ra"a(era" :n care e! &o( s7 n+4s! rec+noasc7
    &7r=! a"e &ro&r!+"+! cor&, %er$And &An7 "a &ro&or=!! de"!ran(e :n $enera" :ns7,
    asoc!a=!!"e d!n(re !de!"e de"!ran(e s! an+%!(e cond!=!! %ed!ca"e $enera"e &ar a %a!
    &+=!n s&ec!.!ce decA( es(e ca/+" &en(r+ a"+c!na=!!
    :n &rec!/area .a&(+"+! dac7 &er(+r'area &s!o(!c7 es(e da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en(a +ne! cond!=!!
    %ed!ca"e $enera"e A&o!, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7 &er(+r'area
    &s!o(!c7 es(e :n re"a=!e e(!o"o$!c7 c+ cond!=!a %ed!ca"7 $enera"7 &r!n(r4+n
    %ecan!s% .!/!o"o$!c O eva"+are a(en(7 s! c+&r!n/7(oare a n+%eroO! .ac(or! es(e
    necesar7 &en(r+ a .ace aceas(7 @+deca(7 DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a
    &rec!/a dac7 re"a=!a d!n(re &er(+r'area &s!o(!c7 s! cond!=!a %ed!ca"7 $enera"7 es(e
    e(!o"o$!c7, +ne"e cons!deren(e o.er7 o oarecare $!dare :n aces( do%en!+ Un &r!%
    cons!deren( es(e ace"a a" &re/en(e! asoc!e% (e%&ora"e d!n(re de'+(+", e<acer'area
    sa+ re%!s!+nea cond!=!e! %ed!ca"e $enera"e s! &er(+r'area &s!o(!c7 Un a" do!"ea
    cons!deren( es(e ace"a a" &re/en(e! e"e%en(e"or care s+n( a(!&!ce &en(r+ o (+"'+rare
    &s!o(!c7 &r!%ar7 Ede e< , e(a(ea a(!&!c7 "a de'+( or! &re/en(a a"+c!na=!!"or v!/+a"e
    sa+ a+d!(!veJ Da(e"e d% "!(era(+r7, care s+$erea/7 c7 &oa(e e<!s(a o asoc!ere d!rec(7
    :n(re cond!=!a %ed!ca"7 $enera"7 :n ces(!+ne s! a&an(!a s!%&(o%e"or &s!o(!ce &o(
    o.er! +n con(e<( +(!" :n a&rec!erea +ne! an+%!(e s!(+a=!! :n a.ar7 de aceas(a,
    c"!n!c!an+" (re'+!e, de ase%enea, s7 s(a'!"easc7 .a&(+" c7 &er(+r'area n+ es(e
    e<&"!ca(7 %a! '!ne de o (+"'+rare &s!o(!c7 &r!%ar7, de o (+"'+rare &s!o(!c7 !nd+s7
    de o s+'s(an=7 or! de a"(7 (+"'+rare %en(a"7 &n%ar7 Ede e<, (+"'+rarea de
    ada&(areJ Aceas(7 &rec!/are es(e e<&"!ca(7 %a! :n de(a"!+ :n sec=!+nea ST+"'+r7r!"e
    %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"eT E&a$ 5G5J
    Subtipuri
    Un+" d% +r%7(oare"e s+'(!&+n &oa(e .! +(!"!/a( &en(r+ a !nd!ca s!%&(o%+"
    &redo%!nan( a" (a'"o+"+! c"!n!c Daca s+n( &re/en(e a(A( !de! de"!ran(e, cA( s!
    a"+c!na=!! se cod!.!c7 ce"e care s+n( &redo%!nan(e
    293.81 C+ !de! de"!ran(e Aces( s+'(!& es(e +(!"!/a( daca !de!"e de"!ran(e
    s+n( s!%&(o%+" &redo%!nan(
    293.82 C+ a"+c!na=!! Aces( s+'(!& es(e +(!"!/a( dac7 a"+c!na=!!"e s+n(
    s!%&(o%+" &redo%!nan(
    ;;R
    Sc%i(o$renia si Alte Tulburri #si%otice
    #rocedee de "nre!istrare
    :n :nre$!s(rarea d!a$nos(!c+"+! de (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 %en=!one/e %a! :n(A! &re/en(a (+"'+r7r!!
    &s!o(!ce, a&o! cond!=!a %ed!ca"7 $enera"7 !den(!.!ca(7 s! cons!dera(7 a .! ca+/a
    &er(+r'7r!! s!, :n .!na", s&ec!.!can(+" cores&+n/7(or !nd!cAnd s!%&(o%+"
    &redo%!nan( a" (a'"o+"+! c"!n!c, &e a<a I Ede e<, (+"'+rare &s!o(!c7 da(ora(7
    (!reo(o<!co/e!, c+ a"+c!na=!!J Cod+" d!a$nos(!c de &e a<a I es(e se"ec(a( con.or%
    s+'(!&+"+! 9F; G5 &en(r+ (+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, c+ !de! de"!ran(e s! 9F; G9 &en(r+ (+"'+rarea &s!o(!c7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, c+ a"+c!na=!! Cod+" ICD4F4CM &en(r+ cond!=!a
    %ed!ca"7 $enera"7 (re'+!e, de ase%enea, %en=!ona( &e a<a III Ede e<, 9I9 F
    (!reo(o<!co/7J E3e/! ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce"or ICD4F4CM
    &en(r+ cond!=!!"e %ed!ca"e $enera"e se"ec(a(eJ
    ondiiile medicale !enerale asociate
    O d!vers!(a(e de cond!=!! %ed!ca"e $enera"e &o( ca+/a s!%&(o%e &s!o(!ce,
    !nc"+/And cond!=!! ne+ro"o$!ce Ede e<, neo&"as%e"e, %a"ad!!"e cere'rovasc+"are,
    %a"ad!a H+n(%$(on, e&!"e&s!a, "e/!+n!"e sa+ de(er!orarea nerv+"+! ac+s(!c sa+
    o&(!c, s+rd!(a(ea, %!$rena, !n.ec=!!"e s!s(e%+"+! nervosJ, cond!=!! endocr!ne Ede e< ,
    !&er4s! !&o(!ro!d!s%+", !&er4s! !&o&ara(!ro!d!s%+", !&oadrenocor(!c!s%+"J,
    cond!=!! %e(a'o"!ce Ede e<, !&o<!a, !&ercar'!a, !&o$"!ce%!aJ, de/ec!"!'re
    !dr!ce sa+ e"ec(ro"!(!ce, %a"ad!! e&a(!ce sa+ rena"e s! (+"'+r7r! a+(o!%+ne c+
    !%&"!carea s!s(e%+"+! nervos cen(ra" Ede e< "+&+s+" en(e%a(os s!s(e%!cJ Ace"e
    cond!=!! ne+ro"o$!ce care !%&"!c7 s(r+c(+r!"e s+'cor("ca"e sa+ "o'+" (e%&ora" s+n(
    asoc!a(e %a! .recv en( c+ !de! de"!ran(e Da(e"e e<a%!n7% so%a(!ce, da(e"e de
    "a'ora(or s! &a((ern+r!"e de &reva"en(7 sa+ de de'+( re."ec(7 cond!=!a %ed!ca"7
    $enera"7 e(!o"o$!c7
    #revalent
    Ra(e"e de &reva"en(7 &en(r+ (+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e s+n( d!.!c!" de es(!%a(, da(7 .!!nd %area _ane(a(e de e(!o"o$+ %ed!ca"e
    s+'!acen(e Cerce(7r!"e s+$erea/7 c7 s!ndro%+" es(e s+'d!a$nos(!ca( % +n!(7=!"e
    %ed!ca"e $enera"e S!%&(o%e"e &s!o(!ce &o( .! &re/en(e :n n+ %a! &+(% de 9Ld
    d!n(re !nd!v!/!! care se &re/!n(7 c+ (+"'+r7r! endocr!ne ne(ra(a(e, :n 5Yd d!n(re ce!
    c+ "+&+s er!(e%a(os s!s(e%!c s! :n ILd sa+ %a! %+"( d!n(re !nd!v!/!! c+ e&!"e&s!e de
    "o' (e%&ora"
    *voluie
    T+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e &oa(e cons(a
    d!n(r4o s!n$+r7 s(are (ran/!(or!e sa+ &oa(e .! rec+ren(7, c!c"And oda(7 c+ e<acer'7r!"e
    s! re%!s!+n!"e cond!=!e! %ed!ca"e $enera"e s+'!acen(e DeO! (ra(a%en(+" cond!=!e!
    %ed!ca"e $enera"e s+'!acen(e d+ce adesea "a re/o"+=!a s!%&(o%e"or &s!o(!ce, n+
    aces(a es(e (o(dea+na ca/+", s!%&(o%e"e &s!o(!ce &+(And
    &ers!s(a %+"( (!%& d+&7 even!%en(+" %ed!ca" ca+/a" Ede e< , (+"'+rare &s!o(!c7
    sec+ndar7 +ne! "e/!+n! cere'ra"e .oca"eJ
    Tulburarea #si%otic datorat unei ondiii Medicale
    Generale
    44?
    Dia!nostic di$erenial
    Ha"+c!na=!!"e s! !de!"e de"!ran(e s+rv!n .recven( :n con(e<(+" +n+! de"!r!+%8 +n
    d!a$nos(!c se&ara( de (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e
    n+ es(e &+s, :ns7, dac7 &er(+r'area s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+%. :n
    sc!%', d!a$nos(!c+" de (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e &oa(e .! &+s &e "An$7 +n d!a$nos(!c de de%en=7, dac7 s!%&(o%e"e
    &s!o(!ce s+n( consec!n=a e(!o"o$!c7 d!rec(7 a &roces+"+! &a(o"o$!c care a ca+/a(
    de%en=a. D!n ca+/a cer!n=e"or cod!.!c7r!! c+ ICD4F4CM, o e<ce&=!e de "a aces(a se
    .ace a(+nc! cAnd !de!"e de"!ran(e s+rv!n e<c"+s!v :n c+rs+" de%en=e! vasc+"are, :n
    aces( ca/ es(e &+s n+%a! d!a$nos(!c+" de de%en=7 vasc+"ar7, c+ s+'(!&+" Sc+ !de!
    de"!ran(eT, +n d!a$nos(!c se&ara( de (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e n+ es(e &+s Dac7 (a'"o+" c"!n!c !nc"+de +n a%es(ec de d!.er!(e
    (!&+r! de s!%&(o%e Ede e< , s!%&(o%e &s!o(!ce sa+ an<!oaseJ, d!a$nos(!c+" es(e de
    re$+"7 ce" de (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, deoarece
    :n as(.e" de s!(+a=!! s!%&(o%e"e &s!o(!ce &redo%!n7 :n (a'"o+" c"!n!c
    Dac7 e<!s(7 &ro'a +n+! +/ recen( sa+ &re"+n$!( de o s+'s(an=7 E!nc"+s!v de
    %ed!ca%en(e c+ e.ec(e &s!oac(!veJ, de a's(!nen=7 de o s+'s(an=7 or! de e<&+nere
    "a +n (o<!c Ede e<, !n(o<!ca=!e c+ LSD, a's(!nen=7 a"coo"!c7J, (re'+!e "+a(7 :n
    cons!dera=!e o (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7 Poa(e .! +(!" s7 se
    e.ec(+e/e +n e<a%en a" +r%!! sa+ sAn$e"+! &en(r+ de&!s(area dro$+"+! or! a"(e
    e<a%ene de "a'ora(or adecva(e S!%&(o%e"e care s+rv!n :n c+rs+" sa+ "a sc+r( (!%&
    d+&7 !n(o<!ca=!a sa+ a's(!nen(a de o s+'s(an=7 Ead!c7, :n dec+rs de I s7&(7%An!J, or!
    d+&7 +/+" +n+! %ed!ca%en( &o( .! e<(re% de s+$es(!ve de o (+"'+rare &s!o(!c7
    !nd+s7 de o s+'s(an=7, :n .+nc=!e de carac(er+", d+ra(a s! can(!(a(ea de s+'s(an=7
    +(!"!/a(7 Dac7 c"!n!c!an+" a s(a'!"!( c7 &er(+r'area se da(orea/7, a(A( +ne! cond!=!!
    %ed!ca"e $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, &o( .! &+se a%'e"e d!a$nos(!ce
    Ead!c7, (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, s! (+"'+rare
    &s!o(!c7 !nd+s7 de o s+'s(an=7J
    T+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e (re'+!e s7 .!e
    d!s(!ns7 de o (+"'+rare &s!o(!c7 &r!%ar7 Ede e<, sc!/o.ren!a, (+"'+rarea
    de"!ran(7, (+"'+rarea sc!/oa.ecv7J sa+ de o (+"'+rare a.ec(!v7 &r!%ar7 c+
    e"e%en(e &s!o(!ce :n (+"'+r7r!"e &s!o(!ce &r!%are s! :n (+"'+r7r!"e a.ec(!ve
    &r!%are c+ e"e%en(e &s!o(!ce n+ &oa(e .! de%ons(ra(7 &re/en(a n!c! +n+!
    %ecan!s% .!/!o"o$!c s&ec!.!c s! ca+/a" d!rec(, asoc!a( c+ o cond!=!e %ed!ca"7
    $enera"7. E(a(ea %a! avansa(7 "a de'+( Ede e< , a&ar!=!a &en(r+ &r!%a da(7 a !de!"or
    de"!ran(e "a +n !nd!v!d :n e(a(e de &es(e ;Y an!J s! a'sen(a +n+! !s(or!c .a%!"!a" de
    sc!/o.ren!e sa+ de (+"'+rare de"!ran(7 s+$erea/7 neces!(a(ea +ne! eva"+7r!
    co%&"e(e &en(r+ a e<c"+de d!a$nos(!c+" de (+"'+rare &s!o(!c7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e Ha"+c!na=!!"e a+d!(!ve care !%&"!c7 voc! &ron+n=And
    &ro&o/!=!+% co%&"e(e s+n( %a! s&ec!.!ce sc!/o.ren!e! decA( (+"'+r7% &s!o(!ce
    da(ora(e +ne! cond!=!! %ed!ca"e $enera"e A"(e (!&+r! de a"+c!na=!! Ede e< , v!/+a"e,
    o".ac(!veJ se%na"ea/7 .recven( o (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e or! o (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7
    T+"'+rarea &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e es(e d!a$nos(!ca(7 cAnd c"!n!c!an+"
    n+ &oa(e &rec!/a dac7 &er(+r'area &s!o(!c7 es(e &r!%ar7, es(e !nd+s7 de o
    s+'s(an=7 sa+ se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e Ha"+c!na=!!
    !&na$o$!ce s! !&no&o%&!ce &o( s+rven! s! "a !nd!v!/!! .7r7 n!c! o (+"'+rare
    %en(a"7, dar e"e s+rv!n n+%a! :n c+rs+" ador%!r!! sa+ a" deO(e&(7r!! d!n so%n
    448 Sc%i(o$renia si Alte Tulburri #si%otice

    Criteriile $e $ia/no&ti# pentru C54.,, Tul-urarea P&i@oti#(
    $atorat( ... [Se indic Condiia Medical General]
    A Lalucinaii sau idei delirante proeminente
    S *xist proba, din istoric, examenul somatic sau datele de laborator, a
    $aptului c perturbarea este consecina $i(iolo!ic direct a unei condiii
    medicale !enerale
    #erturbarea nu este explicat mai bine de alt tulburare mental
    D #erturbarea nu survine exclusiv "n cursul unui delinum A se
    codi"ica pe ba(a simptomului predominant
    .>* Cu i$ei $elirante dac ideile delirante sunt simptomul predominant .>C
    Cu @alu#ina!ii dac %alucinaiile sunt simptomul predominant
    Not( $e #o$i%i#are Fumele condiiei medicale !enerale se include pe axa l, de
    ex, 764 8E Tulburare psi%otic datorat unui neoplasm pulmonar mali!n, cu
    idei delirante, condiia medical !eneral se codi$ic, de asemenea, pe axa III
    &ve(i anexa G pentru coduri)
    Not( $e #o$i%i#are Dac ideile delirante sunt parte a unei demente vasculare,
    se indic ideile delirante prin codi$icarea subtipuiui corespun(tor, de ex,
    765 H7 Dement vascular, cu idei delirante
    Tul-urarea P&i@oti#( in$u&( $e o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! &s!o(!ce !nd+se de o s+'s(an=7 s+n(
    a"+c!na=!!"e sa+ !de!"e de"!ran(e &roe%!nen(e Ecr!(er!+" AJ, cons!dera(e a .! da(ora(e
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ead!c7, +n dro$ de a'+/, +n
    %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ Ecr!(er!+" BJ Ha"+c!na=!!"e, &e care !nd!v!d+"
    "e conO(!en(!/ea/7 ca .+nd !nd+se de s+'s(an=7, n+ s+n( !nc"+se a!c!, c! (re'+!e
    d!a$nos(!ca(e ca !n(o<!ca=!e c+ o s+'s(an=7 sa+ a's(!nen(7 de o s+'s(an=7, c+
    s&ec!.!can(+" aco%&an!an( de Sc+ &er(+r'7r! de &erce&=!e Aceas(7 &er(+r'are n+
    (re'+!e s7 .!e e<&"!ca(7 %a! '!ne de o (+"'+rare &s!o(!c7 ne!nd+s7 de o s+'s(an=7
    Ecr!(er!+" CJ D!a$nos(!c+" n+ se &oa(e &+ne dac7 s!%&(o%e"e &s!o(!ce s+rv!n
    n+%a! :n c+rs+" +n+! den+% Ecr!(er!+" DJ Aces( d!a$nos(!c (re'+!e &+s :n "oc+"
    +n+! d!a$nos(!c de !n(o<!ca=!e c+ o s+'s(an=7 or! de a's(!nen(7 de o s+'s(an=7,
    n+%a! cAnd s!%&(o%e"e &s!o(!ce s+n( :n e<ces .a(7 de ce"e asoc!a(e de re$+"7 c+
    s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen(7 or! cAnd s!%&(o%e"e s+n( s+.!c!en( de
    severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 Pen(r+ o d!sc+=!e %a! de(a"!a(7 a
    (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7 ve/! &a$ 5F5
    O (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare &s!o(!c7
    &r!%ar7 &r!n "+area :n cons!dera=!e a de'+(+"+!, evo"+=!e!, &rec+% s! a a"(or .ac(or!
    Pen(r+ dro$+r!"e de a'+/, d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or,
    (re'+!e s7 re/+"(e &ro'a !n(o<!ca=!e! sa+ a's(!nen(e! T+"'+r7r!"e &s!o(!ce !nd+se de
    Tulburarea #si%otic indus de o
    Substan
    ++4
    o s+'s(an=7 s+rv!n n+%a! :n asoc!a=!e c+ s(7r!"e de !n(o<!ca=!e sa+ de a's(!nen(7, &e
    cAnd (+"'+r7r!"e &s!o(!ce &r!%are &o( &receda de'+(+" +/+"+! de o s+'s(an=7 sa+
    &o( s+rven! :n c+rs+" &er!oade"or de a's(!nen=7 &re"+n$!(7 Oda(7 a&7r+(e,
    s!%&(o%e"e &s!o(!ce &o( &ers!s(a a(A( (!%& cA( con(!n+7 +/+" de s+'s(an=7 Un a"(
    cons!deren( :" cons(!(+!e &re/en(a de e"e%en(e care s+n( a(!&!ce &en(r+ o (+"'+rare
    &s!o(!c7 &r!%ar7 Ede e<, e(a(ea de de'+( sa+ evo"+=!a a(!&!ceJ De e<e%&"+,
    a&ar!=!a de !de! de"!ran(e de novo "a o &ersoan7 :n e(a(e de &es(e ;Y de a%, .7r7 +n
    !s(or!c c+nosc+( de (+"'+rare &s!o(!c7 &r!%ar7, (re'+!e s7 a(ra$7 a(en=!a
    c"!n!c!an+"+! as+&ra &os!'!"!(7=!! e<!s(en=e! +ne! (+"'+r7r! &s!o(!ce !nd+se de o
    s+'s(an=7 C!ar +n !s(or!c an(er!or de (+"'+rare &s!o(!c7 &r!%ar7 n+ e<c"+de
    &os!'!"!(a(ea e<!s(en(e! +ne! (+"'+r7r! !nd+se de o s+'s(an=7 S4a s+$era( c7 :n F d!n
    5L, a"+c!na=!!"e nona+d!(!ve s+n( &rod+s+" +ne! (+"'+r7r! &s!o(!ce !nd+se de o
    s+'s(an=7 or! a" +ne! (+"'+r7r! &s!o(!ce da(ora(e +ne! cond!=!! %ed!ca"e $enera"e
    D!n con(ra, .ac(o% care s+$erea/7 c7 s!%&(o%e"e &s!o(!ce s+n( e<&"!ca(e %a! '!ne
    de o (+"'+rare &s!o(!c7 &r!%ar7 !nc"+d &ers!s(en(a de s!%&(o%e &s!o(!ce o
    &er!oad7 s+'s(an=!a"7 de (!%& Ead!c7, o "+n7 sa+ %a! %+"(J, d+&7 (er%!narea
    !n(o<!ca=!e! c+ o s+'s(an=7 or! a a's(!nen=e! ac+(e de o s+'s(an=7, a&ar!=!a de
    s!%&(o%e care s+n( s+'s(an=!a" :n e<ces .a(7 de ceea ce ar de aO(e&(a(, da( .+nd
    (!&+" sa+ can(!(a(ea de s+'s(an=7 +(!"!/a(7 sa+ d+ra(a de +/ or! +n !s(or!c de
    (+"'+r7r! &s!o(!ce &r!%are rec+ren(e an(er!oare A"(e ca+/e de s!%&(o%e &s!o(!ce
    (re'+!e s7 .!e "+a(e :n cons!dera=!e, c!ar "a o &ersoan7 c+ !n(o<!ca=!e sa+ a's(!nen(7,
    deoarece &ro'"e%e"e :n ra&or( c+ +/+" de o s+'s(an=7 n+ s+n( rare &r!n(re
    &ersoane"e c+ (+"'+r7r! &s!o(!ce E&ro'a'!"J ne%d+se de o s+'s(an=7
    Subtipuri si speci$icanti
    Un+" d!n(re +r%7(oare"e s+'(!&+n &oa(e .! +(!"!/a( &en(r+ a !nd!ca s!%&(o%+"
    &redo%!nan( a" (a'"o+"+! c"!n!c Dac7 s+n( &re/en(e, a(A( !de! de"!ran(e, cA( s!
    a"+c!na=!!, se cod!.!c7 ceea ce &redo%!n7
    C+ !de! de"!ran(e Aces( s+'(!& es(e +(!"!/a( dac7 !de!"e de"!ran(e s+n(
    s!%&(o%+" &redo%!nan(
    C+ a"+c!na=!! A(es( s+'(!& es(e +(!"!/a( dac7 a"+c!na=!!"e s+n( s!%&(o%+"
    &redo%!nan(
    Con(e<(+" a&ar!=!e! s!%&(o%e"or &s!o(!ce &oa(e .! !nd!ca( &r!n +(!"!/area +n+!a
    d!n(re s&ec!.!can(n %en=!ona=! %a! @os
    C+ de'+( :n c+rs+" !n(o<!ca=!e! Aces( s&ec!.!can( (re'+!e sa e +(!"!/a( dac7
    cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7 s+n( sa(!s.7c+(e, !ar s!%&(o%e"e
    a&ar :n c+rs+" s!ndro%+"+! de !n(o<!ca=!e
    C+ de'+( :n c+rs+" a's(!nen(e! Aces( s&ec!.!can( (re'+!e sa .!e +(!"!/a( dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a's(!nen(a de o s+'s(an=a, !ar s!%&(o%e"e
    a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7 +n s!ndro% de a's(!nen(a
    #rocedee de "nre!istrare
    N+%e"e (+"'+r7% &s!o(!ce !nd+se de o s+'s(an=7 :nce&e c+ ce" a" s+'s(an=e! care
    se &res+&+ne c7 es(e ca+/a s!%&(o%e"or &s!o(!ce Ede e_, o<a!na, %e".erada(+",
    de<a%e(a/onaJ Cod+" d!a$nos(!c es(e se"ec(a( d!n "!s(a c"ase"or de s+'s(an=e
    &rev7/+(e :n se(+" de cr!(er!! Pen(r+ s+'s(an=e"e care n+ &o( .! !nc"+se :n n!c! +na
    4H5
    Sc%i(o$renia si Alte Tulburri #si%otice
    d!n(re c"ase Ede ex, de<a%e(a/onaJ (re'+!e s7 .!e +(!"!/a( cod+" &en(r+ Sa"(7
    s+'s(an=7T :n a.ar7 de aceas(a, &en(r+ %ed!ca%en(e"e &rescr!se :n do/e (era&e+(!ce,
    %ed!ca%en(+" res&ec(!v &oa(e .! !nd!ca( &r!n %en=!onarea cod+"+! E cores&+n/7(or
    &e a<a I Eve/! ane<a ,J Cod+" &en(r+ .!ecare d!n(re (+"'+r7r!"e &s!o(!ce !nd+se de
    o s+'s(an=7 s&ec!.!c7 de&!nde de .a&(+" dac7 (a'"o+" c"!n!c es(e &redo%!na( de !de!
    de"!ran(e sa+ de a"+c!na=!! 9F9 55 &en(r+ Sc+ !de! de"!ran(eT s! 9F9 59 &en(r+ Sc+
    a"+c!na=!!T, c+ e<ce&=!a a"coo"+"+!, &en(r+ care cod+" es(e 9F5 Y &en(r+ Sc+ !de!
    de"!ran(eT s! 9F5 ; &en(r+ Sc+ a"+c!na(aT N+%e"e (+"'+r7% Ede e<, (+"'+rare
    &s!o(!c7 !nd+s7 de coca!n7, (+"'+rare &s!o(!c7 !nd+s7 de %e(!".en!da(J es(e +r%a(
    de s+'(!&+" !nd!cAnd s!%&(o%+" &redo%!nan( s! de s&ec!.!can(+" !nd!cAnd con(e<(+"
    :n care a+ a&7r+( s!%&(o%e"e Ede e<, 9F9 55 T+"'+rare &s!o(!c7 !nd+s7 de coca!n7,
    c+ !de! de"!ran(e, c+ de'+( :n c+rs+" !n(o<!ca=!e!, 9F9 59 T+"'+rare &s!o(!c7 !nd+s7
    de &encycd%7, c+ a"+c!na=!!, c+ de'+( :n c+rs+" !n(o<!ca=!e!J CAnd se cons!der7
    c7 %a! %+"( decA( o s!n$+r7 s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n a&ar!=!a
    s!%&(o%e"or &s!o(!ce, .!ecare s+'s(an=7 !%&"!ca(7 (re'+!e s7 .!e %en=!ona(7 se&ara(
    Dac7 se cons!der7 c7 o s+'s(an=7 es(e .ac(or+" e(!o"o$!c, dar s+'s(an=a sa+ c"asa
    s+'s(an=e! res&ec(!ve es(e nec+nosc+(7, &oa(e .! +(!"!/a(7 ca(e$or!a 9F9 55 T+"'+rare
    &s!o(!c7 !nd+s7 de o s+'s(an=7 nec+nosc+(7, c+ !de! de"!ran(e or! 9F9 59 T+"'+rare
    &s!o(!c7 !nd+s7 de o s+'s(an=7 nec+nosc+(7, c+ a"+c!na=!!
    Substanele speci$ice
    T+"'+r7r!"e &s!o(!ce &o( s+rven! :n asoc!ere c+ !n(o<!ca=!a c+ +r%7(oare"e c"ase
    de s+'s(an=e a"coo", a%.e(a%!na s! s+'s(an=e a.!ne, canna'!s, coca!n7,
    a"+c!no$ene, %a"an(e, o&!ace E%e&end!n7J, &encycd%7 s! s+'s(an=e a.!ne,
    seda(!ve, !&no(!ce s! an<!o(!ce, &rec+% s! c+ a"(e s+'s(an=e sa+ c+ s+'s(an=e
    nec+nosc+(e T+"'+r7r!"e &s!o(!ce &o( s+rven! :n asoc!ere c+ a's(!nen(a de
    +r%7(oare"e c"ase de s+'s(an=e a"coo", seda(!ve, !&no(!ce s! an<!o(!ce, &rec+% s!
    de a"(e s+'s(an=e sa+ de s+'s(an=e nec+nosc+(e De'+(+" (+"'+r7% var!a/7
    cons!dera'!" c+ s+'s(an=a De e<e%&"+, .+%area +ne! do/e %ar! de coca!n7 &oa(e
    &rod+ce &s!o/7 :n dec+rs de cA(e_a %!n+(e, :n (!%& ce :n ca/+" a"coo"+"+! sa+
    seda(!ve"or s+n( necesare /!"e sa+ s7&(7%An! de +/ :n do/e %ar! &en(r+ a &rod+ce
    &s!o/a Ha"+c!na=!!"e &o( s+rven! :n or!ce %oda"!(a(e, !ar :n a'sen(a de"!n+%+"+!,
    s+n( de re$+"7 a+d!(!ve T+"'+rarea &s!o(!c7 !nd+s7 de a"coo" c+ a"+c!na=!!
    s+rv!ne n+%a! d+&7 +n +/ e<ces!v s! &re"+n$!( de a"coo" "a !nd!v!X! care a+, d+&7
    cA( se &are, de&enden(7 a"coo"!c7 Ha"+c!na=!!"e a+d!(!ve cons(a+ de re$+"7 d!n voc!
    T+"'+r7r!"e &s!o(!ce !nd+se de !n(o<!ca=!a c+ a%.e(a%!na s! coca!n7 a+ e"e%en(e
    c"!n!ce s!%!"are Ide!"e de"!ran(e de &ersec+=!e &o( a&are ra&!d, "a sc+r( (!%& d+&7
    +/+" de a%.e(a%!na sa+ de +n s!%&a(o%!%e(!c c+ ac=!+ne s!%!"ar7 Poa(e a&are
    d!s(ors!onarea !%a$!n!! cor&ora"e s! &erce&erea erona(7 a .e(e! oa%en!"or
    Ha"+c!narea de !nsec(e sa+ de v!er%! re&(And &e, sa+ s+' (e$+%en(e E.+rn!c7(+r!J
    &oa(e d+ce "a $ra(a@ s! "a e<cona(n c+(ana(e :n(!nse T+"'+rarea &s!o(!c7 !nd+s7 de
    canna'!s &oa(e a&are "a sc+r( (!%& d+&7 +/+" de canna'!s s! co%&or(7 de re$+"7
    !de! de"!ran(e de &ersec+=!e D+&7 cA( se &are, (+"'+rarea es(e rar7 Po( a&are
    an<!e(a(e %arca(7, "a'!"!(a(e a.ec(!v7, de&ersona"!/are s! a%ne/!e consec+(!v7
    &en(r+ e&!sod T+"'+rarea se re%!(e de re$+"7 :n dec+rs de o /!, dar :n +ne"e ca/+r!
    &oa(e &ers!s(a cA(eva /!"e
    T+"'+r7r!"e &s!o(!ce !nd+se de o s+'s(an=7 &o( +neor! s7 n+ se re/o"ve !%ed!a(
    d+&7 :n"7(+rarea a$en(+"+! noc!v S4a ra&or(a( c7 a$en=!, &rec+% a%.e(a%%e"e,
    Tulburarea #si%otic indus de o
    Substan
    47*
    &encycd%a s! coca!na, evoc7 (e%&orar s(an &s!o(!ce care +neor! &o( &ers!s(a
    (!%& de s7&(7%An! sa+ c!ar %a! %+"(, :n d!s&re=+" s+&r!%7% a$en(+"+! s! a"
    (ra(a%en(+"+! c+ ne+ro"e&(!ce Aces(ea &o( .! !n!=!a" d!.!c!" de d!s(!ns de (+"'+r7r!"e
    &s!o(!ce ne%d+se de o s+'s(an=7
    Une"e d!n(re %ed!ca%en(e"e descr!se a evoca s!%&(o%e &s!o(!ce !nc"+d
    anes(e/!ce"e s! ana"$e(!ce"e, a$en=!! an(!co"%er$!c!, an(!conv+"s!van(e"e,
    aX!(!!s(a%!n!ce"e, %ed!ca%en(e"e an(!!&er(ens!ve s! card!ovasc+"are,
    %ed!ca%en(e"e an(!%!cro'!ene, %ed!ca%en(e"e an(!&ar)!nso%ene, a$en=!!
    c!%!o(era&e+(!c! Ede e_ , c!c"os&onna s! &rocar'a/%aJ, cor(!cos(ero!/+,
    %ed!ca%en(e"e $as(ro!n(es(% "e, re"a<an(e"e %+sc+"are, %ed!ca%en(e"e
    an(!%."a%a(orn nons(ero!d!ce, a"(e %ed!ca%en(e vAnd+(e .7r7 &rescr!&=!e
    %ed!ca"7 Ede e<, .e%"e.r!na, &?e+doe.edr!naJ, %ed!ca%en(e"e ande&res!ve s!
    d!s+".!ra%+" S+'s(an=e"e (o<!ca %en=!ona(e a !nd+ce s!%&(o%e &s!o(!ce !nc"+d
    an(!co"%es(era/!ce"e, !nsec(!c!de"e or$ano4.os.ora(e, $a/e"e ne+ro&ara(!ce,
    %ono<!d+" de car'on, '!o<!d :" de car'on s! s+'s(an=e"e vo"a(!"e, c+% ar .!
    car'+ran=!! sa+ vo&se"e"e
    Dia!nostic di$erenial
    Un d!a$nos(!c de (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7 (re'+!e &+s :n "oc+"
    d!a$nos(!c+"+! de !n(o<!ca=!e c+ o s+'s(an=7 or! de a's(!nen(7 de o s+'s(an=7,
    n+%a! cAnd s!%&(o%e"e &s!o(!ce s+n( cons!dera(e a .! :n e<ces .a de ce"e asoc!a(e
    de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen(7 s! cAnd s!%&(o%e"e s+n(
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 Indn !/n !n(o<!ca=! c+
    s(!%+"an(e, canna'!s, o&!ace+" %e&end!na sa+ c+ &encycc+n7, or! ce! c+
    a's(!nen(7 de a"coo" sa+ de seda(!ve, &o( e<&er!en=a &erce&=!! a"(era(e E"+%!n!
    sc%(!"an(e, s+ne(e, !"+/!! v!/+a"eJ &e care e! "e rec+nosc ca .+nd e.c (e a"e dro$+"+!
    Dac7 (es(area rea"!(7=!! &en(r+ aces(e e<&er!en=e r7%Ane !n(ac(a !d!c7, &ersoana
    rec+noaO(e c7 &erce&=!a es(e !nd+s7 de o s+'s(an=7, n+ crede n ea s! n!c! n+
    ac=!onea/7 con.or% e!J, d!a$nos(!c+" n+ es(e ce" de (+"'+rare &s!"+ (!c7 !nd+s7 de o
    s+'s(an=7 :n sc!%', es(e d!a$nos(!ca(7 !n(o<!ca=!a c+ o s+'s(an(. sa+ a's(!nen=a
    de o s+'s(an=7, c+ &er(+r'7r! de &erce&=!e Ede e<, !n(o<!ca=!e c+ coca!n7, c+
    &er(+r'7r! de &erce&=!eJ Ha"+c!na=!!"e Sre(ros&ec(!veT E."as'ac)J ?are &o( s+rven!
    %+"( (!%& d+&7 ce +/+" de a"+c!no$en a :nce(a( s+n( d!a$nos(!ca(e ca (+"'+rare de
    &erce&=!e a"+c!no$en7 &ers!s(en(7 Eve/! &a$ 9Y;J De ase%enea, c!ac7 s!%&(o%e"e
    &s!o(!ce !nd+se de o s+'s(an=7 s+rv!n e<c"+s!v :n c+rs+" +n+! de"!r %%, ca :n +ne"e
    .or%e severe de a's(!nen(7 de a"coo", s!%&(o%e"e &s!o(!ce s+n( cons!dera(e a .! +n
    e"e%en( asoc!a( a" de"!n+%+"+! s! n+ s+n( d!a$nos(!ca(e se&ara(
    O (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare &s!o(!c7
    &r!%ar7 &r!n .a&(+" c7 o s+'s(an=7 es(e cons!dera(7 a .! :n re"a=!e e(!o"o$!c7 c+
    s!%&(o%e"e Eve/! &a$ ;;GJ
    O (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7 da(ora(7 +n+! (ra(a%en( &rescr!s
    &en(r+ o cond!=!e %en(a"7 sa+ %ed!ca"7 $enera"7, (re'+!e s74s! a!'7 de'+(+" :n
    (!%&+" &er!oade! cA( &ersoana res&ec(!v7 &r!%eO(e %ed!ca%en(! " Esa+ :n c+rs+"
    a's(!nen(e!, dac7 e<!s(7 +n s!ndro% de a's(!nen(7 asoc!a( c+ %ed!ca%en(+"J Oda(7
    ce (ra(a%en(+" es(e :n(rer+&(, s!%&(o%e"e &s!o(!ce se vor renT ? :n dec+rs de
    cA(eva /!"e &An7 "a cA(eva s7&(7%An! E:n .+nc=!e de se%!v!a(a s+'s24!n(e! s! &re/en(a
    s!ndro%+"+! de a's(!nen(7J Dac7 s!%&(o%e"e &ers!s(7 &es(e I ?7 !(7%an!, (re'+!e
    "+a(e :n d!sc+=!e a"(e ca+/e &en(r+ s!%&(o%e"e &s!o(!ce Deoa!ece !nd!v!/!! c+
    cond!=!! %ed!ca"e $enera"e !a+ adesea %ed!ca%en(e &en(r+ !ces(e cond!=!!,
    c"!n!c!an+" (re'+!e s7 !a :n cons!dera=!e s! &os!'!"!(a(ea ca s!%&(o%e"e &s!o(!ce s7 .!e
    ;I9 Sc%i(o$renia si Alte Tulburri #si%otice

    ca+/a(e de consec!n=e"e .!/!o"o$!ce a"e cond!=!e! %ed!ca"e $enera"e %a! c+rAnd decA(
    de %ed!ca%en(, ca/ :n care es(e d!a$nos(!ca(7 (+"'+rarea &s!o(!c7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e Is(or!c+" o.er7 adesea 'a/a &n%ar7 &en(r+ o as(.e" de [
    +deca(7 Uneor!, o sc!%'are a (ra(a%en(+"+! cond!=!e! %ed!ca"e $enera"e Ede e< ,
    :n"oc+!rea sa+ :n(rer+&erea (ra(a%en(+"+!J &oa(e .! necesar7 &en(r+ a de(er%!na
    e%&!r!c &en(r+ &ersoana res&ec(!v7, dac7 %ed!ca%en(+" es(e a$en(+" ca+/a" Dac7
    c"!n!c!an+" a&rec!a/7 c7 &er(+r'area es(e da(ora(7, a(A( +ne! cond!=!! %ed!ca"e
    $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, &o( .! &+se a%'e"e d!a$nos(!ce Ead!c7,
    (+"'+rare &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! (+"'+rare &s!o(!c7
    !nd+s7 de o s+'s(an=7J CAnd e<!s(7 da(e !ns+.!c!en(e &en(r+ a s(a'!"! dac7
    s!%&(o%e"e &s!o(!ce se da(orea/7 +ne! s+'s(an=e E!nc"+s!v +n+! %ed!ca%en(J or!
    +ne! cond!=!! %ed!ca"e $enera"e sa+ s+n( &r!%are Ead!c7, n+ se da(orea/7 n!c! +ne!
    s+'s(an=e s! n!c! +ne! cond!=!! %ed!ca"e $enera"eJ es(e !nd!ca( d!a$nos(!c+" de
    (+"'+rare &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e.
    Criteriile $e $ia/no&ti# pentru Tul-urarea P&i@oti#(
    in$u&( $e o Su-&tan!(
    A Lalucinaii sau idei delirante proeminente FotD Fu se includ %alucinaiile
    c@nd persoana este con,tient de $aptul c acestea sunt induse de o
    substan
    S *xist proba dm istoric, examenul somatic sau datele de laborator, $ie a &E),
    $ie a &7)
    (1)simptomele de la criteriul A au aprut "n cursul ori "n decurs de o lun de
    la intoxicaia sau abstinenta de o substan,
    (2)u(ul unui medicament este etiolo!ic "n relaie cu perturbarea
    #erturbarea nu este explicat mai bine de o tulburare psi%otic nemdus de
    o substan #roba c simptomele sunt explicate mai bine de o tulburare
    psi%otic nemdus de o substan poate include urmtoarele simptomele
    preced debutul u(ului de o substan &de ex, u(ul unui medicament),
    simptomele persist o perioad considerabil de timp &de ex, aproape o
    lun) dup "ncetarea abstinentei acute sau a intoxicaiei severe, sau sunt
    considerabil "n exces $at de ceea ce ar $i de a,teptat, dat $und timpul sau
    cantitatea de substan utili(at ori durata u(ului, sau exist alte indicii care
    su!erea( existenta unei tulburri psi%otice independente nonmduse de o
    substan &de ex, un istoric de episoade recurente nerelationate cu o
    substan)
    D #erturbarea nu survine exclusiv "n cursul unui delinum
    FotD Acest dia!nostic trebuie pus "n locul unui dia!nostic de intoxicaie cu o
    substan sau al celui de abstinenta de o substan, numai c@nd simptomele
    sunt "n exces $at de cele asociate de re!ul cu sindromul de intoxicaie sau de
    abstinent, precum si c@nd simptomele sunt su$icient de severe pentru a
    0usti$ica o atenie clinic separat
    768 6 Tulburarea #si%otic 'r Alt
    Speci$icaie
    4H4

    A se codi"ica ast$el tulburarea psi%otic indus de &o substan speci$ic)
    &76EA alcool, cu idei delirante, 76E4 alcool, cu %alucinaii, 767EE
    am$etamina 9sau o substan similar cu am$etamina:, cu %alucinaii, 767 EE
    cannabis, cu idei delirante, 767 E7 cannabis, cu %alucinaii, 767 EE cocain,
    cu idei delirante, 767 E7 cocain, cu %alucinaii, 767 EE %alucino!en, cu idei
    delirante, 767E7 %alucino!en, cu %alucinaii, 767EE m%alant, cu idei
    delirante, 767 E7 m%alant, cu %alucinaii, 767 EE opiacee, cu idei delirante,
    767 E7 opiacee, cu %alucinaii, 767 EE p%encKclidm 9ori o substan similar
    p%encKclidmei:, cu idei delirante, 767 E7 p%encKclidm 9ori o substan
    similar p%encKclidmei:, cu %alucinaii, 767EE sedative, %ipnotice sau
    anxiolitice, cu idei delirante, 767 E7 sedative, %ipnotice sau anxiolitice, cu
    %alucinaii, 767EE alt substan 9sau o substan necunoscut:, cu idei
    delirante, 767 E7 alt substan 9sau o substan necunoscut, cu
    %alucinaii)
    De speci"icat dac &ve(i tabloul de la pa! E64 pentru aplicabilitatea la $iecare
    substan
    u debut "n cursul intoxicaiei dac sunt satis$cute criteriile pentru
    intoxicaia cu o substan, iar simptomele apar "n cursul sindromului de
    intoxicaie
    u debut "n cursul abstinentei dac sunt satis$cute criteriile pentru
    abstinenta de o substan, iar simptomele apar "n cursul sau scurt timp dup
    un sindrom de abstinent
    C5>.5 Tul-urarea P&i@oti#( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e !nc"+de s!%&(o%a(o"o$!a &s!o(!c7 Ede e<, !de! de"!ran(e,
    a"+c!na=!!, "!%'a[ de/or$an!/a(, co%&or(a%en( ca(a(on!c sa+ ."a$ran( de/or$an!/a(J
    des&re care n+ e<!s(7 !n.or%a=!! s+.!c!en(e &en(r+ a &+ne +n d!a$nos(!c s&ec!.!c sa+
    des&re care e<!s(7 !n.or%a=!! con(rad!c(or!!, or! (+"'+r7r!"e c+ s!%&(o%e &s!o(!ce
    care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare &s!oc7 s&ec!.!c7
    E<e%&"e"e !nc"+d
    1 Ps!o/a &os(&ar(+% care n+ sa(!s.ace cr!(er!!"e &en(r+ (+"'+rarea a.ec(!v7 c+
    e"e%en(e &s!o(!ce, (+"'+rarea &s!o(!c7 sc+r(7, (+"'+rarea &s!o(!c7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e sa+ (+"'+rarea &s!o(!c7 !nd+ra de o s+'s(an=7,
    2 S!%&(o%e"e &s!o(!ce care d+rea/7 de %a! &+=!n de o "+na dar care n+ s4a+
    re%!s, :nc7, as(.e" c7 n+ s+n( sa(!s.7c+(e cn(en!"e &en(r+ (+"'+rarea &s!o(!c7 sc+r(7,
    3 Ha"+c!na=!! a+d!(!ve &ers!s(en(e !n a'sen(a or!c7ror a"(e e"e%en(e,
    4 Ide! de"!ran(e non'!/are &ers!s(en(e c+ &er!oade de s+&ra&+nere de e&!soade
    de&res!ve, care a+ .os( &re/en(e o &er!oad7 s+'s(an=!a"a d!n d+ra(a &er(+r'7%
    de"!ran(e,
    5 S!(+a=!!"e :n care c"!n!c!an+" a conc!s ca (+"'+rarea &s!o(!?a es(e &re/en(7, dar
    es(e !nca&a'!" s7 &rec!/e/e dac7 es(e &r!%ar7, da(ora(7 +ne! Cond!=!! %ed!ca"e
    $enera"e or! !nd+s7 de o s+'s(an=a

    Tulburrile A$ective
    2ec(!+nea (+"'+r7r!"or a.ec(!ve !nc"+de (+"'+r7r!"e care a+ ca e"e%en(
    &redo%!nan( o &er(+r'are de d!s&o/!=!e Aceas(7 sec=!+ne es(e
    d!v!/a(7 :n (re! &7r=! Pr!%a &ar(e descr!e e&!soade"e a.ec(!ve Ee&!sod+"
    de&res!v %a@or, e&!sod+" %an!aca", e&!sod+" %!<( s! e&!sod+"
    !&o%a%aca"J care a+ .os( !nc"+se se&ara( "a :nce&+(+" aces(e! sec=!+n!
    &en(r+ co%od!(a(ea d!a$nos(!c7r!! d!verse"or (+"'+r7r! a.ec(!ve Aces(e
    e&!soade n+ a+ &ro&r!+" "or cod d!a$nos(!c s!, ca a(are, n+ &o( .!
    d!a$nos(!ca(e ca en(!(7=! se&ara(e, e"e servesc :ns7 dre&( c7r7%!/! de cons(r+c=!e
    &en(r+ d!a$nos(!c+" (+"'+r7r!"or Par(ea a do+a descr!e (+"'+r7r!"e a.ec(!ve Ede
    e< , (+"'+rarea de&res!v7 %a@or7, (+"'+rarea d!s(!%!c7, (+"'+rarea '!&o"ar7 IJ
    Se(+r!"e de cr!(er!! &en(r+ ce"e %a! %+"(e (+"'+r7r! a.ec(!ve neces!(7 &re/en(a sa+
    a'sen(a e&!soade"or a.ec(!ve descr!se :n &r!%a &ar(e a sec=!+n!! Par(ea a (re!a
    !nc"+de s&ec!.!can(n care descr!+, .!e ce" %a! recen( e&!sod a.ec(!v, .!e evo"+=!a
    e&!soade"or rec+ren(e
    T+"'+r7r!"e a.ec(!ve s+n( :%&7r=!(e :n (+"'+r7r! de&res!ve ESde&res!a
    +n!&o"ar7TJ, (+"'+r7r! '!&o"are s! do+7 (+"'+r7r! 'a/a(e &e e(!o"o$!c U (+"'+rarea
    a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! (+"'+rarea a.ec(!v7 !nd+s7 de o
    s+'s(an=7 T+"'+r7r!"e de&res!ve Ead!c7, (+"'+rarea de&res!v7 %a@or7, (+"'+rarea
    d!s(!%!c7 s! (+"'+rarea de&res!v7 .7r7 a"(7 s&ec!.!ca=!eJ se d!s(!n$ de (+"'+r7r!"e
    '!&o"are &r!n .a&(+" c7 n+ e<!s(7 n!c! +n !s(or!c de a .! av+( vreoda(7 +n e&!sod
    %an!aca", %!<( sa+ !&o%a%aca" T+"'+r7r!"e '!&o"are Ede e< , (+"'+rarea '!&o"ar7
    I, (+"'+rarea '!&o"ar7 II, c!c"o(!%!a s! (+"'+rarea '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!eJ
    !%&"!c7 &re/en(a Esa+ +n !s(or!cJ de e&!soade %an!aca"e, %!<(e sa+ !&o%a%aca"e,
    aco%&an!a(e de re$+"7 de &re/en(a Esa+ +n !s(oncJ de e&!soade de&res!ve %a@ore
    T+"'+rarea de&res!v7 %a@or7 se carac(er!/ea/7 &r%(r4+n+" sa+ %a! %+"(e
    e&!soade de&res!ve %a@ore Ead!c7, ce" &+=!n 9 s7&(7%An! de d!s&o/!=!e de&res!v7 sa+
    de &!erdere a !n(eres+"+!, aco%&an!a(7 de ce" &+=!n &a(r+ s!%&(o%e s+&"!%en(are
    de de&res!eJ
    T+"'+rarea d!s(!%!c7 se carac(er!/ea/7 &r!n ce" &+=!n 9 an! de d!s&o/!=!e
    de&res!v7 %a! %+"(e /!"e da decA( n+, aco%&an!a(7 de s!%&(o%e de&res!ve care n+
    sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or
    T+"'+rarea de&res!v7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    (+"'+r7r!"or c+ e"e%en(e de&res!ve care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea
    de&res!v7 %a@or7, (+"'+rarea d!s(!%!c7, (+"'+rarea de ada&(are c+ d!s&o/!=!e
    de&res!v7 sa+ (+"'+rarea de ada&(are c+ d!s&o/!=!e an<!oas7 s! de&res!v7 Esa+
    s!%&(o%e de&res!ve des&re care e<!s(7 !n.or%a=!! !nadecva(e sa+ con(rad!c(or!!J
    T+"'+rarea '!&o"ar7 I se carac(er!/ea/7 &nn(r4+n+" sa+ %a! %+"(e e&!soade
    %an!aca"e sa+ e&!soade %!<(e, aco%&an!a(e de re$+"7 de e&!soade de&res!ve %a@ore
    T+"'+rarea '!&o"ar7 II se carac(er!/ea/7 &r%(r4+n+" sa+ %a! %+"(e e&!soade
    de&res!ve %a@ore, aco%&an!a(e de ce" &+=!n +n e&!sod !&o%a%aca"
    T+"'+rarea c!c"o(!%!c7 se carac(er!/ea/7 &r!n ce" &+=!n 9 a% de n+%eroase
    &er!oade de s!%&(o%e !&o%a%aca"e care n+ sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod
    4HA
    ;IR Tulburrile A$ective

    %an!aca" s! n+%eroase &er!oade de s!%&o%e de&res!ve care n+ sa(!s.ac cr!(er!!"e
    &en(r+ +n e&!sod de&res!v %a@or.
    T+"'+rarea '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    (+"'+r7r!"or c+ e"e%en(e '!&o"are care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! +na d!n(re
    (+"'+r7r!"e '!&o"are s&ec!.!ce, aOa c+% s+n( aces(ea de.!n!(e :n aceas(7 sec=!+ne Esa+
    s!%&(o%e '!&o"are des&re care e<!s(7 !n.or%a=!! !ns+.!c!en(e sa+ con(rad!c(or!!J.
    T+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e se carac(er!/ea/7
    s
    &r!n(r4o &er(+r'are &ers!s(en(7 s! &roe%!nen(7 de d!s&o/!=!e, cons!dera(7 a .!
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e.
    T+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7 se carac(er!/ea/7 &r!n(r4o &er(+r'are
    &ers!s(en(7 O! &roe%!nen(7 de d!s&o/!=!e, cons!dera(7 a .! consec!n=a .!/!o"o$!c7
    d!rec(7 a +n+! dro$ de a'+/, a +n+! %ed!ca%en(, a +n+! a"( (ra(a%en( so%a(!c
    &en(r+ de&res!e sa+ a e<&+ner!! "a +n (o<!c.
    T+"'+rarea a.ec(!v7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    s!%&(o%e"or a.ec(!ve care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare a.ec(!v7
    s&ec!.!c7 O! :n care es(e d!.!c!" s7 se a"ea$7 :n(re (+"'+rarea de&res!v7 .7r7 a"(7
    s&ec!.!ca=!e O! (+"'+rarea '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e Ede e<., a$!(a=!a ac+(7J.
    S&ec!.!can=!! descr!O! :n cea de a (re!a &ar(e a sec=!+n!! s+n( &rev7/+=! &en(r+ a
    cres(e s&ec!.!c!(a(ea d!a$nos(!c+"+!, &en(r+ a crea s+'$r+&e %a! o%o$ene, &en(r+ a
    a@+(a "a a"e$erea (ra(a%en(+"+! s! a a%e"!ora &red!c=!a &ro$nos(!c+"+!. Un!! d!n(re
    aceO(! s&ec!.!can=! descr!+ s(a(+s+" c"!n!c a" e&!sod+"+! a.ec(!v c+ren( Esa+ ce" %a!
    recen(J Ead!c7, s&ec!.!can=!! sever!(a(eX&s!o(!cX re%!s!+neJ, &e cAnd a"=!! descr!+
    e"e%en(e"e e&!sod+"+! c+ren( Esa+ ce" %a! recen(, dac7 e&!sod+" es(e ac(+a"%en(e :n
    re%!s!+ne &ar=!a"7 sa+ co%&"e(7J Ead!c7, cron!c, c+ e"e%en(e ca(a(on!ce, c+
    e"e%en(e %e"anco"!ce, c+ e"e%en(e a(!&!ce, c+ de'+( &os(&ar(+%J. Ta'e"+" " E&a$.
    I55J !nd!c7 s&ec!.!can=!! de e&!sod care se a&"!c7 .!ec7re! (+"'+r7r! a.ec(!ve
    cod!.!ca'!"e. A"=! s&ec!.!can=! descr!+ evo"+=!a e&!soade"or a.ec(!ve rec+ren(e Ead!c7,
    s&ec!.!can=!! de evo"+=!e "on$!(+d!na"7, c+ &a((ern se/on!er, c+ c!c"are ra&!d7J.
    Ta'e"+" 9 E&a$. I9IJ !nd!c7 s&ec!.!can=!! de evo"+=!e care se a&"!c7 .!ec7re! (+"'+r7r!
    a.ec(!ve cod!.!ca'!"e. S&ec!.!can=!! care !nd!c7 sever!(a(ea, re%!s!+nea s! e"e%en(e"e
    &s!o(!ce &o( .! cod!.!ca=! "a cea de a c!ncea c!.r7 a cod+"+! &en(r+ ce"e %a! %+"(e
    d!n(re (+"'+r7r!"e a.ec(!ve. A"=! s&ec!.!can=! n+ &o( .! cod!.!ca=!.
    Sec=!+nea (+"'+r7r!"or a.ec(!ve es(e or$an!/a(7 d+&7 c+% +r%ea/7Q
    N E&!soade a.ec(!veQ
    E&!sod+" de&res!v %a@or E&a$. ;IFJ
    E&!sod+" %an!aca" E&a$. ;YHJ E&!sod+"
    %!<( E&a$. ;R9J E&!sod+" !&o%an!aca"
    E&a$. ;RYJ
    N T+"'+r7r! de&res!veQ
    9FR.<< T+"'+rarea de&res!v7 %a@or7 E&a$. ;RFJ
    ;LL.I T+"'+rarea d!s(!%!c7 E&a$. ;HHJ
    ;55 T+"'+rarea de&res!v7 .7r7 a"(7 s&ec!.!ca=!e E&a$. ;G5J
    N T+"'+r7r! '!&o"are
    9FR.<< T+"'+rarea '!&o"ar7 I E&a$. ;G9J
    9FR.GF T+"'+rarea '!&o"ar7 II E&a$. ;F9J
    ;L5.; T+"'+rarea c!c"o(!%!c7 E&a$. ;FGJ
    9FR.GL T+"'+rarea '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e E&a$. ILLJ
    Tulburrile
    A$ective
    4H?

    N A"(e (+"'+r7r! a.ec(!ve
    9F; G; T+"'+rarea a.ec(!v7 da(ora(7 LSe md#ic6 cond#Tta medical6 /eneral6A E&a$ IL5J
    9F< << T+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7 E&a$ ILYJ 9FR FL
    T+"'+rarea a.ec(!v7 .7r7 a"(7 s&ec!.!ca=!e E&a$ I5LJ
    N S&ec!.!can=!! care descr!+ s(a(+s+" c"!n!c a" e&!sod+"+! a.ec(!v c+ren( Esa+ ce"
    %a! recen(J
    UOor, Modera(, Sever, .7r7 e"e%en(e &s!o(!ce, Sever, c+ e"e%en(e &s!o(!ce, :n
    re%!s!+ne &ar=!a"7, :n re%!s!+ne co%&"e(7 E&en(r+ e&!sod+" de&res!v %a@or,
    &a$ I55, &en(r+ e&!sod+" %an!aca", &a$ I5;, &en(r+ e&!sod+" %!<(, &a$ I5YJ
    N S&ec!.!can=!! care descr!+ e"e%en(e"e e&!sod+"+! c+ren( Esa+ ce" %a! recen(
    dac7 se a."7 ac(+a"%en(e :n re%!s!+ne &ar=!a"7 sa+ co%&"e(7J
    Cron!c E&a$ I5HJ C+ e"e%en(e ca (a
    (on!ce E&a$ I5GJ C+ e"e%en(e
    %e"anco"!ce E&a$ I5FJ C+ e"e%en(e
    a(!&!ce E&a$ I9LJ C+ de'+(
    &os(&ar(+% E&a$ I99J
    N S&ec!.!can=! care descr!+ evo"+=!a e&!soade"or rec+ren(e
    S&ec!.!can=!! evo"+=!e! "on$!(+d!na"e EC+ sa+ .7r7 rec+&erare %(ere&!sod!c7
    co%&"e(7J E&a$ I9IJ C+
    &a((ern se/on!er E&a$ I9RJ C+
    c!c"are ra&!d7 E&a$ I9HJ
    #rocedee de "nre!istrare pentru tulburarea depresiv ma0or
    si tulburrile bipolar l si bipolar II
    Se"ec(area cod+r!"or d!a$nos(!ce. Cod+r!"e d!a$nos(!ce s+n( De"ec(a(e d+&7
    c+% +r%ea/7
    Pen(r+ (+"'+rarea de&res!v7 %a@or7Q
    1 Pr!%e"e (re! c!.re s+n( 9FR
    2 Cea de a &a(ra c!.r7, es(e .!e 9 Edac7 e<!s(7 n+%a! +n s!n$+r e&!sod de&res!v
    %a@orJ, .!e ; Edac7 e<!s(7 e&!soade de&res!ve %a@ore rec+ren(eJ
    3 Cea de a c!ncea c!.r7 !nd!c7 sever!(a(ea e&!sod+"+! de&res!v %a@or, dac7 s+n(
    sa(!s.7c+(e co%&"e( cr!(er!!"e d+&7 c+% +r%ea/7 " &en(r+ sever!(a(e +Ooar7,
    9 &en(r+ sever!(a(e %odera(7, ; &en(r+ sever7, .7r7 e"e%en(e &s!o(!ce, I
    &en(!+ sever7, c+ e"e%en(e &s!o(!ce Dac7 ac(+a"%en(e n+ s+n( sa(!s.7c+(e
    co%&"e( cr!(er!!"e &en(r+ e&!sod+" de&res!v %a@or, cea de a c!ncea c!.r7 !nd!c7
    s(a(+s+" c"!n!c c+ren( a" (+"'+r7% de&res!ve %a@ore d+&7 c+% +r%ea/7 Y
    &en(r+ :n re%!s!+ne &ar=!a"7, R &en(r+ :n re%!s!+ne co%&"e(7 Dac7
    sever!(a(ea n+ es(e s&ec!.!ca(7, cea de a c!ncea c!.r7 es(e O
    Pen(r+ (+"'+rarea '!&o"ar7 IQ
    1 Pr!%e"e (re! c!.re s+n(, de ase%enea, 9FR
    2 Cea de a &a(ra c!.r7 es(e O, dac7 e<!s(7 +n s!n$+r e&!sod %an!aca" Pen(r+
    e&!soade"e rec+ren(e, cea de a &a(ra c!.r7 !nd!c7 na(+ra e&!sod+"+! c+ren(
    Esa+ dac7 (+"'+rarea '!&o"ar7 I es(e ac(+a"%en(e !n re%!s!+ne &ar=!a"7 sa+
    co%&"e(7, na(+ra ce"+! %a! recen( e&!sodJ d+&7 c+% +r%ea/7 I dac7
    e&!sod+" c+ren( sa+ ce" %a! recen( es(e +n e&!sod !&o%an!aca" sa+ +n
    ;IG
    Tulburrile A$ective

    e&!sod %an!aca", R dac7 es(e +n e&!sod %!<(, Y dac7 es(e +n e&!sod de&res!v
    %a@or s! H dac7 e&!sod+" c+ren( sa+ ce" %a! recen( es(e nes&ec!.!ca( ; Cea de a
    c!ncea c!.r7 Ec+ e<ce&=!a (+"'+r7% '!&o"are I, ce" %a! recen( e&!sod
    !&o%a%aca" s! a (+"'+r7r!! '!&o"are I, ce" %a! recen( e&!sod nes&ec!.!ca(J,
    !nd!c7 sever!(a(ea e&!sod+"+! c+ren( dac7 s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e
    &en(r+ e&!sod+" %an!aca", %!<( sa+ de&res!v %a@or d+&7 c+% +r%ea/7 "
    &en(r+ sever!(a(e +Ooar7, 9 &en(r+ sever!(a(e %odera(7, ; &en(r+ sever7, .7r7
    e"e%en(e &s!o(!ce, I sever7, c+ e"e%en(e &s!o(!ce Dac7 n+ s+n( sa(!s.7c+(e
    co%&"e( cr!(er!!"e &en(r+ +n e&!sod %an!aca", %!<( sa+ de&res!v %a@or, cea de a
    c!ncea c!.r7 !nd!c7 s(a(+s+" c"!n!c c+ren( a" (+"'+r7% '!&o"are I d+&7 c+%
    +r%ea/7 Y &en(r+ :n re%!s%ne &ar=!a"7, R &en(r+ :n re%!s!+ne co%&"e(7 Dac7
    sever!(a(ea c+ren(7 sa+ s(a(+s+" c"!n!c es(e nes&ec!.!ca(, cea de a c!ncea c!.r7
    es(e O Pen(r+ (+"'+rarea '!&o"ar7 I, ce" %a! recen( e&!sod !&o%a%aca", cea de a
    c!ncea c!.r7 es(e (o(dea+na SOT Pen(r+ (+"'+rarea '!&o"ar7, ce" %a! recen( e&!sod
    nes&ec!.!ca(, n+ e<!s(7 cea de a c!ncea c!.r7
    Pen(r+ (+"'+rarea '!&o"ar7 II, cod+" d!a$nos(!c es(e 9FR GF
    :nre$!s(rarea den+%!r!! dia.nosticului. La :nre$!s(rarea den+%!r!! +n+!
    d!a$nos(!c, (er%en!! (re'+!e s7 .!e %en=!ona=! :n +r%7(oarea ord!ne
    1 N+%e"e (+"'+r7% Ede e< , (+"'+rare de&res!v7 %a@or7, (+"'+rare '!&o"ar7J,
    2 S&ec!.!can(n cod!.!ca=! "a cea de a &a(ra c!.r7 Ede e<, rec+ren(, ce" %a! recen(
    e&!sod %an!aca"J,
    3 S&ec!.!can(n cod!.!ca=! "a cea de a c!ncea c!.r7 Ede e<, +Oor, sever, c+ e"e%en(e
    &s!o(!ce, :n re%!s!+ne &ar=!a"7J,
    4 To( a(A=!a s&ec!.!can(! E.7r7 cod+r!J cA=! cores&+nd e&!sod+"+! c+ren( s! ce"+! %a!
    recen( Ede e<, c+ e"e%en(e %e"anco"!ce, c+ de'+( &os(&ar(+%J,
    5 To( a(A=!a s&ec!.!can(! E.7r7 cod+r!J cA=! cores&+nd evo"+=!e! e&!soade"or
    rec+ren(e Ede e< , c+ &a((ern se/on!er, c+ c!c"are ra&!d7J
    Ur%7(oare"e e<e%&"e !"+s(rea/7 c+% s7 se :nre$!s(re/e +n d!a$nos(!c de
    (+"'+rare a.ec(!v7 c+ s&ec!.!can(!
    N 9FR ;9 T+"'+rare de&res!v7 %a@or7 rec+ren(7, %odera(7, c+ e"e%en(e a(!&!ce, c+
    &a((ern se/on!er, c+ rec+&erare !n(ere&!sod!c7 co%&"e(7
    N 9FR YI T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, sever, c+ e"e%en(e
    &s!o(!ce, c+ e"e%en(e %e"anco"!ce, c+ c!c"are ra&!d7
    *pisoadele
    A$ective
    ;IF

    Epi&oa$ele A%e#tive
    Epi&o$ul Depre&iv MaQor
    *lementele episodului
    E"e%en(+" esen=!a" a" e&!sod+"+! de&res!v %a@or :" cons(!(+!e o &er!oad7 de ce"
    &+=!n 9 s7&(7%An! :n c+rs+" c7re!a e<!s(7, .!e d!s&o/!=!e de&res!v7, .!e &!erderea
    !n(eres+"+! sa+ &"7ce% &en(r+ a&roa&e (oa(e ac(!v!(7=!"e La co&!! s! ado"escen=!,
    d!s&o/!=!a &oa(e .! %a! c+rAnd !r!(a'!"7 decA( (r!s(7 Ind!v!d+" (re'+!e, de ase%enea,
    s7 e<&er!en(e/e ce" &+=!n &a(r+ s!%&(o%e s+&"!%en(are e<(rase d%(r4o "!s(7 care
    !nc"+de %od!.!c7r! :n a&e(!( sa+ $re+(a(e, so%n s! ac(!v!(a(ea &s!o%o(one, ener$!e
    sc7/+(7, sen(!%en(e de !n+(!"!(a(e sa+ de c+"&7, d!.!c+"(a(e :n $And!re, concen(rare
    sa+ "+area de dec!/!!, !de! rec+ren(e de %oar(e sa+ !de!, &"an+r! or! (en(a(!ve de
    s+!c!d Pen(r+ a con(a &en(r+ +n e&!sod de&res!v %a@or, +n s!%&(o% (re'+!e s7 .!e
    &re/en( de c+rAnd or! s7 .!e :n %od c"ar a$rava( :n co%&ara=!e c+ s(area
    &ree&!sod!c7 a &ersoane! S!%&(o%e"e (re'+!e s7 &ers!s(e cea %a! %are &ar(e a /!"e!,
    a&roa&e :n .!ecare /!, (!%& de ce" &+=!n 9 s7&(7%An! consec+(!ve E&!sod+" (re'+!e
    s7 .!e aco%&an!a( de de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!%e :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare La +n+ !nd!v!/! c+
    e&!soade %a! +Ooare, .+nc=!onarea &are a .! nor%a"7, dar neces!(7 +n e.or(
    cons!dera'!" cresc+(
    D!s&o/!=!a, :n(r4+n e&!'od de&res!v %a@or es(e descr!s7 adesea de c7(re &ersoana
    res&ec(!v7 ca aceas(a .+nd de&res!v7, (r!s(7, d!s&era(7, desc+ra@a(7 sa+ ca S.7r7 ce.T
    Ecr!(er!+" A"J :n +ne"e ca/+r!, (r!s(e=ea &oa(e .! ne$a(7 "a :nce&+(, dar &oa(e .!
    &rovoca(7 de !n(erv!+ Ede e<, a(r7$And a(en=!a &ersoane! res&ec(!ve c7 ara(7 ca s!
    c+% ar .! &e &+nc(+" de a :nce&e s7 &"An$7J La +n+ !ndA !/! care se &"An$ c7 se s!%(
    S.7r7 verv7T, c7 n+ %a! a+ sen(!%en(e or! c7 s+n( an<!os!, &re/en(a d!s&o/!=!e!
    de&res!ve &oa(e .! ded+s7 d!n e<&res!a .ac!a"7 a &ersoane! s! d!n cond+!(7 Un+
    !nd!v!/! &+n accen(+" %a! c+rAnd &e ac+/e"e so%a(!ce Ede e< &e d!scon.or(+"
    so%a(!cJ decA( &e descr!erea sen(!%en(e"or de (r!s(e=e M+"=! !nd!v/! re"a(ea/7 sa+
    %an!.es(7 o s(are de !r!(a'!(a(e cresc+(7 Ede e< , s(are co"eroas7 &ers!s(en(7,
    (end!n=a de a r7s&+nde "a d!verse even!%en(e &r!n accese de .+r!e or! &r!n '"a%area
    a"(ora, sa+ &r!n(r4+n sen(!%en( e<a$era( de .r+s(rare &en(r+ ces(!+n! %!noreJ La
    co&!! s! ado"escen=! &oa(e a&are %a! c+rAnd o d!s&o/!=!e !r!(a'!"7 sa+ ca&r!c!oas7
    decA( o d!s&o/!=!e (r!s(7 sa+ a'7(+(7 Aces( (a'"o+ c"!%e (re'+!e s7 .!e d!.eren=!a( de
    &a((ern+" de !r!(a'!(a(e a" Sco&!"+"+! r7s.7=a(T cAnd es(e .r+s(ra(
    P!erderea !n(eres+"+! sa+ &"7ce% es(e a&roa&e (o(dea+na &re/en(7 :n(r4+n $rad
    oarecare Ind!v!/!! &o( re"a(a c7 se s!%( %a! &+=!n !n(eresa=! de o''%r!, Sn+4%! %a!
    &as7 de n!%!c ac+%T, n+ %a! s!%( n!c! o &"7cere &en(r+ ac(!v!(7=! cons!dera(e
    an(er!or ca d!s(rac(!ve Ecr!(er!+" A9J Me%'r+ .a%!"!e! no(ea/7 adesea re(ra$erea
    soc!a"7 sa+ ne$"!@area ac(!v!(7=!"or &"7c+(e Ede e< , +n @+c7(or av!d de $o". a"(7da(7,
    n4a %a! @+ca( de %+"( (!%&, +n co&!" c7r+!a :! .7cea &"7cere s7 @oace soccer E.o('a"
    a%er!canJ :O! $7seO(e sc+/e &en(r+ a n+45 %a! &rac(!caJ La +n+ !nd!v!/! e<!s(7 o
    red+cere se%n!.!ca(!v7 de "a n!ve"+" an(er!or a !n(eres+"+! sa+ dor!n=e! se<+a"e
    A&e(!(+" es(e de re$+"7 red+s, %+"=! !nd!v!/! s!%=!nd c7 e! se .or=ea/7 s7
    %7nAnce A"=! !nd!v!/!, :n s&ec!a" ce! :n(A"n!=! :n +n!(7=! a%'+"a(or!!, &o( avea +n
    4A5
    Tulburrile A$ective
    a&e(!( cresc+( s! &o( don co%&+"s!v an+%!(e a"!%en(e Ede e<, d+"c!+r! sa+ a"=!
    !dra(! de car'onJ CAnd %od!.!c7r!"e de a&e(!( s+n( severe E:n or!ce d!rec=!eJ, &oa(e
    .! o'serva(7 .!e o &!erdere, .!e o "+are :n $re+(a(e, sa+, "a co&!!, &oa(e .! no(a(7
    !nca&ac!(a(ea de a "+a :n $re+(a(e &"+s+" aO(e&(a( Ecn(er!+" A;J
    Cea %a! co%+n7 &er(+r'are a so%n+"+!, asoc!a(7 c+ +n e&!sod de&res!v, %a@or
    es(e !nso%n!a Ecr!(er!+" AIJ Ind!v!/!! a+ de re$+"7 o !nso%n!e %ed!an7 Ead!c7, se
    deO(ea&(7 d!n so%n :n c+rs+" no&=!! s! a&o! a+ d!.!c+"(7=! :n a reador%!J sa+ o
    !nso%n!e (er%!na"7 Ead!c7, se deO(ea&(7 d!n so%n &rea d!n (!%& s! n+ %a! &o(
    reador%!J Inso%n!a !n!=!a"7 Ead!c7, d!.!c+"(a(ea de a ador%!J &oa(e, de ase%enea,
    a&are Ma! rar, !nd!v!/!! &re/!n(7 !&erso%%e, s+' .or%a +nor e&!soade &re"+n$!(e
    de so%n noa&(ea sa+ a +ne! creO(er! a d+ra(e! so%n+"+! d!+rn Uneor! %o(!v+"
    &en(r+ care !nd!v!d+" so"!c!(7 (ra(a%en( :" cons(!(+!e so%n+" &er(+r'a(
    Mod!.!c7r!"e &s!o%o(orn !nc"+d a$!(a=!a Ead!c7, !nca&ac!(a(ea de a s(a "!n!O(!(,
    %ers+" de co"o &An7 co"o, .rAn(+" %A!n!"or or! &!scarea sa+ .recarea (e$+%en(e"or,
    ves(!%en(e"or sa+ a"(or o'!ec(e sa+ "en(oarea Ede e< , "en(oare :n vor'!re, $And!re sa+
    :n %!Oc7r!"e cor&+"+!J, creO(erea &a+/e"or :na!n(e de a r7s&+nde, vor'!rea red+s7 ca
    vo"+%, %od+"a=!e, can(!(a(e sa+ var!e(a(e a con=!n+(+"+! on %+(!s% Ecn(er!+" AYJ
    A$!(a=!a &s!o%o(or!e sa+ "en(oarea (re'+!e s7 .!e s+.!c!en( de severe &en(r+ a &+(ea
    .! o'serva(e s! de c7(re a"=!! s! s7 n+ re&re/!n(e n+%a! !%&res!! &ersona"e
    Ener$!a sc7/+(7, e<(en+area s! .a(!$a'!(a(ea s+n( .recven(e Ecr!(er!+" ARJ O
    &ersoan7 &oa(e ac+/a .a(!$a'!(a(e s+s=!n+(7 .7r7 a de&+ne vreo ac(!v!(a(e .!/!c7
    C!ar s! ce"e %a! %!c! sarc!n! &ar a neces!(a +n e.or( cons!dera'!" E.!c!en(a c+ care
    s+n( e.ec(+a(e sarc!n!"e &oa(e .! red+s7 De e<e%&"+, +n !nd!v!d se &oa(e &"An$e c7
    s&7"a(+" s! :%'r7ca(+" d!%!nea=a s+n( e&+!/an(e s!4! !a+ de do+7 or! %a! %+"( (!%&
    decA( :n %od +/+a"
    Sen(!%en(+" de !n+(!"!(a(e sa+ de c+"&7 asoc!a( c+ +n e&!sod de&res!v %a&r
    &oa(e !nc"+de a&rec!er! ne$a(!ve as+&ra &ro&r!e! va"on care n+ cores&+nd rea"!(7=!!
    or! &reoc+&7r! re.er!(oare "a c+"&! %!"!(a(e sa+ r+%!na(n :n "e$7(+r7 c+ eror! %!nore
    :n (rec+( Ecr!(er!+" AHJ As(.e" de !nd!v!/! !n(er&re(ea/7 adesea :n %od erona(
    even!%en(e co(!d!ene ne+(re sa+ 'ana"e ca &ro'7 a de.ec(e"or &ersona"e s! a+ +n
    sen(!%en( e<a$era( de res&onsa'!"!(a(e .a(7 de even!%en(e"e ne.avora'!"e De
    e<e%&"+, +n a$en( !%o'!"!ar se a+(oconda%n7 &en(r+ eOec+" de a .ace vAn/7r!,
    c!ar cAnd &!a=a a sc7/+( % $enera" s! n!c! a"=! a$en=! !%o'!"!ar! n+ s+n( ca&a'!"! s7
    .ac7 vAn/7r! Sen(!%en(+" de !n+(!"!(a(e sa+ de c+"&7 &oa(e .! de &ro&or=!! de"!ran(e
    Ede e<, +n !nd!v!d care es(e co!!_%s c7 e", &ersona", es(e r7s&+n/7(or de %!/er!a
    "+%!!J A+(o'"a%area &en(r+ .a&(+" de a .! s+.er!nd s! &en(r+ a n+ .! re+O!( s7
    sa(!s.ac7 res&onsa'!"!(7=!"e &ro.es!ona"e sa+ %(er&ersona"e ca re/+"(a( a" de&res!e!
    es(e .oar(e .recven(7 s! n+ es(e cons!dera(7 s+.!c!en(7 &en(r+ a sa(!s.ace aces(
    cr!(er!+, c+ e<ce&=!a ca/+"+! cana es(e de"!ran(7
    M+"=! !nd!v!/! ac+/a de(er!orarea ca&ac!(7=!! de a $And!, de a se concen(ra or! de
    a "+a dec!/!! ?cr!(er!+" ASJ F! &o( a&are ca .+nd +Oor de d!s(ras sa+ se &"An$ de
    d!.!c+"(7=! de %e%or!e Ce! care :n &"an !n(e"ec(+a" neces!(7 con(!n+!(a(e Oco"ar7 sa+
    &ro.es!ona"7 s+n( adesea !nca&a'!"! s7 .+nc=!one/e cores&+n/7(or c!ar cAnd a+
    &ro'"e%e +boare de concen(rare (de e< , +n &ro$ra%a(or de co%&+(er care n+ %a!
    &oa(e e.ec(+a de %+"( (!%& sa!a% co%&"!ca(e, dar &e care "e rea/a an(er!orJ La
    co&!!, o sc7dere &rec!&!(a(7 a no(("or &oa(e re."ec(a o concen(rare red+s7 La !nd!v!/!!
    :n e(a(e c+ e&!sod de&resrv %a@or, d!.!c+"(7=!"e %ne/!ce &o( .! ac+/a &r!nc!&a"7 s! &o(
    .! "+a(e :n %od erona( dre&( se!%e de de%en(7 ES&se+dode%en(7TJ CAnd e&!sod+"
    de&resn rra@or es(e (ra(a( c+ s+cces &ro'"e%e"e de %e%or!e d!s&ar co%&"e( :ns7, "a
    *pisodul Depresiv
    Ma0or
    +51
    +n+ !nd!v!/!, :n s&ec!a" "a &ersoane"e :n e(a(e, +n e&!sod de&res!v %a@or &oa(e .!
    +neor! (a'"o+" c"!n!c !n!=!a" a" +ne! de%en(e !revers!'!"e
    Frecven(, e<!s(7 $And+r! de %oar(e, !dea(!e s+!c!dar7 or! (en(a(!ve de s+!c!d
    Ecr!(er!+" AFJ Aces(e $And+r! %er$ de "a conv!n$erea c7 a"=!! ar .! %a! '!ne s!(+a=!
    dac7 &ersoana res&ec(!v7 ar .! %oar(7, "a !de! (ran/!(or!!, dar rec+ren(e de co%!(ere a
    s+!c!d+"+!, &An7 "a an+%!(e &"an+r! rea"e de c+% s7 co%!(7 s+!c!d+" Frecven=a,
    !n(ens!(a(ea s! "e(a(a(ea aces(or !de! &oa(e .! .oar(e var!a'!"7 Ind!v!/!! s+!c!dan %a!
    &+=!n sever! &o( re"a(a !de! de s+!c!d (ran/!(or!! Ede 549 %!n+(eJ, rec+ren(e Eoda(7 sa+
    de do+7 or! &e s7&(7%An7J Ind!v!/!! s+!c!dan %a! sever! &o( s74s! .! &roc+ra(
    %a(er!a"e Ede e<, o .+n!e sa+ o ar%7J &en(r+ a .! +(!"!/a(e :n (en(a(!va de s+!c!d s! &o(
    avea s(a'!"!( "oc+" s! %o%en(+" cAnd vor .! s!n$+r! &en(r+ a4s! &+(ea rea"!/a s+!c!d+"
    DeO! aces(e co%&or(a%en(e s+n( asoc!a(e s(a(!s(!c c+ (en(a(!ve de s+!c!d s! &o( .! +(!"e
    :n !den(!.!carea +n+! $r+& c+ r!sc %are, %+"(e s(+d!! a+ ar7(a( c7 n+ es(e &os!'!" s7 se
    &revad7 c+ cer(!(+d!ne cAnd sa+ dac7 +n !nd!v!d c+ de&res!e va :ncerca s7 se
    s!n+c!d7 Mo(!va=!!"e &en(r+ s+!c!d &o( !nc"+de dor!n=a de a se re(ra$e d!n .a=a +nor
    o's(aco"e &erce&+(e ca !ns+r%on(a'!"e or! dor!n=a !n(ens7 de a (er%!na c+ o s(are
    e%o=!ona"7 d+reroas7, (or(+ran(7, care es(e &erce&+(7 de &ersoan7 a .! !n(er%!na'!"7
    D!a$nos(!c+" de e&!sod de&res!v %a@or n+ se &+ne dac7 s!%&(o%e"e sa(!s.ac
    cr!(er!!"e &en(r+ +n e&!sod %!<( Ecr!(er!+" BJ Un e&!sod %!<( se carac(er!/ea/7 &r!n
    s!%&(o%e a&ar=!nAnd, a(A( +n+! e&!sod %an!aca", cA( s! +n+! e&!sod de&res!v %a@or,
    s+rven!nd a&roa&e :n .!ecare /!, o &er!oad7 de ce" &+(% o s7&(7%An7
    ,rad+" de de(er!orare asoc!a( c+ +n e&!sod de&res!v %a@or var!a/7, dar c!ar :n
    ca/+r!"e +Ooare (re'+!e s7 e<!s(e, .!e o s+.er!n=7 se%n!.!ca(!v7 c"!n!c or! o %(ervene
    oarecare :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de
    .+nc=!onare Ecr!(er!+" CJ Dac7 de(er!orarea es(e sever7, &ersoana :O! &oa(e &!erde
    ca&ac!(a(ea de a .+nc=!ona soc!a" sa+ &ro.es!ona" In ca/+r! e<(re%e, &ersoana &oa(e
    .! !nca&a'!"7 de o %!n!%7 a+(o:n$n@!re Ede e< , s7 se a"!%en(e/e sa+ s7 se :%'race
    s!n$+r7J sa+ s74s! %en=!n7 +n %!n!%+% de !$!en7 &ersona"7
    Un !n(erv!+ a(en( es(e esen=!a" &en(r+ a !den(!.!ca s!%&(o%e"e +n+! e&!sod
    de&res!v %a@or Re"a(area &oa(e .! co%&ro%!s7 de d!.!c+"(7=!"e :n concen(rare,
    de(er!orarea %e%or!e! sa+ (end!n=a de a ne$a, de a %!n!%a"!/a sa+ de a e<&"!ca
    s!%&(o%e"e In.or%a=!!"e &roven!nd de "a !n.or%a(or! a+<!"!ar! &o( .! e<(re% de +(!"e
    :n c"ar!.!carea evo"+=!e! e&!soade"or de&res!ve c+ren(e sa+ an(er!oare s! :n s(a'!"!rea
    .a&(+"+! dac7 a+ e<!s(a( e&!soade %an!aca"e sa+ !&o%a%aca"e Deoarece
    e&!soade"e de&res!ve %a@ore &o( :nce&e $rad+a", o (recere :n rev!s(7 a !n.or%a=!!"or
    c"!n!ce cen(ra(e &e &ar(ea cea %a! rea a e&!sod+"+! c+ren( &oa(e .oar(e &ro'a'!" s7
    de(ec(e/e &re/en(a s!%&(o%e"or Eva"+area s!%&(o%e"or +n+! e&!sod de&res!v
    %a@or es(e e<(re% de d!.!c!"7 cAnd aces(ea s+rv!n "a +n !nd!v!d care are, de
    ase%enea, o cond!=!e %ed!ca"7 $enera"7 Ede e<, cancer, !c(+s, !n.arc( %!ocard!c,
    d!a'e(J Un+ d!n(re !(e%n cr!(er!+ a! e&!sod+"+! de&res!v %a@or s+n( !den(!c! c+
    se%ne"e s! s!%&(o%e"e carac(er!s(!ce a"e cond!=!!"or %ed!ca"e $enera"e Ede e<,
    &!erderea :n $re+(a(e :n(r4+n d!a'e( ne(ra(a(, .a$a'!(a(ea, % cancerJ As(.e" de
    s!%&(o%e (re'+!e s7 &"ede/e &en(r+ +n e&!sod de&res!v %a@or e<ce&(And ca/+"
    cAnd aces(ea s+n( c"ar s! co%&"e( e<&"!ca(e de o cond!=!e %ed!ca"7 $enera"7 De
    e<e%&"+, &!erderea :n $re+(a(e "a o &ersoan7 c+ co"!(7 +"ceroas7, care are %+"(e
    sca+ne s! cons+% red+s de a"!%en(e, n+ (re'+!e s7 con(e/e &en(r+ +n e&!sod
    de&res!v %a@or Pe de a"(7 &ar(e, cAnd (r!s(e=ea, c+"&a, !nso%n!a sa+ &!erderea :n
    $re+(a(e s+n( &re/en(e "a o &ersoan7 c+ !n.arc( %!ocard!c recen(, .!ecare s!%&(o% va
    con(a &en(r+ +n e&!sod de&res!v %a@or, deoarece aces(ea n+ s+n( e<&"!ca(e c"ar s!
    4A7
    Tulburrile A$ective
    co%&"e( de e.ec(e"e .!/!o"o$!ce a"e !n.arc(+"+! de %!ocard La .e", cAnd s!%&(o%e"e
    s+n( da(ora(e :n %od c"ar !de!"or de"!ran(e !ncon$r+en(e c+ d!s&o/!=!a sa+
    a"+c!na=!!"or, Ede e<, o &!erdere :n $re+(a(e de ;L "!vre da(ora(7 re.+/+"+! de a
    %Anca d!n ca+/a !de!! de"!ran(e c7 %Ancarea es(e o(r7v!(7J, aces(e s!%&(o%e n+
    &"edea/7 &en(r+ +n e&!sod de&res!v %a@or
    Pr!n de.!n!=!e, e&!sod+" de&res!v %a@or n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +n+! dro$ de a'+/ Ede e<, :n con(e<(+" !n(o<!ca=!e! a"coo"!ce sa+ a"
    a's(!nen(e! de coca!n7J, e.ec(e"or adverse a"e +nor %ed!ca%en(e sa+ (ra(a%en(e Ede
    e<, s(ero!/nJ or! e<&+ne% "a +n (o<!c La .e", e&!sod+" n+ se da(orea/7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<, !&o(!ro!d!s%+"J
    Ecr!(er!+" DJ De ase%enea, dac7 s!%&(o%e"e :nce& :n dec+rs de , "+n! de "a &!erderea
    +ne! .nn(e !+'!(e s! n+ &ers!s(7 &es(e aces(e , "+n!, e"e s+n( :n $enera" cons!dera(e a
    re/+"(a d!n do"!+ Eve/! &a$ HILJ, c+ e<ce&=!a ca/+"+! c:nd s+n( asoc!a(e c+ o
    de(er!orare .+nc=!ona"7 %arca(7 sa+ !nc"+d &reoc+&7r! %or'!de re.er!(oare "a
    !n+(!"!(a(e, !dea(!e s+!c!dar7, s!%&(o%e &s!o(!ce sa+ "en(oare &s!o(one Ecr!(er!+" EJ
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. Ind!v!/!! c+ e&!sod
    de&res!v %a@or &re/!n(7 .recven( (r!s(e=e, !n(a'!(a(e, %ed!(a(!v!(a(e, r+%%a(!e
    o'ses!v7, an<!e(a(e, .o'!!, &reoc+&7n e<ces!ve re.er!(oare "a s7n7(a(ea .!/!c7 s! ac+/e
    de d+rere Ede e< , ce.a"ee, d+rer! ar(!c+"are, a'do%!na"e sa+ a"(e (!&+r! de d+rereJ
    :n c+rs+" +n+! e&!sod de&res!v %a@or, +n+ !nd!v!/! a+ a(ac+r! de &an!c7 s+rven%d
    :n(r4+n &a((ern ce sa(!s.ace cr!(er!!"e &en(r+ &an!c7 La co&!!, &oa(e s+rven!
    an<!e(a(ea de se&arare Un+ !nd!v!/! no(ea/7 d!.!c+"(7=! :n re"a=!!"e !n(!%e,
    !n(erac=!+n! soc!a"e %a! &+=!n sa(!s.7c7(oare sa+ d!.!c+"(7=! :n ac(!v!(a(ea se<+a"7 Ede
    e<, anor$as%!e "a .e%e! s! d!s.+nc(!e erec(!"7 "a '7r'a=!J Po( e<!s(a &ro'"e%e
    %ar!(a"e Ede e<, d!vor=J, &ro'"e%e &ro.es!ona"e Ede e<, &!erderea serv!c!+"+!J,
    &ro'"e%e Oco"are Ede e<, c!+", eOec Oco"arJ, a'+/ de a"coo" or! de a"(7 s+'s(an=7,
    creO(erea +(!"!/7% serv!c!!"or %ed!ca"e Cea %a! ser!oas7 consec!n=7 a e&!sod+"+!
    de&res!v %a@or o cons(!(+!e (en(a(!va de s+!c!d sa+ s+!c!d+" co%&"e( R!sc+" de
    s+!c!d es(e e<(re% de %are "a !nd!v!/!! c+ e"e%en(e &s!o(!ce, c+ !s(or!c de (en(a(!ve
    de s+!c!d an(er!oare, c+ +n !s(or!c .a%!"!a" de s+!c!d+n co%&"e(e or! de +/
    conco%!(en( de o s+'s(an=7 Poa(e e<!s(a, de ase%enea, o ra(7 cresc+(7 de %or=!
    &re%a(+re &r!n cond!=!! %ed!ca"e $enera"e E&!soade"e de&res!ve %a@ore +r%ea/7
    adesea +nor s(reson &s!osoc!a"! Ede e< , %oar(ea +ne! .nn(e !+'!(e, se&arare
    %ar!(a"7, d!vor=J NaO(erea +n+! co&!" &oa(e &rec!&!(a +n e&!sod de&res!v %a@or, :n
    care ca/ es(e %en=!ona( s&ec!.!can(+" Sc+ de'+( &os(&ar(+%T Eve/! &a$, I99J
    9ate de laborator asociate. N+ a+ .os( !den(!.!ca(e n!c! +n .e" de da(e de
    "a'ora(or s&ec!.!ce s+' as&ec( d!a$nos(!c &en(r+ e&!sod+" de&res!v %a@or C+ (oa(e
    aces(ea, s4a cons(a(a( c7 o d!vers!(a(e de da(e de "a'ora(or s+n( anor%a"e "a !nd!v!/!!
    c+ e&!soade de&res!ve %a@ore :n co%&ara=!e c+ s+'!ec=!! de con(ro" Se &are c7
    ace"eaO! ano%a"!! de "a'ora(or s+n( asoc!a(e c+ +n e&!sod de&res!v %a@or, !nd!.eren(
    de .a&(+" dac7 e&!sod+" es(e &ar(e a +ne! (+"'+r7r! de&res!ve %a@ore, (+"'+r7r!
    '!&o"are I sa+ II Ce"e %a! %+"(e ano%a"!! s+n( de&enden(e de s(are Ead!c7, a.ec(a(e
    de &re/en(a sa+ a'sen(a s!%&(o%e"or de&res!veJ, :ns7 +ne"e da(e &o( &recede
    de'+(+" e&!sod+"+! sa+ &o( &ers!s(a d+&7 re%!s!+nea sa Es(e &os!'!" ca (es(e"e de
    "a'ora(or s7 .!e anor%a"e :n e&!soade"e c+ e"e%en(e %e"anco"!ce sa+ &s!o(!ce,
    &rec+% s! "a !nd!v!/!! %a! sever de&res!v!
    *pisodul Depresiv
    Ma0or
    4A4

    Ano%a"!! EE, de so%n &o( .! ev!den(e "a ILd4RLd d!n(re &ac!en=!! a%'+"a(on
    s! :n &An7 "a FLd d!n(re &ac!en=!! !n(erna=! c+ +n e&!sod de&res!v %a@or Da(e"e
    &o"!so%no$ra.!ce asoc!a(e ce" %a! .recven( !nc"+d 5J &er(+r'7r! a"e con(!n+!(7=!!
    so%n+"+!, c+% ar .! "a(en(a de so%n &re"+n$!(7, v!$!(a(e !n(er%!(en(7 cresc+(7,
    deO(e&(are %a(!na"7 &recoce, 9J red+cerea s(ad!!"or ; s! I de so%n non4REM
    Eso%n+" c+ +nde "en(eJ c+ o de&"asare a ac(!v!(7=!! c+ +nde "en(e %a! de&ar(e de
    &r!%a &er!oad7 NREM, ;J red+cerea "a(en(e! %!Oc7r!"or oc+"are ra&!de Ead!c7,
    sc+r(area d+ra(e! &r!%e! &er!oade NREMJ, IJ creO(erea ac(!v!(7=!! .a/!ce REM Ead!c7,
    a n+%7r+"+! de %!Oc7r! rea"e a"e oc!"or :n c+rs+" so%n+"+!J s! YJ creO(erea d+ra(e!
    de so%n REM "a :nce&+(+" no&(n Une"e da(e s+$erea/7 c7 aces(e ano%a"!! de so%n
    &ers!s(7 s! d+&7 re%!s!+nea c"!n!c7 sa+ &o( &recede de'+(+" e&!sod+"+! de&res!v
    %a@or !n!=!a" &r!n(re ce! c+ r!sc cresc+( &en(r+ o (+"'+rare a.ec(!v7 Ede e< , %e%'n
    de $rad+" I a! .a%!"!e! !nd!v!/!"or c+ (+"'+rare de&res!v7 %a@or7J
    F!/!o&a(o"o$!a +n+! e&!sod de&res!v %a@or !%&"!c7 o dere$"are a n+%7r+"+! de
    s!s(e%e de ne+ro(rans%!(7(or! !nc"+/And sero(on%a, nore&%e.r!na, do&a%!na,
    ace(!"cona s! s!s(e%e"e ac!d+"+! $a%%a4a%!no'+(!nc E<!s(7, de ase%enea, &ro'e
    de a"(erare a d!verse"or ne+ro&e&(!de !nc"+/And or%on+" de e"!'erare a
    cor(!co(ro&!ne! La +n+ &ac!en=! de&res!v! a+ .os( o'serva(e &er(+r'7r! or%ona"e
    !nc"+/And creO(erea secre=!e! de $"+cocor(!co!d Ede e<, creO(erea n!ve"e"or
    cor(!/o"+"+! "!'er :n +r!n7 sa+ nons+&res!+nea de c7(re de<a%e(a/on7 a cor(!/o"+"+!
    &"as%a(!cJ s! a&"a(!/area concen(ra=!e! or%on+"+! de creO(ere, a or%on+"+! de
    s(!%+"are a (!ro!de! s! a r7s&+ns+"+! &ro"ac(!ne! "a d!verse (es(e de &rovocare
    S(+d!!"e de !%a$!s(!c7 .+nc=!ona"7 cere'ra"7 cer(!.!c7 a"(er7r! a"e ."+<+"+! san$+!n s!
    %e(a'o"!s%+"+! cere'ra" "a +n+ !nd!v!/!, !nc"+/And creO(erea ."+<+"+! san$+!n :n
    re$!+n!"e %'!c7 s! &ara%'!c7 s! sc7derea aces(+!a :n cor(e<+" &re.ron(a" "a(era"
    De&res!a care de'+(ea/7 (Ar/!+ :n v!a(7 es(e asoc!a(7 c+ a"(er7r! a"e s(r+c(+r!!
    cere'ra"e, !nc"+/And %od!.!c7r! vasc+"are &enven(nc+"are N!c! +na d!n(re aces(e
    %od!.!c7r! n+ es(e &re/en(7 "a (o=! !nd!v!/!! :n e&!sod de&res!v %a@or s! n!c! +na n+
    re&re/!n(7 o &er(+r'are &ar(!c+"ar7 s&ec!.!c7 de&res!e!
    *lemente speci$ice culturii, etii si sexului
    C+"(+ra &oa(e !n."+en(a e<&enen(area s! co%+n!carea s!%&(o%e"or de&res!e!
    S+'d!a$nos(!carea sa+ d!a$nos(!carea erona(7 &o( .! red+se &r!n acordarea de
    a(en=!e s&ec!.!c!(7=!! e(n!ce s! c+"(+ra"e :n &re/en(area ac+/e"or +n+! e&!sod de&res!v
    %a@or De e<e%&"+, :n +ne"e c+"(+n, de&res!a &oa(e .! e<&enen(a(7 :n %are %7s+r7
    :n (er%en! so%a(!c! %a! c+rAnd dec:( ca (r!s(e=e sa+ c+"&7 Ac+/e"e de Snerv!T s! de
    ce.a"ee E:n c+"(+r!"e "a(!no s! %ed!(eraneeneJ, de as(en!e, de de'!"!(a(e, de
    Sde/ec!"!'r+T E:n c+"(+ra c!ne/7 s! a"(e c+"(+r! as!a(!ceJ, de &ro'"e%e de S!n!%7T
    E:n c+"(+r!"e %ed!oonen(a"eJ or! de a .! Sc+ %!%a .rAn(7T E&r!n(re o&!J &o( e<&r!%a
    e<&er!en=a de&res!v7 As(.e" de (a'"o+r! c"!n!ce co%'!n7 e"e%en(e a"e (+"'+r7r!"or
    de&res!ve, an<!oase s! so%a(o.or%e C+"(+r!"e &o( d!.en :n a&rec!er!"e re.er!(oare "a
    sever!(a(ea e<&er!en(7% sa+ e<&n%7rn d!s.one! Ede e< , !n(a'!(a(ea &oa(e &rovoca
    o &reoc+&are %a! %are decA( (r!s(e=ea sa+ !/o"areaJ E<&er!en=e"e d!s(!nc(!ve
    c+"(+ra" Ede e< , (ea%a de a n+ .! deoc!a( sa+ .e%eca(, sen/a=!a de Sc7"d+r7 :n ca&T
    sa+ sen/a=!a de re&(are de v!er%! sa+ .+rn!c!, or! !%&res!a v!e c7 es(e v!/!(a( de ce!
    %or=!J (re'+!e s7 .!e d!s(!nse de a"+c!na=!!"e sa+ !de!"e de"!ran(e rea"e care &o( .!
    &ar(e a +n+! e&!sod de&res!v %a@or c+ e"e%en(e &s!o(!ce De ase%enea, es(e
    !%&or(an( &en(r+ c"!n!c!an s7 n+ e<c"+d7 :n %od r+(!n!er +n s!%&(o% doar &en(r+
    .a&(+" c7 aces(a es(e v7/+( ca Snor%7T &en(r+ o an+%!(7 c+"(+r7
    4<7
    Tulburrile A$ective
    S!%&(o%e"e de n+c"e+ a"e +n+! e&!sod de&res!v %a@or s+n( ace"eaO! "a co&!! s!
    ado"escen=!, deO! e<!s(7 da(e care s+$erea/7 c7 &roe%!nen=a s!%&(o%e"or
    carac(er!s(!ce se sc!%'7 c+ e(a(ea. An+%!(e s!%&(o%e, c+% s+n( ac+/e"e so%a(!ce,
    !r!(a'!"!(a(ea O! !/o"area soc!a"7, s+n( e<(re% de .recven(e "a co&!!, :n (!%& ce "en(oarea
    &s!o%o(or!e, !&erso%n!a O! !de!"e de"!ran(e s+n( %a! &+=!n .recven(e :n
    &re&+'er(a(e decA( :n ado"escen=7 s! :n &er!oada ad+"(7. La co&!! &re&+'er(ar!,
    e&!sod+" de&res!v %a@or s+rv!ne %a! .recven( :%&re+n7 c+ a"(e (+"'+r7r! %en(a"e E:n
    s&ec!a" c+ (+"'+r7r!"e de co%&or(a%en( d!sr+&(!v, de.!c!(e"e de a(en=!e s! (+"'+r7r!"e
    an<!oaseJ decA( !/o"a(. La ado"escen=!, e&!soade"e de&res!ve %a@ore s+n( asoc!a(e
    .recven( c+ (+"'+r7r! de co%&or(a%en( d!sr+&(!v, de.!c!(e de a(en=!e, (+"'+r7r!
    an<!oase, (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 O! (+"'+r7r! de co%&or(a%en(
    a"!%en(ar. La ad+"=!! :n e(a(e, s!%&(o%e"e co$n!(!ve Ede e<., de/or!en(area, &!erderea
    %e%or!e! s! d!s(rac(!'!"!(a(eaJ &o( .! e<(re% de &roe%!nen(e.
    Fe%e!"e s+n( e<&+se +n+! r!sc se%n!.!ca(!v %a! %are decA( '7r'a=!! de a
    &re/en(a e&!soade de&res!ve %a@ore "a +n %o%en( da( :n c+rs+" v!e=!! "or, ce"e %a!
    %ar! d!.eren=e .!!nd cons(a(a(e :n s(+d!!"e e.ec(+a(e :n S(a(e"e Un!(e O! E+ro&a. Aces(
    r!sc d!.eren=!a" cresc+( a&are :n c+rs+" ado"escen=e! s! &oa(e co!nc!de c+ de'+(+"
    &+'er(7=!! Un &rocen( se%n!.!ca(!v de .e%e! re"a(ea/7 o :nr7+(7=!re a s!%&(o%e"or
    +n+! e&!sod de&res!v %a@or c+ cA(eva /!"e :na!n(e de :nce&+(+" %ens(r+a=!!"or.
    S(+d!!"e ara(7 c7 e&!soade"e de&res!ve s+rv!n de do+7 or! %a! .recven( "a .e%e!
    decA( "a '7r'a=!. 3e/! sec=!+n!"e cores&+n/7(oare a"e (e<(e"or &en(r+ (+"'+rarea
    de&res!v7 %a@or7 E&a$. ;H9J, (+"'+rarea '!&o"ar7 I E&a$. ;GYJ O! (+"'+rarea '!&o"ar7
    II E&a$. ;FIJ &en(r+ !n.or%a=!! re.er!(oare "a se<.
    *voluie
    S!%&(o%e"e +n+! e&!sod de&res!v %a@or se de/vo"(7 de re$+"7 :n dec+rs de /!"e
    sa+ s7&(7%An!. O &er!oad7 &rodro%a"7, care &oa(e !nc"+de s!%&(o%e an<!oase O!
    s!%&(o%e de&res!ve +Ooare, &oa(e d+ra (!%& de s7&(7%An! sa+ "+n! :na!n(ea
    de'+(+"+! +n+! e&!sod de&res!v %a@or co%&"e(. D+ra(a +n+! e&!sod de&res!v %a@or
    es(e, de ase%enea, var!a'!"7. Un e&!sod ne(ra(a( d+rea/7 de re$+"7 R "+n! sa+ %a!
    %+"(, !nd!.eren( de e(a(ea "a de'+(, :n %a@or!(a(ea ca/+r!"or, e<!s(7 o re%!s!+ne
    co%&"e(7 a s!%&(o%e"or, !ar .+nc=!onarea rev!ne "a n!ve"+" &re%or'!d. :n(r4+n
    &rocen( !%&or(an( de ca/+r! E&oa(e 9Ld4;LdJ, +ne"e s!%&(o%e de&res!ve,
    !ns+.!c!en(e &en(r+ a sa(!s.ace co%&"e( cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or,
    &o( &ers!s(a "+n! sa+ an! O! &o( .! asoc!a(e c+ o oarecare !nca&ac!(a(e sa+ d!.!c+"(a(e
    E:n care ca/ &oa(e .! %en=!ona( s&ec!.!can(+" S:n re%!s!+ne &ar=!a"7T8 &a$. I59J.
    Re%!s!+nea &ar=!a"7 +r%And +n+! e&!sod de&res!v %a@or &are a .! &red!c(!v7 de +n
    &a((ern s!%!"ar d+&7 e&!soade"e +"(er!oare. La +n!! !nd!v!/! EYd45LdJ, cr!(er!!"e
    co%&"e(e &en(r+ +n e&!sod de&res!v %a@or con(!n+7 s7 .!e sa(!s.7c+(e (!%& de 9 sa+
    %a! %+"=! an! E:n care ca/ &oa(e .! %en=!ona( s&ec!.!can(+" Scron!cT, ve/! &a$. I5HJ.
    Dia!nostic di$erenial
    Un e&!sod de&res!v %a@or (re'+!e s7 .!e d!s(!ns de o (+"'+rare a.ec(!v7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" adecva( (re'+!e s7 .!e ce" de
    (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, dac7 &er(+r'area
    a.ec(!v7 es(e cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<., sc"ero/7 %+"(!&"7, !c(+s, !&o(!ro!d!s%J Eve/! &a$. IL5J. Aceas(7
    &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c. Dac7 s+n(
    Tulburrile
    A$ective
    4<<

    &re/en(e, a(A( +n e&!sod de&res!v %a@or, cA( s! o cond!=!e %ed!ca"7 $enera"7, dar se
    cons!der7 c7 s!%&(o%e"e de&res!ve n+ s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a cond!=!e!
    %ed!ca"e $enera"e, a(+nc! (+"'+rarea a.ec(!v7 &r!%ar7 es(e :nre$!s(ra(7 &e a<a I Ede
    e<., (+"'+rare de&res!v7 %a@or7J, !ar cond!=!a %ed!ca"7 $enera"7, &e a<a III Ede e<.,
    !n.arc( %!ocard!cJ. Aces(a (re'+!e s7 .!e, de e<e%&"+, ca/+" dac7 e&!sod+" de&res!v
    %a@or es(e cons!dera( a .! consec!n=a .!/!o"o$!c7 a .a&(+"+! de a avea o cond!=!e
    %ed!ca"7 $enera"7 sa+ dac7 n+ e<!s(7 n!c! o re"a=!e e(!o"o$!c7 :n(re e&!sod+" de&res!v
    %a@or s! cond!=!a %ed!ca"7 $enera"7.
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de +n e&!sod de&res!v
    %a@or &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n dro$ de a'+/, +n %ed!ca%en( sa+ +n
    (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$. ILYJ.
    De e<e%&"+, d!s&o/!=!a de&res!v7 care s+rv!ne n+%a! :n con(e<(+" a's(!nen=e! de
    coca!n7 va .! d!a$nos(!ca(7 ca (+"'+rare a.ec(!v7 !nd+s7 de coca!n7, c+ e"e%en(e
    de&res!ve, c+ de'+( :n c+rs+" a's(!nen=e!.
    La &ersoane"e :n e(a(e, adesea es(e d!.!c!" s7 se s(a'!"easc7 dac7 s!%&(o%e"e
    co$n!(!ve Ede e<., de/or!en(area, a&a(!a, d!.!c+"(a(ea :n concen(rare, &!erderea
    %e%or!e!J s+n( e<&"!ca(e %a! '!ne de o de%en=7 or! de +n e&!sod de&res!v %a@or. O
    eva"+are %ed!ca"7 co%&"e(7 s! o eva"+are a de'+(+"+! &er(+r'7r!!, a secven=!er!!
    (e%&ora"e a s!%&(o%e"or de&res!ve s! co$n!(!ve, a evo"+=!e! %a"ad!e! s! a
    r7s&+ns+"+! "a (ra(a%en( s+n( +(!"e :n e.ec(+area aces(e! &rec!/7r!. S(area &re%or'!d7
    a !nd!v!d+"+! &oa(e a@+(a "a d!.eren=!erea +n+! e&!sod de&res!v %a@or de o de%en=7,
    :n(r4o de%en=7, e<!s(7 de re$+"7 +n !s(or!c &re%or'!d de dec"!n a" .+nc=!e! co$n!(!ve,
    :n (!%& ce +n !nd!v!d c+ +n e&!sod de&res!v %a@or es(e .oar(e &os!'!" s7 a!'7 o s(are
    &re%or'!d7 nor%a"7 s! +n dec"!n co$n!(!v a'r+&(, asoc!a( c+ de&res!a.
    E&!soade"e de&res!ve %a@ore c+ d!s&o/!=!e !r!(a'!"7 &roe%!nen(7 &o( .! d!.!c!" de
    d!s(!ns de e&!soade"e %an!aca"e c+ d!s&o/!=!e !r!(a'!"7 or! de e&!soade"e %!<(e.
    Aceas(7 d!s(!nc=!e neces!(7 o eva"+are c"!n!c7 a(en(7 a &re/en=e! s!%&(o%e"or
    %an!aca"e. Dac7 s+n( sa(!s.7c+(e cr!(er!!"e, a(A( &en(r+ +n e&!sod %an!aca", cA( s!
    &en(r+ +n e&!sod de&res!v %a@or Ec+ e<ce&=!a ce"+! c+ o d+ra(7 de 9 s7&(7%An!J,
    a&roa&e :n .!ecare /!, (!%& de ce" &+=!n o s7&(7%An7, es(e vor'a de +n e&!sod %!<(.
    D!s(rac(!'!"!(a(ea s! re/!s(en=a sc7/+(7 "a .r+s(rare &o( s+rven!, a(A( :n (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e, cA( s! :n e&!sod+" de&res!v %a@or8 dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ a%'e"e, (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e
    &oa(e .! d!a$nos(!ca(7 ad!=!ona" (+"'+r7r!! a.ec(!ve, :ns7, c"!n!c!an+" (re'+!e s7 .!e
    a(en( s7 n+ s+&rad!a$nos(!ce/e e&!sod+" de&res!v %a@or "a co&!!! c+ (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e a c7ror &er(+r'are de d!s&o/!=!e es(e carac(er!/a(7
    %a! c+rAnd &r!n !r!(a'!"!(a(e decA( &r!n (r!s(e=e sa+ &!erderea !n(eres+"+!.
    Un e&!sod de&res!v %a@or, care s+rv!ne ca +n r7s&+ns "a +n s(resor &s!osoc!a",
    se d!s(!n$e de (+"'+rarea de ada&(are c+ d!s&o/!=!e de&res!v7 &r!n .a&(+" c7 n+
    s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or :n (+"'+rarea de
    ada&(are. D+&7 &!erderea +ne! .!!n=e !+'!(e, c!ar dac7 s!%&(o%e"e de&res!ve s+n(
    de s+.!c!en(7 d+ra(7 s! n+%7r &en(r+ a sa(!s.ace cr!(er!!"e &en(r+ +n e&!sod de&res!v
    %a@or, aces(ea (re'+!e s7 .!e a(r!'+!(e %a! c+rAnd do"!+"+! decA( +n+! e&!sod
    de&res!v %a@or, c+ e<ce&=!a ca/+"+! cAnd &ers!s(7 &es(e 9 "+n! or! !nc"+d o
    de(er!orare .+nc=!ona"7 %arca(7, &reoc+&are %or'!d7 :n "e$7(+r7 c+ !n+(!"!(a(ea,
    !dea=!e s+!c!dar7, s!%&(o%e &s!o(!ce or! "en(oare &s!o%o(or!e.
    :n .!ne, &er!oade"e de (r!s(e=e s+n( as&ec(e !neren(e a"e e<&er!en=e! +%ane. Aces(e
    &er!oade n+ (re'+!e s7 .!e d!a$nos(!ca(e ca e&!sod de&res!v %a@or decA( dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ sever!(a(e Ead!c7, c!nc! d!n no+7 s!%&(o%eJ, d+ra(a Ead!c7,
    ;YR
    Tulburrile A$ective
    cea %a! %are &ar(e a /!"e!, a&roa&e :n .!ecare /!, (!%& de ce" &+=!n 9 s7&(7%An!J s!
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c D!a$nos(!c+" de (+"'+rare de&res!v7 .7r7
    a"(7 s&ec!.!ca=!e &oa(e .! !nd!ca( &en(r+ (a'"o+r!"e c"!n!ce de d!s&o/!=!e de&res!v7 c+
    de(er!orare se%n!.!ca(!v7 c"!n!c s! care n+ sa(!s.ac cr!(er!!"e de d+ra(7 sa+ sever!(a(e
    Criteriile $e $ia/no&ti# pentru Epi&o$ul Depre&iv MaQor
    A inci &sau mai multe) dintre urmtoarele simptome au $ost pre(ente "n
    cursul aceleia,i perioade de 7 sptm@ni, si repre(int o modi$icare de la
    nivelul anterior de $uncionare, cel puin unul dintre simptome este, $ie &E)
    dispo(iie depresiv, $ie &7) pierderea interesului sau plcem
    FotD Fu se includ simptome care este clar c se datorea( unei condiii
    medicale !enerale ori idei delirante sau %alucinaii incon!ruente cu
    dispo(iia
    (1) dispo(iie depresiv cea mai mare parte a (ilei, aproape "n $iecare
    (i,
    indicat $ie prin relatare personal &de ex, se simte trist sau inutil), ori
    observaie $cut de altn &de ex, pare "nlcrimat) Fot La copii si
    adolesceni, dispo(iia poate $i iritabil,
    (2) diminuare marcat a interesului sau plcem pentru toate sau
    aproape
    toate activitile, cea mai mare parte a (ilei, aproape "n $iecare (i &dup
    cum este indicat, $ie prin relatare personal, $ie prin observaii $cute de
    alii,
    (3) pierdere semni$icativ "n !reutate, de,i nu tine diet, ori luare
    "n
    !reutate &de ex , o modi$icare de mai mult de Ad din !reutatea corpului
    "ntr-o lun) ori scdere sau cre,tere a apetitului aproape "n $iecare (i
    Fot La copii, se ia "n consideraie incapacitatea de a atin!e plusurile
    ponderale expectate,
    (3) insomnie sau %ipersomnie aproape "n $iecare (i,
    (4) a!itaie sau lentoare psi%omotone aproape "n $iecare (i &observabil
    de
    ctre altn, nu numai sen(aiile subiective de nelini,te sau de lentoare),
    &S)$ati!abilitate sau lips de ener!ie aproape "n $iecare (i,
    &I) sentimente de inutilitate sau de culp excesiv ori inadecvat &care poate
    $i delirant) aproape "n $iecare (i &nu numai autorepros sau culpabili(are
    "n le!tur cu $aptul de a $i su$erind),
    (8) diminuarea capacitii de a !@ndi sau de a se concentra ori
    indeci(ie
    aproape "n $iecare (i &$ie prin relatare personala, $ie observat de altn),
    (9) !@nduri recurente de moarte &nu doar teama de moarte),
    ideatie
    suicidar recurent $r un plan anume, ori o tentativa de suicid sau un
    plan anume pentru comiterea suicidului
    S Simptomele nu satis$ac criteriile pentru un episod mixt &ve(i pa! 4IA)
    Simptomele cau(ea( o detres sau o deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare
    D Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex, un dro! de abu(, un medicament) ori ale unei condiii !enerale
    medicale &de ex , %ipotiroidism)
    * Simptomele nu sunt explicate mai bine de doliu, adic, dup pierderea unei
    $iine iubite, Simptomele persist mai mult de 7 luni ori sunt caracteri(ate
    printr-o deteriorare $uncional semni$icativ, preocupare morbid de
    inutilitate, ideatie suicidar, simptome psi%otice sau lentoare psi%omotone
    *pisodul Mania
    cal 4<G
    Epi&o$ul Mania#al
    *lementele episodului
    Un e&!sod %an!aca" es(e de.!n!( &r%(r4o &er!oad7 d!s(!nc(7 :n c+rs+" c7re!a e<!s(7
    o d!s&o/!=!e cresc+(7, e<&ans!v7 sa+ !r!(a'!"7 anor%a"7 s! &ers!s(en(7 Aceas(7
    &er!oad7 de d!s&o/!=!e anor%a"7 d+rea/7 ce" &+=!n o s7&(7%An7 Esa+ %a! &+=!n,
    dac7 es(e necesar7 s&!(a"!/areaJ Ecr!(er!+" AJ Per(+r'area de d!s&o/!=!e (re'+!e s7 .!e
    aco%&an!a(7 de ce" &+=!n (re! s!%&(o%e ad!=!ona"e d%(r4o "!s(7 care !nc"+de s(!%a
    de s!ne e<a$era(7 sa+ $randoarea, sc7derea neces!(7=!! de so%n, &res!+nea de a
    vor'!, .+$a de !de!, d!s(rac(!'!"!(a(ea, creO(erea !%&"!c7r!! :n ac(!v!(7=! or!en(a(e s&re
    +n sco& or! a$!(a=!e &s!o%o(one s! !%&"!carea e<ces!v7 :n ac(!v!(7=! &"7c+(e c+ +n
    :na"( &o(en=!a" de consec!n=e !nde/!ra'!"e Dac7 d!s&o/!=!a es(e !r!(a'!"7 E%a! c+rAnd
    decA( cresc+(7 sa+ e<&ans!v7J, ce" &+=!n &a(r+ d!n(re s!%&(o%e"e de %a! s+s (re'+!e
    s7 .!e &re/en(e Ecr!(er!+" BJ S!%&(o%e"e n+ sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod %!<(
    care es(e carac(er!/a(, a(A( &r!n s!%&(o%e a"e e&!sod+"+! %an!aca", cA( s! &r!n
    s!%&(o%e a"e e&!sod+"+! de&res!v %a@or, s+rven!nd a&roa&e :n .!ecare /!, o
    &er!oad7 de ce" &+=!n o s7&(7%An7 Ecr!(er!+" CJ Per(+r'area (re'+!e s7 .!e s+.!c!en(
    de sever7 &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea soc!a"7 sa+
    &ro.es!ona"7 or! &en(r+ a neces!(a s&!(a"!/area, sa+ es(e carac(en/a(7 &r!n &re/en(a
    de e"e%en(e &s!o(!ce Ecr!(er!+" DJ E&!sod+" n+ (re'+!e s7 se da(ore/e e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +n+! dro$ de a'+/, a"e +n+! %ed!ca%en( or! a"e a"(or
    (ra(a%en(e so%a(!ce &en(r+ de&res!e Ede e<, (era&!e e"ec(roconv+"s!van(7 sa+
    .o(o(era&!eJ or! a"e e<&+ne% "a +n (o<!c De ase%enea, e&!sod+" n+ (re'+!e s7 se
    da(ore/e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<,
    sc"ero/7 %+"(!&"7, (+%or7 cere'ra"7J Ecr!(er!+" EJ
    D!s&o/!=!a cresc+(7 a +n+! e&!sod %an!aca" &oa(e .! descr!s7 ca e+.or!c7,
    e<(raord!nar de '+n7, @ov!a"7 sa+ e<a"(a(7 DeO! d!s&o/!=!a &ersoane! &oa(e avea
    !n!=!a" +n carac(er con(a$!os &en(r+ +n o'serv a(or ne!%&"!ca( ea es(e rec+nosc+(7
    ca e<ces!v7 de ce! care c+nosc '!ne &ersoana res&ec(n7 Ca"!(a(ea e<&ans!v7 a
    d!s&o/!=!e! se carac(er!/ea/7 &nn(r4+n en(+/!as% con(!n++ s! %d!scr!%%a(!v
    &en(r+ !n(erac=!+n! !n(er&ersona"e, se<+a"e sa+ &ro.es!ona"e De e<e%&"+, &ersoana
    res&ec(!v7 &oa(e :nce&e :n %od s&on(an conversa=!! :n(!nse c+ s(r7!n!! :n "oc+r!
    &+'"!ce or! +n vAn/7(or &oa(e (e"e.ona acas7 +nor &ersoane s(r7!ne :n &r!%e"e ore
    a"e d!%!ne=!! &en(r+ a :nce&e vAn/7r!"e DeO! d!s&o/!=!a cresc+(7 es(e cons!dera(7 a
    .! s!%&(o%+" (!&!c, &er(+r'area de d!s&o/!=!e &redo%!nan(7 &oa(e .! !n(a'!"!(a(ea, :n
    s&ec!a" cAnd dor!n=e"e &ersoane! n+ s+n( sa(!s.7c+(e La'!"!(a(ea d!s&o/!=!e! Ede e< ,
    a"(ernan(7 :n(re e+.or!e s! !n(a'!(a(eJ es(e o'serva(7 .recven(
    S(!%a de s!ne e<a$era(7 es(e de re$+"7 &re/en(7, %er$And de "a :ncrederea necnc7
    :n s!ne &An7 "a $randoarea %arca(7, s! &oa(e a(!n$e &ro&or=!! de"!ran(e Ecr!(er!+" B"J
    Ind!v!/!! :O! &o( da c+ &7rerea :n ces(!+n! des&re care n+ a+ n!c! +n .e" de c+noO(!n=e
    Ede e<, c+% s7 se cond+c7 Na=!+n!"e Un!(eJ :n d!s&re=+" "!&se! or!c7re! e<&er!en=e sa+
    (a"en( s&ec!a", !nd!v!d+" se &oa(e an$a@a s7 sene +n ro%an sa+ s7 co%&+n7 o s!%.on!e,
    or! ca+(7 &+'"!c!(a(e &en(r+ o !nven=!e !%&rac(!c7 oarecare Ide!"e de"!ran(e de
    $randoare s+n( .recven(e Ede e< , are o re"a=!e s&ec!a"7 c+ D+%ne/e+ on c+ o an+%!(7
    &ersoan7 &+'"!c7 d!n "+%ea &o"!(!c7, re"!$!oas7 sa+ a s&ec(aco"+"+!J
    A&roa&e cons(an(, e<!s(7 o neces!(a(e red+s7 de so%n Ecr!(er!+" B9J Persoana se
    deO(ea&(7 de re$+"7 d!n so%n c+ cA(eva ore %a! d!n (!%& decA( :n %od +/+a", dar
    se s!%(e &"!n7 de ener$!e CAnd &er(+r'area so%n+"+! es(e sever7, &ersoana &oa(e
    &e(rece /!"e :n(re$! .7r7 s7 doar%7, s! (o(+O! s7 n+ s!%(7 n!c! +n .e" de .a(!$a'!(a(e
    4<>
    Tulburrile A$ective

    3or'!rea %an!aca"7 es(e de re$+"7 &resan(7, sonor7, ra&!d7 s! d!.!c!" de :n(rer+&(
    Ecr!(er!+" B;J. Ind!v!/!! &o( vor'! nons(o&, +neor! ore :n(re$!, .7r7 n!c! o
    cons!dera=!+ne .a=7 de dor!n=a a"(ora de a co%+n!ca. L!%'a@+" es(e carac(er!/a(
    +neor! &r!n &"e/an(er!e, @oc de c+v!n(e O! !%&er(!nen=e care a%+/7. Ind!v!d+" &oa(e
    deven! os(en(a(!v, c+ %an!er!s%e s! %od de a cAn(a de%ons(ra(!v. Ma! c+rAnd
    s+ne(e"e decA( re"a=!!"e conce&(+a"e se%n!.!ca(!ve, $+vernea/7 a"e$erea c+v!n(e"or
    Ead!c7, c"an$or+"J. Dac7 d!s&o/!=!a &ersoane! es(e %a! %+"( !r!(a'!"7 decA( e<&ans!v7,
    d!sc+rs+" &oa(e .! %arca( de "a%en(7r!, co%en(ar!! os(!"e sa+ (!rade co"eroase.
    ,And+r!"e !nd!v!d+"+! &o( .! acce"era(e, adesea :n(r4+n r!(% %a! ra&!d decA( ce"
    :n care &o( .! ar(!c+"a(e Ecr!(er!+" BIJ. Un!! !nd!v!/! c+ e&!soade %an!aca"e re"a(ea/7
    c7 aceas(7 e<&er!en=7 sea%7n7 c+ aceea a +r%7r!r!! s!%+"(ane a do+7 sa+ (re!
    &ro$ra%e de (e"ev!/!+ne. Frecven( e<!s(7 .+$7 de !de!, ev!den=!a(7 &r!n(r4+n ."+<
    a&roa&e con(!n++ de vor'!re acce"era(7, c+ (recer! 'r+O(e de "a +n s+'!ec( "a a"(+".
    De e<e%&"+, :n (!%& ce vor'eO(e des&re o even(+a"7 a.acere cons(And d!n vAn/area
    de co%&+(ere, +n vAn/7(or &oa(e (rece "a d!sc+(area :n ce"e %a! %!c! de(a"!! a !s(or!e!
    c!&+"+! &en(r+ co%&+(er, a revo"+=!e! !nd+s(r!a"e sa+ a %a(e%a(!c!"or a&"!ca(e. CAnd
    .+$a de !de! es(e sever7, "!%'a@+" dev!ne de/or$an!/a( O! !ncoeren(.
    D!s(rac(!'!"!(a(ea Ecr!(er!+" BYJ es(e ev!den=!a(7 &r!n !nca&ac!(a(ea de a e"!%!na
    s(!%+"!! e<(ern! !re"evan=! Ede e<., crava(a e<a%!na(or+"+!, /$o%o(+" de .ond sa+
    conversa=!!"e or! %o'!"e"e d!n ca%er7J. Poa(e e<!s(a o ca&ac!(a(e red+s7 de a .ace
    d!s(!nc=!e :n(re !de!"e adecva(e s+'!ec(+"+! s! !de!"e n+%a! &+=!n re"evan(e or! c"ar
    !re"evan(e.
    CreO(erea ac(!v!(7=!! or!en(a(e s&re +n sco& !%&"!c7 adesea o &"an!.!care
    e<ces!v7, o &ar(!c!&are e<ces!v7 "a %+"(!&"e ac(!v!(7=! Ede e<., se<+a"7, &ro.es!ona"7,
    &o"!(!c7, re"!$!oas7J Ecr!(er!+" BRJ. I%&+"s!+n!"e, .an(e/!!"e s! co%&or(a%en(+"
    se<+a" cresc+( s+n( adesea &re/en(e. Persoana se &oa(e an$a@a conco%!(en( :n
    n+%eroase s&ec+"a=!! no! :n a.acer! .7r7 a "+a :n cons!dera=!e r!sc+r!"e sa+
    neces!(a(ea de a .!na"!/a :n %od sa(!s.7c7(or .!ecare s&ec+"a=!e. A&roa&e cons(an(,
    e<!s(7 o soc!a'!"!(a(e cresc+(7 Ede e<., re:no!rea +nor vec! c+noO(!n=e sa+ ce%area
    "a (e"e.on a a%!c!"or sa+ c!ar a s(r7!n!"or "a or!ce or7 d!n /! s! d!n noa&(eJ, .7r7 a "+a
    :n cons!dera=!e na(+ra !n(r+s!v7, do%!na(oare s! revend!ca(!v7 a aces(or !n(erac=!+n!.
    Ind!v!/!! &re/!n(7 adesea a$!(a=!e sa+ ne"!n!O(e &s!o%o(or!e &r!n %ers+" de co"o
    &An7 co"o or! &r!n =!nerea s!%+"(an7 a n+%eroase conversa=!! Ede e<., "a (e"e.on, s!
    c+ a"(7 &ersoan7 :n ace"aO! (!%&J. Un!! !nd!v!/! scr!+ +n (oren( de scr!sor! des&re
    ce"e %a! d!.er!(e s+'!ec(e a%!c!"or, &ersona"!(7=!"or &+'"!ce sa+ %ass %ed!a.
    E<&ans!v!(a(ea, o&(!%!s%+" ne@+s(!.!ca(, $randoarea O! @+deca(a red+s7 d+c
    adesea "a o !%&"!care !%&r+den(7 :n ac(!v!(7=! &"7c+(e, c+% ar .! c+%&7r7(+r!
    e<ces!ve, cond+s+" (e%erar, !nves(!=!! :n a.acer! nes7'+!(e O! co%&or(a%en( se<+a"
    !nso"!( &en(r+ &ersoana res&ec(!v7, c!ar dac7 aces(e ac(!v!(7=! es(e &os!'!" s7 a!'7
    consec!n=e !nde/!ra'!"e Ecr!(er!+" BHJ. Ind!v!d+" &oa(e c+%&7ra %+"(e "+cr+r! care
    n+4! s+n( necesare Ede e<., 9L de &erec! de &an(o.!, an(!c!(7=! sc+%&eJ, .7r7 s7 a!'7
    'an! &en(r+ a "e ac!(a. Co%&or(a%en(+" se<+a" !nso"!( !nc"+de !n.!de"!(a(ea sa+
    re"a=!!"e se<+a"e !nd!scr!%!na(!ve c+ &ersoane s(r7!ne.
    De(er!orarea re/+"(And d!n &er(+r'are (re'+!e s7 .!e s+.!c!en( de sever7 &en(r+ a
    ca+/a o de(er!orare se%n!.!ca(!v7 :n .+nc=!onare sa+ &en(r+ a neces!(a s&!(a"!/area
    s&re a &ro(e@a !nd!v!d+" de consec!n=e"e ne$a(!ve a"e ac=!+n!"or care re/+"(7 d!n
    @+deca(a red+s7 Ede e<., &!erder! .!nanc!are, ac(!v!(7=! !"e$a"e, &!erderea serv!c!+"+!,
    co%&or(a%en( a$res!vJ. Pr!n de.!n!=!e, &re/en=a de e"e%en(e &s!o(!ce :n c+rs+"
    e&!sod+"+! %an!aca" cons(!(+!e o de(er!orare se%n!.!ca(!v7 a .+nc=!on7r!! Ecr!(er!+" DJ.
    *pisodul
    Maniacal
    ;YF

    S!%&(o%e ase%7n7(oare ce"or :n(A"n!(e :n e&!sod+" %an!aca" se &o( da(ora
    e.ec(e"or d!rec(e a"e %ed!ca=!e! an(!de&res!ve, (era&!e! e"ec(roconv+"s!van(e,
    .o(o(era&!e! or! +n+! %ed!ca%en( &rescr!s &en(r+ a"(e cond!=!! %ed!ca"e $enera"e Ede
    e<., cor(!cos(ero!/!!J. As(.e" de (a'"o+r! c"!n!ce n+ s+n( cons!dera(e e&!soade
    %an!aca"e O! n+ con(ea/7 &en(r+ d!a$nos(!c+" de (+"'+rare '!&o"ar7 I. De e<e%&"+,
    dac7 o &ersoan7 c+ (+"'+rare de&res!v7 %a@or7 rec+ren(7 de/vo"(7 s!%&(o%e
    %an!aca"e, +r%And ad%!n!s(r7r!! +ne! %ed!ca=!! an(!de&res!ve, e&!sod+" es(e
    d!a$nos(!ca( ca (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7, c+ e"e%en(e %an!aca"e, s!
    n+ es(e cons!dera( o co%+(are de "a d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7 "a
    ce" de (+"'+rare '!&o"ar7 I. Une"e da(e s+$erea/7 c7 &oa(e e<!s(a o Sd!a(e/7T
    '!&o"ar7 "a !nd!v!/!! care &re/!n(7 e&!soade s!%!"are ce"or %an!aca"e, d+&7 +n
    (ra(a%en( so%a(!c &en(r+ de&res!e. As(.e" de !nd!v!/! &o( avea o &ro'a'!"!(a(e
    cresc+(7 de e&!soade %an!aca"e, %!<(e sa+ !&o%an!aca"e v!!(oare, care n+ s+n( :n
    "e$7(+r7 c+ s+'s(an=e"e sa+ c+ (ra(a%en(e"e so%a(!ce &en(r+ de&res!e. Aceas(a
    &oa(e .! +n as&ec( e<(re% de !%&or(an( "a co&!! O! "a ado"escen=!.
    *lemente ,i tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Ind!v!/!! c+ e&!sod
    %an!aca" n+ rec+nosc de re$+"7 c7 e! s+n( s+.er!n/! O! se o&+n e.or(+r!"or de a4!
    (ra(a. E! &o( c7"7(or! !%&+"s!v :n a"(e oraOe, &o( &!erde con(ac(+" c+ r+de"e s!
    c+ra(or!!, :O! &o( sc!%'a ves(!%en(a=!a, %ac!a@+", :n.7=!Oarea &en(r+ +n s(!" %a!
    &rovoca(or se<+a" or! orna( (ea(ra", care es(e :n a.ara %od+"+! "or de a .!. Se &o(
    an$a@a :n ac(!v!(7=! c+ carac(er de/or$an!/a( sa+ '!/ar Ede e<., d!s(r!'+!rea de
    'o%'oane, de 'an! sa+ de cons!"!! (rec7(or!"or s(r7!n!J. *oc+" de Oans7 O!
    co%&or(a%en(e"e an(!soc!a"e &o( aco%&an!a e&!sod+" %an!aca". Preoc+&7r!"e e(!ce
    &o( .! descons!dera(e c!ar de c7(re ce! care de re$+"7 s+n( .oar(e oneO(! Ede e<., +n
    a$en( de '+rs7 c+%&7r7 s! v!nde :n %od necores&+n/7(or s(oc+r!, .7r7 c+noO(!n=a
    sa+ &er%!s!+nea c"!en=!"or8 +n savan( :O! :ns+OeO(e desco&er!r! a"e a"(oraJ. Persoana
    &oa(e .! os(!"7 O! a%en!n=7(oare .!/!c .a=7 de a"=!!. Un!! !nd!v!/!, :n s&ec!a" ce! c+
    e"e%en(e &s!o(!ce, &o( deven! a$res!v! .!/!c sa+ se s!n+c!d. Consec!n=e"e adverse
    a"e +n+! e&!sod %an!aca" Ede e<., s&!(a"!/are nevo"+n(ar7, d!.!c+"(7=! c+ "e$ea sa+
    d!.!c+"(7=! .!nanc!are ser!oaseJ re/+"(7 adesea d!n @+deca(a red+s7 O! d!n
    !&erac(!v!(a(e. CAnd n+ %a! s+n( :n e&!sod %an!aca", ce! %a! %+"=! !nd!v!/! re$re(7
    co%&or(a%en(e"e :n care s4a+ an$a@a( :n (!%&+" e&!sod+"+! %an!aca". Un!! !nd!v!/!
    a.!r%7 c7 a+ +n s!%= o".ac(!v, a+d!(!v sa+ v!/+a" %+"( %a! asc+=!( Ede e<., c+"or!"e
    &ar a .! e<(re% de s(r7"+c!(oareJ. CAnd s+n( &re/en(e s!%&(o%e ca(a(on!ce Ede e<.,
    s(+&oare, %+(!s%, ne$a(!v!s% s! a(!(+d!n!J, &oa(e .! !nd!ca( s&ec!.!can(+" Sc+
    e"e%en(e ca(a(on!ceT Eve/! &a$. I5GJ.
    D!s&o/!=!a &oa(e (rece ra&!d :n s(are co"eroas7 sa+ de&res!e. S!%&(o%e"e
    de&res!ve &o( d+ra cA(eva %o%en(e, ore, sa+, %a! rar, /!"e. N+ rar, s!%&(o%e"e
    de&res!ve O! s!%&(o%e"e %an!aca"e s+rv!n conco%!(en(. Dac7, a(A( cr!(er!!"e &en(r+
    e&!sod+" de&res!v %a@or, cA( O! cr!(er!!"e &en(r+ e&!sod+" %an!aca" s+n( &roe%!nen(e
    :n .!ecare /!, (!%& de ce" &+=!n o s7&(7%An7, e&!sod+" es(e cons!dera( ca .!!nd +n
    e&!sod %!<( Eve/! &a$. ;R9J. Pe %7s+r7 ce e&!sod+" %an!aca" se des.7Ooar7, e<!s(7
    adesea o s+'s(an=!a"7 creO(ere a +/+"+! de a"coo" sa+ de s(!%+"an(e, care &oa(e
    e<acer'a sa+ &re"+n$! e&!sod+".
    9ate de laborator asociate. N+ a+ .os( !den(!.!ca(e n!c! +n .e" de da(e de
    "a'ora(or c+ va"oare d!a$nos(!c7 &en(r+ e&!sod+" %an!aca". S4a cons(a(a( :ns7, c7 o
    +>E
    Tulburrile A$ective
    d!vers!(a(e de da(e de "a'ora(or s+n( anor%a"e "a !nd!v!/!! c+ e&!sod %an!aca", :n
    co%&ara=!e c+ s+'!ec=!! de con(ro" Da(e"e de "a'ora(or d!n e&!sod+" %an!aca" !nc"+d
    ano%a"!! &o"!so%no$race, creO(erea secre=!e! de cor(!/o" O! a'sen=a nons+&res!+nn
    "a de<a%e(a/on7 Ma! &o( e<!s(a ano%a"!! !%&"!cAnd nore&%e.nna, sero(o%na,
    ace(!"co"%a, do&a%!na sa+ s!s(e%e"e de ne+ro(rans%!=7(on a"e ac!d+"+! $a%%a4
    a%!no'+(!nc, d+&7 c+% de%ons(rea/7 s(+d!!"e %e(a'o""(""or ne+ro(rans%!=7(on"or,
    .+nc=!on7r!! rece&(or!"or, &rovoc7r!! .ar%aco"o$!ce s! .+nc=!e! ne+roendocr!ne.
    *lemente speci$ice culturii, etii si sexului
    Cons!dera=!+n!"e re.er!(oare "a c+"(+r7 care a+ .os( s+$era(e &en(r+ e&!soade"e
    de&res!ve %a@ore s+n(, de ase%enea, re"evan(e s! &en(r+ e&!soade"e %an!aca"e Eve/!
    &a$ ;Y;J Es(e .oar(e &os!'!" ca e&!soade"e %an!aca"e "a ado"escen=! s7 !nc"+d7
    e"e%en(e &s!oce s! s7 .!e asoc!a(e c+ c!+" de "a scoa"7, co%&or(a%en( an(!soc!a",
    eOec Oco"ar sa+ +/ de o s+'s(an=7 Un n+%7r se%n!.!ca(!v de ado"escen=! a+, d+&7
    cA( se &are, +n !s(or!c de &ro'"e%e de co%&or(a%en( d+rAnd de %+"( (!%& s! care
    &reced de'+(+" +n+! e&!sod %an!aca" .ranc Es(e nec"ar dac7 aces(e &ro'"e%e
    re&re/!n(7 +n &rodro% &re"+n$!( a" (+"'+r7r!! '!&o"are sa+ o (+"'+rare
    !nde&enden(7 3e/! sec=!+n!"e cores&+n/7(oare a"e (e<(e"or &en(r+ (+"'+rarea
    '!&o"ar7 I E&a$ ;GYJ s! (+"'+rarea '!&o"ar7 II E&a$ ;FIJ &en(r+ !n.or%a=!!"e s&ec!.!ce
    re.er!(oare "a se<
    *voluie
    E(a(ea %ed!e "a de'+( &en(r+ &r!%+" e&!sod %an!aca" se s!(+ea/7 "a :nce&+(+"
    an!"or 9L, dar :n +ne"e ca/+r! de'+(+" are "oc :n ado"escen(7, !ar :n a"(e"e d+&7 e(a(ea
    de YL de a% E&!soade"e %an!aca"e :nce& de re$+"7 'r+sc, c+ o esca"adare ra&!d7 a
    s!%&(o%e"or :n dec+rs de cA(eva /!"e Frecven(, e&!soade"e %an!aca"e s+rv!n d+&7
    s(resor! &s!osoc!a"! E&!soade"e d+rea/7 de re$+"7 de "a cA(eva s7&(7%An! "a cA(eva
    "+n!, s+n( %a! sc+r(e s! se (er%!n7 %a! 'r+sc decA( e&!soade"e de&res!ve %a@ore In
    %+"(e ca/+r! EYL
    c
    c4RLdJ, +n e&!sod de&res!v %a@or &recede sa+ +r%ea/7 !%ed!a(
    +n+! e&!sod %an!aca", .7r7 e<!s(en=a vre+ne! &er!oade de e+(!%!e Dac7 e&!sod+"
    %an!aca" s+rv!ne :n &er!oada de &os(&ar(+%, &oa(e e<!s(a +n r!sc cresc+( de
    rec+ren(7 :n +r%7(oare"e &er!oade de &os(&ar(+%, !ar s&ec!.!can(+" Sc+ de'+(
    &os(&ar(+%T es(e a&"!ca'!" Eve/! &a$ I99J
    Dia!nostic di$erenial
    Un e&!sod %an!aca" (re'+!e s7 .!e d!s(!ns de o (+"'+rare a.ec(!v7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e D!a$nos(!c+" adecva( ar &+(ea .! ce" de (+"'+rare
    a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, dac7 &er(+r'area de d!s&o/!=!e es(e
    cons!dera(7 ca .+nd consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!! %ed!ca"e
    $enera"e Ede e< , sc"ero/7 %+"(!&"7, (+%or7 cere'ra"7, s!ndro% C+s%$J Eve/! &a$.
    IL5J Aceas(7 &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+"
    so%a(!c Dac7 se cons!der7 c7 s!%&(o%e"e %an!aca"e n+ s+n( consec!n=a .!/!o"o$!c7
    d!rec(7 a cond!=!e! %ed!ca"e $enera"e, a(+nc! (+"'+rarea a.ec(!v7 &r!%ar7 es(e
    :nre$!s(ra(7 &e a<a I Ede e< , (+"'+rare '!&o"ar7 IJ, !ar cond!=!a %ed!ca"7 $enera"7 es(e
    :nre$!s(ra(7 &e a<a III Ede e< , !n.arc( %!ocard!cJ Un de'+( (ard!v a" &r!%+"+! e&!sod
    %an!aca" Ede e<, d+&7 e(a(ea de YL de an!J (re'+!e s7 a"er(e/e c"!n!c!an+" as+&ra
    &os!'!"!(7=!! e(!o"o$!ce a +ne! cond!=!! %ed!ca"e $enera"e or! a +ne! s+'s(an=e
    *pisodul
    Maniacal
    +>1
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de +n e&!sod %an!aca"
    &r!n .a&(+" c7 o s+'s(an=7 Ede e< , +n dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea
    "a +n (o<!cJ es(e cons!dera(7 a e(!o"o$!c :n re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$
    ILYJ S!%&(o%e ase%7n7(oare ce"or :n(A"n!(e :n e&!sod+" %an!aca" &o( .! &rec!&!(a(e
    de +n dro$ de a'+/ Ede e< , s!%&(o%e"e %an!aca"e care s+rv!n n+%a! :n con(e<(+"
    !n(o<!ca=!e! c+ coca!n7, vor .! d!a$nos(!ca(e ca (+"'+rare a.ec(!v7 !nd+s7 de coca!n7
    c+ e"e%en(e %an!aca"e, c+ de'+( :n c+rs+" !n(o<!ca=!e!J S!%&(o%e ase%7n7(oare c+
    ce"e :n(A"n!(e :n e&!sod+" %an!aca" &o( .!, de ase%enea, &rec!&!(a(e de +n (ra(a%en(
    an(!de&res!v, c+% ar .! +n %ed!ca%en(, (era&!a e"ec(roconv+"s!van(7 sa+
    .o(o(era&!a As(.e" de e&!soade s+n(, de ase%enea, d!a$nos(!ca(e ca (+"'+r7r!
    a.ec(!ve !nd+se de o s+'s(an=7 Ede e< , (+"'+rare a.ec(!v7 !nd+s7 de a%!(r!&"%7, c+
    e"e%en(e %an!aca"e, (+"'+rare a.ec(!v7 !nd+s7 de (era&!a e"ec(roconv+"s!van(7, c+
    e"e%en(e %an!aca"eJ *+deca(a c"!n!c7 es(e :ns7 esen=!a"7 :n a s(a'!"! dac7
    (ra(a%en(+" es(e vera%en(e ca+/a" sa+ dac7 +n e&!sod %an!aca" &r!%ar :O! are
    de'+(+" :n (!%& ce &ersoana a &r!%!( (ra(a%en(+"
    E&!soade"e %an!aca"e (re'+!e s7 .!e d!s(!nse de e&!soade"e !&o%an!aca"e C+
    (oa(e c7 e&!soade"e %an!aca"e s! ce"e !&o%an!aca"e a+ o "!s(7 !den(!c7 de s!%&(o%e
    carac(er!s(!ce, &er(+r'area :n e&!soade"e !&o%an!aca"e n+ es(e s+.!c!en( de sever7
    &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 :n do%en!+" soc!a" sa+ &ro.es!ona" on
    &en(r+ a neces!(a s&!(a"!/are Une"e e&!soade !&o%an!aca"e &o( evo"+a :n e&!soade
    %an!aca"e co%&"e(e
    E&!soade"e de&res!ve %a@ore c+ d!s&o/!=!e !r!(a'!"7 &roe%!nen(7 &o( .! d!.!c!"
    de d!s(!ns de e&!soade"e %an!aca"e c+ d!s&o/!=!e !r!(a'!"7 or! de e&!soade"e %!<(e
    Aceas(7 &rec!/are neces!(7 o eva"+are a(en(7 a &re/en(e! s!%&(o%e"or %an!aca"e
    Dac7 s+n( sa(!s.7c+(e cr!(er!!"e, a(A( &en(r+ +n e&!sod %an!aca", cA( s! &en(r+ +n
    e&!sod de&res!v %a@or a&roa&e :n .!ecare /!, &en(r+ o &er!oad7 de ce" &+=!n "
    s7&(7%An7, aceas(a va cons(!(+! +n e&!sod %!<(
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e s! e&!sod+" %an!aca" s+n(
    carac(er!/a(e a%'e"e &r!n ac(!v!(a(e e<cesn7, co%&or(a%en( !%&+"s!v, @+deca(7
    red+s7 s! ne$area &ro'"e%e"or T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e se
    d!s(!n$e de e&!sod+" %an!aca" &r!n de'+(+" s7+ &recoce carac(er!s(!c Ead!c7, :na!n(e
    de e(a(ea de H an!J, evo"+=!a %a! c+rAnd cron!c7 decA( e&!sod!c7, "!&sa de de'+(+r!
    s! (er%!n7r! re"a(!v c"are s! a'sen(a +ne! d!s&o/!=!! e<&ans!ve sa+ cresc+(e, or! a
    e"e%en(e"or &s!oce
    ;R9
    Tulburrile A$ective

    Criteriile $e $ia/no&ti# pentru Epi&o$ul Mania#al
    A2 O perioad distinct de dispo(iie crescut, expansiv sau iritabil anormal
    ,i persistent, dur@nd cel puin o sptm@n &sau orice durat, dac este
    necesar spitali(area)
    S2 "n timpul perioadei de perturbare a dispo(iiei, trei &sau mai multe) dintre
    urmtoarele simptome au persistat &patru, dac dispo(iia este numai
    iritabil) ,i au $ost pre(ente "ntr-un !rad semni$icativD
    (1) stim de sine exa!erat sau !randoare3
    (2) scderea necesitii de somn &de ex2, se simte re$cut dup numai trei
    ore
    de somn)3
    (3) mai locvace dec@t "n mod u(ual sau se simte presat s vorbeasc con
    tinuu3
    &H) $u! de idei sau experiena subiectiv c !@ndurile sunt accelerate3
    &A)distractibilitate &adic, atenia este atras prea u,or de stimuli externi
    $r importan sau irelevani)3
    (6) cre,terea activitii orientate spre un scop &$ie "n societate, la serviciu
    sau
    la scoal, ori din punct de vedere sexual) sau a!itaie psi%omotorie3
    (7) implicare excesiv "n activiti plcute care au un "nalt potenial
    de
    consecine nedorite &de ex2, an!a0area "n cumprturi excesive, indiscreii
    sexuale ori investiii "n a$aceri nesbuite)2
    2 Simptomele nu satis$ac criteriile pentru un episod mixt &ve(i pa!2 4IA)2
    D2 #erturbarea de dispo(iie este su$icient de sever pentru a cau(a o dete
    riorare semni$icativ "n $uncionarea pro$esional sau "n activitile sociale
    u(uale ori "n relaiile cu alii, ori s necesite spitali(are pentru a preveni
    vtmarea sa sau a altora, ori exist elemente psi%otice2
    *2 Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament sau un alt tratament) ori ale unei
    condiii medicale !enerale &de ex2, %ipertiroidismul)2
    FotD *pisoadele asemntoare celor maniacale si care sunt clar cau(ate de
    tratamentul antidepresiv somatic &de ex2, medicamente, terapie electrocon-
    vulsivant, $ototerapie) nu trebuie s conte(e pentru un dia!nostic de
    tulburare bipolar l)2
    Epi&o$ul Mi,t
    *lementele episodului
    Un e&!sod %!<( se carac(er!/ea/7 &r!n(r4o &er!oad7 de (!%& Ed+rAnd ce" &+=!n o
    s7&(7%An7J :n care s+n( sa(!s.7c+(e cr!(er!!"e, a(A( &en(r+ e&!sod+" %an!aca", cA( s!
    &en(r+ e&!sod+" de&res!v %a@or, a&roa&e :n .!ecare /! Ecr!(er!+" AJ. Ind!v!d+"
    e<&er!en(ea/7 ra&!d d!s&o/!=!! a"(ernan(e E(r!s(e=e, e+.or!e, !r!(a'!"!(a(eJ aco%&an!a(e
    de s!%&(o%e a"e e&!sod+"+! %an!aca" Eve/! &a$. ;YHJ s! e&!sod+"+! de&res!v %a@or
    Eve/! &a$. ;IFJ. Pre/en(area s!%&(o%e"or !nc"+de .recven( a$!(a=!e, !nso%n!e,
    *pisodul
    Mixt
    +>+

    dere$"area a&e(!(+"+!, e"e%en(e &s!o(!ce s! !de! de s+!c!d. Per(+r'area (re'+!e s7 .!e
    s+.!c!en( de sever7 &en(r+ a ca+/a o de(er!orare %arca(7 :n ac(!v!(a(ea soc!a"7 sa+
    &ro.es!ona"7, or! &en(r+ a neces!(a s&!(a"!/are, sa+ es(e carac(er!/a(7 &r!n &re/en=a
    de e"e%en(e &s!o(!ce Ecr!(er!+" BJ. Per(+r'area n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n %ed!ca%en( sa+ a"(
    (ra(a%en(J or! a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<., !&er(!ro!d!s%J Ecr!(er!+"
    CJ. S!%&(o%e s!%!"are ce"or :n(A"n!(e :n e&!sod+" %!<( &o( .! da(ora(e e.ec(e"or
    d!rec(e a"e +n+! %ed!ca%en( an(!de&res!v, (era&!e! e"ec(roconv+"s!van(e,
    .o(o(era&!e!, or! %ed!ca=!e! &rescr!se &en(r+ &en(r+ a"(e cond!=!! %ed!ca"e $enera"e
    Ede e<., cor(!co!/!"orJ. As(.e" de (a'"o+r! c"!n!ce n+ s+n( cons!dera(e e&!soade %!<(e
    s! n+ s+n( "+a(e :n cons!dera=!e &en(r+ d!a$nos(!c+" de (+"'+rare '!&o"ar7 I. De
    e<e%&"+, dac7 o &ersoan7 c+ (+"'+rare de&res!v7 %a@or7 rec+ren(7 de/vo"(7 +n
    (a'"o+ c"!n!c cons(And d!n s!%&(o%e %!<(e :n c+rs+" ad%!n!s(r7r!! +n+!
    %ed!ca%en( an(!de&res!v, d!a$nos(!c+" e&!sod+"+! es(e ce" de (+"'+rare a.ec(!v7
    !nd+s7 de o s+'s(an=7, c+ e"e%en(e %!<(e, s! n+ e<!s(7 n!c! o co%+(are de "a
    d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7 "a ce" de (+"'+rare '!&o"ar7 I. Une"e
    da(e s+$erea/7 c7 &oa(e e<!s(a o Sd!a(e/7T '!&o"ar7 "a !nd!v!/!! care de/vo"(7
    e&!soade ase%7n7(oare ce"or %!<(e, +r%And (ra(a%en(+"+! so%a(!c &en(r+
    de&res!e. As(.e" de !nd!v!/! &o( avea o &ro'a'!"!(a(e cresc+(7 de e&!soade %an!aca"e,
    %!<(e sa+ !&o%an!aca"e v!!(oare care n+ s+n( :n "e$7(+r7 c+ o s+'s(an=7 sa+ c+
    (ra(a%en(e"e so%a(!ce &en(r+ de&res!e. Aceas(a &oa(e .! +n as&ec( e<(re% de
    !%&or(an( de av+( :n vedere "a co&!! s! "a ado"escen=!.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. E"e%en(e"e asoc!a(e a"e
    e&!sod+"+! %!<( s+n( s!%!"are c+ ce"e a"e e&!soade"or %an!aca"e O! e&!soade"or
    de&res!ve %a@ore. Ind!v!/!! &o( .! de/or$an!/a=! :n $And!rea sa+ co%&or(a%en(+"
    "or. Deoarece !nd!v!/!! :n e&!soade"e %!<(e e<&er!en(ea/7 %a! %+"(7 d!s.or!e decA( o
    .ac ce! :n e&!sod %an!aca", es(e .oar(e &ro'a'!" ca e! s7 so"!c!(e a@+(or.
    9ate de laborator asociate. Da(e"e de "a'ora(or &en(r+ e&!sod+" %!<( n+ s+n(
    '!ne s(+d!a(e, deO! o'serva=!!"e de &An7 ac+% !nd!c7 da(e .!/!o"o$!ce s! endocr!ne
    s!%!"are c+ ce"e cons(a(a(e :n e&!soade"e de&res!ve %a@ore.
    *lemente speci$ice culturii, etii si sexului
    Cons!dera=!+n!"e re.er!(oare "a c+"(+r7 care a+ .os( s+$era(e "a e&!soade"e
    de&res!ve %a@ore s+n( re"evan(e, de ase%enea, O! &en(r+ e&!soade"e %!<(e Eve/! &a$.
    ;Y;J. E&!soade"e %!<(e &ar a .! %a! .recven(e "a !nd!v!/!! %a! (!ner!, &rec+% s! "a
    !nd!v!/!! :n e(a(e de &es(e RL de an! c+ (+"'+rare '!&o"ar7, s! &o( .! %a! .recven(e "a
    '7r'a=! decA( "a .e%e!.
    *voluie
    E&!soade"e %!<(e &o( &roven! d!n(r4+n e&!sod %an!aca" or! d!nrr4+n e&!sod
    de&res!v %a@or sa+ &o( a&are de novo. De e<e%&"+, d!a$nos(!c+" de (+"'+rare
    '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", (re'+!e sc!%'a( :n ce" de (+"'+rare
    '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, "a +n !nd!v!d c+ ; s7&(7%An! de s!%&(o%e
    %an!aca"e +r%a(e de o s7&(7%An7, a(A( de s!%&(o%e %an!aca"e, cA( s! de s!%&(o%e
    +>F
    Tulburrile A$ective
    de&res!ve E&!soade"e %!<(e &o( d+ra de "a cA(eva s7&(7%An! "a cA(eva "+n! s! se &o(
    red+ce "a o &er!oad7 c+ &+=!ne s!%&(o%e sa+ c+ n!c! +n s!%&(o%, or! evo"+ea/7
    :n(r4+n e&!sod de&res!v %a@or Es(e e<(re% de rar ca/+" ca +n e&!sod %!<( s7
    evo"+e/e :n(r4+n e&!sod %an!aca"
    Dia!nostic di$erenial
    Un e&!sod %!<( (re'+!e s7 .!e d!s(!ns de o (+"'+rare a.ec(!v7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e, dac7 &er(+r'area de d!s&o/!=!e es(e cons!dera(7 a .!
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!! %ed!ca"e $enera"e Ede e<,
    sc"ero/7 %+"(!&"7, (+%or7 cere'ra"7, s!ndro% C+s%$J Eve/! &a$ IL5J Aceas(7
    &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c Dac7 se
    cons!der7 c7 s!%&(o%e"e %!<(e, %an!aca"e s! de&res!ve, n+ s+n( consec!n=a
    .!/!o"o$!c7 d!rec(7 a cond!=!e! %ed!ca"e $enera"e, a(+nc! (+"'+rarea a.ec(!v7 &r!%ar7
    es(e :nre$!s(ra(7 &e a<a I Ede e<, (+"'+rare '!&o"ar7 IJ, !ar cond!=!a %ed!ca"7
    $enera"7 es(e :nre$!s(ra(7 &e a<a III Ede e< , !n.arc( %!ocard!cJ
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de +n e&!sod %!<( &r!n
    .a&(+" c7 o s+'s(an=7 Ede e< , +n dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea "a +n
    (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+ &er(+r'area de d!s&o/!=!e Eve/! &a$
    ILYJ S!%&(o%e s!%!"are ce"or o'serva(e :n(r4+n e&!sod %!<( &o( .! &rec!&!(a(e de
    +/+" +n+! dro$ de a'+/ Ede e< , s!%&(o%e"e %an!aca"e s! de&res!ve care a&ar n+%a!
    :n con(e<(+" !n(o<!ca=!e! c+ coca!n7 vor .! d!a$nos(!ca(e ca (+"'+rare a.ec(!v7 !nd+s7
    de coca!n7, c+ e"e%en(e %!<(e, c+ de'+( :n c+rs+" !n(o<!ca=!e!J S!%&(o%e s!%!"are
    ce"or o'serva(e :n(r4+n e&!sod %!<( &o( .!, de ase%enea, &rec!&!(a(e de (ra(a%en(+"
    an(!de&res!v, c+% ar .! +n %ed!ca%en(, (era&!a e"ec(roconv+"s!van(7 or! .o(o(era&!a
    As(.e" de e&!soade s+n( d!a$nos(!ca(e, de ase%enea, ca (+"'+r7r! a.ec(!ve !nd+se de
    o s+'s(an=7 Ede e< , (+"'+rare a.ec(!v7 !nd+s7 de a%!(n&(!n7, c+ e"e%en(e %!<(e,
    (+"'+rare a.ec(!v7 !nd+s7 de (era&!a e"ec(roconv+"s!van(7, c+ e"e%en(e %!<(eJ
    E&!soade"e de&res!ve %a@ore c+ d!s&o/!=!e !r!(a'!"7 no(a'!"7 s! e&!soade"e
    %an!aca"e c+ d!s&o/!=!e !r!(a'!"7 &roe%!nen(7 &o( .! d!.!c!" de d!s(!ns de e&!soade"e
    %!<(e Aceas(7 &rec!/are neces!(7 o eva"+are c"!n!c7 a(en(7 a &re/en=e! s!%&(o%e"or
    care s+n( carac(er!s(!ce, a(A( +n+! e&!sod %an!aca" co%&"e(, cA( s! +n+! e&!sod
    de&res!v %a@or co%&"e( Ee<ce&(And d+ra(aJ
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e s! e&!sod+" %!<( s+n( a%'e"e
    carac(er!/a(e &r%rr4o ac(!v!(a(e e<ces!v7, co%&or(a%en( !%&+"s!v, @+deca(7 red+s7
    s! ne$area &ro'"e%e"or T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e se d!s(!n$e de
    +n e&!sod %!<( &r!n de'+(+" s7+ carac(er!s(!c &recoce Ead!c7, :na!n(e de e(a(ea de H
    an!J, evo"+=!e %a! c+rAnd cron!c7 decA( e&!sod!c7, "!&sa de :nce&+( s! (er%!nare
    re"a(!v c"ar7, a'sen(a d!s&o/!=!e! e<&ans!ve sa+ cresc+(e anor%a"e or! a e"e%en(e"or
    &s!oce Co&!! c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e &re/!n(7, de
    ase%enea, +neor! s!%&(o%e de&res!ve, c+% ar .! s(!%a de s!ne s! (o"eran(a "a
    .r+s(rare sc7/+(e Dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a%'e"e, &e "An$7 (+"'+rarea
    a.ec(!v7 &oa(e .! d!a$nos(!ca(7 s! (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e
    *pisodul
    Lipomaniacal
    4=<

    Criteriile $e $ia/no&ti# pentru Epi&o$ul Mi,t
    A Sunt satis$cute criteriile, at@t pentru episodul maniacal &ve(i pa! 4I7), c@t
    si pentru episodul depresiv ma0or &ve(i pa! 4AI) &cu excepia duratei)
    aproape "n $iecare (i, "n cursul unei perioade de cel puin o sptm@n
    S #erturbarea a$ectiv este su$icient de sever pentru a cau(a o deteriorare
    semni$icativ "n $uncionarea pro$esional sau "n activitile sociale u(uale
    ori "n relaiile cu altn, sau pentru a necesita spitali(are spre a preveni
    vtmarea sa sau a altora, ori exist elemente psi%otice
    Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex, un dro! de abu(, un medicament sau alt tratament) ori ale unei
    condiii medicale !enerale &de ex , %ipertiroidismul)
    Not(M *pisoadele similare celor mixte si care sunt evident cau(ate de
    tratamentul antidepresiv somatic &de ex, un medicament, terapie
    electroconvulsivant, $ototerapie) nu trebuie s conte(e pentru dia!nosticul
    de tulburare bipolar l
    Epi&o$ul Fipo"ania#al
    *lementele episodului
    Un e&!sod !&o%a%aca" es(e de.!n!( ca o &er!oad7 d!s(!nc(7 :n c+rs+" c7re!a e<!s(7
    o d!s&o/!=!e cresc+(7, e<&ans!v7 sa+ !r!(a'!"7 anor%a"7 s! &ers!s(en(7 care d+rea/7 ce"
    &+=!n &a(r+ /!"e Ecr!(er!+" AJ Aceas(7 &er!oad7 de d s&o/!(!e anor%a"7 (re'+!e s7 .!e
    aco%&an!a(7 de ce" &+=!n (re! s!%&(o%e ad!=!ona"e d!n(r4o "!s(7 care !nc"+de s(!%a de
    s!ne e<a$era(7 sa+ $randoarea Enonderan(7J sc7derea neces!(7=!! de so%n,
    &res!+nea de a vor'!, .+$a de !de!, d!s(rac(!'!(a(ea, !%&"!carea cresc+(7 :n ac(!v!(7=!
    or!en(a(e s&re +n sco& sa+ a$!(a=!a &s!o%o(one s! !%&"!carea e<ces!v7 :n ac(!v!(7=!
    &"7c+(e care a+ +n :na"( &o(en=!a" de consec!n=e !nde/!ra'!"e Ecr!(er!+" BJ Dac7
    d!s&o/!=!a es(e %a! c+rAnd !r!(a'!"7 decA( cresc+(7 sa+ e<&ans!v7, ce" &+=!n &a(r+
    d!n(re s!%&(o%e"e de %a! s+s (re'+!e s7 .!e &re/en(e Aceas(7 "!s(7 de s!%&(o%e
    ad!=!ona"e es(e !den(!c7 c+ cea care de.!neO(e e&!sod+" %an!aca" Eve/! &a$ ;YHJ,
    e<ce&(And .a&(+" c7 !de!"e de"!ran(e sa+ a"+c!na=!!"e n+ &o( .! &re/en(e D!s&o/!=!a :n
    c+rs+" e&!sod+"+! !&o%a%aca" (re'+!e s7 .!e ne( d!s(!nc(7 de d!s&o/!=!a
    nonde&res!v7 +/+a"7 a !nd!v!d+"+! s! (re'+!e s7 e<!s(e o sc!%'are ne(7 :n
    .+nc=!onare, care n+ es(e carac(er!s(!c7 .+nc=!on7% +/+a"e a !nd!v!d+"+! Ecr!(er!+" CJ
    Deoarece %od!.!carea d!s&o/!=!e! M .+nc=!on7r!! (re'+!e s7 .!e o'serva'!"e de c7(re a"=!!
    Ecr!(er!+" DJ, eva"+area aces(+! cr!(er!+ neces!(7 adesea !n(erv!evarea a"(or !n.or%a(or!
    Ede e<, a %e%'r!"or .a%!"!e!J Is(or!c+" o'=!n+( de "a a"=! !n.or%a(or! es(e e<(re% de
    !%&or(an( :n eva"+area ado"escen=!"or Con(rar e&!sod+"+! %an!aca", e&!sod+"
    !&o%a%aca" n+ es(e s+.!c!en( de sever &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 :n
    .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7 or! &en(r+ a neces!(a s&!(a"!/area, s! n+ e<!s(7
    e"e%en(e &s!o(!ce Ecr!(er!+" EJ Mod!.!carea :n ac(!v!(a(e "a +n+ !nd!v!/! &oa(e "+a
    .or%a +ne! creO(er! cons!dera'!"e :n e.!c!en(7, randa%en( sa+ crea(!v!(a(e :ns7, "a a"(n,
    !&o%a%a &oa(e ca+/a o oarecare de(er!orare soc!a"7 sa+ &ro.es!ona"7
    +>>
    Tulburrile A$ective
    Per(+r'area de d!s&o/!=!e s! a"(e s!%&(o%e n+ (re'+!e s7 se da(ore/e e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +n+! dro$ de a'+/, a"e +n+! %ed!ca%en( sa+ a"(+! (ra(a%en(
    &en(r+ de&res!e E(era&!e e"ec(roconv+"s!van(7, .o(o(era&!e or! e<&+nere "a +n (o<!cJ.
    E&!sod+" (re'+!e, de ase%enea, s7 n+ .!e da(ora( e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne!
    cond!=!! %ed!ca"e $enera"e Ede e<., sc"ero/7 %+"(!&"7, (+%or7 cere'ra"7J Ecr!(er!+" FJ.
    S!%&(o%e s!%!"are ce"or o'serva(e :n(r4+n e&!sod !&o%an!aca" &o( .! da(ora(e
    e.ec(e"or d!rec(e a"e +n+! %ed!ca%en( an(!de&res!v, (era&!e! e"ec(roconv+"s!van(e,
    .o(o(era&!e! or! +n+! %ed!ca%en( &rescr!s &en(r+ a"(e cond!=!! %ed!ca"e $enera"e Ede
    e<., cor(!cos(ero!/!!J. As(.e" de (a'"o+r! c"!n!ce n+ s+n( cons!dera(e e&!soade
    !&o%an!aca"e s! n+ con(ea/7 &en(r+ d!a$nos(!c+" de (+"'+rare '!&o"ar7 IIJ. De
    e<e%&"+, dac7 o &ersoan7 c+ (+"'+rare de&res!v7 %a@or7 rec+ren(7 &re/!n(7 s!%&(o%e
    s!%!"are c+ ce"e a"e e&!sod+"+! !&o%an!aca" :n c+rs+" ad%!n!s(r7r!! +n+! %ed!ca%en(
    an(!de&res!v, e&!sod+" es(e d!a$nos(!ca( dre&( (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7,
    c+ e"e%en(e %an!aca"e, s! n+ e<!s(7 n!c! o co%+(are de "a d!a$nos(!c+" de (+"'+rare
    de&res!v7 %a@or7 "a ce" de (+"'+rare '!&o"ar7 II. Une"e da(e s+$erea/7 c7 &oa(e e<!s(a
    o Sd!a(e/7T '!&o"ar7 "a !nd!v!/!! care de/vo"(7 e&!soade s!%!"are e&!soade"or %an!aca"e
    s! !&o%an!aca"e d+&7 +n (ra(a%en( so%a(!c &en(r+ de&res!e. As(.e" de !nd!v!/! &o(
    avea o &ro'a'!"!(a(e cresc+(7 de e&!soade %an!aca"e s! !&o%an!aca"e care n+ s+n( :n
    "e$7(+r7 c+ s+'s(an=e"e sa+ c+ (ra(a%en(e"e so%a(!ce &en(r+ de&res!e.
    D!s&o/!=!a cresc+(7 a +n+! e&!sod !&o%an!aca" es(e descr!s7 ca e+.or!c7, e<(re%
    de '+n7, @ov!a"7 sa+ e<a"(a(7. DeO! d!s&o/!=!a &ersoane! &oa(e avea +n carac(er
    con(a$!os &en(r+ +n o'serva(or ne!%&"!ca(, ea es(e rec+nosc+(7 ca o sc!%'are ne(7
    de "a %od+" +/+a" de a .! de c7(re ce! care c+nosc '!ne &ersoana res&ec(!v7. Ca"!(a(ea
    e<&ans!v7 a &er(+r'7r!! de d!s&o/!=!e es(e carac(er!/a(7 &r!n en(+/!as% &en(r+
    !n(erac=!+n!"e soc!a"e, !n(er&ersona"e sa+ &ro.es!ona"e. DeO! d!s&o/!=!a cresc+(7 es(e
    cons!dera(7 (!&!c7, d!s&o/!=!a &er(+r'a(7 &oa(e .! !r!(a'!"7 sa+ &oa(e a"(erna :n(re
    e+.or!e O! !r!(a'!"!(a(e. :n %od carac(er!s(!c, es(e &re/en(7 %a! c+rAnd s(!%a de s!ne
    e<a$era(7, de re$+"7 "a n!ve"+" +ne! :ncreder! necr!(!ce :n s!ne, decA( $randoarea
    %arca(7 Ecr!(er!+" B"J. Foar(e .recven( e<!s(7 o neces!(a(e sc7/+(7 de so%n Ecr!(er!+"
    B9J8 &ersoana se deO(ea&(7 d!n so%n :na!n(ea ore! +/+a"e, &"!n7 de ener$!e.
    Persoana c+ e&!sod !&o%an!aca" vor'eO(e (are O! %a! re&ede decA( :n %od +/+a",
    dar de re$+"7 n+ es(e d!.!c!" de :n(rer+&(. L!%'a@+" &oa(e .! &"!n de s&!r!(e,
    ca"a%'+r+r!, @oc+r! de c+v!n(e O! !%&er(!nen=e Ecr!(er!+" B;J. F+$a de !de! n+ es(e
    rar7 O!, dac7 es(e &re/en(7, d+rea/7 &er!oade .oar(e sc+r(e de (!%& Ecr!(er!+" BIJ.
    D!s(rac(!'!"!(a(ea es(e adesea &re/en(7, d+&7 c+% o de%ons(rea/7 %od!.!c7r!"e
    ra&!de de vor'!re sa+ ac(!v!(a(e ca re/+"(a( a" reac(!v!(7=!! "a d!verO! s(!%+"! e<(ern!
    !re"evan=! Ecr!(er!+" BYJ. CreO(erea ac(!v!(7=!! :ndre&(a(e s&re +n sco& &oa(e !%&"!ca
    &"an!.!carea O! &ar(!c!&area "a ac(!v!(7=! %+"(!&"e Ecr!(er!+" BRJ. Aces(e ac(!v!(7=! s+n(
    adesea crea(oare O! &rod+c(!ve Ede e<., scr!erea +ne! scr!sor! ed!(or+"+!, (er%!narea
    +ne! "+cr7r!J. Soc!a'!"!(a(ea es(e de re$+"7 cresc+(7, O! &oa(e e<!s(a s! o creO(ere a
    ac(!v!(7=!! se<+a"e. Poa(e e<!s(a o ac(!v!(a(e !%&+"s!v7, c+% ar .! e.ec(+area e<ces!v7
    de c+%&7r7(+r!, cond+s+" !%&r+den( sa+ !nves(!=!! :n a.acer! nes7'+!(e kcr!(er!+"
    BHJ. As(.e" de ac(!v!(7=! s+n( :ns7 de re$+"7 or$an!/a(e, n+ s+n( '!/are O! n+ a(!n$
    n!ve"+" de de(er!orare carac(er!s(!c e&!sod+"+! %an!aca".
    *lemente si tulburri asociate
    E"e%en(e"e asoc!a(e a"e e&!sod+"+! !&o%an!aca" s+n( s!%!"are c+ ce"e a"e
    e&!sod+"+! %an!aca". D!s&o/!=!a &oa(e .! carac(er!/a(7 ca d!s.or!c7 dac7 s!%&(o%e
    !r!(a'!"e sa+ de&res!ve s+n( %a! &roe%!nen(e decA( e+.or!a :n (a'"o+" c"!n!c.
    Tulburrile
    A$ective
    4I?

    *lemente speci$ice culturii si etii
    Cons!dera=!+%"e re.er!(oare "a c+"(+r7 care a+ .os( s+$era(e &en(r+ e&!soade"e
    de&res!ve %a@ore s+n(, de ase%enea, re"evan(e s! &en(r+ e&!soade"e !&o%ar+aca"e
    Eve/! &a$ ;Y;J La &ersoane"e %a! (!nere Ede e<, "a ado"escen=!J, e&!soade"e
    !&o%a%aca"e &o( .! asoc!a(e c+ c!+" de "a scoa"7, co%&or(a%en( an(!soc!a", eOec
    Oco"ar sa+ +/ de o s+'s(an=7
    *voluie
    Un e&!sod !&o%a%aca" :nce&e de re$+"7 'r+sc, c+ o esca"adare ra&!d7 a
    s!%&(o%e"or :n dec+rs de o /! sa+ do+7 E&!soade"e &o( d+ra de "a cA(eva s7&(7%An!
    "a cA(eva "+n! s! de re$+"7 s+n( %a! 'r+O(e ca de'+( s! %a! sc+r(e ca d+ra(7 decA(
    e&!soade"e de&res!ve %a@ore :n %+"(e ca/+r!, e&!sod+" !&o%a%aca" &oa(e .!
    &receda( sa+ +r%a( de +n e&!sod de&res!v %a@or S(+d!!"e s+$erea/7 c7 Yd45Yd
    d!n(re !nd!v!/!! c+ !&o%a%e vor de/vo"(a :n ce"e d!n +r%7 +n e&!sod %an!aca"
    Dia!nostic di$erenial
    E&!sod+" !&o%a%aca" (re'+!e s7 .!e d!s(!ns de o (+"'+rare a.ec(!v7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, dac7 &er(+r'area a.ec(!v7 es(e cons!dera(7
    a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!! %ed!ca"e $enera"e Ede e< ,
    sc"ero/7 %+"(!&"7, (+%or7 cere'ra"7, s!ndro% C+s%$J Eve/! &a$ IL5J Aceas(7
    &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c Dac7 se
    cons!der7 c7 s!%&(o%e"e !&o%a%aca"e n+ s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a
    cond!=!e! %ed!ca"e $enera"e, a(+nc! (+"'+rarea a.ec(!v7 &r!%ar7 es(e :nre$!s(ra(7 &e
    a<a I Ede e< , (+"'+rare '!&o"ar7 IIJ, !ar cond!=!a %ed!ca"7 $enera"7 es(e :nre$!s(ra(7
    &e a<a III Ede e<, !n.arc( %!ocard!cJ
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de +n e&!sod
    !&o%a%aca" &r!n .a&(+" c7 o s+'s(an=7 Ede e< , +n dro$ de a'+/, +n %ed!ca%en(
    or! e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+ &er(+r'area
    a.ec(!v7 Eve/! &a$ ILYJ S!%&(o%e s!%!"are ce"or o'serva(e :n e&!sod+"
    !&o%a%aca" &o( .! &rec!&!(a(e de +n dro$ de a'+/ Ede e< , s!%&(o%e"e
    !&o%a%aca"e care a&ar n+%a! :n con(e<(+" !n(o<!ca=!e! c+ coca!n7 vor .!
    d!a$nos(!ca(e ca (+"'+rare a.ec(!v7 !nd+s7 de coca!n7, c+ e"e%en(e %an!aca"e, c+
    de'+( :n c+rs+" !n(o<!ca=!e!J S!%&(o%e s!%!"are ce"or o'serva(e :n e&!sod+"
    !&o%a%aca" &o( .!, de ase%enea, &rec!&!(a(e de (ra(a%en(+" an(!de&res!v, c+%
    ar .! +n %ed!ca%en(, (era&!a e"ec(roconv+"s!van(7 or! .o(o(era&!a As(.e" de
    e&!soade s+n(, de ase%enea, d!a$nos(!ca(e ca (+"'+r7r! a.ec(!ve !nd+se de o
    s+'s(an=7 Ede e< , (+"'+rare a.ec(!v7 !nd+s7 de a%!(n&(!"%7, c+ e"e%en(e %an!aca"e,
    (+"'+rare a.ec(!v7 !nd+s7 de (era&!a e"ec(roconv+"s!van(7, c+ e"e%en(e %an!aca"eJ
    *+deca(a c"!n!c7 es(e :ns7 esen=!a"7 :n a s(a'!"! dac7 (ra(a%en(+" es(e rea"%en(e
    ca+/a" sa+ dac7 s4a :n(A%&"a( ca +n e&!sod !&o%a%aca" &r!%ar s7 de'+(e/e :n
    (!%& ce &ersoana &r!%ea (ra(a%en(+" Eve/! &a$ ILRJ
    E&!soade"e %an!aca"e (re'+!e s7 .!e d!s(!nse de e&!soade"e !&o%a%aca"e DeO!
    e&!soade"e %an!aca"e s! e&!soade"e !&o%a%aca"e a+ "!s(e !den(!ce de S!%&(o%e
    carac(er!s(!ce, &er(+r'area a.ec(!v7 d% e&!soade"e !&o%a%aca"e n+ es(e s+.!c!en(
    de sever7 &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea soc!a"7 sa+
    &ro.es!ona"7 or! &en(r+ a neces!(a s&!(a"!/area Une"e e&!soade !&o%a%aca"e &o(
    evo"+a :n e&!soade %an!aca"e co%&"e(e
    4=>
    Tulburrile A$ective
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e s! e&!sod+" !&o%an!aca" s+n(
    carac(er!/a(e a%'e"e &r!n ac(!v!(a(e e<ces!v7, co%&or(a%en( !%&+"s!v, @+deca(7 red+s7
    s! ne$area &ro'"e%e"or T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e se d!s(!n$e de
    e&!sod+" !&o%an!aca" &nn de'+(+" s7+ &recoce carac(er!s(!c Ead!c7, :na!n(e de e(a(ea
    de H an!J, evo"+=!e %a! c+rAnd cron!c7 decA( e&!sod!c7, "!&sa de :nce&+( s! (er%!nare
    re"a(!v c"ar7, s! a'sen(a +ne! d!s&o/!=!! e<&ans!ve sa+ cresc+(e anor%a"e
    Un e&!sod !&o%an!aca" (re'+!e s7 .!e d!s(!ns de e+(!%!e, :n s&ec!a" "a !nd!v!/!!
    care a+ .os( de&res!v! :n %od cron!c s! n+ s+n( de&r!nO! s7 e<&enen(e/e o s(are de
    d!s&o/!=!e nonde&res!v7
    Criteriile $e $ia/no&ti# pentru Epi&o$ul Fipo"ania#al
    A O perioad distinct de dispo(iie crescut, expansiv sau iritabil
    persistent, dur@nd cel puin H (ile, si care este net di$erita de dispo(iia
    nondepresiv u(ual
    S "n cursul perioadei de perturbare a$ectiv, au persistat trei &sau mai multe)
    dintre urmtoarele simptome &patru, dac dispo(iia este numai iritabil) si
    au $ost pre(ente "ntr-un !rad semni$icativ
    (1) stim de sine exa!erat sau !randoare,
    (2) scderea necesitaii de somn &de ex, se simte recon$ortat dup numai
    4
    ore de somn),
    (3) mai locvace dec@t "n mod u(ual sau presiunea de a vorbi continuu,
    &H) $u!a de idei sau experiena subiectiv c !@ndurile sunt accelerate,
    &S)distractibilitate &adic, atenie prea u,or de atras de stimuli externi
    neimportani sau irelevanti),
    (6) cre,terea activitii orientate spre un scop &$ie "n societate, la serviciu
    sau
    la scoal ori dm punct de vedere sexual) sau a!itaie psi%omotone,
    (7) implicare excesiv "n activiti plcute care au un "nalt potenial de con
    secine inde(irabile &de ex , persoana se an!a0ea( "n e$ectuarea de cum
    prturi excesive, "n indiscreii sexuale, "n investiii "n a$aceri nesbuite)
    *pisodul este asociat cu o modi$icare $r ec%ivoc "n activitate care nu este
    caracteristic persoanei atunci c@nd nu pre(int simptome
    D #erturbarea dispo(iiei si modi$icarea "n $uncionare sunt observabile de
    ctre ali i
    * *pisodul nu este su$icient de sever pentru a cau(a o deteriorare
    semni$icativ "n $uncionarea social sau pro$esional, ori pentru a necesita
    spitali(are, si nu exist elemente psi%otice
    ' Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex, un dro! de abu(, un medicament, sau alt tratament) ori unei
    condiii medicale !enerale &de ex , %ipertiroidismul)
    FotD *pisoadele similare celor %ipomaniacale si care sunt cau(ate "n mod
    clar de tratamentul antidepresiv somatic &de ex, un medicament, terapie
    electroconvulsivant, $ototerapie) nu trebuie s $ie luate "n consideraie
    pentru un dia!nostic de tulburare bipolar II
    Tulburrile
    Depresive
    ;RF

    Tul-ur(rile Depre&ive
    Tul-urarea Depre&iv( MaQor(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de&res!ve %a@ore :" cons(!(+!e o evo"+=!e c"!n!c7
    carac(er!/a(7 &r!n(r4+n+" sa+ %a! %+"(e e&!soade de&res!ve %a@ore Eve/! &a$. ;IFJ,
    .7r7 +n !s(or!c de e&!soade %an!aca"e, %!<(e sa+ !&o%an!aca"e Ecr!(er!!"e A O! CJ.
    E&!soade"e de (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 Eda(ora(e e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +n+! dro$ de a'+/, %ed!ca%en( or! e<&+ner! "a +n (o<!cJ or!
    de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e n+ con(ea/7 &en(r+
    d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7, :n a.ar7 de aceas(a, e&!soade"e n+
    (re'+!e s7 .!e e<&"!ca(e %a! '!ne de (+"'+rarea sc!/oa.ec(!v7 O! s7 n+ .!e s+&ra&+se
    &es(e sc!/o.ren!e, (+"'+rarea sc!/o.ren!.or%7, (+"'+rarea de"!ran(7 sa+ (+"'+rarea
    &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e Ecr!(er!+" BJ.
    Cea de a &a(ra c!.r7 a cod+"+! d!a$nos(!c a" (+"'+r7r!! de&res!ve %a@ore !nd!c7
    .a&(+" dac7 es(e vor'a de +n e&!sod +n!c Ese +(!"!/ea/7 n+%a! &en(r+ &r!%+" d!n(re
    e&!soadeJ sa+ de +n e&!sod rec+ren(. Uneor! es(e d!.!c!" s7 se d!s(!n$7 :n(re +n
    s!n$+r e&!sod c+ s!%&(o%e care se !n(ens!.!c7 sa+ se a%endea/7 O! do+7 e&!soade
    se&ara(e. Pen(r+ sco&+r!"e aces(+! %an+a", +n e&!sod es(e cons!dera( a se .!
    (er%!na(, a(+nc! cAnd cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or n+ %a!
    s+n( sa(!s.7c+(e de ce" &+=!n 9 "+n! consec+(!ve, :n c+rs+" aces(e! &er!oade de 9 "+n!
    es(e vor'a, .!e de o re/o"+=!e co%&"e(7 a s!%&(o%e"or, .!e de &re/en=a de s!%&(o%e
    de&res!ve care n+ sa(!s.ac cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or E:n
    re%!s!+ne &ar=!a"7J.
    Cea de a c!ncea c!.r7 a cod+"+! d!a$nos(!c &en(r+ (+"'+rarea de&res!v7 %a@or7
    !nd!c7 s(area ac(+a"7 a &er(+r'7r!!. Dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ +n e&!sod
    de&res!v %a@or, sever!(a(ea e&!sod+"+! es(e no(a(7 ca +Ooar7, %odera(7, sever7, .7r7
    e"e%en(e &s!o(!ce sa+ sever7, c+ e"e%en(e &s!o(!ce. Dac7 cr!(er!!"e &en(r+
    e&!sod+" de&res!v %a@or n+ s+n( sa(!s.7c+(e ac(+a"%en(e, cea de a c!ncea c!.r7 es(e
    +(!"!/a(7 &en(r+ a !nd!ca .a&(+" c7 (+"'+rarea se a."7 :n re%!s!+ne &ar=!a"7 sa+ :n
    re%!s!+ne co%&"e(7 Eve/! &a$. I59J.
    Dac7 :n c+rs+" (+"'+r7r!! de&res!ve %a@ore a&ar e&!soade %an!aca"e, %!<(e sa+
    !&o%an!aca"e, d!a$nos(!c+" es(e sc!%'a( :n ce" de (+"'+rare '!&o"ar7. Dac7 :ns7
    s!%&(o%e"e %an!aca"e sa+ !&o%an!aca"e s+rv!n ca +n e.ec( d!rec( a" (ra(a%en(+"+!
    an(!de&res!v, a" +/+"+! de a"(e %ed!ca%en(e, a" +/+"+! de o s+'s(an=7 or! a"
    e<&+ner!! "a +n (o<!c, d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7 r7%Ane ce"
    adecva( s! (re'+!e no(a( +n d!a$nos(!c ad!=!ona" de (+"'+rare a.ec(!v7 !nd+s7 de o
    s+'s(an=7, c+ e"e%en(e %an!aca"e Eor! c+ e"e%en(e %!<(eJ. La .e", dac7 s!%&(o%e"e
    %an!aca"e sa+ !&o%an!aca"e s+rv!n ca e.ec( d!rec( a" +ne! cond!=!! %ed!ca"e
    $enera"e, r7%Ane !nd!ca( d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7 O! (re'+!e s7
    .!e no(a( +n d!a$nos(!c ad!=!ona" de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c+ e"e%en(e %an!aca"e Esa+ c+ e"e%en(e %!<(eJ.
    4G+
    Tulburrile A$ective

    Speci$icani
    Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or, &o(
    .! +(!"!/a=! +r%7(or!! s&ec!.!can=! &en(r+ a descr!e s(a(+s+" c"!n!c c+ren( a" e&!sod+"+!
    O! e"e%en(e"e e&!sod+"+! c+ren(.
    UOor8 Modera(8 Sever, .7r7 e"e%en(e &s!o(!ce8 Sever, c+ e"e%en(e &s!o(!ce8
    Cron!c Eve/! &a$ I5HJ
    C+ e"e%en(e ca(a(on!ce Eve/! &a$ I5GJ
    C+ e"e%en(e %e"anco"!ce Eve/! &a$ I5FJ
    C+ e"e%en(e a(!&!ce Eve/! &a$ I9LJ
    C+ de'+( &os(&ar(+% Eve/! &a$ I99J
    Dac7 ac(+a"%en(e n+ s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e &en(r+ +n e&!sod
    de&res!v %a@or, &o( .! +(!"!/a=! +r%7(or!! s&ec!.!can=! &en(r+ a descr!e s(a(+s+" c"!n!c
    c+ren( a" e&!sod+"+! de&res!v %a@or, &rec+% s! &a((ern+" ce"+! %a! recen( e&!sod
    :n re%!s!+ne &ar=!a"7, :n re%!s!+ne co%&"e(7 Eve/! &a$ I55J
    Cron!c Eve/! &a$ I5HJ
    C+ e"e%en(e ca(a(on!ce Eve/! &a$ I5GJ
    C+ e"e%en(e %e"anco"!ce Eve/! &a$ I5FJ
    C+ e"e%en(e a(!&!ce Eve/! &a$ I9LJ
    C+ de'+( &os(&ar(+% Eve/! &a$ I99J
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a !nd!ca &a((ern+" e&!soade"or s!
    &re/en=a s!%&(o%e"or !n(ere&!sod!ce &en(r+ (+"'+rarea de&res!v7 %a@or7 rec+ren(7.
    S&ec!.!can=!! evo"+=!e! "on$!(+d!na"e EC+ s! F7r7 rec+&erare !n(ere&!sod!c7
    co%&"e(7J Eve/! &a$ I9IJ C+
    &a((ern seXon!er Eve/! &a$ I9YJ
    #rocedee de "nre!istrare
    Cod+r!"e d!a$nos(!ce &en(r+ (+"'+rarea de&res!v7 %a@or7 s+n( se"ec(a(e d+&7
    c+% +r%ea/7
    1 Pr!%e"e (re! c!.re s+n( 9FR
    2 Cea de a &a(ra c!.r7 es(e, .!e 9 Edac7 e<!s(7 n+%a! +n s!n$+r e&!sod de&res!v
    %a@orJ, .!e ; Edac7 e<!s(7 e&!soade de&res!ve %a@ore rec+ren(eJ
    3 Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e &en(r+ +n e&!sod
    de&res!v %a@or, cea de a c!ncea c!.r7 !nd!c7 sever!(a(ea c+ren(7, d+&7 c+%
    +r%ea/7 ", sever!(a(e +Ooar7, 9, sever!(a(e %odera(7, ;, sever7, .7r7 e"e%en(e
    &s!o(!ce, I, sever7, c+ e"e%en(e &s!o(!ce Dac7 ac(+a"%en(e n+ s+n(
    sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or, cea de a
    c!ncea c!.r7 !nd!c7 s(a(+s+" c"!n!c c+ren( a" e&!sod+"+! de&res!v %a@or, d+&7
    c+% +r%ea/7 Y, :n re%!s!+ne &ar=!a"7, R, :n re%!s!+ne co%&"e(7 Dac7
    sever!(a(ea e&!sod+"+! c+ren( sa+ s(area de re%!'!+ne c+ren(7 a (+"'+r7% n+
    es(e s&ec!.!ca(7, a(+nc! cea de a c!ncea c!.r7 es(e O N+ &o( .! cod!.!ca=! a"=!
    s&ec!.!can=! &en(r+ (+"'+rarea de&res!v7 %a@or7
    La :nre$!s(rarea den+%!% +n+! d!a$nos(!c, (er%en!! (re'+!e s7 .!e %en=!ona=! :n
    +r%7(oarea ord!ne (+"'+rare de&res!v7 %a@or7, s&ec!.!can(n cod!.!ca=! c+ cea de a
    Tulburarea Depresiv
    Ma0or
    4?E

    &a(ra c!.r7 Ede e< , rec+ren(7J, s&ec!.!can=+ cod!.!ca=! c+ cea de a c%cea c!.r7 Ede e<.,
    +Ooar7, sever7, c+ e"e%en(e &s!o(!ce, :n re%!s%ne &ar=!a"7J, (o( a(A=!a s&ec!.!can
    E.7r7 cod+r!J cA=! cores&+nd ce"+! %a! recen( e&!sod Ede e<, c+ e"e%en(e
    %e"anco"!ce, c+ de'+( &os(&ar(+%J s! (o( a(A=!a s&ec!.!can(! E.7r7 cod+nJ cA=!
    cores&+nd evo"+=!e! e&!soade"or Ede e< , c+ rec+&erare %(ere&!sod!c7 co%&"e(7J, de
    e< , 9FR ;9 T+"'+rare de&res!v7 %a@or7, rec+ren(7, %odera(7, c+ e"e%en(e a(!&!ce, c+
    &a((ern se/on!er, c+ rec+&erare %(ere&!sod!c7 co%&"e(7
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. T+"'+rarea de&res!v7
    %a@or7 es(e asoc!a(7 c+ o %or(a"!(a(e r!d!ca(7 PAn7 "a 5Yd d!n(re !nd!v!/!! c+
    (+"'+rare de&res!v7 %a@or7 sever7 %or &r!n s+!c!d Da(e e&!de%!o"o$!ce s+$erea/7,
    de ase%enea, c7 e<!s(7 o creO(ere de &a(r+ on a ra(e! %or(a"!(7=!! "a !nd!v!/!! c+
    (+"'+rare de&res!v7 %a@or7 :n e(a(e de &es(e YY de an! Ind!v!/!! c+ (+"'+rare
    de&res!v7 %a@or7 ad%!O! :n c7%!ne s&!(a" &o( avea o &ro'a'!"!(a(e cresc+(7
    cons!dera'!" de %oar(e :n &r!%+" an Pr!n(re !nd!v!/!! d!n +n!(7=!"e %ed!ca"e
    $enera"e, ce! c+ (+"'+rare de&res!v7 %a@or7 a+ %a! %+"(7 d+rere s! %a"ad!!
    so%a(!ce O! o .+nc=!onare .!/!c7, soc!a"7 s! a ro"+"+! red+s7
    T+"'+rarea de&res!v7 %a@or7 &oa(e .! &receda(7 de (+"'+rarea d!s(!%!c7 E5Ld :n
    eOan(!oane"e e&!de%!o"o$!ce s! 5Yd49Yd :n esanoane"e c"!n!ceJ Se es(!%ea/7, de
    ase%enea, c7 :n .!ecare an a&ro<!%a(!v 5Ld d!n(re !nd!v!/!! c+ (+"'+rare d!s(!%!c7
    doar vor a@+n$e s7 a!'7 +n &r!% e&!sod de&res!v %a@or :n %od .recven(,
    conco%!(en( c+ (+"'+rarea de&res!v7 %a@or7 s+rv!n s! a"(e (+"'+r7r! %en(a"e Ede e< ,
    (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7, &an!ca, (+"'+rarea o'ses!vo4co%&+"s!v7,
    anore<!a nervoas7, '+"!%!a nervoas7, (+"'+rarea de &ersona"!(a(e 'order"%eJ
    9ate de laborator asociate. Ano%a"!!"e de "a'ora(or care s+n( asoc!a(e c+
    (+"'+rarea de&res!v7 %a@or7 s+n( ce"e asoc!a(e c+ e&!sod+" de&res!v %a@or Eve/!
    &a$ ;Y9J N!c! +na d!n(re ace'(ea n+ are va"oare d!a$nos(!c7 &en(r+ (+"'+rarea
    de&res!v7 %a@or7, dar s4a cons(a(a( c7 s+n( &re/en(e ca anor%a"e :n $r+&+r!"e de
    !nd!v!/! c+ (+"'+rare de&res!v7 %a@or7 :n co%&ara=!e c+ s+'!ec=!! de con(ro"
    Per(+r'7r!"e ne+ro'!o"o$!ce, c+% ar .! concen(ra=!!"e cresc+(e de $"+cocor(!co!d s!
    ano%a"!!"e EE, a"e so%n+"+!, &reva"ea/7 "a !nd!v!/!! c+ e"e%en(e &s!o(!ce s! "a ce!
    c+ e&!soade %a! severe sa+ c+ e"e%en(e %e"anco"!ce Ce"e %a! %+"(e ano%a"!! de
    "a'ora(or s+n( de&enden(e de s(are Ead!c7, s+n( &re/en(e n+%a! cAnd s! s!%&(o%e"e
    de&res!ve s+n( &re/en(eJ Da(e"e s+$erea/7 :ns7 c7 +ne"e ano%a"!! EE, de so%n
    &ers!s(7 :n re%!s!+nea c"!n!c7 on &o( &receda de'+(+" e&!sod+"+! de&res!v %a@or
    9atele examinrii somatice si condi3iile medicale .enerale asociate. Ind!v!/!!
    c+ cond!=!! %ed!ca"e $enera"e severe sa+ cron!ce &re/!n(7 +n nsc cresc+( de a
    de/vo"(a o (+"'+rare de&res!v7 %a@or7 PAn7 "a 9Ld49Yd d!n(re !nd!v!/!! c+
    an+%!(e cond!=!! %ed!ca"e $enera"e Ede e< , d!a'e(, !n.arc( de %!ocard, neo&"as%e,
    !c(+sJ vor &re/en(a o (+"'+rare de&res!v7 %a@or7 :n c+rs+" evo"+=!e! cond!=!e! "or
    %ed!ca"e $enera"e Tra(a%en(+" cond!=!e! %ed!ca"e $enera"e es(e %a! co%&"e<, !ar
    &ro$nos(!c+" %a! &+=!n .avora'!", dac7 es(e &re/en(7 (+"'+rarea de&res!v7 %a@or7
    :n &"+s, &ro$nos(!c+" (+"'+r7r!! de&res!ve %a@ore es(e a.ec(a( !n %od ne.avora'!" de
    cond!=!! %ed!ca"e $enera"e cron!ce conco%!(en(e Ede e< , e&!soade"e s+n( %a! "+n$!,
    !ar r7s&+ns+" "a (ra(a%en( %a! r7+J
    +82
    Tulburrile A$ective
    *lemente speci$ice culturii, ettn si sexului
    E"e%en(e"e s&ec!.!ce :n "e$7(+r7 c+ c+"(+ra s+n( d!sc+(a(e :n (e<(+" &en(r+
    e&!sod+" de&res!v %a@or Eve/! &a$ ;Y;J S(+d!!"e e&!de%!o"o$!ce s+$erea/7 e.ec(e
    se%n!.!ca(!ve de coor(7 :n r!sc+" &en(r+ de&res!e De e<e%&"+, !nd!v!/!! n7sc+=!
    :n(re 5FIL s! 5FYL &ar a avea o e(a(e %a! %!c7 "a de'+( s! +n r!sc &e v!a(7 &en(r+
    de&res!e %a! %are decA( ce! n7sc+=! :na!n(e de 5FIL E<!s(7 +ne"e &ro'e c7
    e"e%en(e"e a(!&!ce s+n( %a! .recven(e "a !nd!v!/!! %a! (!ner!, &e cAnd e"e%en(e"e
    %e"anco"!ce s+n( %a! .rec_ en(e "a !nd!v!/!! de&res!v! %a! % e(a(e La ce! c+ de'+(+"
    de&res!e! %a! (ard!v :n v!a(7, e<!s(7 &ro'e de !&enn(ens!(a(e a s+'s(an=e! a"'e
    s+'cor(!ca"e asoc!a(e c+ %a"ad!e cere'rovasc+"ar7 Aces(e Sde&res!! vasc+"areT s+n(
    asoc!a(e c+ de(er!or7r! ne+ro&s!o"o$!ce %a! %ar! s! c+ r7s&+ns+r! %a! re"e "a
    (era&!!"e s(andard T+"'+rarea de&res!v7 %a@or7 Ee&!sod +n!c sa+ rec+ren(J es(e de
    do+7 or! %a! .recven(7 "a .e%e!"e ado"escen(e s! ad+"(e decA( "a '7r'a=!! ado"escen=!
    s! ad+"=! La co&!! &re&+'er(an, '7!e=!! s! .e(e"e s+n( a.ec(a=! :n e$a"7 %7s+r7
    #revalent
    S(+d!!"e re.er!(oare "a (+"'+rarea de&res!v7 %a@or7 a+ ra&or(a( o $a%7 "ar$7 de
    va"on &en(r+ &rocen(+" de &o&+"a=!e ad+"(7 c+ aceas(7 (+"'+rare R!sc+" &e v!a(7
    &en(r+ (+"'+rarea de&res!v7 %a@or7 :n esan(!oane"e co%+n!(are var!a/7 :n(re 5Ld s!
    9Yd &en(r+ .e%e!, s! :n(re Yd s! 59d &en(r+ '7r'a=! Preva"en(a &+nc(+a"7 a
    (+"'+r7r!! de&res!ve %a@ore "a ad+"=!, &e eOan(!oane co%+n!(are var!a/7 :n(re Yd s!
    Fd &en(r+ .e%e!, s! !n(re 9d s! ;d &en(r+ '7r'a=! Ra(e"e de &reva"en(7 &en(r+
    (+"'+rarea de&res!v7 %a@or7 &ar a .! .7r7 "e$7(+r7 c+ e(n!a, ed+ca=!a, ven!(+" sa+
    s(a(+s+" %ar!(a"
    *voluie
    T+"'+rarea de&res!v7 %a@or7 &oa(e :nce&e "a or!ce e(a(e, c+ o e(a(e %ed!e "a
    de'+( s!(+a(7 "a @+%7(a(ea an!"or 9L Da(e"e e&!de%!o"o$!ce s+$erea/7 c7 e(a(ea "a
    de'+( es(e :n descreO(ere "a ce! n7sc+=! %a! recen( Evo"+=!a (+"'+r7% de&res!ve
    %a@ore rec+ren(e es(e var!a'!"7 Un+ !nd!v!/! a+ e&!soade !/o"a(e, se&ara(e &r!n
    %+"=! an! .7r7 n!c! +n .e" de s!%&(o%e de&res!ve :n (!%& ce a"=!! a+ race%! de
    e&!soade s!, :n .!ne, a"=!! a+ e&!soade d!n ce !n ce %a! .recven(e, &e %7s+r7 ce
    avansea/7 :n e(a(e Une"e da(e s+$erea/7 c7 &er!oade"e de re%!s!+ne d+rea/7, :n
    $enera", %a! %+"( "a :nce&+(+" evo"+=!e! (+"'+r7r!! N+%7r+" de e&!soade an(er!oare
    &re/!ce &ro'a'!"!(a(ea a&ar!=!e! +n+! e&!sod de&res!v %a@or +"(er!or Ce" &+=!n RLd
    d!n(re !nd!v!/!! c+ (+"'+rare de&res!v7 %a@or7, e&!sod +n!c, se &o( aO(e&(a s7 a!'7
    +n a" do!"ea e&!sod Ind!v!/!! care a+ av+( do+7 e&!soade a+ o Oans7 de HLd de a
    avea +n a" (re!"ea e&!sod, !ar !nd!v!/!! care a+ av+( (re! e&!soade a+ o Oans7 de FLd
    de a avea +n a" &a(r+"ea e&!sod A&ro<!%a(!v Yd45Ld d!n(re !nd!v!/!! c+ (+"'+rare
    de&res!v7 %a@or7, e&!sod +n!c, &re/!n(7 +"(er!or +n e&!sod %an!aca" Ead!c7, &re/!n(7
    (+"'+rare '!&o"ar7 IJ
    E&!soade"e de&res!ve %a@ore se &o( re/o"va co%&"e( E:n a&roa&e do+7 (re!%! d!n
    ca/+r!J, or! n+%a! &ar=!a" sa+ de"oc E:n a&ro<!%a(!v o (re!%e d!n ca/+r!J Pen(r+
    !nd!v!/!! care a+ n+%a! o re%!s!+ne &ar=!a"7, e<!s(7 o &ro'a'!"!(a(e %a! %are de a
    de/vo"(a e&!soade ad!=!ona"e s! de a con(!n+a &a((ern+" de rec+&erare
    !n(ere&!sod!c7 &ar=!a"7 S&ec!.!can(n de evo"+=!e "on$!(+d!na"7, c+ rec+&erare
    r
    e
    r
    e&!'od!c7 co%&"e(7 s! .7r7 rec+&erare %(ere&!sod!c7 co%&"e(7 Eve/! &a$ I9IJ
    Tulburarea Depresiv
    Ma0or
    4G4
    &o( avea, &r!n +r%are, va"oare &ro$nos(!c7 Un n+%7r oarecare de !nd!v!/! a+
    (+"'+rare d!s(!%!c7 &ree<!s(en(7 de'+(+"+! (+"'+r7% de&res!ve %a@ore, e&!sod +n!c
    Une"e da(e s+$erea/7 c7 aceO(! !nd!v!/! vor avea .oar(e &ro'a'!" e&!soade de&res!ve
    %a@ore ad!=!ona"e, c+ rec+&erare !n(ere&!sod!c7 %a! red+s7, neces!(And (ra(a%en(
    s+&"!%en(ar .a/e! ac+(e s! o &er!oad7 %a! "+n$7 de con(!n+are a (ra(a%en(+"+!
    &en(r+ a a(!n$e s! %en=!ne o s(are e+(!%!c7 %a! co%&"e(7 s! de %a! "+n$7 d+ra(7
    S(+d!! ca(a%nes(!ce e%&!r!ce s+$erea/7 c7 "a +n an d+&7 d!a$nos(!carea +n+!
    e&!sod de&res!v %a@or, ILd d!n(re !nd!v!/! a+ :nc7 s!%&(o%e care s+n( s+.!c!en( de
    severe &en(r+ a sa(!s.ace cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or co%&"e(,
    a&ro<!%a(!v 9Ld con(!n+7 s7 a!'7 cA(eva s!%&(o%e care n+ %a! sa(!s.ac co%&"e(
    cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or Ead!c7, (+"'+rare de&res!v7 %a@or7, :n
    re%!s!+ne &ar=!a"7J, !ar ILd n+ %a! a+ n!c! o (+"'+rare a.ec(!v7 Sever!(a(ea
    e&!sod+"+! de&res!v %a@or !n!=!a" &are a &red!c(a &ers!s(en(a Cond!=!!"e %ed!ca"e
    $enera"e cron!ce s+n(, de ase%enea, +n .ac(or de r!sc de e&!soade %a! &ers!s(en(e
    E&!soade"e de (+"'+rare de&res!v7 %a@or7 +r%ea/7 adesea +n+! s(resor
    &s!osoc!a" sever, c+% ar .! %oar(ea +ne! .!!n=e !+'!(e sa+ d!vor=+" S(+d!!"e
    s+$erea/7 c7 even!%en(e"e &s!osoc!a"e Es(resornJ &o( @+ca +n ro" %a! !%&or(an( :n
    &rec!&!(area &r!%+"+! sa+ a ce"+! de a" do!"ea e&!sod de (+"'+rare de&res!v7 %a@or7
    s! +n ro" red+s :n a&ar!=!a e&!soade"or +r%7(oare Cond!=!!"e %ed!ca"e $enera"e
    cron!ce s! de&enden(a de o s+'s(an=7 E:n s&ec!a" de&enden(a de a"coo" sa+ de
    coca!n7J &o( con(r!'+! "a de'+(+" s! e<acer'area (+"'+r7r!! de&res!ve %a@ore
    Es(e d!.!c!" de &re/!s dac7 &r!%+" e&!sod de (+"'+rare de&res!v7 %a@or7 "a o
    &ersoan7 (An7r7 va evo"+a :n .!na" :n (+"'+rare '!&o"ar7 Une"e da(e s+$erea/7 c7
    de'+(+" ac+( a" de&res!e! severe, :n s&ec!a" c+ e"e%en(e &s!oce s! "en(oare
    &s!o%o(one, "a o &ersoan7 (An7r7 .7r7 &s!o&a(o"o$!e &re&+'er(ar7, es(e .oar(e
    &os!'!" s7 !nd!ce o evo"+=!e '!&o"ar7 Un !s(or!c .a%!"!a" de (+"'+rare '!&o"ar7 &oa(e
    .!, de ase%enea, s+$es(!v de de/vo"(are +"(er!oar7 a (+"'+r7% '!&o"are
    #attern $amilial
    T+"'+rarea de&res!v7 %a@or7 es(e de 5,Y4; or! %a! .recven(7 &r!n(re r+de"e
    '!o"o$!ce a"e &ersoane"or c+ aceas(7 (+"'+rare decA( :n &o&+"a=!a $enera"7 E<!s(7
    &ro'e de r!sc cresc+( de de&enden(7 a"coo"!c7 "a r+de"e '!o"o$!ce de $rad+" I ad+"(e
    s! &oa(e e<!s(a o !nc!den=7 cresc+(7 a (+"'+r7% !&erac(!v!(a(eXde.!c!( de a(en=!e "a
    co&!a ad+"=!"or c+ aceas(7 (+"'+rare
    Dia!nostic di$erenial
    3e/! sec=!+nea Sd!a$nos(!c d!.eren=!a"T &en(r+ e&!sod+" de&res!v %a@or E&a$
    ;YIJ Un !s(or!c de e&!sod %an!aca", %!<( sa+ !&o%an!aca" e<c"+de d!a$nos(!c+"
    de (+"'+rare de&res!v7 %a@or7 Pre/en(a de e&!soade !&o%a%aca"e E.7r7 n!c! +n
    !s(or!c de e&!soade %an!aca"eJ !nd!c7 +n d!a$nos(!c de (+"'+rare '!&o"ar7 II
    Pre/en=a de e&!soade %an!aca"e sa+ de e&!soade %!<(e Ec+ sa+ .7r7 e&!soade
    !&o%a%aca"eJ !nd!c7 +n d!a$nos(!c de (+"'+rare '!&o"ar7 I
    E&!soade"e de&res!ve %a@ore d!n (+"'+rarea de&res!v7 %a@or7 (re'+!e s7 .!e
    d!s(!nse de o (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e.
    D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    dac7 &er(+r'area de d!s&o/!=!e es(e cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a
    +ne! an+%!(e cond!=!! %ed!ca"e $enera"e Ede e< , sc"ero/7 %+"(!&"7, !c(+s,
    !&o(!ro!d!s%J Eve/! &a$ IL5J Aceas(7 &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de
    4G7
    Tulburrile A$ective
    "a'ora(or sa+ e<a%en+" so%a(!c. Dac7 se cons!der7, :ns7, c7 s!%&(o%e"e de&res!ve
    n+ s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a cond!=!e! %ed!ca"e $enera"e, a(+nc!
    (+"'+rarea a.ec(!v7 &r!%ar7 es(e :nre$!s(ra(7 &e a<a I Ede e<., (+"'+rare de&res!v7
    %a@or7J, !ar cond!=!a %ed!ca"7 $enera"7 es(e :nre$!s(ra(7 &e a<a III Ede e<., !n.arc(
    %!ocard!cJ. Aces(a ar .! ca/+", de e<e%&"+, dac7 e&!sod+" de&res!v %a@or es(e
    cons!dera( a .! consec!n=a &s!o"o$!c7 a .a&(+"+! de a avea cond!=!a %ed!ca"7
    $enera"7 sa+ dac7 n+ e<!s(7 n!c! o re"a=!e e(!o"o$!c7 :n(re e&!sod+" de&res!v %a@or s!
    cond!=!a %ed!ca"7 $enera"7.
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de e&!soade"e de&res!ve
    %a@ore d!n (+"'+rarea de&res!v7 %a@or7 &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n dro$
    de a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n
    re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$. ILYJ. De e<e%&"+, d!s&o/!=!a de&res!v7 care
    s+rv!ne n+%a! :n con(e<(+" a's(!nen=e! de coca!n7 va .! d!a$nos(!ca(7 ca (+"'+rare
    a.ec(!v7 !nd+s7 de coca!n7, c+ e"e%en(e de&res!ve, c+ de'+( :n c+rs+" a's(!nen=e!.
    T+"'+rarea d!s(!%!c7 s! (+"'+rarea de&res!v7 %a@or7 s+n( d!.eren=!a(e &e 'a/a
    sever!(7=!!, cron!c!(7=!! O! &ers!s(en=e!, :n (+"'+rarea de&res!v7 %a@or7, d!s&o/!=!a
    de&res!v7 (re'+!e s7 .!e &re/en(7 cea %a! %are &ar(e a /!"e!, a&roa&e :n .!ecare /!, o
    &er!oad7 de ce" &+=!n 9 s7&(7%An!, :n (!%& ce :n (+"'+rarea d!s(!%!c7 (re'+!e s7 .!e
    &re/en(7 %a! %+"(e /!"e da decA( n+, :n c+rs+" +ne! &er!oade de ce" &+=!n 9 an!.
    D!a$nos(!c+" d!.eren=!a" d!n(re (+"'+rarea d!s(!%!c7 s! (+"'+rarea de&res!v7 %a@or7
    es(e e<(re% de d!.!c!" d!n ca+/a .a&(+"+! c7 ce"e do+7 (+"'+r7r! a+ s!%&(o%e
    s!%!"are s! c7 d!.eren=a d!n(re e"e s+' as&ec(+" de'+(+"+!, d+ra(e!, &ers!s(en=e! s!
    sever!(7=!! n+ es(e +Oor de eva"+a( re(ros&ec(!v. De re$+"7, (+"'+rarea de&res!v7
    %a@or7 cons(7 d!n(r4+n+" sa+ %a! %+"(e e&!soade de&res!ve %a@ore d!.er!(e care &o(
    .! d!s(!nse de .+nc=!onarea +/+a"7 a &ersoane!, :n (!%& ce (+"'+rarea d!s(!%!c7 se
    carac(er!/ea/7 &r!n s!%&(o%e de&res!ve cron!ce %a! &+=!n severe, care a+ .os(
    &re/en(e %+"=! an!. Dac7 de'+(+" !n!=!a" a" s!%&(o%e"or de&res!ve cron!ce es(e de
    sever!(a(e s! n+%7r s+.!c!en( &en(r+ a sa(!s.ace cr!(er!!"e &en(r+ +n e&!sod de&res!v
    %a@or, d!a$nos(!c+" va .! ce" de (+"'+rare de&res!v7 %a@or7, cron!c7 Edac7 cr!(er!!"e
    %a! s+n( :nc7 sa(!s.7c+(eJ or! de (+"'+rare de&res!v7 %a@or7, :n re%!s!+ne &ar=!a"7
    Edac7 cr!(er!!"e n+ %a! s+n( sa(!s.7c+(eJ. D!a$nos(!c+" de (+"'+rare d!s(!%!c7 es(e
    &+s d+&7 ce" de (+"'+rare de&res!v7 %a@or7, n+%a! d+&7 ce s4a s(a'!"!( c7
    (+"'+rarea d!s(!%!c7 es(e an(er!oar7 &r!%+"+! e&!sod de&res!v %a@or Ead!c7, n!c! +n
    .e" de e&!soade de&res!ve %a@ore :n (!%&+" &r!%!"or 9 an! de s!%&(o%e d!s(!%!ceJ
    or! dac7 a e<!s(a( o re%!s!+ne co%&"e(7 a e&!sod+"+! de&res!v %a@or Ead!c7, d+rAnd
    ce" &+=!n 9 "+n!J :na!n(ea de'+(+"+! (+"'+r7r!! d!s(!%!ce.
    T+"'+rarea sc!/oa.ec(!v7 d!.er7 de (+"'+rarea de&res!v7 %a@or7 c+ e"e%en(e
    &s!o(!ce &r!n cererea ca :n (+"'+rarea sc!/oa.ec(!v7 s7 e<!s(e ce" &+=!n 9 s7&(7%An!
    de !de! de"!ran(e sa+ a"+c!na=!!, s+rven!nd :n a'sen(a +nor s!%&(o%e a.ec(!ve
    no(a'!"e. S!%&(o%e"e de&res!ve &o( .! &re/en(e :n c+rs+" sc!/o.ren!e!, (+"'+r7r!!
    de"!ran(e s! (+"'+r7r!! &s!o(!ce .7r7 a"(7 s&ec!.!ca=!e. Ce" %a! .recven(, as(.e" de
    s!%&(o%e de&res!ve &o( .! cons!dera(e e"e%en(e asoc!a(e a"e aces(or (+"'+r7r! s! n+
    %er!(7 a .! d!a$nos(!ca(e se&ara(. CAnd :ns7, s!%&(o%e"e de&res!ve sa(!s.ac co%&"e(
    cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or Esa+ s+n( de o !%&or(an=7 c"!n!c7 a&ar(eJ,
    !!a$nos(!c+" de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e &oa(e .! &+s &e
    "An$7
    Q
    a$nos(!c+" de sc!/o.ren!e, (+"'+rare de"!ran(7 sa+ de (+"'+rare &s!o(!c7
    .7r7 a"(7 -!.!ca=!e. Sc!/o.ren!a de (!& ca(a(on!c &oa(e .! d!.!c!" de d!s(!ns de
    (+"'+rarea
    4e'!v7 %a@or7 c+ e"e%en(e ca(a(on!ce. Is(or!c+" an(er!or sa+ !s(or!c+" .a%!"!a"
    .! +(!"!/a( &en(r+ a .ace aceas(7 d!s(!nc=!e.
    Tulburarea Depresiv
    Ma0or
    4G<
    La !nd!v!/!! :n e(a(e, adesea es(e d!.!c!" de s(a'!"!( dac7 s!%&(o%e"e co$n!(!ve Ede
    e<, de/or!en(area, a&a(!a, d!.!c+"(a(ea :n concen(rare, &!erderea %e%or!e!J s+n(
    e<&"!ca(e %a! '!ne de o de%en(7 or! de +n e&!sod de&res!v %a@or d!n (+"'+rarea
    de&res!v7 %a@or7 Aces( d!a$nos(!c d!.eren=!a" &oa(e .! &rec!/a( &r%(r4o eva"+are
    %ed!ca"7 $enera"7 de(a"!a(7 s! "+area :n cons!dera=!e a de'+(+"+! &er(+r'7r!!,
    s+cces!+nea (e%&ora"7 a s!%&(o%e"or de&res!ve s! co$n!(!ve, evo"+=!a %a"ad!e! s!
    r7s&+ns+" "a (ra(a%en( S(area &re%or'!d7 a !nd!v!d+"+! &oa(e a@+(a "a d!.eren=!erea
    +ne! (+"'+r7r! de&res!ve %a@ore de de%en(7 :n de%en(7, e<!s(7 de re$+"7 +n !s(or!c
    &re%or'!d de dec"!n a" .+nc=!e! co$n!(!ve, :n (!%& ce !nd!v!d+" c+ (+"'+rare
    de&res!v7 %a@or7 es(e .oar(e &os!'!" s7 a!'7 o s(are &re%or'!d7 re"a(!v nor%a"7 s! +n
    dec"!n co$n!(!v a'r+&(, asoc!a( c+ de&res!a
    Criteriile $e $ia/no&ti# pentru
    C5=.C, Tul-urarea Depre&iv( MaQor(2 Epi&o$ Uni#
    A2 #re(enta unui sin!ur episod depresiv ma0or &ve(i pa! 4AI)
    S *pisodul depresiv ma0or nu este explicat mai bine de tulburarea sc%i(o-
    a$ectiv si nu este suprapus peste sc%i(o$renie, tulburarea sc%i(o$rem$orm,
    tulburarea delirant ori tulburarea psi%otic $r alt speci$icaie
    Fu a existat niciodat un episod maniacal &ve(i pa! 4I7), un episod mixt
    &ve(i pa! 4IA) ori un episod %ipomamacal &ve(i pa! 4I8) FotD Aceast
    excludere nu se aplic, dac toate episoadele similare episoadelor
    maniacale, mixte sau %ipomamacale sunt induse de o substana sau de un
    tratament ori sunt datorate e$ectelor $i(iolo!ice directe ale unei condiii
    medicale !enerale
    Dac actualmente sunt satis$cute complet criteriile pentru un episod depresiv
    ma0or, s se speci"ice statusul clinic curent si1sau elementele sale
    .,or3 Moderat3 Sever, $r elemente psi%otice3 Sever, cu elemente psi%otice3
    ronic &ve(i pa! HE?)
    u elemente catatonice &ve(i pa! HE8)
    u elemente melancolice &ve(i pa! HE6)
    u elemente atipice &ve(i pa! H75)
    u debut postpartum &ve(i pa! H77)
    Dac actualmente nu sunt satis$cute complet criteriile pentru un episod
    depresiv ma0or, s se speci"ice statusul clinic curent al tulburm depresive
    ma0ore sau elementele celui mai recent episod
    "n remisiune parial3 "n remisiune complet &ve(i pa! HEE)
    ronic &ve(i pa! HE?)
    u elemente catatonice &ve(i pa! HE8)
    u elemente melancolice &ve(i pa! HE6)
    u elemente atipice &ve(i pa! H75)
    u debut postpartum &ve(i pa! H77)
    ;HR
    Tulburrile A$ective
    Criteriile $e $ia/no&ti# pentru
    C5=.4, Tul-urarea Depre&iv( MaQor( Re#urent(M
    A2 #re(ena a dou sau a mai multe episoade depresive ma0ore &ve(i pa!2 4AI)2
    FotD #entru a $i considerate episoade separate, trebuie s existe un interval
    de cel puin 7 luni consecutive "n care nu sunt satis$cute criteriile pentru un
    episod depresiv ma0or2
    S2 *pisoadele depresive ma0ore nu sunt explicate mai bine de tulburarea sc%i(o-
    a$ectiv si nu sunt suprapuse peste sc%i(o$renie, tulburarea sc%i(o$reni$orm,
    tulburarea delirant sau tulburarea psi%otic $r alt speci$icaie2
    2 Fu a existat niciodat un episod maniacal &ve(i pa!2 4I7), un episod mixt &ve(i
    pa!2 4IA) ori un episod %ipomaniacal &ve(i pa!2 4I8)2 FotD Aceast excludere
    nu se aplic, dac toate episoadele similare episoadelor maniacale, mixte sau
    %ipomaniacale sunt induse de o substan ori de un tratament sau sunt
    datorate e$ectelor $i(iolo!ice directe ale unei condiii medicale !enerale2
    Dac actualmente sunt satis$cute complet criteriile pentru un episod depresiv
    ma0or, s se speci"ice statusul clinic curent si1sau elementele saleD
    UEorS Mo$eratS Sever2 %(r( ele"ente p&i@oti#eS Sever2 #u ele"ente
    psi%otice3 &ve(i pa!2 HEE)2 ronic &ve(i
    pa!2 HE?)2 u elemente catatonice &ve(i pa!2
    HE?)2 u elemente melancolice &ve(i pa!2
    HE6)2 u elemente atipice &ve(i pa!2 H75)2
    u debut postpartum &ve(i pa!2 H77)2
    Dac actualmente nu sunt satis$cute complet criteriile pentru un episod depresiv
    ma0or, s se speci"ice statusul clinic curent al tulburrii depresive ma0ore sau
    elementele celui mai recent episodD
    "n remisiune parial3 "n remisiune complet &ve(i pa!2 HEE)2
    ronic &ve(i pa!2 HE?)2
    u elemente catatonice &ve(i pa!2 HE?)2
    u elemente melancolice &ve(i pa!2 HE6)2
    u elemente atipice &ve(i pa!2 H75)2
    u debut postpartum &ve(i pa!2 H77)2
    De speci"icat'
    Spe#i%i#an!ii evolu!iei lon/itu$inale 3Cu Ei '(r( re#uperare interepi&o$i#(
    &ve(i pa!2 H7H)2 u pattern
    se(onier &ve(i pa!2 H7I)
    4552H Tulburarea
    Distimic
    4GG

    4++.7 Tul-urarea Di&ti"i#(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7% d!s(!%!ce :" cons(!(+!e d!s&o/!=!a de&res!v7
    cron!c7, s+rve%nd cea %a! %are &ar(e a /!"e!, %a! %+"(e /!"e da decA( n+, (!%& de
    ce" &+=!n 9 a% Ecr!(er!+" AJ Ind!v!/!! c+ (+"'+rare d!s(!%!c7 :O! descr!+ d!s&o/!=!a ca
    (r!s(a or! Sa'7(+(7T La co&!!, d!s&o/!=!a &oa(e .! %a! c+rAnd !r!(a'!"7 decA(
    de&res!v7, !ar d+ra(a %!n!%7 cer+(7 es(e de n+%a! " an :n c+rs+" &er!oade"or de
    d!s&o/!=!e de&res!v7, ce" &+=!n do+7 d!n(re +r%7(oare"e s!%&(o%e ad!=!ona"e s+n(
    &re/en(eQ a&e(!( red+s sa+ %Anca( e<ces!v, !nso%n!e sa+ !&erso%%e, ener$!e
    sc7/+(7 sa+ .a$a'!(a(e, s(!%7 de s!ne sc7/+(7, concen(rare red+s7 sa+ d!.!c+"(a(e
    :n a "+a dec!/!! s! sen(!%en(+" de d!s&erare Ecr!(er!+" BJ Ind!v!/!! &o( re%arca
    &re/en=a no(a'!"7 a +n+! !n(eres sc7/+( s! a a+(ocr!(!c!!, v7/And+4se adesea &e e!
    :nO!O! ca ne%(eresan(! sa+ !nca&a'!"! Pen(r+ c7 aces(e s!%&(o%e a+ deven!( a(A( de
    %+"( o &ar(e a e<&er!en=e! co(!d!ene a !nd!v!d+"+! Ede e<, Se+ (o(dea+na a% .os(
    as(.e"T, Sad!c7, e<ac( c+% s+n(TJ, e"e n+ s+n( re"a(a(e adesea decA( dac7 es(e :n(re'a(
    :n %od d!rec( des&re e"e de c7(re e<a%!na(or
    In c+rs+" &er!oade! de 9 an! E" an &en(r+ co&!! s! ado"escen=!J n!c! +n .e" de
    !n(erva"e .7r7 s!%&(o%e s7 n+ d+re/e %a! %+"( de 9 "+n! Ecr!(er!+" CJ D!a$nos(!c+"
    de (+"'+rare d!s(!%!c7 &oa(e .! &+s, n+%a! dac7 &er!oada !n!=!a"7 de 9 a% de
    s!%&(o%e d!s(!%!ce es(e .7r7 e&!soade de&res!ve %a@ore Ecr!(er!+" DJ Dac7
    s!%&(o%e"e de&res!ve cron!ce !nc"+d +n s!%&(o% de&res!v %a@or :n c+rs+" aces(or
    &r!%! 9 an!, a(+nc! d!a$nos(!c+" es(e ce" de (+"'+rare de&res!v7 %a@or7 cron!c7 Edac7
    s+n( sa(!s.7c+(e !n(e$ra" cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@orJ or! de (+"'+rare
    de&res!v7 %a@or7, :n re%!s!+ne &ar=!a"7 Edac7 ac(+a"%en(e n+ s+n( sa(!s.7c+(e
    !n(e$ra" cr!(er!!"e &en(r+ +n e&!sod de&res+ %a@orJ D+&7 &r!%!! 9 a% de (+"'+rare
    d!s(!%!c7, e&!soade"e de&res!ve %a@ore &o( (! s+&ra&+se &es(e (+"'+rarea d!s(!%!c7
    :n as(.e" de ca/+r! Ede Sd+'"7 de&res!eTJ, se d!a$nos(!cea/7, a(A( (+"'+rarea
    de&res!v7 %a@or7, cA( s! (+"'+rarea d!s(!%!c7 :nda(7 ce &ersoana rev!ne "a "!%a de
    'a/7 d!s(!%!c7 Ead!c7, cr!(er!!"e &en(r+ e&!sod+" de&res!v %a@or n+ %a! s+n(
    sa(!s.7c+(e, dar s!%&(o%e"e d!s(!%!ce &ers!s(7J, se d!a$nos(!cea/7 n+%a!
    (+"'+rarea d!s(!%!c7
    D!a$nos(!c+" de (+"'+rare d!s(!%!c7 n+ es(e &+s dac7 !nd!v!d+" a av+( cAndva +n
    e&!sod %an!aca" E&a$ ;YHJ, +n e&!sod %!<( E&a$ ;R9J or! +n e&!sod !&o%an!aca"
    E&a$ ;RYJ, or! dac7 a+ .os( sa(!s.7c+(e vreoda(7 cr!(er!!"e &en(r+ (+"'+rarea
    c!c"o(!%!c7 Ecr!(er!+" EJ Un d!a$nos(!c se&ara( de (+"'+rare d!s(!%!c7 n+ es(e &+s
    dac7 s!%&(o%e"e de&res!ve s+rv!n e<c"+s!v :n c+rs+" +ne! (+"'+r7r! &s!o(!ce
    cron!ce, c+% ar .! sc!/o.ren!a sa+ (+"'+rarea de"!ran(7 Ecr!(er!+" FJ, :n care ca/ e"e
    s+n( cons!dera(e ca e"e%en(e asoc!a(e a"e aces(or (+"'+r7r! T+"'+rarea d!s(!%!c7 n+
    es(e d!a$nos(!ca(7, de ase%enea, dac7 &er(+r'area es(e da(ora(7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! s+'s(an=e Ede e<, a"coo"+", %ed!ca%en(e"e an(!!&er(ens!veJ or!
    +ne! cond!=!! %ed!ca"e $enera"e Ede e< , !&o(!ro!d!s%+", %a"ad!a A"/e!%erJ
    Ecr!(er!+" ,J S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7
    c"!n!c :n do%en!+" soc!a", &ro.es!ona" Esa+ Oco"arJ or! :n a"(e do%en!! !%&or(an(e de
    .+nc=!onare Ecr!(er!+" HJ
    4?8
    Tulburrile A$ective
    Speci$icani
    E(a(ea "a de'+( s! &a((ern+" carac(er!s(!c de s!%&(o%e d!n (+"'+rarea d!s(!%!c7
    &oa(e .! !nd!ca( &r!n +(!"!/area +r%7(or!"or s&ec!.!cAndQ
    9ebut precoce. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( dac7 de'+(+" s!%&(o4
    %e"or d!s(!%!ce s+rv!ne :na!n(e de e(a(ea de 95 de an!. As(.e" de !nd!v!/! es(e
    .oar(e &ro'a'!" c7 vor &re/en(a +"(er!or e&!soade de&res!ve %a@ore. 9ebut
    tardiv. Aces( s&ec!.!can( va .! +(!"!/a( dac7 de'+(+" s!%&(o%e"or
    d!s(!%!ce s+rv!ne "a e(a(ea de 95 de an! sa+ %a! (Ar/!+. (u elemente
    atipice. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( dac7 &a((ern+" de s!%&(o%e
    d!n c+rs+" ce"or %a! recen=! , an! a! (+"'+r7r!! sa(!s.ace cr!(er!!"e &en(r+ Sc+
    e"e%en(e a(!&!ceT Eve/! &a$. I9LJ.
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. E"e%en(e"e asoc!a(e a"e
    (+"'+r7r!! d!s(!%!ce s+n( s!%!"are c+ ce"e a"e e&!sod+"+! de&res!v %a@or E&a$.;Y9J.
    M+"(e s(+d!! s+$erea/7 c7 s!%&(o%e"e :n(A"n!(e ce" %a! .recven( :n (+"'+rarea
    d!s(!%!c7 s+n( sen(!%en(e"e de !ns+.!c!en=7, &!erderea $enera"!/a(7 a !n(eres+"+! sa+
    &"7cer!!, re(ra$erea soc!a"7, sen(!%en(e"e de c+"&7 or! r+%!na=!a re.er!(oare "a (rec+(,
    sen(!%en(e"e s+'!ec(!ve de !r!(a'!"!(a(e sa+ de s(are co"eroas7 e<ces!v7 O! ac(!v!(a(ea,
    e.!cac!(a(ea sa+ &rod+c(!v!(a(ea red+s7. EAne<a B &revede o a"(erna(!v7 "a cr!(er!+"
    B &en(r+ +/+" :n s(+d!!"e de cerce(are care !nc"+de aceO(! !(e%!J. La !nd!v!/!! c+
    (+"'+rare d!s(!%!c7, s!%&(o%e"e ve$e(a(!ve Ede e<., %od!.!carea so%n+"+!,
    a&e(!(+"+!, $re+(7=!! s! s!%&(o%e &s!o%o(or!!J &ar a .! %a! &+=!n .recven(e decA( "a
    &ersoane"e c+ e&!sod de&res!v %a@or. CAnd es(e &re/en(7 (+"'+rarea d!s(!%!c7 .7r7
    (+"'+rare de&res!v7 %a@or7 an(er!oar7, aces( .a&( cons(!(+!e +n .ac(or de r!sc &en(r+
    de/vo"(area (+"'+r7r!! de&res!ve %a@ore E:n cond!=!! c"!n!ce &An7 "a HYd d!n(re
    !nd!v!/!! c+ (+"'+rare d!s(!%!c7 vor &re/en(a (+"'+rarea de&res!v7 %a@or7 :n dec+rs
    de c!nc! an!J. T+"'+rarea d!s(!%!c7 &oa(e .! asoc!a(7 c+ (+"'+r7r!"e de &ersona"!(a(e
    'order"!ne, !s(r!on!c7, narc!s!s(!c7, ev!(an(7 s! de&enden(7, :ns7, a&rec!erea
    e"e%en(e"or +ne! (+"'+r7r! de &ersona"!(a(e es(e d!.!c!" de .7c+( Ia as(.e" de !nd!v!/!,
    &en(r+ c7 s!%&(o%e"e a.ec(!ve cron!ce &o( con(r!'+! "a &ro'"e%e"e !n(er&ersona"e
    sa+ &o( .! asoc!a(e c+ o &erce&ere de s!ne d!s(ors!ona(7. A"(e (+"'+r7r! cron!ce de &e
    a<a I Ede e<., de&enden=a de o s+'s(an=7J sa+ s(resor!! &s!osoc!a"! cron!c! &o( .!
    asoc!a=! c+ (+"'+rarea d!s(!%!c7 "a ad+"=!. La co&!!, (+"'+rarea d!s(!%!c7 &oa(e .!
    asoc!a(7 c+ (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (+"'+rarea de cond+!(7,
    (+"'+r7r!"e an<!oase, (+"'+r7r!"e de :nv7=are s! c+ re(ardarea %en(a"7.
    9ate de laborator asociate. A&ro<!%a(!v 9Yd4YLd d!n(re ad+"=!! c+ (+"'+rare
    d!s(!%!c7 a+ +ne"e d!n(re e"e%en(e"e &o"!so%no$ra.!ce cons(a(a(e "a !nd!v!/!! c+
    (+"'+rare de&res!v7 %a@or7 Ede e<., red+cerea "a(en=e! %!Oc7r!"or oc+"are ra&!de
    .REM[, creO(erea dens!(7=!! REM, red+cerea so%n+"+! c+ +nde "en(e, de(er!orarea
    4%(!n+!(7=!! so%n+"+!J. Ind!v!/!! c+ ano%a"!! &o"!so%no$ra.!ce a+ adesea +n !s(or!c
    n!"!a" &o/!(!v &en(r+ (+"'+rarea de&res!v7 %a@or7J s! &o( r7s&+nde %a! '!ne "a
    Nca%en(e"e an(!de&res!veJ decA( ce! .7r7 as(.e" de da(e. Dac7 ano%a"!!"e
    rrno$ra.!ce se :n(A"nesc s! "a ce! c+ (+"'+rare d!s(!%!c7 S&+r7T Ead!c7, "a ce!
    rQc * e e&!soade de&res!ve %a@ore an(er!orJ n+ es(e c"ar. Nons+&res!+nea "a
    T./on7 n+ es(e .recven(7 :n (+"'+rarea d!s(!%!c7, :n a.ar7 de ca/+" cAnd, de
    r+rQ sa(!s.7c+(e cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or.
    Tul-ur(rile
    A%e#tive
    +84

    *lemente speci$ice etii si sexului
    La co&!!, (+"'+rarea d!s(!%!c7 &are a s+rven! :n %od e$a" "a a%'e"e se<e s! d+ce
    adesea "a de(er!orarea &er.or%an(e! Oco"are O! !n(erac=!+n!! soc!a"e Co&!!! s!
    ado"escen=!! c+ (+"'+rare d!s(!%!c7 s+n( de re$+"7 !r!(a'!"! s! ca&nc!os!, &rec+% s!
    de&res!v! E! a+ o s(!%7 de s!ne sc7/+(7 s! a&(!(+d!n! soc!a"e red+se, s! s+n(
    &es!%!O(! :n &er!oada ad+"(7, es(e &os!'!" ca (+"'+rarea d!s(!%!c7 s7 a&ar7 de do+7,
    (re! or! %a! .recven( "a .e%e! decA( "a '7r'a=!
    #revalent
    Preva"en(a &e v!a=7 a (+"'+r7r!! d!s(!%!ce Ec+ sa+ .7r7 (+"'+rare de&res!v7
    %a@or7 s+&ra&+s7J es(e de a&ro<!%a(!v Rd Preva"en(a &+nc(+a"7 a (+"'+r7r!!
    d!s(!%!ce es(e de a&ro<!%a(!v ;d
    *voluie
    T+"'+rarea d!s(!%!c7 are adesea +n de'+( &recoce s! !ns!d!os Ede e< , :n co&!"7r!e,
    ado"escen=7 or! de (!%&+r!+ :n v!a(a ad+"(7J, &rec+% s! o evo"+=!e cron!c7 :n %ed!+"
    c"!n!c, !nd!v!/!! c+ (+"'+rare d!s(!%!c7 a+ de re$+"7 s+&ra&+s7 (+"'+rarea de&res!v7
    %a@or7, care es(e adesea %o(!v+" &en(r+ so"!c!(area (ra(a%en(+"+! Dac7 (+"'+rarea
    d!s(!%!c7 &recede de'+(+" (+"'+r7r!! de&res!ve %a@ore, es(e .oar(e &+=!n &ro'a'!" c7
    va e<!s(a o rec+&erare co%&"e(7 s&on(an7 :n(re e&!soade"e de (+"'+rare de&res!v7
    %a@or7 O! es(e .oar(e &ro'a'!" ca s+'!ec(+" s7 a!'7 e&!soade +"(er!oare %a! .recven(e
    #attern $amilial
    T+"'+rarea d!s(!%!c7 es(e %a! .recven(7 &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e
    ce"or c+ (+"'+rare de&res!v7 %a@or7 decA( :n &o&+"a=!a $enera"7 :n a.ar7 de aceas(a,
    a(A( (+"'+rarea d!s(!%!c7, cA( s! (+"'+rarea de&res!v7 %a@or7 s+n( %a! .recven(e "a
    r+de"e de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare d!s(!%!c7
    Dia!nostic di$erenial
    3e/! sec=!+nea Sd!a$nos(!c d!.eren=!a"T &en(r+ (+"'+rarea de&res!v7 %a@or7 E&a$
    ;H;J D!a$nos(!c+" d!.eren=!a" :n(re (+"'+rarea d!s(!%!c7 s! (+"'+rarea de&res!v7
    maAor es(e e<(re% de d!.!c!" d!n ca+/a .a&(+"+! c7 ce"e do+7 (+"'+r7r! a+ s!%&(o%e
    s!%!"are, !ar d!.eren(e"e d!n(re e"e s+' ra&or(+" de'+(+"+!, d+ra(e!, &ers!s(en(e! s!
    sever!(7=!! n+ s+n( +Oor de eva"+a( re(ros&ec(!v De re$+"7, (+"'+rarea de&res!v7
    %a@or7 cons(7 d%(r4+n+" sa+ %a! %+"(e e&!soade de&res!ve %a@ore se&ara(e care
    &o( .! d!s(!nse de %od+" +/+a" de .+nc=!onare a" &ersoane!, &e cAnd (+"'+rarea
    d!s(!%!c7 es(e carac(er!/a(7 &r!n s!%&(o%e de&res!ve %a! &+=!n severe s! cron!ce
    care s+n( &re/en(e de %+"=! a% CAnd (+"'+rarea d!s(!%!c7 d+rea/7 de %+"=! a%,
    &er(+r'area de d!s&o/!=!e n+ &oa(e .! d!s(!ns7 +Oor de .+nc=!onarea S+/+a"7T a
    &ersoane! Dac7 de'+(+" !n!=!a" a" s!%&(o%e"or de&res!ve cron!ce es(e de s+.!c!en(7
    sever!(a(e, !ar aces(ea s+n( s+.!c!en(e ca n+%7r &en(r+ a sa(!s.ace cr!(er!!"e &en(r+ +n
    e&!sod de&res!v %a@or, d!a$nos(!c+" va .! ce" de (+"'+rare de&res!v7 %a@or7, cron!c7
    Edac7 cr!(er!!"e s+n( :nc7 sa(!s.7c+(e co%&"e(J or! ce" de (+"'+rare de&res!v7 %a@or7,
    :n re%!s%ne &ar=!a"7 Edac7 cr!(er!!"e n+ %a! s+n( co%&"e( sa(!s.7c+(eJ D!a$nos(!c+"
    de (+"'+rare d!s(!%!c7 &oa(e .! &+s d+&7 (+"'+rarea de&res!v7 %a@or7, n+%a! dac7
    es(e s(a'!"!( c7 (+"'+rarea d!s(!%!c7 era &re/en(7 :na!n(ea &r!%+"+! e&!sod de&res!v
    485
    Tulburrile A$ective
    %a@or Ead!c7, n!c! +n e&!sod de&res!v :n c+rs+" &r!%!"or 9 a% de s!%&(o%e
    d!s(!%!ceJ or! dac7 a e<!s(a( o re%!s!+ne co%&"e(7 a (+"'+r7r!! de&res!ve %a@ore
    Ead!c7, d+rAnd ce" &+=!n 9 "+n!J :na!n(ea de'+(+"+! (+"'+r7% d!s(!%!ce
    S!%&(o%e"e de&res!ve &o( .! +n asoc!a( .recven( a" tulburrilor psi-otice
    cronice Ede ex, a" (+"'+r7r!! sc!/oa.ec(!ve, sc!/o.ren!e!, (+"'+r7% de"!ran(eJ Un
    d!a$nos(!c se&ara( de (+"'+rare d!s(!%!c7 n+ se &+ne dac7 s!%&(o%e"e s+rv!n
    n+%a! :n c+rs+" (+"'+r7r!! &s!o(!ce E!nc"+s!v :n .a/e"e re/!d+a"eJ
    T+"'+rarea d!s(!%!c7 (re'+!e s7 .!e d!s(!ns7 de o tulburare afectiv datorat unei
    condi3ii medicale .enerale. D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e, c+ e"e%en(e de&resrv e, dac7 &er(+r'area a.ec(!v7
    es(e cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!! %ed!ca"e
    $enera"e, de re$+"7 cron!c7 Ede e<, sc"ero/a %+"(!&"7J E_e/! &a$ IL5J Aceas(7
    &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c Dac7 se
    cons!der7 :ns7, c7 s!%&(o%e"e de&res!ve n+ s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a
    cond!=!e! %ed!ca"e $enera"e, a(+nc! (+"'+rarea a.ec(!v7 &r!%ar7 es(e :nre$!s(ra(7 &e
    a<a I Ede e< , (+"'+rare d!s(!%!c7J, !ar cond!=!a %ed!ca"7 $enera"7 es(e :nre$!s(ra(7 &e
    a<a III Ede e<, d!a'e( /aara(J Aces(a ar &+(ea .! ca/+", de e<e%&"+, dac7
    s!%&(o%e"e de&res!ve s+n( cons!dera(e a .! consec!n=a .!/!o"o$!c7 a .a&(+"+! de a
    avea o cond!=!e %ed!ca"7 $enera"7 cron!c7 or! dac7 n+ e<!s(7 n!c! o re"a=!e e(!o"o$!c7
    :n(re s!%&(o%e"e de&res!ve s! cond!=!a %ed!ca"7 $enera"7 O tulburare afectiv
    indus de o substan3 se d!s(!n$e de (+"'+rarea d!s(!%!c7 &r!n .a&(+" c7 o s+'s(an=7
    Ede e< , +n dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea "a +n (o<!cJ es(e cons!dera(7
    a .! e(!o"o$!c :n re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$ ILYJ
    Adesea e<!s(7 !nd!c!! a"e +ne! perturbri de personalitate coexistente. CAnd
    (a'"o+" c"!n!c a" +n+! !nd!v!d sa(!s.ace cr!(er!!"e, a(A( &en(r+ (+"'+rarea d!s(!%!c7, cA(
    s! &en(r+ o (+"'+rare de &ersona"!(a(e, s+n( &+se a%'e"e d!a$nos(!ce
    Criteriile $e $ia/no&ti# pentru 4++.7 Tul-urarea Di&ti"i#(
    A Dispo(iie depresiv cea mai mare parte a (ilei, mai multe (ile da dec@t nu,
    dup cum este indicat, $ie de relatarea subiectului, $ie de observaiile $cute
    de altn, timp de cel puin 7 ani Fot La copii si la adolesceni dispo(iia
    poate $i iritabil, iar durata trebuie s $ie de cel putm E an
    S #re(enta "n timp ce este depresiv a dou &sau a mai multe) dintre urmtoarele
    (1)apetit redus sau m@ncat excesiv,
    (2)insomnie sau %ipersomnie,
    (3)ener!ie sc(ut sau $ati!abi%tate,
    (4)stim de sine sc(ut,
    (5)capacitate de concentrare redus sau di$icultate "n a lua deci(ii,
    (6)sentimente de disperare
    "n cursul perioadei de 7 ani &E an pentru copii sau adolesceni) persoana nu
    a $ost niciodat $r simptomele de la criteriile A si S timp de mai mult de
    7 luni, odat
    D FII un episod depresiv ma0or &ve(i pa! 4AI) nu a $ost pre(ent "n cursul primilor
    7 ani ai perturbm &E an pentru copii si adolesceni) adic, perturbarea nu este
    explicat mai bine de tulburarea depresiv ma0or cronic sau de tulburarea
    depresiv ma0or, "n remisiune parial
    4EE Tulburarea Depresiv 'r Alt
    Speci$icaie
    4>*
    Fot #oate s $i existat un episod depresiv ma0or anterior cu condiia ca s
    $i $ost urmat de remisiune complet &nici un $el de semne sau simptome
    timp de 7 luni) "naintea apariiei tulburm distimice "n a$ar de aceasta,
    dup primii 7 ani &E an la copii si adolesceni) de tulburare distimic, pot
    exista episoade suprapuse de tulburare depresiva ma0ora, "n care ca( vor $i
    puse ambele dia!nostice c@nd sunt satis$cute criteriile pentru un episod
    depresiv ma0or
    * Fu a existat niciodat un episod maniacal &ve(i pa! 4I7), un episod mixt
    &ve(i pa! 4IA) ori un episod %ipomamacal &ve(i pa! 4I8) si nu au $ost
    satis$cute niciodat criteriile pentru tulburarea ciclotimic
    ' #erturbarea nu survine exclusiv "n cursul unei tulburri psi%otice cronice,
    cum ar $i sc%i(o$renia ori tulburarea delirant
    G Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex, un dro! de abu(, un medicament) ori ale unei condiii medicale
    !enerale &de ex , %ipotiroidismul)
    L Simptomele cau(ea( o detres sau deteriorarea semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare
    De speci"icat dac
    Debut precoce daca debutul survine "nainte de etatea de 7E de ani
    Debut tardiv daca debutul are loc la etate de 7E de ani sau mai t@r(iu
    De speci"icat &pentru cei mai receni 7 ani ai tulburam distimice)
    u elemente atipice &ve(i pa! H75)
    4** Tul-urarea Depre&iv( '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e !nc"+de (+"'+r7r!"e c+
    e"e%en(e de&res!ve care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de&res!v7 %a@or7,
    (+"'+rarea d!s(!%!c7, (+"'+rarea de ada&(are c+ d!s&o/!=!e de&res!v7 Eve/! &a$ RHFJ
    or! (+"'+rarea de ada&(are c+ d!s&o/!=!e %!<(7, de&resn 7 s! an<!oas7 Eve/! &a$
    RGLJ Uneor! S!%&(o%e"e de&res!ve se &o( &re/en(a ca &ar(e a +ne! (+"'+r7r!
    an<!oase .7r7 a"(7 s&ec!.!ca=!e Eve/! &a$ IGIJ E<e%&"e"e de (+"'+rare de&res!v7 .7r7
    a"(7 s&ec!.!ca=!e !nc"+d
    1 T+"'+rarea d!s.onc7 &re%ens(r+a"7 :n ce"e %a! %+"(e c!c"+r! %ens(r+a"e d!n
    c+rs+" +"(!%+"+! an, s!%&(o%e Ede e< , d!s&o/!=!e ae&res!v7 %arca(7, an<!e(a(e
    %arca(7, "a'!"!(a(e a.ec(!v7 %arca(7, sc7derea !n(eres+"+! &en(r+ d!verse
    ac(!v!(7=!J s+rven!nd de re$+"7 !n +"(!%a s7&(7%An7 a .a/e! "+(ea"e Es! care se
    re%!( :n dec+rs de cA(eva /!"e de "a de'+(+" %ers(r+a(!e!J Aces(e s!%&(o%e
    (re'+!e s7 .!e s+.!c!en( de severe &en(r+ a !n(er.era !n %od se%n!.!ca(!v c+
    serv!c!+", scoa"7 or! c+ ac(!v!(7=!"e +/+a"e, s! sa .!e co%&"e( a'sen(e (!%& de ce"
    &+=!n o s7&(7%An7 d+&7 %ens(r+a=!! Eve/! &a$ HH5 &en(r+ cr!(er!!"e de
    cerce(are s+$era(eJ
    2 T+"'+rarea de&res!v7 %!nor7 e&!soade de s!%&(o%e de&res!ve c+ o d+ra(7 de
    ce" &+(% 9 s7&(7%An!, dar c+ %a! &+=!n de c%c
    5
    !(e%! cer+=! &en(r+ (+"'+rarea
    de&res!v7 %a@or7 Eve/! &a$ HHY &en(r+ cr!(er!!"e de cerce(are s+$era(eJ
    4>C Tulburrile A$ective

    T+"'+rarea de&res!v7 sc+r(7 rec+ren(7 e&!soade de&res!ve d+rAnd de "a , /!"e
    &An7 "a 9 s7&(7%An!, s+rven!nd ce" &+=!n oda(7 &e "+n7, (!%& de 59 "+n!
    Eneasoc!a(7 c+ c!c"+" %ens(r+a"J Eve/! &a$ HHG &en(r+ cr!(er!!"e de cerce(are
    s+$era(eJ
    T+"'+rarea de&res!v7 &os(&s!o(!c7 a sc!/o.ren!e! +n e&!sod de&res!v %a@or
    care s+rv!ne :n c+rs+" .a/e! re/!d+a"e a sc!/o.ren!e! Eve/! &a$ HRH &en(r+
    cr!(er!!"e de cerce(are s+$era(eJ
    Un e&!sod de&res!v %a@or s+&ra&+s &es(e (+"'+rarea de"!ran(7, (+"'+rarea
    &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e or! .a/a ac(!v7 a sc!/o.ren!e!
    S!(+a=!!"e :n care c"!n!c!an+" a a@+ns "a conc"+/!a c7 es(e &re/en(7 o (+"'+rare
    de&res!v7, dar es(e !nca&a'!" s7 &rec!/e/e dac7 aceas(a es(e &r!%ar7, da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e or! !nd+s7 de o s+'s(an=7
    Tul-ur(rile 8ipolare
    Aceas(7 sec=!+ne !nc"+de (+"'+rarea '!&o"ar7 I, (+"'+rarea '!&o"ar7 II,
    c!c"o(!%!a s! (+"'+rarea '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e E<!s(7 sase se(+r! de cr!(er!!
    se&ara(e &en(r+ (+"'+rarea '!&o"ar7 I e&!sod+" %an!aca" +n!c, ce" %a! recen(
    e&!sod !&o%a%aca", ce" rra! recen( e&!sod %an!aca", ce" %a! recen( e&!sod %!<(,
    ce" %a! recen( e&!sod de&resn s! ce" %a! recen( e&!sod nes&ec!.!ca( T+"'+rarea
    '!&o"ar7 I, e&!sod %an!aca" +n!c, es(e +(!"!/a( &en(r+ a descr!e !nd!v!/!! care a+
    av+( +n &r!% e&!sod de %a%e Res(+" se(+r!"or de cr!(er!! s+n( +(!"!/a(e &en(r+ a
    s&ec!.!ca na(+ra e&!sod+"+! c+ren( Eor! ce" %a! recen(J "a !nd!v!/!! care a+ av+(
    e&!soade a.ec(!ve rec+ren(e
    Tul-urarea 8ipolar( l
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7% '!&o"are I :" cons(!(+!e evo"+=!a c"!n!c7, aceas(a
    .+nd carac(er!/a(7 &r!n a&ar (!a +n+!a sa+ a %a! %+"(or e&!soade %an!aca"e Eve/!
    &a$ ;YHJ or! e&!soade %!<(e Eve/! &a$ ;R9J Adesea !nd!v!/!! a+ av+(, de ase%enea,
    +n+" sa+ %a! %+"(e e&2soade de&res!ve %a@ore E_e/! &a$ ;IFJ E&!soade"e de
    (+"'+rare a.ec(!va !nd+s7 de o s+'s(an=7 Eda(ora(e e.ec(e"or d!rec(e a"e +n+!
    %ed!ca%en(, a"(or (ra(a%en(e so%a(!ce &en(r+ de&res!e, +n+! dro$ de a'+/ or!
    e<&+ne% "a +n (o<!cJ sa+ e&!soade"e de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e n+ (re'+!e s7 con(eXe &en(r+ d!a$nos(!c+" de (+"'+rare '!&o"ar7
    I In a.ar7 de aceas(a, e&!soade"e n+ s+n( e<&"!ca(e %a! '!ne de (+"'+rarea
    sc!/oa.ec(!v7 s! n+ s+n( s+&ra&+se &es(e sc!/o.ren!e, (+"'+rarea
    sc!/o.re%.or%7, (+"'+rarea de"!ran(7 sa+ (+"'+rarea &s!o( c7 .7r7 a"(7
    s&ec!.!ca=!e T+"'+rarea '!&o"ar7 I es(e a'c"as!.!ca(7 "a cea de a &a(ra o.r7 a
    cod+"+! :n ra&or( c+ .a&(+" dac7 !nd!v!d+" se 2a "a &r!%+" e&!sod Ede e<, e&!sod
    %an!aca" +n!cJ or! dac7 (+"'+rarea es(e ren(7 Rec+ren(a es(e !nd!ca(7 .!e
    &r!n(r4o sc!%'are :n &o"ar!(a(ea e&!sod+"+!, n(r4+n !n(erva" :n(re e&!soade c+ o
    d+ra(7 de ce" &+=!n 9 "+n! .7r7 s!%&(o%e ne O sc!%'are de &o"ar!(a(e es(e
    de.!n!(7 ca o evo"+=!e c"!n!c7 :n care +n r`eM_ %a@or evo"+ea/7 :n(r4+n e&!sod
    %an!aca" sa+ :n(r4+n e&!sod %!<(,
    Tulburarea
    Sipolar
    484

    or! :n care +n e&!sod %an!aca" sa+ +n e&!sod %!<( evo"+ea/7 :n(r4+n e&!sod
    de&res!v %a@or D!n con(ra, +n e&!sod !&o%a%aca" care evo"+ea/7 :n(r4+n e&!sod
    %an!aca" sa+ :n(r4+n e&!sod %!<(, or! +n e&!sod %an!aca" care evo"+ea/7 :n(r4+n
    e&!sod %!<( Esa+ v!ceversaJ es(e cons!dera( a .! doar +n s!n$+r e&!sod Pen(r+
    (+"'+r7r!"e '!&o"are I rec+ren(e, na(+ra e&!sod+"+! c+ren( Eor! a ce"+! %a! recen(J
    &oa(e .! s&ec!.!ca(7 Ece" %a! recen( e&!sod !&o%a%aca", ce" %a! recen( e&!sod
    %an!aca", ce" %a! recen( e&!sod %!<(, ce" %a! recen( e&!sod de&res!v, ce" %a! recen(
    e&!sod nes&ec!.!ca(J
    Speci$icani
    Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ e&!sod+" %an!aca",
    %!<( sa+ de&res!v %a@or, +r%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a descr!e
    s(a(+s+" c"!n!c c+ren( a" e&!sod+"+! s! &en(r+ a descr!e e"e%en(e"e e&!sod+"+! c+ren(
    UOor8 Modera(8 Sever, .7r7 e"e%en(e &s!o(!ce8 Sever, c+ e"e%en(e &s!o(!ce8
    Eve/! &a$ I55J
    C+ e"e%en(e ca(a(on!ce Eve/! &a$ I5GJ C+
    de'+( &os(&ar(+% Eve/! &a$ I99J
    Dac7 ac(+a"%en(e n+ s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ e&!sod+"
    %an!aca", %!<( sa+ de&res!v %a@or, +r%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a
    descr!e s(a(+s+" c"!n!c c+ren( a" (+"'+r7% '!&o"are I s! &en(r+ a descr!e e"e%en(e"e
    ce"+! %a! recen( e&!sod
    :n re%!s!+ne &ar=!a"78 In re%!s!+ne co%&"e(7 Eve/! &a$ I55J
    C+ e"e%en(e ca(a(on!ce Eve/! &a$ I5HJ C+ de'+( &os(&ar(+%
    Eve/! &a$ I99J
    Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e cr!(er!!"e &en(!+ +n e&!sod de&res!v %a@or,
    +r%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a descr!e e"e%en(e"e e&!sod+"+! c+ren(
    Esa+, dac7 ac(+a"%en(e n+ s+n( sa(!s.7c+(e, dar ce" %a! recen( e&!sod de (+"'+rare
    '!&o"ar7 I a .os( +n e&!sod de&res!v %a@or, aceO(! s&ec!.!can=! se a&"!c7 ace"+! e&!sodJ
    Cron!c Eve/! &a$ I5HJ
    C+ e"e%en(e %e"anco"!ce Eve/! &a$ I5FJ
    C+ e"e%en(e a(!&!ce Eve/! &a$ I9LJ
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a !nd!ca &a((ern+" e&!soade"or
    S&ec!.!can=!! evo"+=!e! "on$!(+d!na"e EC+ s! F7r7 rec+&erare !n(ere&!sod!c7
    co%&"e(7J Eve/! &a$ I9IJ C+ &a((ern se/on!er Ese a&"!c7 n+%a! &a((ern+"+!
    e&!soade"or de&res!ve %a@oreJ
    Eve/! &a$ I9RJ C+ c!c"are
    ra&!d7 Eve/! &a$ I9HJ
    #rocedee de "nre!istrare
    Cod+r!"e d!a$nos(!ce &en(r+ (+"'+rarea '!&o"ar7 I s+n( se"ec(a(e d+&7 c+% +r%ea/7
    1 Pr!%e"e (re! c!.re s+n( 9FR
    2 Cea de a &a(ra c!.r7 es(e O, dac7 e<!s(7 +n s!n$+r e&!sod %an!aca" Pen(r+
    e&!soade"e rec+ren(e, cea de a &a(ra c!.r7 !nd!c7 na(+ra e&!sod+"+! c+ren( Esa+,
    48H
    Tulburrile A$ective
    dac7 (+"'+rarea '!&o"ar7 I es(e ac(+a"%en(e :n re%!s%ne &ar=!a"7 sa+ co%&"e(7,
    na(+ra ce"+! %a! recen( e&!sodJ d+&7 c+% +r%ea/7 I, dac7 e&!sod+" c+ren( sa+
    ce" %a! recen( es(e +n e&!sod !&o%a%aca" or! +n e&!sod %an!aca", Y, dac7
    aces(a es(e +n e&!sod de&res!v %a@or, R, dac7 aces(a es(e +n e&!sod %!<(, s! H,
    dac7 e&!sod+" c+ren( sa+ ce" %a! recen( es(e nes&ec!.!ca(
    ;. Cea de a c!ncea c!.r7 Ee<ce&(And (+"'+rarea '!&o"ar7 I, ce" %a! recen( e&!sod
    !&o%a%aca" s! (+"'+rarea '!&o"ar7 I, ce" %a! recen( e&!sod nes&ec!.!ca(J !nd!c7
    sever!(a(ea e&!sod+"+! c+ren( dac7 s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n
    e&!sod %an!aca", %!<( sa+ de&res!v %a@or, d+&7 c+% +r%ea/7 ", sever!(a(e
    +Ooar7, 9, sever!(a(e %odera(7, ;, sever, .7r7 e"e%en(e &s!o(!ce8 I, sever, c+
    e"e%en(e &s!o(!ce Dac7 n+ s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod
    %an!aca", %!<( sa+ de&res!v %a@or, cea de a c!ncea c!.r7 !nd!c7 s(a(+s+" c"!n!c
    c+ren( a" (+"'+r7r!! '!&o"are I, d+&7 c+% +r%ea/7 C, :n re%!s%ne &ar=!a"78 R, :n
    re%!s%ne co%&"e(7 Dac7 sever!(a(ea c+ren(7 sa+ s(a(+s+" c"!n!c es(e
    nes&ec!.!ca(, cea de a c!ncea c!.r7 es(e L. A"=! s&ec!.!can=! &en(r+ (+"'+rarea
    '!&o"ar7 I n+ &o( .! cod!.!ca=! Pen(r+ (+"'+rarea '!&o"ar7 I, ce" %a! recen(
    e&!sod !&o%a%aca", cea de a c!ncea c!.r7 es(e (o(dea+na O Pen(r+ (+"'+rarea
    '!&o"ar7, ce" %a! recen( e&!sod nes&ec!.!ca(, n+ e<!s(7 cea de a c!ncea c!.r7
    La :nre$!s(rarea den+%!% +n+! d!a$nos(!c, (er%en!! (re'+!e s7 .!e "!s(a=! :n
    +r%7(oarea ord!ne (+"'+rarea '!&o"ar7 I, s&ec!.!can(n cod!.!ca=! c+ cea de a &a(ra
    c!.r7 Ede e<, ce" %a! recen( e&!sod %an!aca"J, s&ec!.!can(n cod!.!ca=! "a cea de a
    c!ncea c!.r7 Ede e< , +Ooar7, sever7, c+ e"e%en(e &s!o(!ce, :n re%!s!+ne &ar=!a"7J, (o(
    a(A=!a s&ec!.!can=! E.7r7 codJ cA=! cores&+nd ce"+! %a! recen( e&!sod Ede e<, c+
    e"e%en(e %e"anco"!ce, c+ de'+( &os(&ar(+%J s! (o( a(A=!a s&ec!.!can=! E.7r7 codJ cA=!
    cores&+nd evo"+=!e! e&!sod+"+! Ede e<, c+ c!c"are ra&!d7J, de e<e%&"+, 9FR YI
    T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, sever, c+ e"e%en(e &s!o(!ce, c+
    e"e%en(e %e"anco"!ce, c+ c!c"are ra&!d7
    De re=!n+( c7, dac7 s!n$+r+" e&!sod de (+"'+rare '!&o"ar7 I es(e +n e&!sod %!<(,
    d!a$nos(!c+" va .! !nd!ca( ca 9FR O< T+"'+rare '!&o"ar7, e&!sod %an!aca" +n!c, %!<(
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. S+!c!d+" co%&"e( s+rv!ne
    "a 5Ld45Yd d!n(re !nd!v!/!! c+ (+"'+rare '!&o"ar7 I Idea(!a s+!c!dar7 s! (en(a(!ve"e
    de s+!c!d es(e .oar(e &ro'a'!" c7 a&ar cAnd !nd!v!d+" es(e :n(r4o s(are de&res!v7 sa+
    %!<(7 Ma"(ra(area co&!"+"+!, a so=!e! Eso=+"+!J or! a"( co%&or(a%en( v!o"en( &oa(e
    s+rven! :n c+rs+" e&!soade"or %an!aca"e severe or! a" ce"or c+ e"e%en(e &s!o(!ce
    A"(e &ro'"e%e asoc!a(e !nc"+d c!+"+" de "a scoa"7, eOec+" Oco"ar, eOec+" &ro.es!ona",
    d!vor=+" or! co%&or(a%en(+" an(!soc!a" e&!sod!c T+"'+rarea '!&o"ar7 I es(e asoc!a(7
    c+ (+"'+r7r!"e &rovoca(e de +/+" de a"coo" sa+ de a"(e s+'s(an=e "a %+"=! !nd!v!/!
    Ind!v!/!! c+ de'+( &recoce a" (+"'+r7r!! '!&o"are I es(e .oar(e &os!'!" s7 a!'7 +n
    !s(or!c de &ro'"e%e c+ren(e c+ +/+" de a"coo" sa+ de a"(7 s+'s(an=7 U/+"
    conco%!(en( de a"coo" s! de a"(e s+'s(an=e es(e asoc!a( c+ +n n+%7r cresc+( de
    s&!(a"!/7r! s! de e vo"+(!e %a! rea a %a"ad!e! A"(e (+"'+r7r! %en(a"e asoc!a(e !nc"+d
    anore<!a nervoas7, '+"!%!a nervoas7, (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e,
    &an!ca s! .o'!a soc!a"7
    9ate de laborator asociate. D+&7 cA( se &are, n+ e<!s(7 da(e de "a'ora(or care
    s7 .!e d!a$nos(!ce &en(r+ (+"'+rarea '!&o"ar7 I sa+ care s7 d!s(!n$7 e&!soade"e
    Tul-urarea
    8ipolar(
    4><
    de&res!ve %a&re d!n (+"'+rarea '!&o"ar7 I de ce"e d!n (+"'+rarea de&res!v7 %a@or7
    sa+ (+"'+rarea '!&o"ar7 II S(+d!!"e de !%a$!s(!c7 co%&arAnd $r+&e de !nd!v!/! c+
    (+"'+rare '!&o"ar7 I c+ $r+&e c+ (+"'+rare de&res!v7 %a@or7 sa+ c+ $r+&e .7r7 n!c!
    o (+"'+rare a.ec(!v7 (!nd a ar7(a &rocen(e cresc+(e de "e/!+n! a"e e%!s.ere! dre&(e,
    "e/!+n! s+'cor(!ca"e sa+ &enven(nc+"are '!"a(era"e "a ce! c+ (+"'+rare '!&o"ar7 I
    9atele examinrii somatice si condi3iile medicale .enerale asociate. O e(a(e "a
    de'+( d+&7 IL de a% &en(r+ &r!%+" e&!sod %an!aca" (re'+!e s7 a"er(e/e c"!n!c!an+"
    as+&ra &os!'!"!(7=!! ca s!%&(o%e"e s7 .!e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e or!
    +/+"+! +ne! s+'s(an=e H!&o(!ro!d!s% :n &re/en( sa+ :n (rec+( or! &ro'a de "a'ora(or
    a +ne! !&o.+nc=n (!ro!d!ene +Ooare &oa(e .! asoc!a(7 c+ c!c"area ra&!d7 Eve/! &a$!na
    I9HJ In &"+s, !&er(!ro!d!s%+" &oa(e &rec!&!(a sa+ :nr7+(7=! s!%&(o%e"e %an!aca"e
    "a !nd!v!/!! c+ o (+"'+rare a.ec(!v7 &ree<!s(en(7 La !nd!v!/!! .7r7 (+"'+rare a.ec(!v7
    &ree<!s(en(7 :ns7, !&er(!ro!d!s%+" n+ &rovoac7 de re$+"7 s!%&(o%e %an!aca"e
    *lemente speci$ice culturii, etii si sexului
    N+ e<!s(7 co%+n!c7r! re.er!(oare "a !nc!den=a d!.eren=!a(7 a (+"'+r7r!! '!&o"are I
    :n .+nc=!e de ras7 sa+ e(n!e E<!s(7 +ne"e da(e con.or% c7rora c"!n!c!enn a+ (end!n=a
    de a s+&rad!a$nos(!ca sc!/o.ren!a E:n "oc+" (+"'+ra% '!&o"areJ "a +ne"e $r+&+r!
    e(n!ce s! "a !nd!v!/!! %a! (!ner!
    A&ro<!%a(!v 5Ld45Yd d!n(re ado"escen=!! c+ e&!soade de&res!ve %a@ore
    rec+ren(e vor a@+n$e s7 de/vo"(e (+"'+rarea '!&o"ar7 I E&!soade"e %!<(e &ar a .!
    %a! &ro'a'!"e "a ado"escen=! s! "a ad+"=!! (!ner! decA( "a ad+"=!! %a! :n e(a(e
    S(+d!! e&!de%!o"o$!ce recen(e e.ec(+a(e % S(a(e"e Un!(e !nd!c7 .a&(+" c7
    (+"'+rarea '!&o"ar7 I es(e "a .e" de .recven(7 "a '7r'a=! ca s! "a .e%e! Econ(rar
    (+"'+r7% de&res!ve %a@ore, care es(e %a! .recven(a "a .e%e!J Se<+" &are a .! :n
    re"a=!e c+ ord!nea de a&ar!=!e a e&!soade"or %an!aca"e s! de&res!ve %a@ore Pr!%+"
    e&!sod "a '7r'a=! es(e .oar(e &os!'!" s7 .!e +n+" %an!aca" Pr!%+" e&!sod "a .e%e! es(e
    .oar(e &os!'!" s7 .!e +n+" de&res!v %a@or La '7r'a=!, n+%7r+" de e&!soade
    %an!aca"e es(e e$a" sa+ e<cede n+%7r+" de e&!soade de&res!ve %a@ore, &e cAnd "a
    .e%e! &redo%!n7 e&!soade"e de&res!ve %a@ore :n a.ara de aceas(a, c!c"area ra&!d7
    Eve/! &a$ I9HJ es(e %a! .recven(7 "a .e%e! decA( "a '7r'a=! Une"e da(e s+$erea/7 c7
    s!%&(o%e"e %!<(e sa+ de&res!ve d!n c+rs+" e&!soade"or %an!aca"e s+n(, de
    ase%enea, %a! .recven(e "a .e%e!, dar n+ (oa(e s(+d!!"e s+n( de acord c+ aceas(a
    Dec!, .e%e!"e &o( &re/en(a +n r!sc &ro&r!+ &en(r+ s!%&(o%e"e a.ec(!ve de&res!ve
    sa+ %(nca(e Fe%e!"e c+ (+"'+rare '!&o"ar7 I a+ +n r!sc cresc+( de a &re/en(a
    e&!soade +"(er!oare :n &er!oada de &os(&ar(+% !%ed!a( Une"e .e%e! a+ &r!%+" "or
    e&!sod :n c+rs+" &er!oade! de &os(&ar(+% S&ec!.!can(+" Sc+ de'+( &os(&ar(+%T
    &oa(e .! +(!"!/a( &en(r+ a !nd!ca .a&(+" ca de'+(+" e&!sod+"+! a s+rven!( :n &r!%e"e
    I s7&(7%An! d+&7 naO(erea co&!"+"+! Eve/! &a$ I99J Per!oada &re%ens(r+a"7 &oa(e
    .! asoc!a(7 c+ :nr7+(7=!rea +n+! e&!sod de&res!v %a@or, %an!aca", %!<( sa+
    !&o%a%aca" :n evo"+=!e
    #revalent
    Preva"en(a &e v!a(7 a (+"'+r7% '!&o"are I :n esan(!oane"e co%+n!(are a var!a( de
    "a L,Id "a 5,Rd
    ;GR
    Tulburrile A$ective
    *voluie
    E(a(ea %ed!e "a de'+( es(e de 9L a%, a(A( &en(r+ '7r'a=! cA( s! &en(r+ .e%e!
    T+"'+rarea '!&o"ar7 I es(e o (+"'+rare rec+ren(7 U %a! %+"( de FLd d!n(re
    !nd!v!/!! care a+ +n s!n$+r e&!sod %an!aca" vor a@+n$e s7 a!'7 s! a"(e e&!soade :n
    v!!(or A&ro<!%a(!v RLd4HLd d!n(re e&!soade"e %an!aca"e s+rv!n !%ed!a( :na!n(ea
    sa+ d+&7 +n e&!sod de&res!v %a@or Adesea, e&!soade"e %an!aca"e &reced sa+
    +r%ea/7 e&!soade"or de&res!ve %a@ore :n(r4+n %od carac(er!s(!c &en(r+ o an+%!(7
    &ersoan7 N+%7r+" &e v!a(7 a" e&!soade"or Ea(A( %an!aca"e, cA( s! de&res!ve
    %a@oreJ (!nde a .! %a! %are &en(r+ (+"'+rarea '!&o"ar7 I :n co%&ara=!e c+
    (+"'+rarea de&res!v7 %a@or7 rec+ren(7 S(+d!!"e re.er!(oare "a evo"+=!a (+"'+r7r!!
    '!&o"are I e.ec(+a(e :na!n(ea !n(rod+cer!! (ra(a%en(+"+! de :n(re=!nere c+ "!(!+
    s+$erea/7 c7, :n %ed!e, &a(r+ e&!soade s+rv!n :n(r4+n !n(erva" de 5L an! In(erva"+"
    d!n(re e&!soade (!nde s7 scad7 &e %7s+r7 ce !nd!v!d+" :na!n(ea/7 :n e(a(e E<!s(7
    +ne"e da(e, &rec+% c7 %od!.!c7r!"e :n orar+" so%n4v!$!"!(a(e, c+% ar .! ce"e care
    s+rv!n :n (!%&+" sc!%'7% .+s+"+! orar sa+ a" de&r!v7rn de so%n, &o( &rec!&!(a
    sa+ e<acer'a +n e&!sod %an!aca", %!<( sa+ !&o%a%aca" A&ro<!%a(!v Yd45Yd
    d!n(re !nd!v!/!! c+ (+"'+rare '!&o"ar7 I a+ n+%eroase E&a(r+ sa+ %a! %+"(eJ
    e&!soade a.ec(!ve Ede&res!ve %a@ore, %an!aca"e, %!<(e sa+ !&o%a%aca"eJ care
    s+rv!n :n c+rs+" +n+! an da( Dac7 es(e &re/en( aces( &a((ern, e" es(e no(a( &r!n
    s&ec!.!can(+" Sc+ c!c"are ra&!d7T Eve/! &a$ I9HJ Un &a((ern de c!c"are ra&!d7 es(e
    asoc!a( c+ +n &ro$nos(!c %a! sever
    DeO! %a@or!(a(ea !nd!v!/!"or c+ (+"'+rare '!&o"ar7 I rev!n co%&"e( "a n!ve"+"
    an(er!or de .+nc=!onare :n(re e&!soade, +n!! E9Ld4;LdJ con(!n+7 s7 &re/!n(e
    "a'!"!(a(e a.ec(!v7 s! a"(e s!%&(o%e a.ec(!ve re/!d+a"e N+ %a! &+=!n de RLd &re/!n(7
    d!.!c+"(7=! !n(er&ersona"e sa+ &ro.es!ona"e cron!ce !n(re e&!soade"e ac+(e S!%&(o%e
    &s!o(!ce &o( a&are d+&7 /!"e sa+ s7&(7%An! :n ceea ce era an(er!or +n e&!sod
    %an!aca" sa+ %!<( non&s!oc CAnd +n !nd!v!d are e&!soade %an!aca"e c+
    e"e%en(e &s!o(!ce, es(e .oar(e &os!'!" ca s! e&!soade"e %an!aca"e +"(er!oare s7 a!'7
    e"e%en(e &s!4o(!ce Rec+&erarea !n(ere&!sod!c7 !nco%&"e(7 es(e %a! .recven(7 cAnd
    e&!sod+" c+ren( es(e aco%&an!a( de e"e%en(e &s!o(!ce !ncon$r+en(e c+ d!s&o/!=!a
    #attern $amilial
    R+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare '!&o"ar7 I a+ &rocen(e
    cresc+(e de (+"'+rare '!&o"ar7 I EId49IdJ de (+"'+rare '!&o"ar7 II E"d4YdJ s! de
    (+"'+rare de&res!v7 %a@or7 EId49IdJ Ind!v!/!! c+ (+"'+rare a.ec(!v7 "a r+de"e "or
    '!o"o$!ce de $rad+" I es(e &os!'!" s7 a!'7 o e(a(e %a! %!c7 "a de'+( S(+d!!"e &e
    $e%en! s! &e ado&(a=! o.er7 &ro'a !ncon(es(a'!"7 a !n."+en(e! $ene(!ce &en(r+
    (+"'+rarea '!&o"ar7 I
    Dia!nostic di$erenial
    E&!soade"e de&res!ve %a@ore, %an!aca"e, %!<(e s! !&o%a%aca"e d!n (+"'+rarea
    '!&o"ar7 I (re'+!e s7 .!e d!s(!nse de e&!soade"e +ne! (+"'+r7r! a.ec(!ve da(ora(e +ne!
    cond!=!! %ed!ca"e $enera"e D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e &en(r+ e&!soade"e cons!dera(e a .! consec!n=a
    .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!! %ed!ca"e $e nera"e Ede e<, sc"ero/7
    %+"(!&"7, !c(+s, !&o(!ro!d!s%J Eve/! &a$ IL5J Aceas(7 conc"+/!e se 'a/ea/7 &e
    !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c
    Tulburarea
    Sipolar l
    4>G
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de e&!soade"e de&res!ve,
    %an!aca"e sa+ %!<(e care a&ar :n (+"'+rarea '!&o"ar7 I &r!n .a&(+" c7 o s+'s(an=7 Ede
    e< , +n dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a
    .! e(!o"o$!c :n re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$ ILYJ. S!%&(o%e s!%!"are
    ce"or o'serva(e :n(r4+n e&!sod %an!aca", %!<( sa+ !&o%a%aca" &o( .! &ar(e a +ne!
    !n(o<!ca=!! or! a's(!nen(e de +n dro$ de a'+/ s! (re'+!e s7 .!e d!a$nos(!ca(e ca
    (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 Ede e< , d!s&o/!=!a e+.or!c7, a&7rAnd n+%a!
    :n con(e<(+" +ne! !n(o<!ca=!! c+ coca!n7, va .! d!a$nos(!ca(7 ca (+"'+rare a.ec(!v7
    !nd+s7 de coca!n7, c+ e"e%en(e %an!aca"e, c+ de'+( :n c+rs+" !n(o<!ca=!e!J
    S!%&(o%e s!%!"are c+ ce"e o'serva(e :n(r4+n e&!sod %an!aca" sa+ %!<( &o( .!, de
    ase%enea, &rec!&!(a(e de (ra(a%en(+" an(!de&res!v, de e<e%&"+, de +n %ed!ca%en(,
    de (era&!a e"ec(roconv+"s!van(7 sa+ de .o(o(era&!e As(.e" de e&!soade &o( .!
    d!a$nos(!ca(e dre&( (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 Ede e<, (+"'+rare
    a.ec(!v7 !nd+s7 de a%!(r!&(!n7, c+ e"e%en(e %an!aca"e8 (+"'+rare a.ec(!v7 !nd+s7
    de (era&!a e"ec(roconv+"s!van(7, c+ e"e%en(e %an!aca"eJ s! n+ (re'+!e s7 con(e/e
    &en(r+ +n d!a$nos(!c de (+"'+rare '!&o"ar7 I CAnd se cons!der7 :ns7 ca +/+" de o
    s+'s(an=7 sa+ %ed!ca%en( n+ e<&"!c7 !n(e$ra" e&!sod+" Ede e<., e&!sod+" con(!n+7
    a+(ono% o &er!oad7 cons!dera'!"7 de (!%& d+&7 :n(rer+&erea s+'s(an=e!J, e&!sod+"
    va .! "+a( :n cons!dera=!e &en(r+ d!a$nos(!c+" de (+"'+rare '!&o"ar7 I.
    T+"'+rarea '!&o"ar7 I se d!s(!n$e de (+"'+rarea de&res!v7 %a@or7 s! de
    (+"'+rarea d!s(!%!c7 &r!n !s(or!c+" &e v!a(7 a" a ce" &+=!n +n e&!sod %an!aca" sa+
    %!<( T+"'+rarea '!&o"ar7 I se d!s(!n$e de (+"'+rarea '!&o"ar7 II &r!n &re/en=a
    +n+!a sa+ a %a! %+"(or e&!soade %an!aca"e sa+ %!<(e CAnd +n !nd!v!d,
    d!a$nos(!ca( an(er!or c+ (+"'+rarea '!&o"ar7 II, &re/!n(7 +n e&!sod %an!aca" sa+
    %!<(, d!a$nos(!c+" es(e sc!%'a( c+ ce" de (+"'+rare '!&o"a!a I
    :n (+"'+rarea c!c"o(!%!c7, e<!s(7 n+%eroase &er!oade de s!%&(o%e !&o%a4
    %aca"e care n+ sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod %an!aca" s! &er!oade de s!%&(o%e
    de&res!ve care n+ sa(!s.ac cr!(er!!"e s!%&(o%a(o"o$!ce s! de d+ra(7 &en(r+ +n e&!sod
    de&res!v %a@or T+"'+rarea '!&o"ar7 I se d!s(!n$e de (+"'+rarea c!c"o(!%!c7 &r!n
    &re/en=a +n+!a sa+ a %a! %+"(or e&!soade %an!aca"e sa+ %!<(e Dac7 +n e&!sod
    %an!aca" sa+ %!<( s+rv!ne d+&7 &r!%!! 9 an! de (+"'+rare c!c"o(!%!c7, a(+nc!
    (+"'+rarea c!c"o(!%!c7 s! (+"'+rarea '!&o"ar7 I &o( .! d!a$nos(!ca(e a%'e"e
    D!a$nos(!c+" d!.eren=!a" d!n(re (+"'+r7r!"e &s!o(!ce Ede e<, (+"'+rarea
    sc!/oa.ec(!v7, sc!/o.ren!a s! (+"'+rarea de"!ran(7J s! (+"'+rarea '!&o"ar7 I &oa(e
    .! d!.!c!" E%a! a"es "a ado"escen=!J, deoarece aces(e (+"'+r7r! &o( avea :n co%+n +n
    n+%7r de s!%&(o%e Ede e< , !de! de"!ran(e de $randoare s! de &ersec+=!e,
    !r!(a'!(a(e, a$!(a=!e s! s!%&(o%e ca(a(on!ceJ, :n s&ec!a" &e sec=!+ne (ransversa"7 O!
    &recoce :n evo"+=!a "or :n con(ras( c+ (+"'+rarea '!&o"ar7 I, sc!/o.ren!a, (+"'+4
    ra!ea sc!/oa.ec(!v7 s! (+"'+rarea de"!ran(7 s+n(, (oa(e, carac(er!/a(e &r!n &er!oade
    de s!%&(o%e &s!o(!ce s+rve%nd :n a'sen(a +nor s!%&(o%e a.ec(!ve &roe%!nen(e
    A"(e cons!deren(e +(!"e !nc"+d s!%&(o%e"e de aco%&an!a%en(, evo"+=!a an(er!oar7
    s! !s(or!c+" .a%!"!a" S!%&(o%e %an!aca"e s! de&res!ve &o( .! &re/en(e :n
    sc!/o.ren!e, (+"'+rarea de"!ran(7 s! (+"'+rarea &s!o(!(7 .7r7 a"(7 s&ec!.!ca=!e, dar
    rar s+n( s+.!c!en(e ca n+%7r, d+ra(7 s! &en as!_ *a(e &en(r+ a sa(!s.ace cr!(er!!"e
    &en(r+ +n e&!sod %an!aca" sa+ &en(r+ +n e&!sod de&res!v %a@or CAnd :ns7 s+n(
    sa(!s.7c+(e co%&"e( cr!(er!!"e Esa+ s!%&(o%e"e a+ o se%n!.!ca=!e c"!n!c7 &ar(!c+"ar7J,
    +n d!a$nos(!c de (+"'+rare '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e &oa(e .! &+s &e "An$7
    d!a$nos(!c+" de sc!/o.ren!e, (+"'+rare de"!ran(7 sa+ (+"'+rare &s!o(!c7 .7r7 a"(7
    s&ec!.!ca=!e
    488
    Tulburrile A$ective

    Dac7 e<!s(7 o a"(ernare e<(re% de ra&!d7 E:n dec+rs de /!"eJ :n(re s!%&(o%e"e
    %an!aca"e s! ce"e de&res!ve Ede e<., cA(eva /!"e de s!%&(o%e e<c"+s!v %an!aca"e
    +r%a(e de cA(eva /!"e de s!%&(o%e e<c"+s!v de&res!veJ care n+ sa(!s.ac cr!(er!!"e de
    d+ra(7 %!n!%7 &en(r+ +n e&!sod %an!aca" sa+ de&res!v %a@or, d!a$nos(!c+" es(e ce"
    de tulburare bipolar fr alt specifica3ie.
    Criteriile $e $ia/no&ti# pentru
    C5=.O, Tul-urarea 8ipolar( l. Epi&o$ Mania#al Uni#
    A2 #re(ena numai a unui sin!ur episod maniacal &ve(i pa!2 4I7) ,i nici un $el
    de episoade depresive "n trecut2
    FotD +ecurena este de$init, $ie ca o sc%imbare "n polaritate de la
    depresie, $ie ca un interval de cel puin 7 luni $r simptome maniacale2
    S2 *pisodul maniacal nu este explicat mai bine de tulburarea sc%i(oa$ectiv si
    nu este suprapus peste sc%i(o$renie, tulburarea sc%i(o$reni$orm,
    tulburarea delirant sau tulburarea psi%otic $r alt speci$icaie2
    De speci"icat dacD
    MixtD dac simptomele satis$ac criteriile pentru un episod mixt &ve(i pa!2 4IA)2
    Dac actualmente sunt satis$cute criteriile complete pentru un episod maniacal,
    mixt sau depresiv ma0or, de speci"icat statusul clinic curent si1sau elementele saleD
    UEorS Mo$eratS Sever2 %(r( ele"ente p&i@oti#eS Sever2 #u ele"ente p&i@oti#e
    &ve(i pa!2 HE5)
    u elemente catatonice &ve(i pa!2HE8)
    u debut postpartum &ve(i pa!2 H77)
    Dac actualmente nu sunt satis$cute criteriile complete pentru un episod
    maniacal, mixt sau depresiv ma0or, sa se speci"ice statusul clinic curent al
    tulburrii bipolare l sau elementele celui mai recent episodD
    "n remisiune parial2 In remisiune complet &ve(i pa!2 HE5)
    u elemente catatonice &ve(i pa!2 HE8) u debut postpartum
    &ve(i pa!2 H77)

    Criteriile $e $ia/no&ti# pentru C5=.7+ Tul-urarea 8ipolar( l2
    #el "ai re#ent Epi&o$ Fipo"ania#al
    A2 Actualmente &sau cel mai recent) "n episod %ipcmaniacal &ve(i pa!2 4I8)2
    S Anterior a existat cel puin un episod maniacal &ve(i pa!24I7) ori un episod
    mixt &ve(i pa!2 4IA)
    S ->2ptcmele a$ective cau(ea( o detres sau deteriorare semni$icativ clinic "n
    -r<eniul social, pro$esional ori "n alte domenii importante de $uncionare2
    iz, D-D3De e a$ective de la criteriile A si S nu sunt explicate mai bine de
    tul-3D
    n
    i(oa$ectiv@ ,i nu sunt suprapuse peste sc%i(o$renie,
    tulburarea 3- -3M -r,a, tulburarea deliranta sau tulburarea psi%otic
    $r alt
    Tulburarea
    Sipolar
    4>5
    Criteriile $e $ia/no&ti# pentru C5=.7+ Tul-urarea 8ipolar( l2
    #el "ai re#ent Epi&o$ Fipo"ania#al (continuare)
    De speci$icatD
    Spe#i% i#an!ii $e evolu!ie lon/itu$inal( 3Cu &i '(r( re#uperare interepi&o$i#(6
    &ve(i pa!2 48?) u pattern se(onier &se aplic numai patternului
    episoadelor depresive
    ma0ore) &ve(i pa!2 H7I) u ciclare
    rapid &ve(i pa!2 H7?)
    Criteriile $e $ia/no&ti# pentru C5=.7, Tul-urarea 8ipolar(
    l2 #el "ai re#ent Epi&o$ Mania#al
    A2 Actualmente &sau cel mai recent) "n episod maniacal &ve(i pa!2 4I7)2
    S2 Anterior a existat cel puin un episod depresiv ma0or &ve(i pa!2 4AI), un
    episod maniacal &ve(i pa!2 4I7) ori un episod mixt &ve(i pa!2 4IA)2
    2 *pisoadele a$ective de la criteriile A ,i S nu sunt explicate mai bine de
    tulburarea sc%i(oa$ectiv ,i nu sunt suprapuse peste sc%i(o$renie,
    tulburarea sc%i(o$reni$orm, tulburarea delirant sau tulburarea psi%otic
    $r alt speci$icaie2
    Dac actualmente sunt satis$cute criteriile complete pentru episodul
    maniacal, s se speci"ice statusul su clinic curent si1sau elementele celui mai
    recent episod maniacalD
    .,or3 Moderat3 Sever, $r elemente psi%otice3 Sever, cu elemente psi%otice
    &ve(i pa!2 HE4)
    u elemente catatonice &ve(i pa!2 HE8)
    u debut postpartum &ve(i pa!2 H77)
    Dac actualmente nu sunt satis$cute criteriile complete pentru un episod
    maniacal, s se speci"ice statusul cl i ni c curent al tulburrii bipolare l si1sau
    elementele celui mai recent episodmaniacalD
    "n remisiune parial, "n remisiune complet &ve(i pa!2 HEH)
    u elemente catatonice &ve(i pa!2 HE8) u debut postpartum
    &ve(i pa!2 H77)
    De speci"icat'
    Speci$icanii de evoluie lon!itudinal &u si 'r recuperare interepisodic)
    &ve(i pa!2 H7H) u pattern se(onier &se aplic numai patte-nului
    episoadelor depresive
    ma0ore) &ve(i pa!2 H7I) u
    ciclare rapid &ve(i pa!2 H7?)
    ;FL
    Tulburrile A$ective
    Criteriile $e $ia/no&ti# pentru
    C5=.=, Tul-urarea 8ipolar( l2 #el "ai re#ent Epi&o$ Mi,t
    A2 Actualmente &sau cel mai recent) "n episod mixt &ve(i pa!2 4IA)2
    S2 Anterior a existat cel puin un episod depresiv ma0or &ve(i pa!2 4AI), un
    episod maniacal &ve(i pa!2 4I7) ori un episod mixt &ve(i pa!2 4IA)2
    2 *pisoadele a$ective de la criteriile A si S nu sunt explicate mai bine de
    tulburarea sc%i(oa$ectiv ,i nu sunt suprapuse peste sc%i(o$renie,
    tulburarea sc%i(o$reni$orm, tulburarea delirant ori tulburarea psi%otic
    $r alt speci$icaie2
    Dac actualmente sunt satis$"cute criteriile complete pentru episodul mixt, s
    se speci"ice statusul clinic curent ,i1sau elementele saleD
    UEorS Mo$eratS Sever2 %(r( ele"ente p&i@oti#eS Sever2 #u ele"ente p&i@oti#e
    &ve(i pa!2 HEA)
    Cu ele"ente #atatoni#e &ve(i pa!2 HE8)
    Cu $e-ut po&tpartu" &ve(i pa!2 H77)
    Dac actualmente nu sunt satis$cute criteriile complete pentru un episod mixt,
    s se speci"ice statusul clinic curent al tulburrii bipolare l si1sau elementele
    celui mai recent episod mixtD
    .n re"i&iune par!ial(2 .n re"i&iune #o"plet( &ve(i pa!2 HEI)
    Cu ele"ente #atatoni#e &ve(i pa!2 HE8) Cu $e-ut po&tpartu"
    &ve(i pa!2 H77)
    De speci"icat'
    Spe#i%i#an!ii $e evolu!ie lon/itu$inal( 3Cu &i '(r( re#uperare interepi&o$i#(
    &ve(i pa!2 H7H) Cu pattern &e)onier &se aplic numai patternului
    episoadelor depresive
    ma0ore) &ve(i pa!2 H7I) Cu
    #i#lare rapi$( &ve(i pa!2 H7?)
    Tulburarea
    Sipolar l
    +41
    Criteriile $e $ia/no&ti# pentru
    C5=.<, Tul-urarea 8ipolar( l2 #el "ai re#ent Epi&o$ Depre&iv
    A2 Actualmente &sau cel mai recent) "n episod depresiv ma0or &ve(i pa!2 4AI)2
    S2 Anterior a existat cel puin un episod maniacal &ve(i pa!2 4I7) sau un episod
    mixt &ve(i pa!2 4IA)2
    2 *pisoadele a$ective de la criteriile A ,i S nu sunt explicate mai bine de
    tulburarea sc%i(oa$ectiv ,i nu sunt suprapuse peste sc%i(o$renie,
    tulburarea sc%i(o$reni$orm, tulburarea delirant sau tulburarea psi%otic
    $r alt speci$icaie2
    Dac actualmente sunt satis$cute criteriile complete pentru episodul depresiv
    ma0or, s se speci"ice statusul clinic curent ,i1sau elementele saleD
    UEorS Mo$eratS Sever2 %(r( ele"ente p&i@oti#eS Sever2 #u ele"ente p&i@oti#e
    &ve(i pa!2 HEE) Croni# &ve(i pa!2 HE?) Cu
    ele"ente #atatoni#e &ve(i pa!2 HE8) Cu
    ele"ente "elan#oli#e &ve(i pa!2 HE6) Cu
    ele"ente atipi#e &ve(i pa!2 H75) Cu $e-ut
    po&tpartu" &ve(i pa!2 H77)
    Dac actualmente nu sunt satis$cute criteriile complete pentru un episod
    depresiv ma0or, s se speci"ice statusul clinic curent al tulburrii bipolare l ,i1sau
    elementele celui mai recent episod depresiv ma0or D
    .n re"i&iune par!ial(2 .n re"i&iune #o"plet( &ve(i pa!2 HEE)
    Croni# &ve(i pa!2 HE?)
    Cu ele"ente #atatoni#e &ve(i HE8)
    Cu ele"ente "elan#oli#e &ve(i pa!2 HE6)
    Cu ele"ente atipi#e &ve(i pa!2 H75)
    Cu $e-ut po&tpartu" &ve(i pa!2 H77)
    7e speci"icat'
    Spe#i%i#an!ii $e evolu!ie lon/itu$inal( 3Cu &i '(r( re#uperare interepi&o$i#(
    &ve(i pa!2 H7H) Cu pattern &e)onier &se aplic numai patternului
    episoadelor depresive
    ma0ore) &ve(i pa!2 H7I) Cu
    #i#lare rapi$( &ve(i pa!2 H7?)
    ;F9
    Tulburrile A$ective
    Criteriile $e $ia/no&ti# pentru C5=.G Tul-urarea 8ipolar( l2
    #el "ai re#ent Epi&o$ Ne&pe#i%i#at
    A2 riteriile, cu excepia duratei, sunt satis$cute actualmente &ori au $ost
    $oarte recent) pentru un episod maniacal &ve(i pa!2 4I7), %ipomaniacal &ve(i
    pa!2 4I8), mixt &ve(i pa!2 4IA) ori depresiv ma0or &ve(i pa!2 4AI)2
    S2 Anterior a existat cel puin un episod maniacal &ve(i pa!24I7) ori mixt &ve(i
    pa!2 4IA)2
    2 Simptomele a$ective cau(ea( o detres sau deteriorare semni$icativ clinic
    "n domeniul social, pro$esional ori "n alte domenii importante de
    $uncionare2
    D2 Simptomele a$ective de la criteriile A si S nu sunt explicate mai bine de
    tulburarea sc%i(oa$ectiv si nu sunt suprapuse peste sc%i(o$renie,
    tulburarea sc%i(o$reni$orm ori tulburarea psi%otic $r alt speci$icaie2
    *2 Simptomele a$ective de la criteriile A si S nu sunt datorate e$ectelor $i(iolo
    !ice directe ale unei substane &de ex2, un dro! de abu(, un medicament ori
    alt tratament) ori al e unei condiii medicale !enerale &de ex2,
    %ipertiroidismul)2
    De speci"icat'
    Speci$icanii de evoluie lon!itudinal &u si 'r recuperare interepisodic)
    &ve(i pa!2 H7H) u pattern se(onier &se aplic numai patternului episoadelor
    depresive ma0ore)
    &ve(i pa!2 H7A) u ciclare
    rapid &ve(i pa!2 H7?)
    C5=.>5 Tul-urarea 8ipolar( II 3Epi&oa$e $epre&ive
    "aQore re#urente #u epi&oa$e @ipo"ania#ale6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! '!&o"are II :" cons(!(+!e evo"+=!a c"!n!c7
    carac(er!/a(7 &r!n a&ar!=!a +n+!a or! a %a! %+"(or e&!soade de&res!ve %a@ore
    Ecr!(er!+" AJ, aco%&an!a(e de ce" &+=!n +n e&!sod !&o%an!aca" Ecr!(er!+" BJ.
    E&!soade"e !&o%an!aca"e n+ (re'+!e s7 .!e con.+nda(e c+ /!"e"e de e+(!%!e care &o(
    +r%a re%!s!+%! +n+! e&!sod de&res!v %a@or. PrcXen(a +n+! e&!sod %an!aca" sa+
    %!<( e<c"+de d!a$nos(!c+" de (+"'+rare '!&o"ar7 II Ecr!(er!+" CJ. E&!soade"e de (+"'+
    rare a.ec(!v7 !nd+s7 de o s+'s(an=7 Eda(ora(e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +n+!
    %ed!ca%en(, a"(or (ra(a%en(e so%a(!ce &en(r+ de&res!e, +n+! dro$ de a'+/ sa+
    e<&+ner!! "a +n (o<!c! sa+ +ne! (+"'+r7r! a.ec(!ve da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e n+ con(ea/7 &en(r+ d!a$nos(!c+" de (+"'+rare '!&o"ar7 II. :n a.ar7 de
    aceas(a, e&!soade"e n+ (re'+!e s7 .!e e<&"!ca(e %7Q '!ne de (+"'+rarea sc!/oa.ec(!v7
    s! n+ s+n( s+&ra&+se &es(e sc!/o.ren!e, (+"'+rarea sc!/o.ren!.or%7, (+"'+rarea
    de"!ran(7 or! (+"'+rarea &s!o(!c7 .7r7 a"(7 s&ec!! V.ar!e Ecr!(er!+" DJ. S!%&(o%e"e
    76I286 Tulburarea Sipolar II &*pisoade depresive
    ma0ore recurente cu episoade %ipomamacale) +4+
    (re'+!e s7 ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" or! :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ :n +ne"e
    ca/+r!, e&!soade"e !&o%a%aca"e &r!n e"e :nseO! n+ ca+/ea/7 de(er!orare, :n
    sc!%', de(er!orarea &oa(e re/+"(a d!n e&!soade"e de&res!ve %a@ore sa+ d!n(r4+n
    &a((ern cron!c de e&!soade a.ec(!ve !%&rev!/!'!"e s! .+nc=!onare &ro.es!ona"7 sa+
    %(er&ersona"7 !ncons(an(7, ."+c(+an(7
    Ind!v!/!! c+ (+"'+rare '!&o"ar7 II &o( s7 n+ vad7 e&!soade"e !&o%a%aca"e ca
    &a(o"o$!ce, deO! ce!"a"=! &o( .! deran@a=! de co%&or(a%en(+" e<cen(r!c a" res&ec(!v!"or
    Adesea !nd!v!/!!, :n s&ec!a" cAnd se a."7 :n %!@"oc+" +n+! e&!sod de&res!v %a@or, n+4
    s! a%!n(esc &er!oade"e de !&o%a%e .7r7 evoc7r! d!n &ar(ea a%!c!"or sa+ r+de"or
    a&ro&!a(e In.or%a=!!"e &roven!nd de "a a"=! !n.or%a(or! s+n( adesea dec!s!ve :n
    s(a'!"!rea d!a$nos(!c+"+! de (+"'+rare '!&o"ar7 II
    Speci$icanti
    Ur%7(or!! s&ec!.!can &en(r+ (+"'+rarea '!&o"ar7 II (re'+!e s7 .!e +(!"!/a=! &en(r+
    a !nd!ca na(+ra e&!sod+" c+ren( sa+, dac7 cr!(er!!"e co%&"e(e n+ s+n( sa(!s.7c+(e
    ac(+a"%en(e &en(r+ +n e&!sod !&o%a%aca" sa+ +n e&!sod de&res!v %a@or, na(+ra
    ce"+! %a! recen( e&!sod
    H!&o%an!aca". Aces( s&ec!.!can( es(e +(!"!/a( dac7 e&!sod+" c+ren( Esa+ ce"
    %a! recen(J es(e +n e&!sod !&o%a%aca"
    De&res!v. Aces( s&ec!.!can( es(e +(!"!/a( dac7 e&!sod+" c+ren( Esa+ ce" %a!
    recen(J es(e +n e&!sod de&res!v %a@or
    Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v
    %a@or, +r%7(or!! s&ec!.!can(! &o( .! +(!"!/a=! &en(r+ a descr!e s(a(+s+" c"!n!c c+ren( a"
    e&!sod+"+! s! &en(r+ a descr!e e"e%en(e"e e&!sod+"+! c+ren(
    UOor8 Modera(8 Sever, .7r7 e"e%en(e &s!o(!ce8 Sever, c+ e"e%en(e &s!o(!ce
    Eve/! &a$ I55J Cron!c E_ e/! &a$ I5HJ C+
    e"e%en(e ca(a(on!ce Eve/! &a$ I5GJ C+
    e"e%en(e %e"anco"!ce Eve/! &a$ I5FJ C+
    e"e%en(e a(!&!ce Eve/! &a$ I9LJ C+ de'+(
    &os(&ar(+% Eve/! &a$ I99J
    Dac7 ac(+a"%en(e n+ s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod
    !&o%a%aca" sa+ de&res!v %a@or, +r%7(or!! s&ec!.!can(! &o( (! +(!"!/a=! &en(r+ a
    descr!e s(a(+s+" c"!n!c c+ren( a" (+"'+r7% '!&o"are II s! &en(r+ a descr!e e"e%en(e"e
    ce"+! %a! recen( e&!sod de&res!v %a@or 2n+%a! dac7 aces(a es(e ce" %a! recen( (!& de
    e&!sod a.ec(!vJ
    In re%!s!+ne &ar=!a"7, :n re%!s!+ne co%&"e(7 Eve/! &a$ I55J
    Cron!c Eve/! &a$ I5
    H
    J
    C+ e"e%en(e ca(a(on!ce Eve/! &a$ I5GJ
    C+ e"e%en(e %e"anco"!ce Eve/! &a$ I5FJ
    C+ e"e%en(e a(!&!ce Eve?
    5
    &a$ I9LJ
    C+ de'+( &os(&ar(+% (U e/! &a$ I99J
    ;FI Tulburrile A$ective
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a !nd!ca &a((ern+" sa+ .recven=a
    e&!soade"orQ
    Specifican3ii evolu3iei lon.itudinale *(u /i )r recuperare interepisodic
    Eve/! &a$. I9IJ C+ &a((ern se/on!er Ese a&"!c7 n+%a! &a((ern+"+! e&!soade"or
    de&res!ve %a@oreJ
    Eve/! &a$. I9RJ C+ c!c"are
    ra&!d7 Eve/! &a$. I9HJ
    #rocedee de "nre!istrare
    Cod+" d!a$nos(!c &en(r+ (+"'+rarea '!&o"ar7 II es(e 9FR.GF8 n!c! +n+" d!n(re
    s&ec!.!can=! n+ es(e cod!.!ca'!". La :nre$!s(rarea den+%!r!! d!a$nos(!c+"+!, (er%en!!
    (re'+!e s7 .!e %en=!ona=! :n +r%7(oarea ord!neQ (+"'+rare '!&o"ar7 II, s&ec!.!can=!!
    !nd!cAnd e&!sod+" c+ren( sa+ &e ce" %a! recen( Ede e<., !&o%an!aca", de&res!vJ,
    s&ec!.!can=!! de sever!(a(e care se a&"!c7 e&!sod+"+! de&res!v %a@orJ Ede e<.,
    %odera(J (o( a(A=!a s&ec!.!can=! cA=! se a&"!c7 e&!sod+"+! de&res!v %a@or c+ren( sa+
    ce"+! %a! recen( Ede e<., c+ e"e%en(e %e"anco"!ce, c+ de'+( &os(&ar(+%J O! (o( a(A=!a
    s&ec!.!can=! cA=! cores&+nd evo"+=!e! e&!soade"or Ede e<., c+ &a((ern se/on!erJ8 de
    e<e%&"+, 9FR.GF T+"'+rare '!&o"ar7 II, e&!sod de&res!v, sever, c+ e"e%en(e
    &s!o(!ce, c+ e"e%en(e %e"anco"!ce, c+ &a((ern se/on!er.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. S+!c!d+" co%&"e( Ede
    re$+"7, :n c+rs+" e&!soade"or de&res!ve %a@oreJ es(e +n r!sc !%&or(an(, s+rven!nd "a
    5Ld45Yd d!n(re &ersoane"e c+ (+"'+rare '!&o"ar7 II. C!+"+" de "a scoa"7, eOec+"
    Oco"ar, eOec+" &ro.es!ona" sa+ d!vor=+", &o( .! asoc!a(e c+ (+"'+rarea '!&o"ar7 II.
    T+"'+r7r!"e %en(a"e asoc!a(e !nc"+d a'+/+" sa+ de&enden=a de o s+'s(an=7,
    anore<!a nervoas7, '+"!%!a nervoas7, (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e,
    &an!ca, .o'!a soc!a"7 O! (+"'+rarea de &ersona"!(a(e 'order"!ne.
    9ate de laborator asociate. D+&7 cA( se &are n+ e<!s(7 e"e%en(e de "a'ora(or
    care s7 .!e d!a$nos(!ce &en(r+ (+"'+rarea '!&o"ar7 II sa+ care s7 d!s(!n$7 e&!soade"e
    de&res!ve %a@ore d!n (+"'+rarea '!&o"ar7 II de ce"e d!n (+"'+rarea de&res!v7 %a@or7
    sa+ d!n (+"'+rarea '!&o"ar7 I.
    9atele examinrii somatice /i condi3ii medicale .enerale asociate. O e(a(e "a
    de'+( &en(r+ &r!%+" e&!sod !&o%an!aca" d+&7 e(a(ea de IL an! (re'+!e s7 a"er(e/e
    c"!n!c!an+" as+&ra &os!'!"!(7=!! ca s!%&(o%e"e s7 .!e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e sa+ +/+"+! +ne! s+'s(an=e. H!&o(!ro!d!s%+" ac(+a"%en(e sa+ :n (rec+( sa+
    da(e"e de "a'ora(or des&re o !&o.+nc=!e (!ro!d!an7 +Ooar7 &o( .! asoc!a(e c+ c!c"area
    ra&!d7 Eve/! &a$. I9HJ. :n &"+s, !&er(!ro!d!s%+" &oa(e &rec!&!(a sa+ :nr7+(7=!
    s!%&(o%e"e "a !nd!v!/!! c+ o (+"'+rare a.ec(!v7 &ree<!s(en(7. La a"=! !nd!v!/! :ns7
    !&er(!ro!d!s%+" n+ ca+/ea/7 de re$+"7 s!%&(o%e !&o%an!aca"e.
    *lemente speci$ice sexului
    T+"'+rarea '!&o"ar7 II &are a .! %a! .recven(7 "a .e%e! decA( "a '7r'a=!. Se<+" &are
    a .! :n "e$7(+ra7 c+ n+%7r+" s! (!&+" de e&!soade !&o%an!aca"e s! de&res!ve %a@ore.
    La '7r'a=! n+%7r+" de e&!soade !&o%an!aca"e es(e e$a" sa+ de&7OeO(e &e ce" a"
    76I286 Tulburarea Sipolar II &*pisoade depresive ma0ore
    recurente cu episoade %ipomaniacaie) 46A
    e&!soade"or de&res!ve %a@ore, &e cAnd "a .e%e! &redo%!n7 e&!soade"e de&res!ve
    %a@ore, :n a.ar7 de aceas(a, c!c"area ra&!d7 Eve/! &a$. I9HJ es(e %a! .recven(7 "a
    .e%e! decA( "a '7r'a=!. Une"e da(e s+$erea/7 c7 s!%&(o%e"e %!<(e sa+ de&res!ve d!n
    c+rs+" e&!soade"or !&o%an!aca!e &o( .!, de ase%enea, %a! .recven(e "a .e%e!, deO!
    n+ (oa(e s(+d!!"e s+n( de acord c+ aceas(a. Dec!, .e%e!"e &o( .! e<&+se +n+! r!sc
    a&ar(e &en(r+ s!%&(o%e"e de&res!ve sa+ a%es(eca(e. Fe%e!"e c+ (+"'+rare '!&o"ar7
    II &o( .! e<&+se +n+! r!sc cresc+( de a &re/en(a e&!soade s+'secven(e :n &er!oada de
    &os(&ar(+% !%ed!a(.
    #revalent
    S(+d!!"e co%+n!(are s+$erea/7 o &reva"en(7 &e v!a=7 a (+"'+r7r!! '!&o"are II de
    a&ro<!%a(!v L,Yd.
    *voluie
    A&ro<!%a(!v RLd4HLd d!n(re e&!soade"e !&o%an!aca!e d!n (+"'+rarea '!&o"ar7
    II s+rv!n !%ed!a( :na!n(e sa+ d+&7 +n e&!sod de&res!v %a@or. E&!soade"e
    !&o%an!aca!e &reced adesea sa+ +r%ea/7 e&!soade"or de&res!ve %a@ore :n(r4+n
    &a((ern carac(er!s(!c &en(r+ o an+%!(7 &ersoan7. N+%7r+" de e&!soade Ea(A(
    !&o%an!aca!e, cA( s! de&res!ve %a@oreJ &e v!a=7 (!nde a .! %a! %are &en(r+
    (+"'+rarea '!&o"ar7 II, :n co%&ara=!e c+ (+"'+rarea de&res!v7 %a@or7 rec+ren(7.
    In(erva"+" d!n(re e&!soade (!nde a descreO(e &e %7s+r7 ce !nd!v!d+" :na!n(ea/7 :n
    e(a(e. A&ro<!%a(!v Yd45Yd d!n(re !nd!v!/!! c+ (+"'+rare '!&o"ar7 II a+ e&!soade
    a.ec(!ve E!&o%an!aca!e sa+ de&res!ve %a@oreJ n+%eroase E&a(r+ sa+ %a! %+"(eJ
    s+rven!nd :n c+rs+" +n+! an da(. Dac7 es(e &re/en( aces( &a((ern, e" es(e %en=!ona(
    &r!n s&ec!.!can(+" Sc+ c!c"are ra&!d7TEve/! &a$. I9HJ. Un &a((ern de c!c"are ra&!d7
    es(e asoc!a( c+ +n &ro$nos(!c r7+.
    DeO! %a@or!(a(ea !nd!v!/!"or c+ (+"'+rare '!&o"ar7 II rev!n co%&"e( "a n!ve"+"
    an(er!or de .+nc=!onare :n(re e&!soade, a&ro<!%a(!v 5Yd con(!n+7 s7 &re/!n(e
    "a'!"!(a(e a.ec(!v7 O! d!.!c+"(7=! !n(er&ersona"e O! &ro.es!ona"e, :n e&!soade"e
    !&o%an!aca!e n+ a&ar s!%&(o%e &s!o(!ce, !ar :n e&!soade"e de&res!ve %a@ore d!n
    (+"'+rarea '!&o"ar7 II s+n( %a! &+=!n .recven(e decA( :n ce"e d!n (+"'+rarea '!&o"ar7
    I. Une"e da(e s+n( concordan(e c+ o'serva=!a c7 %od!.!c7r! se%n!.!ca(!ve :n r!(%+"
    so%n4v!$!"!(a(e, c+% ar .! ce"e s+rven!nd :n c+rs+" sc!%'7r!"or de .+s orar or! a"
    de&r!v7r!! de so%n, &o( &rec!&!(a sa+ e<acer'a e&!soade"e !&o%an!aca!e sa+
    de&res!ve %a@ore. Dac7 +n e&!sod %an!aca" sa+ %!<( a&are :n c+rs+" (+"'+r7r!!
    '!&o"are II, d!a$nos(!c+" es(e sc!%'a( :n ce" de (+"'+rare '!&o"ar7 I. Pes(e Y an! de
    "a de'+(, a&ro<!%a(!v Yd45Yd d!n !nd!v!/!! c+ (+"'+rare '!&o"ar7 II vor de/vo"(a +n
    e&!sod %an!aca".
    #attern $amilial
    Une"e s(+d!! a+ !nd!ca( c7 r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+
    (+"'+rare '!&o"ar7 II a+ ra(e cresc+(e de (+"'+rare '!&o"ar7 II, (+"'+rare '!&o"ar7 I
    s! (+"'+rare de&res!v7 %a@or7 :n co%&ara=!e c+ &o&+"a=!a $enera"7.
    Dia!nostic di$erenial
    E&!soade"e !&o%an!aca!e s! de&res!ve %a@ore d!n (+"'+rarea '!&o"ar7 II (re'+!e
    s7 .!e d!s(!nse de e&!soade"e +ne! (+"'+r7r! a.ec(!ve da(ora(e +ne! cond!=!!
    +4> Tulburrile A$ective
    %ed!ca"e $enera"e D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e &en(r+ e&!soade"e cons!dera(e a .! consec!n=a .!/!o"o$!c7
    d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e s&ec!.!ce Ede e< , sc"ero/7 %+"(!&"7, !c(+s,
    !&o(!ro!d!s%J Eve/! &a$ IL5J Aceas(7 conc"+/!e se 'a/ea/7 &e !s(or!c, da(e"e de
    "a'ora(or s! e<a%en+" so%a(!c
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de e&!soade"e
    !&o%an!aca"e sa+ de&res!ve %a@ore care s+rv!n :n (+"'+rarea '!&o"ar7 II &r!n
    .a&(+" c7 o s+'s(an=7 Ede e< , +n dro$ de a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n
    (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$ ILYJ
    S!%&(o%e s!%!"are ce"or o'serva(e :nrr4+n e&!sod !&o%a%aca" &o( .! &ar(e a +ne!
    !n(o<!ca=!! or! a's(!nen(e de +n dro$ de a'+/ s! (re'+!e s7 .!e d!a$nos(!ca(e ca
    (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 Ede e<, +n e&!sod s!%!"ar e&!sod+"+!
    de&res!v %a@or, s+rven%d n+%a! :n con(e<(+" a's(!nen(e! de coca!n7, (re'+!e s7 .!e
    d!a$nos(!ca( ca (+"'+rare a.ec(!v7 !nd+s7 de coca!n7, c+ e"e%en(e de&res!ve, c+
    de'+( :n c+rs+" a's(!nen(e!J S!%&(o%e s!%!"are ce"or o'serva(e :n(r4+n e&!sod
    !&o%a%aca" &o( .!, de ase%enea, &rec!&!(a(e de +n (ra(a%en( an(!de&res!v, de
    e<e%&"+, de +n %ed!ca%en(, de (era&!a e"ec(roconv+"s!van(7 or! de .o(o(era&!e
    As(.e" de e&!soade &o( .! d!a$nos(!ca(e ca (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7
    Ede e< , (+"'+rare a.ec(!v7 !nd+s7 de a%!(n&(!"%7, c+ e"e%en(e %an!aca"e, (+"'+rare
    a.ec(!v7 !nd+s7 de (era&!e e"ec(roconv+"s!van(7, c+ e"e%en(e %an!aca"eJ s! n+ va
    con(a &en(r+ +n d!a$nos(!c de (+"'+rare '!&o"ar7 II CAnd :ns7 +/+" de o s+'s(an=7
    sa+ %ed!ca%en( n+ es(e cons!dera( a e<&"!ca co%&"e( e&!sod+" Ede e<, e&!sod+"
    con(!n+7 :n %od !nde&enden( o &er!oad7 cons!dera'!"7 de (!%& d+&7 :n(rer+&erea
    s+'s(an=e!J, e&!sod+" va con(a &en(r+ +n d!a$nos(!c de (+"'+rare '!&o"ar7 II
    T+"'+rarea '!&o"ar7 II se d!s(!n$e de (+"'+rarea de&res!v7 %a@or7 &r!n !s(or!c+"
    &e v!a(7 a ce" &+=!n +n e&!sod !&o%a%aca" A(en=!a acorda(7 :n c+rs+" !n(erv!+"+!
    .a&(+"+! dac7 e<!s(7 +n !s(or!c de !&o%a%e e+.or!c7 sa+ d!s.onc7 es(e !%&or(an( :n
    e.ec(+area d!a$nos(!c+"+! d!.eren=!a" T+"'+rarea '!&o"ar7 II se d!s(!n$e de
    (+"'+rarea '!&o"ar7 I &r!n &re/en(a +n+!a sa+ a %a! %+"(or e&!soade %an!aca"e sa+
    %!<(e :n aceas(a d!n +r%7 CAnd +n !nd!v!d, d!a$nos(!ca( an(er!or c+ (+"'+rare
    '!&o"ar7 II, &re/!n(7 +n e&!sod %an!aca" sa+ %!<(, d!a$nos(!c+" es(e sc!%'a( :n ce"
    de (+"'+rare '!&o"ar7 I
    :n (+"'+rarea c!c"o(!r%c7, e<!s(7 n+%eroase &er!oade de S!%&(o%e
    !&o%an!aca"e s! n+%eroase &er!oade de s!%&(o%e de&res!ve care n+ sa(!s.ac
    cr!(er!!"e s!%&(o%a(o"o$!ce sa+ de d+ra(7 &en(r+ +n e&!sod de&res!v %a@or
    T+"'+rarea '!&o"ar7 II se d!s(!n$e de (+"'+rarea c!c"o(!%!c7 &r!n &re/en(a +n+!a sa+
    a %a! %+"(or e&!soade de&res!ve %a@ore Dac7 +n e&!sod de&res!v %a@or s+rv!ne
    d+&7 &r!%!! 9 an! de (+"'+rare c!c"o(!%!c7, es(e &+s d!a$nos(!c+" ad!=!ona" de
    (+"'+rare '!&o"ar7 II
    T+"'+rarea '!&o"ar7 II (re'+!e s7 .!e d!s(!ns7 de (+"'+r7r!"e &s!oce Ede e<,
    (+"'+rarea sc!/oa.ec(!v7, sc!/o.ren!e s! (+"'+rarea de"!ran(7J Sc!/o.ren!a,
    (+"'+rarea sc!/oa.ec(!v7 s! (+"'+rarea de"!ran(7 s+n( carac(er!/a(e (oa(e &r!n
    &er!oade de s!%&(o%e &s!oce care s+rv!n :n a'sen(a +nor s!%&(o%e a.ec(!ve
    &roe%!nen(e A"(e cons!deren(e +(!"e !nc"+d s!%&(o%e"e de aco%&an!a%en(,
    evo"+=!a an(er!oar7 s! !s(or!c+" .a%!"!a"
    76I286 Tulburarea Sipolar II &*pisoade depresive
    ma0ore recurente cu episoade %ipomaniacale) ;FH
    Criteriile $e $ia/no&ti# pentru C5=.>5 Tul-urarea 8ipolar( II
    A2 #re(enta &sau istoricul) unuia sau a mai multe episoade depresive ma0ore
    &ve(i pa! 4AI)
    S2 #re(enta &sau istoricul) a cel putm un episod %ipomamacal &ve(i pa! 4I8)
    2 Fu a existat niciodat un episod maniacal &pa! 4I7) ori un episod mixt &pa! 4IA)
    D2 Simptomele a$ective de la criteriile A si S nu sunt explicate mai bine de
    tulburarea sc%i(oa$ectiv si nu sunt suprapuse peste sc%i(o$renie,
    tulburarea sc%i(o$rem$orm, tulburarea delirant sau tulburarea psi%otic
    $r alt speci$icaie
    *2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare
    De speci"icat episodul curent sau cel mai recent
    Lipomaniacal dac actualmente &sau cel mai recent) "n episod %ipomamacal
    &ve(i pa! 4I8) DepresivD dac actualmente &sau cel mai recent) "n
    episod depresiv ma0or
    &ve(i pa! 4AI)
    Dac actualmente sunt satis$"cute criteriile complete pentru episodul depresiv
    ma0or, s se speci"ice statusul clinic curent si1sau elementele sale
    .,or3 Moderat3 Sever, $r elemente psi%ottce3 Sever, cu elemente psi%otice
    &ve(i pa! HEE) ronic &ve(i pa! HE?) u
    elemente catatonice &ve(i HE8) u
    elemente melancolice &ve(i pa! HE6) u
    elemente atipice &ve(i pa! H75) u debut
    postpartum &ve(i pa! H77)
    Dac actualmente nu sunt satis$cute criteriile complete pentru un episod
    %ipomamacal sau depresiv ma0or, sa se speci"ice statusul clinic al tulburm
    bipolare II si1sau elementele celui mai recent episod depresiv ma0or &numai
    dac acesta este cel mai recent tip de episod a$ectiv)
    "n remisiune parial, "n remisiune complet &ve(i pa! HEE) FotD odurile
    cu cinci ci$re speci$icate la pa! HE4 nu pot $i utili(ate aici deoarece codul
    pentru tulburareabipolar II utili(ea( de3a cea de a cmcea ci$r
    ronic &ve(i pa! HE?)
    u elemente catatonice &ve(i pa! HE8)
    u elemente melancolice &ve(i pa! HE6)
    u elemente atipice &ve(i pa! H75)
    u debut postpartum &ve(i pa! H77)
    De speci"icat
    Speci$icantii evoluiei lon!itudinale &u si 'r recuperare interepisodic)
    &ve(i pa! H7H)
    u pattern se(onier &se aplic numai patternuMui episoadelor depresive
    ma0ore) &ve(i pa! H7I) u
    ciclare rapid &ve(i pa! H7?)
    ;FG Tulburrile A$ective

    4+*.*4 Tul-urarea #i#loti"i#(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! c!c"o(!%!ce :" cons(!(+!e o
    &er(+r'are a.ec(!v7 ."+c(+an(7, cron!c7, !%&"!cAnd n+%eroase
    &er!oade de s!%&(o%e !&o%an!aca"e Eve/! &a$. ;RYJ s!
    n+%eroase &er!oade de s!%&(o%e de&res!ve Eve/! &a$. ;IFJ
    Ecr!(er!+" AJ. S!%&(o%e"e !&o%an!aca"e s+n( !ns+.!c!en(e ca
    n+%7r, sever!(a(e, &ervas!v!(a(e sa+ d+ra(7 &en(r+ a sa(!s.ace
    cr!(er!!"e co%&"e(e &en(r+ +n e&!sod %an!aca", !ar s!%&(o%e"e
    de&res!ve s+n(, de ase%enea, !ns+.!c!en(e ca n+%7r,
    sever!(a(e, &ervas!v!(a(e sa+ d+ra(7 &en(r+ a sa(!s.ace cr!(er!!"e
    co%&"e(e &en(r+ +n e&!sod de&res!v %a@or. N+ es(e necesar :ns7
    ca n!c! +na d!n(re &er!oade"e de s!%&(o%e !&o%an!aca"e s7
    sa(!s.ac7 .!e cr!(er!+" de d+ra(7, .!e cr!(er!+" &ra$+"+! de s!%&(o%
    &en(r+ +n e&!sod !&o%an!aca". :n c+rs+" &er!oade! de 9 an! E"
    an &en(r+ co&!! O! ado"escen=!J, n!c! +n !n(erva" .7r7 s!%&(o%e n+
    d+rea/7 %a! %+"( de 9 "+n! Ecr!(er!+" BJ. D!a$nos(!c+" de
    (+"'+rare c!c"o(!%!c7 se &+ne n+%a! dac7 :n &er!oada !n!=!a"7 de
    9 an! de s!%&(o%e c!c"o(!%!ce n+ s+n( &re/en(e e&!soade de&res!ve
    %a@ore, %an!aca"e sa+ %!<(e Ecr!(er!+" CJ. D+&7 ce! 9 an! !n!=!a"!
    a! (+"'+r7r!! c!c"o(!%!ce, e&!soade %an!aca"e sa+ %!<(e &o( .!
    s+&ra&+se &es(e (+"'+rarea c!c"o(!%!c7, :n care ca/ s+n(
    d!a$
    nos(
    !ca(e
    a(A(
    (+"'
    +rar
    ea
    c!c"
    o(!%
    !c7,
    cA(
    s!
    (+"'
    +rar
    ea
    '!&o
    "ar7
    II.
    D!a
    $nos
    (!c+"
    n+
    es(e
    &+s
    dac7 &a((ern+" de osc!"a=!! a.ec(!ve es(e e<&"!ca( %a! '!ne de
    (+"'+rarea sc!/oa.ec(!v7 sa+ es(e s+&ra&+s &es(e o (+"'+rare
    &s!o(!c7, de e<., &es(e sc!/o.ren!e sa+ (+"'+rarea
    sc!/o.ren!.or%7, (+"'+rarea de"!ran(7 sa+ (+"'+rarea &s!o(!c7
    .7r7 a"(7 s&ec!.!ca=!e Ecr!(er!+" DJ :n care ca/ s!%&(o%e"e a.ec(!ve
    s+n( cons!dera(e a .! e"e%en(e asoc!a(e a"e (+"'+r7r!! &s!o(!ce.
    De ase%enea, (+"'+rarea a.ec(!v7 n+ (re'+!e s7 se da(ore/e
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de
    a'+/, +n %ed!ca%en(J or! +ne! cond!=!! %ed!ca"e $enera"e
    Ede e<., !&er(!ro!d!s%+"J Ecr!(er!+" EJ. DeO! +n!! oa%en! &o(
    .+nc=!ona e<(re% de '!ne :n c+rs+" +nor &er!oade de
    !&o%an!e, :n $enera" (re'+!e s7 e<!s(e o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona"
    or! :n a"(e do%en!! !%&or(an(e de .+nc=!onare ca re/+"(a( a"
    &er(+r'7r!! a.ec(!ve Ecr!(er!+" FJ. De(er!orarea &oa(e a&are ca
    re/+"(a( a" +nor &er!oade &re"+n$!(e de %od!.!c7r! a.ec(!ve
    c!c"!ce, adesea !%&rev!/!'!"e Ede e<., &ersoana &oa(e .!
    cons!dera(7 ca .!!nd (e%&era%en(a"7, ca&r!c!oas7, !%&rev!/!'!"7,
    !ncons(an(7, :n care n+ &o( avea :ncredereJ.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Po( .!
    &re/en(e (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 s! (+"'+r7r! de
    so%n Ead!c7, d!.!c+"(7=! :n !n!=!erea s! %en=!nerea so%n+"+!J.
    *lemente speci$ice etii si sexului
    T+"'+rarea c!c"o(!%!c7 :nce&e adesea &recoce :n v!a=7, !ar
    +neor! es(e cons!dera(7 a re."ec(a o &red!s&o/!=!e
    (e%&era%en(a"7 &en(r+ a"(e (+"'+r7r! a.ec(!ve E:n s&ec!a", &en(r+
    (+"'+r7r!"e '!&o"areJ. Pe eOan(!oane"e co%+n!(are, (+"'+rarea
    c!c"o(!%!c7 es(e, d+&7 cA( se &are, "a .e" de .recven(7 "a '7r'a=!
    s! "a .e%e!, :n cond!=!! c"!n!ce, .e%e!"e c+ (+"'+rare c!c"o(!%!c7
    es(e
    &os!
    '!"
    s7
    .!e
    &re/
    en(e
    &en(
    r+
    (ra(
    a%e
    n(
    :n(r4
    +n
    &ro
    cen(
    %a!
    %ar
    e
    dec
    A(
    '7r
    'a=!
    !.
    Tulburrile
    A$ective
    +44
    #revalent
    S(+d!!"e a+ ra&or(a( o &reva"en(7 a (+"'+r7r!! c!c"o(!%!ce &e v!a=7 %er$And de "a
    L,Id &An7 "a 5d. Preva"en(a :n c"!n!c!"e de (+"'+r7r! a.ec(!ve &oa(e %er$e de "a ;d
    &An7 "a Yd.
    *voluie
    T+"'+rarea c!c"o(!%!c7 :nce&e de re$+"7 :n ado"escen=7 sa+ &recoce :n v!a=a
    ad+"(7. De'+(+" (+"'+r7r!! c!c"o(!%!ce (ard!v :n v!a=a ad+"(7 &oa(e s+$era o
    (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, c+% ar .! sc"ero/a
    %+"(!&"7. T+"'+rarea c!c"o(!%!c7 are de re$+"7 +n de'+( !ns!d!os s! o evo"+=!e
    cron!c7. E<!s(7 +n r!sc de 5Y4YLd ca &ersoane"e res&ec(!ve s7 de/vo"(e +"(er!or o
    (+"'+rare '!&o"ar7 I sa+ II.
    #attern $amilial
    T+"'+rarea de&res!v7 %a@or7 s! (+"'+rarea '!&o"ar7 I sa+ II &ar a .! %a! .recven(e
    &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e &ersoane"or c+ (+"'+rare c!c"o(!%!c7 decA(
    :n &o&+"a=!a $enera"7. Poa(e e<!s(a, de ase%enea, +n r!sc .a%!"!a" cresc+( de
    (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7, :n a.ar7 de aceas(a, (+"'+rarea c!c"o(!%!c7
    &oa(e .! %a! .recven(7 "a r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare
    '!&o"ar7 I.
    Dia!nostic di$erenial
    T+"'+rarea c!c"o(!%!c7 &oa(e .! d!s(!ns7 de o (+"'+rare a.ec(!v7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" es(e ce" de (+"'+rare a.ec(!v7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, c+ e"e%en(e %!<(e, cAnd &er(+r'area a.ec(!v7 es(e
    cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!! %ed!ca"e
    $enera"e, de re$+"7 cron!c7 Ede e<., !&er(!ro!d!s%+"J Eve/! &a$. IL5J. Aceas(7
    conc"+/!e se 'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c. Dac7 se
    cons!der7, :ns7, c7 s!%&(o%e"e de&res!ve n+ s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a
    cond!=!e! %ed!ca"e $enera"e, a(+nc! (+"'+rarea a.ec(!v7 &r!%ar7 es(e :nre$!s(ra(7 &e
    a<a I Ede e<., (+"'+rare c!c"o(!%!c7J, !ar cond!=!a %ed!ca"7 $enera"7 es(e :nre$!s(ra(7 &e
    a<a III. Aces(a ar .! ca/+", de e<e%&"+, dac7 s!%&(o%e"e a.ec(!ve s+n( cons!dera(e a .!
    consec!n=a &s!o"o$!c7 a .a&(+"+! de a avea o cond!=!e %ed!ca"7 $enera"7 or! dac7 n+
    e<!s(7 n!c! o re"a=!e e(!o"o$!c7 :n(re s!%&(o%e"e a.ec(!ve s! cond!=!a %ed!ca"7 $enera"7.
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de (+"'+rarea c!c"o(!%!c7
    &r!n .a&(+" c7 o s+'s(an=7 E:n s&ec!a", o s+'s(an=7 s(!%+"an(7J es(e cons!dera(7 a .!
    e(!o"o$!c :n re"a=!e c+ &er(+r'area a.ec(!v7 Eve/! &a$. ILYJ. Osc!"a=!!"e a.ec(!ve
    .recven(e care s+n( s+$es(!ve de (+"'+rare c!c"o(!%!c7 d!s&ar de re$+"7 d+&7
    :nce(area +/+"+! de dro$.
    T+"'+rarea '!&o"ar7 I, c+ c!c"are ra&!d7 s! (+"'+rarea '!&o"ar7 II c+ c!c"are
    ra&!d7 se asea%7n7 a%'e"e c+ (+"'+rarea c!c"o(!%!c7 :n v!r(+(ea .recven(e"or s!
    %arca(e"or co%+(7r! a.ec(!ve. Pr!n de.!n!=!e, s(7r!"e a.ec(!ve d!n (+"'+rarea
    c!c"o(!%!c7 n+ sa(!s.ac cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or,
    %an!aca" sa+ %!<(, avAnd :n vedere .a&(+" c7 s&ec!.!can(+" Sc+ c!c"are ra&!d7T cere
    s7 .!e &re/en(e e&!soade a.ec(!ve co%&"e(e. Dac7 +n e&!sod de&res!v %a@or,
    %an!aca" sa+ %!<( s+rv!ne :n c+rs+" evo"+=!e! +ne! (+"'+r7r! c!c"o(!%!ce de@a
    e<!s(en(e, es(e &+s d!a$nos(!c+", .!e de (+"'+rare '!&o"ar7 I E&en(r+ +n e&!sod
    7++ Tulburrile A$ective
    %an!aca" sa+ %!<(J, .!e de (+"'+rare '!&o"ar7 II E&en(r+ +n e&!sod de&res!v %a@orJ,
    :%&re+n7 c! d!a$nos(!c+" de (+"'+rare c!c"o%!c7
    T+"'+rarea de &ersona"!(a(e 'order"!ne es(e asoc!a(7 c+ co%+(7r! %arca(e de
    d!s&o/!=!e care &o( s+$era (+"'+rarea c!c"o(!%!c7 Dac7 s+n( sa(!s.7c+(e cr!(er!!"e
    &en(r+ .!ecare (+"'+rare, &o( .! d!a$nos(!ca(e, a(A( (+"'+rarea de &ersona"!(a(e
    'order"!ne, cA( s! (+"'+rarea c!c"o(!%!c7
    Criteriile $e $ia/no&ti# pentru 4+*.*4 Tul-urarea Ci#loti"i#(
    A #entru cel puin 7 ani, pre(enta a numeroase perioade de simptome
    %ipomaniacale &ve(i pa! 4I8) si a numeroase perioade de simptome
    depresive care nu satis$ac criteriile pentru un episod depresiv ma0or FotD
    La copii si la adolesceni, durata trebuie s $ie de cel puin un an
    S "n cursul perioadei de 7 ani de mai sus &E an pentru copii si adolesceni)
    persoana nu s-a a$lat $r simptomele de la criteriul A pentru mai mult de 7
    luni odat
    FII un episod depresiv ma0or &pa! 4AI), episod maniacal &pa! 4I7) ori
    episod mixt &pa! 4IA) nu a $ost pre(ent "n cursul primilor 7 ani ai perturbrii
    Fot Dup cei 7 ani iniiali de tulburare ciclotimic &E an la copii si la
    adolesceni), pot $i suprapuse episoade maniacale sau mixte &"n care ca( pot
    $i dia!nosticate, at@t tulburarea bipolar l, c@t si tulburarea ciclotimic) ori
    episoade depresive ma0ore &"n care ca( pot $i dia!nosticate, at@t tulburarea
    bipolar II, c@t si tulburarea ciclotimic)
    D Simptomele de la criteriul A nu sunt explicate mai bine de tulburarea sc%i(o-
    a$ectiv si nu sunt suprapuse peste sc%i(o$renie, tulburarea sc%i(o$rem-
    $orm, tulburarea delirant ori tulburarea psi%otic $r alt speci$icaie
    * Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex, un dro! de abu(, un medicament) ori ale unei condiii medicale
    !enerale &de ex , %ipertiroidismul)
    ' Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare
    C5=.>+ Tul-urarea 8ipolar( '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a (+"'+r7% '!&o"are .7r7 a"(7 s&ec!.!ca=!e !nc"+de (+"'+r7r! c+ e"e%en(e
    '!&o"are care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare '!&o"ar7 s&ec!.!c7
    E<e%&"e"e !nc"+d
    1 A"(ernarea .oar(e ra&!d7 E:n dec+rs de cA(eva /!"eJ :n(re s!%&(o%e %an!aca"e s!
    s!%&(o%e de&res!ve care sa(!s.ac cr!(er!!"e de &ra$ &en(r+ s!%&(o%, dar n+
    sa(!.ac cr!(er!!"e de d+ra(7 %!n!%7 &en(r+ +n e&!sod %an!aca" or! &en(r+ +n
    e&!sod de&res!v %a@or
    2 E&!soade !&o%an!aca"e rec+ren(e, .7r7 s!%&(o%e de&res!ve !n(erc+ren(e
    3 Un e&!sod %an!aca" sa+ %!<( s+&ra&+s &es(e (+"'+rarea de"!ran(7, sc!/o.ren!a
    reX!d+a"7 or! (+"'+rarea &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e
    Alte Tulburri
    A$ective
    IL5
    4. E&!soade"e !&o%an!aca"e :%&re+n7 c+ s!%&(o%e de&res!ve cron!ce, care s+n(
    &rea rare &en(r+ a @+s(!.!ca +n d!a$nos(!c de (+"'+rare c!c"o(!%!c7.
    5. S!(+a=!!"e :n care c"!n!c!an+" a conc"+/!ona( c7 es(e &re/en(7 o (+"'+rare '!&o"ar7,
    dar es(e !nca&a'!" s7 &rec!/e/e dac7 aceas(a es(e &r!%ar7, da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e or! !nd+s7 de o s+'s(an=7.
    Alte Tul-ur(ri A%e#tive
    C54.>4 Tul-urarea A%e#tiv( $atorat(
    unei Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! a.ec(!ve da(ora(e +ne! cond!=!! %ed!ca"e $enera"e
    :" cons(!(+!e o &er(+r'are &ers!s(en(7 O! &roe%!nen(7 a d!s&o/!=!e!, cons!dera(7 a .!
    da(ora(7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e.
    Per(+r'area a.ec(!v7 &oa(e !%&"!ca d!s&o/!=!a de&res!v7, sc7derea cons!dera'!"7 a
    !n(eres+"+! O! &"7cer!! or! d!s&o/!=!a cresc+(7, e<&ans!v7 sa+ !r!(a'!"7 Ecr!(er!+" AJ.
    DeO! (a'"o+" c"!n!c a" &er(+r'7r!! a.ec(!ve &oa(e .! ase%7n7(or c+ ce" a" e&!sod+"+!
    de&res!v %a@or, %an!aca", %!<( sa+ !&o%an!aca", n+ es(e necesar s7 .!e sa(!s.7c+(e
    cr!(er!!"e co%&"e(e &en(r+ n!c! +n+" d!n(re aces(e e&!soade8 (!&+" de s!%&(o%e
    &redo%!nan(e &oa(e .! !nd!ca( &r!n +(!"!/area +n+!a d!n(re +r%7(oare"e s+'(!&+r!Q c+
    e"e%en(e de&res!ve, c+ e&!sod s!%!"ar e&!sod+"+! de&res!v %a@or, c+ e"e%en(e
    %an!aca"e or! c+ e"e%en(e %!<(e. D!n !s(or!c, e<a%en+" so%a(!c or! da(e"e de
    "a'ora(or, (re'+!e s7 .!e ev!den( .a&(+" c7 &er(+r'area es(e consec!n=a .!/!o"o$!c7
    d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" BJ. Per(+r'area a.ec(!v7 n+ es(e
    e<&"!ca(7 %a! '!ne de o a"(7 (+"'+rare %en(a"7 Ede e<., (+"'+rarea de ada&(are c+
    d!s&o/!=!e de&res!v7 care s+rv!ne ca r7s&+ns "a s(res+" &s!osoc!a" a" .a&(+"+! de a
    avea cond!=!a %ed!ca"7 $enera"7J Ecr!(er!+" CJ. De ase%enea, d!a$nos(!c+" n+ se
    &+ne dac7 &er(+r'area a.ec(!v7 s+rv!ne n+%a! :n c+rs+" +n+! de"!r!+% Ecr!(er!+" DJ.
    Per(+r'area a.ec(!v7 (re'+!e s7 ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7
    c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare
    Ecr!(er!+" EJ, :n +ne"e ca/+r!, !nd!v!d+" &oa(e .! ca&a'!" s7 %a! .+nc=!one/e :nc7, dar
    n+%a! c+ +n e.or( cons!dera'!" cresc+(.
    :n &rec!/area .a&(+"+!, dac7 (+"'+rarea a.ec(!v7 es(e da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en=a +ne! cond!=!!
    %ed!ca"e $enera"e. A&o!, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7 (+"'+rarea
    a.ec(!v7 es(e :n re"a=!e e(!o"o$!c7 c+ cond!=!a %ed!ca"7 $enera"7 &r!n(r4+n %ecan!s%
    .!/!o"o$!c. O eva"+are a(en(7 O! c+&r!n/7(oare a n+%eroO! .ac(or! es(e necesar7
    &en(r+ a .ace aceas(7 &rec!/are. DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a s(a'!"! dac7
    re"a=!a d!n(re &er(+r'area a.ec(!v7 s! cond!=!a %ed!ca"7 $enera"7 es(e +na e(!o"o$!c7,
    cA(eva cons!deren(e o.er7 o oarecare $!dare :n aces( do%en!+. Un &r!%
    cons!deren( es(e ace"a a" &re/en=e! +ne! asoc!er! (e%&ora"e :n(re de'+(+",
    e<acer'area sa+ re%!s!+nea cond!=!e! %ed!ca"e $enera"e s! ce"e a"e &er(+r'7r!!
    a.ec(!ve. Un a" do!"ea cons!deren( :" cons(!(+!e &re/en=a +nor e"e%en(e care s+n(
    a(!&!ce &en(r+ (+"'+r7r!"e a.ec(!ve &r!%are Ede e<., e(a(ea "a de'+( O! evo"+=!a a(!&!c7
    FE2 Tulburrile A$ective

    sa+ a'sen=a !s(or!c+"+! .a%!"!a"J. Da(e"e d!n "!(era(+r7 care s+$erea/7 c7 &oa(e e<!s(a
    o asoc!ere d!rec(7 :n(re cond!=!a %ed!ca"7 $enera"7 :n ces(!+ne s! a&ar!=!a
    s!%&(o%e"or a.ec(!ve &o( o.er! +n con(e<( +(!" :n eva"+area +ne! an+%!(e s!(+a=!!, :n
    a.ar7 de aceas(a, c"!n!c!an+" (re'+!e s7 a&rec!e/e, de ase%enea, dac7 &er(+r'area n+
    es(e e<&"!ca(7 %a! '!ne de o (+"'+rare a.ec(!v7 &r!%ar7, de o (+"'+rare a.ec(!v7
    !nd+s7 de o s+'s(an=7 or! de a"(e (+"'+r7r! %en(a"e &r!%are Ede e<., (+"'+rarea de
    ada&(areJ. Aceas(7 &rec!/are es(e e<&"!ca(7 :n %a! %are de(a"!+ :n sec=!+nea
    ST+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"eT E&a$. 5G5J.
    Con(rar (+"'+r7r!! de&res!ve %a@ore, (+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c+ e"e%en(e de&res!ve, &are a .! d!s(r!'+!(7 a&roa&e e$a" "a ce"e
    do+7 se<e. T+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e cres(e r!sc+"
    de (en(a(!v7 de s+!c!d s! de s+!c!d co%&"e(. Ra(e"e de s+!c!d d!.er7 :n .+nc=!e de
    cond!=!a %ed!ca"7 $enera"7, de cond!=!!"e cron!ce, !nc+ra'!"e s! d+reroase Ede e<.,
    cancer, "e/!+n! %ed+"are s&!na"e, +"cer &e&(!c, %a"ad!e H+n(!n$(on, s!ndro%+"
    !%+node.!c!en=e! c7&7(a(e ESIDAJ, %a"ad!e rena"7 :n s(ad!+" .!na", (ra+%a(!s%
    cran!anJ care co%&or(7 ce" %a! %are r!sc de s+!c!d.
    Subtipuri
    Poa(e .! +(!"!/a( +n+" d!n(re +r%7(oare"e s+'(!&+r! &en(r+ a !nd!ca an+%e care
    d!n +r%7(oare"e &re/en(7r! de s!%&(o%e &redo%!n7Q
    C+ e"e%en(e de&res!ve. Aces( s+'(!& es(e +(!"!/a( dac7 d!s&o/!=!a
    &redo%!nan(7 es(e de&res!v7, dar n+ s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e
    &en(r+ +n e&!sod de&res!v %a@or.
    E&!sod s!%!"ar e&!sod+"+! de&res!v %a@or. Aces( s+'(!& es(e +(!"!/a( dac7
    s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or Ec+
    e<ce&=!a cr!(er!+"+! DJ Eve/! &a$. ;YRJ.
    C+ e"e%en(e %an!aca"e. Aces( s+'(!& es(e +(!"!/a( dac7 d!s&o/!=!a
    &redo%!nan(7 es(e cresc+(7, e+.or!c7 sa+ !r!(a'!"7.
    C+ e"e%en(e %!<(e. Aces( s+'(!& es(e +(!"!/a( dac7 s+n( &re/en(e, a(A(
    s!%&(o%e"e %an!e!, cA( s! ce"e a"e de&res!e!, dar n+ &redo%!n7 n!c! +ne"e.
    #rocedee de "nre!istrare
    La :nre$!s(rarea d!a$nos(!c+"+! de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 conse%ne/e a(A( .eno%eno"o$!a s&ec!.!c7
    a &er(+r'7r!!, !nc"+/And s+'(!&+" cores&+n/7(or, cA( s! cond!=!a %ed!ca"7 $enera"7
    !den(!.!ca(7 s! cons!dera(7 a .! ca+/a &er(+r'7r!! de &e a<a I Ede e<., 9F;.G; T+"'+rare
    a.ec(!v7 da(ora(7 (!reo(o<!co/e!, c+ e"e%en(e %an!aca"eJ. Cod+" ICD4F4CM &en(r+
    cond!=!a %ed!ca"7 $enera"7, de ase%enea, (re'+!e no(a( &e a<a III Ede e<., 9I9.F
    T!reo(o<!co/7J. E3e/! ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce ICD4F4CM se"ec(a(e
    &en(r+ cond!=!!"e %ed!ca"e $enera"eJ.
    Un d!a$nos(!c se&ara( de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e n+ es(e &+s, dac7 s!%&(o%e"e de&res!ve a&ar e<c"+s!v :n c+rs+" de%en(e!
    vasc+"are, :n aces( ca/, s!%&(o%e"e de&res!ve s+n( !nd!ca(e &r!n s&ec!.!ca=!a
    s+'(!&+"+! Tc+ d!s&o/!=!e de&res!v7T Ede e<., 9FL.I; De%en=7 vasc+"ar7, c+
    d!s&o/!=!e de&res!v7J.
    Tulburrile
    A$ective
    H54
    ondiii medicale !enerale asociate
    O d!vers!(a(e de cond!=!! %ed!ca"e $enera"e &o( ca+/a s!%&(o%e a.ec(!ve. Aces(e
    cond!=!! !nc"+d %a"ad!! ne+ro"o$!ce de$enera(!ve Ede e<., %a"ad!a Par)!nson,
    %a"ad!a H+n(!n$(onJ, %a"ad!a cere'rovasc+"ar7 Ede e<., !c(+s+"J, cond!=!!
    %e(a'o"!ce Ede e<., de.!c!en=a de v!(a%!na B 59J, cond!=!! endocr!ne Ede e<., !&er4 s!
    !&o(!ro!d!s%+", !&er4 O! !&o&ara(!ro!d!s%+", !&er4 s! !&oadrenocor(!c!s%+"J,
    cond!=!! a+(o!%+ne Ede e<., "+&+s+" er!(e%a(os s!s(e%!cJ, !n.ec=!! v!ra"e sa+ de a"(7
    na(+r7 Ede e<., e&a(!(a, %onon+c"eo/a, v!r+s+" !%+node.!c!en=e! +%ane ZHT3[ s!
    an+%!(e cancere Ede e<., carc!no%+" &ancreas+"+!J. Da(e"e e<a%!n7r!! so%a(!ce s!
    da(e"e de "a'ora(or asoc!a(e, &a((ern+r!"e de &reva"en(7 sa+ de de'+( re."ec(7
    cond!=!a %ed!ca"7 $enera"7 e(!o"o$!c7.
    #revalent
    Es(!%7r!"e &reva"en(e! &en(r+ (+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e se "!%!(ea/7 "a ce"e a"e (a'"o+r!"or c"!n!ce c+ e"e%en(e de&res!ve.
    S4a o'serva( c7 9Yd4ILd d!n(re !nd!v!/!! c+ an+%!(e cond!=!! ne+ro"o$!ce
    E!nc"+/And %a"ad!a Par)!nson, %a"ad!a H+n(!n$(on, sc"ero/a %+"(!&"7, !c(+s+" s!
    %a"ad!a A"/e!%erJ a+ &re/en(a( o &er(+r'are de&res!v7 %arca(7 :n(r4o an+%!(7
    &er!oad7 d!n c+rs+" evo"+=!e! %a"ad!e!. Pen(r+ cond!=!!"e %ed!ca"e $enera"e .7r7
    !%&"!carea d!rec(7 a s!s(e%+"+! nervos cen(ra", &rocen(e"e s+n(, de de&ar(e, .oar(e
    var!a'!"e, %er$And de "a %a! %+"( de RLd :n s!ndro%+" C+s!n$ &An7 "a %a! &+=!n
    de Gd :n s(ad!+" .!na" a" +ne! %a"ad!! rena"e.
    Dia!nostic di$erenial
    Un d!a$nos(!c se&ara( de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e n+ es(e &+s dac7 &er(+r'area a.ec(!v7 s+rv!ne e<c"+s!v :n c+rs+" +n+!
    de"!r!+%. D!n con(ra, +n d!a$nos(!c de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e &oa(e .! &+s &e "An$7 d!a$nos(!c+" de de%en(7 dac7 s!%&(o%e"e
    a.ec(!ve s+n( consec!n=a e(!o"o$!c7 d!rec(7 a &roces+"+! &a(o"o$!c ca+/a" a" de%en=e!
    s! dac7 s!%&(o%e"e a.ec(!ve s+n( o &ar(e &roe%!nen(7 a (a'"o+"+! c"!n!c.Ede e<.,
    (+"'+rare a.ec(!v7 da(ora(7 %a"ad!e! A"/e!%erJ. D!n ca+/a cer!n=e"or de cod!.!care
    a"e ICD4F4CM, o e<ce&=!e de "a aceas(a o cons(!(+!e ca/+" cAnd s!%&(o%e"e
    de&res!ve s+rv!n e<c"+s!v :n c+rs+" de%en=e! vasc+"are, :n aces( ca/, se &+ne
    n+%a! d!a$nos(!c+" de de%en=7 vasc+"ar7, c+ s+'(!&+" Sc+ d!s&o/!=!e de&res!v7T8
    n+ se &+ne d!a$nos(!c+" se&ara( de (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e. Dac7 (a'"o+" c"!n!c !nc"+de o %!<(+r7 de d!.er!(e (!&+r! de
    s!%&(o%e Ede e<., a.ec(!ve s! an<!oaseJ, (+"'+rarea %en(a"7 s&ec!.!c7 da(ora(7 +ne!
    cond!=!! %ed!ca"e s&ec!.!ce, de&!nde de care s!%&(o%e &redo%!n7 :n (a'"o+" c"!n!c.
    Dac7 e<!s(7 &ro'a +n+! +/ recen( sa+ &re"+n$!( de o s+'s(an=7 E!nc"+s!v de
    %ed!ca%en(e c+ e.ec(e &s!oac(!veJ, a a's(!nen=e! de o s+'s(an=7 or! a e<&+ner!! "a
    +n (o<!c, &oa(e .! "+a(7 :n d!sc+=!e (+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7. Poa(e
    .! +(!" s7 se e.ec(+e/e +n screen!n$ a" dro$+"+! :n sAn$e sa+ +r!n7 or! a"(e e<a%ene
    de "a'ora(or adecva(e. S!%&(o%e"e care a&ar :n c+rs+" sa+ "a sc+r( (!%& Ead!c7, :n
    dec+rs de I s7&(7%An!J d+&7 o !n(o<!ca=!e sa+ a's(!nen=7 de o s+'s(an=7 or! d+&7
    +(!"!/area +n+! %ed!ca%en( &o( .! e<(re% de evoca(oare de o (+"'+rare !nd+s7 de o
    s+'s(an=7, :n .+nc=!e de carac(er+", d+ra(a sa+ can(!(a(ea de s+'s(an=7 +(!"!/a(7.
    Dac7 c"!n!c!an+" cons!der7 c7 &er(+r'area se da(orea/7, a(A( +ne! cond!=!! %ed!ca"e
    H5H Tulburrile A$ective
    $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, &o( .! &+se a%'e"e d!a$nos(!ce Ead!c7,
    (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! (+"'+rare a.ec(!v7
    !nd+s7 de o s+'s(an=7J.
    T+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e (re'+!e s7 .!e
    d!s(!ns7 de (+"'+rarea de&res!v7 %a@or7, (+"'+rarea '!&o"ar7 I, (+"'+rarea
    '!&o"ar7 II s! de (+"'+rarea de ada&(are c+ d!s&o/!=!e de&res!v7 Ede e<., +n
    r7s&+ns de/ada&(a(!v "a s(res+" de a avea o a.ec=!+ne %ed!ca"7 $enera"7J. In
    (+"'+r7r!"e, de&res!v7 %a@or7, '!&o"are s! de ada&(are n+ a &+(+( .! de%ons(ra(7
    e<!s(en=a +nor %ecan!s%e .!/!o"o$!ce ca+/a"e d!rec(e s! s&ec!.!ce, asoc!a(e c+ o
    cond!=!e %ed!ca"7 $enera"7. Adesea es(e d!.!c!" de s(a'!"!( dac7 an+%!(e s!%&(o%e
    Ede e<., &!erderea :n $re+(a(e, !nso%n!a, .a(!$a'!"!(a(eaJ re&re/!n(7 o (+"'+rare
    a.ec(!v7 or! s+n( %an!.es(area d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    cancer, !c(+s, !n.arc( %!ocard!c, d!a'e(J. As(.e" de s!%&(o%e &"edea/7 &en(r+
    d!a$nos(!c+" de e&!sod de&res!v %a@or, c+ e<ce&=!a ca/+r!"or :n care e"e s+n(
    e<&"!ca(e :n %od c"ar s! co%&"e( de o cond!=!e %ed!ca"7 $enera"7. Dac7 c"!n!c!an+"
    n+ &oa(e s(a'!"! dac7 &er(+r'area a.ec(!v7 es(e &r!%ar7, !nd+s7 de o s+'s(an=7 or!
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, &oa(e .! &+s d!a$nos(!c+" de (+"'+rare
    a.ec(!v7 .7r7 a"(7 s&ec!.!ca=!e.
    Criteriile $e $ia/no&ti# pentru C54.>4 Tul-urarea A%e#tiv(
    $atorat(... [Se indic Condiia Medical General]
    A2 O perturbare a$ectiv persistent ,i proeminent predomin "n tabloul clinic
    ,i este caracteri(at prin oricare &ori ambele) din urmtoareleD
    (1)dispo(iie depresiv ori diminuare marcat a interesului sau plcerii
    pentru toate sau aproape toate activitile,
    (2)dispo(iie crescut, expansiv sau iritabil2
    S2 Din istoric, examenul somatic ,i datele de laborator re(ult proba c pertur
    barea este consecina $i(iolo!ic direct a unei condiii medicale !enerale2
    2 #erturbarea nu este explicat mai bine de alt tulburarea mental &de ex2,
    de tulburarea de adaptare cu dispo(iie depresiv ca rspuns la stresul de a
    avea o condiie medical !eneral)2
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    De speci"icat tipulD
    u elemente depresiveD dac dispo(iia predominant este depresiv, dar
    nu sunt satis$cute criteriile complete pentru un episod depresiv ma0or
    u episod similar episodului depresiv ma0orD dac sunt satis$cute complet
    criteriile pentru un episod depresiv ma0or &cu excepia criteriului D) &ve(i
    pa!2 4AI)
    u elemente maniacaleD dac predispo(iia predominant este crescut,
    eu$oric sau iritabil
    u elemente mixteD Dac sunt pre(ente, at@t simptome de manie, c@t si de
    depresie, dar nu predomin nici unele
    Tulburrile
    A$ective
    7+<
    Fot de codi$icare Fumele condiiei medicale !enerale se include pe axa l,
    de ex, 764 84 Tulburare a$ectiv datorat %ipertiroidismului, cu elemente
    depresive, condiia medical !eneral se codi$ic, de asemenea, pe axa III
    &ve(i anexa G pentru coduri)
    Fot de codi$icare Dac simptomele depresive survin ca parte a unei
    demente vasculare preexistente, simptomele depresive se indic prin
    codi$icarea subtipului corespun(tor, adic 765H4 Dement vascular, cu
    dispo(iie depresiv
    Tul-urarea A%e#tiv( in$u&( $e o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! a.ec(!ve !nd+se de o s+'s(an=7 :" cons(!(+!e o
    &er(+r'are a.ec(!v7 &ers!s(en(7 s! &roe%!nen(7 Ecr!(er!+" AJ cons!dera(7 a .! da(ora(7
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<, +n dro$ de a'+/, +n
    %ed!ca%en(, a"( (ra(a%en( so%a(!c &en(r+ de&res!e or! e<&+nerea "a +n (o<!cJ
    Ecr!(er!+" BJ :n .+nc=!e de na(+ra s+'s(an=e! s! de con(e<(+" :n care a&ar s!%&(o%e"e
    Ead!c7, :n c+rs+" !n(o<!ca=!e! or! a's(!nen(e!J, &er(+r'area &oa(e co%&or(a d!s&o/!=!e
    de&res!v7, d!%!n+area no(a'!"7 a !n(eres+"+! sa+ &"7cer!!, or! d!s&o/!=!e cresc+(7,
    e<&ans!v7 sa+ !r!(a'!"7 DeO! (a'"o+" c"!n!c a" &er(+r'7r!! a.ec(!ve &oa(e .!
    ase%7n7(or c+ ce" a" +n+! e&!sod de&res!v %a@or, %an!aca", %!<( sa+ !&o%a%aca"
    n+ s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ n!c! +n+" d!n(re aces(e e&!soade T!&+"
    de s!%&(o% &redo%!nan( &oa(e .! !nd!ca( &r!n +(!"!/area +n+!a d!n(re +r%7(oare"e
    s+'&+r! c+ e"e%en(e de&res!ve, c+ e"e%en(e %an!aca"e, c+ e"e%en(e %!<(e
    Per(+r'area n+ (re'+!e s7 .!e e<&"!ca(7 %a! '!ne de o (+"'+rare a.ec(!v7 care n+ es(e
    !nd+s7 de o s+'s(an=7 Ecr!(er!+" CJ D!a$nos(!c+" n+ es(e &+s dac7 &er(+r'area
    a.ec(!v7 s+rv!ne n+%a! :n c+rs+" +n+! den+% Ecr!(er!+" DJ S!%&(o%e"e (re'+!e s7
    ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ :n +ne"e
    ca/+r!, !nd!v!d+" :nc7 %a! &oa(e .! ca&a'!" s7 .+nc=!one/e, dar n+%a! c+ e.or(
    cons!dera'!" cresc+( Aces( d!a$nos(!c n+ (re'+!e &+s :n "oc+" +n+! d!a$nos(!c de
    !n(o<!ca=!e c+ o s+'s(an=7 sa+ a" ce"+! de a's(!nen(7 de o s+'s(an=7 decA( a(+nc!
    cAnd s!%&(o%e"e a.ec(!ve s+n( :n e<ces .a(7 de ce"e asoc!a(e de re$+"7 c+ s!ndro%+"
    de !n(o<!ca=!e sa+ de a's(!nen(7 s! cAnd s!%&(o%e"e a.ec(!ve s+n( s+.!c!en( de severe
    &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare a.ec(!v7
    &r!%ar7 &r!n "+area :n cons!dera=!e a de'+(+"+!, evo"+=!e! s! a"(or .ac(or! Pen(r+
    dro$+r!"e de a'+/ (re'+!e s7 .!e ev!den(7 d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e
    de "a'ora(or, !n(o<!ca=!a sa+ a's(!nen(a T+"'+r7r!"e a.ec(!ve !nd+se de o s+'s(an=7
    s+rv!n n+%a! :n asoc!ere c+ s(7r!"e de !n(o<!ca=!e sa+ de a's(!nen(7, !n (!%& ce
    (+"'+r7r!"e a.ec(!ve &r!%are &o( &recede de'+(+" +/+"+! +ne! s+'s(an=e or! &o(
    s+rven! :n c+rs+" &er!oade"or de a's(!nen(7 &re"+n$!(7 Deoarece s(area de
    a's(!nen(7 &en(r+ +ne"e s+'s(an=e &oa(e .! re"a(!v &re"+n$!(7, de'+(+" s!%&(o%e"or
    a.ec(!ve &oa(e avea "oc :n &An7 "a I s7&(7%An! d+&7 :nce(area +/+"+! de s+'s(an=7
    Un a"( cons!deren( :" cons(!(+!e &re/en(a de e"e%en(e care s+n( a(!&!ce &en(r+
    (+"'+r7r!"e a.ec(!ve &r!%are Ede e<, e(a(ea "a de'+( sa+ evo"+=!a a(!&!c7J De
    FE> Tulburrile A$ective
    e<e%&"+, de'+(+" +n+! e&!sod %an!aca" d+&7 e(a(ea de IY de an! &oa(e s+$era o
    e(!o"o$!e !nd+s7 de o s+'s(an=7. D!n con(ra, .ac(or!! care s+$erea/7 c7 s!%&(o%e"e
    a.ec(!ve s+n( e<&"!ca(e %a! '!ne de c7(re o (+"'+rare a.ec(!v7 &r!%ar7 !nc"+d
    &ers!s(en=a s!%&(o%e"or a.ec(!ve &en(r+ o &er!oad7 s+'s(an=!a"7 de (!%& Ead!c7,
    a&ro<!%a(!v o "+n7J, d+&7 (er%!narea !n(o<!ca=!e! c+ o s+'s(an=7 or! a a's(!nen=e!
    ac+(e de o s+'s(an=78 a&ar!=!a de s!%&(o%e a.ec(!ve care s+n( cons!dera'!" :n e<ces
    .a=7 de ceea ce ar .! de aO(e&(a(, da( .!!nd (!&+" sa+ can(!(a(ea de s+'s(an=7 +(!"!/a(7
    or! d+ra(a de +/ s!, :n .!ne, +n !s(or!c de e&!soade rec+ren(e de (+"'+rare a.ec(!v7
    &r!%ar7 an(er!oare.
    Une"e %ed!ca%en(e Ede e<., s(!%+"an(e"e, s(ero!/!!, 54do&a, anr!de&res!ve"eJ sa+
    +ne"e (ra(a%en(e so%a(!ce &en(r+ de&res!e Ede e<., (era&!a e"ec(roconv+"s!van(7 sa+
    .o(o(era&!aJ &o( !nd+ce &er(+r'7r! a.ec(!ve s!%!"are %an!e!. *+deca(a c"!n!c7 es(e
    esen=!a"7 :n a s(a'!"! .a&(+", dac7 (ra(a%en(+" es(e rea"%en(e ca+/a" or! es(e vor'a de
    o (+"'+rare a.ec(!v7 &r!%ar7 care s4a :n(A%&"a( s7 a!'7 de'+(+" :n &er!oada :n care
    &ersoana a &r!%!( aces( (ra(a%en(. De e<e%&"+, s!%&(o%e"e %an!aca"e care a&ar "a
    o &ersoan7 :n (!%& ce aceas(a !a "!(!+, n+ vor .! d!a$nos(!ca(e ca (+"'+rare a.ec(!v7
    !nd+s7 de o s+'s(an=7, deoarece n+ es(e &os!'!" ca "!(!+" s7 !nd+c7 e&!soade s!%!"are
    ce"or %an!aca"e. Pe de a"(7 &ar(e, +n e&!sod de&res!v, care a&are :n c+rs+" &r!%e"or
    c:(eva s7&(7%An! de "a :nce&+(+" (ra(a%en(+"+! c+ a".a4%e(!"do&a E+n a$en(
    an(!!&er(ens!vJ "a o &ersoan7 .7r7 !s(or!c de (+"'+rare a.ec(!v7, va .! !nd!ca( &en(r+
    d!a$nos(!c+" de (+"'+rare a.ec(!v7 !nd+s7 de a".a%e(!"do&a, c+ e"e%en(e de&res!ve,
    :n +ne"e ca/+r!, o cond!=!e &re/en(7 an(er!or Ede e<., (+"'+rarea de&res!v7 %a@or7
    rec+ren(7J &oa(e rea&are :n (!%& ce &ersoana !a :n %od cas+a" +n %ed!ca%en( care
    are ca&ac!(a(ea de a ca+;a s!%&(o%e de&res!ve Ede e<., 54do&a, &!"+"e
    an(!conce&=!ona"eJ, :n as(.e" de ca/+r!, c"!n!c!an+" (re'+!e s7 a&rec!e/e dac7
    %ed!ca%en(+" es(e .ac(or+" ca+/a" :n aceas(7 s!(+a=!e &ar(!c+"ar7. Pen(r+ o d!sc+=!e
    %a! de(a"!a(7 a (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7, ve/! &a$. 5F5.
    Subtipuri si speci$icani
    Un+" d!n +r%7(oare"e s+'(!&+r! (re'+!e s7 .!e +(!"!/a( &en(r+ a !nd!ca
    +r%7(oare"e &re/en=e de s!%&(o%e &redo%!nan(eQ
    C+ e"e%en(e de&res!ve. Aces( s+'(!& es(e +(!"!/a( dac7 d!s&o/!=!a
    &redo%!nan(7 es(e de&res!v7.
    C+ e"e%en(e %an!aca"e. Aces( s+'(!& es(e +(!"!/a( dac7 d!s&o/!=!a
    &redo%!nan(7 es(e cresc+(7, e+.or!c7 sa+ !r!(a'!"7.
    C+ e"e%en(e %!<(e. Aces( s+'(!& es(e +(!"!/a( dac7 s+n( &re/en(e, a(A(
    s!%&(o%e de %an!e, cA( s! de de&res!e, dar n+ &redo%!n7 n!c! +ne"e.
    Con(e<(+" a&ar!=e! s!%&(o%e"or a.ec(!ve &oa(e .! !nd!ca( &r!n +(!"!/area +n+!a
    d!n(re +r%7(or!! s&ec!.!can=!Q
    C+ de'+( :n c+rs+" !n(o<!ca=!e!. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7, !ar s!%&(o%e"e
    a&ar :n c+rs+" s!ndro%+"+! de !n(o<!ca=!e.
    C+ de'+( :n c+rs+" a's(!nen=e!. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a's(!nen=a de o s+'s(an=7, !ar s!%&(o%e"e
    a&ar :n c+rs+" or! "a sc+r( (!%& d+&7 s!ndro%+" de a's(!nen=7.
    Tulburarea A$ectiv indus de o
    Substan
    H5?
    #rocedee de "nre!istrare
    N+%e"e +ne! (+"'+r7r! a.ec(!ve !nd+se de o s+'s(an=7 :nce&e c+ ce" a" s+'s(an=e!
    s&ec!.!ce sa+ a" (ra(a%en(+"+! so%a(!c Ede e<., coca!n7, a%!(r!&(!"!n7, (era&!e
    e"ec(roconv+"s!van(7J &res+&+s7 a .! ca+/a s!%&(o%e"or a.ec(!ve. Cod+" d!a$nos(!c
    es(e se"ec(a( d!n "!s(a c"ase"or de s+'s(an=e &rev7/+(e :n se(+r!"e de cr!(er!!. Pen(r+
    s+'s(an=e"e care n+ !n(r7 :n n!c! +na d!n(re c"ase Ede e<., a%!(r!&(!"!n7J O! &en(r+ a"(e
    (ra(a%en(e so%a(!ce Ede e<., (era&!a e"ec(roconv+"s!van(7J, (re'+!e s7 .!e +(!"!/a(
    cod+" &en(r+ Sa"(7 s+'s(an=7T, :n a.ar7 de aceas(a, &en(r+ %ed!ca%en(e"e &rescr!se
    :n do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!c &oa(e .! !nd!ca( &r!n %en=!onarea
    cod+"+! E cores&+n/7(or Eve/! ane<a ,J. N+%e"e (+"'+r7r!! Ede e<., (+"'+rare
    a.ec(!v7 !nd+s7 de coca!n7J es(e +r%a( de s+'(!&+" care !nd!c7 s!%&(o%+"
    &redo%!nan( &re/en( s! s&ec!.!can(+" !nd!cAnd con(e<(+" :n care a&ar s!%&(o%e"e
    Ede e<., 9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de coca!n7, c+ e"e%en(e de&res!ve, c+
    de'+( :n c+rs+" a's(!nen=e!. CAnd se cons!der7 c7 %a! %+"( decA( o s!n$+r7
    s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n a&ar!=!a s!%&(o%e"or a.ec(!ve, .!ecare d!n(re
    aces(ea (re'+!e s7 .!e %en=!ona(7 se&ara( Ede e<., 9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    de coca!n7, c+ e"e%en(e %an!aca"e, c+ de'+( :n c+rs+" a's(!nen=e!8 9F9.GI T+"'+rare
    a.ec(!v7 !nd+s7 de .o(o(era&!e, c+ e"e%en(e %an!aca"eJ. Dac7 o s+'s(an=7 es(e
    cons!dera(7 a .! .ac(or+" e(!o"o$!c, dar s+'s(an=a s&ec!.!c7 sa+ c"asa de s+'s(an=e es(e
    nec+nosc+(7, &oa(e .! +(!"!/a(7 ca(e$or!a 9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de o
    s+'s(an=7 nec+nosc+(7.
    Substanele speci$ice
    T+"'+r7r!"e a.ec(!ve &o( s+rven! :n asoc!a=!e c+ !n(o<!ca=!a :n cadr+" +r%7(oare"or
    c"ase de s+'s(an=eQ a"coo"8 a%.e(a%!na s! s+'s(an=e a.!ne8 coca!n78 a"+c!no$ene8
    !na"an(e8 o&!acee8 &encyc"!d!n7 O! s+'s(an=e a.!ne8 seda(!ve, !&no(!ce s!
    an<!o"!(!ce O! a"(e s+'s(an=e sa+ s+'s(an=e nec+nosc+(e. T+"'+r7r!"e a.ec(!ve &o(
    s+rven! :n asoc!a=!e c+ a's(!nen=a de +r%7(oare"e c"ase de s+'s(an=eQ a"coo"8
    a%.e(a%!na O! s+'s(an=e a.!ne8 coca!n78 seda(!ve, !&no(!ce s! an<!o"!(!ce O! a"(e
    s+'s(an=e sa+ s+'s(an=e nec+nosc+(e.
    Une"e d!n(re %ed!ca%en(e"e descr!se ca evocAnd s!%&(o%e a.ec(!ve !nc"+d
    anes(e/!ce"e, ana"$e/!ce"e, an(!co"!ner$!ce"e, an(!conv+"s!van(e"e, %ed!ca%en(e"e
    an(!&ar)!nson!ene, an(!+"ceroase, card!ace, an(!conce&=!ona"e"e ora"e,
    %ed!ca%en(e"e &s!o(ro&e Ean(!de&res!ve"e, 'en/od!a/e&!ne"e, an(!&s!o(!ce"e,
    d!s+".!ra%+"J, re"a<an(e"e %+sc+"are, s(ero!/!! O! s+".ona%!de"e. Une"e
    %ed!ca%en(e a+ o &ro'a'!"!(a(e des(+" de %are de a &rod+ce e"e%en(e de&res!ve
    Ede e<., do/e"e %ar! de re/er&!n7, cor(!cos(ero!/!!, s(ero!/!! ana'o"!/an=!J. De no(a(
    c7 aceas(a n+ es(e o "!s(7 e<a+s(!v7 a %ed!ca%en(e"or &os!'!"e O! c7 %+"(e a"(e
    %ed!ca%en(e &o( &rod+ce, oca/!ona", o reac=!e de&res!v7 !d!os!ncra(!c7. Me(a"e"e
    $re"e s! (o<!ce"e Ede e<., s+'s(an=e"e vo"a(!"e, c+% ar .! $a/o"!na s! vo&se"e"e,
    !nsec(!c!de"e or$ano4.os.ora(e, $a/e"e ne+ro(o<!ce, %ono<!d+" de car'on s!
    '!o<!d+" de car'onJ &o( &rod+ce, de ase%enea, s!%&(o%e a.ec(!ve.
    Dia!nostic di$erenial
    :n !n(o<!ca=!a c+ o s+'s(an=7 O! a's(!nen=a de o s+'s(an=7, a&ar .recven(
    s!%&(o%e a.ec(!ve, !ar d!a$nos(!c+" de !n(o<!ca=!e c+ o an+%!(7 s+'s(an=7 sa+ de
    a's(!nen=7 de o an+%!(7 s+'s(an=7 es(e de re$+"7 s+.!c!en( &en(r+ c"as!.!carea
    7+> Tulburrile A$ective
    s!%&(o%e"or &re/en(a(e. D!a$nos(!c+" de (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7
    (re'+!e &+s :n "oc+" +n+! d!a$nos(!c de !n(o<!ca=!e c+ o s+'s(an=7 or! de a's(!nen=7
    de o s+'s(an=7, n+%a! cAnd s!%&(o%e"e a.ec(!ve s+n( cons!dera(e a .! :n e<ces .a=7
    de ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen=7 s! cAnd
    s!%&(o%e"e a.ec(!ve s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7
    se&ara(7. De e<e%&"+, d!s&o/!=!a d!s.or!c7 es(e +n e"e%en( carac(er!s(!c a"
    a's(!nen(e! de coca!n7. T+"'+rarea a.ec(!v7 !nd+s7 de coca!n7 (re'+!e s7 .!e
    d!a$nos(!ca(7 :n "oc+" a's(!nen=e! de coca!n7, n+%a! dac7 &er(+r'area a.ec(!v7 es(e
    cons!dera'!" %a! !n(ens7 decA( cea :n(A"n!(7 de re$+"7 :n a's(!nen=a de coca!n7 s!
    es(e s+.!c!en( de sever7 &en(r+ a .! +n o'!ec(!v se&ara( a" a(en=!e! O! (ra(a%en(+"+!.
    Dac7 s!%&(o%e"e a.ec(!ve !nd+se de o s+'s(an=7 s+rv!n e<c"+s!v :n c+rs+" +n+!
    de"!r!+%, s!%&(o%e"e a.ec(!ve s+n( cons!dera(e a .! +n e"e%en( asoc!a( a"
    de"!r!+%+"+! s! n+ s+n( d!a$nos(!ca(e se&ara(, :n (a'"o+r!"e c"!n!ce !nd+se de o
    s+'s(an=7 care con=!n +n a%es(ec de d!.er!(e (!&+r! de s!%&(o%e Ede e<., s!%&(o%e
    a.ec(!ve, &s!o(!ce s! an<!oaseJ, (!&+" s&ec!.!c de (+"'+rare !nd+s7 de o s+'s(an=7 de
    d!a$nos(!ca( de&!nde de care (!& de s!%&(o%e &redo%!n7 :n (a'"o+" c"!n!c.
    O (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare a.ec(!v7
    &r!%ar7 &r!n .a&(+" c7 o s+'s(an=7 es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+
    s!%&(o%e"e Ede e<., +n %ed!ca%en( an(!!&er(ens!vJ Esa+ :n (!%&+" a's(!nen=e!,
    dac7 e<!s(7 +n s!ndro% de a's(!nen=7 asoc!a( c+ %ed!ca%en(+"J. Oda(7 ce
    (ra(a%en(+" es(e :n(rer+&(, s!%&(o%e"e a.ec(!ve se vor re%!(e de re$+"7 :n dec+rs de
    cA(eva /!"e sa+ s7&(7%An!, :n .+nc=!e de se%!v!a=a s+'s(an=e! s! de &re/en=a +n+!
    s!ndro% de a's(!nen=7. Dac7 s!%&(o%e"e &ers!s(7 &es(e &a(r+ s7&(7%An!, (re'+!e s7
    .!e "+a(e :n cons!dera=!e a"(e ca+/e &en(r+ s!%&(o%e"e a.ec(!ve.
    Deoarece !nd!v!/!! c+ cond!=!! %ed!ca"e $enera"e !a+ adesea %ed!ca%en(e
    &en(r+ aces(ea, c"!n!c!an+" (re'+!e s7 !a :n cons!dera=!e even(+a"!(a(ea c7 s!%&(o%e"e
    a.ec(!ve s+n( ca+/a(e de consec!n=e"e .!/!o"o$!ce a"e cond!=!e! %ed!ca"e $enera"e %a!
    c+rAnd decA( de %ed!ca%en(e, :n care ca/ se &+ne d!a$nos(!c+" de (+"'+rare
    a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Is(or!c+" o.er7 adesea 'a/a
    &r!nc!&a"7 &en(r+ o as(.e" de @+deca(7. Uneor!, o sc!%'are :n (ra(a%en(+" cond!=!e!
    %ed!ca"e $enera"e Ede e<., s+'s(!(+!rea +n+! %ed!ca%en( sa+ s+&r!%area "+!J &oa(e
    .! necesar7 &en(r+ a s(a'!"! e%&!r!c &en(r+ &ersoana res&ec(!v7 dac7 %ed!ca%en(+"
    es(e a$en(+" ca+/a". Dac7 c"!n!c!an+" a a@+ns "a conc"+/!a c7 &er(+r'area es(e
    da(ora(7, a(A( +ne! cond!=!! %ed!ca"e $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, &o( .!
    &+se a%'e"e d!a$nos(!ce Ead!c7, (+"'+rare a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e s! (+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7J. CAnd e<!s(7 !ns+.!c!en(e da(e
    &en(r+ a s(a'!"! dac7 s!%&(o%e"e a.ec(!ve s+n( da(ora(e +ne! s+'s(an=e E!nc"+s!v
    +n+! %ed!ca%en(J sa+ +ne! cond!=!! %ed!ca"e $enera"e or! s+n( &r!%are Ead!c7, n+
    se da(orea/7 n!c! +ne! s+'s(an=e, n!c! +ne! cond!=!! %ed!ca"e $enera"eJ, es(e !nd!ca(
    d!a$nos(!c+" de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e sa+ de (+"'+rare
    '!&o"ar7 .7r7 a"(7 s&ec!.!ca=!e.
    Tulburarea A$ectiv indus de o
    Substan
    ILF
    Criteriile $e $ia/no&ti# pentru Tul-urarea A%e#tiv(
    in$u&( $e o Su-&tan!(
    A2 O perturbare persistent ,i proeminent de dispo(iie predomin "n tabloul
    clinic ,i este caracteri(at prin oricare dintre urmtoarele &sau ambele)D
    (1)dispo(iie depresiv sau diminuare marcat a interesului sau plcerii
    pentru toate sau aproape toate activitile3
    (2)dispo(iie crescut, expansiv sau iritabil2
    S2 Din istoric, examenul somatic sau datele de laborator re(ult proba, $ie a
    &E), sau a &7)D
    (1)simptomele de la criteriul A apar "n timpul sau "n decurs de o lun de la
    intoxicaia sau abstinena de o substan3
    (1)utili(area unui medicament este etiolo!ic "n relaie cu perturbarea2
    2 #erturbarea nu este explicat mai bine de o tulburare a$ectiv care nu este
    indus de o substan2 #robele c simptomele sunt explicate mai bine de o
    tulburare a$ectiv care nu este indus de o substan pot include
    urmtoareleD simptomele preced debutul u(ului de substan &sau u(ului
    unui medicament)3 simptomele persist o perioad substanial de timp &de
    ex2, aproape o lun) dup "ncetarea abstinenei acute sau a intoxicaiei
    severe ori sunt considerabil "n exces $a de ceea ce ar $i de a,teptat, dat
    $iind tipul sau cantitatea de substan utili(at ori durata u(ului3 ori exist
    alte probe care su!erea( existena unei tulburri a$ective noninduse de o
    substan &de ex2, un istoric de episoade depresive ma0ore recurente)2
    U
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii de $uncionare importante2
    FotD Acest dia!nostic trebuie pus "n locul unui dia!nostic de intoxicaie cu o
    substan sau de abstinen de o substan, numai c@nd simptomele a$ective
    sunt "n exces $a de cele asociate de re!ul cu sindromul de intoxicaie sau de
    abstinen ,i c@nd simptomele sunt su$icient de severe pentru a 0usti$ica o
    atenie clinic separat2
    A se codi"ica ast$el tulburarea a$ectiv indus de o substan speci$icD
    &76E28 alcool3 76728H cocain3 76728H %alucino!ene3 76728H in%alante3 76728H
    opiacee3 76728H p%encKclidin 9sau o substan similar p%encKclidinei:3
    76728H sedative, %ipnotice sau anxiolitice3 76728H alt substan 9sau o
    substan necunoscut:)2
    De speci"icat tipulD
    u elemente depresiveD dac dispo(iia dominant este depresiv
    u elemente maniacaleD dac dispo(iia predominant este crescut,
    eu$oric sau iritabil
    u elemente mixteD dac sunt pre(ente at@t simptome depresive, c@t si
    simptome maniacale, dar nu predomin nici unele
    7*+ Tulburrile A$ective
    Criteriile $e $ia/no&ti# pentru Tul-urarea A%e#tiv(
    in$u&( $e o Su-&tan!( (continuare)
    7e speci"icat dac &ve(i tabelul de la pa!2 E64 pentru aplicabilitate la o substan)D
    u debut "n cursul intoxicaieiD dac sunt satis$cute criteriile pentru
    intoxicaia cu o substan, iar simptomele apar "n cursul sindromului de
    intoxicaie2 u debut "n cursul abstineneiD dac sunt satis$cute criteriile
    pentru abstinena de o substan, iar simptomele apar "n cursul ori scurt
    timp dup un sindrom de abstinen
    C5=.5+ Tul-urarea A%e#tiv( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e !nc"+de (+"'+r7r!"e c+ s!%&(o%e a.ec(!ve care n+ sa(!s.ac
    cr!(er!!"e &en(r+ n!c! o (+"'+rare a.ec(!v7 s&ec!.!c7 s! :n care es(e d!.!c!" s7 se a"ea$7
    :n(re (+"'+rarea de&res!v7 .7r7 a"(7 s&ec!.!ca=!e s! (+"'+rarea '!&o"ar7 .7r7 a"(7
    s&ec!.!ca=!e Ede e<., a$!(a=!a ac+(7J.
    Spe#i%i#an!ii pentru $e&#rierea Epi&o$ului Curent
    &au a #elui "ai Re#ent
    Pen(r+ (+"'+r7r!"e a.ec(!ve s+n( &rev7/+=! +n n+%7r de s&ec!.!cAnd &en(r+ a
    cres(e s&ec!.!c!(a(ea d!a$nos(!c7 s! a crea s+'$r+&+r! cA( %a! o%o$ene, a a@+(a "a
    a"e$erea (ra(a%en(+"+! s! a%e"!orarea &red!c=!e! &ro$nos(!ce. Ur%7(or!!
    s&ec!.!can=! a&ar=!n e&!sod+"+! c+ren( Esa+ a ce"+! %a! recen(JQ Sever!(a4
    (eXPs!o(!cXRe%!s!+ne, Cron!c, C+ e"e%en(e ca(a(on!ce, C+ e"e%en(e %e"anco"!ce,
    C+ e"e%en(e a(!&!ce, C+ de'+( &os(&ar(+%. S&ec!.!can=!! care !nd!c7 sever!(a(ea,
    re%!s!+nea s! e"e%en(e"e &s!o(!ce &o( .! cod!.!ca=! c+ cea de a c!ncea c!.r7 a cod+"+!
    d!a$nos(!c &en(r+ ce"e %a! %+"(e (+"'+r7r! a.ec(!ve. Ce!"a"=! s&ec!.!can=! n+ &o( .!
    cod!.!ca=!. Ta'e"+" " !nd!c7 S&ec!.!can=!! e&!sod+"+! care se a&"!c7 "a .!ecare
    (+"'+rare a.ec(!v7 Eve/! &a$. I55J.
    Speci$icanii pentru descrierea *pisodului
    urent sau a celui mai +ecent
    I55

    Ta-elul *. Speci$icanii de episod care se aplic tulburrilor a$ective
    Severitate1 ronic u u u u debut
    #si%otic1 elemente elemente elemente post-
    +emisiune catatonice melancolice atipice partum
    Tulburarea
    depresiv ma0or,
    episod unic
    Tulburarea
    depresiv ma0or,
    recurent
    Tulburarea distimic
    Tulburarea bipolar l,
    episod maniacal
    unic
    Tulburarea bipolar l,
    cel
    mai
    recent
    episod
    %ipom
    aniaca
    l
    Tulbura
    rea
    bipola
    r l,
    cel
    mai
    recent
    episod
    mania
    cal
    Tulbura
    rea
    bipola
    r l,
    cel
    mai
    recent
    episod
    mixt
    Tulbura
    rea
    bipola
    r l,
    cel
    mai
    recent
    episod
    depres
    iv
    Tulbura
    rea
    bipolar
    l, cel
    mai
    recent
    episod
    nespe
    ci$icat
    Tulbura
    rea
    bipola
    r II,
    %ipom
    aniac
    al
    Tulbura
    rea
    bipola
    r II,
    depre
    siv
    Tulburar
    ea
    ciclotimi
    c
    - -
    -
    - - - -
    -
    -
    - - - - - -
    -

    Spe#i%i#an!ii SeveritateAP&i@oti#ARe"i&iune
    pentru Epi&o$ul Depre&iv MaQor
    :n (+"'+rarea de&res!v7 %a@or7, aceO(! s&ec!.!can=! !nd!c7 .!e sever!(a(ea
    e&!sod+"+! de&res!v %a@or c+ren( sa+ n!ve"+" de re%!s!+ne dac7 cr!(er!!"e co%&"e(e
    n+ %a! s+n( sa(!s.7c+(e, :n (+"'+rarea '!&o"ar7 I O! '!&o"ar7 II, aceO(! s&ec!.!can=!
    !nd!c7 .!e sever!(a(ea e&!sod+"+! de&res!v %a@or c+ren( sa+ n!ve"+" de re%!s!+ne,
    dac7 ce" %a! recen( e&!sod a .os( +n e&!sod de&res!v %a@or. Dac7 ac(+a"%en(e s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ e&!sod+" de&res!v %a@or, aces(a &oa(e .! c"as!.!ca( ca
    +Oor, %odera(, sever, .7r7 e"e%en(e &s!o(!ce sa+ ca sever, c+ e"e%en(e &s!o(!ce.
    Dac7 :ns7 cr!(er!!"e n+ %a! s+n( sa(!s.7c+(e, s&ec!.!can(+" !nd!c7 dac7 ce" %a! recen(
    7*C Tulburrile A$ective
    e&!sod de&res!v %a@or es(e :n rer%s%ne &ar=!a"7 sa+ co%&"e(7. Pen(r+ (+"'+rarea
    de&res!v7 %a@or7 s! &en(r+ ce"e %a! %+"(e (+"'+r7r! '!&o"are I, s&ec!.!can(+" es(e
    !nd!ca( &r!n cea de a c%cea c!.r7 a cod+"+! (+"'+r7%.
    " U UOor, 9 U Modera(, ; U Sever, .7r7 e"e%en(e &s!o(!ce. Sever!(a(ea es(e
    a&rec!a(7 ca +Ooar7, %odera(7 sa+ sever7, &e 'a/a n+%7r+"+! de s!%&(o%e cr!(er!!,
    sever!(a(ea s!%&(o%e"or s! $rad+" de !nca&ac!(a(e sa+ de(res7 .+nc=!ona"7
    E&!soade"e +Ooare se carac(er!/ea/7 &r!n &re/en(a a n+%a! c!nc! sa+ sase s!%&(o%e
    de&res!ve s!, .!e &r%(r4o !nca&ac!(a(e +Ooar7, .!e &r!n ca&ac!(a(ea de a .+nc=!ona
    nor%a", dar c+ +n e.or( cons!dera'!" s! %+/+a" E&!soade"e se*ere, )6r6 elemente
    psdwtice, s+n( carac(er!/a(e &nn &re/en(a ce"or %a! %+"(e s!%&(o%e cr!(er!! s! &nn(r4
    o !nca&ac!(a(e o'serva'!"7, c"ar7 Ede e< , !nca&ac!(a(ea de a "+cra sa+ de a avea $r!@7
    de co&!!J E&!soade"e moderate a+ o sever!(a(e !n(er%ed!ar7, :n(re +Ooar7 s! sever7
    I U Sever, c+ e"e%en(e &s!o(!ce. Aces( s&ec!.!can( !nd!c7 &re/en=a, .!e a !de!"or
    de"!ran(e, .!e a a"+c!na=!!"or Ede re$+"7, a+d!(!veJ :n c+rs+" e&!sod+"+! c+ren( Ce"
    %a! .recven(, con=!n+(+" !de!"or de"!ran(e sa+ a" a"+c!na=!!"or es(e concorda( c+
    (e%e"e de&res!ve As(.e" de elemente psi-otice con/r+ente c+ dispo;i(ia !nc"+d !de!
    de"!ran(e de c+"&7 Ede e<, de a .! res&onsa'!" de %a"ad!a +ne! .!!n=e !+'!(eJ, !de!
    de"!ran(e de &edea&s7 %er!(a(7 Ede e< , de a .! &ede&s!( d!n ca+/a +n+! &7ca( %ora"
    or! a +ne! !ns+.!c!en(e &ersona"eJ, !de! de"!ran(e n!!"!s(e Ede e<., de d!s(r+$ere
    &ersona"7 sa+ a "+%!!J, !de! de"!ran(e so%a(!ce Ede e<, c7 ar avea cancer or! c7
    &ro&r!+" cor& Sa d!s&7r+(TJ or! !de! de"!ran(e de r+!n7 Ede e<, de a .! r+!na(J
    Ha"+c!na=!!"e, cAnd s+n( &re/en(e, s+n( de re$+"7 (ran/!(or!! s! none"a'ora(e s! &o(
    !%&"!ca voc! care ad%ones(ea/7 &ersoana &en(r+ "!&s+r! sa+ &7ca(e
    Ma! rar, con=!n+(+" a"+c!na=!!"or sa+ !de!"or de"!ran(e n+ are, d+&7 cA( se &are,
    n!c! o re"a=!e c+ (e%e"e de&res!ve As(.e" de elemente psi-otice incon/r+ente c+
    dispo;i(ia !nc"+d !de! de"!ran(e de &ersec+=!e E.7r7 (e%e"e de&res!ve, c+% c7
    !nd!v!d+" %er!(7 a .! &ersec+(a(J, !de! de"!ran(e de !nser=!e a $And+r!"or Ead!c7,
    &ro&r!!"e $And+r! n+ s+n( a"e sa"eJ, !de! de"!ran(e de d!.+/are a $And!% Ead!c7, s!
    a"=!! &o( s74! a+d7 $And+r!"e &ro&r!!J s! !de! de"!ran(e de con(ro" Ead!c7, &ro&r!!"e
    ac=!+n! se a."7 s+' +n con(ro" e<(er!orJ Aces(e e"e%en(e s+n( asoc!a(e c+ +n
    &ro$nos(!c %a! sever C"!n!c!an+" &oa(e !nd!ca na(+ra e"e%en(e"or &s!o(!ce &r!n
    s&ec!.!ca=!a Sc+ e"e%en(e &s!o(!ce con$r+en(e c+ d!s&o/!=!aT or! Sc+ e"e%en(e
    &s!o(!ce !ncon$r+en(e c+ d!s&o/!=!aT
    Y U In re%!s!+ne &ar=!a"7, R U In re%!s!+ne co%&"e(7. Re%!s!+nea co%&"e(7
    neces!(7 o &er!oad7 de ce" &+=!n 9 "+n!, :n care n+ e<!s(7 s!%&(o%e se%n!.!ca(!ve de
    de&res!e E<!s(7 do+7 even(+a"!(7=! &en(r+ +n e&!sod de a .! :n re%!s!+ne &ar=!a"7
    5J +ne"e s!%&(o%e a"e e&!sod+"+! de&res!v %a@or s+n( :nc7 &re/en(e, dar cr!(er!!"e
    co%&"e(e n+ %a! s+n( sa(!s.7c+(e, 9J n+ %a! e<!s(7 n!c! +n .e" de s!%&(o%e
    se%n!.!ca(!ve a"e e&!sod+"+! de&res!v %a@or, dar &er!oada de re%!s!+ne d+rea/7 de
    %a! &+=!n de 9 "+n! Dac7 e&!sod+" de&res!v %a@or a .os( s+&ra&+s &es(e (+"'+rarea
    d!s(!%!c7, d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7, :n re%!s!+ne &ar=!a"7, n+
    es(e &+s c!ar dac7 cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or n+ s+n(
    sa(!s.7c+(e, :n sc!%', d!a$nos(!c+" es(e ce" de (+"'+rare d!s(!%!c7 s! de !s(or!c
    an(er!or de (+"'+rare de&res!v7 %a@or7
    SS#Mii
    l
    Speci$icanii Severitate1#si%otic1+emisiune pentru
    *pisodul Maniacal 7*4
    Criteriile pentru &pe#i%i#an!.. SeveritateA P&i@oti#ARe"i&iune
    pentru Epi&o$ul Depre&iv MaQor #urent 3&au #el "ai re#ent6
    FotD Se codi$ic la cea de a cincea ci$r2 Speci$icanii u,or, moderat, sever, $r
    elemente psi%otice, sever cu elemente psi%otice pot $i aplicai numai dac
    actualmente sunt satis$cute criteriile pentru un episod depresiv ma0or2
    Speci$icanii "n remisiune parial si "n remisiune complet pot $i aplicai celui
    mai recent episod depresiv ma0or din tulburarea depresiv ma0or si episodului
    depresiv ma0or din tulburarea bipolar l sau II, numai dac aceasta este cel mai
    recent tip de episod a$ectiv2
    2xE a .,orD #uine, dac nu c%iar nici un simptom "n exces $a de cele necesare
    pentru a pune dia!nosticul, iar simptomele duc doar la o deteriorare minor "n
    $uncionarea pro$esional sau "n activitile sociale u(uale ori "n relaiile cu
    alii2 2x7 a ModeratD Simptome de deteriorare $uncional "ntre =u,oar> ,i
    =sever>2 2x4 a Sever, $r elemente psi%oticeD Mai multe simptome "n exces
    $a de cele necesare pentru a pune dia!nosticul, iar simptomele inter$erea(
    considerabil cu $uncionarea pro$esional sau cu activitile sociale u(uale ori cu
    relaiile cu alii2 2xH a Sever, cu elemente psi%oticeD Idei delirante sau
    %alucinaii2 Dac este posibil, s se speci$ice dac elementele psi%otice sunt
    con!ruente sau incon!ruente cu dispo(iiaD
    *lemente psi%otice con!ruente cu dispo(iiaD Idei delirante sau
    %alucinaii al cror coninut este "n "ntre!ime concordat cu temele
    depresive tipice de insu$icien personal, de culp, maladie, moarte,
    ni%ilism sau pedeaps meritat2
    *lemente psi%otice incon!ruente cu dispo(iiaD Idei delirante sau
    %alucinaii al cror coninut nu implic temele depresive tipice de
    insu$icien personal, de culp, maladie, moarte, ni%ilism sau pedeaps
    meritat2 Sunt incluse simptome precum ideile delirante de persecuie
    &$r le!tur direct cu temele depresive), inseria de !@nduri,
    di$u(area !@ndirii ,i ideile delirante de control2
    2xA a "n remisiune parialD Sunt pre(ente simptome ale episodului depresiv
    ma0or, dar criteriile complete nu sunt satis$cute ori exist o perioad $r nici
    un simptom semni$icativ de episod depresiv ma0or cu o durat de mai puin de
    7 luni, urm@nd terminrii episodului depresiv ma0or2 &Dac episodul depresiv
    ma0or a $ost suprapus peste tulburarea distimic, este pus dia!nosticul de
    tulburare distimic, odat ce criteriile complete pentru un episod depresiv
    ma0or nu mai sunt satis$cute)2
    2xI a "n remisiune completD "n cursul ultimelor 7 luni nu au $ost pre(ente nici
    un $el de semne sau simptome semni$icative ale perturbrii2 2xO-Fespeci$icat
    Spe#i%i#an!ii SeveritateAP&i@oti#ARe"i&iune
    pentru Epi&o$ul Mania#al
    :n (+"'+rarea '!&o"ar7 I, aceO(! s&ec!.!cAnd !nd!c7 .!e sever!(a(ea e&!sod+"+!
    %an!aca" c+ren(, .!e n!ve"+" de re%!s!+ne, dac7 ce" %a! recen( e&!sod a .os( +n
    e&!sod %an!aca". Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ e&!sod+"
    %an!aca", aces(a &oa(e .! c"as!.!ca( ca +Oor, %odera(, sever, .7r7 e"e%en(e &s!o(!ce
    I5I Tulburrile A$ective
    or! sever, c+ e"e%en(e &s!o(!ce. Dac7 n+ %a! s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ e&!sod+" %an!aca",
    s&ec!.!can(+" !nd!c7 dac7 ce" %a! recen( e&!sod %an!aca" se a."7 :n re%!s!+ne &ar=!a"7 sa+ co%&"e(7.
    AceO(! s&ec!.!cAnd s+n( e<&r!%a=! c+ cea de a c!ncea c!.r7 a cod+"+! &en(r+ (+"'+rare.
    "U UOor, 9 U Modera(, ; U Sever, .7r7 e"e%en(e &s!o(!ce. Sever!(a(ea es(e cons!dera(7 +Ooar7,
    %odera(7 sa+ sever7 &e 'a/a n+%7r+"+! de s!%&(o%e cr!(er!!, sever!(a(ea s!%&(o%e"or, $rad+" de
    !nca&ac!(a(e .+nc=!ona"7 O! neces!(a(ea de s+&rave$ere. E&!soade"e +oare se carac(er!/ea/7 &r!n
    &re/en=a a n+%a! (re! sa+ &a(r+ s!%&(o%e %an!aca"e. E&!soade"e moderate se carac(er!/ea/7 &r!n(r4o
    creO(ere e<(re%7 a ac(!v!(7=!! sa+ de(er!orare a @+dec7=!!. E&!soade"e se*ere, )6r6 elemente psi-otice, se
    carac(er!/ea/7 &r!n neces!(a(ea +ne! s+&rave$er! a&roa&e &er%anen(e &en(r+ a &ro(e@a !nd!v!d+" de a
    n+ se v7(7%a &e s!ne sa+ &e a"=!!.
    I U Sever, c+ e"e%en(e &s!o(!ce. Aces( s&ec!.!can( !nd!c7 &re/en=a, .!e a !de!"or
    de"!ran(e, .!e a a"+c!na=!!"or Ede re$+"7 a+d!(!veJ d!n c+rs+" e&!sod+"+! c+ren(. Ce"
    %a! .recven(, con=!n+(+" !de!"or de"!ran(e sa+ a" a"+c!na=!!"or es(e concordan( c+
    (e%e"e %an!aca"e, ad!c7 aces(ea s+n( elemente psi-otice con/r+ente c+ dispo;i(ia7 De
    e<e%&"+, &oa(e .! a+/!(7 vocea "+! D+%ne/e+, e<&"!cAnd &ersoane! c7 are o %!s!+ne
    s&ec!a"7. Ide!"e de"!ran(e de &ersec+=!e se &o( 'a/a &e !deea c7 &ersoana es(e
    &ersec+(a(7 d!n ca+/a +nor re"a=!! sa+ a(r!'+(e s&ec!a"e.
    Ma! rar, con=!n+(+" !de!"or de"!ran(e sa+ a" a"+c!na=!!"or n+ are n!c! o re"a=!e ev!den(7 c+ (e%e"e
    %an!aca"e, ad!c7 aces(ea s+n( elemente psi-otice incon/r+ente c+ dispo;i(ia7 Aces(ea &o( !nc"+de !de!
    de"!ran(e de &ersec+=!e E.7r7 re"a=!e d!rec(7 c+ (e%e"e de $randoareJ, !de! de"!ran(e de !nser=!e a $And!r!!
    Ead!c7, &ro&r!!"e $And+r! n+4! a&ar=!nJ, !de! de"!ran(e de d!.+/are a $And!r!! Ead!c7, a"=!! :! &o( a+/!
    $And+r!"eJ s! !de! de"!ran(e de con(ro" Ead!c7, ac=!+n!"e &ro&r!! se a."7 s+' con(ro" e<(er!orJ. Pre/en=a
    aces(or e"e%en(e &oa(e .! asoc!a(7 c+ +n &ro$nos(!c %a! sever. C"!n!c!an+" &oa(e !nd!ca na(+ra
    e"e%en(e"or &s!o(!ce s&ec!.!cAnd Sc+ e"e%en(e con$r+en(e c+ d!s&o/!=!aT or! Sc+ e"e%en(e
    !ncon$r+en(e c+ d!s&o/!=!aT.
    A
    U
    Y U In re%!s!+ne &ar=!a"7, R U In re%!s!+ne co%&"e(7. Re%!s!+nea co%&"e(7
    neces!(7 o &er!oad7 de ce" &+=!n 9 "+n! :n care s7 n+ e<!s(e s!%&(o%e se%n!.!ca(!ve
    de %an!e. E<!s(7 do+7 even(+a"!(7=! &en(r+ e&!sod de a .! :n re%!s!+ne &ar=!a"7Q 5J
    s!%&(o%e"e e&!sod+"+! %an!aca" s+n( :nc7 &re/en(e, dar cr!(er!!"e co%&"e(e n+ %a!
    s+n( sa(!s.7c+(e, or! 9J n+ %a! e<!s(7 n!c! +n s!%&(o% se%n!.!ca(!v de e&!sod
    %an!aca", dar &er!oada de re%!s!+ne d+rea/7 de %a! &+=!n de 9 "+n!.
    Speci$icanii Severitate1#si%otic1+emisiune pentru *pisodul Mixt
    I5Y

    Criteriile pentru &pe#i%i#an!ii SeveritateA P&i@oti#ARe"i&iune pentru
    Epi&o$ul Mania#al #urent 3&au #el "ai re#ent6
    FotD Se codi$ic la cea de a cincea ci$r2 Speci$icanii u,or, moderat, sever, $r elemente psi%otice
    ,i sever, cu elemente psi%otice pot $i aplicai numai dac actualmente sunt satis$cute criteriile
    pentru un episod maniacal2 Speci$icanii "n remisiune parial si "n remisiune complet pot $i
    aplicai unui episod maniacal din tulburarea bipolar l numai dac acesta este cel mai recent tip
    de episod a$ectiv2
    2xE a .,orD *ste satis$cut minimumul de criterii simptom pentru un episod
    maniacal2
    2x7 a ModeratD re,tere extrem a activitii sau deteriorarea 0udecii2
    2x4 a Sever, $r elemente psi%oticeD *ste necesar suprave!%erea aproape
    permanent pentru a preveni vtmarea corporal a sa sau a altora2
    2xH a Sever, cu elemente psi%oticeD Idei delirante ,i %alucinaii2 Dac este
    posibil, s se speci$ice dac elementele psi%otice sunt con!ruente sau
    incon!ruente cu dispo(iiaD
    *lemente psi%otice con!ruente cu dispo(iiaD Idei delirante sau %alucinaii al cror
    coninut este "n "ntre!ime concordant cu temele maniacale tipice de valoare exa!erat,
    putere, cuno,tine, identitate ori de relaie special cu o divinitate sau cu o persoan
    celebr2 *lemente psi%otice incon!ruente cu dispo(iiaD Idei delirante sau %alucinaii al
    cror coninut nu implic temele maniacale tipice de valoare exa!erat, putere,
    cuno,tine, identitate ori de relaie special cu o divinitate sau cu o persoan celebr2 Sunt
    incluse simptome, cum ar $i ideile delirante de persecuie &$r relaie direct cu ideile sau
    temele de !randoare), inseria de !@nduri ,i ideile delirante de control2
    2xA a "n remisiune parialD Sunt pre(ente simptomele unui episod maniacal,
    dar nu sunt satis$cute criteriile complete, ori exist o perioad $r simptome
    semni$icative de episod maniacal cu o durat de mai puin de 7 luni de la
    terminarea episodului maniacal2
    2xIa"n remisiune complet, "n cursul celor dou luni precedente nici un $el de
    semne sau simptome de perturbare nu au $ost pre(ente
    2xOaFespeci$icat2
    Spe#i%i#an!ii SeveritateAP&i@oti#ARe"i&iune pentru
    Epi&o$ul Mi,t
    :n (+"'+rarea '!&o"ar7 I, aceO(! s&ec!.!can=! !nd!c7 .!e sever!(a(ea e&!sod+"+! %!<( c+ren(, .!e n!ve"+"
    de re%!s!+ne, dac7 ce" %a! recen( e&!sod a .os( +n e&!sod %!<(. Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ e&!sod+" %!<(, aces(a &oa(e .! c"as!.!ca( ca +Oor, %odera(, sever, .7r7 e"e%en(e &s!o(!ce,
    or! ca sever, c+ e"e%en(e &s!o(!ce. Dac7 n+ %a! s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ +n e&!sod %!<(,
    s&ec!.!can(+" !nd!c7 dac7 ce" %a! recen( e&!sod %!<( se a."7 :n re%!s!+ne &ar=!a"7 sa+ co%&"e(7. AceO(!
    s&ec!.!can=! s+n( !nd!ca=! c+ cea de a c!ncea c!.r7 a cod+"+! &en(r+ (+"'+rare.
    I5R Tulburrile A$ective
    " U UOor, 9 U Modera(, ; U Sever, .7r7 e"e%en(e &s!o(!ce. Sever!(a(ea es(e cons!dera(7 a .!
    +Ooar7, %odera(7 sa+ sever7 &e 'a/a n+%7r+"+! de s!%&(o%e cr!(er!!, sever!(a(ea s!%&(o%e"or,
    $rad+" de !nca&ac!(a(e .+nc=!ona"7 s! neces!(a(ea de s+&rave$ere. E&!soade"e +oare se carac(er!/ea/7
    &r!n &re/en=a a n+%a! (re! sa+ &a(r+ s!%&(o%e %an!aca"e s! a c!nc! sa+ sase s!%&(o%e de&res!ve.
    E&!soade"e moderate se carac(er!/ea/7 &r!n(r4o creO(ere e<(re%7 a ac(!v!(7=!! or! &r!n de(er!orarea @+dec7=!!.
    E&!soade"e se*ere, )6r6 elemente psi-otice, se carac(er!/ea/7 &r!n neces!(a(ea +ne! s+&rave$er! a&roa&e
    con(!n+e &en(r+ a &ro(e@a !nd!v!d+" de a n+ se v7(7%a &e s!ne sa+ &e a"=!!.
    I U Sever, c+ e"e%en(e &s!o(!ce. Aces( s&ec!.!can( !nd!c7 &re/en=a, .!e a !de!"or
    de"!ran(e, .!e a a"+c!na=!!"or Ede re$+"7 a+d!(!veJ d!n c+rs+" e&!sod+"+! c+ren(. Ce"
    %a! .recven(, con=!n+(+" !de!"or de"!ran(e sa+ a" a"+c!na=!!"or es(e concordan(, .!e c+
    (e%e"e %an!aca"e, .!e c+ ce"e de&res!ve, ad!c7, aces(ea s+n( elemente psi-otice
    con/r+ente c+ dispo;i(ia7 De e<e%&"+, &oa(e .! a+/!(7 vocea "+! D+%ne/e+ e<&"!cAnd
    c7 &ersoana res&ec(!v7 are o %!s!+ne s&ec!a"7. Ide!"e de"!ran(e de &ersec+=!e &o(
    avea "a 'a/7 conv!n$erea c7 &ersoana es(e &ersec+(a(7, deoarece %er!(7 o &edea&s7
    s&ec!a"7 or! &en(r+ c7 are o re"a=!e sa+ +n a(r!'+( s&ec!a".
    Ma! rar, con=!n+(+" a"+c!na=!!"or sa+ a" !de!"or de"!ran(e n+ are, ev!den(, n!c! o re"a=!e c+ (e%e"e
    %an!aca"e sa+ de&res!ve, ad!c7, aces(ea s+n( elemente psi-otice incon/r+ente c+ dispo;i(ia7 Aces(ea &o(
    !nc"+de !de! de"!ran(e de !nser=!e a $And+r!"or Ead!c7, &ro&r!!"e $And+r! n+4! a&ar=!nJ, !de! de"!ran(e de
    d!.+/are a $And!r!! Ead!c7, a"=!! :! &o( a+/! $And+r!"eJ s! !de! de"!ran(e de con(ro" Ead!c7, ac=!+n!"e &ro&r!!
    se a."7 s+' +n con(ro" e<(er!orJ. Aces(e e"e%en(e s+n( asoc!a(e c+ +n &ro$nos(!c %a! sever. C"!n!c!an+"
    &oa(e !nd!ca na(+ra e"e%en(e"or &s!o(!ce, s&ec!.!cAnd Sc+ e"e%en(e con$r+en(e c+ d!s&o/!=!aT or! Sc+
    e"e%en(e !ncon$r+en(e c+ d!s&o/!=!aT.
    Y U :n re%!s!+ne &ar=!a"7, R U :n re%!s!+ne co%&"e(7. Re%!s!+nea co%&"e(7
    neces!(7 o &er!oad7 de ce" &+=!n 9 "+n! :n care s7 n+ e<!s(e s!%&(o%e se%n!.!ca(!ve
    de %an!e sa+ de de&res!e. E<!s(7 do+7 even(+a"!(7=! &en(r+ e&!sod de a .! :n
    re%!s!+ne &ar=!a"7Q 5J s!%&(o%e"e e&!sod+"+! %!<( s+n( :nc7 &re/en(e, dar cr!(er!!"e
    co%&"e(e n+ %a! s+n( sa(!s.7c+(e sa+ 9J n+ %a! e<!s(7 n!c! +n .e" de s!%&(o%e
    se%n!.!ca(!ve a"e e&!sod+"+! %!<(, dar &er!oada de re%!s!+ne are o d+ra(7 de %a!
    &+=!n de 9 "+n!.
    Criteriile pentru &pe#i%i#an!ii SeveritateA P&i@oti#ARe"i&iune pentru
    Epi&o$ul Mi,t #urent 3&au #el "ai re#ent6
    FotD Se codi$ic cu cea de a cincea ci$r2 Speci$icanii u,or, moderat, sever, $r elemente psi%otice,
    sever cu elemente psi%otice, pot $i aplicai numai dac actualmente sunt satis$cute criteriile
    pentru un episod mixt2 Speci$icanii "n remisiune parial si "n remisiune complet pot $i aplicai
    unui episod mixt din tulburarea bipolar l numai dac acesta este cel mai recent tip de episod
    a$ectiv2
    2xE a .,orD Sunt satis$cute nu mai mult dec@t minimumul de criterii simptom, at@t pentru un
    episod maniacal, c@t si pentru un episod depresiv ma0or2 2x7 a ModeratD Simptome sau
    deteriorare $uncional "ntre =u,oar> si =sever2 2x4 a Sever, $r elemente psi%oticeD *ste
    necesar suprave!%erea aproape permanent pentru a preveni vtmarea corporal a sa sau a
    altora2
    Speci$icantul =ronic> pentru un *pisod Depresiv Ma0or HE?
    Criteriile pentru &pe#i%i#an!ii SeveritateA P&i@oti#ARe"i&iune
    pentru Epi&o$ul Mi,t #urent 3&au #el "ai re#ent6 (continuare)
    .,7 U Sever2 #u ele"ente p&i@oti#eM Idei delirante sau %alucinaii2 Dac este
    posibil, s se speci$ice dac elementele psi%otice sunt con!ruente sau
    incon!ruente cu dispo(iiaD
    Ele"ente p&i@oti#e #on/ruente #u $i&po)i!iaM Idei delirante sau
    %alucinaii al cror coninut este concordant cu temele maniacale sau
    depresive tipice2
    Ele"ente p&i@oti#e in#on/ruente #u $i&po)i!iaM Idei delirante sau
    %alucinaii al cror coninut nu implic teme maniacale sau depresive
    tipice2 Sunt incluse simptome, precum ideile delirante de persecuie &$r
    le!tur direct cu temele de !randoare sau depresive), inseria de
    !@nduri ,i ideile delirante de a $i controlat2
    2xA a "n remisiune parialD Sunt pre(ente simptomele unui episod mixt, dar
    nu sunt satis$cute criteriile complete ori exist o perioad $r nici un $el de
    simptome semni$icative de episod mixt cu o durat de mai puin de 7 luni
    urm@nd terminrii episodului mixt2
    .,= U .n re"i&iune #o"plet(M "n cursul ultimelor 7 luni, nu au $ost pre(ente nici
    un $el de semne sau simptome semni$icative ale perturbrii2
    .,O U Ne&pe#i%i#at.
    Spe#i%i#antul 0Croni#1
    pentru un Epi&o$ Depre&iv MaQor
    Aces( s&ec!.!can( !nd!c7 na(+ra cron!c7 a e&!sod+"+! de&res!v %a@or Ead!c7
    .a&(+" c7 (!%& de ce" &+=!n do! an! a+ .os( sa(!s.7c+(e &er%anen( cr!(er!!"e co%&"e(e
    &en(r+ +n e&!sod de&res!v %a@orJ. Aces( s&ec!.!can( se a&"!c7 e&!sod+"+! de&res!v
    %a@or c+ren( Esa+ dac7 ac(+a"%en(e n+ %a! s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e
    &en(r+ +n e&!sod de&res!v %a@or, ce"+! %a! recen(J d!n (+"'+rarea de&res!v7
    %a@or7 s! e&!sod+"+! de&res!v %a@or c+ren( Esa+ ce"+! %a! recen(J d!n (+"'+rarea
    '!&o"ar7 I sa+ (+"'+rarea '!&o"ar7 II, n+%a! dac7 aces(a es(e ce" %a! recen( (!& de
    e&!sod a.ec(!v.
    Criteriile pentru Spe#i%i#antul Croni#
    7e speci"icat dac'
    Croni# &poate $i aplicat episodului depresiv ma0or curent sau celui mai recent
    din tulburarea depresiv ma0or ,i episodului depresiv ma0or din tulburarea
    bipolar l sau II, numai dac este cel mai recent tip de episod a$ectiv)2
    riteriile complete pentru un episod depresiv ma0or au $ost satis$cute
    continuu timp de cel puin 7 ani anteriori2
    7*>
    Tulburrile A$ective
    Spe#i%i#antul 0Cu Ele"ente
    Cataton.#e1
    S&ec!.!can(+" SC+ e"e%en(e ca(a(on!ceT &oa(e .! a&"!ca(
    e&!sod+"+! de&res!v %a@or, %an!aca" sa+ %!<( c+ren( d!n
    (+"'
    +rar
    ea
    de&
    res!
    v7
    %a@
    or7,
    (+"'
    +rar
    ea '!&o"ar7 I sa+ (+"'+rarea '!&o"ar7 II. Dac7 n+ %a! s+n(
    sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod a.ec(!v,
    S&ec!.!can(+" se a&"!c7 e&!soade"or ce"or %a! recen(e.
    S&ec!.!can(+" SC+ e"e%en(e ca(a(on!ceT es(e !nd!ca( cAnd
    (a'"o+" c"!n!c es(e carac(er!/a( &r!n(r4o &er(+r'are &s!o%o(or!e
    %arca(7 care &oa(e !%&"!ca !%o'!"!(a(e %o(or!e, ac(!v!(a(e
    %o(or!e e<ces!v7, ne$a(!v!s% e<(re%, %+(!s%, '!/arer!! a"e
    %!Oc7r!"or vo"+n(are, eco"a"!e sa+ eco&ra<!e. I%o'!"!(a(ea
    %o(or!e se &oa(e %an!.es(a &r!n ca(a"e&s!e E."e<!'!"!(a(e ceroas7J
    sa+ s(+&or. Ac(!v!(a(ea %o(or!e e<ces!v7 es(e, ev!den(, "!&s!(7 de
    sco& s! n+ es(e !n."+en=a(7 de s(!%+"!! e<(ern!. Poa(e e<!s(a +n
    ne$a(!v!s% e<(re%, care se %an!.es(7 &r!n %en=!nerea +ne!
    &os(+r! r!$!de con(ra (+(+ror :ncerc7r!"or de a .! %o'!"!/a( sa+
    o&o/!=!e "a (oa(e ord!ne"e da(e. B!/arer!a %!Oc7r!"or vo"+n(are se
    %an!.es(7 &r!n as+%area +nor &os(+r! !nadecva(e sa+ s(ran!!, or!
    &r!n $r!%ase no(a'!"e. Eco"a"!a Ere&e(area &a(o"o$!c7, ase%enea
    +n+! &a&a$a" s!, ev!den(, .7r7 sens, a c+v!n(e"or sa+ e<&res!!"or
    a'!a s&+se de o a"(7 &ersoan7J s! eco&ra<!a E!%!(area re&e(!(!v7
    a %!Oc7r!"or +ne! a"(e &ersoaneJ s+n( adesea &re/en(e.
    E"e%en(e"e ad!=!ona"e &o( !nc"+de s(ereo(!&!!, %an!er!s%e,
    s+&+nerea a+(o%a(7 "a ord!n s! !%!(a=!a, :n (!%&+" e<c!(a=!e!
    sa+ s(+&or!! ca(a(on!ce severe, &ersoana res&ec(!v7 &oa(e
    neces!(a o s+&rave$ere a(en(7 &en(r+ a ev!(a a+(ov7(7%area
    sa+ v7(7%area a"(ora. Consec!n=e"e even(+a"e !nc"+d
    %a"n+(r!=!a, e<(en+area, !&er&!re<!a s! "e/!+n!"e
    a+(o&rovoca(e.
    S4a cons(a(a( c7 s(7r!"e ca(a(on!ce s+rv!n :n Yd4Fd d!n(re
    &ac!en=!! !n(erna=!. La &ac!en=!! c+ ca(a(on!e !n(erna=!, 9Yd4YLd
    d!n ca/+r! s+rv!n :n asoc!ere c+ (+"'+r7r!"e a.ec(!ve, 5Ld45Yd
    d!n ca/+r! s+rv!n :n asoc!ere c+ sc!/o.ren!a Eve/! sc!/o.ren!a,
    (!&+" ca(a(on!e, &a$. ;5YJ, !ar res(+" s+rv!n :n asoc!ere c+ a"(e
    (+"'+r7r! %en(a"e Ede e<., (+"'+rarea o'ses!vo4co%&+"s!v7,
    (+"'+r7r!"e de &ersona"!(a(e s! (+"'+r7r!"e d!soc!a(!veJ. Es(e
    !%&or(an( de re=!n+( c7, de ase%enea, ca(a(on!a &oa(e s+rven!
    :n(r4o "ar$7 var!e(a(e de cond!=!! %ed!ca"e $enera"e !nc"+/And,
    dar n+ "!%!(a(7 "a aces(ea, cond!=!! !n.ec=!oase, %e(a'o"!ce,
    ne+ro"o$!ce Eve/! (+"'+rarea ca(a(on!c7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, &a$.5GYJ, sa+ da(ora(e e.ec(e"or
    sec+ndare a"e +n+! %ed!ca%en( Ede e<., (+"'+rarea de
    %!Ocare !nd+s7 de %ed!ca=!e, ve/! &a$. HF5J. D!n ca+/a
    sever!(7=!! co%&"!ca=!!"or, o a(en=!e s&ec!a"7 (re'+!e acorda(7
    &os!'!"!(7=!! ca +n s!ndro% ne+ro"e&(!c %a"!$n s7 .!e ca+/a
    ca(a(on!e! E&a$. HFYJ.
    ,
    Criteriile pentru Spe#i%i#antul 0Cu Ele"ente Catatoni#e1
    De speci"icat dacD
    u elemente catatonice &poate $i aplicat episodului
    depresiv ma0or, episodului maniacal sau episodului mixt,
    curent sau celui mai recent, din tulburarea depresiv
    ma0or, tulburarea bipolar l sau tulburarea bipolar II)2
    Tabloul clinic este dominat de cel puin dou dintre urmtoareleD
    (1) imobilitate motorie evideniat prin catalepsie
    &inclu(@nd $lexibilitatea
    ceroas) sau stupor3
    (2) activitate motorie excesiv &care este, evident, lipsit de
    scop ,i nu este
    in$luenat de stimul/ externi)3
    Speci$icantul =u *lemente
    Melancolice>
    7*5

    (3) ne!ativism extrem &o opo(iie, aparent $r motiv la toate ordinele
    sau
    meninerea unei posturi ri!ide contra "ncercrilor de a $i mobili(at) sau
    mutism3
    (4) bi(arerii ale mi,crilor voluntare evideniate prin posturi
    &asumarea
    voluntar a unor posturi inadecvate sau bi(are), mi,cri stereotipe, ma-
    nierisme proeminente sau !rimase notabile3
    (3) ecolalie sau ecopraxie2
    Spe#i%i#antul 0Cu Ele"ente Melan#oli#e1
    S&ec!.!can(+" SC+ e"e%en(e %e"anco"!ceT &oa(e .! a&"!ca( e&!sod+"+! de&res!v
    %a@or c+ren( Esa+ dac7 ac(+a"%en(e n+ %a! s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ +n
    e&!sod de&res!v %a@or, ce"+! %a! recen(J d!n (+"'+rarea de&res!v7 %a@or7 s!
    e&!sod+"+! de&res!v %a@or c+ren( Esa+ ce"+! %a! recen(J d!n (+"'+rarea '!&o"ar7 I sa+
    II, n+%a! dac7 es(e ce" %a! recen( (!& de e&!sod a.ec(!v. E"e%en(+" esen=!a" a" +n+!
    e&!sod de&res!v %a@or, c+ e"e%en(e %e"anco"!ce, :" cons(!(+!e &!erderea !n(eres+"+!
    sa+ &"7cer!! &en(r+ (oa(e sa+ a&roa&e (oa(e ac(!v!(7=!"e, or! o "!&s7 de reac(!v!(a(e "a
    s(!%+"! de re$+"7 &"7c+=!. D!s&o/!=!a de&res!v7 a !nd!v!d+"+! n+ (re'+!e s7 se
    a%e"!ore/e, .!e O! (e%&orar, cAnd s+rv!ne ceva '+n Ecr!(er!+" AJ, :n a.ar7 de aceas(a,
    ce" &+=!n (re! d!n(re +r%7(oare"e s!%&(o%e s+n( &re/en(eQ o ca"!(a(e d!s(!nc(7 a
    d!s&o/!=!e! de&res!ve, d!s&o/!=!e care de re$+"7 es(e %a! rea d!%!nea=a, deO(e&(are
    d!n so%n d!%!nea=a &recoce, "en(oare sa+ a$!(a=!e &s!o%o(or!e, anore<!e sa+
    &!erdere :n $re+(a(e se%n!.!ca(!v7, c+"&7 e<ces!v7 sa+ !nadecva(7 Ecr!(er!+" BJ.
    S&ec!.!can(+" SC+ e"e%en(e %e"anco"!ceT se a&"!c7 dac7 aces(e e"e%en(e s+n(
    &re/en(e "a nad!r+" e&!sod+"+!. E<!s(7 o a'sen=7 a&roa&e co%&"e(7 a ca&ac!(7=!!
    &en(r+ &"7cere, s! n+ n+%a! d!%!n+area aces(e!a. Un !nd!c!+ &en(r+ eva"+area "!&se!
    de reac(!v!(a(e a d!s&o/!=!e! es(e ace"a c7, O! :n ca/+" +nor even!%en(e e<(re% de
    dor!(e, d!s&o/!=!a de&res!v7 n+ se "+%!nea/7 de"oc sa+ se "+%!nea/7 n+%a! &ar=!a"
    Ede e<., &An7 "a 9Ld4ILd d!n nor%a" O! n+%a! &en(r+ cA(eva %!n+(e oda(7J.
    Ca"!(a(ea d!s(!nc(7 a d!s&o/!=!e!, care es(e carac(er!s(!c7 s&ec!.!can(+"+! Sc+ e"e%en(e
    %e"anco"!ceT, es(e e<&er!en(a(7 de !nd!v!/! ca .!!nd d!.er!(7 ca"!(a(!v de (r!s(e=ea
    e<&er!en(a(7 :n c+rs+" do"!+"+! sa+ :n(r4+n e&!sod de&res!v non%e"anco"!c. Aceas(a
    se &oa(e ev!den=!a &+nAnd &ersoana res&ec(!v7 s7 co%&are ca"!(a(ea d!s&o/!=!e!
    de&res!ve c+ren(e c+ d!s&o/!=!a e<&er!en(a(7 d+&7 %oar(ea +ne! .!!n=e !+'!(e. O
    d!s&o/!=!e de&res!v7 descr!s7 &+r O! s!%&"+ ca .!!nd %a! sever7, d+rAnd de %a! %+"(
    (!%& or! &re/en(7 .7r7 +n %o(!v n+ es(e cons!dera(7 ca d!s(!nc(7 ca"!(a(!v.
    Mod!.!c7r!"e &s!o%o(or!! s+n( a&roa&e (o(dea+na &re/en(e O! s+n( o'serva'!"e de
    c7(re a"=!!. Ind!v!/!! c+ e"e%en(e %e"anco"!ce es(e .oar(e &+=!n &ro'a'!" s7 a!'7 o
    (+"'+rare de &ersona"!(a(e &re%or'!d7, s7 a!'7 +n .ac(or &rec!&!(an( c"ar &en(r+
    e&!sod O! s7 r7s&+nd7 "a (es(area +n+! %ed!ca%en( &"ace'o. O consec!n=7 a
    &ro'a'!"!(7=!! %a! red+se de a r7s&+nde "a &"ace'o o cons(!(+!e neces!(a(ea %a! %are
    a +n+! (ra(a%en( an(!de&res!v ac(!v.
    Aces(e e"e%en(e %an!.es(7 doar o (end!n=7 %odes(7 "a a se re&e(a de4a "+n$+"
    d!verse"or e&!soade "a ace"aO! !nd!v!d. E"e s+n( %a! .recven(e "a &ac!en=!! !n(erna=!,
    :n co%&ara=!e c+ ce! (ra(a=! a%'+"a(or, O! es(e &+=!n &ro'a'!" c7 vor a&are :n
    e&!soade"e %a! +Ooare O! n+ :n e&!soade"e de&res!ve %a@ore severe, d+&7 c+% es(e
    .oar(e &os!'!" s7 a&ar7 "a ce! c+ s!%&(o%e &s!o(!ce. E"e%en(e"e %e"anco"!ce s+n(
    I9L Tulburrile A$ective

    asoc!a(e %a! .recven( c+ da(e de "a'ora(or de nons+&res!+ne "a de<a%e(a/on7,
    concen(ra=!! cresc+(e de cor(!/o" :n &"as%7, +r!n7 s! sa"!v7, a"(erarea &ro.!"e"or EE,
    de so%n, (es(+" de &rovocare c+ (!ra%!n7 anor%a" s! o as!%e(r!e anor%a"7 "a (es(e"e
    de a+d!=!e '!a+r!c+"ar7.
    Criteriile pentru &pe#i%i#antul 0Cu Ele"ente Melan#oli#e1
    De speci"icat dacD
    u elemente melancolice &poate $i aplicat episodului depresiv ma0or curent
    sau celui mai recent din tulburarea depresiv ma0or ,i episodului depresiv
    ma0or din tulburarea bipolar l sau bipolar II numai dac acesta este cel
    mai recent tip de episod a$ectiv)2
    A2 Oricare dintre urmtoarele survenind "n cursul celei mai severe perioade
    a episodului curentD
    (1)pierderea plcerii pentru toate sau aproape toate activitile,
    (2)lipsa de reactivitate la stimuli de re!ul plcui &a nu se simi mult mai
    bine, c%iar temporar, c@nd survine ceva bun)2
    S2 Trei &sau mai multe) dintre urmtoareleD
    &E)o calitate distinct a dispo(iiei depresive &adic, dispo(iia depresiv
    este experientat ca $iind net di$erit de tipul de sentimente
    experientate dup moartea unei $iine iubite),
    (2)depresie de re!ul mai sever dimineaa,
    (3)de,teptare dimineaa precoce &cu cel puin 7 ore "nainte de ora u(ual
    de de,teptare),
    (4)lentoare sau a!itaie psi%omotorie marcat,
    (5)anorexie sau pierdere "n !reutate semni$icativ,
    (6)culp excesiv sau inadecvat2
    Spe#i%i#antul 0Cu Ele"ente Atipi#e1
    S&ec!.!can(+" SC+ e"e%en(e a(!&!ceT &oa(e .! a&"!ca( e&!sod+"+! de&res!v %a@or
    c+ren( Esa+, dac7 ac(+a"%en(e cr!(er!!"e co%&"e(e &en(r+ +n e&!sod de&res!v %a@or
    n+ s+n( sa(!s.7c+(e, ce"+! %a! recen(J d!n (+"'+rarea de&res!v7 %a@or7 s! e&!sod+"+!
    de&res!v %a@or c+ren( Esa+ ce" %a! recen(J d!n (+"'+rarea '!&o"ar7 I sa+ II, n+%a!
    dac7 aces(a es(e ce" %a! recen( (!& de e&!sod a.ec(!v, sa+ (+"'+r7r!! d!s(!%!ce.
    TDe&res!a a(!&!c7T are se%n!.!ca=!e !s(or!c7 Ead!c7, se re.er7 "a (a'"o+r!"e c"!n!ce de
    de&res!e a(!&!c7 :n o&o/!=!e c+ ce"e %a! c"as!ce de de&res!e Tendo$en7TJ O! n+ are
    cono(a=!a de (a'"o+ c"!n!c rar, aOa c+% "as7 (er%en+" s7 se :n=e"ea$7. E"e%en(e"e
    esen=!a"e s+n( reac(!v!(a(ea d!s&o/!=!e! Ecr!(er!+" AJ s! &re/en=a a ce" &+=!n do+7
    d!n(re +r%7(oare"e e"e%en(e Ecr!(er!+" BJQ a&e(!( cresc+( sa+ &"+s &ondera",
    !&erso%n!e, &ara"!/!e Sca de &"+%'T s! +n &a((ern de "+n$7 d+ra(7 de sens!'!"!(a(e
    e<(re%7 "a &erce&erea re@ec=!e! !n(er&ersona"e. Aces(e e"e%en(e &redo%!n7 :n c+rs+"
    ce"e! %a! recen(e &er!oade de 9 s7&(7%An! Esa+ a ce"e! %a! recen(e &er!oade de 9 an!
    &en(r+ (+"'+rarea d!s(!%!c7J. S&ec!.!can(+" Sc+ e"e%en(e a(!&!ceT n+ es(e &+s, dac7
    a+ .os( sa(!s.7c+(e cr!(er!!"e &en(r+ Sc+ e"e%en(e %e"anco"!ceT or! Sc+ e"e%en(e
    ca(a(on!ceT :n c+rs+" ace"+!aO! e&!sod de&res!v %a@or.
    Tulburrile
    A$ective
    H7E
    Reac(!v!(a(ea d!s&o/!=!e! es(e ca&ac!(a(ea de a se '+c+ra cAnd es(e con.r+n(a( c+
    even!%en(e &o/!(!ve Ede e<., o v!/!(7 a co&!!"or, co%&"!%en(e de "a a"=!!J. D!s&o/!=!a
    &oa(e deven! e+(!%!c7 En+ (r!s(7J &en(r+ &er!oade :n(!nse de (!%&, dac7
    c!rc+%s(an=e"e r7%An .avora'!"e. A&e(!(+" cresc+( se &oa(e %an!.es(a &r!n(r4o
    creO(ere a !n$es(!e! de a"!%en(e or! &r!n(r4+n &"+s &ondera". H!&erso%n!a &oa(e
    !nc"+de, .!e o &er!oad7 :n(!ns7 de so%n :n c+rs+" no&=!!, .!e de a=!&!( :n c+rs+" /!"e!,
    care (o(a"!/ea/7 ce" &+=!n 5L ore de so%n &e /! Esa+ c+ ce" &+=!n 9 ore %a! %+"(,
    decA( a(+nc! cAnd n+ es(e de&res!vJ. Para"!/!a Sca de &"+%'T es(e de.!n!(7 ca
    sen/a=!a de $re+(a(e, de &"+%' or! de :%&ov7rare, de re$+"7, :n 'ra=e sa+ &!c!oare8
    aceas(a es(e :n $enera" &re/en(7 (!%& de ce" &+=!n o or7 &e /!, dar adesea d+rea/7
    %a! %+"(e ore, oda(7. Con(rar a"(or e"e%en(e a(!&!ce, sens!'!"!(a(ea &a(o"o$!c7 "a
    &erce&erea re@ec=!e! !n(er&ersona"e es(e o (r7s7(+r7 care are +n de'+( &recoce s!
    &ers!s(7 cea %a! %are &ar(e a v!e=!! ad+"(e. Sens!'!"!(a(ea "a re@ec=!e s+rv!ne a(A( cAnd
    &ersoana es(e de&res!v7, dar s! cAnd n+ es(e, s! &oa(e .! e<acer'a(7 :n c+rs+"
    &er!oade"or de&res!ve. Pro'"e%e"e care re/+"(7 d!n sens!'!"!(a(ea "a re@ec=!e (re'+!e
    s7 .!e s+.!c!en( de !%&or(an(e &en(r+ a d+ce "a de(er!orare .+nc=!ona"7. Po( e<!s(a
    re"a=!! .+r(+noase c+ r+&(+r! .recven(e s! c+ !nca&ac!(a(ea de a s+s=!ne o re"a=!e de
    "+n$7 d+ra(7. Reac=!a !nd!v!d+"+! "a re.+/ sa+ "a cr!(!c7 se &oa(e %an!.es(a &r!n
    "7sarea &recoce a "+cr+"+!, +/+" e<ces!v de s+'s(an=e sa+ e(a"area a"(or r7s&+ns+r!
    co%&or(a%en(a"e de/ada&(a(!ve se%n!.!ca(!ve c"!n!c. Poa(e e<!s(a, de ase%enea, o
    ev!(are a re"a=!!"or, da(ora(7 .r!c!! de re@ec=!e !n(er&ersona"7. A .! a(!ns oca/!ona" or!
    !&ere%o(!v n+ (re'+!e s7 .!e e(!ce(a( ca o %an!.es(are a sens!'!"!(7=!! "a re@ec=!e
    !n(er&ersona"7. T+"'+r7r!"e de &ersona"!(a(e Ede e<., (+"'+rarea de &ersona"!(a(e
    ev!(an(7J s! (+"'+r7r!"e an<!oase Ede e<.,an<!e(a(ea de se&arare, .o'!a s&ec!.!c7 sa+
    .o'!a soc!a"7J &o( .! %a! .recven(e "a ce! c+ e"e%en(e a(!&!ce. Da(e"e de "a'ora(or
    asoc!a(e c+ e&!sod+" de&res!v %a@or c+ e"e%en(e %e"anco"!ce n+ s+n( &re/en(e :n
    $enera" :n asoc!ere c+ +n e&!sod c+ e"e%en(e a(!&!ce.
    E"e%en(e"e a(!&!ce s+n( de do+7 sa+ (re! or! %a! .recven(e "a .e%e!. Ind!v!/!! c+
    e"e%en(e a(!&!ce re"a(ea/7 o e(a(e %a! &recoce "a de'+(+" e&!soade"or "or
    de&res!ve Ede e<., :n (!%& ce s+n( "a "!ce+J O! a+ %a! .recven( o evo"+=!e %a!
    cron!c7, %a! &+=!n e&!sod!c7, c+ rec+&erare !n(ere&!sod!c7 &ar=!a"7 doar. Es(e
    .oar(e &os!'!" ca !nd!v!/!! %a! (!ner! s7 &re/!n(e e&!soade c+ e"e%en(e a(!&!ce, !ar
    ce! %a! :n e(a(e s7 a!'7 e&!soade c+ e"e%en(e %e"anco"!ce. E&!soade"e c+ e"e%en(e
    a(!&!ce s+n( %a! .recven(e :n (+"'+rarea '!&o"ar7 I, (+"'+rarea '!&o"ar7 II O! :n
    (+"'+rarea de&res!v7 %a@or7 rec+ren(7, s+rven!nd :n &a((ern se/on!er. E&!soade"e
    de&res!ve c+ e"e%en(e a(!&!ce es(e &os!'!" s7 r7s&+nd7 %a! '!ne "a (ra(a%en(+" c+
    !n!'!(or! de %onoa%!noo<!da/7 decA( "a an(!de&res!ve"e (r!c!c"!ce. 3a"oarea
    &red!c(!v7 a e"e%en(e"or a(!&!ce es(e %a! &+=!n c"ar7 :n ca/+" (ra(a%en(e"or %a!
    no!, c+% ar .! ce"e c+ !n!'!(or! a! reca&(7r!! sero(on!ne! sa+ &s!o(era&!!"e
    !n(er&ersona"e sa+ co$n!(!ve.
    F22 Tulburrile A$ective
    Criteriile pentru &pe#i%i#antul 0Cu Ele"ente Atipi#e1
    De speci"icat dacD
    u elemente atipice &poate $i aplicat c@nd aceste elemente predomin "n
    cursul celor mai recente 7 sptm@ni ale unui episod depresiv ma0or "n
    tulburarea depresiv ma0or sau "n tulburarea bipolar l, ori "n tulburarea
    bipolar II, c@nd episodul depresiv ma0or este cel mai recent tip de episod
    a$ectiv ori c@nd aceste elemente predomin "n cursul celor mai receni 7 ani
    de tulburare distimic3 dac nu estre pre(ent episodul depresiv ma0or,
    speci$icantul se aplic dac elementele predomin "n cursul oricrei
    perioade de 7 sptm@ni2
    A2 +eactivitatea dispo(iiei &adic, dispo(iie eu$oric drept rspuns la
    evenimente po(itive actuale sau eventuale)2
    S2 Dou &sau mai multe) dintre urmtoarele elementeD
    (1) plus ponderal semni$icativ sau apetit crescut,
    (2) %ipersomnie,
    (1) parali(ie =ca de plumb> &adic, sen(aii de !reutate, =de
    plumb>, "n
    brae sau "n picioare),
    (2) pattern
    durabil de sensibilitate la re0ecia interpersonal &nelimitat
    la episoadele de perturbare a$ectiv) care duce la o deteriorare
    social sau pro$esional semni$icativ2 2Z
    2 "n cursul aceluia,i episod nu sunt satis$cute criteriile pentru =cu
    elemente melancolice> ori =cu elemente catatonice>2
    Spe#i%i#antul 0Cu De-ut Po&t part u "1
    S&ec!.!can(+" SC+ de'+( &os(&ar(+%T &oa(e .! a&"!ca( e&!sod+"+! de&res!v
    %a@or, %an!aca" sa+ %!<(, c+ren( Esa+, dac7 n+ %a! s+n( sa(!s.7c+(e cr!(er!!"e
    co%&"e(e &en(r+ +n e&!sod de&res!v %a@or, %an!aca" sa+ %!<(, ce"+! %a!
    recen(J d!n (+"'+rarea de&res!v7 %a@or7, (+"'+rarea '!&o"ar7 I, (+"'+rarea
    '!&o"ar7 II sa+ (+"'+rarea &s!o(!c7 sc+r(7 E&a$. ;9FJ, dac7 de'+(+" are "oc :n
    dec+rs de I s7&(7%An! d+&7 naO(erea +n+! co&!", :n $enera", s!%&(o%a(o"o$!a
    +n+! e&!sod de&res!v %a@or, %an!aca" sa+ %!<( &os(&ar(+% n+ d!.er7 de
    s!%&(o%a(o"o$!a e&!soade"or a.ec(!ve non&os(&ar(+%. S!%&(o%e"e care s+n(
    co%+ne e&!soade"or c+ de'+( :n &os(&ar(+%, deO! n+ s+n( s&ec!.!ce de'+(+"+!
    &os(&ar(+%, !nc"+de ."+c(+a=!!"e de d!s&o/!=!e, "a'!"!(a(ea a.ec(!v7 O!
    &reoc+&7r!"e re.er!(oare "a '+n7s(area co&!"+"+!, !n(ens!(a(ea aces(ora %er$And
    de "a &reoc+&are e<a$era(7 "a !de! de"!ran(e &a(en(e. Pre/en=a r+%!na=!!"or
    severe sa+ a !de!"or de"!ran(e re.er!(oare "a co&!" es(e asoc!a(7 c+ +n r!sc cresc+(
    de v7(7%are a co&!"+"+!.
    E&!soade"e a.ec(!ve c+ de'+( &os(&ar(+% &o( &re/en(a sa+ n+ e"e%en(e &s!o(!ce
    In.an(!c!d+" es(e asoc!a( ce" %a! adesea c+ e&!soade &s!o(!ce &os(&ar(+%
    carac(er!/a(e &r!n a"+c!na=!! co%andAnd +c!derea co&!"+"+! sa+ &r!n !de! de"!ran(e
    de &osedare a co&!"+"+!, dar aceas(a &oa(e s+rven! s! :n e&!soade"e a.ec(!ve severe
    &os(&ar(+% .7r7 aces( .e" de a"+c!na=!! sa+ !de! de"!ran(e. E&!soade"e a.ec(!ve
    Ede&res!v %a@or, %an!aca" sa+ %!<(J &os(&ar(+% c+ e"e%en(e &s!o(!ce &ar a
    Speci$icanii descriind *voluia *pisoadelor +ecurente H74
    s+rven! :n 5XYLL &An7 "a 5X5LLL de naO(er! s! &o( .! %a! .recven(e "a .e%e!"e
    &r!%!&are. R!sc+" de e&!soade &os(&ar(+% c+ e"e%en(e &s!o(!ce es(e e<(re% de
    cresc+( &en(r+ .e%e!"e c+ e&!soade a.ec(!ve &os(&ar(+% an(er!oare, dar es(e, de
    ase%enea, cresc+( s! "a ce"e c+ !s(or!c an(er!or de (+"'+rare a.ec(!v7 E:n s&ec!a" de
    (+"'+rare '!&o"ar7 IJ. Oda(7 ce o .e%e!e a av+( +n e&!sod &os(&ar(+% c+ e"e%en(e
    &s!o(!ce, r!sc+" de rec+ren=7 c+ .!ecare naO(ere +r%7(oare se s!(+ea/7 :n(re ;Ld s!
    YLd. E<!s(7, de ase%enea, +ne"e !nd!c!! de r!sc cresc+( de e&!soade a.ec(!ve
    &s!o(!ce &os(&ar(+% &r!n(re .e%e!"e .7r7 +n !s(or!c de (+"'+r7r! a.ec(!ve, dar c+
    !s(or!c .a%!"!a" de (+"'+r7r! '!&o"are. E&!soade"e &os(&ar(+% (re'+!e s7 .!e
    d!.eren=!a(e de de"!r!+%+" s+rven!nd :n &er!oada de &os(&ar(+% care es(e
    carac(er!/a( &r!n red+cerea n!ve"+"+! conO(!en(e! sa+ a(en=!e!.
    Fe%e!"e c+ e&!soade de&res!ve %a@ore &os(&ar(+% &re/!n(7 adesea an<!e(a(e
    sever7 O! c!ar a(ac+r! de &an!c7. A(!(+d!n!"e %a(erne .a=7 de co&!" s+n( e<(re% de
    var!a'!"e s! &o( !nc"+de de/!n(eres+", .r!ca de a r7%Ane s!n$+r7 c+ co&!"+", sa+ o
    &reoc+&are e<ces!v7 care deran@ea/7 "!n!O(ea necesar7 co&!"+"+!. Es(e !%&or(an( s7
    se d!s(!n$7 e&!soade"e a.ec(!ve &os(&ar(+% de S'a'y '"+esT E.+r!a "a&(e"+!J care
    a.ec(ea/7 &An7 "a HLd d!n(re .e%e! :n c+rs+" &r!%e"or 5L /!"e &os(&ar(+%, s+n(
    (ran/!(or!! s! n+ de(er!orea/7 .+nc=!onarea. S(+d!!"e &ros&ec(!ve a+ de%ons(ra( c7
    s!%&(o%e"e a.ec(!ve s! an<!oase d!n c+rs+" sarc!n!! s! S'a'y '"+esT cresc r!sc+"
    &en(r+ +n e&!sod de&res!v %a@or &os(&ar(+%. Un (rec+( &ersona" de (+"'+rare
    a.ec(!v7 non&os(&ar(+% s! +n !s(or!c .a%!"!a" de (+"'+r7r! a.ec(!ve cresc, de
    ase%enea, r!sc+" de a&ar!=!e a +ne! (+"'+r7r! a.ec(!ve &os(&ar(+%. Fac(or!! de r!sc,
    ra(e"e de rec+ren=7 s! s!%&(o%e"e e&!soade"or a.ec(!ve c+ de'+( &os(&ar(+% s+n(
    s!%!"are c+ ce"e a"e e&!soade"or a.ec(!ve non&os(&ar(+%. Per!oada de &os(&ar(+%
    es(e :ns7 +n!c7 re.er!(or "a $rad+" de a"(er7r! ne+roendocr!ne s! de ada&(7r!
    &s!osoc!a"e, !%&ac(+" &o(en=!a" a" a"7&(7r!! as+&ra &"an!.!c7r!! (ra(a%en(+"+! s!
    !%&"!ca=!!"or &e (er%en "+n$ a"e +n+! !s(or!c de (+"'+rare a.ec(!v7 &os(&ar(+%
    as+&ra &"an!.!c7r!! .a%!"!a"e +"(er!oare.
    Criteriile pentru &pe#i%i#antul 0Cu De-ut Po&tpartu"1
    De speci"icat dacD
    u debut postpartum &poate $i aplicat episodului curent sau celui mai recent
    episod depresiv ma0or, maniacal sau mixt din tulburarea depresiv ma0or sau
    din tulburarea bipolar l, tulburarea bipolar II, sau tulburrii psi%otice scurte)2
    Debutul episodului are loc "n decurs de H sptm@ni postpartum2
    Spe#i%i#an!ii $e&#riin$ Evolu!ia
    Epi&oa$elor Re#urente
    S+n( &rev7/+=! +n n+%7r de s&ec!.!can=! &en(r+ (+"'+r7r!"e a.ec(!ve s&re a cres(e
    s&ec!.!c!(a(ea d!a$nos(!c7 s! a crea s+'$r+&+r! %a! o%o$ene, a a@+(a "a a"e$erea
    (ra(a%en(+"+! O! a a%e"!ora &red!c=!a &ro$nos(!c7. S&ec!.!can=!! care descr!+ evo"+=!a
    e&!soade"or rec+ren(e !nc"+d S&ec!.!can=!! evo"+=!e! "on$!(+d!na"e Ec+ sa+ .7r7
    7C7
    Tulburrile A$ective
    rec+&erare !n(ere&!sod!c7 co%&"e(7J, de &a((ern se/on!er s!
    c!c"are ra&!d7. AceO(! s&ec!.!cAnd n+ &o( .! cod!.!ca=!. Ta'e"+" 9
    !nd!c7 s&ec!.!can=!! de c+rs care se a&"!c7 .!ec7re! (+"'+r7r!
    a.e
    c(!v
    e
    Eve
    /!
    &a$
    .
    I9IJ.
    Ta-elul C. Speci$icanii evoluiei care se aplic
    tulburrilor a$ective
    CuA%(r(
    Pattern
    Ci#lare
    re#uperare
    &e)onier
    rapi$(
    interepi&o$i#(
    Tulburarea
    depresiv
    ma0or,
    episod unic
    Tulburarea depresiv ma0or, - -
    recurent
    Tulburarea distimic
    Tulb
    ura
    rea
    bip
    ola
    r
    l,
    epi
    so
    d
    ma
    nia
    cal
    uni
    c
    Tulburarea bipolar l,
    - - -
    cel
    ma
    i
    rec
    ent
    epi
    so
    d
    %ip
    om
    ani
    ac
    al
    Tulburarea bipolar l,
    - - -
    cel
    mai
    r
    e
    c
    e
    n
    t

    e
    p
    i
    s
    o
    d

    m
    a
    n
    i
    a
    c
    a
    l
    Tul
    bur
    are
    a
    bip
    olar
    l,
    -
    -
    -
    ce
    l
    m
    ai
    re
    ce
    nt
    ep
    is
    od
    mi
    xt
    Tul
    bur
    are
    a
    bip
    olar
    l,
    -
    -
    -
    ce
    l
    m
    ai
    re
    ce
    nt episod depresiv
    Tulburarea bipolar l,
    - - -
    cel
    mai
    rec
    ent
    epi
    sod
    nes
    pec
    i$ic
    at
    Tulburarea bipolar II,
    - - -
    %ipomaniacal
    Tulburarea bipolar II,
    -
    -
    -
    de
    pr
    esi
    v
    Tul
    bur
    are
    a
    cicl
    otim
    ic
    Spe#i%i#an!ii Evolu!iei
    Lon/itu$inale 3Cu &i '(r( Re#uperare
    Interepi&o$i#( Co"plet(6
    S&ec!.!can=!! SC+ rec+&erare !n(ere&!sod!c7 co%&"e(7T s!
    SF7r7 rec+&erare !n(ere&!sod!c7 co%&"e(7T s+n( &rev7/+=!
    &en(r+ a a@+(a "a carac(er!/area c+rs+"+! %a"ad!e! "a !nd!v!/!! c+
    (+"'+rare de&res!v7 %a@or7 rec+ren(7, (+"'+rare '!&o"ar7 I sa+
    (+"'+rare '!&o"ar7 II. AceO(! s&ec!.!can=! (re'+!e s7 se a&"!ce
    &er!oade! de (!%& d!n(re ce"e %a! recen(e do+7 e&!soade.
    Carac(er!/area evo"+=!e! es(e a&o! a+$%en(a(7 &r!n no(area
    &re/en=e! (+"'+r7r!! d!s(!%!ce an(eceden(e.
    Speci$icanii *voluiei Lon!itudinale
    &u ,i 'r +ecuperare Interepisodic
    omplet)
    I9Y
    Ce"e &a(r+ re&re/en(7r! $ra.!ce de %a! @os !"+s(rea/7 evo"+=!!"e (!&!ce. A &re/!n(7
    evo"+=!a (+"'+r7r!! de&res!ve %a@ore rec+ren(e, :n care n+ e<!s(7 (+"'+rare d!s(!%!c7
    an(er!oar7 s! :n care, de ase%enea, e<!s(7 o &er!oad7 de re%!s!+ne co%&"e(7 :n(re
    e&!soade. Aces( &a((ern de evo"+=!e are ce" %a! '+n &ro$nos(!c. B &re/!n(7 evo"+=!a
    (+"'+r7r!! de&res!ve %a@ore rec+ren(e :n care n+ e<!s(7 (+"'+rare d!s(!%!c7
    an(er!oar7, dar :n care s!%&(o%e &roe%!nen(e &ers!s(7 :n(re ce"e do+7 e&!soade %a!
    recen(e, ad!c7, es(e a(!ns7 n+ %a! %+"( decA( o re%!s!+ne &ar=!a"7. C &re/!n(7
    &a((ern+" rar E&re/en( "a %a! &+=!n de ;d d!n(re !nd!v!/!! c+ (+"'+rare de&res!v7
    %a@or7J de (+"'+rare de&res!v7 %a@or7 rec+ren(7, c+ (+"'+rare d!s(!%!c7 an(er!oar7,
    dar c+ rec+&erare !n(ere&!sod!c7 co%&"e(7 :n(re ce"e %a! recen(e do+7 e&!soade. D
    &re/!n(7 evo"+=!a (+"'+r7r!! de&res!ve %a@ore rec+ren(e, :n care e<!s(7 o (+"'+rare
    d!s(!%!c7 an(eceden=7, dar :n care n+ e<!s(7 n!c! o &er!oad7 de re%!s!+ne co%&"e(7
    :n(re ce"e %a! recen(e do+7 e&!soade. Aces( &a((ern, den+%!( .recven( Sde&res!e
    d+'"7T Eve/! &a$. ;HHJ, es(e o'serva( "a a&ro<!%a(!v 9Ld49Yd d!n(re !nd!v!/!! c+
    (+"'+rare de&res!v7 %a@or7.
    :n $enera", !nd!v!/!! c+ +n !s(or!c de S.7r7 rec+&erare !n(ere&!sod!c7 co%&"e(7T
    &re/!n(7 o &ers!s(en=7 a aces(+! &a((ern :n(re e&!soade"e +r%7(oare. De ase%enea, e!
    &ar a avea .oar(e &ro'a'!" %a! %+"(e e&!soade de&res!ve %a@ore decA( ce! c+
    rec+&erare !n(ere&!sod!c7 co%&"e(7. T+"'+rarea d!s(!%!c7 an(er!oar7 &r!%+"+!
    e&!sod de (+"'+rare de&res!v7 %a@or7, es(e .oar(e &os!'!" s7 .!e asoc!a(7 +"(er!or c+
    "!&sa rec+&er7r!! !n(ere&!sod!ce co%&"e(e. AceO(! s&ec!.!can=! &o( .! a&"!ca=!, de
    ase%enea, &er!oade! de (!%& d!n(re ce"e %a! recen(e do+7 e&!soade :n (+"'+rarea
    '!&o"ar7 I sa+ (+"'+rarea '!&o"ar7 II, &en(r+ a !nd!ca &re/en=a sa+ a'sen=a
    s!%&(o%a(o"o$!e! a.ec(!ve.
    A2 +ecurent, cu recuperare interepisodic f f f f f f < < f f f f f f f f f f f f
    complet, $r tulburare distimic2
    S2 +ecurent, $r recuperare interepisodic
    complet, $r tulburare distimic2
    2 +ecurent, cu recuperare interepisodic
    complet, suprapus peste tulburarea
    distimic &de asemenea, se codi$ic si 4552H)2
    D2 +ecurent, $r recuperare interepisodic
    complet, suprapus peste tulburarea
    distimic &de asemenea, se codi$ic ,i 4552H)2
    Criteriile pentru Spe#i%i#an!ii Evolu!iei Lon/itu$inale
    De speci"icat dacD &poate $i aplicat la tulburarea depresiv ma0or recurent,
    la tulburarea bipolar l sau II)D
    u recuperare interepisodic completD dac remisiunea complet este
    atins "ntre cele mai recente dou episoade a$ective3 'r remisiune
    interepisodic completD dac remisiunea complet nu este atins "ntre
    cele mai recente dou episoade a$ective2
    H7I Tulburrile A$ective
    Spe#i%i#antul 0Cu Pattern Se)onier1
    S&ec!.!can(+" SC+ &a((ern se/on!erT &oa(e .! a&"!ca( &a((ern+"+! e&!soade"or
    de&res!ve %a@ore d!n (+"'+rarea '!&o"ar7 I, (+"'+rarea '!&o"ar7 II sa+ (+"'+rarea
    de&res!v7 %a@or7 rec+ren(7. E"e%en(+" esen=!a" :" cons(!(+!e de'+(+" s! re%!s!+nea
    e&!soade"or de&res!ve %a@ore :n an+%!(e &er!oade carac(er!s(!ce a"e an+"+!, :n ce"e
    %a! %+"(e ca/+r!, e&!soade"e :nce& (oa%na sa+ !arna s! se re%!( &r!%7vara. Ma!
    rar, &o( e<!s(a s! e&!soade de&res!ve rec+ren(e, vara. Aces( &a((en de de'+( s!
    re%!s!+ne a e&!soade"or (re'+!e s7 .! s+rven!( :n c+rs+" +"(!%!"or 9 an!, .7r7 n!c! +n
    .e" de e&!soade nonse/on!ere s+rven!nd :n aceas(7 &er!oad7, :n a.ar7 de aceas(a,
    e&!soade"e de&res!ve se/on!ere (re'+!e s7 de&7Oeasc7 s+'s(an=!a" d!n &+nc( de
    vedere n+%er!c or!ce .e" de e&!soade de&res!ve nonse/on!ere d!n c+rs+" v!e=!!
    !nd!v!d+"+!. Aces( s&ec!.!can( n+ se a&"!c7 :n ace"e s!(+a=!! :n care &a((ern+" es(e
    e<&"!ca( %a! '!ne de s(resor!! &s!osoc!a"! :n ra&or( c+ se/on+" Ede e<., Oo%a@+"
    se/on!er sa+ ca"endar+" Oco"arJ. E&!soade"e de&res!ve %a@ore care s+rv!n :n &a((ern
    se/on!er se carac(er!/ea/7 adesea &r!n aner$!e no(a'!"7, !&erso%n!e, %Anca(
    e<ces!v de %+"(, &"+s &ondera" O! dor!n=a de a %Anca !dra=! de car'on. N+ es(e
    c"ar dac7 &a((ern+" se/on!er es(e %a! .recven( :n (+"'+rarea de&res!v7 %a@or7
    rec+ren(7 or! :n (+"'+r7r!"e '!&o"are, :n cadr+" $r+&+"+! (+"'+r7r!"or '!&o"are, :ns7,
    &a((ern+" se/on!er &are a .! %a! &ro'a'!" :n (+"'+rarea '!&o"ar7 II decA( :n
    (+"'+rarea '!&o"ar7 I. La +n!! !nd!v!/!, de'+(+" e&!soade"or %an!aca"e sa+
    !&o%an!aca"e &oa(e .!, de ase%enea, :n ra&or( c+ +n an+%!( se/on. S(r7"+c!rea
    "+%!n!! d!n s&ec(r+" v!/!'!" +(!"!/a(7 :n (ra(a%en( &oa(e .! asoc!a(7 c+ co%+(7r! :n
    e&!soade %an!aca"e sa+ !&o%an!aca"e.
    Preva"en(a &a((ern+"+! se/on!er de (!& !verna" &are a var!a c+ "a(!(+d!nea,
    e(a(ea O! se<+". E(a(ea es(e, de ase%enea, +n &red!c(or &+(ern!c a" se/ona"!(7=!!,
    &ersoane"e %a! (!nere .!!nd e<&+se +n+! r!sc %a! %are de e&!soade de&res!ve
    !'erna"e. Fe%e!"e cons(!(+!e RLd4FLd d!n(re &ersoane"e c+ &a((ern se/on!er, :ns7
    n+ es(e c"ar .a&(+" dac7 se<+" .e%!n!n es(e +n .ac(or de r!sc s&ec!.!c :n &"+s .a=7 de
    r!sc+" asoc!a( c+ (+"'+rarea de&res!v7 %a@or7 rec+ren(7. DeO! aces( s&ec!.!can( se
    a&"!c7 a&ar!=!e! se/on!ere de e&!soade de&res!ve %a@ore co%&"e(e, +ne"e cerce(7r!
    s+$erea/7 c7 +n &a((ern se/on!er &oa(e !"+s(ra (a'"o+" c"!n!c "a +n!! !nd!v!/! c+
    e&!soade de&res!ve !'erna"e rec+ren(e care n+ sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod
    de&res!v %a@or.
    Tulburrile
    A$ective
    I9H
    Criteriile pentru &pe#i%i#antul 0Cu Pattern Se)onier1
    7e speci"icat dacD
    u pattern se(onier &poate $i aplicat patternului episoadelor depresive
    ma0ore din tulburarea bipolar l, tulburarea bipolar II sau tulburarea
    depresiv ma0or recurent)2
    A2 *xist o relaie temporal re!ulat "ntre debutul episoadelor depresive
    ma0ore din tulburarea bipolar l sau tulburarea bipolar II, ori tulburarea
    depresiv recurent, ,i o anumit perioad a anului &de ex2, apariia
    re!ulat a episodului depresiv ma0or toamna sau iarna)2
    FotD Fu se includ ca(urile "n care exist un e$ect evident al stresorilor
    psi%osociali "n raport cu se(onul &de ex2, a $i "n mod re!ulat $r serviciu "n
    $iecare iarn)2
    S2 +emisiuni complete &sau sc%imbare din depresie "n manie sau %ipomanie)
    survin, de asemenea, "ntr-o anumit perioad a anului &de ex2, depresia
    dispare primvara)2
    2 "n ultimii 7 ani, au survenit dou episoade depresive ma0ore, ceea ce
    demonstrea( relaiile temporale se(oniere de$inite la criteriile A ,i S, ,i nu
    au survenit nici un $el de episoade depresive ma0ore nonse(oniere "n cursul
    aceleia,i perioade2
    D2 *pisoadele depresive ma0ore cu caracter se(onier &a,a cum au $ost descrise
    mai sus) dep,esc substanial ca numr episoadele depresive ma0ore $r
    caracter se(onier care au putut surveni "n cursul vieii individului2
    Spe#i%i#antul 0Cu Ci#lare Rapi$(1
    S&ec!.!can(+" SC+ c!c"are ra&!d7T &oa(e .! a&"!ca( (+"'+r7r!! '!&o"are I sa+
    (+"'+r7r!! '!&o"are II. E"e%en(+" esen=!a" a" +ne! (+"'+r7r! '!&o"are c+ c!c"are ra&!d7
    :" cons(!(+!e a&ar!=!a a &a(r+ sa+ %a! %+"(e e&!soade a.ec(!ve :n c+rs+" ce"or 59 "+n!
    an(er!oare. Aces(e e&!soade &o( s+rven! :n or!ce co%'!na=!e O! ord!ne. E&!soade"e
    (re'+!e s7 sa(!s.ac7, a(A( d+ra(a, cA( s! cr!(er!!"e s!%&(o%a(o"o$!ce &en(r+ e&!sod+"
    de&res!v %a@or, %an!aca", %!<( sa+ !&o%an!aca", O! (re'+!e s7 .!e de%arca(e, .!e
    &r!n(r4o &er!oad7 de re%!s!+ne co%&"e(7, .!e &r!n(r4o co%+(are "a +n e&!sod de
    &o"ar!(a(e o&+s7. E&!soade"e %an!aca", !&o%an!aca" O! %!<( s+n( cons!dera(e ca
    .!!nd "a ace"aO! &o" Ede e<., +n e&!sod %an!aca", +r%a( !%ed!a( de +n e&!sod %!<(
    es(e cons!dera( +n s!n$+r e&!sod :n ra&or( c+ s&ec!.!can(+" c+ c!c"are ra&!d7J. C+
    e<ce&=!a .a&(+"+! c7 a&ar %a! .recven(, e&!soade"e care a&ar :n(r4+n &a((ern de
    c!c"are ra&!d7 n+ s+n( d!.er!(e de ce"e care a&ar :n(r4+n &a((ern .7r7 c!c"are ra&!d7.
    E&!soade"e a.ec(!ve care con(ea/7 &en(r+ de.!n!rea +n+! &a((ern de c!c"are ra&!d7
    e<c"+d ace"e e&!soade ca+/a(e d!rec( de o s+'s(an=7 Ede e<., coca!na, cor(!cos(ero!/!!J
    sa+ de o cond!=!e %ed!ca"7 $enera"7.
    C!c"area ra&!d7 s+rv!ne "a a&ro<!%a(!v 5Ld49Ld d!n(re &ersoane"e c+ (+"'+rare
    '!&o"ar7 :n(A"n!(e :n c"!n!c!"e de (+"'+r7r! a.ec(!ve, :n (!%& ce :n (+"'+rarea '!&o"ar7,
    :n $enera", ra(a se<+"+! es(e e$a"7, .e%e!"e re&re/!n(7 HLd4FLd d!n(re !nd!v!/!! c+
    7C> Tulburrile A$ective
    +n &a((ern de c!c"are ra&!d7. E&!soade"e a.ec(!ve n+ s+n( :n ra&or( c+ n!c! o .a/7 a
    c!c"+"+! %ens(r+a" s! a&ar a(A( "a .e%e!"e :n &re%eno&a+/7, cA( s! "a ce"e :n
    &os(%eno&a+/7. C!c"area ra&!d7 &oa(e .! asoc!a(7 c+ !&o(!ro!d!s%+", an+%!(e
    cond!=!! ne+ro"o$!ce Ede e<., sc"ero/a %+"(!&"7J, re(ardarea %en(a"7, (ra+%a(!s%e"e
    cran!ene sa+ (ra(a%en(+" an(!de&res!v. C!c"area ra&!d7 &oa(e s+rven! or!cAnd :n
    c+rs+" (+"'+r7r!! '!&o"are s! &oa(e a&are s! d!s&are, :n s&ec!a", dac7 es(e asoc!a(7 c+
    +(!"!/area de an(!de&res!ve. De/vo"(area +ne! c!c"7r! ra&!de es(e asoc!a(7 c+ +n
    &ro$nos(!c %a! sever &e (er%en "+n$.
    Criteriile pentru &pe#i%i#antul 0Cu Ci#lare Rapi$(1
    7e speci"icat dacD
    u ciclare rapid &poate $i aplicat tulburrii bipolare l si tulburrii bipolare II)2
    el puin patru episoade de perturbare a$ectiv care satis$ac criteriile
    pentru un episod depresiv ma0or, maniacal, mixt sau %ipomaniacal, "n cele
    E7 luni anterioare2
    FotD *pisoadele sunt demarcate $ie prin remisiune parial sau complet
    pentru cel puin 7 luni, $ie printr-o comutare la un episod de polaritate
    opus &de ex2, de la un episod depresiv ma0or la un episod maniacal)2
    Tulburrile Anxioase
    !n aceas(7 sec=!+ne s+n( con=!n+(e +r%7(oare"e (+"'+r7r!Q &an!ca .7r7
    a$ora.o'!e, &an!ca c+ a$ora.o'!e, a$ora.o'!a .7r7 !s(or!c de &an!c7, .o'!a s&ec!.!c7,
    .o'!a soc!a"7, (+"'+rarea o'ses!vo4co%&+"s!v7, s(res+" &os((ra+%a(!c, s(res+" ac+(,
    an<!e(a(ea $enera"!/a(7, (+"'+rarea an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, (+"'+rarea an<!oas7 !nd+s7 de o s+'s(an=7 s! (+"'+rarea an<!oas7 .7r7 a"(7
    s&ec!.!ca=!e Deoarece a(ac+r!"e de &an!c7 s! a$ora.o'!a s+rv!n :n con(e<(+" %+"(ora
    d!n(re aces(e (+"'+r7r!, se(+n"e de cr!(er!! &en(r+ a(ac+" de &an!c7 s! &en(r+
    a$ora.o'!e s+n( %en=!ona(e se&ara(, "a :nce&+(+" aces(e! sec=!+n!
    Un a(ac de &an!c7 es(e o &er!oad7 d!scre(7 :n care e<!s(7 de'+(+" 'r+sc a" +ne!
    a&reens!+n!, .r!c! sa+ (eror! !n(ense, asoc!a(e adesea c+ sen/a=!a de %oar(e
    !%!nen(7 :n c+rs+" aces(or a(ac+r! s+n( &re/en(e s!%&(o%e, c+% ar .! sc+r(area
    res&!ra=!e!, &a"&!(a=!!"e, d+rerea sa+ d!scon.or(+" &record!a", sen/a=!!"e de s+.ocare
    sa+ de s(ran$+"are s! .r!ca de Sa n+ :ne'+n!T sa+ de a n+ &!erde con(ro"+"
    A$ora.o'!a es(e an<!e(a(ea re.er!(oare "a, sa+ e_!(a!ea de "oc+r! ba+ s!(+a=!! d!n
    care sc7&area &oa(e .! d!.!c!"7 Esa+ @enan(7J sa+ :n E.are a@+(or+" &oa(e s7 n+ .!e
    acces!'!", :n even(+a"!(a(ea +n+! a(ac de &an!c7 sa+ de s!%&(o%e s!%!"are &an!c!!
    Pan!ca .7r7 a$ora.o'!e se carac(er!/ea/7 &r!n a(ac+r! de &an!c7 rec+ren(e,
    !no&!na(e, :n "e$7(+r7 c+ care e<!s(7 o &reoc+&are &ers!s(en(7 Pan!ca c+ a$ora.o'!e
    se carac(er!/ea/7 a(A( &r!n a(ac+r! de &an!c7 rec+ren(e !no&!na(e, cA( O! &r!n
    a$ora.o'!e
    A$ora.o'!a .7r7 !s(or!c de &an!c7 se carac(er!/ea/7 &r!n &re/en=a a$ora.o'!e! s!
    a s!%&(o%e"or s!%!"are &an!c!!, .7r7 +n !s(or!c de a(ac+r! de &an!c7 !no&!na(e
    Fo'!a s&ec!.!c7 se carac(er!/ea/7 &r%(r4o an<!e(a(e se%n!.!ca(!v7 c"!n!c
    &rovoca(7 de e<&+nerea "a +n an+%!( o'!ec( sa+ s!r+a2!e (e%+(7, d+cAnd adesea "a
    +n co%&or(a%en( de ev!(are
    Fo'!a soc!a"7 se carac(er!/ea/7 &r%(r4o an<!e(a(e se%n!.!ca(!v7 c"!n!c &rovoca(7
    de e<&+nerea "a an+%!(e (!&+r! de s!(+a=!! soc!a"e sa+ de &er.or%an=7, d+cAnd
    adesea "a +n co%&or(a%en( de ev!(are
    T+"'+rarea o'ses!vo4co%&+"s!v7 se carac(er!/ea/7 &r!n o'ses!! Ecare ca+/ea/7 o
    an<!e(a(e sa+ de(res7 %arca(7J s!Xsa+ &r!n co%&+"sn Ecare servesc "a ne+(ra"!/area
    an<!e(7=!!J
    S(res+" &os((ra+%a(!c se carac(er!/ea/7 &r!n ree<&enen(area +n+! even!%en(
    (ra+%a(!c e<(re%, aco%&an!a(7 de s!%&(o%e de e<c!(a=!e cresc+(7 s! de ev!(are a
    s(!%+"!"or asoc!a=! c+ (ra+%a
    S(res+" ac+( se carac(er!/ea/7 &r!n s!%&(o%e s!%!"are ce"or a"e s(res+"+!
    &os((ra+%a(!c care a&ar !%ed!a(, ca +r%are a +n+! even!%en( (ra+%a(!c e<(re%
    An<!e(a(ea $enera"!/a(7 se carac(er!/ea/7 &r!n ce" &+=!n R "+n! de an<!e(a(e s!
    &reoc+&are e<ces!v7 s! &ers!s(en(7
    T+"'+rarea an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e se carac(er!/ea/7
    &r!n s!%&(o%e &roe%!nen(e de an<!e(a(e, cons!dera(e a .! consec!n=a .!/!o"o$!c7
    d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e
    I9F
    H45 Tulburrile Anxioase
    T+"'+rarea an<!oas7 !nd+s7 de o s+'s(an=7 se carac(er!/ea/7 &r!n s!%&(o%e
    &roe%!nen(e de an<!e(a(e, cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +n+! dro$
    de a'+/, a +n+! %ed!ca%en( sa+ e<&+ner!! "a +n (o<!c.
    T+"'+rarea an<!oas7, .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    (+"'+r7r!"or c+ an<!e(a(e sa+ ev!(are .o'!c7 %arca(7 care n+ sa(!s.ac cr!(er!!"e &en(r+
    n!c! +na d!n(re (+"'+r7r!"e an<!oase s&ec!.!ce de.!n!(e :n aceas(7 sec=!+ne Esa+
    s!%&(o%e"e an<!oase :n "e$7(+r7 c+ care e<!s(7 !n.or%a=!! !nadecva(e sa+
    con(rad!c(or!!J.
    Deoarece an<!e(a(ea de se&arare Ecarac(er!/a(7 &r!n an<!e(a(e :n "e$7(+r7 c+
    se&ararea de .!$+r!"e &aren(a"eJ a&are de re$+"7 :n co&!"7r!e, aceas(a es(e !nc"+s7 :n
    sec=!+nea ST+"'+r7r!"e d!a$nos(!ca(e de re$+"7 &en(r+ &r!%a da(7 :n &er!oada de
    s+$ar, :n co&!"7r!e sa+ ado"escen=7T Eve/! &a$. 595J. Ev!(area .o'!c7 "!%!(a(7 "a
    con(ac(+" se<+a" $en!(a" c+ +n &ar(ener se<+a" es(e c"as!.!ca(7 ca avers!+ne se<+a"a s!
    es(e !nc"+s7 :n sec=!+nea ST+"'+r7r!"e se<+a"e s! de !den(!(a(e se<+a"7T Eve/! &a$. YI5J.
    Ata#ul $e Pani#(
    *lemente
    Deoarece a(ac+r!"e de &an!c7 s+rv!n :n con(e<(+" or!c7re! (+"'+r7r! an<!oase ca s!
    a" a"(or (+"'+r7r! %en(a"e Ede e<., (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e :n "e$7(+r7 c+ o
    s+'s(an=7 J s! a" +nor cond!=!! %ed!ca"e $enera"e Ede e<., card!ace, res&!ra(or!!,
    ves(!'+"are, $as(ro!n(es(!na"eJ, (e<(+" s! ser+" de cr!(er!! &en(r+ a(ac+" de &an!c7 s+n(
    &re/en(a(e se&ara( :n aceas(7 sec=!+ne.
    Carac(er!s(!ca esen=!a"7 a +n+! a(ac de &an!c7 o cons(!(+!e o &er!oad7 d!s(!nc(7 de
    .r!c7 sa+ de d!scon.or( !n(ens, aco%&an!a(7 de ce" &+=!n I d!n(re 5; s!%&(o%e
    so%a(!ce sa+ co$n!(!ve. S!%&(o%e"e &o( .! so%a(!ce sa+ de na(+r7 co$n!(!v7 s!
    !nc"+d &a"&!(a=!!"e, (rans&!ra=!a, (re%or+" sa+ (re&!da=!a, sen/a=!a de sc+r(are a
    res&!ra=!e! sa+ de s(ran$+"are, sen/a=!a de s+.ocare, d+rere sa+ d!scon.or(
    &record!a", $rea=7 sa+ de(res7 a'do%!na"7, a%e=ea"7 sa+ ver(!@, derea"!/are sa+
    de&ersona"!/are, .r!ca de a n+4s! &!erde con(ro"+" sa+ de Sa n+ :ne'+n!T, .r!ca de
    %oar(e, &ares(e/!!, .r!soane sa+ va"+r! de c7"d+r7. A(ac+" de'+(ea/7 'r+sc s!
    esca"adea/7 ra&!d &An7 "a !n(ens!(a(ea sa %a<!%7 Ede re$+"7 :n 5L %!n+(e sa+ %a!
    &+=!nJ s! es(e adesea aco%&an!a( de sen(!%en(+" de &er!co" sa+ de %oar(e !%!nen(7
    s! de dor!n=a de a sc7&a. An<!e(a(ea carac(er!s(!c7 a(ac+"+! de &an!c7 &oa(e .!
    d!.eren=!a(7 de an<!e(a(ea $enera"!/a(7 &r!n na(+ra sa a&roa&e &aro<!s(!c7, d!s(!nc(7
    s! sever!(a(ea sa de re$+"7 %a! %are. A(ac+r!"e care sa(!s.ac (oa(e ce"e"a"(e cr!(er!!,
    dar care a+ %a! &+=!n de I s!%&(o%e so%a(!ce sa+ co$n!(!ve s+n( den+%!(e a(ac+r!
    c+ s!%&(o%e "!%!(a(e.
    E<!s(7 (re! (!&+r! carac(er!s(!ce de a(ac+r! de &an!c7Q !no&!na(e Enese%na"!/a(eJ,
    c!rc+%scr!se s!(+a=!ona" Ese%na"!/a(eJ s! &red!s&+se s!(+a=!ona". F!ecare (!& de a(ac
    de &an!c7 es(e de.!n!( &r!n(r4+n se( d!.er!( de re"a=!! :n(re de'+(+" a(ac+"+! s!
    &re/en=a sa+ a'sen=a dec"anOa(or!"or s!(+a=!ona"! care &o( !nc"+de se%na"e .!e
    e<(erne Ede e<., +n !nd!v!d c+ c"a+s(ro.o'!e are +n a(ac :n (!%& ce se a."7 :n(r4+n
    ascensor o&r!( :n(re e(a@eJ sa+ !n(ern! Ede e<., co$n!=!! ca(as(ro.!ce re.er!(oare "a
    consec!n=e"e &a"&!(a=!!"or card!aceJ. A(ac+r!"e !no&!na(e Enese%na"!/a(eJ de &an!c7
    s+n( de.!n!(e ca .!!nd ace"ea &en(r+ care !nd!v!d+" n+ asoc!a/7 de'+(+" c+ +n
    dec"anOa(or s!(+a=!ona" !n(ern sa+ e<(ern Ead!c7, a(ac+" es(e &erce&+( ca s+rven!nd
    Atacul de
    #anic
    F+1
    spontan2 Gdin seninD. Atacurile de panic circumscrise *semnalizate, situa3ional
    s+n( de.!n!(e ca .!!nd ace"ea :n care s+rv!n a&roa&e !nvar!a'!" "a e<&+nerea, sa+ "a
    an(!c!&area e<&+ner!! "a +n se%na" sa+ dec"anOa(or s!(+a=!ona" Ede e<., o &ersoan7
    c+ .o'!e soc!a"7 are +n a(ac de &an!c7 "a &ar(!c!&area sa+ "a !deea c7 va (re'+! s7
    vor'easc7 "a o :n(r+n!re &+'"!c7 J. A(ac+r!"e de &an!c7 &red!s&+se s!(+a=!ona" s+n(
    s!%!"are c+ a(ac+r!"e de &an!c7 c!rc+%scr!se s!(+a=!ona", dar n+ s+n( asoc!a(e
    !nvar!a'!" c+ se%na"e O! n+ s+rv!n necesar%en(e !%ed!a( d+&7 e<&+nere Ede e<.,
    a(ac+r!"e es(e .oar(e &os!'!" s7 a&ar7 :n (!%& ce cond+ce, dar e<!s(7 da=! cAnd
    !nd!v!d+" cond+ce s! n+ are a(ac de &an!c7 sa+ da=! cAnd a(ac+" de &an!c7 s+rv!ne
    d+&7 ce a cond+s o @+%7(a(e de or7 .
    Ind!v!/!! care so"!c!(7 as!s(en=7 %ed!ca"7 &en(r+ a(ac+r!"e de &an!c7 vor descr!e
    de re$+"7 .r!ca dre&( !n(ens7 s! re"a(ea/7 c7 e! se $Andesc c7 s+n( &e &+nc(+" de a
    %+r!, de a4O! &!erde con(ro"+", de a avea +n a(ac de cord sa+ +n !c(+s, or! de Sa
    :nne'+n!T. De re$+"7, e! re"a(ea/7, de ase%enea, dor!n=a !%&er!oas7 de a .+$!
    or!+nde d!n "oc+" :n care a s+rven!( a(ac+". A(ac+r!"e rec+ren(e de &an!c7
    !no&!na(e dev!n c+ (!%&+" c!rc+%scr!se sa+ &red!s&+se s!(+a=!ona", deO! a(ac+r!
    !no&!na(e &o( &ers!s(a.
    A&ar!=!a de a(ac+r! de &an!c7 !no&!na(e es(e cer+(7 &en(r+ d!a$nos(!c+" de
    &an!c7 Ec+ sa+ .7r7 a$ora.o'!eJ. A(ac+r!"e c!rc+%scr!se s! a(ac+r!"e &red!s&+se
    s!(+a=!ona" s+n( .recven(e :n &an!c7, dar &o( s+rven! s! :n con(e<(+" a"(or (+"'+r7r!
    an<!oase s! :n ce" a" a"(or (+"'+r7r! %en(a"e. De e<e%&"+, a(ac+r!"e de &an!c7
    c!rc+%scr!se s!(+a=!ona" s+n( e<&er!en(a(e de %a@or!(a(ea !nd!v!/!"or c+ .o'!e soc!a"7
    Ede e<., &ersoana e<&er!en(ea/7 +n a(ac de &an!c7 de .!ecare da(7 cAnd (re'+!e s7
    vor'easc7 :n &+'"!cJ s! c+ .o'!! s&ec!.!ce Ede e<., o &ersoan7 c+ .o'!e de cA!n!,
    e<&er!en(ea/7 +n a(ac de &an!c7 or! de cA(e or! :n(A"neO(e +n cA!ne care "a(r7 J &e
    cAnd a(ac+r!"e de &an!c7 &red!s&+se s!(+a=!ona" s+rv!n de re$+"7 :n an<!e(a(ea
    $enera"!/a(7 Ede e<., d+&7 ce a v7/+( "a (e"ev!/or &ro$ra%e no! care an+n=7 +n
    dec"!n econo%!c, &ersoana dev!ne e<(re% de &reoc+&a(7 de .!nan=e"e sa"e O! !n(r7
    :n(r4+n a(ac de &an!c7J s! s(res+" &os( (ra+%a(!c Ede e<., v!c(!%a +n+! v!o"
    e<&er!en(ea/7 +neor! a(ac+r! de &an!c7 a(+nc! cAnd es(e con.r+n(a(7 c+ a%!n(!r!"e
    even!%en(+"+! (ra+%a(!c, c+% ar .! vederea +n+! '7r'a( care4! a%!n(eO(e de
    a(aca(or+" s7+J.
    :n &rec!/area se%n!.!ca=!e! d!a$nos(!ce d!.eren=!a"e a +n+! a(ac de &an!c7, es(e
    !%&or(an( s7 se !a :n cons!dera=!e con(e<(+" :n care a&ar a(ac+r!"e de &an!c7.
    D!s(!nc=!a !n(re a(ac+r!"e !no&!na(e O! a(ac+r!"e de &an!c7 c!rc+%scr!se s!(+a=!ona" O!
    &red!s&+se s!(+a=!ona" es(e esen=!a"7, deoarece a(ac+r!"e de &an!c7 !no&!na(e
    rec+ren(e s+n( cer+(e &en(r+ d!a$nos(!c+" de &an!c7 Eve/! &a$. I;;J. A s(a'!"! dac7
    +n !s(or!c de a(ac+r! de &an!c7 @+s(!.!c7 d!a$nos(!c+" de &an!c7 es(e :ns7 co%&"!ca(
    de .a&(+" c7 n+ (o(dea+na e<!s(7 o re"a=!e e<c"+s!v7 :n(re (!&+" de a(ac de &an!c7 O!
    d!a$nos(!c. De e<e%&"+, deO! d!a$nos(!c+" de &an!c7 neces!(7, &r!n de.!n!=!e, ca ce"
    &+=!n +ne"e d!n(re a(ac+r!"e de &an!c7 s7 .!e !no&!na(e, !nd!v!/!! c+ &an!c7 re"a(ea/7
    .recven( c7 a+ a(ac+r! c!rc+%scr!se s!(+a=!ona" sa+ &red!s&+se s!(+a=!ona". Ca a(are,
    cons!derarea a(en(7 a .ocar+"+! an<!e(7=!! asoc!a(e c+ a(ac+r!"e de &an!c7, es(e, de
    ase%enea, !%&or(an(7 :n e.ec(+area d!a$nos(!c+"+! d!.eren=!a". S&re !"+s(rare, s7
    cons!der7 % ca/+" +ne! .e%e! care +n a(ac de &an!c7 :na!n(e de a vor'! "a o :n(r+n!re
    &+'"!c7. Dac7 aceas(7 .e%e!e a.!r%7 c7 .ocar+" an<!e(7=!! sa"e es(e .a&(+" c7 ea &oa(e
    %+r! &r!n(r4+n a(ac !%!nen( de cord, O! dac7 s+n( sa(!s.7c+(e O! a"(e cr!(er!! de
    d!a$nos(!c, ea &oa(e avea &an!c7. Dac7, &e de a"(7 &ar(e, aceas(7 .e%e!e a.!r%7 c7
    .ocar+" an<!e(7=!! sa"e n+ es(e a(ac+" de &an!c7 :n s!ne, c! (ea%a de a n+ .! &+s7 =n
    I;9 Tulburrile Anxioase
    d!.!c+"(a(e sa+ +%!"!(7, ar+nc! es(e &os!'!" ca aceas(7 .e%e!e s7 a!'7 .o'!e soc!a"7.
    Pro'"e%e"e de d!a$nos(!c con(roversa(e, re.er!(oare "a ca/+r!"e de "!%!(7, s+n(
    d!sc+(a(e :n sec=!+n!"e de SD!a$nos(!c d!.eren=!a"T a"e (e<(e"or &en(r+ (+"'+r7r!"e :n
    care &o( a&are a(ac+r! de &an!c7.
    Criteriile $e $ia/no&ti# pentru Ata#ul $e Pani#(
    FotD .n atac de panic nu este o tulburare codi$icabil2 Se codi$ic
    dia!nosticul speci$ic "n care survin atacurile de panic &de ex2, 45527E #anic cu
    a!ora$obie 9pa!2 HHE:2
    O perioad distinct de $ric intens sau de discon$ort "n care patru &sau mai
    multe) dintre urmtoarele simptome apar brusc si atin! culmea "n decurs de E5
    minuteD
    (1)palpitaii, bti puternice ale inimii sau accelerarea ritmului cardiac3
    (2)transpiraii3
    (3)tremor sau trepidaie3
    (4)sen(aii de scurtare a respiraiei sau de stran!ulare3
    (5)sen(aie de su$ocare3
    (6)durere sau discon$ort precordial3
    (7)!rea sau detres abdominal3
    (8)sen(aie de ameeal, de(ec%ilibru, verti0 sau le,in3
    &6)dereali(are &sentimentul de irealitate) sau depersonali(are &deta,are de
    sine "nsu,i)3
    (10)$rica de pierdere a controlului sau de a nu "nnebuni3
    (11)$rica de moarte3
    (12)pareste(ii &sen(aii de amoreal sau de $urnicturi)3
    (13)$risoane sau valuri de cldur
    A/ora%o-ia
    *lemente
    Pen(r+ c7 a$ora.o'!a s+rv!ne :n con(e<(+" &an!c!! c+ a$ora.o'!e s! a" a$ora.o'!e!
    .7r7 !s(or!c de &an!c7, (e<(+" s! se(+" de cr!(er!! &en(r+ a$ora.o'!e s+n( &re/en(a(e
    se&ara( :n aceas(7 sec=!+ne. E"e%en(+" esen=!a" a" a$ora.o'!e! :" cons(!(+!e an<!e(a(ea
    :n "e$7(+r7 c+ .a&(+" de a se a."a :n "oc+r! sa+ :n s!(+a=!! d!n care sc7&area &oa(e .!
    d!.!c!"7 Esa+ @enan(7J, sa+ :n care n+ es(e acces!'!" a@+(or+" :n even(+a"!(a(ea +n+!
    a(ac de &an!c7 Eve/! &a$. I;LJ or! a +nor s!%&(o%e s!%!"are &an!c!! Ede ex7, .r!ca de
    a n+ avea +n a(ac s+'!( de a%e=ea"7 or! +n a(ac de d!areeJ Ecr!(er!+" AJ. An<!e(a(ea
    d+ce de re$+"7 "a o ev!(are &ervas!v7 a +ne! d!vers!(7=! de s!(+a=!! care &o( !nc"+de
    a .! s!n$+r :n a.ara case!, sa+ a .! s!n$+r acas7 , a (e a."a :n(r4o %+"=!%e, a c7"7(or! c+
    a+(o%o'!"+", a+(o'+/+" sa+ av!on+" or! a (e a."a &e +n &od sa+ :n(r4+n ascensor.
    Un!! !nd!v!/! s+n( ca&a'!"! s7 se e<&+n7 e! :nO!O! s!(+a=!!"or (e%+(e, dar :nd+r7 aces(e
    e<&er!en=e c+ o (ea%7 cons!dera'!"7. Adesea !nd!v!d+" es(e %a! ca&a'!" s7 se
    con.r+n(e c+ s!(+a=!a (e%+(7 cAnd es(e :nso=!( de +n co%&an!on Ecr!(er!+" BJ.
    Ev!(area de c7(re !nd!v!/! a s!(+a=!!"or "e &oa(e de(er!ora aces(ora ca&ac!(a(ea de a se
    de&"asa "a serv!c!+ or! de a4O! :nde&"!n! res&onsa'!"!(7=!"e do%es(!ce Ede e<., %ers+"
    #anica
    744

    "a c+%&7r7(+r!, d+cerea co&!!"or "a %ed!cJ. An<!e(a(ea sa+ ev!(area .o'!c7 n+ es(e
    e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7 Ecr!(er!+" CJ. D!a$nos(!c+" d!.eren=!a",
    &en(r+ a d!s(!n$e a$ora.o'!a de .o'!a soc!a"7 s! de .o'!a s&ec!.!c7, &rec+% s! de
    an<!e(a(ea de se&arare sever7 &oa(e .! d!.!c!", deoarece (oa(e aces(e cond!=!! se
    carac(er!/ea/7 &r!n ev!(area an+%!(or s!(+a=!!. Pro'"e%e"e de d!a$nos(!c
    con(roversa(e &en(r+ ca/+r!"e de "!%!(7 s+n( d!sc+(a(e :n sec=!+n!"e de SD!a$nos(!c
    d!.eren=!a"T a"e (e<(e"or &en(r+ (+"'+r7r!"e :n care co%&or(a%en(+" ev!(an( es(e +n
    e"e%en( esen=!a" sa+ asoc!a(.
    Criteriile $e $ia/no&ti# pentru A/ora%o-ie
    FotD A!ora$obia nu este o tulburare codi$icabil2 Se codi$ic tulburarea
    speci$ic "n care apare a!ora$obia 9de ex2, 45527E #anic cu a!ora$obie &pa!2
    HHE) sau 455277 A!ora$obie $r istoric de panic &pa!2 HHE):2
    A2 Anxietate "n le!tur cu a te a$la "n locuri sau situaii din care scparea este
    di$icil &sau 0enant) ori "n care nu poate $i accesibil a0utorul "n eventua
    litatea unui atac de panic inopinat sau predispus situaional, ori a unor
    simptome similare panicii2 'ricile a!ora$obice implic de re!ul !rupe de
    situaii care includ $aptul de a te a$la sin!ur "n a$ara casei, a te a$la "n
    mulime sau a sta la r@nd, a te a$la pe un pod ,i a cltori cu autobu(ul,
    trenul sau automobilul2
    FotD Se ia "n consideraie dia!nosticul de $obie speci$ic, dac evitarea este
    limitat la una sau numai la c@teva situaii speci$ice, ori cel de $obie social,
    dac evitarea este limitat la situaii sociale2
    S2 Situaiile sunt evitate &de ex2, cltoriile sunt restr@nse) sau c%iar sunt
    "ndurate cu o detres marcat ori cu anxietatea de a nu avea un atac de
    panic sau simptome similare panicii, ori necesit pre(ena unui companion2
    2 Anxietatea sau evitarea $obic nu este explicat mai bine de alt tulburare
    mental, cum ar $i $obia social &de ex2, evitarea limitat la situaiile sociale
    din cau(a $ricii de punere "n di$icultate), $obia speci$ic &de ex2, evitarea
    limitat la o sin!ur situaie, cum ar $i ascensoarele), tulburarea obsesivo-
    compulsiv &de ex2, evitarea murdriei, la cineva cu obsesia contaminrii),
    stresul posttraumatic &de ex2, evitarea stimulilor asociai cu un stresor sever),
    sau anxietatea de seaparare &de ex2, evitarea abandonrii casei sau a rudelor)2
    Pani#a
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" &an!c!! :" cons(!(+!e &re/en=a de a(ac+r! de &an!c7
    !no&!na(e, rec+ren(e Eve/! &a$. I;LJ, +r%a(e de ce" &+=!n o "+n7 de &reoc+&are
    &ers!s(en(7 :n "e$7(+r7 c+ .a&(+" de a n+ avea +n a"( a(ac de &an!c7, (ea%7 :n
    "e$7(+r7 c+ &os!'!"e"e !%&"!ca=!! sa+ consec!n=e a"e a(ac+r!"or de &an!c7 or! o
    %od!.!care se%n!.!ca(!v7 de co%&or(a%en( :n ra&or( c+ a(ac+r!"e Ecr!(er!+" AJ.
    A(ac+r!"e de &an!c7 n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e
    Ede e<., !n(o<!ca=!e! c+ ca.e!naJ or! a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    H4H Tulburrile Anxioase
    !&er(!ro!d!s%+"J Ecr!(er!+" CJ, :n .!ne, a(ac+r!"e de &an!c7 n+ s+n( e<&"!ca(e %a!
    '!ne de a"(7 (+"'+rare %en(a"7 Ede e<., de .o'!a s&ec!.!c7 sa+ soc!a"7, (+"'+rarea
    o'ses!vo4co%&+"s!v7, s(res+" &os((ra+%a(!c sa+ an<!e(a(ea de se&arareJ Ecr!(er!+"
    DJ, :n .+nc=!e de .a&(+" dac7 s+n( sa(!s.7c+(e sa+ n+ cr!(er!!"e &en(r+ a$ora.o'!e
    Eve/! &a$. I;;J, es(e d!a$nos(!ca(7, .!e ;LL.95 Pan!c7 c+ a$ora.o'!e, .!e ;LL.L5 Pan!c7
    .7r7 a$ora.o'!e Ecr!(er!+" BJ.
    Un a(ac de &an!c7 !no&!na( Es&on(an, nese%na"!/a(J es(e de.!n!( ca +n+" care n+
    es(e asoc!a( !%ed!a( c+ +n dec"anOa(or s!(+a=!ona" Ead!c7, s+rv!ne Sd!n sen!nTJ.
    Dec"anOa(or!! s!(+a=!ona"! &o( !nc"+de s(!%+"! care s+n( .!e e<(ern! Ede e<., +n o'!ec(
    sa+ s!(+a=!e .o'!c7 J sa+ !n(ern! Ede e<., e<c!(a=!a .!/!o"o$!c7J &en(r+ !nd!v!d, :n +ne"e
    ca/+r!, deO! +n dec"anOa(or s!(+a=!ona" es(e ev!den( &en(r+ c"!n!c!an, aces(a &oa(e s7
    n+ .!e +Oor de !den(!.!ca( de c7(re !nd!v!d+" care e<&er!en(ea/7 a(ac+" de &an!c7. De
    e<e%&"+, +n !nd!v!d &oa(e s7 n+ !den(!.!ce !%ed!a( e<c!(a=!a .!/!o"o$!c7 cresc+(7
    !nd+s7 de de o ca%er7 ca"d7, neaer!s!(7, sa+ sen/a=!a de "eO!n &rod+s7 de s(a(+"
    $e%+!( ca dec"anOa(or! &en(r+ +n a(ac de &an!c7 O! ca a(are as(.e" de a(ac+r! s+n(
    cons!dera(e &e %o%en( ca .!!nd !no&!na(e. S+n( cer+(e ce" &+=!n do+7 a(ac+r! de
    &an!c7 !no&!na(e &en(r+ a &+ne d!a$nos(!c+", dar ce! %a! %+"=! !nd!v!/! a+ de re$+"7
    %a! %+"(e. Ind!v!/!! c+ &an!c7 a+, de ase%enea, O! a(ac+r! de &an!c7 &red!s&+se
    s!(+a=!ona" Ead!c7, a(ac+r! care s+rv!n .oar(e &ro'a'!" "a e<&+nerea "a +n dec"anOa(or
    s!(+a=!ona", dar n+ s+n( asoc!a(e :n %od cons(an( c+ aces(aJ. A(ac+r!"e c!rc+%scr!se
    s!(+a=!ona" Ead!c7, a(ac+r!"e care s+rv!n a&roa&e cons(an( s! !%ed!a( "a e<&+nerea "a
    +n dec"anOa(or s!(+a=!ona"J &o( a&are, de ase%enea, dar s+n( %a! &+=!n .recven(e.
    Frecven=a s! sever!(a(ea a(ac+r!"or de &an!c7 var!a/7 .oar(e %+"(. De e<e%&"+,
    +n!! !nd!v!/! a+ .recven( a(ac+r! %odera(e Ede e<., +n+" &e s7&(7%An7J care s+rv!n
    re$+"a( (!%& de "+n! de /!"e, oda(7. A"=!! re"a(ea/7 c7 a+ sc+r(e accese de a(ac+r! %a!
    .recven(e Ede e<., /!"n!c, (!%& de o s7&(7%An7J, se&ara(e &r!n s7&(7%An! sa+ "+n! .7r7
    n!c! +n .e" de a(ac+r! sa+ c+ a(ac+r! %a! &+=!n .recven(e Ede e<., do+7 a(ac+r! :n
    .!ecare "+n7J, (!%& de %+"=! an!. A(ac+r!"e "!%!(a(e ca s!%&(o%e Ead!c7, a(ac+r!"e care
    s+n( !den(!ce c+ a(ac+r!"e de &an!c7 Sco%&"e(eT, c+ e<ce&=!a .a&(+"+! c7 an<!e(a(ea
    sa+ .r!ca s+'!(7 es(e aco%&an!a(7 de %a! &+=!n de I d!n(re ce"e 5; s!%&(o%e
    ad!=!ona"eJ s+n( .oar(e .recven(e "a !nd!v!/!! c+ &an!c7. DeO! d!s(!nc=!a d!n(re a(ac+r!"e
    de &an!c7 O! a(ac+r!"e "!%!(a(e ca s!%&(o%e es(e oarec+% ar'!(rar7, a(ac+r!"e de
    &an!c7 co%&"e(e s+n( asoc!a(e c+ o %or'!d!(a(e %a! %are Ede e<., o +(!"!/are %a!
    %are a serv!c!!"or de as!s(en=7 %ed!ca"7, o de(er!orare .+nc=!ona"7 %a! %are, o
    ca"!(a(e a v!e=!! %a! rea. Ce! %a! %+"=! !nd!v!/! care a+ a(ac+r! "!%!(a(e ca s!%&(o%e
    a+ av+( a(ac+r! de &an!c7 co%&"e(e "a +n %o%en( da( :n c+rs+" (+"'+r7r!!.
    Ind!v!/!! c+ &an!c7 %an!.es(7 &reoc+&7r! sa+ !n(er&re(7 r! :n "e$7(+r7 c+
    !%&"!ca=!!"e sa+ consec!n=e"e a(ac+r!"or de &an!c7. Un!! se (e% de .a&(+" c7 a(ac+r!"e
    !nd!c7 &re/en=a +ne! %a"ad!! ned!a$nos(!ca(e care "e &er!c"!(ea/7 v!a=a Ede e<., o
    %a"ad!e card!ac7, o cr!/7 e&!"e&(!c7J, :n d!s&re=+" (es(7r!"or %ed!ca"e re&e(a(e O! a"
    reas!$+r7r!"or, e! r7%An (e%7(or! O! sce&(!c! :n "e$7(+r7 c+ .a&(+" c7 n+ a+ o %a"ad!e
    care s7 "e &+n7 v!a=a :n &er!co". A"=!! se (e% c7 a(ac+r!"e de &an!c7 s+n( +n !nd!c!+
    a" .a&(+"+! c7 e! vor S:nne'+n!T, :O! vor &!erde con(ro"+" sa+ c7 s+n( v+"nera'!"!
    e%o=!ona". Un!! !nd!v!/! c+ a(ac+r! de &an!c7 rec+ren(e :O! %od!.!c7 :n %od
    se%n!.!ca(!v co%&or(a%en(+" Ede e<., :O! a'andonea/7 serv!c!+"J ca r7s&+ns "a
    a(ac+r!, dar nea$7 (ea%a de a n+ avea +n a"( a(ac sa+ &reoc+&7r!"e re.er!(oare "a
    consec!n=e"e a(ac+r!"or "or de &an!c7. Preoc+&7r!"e re.er!(oare "a a(ac+" +r%7(or or!
    "a !%&"!ca=!!"e sa"e s+n( asoc!a(e adesea c+ a&ar!=!a +n+! co%&or(a%en( de ev!(are
    care &oa(e sa(!s.ace cr!(er!!"e &en(r+ a$ora.o'!e Eve/! &a$. I;;J, :n care ca/ es(e
    d!a$nos(!ca(7 &an!ca c+ a$ora.o'!e.
    #anica
    74<

    *lemente ,i tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Pe "An$7 &reoc+&area :n
    "e$7(+r7 c+ a(ac+r!"e de &an!c7 s! !%&"!ca=!!"e "or, %+"=! !nd!v!/! c+ &an!c7
    re"a(ea/7, de ase%enea, o an<!e(a(e cons(an(7 sa+ !n(er%!(en(7 care n+ es(e
    cen(ra(7 &e o an+%!(7 s!(+a=!e sa+ even!%en( A"=!! dev!n e<ces!v de (e%7(on :n
    "e$7(+r7 c+ consec!n=e"e ac(!v!(7=!"or sa+ e<&er!en=e"or r+(!n!ere, :n s&ec!a" a"e
    ce"or re.er!(oare "a s7n7(a(e sa+ "a se&ararea de .!!n=a !+'!(7 De e<e%&"+, !nd!v!/!!
    c+ &an!c7 an(!c!&ea/7 adesea +n de/nod7%An( ca(as(ro.!c d%(r4+n s!%&(o%
    so%a(!c +Oor sa+ d%(r4+n e.ec( sec+ndar a" +n+! %ed!ca%en( Ede e< , !deea c7 o
    ce.a"ee !nd!c7 o (+%or7 cere'ra"7 sa+ o cr!/7 !&er(ens!v7J As(.e" de !nd!v!/! s+n(
    adesea %+"( %a! &+=!n (o"eran=! "a e.ec(e"e sec+ndare a"e %ed!ca%en(e"or O!
    neces!(7 :n $enera" o reas!$+rare con(!n+7 :n sco&+" "+7r!! %ed!ca%en(e"or La
    !nd!v!/!! a" c7ror a(ac de &an!c7 n+ a .os( (ra(a( sa+ a .os( d!a$nos(!ca( erona(,
    conv!n$erea c7 e! a+ o %a"ad!e nede(ec(a(7 care "e &+ne :n &er!co" v!a=a &oa(e
    d+ce, a(A( "a o an<!e(a(e cron!c7 de'!"!(an(7, cA( s! "a "a cons+"(a=!! e<ces!ve :n
    +n!(7=!"e de as!s(en=7 %ed!ca"7 Aces( &a((ern &oa(e .! &er(+r'an(, a(A( e%o=!ona",
    cA( s! .!nanc!ar
    :n +ne"e ca/+r!, &!erderea sa+ r+&erea re"a=!!"or !n(er&ersona"e !%&or(an(e Ede
    e< , &"ecarea de acas7 sa+ v!a=a &e &ro&r!!"e s&e/e, d!vor=+"J es(e asoc!a(7 c+ de'+(+"
    sa+ e<acer'area &an!c!! De%ora"!/area es(e o consec!n=7 co%+n7, c+ %+"=! !nd!v!/!
    deven!nd desc+ra@a=!, @ena=! s! ne.er!c!=! :n "e$7(+r7 c+ :nde&"!n!rea r+(%e"or "or
    nor%a"e E! a(r!'+!e adesea aceas(7 &ro'"e%7 +ne! "!&se de S.or=7T sa+ de
    Scarac(erT Aceas(7 de%ora"!/are se &oa(e $enera"!/a "a do%en!! d!nco"o de
    &ro'"e%e"e s&ec!.!ce :n ra&or( c+ &an!ca AceO(! !nd!v!/! &o( a'sen(a .recven( de "a
    serv!c!+ sa+ de "a scoa"7 &en(r+ v!/!(e "a doc(or sa+ "a ca%ere"e de $ard7, care &o(
    d+ce "a Oo%a@ sa+ "a a'andonarea sco"!!
    Procen(e"e de (+"'+rarea de&res!v7 %a@or7 co%or'!d7 var!a/7 .oar(e%+"(,
    %er$And de "a 5Ld "a RYd !nd!v!/!! c+ &an!c7 La a&ro<!%a(!v o (re!%e d!n(re
    !nd!v!/!! c+ a%'e"e (+"'+r7r!, de&res!a &recede de'+(+" &an!c!! :n res(+" de do+7
    (re!%!, de&res!a s+rv!ne conco%!(en( c+, sa+ d+&7 de'+(+" &an!c!! Un s+'se( de
    !nd!v!/! :O! (ra(ea/7 an<!e(a(ea c+ a"coo" sa+ c+ %ed!ca%en(e, !ar +n+ d!n(re e!
    &o( de/vo"(a o (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7, dre&( consec!n=7
    Co%or'!d!(a(ea c+ a"(e (+"'+r7r! an<!oase es(e, de ase%enea, .recven(7, :n
    s&ec!a" :n %ed!!"e c"!n!ce s! "a !nd!v!/!! c+ a$ora.o'!e %a! sever7 Fo'!a soc!a"7 s!
    an<!e(a(ea $enera"!/a(7 a+ .os( ra&or(a(e "a 5Yd4;Ld d!n(re !nd!v!/a c+ &an!c7,
    .o'!a s&ec!.!c7 "a 9d49Ld, !ar (+"'+rarea o'ses!vo4co%&+"s!v7 :n &An7 "a 5Ld. DeO!
    "!(era(+ra s+$erea/7 c7 s(res+" &os((ra+%a(!c a .os( cons(a(a( "a 9d45Ld d!n(re
    !nd!v!/!! c+ &an!c7, +ne"e da(e s+$erea/7 c7 &rocen(e"e &o( .! %a! %ar! cAnd
    s!%&(o%e"e &os((ra+%a(!ce s+n( cerce(a(e s!s(e%a(!c An<!e(a(ea de se&arare :n
    co&!"7r!e a .os( asoc!a(7 c+ aceas(7 (+"'+rare Co%or'!d!(a(ea s! s+&ra&+nerea
    s!%&(o%e"or c+ !&ocondna s+n( .recven(e
    Da(e de "a'ora(or asoc!a(e. N+ a+ .os( !den(!.!ca(e n!c! +n .e" de da(e de
    "a'ora(or care s7 a!'7 va"oare d!a$nos(!c7 &en(r+ &an!c7 S4a o'serva( :ns7, c7
    o sene de da(e de "a'ora(or s+n( anor%a"e "a $r+&e"e de !nd!v!/! c+ a(ac+r! de
    &an!c7 :n ra&or( c+ s+'!ec=!! de con(ro" Un+ !nd!v!/! c+ &an!c7 &re/!n(7 se%ne
    de a"ca"o/7 res&!ra(or!e co%&ensa(7 Ead!c7, sc7derea concen(ra=!e! '!o<!d+"+!
    de car'on s! '!car'ona(+"+!, c+ +n &H a&roa&e nor%a"J A(ac+r!"e de &an!c7,
    74= Tul-ur(rile An,ioa&e
    dre&( r7s&+ns "a !n.+/!a de "ac(a( de sod!+ sa+ "a !na"area de '!o<!d de car'on,
    s+n( %a! .recven(e :n &an!c7 decA( "a s+'!ec=!! de con(ro" sa+ "a !nd!v!/!! c+
    an<!e(a(e $enera"!/a(7
    Datele e,a"in(rii &o"ati#e &i #on$i!iile "e$i#ale /enerale a&o#iate. O
    (a!card!e (ran/!(or!e s! o creO(ere %odera(7 a &res!+n!! san$+!ne s!s(o"!ce &o(
    s+rven! :n c+rs+" +nor a(ac+r! de &an!c7 O sene de s(+d!! a+ !den(!.!ca( o
    co%or'!d!(a(e se%n!.!ca(!v7 :n(re &an!c7 s! n+%eroase cond!=!! s! s!%&(o%e
    %ed!ca"e $enera"e !nc"+/And, dar n+ "!%!(a(e "a aces(ea, ar!(%n"e card!ace,
    !&er(!ro!d!s%+", %a"ad!a &+"%onar7 o's(r+c(!v7 cron!c7 s! s!ndro%+"
    co"on+"+! !r!(a'!" Na(+ra asoc!er!! Ead!c7, re"a=!a ca+/74e.ec(J d!n(re &an!c7 s!
    aces(e cond!=!! r7%Ane :ns7 nec"ar7 DeO! o sene de s(+d!! a+ s+$era( c7 a(A(
    &ro"a&s+" va"ve! %!(ra"e, cA( s! %a"ad!a (!ro!d!an7 s+n( %a! .recven(e &r!n(re
    !nd!v!/!! c+ &an!c7 decA( :n &o&+"a=!a $enera"7, a"(e s(+d!! n+ a+ cons(a(a( n!c! o
    d!.eren=7 :n &reva"en(7
    *lemente speci$ice culturii si sexului
    In +ne"e c+"(+r!, a(ac+r!"e de &an!c7 &o( co%&or(a o .r!c7 !n(ens7 de .ar%ece sa+
    de %a$!e Pan!ca, aOa c+% es(e descr!s7 a!c!, a .os( re&era(7 :n s(+d!!"e
    e&!de%!o"o$!ce d!n :n(rea$a "+%e :n a.ar7 de aceas(a, +n n+%7r de cond!=!! !nc"+se
    !n S,"osar+" s!ndro%e"or c!rc+%scr!se c+"(+ra" Eve/! ane<a IJ &o( (! !n "e$7(+r7 c+
    &an!ca Lne"e $r+&+r! e(n!ce sa+ c+"(+ra"e res(rAn$ &ar(!c!&area .e%e!"or "a v!a(a
    &+'" c7, s! aces( .a&( (re'+!e d!s(!ns de a$ora.o'!e Pan!ca .7r7 a$ora.o'!e es(e
    d!a$nos(!ca(7 de do+7 or!, !ar &an!ca c+ a$ora.o'!e de (re! or! %a! des "a .e%e! decA(
    "a '7r'a=!
    #revalent
    DeO! ra(e"e &reva"en(a &e v!a(7 a"e &an!c!! Ec+ sa+ .7r7 a$ora.o'!eJ &e eOan(!oane
    co%+n!(are a+ .os( ra&or(a(e a .! de &es(e ;,Yd, ce"e %a! %+"(e s(+d!! a+ ra&or(a(
    ra(e de &reva"en(7 de UO#,O Ra(e"e de &reva"en(7 &e +n an var!a/7 :n(re L,Y d s!
    5,Yd Ra(e"e de &reva"en(7 a"e &an!c!! :n esan(!oane"e c"!n!ce s+n( cons!dera'!" %a!
    %ar! De e<e%&"+, &an!ca es(e d!a$nos(!ca(7 "a 5Ld d!n(re !nd!v!/!! (r!%!O! &en(r+
    eva"+area s(7r!! de s7n7(a(e %en(a"7 :n +n!(7=!"e %ed!ca"e $enera"e, ra(e"e de
    &reva"en(7 var!a/7 :n(re 5Ld s! ;Ld :n cn!c!"e de ORL E(+"'+r7r! ves(!'+"areJ,
    &ne+%o"o$!e s! ne+ro"o$!e, s! cresc &An7 "a RLd :n cn!c!"e de card!o"o$!e
    A&ro<!%a(!v o (re!%e &an7 "a @+%7(a(e d!n(re !nd!v!/!! d!a$nos(!ca=! c+ &an!c7 :n
    esan(!oane"e co%+n!(are a+, de ase%enea, a$ora.o'!e, c+ (oa(e c7 +n &rocen( %+"(
    %a! %are de a$ora.o'!e es(e :n(A"n!( :n esan(!oane"e c"!n!ce
    *voluie
    E(a(ea "a de'+( a &an!c!! 4var!a/7 cons!dera'!", dar ce" %a! .recven( se s!(+ea/7
    :n(re +"(!%a &ar(e a ado"escen(e! s! %!@"oc+" an!"or ;L Poa(e e<!s(a o d!s(r!'+=!e
    '!%oda"7 c+ +n &!c :n +"(!%a &ar(e a ado"escen(e! s! c+ +n a" do!"ea &!c, %a! %!c,
    "a %!@"oc+" an!"or ;L Un %!c n+%7r de ca/+r! :nce& :n co&!"7r!e, !ar de'+(+" d+&7
    e(a(ea de IY de an! es(e !n+/+a", dar &oa(e s+rven! Descr!er!"e re(ros&ec(!ve a"e
    !nd!v!/!"or v7/+=! :n cond!=!! c"!n!ce s+$erea/7 c7 evo"+=!a +/+a"7 es(e cron!c7, dar
    c+ a%e"!or7r! s! a$rav7r! Un+ !nd!v!/! &o( avea accese e&!sod!ce, c+ an! de
    #anic
    a
    74G

    re%!s!+ne :n(re e"e, !ar a"=!! &o( avea o s!%&(o%a(o"o$!e sever7 con(!n+7. A(ac+r!"e
    c+ s!%&(o%e "!%!(a(e s+n( %a! .recven(e, dac7 evo"+=!a &an!c!! es(e cron!c7 . DeO!
    a$ora.o'!a &oa(e s+rven! or!cAnd, de'+(+" s7+ are "oc de re$+"7 :n &r!%+" an de "a
    a&ar!=!a a(ac+r!"or de &an!c7 rec+ren(e. Evo"+=!a a$ora.o'!e! s! re"a=!a sa c+
    evo"+=!a a(ac+r!"or de &an!c7 s+n( var!a'!"e, :n +ne"e ca/+r!, o red+cere sa+
    re%!s!+ne a a(ac+r!"or de &an!c7 &oa(e .! +r%a(7 s(rAns de o red+cere
    cores&+n/7(oare a ev!(7r!! a$ora.o'!ce O! a an<!e(7=!!, :n a"(e"e, a$ora.o'!a &oa(e
    deven! cron!c7, !nd!.eren( de &re/en=a sa+ a'sen=a a(ac+r!"or de &an!c7. Un!!
    !nd!v!/! re"a(ea/7 c7 e! &o( red+ce .recven=a a(ac+r!"or de &an!c7 &r!n ev!(area
    an+%!(or s!(+a=!!. S(+d!!"e de +r%7r!re na(+ra"7 a !nd!v!/!"or (ra(a=! :n +n!(7=! de
    c+r7 (er=!ar7 Ecare &o( se"ec(a &en(r+ +n $r+& de &ro$nos(!c severJ s+$erea/7 c7 "a
    R45L an! d+&7 (ra(a%en(, a&ro<!%a(!v ;Ld d!n(re !nd!v!/! s+n( '!ne, ILd4YLd s+n(
    a%e"!ora=!, dar s!%&(o%a(!c!, !ar res(+" de 9Ld4;Ld a+ s!%&(o%e care s+n(
    ace"eaO! sa+ c!ar %a! severe.
    #attern $amilial
    Es(e &os!'!" ca r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ &an!c7 s7 &re/!n(e
    &an!c7 de G or! %a! %+"( EdecA( &o&+"a=!a $enera"7 J. S4a cons(a(a( c7 dac7 &an!ca
    de'+(ea/7 :na!n(e de e(a(ea de 9L an!, es(e &os!'!" ca r+de"e de $rad+" I s7 a!'7
    &an!c7 de 9L de or! %a! %+"( EdecA( &o&+"a=!a $enera"7J, :n cond!=!! c"!n!ce :ns7,
    @+%7(a(e &An7 "a (re! s.er(+r! d!n(re !nd!v!/!! c+ &an!c7 n+ a+ n!c! o r+d7 '!o"o$!c7
    de $rad+" I a.ec(a(7. S(+d!!"e &e $e%en! !nd!c7 o con(r!'+=!e $ene(!c7 "a
    de/vo"(area &an!c!!.
    Dia!nostic di$erenial
    D!a$nos(!c+" de &an!c7 n+ se &+ne dac7 a(ac+r!"e de &an!c7 s+n( cons!dera(e
    a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e, ca/ :n care
    es(e d!a$nos(!ca(7 o (+"'+rare an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e Eve/! &a$. IHRJ. E<e%&"e"e de cond!=!! %ed!ca"e $enera"e care &o( ca+/a
    a(ac+r! de &an!c7 !nc"+d !&er(!ro!d!s%+", !&er&ara(!ro!d!s%+", .eocro%o4
    c!(o%+", d!s.+nc=!!"e ves(!'+"are, cr!/e"e e&!"e&(!ce O! cond!=!!"e card!ace Ede e<.,
    ar!(%!!"e, (a!card!a s+&raven(r!c+"ar7J. Tes(e"e de "a'ora(or adecva(e Ede e<.,
    concen(ra=!!"e ca"c!+"+! ser!c &en(r+ !&er&a(!ro!d!s%J sa+ e<a%!n7r!"e so%a(!ce
    Ede e<., &en(r+ cond!=!!"e card!aceJ &o( .! +(!"e :n &rec!/area ro"+"+! e(!o"o$!c a"
    +ne! cond!=!! %ed!ca"e $enera"e. De ase%enea, &an!ca n+ es(e d!a$nos(!ca(7, dac7
    a(ac+r!"e de &an!c7 s+n( cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne!
    s+'s(an=e Ead!c7, a +n+! dro$ de a'+/, a +n+! %ed!ca%en(J, :n care ca/ es(e
    d!a$nos(!ca(7 o (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7 Eve/! &a$. IHFJ.
    In(o<!ca=!a c+ s(!%+"an(e a"e s!s(e%+"+! nervos cen(ra" Ede e<., c+ coca!n7,
    a%.e(a%!ne, ca.e!naJ sa+ c+ canna'!s s! a's(!nen=a de de&r!%an(e a"e s!s(e%+"+!
    nervos cen(ra" Ede e<., a"coo"+", ar'!(+r!ce"eJ &o( &rec!&!(a +n a(ac de &an!c7.
    Dac7 :ns7, a(ac+r!"e de &an!c7 con(!n+7 s7 s+rv!n7 O! :na.ara con(e<(+"+! de +/ de
    o s+'s(an=7 Ede e<., %+"( (!%& d+&7 ce e.ec(e"e !n(o<!ca=!e! sa+ a's(!nen=e! a+
    :nce(a(J, (re'+!e s7 .!e "+a( :n cons!dera=!e d!a$nos(!c+" de &an!c7, :n &"+s,
    deoarece &an!ca &recede +/+" de o s+'s(an=7 "a +n!! !nd!v!/! s! &oa(e .! asoc!a(7
    c+ +n +/ cresc+( de o s+'s(an=7 :n sco& de a+(o%ed!ca=!e, (re'+!e "+a( +n !s(or!c
    de(a"!a( &en(r+ a s(a'!"! dac7 !nd!v!d+" a av+( +n a(ac de &an!c7 an(er!or +/+"+!
    e<ces!v de s+'s(an=7. Dac7 aces(a es(e ca/+", (re'+!e "+a( :n cons!dera=!e +n
    H48 Tulburrile Anxioase
    d!a$nos(!c de de&enden=7 sa+ a'+/ de o s+'s(an=7. E"e%en(e, c+% ar .! de'+(+"
    d+&7 e(a(ea de IY de an! sa+ &re/en=a de s!%&(o%e a(!&!ce :n c+rs+" +n+! a(ac de
    &an!c7 Ede e<., ver(!@, &!erderea c+noO(!n=e!, &!erderea con(ro"+"+! ve/!c!! +r!nare
    sa+ !n(es(!n+"+! $ros, ce.a"e!, d!/ar(r!e sa+ a%ne/!eJ s+$erea/7 &os!'!"!(a(ea ca o
    cond!=!e %ed!ca"7 $enera"7 sa+ o s+'s(an=7 s7 .!e ca+;a s!%&(o%e"or a(ac+"+!
    de &an!c7.
    Pan!ca (re'+!e s7 .!e d!s(!ns7 de a"(e (+"'+r7r! %en(a"e Ede e<., de a"(e (+"'+r7r!
    an<!oase s! de (+"'+r7r!"e &s!o(!ceJ care a+ ca e"e%en( asoc!a( a(ac+r! de &an!c7.
    Pr!n de.!n!=!e, &an!ca es(e carac(er!/a(7 &r!n a(ac+r! de &an!c7 !no&!na(e
    Es&on(ane, nese%na"!/a(e, Sd!n sen!nTJ. AOa c+% s4a d!sc+(a( an(er!or Eve/! &a$.
    I;LJ, e<!s(7 (re! (!&+r! de a(ac+r! de &an!c7 U !no&!na(e, c!rc+%scr!se s!(+a=!ona"
    O! &red!s&+se s!(+a=!ona". Pre/en=a de a(ac+r! de &an!c7 !no&!na(e rec+ren(e, .!e
    !n!=!a", .!e %a! (Ar/!+ :n c+rs+" evo"+=!e!, es(e necesar7 &en(r+ d!a$nos(!c+" de
    &an!c7. D!n con(ra, a(ac+r!"e de &an!c7 s+rven!nd :n con(e<(+" a"(or (+"'+r7r!
    an<!oase s+n( c!rc+%scr!se s!(+a=!ona" sa+ &red!s&+se s!(+a=!ona" Zde e<., :n .o'!a
    soc!a"7 s+n( dec"anOa(e de s!(+a=!! soc!a"e8 :n .o'!a s&ec!.!c7 s+n( dec"anOa(e de +n
    o'!ec( sa+ de o s!(+a=!e8 :n an<!e(a(ea $enera"!/a(7 s+n( dec"anOa(e de &reoc+&are8
    :n (+"'+rarea o'ses!vo4co%&+"s!v7 s+n( dec"anOa(e de e<&+nerea "a +n o'!ec(
    sa+ s!(+a=!e :n "e$7(+r7 c+ o o'ses!e Ede e<., e<&+nerea "a %+rd7r!e a c+!va c+
    o'ses!a con(a%!n7r!!J8 :n s(res+" &os((ra+%a(!c s+n( dec"anOa(e de s(!%+"! care
    a%!n(esc s(resor+"[. :n +ne"e ca/+r!, !nd!v!d+" &oa(e avea d!.!c+"(7=! :n
    !den(!.!carea se%na"e"or dec"anOa(oare a"e a(ac+"+! de &an!c7 .
    De e<e%&"+, +n !nd!v!d c+ s(res &os((ra+%a(!c &oa(e avea +n a(ac de &an!c7
    dec"anOa( de co$n!=!! sa+ s!%&(o%e .!/!o"o$!ce s!%!"are c+ ace"ea care s+rv!n :n
    c+rs+" even!%en(+"+! (ra+%a(!c Ede e<e%&"+, ar!(%!! card!ace, sen(!%en( de
    de(aOareJ. Aces(e s!%&(o%e &o( s7 n+ .!e asoc!a(e +Oor de c7(re !nd!v!d c+
    even!%en(+" dec"ansan(. Dac7 a(ac+r!"e de &an!c7 s+rv!n n+%a! :n s!(+a=!! care
    &o( .! asoc!a(e c+ even!%en(+" (ra+%a(!c, a(+nc! a(ac+r!"e de &an!c7 (re'+!e s7 .!e
    a(r!'+!(e s(res+"+! &os((ra+%a(!c. De e<e%&"+, "a o &ersoan7 care a .os( v!o"a(7 :n
    (!%& ce se a."a s!n$+r7 acas7 O! care e<&er!%en(ea/7 a(ac+r! de &an!c7 n+%a! cAnd
    n+ se a."7 n!%en! :n @+r, (re'+!e "+a( :n cons!derare d!a$nos(!c+" de s(res
    &os((ra+%a(!c :n "oc+" d!a$nos(!c+"+! de &an!c7. Dac7 :ns7 &ersoana
    e<&er!%en(ea/7 a(ac+r! de &an!c7 !no&!na(e O! :n a"(e s!(+a=!!, a(+nc! (re'+!e "+a(
    :n cons!derare d!a$nos(!c+" ad!=!ona" de &an!c7.
    Foca"!/area an<!e(7=!! a@+(7, de ase%enea, "a d!.eren=!erea &an!c!! c+ a$ora.o'!e
    de a"(e (+"'+r7r! carac(er!/a(e &r!n co%&or(a%en(e de ev!(are. Ev!(area
    a$ora.o'!c7 es(e asoc!a(7 c+ an<!e(a(ea re.er!(oare "a &os!'!"!(a(ea de a n+ avea +n
    a(ac de &an!c7 sa+ sen/a=!! s!%!"are &an!c!!, &e cAnd ev!(area :n a"(e (+"'+r7r! es(e
    asoc!a(7 c+ o &reoc+&are re.er!(oare "a consec!n=e"e ne$a(!ve sa+ d7+n7(oare
    da(ora(e o'!ec(+"+! sa+ s!(+a=!e! (e%+(e Ede e<., .r!ca de scr+(are, de +%!"!re O! de
    &+nere :n d!.!c+"(a(e, :n .o'!a soc!a"78 c7derea d!n(r4+n "oc :na"( :n .o'!a s&ec!.!c7
    de :n7"=!%!8 se&ararea de &7r!n=! :n an<!e(a(ea de se&arare8 &ersec+=!a :n
    (+"'+rarea de"!ran(7J.
    D!.eren=!erea .o'!e! s&ec!.!ce de (!& s!(+a=!ona", de &an!ca c+ a$ora.o'!e &oa(e .!
    e<(re% de d!.!c!"7, deoarece a%'e"e (+"'+r7r! &o( !nc"+de a(ac+r! de &an!c7 s! de
    ev!(are "a ace"eaO! (!&+r! de s!(+a=!! Ede e<., "a cond+s, /'or, (rans&or( &+'"!c, s&a=!!
    :nc!seJ.T!&!c, &an!ca c+ a$ora.o'!e es(e carac(er!/a(7 &r!n de'+(+" !n!=!a" a" +nor
    a(ac+r! de &an!c7 !no&!na(e O! ev!(area +"(er!oar7 a n+%eroase s!(+a=!! cons!dera(e a
    #anica
    F+4
    .! &os!'!"! dec"anOa(or! a! a(ac+r!"or de &an!c7. T!&!c, .o'!a s&ec!.!c7 de (!& s!(+a=!o4
    na", es(e carac(er!/a(7 &r!n ev!(are s!(+a=!ona"7, :n a'sen=a +nor a(ac+r! de &an!c7
    !no&!na(e rec+ren(e. Une"e (a'"o+r! c"!n!ce cad :n(re aces(e &a((ern+r! s! neces!(7
    @+deca(a c"!n!c7 :n a"e$erea ce"+! %a! adecva( d!a$nos(!c. Pa(r+ .ac(or! &o( .! +(!"! :n
    e.ec(+area aces(e! @+dec7=!Q .ocar+" an<!e(7=!!, (!&+" s! n+%7r+" a(ac+r!"or de &an!c7,
    n+%7r+" s!(+a=!!"or ev!(a(e s! n!ve"+" an<!e(7=!! !n(erc+ren(e. De e<e%&"+, +n
    !nd!v!d, c7r+!a %a! :na!n(e n+4! era .r!c7 de ascensoare sa+ n+ "e ev!(a, are +n a(ac
    de &an!c7 :n(r4+n ascensor s! :nce&e s7 se (ea%7 s7 %a! %ear$7 "a serv!c!+, &en(r+
    c7 es(e o'"!$a( s7 !a ascensor+" &An7 "a '!ro+" s7+ de "a e(a@+" 9I. Dac7 aces( !ns are
    :n con(!n+are a(ac+r! de &an!c7 n+%a! :n ascensoare Ec!ar dac7 .ocar+" an<!e(7=!!
    es(e a(ac+" de &an!c7J, a(+nc! +n d!a$nos(!c de .o'!e s&ec!.!c7 &oa(e .! %a! adecva(.
    Dac7, :ns7, !nd!v!d+" e<&er!en(ea/7 a(ac+r! de &an!c7 !no&!na(e :n a"(e s!(+a=!!, O!
    :nce&e s7 ev!(e sa+ s7 :nd+re c+ (ea%7 a"(e s!(+a=!! d!n ca+/a an(!c!&7r!! an<!oase a
    +n+! a(ac de &an!c7, a(+nc! &oa(e .! @+s(!.!ca( +n d!a$nos(!c de &an!c7 c+
    a$ora.o'!e, :n a.ar7 de aceas(a, &re/en=a +ne! a&reens!+n! &ervas!ve :n "e$7(+r7
    c+ .a&(+" de a avea +n a(ac de &an!c7, c!ar cAnd n+ an(!c!&ea/7 e<&+nerea "a o
    s!(+a=!e .o'!c7, @+s(!.!c7, de ase%enea, d!a$nos(!c+" de &an!c7 c+ a$ora.o'!e. Dac7
    !nd!v!d+" are a(ac+r! de &an!c7 !no&!na(e +"(er!oare :n a"(e s!(+a=!!, dar n+ de/vo"(7
    :n &"+s n!c! ev!(are sa+ :nd+rarea c+ (ea%7, a(+nc! d!a$nos(!c+" adecva( ar &+(ea .!
    &an!ca .7r7 a$ora.o'!e. Dac7 .ocar+" ev!(7r!! n+ es(e :n "e$7(+r7 c+ .a&(+" de a avea
    +n a(ac de &an!c7, c! !n(eresea/7 a"(e ca(as(ro.e Ede e<., +n (ra+%a(!s% da(ora(
    r+&er!! ca'"+"+! +n+! ascensorJ, a(+nc! &oa(e .! "+a( :n cons!dera=!e d!a$nos(!c+"
    ad!=!ona" de .o'!e s&ec!.!c7.
    :n %od s!%!"ar, d!s(!nc=!a d!n(re .o'!a soc!a"7 O! &an!ca c+ a$ora.o'!e &oa(e .!
    d!.!c!"7, :n s&ec!a" cAnd e<!s(7 n+%a! ev!(area s!(+a=!!"or soc!a"e. De e<e%&"+,
    !nd!v!/!! c+ &an!c7 c+ a$ora.o'!e s! ce! c+ .o'!e soc!a"7 &o( ev!(a a%'!! s!(+a=!!"e de
    :%'+"/ea"7 Ede e<., cen(re"e co%erc!a"e %ar!, re+n!+n!"e de soc!e(a(eJ. Focar+"
    an<!e(7=!! s! (!&+" de a(ac+r! de &an!c7 &o( .! +(!"e :n e.ec(+area aces(e! d!s(!nc=!!. De
    e<e%&"+, +n !nd!v!d care n+ a av+( an(er!or .r!ca de a vor'! :n &+'"!c, are +n a(ac
    de &an!c7 :n (!%& ce =!ne R con.er!n=7, s! :nce&e s7 se (ea%7 s7 n+ se dea :n s&ec(aco".
    Dac7 +"(er!or, aces( !nd!v!d are a(ac+r! de &an!c7 n+%a! "a s!(+a=!! de .+nc=!onare
    soc!a"7 s! dac7 aces(e a(ac+r! s+n( :nso=!(e de .r!ca de a n+ .! &+s :n d!.!c+"(a(e s!
    +%!"!(, a(+nc! &oa(e .! o&or(+n d!a$nos(!c+" de .o'!e soc!a"7. Dac7 :ns7, !nd!v!d+"
    con(!n+7 s7 e<&er!en(e/e a(ac+r! de &an!c7 !no&!na(e s! :n a"(e s!(+a=!!, a(+nc! ar
    &+(ea .! @+s(!.!ca( d!a$nos(!c+" de &an!c7 c+ a$ora.o'!e. Ind!v!/!! c+ .o'!e soc!a"7 se
    (e% de scr+(are, s! a+ rar +n a(ac de &an!c7 cAnd s+n( s!n$+r!, &e cAnd !nd!v!/!! c+
    &an!c7 c+ a$ora.o'!e &o( .! %a! an<!os! :n s!(+a=!!"e :n care (re'+!e s7 se a."e .7r7 +n
    co%&an!on de :ncredere, :n a.ar7 de aceas(a, a(ac+r!"e de &an!c7 noc(+rne care
    deO(ea&(7 +n !nd!v!d d!n so%n s+n( carac(er!s(!ce &an!c!!.
    CAnd s+n( sa(!s.7c+(e cr!(er!!"e, a(A( &en(r+ &an!c7, cA( s! &en(r+ a"(7 (+"'+rare
    an<!oas7 sa+ a.ec(!v7, (re'+!e s7 .!e d!a$nos(!ca(e a%'e"e (+"'+r7r!. Dac7 :ns7, a&ar
    a(ac+r! !no&!na(e de &an!c7 :n con(e<(+" a"(e! (+"'+r7r! Ede e<., (+"'+rarea de&res!v7
    %a@or7 sa+ an<!e(a(ea $enera"!/a(7J, dar n+ s+n( aco%&an!a(e (!%& de o "+n7 sa+
    %a! %+"( de (ea%a de a n+ avea a(ac+r! +"(er!oare, de &reoc+&7r! asoc!a(e sa+ de o
    %od!.!care de co%&or(a%en(, d!a$nos(!c+" ad!=!ona" de &an!c7 n+ es(e &+s. Pen(r+
    c7 !nd!v!/!! c+ &an!c7 :O! &o( a+(o(ra(a s!%&(o%e"e, (+"'+r7r!"e co%or'!de :n
    "e$7(+r7 c+ o s+'s(an=7, Ece" %a! adesea :n "e$7(+r7 c+ canna'!s+", a"coo"+" O!
    coca!naJ n+ s+n( rare.
    HH5 Tulburrile Anxioase
    Criteriile $e $ia/no&ti# pentru
    4++.+* Pani#a %(r( A/ora%o-ie
    A2 At@t &E), c@t si &7)D
    (1) atacuri de panica inopinate recurente &ve(i pa!2 H47)3
    (2) cel puin unul dintre atacuri a $ost urmat timp de o lun &sau mai
    mult)
    de unul &sau mai muite) dintre urmtoareleD
    (a)preocupare persistent "n le!tur cu $aptul de a nu avea atacuri
    ulterioare3
    (b) team "n le!tur cu implicaiile atacului sau cu consecinele
    sale &de
    ex2, teama de a nu-,i pierde controlul, de a nu avea un atac de cord
    sau =de a nu "nnebuni>)3
    (a)o modi$icare semni$icativ de comportament "n le!tur cu atacurile2
    S2 Absena a!ora$obiei &ve(i pa!2 H44)2
    2 Atacurile de panic nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    substane &de ex2, un dro! de abu(, un medicament) sau ale unei condiii
    medicale !enerale &de ex2, %ipertiroidismul)2
    D2 Atacurile de panic nu sunt explicate mai bine de alt tulburare mental,
    cum ar $i $obia social &de ex2, apariie la situaii sociale temute), $obia
    speci$ic &de ex2, la expunerea la o situaie $obic speci$ic), tulburarea
    obsesivo-compulsiv &de ex2, la expunerea la murdrie a cuiva cu obsesia
    contaminrii), stresul posttraumatic &de ex2, ca rspuns la stimulii asociai cu
    un stresor sever), sau anxietatea de separare &de ex2, ca rspuns la a $i
    departe de cas sau de rudele apropiate)2
    455277 A!ora$obia $r istoric de
    #anic
    FF1
    Criteriile $e $ia/no&ti# pentru
    4++.+* Pani#( #u A/ora%o-ie
    A At@t &E), c@t si ())
    (1)atacuri de panic inopinate recurente &ve(i pa! H47),
    (2)cel puin unul dintre atacuri a $ost urmat timp de o lun &sau mai mult)
    de unul &sau mai multe) dintre urmtoarele
    &a) preocupare persistent "n le!tur cu $aptul de a nu avea atacuri
    ulterioare, &b)team "n le!tur cu implicaiile atacului sau cu
    consecinele sale &de
    ex, teama de a nu-si pierde controlul, de a nu avea un atac de cord,
    =de a nu "nnebuni>), &c) o modi$icare semni$icativ de comportament
    "n le!tur cu atacurile
    S #re(enta a!ora$obiei &ve(i pa! H44)
    Atacurile de panic nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    substane &de ex, un dro! de abu(, un medicament) sau unei condiii
    medicale !enerale &de ex , %ipertiroidismul)
    D Atacurile de panic nu sunt explicate mai bine de alt tulburare mental ,
    cum ar $i $obia social &de ex, apariia la expunerea la situaii sociale
    temute), $obia speci$ic &de ex, la expunerea la o situaie $obic speci$ic),
    tulburarea obsesivo-compulsiv &de ex , expunerea la murdrie a cuiva cu
    obsesia contaminrii), stresul posttraumatic &de ex, ca rspuns la stimuln
    asociai cu un stresor sever) sau anxietatea de separare &de ex , ca rspuns la
    a $i departe de casa sau de rudele apropiate3
    4++.CC A/ora%o-ia %(r( i&tori# $e Pani#(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e a$ora.o'!e! .7r7 !s(or!c de &an!c7 s+n( s!%!"are c+ ce"e
    a"e &an!ca c+ a$ora.o'!e, c+ e<ce&=!a .a&(+"+! c7 .nca es(e cen(ra(7 &e a&ar!=!a +nor
    s!%&(o%e s!%!"are &an!c!! e<(re% de !nco%odan(e sa+ !nca&ac!(an(e or! a +nor
    a(ac+r! c+ s!%&(o%e "!%!(a(e decA( &e a(ac+r! de &an!c7 co%&"e(e Ind!v!/!! c+
    aceas(7 (+"'+!are a+ a$ora.o'!e Eve/! &a$ I;;J Ecr!(er!+" AJ S!%&(o%e"e Ss!%!"are
    &an!c!!T !nc"+d &e or!care d!n(re ce"e 5; s!%&(o%e %en=!ona(e "a a(ac+" de &an!c7
    Eve/! &a$ I;9J sa+ a"(e s!%&(o%e ca! e &o( .! !nca&ac!(an(e sa+ %co%odan(e Ede e< ,
    &!erderea con(ro"+"+! ve/!c!! +r%are, _ o%7(+" :n &+'"!cJ De e<e%&"+, +n !nd!v!d se
    &oa(e (e%e s7 n+ a!'7 o ce(a"ee sa+ s!%&(o%e card!ace severe 4h! s7 n+ e<!s(e
    &os!'!"!(a(ea s7 ! se acorde a@+(or
    Pen(r+ a .! dese%na( &en(r+ aces( d!a$nos(!c, cr!(er!!"e co%&"e(e &en(r+ &an!c7
    n+ (re'+!e s7 .! .os( sa(!.7c+(e n!c!oda(7 Ecr!(er!+" BJ, !ar s!%&(o%e"e n+ (re'+!e s7 se
    da(o!e/e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e< , +n dro$ de a'+/, +n
    %ed!ca%en(J or! a"e +ne! cond!L %ed!ca"e $enera"e Ecr!(er!+" CJ Dac7 es(e
    HH7 Tulburrile Anxioase
    &re/en(7 o cond!=!e %ed!ca"7 $enera"7 asoc!a(7 Ede e<., o cond!=!e card!ac7J, .r!ca de
    a .! !nca&ac!(a( sa+ &+s :n d!.!c+"(a(e de a&ar!=!a s!%&(o%e"or Ede e<., de "eO!nJ es(e
    c"ar :n e<ces .a=7 de cea care es(e asoc!a(7 de re$+"7 c+ cond!=!a Ecr!(er!+" DJ. CAnd
    es(e &+s +n d!a$nos(!c de a$ora.o'!e .7r7. !s(or!c de &an!c7, (re'+!e s7 ne as!$+r7%
    c7 ev!(area es(e carac(er!s(!c7 a$ora.o'!e! O! n+ &oa(e .! e<&"!ca(7 %a! '!ne de a"(7
    (+"'+rare de &e a<a I Ede e<., .o'!a s&ec!.!c7 sa+ .o'!a soc!a"7J sa+ de &e a<a II Ede
    e<., (+"'+rarea de &ersona"!(a(e ev!(an(7 J.
    *lemente speci$ice culturii si sexului
    Une"e $r+&+r! c+"(+ra"e sa+ e(n!ce res(rAn$ &ar(!c!&area .e%e!"or "a v!a=a
    &+'"!c7, s! aces( .a&( (re'+!e s7 .!e d!s(!ns de a$ora.o'!e. Aceas(7 (+"'+rare es(e
    d!a$nos(!ca(7, de de&ar(e, %+"( %a! .recven( "a .e%e! decA( "a '7r'a=!.
    #revalent
    :n cond!=!! c"!n!ce, a&roa&e (o=! !nd!v!/!! E&es(e FYdJ care &re/!n(7 a$ora.o'!e
    a+, de ase%enea, +n d!a$nos(!c c+ren( Esa+ !s(or!cJ de &an!c7. D!n con(ra,
    &reva"en(a a$ora.o'!e! .7r7 !s(or!c de &an!c7 &e esan(!oane"e e&!de%!o"o$!ce a .os(
    ra&or(a(7 ca .!!nd %a! %are decA( cea &en(r+ &an!ca c+ a$ora.o'!e. Pro'"e%e"e
    re.er!(oare "a eva"+are &ar a .! e<a$era( :ns7 &rocen(e"e ra&or(a(e :n s(+d!!"e
    e&!de%!o"o$!ce. Ma! recen(, !nd!v!/!! d!n(r4+n s(+d!+ e&!de%!o"o$!e c7rora "e4a .os(
    &+s d!a$nos(!c+" de a$ora.o'!e .7r7 !s(or!c de &an!c7, a+ .os( reeva"+a=! de
    c"!n!c!en! +(!"!/And sce%e de !n(erv!+r! s(andard!/a(e. S4a cons(a(a( c7 %a@or!(a(ea
    &re/en(a+ .o'!! s&ec!.!ce O! n+ a$ora.o'!e.
    *voluie
    Se O(!e re"a(!v &+=!n des&re evo"+=!a a$ora.o'!e! .7r7 !s(or!c de &an!c7. Da(e de
    !s(or!c s+$erea/7 c7 +ne"e ca/+r! &o( &ers!s(a (!%& de an! s! &o( .! asoc!a(e c+ o
    de(er!orare cons!dera'!"7.
    Dia!nostic di$erenial
    A$ora.o'!a .7r7 !s(or!c de &an!c7 se d!s(!n$e de &an!ca c+ a$ora.o'!e &r!n
    a'sen=a +n+! !s(or!c de a(ac+r! de &an!c7 !no&!na(e O! rec+ren(e. Ev!(area :n
    a$ora.o'!a .7r7 !s(or!c de &an!c7 re/+"(7 d!n .r!ca de !nca&ac!(a(e sa+ +%!"!re
    da(ora(7 s!%&(o%e"or s!%!"are &an!c!!, s+'!(e, !%&rev!/!'!"e, %a! c+rAnd decA( d!n
    .r!ca de +n a(ac co%&"e( de &an!c7, aOa c+% es(e ca/+" :n &an!ca c+ a$ora.o'!e.
    D!a$nos(!c+" de &an!c7 c+ a$ora.o'!e r7%Ane adecva( :n ca/+r!"e :n care a(ac+r!"e
    de &an!c7 se re%!(, dar a$ora.o'!a con(!n+7 s7 .!e e<&er!en=a (a.
    A"(e %o(!ve de ev!(are (re'+!e, de ase%enea, s7 .!e d!s(!nse de a$ora.o'!a .7r7
    !s(or!c de &an!c7, :n .o'!a soc!a"7, !nd!v!/!! ev!(7 s!(+a=!!"e soc!a"e sa+ de .+nc=!onare
    :n care e! se (e% c7 &o( ac=!ona :n(r4+n %od +%!"!(or sa+ @enan(, :n .o'!a s&ec!.!c7,
    !nd!v!/!! ev!(7 o'!ec(+" sa+ s!(+a=!a s&ec!.!c7 (e%+(7, :n (+"'+rarea de&res!v7
    %a@or7, !nd!v!/!! &o( ev!(a s7 &"ece de acas7 d!n ca+/a a&a(!e!, &!erder!! ener$!e! s!
    anedon!e!. Fr!c!"e de &ersec+=!e Eca :n (+"'+rarea de"!ran(7J s! .r!c!"e de
    con(a%!nare Eca :n (+"'+rarea o'ses!vo4co%&+"s!v7J &o( d+ce, de ase%enea,
    .recven( "a ev!(are, :n an<!e(a(ea de se&arare, co&!!! ev!(7 s!(+a=!!"e care4! d+c
    de&ar(e de cas7 sa+ de r+de"e a&ro&!a(e.
    *E &adsE +n a& sn&o@d @ed&&+E @n&!&n.a@d ad EIE!I+aD P* ;IEod EDII* 4=&+&ads
    nes &a!0o +n nD SIIU*E*UI o EKEsd&&+E &+O& +o 2e!+a/a@d +! E**E as &+eo nes
    EA!saD>; :s e?+a?s!s@ad 2 EIeD!E+! EDU* o EKE;IU;!!ad<; @n&=A!&+@ 2O @n+a@=!DJ
    EED!+Ed a& D+o=s! E*E* B=0o@B*OfB no BD!+Ed 2E@E&os E!0o@ 2a@B*Bdas a& EaIEI;!<+E
    2D& 2EA!s=nd+!OD4OA!sas0o Ba@B!n0@n? a&
    X4
    <a a&J E@BI+a+! a!B@n0@n8 B=@B a& a+=0 IBUI
    a=BDP!?<a I+ns n+ =&!0o@ Ba!B=!Aa nBS BD!+Bd a& a@+n?B=e 2Ba?B=a=<+v 2Ed !n+a=!!DJ
    aD!@&ads &=0o@ n@BD&so+SB=& Ba?+!B+! !+n[ F +&nd =aD ?e=s!saad P* BS a%0an
    a=a+!o=d+!=s 2IUB G5
    ;
    P eaeBe; 0ns !=/!A!&+= B0 TEH !n+a=+DJ a!0o@ o B;AB B a& @n=dB@
    a& =!0B!a&!s+oD e?Esa!=a& a=sa BUBOS@ad BDBP +o 2e=e&os BeEIA nBS B@EUO!sa@o@d
    Ba!B+o!&+n@ no 2"a+EOS!ad E EUE!&&oD E+&n@ no A!=ED!@!++!as EKEa!a@!a=+=
    =n@n@n+n=s =+!+=B=+! B ESEOP>UB Ea@Bd&&+E nss EDU* 2EaaE!!Aa B;B& !B+!n+ a=sa
    @nD&so+fEPD TED !n+a?+oJ B+!Ba= no eE!n&+! a?sa +oa+n !sa& D!0o@ @n=n%&s
    2Basa&B IBUI &? 2=ndo@ nD *HKBD a!@ n+ ES a=Bod E=saDB 2ED BIBD!@!Isn=a+ :s
    BA!sa*<a a?sa @oy EDI** BD Dso+nDa@ a@E@n0yn= E@SEaDE :s !=!+aDsa=o&E ED a=Bo8
    n? H(WX( 2fBd IKBAJ ^E+o!IBn8=s snds!&a@d nBS s+Ds+%D@& ED!+Bd a& DBIB %+n
    BUI*O* Bn@ a=Eod s+ndsE* IY;L v 2EF IE!&;U!! SOI>UB s+ndsB* +n @!0EUBA+!
    EDBOAO@d o!0o@ @n@n+!&s B* NE3 @n+a=!*DJ *B& ;InDso+nD;* !@ ?od S*BD
    2;s+;s+!nD@& !&En=!s nES ;ID;!0o ;& BIU;IS!s!;d :s BIB;*BUI EDU@ ;!nI=IS+oD y!
    sD!@&ads =a!0o@ =E @B&+asa ynI+a+!a=$
    Jp ap
    *e Hduiis eiIoA '
    eAIod >JKEEL

    na eJnIe0 ap eiepose SSD ap ei
    MS0epose eJe0auaI eJSDipaiu
    eJ
    N6Je0auaI aJeD/paai uiipuoD 0aun uo
    &luatueDipatu un M(n]e ap So0p un M-xa ap)
    aiue3s]ns laun aJe apa00p aDJIoJO0(002 0oppa<a e(ea0o3ep as nu ea0e]0ni0ad M4
    M&OtMV MIed 0(aA) eDiued n0iuad aiuauD eiepopm a3nDe02sJies 3so2&2 ne nu Ma
    N&aa0eip nes eJeaiaaie M-xa ap) ipmed a0eiiuu0s au0oidoi0s
    0oun e a0iuede ap SD.N2 nD e0nieIaJ ui &eeE? -Ied (aA) 0a/]o02e0oIe eiua(a00 MV
    ap I 8I8I. eiToQ.eQo=v V++W ap

    B@ED=&a+! E!!=&+oD nD e@nSa@ a& B=B&ose
    eaD a& B=e@ saD<a UT *E& ;IY; Ba!B=!Aa nBS BDU* BDEP =E+!n+ 2snd a!@ ES a!n0s!= BD!+Bd
    ap 9#M;FS# BMBM 4iI;MB#;NB ap An9#FS;UN$ia
    B
    *U;Ml3+ a3pBMBU# O9 p#A3pU# Un B3 BSSMB3p
    2N>; a&J ;IBI=nDy!& +! !snd =@ E a& nBS E=+oI!/+B*I aD!+!a!=DS= +nDBIB nD &=A=&+!
    +n B* @n+=sa@ 24<a ;&J ==BI&BdBDU! y n+ B ;& @o@dE@ nD B!n=ef;y +! a3eaA io\iivdnyosid
    =!s a@a+n EI=A; Iod ;@B*;U;f a@ED!&a+! !!I2!&+oD aI!+%+B nD !!/!A=&+@

    &eJduN/S ei]o0 M0ouaue) SD<
    R;2LLi
    asa
    saaxa u0 0ep a3sa v
    o e<ua(a0d a0sa e
    HHH
    Tulburrile Anxioase
    o'!ec(+"+! sa+ s!(+a=!e! Ede e<., +n !nd!v!d se &oa(e (e%e de o
    c7"7(or!e c+ av!on+" d!n ca+/a .a&(+"+! c7 es(e &reoc+&a( de
    c7derea av!on+"+!, se &oa(e (e%e de cA!n! d!n ca+/a
    &reoc+&7r!"or :n "e$7(+r7 c+ .a&(+" de a .! %+sca( or! se (e%e s7
    cond+c7 d!n ca+/a &reoc+&7r!"or :n "e$7(+r7 c+ .a&(+" c7 ar &+(ea
    .! "ov!( de a"(e ve!c+"e &e s(rad7J. Fo'!!"e s&ec!.!ce &o( !%&"!ca,
    de ase%enea, &reoc+&7r! :n "e$7(+r7 c+ &!erderea con(ro"+"+!,
    &an!carea, %an!.es(7 r!"e so%a(!ce a"e an<!e(7 =!! s! .r!c!! Ec+% ar .!
    creO(erea r!(%+"+! card!ac sa+ sc+r(area res&!ra=!e!J O! "eO!n+", care
    &o( s+rven! "a e<&+nerea "a o'!ec(+" (e%+(. De e<e%&"+, !nd!v!/!!
    care se (e% de sAn$e O! de &"7$! &o( .!, de ase%enea, &reoc+&a=! O!
    de &os!'!"!(a(ea a&ar!=!e! +n+! "eO!n8 !nd!v!/!! c7rora "e es(e .r!c7 de
    :n7"=!%! &o( .!, de ase%enea, &reoc+&a=! de a%e=ea"7, !ar ce! care
    se (e% de s!(+a=!! de s&a=!! :nc!se &o( .!, de ase%enea, &reoc+&a=!
    de .a&(+" de a n+4s! &!erde con(ro"+" O! de a n+ voc!.era. Aces(e
    &reoc+&7r! &o( .! e<(re% de &+(ern!ce :n (!&+" s!(+a(!ona" de .o'!e
    s&ec!.!c7 .
    An<!e(a(ea es(e a&roa&e cons(an( s!%=!(7 !%ed!a( "a
    con.r+n(area c+ s(!%+"+" .o'!e Ede e<., o &ersoan7 c+ o .o'!e
    s&ec!.!c7 de &!s!c! va avea a&roa&e cons(an( +n r7s&+ns an<!os
    !%ed!a( cAnd es(e .or=a(7 s7 se con.r+n(e c+ o &!s!c7J. N!ve"+"
    an<!e(7=!! sa+ .r!c!! var!a/7 de re$+"7 :n .+nc=!e, a(A( de $rad+" de
    a&ro&!ere de s(!%+"+" .o'!e Ede e<., .r!ca se !n(ens!.!c7 &e %7s+r7
    ce &!s!ca se a&ro&!e s! d!%!n+a &e %7s+r7 ce &!s!ca se de&7r(ea/7J,
    cA( s! de $rad+" :n care es(e "!%!(a(7 sc7&area de s(!%+"+" .o'!e Ede
    e<., .r!ca se !n(ens!.!c7 &e %7s+r7 ce ascensor+" se a&ro&!e de
    @+%7(a(ea dr+%+"+! d!n(re e(a@e s! d!%!n+a cAnd se desc!de +Oa
    "a e(a@+" +r%7(orJ. In(ens!(a(ea .r!c!! &oa(e s7 n+ .!e :ns7
    (o(dea+na :n ra&or( &red!c(!'!" c+ s(!%+"+" .o'!e Ede e<., o
    &ersoan7 care se (e%e de :n7"=!%! &oa(e e<&er!en=a $rade d!.er!(e
    de .r!c7, a(+nc! cAnd (raversea/7 ace"aO! &od :n oca/!! d!.er!(eJ.
    Uneor!, a(ac+r! de &an!c7 a+(en(!ce s+n( e<&er!en(a(e ca r7s&+ns
    "a s(!%+"! .o'!e!, :n s&ec!a" cAnd &ersoana (re'+!e s7 r7%An7 :n
    s!(+a=!e sa+ crede c7 sc7&area es(e !%&os!'!"7. Oca/!ona",
    a(ac+r!""e de &an!c7 s+n( :n(Ar/!a(e s! n+ a&ar !%ed!a( "a
    con.r+n(area c+ s(!%+"+" .o'!e. Aceas(7 :n(Ar/!ere es(e %a!
    &ro'a'!"7 :n (!&+" s!(+a(!ona". Deoarece o an<!e(a(e an(!c!&a(or!e
    !n(ens7 s+rv!ne cAnd &ersoana es(e con.r+n(a(7 c+ neces!(a(ea
    de a !n(ra :n(r4o s!(+a=!e .o'!c7, as(.e" de s!(+a=!! s+n( de re$+"7
    ev!(a(e. Ma! rar, &ersoana se .or=ea/7 s7 :nd+re s!(+a=!a .o'!c7, dar
    aceas(a es(e e<&er!en(a(7 c+ o an<!e(a(e !n(ens7.
    Ad+"=!! c+ aceas(7 (+"'+rare rec+nosc c7 .o'!a es(e e<ces!v7
    sa+ ne@+s(!.!ca(7 . D!a$nos(!c+" va .! ce" de (+"'+rare de"!ran(7 :n
    "oc de .o'!e s&ec!.!c7 "a +n !nd!v!d care ev!(7 +n ascensor d!n
    ca+/a conv!n$er!! c7 aces(a a .os( sa'o(a( O! care n+ rec+noaO(e c7
    .r!ca sa es(e e<ces!v7 s! ne@+s(!.!ca(7, :n a.ar7 de aceas(a,
    d!a$nos(!c+" n+ va .! &+s dac7 .r!ca es(e %o(!va(7, da( .!!nd
    con(e<(+" de s(!%+"! Ede e<., .r!ca de a n+ .! :%&+Oca( :n(r4+r!
    &er!%e(r+ de vAn7(oare sa+ :n(r4+n car(!er &er!c+"osJ.
    ConO(!en(!/area na(+r!! e<ces!ve sa+ ne@+s(!.!ca(e a .r!c!! (!nde s7
    creasc7 c+ e(a(ea O! n+ es(e necesar7 &en(r+ a &+ne d!a$nos(!c+" "a
    co&!!.
    Fr!c!"e de o'!ec(e sa+ de s!(+a=!! c!rc+%scr!se s+n( .oar(e
    .recven(e, :n s&ec!a" :n co&!"7 r!e, dar :n %+"(e ca/+r! $rad+" de
    de(er!orare es(e !ns+.!c!en( &en(r+ a @+s(!.!ca +n d!a$nos(!c. Dac7
    .o'!a n+
    !n(er.erea
    /7
    se%n!.!ca
    (!v c+
    .+nc=!ona
    rea
    !nd!v!d+"
    +! sa+ n+
    ca+/ea/7
    o de(res7
    %arca(7,
    d!a$nos(!
    c+" n+
    es(e &+s.
    De
    e<e%&"+,
    o
    &ersoan7
    c7re!a :!
    es(e .r!c7
    de Oer&!
    &An7 "a
    &+nc(+"
    de a
    %an!.es(
    a o .r!c7
    !n(ens7 :n
    &re/en=a
    Oer&!"or,
    n+ va
    &r!%!
    d!a$nos(!
    c+" de
    .o'!e
    s&ec!.!c7
    dac7
    (r7!eO(e
    :n(r4o
    /on7
    "!&s!(7 de
    Oer&!, n+4
    s!
    res(rAn$e
    ac(!v!(a(e
    a de .r!ca
    Oer&!"or
    O! n+ es(e
    de(resa(7
    de .a&(+"
    c74! es(e
    .r!c7 de
    Oer&!.
    2%n%?HU&
    455276 'obia Speci$ic &anterior, 'obia
    Simpl)
    77<
    Subtipuri
    Ur%7(oare"e s+'&+n &o( .! s&ec!.!ca(e &en(r+ a !nd!ca cen(rarea .r!c!! sa+
    ev!(7r!! :n .o'!a s&ec!.!c7 Ede e< , .o'!e s&ec!.!c7 de (!& de an!%a"eJ
    De an!%a"e Aces( s+'(!& (re'+!e s7 .!e s&ec!.!ca( dac7 .r!ca es(e &rovoca(7 de
    an!%a"e sa+ !nsec(e Aces( s+'(!& are :n $enera" de'+(+" :n co&!"7r!e De
    %ed!+ na(+ra" Aces( s+'(!& (re'+!e s7 .!e s&ec!.!ca( dac7 .r!ca es(e
    &rovoca(7 de o'!ec(e d!n %ed!+" na(+ra", c+% ar .! .+r(+n!"e, :n7"=!%!"e sa+
    a&a Aces( s+'(!& are :n $enera" de'+(+" :n co&!"7r!e
    De sAn$e4!n@ec=!!4&"7$!. Aces( s+'(!& (re'+!e s&ec!.!ca( dac7 .r!ca es(e
    &rovoca(7 de vederea sAn$e"+! sa+ a +ne! &"7$!, or! de ad%!n!s(rarea +ne!
    !n@ec=!! sa+ a a"(or &roced+r! %ed!ca"e !nvas!ve Aces( s+'(!& es(e e<(re% de
    .recven( s! se carac(er!/ea/7 adesea &nn(r4+n r7s&+ns vasova$a" &+(ern!c
    De s!(+a=!! Aces( s+'(!& (re'+!e s7 .!e s&ec!.!ca( dac7 .r!ca es(e &rovoca(7 de
    o an+%!(7 s!(+a=!e, c+% ar .! (rans&or(<!" &+'"!c, (+ne"e"e, &od+r!"e,
    ascensoare"e, /'or+", cond+s+" sa+ s&a(!!"e :nc!se Aces( s+'(!& are o
    d!s(r!'+=!e '!%oda"7 a e(7=!! "a de'+(, c+ +n &!c :n co&!"7r!e s! c+ +n a"(+" "a
    @+%a (a(ea an!"or 9L Aces( s+'(!& &are a .! s!%!"ar c+ &an!ca c+ a$ora.o'!e
    s+' ra&or(+" carac(er!s(!c!"or sa"e :n "e$7(+r7 c+ ra(e"e se<+"+!, &a((ern+" de
    a$re$are .a%!"!a"7 s! e(a(ea "a de'+(
    De a"( (!& Aces( s+'(!& (re'+!e s7 .!e s&ec!.!ca( dac7 .r!ca es(e &rovoca(7 de
    a"=! s(!%+ AceO(! s(!%+"! &o( !nc"+de .r cV or! ev!(area s!(+a=!!"or care &o(
    d+ce "a s+.ocare, _o%7 sa+ con(rac(area +ne! %a"ad!!, .o'!a de Ss&a=!+T
    Ead!c7, !nd!v!d+" se (e%e s7 n+ cada @os, dac7 se a."7 de&ar(e de +n &ere(e sa+
    de a"(e %!@"oace de s+&or( .!/!cJ s! .nc!"e co&!!"or de s+ne(e &+(ern!ce sa+ de
    &ersoane :n +n!.or%7
    Frecven(a s+'(!&+n"or % serv!c!!"e c"!n!ce &enrr+ ad+"=!, de "a ce" %a! .recven(
    &An7 "a ce" %a! rar, es(e +r%7(oarea s!(+a( ?na" de %ed!+ na(+ra", de sAn$e4
    !n@ec(n4&"7$! s! de an!%a"e S(+d!!"e &e eOan(!oane co%+n!(are &re/!n(7 +n
    &a((ern +Oor d!.er!(, c+ .o'!a de :n7"=!%!, de =?!a%c%, Ooarec! s! !nsec(e %a!
    .recven(e s! c+ .o'!!"e de a"(e an!%a"e sa+ de a?e e"e%en(e a"e %ed!+"+! na(+ra",
    c+% ar .! .+r(+n!"e, (+ne(e"e s! .+"$ere"e %a! &+( n !recven(e Fo'!a de s!(+a=!! de
    s&a=!! :nc!se E+n (!& s!(+a(!ona" de .o'!eJ &oa(e .! %a! .recven(7 "a '7(rAn! :n %+"(e
    ca/+r!, es(e &re/en( %a! %+"( decA( +n s!n$+r s+'(!& de !o'!e s&ec!.!c7 Fa&(+" de a
    avea o .o'!e de +n s+'(!& s&ec!.!c (!nde s7 creasc7 &ro'a'!"!(a(ea de a avea o a"(7
    .o'!e d!n cadr+" ace"+!aO! s+'(!& Ede e< , .r!ca de &!s!c! s! de Oer&!J CAnd e<!s(7 %a!
    %+"( decA( +n s!n$+r s+'(!& de .o'!e, (re'+!e s7 .!e %en=!ona(e (oa(e Ede e< , .o'!e
    s&ec!.!c7, de an!%a"e s! de %ed!+ na(+ra"J
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e Fo'!a s&ec!.!c7 &oa(e
    d+ce "a +n s(!" de v!a(7 res(rAns or! !n(er.erea/7 ca an+%!(e oc+&a=!!, :n .+nc(e de
    (!&+" de .o'!e De e<e%&"+, &ro%ovarea :n .+nc=!e "a serv!c!+ &oa(e .! a%en!n=a(7
    de ev!(area c7"7(or!!"or c+ av!on+", !ar ac(!v!(7=!"e soc!a"e &o( .! res(rAnse de .r!ca
    de "oc+r! a$"o%era(e sa+ de s&a(!! :nc!se Fo'%e s&ec!.!ce a&ar conco%!(en( c+
    a"(e (+"'+r7r! an<!oase, (+"'+r7r! a.ec(!ve sa+ (+"'+r7r! % "e$7(+r7 c+ o s+'s(an=7
    De e<e%&"+, :n esan(!oane"e co%+n!(are, &rocen(+" coa&ar!e! c+ a"(e (+"'+r7r!
    HHI Tulburrile Anxioase
    %er$e de "a YLd "a GLd, aces(e &rocen(e &+(And .! %a! %ar! &r!n(re !nd!v!/!! c+
    .o'!! s&ec!.!ce c+ de'+( &recoce. In cond!=!! c"!n!ce, .o'!!"e s&ec!.!ce s+n( .oar(e
    .recven( d!a$nos(!ce co%or'!de c+ a"(e (+"'+r7r!, :n aces(e s!(+a=!! :ns7, .o'!!"e
    s&ec!.!ce s+n( rar cen(r+" a(en=!e!. Fo'!a s&ec!.!c7 es(e asoc!a(7 de re$+"7 c+ %a!
    &+=!n7 de(res7 sa+ !n(er.erea/7 %a! &+=!n c+ .+nc=!onarea decA( &r!nc!&a"e"e
    d!a$nos(!ce co%or'!de. :n $enera", se es(!%ea/7 c7 n+%a! 59d4;Ld d!n(re
    !nd!v!/! so"!c!(7 as!s(en=7 %ed!ca"7 &en(r+ .o'!!"e "or s&ec!.!ce, :n a'sen=a a"(or
    d!a$nos(!ce, so"!c!(area as!s(en=e! %ed!ca"e &en(r+ .o'!!"e s&ec!.!ce es(e .oar(e
    &os!'!"7 :n .o'!!"e c+ de(er!orare .+nc=!ona"7 %a! %are Ede e<., .o'!!"e de o'!ec(e
    sa+ de s!(+a=!! care s+n( :n(A"n!(e .recven(J. D!n con(ra, !nd!v!/!! c+ .r!c! a's+rde
    de &"7$! sAn$erAnde, de &roced+r! %ed!ca"e s! cond!=!! %ed!ca"e es(e &os!'!" s7
    so"!c!(e %a! &+=!n a@+(or &en(r+ .o'!!.
    Datele e,a"in(rii &o"ati#e Ei #on$i!iile "e$i#ale /enerale a&o#iate. Un
    r7s&+ns vasova$a" cons(And d!n "eO!n es(e carac(er!s(!c .o'!e! s&ec!.!ce de (!&
    sAn$e4!n@ec=!!4&"7$!8 a&ro<!%a(!v HYd d!n(re as(.e" de !nd!v!/! re"a(ea/7 +n !s(or!c
    de "eO!n :n aces(e s!(+a=!!. R7s&+ns+" .!/!o"o$!c es(e carac(er!/a( &r!n(r4o sc+r(7
    acce"erare !n!=!a"7 a r!(%+"+! card!ac s! creO(ere a &res!+n!! san$+!ne, +r%a(7 de o
    dece"erare a r!(%+"+! card!ac s! de o sc7dere a &res!+n!! san$+!ne care con(ras(ea/7
    c+ acce"erarea +/+a"7 a r!(%+"+! card!ac O! creO(erea &res!+n!! san$+!ne d!n a"(e
    .o'!! s&ec!.!ce. An+%!(e cond!=!! %ed!ca"e $enera"e &o( .! e<acer'a(e ca +r%are a
    ev!(7r!! .o'!ce. De e<e%&"+, .o'!!"e s&ec!.!ce de (!&+" sAn$e4!n@ec=!!4&"7$! &o( avea
    e.ec(e d7+n7(oare as+&ra s7n7(7=!! den(are sa+ so%a(!ce, deoarece !nd!v!d+" &oa(e
    ev!(a o'=!nerea as!s(en=e! %ed!ca"e necesare, :n %od s!%!"ar, .r!ca de s+.ocare &oa(e
    avea e.ec(e d7+n7(oare as+&ra s7n7(7=!!, cAnd a"!%en(a=!a es(e red+s7 "a s+'s(an=e
    +Oor de :n$!=!( or! cAnd %ed!ca=!a ora"7 es(e ev!(a(7.
    *lemente speci$ice culturii, etii si sexului
    Con=!n+(+" .o'!!"or var!a/7 :n .+nc=!e de c+"(+r7 O! de e(n!e. De e<e%&"+, .r!c!"e
    de %a$!e sa+ de s&!r!(e s+n( &re/en(e :n %+"(e c+"(+r! O! (re'+!e s7 .!e cons!dera(e
    .o'!e s&ec!.!c7, n+%a! dac7 .r!ca es(e e<ces!v7 :n con(e<(+" c+"(+r!! res&ec(!ve O!
    ca+/ea/7 o de(res7 sa+ de(er!orare se%n!.!ca(!v7. Fo'!!"e s&ec!.!ce &o( .! %a!
    .recven(e "a s(ra(+r!"e soc!oecono%!ce !n.er!oare, deO! da(e"e s+n( %!<(e.
    La co&!!, an<!e(a(ea &oa(e .! e<&r!%a(7 &r!n e<c"a%a=!!, accese co"eroase,
    s(+&e.ac=!e sa+ a$7=are de ceva. Adesea, co&!!! n+ rec+nosc c7 .r!c!"e "or s+n(
    e<ces!ve sa+ ne@+s(!.!ca(e O! re"a(ea/7 rar de(res7 :n "e$7(+r7 c+ .a&(+" c7 a+ .o'!!.
    Fr!c!"e de an!%a"e O! de a"(e o'!ec(e d!n %ed!+" na(+ra" s+n( e<(re% de .recven(e s!
    de re$+"7 s+n( (ran/!(or!! :n co&!"7r!e. Un d!a$nos(!c de .o'!e s&ec!.!c7 n+ es(e
    @+s(!.!ca( decA( dac7 .r!c!"e d+c "a o de(er!orare se%n!.!ca(!v7 c"!n!c Ede e<., re.+/+"
    de a %er$e "a Ocoa"7 d!n ca+/a .r!c!! de a n+ :n(A"n! +n cA!ne &e s(rad7J.
    :n $enera", ra(a .e%e!X'7r'a=! c+ .o'!! s&ec!.!ce es(e de a&ro<!%a(!v 9Q5, c!ar "a
    ce! %a! :n e(a(e. Ra(a se<+"+! var!a/7 a (ransverso &r!n d!.er!(e"e (!&+r! de .o'!!
    s&ec!.!ce. A&ro<!%a(!v NCO#!"O d!n(re !nd!v!/!! c+ (!&+" de an!%a"e O! de %ed!+
    na(+ra" s+n( .e%e! Ec+ e<ce&=!a .r!c!! de :n7"=!%!, :n care &rocen(a@+" de .e%e! es(e
    de YYd4HLdJ. La .e", a&ro<!%a(!v HYd4FLd d!n(re !nd!v!/!! c+ (!&+" s!(+a=!ona"
    s+n( .e%e!. A&ro<!%a(!v YYFc4HLd d!n(re !nd!v!/!! c+ (!&+" sAn$e4!n@ec=!!4&"7$!
    s+n( .e%e!.
    455276 'obia Speci$ic &anterior, 'obia
    Simpl)
    77G

    #revalent
    DeO! .o'!!"e s+n( .recven(e :n &o&+"a=!a $enera"7, e"e d+c rar "a o de(er!orare sa+
    de(res7 s+.!c!en(7 care s7 @+s(!.!ce +n d!a$nos(!c de .o'!e s&ec!.!c7. Preva"en(a
    ra&or(a(7 &oa(e var!a :n .+nc=!e de &ra$+" +(!"!/a( &en(r+ de(er%!narea de(er!or7r!!
    sa+ de(rese! s! n+%7r+" de (!&+r! de .o'!e e<a%!na(e. Pe esan(!oane"e co%+n!(are,
    ra(e"e de &reva"en(7 c+ren(7 %er$ de "a Id "a G,Gd, !ar ra(e"e de &reva"en(7 &e v!a=7
    %er$ de "a H,9d "a 55,;d. Ra(e"e de &reva"en(7 scad "a ce! %a! :n e(a(e. De ase%enea,
    es(!%7r!"e &reva"en(e! var!a/7 &en(r+ d!.er!(e (!&+r! de .o'!! s&ec!.!ce.
    *voluie
    Pr!%e"e s!%&(o%e a"e .o'!e! s&ec!.!ce a&ar :n co&!"7 r!e sa+ "a :nce&+(+"
    ado"escen=e! s! s+rv!n "a o e(a(e %a! %!c7 "a .e%e! decA( "a '7r'a=!. De ase%enea,
    e(a(ea %ed!e "a de'+( var!a/7 :n .+nc=!e de (!&+" de .o'!e s&ec!.!c7. E(a(ea "a de'+(
    &en(r+ .o'!a s&ec!.!c7 de (!& s!(+a=!ona" (!nde a .! d!s(r!'+!(7 '!%oda", c+ +n &!c :n
    co&!"7r!e s! c+ +n a" do!"ea &!c "a %!@"oc+" an!"or 9L. Fo'!!"e s&ec!.!ce de %ed!+
    na(+ra" Ede e<., .o'!a de :n7"=!%!J (!nd a :nce&e :n s&ec!a" :n co&!"7r!e, deO! %+"(e
    ca/+r! no! de .o'!e de :n7"=!%e a&ar &recoce :n v!a=a ad+"(7. E(a(ea "a de'+( &en(r+
    .o'!!"e s&ec!.!ce de an!%a"e s! &en(r+ .o'!!"e s&ec!.!ce de sAn$e4!n@ec=!!4&"7$! se
    s!(+ea/7, de ase%enea, :n co&!"7r!e. Fr!ca de +n s(!%+" es(e &re/en(7 de re$+"7 c+
    cA(va (!%& :na!n(e de a deven! s+.!c!en( de de(resan(7 s! de(er!oran(7 s&re a .!
    cons!dera(7 .o'!e s&ec!.!ca .
    Fac(or!! &red!s&o/an=! "a de'+(+" .o'!!"or s&ec!.!ce !nc"+d even!%en(e
    (ra+%a(!ce Eca de e<., a .! a(aca( de +n an!%a" sa+ :nc!s :n(r4+n d+"a&J, a(ac+r!"e
    de &an!c7 !no&!na(e :n s!(+a=!! de (e%+(, o'servarea +nora care s+.er7 +n
    (ra+%a(!s% sa+ care ara(7 c7 "e es(e .r!c7 Ec+% ar .! vederea +nora care cad de "a
    :n7"=!%e sa+ c7rora "e es(e .r!c7 :n &re/en=a +nor an!%a"eJ O! !n.or%a=!!"e (rans%!se
    Ede e<., aver(!s%en(e"e &7r!n(eO(! re&e(a(e :n "e$7(+r7 c+ &er!c+"o/!(a(ea an+%!(or
    an!%a"e sa+ re"a(7r!"e d!n %ass %ed!a des&re c7der!"e de av!oaneJ. O'!ec(e"e sa+
    s!(+a=!!"e (e%+(e (!nd a !%&"!ca "+cr+r! care rea"%en(e &o( re&re/en(a o a%en!n=are
    sa+ a+ re&re/en(a( o a%en!n=are "a +n %o%en( da( :n c+rs+" evo"+=!e! +%ane.
    Fo'!!"e care re/+"(7 d!n even!%en(e (ra+%a(!ce sa+ a(ac+r! de &an!c7 !no&!na(e
    (!nd a .! e<(re% de ac+(e :n de/vo"(area "or. Fo'!!"e de or!$!ne (ra+%a(!c7 n+ a+ o
    e(a(e carac(er!s(!c7 de de'+( Ede e<., (ea%a de s+.ocare care +r%ea/7 de re$+"7
    +n+! !nc!den( de s+.ocare sa+ a&roa&e de s+.ocare, &oa(e a&are a&roa&e "a or!ce
    e(a(eJ. Fo'!!"e s&ec!.!ce d!n ado"escen=7 cresc Oanse"e, .!e de &ers!s(en=7 a .o'!e!
    s&ec!.!ce, .!e de a&ar!=!e a +nor .o'!! s+&"!%en(are :n v!a(a ad+"(7, dar n+
    &red!c(ea/7 a&ar!=!a a"(or (+"'+r7r!. Fo'!!"e care &ers!s(7 :n v!a=a ad+"(7 se re%!(
    n+%a! rar E:n a&ro<!%a(!v 9Ld d!n ca/+r!J.
    #attern $amilial
    E<!s(7 +n r!sc cresc+( &en(r+ .o'!!"e s&ec!.!ce "a %e%'r!! de .a%!"!e a! ce"or c+
    .o'!! s&ec!.!ce. De ase%enea, e<!s(7 +ne"e da(e care s+$erea/7 c7 &oa(e e<!s(a o
    a$re$are :n .a%!"!! d+&7 (!&+" de .o'!e Ede e<e%&"+, r+de"e '!o"o$!ce de $rad+" I a"e
    &ersoane"or c+ .o'!! s&ec!.!ce de an!%a"e es(e &os!'!" s7 a!'7 .o'!! de an!%a"e, deO!
    n+ :n %od necesar de ace"aO! an!%a", !ar r+de"e '!o"o$!ce de $rad+" I a"e
    &ersoane"or c+ .o'!! s&ec!.!ce de (!& s!(+a=!ona" es(e &os!'!" s7 a!'7 .o'!! de s!(+a=!!J.
    Fr!c!"e de sAn$e s! de &"7$! a+ &a((ern+r! .a%!"!a"e e<(re% de &+(ern!ce.
    HH8 Tulburrile Anxioase
    Dia!nostic di$erenial
    Fo'!!"e s&ec!.!ce d!.er7 de ce"e"a"(e (+"'+r7r! an<!oase &r!n n!ve"e"e de an<!e(a(e
    !n(erc+ren(7. De re$+"7, !nd!v!/!! c+ .o'!e s&ec!.!c7, con(rar ce"or c+ &an!c7 c+
    a$ora.o'!e, n+ se &re/!n(7 c+ an<!e(a(e &ervas!v7, deoarece .r!ca "or es(e "!%!(a(7 "a
    o'!ec(e sa+ s!(+a=!! s&ec!.!ce, c!rc+%scr!se. Poa(e a&are :ns7 o an(!c!&are an<!oas7
    $enera"!/a(7 :n cond!=!!"e :n care :n(A"n!r!"e c+ s(!%+"+" .o'!e dev!n .oar(e &ro'a'!"e
    Ede e<., cAnd o &ersoan7 care se (e%e de Oer&!, se de&"asea/7 &r!n(r4o /on7 de
    deser(J sa+ cAnd even!%en(e de v!a=7 .or=ea/7 "a o con.r+n(are !%ed!a(7 c+ s(!%+"+"
    .o'!e Ede e<., cAnd o &ersoan7 care se (e%e s7 c7"7(oreasc7 c+ av!on+" es(e .or=a(7 de
    c!rc+%s(an=e s7 o .ac7J.
    D!.eren=!erea .o'!e! s&ec!.!ce de (!& s!(+a=!ona" de &an!ca c+ a$ora.o'!e &oa(e .!
    e<(re% de d!.!c!"7, deoarece a%'e"e (+"'+r7r! &o( !nc"+de a(ac+r! de &an!c7 s!
    ev!(area (!&+r!"or de s!(+a=!! s!%!"are Ede e<., cond+s+", /'or+", (rans&or(+" &+'"!c s!
    "oc+r!"e :nc!seJ. De re$+"7, &an!ca c+ a$ora.o'!e se carac(er!/ea/7 !n!=!a" &r!n
    de'+(+" a(ac+r!"or de &an!c7 !no&!na(e O! +"(er!or &r!n ev!(area a n+%eroase s!(+a=!!
    cons!dera(e a .! dec"anOa(or! &os!'!"! a! a(ac+r!"or de &an!c7. T!&!c, .o'!a s&ec!.!c7 de
    (!& s!(+a=!ona" se carac(er!/ea/7 &r!n ev!(are s!r+a=!ona"7, :n a'sen=a a(ac+r!"or de
    &an!c7 !no&!na(e rec+ren(e. Une"e (a'"o+r! c"!n!ce cad :n(re aces(e (!&+r! s! es(e
    necesar7 @+deca(a c"!n!c7 &en(r+ a se"ec(a d!a$nos(!c+" ce" %a! adecva(. Pa(r+ .ac(or!
    &o( .! +(!"! :n e.ec(+area aces(e! @+dec7=!, O! an+%eQ .ocar+" .r!c!!, (!&+" O! n+%7r+"
    a(ac+r!"or de &an!c7, n+%7r+" s!(+a=!!"or ev!(a(e O! n!ve"+" de an<!e(a(e !n(erc+ren(7.
    De e<e%&"+, +n !nd!v!d, c7r+!a %a! :na!n(e n+ !4a .os( .r!c7 sa+ n+ a ev!(a(
    ascensoare"e, are +n a(ac de &an!c7 :n(r4+n ascensor s! :nce&e s7 se (ea%7 s7 %a!
    %ear$7 "a serv!c!+ d!n ca+/a neces!(7=!! de a "+a ascensor+" &An7 "a '!ro+" s7+ de "a
    e(a@+" 9I. Dac7 aces( !nd!v!d are :n con(!n+are a(ac+r! de &an!c7 n+%a! :n
    ascensoare Ec!ar dac7 .r!ca es(e cen(ra(7 &e a(ac+" de &an!c7J, a(+nc! &oa(e .!
    adecva( +n d!a$nos(!c de .o'!e s&ec!.!c7. Dac7 :ns7, !nd!v!d+" e<&er!en(ea/7 a(ac+r!
    de &an!c7 !no&!na(e :n a"(e s!(+a=!! s! :nce&e s7 ev!(e sa+ s7 :nd+re c+ (ea%7 a"(e
    s!(+a=!! d!n ca+/a .r!c!! de +n a(ac de &an!c7, a(+nc! es(e @+s(!.!ca( d!a$nos(!c+" de
    &an!c7 c+ a$ora.o'!e, :n a.ar7 de aceas(a, &re/en=a +ne! a&reens!+n! &ervas!ve :n
    "e$7(+r7 c+ .a&(+" de a avea +n a(ac de &an!c7, c!ar cAnd n+ an(!c!&ea/7 e<&+nerea
    "a o s!(+a=!e .o'!c7, s+s=!ne, de ase%enea, +n d!a$nos(!c de &an!c7 c+ a$ora.o'!e.
    Dac7 !nd!v!d+" are a(ac+r! de &an!c7 !no&!na(e +"(er!oare :n a"(e s!(+a=!!, dar n+
    de/vo"(7 :n &"+s ev!(are sa+ :nd+rare c+ (ea%7, a(+nc! d!a$nos(!c+" adecva( (re'+!e
    s7 )ie ce" de &an!c7 .7r7 a$ora.o'!e.
    Uneor! s+n( @+s(!.!ca(e d!a$nos(!ce conco%!(en(e de .o'!e s&ec!.!c7 O! de &an!c7
    c+ a$ora.o'!e, :n aces(e ca/+r!, "+area :n cons!dera=!e a .ocar+"+! &reoc+&7r!!
    !nd!v!d+"+! :n "e$7(+r7 c+ s!(+a=!a .o'!c7 &oa(e .! +(!"7. De e<e%&"+, ev!(area
    .a&(+"+! de a r7%Ane s!n$+r d!n ca+/a (e%er!! de a n+ avea a(ac+r! de &an!c7
    !no&!na(e @+s(!.!c7 d!a$nos(!c+" de &an!c7 c+ a$ora.o'!e Edac7 s! a"(e cr!(er!! s+n(
    sa(!s.7c+(eJ, &e cAnd ev!(area .o'!c7 +"(er!oar7 a +ne! c7"7(or!! c+ av!on+", dac7 es(e
    da(ora(7 (e%er!"or :n "e$7(+r7 c+ cond!=!!"e a(%os.er!ce re"e O! c7derea av!on+"+!,
    &oa(e @+s(!.!ca +n d!a$nos(!c ad!=!ona" de .o'!e s&ec!.!c7.
    Fo'!a s&ec!.!c7 O! .o'!a soc!a"7 &o( .! d!.eren=!a(e &e 'a/a .oca"!/7r!! .r!c!"or. De
    e<e%&"+, ev!(area .a&(+"+! de a %Anca :n(r4+n res(a+ran( &oa(e avea "a 'a/7
    (e%er!"e :n "e$7(+r7 c+ a&rec!er!"e ne$a(!ve d!n &ar(ea a"(ora Ead!c7, .o'!e soc!a"7J,
    sa+ (e%er!"e :n "e$7(+r7 c+ s+.ocarea Ead!c7, .o'!e s&ec!.!c7J. Con(rar ev!(7r!! d!n
    .o'!a s&ec!.!c7, ev!(area d!n s(res+" &os((ra+%a(!c +r%ea/7 +n+! s(resor care
    a%en!n=7 v!a=a s! es(e aco%&an!a(7 de e"e%en(e :n &"+s Ede e<., ree<&er!en(area
    455276 'obia Speci$ic &anterior, 'obia
    Simpl)
    IIF

    (ra+%e! O! a.ec(+" coarc(a(J. :n (+"'+rarea o'ses!vo4co%&+"s!v7, ev!(area es(e
    asoc!a(7 c+ con=!n+(+" o'ses!e! Ede e<., %+rd7r!e, con(a%!nareJ. La !nd!v!/!! c+
    an<!e(a(e de se&arare, n+ se &+ne d!a$nos(!c+" de .o'!e s&ec!.!c7, dac7
    co%&or(a%en(+" de ev!(are se "!%!(ea/7 e<c"+s!v "a .r!c!"e de se&ararea de
    &ersoane"e de care es(e a(aOa( !nd!v!d+", :n a.ar7 de aceas(a, co&!!! c+ an<!e(a(e de
    se&arare a+ adesea asoc!a(e .r!c! e<a$era(e de oa%en! sa+ de even!%en(e Ede e<., de
    o=!, de s&7r$7(or!, de r7&!(or!! de co&!!, de acc!den(e de a+(o%o'!", de c7"7(or!e c+
    av!on+"J care &o( a%en!n=a !n(e$r!(a(ea .a%!"!e!. Un d!a$nos(!c se&ara( de .o'!e
    s&ec!.!c7 es(e rar @+s(!.!ca(.
    D!.eren=!erea d!n(re !&ocondr!e O! o .o'!e s&ec!.!c7 de a"( (!& Ead!c7, ev!(area
    s!(+a=!!"or care &o( d+ce "a con(rac(area +ne! %a"ad!!J, de&!nde de &re/en=a sa+
    a'sen=a conv!n$er!! :n e<!s(en=a %a"ad!e!. Ind!v!/!! c+ !&ocondr!e s+n( &reoc+&a=!
    de .r!ca de a avea o %a"ad!e, &e cAnd !nd!v!/!! c+ .o'!e s&ec!.!c7 se (e% s7 n+
    con(rac(e/e o %a"ad!e Edar n+ cred c7 aceas(a es(e de@a &re/en(7J. La !nd!v!/!! c+
    anore<!e nervoas7 O! '+"!%!e nervoas7, d!a$nos(!c+" de .o'!e s&ec!.!c7 n+ es(e &+s,
    dac7 co%&or(a%en(+" de ev!(are es(e "!%!(a( e<c"+s!v "a ev!(area a"!%en(e"or O! a
    se%na"e"or :n "e$7(+r7 c+ a"!%en(e"e. Un !nd!v!d c+ sc!/o.ren!e or! c+ a"(7
    (+"'+rare &s!o(!c7 &oa(e ev!(a an+%!(e ac(!v!(7=! ca r7s&+ns "a !de! de"!ran(e, dar
    n+ rec+noaO(e c7 .r!ca sa es(e e<ces!v7 sa+ ne@+s(!.!ca(7.
    Fr!c!"e s+n( .oar(e .recven(e, :n s&ec!a" :n co&!"7r!e, dar e"e n+ @+s(!.!c7
    d!a$nos(!c+" de .o'!e s&ec!.!c7 decA( dac7 e<!s(7 o !n(er.eren=7 se%n!.!ca(!v7 c+
    .+nc=!onarea soc!a"7, ed+ca=!ona"7 sa+ &ro.es!ona"7 or! o de(res7 %arca(7 :n
    "e$7(+r7 c+ .a&(+" de a avea .o'!e.
    Criteriile $e $ia/no&ti# pentru 4++.C5 'o-ia Spe#i%i#(
    A2 'ric marcat si persistent, excesiv sau ne0usti$icat, provocat de
    pre(ena sau anticiparea unui obiect sau situaii speci$ice &de ex2, (bor,
    "nlimi, animale, administrarea unei in0ecii, vederea s@n!elui)2
    S2 *xpunerea la stimulul $obie provoac aproape "n mod constant un rspuns
    anxios imediat care poate lua $orma unui atac de panic circumscris
    situaional sau predispus situaional2 FotD La copii, anxietatea poate $i
    exprimat prin exclamaii, accese coleroase, stupe$acie sau a!are de ceva2
    2 #ersoana recunoa,te c $rica sa este excesiv sau ne0usti$icat2 FotD La copii
    acest element poate $i absent2
    D2 Situaia &situaiile) $obic este evitat sau "ndurat cu anxietate sau detres
    intens2
    *2 *vitarea, anticiparea anxioas ori detres "n situaia &situaiile) temut&e)
    inter$erea( semni$icativ cu rutina normal a persoanei, cu activitatea
    pro$esional &sau ,colar) ori cu activitile sau relaiile sociale, ori exist o
    detres marcat "n le!tur cu $aptul de a avea $obia2
    '2 La indivi(ii sub E8 ani, durata este de cel puin I luni2
    HA5 Tulburrile Anxioase
    Criteriile $e $ia/no&ti# pentru 4++.C5 'o-ia Spe#i%i#(
    (continuare)
    G, Anxietatea, atacurile de panic sau evitarea $obic asociat cu obiectul sau
    situaia speci$ic nu sunt explicate mai bine de alt tulburare mental, cum
    ar $i tulburarea obsesivo-compulsiv &de ex2, $rica de murdrie, la cineva cu
    obsesie re$eritoare la contaminare), stresul posttraumatic &de ex2, evitarea
    stimulilor asociai cu un stresor sever), anxietatea de separare &de ex2,
    evitarea scolii), $obia social &de ex2, evitarea situaiilor sociale din cau(a
    $ricii de a nu $i pus "n di$icultate), panica cu a!ora$obie sau a!ora$obia $r
    istoric de panic2
    De speci"icat tipulD de
    animale,
    de mediu natural &de ex2, "nlimi, $urtuni, ap), de
    s@n!e-in0ecii-pl!i,
    de tip situaional &de ex2, de avioane, ascensoare, spaii "nc%ise), de alt tip
    &de ex2, evitarea $obic a situaiilor care pot duce la su$ocare, vom sau
    contractarea unei maladii3 la copii, evitarea sunetelor puternice sau a
    persoanelor "n uni$orm 2
    4++.C4 'o-ia So#ial( 3An,ietatea So#ial(6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" .o'!e! soc!a"e :" cons(!(+!e .r!ca &ers!s(en(7 s! %arca(7 de
    s!(+a=!!"e soc!a"e sa+ de &er.or%an=7 :n care &oa(e s+rven! o &+nere :n d!.!c+"(a(e
    Ecr!(er!+" AJ. E<&+nerea "a s!(+a=!a soc!a"7 sa+ de &er.or%an=7 &rovoac7 a&roa&e :n
    %od cons(an( +n r7s&+ns an<!os !%ed!a( Ecr!(er!+" BJ. Aces( r7s&+ns &oa(e "+a
    .or%a +n+! a(ac de &an!c7 c!rc+%scr!s s!(+a=!ona" sa+ &red!s&+s s!(+a=!ona" Eve/!
    &a$. I;LJ. Dac7 ado"escen=!! s! ad+"=!! c+ aceas(7 (+"'+rare rec+nosc c7 .r!ca "or es(e
    e<ces!v7 sa+ ne@+s(!.!ca(7 Ecr!(er!+" CJ, aces(a &oa(e s7 n+ .!e ca/+" "a co&!!. Ce" %a!
    adesea, s!(+a=!a soc!a"7 sa+ de &er.or%an=7 es(e ev!(a(7, dar +neor! es(e :nd+ra(7 c+
    (ea%7 Ecr!(er!+" DJ. D!a$nos(!c+" es(e adecva(, n+%a! dac7 ev!(area, .r!ca or!
    an(!c!&area an<!oas7 a :n(A"n!r!! s!(+a=!e! soc!a"e sa+ de &er.or%an=7 !n(er.erea/7
    se%n!.!ca(!v c+ r+(!na co(!d!an7 a &ersoane!, c+ .+nc=!onarea &ro.es!ona"7 sa+ v!a=a
    soc!a"7, or! dac7 &ersoana es(e %arca( de(resa(7 de .a&(+" c7 are .o'!a Ecr!(er!+" EJ.
    La !nd!v!/!! s+' 5G an!, s!%&(o%e"e (re'+!e s7 .! &ers!s(a( (!%& de ce" &+=!n R "+n!
    :na!n(e ca .o'!a soc!a"7 s7 .!e d!a$nos(!ca(7 Ecr!(er!+" FJ. Fr!ca sa+ ev!(area n+ se
    da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ +ne! cond!=!! %ed!ca"e
    $enera"e s! n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7 Ede e<., &an!c7,
    an<!e(a(e de se&arare, (+"'+rarea d!s%or.!c7 cor&ora"7, o (+"'+rare de de/vo"(are
    &ervas!v7 sa+ (+"'+rarea de &ersona"!(a(e sc!/o!d7J Ecr!(er!+" ,J. Dac7 es(e
    &re/en(7 a"(7 (+"'+rare %en(a"7 sa+ cond!=!e %ed!ca"7 $enera"7 Ede e<., 'a"'!s%+",
    %a"ad!a Par)!nson, anore<!a nervoas7J, .r!ca sa+ ev!(area n+ es(e "!%!(a(7 "a
    &reoc+&area re.er!(oare "a !%&ac(+" s7+ soc!a" Ecr!(er!+" HJ.
    :n s!(+a=!!"e soc!a"e sa+ de &er.or%an=7 (e%+(e, !nd!v!/!! c+ .o'!e soc!a"7
    e<&er!en(ea/7 &reoc+&7r! re.er!(oare "a !nco%odare s! se (e% c7 a"=!! :! vor
    455274 'obia Social &Anxietatea
    Social)
    F51
    cons!dera an<!oO!, de'!"!, Sne'+n!T sa+ s(+&!/!. E! se (e% s7 vor'easc7 :n &+'"!c d!n
    ca+/a &reoc+&7r!! c7 a"=!! vor re%arca (re%or+" voc!! sa+ %A!n!"or "or or! &o(
    e<&er!en=a o an<!e(a(e e<(re%7 cAnd conversea/7 c+ a"=!!, d!n ca+/a .r!c!! c7 vor
    &7rea !ncoeren=!. De ase%enea, e! &o( ev!(a s7 %7nAnce, s7 'ea or! s7 scr!e :n &+'"!c
    d!n ca+/a .r!c!! de a n+ .! &+O! :n d!.!c+"(a(e de .a&(+" c7 a"=!! v7d c7 "or "e (re%+r7
    %A!n!"e. Ind!v!/!! c+ .o'!e soc!a"7 e<&er!en(ea/7 a&roa&e (o(dea+na s!%&(o%e de
    an<!e(a(e Ede e<., &a"&!(a=!!, (re%+r7(+r!, (rans&!ra=!e, d!scon.or( $as(ro!n(es(!na",
    d!aree, (ens!+ne %+sc+"ar7, con$es(!e .ac!a"7, con.+/!eJ :n s!(+a=!!"e soc!a"e (e%+(e,
    !ar :n ca/+r!"e severe aces(e s!%&(o%e &o( sa(!s.ace cr!(er!!"e &en(r+ +n a(ac de
    &an!c7 Eve/! &a$. I;9J. Con$es(!a .e=!! &oa(e .! %a! (!&!c7 &en(r+ .o'!a soc!a"7.
    Ad+"=!! c+ .o'!e soc!a"7 rec+nosc c7 .r!ca es(e e<ces!v7 sa+ ne@+s(!.!ca(7, :ns7 n+
    (o(dea+na aces(a es(e ca/+" "a co&!!. De e<e%&"+, d!a$nos(!c+" va .! ce" de (+"'+rare
    de"!ran(7 :n "oc de .o'!e soc!a"7, "a +n !nd!v!d care ev!(7 s7 %7nAnce :n &+'"!c d!n
    ca+/a conv!n$er!! c7 va .! v7/+( de &o"!=!e, s! care n+ rec+noaO(e c7 aceas(7 .r!c7 es(e
    e<ces!v7 O! ne@+s(!.!ca(7. De ase%enea, d!a$nos(!c+" n+ va .! &+s dac7 .r!ca es(e
    @+s(!.!ca(7, da( .!!nd con(e<(+" de s(!%+"! Ede e<., .r!ca de a n+ .! s(r!$a( "a "ec=!e cAnd
    n+ es(e &re$7(!(J.
    Persoana c+ .o'!e soc!a"7 va ev!(a, de re$+"7, s!(+a=!!"e (e%+(e. Ma! rar, &ersoana
    res&ec(!v7 se va .or=a s7 :nd+re s!(+a=!a 2soc!a"7 sa+ de &er.or%an=7 s! o va
    e<&er!en=a c+ o an<!e(a(e !n(ens7. De ase%enea, o an<!e(a(e an(!c!&a(or!e %arca(7
    &oa(e s+rven! c+ %+"( :na!n(e de a&ar!=!a s!(+a=!!"or soc!a"e sa+ &+'"!ce Ede e<.,
    (ea%7 :n .!ecare /!, (!%& de cA(eva s7&(7%An!, :na!n(e de a +r%a +n even!%en(
    soc!a"J. Poa(e e<!s(a +n cerc v!c!os de an<!e(a(e an(!c!&a(or!e care d+ce "a o co$n!=!e
    a&reens!v7 s! "a s!%&(o%e an<!oase :n s!(+a=!!"e (e%+(e care "a rAnd+" "or d+c "a o
    .+nc=!onare rea"%en(e red+s7 sa+ &erce&+(7 ca red+s7 :n s!(+a=!!"e (e%+(e, ceea ce
    d+ce "a !nco%odare s! "a creO(erea an<!e(7=!! an(!c!&a(or!! re.er!(oare "a s!(+a=!!"e
    (e%+(e, s! aOa %a! de&ar(e.
    Fr!ca sa+ ev!(area (re'+!e s7 !n(er.ere/e se%n!.!ca(!v c+ r+(!na nor%a"7 a
    &ersoane!, c+ .+nc=!onarea &ro.es!ona"7 sa+ Oco"ar7, sa+ c+ ac(!v!(7=!"e or! re"a=!!"e
    soc!a"e, sa+ &ersoana (re'+!e s7 e<&er!en(e/e o de(res7 %arca(7 :n "e$7(+r7 c+ a avea
    .o'!a. De e<e%&"+, +ne! &ersoane care se (e%e s7 vor'easc7 :n &+'"!c, n+ ! se va
    &+ne d!a$nos(!c+" de .o'!e soc!a"7 dac7 aceas(7 ac(!v!(a(e n+ es(e :n(A"n!(7 :n %od
    r+(!n!er "a serv!c!+ sa+ :n c"as7, !ar &ersoana n+ es(e !nco%oda(7 :n %od s&ec!a" de
    aceas(a. Fr!c!"e de a n+ .! &+s :n d!.!c+"(a(e :n s!(+a=!! soc!a"e s+n( .recven(e, dar de
    re$+"7 $rad+" de de(res7 sa+ de de(er!orare es(e !ns+.!c!en( &en(r+ a @+s(!.!ca +n
    d!a$nos(!c de .o'!e soc!a"7. An<!e(a(ea sa+ ev!(area soc!a"7 (ran/!(or!e es(e e<(re%
    de .recven(7 :n co&!"7r!e s! ado"escen=7 Ede e<., o ado"escen(7 &oa(e ev!(a s7
    %7nAnce de .a=7 c+ '7!e=!! o sc+r(7 &er!oad7 de (!%&, a&o! :O! re!a co%&or(a%en(+"
    +/+a"J. La ce! s+' 5G an!, n+%a! s!%&(o%e"e care &ers!s(7 (!%& de ce" &+=!n R "+n!
    ca"!.!c7 &en(r+ d!a$nos(!c+" de .o'!e soc!a"7.
    Speci$icant
    ,enera"!/a(7. Aces( s&ec!.!can( &oa(e .! +(!"!/a( cAnd .r!c!"e s+n( :n "e$7(+r7
    c+ ce"e %a! %+"(e s!(+a=!! Ede e<., !n!=!erea sa+ :n(re=!nerea conversa=!!"or,
    &ar(!c!&area "a %!c! $r+&+r!, :n(A"n!r!, a vor'! re&re/en(an=!"or a+(or!(7=!!, a se
    :n(re=!ne "a &e(recer!J. Ind!v!/!! c+ .o'!e soc!a"7, $enera"!/a(7 se (e%, a(A( de
    s!(+a=!!"e &+'"!ce de &er.or%an(7 , cA( s! de s!(+a=!!"e soc!a"e !n(erac=!ona"e.
    Deoarece !nd!v!/!! c+ .o'!e soc!a"7 n+ re"a(ea/7 s&on(an :n(rea$a "or $a%7 de
    .r!c! soc!a"e, es(e +(!" &en(r+ c"!n!c!an s7 (reac7 :n rev!s(7 c+ !nd!v!d+" o "!s(7
    F52 Tulburrile Anxioase
    a s!(+a=!!"or soc!a"e s! de &er.or%an=7 . Ind!v!/!! a"e c7ror %an!.es(7r! c"!n!ce
    n+ sa(!s.ac de.!n!=!a de S$enera"!/a(7T co%&+n +n $r+& care !nc"+de
    &ersoane"e care se (e% de o s!n$+r7 s!(+a=!e de &er.or%an=7 , ca s! &e ce! care
    se (e% de %a! %+"(e, dar n+ de %a@or!(a(ea s!(+a=!!"or soc!a"e. Ind!v!/!! c+
    .o'!e soc!a"7 $enera"!/a(7 es(e .oar(e &os!'!" s7 &re/!n(e de.!c!(e :n
    a&(!(+d!n!"e soc!a"e s! s7 a!'7 o de(er!orare soc!a"7 s! &ro.es!ona"7 sever7.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. E"e%en(e"e asoc!a(e
    co%+ne a"e .o'!e! soc!a"e !nc"+d !&ersens!'!"!(a(ea "a cr!(!c7, eva"+area ne$a(!v7
    sa+ re@ec=!a, d!.!c+"(a(ea :n a se a.!r%a, s(!%7 de s!ne sc7/+(7 sa+ sen(!%en(e de
    !n.er!or!(a(e. Ind!v!/!! c+ .o'!e soc!a"7 se (e% adesea de eva"+area !nd!rec(7 de c7(re
    a"=!!, c+% ar .! "+area +n+! (es(. E! &o( %an!.es(a a&(!(+d!n! soc!a"e red+se Ede e<.,
    con(ac( v!/+a" red+sJ sa+ se%ne o'serva'!"e de an<!e(a(e Ede e<., %A!n! rec! s!
    +%ede, (re%+r7(+r!, voce (re%+ra(7J. Ind!v!/!! c+ .o'!e soc!a"7 o'=!n re/+"(a(e
    Oco"are s+' &os!'!"!(7=!"e "or, d!n ca+/a an<!e(7=!! sa+ ev!(7r!! &ar(!c!&7r!! :n c"as7. De
    ase%enea, e! o'=!n re/+"(a(e s+' &os!'!"!(7=!"e "or "a serv!c!+, d!n ca+/a an<!e(7=!! :n
    (!%& ce vor'esc :n $r+&, :n &+'"!c or! re&re/en(an=!"or a+(or!(7=!! sa+ co"e$!"or, or!
    d!n ca+/a ev!(7r!! aces(or s!(+a=!!. Persoane"e c+ .o'!e soc!a"7 a+ adesea re=e"e de
    s+&or( soc!a" red+se, s! es(e &+=!n &ro'a'!" c7 se vor c7s7(or!, :n ca/+r!"e %a! severe,
    !nd!v!/!! &o( a'andona scoa"7, &o( .! Oo%er! s! n+ ca+(7 de "+cr+ d!n ca+/a
    d!.!c+"(7=!! de a da +n !n(erv!+ &en(r+ serv!c!+, n+ a+ a%!c! sa+ =!n de re"a=!!
    !nsa(!s.7c7(oare, se a'=!n co%&"e( de "a :n(A"n!r! sa+ r7%An c+ .a%!"!a "or de or!$!ne,
    :n &"+s, .o'!a soc!a"7 &oa(e .! asoc!a(7 c+ !dea=!e s+!c!dar7 , :n s&ec!a" cAnd s+n(
    &re/en(e (+"'+r7r! co%or'!de.
    Fo'!a soc!a"7 &oa(e .! asoc!a(7 c+ (+"'+r7r! an<!oase, (+"'+r7r! a.ec(!ve, (+"'+r7r!
    :n "e$7(+r7 c+ o s+'s(an=7 s! '+"!%!a nervoas7 s! &e care de re$+"7 "e &recede, :n
    esan(!oane"e c"!n!ce, (+"'+rarea de &ersona"!(a(e ev!(an(7 es(e &re/en(7 .recven( "a
    !nd!v!/!! c+ .o'!e soc!a"7 $enera"!/a(7.
    Da(e de "a'ora(or asoc!a(e. N+ a .os( re&era( n!c! +n (es( de "a'ora(or care s7
    .!e d!a$nos(!c &en(r+ .o'!a soc!a"7, s! n+ e<!s(7 n!c! s+.!c!en(e &ro'e care s7 s+s=!n7
    +/+" vre+n+! (es( de "a'ora(or Ede e<., !n.+/!a de "ac(a(, !na"area de CO9J s&re a
    d!s(!n$e .o'!a soc!a"7 de a"(e (+"'+r7r! an<!oase Ede e<., &an!caJ.
    *lemente speci$ice culturii, etii si sexului
    Ta'"o+" c"!n!c s! de(er!orarea re/+"(an(7 d!.er7 de "a o c+"(+r7 "a a"(a, :n .+nc=!e
    de e<!$en=e"e soc!a"e, :n an+%!(e c+"(+r! Ede e<., :n *a&on!a s! CoreeaJ, !nd!v!/!! c+
    .o'!e soc!a"7 &o( de/vo"(a .r!c! &ers!s(en(e s! e<ces!ve de a n+ o.ensa &e a"=!! :n
    s!(+a=!! soc!a"e, :n "oc sa .!e !nco%oda=!. Aces(e .r!c! &o( "+a .or%a an<!e(7=!! e<(re%e,
    c+% c7 con$es(!a .e=e!, con(ac(+" .a=7 :n .a=7 or! %!ros+" &ro&r!+"+! cor& ar .!
    re&+$nan(e &en(r+ ce!"a"=! (taiIin 8io)+s-o :n *a&on!aJ.
    La co&!!, &o( .! &re/en(e voc!.er7r!, accese co"eroase, s(+&e.ac=!e, s(a(+" "!&!( sa+
    s(rAns de o &ersoan7 .a%!"!ar7 s! !n!'area !n(erac=!+n!"or &An7 "a %+(!s%. Co&!!!
    %a! %!c! &o( .! e<ces!v de (!%!/! :n s!(+a=!! soc!a"e ne.a%!"!are, se re=!n s7 !n(re :n
    con(ac( c+ a"=!!, re.+/7 s7 &ar(!c!&e "a @oc+" :n $r+&, s(a+ de re$+"7 "a &er!.er!a
    ac(!v!(7=!"or soc!a"e s! :ncearc7 s7 r7%An7 :n a&ro&!erea ad+"=!"or .a%!"!ar!. Con(rar
    ad+"=!"or, co&!!! c+ .o'!e soc!a"7 n+ a+ de re$+"7 o&=!+nea ev!(7r!! (o(a"e a s!(+a=!!"or
    455274 'obia Social &Anxietatea Social) HA4
    (e%+(e s! &o( .! !nca&a'!"! s7 !den(!.!ce na(+ra an<!e(7=!! "or. Poa(e e<!s(a +n dec"!n
    :n ac(!v!(a(ea :n c"as7, re.+/+" de a %a! %er$e "a scoa"7 or! ev!(area ac(!v!(7=!"or
    soc!a"e s! a :n(A"n!r!"or cores&+n/7(oare e(7=!!. Pen(r+ a &+ne d!a$nos(!c+" "a co&!!,
    (re'+!e s7 e<!s(e &ro'a ca&ac!(7=!! de re"a=!! soc!a"e c+ &ersoane .a%!"!are, !ar
    an<!e(a(ea soc!a"7 (re'+!e s7 s+rv!n7 :n s!(+a=!!"e c+ e$a"!!, n+ doar :n !n(erac=!+n!"e
    c+ ad+"=!!. D!n ca+/a de'+(+"+! &recoce O! a evo"+=!e! cron!ce a (+"'+r7r!!, "a co&!!,
    de(er!orarea (!nde s7 !a %a! c+rAnd .or%a !nca&ac!(7=!! de a a(!n$e n!ve"+" de
    .+nc=!onare aO(e&(a(, decA( &e cea a dec"!n+"+! de "a +n n!ve" o&(!% de .+nc=!onare.
    D!n con(ra, cAnd de'+(+" are "oc :n ado"escen=7, (+"'+rarea &oa(e d+ce "a sc7dere :n
    .+nc=!onarea soc!a"7 sa+ Oco"ar7.
    S(+d!!"e e&!de%!o"o$!ce O! &e 'a/a co%+n!(ar7 s+$erea/7 c7 .o'!a soc!a"7 es(e
    %a! .recven(7 "a .e%e! decA( "a '7r'a=!, :n ce"e %a! %+"(e eOan(!oane c"!n!ce, se<e"e
    s+n( .!e e$a" re&re/en(a(e, .!e %a@or!(a(ea s+n( '7r'a=!.
    #revalent
    S(+d!!"e e&!de%!o"o$!ce O! &e 'a/7 co%+n!(ar7 a+ ra&or(a( o &reva"en(7 &e v!a(7
    a .o'!e! soc!a"e %er$And de "a ;d "a 5;d. Preva"en(a ra&or(a(7 &oa(e var!a :n .+nc=!e
    de &ra$+" +(!"!/a( &en(r+ a de(er%!na de(resa sa+ de(er!orarea s! n+%7r+" de (!&+r!
    de s!(+a=!! soc!a"e (rec+(e :n %od s&ec!.!c :n rev!s(7, :n(r4+n s(+d!+, 9Ld a+ re"a(a( o
    .r!c7 e<ces!v7 de vor'!(+" sa+ .+nc=!onarea :n &+'"!c, dar n+%a! a&ro<!%a(!v 9d &ar
    a e<&er!en=a o de(er!orare sa+ de(resa s+.!c!en(7 &en(r+ a @+s(!.!ca +n d!a$nos(!c de
    .o'!e soc!a"7, :n &o&+"a=!a $enera"7, ce! %a! %+"=! !nd!v!/! c+ .o'!e soc!a"7 se (e% s7
    vor'easc7 :n &+'"!c, :n (!%& ce %a! &+=!n de @+%7(a(e se (e% s7 vor'easc7 c+ s(r7!n!!
    sa+ s7 :n(A"neasc7 "+%e no+7. A"(e .r!c! de &er.or%an=7 Ede e<., %Anca(+", '7+(+"
    sa+ scr!s+" :n &+'"!c or! +(!"!/area +ne! (oa"e(e &+'"!ceJ &ar a .! %a! &+=!n .recven(e,
    :n cond!=!! c"!n!ce, %area %a@or!(a(e a &ersoane"or c+ .o'!e soc!a"7 se (e% de %a!
    %+"( decA( de +n s!n$+r (!& de s!(+a=!e soc!a"7. Fo'!a soc!a"7 es(e rar +n %o(!v de
    !n(ernare :n s&!(a", :n c"!n!c!"e c+ &ac!en=! a%'+"a(or!, &rocen(e"e de .o'!e soc!a"7 s4
    a+ s!(+a( :n(re 5Ld s! 9Ld d!n(re !nd!v!/!! c+ (+"'+r7r! an<!oase, dar &rocen(e"e
    var!a/7 "ar$ :n .+nc=!e de "oc.
    *voluie
    Fo'!a soc!a"7 de'+(ea/7 de re$+"7 :n ado"escen=7, a&7rAnd +neor! .7r7 +n !s(or!c
    de !n!'!=!e soc!a"7 sa+ (!%!d!(a(e :n co&!"7r!e. Un!! !nd!v!/! re"a(ea/7 +n de'+(
    &recoce :n co&!"7r!e. De'+(+" &oa(e s+rven! 'r+sc, d+&7 o e<&er!en=7 s(resan(7 sa+
    +%!"!(oare, or! &oa(e .! !ns!d!os. Evo"+=!a .o'!e! soc!a"e es(e adesea con(!n+7.
    T+"'+rarea d+rea/7 .recven( (oa(7 v!a=a, deO! se &oa(e a(en+a ca !n(ens!(a(e sa+
    re%!(e :n &er!oada ad+"(7. Sever!(a(ea de(er!or7r!! &oa(e ."+c(+a c+ s(resor!! O!
    e<!$en=e"e v!e=!!. De e<e%&"+, .o'!a soc!a"7 &oa(e d!%!n+a d+&7 ce o &ersoan7 c+
    .r!ca de :n(A"n!r! se c7s7(oreO(e, O! rea&are d+&7 %oar(ea so=+"+! Eso=!e!J. O avansare
    &ro.es!ona"7 "a o &o/!=!e care neces!(7 vor'!(+" :n &+'"!c &oa(e d+ce "a a&ar!=!a +ne!
    .o'!! soc!a"e "a c!neva care an(er!or n+ a (re'+!( s7 vor'easc7 n!c!oda(7 :n &+'"!c.
    #attern $amilial
    Fo'!a soc!a"7 &are a s+rven! %a! .recven( &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e
    ce"or c+ (+"'+rarea, :n co%&ara=!e c+ &o&+"a=!a $enera"7. Da(e"e &en(r+ aces(a s+n(
    %a! &+(ern!ce &en(r+ s+'(!&+" $enera"!/a(.
    7<7 Tulburrile Anxioase
    Dia!nostic di$erenial
    Ind!v!/!!, a(A( c+ a(ac+r! de &an!c7, cA( s! c+ ev!(are soc!a"7, re&re/!n(7 +neor! o
    &os!'!"7 &ro'"e%7 d!.!c!"7 de d!a$nos(!c. De re$+"7, &an!ca c+ a$ora.o'!e es(e
    carac(er!/a(7 !n!=!a" &r!n de'+(+" +nor a(ac+r! de &an!c7 s! +"(er!or &r!n ev!(area a o
    %+"=!%e de s!(+a=!! cons!dera(e a .! &os!'!"! dec"anOa(or! a! a(ac+r!"or de &an!c7.
    DeO! s!(+a=!!"e soc!a"e &o( .! ev!(a(e :n &an!ca da(ora(7 .r!c!! de a n+ .! v7/+( avAnd
    +n a(ac de &an!c7, &an!ca es(e carac(er!/a(7 &r!n a(ac+r! de &an!c7 !no&!na(e
    rec+ren(e care n+ s+n( "!%!(a(e "a s!(+a=!! soc!a"e, !ar d!a$nos(!c+" de .o'!e soc!a"7 n+
    es(e &+s cAnd s!n$+ra .r!c7 soc!a"7 es(e aceea de a n+ .! v7/+( avAnd +n a(ac de
    &an!c7. Fo'!a soc!a"7 es(e carac(er!/a(7 de re$+"7 &r!n ev!(area s!(+a=!!"or soc!a"e :n
    a'sen=a a(ac+r!"or de &an!c7 !no&!na(e rec+ren(e. CAnd s+rv!n a(ac+r! de &an!c7,
    aces(ea !a+ .or%a +nor a(ac+r! de &an!c7 c!rc+%scr!se s!(+a=!ona" Ede e<., o
    &ersoan7, c+ .r!ca de a n+ .! &+s7 :n d!.!c+"(a(e cAnd vor'eO(e :n &+'"!c,
    e<&er!en(ea/7 a(ac+r! de &an!c7 &rovoca(e n+%a! de vor'!(+" :n &+'"!c sa+ de a"(e
    s!(+a=!! soc!a"eJ. Une"e (a'"o+r! c"!n!ce cad :n(re aces(e e<e%&"e O! neces!(7 @+deca(a
    c"!n!c7 &en(r+ a"e$erea ce"+! %a! adecva( d!a$nos(!c. De e<e%&"+, +n !nd!v!d, care
    n+ a av+( an(er!or .r!ca de a vor'! :n &+'"!c, are +n a(ac de &an!c7 :n (!%& ce =!ne o
    con.er!n=7 O! :nce&e s7 se (ea%7 s7 n+ se dea :n s&ec(aco". Dac7 aces( !nd!v!d are
    +"(er!or +n a(ac de &an!c7 n+%a! :n s!(+a=!! de &er.or%an=7 soc!a"7 Ec!ar dac7 .r!ca
    es(e cen(ra(7 &e &an!c7J, a(+nc! &oa(e .! @+s(!.!ca( +n d!a$nos(!c de .o'!e soc!a"7.
    Dac7 :ns7, !nd!v!d+" con(!n+7 s7 e<&er!en(e/e a(ac+r! de &an!c7 !ne<&ec(a(e, a(+nc!
    ar &+(ea .! @+s(!.!ca( +n d!a$nos(!c de &an!c7 c+ a$ora.o'!e. Dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e, a(A( &en(r+ .o'!a soc!a"7, cA( O! &en(r+ &an!c7, a%'e"e d!a$nos(!ce &o( .!
    &+se. De e<e%&"+, +n !nd!v!d, c+ .r!ca de, O! ev!(area ce"or %a! %+"(e s!(+a=!! soc!a"e
    d+rAnd d!n (o(dea+na E.o'!e soc!a"7J de/vo"(7 %a! (Ar/!+ a(ac+r! de &an!c7 :n
    s!(+a=!! nonsoc!a"e s! o var!e(a(e de co%&or(a%en(e de ev!(are s+&"!%en(are E&an!c7
    c+ a$ora.o'!eJ.
    Ev!(area s!(+a=!!"or d!n ca+/a .r!c!! de o &os!'!"7 +%!"!re es(e e<(re% de ev!den(7
    :n .o'!a soc!a"7, dar &oa(e s+rven!, de ase%enea, :n &an!ca c+ a$ora.o'!e O! :n
    a$ora.o'!a .7r7 !s(or!c de &an!c7. S!(+a=!!"e ev!(a(e :n .o'!a soc!a"7 s+n( "!%!(a(e "a
    ce"e care !%&"!c7 o &os!'!"7 scr+(are de c7(re a"=! oa%en!. Fr!c!"e d!n a$ora.o'!a .7r7
    !s(or!c de &an!c7 !%&"!c7 de re$+"7 o %+"=!%e de s!(+a=!! carac(er!s(!ce care &o( sa+
    n+ !%&"!ca scr+(area de c7(re a"=!! Ede e<., a .! s!n$+r :n a.ara case! sa+ a .! s!n$+r
    acas78 a (e a."a &e +n &od sa+ :n(r4+n ascensor8 a c7"7(or! c+ a+(o'+/+", (ren+",
    a+(o%o'!"+" sa+ av!on+"J. Ro"+" +n+! co%&an!on, de ase%enea, &oa(e .! +(!" :n
    d!s(!n$erea .o'!e! soc!a"e de a$ora.o'!e Ec+ sa+ .7r7 &an!c7J.T!&!c, !nd!v!/!! c+
    ev!(are a$ora.o'!c7 &re.er7 s7 .!e c+ +n co%&an!on de :ncredere cAnd se a."7 :n
    s!(+a=!a (e%+(7, &e cAnd !nd!v!/!! c+ .o'!e soc!a"7 &o( avea o an<!e(a(e an(!c!&a(or!e
    !n(ens7, dar de re$+"7 n+ a+ a(ac+r! de &an!c7 a(+nc! cAnd r7%An s!n$+r!. O
    &ersoan7 c+ .o'!e soc!a"7 care se (e%e de %a$a/!ne"e a$"o%era(e se va s!%=!
    scr+(a(7 c+ sa+ .7r7 +n co%&an!on s! &oa(e .! %a! &+=!n an<!oas7 .7r7 &ovara
    ad7+$a(7 a scr+(7r!! de c7(re aces(a.
    Co&!!! c+ an<!e(a(e de se&arare &o( ev!(a s!(+a=!!"e soc!a"e d!n ca+/a (e%er!"or :n
    "e$7(+r7 c+ .a&(+" de a n+ .! se&ara=! de c+ra(or+" "or, a (e%er!"or :n "e$7(+r7 c+
    .a&(+" de a n+ .! &+O! :n d!.!c+"(a(e de neces!(a(ea de a ren+n=a &rea d!n (!%& "a
    :n(oarcerea acas7 or! a (e%er!"or :n "e$7(+r7 c+ neces!(a(ea &re/en=e! +n+! &7r!n(e
    cAnd aceas(a n+ es(e cores&+n/7(oare evo"+(!v. Un d!a$nos(!c se&ara( de .o'!e
    soc!a"7 n+ es(e :n $enera" @+s(!.!ca(. Co&!!! c+ an<!e(a(e de se&arare de re$+"7 se s!%(
    455274 'obia Social &Anxietatea
    Social)
    7<<
    '!ne :n s!(+a=!!"e soc!a"e d!n &ro&r!a cas7, &e cAnd ce! c+ .o'!e soc!a"7 &re/!n(7
    se%ne de d!scon.or(, c!ar c:nd s!(+a=!!"e (e%+(e s+rv!n acas7.
    DeO! .r!ca de !nco%odare sa+ de +%!"!re &oa(e .! &re/en(7 :n an<!e(a(ea
    $enera"!/a(7 sa+ :n .o'!a s&ec!.!c7 Ede e<., @ena :n "e$7(+r7 c+ .a&(+" de a "eO!na
    cAnd ! se !a sAn$eJ, aces(a n+ es(e &r!nc!&a"+" .ocar a" .r!c!! sa+ an<!e(7=!!
    !nd!v!d+"+!. Co&!!! c+ an<!e(a(e $enera"!/a(7 a+ &reoc+&7r! e<a$era(e re.er!(oare
    "a ca"!(a(ea .+nc=!on7r!! "or, dar aces(ea s+rv!n c!ar cAnd n+ s+n( eva"+a=! de a"=!!,
    &e cAnd :n .o'!a soc!a"7, even(+a"a eva"+are de c7(re a"=!! es(e ce!a an<!e(7=!!.
    :n(r4o (+"'+rare de de/vo"(are &ervas!v7 s! :n (+"'+rarea de &ersona"!(a(e
    sc!/o!d7, s!(+a=!!"e soc!a"e s+n( ev!(a(e d!n ca+/a "!&se! de !n(eres :n re"a=!onarea c+
    a"=! !nd!v!/!. D!n con(ra, !nd!v!/!! c+ .o'!e soc!a"7 a+ ca&ac!(a(ea O! !n(eres+" de a
    s(a'!"! re"a=!! c+ &ersoane .a%!"!are, :n s&ec!a" "a co&!!, &en(r+ a se &+(ea &+ne
    d!a$nos(!c+" de .o'!e soc!a"7, e! (re'+!e s7 a!'7 ce" &+=!n o re"a=!e soc!a"7
    cores&+n/7(oare e(7=!! c+.c!neva d!n a.ara .a%!"!e! !%ed!a(e Ede e<., +n co&!" care se
    s!%(e !nco%oda( :n ad+n7r!"e soc!a"e c+ e$a"!! O! ev!(7 as(.e" de s!(+a=!!, dar care are
    +n !n(eres ac(!v &en(r+ aces(ea s! o re"a=!e c+ +n a%!c .a%!"!ar de aceeaO! e(a(eJ.
    T+"'+rarea de &ersona"!(a(e ev!(an(7 are +n n+%7r de e"e%en(e co%+ne c+
    .o'!a soc!a"7 O! &are a se s+&ra&+ne :n %are %7s+r7 &es(e .o'!a soc!a"7 $enera"!/a(7.
    T+"'+rarea de &ersona"!(a(e ev!(an(7 &oa(e .! o var!an(7 %a! sever7 de .o'!e soc!a"7
    $enera"!/a(7, ad!c7 n+ es(e ca"!(7=! d!s(!nc(7. La !nd!v!/!! c+ .o'!e soc!a"7
    $enera"!/a(7, d!a$nos(!c+" ad!=!ona" de (+"'+rare de &ersona"!(a(e ev!(an(7 (re'+!e
    s7 .!e "+a( :n cons!dera=!e.
    An<!e(a(ea soc!a"7 s! ev!(area s!(+a=!!"or soc!a"e s+n( e"e%en(e asoc!a(e a"e
    %+"(or a"(e (+"'+r7r! %en(a"e Ede e<., (+"'+rarea de&res!v7 %a@or7, (+"'+rarea
    d!s(!%!c7, sc!/o.ren!a, (+"'+rarea d!s%or.!c7 cor&ora"7J. Dac7 s!%&(o%e"e de
    an<!e(a(e sa+ de ev!(are soc!a"7 s+rv!n n+%a! :n c+rs+" a"(e! (+"'+r7r! %en(a"e O!
    s+n( cons!dera(e a .! e<&"!ca(e %a! '!ne de (+"'+rarea res&ec(!v7, d!a$nos(!c+"
    ad!=!ona" de .o'!e soc!a"7 n+ se &+ne.
    Un!! !nd!v!/! &o( e<&er!en=a o an<!e(a(e soc!a"7 s! ev!(are se%n!.!ca(!ve c"!n!c :n
    "e$7 (+r7 c+ o cond!=!e %ed!ca"7 $enera"7 sa+ c+ o (+"'+rare %en(a"7 c+ s!%&(o%e
    &o(en=!a" @enan(e Ede e<., (re%or+" :n %a"ad!a Par)!nson, 'a"'!s%+", o'e/!(a(ea,
    s(ra'!s%+", c!ca(r!c!"e .ac!a"e sa+ co%&or(a%en(+" a"!%en(ar anor%a" :n anore<!a
    nervoas7J.Dac7 :ns7, an<!e(a(ea s! ev!(area soc!a"7 s+n( "!%!(a(e "a &reoc+&7r!
    re.er!(oare "a cond!=!a %ed!ca"7 $enera"7 sa+ "a (+"'+rarea %en(a"7, &r!n conven=!e,
    d!a$nos(!c+" de .o'!e soc!a"7 n+ es(e &+s. Dac7 ev!(area soc!a"7 es(e se%n!.!ca(!v7
    c"!n!c, &oa(e .! &+s d!a$nos(!c+" se&ara( de (+"'+rare an<!oas7 .7r7 n!c! o a"(7
    s&ec!.!ca=!e.
    An<!e(a(ea de .+nc=!onare, .r!ca de scen7 E(rac+"J s! (!%!d!(a(ea :n s!(+a=!!"e
    soc!a"e care !%&"!c7 &ersoane non.a%!"!are s+n( .recven(e O! n+ (re'+!e s7 .!e
    d!a$nos(!ca(e ca .o'!e soc!a"7, decA( dac7 an<!e(a(ea sa+ ev!(area d+c "a o
    de(er!orare se%n!.!ca(!v7 c"!n!c sa+ "a o de(res7 %arca(7. Co&!!! &re/!n(7 .recven(
    an<!e(a(e soc!a"7, :n s&ec!a" cAnd !n(erac=!onea/7 c+ ad+"=! non.a%!"!ar!.
    D!a$nos(!c+" de .o'!e soc!a"7 n+ (re'+!e &+s "a co&!! decA( dac7 an<!e(a(ea soc!a"7
    es(e, de ase%enea, ev!den(7 :n s!(+a=!!"e c+ e$a"!! s! &ers!s(7 ce" &+=!n R "+n!.
    IYR Tulburrile AnxioaMse
    Criteriile $e $ia/no&ti# pentru 4++.C4 'o-ia So#ial(
    A2 O $ric marcat ,i persistent de una sau mai multe situaii sociale sau de
    per$orman, "n care persoana este expus unor oameni non$amiliari sau
    unei posibile scrutri de ctre alii2 Individul se teme c va aciona "ntr-un
    mod &sau va pre(enta simptome anxioase) care vor $i umilitoare sau 0enante2
    FotD La copii, trebuie s existe proba capacitii de relaii sociale cores
    pun(toare etii cu persoane $amiliare, iar anxietatea trebuie s survin "n
    situaiile cu e!alii, nu doar "n interaciunile cu adulii2
    S2 *xpunerea la situaia social temut provoac aproape constant anxietate,
    care ia $orma unui atac de panic limitat situaional sau predispus
    situaional2 FotD La copii, anxietatea se poate exprima prin exclamaii,
    accese coleroase, stupe$acie sau retra!ere din situaiile sociale cu persoane
    ne$amiliare2
    2 #ersoana recunoa,te c $rica sa este excesiv sau ne0usti$icat2 FotD La
    copii, acest element poate $i absent2
    D2 Situaiile sociale sau de per$orman temute sunt evitate sau c%iar "ndurate
    cu o anxietate sau detres intens2
    *2 *vitarea, anticiparea anxioas sau detres "n situaia &situaiile) social sau
    de per$orman temut inter$erea( semni$icativ cu rutina normal, cu
    $uncionarea pro$esional &,colar) sau activitile ori relaiile sociale sau
    exist o detres marcat "n le!tur cu $aptul de a avea $obia2
    '2 La indivi(ii sub E8 ani, durata este de cel puin I luni2
    G2 'rica sau evitarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    substane &de ex2, un dro! de abu(, un medicament) ori ale unei condiii
    medicale !enerale si nu este explicat mai bine de alt tulburare mental
    &de ex2, panica cu sau $r a!ora$obie, anxietatea de separare, tulburarea
    dismor$ic corporal, o tulburare de de(voltare pervasiv sau tulburarea de
    personalitate sc%i(oid)2
    L2 Dac este pre(ent o condiie medical !eneral ori alt tulburare mental,
    $rica de la criteriul A este $r le!tur cu aceasta, de ex2, $rica nu este de
    balbism, de tremor "n maladia #arCinson ori de mani$estarea unui
    comportament alimentar anormal "n anorexia nervoas sau "n bulimia
    nervoas)2
    7e speci"icat dac D
    Generali(atD dac $rica include cele mai multe situaii sociale &a se lua "n
    consideraie, de asemenea, dia!nosticul adiional de tulburare de
    personalitate evitant )2
    45524 Tulburarea Obsesivo-
    ompulsiv
    7<G

    4++.4 Tul-urarea O-&e&ivo-Co"pul&iv(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! o'ses!vo4co%&+"s!ve s+n( o'ses!!"e sa+
    co%&+"s!!"e rec+ren(e Ecr!(er!+" AJ care s+n( s+.!c!en( de severe &en(r+ a .!
    cons+%a(oare de (!%& Ead!c7, e"e !a+ %a! %+"( decA( o or7 &e /!J sa+ ca+/ea/7 o
    de(res7 %arca(7 sa+ o de(er!orare se%n!.!ca(!v7 Ecr!(er!+" CJ, :n(r4+n an+%!(
    %o%en( :n c+rs+" (+"'+r7r!!, &ersoana a rec+nosc+( c7 o'ses!!"e sa+ co%&+"s!!"e
    s+n( e<ces!ve sa+ ne@+s(!.!ca(e Ecr!(er!+" BJ. Dac7 &e a<a I es(e &re/en(7 o a"(7
    (+"'+rare, con=!n+(+" o'ses!!"or sa+ co%&+"s!!"or n+ es(e "!%!(a( "a aceas(a
    Ecr!(er!+" DJ. Per(+r'area n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne!
    s+'s(an=e Ede e<., +n+! dro$ de a'+/, +n+! %ed!ca%en(J sa+ a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ecr!(er!+" EJ.
    N 4bsesiile s+n( !de!, $And+r!, !%&+"s+r! sa+ !%a$!n! &ers!s(en(e care s+n(
    e<&er!en(a(e ca !n(r+s!ve O! !nadecva(e, s! care ca+/ea/7 o an<!e(a(e sa+ de(res7
    %arca(7. Ca"!(a(ea !n(r+s!v7 s! !nadecva(7 a o'ses!!"or a .os( de.!n!(7 ca Se$od!s4
    (on!c7T. Aceas(a se re.er7 "a conv!n$erea !nd!v!d+"+! c7 con=!n+(+" o'ses!!"or :! es(e
    s(r7!n, n+ se a."7 s+' con(ro"+" &ro&r!+ s! n+ es(e (!&+" de $And+r! &e care ar .! dor!(
    s745 a!'7. Ind!v!d+" es(e ca&a'!" :ns7 s7 rec+noasc7 .a&(+" c7 o'ses!!"e s+n( &rod+s+"
    &ro&r!e! sa"e %!n=! s! n+ :! s+n( !%&+se d!n a.ar7 Eca :n !nser=!a de $And+r!J.
    Ce"e %a! .recven(e o'ses!! s+n( $And+r!"e re&e(a(e :n "e$7(+r7 c+ con(a%!narea
    Ede e<., a se con(a%!na &r!n s(rAn$erea %A!n!"or a"(or &ersoaneJ, d+'!(a=!!"e re&e(a(e
    Ede e<., a se :n(re'a dac7 a e.ec(+a( +n ac( oarecare, c+% ar .! ace"a dac7 a v7(7%a(
    &e c!neva :n(r4+n acc!den( de c!rc+"a=!e or! dac7 a "7sa( +Oa desc!s7J, neces!(a(ea de
    a &+ne "+cr+r!"e :n(r4o an+%!(7 ord!ne Ede e<., de(res7 !n(ens7 cAnd o'!ec(e"e s+n(
    &+se :n de/ord!ne sa+ as!%e(r!cJ, !%&+"s+r! a$res!ve sa+ or!'!"e Ede e<., ace"a de a4
    s! v7(7%a &ro&r!+" co&!" sa+ a s(r!$a o o'scen!(a(e :n '!ser!c7J s! !%a$er!e se<+a"7 Ede
    e<., o !%a$!ne &orno$ra.!c7 rec+ren(7J. ,And+r!"e, !%&+"s+r!"e sa+ !%a$!n!"e n+ s+n(
    s!%&"e (e%er! e<ces!ve :n "e$7(+r7 c+ &ro'"e%e rea"e de v!a=7 Ede e<., &reoc+&7r!
    re.er!(oare "a d!.!c+"(7=!"e c+ren(e a"e v!e=!!, c+% ar .! &ro'"e%e"e .!nanc!are, de
    serv!c!+ sa+ Oco"areJ s! es(e &+=!n &ro'a'!" c7 se re.er7 "a o &ro'"e%7 rea"7 de v!a=7.
    Ind!v!d+" c+ o'ses!! :ncearc7 de re$+"7 s7 !$nore sa+ s7 s+&r!%e as(.e" de
    $And+r! sa+ de !%&+"s+r!, or! s7 "e ne+(ra"!/e/e c+ +n a"( $And sa+ ac=!+ne
    Ead!c7, c+ o co%&+"s!eJ. De e<e%&"+, +n !nd!v!d (or(+ra( de d+'!! :n "e$7(+r7 c+ a
    .! "7sa( ara$a/+" desc!s :ncearc7 s7 "e ne+(ra"!/e/e &r!n ver!.!c7r! re&e(a(e s&re a se
    as!$+ra c7 aces(a es(e :nc!s.
    Comp+lsiile s+n( co%&or(a%en(e re&e(!(!ve Ede e<., s&7"a(+" %A!n!"or,
    ordona(+", ver!.!ca(+"J sa+ ac(e %en(a"e Ede e<., r+$a(+", n+%7ra(+", re&e(area de
    c+v!n(e :n $AndJ a" c7ror sco& es(e ace"a de a &reven! sa+ red+ce an<!e(a(ea sa+
    de(res7 s! n+ ce" de a o'=!ne &"7cere sa+ $ra(!.!care. :n ce"e %a! %+"(e ca/+r!,
    &ersoana se s!%(e o'"!$a(7 s7 e.ec(+e/e co%&+"s!a &en(r+ a red+ce de(res7 care
    aco%&an!a/7 o o'ses!e or! &en(r+ a &reven! +n even!%en( sa+ o s!(+a=!e (e%+(7
    oarecare. De e<e%&"+, !nd!v!/!! c+ o'ses!! :n "e$7(+r7 c+ .a&(+" de a .!
    con(a%!na=! :O! &o( red+ce de(res7 %en(a"7 s&7"And+4se &e %A!n! &An7 ce &!e"ea
    "or dev!ne carne v!e8 !nd!v!/!! de(resa=! de o'ses!!"e re.er!(oare "a .a&(+" de a .!
    "7sa( +Oa desc!s7 &o( .! de(er%!na=! s7 ver!.!ce :nc+!e(oarea "a .!ecare cA(eva
    %!n+(e8 !nd!v!/!! de(resa=! de $And+r! '"as.e%!an(e nedor!(e &o( a."a +O+rare
    n+%7rAnd &An7 "a /ece :na!n(e s! :na&o! de
    .
    7<> Tulburrile Anxioase

    o s+(7 de or! &en(r+ .!ecare $And. :n +ne"e ca/+r!, !nd!v!d+" e.ec(+ea/7 ac(e r!$!de
    sa+ s(ereo(!&e, con.or% +nor re$+"! e"a'ora(e !d!os!ncra(!c, .7r7 a .! ca&a'!"! s7
    s&+n7 de ce .ac aceas(a. Pr!n de.!n!=!e, co%&+"s!!"e s+n(, .!e c"ar e<ces!ve, .!e n+ s+n(
    conec(a(e :n %od rea"!s( c+ ceea ce s+n( des(!na(e s7 ne+(ra"!/e/e sa+ s7 &rev!n7.
    Ce"e %a! .recven(e co%&+"s!! !%&"!c7 s&7"a(+" s! c+r7=a(+", n+%7ra(+", ver!.!ca(+",
    cererea sa+ so"!c!(area de as!$+r7r!, ac=!+n!"e re&e(a(e s! ordonarea.
    Pr!n de.!n!=!e, ad+"=!! c+ (+"'+rare o'ses!vo4co%&+"s!v7 rec+nosc "a +n %o%en(
    da( c7 o'ses!!"e sa+ co%&+"s!!"e "or s+n( e<ces!ve sa+ ne@+s(!.!ca(e. Aceas(7 cer!n=7
    n+ se a&"!c7 "a co&!! &en(r+ c7 e! &o( .! "!&s!=! de s+.!c!en(7 ca"!.!care co$n!(!v7 &en(r+
    a .ace o as(.e" de @+dca(7. C!ar "a ad+"=! e<!s(7 :ns7 o $a%7 "ar$7 de !n(+!re a
    ra=!ona"!(7=!! o'ses!!"or sa+ co%&+"s!!"or. Un!! !nd!v!/! a+ !ncer(!(+d!ne :n "e$7(+r7
    c+ ra=!ona"!(a(ea o'ses!!"or sa+ co%&+"s!!"or "or s! or!ce !n(+!=!e da(7 a !nd!v!d+"+!
    &oa(e var!a de4a "+n$+" (!%&+"+! s! :n .+nc=!e de s!(+a=!!. De e<e%&"+, &ersoana
    &oa(e rec+noaO(e o co%&+"s!e de con(a%!nare ca ne@+s(!.!ca(7, cAnd d!sc+(7 aceas(a
    :n(r4o Ss!(+a=!e de s!$+ran=7T Ede e<., :n ca'!ne(+" (era&e+(+"+!J, dar n+ s! cAnd es(e
    .or=a(7 s7 %An+!e 'an!. :n aces(e da=!, cAnd !nd!v!d+" rec+noaO(e c7 o'ses!!"e s!
    co%&+"s!!"e s+n( ne@+s(!.!ca(e, e" &oa(e dor! sa+ c!ar :ncerca s7 "e re/!s(e. CAnd
    :ncearc7 s7 re/!s(e +ne! co%&+"s!!, !nd!v!d+" &oa(e avea sen(!%en(+" de a%&"!.!care
    a an<!e(7=!! sa+ (ens!+n!! care es(e adesea +O+ra(7 &r!n cedarea "a co%&+"s!e. :n
    c+rs+" (+"'+r7r!!, d+&7 eOec+r! re&e(a(e de a re/!s(a o'ses!!"or sa+ co%&+"s!!"or,
    !nd!v!d+" se &oa(e s+&+ne "or, n+ %a! e<&er!en(ea/7 dor!n=a de a "e re/!s(a O! &oa(e
    :ncor&ora co%&+"s!!"e :n r+(!ne"e sa"e co(!d!ene.
    O'ses!!"e sa+ co%&+"s!!"e (re'+!e s7 ca+/e/e o de(res7 cons!dera'!"7, s7 .!e
    cons+%a(oare de (!%& Es7 !a %a! %+"( de o or7 &e /!J or! s7 !n(er.ere/e se%n!.!ca(!v
    c+ r+(!na nor%a"7 a !nd!v!d+"+!, c+ .+nc=!onarea &ro.es!ona"7 or! c+ ac(!v!(7=!"e
    soc!a"e +/+a"e sa+ c+ re"a=!!"e c+ a"=!!. O'ses!!"e sa+ co%&+"s!!"e &o( :n"oc+!
    co%&or(a%en(+" +(!" s! sa(!s.7c7(or, O! &o( .! .oar(e &er(+r'an(e &en(r+ .+nc=!onarea
    $enera"7. Deoarece !n(r+/!+n!"e o'ses!ve &o( d!s(ra$e .oar(e %+"(, e"e &o( d+ce "a o
    .+nc=!onare !ne.!c!en(7 :n sarc!n!"e co$n!(!ve care cer concen(rare, c+% ar .! c!(!(+"
    sa+ ca"c+"a(+", :n a.ar7 de aceas(a, %+"=! !nd!v!/! ev!(7 o'!ec(e"e sa+ s!(+a=!!"e care
    &rovoac7 o'ses!! sa+ co%&+"s!!. O as(.e" de ev!(are &oa(e deven! e<(!ns7 O! &oa(e
    res(rAn$e sever .+nc=!onarea $enera"7.
    Speci$icant
    (u con/tiin3a maladiei redus. Aces( s&ec!.!can( &oa(e .! a&"!ca( cAnd,
    &en(r+ cea %a! %are &ar(e a (!%&+"+! :n c+rs+" e&!sod+"+! c+ren(, !nd!v!d+"
    n+ rec+noaO(e c7 o'ses!!"e sa+ co%&+"s!!"e s+n( e<ces!ve sa+ ne@+s(!.!ca(e.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Frecven(, e<!s(7 ev!(area
    s!(+a=!!"or care !%&"!c7 con=!n+(+" o'ses!!"or, c+% ar .! %+rd7r!a sa+ con(a%!narea. De
    e<e%&"+, o &ersoan7 c+ o'ses!! re.er!(oare "a %+rd7r!e va ev!(a (oa"e(e"e &+'"!ce sa+ s7
    dea %Ana c+ s(r7!n!!. Preoc+&7r!"e !&ocondr!ace s+n( .recven(e, c+ v!/!(e re&e(a(e "a
    d!verO! %ed!c! :n c7+(area reas!$+r7r!!. C+"&a, +n sen(!%en( &a(o"o$!c de
    res&onsa'!"!(a(e O! &er(+r'7r! de so%n &o( .! &re/en(e. Poa(e e<!s(a +n +/ e<ces!v de
    a"coo" sa+ de %ed!ca%en(e seda(!ve, !&no(!ce sa+ an<!o"!(!ce. E.ec(+area co%&+"s!!"or
    &oa(e deven! ac(!v!(a(ea %a@or7 a v!e=!!, d+cAnd "a o !nca&ac!(a(e %ar!(a"7, &ro.es!ona"7
    sa+ soc!a"7 ser!oas7. Ev!(area &ervas!v7 &oa(e "e$a &e !nd!v!d de cas7.
    45524 Tulburarea Obsesivo- omp
    ulsiv
    F54

    La ad+"=!, (+"'+rarea o'ses!vo4co%&+"s!v7 &oa(e .! asoc!a(7 c+ (+"'+rarea
    de&res!v7 %a@or7, c+ a"(e (+"'+r7r! an<!oase Ead!c7 , c+ .o'!a s&ec!.!c7, .o'!a soc!a"7,
    &an!ca, an<!e(a(ea $enera"!/a(7 J, c+ (+"'+r7r!"e de co%&or(a%en( a"!%en(ar O! c+
    +ne"e (+"'+r7r! de &ersona"!(a(e Ede e<., (+"'+rarea de &ersona"!(a(e o'ses!vo4
    co%&+"s!v7, (+"'+rarea de &ersona"!(a(e ev!(an(7, (+"'+rarea de &ersona"!(a(e
    de&enden(7J. La co&!!, aceas(a &oa(e .! asoc!a(7 c+ (+"'+r7r! de :nv7=are s! c+ (+"'+r7r!
    de co%&or(a%en( d!sr+&(!ve. E<!s(7 o !nc!den=7 cresc+(7 a (+"'+r7r!! o'ses!vo4
    co%&+"s!ve "a co&!!! s! ad+"=!! c+ (+"'+rarea To+re((e, c+ es(!%7r! %er$And de "a
    a&ro<!%a(!v ;Yd "a YLd. Inc!den=a (+"'+r7r!! To+re((e :n (+"'+rarea o'ses!vo4
    co%&+"s!v7 es(e %a! red+s7, c+ es(!%7r! c+&r!nse :n(re Yd s! Hd. :n(re 9Ld s! ;Ld
    d!n(re !nd!v!/!! c+ (+"'+rare o'ses!vo4co%&+"s!v7 a+ re"a(a( (!c+r! c+ren(e sa+ (rec+(e.
    9ate de laborator asociate. N+ a+ .os( !den(!.!ca(e n!c! +n .e" de da(e de
    "a'ora(or care s7 .!e d!a$nos(!ce &en(r+ (+"'+rarea o'ses!vo4co%&+"s!v7. S4a cons(a(a(
    :ns7 c7, o var!e(a(e de da(e de "a'ora(or s+n( anor%a"e "a !nd!v!/!! c+ (+"'+rare
    o'ses!vo4co%&+"s!v7 co%&ara(!v c+ s+'!ec=!! de con(ro". E<!s(7 +ne"e da(e, c+% c7
    +n!! a$on!s!! a! sero(on!ne!, ad%!n!s(ra=! ac+(, ca+;ea;6 o !n(ens!.!care a s!%&(o%e"or
    "a +n!! !nd!v!/! c+ (+"'+rarea. Ind!v!/!! c+ (+"'+rarea &o( &re/en(a o creO(ere a
    ac(!v!(7=!! ve$e(a(!ve cAnd s+n( con.r+n(a=! :n "a'ora(or c+ c!rc+%s(an=e care
    dec"anOea/7 o o'ses!e. Reac(!v!(a(ea .!/!o"o$!c7 d!%!n+a d+&7 e.ec(+area
    co%&+"s!!"or.
    9atele examinrii somatice /i condi3iile medicale asociate. Po( .! o'serva(e
    &ro'"e%e der%a(o"o$!ce ca+/a(e de s&7"a(+" e<ces!v c+ a&7 sa+ c+ de(er$en=! ca+s(!c!.
    *lemente speci$ice culturii, etii si sexului
    Co%&or(a%en(+" r!(+a" &rescr!s c+"(+ra" n+ es(e &r!n s!ne !nd!ca(or de (+"'+rare
    o'ses!vo4co%&+"s!v7, dac7 n+ e<cede nor%e"e c+"(+ra"e, n+ s+rv!ne "a da(e O! :n
    "oc+r! cons!dera(e !nadecva(e de c7(re a"=!! a&ar=!nAnd ace"e!aO! c+"(+r!, O! n+
    !n(er.erea/7 c+ .+nc=!onarea ro"+"+! soc!a". DeO! .ac(or!! c+"(+ra"!, &er se, n+ &o(
    d+ce "a (+"'+rarea o'ses!vo4co%&+"s!v7, conv!n$er!"e re"!$!oase s! c+"(+ra"e &o(
    !n."+en=a (e%e"e o'ses!!"or s! co%&+"s!!"orJ Ede e<., evre!! or(odocO! c+ co%&+"s!+n!
    re"!$!oase &o( avea s!%&(o%e cen(ra(e &e &rac(!c!"e a"!%en(areJ. Sc!%'7r!"e de
    v!a=7 !%&or(an(e O! do"!+" &o( d+ce "a o !n(ens!.!care a co%&or(a%en(+"+! r!(+a", care
    &oa(e &are a . ! o o'ses!e &en(r+ +n c"!n!c!an ne.a%!"!ar!/a( c+ con(e<(+" c+"(+ra".
    Ta'"o+r!"e c"!n!ce de (+"'+rare o'ses!vo4co%&+"s!v7 "a co&!! s+n( :n $enera"
    s!%!"are c+ ce"e d!n &er!oada ad+"(7. S&7"a(+", ver!.!ca(+" O! r!(+a"+r!"e de ord!ne
    s+n( e<(re% de .recven(e "a co&!!. Co&!!! :n $enera" n+ so"!c!(7 a@+(or, !ar s!%&(o%e"e
    &o( s7 n+ .!e e$od!s(on!ce. Ce" %a! adesea, &ro'"e%a es(e ses!/a(7 de &7r!n=!, care
    ad+c co&!"+" "a (ra(a%en(. A .os( descr!s +n dec"!n &ro$res!v :n ac(!v!(a(ea Oco"ar7,
    sec+ndar de(er!or7r!! ca&ac!(7=!! de concen(rare. Ca O! ad+"=!!, co&!!! s+n( %a!
    :nc"!na=! s7 se an$a@e/e :n r!(+a"+r!, acas7, decA( :n .a=a e$a"!"or, a &ro.esor!"or sa+ a
    s(r7!n!"or. Pen(r+ +n %!c s+'se( de co&!!, (+"'+rarea o'ses!vo4co%&+"s!v7 &oa(e .!
    asoc!a(7 c+ o !n.ec=!e c+ s(re&(ococ 'e(ae%o"!(!c $r+&7 A Ede e<. scar"a(!na O! S$A(+"
    s(re&(ococ!cTJ. Aceas(7 .or%7 de (+"'+rare o'ses!vo4co%&+"s!v7 se carac(er!/ea/7
    &r!n de'+( &re&+'era", asoc!a( c+ ano%a"!! ne+ro"o$!ce Ede e<., %!Oc7 r! core!.or%e
    O! !&erac(!v!(a(e %o(or!eJ O! +n de'+( 'r+sc a" s!%&(o%e"or sa+ c+ o evo"+=!e
    e&!sod!c7 :n care e<acer'a r! (e%&orare s+n( "e$a(e de !n.ec=!! s(re&(ococ!ce. Ad+"=!!
    %a! :n e(a(e (!nd a &re/en(a %a! %+"( o'ses!! re.er!(oare "a %ora"!(a(e O! r!(+a"+r! de
    s&7"are :n co%&ara=!e c+ a"(e (!&+r! de s!%&(o%e.
    7=+ Tulburrile Anxioase
    La ad+"=!, aceas(7 (+"'+rare es(e "a .e" de .recven(7 "a '7r'a=! s! "a .e%e!.
    T+"'+rarea o'ses!vo4co%&+"s!v7 c+ de'+( :n co&!"7r!e es(e :ns7 %a! .recven(7 "a
    '7!e=! decA( "a .e(e.
    #revalent
    S(+d!!"e co%+n!(are a+ es(!%a( o &reva"en(7 &e v!a=7 de 9,Yd O! o &reva"en(7 &e
    " an de L,Yd49,5d "a ad+"=!. Pro'"e%e"e %e(odo"o$!ce c+ !ns(r+%en(e"e de eva"+are
    +(!"!/a(e a+ s+$era( :ns7 &ro'a'!"!(a(ea c7 ra(e"e de &reva"en(7 rea"e s+n( %+"( %a!
    %!c!. S(+d!!"e co%+n!(are &e co&!! O! &e ado"escen=! a+ es(!%a( o &reva"en(7 &e v!a(7
    de "d49,;d s! o &reva"en(7 &e " an de L,Hd. Cerce(7r!"e !nd!c7 .a&(+" c7 ra(e"e de
    &reva"en(7 a"e (+"'+r7r!! o'ses!vo4co%&+"s!ve s+n( s!%!"are :n %+"(e d!n(re
    d!.er!(e"e c+"(+r! a"e "+%!!.
    *voluie
    C+ (oa(e c7 (+"'+rarea o'ses!vo4co%&+"s!v7 :nce&e de re$+"7 :n ado"escen=7 sa+
    &recoce :n v!a=a ad+"(7, ea &oa(e :nce&e O! :n co&!"7r!e. E(a(ea .or%a"7 "a de'+( es(e
    %a! &recoce "a '7r'a=! decA( "a .e%e!Q :n(re e(a(ea de R s! 5Y an! &en(r+ '7r'a=! O!
    :n(re e(a(ea de 9L O! 9F an! &en(r+ .e%e!. Pen(r+ cea %a! %are &ar(e, de'+(+" es(e
    $rad+a", dar :n +ne"e ca/+r! a .os( re%arca( O! +n de'+( ac+(. Ma@or!(a(ea !nd!v!/!"or
    a+ o evo"+=!e cron!c7, c+ a%e"!or7r! O! a$rav7r!, s! c+ e<acer'area s!%&(o%e"or :n
    re"a=!e c+ s(res+". A&ro<!%a(!v 5Yd &re/!n(7 o de(er!orare &ro$res!v7 :n
    .+nc=!onarea &ro.es!ona"7 s! soc!a"7. A&ro<!%a(!v Yd a+ o evo"+=!e e&!sod!c7, c+
    s!%&(o%e %!n!%e sa+ .7r7 n!c! +n .e" de s!%&(o%e :n(re e&!soade.
    #attern $amilial
    Ra(a de concordan=7 &en(r+ (+"'+rarea o'ses!vo4co%&+"s!v7 es(e %a! %are
    &en(r+ $e%en!! %ono/!$o=! decA( &en(r+ $e%en!! d!/!$o=!. Ra(a (+"'+r7r!! o'ses!vo4
    co%&+"s!ve "a r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare o'ses!vo4
    co%&+"s!v7 O! "a r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rarea To+re((e
    es(e %a! %are decA( cea d!n &o&+"a=!a $enera"7.
    Dia!nostic di$erenial
    T+"'+rarea o'ses!vo4co%&+"s!v7 (re'+!e s7 .!e d!s(!ns7 de (+"'+rarea an<!oas7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" es(e ce" de (+"'+rare
    an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e a(+nc! cAnd se cons!der7 c7
    o'ses!!"e sa+ co%&+"s!!"e s+n( consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! an+%!(e cond!=!!
    %ed!ca"e $enera"e Eve/! &a$. IHRJ. Aceas(7 &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de
    "a'ora(or sa+ e<a%en+" so%a(!c. O (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7 se
    d!s(!n$e de (+"'+rarea o'ses!vo4co%&+"s!v7 &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n
    dro$ de a'+/, +n %ed!ca%en( or! e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a .!
    e(!o"o$!c :n re"a=!e c+ o'ses!!"e sa+ co%&+"s!!"e Eve/! &a$. IHFJ.
    ,And+r!, !%&+"s+r!, !%a$!n! sa+ co%&or(a%en(e !n(r+s!ve sa+ rec+ren(e &o(
    s+rven! :n con(e<(+" %+"(or a"(e (+"'+r7r! %en(a"e. T+"'+rarea o'ses!vo4co%&+"s!v7
    n+ es(e d!a$nos(!ca(7 dac7 con=!n+(+" $And+r!"or sa+ ac(!v!(7=!"or es(e "e$a( e<c"+s!v
    de a"(7 (+"'+rare %en(a"7 Ede e<., &reoc+&area :n "e$7(+r7 c+ as&ec(+" :n (+"'+rarea
    d!s%or.!c7 cor&ora"7, &reoc+&area re.er!(oare "a +n o'!ec( sa+ s!(+a(e (e%+(7 :n
    .o'!a s&ec!.!c7 sa+ soc!a"7, s%+"$erea &7r+"+! :n (r!co(!"o%an!eJ. Un d!a$nos(!c
    45524 Tulburarea Obsesivo-
    ompulsiv
    F>1
    ad!=ona" de (+"'+rare o'ses!vo4co%&+"s!v7 &oa(e .! :ns7 @+s(!.!ca( dac7 e<!s(7 o'ses!!
    sa+ co%&+"s!! a" c7ror con=!n+( n+ are n!c! o "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7.
    :n(r4+n e&!sod de&res!v %a@or, r+%!na=!a &ers!s(en(7 re.er!(oare "a c!rc+%s(an=e
    even(+a" ne&"7c+(e sa+ re.er!(oare "a ac=!+n! a"(erna(!ve &os!'!"e es(e .recven(7 s!
    es(e cons!dera(7 %a! c+rAnd +n as&ec( con$r+en( c+ d!s&o/!=!a a" de&res!e! decA( o
    o'ses!e. De e<e%&"+, +n !nd!v!d care r+%!nea/7 c7 e" es(e "!&s!( de va"oare n+ va .!
    cons!dera( ca avAnd o'ses!!, &en(r+ c7 o as(.e" de r+%!na=!e n+ es(e e$od!s(on!c7.
    An<!e(a(ea $enera"!/a(7 se carac(er!/ea/7 &r!n(r4o &reoc+&are e<a$era(7, dar
    as(.e" de &reoc+&7r! se d!s(!n$ de o'ses!! &r!n .a&(+" c7 &ersoana "e e<&er!en(ea/7
    ca &reoc+&7r! e<ces!ve :n "e$7(+r7 c+ c!rc+%s(an=e de v!a=7 rea"e. De e<e%&"+, o
    &reoc+&are e<ces!v7 &en(r+ .a&(+" c7 !nd!v!d+" res&ec(!v :O! &oa(e &!erde serv!c!+"
    cons(!(+!e o (ea%7, n+ o o'ses!e. D!n con(ra, con=!n+(+" o'ses!!"or n+ !%&"!c7 :n
    %od carac(er!s(!c &ro'"e%e de v!a=7 rea"e, !ar o'ses!!"e s+n( e<&er!en(a(e ca
    !nadecva(e de c7(re !nd!v!d Ede e<., !deea de(resan(7 !n(r+s!v7 c7 SD+%ne/e+
    X,odXT es(e ScA!ne Xdo$XT, s&+s7 &es(e +%7rJ.
    Dac7 $And+r!"e de(resan(e rec+ren(e se re.er7 e<c"+s!v "a .r!ca &ersoane! de a n+
    avea sa+ c7 de@a are o %a"ad!e sever7, &e 'a/a !n(er&re(7r!"or erona(e a s!%&(o%e"or
    so%a(!ce, a(+nc! (re'+!e s7 .!e d!a$nos(!ca(7 !&ocondr!a :n "oc de (+"'+rarea
    o'ses!vo4co%&+"s!v7. :ns7, dac7 (ea%a de a n+ avea o %a"ad!e es(e aco%&an!a(7 de
    r!(+a"+r!, c+% ar .! s&7"a(+" e<ces!v sa+ co%&or(a%en(+" de ver!.!care re.er!(or "a
    &reoc+&7r! :n "e$7(+r7 c+ %a"ad!a sa+ c+ r7s&And!rea e! "a a"=! oa%en!, a(+nc! &oa(e
    .! !nd!ca( +n d!a$nos(!c ad!=!ona" de (+"'+rare o'ses!vo4co%&+"s!v7. Dac7
    &reoc+&area %a@or7 se re.er7 "a con(rac(area +ne! %a"ad!! E%a! c+rAnd decA( "a
    .a&(+" c7 are o %a"ad!eJ s! n+ s+n( !%&"!ca(e n!c! +n .e" de r!(+a"+r!, a(+nc! o .o'!e
    s&ec!.!c7 de %a"ad!e &oa(e .! ce" %a! cores&+n/7(or d!a$nos(!c.
    Ca&ac!(a(ea !nd!v!d+"+! de a rec+noaO(e c7 o'ses!!"e sa+ co%&+"s!!"e s+n(
    e<ces!ve s! ne@+s(!.!ca(e s+rv!ne &e +n con(!n++%. La +n!! !nd!v!/! c+ (+"'+rare
    o'ses!vo4co%&+"s!v7, (es(area rea"!(7=!! &oa(e .! &!erd+(7 !ar o'ses!a &oa(e a(!n$e
    &ro&or=!! de"!ran(e Ede e<., conv!n$erea c+!va c7 a ca+/a( %oar(ea +ne! &ersoane
    &r!n .a&(+" c7 !4a dor!(4oJ. :n as(.e" de ca/+r!, &re/en=a e"e%en(e"or &s!o(!ce &oa(e
    .! !nd!ca(7 &r!n(r4+n d!a$nos(!c ad!=!ona" de (+"'+rare de"!ran(7 sa+ de (+"'+rare
    &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e. S&ec!.!can(+" Sc+ conO(!!n=a %a"ad!e! red+s7T &oa(e
    .! +(!" :n ace"e s!(+a=!! care s+n( "a "!%!(a d!n(re o'ses!e s! !deea de"!ran(7 Ede e<., +n
    !nd!v!d a c7r+! &reoc+&are e<(re%7 de con(a%!nare, deO! e<a$era(7, es(e %a! &+=!n
    !n(ens7 decA( :n(r4o (+"'+rare de"!ran(7 s! es(e @+s(!.!ca(7 de .a&(+" c7 $er%en!! s+n(
    :n(r4adev7r +'!c+!(ar!J.
    Ide!"e de"!ran(e r+%!na(!ve s! co%&or(a%en(e"e s(ereo(!&e '!/are care s+rv!n :n
    sc!/o.ren!e se d!s(!n$ de o'ses!! s! de co%&+"s!! &r!n .a&(+" c7 e"e n+ s+n(
    e$od!s(on!ce O! n+ s+n( s+'!ec( de (es(are a rea"!(7=!!. Un!! !nd!v!/! &re/!n(7 :ns7
    s!%&(o%e, a(A( de (+"'+rare o'ses!vo4co%&+"s!v7, cA( O! de sc!/o.ren!e O! @+s(!.!c7
    a%'e"e d!a$nos(!ce.
    T!c+r!"e E:n (+"'+rarea (!c+r!"orJ s! %!Oc7r!"e s(ereo(!&e E:n (+"'+rarea de
    %!Ocarea s(ereo(!&7J (re'+!e s7 .!e d!s(!nse de co%&+"s!!. Un tic es(e o %!Ocare
    %o(or!e sa+ o voca"!/are s(ereo(!&7 nonr!r%!c7, rec+ren(7, ra&!d7, 'r+sc7 Ede e<.,
    c"!&!(+" Xn!c(a=!aX, &ro(r+/!a "!%'!!, c+r7=!rea .+nd+"+! $A(+"+!J. O micare stereotip6
    es(e +n co%&or(a%en( %o(or non.+nc=!ona", a&aren( &resan(, re&e(!(!v Ede e<.,
    "ov!(+" c+ ca&+", "e$7na(+" cor&+"+!, a+(ov7(7%area &r!n %+scareJ. Con(rar +ne!
    co%&+"s!!, (!c+r!"e O! %!Oc7r!"e s(ereo(!&e s+n( de re$+"7 %a! &+=!n co%&"e<e s! n+
    s+n( des(!na(e s7 ne+(ra"!/e/e o o'ses!e. Un!! !nd!v!/! &re/!n(7 s!%&(o%e, a(A( de
    IR9 Tulburrile Anxioase
    (+"'+rare o'ses!vo4co%&+"s!v7, cA( s! de (!c E:n s&ec!a" de (+"'+rare To+re((eJ, s!
    a%'e"e d!a$nos(!ce &o( .! @+s(!.!ca(e.
    Une"e ac(!v!(7=!, c+% ar .! %Anca(+" Ede e<., (+"'+r7r!"e de co%&or(a%en(
    a"!%en(arJ, co%&or(a%en(+" se<+a" Ede e<., &ara.!"!!"eJ, @oc+" de Oans7 Ede e<., @oc+"
    de Oans7 &a(o"o$!cJ sa+ +/+" de o s+'s(an=7 Ede e<., de&enden=a sa+ a'+/+" de
    a"coo"J cAnd s+n( :n(re&r!nse :n %od e<ces!v, s+n( den+%!(e Sco%&+"s!veT. Aces(e
    ac(!v!(7=! n+ s+n( :ns7 cons!dera(e a .! co%&+"s!!, aOa c+% s+n( aces(ea de.!n!(e :n
    aces( %an+a", &en(r+ c7 de re$+"7 &ersoana :O! &roc+r7 &"7cere d!n ac(!v!(a(e s!
    &oa(e dor! s74! re/!s(e n+%a! d!n ca+/a consec!n=e"or sa"e de"e(ere.
    DeO! (+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7 O! (+"'+rarea o'ses!vo4
    co%&+"s!v7 a+ n+%e s!%!"are, %an!.es(7r!"e c"!n!ce a"e aces(or (+"'+r7r! s+n( .oar(e
    d!.er!(e.T+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7 n+ se carac(er!/ea/7 &r!n
    &re/en=a o'ses!!"or sa+ a co%&+"s!!"or, c! !%&"!c7, :n sc!%', +n &a((ern &ervas!v de
    &reoc+&are &en(r+ ord!ne, &er.ec=!on!s% O! con(ro" s! (re'+!e s7 :ncea&7 &recoce :n
    v!a=a ad+"(7. Dac7 +n !nd!v!d &re/!n(7 s!%&(o%e, a(A( de (+"'+rare o'ses!vo4
    co%&+"s!v7, cA( O! de (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7, &o( .! &+se
    a%'e"e d!a$nos(!ce.
    S+&ers(!=!!"e s! co%&or(a%en(e"e de ver!.!care re&e(!(!ve s+n( :n(A"n!(e .recven(
    :n v!a=a de .!ecare /!. Un d!a$nos(!c de (+"'+rare o'ses!vo4co%&+"s!v7 (re'+!e "+a(
    :n cons!dera=!e, n+%a! dac7 es(e e<(re% de cons+%a(or de (!%& sa+ d+ce "a o
    de(er!orare sa+ de(res7 se%n!.!ca(!v7 c"!n!c.
    Criteriile $e $ia/no&ti# pentru
    4++.4 Tul-urarea O-&e&ivo-Co"pul&iv(
    A2 'ie obsesii sau compulsiiD
    ;bsesii, a9a cum sunt de"inite de (*), ()), (&) 9i (()'
    (1) !@nduri, impulsuri sau ima!ini persistente si recurente care sunt expe-
    rientate, la un moment dat "n cursul tulburrii, ca intrusive si inadecvate,
    si care cau(ea( o anxietate sau detres considerabil3
    (2) !@ndurile, impulsurile sau ima!inile nu sunt pur si simplu
    preocupri
    excesive "n le!tur cu probleme reale de via3
    (3) persoana "ncearc s i!nore sau s suprime ast$el de !@nduri,
    impulsuri
    sau ima!ini, ori s le neutrali(e(e cu alte !@nduri sau aciuni3
    (4) persoana recunoa,te c !@ndurile, impulsurile sau ima!inile obsesive sunt
    un
    produs al propriei sale mini &nu impuse din a$ar, ca "n inseria de !@nduri)2
    Compulsii, a9a cum sunt de"inite de (*) 9i ())'
    (1) comportamente repetitive &de ex2, splatul m@inilor,
    ordonatul,
    veri$icatul) sau acte mentale &de ex2, ru!atul, calculatul, repetarea de
    cuvinte "n !@nd) pe care persoana se simte constr@ns s le e$ectue(e ca
    rspuns la o obsesie, ori con$orm unor re!uli care trebuie s $ie aplicate
    "n mod ri!id3
    (2) comportamentele sau actele mentale sunt destinate s previn sau
    s
    reduc detres, ori s previn un eveniment sau o si tuaie temut
    oarecare3 "ns, aceste comportamente sau acte mentale, sau nu sunt
    conectate "n mod realist cu ceea ce sunt destinate s neutrali(e(e sau s
    previn, ori sunt clar excesive2
    45628E Stresul
    #osttraumatic
    7=4

    Criteriile $e $ia/no&ti# pentru
    4++.4 Tul-urarea O-&e&ivo-Co"pul&iv( (continuare)
    S2 La un moment dat "n cursul tulburrii, persoana a recunoscut c obsesiile sau
    compulsiilesunt excesive sau iraionale2 FotD Aceasta nu se aplic la copii2
    2 Obsesiile sau compulsiile cau(ea( o detres marcat , sunt consumatoare
    de timp &iau mai mult de o or pe (i) sau inter$erea( semni$icativ cu rutina
    normal a persoanei, cu $uncionarea pro$esional &sau ,colar) ori cu
    activitile sau relaiile sociale u(uale2
    D2 Dac este pre(ent o alt tulburare pe axa l, coninutul obsesiilor sau
    compulsiilor nu este restr@ns la aceasta &de ex2, preocuparea pentru
    m@ncare, "n pre(ena unei tulburri de comportament alimentar3 smul!erea
    prului, "n pre(ena tricotilomaniei3 preocupare re$eritoare la aspect, "n
    pre(ena tulburrii dismor$ice corporale3 preocupare re$eritoare la a avea o
    maladie sever, "n pre(ena %ipocondriei3 preocupare pentru necesitile
    sau $ante(iile sexuale, "n pre(ena unei para$ilii, ori ruminaii re$eritoare la
    culp, "n pre(ena tulburrii depresive ma0ore)2
    *2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) ori ale unei condiii medicale
    !enerale2
    De speci"icat dacD
    u con,tiina maladiei redusD dac cea mai mare parte a timpului "n cursul
    episodului curent, persoana nu recunoa,te c obsesiile ,i compulsiile sunt
    excesive sau ne0usti$icate
    4+5.>* Stre&ul Po&ttrau"ati#
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" s(res+"+! &os((ra+%a(!c :" cons(!(+!e a&ar!=!a de s!%&(o%e
    carac(er!s(!ce +r%And e<&+ner!! "a +n s(resor (ra+%a(!c e<(re%, care !%&"!c7
    e<&er!en(area &ersona"7 d!rec(7 a +n+! even!%en( co%&or(And %oar(ea e.ec(!v7 sa+
    a%en!n=area c+ %oar(ea, or! o v7(7%are ser!oas7 sa+ o a%en!n=are a !n(e$r!(7=!!
    cor&ora"e &ro&r!!8 .a&(+" de a .! %ar(or "a +n even!%en( care !%&"!c7 %oar(ea,
    v7(7%area sa+ a%en!n=area !n(e$r!(7=!! cor&ora"e a a"(e! &ersoane8 a a."a des&re
    %oar(ea v!o"en(7 sa+ !no&!na(7, des&re v7(7%area ser!oas7, or! des&re a%en!n=area
    c+ %oar(ea or! v7(7%area s+.er!(7 de +n %e%'r+ a" .a%!"!e! sa+ de +n a"( asoc!a(
    a&ro&!a( Ecr!(er!+" A"J. R7s&+ns+" &ersoane! "a even!%en( (re'+!e s7 co%&or(e .r!ca
    !n(ens7, ne&+(!n=a sa+ oroarea Esa+, "a co&!!, r7s&+ns+" (re'+!e s7 !%&"!ce
    co%&or(a%en(+" a$!(a( sa+ de/or$an!/a(J Ecr!(er!+" A9J. S!%&(o%e"e carac(er!s(!ce
    re/+"(And d!n e<&+nerea "a o (ra+%7 e<(re%7 !nc"+d ree<&er!en(area &ers!s(en(7 a
    even!%en(+"+! (ra+%a(!c Ecr!(er!+" BJ, ev!(area &ers!s(en(7 a s(!%+"!"or asoc!a=! c+
    (ra+%a s! &ara"!/!a reac(!v!(7=!! $enera"e Ecr!(er!+" CJ O! s!%&(o%e &ers!s(en(e de
    e<c!(a=!e cresc+(7 Ecr!(er!+" DJ. Ta'"o+" s!%&(o%a(o"o$!e co%&"e( (re'+!e s7 .!e
    &re/en( (!%& de ce" &+=!n o "+n7 Ecr!(er!+" EJ, !ar &er(+r'area (re'+!e s7 ca+/e/e o
    HIH Tulburrile Anxioase
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n
    a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" FJ
    Even!%en(e"e (ra+%a(!ce care s+n( e<&enen(a(e d!rec( !nc"+d, dar n+ s+n(
    "!%!(a(e doar "a aces(ea, "+&(a ar%a(7, a(ac+" &ersona" v!o"en( Ea(ac se<+a", a(ac
    cor&ora", &r7dare, a(ac 'and!(escJ, .a&(+" de a .! r7&!(, de a .! "+a( os(a(ec, a(ac+"
    (eror!s(, (or(+ra, :ncarcerarea ca &r!/on!er de r7/'o! sa+ :n(r4+n "a$7r de
    concen(rare, de/as(re"e na(+ra"e sa+ &rovoca(e de o%, acc!den(e"e de a+(o%o'!"
    severe or! a .! d!a$nos(!ca( c+ o %a"ad!e care a%en!n=7 v!a=a La co&!!, even!%en(e"e
    (ra+%a(!ce se<+a"e &o( !nc"+de e<&er!en=e"e se<+a"e !nadecva(e d!n &+nc(+" de
    vedere a" de/vo"(7r!!, .7r7 v!o"en(7 or! v7(7%are A .! %ar(or "a even!%en(e !nc"+de,
    dar n+ se "!%!(ea/7 "a aces(ea, as!s(area "a v7(7%area $rav7 or! %oar(ea nena(+ra"7
    a +ne! a"(e &ersoane da(ora(7 +n+! a(ac v!o"en(, +n+! acc!den(, r7/'o! sa+ de/as(r+,
    or! vederea !no&!na(7 a +n+! cadavr+ sa+ a +ne! &7r=! de cadavr+ Even!%en(e"e
    e<&enen(a(e de a"=!! s! des&re care a a."a( !nc"+d, dar n+ se "!%!(ea/7 "a aces(ea,
    a(ac+" v!o"en( "a &ersoan7, +n acc!den( or! o v7(7%are $rav7 s+.er!(7 de +n %e%'r+
    a" .a%!"!e! sa+ de +n a%!c a&ro&!a(, a."area sn! %or=!! !no&!na(e, s+'!(e, a +n+!
    %e%'r+ a" .a%!"!e! or! a +n+! a%!c a&ro&!a(, or! a."area .a&(+"+! c7 &ro&r!+" s7+
    co&!" are o %a"ad!e care4! a%en!n=7 v!a(a T+"'+rarea &oa(e .! e<(re% de sever7 sa+
    de "+n$7 d+ra(7, cAnd s(resor+" es(e de &re%ed!(are +%an7 Ede e<, (or(+ra, v!o"+"J
    Pro'a'!"!(a(ea a&ar!=!e! aces(e! (+"'+r7r! &oa(e cres(e &e %7s+r7 ce !n(ens!(a(ea O!
    a&ro&!erea .!/!c7 de s(resor cresc
    Even!%en(+" (ra+%a(!c &oa(e .! ree<&enen(a( :n d!verse %od+r! Frecven(,
    &ersoana are a%!n(!r! %(r+s!ve s! rec+ren(e a"e even!%en(+"+! Ecr!(er!+" B"J or! v!se
    de(resan(e rec+ren(e :n c+rs+" c7rora even!%en(+" es(e re@+ca( sa+ sa+ a"(.e"
    re&re/en(a( Ecr!(er!+" B9J :n ca/+r! rare, &ersoana e<&enen(ea/7 s(7r! d!soc!a(!ve
    care d+rea/7 de "a cA(eva sec+nde &An7 "a cA(eva ore sa+ c!ar /!"e :n (!%&+" c7rora
    co%&onen(e"e even!%en(+"+! s+n( re(r7!(e, !ar &ersoana se co%&or(7 ca s! c+% ar
    e<&er!en=a even!%en(+" :n ace" %o%en( Ecr!(er!+" B;J Aces(e e&!soade, den+%!(e
    adesea S."as4'ac)4+nTs+n( de re$+"7 sc+r(e, dar &o( .! asoc!a(e c+ de(res7
    &re"+n$!(7 s! e<c!(a=!e cresc+(7 O de(res7 &s!o"o$!c7 !n(ens7 Ecr!(er!+" BIJ sa+ o
    reac(!v!(a(e .!/!o"o$!c7 !n(ens7 Ecr!(er!+" BYJ s+rv!n adesea, cAnd &ersoana es(e
    e<&+s7 "a even!%en(e dec"ansan(e care sea%7n7 c+, sa+ s!%'o"!/ea/7 +n as&ec( a"
    even!%en(+"+! (ra+%a(!c Ede e< , an!vers7r!"e even!%en(+"+! (ra+%a(!c, .r!$+", !arna
    sa+ $7r/!"e :n +n!.or%7, &en(r+ s+&rav!e=+!(or!! "a$7re"or %or(n d!n c"!%a(e"e rec!,
    c7"d+ra, +%e/ea"a, &en(r+ ve(eran!! "+&(e"or d!n Pac!.!c+" de S+d, !n(rarea :n or!ce
    ascensor a +ne! .e%e! care a .os( v!o"a(7 :n ascensorJ
    S(!%+"n asoc!a=! c+ (ra+%a s+n( ev!(a=! :n %od &ers!s(en( Persoana .ace de
    re$+"7 e.or(+r! de"!'era(e &en(r+ a ev!(a $And+n"e, sen(!%en(e"e sa+ conversa=!!"e
    des&re even!%en(+" (ra+%a(!c Ecr!(er!+" CIJ O! &en(r+ a ev!(a ac(!v!(7=!"e, s!(+a=!!"e
    sa+ &ersoane"e care deO(ea&(7 a%!n(!r! des&re aces(a Ecr!(er!+" C9J Ev!(area
    a%!n(!r!"or &oa(e !nc"+de a%ne/!a &en(r+ +n as&ec( !%&or(an( a" even!%en(+"+!
    (ra+%a(!c Ecr!(er!+" C;J D!%!n+area reac(!v!(7=!! "a "+%ea e<(ern7, den+%!(7
    &ara"!/!e &s!!c7T sa+ Sanes(e/!e e%o=!ona"7T :nce&e de re$+"7 c+rAnd d+&7
    even!%en(+" (ra+%a(!c Ind!v!d+" se &oa(e &"An$e de sc7derea cons!dera'!"7 a
    2n(eres+"+! sa+ &ar(!c!&7r!! "a ac(!v!(7=! &"7c+(e an(er!or Ecr!(er!+" CIJ, de .a&(+" c7 se
    s!%(e de(aOa( sa+ :ns(r7!na( de a"=! oa%en! Ecr!(er!+" CYJ or! c7 are o ca&ac!(a(e
    cons!dera'!" red+s7 de a s!%=! e%o=!!"e E:n s&ec!a" &e ce"e asoc!a(e c+ !n(!%!(a(ea,
    (andre=ea s! se<+a"!(a(eaJ Ecr!(er!+" CRJ De ase%enea, !nd!v!d+" &oa(e avea
    sen(!%en(+" de v!!(or :n$+s(a( En+ se aO(ea&(7 s74s! .ac7 o car!er7, s7 se c7s7(oreasc7,
    s7 a!'7 co&!! or! o d+ra(7 nor%a"7 de v!a(7J Ecr!(er!+" CHJ
    45628E Stresul
    #osttraumatic
    7=<
    Ind!v!d+" are s!%&(o%e &ers!s(en(e de an<!e(a(e sa+ de e<c!(a=!e cresc+(7 care n+
    era+ &re/en(e :na!n(e de (ra+%7. Aces(e s!%&(o%e &o( !nc"+de d!.!c+"(7=! de
    ador%!re sa+ de a r7%Ane ador%!(, care se &o( da(ora coO%ar+r!"or rec+ren(e s! :n
    c+rs+" c7rora es(e re(r7!( even!%en(+" (ra+%a(!c Ecr!(er!+" D"J, !&erv!$!"!(a(e
    Ecr!(er!+" DIJ, +n r7s&+ns de (res7r!re e<a$era( Ecr!(er!+" DYJ. Un!! !nd!v!/! re"a(ea/7
    !r!(a'!"!(a(e sa+ accese co"eroase Ecr!(er!+" D9J or! d!.!c+"(a(e :n concen(rare sa+ :n
    e.ec(+area sarc!n!"or Ecr!(er!+" D;J.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a s&ec!.!ca de'+(+" s! d+ra(a
    s!%&(o%e"or s(res+"+! &os((ra+%a(!cQ
    Ac+(. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( cAnd d+ra(a s!%&(o%e"or es(e de
    %a! &+=!n de ; "+n!.
    Cron!c. Aces( s&ec!.!can( (re'+!e +(!"!/a( cAnd s!%&(o%e"e d+rea/7 (!%& de ;
    "+n! sa+ %a! %+"(.
    C+ de'+( (ard!v. Aces( s&ec!.!can( !nd!c7 .a&(+" c7 a+ (rec+( ce" &+=!n R "+n!
    :n(re even!%en(+" (ra+%a(!c s! de'+(+" s!%&(o%e"or.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Ind!v!/!! c+ s(res
    &os((ra+%a(!c &o( descr!e sen(!%en(e de c+"&7 &en!'!"e re.er!(oare "a .a&(+" c7 e!
    a+ s+&rav!e=+!( :n (!%& ce a"=!! n+, or! re.er!(oare "a "+cr+r!"e &e care "e4a+ .7c+(
    &en(r+ a s+&rav!e=+!. Pa((ern+r!"e de ev!(are &o( !n(er.era !n(er.era c+ re"a=!!"e
    !n(er&ersona"e s! d+ce "a con."!c( %ar!(a", d!vor= sa+ &!erderea serv!c!+"+!, :n +ne"e
    ca/+r! cron!ce s! severe &o( .! &re/en(e a"+c!na=!! a+d!(!ve s! !dea=!a &arano!d7.
    Ur%7(oare"e cons(e"a=!! de s!%&(o%e asoc!a(e &o( s+rven! s! s+n( %a! .recven(
    o'serva(e :n asoc!ere c+ +n s(resor !n(er&ersona" Ede e<., %a"(ra(area cor&ora"7 sa+
    a'+/+" se<+a" :n co&!"7r!e, '7(7!"e de acas7JQ de(er!orarea %od+"7r!! a.ec(!ve,
    co%&or(a%en( !%&+"s!v .s! a+(od!s(r+c(!v, s!%&(o%e d!soc!a(!ve, ac+/e so%a(!ce,
    sen(!%en(e de !ne.!c!en(7, r+O!ne, d!s&erare sa+ "!&sa de s&eran=7, sen(!%en(+" de
    &re@+d!c!ere &er%anen(7, &!erderea conv!n$er!"or s+s=!n+(e an(er!or, os(!"!(a(e,
    re(ra$ere soc!a"7, sen(!%en(+" de a%en!n=are &er%anen(7, de(er!orarea re"a=!!"or c+
    ce!"a"=!! or! o %od!.!care a carac(er!s(!c!"or &ersona"!(7=!! an(er!oare a !nd!v!d+"+!.
    S(res+" &os( (ra+%a(!c es(e asoc!a( c+ +n r!sc cresc+( de (+"'+rare de&res!v7
    %a@or7, (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7, &an!c7, a$ora.o'!e, (+"'+rare o'ses!vo4
    co%&+"s!v7, an<!e(a(e $enera"!/a(7, .o'!e soc!a"7, .o'!e s&ec!.!c7 O! (+"'+rare
    '!&o"ar7 II. Aces(e (+"'+r7r! &o( &recede, s+ccede sa+ a&are conco%!(en( c+ de'+(+"
    s(res+"+! &os((ra+%a(!c.
    Da(e de "a'ora(or asoc!a(e. E<c!(a=!a cresc+(7 &oa(e .! %7s+ra(7 &r!n s(+d!!
    re.er!(oare "a .+nc=!onarea ve$e(a(!v7 Ede e<., r!(% card!ac, e"ec(ro%!o$ra.!e,
    ac(!v!(a(ea $"ande"or s+dor!&areJ.
    Da(e"e e<a%!n7r!! so%a(!ce O! cond!=!!"e %ed!ca"e asoc!a(e. Dre&( consec!n=7
    d!rec(7 a (ra+%e! &o( s+rven! "e/!+n! so%a(!ce, :n &"+s, s(res+" &os((ra+%a(!c cron!c
    &oa(e .! asoc!a( c+ +n &rocen( cresc+( de ac+/e so%a(!ce s!, &os!'!", de cond!=!!
    %ed!ca"e $enera"e.
    HII Tulburrile Anxioase
    *lemente speci$ice culturii si etii
    Ind!v!/!! care a+ e%!$ra( recen( d!n /one de .r7%An(are soc!a"7 cons!dera'!"7 s! de
    con."!c( c!v!" &o( avea &rocen(e r!d!ca(e de s(res &os((ra+%a(!c. As(.e" de !nd!v!/! &o( .!
    e<(re% de re.rac(ar! "a a d!v+"$a e<&er!en=e"e de (or(+r7 s! (ra+%e"e s+.er!(e d!n ca+/a
    s(a(+(+"+! "or v+"nera'!" de !%!$ran=! &o"!(!c!. Pen(r+ as(.e" de !nd!v!/! s+n( necesare
    eva"+7r! s&ec!.!ce a"e e<&er!en=e"or (ra+%a(!ce s! a"e s!%&(o%e"or conco%!(en(e.
    La co&!!! %a! %!c!, v!se"e de(resan(e a"e even!%en(+"+! se &o( sc!%'a :n dec+rs
    de cA(eva s7&(7%An! :n coO%ar+r! $enera"!/a(e c+ %onO(r!, c+ sa"vare de c7(re a"=!!,
    or! de a%en!n=7r! "a adresa "or sa+ a a"(ora. Co&!!! %a! %!c! n+ a+ de re$+"7
    sen(!%en(+" c7 e! ree<&er!en(ea/7 (rec+(+"8 ree<&er!en(area (ra+%e! &oa(e s+rven!
    %a! c+rAnd &r!n @oc re&e(!(!v Ede e<., +n co&!" care a .os( !%&"!ca( :n(r4+n acc!den(
    de a+(o%o'!" $rav recons(!(+!e :n %od re&e(a( d!s(r+$erea a+(o%o'!"+"+! c+
    a+(o%o'!"e @+c7r!eJ. Deoarece &oa(e .! d!.!c!" &en(r+ co&!! s7 re"a(e/e sc7derea
    !n(eres+"+! &en(r+ ac(!v!(7=! !%&or(an(e s! cons(r!c=!a a.ec(+"+!, aces(e s!%&(o%e
    (re'+!e s7 .!e eva"+a(e a(en( &r!n re"a(7r! d!n &ar(ea &7r!n=!"or, :nv7=7(or!"or s! a a"(or
    o'serva(or!. La co&!!, sen(!%en(+" de v!!(or :n$+s(a( &oa(e .! ev!den=!a( &r!n
    conv!n$erea c7 v!a=a "or va .! &rea sc+r(7 &en(r+ a "e &+(ea &er%!(e s7 dev!n7 ad+"=!.
    Poa(e e<!s(a, de ase%enea, So%en .or%a(!onT, ad!c7, cred!n=a :n ca&ac!(a(ea de a
    &revedea even!%en(e ne.avora'!"e v!!(oare. De ase%enea, co&!!! &o( &re/en(a
    d!verse s!%&(o%e so%a(!ce, de e<e%&"+, d+rer! a'do%!na"e s! ce.a"e!.
    #revalent
    S(+d!!"e &e 'a/7 co%+n!(ar7 !nd!c7 o &reva"en(7 &e v!a=7 a s(res+"+!
    &os((ra+%a(!c de a&ro<!%a(!v Gd :n &o&+"a=!a ad+"(7 d!n S(a(e"e Un!(e. Ac(+a"%en(e
    n+ se d!s&+ne de !n.or%a=!! re.er!(oare "a &reva"en(a :n &o&+"a=!a $enera"7 d!n a"(e
    =7r!. S(+d!!"e &e !nd!v!/!! e<&+O! r!sc+"+! Ede e<., $r+&+r! e<&+se +nor !nc!den(e
    (ra+%a(!ce s&ec!.!ceJ o.er7 da(e var!a'!"e, c+ ce"e %a! %ar! ra(e E%er$And de T"a 5X;
    "a %a! %+"( de 5X9 d!n(re ce! e<&+O!J cons(a(a(e &r!n(re s+&rav!e=+!(or!! +n+! v!o",
    "+&(e! s! ca&(!v!(7=!!, !n(ern7r!"or &e %o(!ve e(n!ce O! &o"!(!ce s! $enoc!d+"+!.
    *voluie
    S(res+" &os((ra+%a(!c &oa(e s+rven! "a or!ce e(a(e, !nc"+s!v :n co&!"7r!e.
    S!%&(o%e"e a&ar de re$+"7 :n &r!%e"e ; "+n! d+&7 (ra+%7, deO! &oa(e e<!s(a o
    :n(Ar/!ere de "+n! O! c!ar de an! &An7 "a a&ar!=!a "or. Frecven(, reac=!a &ersoane! "a
    (ra+%7 sa(!s.ace %a! :n(A! cr!(er!!"e &en(r+ (+"'+rarea s(res+" ac+( Eve/! &a$. IRFJ, ca
    o consec!n=7 !%ed!a(7 a (ra+%e!. S!%&(o%e"e (+"'+r7r!! s! &redo%!nan=a re"a(!v7 a
    ree<&er!en(7r!!, ev!(area O! s!%&(o%e"e de !&ere<c!(a=!e &o( var!a :n dec+rs+"
    (!%&+"+!. D+ra(a s!%&(o%e"or var!a/7, rec+&erarea co%&"e(7 s+rven!nd :n dec+rs
    de ; "+n! :n a&ro<!%a(!v @+%7(a(e d!n ca/+r!, dar s! c+ %+"=! a"=!! avAnd s!%&(o%e
    care &ers!s(7 %a! %+"( de 59 "+n! d+&7 (ra+%7, :n +ne"e ca/+r!, evo"+=!a es(e
    carac(er!/a(7 &r!n a%e"!orarea O! a$ravarea s!%&(o%e"or. Reac(!varea s!%&(o%e"or
    &oa(e s+rven! ca r7 s&+ns "a rea%!n(!rea (ra+%e! or!$!na"e, a s(resor!"or de v!a=7 sa+
    a even!%en(e"or (ra+%a(!ce no!.
    Sever!(a(ea, d+ra(a s! &ro<!%!(a(ea e<&+ner!! "a even!%en(+" (ra+%a(!c a +n+!
    !nd!v!d s+n( ce! %a! !%&or(an=! .ac(or! care a.ec(ea/7 &ro'a'!"!(a(ea a&ar!=!e! aces(e!
    (+"'+r7r!. E<!s(7 +ne"e da(e, &rec+% c7 s+&or(+" soc!a", !s(or!c+" .a%!"!a",
    e<&er!en=e"e d!n co&!"7r!e, var!a'!"e"e &ersona"!(7=!! s! &ree<!s(en(a (+"'+r7r!"or
    %en(a"e &o( !n."+en=a a&ar!=!a s(res+"+! &os((ra+%a(!c. Aceas(7 (+"'+rare &oa(e
    a&are s! "a !nd!v!/! .7r7 n!c! +n .e" de cond!=!! &red!s&o/an(e, :n s&ec!a" dac7
    s(resor+" es(e e<(re%.
    45628E Stresul
    #osttraumatic
    IRH

    #attern $amilial
    E<!s(7 da(e des&re o co%&onen(7 ered!(ar7 :n (rans%!s!a s(res+"+! &os((ra+%a(!c.
    :n a.ar7 de aces(a, a .os( re"a(a( c7 +n !s(or!c de de&res!e "a r+de"e de $rad+" I cres(e
    v+"nera'!"!(a(ea "a a&ar!=!a s(res+"+! &os((ra+%a(!c.
    Dia!nostic di$erenial
    :n s(res+" &os((ra+%a(!c, s(resor+" (re'+!e s7 .!e de o na(+r7 e<(re%7 Ead!c7, s7
    &er!c"!(e/e v!a=aJ. D!n con(ra, :n (+"'+rarea de ada&(are, s(resor+" &oa(e .! de or!ce
    sever!(a(e. D!a$nos(!c+" de (+"'+rare de ada&(are es(e adecva(, a(A( &en(r+ s!(+a=!!"e
    :n care r7s&+ns+" "a +n s(resor e<(re% n+ sa(!s.ace cr!(er!!"e &en(r+ s(res+"
    &os((ra+%a(!c Esa+ &en(r+ a"(7 (+"'+rare %en(a"7 s&ec!.!c7J, cA( s! &en(r+ s!(+a=!!"e
    :n care &a((ern+" s!%&(o%a(o"o$!e a" s(res+"+! &os((ra+%a(!c s+rv!ne ca r7s&+ns "a
    +n s(resor care n+ es(e e<(re% Zde e<., &"ecarea so=+"+! Eso=!e!J, a .! conced!a( E7J[.
    N+ or!ce &s!o&a(o"o$!e care a&are "a +n !nd!v!d e<&+s "a +n s(resor e<(re%
    (re'+!e s7 .!e a(r!'+!(7 :n %od e<&res s(res+"+! &os((ra+%a(!c. S!%&(o%e"e de ev!(are,
    s!derare s! creO(ere a e<c!(a=!e! care s+n( &re/en(e :na!n(ea e<&+ner!! "a s(resor n+
    sa(!s.ac cr!(er!!"e &en(r+ d!a$nos(!c+" de s(res &os((ra+%a(!c s! neces!(7 "+area :n
    cons!dera=!e a a"(or d!a$nos(!ce Ede e<., o (+"'+rare a.ec(!v7 sa+ a"(7 (+"'+rare
    an<!oas7J, :n a.ar7 de aceas(a, dac7 &a((ern+" de r7s&+ns s!%&(o%a(o"o$!e "a s(resor+"
    e<(re% sa(!s.ace cr!(er!!"e &en(r+ a"(7 (+"'+rare %en(a"7 Ede e<., (+"'+rarea &s!o(!c7
    sc+r(7, (+"'+rarea de convers!e, (+"'+rarea de&res!v7 %a@or7J, aces(e d!a$nos(!ce
    (re'+!e s7 .!e &+se :n "oc+" sa+ ad!=!ona" d!a$nos(!c+"+! de s(res &os((ra+%a(!c.
    S(res+" ac+( se d!s(!n$e de s(res+" &os((ra+%a(!c &r!n .a&(+" c7 &a((ern+"
    s!%&(o%a(o"o$!e :n s(res+" ac+( (re'+!e s7 s+rv!n7 s! s7 se re/o"ve :n dec+rs de I
    s7&(7%An! de "a even!%en(+" (ra+%a(!c. Dac7 s!%&(o%e"e &ers!s(7 %a! %+"( de "
    "+n7 s! sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea s(res+" &os((ra+%a(!c, d!a$nos(!c+" es(e
    sc!%'a( d!n ce" de s(res ac+( :n ce" de s(res &os((ra+%a(!c.
    :n (+"'+rarea o'ses!vo4co%&+"s!v7 e<!s(7 $And+r! !n(r+s!ve rec+ren(e, dar
    aces(ea s+n( e<&er!en(a(e ca !nadecva(e s! n+ s+n( :n "e$7(+r7 c+ +n even!%en(
    (ra+%a(!c e<&er!en(a(. F"as'ac)4+r!"e d!n s(res+" &os((ra+%a(!c (re'+!e s7 .!e
    d!s(!nse de !"+/!!, a"+c!na=!! s! a"(e &er(+r'7r! de &erce&=!e care &o( s+rven! :n
    sc!/o.ren!e, a"(e (+"'+r7r! &s!o(!ce, (+"'+rarea a.ec(!v7 c+ e"e%en(e &s!o(!ce,
    de"!r!+%, (+"'+r7r!"e !nd+se de o s+'s(an=7 s! (+"'+r7r!"e &s!o(!ce da(ora(e +ne!
    cond!=!! %ed!ca"e $enera"e.
    S!%+"area (re'+!e s7 .!e e<c"+s7 :n ace"e s!(+a=!! :n care re%+nera=!a .!nanc!ar7,
    o&or(+n!(a(ea 'ene.!c!+"+! s! dec!/!!"e %ed!co"e$a"e @oac7 +n ro".
    Criteriile $e $ia/no&ti# pentru
    4+5.>* Stre&ul Po&ttrau"ati#
    A2 #ersoana a $ost expus unui eveniment traumatic "n care ambele dintre cele
    care urmea( sunt pre(enteD
    (1)persoana a experientat, a $ost martor ori a $ost con$runtat cu un eve
    niment sau evenimente care au implicat moartea e$ectiv, ameninarea
    cu moartea ori o vtmare serioas sau o periclitare a inte!ritii
    corporale proprii ori a altora,
    (2)rspunsul persoanei a implicat o $ric intens, neputin sau oroare2
    FotD La copii, aceasta poate $i exprimat, "n sc%imb, printr-un comporta
    ment de(or!ani(at sau a!itat2
    Ni
    7=> Tulburrile Anxioase
    Criteriile $e $ia/no&ti# pentru
    4+5.>* Stre&ul Po&ttrau"ati# (continuare)
    <, *venimentul traumatic este reexperimentat persistent "ntr-unul &sau mai
    multe) din urmtoarele moduriD
    (1) amintiri detresante recurente si intrusive ale evenimentului, inclu(@nd
    ima!ini, !@nduri sau percepii2 FotD La copii mici, poate surveni un 0oc
    repetitiv "n care sunt exprimate teme sau aspecte ale traumei3
    (2) vise detresante recurente ale evenimentului2 FotD La copii, pot exista
    vise teri$iante $r un coninut reco!noscibil3
    (3) aciune ,i simire, ca ,i cum evenimentul traumatic ar $i $ost recurent
    &include sentimentul retririi experienei, ilu(ii, %alucinaii si episoade
    disociative de $la%bacC, inclusiv cele care survin la de,teptarea din somn
    sau c@nd este intoxicat)2 FotD La copiii mici poate surveni reconstituirea
    traumei speci$ice3-
    &H)detres psi%olo!ic intens la expunerea la stimuli interni sau externi
    care simboli(ea( sau seamn cu un aspect al evenimentului traumatic3
    &4) reactivitate $i(iolo!ic la expunerea la stimuli interni sau externi care
    simboli(ea( sau seamn cu un aspect al evenimentului traumatic2
    2 *vitarea persistent a stimulilor asociai cu trauma ,i parali(ia reactivitii
    !enerale &care nu era pre(ent "naintea traumei), dup cum este indicat de
    trei &sau mai multe) dintre urmtoareleD
    (1) e$orturi de a evita !@ndurile, sentimentele sau conversaiile asociate cu trauma3
    (1) e$orturi de a evita activiti, locuri sau persoane care de,teapt amintiri
    ale traumei3
    (2) incapacitatea de a evoca un aspect important al traumei3
    (3) diminuare marcat a interesului sau participrii la activiti semni$icative3
    (4) sentiment de deta,are sau de "nstrinare de alii3
    (5) !am restr@ns a a$ectului &de ex2, este incapabil s aib sentimente de amor)3
    (2) sentimentul de viitor "n!ustat &de ex2, nu sper s-,i $ac o carier, s se
    cstoreasc, s aib copii ori o durat de via normal)2
    D2 Simptome persistente de excitaie crescut &care nu erau pre(ente "nainte de
    traum), dup cum este indicat de dou &sau de mai multe) dintre urmtoareleD
    (1) di$icultate "n adormire sau "n a rm@ne adormit3
    (2) iritabilitate sau accese coleroase3
    (3) di$icultate "n concentrare3
    (4) %ipervi!ilitate3
    (5) rspuns de tresrire exa!erat2
    *2 Durata perturbrii &simptomele de la criteriile S, ,i D) este de mai mult de
    o lun2
    '2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    7e speci"icat dacD
    AcutD dac durata simptomelor este mai puin de 4 luni2 ronicD
    dac durata simptomelor este de 4 luni sau mai mult2
    De speci"icat dacD
    u debut tardivD dac debutul simptomelor survine la cel puin I luni dup stresor2
    45824 Stresul Acut
    IRF
    4+>.4 Stre&ul A#ut
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" s(res+"+! ac+( :" cons(!(+!e a&ar!=!a an<!e(7=!! carac(er!s(!ce, a
    s!%&(o%e"or d!soc!a(!ve O! a a"(or s!%&(o%e care s+rv!n :n dec+rs de o "+n7 d+&7
    e<&+nerea "a +n s(resor (ra+%a(!c e<(re% Ecr!(er!+" AJ. Pen(r+ d!sc+(area (!&+r!"or de
    s(resor! !%&"!ca=!, ve/! descr!erea s(res+"+! &osr(ra+%a(!c E&a$. IR;J. F!e :n (!%& ce
    e<&er!en(ea/7 even!%en(+" (ra+%a(!c or! d+&7 even!%en(, !nd!v!d+" are ce" &+=!n (re!
    d!n(re +r%7(oare"e s!%&(o%e d!soc!a(!veQ sen(!%en(+" s+'!ec(!v de &ara"!/!e, de
    de(aOare or! de a'sen=7 a reac(!v!(7=!! e%o=!ona"e8 o red+cere a conO(!!n=e! a%'!an=e!8
    derea"!/are, de&ersona"!/are or! a%ne/!e d!soc!a(!v7 Ecr!(er!+" BJ. D+&7 (ra+%7,
    even!%en(+" (ra+%a(!c es(e ree<&er!en(a( &ers!s(en( Ecr!(er!+" CJ, !ar !nd!v!d+"
    &re/!n(7 o ev!(are ev!den(7 a s(!%+"!"or care &o( deO(e&(a a%!n(!r! des&re (ra+%7
    Ecr!(er!+" DJ O! are s!%&(o%e %arca(e de an<!e(a(e sa+ de e<c!(a=!e cresc+(7 Ecr!(er!+" EJ.
    S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 se%n!.!ca(!v7 c"!n!c, s7 !n(er.ere/e
    se%n!.!ca(!v c+ ac(!v!(a(ea nor%a"7 or! s7 de(er!ore/e ca&ac!(a(ea !nd!v!d+"+! de a
    :nde&"!n! sarc!n!"e necesare Ecr!(er!+" FJ. Per(+r'area d+rea/7 (!%& de ce" &+=!n 9 /!"e
    s! n+ &ers!s(7 d!nco"o de I s7&(7%An! d+&7 even!%en(+" (ra+%a(!c Ecr!(er!+" ,J8 dac7
    s!%&(o%e"e &ers!s(7 %a! %+"( de &a(r+ s7&(7%An!, &oa(e .! a&"!ca( d!a$nos(!c+"
    de s(res &os((ra+%a(!c. S!%&(o%e"e n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e
    a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n %ed!ca%en(J or! a"e +ne! cond!=!!
    %ed!ca"e $enera"e, n+ s+n( e<&"!ca(e %a! '!ne de (+"'+rarea &s!o(!c7 sc+r(7 s! n+
    s+n( &+r O! s!%&"+ o e<acer'are a +ne! (+"'+r7r! %en(a"e &ree<!s(en(e Ecr!(er!+" HJ.
    Dre&( r7s&+ns "a even!%en(+" (ra+%a(!c, !nd!v!d+" de/vo"(7 s!%&(o%e
    d!soc!a(!ve. Ind!v!/!! c+ s(res ac+( a+ o d!%!n+are a reac(!v!(7=!! e%o=!ona"e, adesea
    .!!nd+"e d!.!c!" sa+ !%&os!'!" s7 e<&er!en(e/e &"7cerea :n ac(!v!(7=!"e &"7c+(e an(er!or O!,
    .recven(, se s!%( c+"&a'!"! :n "e$7(+r7 c+ +r%7r!rea sarc!n!"or +/+a"e a"e v!e=!!. E! &o(
    e<&er!en=a d!.!c+"(7=! :n concen(rare, se s!%( de(aOa=! de cor&+r!"e "or,
    e<&er!en(ea/7 "+%ea ca !rea"7 sa+ ca ase%7n7(oare v!s+"+!, or! a+ o d!.!c+"(a(e
    cresc+(7 :n a4s! a%!n(! an+%!(e de(a"!! a"e even!%en(+"+! (ra+%a(!c Ea%ne/!a
    d!soc!a(!v7J, :n a.ar7 de aceas(a, es(e &re/en( ce" &+=!n +n s!%&(o% d!n .!ecare
    $r+&7 de s!%&(o%e cer+(e &en(r+ s(res+" &os((ra+%a(!c. :n &r!%+" rAnd,
    even!%en(+" (ra+%a(!c es(e ree<&er!en(a( &ers!s(en( Ede e<,, a%!n(!r! rec+ren(e,
    !%a$!n!, $And+r!, v!se, !"+/!!, e&!soade de ."as'ac), +n sen(!%en( de ree<&er!en(are a
    even!%en(+"+! sa+ de(res7 "a e<&+nerea "a ceva ce a%!n(eO(e even!%en(+"J, :n a"
    do!"ea rAnd, es(e ev!(a( (o( ceea ce a%!n(eO(e (ra+%a Ede e<., "oc+r!, oa%en!,
    ac(!v!(7=!J, :n .!ne, es(e &re/en(7 !&ere<c!(a=!a ca r7s&+ns "a s(!%+"!! re%!n!scen=! a!
    (ra+%e! Ede e<., d!.!c+"(a(e :n ador%!re, !r!(a'!"!(a(e, concen(rare red+s7,
    !&erv!$!"!(a(e, +n r7s&+ns de (res7r!re e<a$era( O! ne"!n!O(e %o(or!eJ.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. S!%&(o%e"e de
    d!s&erare s! de desc+ra@are &o( .! e<&er!en(a(e :n s(res+" ac+( O! &o( .! s+.!c!en( de
    severe s! de &ers!s(en(e &en(r+ a sa(!s.ace cr!(er!!"e &en(r+ +n e&!sod de&res!v
    %a@or, :n care ca/ &oa(e .! @+s(!.!ca( +n d!a$nos(!c ad!=!ona" de (+"'+rare
    de&res!v7 %a@or7. Dac7 (ra+%a a d+s "a %oar(ea sa+ "a v7(7%area sever7 a c+!va,
    7G+ Tulburrile Anxioase

    s+&rav!e=+!(or!! &o( s7 se s!%(7 c+"&a'!"! &en(r+ .a&(+" c7 a+ r7%as !n(ac=! or!
    &en(r+ .a&(+" c7 n+ a+ acorda( s+.!c!en( a@+(or ce"or"a"=!. Ind!v!/!! c+ aceas(7
    (+"'+rare se &erce& adesea ca avAnd o res&onsa'!"!(a(e %a! %are &en(r+
    consec!n=e"e (ra+%e! decA( es(e @+s(!.!ca(. Po( re/+"(a &ro'"e%e d!n ne$"!@area de
    c7(re !nd!v!d a s7n7(7=!! s! a neces!(7=!"or de s!$+ran=7 .+nda%en(a"e asoc!a(e c+
    re&erc+rs!+n!"e (ra+%e!. Ind!v!/!! c+ aceas(7 (+"'+rare s+n( e<&+O! r!sc+"+! de a
    de/vo"(a s(res &os((ra+%a(!c. A+ .os( ra&or(a(e &rocen(e de s(res &os((ra+%a(!c de
    a&ro<!%a(!v GLd "a s+&rav!e=+!(or!! +nor co"!/!+n! a"e ve!c+"e"or c+ %o(or s! "a
    v!c(!%e"e +nor a$res!+n! v!o"en(e a" c7ror r7s&+ns !n!=!a" "a (ra+%7 a sa(!s.7c+(
    cr!(er!!"e &en(r+ s(res+" ac+(. D+&7 (ra+%7 &oa(e a&are +n co%&or(a%en(
    (e%erar si !%&+"s!v.
    Datele e,a"in(rii &o"ati#e /0 #on$i!iile "e$i#ale /enerale a&o#iate. Ca o
    consec!n=7 a (ra+%e! &o( a&are d!verse cond!=!! %ed!ca"e $enera"e Ede e<.,
    (ra+%a(!s%e cran!ene, ars+r!J.
    *lemente speci$ice culturii
    DeO! +ne"e even!%en(e es(e &os!'!" s7 .!e +n!versa" e<&er!en(a(e ca (ra+%a(!ce,
    sever!(a(ea s! &ar(ern+" de r7s&+ns &o( .! %od+"a(e de d!.eren=e c+"(+ra"e :n
    !%&"!ca=!!"e &!erder!!. Po( e<!s(a, de ase%enea, co%&or(a%en(e de ada&(are
    &rescr!se c+"(+ra" s! care s+n( s&ec!.!ce an+%!(or c+"(+r!. De e<e%&"+, s!%&(o%e"e
    d!soc!a(!ve &o( .! o &ar(e no(a'!"7 a r7s&+ns+"+! "a s(res+" ac+( :n c+"(+r!"e :n care
    as(.e" de co%&or(a%en(e s+n( sanc=!ona(e. Pen(r+ d!sc+(area %a! de(a"!a(7 a
    .ac(or!"or c+"(+ra"! :n "e$7(+r7 c+ even!%en(e"e (ra+%a(!ce, ve/! &a$. IRR.
    #revalent
    Preva"en(a s(res+"+! ac+( :n(r4o &o&+"a=!e e<&+s7 +n+! s(res (ra+%a(!c sever
    de&!nde de sever!(a(ea s! &ers!s(en=a (ra+%e! s! de $rad+" de e<&+nere "a aces(a.
    Preva"en(a s(res+"+! ac+( :n &o&+"a=!a $enera"7 n+ es(e c+nosc+(7, :n &+=!ne"e s(+d!!
    d!s&on!'!"e, a+ .os( ra&or(a(e &rocen(e %er$And de "a 5Id "a ;;d "a !nd!v!/!! e<&+O!
    +nor (ra+%e severe Ede e<., a .! !%&"!ca( :n(r4+n acc!den( de ve!c+" c+ %o(or, a .!
    %ar(or "a o e<ec+=!e :n %as7 J.
    *voluie
    S!%&(o%e"e s(res+"+! ac+( s+n( e<&er!en(a(e :n (!%&+" sa+ !%ed!a( d+&7
    (ra+%7, d+rea/7 ce" &+=!n 9 /!"e s!, .!e se re/o"v7 :n dec+rs de I s7&(7%An! d+&7
    (er%!narea even!%en(+"+! (ra+%a(!c, .!e d!a$nos(!c+" es(e sc!%'a(. CAnd
    s!%&(o%e"e &ers!s(7 &es(e o "+n7, &oa(e .! !nd!ca( d!a$nos(!c+" de s(res
    &os((ra+%a(!c, dac7 s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ s(res+"
    &os((ra+%a(!c. Sever!(a(ea, d+ra(a O! &ro<!%!(a(ea e<&+ner!! !nd!v!d+"+! "a
    even!%en(+" (ra+%a(!c s+n( ce! %a! !%&or(an=! .ac(or! :n s(a'!"!rea &ro'a'!"!(7=!! de
    a&ar!=!e a s(res+"+! ac+(. E<!s(7 +ne"e da(e, c+% c7 s+&or(+r!"e soc!a"e, !s(or!c+"
    .a%!"!a", e<&er!en=e"e co&!"7r!e!, var!a'!"e"e &ersona"!(7=!! s! (+"'+r7r!"e %en(a"e
    &ree<!s(en(e &o( !n."+en=a de/vo"(area s(res+"+! ac+(. Aceas(7 (+"'+rare &oa(e
    a&are s! "a !nd!v!/!! .7r7 n!c! +n .e" de cond!=!! &red!s&o/an(e, :n s&ec!a" dac7
    s(resor+" es(e e<(re%.
    Tulburrile Anxioase
    F81

    Dia!nostic di$erenial
    O oarecare s!%&(o%a(o"o$!e +r%And e<&+ner!! "a +n s(res e<(re% es(e
    +'!c+!(ar7 s! adesea n+ neces!(7 n!c! +n d!a$nos(!c. S(res+" ac+( (re'+!e "+a( :n
    cons!dera=!e, n+%a! dac7 s!%&(o%e"e d+rea/7 ce" &+=!n 9 /!"e s! ca+/ea/7 o de(res7
    sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" or! :n a"(e
    do%en!! !%&or(an(e de .+nc=!onare sa+ de(er!orea/7 ca&ac!(a(ea !nd!v!d+"+! de a
    :nde&"!n! +ne"e sarc!n! necesare Ede e<., o'=!nerea as!s(en=e! necesare or! %o'!"!/area
    res+rse"or &ersona"e &en(r+ a vor'! %e%'r!"or .a%!"!e! des&re e<&er!en=a (ra+%a(!c7J.
    S(res+" ac+( (re'+!e s7 .!e d!s(!ns de o (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e Ede e<., +n (ra+%a(!s% cran!anJ Eve/! &a$. 5G5J s! de o (+"'+rare
    !nd+s7 de o s+'s(an=7 Ede e<., :n "e$7(+r7 c+ !n(o<!ca=!a c+ a"coo"J Eve/! &a$. 9LFJ,
    care &o( .! consec!n=e"e co%+ne a"e e<&+ner!! "a +n s(resor e<(re%. La +n!! !nd!v!/!, &o(
    s+rven! s!%&(o%e &s!o(!ce d+&7 +n s(resor e<(re%, :n as(.e" de ca/+r!, se &+ne
    d!a$nos(!c+" de (+"'+rare &s!o(!c7 sc+r(7, :n "oc de ce" de s(res ac+(. Dac7 d+&7
    (ra+%7 se de/vo"(7 +n e&!sod de&res!v %a@or, &e "An$7 d!a$nos(!c+" de s(res ac+(,
    (re'+!e "+a( :n cons!dera=!e s! d!a$nos(!c+" de (+"'+rare de&res!v7 %a@or7. Un
    d!a$nos(!c se&ara( de s(res ac+( n+ (re'+!e &+s dac7 s!%&(o%e"e s+n( o e<acer'are a
    +ne! (+"'+r7r! %en(a"e &ree<!s(en(e.
    Pr!n de.!n!=!e, d!a$nos(!c+" de s(res ac+( es(e adecva( n+%a! &en(r+ s!%&(o%e"e
    care a&ar :n dec+rs de o "+n7 de "a s(resor+" e<(re%. Pen(r+ c7 s(res+" &os((ra+%a(!c
    cere %a! %+"( decA( " "+n7 de s!%&(o%e, aces( d!a$nos(!c n+ &oa(e .! &+s :n c+rs+"
    aces(e! &er!oade !n!=!a"e de " "+n7. Pen(r+ !nd!v!/!! c+ d!a$nos(!c+" de s(res ac+( a"e
    c7ror s!%&(o%e &ers!s(7 %a! %+"( de " "+n7, (re'+!e "+a( :n cons!dera=!e
    d!a$nos(!c+" de s(res &os((ra+%a(!c. Pen(r+ !nd!v!/!! care a+ +n s(resor e<(re%, dar
    care &re/!n(7 +n &a((ern s!%&(o%a(o"o$!e care n+ sa(!s.ace cr!(er!!"e &en(r+ s(res+"
    ac+(, (re'+!e "+a( :n cons!dera=!e +n d!a$nos(!c de (+"'+rare de ada&(are.
    S!%+"area (re'+!e e<c"+s7 :n ace"e s!(+a=!! :n care re%+nera=!a .!nanc!ar7,
    o&or(+n!(a(ea 'ene.!c!+"+! sa+ dec!/!!"e %ed!co"e$a"e @oac7 +n ro".
    Criteriile $e $ia/no&ti# pentru 4+>.4 Stre&ul A#ut
    A2 #ersoana a $ost expus unui eveniment traumatic "n care ambele dintre
    urmtoarele sunt pre(enteD
    (1) persoana a experientat, a $ost martor ori a $ost con$runtat cu un eveni
    ment sau cu evenimente care implic moartea sau vtmarea !rav, e$ec
    tiv sau amenintoare, ori o ameninare a inte!ritii sale sau a altora3
    (2) rspunsul persoanei implic $rica intens, neputina sau oroarea2
    S2 'ie "n timpul experientrii, $ie dup experientarea evenimentului detresant,
    individul are trei &sau mai multe) dintre urmtoarele simptomeD
    &E) sentimentul subiectiv de insensibilitate, de deta,are sau de absen a
    reactivitii emoionale3
    &7) o reducere a con,tiinei ambianei &de ex2, =a $i stupe$iat>)3
    &4)dereali(are3
    (4) depersonali(are3
    (5) amne(ie disociativ &incapacitatea de a evoca un aspect important al traumei)2
    IH9 Tulburrile Anxioase
    Criteriile $e $ia/no&ti# pentru 4+>.4 Stre&ul A#ut
    (continuare)
    C, *venimentul traumatic este reexperientat persistent "n cel puin unul din
    urmtoarele moduriD ima!ini, !@nduri, vise, ilu(ii, episoade de $las%bacC
    recurente sau sentimentul de retrire a experienei ori detres la expunerea
    la lucruri care amintesc evenimentul raumatic2
    D2 *vitarea marcat a stimulilor care de,teapt amintiri ale traumei &de ex2,
    !@nduri, sentimente, conversaii, activiti, locuri, oameni)2
    *2 Simptome marcate de anxietate sau de excitaie crescut &de ex2, di$icultate
    "n adormire, iritabilitate, capacitate de concentrare redus, %ipervi!ilitate,
    rspuns de tresrire exa!erat, nelini,te motorie)2
    '2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare
    ori deteriorarea capacitii de a "ndeplini unele sarcini necesare, cum ar $i
    obinerea asistenei medicale ori mobili(area resurselor personale pentru a
    vorbi membrilor $amiliei despre experiena traumatic2
    G2 #erturbarea durea( minimum ) (ile ,i maximum H sptm@ni de la evenimentul
    traumatic ,i survine "n decurs de H sptm@ni de la evenimentul traumatic2
    L2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane &de
    ex2, un dro! de abu(, un medicament) ori ale unei condiii medicale !enerale,
    nu este explicat mai bine de tulburarea psi%otic scurt si nu este pur ,i simplu
    o exacerbare a unei tulburri preexistente pe axa l sau axa II2
    4++.C An,ietatea Generali)at( 3in#lu$e
    Tul-urarea An,ietatea E,#e&iv( a Copil(riei6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" an<!e(7=!! $enera"!/a(e :" cons(!(+!e an<!e(a(ea e<ces!v7 s!
    &reoc+&area Ee<&ec(a=!a a&reens!v7J, s+rven!nd %a! %+"(e /!"e da decA( n+, o
    &er!oad7 de ce" &+=!n R "+n!, re.er!(oare "a +n n+%7r de even!%en(e sa+ ac(!v!(7=!
    Ecr!(er!+" AJ. Ind!v!d+" cons(a(7 c7 es(e d!.!c!" s7 con(ro"e/e &reoc+&area Ecr!(er!+" BJ.
    An<!e(a(ea s! &reoc+&area s+n( :nso=!(e de ce" &+=!n (re! s!%&(o%e ad!=!ona"e d!n(r4o
    "!s(7 care !nc"+de ne"!n!O(ea, .a(!$a'!"!(a(ea ra&!d7, d!.!c+"(a(ea :n concen(rare,
    (ens!+nea %+sc+"ar7 s! &er(+r'area so%n+"+! E"a co&!! es(e cer+( n+%a! +n s!n$+r
    s!%&(o% ad!=!ona"J Ecr!(er!+" CJ. An<!e(a(ea s! &reoc+&area n+ s+n( .oca"!/a(e &e
    e"e%en(e"e a"(e! (+"'+r7r! de &e a<a I, c+% ar .! a avea +n a(ac de &an!c7 Eca :n
    &an!c7J, a .! &+s :n d!.!c+"(a(e :n &+'"!c Eca :n .o'!a soc!a"7J, a .! con(a%!na( Eca :n
    (+"'+rarea o'ses!vo4co%&+"s!v7J, a .! de&ar(e de cas7 or! de r+de"e a&ro&!a(e Eca :n
    an<!e(a(ea de se&arareJ, a "+a :n $re+(a(e Eca :n anore<!a nervoas7J, a avea ac+/e
    so%a(!ce %+"(!&"e Eca :n (+"'+rarea de so%a(!/areJ or! a avea o %a"ad!e sever7 Eca :n
    !&ocondr!eJ, !ar an<!e(a(ea O! &reoc+&area n+ s+rv!n e<c"+s!v :n s(res+"
    &os((ra+%a(!c Ecr!(er!+" DJ. DeO! !nd!v!/!! c+ an<!e(a(e $enera"!/a(7 n+ &o(
    (o(dea+na s7 !den(!.!ce &reoc+&7r!"e ca .!!nd Se<ces!veT, e! descr!+ de(res7
    45527 Anxietatea Generali(at
    &include Tulburarea Anxietatea *xcesiv a opilriei)
    H?4

    s+'!ec(!v7 da(ora(7 &reoc+&7r!! cons(an(e, a+ d!.!c+"(7=! :n a con(ro"a &reoc+&area sa+
    e<&er!en(ea/7 o de(er!orare asoc!a(7 :n do%en!+" soc!a", &ro.es!ona" or! :n a"(e
    do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ. Per(+r'area n+ se da(orea/7
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n
    %ed!ca%en( or! e<&+nerea "a +n (o<!cJ sa+ a"e +ne! cond!=!! %ed!ca"e $enera"e s! n+
    s+rv!ne e<c"+s!v :n c+rs+" +ne! (+"'+r7r! a.ec(!ve, (+"'+r7r! &s!o(!ce sa+ (+"'+r7r! de
    de/vo"(are &ervas!v7 Ecr!(er!+" FJ.
    In(ens!(a(ea, d+ra(a sa+ .recven=a an<!e(7=!! O! &reoc+&7r!! s+n( de de&ar(e
    d!s&ro&or=!ona(e .a=7 de &ro'a'!"!(a(ea e.ec(!v7 sa+ !%&ac(+" even!%en(+"+! (e%+(.
    Persoana cons(a(7 c7 es(e d!.!c!" s74s! =!n7 $And+r!"e care4! &rovoac7 ne"!n!O(e de a n+
    !n(er.era c+ a(en=!a acorda(7 sarc!n!"or :n c+rs de e.ec(+are O! are d!.!c+"(7=! :n a s(o&a
    &reoc+&area. Ad+"=!! c+ an<!e(a(e $enera"!/a(7 s+n( &reoc+&a=! adesea de
    c!rc+%s(an=e"e de v!a=7 r+(!n!ere, co(!d!ene, c+% ar .! res&onsa'!"!(7=!"e &os!'!"e a"e
    serv!c!+"+!, .!nan=e"e, s7n7(a(ea %e%'r!"or .a%!"!e!, ne.er!c!rea co&!!"or "or or! de
    s+'!ec(e %!nore Ec+% ar .! &ro'"e%e"e do%es(!ce, re&ara=!!"e %aO!n!! or! :n(Ar/!erea "a
    :n(A"n!r!J. Co&!!! c+ an<!e(a(e $enera"!/a(7 (!nd a .! &reoc+&a=! e<ces!v de
    co%&e(en=a sa+ de ca"!(a(ea &er.or%an=e! "or. :n c+rs+" (+"'+r7r!!, .oca"!/area
    &reoc+&7r!! &oa(e co%+(a de "a o sarc!n7 "a a"(a.
    *lemente ,i tulburri asociate
    Tens!+nea %+sc+"ar7 &oa(e .! asoc!a(7 c+ (re%or, con(rac(+r7, sen/a=!a de
    (re&!da=!e O! d+rere sa+ sens!'!"!(a(e %+sc+"ar7. M+"=! !nd!v!/! c+ an<!e(a(e
    $enera"!/a(7 e<&er!en(ea/7, de ase%enea, s!%&(o%e so%a(!ce Ede e<., %A!n! rec! O!
    +%ede, $+r7 +sca(7, (rans&!ra=!e, $rea=7 sa+ d!aree, %!c=!+n! .recven(e, (+"'+rare de
    de$"+(!=!e sa+ sen/a=!a de Snod :n $A(TJ O! +n r7s&+ns de (res7r!re e<a$era(. De
    ase%enea, s+n( .recven(e s!%&(o%e de&res!ve.
    An<!e(a(ea $enera"!/a(7 a&are .recven( conco%!(en( c+ (+"'+r7r!"e a.ec(!ve Ede
    e<., (+"'+rarea de&res!v7 %a@or7 sa+ (+"'+rarea d!s(!%!c7J, c+ a"(e (+"'+r7r!
    an<!oase Ede e<., &an!ca, .o'!a soc!a"7, .o'!a s&ec!.!c7J O! c+ (+"'+r7r! :n "e$7(+r7 c+
    s+'s(an=e"e Ede e<., a'+/+" sa+ de&enden=a de a"coo", de seda(!ve, !&no(!ce sa+
    an<!o"!(!ceJ. A"(e cond!=!! care &o( .! asoc!a(e c+ s(res+" Ede e<., s!ndro%+" de co"on
    !r!(a'!", ce.a"e!"eJ aco%&an!a/7 .recven( an<!e(a(ea $enera"!/a(7.
    *lemente speci$ice culturii, etii si sexului
    E<!s(7 o d!vers!(a(e c+"(+ra"7 cons!dera'!"7 :n e<&r!%area an<!e(7=!! Ede e<., :n
    an+%!(e c+"(+r!, an<!e(a(ea es(e e<&r!%a(7 &redo%!nan( &r!n s!%&(o%e so%a(!ce, :n
    a"(e"e &r!n s!%&(o%e co$n!(!veJ. Es(e !%&or(an( s7 se =!n7 con( de con(e<(+" c+"(+ra",
    cAnd se eva"+ea/7 .a&(+" dac7 &reoc+&7r!"e re.er!(oare "a an+%!(e s!(+a=!! s+n( e<ces!ve.
    La co&!!! s! ado"escen=!! c+ an<!e(a(e $enera"!/a(7, an<!e(7=!"e s! &reoc+&7r!"e se
    re.er7 adesea "a ca"!(a(ea &er.or%an=e! sa+ co%&e(en=e! "or "a scoa"7 sa+ :n
    even!%en(e"e s&or(!ve, c!ar cAnd &er.or%an=a "or n+ es(e eva"+a(7 de c7(re a"=!!. Po(
    e<!s(a &reoc+&7r! e<ces!ve re.er!(oare "a &+nc(+a"!(a(e. De ase%enea, &oa(e e<!s(a o
    &reoc+&are :n "e$7(+r7 c+ even!%en(e ca(as(ro.!ce, c+% ar .! c+(re%+re"e de &7%An(
    sa+ r7/'o!+" n+c"ear. Co&!!! c+ aceas(7 (+"'+rare &o( .! e<(re% de con.or%!O(!,
    &er.ec=!on!O(! s! nes!$+r! de e! :nO!O!, O! (!nd s74O! re.ac7 (e%e"e d!n ca+/a
    !nsa(!s.ac=!e! :n "e$7(+r7 c+ &er.or%an=a %a! &+=!n decA( &er.ec(7. De re$+"7, e! s+n(
    e<(re% de /e"oO! :n a c7+(a a&ro'are O! neces!(7 reas!$+rare e<ces!v7 :n "e$7(+r7 c+
    e.!c!en=a, &rec+% O! c+ a"(e (e%er! a"e "or.
    7G7 Tulburrile Anxioase

    An<!e(a(ea $enera"!/a(7 &oa(e .! s+&rad!a$nos(!ca(7 "a co&!!, :n "+area :n
    cons!dera=!e a aces(+! d!a$nos(!c "a co&!!, (re'+!e .7c+(7 o eva"+are de(a"!a(7 a
    &re/en=e! a"(or (+"'+r7r! an<!oase a"e co&!"7r!e! s&re a vedea dac7 &reoc+&7r!"e n+
    s+n( e<&"!ca(e %a! '!ne de +na d!n(re aces(e (+"'+r7r!. An<!e(a(ea de se&arare, .o'!a
    soc!a"7 s! (+"'+rarea o'ses!vo4co%&+"s!v7 s+n( aco%&an!a(e adesea de &reoc+&7r!
    care %!%ea/7 &e ce"e descr!se :n an<!e(a(ea $enera"!/a(7. De e<e%&"+, +n co&!" c+
    .o'!e soc!a"7 &oa(e .! &reoc+&a( de &er.or%an=a Oco"ar7 d!n ca+/a +%!"!r!!.
    Preoc+&7r!"e &en(r+ %a"ad!e &oa(e .!, de ase%enea, e<&"!ca(e %a! '!ne de an<!e(a(ea de
    se&arare sa+ (+"'+rarea o'ses!vo4co%&+"s!v7.
    :n cond!=!! c"!n!ce, (+"'+rarea es(e d!a$nos(!ca(7 &+=!n %a! .recven( "a .e%e! decA( "a
    '7r'a=! Ea&ro<!%a(!v YYd4RLd d!n(re ce! care se &re/!n(7 c+ aceas(7 (+"'+rare s+n(
    .e%e!J, :n s(+d!!"e e&!de%!o"o$!ce, ra(a se<+"+! es(e de 9X; &en(r+ .e%e!.
    #revalent
    Pe +n eOan(!on co%+n!(ar, ra(a de &reva"en(7 &e " an &en(r+ an<!e(a(ea
    $enera"!/a(7 a .os( de a&ro<!%a(!v ;d, !ar ra(a de &reva"en(7 &e v!a=7 a .os( Yd. :n
    c"!n!c!"e &en(r+ (+"'+r7r! an<!oase, a&ro<!%a(!v +n s.er( d!n(re !nd!v!/! &re/!n(7
    an<!e(a(e $enera"!/a(7 ca d!a$nos(!c &r!nc!&a" sa+ ca d!a$nos(!c co%or'!d.
    *voluie
    M+"=! !nd!v!/! c+ an<!e(a(e $enera"!/a(7 re"a(ea/7 c7 e! s4a+ s!%=!( an<!os! O!
    nervoO! (oa(7 v!a=a "or. DeO! &es(e @+%7(a(e d!n(re ce! care se &re/!n(7 &en(r+
    (ra(a%en( re"a(ea/7 de'+(+" :n co&!"7r!e sa+ :n ado"escen=7, de'+(+" s+rven!( d+&7
    e(a(ea de 9L an! n+ es(e rar. Evo"+=!a es(e cron!c7, dar ."+c(+an(7 s! adesea se
    :nr7+(7=eO(e :n c+rs+" &er!oade"or de s(res.
    d
    #attern $amilial
    An<!e(a(ea ca (r7s7(+r7 are o asoc!a=!e .a%!"!a"7. DeO! s(+d!!"e %a! vec! o.er7 da(e
    con(rad!c(or!! re.er!(or "a &a((ern+" .a%!"!a" a" an<!e(7=!! $enera"!/a(e, s(+d!!"e %a!
    recen(e &e $e%en! s+$erea/7 o con(r!'+=!e $ene(!c7 "a a&ar!=!a aces(e! (+"'+r7r!.Ma!
    %+"( decA( a(A(, .ac(or!! $ene(!c! care !n."+en=ea/7 r!sc+" &en(r+ an<!e(a(ea
    $enera"!/a(7 &o( .! s(rAns "e$a=! de ce! &en(r+ (+"'+rarea de&res!v7 %a@or7.
    Dia!nostic di$erenial
    An<!e(a(ea $enera"!/a(7 (re'+!e s7 .!e d!s(!ns7 de (+"'+rarea an<!oas7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" es(e ce" de (+"'+rare an<!oas7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, dac7 s!%&(o%e"e an<!oase s+n(
    cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    .eocro%oc!(o%, !&er(!ro!d!s%J Eve/! &a$. IHRJ. Aceas(7 &rec!/are se ba;ea;6 &e !s(or!c,
    da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c. O (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7
    se d!s(!n$e de (+"'+rarea an<!oas7 $enera"!/a(7 &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n
    dro$ de a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c
    :n re"a=!e c+ &er(+r'area an<!oas7 Eve/! &a$. IHFJ. De e<e%&"+, an<!e(a(ea sever7,
    care s+rv!ne n+%a! :n con(e<(+" cons+%+"+! de ca.ea, va .! d!a$nos(!ca(7 ca (+"'+rare
    an<!oas7 !nd+s7 de ca.e!na, c+ an<!e(a(e $enera"!/a(7.
    CAnd es(e &re/en(7 o a"(7 (+"'+rare de &e a<a I, +n d!a$nos(!c ad!=!ona" de
    an<!e(a(e $enera"!/a(7 (re'+!e &+s n+%a! cAnd .ocar+" an<!e(7=!! s! &reoc+&7r!! es(e
    45527 Anxietatea Generali(at
    &include Tulburarea Anxietatea *xcesiv a opilriei)
    7G<

    .7r7 "e$7(+r7 c+ aceas(7 (+"'+rare, ad!c7, &reoc+&area e<ces!v7 n+ es(e res(rAns7 "a
    avea +n a(ac de &an!c7 Eca :n &an!c7J, "a a .! &+s :n d!.!c+"(a(e :n &+'"!c Eca :n .o'!a
    soc!a"7J, a .! con(a%!na( Eca :n (+"'+rarea o'ses!vo4co%&+"s!v7J, a "+a :n $re+(a(e Eca
    :n anore<!a nervoas7J, a avea o %a"ad!e $rav7 Eca :n !&ocondr!eJ, a avea ac+/e
    so%a(!ce %+"(!&"e Eca :n (+"'+rarea de so%a(!/areJ or! "a &reoc+&7r! :n "e$7(+r7 c+
    s7n7(a(ea r+de"or a&ro&!a(e sa+ "a a .! de&ar(e de e"e or! de cas7 Eca :n an<!e(a(ea de
    se&arareJ. De e<e%&"+, an<!e(a(ea &re/en(7 :n .o'!a soc!a"7 es(e cen(ra(7 &e s!(+a=!!
    soc!a"e v!!(oare, :n care !nd!v!d+" (re'+!e s7 .+nc=!one/e sa+ s7 .!e eva"+a( de a"=!!, &e
    cAnd !nd!v!/!! c+ an<!e(a(e $enera"!/a(7 e<&er!en(ea/7 an<!e(a(ea, .!e c7 s+n( sa+ n+
    eva"+a=!.
    Ma! %+"(e e"e%en(e d!s(!n$ &reoc+&area e<ces!v7 a an<!e(7=!! $enera"!/a(e de
    !de!"e o'ses!ve a"e (+"'+r7r!! o'ses!vo4co%&+"s!ve. Ide!"e o'ses!ve n+ s+n( s!%&"e
    &reoc+&7r! e<ces!ve :n "e$7(+r7 c+ &ro'"e%e co(!d!ene sa+ a"e v!e=!! rea"e, c! %a!
    c+rAnd !n(r+s!+n! e$od!s(on!ce care !a+ adesea, &e "An$7 !de!, .or%a
    cons(rAn$er!"or, !%&+"s+r!"or s! !%a$!n!"or, :n .!na", ce"e %a! %+"(e o'ses!! s+n(
    aco%&an!a(e de co%&+"s!! care red+c an<!e(a(ea asoc!a(7 c+ o'ses!!"e.
    An<!e(a(ea es(e &re/en(7 cons(an( :n s(res+" &os((ra+%a(!c. An<!e(a(ea
    $enera"!/a(7 n+ es(e d!a$nos(!ca(7, dac7 an<!e(a(ea s+rv!ne e<c"+s!v :n c+rs+"
    s(res+"+! &os((ra+%a(!c. An<!e(a(ea &oa(e .!, de ase%enea, &re/en(7 :n (+"'+rarea de
    ada&(are, dar aceas(7 ca(e$or!e re/!d+a"7 (re'+!e s7 .!e +(!"!/a(7, n+%a! cAnd n+ s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ n!c! o a"(7 (+"'+rare an<!oas7 E!nc"+s!v an<!e(a(ea
    $enera"!/a(7J, :n a.ar7 de aceas(a, :n (+"'+rarea de ada&(are an<!e(a(ea s+rv!ne ca
    r7s&+ns "a +n s(resor de v!a=7 s! n+ &ers!s(7 %a! %+"( de R "+n! d+&7 (er%!narea
    s(resor+"+! sa+ a consec!n=e"or sa"e. An<!e(a(ea $enera"!/a(7 es(e +n e"e%en( asoc!a(
    co%+n a" (+"'+r7r!"or a.ec(!ve s! (+"'+r7r!"or &s!o(!ce s! n+ (re'+!e s7 .!e
    d!a$nos(!ca(7 se&ara(, dac7 s+rv!ne e<c"+s!v :n c+rs+" aces(or cond!=!!.
    Ma! %+"(e e"e%en(e d!s(!n$ an<!e(a(ea $enera"!/a(7 de an<!e(a(ea
    non&a(o"o$!c7. :n &r!%+" rAnd, &reoc+&7r!"e asoc!a(e c+ an<!e(a(ea $enera"!/a(7 s+n(
    d!.!c!" de con(ro"a( s! de re$+"7 !n(er.erea/7 se%n!.!ca(!v c+ .+nc=!onarea, &e cAnd
    &reoc+&7r!"e &en(r+ v!a=a co(!d!an7 s+n( &erce&+(e ca .!!nd %a! con(ro"a'!"e s! &o( .!
    a%Ana(e &An7 %a! (Ar/!+, :n a" do!"ea rAnd, &reoc+&7r!"e asoc!a(e c+ an<!e(a(ea
    $enera"!/a(7 s+n( %a! &ervas!ve, %a! &ron+n=a(e, %a! de(resan(e s! de %a! "+n$7
    d+ra(7, s! s+rv!n .recven( .7r7 &rec!&!(And. C+ cA( s+n( %a! %+"(e c!rc+%s(an=e"e de
    v!a=7 de care o &ersoan7 es(e &reoc+&a(7 :n %od e<ces!v E.!nan=e, &ro(ec=!a co&!!"or,
    randa%en(+" &ro.es!ona", re&ara=!!"e %aO!n!!J, c+ a(A( es(e %a! &ro'a'!" d!a$nos(!c+",
    :n a" (re!"ea rAnd, es(e .oar(e &+=!n &ro'a'!" ca &reoc+&7r!"e co(!d!ene s7 .!e
    aco%&an!a(e de s!%&(o%e so%a(!ce Ede e<., de .a(!$a'!"!(a(e e<ces!v7, ne"!n!O(e,
    sen(!%en(+" de s(a( ca &e $!%&!, !r!(a'!"!(a(eJ, deO! aceas(a es(e %a! &+=!n adev7ra( "a
    co&!!.
    IHR Tulburrile Anxioase

    Criteriile $e $ia/no&ti# pentru
    4++.+C An,ietatea Generali)at(
    A2 Anxietate ,i preocupare &expectaie apre%ensiv), survenind mai multe (ile
    da dec@t nu timp de cel puin I luni, "n le!tur cu un numr de evenimente
    sau activiti &cum ar $i per$ormana "n munc sau ,colar)2
    S2 #ersoana constat c este di$icil s-,i controle(e preocuparea2
    2 Anxietatea si preocuparea sunt asociate cu trei &sau mai multe) dintre urm
    toarele ,ase simptome &cu cel puin c@teva simptome pre(ente mai multe
    (ile da dec@t nu, "n ultimele I luni)2 Not(M La copii este cerut un sin!ur item2
    (1) nelini,te sau sentimentul de stat ca pe !%impi3
    (2) a $i rapid $ati!abil3
    (3) di$icultate "n concentrare sau sen(aia de vid mintal3
    (4) iritabilitate3
    (5) tensiune muscular3
    (1) perturbare de somn &di$icultate "n a adormi sau "n a rm@ne adormit ori
    somn nelini,tit ,i nesatis$ctor)2
    2 'ocarul anxietii ,i preocuprii nu este limitat la elementele unei tulburri de
    pe axa l, de exemplu, anxietatea sau panica nu este "n le!tur cu a avea un
    atac de panic &ca "n panic), a $i pus "n di$icultate "n public &ca "n $obia
    social), a $i contaminat &ca "n tulburarea obsesivo-compulsiv), a $i departe de
    cas sau de rudele apropiate &ca "n anxietatea de separare), a lua "n !reutate
    &ca "n anorexia nervoas), a avea multimple acu(e somatice &ca "n tulburarea
    de somati(are) sau a avea o maladie !rav &ca "n %ipocondrie), iar anxietatea ,i
    preocuparea nu survin exclusiv "n cursul stresului posttraumatic2
    *2 Anxietatea, preocuparea sau simptomele somatice cau(ea( o detres sau
    deteriorare semni$icativ clinic "n domeniul social, pro$esional sau "n alte
    domenii de $uncionare importante2
    '2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) ori ale unei condiii medicale
    !enerale &de ex2, %ipertiroidismul) ,i nu apare exclusiv "n timpul unei tulburri
    a$ective, tulburri psi%otice ori ale unei tulburri de de(voltare pervasiv2
    C54.>5 Tul-urarea An,ioa&( $atorat( unei
    Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! an<!oase da(ora(e +ne! cond!=!! %ed!ca"e $enera"e
    es(e an<!e(a(ea se%n!.!ca(!v7 c"!n!c s! cons!dera(7 a .! da(ora(7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e. S!%&(o%e"e &o( !nc"+de s!%&(o%e
    no(a'!"e de an<!e(a(e $enera"!/a(7, a(ac+r! de &an!c7, o'ses!! sa+ co%&+"s!! Ecr!(er!+"
    AJ. D!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or (re'+!e s7 re/+"(e .a&(+" c7
    &er(+r'area es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e
    764286 Tulburarea Anxioas datorat
    unei ondiii Medicale Generale
    H??
    Ecr!(er!+" BJ. Per(+r'area n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7, c+% ar
    .! (+"'+rarea de ada&(are c+ an<!e(a(e, :n care s(resor+" es(e cond!=!a %ed!ca"7
    $enera"7 Ecr!(er!+" CJ. D!a$nos(!c+" n+ es(e &+s, dac7 s!%&(o%e"e an<!oase s+rv!n
    n+%a! :n c+rs+" +n+! de"!r!+% Ecr!(er!+" DJ. S!%&(o%e"e an<!oase (re'+!e s7 ca+/e/e
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n
    a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ.
    Pen(r+ a &rec!/a dac7 s!%&(o%e"e an<!oase se da(orea/7 +ne! cond!=!! %ed!ca"e
    $enera"e, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en=a +ne! cond!=!! %ed!ca"e
    $enera"e. A&o!, c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7 s!%&(o%e"e an<!oase s+n(
    e(!o"o$!c :n re"a=!e c+ cond!=!a %ed!ca"7 $enera"7 &r!n(r4+n %ecan!s% .!/!o"o$!c. Es(e
    necesar7 o ana"!/7 a(en(7 s! c+&r!n/7(oare a n+%eroO! .ac(or! &en(r+ a .ace aceas(7
    @+deca(7. DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a s(a'!"! dac7 re"a=!a d!n(re
    s!%&(o%e"e an<!oase s! cond!=!a %ed!ca"7 $enera"7 es(e e(!o"o$!c7, +ne"e
    cons!deren(e o.er7 o oarecare or!en(are :n aces( do%en!+. Un &r!% cons!deren( :"
    cons(!(+!e &re/en=a +ne! asoc!er! (e%&ora"e :n(re de'+(+", e<acer'area sa+
    re%!s!+nea cond!=!e! %ed!ca"e $enera"e s! s!%&(o%e"e an<!oase. Un a" do!"ea
    cons!deren( :" cons(!(+!e &re/en=a e"e%en(e"or a(!&!ce &en(r+ o (+"'+rare an<!oas7
    &r!%ar7 Ede e<., e(a(ea "a de'+( sa+ evo"+=!a a(!&!c7 or! a'sen=a +n+! !s(or!c
    .a%!"!a"J. Da(e"e d!n "!(era(+r7, care s+$erea/7 c7 &oa(e e<!s(a o asoc!ere d!rec(7 :n(re
    cond!=!a %ed!ca"7 $enera"7 :n ces(!+ne s! a&ar!=!a s!%&(o%e"or an<!oase, &o( o.er! +n
    con(e<( +(!" :n eva"+area +ne! an+%!(e s!(+a=!!, :n a.ar7 de aceas(a, c"!n!c!an+" (re'+!e
    s7 a&rec!e/e, de ase%enea, dac7 &er(+r'area n+ es(e e<&"!ca(7 %a! '!ne de o (+"'+rare
    an<!oas7 &r!%ar7, de o (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7 or! de a"(e
    (+"'+r7r! %en(a"e &r!%are Ede e<., (+"'+rarea de ada&(areJ. Aces(e &rec!/7r! s+n(
    e<&"!ca(e %a! :n de(a"!+ :n sec=!+nea ST+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!!
    %ed!ca"e $enera"eT E&a$. 5G5J.
    Sped$icani
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a !nd!ca (a'"o+" s!%&(o%a(o"o$!e
    &redo%!nan( :n (+"'+rarea an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eQ
    C+ an<!e(a(e $enera"!/a(7. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7 an<!e(a(ea
    sa+ &reoc+&area :n "e$7(+r7 c+ +n n+%7r de even!%en(e sa+ ac(!v!(7=!
    &redo%!n7 :n (a'"o+" c"!n!c.
    C+ a(ac+r! de &an!c7. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7 a(ac+r!"e de
    &an!c7 Eve/! &a$. I;LJ &redo%!n7 :n (a'"o+" c"!n!c.
    C+ s!%&(o%e o'ses!vo4co%&+"s!ve. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7
    o'ses!!"e sa+ co%&+"s!!"e &redo%!n7 :n (a'"o+" c"!n!c.
    #rocedee de "nre!istrare
    :n :nre$!s(rarea d!a$nos(!c+"+! (+"'+r7r!! an<!oase da(ora(e +ne! cond!=!!
    %ed!ca"e $enea"e, c"!n!c!an+" (re'+!e s7 %en=!one/e %a! :n(A! &re/en=a (+"'+r7r!!
    an<!oase, a&o! cond!=!a %ed!ca"7 $enera"7 !den(!.!ca(7, cons!dera(7 a .! ca+/a
    &er(+r'7r!! s!, :n .!ne, s&ec!.!can(+" cores&+n/7(or, care !nd!c7 (a'"o+"
    s!%&(o%a(o"o$!e &redo%!nan( de &e a<a I Ede e<., 9F;.GF T+"'+rare an<!oas7
    da(ora(7 (!reo(o<!co/e!, c+ an<!e(a(e $enera"!/a(7J. Cod+" ICD4F4CM &en(r+
    cond!=!a %ed!ca"7 $enera"7 (re'+!e, de ase%enea, s7 .!e %en=!ona( &e a<a III Ede e<.,
    9I9.F T!reo(o<!co/7J. 3e/! ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce a"e ICD4F4CM
    &en(r+ cond!=!!"e %ed!ca"e $enera"e se"ec(a(e.
    7G> Tulburrile Anxioase
    ondiiile medicale !enerale asociate
    O d!vers!(a(e de cond!=!! %ed!ca"e $enera"e &o( ca+;a s!%&(o%e an<!oase,
    !nc"+/And cond!=!! endocr!ne Ede e<., !&er4 s! !&o(!ro!d!s%+", .eocro%oc!(o%+",
    !&o$"!ce%!a, !&eradrenocor(!c!s%+"J, cond!=!! card!ovasc+"are Ede e<.,
    !ns+.!c!en=a card!ac7 con$es(!v7, e%'o"!s%+" &+"%onar, ar!(%!!"eJ, cond!=!!
    res&!ra(or!! Ede e<., %a"ad!a &+"%onar7 o's(r+c(!v7 cron!c7, &ne+%on!a,
    !&erven(!"a=!aJ, cond!=!! %e(a'o"!ce Ede e<., caren=a de v!(a%!n7 B59, &or.!r!aJ s!
    cond!=!! ne+ro"o$!ce Ede e<., neo&"as%e"e, d!s.+nc=!a ves(!'+"ar7, ence.a"!(e"eJ.
    Da(e"e e<a%!n7r!! so%a(!ce asoc!a(e, da(e"e de "a'ora(or s! &ar(ern+" de &reva"en(7
    sa+ de de'+( re."ec(7 cond!=!a %ed!ca"7 $enera"7 e(!o"o$!c7.
    Dia!nostic di$erenial
    Un d!a$nos(!c se&ara( de (+"'+rare an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e n+ es(e &+s, dac7 &er(+r'area an<!oas7 s+rv!ne e<c"+s!v :n c+rs+" +n+!
    de"!r!+%.D!a$nos(!c+" de (+"'+rare an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e &oa(e .! &+s &e "An$7 d!a$nos(!c+" de de%en=7, dac7 an<!e(a(ea es(e
    consec!n=a e(!o"o$!c7 d!rec(7 a &roces+"+! &a(o"o$!c care ca+;ea;6 de%en=a s! es(e o
    &ar(e &roe%!nen(7 a (a'"o+"+! c"!n!c. Dac7 (a'"o+" c"!n!c !nc"+de o %!<(+r7 de
    d!.er!(e (!&+r! de s!%&(o%e Ede e<., a.ec(!ve s! an<!oaseJ, (+"'+rarea %en(a"7
    s&ec!.!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e de&!nde de (!&+" de s!%&(o%e
    care &redo%!n7 :n (a'"o+" c"!n!c.
    Dac7 e<!s(7 &ro'a +n+! +/ recen( sa+ &re"+n$!( de o s+'s(an=7 E!nc"+s!v
    %ed!ca%en(e"e c+ e.ec(e &s!oac(!veJ, a a's(!nen=e! de o s+'s(an=7 or! a e<&+ner!! "a
    +n (o<!c, (re'+!e "+a(7 :n cons!dera=!e (+"'+rarea an<!oas7 !nd+s7 de o s+'s(an=7.
    Poa(e .! +(!" s7 se e.ec(+e/e +n screen!n$ a" sAn$e"+! sa+ +r!n!! sa+ a"(e e<a%ene de
    "a'ora(or adecva(e. S!%&(o%e"e care a&ar :n c+rs+" sa+ "a sc+r( (!%& d+&7
    !n(o<!ca=!a sa+ a's(!nen=a de o s+'s(an=7, or! d+&7 +/+" +n+! %ed!ca%en( Ead!c7, :n
    dec+rs de I s7&(7%An!J &o( .! e<(re% de !nd!ca(!ve &en(r+ o (+"'+rare an<!oas7
    !nd+s7 de o s+'s(an=7, :n .+nc=!e de (!&+", d+ra(a sa+ can(!(a(ea de s+'s(an=7
    +(!"!/a(7. Dac7 c"!n!c!an+" a a@+ns "a conc"+/!a c7 &er(+r'area se da(orea/7, a(A(
    +ne! cond!=!! %ed!ca"e $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, &o( .! &+se a%'e"e
    d!a$nos(!ce Ead!c7, (+"'+rare an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s!
    (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7J.
    T+"'+rarea an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e (re'+!e s7 .!e
    d!s(!ns7 de o (+"'+rare an<!oas7 &r!%ar7 E:n s&ec!a" de &an!c7, de an<!e(a(e
    $enera"!/a(7 s! de (+"'+rarea o'ses!vo4co%&+"s!v7J s! de (+"'+rarea de ada&(are c+
    an<!e(a(e sa+ c+ d!s&o/!=!e %!<(7, an<!oas7 s! de&res!v7 Ede e<., +n r7s&+ns
    de/ada&(a(!v "a s(res or! "a a avea o cond!=!e %ed!ca"7 $enera"7J, :n (+"'+r7r!"e
    %en(a"e &r!%are, n+ &o( .! de%ons(ra(e n!c! +n .e" de %ecan!s%e .!/!o"o$!ce ca+/a"e
    d!rec(e s! s&ec!.!ce, asoc!a(e c+ o cond!=!e %ed!ca"7 $enera"7. E(a(ea (ard!v7 "a de'+( s!
    a'sen=a +n+! !s(or!c .a%!"!a" sa+ &ersona" de (+"'+r7r! an<!oase s+$erea/7
    neces!(a(ea +ne! eva"+7r! a&ro.+nda(e &en(r+ a e<c"+de d!a$nos(!c+" de (+"'+rare
    an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n a.ar7 de aceas(a, s!%&(o%e"e
    an<!oase &o( .! +n e"e%en( asoc!a( a" a"(e! (+"'+r7r! %en(a"e Ede e<., sc!/o.ren!a,
    anore<!a nervoas7J.
    Dac7 c"!n!c!an+" n+ &oa(e &rec!/a c7 &er(+r'area an<!oas7 es(e &r!%ar7, !nd+s7 de
    o s+'s(an=7 or! da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, es(e d!a$nos(!ca(7
    (+"'+rarea an<!oas7 .7r7 a"(7 s&ec!.!ca=!e.
    Tulburarea Anxioas indus de o Substan
    IHF
    Criteriile $e $ia/no&ti# pentru C54.>5 Tul-urarea An,ioa&(
    $atorat(.... (Se indic condiia medical &eneral)
    A2 O anxietate notabil, atacuri de panic, sau obsesii ori compulsii predomin
    "n tabloul clinic2
    S2 Din istoric, examenul somatic sau datele de laborator este evident $aptul c
    perturbarea este consecina $i(iolo!ic direct a unei condiii medicale
    !enerale2
    2 #erturbarea nu este explicat mai bine de alt tulburare mental &de ex2, de
    tulburarea de adaptare cu anxietate "n care stresorul este o condiie
    medical !eneral)2
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    De speci"icat dacD
    u anxietate !enerali(atD dac anxietatea sau preocuparea excesiv "n
    le!tur cu un numr de evenimente sau activiti predomin "n tabloul clinic
    u atacuri de panicD dac atacurile de panic &ve(i pa!2 H47) predomin "n
    tabloul clinic
    u simptome obsesivo-compulsiveD dac obsesiile sau compulsiile
    predomin "n tabloul clinic
    Fot de codi$icareD A se include numele condiiei medicale !enerale pe axa l, de
    ex2, 76428H Tulburare anxioas datorat $eocromocitomului, cu anxietate
    !enerali(at3 a se codi$ica, de asemenea, condiia medical !eneral pe axa III
    &ve(i anexa G pentru coduri)2
    Tul-urarea An,ioa&( in$u&( $e o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e (+"'+r7r!! an<!oase !nd+se de o s+'s(an=7 s+n(
    s!%&(o%e"e an<!oase &roe%!nen(e Ecr!(er!+" AJ care s+n( cons!dera(e a .! e.ec(e"e
    .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n %ed!ca%en( or!
    e<&+nerea "a +n (o<!cJ Ecr!(er!+" BJ, :n .+nc=!e de na(+ra s+'s(an=e! s! de con(e<(+"
    :n care s+rv!n s!%&(o%e"e Ead!c7, :n c+rs+" !n(o<!ca=!e! sa+ a's(!nen=e!J, &er(+r'area
    &oa(e !%&"!ca an<!e(a(e no(a'!"7, a(ac+r! de &an!c7, .o'!!, sa+ o'ses!! or! co%&+"s!!.
    DeO! (a'"o+" c"!n!c a" (+"'+r7r!! an<!oase !nd+se de o s+'s(an=7 &oa(e se%7na c+
    ce" a" &an!c!!, an<!e(7=!! $enera"!/a(e, .o'!e! soc!a"e sa+ (+"'+r7r!! o'ses!vo4
    co%&+"s!ve, n+ s+n( sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ n!c! +na d!n aces(e
    (+"'+r7r!. Per(+r'area n+ (re'+!e s7 .!e e<&"!ca(7 %a! '!ne de o (+"'+rare %en(a"7
    Ede e<., de a"(7 (+"'+rare an<!oas7J care n+ es(e !nd+s7 de o s+'s(an=7 Ecr!(er!+"
    CJ. D!a$nos(!c+" n+ es(e &+s, dac7 s!%&(o%e"e an<!oase s+rv!n n+%a! :n c+rs+"
    +n+! de"!r!+% Ecr!(er!+" DJ. S!%&(o%e"e (re'+!e s7
    7>+ Tulburrile Anxioase
    ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ. Aces(
    d!a$nos(!c (re'+!e s7 .!e &+s :n "oc+" +n+! d!a$nos(!c de !n(o<!ca=!e c+ o s+'s(an=7 sa+
    de a's(!nen=7 de o s+'s(an=7, n+%a! cAnd s!%&(o%e"e an<!oase s+n( :n e<ces .a=7 de
    ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen=7 s! cAnd
    s!%&(o%e"e an<!oase s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7
    se&ara(7. Pen(r+ 2o d!sc+=!e %a! de(a"!a(7 a (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7,
    ve/! &a$. 5F5.
    O (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare an<!oas7
    &r!%ar7, &r!n "+area :n cons!dera=!e a de'+(+"+!, evo"+=!e! s! a a"(or .ac(or!. Pen(r+
    dro$+r!"e de a'+/, d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or (re'+!e s7
    re/+"(e !n(o<!ca=!a sa+ a's(!nen=a.
    T+"'+r7r!"e an<!oase !nd+se de o s+'s(an=7 a&ar n+%a! :n asoc!ere c+ s(7r!"e de
    !n(o<!ca=!e sa+ de a's(!nen=7, &e cAnd (+"'+r7r!"e an<!oase &r!%are &o( &recede
    de'+(+" +/+"+! de s+'s(an=7, or! a&ar :n &er!oade"e de a's(!nen=7 &re"+n$!(7.
    Deoarece s(area de a's(!nen=7 &en(r+ +ne"e s+'s(an=e Ede e<., +ne"e
    'en/od!a/e&!neJ &oa(e .! re"a(!v &re"+n$!(7, de'+(+" s!%&(o%e"or an<!oase
    &oa(e s+rven! :n(r4+n !n(erva" de &An7 "a I s7&(7%An! de "a :nce(area +/+"+! de
    s+'s(an=7.
    Un a"( cons!deren( :" cons(!(+!e &re/en=a e"e%en(e"or a(!&!ce &en(r+ o (+"'+rare
    an<!oas7 &r!%ar7 Ede e<., e(a(ea "a de'+( sa+ evo"+=!a a(!&!ceJ. De e<e%&"+, de'+(+"
    &an!c!! d+&7 e(a(ea de IY de an! Ecare es(e rarJ sa+ &re/en=a +nor s!%&(o%e a(!&!ce :n
    c+rs+" +n+! a(ac de &an!c7 Ede e<., +n ver(!@ ver!(a'!", &!erderea ec!"!'r+"+!,
    &!erderea c+noO(!n=e! sa+.&!erderea con(ro"+"+! ve/!c!! +r!nare sa+ s.!nc(er+"+! ana",
    ce.a"ee, vor'!re !nd!s(!nc(7 sa+ a%ne/!eJ &oa(e s+$era o e(!o"o$!c !nd+s7 de o
    s+'s(an=7. D!n con(ra, .ac(or!! care s+$erea/7 c7 s!%&(o%e"e an<!oase s+n( e<&"!ca(e
    %a! '!ne de o (+"'+rare an<!oas7 &r!%ar7 !nc"+d &ers!s(en=a s!%&(o%e"or an<!oase o
    &er!oad7 s+'s(an=!a"7 de (!%& Ead!c7, a&ro<!%a(!v o "+n7J d+&7 (er%!narea
    !n(o<!ca=!e! c+ o s+'s(an=7 sa+ a a's(!nen=e! ac+(e, a&ar!=!a de s!%&(o%e care s+n(
    s+'s(an=!a" :n e<ces .a=7 de ceea ce ar .! de aO(e&(a(, da( .!!nd (!&+" sa+ can(!(a(ea de
    s+'s(an=7 +(!"!/a(7 or! d+ra(a de +/, sa+ +n !s(or!c de (+"'+r7r! an<!oase &r!%are
    rec+ren(e an(er!oare.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &o( .! +(!"!/a=! &en(r+ a !nd!ca &re/en(area de s!%&(o%e
    care &redo%!n7Q
    C+ an<!e(a(e $enera"!/a(7. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7 :n (a'"o+"
    c"!n!c &redo%!n7 an<!e(a(ea sa+ &reoc+&area :n "e$7(+r7 c+ +n n+%7r de
    even!%en(e sa+ ac(!v!(7=!.
    C+ a(ac+r! de &an!c7. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7 a(ac+r!"e de
    &an!c7 Eve/! &a$. I;LJ &redo%!n7 :n (a'"o+" c"!n!c.
    C+ s!%&(o%e o'ses!vo4co%&+"s!ve. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7
    o'ses!!"e sa+ co%&+"s!!"e &redo%!n7 :n (a'"o+" c"!n!c.
    C+ s!%&(o%e .o'!ce. Aces( s&ec!.!can( &oa(e .! +(!"!/a( dac7 s!%&(o%e"e
    .o'!ce &redo%!n7 :n (a'"o+" c"!n!c.
    Tulburarea Anxioas indus de o Substan H8E
    Con(e<(+" a&ar!=!e! s!%&(o%e"or an<!oase &oa(e .! !nd!ca( &r!n +(!"!/area +n+!a
    d!n(re +r%7(or!! s&ec!.!cAndQ
    C+ de'+( :n c+rs+" !n(o<!ca=!e!. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( dac7
    s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7, !ar s!%&(o%e"e
    a&ar :n c+rs+" s!ndro%+"+! de !n(o<!ca=!e.
    C+ de'+( :n c+rs+" a's(!nen=e!. Aces( s&ec!.!can( (re'+!e +(!"!/a( dac7 s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ a's(!nen=a de o s+'s(an=7, !ar s!%&(o%e"e a&ar :n
    c+rs+", sa+ "a sc+r( (!%& d+&7 +n s!ndro% de a's(!nen=7.
    #rocedee de "nre!istrare
    N+%e"e d!a$nos(!c+"+! (+"'+r7r!! an<!oase !nd+se de o s+'s(an=7 :nce&e E:n
    "!%'a en$"e/7, NTJ c+ ce" a" s+'s(an=e! s&ec!.!ce, care se &res+&+ne a .! ca+/a
    s!%&(o%e"or an<!oase Ede e<., a"coo", %e(!".en!da(, (!ro<!naJ. Cod+" d!a$nos(!c es(e
    se"ec(a( d!n(r4o "!s(7 de c"ase de s+'s(an=e, &rev7/+(7 :n se(+" de cr!(er!!. Pen(r+
    s+'s(an=e"e care n+ !n(r7 :n n!c! +na d!n(re c"ase Ede e<., (!ro<!naJ, (re'+!e +(!"!/a(
    cod+" &en(r+ Sa"(7 s+'s(an=7T, :n a.ar7 de aceas(a, &en(r+ %ed!ca%en(e"e &rescr!se :n
    do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!ca( &oa(e .! !nd!ca( &r!n %en=!onarea cod+"+!
    E cores&+n/7(or &e a<a I Eve/! ane<a ,J. N+%e"e (+"'+r7r!! Ede e<., (+"'+rare
    an<!oas7 !nd+s7 de ca.e!naJ es(e +r%a( de s&ec!.!carea (a'"o+"+! s!%&(o%a(o"o$!e
    &redo%!nan( s! a con(e<(+"+! :n care a&ar s!%&(o%e"e Ede e<., 9F9.GF T+"'+rare
    an<!oas7 !nd+s7 de ca.e!na, c+ a(ac+r! de &an!c7, c+ de'+( :n c+rs+" !n(o<!ca=!e!J.
    CAnd se cons!der7 c7 %a! %+"( decA( o s!n$+r7 s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n
    a&ar!=!a s!%&(o%e"or an<!oase, .!ecare (re'+!e s7 .!e %en=!ona(7 se&ara( Ede e<.,
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de coca!n7, c+ an<!e(a(e $enera"!/a(7, c+ de'+( :n
    c+rs+" !n(o<!ca=!e!8 9F5.G T+"'+rare an<!oas7 !nd+2s7 de a"coo", c+ an<!e(a(e
    $enera"!/a(7, c+ de'+( :n (!%&+" a's(!nen=e!J. Dac7 o s+'s(an=7 es(e cons!dera(7 a .!
    .ac(or+" e(!o"o$!c, dar s+'s(an=a s&ec!.!c7 sa+ c"asa de s+'s(an=e es(e nec+nosc+(7,
    (re'+!e s7 .!e +(!"!/a(7 ca(e$or!a 9F9.GF T+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7
    nec+nosc+(7.
    Substane speci$ice
    T+"'+r7r!"e an<!oase &o( s+rven! :n asoc!ere c+ !n(o<!ca=!a :n +r%7(oare"e c"ase de
    s+'s(an=eQ a"coo", a%.e(a%!na O! s+'s(an=e"e a.!ne, ca.e!na, canna'!s, coca!n7,
    a"+c!no$ene, !na"an(e, &encyc"!d!n7 s! s+'s(an=e"e a.!ne s! a"(e s+'s(an=e or!
    s+'s(an=e nec+nosc+(e. T+"'+r7r!"e an<!oase &o( s+rven! :n asoc!ere c+ a's(!nen=a :n
    +r%7(oare"e c"ase de s+'s(an=eQ a"coo", coca!n7, seda(!ve, !&no(!ce s! an<!o"!(!ce s!
    a"(e s+'s(an=e sa+ s+'s(an=e nec+nosc+(e.
    Une"e d!n(re %ed!ca%en(e"e descr!se a evoca s!%&(o%e an<!oase !nc"+d
    anes(e/!ce"e O! ana"$e/!ce"e, s!%&a(o%!%e(!ce"e sa+ a"(e 'ronod!"a(a(oare,
    an(!co"!ner$!ce"e, !ns+"!na, &re&ara(e"e de (!ro!d7, an(!conce&=!ona"e"e ora"e,
    an(!!s(a%!n!ce"e, %ed!ca%en(e"e an(!&ar)!nson!ene, cor(!cos(ero!/!!,
    %ed!ca%en(e"e an(!!&er(ens!ve O! card!ovasc+"are, an(!conv+"s!van(e"e, car'onar+" de
    "!(!+, %ed!ca%en(e"e an(!&s!o(!ce O! %ed!ca%en(e"e an(!de&res!ve. Me(a"e"e $re"e O!
    (o<!ce"e Ede e<., s+'s(an=e"e vo"a(!"e, &rec+% $a/o"!na O! vo&se"e"e, !nsec(!c!de"e
    or$ano.os.ora(e, $a/e"e ne+ro(o<!ce, o<!d+" de car'on, '!o<!d+" de car'onJ &o(
    ca+;a, de ase%enea, s!%&(o%e an<!oase.
    H87 Tulburrile Anxioase
    Dia!nostic di$erenial
    S!%&(o%e"e an<!oase a&ar .recven( :n !n(o<!ca=!a c+ o s+'s(an=7 s! :n a's(!nen(a
    de o s+'s(an=7. D!a$nos(!c+" de !n(o<!ca=!e c+ o s+'s(an=7 s&ec!.!c7 or! de
    a's(!nen=7 de o s+'s(an=7 s&ec!.!c7 va .! de re$+"7 s+.!c!en( s7 c"as!.!ce (a'"o+"
    s!%&(o%a(o"o$!e. Un d!a$nos(!c de (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7
    (re'+!e s7 .!e &+s :n "oc+" +n+! d!a$nos(!c de !n(o<!ca=!e c+ o s+'s(an=7 sa+ de
    a's(!nen=7 de o s+'s(an=7, n+%a! cAnd s!%&(o%e"e an<!oase s+n( cons!dera(e a .! :n
    e<ces co%&ara(!v c+ ce"e asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e sa+ de
    a's(!nen=7 s! cAnd s!%&(o%e"e an<!oase s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o
    a(en=!e c"!n!c7 se&ara(7. De e<e%&"+, s!%&(o%e"e an<!oase s+n( +n e"e%en(
    carac(er!s(!c a" a's(!nen=e! de a"coo". T+"'+rarea an<!oas7 !nd+s7 de a"coo" (re'+!e
    s7 .!e d!a$nos(!ca(7 :n "oc+" a's(!nen=e! de a"coo", n+%a! dac7 s!%&(o%e"e an<!oase
    s+n( %a! severe decA( ce"e :n(A"n!(e de re$+"7 :n a's(!nen=a de a"coo" s! s+n( s+.!c!en(
    de severe &en(r+ a .! +n .ocar se&ara( a" a(en=!e! s! (ra(a%en(+"+!. Dac7 s!%&(o%e"e
    an<!oase !nd+se de o s+'s(an=7 s+rv!n e<c"+s!v :n c+rs+" +n+! de"!r!+%,
    s!%&(o%e"e an<!oase s+n( cons!dera(e a .! +n e"e%en( asoc!a( a" de"!r!+%+"+! s!, ca
    a(are, n+ s+n( d!a$nos(!ca(e se&ara(, :n (a'"o+r!"e c"!n!ce !nd+se de o s+'s(an=7
    care con=!n o %!<(+r7 de d!verse (!&+r! de s!%&(o%e Ede e<., a.ec(!ve, &s!o(!ce s!
    an<!oaseJ, (!&+" s&ec!.!c de (+"'+rare !nd+s7 de o s+'s(an=7 de d!a$nos(!ca( de&!nde
    de (!&+" de s!%&(o%e care &redo%!n7 :n (a'"o+" c"!n!c.
    O (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare an<!oas7
    &r!%ar7 &r!n .a&(+" c7 o s+'s(an=7 es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+
    s!%&(o%e"e Eve/! &a$. IHFJ.
    O (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7, da(ora(7 +n+! (ra(a%en( &rescr!s
    &en(r+ o (+"'+rare %en(a"7 or! &en(r+ o cond!=!e %ed!ca"7 $enera"7, (re'+!e s74s!
    a!'7 de'+(+" :n (!%& ce &ersoana &r!%eO(e %ed!ca%en(+" Esa+ :n c+rs+" a's(!nen=e!,
    dac7 +n s!ndro% de a's(!nen=7 es(e asoc!a( c+ %ed!ca%en(+"J. Oda(7 ce (ra(a%en(+"
    es(e :n(rer+&(, s!%&(o%e"e an<!oase se vor re%!(e de re$+"7 :n dec+rs de cA(eva /!"e
    &An7 "a cA(eva s7&(7%An! sa+ o "+n7 E:n .+nc=!e de se%!v!a=a s+'s(an=e! s! de
    &re/en=a +n+! s!ndro% de a's(!nen=7J. Dac7 s!%&(o%e"e &ers!s(7 &es(e I s7&(7%An!,
    (re'+!e "+a(e :n cons!dera=!e a"(e ca+/e &en(r+ s!%&(o%e"e an<!oase.
    Deoarece !nd!v!/!! c+ cond!=!! %ed!ca"e $enera"e !a+ adesea %ed!ca%en(e
    &en(r+ aces(e cond!=!!, c"!n!c!an+" (re'+!e s7 a!'7 :n vedere even(+a"!(a(ea c7
    s!%&(o%e"e an<!oase s+n( ca+/a(e de consec!n=e"e .!/!o"o$!ce a"e cond!=!e!
    %ed!ca"e $enera"e %a! c+rAnd decA( de %ed!ca%en(, :n care ca/ es(e d!a$nos(!ca(7
    (+"'+rarea an<!oas7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Is(or!c+"
    .+rn!/ea/7 adesea .+nda%en(+" &r!%ar &en(r+ o as(.e" de @+deca(7. Uneor!, o
    sc!%'are a (ra(a%en(+"+! cond!=!e! %ed!ca"e $enera"e Ede e<., s+'s(!(+!rea sa+
    :n(rer+&erea %ed!ca%en(+"+!J &oa(e .! necesar7 &en(r+ a s(a'!"! e%&!r!c, :n ca/+"
    &ersoane! res&ec(!ve, dac7 %ed!ca%en(+" es(e a$en(+" ca+/a" sa+ n+. Dac7
    c"!n!c!an+" a a&rec!a( c7 (+"'+rarea se da(orea/7, a(A( cond!=!e! $enera"e, cA( s!
    +/+"+! +ne! s+'s(an=e, &o( .! &+se a%'e"e d!a$nos(!ce Ede e<., (+"'+rare an<!oas7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! (+"'+rare an<!oas7 !nd+s7 de o
    s+'s(an=7J. CAnd e<!s(7 da(e !ns+.!c!en(e &en(r+ a s(a'!"! dac7 s!%&(o%e"e
    an<!oase se da(orea/7 +ne! s+'s(an=e E!nc"+s!v +n+! %ed!ca%en(J or! +ne! cond!=!!
    %ed!ca"e $enera"e, sa+ s+n( &r!%are Ead!c7, n+ se da(orea/7 +ne! s+'s(an=e sa+
    +ne! cond!=!! %ed!ca"e $enera"eJ, a(+nc! &oa(e .! !nd!ca( d!a$nos(!c+" de (+"'+rare
    an<!oas7 .7r7 a"(7 s&ec!.!ca=!e.
    Tulburarea Anxioas indus de o
    Substan
    7>4

    Criteriile $e $ia/no&ti# pentru
    Tul-urarea An,ioa&( in$u&( $e o Su-&tan!(
    A2 O anxietate notabil, atacuri de panic, obsesii sau compulsii predomin "n
    tabloul clinic2
    S2 Din istoric, examenul somatic sau datele de laborator este evident, $ie &E),
    sau &7)D
    &l)simptomele de la criteriul A apar "n cursul ori "n decurs de o lun de la
    intoxicaia sau abstinena de o substan3 &7) utili(area unui
    medicament este etiolo!ic "n relaie cu tulburarea2
    2 #erturbarea nu este explicat mai bine de o tulburare anxioas care nu este
    indus de o substan2 #roba c simptomele sunt explicate mai bine de o
    tul burare anxi oas care nu este i ndus de o substan poate i ncl ude
    urmtoareleD simptomele preced debutul u(ului de substan &sau al unui
    medicament)3 simptomele persist o perioad substanial de timp &de ex2,
    aproape o lun) dup "ncetarea intoxicaiei acute sau a abstinenei severe
    ori sunt substanial "n exces $a de ceea ce ar $i de a,teptat, dat $iind tipul
    sau cantitatea de substan utili(at ori durata u(ului, sau exist alt prob
    su!er@nd existena unei tulburri anxioase independente, noninduse de o
    substan &de ex2, un istoric de episoade $r le!tur cu o substan)2
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 #erturbarea cau(ea( o detres sau deteriorare "n domeniul- social sau
    pro$esional, ori "n alte domenii importante de $uncionare2
    FotD Acest dia!nostic trebuie s $ie pus "n locul unui dia!nostic de intoxicaie
    cu o substan sau de abstinen de o substan, numai c@nd simptomele
    anxioase sunt "n exces $a de cele asociate de re!ul cu sindromul de
    intoxicaie sau de abstinen si c@nd simptomele anxioase sunt su$icient de
    severe pentru a 0usti$ica o atenie clinic separat2
    A se codi"ica ast$el tulburrile anxioase induse de o substan speci$icD
    &76E28 alcool3 767286 am$etamina sau substane similare am$etamine/3
    767286 ca$eina3 767286 cannabis3 767286 cocain3 767286 %alucino!ene3
    767286 in%alante3 767286 p%encKclidin &sau substane similare p%encKclidinei)3
    767286 sedative, %ipnotice sau anxiolitice3 767286 alt substan sau o
    substan necunoscut)2
    De speci"icat dac'
    u anxietate !enerali(atD dac anxietatea sau preocuparea "n le!tur cu
    un numr de evenimente sau activiti predomin "n tabloul clinic, u
    atacuri de panicD dac> atacurile de panic &ve(i pa!2 H47) predomin "n
    tabloul clinic,
    u simptome obsesivo-compulsiveD dac obsesiile sau compulsiile
    predomin "n tabloul clinic, u simptome $obiceD dac simptome $obice
    predomin "n tabloul clinic2
    7>7 Tulburrile Anxioase

    Criteriile $e $ia/no&ti# pentru
    Tul-urarea An,ioa&( in$u&( $e o Su-&tan!( (continuare)
    7e speci"icat dac' &ve(i tabelul de la pa!2 E64 pentru aplicabilitatea la substan)D
    u debut "n cursul intoxicaieiD dac sunt satis$cute criteriile pentru
    intoxicaia cu o substan, iarsimptomele apar "n cursul sindromului de
    intoxicaie, u debut "n cursul abstineneiD dac sunt satis$cute criteriile
    pentru abstinena de o substan, iar simptomele apar "n cursul sau la scurt
    timp dup un sindrom de abstinen2
    4++.++ Tul-urarea An,ioa&( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e !nc"+de (+"'+r7r!"e c+ an<!e(a(e sa+ ev!(are .o'!c7 no(a'!"7
    care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare an<!oas7 s&ec!.!c7, &en(r+
    (+"'+rarea de ada&(are c+ an<!e(a(e sa+ (+"'+rarea de ada&(are c+ d!s&o/!=!e %!<(7
    de&res!v7 s! an<!oas7. E<e%&"e"e !nc"+dQ
    1. T+"'+rarea %!<(7 de&res!v4an<!oas7Q s!%&(o%e an<!oase s! de&res!ve
    se%n!.!ca(!ve c"!n!c, dar n+ s+n( sa(!s.7c+(e cr!(er!!"e, n!c! &en(r+ o (+"'+rare
    de&res!v7 s&ec!.!c7 s! n!c! &en(r+ o (+"'+rare an<!oas7 s&ec!.!c7 Eve/! &a$. HGL
    &en(r+ cr!(er!!"e de cerce(are s+$era(eJ,
    2. S!%&(o%e"e se%n!.!ca(!ve c"!n!c de .o'!e soc!a"7 care s+n( :n "e$7(+r7 c+
    !%&ac(+" soc!a" a" .a&(+"+! de a avea o cond!=!e %ed!ca"7 $enera"7 or! o (+"'+rare
    %en(a"7 Ede e<., %a"ad!e Par)!nson, cond!=!! der%a(o"o$!ce, 'a"'!s%, anore<!e
    nervoas7, (+"'+rare d!s%or.!c7 cor&ora"7J,
    3. S!(+a=!!"e :n care &er(+r'area es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca +n
    d!a$nos(!c de (+"'+rare an<!oas7, dar :n care !nd!v!d+" n+ es(e :n s(are s7
    re"a(e/e s+.!c!en(e s!%&(o%e &en(r+ a sa(!s.ace cr!(er!!"e co%&"e(e a"e vre+ne!
    (+"'+r7r! an<!oase8 de e<., +n !nd!v!d care re"a(ea/7 (oa(e e"e%en(e"e &an!c!! .7r7
    a$ora.o'!e c+ e<ce&=!a .a&(+"+! c7 a(ac+r!"e de &an!c7 s+n( (oa(e a(ac+r! c+
    s!%&(o%e "!%!(a(e,
    4. S!(+a=!!"e :n care c"!n!c!an+" a a@+ns "a conc"+/!a c7 es(e &re/en(7 o (+"'+rare
    an<!oas7, dar es(e !nca&a'!" s7 s(a'!"easc7 dac7 aceas(a es(e &r!%ar7, da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e sa+ es(e !nd+s7 de o s+'s(an=7.
    Tulburrile Somato$orme
    I"e%en(+" co%+n a" (+"'+r7r!"or so%a(o.or%e :" cons(!(+!e &re/en=a de
    s!%&(o%e so%a(!ce care s+$erea/7 o cond!=!e %ed!ca"7 $enera"7 Ede
    +nde (er%en+" de somato)orm%, dar care n+ s+n( e<&"!ca(e co%&"e( de o
    cond!=!e %ed!ca"7 $enera"7, de e.ec(e"e d!rec(e a"e +ne! s+'s(an=e or! de
    a"(7 (+"'+rare %en(a"7 Ede e<., &an!caJ. S!%&(o%e"e (re'+!e s7 ca+/e/e
    o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" or! :n
    a"(e do%en!! !%&or(an(e de .+nc=!onare. Con(rar (+"'+r7r!"or .ac(!ce s! s!%+"7r!!,
    s!%&(o%e"e so%a(!ce n+ s+n( !n(en=!ona"e Ead!c7, s+' con(ro" vo"+n(arJ.
    T+"'+r7r!"e so%a(o.or%e d!.er7 de .ac(or!! &s!o"o$!c! care a.ec(ea/7 cond!=!a
    so%a(!c7 &r!n aceea c7 n+ e<!s(7 o cond!=!e %ed!ca"7 $enera"7 d!a$nos(!ca'!"7 care
    s7 e<&"!ce !n(e$ra" s!%&(o%e"e so%a(!ce. ,r+&area aces(or (+"'+r7r! :n(r4o
    s!n$+r7 sec=!+ne se ba;ea;6 &e +(!"!(a(ea c"!n!c7 Ead!c7, &e neces!(a(ea de a
    e<c"+de cond!=!!"e %ed!ca"e $enera"e oc+"(e sa+ e(!o"o$!!"e !nd+se de o s+'s(an=7
    &en(r+ s!%&(o%e"e cor&ora"eJ, %a! c+rAnd decA( &e &res+&+ner! re.er!(oare "a
    e(!o"o$!e sa+ %ecan!s%e co%+ne. Aces(e (+"'+r7r! s+n( :n(A"n!(e adesea :n
    +n!(7=!"e %ed!ca"e $enera"e.
    :n aceas(7 sec=!+ne s+n( !nc"+se +r%7(oare"e (+"'+r7r! so%a(o.or%eQ
    T+"'+rarea de so%a(!/are E!s(or!c, den+%!(7 !s(er!e sa+ s!ndro% Br!0+e(J es(e o
    (+"'+rare &o"!s!%&(o%a(!c7 c+ de'+( :na!n(e de e(a(ea de ;L de an!, care se :n(!nde
    &e o &er!oad7 de an! de /!"e O! es(e carac(er!/a(7 &r!n(r4o co%'!na=!e de d+rere s!
    s!%&(o%e $as(ro!n(es(!na"e, se<+a"e s! &se+done+ro"o$!ce.
    T+"'+rarea so%a(o.or%7 ned!.eren=!a(7 es(e carac(er!/a(7 &r!n ac+/e so%a(!ce
    nee<&"!ca(e, d+rAnd ce" &+=!n R "+n! s! care s+n( s+' &ra$+" &en(r+ +n d!a$nos(!c de
    (+"'+rare de so%a(!/are.
    T+"'+rarea de convers!e !%&"!c7 s!%&(o%e nee<&"!ca(e sa+ de.!c!(e care
    a.ec(ea/7 ac(!v!(a(ea %o(or!e vo"+n(ar7 sa+ sens!'!"!(a(ea, s+$erAnd o cond!=!e
    ne+ro"o$!c7 sa+ a"(7 cond!=!e %ed!ca"7 $enera"7. Se cons!der7 c7 .ac(or! &s!o"o$!c!
    s+n( asoc!a=! c+ s!%&(o%e"e sa+ de.!c!(e"e.
    T+"'+rarea a"$!c7 se carac(er!/ea/7 &r!n d+rere ca .ocar &redo%!nan( a" a(en=!e!
    c"!n!ce, :n &"+s, .ac(or!! &s!o"o$!c! s+n( cons!dera=! a avea +n ro" !%&or(an( :n
    de'+(+", sever!(a(ea, e<acer'area s! &ers!s(en=a sa.
    H!&ocondr!a es(e &reoc+&area c+!va :n "e$7(+r7 c+ .a&(+" c7 ar avea or! !deea c7
    are o %a"ad!e sever7, 'a/a(7 &e !n(er&re(area erona(7 a s!%&(o%e"or sa+ a .+nc=!!"or
    cor&ora"e.
    T+"'+rarea d!s%or.!c7 cor&ora"7 es(e &reoc+&area &en(r+ +n de.ec( &res+&+s
    sa+ e<a$era( :n as&ec(+" .!/!c.
    T+"'+rarea so%a(o.or%7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    (+"'+r7r!"or c+ s!%&(o%e so%a(o.or%e care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! +na d!n
    (+"'+r7r!"e so%a(o.or%e s&ec!.!ce.
    7><
    F=> Tul-ur(rile So"ato%or"e
    4++.>* Tul-urarea $e So"at.)are
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de so%a(!/are es(e +n &a((ern de ac+/e so%a(!ce
    se%n!.!ca(!ve c"!n!c, %+"(!&"e, rec+ren(e. O ac+/7 so%a(!c7 es(e cons!dera(7 a .!
    *
    se%n!.!ca(!v7 c"!n!c, dac7 d+ce "a (ra(a%en( %ed!ca" Ede e<., "a "+area +n+!
    %ed!ca%en(J or! ca+/ea/7 o de(er!orare se%n!.!ca(!v7 :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! de .+nc=!onare !%&or(an(e. Ac+/e"e so%a(!ce
    (re'+!e s7 :ncea&7 :na!n(e de e(a(ea de ;L de an! s! s7 s+rv!n7 o &er!oad7 de %a!
    %+"=! an! Ecr!(er!+" AJ. M+"(!&"e"e ac+/e so%a(!ce n+ &o( .! e<&"!ca(e co%&"e( de n!c!
    o cond!=!e %ed!ca"7 $enera"7 c+nosc+(7 or! de e.ec(e"e d!rec(e a"e +ne! s+'s(an=e.
    Dac7 s+rv!n :n &re/en=a +ne! cond!=!! %ed!ca"e $enera"e, ac+/e"e so%a(!ce sa+
    de(er!orarea re/+"(an(7 a .+nc=!on7r!! soc!a"e sa+ &ro.es!ona"e s+n( :n e<ces .a=7 de
    ceea ce ar .! de aO(e&(a( d!n !s(or!c, e<a%en+" so%a(!c sa+ (es(e"e de "a'ora(or
    Ecr!(er!+" CJ. Tre'+!e s7 e<!s(e +n !s(or!c de d+rere :n ra&or( c+ ce" &+=!n &a(r+ sed!!
    d!.er!(e Ede e<., ca&, a'do%en, s&a(e, ar(!c+"a=!!, e<(re%!(7=!, &!e&(, rec(J sa+ .+nc=!!
    Ede e<., %ens(r+a=!e, ra&or( se<+a", %!c=!+neJ Ecr!(er!+" B"J. Tre'+!e s7 e<!s(e +n
    !s(or!c de ce" &+=!n do+7 s!%&(o%e $as(ro!n(es(!na"e, a"(e"e decA( d+rerea Ecr!(er!+"
    B9J. Ce! %a! %+"=! !nd!v!/! c+ (+"'+rarea descr!+ &re/en=a $re=!! s! 'a"on7r!!
    a'do%!na"e. 37rs7(+r!"e, d!areea s! !n(o"eran=a a"!%en(ar7 s+n( %a! &+=!n .recven(e.
    Ac+/e"e $as(ro!n(es(!na"e d+c adesea "a e<a%!n7r! rad!o"o$!ce .recven(e s! "a
    !n(erven=!! c!r+r$!ca"e a'do%!na"e care +"(er!or se ara(7 a .! .os( !n+(!"e. Tre'+!e s7
    e<!s(e +n !s(or!c de ce" &+=!n +n s!%&(o% se<+a" sa+ re&rod+c(!v, a"(+" decA( d+rerea
    Ecr!(er!+" B;J. La .e%e!, aceas(a &oa(e cons(a d!n %ens(re nere$+"a(e, %enorao$!e
    sa+ v7rs7(+r! :n (!%&+" sarc!n!!. La '7r'a=!, &o( e<!s(a s!%&(o%e &rec+% d!s.+nc=!a
    erec(!"7 sa+ e@ac+"a(or!e. A(A( '7r'a=!!, cA( O! .e%e!"e &o( .! e<&+O! !nd!.eren=e!
    se<+a"e, :n .!ne, (re'+!e s7 e<!s(e, de ase%enea, +n !s(or!c de ce" &+=!n +n s!%&(o%,
    a"(+" decA( d+rerea, care s+$erea/7 o cond!=!e ne+ro"o$!c7 Es!%&(o%e de convers!e,
    c+% ar .! de(er!orarea coordon7r!! sa+ ec!"!'r+"+!, &ara"!/!e sa+ sc7dere "oca"!/a(7
    a .or=e! %+sc+"are, d!.!c+"(a(e :n de$"+(!=!e sa+ sen/a=!e de nod :n $A(, a.on!e,
    re(en=!e de +r!n7, a"+c!na=!!, &!erderea sens!'!"!(7=!! (ac(!"e sa+ d+reroase, d!&"o&!e,
    cec!(a(e, s+rd!(a(e sa+ cr!/e e&!"e&(!ce, s!%&(o%e d!soc!a(!ve, c+% ar .! a%ne/!a, sa+
    &!erderea c+noO(!n=e!, a"(a decA( "eO!n+"J Ecr!(er!+" BIJ. S!%&(o%e"e, :n .!ecare d!n(re
    aces(e $r+&e, a+ .os( %en=!ona(e :n ord!nea a&ro<!%a(!v7 a .recven=e! "or re"a(a(e,
    :n .!ne, s!%&(o%e"e nee<&"!ca(e d!n (+"'+rarea de so%a(!/are n+ s+n( s!%+"a(e sa+
    &rod+se !n(en=!ona( Eca :n (+"'+rarea .ac(!ce sa+ :n s!%+"areJ Ecr!(er!+" DJ.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Ind!v!/!! c+ (+"'+rarea
    de so%a(!/are :O! descr!+ de re$+"7 ac+/e"e :n (er%en! &"!n! de c+"oare, e<a$era=!,
    !ar !n.or%a=!a .ac(+a"7 s&ec!.!c7 "!&seO(e adesea. E! s+n( adesea nara(or!
    !nconsecven=!, aOa c7 e"a'orarea +n+! (a'e" de con(ro" &en(r+ !n(erv!+" d!a$nos(!c
    &oa(e .! %a! &+=!n e.!cace decA( o (recere :n rev!s(7 d!rec(7 a (ra(a%en(e"or
    %ed!ca"e O! a s&!(a"!/7r!"or &en(r+ a doc+%en(a +n &a((ern a" ac+/e"or so%a(!ce
    .recven(e. E! so"!c!(7 adesea :n ace"aO! (!%& (ra(a%en( de "a %a! %+"=! %ed!c!, ceea
    ce &oa(e d+ce "a co%'!na=!! de (ra(a%en(e co%&"!ca(e s! +neor! a/arda(e.
    S!%&(o%e"e an<!oase &roe%!nen(e O! d!s&o/!=!a de&res!v7 s+n( .oar(e .recven(e O!
    45528E Tulburarea de
    Somati(are
    7>G
    &o( .! +n %o(!v &en(r+ a .! :n(A"n!=! :n +n!(7=! de s7n7(a(e %en(a"7. Poa(e &ds(a +n
    co%&or(a%en( an(!soc!a" s! !%&+"s!v, a%en!n=7r! s! (en(a(!ve de s+!c!d s! d!scord!e
    %ar!(a"7. 3!e=!"e aces(or !nd!v!/!, :n s&ec!a" a"e ce"or c+ (+"'+r7r! de &ersona"!(a(e
    asoc!a(e, s+n( adesea "a .e" de ao(!ce s! de co%&"!ca(e ca s! !s(or!c+" "or %ed!ca".
    U/+" .recven( de %ed!ca%en(e &oa(e d+ce "a e.ec(e co"a(era"e s! "a (+"'+r7r! :n
    "e$7(+r7 c+ o s+'s(an=7. AceO(! !nd!v!/! se s+&+n de re$+"7 "a n+%eroase
    e<a%!n7r! %ed!ca"e, &rocedee d!a$nos(!ce, !n(erven=!! c!r+r$!ca"e s! s&!(a"!/7r!
    care e<&+n &ersoana +n+! r!sc cresc+( de %or'!d!(a(e asoc!a(7 c+ aces(e &rocedee.
    T+"'+rarea de&res!v7 %a@or7, &an!ca s! (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 s+n(
    asoc!a(e .recven( c+ (+"'+rarea de so%a(!/are. T+"'+r7r!"e de &ersona"!(a(e
    !s(r!on!c7, 'order"!ne s! an(!soc!a"7 s+n( (+"'+r7r!"e de &ersona"!(a(e ce" %a!
    .recven( asoc!a(e.
    9ate de laborator asociate. Re/+"(a(e"e (es(e"or de "a'ora(or s+n re%arca'!"e
    &r!n a'sen=a de da(e care s7 s+s=!n7 ac+/e"e so%a(!ce.
    9atele examenului somatic /i condi3iile medicale asociate. E<a%en+" so%a(!c
    es(e re%arca'!" &r!n a'sen=a da(e"or o'!ec(!ve care s7 e<&"!ce !n(e$ra" d!verse"e
    ac+/e s+'!ec(!ve a"e !nd!v!/!"or c+ (+"'+rare de so%a(!/are. AceO(! !nd!v!/! &o( .!
    d!a$nos(!ca=! ca avAnd aOa n+%!(e"e (+"'+r7r! .+nc=!ona"e Ede e<., s!ndro% de co"on
    !r!(a'!"J. Deoarece :ns7 aces(e s!ndro%e s+n( &An7 ac+% .7r7 se%ne o'!ec(!ve
    s(a'!"!(e sa+ da(e de "a'ora(or s&ec!.!ce, s!%&(o%e"e "or &o( &"eda &en(r+ +n
    d!a$nos(!c de (+"'+rare de so%a(!/are. Un!! !nd!v!/! a+ da(e o'!ec(!ve s! o cond!=!e
    %ed!ca"7 $enera"7 asoc!a(7 care n+ e<&"!c7 :n (o(a"!(a(e ac+/e"e. De e<e%&"+,
    !nd!v!/!! c+ !&o(!ro!d!s% &o( &re/en(a ac+/e %+"(!&"e s! +n n+%7r se%n!.!ca(!v de
    da(e o'!ec(!ve, dar %a"ad!a n+ e<&"!c7 +n as(.e" de !s(or!c "+n$ de n+%eroase s!
    d!verse ac+/e.
    *lemente speci$ice culturii si sexului
    T!&+" O! .recven=a s!%&(o%e"or so%a(!ce &o( var!a a (ransverso &r!n d!verse"e
    c+"(+r!. De e<e%&"+, ars+r!"e :n %A!n! O! :n &!c!oare or! e<&er!en(area nonde"!ran(7
    de v!er%! :n ca& sa+ de .+rn!c! re&(And s+' (e$+%en(e re&re/!n(7 s!%&(o%e
    &se+done+ro"o$!ce care s+n( %a! .recven(e :n A.r!ca s! As!a de S+d decA( :n
    A%er!ca de Nord. S!%&(o%e"e :n ra&or( c+ .+nc=!a de re&rod+cere %asc+"!n7 &o(
    &reva"a :n c+"(+r!"e :n care e<!s(7 o &reoc+&are "ar$ r7s&And!(7 :n "e$7(+r7 c+
    &!erderea s&er%e! Ede e<., s!ndro%+" d-at :n Ind!aJ, :n consec!n=7, (recerea :n rev!s(7
    a s!%&(o%e"or (re'+!e s7 .!e ada&(a(7 c+"(+r!!. S!%&(o%e"e %en=!ona(e :n aces(
    %an+a" s+n( e<e%&"e"e care a+ .os( cons(a(a(e a .! ce"e %a! re"evan(e d!a$nos(!c :n
    S(a(e"e Un!(e. Tre'+!e re=!n+( c7 ord!nea .recven=e! &rov!ne d!n s(+d!!"e e.ec(+a(e :n
    S(a(e"e Un!(e.
    T+"'+rarea de so%a(!/are s+rv!ne rar "a '7r'a=! :n S(a(e"e Un!(e, !ar .recven=a
    %a! %are ra&or(a(7 "a '7r'a=!! $rec! s! &or(or!can! s+$erea/7 c7 .ac(or!! c+"(+ra"! &o(
    !n."+en=a ra(a se<+"+!.
    #revalent
    S(+d!!"e a+ ra&or(a( ra(e de &reva"en(7 &e v!a=7 e<(re% de var!a'!"e &en(r+
    (+"'+rarea de so%a(!/are, %er$And de "a L,9d "a 9d "a .e%e! s! de %a! &+=!n de
    L,9d "a '7r'a=!. D!.eren=e"e &rocen(+a"e &o( de&!nde s! de .a&(+" dac7 ce" care
    7>> Tulburrile Somato$orme
    !n(erv!evea/7 es(e %ed!c, de %e(oda de eva"+are s! de var!a'!"e"e de%o$ra.!ce d!n
    eOan(!oane"e s(+d!a(e. CAnd s+n( +(!"!/a=! ance(a(or! care n+ s+n( %ed!c!,
    (+"'+rarea de so%a(!/are es(e %+"( %a! &+=!n .recven( d!a$nos(!ca(7.
    *voluie
    T+"'+rarea de so%a(!/are es(e o (+"'+rare cron!c7, dar ."+c(+an(7, care se re%!(e
    rar co%&"e(. Trece rar +n an .7r7 ca !nd!v!d+" sa n+ so"!c!(e o e<a%!nare %ed!ca"7,
    :%&!ns .!!nd de ac+/e so%a(!ce nee<&"!ca(e. Cr!(er!!"e de d!a$nos(!c s+n(
    sa(!s.7c+(e de re$+"7 :na!n(e de e(a(ea de 9Y de an!, !ar s!%&(o%e"e !n!=!a"e s+n(
    adesea &re/en(e d!n ado"escen=7. D!.!c+"(7=!"e %ens(r+a"e &o( .! +n+" d!n(re ce"e
    %a! &recoce s!%&(o%e "a .e%e!. S!%&(o%e"e se<+a"e s+n( asoc!a(e adesea c+
    d!scord!e %ar!(a"7.
    #attern $amilial
    T+"'+rarea de so%a(!/are es(e o'serva(7 "a 5Ld49Ld d!n(re .e%e!"e r+de
    '!o"o$!ce de $rad+" I a"e .e%e!"or c+ (+"'+rare de so%a(!/are. R+de"e %asc+"!ne
    a"e .e%e!"or c+ aceas(7 (+"'+rare &re/!n(7 +n r!sc cresc+( de (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 s! de (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7. S(+d!!"e &e
    ado&(a=! !nd!c7 .a&(+" c7, a(A( .ac(or!! $ene(!c!, cA( s! ce! de %ed!+ con(r!'+!e "a
    r!sc+" de (+"'+rare de &ersona"!(a(e an(!soc!a"7, de (+"'+r7r! :n "e$7(+r7 c+ o
    s+'s(an=7 s! de (+"'+rare de so%a(!/are. A avea +n &7r!n(e '!o"o$!c sa+ ado&(!v
    c+ or!care d!n(re aces(e (+"'+r7r! cres(e r!sc+" de a&ar!=!e, .!e a" (+"'+r7r!! de
    &ersona"!(a(e an(!soc!a"7, .!e a" +ne! (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 sa+ a"
    (+"'+r7r!! de so%a(!/are.
    Dia!nostic di$erenial
    Ta'"o+" s!%&(o%a(o"o$!e :n(A"n!( :n (+"'+rarea de so%a(!/are es(e .recven(
    nes&ec!.!c s! se &oa(e s+&ra&+ne &es(e o %+"(!(+d!ne de cond!=!! %ed!ca"e $enera"e.
    Ce"e (re! e"e%en(e care s+$erea/7 %a! c+rAnd +n d!a$nos(!c de (+"'+rare de
    so%a(!/are decA( o cond!=!e %ed!ca"7 !nc"+d 5J !%&"!carea a n+%eroase s!s(e%e de
    or$ane, 9J de'+(+" &recoce s! evo"+=!a cron!c7, .7r7 a&ar!=!a de se%ne so%a(!ce sa+
    de ano%a"!! s(r+c(+ra"e s! ;J a'sen=a ano%a"!!"or de "a'ora(or carac(er!s(!ce sa+
    s+$erAnd o cond!=!e %ed!ca"7 $enera"7. To(+O!, es(e necesar s7 se e<c"+d7 cond!=!!"e
    %ed!ca"e $enera"e carac(er!/a(e &r!n s!%&(o%e so%a(!ce va$!, %+"(!&"e s! con.+/e
    Ede e<., "+&+s+" er!(e%a(os s!s(e%!c, !&er&ara(!ro!d!s%+", sc"ero/a %+"(!&"7,
    &or.!r!a !n(er%!(en(7 ac+(7, e%ocro%a(o/a, %a"ad!a Ly%e, o %a"ad!e &ara/!(ar7
    cron!c7J. Dea"(.e", (+"'+rarea de so%a(!/are n+ &ro(e@ea/7 !nd!v!/!! de a avea a"(e
    cond!=!! %ed!ca"e $enera"e !nde&enden(e. Da(e"e o'!ec(!ve (re'+!e s7 .!e eva"+a(e
    .7r7 a avea :ncredere e<a$era(7 :n ac+/e"e s+'!ec(!ve. De'+(+" (ard!v :n v!a=7 a
    n+%eroase s!%&(o%e so%a(!ce es(e a&roa&e (o(dea+na da(ora( +ne! cond!=!!
    %ed!ca"e $enera"e.
    Sc!/o.ren!a, c+ %+"(!&"e !de! de"!ran(e so%a(!ce, (re'+!e s7 .!e d!.eren=!a(7 de
    ac+/e"e so%a(!ce nonde"!ran(e a"e !nd!v!/!"or c+ (+"'+rare de so%a(!/are. :n rare
    ca/+r!, !nd!v!/!! c+ (+"'+rare de so%a(!/are a+, de ase%enea, s! sc!/o.ren!e,
    even(+a"!(a(e :n care (re'+!e %en=!ona(e a%'e"e d!a$nos(!ce, :n &"+s, &o( a&are
    a"+c!na=!! ca s!%&(o%e &2se+done+ro"o$!ce s! (re'+!e s7 .!e d!s(!nse de a"+c!na=!!"e
    (!&!ce o'serva(e :n sc!/o.ren!e Eve/! &a$. 9FFJ.
    45528E Tulburarea de
    Somati(are
    F=4

    Poa(e .! d!.!c!" de .7c+( d!s(!nc=!e :n(re (+"'+r7r!"e an<!oase s! (+"'+rarea de
    so%a(!/are. :n &an!c7 s+n( &re/en(e, de ase%enea, n+%eroase s!%&(o%e
    so%a(!ce, dar aces(ea s+rv!n :n s&ec!a" :n c+rs+" a(ac+r!"or de &an!c7. A(ac+r!"e de
    &an!c7 &o( coe<!s(a :ns7 c+ (+"'+rarea de so%a(!/are8 cAnd s!%&(o%e"e so%a(!ce
    s+rv!n O! a"(eor! decA( :n c+rs+" a(ac+r!"or de &an!c7, &o( .! &+se a%'e"e
    d!a$nos(!ce. Ind!v!/!! c+ an<!e(a(e $enera"!/a(7 &o( avea o %+"=!%e de ac+/e
    so%a(!ce asoc!a(e c+ an<!e(a(ea $enera"!/a(7, dar .ocar+" an<!e(7=!! s! &reoc+&7r!!
    n+ es(e "!%!(a( "a ac+/e"e so%a(!ce. Ind!v!/!! c+ (+"'+r7r! a.ec(!ve, :n s&ec!a" c+
    (+"'+r7r! de&res!ve, &o( &re/en(a ac+/e so%a(!ce, ce" %a! .recven( ce.a"ee,
    &er(+r'7r! $as(ro!n(es(!na"e sa+ d+rere nee<&"!ca(7. Ind!v!/!! c+ (+"'+rare de
    so%a(!/are a+ ac+/e so%a(!ce rec+ren(e de4a "+n$+" ce"e! %a! %ar! &7r=! a v!e=!!
    "or, !nd!.eren( de s(area "or a.ec(!v7 ac(+a"7, &e cAnd ac+/e"e so%a(!ce :n
    (+"'+r7r!"e de&res!ve s+n( "!%!(a(e "a e&!soade"e de d!s&o/!=!e de&res!v7. Ind!v!/!!
    c+ (+"'+rare de so%a(!/are &re/!n(7, de ase%enea, .recven( ac+/e de&res!ve. Dac7
    s+n( sa(!s.7c+(e cr!(er!!"e, a(A( &en(r+ (+"'+rarea de so%a(!/are, cA( s! &en(r+
    (+"'+rare a.ec(!v7, &o( .! d!a$nos(!ca(e a%'e"e.
    Pr!n de.!n!=!e, (o=! !nd!v!/!! c+ (+"'+rare de so%a(!/are a+ +n !s(or!c de s!%&(o%e
    de d+rere, s!%&(o%e se<+a"e s! s!%&(o%e de convers!e sa+ d!soc!a(!ve. De aceea,
    dac7 aces(e s!%&(o%e s+rv!n e<c"+s!v :n c+rs+" (+"'+r7r!! de so%a(!/are, n+ (re'+!e
    &+s +n d!a$nos(!c ad!=!ona" de (+"'+rare a"$!c7 asoc!a(7 c+ .ac(or! &s!o"o$!c!, de
    d!s.+nc=!e se<+a"7, (+"'+rare de convers!e or! de (+"'+rare d!soc!a(!v7.
    H!&ocondr!a n+ es(e d!a$nos(!ca(7 dac7 &reoc+&7r!"e :n "e$7(+r7 c+ .a&(+" c7 ar
    avea o %a"ad!e sever7 s+rv!n e<c"+s!v :n c+rs+" (+"'+r7r!! de so%a(!/are.
    Cr!(er!!"e &en(r+ (+"'+rarea de so%a(!/are d!n aces( %an+a" s+n( :n(r4o oarecare
    %7s+r7 %a! res(r!c(!ve decA( cr!(er!!"e or!$!na"e &en(r+ s!ndro%+" Br!0+e(.
    Ta'"o+r!"e c"!n!ce so%a(o.or%e care n+ sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de
    so%a(!/are (re'+!e s7 .!e c"as!.!ca(e ca (+"'+rare so%a(o.or%7 ned!.eren=!a(7, dac7
    d+ra(a s!ndro%+"+! es(e de R "+n! sa+ %a! "+n$7, or! ca (+"'+rare so%a(o.or%7 .7r7
    a"(7 s&ec!.!ca=!e, &en(r+ (a'"o+r!"e c"!n!ce de %a! sc+r(7 d+ra(7.
    :n (+"'+rarea .ac(!ce c+ se%ne s! s!%&(o%e &redo%!nan( so%a(!ce s! :n
    s!%+"are, s!%&(o%e"e so%a(!ce &o( .! &rod+se !n(en=!ona" &en(r+ as+%area
    ro"+"+! de &ac!en( sa+, res&ec(!v, &en(r+ cAO(!$. S!%&(o%e"e &rod+se !n(en=!ona"
    n+ (re'+!e s7 .!e "+a(e :n cons!dera=!e &en(r+ +n d!a$nos(!c de (+"'+rare de
    so%a(!/are. C+ (oa(e aces(ea :ns7, &re/en=a +nor s!%&(o%e .ac(!ce sa+ s!%+"a(e,
    a%es(eca(e c+ a"(e s!%&(o%e non!n(en=!ona"e, n+ es(e rar7. :n as(.e" de ca/+r!
    %!<(e (re'+!e s7 .!e d!a$nos(!ca(e, a(A( (+"'+rarea de so%a(!/are, cA( O! (+"'+rarea
    .ac(!ce sa+ s!%+"area.
    IFL Tulburrile Somato$orme

    Criteriile $e $ia/no&ti# pentru
    4++.>* Tul-urarea $e &o"ati)are
    A2 .n istoric de multe acu(e somatice "ncep@nd "nainte de etatea de 45 de ani
    care survin o perioad de muli ani si care au drept re(ultat solicitarea
    tratamentului sau o deteriorare semni$icativ "n domeniul social, pro$esio
    nal sau "n alte domenii importante de $uncionare2
    S2 'iecare dintre urmtoarele criterii trebuie s $i $ost satis$cute, cu simptome
    individuale survenind oric@nd "n cursul perturbriiD
    (1) patru simptome a1!1ceD un istoric de durere cu cel puin patru sedii
    sau
    $unciuni di$erite &de ex2, cap, abdomen, spate, articulaii, extremiti,
    piept, rect, "n cursul menstruaie/, raportului sexual ori miciunii)3
    (2) dou simptome gastrointestinale' un istoric de cel puin dou
    simptome
    !astrointestinale, altele dec@t durerea &de ex2, !rea, $latulen, vrsturi,
    altele dec@t "n cursul sarcinii, diaree sau intoleran la diverse alimente)3
    (3) un simptom sexual' un istoric de cel puin un simptom sexual sau
    de
    reproducere, altul dec@t durerea &de ex2, indi$eren sexual, dis$uncie
    erectil sau e0aculatorie, menstruaii nere!ulate, s@n!erare menstrual
    excesiv, vrsturi pe toat durata sarcinii)3
    (4) un simptom pseudoneurologic' un istoric de cel puin un simptom
    sau
    de$icit su!er@nd o condiie neurolo!ic nelimitat la durere &simptome
    de conversie, cum ar $i deteriorarea coordonrii sau ec%ilibrului, parali(ie
    sau scderea locali(at a $orei musculare, di$icultate "n de!lutiie sau
    sen(aia de nod "n !@t, a$onie, retenie de urin, %alucinaii, pierderea
    sen(aiei tactile sau de durere, diplopie, cecitate, cri(e epileptice, simptome
    disociative, cum ar $i amne(ia ori o pierdere a cuno,tinei, alta dec@t le,inul)2
    2 'ie &E), $ie ())'
    &E)dup o investi!aie corespun(toare, nici unul dintre simptomele de la
    criteriul S nu poate $i explicat complet de o condiie medical !eneral
    cunoscut ori de e$ectele directe ale unei substane &de ex2, un dro! de
    abu(, un medicament)3
    &7) c@nd exist o condiie medical !eneral asemntoare, acu(ele
    somatice sau deteriorarea social sau pro$esional re(ultant sunt "n
    exces $a de ceea ce ar $i de a,teptat din istoric, examenul somatic sau
    datele de laborator2
    D2 Simptomele nu sunt produse intenional sau inventate ca &ca "n tulburarea
    $actice sau simulare)
    4++.>C Tul-urarea So"ato%or"( Ne$i%eren!iat(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! so%a(o.or%e ned!.eren=!a(e :" cons(!(+!e +na sa+
    %a! %+"(e ac+/e so%a(!ce Ecr!(er!+" AJ, care &ers!s(7 (!%& de R "+n! sa+ %a! %+"(
    Ecr!(er!+" DJ. Ce"e %a! .recven(e ac+/e s+n( .a(!$a'!"!(a(ea cron!c7, &!erderea
    455287 Tulburarea Somato$orm
    Fedi$ereniat
    F41

    a&e(!(+"+! or! s!%&(o%e"e $as(ro!n(es(!na"e sa+ $en!(o+r!nare. Aces(e s!%&(o%e n+
    &o( .! e<&"!ca(e co%&"e( de n!c! o cond!=!e %ed!ca"7 $enera"7 c+nosc+(7 or! de
    e.ec(e"e d!rec(e a"e +ne! s+'s(an=e Ede e<., e.ec(e"e +ne! "e/!+n!, +/+" +ne! s+'s(an=e
    sa+ e.ec(e"e sec+ndare a"e +n+! %ed!ca%en(J, or! ac+/e"e so%a(!ce sa+ de(er!orarea
    re/+"(a(7 s+n( c+ %+"( :n e<ces .a=7 de ceea ce ar .! de aO(e&(a( d!n !s(or!c, e<a%en+"
    so%a(!c sa+ da(e"e de "a'ora(or Ecr!(er!+" BJ. S!%&(o%e"e (re'+!e s7 ca+/e/e o
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a" sa+ &ro.es!ona", or!
    :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ. D!a$nos(!c+" n+ es(e &+s
    cAnd s!%&(o%e"e s+n( e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7 Ede e<., de a"(7
    (+"'+rare so%a(o.or%7, de o d!s.+nc=!e se<+a"7, de o (+"'+rare a.ec(!v7, an<!oas7,
    de so%n sa+ &s!o(!c7J Ecr!(er!+" EJ. S!%&(o%e"e n+ s+n( &rod+se !n(en=!ona" sa+
    s!%+"a(e Eca :n (+"'+rarea .ac(!ce sa+ :n s!%+"areJ Ecr!(er!+" FJ.
    Aceas(a es(e o ca(e$or!e re/!d+a"7 &en(r+ ace"e (a'"o+r! c"!n!ce so%a(o.or%e
    &ers!s(en(e care n+ sa(!s.ac cr!(er!!"e co%&"e(e &en(r+ o (+"'+rare so%a(o.or%7
    s&ec!.!c7 Ede e<., (+"'+rarea de so%a(!/areJ. Tre'+!e acorda(7 %+"(7 a(en=!e .a&(+"+!
    c7 (a'"o+" c"!n!c n+ sa(!s.ace cr!(er!!"e &en(r+ (+"'+rarea de so%a(!/are, deoarece
    !nd!v!/!! c+ aces(a (+"'+rare s+n( de re$+"7 nara(or! !nconsecven=! Ead!c7, re"a(ea/7
    o s!%&(o%a(o"o$!e so%a(!c7 !ns+.!c!en(7 &en(r+ a sa(!s.ace cr!(er!!"e "a o eva"+are,
    dar s+.!c!en(e s!%&(o%e &en(r+ a sa(!s.ace cr!(er!!"e co%&"e(e "a a"(7 eva"+areJ.
    S!%&(o%e"e care &o( .! o'serva(e !nc"+d e<e%&"e"e c!(a(e "a (+"'+rarea de
    so%a(!/are. Poa(e e<!s(a +n s!n$+r s!%&(o% c!rc+%scr!s, c+% ar .! $rea=a or!, %a!
    .recven(, s!%&(o%e so%a(!ce %+"(!&"e. Ac+/e"e so%a(!ce nee<&"!ca(e cron!ce d+c
    adesea "a cons+"(a=!! %ed!ca"e, de re$+"7 c+ +n %ed!c $enera"!s(.
    *lemente speci$ice culturii, etii si sexului
    S!%&(o%e"e nee<&"!ca(e %ed!ca" s! &reoc+&area re.er!(oare "a o %a"ad!e
    so%a(!c7 &o( cons(!(+! S!d!o%+r!"e de(rese!T %ode"a(e c+"(+ra", care s+n(
    :n(re'+!n=a(e c+"(+ra" &en(r+ a e<&r!%a (e%er!"e :n ra&or( c+ "ar$a $a%7 de
    &ro'"e%e &ersona"e s! soc!a"e, .7r7 &s!o&a(o"o$!a care s7 "e !nd!ce c+ (o(
    d!nad!ns+". Cea %a! %are .recven=7 de ac+/e so%a(!ce nee<&"!ca(e se cons(a(7 "a
    .e%e!"e (!nere c+ s(a(+s soc!oecono%!c !n.er!or, dar as(.e" de s!%&(o%e n+ s+n(
    "!%!(a(e "a o an+%!(7 e(a(e, se< sa+ $r+& soc!oc+"(+ra". SNe+ras(en!aT, +n s!ndro%
    descr!s .recven( :n %+"(e &7r=! a"e "+%!! s! carac(er!/a( &r!n .a(!$a'!"!(a(e s! as(en!e,
    es(e c"as!.!ca(7 :n DSM4I3 ca (+"'+rare so%a(o.or%7 ned!.eren=!a(7, dac7
    s!%&(o%e"e a+ &ers!s(a( %a! %+"( de R "+n!.
    *voluie
    Evo"+=!a ac+/e"or so%a(!ce nee<&"!ca(e !nd!v!d+a" es(e !n&red!c(!'!"7.
    D!a$nos(!c+" even(+a" a" +ne! cond!=!! %ed!ca"e $enera"e or! a" a"(e! (+"'+r7r!
    %en(a"e es(e .recven(.
    Dia!nostic di$erenial
    A se cons+"(a, de ase%enea, sec=!+nea de d!a$nos(!c d!.eren=!a" &en(r+
    (+"'+rarea de so%a(!/are Eve/! &a$. IGGJ. T+"'+rarea so%a(o.or%7 ned!.eren=!a(7 se
    d!s(!n$e de (+"'+rarea de so%a(!/are &r!n neces!(a(ea e<!s(en=e! :n (+"'+rarea de
    so%a(!/are a +ne! %+"(!(+d!n! de s!%&(o%e c+ o d+ra(7 de %a! %+"=! an! s! c+ de'+(
    :na!n(e de e(a(ea de ;L de an!. Dac7 ac+/e"e so%a(!ce a+ &ers!s(a( %a! &+=!n de R
    "+n!, (re'+!e &+s d!a$nos(!c+" de (+"'+rare so%a(o.or%7 .7r7 a"(7 s&ec!.!ca=!e.
    F42 Tulburrile Somato$orme
    T+"'+rarea so%a(o.or%7 ned!.eren=!a(7 n+ es(e d!a$nos(!ca(7 dac7 s!%&(o%e"e s+n(
    e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7. A"(e (+"'+r7r! %en(a"e care !nc"+d
    .recven( ac+/e so%a(!ce nee<&"!ca(e s+n( tulburarea depresiv maAor2 tulburrile
    anxioase s! tulburarea de adaptare. Con(rar (+"'+r7r!! so%a(o.or%e ned!.eren=!a(e,
    ac+/e"e so%a(!ce a"e tulburrilor factice s! simulrii s+n( &rod+se !n(en=!ona" sa+
    s!%+"a(e, :n (+"'+rarea .ac(!ce, %o(!va=!a es(e aceea de as+%are a ro"+"+! de &ac!en(
    s! de a o'=!ne eva"+are s! (ra(a%en( %ed!ca", &e cAnd :n s!%+"are s+n( ev!den(e
    %o(!ve %a! e<(erne, c+% ar .! co%&ensa=!a .!nanc!ar7, ev!(area +ne! :nda(or!r!,
    s+s(ra$erea de "a o +r%7r!re &ena"7 sa+ o'=!nerea de dro$+r!.
    Criteriile $e $ia/no&ti# pentru
    4++.>* Tul-urarea So"ato%or"( Ne$i%eren!iat(
    A2 .na sau mai multe acu(e somatice &de ex2, $ati!abilitate, pierderea apetitului,
    acu(e !astrointestinale sau urinare)2
    S2 'ie &E), $ie &7)D
    &E)dup o investi!aie corespun(toare, simptomele nu pot $i explicate
    complet de o condiie medical !eneral cunoscut ori de e$ectele
    directe ale unei substane &de ex2, un dro! de abu(, un medicament)3
    &7) c@nd exist o condiie medical !eneral asemntoare, acu(ele
    somatice sau deteriorarea social ori pro$esional re(ultat este "n exces
    $a de ceea ce ar $i de a,teptat din istoric, examenul somatic sau datele
    de laborator2
    2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    D2 Durata perturbrii este de cel puin I luni2
    *2 #erturbarea nu este explicat mai bine de alt tulburare mental &de ex2, de
    alt tulburare somato$orm, de o dis$uncie sexual, de o tulburare
    a$ectiv, anxioas, de somn sau psi%otic)2
    '2 Simptomele nu sunt produse intenional sau simulate &ca "n tulburarea
    $actice sau "n simulare)2
    4++.** Tul-urarea $e Conver&ie
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de convers!e :" cons(!(+!e &re/en=a de s!%&(o%e
    sa+ de de.!c!(e a.ec(And .+nc=!onarea %o(or!e vo"+n(ar7 sa+ sen/or!a"7, care
    s+$erea/7 o cond!=!e ne+ro"o$!c7 sa+ o cond!=!e %ed!ca"7 $enera"7 Ecr!(er!+" AJ.
    Fac(or!! &s!o"o$!c! s+n( cons!dera=! a .! asoc!a=! c+ s!%&(o%+" sa+ de.!c!(+",
    @+deca(7 'a/a(7 &e o'serva=!a c7 !n!=!erea sa+ e<acer'area s!%&(o%+"+! sa+
    de.!c!(+"+! es(e &receda(7 de con."!c(e sa+ de a"=! s(resor! Ecr!(er!+" BJ. S!%&(o%e"e
    n+ s+n( &rod+se !n(en=!ona" sa+ s!%+"a(e, ca :n (+"'+rarea .ac(!ce sa+ :n s!%+"are
    Ecr!(er!+" CJ. T+"'+rarea de convers!e n+ es(e d!a$nos(!ca(7 dac7 s!%&(o%e"e sa+
    4++.** Tul-urarea $e
    Cpnver&ie
    F4+

    de.!c!(e"e s+n( e<&"!ca(e co%&"e( de o cond!=!e ne+ro"o$!c7 sa+ de a"(7 cond!=!e
    %ed!ca"7 $enera"7, de e.ec(e"e d!rec(e a"e +ne! s+'s(an=e, or! ca o e<&er!en=7 sa+
    co%&or(a%en( sanc=!ona( c+"(+ra" Ecr!(er!+" DJ. Pro'"e%a (re'+!e s7 .!e
    se%n!.!ca(!v7 c"!n!c, .a&( ev!den=!a( &r!n de(res7 %arca(7, de(er!orare :n do%en!+"
    soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare or! &r!n .a&(+" c7
    @+s(!.!c7 eva"+are %ed!ca"7 Ecr!(er!+" EJ. T+"'+rarea de convers!e n+ es(e
    d!a$nos(!ca(7 dac7 s!%&(o%e"e s+n( "!%!(a(e "a d+rere sa+ "a d!s.+nc=!e se<+a"7,
    s+rv!n e<c"+s!v :n c+rs+" (+"'+r7r!! de so%a(!/are or! s+n( e<&"!ca(e %a! '!ne de a"(7
    (+"'+rare %en(a"7 Ecr!(er!+" FJ.
    S!%&(o%e"e de convers!e s+n( :n re"a=!e c+ .+nc=!onarea %o(or!e vo"+n(ar7 sa+
    sen/or!a"7 s! de aceea s+n( den+%!(e S&se+done+ro"o$!ceT. S!%&(o%e"e sa+
    de.!c!(e"e %o(or!! !nc"+d a"(erarea coordon7r!! sa+ ec!"!'r+"+!, &ara"!/!a sa+
    de.!c!(+" %o(or "oca"!/a(, a.on!a, d!.!c+"(a(ea :n de$"+(!=!e sa+ sen/a=!a de nod :n $A(
    s! re(en=!a de +r!n7. S!%&(o%e"e sa+ de.!c!(e"e sen/or!a"e !nc"+d &!erderea sen/a=!e!
    (ac(!"e sa+ de d+rere, d!&"o&!a, cec!(a(ea, s+rd!(a(ea s! a"+c!na=!!"e. S!%&(o%e"e %a!
    &o( !nc"+de, de ase%enea, cr!/e e&!"e&(!ce sa+ conv+"s!!. C+ cA( &ersoana es(e %a!
    !$noran(7 %ed!ca", c+ a(A( s+n( %a! !%&"a+/!'!"e s!%&(o%e"e &re/en(a(e.
    Persoane"e %a! so.!s(!ca(e (!nd s7 &re/!n(e s!%&(o%e s! de.!c!(e %a! s+'(!"e care &o(
    s!%+"a :ndea&roa&e cond!=!! ne+ro"o$!ce sa+ a"(e cond!=!! %ed!ca"e $enera"e.
    D!a$nos(!c+" de (+"'+rare de convers!e (re'+!e &+s n+%a! d+&7 ce a .os(
    e.ec(+a(7 o !nves(!$a=!e %ed!ca"7 co%&"e(7 &en(r+ a e<c"+de o cond!=!e ne+ro"o$!c7
    sa+ o cond!=!e %ed!ca"7 $enera"7 e(!o"o$!c7. Deoarece o e(!o"o$!c %ed!ca"7 $enera"7
    &en(r+ %+"(e ca/+r! de (+"'+rare de convers!e &a(en(7 &oa(e neces!(a an! &An7 s7
    dev!n7 ev!den(7, d!a$nos(!c+" (re'+!e reeva"+a( &er!od!c, :n s(+d!!"e %a! vec!,
    e(!o"o$!! %ed!ca"e $enera"e a+ .os( cons(a(a(e +"(er!or :n(r4+n s.er( &An7 "a @+%7(a(e
    d!n(re &ersoane"e d!a$nos(!ca(e !n!=!a" c+ s!%&(o%e de convers!e, :n s(+d!!"e %a!
    recen(e, eroarea de d!a$nos(!c es(e %a! &+=!n ev!den(7, re."ec(And, &oa(e, creO(erea
    conO(!en(!/7r!! (+"'+r7r!!, ca O! a%e"!orarea c+noO(!n=e"or O! (en!c!"or de d!a$nos(!c.
    Un !s(or!c de a"(e s!%&(o%e so%a(!ce nee<&"!ca(e E:n s&ec!a" de convers!eJ sa+ de
    s!%&(o%e d!soc!a(!ve :nsea%n7 o &ro'a'!"!(a(e %a! %are ca +n s!%&(o% de
    convers!e ev!den( s7 n+ .!e da(ora( +ne! cond!=!! %ed!ca"e $enera"e, :n s&ec!a" dac7
    :n (rec+( a+ .os( sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea de so%a(!/are.
    S!%&(o%e"e de convers!e n+ se con.or%ea/7 de re$+"7 c7!"or ana(o%!ce s!
    %ecan!s%e"or .!/!o"o$!ce 2c+nosc+(e, c! +r%ea/7 :n sc!%' conce&(+a"!/area de c7(re
    !nd!v!d a cond!=!e!. O S&ara"!/!eT &oa(e !%&"!ca !nca&ac!(a(ea de a e.ec(+a o an+%!(7
    %!Ocare sa+ de a %!Oca o :n(rea$7 &ar(e a cor&+"+!, %a! c+rAnd decA( +n de.!c!(
    cores&+n/And &a((ern+"+! de !nerva=!e %o(or!e. S!%&(o%e"e de convers!e s+n(
    adesea con(rad!c(or!!. O e<(re%!(a(e S&ara"!/a(7T va .! %!Oca(7 ne$"!@en( cAnd
    !nd!v!d+" se :%'rac7 or! a(en=!a :! es(e :ndre&(a(7 :n a"(7 &ar(e. Un 'ra= S&ara"!/a(T
    dac7 es(e r!d!ca( deas+&ra ca&+"+! s! e"!'era( :O! va %en=!ne &en(r+ &+=!n (!%&
    &o/!=!a, a&o! va c7dea :n "7(+r!, %a! c+rAnd decA( s7 a(!n$7 ca&+". Po( .! &+se :n
    ev!den=7 .or=a %+sc+"ar7 nerec+nosc+(7 :n %+Oc!! an(a$on!s(!, (on+s+" %+sc+"ar
    nor%a" O! re."e<e"e !n(ac(e. E"ec(ro%!o$ra%a va .! nor%a"7. D!.!c+"(a(ea :n de$"+(!=!e
    va !n(eresa :n e$a"7 %7s+r7 "!c!de"e s! so"!de"e. SAnes(e/!aT de convers!e a +n+!
    &!c!or sa+ %A!n! &oa(e +r%a o d!s(r!'+=!e, aOa /!s7 :n Oose(7 sa+ :n %7n+O7, c+
    &!erdere +n!.or%7 E.7r7 $rad!en( &ro<!%od!s(a"J a (+(+ror %oda"!(7=!"or sen/or!a"e
    Ead!c7, (ac(, (e%&era(+r7 s! d+rereJ, de%arca(7 ne( de +n re&er ana(o%!c, %a! c+rAnd
    decA( con.or% der%a(oa%e"or. O Scr!/7 e&!"e&(!c7T de convers!e va var!a de "a
    conv+"s!e "a conv+"s!e, !ar &e EE, n+ va .! ev!den=!a(7 n!c! o ac(!v!(a(e &aro<!s(!c7.
    IFI Tulburrile Somato$orme
    C!ar cAnd se +r%ea/7 c+ a(en=!e as(.e" de "!n!! d!rec(oare, (re'+!e %an!.es(a(7
    &reca+=!e. C+noaO(erea %ecan!s%e"or ana(o%!ce s! .!/!o"o$!ce es(e !nco%&"e(7, !ar
    %e(ode"e de eva"+are o'!ec(!v7 d!s&on!'!"e a+ "!%!(e. O "ar$7 $a%7 de cond!=!!
    ne+ro"o$!ce &o( .! d!a$nos(!ca(e erona( ca (+"'+rare de convers!e. D!n(re aces(ea
    s+n( de re%arca( sc"ero/a %+"(!&"7, r%2as(en!a $rav!s s! d!s(on!!"e !d!o&a(!ce sa+
    !nd+se de o s+'s(an=7. Pre/en=a +ne! cond!=!! ne+ro"o$!ce n+ e<c"+de :ns7, +n
    d!a$nos(!c de (+"'+rare de convers!e. A&ro<!%a(!v o (re!%e d!n(re !nd!v!/!! c+
    s!%&(o%e de convers!e a+, sa+ a+ av+(, o cond!=!e ne+ro"o$!c7. T+"'+rarea de
    convers!e &oa(e .! d!a$nos(!ca(7 :n &re/en=a +ne! cond!=!! ne+ro"o$!ce sa+ a a"(e!
    cond!=!! %ed!ca"e $enera"e, dac7 s!%&(o%e"e n+ s+n( e<&"!ca(e &e de&"!n, da(7 .!!nd
    na(+ra s! sever!(a(ea cond!=!e! ne+ro"o$!ce sa+ a a"(e! cond!=!! %ed!ca"e $enera"e.
    Trad!=!ona", (er%en+" de con*ersie der!v7 d!n !&o(e/a c7 s!%&(o%e"e so%a(!ce a"e
    !nd!v!d+"+! re&re/!n(7 o re/o"vare s!%'o"!c7 a +n+! con."!c( &s!o"o$!c !nconO(!en(
    care red+ce an<!e(a(ea s! serveO(e "a =!nerea con."!c(+"+! :n a.ara conO(!!n=e!
    ES'ene.!c!+ &r!%arTJ. Ind!v!d+" &oa(e o'=!ne as(.e" +n S'ene.!c!+ sec+ndarT d!n
    s!%&(o%+" de convers!e U ad!c7, s+n( o'=!n+(e 'ene.!c!! e<(erne sa+ s+n( ev!(a(e
    :nda(or!r! sa+ res&onsa'!"!(7=! &re@+d!c!an(e. DeO! se(+" de cr!(er!! DSM4I3 &en(r+
    (+"'+rarea de convers!e n+ !%&"!c7 :n %od necesar .a&(+" c7 s!%&(o%e"e co%&or(7
    as(.e" de cons(r+c(e, e" cere ca .ac(or!! &s!o"o$!c! s7 .!e asoc!a=! c+ de'+(+" sa+
    e<acer'area "or. Deoarece .ac(or!! &s!o"o$!c! s+n( a(A( de +'!c+!(ar &re/en=! :n
    ra&or( c+ cond!=!!"e %ed!ca"e $enera"e, &oa(e .! d!.!c!" de s(a'!"!( dac7 +n an+%!(
    .ac(or &s!o"o$!c es(e e(!o"o$!c :n re"a=!e c+ s!%&(o%+" sa+ de.!c!(+". C+ (oa(e
    aces(ea :ns7, o re"a=!e (e%&ora"7 s(rAns7 :n(re +n con."!c( sa+ s(resor s! !n!=!erea sa+
    e<acer'area s!%&(o%e"or &oa(e .! +(!"7 :n aceas(7 &rec!/are, %a! a"es dac7 &ersoana
    a &re/en(a( s!%&(o%e de convers!e :n c!rc+%s(an=e s!%!"are :n (rec+(.
    DeO! !nd!v!d+" &oa(e o'=!ne +n 'ene.!c!+ sec+ndar d!n s!%&(o%+" de convers!e,
    :n con(ras( c+ s!%+"area s! (+"'+rarea .ac(!ce, s!%&(o%e"e n+ s+n( &rod+se
    !n(en=!ona" s&re a o'=!ne 'ene.!c!!. S(a'!"!rea .a&(+"+! dac7 +n s!%&(o% es(e sa+ n+
    &rod+s !n(en=!ona" or! es(e s!%+"a(, &oa(e .!, de ase%enea, d!.!c!"7, :n $enera", aceas(a
    &oa(e .! ded+s7 &r!n(r4o eva"+are a(en(7 a con(e<(+"+! :n care a&ar s!%&(o%e"e, c+
    re.er!re :n s&ec!a" "a even(+a"e"e reco%&ense e<(erne or! "a as+%area ro"+"+! de
    &ac!en(. Poa(e .! +(!"7 s+&"!%en(area re"a(7r!! &ersoane! res&ec(!ve c+ s+rse ad!=!ona"e
    de !n.or%a=!! Ede e<., de "a asoc!a=! or! d!n doc+%en(eJ.
    T+"'+rarea de convers!e n+ es(e d!a$nos(!ca(7 dac7 +n s!%&(o% es(e e<&"!ca( :n
    (o(a"!(a(e ca o e<&er!en=7 sa+ co%&or(a%en( sanc=!ona( c+"(+ra". De e<e%&"+,
    Sv!/!+n!"eT sa+ !ncan(a=!!"eT care s+rv!n ca &ar(e a +nor r!(+a"+r! re"!$!oase :n care
    as(.e" de co%&or(a%en(e s+n( :nc+ra@a(e s! dor!(e, n+ vor @+s(!.!ca +n d!a$nos(!c de
    (+"'+rare de convers!e decA( dac7 s!%&(o%+" e<cede ceea ce es(e aO(e&(a( :n con(e<(
    s! ca+/ea/7 o de(res7 sa+ de(er!orare e<a$era(7, :n S!s(er!a e&!de%!c7T, s!%&(o%e
    co%+ne a&ar "a +n $r+& c!rc+%scr!s de &ersoane +r%And Se<&+ner!!T "a +n .ac(or
    &rec!&!(an( co%+n. D!a$nos(!c+" de (+"'+rare de convers!e (re'+!e &+s n+%a! dac7
    !nd!v!d+" e<&er!en(ea/7 o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c.
    Subtipuri .
    S+n( no(a(e +r%7(oare"e s+'r!&+r!, &e 'a/a s!%&(o%+"+! sa+ de.!c!(+"+! &re/en(a(Q
    C+ s!%&(o% sa+ de.!c!( %o(or. Aces( s+'(!& !nc"+de s!%&(o%e ca a"(erarea
    coordon7r!! sa+ ec!"!'r+"+!, &ara"!/!a sa+ sc7derea "oca"!/a(7 a .or=e!
    %+sc+"are, d!.!c+"(a(ea :n de$"+(!=!e sa+ sen/a=!a de Snod :n $A(T, a.on!a O!
    re(en(!a de +r!n78
    4552EE Tulburarea de
    onversie
    F45
    (u simptome sau deficit senzorial. Acest subtip include simptome ca
    &!erderea sen/a=!e! (ac(!"e sa+ de d+rere, d!&"o&!a, cec!(a(ea, s+rd!(a(ea s!
    a"+c!na=!!"e8
    (u crize epileptice sau convulsii. Acest subtip include crizele epileptice sau
    conv+"s!!"e c+ co%&onen(e %o(or!! vo"+n(are sa+ sen/or!a"e8
    C+ (a'"o+ c"!n!c %!<(. Aces( s+'(!& es(e +(!"!/a( dac7 s+n( ev!den(e s!%&(o%e
    d!n %a! %+"( decA( o s!n$+r7 ca(e$or!e.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. Ind!v!/!! c+ s!%&(o%e de
    convers!e &o( ar7(a o la belle indi))erence Ead!c7, o "!&s7 re"a(!v7 de &reoc+&are .a=7 de
    na(+ra sa+ !%&"!ca=!!"e s!%&(o%+"+!J or! "e &o( &re/en(a :n(r4o %an!er7 dra%a(!c7
    sa+ !s(r!on!c7. Deoarece aceO(! !nd!v!/! s+n( adesea s+$es(!ona'!"!, s!%&(o%e"e "or
    &o( .! %od!.!ca(e sa+ re/o"va(e &e 'a/a +nor s(!%+"! e<(ern!8 (re'+!e %en=!ona( :ns7
    c7 aces( as&ec( n+ es(e s&ec!.!c (+"'+r7r!! de convers!e, e" &+(And a&are, de
    ase%enea, s! :n cond!=!! %ed!ca"e $enera"e. S!%&(o%e"e &o( .! %a! .recven(e d+&7
    +n s(res &s!osoc!a" e<(re% Ede e<., "+&(a sa+ %oar(ea recen(7 a +ne! &ersoane
    !%&or(an(eJ. De&enden=a s! ado&(area ro"+"+! de &ac!en( &o( .! s(!%+"a(e :n c+rs+"
    (ra(a%en(+"+!. S+n( .recven(e s! a"(e ac+/e so%a(!ce de nonconvers!e. T+"'+r7r!"e
    %en(a"e asoc!a(e !nc"+d (+"'+r7r!"e d!soc!a(!ve, (+"'+rarea de&res!v7 %a@or7 s!
    (+"'+r7r!"e de &ersona"!(a(e !s(r!on!c7, an(!soc!a"7, 'order"!ne s! de&enden(7.
    Da(e de "a'ora(or asoc!a(e. N!c! +n .e" de ano%a"!! de "a'ora(or s&ec!.!ce n+
    s+n( asoc!a(e c+ (+"'+rarea de convers!e. De .a&(, a'sen=a da(e"or aO(e&(a(e es(e cea
    care s+$erea/7 s! s+s=!ne d!a$nos(!c+" de (+"'+rare de convers!e, :ns7, da(e"e de
    "a'ora(or concordan(e c+ o cond!=!e %ed!ca"7 $enera"7 n+ e<c"+d d!a$nos(!c+" de
    (+"'+rare de convers!e, &en(r+ c7 aceas(a cere ca n+%a! +n s!%&(o% s7 n+ .!e
    e<&"!ca( co%&"e( de cond!=!e ca a(are.
    Datele e,a"in(rii &o"ati#e &i #on$i!iile "e$i#ale /enerale a&o#iate.
    S!%&(o%e"e (+"'+r7r!! de convers!e n+ se con.or%ea/7 de re$+"7 c7!"or ana(o%!ce
    s! %ecan!s%e"or .!/!o"o$!ce c+nosc+(e. Ca a(are, se%ne"e o'!ec(!ve aO(e&(a(e Ede e<.,
    %od!.!c7r!"e de re."e<eJ s+n( rar &re/en(e. C+ (oa(e aces(ea, o &ersoan7 &oa(e
    &re/en(a s!%&(o%e care sea%7n7 c+ ce"e o'serva(e "a a"=!! sa+ c!ar "a ea :ns7O! Ede
    e<., !nd!v!/!! c+ e&!"e&s!e &o( s!%+"a Scr!/e e&!"e&(!ceT care sea%7n7 c+ ce"e
    o'serva(e de e! "a a"=!! sa+ c+ &ro&r!!"e "or cr!/e, aOa c+% "e4a+ .os( aces(ea descr!se
    de a"=!!J, :n $enera", s!%&(o%e"e de convers!e !nd!v!d+a"e s+n( a+(o"!%!(a(e s! n+
    d+c "a %od!.!c7r! sa+ !nva"!d!(7=! .!/!ce. Rar, %od!.!c7r!"e so%a(!ce, c+% ar .! a(ro.!a
    sa+ con(rac(+r!"e &o( s+rven! ca re/+"(a( a" !n+(!"!/7r!! or! ca sece"e a"e &rocedee"or
    d!a$nos(!ce sa+ (era&e+(!ce. Es(e !%&or(an( de no(a( :ns7, c7 s!%&(o%e de convers!e
    &o( a&are s! "a !nd!v!/!! c+ cond!=!! ne+ro"o$!ce.
    *lemente speci$ice culturii, etii si sexului
    T+"'+rarea de convers!e a .os( descr!s7 ca .!!nd %a! .recven(7 :n &o&+"a=!!"e
    r+ra"e, "a !nd!v!/!! c+ s(a(+s soc!oecono%!c !n.er!or s! "a !nd!v!/!! c+ %a! &+=!ne
    c+noO(!n=e des&re conce&(e"e %ed!ca"e s! &s!o"o$!ce. Ra(e %a! %ar! de s!%&(o%e
    de convers!e s+n( ra&or(a(e O! :n re$!+n!"e :n c+rs de de/vo"(are, :n $enera"
    !nc!den=a dec"!nAnd &e %7s+ra creO(er!! de/vo"(7r!!. C7derea c+ &!erderea sa+
    H6I Tulburrile Somato$orme
    a"(erarea c+noO(!n=e! es(e +n e"e%en( a" +ne! d!vers!(7=! de s!ndro%e s&ec!.!ce
    c+"(+r!!. For%a s!%&(o%e"or de convers!e re."ec(7 !de!"e c+"(+ra"e "oca"e des&re
    %od+r!"e acce&(a'!"e O! cred!'!"e de e<&r!%are a de(rese!. Mod!.!c7r! ase%7n7(oare
    s!%&(o%e"or de convers!e Eca O! s!%&(o%e"or d!soc!a(!veJ s+n( as&ec(e co%+ne a"e
    an+%!(or r!(+a"+r! re"!$!oase s! de v!ndecare sanc=!ona(e c+"(+ra". C"!n!c!an+"
    (re'+!e s7 a&rec!e/e, dac7 as(.e" de s!%&(o%e s+n( e<&"!ca(e co%&"e( :n con(e<(+"
    soc!a" &ar(!c+"ar s! dac7 e"e cond+c "a o de(res7, !nva"!d!(a(e sa+ de(er!orare a
    ro"+"+!, se%n!.!ca(!ve c"!n!c.
    S!%&(o% e"e de convers!e "a co&!! s+' 5L an! s+n( "!%!(a(e de re$+"7 "a &ro'"e%e22
    de %ers sa+ "a cr!/e e&!"e&(!ce. T+"'+rarea de convers!e &are a .! %a! .recven(a "a
    .e%e! decA( "a '7r'a=!, c+ ra(e co%+n!ca(e var!!nd de "a 9Q5 "a 5LQ5. :n s&ec!a" "a
    .e%e!, s!%&(o%e"e s+n( %+"( %a! .recven(e de &ar(ea s(An$7 decA( de &ar(ea
    drea&(7 a cor&+"+!. Fe%e!"e Es! %a! rar '7r'a=!!J care &re/!n(7 s!%&(o%e de
    convers!e &o( %an!.es(a %a! (Ar/!+ (a'"o+" co%&"e( a" (+"'+r7r!! de so%a(!/are. La
    '7r'a=!, e<!s(7 o asoc!ere :n(re (+"'+rarea de convers!e s! (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7, :n &"+s, "a '7r'a=!, (+"'+rarea de convers!e es(e v7/+(7 adesea :n
    con(e<(+" acc!den(e"or de %+nc7 sa+ :n ar%a(7.
    #revalent
    Ra(e"e de (+"'+rare de convers!e ra&or(a(e a+ var!a( "ar$, %er$And de "a
    55X5LL.LLL &An7 "a YLLX5LL.LLL :n esan(!oane"e de &o&+"a=!e $enera"7. T+"'+rarea
    a .os( ra&or(a(7 :n &An7 "a ;d d!n(re &ac!en=!! a%'+"a(or!! :ndr+%a=! s&re c"!n!c!"e
    de s7n7(a(e %en(a"7. S(+d!!"e &e &ac!en=! %ed!ca"! $enera"!Xc!r+r$!ca"! a+
    !den(!.!ca( ra(e de s!%&(o%e de convers!e var!!nd :n(re 5d s! 5Id.
    *voluie
    De'+(+" (+"'+r7r!! de convers!e are "oc :n $enera" (ard!v :n co&!"7r!e sa+ &recoce
    :n v!a(a ad+"(7, s! rar :na!n(e de e(a(ea de 5L an! sa+ d+&7 e(a(ea de ;Y an!, dar a+
    .os( descr!se de'+(+r! s! :n cea de a no+a decad7 de v!a=7. CAnd o (+"'+rare de
    convers!e ev!den(7 a&are &en(r+ &r!%a da(7 "a o e(a(e %ed!e sa+ avansa(7,
    &ro'a'!"!(a(ea +ne! cond!=!! ne+ro"o$!ce oc+"(e sa+ a a"(e! cond!=!! %ed!ca"e $enera"e
    es(e %are. De'+(+" (+"'+r7r!! de convers!e es(e :n $enera" ac+(, dar &oa(e s+rven!,
    de ase%enea, s! o !n(ens!.!care $rad+a"7 a s!%&(o%a(o"o$!e!. De re$+"7, s!%&(o%e"e
    de convers!e +n!ce s+n( de sc+r(7 d+ra(7. La !nd!v!/!! s&!(a"!/a=! c+ s!%&(o%e de
    convers!e, s!%&(o%e"e se re%!( :n dec+rs de 9 s7&(7%An! :n ce"e %a! %+"(e ca/+r!.
    Rec+ren=a es(e .recven(7, s+rven!nd :n(r4o c!nc!%e &An7 "a +n s.er( d!n(re !nd!v!/!
    :n dec+rs de +n an, o s!n$+r7 rec7dere &red!c(And e&!soade v!!(oare. Fac(or!!
    asoc!a=! c+ +n &ro$nos(!c '+n !nc"+d de'+(+" ac+(, &re/en=a +n+! s(res &rec!s
    !den(!.!ca'!" :n &er!oada de de'+(, +n !n(erva" sc+r( :n(re de'+( s! !ns(!(+!rea
    (ra(a%en(+"+! s! !n(e"!$en=a &es(e %ed!e. S!%&(o%e"e de &ara"!/!e, a.on!e s! cec!(a(e
    s+n( asoc!a(e c+ +n &ro$nos(!c '+n, &e cAnd (re%or+" O! cr!/e"e e&!"e&(!ce n+.
    #attern $amilial
    Da(e "!%!(a(e s+$erea/7 c7 s!%&(o%e"e de convers!e s+n( %a! .recven(e "a r+de"e
    !nd!v!/!"or c+ (+"'+rare de convers!e. A .os( descr!s +n r!sc cresc+( de (+"'+rare de
    convers!e "a &erec!"e de $e%en! %ono/!$o=!, dar n+ O! "a ce"e de d!/!$o=!.
    4552EE Tulburarea de
    onversie
    F48

    Dia!nostic di$erenial
    Preoc+&area d!a$nos(!c7 %a@or7 :n eva"+area even(+a"e"or s!%&(o%e de
    convers!e o cons(!(+!e e<c"+derea cond!=!!"or ne+ro"o$!ce oc+"(e sa+ a a"(or
    cond!=!! %ed!ca"e $enera"e s! a e(!o"o$!!"or !nd+se de o s+'s(an=7 E!nc"+s!v de
    %ed!ca%en(eJ. Eva"+area cores&+n/7(oare a even(+a"e"or cond!=!! %ed!ca"e Ede ex7,
    sc"ero/a %+"(!&"7, %!as(en!a $rav!sJ (re'+!e s7 !nc"+d7 (recerea a(en(7 :n rev!s(7 a
    (a'"o+"+! c"!n!c c+ren(, a !s(or!e! %ed!ca"e $enera"e, e<a%!n7r!"e ne+ro"o$!ce O!
    so%a(!ce $enera"e, e<a%ene"e de "a'ora(or adecva(e, !nc"+s!v &en(r+ +/+" de a"coo"
    s! de a"(e s+'s(an=e.
    T+"'+rarea a"$!c7 sa+ o d!s.+nc=!e se<+a"7 es(e d!a$nos(!ca(7 :n "oc+" (+"'+r7r!!
    de convers!e, dac7 s!%&(o%e"e s+n( "!%!(a(e "a d+rere sa+, res&ec(!v, "a d!s.+nc=!a
    se<+a"7. Un d!a$nos(!c ad!=!ona" de (+"'+rare de convers!e n+ (re'+!e &+s dac7
    s!%&(o%e"e de convers!e a&ar e<c"+s!v :n c+rs+" (+"'+r7r!! de so%a(!/are. De
    ase%enea, (+"'+rarea de convers!e n+ es(e d!a$nos(!ca(7 dac7 s!%&(o%e"e s+n(
    e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7 Ede e<., s!%&(o%e"e ca(a(on!ce sa+
    !de!"e de"!ran(e so%a(!ce :n sc!/o.ren!e sa+ a"(e (+"'+r7r! &s!o(!ce or! (+"'+rarea
    a.ec(!v7, sa+ d!.!c+"(a(ea :n de$"+(!=!e :n(r4+n a(ac de &an!c7J, :n !&ocondr!e,
    !nd!v!d+" es(e &reoc+&a( de S%a"ad!a sever7T s+'!acen(7 s!%&(o%e"or
    &se+done+ro"o$!ce, &e cAnd :n (+"'+rarea de convers!e .oca"!/area es(e &e
    s!%&(o%+" &re/en(a(, s! &oa(e e<!s(a la belle indi))erence7 :n (+"'+rarea d!s%or.!c7
    cor&ora"7, accen(+" es(e &+s &e &reoc+&area &en(r+ +n de.ec( !%a$!nar sa+ %!nor
    :n as&ec(, %a! c+rAnd decA( &e o %od!.!care a .+nc=!e! %o(or!! sa+ sen/or!a"e.
    T+"'+rarea de convers!e are e"e%en(e co%+ne c+ (+"'+r7r!"e d!soc!a(!ve. A%'e"e
    (+"'+r7r! !%&"!c7 s!%&(o%e care s+$erea/7 o d!s.+nc=!e ne+ro"o$!c7 s! &o( avea, de
    ase%enea, an(eceden(e co%+ne. Dac7 "a ace"aO! !nd!v!d a&ar a(A( s!%&(o%e de
    convers!e, cA( s! s!%&(o%e d!soc!a(!ve Eceea ce es(e .recven(J, (re'+!e &+se a%'e"e
    d!a$nos(!ce.
    Es(e con(roversa( .a&(+" dac7 a"+c!na=!!"e ES&se+doa"+c!na=!!"eTJ &o( .!
    cons!dera(e ca s!%&(o% o&or(+n de (+"'+rare de convers!e. Ca d!s(!nse de
    a"+c!na=!!"e care a&ar :n con(e<(+" +ne! (+"'+r7r! &s!o(!ce Ede e<., sc!/o.ren!a
    sa+ a"(7 (+"'+rare &s!o(!c7, (+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, (+"'+rarea :n "e$7(+r7 c+ o s+'s(an=7 or! o (+"'+rare a.ec(!v7 c+
    e"e%en(e &s!o(!ceJ, a"+c!na=!!"e :n (+"'+rarea de convers!e a&ar :n $enera" c+
    conO(!!n=a %a"ad!e! !n(ac(7 O! :n a'sen=a a"(or s!%&(o%e &s!o(!ce, !%&"!c7 adesea
    %a! %+"( decA( o s!n$+r7 %oda"!(a(e sen/or!a"7 Ede e<., o a"+c!na=!e !%&"!cAnd
    co%&onen(e v!/+a"e, a+d!(!ve O! (ac(!"eJ, s! adesea a+ +n con=!n+( na!v, .an(as(!c
    sa+ &+er!". E"e a+ adesea o se%n!.!ca=!e &s!o"o$!c7 O! (!nd a .! descr!se de !nd!v!d
    ca .!!nd ceva !n(eresan(.
    S!%&(o%e"e (+"'+r7r!! .ac(!ce O! s!%+"7r!! s+n( &rod+se !n(en=!ona" sa+
    s!%+"a(e, :n (+"'+rarea .ac(!ce, %o(!va=!a es(e aceea de as+%are a ro"+"+! de &ac!en(
    &en(r+ a o'=!ne eva"+are s! (ra(a%en( %ed!ca", &e cAnd :n s!%+"are s+n( %a!
    ev!den(e sco&+r!, c+% ar .! o co%&ensa=!e .!nanc!ar7, ev!(area +ne! :nda(or!r!,
    sc7&area de +r%7r!re &ena"7 sa+ o'=!nerea de dro$+r!. As(.e" de sco&+r! &o( se%7na
    c+ S'ene.!c!+" sec+ndarT d!n s!%&(o%e"e de convers!e, c+ e"e%en(+" d!s(!nc(!v c7 :n
    s!%&(o%e"e de convers!e "!&seO(e !n(en=!a conO(!en(7 :n &rod+cerea s!%&(o%+"+!.
    IFG Tulburrile Somato$orme
    Criteriile $e $ia/no&ti# pentru
    4++.** Tul-urarea $e Conver&ie
    A2 .nul sau mai multe simptome sau de$icite a$ect@nd $uncia motorie volun
    tar sau sen(orial si care su!erea( o condiie neurolo!ic sau o alt
    condiie medical !eneral2
    S2 'actorii psi%olo!ici sunt considerai a $i asociai cu simptomul sau de$icitul,
    deoarece iniierea sau exacerbarea simptomului sau de$icitului este
    precedat de con$licte sau de ali stresori2
    2 Simptomul sau de$icitul nu este produs intenional sau simulat &ca "n
    tulburarea $actice Sau "n simulare)2
    D2 Dup o investi!aie corespun(toare, simptomul sau de$icitul nu poate $i
    explicat complet de o condiie medical !eneral sau de e$ectele directe ale
    unei substane, ori de un comportament sau experien sancionat cultural2
    *2 Simptomul sau de$icitul cau(ea( o detres sau deteriorare semni$icativ
    clinic "n domeniul social, pro$esional sau "n alte domenii importante de
    $uncionare, ori 0usti$ic evaluarea medical2
    '2 Simptomul sau de$icitul nu este limitat la durere sau la o dis$uncie sexual,
    nu survine exclusiv "n cursul tulburrii de somati(are si nu este explicat mai
    bine de alt tulburare mental2
    7e speci"icat tipul de simptom sau de$icitD
    u simptom sau de$icit motor u
    simptom sau de$icit sen(orial u
    cri(e epileptice sau convulsii u
    tablou clinic mixt
    Tul-urarea Al/i#(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! a"$!ce :" cons(!(+!e d+rerea care es(e .ocar+"
    &redo%!nan( a" (a'"o+"+! c"!n!c s! care es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca
    a(en=!e c"!n!c7 Ecr!(er!+" AJ. D+rerea &oa(e ca+/a de(res7 sa+ de(er!orare
    se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e
    de .+nc=!onare Ecr!(er!+" BJ. Fac(or!! &s!o"o$!c! s+n( cons!dera=! a @+ca +n ro"
    !%&or(an( :n de'+(+", sever!(a(ea, e<acer'area sa+ &ers!s(en=a d+rer!! Ecr!(er!+" CJ.
    D+rerea n+ es(e &rod+s7 !n(en=!ona" sa+ s!%+"a(7, ca :n (+"'+rarea .ac(!ce sa+ :n
    s!%+"are Ecr!(er!+" DJ. T+"'+rarea a"$!c7 n+ es(e d!a$nos(!ca(7, dac7 d+rerea es(e
    e<&"!ca(7 %a! '!ne de o (+"'+rare a.ec(!v7, an<!oas7 sa+ &s!o(!c7, sa+ dac7
    &re/en(area d+rer!! sa(!s.ace cr!(er!!"e &en(r+ d!s&are+n!e Ecr!(er!+" EJ. E<e%&"e"e de
    de(er!orare re/+"(And d!n d+rere !nc"+d !nca&ac!(a(ea de a %+nc! sa+ de a +r%a
    Ocoa"a, +/+" .recven( de s!s(e%+" de as!s(en=7 %ed!ca"7, d+rerea deven!nd cen(r+"
    %a@or a" v!e=!! !nd!v!d+"+!, +/+" s+'s(an=!a" de %ed!ca%en(e s! &ro'"e%e
    Tulburarea
    Al!ic
    F44
    re"a=!ona"e, c+% ar .! d!scord!a %ar!(a"7 s! a"(erarea s(!"+"+! nor%a" de v!a=7 a"
    .a%!"!e!. Fac(or!! &s!o"o$!c! !%&"!ca=! &o( cons(a d!n a"(7 (+"'+rare de &e a<a I sa+
    a<a II Ecare (re'+!e, de ase%enea, d!a$nos(!ca(7J or! &o( .! de aOa na(+r7 c7 n+ a(!n$
    &ra$+" &en(r+ o as(.e" de (+"'+rare Ede e<., reac=!! "a s(resor! &s!o"o$!c!J.
    Subtipuri si speci$icani
    T+"'+rarea a"$!c7 es(e cod!.!ca(7 :n con.or%!(a(e c+ s+'(!&+" care carac(er!/ea/7
    ce" %a! '!ne .ac(or!! !%&"!ca=! :n e(!o"o$!a s! &ers!s(en=a d+rer!!Q
    ;LH.GL T+"'+rare a"$!c7 asoc!a(7 c+ .ac(or! &s!o"o$!c!. Aces( s+'(!& es(e
    +(!"!/a( cAnd se cons!der7 c7 .ac(or!! &s!o"o$!c! a+ +n ro" %a@or :n de'+(+",
    sever!(a(ea, e<acer'area sa+ &ers!s(en=a d+rer!!, :n aces( s+'(!&, cond!=!!"e
    %ed!ca"e $enera"e n+ @oac7 n!c! +n ro" sa+ doar +n ro" %!nor :n de'+(+" sa+
    &ers!s(en=a d+rer!!. Aces( s+'(!& n+ es(e d!a$nos(!ca( dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ (+"'+rarea de so%a(!/are.
    ;LH.GF T+"'+rare a"$!c7 asoc!a(7, a(A( c+ .ac(or! &s!o"o$!c!, cA( s! c+ o
    cond!=!e %ed!ca"7 $enera"7. Aces( s+'(!& es(e +(!"!/a( cAnd, a(A( .ac(or!
    &s!o"o$!c!, cA( s! o cond!=!e %ed!ca"7 $enera"7 s+n( cons!dera=! a avea ro"+r!
    !%&or(an(e :n de'+(+", sever!(a(ea, e<acer'area sa+ &ers!s(en=a d+rer!!.
    Sed!+" ana(o%!c a" d+rer!! sa+ cond!=!a %ed!ca"7 $enera"7 es(e cod!.!ca(7 &e
    a<a III Eve/! S&rocedee de :nre$!s(rareTJ.
    T+"'+rare a"$!c7 asoc!a(7 c+ o cond!=!e %ed!ca"7 $enera"7. Aces( s+'(!& de
    (+"'+rare a"$!c7 n+ es(e cons!dera( (+"'+rare %en(a"7 O! es(e cod!.!ca( &e a<a
    III. Es(e c!(a( :n aceas(7 sec=!+ne &en(r+ a .ac!"!(a d!a$nos(!c+" d!.eren=!a".
    D+rerea re/+"(7 d!n cond!=!a %ed!ca"7 $enera"7, !ar .ac(or!! &s!o"o$!c! s+n(
    cons!dera=! a n+ @+ca n!c! +n ro" sa+ doar +n ro" %!nor :n de'+(+" sa+
    &ers!s(en=a d+rer!!. Cod+" ICD4F4CM &en(r+ aces( s+'(!& es(e se"ec(a( &e
    'a/a sed!+"+! d+rer!! sa+ a cond!=!e! %ed!ca"e $enera"e, dac7 aceas(a a .os(
    s(a'!"!(7 Eve/! S&rocedee de :nre$!s(rareTJ.
    Pen(r+ d+rerea asoc!a(7 c+ .ac(or! &s!o"o$!c! s! d+rerea asoc!a(7, a(A( c+ .ac(or!
    &s!o"o$!c!, cA( O! c+ o cond!=!e %ed!ca"7 $enera"7, &o( .! no(a=! +r%7(or!!
    s&ec!.!can=! &en(r+ a !nd!ca d+ra(a d+rer!!Q
    Ac+(7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 d+ra(a d+rer!! es(e de %a! &+=!n de
    R "+n!.
    Cron!c7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 d+ra(a d+rer!! es(e de R "+n! sa+
    %a! %+"(.
    #rocedee de "nre!istare
    Cod+" d!a$nos(!c &en(r+ d+rere es(e se"ec(a( &e 'a/a s+'(!&+r!"or descr!se %a!
    s+s. Cod+" es(e ;LH.GL &en(r+ (+"'+rarea a"$!c7 asoc!a(7 c+ .ac(or! &s!o"o$!c!.
    Pen(r+ (+"'+rarea a"$!c7 asoc!a(7, a(A( c+ .ac(or! &s!o"o$!c!, cA( O! c+ o cond!=!e
    %ed!ca"7 $enera"7, ;LH.GF es(e cod!.!ca( &e a<a I, !ar cond!=!a %ed!ca"7 $enera"7
    asoc!a(7 sa+ sed!+" d+rer!! es(e cod!.!ca( &e a<a HI Ede e<., ;LH.GF T+"'+rare a"$!c7
    asoc!a(7, a(A( c+ .ac(or! &s!o"o$!c!, cA( s! c+ o cond!=!e %ed!ca"7 $enera"7, &e a<a I8
    ;YH.9 Po"!ne+ro&a(!e d!a'e(!c7, &e a<a IIIJ. Pen(r+ (+"'+rarea a"$!c7 asoc!a(7 c+ o
    cond!=!e %ed!ca"7 $enera"7, cod+" d!a$nos(!c &en(r+ d+rere es(e se"ec(a( &e 'a/a
    cond!=!e! %ed!ca"e $enera"e asoc!a(e, dac7 a .os( s(a'!"!(7r vre+na Eve/! ane<a ,J, or!
    <++ Tulburrile Somato$orme
    a "oca"!/7r!! ana(o%!ce a d+rer!!, dac7 cond!=!a %ed!ca"7 $enera"7 n+ a .os( :nc7
    &rec!s s(a'!"!(7 U de e<e%&"+, re$!+nea "o%'ar7 EH9I.9J, sc!a(!c7 EH9I.;J, &e"v!n7
    ER9Y.FJ, ce.a"ee EHGI.LJ, .ac!a"7 EHGI.LJ, (orac!c7 EHGR.YLJ, ar(!c+"ar7 EH5F.IJ, osoas7
    EH;;.FLJ, a'do%!na"7 EHGF.LJ, %a%ar7 ER55.H5J, rena"7 EHGG.LJ, a+r!c+"ar7 E;GG.HLJ,
    oc+"ar7 E;HF.F5J, oro.ar!n$!an7 EHGI.5J, den(ar7 EY9Y.FJ, +r!nar7 EHGG.LJ.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. D+rerea &oa(e &er(+r'a
    sever d!verse as&ec(e a"e v!e=!! co(!d!ene. Bo%a@+", !nca&ac!(a(ea s! &ro'"e%e"e de
    .a%!"!e s+n( .recven( :n(A"n!(e &r!n(re !nd!v!/!! c+ .or%e cron!ce de d+rere. Poa(e
    a&are de&enden=a sa+ a'+/+" !a(ro$en de o&!acee, or! de&enden=a sa+ a'+/+" de
    'en/od!a/e&!ne. Un !s(or!c de a'+/ sa+ de&enden=7 de o s+'s(an=7, .!e de +n dro$
    !"!c!(, .!e de +n %ed!ca%en( &rescr!s, cres(e r!sc+" de de/vo"(are a de&enden=e! sa+
    a'+/+"+! de o s+'s(an=7 con(ro"a(7 &rescr!s7 &en(r+ (ra(a%en(+" d+rer!!. C!ar
    !nd!v!/!! .7r7 +n !s(or!c de de&enden=7 sa+ a'+/ de o s+'s(an=7 s+n( e<&+O! :ns7
    +neor! de/vo"(7r!! +nor as(.e" de &ro'"e%e. Ma! %+"( de +n s.er( d!n(re !nd!v!/!!
    c7rora "e4a+ .os( &rescr!se o&!acee &en(r+ (ra(a%en(+" d+rer!! cron!ce &o( de/vo"(a
    a'+/ sa+ de&enden=7. R!sc+" !a(ro$en!c de de&enden=7 de o s+'s(an=7 &oa(e .!
    red+s &r!n as!$+rarea +ne! eva"+7r! cores&+n/7(oare a !nd!v!d+"+! c+ d+rere s&re a
    e<c"+de even(+a"!(a(ea +ne! e(!o"o$!! s+'!acen(e (ra(a'!"e &en(r+ d+rere8 dac7 s+n(
    &re/en(e a"(e (+"'+r7r! %en(a"e, &r!n a s(a'!"! dac7 aces(ea s+n( (ra(a(e
    cores&+n/7(or, s! &r!n a ver!.!ca dac7 %ed!ca%en(e"e s+n( &rescr!se de +n s!n$+r
    %ed!c s! c7 !nd!v!d+" n+ "e4a o'=!n+( d!n %a! %+"(e s+rse. A'+/+" sa+ de&enden=a
    de o s+'s(an=7 Ece" %a! adesea, de a"coo"J &oa(e co%&"!ca evo"+=!a &e v!a=7 a
    (+"'+r7r!! a"$!ce :n &An7 "a +n s.er( d!n(re !nd!v!/!! c+ d+rere cron!c7.
    Ind!v!/!! a c7ror d+rere es(e asoc!a(7 c+ de&res!e sever7 s! ce! a c7ror d+rere es(e
    :n "e$7(+r7 c+ o %a"ad!e (er%!na"7, de ce"e %a! %+"(e or! cancer, &ar a .! e<&+O! +n+!
    r!sc cresc+( de s+!c!d. Ind!v!/!! c+ d+rere ac+(7 sa+ cron!c7 rec+ren(7 s+n( conv!nO!
    +neor! c7 e<!s(7 +ndeva +n s&ec!a"!s( :n s7n7(a(e care are +n Sre%ed!+T &en(r+
    d+rere. E! &o( r!s!&! o %are can(!(a(e de (!%& s! 'an! c7+(And +n =e" !n(an$!'!".
    Pro.es!on!O(!! :n as!s(en=7 %ed!ca"7 &o( @+ca, !nvo"+n(ar, +n ro" :n .avor!/area aces(+!
    co%&or(a%en(
    D+rerea &oa(e d+ce "a !nac(!v!(a(e s! "a !/o"are soc!a"7, care d+c :n sc!%' "a
    &ro'"e%e &s!o"o$!ce Ede e<., de&res!eJ s! "a red+cerea re/!s(en=e! .!/!ce, care
    cond+c "a rAnd+" "or "a .a(!$a'!"!(a(e s! "a d+rere s+&"!%en(ar7. D+rerea &are a .!
    asoc!a(7 c+ a"(e (+"'+r7r! %en(a"e, :n s&ec!a" c+ (+"'+r7r! a.ec(!ve s! an<!oase.
    D+rerea cron!c7 &are a .! asoc!a(7 %a! .recven( c+ (+"'+r7r!"e de&res!ve, &e cAnd
    d+rerea ac+(7 &are a .! asoc!a(7 %a! .recven( c+ (+"'+r7r!"e an<!oase. T+"'+r7r!"e
    %en(a"e asoc!a(e &o( &receda (+"'+rarea a"$!c7 Es! even(+a" &red!s&+n !nd!v!d+" "a
    eaJ, a&ar conco%!(en( c+ ea or! re/+"(7 d!n ea. A(A( .or%e"e ac+(e, cA( s! ce"e cron!ce
    de (+"'+rare a"$!c7 s+n( asoc!a(e .recven( c+ d!verse &ro'"e%e de so%n.
    S!%&(o%e"e !&n!ce .recven(e "a !nd!v!/!! c+ d+rere cron!c7 !nc"+d :n(Ar/!erea
    de'+(+"+! so%n+"+!, deO(e&(7r! .recven(e d!n so%n, so%n+" nerecon.or(an( s!
    red+cerea d+ra(e! so%n+"+!. T+"'+r7r!"e de so%n, c+% ar .! a&neea de so%n
    o's(r+c(!v7 O! %!oc"on+s+" noc(+rn s+n( &rocen(+a" %a! .recven(e &r!n(re !nd!v!/!!
    c+ d+rere cron!c7 decA( :n &o&+"a=!a $enera"7 .
    Da(e de "a'ora(or asoc!a(e, :n (+"'+rarea a"$!c7 asoc!a(7, a(A( c+ .ac(or!
    &s!o"o$!c!, cA( s! c+ o cond!=!e %ed!ca"7 $enera"7, (es(e de "a'ora(or adecva(e &o(
    Tulburarea
    Al!ic
    5E1
    reve"a &a(o"o$!a asoc!a(7 c+ d+rerea Zde e<., desco&er!rea +ne! ern!! de d!sc
    "o%'are "a +n e<a%en RMN Ere/onan=7 %a$ne(!c7 n+c"ear7J "a +n !nd!v!d c+
    d+rere rad!c+"ar7 :n re$!+nea "o%'ar7[. Cond!=!!"e %ed!ca"e $enera"e &o( .!
    &re/en(e, :ns7, O! :n a'sen=a da(e"or o'!ec(!ve. Invers, &re/en=a +nor as(.e" de da(e
    &oa(e .! co!nc!den(7 c+ d+rerea.
    Datele e,a"in(rii &o"ati#e Ei #on$i!iile "e$i#ale /enerale a&o#iate2 .n
    (+"'+rarea a"$!c7 asoc!a(7, a(A( c+ .ac(or! &s!o"o$!c!, cA( s! c+ o cond!=!e %ed!ca"7
    $enera"7, e<a%en+" so%a(!c &oa(e reve"a &a(o"o$!a asoc!a(7 c+ d+rerea. T+"'+rarea
    a"$!c7 &oa(e .! asoc!a(7 c+ %+"(e cond!=!! %ed!ca"e $enera"e. Pr!n(re ce"e %a!
    .recven(e cond!=!! %ed!ca"e $enera"e asoc!a(e c+ d+rerea se n+%7r7 d!verse
    cond!=!! %+sc+"osce"e(a"e Ede e<., ern!a de d!sc, os(eo&oro/a, os(eoar(r!(a sa+
    ar(r!(a re+%a(o!d7, s!ndro%e"e %!o.asc!a"eJ, ne+ro&a(!!"e Ede e<., ne+ro&a(!!"e
    d!a'e(!ce, nevra"$!a &os(er&e(!c7J s! (+%or!"e %a"!$ne Ede e<., "e/!+n!"e
    %e(as(a(!ce osoase, !n.!"(ra=!a (+%ora"7 a nerv!"orJ, :ncerc7r!"e de a (ra(a d+rerea
    &o( d+ce "a &ro'"e%e s+&"!%en(are, d!n(re care +ne"e &o( ca+/a s! %a! %+"(7
    d+rere Ede e<., +/+" de %ed!ca%en(e an(!!n."a%a(or!! nons(ero!d!ce d+ce "a de(res7
    $as(ro!n(es(!na"7, +/+" e<ces!v de ace(a%!no&en d+ce "a o %a"ad!e e&a(!c7,
    !n(erven=!!"e c!r+r$!ca"e d+c "a aderen=eJ.
    *lemente speci$ice culturii, etii si sexului
    Po( e<!s(a d!.eren=e :n %od+" c+% d!verse"e $r+&+r! e(n!ce s! c+"(+ra"e r7s&+nd
    "a s(!%+"!! d+reros! s! c+% :O! e<&r!%7 reac=!!"e "a d+rere. Deoarece e<!s(7 :ns7 a(A(
    de %+"(e var!a=!! !nd!v!d+a"e, aceO(! .ac(or! a+ o +(!"!(a(e "!%!(a(7 :n eva"+area O!
    %ana$e%en(+" !nd!v!/!"or c+ (+"'+rare a"$!c7.
    T+"'+rarea a"$!c7 &oa(e s+rven! "a or!ce e(a(e. Fe%e!"e &ar a e<&er!en=a an+%!(e
    cond!=!! cron!ce d+reroase, ce" %a! adesea %!$ren7, ce.a"e! de (ens!+ne O! d+rere
    %+sc+"osce"e(a"7, %a! des decA( o .ac '7r'a=!!.
    #revalent
    D+rerea care ca+/ea/7 o de(er!orare sa+ de(res7 se%n!.!ca(!v7 :n .+nc=!onare
    es(e .recven(7. De e<e%&"+, se es(!%ea/7 c7 :n or!ce an da(, 5Ld45Yd d!n(re ad+"=!!
    d!n S(a(e"e Un!(e a+ o .or%7 oarecare de !nca&ac!(a(e de %+nc7 da(ora(7 n+%a!
    d+rer!! de s&a(e Ed!n(re care n+%a! +n!! a+ (+"'+rare a"$!c7J. Preva"en(a (+"'+r7r!!
    a"$!ce es(e :ns7 nec"ar7. T+"'+rarea a"$!c7 asoc!a(7, a(A( c+ .ac(or! &s!o"o$!c!, cA( s!
    c+ o cond!=!e %ed!ca"7 $enera"7 &are a .! re"a(!v .recven(7 :n an+%!(e +n!(7=! c"!n!ce,
    :n s&ec!a" :n ce"e :n care d+rerea es(e o &ro'"e%7 !%&or(an(7 Ede e<., c"!n!c!"e &en(r+
    d+rere, serv!c!!"e de cons+"(a=!! de &s!!a(r!e d!n(r4+n s&!(a" %ed!ca" $enera"J.
    T+"'+rarea a"$!c7 asoc!a(7 c+ .ac(or! &s!o"o$!c! &are a .! %+"( %a! &+=!n .recven(7 .
    *voluie
    Ce" %a! .recven(, d+rerea ac+(7 se re/o"v7 :n &er!oade de (!%& re"a(!v sc+r(e.
    E<!s(7 o $a%7 "ar$7 de var!a'!"!(a(e :n de'+(+" d+rer!! cron!ce, deO! se &are c7 c+ cA(
    d+rerea ac+(7 &re/en(7 es(e %a! "+n$7, c+ a(A( es(e %a! &os!'!" ca aceas(a s7 dev!n7
    cron!c7 O! &ers!s(en(7, :n ce"e %a! %+"(e ca/+r!, d+rerea es(e &re/en(7 de %+"=! an!,
    :na!n(e ca !nd!v!d+" s7 !n(re :n a(en=!a &ro.es!+n!! de s7n7(a(e %en(a"7. Fac(or!!
    !%&or(an=! care &ar a !n."+en=a rec+&erarea d!n (+"'+rarea a"$!c7 s+n( rec+noaO(erea
    A57 Tulburrile Somato$orme
    de c7(re !nd!v!d a d+rer!!, e.ec(+area +nor e.or(+r! !n+(!"e de a con(ro"a d+rerea,
    &ar(!c!&area "a ac(!v!(7=! c+ orar re$+"a( Ede e<., "a serv!c!+J, $rad+" de red+cere a
    d+rer!!, rec+noaO(erea s! (ra(area (+"'+r7r!"or %en(a"e co%or'!de, ada&(area
    &s!o"o$!c7 "a %a"ad!a cron!c7, s! a n+ &er%!(e d+rer!! s7 dev!n7 .ac(or+"
    de(er%!nan( :n s(!"+" s7+ de v!a=7. Ind!v!/!! c+ +n n+%7r %a! %are de /one
    cor&ora"e d+reroase s! c+ +n n+%7r %a! %are de s!%&(o%e %ed!ca"e, a"(e"e decA(
    d+rerea, a+ +n &ro$nos(!c %a! r7+.
    #attern $amilial
    T+"'+r7r!"e de&res!ve, de&enden=a de a"coo" s! d+rerea cron!c7 &o( .! %a!
    .recven(e "a r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare a"$!c7 cron!c7.
    Dia!nostic di$erenial
    S!%&(o%e"e a"$!ce s+n( !nc"+se :n cr!(er!!"e de d!a$nos(!c &en(r+ (+"'+rarea de
    so%a(!/are. Dac7 d+rerea asoc!a(7 c+ .ac(or! &s!o"o$!c! s+rv!ne e<c"+s!v :n c+rs+"
    (+"'+r7r!! de so%a(!/are, +n d!a$nos(!c ad!=!ona" de (+"'+rare a"$!c7 asoc!a(7 c+
    .ac(or! &s!o"o$!c! n+ es(e &+s. La .e", dac7 (a'"o+" c"!n!c a" d+rer!! sa(!s.ace cr!(er!!"e
    &en(r+ d!s&are+n!e Ead!c7, d+rere asoc!a(7 c+ con(ac(+" se<+a"J, +n d!a$nos(!c
    ad!=!ona" de (+"'+rare a"$!c7 n+ es(e &+s. Ac+/e"e a"$!ce &o( .! no(a'!"e "a !nd!v!/!!
    c+ (+"'+rare de convers!e, dar, &r!n de.!n!=!e, (+"'+rarea de convers!e n+ es(e
    "!%!(a(7 "a s!%&(o%e a"$!ce. S!%&(o%e"e a"$!ce s+n( e"e%en(e asoc!a(e .recven(e a"e
    a"(or (+"'+r7r! %en(a"e Ede e<., a"e (+"'+r7r!"or de&res!ve, an<!oase, &s!o(!ceJ. Un
    d!a$nos(!c ad!=!ona" de (+"'+rare a"$!c7 (re'+!e "+a( :n cons!dera=!e, n+%a! dac7
    d+rerea es(e +n .ocar !nde&enden( de a(en=!e c"!n!c7, d+ce "a o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c s! es(e :n e<ces .a=7 de cea asoc!a(7 de re$+"7 c+ a"(7
    (+"'+rare %en(a"7.
    S!%&(o%e"e a"$!ce &o( .! &rod+se !n(en=!ona" sa+ s!%+"a(e :n (+"'+rarea .ac(!ce
    sa+ :n s!%+"are, :n (+"'+rarea .ac(!ce, %o(!va=!a o cons(!(+!e as+%area ro"+"+! de
    &ac!en( s! o'=!nerea de eva"+are %ed!ca"7 s! (ra(a%en(, &e cAnd :n s!%+"are s+n(
    ev!den(e sco&+r! %a! &rec!se, c+% ar .! co%&ensa=!a .!nanc!ar7, ev!(area o'"!$a=!!"or
    :n "e$7(+r7 c+ serv!c!+" %!"!(ar sa+ :nc!soarea, sc7&area de +r%7r!re &ena"7 sa+
    o'=!nerea de dro$+r!.
    +elaia cu taxonomia propus de
    Asociaia Internaional pentru Studiul Durerii
    S+'co%!(e(+" &en(r+ Ta<ono%!e a" Asoc!a=!e! In(erna=!ona"e &en(r+ S(+d!+"
    D+rer!! a &ro&+s +n s!s(e% de c!nc! a<e &en(r+ c"as!.!carea d+rer!! cron!ce :n
    con.or%!(a(e c+ IJ re$!+nea ana(o%!c7, IIJ s!s(e%+" de or$ane, IIIJ carac(er!s(!c!"e
    (e%&ora"e a"e d+rer!!, I3J descr!erea de c7(re &ac!en( a !n(ens!(7=!! s! (!%&+"+! sc+rs
    de "a de'+(+" d+rer!! s! 3J e(!o"o$!a. Aces( s!s(e% de c!nc! a<e se concen(rea/7 :n
    &r!%+" rAnd &e %an!.es(7r!"e so%a(!ce a"e d+rer!!. E" o.er7 e<&"!ca=!! des&re .ac(or!!
    &s!o"o$!c!, a(A( &e a<a II +nde, &oa(e .! cod!.!ca(7 o (+"'+rare %en(a"7, cA( s! &e a<a
    3, +nde e(!o"o$!!"e &os!'!"e !nc"+d .ac(or!! S&s!o.!/!o"o$!c!T s! S&s!o"o$!c!T.
    Tulburarea
    Al!Nc
    <+4

    Criteriile $e $ia/no&ti# pentru Tul-urarea Al/i#(
    A2 Durerea "ntr-unul sau mai multe sedii anatomice este elementul predominant
    al tabloului clinic si este su$icient de sever pentru a 0usti$ica atenie clinic2
    S2 Durerea cau(ea( o detres sau deteriorare semni$icativ clinic "n domeniul
    social, pro$esional sau "n alte domenii importante de $uncionare2
    2 'actorii psi%olo!ici sunt considerai a avea un rol important "n debutul,
    severitatea, exacerbarea sau persistena durerii2
    D2 Simptomul sau de$icitul nu este produs intenional sau simulat &ca "n
    tulburarea $actice sau simulare)2
    *2 Durerea nu este explicat mai bine de o tulburare a$ectiv, anxioas sau
    psi%otic si nu satis$ace criteriile pentru dispareunie2
    A se codi"ica dup cum urmea(D
    45?285 Tulburare al!ic asociat cu $actori psi%olo!iciD $actorii psi%olo!ici
    sunt considerai a avea rolul ma0or "n debutul, severitatea, exacerbarea sau
    persistena durerii2 &Dac este pre(ent o condiie medical !eneral,
    aceasta nu are un rol ma0or "n debutul, severitatea, exacerbarea sau
    persistena durerii)2 Acest tip de tulburare al!ic nu este dia!nosticat dac
    sunt satis$cute, de asemenea, criteriile pentru tulburarea de somati(are2
    De speci"icat dac'
    AcutD durata de mai puin de I luni
    ronicD durata de I luni sau mai mult
    45?286 Tulburare al!ic asociat, at@t cu $actori psi%olo!ici, c@t ,i cu o
    condiie medical !eneralD at@t $actorii psi%olo!ici, c@t si o condiie
    medical !eneral sunt considerai a avea roluri importante "n debutul,
    severitatea, exacerbarea sau persistena durerii2 ondiia medical !eneral
    asociat sau sediul anatomic al durerii &ve(i mai 0os) este codi$icat pe axa
    III2
    De speci"icat dacD
    AcutD dac durata este de mai puin de I luni
    ronicD durata de I luni sau mai mult
    FotD .rmtoarea nu este considerat tulburare mental ,i este inclus aici
    pentru a $acilita dia!nosticul di$erenial2
    Tulburare al!ic asociat cu o condiie medical !eneralD o condiie medical
    !eneral are un rol ma0or "n debutul, severitatea, exacerbarea sau persistena
    durerii2 &Dac sunt pre(eni si $actori psi%olo!ici, ace,tia nu sunt considerai @
    avea un rol ma0or "n debutul, severitatea, exacerbarea sau persistena durerii)2
    odul dia!nostic pentru durere este selectat pe ba(a condiiei medicale
    !enerale asociate, dac a $ost stabilit vreuna &ve(i anexa G) ori pe sediul
    anatomic al durerii, dac condiia medical !eneral nu a $ost "nc precis
    stabilit a de exemplu, re!iunea lombar &?7H27), sciatic &?7H24), pelvin
    &I7A26), ce$alee &?8H25), $acial &?8H25), toracic &?8I2A5), articular &?E62H),
    osoas &?44265), abdominal &?8625), mamar &IEE2?E), renal &?8825),
    auricular &4882?5), ocular &4?626E), oro$arin!ian &?8H2E), dentar &A7A26),
    urinar &?8825)2
    <+7 Tulburrile Somato$orme
    4++.G Fipo#on$ria
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" !&ocondr!e! :" cons(!(+!e &reoc+&area s+'!ec(+"+! :n
    "e$7(+r7 c+ .a&(+" c7 ar avea sa+ c!ar !deea c7 are o %a"ad!e $rav7, &e 'a/a
    !n(er&re(7r!"or erona(e a +n+!a sa+ a %a! %+"(or se%ne sa+ s!%&(o%e cor&ora"e
    Ecr!(er!+" AJ. O eva"+are %ed!ca"7 de(a"!a(7 n+ !den(!.!c7 n!c! o cond!=!e %ed!ca"7
    $enera"7 care s7 e<&"!ce co%&"e( (e%er!"e &ersoane! :n "e$7(+r7 c+ %a"ad!a or! c+
    se%ne"e sa+ s!%&(o%e"e. so%a(!ce EdeO! o cond!=!e %ed!ca"7 $enera"7 coe<!s(en(7
    &oa(e .! &re/en(7J. Fr!ca ne@+s(!.!ca(7 sa+ !deea c7 ar avea o %a"ad!e &ers!s(7 :n
    d!s&re=+" as!$+r7r!! %ed!ca"e de con(rar!+ Ecr!(er!+" BJ. Conv!n$erea n+ es(e, :ns7,
    de !n(ens!(a(e de"!ran(7 Ead!c7, &ersoana &oa(e rec+noaO(e &os!'!"!(a(ea ca ea s7 .!
    e<a$era( $rav!(a(ea %a"ad!e! (e%+(e, sa+ c7, &oa(e, n+ e<!s(7 n!c! o %a"ad!eJ. De
    ase%enea, conv!n$erea n+ es(e "!%!(a(7 "a (ea%a c!rc+%scr!s7 re.er!(oare "a as&ec(,
    ca :n (+"'+rarea d!s%or.!c7 cor&ora"7 Ecr!(er!+" CJ. Preoc+&area &en(r+ s!%&(o%e"e
    cor&ora"e ca+/ea/7 o de(res7 sa+ de(er!orare :n do%en!+" soc!a", &ro.es!ona" sa+ :n
    a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" DJ O! d+rea/7 (!%& de R "+n!
    Ecr!(er!+" EJ. Preoc+&area n+ es(e e<&"!ca(7 %a! '!ne de an<!e(a(ea $enera"!/a(7,
    (+"'+rarea o'ses!vo4co%&+"s!v7, &an!c7, (+"'+rarea de&res!v7 %a@or7, an<!e(a(ea
    de se&arare sa+ de a"(7 (+"'+rare so%a(o.or%7 Ecr!(er!+" FJ.
    :n !&ocondr!e, &reoc+&area &oa(e !n(eresa .+nc=!! a"e cor&+"+! Ede e<., '7(7!"e
    cord+"+!, (rans&!ra=!a sa+ &er!s(a"(!s%+"J, ano%a"!! so%a(!ce %!nore Ede e<., o %!c7
    d+rere sa+ o (+se oca/!ona"7J, sa+ sen/a=!! so%a(!ce va$! s! a%'!$+e Ede e<., S!n!%a
    o'os!(7T, Svene d+reroaseTJ. Persoana a(r!'+!e aces(e s!%&(o%e sa+ se%ne
    %a"ad!e! s+s&ec(a(e s! es(e .oar(e !n(eresa(7 de se%n!.!ca=!a, a+(en(!c!(a(ea s!
    e(!o"o$!a "or. Te%er!"e &o( !%&"!ca d!verse s!s(e%e Zde or$ane[ a"e cor&+"+!, "a da(e
    d!.er!(e sa+ s!%+"(an. A"(erna(!v, &oa(e e<!s(a o &reoc+&are &en(r+ +n s!n$+r or$an
    sa+ &en(r+ o s!n$+r7 %a"ad!e Ede e<., .r!ca de a n+ avea o %a"ad!e card!ac7J.
    E<a%!n7r!"e %ed!ca"e re&e(a(e, (es(e"e d!a$nos(!ce O! as!$+rarea de c7(re %ed!c .ac
    &+=!n &en(r+ a +O+ra (ea%a de o %a"ad!e sa+ s+.er!n=7 so%a(!c7. De e<e%&"+, +n
    !nd!v!d &reoc+&a( de .a&(+" c7 ar &+(ea avea o %a"ad!e card!ac7 n+ va .! "!n!O(!( de
    "!&sa re&e(a(7 de da(e "a e<a%en+" so%a(!c, EC, sa+ c!ar "a an$!o$ra.!a card!ac7.
    Ind!v!/!! c+ !&ocondr!e se &o( a"ar%a c!(!nd sa+ a+/!nd ceva des&re %a"ad!e,
    c+noscAnd &e c!neva care a con(rac(a( %a"ad!a, or! d!n ca+/a o'serva=!!"or,
    sen/a=!"or sa+ even!%en(e"or d!n &ro&r!+" cor&. Preoc+&area &en(r+ %a"ad!a
    (e%+(7 dev!ne adesea e"e%en(+" cen(ra" a" !%a$!n!! de s!ne a !nd!v!d+"+!, +n s+'!ec(
    de d!sc+rs soc!a" O! +n r7s&+ns "a s(res+r!"e v!e=!!.
    Speci$icant
    C+ conO(!!n=a %a"ad!e! red+s7. Aces( s&ec!.!can( es(e +(!"!/a( dac7, &en(r+
    cea %a! %are &ar(e a (!%&+"+! :n c+rs+" e&!sod+"+! ac(+a", !nd!v!d+" n+
    rec+noaO(e c7 (ea%a sa de a n+ avea o %a"ad!e sever7 es(e e<ces!v7 sa+
    ne@+s(!.!ca(7.
    4552?
    Lipocondria
    <+<
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Fr!ca de :%'7(rAn!re s! de
    %oar(e s+n( .recven(e. DeO! !nd!v!/!! c+ !&ocondr!e acord7 o %are !%&or(an=7
    s7n7(7=!! so%a(!ce, e! n+ a+ :n $enera" de&r!nder! re.er!(oare "a s7n7(a(e %a! '+ne
    Ede e<., d!e(7 s7n7(oas7, e<erc!=!! re$+"a(e, ev!(area .+%a(+"+!J decA( !nd!v!/!! .7r7
    (+"'+rare. Is(or!c+" %ed!ca" es(e &re/en(a( adesea :n de(a"!+ s! a "a "on$ :n
    !&ocondr!e.
    SU%'"a(+" d!n doc(or :n doc(orT s! de(er!orarea re"a=!!"or doc(or4&ac!en(, c+
    .r+s(rare s! s+&7rare de a%'e"e &7r=!, s+n( co%+ne. Ind!v!/!! c+ aceas(7 (+"'+rare
    cred adesea c7 e! n+ a+ &r!%!( as!s(en=a %ed!ca"7 cores&+n/7(oare s! se o&+n c+
    (enac!(a(e (r!%!(er!! "a +n!(7=!"e de s7n7(a(e %en(a"7. Po( re/+"(a co%&"!ca=!! d!n
    &roced+r!"e d!a$nos(!ce re&e(a(e, care co%&or(7 &ro&r!+" r!sc s! s+n( cos(!s!(oare,
    :ns7, &en(r+ c7 aceO(! !nd!v!/! a+ +n !s(or!c de %+"(!&"e ac+/e .7r7 +n .+nda%en(
    so%a(!c c"ar, e! &o( .! e<a%!na=! s+&er.!c!a", s! &re/en=a +ne! cond!=!! %ed!ca"e
    $enera"e &oa(e .! o%!s7. Re"a=!!"e soc!a"e dev!n (ens!ona(e &en(r+ c7 !nd!v!d+" c+
    !&ocondr!e es(e &reoc+&a( n+%a! de cond!=!a sa s! adesea se aO(ea&(7 "a +n
    (ra(a%en( O! o a(en=!e s&ec!a"7. 3!a=a sa de .a%!"!e &oa(e .! &er(+r'a(7, &e %7s+r7 ce
    ea se cen(rea/7 (o( %a! %+"( &e s(area s7n7(7=!! so%a(!ce a !nd!v!d+"+!. Adesea,
    &reoc+&area !n(er.erea/7 c+ &er.or%an=a &ro.es!ona"7 s! .ace &e !nd!v!d s7
    a'sen(e/e de "a serv!c!+, :n ca/+r!"e %a! severe, !nd!v!d+" c+ !&ocondr!e &oa(e
    deven! co%&"e( !nva"!d.
    Ma"ad!! severe, :n s&ec!a" :n co&!"7r!e, O! e<&er!en=a an(er!oar7 c+ %a"ad!a +n+!
    %e%'r+ a" .a%!"!e!, se asoc!a/7 c+ a&ar!=!a !&ocondr!e!. S(resor!! &s!osoc!a"!, :n
    s&ec!a" %oar(ea c+!va a&ro&!a( !nd!v!d+"+!, s+n( cons!dera=! a &rec!&!(a (+"'+rarea
    :n +ne"e ca/+r!. Ind!v!/!! c+ !&ocondr!e a+ adesea O! a"(e (+"'+r7r! %en(a"e E:n
    s&ec!a" (+"'+r7r! an<!oase, de&res!ve O! so%a(o.or%eJ.
    Da(e de "a'ora(or asoc!a(e. Da(e"e de "a'ora(or n+ con.!r%7 &reoc+&area
    !nd!v!d+"+!.
    Da(e"e e<a%!n7r!! so%a(!ce O! cond!=!!"e %ed!ca"e so%a(!ce. Da(e"e e<a%!n7r!!
    so%a(!ce n+ con.!r%7 &reoc+&area !nd!v!d+"+!.
    *lemente speci$ice culturii ,i sexului
    Dac7 es(e ne@+s(!.!ca( ca &reoc+&area &en(r+ %a"ad!e s7 &ers!s(e :n d!s&re=+"
    eva"+7r!! %ed!ca"e adecva(e s! a" as!$+r7r!! de con(rar!+, (re'+!e s7 .!e @+deca( :n
    .+nc=!e de .ond+" c+"(+ra" s! %ode"e"e e<&"!ca(!ve. D!a$nos(!c+" de !&ocondr!e
    (re'+!e s7 .!e &+s c+ &reca+=!e, dac7 !de!"e !nd!v!d+"+! des&re %a"ad!e a+ .os(
    re:n(7r!(e de v!ndec7(or!! (rad!=!ona"! care &o( con(ra/!ce as!$+r7r!"e o.er!(e de
    eva"+7r!"e %ed!ca"e. Da(e"e re.er!(oare "a d!.eren=e"e de e(a(e s! se< :n &reva"en(7
    s+n( con(rad!c(or!!, dar (+"'+rarea s+rv!ne "a .e" de .recven(7 "a '7r'a=! O! "a .e%e!.
    #revalent
    Preva"en(a !&ocondr!e! :n &o&+"a=!a $enera"7 es(e de "d4Yd. Pr!n(re &ac!en=!!
    a%'+"a(or! d!n as!s(en=a &r!%ar7, es(!%7r!"e &reva"en(e! c+ren(e %er$ de "a 9d "a Hd.
    YLR Tulburrile Somato$orme
    *voluie
    H!&ocondr!a &oa(e :nce&e "a or!ce e(a(e, c+ cea %a! .recven(7 e(a(e "a de'+(
    s!(+a(7 "a :nce&+(+" &er!oade! ad+"(e. Evo"+=!a es(e de re$+"7 cron!c7, c+
    !n(ens!.!c7r! s! a%e"!or7r! a"e s!%&(o%e"or, dar O! rec+&erarea co%&"e(7 &oa(e
    s+rven! +neor!. Se &are c7 de'+(+" ac+(, d+ra(a sc+r(7, s!%&(o%e"e !&ocondr!ace
    +Ooare, &re/en=a co%or'!d!(7=!! %ed!ca"e $enera"e, a'sen=a +ne! (+"'+r7r! %en(a"e
    co%or'!de s! a'sen=a 'ene.!c!+"+! sec+ndar s+n( !nd!ca(or! de &ro$nos(!c .avora'!".
    D!n ca+/a cron!c!(7=!! sa"e, +n!! v7d aceas(7 (+"'+rare ca avAnd carac(er!s(!c!
    no(a'!"e Sase%7n7(oare (r7s7(+r!"orT Ead!c7, o &reoc+&are de "+n$7 d+ra(7 &en(r+
    ac+/e"e so%a(!ce s! cen(rarea &e s!%&(o%e"e cor&ora"eJ.
    Dia!nostic di$erenial
    Cea %a! !%&or(an(7 cond!=!e &en(r+ d!a$nos(!c+" d!.eren=!a" :n !&ocondr!e o
    cons(!(+!e o cond!=!e %ed!ca"7 $enera"7 s+'!acen(7, c+% ar .! s(ad!!"e &recoce a"e
    cond!=!!"or ne+ro"o$!ce Ede e<., sc"ero/a %+"(!&"7 sa+ %!as(en!a $rav!sJ, cond!=!!"e
    endocr!ne Ede e<., o %a"ad!e (!ro!d!an7 sa+ &ara(!ro!d!an7J, %a"ad!!"e care a.ec(ea/7
    s!s(e%e a"e cor&+"+! %+"(!&"e Ede e<., "+&+s+" er!(e%a(os s!s(e%!cJ s! neo.or%a=!!"e
    %a"!$ne oc+"(e. DeO! &re/en=a +ne! cond!=!! %ed!ca"e $enera"e n+ e<c"+de
    &os!'!"!(a(ea +ne! !&ocondr!! coe<!s(en(e, &reoc+&7r!"e (ran/!(or!! :n "e$7(+r7 c+ o
    cond!=!e %ed!ca"7 $enera"7 c+ren(7 n+ cons(!(+!e !&ocondr!e. S!%&(o%e"e
    so%a(!ce Ede e<., d+rerea a'do%!na"7J s+n( .recven(e "a co&!! s! n+ (re'+!e s7 .!e
    d!a$nos(!ca(e ca !&ocondr!e, decA( dac7 co&!"+" are o &reoc+&are &re"+n$!(7
    re.er!(oare "a .a&(+" c7 are o %a"ad!e sever7. Preoc+&7r!"e so%a(!ce O! .r!ca de
    de'!"!(a(e &o( .! .recven(e "a &ersoane"e :n e(a(e. De'+(+" &reoc+&7r!"or &en(r+
    s7n7(a(e "a o e(a(e avansa(7 es(e .oar(e &os!'!" :ns7 s7 cores&+nd7 rea"!(7=!! sa+ s7
    re."ec(e o (+"'+rare a.ec(!v7 %a! c+rAnd decA( !&ocondr!a.
    Un n+%7r de a"(e (+"'+r7r! &oa(e .! carac(er!/a( &r!n &reoc+&7r! :n "e$7(+r7 c+
    s7n7(a(ea sa+ %a"ad!a. H!&ocondr!a n+ es(e d!a$nos(!ca(7 dac7 &reoc+&7r!"e &en(r+
    s7n7(a(e a"e !nd!v!d+"+! s+n( e<&"!ca(e %a! '!ne de c7(re +na d!n(re aces(e (+"'+r7r!.
    De e<e%&"+, !nd!v!/!! c+ an<!e(a(e $enera"!/a(7 s+n( &reoc+&a=! de +n n+%7r de
    even!%en(e s! ac(!v!(7=! care &o( !nc"+de &reoc+&7r! :n "e$7(+r7 c+ .a&(+" de a avea
    o %a"ad!e. Un d!a$nos(!c se&ara( de !&ocondr!e (re'+!e "+a( :n cons!dera=!e n+%a!
    dac7 &reoc+&area :n "e$7(+r7 c+ a avea o %a"ad!e se a."7 :n cen(r+" &reoc+&7r!!
    &redo%!nan(e a !nd!v!d+"+!. Un!! !nd!v!/! :n e&!sod de&res!v %a@or vor .!
    &reoc+&a=! de (e%er!"e e<ces!ve re.er!(oare "a s7n7(a(ea so%a(!c7. Un d!a$nos(!c
    se&ara( de !&ocondr!e n+ es(e &+s dac7 aces(e &reoc+&7r! s+rv!n n+%a! :n c+rs+"
    e&!soade"or de&res!ve %a@ore. De&res!a s+rv!ne :ns7 adesea sec+ndar !&ocondr!e!,
    :n care ca/ !&ocondr!a (re'+!e, de ase%enea, d!a$nos(!ca(7.
    Ind!v!/!! c+ !&ocondr!e &o( avea $And+r! !n(r+s!ve re.er!(oare "a a avea o
    %a"ad!e s! &o( avea, de ase%enea, co%&or(a%en(e co%&+"s!ve asoc!a(e Ede e<., s7
    ca+(e reas!$+rareJ. Un d!a$nos(!c se&ara( de (+"'+rare o'ses!vo4co%&+"s!v7 es(e
    &+s n+%a! dac7 o'ses!!"e sa+ co%&+"s!!"e s+n( "!%!(a(e "a &reoc+&7r!"e re.er!(oare "a
    %a"ad!e Ede e<., ver!.!carea :nc+!e(or!"orJ. Oca/!ona", !nd!v!/!! c+ !&ocondr!e &o(
    e<&er!en=a a(ac+r! de &an!c7, aces(ea .!!nd dec"anOa(e de &reoc+&7r!"e
    !&ocondr!ace. Un d!a$nos(!c se&ara( de a(ac+r! de &an!c7 es(e &+s n+%a! cAnd
    s+n(, de ase%enea, &re/en(e a(ac+r! de &an!c7 !no&!na(e rec+ren(e, :n (+"'+rarea
    d!s%or.!c7 cor&ora"7, &reoc+&area es(e "!%!(a(7 "a as&ec(+" .!/!c a" &ersoane!.
    Con(rar +ne! .o'!! s&ec!.!ce CXde %a"ad!eTJ, :n care !nd!v!d+" se (e%e s7 n+ .!e
    e<&+s +ne! %a"ad!!, !&ocondr!a se carac(er!/ea/7 &r!n &reoc+&area re.er!(oare "a
    .a&(+" c7 are de@a %a"ad!a.
    4552? Tulburarea Dismor$ic
    orporal
    <+G

    :n !&ocondr!e, conv!n$erea re.er!(oare "a %a"ad!e n+ a(!n$e &ro&or=!! de"!ran(e
    Ead!c7, !nd!v!d+" &oa(e ad%!(e &os!'!"!(a(ea c7 %a"ad!a (e%+(7 n+ es(e &re/en(7J,
    con(rar !de!"or de"!ran(e so%a(!ce care &o( a&are :n (+"'+r7r!"e &s!o(!ce Ede e<., :n
    sc!/o.ren!e, (+"'+rarea de"!ran(7, (!&+" so%a(!c s! (+"'+rarea de&res!v7 %a@or7, c+
    e"e%en(e &s!o(!ceJ.
    Criteriile $e $ia/no&ti# pentru 4++.G Fipo#on$rie
    A2 #reocuparea subiectului "n le!tur cu $aptul c ar avea sau c%iar ideea c
    are o maladie sever, ba(at pe interpretarea eronat de ctre acesta a
    simptomelor corporale2
    S2 #reocuparea persist "n dispreul evalurii medicale corespun(toare si a
    asi!urrii de contrariu2
    2 onvin!erea de la criteriul A nu este de intensitate delirant &ca "n tulbu
    rarea delirant, tip somatic), si nu este limitat la o preocupare circumscris
    la aspect &ca "n tulburarea dismor$ic corporal)2
    D2 #reocuparea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    *2 Durata perturbrii este de cel puin I luni2
    '2 #reocuparea nu este explicat mai bine de anxietatea !enerali(at, tulbu
    rarea obsesivocompulsiv, panic, un episod depresiv ma0or, anxietatea de
    separare sau alt tulburare somato$orm2
    De speci"icat dacD
    u con,tiina maladiei redusD dac, pentru cea mai mare parte a timpului
    "n cursul episodului curent, persoana nu recunoa,te c preocuparea
    re$eritoare la avea o maladie este excesiv sau ne0usti$icat2
    4++.G Tul-urarea Di&"or%i#( Corporal(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! d!s%or.!ce cor&ora"e E!s(or!c, c+nosc+(7 ca
    d!s%or.o.o'!eJ es(e &reoc+&area re.er!(oare "a +n de.ec( :n as&ec( Ecr!(er!+" AJ.
    De.ec(+" es(e .!e !%a$!nar or!, dac7 es(e &re/en(7 o +Ooar7 ano%a"!e .!/!c7, (e%erea
    !nd!v!d+"+! es(e c"ar e<ces!v7 Ecr!(er!+" AJ. Preoc+&area (re'+!e s7 ca+/e/e o de(res7
    sa+ o de(er!orare se%n!.!ca(!v7 :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!!
    !%&or(an(e de .+nc=!onare Ecr!(er!+" BJ. Preoc+&area n+ es(e e<&"!ca(7 %a! '!ne de
    a"(7 (+"'+rare %en(a"7 Ede e<., de !nsa(!s.ac=!a :n "e$7(+r7 c+ con.or%a=!a s!
    d!%ens!+nea cor&+"+!, d!n anore<!a nervoas7J Ecr!(er!+" CJ.
    Ac+/e"e !%&"!c7 .recven( de.ec(e !%a$!nare sa+ +Ooare a"e .e=e! sa+ ca&+"+!, c+%
    ar .! s+'=!r!%ea &7r+"+!, acneea, r!d+r!"e, c!ca(r!c!"e, &e(e"e vasc+"are, &a"oarea sa+
    rosea=a .e=e!, +%."7(+r!, as!%e(r!e sa+ d!s&ro&or=!e .ac!a"7 or! &7r .ac!a" :n e<ces.
    A"(e &reoc+&7r! co%+ne !nc"+d con.or%a=!a, d!%ens!+nea sa+ +n a"( as&ec( a"
    nas+"+!, oc!"or, &"eoa&e"or, s&rAncene"or, +rec!"or, $+r!!, '+/e"or, d!n=!"or,
    A58 Tulburrile Somato$orme
    %and!'+"e!, '7r'!e!, o'ra@!"or sa+ ca&+"+!, :ns7, or!care a"(7 &ar(e a cor&+"+! &oa(e
    .! :n cen(r+" &reoc+&7r!! Ede e<., or$ane"e $en!(a"e, sAn!!, .ese"e, a'do%en+", 'ra=e"e,
    %A!n!"e, &!c!oare"e, coa&se"e, +%er!!, co"oana ver(e'ra"7, re$!+n! %ar! a"e cor&+"+!
    sa+ d!%ens!+nea (o(a"7 a cor&+"+! sa+ cons(r+c=!a cor&+"+! s! %+sc+"a(+raJ.
    Preoc+&area &oa(e .! cen(ra(7 s!%+"(an &e %a! %+"(e &7r=! a"e cor&+"+!. DeO! ac+/a
    es(e adesea s&ec!.!c7 Ede e<., '+/a Sr7s.rAn(7T sa+ nas S'orc7na(TJ, ea es(e adesea
    va$7 Ede e<., .a=7 Sa'7(+(7T sa+ &r!v!re S!ns+.!c!en( de "!%&edeTJ. D!n ca+/a @ene!
    ca+/a(e de &reoc+&7r!"e "or, +n!! !nd!v!/! c+ (+"'+rare d!s%or.!c7 cor&ora"7 ev!(7 saO!
    descr!e Sde.ec(e"eT :n de(a"!+ s! se re.er7 :n sc!%' doar "a +rA=en!a "or $enera"7.
    Ce! %a! %+"=! !nd!v!/! c+ aceas(7 (+"'+rare e<&er!en(ea/7 o de(res7
    cons!dera'!"7 :n "e$7(+r7 c+ &res+&+sa "or d!.or%!(a(e s! adesea :O! descr!+
    &reoc+&7r!"e ca .!!nd Se<(re% de d+reroaseT, S(+r%en(an(eT sa+ Sdevas(an(eT. Ce!
    %a! %+"=! :O! cons!der7 &reoc+&7r!"e d!.!c!" de con(ro"a( s! &o( .ace doar o %!c7
    :ncercare sa+ n+ .ac n!c! +na &en(r+ a "e re/!s(a, :n consec!n=7, e! &!erd adesea ore
    :n(re$! $And!nd+4se "a Sde.ec(+"T "or, %er$And &An7 aco"o c7 aces(e $And+r! "e &o(
    do%!na co%&"e( v!a=a. S+rv!ne o de(er!orare se%n!.!ca(!v7 :n %+"(e do%en!! de
    .+nc=!onare. Sen(!%en(e"e de @en7 :n "e$7(+r7 c+ Sde.ec(+"T "or &o( d+ce "a ev!(area
    serv!c!+"+! sa+ a s!(+a=!!"or &+'"!ce.
    *lemente ,i tulburri asociate
    3er!.!carea .recven(7 :n o$"!nd7 s! ver!.!carea Sde.ec(+"+!T :n a"(e s+&ra.e=e
    re."ec(an(e d!s&on!'!"e Ede e<., .eres(re"e %a$a/!ne"or, 'are"e de &ro(ec=!e a"e
    a+(o(+r!s%e"or, cadrane"e oro"o$!!"orJ &o( "+a %+"(e ore &e /!. Un!! !nd!v!/!
    +(!"!/ea/7 o "+%!n7 s&ec!a"7 sa+ oce"ar! care %7resc, &en(r+ a4s! o'serva
    Sde.ec(+"T. Poa(e e<!s(a +n co%&or(a%en( de ornare e<ces!v Ede e<., &!e&(7nare
    e<ces!v7 a &7r+"+!, s%+"$erea &7r+"+!, a&"!carea r!(+a"!/a(7 a %ac!a@+"+! or!
    e<&r!%area (e$+%en(e"or :n(re de$e(eJ. DeO! ver!.!carea O! ornarea s+n( e.ec(+a(e de
    +n!! !nd!v!/! &en(r+ a d!%!n+a an<!e(a(ea :n "e$7(+r7 c+ Sde.ec(+"T, aces(ea
    !n(ens!.!c7 adesea &reoc+&area O! an<!e(a(ea asoc!a(7, :n consec!n=7, +n!! !nd!v!/!
    ev!(7 o$"!n/!"e, +neor! "e aco&er7 sa+ "e :nde&7r(ea/7 d!n a%'!an=a "or. A"=!! &ar a
    a"(erna :n(re &er!oade de ver!.!care e<ces!v7 :n o$"!nd7 O! &er!oade de ev!(are a
    aces(e!a. Po( e<!s(a cerer! .recven(e de reas!$+rare re.er!(oare "a Sde.ec(T, dar o as(.e"
    de reas!$+rare d+ce n+%a! (e%&orar, dac7 d+ce, "a +O+rare. Ind!v!/!! c+ aceas(7
    (+"'+rare &o(, de ase%enea, s7 co%&are .recven( &ar(ea S+rA(7T a cor&+"+! "or c+
    cea a a"(ora. S+n(, de ase%enea, .recven(e !de! de re.er!n=7 :n "e$7(+r7 c+
    &res+&+s+" "or de.ec(. Ind!v!/!! c+ aceas(7 (+"'+rare cred adesea c7 a"=!! &o( da Esa+
    c!ar da+J a(en=!e &res+&+s+"+! "or de.ec(, c7 &oa(e vor'esc des&re aces(a O! :" !a+ :n
    rAs. E! &o( :ncerca s74s! ca%+."e/e Sde.ec(+"T Ede e<., :O! "as7 'ar'7 &en(r+ a aco&er!
    c!ca(r!c!"e .ac!a"e !%a$!na(e, &oar(7 &7"7r!e &en(r+ a asc+nde &res+&+sa &!erdere a
    &7r+"+!, :O! +%&"+ Oor(+" &en(r+ a creO(e +n &en!s S%!cTJ. Un!! !nd!v!/! &o( .! e<(re%
    de &reoc+&a=! de (ea%a c7 &ar(ea S+rA(7T a cor&+"+! "or va .+nc=!ona r7+ sa+ es(e
    e<(re% de .ra$!"7 s! :n &er%anen( &er!co" de a .! "e/a(7. ConO(!!n=a de.ec(e"or
    &erce&+(e es(e adesea red+s7, !ar +n!! !nd!v!/! s+n( de"!ran=!, ad!c7 s+n( .er%
    conv!nO! c7 o&!n!a "or des&re de.ec( es(e corec(7 O! ned!s(ors!ona(7 O! n+ &o( .!
    conv!nO! de con(rar!+. Ide!"e de re.er!n=7 O! !de!"e de"!ran(e de re.er!n=7 :n "e$7(+r7
    c+ de.ec(+" !%a$!na( s+n(, de ase%enea, .recven(e, ad!c7, !nd!v!/!! c+ aceas(7
    (+"'+rare cred c7 ce!"a"=! &o( "+a no(7 Esa+ a+ "+a( de@aJ de &res+&+s+" "or de.ec( O!
    vor'esc des&re aces(a sa+ :" !a+ :n rAs.
    Y5L Tulburrile Somato$orme
    (re'+!e s7 .!e d!.eren=!a( de an(rena%en(+" s7n7(os s! de an(rena%en(+" e<ces!v
    care &oa(e s+rven! ca &ar(e a +ne! (+"'+r7r! de co%&or(a%en( a"!%en(ar.
    D!a$nos(!c+" de (+"'+rare d!s%or.!c7 cor&ora"7 n+ (re'+!e s7 .!e &+s dac7
    &reoc+&area es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7. T+"'+rarea
    d!s%or.!c7 cor&ora"7 n+ (re'+!e s7 .!e d!a$nos(!ca(7, dac7 &reoc+&area e<ces!v7 es(e
    "!%!(a(7 "a (e%er!"e re.er!(oare "a S:n$r7OareT d!n anore<!a nervoas7, dac7
    &reoc+&area !nd!v!d+"+! es(e "!%!(a(7 "a d!scon.or(+" sa+ sen(!%en(+" de !nadecvare
    :n "e$7(+r7 c+ carac(er!s(!c!"e sa"e se<+a"e &r!%are sa+ sec+ndare care a&ar :n
    (+"'+rarea de !den(!(a(e se<+a"7, or! dac7 &reoc+&area es(e "!%!(a(7 "a r+%!na=!!
    con$r+en(e c+ d!s&o/!=!a !%&"!cAnd as&ec(+", care a&ar e<c"+s!v :n c+rs+" +n+!
    e&!sod de&res!v %a@or. De&res!a s+rv!ne adesea :ns7 sec+ndar (+"'+r7r!! d!s%or.!ce
    cor&ora"e, :n care ca/ (re'+!e d!a$nos(!ca(7 (+"'+rarea d!s%or.!c7 cor&ora"7 .
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e ev!(an(7 or! c+ .o'!e soc!a"7 &o( .!
    &reoc+&a=! de .a&(+" c7 s+n( &+O! :n d!.!c+"(a(e de de.ec(e rea"e :n as&ec(, dar aceas(7
    &reoc+&are n+ es(e de re$+"7 no(a'!"7, &ers!s(en(7, de(resan(7, cons+%a(oare de
    (!%& s! de(er!oran(7. DeO! !nd!v!/!! c+ (+"'+rare d!s%or.!c7 cor&ora"7 a+ &reoc+&7r!
    o'ses!ve :n "e$7(+r7 c+ as&ec(+" "or O! &o( avea co%&or(a%en(e co%&+"s!ve asoc!a(e
    Ede e<., ver!.!care :n o$"!nd7J, +n d!a$nos(!c se&ara( de (+"'+rare o'ses!vo4
    co%&+"s!v7 es(e &+s, n+%a! cAnd o'ses!!"e sa+ co%&+"s!!"e n+ s+n( red+se "a
    &reoc+&7r! re.er!(oare "a as&ec(. Un!! !nd!v!/! c+ (+"'+rare d!s%or.!c7 cor&ora"7 :O!
    &o( :nde&7r(a &7r+" de &e cor& sa+ :O! &o( &!Oc7 (e$+%en(e"e :n (en(a(!va "or de a4O!
    a%e"!ora as&ec(+"8 aces(e co%&or(a%en(e (re'+!e d!s(!nse de s%+"$erea &7r+"+! d!n
    (r!co(!"o%an!e, care n+ s+rv!ne ca r7s&+ns "a &reoc+&7r! re.er!(oare "a as&ec( s! de
    &!Oca(+" (e$+%en(e"or care &oa(e .! asoc!a( c+ a"(e (+"'+r7r! %en(a"e
    Ind!v!/!! c+ (+"'+rare d!s%or.!c7 cor&ora"7 &o( &r!%! +n d!a$nos(!c ad!=!ona" de
    (+"'+rare de"!ran(7 de (!& so%a(!c, dac7 &reoc+&area "or &en(r+ +n &res+&+s
    de.ec( :n as&ec( es(e %en=!n+(7 c+ !n(ens!(a(e de"!ran(7.
    -oro es(e +n s!ndro% c!rc+%scr!s c+"(+ra" care a&are :n s&ec!a" :n As!a de
    S+d4Es( O! care &oa(e .! a&ro&!a( de (+"'+rarea d!s%or.!c7 cor&ora"7. Se
    carac(er!/ea/7 &r!n &reoc+&area c7 &en!s+" Esa+ "a'!!"e, %a%e"oane"e sa+ sAn!! "a
    .e%e!J se %!cOorea/7 sa+ se re(rac(ea/7 s! va EvorJ d!s&are :n a'do%en. Aceas(7
    &reoc+&are es(e !nso=!(7 adesea de conv!n$erea c7 va s+rven! %oar(ea. -oro d!.er7
    de (+"'+rarea d!s%or.!c7 cor&ora"7 &r!n d+ra(a sa de re$+"7 sc+r(7, e"e%en(e"e
    asoc!a(e d!.er!(e E:n &r!%+" rAnd an<!e(a(ea ac+(7 s! .r!ca de %oar(eJ, r7s&+ns+"
    &o/!(!v "a as!$+rarea de con(rar!+ O! a&ar!=!a oca/!ona"7 ca e&!de%!e.
    Criteriile $e $ia/no&ti# pentru
    4++.G Tul-urarea Di&"or%i#( Corporal(
    A2 #reocupare pentru un presupus de$ect "n aspect2 Dac este pre(ent ,i o
    u,oar anomalie $i(ic, preocuparea persoanei este marcat excesiv2
    S2 #reocuparea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    2 #reocuparea nu este explicat de alt tulburare mental &de ex2, de insatis
    $acia "n le!tur cu con$ormaia ,i dimensiunea corpului "n anorexia nervoas)2
    45528E Tulburarea Somato$orm 'r Alt
    Speci$icaie
    Y55
    4++.>* Tul-urarea So"ato%or"(
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e !nc"+de (+"'+r7r!"e c+ s!%&(o%e so%a(o.or%e care n+ sa(!s.ac
    cr!(er!!"e &en(r+ n!c! o (+"'+rare so%a(o.or%7 s&ec!.!c7. E<e%&"e"e !nc"+dQ
    1. Pse+doc!es!s+"Q conv!n$erea .a"s7 c7 ar .! :ns7rc!na(7, asoc!a(7 c+ se%ne
    o'!ec(!ve de sarc!n7, aces(ea &+(And !nc"+de %7r!rea a'do%en+"+! EdeO!
    o%'!"!c+" n+ es(e O(ersJ, red+cerea ."+<+"+! %ens(r+a", a%enoreea, sen/a=!a
    s+'!ec(!v7 de %!Oc7r! .e(a"e, $rea=a, %7r!rea sAn!"or O! secre=!! O! d+rer! de
    (rava"!+ "a da(a &res+&+s7 a naO(er!!. Po( .! &re/en(e %od!.!c7r! endocr!ne Ede
    e<., o (+%or7 secre(an(7 de or%on!J.
    2. O (+"'+rare !%&"!cAnd s!%&(o%e !&ocondr!ace non&s!o(!ce c+ o d+ra(7 de
    %a! &+=!n de R "+n!.
    3. O (+"'+rare !%&"!cAnd ac+/e so%a(!ce nee<&"!ca(e Ede e<., .a(!$a'!"!(a(e sa+
    de'!"!(a(e cor&ora"7J c+ o d+ra(7 de %a! &+=!n de R "+n! s! care n+ se da(orea/7
    a"(e! (+"'+r7r! %en(a"e.

    Tulburrile 'actice
    +"'+r7r!"e .ac(!ce se carac(er!/ea/7 &r!n s!%&(o%e so%a(!ce sa+
    &s!o"o$!ce care s+n( &rod+se !n(en=!ona" sa+ s!%+"a(e :n sco&+"
    as+%7r!! ro"+"+! de &ac!en(. *+deca(a c7 +n an+%!( s!%&(o% es(e &rod+s
    !n(en=!ona" es(e .7c+(7, a(A( &r!n &ro'a d!rec(7, cA( O! &r!n e<c"+derea
    a"(or ca+/e a"e s!%&(o%+"+!. De e<e%&"+, +n !nd!v!d care se &re/!n(7 c+
    e%a(+r!e es(e desco&er!( a &oseda an(!coa$+"an(e. Persoana nea$7 a "e .! "+a(, dar
    e<a%en+" sAn$e"+! concord7 c+ !n$es(!a de an(!coa$+"an(e. O !n.eren=7 ra=!ona"7, :n
    a'sen=a &ro'e! c7 !n$es(!a a s+rven!( acc!den(a", es(e aceea c7 !nd!v!d+" a &+(+( "+a
    %ed!ca%en(+" !n(en=!ona(. Tre'+!e no(a( c7 &re/en=a de s!%&(o%e .ac(!ce n+
    e<c"+de coe<!s(en=a s!%&(o%e"or so%a(!ce sa+ &s!o"o$!ce adev7ra(e.
    T+"'+r7r!"e .ac(!ce se d!s(!n$ de ac(e"e de s!%+"are, :n s!%+"are, !nd!v!d+"
    &rod+ce, de ase%enea, !n(en=!ona" s!%&(o%e"e, dar are +n sco& care es(e c"ar
    reco$nosc!'!" cAnd s+n( c+nosc+(e c!rc+%s(an=e"e a%'!en(a"e. De e<e%&"+,
    &rod+cerea !n(en=!ona"7 a s!%&(o%e"or &en(r+ a ev!(a :nda(or!rea de @+ra(,
    @+decarea +n+! &roces sa+ :ncor&orarea, (re'+!e s7 .!e c"as!.!ca(e ca s!%+"are. La .e",
    dac7 +n !nd!v!d, care es(e s&!(a"!/a( &en(r+ (ra(a%en(+" +ne! (+"'+r7r! %en(a"e,
    s!%+"ea/7 o e<acer'are a %a"ad!e! &en(r+ a ev!(a (rans.er+" "a a"( s&!(a" %a! &+=!n
    a$rea(, aceas(a va .! cons!dera(a +n ac( de s!%+"are. D!n con(ra, :n (+"'+rarea
    .ac(!ce, %o(!va=!a o cons(!(+!e neces!(a(ea &s!o"o$!c7 de as+%are a ro"+"+! de
    &ac!en(, d+&7 c+% de%ons(rea/7 a'sen=a %o'!"+r!"or e<(erne &en(r+
    co%&or(a%en(. S!%+"area &oa(e .! cons!dera(7 a .! ada&(a(!v7 :n an+%!(e
    c!rc+%s(an=e Ede e<., :n s!(+a=!!"e de os(a(ecJ dar, &r!n de.!n!=!e, +n d!a$nos(!c de
    (+"'+rare .ac(!ce !%&"!c7 (o(dea+na &s!o&a(o"o$!e.
    Tul-urarea %a#ti#e
    E"e%en(+" esen=!a" a" (+"'+r7r!! .ac(!ce :" cons(!(+!e &rod+cerea !n(en=!ona"7 de
    se%ne sa+ s!%&(o%e so%a(!ce sa+ &s!o"o$!ce Ecr!(er!+" AJ. Ta'"o+" c"!n!c &oa(e
    !nc"+de .a'r!carea de ac+/e s+'!ec(!ve Ede e<., ac+/e de d+rere a'do%!na"7 ac+(7,
    :n a'sen=a +ne! as(.e" de d+rer!J, cond!=!! a+(o&rovoca(e Ede e<., &rod+cerea de
    a'cese &r!n !n@ec(area de sa"!v7 :n &!e"eJ, e<a$erarea sa+ e<acer'area cond!=!!"or
    %ed!ca"e $enera"e Ede e<., s!%+"area +ne! cr!/e de $rand %a" de c7(re +n !nd!v!d c+
    +n !s(or!c an(er!or de e&!"e&s!eJ, or! or!ce co%'!na=!e sa+ var!a=!e a aces(ora.
    Mo(!va=!a aces(+! co%&or(a%en( es(e aceea a as+%7r!! ro"+"+! de &ac!en( Ecr!(er!+"
    BJ. Mo'!"+r!"e e<(erne a"e aces(+! co%&or(a%en( Ede e<., avan(a@ econo%!c, ev!(area
    +nor res&onsa'!"!(7=! "e$a"e sa+ a%e"!orarea '+n7s(7r!! %a(er!a"e, ca :n s!%+"areJ
    s+n( a'sen(e Ecr!(er!+" CJ.
    Ind!v!/!! c+ (+"'+rare .ac(!ce :O! &re/!n(7 de re$+"7 !s(or!c+" c+ +n ."er
    dra%a(!c, dar s+n( e<(re% de va$! s! !nconsecven=! cAnd s+n( ces(!ona=! %a! :n
    de(a"!+. E! se &o( an$a@a :n %!nc!+n7 &a(o"o$!c7 de o ase%enea %an!er7, c7
    !n(r!$7 asc+"(7(or+", :n "e$7(+r7 c+ or!care as&ec( a" !s(or!c+"+! sa+ s!%&(o%e"or
    <*4
    Y5I Tulburrile 'actice
    "or Ead!c7, &se+do"o$!e .an(as(!c7J. Adesea, e! a+ c+noO(!n=e :n(!nse de
    (er%!no"o$!e %ed!ca"7 s! de r+(!ne de s&!(a". Ac+/area de d+rer! s! so"!c!(area de
    ana"$e/!ce s+n( .oar(e .recven(e. D+&7 ce e<(!nsa e"a'orare a &r!nc!&a"e"or "or
    ac+/e s4a ar7(a( a .! ne$a(!v7, e! se &"An$ adesea de a"(e &ro'"e%e so%a(!ce sa+
    &s!o"o$!ce, s! &rod+c2 %a! %+"(e s!%&(o%e .ac(!ce. Ind!v!/!! c+ aceas(7
    (+"'+rare se &o( s+&+ne c+ ardoare +nor %+"(!&"e &rocedee s! o&era=!! !nvas!ve.
    :n (!%& ce se a."7 :n s&!(a", a+ de re$+"7 &+=!n! v!/!(a(or!, :n .!na", se a@+n$e "a
    %o%en(+" :n care na(+ra .ac(!ce a s!%&(o%e"or !nd!v!d+"+! es(e desco&er!(7 Ede
    T2
    e<., &ersoana res&ec(!v7 es(e rec+nosc+(7 de c!neva care a :n(A"n!(4o :n c+rs+"
    +ne! !n(ern7r! an(er!oare8 a"(e s&!(a"e con.!r%7 %+"(!&"e"e s&!(a"!/7r! an(er!oare
    &en(r+ s!%&(o%a(o"o$!a .ac(!ceJ. CAnd s+n( con.r+n(a=! c+ &ro'a c7 s!%&(o%e"e
    "or s+n( .ac(!ce, !nd!v!/!! c+ aceas(7 (+"'+rare nea$7 de re$+"7 a"e$a=!!"e sa+ se
    e<(ernea/7 ra&!d, con(rar av!/+"+! %ed!ca". Frecven( vor .! !n(erna=! :n a"( s&!(a",
    c+rAnd d+&7 aceea. S&!(a"!/7r!"e "or re&e(a(e :! d+c adesea &r!n n+%eroase
    oraOe, s(a(e sa+ =7r!.
    Subtipuri
    T+"'+rarea .ac(!ce es(e cod!.!ca(7 :n con.or%!(a(e c+ s+'(!&+" &e care45
    carac(er!/ea/7 ce" %a! '!ne s!%&(o%e"e &redo%!nan(e.
    ;LL.5R C+ se%ne s! s!%&(o%e &redo%!nan( &s!o"o$!ce. Aces( s+'(!&
    descr!e +n (a'"o+ c"!n!c :n care &redo%!n7 se%ne"e s! s!%&(o%e"e
    &s!o"o$!ce. Se carac(er!/ea/7 &r!n &rod+cerea !n(en=!ona"7 sa+ s!%+"area de
    s!%&(o%e &s!o"o$!ce Eadesea &s!o(!ceJ care s+$erea/7 o (+"'+rare %en(a"7.
    Sco&+" !nd!v!d+"+! es(e, ev!den(, ace"a de as+%are a ro"+"+! de S&ac!en(T O!,
    de a"(.e", n+ es(e !n(e"!$!'!" :n "+%!na c!rc+%s(an=e"or a%'!en(a"e E:n con(ras(
    c+ s!%+"areaJ. Aces( s+'(!& &oa(e .! s+$era( de s!%&(o%a(o"o$!a vas(7 care
    adesea n+ cores&+nde +n+! &a((ern s!ndro%o"o$!c (!&!c, de o evo"+=!e O! +n
    r7s&+ns "a (ra(a%en( !n+/+a", O! de a$ravarea s!%&(o%e"or cAnd !nd!v!d+"
    rea"!/ea/7 c7 es(e &+s s+' o'serva=!e. Ind!v!/!! c+ aces( s+'(!& de (+"'+rare
    .ac(!ce &o( ac+/a de&res!e s! !dea=!e s+!c!dar7 +r%And %or=!! so=!e! Eso=+"+!J
    E%oar(ea ne.!!nd con.!r%a(7 de a"=! !n.or%a(or!J, &!erderea %e%or!e! Erecen(e
    s! :nde&7r(a(eJ, a"+c!na=!! Ea+d!(!ve O! v!/+a"eJ s! s!%&(o%e d!soc!a(!ve.
    AceO(! !nd!v!/! &o( .! e<(re% de s+$es(!ona'!"! O! :O! &o( :ns+O! %+"(e d!n(re
    s!%&(o%e"e ad+se :n d!sc+=!e :n c+rs+" +ne! (recer! :n rev!s(7 a aces(ora.
    Invers, &o( .! e<(re% de con(rad!c(or!! O! necoo&eran=! cAnd s+n( ces(!ona=!.
    Ta'"o+" c"!n!c re&re/!n(7 de re$+"7 conce&=!a !nd!v!d+"+! des&re (+"'+rarea
    %en(a"7 O! n+ se con.or%ea/7 n!c! +ne! ca(e$or!! d!a$nos(!ce rec+nosc+(e.
    ;LL.5F C+ se%ne s! s!%&(o%e &redo%!nan( so%a(!ce. Aces( s+'(!& descr!e
    +n (a'"o+ c"!n!c :n care &redo%!n7 se%ne"e O! s!%&(o%e"e +ne! cond!=!!
    %ed!ca"e $enera"e a&aren(e, :n(rea$a v!a=7 a !nd!v!d+"+! &oa(e cons(a d!n
    :ncerc7r! de a .! !n(erna( or! de a s(a :n(r+n s&!(a" E.a&( c+nosc+( ca
    Ss!ndro%+" "+! M!!nca+senTJ. Ta'"o+r!"e c"!n!ce !nc"+d .recven( d+rere :n
    cadran+" !n.er!or dre&(, asoc!a(7 c+ $rea=7 s! vo%7, a%e=ea"7 O! o'n+'!"are,
    e%o&(!/!e %as!v7, ras+r! O! a'cese $enera"!/a(e, .e'r7 de or!$!ne
    nede(er%!na(7, sAn$er7r! sec+ndare !n$es(!e! de an(!coa$+"an(e O! s!ndro%e
    Ss!%!"are "+&+s+"+!T. Toa(e or$ane"e s+n( =!n(e even(+a"e, !ar s!%&(o%e"e
    &re/en(a(e s+n( "!%!(a(e n+%a! de c+noO(!n=e"e %ed!ca"e, so.!s(!carea O!
    !%a$!na=!a !nd!v!d+"+!.
    Tulburrile
    'actice
    515

    ;LL.5F C+ se%ne s! s!%&(o%e &s!o"o$!ce s! so%a(!ce co%'!na(e. Aces(
    s+'(!& descr!e +n (a'"o+ c"!n!c :n care s+n( &re/en(e, a(A( s!%&(o%e s! se%ne
    &s!o"o$!ce, cA( s! so%a(!ce, dar n+ &redo%!n7 n!c! +ne"e.
    *lemente si tulburri asociate
    :n (+"'+rarea .ac(!ce c+ se%ne s! s!%&(o%e &redo%!nan( &s!o"o$!ce &oa(e
    a&are da(+" de r7s&+ns+r! a&ro<!%a(!ve Ede e<., G < G .ac RYJ. Ind!v!d+" &oa(e +(!"!/a
    &e asc+ns s+'s(an=e &s!oac(!ve :n sco&+" &rod+cer!! s!%&(o%e"or care s+$erea/7 o
    (+"'+rare %en(a"7 Ede e<., s(!%+"an(e &en(r+ a &rod+ce ne"!n!O(e s! !nso%n!e,
    a"+c!no$ene &en(r+ a !nd+ce s(7r! de a"(erare a &erce&=!!"or, ana"$e/!ce &en(r+ a
    !nd+ce e+.or!a s! !&no(!ce &en(r+ a !nd+ce "e(ar$!aJ. Co%'!na=!!"e de s+'s(an=e &o(
    &rod+ce (a'"o+r! c"!n!ce e<(re% de !nso"!(e.
    Ind!v!/!! c+ (+"'+rare .ac(!ce c+ se%ne s! s!%&(o%e &redo%!nan( so%a(!ce &o(
    &re/en(a, de ase%enea, s! a'+/ de o s+'s(an=7, :n s&ec!a" de ana"$e/!ce"e s!
    seda(!ve"e &rescr!se. N+%eroase"e s&!(a"!/7r! d+c .recven( "a cond!=!! %ed!ca"e
    $enera"e !nd+se !a(ro$en!c Ede e<., "a .or%area de c!ca(r!c! ce"o!de &r!n !n(erven=!!
    c!r+r$!ca"e !n+(!"e or! "a reac=!! adverse "a %ed!ca%en(eJ. Ind!v!/!! c+ .or%a
    cron!c7 a aces(e! (+"'+r7r! &o( c7&7(a +n Sa'do%en :n .or%7 de $r7(arT, d!n ca+/a
    n+%eroase"or !n(erven=!! c!r+r$!ca"e. T+"'+rarea .ac(!ce es(e de re$+"7
    !nco%&a(!'!"7 c+ %en=!nerea de c7(re !nd!v!d a +n+! serv!c!+ s!$+r, a "e$7(+r!"or de
    .a%!"!e s! a re"a=!!"or !n(er&ersona"e. Pos!'!"!! .ac(or! &red!s&o/an=! "a (+"'+rarea
    .ac(!ce !nc"+d &re/en=a a"(or (+"'+r7r! %en(a"e sa+ cond!=!! %ed!ca"e $enera"e :n
    co&!"7r!e sa+ ado"escen=7 care a+ d+s "a (ra(a%en(e %ed!ca"e s! "a s&!(a"!/7r!
    :nde"+n$a(e, resen(!%en(e"e .a=7 de &ro.es!a %ed!ca"7, .+nc=!onarea :n(r4o &o/!=!e
    a&ro&!a(7 de %ed!c!n7, &re/en=a +ne! (+"'+r7r! severe de &ersona"!(a(e, ce" %a!
    adesea (+"'+rarea de &ersona"!(a(e 'order"!ne.
    #revalent
    E<!s(7 &+=!ne !n.or%a=!! des&re &reva"en(a (+"'+r7r!! .ac(!ce. Ten!c!"e
    e&!de%!o"o$!ce s(andard s+n( !nco%oda(e de .a&(+" c7 (+"'+rarea .ac(!ce !%&"!c7
    (o(dea+na dece&=!e, !ar +neor! O! &ere$r!n7r!, as(.e" c7 adesea n+ &oa(e .!
    rec+nosc+(7. Pe de a"(7 &ar(e, .or%a cron!c7 a (+"'+r7r!! &oa(e .! s+&rara&or(a(7,
    &en(r+ c7 !nd!v!/!! a.ec(a=! se &re/!n(7 "a d!verO! %ed!c! d!n s&!(a"e d!.er!(e, adesea
    .s+' n+%e d!.er!(e. Ce"e 2%a! '+ne da(e !nd!c7 .a&(+" c7 :n ce"e %a! %ar! s&!(a"e
    $enera"e, (+"'+rarea .ac(!ce es(e d!a$nos(!ca(7 "a :n @+r de 5d d!n(re &ac!en=!! &e
    care4! cons+"(7 &ro.es!on!O(!! :n s7n7(a(e %en(a"7. Preva"en(a &are a .! %a! %are :n
    +n!(7=!"e de (ra(a%en( de de :na"(7 s&ec!a"!/are. Ta'"o+r!"e c"!n!ce c+ s!%&(o%e s!
    se%ne &s!o"o$!ce &redo%!nan(e s+n( ra&or(a(e %+"( %a! &+=!n .recven( decA( ce"e
    c+ s!%&(o%e s! se%ne so%a(!ce &redo%!nan(e.
    *voluie
    Evo"+=!a (+"'+r7r!! .ac(!ce cons(7 de re$+"7 d!n e&!soade !n(er%!(en(e. Ma! rar
    e<!s(7 +n s!n$+r e&!sod sa+ o %a"ad!e nonre%!(en(7, cron!c7. De'+(+" are "oc de
    re$+"7 &recoce :n v!a=a ad+"(7, adesea d+&7 o s&!(a"!/are &en(r+ o cond!=!e %ed!ca"7
    $enera"7 or! a"(7 (+"'+rare %en(a"7, :n .or%a cron!c7 a aces(e! (+"'+r7r!, +n &a((ern
    de s&!(a"!/7r! s+cces!ve &oa(e deven! +n &a((ern &e v!a=7.
    <*= Tulburrile 'actice

    Dia!nostic di$erenial
    O (+"'+rare .ac(!ce (re'+!e s7 .!e d!s(!ns7 de o cond!=!e %ed!ca"7 $enera"7
    adev7ra(7 s! de o (+"'+rare %en(a"7 adev7ra(7. S+s&!c!+nea c7 o (+"'+rare %en(a"7
    sa+ o cond!=!e %ed!ca"7 $enera"7 a&aren(7 re&re/!n(7 de .a&( o (+"'+rare .ac(!ce
    (re'+!e s7 a&ar7, dac7 or!ce co%'!na=!e a +r%7(oare"or s!%&(o%e es(e re%arca(7 "a
    +n !nd!v!d s&!(a"!/a(Q +n (a'"o+ c"!n!c a(!&!c sa+ dra%a(!c, care n+ se con.or%ea/7
    +ne! cond!=!! %ed!ca"e $enera"e sa+ (+"'+r7r! %en(a"e !den(!.!ca'!"e8 s!%&(o%e sa+
    co%&or(a%en(e care s+n( &re/en(e n+%a! cAnd !nd!v!d+" es(e o'serva(8
    &se+do"o$!e .an(as(!c78 co%&or(a%en( &er(+r'an( :n sa"on Ede e<., nes+&+nere "a
    re$+"a%en(e"e s&!(a"+"+!, cer(+r! c+ s+ror!"e s! %ed!c!!J8 c+noO(!n=e a%&"e de
    (er%!no"o$!e %ed!ca"7 s! r+(!ne de s&!(a"8 +/ :n asc+ns de o s+'s(an=78 ev!den=a a
    %+"(!&"e !n(erven=!! (era&e+(!ce Ede e<., !n(erven=!! c!r+r$!ca"e re&e(a(e, (era&!e
    e"ec(roconv+"s!van(7 re&e(a(7 :n d!verse rAnd+r!J8 !s(or!c a%&"+ de c7"7(or!!8 n!c! +n
    v!/!(a(or sa+ doar .oar(e &+=!n! :n (!%& ce se a."7 !n(erna( :n s&!(a"8 evo"+=!e c"!n!c7
    ."+c(+an(7 c+ a&ar!=!e ra&!d7 de Sco%&"!ca=!!T sa+ a +ne! no! S&a(o"o$!!T :nda(7 ce
    e"a'orarea !n!=!a"7 s4a &ro'a( a .! ne$a(!v7.
    :n (+"'+r7r!"e so%a(o.or%e, s+n( &re/en(e, de ase%enea, ac+/e so%a(!ce care n+
    s+n( a(r!'+!'!"e :n (o(a"!(a(e +ne! cond!=!! %ed!ca"e $enera"e adev7ra(e, dar
    s!%&(o%e"e n+ s+n( &rod+se !n(en=!ona". S!%+"area d!.er7 de (+"'+rarea .ac(!ce &r!n
    aceea c7 :n s!%+"are !nd!v!d+" es(e %o(!va( conO(!en( de +n %o'!" e<(ern. Ind!v!/!!
    c+ s!%+"are &o( so"!c!(a s&!(a"!/are &r!n &rod+cerea de s!%&(o%e :n :ncercarea de a
    o'=!ne o co%&ensa=!e, de a sc7&a de o +r%7r!re :n @+s(!=!e sa+, %a! s!%&"+, &en(r+
    Sa o'=!ne +n &a( &en(r+ noa&(eT, :ns7, sco&+" es(e de re$+"7 ev!den(, !ar e! &o(
    Ss(o&aT s!%&(o%e"e cAnd aces(ea n+ "e %a! s+n( necesare, :n (+"'+rarea .ac(!ce,
    !nd!v!d+" n+ es(e de re$+"7 conO(!en( de %o(!va=!a d!n s&a(e"e co%&or(a%en(+"+!
    .ac(!ce, !ar %o'!"+r!"e e<(erne s+n( a'sen(e.
    Criteriile $e $ia/no&ti# pentru Tul-urarea 'a#ti#e
    A2 #roducerea intenionat sau simularea de simptome sau semne psi%olo!ice
    sau somatice2
    S2 Motivaia comportamentului o constituie asumarea rolului de pacient2
    2 Mobilurile externe pentru comportament &cum ar $i avanta0ul economic,
    evitarea responsabilitilor le!ale sau ameliorarea sntii $i(ice, ca "n
    simulare) sunt absente2
    Se codi"ic pe ba(a tipuluiD
    4552EI u simptome ,i semne psi%olo!ice predominanteD dac simptomele
    si semnele psi%olo!ice predomin "n tabloul clinic,
    4552E6 u simptome si semne somatice predominanteD dac simptomele si
    semnele somatice predomin "n tabloul clinic,
    4552E6 u simptome ,i semne somatice ,i psi%olo!ice combinateD dac at@t
    simptomele ,i semnele somatice, c@t si cele psi%olo!ice sunt pre(ente, dar
    nici unele nu predomin "n tabloul clinic2
    4552E6 Tulburarea 'actice 'r Alt
    Speci$icaie
    Y5H
    4++.*5 Tul-urarea 'a#ti#e
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e !nc"+de (+"'+r7r!"e c+ s!%&(o%e .ac(!ce care n+ sa(!s.ac
    cr!(er!!"e &en(r+ (+"'+rarea .ac(!ce. Un e<e%&"+ :n aces( sens :" cons(!(+!e
    (+"'+rarea .ac(!ce &r!n &roc+r7 E'y &ro<yJQ &rod+cerea sa+ s!%+"area de
    s!%&(o%e so%a(!ce sa+ &s!o"o$!ce "a a"(7 &ersoan7 care se a."7 s+' :n$r!@!rea
    !nd!v!d+"+! :n sco&+" as+%7r!! ro"+"+! de &ac!en( Eve/! &a$. HG5 &en(r+ cr!(er!!"e
    de cerce(are s+$era(eJ.
    NIIIIIIF
    Tulburrile Disociative
    I"e%en(+" esen=!a" a" (+"'+r7r!"or d!soc!a(!ve :" cons(!(+!e o r+&(+r7 :n
    .+nc=!!"e de re$+"7 !n(e$ra(e a"e conO(!!n=e!, %e%or!e!, !den(!(7=!! sa+ &erce&=!e!
    a%'!an=e!. Per(+r'area &oa(e .! 'r+sc7 sa+ $rad+a"7, (ran/!(or!e sa+ cron!c7, :n
    aceas(7 sec=!+ne s+n( !nc"+se +r%7(oare"e (+"'+r7r!Q
    A%ne/!a d!soc!a(!v7, carac(er!/a(7 &r!n !nca&ac!(a(ea de a evoca !n.or%a=!!
    &ersona"e !%&or(an(e, de re$+"7 de na(+r7 (ra+%a(!c7 sa+ s(resan(7, O! care es(e
    &rea e<(!ns7 &en(r+ a .! e<&"!ca(7 &r!n s!%&"a +!(are.
    F+$a d!soc!a(!v7, carac(er!/a(7 &r!n(r4o c7"7(or!e 'r+sc7, !no&!na(7, de&ar(e
    de cas7 sa+ de "oc+" de %+nc7 a'!(+a", :nso=!(7 de !nca&ac!(a(ea de a evoca
    &ro&r!+" (rec+( O! de con.+/!e re.er!(oare "a !den(!(a(ea &ersona"7 sa+ as+%area
    +ne! no! !den(!(7=!.
    T+"'+rarea de !den(!(a(e d!soc!a(!v7 Ean(er!or, (+"'+rarea de &ersona"!(a(e
    %+"(!&"7J, carac(er!/a(7 &r!n &re/en=a a do+7 sa+ %a! %+"(e !den(!(7=! sa+ s(7r! de
    &ersona"!(a(e d!s(!nc(e care !a+ rec+ren( con(ro"+" co%&or(a%en(+"+! !nd!v!d+"+! O!
    s+n( :nso=!(e de !nca&ac!(a(ea de a evoca !n.or%a=!! &ersona"e !%&or(an(e, O! care
    es(e &rea e<(!ns7 &en(r+ a &+(ea .! e<&"!ca(7 &r!n s!%&"a +!(are. Aceas(a es(e o
    (+"'+rare carac(er!/a(7 &r!n .ra$%en(area &ersona"!(7=!!, %a! c+rAnd decA( &r!n(r4o
    &ro"!.erare de &ersona"!(7=! se&ara(e.
    T+"'+rarea de de&ersona"!/are, carac(er!/a(7 &r!n sen(!%en(+" &ers!s(en( sa+
    rec+ren( de a .! de(aOa( de &ro&r!!"e &rocese %en(a"e sa+ de &ro&r!+" cor&, O! care
    es(e :nso=!(7 de o (es(are a rea"!(7=!! !n(ac(7.
    T+"'+rarea d!soc!a(!v7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    (+"'+r7r!"or :n care e"e%en(+" &redo%!nan( es(e +n s!%&(o% d!soc!a(!v, dar care n+
    sa(!s.ace cr!(er!!"e &en(r+ n!c! o (+"'+rare d!soc!a(!v7 s&ec!.!c7.
    S!%&(o%e"e d!soc!a(!ve s+n( !nc"+se, de ase%enea, O! :n se(+r!"e de cr!(er!!
    &en(r+ s(res+" ac+(, s(res+" &os((ra+%a(!c O! (+"'+rarea de so%a(!/are. Un
    d!a$nos(!c ad!=!ona" de (+"'+rare d!soc!a(!v7 n+ es(e &+s dac7 s!%&(o%e"e
    d!soc!a(!ve a&ar e<c"+s!v :n c+rs+" +ne!a d!n(re aces(e (+"'+r7r!, :n +ne"e c"as!.!c7r!,
    reac=!a de convers!e es(e cons!dera(7 a .! +n .eno%en d!soc!a(!v8 :n DSM4I3 :ns7,
    (+"'+rarea de convers!e es(e &"asa(7 :n sec=!+nea ST+"'+r7r!"or so%a(o.or%eT
    &en(r+ a s+'"!n!a !%&or(an=a cond!=!!"or ne+ro"o$!ce sa+ a cond!=!!"or %ed!ca"e
    $enera"e, "+a(e :n cons!dera=!e :n d!a$nos(!c+" d!.eren=!a".
    O &ers&ec(!v7 (ransc+"(+ra"7 es(e e<(re% de !%&or(an(7 :n eva"+area (+"'+r7r!"or
    d!soc!a(!ve, deoarece s(7r!"e d!soc!a(!ve s+n( o e<&res!e acce&(a(7 O! co%+n7 a
    ac(!v!(7=!"or c+"(+ra"e sa+ a e<&er!en=e"or re"!$!oase :n %+"(e soc!e(7=!, :n ce"e %a!
    %+"(e ca/+r!, s(7r!"e d!soc!a(!ve n+ s+n( &a(o"o$!ce O! n+ d+c "a de(res7, de(er!orare
    sa+ co%&or(a%en( de c7+(are a a@+(or+"+! se%n!.!ca(!ve. Un n+%7r de s!ndro%e
    de.!n!(e c+"(+ra" s! carac(er!/a(e &r!n d!soc!ere ca+/ea/7 :ns7 de(res7 O! de(er!orare
    O! s+n( rec+nosc+(e :n %od s&ec!a" ca %an!.es(7r! &a(o"o$!ce Eve/! &a$. HG; O! GFHJ,
    deO! s!%&(o%a(o"o$!a &oa(e "+a d!.er!(e .or%e :n d!verse c+"(+r!, c+% ar .!
    e&!soade"e sc+r(e de s(+&or d!soc!a(!v sa+ de &oses!+ne a s&!r!(+"+! :n Ind!a.
    <*5
    Y9L Tulburrile Disociative
    4++.*C A"ne)ia Di&o#iativ(
    (anterior A"ne)ia P&i@o/en(6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" a%ne/!e! d!soc!a(!ve :" cons(!(+!e !nca&ac!(a(ea de a evoca
    !n.or%a=!! &ersona"e !%&or(an(e, de re$+"7 de na(+r7 (ra+%a(!c7 sa+ s(resan(7, care
    es(e &rea :n(!ns7 &en(r+ a .! e<&"!ca(7 &r!n +!(area co%+n7 Ecr!(er!+" AJ. Aceas(7
    (+"'+rare !%&"!c7 o de(er!orare revers!'!"7 a %e%or!e!, :n care a%!n(!rea e<&er!en=e!
    &ersona"e n+ &oa(e .! re&rod+s7 :n .or%a ver'a"7 Esa+ dac7 es(e re&rod+s7, n+
    &oa(e .! re=!n+(7 :n (o(a"!(a(e :n conO(!!n=7J. Per(+r'area n+ s+rv!ne e<c"+s!v :n
    c+rs+" (+"'+r7r!! de !den(!(a(e d!soc!a(!v7, .+$!! d!soc!a(!ve, s(res+"+! &os((ra+%a(!c,
    s(res+"+! ac+( sa+ (+"'+r7r!! de so%a(!/are s! n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! s+'s(an=e or! a"e +ne! cond!=!! ne+ro"o$!ce sa+ a"e a"(e! cond!=!!
    %ed!ca"e $enera"e Ecr!(er!+" BJ. S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" or! :n a"(e do%en!!
    !%&or(an(e de .+nc=!onare Ecr!(er!+" CJ.
    A%ne/!a d!soc!a(!v7 se &re/!n(7 ce" %a! .recven( ca o "ac+n7 sa+ o ser!e de
    "ac+ne ra&or(a(e re(ros&ec(!v :n evocarea +nor as&ec(e d!n !s(or!a v!e=!! !nd!v!d+"+!.
    Aces(e "ac+ne se re.er7 de re$+"7 "a even!%en(e (ra+%a(!ce sa+ e<ces!v de s(resan(e.
    Un!! !nd!v!/! &o( avea a%ne/!e &en(r+ e&!soade"e de a+(o%+(!"are, accese"e de .+r!e
    v!o"en(e sa+ (en(a(!ve"e de s+!c!d. Ma! rar, a%ne/!a d!soc!a(!v7 se &re/!n(7 ca +n
    e&!sod ."or!d c+ de'+( 'r+sc. Es(e &os!'!" ca aceas(7 .or%7 ac+(7 s7 s+rv!n7 :n
    &er!oade"e de r7/'o! sa+ ca r7s&+ns "a +n de/as(r+ na(+ra".
    :n a%ne/!a d!soc!a(!v7 a+ .os( descr!se %a! %+"(e (!&+r! de &er(+r'7r! de
    %e%or!e, :n amne;ia locali;at6, !nd!v!d+" n+4s! &oa(e a%!n(! even!%en(e"e care a+
    av+( "oc :n dec+rs+" +nor &er!oade c!rc+%scr!se de (!%&, de re$+"7 :n &r!%e"e ore
    care +r%ea/7 +n+! even!%en( &ro.+nd &er(+r'an( Ede e<., s+&rav!e=+!(or+" !nde%n
    a" +n+! acc!den( de %aO!n7, :n care +n %e%'r+ a" .a%!"!e! sa"e a .os( +c!s, n+ es(e
    ca&a'!" s7 evoce n!%!c d!n ceea ce s4a :n(A%&"a( d!n %o%en(+" acc!den(+"+! s! &An7
    c+ do+7 /!"e %a! (Ar/!+J, =n amne;ia selecti*6, &ersoana :O! &oa(e a%!n(! ceva, dar n+
    (oa(e even!%en(e"e d!n c+rs+" +ne! &er!oade c!rc+%scr!se de (!%& Ede e<., +n
    ve(eran de r7/'o! :O! &oa(e a%!n(! n+%a! +ne"e &7r=! a"e +ne! ser!! de e<&er!en=e
    v!o"en(e de "+&(7J. A"(e (re! (!&+r! de a%ne/!e U $enera"!/a(7, con(!n+7 s!
    s!s(e%a(!/a(7 U s+n( %a! &+=!n .recven(e, :n amne;ia /enerali;at6, !nca&ac!(a(ea de
    evocare !n(eresea/7 :n(rea$a v!a=7 a &ersoane!. Ind!v!/!! c+ aceas(7 (+"'+rare rar7
    s+n( ad+O! "a &o"!=!e, "a ca%ere"e de $ard7 sa+ "a serv!c!!"e de cons+"(a=!! :n a"(e
    s&ec!a"!(7=! E!nc"+s!v &s!!a(r!eJ a"e s&!(a"e"or $enera"e. Amne;ia contin+6 es(e
    de.!n!(7 ca !nca&ac!(a(ea de a evoca even!%en(e"e +"(er!oare +ne! an+%!(e da(e s!
    &An7 :n &re/en(. Amne;ia sistemati;at6 es(e &!erderea %e%or!e! &en(r+ o an+%!(7
    ca(e$or!e de !n.or%a=!!, c+% ar .! (oa(e a%!n(!r!"e re.er!(oare "a &ro&r!a .a%!"!e sa+
    "a o an+%!(7 &ersoan7. Ind!v!/!! care &re/!n(7 aces(e +"(!%e (re! (!&+r! de a%ne/!e
    d!soc!a(!v7 &o( .! d!a$nos(!ca=! :n .!na" ca avAnd o .or%7 %a! co%&"e<7 de (+"'+rare
    d!soc!a(!v7 Ede e<., (+"'+rare de !den(!(a(e d!soc!a(!v7J.
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. Un!! !nd!v!/! c+ a%ne/!e
    d!soc!a(!v7 re"a(ea/7 s!%&(o%e de&res!ve, an<!oase, de&ersona"!/are, s(7r! de
    4552E7 Amne(ia Disociativ &anterior Amne(ia #si%o!en) A7E
    (rans7, ana"$e/!e s! re$res!e4s&on(an7 a e(7=!!. E! &o( da r7s&+ns+r! a"7(+r! "a
    :n(re'7r! Ede e<., 9 &"+s 9 .ac YJ ca :n s!ndro%+" ,anser. A"(e &ro'"e%e care :nso=esc
    +neor! aceas(7 (+"'+rare !nc"+d d!s.+nc=!a se<+a"7, de(er!orarea :n ac(!v!(a(ea
    &ro.es!ona"7 s! :n re"a=!!"e !n(er&ersona"e, a+(o%+(!"area, !%&+"s+r!"e a$res!ve O!
    !%&+"s+r!"e s! ac(e"e s+!c!dare. Ind!v!/!! c+ a%ne/!e d!soc!a(!v7 &o( avea, de
    ase%enea, s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de convers!e, o
    (+"'+rare a.ec(!v7 sa+ o (+"'+rare de &ersona"!(a(e.
    Da(e de "a'ora(or asoc!a(e. Ind!v!/!! c+ a%ne/!e d!soc!a(!v7 &re/!n(7 adesea
    !&no(!/a'!"!(a(e cresc+(7, d+&7 c+% !nd!c7 %7s+r7(or!"e &r!n (es(e s(andard!/a(e.
    *lemente speci$ice etii
    A%ne/!a d!soc!a(!v7 es(e e<(re% de d!.!c!" de eva"+a( "a co&!! &reado"escen=!,
    &en(r+ c7 &oa(e .! con.+nda(7 c+ !na(en=!a, an<!e(a(ea, co%&or(a%en(+"
    o&o/!=!on!s(, (+"'+r7r!"e de :nv7=are, (+"'+r7r!"e &s!o(!ce O! a%ne/!a co&!"7r!e!
    cores&+n/7(oare de/vo"(7r!! Ead!c7, evocarea red+s7 a even!%en(e"or
    a+(o'!o$ra.!ce care a+ av+( "oc :na!n(e de e(a(ea de Y an!J. Poa(e .! necesar7 o
    ser!e de o'serva=!! sa+ o eva"+are de c7(re %a! %+"=! e<a%!na(or! Ede e<., :nv7=7(or,
    (era&e+(, as!s(en( soc!a"J &en(r+ a &+ne +n d!a$nos(!c e<ac( de a%ne/!e d!soc!a(!v7
    "a co&!!.
    #revalent
    :n +"(!%!! an! :n S(a(e"e Un!(e, e<!s(7 o creO(ere :n ra&or(area de ca/+r! de
    a%ne/!e d!soc!a(!v7 care !%&"!c7 (ra+%e"e %!c!! co&!"7r!!, +!(a(e an(er!or. Aceas(7
    creO(ere a .os( s+'!ec(+" +nor !n(er&re(7r! .oar(e d!.er!(e. Un!! cons!der7 c7 o %a!
    %are conO(!en(!/are a d!a$nos(!c+"+! &r!n(re &ro.es!on!O(!! :n s7n7(a(e %en(a"7 a d+s
    "a !den(!.!carea de ca/+r! care an(er!or n+ .+seser7 d!a$nos(!ca(e ca a(are. D!n
    con(ra, a"=!! cons!der7 c7 s!ndro%+" a .os( s+&rad!a$nos(!ca( "a !nd!v!/!! care s+n(
    .oar(e s+$es(!ona'!"!.
    *voluie
    A%ne/!a d!soc!a(!v7 &oa(e .! &re/en(7 "a or!ce $r+& de e(a(e, de "a co&!! %!c! &An7
    "a ad+"=!. Pr!nc!&a"a %an!.es(are "a ce! %a! %+"=! !nd!v!/! o cons(!(+!e o "ac+n7
    re(ros&ec(!v7 :n %e%or!e. D+ra(a a.!r%a(7 a even!%en(e"or &en(r+ care e<!s(7
    a%ne/!e &oa(e .! de "a cA(eva %!n+(e &An7 "a cA=!va an!. Poa(e .! descr!s +n s!n$+r
    e&!sod de a%ne/!e, deO! a+ .os( descr!se .recven( do+7 sa+ %a! %+"(e e&!soade.
    Ind!v!/!! care a+ av+( +n e&!sod de a%ne/!e d!soc!a(!v7 &o( .! &red!s&+s! "a a &re/en(a
    a%ne/!e &en(r+ c!rc+%s(an=e (ra+%a(!ce +"(er!oare. A%ne/!a ac+(7 se &oa(e re/o"va
    s&on(an, d+&7 ce !nd!v!d+" es(e scos d!n c!rc+%s(an=e"e (ra+%a(!ce c+ care es(e
    asoc!a(7 a%ne/!a Ede e<., +n so"da(, c+ a%ne/!e "oca"!/a(7 d+&7 %a! %+"(e /!"e de
    "+&(7 !n(ens7, :O! &oa(e rec7&7(a s&on(an %e%or!a aces(or e<&er!en=e, d+&7 ce es(e
    scos d!n cA%&+" de "+&(7J. Un!! !nd!v!/! c+ a%ne/!e cron!c7 &o( :nce&e $rad+a" s7
    evoce a%!n(!r!"e d!soc!a(e. A"=! !nd!v!/! &o( &re/en(a o .or%7 cron!c7 de a%ne/!e.
    Dia!nostic di$erenial
    A%ne/!a d!soc!a(!v7 (re'+!e s7 .!e d!s(!ns7 de (+"'+rarea a%nes(!c7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e, :n care a%ne/!a es(e cons!dera(7 a .! consec!n=a
    .!/!o"o$!c7 a +ne! cond!=!! ne+ro"o$!ce sa+ a a"(e! cond!=!! %ed!ca"e $enera"e Ede
    522 Tulburrile Disociative
    e<., +n (ra+%a(!s% cran!an, e&!"e&s!aJ Eve/! &a$. 5HYJ. Aceas(7 &rec!/are se
    'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c, :n (+"'+rarea
    a%nes(!c7 da(ora(7 +ne! "e/!+n! cere'ra"e, &er(+r'area evoc7r!!, deO!
    c!rc+%scr!s7, es(e adesea a(A( re(ro$rad7 Ead!c7, c+&r!nde o &er!oad7 de (!%&
    d!na!n(ea (ra+%a(!s%+"+! cran!anJ, cA( s! an(ero$rad7 Ead!c7, &en(r+
    even!%en(e"e de d+&7 (ra+%a(!s%J s! e<!s(7 de re$+"7 +n !s(or!c c"ar de
    (ra+%a(!s% .!/!c, o &er!oad7 de !nconO(!en=7 sa+ &ro'a c"!n!c7 a +ne! "e/!+n!
    cere'ra"e. D!n con(r7, :n a%ne/!a d!soc!a(!v7, &er(+r'area evoc7r!! es(e a&roa&e
    (o(dea+na an(ero$rad7 Ead!c7, &!erderea %e%or!e! es(e "!%!(a(7 "a &er!oada de
    d+&7 (ra+%a(!s%J s! n+ e<!s(7 de re$+"7 &ro'"e%e c+ :nv7=area !n.or%a=!!"or no!.
    Rare"e ca/+r! de a%ne/!e d!soc!a(!v7 c+ a%ne/!e re(ro$rad7 &o( .! d!s(!nse &r!n
    +/+" d!a$nos(!c a" !&no/e!8 rec+&erarea &ro%&(7 a a%!n(!r!"or &!erd+(e
    s+$erea/7 o 'a/7 d!soc!a(!v7 &en(r+ &er(+r'are, :n cr!/e"e e&!"e&(!ce, de(er!orarea
    %e%or!e! de'+(ea/7 'r+sc, &o( .! &re/en(e ano%a"!! %o(or!!, !ar e<a%ene"e EE,
    re&e(a(e re"ev7 ano%a"!! carac(er!s(!ce, :n de"!r!+% O! :n de%en=7, &!erderea
    %e%or!e! es(e :ncr+s(a(7 :n(r4+n se( %a! "ar$ de &er(+r'7r! co$n!(!ve, "!n$v!s(!ce,
    a.ec(!ve, de a(en=!e, &erce&=!e O! co%&or(a%en(. D!n con(ra, :n a%ne/!a
    d!soc!a(!v7, &!erderea %e%or!e! !n(eresea/7 :n &r!%+" rAnd da(e"e a+(o'!o$ra.!ce,
    !ar ca&ac!(7=!"e co$n!(!ve s+n( :n $enera" conserva(e. A%ne/!a asoc!a(7 c+ o
    cond!=!e %ed!ca"7 $enera"7 de re$+"7 n+ es(e revers!'!"7.
    P!erderea %e%or!e! asoc!a(7 c+ +/+" +nor s+'s(an=e sa+ a" +nor %ed!ca%en(e
    (re'+!e s7 .!e d!s(!ns7 de a%ne/!a d!soc!a(!v7. T+"'+rarea a%nes(!c7 &ers!s(en(7
    !nd+s7 de o s+'s(an=7 (re'+!e s7 .!e d!a$nos(!ca(7, dac7 se cons!der7 c7 e<!s(7 o
    &!erdere &ers!s(en(7 a %e%or!e! care es(e :n ra&or( c+ e.ec(e"e .!/!o"o$!ce d!rec(e a"e
    +ne! s+'s(an=e Ede e<., +n dro$ de a'+/ sa+ +n %ed!ca%en(J Eve/! &a$. 5HHJ. :n (!%&
    ce :n a%ne/!a d!soc!a(!v7 ca&ac!(a(ea de a evoca a%!n(!r!"e no! es(e &re/erva(7, :n
    (+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7 de o s+'s(an=7 %e%or!a de sc+r(7 d+ra(7
    es(e de(er!ora(7 Ead!c7, even!%en(e"e &o( .! evoca(e !%ed!a( d+&7 ce a+ av+( "oc, dar
    n+ s! d+&7 ce a+ (rec+( cA(eva %!n+(eJ. P!erderea %e%or!e! asoc!a(7 c+ !n(o<!ca=!a
    c+ o s+'s(an=7 Ede e<., S'"ac)o+(sTJ &o( .! d!s(!nse de a%ne/!a d!soc!a(!v7 &r!n
    asoc!erea &!erder!! %e%or!e! c+ +/+" e<ces!v de o s+'s(an=7 s! &r!n .a&(+" c7
    a%ne/!a n+ es(e de re$+"7 revers!'!"7.
    S!%&(o%+" d!soc!a(!v de a%ne/!e es(e +n e"e%en( carac(er!s(!c, a(A( a" .+$!!
    d!soc!a(!ve, cA( s! a" (+"'+r7r!! de !den(!(a(e d!soc!a(!v7. Ca a(are, dac7 a%ne/!a
    d!soc!a(!v7 s+rv!ne e<c"+s!v :n c+rs+" .+$!! d!soc!a(!ve sa+ a" (+"'+r7r!! de
    !den(!(a(e d!soc!a(!v7, +n d!a$nos(!c se&ara( de a%ne/!e d!soc!a(!v7 n+ es(e &+s.
    Deoarece de&ersona"!/area es(e +n e"e%en( asoc!a( a" a%ne/!e! d!soc!a(!ve,
    de&ersona"!/area care s+rv!ne n+%a! :n c+rs+" a%ne/!e! d!soc!a(!ve n+ va .!
    d!a$nos(!ca(7 se&ara( ca (+"'+rare de de&ersona"!/are.
    :n s(res+" &os(ra+%a(!c O! :n s(res+" ac+(, &oa(e e<!s(a a%ne/!e &en(r+
    even!%en(+" (ra+%a(!c. De ase%enea, s!%&(o%e d!soc!a(!ve, ca a%ne/!a, s+n(
    !nc"+se :n se(+" de cr!(er!! &en(r+ (+"'+rarea de so%a(!/are. A%ne/!a d!soc!a(!v7 n+
    es(e d!a$nos(!ca(7 dac7 a&are e<c"+s!v :n c+rs+" aces(or (+"'+r7r!.
    A%ne/!a de s!%+"are .es(e %a! .recven(7 "a !nd!v!/!! c+ s!%&(o%e ."or!de, ac+(e,
    :n(r4+n con(e<( :n care es(e ev!den( +n 'ene.!c!+ sec+ndar &o(en=!a" U de e<e%&"+,
    &ro'"e%e .!nanc!are sa+ "e$a"e or! dor!n=a de a ev!(a "+&(a, deO! a%ne/!a adev7ra(7
    &oa(e .! asoc!a(7 c+ as(.e" de s(resor!. :n a.ar7 de aceas(a, !nd!v!/!! c+ a%ne/!e
    d!soc!a(!v7 ver!(a'!"7 o'=!n scor+r! %ar! "a %7s+r7(or!"e s(andard a"e ca&ac!(7=!!
    d!soc!a(!ve s! de !&no(!/a'!"!(a(e.
    4552E4 'u!a Disociativ &anterior 'u!a
    #si%o!en)
    52+

    Tre'+!e s7 .!% &reca+=! :n eva"+area ac+ra(e=e! a%!n(!r!"or rec+&era(e, deoarece
    !n.or%a(or!! s+n( adesea .oar(e s+$es(!ona'!"!. A+ e<!s(a( con(roverse cons!dera'!"e
    re.er!(oare "a a%ne/!a :n "e$7(+r7 c+ %a"(ra(area cor&ora"7 sa+ a'+/+" se<+a"
    re"a(a(, :n s&ec!a" cAnd se s+s=!ne c7 a'+/+" a av+( "oc :n %!ca co&!"7r!e. Un!!
    c"!n!c!en! cred c7 a e<!s(a( o s+'ra&or(are a +nor as(.e" de even!%en(e, :n s&ec!a"
    &en(r+ .a&(+" c7 v!c(!%e"e s+n( adesea co&!!, !ar co%!(en=!! s+n( :nc"!na=! s74s! ne$e
    sa+ s74s! d!s(ors!one/e ac=!+n!"e. A"=! c"!n!c!en!, :ns7, s+n( &reoc+&a=! de .a&(+" c7
    &oa(e e<!s(a o s+&rara&or(are, da(7 .!!nd :n s&ec!a" "!&sa de .!de"!(a(e a a%!n(!r!"or
    co&!"7r!e!. N+ e<!s(7 ac(+a"%en(e n!c! o %e(od7 &en(r+ a s(a'!"! c+ cer(!(+d!ne
    ac+ra(e=ea +nor ase%enea a%!n(!r! rec+&era(e, :n a'sen=a +nor &ro'e coro'oran(e.
    A%ne/!a d!soc!a(!v7 (re'+!e s7 .!e d!s(!ns7, de ase%enea, de &!erderea %e%or!e!
    :n ra&or( c+ dec"!n+" co$n!(!v :n "e$7(+r7 c+ e(a(ea s! .or%e"e non&a(o"o$!ce de
    a%ne/!e !nc"+/And &!erderea %e%or!e! de .!ecare /!, a%ne/!a &os(!&no(!c7,
    a%ne/!a !n.an(!"7 s! a co&!"7r!e! O! a%ne/!a &en(r+ so%n s! v!s. A%ne/!a d!soc!a(!v7
    &oa(e .! d!s(!ns7 de "ac+ne"e %nes(!ce nor%a"e &r!n na(+ra !n(er%!(en(7 s!
    !nvo"+n(ar7 a !nca&ac!(7=!! de evocare s! &r!n &re/en=a +ne! de(rese sa+ de(er!or7r!
    se%n!.!ca(!ve.
    Criteriile $e $ia/no&ti# pentru 4++.*C A"ne)ia Di&o#iativ(
    A2 #erturbarea predominant o constituie unul sau mai multe episoade de
    incapacitate de a evoca in$ormaii personale importante, de re!ul de
    natur traumatic sau stresant, si care este prea "ntins pentru a putea $i
    explicat de uitarea comun2
    S2 #erturbarea nu survine exclusiv "n cursul tulburrii de identitate disociativ,
    $u!ii disociative, stresului posttraumatic, stresului acut sau tulburrii de
    somati(are si nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau ale unei condiii neurolo!ice
    ori ale altei condiii medicale !enerale &de ex2, tulburarea amnestic
    datorat unui traumatism cranian)2
    2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii de $uncionare importante2
    4++.*4 'u/a Di&o#iativ(
    (anterior 'u/a P&i@o/en(6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" .+$!! d!soc!a(!ve :" cons(!(+!e c7"7(or!a 'r+sc7, !no&!na(7,
    de&ar(e de cas7 sa+ de "oc+" a'!(+a" de ac(!v!(7=! /!"n!ce, c+ !nca&ac!(a(ea de a
    rea%!n(! o &ar(e sa+ :n(re$+" (rec+( Ecr!(er!+" AJ. Aceas(a es(e :nso=!(7 de con.+/!e :n
    "e$7(+r7 c+ !den(!(a(ea &ersona"7 sa+ c!ar c+ as+%area +ne! no! !den(!(7=! Ecr!(er!+"
    BJ. Per(+r'area n+ s+rv!ne e<c"+s!v :n c+rs+" (+"'+r7r!! de !den(!(a(e d!soc!a(!v7 O!
    n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ecr!(er!+" CJ. S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 sa+
    <C7 Tulburrile Disociative
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a" sa+ &ro.es!ona" or! :n a"(e
    do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" DJ.
    C7"7(or!a &oa(e %er$e de "a sc+r(e e<c+rs!!, :n (!%&+" +nor &er!oade sc+r(e de
    (!%& Ede e<., ore sa+ /!"eJ, &An7 "a &ere$r!na@e co%&"e<e, d!scre(e, :n dec+rs+" +nor
    "+n$! &er!oade de (!%& Ede e<., s7&(7%An! sa+ "+n!J, c+ +n!! !nd!v!/! re"a(And
    (raversarea a n+%eroase .ron(!ere na=!ona"e s! &arc+r$erea a %!! de %!"e. :n c+rs+"
    .+$!!, !nd!v!/!! &ar a .! :n $enera" .7r7 n!c! +n .e" de &s!o&a(o"o$!e, s! n+ a(ra$ :n
    n!c! +n .e" a(en=!a, :n(r4+n an+%!( %o%en( :ns7, !nd!v!d+" a(ra$e a(en=!a c"!n!c7, de
    re$+"7 d!n ca+/a a%ne/!e! sa"e &en(r+ even!%en(e"e recen(e sa+ a "!&se! conO(!!n=e!
    !den(!(7=!! &ersona"e, :nda(7 ce rev!ne "a s(area an(er!oar7 .+$!!, !nd!v!d+" &oa(e s7
    n+ %a! a!'7 n!c! o a%!n(!re des&re even!%en(e"e care a+ av+( "oc :n (!%&+" .+$!!.
    Ce"e %a! %+"(e .+$! n+ !%&"!c7 .or%area +ne! no! !den(!(7=!. Dac7 :n c+rs+" .+$!!
    es(e as+%a(7 o no+7 !den(!(a(e, aceas(a es(e carac(er!/a(7 de re$+"7 &r!n (r7s7(+r!
    %a! $re$are s! %a! de/!n!'a(e decA( ce"e care carac(er!/ea/7 !den(!(a(ea an(er!oar7.
    Persoana :O! &oa(e "+a +n no+ n+%e, :O! &oa(e s(a'!"! a"( do%!c!"!+ s! se &oa(e an$a@a
    :n ac(!v!(7=! soc!a"e co%&"e<e care s+n( '!ne !n(e$ra(e s! care n+ s+$erea/7 &re/en=a
    +ne! (+"'+r7r! %en(a"e.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. D+&7 reven!rea "a s(area
    an(er!oar7 .+$!!, &oa(e .! re%arca(7 a%ne/!a &en(r+ even!%en(e"e (ra+%a(!/an(e d!n
    (rec+(+" &ersoane! Ede e<., d+&7 (er%!narea +ne! .+$! "+n$!, +n so"da( r7%Ane
    a%ne/!c &en(r+ even!%en(e"e d!n (!%&+" r7/'o!+"+! care a+ av+( "oc c+ %+"( (!%&
    :na!n(e s! :n care ce" %a! '+n a%!c a" s7+ a .os( +c!sJ. Po( .! &re/en(e de&res!a,
    d!s.or!a, de/o"area, r+O!nea, c+"&a, s(res+" &s!o"o$!c, !%&+"s+r! con."!c(+a"e,
    s+!c!dare s! a$res!ve. Persoana &oa(e da r7s&+ns+r! !ncorec(e s! a"7(+r! "a :n(re'7r!
    Ede e<., 9 &"+s 9 .ac YJ ca :n s!ndro%+" ,anser. :n(!nderea O! d+ra(a .+$!! &oa(e
    de(er%!na $rad+" a"(or &ro'"e%e, c+% ar .! &!erderea serv!c!+"+! sa+ r+&erea $rav7
    a re"a=!!"or &ersona"e sa+ .a%!"!a"e. Ind!v!/!! c+ .+$7 d!soc!a(!v7 &o( avea o (+"'+rare
    a.ec(!v7, s(res &os((ra+%a(!c sa+ o (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7.
    *lemente speci$ice culturii
    Ind!v!/!! c+ d!verse s!ndro%e Sde .+$7T de.!n!(e c+"(+ra" Ede e<., piblo8to:,
    &r!n(re na(!v!! d!n /ona arc(!c7, /risi si8nis, &r!n(re %!s)!(o d!n Hond+ras s!
    N!cara$+a, %a$!a S.rene(!c7T a &o&+"a=!e! Nava@o O! +ne"e .or%e de amo8 :n
    c+"(+r!"e d!n ves(+" Pac!.!c+"+!J &o( avea s!%&(o%e care sa(!s.ac cr!(er!!"e de
    d!a$nos(!c &en(r+ .+$a d!soc!a(!v7. Aces(ea s+n( cond!=!! carac(er!/a(e &r!n de'+(+"
    'r+sc a" +n+! :na"( n!ve" de ac(!v!(a(e, a" +ne! s(7r! ase%7n7(oare (ranse!, a" +n+!
    co%&or(a%en( &o(en=!a" &er!c+"os s+' .or%7 de .+$7 sa+ d!s&ar!=!e s! e&+!/area,
    so%n+" O! a%ne/!a consec+(!ve &en(r+ e&!sod. E3e/!, de ase%enea, (ransa
    d!soc!a(!v7 :n ane<a B, &a$. HG;J.
    #revalent
    :n &o&+"a=!a $enera"7 a .os( ra&or(a(7 o ra(7 de &reva"en(7 &en(r+ .+$a
    d!soc!a(!v7 de L,9d. Preva"en(a &oa(e cres(e :n c+rs+" &er!oade"or de even!%en(e
    e<(re% de s(resan(e, c+% ar .! r7/'o!+" sa+ +n de/as(r+ na(+ra".
    4552E4 'u!a Disociativ &anterior 'u!a
    #si%o!en)
    <C<
    *voluie
    De'+(+" .+$!! d!soc!a(!ve es(e de re$+"7 :n ra&or( c+ even!%en(e de v!a=7
    (ra+%a(!/an(e, s(resan(e sa+ co&"eO!(oare. Ce"e %a! %+"(e ca/+r! s+n( descr!se "a
    ad+"=!. Ce" %a! .recven( s+n( ra&or(a(e e&!soade +n!ce, care &o( d+ra de "a cA(eva
    ore "a cA(eva "+n!. Rec+&erarea es(e de re$+"7 ra&!d7, :ns7 :n +ne"e ca/+r! &oa(e
    &ers!s(a o a%ne/!e d!soc!a(!v7 re.rac(ar7.
    Dia!nostic di$erenial
    F+$a d!soc!a(!v7 (re'+!e s7 .!e d!s(!ns7 de s!%&(o%e care s+n( cons!dera(e a .!
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e s&ec!.!ce Ede e<
    v
    a +n+!
    (ra+%a(!s% cran!anJ Eve/! &a$. 5G5J. Aceas(7 &rec!/are se ba;ea;6 &e !s(or!c, da(e"e
    de "a'ora(or sa+ e<a%en+" so%a(!c. S4a o'serva( c7 !nd!v!/!! c+ cr!/e &ar=!a"e
    co%&"e<e &re/!n(7 va$a'onda@ sa+ +n co%&or(a%en( se%!or!en(a( s&re +n sco& :n
    (!%&+" cr!/e"or sa+ a" s(7r!"or &os(!c(a"e &en(r+ care e<!s(7 a%ne/!e consec+(!v7,
    :ns7, o .+$7 e&!"e&(!c7 &oa(e .! rec+nosc+(7, &en(r+ c7 de re$+"7 !nd!v!d+" &oa(e
    &re/en(a a+r7, ano%a"!! %o(or!!, co%&or(a%en( s(ereo(!&, a"(er7r! &erce&(!ve, o
    s(are &os(!c(a"7 s! da(e anor%a"e &e EE, ser!a(e. S!%&(o%e"e d!soc!a(!ve
    cons!dera(e a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e
    (re'+!e s7 .!e d!a$nos(!ca(e ca (+"'+rare %en(a"7 .7r7 a"(7 s&ec!.!ca=!e da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e. F+$a d!soc!a(!v7 (re'+!e d!s(!ns7, de ase%enea, de
    s!%&(o%e"e ca+/a(e de e.ec(e"e .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Eve/! &a$. 9LFJ.
    Dac7 s!%&(o%e"e .+$!! s+rv!n n+%a! :n c+rs+" (+"'+r7r!! de !den(!(a(e
    d!soc!a(!v7, .+$a d!soc!a(!v7 n+ (re'+!e s7 .!e d!a$nos(!ca(7 se&ara(. A%ne/!a
    d!soc!a(!v7 s! (+"'+rarea de de&ersona"!/are n+ (re'+!e s7 .!e d!a$nos(!ca(e
    se&ara(, dac7 s!%&(o%e"e de a%ne/!e sa+ de de&ersona"!/are s+rv!n n+%a! :n
    c+rs+" .+$!! d!soc!a(!ve. 3a$a'onda@+" s! c7"7(or!a .7r7 sco& care s+rv!n :n c+rs+"
    +n+! e&!sod %an!aca", (re'+!e s7 .!e d!s(!nse de .+$a d!soc!a(!v7. Ca s! :n .+$a
    d!soc!a(!v7, !nd!v!/!! :n e&!sod %an!aca" &o( re"a(a a%ne/!e &en(r+ an+%!(e
    &er!oade d!n v!a=a "or, :n s&ec!a" &en(r+ co%&or(a%en(+" care s+rv!ne :n c+rs+"
    s(7r!"or e+(!%!ce sa+ de&res!ve, :n(r4+n e&!sod %an!aca" :ns7, c7"7(or!a es(e asoc!a(7
    c+ !de! de $randoare s! a"(e s!%&(o%e %an!aca"e, !ar as(.e" de !nd!v!/! a(ra$ adesea
    a(en=!a as+&ra "or &r!n(r4+n co%&or(a%en( !nadecva(. N+ s+rv!ne as+%area +ne!
    !den(!(7=! a"(erna(!ve.
    Co%&or(a%en(+" &er!&a(e(!c Eva$a'onda@+"J &oa(e s+rven!, de ase%enea, :n
    sc!/o.ren!e. Me%or!a &en(r+ even!%en(e"e care a+ av+( "oc :n c+rs+" e&!soade"or
    de va$a'onda@ "a !nd!v!/!! c+ sc!/o.ren!e &oa(e .! d!.!c!" de s(a'!"!( d!n ca+/a
    "!%'a@+"+! de/or$an!/a( a" !nd!v!d+"+!. Ind!v!/!! c+ .+$7 d!soc!a(!v7 n+ &re/!n(7
    :ns7 :n $enera" n!c! o &s!o&a(o"o$!e asoc!a(7 c+ sc!/o.ren!a Ede e<., !de! de"!ran(e,
    s!%&(o%e ne$a(!veJ.
    S(7r!"e de .+$7 s!%+"a(e &o( s+rven! "a !nd!v!/! care :ncearc7 s7 .+$7 de o s!(+a=!e
    !%&"!cAnd d!.!c+"(7=! "e$a"e, .!nanc!are sa+ &ersona"e, ca s! "a so"da=!! care :ncearc7
    s7 ev!(e "+&(a sa+ o'"!$a=!!"e %!"!(are ne&"7c+(e EdeO!, s! .+$a d!soc!a(!v7 ver!(a'!"7
    &oa(e .! asoc!a(7 c+ as(.e" de s(resor!J. S!%+"area s!%&(o%e"or d!soc!a(!ve &oa(e .!
    %en=!n+(7 c!ar :n (!%&+" !n(erv!+r!"or s+' !&no/7 sa+ a" ce"or .ac!"!(a(e de
    'ar'!(+r!ce. :n con(e<( %ed!co4"e$a", e<a%!na(or+" (re'+!e s7 dea :n(o(dea+na
    a(en=!e d!a$nos(!c+"+! de s!%+"are cAnd es(e !nvoca(7 .+$a. Cond+!(a !n.rac=!ona"7
    care es(e '!/ar7 sa+ c+ &+=!n 'ene.!c!+ rea" &oa(e .! %a! co%&a(!'!"7 c+ o &er(+r'are
    d!soc!a(!v7 ver!(a'!"7.
    <C= Tulburrile Disociative
    Criteriile $e $ia/no&ti# pentru 4++.*4 'u/a Di&o#iativ(
    A2 #erturbarea predominant o constituie o cltorie inopinat departe de cas
    sau de locul u(ual de munc, cu incapacitatea de a reaminti propriul trecut2
    S2 on$u(ie re$eritoare la identitatea personal sau asumarea unei noi
    identiti &parial sau complet)2
    2 #erturbarea nu survine exclusiv "n cursul tulburrii de identitate disociativ
    ,i nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane &de ex2, un
    dro! de abu(, un medicament) sau ale unei condiii medicale !enerale &de
    ex2, epilepsia de lob temporal)2
    D2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    4++.*7 Tul-urarea $e I$entitate Di&o#iativ(
    (anterior Tul-urarea $e Per&onalitate Multipl(6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de !den(!(a(e d!soc!a(!v7 :" cons(!(+!e &re/en=a a
    do+7 sa+ %a! %+"(e s(7r! de &ersona"!(a(e sa+ !den(!(7=! d!s(!nc(e Ecr!(er!+" AJ care
    !a+ :n %od rec+ren( con(ro"+" co%&or(a%en(+"+! Ecr!(er!+" BJ. E<!s(7 o !nca&ac!(a(e
    de a evoca !n.or%a=!! &ersona"e !%&or(an(e a c7re! :n(!ndere es(e &rea %are &en(r+
    a .! e<&"!ca(7 &r!n +!(area co%+n7 Ecr!(er!+" CJ. Per(+r'area n+ se da(orea/7
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ a"e +ne! cond!=!! %ed!ca"e
    $enera"e Ecr!(er!+" DJ. La co&!!, s!%&(o%e"e n+ &o( .! a(r!'+!(e +nor co%&an!on! de
    @oc !%a$!nar! sa+ a"(+! @oc a" .an(e/!e!.
    T+"'+rarea de !den(!(a(e d!soc!a(!v7 re."ec(7 !nca&ac!(a(ea de a !n(e$ra d!verse"e
    as&ec(e a"e !den(!(7=!!, %e%or!e! s! conO(!!n=e!. F!ecare s(are de &ersona"!(a(e &oa(e .!
    e<&er!en(a(7 ca O! c+% aceas(a ar avea o !s(or!e &ersona"7, o !%a$!ne de s!ne s!
    !den(!(a(e d!s(!nc(7, !nc"+s!v +n n+%e se&ara(. De re$+"7 e<!s(7 o !den(!(a(e &r!%ar7
    care &oar(7 n+%e"e da( !nd!v!d+"+! O! care es(e &as!v7, de&enden(7, c+"&a'!"7 s!
    de&res!v7. Iden(!(7=!"e a"(erna(!ve a+ .recven( n+%e O! carac(er!s(!c! care con(ras(ea/7
    c+ !den(!(a(ea &r!%ar7 Ede e<., s+n( os(!"e, con(ro"an(e s! a+(od!s(r+c(!veJ. Iden(!(7=!"e
    &ar(!c+"are &o( a&are :n an+%!(e c!rc+%s(an=e s! &o( .! d!.er!(e d!n &+nc( de vedere
    a" e(7=!! s! se<+"+! re"a(a(, a" voca'+"ar+"+!, c+noO(!n=e"or $enera"e sa+ a.ec(+"+!
    &redo%!nan(. Iden(!(7=!"e a"(erna(!ve s+n( e<&er!en(a(e ca "+And con(ro"+" s+cces!v,
    +na c+ sacr!.!carea a"(e!a, O! &o( ne$a c7 se c+nosc +na &e a"(a, &o( .! cr!(!ce +na c+
    a"(a sa+ &ar a .! :n con."!c( desc!s. Oca/!ona", +na sa+ %a! %+"(e &ersona"!(7=!
    &+(ern!ce re&ar(!/ea/7 (!%& ce"or"a"(e. Iden(!(7=!"e a$res!ve sa+ os(!"e &o( :n(rer+&e
    +neor! ac(!v!(7=!"e sa+ "oc+" ce"or"a"(e :n s!(+a=!! de"!ca(e.
    Ind!v!/!! c+ aceas(7 (+"'+rare &re/!n(7 .recven( "ac+ne %nes(!ce &en(r+ !s(or!a
    &ersona"7, a(A( :nde&7r(a(7, cA( s! recen(7. A%ne/!a es(e .recven( as!%e(r!c7.
    Iden(!(7=!"e %a! &as!ve (!nd s7 a!'7 %e%or!! %a! red+se, &e cAnd !den(!(7=!"e %a!
    os(!"e, %a! con(ro"an(e sa+ S&ro(ec(oareT a+ %e%or!! %a! co%&"e(e. O !den(!(a(e care
    4552EH Tulburarea de Identitate Disociativ
    &anterior Tulburarea de #ersonalitate
    Multipl)
    528

    n+ es(e :n con(ro" &oa(e avea (o(+O! acces :n conO(!!n=7 &r!n &rod+cerea de a"+c!na=!!
    a+d!(!ve sa+ v!/+a"e Ede e<., voc! care da+ !ns(r+c=!+n!J. Pro'a a%ne/!e! &oa(e .!
    .7c+(7 &r!n re"a(7r! d!n &ar(ea a"(ora care a+ .os( %ar(or! a! co%&or(a%en(+"+! ne$a(
    de !nd!v!d sa+ &r!n &ro&r!!"e desco&er!r! Ede e<., desco&er!rea acas7 a +nor ar(!co"e
    de :%'r7c7%!n(e &e care n+4s! a%!n(eO(e s7 "e .! c+%&7ra(J. Poa(e e<!s(a o &!erdere a
    %e%or!e! n+ n+%a! &en(r+ &er!oade rec+ren(e de (!%&, O!, de ase%enea, o &!erdere
    $"o'a"7 a %e%or!e! '!o$ra.!ce &en(r+ o &er!oad7 :n(!ns7 d!n co&!"7r!e. Tran/!=!!"e
    d!n(re !den(!(7=! s+n( dec"anOa(e adesea de s(res+" &s!osoc!a". T!%&+" necesar
    co%+(7r!! de "a o !den(!(a(e "a a"(a es(e de re$+"7 de ord!n+" sec+nde"or, dar, %a! rar,
    &oa(e .! O! $rad+a"7. Co%&or(a%en(+" asoc!a( .recven( c+ co%+(7r!"e de !den(!(a(e
    !nc"+de c"!&!(+" ra&!d, sc!%'7r!"e .e=!!, %od!.!c7r!"e voc!! sa+ co%&or(a%en(+"+!,
    sa+ :n(rer+&erea (ren+"+! de !de! a" !nd!v!d+"+!. N+%7r+" de !den(!(7=! ra&or(a(e
    %er$e de "a do+7 "a %a! %+"( de o s+(7. *+%7(a(e d!n(re ca/+r!"e ra&or(a(e !nc"+d
    !nd!v!/! c+ /ece sa+ %a! &+=!ne !den(!(7=!.
    *lemente ,i tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Ind!v!/!! c+ (+"'+rare de
    !den(!(a(e d!soc!a(!v7 re"a(ea/7 .recven( c7 a+ .os( s+&+O! +n+! a'+/ .!/!c O! se<+a"
    sever, :n s&ec!a" :n co&!"7r!e. Ac+ra(e=ea +nor as(.e" de re"a(7r! es(e s+'!ec( de
    con(rovers7, deoarece a%!n(!r!"e co&!"7r!e! &o( .! d!s(ors!ona(e, !ar !nd!v!/!! c+
    aceas(7 (+"'+rare (!nd s7 .!e e<(re% de !&no(!/a'!"! s! de v+"nera'!"! "a !n."+en=e"e
    s+$es(!ve. Re"a(area de c7(re !nd!v!/!! c+ (+"'+rare de !den(!(a(e d!soc!a(!v7 a +n+!
    !s(or!c de a'+/ .!/!c sa+ se<+a" es(e adesea con.!r%a(7 de da(e o'!ec(!ve. Pe de a"(7
    &ar(e, &ersoane"e res&onsa'!"e de ac(e de a'+/ .!/!c O! se<+a" &o( .! :nc"!na(e s7 ne$e
    sa+ s74O! d!s(ors!one/e co%&or(a%en(+". Ind!v!/!! c+ (+"'+rare de !den(!(a(e
    d!soc!a(!v7 &o( &re/en(a s!%&(o%e &os((ra+%a(!ce Ede e<., coO%ar+r!, ."as'ac)4+r!
    s! r7s&+ns+r! de (res7r!reJ sa+ s(res &os(4(ra+%a(!c. Poa(e s+rven! a+(o%+(!"area sa+
    +n co%&or(a%en( s+!c!dar O! a$res!v. Un!! !nd!v!/! &o( avea +n &a((ern re&e(!(!v de
    re"a=!! !%&"!cAnd a'+/+" .!/!c s! se<+a". An+%!(e !den(!(7=! &o( e<&er!en=a s!%&(o%e
    de convers!e Ede e<., &se+doconv+"s!!J sa+ a+ ca&ac!(7=! !nso"!(e de a con(ro"a
    d+rerea sa+ a"(e s!%&(o%e so%a(!ce. Ind!v!/!! c+ aceas(7 (+"'+rare &o( avea, de
    ase%enea, s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e
    !n "e$7(+r7 c+ o s+'s(an=7, (+"'+r7r!"e se<+a"e, de co%&or(a%en( a"!%en(ar sa+ de
    so%n. Co%&or(a%en(+" a+(o%+(!"an(, !%&+"s!v!(a(ea O! sc!%'7r!"e 'r+O(e O!
    !n(ense :n re"a=!! &o( @+s(!.!ca +n d!a$nos(!c conco%!(en( de (+"'+rare de
    &ersona"!(a(e 'order"!ne.
    Da(e de "a'ora(or asoc!a(e. Ind!v!/!! c+ (+"'+rare de !den(!(a(e d!soc!a(!v7
    &re/!n(7 +n scor s&re ca&7(+" s+&er!or a" d!s(r!'+=!e! "a %7s+r7r!"e !&no(!/a'!"!(7=!!
    YT. ca&ac!(7=!! d!soc!a(!ve. E<!s(7 re"a(7r! des&re var!a=!! :n .+nc=!onarea .!/!o"o$!c7 &e
    c
    ec=!+ne (ransversa"7 &r!n d!verse"e s(7r! de !den(!(a(e Ede e<., d!.eren=e :n ac+!(a(ea
    4. ./+a"7, (o"eran=a "a d+rere, s!%&(o%e"e de as(%, sens!'!"!(a(ea "a a"er$en! s! :n
    r7s&+ns+" $"+co/e! san$+!ne "a !ns+"!naJ.
    Da(e"e e<a%!n7r!! so%a(!ce s! cond!=!!"e %ed!ca"e asoc!a(e. Po( e<!s(a c!ca(r!c!
    /+&7 "e/!+n!"e a+(o&rovoca(e sa+ a'+/+" .!/!c. Ind!v!/!! c+ aceas(7 (+"'+rare &o(
    a4, ea %!$ren7 O! a"(e (!&+r! de ce.a"ee, s!ndro%+" co"on+"+! !r!(a'!" s! as(%.
    52= Tulburrile Disociative
    *lemente speci$ice culturii, etii si sexului
    T+"'+rarea de !den(!(a(e d!soc!a(!v7 a .os( cons(a(a(7 "a !nd!v!/! d!n d!verse
    c+"(+r! a"e "+%!!.. La co&!!! &reado"escen=!, se !%&+ne o a(en=!e s&ec!a"7 :n s(a'!"!rea
    d!a$nos(!c+"+!, deoarece %an!.es(7r!"e &o( .! %a! &+=!n d!s(!nc(!ve decA( "a
    ado"escen=! O! ad+"=!. T+"'+rarea de !den(!(a(e d!soc!a(!v7 es(e d!a$nos(!ca(7 de (re!
    &An7 "a no+7 or! %a! .recven( "a .e%e!"e ad+"(e decA( "a '7r'a=!! ad+"=!8 :n co&!"7r!e,
    ra&or(+" .e%e!X'7r'a=! &oa(e .! c!ar %a! r!d!ca(, dar da(e"e s+n( "!%!(a(e. Fe%e!"e
    (!nd a avea %a! %+"(e !den(!(7=! decA( '7r'a=!!, :n @+r de 5Y sa+ c!ar %a! %+"(e, &e
    cAnd '7r'a=!! a+ :n %ed!e a&ro<!%a(!v G !den(!(7=!.
    #revalent
    CreO(erea ac+(7 a ca/+r!"or de (+"'+rare de !den(!(a(e d!soc!a(!v7 ra&or(a(e :n
    S(a(e"e Un!(e :n +"(!%!! an! a .os( s+'!ec(+" a d!verse !n(er&re(7r!. Un!! cred c7 o %a!
    '+n7 c+noaO(ere a d!a$nos(!c+"+! de c7(re s&ec!a"!O(!! :n s7n7(a(e %en(a"7 a d+s "a
    !den(!.!carea ca/+r!"or ned!a$nos(!ca(e an(er!or. D!n con(ra, a"=!! cred c7 s!ndro%+"
    a .os( s+&rad!a$nos(!ca( "a !nd!v!/!! e<(re% de s+$es(!ona'!"!.
    *voluie
    T+"'+rarea de !den(!(a(e d!soc!a(!v7 &are a avea o evo"+=!e c"!n!c7 ."+c(+an(7,
    care (!nde s7 .!e cron!c7 O! rec+ren(7. Per!oada %ed!e de (!%& de "a &re/en(area
    &r!%+"+! s!%&(o% O! &An7 "a d!a$nos(!c es(e de R4H an!. A+ .os( descr!se, a(A(
    evo"+=!! e&!sod!ce, cA( s! con(!n+e. T+"'+rarea &oa(e deven! %a! &+=!n %an!.es(7
    d+&7 e(a(ea de YL de an!, dar &oa(e rea&are :n c+rs+" e&!soade"or de s(res sa+
    (ra+%e, or! de a'+/ de o s+'s(an=7.
    #attern $amilial
    Ma! %+"(e s(+d!! s+$erea/7 c7 (+"'+rarea de !den(!(a(e d!soc!a(!v7 es(e %a!
    .recven(7 &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e &ersoane"or c+ (+"'+rarea decA( :n
    &o&+"a=!a $enera"7.
    Dia!nostic di$erenial
    T+"'+rarea de !den(!(a(e d!soc!a(!v7 (re'+!e s7 .!e d!s(!ns7 de s!%&(o%e"e care
    s+n( ca+/a(e de e.ec(e"e .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e
    Ede e<., cr!/a e&!"e&(!c7J Eve/! &a$. 5G5J. Aceas(7 d!s(!nc=!e se 'a/ea/7 &e !s(or!c,
    da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c. T+"'+rarea de !den(!(a(e d!soc!a(!v7
    (re'+!e s7 .!e d!s(!ns7 de s!%&(o%e"e d!soc!a(!ve da(ora(e cr!/e"or &ar=!a"e
    co%&"e<e, :ns7 ce"e do+7 (+"'+r7r! &o( a&are s! conco%!(en(. E&!soade"e cr!(!ce
    s+n( :n $enera" sc+r(e E;L de sec+nde &An7 "a Y %!n+(eJ O! n+ !%&"!c7 s(r+c(+r!"e
    co%&"e<e O! d+ra'!"e de !den(!(a(e O! co%&or(a%en( :n(A"n!(e de re$+"7 :n
    (+"'+rarea de !den(!(a(e d!soc!a(!v7. De ase%enea, +n !s(or!c de %a"(ra(are .!/!c7 s!
    se<+a"7 es(e %a! &+=!n .recven( "a !nd!v!/!! c+ cr!/e &ar=!a"e co%&"e<e. S(+d!!"e
    EE,, :n s&ec!a" :n de&r!varea de so%n O! c+ e"ec(ro/! na/o.ar!n$!en!, &o( a@+(a "a
    c"ar!.!carea d!a$nos(!c+"+! d!.eren=!a".
    S!%&(o%e"e ca+/a(e de e.ec(e"e .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e &o( .!
    d!s(!nse de (+"'+rarea de !den(!(a(e d!soc!a(!v7 &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n
    4552EH Tulburarea de Identitate Disociativ
    &anterior Tulburarea de #ersonalitate
    Multipl)
    Y9F
    dro$ de a'+/ sa+ +n %ed!ca%en(J es(e cons!dera(7 a .! e(!o"o$!c :n re"a=!e c+
    &er(+r'area Eve/! &a$. 9LFJ.
    D!a$nos(!c+" de (+"'+rare de !den(!(a(e d!soc!a(!v7 are &receden( as+&ra
    a%ne/!e! d!soc!a(!ve, .+$!! d!soc!a(!ve s! (+"'+r7r!! de de&ersona"!/are. Ind!v!/!!
    c+ (+"'+rare de !den(!(a(e d!soc!a(!v7 &o( .! d!s(!nO! de ce! c+ s!%&(o%e de (rans7 s!
    de (rans7 c+ &oses!+ne, care (re'+!e s7 .!e d!a$nos(!ca(e ca (+"'+rare d!soc!a(!v7
    .7r7 a"(7 s&ec!.!ca=!e, &r!n .a&(+" c7 ce! c+ s!%&(o%e de (rans7 s! (rans7 c+
    &oses!+ne descr!+ de re$+"7 s&!r!(e sa+ en(!(7=! e<(erne care a+ !n(ra( :n cor&+" "or
    O! a+ "+a( con(ro"+".
    D!a$nos(!c+" d!.eren=!a" d!n(re (+"'+rarea de !den(!(a(e d!soc!a(!v7 O! o var!e(a(e
    de a"(e (+"'+r7r! %en(a"e E!nc"+/And sc!/o.ren!a O! a"(e (+"'+r7r! &s!o(!ce,
    (+"'+rarea '!&o"ar7 c+ c!c"are ra&!d7, (+"'+r7r!"e an<!oase, (+"'+r7r!"e de
    so%a(!/are O! (+"'+r7r!"e de &ersona"!(a(eJ es(e co%&"!ca( de s+&ra&+nerea ev!den(7
    a s!%&(o%e"or (a'"o+r!"or c"!n!ce. De e<e%&"+, &re/en=a a %a! %+"( decA( a +ne!
    s!n$+re s(7r! de &ersona"!(a(e d!soc!a(7 &oa(e .! :n %od erona( "+a(7 dre&( !dee
    de"!ran(7 sa+ co%+n!carea d!n(re o !den(!(a(e O! a"(a &oa(e .! "+a(7 :n %od erona(
    dre&( a"+c!na=!e a+d!(!v7 s! d+ce as(.e" "a con.+/!e c+ (+"'+r7r!"e &s!o(!ce, !ar
    co%+(7r!"e d!n(re s(7r!"e de !den(!(a(e &o( .! con.+nda(e c+ ."+c(+a=!!"e de d!s&o/!=!e
    c!c"!ce O! d+ce as(.e" "a con.+/!e c+ (+"'+rarea '!&o"ar7J. Fac(or!! care &o( s+s=!ne
    d!a$nos(!c+" de (+"'+rare de !den(!(a(e d!soc!a(!v7 s+n( &re/en=a +ne!
    s!%&(o%a(o"o$!! ne( d!soc!a(!ve c+ co%+(7r! ra&!de :n s(7r! de !den(!(a(e,
    &ers!s(en=a O! cons!s(en=a co%&or(a%en(e"or O! cond+!(e"or s&ec!.!ce !den(!(7=!! :n
    (!%&, a%ne/!a revers!'!"7, &ro'a co%&or(a%en(+"+! d!soc!a(!v care &recede
    &re/en(area %ed!co"e$a"7 sa+ c"!n!c7 Ede e<., re"a(7r!"e .a%!"!e! sa+ co"a'ora(or!"orJ,
    scor+r!"e :na"(e "a %7s+r7r!"e d!soc!er!! s! !&no(!/a'!"!(7=!! "a !nd!v!/!! care n+ a+
    (a'"o+r! c"!n!ce carac(er!s(!ce a"(e! (+"'+r7r! %en(a"e.
    T+"'+rarea de !den(!(a(e d!soc!a(!v7 (re'+!e s7 .!e d!s(!ns7 de s!%+"are, :n
    s!(+a=!!"e :n care &oa(e e<!s(a +n 'ene.!c!+ .!nanc!ar sa+ %ed!co"e$a", O! de
    (+"'+rarea .ac(!ce, :n care &oa(e e<!s(a +n &a((ern de co%&or(a%en( de c7+(are
    a a@+(or+"+!.
    Criteriile $e $ia/no&ti# pentru
    4++.*7 Tul-urarea $e I$entitate Di&o#iativ(
    A2 #re(ena a dou sau mai multe stri de personalitate sau identiti distincte
    &$iecare cu propriul su pattern durabil de percepere, relaionare cu, ,i
    !@ndire despre ambian ,i sine)2
    S2 el puin dou dintre aceste stri de personalitate sau identiti iau "n mod
    recurent controlul comportamentului persoanei2
    Incapacitatea de a evoca in$ormaii personale importante, care este prea
    extins pentru a putea $i explicat prin uitarea comun2
    D2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, unui blacCouts sau comportament %aotic, "n cursul intoxicaiei
    alcoolice) sau ale unei condiii medicale !enerale &de ex2, unei cri(e pariale
    complexe)2 FotD La copii, simptomele nu sunt atribuibile unor companioni
    de 0oc ima!inari sau altui 0oc $ante(ist2
    <4+ Tulburrile Disociative
    4++.= Tul-urarea $e Deper&onali)are
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de de&ersona"!/are :" cons(!(+!e e&!soade"e
    &ers!s(en(e sa+ rec+ren(e de de&ersona"!/are carac(er!/a(e &r!n(r4+n sen(!%en( de
    de(aOare sa+ de :ns(r7!nare de s!ne Ecr!(er!+" AJ. Ind!v!d+" se &oa(e s!%=! ca +n
    a+(o%a( sa+, ca s! c+% ar v!sa or! ar @+ca :n(r4+n .!"%. Poa(e e<!s(a o sen/a=!e de
    o'serva(or e<(ern a" &ro&r!!"or &rocese %en(a"e, a" &ro&r!+"+! cor& sa+ a" +nor
    &7r=! a"e &ro&r!+"+! cor&. Adesea s+n( &re/en(e d!verse (!&+r! de anes(e/!e
    sen/or!a"7, de "!&s7 de r7s&+ns a.ec(!v s! de "!&s7 de con(ro" a &ro&r!!"or ac=!+n!,
    !nc"+s!v a vor'!r!!. Ind!v!d+" c+ (+"'+rare de de&ersona"!/are %en=!ne !n(ac(7
    (es(area rea"!(7=!! Ead!c7, rea"!/ea/7 c7 es(e n+%a! o sen/a=!e s! c7 e" n+ es(e :n
    re"!(a(e +n ro'o(J Ecr!(er!+" BJ. De&ersona"!/area es(e o e<&er!en=7 co%+n7, s! aces(
    d!a$nos(!c (re'+!e s7 .!e &+s n+%a! dac7 s!%&(o%e"e s+n( s+.!c!en( de severe
    &en(r+ a ca+/a o de(res7 sa+ de(er!orare %arca(7 :n .+nc=!onare Ecr!(er!+" CJ.
    Pen(r+ c7 de&ersona"!/area es(e +n e"e%en( asoc!a( co%+n a" %+"(or a"(e (+"'+r7r!
    %en(a"e, +n d!a$nos(!c se&ara( de (+"'+rare de de&ersona"!/are n+ es(e &+s dac7
    e<&er!en=a s+rv!ne e<c"+s!v :n c+rs+" a"(e! (+"'+r7r! %en(a"e Ede e<., sc!/o.ren!a,
    &an!ca, s(res+" ac+( sa+ a"(7 (+"'+rare d!soc!a(!v7J, :n a.ar7 de aceas(a, &er(+r'area
    n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ecr!(er!+" DJ.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Adesea !nd!v!/!! c+
    (+"'+rare de de&ersona"!/are &o( avea d!.!c+"(7=! :n a4O! descr!e s!%&(o%e"e s! se
    &o( (e%e c7 aces(e e<&er!en=e :nsea%n7 c7 e! s+n( Sne'+n!T. Derea"!/area &oa(e .!,
    de ase%enea, &re/en(7 s! es(e e<&er!en(a(7 ca sen(!%en(+" c7 "+%ea e<(ern7 es(e
    s(ran!e sa+ !rea"7. Ind!v!d+" &oa(e &erce&e o a"(erare s(ran!e :n d!%ens!+nea sa+
    .or%a o'!ec(e"or E%acro&s!e sa+ %!cro&s!eJ, !ar oa%en!! &o( &are non.a%!"!ar! sa+
    %ecan!c!. A"(e e"e%en(e asoc!a(e co%+ne !nc"+d s!%&(o%e an<!oase, s!%&(o%e
    de&res!ve, r+%!na=!a o'ses!v7, &reoc+&7r! so%a(!ce s! o &er(+r'are a
    sen(!%en(+"+! &ro&r!+ a" (!%&+"+!. H!&ocondr!a, (+"'+rarea de&res!v7 %a@or7 sa+
    d!s(!%!a, (+"'+r7r!"e an<!oase, (+"'+r7r!"e de &ersona"!(a(e Ece" %a! .recven(
    ev!(an(7, 'order"!ne s! o'ses!vo4co%&+"s!v7 J O! (+"'+r7r!"e :n "e$7(+r7 c+ o
    s+'s(an=7 &o( coe<!s(a, de ase%enea, c+ (+"'+rarea de de&ersona"!/are.
    De&ersona"!/area O! derea"!/area s+n( s!%&(o%e .oar(e .recven(e a"e a(ac+r!"or de
    &an!c7 O! s+n( %a! .recven(e cAnd s!%&(o%e"e an<!oase +r%ea/7 +n+! s(resor
    (ra+%a(!c, ca :n s(res+" &os((ra+%a(!c. Un d!a$nos(!c se&ara( de (+"'+rare de
    de&ersona"!/are n+ (re'+!e &+s cAnd de&ersona"!/area O! derea"!/area s+rv!n
    e<c"+s!v :n c+rs+" +nor as(.e" de a(ac+r!.
    9ate de laborator asociate. Ind!v!/!! c+ (+"'+rare de de&ersona"!/are &o(
    &re/en(a o !&no(!/a'!"!(a(e %are s! o ca&ac!(a(e d!soc!a(!v7 cresc+(7 "a %7s+r7(or!"e
    &r!n (es(e s(andard!/a(e.
    4552I Tulburarea de
    Depersonali(are
    <4*

    *lemente speci$ice culturii
    E<&er!en=e"e de de&ersona"!/are sa+ de derea"!/are !nd+se vo"+n(ar .ac &ar(e
    d!n &rac(!c!"e %ed!(a(!ve s! de (rans7 care s+n( &reva"en(e :n %+"(e re"!$!! s! c+"(+r!,
    s! n+ (re'+!e s7 .!e con.+nda(e c+ (+"'+rarea de de&ersona"!/are :n esan(!oane"e
    c"!n!ce, aceas(7 (+"'+rare es(e d!a$nos(!ca(7 de ce" &+=!n do+7 or! %a! .recven( "a
    .e%e! decA( "a '7r'a=!
    #revalent
    Preva"en(a &e v!a=7 a (+"'+r7r!! de de&ersona"!/are :n co%+n!(a(e s! :n cond!=!!
    c"!n!ce es(e nec+nosc+(7. La +n %o%en( da( :n c+rs+" v!e=!! "or, a&ro<!%a(!v
    @+%7(a(e d!n (o=! ad+"=!! a+ e<&er!en(a( +n s!n$+r e&!sod sc+r( de de&ersona"!/are,
    &rec!&!(a( de re$+"7 de +n s(res sever. O e<&er!en=7 de de&ersona"!/are (ran/!(or!e
    a&are "a a&roa&e o (re!%e d!n(re !nd!v!/!! e<&+O! +n+! &er!co" v!(a" s! "a a&roa&e ILd
    d!n(re &ac!en=!! s&!(a"!/a=! &en(r+ (+"'+r7r! %en(a"e
    *voluie
    Ind!v!/!! c+ (+"'+rare de de&ersona"!/are se &re/!n(7 de re$+"7 &en(r+ (ra(a%en(
    :n ado"escen=7 sa+ :n &er!oada ad+"(7, :ns7 (+"'+rarea &oa(e avea +n de'+(
    nede(ec(a( :n co&!"7r!e E(a(ea %ed!e "a de'+( a .os( ra&or(a(7 ca .+nd :n @+r+" e(7=!!
    de 5R a% Deoarece de&ersona"!/area es(e rar ac+/a &re/en(a(7, !nd!v!/!! c+
    (+"'+rare de de&ersona"!/are rec+ren(7 se &re/!n(7 adesea c+ a"(e s!%&(o%e, c+% ar
    .! an<!e(a(ea, &an!ca sa+ de&res!a D+ra(a e&!soade"or de de&ersona"!/are &oa(e
    var!a de "a .oar(e sc+r(7 EcA(eva sec+ndeJ "a &ers!s(en(7 Ean!J. De&ersona"!/area
    consec+(!v7 s!(+a=!!"or care a%en!n=7 v!a=a Ede e< , "+&(a, acc!den(e (ra+%a(!/an(e, a
    .! v!c(!%a +n+! a(ac c+ v!o"en=7J a&are de re$+"7 'r+sc "a e<&+nerea "a (ra+%7, !ar
    !s(or!ce"e de (ra+%7 s+n( asoc!a(e adesea c+ aceas(7 (+"'+rare Evo"+=!a es(e de
    re$+"7 cron!c7 s! &oa(e cres(e sa+ d!%!n+a ca !n(ens!(a(e, dar &oa(e +neor! .! s!
    e&!sod!c7 Ce" %a! adesea e<acer'7r!"e s+rv!n :n asoc!ere c+ even!%en(e s(resan(e
    rea"e sa+ &erce&+(e Eca a(areJ
    Dia!nostic di$erenial
    T+"'+rarea de de&ersona"!/are (re'+!e s7 .!e d!s(!ns7 de s!%&(o%e"e care s+n(
    da(ora(e consec!n=e"or .!/!o"o$!ce a"e +ne! cond!=!! %ed!ca"e $enera"e s&ec!.!ce
    Ede e<., e&!"e&s!e!J Eve/! &a$. 5G5J Aceas(7 d!.eren=!ere se ba;ea;6 &e !s(or!c, da(e"e
    de "a'ora(or sa+ e<a%en+" so%a(!c. De&ersona"!/area ca+/a(7 de e.ec(e"e
    .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e se d!s(!n$e de (+"'+rarea de de&ersona"!/are
    &r!n .a&(+" c7 o s+'s(an=7 Ede e<, +n dro$ de a'+/, +n %ed!ca%en(J es(e
    cons!dera(7 a .! :n re"a=!e e(!o"o$!c7 c+ de&ersona"!/area Eve/! &a$. 9LFJ In(o<!ca=!a
    sa+ a's(!nen=a ac+(7 de a"coo" s! de o d!vers!(a(e de a"(e s+'s(an=e &oa(e d+ce "a
    de&ersona"!/are. Pe de a"(7 &ar(e, +/+" de o s+'s(an=7 &oa(e !n(ens!.!ca s!%&(o%e"e
    +ne! (+"'+r7r! de de&ersona"!/are &ree<!s(en(e Dec!, +n d!a$nos(!c corec( de
    (+"'+rare de de&ersona"!/are, "a !nd!v!/!! c+ +n !s(or!c de de&ersona"!/are !nd+s7 de
    a"coo" sa+ de o a"(7 s+'s(an=7, (re'+!e s7 !nc"+d7 +n !s(or!c "on$!(+d!na" de a'+/ de
    o s+'s(an=7 s! s!%&(o%e de de&ersona"!/are.
    T+"'+rarea de de&ersona"!/are n+ (re'+!e s7 .!e d!a$nos(!ca(7 se&ara( cAnd
    s!%&(o%e"e s+rv!n n+%a! :n c+rs+" +n+! a(ac de &an!c7, aces(a .+nd &ar(e a &an!c!!,
    A47 Tulburrile Disociative
    .o'!e! soc!a"e sa+ s&ec!.!ce, s(res+"+! &os((ra+%a(!c sa+ s(res+"+! ac+(. :n con(ras(
    c+ sc!/o.ren!a, :n (+"'+rarea de de&ersona"!/are es(e %en=!n+(7 !n(ac(7 (es(area
    rea"!(7=!!. Sen(!%en(+" de anes(e/!e asoc!a( c+ de&ersona"!/area &oa(e %!%a o
    de&res!e. Sen(!%en(e"e de anes(e/!e "a !nd!v!/!! c+ (+"'+rare de de&ersona"!/are
    s+n( asoc!a(e :ns7 c+ a"(e %an!.es(7r! de de&ersona"!/are Ede e<., c+ sen(!%en(+" de
    de(aOare de s!ne :ns+O!J s! s+rv!n c!ar cAnd !nd!v!d+" n+ es(e de&res!v.
    Criteriile $e $ia/no&ti# pentru 4++.=
    Tul-urarea $e Deper&onali)are
    A2 *xperientri recurente ,i persistente ale sentimentului de deta,are de, ,i de
    ca si cum subiectul este un observator extern al propriilor procese mentale
    sau al propriului corp &de ex2, sentimentul subiectului c visea( )2
    S2 "n timpul experienelor de depersonali(are, testarea realitii rm@ne intact2
    2 Depersonali(area cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    D2 *xperiena de depersonali(are nu survine exclusiv "n cursul altei tulburri
    mentale, cum ar $i sc%i(o$renia, panica, stresul acut ori alt tulburare
    disociativ si nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau unei condiii medicale
    !enerale &de ex2, epilepsiei de lob temporal)2
    4++.*< Tul-urarea Di&o#iativ(
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e !nc"+s7 &en(r+ (+"'+r7r!"e :n care e"e%en(+" &redo%!nan(
    es(e +n s!%&(o% d!soc!a(!v Ead!c7, o r+&(+r7 :n .+nc=!!"e de re$+"7 !n(e$ra(e a"e
    conO(!!n=e!, %e%or!e!, !den(!(7=!! sa+ &erce&er!! a%'!an=e!J, care n+ sa(!s.ac cr!(er!!"e
    &en(r+ n!c! o (+"'+rare d!soc!a(!v7 s&ec!.!c7. E<e%&"e"e !nc"+dQ
    1. Ta'"o+r! c"!n!ce s!%!"are (+"'+r7r!! de !den(!(a(e d!soc!a(!v7, dar care n+ sa(!s.ac
    co%&"e( cr!(er!!"e &en(r+ aceas(7 (+"'+rare. E<e%&"e"e !nc"+d (a'"o+r!"e c"!n!ce :n
    care aJ n+ e<!s(7 do+7 sa+ %a! %+"(e s(7r! de &ersona"!(a(e d!s(!nc(7 or! 'J n+
    a&are a%ne/!a &en(r+ !n.or%a=!!"e &ersona"e !%&or(an(e.
    2. Derea"!/area ne:nso=!(7 de de&ersona"!/are "a ad+"=!.
    3. S(7r!"e de d!soc!ere care a&ar "a !nd!v!/!! care a+ .os( s+&+O! +nor &er!oade de
    &ers+as!+ne coerc!(!v7 &re"+n$!(7 s! !n(ens7 Ede e<., s&7"area cre!er+"+!,
    re.or%area $And!r!! sa+ :ndoc(r!narea :n (!%&+" ca&(!v!(7=!!J.
    4. Transa d!soc!a(!v7Q &er(+r'7r! +n!ce sa+ e&!sod!ce :n s(area de conO(!!n=7,
    !den(!(a(e sa+ %e%or!e, care s+n( &ro&r!! an+%!(or "oc+r! s! c+"(+r!. Transa
    d!soc!a(!v7 !%&"!c74 :n$+s(area conO(!!n=e! a%'!an=e! !%ed!a(e sa+
    co%&or(a%en(e or! %!Oc7r! s(ereo(!&e care s+n( e<&er!en(a(e ca .!!nd deas+&ra
    &ro&r!+"+! con(ro". Transa c+ &oses!+ne !%&"!c7 :n"oc+!rea sen(!%en(+"+! +/+a"
    a" !den(!(7=!! &ersona"e c+ o no+7 !den(!(a(e, a(r!'+!(7 !n."+en=e! +n+! s&!r!(,
    &+(er!, /e!(7=! sa+ a"(e! &ersoane s! es(e asoc!a(7 c+ %!Oc7r! S!nvo"+n(areT
    $
    4552EA Tulburarea Disociativ 'r Alt Speci$icaie
    <44
    s(ereo(!&e sa+ c+ a%ne/!e8 es(e cea %a! .recven(7 (+"'+rare d!soc!a(!v7 :n As!a.
    E<e%&"e"e !nc"+d amo8 EIndone/!aJ, bebainan EIndone/!aJ, lata- EMa"a!e/!aJ,
    piblo8to: E/ona arc(!c7J, ata:+e de ner*ios EA%er!ca La(!n7J s! &oses!+nea EInd!aJ.
    T+"'+rarea d!soc!a(!v7 sa+ (ransa n+ es(e o &ar(e nor%a"7 a +ne! &rac(!c!
    re"!$!oase sa+ c+"(+ra"e co"ec(!ve "ar$ acce&(a(e. E3e/! &a$. HGY &en(r+ cr!(er!!"e
    de cerce(are s+$era(eJ.
    5. P!erderea c+nos(!!n=e!, s(+&or+" sa+ co%a nona(r!'+!'!"e +ne! cond!=!! %ed!ca"e
    $enera"e.
    6. S!ndro%+" ,anserQ da(+" de r7s&+ns+r! a"7(+r! "a :n(re'7r! Ede e<., S9 &"+s 9 .ac
    YTJ, cAnd n+ es(e asoc!a( c+ a%ne/!a d!soc!a(!v7 sa+ c+ .+$a d!soc!a(!v7.
    nC
    H
    Tulburrile Sexuale si
    de Identitate Sexual
    mPQmce
    ceas(a sec=!+ne con=!ne d!s.+nc=!!"e se<+a"e, &ara.!"!!"e s! (+"'+r7r!"e de
    !den(!(a(e se<+a"7. D!s.+nc=!!"e se<+a"e s+n( carac(er!/a(e &r!n &er(+r'area dor!n=e!
    se<+a"e O! %od!.!c7r!"or &s!o.!/!o"o$!ce care carac(er!/ea/7 c!c"+" de r7s&+ns se<+a"
    s! ca+/ea/7 de(res7 O! d!.!c+"(a(e !n(er&ersona"7 %arca(7. D!s.+nc=!!"e se<+a"e !nc"+d
    (+"'+r7r!"e dor!n=e! se<+a"e Ead!c7, dor!n=a se<+a"7 d!%!n+a(7, avers!+nea se<+a"7J,
    (+"'+r7r!"e de e<c!(a=!e se<+a"7 E(+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!!, (+"'+rarea
    de erec=!e a '7r'a(+"+!J, (+"'+r7r!"e or$as%!ce Ead!c7, (+"'+rarea de or$as% a
    .e%e!!, (+"'+rarea de or$as% a '7r'a(+"+!, e@ac+"area &recoceJ, (+"'+r7r!"e se<+a"e
    a"$!ce Ede e<., d!s&are+n!a, va$!n!s%+"J, d!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, d!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7 O! d!s.+nc=!a se<+a"7
    .7r7 a"(7 s&ec!.!ca=!e.
    Para.!"!!"e s+n( carac(er!/a(e &r!n co%&or(a%en(e, .an(e/!! sa+ dor!n=e se<+a"e
    !n(ense, rec+ren(e, care !%&"!c7 o'!ec(e, ac(!v!(7=! sa+ s!(+a=!! !nso"!(e O! ca+;ea;6
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e
    do%en!! !%&or(an(e de .+nc=!onare. Para.!"!!"e !nc"+d e<!'!=!on!s%+", .e(!O!s%+",
    .ro((e+r!s%+", &edo.!"!a, %asoc!s%+" se<+a", sad!s%+" se<+a", .e(!O!s%+"
    (ransves(!c, voye+r!s%+" s! &ara.!"!a .7r7 a"(7 s&ec!.!ca=!e.
    T+"'+r7r!"e de !den(!(a(e se<+a"7 s+n( carac(er!/a(e &r!n(r4o !den(!.!care
    &+(ern!c7 O! &ers!s(en(7 c+ se<+" o&+s, asoc!a(7 c+ d!scon.or( &ers!s(en( re.er!(or "a
    &ro&r!+" se< a(r!'+!(. 5dentitatea sex+al6 se re.er7 "a &erce&erea de s!ne ca '7r'a( sa+
    .e%e!e. Ter%en+" de dis)orie sex+al6 deno(7 sen(!%en(e"e &ers!s(en(e O! &+(ern!ce de
    d!scon.or( a"e c+!va :n "e$7(+r7 c+ se<+" a(r!'+!(, dor!n=a de a &oseda cor&+"
    ce"+!"a"( se< O! dor!n=a de a .! &r!v!( de ce!"a"=!! ca %e%'r+ a" ce"+!"a"( se<. Ter%en!!
    de !den(!(a(e se<+a"7 O! de d!s.or!e se<+a"7 (re'+!e s7 .!e d!s(!nO! de (er%en+" de
    or!en(are se<+a"7 care se re.er7 "a a(rac=!a se<+a"7 &en(r+ '7r'a=!, &en(r+ .e%e! sa+
    &en(r+ a%'e"e se<e.
    T+"'+rare se<+a"7 .7r7 a"(7 s&ec!.!ca=!e es(e !nc"+s7 &en(r+ cod!.!carea
    (+"'+r7r!"or de .+nc=!onare se<+a"7 care n+ s+n( c"as!.!ca'!"e :n n!c! +na d!n(re
    ca(e$or!!"e s&ec!.!ce. Es(e de%n de re=!n+( c7 no=!+n!"e de dev!ere, s(andarde de
    &er.or%an=7 se<+a"7 O! conce&(e"e de ro" cores&+n/7(or se<+"+! &o( var!a de "a
    c+"(+r7 "a c+"(+r7.
    Di&%un#!iile Se,uale
    O d!s.+nc=!e se<+a"7 es(e carac(er!/a(7 &r!n(r4o &er(+r'are :n &roces+" care
    de.!neO(e c!c"+" de r7s&+ns se<+a" sa+ &r!n d+rerea asoc!a(7 c+ ra&or(+" se<+a".
    C!c"+" de r7s&+ns se<+a" &oa(e .! d!v!/a( :n +r%7(oare"e .a/eQ
    A4A
    5+> Tul-ur(rile Se,uale &i $e I$entitate Se,ual(
    1. 0orin(6? Aceas(7 .a/7 cons(7 d!n .an(e/!! :n "e$7(+r7 c+ ac(!v!(a(ea se<+a"7 s!
    dor!n=a de a avea ac(!v!(a(e se<+a"7.
    2. Excita(ie? Aceas(7 .a/7 cons(7 d!n sen/a=!a s+'!ec(!v7 de &"7cere se<+a"7 care
    aco%&an!a/7 %od!.!c7r!"e .!/!o"o$!ce. Mod!.!c7r!"e %a@ore "a '7r'a( cons(a+
    d!n (+%escen=a &en!an7 s! erec=!e. Mod!.!c7r!"e %a@ore "a .e%e!e cons(a+ d!n
    vasocon$es(!a &e"v!s+"+!, "+'r!.!erea s! e<&ans!+nea va$!n+"+! s! (+r$escen=a
    or$ane"or $en!(a"e e<(erne.
    ;. 4r/asm? Fa;a cons(7 :n a(!n$erea c+"%!! &"7cer!! se<+a"e, c+ re"a<area (ens!+n!!
    se<+a"e s! con(rac=!! r!(%!ce a"e %+Oc!"or &er!nea"! s! a"e or$ane"or de
    re&rod+cere. La '7r'a(, e<!s(7 sen/a=!a de !nev!(a'!"!(a(e a e@ac+"7r!! s&er%e!.
    La .e%e!e, e<!s(7 con(rac=!! En+ (o(dea+na e<&er!en(a(e s+'!ec(!v ca a(areJ a"e
    &ere(e"+! (re!%!! e<(erne a va$!n+"+!. La a%'e"e se<e, s.!nc(er+" ana" se
    con(rac(7 r!(%!c.
    I. Re;ol+(ie? Fa;a cons(7 d!n sen/a=!a de re"a<are %+sc+"ar7 s! de '!ne. :n (!%&+"
    aces(e! .a/e, '7r'a=!! s+n( re.rac(ar! "a +r%7(oarea erec=!e s! or$as% o
    &er!oad7 var!a'!"7 de (!%&. D!n con(ra, .e%e!"e &o( .! ca&a'!"e s7 r7s&+nd7 "a
    o s(!%+"are s+&"!%en(ar7 a&roa&e !%ed!a(.
    T+"'+r7r!"e r7s&+ns+"+! se<+a" &o( s+rven! :n(r4+na sa+ :n %a! %+"(e d!n(re
    aces(e .a/e. Or! de cA(e or! es(e &re/en(7 %a! %+"( decA( o s!n$+r7 d!s.+nc=!e
    se<+a"7, s+n( :nre$!s(ra(e (oa(e. N+ s4a .7c+( n!c! o (en(a(!v7 de a s&ec!.!ca :n se(+r!"e
    de cr!(er!! +n %!n!%+% de .recven=7 sa+ de var!e(7=! de s!(+a=!!, ac(!v!(7=! sa+ (!&+r!
    de ra&or(+r! se<+a"e :n care d!s.+nc=!a (re'+!e s7 a&ar7. Aceas(7 @+deca(7 (re'+!e s7
    .!e .7c+(7 de c"!n!c!an =!nAnd con( de .ac(or! &rec+% e(a(ea s! e<&er!en=a !nd!v!d+"+!,
    .recven=a s! cron!c!(a(ea s!%&(o%e"or, de(resa s+'!ec(+"+! s! e.ec(+" as+&ra a"(or
    do%en!! de .+nc=!onare. C+v!n(e"e S&ers!s(en( sa+ rec+ren(T :n cr!(er!!"e de
    d!a$nos(!c !nd!c7 neces!(a(ea +ne! as(.e" de @+dec7=! c"!n!ce. Dac7 s(!%+"area se<+a"7
    es(e !nadecva(7, .!e :n .oca"!/are, !n(ens!(a(e sa+ d+ra(7, d!a$nos(!c+" de d!s.+nc=!e
    se<+a"7 !%&"!cAnd e<c!(a=!a sa+ or$as%+" n+ es(e &+s.
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+", con(e<(+" s! .ac(or!!
    e(!o"o$!c! asoc!a=! c+ d!s.+nc=!a se<+a"7. Dac7 s+n( &re/en(e d!s.+nc=!! se<+a"e
    %+"(!&"e, (re'+!e s7 .!e %en=!ona(e s+'(!&+r!"e adecva(e. Aces(e s+'(!&+r! n+ se
    a&"!c7 d!a$nos(!c+"+! de d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e
    sa+ d!s.+nc=!e! se<+a"e !nd+se de o s+'s(an=7.
    Un+" d!n(re +r%7(oare"e s+'(!&+r! &oa(e .! +(!"!/a( &en(r+ a !nd!ca na(+ra
    de'+(+"+! d!s.+nc=!e! se<+a"eQ
    T!& &r!%ar Ee<!s(en( d!n(o(dea+naJ. Aces( s+'(!& se a&"!c7 dac7 d!s.+nc=!a
    se<+a"7 a .os( &re/en(7 de "a de'+(+" ac(!v!(7=!! se<+a"e. T!& c7&7(a(. Aces(
    s+'(!& se a&"!c7 dac7 d!s.+nc=!a se<+a"7 a&are n+%a! d+&7 o &er!oad7 de
    .+nc=!onare nor%a"7.
    Un+" d!n(re +r%7(oare"e s+'(!&+r! &oa(e .! +(!"!/a( &en(r+ a !nd!ca con(e<(+" :n
    care a&are d!s.+nc=!a se<+a"7Q
    T!& $enera"!/a(. Aces( s+'(!& se a&"!c7 dac7 d!s.+nc=!a se<+a"7 n+ es(e
    "!%!(a(7 "a an+%!(e (!&+r! de s(!%+"are, de s!(+a=!! sa+ de &ar(ener!.
    Dis$unctiile
    Sexuale
    <4G

    T!& s!(+a=!ona". Aces(.s+'(!& se a&"!c7 dac7 d!s.+nc=!a se<+a"7 es(e "!%!(a(7 "a
    an+%!(e (!&+r! de s(!%+"are, de s!(+a=!! sa+ de &ar(ener!. Pa((ern+" s!(+a=!ona"
    s&ec!.!c a" d!s.+nc=!e! &oa(e a@+(a :n e.ec(+area d!a$nos(!c+"+! d!.eren=!a". De
    e<e%&"+, .+nc=!a %as(+r'a(or!e nor%a"7 :n &re/en=a +ne! .+nc=!on7r!
    re"a=!ona"e de(er!ora(e c+ &ar(ener+" E&ar(eneraJ ar &+(ea s+$era c7 ac+/a
    &r!nc!&a"7 de d!s.+nc=!e se<+a"7 es(e .oar(e &ro'a'!" da(ora(7 +ne! &ro'"e%e
    !n(ra&s!!ce sa+ !n(er&ersona"e %a! c+rAnd decA( +ne! cond!=!! %ed!ca"e
    $enera"e sa+ +ne! s+'s(an=e.
    Un+" d!n(re +r%7(oare"e s+'(!&+r! &oa(e .! +(!"!/a( &en(r+ a !nd!ca .ac(or!!
    e(!o"o$!c! asoc!a=! c+ d!s.+nc=!a se<+a"7Q
    Da(ora(7 .ac(or!"or &s!o"o$!c!. Aces( s+'(!& se a&"!c7 a(+nc! cAnd .ac(or!!
    &s!o"o$!c! s+n( cons!dera=! a avea ro"+" %a@or :n de'+(+", sever!(a(ea,
    e<acer'area sa+ &ers!s(en=a d!s.+nc=!e! se<+a"e, !ar cond!=!!"e %ed!ca"e
    $enera"e s! s+'s(an=e"e n+ @oac7 n!c! +n ro" :n e(!o"o$!a d!s.+nc=!e! se<+a"e.
    Da(ora(7 .ac(or!"or co%'!na=!. Aces( s+'(!& se a&"!c7 ar+nc! cAnd 5J .ac(or!!
    &s!o"o$!c! s+n( cons!dera=! a avea +n ro" :n de'+(+", sever!(a(ea, e<acer'area
    sa+ &ers!s(en=a d!s.+nc=!e! se<+a"e s! 9J o cond!=!e %ed!ca"7 $enera"7 sa+ +/+"
    de o s+'s(an=7 es(e cons!dera(, de ase%enea, a .! con(r!'+an(, dar n+ es(e
    s+.!c!en( &en(r+ a e<&"!ca d!s.+nc=!a se<+a"7. Dac7 o cond!=!e %ed!ca"7
    $enera"7 sa+ +/+" +ne! s+'s(an=e E!nc"+s!v e.ec(e"e sec+ndare a"e
    %ed!ca%en(e"orJ es(e s+.!c!en( &en(r+ a e<&"!ca d!s.+nc=!a se<+a"7, es(e
    d!a$nos(!ca(7 d!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e
    E&a$. YYGJ s!Xsa+ d!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7 E&a$. YR9J.
    Tulburri asociate
    D!s.+nc=!a se<+a"7 &oa(e .! asoc!a(7 c+ (+"'+r7r! a.ec(!ve s! c+ (+"'+r7r! an<!oase
    E(+"'+rarea o'ses!vo4co%&+"s!v7, &an!ca c+ a$ora.o'!e s! .o'!a s&ec!.!c7J.
    *lemente speci$ice culturii, etii si sexului
    *+dec7=!"e c"!n!ce re.er!(oare "a &re/en=a +ne! d!s.+nc=!! se<+a"e (re'+!e s7 !a :n
    cons!dera=!e .ond+" e(n!c, c+"(+ra", re"!$!os s! soc!a" a" !nd!v!d+"+!, care &oa(e
    !n."+en=a dor!n=a se<+a"7, aO(e&(7r!"e s! a(!(+d!n!"e .a=7 de &er.or%an=7. De
    e<e%&"+, :n +ne"e soc!e(7=!, dor!n=e"or se<+a"e d!n &ar(ea .e%e!! "! se acord7 &+=!n7
    re"evan=7 E:n s&ec!a" cAnd .er(!"!(a(ea es(e o'!ec(!v+" &r!nc!&a"J. Avansarea :n e(a(e
    &oa(e .! asoc!a(7 c+ o d!%!n+are a !n(eres+"+! s! .+nc=!on7r!! se<+a"e E:n s&ec!a" "a
    '7r'a=!J, :ns7 e<!s(7 "ar$! d!.eren=e !nd!v!d+a"e :n "e$7(+r7 c+ e.ec(e"e e(7=!!.
    #revalent
    E<!s(7 .oar(e &+=!ne da(e e&!de%!o"o$!ce s!s(e%a(!ce re.er!(oare "a &reva"en(a
    d!verse"or d!s.+nc=!! se<+a"e, !ar aces(ea &re/!n(7 o var!a'!"!(a(e e<(re% de %are,
    re."ec(And &ro'a'!" d!.eren=e :n %e(ode"e de eva"+are, de.!n!=!!"e .o"os!(e s!
    carac(er!s(!c!"e &o&+"a=!e! esan(!ona(e. Cea %a! a%&"7 ance(7 de &An7 ac+%
    e.ec(+a(7 :n SUA, &e +n eOan(!on re&re/en(a(!v de !nd!v!/! :n e(a(e de 5G4YF an!,
    s+$erea/7 +r%7(oare"e es(!%7r! a"e &reva"en(e! &en(r+ d!verse ac+/e se<+a"eQ ;d
    &en(r+ d!s&are+n!a '7r'a(+"+!, 5Yd &en(r+ d!s&are+n!a .e%e!!, 5Ld &en(r+
    &ro'"e%e"e de or$as% a"e '7r'a(+"+!, 9Yd &en(r+ &ro'"e%e"e de or$as% a"e .e%e!!,
    <4> Tulburrile Sexuale ,i de Identitate Sexual
    ;;d &en(r+ dor!n=a se<+a"7 red+s7 a .e%e!!, 9Hd &en(r+ e@ac+"area &recoce, 9Ld
    &en(r+ &ro'"e%e"e de e<c!(a=!e a"e .e%e!! s! 5Ld &en(r+ d!.!c+"(7=!"e de erec=!e a"e
    '7r'a(+"+!. Pro'"e%e"e de erec=!e a"e '7r'a(+"+! cresc ca &reva"en(7 d+&7 e(a(ea de
    YL an!. N+ es(e c"ar dac7 aces(e ac+/e se<+a"e sa(!s.ac cr!(er!!"e &en(r+ o (+"'+rare
    se<+a"7 DSM4I3. N+ s+n( d!s&on!'!"e es(!%7r! a"e ra(e"or de &reva"en(7 &en(r+
    avers!+nea se<+a"7, va$!n!s%, d!s.+nc=!!"e se<+a"e da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e s! d!s.+nc=!!"e se<+a"e !nd+se de o s+'s(an=7.
    Dia!nostic di$erenial
    Dac7 d!s.+nc=!a se<+a"7 es(e cons!dera(7 a .! ca+/a(7 e<c"+s!v de e.ec(e"e
    .!/!o"o$!ce a"e +ne! an+%!(e cond!=!! %ed!ca"e $enera"e, d!a$nos(!c+" es(e ce" de
    d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e E&a$. YYGJ. Aceas(7
    &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c. Dac7
    d!s.+nc=!a se<+a"7 es(e cons!dera(7 a .! ca+/a(7 e<c"+s!v de e.ec(e"e .!/!o"o$!ce a"e
    +n+! dro$ de a'+/, a"e +n+! %ed!ca%en( or! e<&+ner!! "a +n (o<!c, d!a$nos(!c+"
    es(e ce" de d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 Eve/! &a$. YR9J. C"!n!c!an+"
    (re'+!e s7 se !n.or%e/e a(en( as+&ra na(+r!! s! :n(!nder!! +/+"+! de o s+'s(an=7,
    !nc"+s!v de %ed!ca%en(e. S!%&(o%e"e care s+rv!n n+%a! :n c+rs+" sa+ "a sc+r(
    (!%& Ead!c7, :n dec+rs de I s7&(7%An!J d+&7 !n(o<!ca=!a c+ o s+'s(an=7 sa+ d+&7
    +/+" +n+! %ed!ca%en( &o( .! e<(re% de !nd!ca(oare de o d!s.+nc=!e se<+a"7 !nd+s7
    de o s+'s(an=7, :n .+nc=!e de (!&+" sa+ can(!(a(ea de s+'s(an=7 +(!"!/a(7 sa+ de
    d+ra(a +/+"+!.
    Dac7 c"!n!c!an+" a s(a'!"!( c7 d!s.+nc=!a se<+a"7 se da(orea/7, a(A( +ne! cond!=!!
    %ed!ca"e $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, a%'e"e d!a$nos(!ce &o( .! &+se
    Ead!c7, d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! d!s.+nc=!e
    se<+a"7 !nd+s7 de o s+'s(an=7J. Un d!a$nos(!c de d!s.+nc=!e se<+a"7 &r!%ar7 c+
    s+'(!&+" de da(ora(7 +nor .ac(or! co%'!na=! es(e &+s dac7 se a&rec!a/7 c7 o
    co%'!na=!e de .ac(or! &s!o"o$!c! s! o cond!=!e %ed!ca"7 $enera"7 or! o s+'s(an=7 a+
    +n ro" e(!o"o$!c, dar n!c! o e(!o"o$!c s!n$+r7 n+ es(e :n %7s+r7 s7 e<&"!ce d!s.+nc=!a.
    Dac7 c"!n!c!an+" n+ &oa(e &rec!/a ro"+" e(!o"o$!c a" .ac(or!"or &s!o"o$!c!, a" cond!=!e!
    %ed!ca"e $enera"e sa+ a" +/+"+! +ne! s+'s(an=e, es(e &+s d!a$nos(!c+" de d!s.+nc=!e
    se<+a"7 .7r7 a"(7 s&ec!.!ca=!e.
    De ase%enea, d!a$nos(!c+" de d!s.+nc=!e se<+a"7 n+ es(e &+s dac7 d!s.+nc=!a es(e
    e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de &e a<a I Ede e<., dac7 d!%!n+area dor!n=e!
    se<+a"e s+rv!ne n+%a! :n con(e<(+" +n+! e&!sod de&res!v %a@orJ. Dac7 :ns7
    &er(+r'area :n ac(!v!(a(ea se<+a"7 an(eda(ea/7 (+"'+rarea de &e a<a I sa+ es(e
    cen(r+" +ne! a(en=!! c"!n!ce se&ara(e, &oa(e .! &+s +n d!a$nos(!c ad!=!ona" de
    d!s.+nc=!e se<+a"7. De re$+"7, dac7 es(e &re/en(7 o d!s.+nc=!e se<+a"7 Ede e<., o
    (+"'+rare de e<c!(a=!e se<+a"7J, vor .!, de ase%enea, &re/en(e d!s.+nc=!! se<+a"e
    s+&"!%en(are Ede e<, dor!n=a se<+a"7 d!%!n+a(7J, :n as(.e" de ca/+r!, (re'+!e
    d!a$nos(!ca(e (oa(e. O (+"'+rare de &ersona"!(a(e &oa(e coe<!s(a c+ o d!s.+nc=!e
    se<+a"7, :n as(.e" de ca/+r!, d!s.+nc=!a se<+a"7 (re'+!e :nre$!s(ra(7 &e a<a I, !ar
    (+"'+rarea de &ersona"!(a(e &e a<a II. Dac7 o a"(7 cond!=!e c"!n!c7, c+% ar .! o
    &ro'"e%7 re"a=!ona"7, es(e asoc!a(7 c+ o &er(+r'are :n .+nc=!onarea se<+a"7, (re'+!e
    sa .!e d!a$nos(!ca(7 d!s.+nc=!a se<+a"7, !ar cea"a"(7 cond!=!e c"!n!c7, de ase%enea,
    no(a(7 &e a<a I. Pro'"e%e"e oca/!ona"e c+ dor!n=a se<+a"7, e<c!(a=!a sa+ or$as%+",
    care n+ s+n( &ers!s(en(e sa+ rec+ren(e or! n+ s+n( aco%&an!a(e de de(res7 sa+ de
    d!.!c+"(a(e !n(er&ersona"7 %arca(7 n+ s+n( cons!dera(e a .! d!s.+nc=!! se<+a"e.
    4572 ?E Dorina Sexual
    Diminuat
    5+4

    Tulburrile Dorinei Se.uale
    4+C. G* Dorin!a Se,ual( Di"inuat(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" dor!n=e! se<+a"e d!%!n+a(e :" cons(!(+!e o de.!c!en=7 sa+
    a'sen=7 a .an(e/!!"or se<+a"e s! a dor!n=e! de ac(!v!(a(e se<+a"7 Ecr!(er!+" AJ.
    Per(+r'area (re'+!e s7 ca+/e/e de(res7 sa+ d!.!c+"(a(e !n(er&ersona"7 %arca(7
    Ecr!(er!+" BJ. D!s.+nc=!a n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de &e a<a I Ec+
    e<ce&=!a a"(e! d!s.+nc=!! se<+a"eJ s! n+ se da(orea/7 e<c"+s!v e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! s+'s(an=e E!nc"+s!v a"e %ed!ca%en(e"orJ or! a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ecr!(er!+" CJ. Dor!n=a se<+a"7 d!%!n+a(7 &oa(e .! $"o'a"7 s!
    c+&r!nde (oa(e .or%e"e de %an!.es(are se<+a"7 sa+ &oa(e .! s!(+a=!ona"7 s! "!%!(a(7
    "a +n &ar(ener sa+ "a o an+%!(7 ac(!v!(a(e se<+a"7 Ede e<., "a ra&or(+" se<+a" nor%a",
    dar n+ s! "a %as(+r'areJ. E<!s(7 &+=!n7 %o(!va=!e &en(r+ a c7+(a s(!%+"! O! o
    .r+s(rare red+s7 cAnd &ersoana es(e de&r!va(7 de o&or(+n!(7=! &en(r+ %an!.es(area
    se<+a"7. Ind!v!d+" n+ !n!=!a/7 de re$+"7 n!c! o ac(!v!(a(e se<+a"7 sa+ se &oa(e an$a@a
    :n ea :n %od !nvo"+n(ar, cAnd es(e !n!=!a(7 de &ar(ener. DeO! .recven=a e<&er!en=e"or
    se<+a"e es(e red+s7, &res!+nea d!n &ar(ea &ar(ener+"+! sa+ a neces!(7=!"or
    nonse<+a"e Ede e<., &en(r+ con.or( .!/!c sa+ !n(!%!(a(eJ &oa(e cres(e .recven=a
    con(ac(e"or se<+a"e. D!n ca+/a "!&se! de da(e nor%a(!ve :n "e$7(+r7 c+ e(a(ea sa+ c+
    se<+" re.er!(oare "a .recven=a sa+ $rad+" dor!n=e! se<+a"e, d!a$nos(!c+" (re'+!e s7 se
    'a/e/e &e @+deca(a c"!n!c7 .onda(7 &e carac(er!s(!c!"e !nd!v!d+"+!, de(er%!nan=!!
    !n(er&ersona"!, con(e<(+" de v!a=7 s! cond!=!a c+"(+ra"7. C"!n!c!an+" &oa(e neces!(a
    eva"+area a%'!"or &ar(ener!, cAnd d!scre&an=e"e :n dor!n=a se<+a"7 cons(!(+!e %o(!v
    de a(en=!e &ro.es!ona"7. SDor!n=a a&aren( d!%!n+a(7T a +n+! &ar(ener &oa(e re."ec(a,
    :n sc!%', neces!(a(ea e<ces!v7 de e<&r!%are se<+a"7 a ce"+!"a"( &ar(ener. A"(erna(!v,
    a%'!! &ar(ener! &o( avea n!ve"e de dor!n=7 :n "!%!(e nor%a"e, dar "a e<(re%!(7=!
    d!.er!(e a"e con(!n++%+"+!.
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+" E&r!%ar7 vers+s c7&7(a(7J,
    con(e<(+" E$enera"!/a(7 vers+s s!(+a=!ona"7J s! .ac(or!! e(!o"o$!c! Eda(ora(7 .ac(or!"or
    &s!o"o$!c!, da(ora(7 +nor .ac(or! co%'!na=!J &en(r+ dor!n=a se<+a"7 d!%!n+a(7.
    E3e/! descr!er!"e de "a &a$. Y;RJ.
    *lemente si tulburri asociate
    In(eres+" se<+a" sc7/+( es(e asoc!a( .recven( c+ &ro'"e%e de e<c!(a=!e se<+a"7 sa+
    c+ d!.!c+"(7=! or$as%!ce. De.!c!en=a :n dor!n=a se<+a"7 &oa(e .! d!s.+nc=!a &r!%ar7
    sa+ &oa(e .! consec!n=a de&r!v7r!! e%o=!ona"e !nd+se de &er(+r'7r!"e :n e<c!(a=!e sa+
    or$as%. Un!! !nd!v!/! c+ dor!n=7 se<+a"7 sc7/+(7 :O! %en=!n :ns7 ca&ac!(a(ea &en(r+
    o e<c!(a=!e se<+a"7 O! or$as% adecva(e, ca r7s&+ns "a s(!%+"area se<+a"7. Cond!=!!"e
    %ed!ca"e $enera"e &o( avea +n e.ec( de"e(er nes&ec!.!c as+&ra dor!n=e! se<+a"e
    da(ora(7 de'!"!(7=!!, d+rer!!, &ro'"e%e"or c+ !%a$!nea cor&ora"7 sa+ &reoc+&7r!"or
    re.er!(oare "a s+&rav!e=+!re. T+"'+r7r!"e de&res!ve s+n( adesea asoc!a(e c+ dor!n=a
    se<+a"7 sc7/+(7, !ar de'+(+" de&res!e! &oa(e &recede, &oa(e .! conco%!(en( or! &oa(e
    <7+ Tulburrile Sexuale ,i de Identitate Sexual
    .! consec!n=a dor!n=e! se<+a"e de.!c!(are. Ind!v!/!! c+ dor!n=7 se<+a"7 d!%!n+a(7 &o(
    avea d!.!c+"(7=! :n de/vo"(area +nor re"a=!! se<+a"e s(a'!"e O! &o( avea !nsa(!s.ac=!e s!
    r+&(+r7 %ar!(a"7.
    *voluie
    E(a(ea "a de'+( &en(r+ !nd!v!/!! c+ .or%e de dor!n=7 se<+a"7 d!%!n+a(7 &r!%ar7
    es(e &+'er(a(ea. Ma! .recven(, (+"'+rarea a&are :n &er!oada ad+"(7, d+&7 o &er!oad7
    de !n(eres se<+a" adecva(, :n asoc!ere c+ %!/er!a &s!o"o$!c7, even!%en(e de v!a=7
    s(resan(e sa+ d!.!c+"(7=! !n(er&ersona"e. P!erderea dor!n=e! se<+a"e &oa(e .! con(!n+7
    sa+ e&!sod!c7, :n .+nc=!e de .ac(or!! &s!osoc!a"! sa+ re"a=!ona"!. Un &a((ern e&!sod!c
    de &!erdere a dor!n=e! se<+a"e s+rv!ne "a +n!! !nd!v!/! :n "e$7(+r7 c+ &ro'"e%e
    re.er!(oare "a !n(!%!(a(e s! o'"!$a=!!"e con@+$a"e.
    Dia!nostic di$erenial
    Dor!n=a se<+a"7 d!%!n+a(7 (re'+!e s7 .!e d!s(!ns7 de d!s.+nc(!a se<+a"7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" cores&+n/7(or es(e ce" de d!s.+nc=!e
    se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd d!s.+nc(!a es(e cons!dera(7 a
    .! da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce a"e +ne! cond!=!! %ed!ca"e s&ec!.!ce Eve/!
    &a$. YYGJ. Aceas(7 &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+"
    so%a(!c. An+%!(e cond!=!! %ed!ca"e $enera"e, c+% ar .! ano%a"!!"e ne+ro"o$!ce,
    or%ona"e s! %e(a'o"!ce &o( de(er!ora :n %od s&ec!.!c s+'s(ra(+" .!/!o"o$!c a"
    dor!n=e"or se<+a"e. Ano%a"!!"e :n (es(os(eron+" s! &ro"ac(!na, (o(a"e s!
    '!od!s&on!'!"e, &o( !nd!ca (+"'+r7r! or%ona"e res&onsa'!"e de &!erderea dor!n=e!
    se<+a"e. Dac7 a(A( dor!n=a se<+a"7 d!%!n+a(7, cA( s! o cond!=!e %ed!ca"7 $enera"7
    s+n( &re/en(e, dar se cons!der7 c7 d!s.+nc(!a se<+a"7 n+ se da(orea/7 e<c"+s!v
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e cond!=!e! %ed!ca"e $enera"e, ar+nc! es(e
    d!a$nos(!ca(7 dor!n=a se<+a"7 d!%!n+a(7 da(ora(7 +nor .ac(or! co%'!na=!.
    Con(rar dor!n=e! se<+a"e d!%!n+a(e, d!s.+nc(!a se<+a"7 !nd+s7 de o s+'s(an=7
    es(e cons!dera(7 a .! da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e
    Ede e<., +n %ed!ca%en( an(!!&er(ens!v, +n dro$ de a'+/J Eve/! &a$. YR9J. Dac7, a(A(
    dor!n=a se<+a"7 d!%!n+a(7, cA( O! +/+" +ne! s+'s(an=e s+n( &re/en(e, dar se
    cons!der7 c7 d!s.+nc(!a se<+a"7 n+ se da(orea/7 e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e
    a"e +/+"+! de o s+'s(an=7, a(+nc! se d!a$nos(!cea/7 dor!n=a se<+a"7 d!%!n+a(7
    da(ora(7 +nor .ac(or! co%'!na=!. Dac7 dor!n=a se<+a"7 sc7/+(7 es(e cons!dera(7 a .!
    da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce, a(A( a"e +ne! cond!=!! %ed!ca"e $enera"e, cA(
    s! a"e +/+"+! +ne! s+'s(an=e, va .! d!a$nos(!ca(7, a(A( d!s.+nc(!a se<+a"7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e, cA( O! d!s.+nc(!a se<+a"7 !nd+s7 de o s+'s(an=7.
    Dor!n=a se<+a"7 d!%!n+a(7 &oa(e s+rven!, de ase%enea, :n asoc!ere c+ a"(e
    d!s.+nc=!! se<+a"e Ede e<., d!s.+nc(!a erec(!"7 a '7r'a(+"+!J. Dac7 es(e aOa, (re'+!e
    d!a$nos(!ca(e a%'e"e. Un d!a$nos(!c ad!=!ona" de dor!n=7 se<+a"7 d!%!n+a(7 n+ es(e
    &+s de re$+"7, dac7 dor!n=a se<+a"7 d!%!n+a(7 es(e e<&"!ca(7 %a! '!ne de a"(7
    (+"'+rare de &e a<a I Ede e<., (+"'+rarea de&res!v7 %a@or7, (+"'+rarea o'se4s!vo4
    co%&+"s!v7, s(res+" &os((ra+%a(!cJ. D!a$nos(!c+" ad!=!ona" &oa(e .! adecva(, cAnd
    dor!n=a se<+a"7 d!%!n+a(7 &recede (+"'+rarea de &e a<a I sa+ es(e cen(r+" +ne!
    a(en=!! c"!n!ce se&ara(e. Pro'"e%e"e oca/!ona"e c+ dor!n=a se<+a"7, care n+ s+n(
    &ers!s(ene sa+ rec+ren(e, or! n+ s+n( aco%&an!a(e de de(res7 sa+ de d!.!c+"(a(e
    !n(er&ersona"7 %arca(7, n+ s+n( cons!dera(e a .! dor!n=7 se<+a"7 d!%!n+a(7.
    4572?6 Aversiunea
    Sexual
    <7*

    Criteriile $e $ia/no&ti# pentru 4+C.G*
    Dorin!a Se,ual( Di"inuat(
    A2 'ante(ii sexuale si dorina de activitate sexual persistent sau recurent
    de$icitare &sau absente)2 Nudecata de de$icien sau de absen este $cut
    de clinician, lu@nd "n consideraie $actorii care a$ectea( $uncionarea
    sexual, cum ar $i etatea si contextul vieii persoanei2
    S2 #erturbarea cau(ea( detres sau di$icultate interpersonal marcat 2
    2 Dis$uncia sexual nu este explicat mai bine de alt tulburare de pe axa l
    &cu excepia altei dis$uncii sexuale) si nu se datorea( exclusiv e$ectelor
    $i(iolo!ice directe ale unei substane &de ex2, un dro! de abu(, un
    medicament) ori ale unei condiii medicale !enerale2
    De speci"icat tipulD Tip
    primar Tip cptat
    De speci"icat tipulD
    Tip !enerali(at
    Tip situaional
    De speci"icat'
    Datorat $actorilor psi%olo!ici
    Datorat $actorilor combinai
    4+C.G5 Aver&iunea Se,ual(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" avers!+n!! se<+a"e :" cons(!(+!e avers!+nea .a=7 de, s!
    ev!(area ac(!v7 a con(ac(+"+! se<+a" $en!(a" c+ +n &ar(ener se<+a" Ecr!(er!+" AJ.
    Per(+r'area (re'+!e s7 ca+/e/e de(res7 sa+ d!.!c+"(a(e !n(er&ersona"7 %arca(7
    Ecr!(er!+" BJ. D!s.+nc=!a n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de &e a<a I Ec+
    e<ce&=!a a"(e! d!s.+nc=!! se<+a"eJ Ecr!(er!+" CJ. Ind!v!d+" ac+/7 an<!e(a(e, .r!c7 sa+
    de/$+s( cAnd es(e con.r+n(a( c+ o&or(+n!(a(ea de a avea +n con(ac( se<+a" c+ +n
    &ar(ener. Avers!+nea .a=7 de con(ac(+" $en!(a" &oa(e .! cen(ra(7 &e +n an+%!( as&ec(
    a" e<&er!en=e! se<+a"e Ede e<., secre=!!"e $en!(a"e, &ene(ra=!a va$!na"7J. Un!! !nd!v!/!
    e<&er!en(ea/7 o re&+"s!e .a=7 de (o=! s(!%+"!! se<+a"!, !nc"+s!v .a=7 de s7r+( s!
    a(!n$ere. In(ens!(a(ea reac=!e! !nd!v!d+"+!, cAnd es(e e<&+s "a s(!%+"! avers!v!, &oa(e
    %er$e de "a an<!e(a(e %odera(7 s! "!&s7 de &"7cere "a de(res7 &s!o"o$!c7 e<(re%7.
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+" E&r!%ar7 vers+s c7&7(a(7J,
    con(e<(+" E$enera"!/a(7 vers+s s!(+a=!ona"7J s! .ac(or!! e(!o"o$!c! Eda(ora(7 .ac(or!"or
    &s!o"o$!c!, da(ora(7 +nor .ac(or! co%'!na=!J &en(r+ avers!+nea se<+a"7. E3e/!
    descr!erea "a &a$. Y;RJ.
    AH7 Tulburrile Sexuale ,i de Identitate Sexual
    *lemente ,i tulburri asociate
    CAnd s+n( con.r+n(a=! c+ o s!(+a=!e se<+a"7, +n!! !nd!v!/! c+ avers!+ne se<+a"7
    sever7 &o( e<&er!en=a a(ac+r! de &an!c7 c+ an<!e(a(e e<(re%7, sen(!%en(e de (eroare,
    "eO!n, $rea=7, &a"&!(a=!!, a%e=ea"7 O! d!.!c+"(7=! res&!ra(or!!. Po( e<!s(a re"a=!!
    !n(er&ersona"e %arca( de(er!ora(e Ede e<., !nsa(!s.ac=!e %ar!(a"7J. Ind!v!/!! &o( ev!(a
    s!(+a=!!"e se<+a"e sa+ even(+a"!! &ar(ener! se<+a"! &r!n s(ra(e$!! %asca(e Ede.e<., %er$
    "a c+"care d!n (!%&, c7"7(oresc, :O! ne$"!@ea/7 =!n+(a &ersona"7, .ac +/ de d!verse
    s+'s(an=e s! s+n( s+&er!%&"!ca=! :n ac(!v!(7=! de serv!c!+, soc!a"e sa+ de .a%!"!eJ.
    Dia!nostic di$erenial
    Avers!+nea se<+a"7 &oa(e a&are, de ase%enea, :n asoc!ere c+ a"(e d!s.+nc=!!
    se<+a"e Ede e<., d!s&are+n!aJ. Dac7 es(e aOa, (re'+!e %en=!ona(e a%'e"e. Un
    d!a$nos(!c ad!=!ona" de avers!+ne se<+a"7 n+ se &+ne, dac7 avers!+nea se<+a"7 es(e
    e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7 de &e a<a I Ede e<., (+"'+rarea
    de&res!v7 %a@or7, (+"'+rarea o'ses!vo4co%&+"s!v7, s(res+" &os((ra+%a(!cJ.
    D!a$nos(!c+" ad!=!ona" &oa(e .! &+s cAnd avers!+nea &recede (+"'+rarea de &e a<a I
    sa+ es(e cen(r+" +ne! a(en=!! c"!n!ce se&ara(e. DeO! avers!+nea se<+a"7 &oa(e sa(!s.ace
    d!n &+nc( de vedere (en!c cr!(er!!"e &en(r+ .o'!a s&ec!.!c7, aces( d!a$nos(!c
    ad!=!ona" n+ es(e &+s. Avers!+nea se<+a"7 oca/!ona"7, care n+ es(e &ers!s(en(7 sa+
    rec+ren(7, sa+ n+ es(e :nso=!(7 de de(res7 sa+ de d!.!c+"(a(e !n(er&ersona"7 %arca(7,
    n+ es(e cons!dera(7 a .! avers!+ne se<+a"7.
    Criteriile $e $ia/no&ti# pentru
    4+C.G5 Aver&iunea Se,ual(
    A2 Aversiune extrem, recurent sau persistent $a de contactul sexual si
    evitarea tuturor &sau aproape a tuturor) contactelor sexuale !enitale cu un
    partener sexual2
    S2 #erturbarea cau(ea( detres sau di$icultate interpersonal marcat 2
    2 Dis$uncia sexual nu este explicat mai bine de alt tulburare de pe axa l
    &cu excepia altei dis$uncii sexuale)2
    De speci"icat tipulD
    Tip primar Tip
    cptat
    De speci"icat tipulD
    Tip situaional
    Tip !enerali(at
    De speci"icat'
    Datorat $actorilor psi%olo!ici
    Datorat $actorilor combinai
    4572?7 Tulburarea de *xcitaie Sexual a 'emeii
    <74
    Tulburrile de 1.citaie Se.ual 4+C.GC
    Tul-urarea $e E,#ita!ie Se,ual( a 'e"eii
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de e<c!(a=!e se<+a"7 a .e%e!! :" cons(!(+!e
    !nca&ac!(a(ea rec+ren(7 sa+ &ers!s(en(7 de a a(!n$e sa+ de a %en=!ne &An7 "a
    rea"!/area ac(!v!(7=!! se<+a"e, +n r7s&+ns adecva( de "+'r!.!ere4(+r$escen=7 a"
    e<c!(a=!e! se<+a"e Ecr!(er!+" AJ. R7s&+ns+" "a e<c!(a=!e cons(7 d!n vasocon$es(!a
    &e"v!s+"+!, "+'r!.!erea O! e<&ans!+nea va$!n+"+! s! (+r$escen=a or$ane"or $en!(a"e
    e<(erne. Per(+r'area (re'+!e s7 ca+/e/e de(res7 sa+ d!.!c+"(a(e !n(er&ersona"7
    %arca(7 Ecr!(er!+" BJ. D!s.+nc=!a n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de &e
    a<a I Ec+ e<ce&=!a a"(e! d!s.+nc=!! se<+a"eJ s! n+ es(e da(ora(7 e<c"+s!v e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e E!nc"+s!v a %ed!ca%en(e"orJ or! a"e +ne!
    cond!=!! %ed!ca"e $enera"e Ecr!(er!+" CJ.
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+" E&r!%ar7 vers+s c7&7(a(7J,
    con(e<(+" E$enera"!/a(7 vers+s s!(+a=!ona"7J O! .ac(or!! e(!o"o$!c! Eda(ora(7 .ac(or!"or
    &s!o"o$!c!, da(ora(7 +nor .ac(or! co%'!na=!J &en(r+ (+"'+rarea de e<c!(a=!e
    se<+a"7 "a .e%e!. E3e/! descr!erea "a &a$. Y;RJ.
    *lemente si tulburri asociate
    Da(e "!%!(a(e s+$erea/7 c7 (+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!! es(e
    aco%&an!a(7 adesea de (+"'+r7r! a"e dor!n=e! se<+a"e O! de (+"'+rarea de or$as% a
    .e%e!!. Ind!v!da c+ (+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!! &oa(e avea &+=!n7, sa+
    n!c! o sen/a=!e s+'!ec(!v7 de e<c!(a=!e se<+a"7. T+"'+rarea &oa(e d+ce "a con(ac(
    se<+a" d+reros, ev!(are se<+a"7 O! &er(+r'area re"a=!!"or %ar!(a"e sa+ se<+a"e.
    Dia!nostic di$erenial
    T+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!! (re'+!e s7 .!e d!s(!ns7 de d!s.+nc=!a
    se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" adecva( va .! ce" de
    d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e cAnd se cons!der7 c7
    d!s.+nc=!a es(e da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce a"e +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<., red+cerea %eno&a+/a"7 s! &os(%eno&a+/a"7 a n!ve"+"+!
    es(ro$en!"or, va$!n!(a a(ro.!c7, d!a'e(+" /aara(, rad!o(era&!a &e"v!s+"+!J Eve/! &a$.
    YYGJ. Red+cerea "+'r!.!er!! va$!n+"+! a .os( descr!s7, de ase%enea, :n asoc!ere c+
    "ac(a=!a. Aceas(7 &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+"
    so%a(!c. Dac7 a(A( (+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!!, cA( s! o cond!=!e %ed!ca"7
    $enera"7 s+n( &re/en(e, dar se cons!der7 c7 d!s.+nc=!a se<+a"7 n+ se da(orea/7
    e<c"+s!v consec!n=e"or .!/!o"o$!ce d!rec(e a"e cond!=!e! %ed!ca"e $enera"e, a(+nc! es(e
    d!a$nos(!ca(7 (+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!! da(ora(7 +nor .ac(or! co%'!na=!.
    :n con(ras( c+ (+"'+rarea de e<c!(a=!e se<+a"7, o d!s.+nc=!e se<+a"7 !nd+s7 de
    o s+'s(an=7 es(e cons!dera(7 a .! da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e
    +ne! s+'s(an=e Ede e<., red+cerea "+'r!.!er!! ca+/a(7 de an(!!&er(ens!ve sa+ de
    <77 Tulburrile Sexuale si de Identitate Sexual
    an(!!s(a%!n!ceJ Eve/! &a$. YR9J. Dac7, a(A( (+"'+rarea de e<c!(a=!e se<+a"7 a
    .e%e!!, cA( s! +/+" de o s+'s(an=7 s+n( &re/en(e, dar se cons!der7 c7 d!s.+nc=!a
    se<+a"7 n+ se da(orea/7 e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +/+"+! de
    s+'s(an=7, a(+nc! se d!a$nos(!cea/7 (+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!!
    da(ora(7 +nor .ac(or! co%'!na=!.
    Dac7 &ro'"e%e"e de e<c!(a=!e s+n( cons!dera(e a .! da(ora(e e<c"+s!v e.ec(e"or
    .!/!o"o$!ce, a(A( a"e +ne! cond!=!! %ed!ca"e $enera"e, cA( s! a"e +/+"+! +ne! s+'s(an=e,
    es(e d!a$nos(!ca(7, a(A( d!s.+nc=!a se<+a"7 da(ora(7 cond!=!e! %ed!ca"e $enera"e, cA(
    O! d!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7.
    T+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!! &oa(e s+rven!, de ase%enea, :n asoc!ere
    c+ a"(e d!s.+nc=!! se<+a"e Ede e<., (+"'+rarea de or$as% a .e%e!!J. Dac7 es(e aOa,
    (re'+!e s7 .!e %en=!ona(e a%'e"e. Un d!a$nos(!c ad!=!ona" de (+"'+rare de e<c!(a=!e
    se<+a"7 a .e%e!! n+ se &+ne de re$+"7, dac7 &ro'"e%a de e<c!(a=!e se<+a"7 es(e
    e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de &e a<a I Ede e<., (+"'+rarea de&res!v7
    %a@or7, (+"'+rarea o'ses!vo4co%&+"s!v7, s(res+" &os((ra+%a(!cJ. D!a$nos(!c+"
    ad!=!ona" &oa(e .! &+s cAnd &ro'"e%a re.er!(oare "a e<c!(a=!a se<+a"7 &recede
    (+"'+rarea de &e a<a I or! es(e cen(r+" +ne! a(en=!! c"!n!ce se&ara(e. Pro'"e%e"e
    oca/!ona"e c+ e<c!(a=!a se<+a"7 care s+n( &ers!s(en(e sa+ rec+ren(e or! n+ s+n(
    aco%&an!a(e de de(res7 sa+ de d!.!c+"(a(e !n(er&ersona"7 %arca(7, n+ s+n(
    cons!dera(e a .! (+"'+rare de e<c!(a=!e se<+a"7 a .e%e!!. Un d!a$nos(!c de (+"'+rare
    de e<c!(a=!e se<+a"7 a .e%e!!, de ase%enea, n+ es(e adecva(, dac7 &ro'"e%e"e :n
    "e$7(+r7 c+ e<c!(a=!a se da(orea/7 +ne! s(!%+"7r! se<+a"e care n+ es(e adecva(7 :n
    .oca"!/are, !n(ens!(a(e s! d+ra(7.
    Criteriile $e $ia/no&ti# pentru
    4+C.GC Tul-urarea2 $e E,#ita!ie Se,ual( a 'e"eii
    A2 Incapacitatea persistent sau recurent de a atin!e sau de a menine p@n
    la reali(area activitii sexuale, un rspuns adecvat de lubri$iere-tur!escen
    la excitaia sexual2
    S2 #erturbarea cau(ea( detres sau di$icultate interpersonal marcat2
    2 Dis$uncia sexual nu este explicat mai bine de alt tulburare de pe axa l
    &cu excepia altei dis$uncii sexuale) si nu se datorea( exclusiv e$ectelor
    $i(iolo!ice directe ale unei substane &de ex2, un dro! de abu(, un
    medicament) ori ale unei condiii medicale !enerale2
    De speci"icat tipulD Tip
    pri"ar Tip #(p(tat
    De speci"icat tipulD
    Tip /enerali)at
    Tip &itua!ional
    De speci"icat'
    Datorat( %a#torilor p&i@olo/i#i
    Datorat( %a#torilor #o"-ina!i
    4572?7 Tulburarea de *recie a
    Srbatului
    <7<
    4+C.GC Tul-urarea $e Ere#!ie a 8(r-atului
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de erec=!e a '7r'a(+"+! :" cons(!(+!e !nca&ac!(a(ea
    rec+ren(7 sa+ &ers!s(en(7 de a a(!n$e sa+ de a %en=!ne &An7 "a rea"!/area ac(!v!(7=!!
    se<+a"e o erec=!e adecva(7 Ecr!(e@!+" AJ. Per(+r'area (re'+!e s7 ca+/e/e de(res7 sa+
    d!.!c+"(a(e !n(er&ersona"7 %arca(7 Ecr!(er!+" BJ. D!s.+nc=!a n+ es(e e<&"!ca(7 %a! '!ne
    de a"(7 (+"'+rare de &e a<a I Ec+ e<ce&=!a a"(e! d!s.+nc=!! se<+a"eJ s! n+ se da(orea/7
    e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e E!nc"+s!v a %ed!ca%en(e"orJ
    or! a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" CJ.
    E<!s(7 d!verse &a((ern+r! de d!s.+nc=!e erec(!"7. Un!! !nd!v!/! re"a(ea/7
    !nca&ac!(a(ea de a avea erec=!e :nc7 de "a :nce&+(+" e<&er!en=e! se<+a"e. A"=!! se
    &"An$ de .a&(+" c7 a+ o erec=!e adecva(7 :na!n(ea ac(+"+! se<+a", dar &!erd (+r$es4
    cen=a &en!an7 cAnd :ncearc7 &ene(rarea, :n .!ne, a"=!! re"a(ea/7 c7 a+ o erec=!e
    s+.!c!en( de .er%7 &en(r+ &ene(rare, dar c7 &!erd (+r$escen=a &en!an7, :na!n(e sa+
    :n (!%&+" !n(ro%!s!+n!!. Un!! '7r'a=! re"a(ea/7 c7 s+n( ca&a'!"! de erec=!e n+%a! :n
    c+rs+" %as(+r'7r!! sa+ "a deO(e&(area d!n so%n. Erec=!!"e %as(+r'a(or!! &o( .!, de
    ase%enea, &!erd+(e, dar aces( .a&( n+ es(e .recven(.
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+" *primar vers+s cptat,2
    con(e<(+" *.eneralizat vers+s situa3ional, s! .ac(or!! e(!o"o$!c! *datorat factorilor
    psi-olo.ici2 datorat unor factori combina3i, &en(r+ (+"'+rarea de erec=!e a
    '7r'a(+"+!. E3e/! descr!erea "a &a$. Y;RJ.
    *lemente ,i tulburri asociate
    D!.!c+"(7=!"e erec(!"e d!n (+"'+rarea de erec=!e a '7r'a(+"+! s+n( asoc!a(e .recven(
    c+ an<!e(a(e se<+a"7, (ea%7 de eOec, &reoc+&7r! :n "e$7(+r7 c+ .+nc=!onarea se<+a"7
    s! o sc7dere a sen(!%en(+"+! s+'!ec(!v de e<c!(a=!e s! &"7cere se<+a"7. D!s.+nc=!a
    erec(!"7 &oa(e r+&e re"a=!!"e %ar!(a"e sa+ se<+a"e e<!s(en(e O! &oa(e .! ca+/a
    %ar!a@e"or necons+%a(e O! a !n.er(!"!(7=!!. Aceas(7 (+"'+rare se<+a"7 &oa(e .! asoc!a(7
    c+ dor!n=a se<+a"7 d!%!n+a(7 O! c+ e@ac+"area &recoce. Ind!v!/!! c+ (+"'+r7r! a.ec(!ve
    O! c+ (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 re"a(ea/7 adesea &ro'"e%e :n "e$7(+r7 c+
    e<c!(a=!a se<+a"7.
    *voluie
    D!verse"e .or%e de (+"'+rare de erec=!e a '7r'a(+"+! +r%ea/7 evo"+=!! d!.er!(e,
    !ar e(a(ea "a de'+( var!a/7 cons!dera'!". P+=!n!! !nd!v!/!, care n4a+ .os( n!c!oda(7
    ca&a'!"! s7 a!'7 o erec=!e de ca"!(a(e s+.!c!en(7 &en(r+ a rea"!/a con(ac( se<+a" c+ o
    &ar(ener7, a+ de re$+"7 o (+"'+rare cron!c7, e<!s(And d!n, O! &en(r+, (o(dea+na.
    Ca/+r!"e c7&7(a(e se &o( re%!(e s&on(an :n (!%&, :n &ro&or=!e de 5Yd4;Ld. Ca/+r!"e
    s!(+a=!ona"e &o( .! de&enden(e de +n (!& de &ar(ener7 sa+ de !n(ens!(a(ea sa+
    ca"!(a(ea re"a=!e! O! s+n( e&!sod!ce O!, .recven(, rec+ren(e.
    YIR Tul-ur(rile Se,uale Ei $e I$entitate Se,ual(

    Dia!nostic di$erenial
    T+"'+rarea de erec=!e a '7r'a(+"+! (re'+!e s7 .!e d!s(!ns7 de d!s.+nc=!a se<+a"7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" cores&+n/7(or va .! ce" de
    d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd se cons!der7 c7
    d!s.+nc=!a se da(orea/7 e<c"+s!v e.ec(e"or .!/!o"o$!ce a"e +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<., d!a'e( /aara(, sc"ero/7 %+"(!&"7, !ns+.!c!en=7 rena"7, ne+ro&a(!e
    &er!.er!c7, %a"ad!e vasc+"ar7 &er!.er!c7, "e/!+ne %ed+"ar7 s&!na"7, "e/!+ne a
    s!s(e%+"+! nervos ve$e(a(!v &r!n !n(erven=!e c!r+r$!ca"7 sa+ !rad!ereJ Eve/! &a$.
    YYGJ. Aceas(7 &rec!/are se 'a/ea/7 &e !s(or!c Ede e<., de(er!orarea ac(!v!(7=!! erec(!"e
    :n c+rs+" %as(+r'7r!!J, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c S(+d!!"e as+&ra
    (+r$escen=e! &en!ene noc(+rne &o( de%ons(ra dac7 erec=!!"e s+rv!n :n c+rs+"
    so%n+"+!, s! &o( .! +(!"e :n d!.eren=!erea (+"'+r7r!"or de erec=!e &r!%are de
    (+"'+rarea de erec=!e a '7r'a(+"+! da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e.
    Pres!+nea sAn$e"+! &en!an, eva"+7r!"e +nde! &+"s+"+! sa+ s(+d!!"e c+ +"(ras+ne(e
    d+&"e< &o( !nd!ca &!erderea vasc+"o$en7 a .+nc=!e! erec(!"e. Procedee"e !nvas!ve,
    &rec+% (es(area .ar%aco"o$!c7 !n(racor&ora"7 sa+ an$!o$ra.!a, &o( eva"+a &re/en=a
    &ro'"e%e"or de ."+< ar(er!a". Cavernoso$ra.!a &oa(e eva"+a s(area venoas7. Dac7,
    a(A( (+"'+rarea de erec=!e a '7r'a(+"+!, cA( s! o cond!=!e %ed!ca"7 $enera"7, s+n(
    &re/en(e, dar se cons!der7 c7 d!s.+nc=!a erec(!"7 n+ se da(orea/7 e<c"+s!v e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e, ar+nc! es(e d!a$nos(!ca(7
    (+"'+rarea de erec=!e a '7r'a(+"+! da(ora(7 +nor .ac(or! co%'!na=!.
    O d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 se &oa(e d!s(!n$e de (+"'+rarea de
    erec=!e a '7r'a(+"+! &r!n .a&(+" c7 d!s.+nc=!a se<+a"7 es(e cons!dera(7 a .! da(ora(7
    e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., o %ed!ca=!e
    an(!!&er(ens!v7, an(!de&res!v7, ne+ro"e&(!c7, +n dro$ de a'+/J Eve/! &a$ YR9J.
    Dac7 s+n( &re/en(e, a(A( (+"'+rarea de erec=!e a '7r'a(+"+!, cA( s! +/+" de o
    s+'s(an=7, dar se cons!der7 c7 d!s.+nc=!a erec(!"7 n+ se da(orea/7 e<c"+s!v e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +/+"+! de o s+'s(an=7, a(+nc! es(e d!a$nos(!ca(7 (+"'+rarea de
    erec=!e a '7r'a(+"+! da(ora(7 +nor .ac(or! co%'!na=!.
    Dac7 se cons!der7 c7 &ro'"e%e"e de e<c!(a=!e se da(orea/7 e<c"+s!v e.ec(e"or
    .!/!o"o$!ce a(A( a"e +ne! cond!=!! %ed!ca"e $enera"e, cA( s! a"e +/+"+! +ne! s+'s(an=e,
    es(e d!a$nos(!ca(7 a(A( d!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    cA( s! d!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7.
    T+"'+rarea de erec=!e4a '7r'a(+"+! &oa(e s+rven!, de ase%enea, :n asoc!ere c+
    a"(e d!s.+nc=!! se<+a"e Ede e<., e@ac+"area &recoceJ. Dac7 es(e aOa, (re'+!e %en=!ona(e
    a%'e"e. Un d!a$nos(!c ad!=!ona" de (+"'+rare de erec=!e a '7r'a(+"+! n+ se &+ne,
    dac7 d!s.+nc=!a erec(!"7 es(e e<&"!ca(7 %a! '!ne de o a"(7 (+"'+rare de &e a<a I E de
    e<. (+"'+rarea de&res!v7 %a@or7, (+"'+rarea o'ses!vo4co%&+"s!vAJ D!a$nos(!c+"
    ad!=!ona" &oa(e .! &+s cAnd d!s.+nc=!a erec(!"7 &recede (+"'+rarea de &e a<a I or! es(e
    cen(r+" +ne! a(en=!! c"!n!ce se&ara(e. Pro'"e%e"e oca/!ona"e c+ erec=!a, care n+ s+n(
    &ers!s(en(e sa+ rec+ren(e, sa+ n+ s+n( :nso=!(e de de(res7 sa+ de d!.!c+"(a(e
    !n(er&ersona"7 %arca(7 , n+ s+n( cons!dera(e a .! (+"'+rare de erec=!e a '7r'a(+"+!.
    Un d!a$nos(!c de (+"'+rare de erec=!e a '7r'a(+"+! n+ es(e, de ase%enea, adecva(,
    dac7 d!s.+nc=!a erec(!"7 se da(orea/7 +ne! s(!%+"7r! se<+a"e care n+ es(e adecva(7 ca
    .oca"!/are, !n(ens!(a(e s! d+ra(7. B7r'a=!! %a! :n e(a(e &o( neces!(a %a! %+"(7
    s(!%+"are sa+ %a! %+"( (!%& &en(r+ a a@+n$e "a o erec=!e co%&"e(7. Aces(e
    %od!.!c7r! .!/!o"o$!ce n+ (re'+!e s7 .!e cons!dera(e (+"'+rare de erec=!e a '7r'a(+"+!.
    4+C.G4 Tul-urarea $e Or/a&" a
    'e"eii 3anterior. Or/a&"ul 'e"inin
    in@i-at6
    <7G

    (riteriile de dia.nostic pentru
    +E2.82 Tulburarea de $rec3ie a Brbatului
    A. In#apa#itatea re#urent( &au per&i&tent( $e a atin/e ori $e a "en!ine o
    ere#!ie a$e#vat( pNn( a reali)area a#tivit(!ii &e,uale.
    8. Pertur-area #au)ea)( $etre&( &au $i%i#ultate interper&onal( "ar#at( .
    C. Di&%un#!ia ere#til( nu e&te e,pli#at( "ai -ine $e art( tul-urare $e pe a,a l
    3arta $e#Nt o $i&%un#!ie &e,ual(6 &i nu &e $atorea)( e,#lu&iv e%e#telor
    %i)iolo/i#e ale unei &u-&tan!e 3$e e,2 un $ro/ $e a-u) &au un "e$i#a"ent6
    ori ale unei #on$i!ii "e$i#ale /enerale.
    De secificat tipulM
    Tip pri"ar Tip
    #(p(tat
    De &pe#i%i#at tipulM
    Tip /enerali)at
    Tip &ituational
    De secificat2
    Datorat( %a#torilor p&i@olo/i#i
    Datorat( unor %a#tori #o"-ina!i
    Tulburrile Or/a&"A#e
    4+C.G4 Tul-urarea $e Or/a&" a 'e"eii
    (anterior3 Or/a&"ul 'e"inin In@i-at6
    Ele"ente $e $ia/no&ti#
    $lementul esen3ial al tulburrii de or.asm a femeii @l constituie @ntPrzierea sau
    absen3a2 recurent sau persistent2 a or.asmului2 dup o faz de excita3ie sexual
    normal *criteriul A,. )emeile prezint o mare variabilitate in tipul sau intensitatea
    stimulrii care declan/eaz or.asmul. 9ia.nosticul de tulburare de or.asm a femeii
    trebuie s se bazeze pe Audecata clinicianului c abilitatea or.asmic a femeii este
    sub cea rezonabil pentru etatea2 experien3a sexual si adecvarea stimulrii sexuale
    pe care aceasta o prime/te. 6erturbarea trebuie s cauzeze detres sau dificult3i
    interpersonale semnificative *criteriul B,. 9isfunc3ia nu este explicat mai bine de
    alt tulburare de pe axa # *cu excep3ia altei disfunc3ii sexuale, si nu se datoreaz
    exclusiv efectelor fiziolo.ice directe ale unei substan3e *inclusiv medicamente, ori
    ale unei condi3ii medicale .enerale *criteriul Q.
    Su-tipuri
    Subtipurile sunt prevzute pentru a indica debutul *primar versus cptat,2
    contextul *.eneralizat versus situational, si factorii etiolo.ici *datorat factorilor
    AH8 Tulburrile Sexuale ,i de Identitate Sexual

    &s!o"o$!c!, da(ora(7 +nor .ac(or! co%'!na=!J &en(r+ (+"'+rarea or$as%!c7 a
    .e%e!!. E3e/! descr!er!"e "a &a$. Y;RJ.
    *lemente si tulburri asociate
    N+ s4a cons(a(a( n!c! o asoc!ere :n(re &ar(ern+r!"e s&ec!.!ce de (r7s7(+r! de
    &ersona"!(a(e sa+ de &s!o&a(o"o$!e s! d!s.+nc(!a or$as%!c7 "a .e%e!. T+"'+rarea de
    or$as% a .e%e!! &oa(e a.ec(a !%a$!nea cor&ora"7, s(!%a de s!ne sa+ sa(!s.ac=!a
    re"a=!ona"7. Con.or% +nor s(+d!! con(ro"a(e, ca&ac!(a(ea or$as%!c7 n+ es(e core"a(7
    c+ d!%ens!+nea va$!n+"+! sa+ c+ .or=a %+Oc!"or &e"v!n!. DeO! .e%e! c+ "e/!+n! a"e
    %7d+ve! s&!n7r!!, :nde&7r(area v+"ve! sa+ e<c!/!a O! recons(r+c=!a va$!n+"+!, a+
    re"a(a( c7 a@+n$ "a or$as%, d!s.+nc(!a or$as%!c7 es(e ra&or(a(7 .recven( "a .e%e!"e c+
    aces(e cond!=!!, :n $enera", :ns7 cond!=!! %ed!ca"e $enera"e, ca d!a'e(+" s! cancer+"
    &e"v!n, es(e .oar(e &os!'!" s7 a"(ere/e .a/a de e<c!(a=!e a r7s&+ns+"+! se<+a", "7sAnd
    ca&ac!(a(ea or$as%!c7 re"a(!v !n(ac(7.
    *voluie
    Deoarece ca&ac!(a(ea or$as%!c7 "a .e%e! cres(e c+ e(a(ea, (+"'+rarea de or$as%
    a .e%e!! &oa(e .! %a! &reva"en(7 "a .e%e!"e (!nere. Ce"e %a! %+"(e (+"'+r7r! de
    or$as% a"e .e%e!! s+n( %a! c+rAnd e<!s(en(e d!n(o(dea+na, decA( c7&7(a(e. Oda(7 ce
    o .e%e!e :nva=7 c+% s7 a@+n$7 "a or$as%, ea .oar(e rar &!erde aceas(7 ca&ac!(a(e,
    e<ce&(And co%+n!carea se<+a"7 red+s7, re"a=!!"e con."!c(+a"e, o e<&er!en=7
    (ra+%a(!/an(7 Ede e<., v!o"+"J, o (+"'+rare a.ec(!v7 sa+ o cond!=!e %ed!ca"7 $enera"7.
    CAnd d!s.+nc(!a or$as%!c7 s+rv!ne n+%a! :n an+%!(e s!(+a=!!, &e "An$7 (+"'+rarea
    or$as%!c7, s+n( adesea &re/en(e d!.!c+"(7=! c+ dor!n=a s! e<c!(a=!a se<+a"7. M+"(e
    .e%e! :O! cresc ca&ac!(a(ea or$as%!c7 &e %7s+r7 ce e<&er!en(ea/7 o var!e(a(e %a!
    "ar$7 de s(!%+"are s! ca&7(7 %a! %+"(e c+noO(!n=e des&re &ro&r!+" "or cor&.
    Dia!nostic di$erenial
    T+"'+rarea de or$as% a .e%e!! (re'+!e s7 .!e d!s(!ns7 de o d!s.+nc=!e se<+a"7
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" adecva( (re'+!e s7 .!e ce" de
    d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd se cons!der7 c7
    d!s.+nc(!a es(e da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce a"e +ne! cond!=!! %ed!ca"e
    $enera"e s&ec!.!ca(e Ede e<., o "e/!+ne a %7d+ve! s&!n7r!!J Eve/! &a$. YYGJ. Aceas(7
    &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c. Dac7, a(A(
    (+"'+rarea de or$as% a .e%e!!, cA( s! o cond!=!e %ed!ca"7 $enera"7 s+n( &re/en(e,
    dar se cons!der7 c7 d!s.+nc(!a se<+a"7 n+ se da(orea/7 e<c"+s!v e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e cond!=!e! %ed!ca"e $enera"e, a(+nc! es(e d!a$nos(!ca(7 (+"'+rarea de
    or$as% a .e%e!! da(ora(7 +nor .ac(or! co%'!na=!.
    :n con(ras( c+ (+"'+rarea de or$as% a .e%e!!, o d!s.+nc=!e se<+a"7 !nd+s7 de o
    s+'s(an=7 es(e cons!dera(7 a .! da(ora(7 e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne!
    s+'s(an=e Ede e<., an(!de&res!ve, 'en/od!a/e&!ne, ne+ro"e&(!ce, an(!!&er(ens!ve,
    o&!aceeJ Eve/! &a$. YR9J. Dac7, a(A( (+"'+rarea de or$as% a .e%e!!, cA( s! +/+" +ne!
    s+'s(an=e s+n( &re/en(e, dar se cons!der7 c7 d!s.+nc(!a se<+a"7 n+ se da(orea/7
    e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +/+"+! de s+'s(an=7, a(+nc! es(e
    d!a$nos(!ca(7 (+"'+rarea de or$as% a .e%e!! da(ora(7 +nor .ac(or! co%'!na=!.
    Dac7 d!s.+nc(!a se<+a"7 es(e cons!dera(7 a .! da(ora(7 e<c"+s!v e.ec(e"or
    .!/!o"o$!ce, a(A( a"e +ne! cond!=!! %ed!ca"e $enera"e, cA( O! a"e +/+"+! +ne! s+'s(an=e,
    4572?4 Tulburarea de Or!asm a
    'emeii &anterior2 Or!asmul 'eminin
    In%ibat)
    YIF
    es(e d!a$nos(!ca(7, a(A( d!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    cA( s! d!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7.
    T+"'+rarea de or$as% a .e%e!! &oa(e s+rven!, de ase%enea, :n asoc!ere c+ a"(e
    d!s.+nc=!! se<+a"e Ede e<., (+"'+rarea de e<c!(a=!e se<+a"7 a .e%e!!J. Dac7 es(e aOa,
    (re'+!e s7 .!e d!a$nos(!ca(e a%'e"e. Un d!a$nos(!c ad!=!ona" de (+"'+rare de or$as%
    a .e%e!! n+ es(e &+s de re$+"7 dac7 d!.!c+"(a(ea or$as%!c7 es(e e<&"!ca(7 %a! '!ne
    de alt tulburare de pe axa # Ede e<., (+"'+rarea de&res!v7 %a@or7J. Aces( d!a$nos(!c
    ad!=!ona" &oa(e .! &+s cAnd d!.!c+"(a(ea or$as%!c7 &recede (+"'+rarea de &e a<a I or!
    cAnd es(e cen(r+" +ne! a(en=!! c"!n!ce se&ara(e. 6roblemele or.asmice ocazionale2
    care n+ s+n( &ers!s(en(e sa+ rec+ren(e, or! n+ s+n( aco%&an!a(e de de(res7 sa+ de
    d!.!c+"(a(e !n(er&ersona"7 %arca(7, n+ s+n( cons!dera(e a .! (+"'+rare de or$as% a
    .e%e!!. Un d!a$nos(!c de (+"'+rare de or$as% a .e%e!!, de ase%enea, n+ es(e
    adecva( dac7 &ro'"e%e"e se da(orea/7 +ne! s(!%+"7r! se<+a"e !nadecva(e :n cen(rare,
    !n(ens!(a(e s! d+ra(7.
    Criteriile $e $ia/no&ti# pentru 4+C.G4
    Tul-urarea $e Or/a&" a 'e"eii
    A2 "nt@r(ierea sau absena, persistent sau recurent, a or!asmului, dup o
    $a( de excitaie sexual normal2 'emeile pre(int o mare variabilitate "n
    tipul sau intensitatea stimulrii care declan,ea( or!asmul2 Dia!nosticul de
    tulburare de or!asm a $emeii trebuie s se ba(e(e pe 0udecata clinicianului
    c abilitatea or!asmic a $emeii este mai redus dec@t ar $i re(onabil pentru
    etatea $emeii, experiena sa sexual ,i adecvarea stimulrii sexuale pe care
    L prime,te2
    S2 #erturbarea cau(ea( detres sau di$icultate interpersonal marcat 2
    2 Dis$uncia or!asmic nu este explicat mai bine de alt tulburare de pe axa
    E&cu excepia altei dis$uncii sexuale) ,i nu se datorea( exclusiv e$ectelor
    $i(iolo!ice directe ale unei substane &de ex2, un dro! de abu(, un
    medicament) sau ale unei condiii medicale !enerale2
    De speci"icat tipulD Tip
    primar Tip cptat
    De speci"icat tipulD
    Tip !enerali(at
    Tip situaional
    De speci"icat'
    Datorat $actorilor psi%olo!ici
    Datorat unor $actori combinai
    55E Tul-ur(rile Se,uale Ei $e I$entitate Se,ual(

    4++.G7 Tul-urarea $e Or/a&" a 8(r-atului
    (anterior, Or/a&"ul Ma&#ulin In@i-at6
    Ele"ente $e $ia/no&ti#
    $lementul esen3ial al tulburrii de or.asm a brbatului @l constituie o @ntPrziere
    sau absen32 persistent sau recurent2 a or.asmului2 dup o faz de excita3ie
    sexual normal2 @n Audecarea faptului dac or.asmul este @ntPrziat2 clinicianul
    trebuie s ia @n considera3ie etatea persoanei si faptul dac stimularea este adecvat
    @n centrare2 intensitate si durat *criteriul A,. 6erturbarea trebuie s cauzeze o
    detres sau dificultate interpersonal marcat *criteriul B,. 9isfunctia or.asmic nu
    este explicat mai bine de alt tulburare de pe axa # *cu excep3ia altei disfunc3ii
    sexuale, /i nu este datorat exclusiv efectelor fiziolo.ice directe ale unei substan3e
    *inclusiv a medicamentelor, sau ale unei condi3ii medicale .enerale *criteriul Q. @n
    cea mai comun form de tulburare de or.asm a brbatului2 un brbat nu poate
    aAun.e la or.asm @n timpul actului sexual2 de/i poate eAacula la stimularea manual
    sau oral a partenerei. Unii brba3i cu tulburarea de or.asm a brbatului pot aAun.e
    ia or.asm coital2 dar numai dup o foarte prelun.it /i intens stimulare
    noncoital. Unii pot eAacula numai prin masturbare. Un .rup si mai mic a
    experimentat or.asm numai @n momentul de/teptrii dintrBun vis erotic.
    Subtipuri
    Subtipurile sunt prevzute pentru a indica debutul *primar versus cptat,2
    contextul *.eneralizat versus situa3ional, si factorii etiolo.ici *datorat factorilor
    psi-olo.ici2 datorat unor factori combina3i, pentru tulburarea or.asmic a
    brbatului. *:ezi descrierea la pa.. 5+>,.
    *lemente si tulburri asociate
    M+"=! '7r'a=! anor$as%!c! co!(a" descr!+ o sen/a=!e e<c!(an(7 "a :nce&+(+" +n+!
    ac( se<+a", dar c7 !n(ro%!s!+nea dev!ne %a! c+rAnd o corvoad7 decA( o &"7cere.
    Poa(e .! &re/en( +n &a((e% de e<c!(a=!e se<+a"7 &ara.!")7. CAnd +n '7r'a( a asc+ns
    "!&sa sa de or$as% co!(a" .a=7 de Oo(!a sa, c+&"+" se &oa(e &re/en(a c+ !n.er(!"!(a(e de
    ca+/7 nec+nosc+(7. T+"'+rarea &oa(e d+ce "a &er(+r'area re"a=!!"or %ar!(a"e sa+
    se<+a"e e<!s(en(e. B7r'a=!! &o( a@+n$e de re$+"7 "a or$as%, c!ar cAnd cond!=!!
    vasc+"are sa+ ne+ro"o$!ce !n(er.erea/7 c+ r!$!d!(a(ea erec(!"7. A(A( sen/a=!a de
    or$as%, cA( s! con(rac=!!"e %+Oc!+"+! s(r!a( "a or$as% r7%An !n(ac(e "a '7r'a=!! care4
    O! &!erd &ros(a(a O! ve/!c+"e"e se%!na"e &r!n c!r+r$!e &e"v!n7 rad!ca"7. Or$as%+"
    &oa(e, de ase%enea, s+rver+ :n a'sen=a e%!s!+n!! de s&er%7 Ede e<., cAnd $an$"!on!!
    s!%&a(!c! s+n( "e/a=! c!r+r$!ca" sa+ &r!n(r4o ne+ro&a(!e ve$e(a(!v7J.
    Dia!nostic di$erenial
    Tulburarea de or.asm a brbatului trebuie s fie distins de o disfunc3ie sexuala
    datorat unei condi3ii medicale .enerale. 9ia.nosticul corespunztor trebuie s fie
    cel de disfunc3ie sexual datorat unei condi3ii medicale .enerale2 cPnd disfunc3ia
    este considerat a fi datorat exclusiv efectelor fiziolo.ice ale unei condi3ii medicale
    .enerale specifice *de ex.2 -iperprolactinemie, *vezi pa.. 55=,. Aceasta precizare se
    4++.G7 Tul-urarea $e Or/a&" a 8(r-atului
    3anterior. Or/a&"ul Ma&#ulin In@i-at6 <<*
    bazeaz pe istoric2 datele de laborator sau examenul somatic. Testarea pra.ului
    senzorial poate demonstra o reducere a sensibilit3ii @n pielea de pe penis datorat
    unei condi3ii neurolo.ice *de ex.2 leziuni ale mduvei spinrii2 neuropatii senzitive,.
    9ac2 atPt tulburarea de or.asm a brbatului2 cPt /i o condi3ie medical .eneral
    sunt prezente2 dar se consider c disfunc3ia sexual nu se datoreaz exclusiv
    efectelor fiziolo.ice directe ale condi3iei medicale .enerale2 atunci este
    dia.nosticat tulburarea de or.asm a barbarului datorat unor factori combina3i.
    #n contrast cu tulburarea de or.asm a brbatului2 o disfunctie sexual indus
    de o substan3 este considerat a fi datorat exclusiv efectelor fiziolo.ice directe ale
    unei substan3e *de ex.2 alcool2 opiacee2 anti-ipertensive2 antidepresive2
    neuroleptice, *vezi pa.. 5>2,. 9ac2 atPt tulburarea de or.asm a brbatului2 cPt /i
    uzul de o substan3 sunt prezente2 dar se consider c disfunc3ia sexual nu se
    datoreaz exclusiv efectelor fiziolo.ice directe ale substan3ei2 atunci este
    dia.nosticat tulburarea de or.asm a brbatului datorat unor factori combina3i.
    9ac disfunc3ia sexual este considerat a fi datorat exclusiv efectelor
    fiziolo.ice2 atPt ale unei condi3ii medicale .enerale2 cPt si ale uzului unei substan3e2
    atunci este dia.nosticat2 atPt disfunc3ia sexual datorat unei condi3ii medicale
    .enerale2 cPt si disfunc3ia sexual indus de o substan3.
    Tulburarea de or.asm a brbatului poate surveni2 de asemenea2 @n asociere cu
    alte disfunctii sexuale *de ex.2 tulburarea de erec3ie a brbatului,. 9ac este a/a2
    trebuie s fie men3ionate ambele. Un dia.nostic adi3ional de tulburare de or.asm a
    brbatului nu se pune de re.ul2 dac tulburarea de or.asm a brbatului este
    explicat mai bine de alt tulburate de pe axa # *de ex.2 tulburarea depresiv
    maAor,. Un dia.nostic adi3ional poate fi pus cPnd dificultatea or.asmic precede
    tulburarea de pe axa # sau este centrul unei aten3ii dimce separate. <ai multe tipuri
    de disfunctie sexual *de Rx.2 eAaculare2 dar fr or.asm plcut2 or.asm care survine
    fr eAaculare de sperm mai curPnd decPt cu o eAaculare propulsiv,2 trebuie s fie
    dia.nosticate ca disfunctie sexual fr alt specifica3ie mai curPnd ca tulburare
    de or.asm a brbatului.
    6roblemele or.asmice ocazionale2 care nu sunt persistente sau recurente2 sau
    nu sunt @nso3ite de detres sau de dificult3i interpersonale marcate2 nu sunt
    considerate a fi tulburare de or.asm a brbatului. 6e msur ce brba3ii avanseaz
    @n etate2 ei pot necesita o perioad mai lun. de stimulare pentru a aAun.e la
    or.asm. (linicianul trebuie s se asi.ure2 de asemenea2 c a existat suficient
    stimulare pentru a atin.e or.asmul.
    YY9 Tulburrile Sexuale ,i de Identitate Sexual
    Criteriile $e $ia/no&ti# pentru
    4+C.G7 Tul-urarea $e Or/a&" a 8(r-atului
    A2 "nt@r(ierea sau absena, persistent sau recurent, a or!asmului, dup o
    $a( de excitaie sexual normal "n cursul activitii sexuale pe care
    clinicianul, in@nd cont de etatea persoanei, o consider a $i adecvat "n
    $ocali(are, intensitate ,i durat2
    S2 #erturbarea cau(ea( detres sau di$icultate interpersonal marcat 2
    2 Dis$uncia or!asmic nu este explicat mai bine de alt tulburare de pe axa
    l &cu excepia altei dis$uncii sexuale) ,i nu se datorea( exclusiv e$ectelor
    $i(iolo!ice directe ale unei substane &de ex2, un dro! de abu(, un
    medicament) ori ale unei condiii medicale !enerale2
    7e speci"icat tipulD
    Tip primar Tip
    cptat
    7e speci"icat tipulD
    Tip !enerali(at
    Tip situaional
    De speci"icat'
    Datorat $actorilor psi%olo!ici
    Datorat unor $actori combinai
    4+C.G< EQa#ularea Pre#o#e
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" e@ac+"7r!! &recoce :" cons(!(+!e de'+(+" rec+ren( sa+
    &ers!s(en( a" or$as%+"+! s! e@ac+"7r!! "a o s(!%+"are se<+a"7 %!n!%7, :na!n(e, :n
    c+rs+" sa+ "a sc+r( (!%& d+&7 &ene(rare s! :na!n(e ca &ersoana s4o doreasc7 Ecr!(er!+"
    AJ. C"!n!c!an+" (re'+!e s7 =!n7 con( de .ac(or!! care a.ec(ea/7 d+ra(a .a/e! de
    e<c!(a=!e, c+% ar .! e(a(ea, no+(a(ea &ar(enere! sa+ a s!(+a=!e! se<+a"e s! .recven=a
    recen(7 a ac(!v!(7=!! se<+a"e. Ma@or!(a(ea '7r'a=!"or c+ aceas(7 (+"'+rare &o( :n(Ar/!a
    or$as%+" &r!n a+(o%as(+r'are, o &er!oad7 de (!%& cons!dera'!" %a! "+n$7 decA( :n
    (!%&+" co!(+"+!. Es(!%7r!"e &ar(enere"or re.er!(oare "a d+ra(a &er!oade! de (!%&, de
    "a :nce&+(+" ac(!v!(7=!! se<+a"e s! &An7 "a e@ac+"are, &rec+% s! &7rerea "or dac7
    e@ac+"area &recoce cons(!(+!e o &ro'"e%7, &o( .! .oar(e d!.er!(e. Per(+r'area (re'+!e
    s7 ca+/e/e o de(res7 sa+ d!.!c+"(a(e !n(er&ersona"7 %arca(7 Ecr!(er!+" BJ. E@ac+"area
    &recoce n+ se da(orea/7 e<c"+s!v e.ec(e"or d!rec(e a"e +ne! s+'s(an=e Ede e<.,
    a's(!nen=e! de o&!aceeJ Ecr!(er!+" CJ.
    4572?A *0acularea
    #recoce
    <<4
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+" E&r!%ar7 vers+s c7&7(a(7J,
    con(e<(+" E$enera"!/a(7 vers+s s!(+a=!ona"7J s! .ac(or!! e(!o"o$!c! Eda(ora(7
    .ac(or!"or &s!o"o$!c!, da(ora(7 +nor .ac(or! co%'!na=!J &en(r+ e@ac+"area &recoce.
    E3e/! &a$. Y;RJ.
    *lemente si tulburri asociate
    Ca s! a"(e d!s.+nc=!! se<+a"e, e@ac+"area &recoce &oa(e crea (ens!+ne :n(r4o re"a=!e.
    Un!! '7r'a=! nec7s7(or!=! e/!(7 s7 se :n(A"neasc7 c+ &ar(enere no! d!n ca+/a .r!c!! de
    a n+ .! !nco%oda=! de (+"'+rare. Aceas(a &oa(e con(r!'+! "a !/o"area soc!a"7.
    *voluie
    O %+"=!%e de '7r'a=! (!ner! :nva=7 s7 :n(Ar/!e or$as%+" &e %7s+r7 ce ca&7(7
    e<&er!en=7 se<+a"7 s! ava2nsea/7 :n e(a(e, dar +n!! con(!n+7 s7 e@ac+"e/e &recoce s!
    &o( cere a@+(or &en(r+ (+"'+rare. Un!! '7r'a=! s+n( ca&a'!"! s7 :n(Ar/!e e@ac+"area
    :n(r4o re"a=!e de "+n$7 d+ra(7, dar e<&er!en(ea/7 o rec7dere a e@ac+"7r!! &recoce cAnd
    a+ o &ar(ener7 no+7. De re$+"7, e@ac+"area &recoce se :n(A"neO(e "a '7r'a=!! (!ner! s!
    es(e &re/en(7 de "a &r!%a "or :ncercare de con(ac( se<+a", :ns7, +n!! '7r'a=! :O! &!erd
    ca&ac!(a(ea de a :n(Ar/!a or$as%+" d+&7 o &er!oad7 de .+nc=!onare adecva(7. CAnd
    de'+(+" s+rv!ne d+&7 o &er!oad7 de .+nc=!onare adecva(7, con(e<(+" :" cons(!(+!e
    adesea o red+cere a .recven=e! ac(!v!(7=!! se<+a"e, an<!e(a(ea !n(ens7 :n "e$7(+r7 c+
    rea"!/area ac(+"+! se<+a" c+ o &ar(ener7 no+7 sa+ &!erderea con(ro"+"+! as+&ra
    e@ac+"7r!! asoc!a(7 c+ d!.!c+"(a(ea de a a@+n$e "a erec=!! sa+ de a "e %en=!ne. Un!!
    '7r'a=!, care a+ :nce(a( +/+" re$+"a( de a"coo", &o( &re/en(a e@ac+"are &recoce,
    deoarece e! se 'a/a+ &e '7+( &en(r+ a :n(Ar/!a or$as%+", :n "oc de s(ra(e$!!
    co%&or(a%en(a"e :nv7=a(e.
    Dia!nostic di$erenial
    E@ac+"area &recoce (re'+!e s7 .!e d!s(!ns7 de d!s.+nc=!a erec(!"7 :n "e$7(+r7 c+
    de/vo"(area +ne! cond!=!! %ed!ca"e $enera"e Eve/! &a$. YYGJ. Un!! !nd!v!/! c+
    d!s.+nc=!e erec(!"7 &o( o%!(e s(ra(e$!!"e +/+a"e de :n(Ar/!ere a or$as%+"+!. A"=!!
    neces!(7 o s(!%+"are nonco!(a"7 &re"+n$!(7 &en(r+ a de/vo"(a +n $rad de erec=!e
    s+.!c!en(7 &en(r+ !n(ro%!s!+ne. La as(.e" de !nd!v!/!, e<c!(a=!a se<+a"7 &oa(e .! a(A(
    de !n(ens7, c7 e@ac+"area s+rv!ne !%ed!a(. Pro'"e%e"e oca/!ona"e c+ e@ac+"area
    &recoce, care n+ s+n( &ers!s(en(e sa+ rec+ren(e or! n+ s+n( aco%&an!a(e de de(res7
    or! d!.!c+"(a(e !n(er&ersona"7 %arca(7, n+ dese%nea/7 &en(r+ d!a$nos(!c+" de
    e@ac+"are &recoce. C"!n!c!an+" (re'+!e, de ase%enea, s7 =!n7 con( de e(a(ea
    !nd!v!d+"+!, de e<&er!en=a sa se<+a"7 $enera"7, ac(!v!(a(ea se<+a"7 recen(7 s! de
    no+(a(ea &ar(enere!. CAnd &ro'"e%e"e c+ e@ac+"area &recoce se da(orea/7 e<c"+s!v
    +/+"+! +ne! s+'s(an=e Ede e<., a's(!nen=e! de o&!aceeJ, &oa(e .! d!a$nos(!ca(7 o
    d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 Eve/! &a$. YR9J.
    <<7 Tul-ur(rile Se,uale &i $e I$entitate Se,ual(

    Criteriile $e $ia/no&ti# pentru 4+C.G< EQa#ularea Pre#o#e
    A. EQa#ulare per&i&tent( &au re#urent( la o e,#ita!ie &e,ual( "ini"(2 .naintea2
    .n ti"pul &au &#urt ti"p $up( penetrare2 Ei .nainte #a per&oana &-o $orea&#(.
    Clini#ianul tre-uie &( !in( #ont $e %a#torii #are a%e#tea)( $urata %a)ei $e
    e,#ita!ie2 #u" ar %i noutatea partenerei &au &itua!iei &e,uale &i %re#ven!a
    re#ent( a a#tivit(!ii &e,uale.
    8. Pertur-area #au)ea)( o $etre&( &au $i%i#ultate interper&onal( "ar#at( .
    C. EQa#ularea pre#o#e nu &e $atorea)( e,#lu&iv e%e#telor $ire#te ale unei
    &u-&tan!e 3$e e,2 a-&tinen!ei $e opia#ee6.
    De secificat tipulM
    Tip pri"ar Tip
    #(p(tat
    De secificat tipulM
    Tip /enerali)at
    Tip &itua!ional
    De secificat2
    Datorat( %a#torilor p&i@olo/i#i
    Datorat( %a#torilor #o"-ina!i
    Tulburrile #l&ice Se.uale
    4+C.G= Di&pareunia 3Ne$atorat(
    unei Con$i!ii Me$i#ale Generale6
    Ele"ente $e $ia/no&ti#
    $lementul esen3ial al dispareuniei @l constituie durerea .enital asociat cu
    contactul sexual *criteriul A,. 9e/i aceasta este cel mai frecvent experientat in
    cursul coltului2 ea poate apare2 de asemenea2 @nainte sau dup contactul sexual
    Tulburarea poate apare atPt la brba3i2 cPt si la femeiB a femei2 durerea poate fi
    descris ca superficial2 @n cursul intromisiunii2 sau ca profund2 @n timpul
    ptrunderii penisului. #ntensitatea simptomelor poate mer.e de la un u/or
    disconfort pPn la o durere acut. 6erturbarea trebuie s cauzeze detres sau
    dificultate interpersonal marcat *criteriul B,. 6erturbarea nu este cauzat
    exclusiv de va.inism sau de lipsa de lubrifiere2 nu este explicat mai bine de a-a
    tulburare de pe axa # *cu excep3ia altei disfunc3ii sexuale, si nu este datorat
    exclusiv efectelor fiziolo.ice ale unei substan3e *de ex.2 un dro. de abuz2 un
    medicament, ori ale unei condi3ii medicale .enerale *criteriul Q.
    4+C.G= Di&pareunia
    3Ne$atorat( unei Con$i!ii Me$i#ale
    Generale6
    <<<

    Su-tipuri
    Subtipurile sunt prevzute pentru a indica debutul *primar versus cptat,2
    contextul *.eneralizat versus situational, si factorii etiolo.ici *datorat factorilor
    psi-olo.ici2 datorat unor factori combina3i, pentru dispareunie. *:ezi descrierea
    de la pa.. 5+>,.
    Ele"ente Ei tul-ur(ri a&o#iate
    9ispareunia este rar principala acuz @n unit3ile de sntate mental. #ndivizii
    cu dispareunie solicit de re.ul tratament @n unit3ile medicale .enerale.
    $xamenul somatic al indivizilor cu aceast tulburare nu demonstreaz de re.ul
    anomalii .enitale. $xperientarea repetat a durerii .enitale @n cursul croitului poate
    duce la evitarea experien3elor sexuale2 la ruperea rela3iilor sexuale existente ori la
    limitarea dezvoltrii unor noi rela3ii sexuale.
    Evolu!ie
    (antitatea limitat de informa3ii disponibile su.ereaz c evolu3ia dispareuniei
    tinde a fi cronic.
    Dia/no&ti# $i%eren!ial
    9ispareunia trebuie s fie distins de disfunctia sexual datorat unei condi3ii
    medicale .enerale *vezi pa.. 55=,. 9ia.nosticul corespunztor trebuie s fie cel de
    disfunc3ie sexual datorat unei condi3ii medicale .enerale2 cPnd disfunctia este
    considerat a fi datorat exclusiv efectelor fiziolo.ice ale unei condi3ii medicale
    .enerale specifice *de ex..r lubrifiere va.inal insuficientS patolo.ie pelvin2 cum ar
    fi infec3ii va.inale sau ale tractului urinar2 3esut va.inal dcatriaal2 endometrioz
    sau aderen3eS atrofie va.inal postmenopauz2 deprivare estro.en temporar prin
    lacta3ieS iritarea sau infec3ia tractului urinar sau condi3ii .astrointestinale,. Aceast
    precizare se bazeaz pe istoric2 datele de laborator sau examenul somatic. 9ac2 atPt
    dispareunia2 cPt /i o condi3ie medical .eneral sunt prezente2 dar se consider c
    disfunctia sexual nu se datoreaz exclusiv efectelor fiziolo.ice directe ale unei
    condi3ii medicale .enerale2 atunci este pus dia.nosticul de dispareunie datorat
    unor factori combina3i.
    @n contrast cu dispareunia2 o disfunc3ie sexual indus de o substan3 este
    considerat a fi datorat exclusiv efectelor fiziolo.ice ale substan3ei *vezi pa.. 5>2,.
    Un or.asm dureros a fost descris la fiuf enazin2 tioridazin si amoxapin. 9ac este
    prezent atPt dispareunia2 cPt /i uzul unei substan3e2 dar se consider c disfunctia
    sexual nu se datoreaz exclusiv efectelor fiziolo.ice ale uzului substan3ei2 arunci
    este dia.nosticat dispareunia datorat unor factori combina3i
    9ac durerea sexual este considerat a fi datorat exclusiv efectelor fiziolo.ice
    atPt ale unei substan3e2 cPt si ale unei condi3ii medicale .enerale2 este dia.nosticat
    atPt disfunctia sexual indus de o substan32 cPt si disfunctia sexual datorat unei
    condi3ii medicale .enerale.
    9ispareunia nu este dia.nosticat dac este cauzat exclusiv de va.inism sau de
    o lips de lubrifiere. Un dia.nostic adi3ional de dispareunie nu este pus de re.ul
    dac disfunctia sexual este explicat mai bine de alt tulburare de pe axa # *de ex.2
    tulburarea de somatizare,. 9ia.nosticul adi3ional poate fi pus cPnd dificult3ile
    AAI Tulburrile Sexuale ,i de Identitate Sexual
    or$as%!ce &reced (+"'+rarea de &e a<a I or! s+n( cen(r+" +ne! a(en=!! c"!n!ce
    se&ara(e. D!s&are+n!a &oa(e s+rven!, de ase%enea, :n asoc!ere c+ a"(7 d!s.+nc=!e
    se<+a"7 Ec+ e<ce&=!a va$!n!s%+"+!J, !ar dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+
    a%'e"e, (re'+!e s7 .!e cod!.!ca(e a%'e"e. D+rerea oca/!ona"7 asoc!a(7 c+ ra&or(+"
    se<+a", care n+ es(e &ers!s(en(7 sa+ rec+ren(7 or! n+ es(e aco%&an!a(7 de de(res7
    sa+ de d!.!c+"(a(e !n(er&ersona"7 %arca(7, n+ es(e cons!dera(7 a .! d!s&are+n!e.
    Criteriile $e $ia/no&ti# pentru 4+C.G= Di&pareunie
    A2 Durere !enital recurent sau persistent asociat cu contactul sexual, $ie la
    brbat, $ie la $emeie2
    S2 #erturbarea cau(ea( detres sau di$icultate interpersonal marcat 2
    2 #erturbarea nu este cau(at exclusiv de va!inism sau de lipsa de lubri$iere,
    nu este explicat mai bine de alt tulburare de pe axa l &cu excepia altei
    dis$uncii sexuale) ,i nu se datorea( exclusiv e$ectelor $i(iolo!ice ale unei
    substane &de ex2, un dro! de abu(, un medicament) ori ale unei condiii
    medicale !enerale2
    7e speci"icat tipulD Tip
    primar Tip cptat
    7e speci"icat tipulD
    Tip !enerali(at
    Tip situeional
    De speci"icat'
    Datorat( %a#torilor p&i@olo/i#i
    Datorat( unor %a#tori #o"-ina!i
    4+=.<* Va/ini&"ul 3Ne$atorat unei
    Con$i!ii Me$i#ale Generale6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" va$!n!s%+"+! :" cons(!(+!e con(rac=!a !nvo"+n(ar7
    &ers!s(en(7 sa+ rec+ren(7 a %+Oc!"or &er!nea"! care :ncon@oar7 (re!%ea e<(ern7 a
    va$!n+"+! cAnd se :ncearc7 &ene(rarea va$!n+"+! c+ &en!s+", de$e(+", (a%&on+" sa+
    s&ec+"+" Ecr!(er!+" AJ. Per(+r'area (re'+!e s7 ca+/e/e de(res7 sa+ d!.!c+"(a(e
    !n(er&ersona"7 %arca(7 Ecr!(er!+" BJ. Per(+r'area n+ es(e e<&"!ca(7 %a! '!ne de a"(7
    (+"'+rare de &e a<a I Ec+ e<ce&=!a a"(e! d!s.+nc=!! se<+a"eJ s! n+ se da(orea/7
    e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" CJ.
    La +ne"e .e%e!, c!ar an(!c!&area +ne! &ene(r7r! va$!na"e &oa(e d+ce "a s&as%
    %+sc+"ar. Con(rac=!a &oa(e %er$e de "a +Ooar7, !nd+cAnd o oarecare s(rA%(are sa+
    d!scon.or(, &An7 "a sever7, :%&!ed!cAnd &ene(rarea.
    45I2AE Va!inismul &Fedatorat unei ondiii Medicale Generale) AA?
    Subtipuri
    S+'(!&+r!"e s+n( &rev7/+(e &en(r+ a !nd!ca de'+(+" *primar vers+s c7&7(a(J,
    con(e<(+" *.eneralizat vers+s situational, O! .ac(or!! e(!o"o$!c! *datorat factorilor
    psi-olo.ici2 datorat unor factori combina3i, &en(r+ va$!n!s%. E3e/! descr!er!"e de
    "a &a$. Y;RJ.
    *lemente si tulburri asociate
    R7s&+ns+r!"e se<+a"e Ede e<., dor!n=7, &"7cere, ca&ac!(a(ea or$as%!c7J &o( s7 n+
    .!e de(er!ora(e, :n a.ar7 de ca/+" cAnd es(e :ncerca(7 sa+ an(!c!&a(7 &ene(rarea.
    O's(r+c=!a .!/!c7 da(ora(7 con(rac=!e! %+sc+"are &rev!ne de re$+"7 co!(+". Ca a(are,
    cond!=!a &oa(e "!%!(a de/vo"(area re"a=!!"or se<+a"e s! r+&e re"a=!!"e se<+a"e e<!s(en(e.
    A+ .os( descr!se ca/+r! de %ar!a@ necons+%a( s! de !n.er(!"!(a(e, asoc!a(e c+ aceas(7
    cond!=!e. D!a$nos(!c+" es(e &+s adesea :n c+rs+" +nor e<a%ene $!neco"o$!ce de
    r+(!n7, cAnd r7s&+ns+" "a e<a%!narea &e"v!s+"+! d+ce "a o con(rac=!e +Oor de
    o'serva( a or!.!c!+"+! va$!na". :n +ne"e ca/+r!, !n(ens!(a(ea con(rac=!e! &oa(e .! a(A(
    de sever7 sa+ de &re"+n$!(7, c7 &rovoac7 d+rere. La +ne"e .e%e!, va$!n!s%+"
    s+rv!ne :ns7 :n (!%&+" ac(!v!(7=!! se<+a"e, dar n+ O! :n (!%&+" e<a%!n7r!!
    $!neco"o$!ce. T+"'+rarea es(e :n(A"n!(7 %a! .recven( "a .e%e!"e (!nere decA( "a ce"e
    '7(rAne, "a .e%e!"e c+ a(!(+d!n! ne$a(!ve .a=7 de se< O! "a .e%e!"e care a+ +n !s(or!c
    de a'+/ sa+ (ra+%a(!s% se<+a".
    *voluie
    3a$!n!s%+" &r!%ar are de re$+"7 +n de'+( 'r+sc, deven!nd %an!.es( &en(r+
    &r!%a da(7 :n c+rs+" :ncerc7r!"or !n!=!a"e de &ene(rare se<+a"7 de c7(re +n &ar(ener
    sa+ :n c+rs+" &r!%e! e<a%!n7r! $!neco"o$!ce. Oda(7 ce (+"'+rarea es(e !ns(a"a(7,
    evo"+=!a sa es(e cron!c7, c+ e<ce&=!a ca/+"+! cAnd es(e a%e"!ora(7 &r!n (ra(a%en(.
    3a$!n!s%+" c7&7(a( &oa(e, de ase%enea, s+rven! 'r+sc, ca r7s&+ns "a +n (ra+%a(!s%
    se<+a" sa+ "a o cond!=!e %ed!ca"7 $enera"7.
    Dia!nostic di$erenial
    3a$!n!s%+" (re'+!e d!s(!ns de o d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e Eve/! &a$. YYGJ. D!a$nos(!c+" adecva( (re'+!e s7 .!e ce" de
    d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd se cons!der7 c7
    d!s.+nc=!a se da(orea/7 e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    %ed!ca"e $enera"e s&ec!.!ce Ede e<., endo%e(r!o/7 sa+ o !n.ec=!e va$!na"7J.
    Aceas(7 &rec!/are se ba;ea;6 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+"
    so%a(!c.3a$!n!s%+" &oa(e r7%Ane ca o &ro'"e%7 re/!d+a"7 d+&7 re/o"varea +ne!
    cond!=!! %ed!ca"e $enera"e. Dac7 a(A( va$!n!s%+", cA( O! o cond!=!e %ed!ca"7
    $enera"7 s+n( &re/en(e, dar se cons!der7 c7 s&as%e"e va$!na"e n+ se da(orea/7
    e<c"+s!v e.ec(e"or .!/!o"o$!ce d!rec(e a"e cond!=!e! %ed!ca"e $enera"e, es(e &+s
    d!a$nos(!c+" de va$!n!s% da(ora( +nor .ac(or! co%'!na=!.
    3a$!n!s%+" &oa(e s+rven!, de ase%enea, :n asoc!ere c+ a"(e d!s.+nc=!! se<+a"e Ede
    e<., dor!n=a se<+a"7 d!%!n+a(7J. Dac7 es(e aOa, (re'+!e %en=!ona(e a%'e"e. DeO!
    d+rerea asoc!a(7 c+ con(ac(+" se<+a" &oa(e s+rven! :n va$!n!s%, +n d!a$nos(!c
    ad!=!ona" de d!s&are+n!e4n+ es(e &+s. Un d!a$nos(!c ad!=!ona" de va$!n!s% n+ es(e
    &+s de re$+"7, dac7 s&as%e"e va$!na"e s+n( e<&"!ca(e %a! '!ne de a"(7 cond!=!e de
    55= Tul-ur(rile Se,uale &i $e I$entitate Se,ual(

    &e a<a I Ede e<., (+"'+rarea de so%a(!/areJ. D!a$nos(!c+" ad!=!ona" &oa(e .! &+s cAnd
    s&as%e"e va$!na"e &reced (+"'+rarea de &e a<a I or! s+n( cen(r+" +ne! a(en=!! c"!n!ce
    se&ara(e.
    Criteriile $e $ia/no&ti# pentru 4+=.<*Va/ini&"
    A2 Spasm involuntar, persistent sau recurent, al musculaturii treimii externe a
    va!inului, care inter$erea( cu actul sexual2
    8. Pertur-area #au)ea)( $etre&( &au $i%i#ultate interper&onal( "ar#at( .
    C. Pertur-area nu e&te e,pli#at( "ai -ine $e alt( tul-urare $e pe a,a l 3$e e,..
    tul-urarea $e &o"ati)are6 &i nu e&te $atorat( e,#lu&iv e%e#telor %i)iolo/i#e
    $ire#te ale unei #on$i!ii "e$i#ale /enerale.
    De secificat tipulM
    Tip pri"ar Tip
    #(p(tat
    De secificat
    tipulM Tip
    /enerali)at Tip
    &ituational
    De secificat
    Datorat %a#torilor p&i@olo/i#i
    Datorat unor %a#tori #o"-ina!i
    Di&%un#!ia Se,ual( $atorat(
    unei Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    $lementul esen3ial al disfunc3iei sexuale datorate unei condi3ii medicale
    .enerale @l constituie prezen3a unei disfunctii sexuale semnificative clinic
    considerat a fi datorat exclusiv efectelor fiziolo.ice ale unei condi3ii medicale
    .enerale. 9isfunc3ia sexual poate impl1a durerea asociat cu contactul sexual2
    dorin3a sexual redus2 disfunc3ia erectil a brbatului sau alte forme de disfunctie
    sexual *de ex.2 tulburri or.asm1e, si trebuie s cauzeze detres sau dificultate
    interpersonal marcat *criteriul A,. 9in istoric2 examenul somatic si datele de
    laborator trebuie s rezulte c disfunc3ia este explicat inte.ral de efectele
    fiziolo.ice directe ale unei condi3ii medicale .enerale *criteriul B,. 6erturbarea nu
    este explicat mai bine de alt tulburare mental *de ex.2 tulburarea depresiv
    maAor, *criteriul Q.
    @n a preciza dac disfunc3ia sexual este datorat exclusiv unei condi3ii
    medicale .enerale2 clinicianul trebuie s stabileasc mai @ntPi prezen3a unei
    condi3ii medicale .enerale. Apoi2 clinicianul trebuie s stabileasc faptul c
    disfunc3ia sexual este etiolo.ic @n rela3ie cu condi3ia medical .eneral printrBun
    mecanism fiziolo.ic. $ste necesar o evaluare atent si cuprinztoare a numero/i
    factori pentru a face aceast Audecat. 9e/i nu exist criterii infailibile pentru a
    Oi&%un#!ia Se,ual( $atorat( unei Con$i!ii Me$i#ale
    Generale
    <<5

    s(a'!"! dac7 re"a=!a d!n(re d!s.+nc=!a se<+a"7 s! cond!=!a %ed!ca"7 $enera"7 es(e
    e(!o"o$!c7, %a! %+"(e cons!deren(e o.er7 o oarecare $!dare :n aces( do%en!+. Un
    &r!% cons!deren( :" cons(!(+!e &re/en=a +ne! asoc!er! (e%&ora"e :n(re de'+(+",
    e<acer'area sa+ re%!s!+nea cond!=!e! %ed!ca"e $enera"e s! cea a d!s.+nc=!e!
    se<+a"e. Un a" do!"ea cons!deren( :" cons(!(+!e &re/en=a de e"e%en(e care s+n(
    a(!&!ce &en(r+ o d!s.+nc=!e se<+a"7 &r!%ar7 Ede e<., e(a(ea "a de'+( sa+ evo"+=!a
    a(!&!c7J. Da(e"e d!n "!(era(+r7, care s+$erea/7 c7 &oa(e e<!s(a o asoc!ere d!rec(7 :n(re
    cond!=!a %ed!ca"7 $enera"7 :n ces(!+ne O! a&ar!=!a d!s.+nc(!e! se<+a"e, &o( o.er! +n
    con(e<( +(!" :n eva"+area +ne! an+%!(e s!(+a=!!, :n a.ar7 de aceas(a, c"!n!c!an+"
    (re'+!e s7 @+dece .a&(+" dac7 &er(+r'area n+ es(e e<&"!ca(7 %a! '!ne de o d!s.+nc=!e
    se<+a"7 &r!%ar7, de o d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 or! de a"(7
    (+"'+rare %en(a"7 &r!%ar7 Ede e<., (+"'+rarea de&res!v7 %a@or7J. Aces(e &rec!/7r!
    s+n( e<&"!ca(e %a! :n de(a"!+ :n sec=!+nea ST+"'+r7r! %en(a"e da(ora(e +ne! cond!=!!
    %ed!ca"e $enera"eT E&a$. 5G5J.
    D!n con(ra, +n d!a$nos(!c de d!s.+nc=!e se<+a"7 c+ s+'(!&+" Sda(ora(7 +nor
    .ac(or! co%'!na=!T es(e &+s dac7 se cons!der7 c7 o co%'!na=!e de .ac(or! &s!o"o$!c!
    O!, .!e o cond!=!e %ed!ca"7 $enera"7, .!e o s+'s(an=7 es(e cons!dera(7 a avea +n ro"
    e(!o"o$!c, dar n!c! o e(!o"o$!c n+ es(e s+.!c!en(7 &en(r+ a e<&"!ca d!s.+nc=!a.
    Subtipuri
    Cod+" d!a$nos(!c O! (er%en+" &en(r+ o d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e es(e se"ec(a( &e 'a/a d!s.+nc(!e! se<+a"e &redo%!nan(e. Ter%en!!
    %en=!ona=! %a! @os (re'+!e s7 .!e +(!"!/a=! :n "oc+" r+'r!c!! $enera"e de Sd!s.+nc=!e
    se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"eT.
    R9Y.G Dor!n=7 se<+a"7 d!%!n+a(7 a .e%e!! da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A7 Aces( (er%en es(e +(!"!/a( dac7, "a o .e%e!e, dor!n=a se<+a"7
    de.!c!(ar7 sa+ a'sen(7 es(e e"e%en(+" &redo%!nan(.
    >E=.=4 9orin3 sexuala diminuat a brbatului datorat... [Se indic
    condi(ia medical6 /eneral6A7 Aces( (er%en es(e +(!"!/a( dac7, "a +n '7r'a(,
    dor!n=a se<+a"7 de.!c!(ar7 sa+ a'sen(7 es(e e"e%en(+" &redo%!nan(.
    RLH.GI T+"'+rare de erec=!e a '7r'a(+"+! da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A7 Aces( (er%en se +(!"!/ea/7 dac7 d!s.+nc=!a erec(!"7 a
    '7r'a(+"+!, es(e e"e%en(+" &redo%!nan(.
    R9Y.L D!s&are+n!e .e%!n!n7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A7
    Aces( (er%en es(e +(!"!/a( dac7, "a o .e%e!e, d+rerea asoc!a(7 c+ con(ac(+"
    se<+a" es(e e"e%en(+" &redo%!nan(.
    RLG.GF D!s&are+n!e %asc+"!n7 da(ora(7. . ) Se indic6 condi(ia medical6
    /eneral6A7 Aces( (er%en es(e +(!"!/a( dac7, !a +n '7r'a(, d+rerea asoc!a(7 c+
    con(ac(+" se<+a" es(e e"e%en(+" &redo%!nan(.
    R9Y.G A"(7 d!s.+nc=!e se<+a"7 a .e%e!! da(ora(7... @Se indic6 condi(ia medical6
    /eneral6A7 Aces( (er%en es(e +(!"!/a( dac7, "a o .e%e!e, &redo%!n7 a"( e"e%en(
    Ede e<., (+"'+rarea de or$as%J sa+ n+ &redo%!n7 n!c! +n+".
    RLG.GF A"(7 d!s.+nc=!e se<+a"7 a '7r'a(+"+! da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A7 Aces( (e%en es(e +(!"!/a( dac7, "a +n '7r'a(, &redo%!n7 a"(
    e"e%en( Ede e<., (+"'+rarea de or$as%J or! n+ &redo%!n7 n!c! +n+".
    5>E Tulburrile Sexuale si de Identitate Sexual

    #rocedee de "nre!istrare
    :n :nre$!s(rarea d!a$nos(!c+"+! de d!s.+nc(!e se<+a"7 da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, c"!n!c!an+" (re'+!e s7 no(e/e, a(A( .eno%eno"o$!a s&ec!.!c7 a
    d!s.+nc=!e! Ed!n "!s(a de %a! s+sJ, cA( s! cond!=!a %ed!ca"7 $enera"7 !den(!.!ca(7,
    cons!dera(7 a .! ca+/a d!s.+nc=!e! de &e a<a I Ede e< , RLH GI T+"'+rare de erec=!e a
    '7r'a(+"+! da(ora(7 d!a'e(+"+! /aara(J Cod+" ICD4F4CM &en(r+ cond!=!a %ed!ca"7
    $enera"7 es(e, de ase%enea, no(a( &e a<a III Ede e<, 9YL O d!a'e( /aara(J E3e/!
    ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce"or ICD4F4CM se"ec(a(e &en(r+ cond!=!!"e
    %ed!ca"e $enera"eJ
    ondiii medicale !enerale asociate
    O d!vers!(a(e de cond!=!! %ed!ca"e $enera"e &o( ca+/a d!s.+nc(!e se<+a"7,
    !nc"+/And cond!=!! ne+ro"o$!ce Ede e<, sc"ero/a %+"(!&"7, "e/!+n!"e %ed+"are
    s&!na"e, ne+ro&a(n"e, "e/!+n!"e "o'+"+! (e%&ora"J, cond!=!! endocr!ne Ede e<,
    d!a'e(+" /aara(, !&o(!ro!d!s%+", !&er4 s! !&oadrenocor(!c!s%+",
    !&er&ro"ac(!ne%!a, s(7r!"e !&o$onada"e, d!s.+nc=!a &!(+!(ar7J, cond!=!! vasc+"are
    s! $en!(o+r%are Ede e<, o %a"ad!e (es(!c+"ar7, %a"ad!a Peyro%e, !n.ec=!!"e
    +re(ra"e, co%&"!ca=!!"e &os(&ros(a(ec(o%!e, (ra+%a(!s%e"e sa+ !n.ec=!!"e $en!(a"e,
    va$%!(a a(ro.!c7, !n.ec=!!"e va$!n+"+! s! or$ane"or $en!(a"e e<(erne, co%&"!ca=!!"e
    &os(c!r+r$!ca"e, c+% ar .! c!ca(nc!"e &os(e&!s!o(o%!e, va$!n+" sc+r(, c!s(a,
    endo%e(no/a, &ro"a&s+" +(enn, !n.ec=!!"e &e"v%e, neo&"as%e"e, oo.orec(o%!a .7r7
    (ra(a%en( or%ona" de s+'s(!(+=!e s! e.ec(e"e sec+ndare a"e (ra(a%en(e"or
    cancer+"+! Zc!r+r$!ca", !rad!ere, ce%o(era&!e[J E<&er!en=a c"!n!c7 c+ren(7
    s+$erea/7 c7 d!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e es(e de
    re$+"7 $enera"!/a(7 Da(e"e s+&"!%en(are a"e e<a%en+"+! so%a(!c, da(e"e de
    "a'ora(or s! &a((ern+n"e de &reva"en(7 sa+ de de'+( re."ec(7 cond!=!a %ed!ca"7
    $enera"7 e(!o"o$!c7
    Dia!nostic di$erenial
    D!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e es(e d!a$nos(!ca(7
    n+%a! dac7 d!s.+nc=!a se<+a"7 es(e e<&"!ca(7 !n(e$ra" de e.ec(e"e d!rec(e a"e cond!=!e!
    %ed!ca"e $enera"e Dac7 .ac(or!! &s!o"o$!c! @oac7, de ase%enea, +n ro" :n de'+(+",
    sever!(a(ea, e<acer'area sa+ %en=!nerea +ne! d!s.+nc=!! se<+a"e, d!a$nos(!c+" es(e ce"
    de d!s.+nc(!e se<+a"7 &r!%ar7 Ec+ s+'&+" da(ora(7 +nor .ac(or! co%'!na=!J :n
    &rec!/area .a&(+"+!, dac7 d!s.+nc=!a se<+a"7 es(e &r!%ar7 sa+ da(ora(7 e<c"+s!v
    e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e, +n !s(onc %ed!ca" s! &s!ose<+a"
    c+&r!n/7(or es(e ce" %a! !%&or(an( co%&onen( a" eva"+7% Pen(r+ '7r'a=!, (es(e
    &rec+% (+r$escen(a &en!an7 noc(+rn7, s(+d!!"e vasc+"are s! !n@ec(area de ac(!va(or!
    (!s+"ar!, &o( .! +(!"e :n eva"+are O e<a%!nare $!neco"o$!c7 a(en(7 es(e !%&or(an(7 :n
    e.ec(+area aces(or eva"+7r! "a .e%e!, :n s&ec!a" :n eva"+area d+rer!"or se<+a"e
    Eva"+area ne+ro"o$!c7 s! endocr!n7 &oa(e .! +(!"7, a(A( "a '7r'a=!, cA( s! "a .e%e!
    Dac7 e<!s(7 &ro'a +n+! +/ recen( sa+ &re"+n$!( de o s+'s(an=7 E!nc"+s!v de
    %ed!ca%en(eJ, a's(!nen(e! de o s+'s(an=7 or! e<&+ner!! "a +n (o<!c, s! .a&(+" c7
    d!s.+nc=!a se<+a"7 es(e e<&"!ca(7 %a! '!ne de e.ec(e"e d!rec(e a"e s+'s(an=e!, (re'+!e
    "+a(7 :n cons!dera=!e o d!s.+nc(!e se<+a"7 !nd+s7 de o s+'s(an=7. C"!n!c!an+"
    (re'+!e s7 se !n.or%e/e a(en( as+&ra na(+r!! s! :n(!nde% +/+"+! de o s+'s(an=7,
    !nc"+s!v de %ed!ca%en(e S!%&(o%e"e care s+rv!n :n c+rs+" sa+ "a sc+r( (!%& Ead!c7,
    :n dec+rs de I s7&(7%An!J d+&7 !n(o<!ca=!a c+ o s+'s(an=7 sa+ d+&7 +/+" +n+!
    Dis$uncia Sexual datorat unei ondiii Medicale Generale AIE
    %ed!ca%en( &o( .! e<(re% de evoca(oare de o d!s.+nc=!e se<+a"7 !nd+s7 de o
    s+'s(an=7, :n .+nc=!e de (!&+" sa+ can(!(a(ea s+'s(an=e! +(!"!/a(e or! de d+ra(a +/+"+!.
    Dac7 c"!n!c!an+" a&rec!a/7 c7 d!s.+nc=!a se<+a"7 se da(orea/7, a(A( +ne! cond!=!!
    %ed!ca"e $enera"e, cA( s! +/+"+! +ne! s+'s(an=e, &o( .! &+se a%'e"e d!a$nos(!ce
    Ead!c7, d!s.+nc=!e se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! d!s.+nc=!e
    se<+a"7 !nd+s7 de o s+'s(an=7J.
    Dor!n=a se<+a"7 d!%!n+a(7, d!s.+nc=!a e<c!(a(or!e s!, :n %a! %!c7 %7s+r7,
    d!s.+nc=!a or$as%!c7 &o( s+rven! O! ca s!%&(o%e a"e (+"'+r7r!! de&res!ve %a@ore, :n
    (+"'+rarea de&res!v7 %a@or7, n+ &o( .! de%ons(ra(e n!c! +n .e" de %ecan!s%e
    .!/!o&a(o"o$!ce ca+/a"e s&ec!.!ce s! d!rec(e, asoc!a(e c+ o cond!=!e %ed!ca"7 $enera"7.
    D!s.+nc=!a se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e (re'+!e s7 .!e d!s(!ns7 de
    d!%!n+area !n(eres+"+! O! .+nc=!on7r!! se<+a"e care &oa(e :nso=! avansarea :n e(a(e.
    Criteriile $e $ia/no&ti# pentru Di&%un#!ia Se,ual(
    $atorat( ... [Se indic condiia medical &eneral]
    A2 Dis$uncie sexual semni$icativ clinic care duce la detres sau di$icultate
    interpersonal marcat ,i predomin "n tabloul clinic2
    S2 Din istoric, examenul somatic sau datele de laborator re(ult proba c
    dis$uncia sexual este explicat inte!ral de e$ectele $i(iolo!ice directe ale
    unei condiii medicale !enerale2
    2 #erturbarea nu este explicat mai bine de alt tulburare mental &de ex2,
    tulburarea depresiv ma0or)2
    A se selecta codul si termenul pe ba(a dis$unciei sexuale predominanteD
    =C<.> Dorin!( &e,ual( $i"inuat( a %e"eii $atorat( 333[Se indic condiia
    medical general=' dac dorina sexual de$icitar sau absent este
    elementul predominant
    =+>.>5 Dorin!( &e,ual( $i"inuat( a -(r-atului $atorat( 333[Se indic
    condiia medical general=' dac dorina sexual de$icitar sau absent
    este elementul predominant
    =+G.>7 Tul-urare $e ere#!ie a -(r-atului $atorat(...[Se indic condiia medical
    !eneral:D dac dis$uncia erectil a brbatului este elementul predominant
    =C<.+ Di&pareunie %e"inin( $atorat(...[Se indic condiia medical &eneral]2
    dac durerea asociat cu actul sexual este elementul predominant
    =+>.>5 Di&pareunie "a&#ulin( $atorat(...[Se indic condiia medical &eneral]2
    dac durerea asociat cu actul sexual este elementul predominant
    =C<.> Alt( $i&%un#!ie &e,ual( a %e"eii $atorat(. 33[Se indic condiia
    medical general=' dac predomin un alt element &de ex2, tulburarea de
    or!asm) sau nu predomin nici un element
    =+>.>5 Alt( $i&%un#!ie &e,ual( a -(r-atului $atorat(. 33[Se indic condiia
    medical general=' dac predomin un alt element &de ex2, tulburarea de
    or!asm) sau nu predomin nici un element
    Fot de codi$icareD Fumele condiiei medicale !enerale se incude pe axa l, de
    ex2, I5?28H Tulburare de erecie a brbatului datorat diabetului (a%arat3
    condiia medical !eneral se include pe axa III &ve(i anexa G pentru coduri)2
    YR9 Tulburrile Sexuale ,i de Identitate Sexual
    Di&%un#!ia Se,ual( in$u&( $e o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" d!s.+nc=!e! se<+a"e !nd+se de o s+'s(an=7 :" cons(!(+!e o
    d!s.+nc=!e se<+a"7 se%n!.!ca(!v7 c"!n!c care d+ce "a de(res7 sa+ "a d!.!c+"(a(e
    !n(er&ersona"7 %arca(7 Ecr!(er!+" AJ, :n .+nc=!e de s+'s(an=a !%&"!ca(7, d!s.+nc=!a
    &oa(e co%&or(a de(er!orarea dor!n=e!, de(er!orarea e<c!(a=!e!, de(er!orarea
    or$as%+"+! sa+ d+rere se<+a"7. D!s.+nc=!a se<+a"7 es(e cons!dera(7 a .! e<&"!ca(7
    !n(e$ra" de e.ec(e"e .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ead!c7, +n dro$ de a'+/, +n
    %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ Ecr!(er!+" BJ. Per(+r'area n+ (re'+!e s7 .!e
    e<&"!ca(7 %a! '!ne de o d!s.+nc=!e se<+a"7 care n+ es(e !nd+s7 de o s+'s(an=7
    Ecr!(er!+" CJ, Aces( d!a$nos(!c (re'+!e s7 .!e &+s :n "oc+" ce"+! de !n(o<!ca=!e c+ o
    s+'s(an=7, n+%a! cAnd s!%&(o%e"e se<+a"e s+n( :n e<ces .a=7 de ce"e asoc!a(e de
    re$+"7 c+ s!ndro%+" de !n(o<!ca=!e s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe
    &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7. Pen(r+ o d!sc+=!e %a! de(a!"a(7 a
    (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7, ve/! &a$. 5F5J.
    O d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o d!s.+nc=!e se<+a"7
    &r!%ar7 &r!n "+area :n cons!dera=!e a de'+(+"+! s! evo"+=!e!. Pen(r+ dro$+r!"e de
    a'+/, (re'+!e s7 e<!s(e &ro'a !n(o<!ca=!e! d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de
    "a'ora(or. D!s.+nc(!!"e se<+a"e !nd+se de o s+'s(an=7 a&ar n+%a! :n asoc!ere c+
    !n(o<!ca=!a, :n (!%& ce d!s.+nc=!!"e se<+a"e &r!%are &o( &recede de'+(+" +/+"+! de o
    s+'s(an=7 sa+ a&ar :n c+rs+" &er!oade"or de a's(!nen=7 &ers!s(en(7 de o s+'s(an=7.
    Fac(or!! care s+$erea/7 c7 d!s.+nc=!a es(e e<&"!ca(7 %a! '!ne de o d!s.+nc=!e se<+a"7
    &r!%ar7 !nc"+d &ers!s(en=a d!s.+nc=!e! o &er!oad7 de (!%& cons!dera'!"7 Ead!c7,
    a&ro<!%a(!v o "+n7J d+&7 (er%!narea !n(o<!ca=!e! c+ o s+'s(an=7 s! a&ar!=!a +ne!
    d!s.+nc=!! care es(e cons!dera'!" :n e<ces .a=7 de ceea ce ar .! de aO(e&(a(, da( .!!nd
    (!&+" sa+ can(!(a(ea s+'s(an=e! +(!"!/a(e or! d+ra(a +/+"+!, sa+ +n !s(or!c de
    d!s.+nc=!! se<+a"e &r!%are rec+ren(e an(er!oare.
    Speci$icani
    Ur%7(or!! s&ec!.!can=! &en(r+ d!s.+nc=!a se<+a"7 !nd+sa de o s+'s(an=7 s+n(
    se"ec(a=! &e 'a/a d!s.+nc=!e! se<+a"e &redo%!nan(e. DeO! &re/en(area c"!n!c7 a
    d!s.+nc=!e! se<+a"e &oa(e .! ase%7n7(oare c+ cea a d!s.+nc=!!"or se<+a"e &r!%are, n+
    es(e necesar s7 .!e sa(!s.7c+(e cr!(er!!"e co%&"e(e &en(r+ vre+na d!n(re aces(e d!s.+nc=!!.
    C+ dor!n=7 de(er!ora(7. S&ec!.!can(+" es(e +(!"!/a( dac7 dor!n=a se<+a"7
    de.!c!(ar7 sa+ a'sen(7 es(e e"e%en(+" &redo%!nan(.
    C+ e<c!(a=!e de(er!ora(7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 de(er!orarea
    e<c!(a=!e! se<+a"e Ede e<., d!s.+nc=!a erec(!"7, de(er!orarea "+'r!.!er!!J es(e
    e"e%en(+" &redo%!nan(.
    C+ or$as% de(er!ora(. Aces( s&ec!.!can( es(e +(!"!/a( dac7 de(er!orarea
    or$as%+"+! es(e e"e%en(+" &redo%!nan(.
    C+ d+rere se<+a"7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 d+rerea asoc!a(7 c+
    con(ac(+" se<+a" es(e e"e%en(+" &redo%!nan(.
    D!s.+nc=!!"e se<+a"e !nd+se de o s+'s(an=7 :O! a+ de'+(+" :n c+rs+" !n(o<!ca=!e! c+
    o s+'s(an=7 s! aceas(a &oa(e .! !nd!ca( &r!n %en=!+nea c+ de'+( :n c+rs+" !n(o<!ca=!e!.
    Dis$uncia Sexual indus de o
    Substan
    <=4

    #rocedee de "nre!istrare
    N+%e"e d!s.+nc=!e! se<+a"e !nd+s7 de o s+'s(an=7 :nce&e c+ ce" a" s+'s(an=e!
    s&ec!.!ce Ede e<., a"coo", ."+o<e(!n7J care se &res+&+ne a .! d!n ca+/a d!s.+nc=!e!
    se<+a"e. Cod+" d!a$nos(!c es(e se"ec(a( d!n "!s(a c"ase"or de s+'s(an=e &rev7/+(e :n
    se(+" de cr!(er!!. Pen(r+ s+'s(an=e"e care n+ !n(r7 :n n!c! +na d!n(re c"ase Ede e<.,
    ."+o<e(!n7J (re'+!e s7 .!e +(!"!/a( cod+" &en(r+ Sa"(7 s+'s(an=7T, :n a.ar7 de aceas(a
    &en(r+ %ed!ca%en(e"e &rescr!se :n do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!c &oa(e
    .! !nd!ca( &r!n %en=!onarea cod+"+! E &e a<a I Eve/! ane<a ,J. N+%e"e (+"'+r7r!!
    es(e +r%a( de s&ec!.!carea &re/en(7r!! s!%&(o%+"+! do%!nan( Ede e<., 9F9.GF
    D!s.+nc=!e se<+a"7 !nd+s7 de coca!n7, c+ de(er!orarea e<c!(a=!e!J. CAnd se
    cons!der7 c7 %a! %+"( decA( o s!n$+r7 s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n
    de/vo"(area d!s.+nc=!e! se<+a"e, .!ecare (re'+!e s7 .!e %en=!ona(7 se&ara( Ede e<.,
    9F5.G D!s.+nc=!e se<+a"7 !nd+s7 de a"coo", c+ de(er!orarea e<c!(a=!e!8 9F9.GF
    D!s.+nc=!e se<+a"7 !nd+s7 de ."+o<e(!n7, c+ de(er!orarea or$as%+"+!J. Dac7 o
    s+'s(an=7 es(e cons!dera(7 a .! .ac(or e(!o"o$!c, dar s+'s(an=a s&ec!.!c7 sa+ c"asa de
    s+'s(an=e es(e nec+nosc+(7, &oa(e .! +(!"!/a(7 ca(e$or!a 9F9.GF D!s.+nc=!e se<+a"7
    !nd+s7 de o s+'s(an=7 nec+nosc+(7.
    Substane speci$ice
    D!s.+nc=!!"e se<+a"e &o( s+rven! :n asoc!ere c+ !n(o<!ca=!a c+ +r%7(oare"e c"ase
    de s+'s(an=eQ a"coo"8 a%.e(a%!na s! s+'s(an=e a.!ne8 coca!n78 o&!acee8 seda(!ve,
    !&no(!ce s! an<!o"!(!ce, O! a"(e s+'s(an=e sa+ s+'s(an=e nec+nosc+(e. S4a re"a(a( c7
    !n(o<!ca=!a ac+(7 sa+ a'+/+" cron!c de s+'s(an=e de a'+/ scade !n(eres+" se<+a" s!
    ca+/ea/7 &ro'"e%e de e<c!(a=!e "a a%'e"e se<e. Sc7derea !n(eres+"+! se<+a" E"a
    a%'e"e se<eJ, (+"'+r7r!"e de e<c!(a=!e E"a a%'e"e se<eJ O! (+"'+r7r!"e de or$as% E%a!
    .recven(e "a '7r'a=!J &o( .!, de ase%enea, ca+/a(e de %ed!ca%en(e"e &rescr!se,
    !nc"+/And an(!!&er(ens!ve"e, an(a$on!O(!! rece&(or!"or H9 a! !s(a%!ne!,
    an(!de&res!ve"e E:n s&ec!a", !n!'!(or!! se"ec(!v! a! reca&(7r!! sero(on!ne!J,
    ne+ro"e&(!ce"e, an<!o"!(!ce"e, s(ero!/!! ana'o"!c! O! an(!e&!"e&(!ce"e. Un or$as%
    d+reros a .os( descr!s "a ."+.ena/!n7, (!or!da/!n7 s! a%o<a&!n7. Pr!a&!s%+" a .os(
    descr!s :n +/+" de c"or&ro%a/!n7, (ra/odon7, c"o/a&!n7 s! d+&7 !n@ec=!!"e &en!ene c+
    &a&aver!n7 s! &ros(a$"and!n7. B"ocan(!! reca&(7r!! sero(on!ne! &o( ca+/a sc7derea
    dor!n=e! se<+a"e sa+ (+"'+r7r! de e<c!(a=!e. Med!ca%en(e, c+% ar .! a$en=!!
    !&er(ens!v! sa+ s(ero!/!! ana'o"!c!, &o(, de ase%enea, &rovoca d!s&o/!=!e de&res!v7
    sa+ !r!(a'!"7 &e "An$7 d!s.+nc=!a se<+a"7, s! &oa(e .! @+s(!.!ca( +n d!a$nos(!c ad!=!ona"
    de (+"'+rare de&res!v7 !nd+s7 de o s+'s(an=7. E<&er!en=a c"!n!c7 c+ren(7 s+$erea/7
    :n %od c"ar c7 d!s.+nc=!a se<+a"7 !nd+s7 es(e de re$+"7 $enera"!/a(7 Ead!c7 n+ es(e
    "!%!(a(7 "a an+%!(e (!&+r! de s(!%+"are, de s!(+a=!! sa+ de &ar(ener!J.
    Dia!nostic di$erenial
    D!s.+nc=!!"e se<+a"e s+rv!n .recven( :n !n(o<!ca=!a c+ o s+'s(an=7. D!a$nos(!c+"
    de !n(o<!ca=!e c+ o s+'s(an=7 s&ec!.!c7 va .! s+.!c!en( &en(r+ a :ncadra &re/en(area
    s!%&(o%+"+!. Un d!a$nos(!c de d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 (re'+!e s7
    .!e &+s :n "oc+" d!a$nos(!c+"+! de !n(o<!ca=!e c+ o s+'s(an=7, n+%a! cAnd se
    cons!der7 c7 d!s.+nc=!a es(e :n e<ces .a=7 de cea asoc!a(7 de re$+"7 c+ s!ndro%+" de
    !n(o<!ca=!e s! cAnd s!%&(o%e"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7. Dac7 .ac(or!! &s!o"o$!c! @oac7, de ase%enea, +n ro" :n de'+(+",
    <=7 Tulburrile Sexuale ,i de Identitate Sexual

    sever!(a(ea, e<acer'area sa+ %en=!nerea +ne! d!s.+nc=!! se<+a"e, d!a$nos(!c+" es(e
    ce" de d!s.+nc=!e se<+a"7 &r!%ar7 Ec+ s+'(!&+" Sda(ora(7 +nor .ac(or! co%'!na=!TJ.
    D!s.+nc=!a se<+a"7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de o d!s.+nc=!e se<+"7
    &r!%ar7, &r!n .a&(+" c7 s!%&(o%e"e s+n( cons!dera(e a .! e<&"!ca(e !n(e$ra" de
    e.ec(e"e d!rec(e a"e s+'s(an=e! Eve/! &a$. YR9J.
    O d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7 da(ora(7 +n+! (ra(a%en( &rescr!s
    &en(r+ o (+"'+rare %en(a"7 sa+ o cond!=!e %ed!ca"7 $enera"7 (re'+!e s74s! a!'7
    de'+(+" :n (!%& ce &ersoana &r!%eO(e %ed!ca%en(+" Ede e<., %ed!ca=!a
    !&er(ens!v7J. Oda(7 ce (ra(a%en(+" es(e :n(rer+&(, d!s.+nc=!a se<+a"7 se va re%!(e
    :n dec+rs de cA(eva /!"e sa+ s7&(7%An! E:n .+nc=!e de se%!v!a=a s+'s(an=e!J. Dac7
    d!s.+nc=!a se<+a"7 &ers!s(7, (re'+!e s7 .!e "+a(e :n cons!dera=!e a"(e ca+/e &en(r+
    d!s.+nc=!e. E.ec(e"e sec+ndare a"e %ed!ca%en(e"or &rescr!se, care a.ec(ea/7 .+nc=!a
    se<+a"7, &o( .ace &e !nd!v!/! s7 .!e nonco%&"!an=! "a (ra(a%en(, dac7 e! &+n
    .+nc=!onarea se<+a"7 deas+&ra 'ene.!c!+"+! %ed!ca%en(+"+!.
    Deoarece !nd!v!/!! c+ cond!=!! %ed!ca"e $enera"e !a+ adesea %ed!ca%en(e
    &en(r+ aces(e cond!=!!, c"!n!c!an+" (re'+!e s7 !a :n cons!dera=!e &os!'!"!(a(ea ca
    d!s.+nc=!a se<+a"7 s7 .!e ca+/a(7 %a! c+rAnd de consec!n=e"e .!/!o"o$!ce a"e cond!=!e!
    %ed!ca"e $enera"e decA( de %ed!ca%en(, :n care ca/ es(e d!a$nos(!ca(7 d!s.+nc=!a
    se<+a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Is(or!c+" .+rn!/ea/7 adesea 'a/a
    .+nda%en(a"7 &en(r+ o as(.e" de @+deca(7. Uneor! &oa(e .! necesar7 o %od!.!care :n
    (ra(a%en(+" cond!=!e! %ed!ca"e $enera"e Ede e<., s+'s(!(+!rea sa+ :n(rer+&erea
    %ed!ca%en(+"+!J &en(r+ a de(er%!na e%&!r!c .a&(+" dac7 &en(r+ &ersoana
    res&ec(!v7 %ed!ca%en(+" es(e a$en(+" ca+/a". Dac7 c"!n!c!an+" a a@+ns "a conc"+/!a
    c7 d!s.+nc=!a se da(orea/7, a(A( cond!=!e! %ed!ca"e $enera"e, cA( s! +/+"+! +ne!
    s+'s(an=e, s+n( &+se a%'e"e d!a$nos(!ce Ead!c7, d!s.+nc=!e se<+a"7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e s! d!s.+nc=!e se<+a"7 !nd+s7 de o s+'s(an=7J. CAnd e<!s(7
    !ns+.!c!en(e da(e &en(r+ a &rec!/a dac7 d!s.+nc=!a se<+a"7 se da(orea/7 +ne!
    s+'s(an=e E!nc"+s!v +n+! %ed!ca%en(J sa+ +ne! cond!=!! %ed!ca"e $enera"e, or! es(e
    &r!%ar7 Ead!c7, n+ se da(orea/7 n!c! +ne! s+'s(an=e s! n!c! +ne! cond!=!! %ed!ca"e
    $enera"eJ es(e !nd!ca(7 d!s.+nc=!a se<+a"7 .7r7 a"(7 s&ec!.!ca=!e .
    Dis$uncia Sexual indus de o
    Substan
    <=<
    Criteriile $e $ia/no&ti# pentru Di&%un#!ia
    Se,ual( in$u&( $e o Su-&tan!(
    A2 Dis$uncie sexual semni$icativ clinic, care duce la detres ori la di$icultate
    interpersonal marcat si predomin "n tabloul clinic2
    S2 *xist probe din istoric, examenul somatic ,i datele de laborator, c
    dis$uncia sexual este explicat inte!ral de u(ul de o substan, dup cum
    este indicat, $ie de &E), sau &7)D
    (1) simptomele de la criteriul A apar "n cursul intoxicaiei sau "n mai puin
    de
    o lun de la intoxicaia cu o substan,
    (2) utili(area unui medicament este etiolo!ic "n le!tur cu perturbarea2
    2 #erturbarea nu este explicat mai bine de o dis$uncie sexual care nu este
    indus de o substan2 #roba c simptomele sunt explicate mai bine de o
    dis$uncie sexual care nu este indus de o substan poate include
    urmtoareleD simptomele preced debutul u(ului sau dependenei de o
    substan &sau al u(ului de un medicament)3 simptomele persist o perioad
    considerabil de timp &de ex2, aproximativ o lun) dup "ncetarea
    intoxicaiei sau sunt substanial "n exces $a de ceea ce ar $i de a,teptat, dat
    $iind tipul sau cantitatea de substan utili(at sau durata u(ului, ori exist
    alte date care su!erea( existena unei dis$uncii sexuale independente,
    neinduse de o substan &de ex2, un istoric de episoade recurente $r
    le!tur cu o substan)2
    FotD Acest dia!nostic trebuie pus "n locul unui dia!nostic de intoxicaie cu o
    substan, numai c@nd dis$uncia sexual este "n exces $a de cea asociat de
    re!ul cu sindromul de intoxicaie ,i c@nd dis$uncia este su$icient de sever
    pentru a 0usti$ica o atenie clinic separat2
    A se codi"ica ast$el dis$uncia sexual indus de 9substana speci$ic:D
    76E28 alcool3 767286 am$etamina &sau o substan similar am$etaminei)3
    767286 cocain3 767286 opiacee3 767286 sedative, %ipnotice sau anxiolitice,
    767286 alt substan &ori o substan necunoscut)2
    De speci"icat dac D u
    dorin deteriorat u
    excitaie deteriorat u
    or!asm deteriorat u
    durere sexual
    De speci"icat dac '
    u debut "n cursul intoxicaieiD dac sunt satis$ cute criteriile pentru
    intoxicaia cu o substan, iar simptomele apar "n cursul sindromului de
    intoxicaie2
    YRR Tulburrile Sexuale ,i de Identitate Sexual
    4+C.G+ Di&%un#!ia Se,ual( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e !nc"+de d!s.+nc=!!"e se<+a"e care n+ sa(!s.ac cr!(er!!"e &en(r+
    n!c! o d!s.+nc=!e se<+a"7 s&ec!.!c7. E<e%&"e"e !nc"+dQ
    1. N!c! +n .e" de sen/a=!! ero(!ce s+'!ec(!ve Eor! cons!dera'!" d!%!n+a(eJ, :n d!s&re=+"
    +ne! e<c!(a=!! s! or$as%, de a"(.e" nor%a"e.
    2. S!(+a=!!"e :n care c"!n!c!an+" a a@+ns "a conc"+/!a c7 es(e &re/en(7 o d!s.+nc=!e
    se<+a"7, dar es(e !nca&a'!" s7 &rec!/e/e dac7 aceas(a es(e &r!%ar7, da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e sa+ es(e !nd+s7 de o s+'s(an=7.
    Para%iliile
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e +ne! &ara.!"!! "e cons(!(+!e .an(e/!!"e e<c!(an(e se<+a"
    !n(ense, rec+ren(e s! !%&+"s!+n!"e se<+a"e sa+ co%&or(a%en(e"e care !%&"!c7 :n
    $enera" 5J o'!ec(e non+%ane, 9J s+.er!n=a sa+ +%!"!rea s+'!ec(+"+! sa+ a
    &ar(ener+"+! aces(+!a sa+ ;J co&!! or! a"(e &ersoane care n+ cons!%(, care s+rv!n
    &en(r+ o &er!oad7 de ce" &+=!n D "+n! Ecr!(er!+" AJ. Pen(r+ +n!! !nd!v!/!, .an(e/!!"e
    sa+ s(!%+"!! &ara.!"!c! s+n( o'"!$a(or!! &en(r+ e<c!(a=!a ero(!c7 s! s+n( (o(dea+na
    !nc"+O! :n ac(!v!(a(ea se<+a"7, :n a"(e ca/+r!, &re.er!n=e"e &ara.!"!ce s+rv!n n+%a!
    e&!sod!c Ede e<., :n c+rs+" &er!oade"or de s(resJ, :n (!%& ce a"(e or! &ersoana es(e
    ca&a'!"7 s7 .+nc=!one/e se<+a" .7r7 .an(e/!! sa+ s(!%+"! &ara.!"!c!. Pen(r+ &edo.!"!e,
    voye+r!s%, e<!'!=!on!s% s! .ro((e+r!s%, d!a$nos(!c+" es(e &+s dac7 &ersoana a
    ac=!ona( con.or% aces(or &+"s!+n! sa+ &+"s!+n!"e sa+ .an(e/!!"e se<+a"e ca+/ea/7 o
    de(res7 sa+ d!.!c+"(a(e !n(er&ersona"7 %arca(7. Pen(r+ sad!s%+" se<+a",
    d!a$nos(!c+" es(e &+s dac7 &ersoana a ac=!ona( con.or% aces(or &+"s!+n! c+ o
    &ersoan7 care n+ cons!%(e sa+ aces(e &+"s!+n!, .an(e/!! se<+a"e sa+ co%&or(a%en(e
    ca+/ea/7 o de(res7 sa+ d!.!c+"(a(e !n(er&ersona"7 %arca(7. Pen(r+ res(+" &ara.!"!!"or,
    d!a$nos(!c+" es(e &+s dac7 co%&or(a%en(+", &+"s!+n!"e sa+ .an(e/!!"e se<+a"e
    ca+/ea/7 o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! de .+nc=!onare !%&or(an(e Ecr!(er!+" BJ.
    Se &oa(e (rece "a rea"!/area !%a$er!e! &ara.!"!ce c+ +n &ar(ener care n+ cons!%(e,
    :n(r4+n %od care &oa(e .! !n@+r!os &en(r+ &ar(ener Eca :n sad!s%+" se<+a" sa+ :n
    &edo.!"!eJ. Ind!v!d+" &oa(e .! s+'!ec( de ares(are s! :ncarcerare. O.ense"e se<+a"e
    con(ra co&!!"or cons(!(+!e +n &rocen( se%n!.!ca(!v d!n (oa(e ac(e"e se<+a"e
    !n.rac=!ona"e ra&or(a(e, !ar !nd!v!/!! c+ e<!'!=!on!s%, &edo.!"!e s! voye+r!s%
    cons(!(+!e %a@or!(a(ea o.ensa(or!"or se<+a"! ares(a=!, :n +ne"e s!(+a=!!, (recerea "a
    rea"!/area !%a$er!e! &ara.!"!ce &oa(e d+ce "a a+(ov7(7%are Eca :n %asoc!s%+"
    se<+a"J. Re"a=!!"e soc!a"e s! se<+a"e &o( s+.er!, dac7 a"=!! cons!der7 co%&or(a%en(+"
    se<+a" !nso"!( r+O!nos sa+ re&+$nan(, sa+ dac7 &ar(ener+" se<+a" a" !nd!v!d+"+!
    re.+/7 s7 coo&ere/e "a &re.er!n=e"e se<+a"e !nso"!(e, :n +ne"e ca/+r!,
    co%&or(a%en(+" !nso"!( Ede e<., ac(e"e e<!'!=!on!s(e sa+ co"ec(area de o'!ec(e .e(!OJ
    &oa(e deven! ac(!v!(a(ea se<+a"7 %a@or7 d!n v!a=a !nd!v!d+"+!. AceO(! !nd!v!/! se
    adresea/7 rar d!n &ro&r!e !n!=!a(!v7, de re$+"7 !n(rAnd :n a(en=!a s&ec!a"!O(!"or :n
    s7n7(a(e %en(a"7, n+%a! cAnd co%&or(a%en(+" "or :! ad+ce :n con."!c( c+ &ar(ener!!
    se<+a"! sa+ c+ soc!e(a(ea.
    #ara$ilii
    le
    <=G

    Para.!"!!"e descr!se a!c! s+n( cond!=!! care a+ .os( !den(!.!ca(e ca a(are :n
    c"as!.!c7r!"e an(er!oare. E"e !nc"+d e<!'!=!on!s%+" Ee<&+nerea or$ane"or $en!(a"eJ,
    .e(!O!s%+" E+/+" de o'!ec(e !ner(eJ, .ro((e+r!s%+" Ea(!n$erea s! .recarea de o &ersoan7
    care n+ cons!%(eJ, &edo.!"!a Ecen(rarea &e co&!! &re&+'er(ar!J, %asoc!s%+" se<+a" Ea
    .! +%!"!( sa+ a .! .7c+( s7 s+.ereJ, sad!s%+" se<+a" E&rovocarea de +%!"!re O! s+.er!n=7J,
    .e(!O!s%+" (ransves(!c E(raves(!reaJ O! voye+r!s%+" Eo'servarea ac(!v!(7=!! se<+a"eJ.
    Ca(e$or!a re/!d+a"7 de &ara.!"!e .7r7 a"(7 s&ec!.!ca=!e, !nc"+de a"(e &ara.!"!! care s+n(
    %a! &+=!n .recven( :n(A"n!(e. N+ rar, !nd!v!/!! a+ %a! %+"( decA( o s!n$+r7 &ara.!"!e.
    #rocedee de "nre!istrare
    Ind!v!/!! c+ &ara.!"!e se d!.eren=!a/7 &e 'a/a .oca"!/7r!! &ara.!"!ce carac(er!s(!ce.
    Dac7 :ns7 &re.er!n=e"e se<+a"e a"e !nd!v!d+"+! sa(!s.ac cr!(er!!"e &en(r+ %a! %+"(
    decA( o s!n$+r7 &ara.!"!e, (re'+!e d!a$nos(!ca(e (oa(e. Cod+" s! (er%en!! d!a$nos(!c!
    s+n( +r%7(or!!Q ;L9.I E<!'!=!on!s%, ;L9.G5 Fe(!O!s%, ;L9.GF Fro((e+r!s%, ;L9.9
    Pedo.!"!e, ;L9.G; Masoc!s% se<+a", ;L9.GI Sad!s% se<+a", ;L9.; Fe(!O!s%
    (ransves(!c, ;L9.G9 3oye+r!s%, O! ;L9.F Para.!"!e .7r7 a"(7 s&ec!.!ca=!e.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. S(!%+"+" &re.era(, c!ar :n
    cadr+" +ne! &ara.!"!! an+%!(e, &oa(e .! e<(re% de s&ec!.!c. Ind!v!/!! care n+ a+ +n
    &ar(ener consen(!v c+ care s7 (reac7 "a rea"!/area .an(e/!!"or "or &o( rec+r$e "a serv!c!!"e
    &ros(!(+a(e"or sa+ :O! &o( rea"!/a .an(e/!!"e c+ &ersoane care se o&+n. Ind!v!/!! c+
    &ara.!"!!"e :O! &o( a"e$e o oc+&a=!e, de/vo"(a +n o''y sa+ se &o( o.er! s7 :nde&"!neasc7
    o ac(!v!(a(e care4! ad+ce :n con(ac( c+ s(!%+"+" dor!( Ede e<., vAn/7(or! de &an(o.! sa+
    de "en@er!e de da%7 Z.e(!O!s%[, "+cr+" c+ co&!! Z&edo.!"!e[, cond+cerea +ne! a%'+"an=e
    Zsad!s% se<+a"[J. E! &o(, :n %od se"ec(!v, vedea, c!(!, &roc+ra sa+ co"ec(a .o(o$ra.!!,
    .!"%e s! descr!er! (e<(+a"e care s+n( cen(ra(e &e (!&+" "or &re.era( de s(!%+" &ara.!"!e.
    M+"=! !nd!v!/! c+ aces(e (+"'+r7r! a.!r%7 c7 co%&or(a%en(+" n+ "e ca+/ea/7 n!c! +n .e"
    de de(res7 O! c7 s!n$+ra *or &ro'"e%7 o cons(!(+!e d!s.+nc=!a soc!a"7 ca re/+"(a( a"
    reac=!e! a"(ora "a co%&or(a%en(+" "or. A"=!! re"a(ea/7 +n sen(!%en( de c+"&7 e<(re%7, de
    r+O!ne s! de&res!e &en(r+ .a&(+" de a se .! an$a@a( :n(r4o ac(!v!(a(e se<+a"7 care es(e
    !nacce&(a'!"7 soc!a" sa+ &e care e! o cons!der7 dre&( !%ora"7. Adesea e<!s(7 o
    de(er!orare :n ca&ac!(a(ea &en(r+ o ac(!v!(a(e se<+a"7 a.ec(+oas7, rec!&roc7, O! &o( .!
    &re/en(e d!s.+nc=!! se<+a"e. Per(+r'7r!"e de &ersona"!(a(e s+n(, de ase%enea, .recven(e
    O! &o( .! s+.!c!en( de severe &en(r+ a @+s(!.!ca +n d!a$nos(!c de (+"'+rare de
    &ersona"!(a(e. La !nd!v!/!! c+ &ara.!"!! &o( a&are s!%&(o%e de de&res!e, aces(ea &+(And
    .! :nso=!(e de o creO(ere :n .recven=a O! !n(ens!(a(ea co%&or(a%en(+"+! &ara.!"!e.
    Da(e de "a'ora(or asoc!a(e. P"e(!s%o$ra.!a &en!an7 a .os( +(!"!/a(7, :n cond!=!! de
    cerce(are, &en(r+ a eva"+a d!verse"e &ara.!"!! &r!n %7s+rarea e<c!(a=!e! se<+a"e a
    !nd!v!d+"+! ca r7s&+ns "a s(!%+"! v!/+a"! O! a+d!(!v!. F!a'!"!(a(ea s! va"!d!(a(ea aces(+!
    &rocede+ :n eva"+area c"!n!c7 n+ a .os( '!ne s(a'!"!(7, !ar e<&er!en=a c"!n!c7 s+$erea/7
    c7 s+'!ec=!! &o( s!%+"a r7s&+ns+r!"e &r!n %an!&+"area !%a$!n!"or %en(a"e.
    Cond!=!! %ed!ca"e $enera"e asoc!a(e. Frecven(, con(ac(+" se<+a" ne&ro(e@a(
    &oa(e d+ce "a o !n.ec=!e sa+ "a (rans%!(erea +ne! %a"ad!! (rans%!se se<+a".
    Co%&or(a%en(e"e sad!ce sa+ %asoc!s(e &o( d+ce "a v7(7%7r!, %er$And ca
    !%&or(an=7 de "a %!nore &An7 "a a &+ne :n &er!co" v!a=a.
    YRG Tulburrile Sexuale si de Identitate Sexual
    *lemente speci$ice culturii ,i sexului
    D!a$nos(!c+" &ara.!"!!"or &e sec=!+ne (ransversa"7 &r!n d!verse c+"(+r! sa+ re"!$!!
    es(e co%&"!ca( de .a&(+" c7, ceea ce es(e cons!dera( dev!an( :n(r4+n %ed!+ c+"(+ra"
    &oa(e .! %a! acce&(a'!" :n a"( %ed!+. C+ e<ce&=!a %asoc!s%+"+! se<+a", :n care ra(a
    se<+"+! es(e es(!%a(7 a .! de 9L de '7r'a=! "a .!ecare .e%e!e, ce"e"a"(e &ara.!"!! n+ s+n(
    a&roa&e n!c!oda(7 d!a$nos(!ca(e "a .e%e!, deO! a+ .os( descr!se cA(eva ca/+r!.
    #revalent
    DeO! &ara.!"!!"e s+n( rar d!a$nos(!ca(e :n +n!(7=!"e c"!n!ce $enera"e, %area &!a=7
    co%erc!a"7 de &orno$ra.!e s! accesor!! &ara.!"!ce s+$erea/7 c7 &reva"en(a sa :n
    co%+n!(a(e es(e &os!'!" s7 .!e %a! %are. Ca/+r!"e ce" %a! .recven( &re/en(e :n c"!n!c!"e
    s&ec!a"!/a(e :n (ra(a%en(+" &ara.!"!!"or s+n( re&re/en(a(e de &edo.!"!e, voye+r!s% s!
    e<!'!=!on!s%. Masoc!s%+" s! sad!s%+" se<+a" s+n( :n(A"n!(e .oar(e rar.
    A&ro<!%a(!v @+%7(a(e d!n(re !nd!v!/!! c+ &ara.!"!! :n(A"n!=! :n c"!n!c7 s+n( c7s7(or!=!.
    *voluie
    Une"e d!n .an(e/!!"e s! co%&or(a%en(e"e asoc!a(e c+ &ara.!"!!"e &o( :nce&e :n
    co&!"7r!e sa+ &recoce :n ado"escen=7, :ns7 dev!n %a! '!ne de.!n!(e s! e"a'ora(e :n
    c+rs+" ado"escen=e! s! :nce&+(+" &er!oade! ad+"(e. E"a'orarea s! rev!/+!rea
    .an(e/!!"or &ara.!"!ce &oa(e con(!n+a de4a "+n$+" :n(re$!! v!e=! a !nd!v!d+"+!. Pr!n
    de.!n!=!e, .an(e/!!"e O! &+"s!+n!"e asoc!a(e c+ aces(e (+"'+r7r! s+n( rec+ren(e. M+"=!
    !nd!v!/! re"a(ea/7 c7 .an(e/!!"e s+n( (o(dea+na &re/en(e, dar c7 e<!s(7 &er!oade de
    (!%& cAnd .recven=a .an(e/!!"or s! !n(ens!(a(ea &+"s!+n!"or var!a/7 cons!dera'!".
    T+"'+r7r!"e (!nd a .! cron!ce s! s7 d+re/e (oa(7 v!a=a, dar a(A( .an(e/!!"e, cA( s!
    co%&or(a%en(e"e d!%!n+a adesea c+ avansarea :n e(a(e "a ad+"=!. Co%&or(a%en(e"e
    se &o( !n(ens!.!ca dre&( r7s&+ns "a s(resor! &s!osoc!a"!, :n re"a=!e c+ a"(e (+"'+r7r!
    %en(a"e or! c+ creO(erea o&or(+n!(7=!"or de a se an$a@a :n &ara.!"!e.
    Dia!nostic di$erenial
    O &ara.!"!e (re'+!e s7 .!e d!s(!ns7 de +/+" non&a(o"o$!c de .an(e/!! se<+a"e,
    co%&or(a%en(e sa+ o'!ec(e dre&( s(!%+" &en(r+ e<c!(a=!a se<+a"7 "a !nd!v!/!! .7r7
    &ara.!"!e. Fan(e/!!"e, co%&or(a%en(e"e sa+ o'!ec(e"e s+n( &ara.!"!ce n+%a! cAnd d+c
    "a o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c Ede e<., s+n( o'"!$a(or!!, d+c "a
    d!s.+nc=!e se<+a"7, neces!(7 &ar(!c!&area de !nd!v!/! care n+ cons!%(, d+c "a
    co%&"!ca=!! "e$a"e, !n(er.erea/7 c+ re"a=!!"e soc!a"eJ.
    :n re(ardarea %en(a"7, de%en=7, %od!.!carea de &ersona"!(a(e da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, !n(o<!ca=!a c+ o s+'s(an=7, e&!sod+" %an!aca" sa+
    sc!/o.ren!e, &oa(e e<!s(a o red+cere a @+dec7=!!, a a&(!(+d!n!"or soc!a"e sa+ a
    con(ro"+"+! !%&+"s+"+! care, :n rare ca/+r!, &o( d+ce "a +n co%&or(a%en( se<+a"
    !nso"!(. Aces(a &oa(e .! d!s(!ns de o &ara.!"!e &r!n .a&(+" c7 co%&or(a%en(+"
    !nso"!( n+ es(e &a((ern+" &re.era( sa+ o'"!$a(or!+ a" !nd!v!d+"+!, s!%&(o%e"e
    se<+a"e s+rven!nd e<c"+s!v :n c+rs+" aces(or (+"'+r7r! %en(a"e, !ar ac(e"e se<+a"e
    !nso"!(e (!nd a .! %a! c+rAnd !/o"a(e decA( rec+ren(e O! de'+(ea/7 de re$+"7 "a o
    e(a(e %a! avansa(7.
    Para.!"!!"e !nd!v!d+a"e &o( .! d!s(!nse &e 'a/a d!.eren=e"or :n cen(rarea &ara.!"!c7
    carac(er!s(!c7. Dac7 :ns7 &re.er!n=e"e se<+a"e a"e !nd!v!d+"+! sa(!s.ac cr!(er!!"e &en(r+
    4572H
    *x%ibiionismul
    YRF

    %a! %+"( decA( o &ara.!"!e, &o( .! d!a$nos(!ca(e (oa(e. E<!'!=!on!s%+" (re'+!e s7 .!e
    d!s(!ns de +r!na(+" :n &+'"!c, care es(e o.er!( +neor! dre&( e<&"!ca=!e &en(r+ aces(
    co%&or(a%en(. Fe(!O!s%+" s! .e(!O!s%+" (ransves(!c co%&or(7 adesea, a%'e"e,
    ar(!co"e de :%'r7c7%!n(e .e%!n!n7, :n .e(!O!s%, .ocar+" e<c!(a=!e! se<+a"e :"
    cons(!(+!e ar(!co"e"e de :%'r7c7%!n(e :n s!ne Ede e<., c!"o=!!J, &e cAnd :n .e(!O!s%+"
    (ransves(!c e<c!(a=!a se<+a"7 &rov!ne d!n ac(+" (raves(!r!!. Traves(!rea, care es(e
    &re/en(7 :n .e(!O!s%+" (ransves(!c, &oa(e .! &re/en(7 s!4n %asoc!s%+" se<+a", :n
    %asoc!s%+" se<+a", +%!"!rea de a .! .or=a( s7 se (raves(easc7 es(e cea care es(e
    e<c!(an(7 se<+a" s! n+ ar(!co"e"e de :%'r7c7%!n(e :n s!ne.
    Traves(!rea &oa(e .! asoc!a(7 c+ d!s.or!e se<+a"7. Dac7 es(e &re/en(7 o oarecare
    d!s.or!e se<+a"7, dar n+ s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e &en(r+ (+"'+rarea de
    !den(!(a(e se<+a"7, d!a$nos(!c+" es(e ce" de .e(!O!s% (ransves(!c, c+ d!s.or!e se<+a"7.
    Ind!v!/!! (re'+!e s7 &r!%easc7 d!a$nos(!c+" ad!=!ona" de (+"'+rare de !den(!(a(e
    se<+a"7, dac7 (a'"o+" "or c"!n!c sa(!s.ace co%&"e( cr!(er!!"e &en(r+ (+"'+rarea de
    !den(!(a(e se<+a"7.
    4+C.7 E,@i-i!ioni&"ul
    Foca"!/area &ara.!"!c7 :n e<!'!=!on!s% !%&"!c7 e<&+nerea or$ane"or $en!(a"e
    &ro&r!! +n+! s(r7!n. Uneor! !nd!v!d+" se %as(+r'ea/7 :n (!%& ce se e<!'7 Esa+ :n
    (!%& ce :O! !%a$!nea/7 c7 se e<!'7J. Dac7 &ersoana (rece "a rea"!/area aces(or
    &+"s!+n!, n+ e<!s(7 :n $enera" n!c! o (en(a(!v7 de ac(!v!(a(e se<+a"7 +"(er!oar7 c+
    s(r7!n+", :n +ne"e ca/+r!, !nd!v!d+" es(e conO(!en( de .a&(+" c7 doreO(e s7 s+r&r!nd7
    sa+ s7 Ooce/e o'serva(or+", :n a"(e ca/+r!, !nd!v!d+" are .an(e/!a e<c!(an(7 se<+a",
    c7 o'serva(or+" se va e<c!(a O! e" se<+a". De'+(+" s+rv!ne de re$+"7 :na!n(e de e(a(ea
    de 5G an!, :ns7 &oa(e avea "oc s! "a o e(a(e %a! avansa(7. La $r+&e"e de !nd!v!/! :n
    e(a(e s+n( .7c+(e %a! &+=!ne ares(7r!, ceea ce &oa(e s+$era c7 aceas(7 cond!=!e dev!ne
    %a! &+=!n sever7 d+&7 e(a(ea de IL de an!.
    Criteriile $e $ia/no&ti# pentru 4+C.7 E,@i-i!ioni&"
    A2 "n decursul unei perioade de cel puin I luni, $ante(ii excitante sexual,
    intense, recurente, pulsiuni sexuale sau comportamente implic@nd
    expunerea or!anelor !enitale proprii unui strin insuspectant2
    S2 #ersoana a acionat, con$orm acestor pulsiuni sexuale, ori pulsiunile sau
    $ante(iile sexuale cau(ea( o detres sau di$icultate interpersonal
    marcat2
    4+C.>* 'etiEi&"ul
    Foca"!/area &ara.!"!c7 :n .e(!O!s% !%&"!c7 +(!"!/area de o'!ec(e !ner(e ES.e(!O+r!TJ.
    Pr!n(re ce"e %a! .recven(e o'!ec(e .e(!O se a."7 c!"o=!! de da%7, s+(!ene"e, c!ora&!!,
    &an(o.!!, c!/%e"e sa+ a"(e ar(!co"e de :%'r7c7%!n(e. Persoana c+ .e(!O!s% se
    %as(+r'ea/7 .recven( :n (!%& ce &oar(7, %An$A!e sa+ %!roase o'!ec(+" .e(!O, or!
    &oa(e cere &ar(enere! se<+a"e s7 :%'race o'!ec(+" :n (!%&+" ra&or(+r!"or se<+a"e. De
    <G+ Tulburrile Sexuale ,i de Identitate Sexual
    re$+"7, .e(!O+" es(e cer+( sa+ !n(ens &re.era( &en(r+ e<c!(a=!a se<+a"7, :n a'sen=a sa
    &+(And e<!s(a d!s.+nc=!e erec(!"7 "a '7r'a=!. Aceas(7 &ara.!"!e n+ es(e d!a$nos(!ca(7,
    cAnd .e(!O+r!"e s+n( "!%!(a(e "a ar(!co"e de :%'r7c7%!n(e .e%!n!n7 +(!"!/a(e :n
    (raves(!re, ca :n .e(!O!s%+" (ransves(!c, sa+ cAnd o'!ec(+" es(e s(!%+"an( $en!(a",
    &en(r+ c7 e" a .os( des(!na( aces(+! sco& Ede e<., +n v!'ra(orJ. De re$+"7 &ara.!"!a
    :nce&e :n ado"escen=7, deO! .e(!O+" se &oa(e s7 .! .os( :n/es(ra( c+ o se%n!.!ca=!e
    s&ec!a"7 &recoce :n co&!"7r!e. Oda(7 !ns(a"a(, .e(!O!s%+" (!nde a .! cron!c.
    Criteriile $e $ia/no&ti# pentru 4+C.>* 'etiEi&"
    A2 "n decursul unei perioade de cel puin I luni, $ante(ii excitante sexual
    intense, recurente, pulsiuni sexuale sau compoTtamente implic@nd u(ul
    unor obiecte inerte &de ex2, len0erie $eminin)2
    S2 'ante(iile, pulsiunile sexuale sau comportamentale cau(ea( o detres sau
    deteriorare semni$icativ clinic "n domeniul social, pro$esional sau "n alte
    domenii importante de $uncionare2
    2 Obiectele $eti, nu sunt limitate la articole de "mbrcminte $eminin
    utili(ate "n travestire &ca "n $eti,ismul transvestic) sau la instrumente
    destinate stimulrii !enitale tactile &de ex2, un vibrator)2
    4+C.>5 'rotteuri&"ul
    Foca"!/area &ara.!"!c7 a .ro((e+r!s%+"+! !%&"!c7 a(!n$erea s! .recarea de o
    &ersoan7 care n+ cons!%(e. Co%&or(a%en(+" s+rv!ne de re$+"7 :n "oc+r!
    a$"o%era(e, d!n care !nd!v!d+" &oa(e sc7&a +Oor de ares(are Ede e<., &e (ro(+are
    a$"o%era(e sa+ :n ve!c+"e"e de (rans&or( &+'"!cJ. E" :O! .reac7 or$ane"e $en!(a"e de
    coa&se"e sa+ .ese"e v!c(!%e! sa+ :! %An$A!e or$ane"e $en!(a"e or! sAn!! c+ %A!n!"e, :n
    (!%& ce .ace aceas(a, e" :O! !%a$!nea/7 de re$+"7 o re"a=!e a.ec(+oas7, e<c"+s!v7, c+
    v!c(!%a. E" rec+noaO(e :ns7 c7, &en(r+ a ev!(a o &os!'!"7 +r%7r!re, e" (re'+!e s7 sca&e
    de(ec(7r!! d+&7 a(!n$erea v!c(!%e! sa"e. De re$+"7 &ara.!"!a :nce&e :n ado"escen=7.
    Ce"e %a! %+"(e ac(e de .ro(a@ s+rv!n cAnd &ersoana es(e :n e(a(e de 5Y49Y de an!,
    d+&7 care a&are +n dec"!n $rad+a" :n .recven=7.
    Criteriile $e $ia/no&ti# pentru 4+C.>5 'rotteuri&"
    A2 "n cursul unei perioade de cel puin I luni, $ante(ii excitante sexual, intense,
    recurente, pulsiuni sexuale sau comportamente implic@nd atin!erea sau
    $recarea de o persoan care nu consimte2
    S2 #ersoana a acionat con$orm acestor pulsiuni sexuale, ori pulsiunile sau
    $ante(iile sexuale cau(ea( o detres sau di$icultate interpersonal marcat2
    <G+ Tulburrile Sexuale ,i de Identitate Sexual

    re$+"7, .e(!O+" es(e cer+( sa+ !n(ens &re.era( &en(r+ e<c!(a=!a se<+a"7, :n a'sen=a sa
    &+(And e<!s(a d!s.+nc=!e erec(!"7 "a '7r'a=!. Aceas(7 &ara.!"!e n+ es(e d!a$nos(!ca(7,
    cAnd .e(!O+r!"e s+n( "!%!(a(e "a ar(!co"e de :%'r7c7%!n(e .e%!n!n7 +(!"!/a(e :n
    (raves(!re, ca :n .e(!O!s%+" (ransves(!c, sa+ cAnd o'!ec(+" es(e s(!%+"an( $en!(a",
    &en(r+ c7 e" a .os( des(!na( aces(+! sco& Ede e<., +n v!'ra(orJ. De re$+"7 &ara.!"!a
    :nce&e :n ado"escen=7, deO! .e(!O+" se &oa(e s7 .! .os( :n/es(ra( c+ o se%n!.!ca=!e
    s&ec!a"7 &recoce :n co&!"7r!e. Oda(7 !ns(a"a(, .e(!O!s%+" (!nde a .! cron!c.
    Criteriile $e $ia/no&ti# pentru 4+C.>* 'etiEi&"
    A2 "n decursul unei perioade de cel puin I luni, $ante(ii excitante sexual
    intense, recurente, pulsiuni sexuale sau comportamente implic@nd u(ul
    unor obiecte inerte &de ex2, len0erie $eminin)2
    S2 'ante(iile, pulsiunile sexuale sau comportamentale cau(ea( o detres sau
    deteriorare semni$icativ clinic "n domeniul social, pro$esional sau "n alte
    domenii importante de $uncionare2
    2 Obiectele $eti, nu sunt limitate la articole de "mbrcminte $eminin
    utili(ate "n travestire &ca "n $eti,ismul transvestic) sau la instrumente
    destinate stimulrii !enitale tactile &de ex2, un vibrator)2
    4+C.>5 'rotteuri&"ul
    Foca"!/area &ara.!"!c7 a .ro((e+r!s%+"+! !%&"!c7 a(!n$erea O! .recarea de o
    &ersoan7 care n+ cons!%(e. Co%&or(a%en(+" s+rv!ne de re$+"7 :n "oc+r!
    a$"o%era(e, d!n care !nd!v!d+" &oa(e sc7&a +Oor de ares(are Ede e<., &e (ro(+are
    a$"o%era(e sa+ :n ve!c+"e"e de (rans&or( &+'"!cJ. E" :O! .reac7 or$ane"e $en!(a"e de
    coa&se"e sa+ .ese"e v!c(!%e! sa+ :! %An$A!e or$ane"e $en!(a"e or! sAn!! c+ %A!n!"e, :n
    (!%& ce .ace aceas(a, e" :O4! !%a$!nea/7 de re$+"7 o re"a=!e a.ec(+oas7, e<c"+s!v7, c+
    v!c(!%a. E" rec+noaO(e :ns7 c7, &en(r+ a ev!(a o &os!'!"7 +r%7r!re, e" (re'+!e s7 sca&e
    de(ec(7r!! d+&7 a(!n$erea v!c(!%e! sa"e. De re$+"7 &ara.!"!a :nce&e :n ado"escen=7.
    Ce"e %a! %+"(e ac(e de .ro(a@ s+rv!n cAnd &ersoana es(e :n e(a(e de 5Y49Y de an!,
    d+&7 care a&are +n dec"!n $rad+a" :n .recven=7.
    Criteriile $e $ia/no&ti# pentru 4+C.>5 'rotteuri&"
    A2 "n cursul unei perioade de cel puin I luni, $ante(ii excitante sexual, intense,
    recurente, pulsiuni sexuale sau comportamente implic@nd atin!erea sau
    $recarea de o persoan care nu consimte2
    S2 #ersoana a acionat con$orm acestor pulsiuni sexuale, ori pulsiunile sau
    $ante(iile sexuale cau(ea( o detres sau di$icultate interpersonal marcat2
    45727
    #edo$ilia
    581

    4+C.C Pe$o%ilia
    Foca"!/area &ara.!"!c7 a &edo.!"!e! !%&"!c7 ac(!v!(a(ea se<+a"7 c+ +n co&!"
    &re&+'er(ar E:n $enera", :n e(a(e de 5; an! sa+ %a! %!cJ. Ind!v!d+" c+ &edo.!"!e
    (re'+!e s7 .!e :n e(a(e de 5R an! sa+ %a! %+"(, s! c+ ce" &+=!n Y an! %a! :n e(a(e decA(
    co&!"+". Pen(r+ !nd!v!/!! :n +"(!%a &ar(e a ado"escen=e! c+ &edo.!"!e, n+ es(e
    s&ec!.!ca(7 o d!.eren=7 de e(a(e &rec!s7 s! (re'+!e .7c+( +/ de @+deca(a c"!n!c7, .!!nd
    "+a(7 :n cons!dera=!e, a(A( %a(+r!(a(ea se<+a"7 a co&!"+"+!, cA( s! d!.eren=a de e(a(e.
    Ind!v!/!! c+ &edo.!"!e re"a(ea/7 :n $enera" o a(rac=!e .a=7 de co&!! de o an+%!(7 $r+&7
    de e(a(e. Un!! !nd!v!/! &re.er7 '7r'a=!!, a"=!! .e%e!"e, !ar a"=!! s+n( e<c!(a=!, a(A( de
    '7r'a=!, cA( s! de .e%e!. Ce! a(raO! de .e%e! &re.er7 de re$+"7 .e(e"e :n e(a(e de G &An7
    "a 5L an!, &e cAnd ce! a(raO! de '7r'a=! &re.er7 '7!e=!! ceva %a! %ar!. Pedo.!"!a,
    !%&"!cAnd v!c(!%e .e%!n!ne, es(e ra&or(a(7 %a! .recven( decA( cea !%&"!cAnd
    v!c(!%e %asc+"!ne. Un!! !nd!v!/! c+ &edo.!"!e s+n( a(raO! se<+a" n+%a! de co&!! E(!&
    e<c"+s!vJ, :n (!%& ce a"=!! s+n( a(raO! +neor! O! de ad+"=! E(!& none<c"+s!vJ. Ind!v!/!!
    c+ &edo.!"!e, care ac=!onea/7 con.or% &+"s!+n!"or "or c+ co&!!, :O! &o( "!%!(a
    ac(!v!(a(ea "a de/'r7carea O! &r!v!rea co&!"+"+!, e<!'area "or :nO!O!, %as(+r'area :n
    &re/en=a co&!"+"+! sa+ a(!n$erea s! %An$A!erea (andr7 a aces(+!a. A"=!!, :ns7,
    &rac(!c7 .e"a(!a sa+ c+n!n"!nc=!a as+&ra co&!"+"+! sa+ &ene(rea/7 va$!n+" .e(!=e!,
    $+ra sa+ an+s+" c+ de$e(e"e "or, c+ o'!ec(e s(r7!ne sa+ c+ &en!s+" O! +(!"!/ea/7
    d!verse $rade de .or=7 &en(r+ a .ace aOa ceva. Aces(e ac(!v!(7=! s+n( e<&"!ca(e
    .recven( c+ sc+/e sa+ ra=!ona"!/7r!, c+% c7 e"e a+ Sva"oare ed+ca(!v7T &en(r+ co&!"
    s! c7 aces(a o'=!ne S&"7cere se<+a"7T d!n e"e or! c7 co&!"+" a .os( S&rovoca(or se<+a"T
    U (e%e care s+n(, de ase%enea, co%+ne :n &orno$ra.!a &edo.!"!c7. D!n ca+/a
    na(+r!! e$os!n(on!ce a &edo.!"!e!, %+"=! !nd!v!/! c+ .an(e/!!, &+"s!+n! sa+
    co%&or(a%en(e &edo.!"!ce n+ e<&er!en(ea/7 o de(res7 se%n!.!ca(!v7. Es(e !%&or(an(
    de :n=e"es c7 e<&er!en(area de(rese! :n "e$7(+r7 c+ .a&(+" de a avea .an(e/!!, &+"s!+n!
    sa+ co%&or(a%en(e n+ es(e necesar7 &en(r+ d!a$nos(!c+" de &edo.!"!e. Ind!v!/!!
    care a+ +n &a((ern de e<c!(a=!e &edo.!"!c7 s! ac=!onea/7 con.or% aces(or .an(e/!! sa+
    &+"s!+n! c+ +n co&!" s+n( dese%na=! &en(r+ d!a$nos(!c+" de &edo.!"!e.
    Ind!v!/!! :O! &o( "!%!(a ac(!v!(7=!"e "a &ro&r!! "or co&!!, "a co&!!! v!(re$! or! r+de, sa+
    &o( v!c(!%!/a co&!! d!n a.ara .a%!"!e! "or. Un!! !nd!v!/! c+ &edo.!"!e a%en!n=7 co&!"+"
    s&re a &reven! den+n=area. A"=!!, :n s&ec!a" ce! care v!c(!%!/ea/7 co&!! .recven(,
    e"a'orea/7 (en!c! co%&"!ca(e &en(r+ a avea acces "a co&!!, (en!c! care &o( !nc"+de
    cAO(!$area :ncreder!! %a%e! co&!"+"+!, c7s7(or!rea c+ o .e%e!e c+ +n co&!" a(r7$7(or,
    co%erc!a"!/area de co&!! c+ a"=! !nd!v!/! c+ &edo.!"!e sa+, :n rare ca/+r!, !a+ :n
    c+s(od!e co&!! d!n =7r!"e ne!nd+s(r!a"!/a(e or! r7&esc co&!! de "a s(r7!n!. C+ e<ce&=!a
    ca/+r!"or :n care (+"'+rarea es(e asoc!a(7 c+ sad!s%+" se<+a", &ersoana &oa(e .!
    a(en(7 "a neces!(7=!"e co&!"+"+!, :n sco&+" cAO(!$7r!! a.ec=!+n!!, !n(eres+"+! O! "o!a"!(7=!!
    co&!"+"+! O! s&re a &reven! re"a(area de c7(re co&!" a ac(!v!(7=!! se<+a"e. T+"'+rarea
    :nce&e de re$+"7 :n ado"escen=7, deO! +n!! !nd!v!/! c+ &edo.!"!e re"a(ea/7 c7 e! n+ a+
    .os( e<c!(a=! de co&!! decA( &An7 "a o e(a(e %ed!e. Frecven=a co%&or(a%en(+"+!
    &edo.!"!e ."+c(+ea/7 c+ s(res+" &s!osoc!a". Evo"+=!a es(e de re$+"7 cron!c7, :n
    s&ec!a" "a ce! a(raO! de '7r'a=!. Ra(a rec!d!v!s%+"+! &en(r+ !nd!v!/!! c+ &edo.!"!e
    !%&"!cAnd &re.er!n=a &en(r+ '7!e=! es(e de a&ro<!%a(!v do+7 or! %a! %are decA( ra(a
    ce"or care &re.er7 .e(e"e.
    582 Tulburrile Sexuale ,i de Identitate Sexual
    Criteriile $e $ia/no&ti# pentru 4+C.C Pe$o%ilie
    A2 "n cursul unei perioade de cel puin I luni, $ante(ii excitante sexual, intense,
    recurente, pulsiuni sexuale sau comportamente implic@nd activitatea
    sexual cu un copil sau cu copii prepubertari &"n !eneral "n etate de E4 ani
    sau mai mici)2
    S2 #ersoana a acionat con$orm acestor pulsiuni sexuale, sau pulsiunile sau $an
    te(iile sexuale cau(ea( o detres sau di$icultate interpersonal marcat2
    2 #ersoana este "n etate de cel puin EI ani si cu cel puin A ani mai mare dec@t
    copilul sau copii de la criteriul A2
    FotD A nu se include un individ "n ultima parte a adolescenei implicat "ntr-o
    relaie sexual care continu cu un altul &alta) "n etate de E7-E4 ani2
    De speci"icat dacD
    Atra& &e,ual $e -(r-a!i Atra&
    &e,ual $e %e"ei Atra& &e,ual $e
    a"-ele &e,e
    De speci"icat dacD
    Li"itat( la in#e&t
    De speci"icat tipulD
    Tip e,#lu&iv &atras numai de copii)
    Tip none,#lu&iv
    4+C.>4 Ma&o#@i&"ul Se,ual
    Foca"!/area &ara.!"!c7 a %asoc!s%+"+! se<+a" !%&"!c7 ac(+" Erea", n+ s!%+"a(J
    de a .! +%!"!(, '7(+(, "e$a( sa+ .7c+( s7 s+.ere :n a"( %od. Un!! !nd!v!/! s+.er7 d!n
    ca+/a .an(e/!!"or "or %asoc!s(e care &o( .! !nvoca(e :n c+rs+" ac(+"+! se<+a" sa+
    a" %as(+r'7r!!, dar n+ rea"!/a(e :n a"( %od. :n as(.e" de ca/+r!, .an(e/!!"e
    %asoc!s(e !%&"!c7 de re$+"7 .a&(+" de a .! v!o"a( :n (!%& ce es(e =!n+( sa+ "e$a( de
    a"=!!, as(.e" c7 n+ e<!s(7 n!c! o &os!'!"!(a(e de sc7&are. A"=!! (rec e! :nO!O! "a rea"!/area
    &+"s!+n!"or "or se<+a"e %asoc!s(e Ede e<., se :n=ea&7 c+ ace, :O! a&"!c7 Ooc+r!
    e"ec(r!ce sa+ se a+(o%+(!"ea/7J or! :%&re+n7 c+ +n &ar(ener. Ac(e"e %asoc!s(e care
    &o( .! o'serva(e c+ +n &ar(ener !nc"+d con(en=!a Eserv!(+(e cor&ora"7J, "e$a(+" "a oc!
    Eserv!(+(e sen/or!a"7J, '7(+(+" c+ rr!a!+" E&add"!n$J, '7(+(+" c+ &a"%a &es(e .ese
    Es&an)!n$J, '!c!+!(+", '7(+(+" E'ea(!n$J, Ooc+r!"e e"ec(r!ce, (7!a(+", S:n=e&a(+" O!
    s(r7&+ns+"T E!n.!'+"a=!aJ O! +%!"!rea Ede e<., a se +r!na sa+ de.eca &e e", a .! .or=a( s7
    se (Arasc7 O! s7 "a(re ca +n cA!ne or! s7 .!e e<&+s +nor %a"(ra(7r! ver'a"eJ. Poa(e .!
    o'serva(7 (raves(!rea .or=a(7 &en(r+ asoc!a=!!"e sa"e +%!"!(oare. Ind!v!d+" &oa(e avea
    dor!n=a de a .! (ra(a( ca +n co&!" nea@+(ora( O! :n.7Oa( :n sc+(ece ES!n.an(!"!s%TJ. O
    .or%7 e<(re% de &er!c+"oas7 de %asoc!s% se<+a", n+%!(7 S!&o<!.!"!eT, !%&"!c7
    e<c!(a=!a se<+a"7 &r!n de&r!varea de o<!$en, o'=!n+(7 c+ a@+(or+" +ne! co%&res!+n!
    (orac!ce, "a=, "!$a(+r!, &+n$! de &"as(!c, %7O(!, or! c!%!c Eadesea +n n!(r!( vo"a(!"
    care &rod+ce o red+cere (e%&orar7 a o<!$en7r!! cre!er+"+! &r!n vasod!"a(a=!e
    &er!.er!c7J. Ac(!v!(7=!"e &r!n de&r!varea de o<!$en &o( .! an$a@a(e de +n+" s!n$+r
    sa+ c+ +n &ar(ener. D!n
    45728H Sadismul
    sexual
    <G4

    ca+/a .+nc=!on7r!! de.ec(+oase a ec!&a%en(+"+!, &o( a&are +neor! eror! :n &"asarea
    "a=+"+! sa+ "!$a(+r!! or! a"(e eror! sa+ %or=! acc!den(a"e. Da(e d!n S(a(e"e Un!(e,
    An$"!a, A+s(ra"!a s! Canada !nd!c7 .a&(+" c7 :n .!ecare an s+n( de(ec(a(e s! ra&or(a(e
    +n+" sa+ do+7 decese ca+/a(e de !&o<!.!"!e "a +n %!"!on de !nd!v!/!. Un!! '7r'a=! c+
    %asoc!s% se<+a" &o( avea s! .e(!O!s%, .e(!O!s% (ransves(!c sa+ sad!s% se<+a". Es(e
    &os!'!" ca .an(e/!!"e %asoc!s(e s7 .!e &re/en(e d!n co&!"7r!e. E(a(ea "a care :nce&
    ac(!v!(7=!"e %asoc!s(e c+ +n &ar(ener es(e var!a'!"7, :ns7 se s!(+ea/7 .recven( "a
    :nce&+(+" &er!oade! ad+"(e. Masoc!s%+" se<+a" es(e de re$+"7 cron!c, &ersoana
    (!n/And s7 re&e(e ace"aO! ac( %asoc!s(. Un!! !nd!v!/! c+ %asoc!s% se<+a" se &o(
    an$a@a :n ac(e %asoc!s(e, .7r7 a cres(e v+"nera'!"!(a(ea even(+a"7 a ac(e"or "or. A"=!!,
    :ns7, cresc sever!(a(ea ac(e"or %asoc!s(e c+ (!%&+" sa+ :n c+rs+" &er!oade"or de
    s(res, ceea ce &oa(e d+ce even(+a" "a v7(7%7r! $rave sa+ c!ar "a %oar(e.
    Criteriile $e $ia/no&ti# pentru 4+C.>4 Ma&o#@i&"ul Se,ual
    A2 "n cursul unei perioade de cel puin I luni, $ante(ii excitante sexual, intense,
    recurente, pulsiuni sexuale sau comportamente implic@nd actul &real, nu
    simulat) de a $i umilit, btut, le!at sau $cut s su$ere "n alt mod2
    S2 'ante(iile, pulsiunile sexuale sau comportamentale cau(ea( o detres sau
    deteriorare semni$icativ clinic "n domeniul social, pro$esional sau "n alte
    arii importante de $uncionare2
    4+C.>7 Sa$i&"ul &e,ual
    Foca"!/area &ara.!"!c7 a sad!s%+"+! se<+a" !%&"!ca ac(e Erea"e, n+ s!%+"a(eJ &r!n
    care !nd!v!d+" o'=!ne e<c!(a=!e se<+a"7 d!n s+.er!n=a &s!o"o$!c7 sa+ .!/!c7 E!nc"+s!v
    +%!"!reaJ v!c(!%e!. Un!! !nd!v!/! c+ aceas(7 &ara.!"!e s+n( deran@a=! de .an(e/!!"e "or
    sad!ce, care &o( .! !nvoca(e :n c+rs+" ac(!v!(7=!! "or se<+a"e, dar n+ ac=!onea/7 :n n!c!
    +n %od con.or% "or8 :n as(.e" de ca/+r! .an(e/!!"e sad!ce !%&"!c7 .a&(+" de a avea +n
    con(ro" co%&"e( as+&ra v!c(!%e!, care es(e (er!.!a(7 de an(!c!&area ac(+"+! sad!c
    !%!nen(. A"=!! ac=!onea/7 con.or% &+"s!+n!"or se<+a"e sad!ce c+ +n &ar(ener care
    cons!%(e Ecare &oa(e avea %asoc!s% se<+a"J, care doreO(e s7 s+.ere d+rere sa+
    +%!"!re, :n .!ne, a"=!! c+ sad!s% se<+a", ac=!onea/7 con.or% &+"s!+n!"or "or se<+a"e
    c+ v!c(!%e care n+ cons!%(, :n (oa(e aces(e ca/+r!, s+.er!n=a v!c(!%e! es(e cea care
    es(e e<c!(an(7 se<+a". Fan(e/!!"e sa+ ac(e"e sad!ce &o( !%&"!ca ac(!v!(7=! care
    co%&or(7 do%!narea &ersoane! res&ec(!ve as+&ra v!c(!%e! Ede e<., .or=area v!c(!%e!
    s7 se (Arasc7 or! =!nerea v!c(!%e! :n(r4o c+Oc7J. E"e &o( !%&"!ca, de ase%enea,
    con(en=!a, "e$area "a oc!, '7(+(+" c+ %a!+", '7(+(+" c+ &a"%a &es(e .ese, '!c!+!(+",
    :n=e&a(+", '7(+(+", ars+", Ooc+r!"e e"ec(r!ce, v!o"+", (7!a(+", s(r7&+ns+", s(ran$+"area,
    (or(+ra, %+(!"area sa+ +c!derea. Es(e &os!'!" ca .an(e/!!"e se<+a"e sad!ce s7 .!e
    &re/en(e d!n co&!"7r!e. E(a(ea "a de'+(+" ac(!v!(7=!"or sad!ce es(e var!a'!"7, dar de
    re$+"7 aces(ea s+rv!n "a :nce&+(+" &er!oade! ad+"(e. Sad!s%+" se<+a" es(e de re$+"7
    cron!c. CAnd sad!s%+" se<+a" es(e &rac(!ca( c+ &ar(ener! care n+ cons!%(, es(e
    &os!'!" ca ac(!v!(a(ea s7 .!e re&e(a(7 &An7 cAnd &ersoana c+ sad!s% se<+a" es(e
    &r!ns7. Un!! !nd!v!/! c+ sad!s% se<+a" se &o( an$a@a :n ac(e sad!ce &en(r+ %+"=! an!,
    .7r7 neces!(a(ea de a creO(e &o(en=!a"+" de &rod+cere a +ne! v7(7%7r! cor&ora"e
    <G7 Tulburrile Sexuale si de Identitate Sexual

    $rave. De re$+"7, :ns7, sever!(a(ea ac(e"or sad!ce cres(e c+ (!%&+". CAnd sad!s%+"
    se<+a" es(e sever, s! :n s&ec!a" cAnd aces(a es(e asoc!a( c+ (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7, !nd!v!/!! c+ sad!s% se<+a" :O! &o( v7(7%a $rav sa+ +c!de v!c(!%e"e.
    Criteriile $e $ia/no&ti# pentru 4+C.>7 Sa$i&"ul Se,ual
    A2 "n cursul unei perioade de cel puin I luni, $ante(ii excitante sexual, intense,
    recurente, pulsiuni sexuale sau comportamente implic@nd acte &reale, nu
    simulate) "n care su$erina psi%ic sau $i(ic a victimei &inclusiv umilirea) este
    excitant sexual pentru persoan2
    S2 #ersoana a acionat con$orm acestor pulsiuni sexuale cu o persoan care nu
    consimte, sau pulsiunile sau $ante(iile sexuale cau(ea( o detres sau
    di$icultate interpersonal marcat2
    4+C.4 'etiEi&"ul Tran&ve&ti#
    Foca"!/area &ara.!"!c7 a .e(!O!s%+"+! (ransves(!c !%&"!c7 (raves(!rea de c7(re +n
    '7r'a( :n :%'r7c7%!n(e de .e%e!e, :n %+"(e sa+ :n ce"e %a! %+"(e ca/+r!, e<c!(a=!a
    se<+a"7 es(e &rod+s7 de $And+" sa+ de !%a$!nea aco%&an!an(7 a &ersoane! ca .e%e!e
    Eden+%!(7 Ta+(o$!ne.!"!eTJ. Aces(e !%a$!n! &o( %er$e de "a a .! o .e%e!e c+ or$ane
    $en!(a"e .e%!n!ne &An7 "a a se vedea &e s!ne :%'r7ca( co%&"e( ca .e%e!e, .7r7 o a(en=!e
    rea"7 &en(r+ or$ane"e $en!(a"e. Ar(!co"e"e de :%'r7c7%!n(e .e%!n!ne s+n( e<c!(an(e :n
    s&ec!a" ca s!%'o"+r! a"e .e%!n!(7=!! !nd!v!d+"+! s! n+ ca .e(!O+r! c+ &ro&r!e(7=! o'!ec(!ve
    s&ec!.!ce Ede e<., o'!ec(e"e .7c+(e d!n ca+c!+cJ. De re$+"7, '7r'a(+" c+ .e(!O!s%
    (ransves(!c =!ne o co"ec=!e .de :%'r7c7%!n(e .e%!n!n7 &e care o +(!"!/ea/7 !n(er%!(en(
    &en(r+ (raves(!re. Aceas(7 (+"'+rare a .os( descr!s7 n+%a! "a '7r'a=!! e(erose<+a"!.
    Fe(!O!s%+" (ransves(!c n+ es(e d!a$nos(!ca( cAnd (raves(!rea s+rv!ne e<c"+s!v :n c+rs+"
    (+"'+r7r!! de !den(!(a(e se<+a"7. Feno%ene"e (ransves(!ce %er$ de "a :%'r7carea
    so"!(ar7, oca/!ona"7, de :%'r7c7%!n(e .e%!n!n7 &An7 "a !%&"!carea :n(r4o s+'c+"(+r7
    (ransves(!c7. Un!! '7r'a=! &oar(7 +n s!n$+r ar(!co" de :%'r7c7%!n(e .e%!n!n7 Ede e<.,
    c!"o=! sa+ $a"an(er!e de da%7J s+' :%'r7c7%!n(ea "or %asc+"!n7. A"=! '7r'a=! c+
    .e(!O!s% (ransves(!c se :%'rac7 co%&"e( ca .e%e! s! se %ac!a/7. ,rad+" "a care
    !nd!v!d+" (raves(!( &are a .! c+ adev7ra( .e%e!e, var!a/7 :n .+nc=!e de %an!er!s%e,
    a'!(+s cor&ora" O! a&(!(+d!nea de a se (raves(!. CAnd n+ es(e (raves(!(, '7r'a(+" c+
    .e(!=!s% (ransves(!c n+ es(e de re$+"7 c+ n!%!c !eO!( d!n co%+n, %asc+"!n. DeO!
    &re.er!n=a sa .+nda%en(a"7 es(e e(erose<+a"7, e" (!nde a avea &+=!ne &ar(enere
    se<+a"e O! se &oa(e an$a@a :n ac(e o%ose<+a"e oca/!ona"e. Un e"e%en( asoc!a( &oa(e
    .! &re/en=a %asoc!s%+"+! se<+a". T+"'+rarea :nce&e de re$+"7 c+ (raves(!re :n
    co&!"7r!e sa+ de (!%&+r!+ :n ado"escen=7, :n %+"(e ca/+r!, (raves(!rea n+ es(e .7c+(7 :n
    &+'"!c &An7 :n &er!oada ad+"(7. E<&er!en=a !n!=!a"7 &oa(e !%&"!ca (raves(!rea &ar=!a"7
    sa+ (o(a"78 (raves(!rea &ar=!a"7 &oa(e &ro$resa adesea :n +na (o(a"7. Un ar(!co" de
    :%'r7c7%!n(e .avor!( &oa(e deven! ero(!c :n s!ne O! &oa(e .! +(!"!/a( :n %od +/+a", %a!
    :n(A! :n %as(+r'are O! %a! (Ar/!+ :n ac(+" se<+a". La +n!! !nd!v!/!, %o(!va=!a &en(r+
    (raves(!re se &oa(e sc!%'a :n dec+rs+" (!%&+"+!, (e%&orar sa+ &er%anen(, &e
    %7s+r7 ce e<c!(a=!a se<+a"7, ca r7s&+ns "a (raves(!re, d!%!n+a sa+ d!s&are, :n as(.e" de
    457287
    VoKeurismul
    <G<
    ca/+r!, (raves(!rea dev!ne +n an(!do( &en(r+ an<!e(a(e sa+ de&res!e sa+ con(r!'+!e "a
    +n sen(!%en( de &ace s! de ca"%. La a"=! !nd!v!/!, d!s.or!a se<+a"7 &oa(e a&are :n
    s&ec!a" :n s!(+a=!! de s(res, c+ sa+ .7r7 s!%&(o%e de de&res!e. Pen(r+ +n %!c n+%7r de
    !nd!v!/!, d!s.or!a se<+a"a dev!ne o &ar(e s(a'!"7 a (a'"o+"+! c"!n!c s! es(e :nso=!(7 de
    dor!n=a de a se :%'r7ca s! de a (r7! &er%anen( ca .e%e!e s! ca+(7 rea(r!'+!re se<+a"7
    or%ona"7 sa+ c!r+r$!ca"7. Ind!v!/!! c+ .e(!O!s% (ransves(!c so"!c!(7 adesea (ra(a%en(
    cAnd a&are d!s.or!a se<+a"a. S+'(!&+" Sc+ d!s.or!e se<+a"aT es(e &rev7/+( &en(r+ a
    &er%!(e c"!n!c!an+"+! s7 no(e/e d!s.or!a se<+a"a ca &ar(e a .e(!O!s%+"+! (ransves(!c.
    Criteriile $e $ia/no&ti# pentru
    4+C.4 'etiEi&"ul Tran&ve&ti#
    A2 "n decursul unei perioade de cel puin I luni, la un brbat %eterosexual, $an
    te(ii excitante sexual, intense, recurente, pulsiuni sexuale sau comporta
    mente implic@nd travestirea2
    S2 'ante(iile, pulsiunile sexuale sau comportamentele cau(ea( o detres sau
    deteriorare semni$icativ clinic "n domeniul social, pro$esional sau "n alte
    domenii importante de $uncionare2
    De speci"icat dacD
    Cu $i&%orie &e,ual(M dac persoana are un discom$ort persistent "n le!tur
    cu identitatea sau rolul sexului2
    4+C.>C VoPeuri&"ul
    Foca"!/area &ara.!"!c7 a voye+r!s%+"+! !%&"!c7 ac(+" &r!v!r!! +nor !nd!v!/! care
    n+4O! da+ sea%a c7 s+n( &r!v!=!, de re$+"7 s(r7!n!, care s+n( n+/!, :n &roces+"
    de/'r7c7r!! or! an$a@a=! :n ac(!v!(a(e se<+a"7. Ac(+" &r!v!(+"+! ES&ee&!n$TJ es(e
    e.ec(+a( :n sco&+" o'=!ner!! e<c!(a=!e! se<+a"e s!, :n $enera", n+ es(e av+(7 :n vedere
    ac(!v!(a(ea se<+a"7 c+ &ersoane"e o'serva(e. Or$as%+", &rod+s de re$+"7 &r!n
    %as(+r'are, &oa(e s+rven! :n c+rs+" ac(!v!(7=!! voye+r!s(!ce or!, %a! (Ar/!+, ca
    r7s&+ns "a a%!n(!rea a ceea ce !nd!v!d+" a .os( %ar(or. Adesea, aceO(! !nd!v!/! a+
    .an(e/!a de a avea o e<&er!en=7 se<+a"7 c+ &ersoana o'serva(7, :ns7 :n rea"!(a(e
    aceas(a s+rv!ne rar. :n .or%a sa sever7, sco&(o.!"!a ES&ee&!n$+"TJ cons(!(+!e .or%a
    e<c"+s!v7 de ac(!v!(a(e se<+a"7. De'+(+" co%&or(a%en(+"+! voye+r!s(!c are "oc de
    re$+"7 :na!n(e de e(a(ea de 5Y an!. Evo"+=!a (!nde a .! cron!c7.
    Criteriile $e $ia/no&ti# pentru 4+C.>C VoPeuri&"
    A2 "n cursul unei perioade de cel puin I luni, $ante(ii excitante sexual, intense,
    recurente2pulsiuni sexuale sau comportamente implic@nd actul observrii
    unei persoane care nu suspectea( nimic si care este nud, "n curs de
    de(brcare sau "n activitate sexual 2
    S2 #ersoana a acionat con$orm acestor pulsiuni sexuale, sau pulsiunile sau
    $ante(iile sexuale cau(ea( detres sau di$icultate interpersonal marcat 2
    YHR Tulburrile Sexuale ,i de Identitate Sexual

    4+C.5 Para%ilie '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e !nc"+s7 &en(r+ a cod!.!ca &ara.!"!!"e care n+ sa(!s.ac
    cr!(er!!"e &en(r+ n!c! +na d!n(re ca(e$or!!"e s&ec!.!ce. E<e%&"e"e !nc"+d, dar n+ s+n(
    "!%!(a(e "a aces(ea, sca(o"o$!a (e"e.on!c7 Ea&e"+r! (e"e.on!ce o'sceneJ, necro.!"!a
    EcadavreJ, &ar=!a"!s%+" E.oca"!/area e<c"+s!v7 &e o &ar(e a cor&+"+!J, /oo.!"!a
    Ean!%a"eJ, co&ro.!"!a E.eca"eJ, c"!s%a.!"!a Ec"!s%7J, +ro.!"!a E+r!n7J.
    Tul-ur(rile $e I$entitate Se,ual(
    Tul-urarea $e I$entitate Se,ual(
    *lemente de dia!nostic
    E<!s(7 do+7 co%&onen(e a"e (+"'+r7r!! de !den(!(a(e se<+a"7, a%'e"e (re'+!nd s7 .!e
    &re/en(e &en(r+ a &+ne d!a$nos(!c+". Tre'+!e s7 e<!s(e &ro'a +ne! !den(!.!c7r!
    &+(ern!ce s! &ers!s(en(e c+ se<+" o&+s, care es(e dor!n=a de a .! or! !ns!s(en=a s+'!ec(+"+!
    c7 es(e de ce"7"a"( se< Ecr!(er!+" AJ. Aceas(7 !den(!.!care c+ se<+" o&+s (re'+!e s7 n+ .!e
    doar o dor!n=7 de vre+n+" d!n avan(a@e"e c+"(+ra"e &erce&+(e d!n .a&(+" de a .! se<+"
    o&+s. Tre'+!e, de ase%enea, s7 e<!s(e &ro'a +n+! d!scon.or( &ers!s(en( :n "e$7(+r7 c+
    &ro&r!+" se< a(r!'+!( or! +n sen(!%en( de !nadecvare :n ro"+" $en+"+! ace"+! se<
    Ecr!(er!+" BJ. D!a$nos(!c+" n+ es(e &+s dac7 !nd!v!d+" are o cond!=!e !n(erse<+a"7
    so%a(!c7 conco%!(en(7 Ede e<., s!ndro% de !nsens!'!"!(a(e andro$en7 &ar=!a"7 sa+
    !&er&"a/!e s+&rarena"7 con$en!(a"7J Ecr!(er!+" CJ. Pen(r+ a &+ne d!a$nos(!c+", (re'+!e
    s7 e<!s(e &ro'a +ne! de(rese sa+ de(er!or7r! se%n!.!ca(!ve c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! de .+nc=!onare !%&or(an(e Ecr!(er!+" DJ.
    La '7!e=!, !den(!.!carea c+ se<+" o&+s se %an!.es(7 &r!n(r4o &reoc+&are %arca(a
    &en(r+ ac(!v!(7=! (rad!=!ona" .e%!n!ne. E! &o( avea &re.er!n=a &en(r+ :%'r7carea c+
    ar(!co"e de ves(!%en(a=!e .e%!n!n7, sa+ :O! &o( !%&rov!/a as(.e" de ar(!co"e d!n
    %a(er!a"e d!s&on!'!"e cAnd ar(!co"e"e or!$!na"e n+ s+n( acces!'!"e. Prosoa&e, sor(+r!,
    .+"are s+n( +(!"!/a(e adesea &en(r+ a re&re/en(a &7r+" "+n$ sa+ .+s(e"e. E<!s(7 o
    a(rac=!e &+(ern!c7 &en(r+ @oc+r!"e s! d!s(rac=!!"e .e(e"or. Lor "e &"ace :n s&ec!a" s7 se
    @oace Sde4a casaT, s7 desene/e (a'"o+r! de .e(e s! &r!n=ese .r+%oase O! s7 &r!veasc7 "a
    (e"ev!/or sa+ "a v!deo &ersona@e"e "or .e%!n!ne .avor!(e. P7&+O!"e de ser!e de (!&
    .e%!n!n, ca B7r'!e, s+n( adesea @+c7r!!"e "or .avor!(e, !ar .e(e"e, &ar(ener!! "or de @oc
    &re.era=!. CAnd se @oac7 Sde4a casaT, aceO(! '7!e=! @oac7 ro"+" &ersona@e"or .e%!n!ne, ce"
    %a! .recven( Sro"+r! de %a%7T s! adesea s+n( .oar(e &reoc+&a=! de &ersona@e .e%!n!ne
    !%a$!nare. E! ev!(7 @oc+r!"e c+ :nv7"%7Oea"7 O! s&or(+r!"e co%&e(!(!ve O! s+n( &+=!n
    !n(eresa=! de a+(o(+r!s%e s! de ca%!oane sa+ de a"(e @+c7r!! nona$res!ve, dar (!&!c
    '7!e=eO(!, :O! &o( e<&r!%a dor!n=a de a .! .a(7 s! a.!r%7 c7 a(+nc! cAnd vor cres(e %ar!,
    vor .! .e%e!e. Po( !ns!s(a s7 se aOe/e s&re a +r!na O! &re(!nd c7 n+ a+ &en!s, &r!n
    &resarea aces(+!a :n(re &!c!oare. Ma! rar, '7!e=!! c+ (+"'+rare de !den(!(a(e se<+a"7 &o(
    a.!r%a c7 e! :O! $7sesc &en!s+" sa+ (es(!co"e"e de/$+s(7(oare, c7 e! doresc s7 "e :n"7(+re
    or! c7 e! a+, sa+ c7 doresc s7 a!'7 va$!n.
    Fe(e"e c+ (+"'+rarea de !den(!(a(e se<+a"7 &re/!n(7 reac=!! ne$a(!ve !n(ense "a
    dor!n=e"e sa+ :ncerc7r!"e &7r!n=!"or de a "e .ace s7 &oar(e roc!=e sa+ a"(e ar(!co"e de
    Tulburarea de Identitate
    Sexual
    A??
    :%'r7c7%!n(e .e%!n!n7. Une"e &o( re.+/a s7 %ear$7 "a scoa"7 sa+ s7 &ar(!c!&e "a
    even!%en(e"e soc!a"e, +nde &oa(e .! cer+(7 o as(.e" de ves(!%en(a=!e. E"e &re.er7
    :%'r7c7%!n(ea '7!e=easc7 s! &7r+" sc+r(, s! adesea s+n( !den(!.!ca(e :n %od erona(
    de c7(re s(r7!n! ca '7!e=!, s! &o( cere s7 .!e ce%a(e c+ n+%e de '7!a(. Ero!! .an(e/!!"or
    "or s+n( ce" %a! adesea &ersona@e %asc+"!ne &+(ern!ce &rec+% Ha(%an sa+
    S+&er%an. Aces(e .e(e &re.er7 '7!e=!! ca &ar(ener! de @oc, c+ care a+ &reoc+&7r!
    co%+ne re.er!(oare "a s&or(, @oc+r!"e c+ :nv7"%7Oea"7 s! @oc+r!"e (rad!=!ona" '7!e=eO(!.
    Man!.es(7 &+=!n !n(eres &en(r+ &7&+O!, &en(r+ or!ce .or%7 de :%'r7c7%!n(e
    .e%!n!n7 or! ac(!v!(a(e de @oc :n care s7 de=!n7 ro"+" de .e%e!e. O .a(7 c+ aceas(7
    (+"'+rare &oa(e, oca/!ona", re.+/a s7 +r!ne/e :n &o/!=!e aOe/a(7. Ea &oa(e s+s=!ne c7
    are, sa+ c74! va creO(e &en!s O! &oa(e s+s=!ne c7 n+ doreO(e s74! cresc7 sAn!! sa+ s7 a!'7
    %ens(re. Poa(e s+s=!ne c7, a(+nc! cAnd va creO(e, va .! '7r'a(. T!&!c, as(.e" de .e(e
    &re/!n(7 o !den(!.!care %arca(7 c+ se<+" o&+s :n ro"+r!"e d!n @oc+r!, :n v!se s! .an(e/!!.
    Ad+"=!! c+ (+"'+rare de !den(!(a(e se<+a"7 s+n( &reoc+&a=! de dor!n=a "or de a (r7!
    ca %e%'r+ a" ce"+!"a"( se<. Aceas(7 &reoc+&are se &oa(e %an!.es(a ca o dor!n=7
    !n(ens7 de a ado&(a ro"+" soc!a" a" ce"+!"a"( se< sa+ de a c7&7(a as&ec(+" .!/!c a"
    ce"+!"a"( se< &r!n %an!&+"are or%ona"7 sa+ c!r+r$!ca"7. Ad+"=!! c+ aceas(7
    (+"'+rare n+ se s!%( '!ne cAnd s+n( cons!dera=! sa+ .+nc=!onea/7 :n soc!e(a(e ca
    %e%'r! a! se<+"+! a(r!'+!( "or. :n $rade var!a'!"e, e! ado&(7 co%&or(a%en(+",
    :%'r7c7%!n(ea s! %an!ere"e ce"+!"a"( se<. :n &ar(!c+"ar, aceO(! !nd!v!/! &o( &!erde
    %+"( (!%& c+ (raves(!rea O! c+ aran@area =!n+(e!, &en(r+ a &are de ce"7"a"( se<. M+"=!
    :ncearc7 s7 (reac7 O! :n &+'"!c ca .!!nd de ce"7"a"( se<. Pr!n (raves(!re O! (ra(a%en(
    or%ona" E!ar &en(r+ '7r'a=!, e"ec(ro"!/!s+"J, %+"=! !nd!v!/! c+ aceas(7 (+"'+rare &o(
    (rece :n %od conv!n$7(or ca a&ar=!nAnd ce"+!"a"( se<. Ac(!v!(a(ea se<+a"7 a aces(or
    !nd!v!/! c+ &ar(ener! de ace"aO! se< es(e :n $enera" %arca(7 de &re.er!n=a ca
    &ar(ener!! "or s7 n+ "e vad7 n!c!oda(7 or$ane"e $en!(a"e s! n!c! s7 "! "e a(!n$7. Pen(r+
    +n!! '7r'a=!, care se %an!.es(7 %a! (Ar/!+ :n v!a=7 Eadesea d+&7 c7s7(or!eJ,
    ac(!v!(a(ea se<+a"7 c+ o .e%e!e es(e aco%&an!a(7 de .an(e/!a de a .! a%an(e "es'!ene
    sa+ c7 &ar(enera sa es(e '7r'a(, !ar e" es(e .e%e!e.
    La ado"escen=!, e"e%en(e"e c"!n!ce &o( a%!n(!, .!e &e ce"e a"e co&!!"or, .!e &e ce"e a"e
    ad+"=!"or, :n .+nc=!e de n!ve"+" de de/vo"(are a" !nd!v!d+"+!, !ar cr!(er!!"e (re'+!e s7 .!e
    a&"!ca(e cores&+n/7(or. La +n ado"escen( %a! (An7r, &oa(e .! %a! d!.!c!" s7 se a@+n$7
    "a +n d!a$nos(!c corec( d!n ca+/a &r+den=e! s+'!ec(+"+!. Aceas(a &oa(e .! cresc+(7,
    dac7 ado"escen(+" se s!%(e a%'!va"en( :n "e$7(+r7 c+ !den(!.!carea c+ se<+" o&+s sa+
    s!%(e c7 aceas(a es(e !nacce&(a'!"7 &en(r+ .a%!"!e. Ado"escen(+" &oa(e .! ad+s "a
    %ed!c &en(r+ c7 &7r!n=!! sa+ &ro.esor!! s+n( &reoc+&a=! de !/o"area soc!a"7 sa+ de
    (ac!narea O! re@ec=!a e$a"!"or, :n as(.e" de ca/+r!, d!a$nos(!c+" (re'+!e s7 .!e re/erva(
    &en(r+ ace! ado"escen=! care &ar a .! &er.ec( !den(!.!ca=! c+ se<+" o&+s :n ves(!%en(a=!a
    "or O! care se an$a@ea/7 :n co%&or(a%en(e care s+$erea/7 o !den(!.!care se%n!.!ca(!v7
    c+ se<+" o&+s Ede e<., ras+" &e &!c!oare "a '7r'a=!J. C"ar!.!carea d!a$nos(!c+"+! "a co&!!
    O! "a ado"escen=! &oa(e neces!(a %on!(or!/are o "+n$7 &er!oad7 de (!%&.
    De(resa sa+ !nca&ac!(a(ea "a !nd!v!/!! c+ (+"'+rare de !den(!(a(e se<+a"7 se
    %an!.es(7 d!.eren=!a( de4a "+n$+" c!c"+"+! v!e=!!. La co&!! %a! %!c!, de(resa se %an!.es(7
    &r!n(r4o ne.er!c!re .7=!O7 :n "e$7(+r7 c+ se<+" a(r!'+!( "or. Preoc+&area &en(r+ dor!n=e"e
    se<+"+! o&+s !n(er.erea/7 adesea c+ ac(!v!(7=!"e co%+ne. La co&!!! %a! %ar!,
    !nca&ac!(a(ea de a de/vo"(a re"a=!! O! de&r!nder! cores&+n/7(oare e(7=!! c+ e$a"!! de
    ace"aO! se< d+c adesea "a !/o"are O! de(resa, !ar +n!! co&!! &o( re.+/a s7 +r%e/e Ocoa"a
    d!n ca+/a !ron!!"or sa+ cons(rAn$er!! de a &+r(a o :%'r7c7%!n(e cores&+n/7(oare
    se<+"+! a(r!'+!( "or. La ado"escen=! O! ad+"=!, &reoc+&area &en(r+ dor!n=e"e se<+"+! o&+s
    <G> Tulburrile Sexuale ,i de Identitate Sexual
    !n(er.erea/7 adesea c+ ac(!v!(7=!"e +/+a"e. D!.!c+"(7=!"e re"a=!ona"e s+n( .recven(e, !ar
    .+nc=!onarea "a scoa"7 sa+ "a serv!c!+ &oa(e .! de(er!ora(7.
    Speci$icani
    Pen(r+ !nd!v!/!! %a(+r! se<+a", &o( .! %en=!ona=! +r%7(or!! s&ec!.!can=! &e 'a/a
    or!en(7r!! se<+a"e a !nd!v!d+"+!Q atras sexual de brba3i2 atras sexual de femei2
    atras sexual de ambele se<e, neatras de nici un sex. B7r'a=!! c+ (+"'+rare de
    !den(!(a(e se<+a"7 c+&r!nd &ro&or=!! s+'s(an=!a"e d!n (o=! ce! &a(r+ s&ec!.!can=!. Ce!
    care s+n( a(raO! de '7r'a=! e<&er!en(ea/7 de re$+"7 (+"'+rarea :nce&And d!n
    co&!"7r!e sa+ &recoce :n ado"escen=7, &e cAnd '7r'a=!! care s+n( a(raO! de .e%e!, de
    a%'e"e se<e sa+ de n!c! +n+", :O! ra&or(ea/7 d!s.or!a se<+a"7 ca :nce&And &recoce
    sa+ "a %!@"oc+" &er!oade! ad+"(e. Ind!v!/!! care n+ s+n( a(raO! de n!c! +n se< s+n(
    adesea !nd!v!/! !/o"a=! c+ (r7s7(+r! sc!/o!de. Prac(!c, (oa(e .e%e!"e c+ (+"'+rarea de
    !den(!(a(e se<+a"7 vor &r!%! ace"aO! s&ec!.!can( U a(ras7 se<+a" de .e%e! U deO!
    e<!s(7 ca/+r! e<ce&=!ona"e !%&"!cAnd .e%e! care s+n( a(rase se<+a" de '7r'a=!.
    #rocedee de "nre!istrare
    Cod+" d!a$nos(!c a(r!'+!( de&!nde de e(a(ea ac(+a"7 a !nd!v!d+"+!Q dac7
    (+"'+rarea s+rv!ne :n co&!"7r!e, es(e +(!"!/a( cod+" ;L9.R8 &en(r+ +n ado"escen( sa+
    +n ad+"( es(e +(!"!/a( cod+" ;L9.GY.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. M+"=! !nd!v!/! c+
    (+"'+rarea de !den(!(a(e se<+a"7 dev!n !/o"a=! soc!a". I/o"area s! os(rac!s%+"
    con(r!'+!e "a s(!%a de s!ne sc7/+(7 s! &o( d+ce "a avers!+ne .a=7 de Ocoa"7 sa+ "a
    a'andonarea sco"!!. Os(rac!s%+" O! !ron!a e$a"!"or s+n( consec!n=e e<(re% de
    co%+ne &en(r+ '7!e=!! c+ aceas(7 (+"'+rare. B7!e=!! c+ (+"'+rare de !den(!(a(e
    se<+a"7 &re/!n(7 adesea %an!ere O! &a((ern+r! de vor'!re .e%!n!ne.
    Per(+r'area &oa(e .! a(A( de &ervas!v7, c7 v!a=a %en(a"7 a +nor !nd!v!/! se :nvAr(e
    n+%a! :n @+r+" ace"or ac(!v!(7=! care +O+rea/7 de(resa se<+a"7. E! s+n( &reoc+&a=!
    adesea de as&ec(, :n s&ec!a" "a :nce&+(+" (ran/!=!e! s&re (r7!rea :n ro"+" se<+"+! o&+s.
    Re"a=!!"e c+ +n+" sa+ c+ a%'!! &7r!n=! &o( .!, de ase%enea, ser!os de(er!ora(e. Un!!
    '7r'a=! c+ (+"'+rare de !den(!(a(e se<+a"7 rec+r$ "a a+(o(ra(a%en( c+ or%on! s!,
    %a! rar, :O! &rac(!c7 a+(ocas(rare sa+ &enec(o%!e. :n %ed!+" +r'an :n s&ec!a", +n!!
    '7r'a=! c+ (+"'+rarea se &o( an$a@a :n &ros(!(+=!e, ceea ce :! &"asea/7 &e (rea&(a +n+!
    r!sc cresc+( &en(r+ !n.ec=!a c+ v!r+s+" !%+node.!c!en=e! +%ane EHI3J. Ten(a(!ve"e de
    s+!c!d s! (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 s+n( asoc!a(e .recven(.
    Co&!!! c+ (+"'+rare de !den(!(a(e se<+a"7 &o( %an!.es(a, ca .!!nd coe<!s(en(e,
    an<!e(a(e de se&arare, an<!e(a(e $enera"!/a(7 s! s!%&(o%e de&res!ve. Ado"escen=!!
    s+n( e<(re% de e<&+O! r!sc+"+! de de&res!e, !dea=!e s+!c!dar7 O! (en(a(!ve de s+!c!d.
    La ad+"=!, &o( .! &re/en(e s!%&(o%e an<!oase O! de&res!ve, :n eOan(!oane"e c"!n!ce,
    (+"'+r7r!"e de &ersona"!(a(e asoc!a(e s+n( %a! .recven(e &r!n(re '7r'a=! decA( &r!n(re
    .e%e!. B7r'a=!! ad+"=! care s+n( a(raO! se<+a" de .e%e!, a(A( de .e%e!, cA( O! de '7r'a=!
    sa+ n+ s+n( a(raO! se<+a" de n!c! +n se< re"a(ea/7 +n !s(or!c de e<c!(a=!e se<+a"7
    asoc!a( c+ $And+r! sa+ !%a$!n! de s!ne ca .e%e!e En+%!( a+to/ine)ilie%7 :n ce"e %a!
    %+"(e ca/+r!, !nd!v!d+" ar .! dese%na(, ce" &+=!n :n (rec+(+" s7+ &en(r+ d!a$nos(!c+"
    de .e(!O!s% (ransves(!c. In a"(e ca/+r!, :ns7, .an(e/!a .avor!(7 a !nd!v!d+"+!
    accen(+ea/7 a(r!'+(e .e%!n!ne, a"(e"e decA( ves(!%en(a=!a. Un!! '7r'a=!, de e<e%&"+,
    Tulburarea de Identitate
    Sexual
    584
    se %as(+r'ea/7 :n (!%& ce se !%a$!nea/7 &e e! :nO!O! ca .e%e!e n+d7 s! se cen(rea/7
    &e sAn!! s! v+"va !%a$!na(78 a"=!! se %as(+r'ea/7 :n (!%& ce se !%a$!nea/7 &e e!
    :nO!O! ca an$a@a=! :n +ne"e ac(!v!(7=! (!&!c .e%!n!ne, c+% ar .! (r!co(a(+".
    9ate de laborator asociate. N+ e<!s(7 n!c! +n (es( d!a$nos(!c s&ec!.!c &en(r+
    (+"'+rarea de !den(!(a(e se<+a"7, :n &re/en=a +ne! e<a%!n7r! so%a(!ce nor%a"e,
    car!o(!&area &en(r+ cro%o/o%!! se<+a"! sa+ do/area or%on!"or se<+a"! n+ s+n( de
    re$+"7 !nd!ca(e. Tes(area &s!o"o$!c7 &oa(e reve"a !den(!.!carea sa+ &a((ern+r! de
    co%&or(a%en( (ransse<+a"e.
    9atele examinrii somatice /i cond!=!!"e medicale .enerale asociate.
    Ind!v!/!! c+ (+"'+rare de !den(!(a(e se<+a"7 a+ or$ane $en!(a"e nor%a"e E:n con(ras(
    c+ or$ane"e $en!(a"e a%'!$+! sa+ !&o$onad!s%+" o'serva( :n cond!=!!"e
    !n(erse<+a"e so%a(!ceJ. B7r'a=!! ado"escen=! s! ad+"=! c+ (+"'+rare de !den(!(a(e
    se<+a"7 &o( &re/en(a o %7r!re a sAn!"or re/+"(And d!n !n$es(!a de or%on!, de&!"are
    &r!n e&!"are (e%&orar7 sa+ &er%anen(7, s! a"(e %od!.!c7r! so%a(!ce ca re/+"(a( a"
    +nor &roced+r!, ca r!no&"as(!a s! raderea car(!"a$!+"+! (!ro!d Ered+cerea
    c!r+r$!ca"7 a %7r+"+! "+! Ada%J. SAn! de.or%a=! sa+ !r!(a=!! "a n!ve"+" sAn!"or &o(
    .! v7/+(e "a .e%e!"e care &oar(7 'en/! "a n!ve"+" sAn!"or. Co%&"!ca=!!"e
    &os(c!r+r$!ca"e "a .e%e!"e $ene(!ce !nc"+d c!ca(r!c! no(a'!"e a"e &ere(e"+! an(er!or
    a" (orace"+!, !ar "a '7r'a=!! $ene(!c!, s(r!c(+r! va$!na"e, .!s(+"e rec(ova$!na"e,
    s(eno/e +re(ra"e s! @e( +r!nar r7+ or!en(a(. Fe%e!"e ad+"(e c+ (+"'+rarea de
    !den(!(a(e se<+a"7 &o( avea, c+ o &ro'a'!"!(a(e %a! %are decA( cea aO(e&(a(7, ovare
    &o"!c!s(!ce.
    *lemente speci$ice etii si sexului
    Fe%e!"e c+ (+"'+r7r! de !den(!(a(e se<+a"7 e<&er!en(ea/7 :n $enera" %a! &+=!n
    os(rac!s% d!n ca+/a !n(eres+"+! &en(r+ se<+" o&+s O! &o( s+.er! %a! &+=!n d!n ca+/a
    re@ec=!e! e$a"!"or, ce" &+=!n &An7 "a ado"escen=7, :n eOan(!oane"e c"!n!ce de co&!!,
    '7!e=!! c+ aceas(7 (+"'+rare s+n( (r!%!O! &en(r+ eva"+are %+"( %a! .recven( decA(
    .e(e"e, :n eOan(!oane"e c"!n!ce de ad+"=!, '7r'a=!! s+n( de do+7, (re! or! %a! n+%eroO!
    decA( .e%e!"e. La co&!!, &re@+deca(a (r!%!(er!! "a %ed!c a '7!e=!"or, &oa(e re."ec(a,
    &ar=!a", s(!$%a(+" %a! %are &e care45 &oar(7 co%&or(a%en(+" carac(er!s(!c se<+"+!
    o&+s &en(r+ '7!e=! decA( &en(r+ .e(e.
    #revalent
    N+ e<!s(7 s(+d!! e&!de%!o"o$!ce recen(e care s7 o.ere da(e des&re &reva"en(a
    (+"'+r7r!! de !den(!(a(e se<+a"7. Da(e d!n =7r!"e e+ro&ene %a! %!c! c+ acces "a
    s(a(!s(!ca (o(a"7 a &o&+"a=!e! O! (r!%!(ere "a %ed!c, s+$erea/7 c7 a&ro<!%a(!v " d!n
    ;L.LLL '7r'a=! ad+"=! O! " d!n 5LL.LLL .e%e! ad+"(e so"!c!(7 !n(erven=!e c!r+r$!ca"7
    &en(r+ sc!%'area se<+"+!.
    *voluie
    La co&!!! (r!%!O! &en(r+ cons+"( c"!n!c, de'+(+" &reoc+&7r!"or O! ac(!v!(7=!"or
    carac(er!s(!ce se<+"+! o&+s are "oc de re$+"7 :n(re e(a(ea de 9 O! I an!, !ar +n!! &7r!n=!
    re"a(ea/7 c7 co&!"+" "or a av+( d!n (o(dea+na &reoc+&7r! carac(er!s(!ce se<+"+! o&+s.
    N+%a! +n .oar(e %!c n+%7r de co&!! c+ (+"'+rarea de !den(!(a(e se<+a"7 vor
    con(!n+a s7 &re/!n(e s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea de
    !den(!(a(e se<+a"7, (Ar/!+ :n ado"escen=7 sa+ :n &er!oada ad+"(7. De re$+"7, co&!!!
    s+n( &re/en(a=! "a %ed!c :n @+r+" &er!oade! de %ers "a scoa"7, d!n ca+/a &reoc+&7r!!
    <>+ Tulburrile Sexuale ,i de Identitate Sexual
    &7r!n=!"or &en(r+ .a&(+" c7, ceea ce e! cons!dera+ dre&( S.a/7T, n+ &are a .! (rec+(.
    Ce! %a! %+"=! co&!! c+ (+"'+rare de !den(!(a(e se<+a"7 %an!.es(7, c+ (!%&+", d!n
    ca+/a !n(erven=!e! &7r!n=!"or or! a r7s&+ns+"+! d!n &ar(ea e$a"!"or, co%&or(a%en(e
    carac(er!s(!ce se<+"+! o&+s %a! &+=!n ev!den(e. TAr/!+, :n ado"escen=7 sa+ :n
    &er!oada ad+"(7, a&roa&e (re! s.er(+r! d!n(re '7!e=!! care a+ av+( +n !s(or!c de
    (+"'+rare de !den(!(a(e se<+a"7 :n co&!"7r!e re"a(ea/7 o or!en(are o%ose<+a"7 sa+
    '!se<+a"7, dar .7r7 (+"'+rare de !den(!(a(e se<+a"7 conco%!(en(7. Ce! %a! %+"=!
    d!n(re ce! r7%aO! re"a(ea/7 o or!en(are e(erose<+a"7, de ase%enea, .7r7 (+"'+rare
    de !den(!(a(e se<+a"7 conco%!(en(7. Procen(a@e"e cores&+n/7(oare de or!en(are
    se<+a"7 "a .e(e n+ s+n( c+nosc+(e. Un!! ado"escen=! &o( &re/en(a o !den(!.!care %a!
    c"ar7 c+ se<+" o&+s s! so"!c!(7 !n(erven=!e c!r+r$!ca"7 &en(r+ sc!%'area se<+"+!
    sa+ con(!n+7 s7 (r7!asc7 :n evo"+=!a cron!c7 a con.+/!e! sa+ d!s.or!e! se<+a"e.
    La '7r'a=!! ad+"=!, e<!s(7 do+7 %od+r! de evo"+=!e d!.er!(e &en(r+ de/vo"(area
    (+"'+r7r!! de !den(!(a(e se<+a"7. Pr!%+" es(e o con(!n+are a (+"'+r7r!! de !den(!(a(e
    se<+a"7 care a de'+(a( :n co&!"7r!e sa+ &recoce, :n ado"escen=7. AceO(! !nd!v!/!
    &re/!n(7 de re$+"7 (+"'+rarea :n +"(!%a &ar(e a ado"escen=e! sa+ :n &er!oada ad+"(7.
    In ce"7"a"( c+rs, se%ne %a! c"are de !den(!.!care c+ se<+" o&+s a&ar %a! (Ar/!+ s! %a!
    $rad+a", c+ o &re/en(are c"!n!c7 "a :nce&+(+" @+%7(7=!! &er!oade! ad+"(e, +r%And de
    re$+"7, dar +neor! .!!nd conco%!(en(e c+ .e(!O!s%+" (ransves(!c. ,r+&+" c+ de'+( %a!
    (ard!v &oa(e .! %a! ."+c(+an( :n $rad+" de !den(!.!care c+ se<+" o&+s, %a! a%'!va"en(
    :n "e$7(+r7 c+ !n(erven=!!"e c!r+r$!ca"e de sc!%'are a se<+"+!, s! es(e .oar(e &ro'a'!"
    ca '7r'a=!! s7 .!e a(raO! de .e%e! s! .oar(e &+=!n &ro'a'!" s7 .!e sa(!s.7c+=! d+&7
    !n(erven=!!"e c!r+r$!ca"e de sc!%'are a se<+"+!. B7r'a=!! c+ (+"'+rare de !den(!(a(e
    se<+a"7 care s+n( a(raO! se<+a" de '7r'a=! (!nd s7 se &re/!n(e :n ado"escen=7 sa+
    &recoce :n &er!oada ad+"(7 c+ +n !s(or!c de d!s.or!e se<+a"7 e<!s(en(7 d!n(o(dea+na.
    D!n con(r7, ce! care s+n( a(raO! se<+a" de .e%e!, or! a(A( de '7r'a=!, cA( s! de .e%e! sa+
    n+ s+n( a(raO! de n!c! +n se<, (!nd s7 se %an!.es(e %a! (Ar/!+, s! a+ de re$+"7 +n !s(or!c
    de .e(!O!s% (ransves(!c. De re$+"7, d+&7 rea(r!'+!rea se<+"+!, ace! '7r'a=! care era+
    a(raO! de .e%e!, doresc s7 (r7!asc7 c+ a"(7 .e%e!e, .!e :n(r4o re"a=!e "es'!an7 sa+ ca
    s+ror!. Dac7 (+"'+rarea de !den(!(a(e se<+a"7 es(e &re/en(7 :n &er!oada ad+"(7, ea
    (!nde s7 a!'7 o evo"+=!e cron!c7, dar a+ .os( ra&or(a(e O! re%!s!+n! s&on(ane.
    Dia!nostic di$erenial
    T+"'+rarea de !den(!(a(e se<+a"7 &oa(e .! d!s(!ns7 de s!%&"a noncon.or%are "a
    co%&or(a%en(+" s(ereo(!& a" ro"+"+! se<+"+! &r!n :n(!nderea s! &ervas!v!(a(ea
    dor!n=e"or, !n(erese"or O! ac(!v!(7=!"or carac(er!s(!ce se<+"+! o&+s. Aceas(7 (+"'+rare
    n+ se re.er7 "a descr!erea noncon.or%!s%+"+! co&!"+"+! "a co%&or(a%en(+"
    s(ereo(!& a" ro"+"+! se<+"+!, ca de e<e%&"+, :n co%&or(a%en(+" S'7!e=escT "a .e(e sa+
    Se.e%!na(T "a '7!e=!. Ea re&re/!n(7 %a! c+rAnd o &er(+r'are &ro.+nd7 a
    sen(!%en(+"+! de !den(!(a(e a" !nd!v!d+"+! c+ &r!v!re "a %asc+"!n!(a(e sa+ .e%!n!(a(e.
    Co%&or(a%en(+"+! co&!!"or, care n+ cores&+nde %ode"+"+! c+"(+ra" de
    %asc+"!n!(a(e sa+ .e%!n!(a(e, n+ (re'+!e s7 ! se &+n7 d!a$nos(!c+", decA( dac7 es(e
    &re/en( s!ndro%+" co%&"e(, !nc"+s!v de(resa sa+ de(er!oarea %arca(7 .
    Fe(!O!s%+" (ransves(!c s+rv!ne "a '7r'a=!! e(erose<+a"! Esa+ '!se<+a"!J &en(r+
    care co%&or(a%en(+" de (raves(!re are dre&( sco& e<c!(a=!a se<+a"7. E<ce&(And
    (raves(!rea, ce! %a! %+"=! !nd!v!/! c+ .e(!O!s% (ransves(!c n+ a+ +n !s(or!c d!n
    co&!"7r!e de co%&or(a%en(e a&ar=!nAnd se<+"+! o&+s. B7r'a=!"or, c+ +n (a'"o+ c"!n!c
    care sa(!s.ace !n(e$ra" cr!(er!!"e &en(r+ (+"'+rarea de !den(!(a(e se<+a"7 ca s! &en(r+
    .e(!O!s%+" (ransves(!c, (re'+!e s7 "! se &+n7 a%'e"e d!a$nos(!ce. Dac7 d!s.or!a
    Tulburarea de Identitate
    Sexual
    5=1
    se<+a"7 es(e &re/en(7 "a +n !nd!v!d c+ .e(!O!s% (ransves(!c, dar cr!(er!!"e co%&"e(e
    &en(r+ (+"'+rarea de !den(!(a(e se<+a"7 n+ s+n( sa(!s.7c+(e, &oa(e .! +(!"!/a(
    s&ec!.!can(+" c+ d!s.or!e se<+a"7 .
    Ca(e$or!a de (+"'+rare de !den(!(a(e se<+a"7 .7r7 a"(7 s&ec!.!ca=!e &oa(e .!
    +(!"!/a(7 &en(r+ !nd!v!/!! care a+ o &ro'"e%7 de !den(!(a(e se<+a"7 c+ o cond!=!e
    !n(erse<+a"7 con$en!(a"7 conco%!(en(7 Ede e<., s!ndro%+" de !nsens!'!"!(a(e
    andro$en7 &ar=!a"7 sa+ !&er&"a/!a s+&rarena"7 con$en!(a"7J.
    :n sc!/o.ren!e, %a! rar, &o( e<!s(a !de! de"!ran(e de a&ar(enen=7 "a ce"7"a"( se<.
    Pre(en=!a +ne! &ersoane c+ (+"'+rare de !den(!(a(e se<+a"7, c7 ea a&ar=!ne se<+"+!
    o&+s n+ es(e cons!dera(7 !dee de"!ran(7, deoarece ceea ce es(e s&+s :n %od cons(an(
    es(e .a&(+" c7 aceas(a se s!%(e %a! c+rAnd ca +n %e%'r+ a" ce"+!"a"( se< decA( se
    crede ca .!!nd c+ adev7ra( +n %e%'r+ a" se<+"+! o&+s. :n .oar(e rare ca/+r! :ns7,
    sc!/o.ren!a s! (+"'+rarea de !den(!(a(e se<+a"7 sever7 &o( coe<!s(a.
    Criteriile $e $ia/no&ti# pentru
    Tul-urarea $e I$entitate Se,ual(
    A2 O puternic si persistent identi$icare cu sexul opus &nu doar dorirea unora
    dintre avanta0ele percepute cultural ale $aptului de a $i de cellalt sex)2
    La copii perturbarea se mani$est prin patru &sau mai multe) dintre urmtoareleD
    (1) dorina declarat "n mod repetat de a $i ori pretenia c &el sau ea) este
    de cellalt sex3
    (2) la biei, pre$erina pentru travestire sau "mbrcminte care simulea(
    pe cea $eminin3 la $ete, pre$erina de a se "mbrca numai cu vestimente
    tipic masculine3
    (3) pre$erine persistente ,i puternice pentru roluri de sex opus "n 0ocuri
    din
    ima!inaie sau $ante(ii persistente de a $i de cellalt sex3
    (4) dorina intens de a participa la 0ocuri sau distracii tipice celuilalt sex3
    (5) pre$erina puternic pentru companioni de 0oac de cellalt sex2
    La adolesceni si aduli perturbarea se mani$est prin simptome cum ar $i
    dorina declarat de a $i de cellalt sex, trecerea $recvent ca $iind de
    cellalt sex, dorina de a tri sau de a $i tratat ca $iind de cellalt sex ori
    convin!erea c &el sau ea) are reacii si sentimente tipice celuilalt sex2
    S2 Discon$ort persistent "n le!tur cu sexul su ori sentimentul de inadecvare
    "n rolul !enului acelui sex2
    La copii, perturbarea se mani$est prin oricare dintre urmtoareleD la biei,
    a$irmaia c penisul sau testiculele lor sunt de(!usttoare sau c vor dispare
    ori a$irmaia c ar $i mai bine dac nu ar avea penis sau aversiune $a de
    0ocurile cu "nvlm,eal ,i re0ectarea 0ucriilor, 0ocurilor si activitilor tipic
    masculine3 la $ete, re$u(ul de a urina "n po(iie ,e(@nd, a$irmaia c au sau
    c le va cre,te penis, sau a$irmaia c nu doresc s le creasc s@nii sau s aib
    menstruaii sau aversiune marcat $a de "mbrcmintea $eminin normativ
    La adolesceni ,i la aduli perturbarea se mani$est prin simptome cum ar $i
    preocuparea pentru debarasarea de caracteristicile sexuale primare si
    secundare &de ex2, solicitarea de %ormoni, intervenie c%irur!ical sau alte
    procedee pentru a modi$ica somatic caracteristicile sexuale spre a simula
    cellalt sex) ori credina c el sau ea a $ost nscut&) cu un sex eronat2
    5=2 Tul-ur(rile Se,uale &i $e I$entitate Se,ual(

    Criteriile $e $ia/no&ti# pentru
    Tul-urarea $e I$entitate Se,ual( (continuare)
    C3 Pertur-area nu e&te #on#o"itent( #u o #on$i!ie inter&e,ual( &o"ati#(.
    D. Pertur-area #au)ea)( $etre&( &au $eteriorare &e"ni%i#ativ( #lini# .n
    $o"eniul &o#ial2 pro%e&ional &au .n alte $o"enii i"portante $e %un#!ionare.
    Se codific pe -a)a et(!ii a#tualeM
    4+C.= Tul-urare $e i$entitate &e,ual( la #opii
    4+C.>< Tul-urare $e i$entitate &e,ual( la a$ole&#en!i &au la a$ul!i
    De secificat $a#(M 3pentru in$ivi)ii "aturi &e,ual6M
    Atra& &e,ual $e -(r-a!i Atra& &e,ual $e %e"ei
    Atra& &e,ual atNt $e %e"ei2 #Nt Ei $e -(r-a!i
    Neatra& &e,ual2 ni#i $e %e"ei Ei ni#i $e -(r-a!i
    4+C.= Tul-urarea $e I$entitate Se,ual(
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e !nc"+s7 &en(r+ cod!.!carea (+"'+r7r!"or de !den(!(a(e
    se<+a"7 care n+ s+n( c"as!.!ca'!"e ca (+"'+rare de !den(!(a(e se<+a"7 s&ec!.!c7.
    E<e%&"e"e !nc"+dQ
    1. cond!=!!"e !n(erse<+a"e Ede e<., s!ndro%+" de !nsens!'!"!(a(e andro$en7 &ar=!a"7 sa+
    !&er&"a/!a s+&rarena"7 con$en!(a"7J s! d!s.or!a se<+a"7 care "e aco%&an!a/7,
    2. co%&or(a%en(+" (ran/!(or de (raves(!re :n "e$7(+r7 c+ s(res+",
    3. &reoc+&area &er%anen(7 :n "e$7(+r7 c+ cas(rarea sa+ &enec(o%!a, .7r7 dor!n=a
    de a c7&7(a carac(er!s(!c!"e se<+a"e a"e ce"+!"a"( se<.
    4+C.5 Tul-urarea Se,ual( '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e :nc"+s7 &en(r+ cod!.!carea +ne! &er(+r'7r! se<+a"e care n+
    sa(!s.ace cr!(er!!"e &en(r+ n!c! +na d!n(re (+"'+r7r!"e se<+a"e s&ec!.!ce s! n+ es(e, n!c!
    d!s.+nc=!e se<+a"7, n!c! &ara.!"!e. E<e%&"e"e !nc"+dQ
    1. Sen(!%en(e %arca(e de !nadecvare re.er!(oare "a .+nc=!onarea se<+a"7 sa+ a"(e
    (r7s7(+r! :n "e$7(+r7 c+ s(andarde"e a+(o!%&+se de %asc+"!n!(a(e sa+ .e%!n!(a(e.
    2. De(res7 :n "e$7(+r7 c+ +n &a((ern de re"a=!! se<+a"e re&e(a(e !%&"!cAnd o s+cces!+ne
    de a%an(e.![, care s+n. e<&er!en(a=! de !nd!v!dE7J n+%a! ca "+cr+r! de +(!"!/a(.
    ;. De(res7 &ers!s(en(7 s! %arca(7 :n "e$7(+r7 c+ or!en(area se<+a"7.
    r
    Tulburrile de
    omportament Alimentar
    " +"'+r7r!"e de co%&or(a%en( a"!%en(ar se carac(er!/ea/7
    &r!n &er(+r'7r! severe de co%&or(a%en( a"!%en(ar. Aceas(7
    sec=!+ne !nc"+de do+7 d!a$nos(!ce s&ec!.!ce, anore<!a nervoas7 s!
    '+"!%!a nervoas7. Anore<!a nervoas7 se carac(er!/ea/7 &r!n
    re.+/+" de a %en=!ne o $re+(a(e cor&ora"7 nor%a"7 %!n!%7.
    B+"!%!a nervoas7 se carac(er!/ea/7 &r!n e&!soade re&e(a(e de
    %Anca( co%&+"s!v +r%a(e de co%&or(a%en(e co%&ensa(or!!
    !nadecva(e, c+% ar .! v7rs7(+r!"e a+(o&rovoca(e, a'+/+" de
    "a<a(!ve, de d!+re(!ce sa+ de a"(e %ed!ca%en(e, &os(+r! sa+
    e<erc!=!! .!/!ce e<ces!ve. O &er(+r'are :n &erce&rea con.or%a=!e! s!
    $re+(7=!! cor&+"+! es(e e"e%en(+" esen=!a", a(A( a" anore<!e!
    nervoase, cA( O! a" '+"!%!e! nervoase. De ase%enea, es(e &rev7/+(7
    o ca(e$or!e, (+"'+rarea de co%&or(a%en( a"!%en(ar .7r7 a"(7
    s&ec!.!ca=!e, &en(r+ cod!.!carea (+"'+r7r!"or care n+ sa(!s.ac
    cr!(er!!"e &en(r+ o (+"'+rare de co%&or(a%en( a"!%en(ar s&ec!.!c7.
    O'e/!(a(ea s!%&"7 es(e !nc"+s7 :n Clasi)icarea 5nterna(ional6 a
    .aladiilor ECIMJ dre&( cond!=!e %ed!ca"7 $enera"7,dar ea n+ a&are :n
    DSM4I3, deoarece n+ s4a s(a'!"!( c7 aceas(a es(e asoc!a(7 :n %od
    cons(an( c+ +n s!ndro% &s!o"o$!c sa+ co%&or(a%en(a". C+ (oa(e
    aces(ea :ns7, cAnd e<!s(7 &ro'a c7 .ac(or!! &s!o"o$!c! s+n( !%&or(an=!
    :n e(!o"o$!a sa+ evo"+=!a +n+! an+%!( ca/ de o'e/!(a(e, aceas(a
    &oa(e .! !nd!ca( &r!n no(area &re/en=e! .ac(or!"or &s!o"o$!c! care
    a.ec(ea/7 cond!=!a %ed!ca"7 E&a$. H;5J.
    T+"'+r7r!"e de a"!%en(are s! de co%&or(a%en( a"!%en(ar care
    s+n( d!a$nos(!ca(e de re$+"7 &en(r+ &r!%a da(7 :n &er!oada de s+$ar
    sa+ a %!c!! co&!"7r!! Ede e<., &!ca, r+%!na=!a, (+"'+rarea de
    a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!J s+n( !nc"+se :n
    sec=!+nea ST+"'+r7r!"e de a"!%en(are O! de co%&or(a%en( a"!%en(ar
    a"e &er!oade! de s+$ar sa+ %!c!! co&!"7r!!T E&a$. 5L;J.
    4+G.* Anore,ia Nervoa&(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e anore<!e! nervoase s+n( ace"ea c7
    !nd!v!d+" re.+/7 s7 %en=!n7 +n %!n!%+% de $re+(a(e cor&ora"7
    nor%
    a"7,
    es(e
    e<(re
    % de
    s&er!
    a( de
    "+a(+
    " :n
    $re+(
    a(e s!
    &re/!
    n(7 o de(er!orare !%&or(an(7 :n &erce&erea con.or%a=!e! sa+
    d!%ens!+n!! cor&+"+! s7+. :n a.ar7 de aceas(a, .e%e!"e &os(%enar!ce
    c+ aceas(7 (+"'+rare s+n( a%enore!ce. ETer%en+" de anore<!e es(e
    !%&ro&r!+, deoarece &!erderea a&e(!(+"+! es(e rar7J.
    Ind!v!d+" :O! %en=!ne o $re+(a(e cor&ora"7 care es(e s+' n!ve"+"
    %!n!% nor%a" &en(r+ e(a(ea O! :n7"=!%ea sa Ecr!(er!+" AJ. CAnd
    anore<!a nervoas7 a&are "a +n !nd!v!d :n c+rs+" co&!"7r!e! sa+ "a
    :nce&+(+" ado"escen(e!, &oa(e e<!s(a o !nca&ac!(a(e de a "+a :n
    $re+(a(e &"+s+" s&era( Ead!c7, :n (!%& ce cres(e :n :n7"=!%eJ, :n "oc
    s7 &!ard7 :n $re+(a(e.
    <>4
    <>7 Tulburrile de omportament Alimentar
    Cr!(er!+" A o.er7 +n re&er &en(r+ a &rec!/a cAnd !nd!v!d+" a(!n$e &ra$+" &en(r+
    a .! s+'&ondera". Se s+$erea/7 ca "!%!(7, $re+(a(ea !nd!v!d+"+! de %a! &+=!n de GYd
    d!n $re+(a(ea cons!dera(7 nor%a"7 &en(r+ e(a(ea s! :n7"=!%ea &ersoane! res&ec(!ve
    Eca"c+"a(7 .o"os!nd de re$+"7 +na d!n d!verse"e vers!+n! a"e (a'e"e"or "+!
    Me(ro&o"!(an L!.e Ins+rance sa+ d!a$ra%e"e &ondera"e &ed!a(r!ceJ. O a"(erna(!v7, s!
    :n(r+cA(va +n re&er %a! s(r!c( E+(!"!/a( :n cr!(er!!"e de d!a$nos(!c &en(r+ cerce(are a"e
    ICD45LJ cere ca !nd!v!d+" s7 a!'7 +n !nd!ce de %as7 cor&ora"7 EIMCJ e$a" c+, sa+
    s+' 5H,Y )$X%
    9
    E!nd!ce"e de %as7 cor&ora"7 se ca"c+"ea/7 :%&7r=!nd $re+(a(ea :n
    )!"o$ra%e "a :n7"=!%e :n %e(r! &7(ra=!J. Aces(e "!%!(e s+n( &rev7/+(e n+%a! ca
    re&ere or!en(a(!ve &en(r+ c"!n!c!an, deoarece n+ es(e re/ona'!" s7 se s&ec!.!ce +n
    s!n$+r s(andard &en(r+ $re+(a(ea nor%a"7 %!n!%7 care s7 se a&"!ce (+(+ror
    !nd!v!/!"or de o an+%!(7 e(a(e s! :n7"=!%e, :n s(a'!"!rea +ne! $re+(7=! nor%a"e
    %!n!%e, c"!n!c!an+" (re'+!e s7 !a :n cons!dera=!e n+ n+%a! as(.e" de re&ere, c! s!
    !s(or!c+" con.or%a=!e! cor&+"+! s! $re+(7=!! !nd!v!d+"+!.
    De re$+"7 &!erderea :n $re+(a(e se rea"!/ea/7 :n &r!%+" rAnd &r!n red+cerea
    can(!(7=!! de a"!%en(e !n$era(e. C!ar dac7 !nd!v!/!! :nce& &r!n e<c"+derea d!n d!e(a "or
    a ceea ce e! &erce& a .! a"!%en(e c+ va"oare ca"or!c7 %are, e! (er%!n7 .oar(e &ro'a'!" c+
    o d!e(7 e<(re% de res(r!c(!v7, "!%!(a(7 +neor! n+%a! "a cA(eva a"!%en(e. Me(ode"e
    s+&"!%en(are de &!erdere :n $re+(a(e !nc"+d &+r$a=!a Ead!c7, v7rs7(+r!"e a+(o&rovoca(e
    sa+ a'+/+" de "a<a(!ve sa+ de d!+re(!ceJ s! e<erc!=!!"e !n(ense sa+ e<ces!ve.
    Ind!v!/!! c+ aceas(7 (+"'+rare se (e% .oar(e %+"( s7 n+ !a :n $re+(a(e sa+ s7
    dev!n7 o'e/! Ecr!(er!+" BJ. Aceas(7 .r!c7 !n(ens7 de a n+ deven! o'e/ n+ es(e +O+ra(7
    de re$+"7 de &!erderea :n $re+(a(e. De .a&(, &reoc+&area :n "e$7(+r7 c+ &"+s+"
    &ondera" cres(e adesea c!ar cAnd $re+(a(ea rea"7 con(!n+7 s7 scad7.
    E<&er!en(area s! se%n!.!ca=!a $re+(7=!! s! con.or%a=!e! cor&ora"e s+n(
    d!s(ors!ona(e "a aceO(! !nd!v!/! Ecr!(er!+" CJ. Un!! !nd!v!/! se s!%( :n :n(re$!%e
    s+&ra&ondera"!. A"=!! rea"!/ea/7 c7 e! s+n( s"a'!, dar s+n( :nc7 &reoc+&a=! de .a&(+"
    c7 an+%!(e &7r=! a"e cor&+"+! "or, :n s&ec!a" a'do%en+", .ese"e s! coa&se"e s+n( S&rea
    /raseS7 Ei &o( +(!"!/a o %are var!e(a(e de (en!c! &en(r+ a4s! eva"+a d!%ens!+nea sa+
    $re+(a(ea cor&+"+!, !nc"+/And cAn(7r!rea e<ces!va, %7s+rarea o'ses!v7 a &7r=!"or
    cor&+"+! s! +(!"!/area &ers!s(en(7 a o$"!n/!! &en(r+ a con(ro"a /one"e &erce&+(e
    S$raseT. S(!%a de s!ne a !nd!v!/!"or c+ anore<!e nervoas7 es(e e<(re% de
    de&enden(7 de con.or%a=!a O! $re+(a(ea cor&+"+! "or. P!erderea :n $re+(a(e es(e
    v7/+(7 ca o rea"!/are !%&res!onan(7 s! +n se%n de a+(od!sc!&"!n7, &e cAnd "+area :n
    $re+(a(e es(e &erce&+(7 ca +n eOec !nacce&(a'!" a" a+(ocon(ro"+"+!. DeO! +n!! !nd!v!/!
    c+ aceas(7 (+"'+rare &o( rec+noaO(e c7 s+n( s"a'!, e! de re$+"7 nea$7 !%&"!ca=!!"e
    %ed!ca"e severe a"e s(7r!! "or de den+(r!=!e.
    La .e%e!"e &os(%enar!ce, a%enoreea Eda(ora(7 n!ve"e"or anor%a" de sc7/+(e a"e
    secre=!e! de es(ro$en! care se da(orea/7 :n sc!%' d!%!n+7r!! secre=!e! &!(+!(are a
    or%on+"+! .o"!c+"!nos(!%+"an( ZFSH[ s! a or%on+"+! "+(e!n!/an( ZLH[J es(e +n
    !nd!ca(or a" d!s.+nc=!e! .!/!o"o$!ce :n anore<!a nervoas7 Ecr!(er!+" DJ. A%enoreea es(e de
    re$+"7 o consec!n=7 a &!erder!! :n $re+(a(e, dar, "a +n n+%7r red+s de .e%e!, &oa(e :n
    rea"!(a(e s4o &recead7. La .e%e!"e &re&+'er(are, %enara &oa(e .! :n(Ar/!a(7 de %a"ad!e.
    Ind!v!d+" es(e ad+s adesea &en(r+ cons+"( %ed!ca" de c7(re %e%'r!! .a%!"!e!,
    d+&7 ce a s+rven!( o &!erdere :n $re+(a(e cons!dera'!"7 Esa+ !nca&ac!(a(ea de a "+a
    :n $re+(a(e &"+s+" s&era(J. Dac7 !nd!v!/!! so"!c!(7 e! :nO!O! a@+(or, a(+nc! .ac aceas(a
    de re$+"7 d!n ca+/a de(rese! s+'!ec(!ve :n "e$7(+r7 c+ sece"e"e so%a(!ce O!
    &s!o"o$!ce a"e !nan!=!e!. Es(e rar ca +n !nd!v!d c+ anore<!e nervoas7 s7 se &"An$7
    de &!erderea :n $re+(a(e. Ind!v!/!! c+ anore<!e nervoas7 s+n( .recven( "!&s!=! de
    45? E Anorexia
    Fervoas
    A8A

    conO(!!n=a &ro'"e%e! sa+ o nea$7, s! &o( .! !s(or!c! !ncred!'!"! De aceea, adesea, es(e
    necesar s7 se o'=!n7 !n.or%a=!! de "a &7r!n=! sa+ d!n a"(e s+rse &en(r+ a eva"+a
    $rad+" de &!erdere :n $re+(a(e s! a"(e e"e%en(e a"e %a"ad!e!
    Subtipun
    Ur%7(oare"e s+'(!&+r! &o( .! +(!"!/a(e &en(r+ a s&ec!.!ca &re/en(a sa+ a'sen(a
    %Anca(+"+! co%&+"s!v re$+"a(, sa+ a &+r$7rn :n (!%&+" e&!sod+"+! c+ren( de
    anore<!e nervoas7
    T!&+" res(r!c(!v Aces( s+'(!& descr!e (a'"o+r!"e c"!n!ce :n care &!erderea :n
    $re+(a(e es(e rea"!/a(7 :n &r!%+" rAnd &r!n d!e(7, &os( sa+ e<erc!=!! .!/!ce
    e<ces!ve :n c+rs+" e&!sod+"+! ac(+a", aceO(! !nd!v!/! n+ s4a+ an$a@a( :n %od
    re$+"a( :n %Anca( co%&+"s!v sa+ :n &+r$are
    T!&+" de %Anca( co%&+"s!vX&+r$are Aces( s+'(!& es(e +(!"!/a( cAnd
    !nd!v!d+" s4a an$a@a( :n %od re$+"a( :n %Anca( co%&+"s!v sa+ :n &+r$are Eon
    :n a%'e"eJ, :n c+rs+" e&!sod+"+! c+ren( Ce! %a! %+"=! !nd!v!/! c+ anore<!e
    nervoas7 care %7nAnc7 co%&+"s!v se &+r$ea/7 &r!n v7rs7(+r! a+(o&rovo4
    ca(e or! &r!n a'+/ de "a<a(!ve, d!+re(!ce sa+ cs%e Un+ !nd!v!/! !nc"+O! :n
    aces( s+'(!& n+ %7nAnc7 co%&+"s!v, dar .ac :n %od re$+"a( &+r$are d+&7
    cons+%+" +nor can(!(7=! %!c! de a"!%en(e Se &are c7 ce! %a! %+"=! !nd!v!/! c+
    (!&+" de %Anca( co%&+"s!vX&+r$are se an$a@ea/7 :n aces(e co%&or(a%en(e
    ce" &+=!n s7&(7%Ana", dar n+ s+n( d!s&on!'!"e s+.!c!en(e !n.or%a=!! &en(r+ a
    @+s(!.!ca s&ec!.!carea +n+! %!n!%+% de .recven(7
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. CAnd a@+n$ sever
    s+'&ondera"!, !nd!v!/!! c+ anore<!e nervoas7 &re/!n(7 s!%&(o%e de&res!ve, c+% ar .!
    d!s&o/!=!a de&res!v7, !/o"area soc!a"7, %(a'!(a(ea, !nso%n!a s! d!%!n+area
    !n(eres+"+! &en(r+ se< As(.e" de !nd!v!/! &o( avea s!%&(o%e care sa(!s.ac cr!(er!!"e
    &en(r+ (+"'+rarea de&res!v7 %a@or7 Pen(r+ c7 aces(e e"e%en(e s+n( o'serva(e, de
    ase%enea, "a !nd!v!/! .7r7 anore<!e nervoas7 care s+.er7 de %an!(!e Es(arva(!onJ,
    %+"(e d!n(re e"e%en(e"e de&res!ve &o( .! sec+ndare sece"e"or .!/!o"o$!ce a"e
    s+'n+(r!=!e! S!%&(o%e"e de &er(+r'are a.ec(!v7 (re'+!e, de aceea, s7 .!e reeva"+a(e
    d+&7 rec+&erarea &ondera"7 &ar=!a"7 sa+ co%&"e(7
    E"e%en(e"e o'ses!vo4co%&+"s!v e a(A( :n "e$7(+r7, cA( s! .7r7 "e$7(+r7 c+
    a"!%en(area, s+n( adesea &roe%!nen(e Ce! %a! %+"=! !nd!v!/! c+ anore<!e nervoas7
    s+n( &reoc+&a=! de !de! :n "e$7(+r7 c+ a"!%en(area Un+ d!n(re e! co"ec(ea/7 re=e(e
    c+"!nare sa+ .ac &rov!/!! de a"!%en(e O'serva=!!"e co%&or(a%en(e"or asoc!a(e c+
    a"(e .or%e de !na%(!e s+$erea/7 c7 o'ses!!"e s! co%&+"sn"e :n "e$7(+r7 c+
    a"!%en(area &o( .! ca+/a(e sa+ e<acer'a(e de s+'n+(n(!e CAnd !nd!v!/!! c+ anore<!e
    nervoas7 &re/!n(7 o'ses!! sa+ co%&+"s!! care n+ s+n( :n "e$7(+r7 c+ a"!%en(area,
    con.or%a=!a cor&+"+! sa+ $re+(a(ea, &oa(e .! @+s(!.!ca( +n d!a$nos(!c ad!=!ona" de
    (+"'+rare o'ses!vo4co%&+"s!v7
    A"(e e"e%en(e asoc!a(e +neor! c+ anore<!a nervoas7 !nc"+d &reoc+&7r!"e :n
    "e$7(+r7 c+ %Anca(+" :n &+'"!c, sen(!%en(e"e de !ne.!c!en(7, neces!(a(ea !n(ens7
    de a con(ro"a a%'!an(a &ro&r!e, $And!rea !n."e<!'!"7, s&on(ane!(a(ea soc!a"7
    "!%!(a(7, &er.ec(!on!s%+", !n!=!a(!va s! e<&res!a e%o=!ona"7 e<(re% de res(rAnse
    O &ar(( s+'s(an=!a"7 de !nd!v!/! c+ anore<!e nervoas7 a+ s!%&(o%e care
    sa(!s.ac cr!(er!!"e &en(r+ ce" &+=!n o (+"'+rare de &ersona"!(a(e :n co%&ara=!e
    c+
    5=> Tulburrile de omportament Alimentar

    !nd!v!/!! c+ anore<!e nervoas7 de (!& res(r!c(!v, ce! c+ (!&+" de %Anca( co%&+"s!vX
    &+r$are es(e .oar(e &os!'!" s7 a!'7 a"(e &ro'"e%e de con(ro" a" !%&+"s+"+!, s7
    a'+/e/e de a"coo" sa+ de a"(e dro$+r!, s7 %an!.es(e %a! %+"(7 "a'!"!(a(e a.ec(!v7, s7
    .!e ac(!v! se<+a", s7 a!'7 o .recven=7 %a! %are a (en(a(!ve"or de s+!c!d :n !s(or!c+" "or
    s! s7 a!'7 o &er(+r'are de &ersona"!(a(e care sa(!s.ace cr!(er!!"e &en(r+ (+"'+rarea de
    &ersona"!(a(e 'order"!ne.
    9ate de laborator asociate. DeO! +n!! !nd!v!/! c+ anore<!e nervoas7 n+ &re/!n(7
    ano%a"!! de "a'ora(or, s+'n+(r!=!a carac(er!s(!c7 aces(e! (+"'+r7r! &oa(e a.ec(a ce"e
    %a! %+"(e s!s(e%e de or$ane %a@ore s! &rod+ce o d!vers!(a(e de &er(+r'7r!.
    37rs7(+r!"e !nd+se s! a'+/+" de "a<a(!ve, d!+re(!ce s! c"!s%e &o( ca+/a, de ase%enea,
    +n n+%7r de &er(+r'7r! care d+c "a da(e de "a'ora(or anor%a"e.
    9ematolo/ie? "e+co&en!a s! ane%!a +Ooar7 s+n( .recven(e8 (ro%'oc!(o&en!a
    s+rv!ne rar.
    C-imie? des!dra(area &oa(e .! re."ec(a(7 de o creO(ere a +r!ne! n!(ro$en!ce
    san$+!ne EUNSJ. H!&erco"es(ero"e%!a es(e .recven(7. Tes(e"e de e<&"orare a
    .+nc=!!"or e&a(!ce &o( .! cresc+(e. Oca/!ona" se cons(a(7 !&o%a$ne/!e%!e,
    !&o/!nce%!e, !&o.os.a(e%!e s! !&era%!"a/e%!e. 37rs7(+r!"e a+(o&rovoca(e &o(
    d+ce "a a"ca"o/7 %e(a'o"!c7 EcreO(erea '!car'ona(+"+! ser!cJ, !&oc"ore%!e s!
    !&o)a"!e%!e, !ar a'+/+" de "a<a(!ve &oa(e ca+/a ac!do/7 %e(a'o"!c7. N!ve"e"e
    (!ro<!ne! ser!ce ETIJ se a."7 de re$+"7 "a "!%!(a !n.er!oar7 a nor%a"+"+!, !ar n!ve"e"e
    de (r!!odo(!ron!n7 ET;J s+n( sc7/+(e. H!&eradrenocor(!c!s%+" s! reac(!v!(a(ea
    anor%a"7 "a o ser!e de so"!c!(7r! ne+roendocr!ne s+n( .recven(e.
    La .e%e!, s+n( &re/en(e n!ve"e red+se a"e es(ro$en!"or ser!c!, &e cAnd '7r'a=!! a+
    n!ve"e red+se a"e (es(os(eron+"+! ser!c. E<!s(7 o re$res!+ne a a<+"+! !&o(a"a%o4
    &!(+!(aro4$onada" "a a%'e"e se<e, cons(And :n aceea c7 &a((ern+" de secre=!e a"
    or%on+"+! "+(e!n!/an( ELHJ &e 9I ore es(e ase%7n7(or ce"+! o'serva( :n %od
    nor%a" "a !nd!v!/!! &re&+'er(ar! sa+ &+'er(ar!.
    Electrocardio/ra)ie? s+n( o'serva(e 'rad!card!e s!n+sa"7 s!, %a! rar, ar!(%!!.
    Electroence)alo/ra)ie? ano%a"!! d!.+/e, re."ec(And o ence.a"o&a(!e %e(a'o"!c7, &o(
    re/+"(a d!n &er(+r'7r! se%n!.!ca(!ve a"e ."+!de"or s! e"ec(ro"!=!"or.
    5ma/istica cerebral6? Adesea es(e o'serva(7 o creO(ere a ra&or(+"+!
    ven(r!c+"Xcre!er, sec+ndar7 !nan!=!e!.
    C-elt+iala de ener/ie pentr+ relaxare? Aceas(a es(e se%n!.!ca(!v red+s7.
    9atele examinrii somatice /i condi3iile medicale .enerale asociate. M+"(e
    d!n se%ne"e s! s!%&(o%e"e anore<!e! nervoase s+n( a(r!'+!(e !nan!=!e!. Pe "An$7
    a%enoree, %a! &o( e<!s(a ac+/e de cons(!&a=!e, d+rere a'do%!na"7, !n(o"eran=7 "a
    .r!$, "e(ar$!e sa+ e<ces de ener$!e. Cea %a! ev!den(7 cons(a(are "a e<a%en+" so%a(!c
    es(e e%ac!erea. Ma! &oa(e e<!s(a, de ase%enea, !&o(ens!+ne se%n!.!ca(!v7,
    !&o(er%!e s! (e$+%en(e +sca(e. Un!! !nd!v!/! &re/!n(7 "an+$o, +n &7r .!n ca &+.+",
    &e (r+nc!. Ce! %a! %+"=! !nd!v!/! c+ anore<!e nervoas7 &re/!n(7 'rad!card!e. La
    +n!! a&ar ede%e &er!.er!ce, :n s&ec!a" :n (!%&+" res(a+r7r!! &ondera"e sa+ "a
    :nce(area a'+/+"+! de "a<a(!ve s! d!+re(!ce. Ma! rar, &o( a&are &e(es!!, de re$+"7 "a
    n!ve"+" e<(re%!(7=!"or, !nd!cAnd o d!a(e/7 e%ora$!c7. Un!! !nd!v!/! &re/!n(7 o (en(7
    $7"'+!e a (e$+%en(e"or asoc!a(7 c+ !&ercaro(ene%!a. H!&er(ro.!a $"ande"or
    sa"!vare, :n s&ec!a" a $"ande"or &aro(!de, &oa(e .! &re/en(7. Ind!v!/!! care4O! &rovoac7
    v7rs7(+r! &o( avea ero/!+n! a"e s%a"=+"+! den(ar, !ar a"=!! &o( avea c!ca(r!c! sa+
    ca"o/!(7=! a"e .e=!! dorsa"e a %A!n!! &r!n con(ac(+" c+ d!n=!! cAnd +(!"!/ea/7 %Ana
    &en(r+ a4s! &rovoca v7rs7(+r!.
    45?2E Anorexia Fervoas A8?
    S+'n+(r!=!a anore<!e! nervoase s! co%&or(a%en(e"e de &+r$are asoc!a(e +neor!
    c+ ea &o( d+ce "a cond!=!! %ed!ca"e $enera"e asoc!a(e !%&or(an(e. Aces(ea !nc"+d
    a&ar!=!a +ne! ane%!! nor%oc!(e%!ce nor%ocro%!ce, de(er!orarea .+nc=!e! rena"e
    Easoc!a(7 c+ des!dra(are cron!c7 s! !&o)a"e%!eJ, &ro'"e%e card!ovasc+"are
    E!&o(ens!+ne sever7, ar!(%!!J, &ro'"e%e den(are s! os(eo&oro/7 Ere/+"(And d!n
    !nd!$es(!a s! a'sor'=!a red+s7 de ca"c!+, red+cerea secre=!e! de es(ro$en s! creO(erea
    secre=!e! de cor(!/o"J.
    *lemente speci$ice culturii si sexului
    Anore<!a nervoas7 &are a .! de de&ar(e %a! .recven(7 :n =7r!"e !nd+s(r!a"!/a(e, :n
    care e<!s(7 a'+nden=7 de2%Ancare O! :n care, :n s&ec!a" &en(r+ .e%e!, a .! cons!dera(
    a(rac(!v es(e "e$a( de a .! $rac!". Aceas(7 (+"'+rare es(e &ro'a'!" %a! .recven(7 :n
    S(a(e"e Un!(e, Canada, E+ro&a, A+s(ra"!a, *a&on!a, No+a Kee"and7 s! A.r!ca de S+d,
    dar &+=!ne "+cr7r! s!s(e%a(!ce a+ e<a%!na( &reva"en(a e! :n a"(e c+"(+r!. I%!$ran=!!
    d!n c+"(+r!"e :n care (+"'+rarea es(e rar7, care a+ e%!$ra( :n c+"(+r!"e :n care
    (+"'+rarea es(e %a! .recven(7, &o( de/vo"(a anore<!e nervoas7 &e %7s+r7 ce !dea"+"
    de cor& $rac!" es(e as!%!"a(. Fac(or!! c+"(+ra"! &o(, de ase%enea, !n."+en=a
    %an!.es(7r!"e (+"'+r7r!!. De e<e%&"+, :n +ne"e c+"(+r!, &erce&=!a &er(+r'a(7 a
    cor&+"+! sa+ .r!ca de "+a( :n $re+(a(e &oa(e s7 n+ .!e &roe%!nen(7, !ar %o(!va=!a
    e<&r!%a(7 a res(r!c=!e! a"!%en(are &oa(e avea +n con=!n+( d!.er!(, c+% ar .!
    d!scon.or(+" e&!$as(r!c sa+ de/$+s(+" de %Ancare.
    Anore<!a nervoas7 :nce&e rar :na!n(e de &+'er(a(e, dar e<!s(7 !nd!c!! c7
    sever!(a(ea &er(+r'7r!"or %en(a"e asoc!a(e &oa(e .! %a! %are &r!n(re !nd!v!/!!
    &re&+'er(ar! care de/vo"(7 %a"ad!a. C+ (oa(e aces(ea, da(e"e s+$erea/7, de
    ase%enea, c7 a(+nc! cAnd %a"ad!a de'+(ea/7 &recoce :n ado"escen=7 E:n(re 5; s! 5G
    an!J, aceas(a &oa(e .! asoc!a(7 c+ +n &ro$nos(!c %a! '+n. Ma! %+"( de FLd d!n
    ca/+r!"e de anore<!e nervoas7 s+rv!n "a .e%e!.
    #revalent
    Preva"en(a &e v!a=7 a anore<!e! nervoase &r!n(re .e%e! es(e de a&ro<!%a(!v L,Yd.
    Ind!v!/!! care s+n( s+' &ra$+" &en(r+ (+"'+rare Ead!c7, c+ (+"'+rare de
    co%&or(a%en( a"!%en(ar .7r7 a"(7 s&ec!.!ca=!eJ s+n( :n(A"n!=! %a! .recven(.
    Preva"en(a anore<!e! nervoase "a '7r'a=! es(e de a&ro<!%a(!v 5X5L d!n cea a
    .e%e!"or. Inc!den=a anore<!e! nervoase &are a .! cresc+( :n +"(!%e"e decen!!.
    *voluie
    Anore<!a nervoas7 :nce&e de re$+"7 "a @+%7(a(ea s! s&re .!ne"e ado"escen=e!
    Ee(a(ea de 5I45G an!J. De'+(+" (+"'+r7r!! &oa(e .! asoc!a( c+ +n even!%en( de v!a=7
    s(resan(. Evo"+=!a s! de/nod7%An(+" anore<!e! nervoase s+n( e<(re% de var!a'!"e.
    Un!! !nd!v!/! c+ anore<!e nervoas7 se rec+&erea/7 co%&"e( d+&7 +n s!n$+r e&!sod,
    a"=!! &re/!n(7 +n &a((ern ."+c(+an( de "+a( :n $re+(a(e +r%a( de rec7dere, !ar a"=!!
    e<&er!%en(ea/7 o evo"+=!e cron!c7 de(er!oran(7 a %a"ad!e!, (!%& de %+"=! an!. C+
    (!%&+", :n s&ec!a" :n dec+rs+" &r!%!"or Y an! de "a de'+(, o .rac=!+ne se%n!.!ca(!v7
    de !nd!v!/! c+ (!&+" res(r!c(!v de anore<!e nervoas7 &re/!n(7 %Anca( co%&+"s!v,
    !nd!cAnd o (recere "a s+'(2!&+" %Anca( co%&+"s!vX&+r$are. O co%+(are s+s=!n+(7 :n
    (a'"o+" c"!n!c Ede e<., "+a( :n $re+(a(e &"+s &re/en=a %Anca(+"+! co%&+"s!v s! a
    &+r$7r!!J &o( @+s(!.!ca even(+a" o sc!%'are a d!a$nos(!c+"+! :n '+"!%!e nervoas7.
    UIUMC
    <>> Tulburrile de omportament Alimentar
    Poa(e .! necesar7 s&!(a"!/area &en(r+ a res(a'!"! $re+(a(ea s! redresa
    de/ec!"!'re"e !droe"ec(ro"!(!ce. La !nd!v!/!! !n(erna=! :n s&!(a"e"e +n!vers!(are,
    %or(a"!(a(ea &e (er%en "+n$ &r!n anore<!e nervoas7 es(e de &es(e 5Ld. Moar(ea
    s+rv!ne ce" %a! .recven( ca re/+"(a( a" !nan!=!e!, s+!c!d+"+! sa+ de/ec!"!'r+"+!
    e"ec(ro"!(!c.
    #attern $amilial
    E<!s(7 +n r!sc cresc+( de anore<!e nervoas7 &r!n(re r+de"e '!o"o$!ce de $rad+" I
    a"e !nd!v!/!"or c+ aceas(7 (+"'+rare. Un r!sc cresc+( de (+"'+r7r! a.ec(!ve a .os(
    cons(a(a(, de ase%enea, &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+
    anore<!e nervoas7, :n s&ec!a" "a r+de"e !nd!v!/!"or c+ (!&+" de %Anca(
    co%&+"s!vX&+r$are. S(+d!!"e as+&ra anore<!e! nervoase &e $e%en! a+ cons(a(a( ra(e
    de concordan=7 &en(r+ $e%en!! %ono/!$o=! se%n!.!ca(!v %a! cresc+(e decA( ce"e
    &en(r+ $e%en!! d!/!$o=!.
    Dia!nostic di$erenial
    :n d!a$nos(!c+" d!.eren=!a" a" anore<!e! nervoase (re'+!e "+a(e :n cons!dera=!e s!
    a"(e ca+/e &os!'!"e de &!erdere se%n!.!ca(!v7 :n $re+(a(e, :n s&ec!a" cAnd e"e%en(e"e
    &re/en(a(e s+n( a(!&!ce Ec+% ar .! de'+(+" %a"ad!e! d+&7 e(a(ea de IL de an!J, :n
    cond!=!!"e %ed!ca"e $enera"e Ede e<., %a"ad!! $as(ro4!n(es(!na"e, (+%or! cere'ra"e,
    (+%or! %a"!$ne oc+"(e O! s!ndro%+" de !%+node.!c!en=7 c7&7(a(7 ZSIDA[, &o(
    s+rven! &!erder! severe :n $re+(a(e, dar !nd!v!/!! c+ as(.e" de (+"'+r7r! n+ a+ o
    !%a$!ne cor&ora"7 &er(+r'a(7 s! n!c! dor!n=a de a &!erde :n $re+(a(e :n con(!n+are.
    S!ndro%+" ar(ere! %e/en(er!ce s+&er!oare Ecarac(er!/a( &r!n v7rs7(+r!
    &os(&rand!a"e sec+ndare o's(r+c=!e! !n(er%!(en(e a &!"or+"+!J (re'+!e s7 .!e d!s(!ns
    de anore<!a nervoas7, deO! aces( s!ndro% &oa(e a&are +neor! "a !nd!v!/!! c+ anero<!e
    nervoas7 d!n ca+/a e%ac!er!! "or. :n (+"'+rarea de&res!v7 %a@or7, &oa(e s+rven! o
    &!erdere sever7 :n $re+(a(e, dar ce! %a! %+"=! !nd!v!/! c+ (+"'+rare de&res!v7
    %a@or7 n+ a+ dor!n=a de a &!erde co%&+"s!v :n $re+(a(e sa+ .r!ca co%&+"s!v7 de a
    n+ "+a :n $re+(a(e, :n sc!/o.ren!e, !nd!v!/!! &o( &re/en(a +n co%&or(a%en( '!/ar
    de a %Anca O! oca/!ona" e<&er!en(ea/7 o &!erdere se%n!.!ca(!v7 :n $re+(a(e, dar e!
    &re/!n(7 rar .r!ca de a "+a :n $re+(a(e O! &er(+r'area !%a$!n!! cor&ora"e cer+(e
    &en(r+ a &+ne d!a$nos(!c+" de anore<!e nervoas7.
    Une"e d!n(re e"e%en(e"e anore<!e! nervoase s+n( &ar(e a se(+"+! de cr!(er!! &en(r+
    .o'!a soc!a"7, (+"'+rare o'ses!vo4co%&+"s!v7 s! (+"'+rarea d!s%or.!c7 cor&ora"7.
    :n %od s&ec!.!c, !nd!v!d+" &oa(e .! +%!"!( sa+ !nco%oda( de .a&(+" de a .! v7/+(
    %AncAnd :n &+'"!c, ca :n .o'!a soc!a"78 &oa(e &re/en(a o'ses!! sa+ co%&+"s!! :n
    "e$7(+r7 c+ a"!%en(e"e, ca :n (+"'+rarea o'ses!vo4co%&+"s!v7 sa+ &oa(e .!
    &reoc+&a( de +n de.ec( !%a$!nar :n as&ec(+" cor&+"+!, ca :n (+"'+rarea d!s%or.!c7
    cor&ora"7. Dac7 !nd!v!d+" c+ anero<!e nervoas7 are .r!c! soc!a"e care s+n( "!%!(a(e
    n+%a! "a co%&or(a%en(+" a"!%en(ar, d!a$nos(!c+" de .o'!e soc!a"7 n+ (re'+!e &+s,
    :ns7 .r!c!"e soc!a"e .7r72 "e$7(+r7 c+ co%&or(a%en(+" a"!%en(ar Ede e<., .r!ca
    co%&+"s!v7 de a vor'! :n &+'"!cJ &o( @+s(!.!ca +n d!a$nos(!c ad!=!ona" de .o'!e
    soc!a"7. La .e", d!a$nos(!c+" de (+"'+rare o'ses!vo4co%&+"s!v7 (re'+!e "+a( :n
    cons!dera=!e, n+%a! dac7 !nd!v!d+" &re/!n(7 o'ses!! s! co%&+"s!! .7r7 "e$7(+r7 c+
    a"!%en(area Ede e<., o .r!c7 co%&+"s!v7 de con(a%!nareJ, !ar d!a$nos(!c+" de
    (+"'+rare d!s%or.!c7 cor&ora"7 (re'+!e "+a( :n cons!dera=!e n+%a! dac7 des.!$+rarea
    es(e .7r7 "e$7(+r7 c+ con.or%a=!a sa+ d!%ens!+nea cor&+"+! Ede e<., &reoc+&area c7
    nas+" es(e &rea %areJ.
    45?2AE Sulimia Fervoas A86
    :n '+"!%!a nervoas7, !nd!v!/!! &re/!n(7 e&!soade rec+ren(e de %Anca(
    co%&+"s!v, se an$a@ea/7, :n co%&or(a%en(e !nadecva(e &en(r+ a ev!(a "+area :n
    $re+(a(e Ede e<., a+(o&rovocarea de v7rs7(+r!J s! s+n( &reoc+&a=! de $re+(a(ea s!
    con.or%a=!a cor&+"+!, :ns7, con(rar !nd!v!/!"or c+ anore<!e nervoas7, (!&+" de
    %Anca( co%&+"s!vX&+r$are, !nd!v!/!! c+ '+"!%!e nervoas7 s+n( ca&a'!"! s7 %en=!n7
    $re+(a(ea cor&ora"7 "a, sa+ deas+&ra +n+! n!ve" nor%a" %!n!%a".
    Criteriile $e $ia/no&ti# pentru 4+G.* Anore,ia Nervoa&(
    A2 +e$u(ul de a menine !reutatea corporal la, sau deasupra unei !reuti
    normale minime pentru etatea si "nlimea sa &de ex2, pierdere "n !reutate
    duc@nd la meninerea !reutii corporale la mai puin de 8Ad din cea
    sperat sau incapacitatea de a lua "n !reutate plusul sperat "n cursul
    perioadei de cre,tere, duc@nd la o !reutate corporal de mai puin de 8Ad
    din cea sperat)2
    S2 'rica intens de a nu lua "n !reutate sau de a deveni !ras&), c%iar dac este
    subponderal&)2
    2 #erturbarea modului "n care este experientat !reutatea sau con$ormaia
    corpului propriu, nedatorat in$luenei !reutii sau con$ormaiei corporale
    asupra autoevalurii sau ne!area serio(itii !reutii corporale actuale sc(ute2
    D2 La $emeile postmenar%ice, amenoree, adic absena a cel puin trei cicluri
    menstruale consecutive2 &O $emeie este considerat a avea amenoree, dac
    menstrele sale survin numai dup administrarea de %ormoni, de ex2, estro!eni)2
    De speci"icat tipulD
    Tip restrictivD "n cursul episodului actual de anorexie nervoas, persoana
    nu s-a an!a0at re!ulat "ntr-un comportament de m@ncat compulsiv sau
    de pur!are &adic, vrsturi autoprovocate sau abu( de laxative,
    diuretice sau clisme)
    Tip de m@ncat compulsiv1pur!areD "n cursul episodului actual de anorexie
    nervoas, persoana se an!a0ea( "n mod re!ulat "ntr-un comportament
    de m@ncat compulsiv sau de pur!are &adic, vrsturi autoprovocate sau
    abu( de laxative, diuretice sau clisme)
    4+G.<* 8uli"ia Nervoa&(
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e '+"!%!e! nervoase "e cons(!(+!e %Anca(+" co%&+"s!v s!
    %e(ode"e co%&ensa(or!! !nadecva(e de a &reven! "+a(+" :n $re+(a(e, :n a.ar7 de
    aceas(a, a+(oeva"+area !nd!v!/!"or c+ '+"!%!e nervoas7 es(e !n."+en=a(7 de
    con.or%a=!a s! $re+(a(ea cor&+"+!. Pen(r+ a .! dese%na(e &en(r+ d!a$nos(!c,
    %Anca(+" co%&+"s!v s! co%&or(a%en(e"e co%&ensa(or!! !nadecva(e (re'+!e s7 a&ar7,
    :n %ed!e, de ce" &+=!n do+7 or! &e s7&(7%An7, (!%& de ce" &+=!n ; "+n! Ecr!(er!+" CJ.
    Un mTncat comp+lsi* e<ces es(e de.!n!( ca %Anca(+" :n(r4o an+%!(7 &er!oad7 de
    (!%&, a +ne! can(!(7=! de %Ancare care es(e :n %od ev!den( %a! %are decA( cea &e
    care ar %Anca4o ce! %a! %+"=! !nd!v!/! :n c!rc+%s(an=e s!%!"are Ecr!(er!+" A"J.
    YFL Tulburrile de omportament Alimentar

    C"!n!c!an+" (re'+!e s7 !a :n cons!dera=!e con(e<(+" :n care s+rv!ne %:nca(+", ceea ce
    ar &+(ea .! cons!dera( dre&( +n cons+% e<ces!v "a +n &rAn/ (!&!c, &oa(e .! cons!dera(
    nor%a" :n (!%&+" +ne! .es(!v!(7=! sa+ &rAn/ de vacan=7. SO an+%!(7 &er!oad7 de
    (!%&T se re.er7 "a o &er!oad7 "!%!(a(7 de (!%&, de re$+"7 de %a! &+=!n de 9 ore. Un
    s!n$+r e&!sod de %Anca( co%&+"s!v n+ (re'+!e s7 .!e res(rAns "a +n s!n$+r "oc. De
    e<e%&"+, +n !nd!v!d &oa(e :nce&e +n %Anca( co%&+"s!v "a res(a+ran( s! s745
    con(!n+!e a&o! cAnd a@+n$e acas7. ,+s(a(+" con(!n++ de %!c! can(!(7=! de %Ancare
    de4a "+n$+" /!"e! n+ (re'+!e s7 .!e cons!dera( %Anca( co%&+"s!v.
    DeO! (!&+" de a"!%en(e cons+%a(e :n (!%&+" %Anca(+"+! co%&+"s!v var!a/7,
    aces(a !nc"+de de re$+"7 d+"c!+r!, a"!%en(e c+ +n :na"( con=!n+( ca"or!c, c+% ar .!
    :n$e=a(a sa+ &r7@!(+r!"e, :ns7, %Anca(+" co%&+"s!v &are a .! carac(er!/a( %a! %+"(
    &r!n(r4o ano%a"!e :n can(!(a(ea de a"!%en(e cons+%a(e decA( &r!n dor!n=a arden(7
    de +n an+%!( a"!%en(, c+% ar .! d+"c!+r!"e. DeO! !nd!v!/!! c+ '+"!%!e cons+%7 %a!
    %+"(e ca"or!! :n c+rs+" +n+! e&!sod de %Anca( co%&+"s!v decA( cons+%7 &ersoane"e
    .7r7 '+"!%!e nervoas7 :n c+rs+" +ne! %ese, .rac=!+n!"e de ca"or!! der!va(e d!n
    &ro(e!ne, $r7s!%! s! $"+c!de s+n( s!%!"are.
    Ind!v!/!! c+ '+"!%!e nervoas7 s+n( de re$+"7 !nco%oda=! de &ro'"e%e"e "or c+
    %Anca(+" s! :ncearc7 s74s! asc+nde s!%&(o%e"e. MAnca(+" co%&+"s!v s+rv!ne de
    re$+"7 :n secre( sa+ cA( %a! !no'serva'!" &os!'!". Un e&!sod &oa(e .! sa+ n+
    &"an!.!ca( d!na!n(e, s! es(e de re$+"7 Edar n+ (o(dea+naJ carac(er!/a( &r!n cons+%are
    ra&!d7. MAnca(+" co%&+"s!v con(!n+a &An7 ce !nd!v!d+" es(e !ncon.or(a'!" sa+
    d+reros de s7(+". MAnca(+" co%&+"s!v es(e dec"anOa( de re$+"7 de s(7r! a.ec(!ve
    d!s.or!ce, s(resor! !n(er&ersona"!, .oa%ea !n(ens7 +r%And +nor res(r!c=!! de d!e(7 or!
    +nor sen(!%en(e :n "e$7(+r7 c+ $re+(a(ea, con.or%a=!a cor&+"+! O! %Ancarea.
    MAnca(+" co%&+"s!v &oa(e red+ce (ran/!(or!+ d!s.or!a, dar adesea +r%ea/7
    d!&ar!=!a a+(ocr!(!c!! s! a&ar!=!a +ne! d!s&o/!=!! de&res!ve.
    Un e&!sod de %Anca( co%&+"s!v se :nso=eO(e, de ase%enea, de sen(!%en(+" de
    "!&s7 de con(ro" Ecr!(er!+" A9J. Un !nd!v!d &oa(e .! :n(r4o s(are de .rene/!e :n (!%&+"
    %Anca(+"+! co%&+"s!v, :n s&ec!a" "a :nce&+(+" %a"ad!e!. Un!! !nd!v!/! descr!+ o s(are
    d!soc!a(!v7 :n c+rs+" e&!soade"or de %Anca( co%&+"s!v sa+ d+&7 aceea. D+&7 ce
    '+"!%!a nervoas7 a &ers!s(a( cA(va (!%&, !nd!v!/!! res&ec(!v! &o( re"a(a c7 e&!soade"e
    "or de %Anca( co%&+"s!v n+ %a! s+n( carac(er!/a(e &r!n sen(!%en(+" ac+( de
    &!erdere a con(ro"+"+!,2 c! %a! c+rAnd &r!n !nd!ca(or! co%&or(a%en(a"! de
    de(er!orare a con(ro"+"+!, c+% ar .! d!.!c+"(a(ea de a re/!s(a %Anca(+"+! co%&+"s!v
    sa+ d!.!c+"(a(ea de a s(o&a +n %Anca( co%&+"s!v, oda(7 ce aces(a a :nce&+(.
    De(er!orarea con(ro"+"+! asoc!a(7 c+ %Anca(+" co%&+"s!v :n '+"!%!a nervoas7 n+
    es(e a'so"+(78 de e<e%&"+, +n !nd!v!d &oa(e con(!n+a s7 %7nAnce co%&+"s!v :n
    (!%& ce s+n7 (e"e.on+", dar :nce(ea/7 !%ed!a( cAnd !n(r7 &e neaO(e&(a(e :n ca%er7
    so=!a Eso=+"J sa+ ce" EceaJ c+ care :%&ar(e ca%era.
    A"( e"e%en( esen=!a" a" '+"!%!e! nervoase :" cons(!(+!e +/+" rec+ren( de
    co%&or(a%en(e co%&ensa(or!! !nadecva(e &en(r+ a &reven! "+a(+" :n $re+(a(e
    Ecr!(er!+" BJ. M+"=! !nd!v!/! c+ '+"!%!e nervoas7 :n(re'+!n=ea/7 d!verse %e(ode :n
    (en(a(!va "or de a co%&ensa %Anca(+" co%&+"s!v. Cea %a! co%+n7 (en!c7
    co%&ensa(or!e o cons(!(+!e &rovocarea de v7rs7(+r! d+&7 +n e&!sod de %Anca(
    co%&+"s!v. Aceas(7 %e(od7 de &+r$are es(e :n(re'+!n=a(7 de GLd &An7 "a FLd
    d!n(re !nd!v!/!! c+ '+"!%!e nervoas7 care se &re/!n(7 &en(r+ (ra(a%en( :n c"!n!c!"e de
    (+"'+r7r! de n+(r!=!e. E.ec(e"e !%ed!a(e a"e v7rs7(+r!"or !nc"+d +O+rarea
    d!scon.or(+"+! so%a(!c O! red+cerea .r!c!! de a n+ "+a :n $re+(a(e, :n +ne"e ca/+r!,
    vo%a dev!ne +n sco& :n s!ne, !ar &ersoana va %Anca co%&+"s!v &en(r+ a vo%!(a sa+
    45?2AE Sulimia
    Fervoas
    YF5
    va vo%!(a d+&7 !n$erarea +ne! %!c! can(!(7=! de a"!%en(e. Ind!v!/!! c+ '+"!%!e
    nervoas7 &o( +(!"!/a o d!vers!(a(e de %e(ode &en(r+ a4s! &rovoca v7rs7(+r!,
    !nc"+/And +/+" de$e(e"or sa+ a" !ns(r+%en(e"or &en(r+ a s(!%+"a re."e<+" de vo%7.
    Ind!v!/!! dev!n :n $enera" ade&=!! &rovoc7r!! de v7rs7(+r! s!, :n .!na", s+n( ca&a'!"! s7
    vo%!(e d+&7 dor!n=7. Ma! rar, aceO(! !nd!v!/! .ac +/ de s!ro& de !&eca &en(r+ a4s!
    &rovoca v7rs7(+r!. A"(e co%&or(a%en(e de &+r$are !nc"+d a'+/+" de "a<a(!ve s! de
    d!+re(!ce. A&ro<!%a(!v o (re!%e d!n(re ce! c+ '+"!%!e nervoas7 .ac +/ de "a<a(!ve
    d+&7 +n e&!sod de %Anca( co%&+"s!v. Ma! rar, !nd!v!/!! c+ aceas(7 (+"'+rare
    a'+/ea/7 de c"!s%e d+&7 e&!soade"e de %Anca( co%&+"s!v, dar aceas(a es(e rar
    %e(oda co%&ensa(or!e :n(re'+!n=a(7 +/+a".
    Ind!v!/!! c+ '+"!%!e nervoas7 &o( &os(! +na sa+ %a! %+"(e /!"e or! e<ersea/7
    e<ces!v de %+"( :n (en(a(!va de a co%&ensa %Anca(+" co%&+"s!v. E<erc!=!!"e &o( .!
    cons!dera(e e<ces!ve cAnd !n(er.erea/7 c+ ac(!v!(7=! !%&or(an(e, cAnd a+ "oc "a ore
    sa+ :n "oc+r! !nadecva(e or! cAnd !nd!v!d+" con(!n+7 s7 e<erse/e :n d!s&re=+"
    (ra+%a(!s%e"or sa+ a" a"(or co%&"!ca=!! %ed!ca"e. Ma! rar, !nd!v!/!! c+ aceas(7
    (+"'+rare &o( "+a or%on (!ro!d!an :n (en(a(!va "or de a ev!(a "+a(+" :n $re+(a(e.
    Ind!v!/!! c+ d!a'e( /aara( s! '+"!%!e nervoas7 &o( o%!(e sa+ red+ce do/e"e de
    !ns+"!na :n sco&+" red+cer!! %e(a'o"!s%+"+! a"!%en(e"or cons+%a(e :n c+rs+"
    e&!soade"or de %Anca( co%&+"s!v.
    Ind!v!/!! c+ '+"!%!e nervoas7 &+n +n accen( e<a$era( &e con.or%a=!a s! $re+(a(ea
    cor&+"+! :n a+(oeva"+area "or, s! aceO(! .ac(or! s+n( de re$+"7 +n!! d!n(re ce! %a!
    !%&or(an=! :n de(er%!narea s(!%e! de s!ne Ecr!(er!+" DJ. Ind!v!/!! c+ aceas(7 (+"'+rare
    &o( se%7na .oar(e %+"( c+ ce! c+ anore<!e nervoas7 s+' as&ec(+" .r!c!! de a n+ "+a :n
    $re+(a(e, a" dor!n=e! "or de a &!erde :n $re+(a(e O! a" n!ve"+"+! de !nsa(!s.ac=!e :n
    "e$7(+r7 c+ cor&+" "or. D!a$nos(!c+" de '+"!%!e nervoas7 n+ va .! &+s :ns7, cAnd
    &er(+r'area s+rv!ne n+%a! :n c+rs+" e&!soade"or de anore<!e nervoas7 Ecr!(er!+" EJ.
    Subtipuri
    Ur%7(oare"e s+'(!&+r! &o( .! +(!"!/a(e &en(r+ a s&ec!.!ca &re/en=a sa+ a'sen=a +/+"+!
    re$+"a( de %e(ode de &+r$are ca %!@"oace de co%&ensare a %Anca(+"+! co%&+"s!vQ
    T!& de &+r$are. Aces( s+'(!& descr!e (a'"o+r!"e c"!n!ce :n care &ersoana s4a
    an$a@a( :n a+(o&rovocarea de v7rs7(+r!, :n a'+/ de "a<a(!ve, d!+re(!ce sa+
    c"!s%e :n c+rs+" e&!sod+"+! c+ren(.
    T!& de non&+r$are. Aces( s+'(!& descr!e (a'"o+r!"e c"!n!ce :n care &ersoana a
    +(!"!/a( a"(e co%&or(a%en(e co%&ensa(or!! !nadecva(e, c+% ar .! &os(+" sa+
    e<erc!=!!"e e<ces!ve, dar care n+ s4a an$a@a( :n %od re$+"a( :n v7rs7(+r!
    a+(o&rovoca(e sa+ :n a'+/+" de "a<a(!ve, d!+re(!ce sa+ c"!s%e :n c+rs+"
    e&!sod+"+! ac(+a".
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. Ind!v!/!! c+ '+"!%!e
    nervoas7 se a."7 de re$+"7 :n cadr+" ser!e! de $re+(a(e nor%a"7, deO! +n!! &o( .! +Oor
    s+'&ondera"! sa+ s+&ra&ondera"!. T+"'+rarea s+rv!ne, dar es(e rar7, &r!n(re !nd!v!/!!
    o'e/! %odera=! O! %or'!/!. E<!s(7 !nd!c!!, c7 :na!n(ea de'+(+"+! (+"'+r7r!! de
    co%&or(a%en( a"!%en(ar,4!nd!v!/!! c+ '+"!%!e nervoas7 es(e .oar(e &os!'!" s7 .!e %a!
    s+&ra&ondera"! decA( e$a"!! "or. :n(re e&!soade"e de %Anca( co%&+"s!v, !nd!v!/!! c+
    '+"!%!e :O! res(rAn$ de re$+"7 cons+%+" ca"or!c s! se"ec(ea/7 &re.eren=!a" a"!%en(e"e
    c+ va"oare ca"or!c7 red+s7 ZSd!e(aT[, :n (!%& ce ev!(7 a"!%en(e"e &e care "e &erce& ca
    d+cAnd "a :n$r7sare sa+ care dec"anOea/7 &ro'a'!" +n e&!sod de %Anca( co%&+"s!v.
    542 Tulburrile de omportament Alimentar

    E<!s(7 o .recven=7 cresc+(7 a s!%&(o%e"or de&res!ve Ede e<., s(!%a de s!ne
    sc7/+(7J sa+ a (+"'+r7r!"or a.ec(!ve E:n s&ec!a" (+"'+rarea d!s(!%!c7 s! (+"'+rarea
    de&res!v7 %a@or7J "a !nd!v!/!! c+ '+"!%!e nervoas7. La %+"=! sa+ "a ce! %a! %+"=!
    !nd!v!/!, &er(+r'area de d!s&o/!=!e :nce&e :n ace"aO! (!%& c+, sa+ +r%ea/7 a&ar!=!e!
    '+"!%!e! nervoase, !ar !nd!v!/!! :O! a(r!'+!e adesea &er(+r'7r!"e a.ec(!ve '+"!%!e!
    nervoase. La +n!! !nd!v!/!, :ns7, &er(+r'area a.ec(!v7 &recede c"ar a&ar!=!a '+"!%!e!
    nervoase. Poa(e e<!s(a, de ase%enea, o creO(ere a .recven=e! s!%&(o%e"or an<!oase
    Ede e<., .r!ca de s!(+a=!! soc!a"eJ sa+ a (+"'+r7r!"or an<!oase. Aces(e &er(+r'7r!
    a.ec(!ve O! an<!oase se re%!( .recven( d+&7 +n (ra(a%en( e.!c!en( a" '+"!%!e!
    nervoase. Preva"en(a &e v!a=7 a a'+/+"+! sa+ de&enden=e! de o s+'s(an=7, !%&"!cAnd
    :n s&ec!a" a"coo"+" O! s(!%+"an(e"e, s+rv!ne "a ce" &+=!n ;Ld d!n(re !nd!v!/!! c+ '+"!%!e
    nervoas7. U/+" de s(!%+"an(e :nce&e adesea :n (en(a(!va de a con(ro"a a&e(!(+" s!
    $re+(a(ea. Un &rocen( s+'s(an=!a" de !nd!v!/!! c+ '+"!%!e nervoas7 a+, de ase%enea,
    e"e%en(e de &ersona"!(a(e care sa(!s.ac cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r!
    de &ersona"!(a(e Ece" %a! .recven( &en(r+ (+"'+rarea de &ersona"!(a(e 'order"!neJ.
    Da(e de "a'ora(or asoc!a(e. Frecven(, co%&or(a%en(+" de &+r$are de or!ce (!&
    &oa(e &rod+ce ano%a"!! !droe"ec(ro"!(!ce, ce" %a! .recven( !&o)a"!e%!e,
    n!&ona(re%!e s! !&oc"ore%!e. P!erderea de s+c $as(r!c &r!n v7rs7(+r! &oa(e d+ce "a
    o a"ca"o/7 %e(a'o"!c7 EcreO(erea '!car'ona(+"+! ser!cJ, !ar &rovocarea .recven(7 de
    d!aree &r!n a'+/ de "a<a(!ve &oa(e ca+/a ac!do/7 %e(a'o"!c7. Un!! !nd!v!/! c+
    '+"!%!e nervoas7 &re/!n(7 n!ve"e +Oor cresc+(e a"e a%!"a/e! ser!ce, re."ec(And
    &ro'a'!" o creO(ere a !soen/!%e! sa"!vare.
    Datele e,a"in(rii &o"ati#e Ei #on$i!iile "e$i#ale /enerale a&o#iate.
    37rs7(+r!"e rec+ren(e d+c :n .!na" "a o &!erdere se%n!.!ca(!v7 O! &er%anen(7 a
    s%a"=+"+! den(ar, :n s&ec!a" &e .a=a "!n$+a"7 a d!n=!"or .ron(a"!. AceO(! d!n=! &o(
    deven! c!o'!=! O! &ar a .! co"=+ros! O! S%Anca=! de %o"!!T. Poa(e e<!s(a, de ase%enea,
    o .recven=7 cresc+(7 a car!!"or den(are. La +n!! !nd!v!/!, $"ande"e sa"!vare, :n s&ec!a"
    $"ande"e &aro(!de, &o( .! %7r!(e cons!dera'!". Ind!v!/!! care4O! &rovoac7 v7rs7(+r!
    &r!n s(!%+"area %an+a"7 a re."e<+"+! de vo%7 &o( &re/en(a ca"o/!(7=! sa+ c!ca(r!c!
    &e .a=a dorsa"7 a de$e(e"or &r!n (ra+%e re&e(a(e d!n ca+/a d!n=!"or. M!o&a(!!
    card!ace O! sce"e(a"e severe a+ .os( ra&or(a(e &r!n(re !nd!v!/!! care +;ea;6 :n %od
    re$+"a( de s!ro& de !&eca &en(r+ a4O! &rovoca v7rs7(+r!.
    C!c"+" %ens(r+a" nere$+"a( sa+ a%enoreea s+rv!ne +neor! &r!n(re .e%e!"e c+
    '+"!%!e nervoas78 es(e !ncer( dac7 as(.e" de &er(+r'7r! s+n( :n "e$7(+r7 c+
    ."+c(+a=!!"e &ondera"e, c+ de.!c!en=e"e n+(r!=!ona"e sa+ c+ s(res+" e%o=!ona".
    Ind!v!/!! care a'+/ea/7 :n %od cron!c de "a<a(!ve &o( deven! de&enden=! de +/+" "or
    &en(r+ a s(!%+"a %!Oc7r!"e a%&+"e! rec(a"e. Per(+r'7r!"e !droe"ec(ro"!(!ce re/+"(And
    d!n co%&or(a%en(+" de &+r$are s+n( +neor! s+.!c!en( de severe &en(r+ a cons(!(+!
    &ro'"e%e %ed!ca"e severe. Rar, dar :n .!na" .a(a"e, co%&"!ca=!!"e !nc"+d d!"acer7r!"e
    eso.a$!ene, r+&(+ra $as(r!c7 s! ar!(%!!"e card!ace. Pro"a&s+" rec(a" a .os(, de
    ase%enea, ra&or(a( &r!n(re !nd!v!/!! c+ aceas(7, (+"'+rare, :n co%&ara=!e c+ !nd!v!/!!
    c+ '+"!%!e nervoas7, (!&+" de non&+r$are, ce! c+ (!&+" de &+r$are es(e .oar(e &os!'!"
    s7 a!'7 &ro'"e%e so%a(!ce, c+% ar .! &er(+r'7r!"e !droe"ec(ro"!(!ce.
    *lemente speci$ice culturii, etii si sexului
    B+"!%!a nervoas7 a .os( descr!s7 ca a&7rAnd, :n %are, c+ .recven=e s!%!"are :n
    ce"e %a! %+"(e =7r! !nd+s(r!a"!/a(e, !nc"+/And S(a(e"e Un!(e, Canada, E+ro&a,
    A+s(ra"!a, *a&on!a, No+a Kee"and7 O! A.r!ca de S+d. P+=!ne s(+d!! a+ e<a%!na(
    &reva"en(a '+"!%!e! nervoase :n a"(e c+"(+r!, :n s(+d!!"e c"!n!ce as+&ra '+"!%!e!
    45?2AE Sulimia
    Fervoas
    54+

    nervoase, :n S(a(e"e Un!(e, !nd!v!/!! care &re/!n(7 aceas(7 (+"'+rare s+n( :n $enera"
    a"'!, dar (+"'+rarea a .os( ra&or(a(7 s! &r!n(re a"(e $r+&+r! e(n!ce.
    :n esan(!oane"e c"!n!ce s! &o&+"a=!ona"e, ce" &+=!n FLd d!n(re !nd!v!/!! c+ '+"!%!e
    nervoas7 s+n( .e%e!. Une"e da(e s+$erea/7 c7 '7r'a=!! c+ '+"!%!e a+ o &reva"en(7
    %a! %are a o'e/!(7=!! &re%or'!de decA( .e%e!"e c+ '+"!%!e nervoas7.
    #revalent
    Preva"en(a &e v!a=7, a '+"!%!e! nervoase &r!n(re .e%e! es(e de a&ro<!%a(!v " d4;d8
    ra(a a&ar!=!e! aces(e! (+"'+r7r! "a '7r'a=! es(e de a&ro<!%a(!v 5X5L d!n cea a .e%e!"or.
    *voluie
    B+"!%!a nervoas7 :nce&e de re$+"7 :n +"(!%a &ar(e a ado"escen=e! sa+ "a
    :nce&+(+" v!e=!! ad+"(e. MAnca(+" co%&+"s!v :nce&e .recven( :n c+rs+" sa+ d+&7 +n
    e&!sod de d!e(7. Co%&or(a%en(+" &er(+r'a( de a %Anca &ers!s(7 ce" &+=!n cA=!va an!
    :n(r4+n &rocen( r!d!ca( de eOan(!oane c"!n!ce. Evo"+=!a &oa(e .! cron!c7 sa+
    !n(er%!(en(7, c+ &er!oade de re%!s!+ne a"(ernAnd c+ rec+ren=a e&!soade"or de
    %Anca( co%&+"s!v. D+&7 o &er!oad7 "+n$7 de +r%7r!re ca(a%nes(!c7, s!%&(o%e"e
    %+"(or !nd!v!/! &ar a d!%!n+a. Per!oade"e de re%!s!+ne %a! "+n$! de " an s+n(
    asoc!a(e c+ +n de/nod7%An( %a! '+n &e (er%en "+n$.
    #attern $amilial
    D!verse s(+d!! a+ s+$era( o .recven=7 cresc+(7 a '+"!%!e! nervoase, a (+"'+r7r!"or
    a.ec(!ve s! a a'+/+"+! s! de&enden=e! de o s+'s(an=7 "a r+de"e '!o"o$!ce de $rad+" I
    a"e !nd!v!/!"or c+ '+"!%!e nervoas7. Poa(e e<!s(a o (end!n=7 .a%!"!a"7 "a o'e/!(a(e,
    dar aces( .a&( n+ es(e s(a'!"!( de.!n!(!v.
    Dia!nostic di$erenial
    Ind!v!/!"or a" c7ror co%&or(a%en( de %Anca( co%&+"s!v s+rv!ne n+%a! :n
    anore<!a nervoas7, "! se &+ne d!a$nos(!c+" de anore<!e nervoas7, (!& de %Anca(
    co%&+"s!vX&+r$are s! n+ d!a$nos(!c+" ad!=!ona" de '+"!%!e nervoas7. Pen(r+ +n
    !nd!v!d care %7nAnc7 co%&+"s!v s! se &+r$ea/7, dar a" c7r+! (a'"o+ c"!n!c n+ %a!
    sa(!s.ace cr!(er!!"e co%&"e(e &en(r+ anore<!a nervoas7, (!& de %Anca(
    co%&+"s!vX&+r$are Ede e<., cAnd $re+(a(ea es(e nor%a"7 sa+ %ens(r+a=!!"e a+
    deven!( re$+"a(eJ es(e o &ro'"e%7 de @+deca(7 c"!n!c7, dac7 ce" %a! cores&+n/7(or
    d!a$nos(!c ac(+a" es(e ce" de anore<!e nervoas7, (!& %Anca( co%&+"s!vX&+r$are, :n
    re%!s!+ne &ar=!a"7, sa+ de '+"!%!e nervoas7.
    :n an+%!(e cond!=!! ne+ro"o$!ce sa+ :n a"(e cond!=!! %ed!ca"e $enera"e, c+% ar .!
    s!ndro%+" -"e!ne4Lev!n, e<!s(7 +n co%&or(a%en( a"!%en(ar &er(+r'a(, dar n+ s+n(
    &re/en(e e"e%en(e"e &s!o"o$!ce carac(er!s(!ce a"e '+"!%!e! nervoase, ca de e<e%&"+,
    &reoc+&area e<a$era(7 &en(r+ con.or%a=!a O! $re+(a(ea cor&+"+!. H!&er.a$!a es(e
    co%+n7 :n (+"'+rarea de&res!v7 %a@or7 c+ e"e%en(e a(!&!ce, dar as(.e" de !nd!v!/! n+
    se an$a@ea/7 :n co%&or(a%en(e co%&ensa(or!! !nadecva(e O! n+ &re/!n(7 &reoc+&area
    e<ces!v7, carac(er!s(!c7 &en(r+ con.or%a=!a s! $re+(a(ea cor&+"+!. Dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ a%'e"e (+"'+r7r!, (re'+!e &+se a%'e"e d!a$nos(!ce. Co%&or(a%en(+"
    de %Anca( co%&+"s!v es(e !nc"+s :n cr!(er!+" co%&or(a%en(+"+! !%&+"s!v, care es(e
    &ar(e a de.!n!=!e! (+"'+r7r!! de &ersona"!(a(e 'order"!ne. Dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e co%&"e(e &en(r+ a%'e"e (+"'+r7r!, a%'e"e d!a$nos(!ce &o( .! &+se.
    YFI Tulburrile de omportament Alimentar
    Criteriile $e $ia/no&ti# pentru 4+G.<* 8uli"ia Nervoa&(
    A2 *pisoade recurente de m"ncat compulsiv2 .n episod de m"ncat compulsiv se
    caracteri(ea( prin ambii itemi care urmea(D
    (1) m@ncatul "ntr-o anumit perioad de timp &de ex2, "n decursul unei
    perioade de dou ore), a unei cantiti de m@ncare mai mare dec@t cea
    pe care ar m@nca-o cei mai muli oameni "ntr-o perioad, similar, de
    timp si "n circumstane similare2
    (2) sentimentul de lips de control al m"ncatului "n cursul episodului &de
    ex2,
    sentimentul c persoana respectiv nu poate stopa m@ncatul sau
    controla ce sau c@t de mult mn@nc)2
    S2 omportament compensator inadecvat recurent "n scopul prevenirii lurii "n
    !reutate, cum ar $i vrsturile autoprovocate, abu(ul de laxative, diuretice,
    clisme sau alte medicamente, postul sau exerciiile excesive2
    2 M@ncatul compulsiv ,i comportamentele compensatorii inadecvate apar
    ambele, "n medie de cel puin dou ori pe sptm@n, timp de 4 luni2
    D2 Autoevaluarea este "n mod ne0usti$icat in$luenat de con$ormaia si
    !reutatea corpului2
    *2 #erturbarea nu survine exclusiv "n cursul episoadelor de anorexie nervoas2
    De speci"icat tipulD
    Tip de pur!areD "n cursul episodului curent de bulimie nervoas, persoana s-
    a an!a0at re!ulat "n autoprovocarea de vrsturi sau "n abu(ul de laxative,
    diuretice sau clisme2
    Tip de nonpur!areD "n cursul episodului curent de bulimie nervoas,
    persoana a utili(at alte comportamente compensatorii inadecvate cum ar $i
    postul sau exerciiile excesive, dar nu s-a an!a0at "n mod re!ulat "n vrsturi
    autoinduse sau "n abu(ul de laxative, diuretice sau clisme2
    4+G.<+ Tul-urare $e Co"porta"ent Ali"entar
    '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a (+"'+r7r!! de co%&or(a%en( a"!%en(ar .7r7 a"(7 s&ec!.!ca=!e es(e
    des(!na(7 (+"'+r7r!"or de co%&or(a%en( a"!%en(ar care n+ sa(!s.ac cr!(er!!"e &en(r+
    n!c! +na d!n(re (+"'+r7r!"e de co%&or(a%en( a"!%en(ar s&ec!.!ce. E<e%&"e"e !nc"+dQ
    1. Pen(r+ .e%e!, s+n( sa(!s.7c+(e (oa(e cr!(er!!"e &en(r+ anore<!a nervoas7 c+
    e<ce&=!a .a&(+"+! c7 aces(ea a+ %ens(r+a=!! re$+"a(e.
    2. S+n( sa(!s.7c+(e (oa(e cr!(er!!"e &en(r+ anore<!a nervoas7 c+ e<ce&=!a .a&(+"+! c7,
    :n d!s&re=+" &!erder!! se%n!.!ca(!ve :n $re+(a(e, $re+(a(ea ac(+a"7 a !nd!v!d+"+!
    es(e :n "!%!(e nor%a"e.
    3. S+n( sa(!s.7c+(e (oa(e cr!(er!!"e &en(r+ '+"!%!a nervoas7 c+ e<ce&=!a .a&(+"+! c7
    %Anca(+" co%&+"s!v s! %ecan!s%e"e co%&ensa(or!! !nadecva(e s+rv!n c+ o
    .recven=7 de %a! &+=!n de do+7 or! &e s7&(7%An7 or! &en(r+ o d+ra(7 de %a!
    &+=!n de ; "+n!.
    45?2A5 Tulburare de omportament
    Alimentar 'r Alt Speci$icaie 545

    4. U/+" re$+"a( a" +n+! co%&or(a%en( co%&ensa(or !nadecva( de c7(re +n !nd!v!d
    c+ $re+(a(e cor&ora"7 nor%a"7 d+&7 %Ancarea +nor can(!(7=! %!c! de a"!%en(e
    Ede e<., v7rs7(+r! a+(o&rovoca(e d+&7 cons+%area a do+7 .+rsec+r!J.
    5. Mes(ecarea re&e(a(7 s! sc+!&area, dar n+ :n$!=!rea +nor %ar! can(!(7=! de
    %Ancare.
    6. T+"'+rarea de %Anca( co%&+"s!vQ e&!soade rec+ren(e de %Anca( co%&+"s!v, :n
    a'sen=a +/+"+! re$+"a( a" +nor co%&or(a%en(e co%&ensa(or!! !nadecva(e
    carac(er!s(!ce '+"!%!e! nervoase Eve/! &a$. HGY &en(r+ cr!(er!!"e de cerce(are
    s+$era(eJ.

    Tulburrile de Somn
    +"'+r7r!"e de so%n s+n( or$an!/a(e :n &a(r+ sec=!+n! %a@ore, :n .+nc=!e de
    e(!o"o$!a &res+&+s7. T+"'+r7r!"e de so%n &r!%are s+n( ace"ea :n care n!c!
    +na d!n e(!o"o$!!"e %en=!ona(e %a! @os Ead!c7, a"(7 (+"'+rare %en(a"7, o
    cond!=!e %ed!ca"7 $enera"7, sa+ o s+'s(an=7J n+ es(e res&onsa'!"7.
    T+"'+r7r!"e de so%n &r!%are s+n( &res+&+se a &roven! d!n ano%a"!!
    endo$ene :n %ecan!s%e"e de $enerare sa+ re$"are so%n4v!$!"!(a(e, co%&"!ca(e
    adesea de .ac(or! cond!=!ona"!. T+"'+r7r!"e de so%n &r!%are s+n( d!v!/a(e :n
    d!sso%n!! Ecarac(er!/a(e &r!n ano%a"!! :n can(!(a(ea, ca"!(a(ea sa+ re$"area
    X(!%!n$X so%n+"+!J s! &araso%n!! Ecarac(er!/a(e &r!n co%&or(a%en( anor%a" sa+
    even!%en(e .!/!o"o$!ce a&7rAnd :n asoc!ere c+ so%n+", c+ s(ad!!"e s&ec!.!ce
    so%n+"+! sa+ c+ (ran/!=!!"e so%n4v!$!"!(a(eJ.
    T+"'+rarea de so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 !%&"!c7 ac+/a
    no(a'!"7 a +ne! &er(+r'7r! de so%n care re/+"(7 d!n(r4o (+"'+rare %en(a"7
    d!a$nos(!ca'!"7 Eadesea o (+"'+rare a.ec(!v7 sa+ o (+"'+rare an<!oas7J, dar care es(e
    s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7. Es(e &os!'!" ca
    %ecan!s%e"e .!/!o&a(o"o$!ce res&onsa'!"e de (+"'+rarea %en(a"7 s7 a.ec(e/e, de
    ase%enea, re$"area so%n4v!$!"!(a(e.
    T+"'+rarea de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e !%&"!c7 ac+/a
    no(a'!"7 a +ne! (+"'+r7r! de so%n care re/+"(7 d!n e.ec(e"e .!/!o"o$!ce d!rec(e a"e
    +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+! so%n4v!$!"!(a(e.
    T+"'+rarea de so%n !nd+s7 de o s+'s(an=7 !%&"!c7 ac+/e no(a'!"e de
    &er(+r'are de so%n care re/+"(7 d!n +/+" conco%!(en( sa+ d!n :nce(area recen(7 a
    +/+"+! +ne! s+'s(an=e E!nc"+s!v a %ed!ca%en(e"orJ.
    Eva"+area s!s(e%a(!c7 "a !nd!v!/!! care se &re/!n(7 c+ ac+/e no(a'!"e de
    &er(+r'are de so%n !nc"+de o eva"+are a (!&+"+! s&ec!.!c de ac+/7 de so%n s! o "+are
    :n cons!dera=!e a (+"'+r7r!"or %en(a"e conco%!(en(e, a cond!=!!"or %ed!ca"e
    $enera"e, a +/+"+! +ne! s+'s(an=e E!nc"+s!v a +n+! %ed!ca%en(J care &o( .!
    res&onsa'!"e de &er(+r'area de so%n.
    C!nc! s(ad!! d!s(!nc(e de so%n &o( .! %7s+ra(e &r!n &o"!so%no$ra.!eQ so%n+" c+
    %!Oc7r! oc+"are ra&!de EREMJ O! &a(r+ s(ad!! de so%n .7r7 %!Oc7r! oc+"are ra&!de
    Enon4REMJ Es(ad!!"e ", 9,; s! IJ. S(ad!+" " de so%n NREM es(e o (ran/!=!e de "a s(area
    de v!$!"!(a(e "a so%n s! oc+&7 a&roa&e Yd d!n (!%&+" a"oca( so%n+"+! de ad+"=!!
    s7n7(oO!. S(ad!+" 9 de so%n NREM, care es(e carac(er!/a( &r!n .or%e de +nde EE,
    s&ec!.!ce E.+s+r! de so%n O! co%&"e<e -J, oc+&7 a&ro<!%a(!v YLd d!n (!%&+"
    re/erva( so%n+"+!. S(ad!!"e ; s! I de so%n NREM Ec+nosc+(e, de ase%enea, s+'
    den+%!rea co"ec(!v7 de so%n c+ +nde "en(eJ s+n( ce"e %a! &ro.+nde n!ve"e de so%n
    s! oc+&7 a&ro<!%a(!v 5Ld49Ld d!n (!%&+" de so%n. So%n+" REM, :n c+rs+" c7r+!a
    s+rv!n %a@or!(a(ea v!se"or ase%7n7(oare +ne! nara=!+n! (!&!ce, oc+&7 a&ro<!%a(!v
    9Ld49Yd d!n so%n+" (o(a".
    Aces(e s(ad!! de so%n a+ o or$an!/are (e%&ora"7 carac(er!s(!c7 de4a "+n$+" no&=!!.
    S(ad!!"e NREM ; s! I (!nd s7 s+rv!n7 :n &r!%a (re!%e sa+ :n &r!%a @+%7(a(e a no&=!!
    s! cresc :n d+ra(7 ca r7s&+ns "a de&r!varea de so%n. So%n+" REM s+rv!ne c!c"!c :n (o(
    YFH
    54= Tulburrile de Somn
    c+rs+" no&=!!, a"(ernAnd c+ so%n NREM a&ro<!%a(!v "a .!ecare GL45LL %!n+(e.
    Penoade"e de so%n REM cresc ca d+ra(7 s&re d!%!nea=7. So%n+" +%an var!a/7, de
    ase%enea, :n %od carac(er!s(!c :n c+rs+" v!e=!!. D+&7 o s(a'!"!(a(e re"a(!v7, c+ %An
    can(!(7=! de so%n c+ +nde "en(e :n co&!"7r!e O! :nce&+(+" ado"escen=e!, con(!n+!(a(ea s!
    &ro.+n/!%ea so%n+"+! se de(er!orea/7 &e %7s+r7 ce ad+"(+" avansea/7 :n e(a(e
    Aceas(7 de(enorare es(e re."ec(a(7 &nn creO(erea v!$!"!(7=!! s! s(ad!+"+! " de so%n s!
    d!%!n+area s(ad!!"or ; s! I de so%n. D!n aceas(7 ca+/7, e(a(ea (re'+!e "+a(7 :n
    T
    cons!dera=!e :n d!a$nos(!carea +ne! (+"'+r7r! de so%n "a or!ce !nd!v!d
    Polisomno/ra)w es(e %on!(or!/area +nor &ara%e(r! e"ec(ro.!/!o"o$!c! %+"(!&"! :n
    c+rs+" so%n+"+!, s! !nc"+de :n $enera" %7s+rarea ac(!v!(7=!! EE,, a ac(!v!(7=!!
    e"ec(rooc+"o$ra.!ce s! a ac(!v!(7=!! e"ec(ro%!o$ra.!ce M7s+r7(or!"e &o"!so%no$ra.!ce
    s+&"!%en(are &o( !nc"+de ."+<+" aenan ora" sa+ na/a", e.or(+" res&!ra(or, %!Oc7r!"e
    &ere(e"+! a'do%!na" s! a"e &"as(ron+"+! cos(a", sa(+ra=!a :n o<!$en a e%o$"o'!ne!
    'a+ concen(ra=!a '!o<!d+"+! de car'on e<a"a(, aces(e %7s+r7(or! s+n( +(!"!/a(e
    &en(r+ %on!(or!/area res&!ra=!e! :n (!%&+" so%n+"+! s! &en(r+ a de(ec(a &re/en=a s!
    sever!(a(ea a&ne!! de so%n M7s+rarea ac(!v!(7=!! e"ec(ro%!o$ra.!ce &er!.er!ce &oa(e
    .! +(!"!/a(7 &en(r+ a de(ec(a %!Oc7r! anor%a"e :n (!%&+" so%n+"+!. Ce"e %a! %+"(e
    s(+d!! &o"!so%no$ra.!ce s+n( e.ec(+a(e :n (!%&+" ore"or de so%n +/+a"e a"e
    &ersoane! U ad!c7, noa&(ea S(+d!!"e &o"!so%no$ra.!ce e.ec(+a(e :n (!%&+" /!"e! s+n(
    +(!"!/a(e "a c+an(!.!carea so%no"en=e! d!+rne Ce" %a! .recven( &rocede+ &en(r+
    (!%&+" /!"e! :" cons(!(+!e (es(+" de "a(en=7 a so%n+"+! %+"(!&"+ ETLSMJ, :n care
    !nd!v!d+" es(e !ns(r+!( s7 s(ea c+"ca( :n(r4o ca%er7 :n(+neca(7 s! s7 n+ re/!s(e
    so%n+"+!, aces( &ro(oco" se re&e(7 de c!nc! or! :n c+rs+" /!"e! La(en=a de so%n
    E(!%&+" necesar &en(r+ a ador%!J es(e %7s+ra(7 "a .!ecare (r!a" O! es(e +(!"!/a(7 dre&(
    !nd!c!+ a" so%no"en=e! .!/!o"o$!ce Invers+" TLSM es(e, de ase%enea, +(!"!/a(, :n
    (es(+" re&e(a( de v!$!"!(a(e s+s=!n+(7 ETR3SJ, !nd!v!d+" es(e aOe/a( :n(r4o ca%er7
    "!n!O(!(7, s"a' "+%!na(7 s! !ns(r+!( s7 r7%An7 v!$!", aces( &ro(oco" es(e re&e(a( de %a!
    %+"(e or! :n (!%&+" /!"e! D!n no+ es(e %7s+ra(7 "a(en(a so%n+"+!, dar aceas(a es(e
    +(!"!/a(7 dre&( !nd!c!+ a" ca&ac!(7=!! !nd!v!d+"+! de a4s! %en=!ne v!$!"!(a(ea
    Ter%!no"o$!a s(andard &en(r+ %7s+r7(or!"e &o"!so%no$ra.!ce es(e +(!"!/a(7 &es(e
    (o( :n (e<(+" aces(e! sec=!+n! Contin+itatea somn+l+i se re.er7 "a 'a"an=a $enera"7 a
    so%n+"+! s! v!$!(7=n, :n c+rs+" +ne! no&=! de so%n Con(!n+!(a(ea de so%n S%a!
    '+n7T !nd!c7 +n so%n con(!n++, c+ v!$!"!(a(e &+=!n7, con(!n+!(a(ea de so%n S%a! reaT
    !nd!c7 +n so%n :n(rer+&(, c+ %a! %+"(7 v!$!"!(a(e M7s+r7(or!"e con(!n+!(7=!! de so%n
    s&ec!.!ce !nc"+d latenta de somn U &enoada de (!%& necesar7 &en(r+ a ador%!
    Ee<&r!%a(7 :n %!n+(eJ, *i/ilitatea intermitent6 U can(!(a(ea de (!%& v!$!" d+&7 de'+(+"
    so%n+"+! !n!=!a" Ee<&r!%a(7 :n %!n+(eJ O! e)icienta somn+l+i U ra&or(+" d!n(re (!%&+"
    rea" &e(rec+( dor%!nd s! (!%&+" &e(rec+( :n &a( Ee<&r!%a( ca +n &rocen(, va"or!"e
    n+%er!ce %ar! !nd!cAnd o %a! '+n7 con(!n+!(a(e a so%n+"+!J Ar-itect+ra somn+l+i se
    re.er7 "a d+ra(a s! d!s(r!'+=!a s(ad!!"or s&ec!.!ce de so%n M7s+r7(or!"e ar!(ec(+r!!
    so%n+"+! !nc"+d d+ra(e"e a'so"+(e a"e s(ad!+"+! de so%n REM O! a"e .!ec7r+! s(ad!+
    de so%n NREM E:n %!n+(eJ, can(!(a(ea re"a(!v7 de s(ad!! de so%n REM s! de so%n
    NREM Ee<&r!%a(7 ca +n &rocen( a" (!%&+"+! (o(a" de so%nJ s! &enoada de "a(en=7
    d!n(re de'+(+" so%n+"+! s! &r!%a &enoada de REM E"a(en(a REMJ
    Te<(+" .!ec7re! (+"'+r7r! de so%n con=!ne o sec=!+ne care descr!e re"a=!!"e sa"e c+
    (+"'+r7r!"e cores&+n/7(oare d!n T-e 5nternational Classi)ication o) Sleep 0isorders
    (5CS50% 0ia/nostic and Codm/ .an+al (Clasi)icarea 5nterna(ional6 a T+lb+r6rilor de
    Somn (C5TS% .an+al de 0ia/nostic si Codi)icare%, &+'"!ca( :n 5FFL de A%er!can S"ee&
    D!sorder(. Assoc!a(!on
    45?2H7 Insomnia
    #rimar
    544
    Tul-ur(rile $e So"n Pri"are
    Dissomniile
    D!sso%n!!"e s+n( (+"'+r7r! &r!%are a"e !n!=!er!! s! %en=!ner!! so%n+"+! sa+ de
    so%no"en(7 e<ces!v7, s! s+n( carac(er!/a(e &r!n(r4o &er(+r'are :n can(!(a(ea, ca"!(a(ea
    sa+ re$"area so%n+"+!. Aceas(7 sec=!+ne !nc"+de !nso%n!a &r!%ar7, !&erso%n!a
    &r!%ar7, narco"e&s!a, (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a, (+"'+rarea
    r!(%+"+! c!rcad!an a" so%n+"+! s! d!sso%n!a .7r7 a"(7 s&ec!.!ca=!e.
    4+G.7C In&o"nia Pri"ar(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" !nso%n!e! &r!%are :" cons(!(+!e ac+/area +ne! d!.!c+"(7=! :n
    !n!=!erea sa+ :n %en=!nerea so%n+"+!, or! a +n+! so%n nerecon.or(an(, care d+rea/7
    ce" &+=!n o "+n7 Ecr!(er!+" AJ s! ca+/ea/7 de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c
    :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare
    Ecr!(er!+" BJ. Per(+r'area so%n+"+! n+ s+rv!ne e<c"+s!v :n c+rs+" a"(e! (+"'+r7r! de
    so%n Ecr!(er!+" CJ or! (+"'+r7r! %en(a"e Ecr!(er!+" DJ O! n+ es(e da(ora(7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e or! a"e +ne! cond!=!! %ed!ca"e $enera"e
    Ecr!(er!+" EJ.
    Ind!v!/!! c+ !nso%n!e &r!%ar7 re"a(ea/7 ce" %a! adesea o co%'!na=!e de
    d!.!c+"(a(e :n a r7%Ane ador%!=! O! v!$!"!(a(e !n(er%!(en(7 :n (!%&+" so%n+"+!. Ma!
    rar, aceO(! !nd!v!/! se &o( &"An$e n+%a! de so%n nerecon.or(an(, ad!c7, sen/a=!a c7
    so%n+" "or es(e ne"!n!O(!(, s+&er.!c!a" sa+ de ca"!(a(e rea. Inso%n!a &r!%ar7 es(e
    asoc!a(7 adesea c+ e<c!(a=!e .!/!o"o$!c7 sa+ &s!o"o$!c7 :n c+rs+" no&=!!, :n
    co%'!na=!e c+ o cond!=!onare ne$a(!v7 &en(r+ so%n. O &reoc+&are %arca(7
    re.er!(oare "a so%n O! de(res7 da(ora(7 !nca&ac!(7=!! de a dor%! &o( con(r!'+! "a
    a&ar!=!a +n+! cerc v!c!osQ c+ cA( !nd!v!d+" :ncearc7 %a! %+"( s7 doar%7, c+ a(A(
    dev!ne %a! .r+s(ra( O! %a! de(resa(, s! es(e %a! &+=!n ca&a'!" s7 doar%7. K7c+(+" :n
    &a(+" :n care !nd!v!d+" a &e(rec+( .recven( no&=! .7r7 so%n &oa(e cauza .r+s(rare O!
    e<c!(a=!e cond!=!ona(7. Invers, !nd!v!d+" &oa(e ador%! %a! +Oor cAnd n+ :ncearc7 s4
    o .ac7 Ede e<., :n (!%& ce &r!veO(e "a (e"ev!/or, c!(eO(e sa+ .ace o &"!%'are c+
    a+(o(+r!s%+"J. Un!! !nd!v!/!, c+ e<c!(a=!e cresc+(7 O! cond!=!onare ne$a(!v7, re"a(ea/7
    c7 e! dor% %a! '!ne de&ar(e de dor%!(oare"e "or O! de r+(!ne"e "or v!/+a"e. Inso%n!a
    cron!c7 &oa(e d+ce "a sen(!%en(e de s(are rea a s7n7(7=!! :n (!%&+" /!"e! Ede e<.,
    de(er!orarea a.ec(!v!(7=!! O! %o(!va=!e!, d!%!n+area a(en=!e!, ener$!e! O! concen(r7r!!
    O! o creO(ere a .a(!$a'!"!(7=!! O! %a"e/e!J. DeO! !nd!v!/!! a+ adesea ac+/a s+'!ec(!v7 de
    .a(!$a'!"!(a(e :n (!%&+" /!"e!, s(+d!!"e &o"!so%no$ra.!ce n+ de%ons(rea/7 de re$+"7
    o creO(ere a se%ne"or .!/!o"o$!ce de so%no"en=7.
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. M+"=! !nd!v!/! c+
    !nso%n!e &r!%ar7 a+ +n !s(or!c de &er(+r'are s+&er.!c!a"7 sa+ S+Ooar7T de so%n,
    :na!n(e s7 a&ar7 &ro'"e%e %a! &ers!s(en(e :n "e$7(+r7 c+ so%n+". A"=! .ac(or!
    asoc!a=! &o( !nc"+de &reoc+&area an<!oas7 :n "e$7(+r7 c+ s7n7(a(ea $enera"7 s!
    sens!'!"!(a(ea
    =++ Tulburrile de Somn
    cresc+(7 "a e.ec(e"e d!n (!%&+" /!"e! a"e +ne! &!erder! a so%n+"+! +Oor. Po( .! &re/en(e
    s!%&(o%e de an<!e(a(e sa+ de de&res!e, care n+ sa(!s.ac cr!(er!!"e &en(r+ o (+"'+rare
    %en(a"7 s&ec!.!c7. Pro'"e%e !n(er&ersona"e, soc!a"e s! &ro.es!ona"e &o( a&are ca
    re/+"(a( a" &reoc+&7r!! e<a$era(e &en(r+ so%n, !r!(a'!"!(7=!! cresc+(e d!n (!%&+" /!"e!
    s! concen(r7r!! red+se. Pro'"e%e"e c+ nea(en=!a s! concen(rarea &o( d+ce "a
    acc!den(e. Ind!v!/!! c+ !nso%n!e sever7 &o( avea o de(er!orare .+nc=!ona"7 %a! %are,
    o &rod+c(!v!(a(e %a! red+s7 s! o +(!"!/are cresc+(7 a serv!c!!"or de s7n7(a(e %en(a"7
    :n co%&ara=!e c+ !nd!v!/!! .7r7 ac+/e de so%n. Ind!v!/!! c+ !nso%n!e &r!%ar7 &o(,
    de ase%enea, re"a(a s(res !n(er&ersona" sa+ :n "e$7(+r7 c+ %+nca.
    Ind!v!/!! c+ !nso%n!e &r!%ar7 &o( avea +n !s(or!c de (+"'+r7r! %en(a"e, :n s&ec!a"
    de (+"'+r7r! a.ec(!ve s! de (+"'+r7r! an<!oase. Inso%n!a &r!%ar7 cons(!(+!e, de
    ase%enea, +n .ac(or de .r!sc Esa+, &oa(e, +n s!%&(o% &recoceJ &en(r+ (+"'+r7r!
    a.ec(!ve, (+"'+r7r! an<!oase s! (+"'+r7r! :n "e$7(+r7 c+ +/+" +ne! s+'s(an=e,
    +"(er!oare. Ind!v!/!! c+ !nso%n!e &r!%ar7 +/ea/7 +neor! de %ed!ca%en(e
    necores&+n/7(oareQ !&no(!ce sa+ a"coo" &en(r+ a dor%! :n (!%&+" no&=!!, an<!o"!(!ce
    &en(r+ a co%'a(e (ens!+nea sa+ an<!e(a(ea, s! ca.e!na sa+ a"(e s(!%+"an(e &en(r+ a
    co%'a(e .a(!$a'!"!(a(ea e<ces!v7, :n +ne"e ca/+r!, aces( (!& de +/ de s+'s(an=7 &oa(e
    &ro$resa "a a'+/ de o s+'s(an=7 sa+ "a de&enden=7 de o s+'s(an=7.
    Da(e de "a'ora(or asoc!a(e. Po"!so%no$ra.!a &oa(e de%ons(ra o con(!n+!(a(e
    red+s7 a so%n+"+! Ede e<., creO(erea "a(en=e! so%n+"+!, v!$!"!(a(e !n(er%!(en(7
    cresc+(7 s! sc7derea e.!c!en=e! so%n+"+!J, creO(erea s(ad!+"+! " de so%n, sc7derea
    s(ad!!"or ; s! I de so%n. A"(e da(e de "a'ora(or &o( !nc"+de (ens!+nea %+sc+"ar7
    cresc+(7 s! creO(erea can(!(7=!! de ac(!v!(a(e a".a s! 'e(a :n (!%&+" so%n+"+!, d+&7
    c+% !nd!c7 ana"!/a EE, can(!(a(!v7. Aces(e e"e%en(e (re'+!e s7 .!e !n(er&re(a(e :n
    cadr+" con(e<(+"+! de nor%e cores&+n/7(oare e(7=!!. M7s+r7(or!"e &o"!so%no$ra.!ce
    &re/!n(7 adesea o var!e(a(e cons!dera'!"7 d,e "a o noa&(e "a a"(a. Ind!v!/!! c+
    !nso%n!e &r!%ar7 &o( &re/en(a, de ase%enea, d!scre&an=e s+'s(an=!a"e :n(re
    %7s+r7(or!"e s+'!ec(!ve O! &o"!so%no$ra.!ce a"e can(!(7=!! so%n+"+!, ce" %a! .recven(
    :n d!rec=!a s+'es(!%7r!! can(!(7=!! de so%n. Un!! !nd!v!/! &o( re"a(a c7 dor% %a! '!ne
    :n "a'ora(or decA( acas7, s+$erAnd o 'a/7 cond!=!ona(7 &en(r+ ac+/e"e "or :n
    "e$7(+r7 c+ so%n+". Ind!v!/!! c+ !nso%n!e &r!%ar7 n+ &re/!n(7 de re$+"7 o
    so%no"en=7 d!+rn7 cresc+(7 %7s+ra'!"7 &r!n (es(area :n "a'ora(or a so%n+"+! :n
    co%&ara=!e c+ !nd!v!/!! .7r7 n!c! o (+"'+rare de so%n. A"(e (es(e &s!o.!/!o"o$!ce &o(
    !nd!ca, de ase%enea, o e<c!(a=!e cresc+(7 Ede e<., (ens!+ne %+sc+"ar7 cresc+(7,
    reac(!v!(a(e .!/!o"o$!c7 e<ces!v7 "a s(res O! creO(erea r!(%+"+! %e(a'o"!cJ.
    Ind!v!/!! c+ !nso%n!e &r!%ar7 &o( avea, de ase%enea, scor+r! r!d!ca(e "a
    !nven(are"e de &ersona"!(a(e sa+ "a a+(odescr!er!"e &s!o"o$!ce Ede e<., "a &ro.!"e"e
    !nd!cAnd de&res!a cron!c7 +Ooar7 s! an<!e(a(ea, +n s(!" de S!n(erna"!/areT a
    re/o"v7r!! con."!c(+"+! s! o .oca"!/are so%a(!c7J. M7s+r7(or!"e &er.or%an=e! "a (es(e"e
    ne+ro&s!o"o$!ce n+ &re/!n(7 &a((ern+r! concordan(e de de(er!orare &r!n(re
    !nd!v!/!! c+ !nso%n!e &r!%ar7.
    Datele e,a"in(rii &o"ati#e Ei #on$i!iile "e$i#ale /enerale a&o#iate.
    Ind!v!/!! c+ !nso%n!e &r!%ar7 &o( a&are ca e<(en+a=! sa+ c+ oc!! d+O! :n .+nd+"
    ca&+"+!, :ns7 n+ &re/!n(7 a"(e ano%a"!! carac(er!s(!ce "a e<a%en+" so%a(!c. Poa(e
    e<!s(a o !nc!den=7 cresc+(7 a &ro'"e%e"or &s!o.!/!o"o$!ce :n "e$7(+r7 c+ s(res+" Ede
    e<., ce.a"ee2de (ens!+ne, (ens!+ne %+sc+"ar7 cresc+(7, de(res7 $as(r!c7J.
    45?2H7 Insomnia
    #rimar
    >E1
    *lemente speci$ice etii si sexului
    Da(e"e ance(e"or de%ons(rea/7 c"ar c7 ac+/e"e de !nso%n!e dev!n %a! .recven(e
    oda(7 c+ avansarea :n e(a(e s! %a! a"es &r!n(re .e%e!. Frecven=a crescAnd7 a ac+/e"or
    de !nso%n!e oda(7 c+ avansarea :n e(a(e &oa(e .! a(r!'+!(7 :n &ar(e creO(er!!
    &rocen(e"or de &ro'"e%e :n "e$7(+r7 c+ s7n7(a(ea so%a(!c7 "a '7(rAn!. Ad+"=!! (!ner!
    se &"An$ ce" %a! adesea de d!.!c+"(7=! :n a ador%!, &e cAnd ad+"=!! de e(a(e %ed!e s!
    '7(rAn!! es(e .oar(e &os!'!" s7 a!'7 d!.!c+"(7=! c+ %en=!nerea so%n+"+! s! deO(e&(area
    %a(!na"7 &recoce, :n %od &arado<a", :n d!s&re=+" .recven=e! %a! %ar! a ac+/e"or de
    !nso%n!e &r!n(re .e%e!"e :n e(a(e, s(+d!!"e &o"!so%no$ra.!ce !nd!c7 :n $enera" o %a!
    '+n7 &re/ervare a con(!n+!(7=!! so%n+"+! s! so%n c+ +nde "en(e "a .e%e!"e :n e(a(e
    decA( "a '7r'a=!! :n e(a(e. Mo(!v+" &en(r+ aceas(7 d!scre&an=7 :n(re a+(ore"a(7r! s!
    da(e"e de "a'ora(or n+ es(e c+nosc+(. DeO! s(+d!!"e &o"!so%no$ra.!ce s+n( "!%!(a(e ca
    !%&or(an=7 :n eva"+area de r+(!n7 a !nso%n!e!, e"e &o( .! %a! +(!"e :n e.ec(+area
    d!a$nos(!c+"+! d!.eren=!a" a" !nso%n!e! "a !nd!v!/!! ad+"=! %a! :n e(a(e decA( "a ce!
    %a! (!ner!. Aceas(a deoarece !nd!v!/!! %a! :n e(a(e a+ %a! .recven( e(!o"o$!!
    !den(!.!ca'!"e &en(r+ ac+/e"e "or !&n!ce, c+% ar .! %!Oc7r!"e &er!od!ce a"e
    %e%'re"or s! a&neea de so%n.
    #revalent
    E<!s(7 &+=!ne da(e re.er!(oare "a &reva"en(a !nso%n!e! &r!%are :n &o&+"a=!a
    $enera"7. Ance(e"e &o&+"a(!ona"e !nd!c7 o &reva"en(7 &e " an a ac+/e"or de
    !nso%n!e de ;Ld4IYd "a ad+"=!. Preva"en(a !nso%n!e! &r!%are es(e de a&ro<!%a(!v
    545Ld :n &o&+"a=!a $enera"7 ad+"(7 s! de &An7 "a 9Yd "a '7(rAn!, :n c"!n!c!"e
    s&ec!a"!/a(e :n (+"'+r7r!"e de so%n, a&ro<!%a(!v 5Yd49Yd d!n(re !nd!v!/!! c+
    !nso%n!e cron!c7 s+n( d!a$nos(!ca=! c+ !nso%n!e &r!%ar7.
    *voluie
    Fac(or!! care &rec!&!(7 !nso%n!a &r!%ar7 &o( .! d!.er!=! de ce! care o
    &er&e(+ea/7. Ce"e %a! %+"(e ca/+r! a+ +n de'+( cA( se &oa(e de 'r+sc, :n c+rs+"
    +n+! s(res &s!o"o$!c, soc!a" sa+ %ed!ca". Inso%n!a &r!%ar7 &ers!s(7 adesea %+"(
    (!%& d+&7 ce .ac(or!! ca+/a"! or!$!nar! s4a+ re/o"va(, da(or!(7 !n(ens!.!c7r!!
    e<c!(a=!e! s! cond!=!on7r!! ne$a(!ve. De e<e%&"+, o &ersoan7 c+ o s+.er!n=7
    d+reroas7, care &e(rece o %are &ar(e a (!%&+"+! :n &a( s! are d!.!c+"(7=! :n
    ador%!re, &oa(e de/vo"(a a&o! asoc!a=!! ne$a(!ve &en(r+ so%n. Asoc!a=!!"e
    ne$a(!ve, e<c!(a=!a cresc+(7 s! deO(e&(area d!n so%n cond!=!ona(7 &o( a&o! &ers!s(a
    d!nco"o de &er!oada de conva"escen=7, d+cAnd "a !nso%n!e &r!%ar7. Un scenar!+
    s!%!"ar &oa(e a&are :n asoc!ere c+ !nso%n!a care s+rv!ne :n con(e<(+" +n+! s(res
    &s!o"o$!c ac+( sa+ a" +ne! (+"'+r7r! %en(a"e. De e<e%&"+, !nso%n!a care s+rv!ne
    :n c+rs+" +n+! e&!sod de (+"'+rare de&res!v7 %a@or7 &oa(e deven! cen(r+" a(en=!e!
    c+ cond!=!onare ne$a(!v7 consec+(!v7, !ar !nso%n!a &oa(e &ers!s(a %+"( (!%& d+&7
    re/o"varea e&!sod+"+! de&res!v, :n +ne"e ca/+r!, !nso%n!a &r!%ar7 &oa(e a&are
    (re&(a(, .7r7 +n s(resor c"ar.
    Inso%n!a &r!%ar7 :nce&e de re$+"7 :n &er!oada de ad+"( (An7r sa+ "a e(a(ea
    %ed!e, s! es(e rar7 :n co&!"7r!e sa+ ado"escen=7, :n ca/+r! e<ce&=!ona"e, !nso%n!a
    &oa(e .! doc+%en(a(7 re(ros&ec(!v &An7 :n co&"7r!e. Evo"+=!a !nso%n!e! &r!%are es(e
    var!a'!"7. Ea &oa(e .! "!%!(a(7 "a o &er!oad7 de cA(eva "+n!, :n s&ec!a" dac7 es(e
    &rec!&!(a(7 de +n s(resor &s!osoc!a" sa+ %ed!ca", care se re/o"v7 %a! (Ar/!+.
    >E2 Tulburrile de Somn
    A&ro<!%a(!v YLd4HYd d!n(re !nd!v!/!! c+ ac+/e !&n!ce &re/!n(7 :ns7 s!%&(o%e
    cron!ce d+rAnd %a! %+"( de " an, !ar !nso%n!a an(er!oar7 es(e ce" %a! &+(ern!c
    .ac(or de r!sc +n!c &en(r+ !nso%n!a ac(+a"7. Un!! !nd!v!/! e<&er!en(ea/7 o evo"+=!e
    e&!sod!c7, c+ &er!oade de so%n %a! '+n sa+ %a! r7+ s+rven!nd ca r7s&+ns "a
    even!%en(e de v!a=7, c+% ar .! conced!!"e sa+ s(res+".
    #attern $amilial
    Pred!s&o/!=!a &en(r+ +n so%n s+&er.!c!a" s! :n(rer+&( are o asoc!ere .a%!"!a"7.
    P+=!ne"e da(e d!n s(+d!!"e &e $e%en! d+c "a conc"+/!! con(rad!c(or!! re.er!(oare "a
    !%&or(an=a .ac(or!"or $ene(!c! :n !nso%n!a &r!%ar7 .
    Dia!nostic di$erenial
    D+ra(a de so%n Snor%a"7T var!a/7 cons!dera'!" :n &o&+"a=!a $enera"7. Un!!
    !nd!v!/!, care neces!(7 &+=!n so%n ESce! care dor% &+=!nTJ, &o( .! &reoc+&a=! de
    d+ra(a so%n+"+! "or. Ce! care dor% &+=!n (re'+!e d!s(!nO! de ce! c+ !nso%n!e
    &r!%ar7 &r!n "!&sa "or de d!.!c+"(a(e :n ador%!re s! &r!n a'sen=a se%ne"or
    carac(er!s(!ce de !nso%n!e &r!%ar7 Ede e<., deO(e&(are d!n so%n !n(er%!(en(7,
    .a(!$a'!"!(a(e, &ro'"e%e de concen(rare sa+ !r!(a'!"!(a(eJ. Un!! !nd!v!/! care dor%
    &+=!n n+ s+n( :ns7 !n.or%a=! des&re neces!(a(ea "or '!o"o$!c7 red+s7 de so%n s! :n
    (en(a(!va "or de a4O! &re"+n$! (!%&+" de Oedere :n &a(, :O! creea/7 +n &a(ern de so%n
    de !nso%n!e.
    So%no"en=a d!+rn7, care es(e +n e"e%en( carac(er!s(!c a" !&erso%n!e! &r!%are,
    &oa(e s+rven! +neor! :n !nso%n!a &r!%ar7, dar n+ es(e (o( a(A( de sever7 ca :n
    aceas(a. CAnd so%no"en=a d!+rn7 es(e cons!dera(7 a .! da(ora(7 !nso%n!e!, n+ se
    &+ne d!a$nos(!c+" ad!=!ona" de !&erso%n!e &r!%ar7.
    T!&+r!"e de %od!.!care de .+s orar sa+ de "+cr+ :n (+re a"e (+"'+r7r!! r!(%+"+!
    c!rcad!an de so%n se d!s(!n$ de !nso%n!a &r!%ar7 &r!n !s(or!c+" +ne! c7"7(or!!
    (rans%er!d!ane recen(e sa+ a" "+cr+"+! :n (+re. Ind!v!/!! c+ (!&+" de .a/7 :n(Ar/!a(7
    de so%n a" (+"'+r7r!! r!(%+"+! c!rcad!an de so%n a.!r%7 !nso%n!e de :nce&+( a
    so%n+"+! n+%a! cAnd :ncearc7 s7 doar%7 :n &er!oade"e nor%a"e soc!a", dar n+
    re"a(ea/7 d!.!c+"(7=! de ador%!re sa+ :n a r7%Ane ador%!=!, cAnd dor% :n &er!oade"e
    "or &re.era(e de so%n.
    Narco"e&s!a &oa(e ca+/a ac+/e de !nso%n!e, :n s&ec!a" "a ad+"=!! :n e(a(e, :ns7,
    narco"e&s!a !%&"!c7 rar ca ac+/7 %a@or7 !nso%n!a s! se d!s(!n$e de !nso%n!a
    &r!%ar7 &r!n s!%&(o%e de so%no"en=7 d!+rn7 no(a'!"7, ca(a&"e<!e, &ara"!/!e de
    so%n s! a"+c!na=!! :n "e$7(+r7 c+ so%n+".
    O (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a, :n s&ec!a" a&neea cen(ra"7 de
    so%n &oa(e !%&"!ca o ac+/7 de !nso%n!e cron!c7 s! de(er!orare d!+rn7. O a&neea de
    so%n se%n!.!ca(!v7 c"!n!c :ns7 es(e o cons(a(are rar7 &r!n(re !nd!v!/!! (!ner! s! de
    e(a(e %ed!e de a"(.e" s7n7(oO! c+ !nso%n!e cron!c7 EdeO! ea4 &oa(e .! %a! .recven(7 "a
    '7(rAn!J. Un !s(or!c a(en( &oa(e reve"a &a+/e &er!od!ce :n res&!ra=!e :n (!%&+"
    so%n+"+! sa+ o res&!ra=!e crescendo4descrescendo Eres&!ra=!e Ceyne4S(o)esJ. Un
    !s(or!c de (ra+%a(!s% sa+ de %a"ad!e a s!s(e%+"+! nervos cen(ra" &oa(e s+$era o
    (+"'+rare ad!=!ona"7 de so%n :n "e$7(+r7 c+ res&!ra=!a. Po"!so%no$ra.!a &oa(e
    con.!r%a &re/en=a even!%en(e"or a&ne!ce. Ce! %a! %+"=! !nd!v!/! c+ (+"'+rare de
    so%n :n "e$7(+r7 c+ res&!ra=!a a+ a&nee o's(r+c(!v7 care &oa(e .! d!s(!ns7 de
    !nso%n!a &r!%ar7 &r!n(r4+n !s(or!c de s.or7!( sonor, &a+/e :n res&!ra=!e :n (!%&+"
    so%n+"+! s! so%no"en(7 d!+rn7 e<ces!v7.
    45?2H7 Insomnia
    #rimar
    =+4

    Paraso%n!!"e s+n( carac(er!/a(e &r!n ac+/area +n+!
    co%&or(a%en( sa+ a +nor even!%en(e !n+/+a"e :n c+rs+"
    so%n+"+!, care &o( d+ce +neor! "a deO(e&(area !n(er%!(en(7
    d!n so%n. :ns7, aces(e even!%en(e co%&or(a%en(a"e s+n(
    ce"e care do%!n7 (a'"o+" c"!n!c :n &araso%n!e, %a! c+rAnd
    decA( !nso%n!a.
    Inso%n!a &r!%ar7 (re'+!e s7 .!e d!s(!ns7 de (+"'+r7r!"e
    %en(a"e care !nc"+d !nso%n!a ca e"e%en( esen=!a" sa+
    asoc!a( Ede e<., (+"'+rarea de&res!v7 %a@or7, an<!e(a(ea
    $enera"!/a(7, sc!/o.ren!aJ. D!a$nos(!c+" de !nso%n!e
    &r!%ar7 n+ es(e &+s dac7 !nso%n!a s+rv!ne e<c"+s!v :n
    c+rs+" a"(e! (+"'+r7r! %en(a"e. O !nves(!$a=!e de(a"!a(7 &en(r+
    &re/en=a a"(or (+"'+r7r! %en(a"e es(e esen=!a"7, :na!n(e de a
    "+a :n cons!dera=!e d!a$nos(!c+" de !nso%n!e &r!%ar7. Un
    d!a$nos(!c de !nso%n!e &r!%ar7 &oa(e .! &+s :n &re/en=a a"(e!
    (+"'+r7r! %en(a"e ac(+a"e sa+ (rec+(e, dac7 (+"'+rarea
    %en(a"7 es(e cons!dera(7 a n+ @+s(!.!ca !nso%n!a or! dac7
    !nso%n!a s! (+"'+rarea %en(a"7 a+ o evo"+=!e !nde&enden(7.
    CAnd !nso%n!a s+rv!ne ca o %an!.es(are a, s! e<c"+s!v :n
    c+rs+", a"(e! (+"'+r7r! %en(a"e Ede e<., o (+"'+rare a.ec(!v7,
    an<!oas7, so%a(o.or%7 sa+ &s!o(!c7J, d!a$nos(!c+" de
    !nso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &oa(e .! %a!
    !nd!ca(. Aces( d!a$nos(!c (re'+!e "+a( :n cons!dera=!e n+%a!
    cAnd !nso%n!a es(e ac+/a &redo%!nan(7 O! es(e s+.!c!en( de
    sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(78 a"(.e", n+
    es(e necesar +n d!a$nos(!c se&ara(. E"e%en(e"e c"!n!ce, c+%
    ar .! cond!=!onarea ne$a(!v7 s! !$!ena so%n+"+! red+s7 s+n(
    %a! concordan(e c+ d!a$nos(!c+" de !nso%n!e &r!%ar7, &e
    cAnd s!%&(o%e"e se%n!.!ca(!ve c"!n!c dar .7r7 "e$7(+r7 c+
    so%n+" Ede e<., d!s&o/!=!a de&res!v7, an<!e(a(eaJ O! o
    evo"+=!e cron!c7 sever7 a !nso%n!e! s+n( %a! .recven(e "a
    !nd!v!/!! c+ !nso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7.
    :n cond!=!! c"!n!ce, &o"!so%no$ra.!a n+ es(e de re$+"7
    +(!"7 :n d!a$nos(!c+" d!.eren=!a" a" !nso%n!e! &r!%are
    vers+s !nso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 .
    Inso%n!a &r!%ar7 (re'+!e s7 .!e d!s(!ns7 de (+"'+rarea
    de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, de (!&
    !nso%n!e. D!a$nos(!c+" (re'+!e s7 .!e ce" de (+"'+rare de
    so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e cAnd
    !nso%n!a es(e cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7
    a +ne! cond!=!! %ed!ca"e $enera"e s&ec!.!ce Ede e<.,
    .eocro%oc!(o%, !&er(!ro!d!s%, !ns+.!c!en=7 card!ac7
    con$es(!v7, (+"'+rare &+"%onar7 o's(r+c(!v7 cron!c7J Eve/!
    &a$. RY5J. Aceas(7 &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de
    "a'ora(or sa+ e<a%en+" so%a(!c. T+"'+rarea de so%n
    !nd+s7 de o s+'s(an=7, de (!& !nso%n!e, se d!s(!n$e de
    !nso%n!a &r!%ar7 &r!n .a&(+" c7 o s+'s(an=7 Ead!c7, +n dro$
    de a'+/, +n %ed!ca%en( sa+ e<&+nerea "a +n (o<!cJ es(e
    cons!dera(7 a .! e(!o"o$!c :n "e$7(+r7 c+ !nso%n!a Eve/! &a$.
    RYYJ. De e<e%&"+, !nso%n!a care s+rv!ne n+%a! :n con(e<(+"
    +n+! cons+% e<ces!v de ca.ea, (re'+!e s7 .!e d!a$nos(!ca(7 ca
    (+"'+rare de so%n !nd+s7 de ca.e!na, de (!& !nso%n!e, c+
    de'+( :n c+rs+" !n(o<!ca=!e!.
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    Inso%n!a &r!%ar7 s+'s+%ea/7 +n n+%7r de d!a$nos(!ce
    de !nso%n!e d!n C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or
    de So%n ECITSJ, !nc"+/And !nso%n!a &s!o.!/!o"o$!c7,
    s(area de &erce&=!e erona(7 a so%n+"+!, !nso%n!a !d!o&a(!c7
    s! +ne"e ca/+r! de !$!en7 de so%n !nadecva(7. Inso%n!a
    &s!o.!/!o"o$!c7 a%!n(eO(e ce" %a! %+"( de !nso%n!a
    &r!%ar7, :n s&ec!a" :n (er%en! de deO(e&(are O! .ac(or!
    cond!=!ona"!. S(area de &erce&=!e erona(7 a so%n+"+! es(e o
    cond!=!e carac(er!/a(7 &r!n ac+/e de !nso%n!e c+ o
    d!scre&an=7 %arca(7 :n(re es(!%7r!"e s+'!ec(!ve s!
    I5H Tulburrile de Somn
    o'!ec(!ve a"e so%n+"+!. Inso%n!a !d!o&a(!c7 !nc"+de ace"e ca/+r! c+ de'+( :n
    co&!"7r!e s! evo"+=!e &e (oa(7 d+ra(a v!e=!!, da(ora(e &ro'a'!" +ne! ano%a"!! :n
    con(ro"+" ne+ro"o$!c a" s!s(e%+"+! so%n4v!$!"!(a(e. I$!ena !nadecva(7 a so%n+"+! se
    re.er7 "a !nso%n!a re/+"(And d!n &rac(!c!"e co%&or(a%en(a"e care cresc v!$!"!(a(ea
    sa+ &er(+r'7 or$an!/area so%n+"+! Ede ex7, "+cr+" &An7 (Ar/!+ noa&(ea, a=!&e"!
    .recven(e :n c+rs+" /!"e!, ore nere$+"a(e de so%nJ.
    Criteriile $e $ia/no&ti# pentru 4+G.7C In&o"nia Pri"ar(
    A2 Acu(a predominant o constituie di$icultatea "n iniierea sau meninerea
    somnului ori somnul nerecon$ortant, pentru cel puin o lun2
    S2 #erturbarea de somn &sau $ati!abilitatea asociat din timpul (ilei) cau(ea(
    o detres sau deteriorare semni$icativ clinic "n domeniul social,
    pro$esional ori "n alte domenii importante de $uncionare2
    2 #erturbarea somnului nu survine exclusiv "n cursul narcolepsiei, tulburrii de
    somn "n le!tur cu respiraia, tulburrii ritmului circadian de somn sau al
    unei parasomnii2
    D2 #erturbarea nu survine exclusiv "n cursul altei tulburri mentale &de ex2,
    tulburarea depresiv ma0or, anxietatea !enerali(at sau deliriumul)2
    *2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) ori ale unei condiii medicale
    !enerale2
    4+G.77 Fiper&o"nia Pri"ar(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" !&erso%n!e! &r!%are :" cons(!(+!e so%no"en=a e<ces!v7
    &en(r+ ce" &+=!n o "+n7 s! care se %an!.es(7, .!e &r!n e&!soade de so%n &re"+n$!(e,
    or! &r!n e&!soade de so%n :n (!%&+" /!"e!, s+rven!nd a&roa&e /!"n!c Ecr!(er!+" AJ.
    So%no"en=a e<ces!v7 (re'+!e s7 .!e s+.!c!en( de sever7 &en(r+ a ca+/a o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!!
    !%&or(an(e de .+nc=!onare Ecr!(er!+" BJ. So%no"en=a e<ces!v7 n+ (re'+!e s7 a&ar7
    e<c"+s!v :n c+rs+" a"(e! (+"'+r7r! de so%n Ecr!(er!+" CJ sa+ (+"'+r7r! %en(a"e
    Ecr!(er!+" DJ s! s7 n+ se da(ore/e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e or!
    a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" EJ.
    La !nd!v!/!! c+ !&erso%n!e, d+ra(a e&!sod+"+! de so%n %a@or Esa+ &en(r+ ce!
    %a! %+"=! !nd!v!/!, so%n+" noc(+rnJ &oa(e %er$e de "a G &An7 "a 59 ore s! es(e
    +r%a(7 a&o! de deO(e&(are d!.!c!"7 d!%!nea=a. Ca"!(a(ea rea"7 a so%n+"+! noc(+rn
    es(e nor%a"7. So%no"en=a e<ces!v7 :n (!%&+" ore"or nor%a"e de v!$!"!(a(e !a .or%a
    +nor a=!&e"! !n(en=!ona(e sa+ a +nor e&!soade !nvo"+n(are de so%n. M7s+r7(or!"e
    o'!ec(!ve de%ons(rea/7 o so%no"en=7 .!/!o"o$!c7 cresc+(7. A=!&e"!"e d!n (!%&+" /!"e!
    (!nd a .! re"a(!v "+n$! Ed+rAnd adesea o or7 sa+ %a! %+"(J, s+n( e<&er!en(a(e ca
    nerecon.or(an(e s! adesea n+ d+c "a a%e"!orarea s(7r!! de v!$!"!(a(e. Ind!v!/!! s!%( de
    re$+"7 so%no"en=a a&7rAnd d+&7 o &er!oad7 de (!%& %a! c+rAnd decA( c7
    45?2HH Lipersomnia
    #rimar
    =+<

    e<&er!en(ea/7 +n Sa(acT s+'!( de so%n. E&!soade"e de so%n non!n(en=!ona" s+rv!n
    :n s!(+a=!! de s+'s(!%+"are s! de s+'ac(!v!(a(e Ede e<., :n (!%& ce !nd!v!d+" asc+"(7
    con.er!n=e, c!(eO(e sa+ &r!veO(e "a (e"ev!/or sa+ cond+ce &e d!s(an=e "+n$!J.
    H!&erso%n!a &oa(e d+ce "a de(res7 O! d!s.+nc=!e se%n!.!ca(!v7 :n %+nc7 s! :n
    re"a=!!"e soc!a"e. So%n+" noc(+rn &re"+n$!( O! deO(e&(area d!.!c!"7 &o( d+ce "a
    d!.!c+"(7=! :n sa(!s.acerea o'"!$a=!!"or %a(!na"e. E&!soade"e de so%n non!n(en=!ona"
    &o( .! !nco%odan(e O! c!ar &er!c+"oase dac7, de e<e%&"+, !nd!v!d+" cond+ce sa+
    %an!&+"ea/7 o %aO!n7 :n4(!%& ce s+rv!ne e&!sod+". N!ve"+" red+s de v!$!"!(a(e, care
    s+rv!ne :n (!%& ce !nd!v!d+" se "+&(7 c+ so%no"en=a, &oa(e d+ce "a e.!c!en=7,
    concen(rare O! %e%or!e red+s7 :n (!%&+" ac(!v!(7=!"or d!n c+rs+" /!"e!. So%no"en=a,
    a(r!'+!(7 adesea :n %od erona( &"!c(!se"!! sa+ "as!(+d!n!!, &oa(e, de ase%enea, a"(era
    re"a=!!"e soc!a"e O! .a%!"!a"e.
    Speci$icant
    Rec+ren(7. Aces( s&ec!.!can( es(e +(!"!/a( dac7 e<!s(7 &er!oade de so%no"en=7
    e<ces!v7 care d+rea/7 ce" &+=!n ; /!"e, de %a! %+"(e or! &e an, (!%& de ce"
    &+=!n 9 an!.
    Ce! %a! %+"=! !nd!v!/! c+ !&erso%n!e &r!%ar7 a+ s!%&(o%e cons!s(en(e s!
    &ers!s(en(e. D!n con(ra, .or%a rec+ren(7 (re'+!e s7 .!e no(a(7 dac7 s!%&(o%e"e rev!n
    &er!od!c (!%& de %a! %+"(e /!"e &An7 "a cA(eva s7&(7%An!, c+ &er!oade de s!%&(o%e
    rea&7rAnd de %a! %+"(e or! &e an. In(re &er!oade"e de so%no"en=7 e<ces!v7, d+ra(a
    so%n+"+! O! v!$!"!(a(ea d!+rn7 s+n( nor%a"e, :n .or%a rec+ren(7 de !&erso%n!e
    &r!%ar7, c+nosc+(7 ca s!ndro%+" -"e!ne4Lev!n, !nd!v!/!! &o( &e(rece 5G49L de ore
    dor%!nd sa+ :n &a(. Per!oade"e rec+ren(e de so%no"en=7 s+n( asoc!a(e c+ a"(e
    e"e%en(e c"!n!ce carac(er!s(!ce !nd!cAnd de/!n!'!=!a. H!&erse<+a"!(a(ea !nd!scr!4
    %!na(7, !nc"+/And avans+r! se<+a"e !nadecva(e O! %as(+r'area .7=!O7 &o( .! v7/+(e
    "a '7r'a=! EO! %a! &+=!n "a .e%e!J. Poa(e s+rven! !&er.a$!a co%&+"s!v7 c+ creO(ere
    ac+(7 :n $re+(a(e. Ir!(a'!"!(a(ea, de&ersona"!/area, de&res!a, con.+/!a O! a"+c!na=!!"e
    oca/!ona"e a+ .os( descr!se "a +n!! !nd!v!/!, !ar co%&or(a%en(e !%&+"s!ve &o(, de
    ase%enea, a&are. A"(e .or%e rec+ren(e de !&erso%n!e &o( .! v7/+(e :n a'sen=a
    aces(or e"e%en(e. De e<e%&"+, +ne"e .e%e! re"a(ea/7 :n %od re$+"a( a&ar!=!a de
    &er!oade de !&erso%n!e :n an+%!(e %o%en(e a"e c!c"+"+! "or %ens(r+a".
    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate2 :n !&erso%n!a &r!%ar7,
    so%n+" (!nde a .! con(!n++ dar n+ recon.or(an(. Ind!v!/!! c+ aceas(7 (+"'+rare ador%
    re&ede O! a+ o '+n7 e.!c!en=7 a so%n+"+!, dar a+ d!.!c+"(7=! c+ deO(e&(area d!n so%n
    d!%!nea=a, +neor! .!!nd con.+/!, !r!(a'!"! sa+ a(a<!c!. Aceas(7 de(er!orare &re"+n$!(7 a
    v!$!"!(7=!! "a (ran/!=!a so%n4v!$!"!(a(e es(e den+%!(7 adesea S'e=!e de so%nT.
    So%no"en=a d!+rn7 &ers!s(en(7 &oa(e d+ce "a +n co%&or(a%en( a+(o%a( Ede
    re$+"7 e<(re% de r+(!n!er, de co%&"e<!(a(e red+s7J, pe care !nd!v!d+" :" e.ec(+ea/7
    c+ &os!'!"!(a(ea de evocare +"(er!oar7 &ar=!a"7 sa+ a'sen(7. De e<e%&"+, !nd!v!/!!
    &o( cons(a(a e! :nO!O! c7 a+ cond+s %a! %+"(e %!"e de +nde cred e! c7 era+,
    !nconO(!en=! de cond+s+" Sa+(o%a(T &e care 54a+ e.ec(+a( :n %!n+(e"e &receden(e.
    DeO! n+ s+n( d!s&on!'!"e da(e &rec!se re.er!(oare "a co%or'!d!(a(ea &r!n (+"'+r7r!
    %en(a"e, %+"=! !nd!v!/! c+ !nso%n!e &r!%ar7 a+ s!%&(o%e de de&res!e care &o(
    sa(!s.ace cr!(er!!"e &en(r+ (+"'+rarea de&res!v7 %a@or7. Aceas(a &oa(e .! :n "e$7(+r7
    RLR Tulburrile de Somn
    c+ consec!n=e"e &s!osoc!a"e a"e so%no"en=e! e<ces!ve. Ind!v!/!! c+ !&erso%n!e
    s+n(, de ase%enea, e<&+O! r!sc+"+! de (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7, :n s&ec!a"
    :n "e$7(+r7 c+ a+(o%ed!ca=!a c+ s(!%+"an(e.
    Da(e de "a'ora(or asoc!a(e, :n !&erso%n!a &r!%ar7, &o"!so%no$ra.!a
    noc(+rn7 de%ons(rea/7 o d+ra(7 de so%n nor%a"7 &An7 "a &re"+n$!(7, "a(en=7 de
    so%n red+s7, con(!n+!(a(e a so%n+"+! de "a nor%a"7 "a cresc+(7 s! d!s(r!'+=!!
    nor%a"e a"e so%n+"+! c+ %!Oc7r! oc+"are ra&!de EREMJ s! so%n+"+! .7r7 %!Oc7r!
    oc+"are ra&!de ENREMJ. Un!! !nd!v!/! c+ aceas(7 (+"'+rare &o( avea can(!(7=!
    cresc+(e de so%n c+ +nde "en(e. Per!oade"e de so%n c+ de'+( de REM Ea&ar!=!a
    so%n+"+! REM :n dec+rs+" a 9L de %!n+(e de "a de'+(+" so%n+"+!J, &er(+r'7r!"e de
    so%n :n "e$7(+r7 c+ res&!ra=!a s! %!Oc7r!"e .recven(e a"e %e%'re"or, s! care :n(rer+&
    so%n+", n+ s+n( &re/en(e. Tes(+" de "a(en=7 a so%n+"+! %+"(!&"+ ETLSMJ
    doc+%en(ea/7 so%no"en=a .!/!o"o$!c7 e<ces!v7 d!n c+rs+" /!"e!, !nd!ca(7 de re$+"7
    &r!n va"or! %ed!! a"e "a(en=e! so%n+"+! de Y45L %!n+(e. So%n+" REM n+ s+rv!ne :n
    c+rs+" e&!soade"or de so%n d!+rn. Po"!so%no$ra.!a noc(+rn7 s! TLSM n+ re"ev7
    da(e carac(er!s(!ce a"(or ca+/e de !&erso%n!e.
    :n .or%a rec+ren(7 -"e!ne4Lev!n a !&erso%n!e! &r!%are, s(+d!!"e EE, de r+(!n7
    e.ec(+a(e :n (!%&+" &er!oade"or de !&erso%n!e ara(7 o :nce(!n!re $enera"7 a
    r!(%+"+! de .ond s! '+.ee &aro<!s(!ce de ac(!v!(a(e (e(a. Po"!so%no$ra.!a noc(+rn7
    ara(7 o creO(ere a (!%&+"+! de so%n (o(a" s! o "a(en=7 sc+r(7 a so%n+"+! REM.
    S(+d!!"e TLSM con.!r%7 so%no"en=a .!/!o"o$!c7 cresc+(7, c+ "a(en=e de so%n :n
    $enera" de %a! &+=!n de 5L %!n+(e. Per!oade REM "a :nce&+(+" so%n+"+! &o( .!
    o'serva(e :n c+rs+" &er!oade"or s!%&(o%a(!ce.
    Da(e"e e<a%!n7r!! so%a(!ce O! cond!=!!"e %ed!ca"e asoc!a(e. Ind!v!/!! c+
    !&erso%n!e &r!%ar7 &ar adesea so%noroO! s! &o( c!ar ador%! :n sa"a de aO(e&(are
    a c"!n!c!an+"+!. Un s+'se( de !nd!v!/! c+ !&erso%n!e &r!%ar7 a+, de ase%enea,
    s!%&(o%e de d!s.+nc=!e a s!s(e%+"+! nervos ve$e(a(!v, !nc"+/And ce.a"e! rec+ren(e
    de (!& vasc+"ar, reac(!v!(a(e a s!s(e%+"+! vasc+"ar &er!.er!c E.eno%en Rayna+dJ s!
    "eO!n+r!. Ind!v!/!! c+ .or%a rec+ren(7 -"e!ne4Lev!n &o( avea da(e nes&ec!.!ce "a
    e<a%en+" ne+ro"o$!c !nc"+/And d!%!n+area accen(+a(7 a re."e<e"or os(eo(en4
    d!noase, d!/ar(r!e s! n!s(a$%+s.
    *lemente speci$ice etii si sexului
    A=!&ea"a vo"+n(ar7 cres(e c+ e(a(ea, dar aces( .eno%en nor%a" es(e d!s(!nc( de
    !&erso%n!a &r!%ar7. S!ndro%+" -"e!ne4Lev!n a.ec(ea/7 '7r'a=!! de a&roa&e (re! or!
    %a! .recven( decA( .e%e!"e.
    #revalent
    Adev7ra(a &reva"en(7 a !&erso%n!e! &r!%are :n &o&+"a=!a $enera"7 n+ es(e
    c+nosc+(7. A&ro<!%a(!v Yd45Ld d!n(re !nd!v!/!! care se &re/!n(7 "a c"!n!c!"e de
    (+"'+r7r! de so%n c+ ac+/e de so%no"en=7 d!+rn7 s+n( d!a$nos(!ca=! ca avAnd
    !&erso%n!e &r!%ar7. For%a rec+ren(7 de !&erso%n!e &r!%ar7 c+nosc+(7 ca
    s!ndro% -"e!ne4Lev!n es(e rar7. Ance(e"e &o&+"a=!ona"e cons(a(7 o ac+/7 de
    so%no"en=7 d!+rn7 "a L,Yd4Yd d!n(re ad+"=!, .7r7 a "+a :n cons!dera=!e ca+/e"e
    s&ec!.!ce sa+ d!a$nos(!ce"e. D+&7 ce a"(e ca+/e .recven(e s+n( c"ar!.!ca(e, &reva"en(a
    &e v!a=7 a !&erso%n!e! se%n!.!ca(!ve c"!n!c es(e de ce" &+=!n 5Rd, !ar !nc!den=a
    &es(e +n !n(erva" de a&ro<!%a(!v I an! es(e de a&roa&e Gd.
    45?2HH Lipersomnia
    #rimar
    =+G
    *voluie
    H!&erso%n!a &r!%ar7 :nce&e de re$+"7 :n(re e(7=!"e de 5Y s! ;L de an!, c+ o
    &ro$res!+ne $rad+a"7 (!%& de s7&(7%An! sa+ "+n!. Pen(r+ ce! %a! %+"=! !nd!v!/!,
    evo"+=!a es(e a&o! cron!c7 s! s(a'!"7, dac7 n+ es(e :nce&+( (ra(a%en(+". A&ar!=!a a"(or
    (+"'+r7r! de so%n Ede e<., (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!aJ &oare
    :nr7+(7=! $rad+" de so%no"en=7. S!ndro%+" -"e!ne4Lev!n :nce&e, de ase%enea, :n
    ado"escen=7 O! :O! &oa(e con(!n+a evo"+=!a sa &er!od!c7 (!%& de decade, deO! adesea
    se re/o"v7 "a e(a(ea %ed!e.
    #attern $amilial
    S+'$r+&+" de !nd!v!/! c+ d!s.+nc=!e ve$e(a(!v7 es(e .oar(e &os!'!" s7 a!'7 %a!
    %+"( decA( a"=! !nd!v!/! c+ !nso%n!e &r!%ar7, %e%'r! de .a%!"!e c+ !&erso%n!e
    &r!%ar7. S!ndro%+" -"e!ne4Lev!n n+ de%ons(rea/7 a$re$are .a%!"!a"7.
    Dia!nostic di$erenial
    D+ra(a Snor%a"7T de so%n var!a/7 cons!dera'!" :n &o&+"a=!a $enera"7. SCe! care
    dor% %+"(T Ead!c7, !nd!v!/!! care neces!(7 o can(!(a(e de so%n %a! %are decA(
    %ed!aJ n+ a+ so%no"en=7 e<ces!v7 d!+rn7, 'e=!e de so%n sa+ co%&or(a%en(
    a+(o%a( cAnd o'=!n can(!(a(ea necesar7 de so%n noc(+rn. Dac7 so"!c!(7r!"e soc!a"e
    sa+ &ro.es!ona"e d+c "a sc+r(area so%n+"+! noc(+rn, &o( a&are s!%&(o%e d!+rne, :n
    !&erso%n!a &r!%ar7, d!n con(ra, s!%&(o%e"e de so%no"en=7 e<ces!v7 a&ar
    !nd!.eren( de d+ra(a so%n+"+! noc(+rn.
    Un so%n noc(+rn !nadecva( can(!(a(!v &oa(e &rod+ce s!%&(o%e de so%no"en=7
    d!+rn7 .oar(e ase%7n7(oare c+ ce"e a"e !&erso%n!e! &r!%are. O d+ra(7 %ed!e a
    so%n+"+! de %a! &+=!n 4de H ore &e noa&(e s+$erea/7 !n(ens +n so%n noc(+rn
    !nadecva(, !ar +n so%n de %a! %+"( de F ore :n %ed!e :n 9I de ore s+$erea/7 o
    !&erso%n!e &r!%ar7. Ind!v!/!! c+ so%n noc(+rn !nadecva( Srec+&erea/7T de re$+"7
    &r!n d+ra(e"e %a! "+n$! de so%n d!n /!"e"e cAnd s+n( "!'er! de so"!c!(7r!"e soc!a"e sa+
    &ro.es!ona"e, sa+ :n conced!!. Con(rar !&erso%n!e! &r!%are, so%n+" noc(+rn
    !ns+.!c!en( n+ es(e &os!'!" s7 d+re/e nec+r%a( (!%& de decade. Un d!a$nos(!c de
    !&erso%n!e &r!%ar7 n+ (re'+!e s7 .!e &+s dac7 es(e vor'a de "+area :n cons!dera=!e
    a adecv7r!! d+ra(e! so%n+"+! noc(+rn. Un d!a$nos(!c s! +n (r!a" (era&e+(!c a"
    e<(ens!e! so%n+"+! &en(r+ 5L45I /!"e &oa(e c"ar!.!ca adesea d!a$nos(!c+".
    So%no"en=a d!+rn7, care es(e +n e"e%en( carac(er!s(!c a" !&erso%n!e! &r!%are,
    &oa(e a&are, de ase%enea, :n !nso%n!a &r!%ar7, dar so%no"en=a sa+ .a(!$a'!"!(a(ea
    es(e %a! &+=!n sever7 "a !nd!v!/!! c+ !nso%n!e &r!%ar7. CAnd so%no"en(a d!+rn7
    es(e cons!dera(7 a .! da(ora(7 !nso%n!e!, d!a$nos(!c+" ad!=!ona" de !&erso%n!e
    &r!%ar7 n+ es(e &+s.
    H!&erso%n!a &r!%ar7 s! narco"e&s!a s+n( s!%!"are c+ &r!v!re "a $rad+"
    so%no"en=e! d!+rne, e(a(ea "a de'+( s! evo"+=!a s(a'!"7 :n dec+rs+" (!%&+"+!, dar &o(
    .! d!s(!nse &e 'a/a e"e%en(e"or c"!n!ce s! de "a'ora(or. Ind!v!/!! c+ !&erso%n!e
    &r!%ar7 a+ de re$+"7 +n so%n %a! "+n$ s! %a! &+=!n :n(rer+&(, d!.!c+"(7=! %a! %ar!
    "a deO(e&(area d!n so%n, o so%no"en=7 d!+rn7 %a! &ers!s(en(7 Eca o&+s7 %a! ne(+"+!
    Sa(ac de so%nT d!n narco"e&s!eJ, e&!soade de so%n d!+rn %a! "+n$! s! %a! &+=!n
    recon.or(an(e O! &+=!ne v!se sa+ de"oc :n (!%&+" a=!&e"!"or d!+rne. D!n con(ra,
    !nd!v!/!! c+ narco"e&s!e a+ ca(a&"e<!e s! !n(r+s!+n! rec+ren(e de e"e%en(e de so%n
    REM :n (ran/!=!a d!n(re so%n s! v!$!"!(a(e Ede e<., a"+c!na=!! :n "e$7(+r7 c+ so%n+"
    =+> Tulburrile de Somn

    s! &ara"!/!e de so%nJ. TLSM de%ons(rea/7 de re$+"7 "a(en=e de so%n %a! sc+r(e
    Ead!c7, so%no"en=7 .!/!o"&$!c7 %a! %areJ, &rec+% s! &re/en=a +nor &er!oade REM
    %+"(!&"e "a :nce&+(+" so%n+"+!, "a !nd!v!/!! c+ narco"e&s!e.
    Ind!v!/!! c+ !&erso%n!e &r!%ar7 s! (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a
    &o( avea &a((ern+r! s!%!"are de so%no"en=7 e<ces!v7. T+"'+rarea de so%n :n
    "e$7(+r7 c+ res&!ra=!a es(e s+$era(7 de +n !s(or!c de s(er(or &+(ern!c, &a+/e :n
    res&!ra=!e :n (!%&+" so%n+"+!, (ra+%a(!s% cran!an sa+ %a"ad!e card!ovasc+"ar7 s!
    &r!n &re/en=a "a e<a%en+" c"!n!c a o'e/!(7=!!, ano%a"!!"or ana(o%!ce oro.ar!n$ea"e,
    !&er(ens!+n!! sa+ !ns+.!c!en=e! card!ace. S(+d!!"e &o"!so%no$ra.!ce &o( con.!r%a
    &re/en=a even!%en(e"or a&ne!ce :n (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a Es!
    a'sen=a "or :n !&erso%n!a &r!%ar7J.
    T+"'+rarea de so%n :n "e$7(+r7 c+ r!(%+" c!rcad!an es(e adesea carac(er!/a(7
    &r!n so%no"en=7 d!+rn7. Un !s(or!c de orar anor%a" de so%n4v!$!"!(a(e Ec+
    sc!%'area ore"or sa+ ore nere$+"a(eJ es(e &re/en( "a !nd!v!/!! c+ (+"'+rarea
    r!(%+"+! c!rcad!an de so%n. Paraso%n!!"e &rod+c rar +n so%n noc(+rn ne(+"'+ra(,
    &re"+n$!( sa+ so%no"en=7 d!+rn7 carac(er!s(!c7 !&erso%n!e! &r!%are.
    H!&erso%n!a &r!%ar7 (re'+!e d!s(!ns7 de (+"'+r7r!"e %en(a"e care !nc"+d
    !&erso%n!a ca e"e%en( esen=!a" sa+ asoc!a(, :n s&ec!a", ac+/e"e de so%no"en=7
    d!+rn7 &o( s+rven! :n(r4+n e&!sod de&res!v %a@or c+ e"e%en(e a(!&!ce O! :n .a/a
    de&res!v7 a (+"'+r7r!! '!&o"are. D!a$nos(!c+" de !&erso%n!e &r!%ar7 n+ es(e &+s,
    dac7 !&erso%n!a s+rv!ne e<c"+s!v :n c+rs+" a"(e! (+"'+r7r! %en(a"e. O !nves(!$a=!e
    de(a"!a(7 &en(r+ &re/en=a a"(or (+"'+r7r! %en(a"e es(e esen=!a"7, :na!n(e de a "+a :n
    d!sc+=!e d!a$nos(!c+" de !&erso%n!e &r!%ar7. Un d!a$nos(!c de !&erso%n!e
    &r!%ar7 &oa(e .! &+s :n &re/en=a a"(or (+"'+r7r! %en(a"e c+ren(e sa+ a +ne! (+"'+r7r!
    %en(a"e an(er!oare, dac7 se cons!der7 c7 (+"'+rarea %en(a"7 n+ e<&"!c7
    !&erso%n!a sa+ dac7 !&erso%n!a s! (+"'+rarea %en(a"7 a+ o evo"+=!e
    !nde&enden(7 Ede e<., "a +n !nd!v!d c+ !&erso%n!e cron!c7, s! care de/vo"(7 %a!
    (Ar/!+ o (+"'+rare de&res!v7 %a@or7J. D!n con(ra, cAnd !&erso%n!a s+rv!ne ca o
    %an!.es(are a, s! e<c"+s!v :n c+rs+", a"(e! (+"'+r7r! %en(a"e, d!a$nos(!c+" de
    !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &oa(e .! %a! !nd!ca(. Aces(
    d!a$nos(!c (re'+!e "+a( :n cons!dera=!e n+%a! cAnd !&erso%n!a es(e ac+/a
    &r!nc!&a"7 s! es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(78
    a"(.e", n+ es(e necesar +n d!a$nos(!c se&area(. :n $enera", (es(e"e de "a'ora(or &en(r+
    so%no"en=a d!+rn7 "a !nd!v!/!! c+ !&erso%n!e :n "e$7(+r7 c+ o (+"'+rare %en(a"7
    ara(7 adesea n!ve"e de so%no"en=7 nor%a"7 sa+ n+%a! n!ve"e +Ooare :n co%&ara=!e
    c+ !nd!v!/!! c+ !&erso%n!e &r!%ar7.
    H!&erso%n!a &r!%ar7 (re'+!e s7 .!e d!s(!ns7 de (+"'+rarea de so%n da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e, de (!& !&erso%n!e. D!a$nos(!c+" es(e ce" de
    (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd !&erso%n!a es(e
    cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e
    s&ec!.!ce Ede e<., o'e/!(a(e %or'!d7, (+%or7 cere'ra"7J Eve/! &a$. RY5J. Aceas(7
    &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or sa+ e<a%en+" so%a(!c.
    T+"'+rarea de so%n !nd+s7 de o s+'s(an=7, de (!& !&erso%n!e, se d!s(!n$e de
    !&erso%n!a &r!%ar7 &r!n .a&(+" c7 o s+'s(an=7 Ead!c7, +n dro$ de a'+/, +n
    %ed!ca%en(, e<&+nerea "a +n (o<!cJ es(e cons!dera(7 a .! e(!o"o$!c :n "e$7(+r7 c+
    !&erso%n!a Eve/! &a$. RYYJ. De e<e%&"+, !&erso%n!a s+rven!nd e<c"+s!v :n
    con(e<(+" a's(!nen=e! de coca!n7 va .! d!a$nos(!ca(7 ca (+"'+rare de so%n !nd+s7 de
    coca!n7, de (!& !&erso%n!e, c+ de'+( :n (!%&+" a's(!nen=e!.
    4H?
    Farcolepsia
    RLF
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    H!&erso%n!a &r!%ar7 es(e ana"o$+" d!a$nos(!c+"+! de !&erso%n!e !d!o&a(!c7
    d!n C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n ECITSJ. :n a.ar7 de aceas(a,
    CITS %a! !nc"+de o ca(e$or!e se&ara(7 &en(r+ !&erso%n!a rec+ren(7, care es(e
    ana"o$+" .or%e! rec+ren(e de !&erso%n!e &r!%ar7.
    Criteriile $e $ia/no&ti# pentru 4+G.77 Fiper&o"nia Pri"ar(
    A2 Acu(a predominant o constituie somnolena excesiv pentru cel puin o
    lun &sau mai puin dac este recurent), evideniat, $ie prin episoade pre
    lun!ite de somn, $ie prin episoade de somn diurn care survin aproape (ilnic2
    S2 Somnolena excesiv cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    2 Somnolena excesiv nu este explicat mai bine de insomnie ,i nu survine
    exclusiv "n cursul evoluiei altei tulburri de somn &de ex2, narcolepsia,
    tulburarea de somn "n le!tur cu respiraia, tulburarea ritmului circadian
    de somn-vi!ilitate sau parasomnia) ,i nu poate $i explicat printr-o cantitate
    inadecvat de somn2
    D2 #erturbarea nu survine exclusiv "n cursul altei tulburri mentale2
    *2 #erturbarea nu se datorea( exclusiv e$ectelor $i(iolo!ice directe ale unei
    substane &de ex2, un dro! de abu(, un medicament) sau ale unei condiii
    medicale !enerale2
    De speci"icat dacD
    +ecurentD dac exist perioade de somnolen excesiv care durea( cel
    puin 4 (ile, survenind de mai multe ori "ntr-un an, timp de cel puin 7 ani2
    47G Nar#olep&ia
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e narco"e&s!e! "e cons(!(+!e a(ac+r!"e !re/!s(!'!"e re&e(a(e
    de so%n recon.or(an(, ca(a&"e<!a s! !n(r+s!+n!"e rec+ren(e de e"e%en(e a"e so%n+"+!
    c+ %!Oc7r! oc+"are ra&!de EREMJ :n &er!oada de (ran/!=!e d!n(re so%n s! v!$!"!(a(e.
    So%no"en=a !nd!v!d+"+! d!%!n+a de re$+"7 d+&7 +n a(ac de so%n, &en(r+ a reven!
    cA(eva ore %a! (Ar/!+. A(ac+r!"e de so%n (re'+!e s7 s+rv!n7 /!"n!c :n c+rs+" +ne!
    &er!oade de ce" &+=!n ; "+n! &en(r+ a s(a'!"! d!a$nos(!c+" Ecr!(er!+" AJ, deO! %+"=!
    !nd!v!/! descr!+ %+"=! an! de a(ac+r! de so%n :na!n(e de a so"!c!(a a(en=!e c"!n!c7. Pe
    "An$7 so%no"en=7, !nd!v!/!! c+ narco"e&s!e e<&er!en(ea/7 +na sa+ a%'e"e d!n(re
    ce"e care +r%ea/7Q ca(a&"e<!e Ead!c7, e&!soade de &!erdere s+'!(7, '!"a(era"7 O!
    revers!'!"7 a (on+s+"+! %+sc+"ar, care d+rea/7 de "a cA(eva sec+nde "a cA(eva
    %!n+(e O! s+n( &rec!&!(a(e de re$+"7 de o e%o=!e &+(ern!c7J Ecr!(er!+" B"J or!
    !n(r+s!+n! rec+ren(e de e"e%en(e a"e so%n+"+! c+ %!Oc7r! oc+"are ra&!de EREMJ :n
    (ran/!=!a d!n(re so%n O! v!$!"!(a(e, %an!.es(a(e &r!n &ara"!/!! a"e %+Oc!"or vo"+n(ar!
    >1E Tulburrile de Somn

    or! a"+c!na=!! ase%7n7(oare v!s+"+! Ecr!(er!+" B9J. M+"=! e<&er=! :n so%n ad%!(
    &+nerea d!a$nos(!c+"+! s! :n a'sen=a ca(a&"e<!e! sa+ a !n(r+s!+n!! e"e%en(e"or de
    so%n REM, dac7 !nd!v!d+" &re/!n(7 so%no"en=7 &a(o"o$!c7 s! do+7 sa+ %a! %+"(e
    &er!oade REM "a :nce&+(+" so%n+"+!, :n c+rs+" (es(+"+! de "a(en=7 a so%n+"+!
    %+"(!&"+ ETLSMJ. S!%&(o%e"e n+ (re'+!e s7 se da(ore/e e.ec(e"or .!/!o"o$!ce d!rec(e
    a"e +ne! s+'s(an=e E!nc"+s!v a"e +n+! %ed!ca%en(J sa+ a"(e! cond!=!! %ed!ca"e
    $enera"e Ecr!(er!+" CJ. DeO! narco"e&s!a es(e c"as!.!ca(7 :n ca&!(o"+" ded!ca( de ICD
    cond!=!!"or ne+ro"o$!ce, ea es(e !nc"+s7 :n aceas(7 sec=!+ne &en(r+ a a@+(a "a
    e.ec(+area d!a$nos(!c+"+! d!.eren=!a" Ia !nd!v!/!! c+ so%no"en=7 e<ces!v7, s! es(e
    cod!.!ca(7 &e a<a I.
    E&!soade"e de so%no"en=7 d!n narco"e&s!e s+n( adesea descr!se ca !re/!s(!'!"e s!
    d+cAnd "a so%n non!n(en=!ona" :n s!(+a=!! !nadecva(e Ede e<., :n (!%& ce cond+ce +n
    a+(o%o'!", &ar(!c!&7 "a :n(A"n!r! or! s+s=!ne o conversa=!eJ. S+'s(!%+"area, s!(+a=!!"e
    de ac(!v!(a(e red+s7 e<a$erea/7 de re$+"7 $rad+" de so%no"en=7 Ede e<., a ador%!
    :n (!%& ce c!(eO(e, &r!veO(e "a (e"ev!/or, a+d!a/7 con.er!n=eJ. E&!soade"e de so%n
    d+rea/7 :n $enera" 5L49L %!n+(e, dar &o( d+ra c!ar &An7 "a o or7, dac7 n+ s+n(
    :n(rer+&(e. S+n( re"a(a(e .recven( v!se. Ind!v!/!! a+ d!verse &rocedee de a se S"+&(aT
    c+ aces(e a(ac+r! de so%n. Un!! !nd!v!/! a=!&esc !n(en=!ona( :n sco&+" %ena@7r!!
    so%no"en=e! "or. Ind!v!/!! c+ narco"e&s!e a+ de re$+"7 94R e&!soade de so%n
    E!n(en=!ona" sa+ non!n(en=!ona"J &e /!, cAnd n+ s+n( (ra(a=!. E&!soade"e de so%n se
    s+&ra&+n de re$+"7 &es(e +n $rad nor%a" de v!$!"!(a(e, deO! +n!! !nd!v!/! descr!+ :n
    %od cons(an( o so%no"en=7 de d!verse $rade.
    Ca(a&"e<!a a&are adesea "a %a! %+"=! an! d+&7 de'+(+" so%no"en=e! d!+rne s!
    s+rv!ne "a a&ro<!%a(!v HLd d!n(re !nd!v!/!! c+ (+"'+rarea. P!erderea (on+s+"+!
    %+sc+"ar :n ca(a&"e<!e &oa(e .! s+'(!"7, d+cAnd "a c7derea %and!'+"e!, &"eoa&e"or,
    ca&+"+! sa+ a %e%'re"or, neses!/a(7 de an(+ra@. Ca(a&"e<!a &oa(e .!, de ase%enea,
    %a! dra%a(!c7, !ar !nd!v!d+" &oa(e sc7&a o'!ec(e"e &e care "e (rans&or(7, ! se &o(
    dero'a $en+nc!! sa+ &oa(e c7dea rea"%en(e @os. M+Oc!! res&!ra(or! s! %+Oc!!
    oc+"ar! n+ s+n( a.ec(a=!. Sc7derea .or=e! %+sc+"are d+rea/7 de re$+"7 n+%a! cA(eva
    sec+nde, deO! a+ .os( descr!se s! &er!oade d+rAnd &An7 "a o @+%7(a(e de or7.
    E&!soade"e s+n( +r%a(e de reven!rea co%&"e(7 "a nor%a" a .or=e! %+sc+"are, :n
    (!%&+" e&!soade"or ca(a&"ec(!ce, conO(!!n=a c"ar7 s! v!$!"!(a(ea s+n( conserva(e.
    Ind!v!/!! &o( descr!e c"ar even!%en(e"e s! n+ a+ n!c! o con.+/!e :na!n(e sa+ d+&7
    e&!sod. Ma! rar, e&!soade"e &re"+n$!(e de ca(a&"e<!e &o( d+ce "a e&!soade de so%n.
    Ca(a&"e<!a es(e dec"anOa(7 de re$+"7 de +n s(!%+" e%o=!ona" &+(ern!c Ede e<., .+r!a,
    s+r&r!/a, rAs+"J. De&r!varea de so%n cres(e de re$+"7 .recven=a O! sever!(a(ea
    e&!soade"or de ca(a&"e<!e.
    A&ro<!%a(!v 9Ld4ILd d!n(re !nd!v!/!! c+ narco"e&s!e e<&er!en(ea/7, de
    ase%enea, o !%a$er!e !n(ens7 ase%7n7(oare v!s+"+!, !%ed!a( :na!n(e de a ador%!
    Ea"+c!na=!! !&na$o$!ceJ sa+ !%ed!a( d+&7 deO(e&(area d!n so%n Ea"+c!na=!!
    !&no&o%&!ceJ. Ha"+c!na=!!"e :n "e$7(+r7 c+ so%n+" ce"e %a! re"a(a(e s+n( ce"e
    v!/+a"e s! :ncor&orea/7 e"e%en(e a"e a%'!an=e! rea"e. De e<e%&"+, !nd!v!/!! &o(
    descr!e o'!ec(e care a&ar &r!n .!s+r!"e d!n &ere=! sa+ descr!+ o'!ec(e care se %!Oc7
    :n(r4+n (a'"o+ de &e &ere(e. Ha"+c!na=!!"e &o( .! O! a+d!(!ve Ede e<., a+/!rea de !n(r+O!
    :n cas7J or! )!ne(!ce Ede e<., sen/a=!a de /'orJ. DeO! a"+c!na=!!"e !&na$o$!ce O!
    !&no&o%&!ce s+n( s!%&(o%e !%&or(an(e &r!n(re !nd!v!/!! c+ narco"e&s!e,
    ase%enea s!%&(o%e s+n(, de ase%enea, &re/en(e :n a&ro<!%a(!v 5Ld45Yd d!n
    &o&+"a=!a $enera"7. A&ro<!%a(!v ;Ld4YLd d!n(re !nd!v!/!! c+ narco"e&s!e
    e<&er!en(ea/7, de ase%enea, &ara"!/!e de so%n !%ed!a( ce ador% sa+ se deO(ea&(7
    4H?
    Farcolepsia
    >11

    d!n so%n. :n aces(e cond!=!!, !nd!v!/!! se descr!+ ca .!!nd v!$!"! dar !nca&a'!"! s7 se
    %!O(e sa+ s7 vor'easc7. E! se &o( &"An$e, de ase%enea, c7 s+n( !nca&a'!"! s7 res&!re,
    deO! d!a.ra$%+" es(e cr+=a(, !ar res&!ra=!a con(!n+7. Tre'+!e no(a( :ns7 c7 ILd4YLd
    d!n(re ce! care dor% nor%a" re"a(ea/7 c7 a+ av+( e&!soade !/o"a(e de &ara"!/!e ce"
    &+=!n oda(7 :n c+rs+" v!e=!! "or. Ha"+c!na=!!"e :n "e$7(+r7 c+ so%n+" O! &ara"!/!a de
    so%n &o( s+rven! s!%+"(an, d+cAnd adesea "a e<&er!en=a (er!.!an(7 de a vedea sa+
    a+/! "+cr+r! !nso"!(e O! de a .! !nca&a'!" s7 se %!O(e. A(A( a"+c!na=!!"e :n "e$7(+r7 c+
    so%n+", cA( O! &ara"!/!a de so%n, d+rea/7 de "a cA(eva sec+nde "a cA(eva %!n+(e s!
    se (er%!n7 s&on(an. A%'e"e .eno%ene E!%a$er!a %en(a"7 v!e s! a(on!a %+Oc!"or
    sce"e(a"!J s+n( cons!dera(e a re/+"(a d!n e"e%en(e"e d!soc!a(e a"e so%n+"+! REM
    care se !n(r+d :n v!$!"!(a(e.
    *lemente ,i tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Un!! !nd!v!/! c+ narco"e&s!e
    e<&er!en(ea/7 so%no"en=7 d!+rn7 $enera"!/a(7 :n(re a(ac+r!"e se&ara(e de so%n. E!
    &o( a.!r%a c7 s+n( ca&a'!"! s7 doar%7 :n or!ce %o%en( O! :n or!ce s!(+a=!e.
    Co%&or(a%en(+" a+(o%a(, :n care !nd!v!d+" se an$a@ea/7 :n ac(!v!(a(e .7r7 s7 .!e &e
    de&"!n conO(!en(, &oa(e s+rven! ca re/+"(a( a" so%no"en=e! &ro.+nde. Ind!v!/!! &o(
    cond+ce, conversa sa+ c!ar "+cra :n (!%&+" e&!soade"or de co%&or(a%en( a+(o%a(.
    3!se v!!, !n(ense, .recven(e, &o( s+rven! :n (!%&+" so%n+"+! noc(+rn. Ind!v!/!! c+
    narco"e&s!e e<&er!en(ea/7 adesea +n so%n noc(+rn .ra$%en(a(, ca re/+"(a( a" +nor
    deO(e&(7r! s&on(ane sa+ a" %!Oc7r!"or &er!od!ce a"e %e%'re"or. Ma! rar, !nd!v!/!! &o(
    &re/en(a ca &r!nc!&a"7 ac+/7, !nso%n!a %a! c+rAnd decA( !&erso%n!a.
    Ind!v!/!! c+ narco"e&s!e &o( e/!(a s7 se an$a@e/e :n ac(!v!(7=! soc!a"e, d!n ca+/a
    .r!c!! de a n+ ador%! sa+ de a n+ avea +n e&!sod de ca(a&"e<!e. E! &o(, de ase%enea,
    (!nde s7 &rev!n7 a(ac+r!"e de ca(a&"e<!e &r!n e<erc!(area +n+! con(ro" as+&ra
    e%o=!!"or "or, ceea ce &oa(e d+ce "a o "!&s7 $enera"!/a(7 de e<&res!v!(a(e care
    !n(er.erea/7 c+ re"a=!!"e soc!a"e. Narco"e&s!a &oa(e "!%!(a sever .+nc=!onarea :n
    (!%&+" /!"e! d!n ca+/a a(ac+r!"or de so%n !ncon(ro"a'!"e re&e(a(e, a
    co%&or(a%en(+"+! a+(o%a( s! a e&!soade"or de ca(a&"e<!e. Ind!v!/!! c+ narco"e&s!e
    r!sc7 s7 .!e v7(7%a=! acc!den(a" sa+ s7 va(7%e &e a"=!! d!n ca+/a ador%!r!! :n s!(+a=!!
    &er!c+"oase Ede e<., :n (!%& ce cond+c +n a+(o%o'!" sa+ %an!&+"ea/7 +n +(!"a@J.
    O (+"'+rare %en(a"7 conco%!(en(7 sa+ +n !s(or!c de a"(7 (+"'+rare %en(a"7 &oa(e
    .! cons(a(a(7 "a a&ro<!%a(!v ILd d!n(re !nd!v!/!! c+ narco"e&s!e. T+"'+r7r!"e ce"e %a!
    .recven( asoc!a(e s+n( (+"'+r7r!"e a.ec(!ve E:n s&ec!a" (+"'+rarea de&res!v7 %a@or7 O!
    d!s(!%!aJ, +r%a(e de (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 O! an<!e(a(ea
    $enera"!/a(7. Un !s(or!c de &araso%n!!, c+% ar .! so%na%'+"!s%+", 'r+<!s%+"
    Es(rAn$erea %and!'+"e! s! scrAOn!(+" d!n d!n=!J, (+"'+rarea de co%&or(a%en( d!n
    so%n+" c+ %!Oc7r! oc+"are ra&!de EREMJ O! en+re/!s+", &are a .! %a! .recven( "a
    !nd!v!/!! c+ narco"e&s!e.
    9ate de laborator asociate. Da(e"e d!n (es(+" de "a(en=7 a so%n+"+! %+"(!&"+
    ETLSMJ !nc"+d o "a(en=7 de so%n %ed!e de %a! &+=!n de Y %!n+(e s! o a&ar!=!e a
    so%n+"+! REM :n c+rs+" a do+7 sa+ %a! %+"(e a=!&e"! &e +n TLSM de c!nc! a=!&e"!.
    Aces(e cr!(er!! TLSM vor !den(!.!ca corec( do! d!n (re! !nd!v!/! c+ narco"e&s!e.
    S(+d!!"e &o"!so%no$ra.!ce noc(+rne de%ons(rea/7 .recven( "a(en=e de so%n de %a!
    &+=!n de 5L %!n+(e s! &er!oade REM "a :nce&+(+" so%n+"+!. Da(e"e s+&"!%en(are "a
    &o"!so%no$ra.!e &o( !nc"+de deO(e&(7r! (ran/!(or!! .recven(e, sc7derea e.!c!en=e!
    so%n+"+!, creO(erea s(ad!+"+! " de so%n, creO(erea so%n+"+! REM O! creO(erea
    =*C Tulburrile de Somn
    .recven=e! %!Oc7r!"or oc+"are :n c+rs+" &er!oade"or REM ESdens!(a(ea REMTJ.
    M!Oc7r! &er!od!ce a"e %e%'re"or s! e&!soade de a&nee de so%n s+n( re%arca(e
    adesea, dar +"(!%e"e a&ar %a! &+=!n .recven( decA( :n (+"'+rarea de so%n :n
    "e$7(+r7 c+ res&!ra=!a. Ind!v!/!! c+ narco"e&s!e &o( &re/en(a d!.eren=e :n
    a%&"!(+d!nea sa+ orar+" .+nc=!on7r!! c!rcad!ene %7s+ra(e &r!n (e%&era(+ra !n(ern7
    a cor&+"+! O! ac(!v!(a(ea %o(or!e.
    T!&7rea an(!$en+"+! "e+coc!(ar +%an EHLAJ a" !nd!v!/!"or c+ narco"e&s!e ara(7
    &re/en=a de HLA4DDB5`LRL9. Aces( %ar)er es(e &re/en( "a a&roa&e (o=! !nd!v!/!! c+
    narco"e&s!e s! ca(a&"e<!e O! es(e !nde&enden( de e(n!a ras!a"7. Ins7, HLA4DDB5`LRL9
    es(e &re/en( n+%a! "a ILd d!n(re !nd!v!/!! c+ narco"e&s!e .7r7 ca(a&"e<!e O! es(e
    &re/en( :n 9Ld49Yd d!n &o&+"a=!a $enera"7. A"=! %ar)er! HLA var!a/7 :n (er%en!!
    sens!'!"!(7=!! O! s&ec!.!c!(7=!! "or "a d!.er!(e $r+&e ras!a"e.
    Da(e"e e<a%!n7r!! so%a(!ce O! cond!=!!"e %ed!ca"e $enera"e asoc!a(e. Ind!v!/!!
    c+ narco"e&s!e &o( &7rea c7 dor% :n c+rs+" !n(erv!+"+! c"!n!c O! a" e<a%!n7r!!, O! &o(
    ador%! rea"%en(e :n sa"a de aO(e&(are sa+ :n ca'!ne(+" %ed!ca", :n c+rs+"
    e&!soade"or de ca(a&"e<!e, !nd!v!/!! &o( c7dea de &e sca+n O! &o( avea o vor'!re
    d!/ar(r!c7 sa+ &"eoa&e"e c7/+(e.
    *lemente speci$ice etii
    H!&erac(!v!(a(ea &oa(e .! +n+" d!n(re se%ne"e &re/en(e "a co&!! c+ so%no"en=7
    d!+rn7. E"e%en(e"e c"!n!ce de n+c"e+ s! da(e"e de "a'ora(or d!n narco"e&s!e "a co&!!
    s+n( s!%!"are c+ ce"e de "a ad+"=!. Ca(a&"e<!a O! so%o"en=a d!+rn7 +Ooar7 &o( .! :ns7
    %a! d!.!c!" de !den(!.!ca( "a co&!! decA( "a ad+"=!.
    #revalent
    S(+d!!"e e&!de%!o"o$!ce !nd!c7 o &reva"en(7 de L,L9d4L,5Rd &en(r+ narco"e&s!e
    :n &o&+"a=!a ad+"(7, c+ ra(e e$a"e "a '7r'a=! O! "a .e%e!.
    *voluie
    So%no"en=a d!+rn7 es(e a&roa&e (o(dea+na &r!%+" s!%&(o% de narco"e&s!e O!
    dev!ne de re$+"7 se%n!.!ca(!v7 c"!n!c :n c+rs+" ado"escen=e!, :ns7, "a o ana"!/7 a(en(7,
    +ne"e $rade de so%no"en=7 &o( .! &re/en(e c!ar de "a e(a(ea de &reOco"ar sa+ Oco"ar
    %!c. De'+(+" d+&7 e(a(ea de IL de an! es(e rar. La +n!! !nd!v!/! c+ narco"e&s!e,
    so%no"en=a e<ces!v7 n+ &oa(e .! !den(!.!ca(7 :ns7 ca s!%&(o% a" %a"ad!e!. Aceas(a
    &oa(e e<&"!ca de ce "a %+"=! !nd!v!/!, narco"e&s!a es(e d!a$nos(!ca(7 &en(r+ &r!%a da(7
    "a %+"=! an! d+&7 de'+(+" &r!%e"or s!%&(o%e. S(resor!! &s!osoc!a"! ac+=! sa+ a"(er7r!"e
    ac+(e a"e orar+"+! de so%n4v!$!"!(a(e &re%er$ de'+(+" :n a&roa&e @+%7(a(e d!n ca/+r!.
    Ca(a&"e<!a &oa(e a&are conco%!(en( c+ so%no"en=a, dar ce" %a! adesea a&are "a "+n!,
    an! sa+ c!ar decade de "a de'+(+" so%no"en=e!. Ha"+c!na=!!"e :n "e$7(+r7 c+ so%n+" O!
    &ara"!/!a de so%n s+n( s!%&(o%e"e ce"e %a! var!a'!"e a"e (+"'+r7r!! O! &o( s7 n+ a&ar7
    "a +n!! !nd!v!/!. So%n+" noc(+rn :n(rer+&( a&are de re$+"7 (Ar/!+ :n c+rs+" (+"'+r7r!!,
    adesea cAnd !nd!v!/!! se a."7 :n an!! IL sa+ YL a! v!e=!! "or.
    So%no"en=a e<ces!v7 a narco"e&s!e! are o evo"+=!e s(a'!"7 :n (!%&. A&ar!=!a a"(or
    (+"'+r7r! de so%n Ede e<., %!Oc7r!"e &er!od!ce a"e %e%'re"or sa+ (+"'+rarea de
    so%n :n "e$7(+r7 c+ res&!ra=!aJ &oa(e :nr7+(7=! $rad+" de so%no"en=7, :n (!%& ce
    (ra(a%en(+" c+ %ed!ca%en(e s(!%+"an(e o &oa(e a%e"!ora. Ca(a&"e<!a are de re$+"7
    o evo"+=!e s(a'!"7, deO! +n!! !nd!v!/! re"a(ea/7 o d!%!n+are a s!%&(o%e"or sa+ c!ar
    4H? Farcol
    epsia =*4
    o d!s&ar!=!e co%&"e(7 a "or d+&7 %+"=! an!. :n %od s!%!"ar, a"+c!na=!!"e :n "e$7(+r7
    c+ so%n+" O! &ara"!/!a de so%n se &o( re%!(e :n (!%& ce so%no"en=a d!+rn7 O!
    a(ac+r!"e de so%n &ers!s(7.
    #attern $amilial
    Da(e d!n s(+d!!"e HLA O! s(+d!!"e .a%!"!a"e s+$erea/7 c"ar ro"+" .ac(or!"or $ene(!c!
    :n a&ar!=!a narco"e&s!e!. Mod+" de er!(are n+ a .os( &rec!/a( dar es(e &ro'a'!"
    %+"(!.ac(or!a". A&ro<!%a(!v YdU5Yd d!n(re r+de"e '!o"o$!ce de $rad+" I a"e
    &ro'an/!"or c+ narco"e&s!e a+ a"(e (+"'+r7r!.A&ro<!%a(!v 9Yd4YLd d!n(re r+de"e
    '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ narco"e&s!e a+ a"(e (+"'+r7r! carac(er!/a(e
    &r!n so%no"en=7 e<ces!v7 Ec+% ar .! !&erso%n!a &r!%ar7J.
    Dia!nostic di$erenial
    Narco"e&s!a (re'+!e s7 .!e d!.eren=!a(7 de var!a=!!"e nor%a"e a"e so%n+"+!,
    de&r!varea de so%n, a"(e (+"'+r7r! de so%n &r!%are s! de (+"'+rarea de so%n :n
    "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7, de (!& !&erso%n!e. M+"=! !nd!v!/! s!%( o oarecare
    so%no"en=7 :n (!%&+" /!"e!, :n s&ec!a" d+&7 a%!a/7, cAnd s+rv!ne o creO(ere a
    so%no"en=e! .!/!o"o$!ce. As(.e" de !nd!v!/! n+ a+ :ns7 so%n+" !re/!s(!'!" "a a"(e ore a"e
    /!"e! s! &o( S"+&(aT con(ra so%no"en=e! "or &r!n(r4+n e.or( %en(a" sa+ .!/!c cresc+(, :n
    $enera" e! n+ e<&er!en(ea/7 ca(a&"e<!e, a"+c!na=!! :n "e$7(+r7 c+ so%n+" sa+
    &ara"!/!! de so%n. E&!soade de sc7dere a .or=e! %+sc+"are &o( s+rven! O! "a !nd!v!/!!
    .7r7 narco"e&s!e. DeO! $"+%e"e O! rAs+" s+n( ce! %a! (!&!c! dec"anOa(or! a! ca(a&"e<!e!,
    e&!soade"e care s+n( dec"anOa(e e<c"+s!v de s(res sa+ de (ens!+ne or! care s+rv!n :n
    con(e<(+" e.or(+"+! .!/!c es(e &+=!n &ro'a'!" s7 re&re/!n(e o ca(a&"e<!e ver!(a'!"7.
    De&r!varea de so%n de or!ce ca+/7 &rod+ce so%no"en=7 d!+rn7. Narco"e&s!a
    (re'+!e s7 .!e d!a$nos(!ca(7, n+%a! dac7 !nd!v!d+" a &re/en(a( +n r!(% re$+"a( de
    so%n4v!$!"!(a(e, c+ o can(!(a(e adecva(7 de so%n noc(+rn. De&r!varea de so%n O!
    orar!!"e de so%n nere$+"a(e &o( d+ce rar "a a"+c!na=!! :n "e$7(+r7 c+ so%n+" sa+ "a
    &ara"!/!e de so%n, dar n+ "a ca(a&"e<!e.
    ,rad+" de so%no"en=7 d!+rn7 &oa(e .! s!%!"ar "a !nd!v!/!! c+ narco"e&s!e s!
    !&erso%n!e &r!%ar7. In co%&ara=!e c+ !nd!v!/!! c+ narco"e&s!e, !nd!v!/!! c+
    !&erso%n!e &r!%ar7 re"a(ea/7 :n $enera" +n so%n noc(+rn &re"+n$!( O! %a! &+=!n
    :n(rer+&(. So%no"en=a d!+rn7 d!n !&erso%n!a &r!%ar7 cons(7 d!n &er!oade de
    so%n %a! &re"+n$!(, nerecon.or(an(, care a+ %a! &+=!n7 +r$en=7 decA( Sa(ac+r!"eT
    de so%n d!n narco"e&s!e O! s+n( %a! &+=!n .recven( asoc!a(e c+ v!se. Ind!v!/!! c+
    !&erso%n!e &r!%ar7 n+ &re/!n(7 ca(a&"e<!e, a"+c!na=!! :n "e$7(+r7 c+ so%n+" or!
    &ara"!/!e de so%n. Po"!so%no$ra.!a noc(+rn7 con.!r%7 +n so%n %a! &+=!n
    :n(rer+&( O! o "a(en=7 REM nor%a"7 "a !nd!v!/!! c+ !&erso%n!e &r!%ar7, !ar TLSM
    n+ ara(7 &er!oade REM "a :nce&+(+" so%n+"+!.
    Ind!v!/!! c+ (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a e<&er!en(ea/7 adesea
    o so%no"en=7 e<ces!v7 care es(e e$a"7 ca %7r!%e c+ cea a !nd!v!/!"or c+ narco"e&s!e.
    :n &"+s, %+"=! !nd!v!/! c+ narco"e&s!e &o( &re/en(a +n an+%!( $rad de a&nee de
    so%n. T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a se d!s(!n$e de narco"e&s!e
    &r!n(r4+n !s(or!c de s(er(or !n(ens, &a+/e :n res&!ra=!e care :n(rer+& so%n+" noc(+rn,
    e&!soade de so%n d!+rn.nerecon.or(an(e, "+n$!, s! a'sen=a s!%&(o%e"or accesor!!,
    c+% ar .! ca(a&"e<!a. Po"!so%no$ra.!a &oa(e !nd!ca &a+/e"e res&!ra(or!! Ea&ne!"eJ "a
    !nd!v!/!! c+ (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a. Dac7 +n !nd!v!d &re/!n(7
    +n !s(or!c !nd+'!(a'!" de narco"e&s!e :%&re+n7 c+ da(e &o"!so%no$ra.!ce
    R5I Tulburrile de Somn
    con.!r%an(e EREM "a :nce&+(+" so%n+"+!J, s! e<!s(7, de ase%enea, &ro'a de
    (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a :n c+rs+" &o"!so%no$ra.!e!, a%'e"e
    d!a$nos(!ce &o( .! &+se. Dac7 +n !nd!v!d are ac(!v!(a(e REM "a :nce&+(+" so%n+"+!
    s! a&nee de so%n :n c+rs+" &o"!so%no$ra.!e!, dar n+ are s!ndro%+" co%&"e( a"
    narco"e&s!e!, a(+nc! (re'+!e &+s n+%a! d!a$nos(!c+" de (+"'+rare de so%n :n
    "e$7(+r7 c+ res&!ra=!a.
    Ind!v!/!! c+ !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &o( re"a(a o
    so%no"en=7 e<ces!v7 s! v!se !n(ense, :n s&ec!a" e&!soade"e de&res!ve %a@ore c+
    e"e%en(e a(!&!ce s! (+"'+rarea '!&o"ar7, ce" %a! recen( e&!sod de&res!v, co%&or(7
    adesea o neces!(a(e !n(ens7 de so%n :n c+rs+" /!"e!. Ind!v!/!! c+ (+"'+r7r! a.ec(!ve a+
    de re$+"7 :ns7 +n so%n noc(+rn &er(+r'a( deO! &re"+n$!(, :n con(ras( c+ so%n+"
    .ra$%en(a(, sc+r(, d!n narco"e&s!e. A=!&e"!"e d!+rne n+ s+n( recon.or(an(e "a
    !nd!v!/!! c+ (+"'+r7r! a.ec(!ve, :n &"+s, aceO(! !nd!v!/! n+ a+ s!%&(o%e"e accesor!!
    carac(er!s(!ce narco"e&s!e! Ede e<., ca(a&"e<!aJ, deO! !nd!v!/!! care a+ (+"'+rare
    de&res!v7 %a@or7 c+ e"e%en(e &s!o(!ce se &o( &"An$e de a"+c!na=!! :n a&ro&!erea
    so%n+"+!, dar s! :n a"(e %o%en(e. S(+d!!"e &o"!so%no$ra.!ce a"e !nd!v!/!"or c+
    (+"'+r7r! a.ec(!ve &o( reve"a o "a(en=7 REM sc+r(7, dar de re$+"7 n+ a(A( de sc+r(7
    ca aceea v7/+(7 :n narco"e&s!e. La(en=a so%n+"+! noc(+rn es(e, de ase%enea, %a!
    "+n$7 "a !nd!v!/!! c+ (+"'+r7r! a.ec(!ve, :n .!ne, (es(area d!+rn7 c+ TLSM ara(7 +n
    $rad %a! red+s de so%no"en=7 .!/!o"o$!c7 s! &er!oade REM "a :nce&+(+" so%n+"+!
    rare "a !nd!v!/!! c+ (+"'+r7r! a.ec(!ve. Dec!, Sso%no"en=aT "a aceO(! !nd!v!/! &are a .!
    %a! %+"( o %an!.es(are a "en(oare! &s!o %o(or!! s! aner$!e!.
    U/+" sa+ a's(!nen=a de s+'s(an=e E!nc"+s!v de %ed!ca%en(eJ &o( &rod+ce +ne"e
    s!%&(o%e de narco"e&s!e. A$on!s(!! co"!ner$!c! E!nc"+s!v &es(!c!de"e anr!co"!nes(e4
    ra/!ceJ &o( :n(rer+&e con(!n+!(a(ea so%n+"+! s! cres(e so%n+" REM. E.ec(e s!%!"are
    &o( re/+"(a d!n :n(rer+&erea 'r+sc7 a a$en=!"or an(!co"!ner$!c!, !nc"+s!v a
    an(!de&res!ve"or (r!c!c"!ce. Reser&!na s! %e(!"do&a &o( cres(e so%n+" REM s!
    &rod+ce so%no"en=7. A's(!nen=a de s(!%+"an(e &oa(e &rod+ce o so%no"en=7 sever7.
    Un d!a$nos(!c de (+"'+rare de so%n !nd+s7 de o s+'s(an=7, de (!& !&erso%n!e,
    &oa(e .! @+s(!.!ca( dac7 s!%&(o%e"e s+n( cons!dera(e a .! da(ora(e e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! s+'s(an=e Eve/! &a$. RYYJ. Invers, +n d!a$nos(!c de narco"e&s!e n+
    (re'+!e &+s dac7 !nd!v!d+" !a sa+ a :nce(a( recen( s7 !a as(.e" de s+'s(an=e.
    Narco"e&s!a (re'+!e s7 .!e d!s(!ns7 de (+"'+rarea de so%n da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, de (!& !&erso%n!e. D!a$nos(!c+" es(e ce" de (+"'+rare de so%n
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd s!%&(o%e"e s+n( cons!dera(e a .!
    consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e s&ec!.!ce Ede e<.,
    (ra+%a(!s% cran!an :nc!s sa+ (+%or7 !&o(a"a%!c7 Eve/! &a$. RY5J.
    +elaiile cu lasi$icarea Internaional a Tulburrilor de Somn
    D!a$nos(!c+" de narcF&e"s!e d!n C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de
    So%n ECITSJ !nc"+de ace"eaO! e"e%en(e esen=!a"e ca s! d!a$nos(!c+" DSM4I3.
    ?852A6 Tulburarea de Somn "n le!tur cu +espiraia =*<
    Criteriile $e $ia/no&ti# pentru 47G Nar#olep&ie
    A2 Atacuri ire(istibile de somn recon$ortant survenind (ilnic, timp de cel puin
    4 luni2
    S2 #re(ena uneia sau a ambelor, din cele ce urmea(D
    &l)cataplexie &adic, scurte episoade de pierdere bilateral a tonusului
    muscular, cel mai adesea "n asociere cu o emoie intens)3
    &7) intru(iuni recurente de elemente ale somnului cu mi,cri oculare rapide
    &+*M) "n tran(iia de la somn la vi!ilitate, mani$estate $ie prin %alucinaii
    %ipnopompice sau %ipna!o!ice, ori parali(ie de somn, la "nceputul sau la
    terminarea episoadelor de somn2
    2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau ale altei condiii medicale !enerale2
    G>+.<5 Tul-urarea $e So"n
    .n le/(tur( #u Re&pira!ia
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de so%n :n "e$7(+r7 c+ res&!ra=!a :" cons(!(+!e
    :n(rer+&erea so%n+"+!, d+cAnd "a so%no"en=7 e<ces!v7 sa+, %a! &+=!n .recven(, "a
    !nso%n!e, cons!dera(7 a .! da(ora(7 ano%a"!!"or de ven(!"a=!e d!n (!%&+" so%n+"+!
    Ede e<., a&neea de so%n sa+ !&oven(!"a=!a a"veo"ar7 cen(ra"7J Ecr!(er!+" AJ. Aceas(7
    :n(rer+&ere a so%n+"+! n+ (re'+!e s7 .!e e<&"!ca(7 %a! '!ne de o (+"'+rare %en(a"7
    s! n+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e E!nc"+s!v
    %ed!ca%en(eJ sa+ a"e +ne! cond!=!! %ed!ca"e $enera"e care &rod+ce s!%&(o%e de
    so%n &r!n(r4+n a"( %ecan!s% decA( res&!ra=!a anor%a"7 Ecr!(er!+" BJ.
    So%no"en=a e<ces!v7 es(e cea %a! .recven(7 ac+/7 &e care o &re/!n(7 !nd!v!/!! c+
    (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a. So%no"en=a re/+"(7 d!n deO(e&(7r!"e
    .recven(e d!n (!%&+" so%n+"+! noc(+rn, &en(r+ c7 !nd!v!d+" :ncearc7 s7 res&!re
    nor%a". So%no"en=a es(e. %a! ev!den(7 :n s!(+a=!!"e de re"a<are, c+% ar .! ace"ea :n
    care !nd!v!d+" c!(eO(e sa+ &r!veO(e "a (e"ev!/or. Inca&ac!(a(ea !nd!v!d+"+! de a
    con(ro"a so%no"en(a &oa(e .! ev!den(7 "a :n(r+n!r!"e &"!c(!coase sa+ :n (!%& ce
    v!/!onea/7 .!"%e, &!ese de (ea(r+ or! a+d!a/7 concer(e. CAnd so%no"en=a es(e
    e<(re%7, &ersoana res&ec(!v7 &oa(e ador%! :n (!%& ce conversea/7, %7nAnc7,
    %er$e sa+ cond+ce +n ve!c+". A=!&e"!"e (!nd a .! nerecon.or(an(e s! &o( .!
    aco%&an!a(e de o ce.a"ee s+rd7 "a deO(e&(are. Po( e<!s(a, :ns7, var!a=!! cons!dera'!"e
    :n !n(ens!(a(ea so%no"en=e!. I%&ac(+" so%no"en=e! &oa(e .! %!n!%a"!/a( de !nd!v!d,
    care se ara(7 a .! %Andr+ de .a&(+" c7 &oa(e dor%! or!+nde O! or!cAnd.
    Inso%n!a, deO(e&(7r!"e .recven(e sa+ so%n+" nerecon.or(an( s+n( %a! &+=!n
    .recven(e decA( so%no"en=a d!+rn7 ca ac+/7 &re/en(a(7 de !nd!v!/!! c+ (+"'+rare de
    so%n :n "e$7(+r7 c+ res&!ra=!a. Un!! !nd!v!/! se &o( &"An$e de d!.!c+"(a(e :n
    res&!ra=!e, :n (!%& ce se a."7 :n dec+'!( dorsa" sa+ dor%.
    Even!%en(e"e res&!ra(or!! anor%a"e d!n (!%&+" (+"'+r7r!! de so%n :n "e$7(+r7 c+
    res&!ra=!a !nc"+d a&ne! Ee&!soade de :nce(are a res&!ra=!e!J, !&o&ne! E:nce(!n!re
    R5R Tulburrile de Somn
    anor%a"7 a res&!ra=!e! sa+ res&!ra=!e s+&er.!c!a"7J s! !&oven(!"a=!e En!ve"e san$+!ne
    anor%a"e a"e o<!$en+"+! s! '!o<!d+"+! de car'onJ. A+ .os( descr!se (re! .or%e de
    (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!aQ s!ndro%+" de a&nee de so%n
    o's(r+c(!v7, s!ndro%+" de a&nee de so%n cen(ra"7 s! s!ndro%+" de !&oven(!"a=!e
    a"veo"ar7 cen(ra"7. Un (er%en %a! vec!, s!ndro%+" P!c)#!c), a .os( +(!"!/a( &en(r+
    a descr!e !nd!v!/!! o'e/! c+ o co%'!na=!e de s!ndro% de a&nee de so%n o's(r+c(!v7
    s! !&oven(!"a=!e care deO(ea&(7 d!n so%n ca s! !&oven(!"a=!e :n "e$7(+r7 c+ so%n+".
    Sindrom+l de apnee de somn obstr+cti*6 es(e cea %a! .recven(7 .or%7 de (+"'+rare
    de so%n :n "e$7(+r7 c+ res&!ra=!a. Aces(a es(e carac(er!/a( &r!n e&!soade re&e(a(e de
    o's(r+c=!e a c7!"or aer!ene s+&er!oare Ea&ne! O! !&o&ne!J :n c+rs+" so%n+"+!.
    S(!%+"+" cen(ra" &en(r+ res&!ra=!e s! %!Oc7r!"e res&!ra(or!! a"e (orace"+! O!
    a'do%en+"+! es(e &re/erva(. Aces( s!ndro% s+rv!ne de re$+"7 "a !nd!v!/!!
    s+&ra&ondera"! s! d+ce "a ac+/a de so%no"en=7 e<ces!v7. S!ndro%+" de a&nee de
    so%n o's(r+c(!v7 se carac(er!/ea/7 &r!n s(er(or !n(ens sa+ sc+r(e ane"a=!! E$A.A!e"!J
    a"(ernAnd c+ &er!oade de s!"en=!+% res&!ra(or care d+rea/7 de re$+"7 9L4;L
    sec+nde. S(er(or+" es(e ca+/a( de res&!ra=!a &r!n(r4o ca"e aer!an7 o's(r+a(7 &ar=!a".
    Per!oade"e de s!"en=!+% s+n( ca+/a(e de a&ne!"e o's(r+c(!ve, c+ :nce(area res&!ra=!e!
    ca+/a(7 de o's(r+c=!a co%&"e(7 a c7!! aer!ene. De re$+"7, s(er(or+" !n(ens es(e
    &re/en( de %a! %+"=! an!, adesea d!n co&!"7r!e, !ar creO(erea sever!(7=!! sa"e &oa(e
    .ace &e !nd!v!d s7 so"!c!(e e<a%!narea %ed!ca"7. S(er(or+" es(e :n %od .recven(
    s+.!c!en( de !n(ens &en(r+ a &er(+r'a so%n+" ce"or d!n !%ed!a(a a&ro&!ere, :nce(area
    res&!ra=!e!, d+rAnd +neor! %a! %+"( de RL4FL sec+nde, s! asoc!erea c+ c!ano/a &o( .!,
    de ase%enea, %o(!ve de &reoc+&are &en(r+ &ar(ener!! de &a(. Ter%!narea
    even!%en(+"+! a&ne!c &oa(e .! asoc!a(7 c+ ronc+s+r! Sres+sc!(a(!veT !n(ense,
    ane"a=!!, s+s&!ne sa+ %+r%+re, or! %!Oc7r! a"e :n(re$+"+! cor&. Par(ener+" de &a(
    (re'+!e s7 se %+(e :n a"( &a( sa+ :n a"(7 ca%er7, ca +r%are a .a&(+"+! c7 es(e a.ec(a(
    de s(er(or+", ane"a=!!"e s! %!Oc7r!"e !nd!v!d+"+!. Ind!v!/!! ce! %a! a.ec(a=! s+n(
    !nconO(!en=! de !n(ens!(a(ea s(er(or+"+!, de d!.!c+"(a(ea :n res&!ra=!e s! de deO(e&(7r!"e
    .recven(e d!n so%n. :ns7, +ne"e &ersoane, :n s&ec!a" &ersoane"e :n e(a(e, s+n( e<(re%
    de conO(!en(e de &er(+r'area de so%n O! se &re/!n(7 c+ ac+;a +nor deO(e&(7r!
    .recven(e s! so%n nerecon.or(an(. Un!! !nd!v!/! .7r7 o's(r+c=!e .ranc7 a c72!"or
    aer!ene &re/!n(7 deO(e&(7r! d!n so%n asoc!a(e c+ creO(erea re/!s(en=e! c7!"or aer!ene
    Eden+%!(7 +neor! sindrom de re;isten(6 a c6ilor aeriene s+perioare sa+ detept6ri din
    somn =n le/6t+r6 c+ +n e*enimen respirator%7 AceO(! !nd!v!/! a+ %+"(e carac(er!s(!c!
    c"!n!ce co%+ne c+ !nd!v!/!! c+ s!ndro%+" a&ne!! de so%n o's(r+c(!ve.
    Sindrom+l apneei de somn centrale es(e carac(er!/a( &r!n :nce(area e&!sod!c7 a
    ven(!"a=!e! :n c+rs+" so%n+"+! Ea&ne! O! !&o&ne!J .7r7 o's(r+c=!a c7!"or aer!ene.
    AOadar, :n con(ras( c+ even!%en(e"e a&ne!ce o's(r+c(!ve, a&ne!"e cen(ra"e n+ s+n(
    asoc!a(e c+ %!Oc7r! res&!ra(or!! con(!n+e a"e &ere(e"+! (orac!c O! a'do%!na" s! s+rv!n
    %a! .recven( "a &ersoane"e :n e(a(e, ca re/+"(a( a" +nor cond!=!! card!ace sa+
    ne+ro"o$!ce care a.ec(ea/7 re$"area res&!ra(or!e. Ind!v!/!! se &re/!n(7 ce" %a! adesea
    c+ ac+/e de !nso%n!e da(ora(7 deO(e&(7r!"or re&e(a(e, &e care e! "e &o( asoc!a sa+ n+
    c+ d!.!c+"(7=!"e res&!ra(or!!. Ind!v!/!! c+ a&nee de so%n cen(ra"7 &o( avea +n s(er(or
    +Oor, dar care n+ es(e o ac+/7 &roe%!nen(7.
    Sindrom+l de -ipo*entila(ie al*eolar6 central6 es(e carac(er!/a( &r!n(r4o de(er!orare a
    con(ro"+"+! ven(!"a(or care d+ce "a n!ve"e anor%a" de sc7/+(e a"e o<!$en+"+!
    ar(er!a", :nr7+(7=!(e :n &"+s &r!n so%n E!&oven(!"a=!e .7r7 a&ne! sa+ !&o&ne!J.
    P+"%on!! !nd!v!/!"or c+ aceas(7 (+"'+rare a+ &ro&r!e(7=! %ecan!ce nor%a"e. Aceas(7
    .or%7 s+rv!ne ce" %a! .recven( "a !nd!v!/!! s+&ra&ondera"!, s! &oa(e .! asoc!a(7\c+ o
    ac+;6, .!e de so%no"en=7 e<ces!v7, .!e de !nso%n!e.
    ?852A6 Tulburarea de Somn "n le!tur cu
    +espiraia
    R5H

    *lemente si tulburri asociate
    $lemente descriptive /i tulburri mentale asociate. Ind!v!d+" c+ (+"'+rare de
    so%n :n "e$7(+r7 c+ res&!ra=!a se &oa(e &"An$e de d!scon.or( noc(+rn :n &!e&(, de
    sen/a=!e de as.!<!e, de s+.ocare or! de an<!e(a(e !n(ens7 :n asoc!ere c+ even!%en(e
    a&ne!ce sa+ c+ !&oven(!"a=!a. M!Oc7r!"e cor&+"+! asoc!a(e c+ d!.!c+"(7=!"e :n
    res&!ra=!e &o( .! v!o"en(e, !ar !nd!v!/!! c+ (+"'+rarea de so%n :n "e$7(+r7 c+
    res&!ra=!a s+n( descr!O! adesea ca dor%!(or! ne"!n!O(!=!. Ind!v!/!! c+ aceas(7 (+"'+rare
    se s!%( de re$+"7 nerecon.or(a=! "a deO(e&(are, O! &o( a.!r%a c7 s+n( %a! e<(en+a=!
    d!%!nea=a decA( a(+nc! cAnd %er$ "a c+"care. E! &o(, de ase%enea, descr!e 'e=!e
    de so%n Ead!c7, d!.!c+"(a(e e<(re%7 :n a se deO(e&(a, con.+/!e O! co%&or(a%en(
    !nadecva(J. Es(e co%+n7 +scarea sever7 a $+r!!, ceea ce de(er%!n7 adesea &ersoana
    s7 'ea a&7 :n c+rs+" no&=!! sa+ d!%!nea=a, "a deO(e&(are. N!c(+r!a s+rv!ne ce" %a!
    adesea oda(7 c+ &ro$res!+nea s!%&(o%e"or. Ce.a"e!"e %a(!na"e $enera"!/a(e, s+rde,
    &o( d+ra " sa+ 9 ore d+&7 deO(e&(are.
    So%no"en=a &oa(e d+ce "a &er(+r'area %e%or!e!, concen(rare red+s7, !r!(a4
    '!"!(a(e O! %od!.!care de &ersona"!(a(e. T+"'+r7r!"e a.ec(!ve E:n s&ec!a", (+"'+rarea
    de&res!v7 %a@or7 O! (+"'+rarea d!s(!%!c7J, (+"'+r7r!"e an<!oase E:n s&ec!a", &an!caJ
    s! de%en=a s+n( asoc!a(e .recven( c+ (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a.
    Ind!v!/!! &o( avea, de ase%enea, o red+cere a "!'!do+"+! O! a ca&ac!(7=!! de erec=!e.
    Rar, d!s.+nc=!a erec(!"7 es(e ac+/a &re/en(a(7 a s!ndro%+"+! de a&nee de so%n
    o's(r+c(!v7. Co&!!! c+ (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a &o( avea
    :n(Ar/!ere :n de/vo"(are O! d!.!c+"(7=! de :nv7=are, a(en=!e sc7/+(7 O! co%&or(a%en(
    !&erac(!v. So%no"en=a d!+rn7 e<ces!v7 &oa(e d+ce "a acc!den(e Ede e<., a ador%! :n
    (!%& ce cond+ce +n ve!c+"J O! &oa(e ca+;a, de ase%enea, o de(er!orare soc!a"7 O!
    &ro.es!ona"7 sever7, care d+ce "a &!erderea serv!c!+"+!, "a &ro'"e%e %ar!(a"e O!
    .a%!"!a"e, s! "a sc7derea &er.or%an=e! Oco"are.
    9ate de laborator asociate. F!ecare d!n(re s!ndroa%e"e %a@ore a"e (+"'+r7r!! de
    so%n :n "e$7(+r7 c+ res&!ra=!a &rod+ce ano%a"!! s&ec!.!ce, :n s!ndro%+" de a&nee
    de so%n o's(r+c(!v7, &o"!so%no$ra.!a noc(+rn7 !nd!c7 e&!soade a&ne!ce %a! "+n$!
    de 5L sec+nde ca d+ra(7 Ede re$+"7 9L4IL sec+ndeJ, c+ rare e&!soade d+rAnd &An7
    "a cA(eva %!n+(e. H!&o&ne!"e s+n( carac(er!/a(e &r!n(r4o red+cere a ."+<+"+! de aer.
    A%'e"e (!&+r! de even!%en(e s+n( asoc!a(e c+ o red+cere a sa(+ra=!e! o<!e%o4
    $"o'!ne!. S!ndro%+" de a&nee de so%n cen(ra"7 &oa(e !nc"+de res&!ra=!a Ceyne4
    S(o)es Ead!c7, +n &a((ern de res&!ra=!e &er!od!c7 cons(And d!n a&nee, +n e&!sod de
    !&erven(!"a=!e de 5L4RL sec+nde consec+(!v a&ne!! O! o red+cere $rad+a"7 a
    ven(!"a=!e!, c+"%!nAnd c+ o a"(7 a&neeJ. :n s!ndro%+" de !&oven(!"a=!e a"veo"ar7
    cen(ra"7, s+rv!n &er!oade de red+cere a res&!ra=!e! d+rAnd &An7 "a cA(eva %!n+(e,
    c+ desa(+rarea &ers!s(en(7 :n o<!$en a sAn$e"+! ar(er!a" s! creO(erea n!ve"e"or de
    '!o<!d de car'on. A"(e e"e%en(e a"e &o"!so%no$ra.!e! noc(+rne "a !nd!v!/!! c+
    (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a !nc"+d d+ra(a sc+r(7 a so%n+"+!,
    deO(e&(7r! .recven(e, creO(erea can(!(7=!! s(ad!+"+! " de so%n O! red+cerea
    can(!(7=!"or de so%n c+ +nde "en(e O! de so%n c+ %!Oc7r! oc+"are ra&!de EREMJ.
    DeO(e&(7r!"e care s+rv!n "a (er%!narea even!%en(e"or a&ne!ce O! de !&oven(!"a=!e &o(
    .! .oar(e sc+r(e EcA(eva sec+ndeJ.
    A&neea, !&o&neea O! !&oven(!"a=a &o( &rod+ce O! a"(e &er(+r'7r!Q desa(+rarea
    o<!e%o$"o'!ne!, ano%a"!! EE,, creO(erea &res!+n!! ar(er!a"e &+"%onare s!
    s!s(e%!ce, s! deO(e&(7r! (ran/!(or!!, &e %7s+r7 ce !nd!v!d+" (er%!n7 +n e&!sod de
    =*> Tulburrile de Somn

    &er(+r'are res&!ra(or!e, :n (!%&+" so%n+"+!, s+rv!n .recven( ar!(%!! card!ace "a
    !nd!v!/!! c+ (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a s! &o( !nc"+de ar!(%!!
    s!n+sa"e, con(rac=!! ven(r!c+"are &re%a(+re, '"oc a(r!oven(r!c+"ar sa+ s(o& s!n+sa".
    Brad!card!a +r%a(7 de (a!card!e es(e o'serva(7 .recven( :n asoc!ere c+ e&!soade"e
    a&ne!ce. DeO(e&(7r!"e noc(+rne .recven(e s! desa(+rarea o<!e%o$"o'!ne! &o( d+ce
    "a so%no"en=7 e<ces!v7 care &oa(e .! de(ec(a(7 &r!n (es(+" de "a(en=7 a so%n+"+!
    %+"(!&"+ ETLSMJ sa+ a"(e (es(e de so%no"en=7. La(en=a de so%n %ed!e "a TLSM es(e
    adesea de %a! &+=!n de 5L %!n+(e s! &oa(e .! de %a! &+=!n de Y %!n+(e E:n %od
    nor%a" es(e de 5L49L %!n+(eJ.
    M7s+r7(or!"e $a/+"+! :n sAn$e"e ar(er!a" :n s(are de v!$!"!(a(e s+n( de re$+"7
    nor%a"e, dar +n!! !nd!v!/! c+ s!ndro% de a&nee de so%n o's(r+c(!v7 sa+ c+
    s!ndro% de !&oven(!"a=!e &o( avea !&o<e%!e sa+ !&ercar'!e :n s(are de v!$!"!(a(e.
    Ce.a"o%e(r!a c+ ra/e >, !%a$!s(!ca c+ re/onan=7 %a$ne(!c7 ERMNJ, (o%o$ra.!a
    co%&+(er!/a(7 ETCJ s! endosco&!a c+ .!'re o&(!ce, &o( !nd!ca o's(r+c=!a c7!"or
    aer!ene s+&er!oare. Tes(area card!ac7 &oa(e !nd!ca e<!s(en=a +ne! a"(er7r! a .+nc=!e!
    ven(r!co"+"+! dre&(. Ind!v!/!! &o( avea, de ase%enea, va"or! cresc+(e a"e
    e%o$"o'!ne! sa+ e%a(ocr!(+"+! d!n ca+/a !&o<e%!e! noc(+rne re&e(a(e. Da(e"e
    &o"!so%no$ra.!ce de "a co&!! d!.er7 de ce"e de "a ad+"=! &r!n aceea c7 ce! %a! %+"=!
    co&!! &re/!n(7 o res&!ra=!e $rea, !&oven(!"a=!e o's(r+c(!v7 &ar=!a"7 c+ desa(+r7r!
    c!c"!ce, !&erca&n!e, %!Oc7r! &arado<a"e O! s(er(or.
    Datele e,a"in(rii &o"ati#e Ei #on$i!iile "e$i#ale /enerale a&o#iate.
    Ma@or!(a(ea !nd!v!/!"or c+ s!ndro% de a&nee de so%n o's(r+c(!v7 O! c+ s!ndro% de
    !&oven(!"a=!e a"veo"ar7 cen(ra"7 s+n( s+&ra&ondera"! s! o'serv7 o creO(ere :n
    sever!(a(ea s!%&(o%e"or, oda(7 c+ creO(erea $re+(7=!! cor&ora"e, :n$+s(area c7!"or
    aer!ene s+&er!oare &oa(e s+rven! d!n ca+/a $ros!%!! e<ces!ve a =es+(+r!"or %o!. :n
    s&ec!a" !nd!v!/!! c+ d!%ens!+n! %ar! a"e nas+"+! Ede e<., o c!rc+%.er!n=7 a nas+"+!
    %a! %are de 5H !nc! "a +n '7r'a( O! %a! %are de 5R !nc! "a o .e%e!eJ s+n( e<&+O! +n+!
    r!sc %a! %are de a &re/en(a a&nee de so%n o's(r+c(!v7. S!ndro%+" de a&nee de
    so%n o's(r+c(!v7, care s+rv!ne "a !nd!v!/!! c+ $re+(a(e cor&ora"7 nor%a"7 sa+
    s+'nor%a"7, s+$erea/7 o o's(r+c=!e a c7!"or aer!ene s+&er!oare da(ora(7 +ne!
    ano%a"!! s(r+c(+ra"e "oca"!/a(e, de.!n!'!"e, c+% ar .! o %a".or%a=!e %a<!"o4
    %and!'+"ar7 or! o !&er(ro.!e adeno(ons!"ar7. O's(r+c=!a c7!"or aer!e nena/a"e &oa(e
    .!, de ase%enea, &re/en(7. Ind!v!/!! &o( avea o res&!ra=!e sonor7, c!ar :n s(are v!$!"7.
    Re."+<+" $as(roeso.a$!an c+ S&!ro/!sT d+reros sever &oa(e s+rven! :n s!ndro%+" de
    a&nee de so%n o's(r+c(!v7, :n asoc!ere c+ e.or(+" de a res(a'!"! res&!ra=!a :n (!%&+"
    so%n+"+!. Ind!v!/!! c+ s!ndro% de a&nee de so%n cen(ra"7 s+n( %a! &+=!n .recven(
    s+&ra&ondera"! sa+ n+ a+ o's(r+c=!! de%ons(ra'!"e a"e c7!"or aer!ene s+&er!oare.
    H!&er(ens!+nea s!s(e%!c7 c+ &res!+ne d!as(o"!c7 cresc+(7 es(e asoc!a(7 .recven(
    c+ (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a. Un!! !nd!v!/!, :n s&ec!a" ce! c+
    %a"ad!e &+"%onar7 o's(r+c(!v7 cron!c7 sa+ c+ !&oven(!"a=!e a"veo"ar7, a+ :n %od
    con(!n++ va"or! sc7/+(e a"e sa(+ra=!e! :n o<!$en :n (!%&+" so%n+"+! s! s+n(
    &red!s&+s! "a de/vo"(area de !&er(ens!+ne &+"%onar7 O! !ns+.!c!en=7 card!ac7
    drea&(7 Ecor &+"%ona"eJ, con$es(!e e&a(!c7 O! ede%e $a%'!ere asoc!a(e.
    Ind!v!/!! c+ (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a &o( avea o ano%a"!e
    s+'!acen(7 :n con(ro"+" ne+ro"o$!c a" %+sc+"a(+r!! c7!"or aer!ene s+&er!oare sa+ a"
    ven(!"a=!e! :n (!%&+" so%n+"+!. T+"'+r7r!"e care a.ec(ea/7 con(ro"+" ven(!"a=!e! se
    %an!.es(7 de re$+"7 ca s!ndro% de a&nee cen(ra"7 de so%n. Un!! !nd!v!/! c+ cond!=!!
    ne+ro"o$!ce a+ o "e/!+ne s&ec!.!c7 a.ec(And con(ro"+" %+Oc!"or .ar!n$!en!, care
    &oa(e d+ce "a s!ndro%+" de a&nee de so%n o's(r+c(!v7.
    ?852A6 Tulburarea de Somn "n le!tur cu +espiraia IE6
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a &oa(e .! asoc!a(7 c+ cond!=!!
    %ed!ca"e $enera"e s!s(e%!ce sa+ ne+ro"o$!ce. De e<e%&"+, a&neea de so%n
    o's(r+c(!v7 &oa(e re/+"(a d!n %7r!rea "!%'!! da(ora(7 acro%e$a"!e!, =es+(+"+!
    (!ro!d!an "!n$+a" sa+ c!s(+r!"or, or! &ara"!/!e! cor/!"or voca"e, aOa c+% se o'serv7 :n
    s!ndro%+" Sy4Dr7$er. F+nc=!a card!ac7, de(er!ora(7 d!n ca+/a red+cer!! de'!(+"+!
    card!ac, &oa(e d+ce "a a&nee de so%n ca :n cond!=!!"e ne+ro"o$!ce care a.ec(ea/7
    con(ro"+" res&!ra=!e! de c7(re (r+nc!+" cere'ra", c+% ar .! s!r!n$o'+"'!a sa+ (+%or!"e
    de (r+nc! cere'ra".
    *lemente speci$ice etii si sexului
    La co&!!! %a! %!c!, se%ne"e s! s!%&(o%e"e (+"'+r7r!! de so%n :n "e$7(+r7 c+
    res&!ra=!a Ea&roa&e e<c"+s!v s!ndro% de a&nee de so%n o's(r+c(!v7J s+n( %a!
    s+'(!"e decA( ce"e de "a ad+"=!, !ar d!a$nos(!c+" es(e %a! d!.!c!" de s(a'!"!(. La co&!!,
    &o"!so%no$ra.!a es(e e<(re% de +(!"7 :n con.!r%area d!a$nos(!c+"+!. S(er(or+", care
    es(e carac(er!s(!c s!ndro%+"+! de a&nee de so%n o's(r+c(!v7 a" ad+"(+"+!, &oa(e s7
    n+ .!e &re/en(. DeO(e&(7r!"e a$!(a(e O! &os(+r!"e de so%n anor%a"e, c+% ar .!
    dor%!(+" c+ ca&+" &e %A!n! O! c+ ca&+" &e $en+nc!, s+rv!n .recven(. En+re/!s+"
    noc(+rn es(e, de ase%enea, co%+n s! (re'+!e s7 deO(e&(e s+s&!c!+nea +n+! s!ndro%
    de a&nee de so%n o's(r+c(!v7, dac7 s+rv!ne "a +n co&!" care era an(er!or +sca(
    noa&(ea. Co&!!! &o(, de ase%enea, &re/en(a so%no"en=7 d!+rn7 e<ces!v7, deO!
    aceas(a n+ es(e a(A( de .recven(7 s! de &ron+n=a(7 ca "a ad+"=!. Res&!ra=!a d!+rn7
    ora"7, d!.!c+"(a(ea :n de$"+(!=!e s! ar(!c+"area de.ec(+oas7 :n vor'!re s+n(, de
    ase%enea, e"e%en(e co%+ne "a co&!!. La co&!!! s+' e(a(ea de C an!, s!%&(o%e"e
    d!+rne c+% ar .! so%no"en=a s! &ro'"e%e"e de co%&or(a%en(, d!.!c+"(7=!"e de
    a(en=!e s! :nv7=are s! ce.a"e!"e %a(!na"e s+n( ce" %a! adesea :n cen(r+" a(en=!e!. La
    e<a%en+" so%a(!c, &oa(e .! o'serva( &ec(+% e<cava(+% s! coas(e"e !eO!(e :n a.ar7.
    Dac7 es(e asoc!a( c+ o !&er(ro.!e adeno(ons!"ar7 Ecea %a! .recven(7 ca+/7 de a&nee
    de so%n o's(r+c(!v7 "a co&!!J, &oa(e .! o'serva( .ac!es+" Sadeno!dT (!&!c c+ o
    e<&res!e s(+&!d7, ede%e &er!or'!(are O! res&!ra=!e ora"7.
    S!ndro%+" de a&nee de so%n o's(r+c(!v7 es(e %a! .recven( "a e(a(ea %ed!e, "a
    '7r'a=!! s+&ra&ondera"! O! "a co&!!! &re&+'er(ar! c+ a%!$da"e !&er(ro.!ce.
    :%'7(rAn!r7 d+ce "a o creO(ere a .recven=e!, a(A( a e"e%en(e"or a&ne!ce o's(r+c(!ve,
    cA( O! a ce"or cen(ra"e, c!ar &r!n(re !nd!v!/!! s7n7(oO! as!%&(o%a(!c!. Deoarece +n
    an+%!( $rad de a&nee &oa(e .! nor%a" oda(7 c+ :%'7(rAn!rea, re/+"(a(e"e &o"!so%4
    no$ra.!ce (re'+!e s7 .!e !n(er&re(a(e :n aces( con(e<(. Pe de a"(7 &ar(e, s!%&(o%e"e
    se%n!.!ca(!ve c"!n!c de !nso%n!e O! !&erso%n!e (re'+!e s7 .!e !nves(!$a(e, !nd!.eren(
    de e(a(ea !nd!v!d+"+!, !ar d!a$nos(!c+" de (+"'+rare de so%n :n "e$7(+r7 c+
    res&!ra=!a (re'+!e s7 .!e &+s, dac7 o &er(+r'are res&!ra(or!e e<&"!c7 ce" %a! '!ne
    s!%&(o%e"e.
    La ad+"=!, &ro&or=!a '7r'a=!X.e%e! c+ s!ndro% de a&nee de so%n o's(r+c(!v7
    %er$e de "a 9Q5 "a IQ5. Pr!n(re co&!!! &re&+'er(ar! n+ e<!s(7 d!.eren=e de se<. La
    ad+"=!, even!%en(e"e a&ne!ce cen(ra"e &ar a .! %a! .recven(e "a '7r'a=! decA( "a .e%e!,
    deO! aceas(7 d!.eren=7 es(e %a! &+=!n ev!den(7 d+&7 %eno&a+/7.
    #revalent
    Preva"en(a (+"'+r7r!! de so%n :n "e$7(+r7 c+ res&!ra=!a, asoc!a(7 c+ a&neea de
    so%n o's(r+c(!v7, es(e es(!%a(7 a .! de 5d45Ld :n &o&+"a=!a ad+"(7, dar &oa(e .! s!
    %a! %are "a !nd!v!/!! %a! :n e(a(e. Preva"en(a (+"'+r7r!! de so%n :n "e$7(+r7 c+
    >2E Tulburrile de Somn
    res&!ra=!a var!a/7 cons!dera'!" :n .+nc=!e de &ra$+" de .recven=7 a" even!%en(e"or
    a&ne!ce. Preva"en(a s!ndro%+"+! de a&nee de so%n cen(ra"7 n+ es(e c+nosc+(7
    &rec!s, dar es(e es(!%a(7 a .! 5Ld d!n ra(a s!ndro%+"+! de a&nee de so%n o's(r+c(!v7.
    *voluie
    S!ndro%+" de a&nee de so%n o's(r+c(!v7 &oa(e s+rven! "a or!ce e(a(e, dar ce! %a!
    %+"=! !nd!v!/! care se &re/!n(7 &en(r+ e<a%!nare s+n( :n e(a(e de IL4RL an! E"a .e%e!,
    es(e .oar(e &os!'!" s7 a&ar7 a&neea de so%n o's(r+c(!v7 d+&7 %eno&a+/7J. A&neea
    de so%n cen(ra"7 es(e o'serva(7 %a! .recven( "a !nd!v!/!! %a! :n e(a(e, c+ %a"ad!! a"e
    s!s(e%+"+! nervos cen(ra" sa+ card!ace. S!ndro%+" de !&oven(!"a=!e a"veo"ar7
    cen(ra"7 O! s!ndro%+" de a&nee de so%n cen(ra"7 &o( a&are "a or!ce e(a(e.
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a are +n de'+( !ns!d!os, &ro$res!+ne
    $rad+a"7 s! evo"+=!e cron!c7. Ce" %a! adesea, (+"'+rarea es(e &re/en(7 de@a de %+"=!
    an!, :n %o%en(+" d!a$nos(!c7r!!. Re/o"varea s&on(an7 a s!ndro%+"+! de a&nee de
    so%n o's(r+c(!v7 a .os( re"a(a(7 oda(7 c+ &!erderea :n $re+(a(e, dar de re$+"7
    evo"+=!a es(e &ro$res!v7 s! &oa(e d+ce :n .!na" "a %oar(e &re%a(+r7 &r!n(r4o %a"ad!e
    card!ovasc+"ar7 sa+ ar!(%!e. S!ndro%+" de a&nee de so%n cen(ra"7 are, de
    ase%enea, o evo"+=!e cron!c7 nonre%!(en(7, deO! (ra(a%en(+" cond!=!!"or %ed!ca"e
    s+'!acen(e &oa(e a%e"!ora &er(+r'area res&!ra(or!e. Ad+"=!! c+ s!ndro% de
    !&oven(!"a=!e a"veo"ar7 cen(ra"7 a+ o evo"+=!e %a! "en( &ro$res!v7.
    #attern $amilial
    A .os( descr!s7 o (end!n=7 .a%!"!a"7 "a s!ndro%+" de a&nee de so%n o's(r+c(!v7.
    Dia!nostic di$erenial
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a (re'+!e s7 .!e d!.eren=!a(7 de a"(e
    ca+/e de so%no"en=7, c+% ar .! narco"e&s!a, !&erso%n!a &r!%ar7 s! (+"'+rarea
    r!(%+"+! c!rcad!an de so%n. T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a &oa(e .!
    d!.eren=!a(7 de narco"e&s!e &r!n a'sen=a ca(a&"e<!e!, a a"+c!na=!!"or :n "e$7(+r7 c+
    so%n+" s! a &ara"!/!e! de so%n, O! &r!n &re/en=a +n+! s(er(or !n(ens, ane"a=!e :n
    (!%&+" so%n+"+! or! o'servarea de a&ne! sa+ de res&!ra=!e s+&er.!c!a"7 :n so%n.
    E&!soade"e de so%n d!+rn d!n narco"e&s!e s+n( :n %od carac(er!s(!c %a! sc+r(e, %a!
    recon.or(an(e, O! ce" %a! adesea, asoc!a(e c+ v!se. T+"'+rarea de so%n :n "e$7(+r7 c+
    res&!ra=!a &re/!n(7 a&ne! carac(er!s(!ce sa+ !&oven(!"a=!e :n c+rs+" s(+d!!"or
    &o"!so%no$ra.!ce noc(+rne, !ar narco"e&s!a d+ce "a %+"(!&"e &er!oade de REM "a
    :nce&+(+" so%n+"+! :n c+rs+" TLSM. Un!! !nd!v!/! a+ conco%!(en( narco"e&s!e O!
    (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a. T+"'+rarea de so%n :n "e$7(+r7 c+
    res&!ra=!a &oa(e .! d!s(!ns7 de !&erso%n!a &r!%ar7 O! de (+"'+rarea r!(%+"+!
    c!rcad!an de so%n &e 'a/a &re/en=e! da(e"or c"!n!ce sa+ de "a'ora(or a"e s!ndro%e"or
    de a&nee de so%n o's(r+c(!v7, de a&nee de so%n cen(ra"7 or! de !&oven(!"a=!e
    a"veo"ar7 cen(ra"7. D!a$nos(!c+" d!.eren=!a" e<ac(, :n(re !&erso%n!a &r!%ar7 s!
    (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a, &oa(e neces!(a s(+d!! &o"!so%no$ra.!ce.
    H!&erso%n!a :n "e$7(+r7 c+ e&!sod+" de&res!v %a@or &oa(e .! d!s(!ns7 de
    (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a &r!n &re/en=a sa+ a'sen=a a"(or
    s!%&ro%e carac(er!s(!ce Ede e<., d!s&o/!=!e de&res!v7 O! &!erderea !n(eres+"+! :n(r4+n
    e&!sod de&res!v %a@or O! s(er(or+" O! ane"a=!a :n c+rs+" (+"'+r7r!! de so%n :n
    "e$7(+r7 c+ res&!ra=!aJ.
    ?852A6 Tulburarea de Somn "n le!tur cu +espiraia I7E
    Ind!v!/!! c+ (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a (re'+!e, de ase%enea,
    s7 .!e d!.eren=!a=! de a"=! ad+"=! as!%&(o%a(!c! care s.or7!e. Aceas(7 d!.eren=!ere
    &oa(e .! .7c+(7 &e 'a/a ac+/e! de !nso%n!e sa+ !&erso%n!e &re/en(a(e, a
    !n(ens!(7=!! %a! %ar! a s(eror+"+! s! &re/en=e! +n+! !s(or!c carac(er!s(!c, a se%ne"or s!
    s!%&(o%e"or de (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a. Pen(r+ !nd!v!/!! care se
    &"An$ de !nso%n!e, !nso%n!a &r!%ar7 &oa(e .! d!.eren=!a(7 de (+"'+rarea de so%n
    :n "e$7(+r7 c+ res&!ra=!a &r!n a'sen=a ac+/e"or Eor! a re"a(7r!"or de "a &ar(ener!! de
    &a(J de d!.!c+"(a(e :n res&!ra=!e :n (!%&+" so%n+"+! s! a'sen=a !s(or!c+"+!, a se%ne"or
    s! s!%&(o%e"or carac(er!s(!ce de (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a.
    A(ac+r!"e de &an!c7 noc(+rne &o( !nc"+de s!%&(o%e de ane"a=!e sa+ de
    s+.ocare :n (!%&+" so%n+"+!, care &o( .! d!.!c!" de d!s(!ns c"!n!c de (+"'+rarea de
    so%n :n "e$7(+r7 c+ res&!ra=!a, :ns7, .recven=a %a! red+s7 a e&!soade"or, e<c!(a=!a
    ve$e(a(!v7 !n(ens7 s! "!&sa so%no"en=e! e<ces!ve d!.eren=!a/7 a(ac+r!"e de &an!c7
    noc(+rn7 de (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a. Po"!so%no$ra.!a "a
    !nd!v!/!! c+ a(ac+r! de &an!c7 noc(+rn7 n+ re"ev7 &a((ern+r! (!&!ce de a&nee,
    !&oven(!"a=!e sa+ desa(+rare :n o<!$en carac(er!s(!ce (+"'+r7r!! de so%n :n "e$7(+r7
    c+ res&!ra=!a.
    T+"'+rarea !&erac(!v!/(a(e4de.!c!( de a(en=!e "a co&!! &oa(e !nc"+de s!%&(o%e
    de !na(en=!e, de(er!orare Oco"ar7 s! !&erac(!v!(a(e, (oa(e .!!nd s!%&(o%e s! a"e a&ne!!
    de so%n a co&!"7r!e!. Pre/en=a a"(or se%ne s! s!%&(o%e de a&nee de so%n a
    co&!"7r!e! Ede e<., res&!ra=!e d!.!c!"7 sa+ s(er(or :n (!%&+" so%n+"+! s! !&er(ro.!e
    adeno(ons!"ar7J ar (re'+! s7 s+$ere/e &re/en=a +ne! (+"'+r7r! de so%n :n "e$7(+r7
    c+ res&!ra=!a.
    D!a$nos(!c+" de (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a es(e adecva( :n
    &re/en=a +ne! cond!=!! %ed!ca"e $enera"e care ca+/ea/7 !nso%n!e sa+ !&erso%n!e
    &r!n %ecan!s%+" de(er!or7r!! ven(!"a=!e! :n c+rs+" so%n+"+!. De e<e%&"+, +n !nd!v!d
    c+ !&er(ro.!e a%!$da"!an7, care are d!.!c+"(7=! de so%n :n "e$7(+r7 c+ s(er(or+" s!
    a&ne!"e de so%n o's(r+c(!ve (re'+!e s7 &r!%easc7 d!a$nos(!c+" de (+"'+rare de so%n
    :n "e$7(+r7 c+ res&!ra=!a, &e a<a I, s! de !&er(ro.!e a%!$da"!an7, &e a<a 5E7 D!n
    con(ra, (+"'+rarea de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e es(e adecva(7,
    dac7 o cond!=!e %ed!ca"7 $enera"7 sa+ ne+ro"o$!c7 ca+/ea/7 s!%&(o%e :n "e$7(+r7
    c+ so%n+" &r!n(r4+n a"( %ecan!s% decA( &er(+r'area res&!ra=!e!. De e<e%&"+,
    !nd!v!/!! c+ ar(r!(7 sa+ !ns+.!c!en=7 rena"7 se &o( &"An$e de !nso%n!e sa+
    !&erso%n!e, dar aceas(a n+ re/+"(7 d!n a"(erarea res&!ra=!e! :n c+rs+" so%n+"+!.
    U/+" sa+ a's(!nen=a de o s+'s(an=7 E!nc"+s!v de %ed!ca%en(eJ &oa(e &rod+ce
    !nso%n!e sa+ !&erso%n!e s!%!"are ce"or d!n (+"'+rarea de so%n :n "e$7(+r7 c+
    res&!ra=!a. Un !s(or!c a(en( es(e de re$+"7 s+.!c!en( &en(r+ a !nd!ca s+'s(an=a
    re"evan(7, !ar +r%7r!rea a(en(7 !nd!c7 &er(+r'area de so%n d+&7 :n(rer+&erea
    s+'s(an=e!, :n a"(e ca/+r!, +/+" +ne! s+'s(an=e Ede e<., a"coo", 'ar'!(+r!ce,
    'en/od!a/e&!ne sa+ (a'acJ s4a ar7(a( a .! asoc!a( c+ (+"'+rarea de so%n :n "e$7(+r7
    c+ res&!ra=!a. Un !nd!v!d c+ s!%&(o%e s! se%ne concordan(e c+ (+"'+rarea de so%n
    :n "e$7(+r7 c+ res&!ra=!a (re'+!e s7 &r!%easc7 aces( d!a$nos(!c, c!ar :n &re/en=a
    +/+"+! conco%!(en( a" +ne! s+'s(an=e care e<acer'ea/7 cond!=!a.
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a es(e !den(!.!ca(7 :n (re! s!ndro%e
    %a! s&ec!.!ce d!n C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n ECITSJQ
    s!ndro%+" de a&nee de so%n o's(r+c(!v7, s!ndro%+" de a&nee de so%n cen(ra"7 s!
    s!ndro%+" de !&oven(!"a=!e a"veo"ar7 cen(ra"7.
    >22 Tulburrile de Somn

    Criteriile $e $ia/no&ti# pentru
    G>+.<5 Tul-urarea $e So"n .n Le/(tur( #u Re&pira!ia
    A2 "ntrerupere a somnului, duc@nd la somnolen excesiv sau insomnie, care
    este considerat a $i datorat unei condiii respiratorii "n le!tur cu somnul
    &de ex2, sindromul de apnee de somn obstructiv sau sindromul de
    %ipoventilaie alveolar central)2
    S2 #erturbarea nu este explicat mai bine de alt tulburare mental si nu se
    datorea( e$ectelor $i(iolo!ice directe ale unei substane &de ex2, un dro! de
    abu(, un medicament) ori ale altei condiii medicale !enerale &alta dec@t o
    tulburare "n le!tur cu respiraia)2
    Fot de codi$icareD A se codi$ica, de asemenea, tulburarea de respiraie "n
    le!tur cu somnul, pe axa III2
    4+G.7< Tul-urarea Rit"ului Cir#a$ian $e So"n
    (anterior Tul-urarea Rit"ului So"n-Ve/@e6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! r!(%+"+! c!rcad!an de so%n :" cons(!(+!e +n
    &a((ern &ers!s(en( sa+ rec+ren( de :n(rer+&ere a so%n+"+!, care re/+"(7 d!n(r4o
    !nadecvare :n(re s!s(e%+" de so%nv!4$!"!(a(e c!rcad!an endo$en a" !nd!v!d+"+!, &e
    de o &ar(e, s! so"!c!(7r!"e e<(erne re.er!(oare "a orar!+" s! d+ra(a so%n+"+!, &e de a"(7
    &ar(e ECr!(er!+" AJ, :n con(ras( c+ a"(e (+"'+r7r! &r!%are de so%n, (+"'+rarea
    r!(%+"+! c!rcad!an de so%n n+ re/+"(7 d!n %ecan!s%e care $enerea/7 so%n+" s!
    v!$!"!(a(ea &er se. Ca +r%are a aces(e! !nadecv7r! c!rcad!ene, !nd!v!/!! c+ aceas(7
    (+"'+rare se &o( &"An$e de !nso%n!e :n an+%!(e %o%en(e a"e /!"e! s! de so%no"en=7
    e<ces!v7 :n a"(e"e, c+ de(er!orarea re/+"(an(7 :n do%en!+" soc!a", &ro.es!ona" or! :n
    a"(e do%en!! !%&or(an(e de .+nc=!onare sa+ de(res7 s+'!ec(!v7 %arca(7 Ecr!(er!+" BJ.
    Pro'"e%e"e so%n+"+! n+ s+n( e<&"!ca(e %a! '!ne de a"(e (+"'+r7r! de so%n or! de
    a"(e (+"'+r7r! %en(a"e Ecr!(er!+" CJ s! n+ s+n( da(ora(e e.ec(e"or .!/!o"o$!ce d!rec(e
    a"e +ne! s+'s(an=e sa+ a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" DJ.
    D!a$nos(!c+" de (+"'+rare a r!(%+"+! c!rcad!an de so%n (re'+!e re/erva( ace"or
    &re/en(7r! :n care !nd!v!d+" are o de(er!orare soc!a"7 sa+ &ro.es!ona"7 se%n!.!ca(!v7,
    sa+ o de(res7 %arca(7 :n "e$7(+r7 c+ &er(+r'area so%n+"+!. Ind!v!/!! var!a/7 .oar(e
    %+"( s+' as&ec(+" ca&ac!(7=!! "or de a se ada&(a "a sc!%'7r!"e s! so"!c!(7r!"e
    co(!d!ene. M+"=!, dac7 n+ ce! %a! %+"=! !nd!v!/! c+ s!%&(o%e de (+"'+rare a
    so%n+"+! :n "e$7(+r7 c+ r!(%+" c!rcad!an n+ so"!c!(7 (ra(a%en( s! n+ &re/!n(7
    s!%&(o%e de s+.!c!en(7 sever!(a(e &en(r+ a @+s(!.!ca +n d!a$nos(!c. Ce! care se
    &re/!n(7 &en(r+ e<a%!nare d!n ca+/a aces(e! (+"'+r7r! s+n( ce" %a! adesea a.ec(a=!
    de sever!(a(ea sa+ &ers!s(en=a s!%&(o%e"or "or. De e<e%&"+, n+ es(e rar ca
    %+nc!(or!! care "+crea/7 :n (+re s7 se &re/!n(e &en(r+ e<a%!nare d+&7 ce a+ ador%!(
    :n (!%&+" serv!c!+"+! sa+ :n (!%& ce cond+cea+ +n ve!c+".
    D!a$nos(!c+" de (+"'+rare a r!(%+"+! c!rcad!an de so%n se 'a/ea/7 :n &r!%+" rAnd
    &e !s(or!c+" c"!n!c, !nc"+/And &a((ern+" de ac(!v!(a(e, so%n+", a=!&e"!"e s! S(!%&+" "!'erT.
    45?2HA Tulburarea +itmului ircadian de
    Somn &anterior Tulburarea +itmului Somn-
    Ve!%e)
    =C4

    Is(or!c+" (re'+!e, de ase%enea, s7 e<a%!ne/e (en(a(!ve"e an(er!oare de aco%odare c+
    s!%&(o%e"e, c+% ar .! :ncerc7r!"e de avansare a orar+"+! de so%n4v!$!"!(a(e :n (!&+" de
    .a/7 de so%n :n(Ar/!a(. Ca"endare"e des(!na(e conse%n7r!! ore"or de so%n s! v!$!"!(a(e
    sa+ d!a$ra%e"e de so%n s+n( adesea +n a+<!"!ar +(!" :n d!a$nos(!c.
    Subtipuri
    T!&+" de .a/7 de so%n :n(Ar/!a(. Aces( (!& de (+"'+rare a r!(%+"+! c!rcad!an
    de so%n se carac(er!/ea/7 &r!n(r4o :n(Ar/!ere a r!(%+r!"or c!rcad!ene, !nc"+s!v
    a c!c"+"+! so%n4v!$!"!(a(e, :n ra&or( c+ cerer!"e soc!e(7=!!. M7s+r7r!"e
    r!(%+r!"or c!rcad!ene endo$ene Ede e<., (e%&era(+ra !n(ern7 a cor&+"+!,
    n!ve"e"e %e"a(on!ne! &"as%a(!ceJ d!n c+rs+" orar!+"+! de so%n4v!$!"!(a(e Ede
    re$+"7, :n(Ar/!a(J a" !nd!v!d+"+! re."ec(7 aceas(7 :n(Ar/!ere. Ind!v!/!! c+ aces(
    s+'(!& se &res+&+ne c7 a+ o ca&ac!(a(e d!%!n+a(7 anor%a" &en(r+ ore"e de
    so%n4v!$!"!(a(e :n avans de .a/7 Ead!c7, de a de&"asa so%n+" O! v!$!"!(a(ea
    s&re ore %a! (!%&+r!!J or! o a"(erare :n a"!n!erea +/+a"7 a so%n+"+! c+ a"(e
    r!(%+r! c!rcad!ene. Ca +r%are a aces(+! .a&(, aceO(! !nd!v!/! se Sc+"c7T de
    re$+"7 "a ore (Ar/!! s! a+ %ar! d!.!c+"(7=! :n a de&"asa aces(e ore de so%n %a!
    :na!n(e. Fa/a c!rcad!an7 de so%n es(e s(a'!"7Q !nd!v!/!! se vor c+"ca s! se vor
    deO(e&(a "a ore concordan(e, deO! (Ar/!! cAnd s+n( "7sa=! "a d!s&o/!=!a
    &ro&r!+"+! "or orar de so%n Ede e<., :n #ee)end sa+ :n conced!+J.Ind!v!/!!
    a.ec(a=! se &"An$ de d!.!c+"(a(e :n a ador%! "a ore acce&(a'!"e soc!a", dar oda(7
    ce ador%, so%n+" es(e nor%a". Conco%!(en(, e<!s(7 d!.!c+"(7=! :n deO(e&(area
    "a ore acce&(a'!"e soc!a" Ede e<., soner!a ceas+"+! es(e adesea !nca&a'!"7 s7
    deO(e&(e !nd!v!d+" d!n so%nJ. M+"=! !nd!v!/! c+ aceas(7 (+"'+rare vor .! cron!c
    de&r!va=! de so%n, ca re/+"(a( a" neces!(7=!! de a se deO(e&(a d!%!nea=a &en(r+
    o'"!$a=!!"e soc!a"e s! oc+&a=!ona"e. Poa(e s+rven! so%no"en=a :n (!%&+"
    &er!oade! de v!$!"!(a(e dor!(e.
    T!&+" de deca"a@ de .+s orar. :n aces( (!& de (+"'+rare a r!(%+"+! c!rcad!an de
    so%n, c!c"+" c!rcad!an de so%n4v!$!"!(a(e endo$en es(e nor%a", !ar (+"'+rarea
    a&are d!n con."!c(+" d!n(re &ar(ern+" de so%n O! v!$!"!(a(e $enera( de s!s(e%+"
    c!rcad!an O! &a((ern+" de so%n cer+( de o /on7 orar7 no+7. Ind!v!/!! c+ aces(
    (!& se &"An$ de o !nadecvare :n(re ore"e dor!(e O! ce"e cer+(e de so%n O!
    v!$!"!(a(e. Sever!(a(ea !nadecv7r!! es(e &ro&or=!ona"7 c+ n+%7r+" de /one
    orare (raversa(e, c+ %a<!%+% de d!.!c+"(7=! no(a(e adesea d+&7 c7"7(or!a
    &r!n o&( sa+ %a! %+"(e .+se orare :n %a! &+=!n de 9I de ore. C7"7(or!a s&re
    es( Eavansarea ore"or de so%n4v!$!"!(a(eJ es(e de re$+"7, &en(r+ ce! %a! %+"=!
    !nd!v!/!, %a! d!.!c!" de (o"era( decA( c7"7(or!a s&re ves( Ea%Anarea ore"or de
    so%n4v!$!"!(a(eJ.
    T!&+" de "+cr+ :n (+re. :n aces( (!& de (+"'+rare a r!(%+"+! c!rcad!an de so%n,
    c!c"+" c!rcad!an de so%n4v!$!"!(a(e endo$en es(e nor%a", !ar (+"'+rarea
    &rov!ne d!n con."!c(+" d!n(re &a((ern+" de so%n O! v!$!"!(a(e $enera( de
    s!s(e%+" c!rcad!an O! &a((ern+" dor!( de so%n s! v!$!"!(a(e cer+( de "+cr+" :n
    (+re. Orar!!"e de (+r7 de noa&(e Ec+ reven!rea "a orar!+" de /!, cA(eva /!"e %a!
    (Ar/!+J s! orar!!"e de (+re &r!n ro(a=!e s+n( ce"e %a! &er(+r'an(e, deoarece e"e
    .or=ea/7 so%n+" O!. v!$!"!(a(ea :n &o/!=!! c!rcad!ene a'eran(e, O! &rev!n or!ce
    ada&(are cons(an(7. M+nc!(or!! c+ aces(e (+re a+ de re$+"7 o d+ra(7 de so%n
    %a! sc+r(7 O! &er(+r'7r! %a! .recven(e :n con(!n+!(a(ea so%n+"+! decA(
    %+nc!(or!! care "+crea/7 d!%!nea=a sa+ d+&7 a%!a/7. Invers, aceO(! !nd!v!/!
    se &o( s!%=! so%noroO! sa+ &o( ador%! :n (!%&+" &er!oade! de v!$!"!(a(e dor!(e,
    R9I Tulburrile de Somn
    ad!c7 :n %!@"oc+" (+re! de "+cr+ de noa&(e. Orar!!"e de "+cr+ care !%&"!c7 (+re
    care se ro(ea/7 %a! "en( sa+ ro(area "a (+re"e an(er!oare :n %od &ro$res!v
    Ead!c7, noa&(e, d+&7 a%!a/7, /!J E(+ra III 4 (+ra II 4 (+ra IJ s+n(, de ase%enea,
    asoc!a(e c+ +n $rad %are de &er(+r'are a so%n+"+! s! a"(e ac+/e, decA( a"(e
    (!&+r! de orar!! de (+re &r!n ro(a=!e. Inadecvarea c!rcad!an7 a (!&+"+! de "+cr+
    :n (+re es(e a&o! e<acer'a(7 de (!%&+" de so%n !ns+.!c!en(, de so"!c!(7r!"e
    soc!a"e s! .a%!"!a"e, +/+" de a"coo" s! de &er(+r'7r!"e a%'!en(a"e Ede e<.,
    (e"e.on+", vacar%+" (ra.!c+"+!J :n (!%&+" ore"or de so%n !n(en=!ona(e. T!&
    nes&ec!.!ca(. Aces( (!& de (+"'+rare a r!(%+"+! c!rcad!an de so%n (re'+!e s7
    .!e !nd!ca( dac7 es(e &re/en( a"( &a((ern de &er(+r'are c!rcad!an7 de so%n
    Ede e<., .a/7 de so%n avansa(, &a((ern de so%n4v!$!"!(a(e de non49I ore or! +n
    &a((ern so%n4v!$!"!(a(e nere$+"a(J. Un S&a((ern de .a/7 de so%n avansa(T
    es(e ana"o$+" (!&+"+! de .a/7 de so%n :n(Ar/!a(, dar :n d!rec=!e o&+s7Q
    !nd!v!/!! se &"An$ de ca&ac!(a(ea de a .! v!$!"!, seara, s! de deO(e&(are s&on(an7
    "a &r!%e"e ore a"e d!%!ne=!!. SPar(ern+" de so%n4v!$!"!(a(e non49I oreT deno(7
    +n c!c"+ "!'er con(!n++Q orar+" de so%n4v!$!"!(a(e +r%ea/7 &er!oada de r!(%
    c!rcad!an endo$en de &es(e 9I ore, :n d!s&re=+" &re/en=e! se%na"e"or +n+!
    (!%& de 9I ore :n a%'!an=7. Con(rar &ar(ern+"+! de so%n4v!$!"!(a(e s(a'!" a"
    (!&+r!"or de .a/7 de so%n :n(Ar/!a( sa+ avansa(, orar!!"e de so%n4v!$!"!(a(e a"e
    aces(or !nd!v!/! dev!n &ro$res!v :n(Ar/!a(e :n ra&or( c+ ora 9I a oro"o$!+"+!,
    d+cAnd "a o %od!.!care a &a((ern+"+! de so%n4v!$!"!(a(e s! "a o sc!%'are a
    ac+/e"or de so%n4v!$!"!(a(e :n /!"e"e +r%7(oare Ede e<., %a! %+"(e /!"e de
    !nso%n!e "a :nce&+(+" so%n+"+!, +r%a(e de /!"e c+ so%no"en=7 :n c+rs+" /!"e!,
    +r%a(e de /!"e de d!.!c+"(a(e :n a .! v!$!" searaJ. SPa((ern+" de so%n4v!$!"!(a(e
    nere$+"a(T !nd!c7 a'sen=a +n+! &a((ern !den(!.!ca'!" de so%n s! v!$!"!(a(e.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e, :n (!&+" de .a/7 de so%n
    :n(Ar/!a(, :n %od .recven(, !nd!v!/!! %er$ (Ar/!+ "a c+"care s! se deO(ea&(7 (Ar/!+ :n
    #ee)4end4+r! sa+ :n conced!!, c+ o red+cere a d!.!c+"(7=!"or :n de'+(+" so%n+"+! s!
    d!.!c+"(a(e :n deO(e&(are. E! vor da %+"(e e<e%&"e de d!.!c+"(7=! "a scoa"7, "a serv!c!+
    sa+ :n soc!e(a(e &roven!nd d!n !nca&ac!(a(ea "or de a se deO(e&(a "a ore"e cer+(e
    soc!a". Dac7 se deO(ea&(7 %a! d!n (!%& decA( ora d!c(a(7 de s!s(e%+" c!rcad!an de
    crono%e(rare, !nd!v!d+" &oa(e &re/en(a S'e=!e de so%nT Ead!c7, d!.!c+"(a(e e<(re%7
    :n a se deO(e&(a, con.+/!e O! co%&or(a%en( !nadecva(J. F+nc=!onarea +r%ea/7
    adesea o .a/7 :n(Ar/!a(7, c+ +n &!c a" e.!c!en=e! s+rven!nd (Ar/!+, s&re sear7.
    T!&+" de .+s orar &oa(e .! %a! .recven( "a !nd!v!/!! care s+n( S=!&! %a(!na"!T.
    Aces(a es(e asoc!a( adesea de s!%&(o%e ca de(er!orarea concen(r7r!! O! %e%or!e!,
    de(er!orarea coordon7r!!, de'!"!(a(e, a%e=ea"7, ce.a"ee, .a(!$a'!"!(a(e, %a"e/7,
    sc7derea a&e(!(+"+! O! !nd!$es(!e. Aces(e s!%&(o%e &o( .! :n "e$7(+r7 n+ n+%a! c+
    !nadecvarea c!rcad!an7, dar O! c+ a"(e cond!=!! a"e c7"7(or!e! c+% ar .! de&r!varea de
    so%n, +/+" de a"coo" s! ca.e!na O! sc7derea &res!+n!! aer+"+! a%'!en(a" :n av!on.
    Per.or%an=a es(e adesea de(er!ora(7, +r%And &a((ern+" care ar .! (re'+!( s7 .!e
    &rev7/+( de r!(%+r!"e c!rcad!ene endo$ene s+'!acen(e.
    T!&+" de "+cr+ :n (+re, de ase%enea, &oa(e .! %a! .recven( "a !nd!v!/!! care s+n(
    Sc!ocAr"!! %a(!na"eT. Concen(rarea s! a(en=!a, e.!c!en=a O! a$!"!(a(ea s+n( adesea
    de(er!ora(e :n c+rs+" ore"or de v!$!"!(a(e dor!(e, d+&7 &a((ern+" care ar .! &red!ca( de
    r!(%+r!"e c!rcad!ene endo$ene s+'!acen(e. Ca"!(a(ea red+s7 a v!e=!! O! d!s.+nc=!a :n
    ro"+r!"e soc!a", .a%!"!a" O! oc+&a=!ona" s+n( o'serva(e "a %+nc!(or!! care "+crea/7 :n
    45?2HA Tulburarea +itmului ircadian de
    Somn &anterior Tulburarea +itmului Somn-
    Ve!%e)
    >25

    (+re, :n s&ec!a" "a ce! care a+ d!.!c+"(7=! de so%n. L+cr+" :n (+re es(e +n .ac(or de r!sc
    &en(r+ so%no"en=a :n "e$7(+r7 c+ %+nca s! c+ acc!den(e"e de ve!c+" c+ %o(or.
    Pa((ern+" de so%n v!$!"!(a(e de non 9I ore a .os( descr!s %a! :n(A! "a !nd!v!/!!
    or'!, s! :n s&ec!a" "a ce! care n+ &erce& "+%!na Ede e<., &r!n .!'ro/7 re(rocr!s(a"!n!an7
    sa+ en+c"eere c!r+r$!ca"7J ca o&+O! ce"or c+ +n an+%!( $rad de &erce&=!e
    "+%!noas7 conO(!en(7. A=!&!rea O! !nso%n!a s+rven!nd re$+"a( a&ar cAnd r!(%+r!"e
    c!rcad!ene endo$ene a"e !nd!v!d+"+! Ecare s+n( +Oor %a! "+n$! decA( 9I oreJ !es d!n
    .a/a c+ c!c"+" "+%!n74:n(+ner!c O! ore"e de so%n4v!$!"!(a(e cores&+n/7(oare soc!a".
    Ind!v!/!! c+ or!ce (+"'+rare a r!(%+"+! c!rcad!an de so%n &o( +(!"!/a can(!(7=!
    cresc+(e de a"coo", seda(!ve4!&no(!ce sa+ s(!%+"an(e :n :ncercarea de a4O! con(ro"a
    (end!n=e"e de so%n4v!$!"!(a(e .a/a(e necores&+n/7(or. U/+" aces(or s+'s(an=e &oa(e,
    :n sc!%', e<acer'a (+"'+rarea r!(%+"+! c!rcad!an de so%n.
    T!&+" de .a/7 de so%n :n(Ar/!a( a .os( asoc!a( c+ e"e%en(e de &ersona"!(a(e
    sc!/o!d7, sc!/o(!&a"7 s! ev!(an(7, :n s&ec!a" "a ado"escen=! s!, de ase%enea, c+
    s!%&(o%e de&res!ve O! c+ (+"'+r7r! de&res!ve. SPa((ern+" de so%n4v!$!"!(a(e de non4
    9I oreT s! S&a((ern+" nere$+"a( de so%n4v!$!"!(a(eT a+ .os(, de ase%enea, asoc!a(e c+
    aces(e e"e%en(e. T!&+r!"e de sc!%'are de .+s orar s! de "+cr+ :n (+re &o( &rec!&!(a
    sa+ e<acer'a +n e&!sod %an!aca" sa+ de&res!v %a@or, or! +n e&!sod a" +ne! (+"'+r7r!
    &s!o(!ce. L+cr+" :n (+re es(e asoc!a(, de ase%enea, c+ s!%&(o%e de&res!ve.
    9ate de laborator asociate. S(+d!!"e so%n+"+! o.er7 re/+"(a(e d!.er!(e :n .+nc=!e
    de (!%&+" cAnd s+n( e.ec(+a(e. Pen(r+ !nd!v!/!! c+ (!&+" de .a/7 de so%n :n(Ar/!a(,
    s(+d!!"e e.ec(+a(e :n ore"e de so%n &re.era(e vor .! :n esen=7 nor%a"e &en(r+ e(a(ea
    res&ec(!v!"or. Ins7, cAnd s+n( s(+d!a=! "a ore"e de so% soc!a" nor%a", aceO(! !nd!v!/!
    a+ o "a(en=7 &re"+n$!(7 de so%n, o e.!c!en=7 a so%n+"+! red+s7 Eda(ora(7 :n s&ec!a"
    d!.!c+"(7=!"or de :nce&+( a"e so%n+"+!J, o d+ra(7 red+s7 a so%n+"+!, !ar "a +n!!
    !nd!v!/!, e<!s(7 o "a(en=7 de so%n REM %odera( sc+r(a(7. Procedee"e de "a'ora(or
    des(!na(e s7 %7soare .a/a &ace%a)er4+"+! c!rcad!an endo$en Ede e<., (e%&era(+ra
    !n(ern7 a cor&+"+!, n!ve"e"e de %e"a(on!n7 &"as%a(!c7J re"ev7 :n(Ar/!erea .a/e!
    aO(e&(a(e :n re$"area acro.a/e! E&ea) (!%eJ s! nad!r+"+!, cAnd !nd!v!/!! s+n( s(+d!a=!
    :n c+rs+" &er!oade"or de so%n4v!$!"!(a(e +/+a"e, :n &"+s, (!%&+" de deO(e&(are &oa(e
    .! :n(Ar/!a( :n co%&ara=!e c+ a"(e r!(%+r! c!rcad!ene.
    CAnd s+n( s(+d!a=! :n (!%&+" ore"or de so%n d!n c+rs+" +ne! s7&(7%An! de "+cr+
    +/+a"e, !nd!v!/!! c+ (!&+" de "+cr+ :n (+re a+ de re$+"7 o "a(en=7 de so%n nor%a"7
    sa+ sc+r(7, o d+ra(7 de so%n red+s7 s! &er(+r'7r! %a! .recven(e a"e con(!n+!(7=!!
    so%n+"+! :n co%&ara=!e c+ !nd!v!/!! de aceeaO! e(a(e c+ &a((ern+r! de so%n noc(+rn
    Snor%a"eT. E<!s(7 o red+cere s&ec!.!c7 a s(ad!!"or 9, ; s! I, s! a so%n+"+! REM :n
    %+"(e ca/+r!. S4a cons(a(a( c7 &a((ern+r!"e &o"!so%no$ra.!ce "a ce! care "+crea/7 :n
    (+re r7%An s(a'!"e s! &es(e +n !n(erva" de 9 an!, s+$erAnd n!c! ada&(are n!c!
    :nr7+(7=!re. M7s+r7r!"e so%no"en=e! .!/!o"o$!ce, c+% ar .! (es(+" de "a(en=7 de so%n
    %+"(!&"+ ETLSMJ ara(7 +n $rad r!d!ca( de so%no"en=7 :n (!%&+" ore"or de v!$!"!(a(e
    dor!(7 Ede e<., :n (!%&+" (+re! de noa&(eJ. D+&7 o &er!oad7 de ada&(are "a +n
    &ro$ra% d!+rn nor%a", aceO(! !nd!v!/! a+ +n so%n noc(+rn nor%a" O! n!ve"e
    nor%a"e a"e so%no"en=e! d!+rne. CAnd s+n( s(+d!a=! :n (!%&+" ore"or +/+a"e de
    "+cr+ :n (+re :n a%'!an=a "or +/+a"7, ce! care "+crea/7 :n (+re &re/!n(7 %od!.!c7r! :n
    s!ncron!/area c"ar7 a r!(%+r!"or "or c!rcad!ene :n co%&ara=!e c+ &a((ern+r!"e d!+rne
    nor%a"e. Aces(e &a((ern+r! d+c :ns7 rar, dac7 n+ c!ar n!c!oda(7 "a o or!en(are
    noc(+rn7 co%&"e(7. In(erven=!!, c+% ar .! "+%!na s(r7"+c!(oare &o( co%+(a r!(%+r!"e
    c!rcad!ene endo$ene :n .a/e c+ co%+(are noc(+rn7, dar n+ a%e"!orea/7 :n %od
    necesar ac+/e"e sa+ &er.or%an=a s+'!ec(+"+!. L+cr+" :n (+r7 de noa&(e &oa(e .!
    asoc!a( c+ creO(erea n!ve"e"or (r!$"!cer!de"or sa+ co"es(ero"+"+!.
    R9R Tulburrile de Somn
    S(+d!!"e de "a'ora(or a"e +n+! .+s orar s!%+"a( de%ons(rea/7 o "a(en=7 de so%n
    cresc+(7, de(er!orarea e.!c!en(e! so%n+"+!, red+cerea so%n+"+! REM s! red+cer!
    %!nore :n so%n+" c+ +nde "en(e. Aces(e e"e%en(e rev!n "a "!n!a de 'a/7 :n dec+rs
    de 549 s7&(7%An! s! s+n( %a! severe :n c+rs+" c7"7(or!e! s!%+"a(e s&re es( Ead!c7 ore
    de so%n avansa(J decA( a" c7"7(or!e! s!%+"a(e s&re ves( Ead!c7, ore de so%n
    :n(Ar/!a(J. A"(e da(e de "a'ora(or, :nc"+/And r!(%+r!"e c!rcad!ene a"e %e"a(on!ne!,
    (e%&era(+ra !n(ern7 a cor&+"+!, v!$!"en=a s! &er.or%an=a, !a+, de ase%enea, cA(eva
    /!"e sa+ s7&(7%An! &en(r+ a se ada&(a d+&7 (!&+" de deca"a@ de .+s orar s!%+"a(.
    Pa((ern+" de so%n4v!$!"!(a(e non 9I ore "a !nd!v!/!! or'! es(e adesea carac(er!/a(
    &r!n r!(%+r! c!rcad!ene S"!'er con(!n++T a"e (e%&era(+r!! !n(erne a cor&+"+!,
    secr(e=!e! de %e"a(on!n7 s! (end!n=e! "a so%n. C+ a"(e c+v!n(e, aces(e r!(%+r! a+ o
    &er!oad7 +Oor %a! "+n$7 decA( 9I ore, s!%!"ar7 c+ a !nd!v!/!"or de&r!va=! de so%n
    o'serva=! :n cond!=!! e<&er!%en(a"e s! "!&s!=! de or!ce !nd!c!+ (e%&ora". Ind!v!/!! c+
    S&a((ern de .a/7 de so%n avansa(, d+&7 c+% es(e de aO(e&(a(, &re/!n(7 +n orar %a!
    &recoce a" r!(%+r!"or c!rcad!ene de so%n, &rec+% s! o sc+r(are a &er!oade! r!(%+"+!
    c!rcad!an endo$en.
    Da(e"e e<a%!n7r!! so%a(!ce s! cond!=!!"e %ed!ca"e $enera"e. N+ s+n( descr!se
    n!c! +n .e" de da(e s&ec!.!ce &en(r+ (+"'+rarea r!(%+"+! c!rcad!an de so%n. Ce! care
    "+crea/7 :n (+re &o( &are (raO! "a .a=7 sa+ so%noroO! O! &o( avea +n.e<ces de
    &er(+r'7r! card!ovasc+"are O! $as(ro!n(es(!na"e, !nc"+/And $as(r!(a O! +"cer+" &e&(!c.
    Ro"+" ca.e!ne! O! cons+%+"+! de a"coo" O! a"(erarea &a((ern+r!"or de a"!%en(are n+ a+
    .os( eva"+a(e &e de&"!n :n aces(e ca/+r!. L+cr+" :n (+re a .os( asoc!a( c+ .ac(or! de r!sc
    &en(r+ (+"'+r7r! card!ovasc+"are, c+% ar .! !&er(ens!+nea, &a((ern+r!"e de &res!+ne
    san$+!n7 de 9I ore S.7r7 &an(7T, creO(erea "!&!de"or a(ero$en!ce O! %od!.!c7r!
    e"ec(rocard!o$ra.!ce anor%a"e E&re"+n$!rea !n(erva"+"+! DTJ. De ase%enea, &oa(e .!
    asoc!a( c+ o +Ooar7 creO(ere a r!sc+"+! &en(r+ o (+"'+rare card!ovasc+"ar7 rea"7, deO!
    n+ (oa(e s(+d!!"e a+ cons(a(a( aOa ceva. SPa((ern+" de so%n4v!$!"!(a(e non49I oreT
    s+rv!ne adesea "a !nd!v!/!! or'!, :n s&ec!a" "a ce! care n+ &erce& "+%!na. T+"'+rarea
    r!(%+"+! c!rcad!an de so%n &oa(e e<acer'a cond!=!!"e %ed!ca"e $enera"e.
    *lemente speci$ice etii
    De'+(+" (!&+"+! de .a/7 de so%n :n(Ar/!a( s+rv!ne ce" %a! adesea :n +"(!%a &ar(e
    a co&!"7r!e! s! :nce&+(+" &er!oade! de ad+"(. S!%&(o%e"e "+cr+"+! :n (+re s! a"e
    sc!%'7r!! de .+s orar s+n( descr!se adesea ca .!!nd %a! severe sa+ %a! +Oor de
    !nd+s :n cond!=!! de "a'ora(or :n +"(!%a &ar(e a e(7=!! %ed!! s! "a !nd!v!/!! %a! :n e(a(e
    :n co%&ara=!e c+ ad+"=!! (!ner!. Ad+"=!! %a! '7(rAn! &re/!n(7, de ase%enea, (+"'+r7r!
    de so%n &o"!so%no$ra.!c %a! severe +r%And s!%+"7r!! +ne! sc!%'7r! de .+s orar
    :n "a'ora(or, dar r!(%+r!"e "or c!rcad!ene &ar a se ada&(a :n aceeaO! %7s+r7 ca s! ce"e
    a"e ad+"=!"or %a! (!ner!. SPa((ern+" de .a/7 de so%n avansa(T creO(e, de ase%enea,
    c+ e(a(ea. Aces(e da(e &o( re/+"(a d!n de(er!orarea :n "e$7(+r7 c+ e(a(ea a so%n+"+!
    noc(+rn O! sc+r(area &er!oade! c!rcad!ene endo$ene.
    #revalent
    Pen(r+ n!c! +n+" d!n (!&+r!"e de (+"'+rare a r!(%+"+! c!rcad!an de so%n n+ a .os(
    '!ne s(a'!"!(7 &reva"en(a. Procen(e"e .recven=e! &en(r+ (!&+" de )a;6 de so%n
    :n(Ar/!a( :n &o&+"a=!a ance(a(7 a+ var!a( "ar$, %er$And de "a L,5 d "a Id "a ad+"=!
    s! &An7 "a Hd "a ado"escen=!. PAn7 "a RLd d!n(re ce! care "+crea/7 :n (+r7 de noa&(e
    &o( avea (!&+" de "+cr+ :n (+re.
    l
    45?2HA Tulburarea +itmului ircadian de Somn
    &anterior Tulburarea +itmului Somn-Ve!%e)
    >28
    *voluie
    T!&+" de .a/7 de so%n :n(Ar/!a( de'+(ea/7 de re$+"7 :n
    ado"escen=7, &+(And +r%a +n+! s(resor &s!osoc!a". F7r7
    !n(erven=!e, (!&+" de .a/7 de so%n :n(Ar/!a( d+rea/7 de re$+"7
    an! sa+ decen!!, dar se &oa(e Scorec(aT s! de "a s!ne, da(7
    .!!nd (end!n=a .a/e! r!(%+"+! c!rcad!an endo$en de a avansa c+
    e(a(ea. Tra(a%en(+" &oa(e nor%a"!/a adesea ore"e de so%n,
    ce" &+=!n (e%&orar, dar e<!s(7 o v+"nera'!"!(a(e &er%anen(7 "a
    a reven! "a ore"e :n(Ar/!a(e de so%n s! "a a"(e s!%&(o%e.
    T!&+" de "+cr+ :n (+re &ers!s(7 de re$+"7 a(A( (!%& cA(
    !nd!v!d+" "+crea/7 con.or% aces(+! orar. D!s&ar!=!a
    s!%&(o%e"or s+rv!ne :n $enera" :n dec+rs+" a 9 s7&(7%An! de
    "a reven!rea "a +n orar de so%n4v!$!"!(a(e d!+rn nor%a".
    Da(e"e e<&er!%en(a"e s! d!n (eren re.er!(oare "a
    sc!%'area de .+s orar !nd!c7 .a&(+" c7 es(e necesar7
    a&ro<!%a(!v o /! &er .+s orar (raversa(, &en(r+ ca s!s(e%+"
    c!rcad!an s7 se res!ncron!/e/e "a no+a or7 "oca"7. D!.er!(e"e
    r!(%+r! c!rcad!ene Ec+% ar .! (e%&era(+ra !n(ern7 a cor&+"+!,
    n!ve"+" or%ona", a$!"!(a(ea s! &a((ern+r!"e de so%nJ se
    reada&(ea/7 :n &ro&or=!! d!.er!(e.
    #attern $amilial
    Un !s(or!c .a%!"!a" &oa(e .! &re/en( :n &An7 "a ILd d!n(re
    !nd!v!/!! c+ (!&+" de .a/7 de so%n :n(Ar/!a(. A .os( !den(!.!ca(7
    o .or%7 .a%!"!a"7 de (!& de .a/7 de so%n avansa( se$re$And
    ca o (r7s7(+r7 do%!nan(7 a+(oso%a"7 c+ &ene(ran(7 cresc+(7.
    Dia!nostic di$erenial
    T+"'+rarea r!(%+"+! c!rcad!an de so%n (re'+!e s7 .!e
    d!s(!ns7 de &a((ern+r!"e nor%a"e de so%n s! de ada&(7r!"e
    nor%a"e +r%And +ne! sc!%'7r! :n orar. Ce!a +nor as(.e" de
    d!s(!c=!! se a."7 :n &ers!s(en=a &er(+r'7r!! s! :n &re/en=a s!
    $rad+" de de(er!orare soc!a"7 sa+ &ro.es!ona"7. De e<e%&"+,
    %+"=! ado"escen=! O! ad+"=! (!ner! %en=!n orare de so%n4
    v!$!"!(a(e :n(Ar/!a(e, dar .7r7 de(res7 sa+ !n(er.eren=7 c+
    r+(!ne"e Oco"are sa+ de ac(!v!(a(e &ro.es!ona"7. Ma! %+"( decA(
    a(A(, %+"=! !nd!v!/! se carac(er!/ea/7 e! :nO!O! ca .!!nd S'+.n!=e
    de noa&(eT sa+ Sc!ocAr"!! %a(!na"eT, d!n ca+/a &re.er!n=e! "or
    .!e &en(r+ ore de so%n (Ar/!!, sa+ (!%&+r!!. Aces(e (end!n=e :n
    s!ne n+ @+s(!.!c7 d!a$nos(!c+" de (!& de .a/7 de so%n
    :n(Ar/!a( sa+ de S&a((ern de .a/7 de so%n avansa(T.
    D!a$nos(!c+" (re'+! &+s n+%a! !nd!v!/!"or care e<&er!en4
    (ea/7 :n %od &ers!s(en( de(res7 sa+ de(er!orare se%n!.!ca(!v7
    c"!n!c s! care a+ d!.!c+"(7=! :n a4s! sc!%'a &ar(ern+" de
    so%n4v!$!"!(a(e. :n %od s!%!"ar, a&roa&e or!c!ne c7"7(oreO(e
    &e .+se orare va e<&er!en=a o dere$"are (ran/!(or!e a
    so%n+"+!. D!a$nos(!c+" de (!& de (!& de .+s orar (re'+!e s7 .!e
    re/erva( !nd!v!/!"or c+ &er(+r'7r! de so%n severe asoc!a(e O!
    dere$"area ac(!v!(7=!! &ro.es!ona"e.
    T!&+" de .a/7 de so%n :n(Ar/!a( (re'+!e s7 .!e d!.eren=!a(
    de &a((ern+r!"e vo"+n(are de ore de so%n :n(Ar/!a(. Un!!
    !nd!v!/!, care :O! a%An7 vo"+n(ar %ers+" "a c+"care &en(r+ a
    &ar(!c!&a "a ac(!v!(7=! soc!a"e sa+ &ro.es!ona"e, se &o( &"An$e
    de d!.!c+"(a(e :n deO(e&(are. CAnd "e es(e &er%!s s7 o .ac7,
    aceO(! !nd!v!/! ador% +Oor s! d!n (!%& O!, d+&7 o &er!oad7 de
    rec+&erare a so%n+"+!, n+ a+ d!.!c+"(7=! se%n!.!ca(!ve :n a
    se deO(e&(a d!%!nea=a, :n as(.e" de ca/+r!, &ro'"e%a &r!%ar7
    o cons(!(+!e %a! c+rAnd de&r!varea de so%n decA( o (+"'+rare
    a r!(%+"+! c!rcad!an de so%n. A"=! !nd!v!/! E:n s&ec!a" co&!!! O!
    ado"escen=!!J &o(, :n %od vo"+n(ar, s74O! sc!%'e ore"e de
    so%n &en(r+ a ev!(a Ocoa"a sa+ so"!c!(7r!"e .a%!"!e!. Par(ern+"
    de d!.!c+"(a(e :n deO(e&(are d!s&are cAnd ac(!v!(7=!"e dor!(e
    s+n( &ro$ra%a(e :n ore"e
    >2= Tulburrile de Somn
    d!%!ne=!!, :n %od s!%!"ar, co&!!! %a! %!c!, !%&"!ca=! :n con(roverse c!rc+%scr!se s!(+a (!o na! c+
    &7r!n=!!, se2&o( &re/en(a ca avAnd (!&+" de .a/7 de so%n :n(Ar/!a(.
    T!&+r!"e de sc!%'are de .+s orar s! de "+cr+ :n (+re (re'+!e s7 .!e d!s(!nse :n &r!nc!&a" de
    a"(e (+"'+r7r! de so%n &r!%are, c+% ar .! !nso%n!a &r!%ar7 s! !&erso%n!a &r!%ar7. Is(or!c+"
    de sc!%'are de .+s orar sa+ de "+cr+ :n (+re, .7r7 so%n &er(+r'a( de a"(e &ro$ra%e, o.er7 de
    re$+"7 s+.!c!en(e &ro'e &en(r+ a e<c"+de aces(e a"(e (+"'+r7r!, :n +ne"e ca/+r!, a"(e (+"'+r7r! de
    so%n &r!%are, c+% ar .! (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a sa+ %!Oc7r!"e
    &er!od!ce a"e %e%'re"or, &o( co%&"!ca (!&+r!"e de "+cr+ :n (+re sa+ de sc!%'are de .+s orar.
    Aceas(7 &os!'!"!(a(e (re'+!e s+s&ec(a(7 cAnd reven!rea "a +n &ro$ra% d!+rn nor%a" n+ d+ce "a
    a%e"!orarea s!%&(o%e"or :n "e$7(+r7 c+ so%n+". A"(e (!&+r! de (+"'+rare a r!(%+"+! c!rcad!an de
    so%n, c+% ar .! S&ar(ern+" de so%n4v!$!"!(a(e non49I oreT s! S&a((ern+" nere$+"a( de so%n4
    v!$!"!(a(eT, se d!s(!n$ de (!&+" de .a/7 de so%n :n(Ar/!a( &r!n &a((ern+" s(a'!" de ore de so%n4
    v!$!"!(a(e :n(Ar/!a(, carac(er!s(!c aces(+!a d!n +r%7.
    Pa((ern+r!"e de so%n :n(Ar/!a( sa+ avansa( care s+rv!n e<c"+s!v :n (!%&+" a"(e! (+"'+r7r!
    %en(a"e n+ s+n( d!a$nos(!ca(e se&ara(. De e<e%&"+, +n !nd!v!d c+ (+"'+rare de&res!v7 %a@or7
    &oa(e avea ore de so%n :n(Ar/!a( s!%!"are c+ a"e ce"or c+ (!&+" de .a/7 de so%n :n(Ar/!a(, dar
    dac7 &ar(ern+" de so%n s!+rv!ne n+%a! :n c+rs+" e&!sod+"+! de&res!v %a@or, +n d!a$nos(!c
    ad!=!ona" de (+"'+rare a r!(%+"+! c!rcad!an de so%n n+ es(e @+s(!.!ca(. La .e", +n !nd!v!d care
    e<&er!en(ea/a o e<acer'are ac+(7 a sc!/o.ren!e! &oa(e avea +n &ar(ern de so%n4v!$!"!(a(e .oar(e
    nere$+"ar, dar dac7 aces( &a((ern de so%n es(e asoc!a( n+%a! c+ e<acer'area, n+ va .! &+s +n
    d!a$nos(!c ad!=!ona" de (+"'+rare a r!(%+"+! c!rcad!an de so%n.
    S+'s(an=e"e E!nc"+s!v %ed!ca%en(e"eJ &o( ca+/a :n(Ar/!erea de'+(+"+! so%n+"+! sa+ a
    deO(e&(7r!!, d!%!nea=a. De e<e%&"+, cons+%area de ca.e!na sa+ de n!co(!n7 seara, &oa(e
    :n(Ar/!a de'+(+" so%n+"+!, !ar +/+" de %ed!ca%en(e !&no(!ce "a %!@"oc+" no&=!! &oa(e
    :n(Ar/!a ora de deO(e&(are d!n so%n. Un d!a$nos(!c de (+"'+rare de so%n !nd+s7 de o
    s+'s(an=7 &oa(e .! "+a( :n cons!dera=!e, dac7 &er(+r'area de so%n es(e cons!dera(7 a .!
    consec!n=a .!/!o"o$!c7 d!rec(7 a +n+! +/ re$+"a( de o s+'s(an=7 s! @+s(!.!c7 o a(en=!e c"!n!c7
    se&ara(7 Eve/! &a$. RYYJ. Cond!=!!"e %ed!ca"e $enera"e ca+/ea/7 rar :n(Ar/!er! sa+ avans7r! .!<e a"e
    orar+"+! de so%n4v!$!"!(a(e s! de re$+"7 n+ creea/7 d!.!c+"(7=! :n e.ec(+area d!a$nos(!c+"+!
    d!.eren=!a".
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n ECITSJ !nc"+de ca(e$or!! &en(r+
    s!ndro%+" de .a/7 de so%n :n(Ar/!a(, (+"'+rarea de so%n :n "e$7(+r7 c+ "+cr+" :n (+re s! c+
    s!ndro%+" sc!%'7r!! de .+s orar E@e( "a$J, s! ca(e$or!! s&ec!.!ce &en(r+ a"(e (re! (+"'+r7r! a"e
    r!(%+"+! c!rcad!an de so%n E&ar(ern+" nere$+"a( de so%n4v!$!"!(a(e, s!ndro%+" de .a/7 de so%n
    avansa( s! s!ndro%+" de so%n4v!$!"!(a(e non49I oreJ.
    45?2H? Dissomnie 'r Alt Speci$icaie
    R9F

    Criteriile $e $ia/no&ti# pentru
    4+G.7< Tul-urarea Rit"ului Cir#a$ian $e So"n
    A2 .n pattern de dere!lare persistent sau recurent a somnului, duc@nd la
    somnolen excesiv sau la insomnie, care se datorea( unei inadecvri "ntre
    orarul de somn-vi!ilitate cerut de ambiana persoanei ,i patternul su
    circadian de somn-vi!ilitate2
    S2 #erturbarea somnului cau(ea( o detres sau deteriorare semni$icativ clinic
    "n domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    2 #erturbarea nu survine exclusiv "n cursul evoluiei altei tulburri de somn
    sau al altei tulburri mentale2
    D2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane &de
    ex2, un dro! de abu(, un medicament), ori ale unei condiii medicale !enerale2
    De speci"icat tipulD
    Tip de $a( de somn "nt@r(iatD un pattern persistent de debut tardiv al
    somnului ,i ore de de,teptare t@r(ie, cu incapacitatea de a adormi ,i de
    a se de,tepta la o or dorit, mai matinal2
    Tip de sc%imbare de $us orarD somnolen ,i vi!ilitate care apar la o or
    inadecvat a (ilei "n raport cu ora local, survenind dup cltorii repetate
    peste mai mult dec"t un $us orar2
    Tip de lucru "n tureD insomnie "n timpul perioadei de somn ma0or, asociat
    cu lucrul "n tur de noapte ori cu sc%imbri $recvente ale turei de lucru2
    Tip ne&pe#i%i#at
    4+G.7G Di&&o"nie '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de d!sso%n!e .7r7 a"(7 s&ec!.!ca=!e es(e re/erva(7 &en(r+ !nso%n!!"e, !&erso%n!!"e
    sa+ (+"'+r7r!"e de r!(% c!rcad!an care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o d!sso%n!e
    s&ec!.!c7.E<e%&"e"e !nc"+dQ
    1. Ac+/e"e de !nso%n!e sa+ !&erso%n!e se%n!.!ca(!ve c"!n!c s! a(r!'+!'!"e +nor
    .ac(or! a%'!en(a"! Ede e<., /$o%o(+", "+%!na, :n(rer+&er!"e .recven(eJ.
    2. So%no"en=a e<ces!v7, a(r!'+!'!"7 +ne! de&r!v7r! de so%n &ro$res!ve.
    3. SS!ndro%+" &!c!oare"or ne"!n!O(!(eTQ aces( s!ndro% se carac(er!/ea/7 &r!n dor!n=a
    de a %!Oca &!c!oare"e sa+ 'ra=e"e asoc!a(7 c+ sen/a=!! !ncon.or(a'!"e descr!se de
    re$+"7 ca .!or!, .+rn!c7(+r!, re&(a=!!, ars+r! sa+ &r+r!(. M!Oc7r!"e .recven(e a"e
    %e%'re"or a&ar :n e.or(+" de a +O+ra sen/a=!!"e de/a$rea'!"e. S!%&(o%e"e se
    a$ravea/7 cAnd !nd!v!d+" s(7 "!n!O(!( seara sa+ noa&(ea s! se a%endea/7
    (e%&orar &r!n %!Ocare. Sen/a=!!"e !ncon.or(a'!"e s! %!Oc7r!"e %e%'re"or &o(
    :n(Ar/!a ador%!rea sa+ deO(ea&(7 !nd!v!d+" d!n so%n s! d+c "a so%no"en=7 sa+
    .a(!$a'!"!(a(e :n c+rs+" /!"e!. S(+d!!"e as+&ra so%n+"+! de%ons(rea/7 %!Oc7r!
    &er!od!ce !nvo"+n(are a"e %e%'re"or :n c+rs+" so%n+"+! "a %a@or!(a(ea
    !nd!v!/!"or c+ s!ndro%+" &!c!oare"or ne"!n!O(!(e. Un %!c n+%7r de !nd!v!/!
    &re/!n(7 ane%!e sa+ red+cerea s(oc+"+! de .!er ser!c. S(+d!!"e e"ec(ro.!/!o"o$!ce
    &e nerv &er!.er!c s! .%or.o"o$!a cere'ra"7 $"o'a"7 s+n( de re$+"7 nor%a"e.
    >+E Tulburrile de Somn
    S!ndro%+" &!c!oare"or ne"!n!O(!(e &oa(e s+rven! :n(r4o .or%7 !d!o&a(!c7 sa+ &oa(e .! asoc!a(
    c+ cond!=!! %ed!ca"e $enera"e sa+ ne+ro"o$!ce, !nc"+/And sarc!na nor%a"7, !ns+.!c!en=a
    rena"7, ar(r!(a re+%a(o!d7, o %a"ad!e vasc+"ar7 &er!.er!c7 sa+ o d!s.+nc=!e de nerv &er!.er!c.
    Feno%eno"o$!c, ce"e do+7 .or%e s+n( !nd!s(!nc(!'!"e. De'+(+" s!ndro%+"+! &!c!oare"or
    ne"!n!O(!(e are "oc :n cea de a do+a sa+ a (re!a decad7, deO! &An7 "a 9Ld d!n(re !nd!v!/!! c+
    aces( s!ndro% &o( avea s!%&(o%e :na!n(e de e(a(ea de 5L an!. Preva"en(a s!ndro%+"+!
    &!c!oare"or ne"!n!O(!(e es(e de 9d45Ld :n &o&+"a=!a $enera"7 O! es(e de &es(e ;Ld :n &o&+"a=!a
    %ed!ca"72$enera"7. Preva"en(a cres(e oda(7 c+ e(a(ea s! es(e aceeaO! "a '7r'a=! s! "a .e%e!.
    Evo"+=!a es(e %arca(7 de s(a'!"!(a(ea sa+ :nr7+(7=!rea s!%&(o%e"or oda(7 c+ e(a(ea. Un
    !s(or!c .a%!"!a" &o/!(!v e<!s(7 :n YLd4FLd d!n(re !nd!v!/!. D!a$nos(!c+" d!.eren=!a" %a@or
    !nc"+de a)a(!s!a !nd+s7 de %ed!ca%en(e, ne+ro&a(!a &er!.er!c7 O! cra%&e"e noc(+rne a"e
    &!c!oare"or, :nr7+(7=!rea noc(+rn7 O! %!Oc7r!"e &er!od!ce a"e %e%'re"or s+n( %a! .recven(e :n
    s!ndro%+" &!c!oare"o2r ne"!n!O(!(e decA( :n a)a(!s!a !nd+s7 de %ed!ca%en(e sa+ :n ne+ro&a(!a
    &er!.er!c7. Con(rar s!ndro%+"+! &!c!oare"or ne"!n!O(!(e, cra%&e"e noc(+rne a"e &!c!oare"or n+
    se &re/!n(7 c+ dor!n=a de a %!Oca &!c!are"e s! n!c! %!Oc7r!"e &!c!oare"or n+ s+n( .recven(e.
    4. M!Oc7r!"e &er!od!ce a"e %e%'re"orQ %!Oc7r!"e &er!od!ce a"e %e%'re"or s+n(
    con(rac=!! sc+r(e, re&e(a(e, de %!c7 a%&"!(+d!ne a"e %e%'re"or, :n s&ec!a" a"e
    e<(re%!(7=!"or !n.er!oare. Aces(e %!Oc7r! :nce& a&roa&e !%ed!a( d+&7 ador%!re
    s! d!%!n+a :n (!%&+" s(ad!!"or ; sa+ I de so%n .7r7 %!Oc7r! oc+"are ra&!de
    ENREMJ O! so%n+"+! c+ %!Oc7r! oc+"are ra&!de EREMJ. M!Oc7r!"e s+rv!n de
    re$+"7 r!(%!c "a .!ecare 9L4RL sec+nde O! s+n( asoc!a(e c+ deO(e&(7r! sc+r(e O!
    re&e(a(e d!n so%n. De re$+"7, !nd!v!/!! s+n( !nconO(!en=! de %!Oc7r!"e rea"e, dar
    se &o( &"An$e de !nso%n!e, de deO(e&(7r! .recven(e or! de so%no"en=7 d!+rn7,
    dac7 n+%7r+" %!Oc7r!"or es(e .oar(e %are. Ind!v!/!! &o( &re/en(a o var!a'!"!(a(e
    cons!dera'!"7 :n n+%7r+" %!Oc7r!"or &er!od!ce a"e %e%'re"or de "a o noa&(e "a
    a"(a. M!Oc7r!"e &er!od!ce a"e %e%'re"or s+rv!n "a %a@or!(a(ea !nd!v!/!"or c+
    s!ndro%+" &!c!oare"or ne"!n!O(!(e s! &o( s+rven! O! .7r7 ce"e"a"(e s!%&(o%e a"e
    aces(+!a. Fe%e!"e c+ sarc!n7 nor%a"7 sa+ !nd!v!/!! c+ cond!=!! ca !ns+.!c!en=a
    rena"7, !ns+.!c!en=a card!ac7 con$es(!v7 s! s(res+" &os((ra+%a(!c &o( &re/en(a,
    de ase%enea, %!Oc7r! &er!od!ce a"e %e%'re"or. DeO! e(a(ea (!&!c7 "a de'+( O!
    &reva"en(a :n &o&+"a=!a $enera"7 s+n( nec+nosc+(e, %!Oc7r!"e &er!od!ce a"e
    %e%'re"or dev!n %a! .recven(e oda(7 c+ e(a(ea O! &o( s+rven! "a %a! %+"( de o
    (re!%e d!n(re !nd!v!/!! :n e(a(e de &es(e RY an!. B7r'a=!! s+n( a.ec(a=! %a!
    .recven( decA( .e%e!"e.
    5. S!(+a=!!"e :n care c"!n!c!an+" a a@+ns "a conc"+/!a c7 d!sso%n!a es(e &re/en(7, dar
    es(e !nca&a'!" s7 &rec!/e/e dac7 aceas(a es(e &r!%ar7, da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e sa+ es(e !nd+s7 de o s+'s(an=7.
    +arasomniile
    Paraso%n!!"e s+n( (+"'+r7r! carac(er!/a(e &r!n even!%en(e co%&or(a%en(a"e sa+ .!/!o"o$!ce
    anor%a"e s+rven!nd :n asoc!a=!e c+ so%n+", c+ s(ad!!"e s&ec!.!ce a"e so%n+"+! sa+ (ran/!=!!"e
    so%n4v!$!"!(a(e. Con(rar d!sso%n!!"or, &araso%n!!"e n+ co%&or(7 ano%a"!! a"e %ecan!s%e"or
    care $enerea/7 s(7r!"e de so%n4v!$!"!(a(e s! n!c! s!ncron!/area so%n+"+! s! v!$!"!(7=!!.
    Paraso%n!!"e re&re/!n(7 %a! c+rAnd ac(!varea s!s(e%e"or .!/!o"o$!ce "a ore !nadecva(e :n (!%&+"
    c!c"+"+! so%n4v!$!"!(a(e.
    45?2H? o,marul (anterior, Anxietatea de Vis)
    R;5

    :n &ar(!c+"ar, aces(e (+"'+r7r! !%&"!c7 %a! c+rAnd ac(!varea s!s(e%+"+! nervos ve$e(a(!v, a
    s!s(e%+"+! %o(or or! a &rocese"or co$n!(!ve :n (!%&+" so%n+"+! sa+ a" (ran/!=!!"or so%n4
    v!$!"!(a=e. D!.er!(e"e &araso%n!! s+rv!n :n %o%en(e d!.er!(e :n (!%&+" so%n+"+!, !ar
    &araso%n!!"e s&ec!.!ce s+rv!n adesea :n (!%&+" s(ad!!"or s&ec!.!ce de so%n. Ind!v!/!! c+
    &araso%n!! se &re/!n(7 de re$+"7 c+ ac+/e de co%&or(a%en( !nso"!( :n (!%&+" so%n+"+!, %a!
    c+rAnd decA( de !nso%n!e sa+ de so%no"en=7 e<ces!v7 :n (!%&+" /!"e!. Aceas(7 sec=!+ne !nc"+de
    coO%ar+", (eroarea de so%n, so%na%'+"!s%+" O! &araso%n!a .7r7 a"(7 s&ec!.!ca=!e.
    4+G.7G CoE"arul (anterior, An,ietatea
    $e Vi&6
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" coO%ar+"+! :" cons(!(+!e a&ar!=!a re&e(a(7 de v!se (er!.!an(e care d+c "a
    deO(e&(area d!n so%n Ecr!(er!+" AJ. Ind!v!d+" es(e co%&"e( a"er( "a deO(e&(are Ecr!(er!+" BJ. 3!se"e
    (er!.!an(e sa+ :n(rer+&er!"e so%n+"+! care re/+"(7 d!n deO(e&(7r! ca+/ea/7 !nd!v!d+"+! o de(res7
    se%n!.!ca(!v7 sa+ d+c "a d!s.+nc=!e soc!a"7 sa+ &ro.es!ona"7 Ecr!(er!+" CJ. Aceas(7 (+"'+rare n+
    es(e d!a$nos(!ca(7, dac7 coO%ar+r!"e s+rv!n e<c"+s!v :n (!%&+" evo"+=!e! a"(e! (+"'+r7r! %en(a"e
    sa+ se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/ sa+ +n
    %ed!ca%en(J or! a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" DJ.
    CoO%ar+r!"e s+rv!n de re$+"7 :n(r4o secven=7 de v!s e"a'ora(7, "+n$7, care es(e e<(re% de
    &rovoca(oare de an<!e(a(e sa+ (er!.!an(7. Con=!n+(+" v!se"or es(e cen(ra( ce" %a! adesea &e
    &er!co"e .!/!ce !%!nen(e &en(r+ !nd!v!d Ede e<., +r%7r!re, a(ac, v7(7%are cor&ora"7J, :n a"(e
    ca/+r!, &er!co"+" &erce&+( &oa(e .! %a! s+'(!", !%&"!cAnd eOec+r!"e sa+ d!.!c+"(7=!"e &ersona"e.
    CoO%ar+r!"e care s+rv!n d+&7 e<&er!en=e"e (ra+%a(!ce &o( re&rod+ce s!(+a=!a &er!c+"oas7 sa+
    a%en!n=7(oare, dar ce"e %a! %+"(e coO%ar+r! n+ re"a(ea/7 even!%en(e rea"e. La deO(e&(are,
    !nd!v!/!! c+ aceas(7 (+"'+rare &o( descr!e secven=a de v!s O! con=!n+(+" :n de(a"!+. Ind!v!/!! &o(
    re"a(a coO%ar+r! %+"(!&"e :n c+rs+" +ne! an+%!(e no&=!, adesea c+ (e%7 rec+ren(7. CoO%ar+r!"e
    a&ar a&roa&e e<c"+s!v :n c+rs+" so%n+"+! c+ %!Oc7r! oc+"are ra&!de EREMJ. Deoarece
    &er!oade"e REM s+rv!n &er!od!c :n (!%&+" so%n+"+! noc(+rn Ea&ro<!%a(!v "a .!ecare FL455L
    %!n+(eJ, coO%ar+r!"e &o( s+rven!, de ase%enea, :n or!ce %o%en( :n c+rs+" e&!sod+"+! de
    so%n. Deoarece :ns7 &er!oade"e de so%n REM dev!n de re$+"7 %a! "+n$! O! v!se"e %a! !n(ense
    :n a do+a @+%7(a(e a no&=!!, coO%ar+r!"e es(e &os!'!" s7 a&ar7, de ase%enea, %a! (Ar/!+
    noa&(ea.
    CoO%ar+r!"e se (er%!n7 de re$+"7 c+ o deO(e&(are d!n so%n asoc!a(7 c+ o reven!re ra&!d7
    "a s(area de v!$!"!(a(e O! c+ +n sen(!%en( &ers!s(en( de (ea%7 sa+ an<!e(a(e. AceO(! .ac(or! d+c
    adesea "a d!.!c+"(a(e :n re"+area so%n+"+!. CoO%ar+" ca+/ea/7 de(res7 s+'!ec(!v7 se%n!.!ca(!v7
    %a! des decA( ca+/ea/7 de(er!orare soc!a"7 sa+ &ro.es!ona"7 de%ons(ra'!"7, :ns7, dac7
    deO(e&(7r!"e noc(+rne s+n( .recven(e, or! dac7 !nd!v!d+" ev!(7 s7, doar%7 d!n ca+/a .r!c!! de
    coO%ar+r!, !nd!v!d+" &oa(e e<&er!en=a so%no"en=7 e<ces!v7, red+cerea ca&ac!(7=!! de
    concen(rare, de&res!e, an<!e(a(e sa+ !r!(a'!"!(a(e care &o( &er(+r'a ac(!v!(a(ea d!n (!%&+" /!"e!.
    >+2 Tulburrile de Somn
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. La !nd!v!/!! c+ coO%ar+r!, "a deO(e&(are
    &oa(e .! ev!den(7 o e<c!(a=!e ve$e(a(!v7 +Ooar7 Ede e<., (rans&!ra=!e, (a!card!e, (a!&neeJ.
    Ind!v!/!! care a+ av+( coO%ar+r! .recven(e :nc7 d!n co&!"7r!e (!nd a &re/en(a &rocen(e r!d!ca(e de
    &s!o&a(o"o$!e $enera"7 "a %7s+rarea s!%&(o%e"or. S!%&(o%e de&res!ve s! an<!oase care n+
    sa(!s.ac cr!(er!!"e &en(r+ +n d!a$nos(!c s&ec!.!c, s+n( .recven(e "a !nd!v!/!! c+ coO%ar+r!.
    M!Oc7r!"e cor&+"+! s! voca"!/area n+ s+n( carac(er!s(!ce coO%ar+"+! d!n ca+/a &!erder!!
    (on+s+"+! %+Oc!"or sce"e(!c!, care :n %od nor%a" s+rv!ne :n (!%&+" so%n+"+! REM. CAnd a&ar
    vor'!(+", =!&a(+" sa+ "ov!(+", es(e .oar(e &ro'a'!" ca aces(ea s7 s+rv!n7 ca .eno%ene sc+r(e care
    (er%!n7 +n coO%ar. De ase%enea, es(e .oar(e &os!'!" ca ac(es(e co%&or(a%en(e s7 s+rv!n7 :n
    coO%ar+r!"e care aco%&an!a/7 s(res+" &os((ra+%a(!c, deoarece aces(e coO%ar+r! &o( s+rven! :n
    (!%&+" so%n+"+! .7r7 %!Oc7r! oc+"are ra&!de ENREMJ.
    Da(e de "a'ora(or asoc!a(e. S(+d!!"e &o"!so%no$ra.!ce !nd!c7 deO(e&(7r! 'r+O(e d!n so%n+"
    REM care cores&+nd re"a(7r!! de c7(re !nd!v!d a coO%ar+r!"or. Aces(e deO(e&(7r! s+rv!n de
    re$+"7 :n c+rs+" ce"e! de a do+a @+%7(7=! a no&=!!, :n ce"e %a! %+"(e ca/+r!, e&!sod+" de so%n va
    .! d+ra( %a! %+"( de 5L %!n+(e O! &oa(e !nc"+de +n n+%7r %a! %are decA( %ed!a de %!Oc7r!
    oc+"are. R!(%+" card!ac O! r!(%+" res&!ra(or &o( creO(e sa+ &o( &re/en(a o %are var!a'!"!(a(e
    :na!n(ea deO(e&(7r!! d!n so%n. CoO%ar+r!"e +r%And even!%en(e"or (ra+%a(!ce Ede e<., "a !nd!v!/!!
    c+ s(res &os((ra+%a(!cJ &o( s+rven! :n (!%&+" so%n+"+! NREM, :n s&ec!a" :n c+rs+" s(ad!+"+!
    9, &rec+% s! :n c+rs+" so%n+"+! REM. A"(e e"e%en(e &o"!so%no$ra.!ce, !nc"+/And con(!n+!(a(ea
    O! ar!(ec(+ra so%n+"+!, n+ s+n( :n %od carac(er!s(!c anor%a"e :n coO%ar.
    *lemente speci$ice culturii, etii si sexului
    Se%n!.!ca=!a a(r!'+!(7 coO%ar+r!"or &oa(e var!a c+ .ond+" c+"(+ra". De e<e%&"+, +ne"e c+"(+r!
    &o( &+ne coO%ar+r!"e :n "e$7(+r7 c+ .eno%ene s&!r!(+a"e sa+ s+&rana(+ra"e, &e cAnd a"(e"e &o(
    vedea coO%ar+r!"e ca !nd!ca(or! a! &er(+r'7r!! %en(a"e sa+ so%a(!ce. Deoarece coO%ar+r!"e a&ar
    .recven( :n co&!"7r!e, aces( d!a$nos(!c n+ (re'+!e s7 .!e &+s dac7 n+ e<!s(7 o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 &ers!s(en(7 care s7 @+s(!.!ce o a(en=!e c"!n!c7 se&ara(7. Es(e .oar(e
    &os!'!" ca coO%ar+" s7 a&ar7 "a co&!!! e<&+O! s(resor!"or &s!osoc!a"! sever!. DeO! con=!n+(+"
    v!s+"+! s&ec!.!c &oa(e re."ec(a e(a(ea !nd!v!d+"+! avAnd coO%ar+r!, e"e%en(e"e esen=!a"e a"e
    (+"'+r7r!! s+n( ace"eaO! "a d!verse $r+&e de e(a(e. Fe%e!"e re"a(ea/7 c7 a+ coO%ar+r! %a!
    .recven( decA( '7r'a=!! :n(r4o &ro&or=!e de a&ro<!%a(!v 94IQ5. N+ es(e c"ar :n ce %7s+r7 aceas(7
    d!.eren=7 re."ec(7 o d!scre&an=7 :n n+%7r+" de coO%ar+r!, ca o&+s7 +ne! d!scre&an=e :n ra&or(are.
    #revalent
    :n(re 5Ld O! YLd d!n(re co&!!! :n e(a(e de ;4Y an! a+ coO%ar+r! de s+.!c!en(7 !n(ens!(a(e
    &en(r+ a ne"!n!O(! &e &7r!n=!, :n &o&+"a=!a ad+"(7 n+ %a! &+=!n de YLd d!n(re !nd!v!/! &o( re"a(a
    ce" &+=!n +n coO%ar oca/!ona". La ad+"=!! (!ner!, ce" &+=!n ;d, re"a(ea/7 c7 a+ coO%ar+r!
    .recven( sa+ (o(dea+na. Preva"en(a rea"7 a coO%ar+r!"or n+ es(e :ns7 c+nosc+(7.
    45?2H? o,marul (anterior, Anxietatea de Vis)
    >++
    *voluie
    CoO%ar+r!"e :nce& adesea :n(re e(a(ea de ; s! R an!. CAnd .recven=a es(e %are Ede e<., %a!
    %+"(e &e s7&(7%An7J, v!se"e &o( deven! o s+rs7 de &reoc+&are s! de(res7, a(A( &en(r+ co&!!, cA(
    s! &en(r+ &7r!n=!. Ce! %a! %+"=! co&!! care &re/!n(7 o &ro'"e%7 re.er!(oare "a coO%ar+r! o
    de&7Oesc, :n(r4+n n+%7r red+s de ca/+r!, v!se"e &o( &ers!s(a c+ .recven=7 %are O! :n &er!oada
    ad+"(7, deven!nd &rac(!c o &er(+r'are &en(r+ (oa(7 v!a=a. Ad+"=!! c+ coO%ar+r! cron!ce
    re"a(ea/7 $rade s!%!"are de &er(+r'are de so%n s+'!ec(!v7. A .os( descr!s7 o (end!n=7 "a
    a%e"!orare :n +"(!%e"e decade.
    Dia!nostic di$erenial
    CoO%ar+r!"e (re'+!e s7 .!e d!.eren=!a(e de (eroarea de so%n. A%'e"e (+"'+r7r! !nc"+d
    deO(e&(7r! sa+ deO(e&(7r! &ar=!a"e c+ .r!c7 s! ac(!vare ve$e(a(!v7, dar &o( .! d!.eren=!a(e &r!n %a!
    %+"(e e"e%en(e c"!n!ce. CoO%ar+r!"e s+rv!n de re$+"7 noa&(ea (Ar/!+, :n c+rs+" so%n+"+! REM,
    O! &rod+c o !%a$er!e de v!s v!e, deO(e&(7r! co%&"e(e, e<c!(a=!e ve$e(a(!v7 +Ooar7 O! evocare
    de(a"!a(7 a even!%en(+"+!. Teror!"e de so%n a&ar de re$+"7 :n &r!%a (re!%e a no&=!!, :n c+rs+"
    s(ad!+"+! ; sa+ I de so%n NREM, O! n+ &rod+c, .!e n!c! o evocare a v!s+"+!, .!e !%a$!n! +n!ce, .7r7
    ca"!(a(ea de nara=!+ne, care es(e (!&!c7 coO%ar+r!"or. Teror!"e de so%n d+c "a deO(e&(7r! &ar=!a"e :n
    care !nd!v!d+" es(e con.+/, de/or!en(a( s! n+%a! &ar=!a" reac(!v, s! are o e<c!(a=!e ve$e(a(!v7
    se%n!.!ca(!v7, :n con(ras( c+ coO%ar+", !nd!v!d+" c+ (eroare de so%n are a%ne/!a e&!sod+"+! "a
    deO(e&(area d!n so%n, d!%!nea=a.
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a &oa(e d+ce "a deO(e&(7r! c+ e<c!(a=!e
    ve$e(a(!v7, dar aces(ea n+ s+n( aco%&an!a(e de evocarea de v!se (er!.!an(e. CoO%ar+r!"e s+n( o
    ac+/7 &er%anen(7 a !nd!v!/!"or c+ narco"e&s!e, :ns7 &re/en=a so%no"en=e! e<ces!ve O!
    ca(a&"e<!e! d!.eren=!a/7 aceas(7 cond!=!e de coO%ar. A(ac+r!"e de &an!c7 s+rven!nd :n c+rs+"
    so%n+"+! &o( &rod+ce, de ase%enea, deO(e&(7r! 'r+O(e d!n so%n, c+ e<c!(a=!e ve$e(a(!v7 O!
    .r!c7, dar !nd!v!d+" n+ re"a(ea/7 v!se (er!.!an(e s! &oa(e !den(!.!ca aces(e s!%&(o%e ca .!!nd
    concordan(e c+ a(ac+r!"e de &an!c7. Pre/en=a +ne! ac(!v!(7=! %o(or!! co%&"e<e :n c+rs+" v!se"or
    (er!.!an(e (re'+!e s7 d+c7 "a eva"+area &ro%&(7 :n con(!n+are &en(r+ a"(e (+"'+r7r! de so%n, c+%
    ar .! S(+"'+rarea de co%&or(a%en( a so%n+"+! REMT Eve/! &araso%n!a .7r7 a"(7 s&ec!.!ca=!eJ.
    N+%eroase %ed!ca%en(e care a.ec(ea/7 s!s(e%+" nervos ve$e(a(!v &o( &rec!&!(a coO%ar+r!"e.
    E<e%&"e"e !nc"+d 54do&a O! a"=! a$on!O(! do&a%!ner$!c!, an(a$on!s(!! 'e(aadrener$!c! O! a"(e
    %ed!ca%en(e an(!de&res!ve. Invers, a's(!nen=a de %ed!ca%en(e"e care s+&r!%7 so%n+" REM,
    c+% ar .! %ed!ca%en(e"e an(!de&res!ve s! a"coo"+", &oa(e d+ce "a +n Sre'o+ndT a" so%n+"+! REM
    aco%&an!a( de coO%ar+r!. Dac7 coO%ar+r!"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7, +n d!a$nos(!c de (+"'+rare de so%n !nd+s7 de o s+'s(an=7, de (!& &araso%n!e,
    &oa(e .! "+a( :n cons!dera=!e Eve/! &a$. RYYJ. De ase%enea, coO%ar+" n+ (re'+!e d!a$nos(!ca( dac7
    v!se"e &er(+r'an(e a&ar ca e.ec( .!/!o"o$!c d!rec( a" +ne! cond!=!! %ed!ca"e $enera"e Ede e<., o
    !n.ec=!e a s!s(e%+"+! nervos cen(ra", "e/!+n! vasc+"are a"e (r+nc!+"+! cere'ra", cond!=!! %ed!ca"e
    $enera"e care ca+/ea/7 de"!r!+%J. Dac7 coO%ar+r!"e s+n( s+.!c!en( de severe &en(r+ a @+s(!.!ca o
    a(en=!e c"!n!c7 se&ara(7, &oa(e .! "+a(7 :n cons!dera=!e (+"'+rarea de so%n da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, de (!& &araso%n!e Eve/! &a$. RY5J. DeO! coO%ar+r!"e &o( a&are .recven( :n
    c+rs+" +n+! de"!r!+%, +n d!a$nos(!c se&ara( de coO%ar n+ se &+ne.
    R;I Tulburrile de Somn

    CoO%ar+r!"e s+rv!n .recven( ca &ar(e a a"(or (+"'+r7r! %en(a"e Ede e<., s(res+" &os((ra+%a(!c,
    sc!/o.ren!a, (+"'+r7r!"e a.ec(!ve, a"(e (+"'+r7r! an<!oase, (+"'+r7r!"e de ada&(are O! (+"'+r7r!"e de
    &ersona"!(a(eJ. Dac7 coO%ar+r!"e s+rv!n e<c"+s!v :n c+rs+" a"(e! (+"'+r7r! %en(a"e, d!a$nos(!c+"
    de coO%ar n+ se &+ne.
    M+"=! !nd!v!/! e<&er!en(ea/7 +n coO%ar !/o"a(, oca/!ona". CoO%ar+" n+ es(e d!a$nos(!ca(
    decA( dac7 .recven=a O! sever!(a(ea coO%ar+r!"or d+ce "a o de(res7 sa+ de(er!orare se%n!.!ca(!v7.
    +elaiile cu lasi$icarea Internaional a Tulburrilor de Somn
    CoO%ar+" cores&+nde d!a$nos(!c+"+! de coO%ar+r! d!n C"as!.!carea In(erna=!ona"7 a
    T+"'+r7r!"or de So%n ECITSJ.
    Criteriile $e $ia/no&ti# pentru 4+G.7G CoE"ar
    A2 De,teptri repetate din perioada de somn ma0or sau din aipeli, cu evocarea
    imediat a unor vise "ntinse si extrem de teri$iante implic@nd de re!ul
    ameninri la supravieuire, securitate sau stima de sine2 De,teptrile survin
    "n !eneral "n cursul celei de a doua 0umti a perioadei de somn2
    S2 La de,teptarea din visele teri$iante, persoana devine rapid orientat ,i
    alert &"n contrast cu con$u(ia si de(orientarea observate "n teroarea de
    somn ,i unele $orme-de epilepsie)2
    2 *xperientarea visului sau perturbarea de somn care re(ult din de,teptare
    cau(ea( o detres sau deteriorare semni$icativ clinic "n domeniul social,
    pro$esional sau "n alte domenii importante de $uncionare2
    D2 o,marurile nu apar exclusiv "n cursul altei tulburri mentale &de ex2, un
    delirium, stres posttraumatic) ,i nu sunt datorate e$ectelor $i(iolo!ice
    directe ale unei substane &de ex2, un dro! de abu(, un medicament) sau o
    condiie medical !eneral2
    4+G.7= Teroarea $e So"n
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (eror!! de so%n :" cons(!(+!e a&ar(!=!a re&e(a(7 a (eror!"or de so%n, ad!c7,
    a deO(e&(7r!"or 'r+O(e d!n so%n, :nce&And de re$+"7 c+ +n =!&7( sa+ s(r!$7( de &an!c7 Ecr!(er!+"
    AJ.Teror!"e de so%n :nce& de re$+"7 :n c+rs+" &r!%e! (re!%! a e&!sod+"+! de so%n %a@or O!
    d+rea/7 545L %!n+(e. E&!soade"e s+n( aco%&an!a(e de e<c!(a=!e ve$e(a(!v7 s! %an!.es(7r!
    co%&or(a%en(a"e de .r!c7 !n(ens7 Ecr!(er!+" BJ, :n c+rs+" e&!sod+"+! !nd!v!d+" es(e d!.!c!" de
    deO(e&(a( sa+ de conso"a( Ecr!(er!+" CJ. Dac7 !nd!v!d+" se deO(ea&(7 d+&7 (eroarea de so%n, n+4s!
    a%!n(eO(e n!c! +n v!s sa+ :O! a%!n(eO(e !%a$!n! s!n$+"are, .ra$%en(are. La deO(e&(are,
    d!%!nea=a +r%7(oare, !nd!v!d+" are a%ne/!e &en(r+ even!%en( Ecr!(er!+" DJ. E&!soade"e de (eroare
    de so%n (re'+!e s7 ca+/e/e de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e
    4+G.7= Teroarea $e So"n
    >+5

    de .+nc=!onare Ecr!(er!+" EJ. Teroarea de so%n %! (re'+!e s7 .!e d!a$nos(!ca(7 dac7 even!%en(e"e
    rec+ren(e se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n
    %ed!ca%en(J or! a"e +ne! cond!=!! %ed!ca"e $enera"e Cr!(er!+" FJ. Teror!"e de so%n s+n( n+%!(e,
    de ase%enea, S(eror! noc(+rneT sa+ &avor noc(+rn.
    :n (!%&+" +n+! e&!sod (!&!c, !nd!v!d+" se scoa"7 'r+sc d!n &a(, =!&And sa+ s(r!$And, or! c+ o
    e<&res!e de (ea%7 s! c+ se%ne ve$e(a(!ve de an<!e(a(e !n(ens7 Ede e<., (a!card!e, res&!ra=!e
    ra&!d7, con$es(!a (e$+%en(e"or, (rans&!ra=!e, d!"a(area &+&!"e"or, (on+s %+sc+"ar cresc+(J.
    Ind!v!d+" n+ r7s&+nde de re$+"7 "a e.or(+r!"e ce"or"a"=! de a45 deO(e&(a sa+ "!n!O(!. Dac7 es(e
    v!$U7, &ersoana es(e con.+/7 s! de/or!en(a(7 (!%& de cA(eva %!n+(e O! re"a(ea/7 +n va$
    sen(!%en( de (eroare, de re$+"7 .7r7 con=!n+( de v!s. DeO! &o( a&are !%a$!n! .ra$%en(are de v!s
    v!+, n+ es(e re"a(a(7 o secven=7 de v!s ase%7n7(oare +ne! nara=!+n! Eca :n coO%arJ. Ce" %a!
    .recven(, !nd!v!d+" n+ se deO(ea&(7 co%&"e(, c! recade :n so%n s! are a%ne/!e &en(r+ e&!sod "a
    deO(e&(are d!%!nea=a +r%7(oare. Un!! !nd!v!/! &o( s74s! a%!n(easc7 va$ c7 a+ av+( +n Se&!sodT :n
    c+rs+" no&=!! (rec+(e, dar n+ a+ o a%!n(!re de(a"!a(7. De re$+"7, :n(r4o noa&(e va a&are +n s!n$+r
    e&!sod, deO!, oca/!ona", :n c+rs+" +ne! no&=! &o( s+rven! %a! %+"(e e&!soade, "a d!.er!(e !n(erva"e.
    Pen(r+ ca d!a$nos(!c+" s7 .!e &+s, !nd!v!d+" (re'+!e s7 e<&er!en(e/e o de(res7 sa+ de(er!orare
    se%n!.!ca(!v7 c"!n!c. *ena :n "e$7(+r7 c+ e&!soade"e &oa(e de(er!ora re"a=!!"e soc!a"e. Ind!v!/!!
    &o( ev!(a s!(+a=!!"e :n care a"=!! &o( deven! conO(!en=! de &er(+r'are, c+% ar .! %ers+" :n (a'7r7,
    v!/!(area a%!c!"or s! r7%as "a e! &es(e noa&(e, dor%!(+" c+ a"(c!neva :n &a(.
    *lemente ,i tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. E&!sod+" es(e :nso=!( de re$+"7 de
    voc!.er7r!, e<c"a%a=!!, s(r!$7(e sa+ voca"!/7r! !ncoeren(e. Ind!v!d+" se &oa(e o&+ne ac(!v "a a .!
    =!n+( sa+ a(!ns, or! &oa(e &re/en(a c!ar o ac(!v!(a(e %o(or!e %a! e"a'ora(7 Ede e<., "e$7na(, "ov!( c+
    &+%n+", r!d!ca( d!n &a( sa+ .+$7J. Aces(e co%&or(a%en(e &ar a re&re/en(a :ncerc7r! de
    a+(o&ro(ec=!e sa+ de "+&(7 con(ra +ne! a%en!n=7r! O! &o( d+ce "a v7(7%are cor&ora"7. Po( a&are
    e&!soade care !nc"+d conco%!(en( e"e%en(e de (eroare de so%n s! de so%na%'+"!s%. U/+" de
    a"coo" sa+ de seda(!ve, de&r!varea de so%n, dere$"7r!"e orar+"+! de so%n4v!$!"!(a(e,
    .a(!$a'!"!(a(ea O! s(res+" .!/!c O! e%o=!ona" cresc &ro'a'!"!(a(ea e&!soade"or.
    Co&!!! c+ (eroare de so%n n+ a+ o !nc!den=7 %a! %are a &s!o&a(o"o$!e! sa+ (+"'+r7r!"or
    %en(a"e decA( &o&+"a=!a $enera"7. Es(e .oar(e &os!'!" ca (eroarea de so%n s7 .!e asoc!a(7 c+
    &s!o&a(o"o$!e "a ad+"=!. Teroarea de so%n &oa(e s+rven! c+ .recven=7 cresc+(7 "a !nd!v!/!! c+
    (+"'+r7r! de &e a<a I, :n s&ec!a" c+ s(res &os((ra+%a(!c s! an<!e(a(e $enera"!/a(7. La !nd!v!/!! c+
    (eroare de so%n &o( s+rven! (+"'+r7r! de &ersona"!(a(e, :n s&ec!a" (+"'+r7r!"e de &ersona"!(a(e
    de&enden(7, sc!/o!d7 s! 'order"!ne. La !nven(are"e de &ersona"!(a(e a+ .os( no(a(e scor+r!
    r!d!ca(e &en(r+ de&res!e s! an<!e(a(e.
    Da(e de "a'ora(or asoc!a(e. Teror!"e de so%n :nce& :n c+rs+" so%n+"+! NREM &ro.+nd,
    care es(e carac(er!/a( &r!n(r4o ac(!v!(a(e EE, c+ .recven(7 "en(7 Ede"(aJ. Aceas(7 ac(!v!(a(e EE,
    es(e &redo%!nan(7 :n s(ad!!"e ; s! I de so%n NREM, care s+n( concen(ra(e :n &r!%a (re!%e a
    e&!sod+"+! %a@or de so%n. :n consec!n=7, es(e .oar(e &os!'!" ca (eror!"e de so%n s7 a&ar7 :n
    &r!%a (re!%e a
    >+> Tul-ur(rile $e So"n
    no&=!!. E&!soade"e de (eroare de so%n &o( s+rven! :ns7 or!cAnd :n c+rs+" so%n+"+! c+ +nde "en(e,
    c!ar :n c+rs+" a=!&e"!"or d!+rne. De'+(+" e&!soade"or de (eroare de so%n es(e !nd!ca( de re$+"7
    de vo"(a@+" .oar(e :na"( a" ac(!v!(7=!! de"(a &e EE,, de creO(erea (on+s+"+! %+sc+"ar O! de
    d+'"area sa+ 0+adr+&"area r!(%+"+! card!ac, care creO(e adesea "a &es(e 59L '7(7! &e %!n+(, :n
    (!%&+" e&!sod+"+!, &o"!so%no4$ra.!a &oa(e .! o'sc+r!/a(7 de ar(e.ac(e"e &rovoca(e de %!Ocare,
    :n a'sen=a +nor as(.e" de ar(e.ac(e, EE, &re/!n(7 de re$+"7 o ac(!v!(a(e (e(a sa+ a".a :n c+rs+"
    e&!sod+"+!, !nd!cAnd deO(e&(area &ar=!a"7. Ind!v!/!! c+ (eroare de so%n &o( &re/en(a, de
    ase%enea, deO(e&(7r! 'r+O(e d!n so%n+" &ro.+nd NREM, care n+ &ro$resea/7 s&re e&!soade
    co%&"e(e de (eroare de so%n. As(.e" de e&!soade &o( !nc"+de (a!card!a 'r+sc7.
    9atele examinrii somatice /i condi3iile medicale .enerale asociate. Fe'ra O! de&r!varea
    de so%n &o( &rod+ce o creO(ere a .recven=e! e&!soade"or de (eroare de so%n.
    *lemente speci$ice culturii, etii si sexului
    N!c! +n .e" de re"a(7r! n+ a+ o.er!( o ev!den=7 c"ar7 a d!.eren=e"or re.er!(oare "a %ed!+" c+"(+ra"
    :n %an!.es(7r!"e (eror!! de so%n, deO! es(e &os!'!" ca se%n!.!ca=!a O! ca+/a a(r!'+!(7 e&!soade"or de
    (eroare de so%n s7 d!.ere :n(re c+"(+r!. Co&!!! %a! %ar! O! ad+"=!! o.er7 o evocare %a! de(a"!a(7 a
    !%a$!n!"or (er!.!an(e asoc!a(e c+ (eror!"e de so%n decA( co&!!! %a! %!c!, care es(e .oar(e &os!'!" s7
    a!'7 a%ne/!e co%&"e(7 sa+ s7 re"a(e/e n+%a! +n va$ sen(!%en( de .r!c7. Pr!n(re co&!!, (eroarea de
    so%n es(e %a! .recven(7 "a '7!e=! decA( "a .e(e. Pr!n(re ad+"=!, ra(a se<+"+! es(e e$a"7.
    #revalent
    E<!s(7 &+=!ne da(e des&re (eroarea de so%n :n &o&+"a=!a $enera"7. Preva"en(a e&!soade"or de
    (eroare de so%n Eca o&+se (eror!! de so%n, :n care e<!s(7 rec+ren=7 s! de(res7 sa+ de(er!orareJ a
    .os( es(!%a(7 "a "d4Rd "a co&!! O! "a %a! &+=!n de 5d "a ad+"=!.
    *voluie
    Teroarea de so%n :nce&e de re$+"7 "a co&!! :n(re I s! 59 an! O! se re/o"v7 s&on(an :n c+rs+"
    ado"escen=e!. La ad+"=!, aceas(a de'+(ea/7 ce" %a! .recven( :n(re 9L O! ;L an! O! +r%ea/7 adesea o
    evo"+=!e cron!c7, c+ a%e"!orarea O! a$ravarea sever!(7=!! O! .recven=e! :n dec+rs+" (!%&+"+!. Frec4
    ven=a e&!soade"or var!a/7, a(A( "a ace"aO! !nd!v!d, cA( O! de "a +n !nd!v!d "a a"(+". E&!soade"e a&ar
    de re$+"7 "a !n(erva"e de /!"e sa+ s7&(7%An!, dar &o( s+rven! O! no&=! consec+(!ve.
    #attern $amilial
    Ind!v!/!! c+ (eroare de so%n re"a(ea/7 .recven( +n !s(or!c .a%!"!a" &o/!(!v, .!e de (eroare de
    so%n, .!e de so%na%'+"!s%. Une"e s(+d!! !nd!c7 o creO(ere de 5L or! a &reva"en(e! (+"'+r7r!!
    &r!n(re r+de"e '!o"o$!ce de $rad+" I. Mod+" e<ac( de er!(are es(e nec+nosc+(.
    Tulburrile de Somn
    >+8
    Dia!nostic di$erenial
    M+"=! !nd!v!/! s+.er7 de e&!soade !/o"a(e de (eroare de so%n "a +n %o%en( da( :n v!a=a "or.
    D!s(!nc=!a d!n(re e&!soade"e !nd!v!d+a"e de (eroare de so%n s! (+"'+rarea (eroarea de so%n
    se 'a/ea/7 &e a&ar!=!a re&e(a(7, !n(ens!(a(ea, de(er!orarea sa+ de(resa se%n!.!ca(!v7 c"!n!c s!
    &o(en=!a"+" de v7(7%are a sa sa+ a a"(ora.
    Teroarea de so%n (re'+!e s7 .!e d!.eren=!a(7 de a"(e (+"'+r7r!, care &rod+c deO(e&(7r! &ar=!a"e
    sa+ co%&"e(e d!n so%n noa&(ea sa+ co%&or(a%en( !nso"!(, d!n c+rs+" so%n+"+!. Ce"e %a!
    !%&or(an(e d!a$nos(!ce d!.eren=!a"e &en(r+ (eroarea de so%n !nc"+d coO%ar+", so%na%'+"!s%+",
    a"(e &araso%n!! Eve/! &araso%n!a .7r7 a"(7 s&ec!.!ca=!eJ, (+"'+rarea de so%n :n "e$7(+r7 c+
    res&!ra=!a s! cr!/e"e e&!"e&(!ce s+rven!nd :n c+rs+" so%n+"+!, :n con(ras( c+ !nd!v!/!! c+ (eroare de
    so%n, !nd!v!/!! c+ coO%ar se deO(ea&(7 d!n so%n de re$+"7 +Oor s! co%&"e(, re"a(ea/7 v!se v!!
    ase%7n7(oare +ne! nara=!+n! aco%&an!!nd e&!soade"e O! (!nd s7 &re/!n(e e&!soade noa&(ea %a!
    (Ar/!+. ,rad+" de e<c!(a=!e ve$e(a(!v7 O! de ac(!v!(a(e %o(or!e n+ es(e (o( a(A( de %are ca :n
    (eroarea de so%n, !ar evocarea es(e %a! co%&"e(7. Teror!"e de so%n s+rv!n de re$+"7 :n so%n+"
    c+ +nde "en(e, &e cAnd coO%ar+r!"e s+rv!n :n c+rs+" so%n+"+! REM. P7r!n=!! co&!!"or c+ (eroare
    de so%n &o( !n(er&re(a :n %od erona( re"a(7r!"e de .r!c7 O! !%a$er!a .ra$%en(ar7 dre&( coO%ar+r!.
    So%na%'+"!s%+" &oa(e .! d!.!c!" de d!.eren=!a( de ca/+r!"e de (eroare de so%n care !%&"!c7 o
    ac(!v!(a(e %o(or!e no(a'!"7. De .a&(, ce"e do+7 (+"'+r7r! a&ar .recven( :%&re+n7, !ar !s(or!c+"
    .a%!"!a" !%&"!c7 .recven( a%'e"e (+"'+r7r!. Ca/+" (!&!c de (eroare de so%n !%&"!c7 & &redo%!nare
    a e<c!(a=!e! ve$e(a(!ve s! a .r!c!!, c+ +n $rad %a! +Oor de ac(!v!(a(e %o(or!e, care (!nde a .! 'r+sc7
    O! de/or$an!/a(7. Ca/+" (!&!c de so%na%'+"!s% !%&"!c7 &+=!n7 e<c!(a=!e ve$e(a(!v7 sa+ .r!c7 s! +n
    $rad %a! %are de ac(!v!(a(e %o(or!e or$an!/a(7.
    Paraso%n!a .7r7 a"(7 s&ec!.!ca=!e !nc"+de d!verse &re/en(7r! care &o( a%!n(! (eroarea de
    so%n. Ce" %a! co%+n e<e%&"+ es(e S(+"'+rarea de co%&or(a%en( a so%n+"+! REMT care, de
    ase%enea, &rod+ce .r!c7 s+'!ec(!v7, ac(!v!(a(e %o(or!e v!o"en(7 O! &o(en=!a" de v7(7%are.
    Deoarece aceas(a s+rv!ne :n c+rs+" so%n+"+! REM, ea !%&"!c7 v!se v!! ase%7n7(oare nara=!+n!!,
    o deO(e&(are %a! ra&!d7 O! %a! co%&"e(7 O! o ac(!v!(a(e %o(or!e care +r%ea/7 c"ar con=!n+(+"+!
    v!s+"+!. SD!s(on!a &aro<!s(!c7 noc(+rn7T !nc"+de, de ase%enea, deO(e&(7r! d!n so%n c+ ac(!v!(a(e
    %o(or!e, dar aceas(7 ac(!v!(a(e es(e %a! "+n$7 ca d+ra(7, es(e %a! r!(%!c7 s! s(ereo(!&7, O! n+
    es(e asoc!a(7 c+ re"a(7r! s+'!ec(!ve sa+ se%ne de .r!c7.
    Ha"+c!na=!!"e !&na$o$!ce, e<&er!en(a(e s&orad!c de %+"=! !nd!v!/! de a"(.e" as!%&(o%a(!c!,
    O! %a! a"es de c7(re ce! c+ narco"e&s!e, &o( .! asoc!a(e c+ an<!e(a(e. A&ar!=!a "a :nce&+(+"
    so%n+"+!, !%a$!n!"e v!! O! sen/a=!a s+'!ec(!v7 de v!$!"!(a(e, d!.eren=!a/7 aces(e e&!soade de
    (eroarea de so%n.
    Ma! rar, +n !nd!v!d c+ (+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a &oa(e avea e&!soade de
    deO(e&(are d!n so%n asoc!a(e c+ .r!c7 s! &an!c7 a%!n(!nd &e ce"e d!n (eroarea de so%n. Asoc!erea
    c+ s(er(or+", o'e/!(a(ea s! s!%&(o%e"e res&!ra(or!!, c+% ar .! a&ne!"e con.!r%a(e, o !nca&ac!(a(e de
    a res&!ra sa+ e&!soade de s+.ocare, d!s(!n$ (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a. Un
    e&!sod s!n$+"ar de (eroare de so%n &oa(e s+rven!, de ase%enea, :n c+rs+" re'o+nd+"+!
    so%n+"+! c+ +nde "en(e care +r%ea/7 (ra(a%en(+"+! &rec!&!(a( a" s!ndro%+"+! de a&nee de so%n
    o's(r+c(!v7 Ede e<., d+&7 (era&!a c+ &res!+ne na/a"7 con(!n+7 &ro$res!v7 :n c7!"e aer!ene
    XPNCPXJ.
    R;G Tulburrile de Somn

    Cr!/e"e e&!"e&(!ce care a&ar :n (!%&+" so%n+"+! &o( &rod+ce sen/a=!! s+'!ec(!ve de .r!c7 s!
    co%&or(a%en(e s(ereo(!&e, +r%a(e de con.+/!e s! d!.!c+"(a(e :n deO(e&(are. Ce"e %a! %+"(e
    cr!/e e&!"e&(!ce noc(+rne a&ar "a (ran/!=!a d!n(re so%n s! v!$!"!(a(e, dar &o( a&are s! :n c+rs+"
    so%n+"+! c+ +nde "en(e. Incon(!nen=a s.!nc(er!an7 s! %!Oc7r!"e (on!co4c"on!ce s+$erea/7
    e&!"e&s!a, dar cr!/e"e de "o' .ron(a" s! (e%&ora" &o( &rod+ce co%&or(a%en(e s! %a! co%&"e<e. Un
    e<a%en EE, re"ev7 adesea %od!.!c7r! !n(er!c(a"e "a !nd!v!/!! c+ cr!/e e&!"e&(!ce, !ar %on!(or!/area
    EE, :n c+rs+" so%n+"+! noc(+rn &oa(e .! necesar7 &en(r+ e.ec(+area +n+! d!a$nos(!c d!.eren=!a"
    dec!s!v, :n(rer+&erea so%n+"+! :n "e$7(+r7 c+ cr!/e"e e&!"e&(!ce (re'+!e s7 .!e d!a$nos(!ca(7 ca
    (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, de (!& &araso%n!e Eve/! &a$. RY5J.
    T+"'+r7r!"e de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e, a"(a decA( cr!/e"e e&!"e&(!ce :n
    "e$7(+r7 c+ so%n+", &o( ca+/a rar e&!soade co%&or(a%en(a"e !nso"!(e, noa&(ea. A&ar!=!a recen(7 a
    +n+! co%&or(a%en( anor%a" :n (!%&+" so%n+"+! "a +n ad+"( de e(a(e %ed!e sa+ %a! avansa(7,
    !%&+ne !%ed!a( "+area :n cons!dera=!e a +n+! (ra+%a(!s% cran!an :nc!s or! a +ne! &a(o"o$!! a
    s!s(e%+"+! nervos cen(ra", c+% ar .! o (+%or7 sa+ o !n.ec=!e.
    E&!soade"e de (eroare de so%n &o( .!, de ase%enea, e<acer'a(e sa+ !nd+se de %ed!ca%en(e,
    c+% ar .! de&r!%an(e"e s!s(e%+"+! nervos cen(ra". Dac7 e&!soade"e s+n( cons!dera(e a .! e.ec(+"
    .!/!o"o$!c d!rec( a" "+7r!! +n+! %ed!ca%en( sa+ s+'s(an=e, (+"'+rarea (re'+!e c"as!.!ca(7 ca
    (+"'+rare de so%n !nd+s7 de o s+'s(an=7, de (!& &araso%n!e Eve/! &a$. RYYJ.
    Pan!ca &oa(e ca+/a, de ase%enea, deO(e&(7r! 'r+O(e d!n so%n+" NREM &ro.+nd
    aco%&an!a(e de .r!c7, dar aces(e e&!soade &rod+c o deO(e&(are ra&!d7 O! co%&"e(7, .7r7
    con.+/!e, a%ne/!e sa+ ac(!v!(a(e %o(or!e carac(er!s(!c7 (eror!! de so%n. Ind!v!/!! care a+
    a(ac+r! de &an!c7 :n c+rs+" so%n+"+! re"a(ea/7 c7 aces(e s!%&(o%e s+n( &rac(!c !den(!ce c+
    ce"e a"e a(ac+r!"or de &an!c7 s+rven!nd :n (!%&+" /!"e!. Pre/en=a a$ora.o'!e! &oa(e a@+(a, de
    ase%enea, "a d!.eren=!erea ce"or do+7 (+"'+r7r!.
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    Teroarea de so%n es(e &rac(!c !den(!c7 c+ (eror!"e de so%n d!n C"as!.!carea In(erna=!ona"7
    a T+"'+r7r!"or de So%n ECITSJ. DeO(e&(7r!"e con.+/e, care &o( s+rven! ca o (+"'+rare
    !nde&enden(7 sa+ :n "e$7(+r7 c+ (eroarea de so%n, s+n(, de ase%enea, descr!se :n CITS.
    DeO(e&(7r!"e con.+/e s+n( carac(er!/a(e &r!n deO(e&(7r! sc+r(e d!n so%n+" c+ +nde "en(e c+
    con.+/!e, dar .7r7 (eroare sa+ dea%'+"a=!e.
    45?2HI Somnambulismul
    R;F
    Criteriile $e $ia/no&ti# pentru 4+G.7= Teroarea $e So"n
    A2 *pisoade recurente de de,teptare brusc din somn, survenind de re!ul "n
    cursul primei treimi a episodului de somn ma0or ,i "ncep@nd cu un stri!t de
    panic2
    S2 'ric intens si semne de excitaie ve!etativ, cum ar $i ta%icardia, respiraia
    rapid ,i transpiraia, "n cursul $iecrui episod2
    2 Lipsa relativ de reactivitate la e$orturile altora de a calma persoana "n
    timpul episodului2
    D2 Fici un vis nu este evocat "n detaliu ,i exist amne(ie pentru episod2
    *2 *pisoadele cau(ea( detres sau deteriorare semni$icativ clinic "n domeniul
    social, pro$esional sau "n alte domenii importante de $uncionare2
    '2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau ale unei condiii medicale !enerale
    4+G.7= So"na"-uli&"ul
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" so%na%'+"!s%+"+! :" cons(!(+!e e&!soade"e re&e(a(e de co%&or(a%en(
    %o(or co%&"e< !n!=!a( :n c+rs+" so%n+"+!, !%&"!cAnd sc+"area d!n &a( s! %ers+" :%&re@+r.
    E&!soade"e de so%na%'+"!s% :nce& :n c+rs+" so%n+"+! c+ +nde "en(e s!, ca a(are, s+rv!n adesea
    :n c+rs+" &r!%e! (re!%! a no&=!! Ecr!(er!+" AJ, :n c+rs+" e&!soade"or, !nd!v!d+" &re/!n(7 o s(are de
    v!$!"!(a(e O! reac(!v!(a(e red+s7, &r!v!re !ne<&res!v7 s! o re"a(!v7 "!&s7 de reac(!v!(a(e "a
    co%+n!carea c+ a"=!! sa+ "a e.or(+r!"e a"(ora de a45 deO(e&(a d!n so%n Ecr!(er!+" BJ. Dac7 se
    deO(ea&(7 :n (!%&+" e&!sod+"+! Eor! "a deO(e&(are, d!%!nea=a +r%7(oareJ, !nd!v!d+" :O! a%!n(eO(e
    .oar(e &+=!n de even!%en(e"e d!n (!%&+" e&!sod+"+! Ecr!(er!+" CJ. D+&7 e&!sod, &oa(e e<!s(a
    !n!=!a" o sc+r(7 &er!oad7 de con.+/!e sa+ de d!.!c+"(a(e :n or!en(are, +r%a(7 de rec+&erarea
    co%&"e(7 a .+nc=!e! co$n!(!ve s! co%&or(a%en(+"+! cores&+n/7(or Ecr!(er!+" DJ.
    So%na%'+"!s%+" (re'+!e s7 ca+/e/e de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+"
    soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ.
    So%na%'+"!s%+" n+ (re'+!e s7 .!e d!a$nos(!ca( dac7 co%&or(a%en(+" se da(orea/7 e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de a'+/, +n %ed!ca%en(J or! a"e +ne!
    cond!=!! %ed!ca"e $enera"e Ecr!(er!+" FJ.
    E&!soade"e de so%na%'+"!s% &o( !nc"+de o var!e(a(e de co%&or(a%en(e, :n e&!soade"e
    +Ooare Eden+%!(e +neor! SdeO(e&(7r! con.+/eTJ, !nd!v!d+" se &oa(e r!d!ca &+r O! s!%&"+ :n &a(, &oa(e
    &r!v! :n @+r or! (ra$e de &7(+r7 sa+ de cearcea.. Ma! (!&!c, !nd!v!d+" se d7 rea"%en(e @os d!n &a( s!
    &oa(e n!%er! :n $ardero', &oa(e !eO! d!n ca%er7, +rca sa+ co'or: &e sc7r! O! c!ar !eO! d!n cas7.
    Ind!v!/!! &o( +(!"!/a ca%era de 'a!e, &o( %Anca O! vor'! :n c+rs+" e&!soade"or. Po( s+rven!, de
    ase%enea, .+$a s! :ncerc7r!"e nes7'+!(e de a sc7&a de o .a"s7 a%en!n=are. Ce"e %a!
    %+"(e
    RIL Tulburrile de Somn

    co%&or(a%en(e d!n c+rs+" e&!soade"or de so%na%'+"!s% s+n( r+(!n!ere O! de co%&"e<!(a(e
    red+s7. A+ .os( ra&or(a(e :ns7 ca/+r! de desc+!ere a +O!"or s! c!ar de %an!&+"are a +nor %aO!n7r!!,
    :n s&ec!a" :n co&"7r!e, so%na%'+"!s%+" &oa(e !nc"+de co%&or(a%en(e necores&+n/7(oare Ede e<.,
    +r!na(+" :n ca%er7J. Ce"e %a! %+"(e e&!soade d+rea/7 de "a cA(eva %!n+(e &An7 "a o @+%7(a(e de
    or7.
    E&!soade"e de so%na%'+"!s% se &o( (er%!na &r!n deO(e&(7r! s&on(ane +r%a(e de o sc+r(7
    &er!oad7 de con.+/!e, or! !nd!v!d+" se :n(oarce :n &a( O! con(!n+7 s7 doar%7 &An7 d!%!nea=a.4
    N+ rar, !nd!v!d+" se &oa(e deO(e&(a d!%!nea=a +r%7(oare :n a"( "oc, or! c+ &ro'a .a&(+"+! c7 a
    e.ec(+a( o an+%!(7 ac(!v!(a(e :n (!%&+" no&=!!, dar c+ a%ne/!e co%&"e(7 &en(r+ even!%en(. Une"e
    e&!soade &o( .! +r%a(e de a%!n(!rea va$7 a +nor !%a$!n! .ra$%en(are de v!s, dar de re$+"7 n+
    de v!se ase%enea +ne! nara=!+n! (!&!ce.
    :n c+rs+" e&!soade"or de so%na%'+"!s%, !nd!v!/!! &o( vor'! s! c!ar r7s&+nde "a :n(re'7r!"e
    a"(ora. Pron+n=!a "or es(e :ns7 de.ec(+oas7 s! +n d!a"o$ ver!(a'!" es(e rar. Ind!v!/!! &o( r7s&+nde "a
    cerer!"e a"(ora de a4O! :nce(a ac(!v!(a(ea O! de a se :n(oarce :n &a(. Aces(e co%&or(a%en(e s+n(
    e.ec(+a(e, :ns7, c+ +n n!ve" red+s de v!$!"!(a(e, !ar deO(e&(area !nd!v!d+"+! d!n e&!sod+" de
    so%na%'+"!s% es(e .oar(e d!.!c!"7. Dac7 se deO(ea&(7, !nd!v!d+" r7%Ane con.+/ (!%& de cA(eva
    %!n+(e O! a&o! rev!ne "a s(area de v!$!"!(a(e nor%a"7.
    Pen(r+ a .! &+s d!a$nos(!c+", !nd!v!d+" (re'+!e s7 e<&er!en(e/e o de(res7 sa+ de(er!orare
    se%n!.!ca(!v7 c"!n!c. Ind!v!/!! &o( ev!(a s!(+a=!!"e care ar &+(ea reve"a a"(ora co%&or(a%en(+" "or
    Ede e<., co&!!! &o( ev!(a v!/!(area a%!c!"or sa+ %ers+" :n (a'ere de var78 ad+"=!! &o( ev!(a s7
    doar%7 c+ &ar(ener! de &a(, s7 %ear$7 :n conced!! sa+ s7 s(ea de&ar(e de cas7J. Poa(e re/+"(a
    !/o"are soc!a"7 sa+ d!.!c+"(7=! &ro.es!ona"e.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve O! (+"'+r7r! %en(a"e asoc!a(e. S(!%+"! !n(ern! Ede e<., d!s(ens!a
    ve/!c!!J or! s(!%+"! e<(ern! Ede e<., /$o%o(e"eJ &o( creO(e &ro'a'!"!(a(ea +n+! e&!sod de
    so%na%'+"!s%, aOa c+% o &o( .ace s(resor!! &s!osoc!a"! s! +/+" de a"coo" sa+ de seda(!ve. Un!!
    !nd!v!/! c+ so%na%'+"!s% &o( re"a(a, de ase%enea, e&!soade de %Anca( :n c+rs+" no&=!!, ce" %a!
    adesea c+ a%ne/!e co%&"e(7 sa+ &ar=!a"7. E! &o( cons(a(a .a&(+" c7 a+ %Anca(, n+%a! d!%!nea=a
    +r%7(oare. Ind!v!/!! se &o( v7(7%a :n c+rs+" e&!soade"or de so%na%'+"!s% &r!n "ov!rea de
    d!verse o'!ec(e, %ers+" &e sc7r!, !eO!(+" a.ar7 O! %ers+" &e &ar(ea e<(er!oar7 a .eres(re"or. R!sc+"
    de v7(7%are consec+(!v7 cres(e dac7 e&!soade"e de so%na%'+"!s% !nc"+d e"e%en(e a"e (eror!! de
    so%n, asoc!a(e de .+$! sa+ "ov!rea de d!verse o'!ec(e. Ind!v!/!! c+ so%na%'+"!s% O! (eroare de
    so%n &o(, de ase%enea, v7(7%a &e a"=!! :n c+rs+" e&!soade"or.
    La !nd!v!/!! c+ so%na%'+"!s%, &o( s+rven! s! a"(e &araso%n!! asoc!a(e c+ so%n+" .7r7
    %!Oc7r! oc+"are ra&!de ENREMJ Ede e<., (eroarea de so%nJ. So%na%'+"!s%+" "a co&!! n+ es(e
    asoc!a( de re$+"7 c+ a"(e (+"'+r7r! %en(a"e, dar "a ad+"=! &oa(e .! asoc!a( c+ (+"'+r7r! de
    &ersona"!(a(e, (+"'+r7r! a.ec(!ve sa+ c+ (+"'+r7r! an<!oase.
    Da(e de "a'ora(or asoc!a(e. Po"!so%no$ra.!a, +(!"!/And &rocedee de r+(!n7 c+ ad7+$area
    %on!(or!/7r!! a+d!ov!/+a"e, &oa(e doc+%en(a e&!soade"e de so%na%'+"!s%. E&!soade"e
    :nce& :n &r!%e"e cA(eva ore de so%n, :n c+rs+" so%n+"+! &ro.+nd Ede re$+"7 :n s(ad!!"e ; s! I
    de so%n NREMJ, c+ (oa(e c7 +n!!
    45?2HI Somnambulismul
    >F1
    !nd!v!/!, de e<., ad+"=!! %a! :n e(a(e, &o( &re/en(a e&!soade"e :n c+rs+" s(ad!+"+! 9 de so%n NREM.
    PrecedAnd e&!sod+", EE, ara(7 adesea o ac(!v!(a(e de"(a r!(%!c7 ES!&ers!ncron7TJ c+ vo"(a@
    cresc+(, care &ers!s(7 O! :n c+rs+" deO(e&(7r!!. Se%ne"e EE, de deO(e&(are d!n so%n, c+% ar .!
    ac(!v!(a(ea a".a, &o( a&are, de ase%enea, "a :nce&+(+" e&!sod+"+!. Ce" %a! .recven(, EE, es(e
    o'sc+r!/a(7 &r!n ar(e.ac(e !nd+se de %!Oc7r! :n (!%&+" e&!sod+"+! e.ec(!v. R!(%+" card!ac s! r!(%+"
    res&!ra(or &o( creO(e "a :nce&+(+" e&!sod+"+!. Aces(e %od!.!c7r! &o( s+rven! :n c+rs+" +n+! e&!sod
    de so%na%'+"!s% co%&"e( or! a" +n+! even!%en( co%&or(a%en(a" %a! %!nor Ec+% ar .!
    deO(e&(area con.+/7J. A"(e cons(a(7r! &o"!so%no$ra.!ce &o( !nc"+de +n n+%7r cresc+( de (ran/!=!!
    :na.ara s(ad!!"or ; O! I de so%n, creO(erea deO(e&(7r!"or :n c+rs+" so%n+"+! NREM O! o red+cere a
    e.!c!en=e! so%n+"+!.
    9atele examinrii somatice /i condi3iile medicale .enerale asociate. Fe'ra sa+ de&r!varea
    de so%n &o( cres(e .recven=a e&!soade"or de so%na%'+"!s%. S!ndro%+" de a&nee de so%n
    o's(r+c(!v7, %!Ocarea &er!od!c7 a %e%'re"or O! a"(e (+"'+r7r! care &o( &rod+ce :n(rer+&erea
    sever7 a so%n+"+! c+ +nde "en(e &o( .! asoc!a(e, de ase%enea, c+ e&!soade de so%na%'+"!s%. A
    .os( no(a(7 o asoc!ere :n(re so%na%'+"!s%, ce.a"ee"e %!$renoase, narco"e&s!e O! a"(e cond!=!!
    ne+ro"o$!ce "a +n s+'se( de !nd!v!/!.
    *lemente speci$ice culturii, etii si sexului
    N!c! +n .e" de co%+n!c7r! n+ a+ o.er!( &ro'a c"ar7 a d!.eren=e"or :n "e$7(+r7 c+ c+"(+ra :n
    %an!.es(7r!"e so%na%'+"!s%+"+!, dar es(e &os!'!" ca se%n!.!ca=!a O! ca+/e"e a(r!'+!(e
    so%na%'+"!s%+"+! s7 d!.ere :n(re d!verse"e c+"(+r!. Pe eOan(!oane"e c"!n!ce, e&!soade"e de
    ac(!v!(a(e v!o"en(7 :n c+rs+" so%na%'+"!s%+"+! es(e .oar(e &os!'!" s7 s+rv!n7 "a ad+"=! E:n s&ec!a"
    "a '7r'a=!J, &e cAnd e&!soade"e de %Anca( :n c+rs+" so%na%'+"!s%+"+! s+n( o'serva(e %a!
    .recven( "a .e%e!. So%na%'+"!s%+" "a .e%e! s+rv!ne %a! .recven( :n co&!"7r!e, &e cAnd "a '7r'a=!,
    :n &er!oada ad+"(7.
    #revalent
    :n(re 5Ld O! ;Ld d!n(re co&!! a+ av+( ce" &+=!n +n e&!sod de so%na%'+"!s%, !ar 9d4;d %er$
    adesea :n so%n. Preva"en(a so%na%'+"!s%+"+! E%arca(7 de e&!soade re&e(a(e O! de(er!orare sa+
    de(res7J es(e %+"( %a! red+s7, &ro'a'!" de ord!n+" a "d4Yd. Ance(e"e e&!de%!o"o$!ce ra&or(ea/7 o
    &reva"en(7 a e&!soade"or de so%na%'+"!s% En+ a so%na%'+"!s%+"+! ca (+"'+rareJ de "d4Hd
    &r!n(re ad+"=!, c+ e&!soade s+rven!nd s7&(7%Ana" sa+ "+nar :n L,Yd4L,Hd d!n ca/+r!.
    *voluie
    So%na%'+"!s%+" &oa(e a&are :n or!ce %o%en( d+&7 ce +n co&!" es(e ca&a'!" s7 %ear$7, dar
    e&!soade"e s+rv!n ce" %a! .recven( &en(r+ &r!%a da(7 :n(re e(a(ea de I s! G an!. Preva"en(a
    %a<!%7 s+rv!ne :n @+r+" e(7=!! de 59 an!. E&!soade"e s+rv!n rar &en(r+ &r!%a da(7 "a ad+"=!, !ar
    +ne"e co%&or(a%en(e asoc!a(e, c+% ar .! %Anca(+" :n c+rs+" no&=!! &o( s+rven! "a cA=!va an! d+&7
    de'+(+" so%na%'+"!s%+"+!. De'+(+" so%na%'+"!s%+"+! "a ad+"=!! .7r7 !s(or!c de so%na%'+"!s%
    :n co&!"7r!e (re'+!e s7 de(er%!ne o cerce(are &ro%&(7 a e(!o"o$!!"or s&ec!.!ce, c+% ar .! +/+" +ne!
    s+'s(an=e or! o cond!=!e ne+ro"o$!c7. Ma@or!(a(ea ad+"=!"or c+ so%na%'+"!s% a+, de
    >F2 Tul-ur(rile $e So"n

    ase%enea, +n !s(or!c de e&!soade de so%na%'+"!s% :n c+rs+" co&!"7r!e!. So%na%'+"!s%+" !n
    co&!"7r!e d!s&are de re$+"7 s&on(an "a :nce&+(+" ado"escen=e!, de re$+"7 "a e(a(ea de 5Y an!. Ma!
    rar, e&!soade"e &o( avea o evo"+=!e rec+ren(7, c+ reven!re "a :nce&+(+" &er!oade! ad+"(e, d+&7
    :nce(area "or :n +"(!%a &ar(e a co&!"7r!e!. So%na%'+"!s%+" "a ad+"=! +r%ea/7 ce" %a! adesea o
    evo"+=!e cron!c7, c+ a%e"!or7r! s! a$rav7r! s+cces!ve. E&!soade"e de so%na%'+"!s% &o( s+rven!,
    ca even!%en(e !/o"a(e, "a or!ce e(a(e, dar ce" %a! .recven( &a((ern :" cons(!(+!e e&!soade"e
    re&e(a(e s+rven!nd d+&7 o &er!oad7 de %a! %+"=! an!.
    #attern $amilial
    So%na%'+"!s%+" a$re$7 &r!n(re %e%'r!! .a%!"!e!. Un !s(or!c .a%!"!a" de so%na%'+"!s%
    sa+ de (eror! de so%n a .os( descr!s :n &An7 "a GLd d!n(re !nd!v!/!! care %er$ :n so%n. R!sc+" de
    so%na%'+"!s% es(e cresc+( :n &"+s E&An7 "a %a! %+"( de RLd d!n(re descenden=!J cAnd a%'!!
    &7r!n=! a+ +n !s(or!c a" (+"'+r7r!!. Trans%!s!a $ene(!c7 es(e s+$era(7 de &reva"en(a cresc+(7 de
    $e%en! %ono/!$o=! ca o&+s7 ce"e! de $e%en! d!/!$o=!, dar %od+" e<ac( de er!(are n+ es(e
    c+nosc+(.
    Dia!nostic di$erenial
    M+"=! co&!! a+ e&!soade !/o"a(e sa+ rare de so%na%'+"!s%, c+ sa+ .7r7 even!%en(e
    &rec!&!(an(e. L!%!(a e<ac(7 d!n(re e&!soade"e de so%na%'+"!s% .7r7 se%n!.!ca=!e c"!n!c7 s!
    So%na%'+"!s%+" ca (+"'+rare es(e !nd!s(!nc(7. E&!soade"e .recven(e, v7(7%7r!"e, +n
    co%&or(a%en( %a! ac(!v sa+ v!o"en(, s! de(er!orarea soc!a"7 re/+"(And d!n so%na%'+"!s% es(e
    &os!'!" s7 .ac7 &e &7r!n=!! co&!"+"+! s7 so"!c!(e a@+(or s! @+s(!.!c7 d!a$nos(!c+" de so%na%'+"!s%.
    E&!soade"e care a+ &ers!s(a( d!n co&!"7r!e &An7 (Ar/!+ :n ado"escen=7, or! care a&ar de novo "a
    ad+"=!, es(e .oar(e &os!'!" s7 @+s(!.!ce +n d!a$nos(!c de so%na%'+"!s%.
    C"!n!c &oa(e .! d!.!c!" s7 se d!s(!n$7 So%na%'+"!s%+" de (eroarea de so%n cAnd e<!s(7 o
    (en(a(!v7 de a Ssc7&aT de s(!%+"+" (er!.!an(, :n a%'e"e ca/+r!, !nd!v!d+" &re/!n(7 %!Oc7r!,
    d!.!c+"(a(e :n deO(e&(are O! a%ne/!e &en(r+ even!%en(. Un s(r!$7( !n!=!a", se%ne"e de .r!c7 s!
    &an!c7 !n(ens7 s! e<c!(a=!a ve$e(a(!v7 s+n( %a! carac(er!s(!ce (eror!! de so%n. So%na%'+"!s%+"
    O! (eroarea de so%n &o( a&are "a ace"aO! !nd!v!d, s! :n as(.e" de ca/+r! (re'+!e d!a$nos(!ca(e
    a%'e"e.
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a, :n s&ec!a" s!ndro%+" a&nee! de so%n
    o's(r+c(!ve, &oa(e &rod+ce, de ase%enea, deO(e&(7r! con.+/e c+ a%ne/!e consec+(!v7, :ns7,
    (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a es(e carac(er!/a(7, de ase%enea, &r!n s!%&(o%e de
    s(er(or, &a+/e :n res&!ra=!e s! so%no"en=7 d!+rn7. La +n!! !nd!v!/!, (+"'+rarea de so%n :n
    "e$7(+r7 c+ res&!ra=!a &oa(e &rec!&!(a e&!soade"e de so%na%'+"!s%.
    ST+"'+rarea de co%&or(a%en( d!n so%n+" REMT es(e a"(a &araso%n!e Eve/! &araso%n!a .7r7
    a"(7 s&ec!.!ca=!eJ care &oa(e .! d!.!c!" de d!s(!ns de so%na%'+"!s%. T+"'+rarea de co%&or(a%en(
    d!n so%n+" REM se carac(er!/ea/7 &r!n e&!soade de %!Oc7r! co%&"e<e, no(a'!"e, !%&"!cAnd
    adesea v7(7%area &ersoane! res&ec(!ve, :n con(ras( c+ So%na%'+"!s%+", (+"'+rarea de
    co%&or(a%en( d!n so%n+" REM s+rv!ne :n (!%&+" so%n+"+! c+ %!Oc7r! oc+"are ra&!de, adesea
    :n +"(!%a &ar(e a no&=!!. Ind!v!/!! c+ (+"'+rare de co%&or(a%en( :n so%n+" REM se deO(ea&(7 +Oor
    O! re"a(ea/7 %a! de(a"!a( con=!n+(+" v!+ a" v!s+"+! decA( o .ac !nd!v!/!! c+ so%a%'+"!s%. Un
    %!c n+%7r de !nd!v!/! &oa(e &re/en(a deO(e&(are d!n so%n con.+/7 c+ ac(!v!(a(e %o(or!e
    s+rven!nd :n c+rs+" so%n+"+! NREM s! REM.
    Tulburrile de Somn IH4

    D!a$nos(!c+" de.!n!(!v :n aces(e ca/+r! (re'+!e s7 se 'a/e/e &e o eva"+are a(en(7 a da(e"or c"!n!ce,
    &o"!so%no$ra.!ce s! a a"(or da(e de "a'ora(or.
    O var!e(a(e de a"(e co%&or(a%en(e &oa(e s+rven! oda(7 c+ deO(e&(7r!"e &ar=!a"e d!n so%n.
    DeO(e&(7r!"e con.+/e sea%7n7 c+ e&!soade"e de so%na%'+"!s% s+' (oa(e as&ec(e"e, c+ e<ce&=!a
    da(+"+! @os d!n &a(. SBe=!a de so%nT es(e o s(are :n care !nd!v!d+" &re/!n(7 o (ran/!=!e &re"+n$!(7
    de "a so%n "a v!$!"!(a(e, d!%!nea=a. Ind!v!d+" &oa(e .! d!.!c!" de deO(e&(a( d!n so%n, aces(a
    &+(And re/!s(a v!o"en( e.or(+r!"or de a45 deO(e&(a. D!n no+, dea%'+"a=!a sa+ a"(e co%&or(a%en(e
    %a! co%&"e<e d!s(!n$ so%na%'+"!s%+". A(A( deO(e&(7r!"e con.+/e, cA( s! 'e=!a de so%n &o(
    s+rven!, :ns7, "a !nd!v!/!! c+ so%na%'+"!s%.
    E&!"e&s!a %or.e!c7 &oa(e &rod+ce e&!soade de co%&or(a%en( !nso"!( care s+rv!n n+%a! :n
    c+rs+" so%n+"+!. Ind!v!d+" es(e areac(!v O! a%ne/!c &en(r+ e&!sod. De re$+"7, e&!"e&s!a %or.e!c7
    &rod+ce %!Oc7r! s(ereo(!&e, &ersevera(!ve, de co%&"e<!(a(e %a! red+s7 decA( ce"e d!n
    so%na%'+"!s%. :n ce"e %a! %+"(e ca/+r!, !nd!v!/!! c+ e&!"e&s!e %or.e!c7 a+, de ase%enea,
    e&!soade s!%!"are O! :n (!%&+" s(7r!! de v!$!"!(a(e. EE, &re/!n(7 e"e%en(e de e&!"e&s!e, !nc"+/And
    ac(!v!(a(e &aro<!s(!c7 :n c+rs+" e&!soade"or O! e"e%en(e !n(ercr!(!ce a"(eor!. Pre/en=a cr!/e"or
    %or.e!ce n+ !nc"+de :ns7, &re/en=a e&!soade"or de so%na%'+"!s%. E&!"e&s!a %or.e!c7 (re'+!e
    d!a$nos(!ca(7 ca (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, de (!& &araso%n!e
    Eve/! &a$. RY5J.
    So%na%'+"!s%+" &oa(e .! !nd+s de +/+" sa+ de a's(!nen=a de s+'s(an=e sa+ de %ed!ca%en(e
    Ede e<., a"coo", 'en/od!a/e&!ne, o&!acee, coca!n7, n!co(!n7, an(!&s!o(!ce, an(!de&res!ve
    (r!c!c"!ce, c"ora" !dra(J. :n as(.e" de ca/+r!, (re'+!e &+s d!a$nos(!c+" de (+"'+rare de so%n !nd+s7
    de o s+'s(an=7, de (!& &araso%n!e Eve/! &a$. RYYJ.
    F+$a d!soc!a(!v7 &re/!n(7 s!%!"ar!(7=! s+&er.!c!a"e c+ so%na%'+"!s%+". F+$a es(e rar7 "a
    co&!!, :nce&e de re$+"7 cAnd !nd!v!d+" es(e v!$!", d+rea/7 ore sa+ /!"e O! n+ es(e carac(er!/a(7 &r!n
    &er(+r'7r! de conO(!!n=7. So%na%'+"!s%+" (re'+!e d!.eren=!a(, de ase%enea, de s!%+"are sa+ de
    a"( co%&or(a%en( vo"+n(ar care s+rv!ne :n c+rs+" v!$!"!(7=!!, deO! :n +ne"e ca/+r! o as(.e" de
    d!s(!nc=!e &oa(e .! d!.!c!"7 E"e%en(e"e care s+$erea/7 so%na%'+"!s%+" !nc"+d +n !s(or!c &o/!(!v :n
    co&!"7r!e, +n co%&or(a%en( s(ereo(!& sa+ de co%&"e/!(are red+s7 :n c+rs+" e&!soade"or de
    so%na%'+"!s%, a'sen=a 'ene.!c!+"+! sec+ndar a" !nd!v!d+"+! d!n co%&or(a%en(+" s7+ noc(+rn O!
    &re/en=a da(e"or &o"!so%no$ra.!ce (!&!ce, c+% ar .! deO(e&(7r!"e re&e(a(e d!n so%n+" NREM. :n
    &"+s, &oa(e .! d!.!c!" &en(r+ !nd!v!d s7 .a"s!.!ce :n %od conv!n$7(or as&ec(+" sa+ co%&or(a%en(+"
    d!n so%na%'+"!s%, s+' o'serva=!e d!rec(7 sa+ cAnd es(e :nre$!s(ra( v!deo :n "a'ora(or+" de
    so%n..
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    So%na%'+"!s%+" (+"'+rare es(e &rac(!c !den(!c c+ so%na%'+"!s%+", aOa c+% es(e descr!s :n
    C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n ECITSJ. CITS !nc"+de a"(e do+7 (+"'+r7r! care
    &o( avea e"e%en(e s!%!"are c+ so%na%'+"!s%+"Q deO(e&(7r!"e con.+/e s! s!ndro%+" %Anca(+"+!
    E'7+(+"+!J noc(+rn.
    =77 Tulburrile de Somn

    Criteriile $e $ia/no&ti# pentru 4+G.7= So"na"-uli&"
    A2 *pisoade repetate de sculat din pat "n timpul somnului ,i mers "mpre0ur,
    survenind de re!ul "n prima treime a episodului de somn ma0or2
    S2 "n timp ce somnambulea(, persoana are o $a ri!id, inexpresiv, este
    relativ nonreactiv la e$orturile altora de a comunica cu ea, si poate $i
    de,teptat numai cu mare di$icultate2
    2 La de,teptare &$ie din episodul de somnambulism, $ie dimineaa urmtoare),
    persoana are amne(ie pentru episod2
    D2 Timp de mai multe minute dup de,teptarea din episodul de somnambulism,
    nu exist nici o deteriorare a activitii mentale sau a comportamentului
    &de,i iniial poate exista o scurt perioad de con$u(ie sau de(orientare)2
    *2 Somnambulismul cau(ea( detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    '2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau unei condiii medicale !enerale2
    4+G.7G Para&e" n ia '(r( Alt( Spe#i%i#a!ie
    Ca(e$or!a de &araso%n!e .7r7 a"(7 s&ec!.!ca=!e es(e re/erva(7 &er(+r'7r!"or carac(er!/a(e &r!n
    even!%en(e co%&or(a%en(a"e sa+ .!/!o"o$!ce anor%a"e :n (!%&+" so%n+"+! sa+ a" (ran/!=!!"or
    so%n4v!$!"!(a(e, dar care n+ sa(!s.ac cr!(er!!"e &en(r+ o &araso%n!e %a! s&ec!.!c7. E<e%&"e"e
    !nc"+dQ
    1. T+"'+rarea de co%&or(a%en( d!n so%n+" REMQ ac(!v!(a(e %o(or!e, adesea de
    na(+r7 v!o"en(7, care a&are :n (!%&+" so%n+"+! c+ %!Oc7r! oc+"are ra&!de EREMJ.
    Con(rar so%na%'+"!s%+"+!, aces(e e&!soade (!nd s7 a&ar7 %a! (Ar/!+ noa&(ea s!
    s+n( asoc!a(e c+ evocarea v!e a v!s+"+!.
    2. Para"!/!a de so%nQ o !nca&ac!(a(e de a e.ec(+a vreo %!Ocare vo"+n(ar7 :n c+rs+"
    (ran/!=!e! d!n(re v!$!"!(a(e s! so%n. E&!soade"e &o( s+rven! "a :nce&+(+" so%n+"+!
    E!&na$o$!ceJ or! "a deO(e&(are E!&no&o%&!ceJ. E&!soade"e s+n( asoc!a(e de
    re$+"7 c+ o an<!e(a(e e<(re%7 s!, :n +ne"e ca/+r!, c+ .r!ca de %oar(e !%!nen(7.
    Para"!/!a de so%n s+rv!ne .recven( ca +n s!%&(o% a+<!"!ar a" narco"e&s!e! O!, :n
    as(.e" de ca/+r!, n+ (re'+!e s7 .!e cod!.!ca(7 se&ara(.
    3. S!(+a=!!"e :n care c"!n!c!an+" a a@+ns "a conc"+/!a c7 es(e &re/en(7 o &araso%n!e,
    dar es(e !nca&a'!" s7 &rec!/e/e dac7 aceas(a es(e &r!%ar7, da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e or! !nd+s7 de o s+'s(an=7.
    Tulburrile de Somn "n le!tur cu Alt Tulburare Mental
    RIY

    Tul-ur(rile $e So"n .n le/(tur( #u Alt(
    Tul-urare Mental(
    4+G.7C In&o"nia .n le/(tur(
    #u Alt( Tul-urare Mental(
    4+G.77 Fiper&o"nia .n le/(tur(
    #u Alt( Tul-urare Mental(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" !nso%n!e! :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 s! a" !&erso%n!e! :n
    "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 :" cons(!(+!e &re/en=a .!e a !nso%n!e!, .!e a !&erso%n!e!, care
    es(e cons!dera(7 a .! :n "e$7(+r7 (e%&ora"7 O! ca+/a"7 c+ a"(7 (+"'+rare %en(a"7. Inso%n!a sa+
    !&erso%n!a, care es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! s+'s(an=e, n+ es(e !nc"+s7 a!c!. As(.e"
    de &re/en(7r! (re'+!e s7 .!e d!a$nos(!ca(e ca (+"'+rare de so%n !nd+s7 de o s+'s(an=7 Eve/! &a$.
    RYYJ. Inso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 es(e carac(er!/a(7 &r!n(r4o ac+/7 de
    d!.!c+"(a(e :n a ador%!, deO(e&(7r! .recven(e d!n so%n :n c+rs+" no&=!! sa+ +n sen(!%en( %arca(
    de so%n nerecon.or(an(, care d+rea/7 de ce" &+=!n o "+n7 s! es(e asoc!a( c+ .a(!$a'!"!(a(e d!+rn7
    sa+ de(er!orarea .+nc=!on7r!! d!+rne Ecr!(er!+" AJ. H!&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare
    %en(a"7 es(e carac(er!/a(7 &r!n(r4o ac+/7, .!e de so%n noc(+rn &re"+n$!(, .!e de e&!soade de so%n
    d!+rn re&e(a(e, (!%& de ce" &+=!n o "+n7 Ecr!(er!+" AJ. A(A( :n !nso%n!a, cA( s !4n !&erso%n!a :n
    "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7, s!%&(o%e"e :n re"a=!e c+ so%n+" ca+/ea/7 de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de
    .+nc=!onare Ecr!(er!+" BJ. Inso%n!a sa+ !&erso%n!a n+ es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare de
    so%n Ede e<., narco"e&s!a, (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a or! o &araso%n!eJ, !ar
    !&erso%n!a n+ es(e e<&"!ca(7 %a! '!ne de o can(!(a(e !nadecva(7 de so%n Ecr!(er!+" DJ.
    Per(+r'area de so%n n+ (re'+!e s7 se da(ore/e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede
    ex7, +n dro$ de a'+/, +n %ed!ca%en(J, or! a"e +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" EJ.
    Per(+r'7r!"e so%n+"+! s+n( e"e%en(e co%+ne a"(or (+"'+r7r! %en(a"e. Un d!a$nos(!c
    ad!=!ona" de !nso%n!e sa+ !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 es(e &+s, n+%a!
    cAnd &er(+r'area de so%n es(e ac+/a &redo%!nan(7 s! es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o
    a(en=!e c"!n!c7 se&ara(7 Ecr!(er!+" CJ. Ind!v!/!! c+ aces( (!& de !nso%n!e sa+ !&erso%n!e se
    cen(rea/7 de re$+"7 &e &er(+r'area "or de so%n, %er$And &An7 "a e<c"+derea s!%&(o%e"or
    carac(er!s(!ce a"e (+"'+r7r!! %en(a"e :n care aces(ea a&ar, s! a c7ror &re/en=7 &oa(e deven! ev!den(7
    n+%a! d+&7 +n !n(ero$a(or!+ s&ec!.!c s! &ers!s(en(. N+ rar, e! a(r!'+!e s!%&(o%e"e (+"'+r7r!! "or
    %en(a"e .a&(+"+! c7 dor% r7+.
    M+"(e (+"'+r7r! %en(a"e &o( !%&"!ca +neor! !nso%n!a sa+ !&erso%n!a ca &ro'"e%e
    do%!nan(e. Ind!v!/!! c+ (+"'+rare de&res!v7 %a@or7 se &"An$ adesea de d!.!c+"(a(e :n a ador%!
    or! de a r7%Ane ador%!=!, sa+ de deO(e&(are &recoce d!%!nea=a, c+ !nca&ac!(a(ea de a re"+a
    so%n+". H!&erso%n!a :n "e$7(+r7 c+ o (+"'+rare a.ec(!v7 es(e asoc!a(7 ce" %a! adesea c+
    (+"'+rarea a.ec(!v7 '!&o"ar7, ce"
    RIR Tulburrile de Somn

    %a! recen( e&!sod de&res!v, or! c+ +n e&!sod de&res!v %a@or, c+ e"e%en(e a(!&!ce. Ind!v!/!! c+
    an<!e(a(e $enera"!/a(7 re"a(ea/7 adesea d!.!c+"(a(e :n ador%!re s! se &o( deO(e&(a c+ r+%!na=!!
    an<!oase, :n %!@"oc+" no&=!!. Un!! !nd!v!/! c+ &an!c7 a+ a(ac+r! de &an!c7 noc(+rne, care &o(
    d+ce "a !nso%n!e. O !nso%n!e !%&or(an(7 es(e o'serva(7 adesea :n (!%&+" e<acer'7r!"or
    sc!/o.ren!e! s! a"(or (+"'+r7r! &s!o(!ce, dar es(e rar ac+/a &redo%!nan(7. A"(e (+"'+r7r!
    %en(a"e care &o( .! :n "e$7(+r7 c+ !nso%n!a !nc"+d (+"'+r7r!"e de ada&(are, (+"'+r7r!"e
    so%a(o.or%e s! (+"'+r7r!"e de &ersona"!(a(e.
    #rocedee de "nre!istrare
    N+%e"e d!a$nos(!c+"+! :nce&e c+ (!&+" de &er(+r'are de so%n Ead!c7, !nso%n!e sa+
    !&erso%n!eJ +r%a( de n+%e"e (+"'+r7r!! de &e a<a I sa+ a<a II c+ care aceas(a es(e :n "e$7(+r7,
    &e a<a I Ede e<., ;LH.I9 Inso%n!e :n "e$7(+r7 c+ (+"'+rarea de&res!v7 %a@or7J. T+"'+rarea
    %en(a"7 s&ec!.!c7 (re'+!e cod!.!ca(7, de ase%enea, d+&7 ca/, &e a<a I sa+ &e a<a II.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. Deoarece, &r!n de.!n!=!e, s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea %en(a"7 asoc!a(7, e"e%en(e"e asoc!a(e a"e !nso%n!e! sa+
    !&erso%n!e! :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 !nc"+d e"e%en(e"e carac(er!s(!ce s! asoc!a(e
    a"e (+"'+r7r!! %en(a"e asoc!a(e.
    Ind!v!/!! c+ !nso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &o( &re/en(a ace"aO! (!& de
    deO(e&(are cond!=!ona(7 s! cond!=!onare ne$a(!v7 &e care o &re/!n(7 s! !nd!v!/!! c+ !nso%n!e
    &r!%ar7. De e<e%&"+, e! vor no(a an<!e(a(e cresc+(7 &e %7s+r7 ce se a&ro&!e ora de %ers "a
    c+"care, a%e"!orarea so%n+"+! cAnd s+n( scoO! d!n a%'!an=a +/+a"7 de so%n s! o (end!n=7 de a
    &e(rece &rea %+"( (!%& :n &a(. E! &o( avea, de ase%enea, +n !s(or!c de (ra(a%en(e
    %ed!ca%en(oase %+"(!&"e s! !nadecva(e &en(r+ ac+/e"e "or de !nso%n!e. Ind!v!/!! c+
    !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 vor s+'"!n!a .recven( s!%&(o%e"e de
    .ar!$a'!"!(a(e, S&ara"!/!a de &"+%'T sa+ "!&sa co%&"e(7 de ener$!e. La o ces(!onare a(en(7, aceO(!
    !nd!v!/! &o( .! %a! de(resa(! de as(.e" de s!%&(o%e :n "e$7(+r7 c+ .a(!$a'!"!(a(ea decA( de
    adev7ra(a so%no"en=7. E! &o( avea, de ase%enea, +n !s(or!c de +/ !nadecva( de %ed!ca%en(e
    s(!%+"an(e, !nc"+s!v de ca.e!na.
    Da(e de "a'ora(or asoc!a(e. Da(e"e &o"!so%no$ra.!ce carac(er!s(!ce Edar n+ d!a$nos(!ceJ d!n
    e&!sod+" de&res!v %a@or !nc"+dQ 5J &er(+r'area con(!n+!(7=!! so%n+"+!, c+% ar .! &re"+n$!rea
    "a(en=e! de so%n, creO(erea v!$!"!(7=!! !n(er%!(en(e O! deO(e&(area %a(!na"7 &recoce8 9J red+cerea
    s(ad!!"or ; s! I de so%n .7r7 %!Oc7r! oc+"are ra&!de ENREMJ Eso%n+" c+ +nde "en(eJ, c+ o
    co%+(are :n ac(!v!(a(ea c+ +nde "en(e, de&ar(e de &r!%a &er!oad7 NREMJ8 ;J sc7derea "a(en=e!
    %!Oc7r!"or oc+"are ra&!de EREMJ Ead!c7, o d+ra(7 %a! sc+r(7 a &r!%e! &er!oade NREMJ8 IJ
    creO(erea dens!(7=!! REM Ead!c7, a n+%7r+"+! de %!Oc7r! oc+"are rea"e d!n c+rs+" REMJ8 O! YJ
    creO(erea d+ra(e! so%n+"+! REM "a :nce&+(+" no&=!!. Ano%a"!!"e de so%n &o( .! &+se :n ev!den=7
    "a ILd4RLd d!n(re &ac!en=!! a%'+"a(or! s! :n &An7 "a FLd d!n(re &ac!en=!! !n(erna=! c+ e&!sod
    de&res!v %a@or. Ev!den=a s+$erea/7 c7 ce"e %a! %+"(e d!n aces(e ano%a"!! &ers!s(7 s! d+&7
    re%!s!+nea c"!n!c7 O! &o( &recede de'+(+" e&!sod+"+! de&res!v %a@or !n!=!a".
    45?2H7 Insomnia "n le!tur cu Alt Tulburare Mental 45?2HH
    Lipersomnia "n le!tur cu Alt Tulburare Mental >F8
    Da(e"e &o"!so%no$ra.!ce d!n e&!soade"e %an!aca"e s+n( s!%!"are c+ ce"e cons(a(a(e :n
    e&!soade"e de&res!ve %a@ore, :n sc!/o.ren!e, so%n+" REM es(e red+s &recoce :n c+rs+" +ne!
    e<acer'7r! ac+(e, c+ o reven!re "a va"or!"e nor%a"e &e %7s+r7 ce s(area c"!n!c7 se a%e"!orea/7.
    La(en(a REM &oa(e .! red+s7. T!%&+" (o(a" de so%n es(e adesea d!%!n+a( sever :n sc!/o.ren!e,
    !ar so%n+" c+ +nde "en(e es(e de re$+"7 red+s :n (!%&+" e<acer'7r!"or. Ind!v!/!! c+ &an!c7 &o(
    avea deO(e&(7r! &aro<!s(!ce "a !n(rarea :n s(ad!!"e ; s! I de so%n ENREMJ8 aces(e deO(e&(7r! s+n(
    :nso=!(e de (a!card!e, creO(erea r!(%+"+! res&!ra(or O! s!%&(o%e co$n!(!ve s! e%o=!ona"e de
    a(ac+r! de &an!c7. Ce"e %a! %+"(e (+"'+r7r! %en(a"e &rod+c &a((ern+r! nes&ec!.!ce de
    &er(+r'are a so%n+"+! Ede e<., &re"+n$!rea "a(en=e! de so%n sa+ deO(e&(7r! .recven(eJ.
    Tes(area :n "a'ora(or a so%no"en=e! d!+rne, &r!n (es(+" de "a(en=7 a so%n+"+! %+"(!&"+, "a
    !nd!v!/!! c+ !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7, &re/!n(7 adesea n!ve"e nor%a"e sa+
    n+%a! +Ooare de so%no"en=7 .!/!o"o$!c7 :n co%&ara=!e c+ !nd!v!/!! c+ !&erso%n!e &r!%ar7 sa+
    c+ narco"e&s!e.
    9atele examinrii somatice /i condi3iile medicale asociate. Ind!v!/!! c+ !nso%n!e sa+
    !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &o( a&are ca e<(en+a=!, e&+!/a=! sa+ "!v!/! :n
    (!%&+" e<a%!n7r!! de r+(!n7. Cond!=!!"e %ed!ca"e $enera"e asoc!a(e c+ aces(e (+"'+r7r! de so%n
    s+n( ace"eaO! c+ ce"e asoc!a(e c+ (+"'+rarea %en(a"7 s+'!acen(7.
    *lemente speci$ice culturii, etii ,i sexului
    :n +ne"e c+"(+r!, ac+/e"e :n "e$7(+r7 c+ so%n+" &o( .! v7/+(e ca re"a(!v %a! &+=!n s(!$%a(!/an(e
    decA( (+"'+r7r!"e %en(a"e. Ca a(are, !nd!v!/!! d!n +ne"e %ed!! c+"(+ra"e, es(e .oar(e &ro'a'!" c7
    vor &re/en(a %a! c+rAnd ac+/e de !nso%n!e sa+ !&erso%n!e decA( a"(e s!%&(o%e Ede e<.,
    de&res!e, an<!e(a(eJ.
    Co&!!! O! ado"escen=!! c+ (+"'+rare de&res!v7 %a@or7 se &re/!n(7 :n $enera" c+ rna! &+=!n7
    &er(+r'are de so%n s+'!ec(!v7 s! c+ %a! &+=!ne %od!.!c7r! &o"!so%no$ra.!ce decA( ad+"=!! %a! :n
    e(a(e, :n $enera", !&erso%n!a es(e +n e"e%en( %a! co%+n (+"'+r7r!"or de&res!ve "a ado"escen=!
    s! ad+"=!! (!ner!, !ar !nso%n!a es(e %a! .recven(7 "a ad+"=!! %a! :n e(a(e.
    T+"'+r7r!"e de so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 s+n( %a! .recven(e "a .e%e! decA( "a
    '7r'a=!. Aceas(7 d!.eren=7 es(e &ro'a'!" :n "e$7(+r7 c+ &reva"en(a cresc+(7 a (+"'+r7r!"or a.ec(!ve
    s! a (+"'+r7r!"or an<!oase "a .e%e!, %a! c+rAnd decA( c+ or!care a"(7 d!.eren=7 :n s+sce&(!'!"!(a(ea "a
    &ro'"e%e"e de so%n.
    #revalent
    Pro'"e%e"e de so%n s+n( e<(re% de .recven(e :n (oa(e (!&+r!"e de (+"'+r7r! %en(a"e, dar n+
    e<!s(7 es(!%7r! e<ac(e a"e &rocen(a@+"+! de !nd!v!/! care "e &re/!n(7, :n &r!%+" rAnd d!n ca+/a
    '+"vers7r!! so%n+"+!. Inso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 es(e ce" %a! .recven(
    d!a$nos(!c E;Yd4YLdJ &r!n(re !nd!v!/!! care se &re/!n(7 "a cen(re"e de (+"'+r7r! de so%n &en(r+
    eva"+area !nso%n!e! cron!ce. H!&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 es(e +n
    d!a$nos(!c %+"( %a! &+=!n .recven( E%a! &+=!n de YdJ &r!n(re !nd!v!/!! eva"+a=! &en(r+
    !&erso%n!e "a cen(re"e de (+"'+r7r! de so%n.
    >F= Tulburrile de Somn
    *voluie
    Evo"+=!a (+"'+r7r!"or de so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 +r%ea/7 :n $enera" &e cea
    a (+"'+r7r!"or %en(a"e s+'!acen(e. Per(+r'area so%n+"+! &oa(e .! +n+" d!n(re ce"e %a! &recoce
    s!%&(o%e care a&ar "a !nd!v!/!! care de/vo"(7 consec+(!v o (+"'+rare %en(a"7 asoc!a(7.
    S!%&(o%e"e de !nso%n!e sa+ de !&erso%n!e ."+c(+ea/7 cons!dera'!" :n dec+rs+" (!%&+"+!. La
    %+"=! !nd!v!/! c+ de&res!e, :n s&ec!a" "a ce! (ra(a=! c+ %ed!ca%en(e, &er(+r'area so%n+"+! se
    &oa(e a%e"!ora ra&!d, adesea %a! re&ede decA( a"(e s!%&(o%e a"e (+"'+r7r!! %en(a"e s+'!acen(e.
    Pe de a"(7 &ar(e, a"=! !nd!v!/! a+ !nso%n!e &ers!s(en(7 sa+ !n(er%!(en(7, c!ar d+&7 ce a"(e
    s!%&(o%e a"e (+"'+r7r!! "or de&res!ve %a@ore s4a+ re%!s. Ind!v!/!! c+ (+"'+rare '!&o"ar7 a+ adesea
    s!%&(o%e d!s(!nc(!ve :n "e$7(+r7 c+ so%n+", :n .+nc=!e de na(+ra e&!sod+"+! c+ren(, :n (!%&+"
    e&!soade"or %an!aca"e, !nd!v!/!! e<&er!en(ea/7 !&oso%n!e, deO! e! se &"An$ rar de !nca&ac!(a(ea
    "or de a dor%!. Pe de a"(7 &ar(e, aceO(! !nd!v!/! &o( avea o de(res7 se%n!.!ca(!v7 :n "e$7(+r7 c+
    !&erso%n!a d!n c+rs+" e&!soade"or de&res!ve %a@ore. Ind!v!/!! c+ (+"'+r7r! &s!o(!ce a+ ce"
    %a! adesea o :nr7+(7=!re no(a'!"7 a so%n+"+! :n c+rs+" +ne! e<acer'7r! ac+(e, dar re"a(ea/7
    a&o! o a%e"!orare, &e %7s+r7 ce s!%&(o%e"e &s!o(!ce se a%endea/7.
    Dia!nostic di$erenial
    Inso%n!a sa+ !&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 n+ (re'+!e s7 .!e d!a$nos(!ca(7
    "a .!ecare !nd!v!d c+ o (+"'+rare %en(a"7 care are, de ase%enea, s!%&(o%e :n "e$7(+r7 c+
    so%n+". Un d!a$nos(!c de !nso%n!e sa+ de !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7
    (re'+!e s7 .!e &+s n+%a! cAnd s!%&(o%e"e !&n!ce s+n( severe O! se a."7 :n cen(r+" +ne! a(en=!!
    c"!n!ce se&ara(e. Pen(r+ ce! %a! %+"=! !nd!v!/! c+ (+"'+rare de&res!v7 %a@or7 care re"a(ea/7
    d!.!c+"(7=! de ador%!re sa+ de a r7%Ane ador%!=! "a %!@"oc+" no&=!!, n+ es(e @+s(!.!ca( +n
    d!a$nos(!c se&ara( de (+"'+rare de so%n. Dac7 :ns7, !nd!v!d+" se &"An$e :n &r!%+" rAnd de o
    &er(+r'are !&n!c7, or! dac7 !nso%n!a es(e d!s&ro&or=!ona(7 :n co%&ara=!e c+ ce"e"a"(e
    s!%&(o%e, a(+nc! &oa(e .! @+s(!.!ca( +n d!a$nos(!c ad!=!ona" de !nso%n!e :n "e$7(+r7 c+ a"(7
    (+"'+rare %en(a"7.
    D!s(!n$erea !nso%n!e! &r!%are or! a !&erso%n!e! &r!%are de !nso%n!a sa+ !&erso%n!a :n
    "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &oa(e .! e<(re% de d!.!c!"7 "a !nd!v!/!! care se &re/!n(7, a(A( c+
    s!%&(o%e c"!n!ce se%n!.!ca(!ve de &er(+r'are de so%n, cA( s! c+ a"(e s!%&(o%e a"e +ne! (+"'+r7r!
    %en(a"e. D!a$nos(!c+" de !nso%n!e sa+ de !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 se
    ba;ea;6 &e (re! @+dec7=!. Pr!%a, !nso%n!a sa+ !&erso%n!a (re'+!e cons!dera(e ca a(r!'+!'!"e
    (+"'+r7r!! %en(a"e Ede e<., !nso%n!a sa+ !&erso%n!a s+rv!n e<c"+s!v :n c+rs+" (+"'+r7r!!
    %en(a"eJ. A do+a, !nso%n!a sa+ !&erso%n!a (re'+!e s7 .!e ac+/a &r!nc!&a"7 s! (re'+!e s7 .!e
    s+.!c!en( de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7. A (re!a, &re/en(area s!%&(o%e"or
    (re'+!e s7 sa(!s.ac7 !n(e$ra" cr!(er!!"e &en(r+ a"(7 (+"'+rare %en(a"7. Un d!a$nos(!c de !nso%n!e
    &r!%ar7 sa+ de !&erso%n!e &r!%ar7 es(e adecva( cAnd EaOa c+% es(e adesea ca/+"J !nso%n!a
    sa+ !&erso%n!a es(e aco%&an!a(7 de s!%&(o%e Ede e<., de an<!e(a(e sa+ de d!s&o/!=!e de&res!v7J
    care n+ sa(!s.ac cr!(er!!"e &en(r+ o (+"'+rare %en(a"7 s&ec!.!c7. Un d!a$nos(!c de !nso%n!e
    &r!%ar7 es(e, de ase%enea, adecva( &en(r+ !nd!v!/!! c+ !nso%n!e cron!c7, s! care de/vo"(7 %a!
    (Ar/!+ o (+"'+rare a.ec(!v7 sa+ an<!oas7. Dac7 s!%&(o%e"e de !nso%n!e sa+ de !&erso%n!e
    &ers!s(7 %+"( (!%& d+&7 ce ce"e"a"(e s!%&(o%e a"e
    45?2H7 Insomnia "n le!tur cu Alt Tulburare Mental 45?2HH
    Lipersomnia "n le!tur cu Alt Tulburare Mental >F4
    (+"'+r7r!! %en(a"e :n "e$7(+r7 c+ care a&ar s4a+ re%!s co%&"e(, d!a$nos(!c+" (re'+!e s7 .!e
    sc!%'a( d!n !nso%n!e sa+ !&erso%n!e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 :n ce" de !nso%n!e
    sa+ !&erso%n!e &r!%ar7.
    Inso%n!a sa+ !&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 n+ es(e d!a$nos(!ca(7 dac7
    (a'"o+" c"!n!c es(e e<&"!ca( %a! '!ne de a"(7 (+"'+rare de so%n Ede e<., narco"e&s!a, (+"'+rarea de
    so%n :n "e$7(+r7 c+ res&!ra=!a or! o &araso%n!eJ.
    Inso%n!a sa+ !&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 (re'+!e s7 .!e d!s(!ns7 de o
    (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" es(e ce" de
    (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cAnd &er(+r'area de so%n es(e
    cons!dera(7 a .! consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e s&ec!.!ce Ede e<.,
    .eocro%oc!(o%, !&er(!ro!d!s%J. Aceas(7 &rec!/are se 'a/ea/7 &e !s(or!c, da(e"e de "a'ora(or s!
    e<a%en+" so%a(!c Eve/! &a$. RY5 &en(r+ o d!sc+=!e s+&"!%en(ar7J. O (+"'+rare de so%n !nd+s7
    de o s+'s(an=7 se d!s(!n$e de !nso%n!a sa+ !&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7
    &r!n .a&(+" c7 o s+'s(an=7 Ede e<., +n dro$ de a'+/, +n %ed!ca%en(J es(e cons!dera(7 a .!
    e(!o"o$!c :n re"a=!e c+ &er(+r'area de so%n Eve/! &a$. RYY &en(r+ o d!sc+=!e s+&"!%en(ar7J. De
    e<e%&"+, !nso%n!a care s+rv!ne n+%a! :n con(e<(+" +n+! cons+% e<ces!v de ca.ea (re'+!e s7 .!e
    d!a$nos(!ca(7 ca (+"'+rare de so%n !nd+s7 de ca.e!na, de (!& !nso%n!e.
    T+"'+rarea de so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 (re'+!e s7 .!e d!.eren=!a(7 de
    &a((ern+r!"e de so%n nor%a"e, &rec+% s! de a"(e (+"'+r7r! de so%n. DeO! ac+/e"e de !nso%n!e sa+
    !&erso%n!e oca/!ona"7 s+n( .recven(e :n &o&+"a=!a $enera"7, e"e n+ s+n( aco%&an!a(e de re$+"7
    de a"(e se%ne s! s!%&(o%e a"e +ne! (+"'+r7r! %en(a"e. T+"'+r7r!"e de so%n (ran/!(or!! s+n(
    reac=!! co%+ne "a even!%en(e de v!a=7 s(resan(e s! :n $enera" n+ @+s(!.!c7 +n d!a$nos(!c. Un
    d!a$nos(!c se&ara( de !nso%n!e sa+ de !&erso%n!e :n "e$7(+r7 c+ o (+"'+rare de ada&(are
    (re'+!e s7 .!e "+a( :n cons!dera=!e n+%a! cAnd &er(+r'area de so%n es(e e<(re% de sever7 s! de
    &re"+n$!(7.
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n ECITSJ !nc"+de d!a$nos(!ce ana"oa$e &en(r+
    (+"'+r7r!"e de so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 s! :n %od s&ec!.!c c!(ea/7 &s!o/e"e,
    (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e an<!oase, &an!ca s! a"coo"!s%+".
    =<+ Tulburrile de Somn
    Criteriile $e $ia/no&ti# pentru 4+G.77 In&o"nia .n le/(tur( #u... (Se
    indic tulburarea de e a.a l sau $$)
    A2 Acu(a predominant o constituie di$icultatea "n iniierea sau meninerea
    somnului, sau un somn nerecon$ortant pentru cel puin o lun, ,i care este
    asociat cu $ati!abiliate diurn sau deteriorarea activitii diurne2
    S2 #erturbarea de somn &sau consecinele sale din timpul (ilei) cau(ea( o
    detres sau deteriorare semni$icativ clinic "n domeniul social, pro$esional
    sau "n alte domenii importante de $uncionare2
    2 Insomnia este considerat a $i "n le!tur cu alt tulburare de pe axa l sau
    axa II &de ex2, tulburarea depresiv ma0or, anxietatea !enerali(at, tulbu
    rarea de adaptare cu anxietate), dar este su$icient de sever pentru a
    0usti$ica o atenie clinic separat2
    D2 #erturbarea nu este explicat mai bine de alt tulburare de somn &de ex2,
    narcolepsia, tulburarea de somn "n le!tur cu respiraia, o parasomnie)2
    *2 #erturbarea nu este datorat e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) ori ale unei condiii medicale !enerale2
    Criteriile $e $ia/no&ti# pentru 4+G.77 Fiper&o"nia .n le/(tur( #u ...
    (Se indic tulburarea de e a.a l sau a.a $$)
    A2 Acu(a predominant o constituie somnolena excesiv timp de cel puin o lun dup
    cum este evideniat, $ie prin episoade de somn prelun!ite, ori prin episoade de somn
    diurne care survin aproape (ilnic2
    82 Somnolena excesiv cau(ea( detres sau deteriorare semni$icativ clinic "n domeniul
    social, pro$esional ori "n alte domenii importante de $uncionare2
    2 Lipersomnia este considerat a $i "n le!tur cu alt tulburare de pe axa l
    sau axa II &de ex2, tulburarea depresiv ma0ora, tulburarea distimic), dar
    este su$icient de sever pentru a 0usti$ica o atenie clinic separat2
    D2 #erturbarea nu este explicat mai bine de alt tulburare de somn &de ex2,
    narcolepsia, tulburarea de somn "n le!tur cu respiraia, o parasomnie) sau
    de o cantitate inadecvat de somn2
    *2 #erturbarea nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau ale unei condiii medicale !enerale2
    Alte Tulburri de Somn
    IAE

    Alte Tul-ur(ri $e So"n
    G>+.,, Tul-urarea $e So"n $atorat( unei
    Con$i!ii Me$i#ale Generale
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e :"
    cons(!(+!e o &er(+r'are no(a'!"7 de so%n care es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7 Ecr!(er!+" AJ, s! es(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. S!%&(o%e"e &o(
    !nc"+de !nso%n!a, !&erso%n!a, o &araso%n!e or! o co%'!na=!e oarecare a aces(ora. D!n !s(or!c,
    e<a%en+" so%a(!c or! da(e"e de "a'ora(or, (re'+!e s7 re/+"(e .a&(+" c7 &er(+r'area de so%n
    es(e consec!n=a .!/!o"o$!c7 d!rec(7 a +ne! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" BJ. Per(+r'area n+
    es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7, c+% ar .! o (+"'+rare de ada&(are, :n care
    s(resor+" es(e o cond!=!e %ed!ca"7 sever7 Ecr!(er!+" CJ. D!a$nos(!c+" n+ es(e &+s dac7 &er(+r'area
    de so%n s+rv!ne n+%a! :n c+rs+" +n+! de"!r!+% Ecr!(er!+" DJ. Pr!n conven=!e, &er(+r'7r!"e de
    so%n da(ora(e +ne! (+"'+r7r! de so%n :n "e$7(+r7 c+ res&!ra=!a Ede e<., a&neea de so%nJ or!
    narco"e&s!e! n+ s+n( !nc"+se :n aceas(7 ca(e$or!e Ecr!(er!+" EJ. S!%&(o%e"e (+"'+r7r!! de so%n
    (re'+!e s7 ca+/e/e de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona"
    sa+ :n a"(e do%en!! de .+nc=!onare !%&or(an(e Ecr!(er!+" FJ.
    :n a &rec!/a dac7 &er(+r'area de so%n se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e,
    c"!n!c!an+" (re'+!e s7 s(a'!"easc7 %a! :n(A! &re/en=a +ne! cond!=!! %ed!ca"e $enera"e. A&o!,
    c"!n!c!an+" (re'+!e s7 s(a'!"easc7 .a&(+" c7 &er(+r'area de so%n es(e e(!o"o$!c :n re"a=!e c+ cond!=!a
    %ed!ca"7 $enera"7 &r!n(r4+n %ecan!s% .!/!o"o$!c. O eva"+are a(en(7 s! c+&r!n/7(oare a n+%eroO!
    .ac(or! es(e necesar7 &en(r+ a .ace aceas(7 @+deca(7. DeO! n+ e<!s(7 cr!(er!! !n.a!"!'!"e &en(r+ a
    &rec!/a dac7 re"a=!a d!n(re &er(+r'area de so%n s! cond!=!a %ed!ca"7 $enera"7 es(e e(!o"o$!c7,
    cA(eva cons!deren(e o.er7 o oarecare $!dare :n aces( do%en!+. Un &r!% cons!deren( :"
    cons(!(+!e &re/en=a +ne! asoc!er! (e%&ora"e :n(re de'+(+", e<acer'area sa+ re%!s!+nea
    cond!=!e! %ed!ca"e $enera"e O! cea a &er(+r'7r!! de so%n. Un a" do!"ea cons!deren( :" cons(!(+!e
    &re/en=a de e"e%en(e care s+n( a(!&!ce &en(r+ (+"'+r7r!"e de so%n &r!%are Ede e<., e(a(ea "a
    de'+( sa+ evo"+=!a a(!&!c7, or! a'sen(a +n+! !s(or!c .a%!"!a"J. Da(e"e d!n "!(era(+r7 care
    s+$erea/7 c7 &oa(e e<!s(a o asoc!ere d!rec(7 :n(re cond!=!a %ed!ca"7 $enera"7 :n ces(!+ne s!
    de/vo"(area &er(+r'7r!! de so%n, &o( o.er! +n con(e<( +(!" :n a&rec!erea +ne! an+%!(e s!(+a=!!, :n
    a.ar7 de aceas(a, c"!n!c!an+" (re'+!e, de ase%enea, s7 s(a'!"easc7 dac7 &er(+r'area n+ es(e
    e<&"!ca(7 %a! '!ne de o (+"'+rare &r!%ar7 de so%n, de o (+"'+rare de so%n !nd+s7 de o
    s+'s(an=7 or! de a"(e (+"'+r7r! %en(a"e &r!%are Ede e<., (+"'+r7r!"e de ada&(areJ. Aceas(7
    &rec!/are es(e e<&"!ca(7 %a! :n de(a"!+ :n sec=!+nea ST+"'+r7r!"e %en(a"e da(ora(e +ne! cond!=!!
    %ed!ca"e $enera"eT Eve/! &a$. 5G5J.
    Subtipuri
    S+'(!&+r!"e %en=!ona(e %a! @os &o( .! +(!"!/a(e &en(r+ a !nd!ca an+%e care d!n(re +r%7(oare"e
    &re/en(7r! de s!%&(o%e &redo%!n7. Ta'"o+" c"!n!c a" (+"'+r7r!"or de
    >52 Tulburrile de Somn
    so%n s&ec!.!ce da(ora(e +ne! cond!=!! %ed!ca"e $enera"e &oa(e se%7na c+ ce" a" (+"'+r7r!! de
    so%n &r!%are ana"o$e, :ns7, n+ (re'+!e s7 .!e sa(!s.7c+(e !n(e$ra" cr!(er!!"e de d!a$nos(!c &en(r+
    (+"'+rarea de so%n &r!%ar7 ana"o$7 &en(r+ a s(a'!"! +n d!a$nos(!c de (+"'+rare de so%n da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e.
    De (!& !nso%n!e. Aces( s+'(!& se re.er7 "a o ac+/7 de so%n carac(er!/a(7 :n &r!%+" rAnd
    &r!n d!.!c+"(7=! :n a ador%!, d!.!c+"(7=! :n %en=!nerea so%n+"+! or! +n sen(!%en( de so%n
    nerecon.or(an(.
    De (!& !&erso%n!e. Aces( s+'(!& es(e +(!"!/a( cAnd ac+/a &redo%!nan(7 es(e +na de so%n
    noc(+rn e<ces!v de "+n$ sa+ de so%no"en=7 e<ces!v7 :n (!%&+" ore"or de v!$!"!(a(e.
    De (!& &araso%n!e. Aces( s+'(!& se re.er7 "a o &er(+r'are de so%n carac(er!/a(7 :n &r!%+"
    rAnd &r!n even!%en(e care s+rv!n :n asoc!a=!e c+ so%n+" sa+ c+ (ran/!=!!"e so%n+"+!.
    De (!& %!<(. Aces( s+'(!& (re'+!e s7 .!e +(!"!/a( &en(r+ a dese%na o &ro'"e%7 de so%n
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e carac(er!/a(e &r!n s!%&(o%e !&n!ce %+"(!&"e,
    dar n!c! +n s!%&(o% n+ &redo%!n7 c"ar.
    #rocedee de "nre!istrare
    :n :nre$!s(rarea d!a$nos(!c+"+! +ne! (+"'+r7r! de so%n da(ora(e +ne! cond!=!! %ed!ca"e
    $enera"e, c"!n!c!an+" (re'+!e s7 no(e/e, a(A( .eno%eno"o$!a s&ec!.!c7 a &er(+r'7r!!, !nc"+s!v
    s+'(!&+" cores&+n/7(or, cA( s! cond!=!a %ed!ca"7 $enera"7 cons!dera(7 a .! ca+/And &er(+r'area, &e
    a<a I Ede e<., HGL.Y9 T+"'+rare de so%n da(ora(7 (!reo(o<!co/e!, de (!& !nso%n!eJ. Cod+" ICD4
    F4CM &en(r+ cond!=!a %ed!ca"7 $enera"7 (re'+!e, de ase%enea, no(a( &e a<a III Ede e<.,
    9I9.F (!reo(o<!co/7J. E3e/! ane<a , &en(r+ "!s(a cod+r!"or d!a$nos(!ce ICD4F4CM se"ec(a(e &en(r+
    cond!=!!"e %ed!ca"e $enera"eJ.
    *lemente ,i tulburri asociate
    Da(e de "a'ora(or asoc!a(e. Da(e"e de "a'ora(or s+n( concordan(e c+ cond!=!a %ed!ca"7
    $enera"7 s+'!acen(7. N+ e<!s(7 da(e &o"!so%no$ra.!ce care s7 .!e s&ec!.!ce :n(re$+"+! $r+& de
    (+"'+r7r! de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e. Ce"e %a! %+"(e cond!=!! %ed!ca"e
    $enera"e ca+/ea/7 o red+cere a d+ra(e! (o(a"e de so%n, o creO(ere a deO(e&(7r!"or, o d!%!n+are a
    so%n+"+! c+ +nde "en(e O! E%a! &+=!n concordan(J o d!%!n+are a so%n+"+! c+ %!Oc7r! oc+"are
    ra&!de EREMJ or! a dens!(7=!! .a/!ce a REM. Une"e cond!=!! %ed!ca"e &rod+c da(e
    &o"!so%no$ra.!ce %a! s&ec!.!ce. De e<e%&"+, !nd!v!/!! c+ s!ndro% .!'ro%!a"$!c se &"An$ de
    so%n nerecon.or(an( s! a+ adesea +n &a((ern d!s(!nc( de ac(!v!(a(e EE, a".a :n (!%&+" so%n+"+!
    .7r7 %!Oc7r! oc+"are ra&!de ENREMJ. Cr!/e"e e&!"e&(!ce %or.e!ce d+c "a desc7rc7r! EE, s&ec!.!ce,
    concordan(e c+ (!&+" de cr!/e e&!"e&(!ce s+'!acen(e.
    Da(e"e e<a%!n7r!! so%a(!ce s! cond!=!!"e %ed!ca"e $enera"e asoc!a(e. Ind!v!/!! c+ (+"'+rare
    de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e es(e de &res+&+s c7 (re'+!e s7 a!'7 da(e"e
    so%a(!ce (!&!ce a"e cond!=!e! %ed!ca"e $enera"e s+'!acen(e. Per(+r'7r!"e de so%n &o( re/+"(a
    d!n(r4o var!e(a(e de cond!=!! %ed!ca"e $enera"e s! ne+ro"o$!ce !nc"+/And Edar n+ "!%!(a(e "aJ
    (+"'+r7r!"e ne+ro"o$!ce de$enera(!ve Ede e<., %a"ad!a Par)!nson, %a"ad!a H+n(!n$(onJ, %a"ad!a
    cere'rovasc+"ar7 Ede e<., !nso%n!a +r%And "e/!+n!"or vasc+"are a"e (r+nc!+"+! cere'ra"
    s+&er!orJ, cond!=!!
    ?852xx Tulburarea de Somn datorat unei
    ondiii Medicale Generale >5+

    endocr!ne Ede e<., !&er4 sa+ !&o(!ro!d!s%+", !&o4 sa+ !&eradrenocor(!c!s%+"J, !n.ec=!! +r!nare
    s! 'ac(er!ene Ede e<., !&erso%n!a :n "e$7(+r7 c+ ence.a"!(a v!ra"7J (+Oea :n "e$7(+r7 c+ o %a"ad!e
    &+"%onar7, a"(a decA( cond!=!!"e res&!ra(or!! :n "e$7(+r7 c+ so%n+" Ede e<., 'ronO!(a cron!c7J s!
    d+rerea d!n %a"ad!!"e %+sc+"o4sce"e(a"e Ede e<., ar(r!(a re+%a(o!da, .!'ro%!a"$!aJ. Cond!=!a
    %ed!ca"7 $enera"7 :n care !&erso%n!a &oa(e .! &re/en(7 ca e"e%en( de n+c"e+ a" %a"ad!e!
    !nc"+de d!s(ro.!a %!o(on!c7 s! s!ndro%+" Prader41!""!.
    Dia!nostic di$erenial
    T+"'+r7r!"e de so%n s+n( e<(re% de co%+ne :n con(e<(+" +n+! de"!r!+%8 ca a(are, +n d!a$nos(!c
    se&ara( de (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e n+ es(e &+s, dac7
    &er(+r'area s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+%. D!n con(ra, +n d!a$nos(!c de (+"'+rare de
    so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e &oa(e .! &+s &e "An$7 +n d!a$nos(!c de de%en=7,
    dac7 &er(+r'area de so%n es(e consec!n=a e(!o"o$!c7 d!rec(7 a &roces+"+! &a(o"o$!c ca+/And
    de%en=a, !ar (+"'+rarea de so%n es(e o &ar(e &roe%!nen(7 a (a'"o+"+! c"!n!c.
    T+"'+rarea de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e (re'+!e s7 .!e d!.eren=!a(7 de
    &er(+r'7r!"e &res+&+se d!n &a((ern+r!"e de so%n, (+"'+r7r!"e de so%n &r!%are, (+"'+r7r!"e de
    so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 O! (+"'+r7r!"e de so%n !nd+se de o s+'s(an=7.
    M+"=! !nd!v!/! e<&er!en(ea/7 o &er(+r'are de so%n :n c+rs+" +ne! cond!=!! %ed!ca"e $enera"e
    sa+ ne+ro"o$!ce, :n %a@or!(a(ea ca/+r!"or, as(.e" de ac+/e n+ %er!(7 +n d!a$nos(!c ad!=!ona" de
    (+"'+rare de so%n. D!a$nos(!c+" de (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e
    (re'+!e s7 .!e re/erva( %a! c+rAnd ca/+r!"or :n care &er(+r'area de so%n es(e +n e"e%en( c"!n!c
    re%arca'!", s+n( &re/en(e s!%&(o%e a(!&!ce or! !nd!v!d+" es(e s+.!c!en( de de(resa( de c7(re
    s!%&(o%e"e !&n!ce sa+ de de(er!orarea asoc!a(7, c7 es(e necesar +n (ra(a%en( s&ec!.!c &en(r+
    aceas(7 &er(+r'are.
    T+"'+r7r!"e de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e s+n( carac(er!/a(e &r!n s!%&(o%e
    s!%!"are ce"or d!n (+"'+r7r!"e &r!%are de so%n. D!a$nos(!c+" d!.eren=!a" se ba;ea;6 n+ &e
    s!%&(o%e s&ec!.!ce c!, %a! c+rAnd, &e &re/en=a sa+ a'sen=a +ne! cond!=!! %ed!ca"e cons!dera(e a
    .! e(!o"o$!c :n "e$7(+r7 c+ ac+/a !&n!c7. :n ca/+r!"e de narco"e&s!e O! de (+"'+rare de so%n
    :n "e$7(+r7 c+ res&!ra=!a, e(!o"o$!a s+'!acen(7 a &er(+r'7r!! so%n+"+! se &res+&+ne a .! o cond!=!e
    %ed!ca"7 $enera"7, :ns7, :n aces(e do+7 e<e%&"e (!&!ce, cond!=!a %ed!ca"7 n+ e<!s(7 !nde&enden( de
    s!%&(o%e"e !&n!ce. Pen(r+ aces( %o(!v, ce"e do+7 (+"'+r7r! s+n( !nc"+se :n sec=!+nea
    S(+"'+r7r!"or de so%n &r!%areT.
    D!.eren=!erea +ne! (+"'+r7r! de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e de o (+"'+rare de
    so%n !nd+s7 de o s+'s(an=7 &oa(e .! .oar(e d!.!c!"7, :n %+"(e ca/+r!, !nd!v!/!! c+ o cond!=!e
    %ed!ca"7 se%n!.!ca(!v7 !a+ adesea %ed!ca%en(e &en(r+ cond!=!a res&ec(!v78 aces(e %ed!ca%en(e,
    :n sc!%', &o( ca+/a s!%&(o%e :n "e$7(+r7 c+ so%n+". De e<e%&"+, +n !nd!v!d &oa(e &re/en(a o
    :n(rer+&ere a so%n+"+! :n "e$7(+r7 c+ as(%+", :ns7, !nd!v!d+" res&ec(!v &oa(e .! (ra(a( s! c+
    &re&ara(e de (eo.!"!n7 care, :n +ne"e ca/+r!, &o( &rod+ce e"e :nse"e o &er(+r'are a so%n+"+!.
    D!.eren=!erea +ne! (+"'+r7r! de so%n da(ora(e +ne! cond!=!! %ed!ca"e $enera"e de o (+"'+rare de
    so%n !nd+s7 de o s+'s(an=7 se 'a/ea/7 adesea &e crono"o$!e, r7s&+ns+" "a (ra(a%en( sa+
    :n(rer+&erea %ed!ca=!e! s! evo"+=!a "on$!(+d!na"7, :n +ne"e ca/+r!, &o( .! adecva(e d!a$nos(!ce
    conco%!(en(e de (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s! de (+"'+rare
    de so%n !nd+s7 de o
    RYI Tulburrile de Somn
    s+'s(an=7, :n ca/+r!"e :n care +n dro$ de a'+/ es(e s+s&ec(a( a .! ca+/a (+"'+r7r!! de so%n, +n
    screen!n$ a" dro$+"+! :n sAn$e sa+ :n +r!n7 &oa(e a@+(a "a d!.eren=!erea aces(e! &ro'"e%e de o
    (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. Dac7 c"!n!c!an+" n+ &oa(e &rec!/a
    dac7 &er(+r'area de so%n es(e &r!%ar7, es(e :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7, se da(orea/7
    +ne! cond!=!! %ed!ca"e $enera"e sa+ es(e !nd+s7 de o s+'s(an=7, d!a$nos(!c+" cores&+n/7(or es(e
    ce" de d!sso%n!e sa+ &araso%n!e .7r7 a"(7 s&ec!.!ca=!e.
    +elaia cu lasi$icarea Internaional a Tulburrilor de Somn
    C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n ECITSJ con=!ne sec=!+nea $enera"7
    ST+"'+r7r! de so%n %ed!ca"e s! &s!!a(r!ceT. S+n( &re/en(a(e d!a$nos(!ce"e s&ec!.!ce &en(r+
    (+"'+r7r!"e de so%n asoc!a(e c+ (+"'+r7r! ne+ro"o$!ce Ec+ Oa&(e e<e%&"e %en=!ona(eJ s!
    (+"'+r7r!"e de so%n care s+n( asoc!a(e c+ a"(e (+"'+r7r! %ed!ca"e Ec+ Oa&(e e<e%&"e %en=!ona(eJ.
    DeO!, :n %od s&ec!a", s+n( c!(a(e n+%a! 5I (+"'+r7r! %ed!ca"e s! ne+ro"o$!ce :n CITS, c"!n!c!an+"
    &oa(e d!a$nos(!ca o (+"'+rare de so%n asoc!a(7 c+ or!care a"(7 (+"'+rare %ed!ca"7, s!%&"+, &r!n
    +(!"!/area cod+r!"or ICD4F4CM cores&+n/7(oare.
    Criteriile $e $ia/no&ti# pentru G>+.,, Tul-urarea $e So"n
    $atorat( ... (Se indic condiia medical &eneral)
    A, O perturbare notabil de somn care este su$icient de sever pentru a 0usti$ica
    o atenie clinic separat2
    S2 Din istoric, examenul somatic sau datele de laborator exist probe c perturba
    rea de somn este consecina $i(iolo!ic direct a unei condiii medicale !enerale2
    2 #erturbarea nu este explicat mai bine de alt tulburare mental &de ex2, o
    tulburare de adaptare, "n care stresorul este o maladie medical sever)2
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 #erturbarea nu satis$ace criteriile pentru tulburarea de somn "n le!tur cu
    respiraia sau narcolepsie2
    '2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    De speci"icat tipulD
    2A7 de tip insomnieD dac perturbarea de somn predominant este insomnia3
    2AH de tip %ipersoninieD dac perturbarea de somn predominant este
    %ipersomnia3
    2A6 de tip parasomnieD dac perturbarea de somn predominant este o
    parasomnie3
    2A6 de tip mixtD dac este pre(ent mai mult dec@t o sin!ur tulburare de
    somn, dar nu predomin nici una2
    Fot de codi$icareD A se include numele condiiei medicale !enerale pe axa l, de ex2, ?852A7
    Tulburare de somn datorat tulburrii pulmonare obstructive cronice, de tip insomnie3 de
    asemenea, condiia medical !eneral se codi$ic pe axa III &ve(i anexa G pentru coduri)2
    Tulburarea de Somn indus de o Substan IAA

    Tul-urarea $e So"n in$u&( $e o Su-&tan!(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de so%n !nd+se de o s+'s(an=7 :" cons(!(+!e o &er(+r'are
    no(a'!"7 a so%n+"+!, s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7 Ecr!(er!+" AJ s!
    care es(e cons!dera(7 a .! da(ora(7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<., +n dro$ de
    a'+/, +n %ed!ca%en( sa+ e<&+nere "a +n (o<!cJ Ecr!(er!+" BJ, :n .+nc=!e de s+'s(an=a !%&"!ca(7,
    &oa(e .! no(a( +n+" d!n ce"e &a(r+ (!&+r! de &er(+r'are de so%n. Inso%n!a s! !&erso%n!a s+n(
    (!&+r!"e ce"e %a! .recven(e, !ar &araso%n!a es(e (!&+" ce" %a! &+=!n :n(A"n!(. Un (!& %!<( &oa(e .!
    no(a( cAnd es(e &re/en( %a! %+"( decA( +n s!n$+r (!& de &er(+r'are de so%n, dar n+ &redo%!n7
    n!c! +n+". Per(+r'area n+ (re'+!e s7 .!e e<&"!ca(7 %a! '!ne de o (+"'+rare %en(a"7 care n+ es(e
    !nd+s7 de o s+'s(an=7 Ecr!(er!+" CJ. D!a$nos(!c+" n+ es(e &+s dac7 &er(+r'area de so%n s+rv!ne
    n+%a! :n c+rs+" +n+! de"!r!+% Ecr!(er!+"DJ. S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 sa+
    de(er!orare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a", &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de
    .+nc=!onare Ecr!(er!+" EJ. Aces( d!a$nos(!c (re'+!e &+s :n "oc+" +n+! d!a$nos(!c de !n(o<!ca=!e c+ o
    s+'s(an=7 or! de a's(!nen=7 de o s+'s(an=7, n+%a! cAnd s!%&(o%e"e s+n( :n e<ces .a=7 de ce"e
    asoc!a(e de re$+"7 c+ s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen=7 s! cAnd s!%&(o%e"e s+n( s+.!c!en(
    de severe &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7. Pen(r+ +n co%en(ar!+ %a! de(a"!a( a"
    (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7, ve/! &a$. 5F5.
    O (+"'+rare de so%n !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare de so%n &r!%ar7 s! de
    !nso%n!a sa+ !&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &r!n "+area :n cons!dera=!e a
    de'+(+"+! s! evo"+=!e!. Pen(r+ dro$+r!"e de a'+/, (re'+!e s7 e<!s(e &ro'e de de&enden=7, a'+/,
    !n(o<!ca=!e sa+ de a's(!nen=7, d!n !s(or!c, e<a%en+" so%a(!c sa+ da(e"e de "a'ora(or.
    T+"'+r7r!"e de so%n !nd+se de o s+'s(an=7 a&ar n+%a! :n asoc!ere c+ s(7r!"e de !n(o<!ca=!e sa+ de
    a's(!nen=7, &e cAnd (+"'+r7r!"e de so%n &r!%are &o( &recede de'+(+" +/+"+! de o s+'s(an=7 sa+
    &o( s+rven! :n c+rs+" &er!oade"or de a's(!nen=7 &re"+n$!(7. Deoarece s(area de a's(!nen=7 de
    +ne"e s+'s(an=e c+ se%!v!a=7 "+n$7 Ede e<., 'en/od!a/e&!neJ &oa(e .! re"a(!v "+n$7, de'+(+"
    &er(+r'7r!! de so%n &oa(e avea "oc :n &An7 "a I s7&(7%An! de "a :nce(area +/+"+! de o s+'s(an=7.
    Un a"( cons!deren( :" cons(!(+!e &re/en=a de e"e%en(e care s+n( a(!&!ce &en(r+ (+"'+r7r!"e &r!%are
    de so%n Ede e<., e(a(ea "a de'+( sa+ evo"+=!a a(!&!c7J. D!n con(ra, .ac(or!! care s+$erea/7 c7
    &er(+r'area de so%n es(e e<&"!ca(7 %a! '!ne de o (+"'+rare de so%n &r!%ar7 !nc"+d &ers!s(en=a
    (+"'+r7r!! de so%n &en(r+ %a! %+"( de " "+n7 d+&7 (er%!narea !n(o<!ca=!e! sa+ a's(!nen=e! ac+(e8
    de/vo"(area de s!%&(o%e care s+n( s+'s(an=!a" :n e<ces .a=7 de ceea ce ar .! de &res+&+s, da(
    .!!nd (!&+" sa+ can(!(a(ea de s+'s(an=7 +(!"!/a(7 sa+ d+ra(a +/+"+! or! +n !s(or!c de (+"'+rare de
    so%n &r!%ar7 an(er!oar7.
    Subtipuri si speci$icani
    S+'(!&+r!"e c!(a(e %a! @os &o( .! +(!"!/a(e &en(r+ a !nd!ca &e cea care &redo%!n7 d!n(re
    +r%7(oare"e &re/en(7r! de s!%&(o%e. Pre/en(area c"!n!c7 a (+"'+r7r!! de so%n s&ec!.!ce !nd+se
    de o s+'s(an=7 &oa(e se%7na c+ cea a (+"'+r7r!! &r!%are de so%n ana"o$e, :ns7, cr!(er!!"e
    co%&"e(e &en(r+ (+"'+rarea de so%n &r!%ar7 ana"o$7 n+ (re'+!e s7 .!e sa(!s.7c+(e, &en(r+ a
    s(a'!"! +n d!a$nos(!c de (+"'+rare de so%n !nd+s7 de o s+'s(an=7.
    >5> Tulburrile de Somn
    De (!& !nso%n!e. Aces( s+'(!& se re.er7 "a o ac+/7 de so%n carac(er!/a(7 :n
    &r!%+" rAnd &r!n d!.!c+"(a(e :n ador%!re, d!.!c+"(a(e :n a r7%Ane ador%!( sa+
    sen(!%en(+" de so%n nerecon.or(an(.
    De (!& !&erso%n!e. Aces( s+'(!& es(e +(!"!/a( cAnd ac+/a &redo%!nan(7 es(e
    +na de so%n noc(+rn e<ces!v de "+n$ sa+ de so%no"en=7 e<ces!v7 :n (!%&+"
    ore"or de v!$!"!(a(e.
    De (!& &araso%n!e. Aces( s+'(!& se re.er7 "a o &er(+r'are de so%n
    carac(er!/a(7 :n &r!%+" rAnd &r!n even!%en(e co%&or(a%en(a"e anor%a"e,
    care s+rv!n :n asoc!ere c+ so%n+" sa+ c+ (ran/!=!!"e so%n4v!$!"!(a(e.
    De (!& %!<(. Aces( s+'(!& (re'+!e s7 .!e +(!"!/a( &en(r+ a dese%na o &ro'"e%7
    de so%n !nd+s de o s+'s(an=7, carac(er!/a(7 &r!n %+"(!&"e (!&+r! de s!%&(o%e
    !&n!ce, dar :n care n+ &redo%!n7 :n %od c"ar n!c! +n s!%&(o%.
    Con(e<(+" a&ar!=!e! s!%&(o%e"or de so%n &oa(e .! !nd!ca( &r!n +(!"!/area +n+!a d!n +r%7(or!!
    s&ec!.!can=!Q
    C+ de'+( :n c+rs+" !n(o<!ca=!e!. Aces( s&ec!.!can( (re'+!e sa .!e +(!"!/a( dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ !n(o<!ca=!a c+ o s+'s(an=7, !ar s!%&(o%e"e a&ar :n c+rs+" s!ndro%+"+! de
    !n(o<!ca=!e.
    C+ de'+( :n c+rs+" a's(!nen=e!. Aces( s&ec!.!can( (re'+!e s7 .!e +(!"!/a( dac7 s+n(
    sa(!s.7c+(e cr!(er!"e &en(r+ s!ndro%+" de a's(!nen=7 de o s+'s(an=7, !ar s!%&(o%e"e a&ar :n
    c+rs+" sa+ "a sc+r( (!%& d+&7 +n s!ndro% de a's(!nen=7.
    #rocedee de "nre!istrare
    N+%e"e (+"'+r7r!! de so%n !nd+se de o s+'s(an=7 :nce&e c+ ce" a" s+'s(an=e! s&ec!.!ce Ede
    e<., a"coo", %e(!".en!da(, (!ro<!n7J care es(e &res+&+s7 a .! ca+/a &er(+r'7r!! de so%n. Cod+"
    d!a$nos(!c es(e se"ec(a( d!n "!s(a c"ase"or de s+'s(an=e &rev7/+(e :n se(+" de cr!(er!! &en(r+
    (+"'+rarea de so%n !nd+s7 de o s+'s(an=7. Pen(r+ s+'s(an=e"e care n+ !n(r7 :n n!c! +na d!n(re
    c"ase Ede e<., (!ro<!n7J, (re'+!e +(!"!/a( cod+" &en(r+ Sa"(7 s+'s(an=7T, :n a.ar7 de aceas(a, &en(r+
    %ed!ca%en(e"e &rescr!se :n do/e (era&e+(!ce, %ed!ca%en(+" s&ec!.!c &oa(e .! !nd!ca( &r!n
    %en=!onarea cod+"+! E cores&+n/7(or Eve/! ane<a ,J. N+%e"e (+"'+r7r!! Ede e<., (+"'+rare de
    so%n !nd+s7 de ca.e!naJ es(e +r%a( de s+'(!&+" care !nd!c7 s!%&(o%+" &redo%!nan( s! de
    s&ec!.!can(+" care !nd!c7 con(e<(+" :n care a+ a&7r+( s!%&(o%e"e Ede e<., 9F9.GF T+"'+rare de
    so%n !nd+s7 de ca.e!na, de (!& !nso%n!e, c+ de'+( :n c+rs+" !n(o<!ca=!e!J. CAnd se cons!der7 c7
    %a! %+"( decA( o s!n$+r7 s+'s(an=7 @oac7 +n ro" se%n!.!ca(!v :n a&ar!=!a (+"'+r7r!! de so%n, (re'+!e
    s7 .!e %en=!ona(7 .!ecare :n %od se&ara( Ede e<., 9F9.GF T+"'+rare de so%n !nd+s7 de coca!n7,
    de (!& !nso%n!e, c+ de'+( :n c+rs+" !n(o<!ca=!e!8 9F5.G T+"'+rare de so%n !nd+s7 de a"coo", de (!&
    !nso%n!e, c+ de'+( :n c+rs+" a's(!nen=e!J. Dac7 o s+'s(an=7 es(e cons!dera(7 a .! .ac(or+"
    e(!o"o$!c, dar s+'s(an=a s&ec!.!c7 sa+ c"asa de s+'s(an=7 es(e nec+nosc+(7, &oa(e .! +(!"!/a(7
    ca(e$or!a 9F9.GF T+"'+rare de so%n !nd+s7 de o s+'s(an=7 nec+nosc+(7.
    Substane speci$ice \
    T+"'+rarea de so%n !nd+s7 de o s+'s(an=7 a&are ce" %a! .recven( :n c+rs+" !n(o<!ca=!e! c+
    +r%7(oare"e c"ase de s+'s(an=eQ a"coo", a%.e(a%!na s! s+'s(an=e a.!ne, ca.e!na, coca!n7 o&!acee,
    s! seda(!ve, !&no(!ce s! an<!o"!(!ce. Per(+r'7r!"e de
    Tulburarea de Somn indus de o Substan
    >58
    so%n s+n( :n(A"n!(e %a! &+=!n .recven( :n +/+" de a"(e (!&+r! de s+'s(an=e. T+"'+rarea de
    so%n !nd+s7 de a"(7 s+'s(an=7 &oa(e s+rven!, de ase%enea, :n asoc!a=!e c+ a's(!nen=a de
    +r%7(oare"e c"ase de s+'s(an=eQ a"coo", a%.e(a%!na s! s+'s(an=e a.!ne, coca!n7, o&!acee s!
    seda(!ve, !&no(!ce s! an<!o"!(!ce. F!ecare d!n (+"'+r7r!"e de so%n !nd+se de o s+'s(an=7 &rod+ce
    &a((ern+r! de so%n EE, care s+n( asoc!a(e c+ (+"'+rarea, dar n+ &o( .! cons!dera(e ca d!a$nos(!ce
    &en(r+ aceas(a. Pro.!"+" de so%n EE, &en(r+ .!ecare s+'s(an=7 es(e a&o! :n re"a=!e c+ s(ad!+" de +/,
    ad!c7, dac7 es(e vor'a de !n(o<!ca=!e, de +/ cron!c or! de a's(!nen=7 +r%And :n(rer+&er!! +/+"+!
    s+'s(an=e!.
    A"coo"+". T+"'+rarea de so%n !nd+s7 de a"coo" a&are de re$+"7 ca !nso%n!e, :n c+rs+"
    !n(o<!ca=!e! ac+(e, a"coo"+" &rod+ce de re$+"7 +n e.ec( seda(!v !%ed!a(, c+ so%no"en=7 cresc+(7 s!
    red+cere a v!$!"!(7=!! &en(r+ ;4I ore. Aceas(a es(e :nso=!(7 de o creO(ere :n s(ad!!"e ; s! I de so%n
    .7r7 %!Oc7r! oc+"are ra&!de ENREMJ O! de o red+cere a so%n+"+! c+ %!Oc7r! oc+"are ra&!de
    EREMJ, :n (!%&+" s(+d!!"or as+&ra so%n+"+! EE,. D+&7 aces(e e.ec(e !n!=!a"e, !nd!v!d+" are
    v!$!"!(a(e cresc+(7, so%n ne"!n!O(!( O!, adesea, v!se v!! O! :nc7rca(e an<!os &en(r+ res(+" &er!oade!
    de so%n. S(+d!!"e as+&ra so%n+"+! EE, a+ ar7(a( c7 :n a do+a @+%7(a(e a so%n+"+! d+&7
    !n$es(!a de a"coo", s(ad!!"e ; O! I de so%n s+n( red+se, v!$!"!(a(ea es(e cresc+(7, !ar so%n+" REM
    es(e, de ase%enea, cresc+(. A"coo"+" &oa(e a$rava (+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a
    &r!n creO(erea n+%7r+"+! de even!%en(e de a&nee o's(r+c(!v7. Pr!n con(!n+area +/+"+! a'!(+a",
    a"coo"+" con(!n+7 s7 &re/!n(e +n e.ec( seda(!v &asa$er &en(r+ cA(eva ore, +r%a( de :n(rer+&erea
    con(!n+!(7=!! so%n+"+! &en(r+ %a! %+"(e ore.
    :n (!%&+" a's(!nen=e! a"coo"!ce, so%n+" es(e &er(+r'a( ."a$ran(. Ind!v!d+" are de re$+"7 o
    con(!n+!(a(e a so%n+"+! :n(rer+&(7 sever, aco%&an!a(7 de o creO(ere a can(!(7=!! O! !n(ens!(7=!!
    so%n+"+! REM. Aces(a es(e aco%&an!a( adesea de o creO(ere a v!se"or v!! O!, :n ce" %a! e<(re%
    e<e%&"+, cons(!(+!e o &ar(e a de"!r!+%+"+! &r!n a's(!nen=7 a"coo"!c7. D+&7 a's(!nen=a ac+(7,
    !nd!v!/!! care a+ +/a( cron!c de a"coo" &o( con(!n+a s7 se &"An$7 de so%n s+&er.!c!a", .ra$%en(a(,
    (!%& de s7&(7%An! sa+ an!. S(+d!!"e EE, as+&ra so%n+"+! con.!r%7 +n de.!c!( :n so%n+" c+ +nde
    "en(e O! o &er(+r'are cons!s(en(7 :n con(!n+!(a(ea so%n+"+! :n aces(e ca/+r!.
    A%.e(a%!ne"e O! s(!%+"an(e"e a.!ne. T+"'+rarea de so%n !nd+s7 de a%.e(a%!na se
    carac(er!/ea/7 &r!n !nso%n!e :n (!%&+" !n(o<!ca=!e! O! &r!n !&erso%n!e :n (!%&+" a's(!nen=e!,
    :n c+rs+" &er!oade! de !n(o<!ca=!e ac+(7, a%.e(a%!na red+ce can(!(a(ea (o(a"7 de so%n, cres(e
    "a(en=a so%n+"+! O! &er(+r'7r!"e con(!n+!(7=!! so%n+"+!, cres(e %!Oc7r!"e cor&+"+! O! descreO(e
    so%n+" REM. So%n+" c+ +nde "en(e (!nde s7 .!e red+s, :n (!%&+" a's(!nen=e! d!n +/+" cron!c de
    a%.e(a%!na, !nd!v!/!! e<&er!en(ea/7 de re$+"7 !&erso%n!e, a(A( c+ &re"+n$!rea d+ra(e! so%n+"+!
    noc(+rn, cA( O! c+ so%no"en=7 e<ces!v7 :n (!%&+" /!"e!. So%n+" REM O! so%n+" c+ +nde "en(e &o(
    reven! "a va"or! deas+&ra "!n!e! de 'a/7. Tes(e"e de "a(en=7 de so%n %+"(!&"+ ETMLSJ &o( ar7(a,
    de ase%enea, o creO(ere a so%no"en=e! d!+rne :n (!%&+" .a/e! de a's(!nen=7.
    Ca.e!na. T+"'+rarea de so%n !nd+s7 de ca.e!na &rod+ce de re$+"7 !nso%n!e, deO! +n!!
    !nd!v!/! se &o( &"An$e de !&erso%n!e s! de so%no"en=7 d!+rn7 :n "e$7(+r7 c+ s+'s(an=a Eve/! &a$.
    HRIJ. Ca.e!na e<erc!(7 +n e.ec( de&enden( de do/7, creO(erea do/e"or ca+/And o creO(ere a
    v!$!"!(7=!! O! o red+cere a con(!n+!(7=!! so%n+"+!.
    >5= Tulburrile de Somn

    Po"!so%no$ra.!a &oa(e !nd!ca o "a(en=7 de so%n &re"+n$!(7, o v!$!"!(a(e cresc+(7 s! o red+cere a
    so%n+"+! c+ +nde "en(e. N+ a+ .os( descr!se e.ec(e no(a'!"e as+&ra so%n+"+! REM. A's(!nen=a
    'r+sc7 de "a +/+" cron!c de ca.e!na &oa(e &rod+ce !&erso%n!e. Un!! !nd!v!/! &o(, de ase%enea,
    e<&er!en=a !&erso%n!e :n(re do/e"e /!"n!ce de ca.e!na, &e %7s+r7 ce d!%!n+a e.ec(+" s(!%+"an(
    !%ed!a(.
    Coca!na. Ca s! a"(e s(!%+"an(e, coca!na &rod+ce de re$+"7 !nso%n!e :n c+rs+" !n(o<!ca=!!"or
    ac+(e s! !&erso%n!e :n c+rs+" a's(!nen=e!, :n c+rs+" !n(o<!ca=!e! ac+(e, can(!(a(ea (o(a"7 de so%n
    &oa(e .! red+s7 dras(!c, c+ n+%a! cA(eva accese sc+r(e de so%n .oar(e .ra$%en(a(. Invers,
    a's(!nen=a d+&7 +n e<ces de coca!n7 se asoc!a/7 adesea c+ o d+ra(7 de so%n e<(re% de
    &re"+n$!(7.
    O&!acee"e. :n c+rs+" +n+! +/ ac+( de sc+r(7 d+ra(7, o&!acee"e &rod+c de re$+"7 o creO(ere a
    so%no"en=e! s! o creO(ere a &ro.+n/!%!! s+'!ec(!ve a so%n+"+!. So%n+" REM es(e red+s de
    re$+"7 &r!n ad%!n!s(rarea ac+(7 de o&!acee, c+ &+=!n7 %od!.!care $enera"7 :n v!$!"!(a(e sa+
    (!%&+" (o(a" de so%n. Oda(7 c+ con(!n+area ad%!n!s(r7r!!, ce! %a! %+"=! !nd!v!/! dev!n
    (o"eran=! "a e.ec(e"e seda(!ve a"e o&!acee"or s! &o( :nce&e s7 se &"An$7 de !nso%n!e. Aceas(a se
    re."ec(7 &r!n creO(erea v!$!"!(7=!! s! red+cerea (!%&+"+! de so%n, :n s(+d!!"e &o"!so%no$ra.!ce.
    A's(!nen=a de o&!acee se :nso=eO(e de re$+"7 de ac+/e de !&erso%n!e, deO! &+=!ne s(+d!!
    o'!ec(!ve a+ doc+%en(a( aceas(7 cons(a(are.
    Seda(!ve"e, !&no(!ce"e s! an<!o"!(!ce"e. Dro$+r!"e d!n aceas(7 c"as7 Ede e<., 'ar'!(+r!ce"e,
    'en/od!a/e&!ne"e, %e&ro'a%a(+", $"+(e(!%!da s! %e(!&r!"on+"J a+ e.ec(e s!%!"are, dar n+ !den(!ce
    as+&ra so%n+"+!. D!.eren=e"e :n d+ra(a de ac=!+ne O! se%!v!a=7 &o( a.ec(a ac+/e"e re.er!(oare "a
    so%n s! %7s+r7r!"e o'!ec(!ve a"e so%n+"+!, :n $enera", 'ar'!(+r!ce"e s! vec!"e dro$+r!
    non'ar'!(+r!ce s! nond!a/e&!n!ce &rod+c %a! cons(an( (o"eran=7, de&enden=7 O! a's(!nen=7
    sever7, dar aces(e .eno%ene &o( .! no(a(e "a .e" de '!ne O! "a 'en/od!a/e&!ne.
    :n !n(o<!ca=!a ac+(7, dro$+r!"e seda(!v4!&no(!ce &rod+c creO(erea &rev!/!'!"7 a so%n+"+! s!
    red+cerea :n v!$!"!(a(e. S(+d!!"e &o"!so%no$ra.!ce con.!r%7 aces(e e.ec(e s+'!ec(!ve :n c+rs+"
    ad%!n!s(r7r!! ac+(e, &rec+% O! o red+cere :n so%n+" REM O! o creO(ere :n ac(!v!(a(e a .+s+r!"or de
    so%n. U/+" cron!c E:n s&ec!a" de 'ar'!(+r!ce s! dro$+r! %a! vec!, non'ar'!(+r!ce O!
    non'en/od!a/e&!n!ceJ &oa(e ca+/a (o"eran=7 c+ reven!rea !nso%n!e!. Dac7 !nd!v!d+" creO(e a&o!
    do;a, &oa(e a&are !&erso%n!e d!+rn7. Dro$+r!"e seda(!v4!&no(!ce &o( a$rava (+"'+rarea de
    so%n :n "e$7(+r7 c+ res&!ra=!a &r!n creO(erea .recven=e! O! sever!(7=!! even!%en(e"or de a&nee
    o's(r+c(!v7 de so%n.
    :n(rer+&erea 'r+sc7 a +/+"+! cron!c de seda(!v4!&no(!ce &oa(e d+ce "a !nso%n!e de a's(!nen=7.
    Pe "An$7 red+cerea d+ra(e! so%n+"+!, a's(!nen=a &oa(e &rod+ce creO(erea an<!e(7=!!, (re%+r7(+r!
    O! a(a<!e. Bar'!(+r!ce"e s! dro$+r!"e non'ar'!(+r!ce O! non'en/od!a/e&!n!ce %a! vec! s+n(
    asoc!a(e, de ase%enea, c+ o !nc!den=7 cresc+(7 a cr!/e"or e&!"e&(!ce de a's(!nen=7, care s+n(
    %+"( %a! &+=!n .recven( o'serva(e "a 'en/od!a/e&!ne. De re$+"7, dro$+r!"e seda(!v4!&no(!ce c+
    d+ra(7 sc+r(7 de ac=!+ne es(e .oar(e &os!'!" s7 &rod+c7 ac+/e de !nso%n!e de a's(!nen=7, &e c:nd
    ce"e c+ d+ra(a %a! "+n$7 de ac=!+ne s+n(, ce" %a! adesea, asoc!a(e c+ !&erso%n!e d!+rn7 :n
    (!%&+" +/+"+! ac(!v. C+ (oa(e aces(ea :ns7, or!ce dro$ seda(!v4!&no(!c &oa(e even(+a" ca+;a, .!e
    sedare d!+rn7, .!e !nso%n!e de a's(!nen=7. A's(!nen=a de a$en=! seda(!v4!&no(!c! &oa(e .!
    con.!r%a(7 &r!n s(+d!!
    Tulburarea de Somn indus de o Substan
    >54
    &o"!so%no$ra.!ce care !nd!c7 red+cerea d+ra(e! so%n+"+!, .ra$%en(area cresc+(7 a so%n+"+! s!
    Sreven!reaT so%n+"+! REM.
    A"(e s+'s(an=e. B! a"(e s+'s(an=e &o( &rod+ce &er(+r'7r! de so%n. E<e%&"e"e co%+ne
    !nc"+d %ed!ca%en(e"e care a.ec(ea/7 s!s(e%e"e nervos cen(ra" O! ve$e(a(!v E!nc"+/And a$on!O(!! O!
    an(a$on!O(!! adrener$!c!, a$on!O(!! O! an(a$on!O(!! do&a%!ne!, a$on!O(!! O! an(a$on!O(!! co"!ner$!c!,
    a$on!O(!! O! an(a$on!O(!! sero(on!ner$!c!, an(!!s(a%!n!ce"e O! cor(!cos(ero!/!!J. C"!n!c, as(.e" de
    %ed!ca%en(e s+n( &rescr!se &en(r+ con(ro"+" !&er(ens!+n!! O! ar!(%!!"or card!ace, %a"ad!e!
    &+"%onare o's(r+c4(!ve cron!ce, &ro'"e%e"or de %o(!"!(a(e $as(ro!n(es(!na"7 sa+ &rocese"or
    !n."a%a(or!!.
    Dia!nostic di$erenial
    Per(+r'7r!"e de so%n s+n( :n(A"n!(e .recven( :n con(e<(+" !n(o<!ca=!e! c+ o s+'s(an=7 sa+ a"
    a's(!nen=e! de o s+'s(an=7. Un d!a$nos(!c de (+"'+rare de so%n !nd+s7 de o s+'s(an=7 (re'+!e s7
    .!e &+s :n "oc+" +n+! d!a$nos(!c de !n(o<!ca=!e c+ o s+'s(an=7 or! de a's(!nen=7 de o s+'s(an=7,
    n+%a! cAnd &er(+r'area de so%n es(e cons!dera(7 a .! :n e<ces .a=7 de cea asoc!a(7 de re$+"7 c+
    s!ndro%+" de !n(o<!ca=!e sa+ de a's(!nen=7, sa+ cAnd &er(+r'area es(e s+.!c!en( de sever7 &en(r+ a
    @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7. De e<e%&"+, !nso%n!a es(e +n .eno%en carac(er!s(!c a"
    a's(!nen=e! de seda(!ve, !&no(!ce sa+ an<!o"!(!ce. T+"'+rarea de so%n !nd+s7 de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce (re'+!e s7 .!e d!a$nos(!ca(7 :n "oc+" a's(!nen=e! de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce, n+%a! dac7 !nso%n!a es(e %a! sever7 decA( cea :n(A"n!(7 de re$+"7 :n a's(!nen=a de
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce, O! neces!(7 o a(en=!e s! +n (ra(a%en( s&ec!a". Dac7 &er(+r'area
    de so%n !nd+s7 de o s+'s(an=7 s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+%, &er(+r'area de so%n
    es(e cons!dera(7 a .! +n e"e%en( asoc!a( a" de"!r!+%+"+! O! n+ es(e d!a$nos(!ca(7 se&ara(, :n
    (a'"o+r!"e c"!n!ce !nd+se de o s+'s(an=7 care con=!n o %!<(+r7 de d!.er!(e (!&+r! de s!%&(o%e Ede
    e<., de so%n, a.ec(!ve O! an<!oaseJ, (!&+" s&ec!.!c de (+"'+rare !nd+s7 de s+'s(an=a de d!a$nos(!ca(
    de&!nde de care (!& de s!%&(o%e &redo%!n7 :n (a'"o+" c"!n!c.
    O (+"'+rare de so%n !nd+s7 de o s+'s(an=7 se d!s(!n$e de o (+"'+rare de so%n &r!%ar7 s! de
    !nso%n!a sa+ !&erso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7 &r!n .a&(+" c7 o s+'s(an=7 es(e
    cons!dera(7 a .! e(!o"o$!c :n "e$7(+r7 c+ s!%&(o%e"e Eve/! &a$. RYYJ.
    O (+"'+rare de so%n !nd+s7 de o s+'s(an=7 da(ora(7 +n+! (ra(a%en( &rescr!s &en(r+ o
    (+"'+rare %en(a"a or! &en(r+ o cond!=!e %ed!ca"7 $enera"7 (re'+!e s74O! a!'7 de'+(+" :n (!%&+"
    cA( &ersoana &r!%eO(e %ed!ca%en(+" Eor! :n c+rs+" a's(!nen=e!, dac7 e<!s(7 +n s!ndro% de
    a's(!nen=7 asoc!a( c+ %ed!ca%en(+"J. Oda(7 ce (ra(a%en(+" es(e :n(rer+&(, &er(+r'area de so%n se
    va re%!(e :n dec+rs de cA(eva s7&(7%An! E:n .+nc=!e de se%!v!a=a s+'s(an=e! O! &re/en=a +n+!
    s!ndro% de a's(!nen=7J. AOa c+% s4a d!sc+(a( %a! s+s, +ne"e .or%e de &ro'"e%e de so%n &o(
    &ers!s(a :ns7 "a !n(ens!(a(e descrescAnd7 (!%& de "+n! d+&7 a's(!nen=a de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce. C+ aces(e e<ce&=!!, dac7 s!%&(o%e"e &ers!s(7 &es(e I s7&(7%An!, vor (re'+! "+a(e :n
    cons!dera=!e a"(e ca+/e &en(r+ &er(+r'area de so%n. N+ rar, !nd!v!/!! c+ o (+"'+rare de so%n
    &r!%ar7 .ac +/ de %ed!ca%en(e sa+ de dro$+r! de a'+/ &en(r+ a4O! +O+ra s!%&(o%e"e. Dac7
    c"!n!c!an+" cons!der7 c7 s+'s(an=a @oac7 +n ro" !%&or(an( :n e<acer'area &er(+r'7r!! de so%n,
    &oa(e .! @+s(!.!ca( +n d!a$nos(!c ad!=!ona" de (+"'+rare de so%n !nd+sa de o s+'s(an=7.
    O (+"'+rare de so%n !nd+s7 de o s+'s(an=7 O! (+"'+rarea de so%n da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e &o( .!, de ase%enea, d!.!c!" de d!s(!ns. A%'e"e &o(
    RRL Tulburrile de Somn
    &rod+ce s!%&(o%e s!%!"are de !nso%n!e, !&erso%n!e sa+ E%a! rarJ de &araso%n!e. :n a.ar7 de
    aceas(a, %+"=! !nd!v!/! c+ cond!=!! %ed!ca"e $enera"e care ca+/ea/7 o (+"'+rare de so%n s+n(
    (ra(a=! c+ %ed!ca%en(e care &o( ca+/a (+"'+r7r! de so%n. Crono"o$!a s!%&(o%e"or es(e ce" %a!
    !%&or(an( .ac(or :n d!s(!n$erea :n(re aces(e do+7 ca+/e de &er(+r'are de so%n. De e<e%&"+, o
    &er(+r'are de so%n care &recede c"ar +(!"!/area or!c7r+! %ed!ca%en( &en(r+ (ra(a%en(+" +ne!
    cond!=!! %ed!ca"e $enera"e va s+$era +n d!a$nos(!c de (+"'+rare de so%n da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e. Invers, s!%&(o%e"e de so%n care a&ar n+%a! d+&7 !ns(!(+!rea (ra(a%en(+"+!
    c+ +n an+%!( %ed!ca%en( sa+ s+'s(an=7 vor s+$era o (+"'+rare de so%n !nd+s7 de o s+'s(an=7,
    :n %od s!%!"ar, o &er(+r'are de so%n care a&are :n (!%&+" (ra(a%en(+"+! +ne! cond!=!!
    %ed!ca"e, dar care se a%e"!orea/7 d+&7 :n(rer+&erea %ed!ca%en(+"+!, s+$erea/7 +n
    d!a$nos(!c de (+"'+rare de so%n !nd+s7 de o s+'s(an=7. Dac7 c"!n!c!an+" cons!der7 c7
    &er(+r'area se da(orea/7, a(A( +ne! cond!=!! %ed!ca"e $enera"e cA( s! +ne! s+'s(an=e, s+n( &+se
    a%'e"e d!a$nos(!ce Ead!c7, (+"'+rare de so%n da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e s!
    (+"'+rare de so%n !nd+s7 de o s+'s(an=7J. CAnd e<!s(7 !ns+.!c!en(e &ro'e &en(r+ a &rec!/a c7
    &er(+r'area de so%n es(e da(ora(7 +ne! s+'s(an=e E!nc"+s!v +n+! %ed!ca%en(J or! +ne! cond!=!!
    %ed!ca"e $enera"e, sa+ es(e &r!%ar7 Ead!c7, n+ se da(orea/7 n!c! +ne! s+'s(an=e s! n!c! +ne! cond!=!!
    %ed!ca"e $enera"eJ es(e !nd!ca(7 &araso%n!a .7r7 a"(7 s&ec!.!ca=!e sa+ d!sso%n!a .7r7 a"(7
    s&ec!.!ca=!e.
    Criteriile $e $ia/no&ti# pentru Tul-urarea $e So"n in$u&( $e o
    Su-&tan!(
    A2 #erturbare notabil de somn care este su$icient de sever pentru a 0usti$ica
    o atenie clinic separat2
    S2 Din istoric, examenul somatic sau datele de laborator exist proba, $ie a &E),
    $ie a &7)D
    (1) simptomele de la criteriul A apar "n cursul ori p@n "ntr-o lun de la
    intoxicaia sau abstinena de o substan3
    (2) utili(area unui medicament este etiolo!ic "n le!tur cu perturbarea de
    somn2
    2 #erturbarea nu este explicat mai bine de o tulburare de somn care nu este
    indus de o substan2 #roba c simptomele sunt explicate mai bine de o
    tulburare de somn care nu este indus de o substan poate include
    urmtoareleD simptomele preced debutul u(ului substanei &sau u(ului
    medicamentului)3 simptomele persist o perioad considerabil de timp &de
    ex2, aproape o lun), dup "ncetarea abstinenei acute sau a intoxicaiei
    severe, ori sunt considerabil "n exces $a de ceea ce ar $i de presupus, dat
    $iind tipul sau cantitatea de substan utili(at sau durata u(ului, ori exist
    alt prob care su!erea( existena unei tulburri de somn independente,
    noninduse de o substan &de ex2, un istoric de episoade recurente $r
    le!tur cu o substan)2
    D2 #erturbarea nu survine exclusiv "n cursul unui delirium2
    *2 #erturbarea de somn cau(ea( detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional ori "n alte domenii importante de $uncionare2
    Tulburarea de Somn indus de o Substan
    >>1
    Criteriile $e $ia/no&ti# pentru Tul-urarea $e So"n in$u&( $e o
    Su-&tan!( (continuare)
    Not(M Acest dia!nostic trebuie pus "n locul unui dia!nostic de intoxicaie cu o substan ori
    de abstinen de o substan, numai c@nd simptomele %ipnice sunt "n exces $a de cele
    asociate de re!ul cu sindromul de intoxicaie sau de abstinen ,i c@nd simptomele sunt
    su$icient de severe pentru a 0usti$ica o atenie clinic separat2
    A se codi"ica ast$el tulburarea de somn indus de o substan speci$icD
    76E28 alcool3 767286 am$etamina3 767286 ca$eina3 767286 cocain3 767286 opiacee3 767286
    sedative, %ipnotice sau anxiolitice3 767286 alt substan &sau o substan necunoscut)2
    De speci"icat tipulD
    De tip in&o"nieM dac perturbarea de somn predominant este insomnia3
    De tip @iper&o"nieM dac perturbarea de somn predominant este
    %ipersomnia3
    De tip para&o"nieM dac perturbarea de somn predominant este parasomnia2
    De tip "i,tM dac este pre(ent mai mult dec@t o sin!ur perturbare de
    somn ,i nu predomin nici una2
    Despec1K1catdac &ve(i tabelul de la pa!2 E64 pentru aplicabilitate la substan)D
    Cu $e-ut .n #ur&ul into,i#a!ieiM dac sunt satis$cute criteriile pentru intoxicaia cu o
    substan, iar simptomele apar "n cursul sindromului de intoxicaie2 Cu $e-ut .n #ur&ul
    a-&tinen!eiM dac sunt satis$cute criteriile pentru abstinena de o substan, iar
    simptomele apar "n cursul, sau scurt timp dup sindromul de abstinen2

    Tulburrile ontrolului Impulsului
    Feclasi$icate "n Alt #arte
    eas(7 sec=!+ne !nc"+de (+"'+r7r!"e con(ro"+"+! !%&+"s+"+! care n+ s+n(
    c"as!.!ca(e ca &ar(e a (a'"o+"+! c"!n!c a" (+"'+r7r!"or d!n a"(e sec=!+n! a"e %an+a"+"+!
    Ede e<., (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7, &ara.!"!!"e, (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7, (+"'+rarea de cond+!(7, sc!/o.ren!a, (+"'+r7r!"e a.ec(!ve &o( avea
    e"e%en(e care !%&"!c7 &ro'"e%e a"e con(ro"+"+! !%&+"s+"+!J. E"e%en(+" esen=!a" a"
    (+"'+r7r!"or con(ro"+"+! !%&+"s+"+! :" cons(!(+!e !nca&ac!(a(ea de a re/!s(a +n+!
    !%&+"s sa+ (en(a=!! de a e.ec(+a +n ac( care es(e d7+n7(or &ersoane! res&ec(!ve sa+
    a"(ora, :n ce"e %a! %+"(e (+"'+r7r! d!n aceas(7 sec=!+ne, !nd!v!d+" s!%(e o sen/a=!e
    crecAnd7 de (ens!+ne sa+ de e<c!(a=!e :na!n(e de a co%!(e ac(+", s! a&o! e<&er!en4
    (ea/7 &"7cere, $ra(!.!ca=!e4 sa+ +O+rare :n (!%&+" co%!(er!! ac(+"+!. D+&7 ac(, &oa(e
    e<!s(a sa+ n+ re$re(, a+(ore&ros sa+ c+"&7, :n aceas(7 sec=!+ne s+n( !nc"+se
    +r%7(oare"e (+"'+r7r!Q
    T+"'+rarea e<&"o/!v7 !n(er%!(en(7, carac(er!/a(7 &r!n e&!soade d!s(!nc(e de
    !nca&ac!(a(e de a re/!s(a !%&+"s!+n!"or a$res!ve, d+cAnd "a a(ac+r! $rave sa+
    d!s(r+$er! a"e &ro&r!e(7=!!.
    -"e&(o%an!a, carac(er!/a(7 &r!n !nca&ac!(a(ea rec+ren(7 de a re/!s(a !%&+"s+"+!
    de a .+ra o'!ec(e care n+ s+n( necesare &en(r+ +/+" &ersona" sa+ va"oarea %one(ar7.
    P!ro%an!a, carac(er!/a(7 &r!n(r4+n &a((ern de &+nere a .oc+"+! &en(r+ &"7cere,
    $ra(!.!ca=!e sa+ +O+rare a (ens!+n!!.
    *oc+" de Oans7 &a(o"o$!c, carac(er!/a( &r!n(r4+n co%&or(a%en( de/ada&(a(!v
    rec+ren( s! &ers!s(en( de @oc de Oans7.
    Tr!co(!"o%an!a, carac(er!/a(7 &r!n s%+"$erea rec+ren(7 a &ro&r!+"+! &7r, d!n
    &"7cere, &en(r+ $ra(!.!ca=!e sa+ +O+rare a (ens!+n!!, ceea ce d+ce "a o &!erdere
    a&rec!a'!"7 a &7r+"+!.
    T+"'+rarea con(ro"+"+! !%&+"s+"+! .7r7 a"(7 s&ec!.!ca=!e, care es(e !nc"+s7
    &en(r+ cod!.!carea (+"'+r7r!"or con(ro"+"+! !%&+"s+"+! care n+ sa(!s.ac cr!(er!!"e
    &en(r+ n!c! +na d!n(re (+"'+r7r!"e s&ec!.!ce a"e con(ro"+"+! !%&+"s+"+! descr!se %a!
    s+s or! :n a"(e sec=!+n! a"e %an+a"+"+!.
    4*C.47 Tul-urarea E,plo)iv( Inter"itent(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! e<&"o/!ve !n(er%!(en(e :" cons(!(+!e a&ar!=!a de
    e&!soade d!s(!nc(e de !nca&ac!(a(e de a re/!s(a !%&+"s+r!"or a$res!ve, ceea ce d+ce
    "a ac(e a$res!ve $rave sa+ "a d!s(r+$erea &ro&r!e(7=!! Ecr!(er!+" AJ. E<e%&"e"e de ac(e
    a$res!ve severe !nc"+d "ov!rea sa+ v7(7%area :n a"( %od a a"(e! &ersoane sa+
    a%en!n=area ver'a"7 c+ a$res!v!(a(e .!/!c7. D!s(r+$erea &ro&r!e(7=!! !%&"!c7
    RR;
    RRI Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte
    d!s(r+$erea !n(en=!ona(7 a +n+! o'!ec( de va"oare, avar!erea %!nor7 sa+
    ne!n(en=!ona(7 n+ es(e s+.!c!en( de sever7 &en(r+ a sa(!s.ace aces( cr!(er!+ ,rad+"
    de a$res!v!(a(e e<&r!%a(7 :n (!%&+" +n+! e&!sod es(e :n %od ."a$ran(
    d!s&ro&or=!ona( .a(7 de or!ce &rovocare sa+ s(resor &s!osoc!a" &rec!&!(an( Ecr!(er!+"
    BJ Un d!a$nos(!c de (+"'+rare e<&"o/!v7 !n(er%!(en(7 es(e &+s n+%a! d+&7
    e<c"+derea a"(or (+"'+r7r! %en(a"e care ar &+(ea e<&"!ca e&!sod+" de co%&or(a%en(
    a$res!v Ede e< , (+"'+rarea de &ersona"!(a(e an(!soc!a"7, (+"'+rarea de &ersona"!(a(e
    'order"%e, o (+"'+rare &s!o(!c7, +n e&!sod %an!aca", o (+"'+rare de cond+!(7 on
    (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!eJ Ecr!(er!+" CJ E&!soade"e a$res!ve n+ se
    da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<, +n dro$ de a'+/,
    +n %ed!ca%en(J on a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<, +n (ra+%a(!s%
    cran!an, %a"ad!a A"/e!%erJ Ecr!(er!+" CJ Ind!v!d+" &oa(e descr!e e&!soade"e
    a$res!ve ca S&er!oadeT sa+ Sa(ac+r!T, :n care co%&or(a%en(+" e<&"o/!v es(e
    &receda( de +n sen(!%en( de (ens!+ne sa+ de e<c!(a=!e s! es(e +r%a( !%ed!a( de o
    sen/a=!e de +O+rare Ma! (Ar/!+, !nd!v!d+" se &oa(e s!%=! (+"'+ra(, &"!n de re%+sc7r!,
    de re$re(e sa+ @ena( de co%&or(a%en(+" a$res!v
    *lemente si tulburri asociate
    $lemente descriptive si tulburri mentale asociate. Ind!v!/!! c+ (+"'+rare
    e<&"o/!v7 !n(er%!(en(7 descr!+ +neor! !%&+"s+r! !n(ense s&re a$res!v!(a(e, an(er!or
    ac(e"or "or a$res!ve E&!soade"e e<&"o/!ve &o( .! asoc!a(e c+ s!%&(o%e a.ec(!ve
    E!n(a'!(a(e sa+ .+r!e, ener$!e cresc+(7, !dea(!e acce"era(7J :n c+rs+" !%&+"s+r!"or s!
    ac(e"or a$res!ve s! c+ de'+(+" ra&!d a" +ne! d!s&o/!=!! de&res!ve s! .a(!$a'!(7(! d+&7
    ac(e De ase%enea, +n+ !nd!v!/! &o( re"a(a c7 e&!soade"e "or a$res!ve s+n( &receda(e
    sa+ asoc!a(e adesea c+ s!%&(o%e ca (!n!(+s, (re%or, &a"&!(a=!!, o&res!+ne (orac!c7,
    &res!+ne :n ca& sa+ a+/ :n eco+ Ind!v!/!! &o( descr!e !%&+"s+r!"e "or a$res!ve ca
    .+nd e<(re% de de(resan(e T+"'+rarea &oa(e d+ce "a &!erderea serv!c!+"+!,
    e"!%!narea d!n scoa"7, d!vor=, d!.!c+"(7=! :n re"a=!!"e !n(er&ersona"e sa+ "a a"(e
    de(er!or7r! :n s.ere"e oc+&a(!ona"7 s! soc!a"7, acc!den(e Ede e<, de c!rc+"a=!eJ,
    s&!(a"!/are Ede e<, d!n ca+/a "e/!+n!"or &rod+se :n '7(7! sa+ acc!den(eJ, &ro'"e%e
    .!nanc!are, :ncarcer7r! sa+ a"(e &ro'"e%e "e$a"e
    :n(re e&!soade"e e<&"o/!ve &o( .! &re/en(e se%ne de !%&+"s!v!(a(e sa+
    a$res!v!(a(e e<a$era(7 Ind!v!/!! c+ (+"'+rare e<&"os!v7 !n(er%!(en(7 &o( re"a(a
    &ro'"e%e de %An!e cron!c7 s! de e&!soade Ss+'"!%!na"eT .recven(e :n care
    e<&enen(ea/7 !%&+"s+r! a$res!ve, c7rora, .!e re+Oesc s7 n+ "e dea c+rs, .!e se
    an$a@ea/7 :n co%&or(a%en(e a$res!ve %a! &+=!n d!s(r+c(!ve Ede e< , =!&e(e sa+ da(+"
    c+ &+%n!! :n(r4+n &ere(e, .7r7 s745 s(r!ceJ
    Ind!v!/!! c+ (r7s7(+r! narc!s!s(!ce, o'ses!ve, &arano!de sa+ sc!/o!de &o( .!
    e<(re% de :nc"!na=! s7 &re/!n(e '+.ee e<&"o/!ve de %An!e cAnd s+n( s(resa=! Da(e
    &re"!%!nare s+$erea/7 c7 (+"'+rarea e<&"o/!v7 !n(er%!(en(7 &oa(e .! asoc!a(7 c+
    (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e an<!oase, (+"'+r7r!"e de co%&or(a%en( a"!%en(ar,
    (+"'+r7r!"e +/+"+! de o s+'s(an=7 s! c+ a"(e (+"'+r7r! a"e con(ro"+"+! !%&+"s+"+!
    Re"a(7r!"e d!n co&!"7r!e &o( reve"a accese de .+r!e, a(en=!e de(er!ora(7,
    !&erac(!v!(a(e, s! a"(e (+"'+r7r! de co%&or(a%en(, c+% ar n .+r(+" s! !ncend!erea
    9ate de laborator asociate. Po( s7 e<!s(e da(e EE, nes&ec!.!ce Ede e<, "en(oareJ
    or! &ro'e de ano%a"!! "a (es(area ne+ro&s!o"o$!c7 Ede e< , d!.!c+"(7=! "a !nversarea
    "!(ere"orJ Se%ne de a"(erare a %e(a'o"!s%+"+! sero(o%ne! Ede e< , concen(ra=!! s+'
    %ed!e a"e ac!d+"+! Y4!dro<!4%do"4ace(!c ZY4HIAA[J a+ .os( cons(a(a(e :n "!c!d+"
    4E724H Tulburarea *xplo(iv
    Intermitent
    ==<
    ce.a"ora!d!an a" +nor !nd!v!/! !%&+"s!v! O! :nc"!na=! s&re .+r!e, dar re"a=!a s&ec!.!c7
    a aces(or cons(a(7r! c+ (+"'+rarea e<&"o/!v7 !n(er%!(en(7 es(e nec"ar7.
    Datele e,a"in(rii &o"ati#e Ei #on$i!iile "e$i#ale /enerale a&o#iate. Pot
    e<!s(a se%ne S.r+s(eT sa+ nes&ec!.!ce "a e<a%ene"e ne+ro"o$!ce Ede e<., as!%e(r!e de
    re."e<e sa+ %!Oc7r! :n o$"!nd7J. Po( .! &re/en(e d!.!c+"(7=! de de/vo"(are, !nd!ca(oare
    de o d!s.+nc=!e cere'ra"7 Ede e<., "en(oare :n vor'!re sa+ coordonare red+s7J. De
    ase%enea, &oa(e .! &re/en( +n !s(or!c de cond!=!! ne+ro"o$!ce Ede e<., ce.a"e!
    %!$renoase, (ra+%a(!s% cran!an, e&!soade de !nconO(!en=7, conv+"s!! .e'r!"e :n
    co&!"7r!eJ. Dac7 :ns7 c"!n!c!an+" cons!der7 c7 co%&or(a%en(+" a$res!v es(e
    consec!n=a e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e, (re'+!e
    &+s :n "oc, d!a$nos(!c+" de (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %en(a"e
    $enera"e Ede e<., %od!.!care de &ersona"!(a(e da(ora(7 +n+! (ra+%a(!s% cran!an, de
    (!& a$res!v8 de%en=7 de (!& A"/e!%er, c+ de'+( &recoce, neco%&"!ca(7, c+
    &er(+r'are de co%&or(a%en(J.
    *lemente speci$ice culturii si sexului
    Amo8#+l se carac(er!/ea/7 &r!n(r4+n e&!sod de co%&or(a%en( de/"7n=+!( ac+(,
    &en(r+ care &ersoana !nvoc7 a%ne/!e. DeO! v7/+(e (rad!=!ona" :n =7r!"e As!e! de
    S+d4Es(, ca/+r! de a%o) a+ .os( descr!se O! :n Canada O! S(a(e"e Un!(e. Con(rar
    (+"'+r7r!! e<&"o/!ve !n(er%!(en(e, a%o)4+" s+rv!ne de re$+"7, %a! c+rAnd ca
    e&!sod +n!c decA( ca &a((ern de co%&or(a%en( a$res!v O! adesea se asoc!a/7 c+
    e"e%en(e d!soc!a(!ve &roe%!nen(e. Co%&or(a%en(+" v!o"en( e&!sod!c es(e %a!
    .recven( "a '7r'a=! decA( "a .e%e!.
    #revalent
    L!&sesc !n.or%a=!! de%ne de :ncredere, :ns7 (+"'+rarea e<&"o/!v7 !n(er%!(en(7
    es(e, d+&7 cA( se &are, rar7.
    *voluie
    S+n( d!s&on!'!"e &+=!ne da(e des&re e(a(ea "a de'+( a (+"'+r7r!! e<&"o/!ve
    !n(er%!(en(e, dar se &are c7 de'+(+" are "oc :nce&And d!n +"(!%a &ar(e a
    ado"escen=e! &An7 :n cea de a (re!a decad7 a v!e=!!. Mod+" de de'+( &oa(e .! 'r+sc O!
    .7r7 o &er!oad7 &rodro%a"7. Evo"+=!a (+"'+r7r!! e<&"o/!ve !n(er%!(en(e es(e
    var!a'!"7, c+ (+"'+rare avAnd o evo"+=!e cron!c7 "a +n!! !nd!v!/! O! c+ o evo"+=!e
    %a! c+rAnd e&!sod!c7 "a a"=! !nd!v!/!.
    #attern $amilial
    T+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e +/+"+! de o s+'s(an=7, (+"'+rarea e<&"o/!v7
    !n(er%!(en(7 s! a"(e (+"'+r7r! a"e con(ro"+"+! !%&+"s+"+! &o( .! %a! .recven(e &r!n(re
    r+de"e de $rad+" I a"e !nd!v!/!"or c+ (+"'+rare e<&"o/!v7 !n(er%!(en(7 decA( :n
    &o&+"a=!a $enera"7.
    Dia!nostic di$erenial
    Co%&or(a%en(+" a$res!v &oa(e s+rven! :n con(e<(+" %+"(or a"(e (+"'+r7r!
    %en(a"e. D!a$nos(!c+" de (+"'+rare e<&"o/!v7 !n(er%!(en(7 (re'+!e "+a( :n
    cons!dera=!e, n+%a! d+&7 ce (oa(e ce"e"a"(e (+"'+r7r! care s+n( asoc!a(e c+ !%&+"s+r!
    === Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte
    sa+ c+ co%&or(a%en( a$res!v a+ .os( e<c"+se. Dac7 co%&or(a%en(+" a$res!v
    s+rv!ne e<c"+s!v :n c+rs+" +n+! de"!r!+%, d!a$nos(!c+" de (+"'+rare e<&"o/!v7
    !n(er%!(en(7 n+ es(e &+s. La .e", cAnd co%&or(a%en(+" a&are ca &ar(e a +ne!
    de%en=e, d!a$nos(!c+" de (+"'+rare !n(er%!(en(7 n+ es(e &+s, d!a$nos(!c+"
    cores&+n/7(or .!!nd ce" de de%en=7, c+ s&ec!.!can(+" Sc+ &er(+r'are de
    co%&or(a%en(T. T+"'+rarea e<&"o/!v7 !n(er%!(en(7 (re'+!e s7 .!e d!s(!ns7 de
    %od!.!carea de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, de (!&
    a$res!v care es(e d!a$nos(!ca(7 cAnd &a((ern+" e&!soade"or a$res!ve es(e cons!dera(
    a .! da(ora( e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<.,
    +n !nd!v!d care a s+.er!( o v7(7%are cere'ra"7 :n(r4+n acc!den( de a+(o%o'!" s!
    &re/!n(7 consec+(!v o %od!.!care de &ersona"!(a(e carac(er!/a(7 &r!n e<&"o/!! de
    a$res!v!(a(eJ, :n ca/+r! rare, v!o"en=a e&!sod!c7 &oa(e s+rven! "a !nd!v!/!! c+
    e&!"e&s!e, :n s&ec!a" de na(+r7 .ron(a"7 O! (e%&ora"7 Ee&!"e&s!e co%&"e<7 &ar=!a"7J.
    Un !s(or!c a(en( s! o e<a%!nare ne+ro"o$!c7 de(a"!a(7 s+n( +(!"e :n e.ec(+area
    aces(e! &rec!/7r!. De re=!n+( c7 ano%a"!!"e nes&ec!.!ce "a e<a%!narea ne+ro"o$!c7 Ede
    e<., se%ne"e S.r+s(eTJ s! %od!.!c7r!"e EE, nes&ec!.!ce s+n( co%&a(!'!"e c+
    d!a$nos(!c+" de (+"'+rare e<&"o/!v7 n(er%!(en(7 s! a+ dre&( de &ree%&=!+ne as+&ra
    d!a$nos(!c+"+!, n+%a! dac7 e"e s+n( !nd!ca(oare a"e +ne! cond!=!! %ed!ca"e $enera"e
    d!a$nos(!ca'!"e.
    E<&"o/!! de a$res!v!(a(e &o( s+rven!, de ase%enea, :n asoc!ere c+ !n(o<!ca=!a c+
    o s+'s(an=7 or! c+ a's(!nen=a de o s+'s(an=7, :n s&ec!a" cAnd s+n( :n "e$7(+ra c+
    a"coo"+", &encyc"!d!na, coca!na s! a"(e s(!%+"an(e, c+ 'ar'!(+r!ce s! !na"an(e.
    C"!n!c!an+" (re'+!e s7 se !n.or%e/e a(en( as+&ra na(+r!! s! :n(!nder!! +/+"+! de
    s+'s(an=7, !ar +n screen!n$ a" dro$+"+! :n sAn$e sa+ +r!n7 &oa(e .! ed!.!ca(or.
    T+"'+rarea e<&"o/!v7 !n(er%!(en(7 (re'+!e s7 .!e d!s(!ns7 de co%&or(a%en(+"
    a$res!v sa+ era(!c care &oa(e a&are :n (+"'+rarea o&o/!=!on!s%+" &rovoca(or,
    (+"'+rarea de cond+!(7, (+"'+rarea de &ersona"!(a(e an(!soc!a"7, (+"'+rarea de
    &ersona"!(a(e 'order"!ne, e&!sod+" %an!aca" s! :n sc!/o.ren!e. Dac7
    co%&or(a%en(+" a$res!v es(e e<&"!ca( %a! '!ne ca d!a$nos(!c sa+ e"e%en( asoc!a( a"
    a"(e! (+"'+r7r! %en(a"e, d!a$nos(!c+" se&ara( de (+"'+rare e<&"o/!v7 !n(er%!(en(7 n+
    es(e &+s. A$res!+nea !%&+"s!v7 :ns7, "a !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e
    an(!soc!a"7 s! (+"'+rare de &ersona"!(a(e 'order"!ne &oa(e avea o re"evan=7 c"!n!c7
    s&ec!.!c7, :n care ca/ &o( .! &+se a%'e"e d!a$nos(!ce. De e<e%&"+, dac7 +n !nd!v!d
    c+ d!a$nos(!c+" de (+"'+rare de &ersona"!(a(e 'order"!ne &re/!n(7 e&!soade d!s(!nc(e
    de !nca&ac!(a(e de a re/!s(a !%&+"s+r!"or a$res!ve care d+c "a ac(e de a$res!v!(a(e
    ver'a"7 sa+ .!/!c7 severe sa+ "a d!s(r+$erea &ro&r!e(7=!!, &oa(e .! @+s(!.!ca( +n
    d!a$nos(!c ad!=!ona" de (+"'+rare e<&"o/!v7 !n(er%!(en(7.
    SA(ac+r!"e de .+r!eT 42 e&!soade 'r+O(e de .+r!e, asoc!a(e c+ e<c!(a=!e ve$e(a(!v7
    E(a!card!e, (rans&!ra=!!, con$es(!e .ac!a"7J s! sen(!%en(+" de &!erdere a con(ro"+"+!a+
    .os( descr!se "a !nd!v!/!! c+ (+"'+rare de&res!v7 %a@or7 O! "a ce! c+ &an!c7. Dac7
    aces(e a(ac+r! s+rv!n n+%a! :n cadr+" +n+! e&!sod de&res!v %a@or sa+ a" +n+! a(ac de
    &an!c7, n+ (re'+!e s7 .!e "+a(e :n cons!dera=!e &en(r+ d!a$nos(!c+" de (+"'+rare
    e<&"o/!v7 !n(er%!(en(7. Dac7 :ns7 aces(e a(ac+r! s+rv!n O! a"(eor! decA( :n c+rs+"
    e&!soade"or de&res!ve %a@ore sa+ a" a(ac+r!"or de &an!c7 s! sa(!s.ac cr!(er!+" (+"'+r7r!!
    e<&"o/!ve !n(er%!(en(e &en(r+ a(ac+r! a$res!ve, &o( .! &+se a%'e"e d!a$nos(!ce.
    Co%&or(a%en(+" a$res!v &oa(e s+rven!, des!$+r, s! cAnd n+ es(e &re/en(7 n!c! o
    (+"'+rare %en(a"7. Co%&or(a%en(+" !n(en=!ona" se d!s(!n$e de (+"'+rarea
    e<&"o/!v7 !n(er%!(en(7 &r!n &re/en=a %o(!va=!e! s! 'ene.!c!+"+! d!n ac(+" a$res!v, :n
    s!(+a=!! %ed!co"e$a"e, !nd!v!/!! &o( s!%+"a (+"'+rarea e<&"o/!v7 !n(er%!(en(7
    &en(r+ a ev!(a res&onsa'!"!(a(ea &en(r+ co%&or(a%en(+" "or.
    4E7247
    gleptomania
    ==G
    F+r!a ca reac=!e nor%a"7 "a an+%!(e even!%en(e de v!a=7 sa+ s!(+a=!!
    a%'!en(a"e (re'+!e, de ase%enea, s7 .!e d!s(!ns7 de .+r!a care &oa(e a&are ca &ar(e
    a +n+! e&!sod a$res!v :n (+"'+rarea e<&"o/!v7 !n(er%!(en(7, s+rven!nd c+ .oar(e
    &+=!n7 sa+ .7r7 n!c! +n .e" de &rovocare.
    Criteriile $e $ia/no&ti# pentru
    4*C.47 Tul-urarea E,plo)iv( Inter"itent(
    A2 Mai multe episoade distincte de incapacitate de a re(ista impulsurilor
    a!resive care duc la acte a!resive severe sau la distru!erea proprietii2
    S2 Gradul de a!resivitate mani$estat "n cursul episoadelor este disproporionat
    "n mod $la!rant "n raport cu orice stresori psi%osociali precipitani2
    2 *pisoadele de a!resivitate nu sunt explicate mai bine de alt tulburare men
    tal &de ex2, tulburarea de personalitate antisocial, tulburarea de perso
    nalitate borderline, o tulburare psi%otic, un episod maniacal, tulburarea de
    conduit ori tulburarea %iperactivitate1de$icit de atenie) ,i nu se datorea(
    e$ectelor $i(iolo!ice directe ale unei substane &de ex2, un dro! de abu(, un
    medicament) sau ale unei condiii medicale !enerale &de ex2, un traumatism
    cranian, maladia Al(%eimer)2
    4*C.4C Xlepto"ania
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" )"e&(o%an!e! :" cons(!(+!e !nca&ac!(a(ea rec+ren(7 de a
    re/!s(a !%&+"s+r!"or de a .+ra d!verse "+cr+r!, c!ar dac7 aces(ea n+ s+n necesare
    &en(r+ +/+" &ersona" or! &en(r+ va"oarea "or %one(ar7 Ecr!(er!+" AJ. Ind!v!d+"
    e<&er!en(ea/7 o creO(ere2a sen(!%en(+"+! s+'!ec(!v de (ens!+ne :na!n(ea .+r(+"+!
    Ecr!(er!+" BJ O! s!%(e &"7cere, $ra(!.!care sa+ +O+rare cAnd co%!(e .+r(+" Ecr!(er!+" CJ.
    F+r(+" n+ es(e co%!s &en(r+ a e<&r!%a .+r!a O! r7/'+narea, n+ es(e .7c+( ca r7s&+ns
    "a o !dee de"!ran(7 sa+ a"+c!na=!e Ecr!(er!+" DJ, s! n+ es(e e<&"!ca( %a! '!ne de
    (+"'+rarea de cond+!(7, de +n e&!sod %an!aca" or! de (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7 Ecr!(er!+" EJ. O'!ec(e"e s+n( .+ra(e :n d!s&re=+" .a&(+"+! c7 e"e s+n( de
    re$+"7 de %!c7 va"oare &en(r+ !nd!v!d, care4s! &oa(e &er%!(e s7 "e &"7(easc7 s! &e
    care adesea "e ar+nc7 sa+ se de'arasea/7 de e"e. Oca/!ona", !nd!v!d+" &oa(e
    de&o/!(a o'!ec(e"e .+ra(e sa+ "e &oa(e re(+rna &e asc+ns. DeO! !nd!v!/!! c+ aceas(7
    (+"'+rare ev!(7 :n $enera" s7 .+re cAnd es(e &ro'a'!"7 ares(area !%ed!a(7 Ede e<., :n
    v7/+" +n+! o.!=er de &o"!=!eJ, de re$+"7 e! n+4s! &"an!.!c7 d!na!n(e .+r(+r!"e sa+ !a+
    !nco%&"e( :n cons!dera=!e even(+a"!(a(ea de a .! &r!nO!. F+r(+" es(e co%!s .7r7
    as!s(en=a sa+ co"a'orarea a"(ora.
    *lemente si tulburri asociate
    Ind!v!/!! c+ )"e&(o%an!e e<&er!en(ea/7 !%&+"s+" de a .+ra ca e$od!s(on!c O! s+n(
    conO(!en=! de .a&(+" c7 ac(+" es(e !n.a%an( s! "!&s!( de sens. Frecven(, &ersoana se
    (e%e s7 n+ .!e &r!ns7 O! adesea es(e de&res!v7 sa+ se s!%(e c+"&a'!"7 :n "e$7(+r7 c+
    >>= Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte
    .+r(+r!"e. -"e&(o%an!a &oa(e .! asoc!a(7 c+ c+%&7ra(+" co%&+"s!v &rec+% s! c+
    (+"'+r7r!"e de&res!ve E:n s&ec!a" c+ (+"'+rarea de&res!v7 %a@or7J, (+"'+r7r!"e
    an<!oase, (+"'+r7r!"e de co%&or(a%en( a"!%en(ar E:n s&ec!a" c+ '+"!%!aJ, (+"'+r7r!"e
    de &ersona"!(a(e s! c+ a"(e (+"'+r7r! de con(ro" a"e !%&+"s+"+!. T+"'+rarea &oa(e
    ca+/a d!.!c+"(7=! "e$a"e, .a%!"!a"e, :n car!er7 s! &ersona"e.
    *lemente speci$ice sexului
    Da(e &re"!%!nare s+$erea/7 c7 :n esan(!oane"e c"!n!ce a&ro<!%a(!v do+7 (re!%!
    d!n(re !nd!v!/!! c+ )"e&(o%an!e s+n( .e%e!.
    #revalent
    -"e&(o%an!a es(e o cond!=!e rar7 care a&are "a %a! &+=!n de Yd d!n(re o=!! d!n
    %a$a/!ne !den(!.!ca=!. Preva"en(a sa :n &o&+"a=!a $enera"7 es(e nec+nosc+(7.
    *voluie
    E(a(ea "a de'+( a )"e&(o%an!e! es(e var!a'!"7. T+"'+rarea &oa(e de'+(a :n
    co&!"7r!e, ado"escen=7, &er!oada ad+"(7, s! :n rare ca/+r!, :n &er!oada ad+"(7 (Ar/!e.
    E<!s(7 &+=!ne !n.or%a=!! s!s(e%a(!ce des&re evo"+=!a )"e&(o%an!e!, dar a+ .os(
    descr!se (re! evo"+=!! (!&!ceQ s&orad!c7, c+ e&!soade sc+r(e s! "+n$! &er!oade de
    re%!s!+ne8 e&!sod!c7, c+ &er!oade &re"+n$!(e de .+r(+r! O! &er!oade de re%!s!+ne8 s!
    cron!c7, c+ +n oarecare $rad de ."+c(+a=!e. T+"'+rarea &oa(e con(!n+a :n O!r, :n
    d!s&re=+" n+%eroase"or conda%n7r! &en(r+ .+r( d!n %a$a/!ne.
    #attern $amilial
    N+ e<!s(7 s(+d!! con(ro"a(e as+&ra !s(or!c+"+! .a%!"!a" a" )"e&(o%an!e!. Da(e
    &re"!%!nare s+$erea/7 :ns7 c7 r+de"e de $rad+" I a"e !nd!v!/!"or c+ )"e&(o%an!e &o(
    avea &rocen(e de (+"'+rare o'ses!vo4co%&+"s!v7 %a! cresc+(e decA( &o&+"a=!a
    $enera"7.
    Dia!nostic di$erenial
    -"e&(o%an!a (re'+!e d!s(!ns7 de ac(e"e ord!nare de .+r( sa+ de .+r( d!n
    %a$a/!ne. F+r(+" ord!nar Edac7 es(e &"an!.!ca( sa+ !%&+"s!vJ es(e de"!'era( s!
    %o(!va( de +(!"!(a(ea o'!ec(+"+! or! de va"oarea sa %one(ar7. Un!! !nd!v!/!, :n s&ec!a"
    ado"escen=!!, &o( .+ra d!n s&!r!( de aven(+r7, ca +n ac( de re'e"!+ne or! ca +n dre&(
    de (recere. D!a$nos(!c+" n+ se &+ne decA( dac7 O! a"(e carac(er!s(!c! a"e )"e&(o%an!e!
    s+n(, de ase%enea, &re/en(e. -"e&(o%an!a es(e e<(re% de rar7, &e cAnd .+r(+" d!n
    %a$a/!ne es(e re"a(!v .recven(, :n s!%+"are, !nd!v!/!! &o( s!%+"a s!%&(o%e"e
    )"e&(o%an!e! &en(r+ a ev!(a +r%7r!rea :n @+s(!=!e. T+"'+rarea de &ersona"!(a(e
    an(!soc!a"7 s! (+"'+rarea de cond+!(7 se d!s(!n$ de )"e&(o%an!e &r!n(r4+n &a((ern
    $enera" de co%&or(a%en( an(!soc!a". -"e&(o%an!a (re'+!e d!s(!ns7 de .+r(+"
    !n(en=!ona" O! nec+$e(a( 2care &oa(e s+rven! :n c+rs+" +n+! e&!sod %an!aca", ca
    r7s&+ns "a !de! de"!ran(e sa+ "a a"+c!na=!! Ede e<.,:n sc!/o.ren!eJ, or! ca re/+"(a( a"
    +ne! de%en(e.
    4E7 44
    #iromama
    RRF
    Criteriile $e $ia/no&ti# pentru 4*C.4C Xlepto"anie
    A Incapacitatea recurent de a re(ista impulsurilor de a $ura obiecte care nu
    sunt necesare pentru u( personal ori pentru valoarea lor monetar
    S Sen(aie de tensiune imediat "naintea comitem $urtului
    #lcere, !rati$icatie sau u,urare "n timpul comitem $urtului
    D 'urtul nu este comis pentru a exprima $uria sau r(bunarea si nu este
    rspunsul la o idee delirant sau la o %alucinaie
    * 'urtul nu este explicat mai bine de tulburarea de conduit, de un episod
    maniacal ori de tulburarea de personalitate antisocial
    4*C.44 Piro"ania
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" &!ro%a%e! :" cons(!(+!e &re/en(a a %+"(!&"e e&!soade de
    &+nere de"!'era(7 s! !n(en=!ona(7 a .oc+"+! Ecr!(er!+" AJ Ind!v!/!! c+ aceas(7
    (+"'+rare e<&enen(ea/7 (ens!+ne sa+ e<c!(a=!e a.ec(!v7 :na!n(ea &+ner!! +n+! .oc
    Ecr!(er!+" BJ E<!s(7 o .asc!na=!e c+ !n(eres, c+r!o/!(a(e sa+ a(rac=!e &en(r+ .oc s!
    con(e<(e"e sa"e s!(+a(!ona"e Ede e<, de(a"!!, +(!"!/7r!, consec!n=eJ Ecr!(er!+" CJ
    Ind!v!/!! c+ aceas(7 (+"'+rare s+n( adesea Ss&ec(a(orX2 re$+"a=! a! !ncend!!"or d!n
    car(!ere"e "or, &o( dec"anOa a"ar%e .a"se, s! e &roc+r7 &"7cere !ns(!(+=!!"e,
    ec!&a%en(+" s! &ersona"+" asoc!a( c+ .oc+" E! &o( &!erde %+"( (!%& "a
    de&ar(a%en(+" "oca" de &o%&!er!, &rovoac7 !ncend!! &en(r+ a se a"7(+ra
    de&ar(a%en(+"+! de &o%&!er! or! dev!n c!ar &o%&!er! Ind!v!/!! c+ aceas(7
    (+"'+rare e<&enen(ea/7 &"7cere, $ra(!.!care sa+ o re"a<are a (ens!+n!! cAnd &rovoac7
    !ncend!+", s+n( %ar(or! "a e.ec(e"e sa"e or! &ar(!c!&7 "a :n"7(+rarea consec!n=e"or sa"e
    Ecr!(er!+" DJ Incend!erea n+ es(e .7c+(7 &en(r+ +n 'ene.!c!+ .!nanc!ar, ca e<&res!e a
    +ne! !deo"o$!! soc!o&o"!(!ce, asc+nderea +ne! ac(!v!(7=! cr!%!na"e, s&re a e<&r!%a
    .+r!a sa+ r7/'+narea, s&re a4s! a%e"!ora c!rc+%s(ar(e"e de v!a=7 or! ca r7s&+ns "a o
    !dee de"!ran(7 sa+ "a o a"+c!na=!e Ecr!(er!+" EJ Incend!erea n+ re/+"(7 d!n
    de(enorarea @+dec7=!! Ede e< , ca :n de%en(7, re(ardarea %en(a"7 sa+ !n(o<!ca=!a c+
    o s+'s(an=7J D!a$nos(!c+" n+ se &+ne, dac7 !ncend!erea es(e e<&"!ca(7 %a! '!ne de
    o (+"'+rare de cond+!(7, +n e&!sod %an!aca" or! de (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7 Ecr!(er!+" FJ
    *lemente si tulburri asociate
    Ind!v!/!! c+ &!ro%a%e &o( .ace &re$7(!r! cons!dera'!"e :na!n(e de &rovocarea
    !ncend!+"+! E! &o( .! !nd!.eren=! "a consec!n=e"e &en(r+ v!a(7 sa+ &ro&r!e(a(e ca+/a(e
    de .oc, or! &o( &roc+ra sa(!s.ac=!e d!n d!s(r+$erea &ro&r!e(ar!! care re/+"(7 d!n
    !ncend!+ Co%&or(a%en(e"e &o( d+ce "a &re@+d!c!erea &ro&r!e(7=!!, consec!n=e
    "e$a"e, v7(7%are cor&ora"7 sa+ &!erderea v!e(n, &en(r+ &!ro%an sa+ &en(r+ a"=!!
    Ind!v!/!! care &+n .oc !%&+"s!v E care &o( avea sa+ n+ &!ro%a%eJ a+ adesea +n
    !s(or!c ac(+a" sa+ (rec+( de a'+/ sa+ de&enden(7 a"coo"!c7
    RHL Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte

    *lemente speci$ice etii si sexului
    DeO! !ncend!erea es(e o &ro'"e%7 %a@or7 "a co&!! s! "a ado"escen=! E&es(e ILd
    d!n(re ce! ares(a=! &en(r+ !ncend!er! :n S(a(e"e Un!(e a+ s+' 5G an!J, &!ro%an!a :n
    co&!"7r!e &are a .! rar7. Incend!erea @+ven!"7 es(e asoc!a(7 de re$+"7 c+ (+"'+rarea de
    cond+!(7, (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e or! c+ (+"'+rarea de
    ada&(are. P!ro%an!a s+rv!ne ce" %a! adesea "a '7r'a=!, :n s&ec!a" "a ce! c+ a&(!(+d!n!
    soc!a"e %a! red+se s! c+ d!.!c+"(7=! de :nv7=are.
    #revalent
    P!ro%an!a es(e d+&7 cA( se &are rar7.
    *voluie
    E<!s(7 !ns+.!c!en(e da(e &en(r+ a s(a'!"! o e(a(e (!&!c7 de de'+( a &!ro%an!e!.
    Re"a=!a d!n(re &+nerea .oc+"+! :n co&"7r!e s! &!ro%an!e :n &er!oada ad+"(7 n+ es(e
    '!ne s(a'!"!(7. La !nd!v!/!! c+ &!ro%an!e, !nc!den(e"e de &+nere a .oc+"+! s+n(
    e&!sod!ce s! &o( cres(e s! scade :n .recven=7. Evo"+=!a "on$!(+d!na"7 es(e
    nec+nosc+(7.
    Dia!nostic di$erenial
    Es(e !%&or(an( s7 se e<c"+d7 a"(e ca+/e de &+nere a .oc+"+! :na!n(e de a
    s(a'!"! d!a$nos(!c+" de &!ro%an!e. P+nerea !n(en=!ona(7 a .oc+"+! &oa(e .! .7c!(7
    &en(r+ &ro.!(, sa'o(a@ sa+ r7/'+nare, &en(r+ a asc+nde o cr!%7, &en(r+ a .ace
    o dec"ara=!e &o"!(!c7 Ede e<., +n ac( de (eror!s% sa+ de &ro(es(J or! &en(r+ a
    a(ra$e a(en=!a sa+ rec+noaO(erea Ede e<., &+nerea +n+! .oc :n sco&+"
    desco&er!r!! O! &reven!r!! "+!, /!+aJ. P+nerea .oc+"+! &oa(e a&are, de ase%enea,
    ca &ar(e a +ne! e<&er!en(7r! de de/vo"(are :n co&!"7r!e Ede e<., @oc+" c+
    c!'r!(+r!"e, c+ 'r!ce(e"e sa+ c+ .oc+"J. Un!! !nd!v!/! c+ (+"'+r7r! %en(a"e
    +(!"!/ea/7 &+nerea .oc+"+! &en(r+ a co%+n!ca o dor!n=7 or! o neces!(a(e
    :ndre&(a(7 adesea s&re o'=!nerea +ne! sc!%'7r! :n na(+ra sa+ a%&"asarea
    serv!c!!"or. Aceas(7 .or%7 de &+nere a .oc+"+! a .os( den+%!(7 S!ncend!ere
    co%+n!ca(!v7T s! (re'+!e d!s(!ns7 c+ a(en=!e de &!ro%an!e. Un d!a$nos(!c se&ara(
    de &!ro%an!e n+ se &+ne, cAnd !ncend!erea s+rv!ne ca &ar(e a (+"'+r7r!! de
    cond+!(7, a +n+! e&!sod %an!aca" or! a (+"'+r7r!! de &ersona"!(a(e an(!soc!a"7,
    or! dac7 ea s+rv!ne ca r7s&+ns "a o !dee de"!ran(7 sa+ "a o a"+c!na=!e Ede e<., :n
    sc!/o.ren!eJ sa+ dac7 es(e da(ora(7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne!
    cond!=!! %ed!ca"e $enera"e. D!a$nos(!c+" de &!ro%an!e n+ (re'+!e, (re'+!e &+s,
    de ase%enea, &+s cAnd !ncend!erea re/+"(7 d!n de(er!orarea asoc!a(7 c+
    de%en=a, re(ardarea %en(a"7 or! c+ !n(o<!ca=!a c+ o s+'s(an=7.
    4E724E Nocul de Qans
    #atolo!ic
    =G*

    Criteriile $e $ia/no&ti# pentru 4*C.44 Piro"anie
    A2 #unerea deliberat ,i intenionat a $ocului "n mai mult dec@t o sin!ur oca(ie2
    S2 Tensiune sau excitaie a$ectiv "naintea actului2
    2 'ascinaie, interes, curio(itate sau atracie pentru $oc ,i contextele sale
    situaionale &de ex2, detalii, utili(ri, consecine)2
    D2 #lcere, !rati$icaie sau u,urare c@nd pune $oc ori c@nd asist sau particip
    la "nlturarea consecinelor sale2
    *2 #unerea $ocului nu este $cut pentru un bene$iciu $inanciar, ca expresie a
    unei ideolo!ii sociopolitice, pentru a ascunde o activitate criminal, pentru
    a exprima $uria sau r(bunarea, pentru a ameliora propriile circumstane de
    via, ca rspuns la o idee delirant sau %alucinaie, ori ca re(ultat al
    deteriorrii 0udecii &de ex2, ca "n demen, retardarea mental, intoxicaia
    cu o substan)2
    '2 #unerea $ocului nu este explicat mai bine de tulburarea de conduit, de un
    episod maniacal ori de tulburarea de personalitate antisocial2
    4*C.4* Io#ul $e ?an&( Patolo/i#
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" @oc+"+! de Oans7 &a(o"o$!c, :" cons(!(+!e +n co%&or(a%en(
    de @oc de Oans7 &ers!s(en( s! rec+ren( de/ada&(a(!v Ecr!(er!+" AJ care :n(rer+&e
    +r%7r!rea sco&+r!"or &ersona"e, .a%!"!a"e sa+ &ro.es!ona"e. D!a$nos(!c+" n+ se &+ne
    dac7 co%&or(a%en(+" de @oc de Oans7 es(e e<&"!ca( %a! '!ne de +n e&!sod %an!aca"
    Ecr!(er!+" BJ.
    Ind!v!d+" &oa(e .! &reoc+&a( de @oc+" de Oans7 Ede e<., re(r7!eO(e e<&er!en=e
    an(er!oare de @oc de Oans7, :O! &"an!.!c7 'an!! &en(r+ +r%7(or+" @oc de Oans7 sa+ se
    $:ndeO(e "a %od+r!"e :n care s7 o'=!n7 'an!! c+ care s7 @oaceJ Ecr!(er!+" A"J. Ce! %a!
    %+"=! !nd!v!/! c+ @oc de Oans7 &a(o"o$!c s&+n c7 e! ca+(7 Sac=!+neT Eo s(are de
    e<c!(a=!e, de e+.or!eJ, sa+ de aven(+r7 c!ar %a! %+"( decA( 'an!. Par!+r! 2(o( %a!
    %ar! or! r!sc+r! %a! %ar! &o( .! necesare &en(r+ a con(!n+a s7 &rod+c7 n!ve"+" dor!(
    de e<c!(a=!e Ecr!(er!+" A9J. Ind!v!/!! c+ @oc de Oans7 &a(o"o$!c con(!n+7 adesea s7
    @oace :n d!s&re=+" e.or(+r!"or re&e(a(e de a con(ro"a, red+ce sa+ s(o&a
    co%&or(a%en(+" Ecr!(er!+" A;J. Poa(e e<!s(a ne"!n!O(e sa+ !r!(a'!"!(a(e cAnd :ncearc7
    s7 red+c7 sa+ s7 s(o&e/e @oc+" de Oans7 Ecr!(er!+" AIJ. Ind!v!d+" &oa(e @+ca ca %od
    de a sc7&a de an+%!(e &ro'"e%e or! &en(r+ a +O+ra o d!s&o/!=!e d!s.or!c7 Ede e<.,
    sen(!%en(e"e de v+"nera'!"!(a(e, de c+"&7, an<!e(a(ea, de&res!aJ Ecr!(er!+" AYJ. Poa(e
    a&are +n &a((ern de S+r%7r!reT Ea rec+&er7r!!J a &ro&r!!"or &!erder!, c+ neces!(a(ea
    +r$en(7 de a con(!n+a @oc+" Eadesea c+ %!/e %a! %ar! or! c+ as+%area +nor r!sc+r!
    %a! %ar!J s&re a rec+&era o &!erdere sa+ o ser!e de &!erder!. Ind!v!d+" &oa(e
    ren+n=a "a s(ra(e$!a sa de @oc O! &oa(e :ncerca s7 rec+&ere/e (oa(e &!erder!"e o da(7.
    DeO! (o=! @+c7(or!! de Oans7 &o( +r%7r! rec+&erarea &!erder!"or &en(r+ sc+r(e
    =GC Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte
    &er!oad7 de (!%&, +r%7r!rea rec+&er7r!! &!erder!"or &e (er%en "+n$ es(e %a!
    carac(er!s(!c7 !nd!v!/!"or c+ @oc de Oans7 &a(o"o$!c Ecr!(er!+" ARJ. Ind!v!d+" &oa(e
    %!n=! &e %e%'r!! .a%!"!e!, &e (era&e+=! or! a"(e &ersoane, s&re a asc+nde
    d!%ens!+nea !%&"!c7r!! ."+! :n @oc+" de Oans7 Ecr!(er!+" AHJ. CAnd s+rse"e de
    :%&r+%+( a"e !nd!v!d+"+! s+n( e&+!/a(e, &ersoana &oa(e rec+r$e "a co%&or(a%en(
    an(!soc!a" Ede e<., "a .a"s, .ra+d7, .+r( sa+ de"a&!dareJ s&re a o'=!ne 'an! Ecr!(er!+"
    AGJ. Ind!v!d+" &oa(e s74O! .! &er!c"!(a( sa+ &!erd+( o re"a=!e or! +n &os( !%&or(an(, or!
    o o&or(+n!(a(e ed+ca=!ona"7 sa+ de car!er7 d!n ca+/a @oc+"+! de Oans7 Ecr!(er!+" AFJ.
    Ind!v!d+" &oa(e, de ase%enea, s7 se an$a@e/e :n(r4+n co%&or(a%en( de Ssc7&areT s!
    rec+r$e "a .a%!"!e sa+ "a a"=!! &en(r+ a@+(or :n s!(+a=!! .!nanc!are d!s&era(e ca+/a(e de
    @oc+" de Oans7 Ecr!(er!+" A5LJ.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. La !nd!v!/!! c+ @oc de
    Oans7 &a(o"o$!c &o( .! &re/en(e d!s(ors!+n! :n $And!re Ede e<., ne$are, s+&ers(!=!!,
    :ncredere e<a$era(7 or! +n sen(!%en( de &+(ere s! con(ro"J. M+"=! !nd!v!/! c+ @oc de
    Oans7 &a(o"o$!c cred c7 'an!! s+n(, a(A( ca+;a, cA( O! so"+=!a (+(+ror &ro'"e%e"or "or.
    Ind!v!/!! c+ @oc de Oans7 &a(o"o$!c s+n( .recven( e<(re% de co%&e(!(!v!, ener$!c!,
    ne"!n!O(!=! O! .as(!d!oO!. E! &o( .! e<(re% de &reoc+&a=! de a .! a&ro'a=! de c7(re a"=!! s!
    &o( .! $eneroO! &An7 "a e<(rava$an=7. CAnd n+ @oac7, e! &o( .! %+nc!(or! conO(!!nc!oO!
    sa+ Sco%&+"s!v!T, care aO(ea&(7 &An7 ce s+n( &+O! :n .a=a +nor (er%ene "!%!(7
    :na!n(e de a %+nc! rea"%en(e d!n $re+. Po( .! :nc"!na=! s7 de/vo"(e cond!=!! %ed!ca"e
    $enera"e asoc!a(e c+ s(res+" Ede e<., !&er(ens!+ne, +"cer peptic, %!$ren7J. Ind!v!/!!
    care so"!c!(7 (ra(a%en( &en(r+ @oc+" de Oans7 a+ &rocen(e re"a(!v %ar! de !dea=!e
    s+!c!dar7 O! de (en(a(!ve de s+!c!d. S(+d!!"e as+&ra !nd!v!/!"or c+ @oc de Oans7
    &a(o"o$!c s+$erea/7 c7 +n !s(or!c de s!%&(o%e de !na(en=!e s! de !&erac(!v!(a(e :n
    co&!"7r!e &o( .! +n .ac(or de r!sc &en(r+ de/vo"(area %a! (Ar/!+ :n v!a(7 a @oc+"+! de
    Oans7 &a(o"o$!c. Procen(e cresc+(e de (+"'+r7r! a.ec(!ve, de (+"'+rare
    !&erac(!v!(a(eXde.!c!( de a(en=!e, de a'+/ sa+ de&enden=7 de o s+'s(an=7 s! de
    (+"'+r7r! de &ersona"!(a(e an(!soc!a"7, narc!s!s(!c7 O! 'order"!ne a+ .os( ra&or(a(e "a
    !nd!v!/!! c+ @oc de Oans7 &a(o"o$!c.
    Da(e de "a'ora(or asoc!a(e. N+ e<!s(7 da(e de "a'ora(or s&ec!.!ce care s7 .!e
    d!a$nos(!ce &en(r+ @oc+" de Oans7 &a(o"o$!c. O var!e(a(e de da(e de "a'ora(or a+ .os(
    ra&or(a(e a .! anor%a"e :ns7 "a '7r'a=!! c+ @oc de Oans7 &a(o"o$!c :n co%&ara=!e c+
    s+'!ec=!! de con(ro". Aces(ea !nc"+d do/area ne+ro(rans%!(7(or!"or O! %e(a'o"!(!"or
    "or :n "!c!d+" ce.a"ora!d!an O! +r!n7 s! %7s+rarea r7s&+ns+"+! "a &rovoc7r!"e
    ne+roendocr!ne, !%&"!cAnd ano%a"!! :n(r4o var!e(a(e de s!s(e%e de ne+ro(rans4
    %!=7(or!, c+% ar .! s!s(erne"e sero(on!ner$!c, noradrener$!c O! do&a%!ner$!c. La
    '7r'a=!! c+ @oc de Oans7 &a(o"o$!c a+ .os( ra&or(a(e ano%a"!! :n ac(!v!(a(ea
    %onoa%!no<!da/e! &"ace(are. Ind!v!/!! c+ @oc de Oans7 &a(o"o$!c &o( &re/en(a
    n!ve"e cresc+(e de !%&+"s!v!(a(e "a (es(e"e ne+ro&s!o"o$!ce.
    *lemente speci$ice culturii si sexului
    E<!s(7 var!a=!! c+"(+ra"e :n &reva"en(a O! (!&+" ac(!v!(7=!"or de @oc Ede e<., &a! $o,
    "+&(e"e de cocoO!, c+rse"e de ca!, '+rsaJ. A&ro<!%a(!v o (re!%e d!n(re !nd!v!/!! c+
    @oc de Oans7 &a(o"o$!c s+n( .e%e!, dar :n d!.er!(e ar!! $eo$ra.!ce O! c+"(+r!, ra(a
    se<+"+! var!a/7 cons!dera'!". Fe%e!"e c+ (+"'+rarea s+n( %a! s+sce&(!'!"e s7 .!e
    4E724E Nocul de Qans
    #atolo!ic
    >8+

    de&res!ve O! s7 @oace ca o sc7&are. Fe%e!"e s+n( s+'re&re/en(a(e :n &ro$ra%e"e de
    (ra(a%en( &en(r+ @oc+" de Oans7 s! re&re/!n(7 n+%a! 9d4Id d!n &o&+"a=!a
    @+c7(or!"or de Oans7 anon!%!. Aceas(a se e<&"!c7 &r!n s(!$%a(+" %a! %are a(aOa(
    .e%e!"or @+c7(oare de Oans7.
    #revalent
    Preva"en(a @oc+"+! de Oans7 &a(o"o$!c es(e !n."+en=a(7 a(A( de acces!'!"!(a(ea
    @oc+r!"or de Oans7 s! de d+ra(a acces!'!"!(7=!!, as(.e" c7 oda(7 c+ acces!'!"!(a(ea
    crescAnd7 a @oc+r!"or de Oans7 "e$a"!/a(e e<!s(7 o creO(ere a &reva"en(e! @oc+"+! de
    Oans7 &a(o"o$!c. S(+d!!"e co%+n!(are es(!%ea/7 &reva"en(a &e v!a=7 a @oc+"+! de Oans7
    &a(o"o$!c %er$e de "a L,Id "a ;,Id "a ad+"=!, deO! &rocen(e"e de &reva"en(7 d!n +ne"e
    /one Ede e<. P+er(o R!co, A+s(ra"!aJ a+ ra&or(a(e ca .!!nd %a! %ar! de Hd. Procen(e
    de &reva"en(7 %a! %ar!, %er$And de "a 9,Gd "a Gd a+ .os( ra&or(a(e "a ado"escen=! O!
    s(+den=!! de co"e$!+. Preva"en(a @oc+"+! de Oans7 &a(o"o$!c &oa(e .! cresc+(7 &r!n(re
    !nd!v!/!! c+ (+"'+rarea +/+"+! de o s+'s(an=7 care so"!c!(7 (ra(a%en(.
    *voluie
    *oc+" de Oans7 &a(o"o$!c :nce&e de re$+"7 &recoce :n ado"escen=7 "a '7r'a=!
    O! %a! (Ar/!+ :n v!a=7 "a .e%e!. DeO! cA=!va !nd!v!/! s+n( Sa$7=a=!T de "a &r!%+"
    "or &ar!+, &en(r+ ce! %a! %+"=! evo"+=!a es(e %a! !ns!d!oas7. Po( e<!s(a an! de
    @oc de Oans7 soc!a" +r%a=! de +n de'+( 'r+sc, care &oa(e .! &rec!&!(a( de o
    e<&+nere %a! %are "a @oc+" de Oans7 or! de +n s(resor. Pa((ern+" de @oc de Oans7
    &oa(e .! re$+"a( sa+ e&!sod!c, !ar evo"+=!a (+"'+r7r!! es(e de re$+"7 cron!c7, :n
    $enera", e<!s(7 o &ro$res!+ne :n .recven=a @oc+"+! de Oans7, s+%a &ar!a(7 O!
    &reoc+&area &en(r+ @oc+" de Oans7 O! o'=!nerea de 'an! c+ care s7 @oace. Dor!n=a
    de a @+ca s! ac(!v!(a(ea de @oc de Oans7 creO(e :n $enera" :n c+rs+" &er!oade"or de
    s(res sa+ de de&res!e.
    #attern $amilial
    *oc+" de Oans7 &a(o"o$!c O! de&enden=a de a"coo" s+n( a%'e"e %a! .recven(e
    &r!n(re &7r!n=!! !nd!v!/!"or c+ @oc de Oans7 &a(o"o$!c decA( :n &o&+"a=!a $enera"7.
    Dia!nostic di$erenial
    *oc+" de Oans7 &a(o"o$!c (re'+!e s7 .!e d!s(!ns de @oc+" de Oans7 soc!a" O! de @oc+"
    de Oans7 &ro.es!on!s(. *oc+" de Oans7 soc!a" are "oc de re$+"7 c+ a%!c!! O! co"e$!! O!
    d+rea/7 o &er!oad7 "!%!(a(7 de (!%&, c+ &!erder! acce&(a'!"e &res(a'!"!(e. In @oc+" de
    Oans7 &ro.es!on!s(, r!sc+r!"e s+n( "!%!(a(e !ar d!sc!&"!na es(e cen(ra"7. Un!! !nd!v!/!
    &o( avea &ro'"e%e asoc!a(e c+ @oc+" "or de Oans7 Ede e<., co%&or(a%en( de +r%7r!re
    a rec+&er7r!! &!eder!"or &e (er%en sc+r( O! de &!erdere a con(ro"+"+!J care n+
    sa(!s.ace !n(e$ra" cr!(er!!"e &en(r+ @oc+" de Oans7 &a(o"o$!c.
    P!erderea @+dec7=!! O! +n @oc de Oans7 e<ces!v &o( s+rven! :n c+rs+" +n+! e&!sod
    %an!aca". Un d!a$nos(!c ad!=!ona" de @oc de Oans7 &a(o"o$!c (re'+!e &+s, n+%a!
    dac7 co%&or(a%en(+" de @oc de Oans7 n+ es(e e<&"!ca( %a! '!ne de e&!sod+"
    %an!aca" Ede e<., +n !s(or!c de @oc de Oans7 de/ada&(a(!v, a"(eor! decA( :n c+rs+" +n+!
    e&!sod %an!aca"J. Invers, +n !nd!v!d c+ @oc de Oans7 &a(o"o$!c &oa(e &re/en(a, :n
    c+rs+" +n+! @oc de Oans7 co%&+"s!v, +n co%&or(a%en( care a%!n(eO(e +n e&!sod
    %an!aca", :ns7, :nda(7 ce !nd!v!d+" se :nde&7r(ea/7 de @oc+" de Oans7, aces(e
    =G7 Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte
    e"e%en(e 0+as!%an!aca"e d!s&ar. Pro'"e%e c+ @oc+" de Oans7 &o( s+rven! s! "a
    !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"78 dac7 s+n( sa(!s.7c+(e cr!(er!!"e
    &en(r+ a%'e"e (+"'+r7r!, &o( .! d!a$nos(!ca(e a%'e"e.
    Criteriile $e $ia/no&ti# pentru
    4*C.4* Io#ul $e ?an&( Patolo/i#
    A2 omportament de(adaptativ de 0oc de ,ans persistent ,i recurent, dup
    cum este indicat de cinci &sau de mai multe) dintre urmtoareleD
    &E)este preocupat de 0ocul de ,ans &de ex2, este preocupat de retrirea
    experienelor de 0oc anterioare, de %andicap sau de plani$icarea ,ansei
    ori se !@nde,te la modalitile de procurare a banilor cu care s 0oace)3
    (2) necesit s 0oace cu sume cresc@nde de bani "n vederea obinerii excita
    iei dorite3
    (3) are repetate e$orturi in$ructuoase de a controla, reduce sau stopa 0ocul
    de ,ans3
    (4) este nelini,tit sau iritabil c@nd "ncearc s reduc sau s stope(e 0ocul de
    ,ans3
    (5) 0oac pentru a scpa de probleme ori pentru u,urarea unei dispo(iii dis$orice
    &de ex2, sentimente de vulnerabilitate, de culp, anxietate sau depresie)3
    (6) dup pierderea banilor la 0oc, revine "n alt (i pentru a recupera &=urm
    rirea recuperrii> propriilor pierderi)3
    (7) minte membrii $amiliei, pe terapeut sau pe alii, spre a ascunde dimen
    siunea implicrii "n 0ocul de ,ans patolo!ic3
    (8) a comis acte ile!ale, precum $alsul, $rauda, $urtul sau delapidarea, pentru
    a $inana 0ocul de ,ans3
    (9) a periclitat sau pierdut o relaie important, un post, ori o oportunitate
    educaional sau de carier din cau(a 0ocului de ,ans3
    &E5) se ba(ea( pe alii spre a procura banii necesari ie,irii dintr-o situaie
    $inanciar disperat cau(at de 0ocul de ,ans2
    S2 omportamentul 0ocului de ,ans nu este explicat mai bine de un episod
    maniacal2
    4*C.45 Tr.#otilo"ania
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (r!co(!"o%an!e! :" cons(!(+!e s%+"$erea rec+ren(7 a
    &ro&r!+"+! &7r, .a&( care d+ce "a o &!erdere cons!dera'!"7 a &7r+"+! Ecr!(er!+" AJ.
    Loc+r!"e de s%+"$ere a &7r+"+! &o( !nc"+de or!ce re$!+ne a cor&+"+! :n care cres(e
    &7r E!nc"+s!v re$!+n!"e a<!"ar7, &+'!an7 s! &er!ana"7J, ce"e %a! co%+ne "oc+r! .!!nd
    sca"&+", s&rAncene"e s! &"eoa&e"e. S%+"$erea &7r+"+! &oa(e s+rven! :n sc+r(e
    &er!oade d!s&ersa(e :n c+rs+" /!"e! or! :n &er!oade %a! rare, dar %a! s+s=!n+(e, care
    &o( con(!n+a (!%& de ore. :n %od .recven(, c!rc+%s(an=e"e s(resan(e cresc
    co%&or(a%en(+" de s%+"$ere a &7r+"+!, dar o creO(ere de s%+"$ere a &7r+"+! &oa(e
    s+rven!, de ase%enea, :n s(7r!"e de re"a<are s! de d!s(rac=!e Ede e<., cAnd c!(eO(e o
    4E7246
    Tricotilomania
    >85
    car(e sa+ &r!veO(e "a (e"ev!/orJ. O creO(ere a sen(!%en(+"+! de (ens!+ne es(e &re/en(7
    !%ed!a( :nan(ea s%+"$er!! &7r+"+! Ecr!(er!+" BJ. La +n!!, (ens!+nea n+ &recede :n
    %od necesar ac(+", c! es(e asoc!a(7 c+ (en(a(!ve"e de a re/!s(a dor!n=e!. E<!s(7
    $ra(!.!ca=!e, &"7cere sa+ +n sen(!%en( de +O+rare cAnd se s%+"$e &7r+" Ecr!(er!+" CJ.
    Un!! !nd!v!/! e<&er!en(ea/7 o sen/a=!e de S&r+r!(T "a n!ve"+" sca"&+"+!, care es(e
    +O+ra(7 &r!n ac(+" s%+"$er!! &7r+"+!. D!a$nos(!c+" n+ es(e &+s dac7 s%+"$erea
    &7r+"+! es(e e<&"!ca(7 %a! '!ne de a"(7 (+"'+rare %en(a"7 Ede e<., ca r7s&+ns "a o
    !dee de"!ran(7 sa+ "a o a"+c!na=!eJ or! se da(orea/7 +ne! cond!=!! %ed!ca"e $enera"e
    Ede e<., !n."a%area &!e"!! or! a"(e cond!=!! der%a(o"o$!ceJ Ecr!(er!+" DJ. Per(+r'area
    (re'+!e s7 ca+/e/e de(res7 sa+ de(er!orare se%n!.!ca(!v7 :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecr!(er!+" EJ.
    *lemente si tulburri asociate
    E"e%en(e descr!&(!ve s! (+"'+r7r! %en(a"e asoc!a(e. E<a%!narea r7d7c!n!!
    &7r+"+!, r7s+c!rea "+!, r+&erea O+v!=e"or de &7r :n(re d!n=! sa+ (r!co.a$!a E%Ancarea
    &7r+"+!J &o( s+rven! :%&re+n7 c+ (r!co(!"o%an!a. S%+"$erea &7r+"+! n+ are "oc de
    re$+"7 :n &re/en=a a"(or &ersoane Ec+ e<ce&=!a %e%'r!"or .a%!"!e! !%ed!a(eJ, !ar
    s!(+a=!!"e soc!a"e &o( .! ev!(a(e. Ind!v!/!! nea$7 de re$+"7 co%&or(a%en(+" "or av+"s!v
    s! asc+nd sa+ ca%+."ea/7 a"o&ec!a re/+"(a(7. Un!! !nd!v!/! a+ dor!n=a de a s%+"$e
    &7r+" a"(or &ersoane s! +neor! :ncearc7 s7 $7seasc7 oca/!! de a o .ace &e asc+ns. E!
    &o( s%+"$e &7r de "a an!%a"e"e de cas7, d!n &7&+O! or! d!n a"(e %a(er!a"e .!'roase
    Ede e<., d!n &+"over sa+ car&e(eJ. Roaderea +n$!!"or, sc7r&!na(+", ros+" s! e<cor!e4
    rea &o( .! asoc!a(e c+ (r!co(!"o%an!a. Ind!v!/!! c+ (r!co(!"o%an!e &o( avea, de
    ase%enea, (+"'+r7r! a.ec(!ve, (+"'+r7r! an<!oase E:n s&ec!a" (+"'+rare o'ses!vo4
    co%&+"4s!v7J (+"'+r7r! a"e +/+"+! +ne! s+'s(an=e, (+"'+r7r! de co%&or(a%en(
    a"!%en(ar, (+"'+r7r! de &ersona"!(a(e sa+ re(ard %en(a".
    Da(e de "a'ora(or asoc!a(e. An+%!(e da(e !s(o"o$!ce s+n( cons!dera(e
    carac(er!s(!ce O! &o( a@+(a "a &+nerea d!a$nos(!c+"+! cAnd es(e s+s&ec(a(7
    (r!co(!"o%an!a, !ar !nd!v!d+" nea$7 s!%&(o%e"e. Pro'e"e '!o&s!ce d!n ar!!"e !%&"!ca(e
    &o( reve"a &er! sc+r=! O! r+&=!. E<a%en+" !s(o"o$!c va reve"a .o"!c+"! &!"os! nor%a"!
    s! "e/a=! :n aceeaO! ar!e, &rec+% O! +n n+%7r cresc+( de &er! ca(a$en!. Un!! .o"!c+"!
    &!"os! &o( &re/en(a se%ne de (ra+%7 Er+$o/!(7=! a"e (ec!! e<(erne a r7d7c!n!!J.
    Fo"!c+"!! a.ec(a=! &o( .! v!/! sa+ &o( con=!ne +n %a(er!a" )era(!nos, !n(ens &!$%en(a(.
    A'sen=a !n."a%a=!e! d!s(!n$e a"o&ec!a !nd+s7 &r!n (r!co(!"o%an!e de a"o&ec!a area(7.
    Da(e"e e<a%!n7r!! so%a(!ce s! cond!=!!"e %ed!ca"e $enera"e asoc!a(e. D+rerea
    n+ es(e descr!s7 :n %od re$+"a( ca :nso=!nd s%+"$erea &7r+"+!8 &r+r!(+" O!
    .+rn!c7(+r!"e :n ar!!"e !%&"!ca(e &o( .! &re/en(e. Pa((ern+r!"e de &!erdere a &7r+"+!
    s+n( e<(re% de var!a'!"e. Ar!!"e de a"o&ec!e co%&"e(7 s+n( .recven(e, &rec+% O!
    ar!!"e de dens!(a(e no(a'!"7 a &er!"or s+'=!r!. CAnd es(e !%&"!ca( sca"&+", &oa(e e<!s(a
    o &red!"ec=!e &en(r+ re$!+n!"e &ar!e(a"e or! ver(e<. S+&ra.a=a sca"&+"+! n+ &re/!n(7
    de re$+"7 n!c! o &ro'7 de escor!a=!e. Poa(e e<!s(a +n &a((ern de ca"v!=!e a&roa&e
    co%&"e(7 c+ e<ce&=!a +n+! &er!%e(r+ :n$+s( :n @+r+" %ar$!n!! e<(erne a sca"&+"+! :n
    s&ec!a" "a cea.7 ES(ons+ra (r!co(!"o%an!c7TJ. S&rAncene"e O! $ene"e &o( .! co%&"e(
    a'sen(e. R7r!rea &er!"or &+'!en! &oa(e .! ev!den(7 "a !ns&ec=!e. Po( e<!s(a ar!! "!&s!(e
    de &7r &e %e%'re sa+ &e (r+nc!. Tr!co.a$!a &oa(e d+ce "a 'e/oar! Ecoco"oaOe de
    &7rJ care &o( &rovoca ane%!e, d+rere a'do%!na"7, e%a(e%e/7, $rea=7 s! vo%7,
    oc"+/!e O! c!ar &er.orarea !n(es(!n+"+!.
    >8> Tulburrile ontrolului Impulsului Feclasi$icate "n Alt #arte
    *lemente speci$ice culturii, etii si sexului
    Pr!n(re co&!! c+ (r!co(!"o%a%e, '7r'a=!! s! .e%e!"e s+n( e$a" re&re/en(a=! Pr!n(re
    ad+"=!, (nco(!"o%an!a es(e %+"( %a! .recven(7 "a .e%e! decA( "a '7r'a=! Aceas(a
    &oa(e re."ec(a adev7ra(a ra(7 a se<+"+!, a cond!=!e! or! &oa(e re."ec(a c7+(area
    (ra(a%en(+" d!.eren=!a" 'a/a( &e a(!(+d!n!"e c+"(+ra"e sa+ 'a/a( &e se< re.er!(oare "a
    as&ec( Ede e< , acce&(area +ne! &!erder! nor%a(!ve a &7r+"+! &r!n(re '7r'a=!J
    #revalent
    N+ s+n( d!s&on!'!"e n!c! +n .e" de da(e re.er!(oare "a &reva"en(a (nco(!"o%a%e!
    Ma! :na!n(e se credea c7 (nco(!"o%an!a es(e o cond!=!e rar7, ac+% :ns7 se cons!der7
    c7 s+rv!ne %a! .recven( De e<e%&"+, o ance(7 recen(e &e s(+den=!! de co"e$!+
    cons(a(7 o ra(7 &e v!a(7 de L,Rd
    *voluie
    Per!oade"e (ran/!(or!! de s%+"$ere a &7r+"+! d!n %!ca co&!"7r!e &o( .! cons!dera(e
    o Sa'!(+d!neT 'en!$n7 c+ o evo"+=!e a+(o%!(a(7 Ind!v!/a care &re/!n(7
    (r!co(!"o%an!e cron!c7 :n &er!oada ad+"(7 re"a(ea/7 adesea de'+(+" aces(e!a "a
    :nce&+(+" ado"escen(e! Un+ !nd!v!/! a+ s!%&(o%e con(!n+e (!%& de decade Pen(r+
    a"=!!, (+"'+rarea &oa(e a&are s! d!s&are d!n(r4o da(7, (!%& de s7&(7%An!, "+n! sa+ a%
    Sed!!"e s%+"$er!! &7r+"+! &o( vana :n dec+rs+" (!%&+"+!
    Dia!nostic di$erenial
    La !nd!v!/!! care nea$7 s%+"$erea &7r+"+!, (re'+!e "+a(e :n cons!dera=!e a"(e
    ca+/e de a"o&ec!e Ede e< , a"o&ec!a area(7, &a((ern+" de ca"v!(!e %asc+"!n7, "+&+s+"
    er!(e%a(os cron!c d!sco!d, "!cen+" &"an &!"ar, .o"!c+"!(a deca"van(7, &se+do&e"ada s!
    a"o&ec!a %+c%osaJ Un d!a$nos(!c se&ara( de (r!co(!"o%an!e n+ se &+ne, dac7
    co%&or(a%en(+" es(e e<&"!ca( %a! '!ne de o a"(7 (+"'+rare %en(a"7 Ede e<, ca
    r7s&+ns "a o !dee de"!ran(7 sa+ "a o a"+c!na=!e :n sc!/o.ren!eJ S%+"$erea re&e(a(7
    a &7r+"+! :n (r!co(!"o%an!e (re'+!e d!s(!ns7 de co%&+"s!e, ca :n (+"'+rarea o'ses!vo4
    co%&+"s!v7 :n (+"'+rarea o'ses!vo4co%&+"s!v7, co%&or(a%en(e"e re&e(!(!ve s+n(
    e.ec(+a(e ca r7s&+ns "a o o'ses!e or! con.or% +nor re$+"! care (re'+!e s7 .!e a&"!ca(e
    r!$!d Un d!a$nos(!c ad!=!ona" de (+"'+rare de %!Ocare s(ereo(!&7 n+ es(e &+s, dac7
    co%&or(a%en(+" re&e(!(!v es(e "!%!(a( "a s%+"$erea &7r+"+! A"o&ec!a
    a+(o&rovoca(7 d!n (r!co(!"o%an!e (re'+!e d!s(!ns7 de (+"'+rarea .ac(!ce c+ se%ne O!
    s!%&(o%e &redo%!nan( so%a(!ce :n care %o(!va=!a co%&or(a%en(+"+! o cons(!(+!e
    as+%area ro"+"+! de &ac!en(
    M+"=! !nd!v!/! :O! r7s+cesc s! se @oac7 c+ &7r+", :n s&ec!a" :n s(7r!"e de an<!e(a(e
    !n(ens7, dar aces( co%&or(a%en( n+ dese%nea/7 de re$+"7 &en(r+ d!a$nos(!c+" de
    (r!co(!"o%an!e Un+ !nd!v!/! se &o( &re/en(a c+ e"e%en(e de (r!co(!"o%an!e, dar
    a"(erarea &7r+"+! &oa(e .! a(A( de +Ooar7, c7 &rac(!c es(e %de(ec(a'!"7 :n as(.e" de
    s!(+a=!!, d!a$nos(!c+" (re'+!e "+a( :n cons!dera=!e n+%a! dac7 !nd!v!d+"
    e<&enen(ea/7 o de(res7
    !
    %&or(an(7 La co&!!, &er!oade"e a+(o"!%!(a(e de s%+"$ere
    a &7r+"+! s+n( .recven(e s! &o( .! cons!dera(e ca o Sa'!(+d!neT (e%&orar7 Aceas(7
    .or%7 de s%+"$ere a &7r+"+! a co&!"7r!e! d!.er7 de .or%e"e de (r!co(!"o%an!e a"e
    ad+"(+"+! &r!n aceea c7 &oa(e .! ra&or(a(7 (ens!+nea sa+ +O+rarea asoc!a(e c+
    s%+"$erea &7r+"+! De aceea, "a co&!!, d!a$nos(!c+" (re'+!e s7 .!e re/erva( &en(r+
    s!(+a=!!"e :n care co%&or(a%en(+" a &ers!s(a( %a! %+"(e "+n!
    4E7246
    Tricotilomania
    >88
    Criteriile $e $ia/no&ti# pentru 4*C.45 Tri#otilo"anie
    A2 Smul!erea recurent a propriului pr, duc@nd la o pierdere notabil a prului2
    S2 .n sentiment de tensiune cresc@nd imediat "naintea smul!erii prului ori
    c@nd "ncearc s re(iste comportamentului avulsiv2
    2 #lcere, !rati$icaie sau u,urare c@nd ",i smul!e prul2
    D2 #erturbarea nu este explicat mai bine de alt tulburare mental si nu se da
    torea( unei condiii medicale !enerale &de ex2, o condiie dermatolo!ic)2
    *2 #erturbarea cau(ea( o detres sau deteriorare semni$icativ clinic "n
    domeniul social, pro$esional sau "n alte domenii importante de $uncionare2
    4*C.4+ Tul-urarea Controlului I"pul&ului
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e des(!na(7 (+"'+r7r!"or con(ro"+"+! !%&+"s+"+! care n+
    sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare s&ec!.!c7 a con(ro"+"+! !%&+"s+"+! or!
    &en(r+ a"(7 (+"'+rare %en(a"7, avAnd e"e%en(e care !%&"!c7 con(ro"+" !%&+"s+"+!,
    descr!se :n a"(7 &ar(e :n %an+a" Ede e<., de&enden=a de o s+'s(an=7, o &ara.!"!eJ.

    Tulburrile de Adaptare
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" +ne! (+"'+r7r! de ada&(are :" cons(!(+!e r7s&+ns+"
    &s!o"o$!c "a +n s(resor !den(!.!ca'!" care d+ce "a a&ar!=!a +nor s!%&(o%e
    co%&or(a%en(a"e O! e%o=!ona"e se%n!.!ca(!ve c"!n!c Aces(e s!%&(o%e (re'+!e s7
    a&ar7 :n dec+rs de ; "+n! de "a de'+(+" s(resor+"+! Es(reson"orJ Ecr!(er!+" AJ
    Se%n!.!ca=!a c"!n!c7 a reac=!e! es(e !nd!ca(7 .!e de de(resa %arca(7 care es(e :n e<ces
    .a=7 de ceea ce ar .! de &rev7/+(, da(7 .+nd na(+ra s(resor+"+!, .!e de de(enorarea
    se%n!.!ca(!v7 :n .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7 EOco"ar7J Ecr!(er!+" BJ C+ a"(e
    c+v!n(e, o reac=!e "a +n s(resor care &oa(e .! cons!dera( nor%a" sa+ &rev!/!'!" &oa(e
    (o(+O! dese%na &en(r+ +n d!a$nos(!c de (+"'+rare de ada&(are, dac7 reac=!a es(e
    s+.!c!en( de sever7 &en(r+ a ca+/a o de(er!orare se%n!.!ca(!v7 Aceas(7 ca(e$or!e n+
    (re'+!e s7 .!e +(!"!/a(7 dac7 &er(+r'area sa(!s.ace cr!(er!!"e &en(r+ o a"(7 (+"'+rare de
    &e a<a I Ede e<, o (+"'+rare an<!oas7 sa+ a.ec(!v7 s&ec!.!c7J or! es(e n+%a! o
    e<acer'are a +ne! (+"'+r7r! &ree<!s(en(e &e a<a I sa+ II Ecr!(er!+" CJ C+ (oa(e
    aces(ea, o (+"'+rare de ada&(are &oa(e .! d!a$nos(!ca(7 :n &re/en=a a"(e! (+"'+r7r! de
    &e a<a I sa+ II, dac7 aceas(a d!n +r%7 n+ @+s(!.!c7 &a((ern+" de s!%&(o%e care a+
    a&7r+( ca r7s&+ns "a s(resor De ase%enea, d!a$nos(!c+" de (+"'+rare de ada&(are n+
    se a&"!c7 ar+nc! cAnd s!%&(o%e"e re&re/!n(7 do"!+" Ecr!(er!+" DJ Pr!n de.!n!=!e, o
    (+"'+rare de ada&(are (re'+!e s7 se re/o"ve :n dec+rs de R "+n! de "a (er%!narea
    s(resor+"+! Eor! a consec!n=e"or sa"eJ Ecr!(er!+" EJ S!%&(o%e"e &o( &ers!s(a :ns7, o
    &er!oad7 %a! "+n$7 de (!%& Ede e< , %a! "+n$7 de R "+n!J, dac7 a&ar ca r7s&+ns "a
    +n s(resor cron!c Ede e< , o cond!=!e %ed!ca"7 $enera"7 %ca&ac!(an(7, cron!c7J or! "a
    +n s(resor care are consec!n=e &ers!s(en(e Ede e< , d!.!c+"(7=! a.ec(!ve sa+ .!nanc!are
    re/+"(And d%(r4+n d!vor=J
    S(resor+" &oa(e .! +n s!n$+r even!%en( Ede e< , (er%!narea +ne! re"a=!!
    ro%an(!ceJ or! &o( e<!s(a s(resor! %+"(!&"! Ede e< , d!.!c+"(7=! :n a.acer! s! &ro'"e%e
    %ar!(a"e no(a'!"eJ S(resorn &o( .! rec+ren=! Ede e< , asoc!a=! c+ o cr!/7 se/on!er7 :n
    a.acer!J sa+ con(!n+! Ede e< , a "oc+! :n(r4+n car(!er do%!na( de !n.rac(or!J S(resorn
    &o( a.ec(a +n s!n$+r !nd!v!d, o :n(rea$7 .a%!"!e, +n $r+& %a! %are sa+ o
    co%+n!(a(e Ede e< , +n de/as(r+ na(+ra"J Un+ s(reson &o( aco%&an!a even!%en(e
    s&ec!.!ce de de/vo"(are Ede e<, %ers+" "a scoa"7, &"ecarea d!n casa &7r!n(easc7,
    c7s7(or!a, .a&(+" de a deven! &7r!n(e, !nca&ac!(a(ea de a4s! a(!n$e sco&+r!"e
    &ro.es!ona"e, &ens!onareaJ
    Subtipuri si speci$icanti
    T+"'+r7r!"e de ada&(are s+n( cod!.!ca(e con.or% s+'&+"+! care carac(er!/ea/7
    ce" %a! '!ne s!%&(o%e"e &redo%!nan(e
    ;LF.L C+ d!s&o/!=!e de&res!v7 Aces( s+'(!& (re'+!e +(!"!/a( cAnd
    %an!.es(7r!"e &redo%!nan(e s+n( s!%&(o%e &rec+% d!s&o/!=!a de&res!v7,
    &"Ans+" sa+ sen(!%en(e"e de d!s&erare
    >84
    RGL Tulburrile de Adaptare
    ;LF 9I C+ an<!e(a(e Aces( s+'(!& (re'+!e +(!"!/a( cAnd %an!.es(7r!"e
    &redo%!nan(e s+n( s!%&(o%e &rec+% nervo/!(a(ea, &reoc+&area sa+
    an<!e(a(ea or!, "a co&!!, .r!ca de se&arare de &ersoane"e de a(aOa%en( %a@or
    ;LF.9G C+ d!s&o/!=!e %!<(7 an<!oas7 s! de&res!v7 Aces( s+'(!& (re'+!e +(!"!/a(
    cAnd %an!.es(area &redo%!nan(7 es(e o co%'!na=!e de de&res!e s! an<!e(a(e
    ;LF.; C+ &er(+r'are de cond+!(7. Aces( s+'(!& (re'+!e +(!"!/a( cAnd
    %an!.es(area &redo%!nan(7 o cons(!(+!e o &er(+r'are de cond+!(7 :n care
    e<!s(7 v!o"area dre&(+r!"or a"(ora or! a re$+"!"or s! nor%e"or soc!a"e %a@ore
    cores&+n/7(oare e(7=!! Ede e<, c!+", vanda"!s%, cond+s ne$"!@en(, '7(7!,
    ne$"!@area res&onsa'!"!(7=!"or "e$a"eJ
    ;LF.I C+ &er(+r'area %!<(7 a e%o=!!"or s! cond+!(e! Aces( s+'(!& (re'+!e
    +(!"!/a( cAnd %an!.es(7r! &redo%!nan(e s+n(, a(A( s!%&(o%e e%o=!ona"e Ede
    e<, de&res!e, an<!e(a(eJ, cA( s! o &er(+r'are de cond+!(7 Eve/! s+'(!&+" &receden(J
    ;LF.F Nes&ec!.!ca( Aces( s+'(!& (re'+!e +(!"!/a( &en(r+ reac=!!"e de/ada&4
    (a(!ve Ede e<, ac+/e so%a(!ce, !/o"are soc!a"7, !n!'!=!e :n ac(!v!(a(ea
    &ro.es!ona"7 sa+ Oco"ar7J "a s(resorn &s!osoc!a"!, care n+ s+n( c"as!.!ca'!"e ca
    s+'(!&+n s&ec!.!ce de (+"'+rare de ada&(are
    D+ra(a s!%&(o%e"or +ne! (+"'+r7r! de ada&(are &oa(e .! !nd!ca(7 &r!n a"e$erea
    +n+!a d!n(re +r%7(or!! s&ec!.!can(!
    Ac+(a. Aces( s&ec!.!can( &oa(e .! +(!"!/a( &en(r+ a !nd!ca &ers!s(en=a
    s!%&(o%e"or &en(r+ %a! &+=!n de R "+n!
    Cron!c7. Aces( s&ec!.!can( &oa(e .! +(!"!/a( &en(r+ a !nd!ca &ers!s(en(a
    s!%&(o%e"or (!%& de R "+n! sa+ %a! %+"( Pr!n de.!n!=!e, s!%&(o%e"e n+ &o(
    &ers!s(a %a! %+"( de R "+n! d+&7 (er%!narea s(resor+"+! sa+ consec!n=e"or
    sa"e S&ec!.!can(+" Scron!cT se a&"!c7 a(+nc! cAnd d+ra(a &er(+r'7r!! es(e %a!
    "+n$7 de R "+n!, ca r7s&+ns "a +n s(resor cron!c sa+ "a +n s(resor care are
    consec!n=e &ers!s(en(e
    #rocedee de "nre!istrare
    Pre/en(area s!%&(o%+"+! &redo%!nan( &en(r+ o (+"'+rare de ada&(are (re'+!e
    s7 .!e !nd!ca(7 &r!n a"e$erea cod+"+! s! (er%en+"+! d!a$nos(!c d!n "!s(a de %a! s+s,
    +r%a(7, dac7 se doreO(e, de s&ec!.!can(+" de ac+( sa+ cron!c Ede e< , ;LF O T+"'+rare
    de ada&(are c+ d!s&o/!=!e de&res!v7, ac+(7J :n(r4o eva"+are %+"(!a<!a"7, na(+ra
    s(resor+"+! &oa(e .! !nd!ca(7 &r!n %en=!onarea "+! &e a<a I3 Ede e< , d!vor=J
    *lemente si tulburri asociate
    De(resa s+'!ec(!v7 sa+ de(er!orarea :n .+nc=!onare asoc!a(7 c+ (+"'+r7r!"e de
    ada&(are se %an!.es(7 .recven( ca red+cere a &er.or%an(e! :n ac(!v!(a(ea
    &ro.es!ona"7 sa+ Oco"ar7 s! %od!.!c7r! (e%&orare :n re"a=!!"e soc!a"e T+"'+r7r!"e de
    ada&(are s+n( asoc!a(e c+ +n r!sc cresc+( de (en(a(!ve de s+!c!d s! de s+!c!d co%&"e(,
    +/ e<ces!v de o s+'s(an=7 s! ac+/e so%a(!ce T+"'+rarea de ada&(are a .os( ra&or(a(7
    s! "a !nd!v!/!! c+ (+"'+r7r! %en(a"e &ree<!s(en(e d!n eOan(!oane se"ec(a(e, c+% ar .!
    co&!! s! ado"escen=!! s! &ac!en=!! c!r+r$!ca"! s! %ed!ca"! $enera"! Pre/en(a +ne!
    (+"'+r7r! de ada&(are &oa(e co%&"!ca evo"+=!a %a"ad!e! "a !nd!v!/!! care a+ o
    cond!=!e %ed!ca"7 $enera"7 Ede e<, red+ce co%&an(a "a re$!%+" %ed!ca"
    reco%anda( or! cres(e "+n$!%ea Oeder!! :n s&!(a"J
    Tulburrile de
    Adaptare
    I8E
    *lemente speci$ice culturii, etii si sexului
    Con(e<(+" %ed!+"+! c+"(+ra" a" !nd!v!d+"+! (re'+!e s7 .!e "+a( :n cons!dera=!e :n
    e.ec(+area @+dec7=!! c"!n!ce, dac7 r7s&+ns+" !nd!v!d+"+! "a s(resor es(e
    de/ada&(a(!v sa+ dac7 de(resa asoc!a(7 es(e :n e<ces .a=7 de ceea ce ar .! de
    an(!c!&a(. Na(+ra, se%n!.!ca=!a s! e<&er!en(area s(resor+"+!, O! eva"+area
    r7s&+ns+"+! "a s(resor! &oa(e var!a :n d!verse"e c+"(+r!. T+"'+r7r!"e de ada&(are
    &o( s+rven! "a or!ce $r+&7 de e(a(e. In esan(!oane"e c"!n!ce de ad+"=!, .e%e!"e s+n(
    d!a$nos(!ca(e de do+7 or! %a! .recven( decA( '7r'a=!!. D!n con(ra, :n esan(!oane"e
    c"!n!ce de co&!! s! ado"escen=!, '7!e=!! s! .e(e"e es(e &os!'!" s7 &r!%easc7 aces(
    d!a$nos(!c :n e$a"7 %7s+r7.
    #revalent
    T+"'+r7r!"e de ada&(are s+n( d+&7 cA( se &are .recven(e, deO! ra(e"e de
    &reva"en(7 var!a/7 "ar$ :n .+nc=!e de &o&+"a=!a s(+d!a(7 s! de %e(ode"e de
    eva"+are +(!"!/a(e. Preva"en(a (+"'+r7r!! de ada&(are a .os( ra&or(a(7 ca .!!nd :n(re
    9d s! Gd :n esan(!oane"e co%+n!(are de co&!! s! ado"escen=! &rec+% s! "a ce! %a!
    :n e(a(e. T+"'+rarea de ada&(are a .os( d!a$nos(!ca(7 :n &An7 "a 59d d!n(re
    &ac!en=!! !n(erna=! :n s&!(a"e"e $enera"e care s+n( (r!%!O! &en(r+ +n cons+"(
    &s!!a(r!c, :n 5Ld4;Ld d!n(re ce! d!n serv!c!!"e de s7n7(a(e %en(a"7 a%'+"a(or!!, s!
    :n n+ %a! &+=!n de YLd d!n &o&+"a=!a care a e<&er!en(a( +n s(resor s&ec!.!c Ede e<.,
    +r%And +ne! !n(erven=!! c!r+r$!ca"e &e cordJ. Ind!v!/!! c+ c!rc+%s(an=e de v!a=7
    de/avan(a@oase e<&er!en(ea/7 +n &rocen( r!d!ca( de s(resor! s! &o( .! e<&+O! +n+!
    r!sc cresc+( &en(r+ (+"'+rare.
    *voluie
    Pr!n de.!n!=!e, &er(+r'area :n (+"'+rarea de ada&(are :nce&e :n dec+rs de ; "+n!
    de "a de'+(+" s(resor+"+! O! n+ d+rea/7 %a! %+"( de R "+n! d+&7 ce s(resor+" sa+
    consec!n=e"e sa"e a+ :nce(a(. Dac7 s(resor+" es(e +n even!%en( ac+( Ede e<., a .! da(
    a.ar7 d!n serv!c!+J, de'+(+" (+"'+r7r!! es(e de re$+"7 !%ed!a( Eor! :n dec+rs de
    cA(eva /!"eJ, !ar d+ra(a es(e re"a(!v sc+r(7 Ede e<., n+ %a! %+"( de cA(eva "+n!J. Dac7
    s(resor+" sa+ consec!n=e"e sa"e &ers!s(7, (+"'+rarea de ada&(are &oa(e, de
    ase%enea, &ers!s(a. Pers!s(en=a (+"'+r7r!! de ada&(are sa+ &ro$res!+nea sa s&re
    a"(e (+"'+r7r! %en(a"e %a! severe Ede e<., (+"'+rare de&res!v7 %a@or7 J es(e %a!
    &os!'!"7 "a co&!! O! ado"escen=! decA( "a ad+"=!. O &ar(e sa+ :n(re$+" r!sc cresc+(
    &oa(e .! a(r!'+!( :ns7 .&re/en=e! cond!=!!"or co%or'!de Ede e<., (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!eJ sa+ &os!'!"!(7=!! ca (+"'+rarea de ada&(are s7
    re&re/!n(e :n rea"!(a(e o %an!.es(are &rodro%a"7 s+'c"!n!c7 a +ne! (+"'+r7r!
    %en(a"e %a! severe.
    Dia!nostic di$erenial
    T+"'+rarea de ada&(are es(e o ca(e$or!e re/!d+a"7 +(!"!/a(7 &en(r+ a descr!e
    (a'"o+r!"e c"!n!ce care s+n( +n r7s&+ns "a +n s(resor !den(!.!ca'!" s! care n+ sa(!s.ac
    cr!(er!!"e &en(r+ o a"(7 (+"'+rare s&ec!.!c7 de &e a<a I. De e<e%&"+, dac7 +n !nd!v!d
    are s!%&(o%e care sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or ca r7s&+ns "a
    +n s(resor, d!a$nos(!c+" de (+"'+rare de ada&(are n+ es(e a&"!ca'!". T+"'+rarea de
    ada&(are &oa(e .! d!a$nos(!ca(7 :n &"+s &e "An$7 a"(7 (+"'+rare %en(a"7 de &e a<a I,
    >=2 Tulburrile de Adaptare
    n+%a! dac7 aceas(a d!n +r%7 n+ e<&"!c7 s!%&(o%e"e &ar(!c+"are care a&ar ca reac=!e
    "a s(resor. De e<e%&"+, +n !nd!v!d &oa(e &re/en(a o (+"'+rare de ada&(are c+
    d!s&o/!=!e de&res!v7 d+&7 &!erderea serv!c!+"+!, dar :n ace"aO! (!%& s7 a!'7 +n
    d!a$nos(!c de (+"'+rare o'ses!vo4co%&+"s!v7.
    Deoarece (+"'+r7r!"e de &ersona"!(a(e s+n( .recven( e<acer'a(e de s(res,
    d!a$nos(!c+" ad!=!ona" de (+"'+rare de ada&(are de re$+"7 n+ es(e &+s. Dac7 :ns7
    s!%&(o%e"e care n+ s+n( carac(er!s(!ce (+"'+r7r!! de &ersona"!(a(e a&ar ca r7s&+ns
    "a +n s(esor Ede e<., o &ersoan7 c+ (+"'+rare de &ersona"!(a(e &arano!d7 &re/!n(7
    d!s&o/!=!e de&res!v7 ca r7s&+ns "a &!erderea serv!c!+"+!J, d!a$nos(!c+" ad!=!ona" de
    (+"'+rare de ada&(are &oa(e .! !nd!ca(.
    D!a$nos(!c+" de (+"'+rare de ada&(are neces!(7 &re/en=a +n+! s(resor
    !den(!.!ca'!", con(rar (a'"o+r!"or c"!nce a(!&!ce sa+ s+'"!%!na"e care vor .!
    d!a$nos(!ca(e ca (+"'+rare .7r7 a"(7 s&ec!.!ca=!e Ede e<., (+"'+rarea an<!oas7 .7r7
    a"(7 s&ec!.!ca=!eJ. Dac7 s!%&(o%e"e de (+"'+rare de ada&(are &ers!s(7 %a! %+"( de
    R "+n! d+&7 ce s(resor+" sa+ consec!n=e"e sa"e a+ :nce(a(, d!a$nos(!c+" (re'+!e
    sc!%'a( c+ ce" a" a"(e! (+"'+r7r! %en(a"e, de re$+"7 d!n ca(e$or!a .7r7 a"(7
    s&ec!.!ca=!e.
    T+"'+rarea de ada&(are, s(res+" &os((ra+%a(!c s! s(res+" ac+( neces!(7, (oa(e,
    &re/en=a +n+! s(resor &s!osoc!a". S(res+" &os((ra+%a(!c s! s(res+" ac+( se
    carac(er!/ea/7 &r!n &re/en=a +n+! s(resor e<(re% s! a +ne! cons(e"a=!! s&ec!.!ce de
    s!%&(o%e. D!n con(ra, (+"'+rarea de ada&(are &oa(e .! dec"anOa(7 de s(resor! de
    or!ce sever!(a(e O! &oa(e !%&"!ca o "ar$7 ser!e de s!%&(o%e &os!'!"e.
    In .ac(or!! &s!o"o$!c! care a.ec(ea/7 cond!=!a %ed!ca"7, s!%&(o%e"e
    &s!o"o$!ce s&ec!.!ce, co%&or(a%en(e"e or! a"=! .ac(or! e<acer'ea/7 o cond!=!e
    %ed!ca"7 $enera"7, co%&"!c7 (ra(a%en(+" +ne! cond!=!! %ed!ca"e $enera"e or! cresc
    r!sc+" a&ar!=!e! +ne! cond!=!! %ed!ca"e $enera"e, :n (+"'+rarea de ada&(are, re"a=!a
    es(e !nvers7 Ead!c7, s!%&(o%e"e &s!o"o$!ce a&ar ca r7s&+ns "a s(res+" de a avea sa+
    de a .! d!a$nos(!ca( c+ o cond!=!e %ed!ca"7 $enera"7J. La +n!! !nd!v!/!, &o( .! &re/en(e
    a%'e"e cond!=!!.
    Do"!+" es(e d!a$nos(!ca( :n $enera" :n "oc+" (+"'+r7r!! de ada&(are cAnd reac=!a
    es(e +n r7s&+ns e<&ec(a'!" "a %oar(ea +ne! .!!n=e !+'!(e. D!a$nos(!c+" de (+"'+rare
    de ada&(are &oa(e .! !nd!ca( cAnd reac=!a es(e :n e<ces sa+ %a! &re"+n$!(7 decA( ar .!
    de aO(e&(a(. T+"'+rarea de ada&(are (re'+!e s7 .!e d!s(!ns7, de ase%enea, de a"(e
    reac=!! non&a(o"o$!ce "a s(res, care n+ d+c "a o derres7 %arca(7, :n e<ces .a=7 de ceea
    ce es(e de &rev7/+(, s! care n+ ca+/ea/7 o de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea
    soc!a"7 sa+ &ro.es!ona"7. T+"'+rarea de ada&(are n+ (re'+!e s7 .!e d!a$nos(!ca(7
    cAnd s!%&(o%e"e se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ec+% ar .! de(er!orarea .+nc=!ona"7 (ran/!(or!e care es(e asoc!a(7
    c+ c!%!o(era&!a Ed!n c+rs+" c!%!o(era&!e!J.
    Tulburrile de
    Adaptare
    >=+
    Criteriile $e $ia/no&ti# pentru Tul-ur(rile $e A$aptare
    A2 Apariia de simptome emoionale sau comportamentale ca rspuns la &un)
    stresor&i) identi$icabil&i) survenind "n decurs de 4 luni de la debutul
    stresorului &stresorilor)2
    S2 Aceste simptome sau comportamente sunt semni$icative clinic, dup cum
    este evideniat de oricare dintre urmtoareleD
    (1) detres marcat, care este "n exces $a de ceea ce ar $i de a,teptat de
    la
    expunerea la stresor3
    (2) deteriorare semni$icativ "n $uncionarea social sau pro$esional
    &,colar)2
    2 #erturbarea "n le!tur cu stresul nu satis$ace criteriile pentru alt tulburare
    speci $ i c de pe axa l ,i nu est e doar o exacerbare a unei tul burri
    preexistente de pe axa l sau axa II2
    D2 Simptomele nu repre(int doliul2
    *2 Odat ce stresorul &sau consecinele sale) a disprut, simptomele nu persist
    timp de mai mult de I luni2
    De speci"icat dac D
    AcutD dac perturbarea durea( mai puin de I luni3
    ronicD dac perturbarea durea( I luni sau mai mult2
    Tulburrile de adaptare sunt codi$icate pe ba(a subtipului care este selectat
    dup simptomele predominante2 Stresorul sau stresorii speci$ici pot $i
    menionai pe axa IV2
    4+5.+ Cu $i&po)i!ie $epre&iv(
    4+5.C7 Cu an,ietate
    4+5.C> Cu $i&po)i!ie "i,t( an,ioa&( Ei $epre&iv(
    309.3Cu pertur-are $e #on$uit(
    309.4Cu pertur-are "i,t( $e e"o!ii Ei #on$uit(
    4+5 Ne&pe#i%i#at(

    Tulburrile de #ersonalitate
    ceas(a sec=!+ne :nce&e c+ o de.!n!=!e $enera"7 a (+"'+r7r!! de &ersona"!(a(e
    care se a&"!c7 .!ec7re!a d!n(re ce"e 5L (+"'+r7r! de &ersona"!(a(e s&ec!.!ce O
    (+"'+rare de &ersona"!(a(e es(e +n &a((ern d+ra'!" de e<&er!en=7 !n(ern7 s! de
    co%&or(a%en( care dev!a/7 cons!dera'!" de "a cerer!"e c+"(+r!! !nd!v!d+"+!, es(e
    &ervas!v s! !n."e<!'!", are de'+(+" :n ado"escen(7 sa+ &recoce :n &er!oada ad+"(7,
    es(e s(a'!" :n c+rs+" (!%&+"+! s! d+ce "a de(res7 sa+ de(enorare T+"'+r7r!"e de
    &ersona"!(a(e !nc"+se :n aceas(7 sec=!+ne s+n( %en=!ona(e %a! @os
    T+"'+rarea de &ersona"!(a(e &arano!d7 es(e +n &a((ern de ne:ncredere s!
    s+s&!c!+ne, !n(en=!!"e a"(ora .+nd !n(er&re(a(e ca r7+vo!(oare
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 es(e +n &a((ern de de(aOare de re"a=!!"e
    soc!a"e s! o $a%7 res(rAns7 de e<&res!e e%o=!ona"7
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 es(e +n &a((ern de d!sco%.or( ac+( :n
    re"a=!!"e !n(!%e, de d!s(ors!+n! co$n!(!ve sa+ &erce&(+a"e s! e<cen(r!c!(7=! de
    co%&or(a%en(
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7 es(e +n &a((ern de descons!derare s! de
    v!o"are a dre&(+r!"or a"(ora
    T+"'+rarea de &ersona"!(a(e 'order"%e es(e +n &a((ern de !ns(a'!"!(a(e :n
    re"a=!!"e &ersona"e, !%a$!nea de s!ne s! a.ec(e, s! de !%&+"s!v!(a(e %arca(7
    T+"'+rarea de &ersona"!(a(e !s(r!on!c7 es(e +n &a((ern de e%o=!ona(a(e
    e<ces!v7 s! de c7+(are a a(en=!e!
    T+"'+rarea de &ersona"!(a(e narc!s!s(!c7 es(e +n &a((ern de $randoare,
    neces!(a(e de ad%!ra=!e s! "!&s7 de e%&ae
    T+"'+rarea de &ersona"!(a(e ev!(an(7 es(e +n &a((ern de !n!'!=!e soc!a"7, de
    sen(!%en(e de %adecvare s! de !&ersens!'!"!(a(e "a eva"+area ne$a(!v7
    T+"'+rarea de &ersona"!(a(e de&enden(7 es(e +n &a((ern de co%&or(a%en(
    s+'%!s!v s! de aderen(7 :n "e$7(+r7 c+ neces!(a(ea e<ces!v 7 de a .! &ro(e@a( de c!neva
    T+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7 es(e +n &a((ern de
    &reoc+&are de ord!ne, &er.ec(!on!s% s! con(ro"
    T+"'+rarea de &ersona"!(a(e .7r7 a"(7 s&ec!.!ca=!e es(e o ca(e$or!e &rev7/+(7
    &en(r+ do+7 s!(+a=!! 5J &a((ern+" de &ersona"!(a(e a" !nd!v!d+"+! sa(!s.ace cr!(er!!"e
    $enera"e &en(r+ o (+"'+rare de &ersona"!(a(e, dar s+n( &re/en(e (r7s7(+r! a"e %a!
    %+"(or (+"'+r7r! de &ersona"!(a(e, :ns7 n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ n!c! o
    (+"'+rare de &ersona"!(a(e s&ec!.!c7, 9J &a((ern+" de &ersona"!(a(e a" !nd!v!d+"+!
    sa(!s.ace cr!(er!!"e $enera"e &en(r+ o (+"'+rare de &ersona"!(a(e, dar !nd!v!d+" es(e
    cons!dera( a avea o (+"'+rare de &ersona"!(a(e care n+ es(e !nc"+s7 :n c"as!.!care Ede
    e< , (+"'+rarea de &ersona"!(a(e &as!v4a$res!v7J
    T+"'+r7r!"e de &ersona"!(a(e s+n( :%&7r=!(e :n (re! $r+&e &e 'a/a s!%!"!(+d!n!"or
    descr!&(!ve ,r+&a A !nc"+de (+"'+r7r!"e de &ersona"!(a(e &arano!d7, sc!/o!d7 s!
    sc!/o(!&a"7 Ind!v!/!! c+ aces(e (+"'+r7r! a&ar adesea ca '!/ar! sa+ e<cen(r!c! ,r+&a
    B !nc"+de (+"'+r7r!"e de &ersona"!(a(e an(!soc!a"7 'order"%e, !s(r!on!c7 '!
    narc!s!s(!c7 Ind!v!/!! c+ aces(e (+"'+r7r! a&ar adesea ca (ea(ra"!, e%o=!ona"! or!
    RGY
    >=> Tulburrile de #ersonalitate
    e<(ava$an(! ,r+&a C !nc"+de (+"'+r7r!"e de &ersona"!(a(e ev!(an(7, de&enden(7 s!
    o'ses!vo4co%&+"s!v7 Ind!v!/!! c+ aces(e (+"'+r7r! a&ar adesea ca an<!os! s! .r!coO!
    Tre'+!e %en=!ona( c7 aces( s!s(e% de $r+&are, deO! +(!" :n +ne"e s!(+a=!! de cerce(are
    s! ed+ca=!ona"e, are "!%!(e ser!oase s! n+ a .os( &e de&"!n va"!da( :n a.ar7 de aceas(a,
    !nd!v!/!! &re/!n(7 .recven( conco%!(en( (+"'+r7r! de &ersona"!(a(e d!n d!.er!(e $r+&e
    *lemente de dia!nostic
    Tr6s6t+rile de personalitate s+n( &a((ern+n d+ra'!"e de &erce&ere, re"aonare s!
    $And!re des&re a%'!an(7 s! s!ne :ns+O!, care s+n( %an!.es(a(e :n(r4o $a%7 "ar$7 de
    con(e<(e soc!a"e s! &ersona"e N+%a! cAnd (r7s7(+r!"e de &ersona"!(a(e s+n( !n."e<!'!"e
    s! de/ada&(a(!ve, s! ca+/ea/7 de(enorare .+nc=!ona"7 sa+ de(res7 s+'!ec(!v7
    se%n!.!ca(!v7 cons(!(+!e (+"'+r7r! de &ersona"!(a(e E"e%en(+" esen=!a" a" +ne! (+"'+r7r!
    de &ersona"!(a(e :" cons(!(+!e +n &a((ern d+ra'!" de e<&er!en=7 !n(erna s! de
    co%&or(a%en( care dev!a/7 cons!dera'!" de "a cer!n=e"e c+"(+r!! !nd!v!d+"+! s! se
    %an!.es(7 :n ce" &+=!n do+7 d!n +r%7(oare"e do%en!! c+noaO(ere, a.ec(!v!(a(e,
    .+nc=!onare %(er&ersona"7 or! con(ro" a" !%&+"s+"+! Ecr!(er!+" AJ Aces( &a((ern d+ra'!"
    es(e !n."e<!'!" s! &ervas!v, :n ra&or( c+ o $a%7 "ar$7 de s!(+7r!! &ersona"e s! soc!a"e
    Ecr!(er!+" BJ, s! d+ce "a de(res7 sa+ de(enorare se%n!.!ca(!v7 c"!n!c :n do%en!+" soc!a",
    &ro.es!ona" sa+ :n a"(e do%en!! !%&or(an(e de .+nc=!onare Ecn(en+" CJ Pa((ern+" es(e
    s(a'!" s! de "+n$7 d+ra(7, !ar de'+(+" s7+ &oa(e .! (rasa( re(ros&ec(!v ce" &+=!n &An7 :n
    ado"escen(7 sa+ :nce&+(+" &enoade! ad+"(e Ecn(en+" DJ Pa((ern+" n+ es(e e<&"!ca( %a!
    '!ne ca %an!.es(are sa+ consec!n=7 a a"(e! (+"'+r7n %en(a"e Ecn(en+" EJ s! n+ se
    da(orea/7 cor!scan(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e Ede e<, +n dro$ de a'+/
    +n %ed!ca%en(, e<&+ne!e "a +n (o<!cJ on a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<,
    +n (ra+%a(!s% cran!anJ Ecn(en+" FJ Pen(r+ .!ecare (+"'+rare de &ersona"!(a(e !nc"+s7
    :n aceas(7 sec=!+ne s+n( &rev7/+(e de ase%enea, cn(en! de d!a$nos(!c s&ec!.!ce I(e%n
    d!n se(+r"e de cr!(er!! a"e .!ec7re! Ma"'+r7n de &ersona"!(a(e s&ec!.!ce s+n( %en=!ona=!
    % ord!nea descrescAnd7 a !%&or(an(e! d!a$nos(!ce %7s+ra(7 &nn da(e re"evan(e
    des&re e.!c!en(a d!a$nos(!c7 EcAnd s+n( d!s&on!'!"eJ
    D!a$nos(!c+" de (+"'+rare de &ersona"!(a(e neces!(7 o eva"+are a &a((ern+n"or de
    .+nc=!onare a"e !nd!v!d+"+! &e (er%en "+n$, !ar e"e%en(e"e de &ersona"!(a(e
    &ar(!c+"are (re'+!e s7 .!e %an!.es(e de "a :nce&+(+" &enoade! ad+"(e Tr7s7(+r!"e de
    &ersona"!(a(e care de.!resc aces(e (+"'+r7r! (re'+!e, de ase%enea, d!s(!nse de
    carac(er!s(!c!"e care a&ar ca r7s&+ns "a s(resor! s!(+a(!ona s&ec!.!c! sa+ de s(7r!
    %en(a"e (ran/!(or!! Ede e<, r+"'+r7n"e a.ec(!ve sa+ an<!oase, !n(o<!ca=!a c+ o
    s+'s(an=7J C"!n!c!an+" (re'+!e s7 eva"+e/e s(a'!"!(a(ea (r7s7(+r!"or de &ersona"!(a(e
    :n dec+rs+" (!%&+"+! s! :n ra&or( c+ d!verse s!(+a=!! DeO! +neor! es(e s+.!c!en( +n
    s!n$+r !n(erv!+ c+ &ersoana &en(r+ a &+ne d!a$nos(!c+", adesea es(e necesar %a!
    %+"( decA( +n s!n$+r !n(erv!+ s! d!s(an(7 :n(re e"e :n (!%& Eva"+area &oa(e .!
    co%&"!ca(7, de ase%enea, de .a&(+" c7 e"e%en(e"e carac(ens(!ce care de.!nesc
    (+"'+rarea de &ersona"!(a(e &o( s7 n+ .!e cons!dera(e &ro'"e%a(!ce de c7(re !nd!v!d
    Ead!c7, (r7s7(+r!"e s+n( e$os%(on!ceJ Pen(r+ a a@+(a "a de&7O!rea aces(e! d!.!c+"(7=!,
    &o( .! +(!"e !n.or%a=!! s+&"!%en(are de "a a"=! !n.or%a(or!
    #rocedee de "nre!istrare
    T+"'+r7r!"e de &ersona"!(a(e s+n( cod!.!ca(e &e a<a II CAnd &a((ern+" de
    co%&or(a%en( a" +n+! !nd!v!d sa(!srace cr!(er!!"e &en(r+ %a! %+"( decA( o s!n$+r7
    (+"'+rare de &ersona"!(a(e EaOa c+% es(e adesea ca/+"J, c"!n!c!an+" (re'+!e s7
    Tulburrile de
    #ersonalitate
    =>G
    %en=!one/e (oa(e d!a$nos(!ce"e de (+"'+rare de &ersona"!(a(e re"evan(e, :n ord!nea
    !%&or(an=e!. CAnd o (+"'+rare de &e a<a I n+ es(e d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+"
    cons+"(a=!e!, c"!n!c!an+" es(e :nc+ra@a( s7 !nd!ce care (+"'+rare de &ersona"!(a(e es(e
    d!a$nos(!c+" &r!nc!&a" sa+ %o(!v+" cons+"(a=!e! &r!n no(area Sd!a$nos(!c &r!nc!&a"T
    or! S%o(!v+" cons+"(a=!e!T :n &aran(e/7, :n ce"e %a! %+"(e ca/+r!, d!a$nos(!c+"
    &r!nc!&a" sa+ %o(!v+" cons+"(a=!e! es(e, de ase%enea, cen(r+" a(en=!e! sa+
    (ra(a%en(+"+!. T+"'+rarea de &ersona"!(a(e .7r7 a"(7 s&ec!.!ca=!e es(e d!a$nos(!c+"
    cores&+n/7(or &en(r+ o &re/en(are S%!<(7T :n care n+ s+n( sa(!s.7c+(e cr!(er!!"e
    &en(r+ n!c! o (+"'+rare de &ersona"!(a(e, s!n$+r7, dar s+n( &re/en(e e"e%en(e a"e %a!
    %+"(or (+"'+r7r! de &ersona"!(a(e s! co%&or(7 o de(er!orare se%n!.!ca(!v7 c"!n!c.
    Tr7s7(+r!"e de &ersona"!(a(e de/ada&(!ve s&ec!.!ce care n+ sa(!s.ac &ra$+" &en(r+ o
    (+"'+rare de &ersona"!(a(e &o( .!, de ase%enea, %en=!ona(e &e a<a II. :n as(.e" de
    ca/+r!, n+ (re'+!e s7 .!e +(!"!/a( n!c! +n cod s&ec!.!c8 c"!n!c!an+", de e<., &oa(e :nre$!s(ra
    SA<a IIQ 3H5.LF. N!c! +n d!a$nos(!c &e a<a II, (r7s7(+r! !s(r!on!ce de &ersona"!(a(eT.
    U/+" an+%!(or %ecan!s%e de a&7rare &oa(e .!, de ase%enea, !nd!ca( &e a<a II. De
    e<e%&"+, c"!n!c!an+" &oa(e :nre$!s(ra SA<a IIQ ;L5.R T+"'+rare de &ersona"!(a(e
    de&enden(78 +/ .recven( de ne$areT. ,"osar+" de de.!n!=!! a"e %ecan!s%e"or de
    a&7rare s&ec!.!ce s! sca"a de .+nc=!onare de.ens!v7 a&ar :n ane<a B E&a$. G5LJ.
    CAnd +n !nd!v!d are o (+"'+rare &s!o(!c7 cron!c7 &e a<a I Ede e<., sc!/o.ren!eJ
    care a .os( &receda(7 de o (+"'+rare de &ersona"!(a(e &ree<!s(en(7 Ede e<., sc!/o!d7,
    sc!/o(!&a"7 sa+ &arano!d7J, (+"'+rarea de &ersona"!(a(e (re'+!e :nre$!s(ra(7 &e a<a
    II, +r%a(7 de S&re%or'!dT :n &aran(e/7. De e<e%&"+, a<a IQ 9FY.;L Sc!/o.ren!e de
    (!& &arano!d8 a<a IIQ ;L5.9L T+"'+rare de &ersona"!(a(e sc!/o!d7 E&re%or'!dJ.
    *lemente speci$ice culturii, etii si sexului
    *+dec7=!"e re.er!(oare "a .+nc=!onarea &ersona"!(7=!! (re'+!e s7 !a :n cons!dera=!e
    .ond+" e(n!c, c+"(+ra" s! soc!a" a" !nd!v!d+"+!. T+"'+rarea de &ersona"!(a(e n+ (re'+!e
    s7 .!e con.+nda(7 c+ &ro'"e%e"e asoc!a(e c+ ac+"r+ra=!a +r%And !%!$r7r!! or! c+
    e<&r!%area de a'!(+d!n!, c+(+%e or! va"or! re"!$!oase sa+ &o"!(!ce &ro.esa(e :n
    c+"(+ra de or!$!ne a !nd!v!d+"+!, :n s&ec!a", cAnd se eva"+ea/7 c!neva d!n(r4+n .ond
    d!.er!(, es(e +(!" &en(r+ c"!n!can s7 o'=!n7 !n.or%a=!! de "a !n.or%a(or! .a%!"!ar!/a=!
    c+ .ond+" c+"(+ra" a" &ersoane!.
    Ca(e$or!!"e de (+"'+r7r! de &ersona"!(a(e &o( .! a&"!ca(e "a co&!! O! ado"escen=! :n
    ace"e ca/+r!, re"a(!v rare, :n care an+%!(e (r7s7(+r! de/ada&(a(!ve de &ersona"!(a(e
    &ar a .! &ervas!ve, &ers!s(en(e s! es(e !%&ro'a'!" c7 vor .! "!%!(a(e "a +n an+%!(
    s(ad!+ de de/vo"(are or! "a +n e&!sod a" +ne! (+"'+r7r! de &e a<a I. Tre'+!e O(!+( c7
    (r7s7(+r!"e de &ersona"!(a(e care a&ar :n co&!"7r!e n+ &ers!s(7 adesea nesc!%'a(e :n
    v!a=a ad+"(7. Pen(r+ a d!a$nos(!ca o (+"'+rare de &ersona"!(a(e "a +n !nd!v!d s+' 5G
    an!, (r7s7(+r!"e (re'+!e s7 .! .os( &re/en(e de ce" &+=!n " an. S!n$+ra e<ce&=!e de "a
    aceas(a o cons(!(+!e (+"'+rarea de &ersona"!(a(e an(!soc!a"7, care n+ &oa(e .!
    d!a$nos(!ca(7 "a !nd!v!/!! s+' 5G an! Eve/! &a$. HL5J. DeO!, &r!n de.!n!=!e, o (+"'+rare
    de &ersona"!(a(e neces!(7 +n de'+( n+ %a! (Ar/!+ de :nce&+(+" &er!oade! ad+"(e,
    !nd!v!/!! &o( s7 n+ v!n7 &en(r+ e<a%en c"!n!c decA( re"a(!v (Ar/!+ :n v!a=7. O
    (+"'+rare de &ersona"!(a(e &oa(e .! e<acer'a(7 d+&7 &!erderea +nor &ersoane de
    s+&or( !%&or(an(e Ede e<., so=!a Xso=+"XJ or! a +nor s!(+a=!! soc!a"e s(a'!"e an(er!or
    Ede e<., serv!c!+"J, :n or!ce ca/, a&ar!=!a +ne! %od!.!c7r! de &ersona"!(a(e "a %!@"oc+"
    &er!oade! ad+"(e or! %a! (Ar/!+ :n v!a=7 @+s(!.!c7 o eva"+are co%&"e(7 &en(r+ a
    &rec!/a &re/en=a &os!'!"7 a +ne! %od!.!c7r! de &ersona"!(a(e da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e or! a +ne! (+"'+r7r! nerec+nosc+(e :n "e$7(+r7 c+ o s+'s(an=7.
    =>> Tulburrile de #ersonalitate
    An+%!(e (+"'+r7r! de &ersona"!(a(e Ede e<., (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7J s+n( d!a$nos(!ca(e %a! .recven( "a '7r'a=!. A"(e"e Ede e<., (+"'+r7r!"e de
    &ersona"!(a(e 'order"!ne, !s(r!on!c7 s! de&enden(7J s+n( d!a$nos(!ca(e %a! .recven(
    "a .e%e!. DeO! aces(e d!.eren=e :n &reva"en(7 re."ec(7 &ro'a'!" d!.eren=e"e rea"e d!n(re
    se<e s+' ra&or(+" &re/en=e! +nor as(.e" de &a((ern+r!, c"!n!c!en!! (re'+!e s7 .!e a(en=!
    s7 n+ s+&ra4 sa+ s+'d!a$nos(!ce/e an+%!(e (+"'+r7r! de &ersona"!(a(e "a .e%e! sa+
    "a '7r'a=! d!n ca+/a s(ereo(!&+r!"or soc!a"e re.er!(oare "a ro"+r!"e s! co%&or(a%en(e"e
    (!&!ce se<+"+!.
    *voluie
    E"e%en(e"e +ne! (+"'+r7r! de &ersona"!(a(e dev!n ev!den(e de re$+"7 :n c+rs+"
    ado"escen=e! sa+ "a :nce&+(+" v!e=!! ad+"(e. Pr!n de.!n!=!e, o (+"'+rare de
    &ersona"!(a(e es(e +n &a((ern d+ra'!" de $And!re, V!%=!re s! co%&or(are re"a(!v s(a'!"
    :n dec+rs+" (!%&+"+!. Une"e (!&+r! de (+"'+rare de &ersona"!(a(e E:n s&ec!a",
    (+"'+r7r!"e de &ersona"!(a(e an(!soc!a"7 s! 'order"!neJ (!nd a deven! %a! &+=!n
    ev!den(e or! a se re%!(e c+ e(a(ea, &e cAnd &en(r+ +ne"e d!n(re ce"e"a"(e (!&+r!,
    aceas(a &are a .! %a! &+=!n adev7ra( Ede e<., (+"'+r7r!"e de &ersona"!(a(e o'ses!vo4
    co%&+"s!v7 O! sc!/o(!&a"7J.
    Dia!nostic di$erenial
    M+"(e d!n(re cr!(er!!"e s&ec!.!ce &en(r+ (+"'+r7r!"e de &ersona"!(a(e descr!+
    e"e%en(e Ede e<., s+s&!c!o/!(a(e, de&enden=7 or! !nsens!'!"!(a(eJ care s+n(
    carac(er!s(!ce, de ase%enea, e&!soade"or de (+"'+r7r! %en(a"e de &e a<a L O
    (+"'+rare de &ersona"!(a(e (re'+!e d!a$nos(!ca(7 n+%a! cAnd carac(er!s(!c!"e
    de.!n!(or!! a&ar :na!n(ea :nce&+(+"+! &er!oade! ad+"(e, s+n( (!&!ce &en(r+
    .+nc=!onarea &e (er%en "+n$ a !nd!v!d+"+!, s! n+ s+rv!n :n %od e<c"+s!v :n (!%&+"
    +n+! e&!sod a" +ne! (+"'+r7r! de &e a<a I. Poa(e .! e<(re% de d!.!c!" Edar n+ s! e<(re%
    de +(!"J s7 se d!s(!n$7 (+"'+r7r!"e de &ersona"!(a(e de ce"e de &e a<a I Ede e<.,
    (+"'+rarea d!s(!%!c7J care a+ +n de'+( &recoce s! o evo"+=!e cron!c7, re"a(!v s(a'!"7.
    Une"e (+"'+r7r! de &ersona"!(a(e &o( avea +n Ss&ec(r+T de re"a=!e c+ an+%!(e
    cond!=!! de &e a<a I Ede e<., (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7, c+ sc!/o.ren!a8
    (+"'+rarea de &ersona"!(a(e ev!(an(7, c+ .o'!a soc!a"7J, 'a/a( &e s!%!"!(+d!n!
    .eno%eno"o$!ce sa+ '!o"o$!ce or! &e a$re$are .a%!"!a"7.
    Pen(r+ ce"e (re! (+"'+r7r! de &ersona"!(a(e care &o( .! :n "e$7(+r7 c+ (+"'+r7r!"e
    &s!o(!ce Ead!c7, &arano!d7, sc!/o!d7 s! sc!/o(!&a"7J, e<!s(7 +n cr!(er!+ de
    e<c"+dere s(a(+And c7 &a((ern+" de co%&or(a%en( n+ (re'+!e s7 .! a&7r+( e<c"+s!v
    :n c+rs+" sc/o.ren!e!, a" +ne! (+"'+r7r! a.ec(!ve c+ e"e%en(e &s!o(!ce or! a" a"(e!
    (+"'+r7r! &s!o(!ce. CAnd +n !nd!v!d are o (+"'+rare &s!o(!c7 &e a<a I Ede e<.,
    sc!/o.ren!eJ care a .os( &receda(7 de o (+"'+rare de &ersona"!(a(e &ree<!s(en(7,
    (+"'+rarea de &ersona"!(a(e (re'+!e, de ase%enea, s7 .!e :nre$!s(ra(7 &e a<a II,
    +r%a(7 de S&re%or'!dT :n &aran(e/7.
    C"!n!c!an+" (re'+!e s7 .!e a(en( "a d!a$nos(!carea (+"'+r7r!"or de &ersona"!(a(e :n
    c+rs+" +n+! e&!sod a" +ne! (+"'+r7r! a.ec(!ve or! a" +ne! (+"'+r7r! an<!oase, &en(r+
    c7 aces(e cond!=!! &o( avea &e sec=!+ne (ransversa"7 e"e%en(e care %!%ea/7
    (r7s7(+r!"e de &ersona"!(a(e, s! &o( .ace s! %a! d!.!c!" de eva"+a( re(ros&ec(!v
    &a((ern+r!"e de .+nc=!onare &e (er%en "+n$ a"e !nd!v!d+"+!. CAnd %od!.!c7r!"e de
    &ersona"!(a(e a&ar s! &ers!s(7 d+&7 ce +n !nd!v!d a .os( e<&+s "a +n s(res e<(re%,
    (re'+!e "+a( :n cons!dera=!e d!a$nos(!c+" de s(res &os((ra+%a(!c Eve/! &a$. IR;J.
    Modelele dimensionale pentru Tulburrile de #ersonalitate I86
    CAnd o &ersoan7 are o (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7, es(e !%&or(an( s7 n+
    se &+n7 d!a$nos(!c+" de (+"'+rare de &ersona"!(a(e n+%a! &e 'a/a
    co%&or(a%en(e"or care s+n( consec!n=e a"e !n(o<!ca=!e! sa+ a's(!nen=e! de o
    s+'s(an=7, or! care s+n( asoc!a(e c+ ac(!v!(7=! :n serv!c!+" s+s=!ner!! +ne!
    de&enden=e Ede e<., co%&or(a%en(+" an(!soc!a"J. CAnd %od!.!c7r!"e d+ra'!"e de
    &ersona"!(a(e a&ar ca re/+"(a( a" e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ede e<., o (+%or7 cere'ra"7J, (re'+!e s7 .!e "+a( :n cons!dera=!e +n
    d!a$nos(!c de %od!.!care de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e
    E&a$. 5GHJ.
    T+"'+r7r!"e de &ersona"!(a(e (re'+!e s7 .!e d!s(!nse de (r7s7(+r!"e de &ersona"!(a(e
    care n+ a(!n$ &ra$+" &en(r+ o (+"'+rare de &ersona"!(a(e. Tr7s7(+r!"e de
    &ersona"!(a(e s+n( d!a$nos(!ca(e ca (+"'+rare de &ersona"!(a(e n+%a! cAnd s+n(
    !n."e<!'!"e, de/ada&(a(!ve s! &ers!s(en(e, s! ca+/ea/7 o de(er!orare .+nc=!ona"7 sa+
    de(res7 s+'!ec(!v7 se%n!.!ca(!v7.
    Criteriile $e $ia/no&ti# pentru o Tul-urare $e Per&onalitate
    A2 .n pattern durabil de experien intern ,i de comportament care devia(
    considerabil de la cerinele culturii individului2 Acest pattern se mani$est "n
    dou &sau mai multe) din urmtoarele domeniiD
    (1) cunoa,tere &adic modurile de a se percepe ,i interpreta pe sine,
    alte
    persoane ,i evenimentele)3
    (2) a$ectivitate &adic, !ama, intensitatea, labilitatea si adecvareT rspunsului
    emoional)32
    (1) $uncionare interpersonal3
    (2) controlul impulsului2
    S2 #atternul durabil este in$lexibil ,i pervasiv "n raport cu o !am lar! de
    situaii personale ,i sociale2
    2 #atternul durabil duce la o detres sau deteriorare semni$icativ clinic "n do
    meniul social, pro$esional ori "n alte domenii importante de $uncionare2
    D2 #atternul este stabil ,i de lun! durat, iar debutul su poate $i trasat
    retrospectiv cel puin p@n "n adolescen sau la "nceputul perioadei adulte2
    *2 #atternul durabil nu este explicat mai bine ca mani$estare sau consecin a
    unei alte tulburri mentale2
    '2 #atternul durabil nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    substane &de ex2, un dro! de abu(, un medicament) sau ale unei condiii
    medicale !enerale &de ex2, traumatism cranian)
    Mo$elele $i"en&ionale pentru
    Tul-ur(rile $e Per&onalitate
    A'ordarea d!a$nos(!c7 +(!"!/a(7 :n aces( %an+a" re&re/!n(7 &ers&ec(!va
    ca(e$or!a"7, con.or% c7re!a (+"'+r7r!"e de &ersona"!(a(e re&re/!n(7 s!ndro%e c"!n!ce
    ca"!(a(!v d!s(!nc(e. O a"(erna(!v7 "a a'ordarea ca(e$or!a"7 o cons(!(+!e &ers&ec(!va
    d!%ens!ona"7, con.or% c7re!a (+"'+r7r!"e de &ersona"!(a(e re&re/!n(7 var!an(e
    RFL Tulburrile de #ersonalitate
    de/ada&(a(!ve a"e (r7s7(+r!"or de &ersona"!(a(e care (rec !%&erce&(!'!" :n
    nor%a"!(a(e, &rec+% s! +na :n(r4a"(a. A+ e<!s(a( %+"(e (en(a(!ve d!.er!(e de a
    !den(!.!ca ce"e %a! .+nda%en(a"e d!%ens!+n! care se a."7 "a 'a/a :n(re$+"+!
    do%en!+ a" .+nc=!on7r!! &ersona"!(7=!! nor%a"e s! &a(o"o$!ce. Un %ode" cons(7 d!n
    +r%7(oare"e c!nc! d!%ens!+n!Q ne+ro(!c!s%, !n(rovers!+ne vers+s e<(rovers!+ne,
    :nc!dere vers+s desc!dere "a e<&er!en=7, an(a$on!s% vers+s concordan=7, s!
    conO(!!nc!o/!(a(e. A"(7 a'ordare cons(7 :n a descr!e do%en!! %a! s&ec!.!ce de
    d!s.+nc=!e a &ersona"!(7=!! !nc"+/And n+ %a! &+=!n de 5Y4IL de d!%ens!+n! Ede e<.,
    reac(!v!(a(e a.ec(!v7, a&erens!+ne soc!a"7, d!s(ors!+ne co$n!(!v7, !%&+"s!v!(a(e,
    nes!ncer!(a(e, a+(os+.!c!en=7J. A"(e %ode"e d!%ens!ona"e care a+ .os( &ro&+se
    !nc"+d a.ec(!v!(a(ea &o/!(!v7, a.ec(!v!(a(ea ne$a(!v7 s! cons(rAn$erea, c7+(area
    no+(7=!!, de&enden=a de reco%&ens7, ev!(area &re@+d!c!er!!, cons(an=a,
    a+(ocond+cerea, coo&erarea s! a+(ode&7s!rea8 &+(erea Edo%!nare vers+s s+&+nereJ
    s! a.!"!ere E!+'!re vers+s +r7J8 c7+(area &"7cer!! vers+s ev!(area d+rer!!, aco%odare
    &as!v7 vers+s %od!.!care ac(!v7 s! a+(o!ns(r+!re vers+s a"(7 ed+ca=!e. ,r+&e"e de
    (+"'+r7r! de &ersona"!(a(e d!n DSM4I3 Ead!c7, '!/ar4e<cen(r!c7, dra%a(!c4
    e%o=!ona"7 s! an<!os4(e%7(oareJ &o( .! v7/+(e, de ase%enea, s! ca as&ec(e a"e
    d!s.+nc=!e! &ersona"!(7=!! &e +n con=!n+(+r! c+ (+"'+r7r!"e %en(a"e de &e a<a I.
    Mode"e d!%ens!ona"e a"(erna(!ve a+ %+"(e :n co%+n s! :%&re+n7 &ar a aco&er!
    do%en!! !%&or(an(e a"e d!s.+nc=!e! &ersona"!(7=!!. In(e$rarea, +(!"!(a(ea c"!n!c7 s!
    re"a=!!"e "or c+ ca(e$or!!"e d!a$nos(!ce de (+"'+rare de &ersona"!(a(e s! c+ d!verse"e
    as&ec(e a"e d!s.+nc=!e! &ersona"!(7=!! r7%An s+' o !nves(!$a=!e ac(!v7.
    Tul-ur(rile $e Per&onalitate $in Grupa A
    4+*.+ Tul-urarea $e Per&onalitate Paranoi$(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e &arano!de :" cons(!(+!e +n
    &a((ern de ne:ncredere s! s+s&!c!+ne &ervas!v7 .a=7 de a"=!!, as(.e" c7 !n(en=!!"e
    aces(ora s+n( !n(er&re(a(e ca r7+vo!(oare. Aces( &a((ern :nce&e &recoce :n &er!oada
    ad+"(7 s! es(e &re/en( :n(r4o var!e(a(e de con(e<(e.
    Ind!v!/!! c+ aceas(7 (+"'+rare &res+&+n c7 a"=! oa%en! :! vor e<&"oa(a, "e/a sa+
    :nOe"a, c!ar dac7 n+ e<!s(7 n!c! o &ro'7 care s7 s+s=!n7 aceas(7 &res+&+nere
    Ecr!(er!+" A"J. E! s+s&ec(ea/7, &e 'a/a a .oar(e &+=!ne da(e or! .7r7 n!c! o &ro'7, c7
    a"=!! co%&"o(ea/7 con(ra "or s!4! &o( a(aca 'r+sc, or!cAnd s! .7r7 %o(!v. S!%( adesea
    c7 a+ .os( &ro.+nd s! !revoca'!" &re@+d!c!a=! de o a"(7 &ersoan7 sa+ &ersoane, c!ar
    cAnd n+ e<!s(7 n!c! o &ro'7 o'!ec(!v7 &en(r+ aceas(a. E! s+n( &reoc+&a=! de d+'!!
    ne@+s(!.!ca(e re.er!(oare "a "o!a"!(a(ea O! corec(!(+d!nea a%!c!"or s! asoc!a=!"or "or, a"e
    c7ror ac=!+n! s+n( scr+(a(e con(!n++ &en(r+ de%ons(rarea !n(en=!!"or os(!"e Ecr!(er!+"
    A9J. Or!ce a'a(ere &erce&+(7 de "a corec(!(+d!ne O! "o!a"!(a(e serveO(e "a s+s=!nerea
    s+&o/!=!!"or "or .+nda%en(a"e. E! s+n( a(A( de s+r&r!nO! cAnd +n a%!c sa+ asoc!a( "e
    ara(7 "o!a"!(a(e, c7 n+ "e v!ne s7 cread7 aceas(a. CAnd se a."7 :n d!.!c+"(a(e, se
    aO(ea&(7 ca a%!c!! sa+ asoc!a=!! "or s74! a(ace sa+ s74! !$nore.
    Ind!v!/!! c+ aceas(7 (+"'+rare re.+/7 s7 a!'7 :ncredere sa+ s7 .!e %a! a&ro&!a=! de
    a"=!! &en(r+ c7 se (e% c7 !n.or%a=!!"e &e care "e :%&7r(7Oesc a"(ora vor .! +(!"!/a(e
    45E25 Tulburarea de #ersonalitate
    #aranoid
    >41

    con(ra "or Ecr!(er!+" A;J. E! &o( re.+/a s7 r7s&+nd7 "a :n(re'7r!"e re.er!(oare "a
    &ersoana "or, s&+nAnd c7 !n.or%a=!a cer+(7 es(e o Sces(!+ne &ersona"7T. 37d
    se%n!.!ca=!! de$radan(e sa+ a%en!n=7(oare :n ce"e %a! 'en!$ne re%arc! sa+
    even!%en(e Ecr!(er!+" AIJ. De e<e%&"+, +n !nd!v!d c+ aceas(7 (+"'+rare &oa(e
    !n(er&re(a .a"s o eroare !nocen(7 a +n+! vAn/7(or d!n(r4+n %a$a/!n dre&( o (en(a(!v7
    de"!'era(7 de a n+4! da res(+", or! &oa(e vedea :n(r4o re%arc7 co%!c7 oca/!ona"7 a
    +n+! co"a'ora(or, +n a(ac c+ carac(er $rav. Co%&"!%en(e"e s+n( adesea !n(er&re(a(e
    erona( Ede e<., +n co%&"!%en( re.er!(or "a o ac!/!=!e es(e !n(er&re(a( :n %od erona(
    ca o cr!(!c7 &en(r+ e$o!s%8 +n co%&"!%en( re.er!(or "a o rea"!/are es(e !n(er&re(a( :n
    %od erona( dre&( o :ncercare de a45 o'"!$a "a o .+nc=!onare O! %a! '+n7J. Po( vedea
    o o.er(7 de a@+(or, dre&( o cr!(!c7 a .a&(+"+! c7 e! n+ .ac s+.!c!en( de '!ne ceea ce
    (re'+!e s7 .ac7.
    Ind!v!/!! c+ aceas(7 (+"'+rare &oar(7 (o( (!%&+" &!c7 O! n+ +!(7 !ns+"(e"e, !n@+r!!"e
    or! o.ense"e &e care cred c7 "e4a+ &r!%!( Ecr!(er!+" YJ. O.ense %!nore da+ naO(ere "a
    os(!"!(a(e %a@or7, sen(!%en(e"e de os(!"!(a(e &ers!s(And %+"( (!%&. Pen(r+ c7 e! s+n(
    (o( (!%&+" a(en=! "a !n(en=!!"e &re@+d!c!an(e a"e a"(ora, .oar(e adesea e! s!%( c7
    &ersoana sa+ re&+(a=!a "or a .os( a(aca(7, or! c7 a+ .os( o.ensa=! :n(r4+n %od
    oarecare. S+n( &ro%&=! :n a con(raa(aca sa+ :n a reac=!ona co"eros "a !ns+"(e"e
    &erce&+(e Ecr!(er!+" ARJ. Persoane"e c+ aceas(7 (+"'+rare &o( .! $e"oase &a(o"o$!c,
    s+s&ec(And adesea so=!aE+"J or! &ar(eneraE+"J se<+a"E7J de !n.!de"!(a(e, .7r7 n!c! +n
    %o(!v Ecr!(er!+" AHJ. Po( s(rAn$e S&ro'eT 'ana"e O! c!rc+%s(an=!a"e &en(r+ a4O!
    s+s=!ne conv!n$er!"e de $e"o/!e. S+'!ec=!! doresc s7 %en=!n7 +n con(ro" co%&"e(
    as+&ra re"a=!!"or !n(!%e s&re a ev!(a s7 .!e :nOe"a=! s! se :n(rea'7 O! se .r7%An(7 (o(
    (!%&+" :n "e$7(+r7 c+ "oc+r!"e +nde se a."7, c+ ac=!+n!"e, !n(en=!!"e O! .!de"!(a(ea so=!e!
    Eso=+"+!J sa+ &ar(enere! E&ar(ener+"+!J.
    T+"'+rarea de &ersona"!(a(e &arano!d7 n+ (re'+!e s7 .!e d!a$nos(!ca(7, dac7
    &a((ern+" de co%&or(a%en( s+rv!ne e<c"+s!v :n c+rs+" sc!/o.ren!e!, a" +ne!
    (+"'+r7r! a.ec(!ve c+ e"e%en(e &s!o(!ce or! a" a"(e! (+"'+r7r! &s!or!ce, sa+ dac7 se
    da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! ne+ro"o$!ce or! a"(e! cond!=!!
    %ed!ca"e $enera"e Ede e<., e&!"e&s!a "o'+"+! (e%&ora"J Ecr!(er!+" BJ.
    *lemente ,i tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e &arano!d7 s+n( :n $enera" d!.!c!"! :n a se
    :n=e"e$e c+ a"=!! s! a+ adesea &ro'"e%e :n re"a=!!"e !n(!%e. S+s&!c!o/!(a(ea O!
    os(!"!(a(ea "or e<ces!v7 se &o( e<&r!%a &r!n cer(+r! :n &+'"!c, &ro(es(e re&e(a(e or!
    &r!n(r4o de(aOare ca"%7, ev!den( os(!"7. Deoarece s+n( .oar(e a(en=! "a even(+a"e"e
    a%en!n=7r!, e! &o( ac=!ona :n %od &r+den(, secre( sa+ !nd!rec(, s! &ar a .! Srec!T s!
    "!&s!=! de sen(!%en(e (andre. DeO! &ar a .! o'!ec(!v!, ra=!ona"! O! !nsens!'!"!, e! &re/!n(7
    adesea o $a%7 de a.ec(e "a'!"e :n care &redo%!n7 e<&res!!"e os(!"e, o's(!na(e O!
    sarcas(!ce. Na(+ra "or co%'a(!v7 O! s+s&!c!oas7 &oa(e &rovoca +n r7s&+ns os(!" "a
    a"=!!, ceea ce serveO(e "a con.!r%area s+s&!c!+n!"or "or &r!%are.
    Deoarece !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e &arano!d7 s+n( "!&s!=! de
    :ncredere :n a"=!!, e! a+ o neces!(a(e cresc+(7 de !nde&enden=7 O! +n sen(!%en(
    &+(ern!c de a+(ono%!e. Neces!(7 a avea, de ase%enea, +n $rad cresc+( de con(ro"
    as+&ra ce"or d!n @+r+" "or. E! s+n( adesea r!$!/!, cr!(!c! .a=7 de a"=!!, !nca&a'!"! s7
    co"a'ore/e, c+ (oa(e c7 e! :nO!O! a+ %ar! d!.!c+"(7=! :n a acce&(a cr!(!ca. Po( '"a%a &e
    a"=!! &en(r+ &ro&r!!"e "or de.!c!en=e. D!n ca+/a &ro%&(!(+d!n!! "or de a con(raa(aca,
    dre&( r7s&+ns "a a%en!n=7r!"e &e care Ie &erce& :n @+r, e! &o( .! "!(!$!os! O! s+n(
    !%&"!ca=! .recven( :n d!s&+(e "e$a"e. Ind!v!/!! c+ aceas(7 (+"'+rare ca+(7 O74O!
    RF9 Tulburrile de #ersonalitate
    con.!r%e !de!"e ne$a(!ve &reconce&+(e des&re oa%en!! sa+ s!(+a=!!"e c+ care se
    con.r+n(7, a(r!'+!nd !n(en=!! r7+vo!(oare a"(ora, aces(ea .!!nd &ro!ec(area &ro&r!!"or
    "or .r!c!. E! &re/!n(7 adesea .an(e/!! de $randoare nerea"!s(e, +Oor asc+nse, se &+n
    adesea de acord c+ &ro'"e%e"e de &+(ere s! ran$, s! (!nd s7 de/vo"(e s(ereo(!&+r!
    ne$a(!ve .a=7 de a"=!!, :n s&ec!a" .a=7 de ace"e $r+&+r! de &o&+"a=!! d!s(!nc(e de ce"e
    a"e "or. A(raO! de .or%+"7r! s!%&"!s(e a"e "+%!!, e! se (e% adesea de s!(+a=!!"e
    a%'!$+!. Po( .! &erce&+=! ca S.ana(!c!T s! .or%ea/7 Sc+"(eT sa+ $r+&+r! s(rAns +n!(e
    c+ a"=!! care :%&7r(7Oesc s!s(e%e"e "or de conv!n$er! &arano!de.
    :n s&ec!a" ca r7s&+ns "a s(res, !nd!v!/!! c+ aceas(7 (+"'+rare &o( e<&er!en=a sc+r(e
    e&!soade &s!o(!ce Ed+rAnd %!n+(e sa+ oreJ, :n +ne"e ca/+r!, (+"'+rarea de
    &ersona"!(a(e &arano!d7 &oa(e a&are ca an(eceden( &re%or'!d a" (+"'+r7r!! de"!ran(e
    sa+ a" sc!/o.ren!e!. Ind!v!/!! c+ aceas(7 (+"'+rare &o( &re/en(a (+"'+rare de&res!v7
    %a@or7, &rec+% s! +n r!sc cresc+( &en(r+ a$ora.o'!e s! (+"'+rarea o'ses!vo4
    co%&+"s!v7. S+rv!n .recven( a'+/+" sa+ de&enden=a de a"coo" sa+ de a"(7 s+'s(an=7.
    Ce"e %a! .recven(e (+"'+r7r! de &ersona"!(a(e conco%!(en(e &ar a .! ce"e sc!/o(!&a"7,
    sc!/o!d7, narc!s!s(!c7, ev!(an(7 s! 'order"!ne.
    *lemente speci$ice culturii, etii si sexului
    Une"e co%&or(a%en(e, care s+n( !n."+en=a(e de con(e<(e"e soc!oc+"(+ra"e sa+ de
    an+%!(e c!rc+%s(an=e de v!a=7, &o( .! e(!ce(a(e :n %od erona( ca &arano!de s! c!ar
    &o( .! :n(7r!(e de c7(re &roces+" de eva"+are c"!n!c7. Me%'r!! $r+&+r!"or %!nor!(are,
    !%!$ran=!!, re.+$!a=!! &o"!(!c! s! econo%!c! or! !nd!v!/!! d!n .ond+r! c+"(+(a"e d!.er!(e
    &o( &re/en(a co%&or(a%en(e de.ens!ve sa+ &r+den(e da(ora(e non.a%!"!ar!(7=!! Ede
    e<., 'ar!ere "!n$v!s(!ce sa+ "!&sa de c+noaO(ere a re$+"!"or s! re$"e%en(7r!"orJ, or! ca
    r7s&+ns "a ne$"!@en=a sa+ !nd!.eren=a &erce&+(7 d!n &ar(ea soc!e(7=!! %a@or!(are.
    Aces(e co%&or(a%en(e &o(, :n sc!%', $enera !r!(are s! .r+s(rare "a ce! care se oc+&7
    de aceO(! !nd!v!/!, de(er%!nAnd dec! +n cerc v!c!os de ne:ncredere rec!&roc7 O! care
    n+ (re'+!e con.+nda( c+ (+"'+rarea de &ersona"!(a(e &arano!d7. Une"e $r+&+r!
    e(n!ce &re/!n(7, de ase%enea, co%&or(a%en(e :n "e$7(+r7 c+ c+"(+ra care &o( .!
    !n(er&re(a(e :n %od erona( ca &arano!de.
    T+"'+rarea de &ersona"!(a(e &arano!d7 &oa(e .! ev!den(7 :nc7 d!n co&!"7r!e sa+
    ado"escen=7 &r!n so"!(ar!s%, re"a=!! red+se c+ e$a"!!, an<!e(a(e soc!a"7, &er.or%an=7
    Oco"ar7 red+s7, !&ersens!'!"!(a(e, !dea=!e O! "!%'a@ '!/ar, s! .an(e/!! !d!os!ncra(!ce.
    AceO(! co&!! &o( a&are ca S'!/ar!T sa+ Se<cen(r!c!T O! a(ra$ !ron!!, :n eOan(!oane"e
    c"!n!ce, (+"'+rarea &are a .! d!a$nos(!ca(7 %a! .recven( "a '7r'a=!.
    #revalent
    Preva"en(a (+"'+r7r!! de &ersona"!(a(e &arano!d7 a .os( ra&or(a(7 a .! de
    L,Yd49,Yd :n &o&+"a=!a $enera"7, de 5Ld4;Ld &r!n(re ce! d!n +n!(7=!"e &s!!a(r!ce c+
    !n(ernare "a &a( s! de 9d45Ld &r!n(re ce! d!n c"!n!c!"e de s7n7(a(e %en(a"7 c+
    &ac!en=! a%'+"a(or!.
    #attern $amilial
    E<!s(7 +ne"e &ro'e de &reva"en(7 cresc+(7 a (+"'+r7r!! de &ersona"!(a(e
    &arano!d7 &r!n(re r+de"e &ro'an/!"or c+ sc!/o.ren!e cron!c7 s! de o re"a=!e .a%!"!a"7
    %a! s&ec!.!c7 c+ (+"'+rarea de"!ran(7, (!& de &ersec+=!e.
    45E O Tulburarea de #ersonalitate
    #aranoid
    >4+
    Dia!nostic di$erenial
    T+"'+rarea de &ersona"!(a(e &arano!d7 &oa(e .! d!s(!ns7 de tulburarea delirant2
    tip de persecu3ie2 de sc-izofrenia paranoid si de tulburarea afectiv cu elemente
    psi-otice2 deoarece (oa(e aces(e (+"'+r7r! s+n( carac(er!/a(e &r%(r4o &er!oad7 de
    s!%&(o%e &s!o(!ce &ers!s(en(e Ede e< , !de! de"!ran(e s! a"+c!na=!!J Pen(r+ a &+(ea
    &+ne d!a$nos(!c+" ad!=!ona" de (+"'+rare de &ersona"!(a(e &arano!d7, (+"'+rarea de
    &ersona"!(a(e (re'+!e s7 .! .os( &re/en(7 an(er!or de'+(+"+! s!%&(o%e"or &s!o(!ce s!
    s7 &ers!s(e d+&7 re%!s!+nea aces(ora CAnd +n !nd!v!d are &e a<a I o (+"'+rare
    &s!o(!c7 Ede e< , sc!/o.ren!eJ, care a .os( &receda(7 de (+"'+rarea de &ersona"!(a(e
    &arano!d7, (+"'+rarea de &ersona"!(a(e &arano!d7 (re'+!e s7 .!e :nre$!s(ra(7 &e a<a
    II, +r%a(7 de S&re%or'!dT :n &aran(e/7
    T+"'+rarea de &ersona"!(a(e &arano!d7 (re'+!e s7 .!e d!s(!ns7 de modificarea de
    personalitate datorat unei condi3ii medicale .enerale2 :n care (r7s7(+r!"e a&ar d%
    ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+! nervos
    cen(ra" Ea (re'+!e d!s(!ns7, de ase%enea, de simptomele care pot apare @n asociere
    cu uzul cronic al unei substan3e Ede e< , (+"'+rarea :n "e$7(+r7 c+ coca!na .7r7 a"(7
    s&ec!.!ca=!eJ :n .!ne, ea (re'+!e, de ase%enea, d!s(!ns7 de trsturile paranoide
    asociate cu prezen3a unui -andicap fizic Ede e< , de(er!orarea a+/+"+!J
    A"(e (+"'+r7r! de &ersona"!(a(e &o( (! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    &arano!d7, deoarece a+ :n co%+n c+ aceas(a an+%!(e e"e%en(e De aceea, es(e
    !%&or(an( s7 se d!s(!n$7 :n(re aces(e (+"'+r7r! &e 'a/a d!.eren=e"or d!n(re e"e%en(e"e
    "or carac(er!s(!ce Dac7, :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7 (+"'+rarea
    de &ersona"!(a(e &arano!d7 &o( .! d!a$nos(!ca(e s! aces(ea T+"'+rarea de
    &ersona"!(a(e &arano!d7 s! tulburarea de personalitate sc-izotipal a+ :n co%+n
    (r7s7(+r!"e de s+s&!c!o/!(a(e, de d!s(an=are %(er&ersona"7 s! !dea(!a &arano!d7, dar
    (+"'+rarea sc!/o(!&a"7 !nc"+de, de ase%enea, s!%&(o%e, c+% ar .! $And!rea
    %a$!c7, e<&er!en=e"e &erce&(+a"e !nso"!(e s! '!/arer!!"e de $And!re s! "!%'a@ Ind!v!/!!
    c+ co%&or(a%en(e care sa(!s.ac cr!(er!!"e &en(r+ tulburarea de personalitate
    sc-izoid s+n( &erce&+=! adesea ca .!!nd s(ran!!, e<cen(r!c!, rec! s! d!s(an=!, dar e! n+
    a+ de re$+"7 o !dea(!e &arano!d7 no(a'!"7 Tend!n=a !nd!v!/!"or c+ (+"'+rare de
    &ersona"!(a(e &arano!d7 de a reac=!ona co"eros "a s(!%+"! %!nor!, es(e :n(A"n!(7, de
    ase%enea, :n tulburrile de personalitate borderline si -istrionic Aces(e
    (+"'+r7r! n+ s+n( asoc!a(e :ns7 :n %od necesar c+ s+s&!c!o/!(a(e &ervas!v7 Oa%en!!
    c+ tulburarea de personalitate evitant &o(, de ase%enea, re.+/a s7 a!'7 :ncredere
    :n a"=!!, dar %a! %+"( d% ca+/a .r!c!! de a n+ .! &+O! :n d!.!c+"(a(e sa+ cons!dera=!
    !nca&a'!"! decA( de .r!ca !n(en=!!"or r7+vo!(oare a"e ce"or"a"=! DeO! co%&or(a%en(+"
    an(!soc!a" &oa(e .! &re/en( "a +n+ !nd!v!/! c+ (+"'+rare de &ersona"!(a(e &arano!d7,
    aces(a n+ es(e %o(!va( de re$+"7 de dor!n=a de cAO(!$ &ersona" or! de a e<&"oa(a &e
    a"=!! ca :n tulburarea de personalitate antisocial2 c! es(e %a! c+rAnd da(ora(
    dor!n=e! de r7/'+nare Ind!v!/!! c+ tulburare de personalitate narcisistic &o(
    &re/en(a oca/!ona" s+s&!c!o/!ra(e, !/o"are soc!a"7 sa+ a"!enare, dar aceas(a der!v7 :n
    &r!%+" rAnd d!n .nc!"e de a n+ .! re"eva(e !%&er.ec=!+n!"e sa+ de.!c!en(e"e "or
    Tr7s7(+r!"e &arano!de &o( .! ada&(ave, :n s&ec!a" :n a%'!an=e a%en!n=7(oare
    T+"'+rarea de &ersona"!(a(e &arano!d7 (re'+!e s7 .!e d!a$nos(!ca(7 n+%a! cAnd
    aces(e (r7s7(+r! s+n( !n."e<!'!"e, de/ada&(a(!ve O! &ers!s(en(e, s! ca+/ea/7 o
    de(er!orare .+nc=!ona"7 sa+ de(res7 s+'!ec(!v7 se%n!.!ca(!v7
    RFI Tulburrile de #ersonalitate
    Criteriile $e $ia/no&ti# pentru
    4+*.+ Tul-urarea $e Per&onalitate Paranoi$(
    A2 O ne"ncredere si suspicio(itate pervasiv $a de alii, ast$el c inteniile
    acestora sunt interpretate ca ruvoitoare, "ncep@nd precoce "n perioada
    adult ,i pre(ente "ntr-o varietate de contexte, dup cum este indicat de
    patru &sau mai multe) dintre urmtoareleD
    (1) suspectea(, $r o ba( su$icient, c alii "l &o) exploatea(, pre0udi
    cia( sau "n,eal3
    (2) este preocupat &) de dubii ne0usti$icate re$eritoare la loialitatea
    sau
    corectitudinea amicilor sau asociailor3
    (3) re$u( s aib "ncredere "n alii din cau(a $ricii ne0usti$icate c in$orma
    iile vor $i utili(ate maliios contra sa3
    (4) cite,te intenii de!radante sau amenintoare "n remarci sau
    evenimente
    beni!ne3
    (5) poart pica tot timpul, adic este implacabil &) $a de insulte, in0urii sau
    o$ense3
    (6) percepe atacuri la persoan sau la reputaia sa, care nu sunt
    evidente
    altora si este prompt &) "n a aciona coleros sau "n a contraataca3
    (7) are suspiciuni recurente, $r nici o 0usti$icare, re$eritoare la
    $idelitatea
    soiei &soului) ori partenerei &partenerului) sexual (e),
    S2 Fu survine exclusiv "n cursul sc%i(o$reniei, al unei tulburri a$ective cu ele
    mente psi%otice ori al altei tulburri psi%otice ,i nu se datorea( e$ectelor
    $i(iolo!ice directe ale unei condiii medicale !enerale2
    FotD Dac criteriile sunt satis$cute anterior debutului sc%i(o$reniei, se adau!
    =premorbid>, de ex2, =Tulburare de personalitate paranoid &premorbid)>2
    4+*.C+ Tul-urarea $e Per&onalitate S#@i)oi$(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e sc!/o!de :" cons(!(+!e +n
    &a((ern &ervas!v de de(aOare de re"a=!!"e soc!a"e s! o $a%7 res(rAns7 de e<&r!%are a
    e%o=!!"or :n s!(+a=!! !n(er&ersona"e. Aces( &a((ern :nce&e &recoce :n &er!oada ad+"(7
    s! es(e &re/en( :n(r4o var!e(a(e de con(e<(e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e sc!/o!d7 &ar a .! "!&s!=! de dor!n=a de
    !n(!%!(a(e, &ar !nd!.eren=! "a o&or(+n!(7=!"e de a de/vo"(a re"a=!! s(rAnse s! n+ &ar a
    &roc+ra %+"(7 sa(!s.ac=!e d!n a .! %e%'r+ a" +ne! .a%!"!! or! a" +n+! a"( $r+& soc!a"
    Ecr!(er!+" A"J. E! &re.er7 s74s! &e(reac7 (!%&+" de +n!! s!n$+r!, %a! c+rAnd decA(
    :%&re+n7 c+ a"=!!. Adesea &ar a .! !/o"a=! soc!a" sa+ Ss!n$+ra(!c!T s! a&roa&e
    (o(dea+na a"e$ ac(!v!(7=! sa+ o''!+r! so"!(are care n+ co%&or(7 !n(erac=!+ne c+ a"=!!
    Ecr!(er!+" A9J. Pre.er7 sarc!n! %ecan!ce sa+ a's(rac(e, c+% ar .! @oc+r!"e &e co%&+(er
    sa+ %a(e%a(!ce. Po( %an!.es(a &+=!n !n(eres &en(r+ a avea re"a=!! se<+a"e c+ a"(e
    &ersoane Ecr!(er!+" A;J, s! n+ "e .ac &"7cere decA( .oar(e &+=!ne sa+ n!c! +n .e" de
    ac(!v!(7=! Ecr!(er!+" AIJ. E<!s(7 de re$+"7 o ca&ac!(a(e red+s7 de a $+s(a &"7cere d!n
    45E275 Tulburarea de #ersonalitate
    Sc%i(oid
    >45
    e<&er!en=e sen/or!a"e, cor&ora"e sa+ !n(er&ersona"e, c+% ar .! o &"!%'are &e &"a@7 :n
    as.!n=!( or! a avea +n ra&or( se<+a". AceO(! !nd!v!/! n+ a+ a%!c! sa+ con.!den=!
    a&ro&!a=!, c+ e<ce&=!a &os!'!"7 a +ne! r+de de $rad+" I Ecr!(er!+" AYJ.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e sc!/o!d7 &ar adesea !nd!.eren=! "a
    a&ro'are sa+ "a cr!(!c7 d!n &ar(ea a"(ora O! n+ &ar a .! deran@a=! de ceea ce &o( $And!
    a"=!! des&re e! Ecr!(er!+" ARJ. E! &o( s7 n+ rea"!/e/e s+'(!"!(7=!"e nor%a"e a"e
    !n(erac=!+n!"or soc!a"e s! adesea n+ r7s&+nd :n %od adecva( se%na"e"or soc!a"e,
    as(.e" c7 &ar a .! !na&=! d!n &+nc( de vedere soc!a" or! s+&er.!c!a"! s! c+.+nda=! :n
    &ro&r!!"e $And+r!. Pre/!n(7 de re$+"7 o Sa%a'!"!(a(eT e<(er!oar7 .7r7 reac(!v!(a(e
    e%o=!ona"7 v!/!'!"7 O!, rar, e<&res!! .ac!a"e sa+ $es(+r! de r7s&+ns, c+% ar .!
    /A%'e(+" sa+ :nc"!narea ca&+"+! Ecr!(er!+" AHJ. E! a.!r%7 c7 e<&er!en(ea/7 rar e%o=!!
    &+(ern!ce, c+% ar .! .+r!a s! '+c+r!a. Adesea &re/!n(7 +n a.ec( coarc(a( s! &ar a .! rec!
    s! d!s(an=!, :ns7, :n ace"e c!rc+%s(an=e !nso"!(e, :n care aceO(! !nd!v!/! dev!n, ce" &+=!n
    (e%&orar, &"7c+=! :n a se reve"a "or :nO!O!, e! &o( rec+noaO(e c7 a+ sen(!%en(e care
    dor, "e$a(e :n s&ec!a" de !n(erac=!+n!"e soc!a"e.
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 n+ (re'+!e s7 .!e d!a$nos(!ca(7, dac7
    &a((ern+" de co%&or(a%en( s+rv!ne e<c"+s!v :n c+rs+" sc!/o.ren!e!, a" +ne!
    (+"'+r7r! a.ec(!ve c+ e"e%en(e &s!o(!ce or! a" +ne! (+"'+r7r! de de/vo"(are
    &ervas!v7 sa+ dac7 es(e da(ora(7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    ne+ro"o$!ce sa+ a"e a"(e! cond!=!! %ed!ca"e $enera"e Ecr!(er!+" BJ.
    *lemente si tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e sc!/o!d7 &o( avea an+%!(e d!.!c+"(7=!
    :n e<&r!%area s+&7r7r!!, c!ar ca r7s&+ns "a o &rovocare d!rec(7, ceea ce con(r!'+!e
    "a !%&res!a c7 s+n( "!&s!=! de e%o=!!. 3!e=!"e "or &ar adesea ca "!&s!(e de d!rec=!e, !ar
    e! &o( a&are ca .!!nd Sd+O! de c+ren(T :n sco&+r!"e "or. As(.e" de !nd!v!/!
    reac=!onea/7 adesea &as!v "a c!rc+%s(an=e adverse s! a+ d!.!c+"(7=! :n a r7s&+nde
    adecva( even!%en(e"or de v!a=7 !%&or(an(e. D!n ca+/a "!&se! "or de a&(!(+d!n!
    soc!a"e O! "!&se! dor!n=e! de a avea re"a=!! se<+a"e, !nd!v!/!! c+ aceas(7 (+"'+rare a+
    &+=!n! a%!c!, :n(A"n!r! rare O! adesea n+ se c7s7(oresc. F+nc=!onarea &ro.es!ona"7
    &oa(e .! de(er!ora(7, :n s&ec!a" dac7 es(e necesar7 !%&"!carea !n(er&ersona"7, dar
    !nd!v!/!! c+ aceas(7 (+"'+rare &o( s4o .ac7 '!ne cAnd "+crea/7 :n cond!=!! de !/o"are
    soc!a"7, :n s&ec!a" ca r7s&+ns "a s(res, !nd!v!/!! c+ aceas(7 (+"'+rare &o( e<&er!en=a
    e&!soade &s!o(!ce .oar(e sc+r(e Ed+rAnd de "a cA(eva %!n+(e "a cA(eva oreJ, :n
    +ne"e ca/+r!, (+"'+rarea de &ersona"!(a(e sc!/o!d7 &oa(e a&are ca an(eceden(+"
    &re%or'!d a" (+"'+r7r!! de"!ran(e sa+ a" sc!/o.ren!e!. Ind!v!/!! c+ aceas(7
    (+"'+rare &o( de/vo"(a +neor! (+"'+rare de&res!v7 %a@or7. T+"'+rarea de
    &ersona"!(a(e sc!/o!d7 a&are ce" %a! adesea conco%!(en( c+ (+"'+r7r!"e de
    &ersona"!(a(e sc!/o(!&a"7, &arano!d7 s! ev!(an(7.
    *lemente speci$ice culturii, etii si sexului
    Ind!v!/! d!n(r4o var!e(a(e de .ond+r! c+"(+ra"e &re/!n(7 +neor! co%&or(a%en(e
    de.ens!ve s! s(!"+r! !n(er&ersona"e care &o( .! e(!ce(a(e :n %od erona( ca
    sc!/o!de. De e<e%&"+, ce! care s4a+ %+(a( d!n %ed!+" r+ra" :n %ed!+" +r'an &o(
    reac=!ona c+ Sr7cea"7 e%o=!ona"7T care &oa(e d+ra cA(eva "+n! O! se &oa(e
    %an!.es(a &r!n ac(!v!(7=! so"!(are, a.ec( coarc(a( O! a"(e de.!c!en=e de co%+n!care.
    I%!$ran=!! d!n a"(e =7r! s+n( +neor! &erce&+=! :n %od erona( ca .!!nd rec!, os(!"!
    sa+ !nd!.eren=!.
    RFR Tulburrile de #ersonalitate

    T+"'+rarea de &ersona"!(a(e sc!/o!d7 se &oa(e %an!.es(a :nc7 d!n co&!"7r!e sa+
    ado"escen=7, &r!n so"!(+d!ne, re"a=!! red+se c+ e$a"!! s! &er.or%an=7 Oco"ar7 red+s7,
    care %arcea/7 aceO(! co&!! sa+ ado"escen=! ca d!.er!=! s! .ac d!n e! s+'!ec( de (ac!nare.
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 es(e d!a$nos(!ca(7 :n(r4o oarecare %7s+r7
    %a! .recven( "a '7r'a=!, s! "e &oa(e ca+/a o de(er!orare %a! %are.
    #revalent
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 es(e rar7 :n cond!=!! c"!n!ce.
    #attern $amilial
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 &oa(e avea o &reva"en(7 cresc+(7 "a r+de"e
    !nd!v!/!"or c+ sc!/o.ren!e sa+ c+ (+"'+rare de &ersona"!(a(e sc!/o(!&a"7.
    Dia!nostic di$erenial
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 &oa(e .! d!s(!ns7 de (+"'+rarea de"!ran(7,
    sc!/o.ren!e s! (+"'+rarea a.ec(!v7 c+ e"e%en(e &s!o(!ce, deoarece aces(e
    (+"'+r7r! s+n( (oa(e carac(er!/a(e &r!n(r4o &er!oad7 de s!%&(o%e &s!o(!ce
    &ers!s(en(e Ede e<., !de! de"!ran(e si a"+c!na=!!J. Pen(r+ a &+ne +n d!a$nos(!c
    ad!=!ona" de (+"'+rare de &ersona"!(a(e sc!/o!d7, (+"'+rarea de &ersona"!(a(e
    (re'+!e s7 .! .os( &re/en(7 an(er!or de'+(+"+! s!%&(o%e"or &s!o(!ce s! (re'+!e s7
    &ers!s(e cAnd s!%&(o%e"e s4a+ re%!s. CAnd +n !nd!v!d are o (+"'+rare &s!o(!c7
    cron!c7 &e a<a I Ede e<., sc!/o.ren!eJ care a .os( &receda(7 de (+"'+rarea de
    &ersona"!(a(e sc!/o!d7, (+"'+rarea de &ersona"!(a(e sc!/o!d7 (re'+!e s7 .!e
    :nre$!s(ra(7 &e a<a II, +r%a(7 de S&re%or'!dT :n &aran(e/7.
    Po( e<!s(a %ar! d!.!c+"(7=! :n d!.eren=!erea !nd!v!/!"or c+ (+"'+rare de
    &ersona"!(a(e sc!/o!d7 de ce! c+ .or%e +Ooare de (+"'+rare a+(!s(7 s! de ce! c+
    (+"'+rare As&er$er. For%e"e +Ooare de (+"'+rare a+(!s(7 s! de (+"'+rare As&er$er
    se d!.eren=!a/7 &r!n !n(erac=!+nea soc!a"7 de(er!ora(7 %a! sever s! &r!n
    co%&or(a%en(e s! &reoc+&7r! s(ereo(!&e.
    T+"'+rarea de &ersona"!(a(e sc!/o!d7 (re'+!e s7 .!e d!s(!ns7 de %od!.!carea de
    &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care (r7s7(+r!"e a&ar
    d!n ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+!
    nervos cen(ra". Ea (re'+!e d!s(!ns7, de ase%enea, de s!%&(o%e"e care a&ar :n
    asoc!ere c+ +/+" cron!c a" +ne! s+'s(an=e Ede e<., (+"'+rarea :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ.
    S! a"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    sc!/o!d7, deoarece a+ :n co%+n an+%!(e e"e%en(e. De aceea, es(e !%&or(an( s7 se
    d!s(!n$7 aces(e (+"'+r7r! +ne"e de a"(e"e, &e 'a/a d!.eren=e"or d!n(re e"e%en(e"e "or
    carac(er!s(!ce. Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7 (+"'+rarea de
    &ersona"!(a(e sc!/o!d7, &o( .! d!a$nos(!ca(e s! aces(ea. DeO! carac(er!s(!c!, &rec+%
    !/o"area soc!a"7 s! a.ec(!v!(a(ea coar(a(7, s+n( co%+ne (+"'+r7r!"or de &ersona"!(a(e
    sc!/o!d7, sc!/o(!&a"7 s! &arano!d7, (+"'+rarea de &ersona"!(a(e sc!/o!d7 &oa(e .!
    d!s(!ns7 de (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 &r!n "!&sa d!s(ors!+n!"or
    co$n!(!ve s! de &erce&=!e, !ar de (+"'+rarea de &ersona"!(a(e &arano!d7 &r!n "!&sa
    s+s&!c!o/!(7=!! s! !dea=!e! &arano!de. I/o"area soc!a"7 a (+"'+r7r!! de &ersona"!(a(e
    sc!/o!de &oa(e .! d!s(!ns7 de cea a (+"'+r7r!! de &ersona"!(a(e ev!(an(e, care es(e
    da(ora(7 .r!c!! de a n+ .! &+s :n d!.!c+"(a(e sa+ cons!dera( !nca&a'!" s! an(!c!&7r!!
    45E277 Tulburarea de #ersonalitate
    Sc%i(otipal
    >48
    e<ces!ve a re@ec=!e!. D!n con(ra, oa%en!! c+ (+"'+rare de &ersona"!(a(e sc!/o!d7 a+ o
    de(aOare %a! &ervas!v7 O! o dor!n=7 red+s7 de !n(!%!(a(e soc!a"7. Ind!v!/!! c+
    (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7 &o( &re/en(a, de ase%enea, o
    de(aOare soc!a"7 ev!den(7 &roven!nd d!n devo=!+nea .a=7 de %+nc7 O! d!scon.or(+" "a
    e%o=!!, dar e! a+ ca&ac!(a(ea s+'!acen(7 &en(r+ !n(!%!(a(e.
    Ind!v!/!! Ss!n$+ra(!c!T &o( &re/en(a (r7s7(+r! de &ersona"!(a(e care &o( .!
    cons!dera(e sc!/o!de. N+%a! cAnd aces(e (r7s7(+r! s+n( !n."e<!'!"e s! de/ada&4
    (a(!ve, s! ca+/ea/7 o de(er!orare .+nc=!ona"7 se%n!.!ca(!v7 or! de(res7 s+'!ec(!v7,
    cons(!(+!e (+"'+rare de &ersona"!(a(e sc!/o!d7.
    Criteriile $e $ia/no&ti# pentru
    4+*.C+ Tul-urarea $e Per&onalitate S#@i)oi$(
    A2 .n pattern pervasiv de deta,are de relaiile sociale ,i o !am restr@ns de
    exprimare a emoiilor "n situaii interpersonale, "ncep@nd precoce "n
    perioada adult ,i pre(ente "ntr-o varietate de contexte, dup cum este
    indicat de patru &sau mai multe) dintre urmtoareleD
    (1)nici nu dore,te ,i nici nu se bucur de relaii str@nse, inclusiv de $aptul de
    a $i membru al unei $amilii3
    (2)ale!e aproape "ntotdeauna activiti solitare3
    (3)are puin sau nu are nici un interes "n a avea experiene sexuale cu alt
    persoan3
    (4)"i plac puine ori nu-i plac nici un $el de activiti3
    (5)lipsa amicilor sau con$idenilor apropiai, alii dec@t rude de !radul I3
    (6)pare a $i indi$erent la criticile sau laudele altora3
    (7)pre(int rceal emoional, deta,are sau a$ectivitate plat2
    S2 Fu survine exclusiv "n cursul sc%i(o$reniei, al unei tulburri a$ective cu ele
    mente psi%otice, al altei tulburri psi%otice ori al unei tulburri de
    de(voltare pervasiv ,i nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    condiii medicale !enerale2
    FotD Dac criteriile sunt satis$cute anterior debutului sc%i(o$reniei, se adau!
    =premorbid>, de exemplu, =Tulburare de personalitate sc%i(oid &premorbid)>2
    4+*.CC Tul-urarea $e Per&onalitate S#@i)otipal(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e sc!/o(!&a"e :" cons(!(+!e +n
    &a((ern &ervas!v de de.!c!(e soc!a"e O! !n(er&ersona"e, %an!.es(a( &r!n(r4+n d!scon.or(
    ac+( :n re"a=!! O! red+cerea ca&ac!(7=!! de a avea re"a=!! s(rAnse, &rec+% O! &r!n
    d!s(ors!+n! co$n!(!ve O! de &erce&=!e, O! e<cen(r!c!(7=! de co%&or(a%en(. Aces( &a((ern
    :nce&e &recoce :n &er!oada ad+"(7 O! es(e &re/en( :n(r4o var!e(a(e de con(e<(e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e Sc!/o(!&a"7 a+ adesea !de! de re.er!n=7
    Ead!c7, !n(er&re(7r! !ncorec(e a"e !nc!den(e"or cas+a"e s! even!%en(e"or e<(erne, ca
    avAnd o se%n!.!ca=!e &ar(!c+"ar7 O! !nso"!(7 an+%e &en(r+ &ersoana res&ec(!v7J
    >4= Tulburrile de #ersonalitate

    Ecr!(er!+"A"J. Aces(ea (re'+!e s7 .!e d!s(!nse de !de!"e de"!ran(e de re.er!n=7, :n care
    cred!n=e"e s+n( s+s=!n+(e c+ conv!n$ere de"!ran(7. AceO(! !nd!v!/! &o( .! s+&ers(!=!oO!
    sa+ &reoc+&a=! de .eno%ene &aranor%a"e, care s+n( d!nco"o de nor%e"e s+'c+"(+r!!
    "or Ecr!(er!+" A9J. E! &o( crede c7 a+ &+(er! s&ec!a"e de a !n(+! even!%en(e"e :na!n(e
    ca aces(ea s7 s+rv!n7 or! de a c!(! $And+r!"e a"(ora. De ase%enea, e! &o( crede c7 a+
    +n con(ro" %a$!c as+&ra a"(ora, care &oa(e .! !%&"e%en(a( d!rec( Ede e<.,
    conv!n$erea c7 so=!a a scos cA!ne"e "a &"!%'are es(e re/+"(a(+" d!rec( a" $And+"+! c7
    aOa ceva (re'+!a .7c+( c+ o or7 %a! :na!n(eJ or! !nd!rec(, &r!n co%&"!an=a "a r!(+a"+r!
    %a$!ce Ede e<., %er$e &e "An$7 +n an+%!( o'!ec( de (re! or! &en(r+ a ev!(a +n
    de/nod7%An( &re@+d!c!an(J. Po( .! &re/en(e (+"'+r7r! de &erce&=!e Ede e<., a s!%=! c7
    es(e &re/en(7 o a"(7 &ersoan7 or! a+/!rea +ne! voc! care4! %+r%+r7 n+%e"eJ
    Ecr!(er!+" A;J. L!%'a@+" "or &oa(e !nc"+de e<&res!! s! cons(r+c=!! !n+/+a"e sa+
    !d!os!ncra(!ce. L!%'a@+" es(e adesea de/"Ana(, d!$res!v sa+ va$, dar .7r7 dera!ere
    sa+ !ncoeren=7 rea"7 Ecr!(er!+" AIJ. R7s&+ns+r!"e &o( .!, .!e e<(re% de concre(e, .!e
    e<(re% de a's(rac(e, !ar c+v!n(e"e sa+ conce&(e"e s+n( +(!"!/a(e +neor! de o %an!er7
    !nso"!(7 Ede e<., &ersoana &oa(e a.!r%a c7 n+ era &rea Sco%+n!ca(!v7T "a serv!c!+J.
    Ind!v!/!! c+ aceas(7 (+"'+rare s+n( adesea s+s&!c!oO! O! &o( avea !dea=!e
    &arano!d7 Ede e<., cred c7 co"e$!! de serv!c!+ !n(en=!onea/7 s7 "e s+'%!ne/e
    re&+(a=!a :n .a(a Oe.+"+!J Ecr!(er!+" AYJ. De re$+"7, e! n+ s+n( ca&a'!"! s7 &arc+r$7
    :n(rea$a $a%7 de a.ec(e s! de se%na"!/are !n(er&ersona"7 necesar7 re"a=!!"or de
    s+cces s! de aceea adesea &ar a !n(erac=!ona c+ a"=!! :n %od necores&+n/7(or, r!$!d
    sa+ c+ re=!nere Ecr!(er!+" ARJ. AceO(! !nd!v!/! s+n( cons!dera=! adesea a .! '!/ar! sa+
    e<cen(r!c! d!n ca+/a %an!er!s%e"or !nso"!(e O! a %od+"+! ne$"!@en( de a se :%'r7ca
    c+ ar(!co"e care n+ se &rea Sasor(ea/7T, ca O! a !na(en=!e! .a=7 de conven=!!"e soc!a"e
    +/+a"e Ede e<., &ersoana ev!(7 con(ac(+" v!/+a", &oar(7 o :%'r7c7%!n(e &7(a(7 de
    cernea"7 s! r7+ asor(a(7 O! es(e !nca&a'!"7 s7 !n(re :n &ers!."are rec!&roc7 c+
    co"a'ora(or!!J Ecr!(er!+" AHJ.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e sc!/or!&a"7 e<&er!en(ea/7 re"a=!onarea
    !n(er&ersona"7 ca &ro'"e%a(!c7 s! s+n( !nco%oda=! de &re/en=a a"(or oa%en!. DeO!
    :O! &o( e<&r!%a (r!s(e=ea :n "e$7(+r7 c+ "!&sa "or de re"a=!!, co%&or(a%en(+" "or
    s+$erea/7 o dor!n=7 red+s7 de con(ac(e !n(!%e. Dre&( re/+"(a(, e! n+ a+ n!c! +n .e"
    de a%!c! sa+ con.!den=! or! a+ .oar(e &+=!n!, a"=!! decA( o r+d7 de $rad+" I Ecr!(er!+"
    AGJ. S+n( an<!oO! :n s!(+a=!! soc!a"e, :n s&ec!a" :n ce"e care !%&"!c7 &ersoane
    non.a%!"!are Ecr!(er!+" AFJ. E! !n(erac=!onea/7 c+ a"=! oa%en! cAnd n+ a+ :nco(ro, dar
    &re.er7 s7 =!n7 :n e! :nO!O! &en(r+ c7 s!%( c7 s+n( d!.er!=! s! c7 n+ se &o( Saco%odaT
    c+ aceO(!a. An<!e(a(ea "or soc!a"7 n+ es(e +Oor de :n"7(+ra(, c!ar cAnd &e(rec %a!
    %+"( (!%& :%&re+n7 sa+ dev!n %a! .a%!"!ar! c+ a"=! oa%en!, deoarece an<!e(a(ea "or
    (!nde a .! asoc!a(7 c+ s+s&!c!+n! re.er!(oare "a !n(en=!!"e aces(ora. De e<e%&"+, cAnd
    &ar(!c!&7 "a +n 'ance(, !nd!v!d+" c+ (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 n+ va
    deven! %a! re"a<a( &e %7s+r7 ce (rece (!%&+" c!, d!n con(ra, &oa(e deven! %a!
    (ens!ona( O! %a! s+s&!c!os.
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 n+ (re'+!e s7 .!e d!a$nos(!ca(7, dac7
    &a((ern+" de co%&or(a%en( s+rv!ne e<c"+s!v :n c+rs+" sc!/o.ren!e!, a" +ne!
    (+"'+r7r! a.ec(!ve c+ e"e%en(e &s!o(!ce, a" a"(e! (+"'+r7r! &s!o(!ce or! a" +ne!
    (+"'+r7r! de de/vo"(are &ervas!ve Ecr!(er!+" BJ.
    *lemente si tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e sc!/or!&a"7 so"!c!(7 adesea (ra(a%en( &en(r+
    s!%&(o%e asoc!a(e de an<!e(a(e, de&res!e or! a"(e a.ec(e d!s.or!ce %a! c+rAnd decA(
    45E277 Tulburarea de #ersonalitate
    Sc%i(otipal
    >44
    &en(r+ e"e%en(e"e (+"'+r7r!! de &ersona"!(a(e &er se. :n s&ec!a", ca r7s&+ns "a s(res,
    !nd!v!/!! c+ aceas(7 (+"'+rare &o( e<&er!en=a e&!soade &s!o(!ce (ran/!(or!! Ed+rAnd de
    "a cA(eva %!n+(e, "a cA(eva oreJ, :ns7 e"e s+n( de re$+"7 !ns+.!c!en(e ca d+ra(7 &en(r+ a
    @+s(!.!ca +n d!a$nos(!c ad!=!ona" de (+"'+rare &s!o(!c7 sc+r(7 or! de (+"'+rare
    sc!/o.ren!.or%7. :n +ne"e ca/+r!, &o( a&are s!%&(o%e &s!o(!ce se%n!.!ca(!ve c"!n!c
    care sa(!s.ac cr!(er!!"e &en(r+ (+"'+rarea &s!o(!c7 sc+r(7, (+"'+rarea sc!/o.ren!.or%7,
    (+"'+rarea de"!ran(7 sa+ sc!/o.ren!e. Pes(e @+%7(a(e &o( avea +n !s(or!c de ce" &+=!n
    +n e&!sod de&res!v %a@or, :n(re ;Ld4YLd d!n(re !nd!v!/!! d!a$nos(!ca=! c+ aceas(7
    (+"'+rare a+ +n d!a$nos(!c conco%!(en( de (+"'+rare de&res!v7 %a@or7 cAnd s+n(
    !n(erna=! :n(r4o +n!(a(e c"!n!c7. E<!s(7 o a&ar!=!e conco%!(en(7 cons!dera'!"7 c+
    (+"'+r7r!"e de &ersona"!(a(e sc!/o!d7, &arano!d7, ev!(an(7 s! 'order"!ne.
    *lemente speci$ice culturii, etii si sexului
    D!s(ors!+n!"e co$n!(!ve s! de &erce&=!e (re'+!e s7 .!e eva"+a(e :n con(e<(+"
    %ed!+"+! c+"(+ra" a" !nd!v!d+"+!. Carac(er!s(!c!"e &ervas!ve de(er%!na(e c+"(+ra", :n
    s&ec!a" ce"e re.er!(oare "a cred!n=e"e s! r!(+a"+r!"e re"!$!oase, &o( &are sc!/o(!&a"e
    +n+! s(r7!n ne!n.or%a( Ede e<., #oodoo, vor'!(+" :n "!%'!, v!a=a de d+&7 %oar(e,
    Oa%an!s%+", c!(!rea $And+r!"or, ce" de a" Oase"ea s!%=, deoc!+" s! cred!n=e"e %a$!ce
    re.er!(oare "a s7n7(a(e s! %a"ad!eJ.
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 &oa(e .! ev!den(7 :nc7 d!n co&!"7r!e sa+
    ado"escen=7 &r!n so"!(+d!ne, re"a=!! red+se c+ e$a"!!, an<!e(a(e soc!a"7, &er.or%an=7
    Oco"ar7 s+' &os!'!"!(7=!, !&ersens!'!"!(a(e, $And+r! O! "!%'a@ s!n$+"ar O! .an(e/!!
    '!/are. AceO(! co&!! &o( &are Ss(ran!!T sa+ Se<cen(r!c!T O! a(ra$ (ac!narea.
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 es(e &+=!n %a! .recven(7 "a '7r'a=!.
    #revalent
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 a .os( ra&or(a(7 a s+rven! :n ;d d!n
    &o&+"a=!a $enera"7.
    *voluie
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 are o evo"+=!e re"a(!v s(a'!"7, c+ doar +n
    %!c n+%7r de !nd!v!/! %er$And s&re a&ar!=!a sc!/o.ren!e! sa+ a a"(e! (+"'+r7r!
    &s!o(!ce.
    #attern $amilial
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 &are a se a$re$a .a%!"!a" O! es(e %a!
    .recven(7 &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e !nd!v!/!"or c+ sc!/o.ren!e decA(
    :n &o&+"a=!a $enera"7. Poa(e e<!s(a, de ase%enea, o %odes(7 creO(ere :n sc!/o.ren!e
    sa+ a"(e (+"'+r7r! &s!o(!ce "a r+de"e &ro'an/!"or c+ (+"'+rare de &ersona"!(a(e
    sc!/o(!&a"7.
    Dia!nostic di$erenial
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 &oa(e .! d!s(!ns7 de (+"'+rarea
    de"!ran(7, de sc!/o.ren!e O! de (+"'+rarea a.ec(!v7 c+ e"e%en(e &s!o(!ce,
    deoarece (oa(e aces(e (+"'+r7r! se carac(er!/ea/7 &r!n(r4o &er!oad7 de s!%&(o%e
    &s!o(!ce &ers!s(en(e Ede e<., !de! de"!ran(e s! a"+c!na=!!J. Pen(r+ a &+ne +n
    d!a$nos(!c ad!=!ona" de (+"'+rare de &ersona"!(a(e sc!/o(!&a"7, (+"'+rarea de
    G++ Tulburrile de #ersonalitate
    &ersona"!(a(e (re'+!e s7 .! .os( &re/en(7 an(er!or de'+(+"+! s!%&(o%e"or &s!o(!ce s!
    s7 &ers!s(e s! d+&7 ce s!%&(o%e"e &s!o(!ce s4a+ re%!s. CAnd +n !nd!v!d are o
    (+"'+rare &s!o(!c7 cron!c7 &e a<a I Ede e<., sc!/o.ren!eJ care a .os( &receda(7 de
    (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7, (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7
    (re'+!e s7 .!e :nre$!s(ra(7 &e a<a II, +r%a(7 de S&re%or'!dT :n &aran(e/7.
    Po( e<!s(a %ar! d!.!c+"(7=! :n d!.eren=!erea co&!!"or c+ (+"'+rare s!/o(!&a"7 de $r+&+"
    e(ero$en a" co&!!"or so"!(ar!, '!/ar!, a" c7ror co%&or(a%en( es(e %arca( de !/o"are
    soc!a"7, e<cen(r!c!(a(e or! &ar(!c+"ar!(7=! de "!%'a@, s! a" c7ror d!a$nos(!c ar !nc"+de
    &ro'a'!" .or%e +Ooare de (+"'+rare a+(!s(7, (+"'+rare As&er$er, (+"'+r7r! de "!%'a@
    e<&res!v s! (+"'+r7r! %!<(e de "!%'a@ e<&res!v O! rece&(!v. T+"'+r7r!"e de co%+n!care
    &o( .! d!.eren=!a(e &r!n &r!%ar+" s! sever!(a(ea (+"'+r7r!! de "!%'a@, aco%&an!a(7 de
    e.or(+r! co%&ensa(or!! a"e co&!"+"+! de a co%+n!ca &r!n a"(e %!@"oace Ede e<., &r!n
    $es(+r!J s! &r!n e"e%en(e"e carac(er!s(ce a"e "!%'a@+"+! de(er!ora(, cons(a(a(e "a o
    eva"+are s&ec!a"!/a(7 a "!%'a@+"+!. For%e"e %a! +Ooare de (+"'+rare a+(!s(7 s! de
    (+"'+rare As&er$er se d!.eren=!a/7 &r!n "!&sa %a! %are a conO(!!n=e! soc!a"e s! a
    rec!&roc!(7=!! e%o=!ona"e &rec+% s! &r!n co%&or(a%en(e"e s! &reoc+&7r!"e s(ereo(!&e.
    T+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 (re'+!e s7 .!e d!s(!ns7 de %od!.!carea
    de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care (r7s7(+r!"e a&ar
    d!n ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+!
    nervos cen(ra". Ea (re'+!e d!s(!ns7, de ase%enea, de s!%&(o%e"e care &o( a&are :n
    asoc!ere c+ +/+" cron!c a" +ne! s+'s(an=e Ede e<., (+"'+rarea :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ.
    A"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    sc!/o(!&a"7, deoarece a+ :n co%+n an+%!(e e"e%en(e. De aceea, es(e necesar s7 se
    .ac7 d!s(!nc=!e :n(re aces(e (+"'+r7r!, &e 'a/a d!.eren=e"or d!n(re e"e%en(e"e "or
    carac(er!s(!ce. Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7 (+"'+rarea
    de &ersona"!(a(e sc!/o(!&a"7, &o( .! d!a$nos(!ca(e O! aces(ea. DeO! (+"'+r7r!"e de
    &ersona"!(a(e &arano!d7 s! sc!/o!d7 &o( .!, de ase%enea, carac(er!/a(e &r!n
    de(aOare soc!a"7 O! a.ec( coar(a(, (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 &oa(e .!
    d!s(!ns7 de aces(ea do+7 &r!n &re/en=a d!s(ors!+n!"or co$n!(!ve s! de &erce&=!e s!
    &r!n e<cen(r!c!(a(ea sa+ '!/arer!a no(a'!"7. Re"a=!!"e !n(!%e s+n( "!%!(a(e, a(A( :n
    (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7, cA( s! :n (+"'+rarea de &ersona"!(a(e
    ev!(an(7, :ns7 :n (+"'+rarea de &erso"!(a(e ev!(an(7 dor!n=a ac(!v7 de re"a=!! es(e
    res(rAns7 d!n ca+/a .r!c!! de re@ec=!e, &e cAnd :n (+"'+rarea de &ersona"!(a(e
    sc!/o(!&a"7 e<!s(7 o "!&s7 a dor!n=e! de re"a=!! s! de(aOare &ers!s(en(7. Ind!v!/!! c+
    (+"'+rare de &ersona"!(a(e narc!s!s(!c7 &o( &re/en(a, de ase%enea, s+s&!c!o/!(a(e,
    !/o"are soc!a"7 sa+ a"!enare, dar :n (+"'+rarea de &ersona"!(a(e narc!s!s(!c7 aces(e
    ca"!(7=! der!v7 :n &r!%+" rAnd d!n .r!ca de a n+ .! reve"a(e !%&er.ec=!+n! sa+
    de.!c!en=e. Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne &o( avea, de
    ase%enea, s!%&(o%e (ran/!(or!! ase%7n7(oare ce"or &s!o(!ce, dar aces(ea s+n( de
    re$+"7 %a! s(rAns "e$a(e de sc!%'7r!"e a.ec(!ve ca r7s&+ns "a s(res Ede e<., %An!e
    !n(ens7, an<!e(a(e or! con(rar!ereJ s! de re$+"7 s+n( %a! d!soc!a(!ve Ede e<.,
    derea"!/are sa+ de&ersona"!/areJ. D!n con(ra, es(e .oar(e &os!'!" ca !nd!v!/!! c+
    (+"'+rare de &ersona"!(a(e sc!/o(!&a"7 s7 a!'7 s!%&(o%e d+ra'!"e s!%!"are ce"or
    &s!o(!ce care se &o( :nr7+(7=! :n cond!=!! de s(res, dar es(e %a! &+=!n &ro'a'!" c7 vor
    .! asoc!a(e !nvar!a'!" c+ s!%&(o%e a.ec(!ve &ron+n=a(e. DeO! !/o"area soc!a"7 &oa(e
    s+rven! s! :n (+"'+rarea de &ersona"!(a(e 'order"!ne, aceas(a es(e de re$+"7
    sec+ndar7 re&e(a(e"or eOec+r! !n(er&ersona"e da(ora(e accese"or co"eroase s!
    sc!%'7r!"or .rcven(e de d!s&o/!=!e, %a! c+rAnd decA( +n re/+"(a( a" +ne! "!&se
    &ers!s(en(e de con(ac(e soc!a"e O! dor!n=e! de !n(!%!(a(e, :n &"+s, !nd!v!/!! c+
    Tulburrile de personalitate din !rupa
    S
    ?5E

    (+"'+rare de &ersona"!(a(e sc!/o(!&a"7 n+ &re/!n(7 de re$+"7 co%&or(a%en(e"e
    !%&+"s!ve sa+ %an!&+"a(!ve a"e !nd!v!/!"or c+ (+"'+rare de &ersona"!(a(e 'order"!ne.
    E<!s(7 :ns7, o ra(7 cresc+(7 de a&ar!=!e conco%!(en(7 a ce"or do+7 (+"'+r7r!, aOa c7
    e.ec(+area d!s(!nc=!e! :n(re e"e n+ es(e :n(o(dea+na &os!'!"7. E"e%en(e"e
    sc!/o(!&a"e d!n c+rs+" ado"escen=e! &o( .! %a! c+rAnd e<&res!a +ne! '+"vers7r!
    e%o=!ona"e (ran/!(or!!, decA( o (+"'+rare de &ersona"!(a(e d+ra'!"7.
    Criteriile $e $ia/no&ti# pentru
    4+*.CC Tul-urarea $e Per&onalitate S#@i)otipal(
    A2 .n pattern pervasiv de de$icite sociale si interpersonale mani$estat prin dis
    con$ort acut "n relaii ,i reducerea capacitii de a stabili relaii intime, precum
    ,i prin distorsiuni co!nitive ,i de percepie, si excentriciti de comportament,
    "ncep@nd precoce "n perioada adult si pre(ent "ntr-o varietate de contexte,
    dup cum este indicat de cinci &sau mai multe) dintre urmtoareleD
    (1) idei de re$erin &exclu(@nd ideile delirante de re$erin)3
    (2) !@ndire ma!ic sau credine stranii care in$luenea( comportamentul
    ,i
    sunt incompatibile cu normele subculturale &de ex2, superstiio(itate,
    credin "n clarvi(iune, telepatie ori "n cel de al =,aselea sim>3 la copii ,i
    adolesceni, $ante(ii ,i preocupri bi(are)3
    (3) experiene perceptive insolite, inclu(@nd ilu(ii corporale3
    (4) !@ndire ,i limba0 bi(ar &de ex2, limba0 va!, circumstanial,
    meta$oric,
    supraelaborat sau stereotip)3
    &S)suspicio(itate sau ideaie paranoid3
    (6) a$ect inadecvat sau coarctat3
    (7) comportament sau aspect bi(ar, excentric sau particular3
    (8) lipsa de amici sau con$ideni apropiai, alii dec@t rude de !radul l3
    (6) anxietate social excesiv care nu diminua odat cu $amiliari(area si
    tinde
    a $i asociat mai cur@nd cu temeri paranoide dec@t cu 0udeci ne!ative
    despre sine2
    S2 Fu survine exclusiv "n cursul sc%i(o$reniei, al unei tulburri a$ective cu ele
    mente psi%otice, al> altei tulburri psi%otice ori al unei tulburri de
    de(voltare pervasiv2
    FotD Dac criteriile sunt satis$cute anterior debutului sc%i(o$reniei, se adau!
    =premorbid>, de ex2, =Tulburare de personalitate sc%i(otipal &premorbid)>2
    Tul-ur(rile $e per&onalitate $in /rupa 8
    4+*.G Tul-urarea $e Per&onalitate Anti&o#ial(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e an(!soc!a"e :" cons(!(+!e +n
    &a((ern &ervas!v de descons!derare s! v!o"are a dre&(+r!"or a"(ora, care :nce&e :n
    co&!"7r!e sa+ &recoce :n ado"escen=7 s! se con(!n+7 :n &er!oada ad+"(7.
    ?57 Tulburrile de #ersonalitate
    Aces( &a((ern a .os( den+%!(, de ase%enea, &s!o&a(!e, soc!o&a(!e sa+ (+"'+rare
    de &ersona"!(a(e d!ssoc!a"7. Deoarece !%&os(+ra s! %an!&+"area s+n( e"e%en(e"e
    cen(ra"e a"e (+"'+r7r!! de &ersona"!(a(e an(!soc!a"e, &oa(e .! e<(re% de +(!" s7 se
    !n(e$re/e !n.or%a=!a o'=!n+(7 d!n eva"+area c"!n!c7 s!s(e%a(!c7 c+ !n.or%a=!a
    co"ec(a(7 d!n s+rse co"a(era"e.
    Pen(r+ a .! &+s aces( d!a$nos(!c, !nd!v!d+" (re'+!e s7 a!'7 ce" &+=!n e(a(ea de 5G
    an! Ecr!(er!+" BJ, &rec+% s! +n !s(or!c de cA(eva s!%&(o%e de (+"'+rare de cond+!(7,
    :na!n(e de e(a(ea de 5Y an! Ecr!(er!+" CJ. T+"'+rarea de cond+!(7 !%&"!c7 +n &a((ern
    &ers!s(en( s! re&e(!(!v de co%&or(a%en( :n care dre&(+r!"e .+nda%en(a"e a"e a"(ora
    or!, s! nor%e"e sa+ re$+"!"e soc!a"e cores&+n/7(oare e(7=!! s+n( v!o"a(e.
    Co%&or(a%en(e"e s&ec!.!ce carac(er!s(!ce (+"'+r7r!! de cond+!(7 se :ncadrea/7
    :n(r4+na d!n +r%7(oare"e &a(r+ ca(e$or!!Q a$resarea oa%en!"or sa+ an!%a"e"or,
    d!s(r+$erea &ro&r!e(7=!!, !%&os(+ra sa+ .+r(+", or! v!o"area $rav7 a re$+"!"or.
    Aces(ea s+n( descr!se %a! :n de(a"!+ "a &a$. F;.
    Pa((ern+" de co%&or(a%en( an(!soc!a" se con(!n+7 :n &er!oada ad+"(7. Ind!v!/!! c+
    (+"'+rare de &ersona"!(a(e an(!soc!a"7 n+ re+Oesc s7 se con.or%e/e nor%e"or soc!a"e
    re.er!(oare "a co%&or(a%en(+" "e$a" Ecr!(er!+" A"J. E! &o( co%!(e :n %od re&e(a( ac(e
    care s+n( %o(!v de ares( E.!e c7 s+n( ares(a=! sa+ n+J, c+% ar .! d!s(r+$erea
    &ro&r!e(7=!!, ve<area a"(ora, .+r(+" or! &rac(!carea +nor &ro.es!! !"e$a"e. Persoane"e c+
    aceas(7 (+"'+rare descons!der7 dor!n=e"e, dre&(+r!"e sa+ sen(!%en(e"e a"(ora. E!
    :nOea"7 s! %an!&+"ea/7 .recven( &e a"=!! :n sco&+" o'=!ner!! +n+! &ro.!( &ersona" sa+
    a" &"7cer!! Ede e<., s&re a o'=!ne 'an!, se<, &+(ereJ Ecr!(er!+" A9J. M!n( :n %od re&e(a(,
    .ac +/ de a"!'!+r!, escrocea/7 &e a"=!! or! s!%+"ea/7. Un &a((ern de !%&+"s!v!(a(e
    &oa(e .! %an!.es(a( &r!n !nca&ac!(a(ea de a .ace &"an+r! d!na!n(e Ecr!(er!+" A;J.
    Dec!/!!"e s+n( "+a(e s+' !%&er!+" %o%en(+"+!, .7r7 +n &"an an+%e s! .7r7 a "+a :n
    cons!dera=!e even(+a"e"e consec!n=e &en(r+ s!ne s! &en(r+ a"=!!8 aceas(a &oa(e d+ce "a
    sc!%'7r! 'r+O(e de serv!c!+, de do%!c!"!+ sa+ de re"a=!!. Ind!v!/!! c+ (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 .!nd a .! !r!(a'!"! O! a$res!v! s! se &o( an$a@a :n %od re&e(a(
    :n "+&(e cor& "a cor& or! co%!( ac(e de a$res!v!(a(e cor&ora"7 E!nc"+s!v 'a(erea so=!e!
    sa+ co&!"+"+!J Ecr!(er!+" AIJ. Ac(e"e a$res!ve, care s+n( necesare &en(r+ a se a&7ra &e
    s!ne sa+ &e or!care a"(+", n+ s+n( cons!dera(e a . ! o &ro'7 &en(r+ aces( !(e%. AceO(!
    !nd!v!/! %an!.es(7, de ase%enea, o descons!derare nec+$e(a(7 .a(7 de s!$+ran=a "or
    sa+ a a"(ora Ecr!(er!+" AYJ. Aceas(a se ev!den=!a/7 &r!n co%&or(a%en(+" "or "a
    cond+cerea +n+! ve!c+" Ede&7O!r! de v!(e/7 re&e(a(e, cond+s :n (!%& ce s+n(
    !n(o<!ca=!, acc!den(e %+"(!&"eJ. E! se &o( an$a@a :n co%&or(a%en(e se<+a"e sa+ :n
    +/+" +ne! s+'s(an=e care are +n r!sc cresc+( de consec!n=e d7+n7(oare. Po( ne$"!@a sa+
    n+ re+Oesc s7 a!'7 $r!@7 de +n co&!", or! &+n co&!"+" :n &er!co".
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 (!nd, de ase%enea, a .!
    !res&onsa'!"! :n %od cons(an( O! e<(re% Ecr!(er!+" ARJ. Co%&or(a%en(+"
    !res&onsa'!" :n %+nc7 &oa(e .! !nd!ca( &r!n &er!oade"e se%n!.!ca(!ve de s(a( .7r7
    serv!c!+ :n d!s&re=+" +nor o&r(+n!(7=! de servc!+ d!s&on!'!"e, or! &r!n a'andonarea
    %a! %+"(or serv!c!! .7r7 a avea +n &"an rea"!s( de a o'=!ne +n a"( serv!c!+. De
    ase%enea, &oa(e e<!s(a +n &a((ern de a'sen=e re&e(a(e de "a "+cr+ care n+ s+n(
    e<&"!ca(e &r!n(r4o %a"ad!e, .!e a "or :nO!O!, .!e :n .a%!"!a "or. Ires&onsa'!"!(a(ea
    .!nanc!ar7 es(e !nd!ca(7 &r!n ac(e ca neac!(area da(or!!"or, !nca&ac!(a(ea de a o.er!
    co&!"+"+! s+&or( or! !nca&ac!(a(ea de a s+s=!ne a"=! de&enden=! :n %od re$+"a(.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 a+ .oar(e &+=!n7 re%+Ocare
    &en(r+ consec!n=e"e ac(e"or "or Ecr!(er!+" AHJ. E! &o( .! !nd!.eren=! or! o.er7 o
    @+s(!.!care s+&er.!c!a"7 &en(r+ .a&(+" de a .! v7(7%a(, %a"(ra(a( or! .+ra( de "a c!neva
    45E2? Tulburarea de #ersonalitate
    Antisocial
    ?54
    Ede e<., Snedre&(a(ea v!e=!!T, S&erdan=!! %er!(7 s7 &!ard7T, or! Se" ar .! av+( &ar(e de
    as(a or!c+%TJ. AceO(! !nd!v!/! &o( '"a%a v!c(!%e"e &en(r+ c7 ar .! ne'+ne,
    nea@+(ora(e, or! c7 :O! %er!(7 soar(a8 e! &o( %!n!%a"!/a consec!n=e"e v7(7%7(oare a"e
    ac=!+n!"or "or or! %an!.es(7 &+r s! s!%&"+ o !nd!.eren=7 (o(a"7, :n $enera", s+n(
    !nca&a'!"! s7 co%&ense/e or! s7 &"7(easc7 da+ne &en(r+ co%&or(a%en(+" "or. E! &o(
    crede c7 (oa(7 "+%ea re.+/7 s7 Sa@+(e &e s+'se%na=!!T O! c7 c!neva (re'+!e s7 se
    o&reasc7 "a n!%!c+r! s&re a ev!(a s7 n+ .!e "7sa( :n &acce.
    Co%&or(a%en(+" an(!soc!a" n+ (re'+!e s7 a&ar7 e<c"+s!v :n c+rs+" sc!/o.ren!e!
    sa+ a" +n+! e&!sod %an!aca" Ecr!(er!+" DJ.
    *lemente ,i tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 s+n( "!&s!=! .recven( de e%&a(!e
    O! (!nd a .! cr+/!, c!n!c! O! d!s&re=+!(or! .a=7 de sen(!%en(e"e, dre&(+r!"e O! s+.er!n=e"e
    a"(ora. E! &o( avea o s(!%7 de s!ne e<a$era(7 s! aro$an(7 Ede e<., cons!der7 c7 %+nca
    ord!nar7 es(e %a! &re@os de e! or! "!&sa +ne! &reoc+&7r! rea"!s(e re.er!(oare "a
    &ro'"e%e"e "or c+ren(e or! "a v!!(or+" "orJ O! &o( .! e<ces!v de o's(!na=!, s!$+r! de s!ne
    sa+ !n.a(+a=!. Po( &re/en(a +n .ar%ec a&aren(, s+&er.!c!a", s! &o( .! .oar(e vo"+'!"! O!
    .ac!"! ver'a" Ede e<., +/ea/7 de (er%en! (en!c! sa+ de @ar$on care !%&res!onea/7 &e
    or!c!ne care n+ es(e .a%!"!ar!/a( c+ s+'!ec(+"J. L!&sa de e%&a(!e, s(!%a de s!ne
    e<a$era(7 O! .ar%ec+" s+&er.!c!a" s+n( e"e%en(e care a+ .os( !nc"+se .recven( :n
    conce&(e"e (rad!=!ona"e de &s!o&a(!e O! &o( .! e<(re% de d!s(!nc(!ve &en(r+
    (+"'+rarea de &ersona"!(a(e an(!soc!a"7 :n :nc!soare sa+ :n cadr+" %ed!co"e$a", +nde
    ac(e"e cr!%!na"e, de"!ncven(e sa+ a$res!ve es(e .oar(e &os!'!" s7 .!e nes&ec!.!ce. AceO(!
    !nd!v!/! &o( .!, de ase%enea, !res&onsa'!"! O! e<&"oa(a(or! :n re"a=!!"e "or se<+a"e. E!
    &o( avea +n !s(or!c de %+"(e &ar(enere se<+a"e O! &o( s7 n+ .! s+s=!n+( n!c!oda(7 o
    re"a=!e %ono$a%7. Po( .! !res&onsa'!"! ca &7r!n=!, d+&7 c+% es(e ev!den=!a( de
    %a"n+(r!=!a +n+! co&!", de o %a"ad!e a co&!"+"+! re/+"(And d!n "!&sa +n+! %!n!%+%
    de !$!en7, de de&enden=a co&!"+"+! de vec!n! sa+ de r+de care "oc+!esc :n a"(7 &ar(e,
    &en(r+ %Ancare sa+ ad7&os(, de !nca&ac!(a(ea de a an$a@a o 'on7 &en(r+ +n co&!"
    %!c, cAnd !nd!v!d+" es(e de&ar(e de cas7, or! de ce"(+!rea re&e(a(7 a 'an!"or necesar!
    :n(re=!ner!! .a%!"!e!. AceO(! !nd!v!/! &o( .! e"!'era=! :n %od de/onoran( d!n ar%a(7, &o(
    .! !nca&a'!"! s7 se :n(re=!n7, se &o( &a+&er!/a O! &o( r7%Ane c!ar .7r7 "oc+!n=7 or! :O!
    &e(rec %+"=! an! :n !ns(!(+=!! &ena"e. Ma! %+"( decA( oa%en!! d!n &o&+"a=!a $enera"7,
    es(e .oar(e &ro'a'!" ca !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 s7 %oar7
    &re%a(+r &r!n %!@"oace v!o"en(e Ede e<., s+!c!d, acc!den(e O! o%+c!der!J.
    Ind!v!/!! c+ aceas(7 (+"'+rare &o(, de ase%enea, e<&er!en=a d!s.or!e, !nc"+/And
    ac+/e de (ens!+ne, !nca&ac!(a(e de a (o"era &"!c(!sea"a O! d!s&o/!=!e de&res!v7. E!
    &o( avea asoc!a(e (+"'+r7r! an<!oase, (+"'+r7r! de&res!ve, (+"'+r7r! :n "e$7(+r7 c+
    o s+'s(an=7, (+"'+rare de so%a(!/are, @oc de Oans7 &a(o"o$!c s! a"(e (+"'+r7r! a"e
    con(ro"+"+! !%&+"s+"+!. .Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7, a+
    adesea O! e"e%en(e de &ersona"!(a(e care sa(!s.ac cr!(er!!"e &en(r+ a"(e (+"'+r7r! de
    &ersona"!(a(e, :n s&ec!a" &en(r+ (+"'+r7r!"e de &ersona"!(a(e 'order"!ne, !s(r!on!c7
    s! narc!s!s(!c7. Pro'a'!"!(a(ea de a de/vo"(a (+"'+rarea de &ersona"!(a(e an(!soc!a"7
    :n v!a=a ad+"(7 es(e cresc+(7, dac7 !nd!v!d+" a e<&er!en(a( +n de'+( &recoce a"
    (+"'+r7r!! de cond+!(7 E:na!n(e de e(a(ea de 5L an!J, aco%&an!!nd (+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e. Ma"(ra(area sa+ ne$"!@area co&!"+"+!, ed+ca=!a
    &aren(a"7 !ncons(an(7 sa+ ca&r!c!oas7 or! d!sc!&"!na &aren(a"7 !nadecva(7 &o(
    creO(e &ro'a'!"!(a(ea ca (+"'+rarea de cond+!(7 s7 evo"+e/e :n (+"'+rare de
    &ersona"!(a(e an(!soc!a"7.
    ?5H Tulburrile de #ersonalitate
    *lemente speci$ice culturii, etii ,i sexului
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7 &are a .! asoc!a(7 c+ +n s(a(+s soc!o4eco4
    no%!c !n.er!or s! c+ %ed!+" +r'an A+ .os( avansa(e o&!n!!, c+% c7 d!a$nos(!c+"
    &oa(e .! a&"!ca( +neor! :n %od erona( !nd!v!/!"or :n s!(+a=!! :n care co%&or(a%en(+",
    ev!den( an(!soc!a", &oa(e .! &ar(e a +ne! s(ra(e$!! &ro(ec(oare de s+&rav!e=+!re :n
    eva"+area (r7s7(+r!"or an(!soc!a"e, es(e +(!" &en(r+ c"!n!c!an s7 !a :n cons!dera=!e
    con(e<(+" soc!a" s! econo%!c :n care s+rv!n co%&or(a%en(e"e
    Pr!n de.!n!=!e, &ersona"!(a(ea an(!soc!a"7 n+ &oa(e .! d!a$nos(!ca(7 :na!n(e de
    e(a(ea de 5G an! T+"'+rarea de &ersona"!(a(e an(!soc!a"7 es(e %+"( %a! .recven(7 "a
    '7r'a=! decA( "a .e%e! A+ e<!s(a( o&!n!!, c+% c7 (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7 &oa(e .! s+'d!a$nos(!ca(7 "a .e%e!, :n s&ec!a" d!n ca+/a accen(+"+!
    &+s &e !(e%n de a$res!v!(a(e :n de.!n!=!a (+"'+r7% de cond+!(7
    #revalent
    Preva"en(a $enera"7 a (+"'+r7% de &ersona"!(a(e an(!soc!a"7 &e esan(!oane"e
    co%+n!(are es(e de a&ro<!%a(!v ;d "a '7r'a=! s! de a&ro<!%a(!v 5d "a .e%e!
    Preva"en(a es(!%a(7 :n cond!=!! c"!n!ce a vAna( de "a ;d "a ;Ld, :n .+nc=!e de
    carac(er!s(!c!"e &redo%!nan(e a"e &o&+"a=!e! eOan(!onare Ra(e de &reva"en(e %a!
    %ar! :nc7 se o'serv7 :n con(e<(e de (ra(a%en( &en(r+ a'+/ de o s+'s(an=7 s! :n
    cond!=!! de :nc!soare sa+ %ed!co"e$a"e
    *voluie
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7 are o evo"+=!e cron!c7, dar &oa(e deven!
    %a! &+=!n e_ !den(7 sa+ se &oa(e re%!(e &e %7s+r7 ce !nd!v!d+" :na!n(ea/7 :n e(a(e,
    :n s&ec!a" :n cea de a &a(ra decad7 de v!a(7 DeO! aceas(7 re%!s!+ne (!nde a .!
    ev!den(7 :n s&ec!a" s+' as&ec(+" an$a@7% :n co%&or(a%en(+" !n.rac=!ona", es(e
    &os!'!" s7 e<!'(e o d!%!n+are :n :n(re$ s&ec(r+" de co%&or(a%en(e an(!soc!a"e s! :n
    +/+" de o s+'s(an=7
    #attern $amilial
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7 es(e %a! .recven(7 &r!n(re r+de"e
    '!o"o$!ce de $rad+" I decA( :n &o&+"a=!a $enera"7 R!sc+" &en(r+ r+de"e '!o"o$!ce a"e
    .e%e!"or c+ aceas(7 (+"'+rare (!nde a .! %a! %are decA( r!sc+" r+de"or '!o"o$!ce a"e
    '7r'a=!"or c+ aceas(7 (+"'+rare R+de"e '!o"o$!ce a"e &ersoane"or c+ aceas(7
    (+"'+rare s+n(, de ase%enea, e<&+se +n+! r!sc cresc+( de (+"'+rare de so%a(!/are s!
    de (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7 :n(r4o .a%!"!e care are +n %e%'r+ c+
    (+"'+rare de &ersona"!(a(e an(!soc!a"7, '7r'a=!! a+ ce" %a! adesea (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 s! (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7, &e cAnd .e%e!"e a+
    ce" %a! adesea (+"'+rare de so%a(!/are :n as(.e" de .a%!"!! e<!s(7 :ns7 o creO(ere :n
    &reva"en(7 a (+(+ror aces(or (+"'+r7r!, a(A( "a '7r'a=! cA( s! "a .e%e!, :n co%&ara=!e
    c+ &o&+"a=!a $enera"7 S(+d!!"e &e ado&(a=! !nd!c7 .a&(+" c7, a(A( .ac(or!! $ene(!c!, cA(
    s! ce! de %ed!+ con(r!'+!e "a r!sc+" aces(+! $r+& de (+"'+r7r! A(A( co&!!! ado&(a=!,
    cA( s! ce! '!o"o$!c! a! &7r!n=!"or c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 a+ +n r!sc
    cresc+( de de/vo"(are a (+"'+r7r!! de &ersona"!(a(e an(!soc!a"7, (+"'+r7r!! de
    so%a(!/are s! (+"'+r7r!"or :n "e$7(+r7 c+ o s+'s(an=7 Co&!!! ado&(a=! de&7r(a=!
    sea%7n7 %a! %+"( c+ &7r!n=!! "or '!o"o$!c! decA( c+ &7r!n=!! ado&(!v!, dar %ed!+"
    .a%!"!e! ado&(!ve !n."+en=ea/7 r!sc+" de de/vo"(are a +ne! (+"'+r7r! de &ersona"!(a(e
    s! &s!o&a(o"o$!c! asoc.a(7
    45E ? Tulburarea de #ersonalitate
    Antisocial
    G+<
    Dia!nostic di$erenial
    D!a$nos(!c+" de (+"'+rare de &ersona"!(a(e an(!soc!a"7 n+ se &+ne !nd!v!/!"or s+'
    e(a(ea de 5G a% or! se &+ne n+%a! dac7 e<!s(7 +n !s(or!c de +ne"e s!%&(o%e de
    (+"'+rare de cond+!(7 :na!n(e de e(a(ea de 5Y an! Pen(r+ !nd!v!/!! :n e(a(e de &es(e
    5G an!, +n d!a$nos(!c de (+"'+rare de cond+!(7 es(e &+s n+%a! dac7 n+ s+n(
    sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea de &ersona"!(a(e an(!soc!a"7
    CAnd co%&or(a%en(+" an(!soc!a" "a +n ad+"( es(e asoc!a( c+ o (+"'+rare :n
    "e$7(+r7 c+ o s+'s(an=7, d!a$nos(!c+" de (+"'+rare de &ersona"!(a(e an(!soc!a"7 es(e
    &+s n+%a! dac7 se%ne"e de (+"'+rare de &ersona"!(a(e an(!soc!a"7 era+, de
    ase%enea, &re/en(e :n co&!"7r!e s! a+ con(!n+a( :n &enoda ad+"(7 CAnd +/+" de o
    s+'s(an=7 s! co%&or(a%en(+" an(!soc!a" :nce& a%'e"e :n co&!"7r!e s! con(!n+7 :n
    &er!oada ad+"(7, (re'+!e s7 .!e d!a$nos(!ca(e, a(A( (+"'+rarea :n "e$7(+r7 c+ o
    s+'s(an=7, cA( s! (+"'+rarea de &ersona"!(a(e an(!soc!a"7, dac7 s+n( sa(!s.7c+(e
    cr!(er!!"e &en(r+ a%'e"e, c!ar dac7 +ne"e ac(e an(!soc!a"e &o( .! consec!n=a (+"'+r7%
    :n "e$7(+r7 c+ o s+'s(an=7 Ede e<, vAn/area !"e$a"7 de dro$+r! or! .+r(+", s&re a
    o'=!ne %a! %+"=! 'an! &en(r+ dro$+r!J Co%&or(a%en(+" an(!soc!a" care s+rv!ne
    e<c"+s!v :n c+rs+" sc!/o.ren!e! or! a" e&!sod+"+! %an!aca" n+ (re'+!e s7 .!e
    d!a$nos(!ca( ca (+"'+rare de &ersona"!(a(e an(!soc!a"7
    A"(e (+"'+r7r! de &ersona"!(a(e &o( + con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    an(!soc!a"7, deoarece a+ an+%!(e e"e%en(e :n co%+n Ca a(are, es(e necesar s7 se .ac7
    d!s(!nc=!e :n(re aces(e (+"'+r7r! &e 'a/a d!.eren=e"or d!n(re e"e%en(e"e "or
    carac(er!s(!ce Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7 (+"'+rarea de
    &ersona"!(a(e an(!soc!a"7, &o( .! d!a$nos(!ca(e s! aces(ea Ind!v!/!! c+ (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 s! ce! c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 a+ :n
    co%+n (end!n=a de a .! ca"c+"a=!, nes!ncer!, s+&er.!c!a"!, e<&"oa(a(or! s! "!&s!=! de
    e%&a(!e T+"'+rarea de &ersona"!(a(e narc!s!s(!c7 n+ !nc"+de :ns7 carac(er!s(!c!"e de
    !%&+"s!v!(a(e, a$res!v!(a(e s! !%&os(+r7 :n &"+s, !nd!v!/!! c+ (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 &o( s7 n+ a!'7 neces!(a(ea de a .! ad%!ra=! s! n!c! s7 .!e
    !nv!d!oO! &e a"=!!, !ar &ersoane"e c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 n+ a+, de
    re$+"7, !s(or!c+" de (+"'+rare de cond+!(7 :n co&!"7r!e or! de co%&or(a%en(
    !n.rac=!ona" :n &er!oada ad+"(7 Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"a s!
    ce! c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 a+ :n co%+n (end!n=a de a .! !%&+"s!v!,
    s+&er.!c!a"!, de a c7+(a e<c!(a=!a, de a .! reca"c!(ran=!, sed+c7(or! s! %a%&+"a(!v!, :ns7
    &ersoane"e c+ (+"'+rare de &ersona"!(a(e !s(! !on!c7 (!nd a .! %a! e<a$era(e :n
    e%o=!!"e "or s! de re$+"7 n+ she an$a@ea/7 :n co%&or(a%en(e an(!soc!a"e Ind!v!/!! c+
    (+"'+r7r!"e de &ersona"!(a(e !s(r!on!c7 s! 'order"%e s+n( %a%&+"a(!v! s&re a o'=!ne
    a(en=!e, &e cAnd a]e! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 s+n( %a%&+"a(!v! s&re
    a o'=!ne +n &ro.!(, &+(ere or! vreo a"(7 $ra(!.!ca(!e %a(er!a"7 Ind!v!/!! c+ (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 (!nd a .! %a! &+=!n !ns(a'!"! e%o=!ona" s! %a! a$res!v! decA(
    ce! c+ (+"'+rare de &ersona"!(a(e 'order"%e DeO! co%&or(a%en(+" an(!soc!a" &oa(e .!
    &re/en( "a +n+ !nd!v!/! c+ (+"'+rare de &ersona"!(a(e &arano!d7, e" n+ es(e %o(!va(
    de re$+"7 de dor!n=a de cAO(!$ &ersona" or! de a e<&"oa(a &e a"=!!, ca :n (+"'+rarea de
    &ersona"!(a(e an(!soc!a"7, c! es(e da(ora( %a! c+rAnd dor!n=e! de r7/'+nare
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7 (re'+!e s7 .!e d!s(!ns7 de co%&or(a%en(+"
    !n.rac=!ona" :n(re&r!ns &en(r+ 'ene.!c!+ s! care n+ es(e aco%&an!a( de e"e%en(e de
    &ersona"!(a(e carac(er!s(ce aces(e! (+"'+r7r! Co%&or(a%en(+" an(!soc!a" ad+"(,
    E%en=!ona( :n sec=!+nea SA"(e cond!=!! care &o( .! cen(r+" a(en=!e! c"!n!ceT, &a$. H;FJ
    &oa(e .! +(!"!/a( &en(r+ a desene co%&or(a%en(+" !n.rac=!ona", a$res!v sa+ an(!soc!a"
    HLR Tulburrile de #ersonalitate
    care a@+n$e a .! s+&+s a(en=!e! c"!n!ce, dar care n+ sa(!s.ace cr!(er!!"e &en(r+
    (+"'+rarea de &ersona"!(a(e an(!soc!a"7. N+%a! cAnd (r7s7(+r!"e de &ersona"!(a(e s+n(
    !n."e<!'!"e, de/ada&(a(!ve s! &ers!s(en(e s! ca+/ea/7 o de(er!orare .+nc=!ona"7
    se%n!.!ca(!v7 or! de(res7 s+'!ec(!v7 cons(!(+!e (+"'+rare de &ersona"!(a(e an(!soc!a"7.
    Criteriile $e $ia/no&ti# pentru
    4+*.G Tul-urarea $e Per&onalitate Anti&o#ial(
    A2 *xist un pattern pervasiv de desconsiderare ,i violare a drepturilor altora
    apr@nd de la etatea de EA ani, ca indicat de trei &sau mai multe) dintre
    urmtoareleD
    (1) incapacitate de a se con$orma normelor sociale "n le!tur cu comporta
    mentele le!ale, indicat de comiterea repetat de acte care constituie
    motive de arest3
    (2) incorectitudine, indicat de minitul repetat, u(ul de alibiuri,
    manipularea
    altora pentru pro$it sau plcere personal3
    (1) impulsivitate sau incapacitate de a plnui dinainte3
    (3) iritabilitate si a!resivitate, indicate de luptele sau atacurile
    corporale
    repetate3
    (2) ne!li0en nesbuit pentru si!urana sa sau a altora3
    (4) iresponsabilitate considerabil, indicat prin incapacitatea repetat de a avea
    un comportament consecvent "n munc ori de a-si onora obli!aiile $inanciare3
    (5) lipsa de remuscare, indicat prin a $i indi$erent ori a 0usti$ica de ce a
    $cut
    s su$ere ori a maltratat sau a $urat de la altul2
    S2 Individul este "n etate de cel puin E8 ani2
    2 *xist proba unei tulburri de conduit &ve(i pa!2 68) cu debut "nainte de EA ani2
    D2 omportamentul antisocial nu survine exclusiv "n cursul sc%i(o$reniei ori al
    unui episod maniacal2
    4+*.>4 Tul-urarea $e Per&onalitate 8or$erline
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e 'order"!ne :" cons(!(+!e +n
    &a((ern &ervas!v de !ns(a'!"!(a(e a re"a=!!"or !n(er&ersona"e, a !%a$!n!! de s!ne s! a
    a.ec(e"or s! !%&+"s!v!(a(e %arca(7, care :nce&e &recoce :n &er!oada ad+"(7 s! es(e
    &re/en( :n(r4o var!e(a(e de con(e<(e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne .ac e.or(+r! d!s&era(e &en(r+ a
    ev!(a a'andon+" rea" sa+ !%a$!nar Ecr!(er!+" 5J. Perce&erea se&ar7r!! sa+ re@ec=!e!
    !%!nen(e sa+ &!erderea s(r+c(+r!! e<(erne &o( d+ce "a %od!.!c7r! &ro.+nde :n
    !%a$!nea de s!ne, a.ec(, c+noaO(ere s! co%&or(a%en(. AceO(! !nd!v!/! s+n( .oar(e
    sens!'!"! "a c!rc+%s(an=e"e a%'!en(a"e. E! e<&er!en(ea/7 .r!c! !n(ense de a'andon s!
    o %An!e !nadecva(7, c!ar cAnd s+n( con.r+n(a=! c+ o se&arare rea"7 &e +n (!%&
    "!%!(a(, or! cAnd e<!s(7 %od!.!c7r! !nev!(a'!"e :n &"an Ede e<., d!s&erare 'r+sc7 dre&(
    r7s&+ns "a an+n=area de c7(re c"!n!c!an a (er%!n7r!! ore!8 &an!c7 sa+ .+r!e cAnd
    c!neva !%&or(an( &en(r+ e! :n(Ar/!e cA(eva %!n+(e sa+ (re'+!e s7 an+"e/e o
    45E284 Tulburarea de #ersonalitate
    Sorderline
    G+G
    :n(A"n!reJ. E! &o( crede c7 aceas(7 Sa'andonareT !%&"!c7 .a&(+" c7 e! s+n( Sr7!T.
    Aces(e .r!c! de a'andonare s+n( :n "e$7(+r7 c+ !n(o"eran=a .a=7 de a .! s!n$+r! s!
    neces!(a(ea de a avea a"=! oa%en! c+ e!. E.or(+r!"e "or d!s&era(e de a ev!(a
    a'andonarea &o( !nc"+de ac=!+n! !%&+"s!ve, c+% ar .! a+(o%+(!"area sa+
    co%&or(a%en(e"e s+!c!dare, care s+n( descr!se se&ara( "a cr!(er!+" Y.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne a+ +n &a((ern de re"a=!! !ns(a'!"e
    s! !n(ense Ecr!(er!+" 9J. E! &o( !dea"!/a &o(en=!a"!! (+(or! sa+ !+'!=! de "a &r!%a sa+ de
    "a a do+a :n(A"n!re, cer s7 &e(reac7 %+"( (!%& :%&re+n7 O! d!v+"$7 c!ar O! ce"e %a!
    !n(!%e de(a"!! :nc7 de "a :nce&+(+" re"a=!e!. E! &o( (rece, :ns7, ra&!d de "a !dea"!/area
    a"(or oa%en! "a deva"or!/area "or, avAnd !%&res!a c7 cea"a"(7 &ersoan7 n+ se oc+&7
    s+.!c!en( de e!, n+ "e o.er7 s+.!c!en(, n+ se a."7 Saco"oT, "An$7 e!, des(+". AceO(!
    !nd!v!/! &o( s!%&a(!/a s! .! a(en=! c+ a"=! oa%en!, :ns7 n+%a! :n s&eran=a c7 cea"a"(7
    &ersoan7 va .! Saco"oT &en(r+ a sa(!s.ace :n sc!%', "a cerere, &ro&r!!"e "or neces!(7=!.
    AceO(! !nd!v!/! s+n( :nc"!na=! s&re sc!%'7r! dra%a(!ce :n &7rerea "or des&re a"=!!,
    care &o( .! v7/+=!, a"(erna(!v, ca s+&or(+r! 'ene.!ce or! ca o &edea&s7 cr+d7. As(.e" de
    sc!%'7r! re."ec(7 adesea de/!"+/!a .a=7 de +n (+(ore a"e c7r+! ca"!(7=! ed+ca=!ona"e
    a+ .os( !dea"!/a(e or! a c7r+! re@ec=!e sa+ a'andon es(e aO(e&(a(7.
    Poa(e e<!s(a o &er(+r'are de !den(!(a(e carac(er!/a(7 &r!n(r4o !%a$!ne de s!ne sa+
    conO(!!n=7 de s!ne %arca( O! &ers!s(en( !ns(a'!"7 Ecr!(er!+" ;J. E<!s(7 sc!%'7r! 'r+O(e
    O! dra%a(!ce :n !%a$!nea de s!ne, carac(er!/a(e &r!n sc!%'area o'!ec(!ve"or,
    va"or!"or O! as&!ra=!!"or &ro.es!ona"e. Po( e<!s(a sc!%'7r! 'r+O(e :n o&!n!!"e O!
    &"an+r!"e :n "e$7(+r7 c+ car!era, !den(!(a(ea se<+a"7, va"or!"e s! (!&+r!"e de a%!c!.
    AceO(! !nd!v!/! &o( (rece 'r+sc de "a ro"+" +n+! s7rac care so"!c!(a a@+(or, "a ce" a" +n+!
    r7/'+n7(or :ndre&(7=!( a" +n+! (ra(a%en( erona( a&"!ca( an(er!or. DeO! a+ de re$+"7
    o !%a$!ne de s!ne 'a/a(7 &e .a&(+" de a .! r7! sa+ !%ora"!, !nd!v!/!! c+ aceas(7
    (+"'+rare &o( avea +neor! sen(!%en(+" c7 e! n+ e<!s(7 de"oc. As(.e" de e<&er!en=e
    a&ar de re$+"7 :n s!(+a=!!"e :n care !nd!v!d+" s!%(e "!&sa +ne! re"a=!! se%n!.!ca(!ve, a
    (+(e"7r!! s! s+&or(+"+!. AceO(! !nd!v!/! &o( &re/en(a o &er.or%an=7 sc7/+(7 :n(r4o
    ac(!v!(a(e nes(r+c(+ra(7 or! :n s!(+a=!! Oco"are.
    Ind!v!/!! c+ aceas(7 (+"'+rare %an!.es(7 !%&+"s!v!(a(e :n ce" &+=!n do+7 do%en!!,
    care s+n( &o(en=!a" a+(o&re@+d!c!an(e Ecr!(er!+" IJ. E! &o( @+ca @oc+r! de Oans7, ce"(+!
    'an!! :n %od !res&onsa'!", %Anca co%&+"s!v, a'+/a de o s+'s(an=7, se &o( an$a@a :n
    re"a=!! se<+a"e &er!c+"oase or! &o( cond+ce !%&r+den(. Ind!v!/!! c+ (+"'+rarea de
    &ersona"!(a(e 'order"!ne %an!.es(7 +n co%&or(a%en( s+!c!dar rec+ren(, $es(+r!,
    a%en!n=7r! or! co%&or(a%en( a+(o%+(!"an( Ecr!(er!+" YJ. S+!c!d+" co%&"e( s+rv!ne "a
    Gd45Ld d!n as(.e" de !nd!v!/!, !ar ac(e"e a+(o%+(!"an(e Ede e<., (7!a(+" or! ars+"J s!
    a%en!n=7r!"e s! (en(a(!ve"e de s+!c!d s+n( .oar(e .recven(e. S+!c!da"!(a(ea rec+ren(7 es(e
    adesea %o(!v+" &en(r+ care aceO(! !nd!v!/! se &re/!n(7 &en(r+ a@+(or. Aces(e ac(e
    a+(odes(r+c(!ve s+n( &rec!&!(a(e de re$+"7 de a%en!n=7r!"e de se&arare sa+ de re@ec=!e
    or! de even(+a"!(a(ea ca e! s74O! as+%e o res&onsa'!"!(a(e cresc+(7. A+(o%+(!"area &oa(e
    s+rven! :n c+rs+" e<&er!en=e"or d!soc!a(!ve O! adesea ad+ce +O+rare &r!n rea.!r%area
    ca&ac!(7=!! de a s+.er! or! &r!n e<&!erea sen(!%en(+"+! !nd!v!d+"+! c7 es(e &7c7(os.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne &o( %an!.es(a !ns(a'!"!(a(e
    a.ec(!v7, care se da(orea/7 +ne! reac(!v!(7=! %arca(e a d!s&o/!=!e! Ede e<., d!s.or!e
    e&!sod!c7 !n(ens7, !r!(a'!"!(a(e sa+ an<!e(a(e d+rAnd cA(eva ore s! n+%a! rar, %a!
    %+"( de cA(eva /!"eJ Ecr!(er!+" RJ. D!s&o/!=!a d!s.or!c7 de 'a/7 a ce"or c+ (+"'+rarea
    de &ersona"!(a(e 'order"!ne es(e :n(rer+&(7 adesea de &er!oade de %An!e, &an!c7 sa+
    d!s&erare O! es(e rar +O+ra(7 de &er!oade"e de '+n7s(are sa+ de sa(!s.ac=!e. Aces(e
    e&!soade &o( re."ec(a reac(!v!(a(ea e<(re%7 a !nd!v!d+"+! "a s(res+r! !n(er&ersona"e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne &o( .! deran@a=! de sen(!%en(e
    cron!ce de v!d Ecr!(er!+" HJ. UOor de &"!c(!s!(, e! s+n( :n %od cons(an( :n c7+(area a
    ceva de .7c+(. Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne &re/!n(7 .recven( o
    G+> Tulburrile de #ersonalitate
    %An!e !n(ens7 s! !nadecva(7 or! a+ d!.!c+"(7=! :n a4s! con(ro"a %An!a Ecr!(er!+" GJ. E!
    &o( .! e<(re% de sarcas(!c! O! &o( %an!.es(a o s(are de an!%o/!(a(e d+ra'!"7 or! accese
    ver'a"e. MAn!a es(e &rovoca(7 adesea cAnd +n (+(ore or! !+'!(+" es(e v7/+( ca
    ne$"!@en(, re=!n+(, !nd!.eren( or! de$a@a(. As(.e" de %an!.es(7r! co"eroase s+n( +r%a(e
    adesea de r+O!ne s! c+"&7, O! con(r!'+!e "a sen(!%en(+" c7 e! s+n( r7!. :n (!%&+"
    &er!oade"or de s(res e<(re%, &oa(e a&are o !dea(!e &arano!d7 (ran/!(or!e sa+
    s!%&(o%e d!soc!a(!ve Ede e<., de&ersona"!/areJ Ecr!(er!+" FJ, dar aces(ea s+n( :n
    $enera" de sever!(a(e sa+ d+ra(7 !ns+.!c!en(7 &en(r+ a @+s(!.!ca +n d!a$nos(!c
    ad!=!ona". Aces(e e&!soade s+rv!n ce" %a! .recven( ca r7s&+ns "a +n a'andon rea"
    sa+ !%a$!nar. S!%&(o%e"e (!nd a .! (ran/!(or!!, d+rAnd %!n+(e sa+ ore. Reven!rea
    rea"7 sa+ &erce&+(7 a a(en=!e! (+(ore"+! &oa(e d+ce "a re%!s!+nea s!%&(o%e"or.
    *lemente si tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e 'order"!ne &o( avea +n &a((ern de
    s+'%!nare a "or :nO!O! :n %o%en(+" :n care +n =e" es(e &e &+nc(+" de a .! rea"!/a( Ede
    e<., se "as7 de Ocoa"7 :na!n(e de a'so"v!re8 re$resea/7 cons!dera'!" d+&7 o d!sc+=!e
    des&re cA( de '!ne se des.7Ooar7 (era&!a8 d!s(r+$e o re"a=!e '+n7 c!ar cAnd es(e c"ar
    c7 re"a=!a &oa(e d+raJ. Un!! !nd!v!/! &re/!n(7 s!%&(o%e ase%7n7(oare ce"or &s!o(!ce
    Ede e<., a"+c!na=!!, d!s(ors!+n! a"e !%a$!n!! cor&ora"e, !de! de re.er!n=7 O! .eno%ene
    !&na$o$!ceJ :n (!%&+" &er!oade"or de s(res. Ind!v!/!! c+ aceas(7 (+"'+rare se s!%( %a!
    :n s!$+ran=7 c+ o'!ec(e de (ran/!=!e Ede e<., c+ +n an!%a" de cas7 or! c+ +n "+cr+
    !nan!%a(J decA( :n re"a=!!"e !n(er&ersona"e. Moar(ea &re%a(+r7 &r!n s+!c!d &oa(e
    s+rven! "a !nd!v!/!! c+ aceas(7 (+"'+rare, :n s&ec!a" "a ce! care a+ conco%!(en( O!
    (+"'+r7r! a.ec(!ve or! (+"'+r7r! :n "e$7(+r7 c+ o s+'s(an=7. Poa(e re/+"(a +n and!ca&
    .!/!c d!n co%&or(a%en(e"e de v7(7%are a+(o&rovoca(e or! d!n (en(a(!ve"e de s+!c!d
    eO+a(e. P!erder!"e re&e(a(e a"e serv!c!+"+!, :n(rer+&erea s(+d!!"or s! des.acerea
    c7s7(or!e! s+n( .recven(e. Ma"(ra(area .!/!c7 s! a'+/+" se<+a", ne$"!@en(a, con."!c(e"e
    os(!"e, &!erderea sa+ se&ararea &aren(a"7 &reoce s+n( %a! .recven(e :n !s(or!c+"
    co&!"7r!e! ce"or c+ (+"'+rare de &ersona"!(a(e 'order"!ne. T+"'+r7r!"e de &e a<a I c+
    care a&ar .recven( conco%!(en( !nc"+d (+"'+r7r!"e a.ec(!ve, (+"'+r7r!"e :n "e$7(+r7 c+
    o s+'s(an=7, (+"'+r7r!"e de co%&or(a%en( a"!%en(ar E:n s&ec!a" '+"!%!aJ, s(res+"
    &os((ra+%a(!c s! (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e. T+"'+rarea de
    &ersona"!(a(e 'order"!ne a&are .recven( conco%!(en( c+ a"(e (+"'+r7r! de &ersona"!(a(e.
    *lemente speci$ice culturii, etii ,i sexului
    Pa((ern+" de co%&or(a%en( :n(A"n!( :n (+"'+rarea de &ersona"!(a(e 'order"!ne a
    .os( !den(!.!ca( :n %+"(e "oc+r! d!n "+%e. Ado"escen=!! s! ad+"=!! (!ner! c+ &ro'"e%e
    de !den(!(a(e E:n s&ec!a" cAnd s+n( aco%&an!a(e de +/+" de o s+'s(an=7J &o(
    &re/en(a (ran/!(or co%&or(a%en(e care, :n %od erona(, &o( da !%&res!a de
    (+"'+rare de &ersona"!(a(e 'order"!ne. As(.e" de s!(+a=!! se carac(er!/ea/7 &r!n
    !ns(a'!"!(a(e e%o=!ona"7, d!"e%e Se<!s(en=!a"eT, !ncer(!(+d!ne, a"e$er! care &rovoac7
    an<!e(a(e, con."!c(e :n "e$7(+r7 c+ or!en(area se<+a"7 s! &res!+n! soc!a"e o&+se
    re.er!(oare "a a"e$erea car!ere!. T+"'+rarea de &ersona"!(a(e 'order"!ne es(e
    d!a$nos(!ca(7 &redo%!nan( "a .e%e! Ea&ro<!%a(!v HYd d!n ca/+r!J.
    #revalent
    Preva"en(a (+"'+r7r!! de &ersona"!(a(e 'ordr"!ne es(e es(!%a(7 a .! de a&ro<!%a(!v 9d
    :n &o&+"a=!a $enera"7, de a&ro<!%a(!v 5Ld &r!n(re !nd!v!/!! d!n d!n!c!*e de s7n7(a(e
    %en(a"7 c+ &ac!en=! a%'+"a(or! s! de a&ro<!%a(!v 9Ld &r!n(re &ac!en=!! &s!!a(r!c!
    !n(erna=!. Ea var!a/7 :n(re ;Ld s! RLd d!n &o&+"a=!a c"!n!c7 c+ (+"'+r7r! de &ersona"!(a(e.
    45E 84 Tulburarea de #ersonalitate
    Sorderlme
    8E4
    *voluie
    E<!s(7 o var!a'!(a(e cons!dera'!"7 :n evo"+=!a (+"'+r7% de &ersona"!(a(e
    'order"%e Ce" %a! .recven( &a((ern es(e ce" de !ns(a'!"!(a(e cron!c7 &recoce :n
    &er!oada ad+"(7, c+ e&!soade de d!scon(ro" a.ec(!v O! !%&+"s!v sever, s! n!ve"
    cresc+( de +(!"!/are a res+rse"or de s7n7(a(e s! de s7n7(a(e %en(a"7 De(er!orarea
    &r!n (+"'+rare s! r!sc+" de s+!c!d s+n( ce"e %a! %ar! :n ann &er!oade! de ad+"(
    (An7r s! d!%!n+a (re&(a(, oda(7 c+ avansarea :n e(a(e DeO! (end!n=a "a e%o=!!
    !n(ense, !%&+"s!v!(a(e O! !n(ens!(a(e :n re"a=!! d+rea/7 adesea (oa(7 v!a=a, !nd!v!/!!
    care se an$a@ea/7 :n !n(erven=!! (era&e+(!ce &re/!n(7 adesea a%e"!or7r! :nce&And
    +neor! c!ar d!n &r!%+" an :n c+rs+" ce"+! de a" &a(r+"ea s! de a" c!nc!"ea decen!+
    de v!a=7, %a@or!(a(ea !nd!v!/!"or c+ aceas(7 (+"'+rare a(!n$ o s(a'!"!(a(e %a! %are
    :n re"a=!!"e "or s! :n .+nc=!onarea "or &ro.es!ona"7 S(+d!!"e ca(a%nes(!ce &e !nd!v!/!
    !den(!.!ca=! :n c"%!c!"e de s7n7(a(e %en(a"7 c+ &ac!en=! a%'+"a(or! !nd!c7 .a&(+" c7
    d+&7 a&roa&e 5L a%, %a! %+"( de @+%7(a(e d!n(re !nd!v!/! n+ %a! &re/!n(7
    &a(((ern+" de co%&or(a%en( care sa(!s.ace cr!(er!!"e co%&"e(e &en(r+ (+"'+rarea
    de &ersona"!(a(e 'order"%e
    #attern $amilial
    T+"'+rarea de &ersona"!(a(e 'order"%e es(e de a&roa&e c!nc! or! %a! .recven(7
    &r!n(re r+de"e '!o"o$!ce de $rad+" I a"e ce"or c+ (+"'+rarea decA( :n &o&+"a=!a
    $enera"7 E<!s(7, de ase%enea, +n r!sc .a%!"!a" cresc+( de (+"'+r7r! :n "e$7(+r7 c+ o
    s+'s(an=7, de (+"'+rare de &ersona"!(a(e an(!soc!a"7 s! de (+"'+r7r! a.ec(!ve
    Dia!nostic di$erenial
    T+"'+rarea de &ersona"!(a(e 'order"%e a&are adesea conco%!(en( c+ (+"'+r7r!"e
    a.ec(!ve, s! cAnd '+n( sa(!s.7c+(e cr!(er!!"e &en(r+ a%'e"e, a%'e"e (re'+!e s7 .!e
    d!a$nos(!ca(e Deoarece (a'"o+" c"!n!c &e sec=!+ne (ransversa"7 a" (+"'+r7% de
    &ersona"!(a(e 'order"%e &oa(e .! %!%a( de +n e&!sod de (+"'+rare a.ec(!v7,
    c"!n!c!an+" (re'+!e s7 ev!(e s7 &+n7 +n d!a$nos(!c ad!=!ona" de (+"'+rare de
    &ersona"!(a(e 'order"%e n+%a! &e 'a/a (a'"o+"+! c"!n!c &e sec=!+ne (ransversa"7,
    .7r7 a 'e doc+%en(a dac7 &a((ern+" de co%&or(a%en( are +n de'+( &recoce s! o
    evo"+=!e de "+n$7 d+ra(7
    A"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    'order"%e, deoarece e"e a+ :n co%+n an+%!(e e"e%en(e De aceea, es(e !%&or(an(
    s7 'e .ac7 d!s(!nc=!e !n(re aces(e (+"'+r7r! &e 'a/a d!.eren(e"or d!n(re e"e%en(e"e "or
    carac(er!s(!ce Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7 (+"'+rarea
    de &ersona"!(a(e 'order"%e, &o( .! d!a$nos(!ca(e s! aces(ea DeO! s! (+"'+rarea de
    &ersona"!(a(e !s(r!on!c7 &oa(e .! carac(er!/a(7 &r!n c7+(area a(en=!e!,
    co%&or(a%en( de %an!&+"are s! %od!.!care ra&!d7 a e%o=!!"or, (+"'+rarea de
    &ersona"!(a(e 'order"%e se d!s(!n$e de aceas(a &r!n a+(od!s(r+c(!v!(a(e, :n(rer+&er!
    co"eroase :n re"a=!!"e !n(!%e s! sen(!%en(+" cron!c de !nsa(!s.ac=!e s! de
    s!n$+r7(a(e. Ide! &arano!de sa+ !"+/!! &o( .! &re/en(e a(A( :n (+"'+rarea de
    &ersona"!(a(e 'order"%e cA( s! :n (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7, dar
    aces(e s!%&(o%e s+n( %a! (rec7(oare, %a! reac(!ve !n(er&ersona" s! %a! sens!'!"e
    "a s(r+c(+rarea e<(ern7 :n (+"'+rarea de &ersona"!(a(e 'order"%e. DeO! (+"'+rarea
    de &ersona"!(a(e &arano!d7 O! (+"'+rarea de &ersona"!(a(e narc!s!s(!c7 &o( .!, de
    ase%enea, carac(er!/a(e &r!n reac=!! co"eroase "a s(!%+ %!nor!, s(a'!"!(a(ea re"a(!v7
    a !%a$!n!! de s!ne, &rec+% s!
    H5L Tulburrile de #ersonalitate
    re"a(!va "!&s7 a a+(od!s(r+c(!v!(7=!!, !%&+"s!v!(7=!! s! &reoc+&7r!"or :n "e$7(+r7 c+
    a'andon+", d!s(!n$ aces(e (+"'+r7r! de (+"'+rarea de &ersona"!(a(e 'order"!ne. C+
    (oa(e c7 (+"'+rarea de &ersona"!(a(e an(!soc!a"7 O! (+"'+rarea de &ersona"!(a(e
    'order"!ne se carac(er!/ea/7 a%'e"e &r!n co%&or(a%en( %an!&+"a(!v, !nd!v!/!! c+
    (+"'+rarea de &ersona"!(a(e an(!soc!a"7 s+n( %an!&+"a(!v! s&re a o'=!ne &ro.!(,
    &+(ere sa+ vreo a"(7 $ra(!.!ca=!e %a(er!a"7, &e cAnd sco&+" :n (+"'+rarea de
    &ersona"!(a(e 'order"!ne es(e :ndre&(a( %a! %+"( s&re o'=!nerea a(en=!e! (+(or!"or.
    A(A( (+"'+rarea de &ersona"!(a(e de&enden(7, cA( s! (+"'+rarea de &ersona"!(a(e
    'order"!ne se carac(er!/ea/7 &r!n .r!ca de a'andon, :ns7, !nd!v!d+" c+ (+"'+rare de
    &ersona"!(a(e 'order"!ne reac=!onea/7 "a a'andon c+ sen(!%en(+" de v!d e%o=!ona",
    .+r!e s! revend!care &e cAnd !nd!v!d+" c+ (+"'+rare de &ersona"!(a(e de&enden(7
    reac=!onea/7 c+ creO(erea conc!"!er!! s! s+&+ner!! s! ca+(7 +r$en( o re"a=!e
    s+'s(!(+an(7 care s74! o.ere (+(e"are O! s+&or(. T+"'+rarea de &ersona"!(a(e
    'order"!ne &oa(e .! d!s(!ns7, de ase%enea, de (+"'+rarea de &ersona"!(a(e
    de&enden(7, &r!n &a((ern+" (!&!c de re"a=!! !ns(a'!"e s! !n(ense.
    T+"'+rarea de &ersona"!(a(e 'order"!ne (re'+!e s7 .!e d!s(!ns7 de %od!.!carea de
    &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care (r7s7(+r!"e a&ar d!n
    ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e a s!s(e%+"+! nervos
    cen(ra". Ea (re'+!e s7 .!e d!s(!ns7, de ase%enea, de s!%&(o%e"e care &o( a&are :n
    asoc!ere c+ +/+" cron!c de o s+'s(an=7 Ede e<., (+"'+rarea :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ.
    T+"'+rarea de &ersona"!(a(e 'order"!ne (re'+!e s7 .!e d!s(!ns7 de &ro'"e%a de
    !den(!(a(e Eve/! &a$. HI5J, care es(e re/erva(7 &en(r+ &reoc+&7r!"e re.er!(oare "a
    !den(!(a(ea :n "e$7(+r7 c+ o .a/7 de de/vo"(are s! n+ es(e ca"!.!ca(7 ca (+"'+rare %en(a"7.
    Criteriile $e $ia/no&ti# pentru
    4+*.>4 Tul-urarea $e Per&onalitate 8or$erline
    A2 .n pattern pervasiv de instabilitate a relaiilor interpersonale, ima!inii de
    sine si a$ectelor, si impulsivitate marcat, "ncep@nd precoce "n perioada
    adult ,i pre(ent "ntr-o varietate de contexte, ca indicat de cinci &sau mai
    multe) dintre urmtoareleD
    (1)e$orturi disperate de a evita abandonul real sau ima!inar2 FotD Fu include
    comportamentul suicidar sau automutilant, care $i!urea( la criteriul A3
    (2).n pattern de relaii interpersonale intense ,i instabile caracteri(at prin
    alternare "ntre extremele de ideali(are ,i devalori(are3
    (3)perturbare de identitateD ima!ine de sine sau con,tiin de sine marcat ,i
    persistent instabil3
    (4)impulsivitate "n cel puin dou domenii care sunt potenial autopre0udi-
    ciante &de ex2, c%eltuieli, sex, abu( de o substan, condus imprudent,
    m@ncat compulsiv2 Not(M Fu include comportamentul suicidar sau
    automutlilant, care $i!urea( la criteriul A3
    (5)comportament, !esturi sau ameninri recurente de suicid ori compor
    tament automutilant3
    (6)instabilitate a$ectiv datorat unei reactiviti marcate a dispo(iiei &de
    ex2, dis$orie episodic intens, iritabilitate sau anxietate dur@nd de
    re!ul c@teva ore ,i numai rareori mai mult de c@teva (ile)3
    (7)sentimentul cronic de vid3
    45E2A5 Tulburarea de #ersonalitate
    Listrionic
    G**
    Criteriile $e $ia/no&ti# pentru
    4+*.>4 Tul-urarea $e Per&onalitate 8or$erline (continuare)
    (8) m@nie intens, inadecvat ori di$icultate "n a controla m@nia &de ex2, mani
    $estri $recvente de $urie, stare coleroas permanent, bti repetate)3
    (9) ideaie paranoid sau simptome disociative severe, tran(itorii, "n le!
    tur cu stresul2
    4+*.<+ Tul-urarea $e Per&onalitate Fi&trioni#(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e !s(r!on!ce :" cons(!(+!e
    e%o=!ona"!(a(ea &ervas!v7 O! e<ces!v7 s! co%&or(a%en(+" de c7+(are a a(en=!e!.
    Aces( co%&or(a%en( :nce&e &recoce :n &er!oada ad+"(7 s! es(e &re/en( :n(r4o
    var!e(a(e de con(e<(e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 s+n( !r!(a=! sa+ n+ se s!%(
    a&rec!a=! cAnd n+ se a."7 :n cen(r+" a(en=!e! Ecr!(er!+" 5J. Adesea, :n %od ac(!v O!
    dra%a(!c, e! (!nd s7 a(ra$7 a(en=!a as+&ra "or O!, !n!=!a", &o( :ncAn(a c+noO(!n=e"e no!
    &r!n en(+/!as%+", desc!derea ev!den(7 sa+ (end!n=a s&re ."!r(. Aces(e ca"!(7=! dev!n
    neconv!n$7(oare :ns7, &e %7s+r7 ce !nd!v!/!! con(!n+7 s7 cear7 s7 se a."e :n cen(r+"
    a(en=!e!. E! aca&area/7 ro"+" de Ss+."e( a" re+n!+n!!T. Dac7 n+ s+n( cen(r+" a(en=!e!, e!
    .ac ceva de e.ec( Ede e<., !nven(ea/7 :n(A%&"7r!, crea/7 sceneJ &en(r+ a a(ra$e cen(r+"
    a(en=!e! as+&ra "or. Aceas(7 neces!(a(e es(e ev!den(7 adesea :n co%&or(a%en(+" "or
    .a=7 de c"!n!c!an Ede e<., ."a(are, o.er!rea de cado+r!, descr!er! dra%a(!ce a"e s!%&(o4
    %e"or so%a(!ce s! &s!o"o$!ce, care s+n( :n"oc+!(e de s!%&(o%e no! "a .!ecare v!/!(7J.
    As&ec(+" O! co%&or(a%en(+" !nd!v!/!"or c+ aceas(7 (+"'+rare es(e adesea
    !nadecva( de &rovoca(or sa+ sed+c7(or se<+a" Ecr!(er!+" 9J. Aces( co%&or(a%en( es(e
    :ndre&(a( n+ n+%a! s&re &ersoane"e .a=7 de care !nd!v!d+" are +n !n(eres se<+a" sa+
    ro%an(!c, c! s+rv!ne :n(r4o $a%7 "ar$7 de re"a=!! soc!a"e, oc+&a=!ona"e O!
    &ro.es!ona"e, de&7O!nd ceea ce es(e adecva( con(e<(+"+! soc!a". E<&res!a e%o=!ona"7
    &oa(e .! s+&er.!c!a"7 O! ra&!d sc!%'7(oare Ecr!(er!+" ;J. Ind!v!/!! c+ aceas(7
    (+"'+rare +/ea/7 :n %od re$+"a( de as&ec(+" "or .!/!c &en(r+ a a(ra$e a(en=!a as+&ra
    "or Ecr!(er!+" IJ. E! s+n( e<(re% de &reoc+&a=! de !%&res!a &e care o .ace as+&ra
    a"(ora as&ec(+" "or, O! ce"(+!e .oar(e %+"( (!%&, ener$!e O! 'an! &e :%'r7c7%!n(e O!
    &en(r+ a se .ace cA( %a! a(r7$7(or!. Po( S&esc+! co%&"!%en(eT re.er!(oare "a as&ec(+"
    "or O! &o( .! +Oor s! e<ces!v de deran@a=! de +n co%en(ar!+ cr!(!c :n "e$7(+r7 c+
    as&ec(+" "or or! de o .o(o$ra.!e &e care e! o cons!der7 de.avora'!"7.
    AceO(! !nd!v!/! a+ +n s(!" de a vor'! care es(e e<(re% de va$ O! "!&s!( de de(a"!!
    Ecr!(er!+" YJ. O&!n!!"e .er%e s+n( e<&r!%a(e c+ ."er dra%a(!c, :ns7 %o(!ve"e
    s+'!acen(e s+n( de re$+"7 va$! O! d!.+/e, .7r7 .a&(e O! de(a"!! care s7 "e s+s=!n7. De
    e<e%&"+, +n !nd!v!d c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 &oa(e s&+ne c7 o
    an+%!(7 &ersoan7 es(e o .!!n=7 +%an7 %!n+na(7, :ns7 n+ es(e ca&a'!" s7 o.ere n!c!
    +n .e" de e<e%&"e de ca"!(7=! '+ne &en(r+ a s+s=!ne aceas(7 o&!n!e. Ind!v!/!! c+
    aceas(7 (+"'+rare se carac(er!/ea/7 &r!n a+(odra%a(!/are, (ea(ra"!s% O! e<&r!%area
    e<a$era(7 a e%o=!!"or Ecr!(er!+" RJ. E! :O! &o( &+ne :n d!.!c+"(a(e a%!c!! O! c+noO(!n=e"e
    &r!n(r4o %an!.es(are &+'"!c7 e<ces!v7 a e%o=!!"or Ede e<., :%'r7=!Oarea c+noO(!n=e"or
    cas+a"e c+ o ardoare e<ces!v7, &"An$And necon(ro"a( :n oca/!! sen(!%en(a"e %!nore
    or! avAnd accese de .+r!eJ, :ns7, e%o=!!"e "or &ar adesea a a&are O! d!s&are &rea
    G*C Tulburrile de #ersonalitate
    re&ede &en(r+ a .! res!%=!(e &ro.+nd, ceea ce &oa(e .ace &e ce!"a"=! s7 ac+/e !nd!v!d+"
    de .a"s!.!carea aces(or e%o=!!.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 a+ +n %are $rad de
    s+$es(!'!"!(a(e Ecr!(er!+" N%7 O&!n!!"e s! sen(!%en(e"e "or s+n( +Oor !n."+en=a(e de a"=!!
    s! de ca&r!c!!"e de %o%en(. E! &o( .! .oar(e :ncre/7(or!, :n s&ec!a" :n &ersoane"e
    e<(re% de a+(or!(are &e care e! "e v7d ca re/o"vare %a$!c7 a &ro'"e%e"or "or. A+
    (end!n=a de a ac=!ona &e 'a/7 de s+&o/!=!! s! de a ado&(a conv!n$er! :n %od
    &rec!&!(a(. Ind!v!/!! c+ aceas(7 (+"'+rare cons!der7 adesea re"a=!!"e "or %a! !n(!%e
    decA( s+n( :n rea"!(a(e, &re/en(And a&roa&e .!ecare c+noO(!n=7 ca Ssc+%&+" %e+,
    sc+%& a%!cT or! se adresea/7 %ed!c!"or :n(A"n!=! doar o da(7 sa+ de do+7 or! :n
    c!rc+%s(an=e &ro.es!ona"e s&+nAnd+4"e &e n+%e"e de 'o(e/ Ecr!(er!+" GJ. F+$!"e :n(r4
    o .an(e/!e ro%an(!c7 s+n( .recven(e.
    *lemente si tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 &o( avea d!.!c+"(7=! :n
    o'=!nerea !n(!%!(7=!! e%o=!ona"e :n re"a=!!"e ro%an(!ce sa+ se<+a"e. F7r7 a .!
    conO(!en=! de aceas(a, e! @oac7 adesea +n ro" Ede e<., &e ce" a" +ne! Sv!c(!%eT sa+
    S&r!n=eseTJ :n re"a=!!"e "or c+ a"=!!. Po( :ncerca s74s! con(ro"e/e &ar(ener!! &r!n
    %an!&+"are e%o=!ona"7 sa+ sed+c=!e "a +n n!ve", :n (!%& ce %an!.es(7 o de&enden=7
    %arca(7 de aceO(!a "a a"( n!ve". Ind!v!/!! c+ aceas(7 (+"'+rare a+ adesea re"a=!!
    de(er!ora(e c+ a%!c!! de ace"aO! se< d!n ca+/a s(!"+"+! "or !n(er&ersona" &rovoca(or
    se<+a" care &oa(e &are o a%en!n=are &en(r+ re"a=!!"e a%!c!"or "or. De ase%enea,
    aceO(! !nd!v!/! :O! &o( :ns(r7!na a%!c!! &r!n &re(en=!! "a a(en=!e cons(an(7. E! dev!n
    adesea de&res!v! s! !r!(a=! cAnd n+ s+n( cen(r+" a(en=!e!. Po( .! dorn!c! de no+(a(e,
    s(!%+"are O! sen/a=!! (ar!, s! a+ adesea (end!n=a de a deven! &en!'!"! &r!n r+(!ne"e "or
    +/+a"e. AceO(! !nd!v!/! s+n( adesea !n(o"eran=! or! .r+s(ra=! :n s!(+a=!!"e care !%&"!c7
    :n(Ar/!erea $ra(!.!c7r!!, ac=!+n!"e "or .!!nd :ndre&(a(e adesea s&re o'=!nerea !%ed!a(7
    a sa(!s.ac=!e!. DeO! adesea, :nce& o ac(!v!(a(e sa+ +n &ro!ec( c+ %are en(+/!as%,
    !n(eres+" "or &oa(e d!%!n+a ra&!d. Re"a=!!"e &e (er%en "+n$ &o( .! ne$"!@a(e &en(r+ a
    .ace "oc .e're! +nor no! re"a=!!.
    R!sc+" rea" de s+!c!d n+ es(e c+nosc+(, dar e<&er!en=a c"!n!c7 s+$erea/7 c7
    !nd!v!/!! c+ aceas(7 (+"'+rare &re/!n(7 +n r!sc cresc+( de $es(+r! s! a%en!n=7r! de
    s+!c!d &en(r+ a a(ra$e a(en=!a s! a !%&+ne o as!s(en=7 %ed!ca"7 %a! '+n7.
    T+"'+rarea de &ersona"!(a(e !s(r!on!c7 a .os( asoc!a(7 c+ ra(e %a! %ar! de (+"'+rare
    de so%a(!/are, de (+"'+rare de convers!e O! de (+"'+rare de&res!v7 %a@or7.
    T+"'+r7r!"e de &ersona"!(a(e 'order"!ne, narc!s!s(!c7, an(!soc!a"7 s! de&enden(7 a&ar
    adesea conco%!(en( c+ (+"'+rarea de &ersona"!(a(e !s(r!on!c7.
    *lemente speci$ice culturii, etii si sexului
    Nor%e"e de co%&or(a%en( !n(er&ersona", as&ec( &ersona" s! e<&res!v!(a(e
    e%o=!ona"7 var!a/7 "ar$ a trans*erso &r!n c+"(+r!, se<e s! $r+&e de e(a(e, :na!n(e de a
    "+a :n cons!dera=!e d!verse"e (r7s7(+r! Ede e<., e%o=!ona"!(a(ea, sed+c(!v!(a(ea, s(!"+"
    !n(er&ersona" dra%a(!c, c7+(area no+(7=!!, soc!a'!"!(a(ea, .ar%ec+", !%&res!ona4
    '!"!(a(ea O! (end!n=a "a so%a(!/areJ s&re a ev!den=!a (+"'+rarea de &ersona"!(a(e
    !s(r!on!c7, es(e !%&or(an( s7 se a&rec!e/e dac7 e"e ca+/ea/7 de(er!orare sa+ de(res7
    se%n!.!ca(!v7 c"!n!c, :n cond!=!! c"!n!ce, aceas(7 (+"'+rare a .os( d!a$nos(!ca(7 %a!
    .recven( "a .e%e!. Une"e s(+d!! +(!"!/And eva"+7r! s(r+c(+ra(e, d!n con(ra, ra&or(ea/7
    ra(e de &reva"en(7 s!%!"are "a '7r'a=! s! .e%e!. E<&res!a co%&or(a%en(a"7 a
    (+"'+r7r!! de &ersona"!(a(e !s(r!on!c7 &oa(e .! !n."+en=a(7 de s(ereo(!&!!"e ro"+"+!
    se<+"+!. De e<e%&"+, +n '7r'a( c+ aceas(7 (+"'+rare se &oa(e :%'r7ca s! co%&or(a
    45E2A5 Tulburarea de #ersonalitate
    Listrionic
    G*4
    de o %an!er7 !den(!.!ca(7 adesea ca S%acoT E%asc+"J s! &oa(e c7+(a s7 .!e cen(r+"
    a(en=!e! &r!n a .ace &arad7 de a&(!(+d!n! a("e(!ce, :n (!%& ce o .e%e!e, de e<e%&"+,
    &oa(e a"e$e o :%'r7c7%!n(e .oar(e .e%!n!n7 s! vor'! des&re cA( de %+"( s!4a
    !%&res!ona( ea !ns(r+c(or+" de dans.
    #revalent
    Da(e c!c+%scr!se "a s(+d!!"e &e &o&+"a=!a $enera"7 s+$erea/7 o &reva"en(7 a
    (+"'+r7r!! de &ersona"!(a(e !s(r!on!c7 de a&ro<!%a(!v 9d4;d. Ra(e de a&ro<!%a(!v
    5Ld45Yd a+ .os( ra&or(a(e "a &ac!en=!! !n(erna=! s! a%'+"a(or! d!n +n!(7=!"e de
    s7n7(a(e %en(a"7, cAnd es(e +(!"!/a(7 o eva"+are s(r+c(+ra(7.
    Dia!nostic di$erenial
    A"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    !s(r!on!c7, deoarece e"e a+ an+%!(e e"e%en(e :n co%+n. De aceea, es(e necesar s7 se
    .ac7 d!s(!nc=!e :n(re aces(e (+"'+r7r! &e 'a/a d!.eren=e"or d!n(re e"e%en(e"e "or
    carac(er!s(!ce. Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7 (+"'+rarea de
    &ersona"!(a(e !s(r!on!c7, &o( .! d!a$nos(!ca(e s! aces(ea. DeO! (+"'+rarea de
    &ersona"!(a(e 'order"!ne &oa(e .! carac(er!/a(7, de ase%enea, &r!n c7+(area a(en=!e!,
    co%&or(a%en( %an!&+"a(!v O! e%o=!! ra&!d sc!%'7(oare, ea se d!s(!n$e &r!n
    a+(od!s(r+c(!v!(a(e, :n(rer+&er! co"eroase a"e +nor re"a=!! s(rAnse s! sen(!%en(e cron!ce
    de !nsa(!s.ac=!e &ro.+nd7 s! de &er(+r'are a !den(!(7=!!. Ind!v!/!! c+ (+"'+rare de
    &ersona"!(a(e an(!soc!a"7 s! (+"'+rare de &ersona"!(a(e !s(r!on!c7 a+ :n co%+n
    (end!n=a de a .! !%&+"s!v!, s+&er.!c!a"!, c7+(7(or! de aven(+r7, !%&r+den=!, sed+c7(or!
    s! %an!&+"a(!v!, :ns7 &ersoane"e c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 (!nd a .!
    %a! e<a$era(e :n e%o=!!"e "or s! de re$+"7 n+ se an$a@ea/7 :n co%&or(a%en(e
    an(!soc!a"e. Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 s+n( %an!&+"a(!v!
    &en(r+ a o'=!ne &ro(ec=!e, &e cAnd ce! c+ (+"'+rare de &ersona"!(a(e an(!soc!a"7 s+n(
    %an!&+"a(!v! s&re a o'=!ne &ro.!(, &+(ere or! vreo a"(7 $ra(!.!ca=!e %a(er!a"7. DeO!
    !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 doresc, de ase%enea, a(en=!e d!n
    &ar(ea a"(ora, e! vor de re$+"7 s7 .!e "7+da=! &en(r+ Ss+&er!or!(a(eaT "or, &e cAnd
    !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e !s(r!on!c7 doresc s7 .!e v7/+=! ca .ra$!"! s!
    de&enden=!, dac7 aceas(a "e es(e +(!" :n a a(ra$e a(en=!a. Ind!v!/!! c+ (+"'+rarea de
    &ersona"!(a(e narc!s!s(!c7 &o( e<a$era !n(!%!(a(ea re"a=!!"or "or c+ a"=! oa%en!, :ns7 e!
    s+n( %a! :nc"!na=! s7 accen(+e/e s(a(+(+" de S3IPT or! averea a%!c!"or "or. :n
    (+"'+rarea de &ersona"!(a(e de&enden(7, &ersoana es(e e<ces!v de de&enden(7 de
    a"=!! &en(r+ "a+d7 s! :ndr+%are, dar es(e .7r7 e"e%en(e"e e%o=!ona"e e<a$era(e,
    s(r!den(e, a"e (+"'+r7r!! de &ersona"!(a(e !s(r!on!ce.
    T+"'+rarea de &ersona"!(a(e !s(r!on!c7 (re'+!e s7 .!e d!s(!ns7 de %od!.!carea de
    &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care (r7s7(+r!"e a&ar
    d!n ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+!
    nervos cen(ra". Ea (re'+!e, de ase%enea, s7 .!e d!s(!ns7 de s!%&(o%e"e care a&ar :n
    asoc!ere c+ +/+" cron!c de o s+'s(an=7 Ede e<., (+"'+rarea :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ.
    M+"=! !nd!v!/! &o( &re/en(a (r7s7(+r! !s(r!on!ce, :ns7, n+%a! cAnd aces(e
    (r7s7(+r! s+n( !n."e<!'!"e, de/ada&(a(!ve s! &ers!s(en(e O! ca+/ea/7 o de(er!orare
    .+nc=!ona"7 sa+ de(res7 s+'!ec(!v7 se%n!.!ca(!v7, cons(!(+!e (+"'+rare de
    &ersona"!(a(e !s(r!on!c7.
    ?EH Tulburrile de #ersonalitate
    Criteriile $e $ia/no&ti# pentru
    4+*.<+ Tul-urarea $e Per&onalitate Fi&trioni#(
    .n pattern pervasiv de emotionalitate excesiv si de cutare a ateniei,
    "ncep@nd precoce "n perioada adult si pre(ent "ntr-o varietate de contexte,
    dup cum este indicat de cinci &sau mai multe) dintre urmtoarele
    (1)este incomodat "n situaiile "n care nu se a$l "n centrul ateniei,
    (2)interaciunea cu altn este caracteri(at adesea prmtr-un comportament
    seductor sau provocator sexual inadecvat,
    (3)pre(int o sc%imbare rapid si o expresie super$icial a emoiilor,
    (4)u(ea( "n mod constant de aspectul $i(ic pentru a atra!e atenia asupra sa,
    (5)are un stil de a vorbi extrem de impresionistic si lipsit de detalii,
    (6)mani$est autodramati(are, teatralism, si o expresie exa!erat a emoiilor,
    (7)este su!estionabil, adic u,or de in$luenat de altn sau de circumstane,
    (8)consider relaiile a $i mai intime dec@t sunt "n realitate
    4+*.>* Tul-urarea $e Per&onalitate Nar#i&i&ti#(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e narc!s!s(!c7 :" cons(!(+!e +n
    &a((ern &ervas!v de $randoare, neces!(a(e de ad%!ra=!e s! de "!&s7 de e%&a(!e, care
    :nce&e &recoce :n &er!oada ad+"(7 s! es(e &re/en( :n(r4o var!e(a(e de con(e<(e
    Ind!v!/!! c+ aceas(7 (+"'+rare a+ +n sen(!%en( $rand!os de a+(o!%&or(an(7
    Ecr!(er!+" 5J :n %od +/+a" e! :O! s+&raes(!%ea/7 ca&ac!(7=!"e s! :O! e<a$erea/7
    rea"!/7r!"e, a&7rAnd adesea ca "7+d7ros! s! e<a$era=! E! &o( a.!r%a c+ @ov!a"!(a(e c7
    a"(n a(r!'+!e aceeaO! va"oare e.or(+r!"or "or, s! &o( .! s+r&r!nO! cAnd "a+da &e care o
    aO(ea&(7 s! &e care cred c7 o %en(7 n+ v!ne Adesea, :n a&rec!er!"e e<a$era(e a"e
    &ro&r!!"or "or rea"!/7r! es(e !%&"!c!(7 o s+'es(!%are a con(r!'+=!e! a"(ora S+n(
    &reoc+&a=! adesea de .an(e/!! de s+cces ne"!%!(a(, de &+(ere, s(r7"+c!re, .r+%+se=e
    or! a%or !dea" Ecr!(er!+" 9J Po( %ed!(a "a ad%!ra=!a s! &r!v!"e$!!"e S%+"( aO(e&(a(eT
    s! se co%&ar7 &e ei :nO!O! :n %od .avora'!" c+ &ersoane %arcan(e sa+ &r!v!"e$!a(e
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 cred c7 e! s+n( s+&er!or!,
    a&ar(e sa+ +n!c!, s! aO(ea&(7 ca s! a"(n s74! rec+noasc7 ca a(are Ecn(en+"SJ E! &o(
    crede c7 &o( .! :n=e"eO! s! (re'+!e s7 se asoc!e/e n+%a! c+ oa%en! e<(raord!nar! sa+
    c+ s(a(+s :na"( s! &o( a(r!'+! ca"!(a(ea de S+n!c!T, S&er.ec=!T sa+ Sdo(a=!T ce"or c+ care
    s+n( asoc!a=! Ind!v!/!! c+ aceas(7 (+"'+rare cred c7 neces!(7=!"e "or s+n( s&ec!a"e s!
    d!nco"o de or!/on(+" oa%en!"or co%+n! Pro&r!a "or s(!%7 de s!ne es(e %7r!(7 Ead!c7,
    Sre."ec(a(7TJ &r!n va"oarea !dea"!/a(7 &e care e! o a(r!'+!e ce"or c+ care se asoc!a/7
    E! !ns!s(7 &ro'a'!" s7 a!'7 de a .ace n+%a! c+ &ersoane d!n S(o&T Edoc(or!, avoca=!,
    coa.or!, !ns(r+c(or!J or! sa .!e a.!"!a=! "a ce"e %a! '+ne !ns(!(+=!!, :ns7 deva"or!/ea/7
    d!&"o%e"e ce"or care4! de/a%7$esc
    Ind!v!/!! c+ aceas(7 (+"'+rare so"!c!(7 :n $enera" o ad%!ra=!e e<ces!v7 Ecr!(er!+" IJ
    S(!%a "or de s!ne es(e a&roa&e &er%anen( .oar(e .ra$!"7 Po( .! &reoc+&a=! de cA( de
    '!ne s+n( .7c+=! s! de cA( de .avora'!" s+n( v7/+=! de a"(n Aceas(a !a adesea .or%a
    45E28E Tulburarea de #ersonalitate
    Farcisistic
    G*<

    +r_e! 4neces!(7=! cons(an(e de a(en=!e s! ad%!ra=!e. E! se &o( aO(e&(a ca sos!rea "or s7 .!e
    sa"+(a(7 c+ o (an!a(7 %are s! se %!(7 dac7 a_=__ (_+4_ %v+!Aa/a &er(o+ averea _o:.Mc.(
    &esc+! :n %od cons(an( co%&"!%en(e, adesea c+ %are :ncAn(are. Un sen(!%en( de
    :ndre&(7=!re es(e ev!den( :n es&ec(a(!va ne%o(!va(7 de (ra(a%en( .avora'!" s&ec!a" a
    aces(or !nd!v!/! Ecr!(er!+" YJ. Se aO(ea&(7 s7 se oc+&e c!neva de e! s! s+n( deconcer(a=!
    sa+ .+r!oO! cAnd aOa ceva n+ se :n(A%&"7. De e<e%&"+, e! &o( cons!dera c7 n+ (re'+!e
    s7 s(ea "a rAnd s! ca &r!or!(7=!"e "or s+n( a(A( de !%&or(an(e, c7 ce!"a"=! (re'+!e s7
    cede/e, O! a&o! se !r!(7 cAnd a"=!! n+ re+Oesc s74! a@+(e :n Sac(!v!(a(ea "or .oar(e
    !%&or(an(7T. Aces( sen(!%en( de :ndre&(7=!re, c+ "!&sa de sens!'!"!(a(e "a dor!n=e"e s!
    neces!(7=!"e a"(ora, &oa(e d+ce "a e<&"oa(area conO(!en(7 sa+ .7r7 !n(en=!e a a"(ora
    Ecr!(er!+" RJ. E! se aO(ea&(7 s7 "! se dea (o( ce doresc sa+ cred e! c7 "e es(e necesar,
    !nd!.eren( de ce &oa(e :nse%na aceas(a &en(r+ a"=!!. De e<e%&"+, aceO(! !nd!v!/! se
    &o( aO(e&(a "a o %are d7r+!re d!n &ar(ea a"(ora, O! :! &o( s+&raso"!c!(a .7r7 vreo
    cons!dera=!e &en(r+ !%&ac(+" as+&ra v!e=!! aces(ora. T!nd s74s! .ac7 a%!c!=!! sa+ re"a=!!
    ro%an(!ce n+%a! dac7 cea"a"(7 &ersoan7 &are d!s&+s7 s7 &ro%ove/e sco&+r!"e "or or!
    or!ce %7r!re a s(!%e! de s!ne a "or. Adesea e! +/+r&7 &r!v!"e$!! s&ec!a"e s! res+rse
    s+&"!%en(are care cred c7 "! se c+v!n &en(r+ c7 e! s+n( a(A( de d!s(!nO!.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 s+n( :n $enera" "!&s!=! de
    e%&a(!e O! a+ d!.!c+"(7=! :n a rec+noaO(e dor!n=e"e, e<&er!en=e"e s+'!ec(!ve O!
    sen(!%en(e"e a"(ora Ecr!(er!+" HJ. E! &o( &res+&+ne c7 a"=!! s+n( (o(a" !n(eresa=! de
    &ros&er!(a(ea "or. T!nd s7 d!sc+(e &ro&r!!"e "or !n(erese :n de(a"!! !nadecva(e O!
    !n(er%!na'!"e, :n (!%& ce n+ s+n( ca&a'!"! s7 rea"!/e/e c7 s! a"=!! a+, de ase%enea,
    sen(!%en(e s! neces!(7=!. Adesea s+n( d!s&re=+!(or! O! 'r+(a"! c+ a"=!!, care vor'esc
    des&re &ro&r!!"e "or &ro'"e%e sa+ &reoc+&7r!. AceO(! !nd!v!/! n+ s+n( &reoc+&a=! de
    o.ensa &e care o &o( &rovoca re%arc!"e "or Ede e<., vor'esc e<+'eran( .os(e! !+'!(e
    X.os(+"+! !+'!(X c7 Sa% ac+% o re"a=!e &e v!a=7T8 se "a+d7 c+ s7n7(a(ea :n .a=a c+!va
    care es(e s+.er!ndJ. CAnd rec+nosc neces!(7=!"e, dor!n=e"e or! s+.er!n=e"e a"(ora, es(e
    &os!'!" ca aces(ea s7 .!e v7/+(e, :n %od !ns+"(7(or, ca se%ne de de'!"!(a(e sa+ de
    v+"nera'!"!(a(e. Ce! care vor'esc !nd!v!/!"or c+ (+"'+rare de &ersona"!(a(e
    narc!s!s(!c7 desco&er7 o r7cea"7 e%o=!ona"7 O! o "!&s7 de !n(eres rec!&roc.
    AceO(! !nd!v!/! s+n( adesea !nv!d!oO! &e a"=!! or! cred c7 a"=!! s+n( !nv!d!oO! &e e!
    Ecr!(er!+" GJ. Inv!d!a/7 &e a"=!! &en(r+ s+ccese"e sa+ averea "or, cred c7 e! ar %er!(a
    %a! '!ne rea"!/7r!"e, ad%!ra=!a sa+ &r!v!"e$!!"e ace"ea. Po( deva"or!/a :n %od sever
    con(r!'+=!a a"(ora, :n s&ec!a" cAnd aceO(!a a+ &r!%!( %+"=+%!r! sa+ "a+de &en(r+
    rea"!/7r!"e "or. Co%&or(a%en(e aro$an(e, d!s&re=+!(oare carac(er!/ea/7 aceO(!
    !nd!v!/!. E! %an!.es(7 adesea sno'!s%, d!s&re= sa+ a(!(+d!n! de &a(ronare Ecr!(er!+"
    FJ. De e<e%&"+, +n !nd!v!d c+ aceas(7 (+"'+rare se &oa(e &"An$e de S!%&er(!nen=aT
    sa+ Ss(+&!d!(a(eaT +n+! ce"ner s(An$ac! or! :nce!e o eva"+are %ed!ca"7 c+ o
    a&rec!ere condescenden(7 a %ed!c+"+!.
    *lemente si tulburri asociate
    3+"nera'!"!(a(ea :n s(!%a de s!ne .ace !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e
    narc!s!s(!c7 .oar(e sens!'!"! "a S"e/areaT &r!n cr!(!c7 sa+ .r+s(rare. DeO! &o( s7 n+
    ara(e aceas(a :n a.ar7, cr!(!ca &oa(e o'seda aceO(! !nd!v!/! O!4! &oa(e .ace s7 se s!%(7
    +%!"!=!, de$rada=!, "!&s!=! de va"oare O! !ns!$n!.!an=!. Po( reac=!ona c+ d!s&re=, .+r!e
    sa+ &o( con(raa(aca s.!d7(or. As(.e" de e<&er!en=e d+c adesea "a re(ra$ere soc!a"7 or!
    "a +n as&ec( +%!" care &oa(e %asca O! &ro(e@a $randoarea. Re"a=!!"e !n(er&ersona"e
    s+n( de re$+"7 de(er!ora(e d!n ca+/a &ro'"e%e"or care der!v7 d!n :ndre&(7=!re,
    81> Tulburrile de #ersonalitate

    neces!(a(ea de ad%!ra=!e s! descons!derarea re"a(!v7 a sens!'!"!(7=!! a"(ora DeO!
    a%'!=!a, aro$an(a s! :ncrederea &o( d+ce "a rea"!/7r! %ar!, &er.or%an(a &oa(e .!
    :n(rer+&(7 d!n ca+/a !n(o"eran(e! "a cr!(!c7 sa+ "a eOec Uneor! ac(!v!(a(ea
    &ro.es!ona"7 &oa(e .! .oar(e sc7/+(7, re."ec(And "!&sa de donn(7 de a4s! as+%a r!sc+"
    :n s!(+a=!! co%&e(!(!ve on :n a"(e s!(+a=!! :n care es(e &os!'!" eOec+" Sen(!%en(e"e de
    r+O!ne s! de +%!"!re s+s=!n+(e s! a+(ocr!(!ca :nso=!(oare &o( .! asoc!a(e c+ re(ra$ere
    soc!a"7, d!s&o/!=!e de&res!v7 s! (+"'+rare d!s(!%!c7 sa+ (+"'+rare de&res!v7 %a@or7
    D!n con(ra, &er!oade"e de $randoare s+s=!n+(7 &o( .! asoc!a(e c+ d!s&o/!=!e
    !&o%a%aca"7 T+"'+rarea de &ersona"!(a(e narc!s!s(!c7 &oa(e .!, de ase%enea,
    asoc!a(7 c+ anore<!a nervoas7 s! c+ (+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 E:n s&ec!a"
    c+ coca!naJ T+"'+r7r!"e de &ersona"!(a(e !s(r!on!c7, 'order"%e, an(!soc!a"7 s!
    &arano!d7 &o( .! asoc!a(e c+ (+"'+rarea de &ersona"!(a(e narc!s!s(!c7
    *lemente speci$ice etii si sexului
    Tr7s7(+r!"e narc!s!s(!ce &o( .! e<(re% de co%+ne "a ado"escen=! s! n+ !nd!c7 :n
    %od necesar .a&(+" c7 !nd!v!d+" va a@+n$e s7 a!'7 (+"'+rarea de &ersona"!(a(e
    narc2s!sc7 Ind!v!/!! c+ (@"'+rare de &ersona"!(a(e narc!s!s(!c7 &o( avea an+%!(e
    d!.!c+"(7=! :n a se ada&(a "a de'+(+" +nor "!%!(7r! so%a(!ce s! &ro.es!ona"e care s+n(
    !neren(e :n &roces+" de :%'7(rAn!re D!n(re ce! d!a$nos(!ca=! c+ (+"'+rare de
    &ersona"!(a(e narc!s!s(!c7, YLd4HYd s+n( '7r'a=!
    #revalent
    Es(!%7r!"e &reva"en(e! (+"'+r7% de &ersona"!(a(e narc!s!s(!ce %er$ de "a 9d "a
    5Rd :n &o&+"a=!a c"!n!c7 s! s+n( de %a! &+=!n de 5d :n &o&+"a=!a $enera"7
    Tulburrile de
    #ersonalitate
    818
    an(!soc!a"7 &o( s7 n+ .!e dorn!c! de ad%!ra=!e O! n+ !nv!d!a/7 &e a"=!!, !ar &ersoane"e
    c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 n+ a+ de re$+"7 +n !s(or!c de (+"'+rare de
    cond+!(7 :n co&!"7r!e sa+ de co%&or(a%en( !n.rac=!ona" :n &er!oada ad+"(7. A(A( :n
    (+"'+rarea de &ersona"!(a(e narc!s!s(!c7 cA( s! :n (+"'+rarea de &ersona"!(a(e
    o'ses!vo4co%&+"s!v7, !nd!v!d+" &oa(e a.!r%a aderen=a "a &er.ec=!on!s% s! &oa(e
    crede c7 a"=!! n+ &o( .ace "+cr+r!"e "a .e" de '!ne. :n con(ras( c+ a+(ocr!(!ca ce"or c+
    (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7, !nd!v!/!! c+ (+"'+rare de
    &ersona"!(a(e narc!s!s(!c7 s+n( :nc"!na=! .oar(e &ro'a'!" s7 cread7 c7 e! a+ a(!ns
    &er.ec=!+nea. S+sce&(!'!"!(a(ea O! re(ra$erea soc!a"7 d!s(!n$ &e ce! c+ (+"'+rare de
    &ersona"!(a(e sc!/o(!&a"7 sa+ &arano!d7 de ce! c+ (+"'+rare de &ersona"!(a(e
    narc!s!s(!c7. CAnd aces(e (r7s7(+r! s+n( &re/en(e "a !nd!v!/!! c+ (+"'+rare de
    &ersona"!(a(e narc!s!s(!c7, e"e der!v7 :n &r!%+" rAnd d!n .r!c!"e de a n+ avea
    !%&er.ec=!+n! sa+ de.ec(e reve"a(e. ,randoarea &oa(e s+rven! ca &ar(e a +nor
    e&!soade %an!aca"e sa+ !&o%an!aca"e, dar asoc!erea c+ %od!.!carea d!s&o/!=!e!
    or! c+ de(er!or7r! .+nc=!ona"e a@+(7 "a d!s(!n$erea aces(or e&!soade de (+"'+rarea de
    &ersona"!(a(e narc!s!s(!c7. T+"'+rarea de &ersona"!(a(e narc!s!s(!c7 (re'+!e s7 .!e
    d!s(!ns7, de ase%enea, de s!%&(o%e"e care &o( a&are :n asoc!ere c+ +/+" cron!c a"
    +ne! s+'s(an=e Ede e<., (+"'+rarea :n "e$7(+r7 c+ coca!na .7r7 a"(7 s&ec!.!ca=!eJ.
    M+"=! !nd!v!/! de %are s+cces &re/!n(7 (r7s7(+r! de &ersona"!(a(e care &o( .!
    cons!dera(e ca narc!s!s(!ce. N+%a! cAnd aces(e (r7s7(+r! s+n( !n."e<!'!"e,
    de/ada&(a(!ve O! &ers!s(en(e s! ca+/ea/7 o de(er!orare .+nc=!ona"7 sa+ o de(res7
    s+'!ec(!v7 se%n!.!ca(!v7 e"e cons(!(+!e (+"'+rare de &ersona"!(a(e narc!s!s(!c7.
    Criteriile $e $ia/no&ti# pentru
    4+*.>* Tul-urarea $e Per&onalitate Nar#i&i&ti#(
    .n pattern pervasiv de !randoare &"n $ante(ie si comportament), necesitatea
    de admiraie si lipsa de empatie, "ncep@nd precoce "n perioada adult ,i
    pre(ent "ntr-o varietate de contexte, dup cum este indicat de cinci &sau mai
    multe) dintre urmtoareleD
    (1) are un sentiment !randios de auto i m portant &de ex2, ",i exa!erea( rea
    li(rile ,i talentele, a,teapt s $ie recunoscut ca superior $r reali(ri
    corespun(toare)3
    (2) este preocupat de $ante(ii de succes nelimitat, de putere, strlucire,
    $rumusee sau amor ideal3
    (3) crede c este =aparte> ,i unic ,i poate $i "neles numai de, ori trebuie s
    se
    asocie(e numai cu, ali oameni &sau instituii) speciali ori cu status "nalt3
    (4) necesit admiraie excesiv3
    (5) are un sentiment de "ndreptire, adic pretenii exa!erate de
    tratament
    $avorabil special ori de supunere automat la dorinele sale3
    (6) este exploatator interpersonal, adic pro$it de alii spre a-,i
    atin!e
    propriile scopuri3
    (7) este lipsit de empatieD este incapabil s recunoasc sau s se identi$ice cu
    sentimentele ,i necesitile altora3
    (8) este adesea invidios pe alii sau crede c alii sunt invidio,i pe el3
    (9) pre(int comportamente sau atitudini aro!ante, s$idtoare2
    H5G Tulburrile de #ersonalitate
    Tul-ur(rile $e Per&onalitate $in Grupa C
    4+*.>C Tul-urarea $e Per&onalitate Evitant(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e ev!(an(e :" cons(!(+!e +n &a((ern
    &ervas!v de !n!'!=!e soc!a"7, sen(!%en(e de !nadecvare s! !&ersens!'!"!(a(e "a
    eva"+area ne$a(!v7, care :nce&e &recoce :n &er!oada ad+"(7 s! es(e &re/en( :n(r4o
    var!e(a(e de con(e<(e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e ev!(an(7 ev!(7 %+nca sa+ ac(!v!(7=!"e
    Oco"are care !%&"!c7 +n con(ac( !n(er&ersona" se%n!.!ca(!v d!n ca+/a .r!c!! de
    cr!(!c7, de/a&ro'are sa+ re@ec=!e Ecr!(er!+" 5J. O.er(e"e de &ro%ovare :n serv!c!+ &o(
    .! dec"!na(e, deoarece no!"e res&onsa'!"!(7=! &o( d+ce "a cr!(!c! d!n &ar(ea
    co"a'ora(or!"or. AceO(! !nd!v!/! ev!(7 s74O! .ac7 no! a%!c!, :n a.ar7 de ca/+" cAnd
    s+n( s!$+r! c7 vor .! s!%&a(!/a=! O! acce&(a=! .7r7 cr!(!c7 Ecr!(er!+" 9J. PAn7 ce (rec o
    ser!e de (es(e &ro'And conv!n$7(or con(rar!+", ce!"a"=! oa%en! s+n( cons!dera=! a .!
    cr!(!c! s! de/a&ro'a(or!. Ind!v!/!! c+ aceas(7 (+"'+rare n+ se vor a"7(+ra
    ac(!v!(7=!"or de $r+& a(A( (!%& cA( n+ e<!s(7 o.er(e $eneroase O! re&e(a(e de s+&or(
    s! &ro(ec=!e. In(!%!(a(ea !n(er&ersona"7 es(e adesea d!.!c!"7 &en(r+ aceO(! !nd!v!/!,
    deO! e! s+n( ca&a'!"! s7 s(a'!"easc7 re"a=!! !n(!%e, cAnd e<!s(7 as!$+rarea +ne!
    acce&(7r! necr!(!ce. E! &o( ac=!ona c+ re=!nere, a+ d!.!c+"(7=! :n a vor'! des&re e!
    :nO!O! O! :O! re=!n sen(!%en(e"e !n(!%e, de .r!ca de a n+ .! e<&+O!, r!d!c+"!/a=! sa+
    .7c+=! de rAs Ecr!(er!+" ;J.
    Deoarece !nd!v!/!! c+ aceas(7 (+"'+rare s+n( &reoc+&a=! de .a&(+" de a n+ .!
    cr!(!ca=! sa+ re@ec(a=! :n s!(+a=!! soc!a"e, e! &o( avea +n &ra$ cons!dera'!" de sc7/+(
    &en(r+ a de(ec(a as(.e" de reac=!! Ecr!(er!+" IJ. Dac7 c!neva es(e +Oor de/a&ro'a(or
    sa+ cr!(!c, e! se &o( s!%=! e<(re% de "e/a=!. T!nd a .! (!%!/!, (7c+=!, !n!'a=! O!
    S!nv!/!'!"!T d!n ca+/a .r!c!! ca vreo o'serva=!e s7 n+ .!e de$radan(7 sa+ re@ec(an(7.
    Se aO(ea&(7 "a .a&(+" ca, !nd!.eren( ce s&+n e!, ce!"a"=! s7 cons!dere aceas(a ca
    Serona(T, aOa c7 &o( s7 n+ s&+n7 n!%!c. Reac=!onea/7 &+(ern!c "a !nd!c!! s+'(!"e
    s+$es(!ve de 'a(@oc+r7 sa+ der!/!+ne, :n d!s&re=+" dor!n=e! "or de a .! &ar(!c!&an=!
    ac(!v! "a v!a=a soc!a"7, e! se (e% s74O! &"ase/e av+(+" :n %A!n!"e a"(ora. Ind!v!/!! c+
    (+"'+rare de &ersona"!(a(e ev!(an(7 s+n( !n!'a=! :n s!(+a=!! !n(er&ersona"e no!,
    deoarece e! se s!%( !nadecva(! O! a+ o s(!%7 de s!ne sc7/+(7 Ecr!(er!+" YJ. D+'!!"e :n
    "e$7(+r7 c+ co%&e(en=a soc!a"7 s! a(rac=!a &ersona"7 dev!n e<(re% de %an!.es(e :n
    s!(+a=!!"e care !%&"!c7 !n(erac=!+n! c+ s(r7!n!!. AceO(! !nd!v!/! se cred e! :nO!O! !ne&=!,
    !na(rac(!v! ca &ersoan7 or! !n.er!or! a"(ora Ecr!(er!+" RJ. S+n( e<(re% de re.rac(ar! "a
    a4s! as+%a r!sc+r! &ersona"e or! "a a se an$a@a :n ac(!v!(7=! no!, deoarece aces(ea se
    &o( de%ons(ra a .! !nco%odan(e Ecr!(er!+" HJ. S+n( :nc"!na=! s&re e<a$erarea
    even(+a"e"or &er!co"e a"e s!(+a=!!"or r+(!n!ere, !ar d!n neces!(a(ea "or de cer(!(+d!ne s!
    s!$+ran=7 &oa(e re/+"(a o res(rAn$ere a s(!"+"+! de v!a=7. C!neva c+ aceas(7 (+"'+rare
    &oa(e an+"a +n !n(erv!+ &en(r+ an$a@are, de .r!ca de a n+ .! &+s :n d!.!c+"(a(e de
    .a&(+" c7 n+ es(e :%'r7ca( cores&+n/7(or. S!%&(o%e so%a(!ce %ar$!na"e or! a"(e
    &ro'"e%e &o( deven! %o(!v &en(r+ a ev!(a ac(!v!(7=! no!.
    45E287 Tulburarea de #ersonalitate
    *vitant
    814

    *lemente si tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e ev!(an(7 a&rec!a/7 adesea c+ &reca+=!e
    %!Oc7r!"e O! e<&res!!"e ce"or c+ care v!n :n con(ac(. Fr!ca O! co%&or(a%en(+" "or
    (ens!ona( &o( &rovoca r!d!c+"!/are O! der!/!+ne d!n &ar(ea a"(ora, ceea ce, :n sc!%',
    con.!r%7 d+'!!"e "or. S+n( .oar(e (e%7(or! :n "e$7(+r7 c+ s!(+a=!a ca e! s7 reac=!one/e
    "a cr!(!c! &r!n rosea"7 sa+ =!&e(e. E! s+n( descr!O! de ce!"a"=! ca .!!nd Sr+O!noO!T,
    S(!%!/!T, Ss!n$+ra(!c!T O! S!/o"a=!T. Pro'"e%e"e %a@ore :n "e$7(+r7 c+ aceas(7
    (+"'+rare a&ar :n ac(!v!(a(ea soc!a"7 s! &ro.es!ona"7. S(!%a de s!ne sc7/+(7 O!
    !&ersens!'!"!(a(ea "a re@ec=!e s+n( asoc!a(e c+ res(rAn$erea con(ac(e"or &ersona"e.
    AceO(! !nd!v!/! &o( deven! re"a(!v !/o"a=! s! de re$+"7 n+ a+ o re=ea "ar$7 de s+&or(
    soc!a" care s74! &oa(7 a@+(a :n (!%&+" cr!/e"or. E! doresc a.ec=!+ne O! acce&(are, O! &o(
    avea .an(e/!! des&re re"a=!! !dea"!/a(e c+ a"=!!. Co%&or(a%en(e"e de ev!(are &o(
    a.ec(a, de ase%enea, .+nc=!onarea &ro.es!ona"7, deoarece aceO(! !nd!v!/! :ncearc7 s7
    ev!(e (!&+r!"e de s!(+a=!! soc!a"e care &o( .! !%&or(an(e &en(r+ sa(!s.acerea cer!n=e"or
    .+nda%en(a"e a"e serv!c!+"+! or! &en(r+ avansare.
    A"(e (+"'+r7r! care s+n( d!a$nos(!ca(e :n %od .recven( :%&re+n7 c+ (+"'+rarea
    de &ersona"!(a(e ev!(an(7 !nc"+d (+"'+r7r!"e a.ec(!ve s! an<!oase E:n s&ec!a" .o'!a
    soc!a"7 de (!& $enera"!/a(J. T+"'+rarea de &ersona"!(a(e ev!(an(7 es(e d!a$nos(!ca(7
    adesea :%&re+n7 c+ (+"'+rarea de &ersona"!(a(e de&enden(7, deoarece !nd!v!/!! c+
    (+"'+rare de &ersona"!(a(e ev!(an(7 dev!n .oar(e a(aOa=! O! de&enden=! de ce! cA=!va
    oa%en! c+ care s+n( a%!c!. T+"'+rarea de &ersona"!(a(e ev!(an(7 (!nde, de ase%enea,
    a .! d!a$nos(!ca(7 :%&re+n7 c+ (+"'+rarea de &ersona"!(a(e 'order"!ne O! c+
    (+"'+r7r!"e de &ersona"!(a(e d!n $r+&a A Ead!c7, (+"'+r7r!"e de &ersona"!(a(e
    &arano!d7, sc!/o!d7 sa+.sc!/o(!&a"7J.
    *lemente speci$ice culturii, etii si sexului
    Po( e<!s(a var!a=!! :n $rad+" :n care d!.er!(e $r+&+r! c+"(+ra"e O! e(n!ce
    cons!der7 ne:ncrederea O! ev!(area ca adecva(e. Ma! %+"( decA( a(A(,
    co%&or(a%en(+" ev!(an( &oa(e .! re/+"(a(+" &ro'"e%e"or de ac+"(+ra=!e +r%And
    !%!$r7r!!. Aces( d!a$nos(!c (re'+!e s7 .!e +(!"!/a( c+ %are &reca+=!e "a co&!! O!
    ado"escen=!, &en(r+ care r+O!nea O! co%&or(a%en(+" ev!(an( &o( .! adecva(e d!n
    &+nc(+" de vedere a" de/vo"(7r!!. T+"'+rarea de &ersona"!(a(e ev!(an(7 &are a .! "a
    .e" de .recven(7 "a '7r'a=! s! "a .e%e!.
    #revalent
    Preva"en(a (+"'+r7r!! de &ersona"!(a(e ev!(an(e :n &o&+"a=!a $enera"7 se c!.rea/7
    :n(re L,Yd O! 5d. T+"'+rarea de &ersona"!(a(e ev!(an(7 a .os( ra&or(a(7 a .! &re/en(7
    "a a&ro<!%a(!v 5Ld d!n(re &ac!en=!! a%'+"a(or! :n(A"n!=! :n c"!n!c!"e de s7n7(a(e
    %en(a"7.
    *voluie
    Co%&or(a%en(+" ev!(an( :nce&e adesea :n &er!oada de s+$ar sa+ :n co&!"7r!e c+
    (!%!d!(a(e, !/o"are O! .r!c7 de s(r7!n! O! de s!(+a=!! no!. DeO! (!%!d!(a(ea d!n co&!"7r!e
    es(e +n &rec+rsor co%+n a" (+"'+r7r!! de &ersona"!(a(e ev!(an(e, "a ce! %a! %+"=!
    !nd!v!/! ea (!nde s7 se d!s!&e/e &ro$res!v, &e %7s+r7 ce :%'7(rAnesc. D!n con(ra,
    !nd!v!/!! care vor a@+n$e s7 de/vo"(e (+"'+rarea de &ersona"!(a(e ev!(an(7 &o( deven!
    (o( %a! re/erva=! O! ev!(an=! :n ado"escen=7 s! "a :nce&+(+" &er!oade! ad+"(e, cAnd
    82E Tulburrile de #ersonalitate

    re"a=!!"e soc!a"e c+ oa%en! no! dev!n e<(re% de !%&or(an(e E<!s(7 +ne"e da(e,
    &rec+% c7 "a ad+"=!, (+"'+rarea de &ersona"!(a(e ev!(an(7 (!nde a deven! %a! &+=!n
    ev!den(7 or! a se re%!(e oda(7 c+ avansarea :n e(a(e
    Dia!nostic di$erenial
    Se &are c7 e<!s(7 o %are s+&ra.a=7 de s+&ra&+nere :n(re (+"'+rarea de
    &ersona"!(a(e ev!(an(7 s! .o'!a soc!a"7, (!&+" $enera"!/a(, a(A( de %are c7 e"e &o( .!
    conce&(+a"!/7r! a"(erna(!ve a"e ace"oraO! cond!=!! or! a"e +nor cond!=!! s!%!"are
    Ev!(area carac(er!/ea/7, de ase%enea, a(A( (+"'+rarea de &ersona"!(a(e ev!(an(7, cA(
    s! &an!ca c+ a$ora.o'!e, aces(ea a&7rAnd adesea conco%!(en( Ev!(area :n &an!ca c+
    a$ora.o'!e :nce&e de re$+"7 d+&7 de'+(+" a(ac+r!"or de &an!c7 s! &oa(e var!a :n
    .+c=!e de .recven(a s! !n(ens!(a(ea aces(ora D!n con(ra, ev!(area :n (+"'+rarea de
    &ersona"!(a(e ev!(an(7 (!nde a avea +n de'+( &recoce, a'sen(a +nor &rec!&!(an
    ev!den=! s! o evo"+=!e s(a'!"7
    A"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    ev!(an(7, deoarece e"e a+ an+%!(e e"e%en(e :n co%+n De aceea, es(e !%&or(an( s7
    se .ac7 d!s(!nc=!e :n(re aces(e (+"'+r7r! &e 'a/a d!.eren(e"or d!n(re e"e%en(e"e "or
    carac(er!s(!ce Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e care sa(!s.ac
    cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e &e "An$7 (+"'+rarea
    de &ersona"!(a(e ev!(an(7, &o( d!a$nos(!ca(e s! aces(ea A(A( (+"'+rarea de
    &ersona"!(a(e ev!(an(7, cA( s! (+"'+rarea de &ersona"!(a(e de&enden(7 s+n(
    carac(er!/a(e &r!n sen(!%en(e de %adecvare, !&ersens!'!"!(a(e "a cr!(!c7 s!
    neces!(a(ea de reas!$+rare :ns7, .ocar+" &r!%ar a" &reoc+&7r!! :n (+"'+rarea de
    &ersona"!(a(e ev!(an(7 es(e ev(!rea +%!"!r!! s! re@ec(!e!, &e cAnd :n (+"'+rarea de
    &ersona"!(a(e de&enden(7 .ocar+" es(e cen(ra( s&re a .! "+a( s+' &ro(ec=!e de c!neva
    Es(e .oar(e &os!'!" ca (+"'+rarea de &ersona"!(a(e ev!(an(7 s! (+"'+rarea de
    &ersona"!(a(e de&enden(7 s7 a&ar7 conco%!(en( Ca s! (+"'+rarea de &ersona"!(a(e
    ev!(an(7, (+"'+rarea de &ersona"!(a(e sc!/o!d7 s! (+"'+rarea de &ersona"!(a(e
    sc!/o(!&a"7 se carac(er!/ea/7 &r!n !/o"are soc!a"7 Ind!v!/!! c+ (+"'+rare de
    &ersona"!(a(e ev!(an(7 doresc :ns7 s7 a!'7 re"a=!! c+ a"=!! s! s+.7r &ro.+nd de &e +r%a
    s!n$+r7(7=!! "or &e c:nd ce! c+ (+"'+rare de &ersona"!(a(e sc!/o!d7 sa+ sc!/o(!&a"7
    &o( .! %+"=+%!=!, s! c!ar &re.er7 !/o"area "or soc!a"7 T+"'+rarea de &ersona"!(a(e
    &arano!d7 s! (+"'+rarea de &ersona"!(a(e e_!(an(7 se carac(er!/ea/7 a%'e"e &r!n
    e/!(are :n a se :ncrede :n a"=!! :ns7, :n (+"'+rarea de &ersona"!(a(e ev!(an(7 aceas(7
    e/!(are es(e da(ora(7 %a! c+rAnd .r!c!! de a n+ .! &+s :n d!.!c+"(a(e or! de a n+ .!
    cons!dera( !nadecva( decA( .r!c!! de !n(en=!!"e %a"!=!oase a"e a"(ora
    T+"'+rarea de &ersona"!(a(e ev!(an(7 (re'+!e d!s(!ns7 de %od!.!carea de
    &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care (r7s7(+r!"e a&ar
    d!n ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+!
    nervos cen(ra" Ea (re'+!e d!s(!ns7, de ase%enea, de s!%&(o%e"e care &o( a&are :n
    asoc!ere c+ +/+" cron!c a" +ne! s+'s(an=e Ede e< , (+"'+rarea :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ
    M+"=! !nd!v!/! &re/!n(7 (r7s7(+r! de &ersona"!(a(e ev!(an(7 :ns7, n+%a! cAnd
    aces(e (r7s7(+r! s+n( !n."e<!'!"e, de/ada&(ave s! &ers!s(en(e s! ca+/ea/7 de(er!orare
    .+nc=!ona"7 sa+ de(res7 s+'!ec(!v7, cons(!(+!e (+"'+rare de &ersona"!(a(e ev!(an(7
    45E2I Tulburarea de #ersonalitate
    Dependent
    GC*
    Criteriile $e $ia/no&ti# pentru
    4+*.>C Tul-urarea $e Per&onalitate Evitant(
    .n pattern pervasiv de in%ibiie social, sentimente de insu$icien ,i
    %ipersensibilitate la evaluare ne!ativ, "ncep@nd precoce "n perioada adult ,i
    pre(ent "ntr-o varietate de contexte, dup cum este indicat de patru &sau
    mai multe) dintre urmtoareleD
    (1) evit activitile pro$esionale care implic un contact
    interpersonal
    semni$icativ, din cau(a $ricii de critic, de(aprobare sau re0ecie3
    (1) nu dore,te s se asocie(e cu ali oameni dec@t dac este si!ur c este
    apreciat3
    (2) mani$est reinere "n relaiile intime din cau(a $ricii de a nu se $ace
    de
    r@s ori de a nu $i ridiculi(at3
    (2) este preocupat de $aptul de a nu $i criticat sau re0ectat "n situaii
    sociale,
    (3) este in%ibat "n situaii interpersonale noi din cau(a sentimentelor
    de
    inadecvare3
    (3) se vede pe sine ca inapt social, inatractiv personal ori in$erior altora3
    (4) re$u( s-,i asume riscuri personale sau s se an!a0e(e "n orice
    activiti
    noi din cau(a $aptului c acestea l-ar putea pune "n di$icultate2
    4+*.= Tul-urarea $e Per&onalitate Depen$ent(
    *lemente de dia!nostic
    E"e%en(+" esen=!a4" a" (+"'+r7r!! de &ersona"!(a(e de&enden(e :" cons(!(+!e
    neces!(a(ea e<ces!v7 O! &ervas!v7 de a .! (+(e"a( de c!neva, ceea ce d+ce "a +n
    co%&or(a%en( s+'%!s!v s! aderen( O! "a .r!c7 de se&arare. Aces( &a((ern :nce&e &rcoce
    :n &er!oada ad+"(7 s! es(e &re/en( :n(r4o var!e(a(e de con(e<(e. Co%&or(a%en(e"e
    s+'%!s!ve O! de de&enden=7 s+n( des(!na(e s7 o'=!n7 (+(e"are s! &rov!n d!n
    a+(o&erce&erea .a&(+"+! de a .! !nca&a'!" s7 .+nc=!one/e adecva(, .7r7 a@+(or+" a"(ora.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e de&enden(7 a+ %ar! d!.!c+"(7=! :n "+area
    dec!/!!"or co(!d!ene Ede e<., ce c+"oare s7 a!'7 c7%aOa de &+r(a( "a "+cr+, or! dac7 s74
    O! !a +%'re"aJ .7r7 o can(!(a(e e<ces!v7 de cons!"!! O! de reas!$+r7r! d!n &ar(ea a"(ora
    Ecr!(er!+" 5J. AceO(! !nd!v!/! (!nd a .! &as!v! O! &er%!( a"(or &ersoane Eadesea +ne!a
    s!n$+reJ s7 !a !n!=!a(!va s! s74s! as+%e res&onsa'!"!(a(ea ce"or %a! %+"(e do%en!!
    %a@ore a"e v!e=!! "or Ecr!(er!+" 9J. Ad+"=!! c+ aceas(7 (+"'+rare de&!nd de re$+"7 de
    +n &7r!n(e or! de so=E!eJ &en(r+ a dec!de +nde s7 "oc+!asc7, ce .e" de serv!c!+ s7 a!'7
    O! c+ care vec!n s7 .!e a%!cE7J. Ado"escen=!! c+ aceas(7 (+"'+rare &o( &er%!(e
    &7r!n=!"or, "or s7 dec!d7 c+% s7 se :%'race e!, c+ c!ne s7 se asoc!e/e, c+% s74s!
    &e(reac7 (!%&+" "!'er O! ce .e" de Ocoa"7 sa+ co"e$!+ s7 +r%e/e. Aceas(7 neces!(a(e,
    ca a"=!! s74O! as+%e res&onsa'!"!(a(ea, de&7OeO(e cerer!"e de as!s(en=7 d!n &ar(ea
    a"(ora, cores&+n/7(oare s!(+a=!e! O! cores&+n/7(oare N e(7=!! Ede e<., neces!(7=!"e
    s&ec!.!ce a"e co&!!"or, &ersoane"or :n e(a(e O! &ersoane"or and!ca&a(eJ. T+"'+rarea
    de &ersona"!(a(e de&enden(7 &oa(e s+rven! "a +n !nd!v!d care are o cond!=!e
    %ed!ca"7 $enera"7 or! o !nva"!d!(a(e sever7, dar :n as(.e" de ca/+r! d!.!c+"(a(ea de a
    "+a dec!/!! (re'+!e s7 %ear$7 d!nco"o de cea care ar .! :n %od nor%a" asoc!a(7 c+
    acea cond!=!e sa+ !n.!r%!(a(e.
    822 Tulburrile de #ersonalitate

    Deoarece se (e% s7 n+ &!ard7 s+&or(+" s! a&ro'area, !nd!v!/!! c+ (+"'+rare de
    &ersona"!(a(e de&enden(7 a+ adesea d!.!c+"(7=! :n a4s! e<&r!%a de/acord+" .a=7 de
    a"=! oa%en!, :n s&ec!a" .a=7 de ce! de care s+n( de&enden=! Ecr!(er!+" ;J. AceO(!
    !nd!v!/! se s!%( a(A( de !nca&a'!"! s7 .+nc=!one/e s!n$+r! c7 vor .! de acord c+ "+cr+r!
    &e care "e cons!der7 erona(e, %a! c+rAnd decA( s7 r!O(e &!erderea a@+(or+"+! d!n
    &ar(ea ce"or "a care ca+(7 :ndr+%are. N+ se s+&7r7 cores&+n/7(or &e ce! de a" c7ror
    s+&or( s! a(en=!e a+ nevo!e de .r!ca :ns(r7!n7r!! aces(ora. Dac7 &reoc+&7r!"e
    !nd!v!d+"+! :n "e$7(+r7 c+ consec!n=e"e e<&r!%7r!! de/acord+"+! s+n( rea"e Ede e<.,
    .r!ca rea"7 de &edea&s7 d!n &ar(ea +n+! so= a'+/!vJ, co%&or(a%en(+" n+ (re'+!e s7
    .!e cons!dera( dre&( !nd!c!+ de (+"'+rare de &ersona"!(a(e de&enden(7.
    Ind!v!/!! c+ aceas(7 (+"'+rare a+ d!.!c+"(7=! :n a !n!=!a &ro!ec(e or! :n a .ace
    an+%!(e "+cr+r! :n %od !nde&enden( Ecr!(er!+" IJ. E! s+n( "!&s!=! de :ncredere :n s!ne
    s! cons!der7 c7 neces!(7 a@+(or &en(r+ a :nce&e s! rea"!/a sarc!n!"e. Po( aO(e&(a ca a"=!!
    s7 :ncea&7 "+cr+r!"e, deoarece s+n( conv!nO! c7 de re$+"7 a"=!! &o( .ace aceas(a %a!
    '!ne. AceO(! !nd!v!/! s+n( conv!nO! c7 e! s+n( !nca&a'!"! s7 .+nc=!one/e !nde&enden(
    s! se &re/!n(7 e! :nO!O! ca .!!nd !nco%&e(en=! s! neces!(And as!s(en=7 cons(an(7. E! s+n(
    d!s&+O! :ns7 s7 .+nc=!one/e adecva(, dac7 "! se d7 as!$+rarea c7 a"(c!neva :!
    s+&erv!/ea/7 O!4! a&ro'7. Poa(e e<!s(a s! .r!ca de a n+ deven! sa+ de a n+ &7rea %a!
    co%&e(en=!, deoarece e! &o( crede c7 aceas(a va d+ce "a a'andonare. Pen(r+ c7 e! se
    ba;ea;6 pe a"=!! ca s7 "e re/o"ve &ro'"e%e"e, adesea n+ :nva=7 (en!c!"e e<!s(en=e!
    !nde&enden(e, O! ca a(are :O! &er&e(+ea/7 de&enden=a.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e de&enden(7 &o( %er$e .oar(e de&ar(e
    s&re a o'=!ne (+(e"are O! s+&or( de "a a"=!!, c!ar &An7 "a &+nc(+" de a se o.er! ca
    vo"+n(ar! &en(r+ sarc!n! ne&"7c+(e, dac7 +n as(.e" de co%&or(a%en( "e ad+ce
    s+&erv!/area &e care o neces!(7 Ecr!(er!+" YJ. S+n( d!s&+O! s7 se s+&+n7 dor!n=e"or
    a"(ora, c!ar dac7 cerer!"e s+n( a's+rde. Neces!(a(ea "or de a %en=!ne o "e$7(+r7
    !%&or(an(7 va d+ce adesea "a re"a=!! de/ec!"!'ra(e sa+ d!s(ors!ona(e. Po( .ace
    sacr!.!c!! e<(raord!nare or! (o"era %a"(ra(are ver'a"7, .!/!c7 sa+ se<+a"7. EDe re=!n+(
    c7 aces( co%&or(a%en( (re'+!e s7 .!e cons!dera( +n !nd!c!+ de (+"'+rare de
    &ersona"!(a(e de&enden(7 n+%a! cAnd &oa(e .! s(a'!"!( c7 !nd!v!d+"+! :! s+n(
    d!s&on!'!"e s! a"(e o&=!+n!J. Ind!v!/!! c+ aceas(7 (+"'+rare se s!%( !nco%oda=! sa+
    "!&s!=! de a@+(or cAnd s+n( s!n$+r!, d!n ca+/a .r!c!"or "or e<a$era(e de a n+ .!
    !nca&a'!"! s7 a!'7 $r!@7 de e! :nO!O! Ecr!(er!+" RJ. E! se vor S=!neT d+&7 a"(e &ersoane
    !%&or(an(e n+%a! &en(r+ a ev!(a s7 r7%An7 s!n$+r!, c!ar dac7 n+ s+n( !n(eresa=!
    sa+ !%&"!ca=! :n ceea ce se &e(rece.
    CAnd o re"a=!e s(rAns7 se (er%!n7 Ede e<., o r+&(+r7 c+ +nEoJ !+'!(E7J8 %oar(ea
    +n+! (+(oreJ, !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e de&enden(7 &o( c7+(a +r$en(
    a"(7 re"a=!e &en(r+ a "e o.er! (+(e"area O! s+&or(+" &e care45 neces!(7 Ecr!(er!+" HJ. E!
    cred c7 s+n( !nca&a'!"! s7 .+nc=!one/e :n a'sen=a +ne! re"a=!! s(rAnse, ceea ce .ace ca
    aceO(! !nd!v!/! s7 dev!n7 ra&!d O! !nd!scr!%!na(!v a(aOa=! de a"(7 &ersoan7. Ind!v!/!!
    c+ aceas(7 (+"'+rare s+n( adesea &reoc+&a=! de .r!ca de a n+ .! "7sa=! s74O! &oar(e
    s!n$+r! de $r!@7 Ecr!(er!+" GJ. Se v7d e! :nO!O! a(A( de de&enden=! de cons!"!!"e s!
    a@+(or+" +ne! a"(e &ersoane !%&or(an(e, c7 s+n( &reoc+&a=! de .a&(+" de a n+ .!
    a'andona=! de acea &ersoan7, c!ar cAnd n+ e<!s(7 %o(!ve &en(r+ a @+s(!.!ca as(.e"
    de (e%er!. Pen(r+ a .! cons!dera(e ca &ro'7 a aces(+! cr!(er!+, .r!c!"e (re'+!e s7 .!e
    e<ces!ve O! ne@+s(!.!ca(e. De e<e%&"+, +n '7(rAn c+ cancer care v!ne s7 "oc+!asc7 :n
    casa .!+"+! s7+ &en(r+ a .! :n$r!@!( &re/!n(7 +n co%&or(a%en( de de&enden=7 care
    es(e adecva(, da(e .!!nd c!rc+%s(an=e"e de v!a=7 a"e &ersoane!.
    45E2I Tulburarea de #ersonalitate
    Dependent
    82+
    *lemente ,i tulburri asociate
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e de&enden(7 se carac(er!/ea/7 adesea &r!n
    &es!%!s% s! ne:ncredere :n s!ne s! (!nd s74s! d!%!n+e ca&ac!(7=!"e O! ca"!(7=!"e, s! se
    &o( a+(odescr!e ca Ss(+&!/!T. E! cons!der7 cr!(!ca O! de/a&ro'area ca &ro'e a"e "!&se!
    "or de va"oare O! :O! &!erd :ncrederea :n e!. Po( c7+(a s+&er&ro(ec(!e O! do%!nare d!n
    &ar(ea a"(ora. F+nc=!onarea &ro.es!ona"7 &oa(e .! de(er!ora(7, dac7 es(e necesar7 o
    !n!=!a(!v7 !nde&enden(7. E! &o( ev!(a &os(+r! de r7s&+ndere O! &o( deven! an<!oO!
    cAnd s+n( con.r+n(a=! c+ "+area +nor dec!/!!. Re"a=!!"e soc!a"e (!nd a .! red+se "a ce!
    cA=!va oa%en! de care !nd!v!d+" es(e de&enden(. Poa(e e<!s(a +n r!sc cresc+( de
    (+"'+r7r! a.ec(!ve, an<!oase O! ada&(are. T+"'+rarea de &ersona"!(a(e de&enden(7
    a&are adesea conco%!(en( c+ a"(e (+"'+r7r! de &ersona"!(a(e, :n s&ec!a" c+ (+"'+r7r!"e
    de &ersona"!(a(e 'order"!ne, ev!(an(7 O! !s(r!on!c7. Ma"ad!!"e so%a(!ce cron!ce or!
    an<!e(a(ea de se&arare :n co&!"7r!e sa+ ado"escen=7 &o( &red!s&+ne !nd!v!d+" "a
    de/vo"(area aces(e! (+"'+r7r!.
    *lemente speci$ice culturii, etii ,i sexului
    ,rad+" &An7 "a care co%&or(a%en(e"e de de&enden=7 s+n( cons!dera(e adecva(e
    var!a/7 s+'s(an=!a" :n ra&or( c+ e(a(ea O! c+ $r+&+" soc!oc+"(+ra". E(a(ea O! .ac(or!!
    c+"(+ra"! (re'+!e s7 .!e "+a=! :n cons!dera=!e :n eva"+area &ra$+"+! d!a$nos(!c a"
    .!ec7r+! cr!(er!+. Co%&or(a%en(+" de de&enden=7 (re'+!e s7 .!e cons!dera(
    carac(er!s(!c (+"'+r7r!!, n+%a! cAnd es(e ne( :n e<ces .a=7 de nor%e"e c+"(+ra"e a"e
    !nd!v!d+"+! sa+ re."ec(7 &reoc+&7r! &+=!n rea"!s(e.Un accen( &+s &e &as!v!(a(e,
    &o"!(e=e O! (ra(a%en( de.eren( es(e carac(er!s(!c +nor soc!e(7=!, O! &oa(e .! !n(er&re(a(
    :n %od erona( ca (r7s7(+r7 de &ersona"!(a(e de&enden(7. La .e", soc!e(7=!"e &o(, :n
    %od d!.eren=!a(, .avor!/a O! desc+ra@a co%&or(a%en(+" de de&enden=7 "a '7r'a=! O!
    .e%e!. Aces( d!a$nos(!c (re'+!e s7 .!e +(!"!/a( c+ %are &reca+=!e, dac7 n+ c!ar de"oc,
    "a co&!! s! ado"escen=!, &en(r+ care co%&or(a%en(+" de de&enden=7 &oa(e .!
    cores&+n/7(or de/vo"(7r!!, :n cond!=!! c"!n!ce, aceas(7 (+"'+rare a .os( d!a$nos(!ca(7
    %a! .recven( "a .e%e!, deO! +ne"e s(+d!! a+ ra&or(a( &rocen(e de &reva"en(7 s!%!"are
    &r!n(re '7r'a=! O! .e%e!.
    #revalent
    T+"'+rarea de &ersona"!(a(e de&enden(7 se a."7 &r!n(re ce"e %a! .recven(
    ra&or(a(e (+"'+r7r! de &ersona"!(a(e :n(A"n!(e :n c"!n!c!"e de s7n7(a(e %en(a"7.
    Dia!nostic di$erenial
    T+"'+rarea de &ersona"!(a(e de&enden(7 (re'+!e d!s(!ns7 de de&enden=a care
    a&are ca o consec!n=7 a (+"'+r7r!"or de &e a<a I Ede e<., (+"'+r7r!"e a.ec(!ve, &an!ca
    O! a$ora.o'!aJ O! ca re/+"(a( a" cond!=!!"or %ed!ca"e $enera"e. T+"'+rarea de
    &ersona"!(a(e de&enden(7 are +n de'+( &recoce, evo"+=!e cron!c7 O! +n &a((ern de
    co%&or(a%en( care n+ s+rv!ne e<c"+s!v :n c+rs+" +ne! (+"'+r7r! de &e a<a I sa+ III.
    A"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    de&enden(7, deoarece a+ :n co%+n c+ aceas(a an+%!(e e"e%en(e. De aceea, es(e
    !%&or(an( s7 se .ac7 d!s(!nc=!e :n(re aces(e (+"'+r7r! &e 'a/a d!.eren=e"or d!n(re
    e"e%en(e"e "or carac(er!s(!ce. Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e
    care sa(!s.ac cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7
    (+"'+rarea de &ersona"!(a(e de&enden(7, &o( .! d!a$nos(!ca(e s! aces(ea. DeO! %+"(e
    GC7 Tulburrile de #ersonalitate
    (+"'+r7r! de &ersona"!(a(e se carac(er!/ea/7 &r!n e"e%en(e de de&enden=7,
    (+"'+rarea de &ersona"!(a(e de&enden(7 &oa(e .! d!s(!ns7 &r!n co%&or(a%en(+" s7+
    &redo%!nan( s+'%!s!v, reac(!v s! aderen(. A(A( (+"'+rarea de &ersona"!(a(e
    de&enden(7 cA( s! (+"'+rarea de &ersona"!(a(e 'order"!ne se carac(er!/ea/7 &r!n
    .r!ca de a'andonare8 !nd!v!d+" c+ (+"'+rare de &ersona"!(a(e 'order"!ne
    reac=!onea/7 :ns7 "a a'andon c+ sen(!%en(e de v!d e%o=!ona", .+r!e s!
    revend!ca(!v!(a(e, &e cAnd !nd!v!d+" c+ (+"'+rare de &ersona"!(a(e de&enden(7
    reac=!onea/7 &r!n conces!v!(a(e s! s+'%!s!v!(a(e cresc+(7, s! ca+(7 +r$en( o re"a=!e
    s+'s(!(+(!v7 care s74! o.ere (+(e"are s! s+&or(. T+"'+rarea de &ersona"!(a(e 'order"!ne
    &oa(e .! d!s(!ns7, a&o!, de (+"'+rarea de &ersona"!(a(e de&enden(7 &r!n &a((ern+"
    (!&!c de re"a=!! !n(ense s! !ns(a'!"e. Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e
    !s(r!on!c7, "a .e" ca s! ce! c+ (+"'+rare de &ersona"!(a(e de&enden(7, a+ o neces!(a(e
    !n(ens7 de reas!$+rare s! a&ro'are s! &o( a&are ca .!!nd &+er!"! s! ade/!v!, :ns7,
    con(rar (+"'+r7r!! de &ersona"!(a(e de&enden(e, care es(e carac(er!/a(7 &r!n
    %odes(!e s! co%&or(a%en( doc!", (+"'+rarea de &ersona"!(a(e !s(r!on!c7 es(e
    carac(er!/a(7 &r!n :n."7c7rare soc!a'!"a c+ cerer! ener$!ce de a(en=!e. A(A( (+"'+rarea
    de &ersona"!(a(e de&enden(7 cA( s! (+"'+rarea de &ersona"!(a(e ev!(an(7 se
    carac(er!/ea/7 &r!n sen(!%en(e de !nadecvare, !&ersens!'!"!(a(e "a cr!(!c7 s!
    neces!(a(ea de reas!$+rare8 !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e ev!(an(7 a+ :ns7 o
    .r!c7 !n(ens7 de +%!"!re s! de re@ec=!e, care n+ d!s&are a(A( (!%& cA( e! n+ s+n( s!$+r!
    c7 vor .! acce&(a=!. D!n con(ra, !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e de&enden(7 a+
    +n &a((ern de c7+(are s! de %en=!nere a "e$7(+r!"or c+ a"=!! !%&or(an=!, %a! c+rAnd
    decA( ev!(are s! re(ra$ere d!n re"a=!!.
    T+"'+rarea de &ersona"!(a(e de&enden(7 (re'+!e s7 .!e d!s(!ns7 de %od!.!carea
    de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care (r7s7(+r!"e a&ar
    d!n ca+/a e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra s!s(e%+"+!
    nervos cen(ra". De ase%enea, ea (re'+!e d!s(!ns7 de s!%&(o%e"e care a&ar :n
    asoc!ere c+ +/+" cron!c a" +ne! s+'s(an=e Ede e<., (+"'+rarea :n "e$7(+r7 c+ coca!na
    .7r7 a"(7 s&ec!.!ca=!eJ.
    M+"=! !nd!v!/! &re/!n(7 (r7s7(+r! de &ersona"!(a(e de&enden(7, :ns7, n+%a! cAnd
    aces(e (r7s7(+r! s+n( !n."e<!'!"e, de/ada&(a(!ve s! &ers!s(en(e, s! ca+/ea/7 o
    de(er!orare .+nc=!ona"7 sa+ o de(res7 s+'!ec(!v7 se%n!.!ca(!v7 cons(!(+!e (+"'+rare
    de &ersona"!(a(e de&enden(7.
    45E2H Tulburarea de #ersonalitate Obsesivo-
    ompulsiv
    825
    Criteriile $e $ia/no&ti# pentru
    4+*.= Tul-urarea $e Per&onalitate Depen$ent(
    O necesitate excesiv ,i pervasiv de a $i tutelat, care duce la un
    comportament submisiv ,i ade(iv ,i la $rica de separare, ,i care "ncepe
    precoce "n perioada adult ,i este pre(ent "ntro varietate de contexte, dup
    cum este indicat de cinci &sau mai multe) dintre urmtoareleD
    (1) are di$iculti "n a lua deci(ii comune $r o cantitate excesiv de
    consilii
    ,i reasi!urri din partea altora3
    (2) necesit ca alii s-,i asume responsabilitatea pentru cele mai
    importante
    domenii ale vieii lui3
    (3) are di$iculti "n a-,i exprima de(acordul $a de alii din cau(a $ricii de a
    nu
    pierde suportul sau aprobarea2 Not(M Fu implic $rica real de retribuie3
    (4) are di$iculti "n a iniia proiecte ori a $ace ceva sin!ur &din cau(a
    lipsei
    de "ncredere "n 0udecata sau capacitile sale, mai cur@nd dec@t din cau(a
    lipsei de motivaie sau de ener!ie)3
    (5) mer!e $oarte departe spre a obine solicitudine ,i suport de la alii,
    p@n
    la punctul de a se o$eri voluntar s $ac lucruri care sunt neplcute3
    (6) se simte incomodat sau lipsit de a0utor c@nd rm@ne sin!ur din
    cau(a
    $ricii exa!erate de a nu $i "n stare s aib !ri0 de sine3
    (7) caut ur!ent alt relaie drept surs de solicitudine ,i suport c@nd
    o
    relaie str@ns se termin3
    (1) este exa!erat de preocupat de $rica de a nu $i lsat s aib !ri0 de
    sine2
    4+*.7 Tul-urarea $e Per&onalitate
    O-&e&ivo-Co"pul&iv(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (+"'+r7r!! de &ersona"!(a(e o'ses!vo4co%&+"s!ve :"
    cons(!(+!e &reoc+&area &en(r+ ord!ne, &er.ec=!on!s%, con(ro" %en(a" O! !n(er&er4
    sona", :n de(r!%en(+" ."e<!'!"!(7=!! desc!der!! O! e.!c!en=e!. Aces( &a((ern :nce&e
    &recoce :n &er!oada ad+"(7 O! es(e &re/en( :n(r4o var!e(a(e de con(e<(e.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7 :ncearc7 s7 %en=!n7
    +n sen(!%en( de con(ro" &r!n(r4o a(en=!e &erseveren(7 &en(r+ re$+"!, de(a"!! 'ana"e,
    &rocedee, "!s(e, &"an+r! or! .or%7, %er$And &An7 aco"o :ncA( o'!ec(!v+" %a@or a"
    ac(!v!(7=!! es(e &!erd+( Ecr!(er!+" 5J. E! s+n( e<ces!v de a(en=! O! :nc"!na=! s&re re&e(!=!e,
    acord7 o a(en=!e e<(raord!nar7 de(a"!+"+! s! ver!.!c7r!! re&e(a(e :n c7+(area +nor
    &os!'!"e eror!. U!(7 de .a&(+" c7 a"=! oa%en! (!nd a se enerva &en(r+ :n(Ar/!er!"e O!
    !nconven!en(e"e care re/+"(7 d!n aces( co%&or(a%en(. De e<e%&"+, cAnd as(.e" de
    !nd!v!/! r7(7cesc o "!s(7 c+ "+cr+r!"e &e care "e a+ de .7c+(, ce"(+!e o can(!(a(e e<(re%
    de %are de (!%& c7+(And "!s(a, %a! c+rAnd s7 &!ard7 cA(eva %!n+(e &en(r+ a o
    recrea d!n %e%or!e O! s7 (reac7 a&o! "a :nde&"!n!rea sarc!n!"or. T!%&+" es(e r7+
    a"oca(, ce"e %a! !%&or(an(e sarc!n! .!!nd "7sa(e &en(r+ +"(!%+" %o%en(.
    Per.ec=!on!s%+" O! s(andarde"e :na"(e de e.!c!en=7 a+(o!%&+se ca+/ea/7 d!s.+nc=!e s!
    82> Tulburrile de #ersonalitate
    o de(res7 se%n!.!ca(!v7 "a aceO(! !nd!v!/!. E! &o( deven! a(A( de !%&"!ca=! :n
    e<ec+(area a'so"+( &er.ec(7 a .!ec7r+! de(a"!+ a" +n+! &ro!ec(, c7 &ro!ec(+" n+ es(e
    (er%!na( n!c!oda(7 Ecr!(er!+" 9J. De e<e%&"+, .!na"!/area +n+! ra&or( scr!s es(e
    :n(Ar/!a(7 de n+%eroase"e rescr!er! cons+%a(oare de (!%& care, (oa(e, a(ra$ a(en=!a
    as+&ra de.!c!en=e! S&er.ec=!+n!!T. Ter%ene"e n+ s+n( res&ec(a(e, !ar as&ec(e"e v!e=!!
    !nd!v!d+"+! care n+ se a."7 :n cen(r+" ac(+a" a" ac(!v!(7=!! &o( c7dea :n de/ord!ne.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7 %an!.es(7 +n
    devo(a%en( e<ces!v .a=7 de %+nc7 s! &rod+c(!v!(a(e %er$And &An7 "a e<c"+derea
    ac(!v!(7=!"or recrea(!ve s! a a%!c!=!!"or Ecr!(er!+" ;J. Aces( co%&or(a%en( n+ es(e
    @+s(!.!ca( de neces!(7=! econo%!ce. E! s!%( adesea c7 n+ a+ (!%& s74O! !a o sear7 sa+
    o /! "!'er7 s&re a .ace o &"!%'are or! n+%a! &en(r+ a se re"a<a. Po( a%Ana o ac(!v!(a(e
    d!s(rac(!v7, c+% ar .! +n conced!+, :n aOa .e" c7 aceas(a n+ s+rv!ne n!c!oda(7. CAnd
    :O! .ac (!%& &en(r+ ac(!v!(7=! recrea(!ve sa+ conced!!, se s!%( !nco%oda=! dac7 n+4s!
    !a+ c+ e! ceva de "+cr+ ca s7 n+4s! S&!ard7 (!%&+"T. Poa(e e<!s(a o %are &reoc+&are
    &en(r+ ac(!v!(7=! do%es(!ce Ede e<., c+r7=en!e re&e(a(7 e<ces!v7, :n aOa .e" c7 Sse
    &oa(e %Anca &e @osTJ. Dac7 :O! &e(rec +n (!%& c+ a%!c!!, aceas(a are "oc &ro'a'!" :n
    c+rs+" +ne! ac(!v!(7=! or$an!/a(e conven=!ona" Ede e<., s&or(+"J. Ho''!+r!"e sa+
    ac(!v!(7=!"e recrea(!ve s+n( a'orda(e ca sarc!n! ser!oase neces!(And o or$an!/are
    a(en(7 O! %+"(7 %+nc7 &en(r+ a "e &+(ea con(ro"a. Accen(+" es(e &+s &e e<ec+=!a
    &er.ec(7. AceO(! !nd!v!/! (rans.or%7 +n @oc :n(r4o sarc!n7 s(r+c(+ra(7 Ede e<.,
    corec(ea/7 +n co&!" %!c &en(r+ c7 n+ a &+s !ne"e"e &e 'ar7 :n ord!nea corec(78 s&+ne
    +n+! co&!" %!c c+ %ers (!(+'an( s74s! cond+c7 (r!c!c"e(a :n "!n!e drea&(78 (rans.or%7
    +n @oc de 'asce( :n(r4o S"ec=!eT d+r7J.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7 &o( .! e<ces!v de
    conO(!!nc!oO!, scr+&+"os! s! !n."e<!'!"! :n %a(er!e de %ora"!(a(e, e(!c7 sa+ va"or!
    Ecr!(er!+" IJ. Se &o( .or=a &e e! :nO!O! O! &e a"=!! s7 +r%e/e &r!nc!&!! %ora"e r!$!de O!
    s(andarde de cond+!(7 .oar(e s(r!c(e. Po( .! !%&"aca'!" de a+(ocr!(!c! :n "e$7(+r7 c+
    &ro&r!!"e "or eror!. Ind!v!/!! c+ aceas(7 (+"'+rare s+n( r!$!d de res&ec(+oO! .a=7 de
    a+(or!(7=! O! re$+"!, O! !ns!s(7 as+&ra +ne! s+&+ner! re"a(!v ad "!(era%, c+ n!c! o
    re$+"7 :nc7"ca(7 de c!rc+%s(an=e a(en+an(e. De e<e%&"+, !nd!v!d+" n+ va
    :%&r+%+(a o .!s7 +n+! a%!c &en(r+ a da +n (e"e.on, deoarece Sn!c! n+ !a O! n!c! n+
    d7 c+ :%&r+%+(T or! &en(r+ c7 aceas(a ar .! ceva Sr7+T &en(r+ carac(er+"
    &ersoane!. Aces(e &ar(!c+"ar!(7=! n+ (re'+!e s7 .!e e<&"!ca(e &r!n !den(!.!carea
    c+"(+ra"7 sa+ re"!$!oas7 a !nd!v!d+"+!.
    Ind!v!/!! c+ aceas(7 (+"'+rare &o( .! !nca&a'!"! s7 se de'arase/e de o'!ec(e +/a(e
    sa+ "!&s!(e de va"oare, c!ar dac7 aces(ea n+ a+ n!c! o va"oare sen(!%en(a"7 Ecr!(er!+"
    YJ. Adesea, aceO(! !nd!v!/! ad%!( c7 s+n( S+n con(a!ner de Oo'o"an!T. E! cons!der7
    ar+ncarea o'!ec(e"or ca r!s!&7, deoarece Sn+ O(!! n!c!oda(7 cAnd :=! &oa(e (re'+!
    cevaT s! se s+&7r7 dac7 c!neva :ncearc7 s7 "e ar+nce "+cr+r!"e &e care e! "e4a+ sa"va(.
    So=!!"e Eso=!!J sa+ ce! c+ care dor% :n ca%er7 se &o( &"An$e de can(!(a(ea de s&a=!+
    oc+&a(7 de o'!ec(e vec!, rev!s(e, +s(ens!"e r+&(e, s! aOa %a! de&ar(e.
    Ind!v!/!! c+ (+"'+rare o'ses!vo4co%&+"s!v7 s+n( re(!cen=! :n a de"e$a sarc!n! or!
    :n a "+cra c+ a"=!! Ecr!(er!+" D%7 Ins!s(7 c+ o's(!na=!e O! :n %od e<a$era(, ca or!ce "+cr+
    s7 .!e .7c+( :n %an!era "or O! ca ce!"a"=! s7 se con.or%e/e %od+"+! "or de a .ace
    "+cr+r!"e. Adesea da+ !ns(r+c=!+n! .oar(e de(a"!a(e des&re c+% (re'+!e .7c+(e
    "+cr+r!"e Ede e<., e<!s(7 +n %od O! n+%a! +n+" de a (+nde $a/on+", de a s&7"a vese"a,
    de a cons(r+! +n co(e= &en(r+ cA!neJ O! s+n( s+r&r!nO! O! !r!(a=! dac7 a"=!! s+$erea/7
    a"(erna(!ve crea(oare. A"(eor!, &o( re.+/a o.er(e"e de a@+(or c!ar cAnd s+n( :n
    :n(Ar/!ere c+ &"an+", deoarece e! cred c7 n!%en! a"(c!neva n+45 &oa(e .ace corec(.
    45E2H Tulburarea de #ersonalitate Obsesivo-
    ompulsiv
    828
    Ind!v!/!! c+ aceas(7 (+"'+rare &o( .! avar! s! %esc!n!, s! %en=!n +n s(andard de
    v!a=7 c+ %+"( s+' ceea ce :O! &o( &er%!(e, cons!derAnd c7 ce"(+!e"!"e (re'+!e
    con(ro"a(e s(r!c( s&re a .ace .a=7 even(+a"e"or ca(as(ro.e Ecr!(er!+" HJ. Ind!v!/!! c+
    (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7 se carac(er!/ea/7 &r!n r!$!d!(a(e O!
    o's(!na=!e Ecr!(er!+" GJ. E! s+n( a(A( de &reoc+&a=! ca "+cr+r!"e s7 .!e .7c+(e :n
    s!n$+r+" %od Scorec(T, c7 s+n( deran@a=! de .a&(+" c7 (re'+!e s7 .!e de acord c+ !de!"e
    a"(c+!va. AceO(! !nd!v!/! :O! .ac &"an+" d!na!n(e, :n ce"e %a! %!c! de(a"!!, O! re.+/7 s7
    !a :n cons!dera=!e or!ce .e" de %od!.!c7r!. Preoc+&a=! (o(a" de &ro&r!+" "or %od de a
    vedea "+cr+r!"e, e! a+ d!.!c+"(7=! :n a "+a :n cons!dera=!e &+nc(e"e de vedere a"e
    a"(ora. A%!c!! O! co"e$!! &o( .! .r+s(ra=! de aceas(7 r!$!d!(a(e cons(an(7. C!ar cAnd
    !nd!v!/!! c+ (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7 rec+nosc c7 &oa(e .! :n
    !n(eres+" "or s7 .ac7 +n co%&ro%!s, e! &o( re.+/a c+ o's(!na=!e s4o .ac7,
    ar$+%en(And c7 aces(a es(e S&r!nc!&!+" "+cr+"+!T.
    *lemente ,i tulburri asociate
    CAnd re$+"!"e s! &rocedee"e s(a'!"!(e n+ d!c(ea/7 r7s&+ns+" corec(, "+area dec!/!e!
    &oa(e deven! +n &roces cons+%a(or de (!%&, adesea &en!'!". Ind!v!/!! c+ (+"'+rare de
    &ersona"!(a(e o'ses!vo4co%&+"s!v7 &o( avea o ase%enea d!.!c+"(a(e :n a dec!de care
    sarc!n! a+ &r!or!(a(e sa+ care es(e ce" %a! '+n %od de a e.ec(+a o an+%!(7 sarc!n7, c7
    &oa(e n!c!oda(7 n+ :n(re&r!nd n!%!c. A+ (end!n=a de a se s+&7ra sa+ %An!a :n
    s!(+a=!!"e :n care n+ s+n( ca&a'!"! s7 %en=!n7 con(ro"+" as+&ra %ed!+"+! "or .!/!c sa+
    !n(er&ersona", :ns7 %An!a n+ es(e e<&r!%a(7 de re$+"7 d!rec(. De e<e%&"+, o &ersoan7
    se &oa(e s+&7ra cAnd serv!c!+" :n(r4+n res(a+ran( n+ es(e cores&+n/7(or, dar :n "oc s7
    se &"An$7 d!rec=!e!, !nd!v!d+" se $AndeO(e cA( s7 "ase ca 'acO!O, :n a"(e oca/!!, %An!a
    &oa(e .! e<&r!%a(7 &r!n(r4o !nd!$nare @+s(!.!ca(7 &en(r+ o ces(!+ne a&aren( %!nor7.
    Oa%en!! c+ aceas(7 (+"'+rare &o( .! e<(re% de a(en=! "a s(a(+(+" "or re"a(!v :n re"a=!!"e
    de do%!nare4s+&+nere O! &o( %an!.es(a +n res&ec( e<ces!v .a=7 de o a+(or!(a(e &e care
    o res&ec(7 O! o re/!s(en=7 e<ces!v7 .a=7 de o a+(or!(a(e &e care n+ o res&ec(7.
    Ind!v!/!! c+ aceas(7 (+"'+rare :O! e<&r!%7 de re$+"7 a.ec=!+nea :n(r4+n %od
    e<(re% de con(ro"a( sa+ de s(!"a( s! &o( .! deran@a=! :n &re/en=a a"(ora care s+n(
    e<&res!v! e%o=!ona". Re"a=!!"e "or co(!d!ene a+ +n carac(er .or%a" O! ser!os, !ar e! &o(
    .! r!$!/! :n s!(+a=!! :n care2a"=!! ar /A%'! s! ar .! .er!c!=! Ede e<., :n(A%&!narea !+'!(e!
    X!+'!(+"+!X "a aero&or(J. Se a'=!n c+ $r!@7 s7 s&+n7 ceva &An7 ce n+ s+n( s!$+r! c7
    ceea ce s&+n va .! &er.ec(. Po( .! &reoc+&a=! de "o$!c7 s! !n(e"ec(, O! &o( .! !n(o"eran=!
    "a co%&or(a%en(+" a.ec(!v a" a"(ora. Adesea a+ d!.!c+"(7=! :n e<&r!%area
    sen(!%en(e"or (andre s! .ac rar co%&"!%en(e. Ind!v!/!! c+ aceas(7 (+"'+rare &o(
    e<&er!en=a d!.!c+"(7=! &ro.es!ona"e O! de(res7, :n s&ec!a" cAnd s+n( con.r+n(a=! c+
    s!(+a=!! no! care cer ."e<!'!"!(a(e O! co%&ro%!s.
    Ind!v!/!! c+ (+"'+r7r! an<!oase, !nc"+/And an<!e(a(ea $enera"!/a(7, (+"'+rarea
    o'ses!vo4co%&+"s!v7, .o'!a soc!a"7 O! .o'!!"e s&ec!.!ce a+ o &ro'a'!"!(a(e cresc+(7 de
    a &re/en(a o (+"'+rare de &ersona"!(a(e care sa(!s.ace cr!(er!!"e &en(r+ (+"'+rarea de
    &ersona"!(a(e o'ses!vo4co%&+"s!v7. C!ar dac7 es(e aOa, se &are c7 %a@or!(a(ea
    !nd!v!/!"or c+ (+"'+rare o'ses!vo4co%&+"s!v7 n+ a+ +n &a((ern de co%&or(a%en(
    care s7 sa(!s.ac7 cr!(er!!"e &en(r+ aceas(7 (+"'+rare de &ersona"!(a(e. M+"(e d!n(re
    e"e%en(e"e (+"'+r7r!! de &ersona"!(a(e o'ses!vo4co%&+"s!ve se s+&ra&+n &es(e
    (r7s7(+r!"e &ersona"!(7=!! de S(!& AT Ede e<., &reoc+&7r! &en(r+ %+nc7,
    co%&e(!(!v!(a(e O! a .! &resa( de (!%&J, !ar aces(e e"e%en(e &o( .! &re/en(e "a oa%en!!
    c+ r!sc de !n.arc( %!ocard!c. Poa(e e<!s(a o asoc!ere :n(re (+"'+rarea de &ersona"!(a(e
    o'ses!vo4co%&+"s!v7 s! (+"'+r7r!"e a.ec(!ve s! (+"'+r7r!"e de co%&or(a%en( a"!%en(ar.
    82= Tulburrile de #ersonalitate
    *lemente speci$ice culturii si sexului
    :n eva"+area +n+! !nd!v!d &en(r+ (+"'+rarea de &ersona"!(a(e o'ses!vo4
    co%&+"s!v7, c"!n!c!an+" n+ (re'+!e s7 !nc"+d7 ace"e co%&or(a%en(e care re."ec(7
    a'!(+d!n!, c+(+%e or! s(!"+r! !n(er&ersona"e care s+n( sanc=!ona(e c+"(+ra" de c7(re
    $r+&+" de re.er!n=7 a" !nd!v!d+"+!. An+%!(e c+"(+r! &+n +n accen( cons!dera'!" &e
    %+nc7 s! &rod+c(!v!(a(e8 co%&or(a%en(e"e care re/+"(7 "a %e%'r!! ace"or soc!e(7=!
    n+ (re'+!e s7 .!e cons!dera(e ca !nd!c!! de (+"'+rare de &ersona"!(a(e o'ses!vo4
    co%&+"s!v7. :n s(+d!! s!s(e%a(!ce, (+"'+rarea &are a .! d!a$nos(!ca(7 de a&ro<!%a(!v
    do+7 or! %a! .recven( &r!n(re '7r'a=!.
    #revalent
    S(+d!!"e care a+ +(!"!/a( eva"+area s!s(e%a(!c7 s+$erea/7 o &reva"en(7 a
    (+"'+r7r!! de &ersona"!(a(e o'ses!vo4co%&+"s!v7 es(!%a(7 "a a&ro<!%a(!v 5d :n
    esan(!oane"e co%+n!(are O! "a a&ro<!%a(!v ;d45Ld "a !nd!v!/!! care se &e/!n(7 "a
    c"!n!c!"e de s7n7(a(e %en(a"7.
    Dia!nostic di$erenial
    :n d!s&re=+" s!%!"!(+d!n!! :n den+%!re, (+"'+rarea o'ses!vo4co%&+"s!v7 es(e de
    re$+"7 +Oor de d!s(!ns de (+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7 &r!n
    &re/en=a de o'ses!! s! co%&+"s!! adev7ra(e. Un d!a$nos(!c de (+"'+rare o'ses!vo4
    co%&+"s!v7 (re'+!e "+a( :n cons!derare :n s&ec!a" cAnd co"ec=!on!s%+" es(e e<(re%
    Ede e<., s(rAn$e $r7%e/! de o'!ec(e !n+(!"e care &re/!n(7 +n &er!co" de !ncend!+ s!
    .ace d!.!c!" &en(r+ ce!"a"=! %ers+" &r!n cas7J. CAnd s+n( sa(!s.7c+(e cr!(er!!"e &en(r+
    a%'e"e (+"'+r7r!, a%'e"e d!a$nos(!ce (re'+!e :nre$!s(ra(e.
    A"(e (+"'+r7r! de &ersona"!(a(e &o( .! con.+nda(e c+ (+"'+rarea de &ersona"!(a(e
    o'ses!vo4co%&+"s!v7, deoarece a+ an+%!(e e"e%en(e co%+ne. De aceea, es(e
    !%&or(an( s7 se .ac7 d!s(!nc=!e :n(re aces(e (+"'+r7r! &e 'a/a d!.eren=e"or d!n(re
    e"e%en(e"e "or carac(er!s(!ce. Dac7 :ns7, +n !nd!v!d are e"e%en(e de &ersona"!(a(e
    care sa(!s.ac cr!(er!!"e &en(r+ +na sa+ %a! %+"(e (+"'+r7r! de &ersona"!(a(e, &e "An$7
    (+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7, &o( .! d!a$nos(!ca(e s! aces(ea.
    Ind!v!/!! c+ (+"'+rare de &ersona"!(a(e narc!s!s(!c7 &o( a.!r%a (end!n=a "a
    &er.ec=!on!s% s! cred c7 a"=!! n+ &o( .ace "+cr+r!"e "a .e" de '!ne, dar es(e &os!'!" ca
    aceO(! !nd!v!/! s7 cread7 c7 ei a+ a(!ns &er.ec=!+nea, &e cAnd ce! c+ (+"'+rare de
    &ersona"!(a(e o'ses!vo4co%&+"s!v7 s+n( de re$+"7 a+(ocr!(!c!. Ind!v!/!! c+ (+"'+rare
    de &ersona"!(a(e an(!soc!a"7 sa+ narc!s!s(!c7 s+n( "!&s!=! de $enero/!(a(e dar
    !nd+"$en=! c+ e! :nO!O!, &e cAnd ce! c+ (+"'+rare de &ersona"!(a(e o'ses!vo4
    co%&+"s!v7 ado&(7 +n s(!" de a ce"(+! avar, a(A( .a=7 de e! :nO!O!, cA( s! .a=7 de
    a"=!!. A(A( (+"'+rarea de &ersona"!(a(e sc!/o!d7, cA( O! (+"'+rarea de &ersona"!(a(e
    o'ses!vo4co%&+"s!v7 se carac(er!/ea/7 &r!n .or%a"!s% ev!den( O! de(aOare
    soc!a"7, :n (+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7, aces(ea &rov!n d!n
    d!scon.or(+" c+ e%o=!!"e s! devo(a%en(+" e<ces!v .a=7 de %+nc7, &e cAnd :n
    (+"'+rarea de &ersona"!(a(e sc!/o!d7 e<!s(7 o "!&s7 .+nda%en(a"7 a ca&ac!(7=!! de
    !n(!%!(a(e.
    T+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7 (re'+!e d!s(!ns7 de
    %od!.!carea de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, :n care
    (r7s7(+r!"e a&ar da(or!(7 e.ec(e"or d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e as+&ra
    s!s(e%+"+! nervos cen(ra". Ea (re'+!e d!s(!ns7, de ase%enea, de s!%&(o%e"e care
    a&ar :n "e$7(+r7 c+ +/+" cron!c a" +ne! s+'s(an=e Ede e<., (+"'+rarea :n "e$7(+r7 c+
    coca!na .7r7 a"(7 s&ec!.!ca=!eJ.
    45E2H Tulburare de #ersonalitate 'r Alt
    Speci$icaie
    824

    Tr7s7(+r!"e de &ersona"!(a(e o'ses!vo4co%&+"s!v7 %odera(e &o( .! e<(re% de
    ada&(a(!ve, :n s&ec!a" :n s!(+a=!!"e care reco%&ensea/7 e.!c!en=a cresc+(7. N+%a!
    cAnd aces(e (+"'+r7r! s+n( !n."e<!'!"e, de/ada&(a(!ve, &ers!s(en(e s! ca+/ea/7 o
    de(er!orare .+nc=!ona"7 sa+ o de(res7 s+'!ec(!v7 se%n!.!ca(!v7, e"e cons(!(+!e
    (+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7.
    Criteriile $e $ia/no&ti# pentru
    4+*.7 Tul-urarea $e Per&onalitate O-&e&ivo-Co"pul&iv(
    .n pattern pervasiv de preocupare pentru ordine, per$ecionism ,i control
    mental ,i interpersonal "n detrimentul $lexibilitii, desc%iderii ,i e$icienei,
    "ncep@nd precoce "n perioada adult ,i pre(ent "ntr-o varietate de contexte,
    dup cum este indicat de cel puin patru &sau mai multe) dintre urmtoareleD
    &E)este preocupat de detalii, re!uli, liste, ordine, or!ani(are sau planuri, "n
    a,a msur c obiectivul ma0or al activitii este pierdut3
    (2) pre(int per$ecionism care inter$erea( cu "ndeplinirea sarcinilor
    &de
    ex2, este incapabil s reali(e(e un proiect, deoarece nu sunt satis$cute
    standardele sale extrem de stricte)3
    (3) este excesiv de devotat muncii ,i productivitii, mer!@nd p@n la exclu
    derea activitilor recreative ,i a amiciiilor &ne0usti$icat de o necesitate
    economic evident)3
    (4) este %ipercon,tiincios, scrupulos ,i in$lexibil "n probleme de
    moralitate,
    etic sau valori &$apt ne0usti$icat prin identi$icare cultural sau reli!ioas)3
    (5) este incapabil s se debarase(e de obiecte u(ate sau inutile, c%iar
    c@nd
    acestea nu au nici o valoare sentimental3
    (6) re$u( s dele!e sarcini sau s lucre(e cu alii "n a$ar de ca(ul
    c@nd
    ace,tia se supun exact modului lui de a $ace lucrurile3
    (7) adopt un stil avar de a c%eltui, at@t $a de sine c@t ,i $a de alii,
    banii
    $iind v(ui ca ceva ce trebuie str@ns pentru eventuale catastro$e3
    (8) pre(int ri!iditate ,i obstinaie2
    4+*.7 Tul-urare $e Per&onalitate
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e re/erva(7 (+"'+r7r!"or de .+nc=!onare a &ersona"!(7=!! care
    n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! o (+"'+rare de &ersona"!(a(e s&ec!.!c7. Un e<e%&"+
    :n aces( sens :" cons(!(+!e &re/en=a de e"e%en(e a&ar=!nAnd %a! %+"( decA( +ne!
    s!n$+re (+"'+r7r! de &ersona"!(a(e s&ec!.!ce, dar care n+ sa(!s.ac co%&"e( cr!(er!!"e
    &en(r+ n!c! o (+"'+rare de &ersona"!(a(e ES&ersona"!(a(e %!<(7TJ :ns7 :%&re+n7
    crea/7 o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n +n+" sa+ %a! %+"(e do%en!!
    de .+nc=!onare !%&or(an(e Ede e<., soc!a" sa+ &ro.es!ona"J. Aceas(7 ca(e$or!e &oa(e
    .! +(!"!/a(7, de ase%enea, cAnd c"!n!c!an+" cons!der7 c7 o (+"'+rare de &ersona"!(a(e
    s&ec!.!c7 ne!nc"+s7 :n c"as!.!care, es(e adecva(7. E<e%&"e"e !nc"+d (+"'+rarea de
    &ersona"!(a(e de&res!v7 s! (+"'+rarea de &ersona"!(a(e &as!v4a$res!v7 Eve/! &a$. HGF
    O!, res&ec(!v, &a$. HF5, &en(r+ cr!(er!!"e de cerce(are s+$era(eJ.

    Alte condiii care se pot a$la "n
    centrul ateniei clinice
    eas(7 sec=!+ne c+&r!nde a"(e cond!=!! sa+ &ro'"e%e care se &o( a."a :n
    cen(r+" a(en=!e! c"!n!ce. Aces(ea s+n( :n "e$7(+r7 c+ (+"'+r7r!"e %en(a"e descr!se
    an(er!or :n aces( %an+a" :n(r4+n+" d!n +r%7(oare"e %od+r!Q 5J &ro'"e%a es(e cen(r+"
    d!a$nos(!c+"+! sa+ (rar(a%en(+"+!, !ar !nd!v!d+" n+ are n!c! o (+"'+rare %en(a"7 Ede
    e<., o &ro'"e%7 de re"a=!e c+ &ar(ener+", :n care n!c! &ar(ener+" n+ are s!%&(o%e
    care s7 sa(!s.ac7 cr!(er!!"e &en(r+ o (+"'+rare %en(a"7, ca/ :n care es(e cod!.!ca(7
    n+%a! &ro'"e%a de re"a=!e c+ &ar(ener+"J8 9J !nd!v!d+" are o (+"'+rare %en(a"7, dar
    aceas(a n+ are n!c! o "e$7(+r7 c+ &ro'"e%a Ede e<., o &ro'"e%7 de re"a=!e c+
    &ar(ener+", :n care +n+" d!n(re &ar(ener! are o .o'!e s&ec!.!c7 !nc!den(a"7, ca/ :n care
    s+n( cod!.!ca(e a%'e"eJ8 ;J !nd!v!d+" are o (+"'+rare %en(a"7 care es(e :n "e$7(+r7 c+
    &ro'"e%a, :ns7 &ro'"e%a es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7
    se&ara(7 Ede e<., o &ro'"e%7 de re"a=!e c+ &ar(ener+" s+.!c!en( de sever7 &en(r+ a se
    a."a :n cen(r+" (ra(a%en(+"+! s! care es(e asoc!a(7 c+ (+"'+rare de&res!v7 %a@or7 "a
    +n+" d!n(re &ar(ener!, ca/ :n care &o( .! cod!.!ca(e a%'e"eJ. Cond!=!!"e s! &ro'"e%e"e
    d!n aceas(7 sec=!+ne s+n( cod!.!ca(e &e a<a I.
    'a#torii P&i@olo/i#i #are a%e#tea)(
    Con$i!ia Me$i#al(
    4*= 'a#torii P&i@olo/i#i #are a%e#tea)(
    Con$i!ia Me$i#al(
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" .ac(or!"or &s!o"o$!c! care a.ec(ea/7 cond!=!a %ed!ca"7 :"
    cons(!(+!e &re/en=a +n+!a sa+ a %a! %+"=! .ac(or! co%&or(a%en(a"! sa+ &s!o"o$!c!
    s&ec!.!c! care a.ec(ea/7 ne.avora'!" o cond!=!e %ed!ca"7 $enera"7. E<!s(7 %a! %+"(e
    %od+r! d!.er!(e :n care aceO(! .ac(or! &o( a.ec(a ne.avora'!" cond!=!a %ed!ca"7 $enera"7.
    Fac(or!! &o( !n."+en=a evo"+=!a cond!=!e! %ed!ca"e $enera"e Ecare &oa(e .! !n.era(7 d!nrr4
    o asoc!ere (e%&ora"7 s(rAns7 :n(re .ac(or! s! a&ar!=!a sa+ e<acer'area or! :n(Ar/!erea
    rec+&er7r!! d!n cond!=!a %ed!ca"7J. Fac(or!! &o( cons(!(+! +n r!sc s+&"!%en(ar &en(r+
    s7n7(a(ea !nd!v!d+"+! Ede e<., con(!n+area !&er.a$!e! "a +n !nd!v!d c+ d!a'e(, $rasJ &o(
    &rec!&!(a sa+ e<acer'a s!%&(o%e"e +ne! cond!=!! %ed!ca"e $enera"e &r!n &rovocarea
    +nor r7s&+ns+r! .!/!o"o$!ce :n "e$7(+r7 c+ s(res+" Ede e<., &rovocarea de d+rere
    &record!a"7 "a !nd!v!/!! c+ %a"ad!e coronar!an7, sa+ 'ronos&as% "a !nd!v!/!! c+ as(%J.
    H;5
    G4C Alte condiii care se pot a$la "n centrul ateniei clinice
    Fac(or!! co%&or(a%en(a"! sa+ &s!o"o$!c! care !n."+en=ea/7 cond!=!!"e %ed!ca"e
    $enera"e !nc"+d (+"'+r7r!"e de &e a<a I, (+"'+r7r!"e de &e a<a II, s!%&(o%e"e
    &s!o"o$!ce sa+ (r7s7(+r!"e de &ersona"!(a(e care n+ sa(!s.ac cr!(er!!"e co%&"e(e
    &en(r+ o (+"'+rare %en(a"7 s&ec!.!c7, co%&or(a%en(e"e de/ada&(a(!ve &en(r+
    s7n7(a(e sa+ r7s&+ns+r!"e .!/!o"o$!ce "a s(resor!! a%'!en(a"! sa+ soc!a"!.
    Fac(or!! &s!o"o$!c! sa+ co%&or(a%en(a"! @oac7 +n ro" &o(en=!a" :n &re/en(area
    sa+ (ra(a%en(+" a&roa&e a" .!ec7re! cond!=!! %ed!ca"e $enera"e. Aceas(7 ca(e$or!e
    (re'+!e re/erva(7 ace"or s!(+a=!! :n care .ac(or!! &s!o"o$!c! a+ +n e.ec( se%n!.!ca(!v
    c"!n!c as+&ra evo"+=!e! s! de/nod7%An(+"+! cond!=!e! %ed!ca"e $enera"e sa+ e<&+n
    !nd!v!d+" +n+! r!sc se%n!.!ca(!v cresc+( de de/nod7%An( ne.avora'!". Tre'+!e s7
    e<!s(e &ro'e @+d!c!oase &en(r+ a s+$era o asoc!ere :n(re .ac(or!! &s!o"o$!c! s!
    cond!=!a %ed!ca"7, deO! adesea &oa(e s7 n+ .!e &os!'!" s7 se de%ons(re/e
    ca+/a"!(a(ea d!rec(7 sa+ %ecan!s%e"e s+'!acen(e re"a=!e!. Fac(or!! &s!o"o$!c! s!
    co%&or(a%en(a"! &o( a.ec(a evo"+=!a a&roa&e a .!ec7re! ca(e$or!! %a@ore de %a"ad!e,
    !nc"+s!v a cond!=!!"or card!ovasc+"are, der%a(o"o$!ce, endocr!ne, $as(ro!n(es(!na"e,
    neo&"a/!ce, ne+ro"o$!ce, &+"%onare, rena"e s! re+%a(o"o$!ce.
    D!a$nos(!c+" de .ac(or! &s!o"o$!c! care a.ec(ea/7 cond!=!a %ed!ca"7 es(e
    cod!.!ca( &e a<a I, !ar cond!=!a %ed!ca"7 $enera"7 aco%&an!an(7 es(e cod!.!ca(7 &e
    a<a III. E3e/! ane<a , &en(r+ "!s(a cod+r!"or cond!=!!"or %ed!ca"e $enera"eJ. Pen(r+
    a o.er! o s&ec!.!c!(a(e %a! %are (!&+"+! de .ac(or &s!o"o$!c, n+%e"e es(e a"es d!n
    "!s(a de %a! @os. CAnd %a! %+"( decA( +n s!n$+r (!& de .ac(or es(e &re/en(, (re'+!e
    s&ec!.!ca( ce" %a! &roe%!nen(.
    T+"'+rare %en(a"7 care a.ec(ea/7 777@Se indic6 condi(ia medical6 /eneral6A7 O
    (+"'+rare s&ec!.!c7 de &e a<a I sa+ de &e a<a II a.ec(ea/7 se%n!.!ca(!v evo"+=!a sa+
    (ra(a%en(+" +ne! cond!=!! %ed!ca"e $enera"e Ede e<., (+"'+rarea de&res!v7 %a@or7
    a.ec(ea/7 ne.avora'!" &ro$nos(!c+" !n.arc(+"+! de %!ocard, a" !ns+.!c!en=e! rena"e
    sa+ e%od!a"!/e!8 sc!/o.ren!a co%&"!c7 (ra(a%en(+" d!a'e(+"+! /aara(J. Pe "An$7
    cod!.!carea aces(e! cond!=!! &e a<a I, (+"'+rarea %en(a"7 s&ec!.!c7 es(e cod!.!ca(7, de
    ase%enea, &e a<a I sa+ &e a<a II.
    S!%&(o%e &s!o"o$!ce care a.ec(ea/7 777@Se indic6 condi(ia medical6 /eneral6A7
    S!%&(o%e"e care n+ sa(!s.ac cr!(er!!"e co%&"e(e &en(r+ o (+"'+rare de &e a<a I care
    a.ec(ea/7 :n %od se%n!.!ca(!v evo"+=!a sa+ (ra(a%en(+" +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<., s!%&(o%e an<!oase sa+ de&res!ve care a.ec(ea/7 evo"+=!a s!
    sever!(a(ea +n+! s!ndro% de co"on !r!(a'!" sa+ a +n+! +"cer &e&(!c or! co%&"!c7
    rec+&erarea d+&7 o !n(erven=!e c!(+r$!ca"7J.
    Tr7s7(+r! de &ersona"!(a(e sa+ s(!" de a .ace .a=7 care a.ec(ea/7 777@Se indic6
    condi(ia medical6 /eneral6A7 O (r7s7(+r7 de &ersona"!(a(e sa+ +n s(!" de a .ace .a=7
    de/ada&(a(!v a.ec(ea/7 :n %od se%n!.!ca(!v evo"+=!a sa+ (ra(a%en(+" +ne! cond!=!!
    %ed!ca"e $enera"e. Tr7s7(+r!"e de &ersona"!(a(e &o( .! s+'"!%!na"e &en(r+ o
    (+"'+rare de &e a<a II sa+ re&re/!n(7 +n a"( &a((ern care a .os( de%ons(ra( a .! +n
    .ac(or de r!sc &en(r+ an+%!(e %a"ad!! Ede e<., S(!&+" AT de co%&or(a%en( advers,
    os(!", &en(r+ %a"ad!a ar(er!a"7 coronar!an7J. Tr7s7(+r!"e de &ersona"!(a(e
    &ro'"e%a(!ce s! s(!"+r!"e de a .ace .a=7 de/ada&(a(!ve &o( a.ec(a re"a=!a de "+cr+ c+
    &ersona"+" care acord7 as!s(en=a %ed!ca"7.
    Co%&or(a%en(e de/ada&(a(!ve &en(r+ s7n7(a(e care a.ec(ea/7.777@Se indic6
    condi(ia medical6 /eneral6A7 Co%&or(a%en(e"e de/ada&(a(!ve &en(r+ s7n7(a(e Ede
    4EI 'actorii #si%olo!ici care a$ectea( ondiia Medical ?44
    e<., s(!"+" de v!a=7 seden(ar7, &rac(!c!"e se<+a"e &er!c+"oase, !&er.a$!a, +/+" e<ces!v
    de a"coo" O! de dro$J a.ec(ea/7 :n %od se%n!.!ca(!v evo"+=!a sa+ (ra(a%en(+" +ne!
    cond!=!! %ed!ca"e $enera"e. Dac7 co%&or(a%en(e"e de/ada&(a(!ve s+n( e<&"!ca(e
    %a! '!ne de o (+"'+rare de &e a<a I Ede e<., !&er.a$!a ca &ar(e a '+"!%!e! nervoase,
    +/+" de a"coo" ca &ar(e a de&enden=e! a"coo"!ceJ (re'+!e s7 .!e +(!"!/a(7 den+%!rea
    de S(+"'+rare %en(a"7 care a.ec(ea/7 cond!=!a %ed!ca"7T.
    R7s&+ns+" .!/!o"o$!c :n "e$7(+r7 c+ s(res+" care a.ec(ea/7 777@Se indic6 condi(ia
    medical6 /eneral67 R7s&+ns+r!"e .!/!o"o$!ce :n "e$7(+r7 c+ s(res+" a.ec(ea/7 :n %od
    se%n!.!ca(!v evo"+=!a sa+ (ra(a%en(+" +ne! cond!=!! %ed!ca"e $enera"e E de e<.,
    &rec!&!(7 d+rerea &record!a"7 sa+ ar!(%!a "a +n &ac!en( c+ %a"ad!a ar(ere"or coronareJ.
    A"=! .ac(or! sa+ .ac(or! nes&ec!.!ca=! care a.ec(ea/7 777@Se indic6 condi(ia
    medical6 /eneral6A7 Un .ac(or ne!nc"+s :n s+'(!&+r!"e s&ec!.!ca(e %a! s+s sa+ +n
    .ac(or co%&or(a%en(a" sa+ &s!o"o$!c nes&ec!.!ca( care a.ec(ea/7 :n %od
    se%n!.!ca(!v evo"+=!a sa+ (ra(a%en(+" +ne! cond!=!! %ed!ca"e $enera"e.
    Dia!nostic di$erenial
    O asoc!ere (e%&ora"7 :n(re s!%&(o%e"e +ne! (+"'+r7r! %en(a"e s! o cond!=!e
    %ed!ca"7 $enera"7 es(e, de ase%enea, carac(er!s(!c7 +ne! (+"'+r7r! %en(a"e da(ora(e
    +ne! cond!=!! %ed!ca"e $enera"e, dar ca+/a"!(a(ea &res+&+s7 es(e :n d!rec=!a o&+s7,
    :n(r4o (+"'+rare %en(a"7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e, cond!=!a
    %ed!ca"7 $enera"7 es(e cons!dera(7 a .! ca+/a (+"'+r7r!! %en(a"e &r!n(r4+n
    %ecan!s% .!/!o"o$!c d!rec(, :n .ac(or!! &s!o"o$!c! care a.ec(ea/7 cond!=!a %ed!ca"7,
    .ac(or!! &s!o"o$!c! sa+ co%&or(a%en(a"! s+n( cons!dera=! a a.ec(a evo"+=!a cond!=!e!
    %ed!ca"e $enera"e.
    T+"'+r7r!"e +/+"+! de o s+'s(an=7 Ede e<., de&enden=a de a"coo", de&enden=a de
    n!co(!n7J a.ec(ea/7 ne.avora'!" &ro$nos(!c+" %+"(or cond!=!! %ed!ca"e $enera"e.
    Dac7 +n !nd!v!d are o (+"'+rare coe<!s(en(7 da(ora(7 +/+"+! +ne! s+'s(an=e care
    a.ec(ea/7 ne.avora'!" sa+ ca+/ea/7 o cond!=!e %ed!ca"7 $enera"7, &oa(e .! cod!.!ca(7
    &e a<a I (+"'+rarea %en(a"7 a.ec(And cond!=!a %ed!ca"7 $enera"7 &e "An$7
    (+"'+rarea da(ora(7 +/+"+! +ne! s+'s(an=e. Pen(r+ &a((ern+r!"e +/+"+! de o
    s+'s(an=7 care a.ec(ea/7 o cond!=!e %ed!ca"7 $enera"7, dar care n+ sa(!s.ac cr!(er!!"e
    &en(r+ o (+"'+rare a +/+"+! de o s+'s(an=7, &o( .! s&ec!.!ca(e co%&or(a%en(e"e
    de/ada&(a(!ve &en(r+ s7n7(a(e care a.ec(ea/7 cond!=!a %ed!ca"7.
    T+"'+r7r!"e so%a(o.or%e s+n( carac(er!/a(e &r!n &re/en=a a(A( a .ac(or!"or
    &s!o"o$!c!, cA( s! a s!%&(o%e"or so%a(!ce, dar n+ e<!s(7 n!c! o cond!=!e %ed!ca"7
    $enera"7 care s7 &oa(7 @+s(!.!ca co%&"e( s!%&(o%e"e so%a(!ce. D!n con(ra, :n .ac(or!!
    &s!o"o$!c! care a.ec(ea/7 cond!=!a %ed!ca"7, .ac(or!! &s!o"o$!c! a.ec(ea/7
    ne.avora'!" o cond!=!e %ed!ca"7 d!a$nos(!ca'!"7. Fac(or!! &s!o"o$!c! a.ec(And
    s!ndro%e"e a"$!ce n+ s+n( d!a$nos(!ca(e ca .ac(or &s!o"o$!c care a.ec(ea/7 cond!=!a
    %ed!ca"7 c! ca (+"'+rare a"$!c7 asoc!a(7 c+ .ac(or! &s!o"o$!c! sa+ ca (+"'+rare
    a"$!c7 asoc!a(7 a(A( c+ .ac(or! &s!o"o$!c!, cA( O! c+ o cond!=!e %ed!ca"7 $enera"7.
    CAnd nonco%&"!an=a "a (ra(a%en( &en(r+ o cond!=!e %ed!ca"7 $enera"7 se
    da(orea/7 +nor .ac(or! &s!o"o$!c!, dar dev!ne cen(r+" %a@or a" a(en=!e! c"!n!ce,
    (re'+!e cod!.!ca(7 nonco%&"!an=a "a (ra(a%en( Eve/! &a$. H;FJ.
    ?4H Alte condiii care se pot a$la "n centrul ateniei clinice
    4*=... [De secificat factorul si(olo&ic] #are a%e#tea)( ...
    [Se indic condiia medical &eneral]
    A2 *ste pre(ent o condiie medical !eneral &codi$icat pe axa III)2
    S2 'actorii psi%olo!ici a$ectea( ne$avorabil condiia medical !eneral "ntr-unul
    din urmtoarele moduriD
    (1) $actorii au in$luenat evoluia condiiei medicale !enerale dup cum este
    demonstrat asocierea temporal str@ns dintre $actorii psi%olo!ici ,i apa
    riia sau exacerbarea ori "nt@r(ierea recuperrii din condiia medical
    !eneral3
    (1) $actorii inter$erea( cu tratamentul condiiei medicale !enerale3
    (2) $actorii constituie riscuri suplimentare pentru sntatea individului3
    (2) rspunsurile $i(iolo!ice "n le!tur cu stresul precipit sau exacerbea(
    simptomele condiiei medicale !enerale2
    Alege numele pe ba(a naturii $actorilor psi%olo!ici &dac este pre(ent mai mult
    dec@t un sin!ur $actor, indic pe cel mai proeminent)D
    Tulburare mental care a$ectea( ,,,>6e indic condiia medical general=
    &de ex2, o tulburare mental de pe axa l cum ar $i tulburarea depresiv
    ma0or care "nt@r(ie recuperarea dintr-un in$arct de miocard),
    Simptome psi%olo!ice care a$ectea( 2221Se indic condiia medical
    general= &de ex2,2simptome depresive care "nt@r(ie recuperarea dup o
    intervenie c%irur!ical)
    Trsturi de personalitate sau stiluri de a $ace $a care a$ectea( ,,,>6e
    indic condiia medical general= &de ex2, ne!are patolo!ic a
    necesitii unei intervenii c%irur!icale la un pacient cu cancerD
    comportament de constr@n!ere, ostil, contribuind la o tulburare
    cardiovascular),
    omportament de(adaptativ pentru sntate care a$ectea( ,,,>6e indic
    condiia medical general= &de ex2, %iper$a!ie, lipsa de exerciiu, sex
    neprote0at),
    +spuns $i(iolo!ic "n le!tur cu stresul care a$ectea( 222 >6e indic condiia
    medical general= &exacerbarea "n le!tur cu stresul a ulcerului,
    %ipertensiunii, aritmiilor sau ce$aleei de tensiune)2
    Ali $actori psi%olo!ici sau nespeci$icai care a$ectea( ,,,>6e indic condiia
    medical general= &de ex2, $actori interpersonali, culturali sau reli!io,i)2
    Tul-ur(rile $e MiE#are in$u&e $e Me$i#a"ente
    S+n( !nc"+se (+"'+r7r!"e de %!Ocare !nd+se de %ed!ca%en(e care +r%ea/7 d!n
    ca+/a !%&or(an=e! "or .recven(e :n 5J (ra(a%en(+" %ed!ca%en(os a" (+"'+r7r!"or
    %en(a"e sa+ a" cond!=!!"or %ed!ca"e $enera"e s! 9J d!a$nos(!c+" d!.eren=!a" a"
    (+"'+r7r!"or de &e a<a I Ede e<., (+"'+rarea an<!oas7 vers+s a)a(!s!a !nd+s7 de
    ne+ro"e&(!ce, ca(a(on!a vers+s s!ndro%+" ne+ro"e&(!c %a"!$nJ. DeO! aces(e (+"'+r7r!
    s+n( e(!ce(a(e ca S!nd+se de %ed!ca%en(eT, adesea es(e d!.!c!" de s(a'!"!( re"a=!a
    ca+/a"7 d!n(re e<&+nerea "a +n %ed!ca%en( s! a&ar!=!a (+"'+r7r!! de %!Ocare, :n s&ec!a"
    4472E #arCinsonismul indus de
    Feuroleptice
    G4<
    &en(r+ c7 aces(e %!Oc7r! a&ar, de ase%enea, :n a'sen=a e<&+ner!! "a +n %ed!ca%en(.
    Ter%en+" de ne+roleptic es(e +(!"!/a( &e scar7 "ar$7 :n aces( %an+a" c+ re.er!re "a
    %ed!ca%en(e"e c+ &ro&r!e(7=! an(a$on!s(e do&a%!ne!. DeO! aces( (er%en es(e de&7O!(
    deoarece e" s+'"!n!a/7 &ro&ens!+nea %ed!ca%en(e"or an(!&s!o(!ce de a ca+/a %!Oc7r!
    anor%a"e, (er%en+" de ne+roleptic r7%Ane adecva(. C+ (oa(e c7 %ed!ca%en(e"e
    an(!&s!o(!ce %a! no! es(e &os!'!" s7 &rod+c7 %a! rar (+"'+r7r! de %!Ocare !nd+se de
    ne+ro"e&(!ce, aces(e s!ndro%e (o(+O! s+rv!n. Med!ca%en(e"e ne+ro"e&(!ce !nc"+d
    asan+%!=!! a$en=! an(!&s!or!c! (!&!c! sa+ conven=!ona"! Ede e<., dor&ro%a/!n+",
    a"o&er!do"+", ."+.ena/!naJ, a$en=!! an(!&s!o(!c! Sa(!&!c!T %a! no! Ede e<., c"o/a&!na,
    r!s&er!dona, o"an/a&!na, 0+e(!a&!naJ, an+%!(e %ed!ca%en(e '"ocan(e a"e rece&(or!"or
    do&a%!ne! +(!"!/a(e :n (ra(a%en(+" +nor s!%&(o%e c+% ar .! $rea=a s! $as(ro&are/a Ede
    e<., &roc"or&era/!na, &ro%e(a/!na, (r!%e(o'en/a%!da, (r!e(!"&era/!na s! %e(oc"o4
    &ra%!daJ s! a%o<a&!na, care es(e co%erc!a"!/a( ca an(!de&res!v. T+"'+r7r!"e de %!Ocare
    !nd+se de ne+ro"e&(!ce (re'+!e s7 .!e cod!.!ca(e &e a<a I.
    44C.* ParDin&oni&"ul in$u& $e Neurolepti#e
    !0
    Tre%or &ar)!nson!anX r!$.d!(a(e %+sc+"ar7 sa+ a)!ne/!e a&7rAnd :n dec+rs de
    cA(eva s7&(7%An! de "a :nce&erea (ra(a%en(+"+! sa+ creO(erea do/e! +n+!
    %ed!ca%en( ne+ro"e&(!c Esa+ d+&7 red+cerea +n+! %ed!ca%en( +(!"!/a( :n
    (ra(a%en(+" s!%&(o%e"or e<(ra&!ra%!da"eJ. E3e/! &a$. HFY &en(r+ cr!(er!!"e de
    cerce(are s+$era(eJ.
    444. 5C Sin$ro"ul Neurolepti# Mali/n
    R!$!d!(a(e %+sc+"ar7 sever7, creO(erea (e%&era(+r!! O! a"(e da(e ase%7n7(oare
    Ede e<., (rans&!ra=!e, d!s.a$!e, !ncon(!nen=7, %od!.!c7r! a"e n!ve"+"+! de conO(!en(7
    %er$And de "a con.+/!e "a co%7, %+(!s%, &res!+ne san$+!n7 cresc+(7 sa+ "a'!"7,
    crea(!n.os.o)!na/7 ZCP-[ cresc+(7 a&7rAnd :n asoc!ere c+ +/+" +n+! %ed!ca%en(
    ne+ro"e&(!c. E3e/! &a$. HFG &en(r+ cr!(er!!"e de cerce(are s+$era(e.J
    444.G Di&tonia A#ut( in$u&( $e Neurolepti#e
    Po/!=!e anor%%a"7 sa+ s&as% a" %+Oc!"or ca&+"+!, $A(+"+!, %e%'re"or sa+
    (r+nc!+"+! a&7rAnd :n dec+rs de cA(eva /!"e de "a :nce&erea (ra(a%en(+"+! sa+
    creO(erea do/e! +n+! %ed!ca%en( ne+ro"e&(!c Esa+ d+&7 red+cerea +n+!
    %ed!ca%en( +(!"!/a( :n (ra(a%en(+" s!%&(o%e"or e<(ra&!ra%!da"eJ. E3e/! &a$. GLL
    &en(r+ cr!(er!!"e de cerce(are s+$era(e.J
    444.55 ADati&.a A#ut( in$u&( $e Neurolepti#e
    Ac+/e s+'!ec(!ve de ne"!n!O(e aco%&an!a(e de %!Oc7r! o'serva'!"e Ede e<.,
    %!Oc7r! nervoase a"e %e%'re"or, 'a"ansa(+" de &e +n &!c!or &e a"(+", %ers+" de
    aco"o &An7 co"o, !nca&ac!(a(ea de a s(a aOe/a( sa+ :n &!c!oareJ a&7rAnd :n dec+rs de
    cA(eva s7&(7%An! de "a :nce&erea (ra(a%en(+"+! sa+ de "a creO(erea do/e! +n+!
    %ed!ca%en( ne+ro"e&(!c Esa+ d+&7 red+cerea +n+! %ed!ca%en( +(!"!/a( :n
    (ra(a%en(+" s!%&(o%e"or e<(ra&!ra%!da"eJ. E3e/! &a$. GL9 &en(r+ cr!(er!!"e de
    cerce(are s+$era(eJ.
    H;R Alte condiii care se pot a$la "n centrul ateniei clinice
    444.>C DiDine)ia Tar$iv( in$u&( $e Neurolepti#e
    M!Oc7r! !nvo"+n(are core!.or%e, a(e(o!de sa+ r!(%!ce Ed+rAnd ce" &+=!n cA(eva
    s7&(7%An!J a"e "!%'!!, %and!'+"e! sa+ e<(re%!(7=!"or a&7rAnd :n asoc!ere c+ +/+"
    +n+! %ed!ca%en( ne+ro"e&(!c (!%& de ce" &+=!n cA(eva "+n! E"a &ersoane"e %a! :n
    e(a(e &er!oada de (!%& &oa(e .! %a! sc+r(7J. E3e/! &a$. GLY &en(r+ cr!(er!!"e de
    cerce(are s+$era(eJ.
    444.* Tre"orul Po&tural in$u& $e Neurolepti#e
    Tre%or .!n s+rven!nd :n c+rs+" :ncerc7r!"or de a %en=!ne o &os(+r7 s! care a&ar
    :n asoc!ere c+ +/+" +n+! %ed!ca%en( Ede e<., "!(!+, anr!de&res!ve, va"&roa(J. E3e/!
    &a$. GLH &en(r+ cr!(er!!"e 2de cerce(are s+$era(eJ.
    444.5+ Tul-urare $e MiE#are in$u&( $e
    Neurolepti#e '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e re/erva(7 (+"'+r7r!"or de %!Ocare !nd+se de ne+ro"e&(!ce
    nec"as!.!ca'!"e :n n!c! +na d!n(re (+"'+r7r!"e s&ec!.!ce "!s(a(e %a! s+s. E<e%&"e"e
    !nc"+d 5J &ar)!nson!s%+", a)a(!s!a ac+(7, d!s(on!a ac+(7 sa+ %!Ocarea d!s)!ne(!c7,
    asoc!(e c+ +n %ed!ca%en(, a"(+" decA( +n ne+ro"e&(!c8 9J +n (a'"o+ c"!n!c care
    a%!n(eO(e s!ndro%+" ne+ro"e&(!c %a"!$n, dar care es(e asoc!a( c+ +n %ed!ca%en(,
    a"(+" decA( +n ne+ro"e&(!c sa+ ;J d!s(on!a (ard!v7.
    Alt( Tul-urare in$u&( $e Me$i#a"ente
    55<. C E%e#te A$ver&e ale Me$i#a"entelor
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e d!s&on!'!"7 &en(r+ a .! +(!"!/a(a o&=!ona" de c7(re c"!n!c!an
    s&re a cod!.!ca e.ec(e"e sec+ndare a"e %ed!ca%en(e"or Ea"(e"e decA( s!%&(o%e"e de
    %!OcareJ cAnd aces(e e.ec(e adverse dev!n cen(r+" &r!nc!&a" a" a(en=!e! c"!n!ce.
    E<e%&"e"e !nc"+d !&o(ens!+nea sever7, ar!(%!!"e card!ace s! &r!a&!s%+".
    Pro-le"ele Rela!ionale
    Pro'"e%e"e re"a=!ona"e !nc"+d &a((ern+r! de !n(erac=!+ne :n(re sa+ "a %e%'r!!
    +ne! +n!(7=! re"a=!ona"e asoc!a(e c+ de(er!orare se%n!.!ca(!v7 c"!n!c :n .+nc=!onare
    sa+ s!%&(o%e "a +n+" sa+ "a %a! %+"=! %e%'r! a! +n!(7=!! re"a=!ona"e, sa+
    de(er!orare :n .+nc=!onarea +n!(7=!! re"a=!ona"e :ns7O!. Pro'"e%e"e re"a=!ona"e care
    +r%ea/7 s+n( !nc"+se deoarece e"e s+n( .recven( cen(r+" a(en=!e! c"!n!ce "a !nd!v!/!!
    v7/+=! de &ro.es!on!O(!! :n s7n7(a(e. Aces(e &ro'"e%e &o( e<acer'a sa+ co%&"!ca
    (ra(a%en(+" +ne! (+"'+r7r! %en(a"e sa+ cond!=!! %ed!ca"e $enera"e "a +n+" sa+ "a
    %a! %+"=! %e%'r! a! +n!(7=!! re"a=!ona"e, &o( d+ce "a o (+"'+rare %en(a"7 sa+ "a o
    cond!=!e %ed!ca"7 $enera"7, &o( .! !nde&enden(e de a"(e cond!=!! care s+n( &re/en(e
    VIE26 #roblem +elaional "n le!tur cu o Tulburare
    Mental sau ondiie Medical General G4G
    sa+ &o( s+rven! :n a'sen=a or!c7re! a"(e cond!=!!. CAnd aces(e &ro'"e%e s+n( .ocar+"
    &r!nc!&a" a" a(en=!e! c"!n!ce, e"e (re'+!e s7 .!e "!s(a(e &e a<a I. A"(.e", dac7 s+n(
    &re/en(e, dar n+ s+n( cen(r+" &r!nc!&a" a" a(en=!e! c"!n!ce, &o( .! "!s(a(e &e a<a I3.
    Ca(e$or!a re"evan(7 es(e a&"!ca'!"7 :n $enera" (+(+ror %e%'r!"or +n!(7=!! re"a=!ona"e
    care s+n( (ra(a=! &en(r+ &ro'"e%7.
    V=*.5 Pro-le"( Rela!ional( .n le/(tur( #u o
    Tul-urare Mental( &au Con$i!ie Me$i#al( General(
    Aceas(7 ca(e$or!e (re'+!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e +n
    &a((ern de !n(erac=!+ne de(er!ora(7 care es(e asoc!a( c+ o (+"'+rare %en(a"7 sa+ c+ o
    cond!=!e %ed!ca"7 $enera"7 a +n+! %e%'r+ a" .a%!"!e!.
    V=*.C+ Pro-le"( Rela!ional( P(rinte-Copil
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce !! cons(!(+!e
    +n &a((ern de !n(erac=!+ne :n(re &7r!n(e O! co&!" Ede e<., co%+n!care de(er!ora(7,
    s+&er&ro(ec=!e, d!sc!&"!n7 !nadecva(7J care es(e asoc!a( c+ o de(er!orare
    se%n!.!ca(!v7 c"!n!c :n .+nc=!onarea !nd!v!d+"+! sa+ a .a%!"!e! sa+ c+ a&ar!=!a de
    s!%&(o%e se%n!.!ca(!ve c"!n!c "a &7r!n(e sa+ co&!".
    V=.*+ Pro-le"( Rela!ional( #u Partenerul
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    +n &a((ern de !n(erac=!+ne :n(re so=! sa+ :n(re &ar(ener!, carac(er!/a( &r!n
    co%+n!care ne$a(!v7 Ede e<., cr!(!c7J, co%+n!care d!s(ors!ona(7 Ede e<., s&eran=e
    nerca"!s(eJ, sa+ nonco%+n!care Ede e<., !/o"areJ care es(e asoc!a( c+ o de(er!orare
    se%n!.!ca(!v7 c"!n!c :n .+nc=!onarea !nd!v!d+"+! sa+ .a%!"!e! or! c+ a&ar!=!a de
    s!%&(o%e "a +n+" sa+ "a a%'!! &ar(ener!.
    V=*.> Pro-le"( Rela!ional( .ntre 'ra!i
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 cAnd cen(r+ a(en=!e! c"!n!ce :" cons(!(+!e
    +n &a((ern de !n(erac=!+ne :n(re .ra=!, asoc!a( c+ o de(er!orare se%n!.!ca(!v7 c"!n!c :n
    .+nc=!onarea !nd!v!d+"+! sa+ .a%!"!e! sa+ c+ a&ar!=!a de s!%&(o%e "a +n+" sa+ "a
    %a! %+"=! .ra=!.
    V.=C.>* Pro-le"( Rela!ional(
    '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e (re'+!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    &ro'"e%e re"a=!ona"e care n+ s+n( c"as!.!ca'!"e :n n!c! +na d!n(re &ro'"e%e"e
    s&ec!.!ce "!s(a(e %a! s+s Ede e<., d!.!c+"(7=! c+ co"a'ora(or!!J.
    G4> Alte condiii care se pot a$la "n centrul ateniei clinice
    Pro-le"e .n le/(tur( #u A-u)ul &au Ne/liQen!a
    Aceas(7 sec=!+ne !nc"+de ca(e$or!! care (re'+!e s7 .!e +(!"!/a(e cAnd cen(r+"
    a(en=!e! c"!n!ce :" cons(!(+!e r7+" (ra(a%en( sever a" +n+! !nd!v!d de c7(re +n a"(+"
    &r!n a'+/ .!/!c, a'+/ se<+a" sa+ ne$"!@area co&!"+"+!. Aces(e &ro'"e%e s+n( !nc"+se
    deoarece s+n( .recven( cen(r+" a(en=!e! c"!n!ce "a !nd!v!/!! v7/+=! de &ro.es!on!O(! :n
    s7n7(a(e. Cod+r!"e 3 cores&+n/7(oare se a&"!c7 dac7 cen(r+" a(en=!e! :" cons(!(+!e
    .7&(+!(or+" E&er&e(ra(orJ a'+/+"+! sa+ ne$"!@en=e! sa+ +n!(a(ea re"a=!ona"7 :n care
    .+nc=!onea/7. Dac7 !nd!v!d+" eva"+a( sa+ (ra(a( es(e v!c(!%a a'+/+"+! sa+
    ne$"!@en=e!, se cod!.!c7 FFY,Y9, FFY.Y; sa+ FFY.YI &en(r+ +n co&!" sa+ FFY.G5 or!
    FFY.G; &en(r+ +n ad+"( E:n .+nc=!e de (!&+" de a'+/J.
    V=*.C* A-u)ul 'i)i# al Copilului
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    a'+/+" .!/!c sa+ %a"(ra(area +n+! co&!".
    >ot6 de codi)icare? 0e speci)icat FFY.YI dac6 =n centr+l aten(iei se a)l6 *ictima7
    V=*.C* A-u)ul Se,ual al Copilului
    Aceas(7 ca(e$or!e (re'+!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    a'+/+" se<+a" a" +n+! co&!".
    >ot6 de codi)icare? 0e speci)icat FFY.Y; dac6 =n centr+l aten(iei se a)l6 *ictima7
    V=*.C* Ne/liQarea Copilului
    Aceas(7 ca(e$or!e (re'+!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    ne$"!@area co&!"+"+!.
    >ot6 de codi)icare? 0e speci)icat FFY.Y9 dac6 =n centr+l aten(iei se a)l6 *ictima7
    A-u)ul 'i)i# al A$ultului
    Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    a'+/+" .!/!c a" ad+"(+"+! Ede e<., 'a(erea so=!e!, %a"(ra(area +n+! &7r!n(e :n e(a(eJ.
    >ot6 de codi)icare? Codi)ic6
    3R5.59 dac6 centr+l aten(iei clinice =l constit+ie perpetrator+l si ab+;+l este comis
    .a=7 de &ar(ener 3R9.G; dac6 )ocar+l aten(iei =l constit+ie
    perpetrator+l, iar ab+;+l este comis )a(6
    de a"(7 &ersoan7 decA( &ar(ener+" FFY.G5
    dac6 centr+l aten(iei =l constit+ie *ictima
    A-u)ul Se,ual al A$ultului
    Aceas(7 ca(e$or!e (re'+!e +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    a'+/+" se<+a" a" +n+! ad+"( Ede e<., coerc!=!e se<+a"7, v!o"J. >ot6 de codi)icare?
    Codi)ic6
    ondiii Suplimentare care se pot a$la "n entrul Ateniei
    linice
    8+4

    3R5.59 dac6 centr+l aten(iei clinice =l constit+ie )6pt+itor+l (perpetrator%, iar
    ab+;+l este comis )a(6 de partener 3R9.G; dac6 centr+l aten(iei =l
    constit+ie )6pt+itor+l (perpetrator%, iar ab+;+l este
    comis )a(6 de a"(7 &ersoan7 decA( &ar(ener+"
    FFY.G9 dac6 centr+l aten(iei =l constit+ie *ictima
    Con$i!ii Supli"entare #are &e pot a%la
    .n Centrul Aten!iei Clini#e
    V*<.>* Non#o"plian!a la Trata"ent
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! :" cons(!(+!e
    nonco%&"!an=a "a +n as&ec( !%&or(an( a" (ra(a%en(+"+! &en(r+ o (+"'+rare %en(a"7
    sa+ o cond!=!e %ed!ca"7 $enera"7. Mo(!v+" nonco%&"!an=e! &oa(e .! d!scon.or(+"
    da(ora( (ra(a%en(+"+! Ede e<., e.ec(e"e sec+ndare a"e %ed!ca=!e!J, (ra(a%en(+" &rea
    sc+%&, dec!/!!"e 'a/a(e &e @+dec7=! de va"oare &ersona"7 sa+ re"!$!oas7 or!
    conv!n$er!"e c+"(+ra"e re.er!(oare "a avan(a@e"e s! de/avan(a@e"e (ra(a%en(+"+!
    &ro&+s, (r7s7(+r!"e de &ersona"!(a(e sa+ s(!"+r!"e de a .ace .a=7 de/ada&(a(!ve Ede e<.,
    ne$area %a"ad!e!J sa+ &re/en=a +ne! (+"'+r7r! %en(a"e Ede e<., sc!/o.ren!a,
    (+"'+rarea de &ersona"!(a(e ev!(an(7J. Aceas(7 ca(e$or!e (re'+!e s7 .!e +(!"!/a(7 n+%a!
    cAnd &ro'"e%a es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    V=<.C Si"ularea
    E"e%en(+" esen=!a" a" s!%+"7r!! :" cons(!(+!e &rod+cerea !n(en=!ona(7 de
    s!%&(o%e so%a(!ce sa+ &s!!ce e<a$era(e $ros!er, %o(!va(7 de !nc!(a=!! e<(erne c+%
    ar .! ev!(area serv!c!+"+! %!"!(ar, ev!(area an$a@7r!! :n %+nc7, o'=!nerea de
    co%&ensa=!! .!nanc!are, ev!(area +r%7r!r!! &ena"e sa+ o'=!nerea de dro$+r!, :n
    an+%!(e c!rc+%s(an=e, s!%+"area &oa(e re&re/en(a +n co%&or(a%en( ada&(a(!v 4 de
    e<e%&"+, s!%+"area +ne! %a"ad!! :n (!%& ce es(e &r!/on!er :n (!%& de r7/'o!.
    S!%+"area (re'+!e s7 .!e .er% s+s&ec(a(7 dac7 es(e no(a(7 or!care co%'!na=!e a
    +r%7(oare"orQ
    1. con(e<( %ed!co4"e$a" a" (a'"o+"+! c"!n!c Ede e<., &ersoana es(e (r!%!s7 de &roc+ror
    "a c"!n!c!an &en(r+ e<a%!nareJ,
    2. d!scre&an=7 %arca(7 :n(re s(res+" sa+ !nca&ac!(a(ea ac+/a(7 de &ersoan7 s! da(e"e
    o'!ec(!ve,
    3. "!&sa de coo&erare :n c+rs+" eva"+7r!! d!a$nos(!ce s! :n s+&+nerea "a re$!%+" de
    (ra(a%en( &rescr!s,
    I. &re/en=a (+"'+r7r!! de &ersona"!(a(e an(!soc!a"e
    S!%+"area d!.er7 de (+"'+rarea .ac(!ce &r!n aceea c7 %o(!va=!a &en(r+ &rod+cerea
    de s!%&(o%e :n s!%+"are o cons(!(+!e o !nc!(a=!e e<(ern7, &e cAnd :n (+"'+rarea
    .ac(!ce !nc!(a=!!"e e<(erne s+n( a'sen(e. Pro'a +ne! neces!(7=! !n(ra&s!!ce de a
    %en=!ne ro"+" de &ac!en( s+$erea/7 (+"'+rarea .ac(!ce. S!%+"area se d!.eren=!a/7 de
    (+"'+rarea de convers!e O! de (+"'+r7r!"e so%a(o.or%e &r!n &rod+cerea !n(en=!ona(7
    G7+ Alte condiii care se pot a$la "n centrul ateniei clinice
    de s!%&(o%e s! &r!n !nc!(a=!!"e e<(erne ev!den(e, asoc!a(e c+ ea. :n s!%+"are E:n
    con(ras( c+ (+"'+rarea de convers!eJ +O+rarea s!%&(o%e"or n+ es(e o'=!n+(7 adesea
    &r!n s+$es(!e sa+ !&no/7.
    VG*.+* Co"porta"entul Anti&o#ial al A$ultului
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    co%&or(a%en(+" an(!soc!a" a" ad+"(+"+! care n+ es(e da(ora( +ne! (+"'+r7r! %en(a"e
    Ede e<
    v
    (+"'+rare de cond+!(7, (+"'+rare de &ersona"!(a(e an(!soc!a"7 sa+ o (+"'+rare
    a con(ro"+"+! !%&+"s+"+!J. E<e%&"e"e !nc"+d co%&or(a%en(+" +nor o=!, escroc! sa+
    vAn/7(or! de s+'s(an=e !"e$a"e &ro.es!on!O(!.
    VG*.+C Co"porta"entul Anti&o#ial al
    Copilului &au A$ole&#entului
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    co%&or(a%en(+" an(!soc!a" a" co&!"+"+! sa+ ado"escen(+"+!, care n+ se da(orea/7
    +ne! (+"'+r7r! %en(a"e Ede e<., (+"'+rarea de cond+!(7 sa+ o (+"'+rare a con(ro"+"+!
    !%&+"s+"+!J. E<e%&"e"e !nc"+d ac(e"e an(!soc!a"e !/o"a(e a"e co&!!"or sa+
    ado"escen=!"or En+ +n &a((ern de co%&or(a%en( an(!soc!a"J.
    V=C.>5 'un#!ionarea Intele#tual( Li"inar(
    38or$erline6
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! a(en=!e! c"!n!ce es(e
    asoc!a( c+ .+nc=!onarea !n(e"ec(+a"7 "!%!nar7, ad!c7, c+ +n DI de H54GI. D!a$nos(!c+"
    d!.eren=!a" d!n(re .+nc=!onarea !n(e"ec(+a"7 "!%!nar7 s! re(ardarea %en(a"7 E+n DI de
    HL sa+ s+'J es(e e<(re% de d!.!c!" cAnd es(e !%&"!ca(7 coe<!s(en=a an+%!(or (+"'+r7r!
    %en(a"e Ede e<., sc!/o.ren!aJ.
    >ot6 de codi)icare? Aceasta se codi)ic6 pe axa 55
    G>+.5 De#linul Co/nitiv .n le/(tur( #u Etatea
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! :" cons(!(+!e +n dec"!n
    !den(!.!ca( o'!ec(!v :n .+nc=!onarea co$n!(!v7, consec+(!v &roces+"+! de :%'7(rAn!re
    care es(e :n "!%!(e nor%a"e, da(7 .!!nd e(a(ea &ersoane!. Ind!v!/!! c+ aceas(7 cond!=!e
    &o( re"a(a c7 a+ &ro'"e%e c+ evocarea n+%e"or sa+ :n(A"n!r!"or sa+ &o( e<&er!en=a
    d!.!c+"(7=! :n re/o"varea &ro'"e%e"or co%&"e<e.
    Aceas(7 ca(e$or!e (re'+!e "+a(7 :n cons!dera=!e n+%a! d+&7 ce a .os( s(a'!"!( c7
    de(er!orarea co$n!(!v7 n+ es(e a(r!'+!'!"7 +ne! (+"'+r7r! %en(a"e s&ec!.!ce sa+ +ne!
    cond!=!! ne+ro"o$!ce.
    V=C.>C Doliul
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e o
    reac=!e "a %oar(ea +ne! &ersoane !+'!(e. Ca &ar(e a reac=!e! "or "a &!erdere, +n!!
    !nd!v!/! :nd+rera=! se &re/!n(7 c+ s!%&(o%e carac(er!s(!ce +n+! e&!sod de&res!v
    %a@or Ede e<., sen(!%en(e de (r!s(e=e s! s!%&(o%e asoc!a(e, c+% ar .! !nso%n!a,
    VI724 #roblem
    Qcolar
    8F1
    a&e(!(+" sc7/+( s! &!erderea :n $re+(a(eJ. Ind!v!d+" :ndo"!a( cons!der7 d!s&o/!=!a sa
    (r!s(7 ca Snor%a"7Tdes! &oa(e so"!c!(a a@+(or s&ec!a"!/a( &en(r+ +O+rarea
    s!%&(o%e"or asoc!a(e, c+% ar .! !nso%n!a sa+ anore<!a. D+ra(a s! e<&res!a do"!+"+!
    Snor%a"T var!a/7 cons!dera'!" "a d!.er!(e"e $r+&+r! c+"(+ra"e. D!a$nos(!c+" de
    (+"'+rare de&res!v7 %a@or7 n+ se &+ne :n $enera" dac7 s!%&(o%e"e n+ s+n(
    &re/en(e :nc7 do+7 "+n! d+&7 &!erdere. Pre/en=a an+%!(or s!%&(o%e care n+ s+n(
    carac(er!s(!ce +ne! reac=!! Snor%a"eT de do"!+ &oa(e .! +(!"7 :n d!.eren=!erea do"!+"+!
    de e&!sod+" de&res!v %a@or. Aces(ea !nc"+d 5J c+"&a :n "e$7(+r7 c+ a"(e "+cr+r! decA(
    ac=!+n!"e e.ec(+a(e sa+ nee.ec(+a(e de s+&rav!e=+!(or "a da(a %or=!!8 9J $And+r! de
    %oar(e, a"(+" decA( sen(!%en(+" s+&rav!e=+!(or+"+! c7 ar .! .os( %a! '!ne dac7 %+rea
    sa+ c7 (re'+!a s7 %oar7 oda(7 c+ &ersoana deceda(78 ;J &reoc+&area %or'!d7
    re.er!(oare "a !n+(!"!(a(e8 IJ "en(oare &s!o%o(or!e %arca(78 YJ de(er!orare
    .+nc=!ona"7 %arca(7 s! &re"+n$!(78 RJ e<&er!en=e a"+c!na(or!!, a"(e"e decA(
    conv!n$erea c7 a+de vocea sa+ vede :n %od (ran/!(or !%a$!nea &ersoane! deceda(e.
    V=C.4 Pro-le"( ?#olar(
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e o
    &ro'"e%7 Oco"ar7 care n+ se da(orea/7 +ne! (+"'+r7r! %en(a"e, sa+ dac7 se
    da(orea/7 +ne! (+"'+r7r! %en(a"e, es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(7 . Un e<e%&"+ es(e &a((ern+" de re&e(en=!e sa+ de re/+"(a(e Oco"are
    se%n!.!ca(!v s+' &os!'!"!(7=! "a o &ersoan7 c+ ca&ac!(a(e !n(e"ec(+a"7 adecva(7 :n
    a'sen=a +ne! (+"'+r7r! de :nv7=are sa+ de co%+n!care sa+ a or!c7re! a"(e (+"'+r7r!
    %en(a"e care ar &+(ea @+s(!.!ca &ro'"e%a.
    V=C.C Pro-le"( Pro%e&ional(
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e o
    &ro'"e%7 &ro.es!ona"7 care n+ se da(orea/7 +ne! (+"'+r7r! %en(a"e, sa+ dac7 se
    da(orea/7 +ne! (+"'+r7r! %en(a"e, es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e
    c"!n!c7 se&ara(a. E<e%&"e"e !nc"+d !nsa(!s.ac=!a &ro.es!ona"7 s! !ncer(!(+d!nea :n
    "e$7(+r7 c+ a"e$erea car!ere!.
    4*4.>C Pro-le"( $e I$entitate
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAns cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e
    !ncer(!(+d!nea :n "e$7(+r7 c+ %+"(!&"e"e as&ec(e re.er!(oare "a !den(!(a(e, c+% ar .!
    sco&+r!"e &e (er%en ."+n$, a"e$erea car!ere!, &a((ern+r!"e de a%!c!=!e,
    co%&or(a%en(+" s! or!en(area se<+a"7, va"or!"e %ora"e O! o'"!$a=!!"e .a=7 de $r+&.
    V=C.>5 Pro-le"( Reli/ioa&( &au Spiritual(
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e o
    &ro'"e%7 re"!$!oas7 sa+ s&!r!(+a"7. E<e%&"e"e !nc"+d e<&er!en=e"e de(resan(e care
    !%&"!c7 &!erderea sa+ &+nerea s+' se%n+" :n(re'7r!! a cred!n=e!, &ro'"e%e"e
    asoc!a(e c+ conver(!rea "a o no+7 cred!n=7 sa+ &+nerea s+' se%n+" :n(re'7r!! a
    va"or!"or s&!r!(+a"e care &o( s7 n+ .!e :n "e$7(+r7 c+ o '!ser!c7 sa+ !ns(!(+=!e
    re"!$!oas7 or$an!/a(7.
    G7C NAlte condiii care se pot a$la "n centrul ateniei clinice
    V=C.7 Pro-le"( $e A#ultura!ie
    Aceas(7 ca(e$or!e &oa(e .! +(!"!/a(7 c7nd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e o
    &ro'"e%7 !%&"!cAnd ada&(area "a o c+"(+r7 d!.er!(7 Ede e<., +r%And !%!$r7r!!J.
    V=C.>5 Pro-le"( $e 'a)( $e Via!(
    Aceasd(7 ca(e$or!e &oa(e .! +(!"!/a(7 cAnd cen(r+" a(en=!e! c"!n!ce :" cons(!(+!e o
    &ro'"e%7 asoc!a(7 c+ o an+%!(7 .a/7 de de/vo"(are sa+ c+ a"(e c!rc+%s(an=e de v!a=7
    s! care n+ se da(orea/7 +ne! (+"'+r7r! %en(a"e, sa+ dac7 se da(orea/7 +ne! (+"'+r7r!
    %en(a"e, es(e s+.!c!en( de sever7 &en(r+ a @+s(!.!ca o a(en=!e c"!n!c7 se&ara(7.
    E<e%&"e"e !nc"+d &ro'"e%e"e asoc!a(e c+ !n(rarea "a scoa"7, !eO!rea de s+' con(ro"+"
    &aren(a", :nce&erea +ne! car!ere no! s! sc!%'7r!"e &e care "e !%&"!c7, %ar!a@+",
    d!vor=+" s! &ens!onarea.
    odurile Adiionale
    4++.5 Tul-urare Mental( Ne&pe#i%i#at(
    3nonp&i@oti#(6
    E<!s(7 d!verse c!rc+%s(an=e :n care &oa(e .! adecva( s7 se conse%ne/e aces( cod8
    5J &en(r+ o (+"'+rare %en(a"7 s&ec!.!c7 ne!nc"+s7 :n c"as!.!carea DSM4I3, 9J cAnd
    n!c! +na d!n(re ca(e$or!!"e .7r7 a"(7 s&ec!.!ca=!e d!s&on!'!"e n+ es(e adecva(7, sa+ ;J
    cAnd se cons!der7 c7 o (+"'+rare %en(a"7 non&s!o(!c7 es(e &re/en(7, dar n+ s+n(
    d!s&on!'!"e s+.!c!en(e !n.or%a=!! &en(r+ a d!a$nos(!ca +na d!n(re ca(e$or!!"e
    &rev7/+(e :n c"as!.!care, :n +ne"e ca/+r!, d!a$nos(!c+" &oa(e .! sc!%'a( c+ ce" a" +ne!
    (+"'+r7r! %a! s&ec!.!ce, d+&7 ce s+n( o'=!n+(e %a! %+"(e !n.or%a=!!.
    VG*.+5 Ni#i un Dia/no&ti# &au Con$i!ie pe A,a l
    CAnd &e a<a I n+ es(e &re/en( n!c! +n d!a$nos(!c sa+ cond!=!e, aceas(a (re'+!e
    !nd!ca(. Poa(e sa+ n+ s7 e<!s(e +n d!a$nos(!c &e a<a II.
    G55.5 Dia/no&ti# &au Con$i!ie a"Nnat( pe A,a l
    CAnd e<!s(7 !ns+.!c!en(e !n.or%a=!! &en(r+ a .ace or!ce ra=!ona%en( d!a$nos(!c
    des&re +n d!a$nos(!c sa+ cond!=!e de &e a<a I, aceas(a (re'+!e no(a( ca d!a$nos(!c
    sa+ cond!=!e a%Ana(7 &e a<a I.
    VG*.+5 Ni#i un Dia/no&ti# pe A,a II
    CAnd n!c! +n d!a$nos(!c Ede e<., n!c! o (+"'+rare de &ersona"!(a(eJ n+ es(e &re/en(
    &e a<a II, aceas(a (re'+!e !nd!ca(. Poa(e sa+ n+ e<!s(a +n d!a$nos(!c sa+ cond!=!e &e
    a<a I.
    G55.5 Dia/no&ti# a"Nnat pe A,a II
    CAnd e<!s(7 !n.or%a=!! !ns+.!c!en(e &en(r+ a .ace or!ce ra=!ona%en( d!a$nos(!c
    des&re +n d!a$nos(!c &e a<a II, aceas(a (re'+!e no(a( ca d!a$nos(!c a%Ana( &e a<a II
    ?H4

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    Ane,a 8
    Seturile de riterii si Axele
    prev(ute pentru studii
    suplimentare
    N<Yce
    ceas(a ane<7 con=!ne +n n+%7r de &ro&+ner! de no! ca(e$or!! O! a<e care
    a+ .os( s+$era(e &en(r+ o &os!'!"7 !nc"+dere :n DSM4I3. ,r+&+" O&era(!v s!
    ,r+&+r!"e de L+cr+ a+ s+&+s .!ecare d!n(re aces(e &ro&+ner! +ne! reeva"+7r!
    e%&!r!ce a(en(e s! a+ !nv!(a( "a co%en(ar!! a%&"e d!n (eren. ,r+&+" O&era(!v a
    s(a'!"!( c7 e<!s(7 !ns+.!c!en(e !n.or%a=!! care s7 @+s(!.!ce !nc"+derea aces(or &ro&+ner!
    dre&( ca(e$or!! sa+ a<e o.!c!a"e :n DSM4I3.
    I(e%!!, &ra$+r!"e O! d+ra(e"e con=!n+(e :n se(+r!"e de cr!(er!! a+ .os( conce&+(e s7
    o.ere +n "!%'a@ co%+n &en(r+ c"!n!c!en!! O! cerce(7(or!! !n(eresa=! de s(+d!erea
    aces(or (+"'+r7r!. Se s&er7 c7 as(.e" de cerce(7r! vor a@+(a "a &rec!/area +(!"!(7=!!
    &os!'!"e a aces(or ca(e$or!! &ro&+se s! vor d+ce "a a%e"!orarea se(+r!"or de cr!(er!!.
    Pra$+r!"e s&ec!.!ce s! d+ra(e"e a+ .os( s(a'!"!(e &r!n consens+" e<&er=!"or E!n.or%a=!
    &r!n eva"+area cr!(!c7 a "!(era(+r!!, reana"!/area da(e"or O! re/+"(a(e"e (es(7r!"or :n
    (eren, cAnd o as(.e" de !n.or%a=!e a .os( d!s&on!'!"7J O!, ca a(are, (re'+!e cons!dera(e
    dre&( o (en(a(!v7. Es(e de dor!( ca cerce(7(or!! s7 s(+d!e/e !(e%!! a"(erna(!v!,
    &ra$+r!"e sa+ d+ra(e"e, or! de cA(e or! aceas(a es(e &os!'!".
    :n aceas(7 ane<7 s+n( !nc"+se +r%7(oare"e (+"'+r7r! &ro&+seQ
    T+"'+rarea &os(con(+/!ona"7
    T+"'+rarea ne+roco$n!(!v7 +Ooar7
    A's(!nen=a de ca.e!na
    Descr!&(or!! d!%ens!ona"! a"(erna(!v! &en(r+ sc!/o.ren!e
    T+"'+rarea de&res!v7 &os(&s!o(!c7 a sc!/o.ren!e!
    T+"'+rarea de(er!ora(!v7 s!%&"7 Esc!/o.ren!a s!%&"7J
    T+"'+rarea d!s.or!c7 &re%ens(r+a"7
    A"(erna(!va "a cr!(er!+" B a" (+"'+r7r!! d!s(!%!ce
    T+"'+rarea de&res!v7 %!nor7
    T+"'+rarea de&res!v7 sc+r(7 rec+ren(7
    T+"'+rarea de&res!v4an<!oas7 %!<(7
    T+"'+rarea .ac(!ce &r!n &roc+r7 E'y &ro<yJ
    T+"'+rarea (ransa d!soc!a(!v7
    T+"'+rarea de %Anca( co%&+"s!v
    T+"'+rarea de &ersona"!(a(e de&res!v7
    T+"'+rarea de &ersona"!(a(e &as!v4a$res!v7 E(+"'+rarea de &ersona"!(a(e
    ne$a(!v!s(7J
    HYF
    HRL Anexa S

    T+"'+r7r!"e de %!Ocare !nd+se de %ed!ca%en(eQ
    Par)!nson!s%+" !nd+s de ne+ro"e&(!ce
    S!ndro%+" ne+ro"e&(!c %a"!$n
    D!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce
    A)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce
    D!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce
    Tre%or+" &os(+ra" !nd+s de %ed!ca%en(e T+"'+rarea de %!Ocare
    !nd+s7 de %ed!ca%en(e .7r7 a"(7 s&ec!.!ca=!e
    ENo(7Q Aces(e ca(e$or!! s+n( !nd+se :n sec=!+nea SA"(e cond!=!! care se &o( a."a :n
    cen(r+" a(en=!e! c"!n!ceT. Te<(+" s! se(+r!"e de cr!(er!! &en(r+ cerce(are s+n( !nc"+se a!c!.J
    Sca"a de .+nc=!onare a a&7r7r!!
    Sca"a de eva"+are $"o'a"7 a .+nc=!on7r!! re"a=!ona"e ESE,FRJ
    Sca"a de eva"+are a .+nc=!on7r!! soc!a"e s! &ro.es!ona"e ESEFSPJ
    Tul-urarea Po&t#ontu)ional(
    *lemente caracteristice
    Carac(er!s(!ca esen=!a"7 o cons(!(+!e o de(er!orare c7&7(a(7 :n .+nc=!onarea
    co$n!(!v7, aco%&an!a(7 de s!%&(o%e ne+roco%&or(a%en(a"e s&ec!.!ce care a&ar ca
    o consec!n=7 a +n+! (ra+%a(!s% cran!an :nc!s de sever!(a(e s+.!c!en(7 &en(r+ a
    &rod+ce o con(+/!e cere'ra"7 se%n!.!ca(!v7. Man!.es(7r!"e con(+/!e! !nc"+d
    &!erderea c+noO(!n=e!, a%ne/!a &osr(ra+%a(!c7 s!, %a! &+=!n .recven(, de'+(+"
    &os((ra+%a(!c a" cr!/e"or e&!"e&(!ce. A'ord7r!"e s&ec!.!ce &en(r+ de.!n!rea aces(+!
    cr!(er!+ neces!(7 a .! a%e"!ora(e &r!n cerce(7r! s+&"!%en(are. DeO! e<!s(7 da(e
    !ns+.!c!en(e &en(r+ a s(a'!"! o "!%!(7 &rec!s7 &en(r+ sever!(a(ea (ra+%a(!s%+"+!
    cran!an :nc!s, a+ .os( s+$era(e an+%!(e cr!(er!!, de e<e%&"+, do+7 d!n +r%7(oare"eQ
    5J o &er!oad7 de !nconO(!en(7 d+rAnd %a! %+"( de Y %!n+(e, 9J o &er!oad7 de
    a%ne/!e &os((ra+%a(!c7 d+rAnd %a! %+"( de 59 ore d+&7 (ra+%a(!s%+" cran!an
    :nc!s sa+, ;J +n no+ de'+( a" cr!/e"or e&!"e&(!ce Eor! o :nr7+(7=!re cons!dera'!"7 a
    cr!/e"or e&!"e&(!ce &ree<!s(en(eJ, care s+rv!n :n c+rs+" &r!%e"or D "+n! d+&7
    (ra+%a(!s%+" cran!an :nc!s. Tre'+!e de ase%enea, s7 .!e &ro'a(e de.!c!(e"e
    co$n!(!ve, .!e :n a(en=!e Econcen(rare, co%+(area cen(r+"+! a(en=!e!, e.ec(+area
    s!%+"(an7 a +nor sarc!n! co$n!(!veJ, .!e :n %e%or!e E:nv7=area sa+ re&rod+cerea
    !n.or%a=!!"orJ. Aco%&an!!nd &er(+r'7r!"e co$n!(!ve, (re'+!e s7 e<!s(e (re! Esa+ %a!
    %+"(eJ s!%&(o%e (!%& de ce" &+=!n ; "+n! d+&7 (ra+%a(!s%+" cran!an :nc!s.
    Aces(ea !nc"+d .a(!$a'!"!(a(ea ra&!d7, &er(+r'area so%n+"+!, ce.a"eea, ver(!@+" sa+
    a%e=ea"a, !r!(a'!"!(a(ea sa+ a$res!v!(a(ea "a cea %a! %!c7 &rovocare sa+ .7r7 n!c! +na,
    an<!e(a(ea, de&res!a sa+ "a'!"!(a(ea a.ec(!v7, a&a(!a sa+ "!&sa de s&on(ane!(a(e s! a"(e
    %od!.!c7r! de &ersona"!(a(e Ede e<., !nadecvarea soc!a"7 sa+ se<+a"7J. Per(+r'7r!"e
    co$n!(!ve s! s!%&(o%e"e so%a(!ce s! co%&or(a%en(a"e a&ar d+&7 ce a s+rven!(
    (ra+%a(!s%+" cran!an or! re&re/!n(7 o :nr7+(7=!re se%n!.!ca(!v7 a s!%&(o%e"or
    &ree<!s(en(e. Sece"e"e co$n!(!ve O! ne+roco%&or(a%en(a"e s+n( aco%&an!a(e de o
    de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7 s! re&re/!n(7 +n
    dec"!n se%n!.!ca(!v de "a n!ve"+" an(er!or de .+nc=!onare, :n ca/+" co&!!"or de e(a(e
    Oco"ar7 &oa(e e<!s(a o :nr7+(7=!re se%n!.!ca(!v7 a &er.or%an=e! Oco"are da(And de "a
    (ra+%a(!s%. Aceas(7 (+"'+rare &ro&+s7 n+ (re'+!e s7 .!e "+a(7 :n cons!dera=!e dac7
    s!%&(o%e"e !nd!v!d+"+! sa(!s.ac cr!(er!!"e &en(r+4de%en=a da(ora(7 +n+!
    (ra+%a(!s% cran!an or! dac7 s!%&(o%e"e s+n( e<&"!ca(e %a! '!ne de a"(7 (+"'+rare
    %en(a"7.
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare G=*
    *lemente asociate
    E"e%en(e"e asoc!a(e, care &o( .! sece"e a"e (ra+%a(!s%+"+! cran!an :nc!s, !nc"+d
    de(er!or7r! v!/+a"e sa+ a+d!(!ve s! anos%!e E&!erderea s!%=+"+! o".ac(!vJ. U"(!%a
    &oa(e .! :n "e$7(+r7 c+ o "!&s7 a !n(eres+"+! &en(r+ %Ancare. Po( .! &re/en(e an+%!(e
    co%&"!ca=!! or(o&ed!ce O! ne+ro"o$!ce, :n .+nc=!e de ca+/a, na(+ra s! $rad+"
    (ra+%a(!s%+"+!. T+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7 s+n( .recven( asoc!a(e c+
    (ra+%a(!s%+" cran!an :nc!s. Tra+%a(!s%+" cran!an :nc!s s+rv!ne %a! .recven( "a
    '7r'a=!! (!ner! s! es(e asoc!a( c+ co%&or(a%en(e de as+%are a r!sc+"+!.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!!, a"e c7ror (a'"o+r! c"!n!ce sa(!s.ac aces(e cr!(er!! de cerce(are,
    vor .! d!a$nos(!ca=! ca avAnd (+"'+rare co$n!(!v7 .7r7 a"(7 s&ec!.!ca=!e.
    Dac7 (ra+%a(!s%+" cran!an d+ce "a de%en=7 Ede e<., de(er!orarea %e%or!e! O!
    ce" &+=!n o a"(7 de(er!orare co$n!(!v7J, (+"'+rarea &os(con(+/!ona"7 n+ %a! (re'+!e
    "+a(7 :n cons!dera=!e. T+"'+rarea ne+roco$n!(!v7 +Ooar7, ca O! (+"'+rarea
    &os(con(+/!ona"7, es(e !nc"+s7 :n aceas(7 ane<7 Eve/! &a$. HR9J. T+"'+rarea
    &os(con(+/!ona"7 &oa(e .! d!.eren=!a(7 de (+"'+rarea ne+roco$n!(!v7 +Ooar7 &r!n(r4
    +n an+%!( &a((ern de s!%&(o%e co$n!(!ve, so%a(!ce s! co%&or(a%en(a"e s! &r!n
    &re/en=a +ne! e(!o"o$!! s&ec!.!ce Eres&ec(!v, (ra+%a(!s%+" cran!an :nc!sJ. Ind!v!/!!
    c+ (+"'+rare de so%a(!/are O! (+"'+rare so%a(o.or%7 ned!.eren=!a(7 &o( &re/en(a .
    s!%&(o%e co%&or(a%en(a"e O! so%a(!ce s!%!"are8 aces(e (+"'+r7r! n+ a+ :ns7 o
    e(!o"o$!c s&ec!.!c7 Eres&ec(!v, (ra+%a(!s% cran!an :nc!sJ or! o de(er!orare
    %7s+ra'!"7 :n ac(!v!(a(ea co$n!(!v7. T+"'+rarea &oscon(+/!ona"7 (re'+!e d!s(!ns7 de
    (+"'+rarea .ac(!ce Eneces!(a(ea de a4s! as+%a ro"+" de &ac!en(J O! de s!%+"are E:n
    care dor!n=a de co%&ensa=!e &oa(e d+ce "a &rod+cerea de s!%&(o%e sa+ "a
    &re"+n$!rea s!%&(o%e"or da(ora(e +n+! (ra+%a(!s% cran!an :nc!sJ.
    Criteriile $e #er#etare pentru Tul-urarea Po&t#ontu)ional(
    A2 Istoric de traumatism cranian care a cau(at o contu(ie cerebral semni$icativ2
    FotD Mani$estrile contu(iei includ pierderea cuno,tinei, amne(ia post-
    traumatic, ,i, mai puin $recvent, debutul posttraumatic al cri(elor
    epileptice2 Metoda speci$ic de de$inire a acestui criteriu trebuie s $ie
    stabilit de cercetri suplimentare2
    S2 *videnierea prin testare neuropsi%olo!ic sau evaluare co!nitiv cantitativ
    a di$icultii "n atenie &concentrare, comutarea $ocarului ateniei, e$ectu
    area 2concomitent a unor sarcini co!nitive) sau memorie &"nvarea sau
    reproducerea in$ormaiei)2
    2 Trei &sau mai multe dintre urmtoarele survin la scurt timp dup traumatism
    ,i durea( cel puin 4 luniD
    (1)$ati!abilitate rapid3
    (2)somn perturbat3
    &4)ce$alee3
    (4) verti0 sau ameeal3
    (5) iritabilitate sau a!resivitate la cea mai mic provocare sau $r nici una3
    (6) anxietate, depresie sau labilitate a$ectiv3
    8>2 Ane,a 8
    Criteriile $e #er#etare pentru Tul-urarea Po&t#ontu)ional(
    (continuare)
    (7) modi$icare de personalitate &de ex2, inadecvare social sau sexual)3
    (8) apatie sau lips de spontaneitate2
    D2 Simptomele de la criteriile S si ",i au debutul dup traumatismul cranian
    sau repre(int o "nrutire substanial a simptomelor preexistente2
    *2 #erturbarea cau(ea( o deteriorare semni$icativ2
    Tul-urarea Neuro#o/nitiv( UEoar(
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e a&ar!=!a +ne! de(er!or7r! :n .+nc=!onarea
    ne+ro$on!(!v7, da(ora(7 4+ne! cond!=!! %ed!ca"e $enera"e. Pr!n de.!n!=!e, n!ve"+"
    de(er!or7r!!,co$n!(!ve s! !%&ac(+" as+&ra .+nc=!on7r!! co(!d!ene es(e +Oor Ede e<.,
    !nd!v!d+" es(e ca&a'!" s74s! co%&ense/e &ar=!a" de(er!orarea co$n!(!v7 &r!n(r4+n
    e.or( s+&"!%en(arJ. Ind!v!/!! c+ aceas(7 cond!=!e a+ +n no+ de'+( de de.!c!(e :n ce"
    &+=!n do+7 do%en!! de .+nc=!onare co$n!(!v7. Aces(ea &o( !nc"+de (+"'+r7r! de
    %e%or!e EE:nv7=area sa+ evocarea !n.or%a=!!"or no!J, de )+nc(ionare exec+ti*6 Ede e<.,
    &"an!.!care, ra=!ona%en(J, de a(en=!e sa+ de v!(e/7 de &rocesare a !n.or%a=!e! Ede e<.,
    de concen(rare, de ra&!d!(a(e a as!%!"7r!! sa+ ana"!/7r!! !n.or%a=!e!J, (+"'+r7r! a"e
    ca&ac!(7=!"or &erce&(+a"e %o(or!! Ede e<., de !n(e$rare a !n.or%a=!e! v!/+a"e, (ac(!"e
    sa+ a+d!(!ve c+ ac(!v!(7=!"e %o(or!!J or! de "!%'a@ Ede e<., d!.!c+"(7=! :n re&e(area
    c+v!n(e"or, ."+en=7 red+s7J. A.!r%area de(er!or7r!! co$n!(!ve (re'+!e s7 .!e
    coro'ora(7 c+ re/+"(a(e"e (es(7r!! ne+ro&s!o"o$!ce or! c+ (en!c!"e de eva"+are
    co$n!(!v7 s(andard!/a(e a&"!ca(e "a &a(+" &ac!en(+"+!, :n a.ar7 de aceas(a, de.!c!(e"e
    co$n!(!ve ca+/ea/7 o de(res7 %arca(7 sa+ !n(er.erea/7 c+ .+nc=!onarea soc!a"7,
    &ro.es!ona"7 or! c+ a"(e do%en!! !%&or(an(e de .+nc=!onare s! re&re/!n(7 +n dec"!n
    de "a n!ve"+" an(er!or de .+nc=!onare. Per(+r'area co$n!(!v7 n+ sa(!s.ace cr!(er!!"e
    &en(r+ de"!r!+%, de%en=7 sa+ (+"'+rarea a%nes(!c7 s! n+ es(e e<&"!ca(7 %a! '!ne de
    a"(7 (+"'+rare %en(a"7 Ede e<., de o (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7, (+"'+rarea
    de&res!v7 %a@or7J.
    *lemente asociate
    E"e%en(e"e asoc!a(e de&!nd de cond!=!a %ed!ca"7 $enera"7 s+'!acen(7, :n ca/+"
    an+%!(or (+"'+r7r! cron!ce Ede e<., !&o<e%!e, de/ec!"!'re e"ec(ro"!(!ceJ, &ro.!"+"
    co$n!(!v es(e de re$+"7 +n+" de red+cere $enera"!/a(7 :n (oa(e .+nc=!!"e co$n!(!ve.
    Une"e cond!=!! ne+ro"o$!ce s! a"(e cond!=!! %ed!ca"e $enera"e &rod+c &a((ern+r! de
    de(er!orare co$n!(!v7 care s+$erea/7 %a! %+"( o !%&"!care cere'ra"7 Ss+'cor(!ca"7T
    Ead!c7, o d!s&ro&or=!e :n(re ca&ac!(a(ea de concen(rare s! de :nv7=are a .a&(e"or no!
    s! :n v!(e/a s! e.!c!en=a &roces7r!! !n.or%a=!e!J. Aces(ea !nc"+d .a/e"e !n!=!a"e a"e
    %a"ad!e! H+n(!n$(on, (+"'+rarea ne+roco$n!(!v7 asoc!a(7 c+ HI3 s! %a"ad!a
    Par)!nson. A"(e cond!=!! Ede e<., "+&+s+" er!(e%a(os s!s(e%!cJ s+n( asoc!a(e %a!
    .recven( c+ +n &a((ern %+"(!.oca" sa+ nere$+"a( de &!erdere co$n!(!v7. EE, &oa(e
    Seturile de riterii si Axele prev(ute pentru studii suplimentare ?I4
    ar7(a o +Ooar7 :nce(!n!re a ac(!v!(7=!! de .ond or! o &er(+r'are a &o(en=!a"e"or
    evoca(e. De(er!orarea co$n!(!v7 +Ooar7, c!ar :n ca/+r!"e de %a"ad!e A"/e!%er
    &recoce, es(e &re/en(7 .recven( .7r7 %od!.!c7r! s&ec!.!ce "a s(+d!!"e ne+roana(o%!ce
    +(!"!/And !%a$!s(!ca &r!n re/onan=7 %a$ne(!c7 ERMNJ sa+ (o%o$ra.!a
    co%&+(er!/a(7 ETCJ. Es(e %+"( %a! &ro'a'!" ca ano%a"!!"e s7 .!e &re/en(e :n s(+d!!"e
    de !%a$!s(!c7 cere'ra"7 .+nc=!ona"7 E(o%o$ra.!a co%&+(er!/a(7 c+ e%!s!+nea +n+!
    s!n$+r .o(on ZPET[, !%a$!s(!ca .+nc=!ona"7 &r!n re/onan=7 %a$ne(!c7J. Evo"+=!a
    de&!nde de e(!o"o$!a s+'!acen(7, :n +ne"e ca/+r!, de(er!orarea co$n!(!v7 se
    :nr7+(7=eO(e $rad+a", as(.e" c7, :n ce"e d!n +r%7, d!a$nos(!c+" de de%en=7 dev!ne
    adecva( Ede e<., .a/e"e &recoce a"e %a"ad!e! A"/e!%er, %a"ad!e! H+n(!n$(on s! a"e
    a"(or cond!=!! ne+rode$enera(!ve "en( &ro$res!veJ, :n a"(e ca/+r!, &er(+r'area se
    &oa(e a%e"!ora "en(, ca :n rec+&erarea $rad+a"7 d!n !&o(!ro!d!s%. :n .!ne, :n a"(e
    ca/+r!, &er(+r'7r!"e co$n!(!ve da(ora(e +nor deran@a%en(e %e(a'o"!ce sa+ %a"ad!!
    !n.ec=!oase severe se &o( re/o"va &ar=!a", dar s+n( carac(er!/a(e &r!n(r4o de(er!orare
    re/!d+a"7 care es(e &er%anen(7.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!! a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare co$n!(!v7 .7r7 a"(7 s&ec!.!ca=!e.
    DeO! n+ e<!s(7 "!%!(e c"are :n(re (+"'+rarea ne+roco$n!(!v7 +Ooar7 s! de%en(7,
    (+"'+rarea ne+roco$n!(!v7 +Ooar7 are %a! &+=!n7 de(er!orare co$n!(!v7 O! +n !%&ac(
    %a! red+s as+&ra ac(!v!(7=!"or co(!d!ene, !ar de(er!orarea %e%or!e! n+ es(e o cer!n=7.
    T+"'+rarea ne+roco$n!(!v7 +Ooar7 &oa(e .! con.+nda(7 c+ +n de"!r!+% care
    evo"+ea/7 "en(, :n s&ec!a" "a :nce&+(+" evo"+=!e! sa"e. T+"'+rarea ne+roco$n!(!v7
    +Ooar7 &oa(e .! d!s(!ns7 de o (+"'+rare a%nes(!c7 &r!n cer!n=a e<!s(en=e! +ne!
    de(er!or7r! co$n!(!ve :n ce" &+=!n do+7 do%en!!. T+"'+rarea ne+roco$n!(!v7 +Ooar7
    n+ (re'+!e "+a(7 :n cons!dera=!e, dac7 s!%&(o%e"e +n+! !nd!v!d sa(!s.ac cr!(er!!"e
    &en(r+ o (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7 E!nc"+s!v e.ec(e"e sec+ndare a"e +n+!
    %ed!ca%en(J, :n as(.e" de ca/+r!, (re'+!e &+s d!a$nos(!c+" cores&+n/7(or de
    (+"'+rare :n "e$7(+r7 c+ R s+'s(an=7 .7r7 a"(7 s&ec!.!ca=!e.
    T+"'+rarea &os(con(+/!ona"7, a"(7 ca(e$or!e %en=!ona(7 :n aceas(7 ane<7 Eve/!
    &a$. HRLJ, se d!s(!n$e de (+"'+rarea ne+roco$n!(!v7 +Ooar7 &r!n &re/en=a +n+!
    &a.(ern s&ec!.!c de s!%&(o%e O! o e(!o"o$!c s&ec!.!c7 Ead!c7, +n (ra+%a(!s% cran!an
    :nc!sJ.
    Per(+r'7r!"e ne+roco$n!(!ve +Ooare s+n( +n e"e%en( asoc!a( co%+n &en(r+ +n
    n+%7r de (+"'+r7r! %en(a"e Ede e<., (+"'+rarea de&res!v7 %a@or7J. T+"'+rarea
    ne+roco$n!(!v7 +Ooar7 (re'+!e "+a(7 :n cons!dera=!e, n+%a! dac7 de(er!orarea
    co$n!(!v7 es(e e<&"!ca(7 %a! '!ne de e.ec(e"e d!rec(e a"e +ne! cond!=!! %ed!ca"e
    $enera"e decA( de o (+"'+rare %en(a"7. Ind!v!/!! c+ dec"!n co$n!(!v :n "e$7(+r7 c+
    e(a(ea &o( avea n!ve"e s!%!"are de de(er!orare co$n!(!v7, dar dec"!n+" es(e
    cons!dera( a .! &ar(e a +n+! &roces de :%'7(rAn!re nor%a(!v, %a! c+rAnd decA(
    a(r!'+!'!" +ne! cond!=!! %ed!ca"e $enera"e. Ind!v!/!! &o( re"a(a ac+/e s+'!ec(!ve de
    de(er!orare :n .+nc=!onarea co$n!(!v7 care n+ &o( .! coro'ora(e &r!n (es(area
    ne+ro&s!o"o$!c7 or! s+n( cons!dera(e a n+ .! asoc!a(e c+ o cond!=!e %ed!ca"7
    $enera"7. Aceas(7 (+"'+rare &ro&+s7 n+ (re'+!e s7 .!e "+a(7 :n cons!dera=!e &en(r+
    as(.e" de (a'"o+r! c"!n!ce.
    ?IH Anexa S
    Criteriile $e #er#etare pentru
    Tul-urarea Neuro#o/nitiv( UEoar(
    A2 #re(ena a dou &sau mai multe) dintre urmtoarele deteriorri "n $uncio
    narea co!nitiv, dur@nd de re!ul o perioad de cel puin dou sptm@ni
    &dup cum relatea( individul ori un in$ormator credibil)D
    (1)deteriorarea memoriei, identi$icat printr-o capacitate redus de a
    "nva sau de a evoca in$ormaiile3
    (2)perturbare "n activitatea de execuie &adic, "n plani$icare, or!ani(are,
    secveniere, abstracti(are3
    (3)perturbare "n atenie sau "n vite(a de procesare a in$ormaiei3
    (4)deteriorare "n capacitile perceptual motorii3
    (5)deteriorare "n limba0 &de ex2, "n compre%ensiune, "n !sirea cuvintelor)2
    S2 Din examenul somatic sau datele de laborator &inclusiv te%nicile neuroima!is-
    tice) re(ult proba existenei unei condiii neurolo!ice sau medicale !enerale
    care este considerat a $i etiolo!ic "n relaie cu perturbarea co!nitiv2
    2 Din testarea neuropsi%olo!ic sau din evaluarea co!nitiv cuanti$icat
    re(ult proba unei anomalii sau declin "n per$orman2
    D2 De$icitele co!nitive cau(ea( o detres sau deteriorare marcat "n $uncio
    narea social, pro$esional sau "n alte domenii de $uncionare importante ,i
    repre(int un declin de la nivelul anterior de $uncionare2
    *2 #erturbarea co!nitiv nu satis$ace criteriile pentru delirium, demen, tul
    burarea amnestic ,i nu este explicat mai bine de alt tulburare mental
    &de ex2, o tulburare "n le!tur cu o substan, tulburarea depresiv ma0or)2
    A-&tinen!a $e Ca%eina
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e +n s!ndro% de a's(!nen=7 carac(er!s(!c, da(ora(
    :n(rer+&er!! 'r+O(e sa+ red+cer!! +/+"+! de &rod+se con=!nAnd ca.e!na, d+&7 +n +/
    /!"n!c &re"+n$!(. S!ndro%+" !nc"+de ce.a"eea s! +n+" Esa+ %a! %+"(eJ d!n
    +r%7(oare"e s!%&(o%eQ .ar!$a'!"!(a(e sa+ (or&oare no(a'!"7, an<!e(a(e sa+ de&res!e
    no(a'!"7, sa+ $rea=7 or! vo%7. Aces(e s!%&(o%e &ar a .! %a! .recven(e "a !nd!v!/!! c+
    +/ %as!v EYLL %$X/!J, dar &o( s+rven! s! "a !nd!v!/! c+ +n cons+% red+s E5LL
    %$X/!J. S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 sa+ o de(er!orare se%n!.!ca(!v7 :n
    .+nc=!onarea soc!a"7, &ro.es!ona"7 or! :n a"(e do%en!! de .+nc=!onare !%&or(an(e.
    S!%&(o%e"e n+ (re'+!e s7 se da(ore/e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    %ed!ca"e $enera"e s! n+ (re'+!e s7 .!e e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7.
    *lemente asociate
    S!%&(o%e"e asoc!a(e !nc"+d dor!n=a !n(ens7 de ca.e!na s! :nr7+(7=!rea
    &er.or%an=e"or co$n!(!ve E:n s&ec!a" "a sarc!n!"e de v!$!"en=7J. S!%&(o%e"e &o(
    :nce&e :n dec+rs de 59 ore de2"a :nce(area +/+"+! de ca.e!na, c+ +n &!c de
    G== Anexa S
    d!verse"e s!%&(o%e ne$a(!ve. S(+d!!"e s+$erea/7 c7 sever!(a(ea s!%&(o%e"or d!n
    .!ecare d!n(re aceO(! (re! .ac(or! (!nde a var!a conco%!(en(, a(A( &e sec=!+ne
    (ransversa"7, cA( s! :n (!%&, aceas(a .!!nd %a! &+=!n adev7ra( &en(r+ s!%&(o%e vers+s
    .ac(or!. De e<e%&"+, &e %7s+r7 ce !de!"e de"!ran(e dev!n %a! severe, s! a"+c!na=!!"e
    (!nd a deven! %a! severe. D!n con(ra, sever!(a(ea s!%&(o%e"or ne$a(!ve sa+
    de/or$an!/a(e es(e %a! &+=!n :n "e$7(+r7 c+ sever!(a(ea a"+c!na=!!"or sa+ !de!"or
    de"!ran(e. Un %ode" &en(r+ :n=e"e$erea e(ero$en!(7=!! c"!n!ce a sc!/o.ren!e!
    s+$erea/7 c7 .!ecare d!n(re aces(e (re! d!%ens!+n! &oa(e avea s+'!acen( &rocese
    .!/!o&a(o"o$!ce d!.er!(e s! r7s&+ns+r! d!.er!(e "a (ra(a%en(, :n &rac(!ca c"!n!c7 se
    :n(A"nesc d!verse co%'!na=!! de sever!(a(e &e ce"e (re! d!%ens!+n!, s! es(e re"a(!v rar
    ca o d!%ens!+ne s7 .!e &re/en(7, !ar ce"e"a"(e do+7 co%&"e( a'sen(e. Ur%7(or+" es(e
    +n s!s(e% &en(r+ a&"!carea aces(or d!%ens!+n! :n s(+d!!"e c"!n!ce s! de cerce(are.
    De&#riptorii Di"en&ionali Alternativi pentru S#@i)o%renie
    7e speci"icat' absent, u,oar, moderat, sever, pentru $iecare dimensiune2
    #re(ena "n prim plan a acestor dimensiuni poate $i speci$icat $ie pentru
    episodul actual &adic, pentru cele I luni anterioare), $ie pentru evoluia pe
    "ntrea!a via a tulburrii, ori pentru ambele2
    Dimensiunea #si%otic &%alucinaii1idei delirante)D descrie msura "n care au
    $ost pre(ente %alucinaiile sau ideile delirante2 Dimensiunea
    De(or!ani(riiD descrie msura "n care limba0ul de(or!ani(at,
    comportamentul de(or!ani(at sau a$ectul inadecvat au $ost pre(ente2
    Dimensiunea Fe!ativ &de de$icit)D descrie msura "n care simptomele
    ne!ative &adic, aplati(area a$ectiv, alo!ia, avoliia) au $ost pre(ente2
    FotD A nu se include simptomele care par a $i secundare depresiei,
    e$ectelor secundare ale medicamentelor, %alucinaiilor sau ideilor delirante2
    Ur%7(oare"e s+n( do+7 e<e%&"e care !nc"+d s+'(!&+" DSM4I3, s&ec!.!can=!! de
    evo"+=!e s! a'ordarea d!%ens!ona"7 &ro&+s7Q Exempl+l l
    9FY.;L Sc!/o.ren!e, (!& &arano!d, con(!n+7
    Ac(+a"%en(eQ
    C+ d!%ens!+ne &s!o(!c7 sever7 C+
    d!%ens!+ne de/or$an!/a(7 a'sen(7 C+
    d!%ens!+ne ne$a(!v7 %odera(7 Pe (oa(7 v!a=aQ
    C+ d!%ens!+ne &s!o(!c7 +Ooar7
    C+ d!%ens!+ne de/or$an!/a(7 a'sen(7
    C+ d!%ens!+ne ne$a(!v7 +Ooar7
    Exempl+l ,
    9FY.RL Sc!/o.ren!e, (!& re/!d+a", e&!sod!c7 c+ s!%&(o%e re/!d+a"e
    Ac(+a"%en(eQ
    C+ d!%ens!+ne &s!o(!c7 +Ooar7 \
    C+ d!%ens!+ne de/or$an!/a(7 +Ooar7
    C+ d!%ens!+ne ne$a(!v7 +Ooar7
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ?I?
    Pe (oa(7 v!a=aQ
    N C+ d!%ens!+ne &s!o(!c7 %odera(7
    C+ d!%ens!+ne de/or$an!/a(7 +Ooar7
    C+ d!%ens!+ne ne$a(!v7 +Ooar7
    Tul-urarea Depre&iv( Po&tp&i@oti#( a
    S#@i)o%reniei
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e +n e&!sod de&res!v %a@or Eve/! &a$. ;IFJ care
    es(e s+&ra&+s s! care s+rv!ne n+%a! :n .a/a re/!d+a"7 a sc!/o.ren!e!. Fa/a
    re/!d+a"7 a sc!/o.ren!e! +r%ea/7 .a/e! ac(!ve Ead!c7, s!%&(o%e"or care sa(!s.ac
    cr!(er!+" AJ. Ea se carac(er!/ea/7 &r!n &ers!s(en=a s!%&(o%e"or ne$a(!ve or! a
    s!%&(o%e"or .a/e! ac(!ve :n(r4o .or%7 a(en+a(7 Ede e<., conv!n$er! '!/are,
    e<&er!en=e &erce&(+a"e !nso"!(eJ. E&!sod+" de&res!v %a@or s+&ra&+s (re'+!e s7
    !nc"+d7 d!s&o/!=!a de&res!v7 Ead!c7, &!erderea !n(eres+"+! sa+ &"7cer!! n+ &oa(e
    serv! ca o a"(erna(!v7 &en(r+ d!s&o/!=!a (r!s(7 sa+ de&res!v7J. Ce" %a! adesea,
    e&!sod+" de&res!v %a@or +r%ea/7 !%ed!a( d+&7 re%!s!+nea s!%&(o%e"or .a/e!
    ac(!ve a e&!sod+"+! &s!o(!c. Uneor! aces(a &oa(e +r%a d+&7 +n !n(erva" %a! sc+r(
    sa+ %a! "+n$ :n c+rs+" c7r+!a n+ e<!s(7 s!%&(o%e &s!o(!ce. S!%&(o%e"e a.ec(!ve
    da(ora(e e.ec(e"or .!/!o"o$!ce d!rec(e a"e +n+! dro$ de a'+/, +n+! %ed!ca%en( or!
    +ne! cond!=!! %ed!ca"e $enera"e n+ s+n( "+a(e :n cons!dera=!e &en(r+ (+"'+rarea
    de&res!v7 &os(&s!o(!c7 a sc!/o.ren!e!.
    *lemente asociate
    :n co%&ara=!e c+ !nd!v!/!! c+ sc!/o.ren!e .7r7 e&!soade de&res!ve &os(&s!o(!ce,
    es(e .oar(e &ro'a'!" ca aceO(! !nd!v!/! s7 (r7!asc7 s!n$+r! s! s7 a!'7 %a! &+=!ne
    s+&or(+r! soc!a"e. A"(e e"e%en(e asoc!a(e &o( !nc"+de +n n+%7r %are de s&!(a"!/7r!
    an(er!oare, +n !s(or!c de rec7der! &s!o(!ce :n (!%&+" (ra(a%en(+"+! c+ %ed!ca%en(e
    an(!&s!o(!ce, de'+( !ns!d!os a" e&!soade"or &s!o(!ce, e&!soade an(er!oare de
    de&res!e O! de (en(a(!ve de s+!c!d. Po( e<!s(a &!erder! recen(e, even!%en(e de v!a=7
    !nde/!ra'!"e sa+ a"=! s(resor!. Ra(e"e de &reva"en(7 ra&or(a(e var!a/7, &An7 "a 9Yd
    d!n(re !nd!v!/!! c+ sc!/o.ren!e .!!nd descr!O! ca avAnd aceas(7 cond!=!e "a +n
    %o%en( da( :n c+rs+" %a"ad!e! "or. Es(e &os!'!" ca aceO(! !nd!v!/! s7 recad7 :n(r4+n
    e&!sod &s!o(!c sa+ s7 .!e res&!(a"!/a=! %a! .recven( decA( ce! .7r7 de&res!e. Ind!v!/!!
    c+ sc!/o.ren!e care a+, de ase%enea, r+de '!o"o$!ce de $rad+" I c+ !s(or!c de
    (+"'+rare de&res!v7 %a@or7, &o( .! e<&+O! +n+! r!sc %a! %are de de&res!!
    &os&s!o(!ce. Aceas(7 cond!=!e es(e asoc!a(7 c+ !dea(!c s+!c!dar7, (en(a(!ve de s+!c!d
    O! s+!c!d co%&"e(.
    Dia!nostic di$erenial
    :n DMS4I3, !nd!v!/!! a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e.
    T+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e se d!s(!n$e de
    aceas(7 &er(+r'are &r!n .a&(+" c7 s!%&(o%e"e de&res!ve se da(orea/7, e.ec(e"or
    .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<., !&er(!ro!d!s%+"J.
    G=> Anexa S

    T+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de aceas(7 &er(+r'are &r!n
    .a&(+" c7 s!%&(o%e"e de&res!ve se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +n+!
    dro$ de a'+/ Ede e<., a"coo"+", coca!naJ sa+ e.ec(e"or sec+ndare a"e +n+!
    %ed!ca%en(. Ind!v!/!! c+ sc!/o.ren!e se a."7 adesea :n (ra(a%en( c+ %edQ a%en(e
    ne+ro"e&(!ce de :n(re=!nere care &o( ca+/a d!s.or!e sa+ (+"'+r7r! de %Lcare !nd+se
    de %ed!ca%en(e, ca e.ec(e sec+ndare. Aces(e e.ec(e sec+ndare se &o( con.+nda c+
    s!%&(o%e"e de&res!ve. Par)!nson!s%+" !nd+s de ne+ro"e&(!ce c+ a)!ne/!e Eve/!
    &a$. HF9J es(e carac(er!/a( &r!n(r4o red+cere a ca&ac!(7=!! de a !n!=!a s! a s+s=!ne
    co%&or(a%en(e, care &o( d+ce "a o "!&s7 de s&on(ane!(a(e sa+ anedon!e. A)a(!s!a
    !nd+s7 de ne+ro"e&(!ce Eve/! &a$. GLLJ &oa(e .! con.+nda(7 c+ an<!e(a(ea sa+
    a$!(a=!a, s! &oa(e .! asoc!a(7 c+ d!s&o/!=!e de&res!v7 sa+ !dea(!c s+!c!dar7. Ada&(area
    (!&+"+! de %ed!ca%en( sa+ a do/e! &oa(e d+ce "a red+cerea aces(or e.ec(e sec+ndare
    s! "a c"ar!.!carea ca+/e! +nor as(.e" de s!%&(o%e.
    D!a$nos(!c+" d!.eren=!a" d!n(re s!%&(o%e"e de&res!ve &os(&s!o(!ce s!
    s!%&(o%e"e ne$a(!ve a"e sc!/o.ren!e! Ede e<., avo"!=!a, a"o$!a, a&"a(!/area a.ec(!v7J
    &oa(e .! e<(re% de d!.!c!". S!%&(o%e"e ne$a(!ve (re'+!e s7 .!e d!s(!nse de a"(e
    s!%&(o%e de de&res!e Ede e<., (r!s(e=e, c+"&7, &7c7(+!re, d!s&erare, a'andon, s(!%7
    de s!ne sc7/+(7J, :n (+"'+rarea sc!/oa.ec(!v7 s! :n (+"'+rarea a.ec(!v7 c+
    s!%&(o%e &s!o(!ce, (re'+!e s7 e<!s(e o &er!oad7 de s+&ra&+nere :n(re e&!sod+"
    &s!o(!c co%&"e( s! e&!sod+" a.ec(!v. D!n con(ra, aceas(7 (+"'+rare &ro&+s7 cere ca
    s!%&(o%e"e +n+! e&!sod de&res!v %a@or s7 s+rv!n7 n+%a! :n .a/a re/!d+a"7 a
    sc!/o.ren!e!.
    De%ora"!/area &oa(e s+rven! :n c+rs+" sc!/o.ren!e!, dar n+ (re'+!e s7 .!e
    cons!dera(7 de&res!e &os(&s!o(!c7 decA( dac7 s+n( sa(!s.7c+(e co%&"e( cr!(er!!"e
    &en(r+ e&!sod+" de&res!v %a@or. T+"'+rarea de ada&(are c+ d!s&o/!=!e de&res!v7 se
    d!s(!n$e de s!%&(o%e"e de&res!ve &os(&s!o(!ce d!n sc!/o.ren!e, deoarece
    s!%&(o%e"e de&res!ve d!n (+"'+rarea de ada&(are n+ sa(!s.ac cr!(er!!"e &en(r+
    e&!sod+" de&res!v %a@or.
    Criteriile $e #er#etare pentru Tul-urarea Depre&iv(
    Po&tp&i@oti#( a S#@i)o%reniei
    A2 Sunt satis$cute criteriile pentru un episod depresiv ma0or2
    FotD *pisodul depresiv ma0or trebuie s includ criteriul AD dispo(iia
    depresiv2 A nu se include simptome care sunt explicate mai bine ca
    e$ecte secundare ale unui medicament ori ca simptome ne!ative de
    sc%i(o$renie2
    S2 *pisodul depresiv ma0or este suprapus peste, ,i survine numai "n cursul $a(ei
    re(iduale a sc%i(o$reniei2
    2 *pisodul depresiv ma0or nu se datorea( e$ectelor $i(iolo!ice directe ale unei
    substane ori ale unei condiii medicale !enerale2
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ?I6
    Tul-urarea Deteriorativ( Si"pl(
    3S#@i)o%renia Si"pl(6
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e de/vo"(area de s!%&(o%e ne$a(!ve no(a'!"e, care
    re&re/!n(7 o %od!.!care c"ar7 de "a o "!n!e de 'a/7 &res(a'!"!(7. Aces(e s!%&(o%e
    s+n( s+.!c!en( de severe &en(r+ a d+ce "a +n dec"!n cons!dera'!" :n .+nc=!onarea
    &ro.es!ona"7 sa+ Oco"ar7. Dac7 a+ .os( vreoda(7 &re/en(e s!%&(o%e &s!o(!ce
    &o/!(!ve Ede e<., a"+c!na=!!, !de! de"!ran(e, "!%'a@ de/or$an!/a(, co%&or(a%en(
    de/or$an!/a(, co%&or(a%en( ca(a(on!cJ, aces(ea n+ a+ .os( no(a'!"e. Aces( &a((ern
    (re'+!e "+a( :n cons!dera=!e n+%a! d+&7 ce (oa(e ce"e"a"(e ca+/e &os!'!"e de
    de(er!orare a+ .os( e<c"+se, ad!c7, (a'"o+" c"!n!c n+ es(e e<&"!ca( %a! '!ne de
    (+"'+rarea de &ersona"!(a(e sc!/o(!&a"7 sa+ sc!/o!d7, de o (+"'+rare &s!o(!c7,
    a.ec(!v7 sa+ an<!oas7, de o de%en=7 sa+ re(ardare %en(a"7, !ar s!%&(o%e"e n+ se
    da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ cond!=!! %ed!ca"e
    $enera"e. E<!s(7 o de/vo"(are !ns!d!oas7 s! &ro$res!v7 a s!%&(o%e"or ne$a(!ve :n
    dec+rs+" +ne! &er!oade de ce" &+=!n +n an, :nce&And d!n ado"escen=7 sa+ %a! (Ar/!+.
    R7s&+ns+r!"e e%o=!ona"e dev!n o'(+/e, s+&er.!c!a"e, &"a(e s! v!de. L!%'a@+" es(e
    red+s :n c+v!n(e s! sens+r!. E<!s(7 o %od!.!care ne(7 de S&ersona"!(a(eT, c+ o
    &!erdere cons!dera'!"7 a ra&or(+"+! !n(er&ersona". Re"a=!!"e a.ec(!ve :O! &!erd c7"d+ra
    O! rec!&roc!(a(ea, !n(erac=!+nea soc!a"7 dev!ne :n $enera" d!.!c!"7 O! d+ce "a !/o"are O!
    re(ra$ere. In!=!a(!va .ace "oc a&a(!e! !ar a%'!=!a, avo"!=!e!. P!erderea !n(eres+"+! se
    e<(!nde "a de(a"!!"e co(!d!ene a"e a+(o:n$r!@!r!!. Persoana &oa(e &7rea +!(+c7 O!
    d!s(ra(7. A&(!(+d!n!"e Oco"are sa+ &ro.es!ona"e s+n( &!erd+(e, d+cAnd "a +n &a((ern
    de serv!c!! s!%&"e, sc+r(e, O! Oo%a@ .recven(.
    *lemente asociate
    Po( .! &re/en(e or!care d!n(re e"e%en(e"e (+"'+r7r!! de &ersona"!(a(e sc!/o!de
    sa+ sc!/o(!&a"e. Ce"e %a! .recven(e s+n( &ar(!c+"ar!(7=!"e ves(!%en(are s! de
    co%&or(a%en(, de"7sarea :n %a(er!e de !$!en7, !n(eres e<ces!v &en(r+ !de! s(ran!! or!
    e<&er!en=e &erce&(!ve !nso"!(e, c+% ar .! !"+/!!"e. Aceas(7 (+"'+rare &ro&+s7 &oa(e
    s+rvenHa ado"escen=!! s! ad+"=!! de a%'e"e se<e. N+ e<!s(7 es(!%7r! va"a'!"e a"e
    &reva"en(e! s! !nc!den=e!, dar es(e c"ar c7 (+"'+rarea es(e rar7. Evo"+=a, ce" &+=!n :n
    &r!%!! an!, es(e &ro$res!v a$ravan(7, c+ de(er!orarea no(a'!"7 a .+nc=on7r!!. Aceas(7
    de(er!orare a .+nc=on7r!! a%!n(eO(e evo"+=!a carac(er!s(!c7 a sc!/o.ren!e! O! d!s(!n$e
    aceas(7 cond!=!e de (+"'+r7r!"e de &ersona"!(a(e sc!/o!d7 s! sc!/o(!&a"7. Po( a&are
    s!%&(o%e care sa(!s.ac cr!(er!+" A &en(r+ sc!/o.ren!e, %o%en( :n care d!a$nos(!c+"
    es(e sc!%'a( c+ ce" de sc!/o.ren!e, :n aces(e ca/+r!, aces( &a((ern a&are ca .!!nd +n
    &rodro% &re"+n$!( de sc!/o.ren!e, :n a"(e ca/+r! aces( &a((ern d!%!n+a :n
    sever!(a(e, aOa c+% se :n(A%&"7 :n sc!/o.ren!e. Pen(r+ %a@or!(a(ea !nd!v!/!"or,
    evo"+=!a es(e con(!n+7, c+ de(er!orare s+rven!nd :n &r!%!! an! d+&7 s!%&(o%e"e
    &rodro%a"e O! %en=!nAnd+4se a&o! :n &"a(o+ s&re o ca&ac!(a(e .+nc=!ona"7
    %ar$!na"7 O! red+s7, dar s(a'!"7.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! &en(r+
    cerce(are, (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare %en(a"7 nes&ec!.!ca(7.
    GG+ Anexa S

    Aces( &a((ern (re'+!e "+a( :n cons!dera=!e n+%a! d+&7 ce (oa(e ce"e"a"(e ca+/e
    &os!'!"e de de(er!orare a .+nc=!on7r!! a+ .os( e<c"+se. Aces( &a((ern se d!s(!n$e de
    (+"'+r7r!"e !nc"+se :n sec=!+nea SSc!/o.ren!a s! a"(e (+"'+r7r! &s!o(!ceT &r!n
    a'sen=a s!%&(o%e"or &s!o(!ce &o/!(!ve no(a'!"e. Aces(e (+"'+r7r! !nc"+d
    sc!/o.ren!a, (+"'+rarea sc!/oa.ec(!v7, (+"'+rarea &s!o(!c7 sc+r(7, (+"'+rarea
    de"!ran(7, (+"'+rarea &s!o(!c7 !nd+s7 O! (+"'+rarea &s!o(!c7 .7r7 a"(7
    s&ec!.!ca=!e, (oa(e neces!(And ce" &+=!n +n s!%&(o% &o/!(!v &en(r+ o an+%!(7
    &er!oad7 de (!%&. Aceas(7 (+"'+rare &ro&+s7 se d!s(!n$e de (+"'+r7r!"e de
    &ersona"!(a(e sc!/o!d7 s! sc!/o(!&a"7 ca s! de a"(e (+"'+r7r! de &ersona"!(a(e &r!n
    cer!n=a +ne! %od!.!c7r! c"are de &ersona"!(a(e s! a +ne! de(er!or7r! se%n!.!ca(!ve :n
    .+nc=!onare. D!n con(ra, (+"'+r7r!"e de &ersona"!(a(e re&re/!n(7 &a((ern+r! d+rAnd
    (oa(7 v!a=a, .7r7 de(er!orare &ro$res!v7. T+"'+r7r!"e a.ec(!ve &o( %!%a a&a(!a s!
    anedon!a (+"'+r7r!! de(er!ora(!ve s!%&"e, dar :n(r4o (+"'+rare a.ec(!v7 es(e
    e<&er!en(a( +n a.ec( de&res!v E(r!s(e=e, d!s&erare, a'andon, c+"&7 d+reroas7J, !ar
    evo"+=!a (!nde a .! e&!sod!c7, :n a.ar7 de aceas(a, :n (+"'+rarea de(er!ora(!v7 s!%&"7,
    e<!s(7 +n sen(!%en( %a! c+rAnd de v!d decA( de d+rere sa+ de d!s&o/!=!e de&res!v7
    no(a'!"7, !ar evo"+=!a es(e con(!n+7 s! &ro$res!v7. Poa(e .! %a! d!.!c!"7 d!s(!nc=!a de
    (+"'+rarea d!s(!%!c7, :n care evo"+=!a &oa(e .!, de ase%enea, con(!n+7 s! :n care
    s!%&(o%e"e ve$e(a(!ve s! d!s&o/!=!a de&res!v7 &o( %!%a de&enden=a cron!c7 de o
    s+'s(an=7 s! (re'+!e "+a(7 :n cons!dera=!e n+%a! dac7 %od!.!carea de &ersona"!(a(e
    s! de(er!orarea &reced +/+" e<(!ns de o s+'s(an=7. Mod!.!carea de &ersona"!(a(e
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e se d!s(!n$e &r!n &re/en(a +ne! cond!=!!
    %ed!ca"e $enera"e e(!o"o$!ce. De(er!orarea co$n!(!v7 a (+"'+r7r!! de(er!ora(!ve
    s!%&"e &oa(e .! con.+nda(7 c+ re(ardarea %en(a"7 sa+ c+ de%en=a. Re(ardarea
    %en(a"7 se d!s(!n$e &r!n de'+(+" s7+ (!&!c :n &er!oada de s+$ar sa+ :n co&!"7r!e.
    De%en=a se d!s(!n$e &r!n &re/en=a +ne! cond!=!! %ed!ca"e $enera"e or! a +/+"+! +ne!
    s+'s(an=e, ca .ac(or e(!o"o$!c.
    Ce" %a! d!.!c!" d!a$nos(!c d!.eren=!a" es(e, &oa(e, c+ n!c! o (+"'+rare %en(a"7.
    T+"'+rarea de(er!ora(!v7 s!%&"7 .ace adesea ca o &ersoan7 s7 dev!n7 +n %e%'r+
    %ar$!na" a" soc!e(7=!!. Aceas(a n+ :nsea%n7 :ns7, c7 %e%'r!! %ar$!na"! a! soc!e(7=!!
    a+ :n %od necesar aceas(7 (+"'+rare &ro&+s7. E"e%en(e"e de.!n!(or!! a"e (+"'+r7r!!
    de(er!ora(!ve s!%&"e !%&"!c7 s!%&(o%e ne$a(!ve, care &ar a .! &e +n con(!n++% c+
    nor%a"!(a(ea %a! %+"( decA( s+n( s!%&(o%e"e &o/!(!ve s! care &o( .! %!%a(e de o
    d!vers!(a(e de .ac(or! Eve/! d!sc+=!a re.er!(oare "a ces(!+nea :n ca+/7, :n sec=!+nea
    SSc!/o.ren!aT, &a$. ;L5J. De aceea, se reco%and7 o a(en=!e s&ec!a"7 &en(r+ a n+
    +(!"!/a aceas(7 (+"'+rare &ro&+s7 &rea "ar$.
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    GG*
    Criteriile $e #er#etare pentru Tul-urarea Deteriorativ(
    Si"pl( 3S#@i)o%renia Si"pl(6
    A2 De(voltarea pro!resiv "n decursul unei perioade de cel puin un an a
    oricruia dintre cele ce urmea( D
    (1) declin marcat "n $uncionarea pro$esional sau ,colar apariia
    !radual
    ,i cresc@nd "n intensitate a simptomelor ne!ative, cum ar $i aplati(area
    a$ectiv, alo!ia ,i avoliia3
    (1) raporturi interpersonale reduse, i(olare sau retra!ere social2
    S2 riteriul A pentru sc%i(o$renie nu a $ost satis$cut niciodat2
    2 Simptomele nu sunt explicate mai bine de tulburarea de personalitate sc%i(o-
    tipal sau sc%i(oid, de o tulburare psi%otic, tulburare a$ectiv, tulburare
    anxioas, demen sau retardare mental ,i nu se datorea( e$ectelor $i(io
    lo!ice directe ale unei substane sau ale unei condiii medicale !enerale2
    Tul-urarea Di&%ori#( Pre"en&trual(
    *lemente caracteristice
    E"e%en(e"e esen=!a"e s+n( s!%&(o%e, c+% ar .! d!s&o/!=!a de&res!v7, an<!e(a(ea
    O! "a'!"!(a(ea a.ec(!v7 %arca(7, O! sc7derea !n(eres+"+! &en(r+ an+%!(e ac(!v!(7=!.
    Aces(e s!%&(o%e a+ s+rven!( c+ re$+"ar!(a(e :n c+rs+" +"(!%e! s7&(7%An! a .a/e!
    "+(ea"e, :n ce"e %a! %+"(e c!c"+r! %ens(r+a"e d!n c+rs+" an+"+! (rec+(. S!%&(o%e"e
    :nce& s7 se re%!(7 :n cA(eva /!"e d+&7 de'+(+" %ens(r+a=!e! E.a/a .o"!c+"ar7J O! s+n(
    (o(dea+na a'sen(e :n s7&(7%Ana care +r%ea/7 %ens(r+a=!e!.
    C!nc! Esa+ %a! %+"(eJ d!n +r%7(oare"e s!%&(o%e (re'+!e s7 .! .os( &re/en(e cea
    %a! &ar(e a (!%&+"+! :n c+rs+" +"(!%e! s7&(7%An! a .a/e! "+(ea"e, ce" &+=!n +n+"
    d!n(re s!%&(o%e .!!nd +n+" d!n &r!%e"e &a(r+Q 5J sen(!%en( de (r!s(e=e, de d!s&erare
    sa+ de a+(ode&rec!ere, 9J sen/a=!e de (ens!+ne, an<!e(a(e sa+ de Snervo/!(a(eT, ;J
    "a'!"!(a(e %arca(7 a d!s&o/!=!e! !n(er.erAnd c+ &"Ans .recven(, IJ !r!(a'!"!(a(e
    &ers!s(en(7, %An!e O! con."!c(e !n(er&ersona"e s&or!(e, YJ sc7derea !n(eres+"+! &en(r+
    ac(!v!(7=!"e +/+a"e, care &oa(e .! asoc!a(7 c+ re(ra$erea d!n re"a=!!"e soc!a"e, RJ
    d!.!c+"(a(e :n concen(rare, HJ sen/a=!a de .a(!$a'!"!(a(e, "e(ar$!e sa+ de "!&s7 de
    ener$!e, GJ %od!.!care %arca(7 a a&e(!(+"+!, care &oa(e .! asoc!a(7 c+ %Anca(+"
    co%&+"s!v sa+ c+ dor!n=a arden(7 de an+%!(e %Anc7r+r!, FJ !&erso%n!e sa+
    !nso%n!e, 5LJ sen/a=!a s+'!ec(!v7 de a .! de&7O!(7 sa+ c7 a sc7&a( s!(+a=!a de s+'
    con(ro" s! 55J s!%&(o%e so%a(!ce, c+% ar .! d+rerea sa+ %7r!rea de vo"+% a sAn!"or,
    ce.a"ee sa+ sen/a=!a de S'a"onareT, sa+ de "+a( :n $re+(a(e, c+ s(rA%(area
    :%'r7c7%!n=!!, &an(o.!"or or! !ne"e"or. Po( e<!s(a, de ase%enea, d+rer! ar(!c+"are sa+
    %+sc+"are. S!%&(o%e"e &o( .! :nso=!(e de !de! de s+!c!d.
    Aces( &a((ern de s!%&(o%e (re'+!e s7 .! s+rven!( :n c+rs+" ce"or %a! %+"(e d!n(re
    ce"e 59 "+n! an(er!oare. S!%&(o%e"e d!s&ar co%&"e( sc+r( (!%& d+&7 de'+(+"
    %ens(r+a=!e!. Ce" %a! (!&!c &a((ern &are a .! ce" a" d!s.+nc=!e! d!n c+rs+" s7&(7%An!!
    an(er!oare %ens(r+a=!!"or s! care se (er%!n7 "a @+%7(a(ea %ens(r+a=!!"or. A(!&!c,
    ??7 Ane,a 8
    +ne"e .e%e! a+ as(.e" de s!%&(o%e (!%& de cA(eva /!"e :n a&ro&!erea ov+"a=!e!8 +n
    n+%7r red+s de .e%e! c+ c!c"+r! sc+r(e &o(, &r!n +r%are, s7 n+ &re/!n(e s!%&(o%e
    decA( o s7&(7%An7 &e c!c"+.
    De re$+"7, s!%&(o%e"e s+n( de sever!(a(e Edar n+ s! de d+ra(7J co%&ara'!"7 c+
    ce"e a"e e&!sod+"+! de&res!v %a@or O! (re'+!e s7 ca+/e/e o de(er!orare ev!den(7 s!
    %arca(7 :n ca&ac!(a(ea de a .+nc=!ona soc!a" sa+ &ro.es!ona", :n s7&(7%Ana
    an(er!oar7 %ens(r+a=!!"or. De(er!orarea :n .+nc=!onarea soc!a"7 se &oa(e %an!.es(a
    &r!n d!scord!e %ar!(a"7 s! &ro'"e%e c+ a%!c!! s! .a%!"!a. Es(e .oar(e !%&or(an( s7 n+
    se con.+nde &ro'"e%e"e %ar!(a"e, d+rAnd de %+"( (!%&, sa+ &ro'"e%e"e de serv!c!+,
    c+ d!s.+nc=!a care s+rv!ne n+%a! &re%ens(r+a". E<!s(7 +n %are con(ras( :n(re
    sen(!%en(e"e de&res!ve a"e .e%e!"or s! d!.!c+"(a(ea :n .+nc=!onare d!n c+rs+" aces(or
    /!"e, s! d!s&o/!=!a s! ca&ac!(7=!"e "or d!n res(+" "+n!!. Aces(e s!%&(o%e &o( .!
    s+&ra&+se &es(e o a"(7 (+"'+rare, s! n+ s+n( doar o e<acer'are a s!%&(o%e"or a"(e!
    (+"'+r7r!, c+% ar .! (+"'+rarea de&res!v7 %a@or7, &an!ca sa+ (+"'+rarea d!s(!%!c7
    or! o (+"'+rare de &ersona"!(a(e. Pre/en=a +n+! &a((ern c!c"!c a" s!%&(o%e"or (re'+!e
    s7 .!e con.!r%a(7 &r!n eva"+7r! +"(er!oare /!"n!ce a"e s!%&(o%e"or, ce" &+=!n , "+n!
    consec+(!ve. Eva"+7r!"e /!"n!ce a"e s!%&(o%e"or (re'+!e s7 .!e .7c+(e de .e%e!e, dar
    &o( .! .7c+(e, de ase%enea, s! de a"(c!neva care (r7!eO(e :%&re+n7 c+ ea. Es(e
    !%&or(an( ca aces(e @+rna"e s7 .!e =!n+(e &e 'a/a :nse%n7r!"or /!"n!ce, %a! c+rAnd
    decA( co%&+se re(ros&ec(!v d!n %e%or!e.
    *lemente asociate
    Frecven( e<!s(7 +n !s(or!c de (+"'+r7r! a.ec(!ve O! an<!oase an(er!oare. Ide!
    de"!ran(e s! a"+c!na=!! a+ .os( descr!se :n .a/a I+=ea"7 (ard!v7 a c!c"+"+! %ens(r+a",
    dar s+n( .oar(e rare. N+ se O(!e :ns7 dac7 aces(ea re&re/!n(7 o e<acer'are a +ne!
    (+"'+r7r! %en(a"e &ree<!s(en(e sa+ s+n( s!%&(o%e a"e (+"'+r7r!! d!s.or!ce
    &re%ens(r+a"e. S!%&(o%e"e so%a(!ce O! a.ec(!ve s+rven!nd &re%ens(r+a" (!nd a se
    (rans%!(e :n .a%!"!e, .!!nd, ce" &+=!n :n &ar(e, ered!(are.
    DeO! .e%e!"e c+ o co%'!na=!e de d!s%enoree E%en(r+a=!! d+reroaseJ O! (+"'+rare
    d!s.or!c7 &re%ens(r+a"7 es(e oarec+% .oar(e &os!'!" s7 so"!c!(e (ra(a%en( %a! %+"(
    decA( .e%e!"e c+ n+%a! +na d!n(re aces(e cond!=!!, ce"e %a! %+"(e .e%e! c+ or!care
    d!n aces(e cond!=!! n+ a+ o a+ &e cea"a"(7. O $a%7 "ar$7 de cond!=!! %ed!ca"e se &o(
    :nr7+(7=! :n .a/a &re%ens(r+a"7 sa+ I+=ea"7 Ede e<., %!$rena, as(%+", a"er$!!"e s!
    cr!/e"e e&!"e&(!ceJ. N+ e<!s(7 (es(e de "a'ora(or s&ec!.!ce care s7 .!e d!a$nos(!ce
    &en(r+ &er(+r'are, :ns7, :n %a! %+"(e s(+d!! &re"!%!nare %!c!, an+%!(e da(e de
    "a'ora(or Ede e<., &a((ern+r!"e de secre=!e a"e sero(on!ne! s! %e"a(on!ne!, da(e"e EE,
    de so%nJ a+ .os( no(a(e ca .!!nd anor%a"e "a $r+&e"e de .e%e! c+ aceas(7 (+"'+rare
    &ro&+s7, :n co%&ara=!e c+ s+'!ec=!! de con(ro".
    Se es(!%ea/7 c7 ce" &+=!n HYd d!n(re .e%e! re"a(ea/7 %od!.!c7r! &re%es(r+a"e
    %!nore sa+ !/o"a(e. S(+d!! "!%!(a(e s+$erea/7 o a&ar!=!e a Ss!ndro%+"+!
    &re%ens(r+a"T Ede.!n!( d!.er!(J "a 9LdUYLd d!n(re .e%e! s! c7 ;d4Yd d!n(re .e%e!
    e<&er!en(ea/7 s!%&(o%e care &o( sa(!s.ace cr!(er!!"e &en(r+ aceas(7 (+"'+rare
    &ro&+s7. E<!s(7 .oar(e &+=!ne s(+d!! s!s(e%a(!ce as+&ra evo"+=!e! s! s(a'!"!(7=!! aces(e!
    cond!=!!. S!%&(o%e"e &re%ens(r+a"e &o( de'+(a "a or!ce e(a(e d+&7 %enar7. DeO!
    %a@or!(a(ea .e%e!"or a"e c7ror s!%&(o%e sa(!s.ac cr!(er!!"e de d!a$nos(!c &en(r+
    cerce(are &en(r+ aceas(7 (+"'+rare &ro&+s7 s! care &ar(!c!&7 "a s(+d!!"e de cerce(are
    s+n( :n &r!%a &ar(e a an!"or "or 2;L, .e%e!"e a."a(e :n &er!oada re&rod+c(!v7 re"a(ea/7
    &re%ens(r+a" s!%&(o%e se%n!.!ca(!ve c"!n!c. DeO! s!%&(o%e"e n+ s+rv!n :n %od
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ??4
    necesar :n .!ecare c!c"+, e"e s+n( &re/en(e :n %a@or!(a(ea c!c"+r!"or, :n +ne"e "+n!,
    s!%&(o%e"e &o( .! %a! severe decA( :n a"(e"e. Fe%e!"e re"a(ea/7 c7, de re$+"7,
    s!%&(o%e"e "or se a$rava+ &e %7s+r7 ce avansa+ :n e(a(e O! s4a+ a%enda( "a
    :nce&+(+" %eno&a+/e!.
    Dia!nostic di$erenial
    :n DSM I3, .e%e!"e a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are
    (re'+!e s7 .!e d!a$nos(!ca(e ca avAnd (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e.
    Mod!.!c7r!"e a.ec(!ve (ran/!(or!! &e care "e e<&er!en(ea/7 %+"(e .e%e! :n @+r+"
    &er!oade! "or %ens(r+a"e n+ (re'+!e cons!dera(e (+"'+rare %en(a"7. T+"'+rarea
    d!s.or!c7 &re%ens(r+a"7. (re'+!e "+a(7 :n cons!dera=!e n+%a! cAnd s!%&(o%e"e
    !n(er.erea/7 cons!dera'!" c+ ac(!v!(a(ea &ro.es!ona"7 sa+ Oco"ar7, or! c+ ac(!v!(7=!"e
    soc!a"e +/+a"e O! re"a=!!"e c+ ce!"a"=! Ede e<., ev!(area ac(!v!(7=!"or soc!a"e, sc7derea
    &rod+c(!v!(7=!! s! e.!c!en=e! :n ac(!v!(a(ea &ro.es!ona"7 sa+ Oco"ar7J. T+"'+rarea
    d!s.or!c7 &re%ens(r+a"7 &oa(e .! d!s(!ns7 de de&ar(e %+"( %a! .recven(+" Ss!ndro%
    &re%ens(r+a" T &r!n +(!"!/area eva"+7r!"or /!"n!ce +"(er!oare O! a cr!(er!!"or s(r!c(e
    %en=!ona(e %a! @os. Ea d!.er7 de Ss!ndro%+" &re%ens(r+a"T &r!n &a((ern+" s7+
    carac(er!s(!c de s!%&(o%e, &r!n sever!(a(ea "or s! de(er!orarea care re/+"(7.
    T+"'+rarea d!s.or!c7 &re%ens(r+a"7 (re'+!e s7 .!e d!s(!ns7 de e<acer'area
    &re%ens(r+a"7 a +nor (+"'+r7r! %en(a"e c+ren(e Ede e<., (+"'+r7r! a.ec(!ve,
    an<!oase, so%a(o.or%e, '+"!%!e nervoas7, (+"'+r7r! a"e +/+"+! de o s+'s(an=7 O!
    (+"'+r7r! de &ersona"!(a(eJ, :n as(.e" de s!(+a=!! Ecare s+n( de de&ar(e %a! .recven(e
    decA( (+"'+rarea d!s.or!c7 &re%ens(r+a"7J, e<!s(7 o a$ravare &re%ens(r+a"7 a
    s!%&(o%e"or, dar s!%&(o%e"e &ers!s(7 de "a +n ca&7( "a a"(+" a" c!c"+"+! %ens(r+a".
    DeO! aceas(7 cond!=!e n+ (re'+!e s7 .!e "+a(7 :n cons!dera=!e "a .e%e!"e care
    e<&er!en(ea/7 n+%a! o e<acer'are &re%ens(r+a"7 a a"(e! (+"'+r7r! %en(a"e, ea &oa(e
    .! av+(7 :n vedere, &e "An$7 d!a$nos(!c+" a"(e! (+"'+r7r! %en(a"e c+ren(e, dac7
    .e%e!a e<&er!en(ea/7 s!%&(o%e O! %od!.!c7r! :n n!ve"+" de .+nc=!onare, care s+n(
    carac(er!s(!ce (+"'+r7r!!2 d!s.or!ce &re%ens(r+a"e s! d!.er7 cons!dera'!" de
    s!%&(o%e"e e<&er!en(a(e ca &ar(e a (+"'+r7r!! care con(!n+7 s7 evo"+e/e.
    Une"e .e%e! c+ cond!=!! %ed!ca"e $enera"e &o( &re/en(a d!s.or!e O! .a(!$a'!"!(a(e,
    care s+n( e<acer'a(e :n c+rs+" &er!oade! &re%ens(r+a"e. E<e%&"e"e !nc"+d cr!/e"e
    e&!"e&(!ce, (+"'+r7r!"e (!ro!d!ene s! a"(e (+"'+r7r! endocr!ne, cancer+", "+&+s+"
    er!(e%a(os s!s(e%!c, ane%!!"e, endo%e(r!o/a s! d!verse !n.ec=!!. Tre'+!e s7 .!e .7c+(e
    :ncerc7r! &en(r+ a d!s(!n$e aces(e cond!=!! %ed!ca"e $enera"e de (+"'+rarea d!s.or!c7
    &re%ens(r+a"7 &r!n !s(or!c, (es(e de "a'ora(or s! e<a%en so%a(!c.
    GG7 Anexa S

    Criteriile $e #er#etare pentru
    Tul-urarea Di&%ori#( Pre"en&trual(
    A2 "n cele mai multe cicluri menstruale din cursul anului trecut, cinci &sau mai
    multe) dintre urmtoarele simptome au $ost pre(ente cea mai mare parte a
    timpului "n cursul ultimei sptm@ni a $a(ei luteale, au "nceput s se remit
    "n decurs de c@teva (ile dup debutul $a(ei $oliculare, ,i au $ost absente "n
    sptm@na postmenstrual, cu cel puin unul dintre simptome $iind $ie &E),
    &7), &4) sau &H)D
    (1) dispo(iie depresiv, sentimente de disperare sau idei de subestimare
    marcate3
    (2) anxietate, tensiune, sentimentul de stat =ca pe !%impi> sau =ca
    pe
    0eratic> marcate3
    (3) labilitate a$ectiv marcat &de ex2, a se simi brusc trist sau c "i dau lacri
    mile ori sensibilitate crescut la re0ecie3
    (4) m@nie sau iritabilitate marcat ,i persistent sau con$licte
    interpersonale
    intense3
    (5) scderea interesului pentru activitile u(uale &de ex2, serviciu,
    ,coal,
    amici, %obbK-uri3
    (6) sen(aia subiectiv de di$icultate "n concentrare3
    (7) letar!ie, $ati!abilitate rapid sau lips marcat de ener!ie3
    (8) modi$icare marcat a apetitului, m@ncat excesiv sau dorina ardent
    de
    anumite alimente3
    (9) %ipersomnie sau insomnie3
    (10) sen(aia subiectiv c este dep,it sau c a scpat situaia de
    subcontrol3
    (11)alte simptome somatice, cum ar $i durerea sau con!estia s@nilor, ce$alee,
    durere articular sau muscular, sen(aia de =balonare>, plus ponderal2
    FotD La $emeile menstruate, $a(a Iueal corespunde perioadei dintre ovula-
    ie ,i debutul menstruaiei, iar $a(a $olicular "ncepe cu menstruaia2 La $emeile
    nonmenstruate, &de ex2, la cele care au $ost %isterectomi(ate), orariul $a(elor
    Iueal ,i $olicular poate necesita do(area %ormonilor reproductivi circulani)2
    S2 #erturbarea inter$erea( considerabil cu activitile pro$esional, ,colar
    sau social ,i relaiile cu alii &de ex2, evitarea activitilor sociale, scderea
    productivitii ,i e$icienei "n munc sau la ,coal)2
    2 #erturbarea nu este pur ,i simplu o exacerbare a simptomelor altei tulburri,
    cum ar $i tulburarea depresiv ma0or, panica, distimia sau o tulburare de per
    sonalitate &de,i ea poate $i suprapus peste oricare dintre aceste tulburri)2
    D2 riteriile A, S ,i trebuie s $ie con$irmate de evalurile (ilnice ulterioare
    din cursul a cel puin dou cicluri simptomatolo!ie consecutive2 &Dia!
    nosticul poate $i pus provi(oriu "naintea acestei con$irmri)2
    Criteriul 8 alternativ pentru Tul-urarea Di&ti"i#(
    A+ e<!s(a( +ne"e con(roverse re.er!(oare "a s!%&(o%e"e care de.!nesc ce" %a! '!ne
    (+"'+rarea d!s(!%!c7. Re/+"(a(e"e (es(7r!! :n (eren a (+"'+r7r!"or a.ec(!ve d!n DSM4F3
    s+$erea/7 c7 +r%7(oarea vers!+ne a"(erna(!v7 a cr!(er!+"+! B &oa(e .! %a!
    carac(er!s(!c7 (+"'+r7r!! d!s(!%!ce decA( vers!+nea cr!(er!+"+! B care .!$+ra :n
    DSM4III4R
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ??A
    s! care es(e &re/en(7 s! :n4DSM4I3. S4a dec!s :ns7, c7 %a! es(e necesar7 co"ec(area de
    da(e s+&"!%en(are con.!r%an(e, :na!n(e ca aceO(! !(e%! s7 .!e :ncor&ora=! :n de.!n!=!a
    o.!c!a"7 a (+"'+r7r!! d!s(!%!ce.
    Criteriul 8 $e #er#etare alternativ pentru
    Tul-urarea Di&ti"i#(
    S2 #re(ena, "n timp ce este depresiv, a trei &sau mai multe) dintre urmtoareleD
    (1) stim de sine sau "ncredere "n sine redus sau sentimente de
    insu$icien3
    (2) sentimente de pesimism , disperare sau demorali(are3
    (3) pierderea !enerali(at a interesului sau plcerii3
    (4) retra!ere social3
    &A)$ati!abilitate sau extenuare cronic3
    (6) sentimente de culp, ruminaii despre trecut3
    (7) sentimente subiective de iritabilitate m@nie excesiv3
    (8) reducerea activitii, e$icienei sau productivitii3
    (9) di$icultate "n !@ndire, re$lectat prin concentrare insu$icient,
    memorie
    de$icitar sau indeci(ie2
    Tul-urarea Depre&iv( Minor(
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e +na sa+ %a! %+"(e &er!oade de s!%&(o%e
    de&res!ve, care s+n( !den(!ce c+ e&!soade"e de&res!ve %a@ore ca d+ra(7, dar care
    !%&"!c7 %a! &+=!ne s!%&(o%e O! o de(er!orare %a! red+s7. Un e&!sod !%&"!c7, .!e
    d!s&o/!=!e (r!s(7 sa+ Sde&res!v7T, .!e &!erderea !n(eres+"+! sa+ &"7cer!! &en(r+
    a&roa&e (oa(e ac(!v!(7=!"e, :n (o(a", (re'+!e s7 .!e &re/en(e ce" &+=!n do+7, dar %a!
    &+=!n de c!nc! s!%&(o%e ad!=!ona"e. 3e/! (e<(+" &en(r+ e&!sod+" de&res!v %a@or
    E&a$. ;IFJ &en(r+ o descr!ere %a! de(a"!a(7 a s!%&(o%e"or carac(er!s(!ce. La de'+(+"
    e&!sod+"+!, s!%&(o%e"e s+n( .!e de c+rAnd &re/en(e, or! (re'+!e s7 .!e c"ar a$rava(e,
    :n co%&ara=!e c+ s(area &ree&!sod!c7 a &ersoane!, :n c+rs+" e&!sod+"+!, aces(e
    s!%&(o%e ca+/ea/7 o de2(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n .+nc=!onarea
    soc!a"7, &ro.es!ona"7 or! :n a"(e do%en!! de .+nc=!onare !%&or(an(e. La +n!!
    !nd!v!/!, .+nc=!onarea &oa(e .! a&roa&e nor%a"7, dar es(e :nde&"!n!(7 c+ +n e.or(
    se%n!.!ca(!v cresc+(.
    Un n+%7r de (+"'+r7r! e<c"+d "+area :n cons!dera=!e a aces(e! (+"'+r7r! &ro&+se.
    N+ a e<!s(a( n!c!oda(7 +n e&!sod de&res!v %a@or, %an!aca", %!<( sa+ !&o%an!aca", s!
    n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea d!s(!%!c7 sa+ c!c"o(!%!c7. Per(+r'area
    a.ec(!v7 n+ s+rv!ne e<c"+s!v :n sc!/o.ren!e, (+"'+rarea sc!/o.ren!.or%7, (+"'+rarea
    sc!/oa.ec(!v7, (+"'+rarea de"!ran(7 sa+ (+"'+rarea &s!o(!c7 .7r7 a"(7 s&ec!.!ca=!e.
    *lemente asociate
    Preva"en(a aces(e! (+"'+r7r! &ro&+se, aOa c+% es(e de.!n!(7 a!c!, es(e nec"ar7, dar
    ea &oa(e .! re"a(!v .recven(7, :n s&ec!a" :n +n!(7=!"e de as!s(en=7 %ed!ca"7 &r!%ar7 s!
    88> Anexa S

    de s7n7(a(e %en(a"7 c+ re$!% de a%'+"a(or!+. Un n+%7r de cond!=!! %ed!ca"e
    $enera"e Ede e<., !c(+s+", cancer+" s! d!a'e(+"J &ar a .! asoc!a(e c+ aceas(7 (+"'+rare.
    S(+d!!"e .a%!"!a"e s+$erea/7 o creO(ere a aces(+! &a((ern de s!%&(o%e &r!n(re r+de"e
    &ro'an=!"or c+ (+"'+rare de&res!v7 %a@or7.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e d!a$nos(!ca=! ca avAnd (+"'+rare de ada&(are c+ d!s&o/!=!e de&res!v7, dac7
    s!%&(o%e"e de&res!ve s+rv!n ca r7s&+ns "a +n s(resor &s!osoc!a", a"(.e",
    d!a$nos(!c+" cores&+n/7(or es(e ce" de (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e.
    Un e&!sod de (+"'+rare de&res!v7 %!nor7 se d!s(!n$e de +n e&!sod de&res!v
    %a@or &r!n n+%7r+" de s!%&(o%e cer+(e Edo+7 &An7 "a &a(r+ s!%&(o%e &en(r+
    (+"'+rarea de&res!v7 %!nor7 s! ce" &+=!n c!nc! s!%&(o%e &en(r+ e&!sod+" de&res!v
    %a@orJ. Aceas(7 (+"'+rare &ro&+s7 es(e cons!dera(7 a .! o ca(e$or!e re/!d+a"7 s! n+
    (re'+!e +(!"!/a(7 dac7 e<!s(a +n !s(or!c de e&!sod de&res!v %a@or, %an!aca", %!<(
    sa+ !&o%an!aca", or! dac7 (a'"o+" c"!n!c sa(!s.ace cr!(er!!"e &en(r+ (+"'+rarea
    d!s(!%!c7 sa+ (+"'+rarea c!c"o(!%!c7. S!%&(o%e"e care sa(!s.ac cr!(er!!"e &en(r+
    (+"'+rarea de&res!v7 %!nor7 &o( .! c+ d!.!c+"(a(e d!s(!nse de &er!oade"e de (r!s(e=e
    care s+n( &ar(e !neren(7 a v!e=!! co(!d!ene. Aceas(7 (+"'+rare &ro&+s7 cere ca
    s!%&(o%e"e de&res!ve s7 .!e &re/en(e cea %a! %are &ar(e a /!"e!, a&roa&e :n .!ecare
    /!, (!%& de ce" &+=!n 9 s7&(7%An!, :n a.ar7 de aceas(a, s!%&(o%e"e de&res!ve (re'+!e
    s7 ca+;e;e de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c7. S!%&(o%e"e de&res!ve,
    care a&ar ca r7s&+ns "a &!erderea +ne! .!!n=e !+'!(e, s+n( cons!dera(e do"!+
    Ee<ce&(And ca/+" :n care e"e sa(!s.ac cr!(er!!"e &en(r+ +n e&!sod de&res!v %a@or, ve/!
    &a$. ;IFJ. T+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de aceas(7
    (+"'+rare &r!n aceea c7 s!%&(o%e"e de&res!ve se da(orea/7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +n+! dro$ de a'+/ Ede e<., a"coo" sa+ coca!n7J or! e.ec(e"or sec+ndare a"e
    +n+! %ed!ca%en( Ede e<., s(ero!/!!J Eve/! &a$.]ILYJ. T+"'+rarea a.ec(!v7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e se d!s(!n$e de aceas(7 &er(+r'are &r!n aceea c7
    s!%&(o%e"e de&res!ve se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ede e<., !&er(!ro!d!s%+"J Eve/! &a$. IL5J. Deoarece s!%&(o%e"e
    de&res!ve s+n( .recven( e"e%en(e asoc!a(e a"e (+"'+r7r!"or &s!o(!ce, e"e n+ s+n(
    d!a$nos(!ca(e se&ara(, dac7 s+rv!n e<c"+s!v :n c+rs+" sc!/o.ren!e!, (+"'+r7r!!
    sc!/o.ren!.or%e, (+"'+r7r!! sc!/oa.ec(!ve, (+"'+r7r!! de"!ran(e sa+ (+"'+r7r!!
    &s!o(!ce .7r7 a"(7 s&ec!.!ca=!e. Re"a=!a d!n(re aceas(7 (+"'+rare &ro&+s7 s! d!verse
    a"(e ca(e$or!! &ro&+se !nc"+se :n aceas(7 ane<7 Eres&ec(!v, (+"'+rarea de&res!v7
    rec+ren(7 sc+r(7, (+"'+rarea de &ersona"!(a(e de&res!v7 s! (+"'+rarea de&res!v4
    an<!oas7 %!<(7J s! c+ a"(e (+"'+r7r! de &ersona"!(a(e n+ es(e c+nosc+(7, dar &oa(e
    e<!s(a o s+&ra&+nere cons!dera'!"7 :n(re e"e.
    Seturile de riterii si Axele prev(ute pentru studii
    suplimentare
    GGG
    Criteriile $e #er#etare pentru Tul-urarea Depre&iv( Minor(
    A2 O perturbare a$ectiv de$init dup cum urmea(D
    &E)cel puin dou &dar mai puin dec@t cinci) dintre urmtoarele simptome
    au $ost pre(ente "n cursul aceleia,i perioade de dou sptm@ni ,i
    repre(int o modi$icare de la $uncionarea anterioar3 cel puin unul
    dintre simptome este $ie &a) sau &b)D
    (a) dispo(iie depresiv cea mai mare parte a (ilei, aproape "n
    $iecare (i,
    dup cum este indicat $ie de relatarea subiectului &trist), $ie de
    observaia $cut de alii &de ex2, este "nlcrimat)2 FotD la copii si
    adolesceni, dispo(iia poate $i iritabil3
    (b) diminuare marcat a interesului sau plcerii pentru toate sau
    aproape
    toate activitile, cea mai mare parte a (ilei, aproape "n $iecare (i
    &dup cum este indicat $ie de relatarea subiectului, $ie de observaiiile
    $cute de alii)3
    (c) pierdere semni$icativ "n !reutate c@nd nu ine diet sau plus
    pon
    deral &de ex2, o modi$icare cu mai mult de Ad din !reutatea corpului
    "n decurs de o lun) ori scderea sau cre,terea apetitului aproape "n
    $iecare (i2 FotD la copii se ia "n consideraie incapacitatea de a lua "n
    !reutate plusul a,teptat3
    (d) insomnie sau %ipersomnie aproape "n $iecare (i3
    (e) a!itaie sau lentoare psi%omotorie aproape "n $iecare (i
    &observabil
    de ctre alii ,i nu simpla sen(aie de nelini,te sau de a $i mai lent)3
    (f) $ati!abilitate sau lips de ener!ie aproape "n $iecare (i3
    &!)sentimente de devalori(are ori de culp excesiv sau inadecvat &care
    poate $i delirant) aproape "n $iecare (i & nu simplul autorepro, sau
    culp re$eritoare la $aptul de a $i su$erind)3 &%) diminuarea capacitii
    de a !@ndi sau de a se concentra sau indeci(ie
    aproape "n $iecare (i &$ie relatat de subiect ori observat de alii)3
    &i) !@nduri recurente de moarte &nu doar $rica de a nu muri), ideaie
    suicidar recurent $r un plan speci$ic anume ori o tentativ de
    suicid sau un plan anume de a comite suicidul3
    &7)simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n
    $uncionarea social, pro$esional sau "n alte domenii de $uncionare
    importante3 &4)simptomele nu se datorea( e$ectelor $i(iolo!ice
    directe ale unei
    substane &de ex2, un dro! de abu(, un medicament) sau unei condiii
    medicale !enerale &de ex2, %ipotiroidismul)3 &H)simptomele nu sunt
    explicate mai bine de doliu &adic, de reacia
    normal la moartea unei $iine iubite2
    S2 Fu a existat niciodat un episod depresiv ma0or &ve(i pa!2 4AI) ,i nu sunt
    satis$cute criteriile pentru tulburarea distimic2
    2 Fu a existat niciodat un episod maniacal &ve(i pa!2 4I7), un episod mixt
    &ve(i pa!2 4IA) sau un episod %ipomaniacal &ve(i pa!2 4I8) ,i nu sunt
    satis$cute criteriile pentru tulburarea ciclotimic)2 Fot D aceast excludere
    nu se aplic dac oricare dintre episoadele similare episoadelor maniacal,
    mixt sau %ipomaniacal sunt induse de o substan sau de tratament2
    D2 #erturbarea a$ectiv nu survine exclusiv "n cursul sc%i(o$reniei, tulburrii
    sc%i(o$reni$orme, tulburrii sc%i(oa$ective, tulburrii delirante sau tulbu
    rrii psi%otice $r alt speci$icaie2
    GG> Anexa S
    Tul-urarea Depre&iv( S#urt( Re#urent(
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e rec+ren=a +nor e&!soade sc+r(e de s!%&(o%e
    de&res!ve, care s+n( !den(!ce c+ e&!soade"e de&res!ve %a@ore ca n+%7r s! sever!(a(e
    a s!%&(o%e"or, dar care n+ sa(!s.ac cererea +ne! d+ra(e de do+7 s7&(7%An!. 3e/!
    (e<(+" &en(r+ e&!sod+" de&res!v %a@or E&a$. ;IFJ, &en(r+ o descr!ere %a! de(a"!a(7 a
    s!%&(o%e"or carac(er!s(!ce. E&!soade"e d+rea/7 ce" &+=!n do+7 /!"e, dar %a! &+=!n
    de do+7 s7&(7%An!, de re$+"7 avAnd o d+ra(7 :n(re do+7 O! &a(r+ /!"e. E&!soade"e
    (re'+!e s7 s+rv!n7 ce" &+=!n o da(7 &e "+n7 o &er!oad7 de 59 "+n! consec+(!ve s! n+
    (re'+!e s7 .!e asoc!a(e e<c"+s!v c+ c!c"+" %ens(r+a". E&!soade"e de&res!ve sc+r(e
    (re'+!e s7 ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7 c"!n!c :n .+nc=!onarea
    soc!a"7, &ro.es!ona"7 sa+ :n a"(e do%en!! de .+nc=!onare !%&or(an(e. La +n!!
    !nd!v!/!, .+nc=!onarea &oa(e .! a&roa&e nor%a"7, dar es(e :nde&"!n!(7 c+ +n e.or(
    cresc+( :n %od se%n!.!ca(!v.
    Un n+%7r de (+"'+r7r! e<c"+de "+area :n cons!dera=!e a aces(e! (+"'+r7r!
    &ro&+se. N+ a e<!s(a( n!c!oda(7 +n e&!sod de&res!v %a@or, %an!aca", %!<( sa+
    !&o%an!aca", s! n+ s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea d!s(!%!c7 sa+
    c!c"o(!%!c7. Per(+r'area a.ec(!v7 n+ s+rv!ne e<c"+s!v :n c+rs+" sc!/o.ren!e!,
    (+"'+r7r!! sc!/o.ren!.or%e, (+"'+r7r!! sc!/oa.ec(!ve, (+"'+r7r!! de"!ran(e sa+
    (+"'+r7r!! &s!o(!ce .7r7 a"(7 s&ec!.!ca=!e.
    *lemente asociate
    Pa((ern+" co%or'!d!(7=!! c+ren(e sa+ &e v!a=7 &are a .! s!%!"ar c+ ce" a" (+"'+r7r!!
    de&res!ve %a@ore. T+"'+r7r!"e asoc!a(e &o( !nc"+de (+"'+r7r!"e :n "e$7(+r7 c+ o
    s+'s(an=7 s! (+"'+r7r!"e an<!oase. E&!soade"e &o( +r%a +n &a((ern se/on!er.
    Preva"en(a &e +n an a aces(e! (+"'+r7r! &ro&+se a .os( ra&or(a(7 a .! de a&ro<!%a(!v
    Hd EdeO! aceas(a a .os( asoc!a(7 adesea c+ a"(e (+"'+r7r! %en(a"e &rec!/a(eJ. B7r'a=!!
    s! .e%e!"e &ar a e<&er!en=a :n e$a"7 %7s+r7 e&!soade"e de&res!ve rec+ren(e sc+r(e,
    !ar cea %a! (!&!c7 e(a(e "a de'+( &are a .! :n ado"escen=7. Ten(a(!ve"e de s+!c!d s+n(
    cea %a! ser!oas7 co%&"!ca=!e. Ra(a (+"'+r7r!"or de&res!ve es(e cresc+(7 "a r+de"e
    '!o"o$!ce de $rad+" I a"e !nd!v!/!"or care a+ e&!soade de&res!ve sc+r(e rec+ren(e.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!e.
    Un e&!sod de (+"'+rare de&res!v7 sc+r(7 se d!s(!n$e de +n e&!sod de&res!v
    %a@or, &r!n d+ra(a e&!sod+"+! E945; /!"e &en(r+ e&!sod+" de&res!v sc+r( s! 9
    s7&(7%An! sa+ %a! %+"( &en(r+ e&!sod+" de&res!v %a@orJ. T+"'+rarea de&res!v7
    sc+r(7 rec+ren(7 es(e cons!dera(7 o ca(e$or!e re/!d+a"7 s! n+ (re'+!e s7 .!e +(!"!/a(7
    dac7 e<!s(7 +n !s(or!c de e&!sod de&res!v %a@or, e&!sod %an!aca", e&!sod %!<( sa+
    e&!sod !&o%an!aca", or! dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea
    c!c"o(!%!c7 sa+ (+"'+rarea d!s(!%!c7. T+"'+rarea a.ec(!v7 !nd+s7 de o s+'s(an=7
    se d!s(!n$e de aceas(7 &er(+r'are &r!n aceea c7 s!%&(o%e"e de&res!ve se da(orea/7
    e.ec(e"or .!/!o"o$!ce d!rec(e a"e +n+! dro$ de a'+/ Ede e<., a"coo"+" sa+ coca!naJ or!
    e.ec(e"or sec+ndare a"e +n+! %ed!ca%en( Ede e<., s(ero!/!!J Eve/! &a$. ILYJ.
    T+"'+rarea a.ec(!v7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e se d!s(!n$e de
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    884

    aceas(7 &er(+r'are &r!n aceea c7 s!%&(o%e"e se da(orea/7 e.ec(e"or .!/!o"o$!ce
    d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e Ede e<., !&er(!ro!d!s%+"J Eve/! &a$.
    IL5J. Deoarece s!%&(o%e"e de&res!ve s+n( s!%&(o%e asoc!a(e co%+ne a"e
    (+"'+r7r!"or &s!o(!ce, e"e n+ s+n( d!a$nos(!ca(e se&ara( dac7 s+rv!n e<c"+s!v :n
    c+rs+" sc!/o.ren!e!, (+"'+r7r!! sc!/o.ren!.or%e, (+"'+r7r!! sc!/oa.ec(!ve,
    (+"'+r7r!! de"!ran(e sa+ (+"'+r7r!! &s!o(!ce .7r7 a"(7 s&ec!.!ca=!e. T+"'+rarea
    de&res!v7 sc+r(7 rec+ren(7 are +ne"e e"e%en(e co%+ne c+ (+"'+rarea de
    &ersona"!(a(e 'orde"!ne Ead!c7, a%'e"e (+"'+r7r! &re/!n(7 s!%&(o%e de&res!ve
    e&!sod!ce s! sc+r(e, c+% ar .! !dea=!a s+!c!dar7 sa+ (r!s(e=eaJ, :n ca/+r!"e :n care, a(A(
    o (+"'+rare de &ersona"!(a(e, cA( s! aceas(7 (+"'+rare &ro&+s7 s+n( &re/en(e,
    a%'e"e &o( .! %en=!ona(e Ec+ (+"'+rarea de&res!v7 sc+r(7 rec+ren(7 no(a(7 ca
    (+"'+rare de&res!v7 .7r7 a"(7 s&ec!.!ca=!eJ. Re"a=!a d!n(re aceas(7 (+"'+rare &ro&+s7
    O! %+"(e a"(e ca(e$or!! &ro&+se !nc"+se :n aceas(7 ane<7 Ead!c7, (+"'+rarea
    de&res!v7 %!nor7, (+"'+rarea de &ersona"!(a(e de&res!v7 s! (+"'+rarea de&res!v4
    an<!oas7 %!<(7J s! c+ a"(e2(+"'+r7r! de &ersona"!(a(e n+ es(e c+nosc+(7, dar :n(re e"e
    &o( e<!s(a s+&ra&+ner! s+'s(an=!a"e.
    Criteriile $e #er#etare pentru Tul-urarea
    Depre&iv( S#urt( Re#urent(
    A2 Sunt satis$cute criteriile pentru episodul depresiv ma0or, cu excepia duratei
    &ve(i pa!2 4AI)2
    S2 #erioadele depresive de la criteriul A durea( cel puin 7 (ile, dar mai puin
    de 7 sptm@ni2
    2 #erioadele depresive survin cel puin odat pe lun, timp de E7 luni
    consecutiv si nu sunt asociate cu ciclul menstrual2
    D2 #erioadele de depresie cau(ea( detres sau deteriorare semni$icativ clinic
    "n $uncionarea social, pro$esional sau "n alte domenii de $uncionare
    importante2
    *2 Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau ale unei condiii medicale
    !enerale &de ex2, %ipotiroidism)2
    '2 Fu a existat niciodat un episod depresiv ma0or &ve(i pa!2 4AI) ,i nu satis$ace
    criteriile pentru tulburarea distimic2
    G2 Fu a existat niciodat un episod maniacal &ve(i pa!2 4I7), un episod mixt &ve(i
    pa!2 4IA) sau un episod %ipomaniacal &ve(i pa!2 4I8) ,i nu sunt satis$cute
    criteriile pentru tulburarea ciclotimic2 FotD Aceast excludere nu se aplic
    dac oricare dintre episoadele similare episoadelor maniacale, mixte sau
    %ipomaniacale sunt induse de o substan sau de tratament2
    L2 #erturbarea a$ectiv nu survine exclusiv "n cursul sc%i(o$reniei, tulburrii
    sc%i(o$reni$orme, tulburrii sc%i(oa$ective, tulburrii delirante sau
    tulburrii psi%otice $r alt speci$icaie2
    ?85 Anexa S
    Tul-urarea Depre&iv-An,ioa&( Mi,t(
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e o d!s&o/!=!e d!s.or!c7 rec+ren(7 sa+ &ers!s(en(7
    care d+rea/7 ce" &+=!n o "+n7. D!s&o/!=!a d!s.or!c7 se :nso=eO(e de s!%&(o%e
    ad!=!ona"e care (re'+!e s7 &ers!s(e, de ase%enea, ce" &+=!n o "+n7, s! !nc"+d ce" &+=!n
    &a(r+ d!n +r%7(oare"eQ d!.!c+"(7=! :n concen(rare sa+ %e%or!e, &er(+r'area
    so%n+"+!, .a(!$a'!"!(a(e sa+ ener$!e sc7/+(7, !r!(a'!"!(a(e, a&reens!+ne, +Oor de
    %!Oca( &An7 "a "acr!%!, !&erv!$!"!(a(e, aO(e&(area a (o( ce es(e %a! r7+, d!s&erare sa+
    &es!%!s% :n "e$7(+r7 c+ v!!(or+", s(!%a de s!ne sc7/+(7 sa+ sen(!%en(+" de
    !n+(!"!(a(e. S!%&(o%e"e (re'+!e s7 ca+/e/e o de(res7 sa+ de(er!orare se%n!.!ca(!v7
    c"!n!c :n .+nc=!onarea soc!a"7, &ro.es!ona"7 sa+ :n a"(e do%en!! de .+nc=!onare
    !%&or(an(e. Aceas(7 (+"'+rare &ro&+s7 n+ (re'+!e s7 .!e "+a(7 :n cons!dera=!e, dac7
    s!%&(o%e"e se da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! s+'s(an=e sa+ cond!=!!
    %ed!ca"e $enera"e, or! dac7 s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ (+"'+rarea de&res!v7
    %a@or7, (+"'+rarea d!s(!%!c7, &an!c7 sa+ an<!e(a(ea $enera"!/a(7. De ase%enea,
    d!a$nos(!c+" n+ se &+ne, dac7 ac(+a"%en(e s+n( sa(!s.7c+(e cr!(er!!"e &en(r+ or!care
    a"(7 (+"'+rare an<!oas7 sa+ de&res!v7, c!ar dac7 (+"'+rarea an<!oas7 sa+ de&res!v7
    es(e :n re%!s!+ne &ar=!a"7. S!%&(o%e"e, de ase%enea, n+ (re'+!e s7 .!e e<&"!ca(e %a!
    '!ne de vreo a"(7 (+"'+rare %en(a"7. Fa&( !%&or(an(, re"a=!a "on$!(+d!na"7 d!n(re
    aceas(7 (+"'+rare &ro&+s7 s! a"(e (+"'+r7r! de&res!ve O! an<!oase n+ es(e c+nosc+(7.
    Ca a(are n+ es(e c"ar :n ce &ro&or=!e de !nd!v!/! aces( &a((ern de s!%&(o%e Ead!c7,
    (+"'+rarea de&res!v an<!oas7 %!<(7J &oa(e .! +n .ac(or de r!sc &en(r+ a"(7 (+"'+rare
    %en(a"7 c+% ar .! (+"'+rarea de&res!v7 %a@or7, an<!e(a(ea $enera"!/a(7 sa+ &an!ca.
    Ra(e"e &reva"en(e! c+ren(e %er$ de "a 5;d "a 9d :n cond!=!! de as!s(en=7
    %ed!ca"7 &r!%ar7, :n eOan(!oane"e &o&+"a=!ona"e, ra(a &reva"en(e! c+ren(e a .os(
    es(!%a(7 "a L,Gd. De ase%enea, s4a cons(a(a( c7 (+"'+rarea de&res!v4an<!oas7 %!<(7
    es(e .oar(e .recven(7 :n &+=!ne"e +n!(7=! de s7n7(a(e %en(a"7 :n care a .os( s(+d!a(7.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare an<!oas7 .7r7 a"(7 s&ec!.!ca=!e.
    T+"'+rarea an<!oas7 !nd+s7 de o s+'s(an=7 se d!s(!n$e de aceas(7 &er(+r'are
    &r!n aceea c7 s!%&(o%e"e d!s.or!e! s+n( da(ora(e e.ec(e"or .!/!o"o$!ce d!rec(e a"e
    +n+! dro$ de a'+/ Ede e<., a"coo"+" sa+ coca!naJ, or! e.ec(e"or sec+ndare a"e +n+!
    %ed!ca%en( Ede e<., s(ero!/!!J Eve/! &a$., IHFJ. T+"'+rarea an<!oas7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e se d!s(!n$e de aceas(7 &er(+r'are &r!n aceea c7
    s!%&(o%e"e de d!s.or!e s+n( da(ora(e e.ec(e"or .!/!o"o$!ce $enera"e a"e +ne! cond!=!!
    %ed!ca"e $enera"e Ede e<., .eocro%oc!(o%+", !&er(!ro!d!s%+"J Eve/! &a$., IHRJ.
    S!%&(o%e"e descr!se :n aceas(7 &re/en(are s+n( .recven( e"e%en(e asoc!a(e a"e
    %+"(or (+"'+r7r! %en(a"e O! de aceea n+ (re'+!e s7 .!e d!a$nos(!ca(e se&ara(, dac7
    s+n( e<&"!ca(e %a! '!ne de a"(7 (+"'+rare %en(a"7. Aceas(7 cond!=!e n+ (re'+!e "+a(7
    :n cons!dera=!e "a !nd!v!/!! c+ +n !s(or!c an(er!or sa+ ac(+a" de (+"'+rare de&res!v7
    %a@or7, (+"'+rare d!s(!%!c7, &an!c7 sa+ an<!e(a(e $enera"!/a(7 or! c+ vreo a"(7
    (+"'+rare a.ec(!v7 sa+ an<!oas7 c+ren(7 E!nc"+s!v ce"e :n re%!s!+ne &ar=!a"7J.
    Aceas(7 &re/en(are se d!s(!n$e, de ase%enea, de n!c! o (+"'+rare %en(a"7 &r!n
    .a&(+" c7 s!%&(o%e"e s+n( &ers!s(en(e sa+ rec+ren(e O! ca+/ea/7 o de(res7 sa+
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ?8E
    de(er!orare se%n!.!ca(!v7 c"!n!c :n .+nc=!onarea soc!a"7, &ro.es!ona"7 sa+ :n a"(e
    do%en!! de .+nc=!onare !%&or(an(e.
    Re"a=!a d!n(re aceas(7 (+"'+rare &ro&+s7 s! d!verse a"(e ca(e$or!! &ro&+se !nc"+se
    :n aceas(7 ane<7 Ead!c7, (+"'+rarea de&res!v7 %!nor7, (+"'+rarea de&res!v7 sc+r(7
    rec+ren(7 s! (+"'+rarea de &ersona"!(a(e de&res!v7J s! a"(e (+"'+r7r! de &ersona"!(a(e
    n+ es(e c+nosc+(7, dar &oa(e e<!s(a o s+&ra&+nere s+'s(an=!a"7 :n(re e"e.
    Criteriile $e #er#etare pentru
    Tul-urarea Depre&iv An,ioa&( Mi,t(
    A2 Dispo(iie dis$oric recurent sau persistent dur@nd cel puin E lun2
    S2 Dispo(iia dis$oric este acompaniat timp de cel puin E lun de patru &sau
    mai multe) dintre urmtoarele simptomeD
    (1) di$icultate "n concentrare sau sen(aia de vid mental3
    (2) perturbare de somn &di$icultate "n a adormi sau "n a rm@ne adormit,
    ori
    somn a!itat, nesatis$ctor3
    &S)$ati!abilitate sau ener!ie sc(ut3
    (4) iritabilitate3
    (5) apre%ensiune3
    (6) u,or de mi,cat p@n la lacrimi3
    (7) %ipervi!ilitate3
    (8) se a,teapt la tot ce este mai ru3
    (9) disperare &pesimism perva(iv "n le!tur cu viitorul3
    &E5) stim de sine sc(ut sau sentimente de inutilitate2
    2 Simptomele cau(ea( o detres sau deteriorare semni$icativ clinic "n $uncio-
    narea social, pro$esional sau "n alte domenii de $uncionare importante2
    D2 Simptomele nu se datorea( e$ectelor $i(iolo!ice directe ale unei substane
    &de ex2, un dro! de abu(, un medicament) sau ale unei condiii medicale
    !enerale2
    *2 Oricare dintre urmtoareleD
    (1) nu au $ost satis$cute niciodat criteriile pentru tulburarea depresiv ma
    0or, tulburarea distimic, panic sau anxietatea !enerali(at3
    (2) actualmente nu sunt satis$cute criteriile pentru oricare alt
    tulburare
    a$ectiv sau anxioas &inclusiv o tulburare a$ectiv sau anxioas, "n
    remisiune parial)3
    (3) Simptomele nu sunt explicate mai bine de oricare alt tulburare
    mental
    Tul-urarea 'a#ti#e prin Pro#ur( 3-P Pro,P6
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons!(+!e &rod+cerea de"!'era(7 sa+ s!%+"area de se%ne sa+
    s!%&(o%e so%a(!ce sa+ &s!o"o$!ce "a a"(7 &ersoan7, care se a."7 s+' :n$r!@!rea
    !nd!v!d+"+!. De re$+"7, v!c(!%a es(e +n co&!" %!c, !ar .7&(+!(or+" E&er&e(ra(or 4 ce" care
    8=2 Anexa S

    .ace sa+ co%!(eJ es(e %a%a co&!"+"+!. Mo(!va=!a &en(r+ co%&or(a%en(+"
    .7&(+!(or+"+! se &res+&+ne a .! neces!(a(ea &s!o"o$!c7 de as+%are a ro"+"+! de
    &ac!en( &r!n &roc+r7. Inc!(a=!!"e e<(erne &en(r+ co%&or(a%en(, c+% ar .! avan(a@+"
    econo%!c, s+n( a'sen(e. Co%&or(a%en(+" n+ es(e e<&"!ca( %a! '!ne de a"(7 (+"'+rare
    %en(a"7. F7&(+!(or+" !nd+ce sa+ s!%+"ea/7 %a"ad!a sa+ &roces+" %or'!d "a v!c(!%7
    O! &re/!n(7 a&o! v!c(!%a &en(r+ as!s(en=7 %ed!ca"7, :n (!%& ce nea$7 a avea vreo
    c+noO(!n=7 des&re e(!o"o$!a rea"7 a &ro'"e%e!. Cond!=!!"e ce"e %a! .recven( s!%+"a(e
    O! !nd+se !nc"+d v7rs7(+r!"e &ers!s(en(e s! d!areea, s(o&+" res&!ra(or, as(%+",
    d!s.+nc=!!"e s!s(e%+"+! nervos cen(ra" Ede e<., conv+"s!!"e, !ncoordonarea, &!erderea
    c+noO(!n=e!J, .e'ra, !n.ec=!a, sAn$erarea, d!s(ro.!a, !&o$"!ce%!a, &er(+r'7r!"e
    e"ec(ro"!(!ce s! e<an(e%+". S!%+"area de (+"'+r7r! %en(a"e "a v!c(!%7 es(e ra&or(a(7
    %+"( %a! &+=!n .recven(. T!&+" O! sever!(a(ea se%ne"or O! s!%&(o%e"or s+n( "!%!(a(e
    n+%a! de c+noO(!n=e"e %ed!ca"e O! &os!'!"!(7=!"e .7&(+!(or+"+!. Ca/+r!"e s+n(
    carac(er!/a(e adesea &r!n(r4o evo"+=!e c"!n!c7 a(!&!c7 "a &ac!en( O! re/+"(a(e
    d!scordan(e "a (es(e"e de "a'ora(or, care s+n( :n con(rad!c=!e c+ s(area de s7n7(a(e
    &re(!ns a"(era(7 a v!c(!%e!.
    De re$+"7, v!c(!%a es(e +n co&!" &reOco"ar, :ns7, &o( .! +(!"!/a=! ca v!c(!%e O!
    no+n7sc+=!!, ado"escen=!! O! ad+"=!!. La co&!!! %a! %ar!, (re'+!e "+a(7 :n cons!dera=!e s!
    &os!'!"!(a(ea co"a'or7r!! c+ .7&(+!(or+" :n &rod+cerea se%ne"or s! s!%&(o%e"or.
    F7&(+!(or+" &r!%eO(e +n d!a$nos(!c de (+"'+rare .ac(!ce &r!n &roc+r7. Pen(r+ v!c(!%7
    &o( .! no(a(e, dac7 s+n( adecva(e, a'+/+" .!/!c de +n co&U EFFY.YIJ sa+ a'+/+" .!/!c de
    +n ad+"( EFFY.G5J. :n even(+a"!(a(ea co"a'or7r!! vo"+n(are, &en(r+ co"a'ora(or &oa(e .!
    adecva( +n d!a$nos(!c ad!=!ona" de (+"'+rare .ac(!ce.
    *lemente asociate
    Po( .! &re/en=! s(resor! de v!a=7, c+% ar .! d!s.+nc=!a .a%!"!ar7 cron!c7. F7&(+!(or!!
    &o( &re/en(a %!nc!+n7 &a(o"o$!c7 Esa+ &se+do"o$!e .an(as(!c7J :n descr!erea
    e<&er!en=e"or co(!d!ene O! cAnd &re/!n(7 v!c(!%a &en(r+ as!s(en=7 %ed!ca"7.
    Frecven(, e! a+ o e<&er!en=7 cons!dera'!"7 :n do%en!!"e :n "e$7(+r7 c+ s7n7(a(ea O!
    &ar a .! cresc+( :n(r4+n %ed!+ %ed!ca". E! s+n( adesea !nd!.eren=! .a=7 de co&!! "or
    cAnd n+ rea"!/ea/7 .a&(+" c7 s+n( o'serva=!. 3!c(!%e"e &o( s+.er! o ra(7 de
    %or'!d!(a(e O! %or(a"!(a(e se%n!.!ca(!v7, ca +r%are a cond!=!!"or !nd+se sa+
    &ro'"e%e"or asoc!a(e, c+% ar .! co%&"!ca=!!"e !a(ro$en!ce a"e %ed!ca%en(e, (es(e"or
    d!a$nos(!ce O! !n(erven=!!"or c!r+r$!ca"e. Pe %7s+r7 ce se %a(+r!/ea/7, v!c(!%e"e
    s+n( e<&+se +n+! r!sc cresc+( de a &re/en(a e"e :nse"e (+"'+rare .ac(!ce sa+ &ro'"e%e
    co%&or(a%en(a"e sa+ e%o=!ona"e care &o( !nc"+de d!.!c+"(7=! :n a(en=!e s! :n
    concen(rare, de(er!orarea &er.or%an=e"or Oco"are sa+ s!%&(o%e de s(res
    &os((ra+%a(!c. F7&(+!(or+" es(e de re$+"7 %a%a, (a(7" ne&7rAnd a .! !%&"!ca(.
    Uneor!, :ns7, (a(7" sa+ so=+" &oa(e co"a'ora c+ %a%a sa+ &oa(e ac=!ona s!n$+r.
    F7&(+!(or+" &oa(e .!, de ase%enea, o a"(7 &ersoan7 care se oc+&7 de co&!" Ede e<., o
    'a'y4s!((er, '+n!ca sa+ %a%a v!(re$7J. F7&(+!(or!! &o( avea +n !s(or!c de a .! .os(
    %a"(ra(a=!. Po( .! &re/en(e (+"'+r7r! so%a(o.or%e O! (+"'+r7r! de &ersona"!(a(e.
    Aceas(7 (+"'+rare &ro&+s7 coe<!s(7 adesea c+ (+"'+rarea .ac(!ce, care n+ se
    %an!.es(7 a(A( (!%& cA( .7&(+!(or+" &oa(e !nd+ce sa+ s!%+"a o (+"'+rare .ac(!ce "a
    v!c(!%7. CAnd s+n( con.r+n(a=! c+ consec!n=e"e co%&or(a%en(+"+! "or, .7&(+!(or!!
    &o( deven! de&res!v! s! s+!c!dar!. Un!! se s+&7r7 &e s&ec!a"!O(!! :n s7n7(a(e %en(a"7,
    nea$7 ac+/a=!!"e, :ncearc7 s7 scoa(7 v!c(!%a d!n s&!(a" con(rar av!/+"+! %ed!ca", O!
    so"!c!(7 (ra(a%en( a"(or s&ec!a"!O(!, a."a=! c!ar "a o d!s(an=7 cons!dera'!"7. F7&(+!(or!!
    &o( .! con.r+n(a=! c+ ac+/a=!! &ena"e %er$And de "a a'+/ "a cr!%7. De re$+"7,
    .7&(+!(or+" se concen(rea/7 n+%a! as+&ra +ne! s!n$+re v!c(!%e oda(7, :ns7 s! a"=!
    .ra=! Ea! v!c(!%e!J sa+ a"=! !nd!v!/! a+ .os( sa+ &o( deven! v!c(!%e.
    Mt$//ILLLL
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    G>4
    Dia!nostic di$erenial
    :n DSM4I3, +n !nd!v!d Ead!c7 .7&(+!(or+"J, a" c7r+! (a'"o+ c"!n!c sa(!s.ace aces(e
    cr!(er!! de cerce(are, va .! d!a$nos(!ca( ca avAnd (+"'+rare .ac(!ce .7r7 a"(7
    s&ec!.!ca=!e.
    T+"'+rarea .ac(!ce &r!n &roc+r7 (re'+!e s7 .!e d!s(!ns7 de o cond!=!e %ed!ca"7
    $enera"7 or! de o (+"'+rare %en(a"7 "a !nd!v!d+" ad+s &en(r+ (ra(a%en(. T+"'+rarea
    .ac(!ce &r!n &roc+r7 (re'+!e s7 .!e d!s(!ns7, de ase%enea, de a'+/+" .!/!c sa+ de
    a'+/+" se<+a", care n+ es(e %o(!va( de sco&+" de as+%are !nd!rec(7 a ro"+"+! de
    &ac!en(. S!%+"area d!.er7 de (+"'+rarea .ac(!ce &r!n &roc+r7, &r!n aceea c7 %o(!v+"
    &en(r+ &rod+cerea s!%&(o%e"or :n s!%+"are es(e o !nc!(a=!e e<(ern7, &e cAnd :n
    (+"'+rarea .ac(!ce !nc!(a=!!"e e<(erne s+n( a'sen(e. Ind!v!/!! c+ s!%+"are &o( so"!c!(a
    s&!(a"!/are &en(r+ +n !nd!v!d a."a( :n :n$r!@!rea "or &r!n &rod+cerea de s!%&(o%e :n
    (en(a(!va de a o'=!ne o co%&ensa=!e.
    Criteriile $e #er#etare pentru Tul-urarea 'a#ti#e prin Pro#ur(
    A2 #roducerea intenionat sau simularea de semne sau simptome somatice
    sau psi%olo!ice la o alt persoan care se a$l sub "n!ri0irea individului2
    S2 Motivul comportamentului $ptuitorului este acela de asumare a rolului de
    pacient prin procur2
    2 Incitaiile externe pentru comportament &cum ar $i avanta0ul economic) sunt
    absente2
    D2 omportamentul nu este explicat mai bine de alt tulburare mental2
    Tran&a Di&o#iativ(
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e s(area !nvo"+n(ar7 de (rans7, care n+ es(e
    acce&(a(7 de c+"(+ra &ersoane! ca &ar(e a &rac(!c!! re"!$!oase sa+ c+"(+ra"e co"ec(!ve
    O! care ca+/ea/7 o de(res7 sa+ de(er!orare .+nc=!ona"7 se%n!.!ca(!v7 c"!n!c. Aceas(7
    (+"'+rare &ro&+s7 n+ (re'+!e "+a(7 :n cons!dera=!e "a !nd!v!/!! care !n(r7 :n s(7r! de
    (rans7 sa+ de &oses!+ne :n %od vo"+n(ar s! .7r7 de(res7, :n con(e<(+" &rac(!c!"or
    re"!$!oase s! c+"(+ra"e care s+n( "ar$ acce&(a(e de $r+&+" c+"(+ra" a" &ersoane!. As(.e"
    de s(7r! non&a(o"o$!ce s! vo"+n(are s+n( .recven(e s! cons(!(+!e !%ensa %a@or!(a(e a
    s(7r!"or de (rans7 s! de (rans7 c+ &oses!+ne :n(A"n!(e (ransc+"(+ra". Un!! !nd!v!/! :ns7,
    care (rec &r!n s(7r!"e de (rans7 sa+ de (rans7 c+ &oses!+ne nor%a(!ve c+"(+ra", &o(
    &re/en(a s!%&(o%e care ca+/ea/7 de(res7 sa+ de(er!orare, s! dec! &o( .! "+a(e :n
    cons!dera=!e :n .avoarea aces(e! (+"'+r7r! &ro&+se. Ca/+r!"e "oca"e s&ec!.!ce de
    (rans7 d!soc!a(!v7 &re/!n(7 var!a=!! (ransc+"(+ra"e cons!dera'!"e re.er!(oare "a na(+ra
    e<ac(7 a co%&or(a%en(e"or e.ec(+a(e :n c+rs+" s(7r!! a"(era(e, &re/en=a sa+ a'sen=a
    a"(er7r!"or sen/or!a"e d!soc!a(!ve Ede e<., cec!(a(eaJ, !den(!(a(ea as+%a(7 :n (!%&+"
    aces(or s(7r! s! $rad+" de a%ne/!e e<&er!en(a(7 d+&7 s(area a"(era(7 E&en(r+
    e<e%&"e, ve/! $"osar+" s!ndro%e"or c!rc+%scr!se c+"(+ra" d!n ane<a I, &a$. GFHJ.
    ?8H Anexa S
    :n (rans7, &!erderea !den(!(7=!! nor%a"e n+ es(e asoc!a(7 c+ a&ar!=!a de !den(!(7=!
    a"(erna(!ve, !ar ac=!+n!"e e.ec(+a(e :n c+rs+" s(7r!! de (rans7 n+ s+n(, :n $enera"
    co%&"e<e Ede e<., %!Oc7r! conv+"s!ve, c7dere, .+$7J, :n (ransa c+ &oses!+ne, e<!s(7
    a&ar!=!a +ne!a sa+ a %a! %+"(or !den(!(7=! a"(erna(!ve d!s(!nc(e c+ co%&or(a%en(e,
    %e%or!! s! a(!(+d!n! carac(er!s(!ce, !ar ac(!v!(7=!"e e.ec(+a(e de &ersoan7 (!na a .! %a!
    co%&"e<e Ede e<., conversa=!! coeren(e, $es(+r!, e<&res!! .ac!a"e carac(er!s(!ce s!
    ver'a"!/7r! s&ec!.!ce, care s+n( s(a'!"!(e c+"(+ra" ca a&ar=!nAnd +n+! an+%!( a$en(
    &osedan(J. A%ne/!a &ar=!a"7 sa+ (o(a"7 es(e descr!s7 %a! .recven( d+&7 +n e&!sod de
    (rans7 c+ &oses!+ne decA( d+&7 +n e&!sod de (rans7 EdeO! descr!er!"e de a%ne/!e d+&7
    (rans7 n+ s+n( rareJ. M+"=! !nd!v!/! c+ aceas(7 (+"'+rare &ro&+s7 &re/!n(7 e"e%en(e a"e
    +n+! s!n$+r (!& de (rans7, :ns7, +n!! &re/!n(7 o s!%&(o%a(o"o$!e %!<(7 sa+ ."+c(+ea/7
    :n(re d!verse (!&+r! de (rans7 :n (!%&, :n .+nc=!e de &ara%e(r!! c+"(+ra"! "oca"!.
    *lemente asociate
    3ar!an(e a"e aces(or cond!=!! a+ .os( descr!se :n a&roa&e .!ecare soc!e(a(e
    (rad!=!ona"7, &e .!ecare con(!nen(. Preva"en(a &are a sc7dea oda(7 c+ creO(erea
    !nd+s(r!a"!/7r!!, :ns7 r7%Ane cresc+(7 &r!n(re %!nor!(7=!"e e(n!ce d!n soc!e(7=!"e
    !nd+s(r!a"!/a(e. E<!s(7 var!a=!! "oca"e cons!dera'!"e :n e(a(ea O! %od+" de de'+(.
    Evo"+=!a es(e de re$+"7 e&!sod!c7, c+ d+ra(a var!a'!"7 a e&!sod+"+! ac+(, %er$And
    de "a cA(eva %!n+(e "a cA(eva ore. S4a ra&or(a( c7 :n c+rs+" +ne! s(7r! de (rans7,
    !nd!v!/!! &o( avea +n &ra$ cresc+( "a d+rere, &o( cons+%a %a(er!a"e neco%es(!'!"e
    Ede e<., s(!c"7J s! &o( e<&er!en=a o creO(ere a .or=e! %+sc+"are. S!%&(o%e"e (ranse!
    &a(o"o$!ce &o( .! !n(ens!.!ca(e sa+ d!%!n+a(e ca r7s&+ns "a s(!%+"! a%'!en(a"! O! "a
    s+$es(!!"e a"(ora. A$en=!! &osedan(! &res+&+O! s+n( de re$+"7 de na(+r7 s&!r!(+a"7
    Ede e<., s&!r!(e"e %or=!"or, en(!(7=! s+&rana(+ra"e, /e!, de%on!J O! s+n( e<&er!en(a=!
    adesea ca .7cAnd cerer! sa+ e<&r!%And an!%o/!(7=!. Ind!v!/!! c+ (rans7 c+ &oses!+ne
    &a(o"o$!c7 e<&er!en(ea/7 de re$+"7 +n n+%7r red+s de a$en=! E:n(re +n+" s! c!nc!J
    :n(r4o %an!er7 secven=!a"7, n+ s!%+"(an. Co%&"!ca=!!"e !nc"+d (en(a(!ve de s+!c!d,
    a+(o%+(!"7r! s! acc!den(e. Ca de/nod7%An( &os!'!" a+ .os( ra&or(a(e %or=! s+'!(e,
    da(ora(e, &oa(e, ar!(%!!"or card!ace.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare d!soc!a(!v7 .7r7 a"(7 s&ec!.!ca=!e.
    Aces( d!a$nos(!c n+ (re'+!e &+s dac7 se cons!der7 c7 s(area de (rans7 se
    da(orea/7 e.ec(e"or .!/!o"o$!ce d!rec(e a"e +ne! cond!=!! %ed!ca"e $enera"e E:n care
    ca/ d!a$nos(!c+" va .! ce" de (+"'+rare %en(a"7 .7r7 a"(7 s&ec!.!ca=!e da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, ve/! &a$. 5FLJ or! a"e +ne! s+'s(an=e4E:n care ca/
    d!a$nos(!c+" va .! ce" de (+"'+rare :n "e$7(+r7 c+ o s+'s(an=7 .7r7 a"(7 s&ec!.!ca=!eJ.
    S!%&(o%e"e s(7r!! de (rans7 Ede e<., a+/!rea sa+ vederea de .!!n=e s&!r!(+a"e O! .a&(+"
    de a .! con(ro"a( sa+ !n."+en=a( de a"=!!J &o( .! con.+nda(e c+ a"+c!na=!!"e s! !de!"e
    de"!ran(e d!n sc!/o.ren!e, (+"'+rarea a.ec(!v7 c+ e"e%en(e &s!o(!ce sa+ (+"'+rarea
    &s!o(!c7 sc+r(7. S(area de (rans7 &oa(e .! d!s(!ns7 &r!n con$r+en=a sa c+"(+ra"7, d+ra(a
    sa sc+r(7 O! a'sen=a s!%&(o%e"or carac(er!s(!ce a"e aces(or a"(e (+"'+r7r!.
    Ind!v!/!! c+ (+"'+rare de !den(!(a(e d!soc!a(!v7 &o( .! d!s(!nO! de ce! c+
    s!%&(o%e de (rans7 O! de &oses!+ne &r!n .a&(+" c7 ce! c+ s!%&(o%e de (rans7 s! de
    &oses!+ne descr!+ de re$+"7 s&!r!(e sa+ en(!(7=! e<(erne care a+ !n(ra( :n cor&+" "or
    O! :! &osed7.
    llIlllirnillllllFliiii
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare
    G><
    Aceas(7 (+"'+rare &ro&+s7 n+ (re'+!e s7 .!e "+a(7 :n cons!dera=!e "a !nd!v!/!! care
    !n(r7 :n s(7r! de (rans7 sa+ de &oses!+ne :n %od vo"+n(ar s! .7r7 de(res7 sa+
    de(er!orare :n con(e<(+" &rac(!c!"or re"!$!oase sa+ c+"(+ra"e.
    Criteriile $e #er#etare pentru Tran&a Di&o#iativ(
    A2 'ie &E) sau &7)D
    &E) trans, adic, alterare temporar marcat "n starea de con,tient sau
    pierderea sentimentului u(ual de identitate personal $r "nlocuirea cu
    o identitate alternativ, asociat cu cel puin unul dintre urmtoareleD
    (a)"n!ustarea con,tiinei ambianei imediate sau $ocali(area selectiv ,i
    extrem de "n!ust pe stimulii ambientali3
    (b) mi,cri sau comportamente stereotipe experientate ca $iind
    mai
    presus de controlul propriu3
    &7) trans cu posesiune, o alterare unic sau episodic a strii de con,tient
    caracteri(at prin "nlocuirea sentimentului u(ual de identitate personal
    printr-o nou identitate2 Aceasta este atribuit in$luenei unui spirit,
    puteri, (eiti sau altei persoane, dup cum este ilustrat de unul sau
    ambele dintre urmtoareleD
    (a)mi,cri sau comportamente determinate cultural ,i stereotipe care
    sunt experientate ca $iind controlate de a!entul posedant3
    (b)amne(ie complet sau parial pentru eveniment2
    S2 Transa sau starea dMe trans cu posesiune nu este acceptat ca parte normal
    a practicii reli!ioase sau culturale colective2
    2 Transa sau starea de trans cu posesiune cau(ea( o detres sau deteriorare
    semni$icativ clinic "n $uncionarea social, pro$esional sau "n alte arii de
    $uncionare importante2
    D2 Transa sau starea de trans cu posesiune nu survine exclusiv "n cursul unei
    tulburri psi%otice &inclusiv tulburarea a$ectiv cu simptome psi%otice ,i
    tulburarea psitiotic scurt) sau tulburarea de identitate disociativ ,i nu se
    datorea( e$ectelor $i(iolo!ice directe ale unei substane sau condiii
    medicale !enerale2
    Tul-urarea MNn#atul Co"pul&iv
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e "e cons(!(+!e e&!soade"e rec+ren(e de %Anca( co%&+"s!v,
    asoc!a(e c+ !nd!ca(or! co%&or(a%en(a"! O! s+'!ec(!v! de de(er!orare a con(ro"+"+! s!
    de(res7 se%n!.!ca(!v7 :n "e$7(+r7 c+ %Anca(+" co%&+"s!v, O! a'sen=a +/+"+! re$+"a( a"
    co%&or(a%en(e"or co%&esa(or!! !nadecva(eJ c+% ar .! v7rs7(+r!"e a+(o&rovoca(e,
    +/+" a'+/!v de "a<a(!ve s! de a"(e %ed!ca%en(e, &os(+" s! e<erc!=!!"e e<ces!veJ care s+n(
    carac(er!s(!ce '+"!%!e! nervoase. Carac(er!s(!c!"e +n+! e&!sod de %Anca( co%&+"s!v
    s+n( d!sc+(a(e :n (e<(+" &en(r+ '+"!%!a nervoas7 E&a$. YGFJ. Ind!ca(or!! de(er!or7r!!
    con(ro"+"+! !nc"+d %Anca(+" .oar(e re&ede, %Anca(+" &An7 se s!%(e deran@an( de &"!n,
    G>= Anexa S

    %Anca(+" +nor %ar! can(!(7=! de a"!%en(e .7r7 a4! .! .oa%e, %Anca(+" de +n+" s!n$+r, d!n ca+/a @ene! :n
    "e$7(+r7 c+ cA( de %+"( %7nAnc7, sen(!%en(+" de de/$+s(, c+"&7 sa+ de&res!e d+&7 %Anca(+"
    co%&+"s!v. De(resa %arca(7, cer+(7 de d!a$nos(!c, !nc"+de sen/a=!!"e ne&"7c+(e d!n c+rs+" s! d+&7
    e&!soade"e de %Anca( co%&+"s!v, &rec+% s! &reoc+&7r!"e re.er!(oare "a e.ec(+" &e (er%en "+n$ a"
    e&!soade"or rec+ren(e de %Anca( co%&+"s!v as+&ra $re+(7=!! cor&ora"e s! a s!"+e(e!.
    E&!sode"e de %Anca( co%&+"s!v (re'+!e s7 s+rv!n7, :n %ed!e, :n ce" &+=!n 9 /!"e &e s7&(7%An7, o
    &er!oad7 de ce" &+=!n R "+n!. D+ra(a +n+! e&!sod de %Anca( co%&+"s!v &oa(e var!a %+"(, %+"=!
    !nd!v!/! avAnd d!.!c+"(7=! :n a se&ara %Anca(+" co%&+"s!v :n e&!soade d!s(!nc(e. C+ (oa(e aces(ea, e! a+
    de re$+"7 ceva d!.!c+"(7=! :n a4s! a%!n(! dac7 %Anca(+" co%&+"s!v a s+rven!( sa+ n+ :n(r4o an+%!(7 /!.
    Ca a(are, se s+$erea/7 s7 se ca"c+"e/e %a! c+rAnd n+%7r+" de /!"e :n care s+rv!ne %Anca(+"
    co%&+"s!v decA( n+%7r+" de e&!soade de %Anca( co%&+"s!v, aOa c+% se &rocedea/7 :n &+nerea
    d!a$nos(!c+"+! de '+"!%!e nervoas7. Cerce(area v!!(oare (re'+!e s7 se adrese/e s! aces(+! as&ec(.
    S!%&(o%e"e n+ s+rv!n e<c"+s!v :n c+rs+" anore<!e! nervoase sa+ a" '+"!%!e! nervoase, :n a.ar7 de
    aceas(a, deO! +n co%&or(a%en( co%&ensa(or !nadecva( Ede e<., &+r$area, &os(+" sa+ e<erc!=!+"
    e<ces!vJ &oa(e s+rven! oca/!ona", e" n+ es(e +(!"!/a( de re$+"7 s&re a con(racara e.ec(e"e %Anca(+"+!
    co%&+"s!v. S(+d!!"e de cerce(are e.ec(+a(e &An7 ac+% d!.er7 d+&7 %od+" c+% a+ de.!n!( S+/+" re$+"a(
    de co%&or(a%en(e co%&esa(or!! !nadecva(eT. Une"e s(+d!! a+ &+s se%n+" e$a"!(7=!! :n(re Sre$+"a(T O!
    cr!(er!+" .recven=e! de do+7 or! &e s7&(7%An7 a" '+"!%!e! nervoase O! a+ cons!dera( !nd!v!/!! care se
    an$a@ea/7 :n aces(e co%&or(a%en(e %a! &+=!n de do+7 or! &e s7&(7%An7 Edar n+ %a! rar decA( oda(7
    &e s7&(7%An7J ca .!!nd !nd!ca=! &en(r+ d!a$nos(!c+" de %Anca( co%&+"s!v. A"(e s(+d!! a+ e<c"+s
    !nd!v!/!! care descr!+ or!ce +/ de co%&or(a%en(e co%&esa(or!! !nadecva(e :n c+rs+" e&!soade"or de
    %a"ad!e. Cerce(area v!!(oare (re'+!e s7 se adrese/e O! aces(+! as&ec(.
    *lemente si tulburri asociate
    Un!! !nd!v!/! re"a(ea/7 c7 %Anca(+" co%&+"s!v es(e dec"anOa( de o d!s&o/!=!e d!s.or!c7, c+% ar .!
    an<!e(a(ea sa+ de&res!a. A"=!! s+n( !nca&a'!"! s7 !nden(!.!ce &rec!&!(an=! s&ec!.!c!, :ns7, &o( re"a(a +n
    sen(!%en( nes&ec!.!c de (ens!+ne care es(e +O+ra( de %Anca(+" co%&+"s!v. Ind!v!/!! descr!+ o ca"!(a(e
    d!soc!a(!v7 e&!soade"or de %Anca( co%&+"s!v Esen(!%en(+" de S!nd!.eren=7T sa+ de Sd!s(an=areTJ.
    Un!! !nd!v!/! %7nAnc7 :n (o( c+rs+" /!"e!, .7r7 n!c! o &"an!.!care a ore"or de %as7..
    Ind!v!/!! c+ aces( &a((ern de a %Anca :n(A"n!=! :n cond!=!! c"!n!ce, a+ d!verse $rade de o'e/!(a(e. Ce!
    %a! %+"=! a+ +n "+n$ !s(or!c de e.or(+r! re&e(a(e de a =!ne d!e(7 s! s+n( d!s&era=! d!n ca+/a d!.!c+"(7=!!
    "or de a con(ro"a !n$es(!a de a"!%en(e. Un!! con(!n+7 s7 .ac7 :ncerc7r! de a4s! res(rAn$e a&or(+"
    ca"or!c, :n (!%& ce a"=!! a+ ren+n=a( "a or!ce e.or( de a =!ne d!e(7, d!n ca+/a eOec+r!"or re&e(a(e, :n
    c"!n!c!"e de con(ro" a" $re+(7=!!, !nd!v!/!! c+ aces( &a((ern de a %Anca s+n(, :n %ed!e, %a! o'e/! s! a+
    +n !s(or!c de %a! %+"(e ."+c(+a=!! &ondera"e cons!dera'!"e decA( !nd!v!/!! .7r7 aces( &a((ern. Pe
    eOan(!oane"e co%+n!(are de non&ac!en=!, ce! %a! %+"=! !nd!v!/! c+ aces( &a((ern s+n( s+&ra&ondera"!
    EdeO! +n!! n+ a+ .os( n!c!oda(7 s+&ra&ondera"!J.
    Ind!v!/!! c+ aces( &a((ern de a %Anca &o( re"a(a c7 %an!era "or de a %Anca sa+ $re+(a(ea "or
    cor&ora"7 !n(er.erea/7 c+ re"a=!!"e "or c+ a"=! oa%en!, c+ ac(!v!(a(ea s! c+ ca&ac!(a(ea "or de a se .s!%=!
    '!ne :n ra&or( c+ e! :nO!O!, :n co%&ara=!e c+ !nd!v!/!! de $re+(a(e e$a"7, dar .7r7 aces( &a((ern de a %Anca,
    e! ra&or(ea/7 ra(e %a! :na"(e de a+(ode(es(are, de/$+s( &en(r+ d!%ens!+n!"e cor&+"+!, de&res!e,
    an<!e(a(e,
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare
    ?8?
    &reoc+&7r! so%a(!ce s! sens!'!"!(a(e !n(er&ersona"7. Poa(e e<!s(a o &reva"en(7 &e
    v!a=7 %a! %are a (+"'+r7r!! de&res!ve %a@ore, a (+"'+r7r!""or :n "e$7(+r7 c+ o
    s+'s(an=7 s! a (+"'+r7r!"or de &ersona"!(a(e.
    :n esan(!oane"e e<(rase d!n &ro$ra%e"e de con(ro" a" $re+(7=!!, &reva"en(a
    $enera"7 var!a/7 de "a a&ro<!%a(!v 5Yd "a YLd Ec+ o %ed!e de ;LdJ, .e%e!"e avAnd
    de
    a&ro!%
    a(!v
    5,Y or!
    %a!
    %+"(
    decA(
    '7r'a=!
    ! aces(
    &a((ern de a %Anca. Pe esan(!oane"e co%+n!(are.de non&ac!en=!, a .os( ra&or(a(7
    o ra(7 de &reva"en(7 de L,Hd4Id. De'+(+" %Anca(+"+! co%&+"s!v s+rv!ne de
    re$+"7 :n +"(!%a &ar(e a ado"escen=e! sa+ "a :nce&+(+" an!"or 9L, adesea s+rven!nd
    c+rAnd d+&7 o &!erdere se%n!.!ca(!v7 :n $re+(a(e &r!n d!e(7. Pr!n(re !nd!v!/!!
    care se &re/!n(7 &en(r+ (ra(a%en(, evo"+=!a &are a .! cron!c7.
    Dia!nostic di$erenial
    :n DSM4I3, !nd!v!/!! a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare de co%&or(a%en( a"!%en(ar .7r7
    a"(7 s&ec!.!ca=!e.
    Con(rar '+"!%!e! nervoase, :n care %ecan!s%e"e co%&esa(or!! !nadecva(e s+n(
    +(!"!/a(e &en(r+ a con(racara e.ec(e"e e<cecese"or, :n %Anca(+" co%&+"s!v +n as(.e"
    de co%&or(a%en( n+ es(e &rac(!ca( :n %od re$+"a( &en(r+ a co%&ensa %Anca(+"
    co%&+"s!v. MAnca(+" &rea %+"( es(e o'serva( .recven( :n e&!soade"e de (+"'+rare
    de&res!v7 %a@or7, dar de re$+"7 aces(ea n+ !%&"!c7 %Anca(+" co%&+"s!v. Aces(
    d!a$nos(!c ane<7 (re'+!e "+a( :n cons!dera=!e n+%a! cAnd !nd!v!d+" re"a(ea/7 c7 :n
    c+rs+" e&!soade"or de %Anca( co%&+"s!v s+n( &re/en(e, a(A( !%&res!a s+'!ec(!v7 de
    de(er!orare a con(ro"+"+!, cA( O! (re! d!n(re s!%&(o%e"e asoc!a(e, %en=!ona(e "a
    cr!(er!+" B. M+"=! !nd!v!/! s+n( de(resa=! de e&!soade"e de %Anca( &rea %+"(, care n+
    s+n( e&!soade de %Anca( co%&+"s!v.
    Criteriile $e #er#etare pentru Tul-urarea MNn#atul Co"pul&iv
    A2 *pisoade recurente de m@ncat compulsiv2 .n episod de m@ncat compulsiv se
    caracteri(ea( prin ambele care urmea(D
    (1) m@ncatul, "ntr-o anumit perioad de timp &de ex2
    &
    "n decursul
    unei
    perioade de 7 ore), a unei cantiti de alimente care este de$init ca $iind
    mai mare dec@t cea pe care cei mai muli oameni ar m@nca-o "ntr-o
    perioad de timp ,i "n circumstane similare3
    (2) sentimentul de lips de control asupra m@ncatului "n cursul
    episodului
    &de ex2, sentimentul c persoana respectiv nu poate stopa m@ncatul sau
    controla ce ,i c@t de mult mn@nc)2
    S2 *pisoadele de m@ncat compulsiv sunt asociate cu trei &sau mai multe) dintre
    urmtoareleD
    (1)mn@nc mult mai repede dec@t "n mod normal3
    (2)mn@nc p@n de simte incon$ortabil de plin3
    (3)mn@nc mari cantiti de alimente, c%iar c@nd nu-i este $i(ic $oame3
    (4)mn@nc sin!ur pentru c se simte 0enat de c@t de mult mn@nc3
    (5)se simte de(!ustat de sine, depresiv sau $oarte culpabil dup m@ncatul
    compulsiv2
    2 *ste pre(ent o detres marcat "n le!tur cu m@ncatul compulsiv2
    l ll0l
    G>> Anexa S
    D2 M@ncatul compulsiv survine, "n medie, "n cel puin 7 (ile pe sptm@n, timp
    de I luni2
    FotD Metoda de determinare a $recvenei di$er de cea utili(at pentru bulimia nervoas3
    cercetarea viitoare trebuie s preci(e(e dac metoda pre$erat de stabilire a pra!ului de
    $recven o constituie calcularea numrului de (ile "n care survine m@ncatul compulsiv sau
    calcularea numrului de episoade de m@ncat compulsiv2
    *2 M@ncatul compulsiv nu este asociat cu u(ul re!ulat de comportamente
    compensatorii inadecvate &de ex2, pur!are, post, exerciii excesive) si nu
    survine exclusiv "n cursul anorexie/ nervoase sau al bulimiei nervoase2
    Tul-urarea $e Per&onalitate Depre&iv(
    *lemente caracteristice
    E"e%en(+" esen=!a" ,:" cons(!n+!e +n &a((ern &ervas!v de co$n!=!! s! co%&or(a%en(e care :nce&
    &recoce :n &er!oada ad+"(7 s! care s+rv!n :n(r4o var!e(a(e de con(e<e. Aces( &a((ern n+ s+rv!ne e<c"+s!v
    :n c+rs+" e&!soade"or de&res!ve %a@ore s! n+ es(e e<&"!ca( %a! '!ne de (+"'+rarea d!s(!%!c7.
    Co$n!=!!"e s! co%&or(a%en(e"e de&res!ve !nc"+d +n sen(!%en( &ervas!v s! &ers!s(en( de (r!s(e=e,
    d!s&erare, de/$+s(, de/o"are s! ne.er!c!re. AceO(! !nd!v!/! s+n( e<(re% de ser!oO!, !nca&a'!"! s7 se
    '+c+re sa+ s7 se re"a<e/e s! "!&s!=! de s!%=+" +%or+"+!. E! &o( avea !%&res!a c7 n+ %er!(7 s7 se d!s(re/e
    s! s7 .!e .er!c!=!. De ase%enea, e! (!nd s&re r+%!na=!e s! a&reens!+ne s! !ns!s(7 :n %od &ers!s(en(
    as+&ra $And+r!"or "or n!!"!s(e s! ne.er!c!(e. As(.e" de !nd!v!/! v7d v!!(or+" "a .e" de ne$a(!v ca s!
    &re/en(+"8 se :ndo!esc c7 "+cr+r!"e se vor a%e"!ora vreoda(7, se aO(ea&(7 "a (o( ce es(e %a! r7+ s!, :n
    (!%& ce se %Andresc c+ .a&(+" c7 s+n( rea"!O(!, s+n( cons!dera=! de a"=!! ca &es!%!O(!. Po( .! sever! :n
    a+(oa&rec!er! O! :nc"!na=! s7 se s!%(7 e<ces!v de c+"&a'!"! &en(r+ de.!c!en=e O! eOec+r!. S(!%a de s!ne
    es(e sc7/+(7 O! .oca"!/a(7 :n s&ec!a" &e sen(!%en(e"e de !ns+.!c!en=7. Ind!v!/!! c+ aceas(7 (+"'+rare
    &ro&+s7 (!nd s7 @+dece &e a"=!! "a .e" de sever c+% se @+dec7 &e e! :nO!O!. E! se cen(rea/7 adesea %a!
    c+rAnd as+&ra de.ec(e"or decA( as+&ra a(r!'+(e"or &o/!(!ve a"e a"(ora s! &o( .! sce&(!c!, cr!(!c! O! &r+den=!
    .a=7 de a"=!!.
    *lemente asociate
    AceO(! !nd!v!/! &o( .! "!n!O(!=!, !n(rover(!=!, &as!v! s! %odeO(!, &re.er7 s7 +r%e/e &e a"=!! decA( s7 !a e!
    cond+cerea. Aces( &a((ern &oa(e s+rven! c+ .recven=7 a&ro<!%a(!v e$a"7, a(A( "a '7r'a=!, cA( O! "a .e%e!.
    Ind!v!/!! c+ aceas(7 &re/en(are &o( .! &red!s&+O! "a de/vo"(area (+"'+r7r!! d!s(!%!ce O!, &os!'!", a (+"'+r7r!!
    de&res!ve %a@ore. Aces(e cond!=!! &o( e<!s(a &e +n s&ec(r+, c+ (+"'+rarea de &ersona"!(a(e de&res!v7 ca
    .!!nd var!an(a c+ de'+( &recoce, &ers!s(en(7 s! ase%7n7(oare +ne! (r7s7(+r!, a (+"'+r7r!"or de&res!ve.
    Da(e &re"!%!nare s+$erea/7 c7 (+"'+rarea de &ersona"!(a(e de&res!v7 &oa(e avea o &reva"en(7 cresc+(7
    "a %e%'r! de .a%!"!e a! &ro'an/!"or c+ (+"'+rare de&res!v7 %a@or7. Invers, (+"'+rarea de&res!v7
    %a@or7 &oa(e s+rven! c+ .recven=7 cresc+(7 "a %e%'r!! de .a%!"!e a! &ro'an/!"or c+ (+"'+rare de
    &ersona"!(a(e de&res!v7, care n+ a+ e! :nO!O! (+"'+rare de&res!v7 %a@or7.
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ?86
    Dia!nostic dire$enial
    :n DSM4I3, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare de &ersona"!(a(e .7r7 a"(7 s&ec!.!ca=!e.
    Es(e con(roversa( .a&(+" dac7 es(e +(!"7 d!s(!nc=!a d!n(re (+"'+rarea de
    &ersona"!(a(e de&res!v7 s! (+"'+rarea d!s(!%!c7. Cr!(er!!"e de cerce(are da(e &en(r+
    aceas(7 (+"'+rare &ro&+s7 d!.er7 de cr!(er!!"e de d!a$nos(!c a"e (+"'+r7r!! d!s(!%!ce
    &r!n accen(+" "or &e (r7s7(+r!"e de &ersona"!(a(e co$n!(!ve, !n(er&ersona"e O!
    !n(ra&s!!ce. Aceas(7 (+"'+rare &ro&+s7 n+ (re'+!e s7 .!e "+a(7 :n cons!dera=!e dac7
    s!%&(o%e"e s+n( e<&"!ca(e %a! '!ne de (+"'+rarea d!s(!%!c7 sa+ dac7 s+rv!n
    e<c"+s!v :n c+rs+" e&!soade"or de&res!ve %a@ore. Aceas(7 (+"'+rare &ro&+s7 d!.er7
    de aOa n+%!(e"e (r7s7(+r! de&res!ve nor%a"e Ede e<., ne.er!c!rea, &es!%!s%+",
    a+(ocr!(!ca O! (end!n=a "a c+"&a'!"!/areJ :n care &a((ern+" es(e &ervas!v s! ca+/ea/7 o
    de(res7 sa+ de(er!orare se%n!.!ca(!v7 :n .+nc=!onarea soc!a"7 sa+ &ro.es!ona"7.
    Re"a=!!"e d!n(re (+"'+rarea &ro&+s7 O! d!verse a"(e ca(e$or!! &ro&+se !nc"+se :n
    aceas(7 ane<7 Ead!c7, (+"'+rarea de&res!v7 %!nor7, (+"'+rarea de&res!v7 sc+r(7
    rec+ren(7, (+"'+rarea de&res!v4an<!oas7 %!<(7 O! (+"'+rarea d!s(!%!c7, a(+nc! cAnd
    es(e +(!"!/a( se(+" de cr!(er!! a"(erna(!ve, de ase%enea, &rev7/+( :n aceas(7 ane<7J s!
    c+ a"(e (+"'+r7r! de &ersona"!(a(e n+ es(e c+nosc+(7, dar :n(re e"e &oa(e e<!s(a o
    s+&ra&+nere cons!dera'!"7.
    Criteriile $e #er#etare pentru Tul-urarea
    $e Per&onalitate Depre&iv(
    A2 .n pattern pervasiv de co!niii si comportamente depresive "ncep@nd precoce
    "n perioada adult ,i pre(ent "ntr-o varietate de contexte, dup cum este
    indicat de cinci &sau mai multe) dintre urmtoareleD
    (1) dispo(iia %abitual este dominat de tristee, disperare, de(!ust, de(o
    lare, ne$ericire3
    (2) ideea de sine se centrea( pe convin!erile de insu$icien, inutilitate si
    stim de sine sc(ut3
    (1) este critic, acu(ator ,i depreciativ $a de sine3
    (2) este ruminativ ,i dispus la apre%ensiune3
    (3) este ne!ativist, critic ,i intransi!ent $a de alii3
    (4) este pesimist3
    (5) este "nclinat spre sentimente de culp sau remu,care2
    S2 Fu survine exclusiv "n cursul episoadelor depresive ma0ore si nu este expli
    cat mai bine de tulburarea distimic2
    Tul-urarea $e Per&onalitate Pa&.v-A/re&iv(
    3Tul-urarea $e Per&onalitate Ne/ativi&t(6
    *lemente caracteristice
    E"e%en(+" esen=!a" :" cons(!(+!e +n &a((ern &ervas!v de a(!(+d!n! ne$a(!v!s(e O! de
    re/!s(en=7 &as!v7 "a cerer!"e de &er.or%an=7 adecva(7 :n s!(+a=!!"e soc!a"e s!
    &ro.es!ona"e, care :nce&e 2&recoce :n &er!oada ad+"(7 s! care s+rv!ne :n(r4o var!e(a(e
    84E Anexa S

    de con(e<(e. Aces( &a((ern n+ s+rv!ne e<c"+s!v :n c+rs+" e&!soade"or de&res!ve
    %a@ore O! n+ es(e e<&"!ca( %a! '!ne de (+"'+rarea d!s(!%!c7. De re$+"7, aceO(!
    !nd!v!/! o'!ec(ea/7, se o&+n O! re/!s(7 cerer!"or de a .+nc=!ona "a n!ve"+" dor!( de
    a"=!!. Aceas(7 o&o/!=!e s+rv!ne ce" %a! .recven( :n s!(+a=!! de serv!c!+, dar &oa(e .!
    ev!den(7 O! :n .+nc=!onarea soc!a"7. Re/!s(en=a se e<&r!%7 &r!n a%Anare, +!(are,
    o's(!na=!e O! !ne.!c!en(a !n(en=!ona(7, :n s&ec!a" ca r7s&+ns "a sarc!n!"e (rasa(e de
    &ersoane"e re&re/en(And a+(or!(a(ea. AceO(! !nd!v!/! o's(r+c=!onea/7 e.or(+r!"e
    a"(ora &r!n !nca&ac!(a(ea "or de a &ar(!c!&a "a %+nc7. De e<e%&"+, cAnd +n Oe. d7
    +n+! s+'ordona( +n %a(er!a" de rev!/+!( &en(r+ Oed!n=a d!n d!%!nea=a +r%7(oare,
    s+'ordona(+" &oa(e r7(7c! sa+ &!erde %a(er!a"+", %a! c+rAnd decA( s7 a(ra$7 a(en=!a
    as+&ra .a&(+"+! c7 d!s&+ne de &rea &+=!n (!%& &en(r+ a .ace aces( "+cr+. AceO(!
    !nd!v!/! se s!%( :nOe"a=!, nea&rec!a=! O! ne:n(e"es! s! se &"An$ (o( (!%&+" de a"=!!. CAnd
    a&ar d!.!c+"(7=!, e! &+n eOec+r!"e "or :n con(+" co%&or(a%en(+"+! a"(ora. Po( .!
    s+%'r!, !r!(a'!"!, !%&ac!en(a=!, cer(7re=!, c!n!c!, sce&(!c! O! os(!"!. Persoane"e
    re&re/en(And a+(or!(a(ea Ede e<., +n s+&er!or "a serv!c!+, +n &ro.esor "a Ocoa"7, +n
    &7r!n(e sa+ +n so= care @oac7 ro"+" +n+! &7r!n(eJ dev!n adesea cen(r+" ne%+"=+%!r!!.
    D!n ca+;a ne$a(!v!s%+"+! O! a (end!n=e! "or de a e<(erna"!/a '"a%+", aceO(! !nd!v!/!
    cr!(!c7 O! :O! e<&r!%7 os(!"!(a(ea .a=7 de &ersoane"e re&re/en(And a+(or!(a(ea, "a cea
    %a! %!c7 &rovocare. De ase%enea, e! s+n( !nv!d!oO! s! $e"oO! &e co"e$!! care re+Oesc
    sa+ care s+n( v7/+=! .avora'!" de &ersoane"e care re&re/!n(7 a+(or!(a(ea. AceO(!
    !nd!v!/! se &"An$ adesea de eOec+r!"e "or &ersona"e. A+ o v!/!+ne ne$a(!v7 as+&ra
    v!!(or+"+! O! &o( .ace co%en(ar!! de $en+" Sn+ %er!(7 s7 .!! '+nT O! S"+cr+r!"e '+ne
    n+ d+rea/7T. AceO(! !nd!v!/! &o( osc!"a :n(re a4O! e<&r!%a s.!darea os(!"7 .a=7 de ce!
    &e care4! v7d ca .!!nd ca+/a &ro'"e%e"or "or s! :ncercarea de a :n%+!a aces(e
    &ersoane, cerAnd+4"e !er(are sa+ &ro%!=And+4"e c7 vor .+nc=!ona %a! '!ne :n v!!(or.
    *lemente asociate
    AceO(! !nd!v!/! s+n( adesea .ranc a%'!va"en=!, ."+c(+ea/7 !ndec!s de "a +n c+rs a"
    ac=!+n!! "a e<(re%a o&+s7. Po( +r%a o ca"e ca&r!c!oas7 care ca+/ea/7 d!s&+(e
    !n(er%!na'!"e c+ a"=!! O! dece&=!! &en(r+ e! :nO!O!. Un con."!c( !n(ens :n(re de&enden=a
    de a"=!! s! dor!n=a de a+(oa.!r%are es(e carac(er!s(!c aces(or !nd!v!/!, :ncrederea "or
    :n s!ne es(e adesea sc7/+(7, :n d!s&re=+" +ne! 'ravade s+&er.!c!a"e. E! &rev7d ce" %a!
    r7+ .!na" &os!'!" &en(r+ ce"e %a! %+"(e s!(+a=!!, c!ar &en(r+ ace"ea care se
    des.7Ooar7 '!ne. Aceas(7 v!/!+ne de.e(!s(7 &oa(e evoca r7s&+ns+r! os(!"e s! ne$a(!ve
    d!n &ar(ea ce"or care a+ .os( s+&+O! cr!(!c!"or aces(or !nd!v!/!. Aces( &a((ern de
    co%&or(a%en( s+rv!ne adesea "a !nd!v!/!! c+ (+"'+r7r! de &ersona"!(a(e, 'order"!ne,
    !s(r!on!c7, &arano!d7, de&enden(7, an(!soc!a"7 O! ev!(an(7.
    Dia!nostic di$erenial
    :n DSM 1, !nd!v!/!!, a" c7ror (a'"o+ c"!n!c sa(!s.ace aces(e cr!(er!! de cerce(are,
    (re'+!e s7 .!e d!a$nos(!ca=! ca avAnd (+"'+rare de &ersona"!(a(e .7r7 a"(7 s&ec!.!ca=!e.
    :n (+"'+rarea o&/!=!on!s%+" &rovoca(or, e<!s(7 +n &a((ern s!%!"ar de a(!(+d!n! O!
    &ro'"e%e ne$a(!v!s(e .a=7 de &ersoane"e re&re/en(And a+(or!(a(ea, dar (+"'+rarea
    o&o/!=!on!s%+" &rovoca(or es(e d!a$nos(!ca(7 de re$+"7 "a co&!!, &e cAnd aceas(7
    (+"'+rare &ro&+s7 (re'+!e "+a(7 :n cons!dera=!e n+%a! "a ad+"=!. Aces( &a((ern n+
    (re'+!e "+a( :n cons!dera=!e dac7 s!%&(o%e"e s+n( e<&"!ca(e %a! '!ne de (+"'+rarea
    d!s(!%!c7 or! dac7 s+rv!n e<c"+s!v :n c+rs+" e&!soade"or de&res!ve %a@ore.
    Co%&or(a%en(e"e &as!v4a$res!v se :n(A"nesc .recven( :n v!a=a co(!d!an7, :n s&ec!a"
    :n s!(+a=!!"e d!sc!&"!nare Ede e<., "a serv!c!+, :n ar%a(7 sa+ "a :nc!soareJ care n+
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ?6E
    (o"erea/7 a"(e .or%e de a.!r%are. N+%a! cAnd aces(e (r7s7(+r! de &ersona"!(a(e
    &as!v4a$res!ve s+n( !n."e<!'!"e, de/ada&(a(!ve s! ca+/ea/7 o de(er!orare .+nc=!ona"7
    sa+ de(res7 s+'!ec(!v7 se%n!.!ca(!v7, e"e cons(!(+!e o (+"'+rare.
    Criteriile $e #er#etare pentru
    Tul-urarea $e Per&onalitate Pa&iv A/re&iv(
    A2 .n pattern pervasiv de atitudini ne!ativiste ,i de re(isten pasiv la cererile
    de per$orman adecvat, "ncep@nd precoce "n perioada adult si pre(ent
    "ntr-o varietate de contexte, dup cum este indicat de patru &sau mai multe)
    dintre urmtoareleD
    (1) se opune pasiv "ndeplinirii sarcinilor sociale ,i pro$esionale de rutin3
    (2) se pl@n!e c nu este "neles ,i apreciat de alii3
    (3) este sumbru ,i certre3
    (4) critic ,i dispreuie,te $r motiv autoritatea3
    (5) ",i exprim invidia ,i resentimentele $a de cei evident mai prosperi3
    (6) ",i exprim "n mod exa!erat ,i persistent acu(ele de ne,ans personal3
    (7) alternea( "ntre s$idare ostil ,i peniten2
    S2 Fu survine exclusiv "n cursul episoadelor depresive ma0ore ,i nu este expli
    cat mai bine de tulburarea distimic2
    Tul-ur(rile $e MiE#are in$u&e $e Me$i#a"ente
    L+area :n cons!dera=!e a (+"'+r7r!"or !nd+se de %ed!ca%en(e es(e !%&or(an(7 :n
    (ra(a%en(+" c+ %ed!ca%en(e a" (+"'+r7r!"or %en(a"e sa+ a" cond!=!!"or %ed!ca"e
    $enera"e O! :n d!a$nos(!c+" d!.eren=!a" c+ (+"'+r7r!"e de &e a<a I Ede e<., (+"'+rarea
    an<!oas7 vers+s a)a(!s!a !nd+s7 de ne+ro"e&r!ce8 ca(a(on!a vers+s s!ndro%+"
    ne+ro"e&(!c %a"!$nJ. Aces(e cond!=!! &o( d+ce "a nonco%&"!an=7 "a (ra(a%en( s! "a
    de(er!or7r! &s!osoc!a"e O! &ro.es!ona"e. T+"'+r7r!"e de %!Ocare !nd+se de
    %ed!ca%en(e (re'+!e s7 .!e cod!.!ca(e &e a<a I. DeO! aces(e (+"'+r7r! s+n( e(!ce(a(e
    ca S!nd+se de %ed!ca%en(eT, adesea es(e d!.!c!" de s(a'!"!( re"a=!a ca+/a"7 d!n(re
    e<&+nerea "a +n %ed!ca%en( O! a&ar!=!a (+"'+r7r!! de %!Ocare, deoarece +ne"e d!n(re
    aces(e cond!=!! a&ar O! :n a'sen=a e<&+ner!! "a +n %ed!ca%en(. S+n( o.er!(e (e<( s!
    cr!(er!! &en(r+ aces(e (+"'+r7r!! s&re a .ac!"!(a cerce(area O! a &ro%ova d!a$nos(!c+"
    s! (ra(a%en(+" cores&+n/7(or, :n aceas(7 sec=!+ne s+n( !nc"+se +r%7(oare"e (+"'+r7r!
    de %!Ocare !nd+se de .%ed!ca%en(eQ &ar)!nson!s%+" !nd+s de r!e+ro"e&(!ce,
    s!ndro%+" ne+ro"e&(!c %a"!$n, d!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce, a)a(!s!a ac+(7
    !nd+s7 de ne+ro"e&(!ce, d!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce O! (re%or+"
    &os(+ra" !nd+s de ne+ro"e&(!ce. Es(e &rev7/+(7, de ase%enea, o ca(e$or!e &en(r+
    (+"'+rarea de %!Ocare !nd+s7 de %ed!ca%en(e .7r7 a"(7 s&ec!.!ca=!e, &en(r+
    (+"'+r7r!"e de %!Ocare !nd+se de %ed!ca%en(e care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c!
    +na d!n(re (+"'+r7r!"e de %!Ocare %en=!ona(e %a! s+s. Aces(ea !nc"+d (+"'+r7r!"e de
    %!Ocare Ede e<., &ar)!nson!s%+", a)a(!s!a ac+(7J, care s+n( asoc!a(e c+ +n a"(
    %ed!ca%en( decA( +n ne+ro"e&(!c Ede e<., +n !n!'!(or a" reca&(7r!! sero(on!e!J.
    Ter%en+" de ne+roleptic es(e +(!"!/a( :n sens "ar$ :n aces( %an+a", c+ re.er!re "a
    %ed!ca%en(e"e c+ &ror&!e(7=! an(a$on!s(e do&a%!ne!. DeO! aces( (er%en s4a
    &er!%a(, deoarece e" s+'"!n!a/7 (end!n=a %ed!ca%en(e"or an(!&s!o(!ce de a ca+/a
    HF9 Anexa S
    %!Oc7r! anor%a"e, e" r7%Ane (o(+O! adecva(. C+ (oa(e c7 es(e %a! &+=!n &ro'a'!" ca
    %ed!ca%en(e"e %a! no! s7 ca+/e/e (+"'+r7r! de %!Ocare !nd+se de %ed!ca%en(e,
    aces(e s!ndro%e s+rv!n (o(+O!. Med!ca%en(e"e ne+ro"e&(!ce !nc"+d aOa4n+%!=!!
    a$en=! an(!&s!o(!c! conven=!ona"! sa+ (!&!c! Ede e<., c"or&ro%a/!n+", a"o&er!do"+",
    ."+.ena/!naJ, a$en=!! an(!&s!o(!c! Ta(!&!c!T %a! no! Ede e<., c"o/a&!na, r!s&er!dona,
    o"an/a&!na, 0+e(!a&!naJ an+%!(e %ed!ca%en(e '"ocan(e a"e rece&(or!"or do&a%!ne!
    +(!"!/a(e :n (ra(a%en(+" s!%&(o%e"or so%a(!ce, c+% ar .! $rea=a Ede e<.,
    &roc"or&era/!na. &ro%e(a/!na, (r!%e(o'en/a%!da, %e(oc"o&ra%!daJ s! a%o<a&!na,
    care es(e co%erc!a"!/a(7 ca an(!de&res!v.
    44C.* ParDin&oni&"ul in$u& $e Neurolepti#e
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" &ar)!nson!s%+"+! !nd+s de ne+ro"e&(!ce :" cons(!(+!e
    &re/en=a se%ne"or O! s!%&(o%e"or &ar)!nson!ene Ead!c7, (re%or+", r!$!d!(a(ea
    %+sc+"ar7 sa+ a)!ne/!aJ care se de/vo"(7 :n asoc!ere c+ +/+" %ed!ca%en(e"or
    ne+ro"e&(!ce. Aces(e s!%&(o%e a&ar de re$+"7 :n dec+rs de cA(eva s7&(7%An! de "a
    :nce&erea (ra(a%en(+"+! sa+ creO(erea do/e! +n+! %ed!ca%en( ne+ro"e&(!c or! d+&7
    red+cerea +n+! %ed!ca%en( Ede e<., +n an(!co"!ner$!cJ care es(e +(!"!/a( &en(r+
    (ra(a%en(+" sa+ &reven!rea s!%&(o%e"or e<(ra&!ra%!da"e ac+(e. S!%&(o%e"e n+
    (re'+!e s7 .!e e<&"!ca(e %a! '!ne de o (+"'+rare %en(a"7 Ede e<., ca(a(on!a,
    s!%&(o%e"e ne$a(!ve a"e sc!/o.ren!e!, "en(oarea &s!o%o(or!e d!n(r4+n e&!sod
    de&res!v %a@orJ s! n+ se da(orea/7 +ne! cond!=!! ne+ro"o$!ce sa+ +ne! cond!=!!
    %ed!ca"e $enera"e Ede e<., %a"ad!a Par)!nson !d!o&a(!c7, %a"ad!a 1!"sonJ.
    R!$!d!(a(ea s! a)!ne/!a s+n( ce"e %a! .recven(e, :n (!%& ce (re%or+" es(e oarec+% %a!
    &+=!n .recven(. S4a es(!%a( c7 ce" &+=!n YLd d!n(re &ac!en=!! e<(erna=! care +r%ea/7
    +n (ra(a%en( de "+n$7 d+ra(7 c+ ne+ro"e&(!ce &re/!n(7 +ne"e se%ne sa+ s!%&(o%e
    &ar)!nson!ene "a +n %o%en( da( :n c+rs+" (ra(a%en(+"+!. S!%&(o%e"e &o( a&are
    ra&!d, d+&7 :nce&erea sa+ creO(erea do/e! %ed!ca%en(+"+! neoro"e&(!c, or! se &o(
    de/vo"(a !ns!d!os :n dec+rs+" (!%&+"+!. Cea %a! (!&!c7 evo"+=!e o cons(!(+!e
    de/vo"(area s!%&(o%e"or :n dec+rs de 94I s7&(7%An! de "a :nce&erea (ra(a%en(+"+!
    c+ +n %ed!ca%en( ne+ro"e&(!c. S!%&(o%e"e (!nd a&o! s7 r7%An7 nesc!%'a(e or! s7
    d!%!n+e $rad+a" :n c+rs+" +r%7(oare"or cA(eva "+n!. S!%&(o%e"e d!%!n+a de re$+"7
    oda(7 c+ red+cerea do/e! Esa+ :n(rer+&ereaJ %ed!ca%en(+"+! ne+ro"e&(!c, ad7+$area
    +n+! %ed!ca%en( an(!&ar)!nson!an or! (recerea "a +n a"( %ed!ca%en( ne+ro"e&(!c c+
    !nc!den=7 %a! red+s7 a aces(or e.ec(e sec+ndare.
    Tre%or+" &ar)!nson!an es(e o %!Ocare osc!"a(or!e r!(%!c7, +n!.or%7 E;4R c!c"! &e
    sec+nd7J care es(e de re$+"7 %a! "en(7 decA( a"(e (re%or+r! s! es(e ev!den(7 :n
    re&a+s. Poa(e s+rven! !n(er%!nen( O! &oa(e .! +n!4 sa+ '!"a(era", or! &oa(e de&!nde de
    "oc+" +nde es(e s!(+a( %e%'r+" E(re%or, &o/!=!ona"J. Tre%or+" &oa(e a.ec(a
    %e%'re"e, ca&+", %and!'+"a, $+ra, '+/e"e ESs!ndro%+" !e&+re"+!TJ sa+ "!%'a.
    Tre%or+" &oa(e .! s+&r!%a(, :n s&ec!a", cAnd !nd!v!d+" :ncearc7 s7 e.ec(+e/e o
    sarc!n7 c+ %e%'r+" care (re%+r7. Ind!v!/!! &o( descr!e (re%or+" ca S(re&!da=!eT O!
    re"a(ea/7 c7 s+rv!ne :n s&ec!a" :n &er!oade"e de an<!e(a(e, de s(res sa+ de
    .a(!$a'!"!(a(e.
    Ri/iditatea m+sc+lar6Hpar8insonian6 es(e de.!n!(7 ca o .er%!(a(e O! :ncordare a
    %+Oc!"or :n re&a+s. Ea &oa(e a.ec(a (o=! %+Oc!! sce"e(!c! or! &oa(e !%&"!ca n+%a!
    ar!! %+sc+"are, "!%!(a(e. S+rv!n do+7 (!&+r! de r!$!d!(a(eQ ri/iditatea contin+6 (a
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare ?64
    cond+ctei de pl+mb% s! ri/iditatea =n roata din(at6, :n r!$!d!(a(e :n cond+c(7 de &"+%',
    %e%'r+" sa+ ar(!c+"a=!a4se o&+ne %o'!"!/7r!! dAnd !%&res!a de '"ocare. R!$!d!(a(ea
    es(e con(!n+7 Ead!c7, %e%'r+" n+ &re/!n(7 ."+c(+a=!! de "a +n %o%en( "a a"(+"J, :n
    r!$!d!(a(ea :n roa(7 d!n=a(7, &e %7s+r7 ce %+Oc!+" se :n(!nde :n @+r+" +ne!
    ar(!c+"a=!!, se crea/7 o re/!s(en=7 de c"!ce(, de '"ocare r!(%!c7, s! care :n(rer+&e
    %!Ocarea +/+a"7 +Ooar7 a ar(!c+"a=!e!. R!$!d!(a(ea :n roa(7 d!n=a(7 &oa(e .! s!%=!(7
    &+nAnd %Ana &es(e ar(!c+"a=!e :n (!%& ce aceas(a es(e %o'!"!/a(7. R!$!d!(a(ea :n
    roa(7 d!n=a(7 s+rv!ne cAnd %+Oc!! s+n( %o'!"!/a=! &as!v O! es(e %a! .recven(7 "a
    &+%n s! co( O! adesea se accen(+ea/7 O! d!%!n+a. Ind!v!/!! c+ r!$!d!(a(e
    &ar)!nson!an7 se &o( &"An$e de de'!"!(a(e sa+ de r!$!d!(a(e %+sc+"ar7 $enera"!/a(7,
    d+rer! %+sc+"are sa+ ar(!c+"are, d+rere con(!n+7 :n cor& sa+ "!&s7 de coordonare a
    %!Oc7r!"or :n (!%& ce .ac s&or(.
    A8ine;ia es(e o s(are de red+cere s&on(an7 a ac(!v!(7=!! %o(or!!. E<!s(7 o "en(oare
    $"o'a"7, &rec+% O! o "en(oare :n !n!=!erea O! e<ec+(area %!Oc7r!"or. Co%&or(a%en(e"e
    co(!d!ene Ede e<., e.ec(+area (oa"e(e!J s+n( red+se. Ind!v!/!! se &o( &"An$e de "!&s7 de
    a(en=!e, "!&s7 de s&on(ane!(a(e O! de %o(!va=!e, sa+ de dor%!( &rea %+"(. R!$!d!(a(ea
    &ar)!nson!an7 O! a)!ne/!a se &o( %an!.es(a ca ano%a"!! :n %ers sa+ red+cerea
    "+n$!%!! &as+"+!, 'a"ans+"+! %e%'re"or sa+ s&on(ane!(7=!! $enera"e a %ers+"+!.
    A"(e se%ne !nc"+d :nc"!narea ca&+"+! :n &!e&(, c7derea +%er!"or, .ac!es+" .!@a( O!
    %ers+" re&(a(, c+ &aO! %!c!. Poa(e a&are s!a"oree da(ora(7 +ne! red+cer! $enera"e :n
    ac(!v!(a(ea %o(or!e a .ar!n$e"+!, deO! aceas(a &oa(e .! %a! &+=!n .recven(7 :n
    &ar)!nson!s%+"+! asoc!a( c+ %ed!ca%en(e"e ne+ro"e&(!ce d!n ca+/a &ro&r!e(7=!"or
    an(!co"!ner$!ce a"e aces(or %ed!ca%en(e.
    *lemente asociate
    S!%&(o%e"e co%&or(a%en(a"e asoc!a(e &o( !nc"+de de&res!a O! a$ravarea
    se%ne"or ne$a(!ve a"e sc!/o.ren!e!. A"(e se%ne s! s!%&(o%e asoc!a(e !nc"+d scr!s+"
    de %An7 %!c E%!cro$ra.!aJ, !&o.on!a, !ns(a'!"!(a(ea &os(+ra"7, !n!'area c"!&!(+"+!
    ca r7s&+ns "a &erc+(area $"a'e"e! O! se'oreea. Po( s+rven! co%&"!ca=!! %ed!ca"e
    $enera"e cAnd s!%&(o%e"e &ar)!nson!ene s+n( severe s! d+c "a sc7derea ac(!v!(7=!!
    %o(or!! Ede e<., con(rac(+r!, escare &r!n co%&res!+ne O! e%'o"!! &+"%onareJ.
    D!%!n+area re."e<+"+! de vo%7 s! d!s.a$!a &o( a%en!n=a v!a=a O! se &o( &re/en(a ca
    &ne+%on!e de as&!ra=!e sa+ &!erdere !ne<&"!ca'!"7 :n $re+(a(e. Poa(e e<!s(a
    !ncon(!nen=7 +r!nar7 O! +n &rocen( cresc+( de .rac(+r! de Oo"d "a &ersoane"e :n e(a(e.
    Fac(or!! de r!sc &en(r+ de/vo"(area &ar)!nson!s%+"+! !nd+s de ne+ro"e&(!ce !nc"+d
    +n !s(or!c de e&!soade an(er!oare de &ar)!nson!s% !nd+s de ne+ro"e&(!ce8
    '7(rAne=ea, &re/en=a +n+! de"!r!+%, de%en=e sa+ s!ndro% a%nes(!c coe<!s(en(, or!
    coe<!s(en=a +ne! cond!=!! ne+ro"o$!ce. Co&!! s+n(, de ase%enea, e<&+O! +n+! r!sc
    %are de a de/vo"(a &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce. :n a.ar7 de aceas(a,
    r!sc+" de de/vo"(are a" &ar)!nson!s%+"+! !nd+s de ne+ro"e&(!ce es(e asoc!a( c+ (!&+"
    de %ed!ca%en( ne+ro"e&(!c Ede e<., %ed!ca%en(e an(!&s!o(!ce conven=!ona"e %a!
    vec! vers+s %ed!ca%en(e an(!&s!o(!ce a(!&!ce %a! no!, ra&!d!(a(ea creO(er!! do/e!
    O! do/a a'so"+(78 r!sc+" es(e red+s, dac7 !nd!v!/!! !a+ %ed!ca%en(e an(!co"!ner$!ce.
    Dia!nostic di$erenial
    Es(e !%&or(an( s7 se .ac7 d!s(!nc=!e :n(re &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce s!
    a"(e ca+/e de s!%&(o%e &ar)!nson!ene "a !nd!v!/!! (ra(a=! c+ +n %ed!ca%en(
    ne+ro"e&(!c. Par)!nson!s%+" !nd+s de ne+ro"e&(!ce (re'+!e d!s(!ns de s!%&(o%e"e
    HFI Anexa S
    &ar)!nson!ene da(ora(e a"(or s+'s(an=e sa+ %ed!ca%en(e or! da(ora(e +ne! cond!=!!
    ne+ro"o$!ce sa+ a"(e! cond!=!! %ed!ca"e $enera"e Ede e<., %a"ad!a Par)!nson,
    %a"ad!a 1!"sonJ. Da(e"e de "a'ora(or &o( a@+(a "a s(a'!"!rea a"(or ca+/e &en(r+
    s!rn&(o%e"e &ar)!nson!ene Ede e<., screen!n$+" &o/!(!v a" %e(a"e"or $re"e :n +r!n7,
    ca"c!.!carea $an$"!on!"or. 'a/a"!, !nd!cAnd !&erca"ce%!a, cer+"o&"as%!na ser!c7,
    !nd!cAnd %a"ad!a 1!"sonJ. Tre%or+" da(ora( a"(or ca+/e de s!%&(o%e &ar)!nson!ene,
    (re%or+" .a%!"!a", (re%or+" !nd+s de %ed!ca%en(e nonne+ro"e&(!ce s! (re%or+"
    asoc!a( c+ a's(!nen=a de o s+'s(an=7 (re'+!e s7 .!e d!s(!nse de (re%or+" d!n
    &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce. Tre%+r7(+r!"e non&ar)!nson!ene (!nd a .! %a!
    .!ne Ede e<., de a%&"!(+d!ne %a! %!c7J s! %a! ra&!de E5L c!c"! &e sec+nd7J s! (!nd a se
    a$rava !n(en=!ona" Ede ex7, cAnd !nd!v!d+" :n(!nde %Ana s7 a&+ce +n &aarJ. Tre%or+"
    asoc!a( c+ a's(!nen=a de o s+'s(an=7 va .! :nso=!( de re$+"7 de !&erre."e<!e s! se%ne
    ve$e(a(!ve cresc+(e. Tre%or+" d!n %a"ad!a cere'e"oas7 se a$ravea/7 !n(en=!ona" O!
    &oa(e .! asoc!a( c+ n!s(a$%+s, a(a<!e sa+ vor'!re scanda(7. M!Oc7r!"e core!.or%e
    asoc!a(e c+ d!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce &o( a%!n(! (re%or+"
    &ar)!nson!an, :ns7, (re%or+" &ar)!nson!an se d!s(!n$e de aces(ea &r!n r!(%!c!(a(ea sa
    cons(an(7. Ic(+s+r!"e s! a"(e "e/!+n! .oca"e a"e s!s(e%+"+! nervos cen(ra" &o( ca+/a
    se%ne ne+ro"o$!ce .oca"e, d+&7 c+% ca+;ea;6 s! !%o'!"!(a(e &r!n &ara"!/!e ."asc7 sa+
    s&as(!c7. D!n con(ra, :n &ar)!nson!s%+" ne+ro"e&(!c .or=a %+sc+"ar7 es(e !n!=!a"
    nor%a"7, .a(!$a'!"!(a(ea %+sc+"ar7 !ns(a"And+4se %a! (Ar/!+. R!$!d!(a(ea d!n
    &ar)!nson!s% (re'+!e s7 .!e, de ase%enea, d!.eren=!a(7 de .eno%en+" de S"a%7 de
    'r!cea$T o'serva( :n "e/!+n!"e &!ra%!da"e s! de co%&or(a%en(+" o&o/!=!ona".
    Une"e !nd!c!!, c7 s!rn&(o%e"e &ar)!nson!ene n+ se da(orea/7 ne+ro"e&(!ce"or,
    !nc"+d !s(or!c+" .a%!"!a" a" +ne! cond!=!! ne+ro"o$!ce ered!(are, &ar)!nson!s%+" ra&!d
    &ro$res!v nee<&"!ca( de sc!%'7r! &s!o.ar%aco"o$!ce recen(e, &re/en=a de se%ne
    ne+ro"o$!ce none<(ra&!ra%!da"e Ede e<., se%ne de e"!'erare .ron(a"7, ano%a"!! a"e
    nerv!"or cran!en! or! +n se%n Ba'!ns)! &o/!(!vJ s! se%ne sa+ s!%&(o%e care n+ se
    re%!( :n dec+rs de ; "+n! de "a :n(rer+&erea ne+ro"e&(!c+"+! Eor! +n an, cAnd
    ne+ro"e&(!c+" a .os( ad%!n!s(ra( !n(ra%+sc+"ar s+' .or%a de de&o(J. Ind!v!/!! c+
    s!ndro% ne+ro"e&(!c %a"!$n a+ a(A( a)!ne/!e sever7, cA( s! r!$!d!(a(e, dar a+ s! da(e
    ad!=!ona"e so%a(!ce s! de "a'ora(or Ede e<., .e'r7, crea(!n4.os.o)!na/7 cresc+(7 ZCP-[J.
    D!s(!nc=!a :n(re s!rn&(o%e"e +ne! (+"'+r7r! %en(a"e &r!%are s! &er(+r'7r!"e
    co%&or(a%en(a"e d!n &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce &oa(e .! d!.!c!"7.
    Adesea, d!a$nos(!c+" (re'+!e s7 se 'a/e/e &e %a! %+"(e s+rse de !n.or%a=!! Ede e<.,
    da(e"e e<a%en+"+! so%a(!c, !s(or!c+" (ra(a%en(+"+!, s!rn&(o%e"e %en(a"eJ.
    D!a$nos(!c+" de &ar)!nson!s% !nd+s de ne+ro"e&(!ce (re'+!e s7 .!e &+s &rov!/or!+ s!
    +neor! &oa(e .! con.!r%a( n+%a! &r!n(r4+n (r!a" de red+cere a do/e! Esa+ e"!%!nareJ
    a %ed!ca%en(+"+! ne+ro"e&(!c or! &r!n !n!=!erea +n+! (ra(a%en( an(!co"!ner$!c.
    A)!ne/!a !nd+s7 de ne+ro"e&(!e s! (+"'+rarea de&res!v7 %a@or7 &o( avea %+"(e
    s!%&(o%e s+&ra&+se. T+"'+rarea de&res!v7 %a@or7 es(e .oar(e &ro'a'!" s7 a!'7
    se%ne ve$e(a(!ve Ede e<., deO(e&(are &recoce d!n so%n d!%!nea=aJ, de%ora"!/are,
    d!s&erare, &e cAnd a&a(!a es(e (!&!c7 a)!ne/!e!. Ca(a(on!a asoc!a(7 c+ sc!/o.ren!a,
    (!&+" ca(a(on!c, sa+ c+ (+"'+r7r!"e a.ec(!ve c+ e"e%en(e ca(a(on!ce &o( .! e<(re% de
    d!.!c!" de d!s(!ns de a)!ne/!a sever7. S!%&(o%e"e ne$a(!ve a"e sc!/o.ren!e! &o( .!
    de ase%enea, d!.!c!" de d!s(!ns de a)!ne/!e. R!$!d!(a(ea &oa(e .! asoc!a(7, de
    ase%enea, c+ (+"'+r7r!"e &s!o(!ce, de"!r!+%+", de%en=a, (+"'+r7r!"e an<!oase s!
    (+"'+r7r!"e de convers!e. Re/!s(en=a "a %o'!"!/area &as!v7 es(e cons(an(7 :n (o(
    c+rs+" %!Oc7r!! :n r!$!d!(a(ea &ar)!nson!an7, &e cAnd :n (+"'+r7r!"e %en(a"e sa+ :n
    a"(e cond!=!! ne+ro"o$!ce care se &re/!n(7 c+ r!$!d!(a(e es(e !ncons(an(7, :n a.ar7 de
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare G5<
    aceas(a, !nd!v!/!! c+ r!$!d!(a(e &ar)!nson!an7 a+ :n $enera" o cons(e"a=!e de se%ne O!
    s!%&(o%e, !nc"+s!v +n %ers s! o e<&res!e .ac!a"7 carac(er!s(!c7, s!a"oree, red+cerea
    c"!&!(+"+! s! a"(e as&ec(e de 'rad!)!ne/!e.
    Criteriile $e #er#etare pentru
    44C.* ParDin&oni&"ul in$u& $e Neurolepti#e
    A2 .nul &sau mai multe) din urmtoarele semne sau simptome a aprut in
    asociere cu u(ul unui medicament neurolepticD
    &E)tremor parCinsonian &adic, un tremor de repaus, ritmic, !rosier, cu o
    $recven "ntre 4 ,i I cicli pe secund, a$ect@nd membrele, capul, !ura sau
    limba)3
    (2) ri!iditate muscular parCinsonian &respectiv, ri!iditate "n roat
    dinat
    sau ri!iditate continu de tip =conduct de plumb>3
    (3) aCine(ie &adic, o reducere a expresiilor $aciale spontane, a !esturilor,
    limba0ului sau a mi,crilor corpului)
    S2 Simptomele de la criteriul A apar "n decurs de c@teva sptm@ni de la
    "nceperea tratamentului sau cre,terea do(ei unui medicament neuroleptic
    ori de la reducerea do(ei unui medicament utili(at pentru a trata &sau
    preveni) simptomele extrapiramidale acute &de ex2, a!eni anticoliner!ici)2
    2 Simptomele de la criteriul A nu sunt explicate mai bine de o tulburare
    mental &de ex2, simptomele ne!ative sau catatonice din sc%i(o$renie,
    lentoarea psi%omotorie
    $
    din episodul depresiv ma0or)2 #roba c simptomele
    sunt explicate mai bine de o tulburare mental poate include urmtoareleD
    simptomele preced expunerea la medicamentul neuroleptic sau nu sunt
    compatibile cu patternul interveniei $armacolo!ice &de ex2, nici o
    ameliorare dup reducerea do(ei de neuroleptic sau dup administrarea
    unui medicament anticoliner!ic2
    D2 Simptomele de la criteriul A nu se datorea( unei substane nonneuro-
    leptice ori unei condiii neurolo!ice sau altei condiii medicale !enerale &de
    ex2, maladia #arCinson, maladia Wilson)2 #roba c simptomele se datorea(
    unei condiii medicale !enerale poate include urmtoareleD simptomele
    preced expunerea la medicamentul neuroleptic, sunt pre(ente semne
    neurolo!ice de $ocar neexplicate sau simptomele pro!resea( "n dispreul
    unui re!im medicamentos stabil2
    444.5C Sin$ro"ul Neurolepti# Mali/n
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" s!ndro%+"+! ne+ro"e&(!c :" cons(!(+!e a&ar!=!a +ne!
    r!$!d!(7=! %+sc+"are severe s! o creO(ere a (e%&era(+r!! "a +n !nd!v!d care +(!"!/ea/7
    +n %ed!ca%en( ne+ro"e&(!c. Aceas(a es(e aco%&an!a(7 de do+7 Esa+ %a! %+"(eJ
    d!n(re +r%7(oare"e s!%&(o%eQ (rans&!ra=!e, d!s.a$!e, (re%or, !ncon(!nen=7,
    %od!.!c7r! :n n!ve"+" conO(!en(e! %er$And de "a con.+/!e "a co%7, %+(!s%,
    (a!card!e, &res!+ne san$+!n7 cresc+(7 sa+ "a'!"7, "e+coc!(o/7 s! &ro'a de "a'ora(or
    a a.ec(7r!! %+sc+"are Ede e<., crea(!n4.os.o)!na/a ZCP-[ cresc+(7J. Aces(e s!%&(o%e
    84> Anexa S
    n+ se da(orea/7 a"(e! s+'s(an=e Ede e<., &encyc"!d!naJ or! +ne! cond!=!! ne+ro"o$!ce
    sa+ a"(e! cond!=!! %ed!ca"e $enera"e Ede e<., ence.a"!(a v!ra"7J s! n+ s+n( e<&"!ca(e
    %a! '!ne de o (+"'+rare %en(a"7 Ede e<., (+"'+rarea a.ec(!v7 c+ e"e%en(e ca(a(on!ceJ.
    Poa(e e<!s(a o a$!(a=!e de aco%&an!a%en( sa+ &o( e<!s(a reac=!! d!s(on!ce ac+(e.
    CreO(erea (e%&era(+r!! %er$e de "a ascens!+n! +Ooare Ede e<., FFm45LLmFJ &An7 "a
    s(7r! %arca( !&er(er%!ce Ede e<., 5LRm FJ. Fe'ra da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e Ede e<., o !n.ec=!eJ (re'+!e s7 .!e e<c"+s7 dre&( ca+/7 de (e%&era(+r7
    cresc+(7, :ns7, !nd!v!/!! c+ s!ndro% ne+ro"e&(!c %a"!$n de/vo"(7 adesea a"(e cond!=!!
    %end!ca"e $enera"e care &o( a$rava o (e%&era(+r7 de@a cresc+(7. Crea(!n4
    .os.o)!na/a ZCP-[ es(e de re$+"7 cresc+(7, %er$And de "a ascens!+n! %!nore "a
    n!ve"e e<(re% de r!d!ca(e Ede&7O!nd 5RLLL UIJ. Tre'+!e %en=!ona( c7, ascens!+n!"e
    +Ooare s&re %odera(e a"e CP- &o( .!, de ase%enea, :n(A"n!(e :n "e/!+n!"e %+sc+"are
    da(ora(e +nor ca+/e d!verse c+% ar .! !n@ec=!a !n(ra%+sc+"ar7 O! con(en=!a, O! a+ .os(
    ra&or(a(e, de ase%enea, "a !nd!v!/!! c+ (+"'+r7r! &s!o(!ce ac+(e. Le+coc!(o/a &oa(e
    .! adesea %are, c+ va"or! c+&r!nse :n(re 5LLLL O! 9LLLL. :n ca/+r!"e severe &oa(e
    s+rven! %!o$"o'!n+r!a, care &oa(e an+n=a !ns+.!c!en=a rena"7.
    Ta'"o+" c"!n!c s! evo"+=!a s!ndro%+"+! ne+ro"e&(!c %a"!$n s+n( .oar(e var!a'!"e.
    E" &oa(e avea o evo"+=!e %a"!$n7, even(+a" .a(a"7, or! o evo"+=!e re"a(!v 'en!$n7,
    a+(o"!%!(a(7. Ac(+a"%en(e n+ e<!s(7 n!c! +n %od de a &red!c(a evo"+=!a s!ndro%+"+!
    "a +n an+%!( !nd!v!d. S!ndro%+" ne+ro"e&(!c %a"!$n se de/vo"7 de re$+"7 :n dec+rs
    de I s7&(7%An! de "a :nce&erea ad%!n!s(r7r!! +n+! %ed!ca%en( ne+ro"e&(!c, c+ do+7
    (re!%! d!n ca/+r! s+rven!nd :n &r!%a s7&(7%An7, :ns7, +n!! !nd!v!/! de/vo"(7
    s!ndro%+" ne+ro"e&(!c %a"!$n O! d+&7 "+area ace"eaO! do/e de %ed!ca%en(
    ne+ro"e&(!c (!%& de %+"(e "+n!. D+&7 :n(rer+&erea %ed!ca%en(+"+! ne+ro"e&(!c,
    re/o"+=!a cond!=!e! s+rv!ne :n dec+rs+" +ne! &er!oade c+ o d+ra(7 %ed!e de 9
    s7&(7%An! &en(r+ %ed!can(e"e ne+ro"e&(!ce nonde&o( s! de " "+n7 &en(r+
    %ed!ca%en(e"e ne+ro"e&(!ce de&o(, deO! e<!s(7 ca/+r! :n care con(!n+7 s7 evo"+e/e
    O! d!nco"o de d+ra(a %ed!e de 9 s7&(7%An!, :n ce"e %a! %+"(e ca/+r!, :n .!na" e<!s(7
    o re/o"+=!e (o(a"7 a s!%&(o%e"or. :n(r4+n n+%7r red+s de ca/+r!, de/nod7%An(+"
    es(e .a(a". Procen(e"e de "e(a"!(a(e d!n "!(era(+r7 var!a/7 :n(re 5Ld O! 9Ld, :ns7, aces(e
    &rocen(e &o( .! cresc+(e ar(!.!c!a" ca +r%are a ra&or(7r!"or (enden=!oase. Oda(7 c+
    creO(erea rec+noaO(er!! aces(e! cond!=!!, es(!%7r!"e ra(e"or de "e(a"!(a(e a+ sc7/+(.
    E<!s(7 &+=!ne re"a(7r! de sece"e ne+ro"o$!ce.
    *lemente asociate
    Ce"e %a! %+"(e ca/+r! a+ .os( ra&or(a(e ca s+rven!nd "a !nd!v!/!! c+ sc!/o.ren!e,
    e&!soade %an!aca"e s! (+"'+r7r! %en(a"e da(ora(e +ne! cond!=!! %ed!ca"e $enera"e
    Ede e<., +n de"!r!+% sa+ o de%en=7J. E&!soade an(er!oare de s!ndro% %a"!$n,
    a$!(a=!a, des!dra(area, do/e"e %ar! de %ed!ca%en(e ne+ro"e&(!ce, creO(erea ra&!d7
    a do/e"or O! !n@ec(area !n(ra%+sc+"ar7 a +n+! %ed!ca%en( ne+ro"e&(!c &ar a .!
    .ac(or! de r!sc. :n "!(era(+r7 e<!s(7 o con(rovers7 :n "e$7(+r7 c+ .a&(+" dac7
    (ra(a%en(+" c+ car'ona( de "!(!+ cres(e &ro'a'!"!(a(ea a&ar!=!e! s!ndro%+"+!
    ne+ro"e&(!c %a"!$n. DeO! aceas(7 (+"'+rare &oa(e s+rven!, a(A( :n %ed!!"e ca"de, cA( O!
    :n ce"e rec!, %ed!!"e ca"de s! +%ede &o( con(r!'+! "a de/vo"(area aces(e! cond!=!!.
    Po( s+rven! d!verse cond!=!! %ed!ca"e $enera"e care co%&"!c7 (a'"o+" c"!n!c,
    !nc"+/And &ne+%on!a, !ns+.!c!en=a rena"7, s(o&+" card!ac sa+ res&!ra(or, cr!/e"e
    e&!"e&(!ce, se&(!ce%!a, e%'o"!a &+"%onar7 O! coa$+"area !n(ravasc+"ar7
    d!se%!na(7.
    Es(!%7r!"e &reva"en(e! aces(e! cond!=!! "a !nd!v!/!! e<&+O! %ed!ca%en(e"or
    ne+ro"e&(!ce %er$ de "a L,LHd "a 5,Id. S!ndro%+" ne+ro"e&(!c %a"!$n a .os( descr!s
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    848

    ca s+rve%nd oarec+% %a! .recven( "a '7r'a=! decA( "a .e%e! Cond!=!a &oa(e s+rven!
    "a or!ce e(a(e, dar a .os( ra&or(a(7 %a! .recven( "a ad+"=!! (!ner! 3ar!a=!!"e :n
    &reva"en(a ra&or(a(7 se &o( da(ora +ne! "!&se de consecven(7 :n de.!n!=!a ca/+!s(!c!!,
    :n &rac(!ca &rescnen! ne+ro"e&(!ce"or, :n &"an+" s(+d!+"+! s! de%o$ra.!a &o&+"a=!e!
    s(+d!a(e S!ndro%+" ne+ro"e&(!c %a"!$n &oa(e s+rven! %a! .recven( "a
    %ed!ca%en(e"e ne+ro"e&(!ce de %are &+(ere Un+ !nd!v!/!, care a+ de/vo"(a(
    aceas(7 cond!=!e, es(e &os!'!" s7 .! .os( %a! &+=!n co%&an.a :n "+area
    %ed!ca%en(+"+! ne+ro"e&(!c DeO! %+"=! !nd!v!/! n+ &re/!n(7 n!c! o rec7dere cAnd
    es(e re"+a( (ra(a%en(+" c+ %ed!ca%en(+" ne+ro"e&(!c, +n+ &re/!n(7 o rec7dere
    cAnd %ed!ca%en(+" ne+ro"e&(!c es(e re"+a( c+rAnd d+&7 +n e&!sod ne+ro"e&(!c
    %a"!$n
    Dia!nostic di$erenial
    S!ndro%+" ne+ro"e&(!c %a"!$n (re'+!e s7 .!e d!s(!ns de s!%&(o%e"e +ne! cond!=!!
    ne+ro"o$!ce sa+ a"(e! cond!=!! %ed!ca"e $enera"e O (e%&era(+r7 r!d!ca(7 da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e Ede e<, o !n.ec=!e v!ra"7J (re'+!e d!s(!ns7 de
    (e%&era(+ra cresc+(7 asoc!a(7 c+ s!ndro%+" ne+ro"e&(!c %a"!$n Te%&era(+r!"e
    e<(re% de r!d!ca(e es(e .oar(e &os!'!" s7 .!e da(ora(e +n+! s!ndro% ne+ro"e&(!c, :n
    s&ec!a" :n a'sen(a +ne! cond!=!! %ed!ca"e $enera"e !den(!.!ca'!"e :n a.ara de aceas(a,
    :n s!ndro%+" ne+ro"e&(!c %a"!$n s+n( &re/en(e, de ase%enea, s! a"(e e"e%en(e
    carac(er!s(!ce Ede e< , r!$!d!(a(e %+sc+"ar7 sever7J Cond!=!!"e %ed!ca"e $enera"e c+
    +n (a'"o+ c"!n!c care &oa(e a%!n(! s!ndro%+" ne+ro"e&(!c %a"!$n !nc"+d !n.ec=!!"e
    s!s(e%+"+! nervos cen(ra", s(a(+s+" e&!"e&(!c, "e/!+n!"e cere'ra"e s+'cor(!ca"e Ede e< ,
    !c(+s, (ra+%a(!s%, neo&"as%eJ s! cond!=!! s!s(e%!ce Ede e< , &or.!na ac+(7
    !n(er%!(en(7, (e(an+s+"J Boc+" (er%!c &oa(e %!%a s!ndro%+" ne+ro"e&(!c %a"!$n,
    dar &oa(e .! d!s(!ns &r!n &re/en=a c7"d+r!!, (e$+%en(e +sca(e E%a! c+rAnd decA(
    (rans&!ra=!eJ, !&o(ens%ne E%a! c+rAnd decA( &res!+ne san$+!n7 ."+c(+an(7 sa+
    cresc+(7J s! ."acc!d!(a(ea E%a! c+rAnd decA( r!$!d!(a(eaJ %e%'re"or H!&er(er%!a
    %a"!$n7 se &re/!n(7 c+ (e%&era(+r7 .oar(e r!d!ca(7 s! r!$!d!(a(e, O! s+rv!ne de re$+"7
    "a !nd!v!/!! s+sce&(!'!"! $ene(!c care a+ &r!%!( anes(e/!ce !na"an(e a"o$ena(e s!
    re"a<an(e %+sc+"are de&o"ar!/an(e H!&er(err%a %a"!$n7 :nce&e de re$+"7 :n
    dec+rs de cA(eva %!n+(e de "a ad%!n!s(rarea anes(e/!e! Deoarece a"(e cond!=!!
    %ed!ca"e $enera"e &o( a&are conco%!(en( c+, sa+ re/+"(a d!n s!ndro%+" ne+ro"e&(!c
    %a"!$n, es(e !%&or(an( s7 se s(a'!"easc7 dac7 (e%&era(+ra r!d!ca(7 a s+rven!( :na!n(e
    sa+ d+&7 &ro'"e%e"e %ed!ca"e s+&raad7+$a(e :n(rer+&erea 'r+sc7 a %ed!ca=!e!
    an(!&ar)%so%ene "a o &ersoan7 c+ %a"ad!e Par)%son sha+ (ra(a%en(+" c+ a$en=!
    de&"e(!v! de do&a%!na Ede e<, re/er&%a, (e(ra'er!a/%aJ &oa(e &rec!&!(a o reac=!e
    s!%!"ar7 s!ndro%+"+! ne+ro"e&(!c %a"!$n
    S!ndro%+" ne+ro"e&(!c %a"!$n (re'+!e d!s(!ns de s%dro%e"e s!%!"are re/+"(And
    d!n +/+" a"(or %ed!ca%en(e &s!o(ro&e Ede e< , !n!'!(or! de %onoa%%oo<!da/7,
    co%'!na=!! de !n!'!(or de %onoa%!noo<!da/74(nacc, co%'!na=! de !n!'!(or de
    %onoa%%oo<!da/74a$en( sero(o%ner$!c, co%'!na=!! de !n!'!(or de %onoa%%o4
    o<!da/74%e&end%7, (o<!c!(a(ea "!(!+"+!, de"!r!+% an(!co"%er$!c, a%.e(a%!ne,
    .en."+ra%%7, coca!n7 s! &encycd%7J, or!care d!n(re aces(ea &+(And+4se
    &re/en(a c+ !&er(er%!e, a"(erarea s(7r!! %en(a"e O! %od!.!c7r! ve$e(a(!veJ :n as(.e"
    de ca/+r!, &oa(e .! &+s d!a$nos(!c+" de (+"'+rare de %!Ocare !nd+s7 de
    %ed!ca%en(e .7r7 a"(7 s&ec!.!ca=!e
    Ind!v!/!! c+ sc!/o.ren!e sa+ c+ e&!sod %an!aca" care n+ se a."7 s+' (ra(a%en( c+
    +n %ed!ca%en( ne+ro"e&(!c &o( &re/en(a +neor! s(7r! ca(a(on!ce e<(re%e EaOa
    n+%!(a ca(a(on!e "e(a"7J, care &o( %!%a s!ndro%+" ne+ro"e&(!c %a"!$n s! &o(
    84= Anexa S
    !nc"+de (e%&era(+r7 cresc+(7, d!s.+nc=!e ve$e(a(!v7 s! da(e de "a'ora(or anor%a"e.
    Pen(r+ !nd!v!/!! care &r!%esc de@a +n %ed!ca%en( ne+ro"e&(!c, +n !s(or!c de s(7r!
    ca(a(on!ce e<(re%e an(er!oare, cAnd !nd!v!d+" n+ &r!%ea n!c! +n %ed!ca%en(
    ne+ro"e&(!c, es(e !%&or(an( :n e.ec(+area d!a$nos(!c+"+! d!.eren=!a". Pro'"e%a es(e
    co%&"!ca(7 :n &"+s de .a&(+" c7 %ed!ca%en(+" ne+ro"e&(!c &oa(e a$rava s!%&(o%e"e
    de ca(a(on!e "e(a"7.
    Criteriile $e #er#etare pentru 444.5C
    Sin$ro"ul Neurolepti# Mali/n
    A2 Apariia unei ri!iditi musculare severe si cre,teri a temperaturii asociate cu
    u(ul unui medicament neuroleptic2
    S2 Dou &sau mai multe) dintre urmtoareleD
    &l)transpiraii3
    (2) dis$a!ie3
    (3) tremor3
    (4) incontinen3
    (5) modi$icri ale nivelului con,tientei mer!@nd de la con$u(ie la com3
    (6) mutism3
    (7) ta%icardie3
    (8) presiune san!uin crescut sau labil3
    (9) leucocito(3
    &E5) proba de laborator a a$ectrii &le(iunii) musculare &de ex2, #g crescut)2
    2 Simptomele de la criteriile A si S nu se datorea( altei substane &de ex2
    p%encKclidina) sau unei condiii neurolo!ice ori altei condiii medicale
    !enerale &de ex2, ence$alita viral)2
    D2 Simptomele de la criteriile A si S nu sunt explicate mai bine de o tulburare
    mental &de ex2, o tulburare a$ectiv cu elemente catatonice)2
    444.G Di&tonia A#ut( in$u&( $e Neurolept.#e
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" d!s(on!e! ac+(e !nd+se de ne+ro"e&(!ce :" cons(!(+!e
    &os(+r!"e anor%a"e sa+ s&as%e"e %+sc+"are, care a&ar :n asoc!ere c+ +/+" de
    %ed!ca%en(e ne+ro"e&(!ce. Aces(ea !nc"+d &o/!=!a anor%a"7 a ca&+"+! s! $A(+"+! :n
    ra&or( c+ (r+nc!+" Ede e<., re(roco"!s, (or(!co"!sJ, s&as%+" %+Oc!"or %and!'+"e!
    E(r!s%+s, c7scarea $+r!!, $r!%aseJ, a"(erarea de$"+(!=!e! Ed!s.a$!eJ, a vor'!r!! sa+
    res&!ra=!e! Es&as% .ar!n$o4"ar!n$!an a%en!n=And v!a=a even(+a", d!s.on!eJ,
    :n$rosarea voc!! sa+ vor'!re d!/ar(r!c7, da(ora(7 !&er(on!e! %+Oc!"or "!%'!!
    Ed!/ar(r!e, %acro$"os!eJ, &ro(r+/!a "!%'!! sa+ d!s.+nc=!e "!n$+a"7, dev!erea :n s+s, :n
    @os sa+ :n(r4o &ar(e a $"o'!"or oc+"ar! Ecr!/e oc+"o$!reJ or! &o/!=!a anor%a"7 a
    se$%en(e"or d!s(a"e a"e %e%'re"or4sa+ a (r+nc!+"+! Eo&!s(o(on+sJ. E<!s(7 o %are,
    var!a'!"!(a(e :n sever!(a(ea s!%&(o%e"or s! :n /one"e cor&+"+! care &o( .! a.ec(a(e. De
    re$+"7, es(e &re/en(7 creO(erea (on+s+"+! :n %+Oc!! a.ec(a=!. Se%ne"e sa+
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    844

    s!%&(o%e"e s+rv!n :n dec+rs de H /!"e de "a :nce&erea (ra(a%en(+"+! sa+ creO(erea
    do/e! +n+! %ed!ca%en( ne+ro"e&(!c or! red+cerea do/e! +n+! %ed!ca%en( +(!"!/a(
    :n (ra(a%en(+" sa+ &reven!rea s!%&(o%e"or e<(ra&!ra%!da"e ac+(e Ede e<., a$en=!
    an(!co"!ner$!c!J. S!%&(o%e"e n+ (re'+!e s7 .!e e<&"!ca(e %a! '!ne de o (+"'+rare
    %en(a"7 Ede e<., de s!%&(o%e"e ca(a(on!ce :n sc!/o.ren!eJ s! n+ (re'+!e s7 se
    da(ore/e +ne! s+'s(an=e nonne+ro"e&(!ce or! +ne! cond!=!! ne+ro"o$!ce sa+ a"(e!
    cond!=!! %ed!ca"e $enera"e.
    *lemente asociate
    Fr!ca s! an<!e(a(ea aco%&an!a/7 adesea de'+(+" d!s(on!e! ac+(e !nd+se de
    ne+ro"e&(!ce, :n s&ec!a" "a !nd!v!/!! care n+ rea"!/ea/7 &os!'!"!(a(ea a&ar!=!e!
    d!s(on!e! s! care, :n %od erona(, cons!der7 s!%&(o%e"e ca &ar(e a (+"'+r7r!! "or
    %en(a"e. Un!! !nd!v!/! ac+/7 d+rere sa+ cra%&e :n %+Oc!! a.ec(a=!. Nonco%&"!an=a
    "a (ra(a%en(+" %ed!ca%en(os &oa(e d+ce :n con(!n+are "a a&ar!=!a de reac=!!
    d!s(on!ce ac+(e. D!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce s+rv!ne ce" %a! .recven( "a
    '7r'a=!! (!ner!. Fac(or!! de r!sc &en(r+ de/vo"(area d!s(on!e! ac+(e !nd+se de
    ne+ro"e&(!ce !nc"+d reac=!!"e d!s(on!ce an(er!oare "a (ra(a%en(+" c+ ne+ro"e&(!ce s!
    +/+" +n+! %ed!ca%en( ne+ro"e&(!c .oar(e &+(ern!c
    Dia!nostic di$erenial
    Es(e !%&or(an( s7 se .ac7 d!s(!nc=!e :n(re d!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce s!
    a"(e ca+/e de d!s(on!e, "a !nd!v!/!! (ra(a=! c+ +n %ed!ca%en( ne+ro"e&(!c. Pro'a c7
    s!%&(o%e"e s+n( da(ora(e +ne! cond!=!! ne+ro"o$!ce sa+ a"(e! cond!=!! %ed!ca"e
    $enera"e !nc"+de evo"+=!a Ede e<., s!%&(o%e care &reced ad%!n!s(rarea +n+!
    %ed!ca%en( ne+ro"e&(!c or! &ro$res!+nea s!%&(o%e"or :n a'sen=a sc!%'7r!!
    %ed!ca%en(+"+!J s! &re/en=a de se%ne ne+ro"o$!ce :n .ocar. D!s(on!!"e se$%en(a"e
    sa+ .oca"e s&on(ane &ers!s(7 de re$+"7 (!%& de %a! %+"(e /!"e sa+ s7&(7%An!,
    !nde&enden( de %ed!ca%en(. A"(e cond!=!! ne+ro"o$!ce Ede e<., cr!/e"e e&!"e&(!ce de
    "o' (e%&ora", !n.ec=!!"e v!ra"e s! 'ac(er!ene, (ra+%a(!s%e"e sa+ "e/!+n!"e :n"oc+!(oare
    de s&a=!+ :n s!s(e%+" nervos cen(ra" sa+ &er!.er!cJ s! endocr!no&a(!!"e Ede i<.,
    !&o&ara(!ro!d!s%+"J &o(, de ase%enea, &rod+ce s!%&(o%e Ede e<., (e(an!eJ care
    a%!n(esc d!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce.
    S!ndro%+" ne+ro"e&(!c %a"!$n &oa(e &rod+ce d!s(on!e, dar d!.er7 de aceas(a
    &r!n aceea c7 es(e aco%&an!a( de .e'r7 s! de r!$!d!(a(e $enera"!/a(7. D!s(on!a ac+(7
    !nd+s7 de ne+ro"e&(!ce (re'+!e s7 .!e d!s(!ns7 de d!s(on!a da(ora(7 +n+!
    %ed!ca%en( nonne+ro"e&(!c Ede e<., de %ed!ca%en(e"e an(!conv+"s!van(e, c+% ar
    .! .en!(o!na s! car'a%a/e&!n+"J. :n as(.e" de ca/+r!, &oa(e .! &+s d!a$nos(!c+" de
    (+"'+rare de %!Ocare !nd+s7 de %ed!ca%en(e .7r7 a"(7 s&ec!.!ca=!e.
    Ca(a(on!a asoc!a(7 c+ o (+"'+rare a.ec(!v7 sa+ c+ sc!/o.ren!a &oa(e .! d!s(!ns7
    &r!n re"a=!a (e%&ora"7 d!n(re s!%&(o%e s! ad%!n!s(rarea ne+ro"e&(!c+"+! Ede e<.,
    d!s(on!a &recede ad%!n!s(rarea %ed!ca%en(+"+! ne+ro"e&(!cJ s! r7s&+ns+" "a
    !n(erven=!a .ar%aco"o$!c7 Ede e<., n!c! o a%e"!orare d+&7 d!%!n+area do/e!
    ne+ro"e&(!c+"+! sa+ ad%!n!s(rarea +n+! an(!co"!ner$!cJ. :n &"+s, !nd!v!/!! c+ d!s(on!e
    ac+(7 !nd+s7 de ne+ro"e&(!ce s+n( :n $enera" de(resa=! de reac=!a d!s(on!c7 s! de
    re$+"7 so"!c!(7 !n(erven=!e. D!n con(ra, !nd!v!/!! c+ ca(a(on!e s+n( de re$+"7 %+=! s!
    re(raO!, O! n+ ac+/7 de(res7 s+'!ec(!v7 :n "e$7(+r7 c+ cond!=!a "or.
    >++ Anexa S
    Criteriile $e #er#etare pentru
    444.G Di&tonia A#ut( in#lu&( $e Neurolepti#e
    A2 .nul sau mai multe dintre urmtoarele semne ,i simptome a aprut "n aso
    ciere cu u(ul unui medicament neurolepticD
    (1) po(iie anormal, a capului si !@tului "n raport cu trunc%iul &de
    ex2,
    retrocolis, torticolis)3
    (2) spasme ale mu,c%ilor mandibulei &trismus, cscarea !urii, !rimase)3
    (3) deteriorarea de!lutiiei &dis$a!ie), vorbirii sau respiraiei &spasm
    $arin!o-
    larin!eal, dis$onie)3
    &H)"n!rosarea vocii sau vorbire di(artric datorate %ipertoniei sau mririi
    limbii &di(artrie, macro!losie)3
    (5) protru(ia limbii sau dis$uncia limbii3
    (6) devierea oc%ilor "n sus, "n 0os sau "ntr-o parte &cri( oculo!ir)3
    (7) po(iie anormal a se!mentelor distale ale membrelor sau trunc%iului2
    S2 Semnele si simptomele de la criteriul A apar "n decurs de ? (ile de la
    "nceperea tratamentului sau de la cre,terea do(ei medicamentului
    neuroleptic ori de la reducerea medicamentului utili(at pentru a trata &sau
    preveni) simptomele extrapiramidale acute &de ex2, a!enii anticoliner!ici)2
    2 Simptomele de la criteriul A nu sunt explicate mai bine de o tulburare men
    tal &de ex2, simptomele catatonice din sc%i(o$renie)2 #roba c simptomele
    sunt explicate mai bine de o tulburare mental poate include urmtoareleD
    simptomele preced administrarea unui medicament neuroleptic sau nu sunt
    compatibile cu patternul interveniei $armacolo!ice &de ex2, nici o ameliorare
    dup reducerea do(ei de neuroleptic sau administrarea unui anticoliner!ic)2
    D2 Simptomele de la criteriul A nu se datorea( unei substane nonneuro-
    leptice sau unei condiii neurolo!ice ori altei condiii medicale !enerale2
    #roba c simptomele se datorea( unei condiii medicale !enerale poate
    include urmtoareleD simptomele preced administrarea medicamentului
    neuroieptic, sunt pre(ente semne neurolo!ice $ocale neexplicate sau
    simptomele pro!resea( "n absena sc%imbri "n medicaie2
    444. 55 ADati&.a A#ut( in$u&( $e Neurolepti#e
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e a)a(!s!e! ac+(e !nd+se de ne+ro"e&(!ce s+n( ac+/e"e
    s+'!ec(!ve de ne"!n!O(e s! ce" &+=!n +na d!n +r%7(oare"e %!Oc7r! o'serva(eQ .o!(+" sa+
    &end+"a(+" &!c!oare"or :n (!%& ce s(7 aOe/a(, 'a"ansa(+" de &e +n &!c!or &e a"(+" or!
    S%ers+" &e "ocT :n (!%& ce s(7, %ers+" de co"o &An7 co"o &en(r+ a +O+ra ne"!n!O(ea or!
    !nca&ac!(a(ea de a s(a "!n!O(!(, .!e :n or(os(a(!s%, .!e aOe/a(, ce" &+=!n cA(eva %!n+(e, :n
    .or%a cea %a! sever7 a (+"'+r7r!!, !nd!v!d+" &oa(e .! !nca&a'!" s7 %en=!n7 o &o/!=!e
    oarecare &en(r+ %a! %+"( de cA(eva sec+nde. Ac+/e"e s+'!ec(!ve !nc"+d sen/a=!a de
    ne"!n!O(e !n(ern7, ce" %a! adesea :n &!c!oare, co%&+"s!+nea de a %!Oca con(!n++
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare 85E
    &!c!oare"e, de(res7, dac7 ! se cere s7 n+4s! %a! %!O(e &!c!oare"e, d!s.or!e s! an<!e(a(e.
    S!%&(o%e"e s+rv!n de re$+"7 :n dec+rs de I s7&(7%An! de "a :nce&erea (ra(a%en(+"+!
    sa+ de "a creO(erea do/e! +n+! %ed!ca%en( ne+ro"e&(!c s!, oca/!ona", d+&7 red+cerea
    do/e! +n+! %ed!ca%en( +(!"!/a( &en(r+ a (ra(a sa+ &reven! s!%&(o%e"e e<(ra&!ra%!da"e
    ac+(e Ede e<., a$en=! an(!co"!ner$!c!J. S!%&(o%e"e n+ s+n( e<&"!ca(e %a! '!ne de o
    (+"'+rare %en(a"7 Ede e<., sc!/o.ren!a, a's(!nen=a de o s+'s(an=7, a$!(a=!a d!n e&!sod+"
    de&res!v %a@or sa+ %an!aca", !&erac(!v!(a(ea d!n (+"'+rarea !&erac(!v!(a(eXde.!c!( de
    a(en=!eJ s! n+ se da(orea/7 +ne! s+'s(an=e nonne+ro"e&(!ce or! +ne! cond!=!! ne+ro"o$!ce
    sa+ a"(e! cond!=!! %ed!ca"e $enera"e Ede e<., %a"ad!a Par)!nson, ane%!a .er!&r!v7J.
    *lemente ,i tulburri asociate
    De(res7 s+'!ec(!v7, re/+"(And d!n a)a(!s!e, es(e se%n!.!ca(!v7 O! &oa(e d+ce "a
    nonco%&"!an=7 "a (ra(a%en(+" ne+ro"e&(!c. A)a(!s!a &oa(e .! asoc!a(7 c+ d!s.or!e,
    !r!(a'!"!(a(e, a$res!v!(a(e sa+ (en(a(!ve de s+!c!d. A$ravarea s!%&(o%e"or &s!o(!ce
    sa+ a d!scon(ro"+"+! co%&or(a%en(a" &oa(e d+ce "a creO(erea do/e! %ed!ca%en(+"+!
    ne+ro"e&(!c, care &oa(e e<acer'a (+"'+rarea. A)a(!s!a &oa(e s+rven! .oar(e re&ede
    d+&74 :nce&erea (ra(a%en(+"+! sa+ creO(erea do/e! %ed!ca%en(+"+! ne+ro"e&(!c.
    A&ar!=!a a)a(!s!e! &are a .! de&enden(7 de do/7 O! es(e asoc!a(7 %a! .recven( c+
    an+%!(e %ed!ca%en(e ne+ro"e&(!ce. A)a(!s!a ac+(7 (!nde a &ers!s(a a(A( (!%& cA( s+n(
    ad%!n!s(ra(e %ed!ca%en(e"e ne+ro"e&(!ce, dar !n(ens!(a(ea e! &oa(e var!a &e &arc+rs.
    Preva"en(a ra&or(a(7 a a)a(!s!e! &r!n(re !nd!v!/!! care &r!%esc +n %ed!ca%en(
    ne+ro"e&(!c var!a/7 %+"( E9Ld4HYdJ. DeO! es(e &os!'!" ca %ed!ca%en(e"e
    ne+ro"e&(!ce a(!&!ce s7 &rod+c7 %a! &+=!n a)a(!s!e decA( ne+ro"e&(!ce"e (!&!ce, (o(+O!
    "a +n!! !nd!v!/! aces(e %ed!ca%en(e &rod+c a)a(!s!e. 3ar!a=!!"e :n &reva"en(a
    ra&or(a(7 &o( .! da(ora(e "!&se! de consecven=7 :n de.!n!rea ca+/!s(!c!!, :n &rac(!c!"e de
    &rescr!ere a ne+ro"e&(!ce"or, :n &"an+" de s(+d!+ O! de%o$ra.!a &o&+"a=!e! s(+d!a(e.
    Dia!nostic di$erenial
    A)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce &oa(e .! !nd!s(!nc(!'!"7 c"!n!c de
    s!ndro%e"e de ne"!n!O(e da(ora(e an+%!(or cond!=!! ne+ro"o$!ce sa+ a"(or cond!=!!
    %ed!ca"e $enera"e, s+'s(an=e"or nonne+ro"e&(!ce, s! de a$!(a=!a &re/en(7 ca &ar(e a
    +ne! (+"'+r7r! %en(a"e Ede e<., a +n+! e&!sod %an!aca"J. A)a(!s!a d!n %a"ad!a
    Par)!nson O! ane%!a .er!&r!v7 es(e .eno%eno"o$!c s!%!"ar7 c+ a)a(!s!a ac+(7 !nd+s7
    de ne+ro"e&(!ce. A&ar!=!a .recven( 'r+sc7 a ne"!n!O(!! c+rAnd d+&7 :nce&erea
    (ra(a%en(+"+! sa+ creO(erea do/e! +n+! %ed!ca%en( ne+ro"e&(!c d!s(!n$e de re$+"7
    a)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce.
    Med!ca%en(e"e an(!de&res!ve !n!'!(oare s&ec!.!ce a"e reca&(7r!! sero(on!ne!
    &o( &rod+ce o a)a(!s!e care &are a .! !den(!c7 d!n &+nc( de vedere .eno%eno"o$!c O!
    ca r7s&+ns "a (ra(a%en( c+ a)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce. A)a(!s!a da(ora(7
    %ed!ca=!e! nonne+ro"e&(!ce &oa(e .! d!a$nos(!ca(7 ca (+"'+rare de %!Ocare !nd+s7 de
    %ed!ca%en(e .7r7 a"(7 s&ec!.!ca=!e. A"(e s!(+a=!! care &o( .! !nd+se :n (+"'+r7r!"e de
    %!Ocare !nd+se de %ed!ca%en(e .7r7 a"(7 s&ec!.!ca=!e s+n( a)a(!s!a ac+(7 n+%a! c+
    ac+/e s+'!ec(!ve sa+ n+%a! c+ ac+/e o'!ec(!ve, dar n+ c+ a%'e"e, s! a)a(!s!a s+rven!nd
    (Ar/!+ :n c+rs+" (ra(a%en(+"+! Ede e<., "a R "+n! d+&7 :nce&erea (ra(a%en(+"+! c+ +n
    ne+ro"e&(!c sa+ creO(erea do/e! aces(+!aJ. De ase%enea, D!s)!ne/!a (ard!v7 !nd+s7 de
    ne+ro"e&(!ce are adesea o co%&onen(7 de ne"!n!O(e $enera"!/a(7 care &oa(e coe<!s(a c+
    a)a(!s!a, "a +n !nd!v!d care &r!%eO(e o %ed!ca=!e ne+ro"e&(!c7. A)a(!s!a ac+(7 !nd+s7
    de ne+ro"e&(!ce se d!.eren=!a/7 de d!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce &r!n
    na(+ra %!Oc7r!"or s! ra&or(+" "o( c+ !n!=!erea (ra(a%en(+"+!. Evo"+=!a :n (!%& a (a'"o+"+!
    c"!n!c, :n ra&or( c+ %od!.!c7r!"e do/e! de ne+ro"e&(!c, &oa(e a@+(a "a e.ec(+area aces(e!
    =E2 Anexa S

    d!s(!nc=!!. O creO(ere a do/e! de %ed!ca%en( ne+ro"e&(!c va e<acer'a adesea a)a(!s!a :n
    (!%& ce adesea a%e"!orea/7 (e%&orar s!%&(o%e"e d!s)!ne/!e! (ard!ve.
    A)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce (re'+!e s7 .!e d!s(!ns7 de s!%&(o%e"e care
    s+n( e<&"!ca(e %a! '!ne de o (+"'+rare %en(a"7. Ind!v!/!! c+ e&!soade de&res!ve,
    e&!soade %an!aca"e, an<!e(a(e $enera"!/a(7, sc!/o.ren!e s! a"(e (+"'+r7r! &s!o(!ce,
    (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, de%en=7, de"!r!+%, !n(o<!ca=!e c+ o
    s+'s(an=7 Ede e<., c+ coca!n7J, sa+ a's(!nen=a de o s+'s(an=7 Ede e<., de +n o&!ace+J
    &o( &re/en(a, de ase%enea, a$!(a=!e, care es(e d!.!c!" de d!s(!ns de a)a(!s!e. Un!! d!n(re
    aceO(! !nd!v!/! s+n( ca&a'!"! s7 d!.eren=!e/e a)a(!s!a de an<!e(a(ea, ne"!n!O(ea s! a$!(a=!a
    carac(er!s(!ce +ne! (+"'+r7r! %en(a"e, &r!n e<&er!en(area de c7(re e! a a)a(!s!e! ca .!!nd
    d!.er!(7 de s(7r!"e e<&er!en(a"e an(er!or. A"(7 &ro'7 c7 ne"!n!O(ea sa+ a$!(a=!a &o( .!
    e<&"!ca(e %a! '!ne de o (+"'+rare %en(a"7 !nc"+de de'+(+" a$!(a=!e!, an(er!or
    ad%!n!s(r7r!! %ed!ca=!e! ne+ro"e&(!ce, a'sen=a creO(er!! ne"!n!O(!! oda(7 c+ creO(erea
    do/e"or de %ed!ca%en( ne+ro"e&(!c O! a'sen=a a%e"!or7r!! &r!n !n(erven=!e
    .ar%aco"o$!c7 Ede e<., n!c! o a%e"!orare d+&7 red+cerea do/e! ne+ro"e&(!c+"+! sa+
    d+&7 (ra(a%en(+" c+ +n %ed!ca%en( des(!na( s7 (ra(e/e a)a(!s!aJ.
    Criteriile $e #er#etare pentru
    444.55 ADati&ia A#ut( in$u&( $e Neurolepti#e
    A2 Apariia unor acu(e subiective de nelini,te dup administrarea unui medica
    ment neuroleptic2
    S2 *ste observat cel puin unul dintre urmtoareleD
    (1)$oitul sau pendulatul picioarelor3
    (2)balansatul de pe un picior pe altul3
    (3)mersul de colo p@n colo pentru a-,i u,ura nelini,tea3
    (4)incapacitatea de a sta lini,tit "n picioare sau a,e(at cel puin c@teva minute2
    2 Debutul simptomelor din criteriile A ,i S survine "n decurs de H sptm@ni de
    la "nceperea tratamentului sau cre,terea do(ei unui neuroleptic ori reduce
    rea do(ei unui medicament utili(at pentru a trata &sau preveni) simptomele
    extrapiramidale acute &de ex2, a!enii anticoliner!ici)2
    D2 Simptomele de la criteriul A nu sunt explicate mai bine de o tulburare
    mental &de ex2, sc%i(o$renia, abstinena de o substan, a!itaia dintr-un
    episod depresiv ma0or sau un episod maniacal, %iperactivitatea din tulburarea
    %iperactivitate1de$icit de a atenie)2 #roba c simptomele sunt explicate mai
    bine de o tulburare mental poate include urmtoareleD debutul simptomelor
    precede administrarea unui neuroleptic, absena cre,terii nelini,tii odat cu
    cre,terea do(elor de neuroleptic ,i absena ameliorrii prin intervenie
    $armacolo!ic &de ex2, nici o ameliorare dup reducerea do(ei de neuroleptic
    sau tratamentului cu un medicament destinat s trate(e aCatisia)2
    *2 Simptomele de la criteriul A nu se datorea( unei substane nonneuroleptice
    sau altei condiii medicale !enerale2 #roba c simptomele se datorea( unei
    condiii medicale !enerale poate include $aptul c debutul simptomelor
    precede administrarea neurolepticelor sau pro!resiunea simptomelor "n
    absena unei sc%imbri "n medicaie2
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    >+4
    444. >C Di&Dine)ia Tar$iv( in$u&( $e Neurolepti#e
    *lemente de dia!nostic
    E"e%en(e"e esen=!a"e a"e d!s)!ne/!e! (ard!ve !nd+se de ne+ro"e&(!ce s+n(
    %!Oc7r!"e !nvo"+n(are anor%a"e a"e "!%'!!, %and!'+"e!, (r+nc!+"+! sa+
    e<(re%!(7=!"or, care a&ar :n asoc!ere c+ +/+" +n+! %ed!ca%en( ne+ro"e&(!c. M!Oc7r!"e
    s+n( &re/en(e o &er!oad7 de ce" &+=!n I s7&(7%An!, O! &o( .! de na(+r7 core!.or%7
    Era&!de, s&as%od!ce, nonre&e(a(!veJ, a(e(o!de Cen(e, s!n+oase, con(!n+eJ sa+ r!(%!ce
    Ede e<., s(ereo(!&!!"eJ. Se%ne"e sa+ s!%&(o%e"e s+rv!n :n c+rs+" ad%!n!s(r7r!! +n+!
    %ed!ca%en( ne+ro"e&(!c or! :n dec+rs de I s7&(7%An! de "a s+&r!%area +n+!
    ne+ro"e&(!c ad%!n!s(ra( ora" Eor! :n dec+rs de G s7&(7%An! de "a s+&r!%area +n+!
    ne+ro"e&(!c de&o(J. Tre'+!e s7 e<!s(e +n !s(or!c de +/ de +n %ed!ca%en( ne+ro"e&(!c
    de ce" &+=!n ; "+n! Eo "+n7 &en(r+ !nd!v!/!! :n e(a(e de RL an! sa+ %a! %+"(J. C+ (oa(e
    c7 +n n+%7r %are de s(+d!! e&!de%!o"o$!ce a s(a'!"!( o re"a=!e e(!o"o$!c7 :n(re +/+"
    de ne+ro"e&(!ce O! d!s)!ne/!a (ard!v7, d!s)!ne/!a e<!s(en(7 "a +n !nd!v!d care
    &r!%eO(e +n %ed!ca%en( ne+ro"e&(!c n+ es(e :n %od necesar d!s)!ne/!e (ard!v7
    !nd+s7 de ne+ro"e&(!ce. M!Oc7r!"e n+ (re'+!e s7 .!e da(ora(e +ne! cond!=!!
    ne+ro"o$!ce sa+ a"(e! cond!=!! %ed!ca"e $enera"e Ede e<., %a"ad!e H+n(!n$(on, coree
    Sydena%, d!s)!ne/!e s&on(an7, !&er(!ro!d!s%, %a"ad!e 1!"sonJ, +ne! &ro(e/e
    den(are r7+ .!<a(e or! e<&+ner!! "a a"(e %ed!ca%en(e care &o( ca+/a o d!s)!ne/!e
    revers!'!"7 ac+(7 Ede e<., 54do&a, 'ro%ocr!&(!naJ. De ase%enea, %!Oc7r!"e n+ (re'+!e
    s7 .!e e<&"!ca(e %a! '!ne de o (+"'+rare de %!Ocare ac+(7 !nd+s7 de ne+ro"e&(!ce Ede
    e<., d!s(on!a ac+(7 !nd+s7 de ne+ro"e&(!ce, a)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ceJ.
    Pes(e (re! &7(r!%! d!n(re !nd!v!/!! c+ d!s)!ne/!e (ard!v7 a+ %!Oc7r! oro.ac!a"e
    anor%a"e, a&ro<!%a(!v @+%7(a(e a+ !%&"!ca(e %e%'re"e, !ar &es(e +n s.er( a+
    d!s)!ne/!e a<!a"7 a (r+nc!+"+!. Toa(e ce"e (re! re$!+n! s+n( a.ec(a(e "a a&ro<!%a(!v
    5Ld d!n(re !nd!v!/!. I%&"!carea a"(or $r+&e %+sc+"are Ede e<., .ar!n$!ene,
    a'do%!na"eJ &oa(e s+rven!, dar es(e rar7, :n s&ec!a" :n a'sen=a d!s)!ne/!e! re$!+n!!
    oro.ac!a"e, a %e%'re"or sa+ (r+nc!+"+!. D!s)!ne/!a %e%'re"or sa+ (r+nc!+"+! .7r7
    !%&"!care oro.ac!a"7, es(e %a! .recven(7 "a !nd!v!/!! (!ner!, :n (!%& ce d!s)!ne/!!"e
    oro.ac!a"e s+n( (!&!ce &ersoane"or :n e(a(e.
    *lemente asociate
    S!%&(o%e"e d!s)!ne/!e! (ard!ve (!nd a .! a$rava(e de s(!%+"an(e, a's(!nen=a de
    ne+ro"e&(!ce O! de %ed!ca%en(e"e an(!co"!ner$!ce, O! &o( .! a$rava(e (ran/!(or de
    e<c!(a=!a e%o=!ona"7, de s(res O! de d!s(ra$ere :n c+rs+" %!Oc7r!"or vo"+n(are d!n
    &7r=!"e nea.ec(a(e a"e cor&+"+!. M!Oc7r!"e anor%a"e a"e d!s)!ne/!e! s+n( red+se
    (ran/!(or &r!n re"a<are O! &r!n %!Oc7r! vo"+n(are :n &7r=!"e a.ec(a(e a"e cor&+"+!. E"e
    s+n( :n $enera" a'sen(e :n c+rs+" so%n+"+!. D!s)!ne/!a &oa(e .! s+&r!%a(7, ce" &+=!n
    (e%&orar, &r!n do/e cresc+(e de ne+ro"e&(!ce sa+ de seda(!ve.
    Preva"en(a $"o'a"7 a d!s)!ne/!e! (ard!ve !nd+se de ne+ro"e&(!ce "a !nd!v!/!! care
    a+ &r!%!( +n (ra(a%en( de "+n$7 d+ra(7 var!a/7 :n(re 9Ld O! ;Ld. Inc!den=a $"o'a"7
    &r!n(re !nd!v!/!! %a! (!ner! var!a/7 :n(re ;d O! Yd &e an. Ind!v!/!! de e(a(e %ed!e s!
    ce! %a! :n e(a(e &ar a de/vo"(a d!s)!ne/!e (ard!v7 !nd+s7 de ne+ro"e&(!ce ce" %a!
    adesea c+ o &reva"en(7 de &An7 "a YLd O! o !nc!den=7 de 9Yd4;Ld :n %ed!e, d+&7
    +n an de ad%!n!s(rare c+%+"a(!v7 de %ed!ca%en( ne+ro"e&(!c. Preva"en(a var!a/7,
    de ase%enea, :n .+nc=!e de %ed!+, d!s)!ne/!a (ard!v7 (!n/And a .! %a! .recven(7
    >+7 Anexa S
    &r!n(re !nd!v!/!! s&!(a"!/a=! E:n s&ec!a" &r!n(re ce! !ns(!(+=!ona"!/a=! cron!cJ.
    D!s)!ne/!a (ard!v7 es(e d!a$nos(!ca(7 c+ .recven=7 e$a"7 "a '7r'a=!! s! .e%e!"e (!nere,
    &e cAnd "a !nd!v!/!! :n e(a(e &oa(e .! v7/+(7 %a! .recven( "a .e%e! decA( "a '7r'a=!.
    T+"'+r7r!"e a.ec(!ve E:n s&ec!a", (+"'+rarea de&res!v7 %a@or7J, cond!=!!"e
    ne+ro"o$!ce, can(!(a(ea %are de %ed!ca%en( ne+ro"e&(!c ac+%+"a(7 s! de/vo"(area
    &recoce a e.ec(e"or sec+ndare e<(ra&!ra%!da"e a+ .os( s+$era(e ca .ac(or! de r!sc
    &en(r+ d!s)!ne/!a (ard!v7. 3ar!a=!!"e :n &reva"en(7 ra&or(a(e se &o( da(ora "!&se! de
    concordan=7 :n de.!n!rea ca+/!s(!c!!, :n &rac(!c!"e de &rescr!ere a %ed!ca=!e!
    ne+ro"e&(!ce, :n &"an+" de s(+d!+ s! de%o$ra.!a &o&+"a=!e! s(+d!a(e.
    N+ e<!s(7 d!.eren=e se%n!.!ca(!ve :n ra&or( c+ se<+" :n s+sce&(!'!"!(a(ea "a
    d!s)!ne/!a (ard!v7, deO! r!sc+" &oa(e .! :n(r4o an+%!(7 %7s+r7 %a! %are "a .e%e!"e
    &os(%eno&a+/a"e. Ac+%+"area +nor can(!(7=! %a! %ar! de ne+ro"e&(!ce (!&!ce s!
    a&ar!=!a &recoce a e.ec(e"or sec+ndare e<(ra&!ra%!da"e s+n( do! d!n(re ce! %a!
    cons(an=! .ac(or! de r!sc &en(r+ d!s)!ne/!a (ard!v7. T+"'+r7r!"e a.ec(!ve E:n s&ec!a"
    (+"'+rarea de&res!v7 %a@or7J, cond!=!!"e ne+ro"o$!ce s! de&enden=a de a"coo", a+
    .os(, de ase%enea, cons(a(a(e &r!n(re .ac(or!! de r!sc "a +ne"e $r+&e de !nd!v!/!.
    E<!s(7 +n n+%7r (o( %a! %are de &ro'e c7 ne+ro"e&(!ce"e a(!&!ce %a! no! s+n(
    asoc!a(e c+ o !nc!den=7 %+"( %a! red+s7 a d!s)!ne/!e! (ard!ve co%&ara(!v c+
    ne+ro"e&(!ce"e (!&!ce.
    De'+(+" &oa(e s+rven! "a or!ce e(a(e s! es(e a&roa&e (o(dea+na !ns!d!os. Se%ne"e
    s+n( de re$+"7 %!n!%e s&re +Ooare "a de'+( s! sca&7 ses!/7r!!, c+ e<ce&=!a +n+!
    o'serva(or .!n. :n %a@or!(a(ea ca/+r!"or, d!s)!ne/!a (ard!v7 es(e +Ooar7 O! cons(!(+!e
    :n &r!%+" rAnd o &ro'"e%7 de cos%e(!c7, :n ca/+r!"e severe, :ns7 &oa(e .! asoc!a(7 c+
    co%&"!ca=!! %ed!ca"e $enera"e Ede e<., +"cere &e %+coasa @+$a"7 s! "!%'7, &!erderea
    d!n=!"or, %acro$"os!e, d!.!c+"(a(e :n %ers, :n de$"+(!=!e sa+ res&!ra=!e, vor'!( :n
    s+rd!n7, &!erdere :n $re+(a(e, de&res!e O! !dea=!e s+!c!dar7J. Dac7 !nd!v!d+" c+
    d!s)!ne/!e (ard!v7 s+&r!%7 %ed!ca=!a ne+ro"e&(!c7, d!s)!ne/!a se re%!(e :n dec+rs
    de ; "+n! :n(r4o (re!%e d!n ca/+r! O! :n 5945G "+n! :n %a! %+"( de YLd d!n ca/+r!, :ns7
    aces(e &rocen(e s+n( %a! sc7/+(e "a &ersoane"e :n e(a(e. CAnd !nd!v!/!! care &r!%esc
    o %ed!ca=!e ne+ro"e&(!c7 s+n( e<a%!na=! &er!od!c, se cons(a(7 c7 d!s)!ne/!a (ard!v7
    es(e s(a'!"7 :n dec+rs+" (!%&+"+! :n a&roa&e @+%7(a(e d!n ca/+r!, se a$ravea/7 :n(r4
    +n s.er( s! se a%e"!orea/7 :n res(. :n $enera", !nd!v!/!! %a! (!ner! (!nd a se a%e"!ora
    %a! re&ede8 "a &ersoane"e :n e(a(e e<!s(7 o &ro'a'!"!(a(e %a! %are ca d!s)!ne/!a
    (ard!v7 s7 dev!n7 %a! sever7 sa+ %a! $enera"!/a(7, &r!n +/+" con(!n++ de
    ne+ro"e&(!ce. CAnd se :n(rer+&e %ed!ca=!a ne+ro"e&(!c7, se es(!%ea/7 c7 se re%!(
    :n(re Yd4ILd d!n (oa(e ca/+r!"e s! :n(re YLd O! FLd d!n ca/+r!"e +Ooare.
    Dia!nostic di$erenial
    D!s)!ne/!!"e care a&ar. :n (!%&+" a's(!nen=e! de ne+ro"e&(!ce se &o( re%!(e &r!n
    con(!n+area a's(!nen=e! de %ed!ca%en(+" ne+ro"e&(!c. Dac7 d!s)!ne/!a &ers!s(7
    (!%& de ce" &+=!n I s7&(7%An!, &oa(e .! @+s(!.!ca( d!a$nos(!c+" de d!s)!ne/!e (ard!v7.
    D!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce (re'+!e s7 .!e d!s(!ns7 de a"(e ca+/e de
    d!s)!ne/!e oro.ac!a"7 sa+ cor&ora"7. Aces(e cond!=!! !nc"+d %a"ad!a H+n(!n$(on,
    %a"ad!a 1!"son, coreea Ere+%a(!c7J, Sydena%, "+&+s+" er!(e%a(os s!s(e%!c,
    (!reo(o<!co/a, !n(o<!ca=!a c+ %e(a"e $re"e, &ro(e/e"e den(are r7+ .!<a(e, d!s)!ne/!a
    da(ora(7 a"(or %ed!ca%en(e, c+% ar .! 54do&a, 'ro%ocr!&(!na sa+ a%an(ad!na O!
    d!s)!ne/!!"e s&on(ane. Fac(or!! care &o( .! +(!"! :n e.ec(+area aces(e! d!s(!nc=!! s+n(
    &ro'a c7 s!%&(o%e"e &reced ad%!n!s(rarea %ed!ca%en(+"+! ne+ro"e&(!c sa+ c7 a"(e
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare 85A
    se%ne ne+ro"o$!ce .oca"e s+n( &re/en(e. Tre'+!e re=!n+( c7 a"(e (+"'+r7r! de %!Ocare
    &o( coe<!s(a c+ d!s)!ne/!a (ard!v7 !nd+s7 de ne+ro"e&(!ce. Deoarece d!s)!ne/!a
    s&on(an7 &oa(e s+rven! :n %a! %+"( de Yd d!n(re !nd!v!/! s!, de ase%enea, es(e %a!
    .recven(7 "a &ersoane"e :n e(a(e, &oa(e .! d!.!c!" de &ro'a( c7 %ed!ca%en(e"e
    ne+ro"e&(!ce a+ &rod+s d!s)!ne/!a "a +n an+%!( !nd!v!d. D!s)!ne/!a (ard!v7 !nd+s7
    de ne+ro"e&(!ce (re'+!e s7 .!e d!s(!ns7 de s!%&(o%e"e da(ora(e +ne! (+"'+r7r! de
    %!Ocare ac+(e !nd+se de ne+ro"e&(!ce Ede e<., d!s(on!a ac+(7 !nd+s7 de
    ne+ro"e&(!ce sa+ a)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ceJ. D!s(on!a ac+(7 !nd+s7 de
    ne+ro"e&(!ce se de/vo"(7 :n dec+rs de H /!"e, !ar a)a(!s!a ac+(7 !nd+s7 de
    ne+ro"e&(!ce se de/vo"(7 :n dec+rs de I s7&(7%An! de "a :nce&erea (ra(a%en(+"+! sa+
    creO(erea do/e! +n+! %ed!ca%en( ne+ro"e&(!c Eor! red+cerea do/e! +ne! %ed!ca%en(
    +(!"!/a( &en(r+ (ra(a%en(+" s!%&(o%e"or e<(ra&!ra%!da"e ac+(eJ. D!s)!ne/!a (ard!v7
    !nd+s7 de ne+ro"e&(!ce, &e de a"(7 &ar(e, s+rv!ne :n c+rs+" ad%!n!s(r7r!! Esa+
    a's(!nen=e!J +n+! %ed!ca%en( ne+ro"e&(!c "a !nd!v!/!! c+ +n !s(or!c de +/ de +n
    ne+ro"e&(!c (!%& de ce" &+=!n ; "+n! Esa+ " "+n7 "a &ersoane"e :n e(a(eJ.
    Criteriile $e #er#etare pentru
    444.>C Di&Dine)ia Tar$iv( in$u&( $e Neurolepti#e
    A2 Mi,cri involuntare ale limbii, mandibulei, trunc%iului sau extremitilor
    aprute "n asociere cu u(ul unui medicament neuroleptic2
    S2 Mi,crile involuntare sunt pre(ente o perioad de cel puin H sptm@ni si
    survin "n oricare dintre urmtoarele patternuriD
    N &E) mi,cri corei$orme &adic, rapide, spasmodice, nonrepetitive)3
    (2)mi,cri atetoide &adic, lente, sinuoase, continue)3
    (3)mi,cri ritmice &adic, stereotipe)2
    2 Semnele sau simptomele de la criteriile A ,i S apar "n cursul administrrii
    unui medicament neuroleptic sau "n decurs de H sptm@ni de la retra!erea
    unui medicament neuroleptic administrat oral &sau "n decurs de 8 sptm@ni
    de la retra!erea unui neuroleptic depot)2
    D2 A existat administrarea unui medicament neuroleptic timp de cel puin 4
    luni &E lun, dac individul este "n etate de I5 ani sau mai mult)2
    *2 Simptomele nu se datorea( unei condiii neurolo!ice sau medicale !e
    nerale &de ex2, maladia Luntin!ton, coreea SKden%am, disCine(ia spontan,
    %ipertiroidismul, maladia Wilscn), prote(ele dentare ru $ixate, sau
    administrarea altor medicamente care cau(ea( disCine(ie reversibil acut
    &de ex2, L-dopa, bromocriptina)2 #roba c simptomele sunt datorate uneia
    dintre aceste etiolo!ii poate include urmtoareleD simptomele preced admi
    nistrarea unui medicament neuroleptic sau sunt pre(ente semne neuro
    lo!ice $ocale neexplicate2
    '2 Simptomele nu sunt explicate mai bine de o tulburare de mi,care acut
    indus de neuroleptice &de ex2, distonia acut indus de neuroleptice,
    aCatisia acut indus de neuroleptice)2
    =E> Ane,a 8
    444.* Tre"orul Po&tural in$u& $e Me$i#a"ente
    *lemente de dia!nostic
    E"e%en(+" esen=!a" a" (re%or+"+! &os(+raC !nd+s de %ed!ca%en(e :" cons(!(+!e +n
    (re%or &os(+ra" .!n care s4a de/vo"(a( :n asoc!ere c+ +/+" +n+! %ed!ca%en(.
    Med!ca%en(e"e c+ care &oa(e .! asoc!a( +r( as(.e" de (re%or !nc"+d "!(!+",
    %ed!ca%en(e"e 'e(aadrener$!ce Ede e<., !/o&ro(ereno"+"J, s(!%+"an(e"e Ede e<.,
    a%.e(a%!naJ, %ed!ca%en(e"e do&a%!ner$!ce, an(!conv+"s!van(e"e Ede e<., ac!d+"
    va"&ro!cJ, %ed!ca%en(e"e ne+ro"e&(!ce, an(!de&res!ve"e s! %e(!"<an(!ne"e Ede e<.,
    ca.e!na, (eo.!"!naJ. Tre%or+" es(e o osc!"a=!e r!(%!c7, re$+"a(7, a %e%'re"or Ece" %a!
    .recven( a %A!n!"or s! de$e(e"orJ, ca&+"+!, $+r!! sa+ "!%'!!, c+ o .recven=7 :n(re G s!
    59 c!c"! &e sec+nd7. Tre%or+" es(e .oar(e +Oor de o'serva( cAnd &ar(ea a.ec(a(7 a
    cor&+"+! es(e =!n+(7 :n(r4o &os(+r7 s+s=!n+(7 Ede e<., %A!n!"e :n(!nse, $+ra =!n+(7
    desc!s7J. CAnd +n !nd!v!d descr!e +n (re%or care es(e concordan( c+ aceas(7
    de.!n!=!e, dar c"!n!c!an+" n+ o'serv7 d!rec( (re%or+", &oa(e .! +(!" s7 se :ncerce
    recrearea s!(+a=!e! :n care a s+rven!( (re%or+" Ede e<., '7+(+" d!n(r4+n &aar sa+
    .ar.+r!oar7J. S!%&(o%e"e n+ se da(orea/7 +n+! (re%or !nd+s non.ar%aco"o$!c,
    &ree<!s(en(, s! n+ s+n( e<&"!ca(e %a! '!ne de &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce.
    *lemente asociate
    Ce"e %a! %+"(e !n.or%a=!! d!s&on!'!"e se re.er7 "a (re%or+" !nd+s de "!(!+.
    Tre%or+" !nd+s de "!(!+ es(e +n e.ec( sec+ndar .recven( a" do/e"or (era&e+(!ce, es(e
    '!ne (o"era( s! de re$+"7 es(e 'en!$n. Tre%or+" &oa(e ca+/a :ns7 d!scon.or( soc!a",
    d!.!c+"(7=! &ro.es!ona"e s! nonco%&"!an=7 "a +n!! !nd!v!/!. Pe %7s+r7 ce
    concen(ra=!!"e ser!ce a"e "!(!+"+! se a&ro&!e de n!ve"e"e (o<!ce, (re%or+" &oa(e deven!
    %a! $ros!er s! &oa(e .! aco%&an!a( de con(rac(+r7 %+sc+"ar7, .asc!c+"a=!! sa+ a(a<!e.
    Tre%or+" non(o<!c !nd+s de "!(!+ se &oa(e a%e"!ora s&on(an c+ (!%&+". O d!vers!(a(e
    de .ac(or! &o( cres(e r!sc+" de (re%or !nd+s de "!(!+ Ede e<., e(a(ea avansa(7,
    concen(ra=!!"e ser!ce %ar! de "!(!+, %ed!ca=!a an(!de&res!v7 sa+ ne+ro"e&(!c7
    conco%!(en(7, !n$es(!a e<ces!v7 de ca.e!na, !s(or!c+" &ersona" sa+ .a%!"!a" de (re%or,
    &re/en=a de&enden=e! a"coo"!ce s! an<!e(a(ea asoc!a(7J. Frecven=a ac+/e"or
    re.er!(oare "a (re%or &are a d!%!n+a c+ d+ra(a (ra(a%en(+"+! c+ "!(!+. Fac(or!! care
    &o( e<acer'a (re%or+" !nc"+d an<!e(a(ea, s(res+", .a(!$a'!"!(a(ea, !&o$"!ce%!a,
    (!reo(o<!co/a, .eocro%oc!(o%+", !&o(er%!a s! a's(!nen=a a"coo"!c7.
    Dia!nostic di$erenial
    Tre%or+" &os(+ra" !nd+s de %ed!ca%en(e (re'+!e d!s(!ns de +n (re%or
    &ree<!s(en(, care n+ es(e ca+/a( de e.ec(e"e +n+! %ed!ca%en(. Fac(or!! care a@+(7 "a
    &rec!/area .a&(+"+! c7 (re%or+" era &ree<!s(en( !nc"+d re"a=!a sa (e%&ora"7 c+
    :nce&+(+" ad%!n!s(r7r!! %ed!ca%en(+"+!, "!&sa de core"are c+ concen(ra=!!"e ser!ce
    a"e %ed!ca%en(+"+! s! &ers!s(en=a d+&7 ce %ed!ca%en(+" a .os( :n(rer+&(. Dac7 es(e
    &re/en( +n (re%or &ree<!s(en( ne!nd+s .ar%aco"o$!c, care se a$ravea/7 &r!n
    ad%!n!s(rarea %ed!ca%en(+"+!, +n as(.e" de (re%or n+ (re'+!e s7 .!e cons!dera( ca
    sa(!s.7cAnd cr!(er!!"e &en(r+ +n (re%or &os(+ra" !nd+s de %ed!ca%en(e, c! (re'+!e
    cod!.!ca( ca (+"'+rare de %!Ocare !nd+s7 de +n %ed!ca%en( .7r7 a"(7 s&ec!.!ca=!e.
    Fac(or!! descr!O! %a! s+s, care &o( con(r!'+! "a sever!(a(ea +n+! (re%or &os(+ra"
    !nd+s de +n %ed!ca%en( Ede e<., an<!e(a(ea, s(res+", .a(!$a'!"!(a(ea, !&o$"!ce%!a,
    (!reo(o<!co/a, .eocro%oc!(o%+", !&o(er%!a s! a's(!nen=a a"coo"!c7J &o( .!, de
    ase%enea, o ca+/7 de (re%or !nde&enden( de %ed!ca%en(e.
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    >+G
    Tre%or+" &os(+ra" !nd+s de %ed!ca%en(e n+ es(e d!a$nos(!ca( dac7 (re%or+"
    es(e e<&"!ca( %a! '!ne de &a!)!nson!s%+" !nd+s de ne+!o"e&(!ce. Un (re%or
    &os(+ra" !nd+s de %ed!ca%en(e es(e de re$+"7 a'sen( :n re&a+s O! se !n(ens!.!c7
    a(+nc! cAnd &ar(ea a.ec(a(7 !n(r7 :n ac=!+ne sa+ es(e =!n+(7 :n(r4o &o/!=!e s+s=!n+(7.
    D!n con(ra, (re%or+" :n "e$7(+r7 c+ &ar)!nson!s%+" !nd+s de ne+ro"e&(!ce es(e de
    re$+"7 %a! red+s ca .recven=7, se a$ravea/7 :n re&a+s O! d!s&are :n c+rs+" +ne!
    %!Oc7r! !n(en=!ona"e O! s+rv!ne de re$+"7 :n asoc!ere c+ a"(e s!%&(o%e de
    &ar)!nson!s% !nd+s de ne+ro"e&(!ce Ede e<., a)!ne/!a, r!$!d!(a(eaJ.
    Criteriile $e #er#etare pentru
    444.* Tre"orul Po&tural in$u& $e Me$i#a"ente
    A2 .n tremor postural $in care a aprut "n asociere cu u(ul unui medicament
    &de ex2, litiul, un medicament antidepresiv, acidul valproic)2
    S2 Tremorul &adic, o oscilaie ritmic, re!ulat, a membrelor, capului, !urii sau
    limbii) are o $recven de 8-E7 cicli pe secund2
    2 Simptomele nu se datorea( unui tremor preexistent neindus $armacolo!ic2
    #roba c simptomele nu se datorea( unui tremor preexistent poate include
    urmtoareleD tremorul era pre(ent "nainte de introducerea medicamentului,
    tremorul nu se corelea( cu nivelul seric al medicamentului ,i tremorul
    persist ,i dup "ntreruperea medicamentului2
    D2 Simptomele nu sunt explicate mai bine de parCinsonismul indus de
    neuroleptice2
    444.5+ Tul-urare $e MiE#are in$u&( $e
    Me$i#a"ente '(r( Alt( Spe#i%i#a!ie
    Aceas(7 ca(e$or!e es(e re/erva(7 (+"'+r7r!"or de %!Ocare !nd+se de %ed!ca%en(e
    care n+ sa(!s.ac cr!(er!!"e &en(r+ n!c! +na d!n (+"'+r7r!"e s&ec!.!ce %a! s+s
    %en=!ona(e. E<e%&"e"e !nc"+d 5J &ar)!nson!s%+", a)a(!s!a ac+(7, d!s(on!a ac+(7 sa+
    %!Ocarea d!s)!ne(!c7, asoc!a(e c+ +n a"( %ed!ca%en( decA( +n ne+ro"e&(!c, 9J +n
    (a'"o+ c"!n!c ase%7n7(or s!ndro%+"+! ne+ro"e&(!c %a"!$n, asoc!a( c+ +n a"(
    %ed!ca%en( decA( +n ne+ro"e&(!c, ;J d!s(on!a (ard!v7.
    A,ele propu&e pentru Stu$iu Supli"entar
    S#ala $e 'un#!ionare a Ap(r(rii
    3De%en&ive 'un#tionin/ S#ale6
    .ecanismele de ap6rare Esa+ s(!"+r!"e de a .ace .a=7J Zco&!n$ s(y"es[ s+n( &rocese
    &s!o"o$!ce a+(o%a(e care &ro(e@ea/7 !nd!v!d+" con(ra an<!e(7=!! O! con(ra
    conO(!en(!/7r!! &er!co"e"or sa+ s(resor!"or !n(ern! sa+ e<(ern!. Ind!v!/!! s+n( adesea
    !nconO(!en=! de aces(e &rocese :n (!%& ce e"e o&erea/7. Mecan!s%e"e de a&7rare
    >+> Anexa S
    %ed!a/7 reac=!a !nd!v!d+"+! "a con."!c(e"e e%o=!ona"e s! "a s(resor!! !n(ern! s! e<(ern!.
    Mecan!s%e"e de a&7rare !nd!v!d+a"e s+n( :%&7r=!(e conce&(+a" s! e%&!r!c :n $r+&e
    core"a(e care s+n( den+%!(e ni*ele de ap6rare7
    Pen(r+ a +(!"!/a sca"a de .+nc=!onare a a&7r7r!!, c"!n!c!an+" (re'+!e s7 %en=!one/e
    &An7 "a Oa&(e d!n(re s(!"+r!"e de a&7rare sa+ de a .ace .a=7 s&ec!.!ce E:nce&And c+ ce"
    %a! &roe%!nen(J, s! a&o! s7 !nd!ce n!ve"+" de a&7rare &redo%!nan( %an!.es(a( de
    !nd!v!d. Aces(ea (re'+!e s7 re."ec(e s(!"+r!"e de a&7rare sa+ de a .ace .a=7 +(!"!/a(e :n
    (!%&+" eva"+7r!!, s+&"!%en(a(e de !nd!.eren( ce a"(e !n.or%a=!! s+n( d!s&on!'!"e
    re.er!(or "a &a((ern+r!"e de a .ace .a=7 sa+ de a&7rare :n c+rs+" +"(!%e! &er!oade de
    (!%& care a &receda( eva"+area. Mecan!s%e"e de a&7rare s&ec!.!ce "!s(a(e &o( .!
    e<(rase d!n d!.er!(e"e n!ve"e de a&7rare.
    A<a de .+nc=!onare a a&7r7r!! es(e &re/en(a(7 &r!%a, +r%a(7 de o .or%7 de
    :nre$!s(rare. Res(+" sec=!+n!! cons(7 d!n(r4o "!s(7 de de.!n!=!! &en(r+ %ecan!s%e"e de
    a&7rare s! s(!"+r!"e de a .ace .a=7 s&ec!.!ce.
    Fivelele de aprare ,i mecanismele de aprare ale individului
    N!ve"+" ada&(a(!v r!d!ca(. Aces( n!ve" de .+nc=!onare a a&7r7r!! d+ce "a o
    ada&(are o&(!%7 :n do%!narea s(resor!"or. Aces(e a&7r7r! de re$+"7 %a<!%a"!/ea/7
    $ra(!.!ca=!a s! &er%!( conO(!en(!/area !n(en=!ona"7 a sen(!%en(e"or, !de!"or s!
    consec!n=e"or "or. 0e ase%enea, e"e s+s=!n ec!"!'r+" o&(!% d!n(re %o(!ve o&+se.
    E<e%&"e de a&7r7r! "a aces( n!ve" s+n(
    N an(!c!&area
    N a.!"!erea
    N a"(r+!s%+"
    N +%or+"
    N a+(oa.!r%area
    N a+(oo'servarea
    N s+'"!%area
    N s+&r!%area
    N!ve"+" !n!'!=!!"or %en(a"e E.or%area co%&ro%!s+"+!J. F+nc=!onarea a&7r7r!!
    "a aces( n!ve" =!ne :n a.ara conO(!!n=e!, !de!"e, sen(!%en(e"e, a%!n(!r!"e, dor!n=e"e sa+
    .r!c!"e &os!'!" a%en!n=7(oare. E<e%&"e s+n(
    N de&"asarea
    N d!soc!erea
    N !n(e"ec(+a"!/area
    N !/o"area a.ec(+"+!
    N .or%area reac=!e!
    N re&res!+nea
    N an+"area
    N!ve"+" %!nor de d!s(ors!onare a !%a$!n!!. Aces( n!ve" es(e carac(er!/a( &r!n
    d!s(ors!+n! :n !%a$!nea de s!ne, !%a$!nea cor&ora"7 or! !%a$!nea a"(ora, care &o( .!
    +(!"!/a(e &en(r+ a re$"a s(!%a de s!ne. E<e%&"e s+n(
    N deva"or!/area
    N !dea"!/area
    N o%n!&o(en=a
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare 856
    N!ve"+" de de/av+are. Aces( n!ve" se carac(er!/ea/7 &r!n =!nerea s(resor!"or,
    !%&+"s+r!"or, !de!"or, a.ec(e"or sa+ res&onsa'!"!(7=!"or ne&"7c+(e s! !nacce&(a'!"e :n
    a.ara conO(!!n=e!, c+ sa+ .7r7 o a(r!'+!re erona(7 a aces(ora +nor ca+/e e<(erne.
    E<e%&"e s+n(
    N ne$area
    N &ro!ec=!a
    N ra=!ona"!/area
    N!ve"+" %a@or de d!s(ors!onare a !%a$!n!!. Aces( n!ve" se carac(er!/ea/7 &r!n
    d!s(ors!onarea $ros!er7 sa+ a(r!'+!rea erona(7 a !%a$!n!! de s!ne sa+ de a"=!!.
    E<e%&"e s+n(
    N .an(e/!a a+(!s(7
    N !den(!.!carea &ro!ec(!v7
    N sc!ndarea !%a$!n!! de s!ne or! a !%a$!n!! a"(ora
    N!ve"+" de ac=!+ne. Aces( n!ve" se carac(er!/ea/7 &r!n(r4o .+nc=!onare a a&7r7r!!
    care re/o"v7 s(resor!! !n(ern! sa+ e<(ern! &r!n ac=!+ne sa+ a'=!nere. E<e%&"e s+n(
    N (recerea "a ac=!+ne
    N re(ra$erea a&a(!c7
    N ac+/area re.+/7r!! a@+(or+"+!
    N a$res!+nea &as!v7
    N!ve"+" de dere$"are a a&7r7r!!. Aces( n!ve" se carac(er!/ea/7 &r!n !nca&ac!(a(ea
    re$"7r!! a&7r7r!! de a res(rAn$e reac=!a !nd!v!d+"+! "a s(resor!, d+cAnd "a o r+&(+r7
    &ron+n=a(7 c+ rea"!(a(ea o'!ec(!v7. E<e%&"e s+n(
    N &ro!ec=!a de"!ran(7
    N ne$area &s!o(!c7
    N d!s(ors!+nea &s!o(!c7
    >*+ Anexa S

    'or"a $e .nre/i&trareM
    S#ala $e 'un#!ionare a Ap(r(rii
    A. A&7r7r!"e c+ren(e sa+ s(!"+r!"e de a .ace .a=7Q A se "!s(a :n ord!ne, :nce&And c+
    ce"e %a! no(a'!"e s(!"+r! de a&7rare sa+ de a .ace .a=7.
    5.]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    72]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    42]]]]]]]]]]]]]]]]].]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    H2]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    A2]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    R.]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    H.]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    B. N!ve"+" &redo%!nan( de a&7rare c+ren(7Q]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    *xemple
    A<a IQ 9FR.;9 T+"'+rare de&res!v7 %a@or7, rec+ren(7, %odera(7
    ;LY.IL A'+/ de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    A<a IIQ ;L5.G; T+"'+rare de &ersona"!(a(e 'order"!ne
    E"e%en(e de &ersona"!(a(e an(!soc!a"7
    A<a IUQ GG5.L9 D!"acerarea ar(!c+"a=!e! &+%n+"+!
    A<a I3Q Ares(are recen(7
    A"+n$are de acas7 de c7(re &7r!n=!
    A<a 3Q E,F 6 IY Eac(+a"J
    A. Aprrile curente sau stilurile de a face fa3:
    1. d!soc!ere
    2. !den(!.!care &r!n &ro!ec=!e
    3. (recerea "a ac=!+ne
    4. deva"or!/are
    5. o%n!&o(en=7
    6. ne$are
    7. &ro!ec=!e
    B. N!ve"+" &redo%!nan( de a&7rare c+ren(7Q n!ve"+" %a@or de d!s(ors!onare
    a !%a$!n!!.
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    >**

    Glosar de mecanisme de aprare speci$ice ,i de stiluri de a $ace $a
    Ac+/area re.+/+"+! a@+(or+"+! Ee"&4re@ec(!n$ co%&"a!n!n$J. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n so"!c!(area sa+ .or%+"area
    de cerer! re&e(a(e de a@+(or care de$!/ea/7 sen(!%en(e"e de os(!"!(a(e sa+ de re&roO
    %asca( .a=7 de a"=!!, care s+n( a&o! e<&r!%a(e &r!n re.+/area s+$es(!!"or, cons!"!!"or
    sa+ a@+(or+"+! &e care !! o.er7 a"=!!. So"!c!(7r!"e sa+ cerer!"e &o( !%&"!ca s!%&(o%e
    so%a(!ce sa+ &s!o"o$!ce or! &ro'"e%e de v!a=7.
    A.!"!ere Ea..!"!a(!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!! !n(ern!
    sa+ e<(ern! &r!n :n(oarcerea s&re a"=!! &en(r+ a@+(or sa+ s+&or(. Aceas(a !%&"!c7
    :%&7r(7O!rea &ro'"e%e"or c+ a"=!!, dar n+ s! :ncercarea de a .ace &e a"(c!neva
    r7s&+n/7(or de e"e.
    A$res!+ne &as!v7 E&ass!ve a$$ress!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona"
    or! s(resor!! !n(ern! sa+ e<(ern! &r!n e<&r!%area !nd!rec(7 s! neas+%a(7 a a$res!+n!!
    .a=7 de a"=!!. E<!s(7 o .a=ad7 de s+&+nere %an!.es(7 care %ascea/7 re/!s(en=a,
    resen(!%en(+" sa+ os(!"!(a(ea asc+ns7. A$res!+nea &as!v7 s+rv!ne adesea ca r7s&+ns
    "a cerer!"e de ac=!+ne sa+ e<ec+=!e !nde&enden(7 or! "a "!&sa de $ra(!.!care a
    dor!n=e"or de de&enden=7, dar &oa(e .! ada&(a(!v7 &en(r+ !nd!v!/!! :n &o/!=!! de
    s+'ordonare, care n+ a+ a"(7 %oda"!(a(e de a4s! e<&r!%a &ro(es(+" :n %od desc!s.
    A"(r+!s% Ea"(r+!s%J. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!! !n(ern!
    sa+ e<(ern! &r!n a se ded!ca sa(!s.acer!! neces!(7=!"or a"(ora. Con(rar a+(osacr!.!c!+"+!
    carac(er!s(!c +neor! .or%7r!! reac=!e!, !nd!v!d+" &r!%eO(e $ra(!.!ca=!e, .!e :n %od
    v!car!an(, .!e d!n r7s&+ns+" a"(ora.
    An(!c!&are Ean(!c!&a(!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" sa+ s(resor!!
    !n(ern! sa+ e<(ern! &r!n e<&er!en(area reac=!!"or :n avans sa+ an(!c!&area
    consec!n=e"or +nor &os!'!"e even!%en(e v!!(oare s! "+area :n cons!dera=!e rea"!s(7 a
    r7s&+ns+r!"or sa+ so"+=!!"or a"(erna(!ve.
    An+"are. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern!
    &r!n c+v!n(e sa+ co%&or(a%en(e des(!na(e s7 ne$e sa+ s7 corec(e/e :n %od s!%'o"!c
    $And+r!, sen(!%en(e sa+ ac=!+n! !nacce&(a'!"e.
    A+(oa.!r%are Ese".4asser(!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or!
    s(resor!! &r!n e<&r!%area $And+r!"or O! sen(!%en(e"or sa"e d!rec(, :n(r4+n %od care
    n+ es(e coerc!(!v sa+ %an!&+"a(!v.
    A+(oo'serva=!e Ese".4o'serva(!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or!
    s(resor!! &r!n re."ec(area "a &ro&r!!"e sa"e $And+r!, sen(!%en(e, %o(!va=!! O!
    co%&or(a%en(e, O! r7s&+n/And adecva(.
    De&"asare Ed!s&"ace%en(J. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!!
    !n(ern! sa+ e<(ern! &r!n (rans.erarea +n+! sen(!%en( or! a +n+! r7s&+ns "a +n o'!ec(
    &e +n a"( o'!ec( s+'s(!(+( Ede re$+"7, %a! &+=!n a%en!n=7(orJ.
    Deva"or!/are Edeva"+a(!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!!
    !n(ern! sa+ e<(ern! &r!n a(r!'+!rea +nor ca"!(7=! ne$a(!ve e<a$era(e s!eO! sa+ a"(ora.
    >*C Anexa
    S
    D!soc!ere Ed!ssoc!a(!onJ. Ind!v!d+" re/o"v7 con."!c(+"
    e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n(r4o
    des(r7%are a .+nc=!!"or de re$+"7 !n(e$ra(e a"e conO(!!n=e!,
    %e%or!e!, &erce&=!e! de s!ne sa+ &erce&=!e! a%'!an=e! or! a
    co%&or(a%en(+"+! sen/or!a"X%o(or.
    Fan(e/!e a+(!s(7 Ea+(!s(!c .an(asyJ. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n
    v!sare e<ces!v7, ca +n s+'s(!(+( &en(r+ re"a=!!"e +%ane, o
    ac=!+ne %a! e.!c!en(7 sa+ re/o"varea de &ro'"e%e.
    For%area reac=!e! Ereac(!on .or%a(!onJ. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n
    s+'s(!(+!rea de co%&or(a%en(e, $And+r! sa+ sen(!%en(e
    d!a%e(ra" o&+se $And+r!"or sa+ sen(!%en(e"or sa"e &ro&r!!,
    care s+n( !nacce&(a'!"e Eaceas(a s+rv!ne de re$+"7 :n "e$7(+r7
    c+ re.+"area "orJ.
    Idea"!/are E!dea"!/a(!onJ. Ind!v!d+" re/o"v7 con."!c(+"
    e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n a(r!'+!rea de
    ca"!(7=! &o/!(!ve e<a$era(e, a"(ora.
    Iden(!.!care &ro!ec(!v7 E&ro@ec(!ve Iden(!.!ca(!onJ. Ca s! :n
    &ro!ec=!e, !nd!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!!
    !n(ern! sa+ e<(ern! &r!n a(r!'+!rea, :n %od .a"s, a"(+!a a
    &ro&r!!"or sen(!%en(e, !%&+"s+r! sa+ $And+r! !nacce&(a'!"e.
    Con(rar &ro!ec=!e! s!%&"e, !nd!v!d+" n+ nea$7 co%&"e( ceea ce
    es(e &ro!ec(a(, :n sc!%', !nd!v!d+" r7%Ane conO(!en( de
    &ro&r!!"e sa"e a.ec(e sa+ !%&+"s+r!, dar "e a(r!'+!e :n %od
    erona( a"(e! &ersoane ca reac=!! @+s(!.!ca(e. N+ rar, !nd!v!d+"
    !nd+ce sen(!%en(e adev7ra(e "a a"=!!, care %a! :n(A! a+ .os( :n
    %od erona( cre/+=! a .! aco"o, .7cAnd d!.!c!" de c"ar!.!ca( c!ne
    a .7c+( &r!%+", ce s! c+!.
    In(e"ec(+a"!/are E!n(e""ec(+a"!/a(!onJ. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n +/+"
    e<ces!v a" $And!r!! a's(rac(e sa+ .or%+"area de $enera"!/7r!
    &en(r+ a con(ro"a sa+ %!n!%a"!/a sen(!%en(e"e &er(+r'an(e.
    I/o"area a.ec(+"+! E!so"a(!on o. a..ec(J. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n
    se&ararea !de!"or de sen(!%en(e"e asoc!a(e c+ e"e !n!=!a".
    Ind!v!d+" &!erde con(ac(+" c+ sen(!%en(e"e asoc!a(e c+ o
    an+%!(7 !dee Ede e<., +n even!%en( (ra+%a(!cJ :n (!%& ce
    ro%Ane conO(!en( de e"e%en(e"e co$n!(!ve a"e aces(e!a Ede e<.,
    de(a"!!"e descr!&(!veJ.
    O%n!&o(en=7 Eo%n!&o(enceJ. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n
    sen(!%en(e O! ac=!+n!, ca s! c+% e" ar &oseda &+(er! sa+
    ca&ac!(7=! s&ec!a"e s! es(e s+&er!or a"(ora.
    Pro!ec=!e E&ro@ec(!onJ Ind!v!d+" re/o"v7 con."!c(+"
    e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n a(r!'+!rea :n
    %od .a"s a"(+!a a sen(!%en(e"or, !%&+"s+r!"or sa+ $And+r!"or
    &ro&r!! !nacce&(a'!"e.
    Ra=!ona"!/are Era(!ona"!/a(!onJ. Ind!v!d+" re/o"v7
    con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+ e<(ern! &r!n
    asc+nderea adev7ra(e"or %o(!va=!! a"e $And+r!"or, ac=!+n!"or
    sa+ sen(!%en(e"or &ro&r!!, &r!n e"a'orarea de e<&"!ca=!!
    reas!$+ran(e sa+ a+(oservan(e, dar !ncorec(e.
    Seturile de riterii ,i Axele prev(ute pentru studii
    suplimentare
    =1+

    Re.+/ Eden!a"J. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!! !n(ern!
    sa+ e<(ern! &r!n re.!!/+" rec+noaO(er!! +n+! as&ec( ne&"7c+( a" rea"!(7=!! e<(erne
    or! e<&er!en=e! s+'!ec(!ve care ar .! ev!den( a"(ora. Ter%en+" de re)+; psi-otic
    es(e +(!"!/a( cAnd e<!s(7 o de(er!orare sever7 a s!%=+"+! cr!(!c.
    Re&r!%are Ere&ress!onJ Zre.+"are[. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona"
    or! s(resor!! !n(ern! sa+ e<(ern! &r!n e<c"+derea dor!n=e"or, $And+r!"or sa+
    e<&er!en=e"or &er(+r'an(e d!n conO(!!n=7. Co%&onen(a a.ec(!v7 &oa(e r7%Ane
    conO(!en(7, de(aOa(7 de !de!"e asoc!a(e.
    Sc!ndare. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or! s(resor!! !n(ern! sa+
    e<(ern! &r!n co%&ar(!%en(area s(7r!"or a.ec(!ve o&+se, dar es(e !nca&a'!" s7
    !n(e$re/e ca"!(7=!"e &o/!(!ve O! ne$a(!ve a"e sa"e sa+ a"e a"(ora :n !%a$!n!
    coeren(e. Deoarece a.ec(e"e a%'!va"en=e n+ &o( .! e<&er!en(a(e s!%+"(an,
    o&!n!!"e s! e<&ec(a=!!"e %a! ec!"!'ra(e de s!ne sa+ de a"=!! s+n( e<c"+se d!n
    conO(!!n=a e%o=!ona"7. I%a$!n!"e de s!ne O! de o'!ec(e (!nd a a"(erna :n(re &o"!
    d!a%e(ra" o&+O!Q (andr+, &+(ern!c, %er!(+os, ed+ca( O! $eneros :n %od e<c"+s!v
    U sa+ r7+, od!os, %An!os, d!s(r+c(!v, re@ec(an( sa+ %!/era'!" :n %od e<c"+s!v.
    S+'"!%are Es+'"!%a(!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or!
    s(resor!! !n(ern! sa+ e<(ern! &r!n cana"!/area sen(!%en(e"or sa+ !%&+"s+r!"or
    &o(en=!a" de/ada&(a(!ve :n(r4+n co%&or(a%en( acce&(a'!" soc!a" Ede e<., v!ne :n
    con(ac( c+ s&or(+" s&re a cana"!/a !%&+"s+r!"e co"eroaseJ.
    S+&r!%are Es+&&ress!onJ. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or!
    s(resor!! !n(ern! sa+ e<(ern! &r!n a ev!(a :n %od !n(en=!ona( s7 se $Andeasc7 "a
    &ro'"e%e"e, dor!n=e"e, sen(!%en(e"e sa+ e<&er!en=e"e &er(+r'an(e,
    Trecerea "a ac=!+ne Eac(!n$ o+(J. Ind!v!d+" re/o"v7 con."!c(+" e%o=!ona" or!
    s(resor!! !n(ern! sa+ e<(ern! %a! c+rAnd &r!n ac=!+n! decA( &r!n re."ec=!! sa+
    sen(!%en(e. Aceas(7 de.!n!=!e es(e %a! "ar$7 decA( conce&(+" or!$!na" de &+nere
    :n ac( a (rans.er+"+! sen(!%en(e"or sa+ dor!n=e"or :n c+rs+" &s!o(era&!eC O!
    es(e :n=e"eas7 a !nc"+de co%&or(a%en(+" care &rov!ne, a(A( d!n !n(er!or+", cA( O!
    d!n a.ara re"a=!e! de (rans.er. Trecerea "a ac=!+ne de.ens!v7 n+ es(e s!non!%7 c+
    Sco%&or(a%en(+" r7+T, deoarece ea neces!(7 &ro'a c7 co%&or(a%en(+" es(e :n
    "e$7(+r7 c+ con."!c(e e%o=!ona"e.
    U%or E+%orJ. Ind!v!/!! re/o"v7 con."!c(+" e%o=!ona" sa+ s(resor!! e<(ern!
    &r!n s+'"!n!erea as&ec(e"or a%+/an(e sa+ !ron!ce a"e con."!c(+"+! sa+ s(resor!"or.
    >*7 Anexa
    S
    S#ala $e Evaluare Glo-al( a 'un#!ion(rii
    Rela!ionale 3SEG'R6
    KGlo-al A&&e&&"ent o%
    Rela!ional 'un#tionin/ 3GAR'6 S#aleL
    Ins(r+c=!+n!Q Sca"a E,FR &oa(e .! +(!"!/a(7 &en(r+ a !nd!ca o a&rec!ere $"o'a"7
    a .+nc=!on7r!! +ne! .a%!"!! sa+ a a"(e! re"a=!! ne:n(rer+&(e, &e +n con(!n++%
    !&o(e(!c, %er$And de "a o .+nc=!onare re"a=!ona"7 o&(!%7 "a o re"a=!e
    d!s.+nc=!ona"7, r+&(7. Ea es(e s!%!"ar7 a<e! 3 ESca"a de Eva"+are ,"o'a"7 a
    F+nc=!on7r!!J &en(r+ !nd!v!/! :n DSM4I3. Sca"a E,FR &er%!(e c"!n!c!an+"+! s7
    a&rec!e/e $rad+" "a care o .a%!"!e sa+ a"(7 +n!(a(e re"a=!ona"7 ne:n(rer+&(7 sa(!s.ace
    neces!(7=!"e a.ec(!ve sa+ !ns(r+%en(a"e a"e %e%'r!"or e! :n +r%7(oare"e do%en!!Q
    A. Re;ol*area de probleme U a&(!(+d!n! :n ne$oc!erea sco&+r!"or, re$+"!"or
    s!
    r+(!ne"or8 ada&(a'!"!(a(ea "a s(res8 a&(!(+d!n! de co%+n!care8 ca&ac!(a(ea de
    a
    re/o"va con."!c(+"
    B. 4r/ani;are U %en=!nerea ro"+r!"or !n(er&ersona"e s! a "!%!(e"or
    s+'s!s(e%+"+!8
    .+nc=!onarea !erar!c78 coa"!=!!"e s! d!s(r!'+=!a &+(er!!, con(ro"+"+!
    s!
    res&onsa'!"!(7=!!
    C. Climat a)ecti* U (on+" s! $a%a sen(!%en(e"or8 ca"!(a(ea a(en=!e!,
    e%&a(!e!,
    !%&"!c7r!! s! a(aOa%en(+"+!Xo'"!$a=!e!8 :%&7r(7O!rea va"or!"or8
    reac(!v!(a(ea
    a.ec(!v7, res&ec(+" s! cons!dera=!a rec!&roc78 ca"!(a(ea .+nc=!on7r!! se<+a"e.
    :n ce"e %a! %+"(e ca/+r!, sca"a E,FR (re'+!e +(!"!/a(7 &en(r+ a eva"+a
    ac(!v!(a(ea :n c+rs+" &er!oade! c+ren(e Ead!c7, n!ve"+" de .+nc=!onare re"a=!ona"7
    :n (!%&+" eva"+7r!!J, :n +ne"e s!(+a=!!, sca"a E,FR &oa(e .! +(!"!/a(7, de
    ase%enea, &en(r+ a eva"+a .+nc=!onarea s! :n a"(e &er!oade de (!%& Ead!c7, ce"
    %a! :na"( n!ve" de .+nc=!onare re"a=!ona"7 &en(r+ ce" &+=!n cA(eva "+n! :n c+rs+"
    an+"+! (rec+(J.
    No(7Q A se +(!"!/a cod+r! !n(er%ed!are, s&ec!.!ce, cAnd es.e &os!'!", de
    e<e%&"+, IY, RG, H9. Dac7 n+ s+n( adecva(e !n.or%a=!! de(a"!a(e &en(r+ a e.ec(+a
    o eva"+are s&ec!.!c7, +(!"!/a=! @+%7(7=!"e ce"or c!nc! $rade, ad!c7, FL, HL, YL,;L
    sa+ 5L.
    To(a" G545LLQ Fnitatea rela(ional6 )+nc(ionea;6 satis)6c6tor, d+p6 c+m re;+lt6 din
    a+torelatarea participan(ilor si din perspecti*a obser*atorilor7
    Se acce&(7 c7 e<!s(7 &a((ern+r! sa+ r+(!ne care a@+(7 "a sa(!s.acerea
    neces!(7=!"or co%+ne a"e .!ec7re! .a%!"!! sa+ %e%'r+ a" c+&"+"+!8 e<!s(7
    ."e<!'!"!(a(e "a sc!%'are, ca r7s&+ns "a cerer! sa+ even!%en(e !nso"!(e, !ar
    con."!c(e"e oca/!ona"e O! (ran/!=!!"e s(resan(e s+n( re/o"va(e &r!n co%+n!care
    s! ne$oc!ere, care so"+=!onea/7 &ro'"e%a.
    E<!s(7 o :n=e"e$ere s! +n acord :%&7r(7O!( :n "e$7(+r7 c+ ro"+r!"e s!
    sarc!n!"e adecva(e, "+area dec!/!!"or es(e s(a'!"!(7 &en(r+ .!ecare do%en!+
    .+nc=!ona" s! e<!s(7 o rec+noaO(ere a carac(er!s(!c!"or s!n$+"are s! a
    va"or!! .!ec7r+! s+'s!s(e% Ede e<., &7r!n=!Xso=!, .ra=! O! a"=! !nd!v!/!J.
    E<!s(7 o a(%os.er7 o&(!%!s(7, cores&+n/7(oare s!(+a=!ona" :n .a%!"!e8 o
    $a%7 "ar$7 de sen(!%en(e es(e e<&r!%a(7 O! re$"a(7 :n .a%!"!e, s! e<!s(7 o
    a(%os.er7 $enera"7 de c7"d+r7, de (andre=e O! de :%&7r(7O!re a va"or!"or
    :n(re (o=! %e%'r!! .a%!"!e!. Re"a=!!"e se<+a"e a"e %e%'r!"or ad+"=! s+n(
    sa(!s.7c7(oare.
    Seturile de riterii ,i Axele prev(ute pentru studii suplimentare 8EA
    To(a" R54;LQ F+nc(ionarea +nit6(ii rela(ionale este =ntr#o an+mit6 m6s+r6 insatis)6c6toare7
    0+p6 o perioad6 de timp, m+lte, dar n+ toate di)ic+lt6(ile s+nt re;ol*ate )6r6 ac+;e7
    R+(!ne"e co(!d!ene s+n( &re/en(e, dar e<!s(7 o oarecare s+.er!n=7 s!
    d!.!c+"(a(e :n a r7s&+nde "a !nso"!(. Une"e con."!c(e r7%An nere/o"va(e, dar n+
    des(ra%7 .+nc=!onarea .a%!"!e!.
    L+area dec!/!!"or es(e de re$+"7 co%&e(en(7, dar e.or(+r!"e "a con(ro"+"
    +n+!a de c7(re a"(+" s+n( .oar(e adesea %a! %ar! decA( es(e necesar sa+ s+n(
    !ne.!c!en(e. Ind!v!/!! O! re"a=!!"e s+n( c"ar de%arca(e, dar +neor! +n s!s(e%
    s&ec!.!c es(e de&rec!a( sa+ .7c+( =a& !s&7O!(or.
    Es(e e<&r!%a(7 o $a%7 de sen(!%en(e, dar ca/+r!"e de '"ocare e%o=!ona"7
    sa+ de (ens!+ne s+n( ev!den(e. C7"d+ra s! (andre=ea s+n( &re/en(e, dar
    a"(era(e de !r!(a'!"!(a(ea s! .r+s(7r!"e %e%'r!"or .a%!"!e!. Ac(!v!(a(ea se<+a"7 a
    %e%'r!"or .a%!"!e! &oa(e .! red+s7 sa+ &ro'"e%a(!c7.
    To(a" I54RLQ Un!(a(ea re"a=!ona"7 are oca/!ona", &er!oade de .+nc=!onare
    sa(!s.7c7(oare s! co%&e(en(7 :%&re+n7, :ns7 re"a=!!"e c"ar d!s.+nc=!ona"e,
    nesa(!s.7c7(oare, (!nd s7 &redo%!ne.
    Co%+n!carea es(e .recven( !n!'a(7 de con."!c(e"e nere/o"va(e care
    !n(er.erea/7 adesea c+ r+(!ne"e co(!d!ene8 e<!s(7 o d!.!c+"(a(e se%n!.!ca(!v7 :n
    ada&(area "a s(res+" .a%!"!a" s! sc!%'area (rad!=!ona"7.
    L+area dec!/!!"or es(e n+%a! !n(er%!(en( co%&e(en(7 s! e.!c!en(78 de aces(e
    da=! es(e ev!den(7, .!e r!$!d!(a(ea e<ces!v7, .!e "!&sa se%n!.!ca(!v7 de
    s(r+c(+rare. Neces!(7=!"e !nd!v!d+"+! s+n( .oar(e adesea .!"(ra(e de +n &ar(ener
    sa+ de o coa"!=!e.
    S+&7rarea, %An!a !ne.!c!en(7 or! !nsens!'!"!(a(ea e%o=!ona"7 !n(er.erea/7
    c+ sa(!s.ac=!a .a%!"!ar7. DeO! e<!s(7 o oarecare c7"d+r7 s! s+&or( &en(r+
    %e%'r!! .a%!"!e!, aces(a d!n +r%7 es(e !ne$a" d!s(r!'+!(. D!.!c+"(7=!"e se<+a"e
    @enan(e :n(re ad+"=! s+n( adesea &re/en(e.
    To(a" 954ILQ Un!(a(ea re"a=!ona"7 es(e c"ar s! ser!os d!s.+nc=!ona"78 .or%e"e O!
    &er!oade"e de (!%& de re"a(!onare sa(!s.7c7(oare s+n( rare.
    R+(!ne"e .a%!"!e!Xc+&"+"+! n+ sa(!s.ac neces!(7=!"e %e%'r!"or, e"e .!!nd
    res&ec(a(e c+ s(r!c(e=e sa+ !$nora(e c+ nonOa"an=7. Mod!.!c7r!"e c!c"+"+! de
    v!a=7, c+% ar .! de e<e%&"+, &"ec7r!"e sa+ !n(r7r!"e :n(r4o +n!(a(e re"a=!ona"7,
    $enerea/7 con."!c(e s! eOec+r! ev!den( .r+s(ran(e :n re/o"varea de &ro'"e%e.
    L+area dec!/!!"or es(e (!ran!c7 sa+ .oar(e !ne.!cace. Carac(er!s(!ce"e
    s!n$+"are a"e !nd!v!/!"or s+n( s+'a&rec!a(e sa+ !$nora(e .!e de coa"!=!! r!$!de,
    .!e de coa"!=!! ."+!d con.+/e.
    E<!s(7 rare &er!oade de &"7cere de v!a=7 :%&re+n78 d!s(an=area .recven(7
    sa+ os(!"!(a(ea desc!s7 re."ec(7 con."!c(e se%n!.!ca(!ve care r7%An
    nere/o"va(e O! s+n( .oar(e s+&7r7(oare. D!s.+nc=!a se<+a"7 d!n(re %e%'r!!
    ad+"=! es(e "oc co%+n.
    Total #,"? Fnitatea rela(ional6 a de*enit prea dis)+nc(ional6 pentr+ a re(ine contin+itatea
    contact+l+i si ataament+l+i7
    R+(!ne"e .a%!"!e!Xc+&"+"+! s+n( ne$"!@a(e Ede e<., n+ e<!s(7 ore de %as7,
    orar de so%n sa+ de v!$!"!(a(eJ8 %e%'r! .a%!"!e! n+ O(!+ +n!! de a"=!! +nde
    s+n(, or! cAnd vor .! acas7 sa+ &"eca=!8 e<!s(7 &+=!n7 co%+n!care e.!c!en(7 :n(re
    %e%'r!! .a%!"!e!.
    =1> Anexa S

    Me%'r!! .a%!"!e!Xc+&"+"+! n+ s+n( or$an!/a=! de aOa %an!er7 :ncA(
    res&onsa'!"!(7=!"e &ersona"e sa+ $enera"e s7 .!e rec+nosc+(e. L!%!(e"e
    +n!(7=!! re"a=!ona"e ca :n(re$ s! ca s+'s!s(e% n+ &o( .! !den(!.!ca(e sa+ c7/+(
    de acord as+&ra "or. Me%'r!! .a%!"!e! s+n( &er!c"!(a=! sa+ v7(7%a=! cor&ora"
    or! a(aca=! se<+a".
    D!s&erarea s! c!n!s%+" s+n( &ervas!ve8 e<!s(7 &+=!n7 acen=!e &en(r+
    neces!(7=!"e e%o=!ona"e a"e a"(ora8 n+ e<!s(7 a&roa&e n!c! +n sen(!%en( de
    a(aOa%en(, o'"!$a=!e sa+ !n(eres a" +n+!a &en(r+ '+n7s(area ce"+!"a"(.
    LQ In.or%a=!e !nadecva(7.
    Seturile de riterii si Axele prev(ute pentru studii
    suplimentare
    =18
    S#ala $e Evaluare a 'un#!ion(rii So#iale
    Ei Pro%e&ionale 3SE'PS6
    KSo#ial an$ O##upational
    'un#tionin/ A&&e&&"ent S#ale 3SO'AS6L
    SEFPS ESOFASJ es(e o sca"7 no+7, care d!.er7 de Sca"a de Eva"+are ,"o'a"7 a
    F+nc=!on7r!! EEFAJ E,AFJ &r!n aceea c7 se cen(rea/7 e<c"+s!v &e n!ve"+" .+nc=!on7r!!
    soc!a"e s! &ro.es!ona"e a !nd!v!d+"+! s! n+ es(e !n."+en=a(7 d!rec( de sever!(a(ea
    $"o'a"7 a s!%&(o%e"or &s!o"o$!ce a"e !nd!v!d+"+!. De ase%enea, :n con(ras( c+
    sca"a E,F, or!ce de(er!orare :n .+nc=!onarea soc!a"7 s! &ro.es!ona"7, care es(e
    da(ora(7 cond!=!!"or %ed!ca"e $enera"e, es(e "+a(7 :n cons!dera=!e :n e.ec(+area
    eva"+7r!! SEFSP. SEFSP es(e +(!"!/a(7 de re$+"7 "a eva"+area ac(!v!(7=!! :n &er!oada
    c+ren(7 Ead!c7 n!ve"+" de .+nc=!onare d!n (!%&+" eva"+7r!!J. De ase%enea, SEFSP
    &oa(e .! +(!"!/a(7 "a eva"+area ac(!v!(7=!! d!n a"(e &er!oade de (!%&. De e<e%&"+,
    &en(r+ an+%!(e sco&+r! &oa(e .! +(!"7 eva"+area ac(!v!(7=!! d!n c+rs+" an+"+! (rec+(
    Eres&ec(!v, ce" %a! :na"( n!ve" de .+nc=!onare &en(r+ ce" &+=!n cA(eva "+n! d!n c+rs+"
    an+"+! (rec+(J.
    >*> Anexa S
    S#ala $e Evaluare a 'un#!ion(rii So#iale
    &i Pro%e&ionale 3SE'PS6
    F+nc=!onarea soc!a"7 s! &ro.es!ona"7 se cons!der7 &e +n con(!n++% de "a
    .+nc=!onarea e<ce"en(7 "a .+nc=!onarea de(er!ora(7 $ros!er. Inc"+de de(er!or7r!"e :n
    .+nc=!onare da(ora(e "!%!(e"or .!/!ce, &rec+% s! &e ce"e da(ora(e de(er!or7r!"or
    %en(a"e. Pen(r+ a .! "+a(7 :n cons!dera=!e, de(er!orarea (re'+!e s7 .!e consec!n=a
    d!rec(7 a +nor &ro'"e%e de s7n7(a(e %en(a"7 sa+ so%a(!c78 n+ s+n( "+a(e :n
    cons!dera=!e e.ec(e"e "!&se! de o&or(+n!(a(e sa+ a"(e "!%!(7r! a%'!en(a"e.
    od &FotD A se utili(a coduri intermediare c@nd sunt adecvate, de exemplu, HA,I8, ?7)
    E55 'uncionare superioar "ntr-o !am lar! de activiti
    l
    6E
    65 'uncionare bun "n toate domeniile, e$icient pro$esional i social2
    8E 85
    l ?E
    ?5
    l IE
    I5
    l AE
    A5
    l HE
    H5
    4E 45
    l 7E
    75
    l EE
    E5
    l E
    O
    Fu mai
    mult
    dec@t o
    u,oar
    deterior
    are "n
    $uncion
    area
    social,
    pro$esio
    nal
    sau
    ,colar
    &de ex2,
    con$lict
    e
    interper
    sonale
    rare,
    tempor
    ar
    rm@ne
    re "n
    urm "n
    activitatea ,colar)2
    .nele di$iculti "n $uncionarea social, pro$esional sau ,colar, dar "n
    !eneral $uncionea( bine, are c@teva relaii interpersonale semni$icative2
    Di$icultatea moderat "n $uncionarea social, pro$esional sau ,colar &de ex2,
    puini amici, con$licte cu e!alii sau cu colaboratorii)2
    Deteriorarea sever "n activitatea social, pro$esional sau ,colar &de ex2, nici
    un $el de amici, incapabil s in un serviciu)2
    Deteriorarea ma0or "n diverse domenii, cum ar $i serviciul sau scala, relaile
    de $amilie de ex2, omul depresiv evit amicii, ne!li0ea( $amilia ,i este
    incapabil s lucre(e3 copilul bate de re!ul ali copii mai mici, acas este
    s$idtor ,i absentea( de la ,coal)2
    Incapacitatea de a $unciona "n aproape toate domeniile &de ex2, st "n pat
    toat (iua, nu are serviciu, cas sau amicii)2
    Oca(ional este incapabil s menin un minim de i!ien personal, este incapabil
    s $uncione(e independent2
    Incapacitate persistent de a menine un minimum de i!ien personal2
    Incapabil s $uncione(e $r s-,i pre0udicie(e sie,i sau altora ori $r un
    suport extern considerabil &de ex2, "n!ri0ire ,i suprave!%ere)2
    In$ormaie inadecvat
    FotD *valuarea $uncionrii psi%olo!ice !lobale pe scala de la 5-E55 a $ost
    operaionali(at de LuborsCK "n Lealt%-SicCness +atin! Scale2 LuborsCK LD =liniciansM
    Nud!ments o$ Mintal Lealt%2> Arci!es o" General #s$ciatr$ ?DH5?-HE?, E6I7)2 Spit(er ,i
    cole!ii au e$ectuat o revi(ie a Leait%-SicCness +atin! Scale numit Global Assessment
    icaie &GAb) &*ndicou N, Spiuer +L, 'itiss NL, ,i col2D T%e Global Assessment ScaleD A #ro-
    cedure $or Measurin! Overall SeveritK o$ #sKc%iatric Disturbance2> Arc%ives o$ General
    #sKc%iatrK 44D?II-??E, E6?I)2 SO'AS este derivat din GAS iar crearea sa este descris "n
    Goldman LL, SCodol A*, Lave T+D =+evisin! Axis V $or DSM-IVD A +evieY o$ Measures o$
    Social 'unctionin!2> American ?ournal o" #s$ciatr$ EH6DEEH8-EEAI, E667
    Ane,a C
    Glosar de Termeni Te%nici
    Acce"erarea vor'!r!!. 3or'!re cresc+(7 can(!(a(!v, acce"era(7, s! d!.!c!" sa+ !%&os!'!"
    de :n(rer+&(. De re$+"7, Zvocea[ es(e, de ase%enea, &+(ern!c7 s! e%.a(!c7. Frecven(,
    &ersoana vor'eO(e .7r7 vreo s(!%+"are soc!a"7 O! &oa(e con(!n+a s7 vor'easc7 c!ar
    dac7 n+ o asc+"(7 n!%en!.
    A.a/!e. O de(er!orare :n :n=e"e$erea sa+ (rans%!(erea de !de! &r!n "!%'a@ :n or!care
    d!n(re .or%e"e sa"e 4 c!(!(, scr!s sa+ vor'!(care es(e da(ora(7 +ne! "e/!+n! sa+ %a"ad!! a
    cen(r!"or cere'ra"! !%&"!ca=! :n "!%'a@.
    A.ec(. Un &a((ern de co%&or(a%en(e o'serva'!"e care es(e e<&res!a +ne! s(7r!
    a.ec(!ve Ee%o=!!J e<&er!en(a(e s+'!ec(!v. E<e%&"e co%+ne de a.ec( s+n( (r!s(e=ea,
    e"a=!a Ee+.or!aJ s! %An!a. Con(rar d!s&o/!=!e! care se re.er7 "a +n Sc"!%a(T e%o=!ona"
    %a! s+s=!n+( s! &ervas!v, a.ec(+" se re.er7 "a %od!.!c7r! %a! ."+c(+an(e :n
    Sa(%os.eraT e%o=!ona"7. Ceea ce se cons!der7 $a%7 nor%a"7 a e<&res!e! a.ec(+"+!
    var!a/7 cons!dera'!" a(A( :n cadr+" ace"e!aO! c+"(+r!, cA( s! :n(re c+"(+r! d!.er!(e.
    Per(+r'7r!"e a.ec(+"+! !nc"+dQ
    a.ec(+" o'(+/Q red+cere se%n!.!ca(!v7 a !n(ens!(7=!! e<&res!e! e%o=!ona"e8
    a.ec(+" &"a(Q a'sen=a (o(a"7 sa+ a&roa&e (o(a"7 a or!c7r+! se%n de e<&res!e
    a.ec(!v78
    a.ec(+" !nadecva(Q d!scordan=7 :n(re e<&res!a a.ec(!v7 O! con=!n+(+" vor'!r!!
    sa+ !dea=!e!8
    a.ec(+" "a'!"Q var!a'!"!(a(e anor%a"7 a a.ec(+"+!, c+ %od!.!c7r! 'r+O(e, ra&!de
    O! re&e(a(e :n e<&res!a a.ec(!v78
    a.ec(+" res(rAns sa+ coarc(a(Q red+cere +Ooar7 :n $a%a O! !n(ens!(a(ea
    e<&res!e! e%o=!ona"e.
    A.on!e. Inca&ac!(a(ea de a &rod+ce s+ne(e"e vor'!r!! care neces!(7 +(!"!/area
    "ar!n$e"+! s! care n+ se da(orea/7 +ne! "e/!+n! a s!s(e%+"+! nervos cen(ra".
    A$!(a=!e Ea$!(a=!e &s!o%o(or!eJ. Ac(!v!(a(e %o(or!e e<ces!v7, asoc!a(7 c+ +n
    sen(!%en( de (ens!+ne !n(ern7. Ac(!v!(a(ea es(e de re$+"7 !%&rod+c(!v7 s! re&e(!(!v7,
    s! cons(7 d!n co%&or(a%en(e, &rec+% %ers+" de co"o &An7 co"o, .o!(+", r7s+c!(+"
    %A!n!"or, r+&erea :%'r7c7%!n=!! O! !nca&ac!(a(ea de a s(a "!n!O(!(.
    G5F
    =2E Ane,a C
    A"o$!e. O &a+&er(a(e :n $And!re care es(e !n.era(7 d!n o'servarea vor'!r!! s! co%&or(a%en(+"+!
    "!n$v!s(!c. Po( e<!s(a r7s&+ns+r! concre(e s! sc+r(e "a :n(re'7r! s! red+cerea can(!(7=!! de vor'!( s&on(an
    (pa+pertatea limbaI+l+i%7 Uneor! vor'!rea es(e adecva(7 can(!(a(!v, dar o.er7 .oar(e &+=!n7
    !n.or%a=!e, deoarece es(e e<(re% de concre(7, e<(re% de a's(rac(7, re&e(!(!v7 sa+ s(ereo(!&7
    (pa+pertatea con(in+t+l+i%7
    A%ne/!e. P!erderea %e%or!e!. T!&+r!"e de a%ne/!e !nc"+dQ
    a%en/!a an(ero$rad7Q &!erdere a %e%or!e! even!%en(e"or care s+rv!n d+&7 de'+(+"
    a$en(+"+! sa+ cond!=!e! e(!o"o$!ce8
    a%ne/!a re(ro$rad7Q &!erdere a %e%or!e! even!%en(e"or care a+ s+rven!( :na!n(ea
    de'+(+"+! a$en(+"+! sa+ cond!=!e! e(!o"o$!ce.
    An<!e(a(e. An(!c!&are a&reens!v7 a +n+! &er!co" sa+ nenoroc!r!, aco%&an!a(7 de o d!s&o/!=!e
    d!s.or!c7 sa+ de s!%&(o%e so%a(!ce de (ens!+ne. Focar+" &er!co"+"+! an(!c!&a( &oa(e .! !n(ern sa+
    e<(ern.
    A(ac+r! de &an!c7. Per!oade d!s(!nc(e de a&reens!+ne, .r!c7 sa+ (eroare !n(ens7, c+ de'+( 'r+sc,
    asoc!a(e adesea c+ sen/a=!a de %oar(e !%!nen(7, :n (!%&+" aces(or a(ac+r! e<!s(7 s!%&(o%e, &rec+%
    sen/a=!!"e de sc+r(are a res&!ra=!e! sa+ de s+.ocare, &a"&!(a=!!, acce"erarea r!(%+"+! card!ac, d+rere
    sa+ d!sco%.or( &record!a", s(ran$+"are, s! .r!ca de a r(+ :ne'+n! sa+ de a4s! &!erde con(ro"+". A(ac+r!"e
    de &an!c7 &o( .! !no&!na(e Enese%na"!/a(eJ, :n care de'+(+" a(ac+"+! n+ es(e asoc!a( c+ +n
    dec"anOa(or s!(+a=!ona", c! s+rv!ne Sd!n sen!nT, &o( .! "e$a(e s!(+a=!ona", :n care a(ac+" de &an!c7
    s+rv!ne a&roa&e !nvar!a'!" !%ed!a( "a e<&+nerea "a o s!(+a=!e dec"ansan(7 ESse%na"TJ or! "a
    an(!c!&area aces(e!a s!, :n .!ne, &o( .! &red!s&+se s!(+a=!ona", :n care ca/, a(ac+" de &an!c7 s+rv!ne
    .oar(e &ro'a'!" "a e<&+nerea "a +n dec"anOa(or s!(+a=!ona", dar n+ es(e asoc!a( :n %od !nvar!a'!" c+
    aces(a.
    A(a<!e. P!erdere &ar=!a"7 sa+ co%&"e(7 a coordon7r!! %!Oc7r!! %+sc+"are vo"+n(are.
    A(en=!e. Ca&ac!(a(e de concen(rare de o %an!er7 s+s=!n+(7 as+&ra +n+! an+%!( s(!%+" sa+
    ac(!v!(7=!. Per(+r'area :n a(en=!e se &oa(e %an!.es(a &r!n(r4o d!s(rac(!'!"!(a(e .ac!"7 sa+ d!.!c+"(a(e
    :n rea"!/area sarc!n!"or sa+ :n concen(rarea :n ac(!v!(a(e.
    Avo"!=!e. Inca&ac!(a(e de a !n!=!a s! de a &ers!s(a :n ac(!v!(7=! or!en(a(e s&re +n sco&. CAnd es(e
    s+.!c!en( de sever7 &en(r+ a .! cons!dera(7 &a(o"o$!c7, avo"!=!a es(e &ervas!v7 s! :%&!ed!c7
    &ersoana s7 (er%!ne d!.er!(e (!&+r! de ac(!v!(7=! Ede e<., %+nca, ac(!v!(7=!"e !n(e"ec(+a"e,
    a+(o:n$r!@!reaJ.
    Ca(a"e&s!e. F"e<!'!"!(a(e ceroas7 U %en=!nerea +ne! &o/!=!! r!$!de a cor&+"+! o &er!oad7 "+n$7 de
    (!%&.
    Ca(a&"e<!e. E&!soade de &!erdere 'r+sc7, '!"a(era"7, a (on+s+"+! %+sc+"ar, d+cAnd "a dero'area
    !nd!v!d+"+!, asoc!a(e adesea c+ e%o=!! !n(ense, c+% ar .! rAs+", %An!a, .r!ca sa+ s+r&r!/a.
    Co%&or(a%en( ca(a(on!c. Ano%a"!! %o(or!! %arca(e, !nc"+/And imobilitateaHmotorie Ead!c7,
    ca(a"e&s!a sa+ s(+&oareaJ, an+%!(e (!&+r! de acti*itate motorie excesi*6
    Glosar de Termeni Te%nici
    =21

    Ea$!(a=!e, ev!den(, "!&s!(7 de sco& s! ne!n."+en=a(7 de s(!%+"! e<(ern!J, ne/ati*ism extrem Ere/!s(en=7,
    ev!den(, ne%o(!va(7 "a !ns(r+c=!+n! sa+ (en(a(!ve de a .! %o'!"!/a(J or! m+tism, post+rare sa+ mic6ri
    stereotipe s! ecolalie sa+ ecopraxie7
    Cond!=!e !n(erse<+a"7. Cond!=!e :n care +n !nd!v!d &re/!n(7, a%es(eca(e :n d!verse $rade,
    carac(er!s(!c! a"e .!ec7r+! se<, !nc"+/And .or%a .!/!c7, or$ane"e de re&rod+cere s!
    co%&or(a%en(+" se<+a".
    De&ersona"!/are. A"(erare :n &erce&erea sa+ e<&er!en(area e+"+! de o ase%enea %an!er7, c7
    &ersoana se s!%(e de(aOa(7 de &ro&r!!"e &rocese %en(a"e sa+ de &ro&r!+" cor&, ca O! c+% ar .! +n
    o'serva(or d!n a.ar7 Ede e<., se s!%(e ca O! c+% ar v!saJ.
    Dera!ere ESre"a<area asoc!a=!!"orTJ. Un &a((ern de "!%'a@, :n care !de!"e +ne! &ersoane (rec de "a
    +n s+'!ec( "a a"(+" .7r7 n!c! o "e$7(+r7 :n(re e"e sa+ s+n( "e$a(e doar !nd!rec(, :n de&"asarea de "a o
    .ra/7 sa+ &ro&o/!=!+ne "a a"(a, &ersoana sc!%'7 :n %od carac(er!s(!c s+'!ec(+" de "a +n cadr+ de
    re.er!n=7 "a a"(+", !ar "+cr+r!"e &o( .! s&+se :n(r4o @+<(a&+nere d!n care "!&seO(e o re"a=!e c+ sens.
    Per(+r'area s+rv!ne :n(re &ro&o/!=!+n!, con(rar !ncoeren=e! :n care &er(+r'area es(e :n cadr+"
    &ro&o/!=!+n!!. O sc!%'are oca/!ona"7 a s+'!ec(+"+! .7r7 &reav!/ sa+ cone<!+ne ev!den(7 n+
    cons(!(+!e dera!ere.
    Derea"!/are. A"(erare :n &erce&erea sa+ e<&er!en(area "+%!! e<(erne, de o aOa %an!er7, c7 aceas(a
    &are s(r7!n7 sa+ !rea"7 Ede e<., oa%en!! &o( &7rea ne.a%!"!ar! sa+ ca n!O(e a+(o%a(eJ.
    De/or!en(are. Con.+/!e re.er!(oare "a &er!oada /!"e!, da(7, ano(!%& E(!%&J, "a "oc+" +nde se a."7 E"ocJ
    sa+ "a c!ne es(e E&ersoan7J.
    D!s.or!e se<+a"7. Avers!+ne &ers!s(en(7 .a=7 de +ne"e sa+ .a=7 de (oa(e carac(er!s(!c!"e .!/!ce
    sa+ ro"+r!"e soc!a"e &e care "e !%&"!c7 se<+" '!o"o$!c a" &ro&r!e! &ersoane.
    D!s)!ne/!e. D!s(ors!+ne a %!Oc7r!"or vo"+n(are c+ ac(!v!(a(e %+sc+"ar7 !nvo"+n(ar7.
    D!soc!ere. R+&(+r7 :n(re .+nc=!!"e de re$+"7 !n(e$ra(e a"e conO(!!n=e!, %e%or!e!, !den(!(7=!! sa+
    &erce&er!! a%'!an=e!. Per(+r'area &oa(e .! 'r+sc7 sa+ $rad+a"7, (ran/!(or!e sa+ cron!c7.
    D!s&o/!=!e. E%o=!e s+s=!n+(7 O! &ervas!v7 care co"orea/7 &erce&erea "+%!!. E<e%&"e"e co%+ne
    de d!s&o/!=!e !nc"+d de&res!a, e"a=!a, %An!a s! an<!e(a(ea. Con(rar a.ec(+"+!, care se re.er7 "a
    %od!.!c7r! %a! ."+c(+an(e :n Ss(area (!%&+"+!T a(%os.ere! e%o=!ona"e, d!s&o/!=!a se re.er7 "a +n
    Sc"!%a(T e%o=!ona" %a! s+s=!n+( O! %a! &ervas!v. T!&+r!"e de d!s&o/!=!e !nc"+dQ
    d!s&o/!=!a d!s.or!c7Q d!s&o/!=!e ne&"7c+(7, c+% ar .! (r!s(e=ea, an<!e(a(ea sa+
    !r!(a'!"!(a(ea8
    d!s&o/!=!a cresc+(7Q sen(!%en( e<a$era( de '!ne, de e+.or!e sa+ de e"a=!e. O
    &ersoan7 c+ d!s&o/!=!e cresc+(7 &oa(e descr!e d!s&o/!=!a ca .!!nd Se<a"(a(7T,
    Se<ce"en(7T, S:n c+nea .er!c!r!!T O! S:n a" no+7"ea cerT8
    =22 Anexa
    d!s&o/!=!e e+(!%!c7Q d!s&o/!=!e :n $a%a Snor%a"7T, ceea ce !%&"!c7 a'sen=a d!s&o/!=!e!
    de&res!ve sa+ cresc+(e8
    d!s&o/!=!e e<&ans!v7Q "!&sa de re=!nere :n e<&r!%area sen(!%en(e"or &ro&r!!, asoc!a(7 .recven(
    c+ s+&raeva"+area &ro&r!e! se%n!.!ca=!! sa+ !%&or(an=e8 d!s&o/!=!a !r!(a'!"7Q +Oor de
    con(rar!a( s! de &rovoca( s&re %An!e.
    D!sso%n!e. T+"'+r7r! &r!%are de so%n sa+ de v!$!"!(a(e, carac(er!/a(e &r!n !nso%n!e sa+
    !&erso%n!e, ca s!%&(o% %a@or a" (a'"o+"+! c"!n!c. D!sso%n!!"e s+n( (+"'+r7r! a"e can(!(7=!!, ca"!(7=!!
    sa+ orar+"+! E(!%!n$J so%n+"+!.
    D!s(on!e. Per(+r'area (on!c!(7=!! %+Oc!"or.
    D!s(rac(!'!"!(a(e. Inca&ac!(a(e de a %en=!ne a(en=!a, ad!c7, co%+(area de "a +n do%en!+ de
    s+'!ec(e "a a"(+", c+ o %!n!%7 &rovocare, or! a(en=!a es(e a(ras7 &rea .recven( de s(!%+"! e<(ern!
    nese%n!.!ca(!v! sa+ !re"evan=!.
    D!/ar(r!e. Ar(!c+"are !%&er.ec(7 a c+v!n(e"or, da(ora(7 &er(+r'7r!"or con(ro"+"+! %+sc+"ar.
    Eco"a"!e. Re&e(are &a(o"o$!c7, ase%7n7(oare &a&a$a"!c!s%+"+! s!, ev!den(, "!&s!(7 de sens a +n+!
    c+vAn( sa+ e<&res!! a'!a s&+se de a"(7 &ersoan7.
    Eco&ra<!e. Re&e(area, &r!n !%!(a=!e, a %!Oc7r!"or a"(+!a. Ac=!+nea n+ es(e +na !n(en=!ona(7 sa+
    vo"+n(ar7 s! are ca"!(a(ea de a .! se%!a+(o%a(7 s! !ncon(ro"a'!"7.
    E"e%en(e &s!o(!ce con$r+en(e c+ d!s&o/!=!a. Ide! de"!ran(e sa+ a"+c!na=!! a" c7ror con=!n+( es(e :n
    :n(re$!%e concordan( c+ (e%e"e (!&!ce a"e d!s&o/!=!e! de&res!ve sa+ %an!aca"e. Dac7 d!s&o/!=!a es(e
    de&res!v7, con=!n+(+" !de!"or de"!ran(e sa+ a" a"+c!na=!!"or (re'+!e s7 !%&"!ce (e%e de !ns+.!c!en=7
    &ersona"7, de c+"&7, %a"ad!e, %oar(e, n!!"!s% sa+ &edea&s7 %er!(a(7. Con=!n+(+" !de!"or de"!ran(e
    &oa(e !nc"+de (e%e de &ersec+=!e, dac7 aces(ea s+n( 'a/a(e &e conce&(e de a+(ode&rec!ere, c+% ar .!
    &edea&sa %er!(a(7. Dac7 d!s&o/!=!a es(e %an!aca"7, con=!n+(+" !de!"or de"!ran(e sa+ a"
    a"+c!na=!!"or (re'+!e s7 !%&"!ce (e%e cons(And d!n e<a$erarea va"or!!, &+(er!!, c+noO(!n=e"or sa+
    !den(!(7=!!, or! o re"a=!e s&ec!a"7 c+ o d!v!n!(a(e sa+ c+ o &ersoan7 ce"e'r7. Con=!n+(+" !de!! de"!ran(e
    &oa(e !nc"+de (e%e de &ersec+=!e, dac7 aces(ea s+n( 'a/a(e &e conce&(e, c+% ar .! va"oarea
    e<a$era(7 sa+ &edea&sa %er!(a(7.
    E"e%en(e &s!o(!ce !ncon$r+en(e c+ d!s&o/!=!a. Ide! de"!ran(e sa+ a"+c!na=!! a" c7ror con=!n+( n+
    es(e concordan( c+ (e%e"e (!&!ce a"e d!s&o/!=!e! de&res!ve sa+ %an!aca"e, :n ca/+" de&res!e!, !de!"e
    de"!ran(e sa+ a"+c!na=!!"e n+ (re'+!e s7 !nc"+d7 (e%e de !ns+.!c!en=7 &ersona"7, de c+"&7, %a"ad!e,
    %oar(e, n!!"!s% sa+ &edea&s7 %er!(a(7, :n ca/+" %an!e!, !de!"e de"!ran(e sa+ a"+c!na=!!"e n+
    (re'+!e s7 !nc"+d7 (e%e de va"oare, &+(ere, .c+noO(!n=e sa+ !den(!(a(e e<a$era(e or! de re"a=!e
    s&ec!a"7 c+ d!v!n!(a(ea sa+ c+ o &ersoan7 ce"e'r7. E<e%&"e"e de e"e%en(e &s!o(!ce !ncon$r+en(e
    c+ d!s&o/!=!a !nc"+d !de!"e de"!ran(e de &ersec+=!e E.7r7 con=!n+( de a+(ode&rec!ere sa+ de
    $randoareJ, !nser=!a de $And+r!, d!.+/area $And!r!! O! !de!"e de"!ran(e de con(ro" a" c7ror con=!n+(
    n+ are, d+&7 cA( de &are, n!c! o re"a=!e c+ vre+na d!n (e%e"e %a! s+s %en=!ona(e.
    Glosar de Termeni Te%nici
    =2+

    Fa/a re/!d+a"7. Fa/7 a +ne! %a"ad!! care s+rv!ne d+&7 re%!s!+nea s!%&(o%e"or ."or!de sa+ a
    :n(re$+"+! s!ndro%.
    F"as'ac). Reven!rea +ne! a%!n(!r!, sen(!%en( sa+ e<&er!en=e &erce&(+a"e d!n (rec+(.
    Fo'!e. Fr!c7 !ra=!ona"7, &ers!s(en(7, de +n an+%!( o'!ec(, ac(!v!(a(e sa+ s!(+a=!e Es(!%+"+" .o'!eJ
    care d+ce "a dor!n=a !re/!s(!'!"7 de a45 sa+ de a o ev!(a. Aceas(a d+ce adesea, .!e "a ev!(area
    s(!%+"+"+!, .!e "a s+&or(area "+! c+ (ea%7.
    F+$7 de !de!. F"+< a&roa&e con(!n++ de vor'!re acce"era(7, c+ (recer! 'r+O(e de "a +n s+'!ec( "a a"(
    s+'!ec(, 'a/a(e &e asoc!a=!! !n(e"!$!'!"e, s(!%+"! d!s(rac(!v! sa+ @oc+r! de c+v!n(e. CAnd es(e sever7,
    vor'!rea &oa(e .! de/or$an!/a(7 sa+ !ncoeren(7.
    ,randoare. A&rec!ere e<a$era(7 a &ro&r!e! va"or!, &+(er!, c+noaO(er!, !%&or(an=e sa+ !den(!(7=!.
    CAnd es(e e<(re%7, $randoarea &oa(e .! de &ro&or=!! de"!ran(e.
    ,And!re %a$!c7. Cred!n=a erona(7 c7 &ro&r!!"e $And+r!, c+v!n(e sa+ ac=!+n! vor ca+/a sa+ &reven!
    +n an+%!( de/nod7%An(, :n(r4+n %od an+%e, care s.!dea/7 "e$!"e :n=e"e$er!! co%+ne a ca+/e! O!
    e.ec(+"+!. ,And!rea %a$!c7 &oa(e .! &ar(e a de/vo"(7r!! co&!"+"+! nor%a".
    Ha"+c!na=!e. Perce&=!e sen/or!a"7, c+ sen(!%en(+" !re/!s(!'!" a" rea"!(7=!! +ne! &erce&=!! ver!(a'!"e,
    dar care s+rv!ne .7r7 s(!%+"area e<(ern7 a +n+! or$an sen/or!a" re"evan(. Ha"+c!na=!!"e (re'+!e s7 .!e
    d!s(!nse de il+;ii, :n care +n s(!%+" e<(ern rea" es(e &erce&+( sa+ !n(er&re(a( erona(. Persoana &oa(e
    avea sa+ n+ conO(!!n=a .a&(+"+! c7 are o a"+c!na=!e. O &ersoan7 c+ a"+c!na=!! a+d!(!ve &oa(e
    rec+noaO(e c7 are o e<&er!en=7 sen/or!a"7 .a"s7, :n (!%& ce a"(a &oa(e .! conv!ns7 c7 s+rsa
    e<&er!en=e! sa"e sen/or!a"e are o rea"!(a(e .!/!c7 !nde&enden(7. Ter%en+" de -al+cina(ie n+ se a&"!c7,
    :n $enera", &erce&=!!"or .a"se care s+rv!n :n v!s, :n (!%&+" ador%!r!! (-ipna/o/ice% or! a" deO(e&(7r!!
    d!n so%n (-ipnopompice%7 E<&er!en=e a"+c!na(or!! &o( s+rven! s! "a oa%en!! .7r7 n!c! o (+"'+rare
    %en(a"7. T!&+r!"e de a"+c!na=!! !nc"+dQ
    a"+c!na=!a a+d!(!v7Q a"+c!na=!e !%&"!cAnd &erce&erea de s+ne(e, dar ce" %a! .recven( de
    voc!. Un!! c"!n!c!en! O! cerce(7 (o!! n+ vror s7 !nc"+d7 ace"e e<&er!en=e &erce&+(e ca ven!nd
    d!n !n(er!or+" ca&+"+! O! vror, :n sc!%', s7 "!%!(e/e conce&(+" de a"+c!na=!! a+d!(!ve
    ver!(a'!"e "a ace"e s+ne(e a c7ror s+rs7 es(e &erce&+(7 ca .!!nd e<(ern7, :n DSM I3 :ns7 n+ se
    .ace n!c! o d!s(!nc=!e :n .+nc=!e de c+% s+rsa voc!"or es(e &erce&+(7 ca .!!nd :n !n(er!or+" sa+ :n
    a.ara ca&+"+!8
    a"+c!na=!a $+s(a(!v7Q a"+c!na=!e !%&"!cAnd &erce&erea de $+s(+r! Ede re$+"7 ne&"7 c+(eJ8
    a"+c!na=!a con$r+en(7 c+ d!s&o/!=!aQ ve/! e"e%en(e"e &s!o(!ce con$r+en(e c+ d!s&o/!=!a8
    a"+c!na=!a !ncon$r+en(7 c+ d!s&o/!=!aQ ve/! e"e%en(e"e &s!o(!ce !ncon$r+en(e c+
    d!s&o/!=!a8
    a"+c!na=!a o".ac(!v7Q a"+c!na=!e !%&"!cAnd &erce&erea +n+! %!ros, c+% ar .! ce" de ca+c!+c
    ars sa+ de &es(e s(r!ca(8
    a"+c!na=!a so%a(!c7Q a"+c!na=!e !%&"!cAnd &erce&erea +ne! e<&er!en=e .!/!ce "oca"!/a(e :n
    cor& Ec+% ar .! sen/a=!a de e"ec(roc+(areJ. Ha"+c!na=!a
    >C7 Anexa
    so%a(!c7 (re'+!e s7 .!e d!s(!ns7 de sen/a=!!"e so%a(!ce &roven!nd d!n(r4o cond!=!e %ed!ca"7
    $enera"7 :nc7 ned!a$nos(!ca(7 de &reoc+&area !&ocondr!ac7 &en(r+ sen/a=!!"e so%a(!ce
    nor%a"e s! de o a"+c!na=!e (ac(!"78 a"+c!na=!a (ac(!"7Q a"+c!na=!e !%&"!cAnd &erce&erea
    .a&(+"+! de a .! a(!ns or! a ceva care se a."a s+' &ro&r!a4! &!e"e. Ce"e %a! .recven(e a"+c!na=!!
    (ac(!"e s+n( sen/a=!!"e de Ooc+r! e"ec(r!ce s! )+rnic6t+ra Esen/a=!a de ceva a"+necAnd sa+
    re&(And &eXsa+ s+' (e$+%en(eJ8
    a"+c!na=!a v!/+a"7Q a"+c!na=!e !%&"!cAnd vederea s! care &oa(e cons(a d!n !%a$!n! .or%a(e,
    c+% ar .! ce"e de oa%en!, or! de !%a$!n! ne.or%a(e, c+% ar .! ."as+r!"e de "+%!n7.
    Ha"+c!na=!!"e v!/+a"e (re'+!e d!s(!nse de !"+/!!, care s+n( &erce&=!! erona(e a"e +nor s(!%+"!
    e<(ern! rea"!.
    H!&erac+/!e. Sens!'!"!(a(e d+reroas7 "a s+ne(e.
    H!&erso%n!e. So%no"en=7 e<ces!v7 %an!.es(a(7 &r!n so%n noc(+rn &re"+n$!(, d!.!c+"(a(e :n a
    %en=!ne o s(are de v!$!"!(a(e a"er(7 :n (!%&+" /!"e! sa+ e&!soade de so%n nedor!(e :n (!%&+" /!"e!
    Idea(!c &arano!d7 . Idea(!c, de &ro&or=!! %a! red+se decA( !deea de"!ran(7 , !%&"!cAnd s+s&!c!+nea
    sa+ conv!n$erea c7 res&ec(!v+" es(e 7r=+!(, &ersec+(a( sa+ (ra(a(a( :n %od ar'!(rar.
    Idee de"!ran(7. Conv!n$erea .a"s7, 'a/a(7 &e o !n.eren=7 !ncorec(7 des&re rea"!(a(ea e<(ern7, care es(e
    s+s=!n+(7 .er% :n d!s&re=+" a ceea ce a&roa&e or!c!ne crede s! :n d!s&re=+" a ceea ce cons(!(+!e &ro'a
    c"ar7 s! !nd!sc+(a'!"7 a ev!den=e! de con(rar!+. Conv!n$erea n+ es(e +na acce&(a(7 nor%a"%en(e de
    a"=! %e%'r! a! c+"(+r!! sa+ s+'c+"(+r!! &ersoane! Ede e<., n+ es(e +n ar(!co" de cred!n=7 re"!$!oas7J.
    CAnd o conv!n$ere .a"s7 !%&"!c7 o @+deca(7 .de va"oare, ea es(e cons!dera(7 !dee de"!ran(7 n+%a!
    cAnd @+deca(a es(e a(A( de e<(re%7, :ncA( s.!dea/7 cred!'!"!(a(ea. Conv!n$erea de"!ran(7 s+rv!ne &e +n
    con(!n+a% s! +neor! &oa(e .! !n.era(7 d!n co%&or(a%en(+" !nd!v!d+"+!. Adesea, es(e d!.!c!" de d!s(!ns
    :n(re o !dee de"!ran(7 s! o !dee &reva"en(7 E:n care ca/, !nd!v!d+" are o !dee sa+ cred!n=7 !ra=!ona"7 dar
    "a care n+ =!ne a(A( de .er% ca :n ca/+" !de!! de"!ran(eJ. Ide!"e de"!ran(e s+n( c"as!.!ca(e d+&7 con=!n+(+"
    "or. CA(eva d!n ce"e %a! .recven(e (!&+r! s+n( %en=!ona(e %a! @osQ
    !dee de"!ran(7 '!/ar7Q !dee de"!ran(7 care !%&"!c7 +n .eno%en &e care c+"(+ra &ersoane! 54ar
    cons!dera ca (o(a" !%&"a+/!'!"8
    !dee de"!ran(7 de $e"o/!eQ !dee de"!ran(7 c7 &ro&r!+" &ar(ener se<+a" es(e !n.!de"8
    !dee de"!ran(7 ero(o%an!c7Q !deea de"!ran(7 c7 a"(7 &ersoan7, de re$+"7 c+ s!(+a=!e :na"(7,
    es(e :ndr7$os(!(7 de !nd!v!d E7J8
    !dee de"!ran(7 de $randoareQ !dee de"!ran(7 cons(And :n e<a$erarea va"or!!, &+(er!!,
    c+noO(!n=e"or, !den(!(7=!! !nd!v!d+"+! or! de re"a=!e s&ec!a"7 a aces(+!a c+ o d!v!n!(a(e sa+ c+ o
    &ersoan7 ce"e'r78
    !dee de"!ran(7 con$r+en(7 c+ d!s&o/!=!aQ ve/! e"e%en(e"e &s!o(!ce con$r+en(e c+
    d!s&o/!=!a8
    !dee de"!ran(7 !ncon$r+en(7 c+ d!s&o/!=!aQ ve/! e"e%en(e"e &s!o(!ce !ncon$r+en(e c+
    d!s&o/!=!a8
    !deea de"!ran(7 de a .! con(ro"a(Q !dee de"!ran(7 :n care sen(!%en(e"e, !%&+"s+r!"e, $And+r!"e
    sa+ ac=!+n!"e4s+n( e<&er!en(a(e ca .!!nd s+' con(ro"+" +nor .or=e e<(erne, %a! c+rAnd decA(
    s+b con(ro"+" &ro&r!+8
    Glosar de Termeni Te%nici
    =25

    !dee de"!ran(7 de re.er!n=7Q !dee de"!ran(7 a c7re! (e%7 es(e aceea c7 even!%en(e"e,
    o'!ec(e"e sa+ a"(e &ersoane d!n !%ed!a(a a&ro&!ere a c+!va a+ o se%n!.!ca=!e s&ec!a"7 s!
    !nso"!(7. Aces(e !de! de"!ran(e s+n( de re$+"7 de na(+r7 ne$a(!v7 sa+ &e!ora(!v7, dar &o( .!, de
    ase%enea, s! de $randoare :n con=!n+(. Aces(ea d!.er7 de o !dee de re.er!n=7, :n care
    conv!nerea .a"s7 n+ es(e s+s=!n+(7 (o( a(A( de .er% s! n+ es(e n!c! (o( a(A( de co%&"e( or$an!/a(7
    ca :n(r4o conv!n$ere ver!(a'!"78
    !dee de"!ran(7 de &ersec+=!eQ !dee de"!ran(7 :n care (e%a cen(ra"7 es(e c7 &ersoana Esa+
    c!neva de care &ersoana es(e a&ro&!a(7J es(e a(aca(7, 7r=+!(7, :nOe"a(7, &ersec+(a(7 sa+ se
    cons&!r7 con(ra e!8
    !dee de"!ran(7 so%a(!c7Q !dee de"!ran(7 a" c7re! con=!n+( &r!nc!&a" es(e "e$a( de as&ec(+" sa+
    .+nc=!onarea &ro&r!+"+! cor&8
    !dee de"!ran(7 de d!.+/are a $And!r!!Q !dee de"!ran(7 con.or% c7re!a &ro&r!!"e $And+r! s+n(
    d!.+/a(e c+ voce (are :n a.ar7, as(.e" c7 &o( .! &erce&+(e de a"=!!8 !dee de"!ran(7 de !nser=!e a
    $And!r!!Q !dee de"!ran(7 con.or% c7re!a +ne"e d!n(re $And+r!"e s+'!ec(+"+! n+ s+n( a"e sa"e,
    c! %a! c+rAnd s+n( !nsera(e :n &ro&r!a4! %!n(e.
    Idee &reva"en(7. Idee s+s=!n+(7 s! ne%o(!va(7 care es(e %en=!n+(7 c+ o !n(ens!(a(e %a! red+s7 decA(
    cea de"!ran(7 Ead!c7, &ersoana es(e :n s(are s7 rec+noasc7 &os!'!"!(a(ea c7 cred!n=a e! &oa(e s7 n+
    .!e adev7ra(7J. Cred!n=a n+ es(e +na care es(e acce&(a(7 :n %od nor%a" de a"=! %e%'r! a! c+"(+r!! sa+
    s+'c+"r+r!! &ersoane!.
    Ide! de re.er!n=7. Sen(!%en(+" c7 !nc!den(e cas+a"e s! even!%en(e e<(erne a+ o se%n!.!ca=!e
    &ar(!c+"ar7 s! !nso"!(7 care es(e s&ec!.!c7 &en(r+ &ersoana res&ec(!v7. Aceas(a (re'+!e d!s(!ns7 de
    ideea delirant6 de re)erin(6 :n care e<!s(7 o cred!n=7 care es(e %en=!n+(7 c+ conv!n$ere de"!ran(7.
    Iden(!(a(e se<+a"7. Conv!n$erea !n(!%7 a +ne! &ersoane c7 es(e '7r'a( sa+ .e%e!e.
    I"+/!e. Perce&=!e sa+ !n(er&re(are erona(7 a +n+! s(!%+" e<(ern rea", c+% ar .! a+/!rea .oOne(+"+!
    .r+n/e"or ca s+ne( de voc!. 3e/!, de ase%enea, a"+c!na=!a.
    Incoeren=7. L!%'a@ sa+ $And!re care es(e :n esen=7 !nco%&reens!'!"7 a"(ora, deoarece c+v!n(e"e
    sa+ e<&res!!"e s+n( :%'!na(e :%&re+n7 .7r7 o cone<!+ne "o$!c7 sa+ sens. Aceas(7 &er(+r'are s+rv!ne
    =n cadr+l &ro&o/!=!+n!! :n con(ras( c+ dera!erea, :n care &er(+r'area es(e :n(re &ro&o/!=!+n!. Aceas(a a
    .os( den+%!(7 +neor! dre&( Ssa"a(7 de c+v!n(eT &en(r+ a .ace c+nosc+( $rad+" de de/or$an!/are
    "!n$v!s(!c7. Cons(r+c=!!"e non$ra%a(!ca"e +Ooare sa+ +/a@e"e !d!o%a(!ce carac(er!s(!ce an+%!(or
    .ond+r! c+"(+ra"e sa+ re$!ona"e, "!&sa de ed+ca=!e sa+ $rad+" red+s de !n(e"!$en=7, n+ (re'+!e
    cons!dera(e !ncoeren=7. In $enera", (er%en+" n+ se a&"!c7 a(+nc! cAnd es(e ev!den( c7 &er(+r'area de
    "!%'a@ es(e da(ora(7 +ne! a.a/!!.
    Inso%n!e. Ac+/a s+'!ec(!v7 de d!.!c+"(a(e :n a ador%! sa+ :n a r7%Ane ador%!( or! de ca"!(a(e
    %ed!ocr7 a so%n+"+!. T!&+r!"e de !nso%n!e !nc"+dQ
    !nso%n!a !n!=!a"7Q d!.!c+"(a(e :n a ador%!8
    !nso%n!a %ed!an7Q deO(e&(are d!n so%n :n %!@"oc+" no&=!! +r%a(7 de o
    even(+a"7 reador%!re, dar d!.!c!"78
    !nso%n!a (er%!na"7Q deO(e&(are d!n so%n :na!n(e de ora +/+a"7 a &ersoane!
    s! !nca&ac!(a(ea de a reador%!.
    G9R Anexa

    Len(oare &s!o%o(or!e. :nce(!n!re $enera"!/a(7 v!/!'!"7 a %!Oc7r!"or s! vor'!r!!. Macro&s!e. Perce&=!e
    v!/+a"7, :n care o'!ec(e"e &ar a .! %a! %ar! decA( s+n( :n rea"!(a(e.
    Mecan!s% de a&7rare. Proces &s!o"o$!c a+(o%a( care &ro(e@a/7 !nd!v!d+" con(ra an<!e(7=!! s! de
    conO(!en(!/are a s(resor!"or sa+ &er!co"e"or !n(erne sa+ e<(erne. Mecan!s%e"e de a&7rare %ed!a/7
    reac=!a !nd!v!d+"+! "a con."!c(e"e e%o=!ona"e s! "a s(resor!! e<(ern!. Une"e %ecan!s%e de a&7rare Ede
    e<., &ro!ec=!a, sc!ndarea s! (recerea "a ac=!+neJ s+n( a&roa&e cons(an( de/ada&(a(!ve. A"(e"e, c+%
    ar .! s+&r!%area s! re.+/+", &o( .!, .!e de/ada&(a(!ve, .!e ada&(a(!ve, :n .+nc=!e de sever!(a(ea,
    !n."e<!'!"!(a(ea s! con(e<(+" :n care a&ar. De.!n!=!!"e %ecan!s%e"or de a&7rare s&ec!.!ce s! c+% (re'+!e
    s7 .!e :nre$!s(ra(e e"e +(!"!/And sca"a de .+nc=!onare a a&7r7r!!, s+n( &re/en(a(e "a &a$. GLH.
    Med!ca%en( a$on!s!. O en(!(a(e c!%!c7 e<(r!nsec7 &An7 "a s+'s(an=e &rod+se endo$en, care
    ac=!onea/7 as+&ra +n+! rece&(or s! es(e ca&a'!"7 s7 &rod+c7 %a<!%+%+" de e.ec( care &oa(e .!
    &rod+s &r!n s(!%+"area ace"+! rece&(or. Un a$on!s( &ar=!a" es(e ca&a'!" n+%a! de &rod+cerea +n+!
    e.ec( %a! &+=!n decA( %a<!%a", cAnd es(e ad%!n!s(ra( :n(r4o concen(ra=!e s+.!c!en(7 s&re a se "e$a
    c+ (o=! rece&(or!! d!s&on!'!"!.
    Med!ca%en( a$on!s(Xan(a$on!s(. O en(!(a(e c!%!c7 e<(r!nsec7 &An7 "a s+'s(an=e &rod+se endo$en,
    care ac=!onea/7 as+&ra +ne! .a%!"!! de rece&(or! Ec+% ar .! rece&(or!! o&!ace! %!+, de"(a s! )a&&aJ
    de o ase%enea %an!er7, c7 e" es(e +n a$on!s( sa+ a$on!s( &ar=!a" &en(r+ +n (!& de rece&(or O!
    an(a$on!s( &en(r+ +n a"(+".
    Med!ca%en( an(a$on!s(. O en(!(a(e c!%!c7 e<(r!nsec7 &An7 "a s+'s(an=e &rod+se endo$en care
    oc+&7 +n rece&(or, n+ &rod+c n!c! +n .e" de e.ec(e .!/!o"o$!ce s! :%&!ed!c7 s+'s(an=e"e c!%!ce
    endo$ene s! e<o$ene s7 &rod+c7 +n e.ec( as+&ra ace"+! rece&(or.
    M!cro&s!e. Perce&=!e v!/+a"7, :n care o'!ec(e"e &ar a .! %a! %!c! decA( s+n( :n rea"!(a(e.
    M!Oc7r! s(ereo(!&e. Co%&or(a%en( %o(or re&e(!(!v, ev!den( !%&+"s!v s! non.+nc=!ona" Ede e<.,
    sc+(+ra(+" sa+ +nd+!rea %A!n!"or, 'a"ansarea cor&+"+!, "ov!(+" c+ ca&+", a&+carea o'!ec(e"or c+
    $+ra, a+(o%+Ocarea, &!scarea (e$+%en(e"or sa+ a or!.!c!!"or cor&+"+!, "ov!rea &ro&r!+"+! cor&J.
    N!s(a$%+s. M!Oc7r! r!(%!ce !nvo"+n(are a"e oc!"or, cons(And d!n (re%+r7(+r! ra&!de de %!c7
    a%&"!(+d!ne :n(r4o d!rec=!e, s! o %!Ocare %a! a%&"7, "en(7, rec+ren(7, :n d!rec=!e o&+s7. N!s(a$%+s+"
    &oa(e .! or!/on(a", ver(!ca" sa+ ro(a(or.
    Paraso%n!e. Co%&or(a%en( anor%a" sa+ even!%en(e .!/!o"o$!ce s+rven!(e :n c+rs+" so%n+"+!
    sa+ a" (ran/!=!!"or so%n4v!$!"!(a(e.
    Persona"!(a(e. Par(ern+r! d+ra'!"e de &erce&ere, re"a=!onare s! $And!re des&re a%'!an=7 O! des&re
    s!ne. Tr6s6t+rile de personalitate s+n( as&ec(e &roe%!nen(e a"e &ersona"!(7=!! care s+n( &re/en(a(e :n(r4
    o "ar$7 $a%7 de con(e<(e soc!a"e s! &ersona"e !%&or(an(e. N+%a! cAnd (r7s7(+r!"e de
    &ersona"!(a(e s+n( !n."e<!'!"e O!
    Glosar de Termeni Te%nici
    =28

    de/ada&(a(!ve, s! ca+/ea/7, .!e de(er!orare .+nc=!ona"7 se%n!.!ca(!v7, .!e de(res7 s+'!ec(!v7,
    cons(!(+!e o (+"'+rare de &ersona"!(a(e.
    Prodro%. Se%n sa+ s!%&(o% &re%on!(or sa+ &recoce a" +ne! (+"'+r7r!. Ps!o%o(or!e,
    A$!(a=!e. 3e/! a$!(a=!a.
    Ps!o(!c. Is(or!c, aces( (er%en a &r!%!( +n n+%7r de de.!n!=!! d!.er!(e, d!n(re care n!c! +na n+ a .os(
    +n!versa" acce&(a(7. Cea %a! :n$+s(7 de.!n!=!e a psi-otic+l+i es(e res(rAns7 "a !de! de"!ran(e sa+ "a
    a"+c!na=!! no(a'!"e, c+ a"+c!na=!! s+rven!nd :n a'sen=a conO(!en(!/7r!! na(+r!! "or &a(o"o$!ce. O
    de.!n!=!e +Oor %a! &+=!n res(r!c(!v7 !nc"+de s! a"+c!na=!! no(a'!"e &e care !nd!v!d+" "e conO(!en(!/ea/7 ca
    .!!nd e<&er!en=e a"+c!na(or!!. Ma! "ar$7 :nc7, es(e de.!n!=!a care !nc"+de, de ase%enea, s! a"(e
    s!%&(o%e &o/!(!ve de sc!/o.ren!e Ead!c7, "!%'a@+" de/or$an!/a(, co%&or(a%en(+" ca(a(on!c sa+
    $ros!er de/or$an!/a(J. Con(rar aces(or de.!n!=!! 'a/a(e &e s!%&(o%e, de.!n!=!!"e +(!"!/a(e :n DSM4II O!
    CIM4F era+ &ro'a'!", de de&ar(e, &rea !nc"+s!ve O! cen(ra(e &e sever!(a(ea de(er!or7r!! .+nc=!ona"e,
    as(.e" c7 o (+"'+rare %en(a"7 era e(!ce(a(7 ca psi-otic6, dac7 d+cea "a So de(er!orare care !n(er.era c+
    ca&ac!(a(ea de a sa(!s.ace e<!$en=e"e nor%a"e a"e v!e=!!T, :n ce"e d!n +r%7, (er%en+" a .os( de.!n!(
    conce&(+a" ca o &!erdere a "!%!(e"or e+"+! sa+ ca o de(er!orare ."a$ran(7 a (es(7r!! rea"!(7=!!. Pe 'a/a
    e"e%en(e"or "or carac(er!s(!ce, d!.er!(e"e (+"'+r7r! d!n DSM4I3 s+'"!n!a/7 as&ec(e d!.er!(e a"e
    d!verse"or de.!n!=!! a"e ps)liotic+l+i7
    Ro"+" se<+"+!. A(!(+d!n!, &a((ern+r! de co%&or(a%en( s! a(r!'+(e a"e &ersona"!(7=!! de.!n!(e de
    c+"(+ra :n care (r7!eO(e &ersoana ca .!!nd ro"+r! soc!a"e consacra(e ca S%asc+"!neT sa+ S.e%!n!neT.
    Se%n. Man!.es(are o'!ec(!v7 a +ne! cond!=!! &a(o"o$!ce. Se%ne"e s+n( o'serva(e %a! c+rAnd de
    e<a%!na(or decA( re"a(a(e de !nd!v!d+" a.ec(a(.
    Se<. S(a(+s+" '!o"o$!c a" +ne! &ersoane ca '7r'a(, .e%e!e sa+ !ncer(, :n .+nc=!e de c!rc+%s(an=e,
    aceas(7 &rec!/are &oa(e .! 'a/a(7 &e as&ec(+" or$ane"or $en!(a"e e<(erne sa+ &e )ar!o(!&.
    S!%&(o%. Man!.es(are s+'!ec(!v7 a +ne! cond!=!! &a(o"o$!ce. S!%&(o%e"e s+n( ra&or(a(e %a! c+rAnd
    de !nd!v!d+" a.ec(a( decA( o'serva(e de e<a%!na(or.
    S!%&(o% de convers!e. P!erdere sa+ a"(erare a ac(!v!(7=!! %o(or!! vo"+n(are sa+ sen/or!a"e
    s+$erAnd o cond!=!e ne+ro"o$!c7 sa+ %ed!ca"7 $enera"7. Fac(or!! &s!o"o$!c! s+n( cons!dera=! a .!
    asoc!a=! c+ de/vo"(area s!%&(o%+"+!, !ar s!%&(o%+" n+ es(e e<&"!ca( &e de&"!n de o cond!=!e
    ne+ro"o$!c7 sa+ %ed!ca"7 $enera"7 or! de e.ec(e"e d!rec(e a"e +ne! s+'s(an=e. S!%&(o%+" n+ es(e
    &rod+s !n(en=!ona" sa+ s!%+"a( O! n+ es(e sanc=!ona( c+"(+ra".
    S!ndro%. ,r+&are de se%ne sa+ s!%&(o%e &e 'a/a coa&ar!=!e! "or .recven(e, ceea ce &oa(e s+$era o
    &a(o$ene/7 s+'!acen(7, evo"+=!e, &a((ern .a%!"!a" sa+ se"ec=!e a (ra(a%en(+"+! co%+n7.
    =2= Anexa

    S!nes(e/!e. Cond!=!e :n care o e<&er!en=7 sen/or!a"7 asoc!a(7 c+ o %oda"!(a(e s+rv!ne cAnd es(e
    s(!%+"a(7 a"(7 %oda"!(a(e, de e<e%&"+, +n s+ne( &rod+ce sen/a=!a +ne! an+%!(e c+"or!.
    S(resor &s!osoc!a". Or!ce even!%en( de v!a=7 sa+ sc!%'are de v!a=7 care &oa(e .! asoc!a( (e%&orar
    EO! &oa(e c7 O! ca+/a"J c+ de'+(+", s+rven!rea sa+ e<acer'area +ne! (+"'+r7r! %en(a"e.
    S(+&or. S(are de nonreac(!v!(a(e c+ !%o'!"!(a(e O! %+(!s%.
    T!c. M!Ocare %o(or!e sa+ voca"!/are s(ereo(!&7, nonr!(%!c7, rec+ren(7, ra&!d7, 'r+sc7,
    !nvo"+n(ar7.
    Transe<+a"!s%. D!s.or!e se<+a"7 sever7, c+&"a(7 c+ dor!n=a &ers!s(en(7 de a avea carac(er!s(!c!"e
    .!/!ce O! ro"+r!"e soc!a"e &e care "e !%&"!c7 se<+" '!o"o$!c o&+s.
    Ane,a D
    *videnierea modi$icrilor
    din DSM-IV Text +evi(uit
    ceas(a ane<7 o.er7 o vedere $enera"7 as+&ra %od!.!c7r!"or .7c+(e (e<(+"+!.
    De re=!n+( c7 ceea ce +r%ea/7 n+ es(e +n $!d e<a+s(!v, %od!.!c7r!"e
    :n redac(are .7c+(e &en(r+ c"ar!(a(ea s! e<(!nderea sec=!+n!"or de
    d!a$nos(!c d!.eren=!a" a"e (e<(+"+! ne.!!nd !nc"+se a!c!. De ase%enea,
    (re'+!e no(a( c7 %a@or!(a(ea &ara$ra.e"or DSM4I3 n+ a+ .os( rev!/+!(e,
    ceea ce !nd!c7 .a&(+" c7, c!ar d+&7 reeva"+area "!(era(+r!!, ce"e %a!
    %+"(e !n.or%a=!! d!n (e<(+" or!$!na" r7%An ac(+a"e.
    In(rod+cere. A+ .os( ad7+$a(e %a! %+"(e &ara$ra.e descr!!nd &roces+" de
    rev!/+!re a (e<(+"+! DSM4I3 O! a .os( ad7+$a( +n (e<( s+&"!%en(ar :n sec=!+nea
    +/+"+! ra=!ona%en(+"+! c"!n!c re.er!(or "a !%&or(an=a %e(ode! de co"ec(are a da(e"or
    :n a s(a'!"! .a&(+" dac7 a+ .os( sa(!s.7c+(e cr!(er!!"e de d!a$nos(!c.
    Eva"+area %+"(!a<!a"7. A+ .os( e<(!nse cons!dera'!" !ns(r+c=!+n!"e &en(r+
    e.ec(+area +ne! eva"+7r! c+ ,"o'a" Assess%en( o. F+nc(!on!n$. A+ .os( ad7+$a(e
    co%en(ar!! re.er!(oare "a a&"!carea ,AF "a &er!oada c+ren(7 s! "a s(r+c(+ra
    s+'!acen(7 a sca"e! Ead!c7, .!ecare e"e%en( are o co%&onen(7 s!%&(o%a(o"o$!c7 s!
    +na .+nc=!ona"7 J. :n .!na" es(e &rev7/+(7 o %e(od7 :n &a(r+ (re&(e s&re a $aran(a
    .a&(+" c7 n!c! +n e"e%en( a" sca"e! ,AF n+ es(e o%!s cAnd se .ace o eva"+are ,AF.
    Tul-ur(rile $ia/no&ti#ate $e re/ul(
    pentru pri"a $at( .n perioa$a $e &u/ar2
    .n #opil(rie &au .n a$ole&#en!(
    Re(ardarea %en(a"7. A+ .os( ad7+$a(e !n.or%a=!! s+&"!%en(are :n "e$7(+r7 c+
    asoc!erea an+%!(or .ac(or! e(!o"o$!c! s! s!%&(o%e O! (+"'+r7r! co%or'!de Ede e<.,
    s!ndro%+" > .ra$!" s! (+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!eJ.
    T+"'+r7r!"e de co%+n!care. A .os( ad7+$a( +n (e<( s&re a !nd!ca .a&(+" c7 o
    eva"+are co%&"e(7 a a&(!(+d!n!! "!n$v!s(!ce a !nd!v!d+"+! &oa(e .! .7c+(7 s! a(+nc!
    cAnd (es(e"e s(andard!/a(e n+ s+n( d!s&on!'!"e sa+ s+n( necores&+n/7(oare Ede e<.,
    &en(r+ c7 (es(e"e d!s&on!'!"e a+ .os( s(andard!/a(e &e +n n+%7r red+s de !nd!v!/!J.
    A+ .os( ac(+a"!/a(e sec=!+n!"e &reva"en(e! s! evo"+=!e! &en(r+ (+"'+rarea de "!%'a@
    e<&res!v, (+"'+rarea %!<(7 de "!%'a@ e<&res!v s! rece&(!v s! (+"'+rarea .ono"o$!c7,
    &rec+% O! sec=!+nea evo"+=!e! &en(r+ 'a"'!s%.
    G9F
    >4+ Anexa D
    T+"'+rarea a+(!s(7. A .os( %od!.!ca( (e<(+" d!n sec=!+nea e"e%en(e"or de
    d!a$nos(!c s&re a scoa(e :n ev!den=7 d!.!c+"(7=!"e d!n as&ec(e"e &ra$%a(!ce a"e
    "!%'a@+"+!, care s+n( e<(re% de re"evan(e :n e<a%!narea .+nc=!on7r!! "a n!ve"
    s+&er!or a !nd!v!/!"or, :n a.ar7 de aceas(a, a+ .os( ad7+$a(e e<e%&"e %a! e"ocven(e
    de &a((ern+r! de co%&or(a%en(, &reoc+&7r! s! ac(!v!(7=! s(ereo(!&e, re&e(!(!ve s!
    res(rAnse. De ase%enea, a .os( %od!.!ca( (e<(+" s&re a !"+s(ra .a&(+" c7 :n &An7 "a o
    A
    N'lSice
    c!nc!%e d!n ca/+r!, &7r!n=!! ra&or(ea/7 res(ros&ec(!v o de/vo"(are re"a(!v nor%a"7
    &en(r+ &r!%!! " sa+ 9 an!. A .os( ac(+a"!/a(7 sec=!+nea de.!c!(e"or co$n!(!ve s! a
    cond!=!!"or %ed!ca"e $enera"e asoc!a(e. M7r!%ea va"or!"or &reva"en(e! a .os(
    rev!/+!(7 &en(r+ a !"+s(ra .a&(+" c7 +n n+%7r de s(+d!! %a! recen(e a+ s+$era( o
    &reva"en(7 %a! %are. :n sec=!+nea &a((ern+"+! .a%!"!a" a+ .os( ad7+$a(e !n.or%a=!!
    %a! &rec!se re.er!(oare "a r!sc+" de %or'!d!(a(e a" .ra=!"or.
    T+"'+rarea Re((. A .os( ad7+$a( +n (e<( re.er!(or "a .a&(+" c7 +ne"e ca/+r! de
    (+"'+rare Re(( s+n( asoc!a(e c+ o %+(a=!e $ener!c7 &rec!s7 .
    T+"'+rarea As&er$er. D!n ca+/a &+=!ne"or da(e d!s&on!'!"e re.er!(oare "a aceas(7
    (+"'+rare no+ !n(rod+s7, (e<(+" DSM4I3 &en(r+ (+"'+rarea As&er$er o.er7 &+=!n
    %a! %+"( decA( re.or%+"area cr!(er!!"or de d!a$nos(!c, :n consec!n=7, (e<(+" &en(r+
    (+"'+rarea As&er$er a .os( "ar$ rev!/+!(. S+n( o.er!(e e<e%&"e de %an!.es(are a
    de(er!or7r!! (!&!ce :n !n(rerac(!+nea soc!a"7 rec!&roc7 s! :n co%&or(a%en(+" s!
    &reoc+&7r!"e re&e(!(!ve s! res(rAnse s&re a d!.eren=!a %a! '!ne aceO(! !nd!v!/! de ce!
    c+ (+"'+rare a+(!s(7, :n &"+s, a .os( ad7+$a( +n (e<( s&re a &rec!/a .a&(+" c7 cer!n=a
    &en(r+ n!c! +n .e" de :n(Ar/!er! se%n!.!ca(!ve :n "!%'a@ n+ &res+&+ne s! c7 !nd!v!/!!
    c+ (+"'+rare As&er$er n+ a+ n!c! +n .e" de &ro'"e%e de co%+n!care. Sec=!+n!"e
    e"e%en(e"or s! (+"'+r7r!"or asoc!a(e, evo"+=!e! s! d!a$nos(!c+"+! d!.eren=!a" a+ .os(
    e<(!nse cons!dera'!" s! a .os( ad7+$a(7 o sec=!+ne &en(r+ e"e%en(e"e s&ec!.!ce e(7=!!.
    T+"'+rarea de de/vo"(are &ervas!v7 FS. De.!n!=!a a .os( %od!.!ca(7 &en(r+ a
    corec(a eroarea care &er%!(ea ca. aces( d!a$nos(!c s7 .!e &+s acc!den(a" :n ca/+r! :n
    care e<!s(7 o de(er!orare &ervas!v7 doar :n(r4+n s!n$+r do%en!+ de de/vo"(are
    Ead!c7, :n de/vo"(area !n(erac=!+n!! soc!a"e rec!&roce, :n a&(!(+d!n!"e de co%+n!care,
    co%&or(a%en(e"e, &reoc+&7r!"e sa+ ac(!v!(7=!"e s(ereo(!&eJ. De.!n!=!a cere ac+% s7
    e<!s(e o de(er!orare :n !n(erac=!+nea soc!a"7 rec!&roc7, aceas(a .!!nd asoc!a(7 c+ o
    de(er!orare :n a&(!(+d!n!"e de co%+n!care sa+ c+ &re/en=a de co%&or(a%en(e,
    &reoc+&7r! sa+ ac(!v!(7=! s(ereo(!&e.
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e. M+"(e d!n(re %od!.!c7r! !"+s(rea/7
    d!.eren=e"e d!n(re s+'(!&+r!. De e<e%&"+, !nd!v!/!! c+ (!&+r!"e &redo%!nan( !na(en(
    s! co%'!na( (!nd a &re/en(a de.!c!(e Oco"are s! &ro'"e%e :n "e$7(+r7 c+ Ocoa"a, &e
    cAnd ce! c+ (!&+" &redo%!nan( !%&+"s!v4!&erac(!v (!nd a .! %a! re@ec(a=! de e$a"! s!
    a s+.er! !n@+r!! acc!den(a"e. Ra(a se<+"+! es(e %a! &+=!n &redo%!nan( %asc+"!n7 "a
    (!&+" &redo%!nan( !na(en(. S+n( !nc"+se !n.or%a=!! s+&"!%en(are des&re e"e%en(e"e
    asoc!a(e Ede e<., var!a'!"!(a(e :n DI, &re/en=a d!scord!e! .a%!"!a"eJ s! des&re
    e"e%en(e"e s&ec!.!ce e(7=!! E:n s&ec!a", (+"'+rarea !&erac(!v!(a(eXde.!c!( de
    a(en=!e "a ad+"=!J. Es(!%area &reva"en(e! a .os( rev!/+!(7 a+$%en(a(!v, re."ec(And
    creO(erea &reva"en(e! da(ora(7 !nc"+der!! (!&+r!"or &redo%!nan( !%&+"s!v
    !&erac(!v s! &redo%!nan( !na(en( :n DSM4I3.
    *videnierea modi$icrilor din DSM-IVText
    +evi(uit
    >4*
    T+"'+rarea de cond+!(7. A .os( e<(!ns7 "!s(a .ac(or!"or de r!sc &en(r+ de/vo"(area
    (+"'+r7r!! de cond+!(7. Re"a=!a d!n(re o&o/!=!on!s%+" &rovoca(or s! de/vo"(area
    +"(er!oar7 a (!&+"+! de (+"'+rare de cond+!(7 c+ de'+( :n co&!"7r!e es(e %en=!ona(7
    :n sec=!+nea evo"+=!e!. 2
    T+"'+rarea o&o/!=!on!s%+" &rovoca(or. Sec=!+nea evo"+=!e a (e<(+"+! &rec!/ea/7
    .a&(+" c7 deO! ca/+r! de (+"'+rare de cond+!(7 c+ de'+( :n co&!"7r!e s+n( &receda(e
    adesea de (+"'+rarea o&o/!=!on!s%+" &rovoca(or, %+"=! co&!! c+ aceas(7 (+"'+rare
    n+ vor a@+n$e s7 &re/!n(e (+"'+rare de cond+!(7 .
    P!ca. S+n( &rev7/+(e da(e re.er!(oare "a &reva"en(7, s! es(e %en=!ona(7
    co%or'!d!(a(ea c+ (+"'+r7r!"e &ervas!ve de de/vo"(are.
    T+"'+rarea de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!. A+ .os(
    .7c+(e %od!.!c7r! :n sec=!+n!"e &reva"en(e! Ees(e %en=!ona(7 &reva"en(a :n
    co%+n!(a(eJ s! evo"+=!e! E&ers!s(en=a (a"!e! O! $re+(7=!! sc7/+(e :n ado"escen=7
    co%&ara(!v c+ e$a"!!J.
    T!c+r!"e. A .os( corec(a( se(+" de cr!(er!! a" DSM4I3 &en(r+ (!c+r! &r!n e"!%!narea
    cer!n=e! de Sde(er!orare sa+ de(res7 se%n!.!ca(!v7 c"!n!cT care era ad7+$a(7 "a
    %a@or!(a(ea (+"'+r7r!"or DSM4I3 E&r!n(re care O! "a (!c+r!J. Aces( cr!(er!+ era
    &ro'"e%a(!c :n (!c+r! &en(r+ %a! %+"(e %o(!ve, c+% ar .! .a&(+" c7 venea :n
    con(rad!c=!e c+ e<&er!en=a c"!n!c7 E%+"=! co&!! c+ (+"'+rarea To+re((e n+ &re/!n(7
    de(res7 sa+ de(er!orareJ O! c7 :%&!ed!ca cerce(area e&!de%!o"o$!c7 s! s(+d!!"e
    .a%!"!a"e. A"(e %od!.!c7r! a"e (e<(+"+! !nc"+d o descr!ere e<(!ns7 a (!&+r!"or de (!c+r!,
    o e<(!ndere a sec=!+n!! d!a$nos(!c+"+! d!.eren=!a" Ead!c7, a d!.eren=!er!! d!n(re (!c+r!
    s! a"(e (!&+r! de %!Oc7r!J, &rec+% O! a sec=!+n!"or e"e%en(e O! (+"'+r7r! asoc!a(e
    E!nc"+/And &a((ern+r!"e de co%or'!d!(a(eJ, e"e%e%en(e s&ec!.!ce e(7=!! Era(a
    se<+"+!J, &reva"en(7, evo"+=!e O! &a((ern .a%!"!a" a"e (+"'+r7r!! To+re((e.
    Enco&re/!s+". Enco&re/!s+" c+ cons(!&a=!e .+nc=!ona"7 es(e .or%a cea %a!
    .recven(7. Te<(+" re.er!(or "a &red!s&o/!=!!"e .!/!o"o$!ce "a cons(!&a=!e a .os( ac(+a"!/a(
    s! e<(!ns.
    En+re/!s+". A+ .os( ad7 +$a(e no! !n.or%a=!! des&re %ecan!s%e"e s+'!acen(e
    (!&+"+! e<c"+s!v d!+rn. A+ .os( ac(+a"!/a(e sec=!+n!"e, e"e%en(e O! (+"'+r7r! asoc!a(e
    E:n s&ec!a", .ac(or!! &red!s&o/an=!J, &reva"en(7 O! &a((ern .a%!"!a".
    An<!e(a(ea de se&arare. A+ .os( ac(+a"!/a(e sec=!+n!"e &reva"en(7 O! evo"+=!e
    &en(r+ a !nd!ca .a&(+" c7 e<!s(7 o red+cere a &reva"en(e! %er$And d!n co&!"7r!e s&re
    ado"escen=7 s! c7 ce! %a! %+"=! co&!! c+ an<!e(a(e de se&arare n+ %a! &re/!n(7
    (+"'+rarea :n s(+d!!"e ca"d!sr+!cs(!ce e<(!nse.
    T+"'+(area reac(!v7 de a(aOa%en(. A+ .os( ac(+a"!/a(e sec=!+n!"e SE"e%en(e s!
    (+"'+r7r! asoc!a(eT E.ac(or!! de r!sc, c+% ar .! ne$"!@en=a e<(re%7 s! os&!(a"!s%+"J O!
    evo"+=!e E&ers!s(en=a soc!a'!"!(7=!! !nd!scr!%!na(!veJ.
    T+"'+rarea de %!Ocare s(ereo(!&7. P!Oca(+" &a(o"o$!c a" (e$+%en(e"or a .os(
    :n"7(+ra( d!n "!s(a de e<e%&"e 4 as(.e" de ca/+r! (re'+!nd s7 .!e d!a$nos(!ca(e ca
    >4C Anexa D

    (+"'+rare a con(ro"+"+! !%&+"s+"+! FS. A .os( %od!.!ca(7 sec=!+nea e"e%en(e s!
    (+"'+r7r! asoc!a(e Eres&ec(!v, &rec!/area .a&(+"+! c7 (+"'+rarea &oa(e s+rven! s! "a
    !nd!v!/! .7r7 :n(Ar/!ere :n de/vo"(areJ.
    Deliriu"ul2 $e"en!a2 tul-ur(rile a"n#Y2.i#e &i
    alte tul-ur(ri #o/nitive
    De"!r!+%+". Sec=!+nea e"e%en(e"or s! (+"'+r7r!"or asoc!a(e a .os( %od!.!ca(7
    &en(r+ a scoa(e :n ev!den=7 &re/en=a a do+7 var!e(7=! de de"!r!+%, !&erac(!v s!
    !&oac(!v. A .os( ad7+$a(, de ase%enea, (e<( :n sec=!+nea e"e%en(e"or s&ec!.!ce
    se<+"+!, e(7=!! s! c+"(+r!! &en(r+ a !"+s(ra cons(a(area c7 e(a(ea avansa(7 cons(!(+!e +n
    .ac(or de r!sc &en(r+ de"!r!+% :n d!verse s(+d!! &o&+"a=!ona"e, c!ar d+&7 ce a"=!
    .ac(or! de r!sc Ec+% ar .! o %a"ad!e conco%!(en(7J se a."7 s+' con(ro". Da(e des&re
    &reva"en(a de"!r!+%+"+! "a d!verO! !nd!v!/! s+.er!nd de a.ec=!+n! %ed!ca"e s+n(
    d!s&on!'!"e ac+% Ede e<., &:n7 "a RLd d!n(re re/!den=!! +n+! c7%!n de '7(rAn! :n
    e(a(e de HY an! sa+ &es(e &o( &re/en(a de"!r!+%J. I%&or(an(a rec+noaO(er!! O! (ra(7r!!
    &recoce a de"!r!+%+"+! es(e s+'"!n!a(7 :n adaos+r!"e s+'s(an=!a"e d!n sec=!+nea
    evo"+=!e! a (e<(+"+! Ede e<., !nd!v!/!! c+ o .+nc=!onare so%a(!c7 s! co$n!(!v7
    &re%or'!d7 %a! '+n7 a+ o rec+&erare %a! '+n7 J.
    De"!r!+%+" da(ora( +ne! cond!=!! %ed!ca"e $enera"e. L!s(a cond!=!!"or %ed!ca"e
    $enera"e asoc!a(e a .os( reor$an!/a(7 s! ac(+a"!/a(7 .
    De"!r!+%+" !nd+s de o s+'s(an=7. A .os( co%&"e(a( (e<(+" &en(r+ a &rec!/a
    .a&(+" c7 de'+(+" s! re%!(erea de"!r!+%+"+! &o( .! a.ec(a(e de d!verO! .ac(or!, c+% ar
    .! "e/!+n!"e cere'ra"e, e(a(ea avansa(7, se%!v!a=a s+'s(an=e"or, &re/en=a a %a! %+"(e
    s+'s(an=e s! c"earence4+" red+s.
    De%en(a. E<!s(7 cod+r! d!a$nos(!ce no! &en(r+ de%en=e Ec+ e<ce&=!a ce"e!
    vasc+"are, a" c7re! cod a r7%as nesc!%'a(J. Cod+" &en(r+ (oa(e (!&+r!"e de de%en=e
    Ec+ e<ce&=!a ce"e! vasc+"areJ es(e 9FI.5L dac7 s+'(!&+" es(e S.7r7 (+"'+r7r! de
    co%&or(a%en(T s! 9FI.55, dac7 s+'(!&+" es(e Sc+ (+"'+r7r! de co%&or(a%en(T..
    S+'(!&+r!"e cod!.!ca'!"e care se a&"!ca+ an(er!or (!&+"+! de de%en=7 A"/e!%er Ede
    e<., c+ d!s&o/!=!e de&res!v7J n+ se %a! +(!"!/ea/7, :n sc!%', (+"'+rarea %en(a"7
    cores&+n/7(oare da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e Ede e<., 9F;.G;. T+"'+rare
    a.ec(!v7 da(ora(7 nv*ad!e! A"/e!%erJ (re'+!e cod!.!ca(7 &e a<a I. D!n ca+/a
    conven=!!"or de cod!.!care a"e ICD4F4CM, cod+r!"e s! s+'(!&+r!"e de%en=e! vasc+"are
    a+ r7%as ne%od!.!ca(e. .
    L!s(a ca+/e"or de%en=e! a .os( ac(+a"!/a(7 s&re a re."ec(a .a&(+" c7 cea %a!
    .recven(7 ca+;6, d+&7 de%en=a A"/e!%er, es(e +n a"( &roces ne+rode$enera(!v,
    c+% ar .! %a"ad!a c+ cor&+sc+"! Levy sa+ de$enerarea .ron(o(e%&ora"7 4 do+7
    e(!o"o$!! care n+ s+n( "!s(a(e ca a(are :n DSM4I3. A+ .os( ac(+a"!/a(e va"or!"e
    &reva"en(e! &en(r+ a !"+s(ra ce"e %a! no! da(e e&!de%!o"o$!ce Eres&ec(!v, 5,Yd
    &en(r+ !nd!v!/!! :n e(a(e de RY4RF an! O! crescAnd "a 5Rd49Yd &en(r+ ce! :n e(a(e de
    &es(e ;Y an!J.
    De%en=a de (!& A"/e!%er. DeO! a+ .os( .7c+(e e.or(+r! cons!dera'!"e :n
    &er.ec=!onarea %ar)er!"or '!o"o$!c! &en(+ de%en=a A"/e!%er, n!c! +n+" d!n(re
    aceO(! %ar)er! n+ a .os( acce&(a( &es(e (o(. :n s+'sec=!+nea da(e"or de "a'ora(or
    *videnierea modi$icrilor din DSM-IV Text
    +evi(uit
    >44
    asoc!a(e Eca s! :n sec=!+nea d!a$nos(!c d!.eren=!a" a de%en=e!J .os( ad7+$a( +n (e<( :n
    care se rec+noaO(e c7 de%en=a A"/e!%er r7%Ane +n d!a$nos(!c de e<c"+dere.
    Sec=!+nea evo"+=!e! a .os( ac(+a"!/a(7 s&re a !"+s(ra a&ar!=!a %od!.!c7r!"or de
    &ersona"!(a(e. Preva"en(a es(!%a(7 a .os( rev!/+!(7 &e 'a/a ra&or(+"+! "+! Un!(ed
    S(a(es ,enera" Acco+n(!n$ d!n 5FFG, re.er!(or "a &reva"en(a %a"ad!e! A"/e!%er. :n
    .!na", sec=!+nea &a((ern+"+! .a%!"!a" a .os( ac(+a"!/a(7 s&re a re."ec(a da(e"e c+ren(e
    des&re "!n)a@+" cro%o/o%!a" s! ro"+" %ar)er+"+! $ene(!c APOEI ca .ac(or de r!sc
    &en(r+ a&ar!=!a ca/+r!"or c+ de'+( (ard!v.
    De%en=a da(ora(7 %a"ad!e! Par)!nsonXde%en=a da(ora(7 %a"ad!e! P!c). Do+7
    d!n(re ce"e %a! .recven(e .or%e de de%en=7 s+n( de%en=a c+ cor&+sc+"! Levy Ed!n
    care +n e<e%&"+ es(e de%en=a da(ora(7 %a"ad!e! Par)!nsonJ s! de%en=a
    .ron(o(e%&ora"7 Ed!n care +n e<e%&"+ es(e de%en=a da(ora(7 %a"ad!e! P!c)J. DeO!
    e<!s(7 !ns+.!c!en(e &ro'e &en(r+ a @+s(!.!ca o reor$an!/are rad!ca"7 a aces(e! sec=!+n!,
    a .os( ad7+$a( +n (e<( :n sec=!+n!"e de%en=e! da(ora(e a"(or cond!=!! %ed!ca"e
    $enera"e, de%en=e! da(ora(e %a"ad!e! Par)!nson s! de%en=e! da(ora(e %a"ad!e! P!c)
    s&re a &rec!/a %od+" :n care (re'+!e c"as!.!ca(e as(.e" de ca/+r!.
    De%en=a da(ora(7 %a"ad!e! Cre+(/.e"d(4*a)o'. A .os( ad7+$a( +n (e<( re.er!(or
    "a (rans%!s!a !n(ers&ec!! a !n.ec=!!"or &r!on!ce, !"+s(ra( de a&ar!=!a var!an(e! +%ane a
    ence.a"o&a(!e! s&on$!.or%e 'ov!ne :n Re$a(+" Un!( "a %!@"oc+" an!"or 5FFL.
    Tul-ur(rile "entale $atorate
    unei #on$i!ii "e$i#ale /enerale
    Mod!.!carea de &ersona"!(a(e da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. A .os(
    .7c+(7 o %od!.!care s&re a corec(a o eroare d!n cr!(er!+" de e<c"+dere, care n+
    &er%!(e ca d!a$nos(!c+" de %od!.!care de &ersona"!(a(e da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e s7 .!e &+s co%or'!d c+ d!a$nos(!c+" de de%en=7. Aces( cr!(er!+
    era +n re&or( .or(+!( d!n DSM4III4R, care e<c"+dea %od!.!carea de &ersona"!(a(e :n
    &re/en=a de%en=e!, deoarece %od!.!carea de &ersona"!(a(e era !nc"+s7 :n cr!(er!!"e de
    d!a$nos(!c &en(r+ de%en=7. S!%&(o%e"e se%n!.!ca(!ve c"!n!c care s+rv!n :n c+rs+"
    de%en=e! s+n( d!a$nos(!ca(e &r!n cod!.!carea (+"'+r7r!! %en(a"e s&ec!.!ce da(ora(e
    +ne! cond!=!! %ed!ca"e $enera"e &e a<a I, a"7(+r! de de%en=7. AOadar, aceas(7
    e<c"+dere a .os( :n"7(+ra(7, &er%!=And, de e<e%&"+, ca +n+! !nd!v!d c+ %a"ad!e
    A"/e!%er, care de/vo"(7 o (+"'+rare de &ersona"!(a(e s74! &oa(7 .! &+s d!a$nos(!c+"
    co%or'!d de %od!.!care de &ersona"!(a(e da(ora(7 %a"ad!e! A"/e!%er.
    Tul-ur(rile .n le/(tur( #u o &u-&tan!(
    De&enden=a de o s+'s(an=7. A .os( ac(+a"!/a(7 sec=!+nea e"e%en(e"or Ede
    d!a$nos(!cJ &en(r+ a !nd!ca .a&(+" c7 "a e.ec(e d!.er!(e a"e s+'s(an=e! as+&ra
    s!s(e%+"+! nervos cen(ra" &o( a&are d!verse $rade de (o"eran=7, c7 (o"eran=a &oa(e
    s+rven! s! "a &encyc"!d!n7 s! c7 +n !s(or!c an(er!or de (o"eran=7 sa+ de a's(!nen=7 se
    asoc!a/7 c+ o evo"+=!e c"!n!c7 de.avora'!"7 Ede e<., de'+( &recoce, n!ve"e r!d!ca(e de
    a&or( de s+'s(an=7 s! +n n+%7r %a! %are de &ro'"e%e :n "e$7(+r7 c+ o s+'s(an=7J.
    Sec=!+n!"e de &a((ern .a%!"!a" &en(r+ de&enden=7 Xa'+/X!n(o<!ca=!eXa's(!nen=7.
    A .os( ac(+a"!/a( (e<(+" s&re a &rec!/a .a&(+" c7 !nd!v!/!! care s+n( e<&+O! +n+! r!sc
    cresc+( de de&enden=7 a"coo"!c7 d!n ca+/a +n+! !s(or!c .a%!"!a" de de&enden=7
    >47 Anexa D

    a"coo"!c7 n+ &re/!n(7 :n %od necesar +n r!sc cresc+( de de/vo"(are a de&enden(7 de
    a"(e s+'s(an=e.
    T+"'+r7r!"e !nd+se de o s+'s(an=7. A+ .os( ad7+$a(e e<e%&"e care s7 c"ar!.!ce
    cAnd es(e !nd!ca( s7 se d!a$nos(!ce/e !n(o<!ca=!a c+ o s+'s(an=7 sa+ a's(!nen=a de
    o s+'s(an=7 :n "oc+" (+"'+r7r!! !nd+se de o s+'s(an=7 c+ de'+( :n c+rs+" !n(o<!ca=!e!
    sa+ c+ de'+( :n c+rs+" a's(!nen=e!.
    T+"'+r7r!"e :n "e$7(+r7 c+ a"coo"+". A .os( ac(+a"!/a(7 sec=!+nea e"e%en(e"or s!
    (+"'+r7r!"or asoc!a(e Ede e<., r!sc+" de acc!den(e :n "e$7(+r7 c+ a"coo"+",
    co%or'!d!(a(ea :n "e$7(+r7 c+ a"(e (+"'+r7r!J. A .os( ad7+$a( +n co%en(ar!+ re.er!(or
    "a (es(+" de "a'ora(or a" car'oydra(e de.!c!en( rrans.err!n ECDTJ, +n %ar)er de
    s(are "ar$ +(!"!/a( &en(r+ '7+(+" e<ces!v, :n sec=!+nea e"e%en(e"or s&ec!.!ce se<+"+!,
    e(7=!! s! c+"(+r!!, a .os( e<(!ns (e<(+" re.er!(or "a ra(e"e red+se de de&enden=7 "a
    as!a(!c! s! ce" re.er!(or "a evo"+=!a c"!n!c7 "a .e%e!. A .os( e<(!ns s! reac(+a"!/a( (e<(+"
    re.er!(or "a &reva"en(a +/+"+! de a"coo", "a co%&"!ca=!!"e :n "e$7(+r7 c+ a"coo"+" s! "a
    de&enden=a a"coo"!c7 .
    T+"'+r7r!"e :n "e$7(+r7 c+ a%.e(a%!na sa+ c+ s+'s(an=e"e s!%!"are
    a%.e(a%!ne!. A .os( ac(+a"!/a( s! e<(!ns (e<(+" re.er!(or "a &reva"en(a +/+"+! de
    a%.e(a%!na "a d!.er!(e $r+&e de e(a(e s! (e<(+" re.er!(or "a &reva"en(a de&enden=e!.
    T+"'+r7r!"e :n "e$7(+r7 c+ ca.e!na. A .os( e<(!ns7 sec=!+nea e"e%en(e"or s&ec!.!ce
    se<+"+!, e(7=!! s! c+"(+r!! s&re a !nc"+de !n.or%a=!! des&re sens!'!"!(a(ea cresc+(7 a
    '7(rAn!"or "a e.ec(e"e ca.e!ne!. A .os( ad7+$a(7 o sec=!+ne des&re &reva"en(7 care
    descr!e &a((ern+r!"e +/+"+! de ca.e!na, !ar sec=!+nea evo"+=!e! a .os( e<(!ns7.
    T+"'+r7r!"e :n "e$7(+r7 c+ canna'!s+". :n sec=!+nea !n(rod+c(!va a+ .os(
    ad7+$a(e !n.or%a=!! "a /! re.er!(oare "a %ecan!s%+" de ac=!+ne. A .os( ac(+a"!/a(
    (e<(+" de&enden=e! de canna'!s s&re a &rec!/a .a&(+" c7 !nd!c!! de de&enden=7
    .!/!o"o$!c7 s+n( v7/+(e "a +se+r!! cron!c! O! &o( .! asoc!a(e c+ &ro'"e%e %a! severe :n
    "e$7(+r7 c+ canna'!s+". Te<(+" re.er!(or "a &reva"en(a +/+"+! de canna'!s "a d!.er!(e
    $r+&e de e(a(e s! "a &reva"en(a de&enden=e! a .os( e<(!ns s! ac(+a"!/a(, :n sec=!+nea
    evo"+=!e! a .os( ad7+$a( +n co%en(ar!+ re.er!(or "a .a&(+" dac7 +/+" de canna'!s es(e
    +n &rec+rsor a" +/+"+! a"(or dro$+r! Ead!c7, ro"+" s7+ de S&oar(7 a dro$+"+!TJ.
    T+"'+r7r!"e :n "e$7(+r7 c+ coca!na. A+ .os( ac(+a"!/a(e s! e<(!nse co%&"!ca=!!"e
    !n(o<!ca=!e! severe c+ coca!n7, !ar sec=!+nea e"e%en(e"or s&ec!.!ce se<+"+!, e(7=!! s!
    c+"(+r!! a .os(, de ase%enea, ac(+a"!/a(7. A .os( e<(!ns s! ac(+a"!/a( (e<(+" re.er!(or "a
    &reva"en(a +/+"+! de coca!n7 "a d!.er!(e $r+&e de e(a(e s! ce" re.er!(or "a &reva"en(a
    de&enden=e! s! a'+/+"+!.
    T+"'+r7r!"e :n "e$7(+r7 c+ a"+c!no$ene"e. A .os( ad7+$a( +n (e<( re.er!(or "a
    %od!.!c7r!"e .!/!o"o$!ce asoc!a(e c+ !n(o<!ca=!a Ede e<., creO(erea $"!ce%!e!J. Te<(+"
    re.er!(or "a &reva"en(a +/+"+! de a"+c!no$ene "a d!.er!(e $r+&e de e(a(e s! "a
    &reva"en(a de&enden=e! s! a'+/+"+! a .os(, de ase%enea, ac(+a"!/a( O! e<(!ns.
    T+"'+r7r!"e :n "e$7(+r7 c+ !na"an(e"e. A+ .os( ad7+$a(e !n.or%a=!!
    s+&"!%en(are :n s+'sec=!+nea da(e"or de "a'ora(or asoc!a(e Eres&ec(!v, +(!"!(a(ea
    *videnierea modi$icrilor din DSM-IV Text
    +evi(uit
    >4<

    &ro'e"or de +r!n7 &en(r+ +n %e(a'o"!( a" (o"+en+"+!J, &rec+% s! :n s+'sec=!+nea
    da(e"or e<a%!n7r!! so%a(!ce s! cond!=!!"or %ed!ca"e asoc!a(e Eres&ec(!v, o "!s(7
    e<(!ns7 a co%&"!ca=!!"or res&!ra(or!! s! +n co%en(ar!+ des&re o &os!'!"7 asoc!ere
    d!n(re 'en/en s! "e+ce%!a %!e"oc!(!c7 ac+(7 J. A .os( ad7+$a( +n (e<( re.er!(or "a
    &reva"en(a d!.er!(e"or (!&+r! de +/ de !na"an(e "a $r+&e de e(a(e s! $r+&+r!
    de%o$ra.!ce d!.er!(e.
    T+"'+r7r!"e :n "e$7(+r7 c+ n!co(!n7. A .os( ac(+a"!/a(7 sec=!+nea e"e%en(e"or
    s&ec!.!ce se<+"+!, e(7=!! s! c+"(+r!! Ea+ .os( ad7+$a(e, de e<e%&"+, da(e des&re
    n!ve"e"e san$+!ne de n!co(!n7 cresc+(e "a a.roa%er!can!J,. A .os( ac(+a"!/a( (e<(+"
    re.er!(or "a &reva"en(a .+%a(+"+! s! a a"(+! (!& de +/ de (a'ac "a d!verse $r+&+r!,
    &rec+% O! (e<(+" re.er!(or "a &reva"en(a de&enden=e! de n!co(!n7. Sec=!+nea evo"+=!e!
    a .os(, de ase%enea, rev!/+!(7 &e 'a/a +nor da(e no!.
    T+"'+r7r!"e :n "e$7(+r7 c+ o&!acee"e. :n s+'sec=!+nea da(e"or de "a'ora(or
    asoc!a(e a .os( ad7+$a( +n (e<( re.er!(or "a (es(e"e de screen!n$ a"e e&a(!(e!, !ar :n
    s+'sec=!+nea da(e"or e<a%!na r!! so%a(!ce s! cond!=!!"or %ed!ca"e $enera"e asoc!a(e
    a .os( ad7+$a( +n (e<( re.er!(or "a ra(e"e %or(a"!(7=!! &r!n co%&"!ca=!! %ed!ca"e. A+
    .os( ac(+a"!/a(e sec=!+nea e"e%en(e"or s&ec!.!ce se<+"+!, e(7=!! s! c+"(+r!! Eres&ec(!v,
    ra(a se<+"+!J s! sec=!+nea evo"+=!e! Eres&ec(!v, ra(e"e de re%!s!+neJ. De ase%enea, a
    .os( ac(+a"!/a( s! e<(!ns (e<(+" re.er!(or "a &reva"en(a d!.er!(e"or &a((ern+r! de +/ de
    o&!acee "a d!.er!(e $r+&e de e(a(e s! a"(e $r+&+r! de%o$ra.!ce.
    T+"'+r7r!"e :n "e$7(+r7 c+ &encyc"!d!na sa+ c+ s+'s(an=e s!%!"are &encyc"!4
    d!ne!. A .os( ac(+a"!/a( s! e<(!ns (e<(+" re.er!(or "a &reva"en(a d!.er!(e"or &a((ern+r!
    de +/ de &encyc"!d!na "a d!.er!(e $r+&e de e(a(e.
    T+"'+r7r!"e :n "e$7(+r7 c+ seda(!ve"e, !&no(!ce"e sa+ an<!o"!(!ce"e. A .os(
    ac(+a"!/a( (e<(+" re.er!(or "a &a((ern+r!"e de +/ "a d!.er!(e $r+&e de e(a(e, &rec+% s!
    (e<(+" re.er!(or@a &reva"en(a de&enden=e! s! a'+/+"+!.
    De&enden=a de &o"!s+'s(an=7. A+ .os( ad7+$a(e e<e%&"e s&re a &rec!/a +/+"
    adecva( a" aces(e! ca(e$or!!.
    S#@i)o%renia Ei alte tul-ur(ri p&i@oti#e
    In(rod+cerea a .os( ac(+a"!/a(7 s&re a s+'"!n!a .a&(+" c7 s!%&(o%e"e &s!o(!ce n+
    s+n( :n %od necesar cons!dera(e a .! e"e%en(e"e de n+c"e+ a"e (+"'+r7r!"or !nc"+se
    :n aceas(7 sec=!+ne s! c7 (+"'+r7r!"e !nc"+se :n aceas(7 sec=!+ne n+ a+ :n %od
    o'"!$a(or!+ o e(!o"o$!e co%+n7 .
    Sc-izofrenia. Sec=!+nea e"e%en(e"or s! (+"'+r7r!"or asoc!a(e a .os( ac(+a"!/a(7 O!
    e<(!ns7 s&re a !nc"+de !n.or%a=!! des&re anoso$no/!e E"!&sa conO(!!n=e! (+"'+r7r!!J,
    .ac(or!! de r!sc &en(r+ co%&or(a%en(+" s+!c!dar s! v!o"en(, s! des&re co%or'!d!(a(ea
    c+ a"(e (+"'+r7r! %en(a"e. De ase%enea, a .os( ac(+a"!/a(7 s+'sec=!+nea da(e"or de
    "a'ora(or asoc!a(e s&re a !nc"+de co%en(ar!! se&ara(e des&re ne+ro!%a$!s(!ca
    s(r+c(+ra"7 O! .+nc=!ona"7, de.!c!(e"e ne+ro&s!o"o$!ce s! ano%a"!!"e ne+ro.!/!o4
    "o$!ce. Sec=!+nea e"e%en(e"or s&ec!.!ce se<+"+!, e(7=!! s! c+"(+r!! !nc"+de +n
    co%en(ar!+ e<(!ns re.er!(or "a s+&rad!a$nos(!carea sc!/o.ren!e! :n an+%!(e $r+&+r!
    >4= Ane,a D

    ras!a"e, !n.or%a=!! ac(+a"!/a(e re.er!(oare "a de'+(+" (ard!v a" ca/+r!"or s! +n (e<(
    ac(+a"!/a( re.er!(or "a d!.eren=e"e d!n(re se<e. Sec=!+nea &reva"en(e! a .os( ac(+a"!/a(7
    s&re a !nc"+de !n.or%a=!! s+&"!%en(are s! var!a=!!"e $eo$ra.!ce s! !s(or!ce :n !nc!den=a
    (+"'+r7r!!. Sec=!+nea &a((ern+"+! .a%!"!a" !n(rod+ce conce&(+" de Ts&ec(r+ a"
    sc!/o.ren!e!T Ead!c7, ser!a de (+"'+r7r! %a! &ro'a'!"e "a r+de"e !nd!v!/!"or c+
    sc!/o.ren!eJ.
    S+'(!&+r!"e de sc!/o.ren!e. In(rod+cerea a .os( ac(+a"!/a(7 s&re a !nd!ca
    s(a'!"!(a(ea s! va"oarea &ro$nos(!c7 "!%!(a(7 a s+'(!&+r!"or.
    T+"'+rarea sc!/o.ren!.or%7. S+n( &rev7/+(e !n.or%a=!! ac(+a"!/a(e des&re
    &reva"en(7, !nc"+/And ra(e"e d!ver$en(e d!n(re =7r!"e de/vo"(a(e O! ce"e :n c+rs de
    de/vo"(are. A .os( ad7+$a(7 o sc+r(7 sec=!+ne des&re &a((ern+" .a%!"!a" care !nd!c7
    +n &os!'!" r!sc cresc+( de sc!/o.ren!e "a r+de"e !nd!v!/!"or c+ (+"'+rare
    sc!/o.ren!.or%7 .
    T+"'+rarea sc!/oa.ec(!v7 . A+ .os( ac(+a"!/a/e sec=!+nea e"e%en(e"or s&ec!.!ce
    se<+"+!, e(7=!! s! c+"(+r!! Era(e"e cresc+(e "a .e%e! s+n( :n %are %7s+r7 @+s(!.!ca(e de
    !nc!den=a cresc+(7 a (!&+"+! de&res!vJ s! sec=!+nea evo"+=!e! Eres&ec(!v, asoc!erea
    s(resor!"or c+ +n &ro$nos(!c %a! '+nJ.
    T+"'+rarea de"!ran(7. A .os( ac(+a"!/a(7 sec=!+nea evo"+=!e!. 2
    T+"'+rarea &s!o(!c7 sc+r(7 . A .os( ac(+a"!/a(7 sec=!+nea &reva"en(e! s&re a no(a
    c7 aceas(7 (+"'+rare es(e rar o'serva(7 :n =7r!"e de/vo"(a(e, &e cAnd :n =7r!"e :n c+rs
    de de/vo"(are s+n( %a! .recven(e e&!soade"e &s!o(!ce c+ o d+ra(7 &+=!n %a! "+n$7
    E54R "+n!J.
    T+"'+rarea &s!o(!c7 da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e. A .os(
    ac(+a"!/a(7 "!s(a cond!=!!"or %ed!ca"e $enera"e e(!o"o$!ce s! a+ .os( ad7+$a(e cA(e o
    sec=!+ne &en(r+ &reva"en(7 s! evo"+=!e.
    Tul-ur(rile a%e#tive
    E&!sod+" de&res!v %a@or. S+'sec=!+nea da(e"or de "a'ora(or asoc!a(e a (e<(+"+! a
    .os( e<(!ns7 s! ac(+a"!/a(7 s&re a !nc"+de ano%a"!!"e ne+ro'!o"o$!ce s+&"!%en(are Ede
    e<., a"(er7r!"e :n ne+ro&e&(!de s! a"=! or%on! ca r7s&+ns "a (es(e"e de &rovocareJ s!
    re/+"(a(e"e !%a$!s(!c!! cere'ra"e .+nc=!ona"e. Sec=!+nea e"e%en(e"or s&ec!.!ce
    se<+"+!, e(7=!! s! c+"(+r!! a .os( ac(+a"!/a(7 s&re a &rec!/a .a&(+" c7 r!sc+" cresc+( "a
    .e%e! s+rv!ne :n c+rs+" ado"escen=e! s! &oa(e co!nc!de c+ &+'er(a(ea.
    T+"'+rarea de&res!v7 %a@or7. S+'sec=!+nea da(e"or e<a%!n7r!! so%a(!ce s!
    cond!=!!"or %ed!ca"e $enera"e a .os( ac(+a"!/a(7 s&re a s+'"!n!a .a&(+" c7 cond!=!!"e
    %ed!ca"e $enera"e a$ravea/7 evo"+=!a (+"'+r7r!! de&res!ve %a@ore. Sec=!+nea
    e"e%en(e"or s&ec!.!ce se<+"+!, e(7=!! s! c+"(+r!! a .os( e<(!ns7 s&re a !nc"+de !n.or%a=!!
    des&re da(e"e de "a'ora(or Ede e<., ev!den=!erea !&er!n(ens!(7=!"or d!n s+'s(an=a a"'7
    s+'cor(!ca"7J :n de&res!a c+ de'+( (ard!v. Mod!.!c7r!"e d!n sec=!+nea &a((ern+"+!
    .a%!"!a" !nd!c7 r!sc+" cresc+( de (+"'+r7r! an<!oase "a co&!!! !nd!v!/!"or c+ de&res!e.
    *videnierea modi$icrilor din DSM-IVText
    +evi(uit
    >4G

    T+"'+rarea d!s(!%!c7. S+'sec=!+nea evo"+=!e! a .os( ac(+a"!/a(7 s&re a !nd!ca
    .a&(+" c7 de/nod7%An(+" (+"'+r7r!! d!s(!%!ce es(e se%n!.!ca(!v %a! '+n c+
    (ra(a%en( ac(!v. Mod!.!c7r!"e d!n sec=!+nea &a((ern+"+! .a%!"!a" !nd!c7 ra(e"e
    cresc+(e, a(A( de (+"'+rare d!s(!%!c7, cA( O! de (+"'+rare de&res!v7 %a@or7, "a r+de"e
    ce"or c+ (+"'+rare d!s(!%!c7 .
    T+"'+rarea '!&o"ar7 I O! (+"'+rarea '!&o"ar7 II. S+'sec=!+nea e"e%en(e"or
    descr!&(!ve O! (+"'+r7r!"or %en(a"e asoc!a(e a .os( e<(!ns7 s&re a !nc"+de !n.or%a=!!
    des&re co%or'!d!(a(ea (+"'+r7r!! '!&o"are I c+ (+"'+r7r!"e +/+"+! de a"coo" O! de a"(7
    s+'s(an=7. S+'sec=!+nea da(e"or de "a'ora(or asoc!a(e a .os( e<(!ns7 s&re a reda
    &rocen(+" cresc+( a" an+%!(or "e/!+n! cere'ra"e "a !nd!v!/!! c+ (+"'+rare '!&o"ar7 I,
    ca $r+&. S+'sec=!+nea da(e"or e<a%!n7r!! so%a(!ce s! cond!=!!"or %ed!ca"e $enera"e
    a .os( e<(!ns7 s&re a &rec!/a re"a=!!"e d!n(re (+"'+rarea '!&o"ar7 I s! (+"'+rarea
    '!&o"ar7 II s! d!s.+nc=!a (!ro!d!an7 Eres&ec(!v, asoc!erea d!n(re !&o.+nc=!e s! c!c"area
    ra&!d7 s! e&!soade"e &rec!&!(a(e de !&er(!ro!d!s% "a ce! c+ (+"'+rare a.ec(!v7
    &ree<!s(en(7J. Sec=!+nea e"e%en(e"or s&ec!.!ce se<+"+!, e(7=!! O! c+"(+r!! a .os(
    ac(+a"!/a(7 s&re a !"+s(ra d!.eren=e"e d!n(re se<e :n c!c"area ra&!d7, (!&+" de e&!soade
    O! r!sc+" de e<&!soade %!<(e. Re"a=!a d!n(re e(a(ea "a de'+( O! !s(or!c+" .a%!"!a" es(e
    no(a(7 :n sec=!+nea &a((ern+"+! .a%!"!a" a" (+"'+r7r!! '!&o"are I.
    T+"'+rarea '!&o"ar7 FS. A .os( ad7+$a( +n e<e%&"+ s+&"!%en(ar &en(r+ a
    &rec!/a .a&(+" c7 !nd!v!/!! c+ d!s(!%!e cron!c7 O! care, de ase%enea, e<&er!en(ea/7
    e&!soade !&o%an!aca"e oca/!ona"e, n+ s+n( a&=! n!c! &en(r+ d!a$nos(!c+" de
    d!s(!%!e Ed!n ca+/a &re/en=e! e&!soade"or !&o%an!aca"eJ O! n!c! &en(r+ ce" de
    c!c"o(!%!e Edeoarece e&!soade"e !&o%an!aca"e s+n( &rea rareJ.
    E"e%en(e"e ca(a(on!ce. Te<(+" a .os( e<(!ns &en(r+ a o.er! o "!s(7 cA( %a! "ar$7 a
    ca+/e"or ca(a(on!e!.
    VVV'r.=oU24c. A.!r%a=!a !n!=!a"7, c7 !nd!v!/!! c+ e"e%en(e %e"anco"!ce
    ar r7s&+nde %a! '!ne "a (ra(a%en(+" e"ec(roconv+"s!van(, es(e !ncorec(7 s! a .os(
    :n"oc+!(7 c+ +n (e<( ca!e s+'"!n!a/7 neces!(a(ea +n+! (ra(a%en( ac(!v, da(7 .!!nd ra(a
    de r7s&+ns red+s7 "a &"ace'o.
    E"e%en(e"e a(!&!ce. A .os( ad7+$a( +n (e<( &en(r+ a &rec!/a .a&(+" c7 a(+nc! cAnd
    es(e descr!s ce" %a! recen( e&!sod Eca o&+s e&!sod+"+! c+ren(J, aces( s&ec!.!can( se
    a&"!c7 dac7 e"e%en(e"e %e"anco"!ce &redo%!n7 :n c+rs+" +ne! &er!oade de do+7
    s7&(7%An!, :n &"+s, se %en=!onea/7 c7 !nd!v!/!! c+ aces(e e"e%en(e es(e &os!'!" s7
    r7s&+nd7 "a (ra(a%en(+" c+ !n!'!(or! de %onoa%!noo<!da/7 O! n+ "a (ra(a%en(+"
    c+ an(!de&res!ve (r!c!c"!ce.
    De'+(+" &os(&ar(+%. A .os( ac(+a"!/a( (e<(+" des&re e"e%en(e"e asoc!a(e O! a .os(
    ad7+$a( +n (e<( &en(r+ a accen(+a d!.eren=!erea aces(+! s+'(!& de T'a'y '"+esT
    E.+r!a "a&(e"+!J.
    C!c"area ra&!d7. Te<(+" ac(+a"!/a( !nc"+de da(e des&re &reva"en(7 s! asoc!erea
    &os!'!"7 d!n(re ra(a c!c"7r!! ra&!de s! (era&!a an(!de&res!v7 .
    >4> Ane,a D

    Tul-ur(rile an,ioa&e
    A(ac+" de &an!c7. Te<(+" descr!!nd ce"e (re! (!&+r! de a(ac+r! de &an!c7 Eres&ec(!v,
    !no&!na(, c!rc+%scr!s s!(+a=!ona" s! &red!s&+s s!(+a=!ona"J a .os( e<(!ns s&re a &rec!/a
    na(+ra .ac(or!"or dec"anOAnd, asoc!erea d!n(re (!&+r!"e de a(ac+r! de &an!c7 s!
    an+%!(e (+"'+r7r! an<!oase s! d!a$nos(!c+" d!.eren=!a".
    Pan!ca. A+ .os( ac(+a"!/a(e !n.or%a=!!"e des&re re"a=!a d!n(re a(ac+r!"e de &an!c7
    s! &os!'!"!! dec"anOa(or! a! &an!c!!J de e<., dec"anOa(or+" s!(+a=!ona" &oa(e .!, .!e !n(ern,
    .!e e<(ern, !ar S!no&!na(T2:nsea%n7 c7 !nd!v!d+" n+ asoc!a/7 !%ed!a( a(ac+" c+ +n
    dec"anOa(or s!(+a=!ona"J. L!s(a cond!=!!"or %ed!ca"e $enera"e asoc!a(e a .os( e<(!ns7 O!,
    de ase%enea, a .os( e<(!ns7 O! sec=!+nea &reva"en(e! s&re a !nc"+de &rocen(e"e d!n
    eOan(!oane"e c"!n!ce, !ar sec=!+nea &a((ern+"+! .a%!"!a" a .os( ac(+a"!/a(7 s&re a
    !nc"+de !n.or%a=!!"e &roven!nd d!n ce"e %a! recen(e s(+d!! Ede e<., re"a=!a d!n(re
    e(a(ea "a de'+( a &ro'and+"+! s! r!sc+" de %or'!d!(a(e "a r+de"e de $rad+" I a"e
    aces(+!aJ, :n .!na", a .os( e<(!ns7 sec=!+nea d!a$nos(!c+"+! d!.eren=!a" s&re a !nc"+de
    s!(+a=!!"e :n care &ersoana n+ es(e ca&a'!"7 s7 !den(!.!ce s(!%+"!! dec"ansan=! a! +n+!
    a(ac de &an!c7 Ede e<., co$n!=!!"e sa+ s!%&(o%e"e .!/!o"o$!ce s!%!"are ce"or care s+rv!n
    :n (!%&+" even!%en(+"+! (ra+%a(!c :n s(res+" &os((ra+%a(!cJ.
    Fo'!a s&ec!.!c7. S+n( o.er!(e !n.or%a=!! s+&"!%en(are re.er!(oare "a co%or'!d!(a(e,
    .recven=a re"a(!v7 a s+'(!&+r!"or :n co%+n!(a(e, ra(a se<+"+!, evo"+=!e Ede e<., .a&(+"
    de a avea .o'!e s&ec!.!c7 :n ado"escen=7, creO(e Oanse"e de a avea .o'!e s&ec!.!c7 :n
    &er!oada ad+"(7, dar n+ s! a"(e (+"'+r7r! %en(a"eJ, &rec+% O! "a &a((ern+" .a%!"!a".
    Fo'!a soc!a"7. Sec=!+nea e"e%en(e"or descr!&(!ve s! (+"'+r7r!"or %en(a"e
    asoc!a(e a .os( ac(+a"!/a(7 Easoc!erea c+ !dea=!a s+!c!dar7 s! c+ a"(e (+"'+r7r!
    an<!oaseJ. A .os( ac(+a"!/a(7 s+'sec=!+nea da(e"or de "a'ora(or asoc!a(e s&re a
    &rec!/a c7 n+ e<!s(7 n!c! +n (es( de "a'ora(or care s7 .!e d!a$nos(!c &en(r+ .o'!a
    soc!a"7 E(es(+" %a! vec! care s+$era +n r7s&+ns d!.eren=!a( "a !n@ec(area de "ac(a( a
    .os( e"!%!na(J.
    T+"'+rarea o'ses!vo4co%&+"s!v7. A+ .os( ac(+a"!/a(e !n.or%a=!!"e re.er!(oare "a
    co%or'!d!(a(ea c+ a"(e (+"'+r7r! %en(a"e. Sec=!+nea e"e%en(e"or s&ec!.!ce se<+"+!,
    e(7=!! O! c+"(+r!! a .os( ac(+a"!/a(7 s&re a !nc"+de o %!c7 sec=!+ne des&re +n s+'se( de
    co&!! care de/vo"(7 (+"'+rarea o'ses!vo4co%&+"s!v7 :n asoc!ere c+ $r+&+" A de
    !n.ec=!! c+ s(re&(ococ 'e(a4e%o"!(!c. A+ .os( ad7+$a(e !n.or%a=!! s&re a a(ra$e
    a(en=!a as+&ra vo"+%+"+! cresc+( de da(e re.er!(oare "a co&!! c+ (+"'+rare o'ses!vo4
    co%&+"s!v7 Ede e<., (+"'+r7r!"e co%or'!de, &reva"en(aJ. Sec=!+nea &reva"en(e! a .os(
    ac(+a"!/a(7 O! e<(!ns7 s&re a !nc"+de ra(e"e de "a co&!!.
    S(res+" &os((ra+%a(!c. A+ .os( ac(+a"!/a(e !n.or%a=!!"e re.er!(oare "a e"e%en(e"e
    asoc!a(e, co%or'!d!(a(ea c+ a"(e (+"'+r7r! %en(a"e, asoc!er!"e c+ cond!=!! %ed!ca"e
    $enera"e, ra(e"e de &reva"en(7 s! "a evo"+(!e Ede e<., reac(!varea s!%&(o%e"or ca
    r7s&+ns "a rea%!n(!rea (ra+%e!, "a s(resor! de v!a=7 sa+ "a even!%en(e (ra+%a(!ce
    no!J. A .os( ad7+$a(7 o sc+r(7 sec=!+ne de &a((ern .a%!"!a", care descr!e &ro'e"e
    e<!s(en=e! +ne! co%&onen(e ered!(are :n (rans%!s!a s(res+"+! &os((ra+%a(!c O! re"a=!a
    d!n(re +n !s(or!c de de&res!e "a r+de"e de $rad+" I s! v+"nera'!"!(a(ea cresc+(7 "a
    de/vo"(area s(res+"+! &os((ra+%a(!c.
    *videniecea modi$icrilor din DSM-IV Text
    +evi(uit
    =+4

    S(res+" ac+(. S+n( &rev7/+(e !n.or%a=!! re.er!(oare "a &ro$res!+nea s&re s(res+"
    &os((ra+%a(!c O! o ser!e de ra(e de &reva"en(7 "a !nd!v!/!! e<&+O! "a (ra+%e severe.
    An<!e(a(ea $enera"!/a(7. A .os( ac(+a"!/a(7 &reva"en(a :n cond!=!! c"!n!ce s!
    &a((ern+" .a%!"!a" Ede e<.,2da(e"e d!n s(+d!!"e &e $e%en! care s+$erea/7 o con(r!'+=!e
    $ene(!c7J.
    Tul-ur(rile &o"ato%or"e
    T+"'+rarea de so%a(!/are. S+'sec=!+nea da(e"or e<a%!n7r!! so%a(!ce O!
    cond!=!!"or %ed!ca"e $enera"e asoc!a(e a .os( ac(+a"!/a(7 s&re a &rec!/a .a&(+" c7 +n!!
    !nd!v!/! c+ (+"'+rare de so%a(!/are &re/!n(7, de ase%enea, se%ne o'!ec(!ve care
    a&ar=!n +ne! cond!=!! %ed!ca"e $enera"e.
    T+"'+rarea de convers!e. Sec=!+nea &reva"en(e! a .os( e<(!ns7 s&re a !nc"+de
    ra(e"e d!n an+%!(e %ed!! %ed!ca"e $enera"e.
    T+"'+rarea a"$!c7. Co%en(area r!sc+"+! de&enden=e! !a(ro$en!ce de o s+'s(an=7
    d!n sec=!+nea e"e%en(e"or O! (+"'+r7r!"or asoc!a(e a .os( ac(+a"!/a(7 O! e<(!ns7 s&re a
    !nc"+de .ac(or!! care d!%!n+a &os!'!"!(a(ea de/vo"(7r!! de&enden=e! !a(ro$en!ce de o
    s+'s(an=7, :n &"+s, a .os( e<(!ns (e<(+" des&re &ro'"e%e"e asoc!a(e c+ so%n+". De
    ase%enea, a .os( !nc"+s +n (e<( re.er!(or "a &reva"en(a (+"'+r7r!! a"$!ce :n %ed!!
    c"!n!ce, &rec+% s! !n.or%a=!! s+&"!%en(are des&re evo"+=!e.
    H!&ocondr!a. A+ .os( ac(+a"!/a(e sec=!+n!"e e"e%en(e"or O! (+"'+r7r!"or asoc!a(e,
    &reva"en(e! s! evo"+=!e! Ead!c7, .ac(or!! asoc!a=! c+ +n &ro$nos(!c %a! '+nJ
    T+"'+rarea d!s%or.!c7 cor&ora"7. Cons(r+c=!a cor&+"+! O! %+sc+"a(+ra a+ .os(
    !nc"+se :n "!s(a sed!!"or &reoc+&7r!"or cor&ora"e. Sec=!+nea e"e%en(e"or O! (+"'+r7
    r!"or asoc!a(e a .os( ac(+a"!/a(7 s&re a !nc"+de !n.or%a=!! s+&"!%en(are des&re "!&sa
    conO(!!n=e! (+"'+r7r!! O! e.or(+r!"e de a corec(a sa+ asc+nde de.ec(e"e. S+n( !nc"+se,
    de ase%enea, ra(e"e de &reva"en(7 ra&or(a(e d!n %ed!!"e c"!n!ce.
    Tul-ur(rile %a#ti#e
    T+"'+rarea .ac(!ce. Te<(+" rev!/+!( &en(r+ s+'(!&+" c+ s!%&(o%e s! se%ne
    &redo%!nan( so%a(!ce d!.eren=!a/7 %a! c"ar s!ndro%+" M+nca+sen Ecea %a!
    sever7 O! cron!c7 .or%7 de (+"'+rare .ac(!ceJ de .or%e"e %a! &+=!n severe O!
    (ran/!(or!!. A .os( ad7+$a(7 o sec=!+ne re/erva(7 e"e%en(e"or s&ec!.!ce se<+"+!, !ar
    sec=!+n!"e &reva"en(e! O! evo"+=!e! a+ .os( ac(+a"!/a(e.
    Tul-ur(rile $i&o#iative
    T+"'+rarea de !den(!(a(e d!soc!a(!v7. A .os( %od!.!ca( (e<(+" s&re a !nd!ca .a&(+"
    c7 a+ .os( doc+%en(a(e ca/+r! de (+"'+rare de !den(!(a(e d!soc!a(!v7 :n d!verse
    c+"(+r! d!n "+%e.
    T+"'+rarea de de&ersona"!/are. Sec=!+n!"e e"e%en(e"or s! (+"'+r7r!"or asoc!a(e O!
    evo"+=!e! a+ .os( ac(+a"!/a(e.
    >7+ Anexa D
    Tul-ur(rile &e,uale Ei $e i$entitate &e,ual(
    A .os( ad7+$a( +n (e<( !n(rod+c(!v s&re a c"ar!.!ca de.!n!=!!"e (er%en!"or, identitate
    sex+al6, dis)orie sex+al6 s! orientare sex+al6 7
    D!s.+nc=!!"e se<+a"e. A .os( ad7+$a(7 sec=!+nea (+"'+r7r!"or asoc!a(e, !ar
    sec=!+nea &reva"en(e! a .os( ac(+a"!/a(7 s! e<(!ns7.
    Para.!"!!"e. A+ .os( rev!/+!(e cr!(er!!"e de se%n!.!ca=!e c"!n!c7 s&re a &rec!/a
    .a&(+" c7 &en(r+ &edo.!"!e, voye+r!s%, e<!'!=!on!s% s! .ro((e+r!s%, dac7 &ersoana
    E:n ca+/7J a ac=!ona( con.or% aces(or &+"s!+n!, sa+ &+"s!+n!"e or! .an(e/!!"e se<+a"e
    ca+/ea/7 o de(res7 %arca(7 sa+ d!.!c+"(7=! !n(er&ersona"e, a(+nc!, &r!n de.!n!=!e,
    e<!s(7 se%n!.!ca=!e c"!n!c7. Pen(r+ sad!s%+" se<+a", dac7 &ersoana a ac=!ona(
    con.or% aces(or &+"s!+n! c+ o &ersoan7 care n+ cons!%(e, sa+ &+"s!+n!"e, .an(e/!!"e
    se<+a"e or! co%&or(a%en(e"e ca+/ea/7 o de(res7 %arca(7 sa+ d!.!c+"(7=!
    !n(er&ersona"e, a(+nc! cr!(er!+" se%n!.!ca=!e! c"!n!ce es(e sa(!s.7c+(. Pen(r+ res(+"
    &ara.!"!!"or, cr!(er!+" de se%n!.!ca=!e c"!n!c7 es(e sa(!s.7c+( dac7 co%&or(a%en(+",
    &+"s!+n!"e sa+ .an(e/!!"e se<+a"e ca+/ea/7 de(res7 se%n!.!ca(!v7 c"!n!c sa+
    de(er!orare :n do%en!+" soc!a", oc+&a=!ona" sa+ :n a"(e do%en!! !%&or(an(e de
    .+nc=!onare. De s!$+r, &en(r+ a .! &+s d!a$nos(!c+" (re'+!e s7 .!e &re/en(, de
    ase%enea, &a((ern+" s&ec!.!c de e<c!(a=!e &ara.!"!c7.
    T+"'+rarea de !den(!(a(e se<+a"7. S+n( !nc"+se !n.or%a=!! s+&"!%en(are &en(r+ a
    &rec!/a c+% E&e 'a/a a(rac=!e! se<+a"eJ s+'(!&+r!"e d!.er7 :n(re e"e :n (er%en!!
    e"e%en(e"or asoc!a(e s! evo"+=!e!.
    Tul-ur(rile $e #o"porta"ent ali"entar
    Anore<!a nervoas7. Sec=!+nea e"e%en(e"or s! (+"'+r7r!"or asoc!a(e a .os(
    ac(+a"!/a(7 s&re a !nc"+de co%or'!d!(a(ea c+ (+"'+r7r!"e de &ersona"!(a(e. Sec=!+nea
    &reva"en(e! a .os( e<(!ns7 s&re a !nc"+de &rocen(e"e &en(r+ '7r'a=!. E"e%en(e"e
    evo"+=!e! a+ .os( ac(+a"!/a(e s&re a &rec!/a re"a=!a d!n(re anore<!a nervoas7 s!
    '+"!%!a nervoas7 .
    B+"!%!a nervoas7. A .os( ac(+a"!/a(7 sec=!+nea evo"+=!e! s&re a !nc"+de +ne"e
    !n.or%a=!! des&re de/nod7%An(+" &e (er%en "+n$ a" '+"!%!e! nervoase.
    Tul-ur(rile $e &o"n
    Inso%n!a &r!%ar7. A .os( rev!/+!(7 s+'sec(!+nea e"e%en(e"or descr!&(!ve s!
    (+"'+r7r!"or %en(a"e asoc!a(e Ede e<., de(er!orarea .+nc=!ona"7 J, &rec+% s!
    s+'sec(!+nea da(e"or de "a'ora(or asoc!a(e E de e<., "!&sa so%no"en=e! d!n c+rs+"
    /!"e!, %7s+ra(7 &r!n M+"(!&"e S"ee& La(ency Tes( ZMSLT[, d!scre&an=e"e
    cons!dera'!"e d!n(re re"a(7r!"e s+'!ec=!"or s! eva"+7r!"e &o"!so%no$ra.!ce a"e ca"!(7=!!
    so%n+"+!J. A+ .os( ac(+a"!/a(e, de ase%enea, sec=!+nea e"e%en(e"or s&ec!.!ce
    se<+"+! s! e(7=!! Ede e<., "a '7(rAn!J, sec=!+nea &reva"en(e! Ede e<., ra(e"e (+"'+r7r!! :n
    &o&+"a=!a $enera"7 J, sec=!+nea evo"+=!e! E(e<(+" des&re cron!c!(a(eJ s! sec=!+nea
    &a((ern+"+! .a%!"!a".
    *videnierea modi$icrilor din DSM-IVText
    +evi(uit
    >7*
    H!&erso%n!a &r!%ar7. A+ .os( ac(+a"!/a(e sec=!+nea e"e%en(e"or s&ec!.!ce
    se<+"+! s! e(7=!! Ede e<., "a co&!!J s! sec=!+n!"e &reva"en(e! s! evo"+=!e!.
    Narco"e&s!a. A .os( ad7+$a( +n (e<( &en(r+ a &rec!/a .a&(+" c7 +ne"e s!%&(o%e
    Eres&ec(!v, a"+c!na=!!"e !&na$o$!ce s! !&no&o%&!ce s! &ara"!/!a de so%nJ a&ar, de
    ase%enea, O! "a &ersoane"e nor%a"e. S+'sec=!+nea da(e"or de "a'ora(or asoc!a(e
    E!nc"+s!v (!&7rea HLAJ s! sec=!+nea evo"+=!e! Ee(a(ea "a de'+( s! e(a(ea "a &re/en(areJ
    a+ .os(, de ase%enea, ac(+a"!/a(e. A .os( ad7+$a(7 sec=!+nea e"e%en(e"or s&ec!.!ce
    e(7=!! &en(r+ a ad+ce :n d!sc+=!e d!a$nos(!c+" narco"e&s!e! "a co&!!.
    T+"'+rarea de so%n :n "e$7(+r7 c+ res&!ra=!a. A+ .os( ac(+a"!/a(e s+'sec=!+n!"e
    da(e"or de "a'ora(or asoc!a(e s! da(e"or e<a%!n7r!! so%ace s! cond!=!!"or %ed!ca"e
    $enera"e asoc!a(e Eres&ec(!v, asoc!erea d!n(re d!%ens!+nea nas+"+! s! r!sc+" de a&nee
    o's(r+c(!v7 de so%nJ s! sec=!+nea e"e%en(e"or s&ec!.!ce e(7=!! Ead!c7, "a co&!!J.
    T+"'+rarea r!(%+"+! c!rcad!an de so%n. In.or%a=!! s+&"!%en(are des&re aces(
    s+'(!& s&ec!.!c s+n( o.er!(e :n sec=!+nea e"e%en(e"or s! (+"'+r7r!"or asoc!a(e, &rec+%
    s! :n s+'sec=!+n!"e da(e"or de "a'ora(or asoc!a(e, da(e"or e<a%!n7r!! so%a(!ce s!
    2cond!=!!"or %ed!ca"e $enera"e asoc!a(e s! :n sec=!+n!"e e"e%en(e"or s&ec!.!ce e(7=!!,
    &reva"en(e!, evo"+=!e! s! &a((ern+"+! .a%!"!a"
    D!sso%n!a FS. S+n( ac+% !nc"+se descr!er! e<(!nse a"e s!ndro%+"+! &!c!oare"or
    ne"!n!O(!(e O! %!Oc7r!"or &er!od!ce a"e %e%'re"or, do+7 (+"'+r7r! de so%n '!ne
    con(+ra(e s! !nc"+se :n C"as!.!carea In(erna=!ona"7 a T+"'+r7r!"or de So%n.
    CoO%ar+". A+ .os( ac(+a"!/a(e s+'sec=!+nea e"e%en(e"or descr!&(!ve s!
    (+"'+r7r!"or %en(a"e asoc!a(e Ead!c7, asoc!erea d!n(re coO%ar+r!"e cron!ce
    .recven(e s! creO(erea s!%&(o%e"or &ro&r!! a"(e! &s!o&a(o"o$!!J, sec=!+nea
    &reva"en(e! Ead!c7, ra(a .recven=e! coO%ar+r!"or "a ad+"=!! (!ner!J O! sec=!+nea
    evo"+=!e!.
    So%na%'+"!s%+". A+ .os( ac(+a"!/a(e s+'sec=!+nea da(e"or de "a'ora(or
    asoc!a(e O! sec=!+n!"e s&ec!.!ce se<+"+!, e(7=!! O! c+"(+r!!, &reva"en(e!, evo"+=!e! s!
    &a((ern+"+! .a%!"!a".
    T+"'+rarea de so%n :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7. A .os( ac(+a"!/a(7
    s+'sec=!+nea e"e%en(e"or de "a'ora(or asoc!a(e.
    Tul-ur(rile #ontrolului i"pul&ului
    ne#la&i%i#ate .n alt( parte
    T+"'+rarea e<&"o/!v7 !n(er%!(en(7. A .os( ad7+$a( +n (e<( s&re a &rec!/a .a&(+"
    c7 ac(e"e de a(ac severe !nc"+d a%en!n=7r! ver'a"e sa+ a(ac+r! .!/!ce .a=7 de a"=!
    !nd!v!/!. A+ .os( ac(+a"!/a(e sec=!+nea e"e%en(e"or s! (+"'+r7r!"or asoc!a(e:n s&ec!a"
    s+'sec=!+nea e"e%en(e"or descr!&(!ve O! (+"'+r7r!"or %en(a"e asoc!a(e Ede e<.,
    s!%&(o%e"e care &reced sa+ aco%&an!a/7 ac(e"e a$res!ve, c+% ar .! (!n!r+s+" sa+
    (re%or+", &rec+% s! a.ec(+" aco%&an!an(J s! sec=!+nea evo"+=!e!. A .os( ad7+$a(7 o
    sec=!+ne &en(r+ &a((ern+" .a%!"!a", !nd!cAnd .a&(+" c7 aces(e (+"'+r7r! &o( .! %a!
    .recven(e &r!n(re r+de"e de $rad+" : a"e !nd!v!/!"or c+ (+"'+rare e<&"o/!v7
    !n(er%!(en(7 co%&ara(!v c+ &o&+"a=!a $enera"7 .
    >7C Anexa D
    -"e&(o%an!a. A+ .os( ac(+a"!/a(e sec=!+n!"e e"e%en(e"or O! (+"'+r7r!"or asoc!a(e s!
    &a((ern+"+! .a%!"!a" Eres&ec(!v, !s(or!c+" .a%!"!a" &os!'!" de (+"'+rare o'ses!vo4
    co%&+"s!v7 "a r+de"e de $rad+" I a"e !nd!v!/!"or c+ )"e&(o%an!eJ. De ase%enea, a .os(
    ad7+$a(7 o sec=!+ne &en(r+ e"e%en(e"e s&ec!.!ce se<+"+! Eres&ec(!v, ra(a se<+"+!J.
    *oc+" de Oans7 &a(o"o$!c. A .os( ad7+$a(7 o s+'sec=!+ne &en(r+ da(e"e de
    "a'ora(or asoc!a(e Ede e<., o var!e(a(e de ano%a"!! ra&or(a(e &e eOan(!oane"e de
    '7r'a=!J. A+ .os( ac(+a"!/a(e sec=!+n!"e e"e%en(e"or O! (+"'+r7r!"or asoc!a(e Ede e<.,
    !s(or!c+" de s!%&(o%e de !na(en=!e sa+ de !&erac(!v!(a(e :n co&!"7r!eJ s! &reva"en(a
    Ede e<., !n."+en=a acces!'!"!(7=!! "a @oc+r!"e de Oans7 "e$a"!/a(e as+&ra &reva"en(e!
    @oc+"+! de Oans7 &a(o"o$!cJ.
    Tr!co(!"o%an!a. A+ .os( ac(+a"!/a(e sec=!+n!"e e"e%en(e"or O! (+"'+r7r!"or
    asoc!a(e, &reva"en(e! s! evo"+=!e!.
    Tul-ur(rile $e a$aptare
    Sec=!+nea e"e%en(e"or s! (+"'+r7r!"or asoc!a(e a .os( ac(+a"!/a(7 s&re a &rec!/a
    co%or'!d!(a(ea c+ a"(e (+"'+r7r!. Sec=!+nea &reva"en(e! a .os( e<(!ns7 s&re a !nc"+de
    ra(e"e de "a co&!! s! :n s&ec!a" :n cond!=!! c"!n!ce. Sec=!+nea evo"+=!e! !nc"+de ac+%
    +n (e<( des&re r!sc+" de &ro$res!+ne s&re a"(e (+"'+r7r!.
    Tul-ur(rile $e per&onalitate
    Te<(+" !n(rod+c(!v &en(r+ (+"'+r7r!"e de &ersona"!(a(e. A .os( ac(+a"!/a( (e<(+"
    descr!!nd %ode"e"e d!%ens!ona"e, aces(a &re/en(And d!%ens!+n!"e :n (er%en!!
    +nora d!n(re ce"e %a! !%&or(an(e %ode"e.
    T+"'+rarea de &ersona"!(a(e an(!soc!a"7. A .os( ac(+a"!/a( (e<(+" e"e%en(e"or s!
    (+"'+r7r!"or asoc!a(e &en(r+ a &rec!/a .a&(+" c7 e"e%en(e"e care s+n( &ar(e a
    conce&=!e! (rad!=!ona"e des&re &s!o&a(!e &o( .! %a! &red!c(!ve &en(r+ rec!d!vare :n
    s!(+a=!! :n care ac(e"e !n.rac=!ona"e es(e &os!'!" s7 .!e nes&ec!.!ce Ede e<., :n :nc!sor!J.
    T+"'+rarea de &ersona"!(a(e 'order"!ne. A .os( ad7+$a( +n (e<( :n sec=!+nea
    evo"+=!e! &en(r+ a scoa(e :n ev!den=7 .a&(+" c7, :n con(rad!c=!e c+ o&!n!!"e
    &reconce&+(e a"e %+"(or c"!n!c!en!, &ro$nos(!c+" %+"(or !nd!v!/! c+ (+"'+rare de
    &ersona"!(a(e 'order"!ne es(e '+n.
    T+"'+rarea de &ersona"!(a(e de&enden(7. A .os( %od!.!ca( (e<(+" sec=!+n!!
    e"e%en(e"or s&ec!.!ce se<+"+!, e(7=!! s! c+"(+r!! s&re a :n"7(+ra s+$es(!a c7 d!.eren=a
    d!n(re se<e ra&or(a(7 es(e :n %are %7s+r7 ar(!.!c!a"7 .
    T+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7. Sec=!+nea e"e%en(e"or O!
    (+"'+r7r!"or asoc!a(e a .os( ac(+a"!/a(7 s&re a ad+ce +n &"+s de c"ar!(a(e :n re"a=!a
    d!n(re (+"'+r7r!"e an<!oase E:n s&ec!a", (+"'+rarea o'ses!vo4co%&+"s!v7J O!
    (+"'+rarea de &ersona"!(a(e o'ses!vo4co%&+"s!v7 .
    *videnierea modi$icrilor din DSM-IV Text
    +evi(uit
    >74

    Ane,e
    A+ .os( .7c+(e %od!.!c7r! :n d!verse ane<e. M!c! %od!.!c7r! a+ .os( .7c+(e :n
    (e<(+" descr!&(!v a" +nora d!n(re ca(e$or!!"e de cerce(are d!n ane<a B Ede e<.,
    (+"'+rarea de&res!v7 &os(&s!o(!c7 a sc!/o.ren!e!, (+"'+rarea d!s.or!c7
    &re%ens(r+a"7, (+"'+rarea de&res!v an<!oas7 %!<(7J, !ar (e<(+" sec=!+n!!
    (+"'+r7r!"or de %!Ocare !nd+se de %ed!ca%en(e a .os( ac(+a"!/a( s&re a !nc"+de
    ne+ro4"e&(!ce"e a(!&!ce. Ane<e"e E, F s! , a+ .os( ac(+a"!/a(e &en(r+ a .! &+se de
    acord c+ %od!.!c7r!"e d!n cod!.!carea ICD4F4CM care a+ s+rven!( :n c+rs+"
    +"(!%!"or an!. De ase%enea, a .os( ad7+$a(7 ane<a -, con=!nAnd n+%e"e
    cons!"!er!"or DSM4I34Te<( Rev!s!on.

    Ane,a E
    Lista al$abetic a Dia!nosticelor
    si odurilor DSM-IV-T+
    FS 6 F7r7 a"(7 s&ec!.!ca=!e
    3R5.59 A'+/ .!/!c de +n ad+"( Edac7 de c7(re &ar(enerJ
    3R9.G; A'+/ .!/!c de +n ad+"( Zdac7 de c7(re o a"(7 &ersoan7 decA( &ar(ener+"[
    FFY.G5 A'+/ .!/!c de +n ad+"( Zdac7 :n cen(r+" a(en=!e! se a."7 v!c(!%a[
    3R5.95 A'+/ .!/!c de +n co&!"
    FFY.Y A'+/ .!/!c de +n co&!" Zdac7 !n cen(r+" a(en=!e! se a."7 v!c(!%a[
    3R5.59 A'+/ se<+a" de +n ad+"( Edac7 de c7(re &ar(enerJ
    3R9.G; A'+/ se<+a" de +n ad+"( Edac7 de c7(re o a"(7 &ersoan7 decA( &ar(ener+"J
    FFY.G; A'+/ se<+a" de +n ad+"( (dac6 =n centr+l aten(iei se a)l6 *ictima%
    R5.95 A'+/ se<+a" de +n co&!"
    FFY.Y A'+/ se<+a" de +n co&!" (dac6 =n centr+l aten(iei se a)l6 *ictima%
    3R9.G9 Ac(!v!(a(e !n(e"ec(+a"7 "!%!nar7
    ;LL.99 A$ora.o'!e .7r7 !s(or!c de &an!c7
    deXc+J A"coo"
    9F5.G5 A's(!nen=7
    ;LY.LL A'+/
    9F5.L De"!r!+% &r!n a's(!nen=7
    9F5.L De"!r!+% &r!n !n(o<!ca=!e
    9F5.9 De%en(7 &ers!s(en(7 !nd+s7
    ;L;.FL De&enden=7
    9F5.G D!s.+nc=!e se<+a"7 !nd+s7
    ;L;.LL In(o<!ca=!e
    9F5.G T+"'+rare a.ec(!v7 !nd+s7
    9F5.5 T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7
    291.8 T+"'+rare an<!oas7 !nd+s7
    291.9 T+"'+rare :n "e$7(+r7 c+ a"coo"+" FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F5.9 c+ a"+c!na=!!
    9F5.Y c+ !de! de"!ran(e
    9F5.G T+"'+rare de so%n !nd+s7
    RLG.GF A"(7 d!s.+nc=!e se<+a"7 a '7r'a(+"+! da(ora(7...
    @Se indic6 condi(ia medical6 /eneral6A
    R9R.G A"(7 d!s.+nc=!e se<+a"7 a .e%e!! da(ora(7...
    @Se indic6 condi(ia medical6 /eneral6A EdeXc+J A"(7
    s+'s(an=7 Esa+ o s+'s(an=7 nec+nosc+(7J
    >7<
    =F> Ane,a E

    9F9.L A's(!nen(7 N
    ;LY.FL A'+/
    291.81 De"!r!+% !nd+s
    292.81 De%en=7 &ers!s(en(7 !nd+s7
    ;LI.FL De&enden=7
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7
    9F9.GF In(o<!ca=!e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.G; T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    9F9.GF T+"'+rare de so%n !nd+s7
    EdeXc+J A%.e(a%!na Esa+ s+'s(an=e s!%!"are a%.e(a%!ne!J
    9F9.L A's(!nen=7
    ;LY.HL A'+/
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e
    ;LI.IL De&enden=7
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7
    9F9.GF In(o<!ca=!e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    9F9.GF T+"'+rare de so%n !nd+s7
    ;LL.59 A%ne/!e d!soc!a(!v7
    ;LH.5 Anore<!e nervoas7
    ;LL.L9 An<!e(a(ea $enera"!/a(7
    ;LF.95 An<!e(a(e de se&arare
    ;L9.HF Avers!+ne se<+a"7
    ;LH.L Ba"'!s%
    ;LH.Y5 B+"!%!e nervoas7
    EdeJ Ca.e!na
    ;LY.FL In(o<!ca=!e
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    9F9.GF T+"'+rare de so%n !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    EdeXc+J Canna'!s
    ;LY.9L A'+/
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e
    ;LI.;L De&enden=7
    9F9.GF In(o<!ca=!e
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    Lista al$abetic a Dia!nosticelor si odurilor DSM-IV-T+ 8H?
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9Q55 c+ !de! de"!ran(e
    EdeXc+J Coca!n7
    9F9.L A's(!nen=7
    ;LY.9L A'+/
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e
    ;LI.;L De&enden=7
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7
    9F9.GF In(o<!ca=!e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    9F9.GF T+"'+rare de so%n !nd+s7
    3H5.L5 Co%&or(a%en( an(!soc!a" a" ad+"(+"+! 3H5.L9
    Co%&or(a%en( an(!soc!a" a" co&!"+"+! sa+ ado"escen(+"+! ;LH.IH
    CoO%ar
    HGL.F Dec"!n co$n!(!v :n ra&or( c+ e(a(ea HGL.LF De"!r!+% FS
    9F;.L De"!r!+% da(ora(... @Se indic6 condi(ia medical6 /eneral6A
    De%en=7 da(ora(7 %a"ad!e! Cre+(/.e"d(4*a)o'
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en( 9FI.55`
    c+ (+"'+rare de co%&or(a%en(
    De%en=7 da(ora(7 %a"ad!e! HI3
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en(
    9FI.55` c+ (+"'+rare de co%&or(a%en(
    De%en=7 da(ora(7 %a"ad!e! H+n(!n$(on
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en(
    9FI.55` c+ (+"'+rare de co%&or(a%en(
    De%en=7 da(ora(7 %a"ad!e! Par)!nson
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en(
    9FI.55` c+ (+"'+rare de co%&or(a%en(
    De%en=7 da(ora(7 %a"ad!e! P!c)
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en(
    9FI.55` c+ (+"'+rare de co%&or(a%en(
    De%en=7 da(ora(7 (ra+%a(!s%+"+! cran!an
    9FI.5L` .7r7 (+"'+r7r! de co%&or(a%en( 9FI.55`
    c+ (+"'+r7r! de co%&or(a%en(
    De%en=7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    9FI.5U2 .7r7 (+"'+ra(e de co%&or(a%en(
    ` Cod+" ICD4F4CM va"a'!" de "a " Oc(o%'r!e 9LLL
    >7> Anexa *
    9FI.55` c+ (+"'+rare de co%&or(a%en(
    9FI.G De%en=7 FS
    De%en=7 de (!& A"/e!%er, c+ de'+( &recoce
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en( 9FI.55`
    c+ (+"'+rare de co%&or(a%en(
    De%en=7 de (!& A"/e!%er, c+ de'+( (ard!v
    9FI.5L` .7r7 (+"'+rare de co%&or(a%en( 9FI.55 `
    c+ (+"'+rare de co%&or(a%en(
    De%en=7 vasc+"ar7
    9FL.I5 c+ de"!r!+%
    9FL.I; c+ d!s&o/!=!e de&res!v7
    9FL.I9 c+ !de! de"!ran(e
    9FL.IL neco%&"!ca(7
    ;LI.GL De&enden=a de &o"!s+'s(an=7
    HFF.F D!a$nos(!c a%Ana( &e a<a II
    HFF.F D!a$nos(!c sa+ cond!=!e a%Ana(7 &e a<a I
    ;5Y.5 D!sca"c+"!e ZT+"'+rare de ca"c+"[
    ;L9.HL D!s.+nc=!e se<+a"7 FS
    ;5Y.9 D!s$ra.!e ZT+"'+rare a e<&res!e! $ra.!ce[
    ;5Y.LL D!s"e<!e ZT+"'+rare de c!(!([
    ;L9.HR D!s&are+n!e @>edatorat6 +nei condi(ii medicale /eneraleA 777
    @Se indic6 condi(ia medical6 /eneral6A
    R9Y.L D!s&are+n!e .e%!n!n7 da(ora(7
    RLG.GF D!s&are+n!e %asc+"!n7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6
    ;LH.IH D!sso%n!e FS[
    3R9.G9 Do"!+
    ;L9.H5 Dor!n=7 se<+a"7 d!%!n+a(7
    RLG.GF Dor!n=7 se<+a"7 d!%!n+a(7 a '7r'a(+"+! da(ora(7...
    @Se indic6 condi(ia medical6 /eneral6A
    R9Y.G Dor!n=7 se<+a"7 d!%!n+a(7 a .e%e!! da(ora(7...
    @Se indic6 condi(ia medical6 /eneral6A
    FFY.9 E.ec(e adverse a"e %ed!ca%en(e"or FS
    ;L9.HY E@ac+"are &recoce
    HGH.R Enco&re/!s c+ cons(!&a=!e s! !ncon(!nen=7 &r!n &rea&"!n
    ;LH.H Enco&re/!s .7r7 cons(!&a=!e s! !ncon(!nen=7 &r!n &rea&"!n
    ;LH.R En+re/!s ZNeda(ora( +ne! cond!=!! %ed!ca"e $enera"e[
    ;L9.I E<!'!=!on!s%
    ;5R Fac(or! &s!o"o$!c! care a.ec(ea/7 cond!=!a %ed!ca"7 $enera"7
    ;L9.G5 Fe(!O!s%
    ;L9.; Fe(!O!s% (ransves(!c
    ;LL.9; Fo'!e soc!a"7
    ;LL.9F 4o'!e s&ec!.!c7
    ;L9.GF Fro((e+r!s%
    N;LL.5; F+$7 d!soc!a(!v7
    ` Cod+" ICD4F4CM va"a'!" de "a " Oc(o%'r!e 9LLL
    Lista al$abetic a Dia!nosticelor ,i odurilor DSM-IV-
    T+
    =F4
    EdeXc+J Ha"+c!no$ene
    ;LY.;L A'+/
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e
    ;LI.YL De&enden=7
    9F9.GI In(o<!ca=!e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    9F9.GF T+"'+rare de &erce&=!e &ers!s(en(7 !nd+s7
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    ;LH.II H!&erso%n!e
    &r!%ar7
    ;LH.IIH!&erso%n!e :n "e$7(+r7 c+... @Se indic6 t+lb+rarea de pe axa 5 sa+ II[
    ;LL.H H!&ocondr!e
    EdeXc+J Ina"an(e
    ;LY.FL A'+/
    292.81 De"!r!+% &r!n !n(o<!ca=!e
    292.82 De%en=7 &ers!s(en(7 !nd+s7
    ;LI.RL De&enden=72
    9F9.GF In(o<!ca=!e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.GF N T+"'+rare an<!oas7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    ;LH.I9Inso%n!e :n "e$7(+r7 c+... @Se indic6 t+lb+rarea de pe axa 5 sa+ axa 55A
    ;LH.I9 Inso%n!e &r!%ar7
    312.31 *oc+" de Oans7 &a(o"o$!c
    312.32 -"e&(o%an!e
    ;L9.G; Masoc!s% se<+a"
    Med!ca%en(e
    ;;;.FL T+"'+rare de %!Ocare !nd+s7 de... FS
    ;;;.5 Tre%or &osr+ra" !nd+s de...
    ;5L.5 Mod!.!care de &ersona"!(a(e da(ora(7...
    @Se indic6 condi(ia medical6 /eneral6A
    ;5;.9; M+(!s% se"ec(!v
    ;IH Narco"e&s!e
    3R5.95 Ne$"!@are a co&!"+"+!
    FFY.YNe$"!@are a co&!"+"+! @dac6 in centr+l aten(iei se a)l6 *ictimaA
    ZInd+sE7J de[ Ne+ro"e&(!ce
    ;;;.FF A)a(!s!e ac+(7
    ;;;.G9 D!s)!ne/!e (ard!v7
    ;;;.H D!s(on!e ac+(7
    ;;9.5 Par)!nson!s%
    ><+ Ane,a E

    ;;;.F9 S!ndro% ne+ro"e&(!c %a"!$n
    3H5.LF N!c! +n d!a$nos(!c &e a<a n
    3H5.LF N!c! +n d!a$nos(!c sa+ cond!=!e &e a<a I
    EdeJ N!co(!n7
    9F9.L A's(!nen=7
    ;LY.5L De&enden(7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    35Y.G5 Nonco%&"!an=7 "a (ra(a%en(
    EdeXc+J O&!acee
    9F9.L A's(!nen=7
    ;LY.YL A'+/
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e
    ;LI.LL De&enden=7
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7
    9F9.GF In(o<!ca=!e N
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    9F9.GF T+"'+rare de so%n !nd+s7
    Pan!ca
    ;LL.95 c+ a$ora.o'!e
    ;LL.L5 .7r7 a$ora.o'!e
    ;L9.F Para.!"!e FS
    ;LH.IH Paraso%n!e FS
    ;L9.9 Pedo.!"!e
    ;LH.Y9 P!ca
    ;59.9; P!ro%an!e
    EdeXc+J Pencyc"!d!n7 Esa+ s+'s(an=e s!%!"are &encyd!d!ne!J
    ;LY.FL A'+/
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e
    ;LI.FL De&enden=7
    9F9.GF In(o<!ca=!e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    3R9.I Pro'"e%7 de ac+"(+ra=!e
    3R9.GF Pro'"e%7 de .a/7 de v!a=7
    ;5;.G9 Pro'"e%7 de !den(!(a(e
    3R9.9 Pro'"e%7 &ro.es!ona"7
    3R9.G5 Pro'"e%7 de re"a=!e FS
    3R5.F Pro'"e%7 de re"a=!e :n "e$7(+r7 c+ o (+"'+rare %en(a"7 sa+ c+ o cond!=!e
    %ed!ca"7 $enera"7
    Lista al$abetic a Dia!nosticelor ,i odurilor DSM-IV-T+ 8AE
    3R5.G Pro'"e%7 de re"a=!e :n(re .ra=!
    3R5.5 Pro'"e%7 de re"a=!e c+ &ar(ener+"
    3R5.9L Pro'"e%7 de re"a=!e &7r!n(e4co&!"
    3R9.GF Pro'"e%7 re"!$!oas7 sa+ s&!r!(+a"7
    3R9.; Pro'"e%7 Oco"ar7
    ;5G.L Re(ardare %en(a"7 %odera(7
    ;5G.9 Re(ardare %en(a"7 &ro.+nd7
    ;5G.5 Re(ardare %en(a"7 sever7
    ;5F Re(ardare %en(a"7 de sever!(a(e nes&ec!.!ca(7
    ;5H Re(ardare %en(a"7 +Ooar7
    ;LH.YY R+%!na=!e
    ;L9.GI Sad!s% se<+a"
    Sc!/o.ren!e, (!&
    9FY.9L ca(a(on!c
    9FY.5L de/or$an!/a(
    9FY.FL ned!.eren=!a(
    9FY.;L &arano!d
    9FY.RL re/!d+a"
    EdeXc+J Seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    9F9.L A's(!nen=7
    ;LY.IL A'+/
    9F9.G5 De"!r!+% &r!n a's(!nen=7
    292.81 De"!r!+% &r!n !n(o<!ca=!e
    292.82 De%en=7 &ers!s(en(7 !nd+s7
    ;LI.5L De&enden(7
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7
    9F9.GF In(o<!ca=!e 2
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7
    9F9.G; T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7
    9F9.GF T+"'+rare an<!oas7 !nd+s7
    9F9.F T+"'+rare :n "e$7(+r7 c+... FS
    T+"'+rare &s!o(!c7 !nd+s7
    9F9.59 c+ a"+c!na=!!
    9F9.55 c+ !de! de"!ran(e
    9F9.GF T+"'+rare de so%n !nd+s7
    3RY.9 S!%+"are
    ;LH.IR So%na%'+"!s%
    ;LG.; S(res ac+(
    ;LF.G5 S(res &os((ra+%a(!c
    ;LH.IR Teroare de so%n
    ;LH.9L T!c FS
    ;LH.99 T!c %o(or sa+ voca" cron!c
    ;LH.95 T!c (ran/!(or
    ;59.;F Tr!co(!"o%an!a 2
    9F;.G; T+"'+rare a.ec(!v7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    9FR.FL T+"'+rare a.ec(!v7 FS
    ><C Anexa *
    T+"'+rare a"$!c7
    ;LH.GFasoc!a(7, a(A( c+ .ac(or! &s!o"o$!c!, cA( s! c+ o cond!=!e %ed!ca"7 $enera"7
    ;LH.GL asoc!a(7 c+ .ac(or! &s!o"o$!c!
    ;LH.YF T+"'+rare de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!
    9FI.L T+"'+rare a%nes(!ca da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    9FI.G T+"'+rare a%nes(!ca FS
    9F;.GFT+"'+rare an<!oas7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    ;LL.LL T+"'+rare an<!oas7 FS
    9FF.GL T+"'+rare As&er$er
    9FF.LL T+"'+rare a+(!s(7
    T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod, de&res!v
    9FR.YR :n re%!s!+ne co%&"e(7
    9FR.YY :n re%!s!+ne &ar=!a"7
    9FR.Y9 %odera(
    9FR.YL nes&ec!.!ca(
    9FR.YI sever, c+ e"e%en(e &s!o(!ce
    9FR.Y; sever, .7r7 e"e%en(e &s!o(!ce
    9FR.Y5 +Oor
    ,!D7B" T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod, !&o%an!aca"
    T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod, %an!aca"
    9FR.IR :n re%!s!+ne co%&"e(7
    9FR.IY :n re%!s!+ne &ar=!a"7
    9FR.I9 %odera(
    9FR.IL nes&ec!.!ca(
    ,!D7BB sever, c+ e"e%en(e &s!o(!ce
    9FR.I; sever, .7r7 e"e%en(e &s!o(!ce
    9FR.I5 +Oor
    T+"'+rare '!&o"ar7 I. ce" %a! recen( e&!sod, %!<(
    9FR.RR :n re%!s!+ne co%&"e(7
    9FR.RY :n re%!s!+ne &ar=!a"7
    9FR.R9 %odera(
    9FR.RL nes&ec!.!ca(
    9FR.RI sever, c+ e"e%en(e &s!o(!ce
    9FR.R; sever, .7r7 e"e%en(e &s!o(!ce
    9FR.R5 +Oor
    9FR.H T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod, nes&ec!.!ca(
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c
    9FR.LR :n re%!s!+ne co%&"e(7
    9FR.LY :n re%!s!+ne &ar=!a"7
    9FR.L9 %odera(
    9FR.LL nes&ec!.!ca(
    9FR.LI sever, c+ e"e%en(e s&ec!.!ce
    9FR.L; sever, .7r7 e"e%en(e s&ec!.!ce
    9FR.L5 +Oor
    9FR.GF T+"'+rare '!&o"ar7 II
    9FR.GL T+"'+rare '!&o"ar7 FS
    Lista al$abetic a Dia!nosticelor si odurilor DSM-IV-T+ 8A4
    9F;.GF T+"'+rare ca(a(on!c7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    ;L5.5; T+"'+rare c!c"o(!%!c7
    9F9.I T+"'+rare co$n!(!v7 FS
    ;LH.YL T+"'+rare de co%&or(a%en( a"!%en(ar FS
    ;59.F T+"'+rare de co%&or(a%en( d!sr+&(!v FS
    ;LH.F T+"'+rare de co%+n!care FS
    T+"'+rare de cond+!(7
    ;59.G5 (!& c+ de'+( :n co&!"7r!e
    ;59.G9. (!& c+ de'+( :n ado"escen=7
    ;59.GF (!& nes&ec!.!ca(
    ;59.9L T+"'+rare a con(ro"+"+! !%&+"s+"+!
    ;LL.55 T+"'+rare de convers!e
    9FH.5 T+"'+rare de"!ran(7
    ;LL.R T+"'+rarea de de&ersona"!/are
    ;55 T+"'+rare de&res!v7 FS
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c
    9FR.9R :n re%!s!+ne co%&"e(7
    9FR.9Y :n re%!s!+ne &ar=!a"7
    9FR.99 %odera(
    9FR.9L nes&ec!.!ca(
    9FR.9I sever, c+ e"e%en(e &s!o(!ce
    9FR.9; sever, .7r7 e"e%en(e &s!o(!ce
    9FR.95 +Oor
    T+"'+rare de&res!v7 %a@or7 rec+ren(7
    9FR.;R :n re%!s!+ne co%&"e(7
    9FR.;Y :n re%!s!+ne &ar=!a"7
    9FR.;9 %odera(7
    9FR.;L nes&ec!.!ca(7
    9FR.;I sever7, c+ e"e%en(e &s!o(!ce
    9FR.;; sever7, .7r7 e"e%en(e &s!o(!ce
    9FR.;5 +Ooar7
    9FF.5L T+"'+rare de/!n(e$ra(!v7 a co&!"7r!e!
    ;5Y.I T+"'+rare de de/vo"(are a coordon7r!!
    9FF.GL T+"'+rare de de/vo"(are &ervas!v7
    ;LL.H T+"'+rare d!s%or.!c7 cor&ora"7
    ;LL.5Y T+"'+rare d!soc!a(!v7 FS
    ;LL.I T+"'+rare d!s(!%!c7
    ;L9.H9 T+"'+rare de erec=!e a '7r'a(+"+!
    RLH.GI T+"'+rare de erec=!e a '7r'a(+"+! da(ora(7...
    @Se indic6 condi(ia medical6 /eneral6A
    ;L9.H9 T+"'+rare de e<c!(a=!e se<+a"7 a .e%e!!
    ;59.;I T+"'+rare e<&"o/!v7 !n(er%!(en(7
    T+"'+rare .ac(!ce
    ;LL.5R c+ se%ne s! s!%&(o%e &redo%!nan( &s!o"o$!ce
    ;LL.5F c+ se%ne s! s!%&(o%e &redo%!nan( so%a(!ce
    ;LL.5F c+ se%ne s! s!%&(o%e &s!o"o$!ce s! so%a(!ce co%'!na(e
    ><7 Ane,a E

    ;LL.5F T+"'+rare .ac(!ce FS
    ;5Y.;F T+"'+rare .ono"o$!c7
    T+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e
    ;5I.L5 de (!& co%'!na(
    ;5I.L5 de (!& &redo%!nan( !&erac(!v4!%&+"s!v
    ;5I.LL de (!& &redo%!nan( !na(en(
    ;5I.F T+"'+rare !&erac(!v!(a(eXde.!c!( de a(en=!e FS
    ;LL.5I T+"'+rare de !den(!(a(e d!soc!a(!v7
    T+"'+rare de !den(!(a(e se<+a"7
    ;L9.GY "a ado"escen=! sa+ "a ad+"=!
    ;L9.R "a co&!!
    ;L9.R T+"'+rare de !den(!(a(e se<+a"7 FS
    ;5Y.F T+"'+rare de :nv7=are FS
    ;5Y.;5 T+"'+rare de "!%'a@ e<&res!v
    9F;.F T+"'+rare %en(a"7 FS da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    ;LL.F T+"'+rare %en(a"7 nes&ec!.!ca(7 Znon&s!o(!c7[
    ;LH.; T+"'+rare de %!Ocare s(ereo(!&7
    ;5Y.;5 T+"'+rare %!<(7 de "!%'a@ rece&(!v s! e<&res!v
    ;LL.; T+"'+rare o'ses!vo4co%&+"s!v7
    ;5;.G5 ET+"'+rareaJ O&o/!(!on!s% &rovoca(or
    ;L9.HI T+"'+rare de or$as% a '7r'a(+"+!
    ;L9.H; T+"'+rare de or$as% a .e%e!!
    ;5;.F T+"'+rare a &er!oade! de s+$ar, a co&!"7r!e! sa+ ado"escen=e! FS
    ;L5.H T+"'+rare de &ersona"!(a(e an(!soc!a"7
    ;L5.G; T+"'+rare de &ersona"!(a(e 'order"!ne
    ;L5.R T+"'+rarea de &ersona"!(a(e de&enden(7
    ;L5.G9 T+"'+rare de &ersona"!(a(e ev!(an(7
    ;L5.F T+"'+rare de &ersona"!(a(e FS
    ;L5.YL T+"'+rare de &ersona"!(a(e !s(r!on!c7
    ;L5.G5 T+"'+rare de &ersona"!(a(e narc!s!s(!c7
    ;L5.I T+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7
    ;L5.L T+"'+rare de &ersona"!(a(e &arano!d7
    ;L5.9L T+"'+rare de &ersona"!(a(e sc!/o!d7
    ;L5.99 T+"'+rare de &ersona"!(a(e sc!/o(!&a"7
    T+"'+rare &s!o(!c7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    9F;.G9 c+ a"+c!na=!!
    9F;.G5 c+ !de! de"!ran(e
    9FG.F T+"'+rare &s!o(!c7 FS
    9FH.; T+"'+rare &s!o(!c7 !nd+s7
    9FG.G T+"'+rare &s!o(!c7 sc+r(7
    ;5;.GF T+"'+rarea reac(!v7 de a(aOa%en( a &er!oade! de s+$ar s! a %!c!! co&!"7r!!
    9FG.GL T+"'+rare Re((
    ;LH.IY T+"'+rare a r!(%+"+! c!rcad!an de so%n
    9FY.HL T+"'+rare sc!/oa.ec(!v7
    9FY.IL T+"'+rare sc!/o.ren!.or%7
    ;L9.F T+"'+rare se<+a"7 FS
    Lista al$abetic a Dia!nosticelor ,i odurilor DSM-IV-T+ 8AA
    ;LL.G5 T+"'+rare de so%a(!/are
    ;LL.G5 T+"'+rare so%a(o.or%7 FS
    ;LL.G5 T+"'+rare so%a(o.or%7 ned!.eren=!a(7
    T+"'+rare de so%n da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    HGL.YI de (!& !&erso%n!e
    HGL.Y9 de (!& !nso%n!e
    HGL.YF de (!& %!<(
    HGL.YF de (!& &araso%n!e
    HGL.YF T+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a
    ;LH.9; T+"'+rare To+re((e
    T+"'+r7r! de ada&(are
    ;LF.9I c+ an<!e(a(e
    ;LF.L c+ d!s&o/!=!e de&res!v7
    ;LF.9G c+ d!s&o/!=!e %!<(7 de&res!v7 s! an<!oas7
    309.3 c+ &er(+r'are de cond+!(7
    309.4 c+ &er(+r'are %!<(7 de e%o=!! O! cond+!(7
    ;LF.F nes&ec!.!ca(7
    ;LR.YY 3a$!n!s% ENeda(ora( +ne! cond!=!! %ed!ca"e $enera"eJ
    ;L9.G5 3oye+r!s%

    Ane,a '
    Lista Fumeric a Dia!nosticelor
    si odurilor DSM-IV-T+
    en(r+ a %en=!ne co%&a(!'!"!(a(ea c+ ICD4F4CM, +ne"e d!a$nos(!ce DSM4I3 c+
    ace"eaO! n+%ere de cod. Aces(ea s+n( !nd!ca(e :n aceas(7 "!s(7 &r!n &aran(e/e.
    FS 6 .7r7 a"(7 s&ec!.!ca=!e
    290.40 De%en=7 vasc+"ar7, neco%&"!ca(7
    290.41 De%en=7 vasc+"ar7, c+ de"!r!+%
    290.42 De%en=7 vasc+"ar7, c+ !de! de"!ran(e
    9FL.I; De%en=7 vasc+"ar7, c+ d!s&o/!=!e de&res!v7
    9F5.L De"!r!+% &r!n a's(!nen=7 de a"coo"
    291.0 De"!r!+% &r!n !n(o<!ca=!e c+ a"coo"
    291.1 T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de a"coo"
    291.2 De%en=7 &ers!s(en(7 !nd+s7 de a"coo"
    9F57$ T+"'+rare &s!o(!c7 !nd+s7 de a"coo", c+ a"+c!na=!!
    9F5.Y T+"'+rare &s!o(!c7 !nd+s7 de a"coo", c+ !de! de"!ran(e
    9F5.G5 A's(!nen=7 a"coo"!c7
    !U 9F5.GF D!s.+nc=!e se<+a"7 !nd+s7 de a"coo"
    9F5.GF T+"'+rare a.ec(!v7 !nd+s7 de a"coo"
    9F5.GF T+"'+rare an<!oas7 !nd+s7 de a"coo"
    5
    U 9F5.GF T+"'+rare de so%n !nd+s7 de a"coo"
    9F5.F T+"'+rare :n "e$7(+r7 c+ a"coo"+" FS
    !U 9F9.L A's(!nen=7 de a%.e(a%!na
    9F9.L A's(!nen=7 de coca!n7
    9F9.L A's(!nen=7 de n!co(!n7
    9F9.L A's(!nen=7 de o&!acee
    9F9.L A's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    9F9.L A's(!nen=7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J
    !U 9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de a%.e(a%!na, c+ !de! de"!ran(e
    9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de canna'!s, c+ !de! de"!ran(e
    9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de coca!n7, c+ !de! de"!ran(e
    9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de a"+c!no$ene, c+ !de! de"!ran(e
    9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de !na"an(e, c+ !de! de"!ran(e
    9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de &enyc"!d!n7, c+ !de! de"!ran(e
    ><G
    ><> Ane,a '

    9F9."" T+"'+rare &s!o(!c7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce, c+ !de!
    de"!ran(e
    9F9.55 T+"'+rare &s!o(!c7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J c+ !de! de"!ran(e
    #
    L
    !U 9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de a%.e(a%!na, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de car(na'!s, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de coca!n7, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de a"+c!no$ene, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de !na"an(e, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de o&!acee, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de &encyc"!d!n7, c+ a"+c!na=!!
    9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce, c+ a"+c!na=!!
    "U 9F9.59 T+"'+rare &s!o(!c7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J c+ a"+c!na=!!
    4 9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ a%.e(a%!na
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ canna'!s
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ coca!n7
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ a"+c!no$ene
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ !na"an(e
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ o&!acee
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ &encyc"!d!n7
    9F9.G5 De"!r!+% &r!n a's(!nen=7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    9F9.G5 De"!r!+% &r!n !n(o<!ca=!e c+ seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    5
    U 9F9.G5 De"!r!+% !nd+s de a"(7 s+'s(an=7 Esa+ o s+'s(an=7 nec+nosc+(7J
    9F9.G9 De%en=7 &ers!s(en(7 !nd+s7 de !na"an(e
    9F9.G9 De%en=7 &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    9F9.G9 De%en=7 &ers!s(en=7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7
    9F9.G; T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    9F9.G; T+"'+rare a%nes(!c7 &ers!s(en(7 !nd+s7 de a"(7 s+'s(an=7 Esa+ o
    s+'s(an=7 nec+nosc+(7J
    .U 9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de a%.e(a%!na
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de coca!n7
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de a"+c!no$ene
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de !na"an(e
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de o&!acee
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de &encyc"!d!n7
    9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    U 9F9.GI T+"'+rare a.ec(!v7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J
    rU 9F9.GF T+"'+rare an<!oas7 !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J
    9F9.GF T+"'+rare de so%n !nd+s7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J
    9F9.GF D!s.+nc=!e se<+a"7 !nd+s7 de a%.e(a%!na
    9F9.GF In(o<!ca=!e c+ a%.e(a%!na
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de a%.e(a%!na
    9F9.GF T+"'+rare de so%n !nd+s7 de a%.e(a%!na
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de ca.e!na
    9F9.GF T+"'+rare de so%n !nd+s7 de ca.e!na
    9F9.GF In(o<!ca=!e !nd+s7 de canna'!s
    9F9.GF T+"'+rare an<!oas7 !nd+s7 de canna'!s
    E
    E
    Lista Fumeric a Dia!nosticelor si odurilor DSM-IV-T+ 8A6

    D!s.+nc=!e se<+a"7 !nd+s7 de coca!n7
    In(o<!ca=!e c+ coca!n7
    T+"'+rare an<!oas7 !nd+s7 de coca!n7
    T+"'+rare de so%n !nd+s7 de coca!n7
    In(o<!ca=!e c+ a"oc!no$ene
    T+"'+rare an<!oas7 !nd+s7 de a"+c!no$ene
    T+"'+rare de &erce&=!e &ers!s(en(7 !nd+s7 de a"+c!no$ene
    In(o<!ca=!e c+ !na"an(e
    T+"'+rare an<!oas7 !nd+s7 de !na"an(e
    D!s.+nc=!e se<+a"7 !nd+s7 de o&!acee
    In(o<!ca=!e c+ o&!acee
    T+"'+rare de so%n !nd+s7 de o&!nacee
    In(o<!ca=!e c+ &encyc"!d!n7
    T+"'+rare an<!oas7 !nd+s7 de &encyc"!d!n7
    D!s.+nc=!e se<+a"7 !nd+s7 de seda(!ve, !&no(!ce sa+
    an<!o"!r!ce
    In(o<!ca=!e c+ seda(!ve, !&no(!ce sa+ na<!o"!(!ce
    T+"'+rare an<!oas7 !nd+s7 de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce
    T+"'+rare de so%n !nd+s7 de seda(!ve, !&no(!ce sa+
    an<!o"!(!ce
    D!s.+nc=!e se<+a"7 !nd+s7 de a"(7 s+'s(an=7 Esa+ o s+'s(an=7
    nec+nosc+(7J
    In(o<!ca=!e c+ a"(7 s+'s(an=7 Esa+ c+ o s+'s(an=7 nec+nosc+(7J
    T+"'+rare :n "e$7(+r7 c+ a%.e(a%!na FS
    T+"'+rare :n "e$7(+r7 c+ ca.e!na FS
    T+"'+rare :n "e$7(+r7 c+ canna'!s+" FS
    T+"'+rare :n "e$7(+r7 c+ coca!na FS
    T+"'+rare :n "e$7(+r7 c+ a"+c!no$ene"e FS
    T+"'+rare :n "e$7(+r7 c+ !na"an(e"e FS
    T+"'+rare :n "e$7(+r7 c+ n!co(!n7 FS
    T+"'+rare :n "e$7(+r7 c+ o&!acee"e FS
    T+"'+rare :n "e$7(+r7 c+ &encyc"!d!n7 FS
    T+"'+rare :n "e$7(+r7 c+ seda(!ve"e, !&no(!ce"e sa+
    an<!o"!(!ce"e FS
    T+"'+rare :n "e$7(+r7 c+ a"(7 s+'s(an=7 Esa+ c+ o s+'s(an=7
    nec+nosc+(7J FS
    De"!r!+% da(ora(... @Se indic6 condi(ia medical6 /eneral6A
    T+"'+rare &s!o(!c7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A, c+
    !de! de"!ran(e
    T+"'+rare &s!o(!c7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A c+
    a"+c!na=!!
    T+"'+rare a.ec(!v7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    T+"'+rare an<!oas7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    T+"'+rare ca(a(on!c7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    T+"'+rare %en(a"7 FS da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    T+"'+rare a%nes(!c7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    De%en=7 da(ora(7 .. 7@Se indic6 condi(ia medical6 /eneral6 A, .7r7 (+"'+rare
    de co%&or(a%en(
    r
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
    9F9.GF
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    U 9F9.GF
    . 9F9.F
    9F9.F
    9F9.F
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    9F9.F
    U 9F9.F
    9F;.L
    9F;.G5
    293.82
    293.83
    293.84
    293.89
    293.9
    294.0
    294.10*
    ` Cod+" ICD4F4CM va"a'!" de "a " Oc(o%'r!e 9LLL
    GRL Anexa '


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    `
    9FI.5L
    `
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    @Se indic6
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    c+
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    De%en=7 FS
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    Sc!/o.ren!e, (!& de/or$an!/a(
    Sc!/o.ren!e, (!& ca(a(on!c
    Sc!/o.ren!e, (!& &arano!d
    T+"'+rare sc!/o.ren!.or%7
    Sc!/o.ren!e, (!& re/!d+a"
    T+"'+rare sc!/oa.ec(!v7
    Sc!/o.ren!e, (!& ned!.eren=!a(
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, nes&ec!.!ca(
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, +Oor
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, %odera(
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, sever, .7r7 e"e%en(e
    &s!o(!ce
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, sever, c+ e"e%en(e
    &s!o(!ce
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, :n re%!s!+ne &ar=!a"7
    T+"'+rare '!&o"ar7 I, e&!sod %an!aca" +n!c, :n re%!s!+ne co%&"e(7
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, nes&ec!.!ca(
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, +Oor
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, %odera(
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, sever, .7r7 e"e%en(e
    &s!o(!ce
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, sever, c+ e"e%en(e &s!o(!ce
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, :n re%!s!+ne &ar=!a"7
    T+"'+rare de&res!v7 %a@or7, e&!sod +n!c, :n re%!s!+ne co%&"e(7
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, nes&ec!.!ca(7
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, +Ooar7
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, %odera(7
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, sever7, .7r7 e"e%en(e
    &s!o(!ce
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, sever7, c+ e"e%en(e &s!o(!ce
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, :n re%!s!+ne &ar=!a"7
    T+"'+rare de&res!v7 %a@or7, rec+ren(7, :n re%!s!+ne co%&"e(7
    T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod !&o%an!aca"
    T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", nes&ec!.!ca(
    T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", +Oor
    N Cod+" ICD4F4CM va"a'!" de "a " Oc(o%'r!e 9LLL
    Lista Fumeric a Dia!nosticelor ,i odurilor DSM-IV-T+ 8IE
    296.42 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", %odera(
    296.43 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", sever, .7r7
    e"e%en(e &s!o(!ce
    296.44 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", sever, c+ e"e%en(e
    &s!o(!ce
    296.45 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", :n re%!s!+ne &ar=!a"7
    296.46 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %an!aca", :n re%!s!+ne co%&"e(7
    296.50 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, nes&ec!.!ca(
    296.51 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, +Oor
    296.52 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, %odera(
    296.53 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, sever, .7r7 e"e%en(e
    &s!o(!ce
    296.54 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, sever, c+ e"e%en(e
    &s!o(!ce
    296.55 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, :n re%!s!+ne &ar=!a"7
    296.56 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod de&res!v, :n re%!s!+ne
    co%&"e(7
    296.60 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, nes&ec!.!ca(
    296.61 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, +Oor
    296.62 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, %odera(
    296.63 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, sever, .7r7 e"e%en(e
    &s!o(!ce
    296.64 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, sever, c+ e"e%en(e
    &s!o(!ce
    296.65 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, :n re%!s!+ne &ar=!a"7
    296.66 T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod %!<(, :n re%!s!+ne co%&"e(7
    9FR.H T+"'+rare '!&o"ar7 I, ce" %a! recen( e&!sod nes&ec!.!ca(
    9FR.GL T+"'+rare '!&o"ar7 FS
    9FR.GF T+"'+rare '!&o"ar7 II
    9FR.FL T+"'+rare a.ec(!v7 FS
    9FH.5 T+"'+rare de"!ran(7
    9FH.; T+"'+rare de"!ran(7 !nd+s7
    9FG.G T+"'+rare &s!o(!c7 sc+r(7
    298.9 T+"'+rare &s!o(!c7 FS
    9FF.LL T+"'+rare a+(!s(7
    299.9 T+"'+rare de/!n(e$ra(!v7 a co&!"7r!e!
    9FF.GL T+"'+rare As&er$er
    9FF.GL T+"'+rare de de/vo"(are &ervas!v7 FS
    9FF.GL T+"'+rare Re((
    300.0 T+"'+rare an<!oas7 FS
    300.1 Pan!c7 .7r7 a$ora.o'!e
    300.2 An<!e(a(e $enera"!/a(7
    300.11 T+"'+rare de convers!e
    300.12 A%ne/!e d!soc!a(!v7
    300.13 F+$7 d!soc!a(!v7
    300.14 T+"'+rare de !den(!(a(e d!soc!a(!v7
    300.15 T+"'+rare d!soc!a(!v7 FS
    300.16 T+"'+rare .ac(!ce c+ se%ne O! s!%&(o%e &redo%!nan( &s!o"o$!ce
    =>2 Anexa '


    ;LL.5F T+"'+rare .ac(!ce FS


    ;LL.5F T+"'+rare .ac(!ce c+ se%ne s! s!%&(o%e &s!o"o$!ce s! so%a(!ce
    co%'!na(e
    ;LL.5F T+"'+rare .ac(!ce c+ se%ne O! s!%&(o%e &redo%!nan( so%a(!ce
    300.21 Pan!c7 c+ a$ora.o'!e
    300.22 A$ora.o'!e .7r7 !s(or!c de &an!c7
    ;LL.9; Fo'!e
    soc!a"7
    ;LL.9F Fo'!e
    s&ec!.!c7
    300.3 T+"'+rare o'ses!vo4co%&+"s!v7
    300.4 T+"'+rare d!s(!%!c7
    ;LL.R T+"'+rare de de&ersona"!/area
    ;LL.H T+"'+rare d!s%or.!c7
    cor&ora"7
    ;LL.H H!&ocondr!e
    ;LL.G5 T+"'+rare de so%a(!/are
    ;LL.G5 T+"'+rare so%a(o.or%7 FS
    ;LL.G5 T+"'+rare so%a(o.or%7 ned!.eren=!a(7
    ;LL.F T+"'+rare %en(a"7 nes&ec!.!ca(7 Enon&s!o(!c7J
    ;L5.L T+"'+rare de &ersona"!(a(e &arano!d7
    ;L5.5; T+"'+rare c!c"o(!%!c7
    ;L5.9L T+"'+rare de &ersona"!(a(e
    sc!/o!d7
    ;L5.99 T+"'+rare de &ersona"!(a(e
    sc!/o(!&a"7
    ;L5.I T+"'+rare de &ersona"!(a(e o'ses!vo4co%&+"s!v7
    ;L5.YL T+"'+rare de &ersona"!(a(e !s(r!on!c7
    301.6 T+"'+rare de &ersona"!(a(e de&enden(7
    301.7 T+"'+rare de &ersona"!(a(e an(!soc!a"7
    301.81 T+"'+rare de &ersona"!(a(e narc!s!s(!c7
    301.82 T+"'+rare de &ersona"!(a(e ev!(an(7
    ;L5.G; T+"'+rare de &ersona"!(a(e
    'order"!ne
    ;L5.F T+"'+rare de &ersona"!(a(e FS
    302.2 Pedo.!"!e
    302.3 Fe(!O!s% (ransves(!c
    302.4 E<!'!=!on!s%
    ;L9.R T+"'+rare de !den(!(a(e se<+a"7 "a co&!!
    ;L9.R T+"'+rare de !den(!(a(e FS
    302.70 D!s.+nc=!e se<+a"7 FS
    302.71 Dor!n=7 se<+a"a red+s7
    302.72 T+"'+rare de e<c!(a=!e se<+a"7 a .e%e!!
    302.72 T+"'+rare de erec=!e a '7r'a(+"+!
    302.73 T+"'+rare de or$as% a .e%e!!
    302.74 T+"'+rare de or$as% a '7r'a(+"+!
    302.75 E@ac+"are &recoce Z&re%a(+r7[
    ;L9.HR D!s&are+n!e Eneda(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"eJ
    ;L9.HF Avers!+ne se<+a"7
    302.81 Fe(!O!s%
    302.82 3oye+r!s%
    302.83 Masoc!s% se<+a"
    302.84 Sad!s% se<+a"
    ;L9.GY T+"'+rare de !den(!(a(e se<+a"7 "a ado"escen=! sa+ "a
    ad+"=!
    ;L9.GF Fro((e+r!s%
    Lista Fumeric a Dia!nosticelor ,i odurilor DSM-IV-T+ 8I4
    ;L9.LF Para.!"!e FS
    302.9 T+"'+rare se<+a"7 FS
    ;L;.LL In(o<!ca=!e a"coo"!c7
    ;L;.FL De&enden=7 a"coo"!c7
    ;LI.LL De&enden=7 de o&!acee
    304.9 De&enden=7 de seda(!ve, !&no(!ce sa+ an<!o"o(!ce
    ;LI.9L De&enden=7 de coca!n7
    ;LI.;L De&enden=7 de2canna'!s
    ;LI.IL De&enden=7 de a%.e(a%!na
    ;LI.YL De&enden=7 de a"+c!no$ene
    ;LI.RL De&enden=7 de !na"an(e
    ;LI,RL De&enden=7 de &encyc"!d!n7
    ;LI.GL De&enden=7 de &o"!s+'s(an=7
    ;LI.FL De&enden=7 de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J
    ;LY.LL A'+/ de a"coo"
    ;LY.5 De&enden=7 de n!co(!n7
    ;LY.9L A'+/ de canna'!s
    ;LY.;L A'+/ de a"+c!no$ene
    ;LY.IL A'+/ de seda(!ve, !&no(!ce sa+ an<!o"!(!ce
    ;LY.YL A'+/ de o&!acee
    ;LY.RL A'+/ de coca!n7 N
    ;LY.HL A'+/ de a%.e(a%!na
    !U ;LY.FL In(o<!ca=!e c+ ca.e!na
    ;LY.FL A'+/ de !na"an(e
    ;LY.FL A'+/ de a"(7 s+'s(an=7 Esa+ de o s+'s(an=7 nec+nosc+(7J
    U ;LY.FL A'+/ de &encyc"!d!n7
    ;LR.Y5 3a$!n!s% Eneda(ora( +ne! cond!=!! %ed!ca"e $enera"eJ
    307.0 Ba"'!s%
    307.1 Anore<!e nervoas7
    307.20 T!c FS
    307.21 T!c (ran/!(or
    307.22 T!c %o(or sa+ voca" cron!c
    307.23 T+"'+rare To+re((e
    ;LH.; T+"'+rare de %!Ocare s(ereo(!&7
    ;LH.I9 Inso%n!e :n "e$7(+r7 c+... @Se indic6 t+lb+rarea de pe axa 5 sa+ axa 55A
    ;LH.I9 Inso%n!e &r!%ar7
    ;LH.II H!&erso%n!e :n "e$7(+r7 c+... @Se indic6 t+lb+rarea de pe axa 5 sa+ axa 55A
    ;LH.II H!&erso%n!e &r!%ar7
    ;LH.IY T+"'+rare a r!(%+"+! c!rcad!an de so%n
    ;LH.IR Teroare de so%n
    ;LH.IR So%na%'+"!s%
    NU ;LH.IH D!sso%n!e FS4
    ;LH.IH CoO%ar
    "U ;LH.IH Paraso%n!e FS
    ;LH.YL T+"'+rare de co%&or(a%en( a"!%en(ar FS
    ;LH.Y52 B+"!%!e nervoas7
    307.52 P!ca
    307.53 R+%!na=!e
    >=7 Ane,a '

    ;LH.YF T+"'+rare de a"!%en(are a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!
    307.6 En+re/!s Eneda(ora( +ne! cond!=!! %ed!ca"e $enera"eJ
    307.7 Enco&re/!s .7r72cons(!&a=!e sa+ !ncon(!nen=7 &r!n &rea&"!n
    ;LH.GL T+"'+rare a"$!c7 asoc!a(7 c+ .ac(or! &s!o"o$!c!
    C
    C
    ;LH.GF T+"'+rare a"$!c7 asoc!a(7 a(A( c+ .ac(or! &s!o"o$!c!, cA( s! c+ o cond!=!e
    %ed!ca"7 $enera"7
    ;LH.F T+"'+rare de co%+n!care FS
    ;LG.; S(res ac+(
    ;LF.L T+"'+rare de ada&(are c+ d!s&o/!=!e de&res!v7
    ;LF.95 An<!e(a(e de se&arare
    ;LF.9I T+"'+rare de ada&(are c+ an<!e(a(e
    ;LF.9G T+"'+rare de ada&(are c+ d!s&o/!=!e %!<(7 an<!oas7 s! de&res!v7
    309.3 T+"'+rare de ada&(are c+ &er(+r'are de cond+!(7
    309.4 T+"'+rare de ada&(are c+ &er(+r'are %!<(7 de e%o=!! s! cond+!(7
    ;LF.G5 S(res &os((ra+%a(!c
    ;LF.F T+"'+rare de ada&(are nes&ec!.!ca(7
    ;5L.5 Mod!.!care de &ersona"!(a(e da(ora(7... @Se indic6 condi(ia medical6 /eneralaA
    ;55 T+"'+rare de&res!v7 FS
    312.30 T+"'+rare a con(ro"+"+! !%&+"s+"+! FS
    312.31 *oc de Oans7 &a(o"o$!c
    312.32 -"e&(o%an!e
    312.33 P!ro%an!e
    ;59.;I T+"'+rare e<&"o/!v7 !n(er%!(en(7
    4;59.;F Tr!co(!"o%an!e
    ;59.G T+"'+rare de cond+!(7
    ;59.F T+"'+rare de co%&or(a%en( d!sr+&(!v FS
    ;5;.9; M+(!s% se"ec(!v
    313.81 T+"'+rarea o&o/!=!on!s%+" &rovoca(or
    313.82 Pro'"e%7 de !den(!(a(e
    ;5;.GF T+"'+rare reac(!v7 de a(aOa%en( a &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!
    ;5;.F T+"'+rare a &er!oade! de s+$ar, a co&!"7r!e! sa+ ado"escen=e! FS
    314.0 T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (!& &redo%!nan( de !na(en=!e
    314.1 T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (!& co%'!na(
    ;5I.L5 T+"'+rarea !&erac(!v!(a(eXde.!c!( de a(en=!e, (!& &redo%!nan( !%&+"s!v4
    !&erac(!v
    ;5I.F T+"'+rarea H&erac(!v!(a(eXde.!c!( de a(en=!e, (!& FS
    ;5Y.LL D!sca"c+"!e ZT+"'+rare de ca"c+"[
    ;5Y.9 D!s$ra.!e ET+"'+rare a e<&res!e! $ra.!ceJ
    ;5Y.;5 T+"'+rare de "!%'a@ e<&res!v
    ;5Y.;9 T+"'+rare %!<(7 de "!%'a@ rece&(!v s! e<&res!v
    ;5Y.;F T+"'+rare .ono"o$!c7
    ;5Y.I T+"'+rare de de/vo"(are a coordon7r!!
    ;5Y.F T+"'+rare de :nv7=are FS
    ;5R ... @0e speci)icat )actor+l psi-olo/icA care a.ec(ea/7 @Se indic6 condi(ia
    medical6 /eneral6A
    ;5H Re(ardare %en(a"7 +Ooar7
    ;5G.L Re(ardare %en(a"7 %odera(7
    Lista Fumeric a Dia!nosticelor si odurilor DSM-IV-T+ 8IA

    ;5G.5
    ;5G.9
    ;5F
    ;;9.5
    ;;;.5
    ;;;.H
    ;;;.G
    9
    ;;;.F
    L
    ;;;.F9
    ;;;.F
    F
    ;IH
    RLH.G
    I
    4 RLG.GF
    RLG.G
    F
    "U RLG.GF
    R9Y.L
    R9Y.G
    R9Y.G
    HGL.LF
    HGL.Y9
    ?852A4
    ,U HGL.YF
    HGL.YF
    U HGL.YF
    HGL.F
    HGH.R
    HFF.F
    HFF.F
    FFY.9
    FFY.Y
    FFY.Y
    FFY.Y
    FFY.G5
    FFY.G5
    35Y.G5
    3R5.5
    3R5.5
    3R5.5
    3R9.L
    c
    L
    Re(ardare
    %en(a"7
    sever7
    Re(ardare
    %en(a"7
    &ro.+nd7
    Re(ardare
    %en(a"7
    de
    sever!(a(e
    nes&ec!.!
    ca(7
    Par)!nso
    n!s%
    !nd+s de
    ne+ro"e&(
    !ce
    Tre%or
    &os(+ra"
    !nd+s de
    +n
    %ed!ca%
    en(
    D!s(on!e
    ac+(7
    !nd+s7 de
    ne+ro"e&(
    !ce
    D!s)!ne/!
    e (ard!v7
    !nd+s7 de
    ne+ro"e&(
    !ce
    T+"'+rare
    de
    %!Ocare
    !nd+s7 de
    ne+ro"e&(!
    ce FS
    S!ndro% ne+ro"e&(!c %a"!$n
    A)a(!s!e ac+(7 !nd+s7 de ne+ro"e&(!ce
    Narco"e&s!e
    T+"'+rare de erec=!e a '7r'a(+"+! da(ora(7. . . @Se indic6 condi(ia medical6
    /eneral6A
    D!s&are+n!e %asc+"!n7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    Dor!n=7 se<+a"a d!%!n+a(7 a '7r'a(+"+! da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A
    A"(7 d!s.+nc=!e se<+a"7 a '7r'a(+"+!
    D!s&are+n!e .e%!n!n7 da(ora(7... @Se indic6 condi(ia medical6 /eneral6A
    Dor!n=7 se<+a"7 d!%!n+a(7 a .e%e!! da(ora(7... @Se indic6 condi(ia medical6
    /eneral6A
    A"(7 d!s.+nc=!e se<+a"7 a .e%e!! da(ora(7. . . @Se indic6 condi(ia medical6
    /eneral6A
    De"!r!+% FS
    T+"'+rare de so%n da(ora(7. . . @Se indic6 condi(ia medical6 /eneral6A, de (!&
    !nso%n!e
    T+"'+rare de so%n da(ora(7. . . @Se indic6 condi(ia medical6 /eneral6A, de (!&
    !&erso%n!e
    T+"'+rare de so%n :n "e$7(+r7 c+ res&!ra=!a
    T+"'+rare de so%n da(ora(7. . . @Se indic6 condi(ia medical6 /eneral6A, de (!&
    %!<(
    T+"'+rare de so%n da(ora(7. . . @Se indic6 condi(ia medical6 /eneral6A, de (!&
    &araso%n!e
    Dec"!n co$n!(!v :n "e$7(+r7 c+ e(a(ea
    Enco&re/!s c+ cons(!&a=!e s! !ncon(!nen=7 &r!n &rea&"!n
    D!a$nos(!c a%Ana( &e a<a II
    D!a$nos(!c sa+ cond!=!e a%Ana(7 &e a<a II
    E.ec(e adverse a"e %ed!ca%en(e"or FS
    Ne$"!@area co&!"+"+! @dac6 =n centr+l aten(iei se a)l6 *8timaA
    A'+/ se<+a" de +n co&!" @dac6 =n centr+l aten(iei se a)l6 *ictimaA
    A'+/ .!/!c de +n co&!" @dac6 =n centr+l aten(iei se a)l6 *ictimaA
    A'+/ .!/!c de +n ad+"( @dac6 =n centr+l aten(iei se a)l6 *ictimaA
    A'+/ se<+a" de +n ad+"( @dac6 =n centr+l aten(iei se a)l6 *ictimaA
    Nonco%&"!an=7 "a (ra(a%en(
    Pro'"e%7 re"a=!ona"7 c+ &ar(ener+"
    A'+/ .!/!c de +n ad+"( Edac7 de c7(re &ar(enerJ
    A'+/ se<+a" de +n ad+"( Edac7 de c7(re &ar(enerJ
    Pro'"e%7 re"a=!ona"7 &7r!n(e4co&!"
    =>> Ane,a '


    3R5.95
    3R5.95
    3R5.95
    3R5.G
    3R5.F
    3R9.9
    3R9.;
    3R9.I
    3R9.G5
    3R9.G9
    NU 3R9.GF
    3R9.GF
    "U 3R9.GF
    3RY.9 3H5.L5 3H5.L9
    "U3H5.LF
    "U 3H5.LF
    Ne$"!@are a
    co&!"+"+!
    A'+/ .!/!c
    de +n
    co&!"
    A'+/
    se<+a" de
    +n co&!"
    Pro'"e%7
    re"a=!ona"7
    :n(re .ra=!
    Pro'"e%7
    re"a=!ona"7
    re.er!(oare
    "a o
    (+"'+rare %en(a"7 sa+ "a o cond!=!e
    %ed!ca"7 $enera"7
    Pro'"e%7 &ro.es!ona"7
    Pro'"e%7 Oco"ar7
    Pro'"e%7 de ac+"r+ra=!e
    Pro'"e%7 re"a=!ona"7 FS
    Do"!+
    Ac(!v!(a(e !n(e"ec(+a"7 "!%!nar7 E'order"!neJ
    Pro'"e%7 de .a/7 de v!a=7
    Pro'"e%7 re"!$!oas7 sa+ s&!r!(+a"7
    S!%+"are
    Co%&or(a%en( an(!soc!a" a" ad+"(+"+!
    Co%&or(a%en( an(!soc!a" a" co&!"+"+! sa+ ado"escen(+"+!
    N!c! +n d!a$nos(!c &e a<a II
    N!c! +n d!a$nos(!c sa+ cond!=!e &e a<a II
    Anexa '
    Cod+r!"e 5CD4F4CM &en(r+
    Cond!=!!"e Med!ca"e ,enera"e
    se"ec(a(e s! T+"'+r7r!"e Ind+se de
    Med!ca%en(e
    Rev!/+!(e &en(r+ a !nc"+de cod+r!"e ICD4F4CM deven!(e e.ec(!ve de "a " Oc(o%'r!e 9LLL
    2!s(e%+" o.!c!a" de cod!.!care :n +/ "a da(a &+'"!c7r!! DSM4I3 es(e
    C"as!.!carea In(erna=!ona" 7 a Ma"ad!!"or, cea de a F4a rev!/+!re,
    Mod!.!carea C"!n!c7 EICD4F4CMJ. Aceas(7 ane<7 con=!ne do+7 sec=!+n!
    care s+n( &rev7/+(e &en(r+ a .ac!"!(a cod!.!carea ICD4F4CMQ 5J cod+r!"e
    &en(r+ cond!=!!"e %ed!ca"e $enera"e se"ec(a(e O! 9J cod+r!"e &en(r+
    (+"'+r7r!"e !nd+se de %ed!ca%en(e.
    (odurile #(9B4B(< pentru (ondi3iile <edicale
    'enerale selectate
    Cod+r!"e s&ec!.!ca(e &en(r+ a .! +(!"!/a(e &e a<a I O! a<a II a DSM4I3 re&re/!n(7
    n+%a! o %!c7 .rac=!+ne d!n cod+r!"e &rev7/+(e :n ICD4F4CM. Cond!=!!"e c"as!.!ca(e
    :n a.ara ca&!(o"+"+! ST+"'+r7r!"e %en(a"eT a" ICD4F4CM s+n(, de ase%enea,
    !%&or(an(e &en(r+ d!a$nos(!c c"!n!c O! (ra(a%en( :n +n!(7=!"e de s7n7(a(e %en(a"7.
    A<a III es(e &rev7/+(7 &en(r+ a .ac!"!(a ra&or(area aces(or cond!=!! Eve/! &a$. 9FJ.
    Pen(r+ a a@+(a c"!n!c!an+" :n re&erarea cod+r!"or ICD4F4CM, aceas(7 ane<7 &revede
    +n !nde< se"ec(!v a" ace"or cod+r! ICD4F4CM &en(r+ cond!=!!"e %ed!ca"e $enera"e
    care s+n( ce"e %a! re"evan(e &en(r+ d!a$nos(!c O! (ra(a%en( :n +n!(7=!"e de s7n7(a(e
    %en(a"7. ICD4F4CM o.er7 os&ec!.!c!(a(e d!a$nos(!c7, d!nco"o de cea re."ec(a(7 de
    %+"(e d!n(re cod+r!"e care a&ar :n aceas(7 ane<7 Ede e<., &en(r+ a !nd!ca +n an+%!(
    sed!+ ana(o%!c sa+ &re/en=a +ne! an+%!(e co%&"!ca=!!J, :n ca/+r!"e :n care
    s&ec!.!c!(a(ea cresc+(7 es(e !nd!ca(7 de cea de a c!ncea c!.r7 a cod+"+!, a .os( se"ec(a(
    cod+" ce" %a! &+=!n s&ec!.!c Ede re$+"7 SOTJ. De e<e%&"+, cod+" &en(r+ "!%.osarco%
    es(e da( ca .!!nd 9LL.5L E&en(r+ sed!+ nes&ec!.!ca(J, :ns7 o s&ec!.!c!(a(e %a! %are c+
    &r!v!re "a sed!+" ana(o%!c &oa(e .! !nd!ca(7 &r!n a"(e cod+r! c+ c!nc! c!.re, de
    e<e%&"+, 9LL.59 "!%.osarco%, $an$"!on!! "!%.a(!c! !n(ra(orac!c!. :n ca/+r!"e :n care
    s&ec!.!c!(a(ea cresc+(7 es(e re."ec(a(7 de cea de a &a(ra c!.r7 a cod+"+!, aceas(7 ane<7
    &revede adesea ca(e$or!a Snes&ec!.!ca(T Ede e<., YYY.F es(e "!s(a( &en(r+ en(er!(a
    re$!ona"78 ICD4F4CM !nc"+de, de ase%enea, YYY.L &en(r+ en(er!(a !%&"!cAnd
    !n(es(!n+" s+'=!re, YYY.5, &en(r+ !%&"!carea !n(es(!n+"+! $ros O! YYY.9, &en(r+
    !%&"!carea a%'e"orJ. Cod+r!"e d!a$nos(!ce &en(r+ care es(e d!s&on!'!"7 o
    >=G
    =>= Ane,a G
    s&ec!.!c!(a(e %a! %are s+n( !nd!ca(e :n aceas(7 ane<7 &r!n(r4+n as(er!sc E`J.
    C"!n!c!en!! !n(eresa=! :n :nre$!s(rarea +ne! s&ec!.!c!(7=! %a! %ar! (re'+!e s7 cons+"(e
    "!s(a co%&"e(7 de cod+r! &+'"!ca(7 :n ICD4F4CM a %a"ad!!"or, "!s(a (a'+"ar7
    Evo"+%+" 5J s! ICD4F4CM a %a"ad!!"or, !nde<+" a".a'e(!c Evo"+%+" 9J. Aces(e
    doc+%en(e s+n( ad+se "a /! :n "+na oc(o%'r!e a .!ec7r+! an s! s+n( &+'"!ca(e de
    De&ar(a%en(+" S7n7(7=!! O! Serv!c!!"or U%ane a" S(a(e"or Un!(e. E"e s+n( acces!'!"e
    S
    &r!n D!rec=!a de Doc+%en(e, O.!c!+" de I%&r!%a(e a" ,+vern+"+! S(a(e"or Un!(e,
    &rec+% s! &r!n(r4+n n+%7r de ed!(or! &ar(!c+"ar!.
    No(7Q Un as(er!sc E`J +r%And cod+"+! ICD4F4CM !nd!c7 .a&(+" c7 es(e d!s&on!'!"7
    o s&ec!.!c!(a(e %a! %are Ede e<., o an+%!(7 co%&"!ca=!e sa+ sed!+ ana(o%!cJ. A se
    cons+"(a ICD4F4CM Ma"ad!!Q L!s(a Ta'+"ar7 Evo!. 5J &en(r+ ace"e cod+r! care neces!(7
    !n.or%a=!! s+&"!%en(are.
    Maladii ale sistemului nervos
    47H25
    I;Y.F
    I;H.L
    ;;I.I
    ;YI.L
    H4I275
    GYL.F`
    GY5.GL`
    ;;;.I
    ;YF.5
    4A527
    4H82A
    LIF.F`
    A?727
    H4?27
    4H824U
    ;IY.5L`
    ;IY.IL`
    ;IY.YL`
    ;IY.LL`
    H4725
    8A72H5U
    I;5
    I;L
    GY9.LL`
    I;9.5
    8A7275U
    ;;5.;
    ;;5.I
    H4I
    LIR.5
    LIR.;
    ;;L.5
    ;;5.L
    A'ces !n(racran!an
    A(ac !sce%!c (ran/!(or
    A(erosc"ero/7 cere'ra"7
    A(a<!e cere'e"oas7
    Ca+/a"$!e
    Ce.a"ee :n c!orc!ne
    Co%o=!e
    Con(+/!e cere'ra"7
    Coree H+n(!n$(on
    D!s(ro.!e %+sc+"ar7 D+cenne
    D+rere .ac!a"7 a(!&!c7
    Ede% cere'ra"
    Ence.a"!(7 v!ra"7
    Ence.a"o&a(!e e&a(!c7
    Ence.a"o&a(!e !&er(ens!v7
    Ence.a"o&a(!e nes&ec!.!ca(7
    E&!"e&s!e $rand %a"
    E&!"e&s!e &ar=!a"7, c+ a"(erarea conO(!!n=e! E"o' (e%&ora"J
    E&!"e&s!e &ar=!a"7, .7r7 a"(erarea conO(!!n=e! E@ac)son!an7J
    E&!"e&s!e &e(!( %a" Ea'sen=eJ
    He%ora$!e e<(rad+ra"7 non(ra+%a(!c7
    He%ora$!e e<(rad+ra"7 (ra+%a(!c7
    He%ora$!e !n(racere'ra"7 non(ra+%a(!c7
    He%ora$!e s+'arano!d!an7 non(ra+%a(!c7
    He%ora$!e s+'arano!d!an7 (ra+%a(!c7
    He%ora$!e s+'d+ra"7 non(ra+%a(!c7
    He%ora$!e s+'d+ra"7 (ra+%a(!c7
    H!droce.a"!e co%+n!can(7
    H!droce.a"!e o's(r+c(!v7
    Icr+s EA3CJ
    -+r+
    Le+coence.a"o&a(!e %+"(!.oca"7 &ro$res!v7
    L!&!do/7 cere'ra"7
    Ma"ad!e A"/e!%er
    odurile ID-6-M pentru ondiiile Medicale Generale selectate
    ,i Tulburrile Induse de Medicamente 8I6
    LIR.5 Ma"ad!e Cre+(/.e"d(4*a)o'
    332.0 Ma"ad!e Par)!nson, &r!%ar7
    331.0 Ma"ad!e P!c)
    ;;L.5 Ma"ad!e Tay4Sacs
    ;95.5` Men!n$!(7 .+n$!c7, A"(7
    ;9L.F` Men!n$!(7 'ac(er!an7 Eda(ora(7 +ne! 'ac(er!! nes&ec!.!ca(eJ
    ;95.L Men!n$!(7 cr!&(ococ!c7
    LYI.H9 Men!n$!(7 c+ v!r+s+" er&es s!%&"e<
    LY;.L Men!n$!(7 c+ er&es /os(er
    LFI.9 Men!n$!(7 "+e(!c7
    LIH.F` Men!n$!(7 v!ra"7 Eda(ora(7 +n+! v!r+s nes&ec!.!ca(J
    ;YG.L M!as(en!a $rav!s
    ;IR.LL` M!$ren7 c"as!c7 Ec+ a+r7J
    ;IR.5L` M!$ren7 co%+na
    ;IR.FL M!$ren7 nes&ec!.!ca(7
    ;;H.5 Ne+ro&a(!e &er!.er!c7 ve$e(a(!v7
    9YL.5 Nevra"$!e de (r!$e%en
    I;I.F` Oc"+/!e de ar(er7 cere'ra"7
    LIR.9 Panence.a"!(7 sc"ero/an(7 s+'ac+(7
    351.0 Para"!/!e Be""
    ;I;.F` Para"!/!e cere'ra"7
    094.0 Para"!/!a $enera"7
    ;;Y.9; Para"!/!e &se+d''+"'ar7
    ;YH.F` Po"!ne+ro&a(!e
    348.0 Pse+do(+%or7 cere'ra"7
    ;;Y.9L Sc"ero/7 "a(era"7 a%!o(ro.!c7
    ;IL Sc"ero/7 %+"(!&"7 ESMJ
    ;YI.L S!ndro% de (+ne" car&!an
    ;IY.; S(a(+s $rand %a"
    ;IY.HL S(a(+s de "o' (e%&ora" E&s!o%o(orJ
    ;IY.9 S(a(+s &e(!( %a"
    I;;.5 S(eno/7 de ar(er7 caro(!d7, .7r7 !n.arc(!/are cere'ra"7
    ;;;.5 Tre%or esen=!a" 'en!$n
    Maladii ale sistemului circulator
    I5;.F` An$or &ec(or!s
    IIL.F` A(erosc"ero/7
    I5I.LL` A(erosc"ero/7 coronar!an7
    I9H.RL` B7(7! &re%a(+re
    I9R.5L` B"oc a(r!oven(r!c+"ar
    426.4 B"oc de ra%+r7 drea&(7
    I9R.;` B"oc de ra%+r7 s(An$7
    425.4 Card!o%!o&a(!e a"coo"!c7
    I9Y.I` Card!o%!o&a(!e !d!o&a(!c7
    I5R.F` Cord &+"%onar cron!c
    I9H.F` D!sr!(%!e card!ac7 nes&ec!.!ca(7
    I5Y.5F` E%'o"!e &+"%onar7
    I95.F` Endocard!(7 'ac(er!an7
    >G+ Ane,a G


    I9H.;5
    I9H.I5
    IY5.F`
    I9H.;9
    I9H.I9
    IYY.R`
    IL5.F`
    IYG.L
    I5L.FL`
    I9G.L`
    I9L.L
    IL9.F5`
    IL9 FL`
    IUF5`
    IL;.FL`
    I9I.;
    ;FH.5
    I9I.9
    ;FH.L
    II;.F`
    I9;.F`
    IIR.L
    I9I.L
    ;FI.L`
    I9H.Y
    I9H.9
    H7?25
    H7?2E
    I9I.5
    IYR.L
    IYR.5
    IYI.F`
    F!'r!"a=!e a(r!a"7
    F!'r!"a=!e ven(r!c+"ar7
    F"e'!(7X(ro%'o."e'!(7
    F"+((er a(r!a"
    F"+((er ven(r!c+"ar
    He%oro!/!
    H!&er(ens!+ne esen=!a"7
    H!&o(ens!+ne or(os(a(!c7
    In.arc( %!ocard!c ac+(
    Ins+.!c!en=7 card!ac7 con$es(!v7
    Ins+.!c!en=7 a va"ve! %!(ra"e Enonre+%a(!c7J
    Ma"ad!e !&er(ens!v7 card!ac7 c+ !ns+.!c!en=7 card!ac7 con$es(!v7
    Ma"ad!e !&er(ens!v7 card!ac7 .7r7 !ns+.!c!en=7 card!ac7 con$es(!v7
    Ma"ad!e !&er(ens!v7 rena"7 c+ !ns+.!c!en=7
    Ma"ad!e !&er(ens!v7 rena"7 .7r7 !ns+.!c!en=7
    Ma"ad!e Enonre+%a(!c7J a va"ve! &+"%onare
    Ma"ad!e re+%a(!c7 a va"ve! &+"%onare
    Ma"ad!e Enonre+%a(!c7J a va"ve! (r!c+s&!de
    Ma"ad!e re+%a(!c7 a va"ve! (r!c+s&!de
    Ma"ad!e vasc+"ar7 &er!.er!c7
    Per!card!(7
    Po"!ar(er!(7 nodoas7
    Pro"a&s a" va"ve! %!(ra"e
    S(eno/7 Ere+%a(!c7J a va"ve! %!(ra"e
    S(o& card!ac
    Ta!card!e &aro<!s(!c7, nes&ec!.!ca(7
    Ta!card!e &aro<!s(!c7 s+&raven(r!c+"ar7
    Ta!card!e E&aro<!s(!c7J ven(r!c+"ar7
    T+"'+rare a va"ve! aor(!ce
    3ar!ce eso.a$!ene c+ sAn$erare
    3ar!ce eso.a$!ene .7r7 sAn$erare
    3ene var!coase "a %e%'re"e !n.er!oare
    Maladii ale sistemului respirator
    A'ces &+"%onar
    As(% o's(r+c(!v cron!c
    As(% nes&ec!.!ca(
    A(e"ec(a/!e
    BronO!ec(a/!e
    BronO!(7 ac+(7
    BronO!(7 o's(r+c(!v7 cron!c7 EMPOCJ, c+ e<acer'are ac+(7
    BronO!(7 o's(r+c(!v7 cron!c7 EMPOCJ, .7r7 e<acer'are ac+(7
    E%.!/e%
    EOa&a%en( &"e+ra"
    F!'ro/7 c!s(!c7
    Ins+.!c!en=7 res&!ra(or!e
    odurile ID-6-M pentru ondiiile Medicale
    Generale selectate ,i Tulburrile Induse de Medicamente >G*

    YLY
    IG9.F`
    IGR`
    IG;.L
    IG5
    5;R.;
    IG9.;L`
    IGL.F`
    GRL.I`
    Y59.G`
    GRL.L`
    L55.F`
    Y5;.L
    IF;.9L
    `
    IF;.FL
    `
    Y5G.L
    IFI.5
    IRR.L
    IF5.95
    IF5.9L
    IF9.G`
    Y55.F`
    9HH.LL`
    Pne+%ocon!o/
    7
    Pne+%on!e
    'ac(er!an7
    nes&ec!.!ca(7
    Pne+%on!e c+ $er%en nes&ec!.!ca( Pne+%on!e c+ %!co&"as%a
    Pne+%on!e &ne+%ococ!c7 Pne+%on!e &ne+%ocys(!c7 Pne+%on!e
    s(re&(ococ!c7 Pne+%on!e v!ra"7 Pne+%oe%o(ora< (ra+%a(!c
    Pen+%o(ora< s&on(an Pne+%o(ora< (ra+%a(!c T+'erc+"o/7
    &+"%onar7
    Feoplasme
    Cod+r!"e d!a$nos(!ce a"e ICD4F4CM &en(r+ neo&"as%e s+n( c"as!.!ca(e :n (a'e"+"
    neo&"as%e"or d!n !nde<+" a".a'e(!c a" ICD4F4CM Evo"+%+" 9J con.or% sed!+"+! s!
    $rad+"+! de %a"!$n!(a(e E&r!%ar, sec+ndar, !n s!(+, 'en!$n, !ncer(, nes&ec!.!ca(J.
    No(7Q Pen(r+ &ac!en=!! c+ !s(or!c &ersona" de neo&"as%e %a"!$ne care a+ .os(
    :nde&7r(a(e c!r+r$!ca" sa+ erad!ca(e &r!n c!%!o(era&!e sa+ rad!o(era&!e, (re'+!e s7
    .!e +(!"!/a(e cod+r!"e 35L.L435L.F8 &en(r+ sed!!"e s&ec!.!ce a se cons+"(a !nde<+"
    a".a'e(!c Evo"+%+" 9J a" ICD4F4CM d!n S!s(or!c &ersona" de neo&"as% %a"!$nT.
    Ma! @os s+n( "!s(a(e +ne"e d!n ce"e %a! .recven(e cod+r! re/erva(e &en(r+
    neo&"as%e.
    99H.L Feocro%oc!(o% 'en!$n
    5FI.L Feocro%oc!(o% %a"!$n
    99G.L9 He%an$!o% cere'ra"
    9LG.LL` Le+ce%!e ac+(7
    9LG.L5` Le+ce%!e ac+(7, :n re%!s!+ne
    9LG.5L` Le+ce%!e cron!c7
    9LG.55` Le+ce%!e cron!c7, :n re%!s!+ne
    9LL.5L` L!%.osarco%
    9L5.FL` Ma"ad!e Hod$)!n
    99Y.9 Men!n$!o% Ecere'ra"J
    9L;.LL M!e"o% %+"(!&"+
    9L;.L5 M!e"o% %+"(!&"+, :n re%!s!+ne
    99Y.L Neo&"as%`` 'en!$n cere'ra"
    955.I Neo&"as%`` 'en!$n a" co"on+"+!
    5FY.9 Neo&"as% %a"!$n &r!%ar a" cav!(7=!! a'do%!na"e
    5R9.F` Neo&"as% %a"!$n &r!%ar a" 'ron!!"or
    5Y;.F` Neo&"as% %a"!$n &r!%ar a" co"on+"+!
    5FH.Y Neo&"as% %a"!$n sec+ndar a" co"on+"+!
    5GL.F` Neo&"as% %a"!$n &r!%ar a" co"+"+! +(er!n
    5F5.F` Neo&"as% %a"!$n &r!%ar a" cre!er+"+!
    5FG.; Neo&"as% %a"!$n sec+ndar a" cre!er+"+!
    5YL.F` Neo&"as% %a"!$n &r!%ar a" eso.a$+"+!
    `` 4 :n :n=e"es de (+%or7, n+ de cancer
    =82 Anexa G

    5YY.L
    5FH.H
    5Y9.F`
    5FR.F`
    5HY.F`
    5HI.F`
    5H9.F`
    HL.F`
    5FG.Y
    5G;.L`
    5YH.F`
    5H;.F`
    5GY
    5R9.F`
    5FH.L
    5YI.5
    5GF.L`
    5Y5.F
    5FI.L
    5GR.F`
    5F;
    5H5.F`
    5HF`
    5GG.F`
    9;H.HL`
    9;G.I
    5HR.F`
    Neo&"as% %a"!$n &r!%ar a" .!ca(+"+!
    Neo&"as% %a"!$n sec+ndar a" .!ca(+"+!
    Neo&"as% %a"!$n &r!%ar a" a" !n(es(!n+"+! s+'=!re
    Neo&"as% %a"!$n sec+ndar a" $an$"!on!"or "!%.a(!c!
    Neo&"as% %a"!$n &r!%ar %a%ar a" '7r'a(+"+!
    Neo&"as% %a"!$n &r!%ar %a%ar a" .e%e!!
    Neo&"as% %a"!$n, %e"ano% &r!%ar
    Neo&"as% %a"!$n &r!%ar a" os+"+!
    Neo&"as% %a"!$n sec+ndar a" os+"+!
    Neo&"as% %a"!$n &r!%ar a" ovar+"+!
    Neo&"as% %a"!$n &r!%ar a" &ancreas+"+!
    Neo&"as% %a"!$n &r!%ar a" &!e"!!
    Neo&"as% %a"!$n &r!%ar a" &ros(a(e!
    Neo&"as% %a"!$n &r!%ar a" &+"%on+"+!
    Neo&"as% %a"!$n sec+ndar a" &+"%on+"+!
    Neo&"as% %a"!$n &r!%ar a" rec(+"+!
    Neo&"as% %a"!$n &r!%ar a" r!n!c!+"+!
    Neo&"as% %a"!$n &r!%ar a" s(o%ac+"+!, sed!+ nes&ec!.!ca(
    Neo&"as% %a"!$n &r!%ar a" $"ande! s+&rarena"e
    Neo&"as% %a"!$n &r!%ar a" (esr!co"+"+!
    Neo&"as% %a"!$n &r!%ar a" (!ro!de!
    Neo&"as% %a"!$n &r!%ar a" =es+(+"+! con@+nc(!v
    Neo&"as% %a"!$n &r!%ar a" +(er+"+!
    Neo&"as% %a"!$n &r!%ar a" ve/!c!! +r!nare
    Ne+ro.!'ro%a(o/7
    Po"!c!(e%!a vera
    Sarco% -a&os!
    Maladii endocrine
    9Y;.L
    9YF.L
    9YF.5
    9Y;.Y
    9YL.L5`
    9YL.LL`
    9YR.F`
    9YH.F`
    9I5.F`
    9IL.F`
    9YY.5
    9Y9.L
    9Y9.5
    9II.F`
    9I;
    9YY.I
    9Y;.9
    Acro%e$a"!e
    De/vo"(are se<+a"7 s! &+'er(a(e :n(Ar/!a(7
    De/vo"(are se<+a"7 s! &+'er(a(e &recoce
    D!a'e( !ns!&!d
    D!a'e( /aara(, (!& IX!ns+"!no4de&enden(
    D!a'e( /aara(, (!& IIXnon!ns+"!no4de&enden(
    D!s.+nc=!e ovar!an7
    D!s.+nc=!e (es(!c+"ar7
    ,+O7 nod+"ar7 non(o<!c7
    ,+O7 s!%&"7
    H!&era"dos(eron!s%
    H!&er&ara(!ro!d!s%
    H!&o&ara(!ro!d!s%
    H!&o(!ro!d!s% c7&7(a(
    H!&o(!ro!d!s% con$en!(a"
    Ins+.!c!en=7 cor(!cos+&rarena"7
    Nan!s% &!(+!(ar
    odurile ID-6-M pentru ondiiile Medicale Generale
    selectate si Tulburrile Induse de Medicamente >G4

    9Y;.9
    9YF.9
    9YY.L
    9IY.F`
    9I9.F`
    9YY.9
    Pan!&o&!(+!(ar!s% S!ndro% carc!no!d S!ndro% C+s!n$
    T!ro!d!(7 T!reo(o<!co/7 T+"'+rare adreno$en!(a"7
    Maladii de nutriie
    9RY.L Ber!'er!
    9RR.9 De.!c!en=7 de ac!d .o"!e
    9RF.; De.!c!en=7 de ca"c!+
    9RF.; De.!c!en=7 de !od
    9RR.L De.!c!en=7 de r!'o."av!n7
    9RI.F` De.!c!en=7 de v!(a%!n7 A
    9RR.5 De.!c!en=7 de v!(a%!n7 BR
    9RR.9 De.!c!en=7 de v!(a%!n7 B"9
    9RH De.!c!en=7 de v!(a%!n7 C
    9RG.F` De.!c!en=7 de v!(a%!n7 D
    9RF.5 De.!c!en=7 de v!(a%!n7 E
    9RF.L De.!c!en=7 de v!(a%!n7 -
    9RL -#as!or)or
    9R9 Ma"n+(r!=!e &ro(e!n4ca"or!c7 sever7
    9R5 Maras% n+(r!=!ona"
    9HG.L O'e/!(a(e
    9RY.9 Pe"a$r7 Ede.!c!en=7 de n!ac!n7J
    Maladii metabolice
    267.2 Ac!do/7
    276.2 A"ca"o/7
    9HH.; A%!"o!do/7
    9HR.Y Des!dra(are Zde&"e=!e de "!c!de Evo"+%J[
    9HR.F` De/ec!"!'r+ e"ec(ro"!(!c
    9HL.5 Fen!")e(on+r!e EP-UJ
    9HI.F` ,+(7
    9HY.L He%ocro%a(o/7
    9HY.I H!&erca"ce%!e
    9HR.H H!&er)a"!e%!e
    9HR.L H!&erna(re%!e
    9HY.I H!&oca"ce%!e
    9HR.G H!&o)a"!e%!e
    9HR.5 H!&ona(re%!e
    9H5.; Ma"a'sor'=!e de d!/aar!de E!n(o"eran=7 "a "ac(o/7J
    9HY.5 Ma"ad!e 1!"son
    277.1 Por.!r!e
    272.1 S!ndro% Lesc4Nyan
    >G7 Ane,a G

    Maladii ale sistemului di!estiv
    YIL.F` A&end!c!(7 ac+(7 YH5.9 C!ro/a
    a"coo"!c7
    Co"ec!s(!(7 ac+(7
    Co"ec!s(!(7 cron!c7
    Co"!(7 +"ceroas7
    Cons(!&a=!e
    D!aree !n.ec=!oas7
    D!aree nes&ec!.!ca(7
    D!ver(!c+"!(7 de co"on, c+ e%ora$!e
    D!ver(!c+"!(a de co"on, nes&ec!.!ca(7
    D!ver(!c+"o/7 de co"on, c+ e%ora$!e
    D!ver(!c+"o/7 de co"on, nes&ec!.!ca(7
    D+oden!(7 s! $as(r!(a
    En(er!(7 re$!ona"7
    Eso.a$!(7
    ,as(r!(a s! d+oden!(7
    ,as(roen(er!(7
    He&a(!(7 a"coo"!c7 ac+(7
    He&a(!(7 cron!c7
    He&a(!(7 (o<!c7 E!nc"+de s! &e cea !nd+s7 de dro$+r!J
    He&a(!(7 v!ra"7 A
    He&a(!(7 v!ra"7 B
    He&a(!(7 v!ra"7 C
    Hern!e !n$!na"7
    I%&ac(are de .eca"e
    Ma"ad!e Cron
    Oc"+/!e de cana" '!"!ar
    Oc"+/!e !n(es(!na"7
    Pancrea(!(7 ac+(7
    Pancrea(!(7 cron!c7
    Per!(on!(7
    Re."+< eso.a$!an
    R+&(+r7 eso.a$!an7
    S!ndro% de co"on !r!(a'!"
    S(r!c(+r7 eso.a$!an7
    U"cer d+odena" ac+(
    U"cer d+odena" cron!c
    U"cer $as(r!c ac+(
    U"cer $as(r!c cron!c
    Maladiile sistemului !enitourinar
    592.0 Ca"c+" rena"
    592.1 Ca"c+" +re(era"
    YF9.F` Ca"c+" +r!nar nes&ec!.!ca(
    YHY.L
    YHY.5
    YYR
    YRI.L
    LLF.9
    YYG.F`
    YR9.59
    YR9.5L
    YR9.5;
    YR9.55
    Y;Y.YL
    `
    YYY.F`
    Y;L.5
    Y;Y.YL
    `
    YYG.F`
    YH5.5
    YH5.IL
    `
    YH;.;`
    LH5.5`
    LHL.;L`
    LHL.Y5`
    YYL.FL
    YRL.;F
    YYY.F`
    YHR.9
    YRL.F`
    YHH.L
    YHH.5
    YRH.F`
    Y;L.5
    Y;L.I
    YRI.5
    Y;L.;
    Y;9.;L`
    Y;9.HL`
    odurile ID-6-M pentru ondiiile Medicale Generale selectate
    si Tulburrile Induse de Medicamente 8?A

    R9L.9`
    YFY.F`
    R9Y.;
    R9Y.9
    R5H.F`
    95G.F`
    YGL.F`
    RLL
    YFF.L
    R9G.F`
    RLR.F`
    YGI.F`
    YGY
    IL;.F5`
    YGR`
    R5I.F
    RLH.;
    R5G.F`
    RL5.F`
    YF;.;
    YFG.F
    R9H.F`
    R9R.F`
    YFR.I
    C!s( ovar!an
    C!s(!(7
    D!s%enoree
    D+rere de %!@"oc ZM!((e"sc%er/[
    Endo%e(r!o/7
    F!'ro% +(er!n
    ,"o%er+"one.r!(7 ac+(7
    H!&er(ro.!e de &ros(a(7, 'en!$n7 EHPBJ
    In.ec=!e a (rac(+"+! +r!nar
    In.er(!"!(a(e .e%en!n7
    In.er(!"!(a(e %asc+"!n7
    Ins+.!c!en=7 rena"7 ac+(7
    Ins+.!c!en=7 rena"7 cron!c7
    Ins+.!c!en=7 rena"7 !&er(ens!v7
    Ins+.!c!en=7 rena"7 nes&ec!.!ca(7
    Ma"ad!e !n."a%a(or!e &e"v!n7
    Pr!a&!s%
    Pro"a&s $en!(a"
    Pros(a(!(7
    S(r!c(+r7 +re(era"7
    S(r!c(+r7 +re(ra"7
    T+"'+rare de %eno&a+/7 sa+ de &os(%eno&a+/7
    T+"'+rare de %ens(r+a=!e s! sAn$erare anor%a"7
    3e/!c7 +r!nar7 a(on7
    Maladiile %ematolo!ice
    9GG.L A$ran+"oc!(o/7
    Ane%!e a&"as(!c7
    Ane%!e &r!n de.!c!en=7 de .!er
    Ane%!e &r!n de.!c!en=7 de .o"a(
    Ane%!e .a"c!.or%7
    Ane%!e e%o"!(!c7 a+(o!%+n7, A"(7
    Ane%!e e%o"!(!c7 c7&7(a(7
    Ane%!e e%o"!(!c7 nona+(o!%+n7, nes&ec!.!ca(7
    Ane%!e e%o"!(!c74s!ndro% +re%!e
    Ane%!e &ern!c!oas7
    De.ec(e de coa$+"are
    Eo/!no.!"!e
    P+r&+r7 a"er$!c7
    Ta"ase%!e
    Tro%'oc!(o&en!e
    Maladiile oc%iului
    ;RR.F` Ca(arac(7
    ;R5.F` De(aOare de re(!n7
    9GI.F`
    9GL.F`
    9G5.9
    9G9.RL
    `
    9G;.5F
    9G;.F`
    9G;.5L
    9G;.55
    9G5.L
    9GR.F`
    9GG.;
    9GH.L
    9G9.I
    9GH.Y`
    8?I Anexa G
    ;HH.LL` Ede% &a&!"ar
    ;RY.F` ,"a+co%
    ;HH.;L` Nevr!(7 o&(!c7
    ;HF.YL` N!s(a$%+s
    ;RF.F` P!erderea veder!!
    ;H9.F` T+"'+rare a con@+nc(!ve!
    Maladiile urec%ii, nasului si !@tului
    IR; A%!$da"!(7 ac+(7
    IR9 Far!n$!(7 ac+(7
    IRI.L Lar!n$!(7 ac+(7
    ;GR.LL` Ma"ad!e Men!ere
    ;G9.F` O(!(7 %ed!e
    ;GF.F` P!erderea a+/+"+!
    IRL R7cea"7 co%+n7
    IHH.F` R!n!(7 a"er$!c7
    IR5.F` S!n+/!(7 ac+(7
    IH;.F` S!n+/!(7 cron!c7
    ;GG.;L` T!n!r+s, nes&ec!.!ca(
    Maladiile sistemului musculosc%eletal si esutului con0unctiv
    H5R.9L` Ar(r!(7 a"er$!c7
    H55.FL` Ar(r!(7 !n.ec=!oas7
    H5I.L Ar(r!(7 re+%a(o!d7
    H5L.; Der%a(o%!o/!(7
    H;;.5L` Frac(+r7 &a(o"o$!c7
    H5L.L L+&+s er!(e%a(os s!s(e%!c
    H5L.9 Ma"ad!e S@o$ren
    H;;.IL` Necro/7 ase&(!c7 a os+"+!
    H5Y.FL` Os(eoar(ro/7 Eos(eoar(r!(7J
    H;L.9L` Os(eo%!e"!(7
    H;;.LL` Os(eo&oro/7
    H5L.9 Sc"eroder%!e Esc"ero/7 s!s(e%!c7J
    H9L.L S&ond!"!(7 anc!"o/an(7
    H99.F5 D!sco&a(!e !n(erver(e'ra"7 cerv!ca"7
    H99.F; D!sco&a(!e !n(erver(e'ra"7 "o%'ar7
    H99.F9 D!sco&a(!e !n(erver(e'ra"7 (orac!c7
    Maladiile pielii
    HLI.LL` A"o&ec!a
    RG9.F` Ce"+"!(a, sed!+ nes&ec!.!ca(
    HL5.I C!ca(r!ce ce"o!d7
    R9F.F` Der%a(!(7 de con(ac(
    RF;.L` Der%a(!(7 da(ora(7 +ne! s+'s(an=e E"+a(e !n(ernJ
    RFY.5 Er!(e% %+"(!.or%
    odurile ID-6-M pentru ondiiile Medicale Generale selectate
    ,i Tulburrile Induse de Medicamente 8??
    RFR.5` Psor!a/!s
    HLH.L U"cer de dec+'!(
    HL9.L Un$!e :ncarna(7
    HLG.L Ur(!car!e a"er$!c7
    Mal$ormaiile con!enitale, de$ormaiile si
    anomaliile cromo(omiale
    HRL.H5 E.ec(e (o<!ce a"e a"coo"+"+!
    HRL.HL E.ec(e (o<!ce a"e a"(or s+'s(an=e E!nc"+s!v %ed!ca%en(e"eJ
    HRL.HY E.ec(e (o<!ce a"e coca!ne!
    HRL.H; E.ec(e (o<!ce a"e a"+c!no$ene"or
    HRL.H9 E.ec(e (o<!ce a"e narco(!ce"or
    HIF.5L` F!s+r7 "a'!a"7 E'+/a de !e&+reJ
    HIF.LL` F!s+ra &a"a(+"+!
    HY5.; Ma"ad!e H!rsc&r+n$ Ed!s.+nc(!e con$en!(a"7 a co"on+"+!J
    HI9.; H!droce.a"!e con$en!(a"7
    HI9.5 M!croce.a"!e
    HYF.Y Sc"ero/7 (+'eroas7
    HY9.H Se< !nde(er%!na( s! &se+doer%a.rod!(!s%
    HYG.; S!ndro% Scr!4d+4ca(T Ean(!%on$o"!s%J
    HYG.L S!ndro% Do#n
    HRL.H5 S!ndro% .e(a" a"coo"!c
    HYG.H S!ndro% -"!ne.e"(er
    HYF.G9 S!ndro% Mar.an
    HYG.R S!ndro% T+rner
    HI5.FL` S&!na'!.!da
    HYL.Y S(eno/7 &!"or!c7 !&er(ro.!c7 con$en!(a"7
    HY9.Y Tes(!co" ec(o&!c
    Maladiile !raviditii, na,terii si puerperiumului
    D!a$nos(!ce"e asoc!a(e, c+ $rav!d!(a(ea &o( .! re&era(e :n !nde<+" a".a'e(!c a" ICD4
    F4CM Evo"+%+" 9J "a S$rav!d!(a(e co%&"!ca(7 EdeJT sa+ "a S$rav!d!(a(e, evo"+=!e
    a.ec(a(7 deT. Ma! @os s+n( %en=!ona(e +ne"e d!n ce"e %a! .recven(e cond!=!!.
    RI9.LL`
    RI9.L`
    RI9.L`
    RI;.L`
    RI;.L`
    Ec"a%&s!e
    Preec"a%&s!e sever7
    Preec"a%&s!e +Ooar7
    37rs7(+r! de sarc!n7 Ey&ere%es!s $rav!dar+%J, &er(+r'are %e(a'o"!c7
    37rs7(+r! de sarc!n7 Ey&ere%es!s $rav!dar+%J +Ooare
    Maladiile in$ecioase
    Cod+r!"e care +r%ea/7 re&re/!n(7 cod+r!"e d!a$nos(!ce ICD4F4CM &en(r+
    !n.ec=!!"e c+ or$an!s%e s&ec!.!ce. Trad!=!ona", cod+r!"e &en(r+ or$an!s%e"e de "a
    ca(e$or!a LI5 s+n( +(!"!/a(e dre&( cod+r! sec+ndare Ede e<., !n.ec=!a c7!"or +r!nare
    >G> Anexa G

    da(ora(7 $er%en+"+! Esc-eric-ia coli (re'+!e s7 .!e cod!.!ca( ca YFF.L Zd!a$nos(!c
    &r!%ar[ s! ca LI5.I Zd!a$nos(!c sec+ndar[J.
    LLR.F` 559.I
    5L9.L
    559.;
    559.Y
    559.I
    559.F
    559.5
    LFF.I5
    LI5.G;
    55I.F`
    LHG.5
    55H.Y
    LI5.I
    LGG.G5
    LL9.L
    LLH.5
    LFG.9`
    IGH.L
    IGH.5
    LI5.Y
    LH5.5`
    LH;.;`
    LHL.Y5
    LYI.F`
    LY;.F`
    55Y.F`
    LL5.F`
    L.I9
    L;R.F`
    LHF.FF`
    LI5.;
    LGI.R`
    LHY
    LI5.G5
    LH9.F`
    LI5.9
    LI5.R
    5HE2?
    LH5
    LG9.F`
    LYR.F`
    LL;.F`
    A%!'!a/7
    Cand!do/7, a"(e "oca"!/7r! +ro$en!(a"e
    Cand!do/7 '+ca"7
    Cand!do/7 c+(ana(7 O! +n$ea"7
    Cand!do/7 d!se%!na(7
    Cand!do/7 &+"%onar7
    Cand!do/7, sed!+ nes&ec!.!ca(
    Cand!do/7 v+"var7 O! va$!na"7
    C-lamydia trac-omatis
    Clostridi+m per)rin/ens
    Cocc!d!o!do%!co/7
    Condyloma ac+minat+m Eve$e(a=!! v!ra"eJ
    Cry&(ococco/7
    Esc-eric-ia coli (E7 coli%
    Fe'r7 rec+ren(7 de c7&+Oe
    Fe'r7 (!.o!d7
    ,!ard!a/7
    ,onoree
    ,r!&7 c+ &ne+%on!e
    ,r!&7 nes&ec!.!ca(7
    9emop-il+s in)l+en;ae (97 in)l+en;ae%
    He&a(!(7 v!ra"7 A
    He&a(!(7 v!ra"7 B
    He&a(!(7 v!ra"7 C
    Her&es s!%&"e<
    Her&es /os(er
    H!s(o&"as%o/7
    Ho"er7
    In.ec=!e HI3 Es!%&(o%a(!c7J
    In.ec=!e %en!n$ococ!c7
    In.ec=!e v!ra"7 nes&ec!.!ca(7
    Plebsiella pne+moniae
    Ma"ar!e
    Monon+c"eo/7
    .ycoplasma
    Paro(!d!(7 e&!de%!c7
    Pne+mococ
    Prote+s
    Pse+domonas
    Ra'!e
    R!)e((s!o/7 ve!c+"a(7 de c7&+Oe
    R+'eo"7
    Sa"%one""a
    a/o& +! as+Dsaad 2a=+a+!eo!&a+! a=saos BIBD +! a=!!@Er0!s +! %a&!+!& a.(eED a&
    @E+o&do /n r+=+ad a@!0!+ods!& e+ns a@$ 4e=+e?s0ns o a& asn&+! +e@n0^n8 EKTIED eod
    a?c&a=as a@a=+a+!ED=&a+! na8+ad 5X?;4R4DDI
    ap a&npui aOueQnTOni
    aKunpo4
    a+!/e=!o+a@ a& v/e0 ad a+o+a@oa=!n0 a& BKB0 ad
    a+!da/e!&o/+a0 a& e/s0 ad B&!o.!(e a&
    :s B&!o@!@]
    &!=o0e+e :s "+aSoa&+B !/!o@a=$
    (2RFR ;2RFR
    ?2RFR K2KFR
    R2OKR L29FR
    VY!D "2SFR
    i2GFR
    IO`S ap #I-R `M86I
    aaDSdo 55MS6I
    ap inF
    :s BU!=ns+@
    XHY!D F2 RFR
    BUIBDL; $4GFR
    L2RFR "2"@iR !do IB
    &s!+oAB=+v "2OKR
    !T E+eo=oD +! E=UB=s0ns Bdn& D&a0e@=B a?s!= 2
    :s ao&=+a+!Bo!&av+ =n&0Be +! E; ^n+!n=oAJ &3D2R4DDI I
    B
    s=&0e@=B =n<a&+! +! !@ =od
    a@B;!<oI+!Xa@E/o&B!dns n@=+ad aaE=+a+!!@dns ;D!=so+fE!& a@+n&cD
    ea0e(ope0dns
    92RXL
    `R2Ln"
    UIMt85
    J++VtZ
    BOlMl"MO
    VR21O
    SWl
    aJe4ipaJ1iJ ap asnpui n00uad IAND-I-RDI aJJ
    885 Anexa G
    (era&e+(!ce, a+ d+s "a +na d!n(re +r%7(oare"e (+"'+r7r!Q de"!r!+% !nd+s de o
    s+'s(an=7, de%en=7 &ers!s(en(7 !nd+s7 de o s+'s(an=7, (+"'+rare a%nes(!c7 !nd+s7
    de o s+'s(an=7, (+"'+rare &s!o(!c7 !nd+s7 de o s+'s(an=7, (+"'+rare a.ec(!v7 !nd+s7
    de o s+'s(an=7, (+"'+rare an<!oas7 !nd+s7 de o s+'s(an=7, d!s.+nc=!e se<+a"7 !nd+s7
    de o s+'s(an=7, (+"'+rare de so%n !nd+s7 de o s+'s(an=7 s! (+"'+r7r! de %!Ocare
    !nd+se de o s+'s(an=7. CAnd s+n( +(!"!/a(e :n eva"+area %+"(!a<!a"7, cod+r!"e E
    (re'+!e s7 .!e :nre$!s(ra(e &e a<a I, !%ed!a( d+&7 (+"'+rarea res&ec(!v7. Tre'+!e
    re=!n+( c7 aces(e cod+r! E n+ se a&"!c7 !n(o<!ca=!!"or Eo(r7v!r!"orJ sa+ +n+!
    %ed!ca%en( "+a( :n do/7 e<ces!v7.
    E<e%&"+Q
    9F9.; T+"'+rare a.ec(!v7 !nd+s7 de o s+'s(an=7, c+ s!%&(o%e de&res!ve
    EF;9.9 An(!conce&=!ona"e ora"e
    Anal!etice si antipiretice
    EF;Y.I Ace(a%!no.enX.enace(!n7
    EF;Y.R A$en=! an(!!n."a%a(or! nons(ero!d!c!
    EF;Y.9 A"(e narco(!ce Ede e<., code!na, %e&er!d!naJ
    EF;Y.5 Me(adon7
    EF;Y.; Sa"!c!"a=! Ede e<., as&!r!naJ
    Anticonvulsivante
    EF;R.; Ac!d va"&ro!c
    EF;R.; Car'a%a/e&!n
    EF;R.9 E(os+<!%!d7
    EF;R.5 Fen!(o!n7
    EF;H.L Feno'ar'!(a"
    Medicamente antiparCinsoniene
    EF;R.I A%an(ad!n7
    EFI5.5 Ben/(ro&!n7
    EF;;.L D!&enydra%!n7
    EF;R.I L4Do&a
    Medicamente neuroleptice
    EF;F.; A"(e ne+ro"e&(!ce Ede e<., (!o(!<eneJ
    EF;F.9 Ne+ro"e&(!ce &e 'a/7 de '+(!ro.enon7 Ede e<., a"o&er!do"+"J
    EF;F.5 Ne+ro"e&(!ce &e 'a/7 de .eno(!a/!n7 Ede e<., c"or&ro%a/!n+"J
    Sedative, %ipnotice sau anxiolitice
    EF;H.L Bar'!(+r!ce
    EF;H.5 C"ora"!dra(
    EF;F.Y H!dro<!/!n
    EF;F.I Med!ca%en(e &e 'a/7 de 'en/od!a/e&!n7
    EF;H.9 Para"de!d7
    odurile ID-6-M pentru ondiiile Medicale Generale selectate
    ,i Tulburrile Induse de Medicamente 88E
    Alte medicamente psi%otrope
    EFIL.5 An(a$on!O(! a! o&!acee"or
    EF;F.L An(!de&res!ve
    EF;F.R Canna'!s
    EF;H.H S(!%+"an(e Ee<c"+s!v de&r!%an(e"e cen(ra"e a"e a&e(!(+"+!J
    Medicamente cardiovasculare
    EFI9.; A$en=! de '"oca@ $an$"!onar E&en(a%e(on!+%J
    EFI9.Y A"(e vasod!"a(a(oare
    EFI9.R A"=! a$en=! an(!!&er(ens!v! Ede e<., c"on!d!na, $+ane(!d!na, reser&!naJ
    EFI9.5 ,"!co/!de card!ace Ede e<., d!$!(a"aJ
    EFI9.L Med!ca%en(e an(!ar!(%!ce E!nc"+s!v &ro&rano"o"+"J
    EFI9.9 Med!ca%en(e a(!"!&e%!ce O! care scad co"es(ero"+"
    EFI9.I 3asod!"a(a(oare coronar!ene Ede e<., n!(ra=!!J
    A!eni esenialmente sistemici
    EF;;.L A$en=! an(!a"er$!c! s! an(!e%e(!c! Ee<c"+s!v .eno(!a/!ne"e, !dro<!/!n+"J
    EF;I.9 An(!coa$+"an(e
    EFI5.5 An(!co"!ner$!ce Ede e<., a(ro&!n7J O! s&as%o"!(!ce
    EFI5.L Co"!ner$!ce E&aras!%&(o%!%e(!ceJ
    EF;;.5 Med!ca%en(e an(!neo&"a/!ce O! !%+nos+&resoare
    EFI5.9 S!%&a(o%!%e(!ce Eadrener$!ceJ
    EF;;.Y 3!(a%!ne Ee<c"+s!v v!(a%!na -J
    Medicamente cu aciune asupra mu,c%ilor
    ,i sistemului respirator
    EFIY.L A$en=! o<!(oc!c! Ea"ca"o!/! er$o(a%!n!c!, &ros(a$"and!neJ
    EFIY.G A"(e %ed!ca%en(e res&!ra(or!!
    EFIY.H An(!as(%a(!ce Ea%!no.!"!n7J
    EFIY.I An(!(+s!ve Ede e<., de<(ro%e(or&anJ
    EFIY.5 Re"a<an(e a"e %+Oc!"or ne(e/! E%e(a&ro(ereno"J
    EFIY.9 Re"a<an(e a"e %+Oc!"or sce"e(!c!
    Lormoni ,i substitueni sintetici
    EF;9.G A$en=! an(!(!ro!d!en!
    EF;9.9 Hor%on! ovar!en! E!nc"+de s! an(!conce&=!ona"e"e ora"eJ
    EF;9.H :n"oc+!(or! de (!ro!d7
    EF;9.5 S(ero!/! ana'o"!c! O! andro$en!
    EF;9.L S(ero!/! cor(!cos+&rarena"!
    Medicamente diuretice ,i medicamente care in$luenea(
    metabolismul mineral ,i pe cel al acidului uric
    EFII.I A"(e d!+re(!ce E.+rose%!d+", ac!d+" e(acryn!cJ
    EFII.; C"oro(!a/!de .
    >>C Ane,a G
    EFII.L D!+re(!ce %erc+r!a"e
    EFII.5 D!+re(!ce der!va(e d!n &+r!n7
    EFII.9 In!'!(or! a! an!dra/e! ac!d+"+! car'on!c
    EFII.H Med!ca%en(e care !n."+en=ea/7 %e(a'o"!s%+" ac!d+"+! +r!c E&ro'enec!d+"J
    Ane,a F
    lasi$icarea DSM-IV &cu
    codurile ID-E5)
    2! d+&7 &+'"!carea rev!/+!r!! aces(+! (e<( E:n +"(!%a &ar(e a &r!%7ver!!
    an+"!.! 9LLLJ, s!s(e%+" de cod!.!care o.!c!a" :n +/ :n S(a(e"e Un!(e r7%Ane C"as!.!carea
    In(erna=!ona"7 a Ma"ad!!"or, cea de No+a Rev!/+!re, Mod!.!carea C"!n!c7 EICD4F4
    CMJ. Pes(e (o( :n "+%e, s!s(e%+" o.!c!a" de cod!.!care es(e Clasi)icare 5nterna(ional6 a
    .aladiilor s! a Problemelor Re)eritoare la S6n6tate, cea de Kecea Rev!/+!re EICD45LJ.
    E"a'orarea DSM4I3 a .os( coordona(7 s(rAns c+ e"a'orarea ca&!(o"+"+! 3
    ST+"'+r7r!"e Men(a"e O! de Co%&or(a%en(T a" ICD45L Ee"a'ora( de Or$an!/a=!a
    Mond!a"7 a S7n7(7=!! %a! :na!n(e :n vederea !%&"e%en(7r!! sa"e :n S(a(e"e Un!(eJ.
    Cons+"(7r!"e d!n(re Asoc!a=!a A%er!can7 de Ps!!a(r!e s! Or$an!/a=!a Mond!a"7 a
    S7n7(7=!! a+ av+( ca re/+"(a( cod+r!"e s! (er%en!! DSM4I3, care s+n( :n (o(a"!(a(e
    co%&a(!'!"! c+ cod+r!"e s! (er%en!! d!n !nde<+" (a'+"ar a" ICD45L. S&re a .ac!"!(a
    +(!"!/area !n(erna=!ona"7 a DSM4I3, %a! @os es(e &re/en(a(7 C"as!.!carea DSM4I3 c+
    cod+r!"e ICD45L.
    FAS6 F7r7 a"(7 s&ec!.!ca=!e
    Un x a&7rAnd :n(r4+n cod d!a$nos(!c
    !nd!c7 .a&(+" c7 se cere +n n+%7r de
    cod.
    O e"!&s7 E....J es(e +(!"!/a(7 :n n+%e"e
    an+%!(or (+"'+r7r! &en(r+ a !nd!ca
    .a&(+" c7 (re'+!e !nsera( n+%e"e +ne!
    (+"'+r7r! %en(a"e s&ec!.!ce sa+ cond!=!!
    %ed!ca"e $enera"e cAnd se :nre$!s(rea/7
    n+%e"e Ede e<., FLY.L De"!r!+% da(ora(
    !&o(!ro!d!s%+"+!.
    N+%ere"e d!n(re &aran(e/e s+n(
    n+%ere"e &a$!n!"or.
    Dac7 ac(+a"%en(e s+n( sa(!s.7c+(e
    cr!(er!!"e, d+&7 d!a$nos(!c &oa(e .! no(a(
    +n+" s&ec!.!c, d!n(re +r%7(or!!
    s&ec!.!cAnd de sever!(a(eQ
    +Ooar7
    %odera(7
    sever7
    Dac7 cr!(er!!"e n+ %a! s+n( sa(!s.7c+(e,
    &oa(e .! no(a( +n+" d!n(re +r%7(or!!
    s&ec!.!can=!Q
    :n re%!s!+ne &ar=!a"7
    :n re%!s!+ne co%&"e(7
    !s(or!c an(er!or

    >>4
    >>7 Anexa L

    Tulburrile Mentale dia!nosticate de re!ul "n
    #erioada de su!ar, "n opilrie
    sau "n Adolescen &46)
    RETARDAREA MENTALA EI5J >ot6?
    Acestea s+nt codi)icate pe axa 557 FHL.F
    Re(ardare %en(a"7 +Ooar7 EI;J FH5.F
    Re(ardare %en(a"7 %odera(7
    EI;J
    FH9.F Re(ardare %en(a"7 sever7 EI;J
    FH;.F Re(ardare %en(a"7 &ro.+nd7
    EIIJ FHF.F Re(ardare %en(a"7
    de sever!(a(e
    nes&ec!.!ca(7 EIIJ
    T.LS.+h+IL* D* _FVhGA+* &H6)
    FG5.L D!s"e<!e ET+"'+rarea c!(!(+"+!J EY5J
    FG5.9 D!sca"c+"!e ET+"'+rarea de
    ca"c+"J EY;J
    FG5.G D!s$ra.!e ET+"'+rarea e<&res!e!
    $ra.!ceJ EYIJ
    FG5.F T+"'+rare de :nv7=are FS EYRJ
    T.LS.+A+*A A#TIT.DIFILO+
    MOTO+II &AI)
    FG9 T+"'+rare de de/vo"(are a
    coordon7r!! EYRJ
    TULBURlRILE DE COMUNICARE EYGJ
    FG5. " T+"'+rare de "!%'a@ e<&res!v EYGJ
    FGL.9 T+"'+rare %!<(7 de "!%'a@
    rece&(!v s! e<&res!v ER9J FGL.
    T+"'+rare .ono"o$!c7 ERYJ FFG.Y
    Ba"'!s% ERHJ FGL.F T+"'+rare de
    co%+n!care FS ERFJ
    T.LS.+h+IL* D* D*`VOLTA+*
    #*+VASIVh &I6)
    FGI.L T+"'+rare a+(!s(7 EHLJ
    FGI.9 T+"'+rare Re(( EHRJ
    FGI.; T+"'+rare de/!n(e$ra(!v7 a
    co&!"7r!e! EHHJ
    FGI.Y T+"'+rare As&er$er EGLJ FGI.F
    T+"'+rare de de/vo"(are &erva4
    s!v7 FS EGIJ
    T.LS.+h+IL* D* D*'IIT D*
    AT*FGI* SI D* OM#O+TAM*FT
    DIS+.#TIV &8A)
    U.U T+"'+rarea !&erac(!v!(a(eXde.!c!(
    de a(en=!e EGYJ
    FFL.L (!& co%'!na(
    FFG.G (!& &redo%!nan( !na(en(
    FFL.L (!& &redo%!nan( !%&+"s!v4
    !&erac(!v
    FFL.F T+"'+rarea !&erac(!v!(a(eXde.!c!(
    de a(en=!e FS EF;J
    FF5.G T+"'+rare de cond+!(7 EF;J
    0e speci)icat tip+l? (!& c+ de'+( :n
    co&!"7r!eX(!& c+ de'+( :n
    ado"escen=7
    FF5.; T+"'+rarea o&o/!=!on!s%+"
    &rovoca(or E5LLJ
    FF5.F T+"'+rare de co%&or(a%en(
    d!sr+&(!v FS E5L;J
    T.LS.+h+IL* D* ALIM*FTA+*
    SI D* OM#O+TAM*FT
    ALIM*FTA+ AL* #*+IOAD*I D*
    S.GA+ SI MIII O#ILh+II &E54)
    FFG.; P!ca E5L;J
    FFG.9 R+%!na=!e E5LYJ
    FFG.9 T+"'+rare de a"!%en(are a
    &er!oade! de s+$ar sa+ a %!c!!
    co&!"7r!! E5LHJ
    TI.+IL* &E58)
    FFY.9 T+"'+rare To+re((e E555J
    FFY.5 T!c %o(or sa+ voca" cron!c E55IJ
    FFY.L T!c (ran/!(or E55YJ
    0e speci)icat dac6? e&!sod +n!cXrec+ren(
    FFY.F T!c FS E55RJ
    T.LS.+h+IL* D* *LIMIFA+* &EEI)
    U.U Enco&re/!s E55RJ
    R5Y c+ cons(!&a=!e s! !ncon(!nen=7
    &r!n &rea&"!n (de asemenea, se codi)ic6
    -YF.L cons(!&a=!e, &e a<a IIIJ FFG.5
    .7r7 cons(!&a=!e s! !ncon(!nen=7
    &r!n &rea&"!n
    FFG.L En+re/!s ENeda(ora( +ne! cond!=!!
    %ed!ca"e $enera"eJ E55GJ 0e
    speci)icat tip+l? n+%a! noc(+rnX
    n+%a! d!+rnXnoc(+rn s! d!+rn
    lasi$icarea DSM-IV &cu codurile ID-
    E5)
    >><

    ALT* T.LS.+h+I AL* #*+IOAD*I
    D* S.GA+, O#ILh+I*I SA.
    ADOL*S*FG*I &E7E)
    FF;.L An<!e(a(e de se&arare E595J
    0e speci)icat dac6? c+ de'+( &recoce
    FFI.L M+(!s% se"ec(!v E59YJ FFI.<
    T+"'+rare reac(!v7 de a(aOa%en(
    a &er!oade! de s+$ar sa+ a %!c!!
    co&!"7r!! E59HJ .5 (!& :n!'a( .9
    (!& de/!n!'a( FFG.I T+"'+rare de
    %!Ocare s(ereo(!&7
    E5;5J
    0e speci)icat dac6? c+ co%&or(a%en(
    a+(ov+"neran(
    FFG.F T+"'+rare a &er!oade! de s+$ar, a
    co&!"7r!e! sa+ ado"escen=e! FS E5;IJ
    Deliriumul, Demena,
    Tulburrile amnestice si Alte
    Tulburri o!nitive &E4A)
    D*LI+I.M.L &E4I)
    FLY.L De"!r!+% da(ora(.... Se indic6
    condi(ia medical6 /eneral6Pa se
    codi)ica F"C7 dac6 este s+prap+s
    peste demen(6% E5I5J
    U.U De"!r!+% &r!n !n(o<!ca=!e c+ o
    s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6 pentr+ cod+rile )iec6rei
    s+bstan(e speci)ice% E5I;J
    U.U De"!r!+% &r!n a's(!nen=7 de o
    s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6 pentr+ cod+rile speci)ice
    )iec6rei s+bstan(e% E5I;J
    U.U De"!r!+% da(ora( +nor e(!o"o$!!
    %+"(!&"e (a se codi)ica )iecare
    dintre etiolo/iile speci)ice% E5IRJ
    FLY.F De"!r!+% FS E5IHJ
    D*M*FGA &EH?)
    FOO.<< De%en=7 de (!& A"/e!%er, c+
    de'+( &recoce (de asemenea, se
    codi)ica ,;L.L .aladie Al;-eimer c+
    deb+t precoce pe axa 555% E5YIJ .LL
    neco%&"!ca(7 .L5 c+ !de!
    de"!ran(e .L; c+ d!s&o/!=!e
    de&res!v7
    0e speci)icat dac6? c+ (+"'+rare de
    co%&or(a%en(
    FOO.<< De%en=7 de (!& A"/e!%er, c+
    de'+( (ard!v (de asemenea, se
    codi)ic6 ,;L.5 .aladie Al;-eimer, c+
    deb+t tardi* pe axa 555% (CB% .5L
    neco%&"!ca(7 .55 c+ !de!
    de"!ran(e .59 c+ d!s&o/!=!e
    de&res!v7
    0e speci)icat dac6? c+ t+lb+rare de
    comportament
    FOI.<< De%en=7 vasc+"ar7 E5YGJ .
    GL neco%&"!ca(7 .G5 c+
    !de! de"!ran(e .G9 c+
    d!s&o/!=!e de&res!v7
    0e speci)icat dac6? c+ (+"'+rare de
    co%&or(a%en(
    FL9.I De%en=7 da(ora(7 %a"ad!e! HI3
    (de asemenea, se codi)ic6 Z,,7"
    .aladie 95V d+cTnd la
    ence)alopatie, pe axa 555% E5R;J
    FL9.G De%en=7 da(ora(7
    (ra+%a(!s%+"+! cran!an (de asemenea,
    se codi)ic6 SLR.F le;i+ne intracra#nian6,
    pe axa 555% E5RIJ FL9.; De%en=7
    da(ora(7 %a"ad!e! Par4)!nson (de
    asemenea, se codi)ic6 2," .aladia
    Par8inson, pe axa 555% E5RIJ FL9.9
    De%en=7 da(ora(7 %a"ad!e! H+n(!n$(on
    (de asemenea, se codi)ic6 23 .aladie
    9+ntin/ton, pe axa 555% E5RYJ
    FL9.L De%en=7 da(ora(7 %a"ad!e! P!c)
    (de asemenea, se codi)ic6 ,;5.L .aladie
    Pic8, pe axa 555% E5RYJ FL9.5 De%en=7
    da(ora(7 %a"ad!e! Cre+(/.e"d(4*a)o'
    (de asemenea, se codi)ic6 A&7" .aladie
    Cre+t;)eldt#Ea8ob, pe axa 555% E5RRJ
    ==> Anexa L


    FL9.G De%en=7 da(ora(7... @Se indic6
    condi(ia medical6 /eneral6
    nemen(ionat6 mai s+sA (de
    asemenea, se codi)ic6 condi(ia
    medical6 /eneral6 pe axa 555% E5RHJ
    U.U De%en(7 &ers!s(en(7 !nd+s7 de
    o s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6, pentr+ cod+rile
    speci)ice )iec6rei s+bstan(e% E5RGJ
    FL9.G De%en=7 da(ora(7 +nor e(!o"o$!!
    %+"(!&"e (se codi)ic6 =n sc-imb
    F""7, pentr+ demen(a mixt6,
    Al;-eimer si *asc+lar6% E5HLJ
    FL; De%en=7 FS E5H5J
    T.LS.+h+IL* AMF*STI* O
    FLI T+"'+rarea a%nes(!c7 da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A E5HYJ 0e speci)icat dac6?
    (ran/!(or!eXcron!c7
    U.U T+"'+rare a%nes(!c7 &ers!s(en(7
    !nd+s7 de o s+'s(an=7 (a se
    cons+lta t+lb+r6rile =n le/6t+r6 c+
    o s+bstan(6 pentr+ cod+rile
    speci)ice )iec6rei s+bstan(e% E5HHJ
    RI5.; T+"'+rare a%nes(!c7 FS E5HFJ
    ALT* T.LS.+h+I OGFITIV* O
    FLR.F T+"'+rare co$n!(!v7 FS E5HFJ
    Tulburrile Mentale datorate
    unei ondiii Medicale
    Feclasi$icate "n Alt #arte &E8E)
    FLR.5 T+"'+rare ca(a(on!c7 da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A E5GYJ
    FLH.5 Mod!.!carea de &ersona"!(a(e
    da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A E5GHJ De
    s&ec!.!ca( (!&+"Q (!& "a'!"X(!&
    de/!n!'a(X(!& a$res!vX(!& a&a(!cX
    (!& &arano!dXa"( (!&X(!& co%'!na(X
    (!& nes&ec!.!ca(
    FLF T+"'+rare %en(a"7 FS da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A E5FLJ
    Tulburrile induse de o
    Substan &E6E)
    Frm6torii speci)ican(i pot )i aplica(i
    dependen(ei de o s+bstan(6?
    0e speci)icat dac6? c+ de&enden=7
    .!/!o"o$!c7X .7r7 de&enden=7
    .!/!o"o$!c7
    E*ol+(ia dependen(ei se codi)ic6 la cea de
    a cincea ci)r6?
    O 6 re%!s!+ne co%&"e(7 &recoceXre%!4
    s!+ne &ar=!a"7 &recoce
    L 6 re%!s!+ne co%&"e(7 &re"+n$!(7Xre4
    %!s!+ne &ar=!a"7 &re"+n$!(7
    16 :n(r4+n %ed!+ con(ro"a(
    26 s+' (era&!e a$on!s(7
    I 6 +soar7X%odera(7Xsever7
    Frm6torii speci)ican(i se aplic6 t+lb+r6rilor
    ind+se de o s+bstan(6 ca nota(i?
    ! c+ de'+( :n c+rs+" !n(o<!ca=!e!X
    A

    c+ de'+( :n c+rs+" a's(!nen=e!
    T.LS.+h+IL* _F L*GhT.+h
    . ALOOL.L &7E7)
    T+"'+r7r!"e +/+"+! de a"coo" E95;J
    F5L.9< De&enden=7 de a"coo" a E95;J
    F5L.5 A'+/ de a"coo" E95IJ
    T+"'+r7r!"e !nd+se de a"coo" E95IJ
    F5L.LL In(o<!ca=!e a"coo"!c7 E95IJ
    F5L.; A's(!nen=7 a"coo"!c7 E95YJ
    0e speci)icat dac6? c+ &er(+r'7r! de
    &erce&=!e
    F5L.L; De"!r!+% &r!n !n(o<!ca=!e
    a"coo"!c7 E5I;J FI L.I De"!r!+% &r!n
    a's(!nen=7 de
    a"coo" E5I;J FI L.H; De%en=7
    &ers!s(en(7 !nd+s7 de
    a"coo" E5RGJ FI L.R T+"'+rare
    a%nes(!c7 &ers!s(en(7
    !nd+s7 de a"coo" E5HHJ F"O.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    a"coo" E;;GJ
    .Y5 c+ !de! de"!ran(e!4 A .Y9 c+
    a"+c!na=!!" A FI L.G T+"'+rare
    a.ec(!v7 !nd+s7 de
    lasi$icarea DSM-IV &cu codurile ID-
    E5)
    >>G

    a"coo" !, A EILYJ
    F5L.G T+"'+rare an<!oas7 !nd+s7 de
    a"coo" L A EIHFJ
    FI L.G D!s.+nc=!e se<+a"7 !nd+s7 de
    a"coo" I EYR9J
    F5L.G T+"'+rare de so%n !nd+s7 de
    a"coo" !, A ERYYJ
    F5L.F T+"'+rare :n "e$7(+r7 c+
    a"coo"+" FS E99;J
    T.LS.+h+IL* _F L*GhT.+h .
    AM'*TAMIFA &SA. .
    S.SSTAFG* SIMILA+*
    AM'*TAMIF*/) &774)
    T+"'+r7r!"e +/+"+! de a%.e(a%!na E99IJ
    F5Y.9< De&enden=7 de a%.e(a%!na a
    E99IJ F5Y.5 A'+/ de
    a%.e(a%!na E99YJ
    T+"'+r7r!"e !nd+se de a%.e(a%!na E99RJ
    F5Y.LL In(o<!ca=!e c+ a%.e(a%!na E99RJ
    F5Y.LI In(o<!ca=!e c+ a%.e(a%!na, c+
    &er(+r'7r! de &erce&=!e E99RJ
    F5Y.; A's(!nen=7 de a%.e(a%!na E99HJ
    F5Y.L; De"!r!+% &r!n !n(o<!ca=!e c+
    a%.e(a%!na E5I;J FIS.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    a%.e(a%!na E;;GJ .Y5 c+ !de! de"!ran(e
    l
    .
    Y9 c+ a"+c!na=!! " F5Y.G T+"'+rare
    a.ec(!v7 !nd+s7 de
    a%.e(a%!na "4 A EILYJ FIY.G
    T+"'+rare an<!oas7 !nd+s7 de
    a%.e(a%!na " EIHFJ F5Y.G
    D!s.+nc=!e se<+a"7 !nd+s7 de
    a%.e(a%!na ! EYR9J F5Y.G
    T+"'+rare de so%n !nd+s7 de
    a%.e(a%!na !X A ERYYJ F5Y.F
    T+"'+rare :n "e$7(+r7 c+ a%.e(a%!na
    FS E9;5J
    T.LS.+h+IL* _F L*GhT.+h
    . A'*IFA &74E)
    T+"'+r7r!"e !nd+se de ca.e!na E9;5J
    F5Y.LL In(o<!ca=!e c+ ca.e!na E9;9J
    F5Y.G T+"'+rare an<!oas7 !nd+s7 de
    ca.e!na " EIHFJ F5Y.G
    T+"'+rare de so%n !nd+s7 de
    ca.e!na ! ERYYJ
    F5Y.F T+"'+rare :n "e$7(+r7 c+ ca.e!na
    FS E9;IJ
    T.LS.+h+IL* _F L*GhT.+h
    . AFFASIS.L &74I)
    T+"'+r7r!"e +/+"+! de canna'!s E9;RJ
    F59.9< De&enden=7 de canna'!s a E9;RJ
    F59.5 A'+/ de canna'!s E9;RJ
    T+"'+r7r!"e !nd+se de canna'!s E9;HJ
    FI 9.LL In(o<!ca=!e c+ canna'!s E9;HJ
    F59.LI In(o<!ca=!e c+ canna'!s, c+
    &er(+r'7r! de &erce&=!e E9;HJ
    F59.L; De"!r!+% &r!n !n(o<!ca=!e c+
    canna'!s E5I;J F59.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    canna'!s E;;GJ .Y5 c+ !de!
    de"!ran(e ! .Y9 c+ a"+c!na=!! ! F59.G
    T+"'+rare an<!oas7 !nd+s7 de
    canna'!s I EIHFJ F59.F
    T+"'+rare :n "e$7(+r7 c+
    canna'!s+" FS E9I5J
    T.LS.+h+IL* _F L*GhT.+h
    . OAIFA &7HE)
    T+"'+r7r!"e +/+"+! de coca!n7 E9I9J
    F5I.9< De&enden(7 de coca!n7 a E9I9J
    F5I.5 A'+/ de coca!n7 E9I;J
    T+"'+r7r!"e !nd+se de coca!n7 E9IIJ
    F5I.LL In(o<!ca=!e c+ coca!n7 E9IIJ
    F5I.LI In(o<!ca=!e c+ coca!n7, c+
    &er(+r'7r! de &erce&=!e E9IIJ F5I.;
    A's(!nen=7 de coca!n7 E9IYJ F5I.L;
    De"!r!+% &r!n !n(o<!ca=!e c+
    coca!n7 E5I;J F5I.<< T+"'+rare
    &s!o(!c7 !nd+s7 de
    coca!n7 E;;GJ .Y5 c+ !de!
    de"!ran(e I .Y9 c+ a"+c!na=!! I F5I.G
    T+"'+rare a.ec(!v7 !nd+s7 de
    coca!n7 " A EILYJ F5I.G
    T+"'+rare an<!oas7 !nd+s7 de
    coca!n7 !4 A EIHFJ
    F5I.G D!s.+nc=!e se<+a"7 !nd+s7 de
    coca!n7 ! EYR9J
    >>> Anexa L


    F5I.G T+"'+rare de so%n !nd+s7 de
    coca!n7 " A ERYYJ F5I.F
    T+"'+rare :n "e$7(+r7 c+ coca!na
    FS E9YLJ
    T.LS.+h+IL* _F L*GhT.+h
    . LAL.IFOG*F*L* &7A5)
    T+"'+r7r!"e +/+"+! de a"+c!no$ene E9Y5J
    F5R.9< De&enden=7 de a"+c!no$ene
    a
    E9Y5J FI R. " A'+/ de
    a"+c!no$ene E9Y9J
    Tulburrile induse de %alucino!ene &7A7)
    FI R.LL In(o<!ca=!e c+ a"+c!no$ene
    E9Y9J
    F5R.HL T+"'+rare de &erce&=!e
    &ers!s(en(7 a"+c!no$en7
    E."as'ac)sJ E9Y;J
    F5R.L; De"!r!+% &r!n !n(o<!ca=!e c+
    a"+c!no$ene E5I;J
    FI R.LL T+"'+rare &s!o(!c7 !nd+s7 de
    a"+c!no$ene E;;GJ .Y5
    c+ !de! de"!ran(e " .Y9 c+
    a"+c!na=!! "
    F5R.G T+"'+rare a.ec(!v7 !nd+s7 de
    a"+c!no$ene I EILYJ
    F5R.G T+"'+rare an<!oas7 !nd+s7 de
    a"+c!no$ene I EIHFJ
    F5R.F T+"'+rare :n "e$7(+r7 c+
    a"+c!no$ene"e FS E9YRJ
    T.LS.+h+IL* _F L*GhT.+h
    . IFLALAFT*L* &7A?)
    T+"'+r7r!"e +/+"+! de !na"an(e E9YGJ
    F5G.9< De&enden(7 de !na"an(e a E9YGJ
    F5G.5 A'+/ de !na"an(e E9YFJ
    T+"'+r7r!"e !nd+se de !na"an(e E9YFJ
    F5G.LL In(o<!ca=!e c+ !na"an(e E9YFJ
    FIG.L; De"!r!+% &r!n !n(o<!ca=!e c+
    !na"an(e E5I;J FI G.H;
    De%en=7 &ers!s(en(7 !nd+s7 de
    !na"an(e E5RGJ FIS.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    !na"an(e E;;GJ .Y5 c+ !de!
    de"!ran(e I .Y9 c+ a"+c!na=!! ! F5G.G
    T+"'+rare a.ec(!v7 !nd+s7 de
    !na"an(e ! EILYJ
    F5G.G T+"'+rare an<!oas7 !nd+s7 de
    !na"an(e " EIHFJ F5G.F
    T+"'+rare :n "e$7(+r7 c+ !na4
    "an(e"e FS E9R;J
    T.LS.+h+IL* _F L*GhT.+h
    . FIOTIFh &7IH)
    T+"'+r7r!"e +/+"+! de n!co(!n7 E9RIJ
    F5H.9< De&enden=7 de n!co(!n7 a E9RIJ
    T+"'+rarea !nd+s7 de n!co(!n7 E9RYJ
    FI H.; A's(!nen=7 de n!co(!n7 E9RYJ FI
    H.F T+"'+rare :n "e$7(+r7 c+ n!co(!n7
    FS E9RFJ
    T.LS.+h+IL* _F L*GhT.+h
    . O#IA**L* &7I6)
    T+"'+r7r!"e +/+"+! de o&!acee E9HLJ
    F55.9< De&enden=7 de o&!acee a E9HLJ
    FII. " A'+/ de o&!acee E9H5J
    T+"'+r7r!"e !nd+se de o&!acee E9H5J
    FII .LL In(o<!ca=!e c+ o&!acee E9H5J
    FII.LI In(o<!ca=!e c+ o&!acee c+
    &er(+r'7r! de &erce&=!e E9H9J FII .;
    A's(!nen=7 de o&!acee E9H9J FII.L;
    De"!r!+% &r!n !n(o<!ca=!e c+
    o&!acee E5I;J FII.<< T+"'+rare
    &s!o(!c7 !nd+s7 de
    o&!acee E;;GJ .Y5 c+ !de!
    de"!ran(e " .Y9 c+ a"+c!na=!! " FII.G
    T+"'+rare a.ec(!v7 !nd+s7 de
    o&!acee I EILYJ FII.G
    D!s.+nc=!e se<+a"7 !nd+s7 de
    o&!acee I EYR9J FII .G
    T+"'+rare de so%n !nd+s7 de
    o&!acee l A ERYYJ FII.F
    T+"'+rare :n "e$7(+r7 c+ o&!a4
    cee"e FS E9HHJ
    T.LS.+h+IL* _F L*GhT.+h
    . #L*FVLIDIFA &SA. O
    S.SSTAFGh SIMILA+h
    #L*FVLIDIF*I) &7?8)
    T+"'+r7r!"e +/+"+! de &encyc"!d!n7 E9HFJ
    F5F.9< De&enden=7 de &encyc"!d!n7 a
    E9HFJ FI F. " A'+/ de
    &encyc"!d!n7 E9HFJ
    lasi$icarea DSM-IV &cu codurile ID-
    E5)
    ==4


    T+"'+r7r!"e !nd+se de &encyc"!d!n7 E9GLJ
    F5F.LL In(o<!ca=!e c+ &encyc"!d!n7
    E9GLJ F5F.LI In(o<!ca=!e c+
    &encyc"!d!n7 c+
    &er(+r'7r! de &erce&=!e E9GLJ
    F5F.L; De"!r!+% &r!n !n(o<!ca=!e c+
    &encyc"!d!n7 E5I;J F5F.<<
    T+"'+rare &s!o(!c7 !nd+s7 de
    &encyc"!d!n7 E;;GJ .Y5 c+ !de!
    de"!ran(e ! .Y9 c+ a"+c!na=!! " F5F.G
    T+"'+rare a.ec(!v7 !nd+s7 de
    &encyc"!d!n7 ! EILYJ F5F.G
    T+"'+rare an<!oas7 !nd+s7 de
    &encyc"!d!n7 ! EIHFJ F5F.F T+"'+rare
    :n "e$7(+r7 c+ &encyc"!d!n7 FS E9G;J
    T.LS.+h+IL* _F L*GhT.+h
    . S*DATIV*L*, LI#FOTI*L*
    SA. AF-IOLITI*L* &78H)
    T+"'+r7r!"e +/+"+! de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce E9GYJ F5;.9<
    De&enden=7 de seda(!ve, !&no(!ce
    sa+ an<!o"!(!ce a E9GYJ F5;.5 A'+/ de
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce E9GRJ
    Tulburrile induse de sedative,
    %ipnotice sau anxiolitice &78A)
    F5;.LL In(o<!ca=!e c+ seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce E9GRJ
    F5;.; A's(!nen=7 de seda(!ve,
    !&no(!ce sa+ an<!o"!(!ce E9GHJ
    0e speci)icat dac6? c+ &er(+r'7r! de
    &erce&=!e
    F5;.L; De"!r!+% &r!n !n(o<!ca=!e c+
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce E5I;J
    F5;.I De"!r!+% &r!n a's(!nen=7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce E5I;J
    F5;.H; De%en=7 &ers!s(en(7 !nd+s7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce E5RGJ
    FI ;.R T+"'+rare a%nes(!c7 &ers!s(en(7
    !nd+s7 de seda(!ve, !&no(!ce
    sa+ an<!o"!(!ce E5HHJ
    FIS.<< T+"'+rare &s!o(!c7 !nd+s7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce E;;GJ
    .Y5 c+ !de! de"!ran(e !, A .
    Y9 c+ a"+c!na=!! !4 A
    FI ;.G T+"'+rare a.ec(!v7 !nd+s7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ceLA EILYJ
    F5;.G T+"'+rare an<!oas7 !nd+s7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce A EIHFJ
    F5;.G D!s.+nc=!e se<+a"7 !nd+s7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce ! EYR9J
    F5;.G T+"'+rare de so%n !nd+s7 de
    seda(!ve, !&no(!ce sa+
    an<!o"!(!ce " A ERYYJ
    F5;.F T+"'+rare :n "e$7(+r7 c+ seda4
    (!ve"e, !&no(!ce"e sa+ an<!o"!(!4
    ce"e FS E9F;J
    T.LS.+A+*A _F L*GhT.+h
    . #OLIS.SSTAFGA &764)
    F5F.9< De&enden=7 de &o"!s+'s(an=7 a
    E9F;J
    T.LS.+h+IL* _F L*GhT.+h
    . ALTh S.SSTAFGh &SA. .
    O S.SSTAFGh
    F*.FOS.Th) &76H)
    T+"'+r7r!"e +/+"+! de a"(7 s+'s(an=7
    Esa+ de o s+'s(an=7 nec+nosc+(7J E9FIJ
    F5F.9< De&enden=7 de a"(7 s+'s(an=7
    Esa+ de o s+'s(an=7 nec+nosc+(7J a
    E5F9J
    F5F.5 A'+/+" de a"(7 s+'s(an=7 Esa+ de
    o s+'s(an=7 nec+nosc+(7J E5FGJ
    T+"'+r7r!"e !nd+se de a"(7 s+'s(an=7
    Esa+ de o s+'s(an=7 nec+nosc+(7J E9FYJ
    FI F.LL In(o<!ca=!e c+ a"(7 s+'s(an=7 Esa+
    c+ o s+'s(an=7 nec+nosc+(7J E5FFJ FIF.LI
    In(o<!ca=!e c+ a"(7 s+'s(an=7 Esa+ c+
    o s+'s(an=7 nec+nosc+(7J, c+ &er(+r'7r!
    de &erce&=!e E5FFJ FIF.; A's(!nen=a
    de a"(7 s+'s(an=7 Esa+ de o
    s+'s(an=7 nec+nosc+(7J E9L5J
    0e speci)icat dac6? c+ &er(+r'7r! de
    &erce&=!e
    GFL Anexa L

    FI F.L; De"!r!+% !nd+s de a"(7
    s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J (se codi)ic6 F!7B,
    daca deb+t+l s+r*ine =n c+rs+l
    abstinen(ei% E5I;J
    F5F.H; De%en=7 &ers!s(en(7 !nd+s7 de
    a"(7 s+'s(an=7 Esa+ de o
    s+'s(an=7 nec+nosc+(7J E5RGJ
    F5F.R T+"'+rare a%nes(!c7 &ers!s(en(7
    !nd+s7 a"(7 s+'s(an=7 Esa+ de o
    s+'s(an=7 nec+nosc+(7J E5HHJ
    F5F.<< T+"'+rare &s!o(!c7 !nd+s7 de
    a"(7 s+'s(an=7 Esa+ de o
    s+'s(an=7 nec+nosc+(7J E;;GJ .Y5
    c+ !de! de"!ran(e !X A .Y9 c+
    a"+c!na=!! " A
    FI F.G T+"'+rare a.ec(!v7
    !nd+s7 de a"(7 s+'s(an=7 Esa+
    de o s+'s(an=7 nec+nosc+(7J !, A
    EILYJ
    FI F.G T+"'+rare an<!oas7
    !nd+s7 de a"(7 s+'s(an=7 Esa+
    de o s+'s(an=7 nec+nosc+(7J !, A
    EIHFJ
    FI F.G D!s.+nc=!e se<+a"7
    !nd+s7 de a"(7 s+'s(an=7 Esa+
    de o s+'s(an=7 nec+nosc+(7J !
    EYR9J
    F5F.G T+"'+rare de so%n !nd+s7 de
    a"(7 s+'s(an=7 Esa+ de o
    s+'s(an=7 nec+nosc+(7J !X A
    ERYYJ
    FI F.F T+"'+rare :n "e$7(+r7 c+ a"(7
    s+'s(an=7 Esa+ de o s+'s(an=7
    nec+nosc+(7J FS E9FYJ
    Sc%i(o$renia si Alte Tulburri
    #si%otice & 76?)
    F9L.<< Sc!/o.ren!a E9FGJ .O<
    (!& &arano!d E;5;J ."< (!&
    de/or$an!/a( E;5IJ .9< (!& ca
    (a (on!c E;5YJ .;< (!&
    ned!.eren=!a( E;5RJ .Y< (!&
    re/!d+a" E;5RJ
    E*ol+(ia sc-i;o)reniei se codi)ic6 c+ cea de a
    cincea ci)r6 ca?

    E&!sod!c7, c+ s!%&(o%e re/!d+a"e
    !n(ere&!sod!ce (de speci)icat dac6? c+
    s!%&(o%e ne$a(!ve no(a'!"eJ
    E&!sod!c7, .7r7 s!%&(o%e re/!d+a"e
    !n(ere&!sod!ce
    Con(!n+7 (de speci)icat dac6? c+
    s!%&(o%e ne$a(!ve no(a'!"eJ
    E&!sod +n!c, :n re%!s!+ne &ar=!a"7
    (de speci)icat dac6? c+ s!%&(o%e
    ne$a(!ve no(a'!"eJ
    E&!sod +n!c, :n re%!s!+ne co%&"e(7
    A"( &a((ern sa+ &a((ern nes&ec!.!ca(
    Ma! &+=!n de " an de "a de'+(+"
    s!%&(o%e"or .a/e! ac(!ve !n!=!a"e
    F9L.G
    T+"'+rare sc!/o.ren!.or%7 E;5HJ
    0e speci)icat dac6? .7r7 e"e%en(e
    de &ro$nos(!c '+nXc+ e"e%en(e
    de &ro$nos(!c '+n
    F9Y.< T+"'+rare sc!/oa.ec(!v7 E;5FJ .L
    (!& '!&o"ar 4.5 (!& de&res!v
    F99.L T+"'+rare de"!ran(7 E;9;J
    0e speci)icat tip+l? (!&
    ero(o%an!eX(!& de $randoareX(!&
    de $e"o/!eX(!& de &ersec+=!eX(!&
    somatic1 (!& %!<(X(!& nes&ec!.!ca(
    F9;.<< T+"'+rare &s!o(!c7 sc+r(7 E;9FJ
    .G5 c+ srresor E!J %arcan( E!J .GL
    .7r7 s(resor E!J %arcan( E!J 0e
    speci)icat dac6? c+ de'+( &os( &arr+%
    F9I T+"'+rare &s!o(!c7 !nd+s7
    Z:%&7r(7O!(7[ E;;9J
    FLR. < T+"'+rare &s!o(!c7 da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A E;;IJ
    .9 c+ !de! de"!ran(e .L
    c+ a"+c!na=!!
    U.U T+"'+rare &s!o(!c7 !nd+s7 de o
    s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6 t+r6 c+ o
    s+bstan(6 pentr+ cod+rile speci)ice
    )iec6rei s+bstan(e% E;;GJ
    0e speci)icat dac6? c+ de'+( :n c+rs+"
    !n(o<!ca=!e!Xc+ de'+( :n c+rs+"
    a's(!nen=e!
    F9F T+"'+rare &s!o(!c7 FS E;I;J
    lasi$icarea DSM-IV &cu codurile ID-
    E5)
    =41


    Tulburrile A$ective &4HA)
    Frm6torii speci)ican(i se aplic6 t+lb+r6rilor
    a)ecti*e (episod+l c+rent sa+ episod+l cel
    mai recent%?
    a s&ec!.!cAndC de sever!(a(eX&s!o4
    (!cXre%!s!+ne
    ' cron!cX
    c c+ e"e%en(e ca(a(on!ceX
    d c+ e"e%en(e %e"anco"!ceX
    e c+ e"e%en(e a(!&!ceX
    . c+ de'+( &os(&ar(+%
    A P
    5 P
    F 6
    9 6
    H P
    4 P
    Frm6torii speci)ican(i se aplic6 t+lb+r6rilor
    a)ecti*e?
    $ c+ sa+ .7r7 rec+&erare !n(ere&!so4
    d!c7 co%&"e(7X c+ &a((ern
    se/on!erX ! c+ c!c"are ra&!d7
    TULBURlRILE DEPRESI3E E;RFJ
    F;9.< T+"'+rare de&res!v7 %a@or7,
    e&!sod +n!c
    a
    , ', c, d, e, . E;RFJ
    F;;. < T+"'+rare de&res! v7 %a@or7,
    rec+ren(7 a, ', c, d, e, ., $, E;YFJ
    Starea act+al6 a episod+l+i depresi* maIor
    se codi)ic6 c+ cea de a patra ci)r6 ca?
    06 +Oor
    16 %odera(
    26 sever, .7r7 e"e%en(e &s!o(!ce
    36 sever, c+ e"e%en(e &s!o(!ce
    0e speci)icat? c+ s!%&(o%e &s!o(!ce
    con$r+en(e c+ d!s&o/!=!aXc+ s!%&(o%e
    &s!o(!ce !ncon$r+en(e c+ d!s&o/!=!a
    I 6 :n re%!s!+ne &ar=!a"7
    I 6 :n re%!s!+ne co%&"e(7
    F 6 nes&ec!.!ca(
    F;I.5 T+"'+rare d!s(!%!c7 E;HRJ
    0e speci)icat dac6? c+ de'+(
    &recoceXc+ de'+( (ard!v 0e
    speci)icat? c+ e"e%en(e a(!&!ce
    F;9.F T+"'+rare de&res!v7 FS E;G5J
    TULBURlRILE BIPOLARE E;G9J
    F;L.< T+"'+rare '!&o"ar7 I, e&!sod
    %an!aca" +n!c a, c, . E;G9J
    0e speci)icat dac6? %!<(
    Starea act+al6 a episod+l+i maniacal se
    codi)ic6 c+ cea de a patra ci)r6 ca ?
    5 6 +Oor, %odera( sa+ sever, .7r7
    s!%&(o%e &s!o(!ce
    9 6 sever, c+ s!%&(o%e &s!o(!ce
    G 6 :n re%!s!+ne &ar=!a"7 sa+ co%&"e(7
    F;5.L T+"'+rare '!&o"ar7 I, ce" %a!
    recen( e&!sod !&o%an!aca" $4 a
    ! E;G9J
    FS".< T+"'+rare '!&o"ar7 I, ce" %a!
    recen( e&!sod %an!aca" a, c, ., $,
    , ! E;G9J
    Starea act+al6 a episod+l+i maniacal se
    codi)ic6 c+ cea de a patra ci)r6 ca?
    5 6 +Oor, %odera( sa+ sever, .7r7 s!%&4
    (o%e &s!o(!ce
    9 6 sever, c+ s!%&(o%e &s!o(!ce
    H 6 :n re%!s!+ne &ar=!a"7 sa+ co%&"e(7
    F;5.R T+"'+rare '!&o"ar7 I, ce" %a!
    recen( e&!sod %!<( a, c, ., $, , ! E;G9J
    F;5 .< T+"'+rare '!&o"ar7 I, ce" %a!
    recen( e&!sod de&res!v a, ', c, d, e, ., $4 , !
    E;G9J
    Starea act+al6 a episod+l+i depresi* maIor
    se codi)ic6 c+ cea de a patra ci)r6 ca?
    36 +Oor sa+ %odera(
    46 sever, .7r7 s!%&(o%e &s!o(!ce
    56 sever, c+ s!%&(o%e &s!o(!ce
    H 6 :n re%!s!+ne &ar=!a"7 sa+ co%&"e(7
    F;5.F T+"'+rare '!&o"ar7 I, ce" %a!
    recen( e&!sod nes&ec!.!ca( J , ! E;G9J F;5.G
    T+"'+rare '!&o"ar7 II a, ', c, d, e, ., $, , !
    E;F9J
    0e speci)icat (episod+l act+al sa+ cel mai
    recent%? !&o%an!aca"Xde&res!v F;I.L
    T+"'+rare c!c"o(!%!c7 E;FGJ F;5.F
    T+"'+rare '!&o"ar7 FS EILLJ FLR.>>
    T+"'+rare a.ec(!v7 da(ora(7... @Se
    indic6 condi(ia medical6 /eneral6A EIL5J
    .;9 c+ s!%&(o%e de&res!ve .;9
    c+ e&!sod s!%!"ar e&!sod+"+!
    de&res!v %a@or .;L c+ s!%&(o%e
    %an!aca"e .;; c+ s!%&(o%e %!<(e U.
    U T+"'+rare a.ec(!v7 !nd+s7 de o
    s+'s(an=7 (a se cons+lta t+lb+r6rile =n
    le/6t+r6 c+ o s+bstan(6 pentr+ cod+rile
    speci)ice )iec6rei s+bstan(e% EILYJ
    GF9 Anexa L


    0e speci)icat tip+l? c+ s!%&(o%e
    de&res!veXc+ s!%&(o%e
    %an!aca"eX c+ s!%&(o%e %!<(e
    0e speci)icat dac6? c+. de'+( :n c+rs+"
    !n(o<!ca=!e!Xc+ de'+( :n c+rs+"
    a's(!nen=e! T+"'+rare a.ec(!v7
    FS EI5LJ
    F;F
    Tulburrile Anxioase &H76)
    FI5.L Pan!c7 .7r7 a$ora.o'!e EI;;J
    FIL.L5 Pan!c7 c+ a$ora.o'!e EI;;J
    FIL.LL A$ora.o'!e .7r7 !s(or!c de
    &an!c7 EII5J
    FIL.9 Fo'!e s&ec!.!c7 EII;J
    0e speci)icat tip+l? de an!%a"Xde
    %ed!+ na(+ra"Xde sAn$e4!n@ec=!!4
    &"7$!Xde (!& s!(+a=!ona"Xde a"( (!&
    FIL.5 Fo'!e soc!a"7 EIYLJ
    0e speci)icat dac6? $enera"!/a(7
    FI9.G T+"'+rare o'ses!vo4co%&+"s!v7
    EIYRJ
    0e speci)icat dac6? c+ conO(!!n=a
    %a"ad!e! red+s7
    FI;.5 S(res &os((ra+%a(!c EIR;J
    0e speci)icat dac6? ac+( sa+ cron!c 0e
    speci)8at dac6? c+ de'+( (ard!v
    FI;.L S(res ac+( EIRFJ
    FI5.5 An<!e(a(e $enera"!/a(7 EIH9J
    FLR.I T+"'+rare an<!oas7 da(ora(7...
    @Se indic6 condi(ia medical6
    /eneral6A EIHRJ
    0e speci)icat? c+ an<!e(a(e
    $enera"!/a(7X c+ a(ac+r! de
    &an!c7Xc+ s!%&(o%e o'ses!vo4
    co%&+"s!ve
    U.U T+"'+rare an<!oas7 !nd+s7 de o
    s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6 pentr+ cod+rile speci)ice
    )iec6rei s+bstan(e% EIHFJ
    0e speci)icat dac6? c+ an<!e(a(e
    $enera"!/a(7Xc+ a(ac+r! de
    &an!c7Xc+ s!%&(o%e o'ses!vo4
    co%&+"s!veXc+ s!%&(o%e .o'!ce
    0e speci)icat? c+ de'+( :n c+rs+"
    !n(o<!ca=!e!Xc+ de'+( :n (!%&+"
    a's(!nen=e!
    FI5.F T+"'+rare an<!oas7 FS EIGIJ
    Tulburrile Somato$orme &H8A)
    FIY.L T+"'+rare de so%a(!/are EIGRJ
    FIY.5 T+"'+rare so%a(o.or%7
    ned!.eren=!a(7 EIFLJ
    FII.< T+"'+rare de convers!e EIF9J .I
    c+ s!%&(o% sa+ de.!c!( %o(or .Y
    c+ cr!/e e&!"e&(!ce sa+ conv+"s!! .R
    c+ s!%&(o% sa+ de.!c!(
    sen/or!a"
    .H c+ (a'"o+ c"!n!c %!<(
    FIY.9 T+"'+rare a"$!c7 EIFGJ
    0e speci)icat tip+l? asoc!a(7 c+ .ac(or!
    &s!o"o$!c!Xasoc!a(7, a(A( c+ .ac(or!
    &s!o"o$!c!, cA( s! c+ o cond!=!e
    %ed!ca"7 $enera"7
    0e speci)icat dac6? ac+(7Xcron!c7
    FIY.9 H!&ocondr!e EYLIJ
    0e speci)icat dac6? c+ conO(!!n=a %a"ad!e!
    red+s7 FIY.9 T+"'+rare d!s%or.!c7
    cor&ora"7
    EYLHJ
    FIY.F T+"'+rare so%a(o.or%7 FS
    EY55J
    Tulburrile 'actice &AE4)
    FRG.5 T+"'+rare .ac(!ce EY5;J
    0e speci)icat tip+l? c+ se%ne O!
    S!%&(o%e &redo%!nan( &s!o"o$!ce
    Xc+ se%ne s! s!%&(o%e
    &redo%!nan( so%a(!ceXc+ se%ne s!
    s!%&(o%e co%'!na(e, &s!o"o$!ce s!
    so%a(!ce
    FRG.5 T+"'+rare .ac(!ce FS EY5HJ
    Tulburrile Disociative &AE6)
    FII.L A%ne/!e d!soc!a(!v7 EY9LJ FII.5
    F+$7 d!soc!a(!v7 EY9;J FII.G5
    T+"'+rare de !den(!(a(e d!soc!a(!v7
    EY9RJ
    lasi$icarea DSM-IV &cu codurile ID-
    E5)
    =4+


    FIG.5 T+"'+rare de de&ersona"!/are
    EY;LJ FII.F T+"'+rare
    d!soc!a(!v7 FS EY;9J
    Tulburrile Sexuale ,i de
    Identitate Sexual &A4A)
    DIS'.FGIIL* S*-.AL* &A4A)
    Frm6torii speci)ican(i se aplic6 t+t+ror
    dis)+nc)iilor sex+ale primare?
    (!& e<!s(en( d!n (o(dea+naX(!&
    c7&7(a(X(!& $enera"!/a(X(!&
    s!(+a(!ona"X da(ora(7 .ac(or!"or
    &s!o"o$!c!Xda(ora(7 +nor .ac(or!
    co%'!na=!
    T+"'+r7r!"e dor!n=e! se<+a"e EY;FJ
    FY9.L Dor!n=7 se<+a"7 d!%!n+a(7 EY;FJ
    FY9.5L Avers!+ne se<+a"7 EYI5J
    T+"'+r7r!"e de e<c!(a=!e se<+a"7 EYI;J
    FY9.9 T+"'+rare de e<c!(a=!e se<+a"7 a
    .e%e!! EYI;J
    FY9.9 T+"'+rare de erec=!e a
    '7r'a(+"+! EYIYJ
    Tulburrile de or!asm &AH?)
    FY9.; T+"'+rare de or$as% a .e%e!!
    EYIHJ
    FY9.; T+"'+rare de or$as% a
    '7r'a(+"+! EYYLJ
    FY9.I E@ac+"are &recoce E&re%a(+r7J
    EYY9J
    T+"'+r7r!"e se<+a"e d+reroase EYYIJ
    FY9.R D!s&are+n!e ENeda(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"eJ EYYIJ FY9.Y
    3a$!n!s% ENeda(ora( +ne! cond!=!!
    %ed!ca"e $enera"eJ EYYRJ
    D!s.+nc=!e se<+a"7 da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e E YYGJ
    NFI.G Dor!n=7 se<+a"7 red+s7 a .e%e!!
    da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A EYYGJ NYL.G
    Dor!n=7 se<+a"7 d!%!n+a(7 a
    '7r'a(+"+! da(ora(7... @Se indic6
    condi(ia medical6 /eneral6A EYYGJ
    NIG.I T+"'+rare de erec=!e a
    '7r'a(+"+! da(ora(7... @Se indic6
    condi(ia medical6 /eneral6A EYYGJ
    NFI.5 D!s&are+n!e .e%!n!n7
    da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A EYYGJ
    NYL.G D!s&are+n!e %asc+"!n7
    da(ora(7.. . @Se indic6 condi(ia
    medical6 /eneral6A EYYGJ
    NFI.G A"(7 d!s.+nc=!e se<+a"7 a .e%e!!
    da(ora(7... @Se indic6 condi(ia
    medical6 /eneral6A EYYGJ
    NYL.G A"(7 d!s.+nc=!e se<+a"7 a
    '7r'a(+"+! da(ora(7... @Se
    indic6 condi(ia medical6
    /eneral6A EYYGJ
    U.U D!s.+nc=!e se<+a"7 !nd+s7 de o
    s+'s(an=7 (a se cons+lta
    t+lb+r6rile =n le/6t+r6 c+ o
    s+bstan(6 pentr+ cod+rile speci)ice
    )iec6rei s+bstan(e% EYR9J
    0e speci)icat dac6? c+ de(er!orarea
    dor!n=e!Xc+ de(er!orarea e<c!(a=!e!X
    c+ de(er!orarea or$as%+"+!Xc+
    d+rere "a n!ve"+" or$ane"or $en!(a"e
    0e speci)icat dac6? c+ de'+( :n (!%&+"
    !n(o<!ca=!e!
    FY9.F D!s.+nc=!e se<+a"7 FS EYRYJ
    #A+A'ILIIL* &AII)
    FRY.9 E<!'!=!on!s% EYRFJ
    FRY.L Fe(!O!s% EYRFJ
    FRY.G Fror(e+r!s% EYHLJ
    FRY.I Pedo.!"!e EYH5J
    0e speci)icat dac6? a(ras se<+a" de
    '7!e=!X a(ras se<+a" de .e(eXa(ras
    se<+a" a(A( de '7!e=!, cA( O! de .e(e
    0e speci)icat dac6? "!%!(a( "a !nces(
    0e speci)icat tip+l? (!& e<c"+s!vX(!&
    none<d+s!v
    FRY.Y Masoc!s% se<+a" EYH9J
    FRY.Y Sad!s% se<+a" EYH;J
    FRY.5 Fe(!O!s% rransves(!c EYHIJ
    0e speci)icat dac6? c+ d!s.or!e
    se<+a"7
    FRY.; 3oye+r!s% EYHYJ
    FRY.F Para.!"!e FS EYHRJ
    GFI Anexa L

    T.LS.+h+IL* D* ID*FTITAT*
    S*-.ALh &A?I)
    FRI.< T+"'+rare de !den(!(a(e se<+a"7
    EYHRJ "a co&!!
    "a ado"escen=! O! ad+"=! 0e
    speci)icat dac6? a(ras se<+a" de
    '7r'a=!X a(ras se<+a" de .e%e!X
    a(ras se<+a" de a%'e"e se<eX
    nea(ras se<+a" de n!r!+n+"
    T+"'+rare de !den(!(a(e se<+a"7
    FS EYG9J T+"'+rare se<+a"7
    FS EYG9J
    FY9.F
    Tulburrile de omportament
    Alimentar & A84)
    FYL.L Anore<!e nervoas7 EYG;
    2
    7
    FRI.F
    0e speci)icat tip+l? tip res(r!c(!v8 (!&
    de %Anca( e<ces!vX&+r$are
    FYL.9 B+"!%!e nervoas7 EYGF
    0e speci)icat tip+l? (!& de &+r$areX(!&
    de non&+r$are
    FYL.F T+"'+rare de co%&or(a%en(
    a"!%en(ar FS EYFI
    Tulburrile de Somn &A6?)
    #arasomniile &I45)
    FY5.Y CoO%ar ER;5J
    FY5.I Teroare de so%n ER;IJ
    FY5.; So%na%'+"!s% ER;FJ
    FY5.G Paraso%n!e FS ERIIJ
    T.LS.+h+IL* D* SOMF _F
    L*GhT.+h . ALTh T.LS.+A+*
    M*FTALh &IHA)
    FY5.L Inso%n!e :n "e$7(+r7 c+ ... @Se
    indic6 t+lb+rarea de pa axa 5 sa+
    axa 55A ERIYJ FY5.5
    H!&erso%n!e :n "e$7(+r7 c+ ...
    @Se indic6 t+lb+rarea de pe axa 5
    sa+ axa 55A ERIYJ
    ALTE TULBURlRI DE SOMN ERY5J
    ,IH.< T+"'+rare de so%n da(ora(7 ...
    @Se indic6 condi(ia medical6 /eneral6A
    ERY5J
    .L de (!& !nso%n!e
    .5 de (!& !&erso%n!e
    .G de (!& &araso%n!e
    .G de (!& %!<(
    U.U T+"'+rare de so%n !nd+s7 de o
    s+'s(an=7... @a se cons+lta t+lb+#
    r6tile =n le/6t+r6 c+ o s+bstan(6
    pentr+ cod+rile speci)ice )iec6rei
    s+bstan(eA ERYYJ
    0e speci)icat tip+l? de (!& !nso%n!eX
    de (!& !&erso%n!eXde (!& %!<( 0e
    speci)icat tip+l? c+ de'+( :n c+rs+"
    !n(o<!ca=!e!X c+ de'+( :n c+rs+"
    a's(!nen(e!

    T.LS.+h+IL* D* SOMF #+IMA+*
    &A68)
    Dissomniile &A68)
    FY5.L Inso%n!e &r!%ar7 EYFFJ
    FY5.5 H!&erso%n!e &r!%ar7 ERLIJ 0e
    speci)icat dac6? rec+ren(7
    ,IH.I Narco"e&s!e ERLFJ
    ,IH.; T+"'+rare de so%n :n "e$7(+r7
    c+ res&!ra=!a ER5YJ
    FY5.9 T+"'+rare a r!(%+"+! c!rcad!an
    de so%n ER99J
    0e speci)icat tip+l? (!& de .a/7 de
    so%n :n(Ar/!a(X(!& de deca"a@ de .+s
    orarX(!& de "+cr+ :n (+reX(!&
    nes&ec!.!ca(
    FY5.F D!sso%n!e FS ER9FJ
    Tulburarea ontrolului
    Impulsului Feclasi$icat
    "n Alt #arte & II4) ]]]]]]]]]]]]
    FR;.G T+"'+rare e<&"o/!v7
    !n(er%!(en(7 ERR;J
    FR;.9 -"e&(o%an!e ERRHJ
    FR;.5 P!ro%an!e ERRFJ
    FR;.L ET+"'+rareaJ *oc de Oans7
    &a(o"o$!c ERH5J
    FR;.; Tr!cor!"o%an!e ERHIJ
    FR;.F T+"'+rare a con(ro"+"+!
    !%&+"s+"+! FS ERHHJ
    lasi$icarea DSM-IV &cu codurile ID-
    E5)
    =45
    Tulburrile de Adaptare &I?6) Alte ondiii care se pot a$la "n
    N>- .................................>>\ . . .> 22\ 2 2
    lP
    entrul Ateniei linice &?4E)
    FI;.<< T+"'+rare de ada&(are ERHFJ .9L c+ d!s&o/!=!e de&res!v7 .9G c+
    an<!e(a(e .99 c+ d!s&o/!=!e %!<(7,
    an<!oas7
    s! de&res!v7
    .9I c+ &er(+r'are de cond+!(7 .
    9Y c+ &er(+r'are %!<(7 de e%o=!!
    O! cond+!(7 .F
    nes&ec!.!ca(7
    0e speci)icat dac6? ac+(7Xcron!c7
    Tulburrile de #ersonalitate
    &I8A)
    ]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    >ot6? Acestea s+nt codi)icate pe axa 557
    FRL.L T+"'+rare de &ersona"!(a(e &ara4
    no!d7 ERFLJ
    FRL.5 T+"'+rare de &ersona"!(a(e
    sc!/o!d7 ERFIJ
    F95 T+"'+rare de &ersona"!(a(e sc!4
    /o(!&a"7 ERFHJ
    FRL.9 T+"'+rare de &ersona"!(a(e
    an(!soc!a"7 EHL5J
    FRL.;5 T+"'+rare de &ersona"!(a(e 'or4
    der"!ne EHLRJ
    FRL.I T+"'+rare de &ersona"!(a(e
    !s(r!on!c7 EH55J
    FRL.G T+"'+rare de &ersona"!(a(e nar4
    c!s!s(!c7 EH5IJ
    FRL.R T+"'+rare de &ersona"!(a(e ev!4
    (an(7 EH5GJ
    FRL.H T+"'+rare de &ersona"!(a(e
    de&enden(7 EH95J
    FRL.Y T+"'+rare de &ersona"!(a(e o'se4
    s!vo4co%&+"s!v7 EH9YJ
    FRL.L T+"'+rare de &ersona"!(a(e FS
    EH9FJ
    'ACTORII PSIFOLOGICI CARE
    A'ECTEA9 CONDI;IA
    MEDICAL9 3G4*6
    FYI .. 7@Se speci)ic6 )actor+l psi-olo/icA
    care a.ec(ea/7... @Se indic6
    condi(ia medical6 /eneral6A (N$%
    A se ale/e n+mele pe ba;a nat+rii
    )actorilor? EH;5J T+"'+rare
    %en(a"7 care a.ec(ea/7
    cond!=!a %ed!ca"7
    S!%&(o%e &s!o"o$!ce care
    a.ec(ea/7 cond!=!a %ed!ca"7
    Tr7s7(+r! de &ersona"!(a(e sa+
    s(!"+r! de a .ace .a=7 care
    a.ec(ea/7 cond!=!a %ed!ca"7
    Co%&or(a%en(e de/ada&(a(!ve
    &en(r+ s7n7(a(e care
    a.ec(ea/7 cond!=!a %ed!ca"7
    R7s&+ns .!/!o"o$!c :n "e$7(+r7 c+
    s(res+" care a.ec(ea/7 cond!=!a
    %ed!ca"7 A"=! .ac(or!
    &s!o"o$!c! sa+ .ac(or!
    &s!o"o$!c! nes&ec!.!ca=! care
    a.ec(ea/7 cond!=!a %ed!ca"7
    T.LS.+h+IL* D* MIQA+*
    IFD.S* D* M*DIAM*FT* &?4H)
    G7E25 #arCinsonism indus de
    ne+ro"e&(!ce EH;YJ
    ,95.L S!ndro% ne+ro"e&r!c %a"!$n EH;YJ
    ,9I.L D!s(on!e ac+(7 !nd+s7 de
    ne+ro"e&(!ce EH;YJ
    ,95.5 A)a(!s!e ac+(7 !nd+s7 de
    ne+ro"e&(!ce EH;YJ ,9I.5 D!s)!ne/!e
    (ard!v7 !nd+s7 de
    ne+ro"e&(!ce EH;RJ ,9Y.5
    Tre%or &os(+ra" !nd+s de
    %ed!ca%en(e EH;RJ
    ,9Y.F T+"'+rare de %!Ocare !nd+s7 de
    %ed!ca%en(e FS EH;RJ
    =4> Anexa L

    ALTh T.LS.+A+* D*MIFD.Sh D*
    M*DIAM*FT* &?4I)
    TGG.H E.ec(e adverse a"e
    %ed!ca%en(e"or EH;RJ
    #+OSL*M* +*LAGIOFAL* &?4I)
    KR;.H Pro'"e%7 re"a=!ona"7 :n "e$7(+r7
    c+ o (+"'+rare %en(a"7 sa+
    cond!=!e %ed!ca"7 $enera"7 EH;HJ
    KR;.G Pro'"e%7 de re"a=!e &7r!n(e4co4&!"
    (se codi)ic6 YD$7 dac6 =n centr+l
    aten(iei se a)l6 copil+l% EH;HJ
    KR;.L Pro'"e%7 de re"a=!e c+
    &ar(ener+" EH;HJ
    FF;.L Pro'"e%7 de re"a=!e :n(re .ra=!
    EH;HJ
    KR;.F Pro'"e%7 de re"a=!e FS EH;HJ
    PROBLEME jN LE,lTURl CU
    ABUKUL SAU NE,LI*AREA EH;GJ
    THI.5 A'+/ .!/!c de +n co&!" EH;GJ
    THI.9 A'+/ se<+" de +n co&!" EH;GJ
    THI.5 Ne$"!@area co&!"+"+! EH;GJ 5HI.5
    A'+/ .!/!c de +n ad+"( EH;GJ THI.5
    A'+/ se<+a" de +n ad+"( EH;GJ
    CONDIPII ADIPIONALE CARE SE
    POT AFLA jN CENTRUL ATENPIEI
    CLINICE EH;FJ KF5.5 Nonco%&"!an=7
    "a (ra(a%en(
    EH;FJ KHR.Y
    S!%+"are EH;FJ
    KH9.G Co%&or(a%en( an(!soc!a" a"
    ad+"(+"+! EHILJ KH9.G
    Co%&or(a%en( an(!soc!a" a"
    ado"escen(+"+! EHILJ RI5.G
    F+nc=!onare !n(e"ec(+a"7 "!%!4
    nar7 EHILJ RI5.G Dec"!n
    co$n!(!v :n "e$7(+r7 c+
    e(a(ea EHILJ KR;.I Do"!+ EHILJ KYY.H
    Pro'"e%7 Oco"ar7 EHI5J KYR.H
    Pro'"e%7 &ro.es!ona"7 EHI5J FF;.G
    Pro'"e%7 de !nden(!(a(e EHI5J KH5.G
    Pro'"e%7 re"!$!oas7 sa+ s&!r!(+a"7
    EHI5J
    KRL.; Pro'"e%7 de ac+"(+ra=!e EHI5J
    KRL.L Pro'"e%7 de .a/7 de v!a=7 EHI9J
    odurile Adiionale &?H4)
    FFF T+"'+rare %en(a"7 nes&ec!.!ca(7
    Enon&s!o(!c7J EHI;J
    KL;.9 N!c! +n d!a$nos(!c sa+ cond!=!e
    &e a<a I EHI;J
    RRF D!a$nos(!c sa+ cond!=!e
    a%Ana(7 &e a<a I EHI;J
    KL;. 9 N! c! +n d! a$nos( ! c &e a<a
    II EHI;J
    RIR. G D! a$nos( ! c a%Ana( &e a<a
    II EHI;J
    Ane,a l
    Sc%ia pentru 'ormularea
    ultural si Glosarul Sindromelor
    i
    ircumscrise ultural
    ceas(a ane<7 es(e :%&7r=!(7 :n do+7 sec=!+n!. Pr!%a sec=!+ne &revede o
    sc!=7 &en(r+ .or%+"area c+"(+ra"7 des(!na(7 s7 a@+(e c"!n!c!an+" :n eva"+area
    s!s(e%a(!c7 s! :n ra&or(area !%&ac(+"+! con(e<(+"+! c+"(+ra" a" !nd!v!d+"+!. A do+a
    es(e +n $"osar de s!ndro%e c!rc+%scr!se c+"(+ra".
    S#@i!( pentru %or"ularea #ultural(
    Ur%7(oarea sc!=7 &en(r+ .or%+"area c+"(+ra"7 es(e des(!na(7 s7 co%&"e(e/e
    eva"+area d!a$nos(!c7 %+"(!a<!a"7 s! s7 a'orde/e d!.!c+"(7=!"e care &o( .! :n(A"n!(e :n
    a&"!carea cr!(er!!"or DSM4I3 :n(r4+n %ed!+ %+"(!c+"(+ra". For%+"area c+"(+ra"7
    o.er7 o (recere :n rev!s(7 s!s(e%a(!c7 a .ond+"+! c+"(+ra" a" !nd!v!d+"+!, a ro"+"+!
    con(e<(+"+! c+"(+ra" :n e<4&r!%area s! eva"+area s!%&(o%e"or O! d!s.+nc=!e!, &rec+%
    O! a e.ec(e"or &e care d!.eren=e"e c+"(+ra"e "e &o( avea as+&ra re"a=!e! d!n(re !nd!v!d
    s! c"!n!c!an.
    AOa c+% es(e !nd!ca( :n !n(rod+cerea %an+a"+"+! Eve/! &a$. <<!!!J, es(e
    !%&or(an( ca c"!n!c!an+" s7 =!n7 con( de con(e<(+" e(n!c O! c+"(+ra" a" !nd!v!d+"+!
    :n eva"+area .!ec7re! a<e a DSM4I3. :n &"+s, .or%+"area c+"(+ra"7 s+$era(7 %a! @os
    o.er7 o&or(+n!(a(ea de a descr!e s!s(e%a(!c $r+&+" de re.er!n=7 c+"(+ra"7 O! soc!a"7
    a" !nd!v!d+"+! O! %od+" :n care con(e<(+" c+"(+ra" es(e re"evan( &en(r+ a(en=!a
    c"!n!c7. C"!n!c!an+" &oa(e o.er! +n s+%ar nara(!v &en(r+ .!ecare d!n(re
    +r%7(oare"e ca(e$or!!Q
    Iden(!(a(ea c+"(+ra"7 a !nd!v!d+"+!. Se no(ea/7 $r+&+r!"e de re.er!n=7 e(n!c7 a
    !nd!v!d+"+!. Pen(r+ !%!$ran=! O! %!nor!(7=!"e e(n!ce, se no(ea/7 se&ara( $rad+" de
    !%&"!care, a(A( :n c+"(+ra de or!$!ne, cA( O! :n c+"(+ra rece&(oare Eaco"o +nde aceas(a
    es(e a&"!ca'!"J. Se conse%nea/7, de ase%enea, a&(!(+d!n!"e, +/+" O! &re.er!n=e"e
    "!n$v!s(!ce E!nc"+s!v %+"(!"!n$v!s%+"J.
    E<&"!ca=!!"e c+"(+ra"e a"e %a"ad!e! !nd!v!d+"+!. Po( .! !den(!.!ca(e +r%7(oare"eQ
    e<&res!!"e &redo%!nan(e de s+.er!n=7 &r!n care s+n( co%+n!ca(e s!%&(o%e"e sa+
    neces!(a(ea de s+&or( soc!a" Ede e<., Snerv!T, s&!r!(e &osedan(e, ac+/e so%a(!ce,
    neOans7 !ne<&"!ca'!"7J, sens+" s! sever!(a(ea &erce&+(7 a s!%&(o%e"or !nd!v!d+"+! :n
    re"a=!e c+ nor%e"e $r+&+"+! c+"(+ra" de re.er!n=7, or!ce ca(e$or!e "oca"7 de %a"ad!e
    +(!"!/a(7 de .a%!"!a O! co%+n!(a(ea !nd!v!d+"+! &en(r+ a !den(!.!ca cond!=!a Eve/!
    86?
    GFG Anexa

    S,"osar+" s!%&(o%e"or c!rc+%scr!se c+"(+ra"T de %a! @osJ, ca+/e"e &erce&+(e sa+
    %ode"e"e e<&"!ca(!ve &e care !nd!v!d+" s! $r+&+" de re.er!n=7 "e +(!"!/ea/7 &en(r+ a
    e<&"!ca %a"ad!a s! &re.er!n=e"e c+ren(e, s! e<&er!en=e"e (rec+(e c+ s+rse"e de
    (ra(a%en( &ro.es!ona" s! &o&+"ar.
    )actorii culturali @n le.tur cu mediul psi-osocial si nivelele de func3ionare.
    Se no(ea/7 !n(er&re(7r!"e re"evan(e c+"(+ra" a"e s(resor!"or soc!a"!, s+&or(+r!"e soc!a"e
    d!s&on!'!"e s! n!ve"e"e de .+nc=!onare s! de !nca&ac!(a(e. Aces(ea (re'+!e s7 !nc"+d7
    (ens!+n!"e d!n %ed!+" soc!a" "oca" s! ro"+" re"!$!e! s! a" re=e"e! .a%!"!a"e :n as!$+rarea
    s+&or(+"+! e%o=!ona", o&era=!ona" s! !n.or%a=!ona".
    E"e%en(e"e c+"(+ra"e a"e re"a=!e! d!n(re !nd!v!d s! c"!n!c!an. Se !nd!c7
    d!.eren=e"e de c+"(+r7 s! s(a(+( soc!a" d!n(re !nd!v!d s! c"!n!c!an, s! &ro'"e%e"e &e
    care aces(e d!.eren=e "e &o( ca+;a :n d!a$nos(!c s! (ra(a%en( Ede e<., d!.!c+"(a(e :n
    co%+n!care :n &r!%a "!%'7 a !nd!v!d+"+!, :n re"evarea s!%&(o%e"or sa+
    :n=e"e$erea se%n!.!ca=!e! "or c+"(+ra"e, :n s(a'!"!rea +ne! re"a=!! sa+ n!ve" de
    !n(!%!(a(e cores&+n/7(or, :n &rec!/area .a&(+"+! dac7 +n co%&or(a%en( es(e
    nor%a(!v sa+ &a(o"o$!cJ.
    Eva"+area c+"(+ra"7 $"o'a"7 &en(r+ d!a$nos(!c O! (ra(a%en(. For%+"area se
    :nce!e c+ o d!sc+=!e as+&ra %od+"+! c+% cons!deren(e"e c+"(+ra"e !n."+en=ea/7 :n
    %od s&ec!.!c d!a$nos(!c+" s! (ra(a%en(+" cores&+n/7(or.
    Glo&arul &in$ro"elor #ir#u"&#ri&e #ultural
    Ter%en+" de sindrom circ+mscris c+lt+ral den+%eO(e &a((ern+r! rec+ren(e,
    s&ec!.!ce "oca"!(7=!!, de co%&or(a%en( a'eran( s! de e<&er!en=e &er(+r'an(e, care &o(
    .! sa+ n+ :n "e$7(+r7 c+ o an+%!(7 ca(e$or!e d!a$nos(!c7 DSM4I3. M+"(e d!n(re
    aces(e &a((ern+r! s+n( cons!dera(e :n %od !neren( S%a"ad!!T sa+ ce" &+=!n s+.er!n=e,
    !ar ce"e %a! %+"(e a+ an+%!(e den+%!r! "oca"e. DeO! (a'"o+r! c"!n!ce con.or%e
    ca(e$or!!"or %a@ore a"e DSM4I3 &o( .! re&era(e :n (oa(7 "+%ea, an+%!(e s!%&(o%e,
    evo"+=!a s! r7s&+ns+" soc!a", s+n( .oar(e adesea !n."+en=a(e de .ac(or! c+"(+ra"! "oca"!.
    D!n con(ra, s!ndro%e"e c!rc+%scr!se s+n( :n $enera" "!%!(a(e "a an+%!(e soc!e(7=! sa+
    ar!! c+"(+ra"e s! s+n( ca(e$or!! d!a$nos(!ce &o&+"are, "oca"!/a(e, care con.er7
    se%n!.!ca=!! cores&+n/7(oare an+%!(or se(+r! de e<&er!en=e s! o'serva=!! re&e(!(!ve,
    %ode"a(e s! &er(+r'an(e.
    E<!s(7 rar o ec!va"en=7 de +n+ "a +n+ a or!c7r+! s!ndro% c!rc+%scr!s c+"(+ra"
    c+ o en(!(a(e d!a$nos(!c7 DSM4I3. Co%&or(a%en(+" a'eran(, care &oa(e .! c"as!.!ca(
    :n %a! %+"(e ca(e$or!! de c7(re +n d!a$nos(!c!an care +(!"!/ea/7 DSM4I3, &oa(e .!
    !nc"+s :n(r4o s!n$+r7 ca(e$or!e &o&+"ar7, !ar (a'"o+r!"e c"!n!ce, cons!dera(e ca
    a&ar=!nAnd +ne! s!n$+re ca(e$or!! de c7(re +n d!a$nos(!c!an care +(!"!/ea/7 DSM4
    I3, &o( .! c"as!.!ca(e :n %a! %+"(e ca(e$or!! de c7(re +n c"!n!c!an !nd!$en. Pe "An$7
    aceas(a, +ne"e cond!=!! s! (+"'+r7r! a+ .os( conce&(+a"!/a(e ca .!!nd s!ndro%
    c!rc+%scr!s c+"(+ra", s&ec!.!ce c+"(+r!! !nd+s(r!a"e Ede e<., anore<!a nervoas7,
    (+"'+rarea de !den(!(a(e d!soc!a(!v7J, da(7 .!!nd a'sen=a sa+ rar!(a(ea "or ev!den(7
    :n a"(e c+"(+r!. De ase%enea, (re'+!e re=!n+( c7 (oa(e soc!e(7=!"e !nd+s(r!a"!/a(e
    !nc"+d s+'c+"(+r! d!s(!nc(e s! $r+&+r! e<(re% de d!verse de !%!$ran=! care &o(
    &re/en(a s!ndro%e c!rc+%scr!se c+"(+ra".
    Sc%ia pentru 'ormularea ultural si Glosarul
    Sindromelor ircumscrise ultural =44
    Aces( $"osar "!s(ea/7 +ne"e d!n(re ce"e %a! '!ne s(+d!a(e s!ndro%e c!rc+%scr!se
    c+"(+ra" s! %od+r! de e<&r!%are a de(rese!, care &o( .! :n(A"n!(e :n &rac(!ca c"!n!c7 :n
    A%er!ca de Nord, O! !nc"+de ca(e$or!!"e DSM4I3 re"evan(e, cAnd da(e"e s+$erea/7
    c7 aces(ea (re'+!e s7 .!e "+a(e :n cons!dera=!e :n .or%+"area d!a$nos(!c+"+!.
    A%o). Es(e +n e&!sod d!soc!a(!v carac(er!/a( &r!n(r4o &er!oad7 de r+%!na=!e
    +r%a(7 de +n acces de co%&or(a%en( v!o"en(, a$res!v sa+ o%!c!dar :ndre&(a( con(ra
    oa%en!"or s! o'!ec(e"or. E&!sod+" (!nde a .! &rec!&!(a( de &erce&erea +n+! a.ron( sa+
    !ns+"(e s! &are a &reva"a n+%a! &r!n(re '7r'a=!. E&!sod+" es(e aco%&an!a( adesea de
    !de! de &ersec+=!e, a+(o%a(!s%, a%ne/!e, e&+!/are s! reven!re "a s(area &re%or'!d7,
    d+&7 e&!sod. Une"e ca/+r! de a%o) &o( s+rven! :n c+rs+" +n+! e&!sod &s!o(!c sc+r(
    sa+ cons(!(+!e de'+(+" sa+ e<acer'area +n+! &roces &s!o(!c cron!c. Co%+n!c7r!"e
    or!$!na"e care +(!"!/a+ aces( (er%en era+ d!n Ma"ae/!a. Un &a((ern de
    co%&or(a%en( s!%!"ar es(e :n(A"n!( :n Laos, F!"!&!ne, Po"!ne/!a (ca)ard sa+ cat-ard%,
    Pa&+a4No+a ,+!nee s! P+er(o R!co (mal de pelea%, &rec+% s! &r!n(re Nava@o (iic-Haa%7
    A(a0+e de nerv!os. Un "!%'a@ de de(res7 &re/en( :n s&ec!a" &r!n(re "a(!nos d!n
    Cara!'e, dar rec+nosc+( s! &r!n(re %+"(e $r+&+r! "a(!no4a%er!cane s! "a(!no4
    %ed!(eraneene. S!%&(o%e"e re"a(a(e !nc"+d .recven( voc!.er7r! !ncon(ro"a'!"e,
    a(ac+r! de =!&e(e, (re%or, c7"d+r7 d!n &!e&( care +rc7 "a ca& s! a$res!v!(a(e ver'a"7 s!
    .!/!c7. E<&er!en=e"e d!soc!a(!ve, e&!soade"e ase%7n7(oare cr!/e"or e&!"e&(!ce sa+ de
    "eO!n O! $es(+r!"e s+!c!dare s+n( no(a'!"e :n +ne"e a(ac+r!, dar a'sen(e :n a"(e"e. O
    carac(er!s(!c7 $enera"7 a +n+! a(ac de nerv! o cons(!(+!e sen(!%en(+" de &!erdere a
    con(ro"+"+!. A(ac+r!"e de nerv! s+rv!n .recven( ca re/+"(a( d!rec( a" +n+! even!%en(
    s(resan( re.er!(or "a .a%!"!e Ede e<., O(!rea %or=!! +ne! r+de a&ro&!a(e, se&ararea sa+
    d!vor=+" de so=E!eJ, con."!c(e"e c+ so=+" Eso=!aJ sa+ c+ co&!!, or! a .! %ar(orE7J "a +n
    acc!den( !%&"!cAnd +n %e%'r+ a" .a%!"!e!J.Oa%en!! &o( e<&er!en=a a%ne/!e &en(r+
    ceea ce a s+rven!( :n c+rs+" a(ac+"+! de nerv!, dar de re$+"7 rev!n ra&!d "a n!ve"+"
    "or an(er!or de .+nc=!onare. DeO! descr!er!"e +nor a(ac+r! de nerv! cadrea/7 .oar(e
    %+"( c+ descr!erea a(ac+r!"or de &an!c7 d!n DSM41, asoc!erea ce"or %a! %+"(e
    a(ac+r! c+ +n even!%en( .&rec!&!(an(, s! a'sen=a .recven(7 a s!%&(o%e"or de %arc7
    a"e .r!c!! ac+(e sa+ a&reens!+n!!, "e d!s(!n$e de &an!c7. A(ac+r!"e c+&r!nd o $a%7
    %er$And de "a e<&res!a nor%a"7 a de(rese!, neasoc!a(7 c+ .a&(+" de a avea o
    (+"'+rare %en(a"7, &An7 "a &re/en(7r! de s!%&(o%e asoc!a(e c+ d!a$nos(!ce"e de
    (+"'+r7r! an<!oase, a.ec(!ve sa+ so%a(o.or%e.
    B!"!s s! co"era Eden+%!(7, de ase%enea, O! m+ina%7 Ca+/a s+'!acen(7 a aces(or
    s!ndro%e es(e cons!dera(7 a .! s(area co"eroas7 sa+ .+r!a !n(ens e<&er!en(a(7. S(area
    co"eroas7 es(e v7/+(7 &r!n(re %+"(e $r+&+r! "a(!no ca o e%o=!e e<(re% de !n(ens7, c+
    e.ec(e d!rec(e as+&ra cor&+:+!, O! care &oa(e e<acer'a s!%&(o%e"e e<!s(en(e. E.ec(+"
    %a!or a" s(7r!! co"eroasc es(e ace"a de a &er(+r'a ec!"!'re"e !n(r!nsec! a"e cor&+"+!
    Ecare s+n( :n=e"ese ca o 'a"an=7 :n(re va"en=e"e ca"de O! rec! d!n cor& s! :n(re as&ec(e"e
    %a(er!a"e s! s&!r!(+a"e a"e cor&+"+!J. S!%&(o%e!e &o( !nc"+de (ens!+ne nervoas7
    ac+(7, ce.a"ee. (re%or, voc!.er7r!, &er(+r'7r! $as(r!ce, !ar :n ca/+r!"e %a! severe,
    &!erderea c+noO(!n=e!. D!n e&!sod+" ac+( &oa(e re/+"(a o .a(!$a'!"!(a(e cron!c7.
    Bo+.ee de"!ran(e Es(e +n vndrorn o'serva( :n A.r!ca de 3es( O! :n Ha!(!. Aces(
    (er%en .rance/ 6e re(2er7 !a a4.4@o4E4"e 'r+O(e de co%&or(a%en( a$!(a( s! a$res!v,
    con.+/!e %arca(7 s! e<2c!(?=!. &?!o%o(o+e. Uneor! &oa(e .! aco%&an!a( d(
    FLL Anexa
    a"+c!na=!! v!/+a"e s! a+d!(!ve sa+ de !dea=!e &arano!d7. Aces(e e&!soade &o(
    se%7na c+ +n e&!sod de (+"'+rare &s!o(!c7 sc+r(7.
    Bra!n .a$. Ter%en +(!"!/a( !n!=!a" :n A.r!ca de 3es( &en(r+ a den+%! o cond!=!e
    e<&er!en(a(7 de s(+den=!! Oco"!"or s+&er!oare sa+ a! +n!vers!(7=!"or, ca r7s&+ns "a
    e<!$en(e"e Oco"are. S!%&(o%e"e !nc"+d d!.!c+"(7=! :n concen(rare, %e%orare s!
    $And!re. S(+den=!! a.!r%7 adesea c7 cre!er+" "or es(e So'os!(T. S!%&(o%e"e so%a(!ce
    s+&"!%en(are s+n( cen(ra(e de re$+"7 &e ca& s! $A(, s! !nc"+d d+rerea, &res!+nea sa+
    (ens!+nea, o'n+'!"area veder!!, sen/a=!a de c7"d+r7 sa+ de ars+r7. SFa(!$a'!"!(a(ea
    cere'ra"7T sa+ .a(!$a'!"!(a(ea &r!n S$And!( &rea %+"(T es(e +n %od de e<&r!%are a
    de(rese! :n %+"(e c+"(+r! s! d+ce "a s!ndro%e care sea%7n7 c+ an+%!(e (+"'+r7r!
    an<!oase, de&res!ve s! so%a(o.or%e.
    Da(. Es(e +n (er%en d!a$nos(!c &o&+"ar +(!"!/a( :n Ind!a &en(r+ a den+%!
    an<!e(a(ea sever7 sa+ &reoc+&7r!"e !&ocondr!ace asoc!a(e c+ sc+r$erea de s&er%7
    s! c+ deco"orarea +r!n!! Ecare dev!ne a"'!c!oas7J s! sen/a=!a de "!&s7 de .or=7 s! de
    e&+!/are. S!%!"are c+ da(+" s+n( Iiryan EInd!aJ, s+8ra prame-a ESr!4La%)aJ O! s-en#
    8H+ei EC!naJ.
    Fa""!n$4o+( sa+ '"ac)!n$ o+(. Aces(e e&!soade s+rv!n :n s&ec!a" "a $r+&+r!"e d!n
    s+d+" S(a(e"or Un!(e s! Cara!'e. Se carac(er!/ea/7 &r!n(r4+n co"a&s 'r+sc care
    s+rv!ne .7r7 aver(!s%en(, dar +neor! es(e &receda( de sen/a=!a de a%e=ea"7 sa+ de
    S&!erdere a %!n=!!T. Oc!! !nd!v!d+"+! s+n( desc!O!, dar &ersoana rec"a%7 .a&(+" c7
    n+ vede. De re$+"7, &ersoana a+de s! :n=e"e$e ceea ce se &e(rece :n @+r+" s7+, dar
    es(e !nca&a'!"7 s7 se %!O(e. Aceas(a &oa(e cores&+nde +n+! d!a$nos(!c de (+"'+rare
    de convers!e sa+ de (+"'+rare d!soc!a(!v7.
    ,os( s!c)ness. Es(e o &reoc+&are de %oar(e s! de ce! deceda=! Easoc!a(7 +neor!
    c+ %a$!a nea$r7J o'serva(7 .recven( &r!n(re %e%'r!! %+"(or (r!'+r! de !nd!en!
    a%er!can!. D!verse s!%&(o%e !nc"+/And v!se"e re"e, sen/a=!a de "!&s7 de .or=7,
    sen(!%en(+" de &er!co", &!erderea a&e(!(+"+!, "eO!n+"+!, a%e=ea"a, .r!ca, an<!e(a(ea,
    a"+c!na=!!"e, &!erderea c+noO(!n=e!, con.+/!a, sen(!%en(+" de !n+(!"!(a(e O! sen/a=!a
    de s+.ocare &o( .! a(r!'+!(e %a"ad!e! .an(o%e"or.
    H#a 'y+n$ Ec+nosc+(7 s! ca #oo"4#a4'y+n$J. Es(e +n s!ndro% &o&+"ar
    coreean, (rad+s "!(era" :n en$"e/7 ca San$er s!ndro%T, O! a(r!'+!( s+&r!%7r!! %an!e!.
    S!%&(o%e"e !nc"+d !nso%n!a, .a(!$a'!"!(a(ea, &an!ca, .r!ca sa+ sen/a=!a de %oar(e
    !%!nen(7, a.ec(+" d!s.or!c, !nd!$es(!a, anore<!a, d!s&neea, &a"&!(a=!!"e, d+rer!"e
    $enera"!/a(e O! sen/a=!a de e<!s(en=7 a +ne! .or%a=!+n! :n e&!$as(r+.
    -oro. Un (er%en de or!$!ne %a"ae/!an7 &ro'a'!", care se re.er7 "a +n e&!sod de
    an<!e(a(e s+'!(7 s! !n(ens7, c+% c7 &en!s+" Esa+, "a .e%e! v+"va s! %a%e"oane"eJ se
    va re(ra$e :n cor& O! vor ca+/a &ro'a'!" %oar(ea. S!ndro%+" es(e ra&or(a( :n s+d+"
    O! es(+" As!e!, +nde es(e c+nosc+( s+' o var!e(a(e de (er%en! "oca"!, c+% s+n( s-+8
    yan/, s-oo8 yon/ O! s+o yan/ EC!naJ, IinIinia bemar EAssa%J sa+ ro8#Ioo ETa!"andaJ.
    Oca/!ona" es(e :n(A"n!( O! :n 3es(. Uneor!, )oro s+rv!ne s+' .or%a de e&!de%!!
    "oca"!/a(e :n ar!! d!n es(+" As!e!. Aces( d!a$nos(!c es(e !nc"+s :n RClasi)icarea C-ine;6
    a T+lb+r6rilor .entaleS, ed!=!a a I"4a ECCTM49J.
    Sc%ia pentru 'ormularea ultural ,i Glosarul
    Sindromelor ircumscrise ultural 5+*
    La(a. Es(e o !&ersens!'!"!(a(e "a o s&a!%7 'r+sc7, adesea c+ eco&ra<!e, eco"a"!e,
    s+&+nere "a co%and7 s! co%&or(a%en( d!soc!a(!v sa+ ase%7n7(or (ranse!. Ter%en+"
    de lata- es(e de or!$!ne %a"ae/!an7 sa+ !ndone/!ana, dar s!ndro%+" a .os( :n(A"n!( O!
    :n %+"(e a"(e &7r=! a"e "+%!!. A"=! (er%en! &en(r+ aceas(7 cond!=!e s+n( am+ra8-,
    ir8+nii, i8ota, olan, myriac-it O! men8eiti E$r+&+r!"e s!'er!eneJ, ba- tsc-i, ba- tsi, baa- Ii
    ETa!"andaJ, im+ EA!n+, Saa"!n, *a&on!aJ O! mali#mali s! stto8 EF!"!&!neJ. :n Ma"ae/!a
    es(e %a! .recven( "a .e%e!"e de e(a(e %ed!e.
    Loc+ra. Es(e +n (er%en +(!"!/a( de "a(!nos :n S(a(e"e Un!(e O! A%er!ca La(!n7
    &en(r+ a den+%! o .or%7 sever7 de &s!o/7 cron!c7. Cond!=!a es(e a(r!'+!(7 +ne!
    v+"nera'!"!(7=! :n7sc+(e, e.ec(e"or d!.!c+"(7=!"or %+"(!&"e a"e v!e=!! sa+ +ne!
    co%'!na=!! a a%'!"or .ac(or!. S!%&(o%e"e &re/en(a(e de &ersoane"e c+ "oc+ra !nc"+d
    !ncoeren=a, a$!(a=!a, a"+c!na=!!"e a+d!(!ve O! v!/+a"e, !nca&ac!(a(ea de a +r%a
    re$+"!"e de !n(erac=!+ne soc!a"7, !%&rev!/!'!"!(a(ea O!, even(+a", v!o"en=a.
    Ma" de o@o. Es(e +n conce&( "ar$ :n(A"n!( :n c+"(+r!"e %ed!(eran!ene, &rec+!r s! :n
    a"(e &7r=! a"e "+%!!. .al de oIo es(e (rad+s :n en$"e/7 ca Sev!" eyeT Edeoc!+J. Co&!!!
    s+n( ce! %a! e<&+O!. S!%&(o%e"e !nc"+d so%n a$!(a(, =!&e(e .7r7 %o(!v, d!aree,
    v7rs7(+r! O! .e'r7, "a co&!! sa+ s+$ar!. Uneor! s! ad+"=! E:n s&ec!a" .e%e!"eJ &re/!n(7
    aceas(7 cond!=!e.
    Nerv!os. Es(e o e<&res!e de de(res7 .recven(7 &r!n(re "a(!nos d!n S(a(e"e Un!(e O!
    A%er!ca La(!n7. Un n+%7r de a"(e $r+&+r! e(n!ce a+ re"a(a(, deO! adesea oarec+%
    d!s(!nc(e, !de! de Snerv!T Ec+% ar .! nevra &r!n(re $rec!! d!n A%er!ca de NordJ.
    Nerv!os se re.er7, a(A( "a o s(are $enera"7 de v+"nera'!"!(a(e "a e<&er!en=e"e s(resan(e
    a"e v!e=!!, cA( O! "a +n s!ndro% &rovoca( de c!rc+%s(an=e de v!a=7 d!.!c!"e. Ter%en+"
    de ner*ios !nc"+de o $a%7 "ar$7 de s!%&(o%e de de(res7 e%o=!ona"7, de &er(+r'are
    so%a(!c7 O! de !nca&ac!(a(e de a .+nc=!ona. S!%&(o%e"e co%+ne !nc"+d ce.a"eea s!
    Sd+rer!"e cere'ra"eT, !r!(a'!"!(a(ea, &er(+r'7r!"e $as(r!ce, d!.!c+"(7=!"e de so%n,
    nervo/!(a(ea, &"Ans+" .ac!", !nca&ac!(a(ea de concen(rare, (re%or+", (!n!(+s+" s!
    mareos Ea%e=e"! c+ e<acer'7r! oca/!ona"e, ase%7n7(oare ver(!@+"+!J. Nerv!os (!nd a .!
    o &ro'"e%7 :n con(!n+7 creO(ere, deO! c+ var!a=!! :n $rad+" de !nca&ac!(a(e
    %an!.es(a(7. Nerv!os es(e +n s!ndro% .oar(e "ar$, care se :n(!nde de "a ca/+r! .7r7
    n!c! o (+"'+rare %en(a"7 &An7 "a &re/en(7r! ase%7n7(oare (+"'+r7r!"or de ada&(are,
    an<!oase, de&res!ve, d!soc!a(!ve, so%a(o.or%e sa+ &s!o(!ce. D!a$nos(!c+"
    d!.eren=!a" va de&!nde de cons(e"a=!a de s!%&(o%e e<&er!en(a(e, de (!&+"
    even!%en(e"or soc!a"e care s+n( asoc!a(e c+ de'+(+" s! &ro$res!+nea Snerv!osT, O! de
    n!ve"+" de !nca&ac!(a(e e<&er!en(a(.
    P!'"o)(o0. Un e&!sod d!soc!a(!v 'r+sc aco%&an!a( de e<c!(a=!e e<(re%7 c+ o
    d+ra(7 de &An7 "a ;L de %!n+(e O! +r%a(7 .recven( de cr!/e conv+"s!ve s! co%7
    d+rAnd &An7 "a 59 ore. Aces(a a .os( o'serva( !n!=!a" :n co%+n!(7=!"e arc(!ce O!
    s+'arc(!ce de esc!%oO!, deO! e<!s(7 var!a=!! re$!ona"e :n den+%!re. Ind!v!d+"
    &oa(e .! re(ras sa+ +Oor !r!(a'!" o &er!oad7 de cA(eva ore sa+ /!"e :na!n(ea a(ac+"+!
    O! va re"a(a o a%ne/!e co%&"e(7 &en(r+ a(ac. :n (!%&+" a(ac+"+!, !nd!v!d+" :O! &oa(e
    s%+"$e :%'r7c7%!n(ea, &oa(e d!s(r+$e %o'!"a, s&+ne o'scen!(7=!, %Anca .eca"e,
    .+$! d!n re.+$!!"e &ro(e@a(e sa+ e.ec(+a a"(e ac(e !ra=!ona"e sa+ &er!c+"oase.
    FL9 Anexa
    Reac=!a &s!o(!c7 0!4$on$. Es(e +n (er%en care descr!e +n e&!sod ac+(, "!%!(a( :n
    (!%&, carac(er!/a( &r!n s!%&(o%e d!soc!a(!ve, &arano!de sa+ a"(e s!%&(o%e &s!o(!ce,
    sa+ non&s!o(!ce, care &o( s+rven! d+&7 &rac(!carea 0!4$on$4+"+! Ee<erc!=!+ de
    ener$!e v!(a"7J, care :n (rad!=!a &o&+"ar7 c!ne/7 .or(!.!c7 s7n7(a(ea. S+n( v+"nera'!"!
    :n s&ec!a" !nd!v!/!! e<ces!v de !%&"!ca=! :n aceas(7 &rac(!c7. Aces( d!a$nos(!c es(e
    !nc"+s :n Clasi)icarea C-ine;6 a T+lb+r6rilor .entale, ed!=!a a I"4a ECCTM49J.
    Roo(#or). Es(e +n se( de !n(er&re(7r! c+"(+ra"e care a(r!'+!e %a"ad!a .ar%ece"or,
    !ncan(a=!!"or, %a$!e! ne$re sa+ !n."+en=e! %a"e.!ce a a"(e! &ersoane. S!%&(o%e"e &o(
    !nc"+de an<!e(a(e $enera"!/a(7 s! ac+/e $asrro!n(es(!na"e Ede e<., $rea=7, vo%7,
    d!areeJ as(en!e, a%e=ea"7, (ea%a de a n+ .! o(r7v!( s!, +neor!, .r!ca de a n+ .! +c!s
    ES%oar(e #oodooTJ. SFar%ece"eT, S!ncan(a=!!"eT, S%a$!a nea$r7T &o( .! S&+seT sa+
    &"asa(e &e a"(e &ersoane, ca+/And o var!e(a(e de &ro'"e%e e%o=!ona"e s!
    &s!o"o$!ce. Persoana S.er%eca(7T se &oa(e c!ar (e%e de %oar(e, &An7 ce .ar%ece"e
    n+ s+n( S:nde&7r(a(eT, de re$+"7 &r!n ac=!+nea +n+! Sdoc(or :n .ar%eceT E+n
    v!ndec7(or :n aceas(7 (rad!=!eJ, care, de ase%enea, &oa(e .! ce%a( s7 .ar%ece +n
    !na%!c. SFar%ece"eT se :n(A"nesc :n s+d+" S(a(e"or Un!(e, a(A( &r!n(re &o&+"a=!a
    a.roa%er!can7, cA( s! e+roa%er!can7, &rec+% s! :n soc!e(7=!"e cara!'!ene. :n
    soc!e(7=!"e "a(!no, .ar%ece"e s+n( c+nosc+(e O! ca mal p+esto sa+ br+Ieria7
    San0+e dor%!do ESsAn$e ador%!(TJ. Aces( s!ndro% se :n(A"neO(e &r!n(re
    !ns+"ar!! d!n Ca'o 3erde &or(+$e/ EO! &r!n(re !%!$ran=!! de a!c!, :n S(a(e"e Un!(eJ s!
    !nc"+de d+rere, &ares(e/!!, (re%or, &ara"!/!e, conv+"s!!, !c(+s, cec!(a(e, a(ac de cord,
    !n.ec=!e s! avor(.
    Sen@!n$ s+!r+o ESne+ras(en!aTJ. Es(e o cond!=!e carac(er!/a(7 :n C!na &r!n
    .a(!$a'!"!(a(e .!/!c7 s! %en(a"7, a%e=ea"7, ce.a"ee, a"(e d+rer!, d!.!c+"(7=! :n
    concen(rare, &er(+r'area so%n+"+! s! &!erderea %e%or!e!. A"(e s!%&(o%e !nc"+d
    &ro'"e%e $as(ro!n(ens(!na"e, d!s.+nc=!e se<+a"7, !r!(a'!"!(a(e, e<c!(a'!"!(a(e O! d!verse
    se%ne s+$erAnd &er(+r'area s!s(e%+"+! nervos ve$e(a(!v, :n %+"(e ca/+r!,
    s!%&(o%e"e ar sa(!s.ace cr!(er!!"e &en(r+ o (+"'+rare a.ec(!v7 sa+ an<!oas7 d!n DSM4
    I3. Aces( d!a"o$nos(!c es(e !nd+s :n Clasi)icarea C-ine;6 a T+lb+r6rilor .entale, ed!=!a
    a I"4a ECCTM49J.
    Sen4)2+e! ETa!#anJ8 sen)+! EC!naJ. Es(e o den+%!re &o&+"ar7 c!ne/7
    descr!!nd o an<!e(a(e %arca(7 sa+ s!%&(o%e de &an!c7 c+ ac+/e so%a(!ce de
    aco%&an!a%en( &en(r+ care n+ &oa(e .! de%ons(ra(7 n!c! o ca+/7 so%a(!c7.
    S!%&(o%e"e !nc"+d a%e=ea"7, d+rere :n re$!+nea "o%'ar7, .a(!$a'!"!(a(e, de'!"!(a(e
    $enera"7, !nso%n!e, v!se .recven(e O! ac+/e de d!s.+nc=!e se<+a"7 Ec+% ar .!
    e@ac+"area &recoce s! !%&o(en=aJ. S!%&(o%e"e s+n( a(r!'+!(e &!erder!! e<ces!ve de
    s&er%7 &r!n con(ac(e se<+a"e .recven(e, %as(+r'are, &o"+=!! noc(+rne sa+ e%!s!a de
    S+r!n7 a"'7, (+"'+reT, cons!dera(7 a con=!ne s&er%7 . P!erderea e<ces!v7 de s&er%7
    es(e (e%+(7, d!n ca+/a cred!n=e! c7 aceas(a re&re/!n(7 &!erderea esen=e! v!(a"e
    &ro&r!!, s! &oa(e .! as(.e" a%en!n=7(oare &en(r+ v!a=7.
    S!n4'y+n$. Es(e o den+%!re &o&+"ar7 coreean7 &en(r+ +n s!ndro% :n care
    .a/e"e !n!=!a"e s+n( carac(er!/a(e &r!n an<!e(a(e s! ac+/e so%a(!ce Ede'!"!(a(e
    $enera"7, a%e=ea"7, .r!c7, anore<!e, !nso%n!e, &ro'"e%e $asrro!n(es(!na"eJ, c+
    d!soc!ere s! &oses!+ne consec+(!v7 de c7(re s&!r!(e"e s(r7%oO!"or.
    Sc%ia pentru 'ormularea ultural si Glosarul
    Smdromelor ircumscrise ultural 4E+
    S&e"!. Es(e o s(are de (rans7 :n care !nd!v!/!! Sco%+n!c7T c+ r+de"e deceda(e sa+
    c+ s&!r!(e"e Uneor! aceas(7 s(are es(e asoc!a(7 c+ sc+r(e &er!oade de %od!.!care de
    &ersona"!(a(e Aces( s!ndro% s&ec!.!c c+"(+ra" es(e :n(A"n!( &r!n(re a.roa%encann s!
    e+ro&en!! d!n s+d+" S(a(e"or Un!(e S&!r!(!s%+" n+ es(e cons!dera( a .! +n .a&(
    %ed!ca" :n (rad!=!a &o&+"ar7, dar &oa(e .! !n(er&re(a( erona( ca e&!sod &s!o(!c :n
    cond!=!! c"!n!ce
    Susto ESs&a!%7 T sa+ S&!erderea s+."e(+"+!TJ Es(e o %a"ad!e &o&+"ar7 care
    &reva"ea/7 &r!n(re +n+ "a(!nos d!n S(a(e"e Un!(e s! &r!n(re &o&+"a=!!"e d!n Me<!c,
    A%er!ca Cen(ra"7 s! A%er!ca de S+d S+s(o %a! es(e den+%!(7 s! espanto, pasmo,
    tnpa ida, perdida del alma sa+ dnbi- S+s(o es(e o %a"ad!e a(r!'+!(7 +n+! even!%en(
    (er!.!an(, care ca+/ea/7 a'andonarea cor&+"+! de c7(re s+."e(, ceea ce d+ce "a
    ne.er!c!re s! %a"ad!e Ind!v!/!! c+ s+s(o e<&enen(ea/7, de ase%enea, (ens!+n!
    !%&or(an(e :n ro"+r!"e soc!a"e ce!e S!%&(o%e"e &o( a&are oncAnd, d+&7 /!"e sa+
    an! de "a e<&enen(area s&a!%e! Se crede c7 :n ca/+n e<(re%e, s+s(o &oa(e d+ce "a
    %oar(e S!%&(o%e"e (!&!ce !nc"+d &er(+r'area a&e(!(+"+!, so%n !ns+.!c!en( sa+
    e<ces!v, so%n &er(+r'a( sa+ v!se, sen(!%en(e de (r!s(e=e, "!&s7 de %o(!va=!e &en(r+ a
    .ace ceva s! sen(!%en(e de s+'es(!%are sa+ de !%+nd!(a(e S!%&(o%e"e so%a(!ce
    care aco%&an!a/7 s+s(o !nc"+d d+rer! %+sc+"are, ce.a"ee, d+rerea $as(r!c7 s!
    d!areea Tra(a%en(e"e r!(+a"e s+n( cen(ra(e &e ce%area s+."e(+"+! :na&o!, :n cor&, s!
    c+r7=!rea &ersoane!, &en(r+ a res(a+ra ec!"!'r+" cor&ora" O! s&!r!(+a" D!.er!(e"e
    e<&er!en=e de s+s(o &o( .! &+se :n "e$7(+r7 c+ (+"'+rarea de&res!v7 %a@or7, s(res+"
    &os((ra+%a(!c s! (+"'+r7r!"e so%a(o.or%e Conv!n$er! e(!o"o$!ce s! con.!$+ra=!! de
    s!%&(o%e s!%!"are se :n(A"nesc :n %+"(e a"(e &7r=! a"e "+%!!
    Ta!@!n )yo.+so. Es(e o .o'!e d!s(!nc(!v7 c+"(+ra" d% *a&on!a, :n(r4o an+%!(7
    %7s+r7 ase%7n7(oare c+ .o'!a soc!a"7 d!n DSM4I3 Aces( s!ndro% se re.er7 "a .r!ca
    !n(ens7 a +n+! !nd!v!d, &rec+% c7 cor&+" s7+ :n (o(a"!(a(e sa+ &7r=! or! .+nc=!! a"e
    cor&+"+! s7+, n+ &"ac, deran@ea/7 sa+ c7 e" es(e v7(7%7(or &en(r+ ce!"a"=! oa%en!
    &r!n as&ec(+", %!ros+", e<&res!!"e .ac!a"e sa+ %!Oc7r!"e sa"e Aces( s!ndro% es(e
    !nc"+s % s!s(e%+" de d!a$nos(!c o.!c!a" @a&one/ &en(r+ (+"'+r7r!"e %en(a"e
    Kar. Es(e +n (er%en $enera", a&"!ca( :n E(!o&!a, So%a"!a, E$!&(, S+dan, Iran s! a"(e
    soc!e(7=! d% A.r!ca de Nord s! Or!en(+" M!@"oc!+, e<&er!en=e"or de &osedare de c7(re
    s&!r!(e a +n+! !nd!v!d Persoane"e &oseda(e de +n s&!r!( &o( e<&er!en=a e&!soade
    d!soc!a(!ve care &o( !nc"+de s(r!$7(+" rAs+" '7(+(+" c+ ca&+" de &ere=!, can(a(+" sa+
    &"Ans+" Ind!v!/ ! &o( &re/en(a a&a(!e, !/o"are, re.+/+" de a %Anca sa+ de a4s!
    :nde&"!n! sarc!n!"e co(!d!ene ?a+ &o( de/_o"(a o re"a=!e &e (errren "+n$ c+ s&!r!(+"
    &oseda( Loca" aces( co%&or(a%en( n+ es(e cons!dera( ca &a(o"o$!c

    Ane,a I
    olaboratorii DSM-IV
    eoarece DSM4I3 es(e des(!na( a .! +(!"!/a( de d!verse $r+&+r! de
    &ro.es!on!O(! :n do%en!+" s7n7(7=!! %en(a"e s! :n d!verse "oc+r!, ,r+&+" O&era(!v
    &en(r+ DSM4I3 s! ,r+&+r!"e de L+cr+ a+ so"!c!(a( s! :nc+ra@a( &ar(!c!&area +ne!
    ca(e$or!! "ar$! de &ro.es!on!O(! &en(r+ a serv! dre&( cons!"!er! a! ,r+&+"+! O&era(!v
    s! ,r+&+r!"or de L+cr+. Cons!"!er!! !nc"+d &ersoane d!n a"(e asoc!a=!! de s7n7(a(e,
    c"!n!c!en!, cerce(7(or!, s&ec!a"!O(! :n %ed!c!na "e$a"7, e<&er=! :n &ro'"e%e :n "e$7(+r7
    c+ se<+", e(a(ea O! %ed!+" c+"(+ra", &rec+% s! e<&er=! d!n a"(e =7r!. ,r+&+r!"e de
    cons!"!er! a+ !den(!.!ca( &ro'"e%e &er(!nen(e re.er!(oare "a .!ecare d!a$nos(!c, a+
    e"a'ora( O! co%en(a( rev!/+!r!"e cr!(!ce a"e "!(era(+r!!, (e<(+" O! cr!(er!!"e, s! a+
    &ar(!c!&a( "a &ro!ec(e"e de (es(are :n (eren O! de reana"!/are a da(e"or. Me%'r!!
    ,r+&+"+! O&era(!v &en(r+ DSM4I3 O! ce! a! ,r+&+r!"or de L+cr+ acord7 (oa(7
    cons!dera=!a "or O! %+"=+%esc d!n !n!%7 &ersoane"or O! or$an!/a=!!"or care a+
    con(r!'+!( a(A( de $eneros c+ (!%&+" O! c+noO(!n=e"e "or.
    Con&ilierii Grupurilor $e Lu#ru
    Cons!"!er!! &en(r+ T+"'+r7r!"e
    An<!oase
    1. S(+ar( A$ras,M.D. Ha$o&
    A)!s)a",M.D. La+ren Bers A""oy,
    M.D. *a%es B7r'!e, M.D. Aaron T.
    Bec), M.D. *ean Bec)a%, P.D.
    De'ora C. Be!de", P.D. Is(van
    B!((er, M.D. Ar(+r S. B"an), *r.,
    M.D. To%as D. Bor)ovec , P.D.
    Lore((a E. Bra<=on, P.D. Nao%!
    Bres"a+, P.D. E"!/a'e( Bre((, M.D.
    Eve"yn Bro%e(, P.D. T!%o(y A.
    Bro#n, Psy.D A""an B+rs(e!n, M.D.
    Dav!d M. C"ar), P.D. De'ora S.
    Co#"ey, M.D. M!ce""e ,.Cras)e,
    M.D.
    Ray%ond R Cro#e, M.D. ,eor$e
    C. C+r(!s, M.D. Mae" Dan!e"!, P.D.
    *ose& A. De"(!(o, M.D. Pe(er A.
    D!Nardo, P.D -e!( S(e&en
    Do'son, P.D S&encer E(, M.D.
    *on Fa!r'an), P.D. Br!an Fa""on,
    M.D. Car"es F!$"ey, P.D.
    S(e&en M. Ford, M.D. E""en
    Fran), P.D. Ma(e# Fr!ed%an,
    M.D. -!sore ,adde, M.D.
    Rona"d ,ane""en, P.D. M!cae"
    ,e"der, M.D. Ear" ,!""er, M.D.
    1ayne ,ood%an, M.D. Tana
    ,rady, M.D. Bonn!e ,reen, P.D.
    Pe(er ,+arnacc!a, P.D.
    FLY
    4E> Ane,a I

    R!card He!%'er$, M.D.
    *on E. He"/er, M.D.
    *+d!( Her%an, M.D.
    R+do". Hoen4Sar!c, M.D.
    S(even -en Ho$e, M.D.
    Er!c Ho""ander, M.D.
    Mard! Horo#!(/, M.D.
    To% Inse!, M.D.
    M!cae" *en!)e, M.D.
    1ayne -a(on, M.D.
    He!n/ -a(scn!$, M.D.
    Terrance -eane, P.D.
    Dean -!"&a(r!c), P.D.
    La+rence -!r%ayer, M.D.
    Dona"d F. -"e!n, M.D.
    S(+ar( -"e!n%an, M.D.
    ,era"d L. -"er%an, M.D. Edeceda(J
    La#rence -o"', M.D.
    M!cae" *. -o/a), P.D.
    Cyn(!a Las(, P.D.
    Bernard Lerer, M.D.
    Andre# Lev!n, M.D.
    R. Br+ce Lyd!ard, M.D., P.D.
    Sa"va(ore Mann+//a, P.D.
    *on S. Marc, M.D.
    Andre# Ma(e#s, P.D.
    Ma(!$ Mav!ssa)a"!an, M.D.
    A"e<ander McFar"ane, M.B., B.S.
    EHonsJ, M.D. R!card
    McNa""y, M.D. Car"es A. Meyer,
    *r, M.D. -ar"a Moras, P.D.
    Denn!s M+n@ac), M.D. Lars
    ,oran Os(, P.D. Ho#ard Parad,
    D.S.1. -o) Lee Fen$, M.D.
    Ro$er P!(%an, M.D. Ro'er(
    Pynoos, M.D. Rona"d M Ra&ee,
    P.D N Bever"ey Ra&ae", M.D.
    S(even Ras%+ssen, M D. @arr.es
    Re!c, M.D.. M.P-. Pa(r!a
    -cs%c), P D. @e..!ey C
    R!cards, P.D. -ar" R!d c!.4,
    M.D. @ . 4 ! . n! ! . -.s)!nd, PD
    S!rMar2 .2 r(Ro(. MP
    Barbara !ot-baum2 6-.9.
    6eter !o0BB0rne2 <.9.
    P!"!& Sa!$, P.D.
    6aul Sal1ovs1is2 6-.9.
    1!""!a% C. Sanderson, P.D.
    Fran)"!n Scne!er, M.D.
    *ava!d Se!), M.D.
    Kaava So"o%on, M.D.
    S+san So"o%on, P.D.
    Larry H. S(ras'+r$er, M.D., P. D.
    Suzanne Sut-erland2 <.9.
    R!card S#!nson, M.D.
    Lenore Terr, M.D.
    Pe(er Tro#er, P.D.
    Sa%+e" M. T+rner, P.D.
    To%as Ude, M.D.
    9avid Tatson2 6-.9.
    Hans U"r!c 1!((cen, P.D.
    Pa((! Ke("!n, M.S.1.
    R!card K!n'ar$, P. D.
    *ose& Koar, M.D.
    (onsilierii pentru 9elirium2
    9emen32 Tulburrile Amnestice si
    Alte Tulburri (o.nitive
    Fran) Benson, M.D.
    *on Bre!(ner, M.D.
    S(eve B+c)!n$a%, D.S.1.
    Ne"son B+((ers, P.D.
    S(even Coen4Co"e, M.D.
    *e..rey Lee C+%%!n$s, M.D.
    Horac!o Fa're$a, *r, M.D.
    Barry Fo$e", M.D.
    Ro'er( P. ,ranacer, M.D., P.D.
    Ro'er( C. ,reen, M.
    Ro'er( Hea(on, M.D.
    S(even -en Ho$e, M.D.
    -. Ran$a Ra%a -r!snan, M.D.
    -e4M!n$ L!n, M.D.
    K'!$n!e# L!&o#s)!, M.D.
    A!#yn L!s%an, M.D.
    R!card Maye+<, M.D.
    Marse" Mes+"a%, M.D.
    3ernon N2e&&e, M D.
    Barry -c!4'er$, M.D.
    SQr Mar(!n Ro(, M.D.
    Hc!v!d R+'!no# M D.
    olaboratorii DSM-
    IV
    4E8


    Randy Sc!..er, M.D.
    M!cae" Tay"or, M.D. L!nda
    Ter!, P.D. A""an Mo/a#!(/,
    M.D. S(+ar( C. M+do.s)y,
    M.D. M!cae" Ka+d!$,
    M.D.
    Cons!"!er!! &en(r+ T+"'+r7r!"e
    d!a$nos(!ca(e &en(r+ &r!%a da(7
    :n Per!oada de S+$ar, :n Co&!"7r!e
    sa+ :n Ado"escen=7
    Marc A%aya, M.D.
    L!sa A%aya4*ac)son, M.D.
    Adr!an An$o"d, M.B., B.S.,
    M.R.C.Psyc.
    1!""!a% Arroyo, M.D.
    Ro'er( F. Asarno#, P.D,
    ,eor$e Ba!"ey, M.D.
    *ose& B!eder%an, M.D.
    Ray B"ancard, P.D.
    Le#!s M. B"oo%!n$da"e, M.D.
    *on Brad.ord, M.D.
    *oe" Bre$%an, M.D.
    ,"or!ssa Can!no, P.D.
    Ian A"'er(o Can!no, M.D.
    Ir!s Ca$#edera, P.D.
    Dan(e C!cce((!, P.D.
    S+san Coa(es, P.D.
    Pa(r!c!a Coen, P.D.
    C. -e!( Conners, P.D.
    *ane Cos(e""o, M.D.
    Car"es Daven&or(, M.D.
    Ro'er( De"on$, M.D.
    Mar(a Denc)"a, M.D.
    Par) E""!o(( D!e(/, M.D., P.D.
    Cra!$ Donne""y, M.D.
    Fe"(on Ear"s, M.D.
    L. Er"en%eyer4-!%"!n$, P.D.
    *ac) F"e(cer, P.D.
    S(even Forness, Ed.D.
    R!card ,reen, M.D., *.D.
    La+rence ,reen!"", M.D.
    S(an"ey ,reens&an, M.D.
    R!card L. ,ross, M.D.
    Ro'er( Har%on, M.D.
    L!"y Hec(%an, M.D.
    Marare( Her(/!$, M.D.
    *a%es *. H+d/!a), M.D.
    Pe(er *ensen, M.D.
    ,"or!a *onson4Po#e"", M.D.
    Ro'er( -!n$, M.D.
    M!ndy -ro(!c), M.A.
    Cyn(!a Las(, P.D.
    *a%es Lec)%an, M.D.
    *a%es Lee, M.D.
    S(e&en Lev!ne, M.D.
    *on Loc%an, M.D.
    Ca(er!ne Lord, P.D.
    *on S. Marc, M.D.
    *a%es Mc-!nney, P.D.
    *on Meyer, M.D.
    He!no F.L. Meyer4Ba"'+r$, Dr., rer.,
    na(.
    *+an Enr!0+e Me//!c, M.D., P.D.
    -"a+s M!nde, M.D. Dav!d Mra/e),
    M.D. *oy Oso.s)y, P.D. Ira Pa+"y,
    M.D. ,ary Pe(erson, M.D. Sa""y
    Provence, M.D. *oa0+!% P+!$4An(!c,
    M.D. Edeceda(J -a("een May D+!nn,
    M.D. S(even Ras%+ssen, M.D. Ro'er(
    *. Re!c"er, M.D. Mar) A. R!dd"e, M.D.
    Ed#ard R!(vo, M.D. R!card Rosner,
    M.D. Byron Ro+r)e, P.D. D!ane H.
    Sce()y, M.D. Er!c Sco&"er, P.D.
    Ro+r)e Sco&"er, P.D. Ar(+r
    Sa&!ro, M.D. Teodore Sa&!ro, M.D.
    Benne( Say#!(/, M.D. Larry S!"ver,
    M.D. Ro'er( S(o""er, M.D. Edeceda(J
    A"an S(one, M.D. Pe(er S/a(%ar!, M.D.
    L+d#!$ S/y%ans)!, M.D. Pa+"a Ta""a",
    P.D. -enne( To#'!n, M.D. L+)e
    Tsa!, M.D. -enne( *ay 1e!ss, M.D.
    Myrna M. 1e!ss%an, P.D. E"!/a'e(
    1e""er, M.D. -aren 1e""s, P.D.
    4E= Anexa N

    A$nes 1!((a)er, MD. *ane( B.
    1. 1!""!a%s, D.S.1. Rona"d
    1!nce", M.D. A""an Mo/a#!(/,
    M.D. -enne( *. K+c)er, P.D.
    Barry K+c)er%an, M.D. Bernard
    K+$er, M.D.
    (onsilierii pentru Tulburrile de
    (omportament Alimentar
    1. S(e#ar( A$ras, M.D. Arno"d
    Anderson, M.D. . 1!""!a%
    Ber%an, P.D. Pe(er Be+%on(,
    M.D. Bar(on *. B"!nder, M.D.
    S+san *ane B"+%en(a", M.D.
    LCDR *a%es M. B"+n( Harry A.
    Brand(, M.D. T!%o(y D.
    Bre#er(on, M.D. -e""y Bro#ne"",
    P.D. ,a'ne""e A. Car"son, M.D. Eva
    Carr, M.A. Re$!na Cas&er, M.D. Les"!e
    C!(ro%e, M.D. Pe(er *. Coo&er, M.D.
    Ar(+r H. Cr!s&, M.D. M7r!a
    DaCos(a, M.D. Bonn!e Dans)y, P.D.
    M!cae" Dev"!n, M.D. Ada%
    Dre#no#s)!, P.D. E")e Ec)er(, M.D.
    Ro'er( Ede"%an, M.D. Cr!s(o&er
    Fa!r'+rn, M.D. Made"!ne Ferns(ro%,
    P.D. Man.red F!c(er, M.D. Mar(!ne
    F"a%en(, M.D. Henr! F"!)!er, A.C.S.1.
    3!c(or Fornar!, M.D. Cr!s Free%an,
    M.D. Dav!d M. ,arner, P.D. P!"!&
    1. ,o"d, M.D. Harry E. ,#!r(s%an,
    M.D. De'ora Has!n, P.D. C. Pe(er
    Her%an, P.D. Dav!d Her/o$, M.D.
    *+"es H!rsc, M.D. Hans 1. Hoe),
    M.D., P.D. S(even -en Ho$e,
    M.D.
    L.-. ,eor$e Hs+, M.D.
    *a%es I. H+dson, M.D.
    La+r!e H+%&r!es, M.D.
    P!"!&&e *ea%%e(, M.D.
    Dav!d C. *!%erson, M.D.
    Cra!$ *onson, P.D.
    Ross S. -a"+cy, M.D.
    *ac) L. -a(/, M.D.
    1a"(er -aye, M.D.
    *+s(!n -enardy, P.D.
    -enne( S. -end"er, M.D.
    S!d -ennedy, M.D.
    Dean -!"&a(r!c), P.D.
    Dean D. -ran, M.D.
    S!n$ Lee, M.R.C.Psyc.
    P!erre Le!cner, M.D.
    Haro"d Le!(en'er$, P.D.
    *!"" Leo"'onne, M.D.
    ,"or!a Leon, P.D.
    -a(ar!ne Loe', B.A.
    A"e<ander R. L+cas, M.D.
    Marsa Marc+s, P.D.
    3a"er!e Rae McC"a!n, B.A.
    *+an Enr!0+e Me//!c, M.D., P.D.
    *+"!an Morro#, P.D.
    C"aes Norr!n$, Dr.Med.Sc.
    Pa(r!c) O2Conner, P.D.
    Mar!on P. O"%s(ead, P.D.
    Caro" B. Pe(erson, P.D.
    -ar" P!r)e, M.D.
    *ane( Po"!vy, P.D.
    Harr!son Po&e, M.D.
    Car"es Por(ney, M.D.
    A"'er( M. Po#e"", M.D.
    Ray%ond Pr!nce, M.D.
    R!card Py"e, M.D.
    E""en Raynes, Psy.D.
    Rory R!cardson, M.A.
    Cery" R!(en'a+$, P.D., M.P.H.
    Pa+" Ro'!nson, M.D.
    *+d!( Rod!n, P.D.
    Bar'ara *. Ro""s, P.D.
    *a%es Rosen, P.D.
    ,era"d R+sse", M.D.
    Ronna Sa+nders, L.C.S.1.
    *ose& S!"ver%an, M.D.
    M!cae" S(ro'er, P.D.
    olaboratorii DSM-
    IV
    FLF

    A"'er( *. S(+n)ard, M.D. A""an
    S+$ar%an, M.D. ,eor$e
    S/%+)"er, M.D. S(en Teander,
    M.D. S+e""en To%sen, B.A.
    Dav!d To'!n, P.D. 1a"(er
    3andereyc)en, M.4D. Dav!d
    3ea"e, M.R.C.Psyc. -e""y Be%!s
    3!(o+se), P.D. To%as 1adden,
    P.D. Dav!d 1a""er, M.D. 1!nny
    1eeda4Manna), P.D. Her'er(
    1e!ner, M.D. M!(ce" 1e!ss, M.D.,
    P.D. Dav!d 1eadon, M.D. Rena
    1!n, M.D. S(eve 1onder"!c,
    P.D. S+san 1oo"ey, P.D.
    1ayne 1oo"ey, P.D. *+d!(
    1+r(%an, P.D. *oe" Ma$er, M.D.
    S+san Manovs)!, M.D. Pres(on
    K+c)er, M.D.
    Cons!"!er!! &en(r+ T+"'+r7r!"e
    A.ec(!ve
    Ha$o& A)!s)a", M.D. *ay
    A%s(erda%, M.D. *+"es An$s(,
    M.D. Pa+" S. A&&e"'a+%, M.D.
    M7r!e ls'er$, M.D. Dav!d Avery,
    M.D. Aaron T. Bec), M.D. *a%es
    C. Bec), M.D. Dan B"a/er, M.D.
    Car"es Bo#den, M.D. Ian
    Broc)!n$(on, M.D. S+san B.
    Ca%&'e"", P.D. Denn!s P.
    Can(#e"", M.D. Bernard *. Carro"",
    M.D., P.D. ,!ovann! Cassano,
    M.D. N Pa+" Codo.., M.D.
    1!""!a% Corye"", M.D. *on L.
    Co<, M.D. *ona(an Dav!dson,
    M.D. *on Dav!s, M.D. Cr!s(!ne
    Dean, M.D. Ro'er( De"on$, M.D.
    *. Ray%ond DePa+"o, M.D.
    *ean End!cor(, P.D.
    Cec!"e Erns(, M.D.
    Ma< F!n), M.D.
    Les"!e M. For%an, M.D.
    L!nda ,eor$e, P.D.
    Ro'er( ,erner, M.D.
    E""!o( ,erson, M.D.
    1!""!a% ,o"ds(e!n, M.D.
    Byron ,ood, P.D.
    Freder!c) -. ,ood#!n, M.D.
    To%as ,ordon ,+(e!", M.D.
    1!"%a M. Harr!son, M.D.
    *ona(on M. H!%%e"oc, M.D.
    Ro'er( M. A. H!rsc.e"d, M.D.
    S(even -en Ho$e, M.D.
    Car"es Ho"/er III, M.D.
    Ro'er( Ho#"and, M.D.
    E%!"y Hoyer, B.A.
    *a%es *e..erson,, M.D.
    Ira -a(/, M.D.
    ,a'or -e!(ner, M.D.
    Ro'er( -ende"", M.D.
    -enne( S. -end"er, M.D.
    Dan!e" -"e!n, P.D.
    ,era"d L. -"er%an, M.D. Edeceda(J
    *a%es -ocs!s, M.D.
    Haro"d -oen!$, M D.
    Ernes( -ovacs, M.D.
    He"ena -rae%er, P.D.
    -. Ran$a Ra%a -r!snan, M.D.
    Andre# -rys(a", M.D.
    Dav!d *. -+&.er, M.D.
    *ac0+e"!ne LaL!ve, M.D.
    Pe(er Le#!nson, P.D.
    1o".$an$ Ma!er, M.D.
    *on Mann, M.D.
    S&ero ManOon, P.D.
    *a%es P. McC+""o+$, P.D.
    Pa(r!c) Mc,ra(, M.D.
    *+"!en Mende"e#!c/, M.D.
    -a("een Mer!)an$as, P.D.
    Ro'er( M!ce"s, M.D.
    Ivan M!""er, P.D.
    Py""!s Nas, D.S.1.
    M!cae" O2Hara, P.D.
    Dav!d Osser, M.D.

    41E Ane,a I


    Cordon Par)er, M.D.
    Bar'ara Parry, M.D.
    E+$ene Pay)e", M.D.
    -o) Lee Pen$, M.D.
    Fredr!c) Pe((y, M.D., P.D.
    Ro'er( M. Pos(, M.D.
    Dan!e" P+rdy, A. B.
    Freder!c D+!n()!n, M.D.
    *+d!( ,. Ra')!n, P.D.
    Ted Re!c, M.D.
    R!card R!es, M.D.
    Dona"d Ro'!nson, M.D.
    Ho""y Ro$ers, M.D.
    *erro"d F. Rdsen'a+%, M.D.
    Nor%an Rosen(a", M.D.
    An(ony Ro(sc!"d, M.D.
    A"ee Roy, M.D.
    Corde"!a R+sse"", B.A.
    A"an Sca(/'er$, M.D. N
    *an Sco((, P.D.
    Trac!e Sea, P.D.
    Anne S!%%ons, P.D.
    S(+ar( So(s)y, M.D.
    Dav!d S(e..ens, M.D.
    *ona(an S(e#ar(, M.D.
    Larry H. S(ras'+r$er, M.D, P.D.
    Tr!sa S+&&es, M.D., P.D.
    M!cae" Tase, M.D.
    R!card 1e!ner, M.D.
    *an 1e!ssen'+r$er, M.A.
    Myrna M. 1e!ss%an, P.D.
    -enne( 1e""s, M.D.
    Pe(er C. #y'ro#, M.D.
    ,eor$e 1!no)+r, M.D.
    Anna 1!r/4*+s(!ce, P D.
    Hans U"r!c 1!((cen, P.D.
    Cons!"!er!! &en(r+ Pro'"e%e"e
    Cod!.!c7r!! M+"(!a<a!a"e
    *ona(an F. Bor+h, M.D -a(!een
    B+c)#a"(er, P D. Freder!c B+sc,
    M D. Er!c Do+$:as Ca .ne, M.D
    To%as Cr.r"!, 3.U. Arnc.d Coo&er,
    M D Pa+C Cr!N4Cr?(c&n, M H
    S+san F!ne M A. Pa+" I. r!n), M.D
    *ac) Froo%, M.D.
    A)!ra F+@!na#a, M.D.
    Dan!e" 1. ,!""e((e, M.D.
    Ro'er( ,"!c), M.D.
    Byron ,ood, P.D.
    R!card E. Cordon, M.D., P.D.
    Barry ,+r"and, M.D.
    Her(a A. ,+((%an, M.D.
    R!card Ha"!, M.D.
    Mard! Horo#!(/, M.D.
    Car"es H+$es, P.D.
    T. Byra% -aras+, M.D.
    *a%es -ar"s, D.S.1.
    F"orence -as"o#, P. D.
    O((o -ern'er$, M.D.
    ,era"d L. -"er%an, M.D. Edeceda(J
    To%as -+"%an, P.D.
    Po#e"" La#(on, P.D.
    *os+a D. L!&s!(/, P.D.
    Cr!s(!ne L"oyd, M.D.
    Les(er L+'ors)y, M.D.
    Ro$er Mac)!nnon, M.D.
    Caro"yn Ma/+re, P.D.
    Teodore M!"!on, P.D.
    ,"en Pearson, M.D.
    *. Cr!s(o&er Perry, M.D.
    ,eor$e H. Po""oc), M.D.
    *ose& M. Rey, P.D.
    La#rence Roc)"and, M.D.
    ,eo..rey Srader, M.D.
    Rona"d C. S!%ons, M.D., M.A.
    A"an S(o+de%!re, M.D.
    *a%es *. S(r7!n, M.D.
    *on S. S(ra+ss, M.D.
    Cr!s(o&er Tennan(, M.D.
    Mary D+rAnd To%as, R.N., P.D.
    3!r$!n!a T!"den, R.N., D.-.Sc.
    ,eor$e 3a!""an(, M.D.
    Ho""y S)odo" 1!"son, R7>7, P.D.
    Rona"d M. 1!n(ro', M.D.
    Ly%an C. 33ynr.e, M.D , P.D.
    Cons!"!er!! &en(r+ T+"'+r7r!"e de
    Persona"!(a(e
    ,era"d Ad"er, M.D, Sa"%an
    A)a(ar, M.D. Ha$o&
    A)!s)a", M.D. N2on%assa
    A)+(a. M.D.
    olaboratorii DSM-
    IV
    411

    Rena(o Dan!e" A"arcon, M.D., M.P.H.
    Ar(+r A"(er%an, P.D.
    An(on!o Andreo"!, M.D.
    Pa+" S. A&&e"'a+%, M.D.
    Ben$4A)e Ar%e"!+s, P.D.
    Lorna S%!( Ben@a%!n, P.D.
    Mar) Bere"o#!(/, M.D.
    *ac) Brandes, M.D.
    Re%! Cadore(, M.D.
    Pa+" Codo.., M.D.
    Lee Anna C"ar), P.D.
    *on C"ar)!n$, P.D.
    C. Ro'er( C"on!n$er, M.D.
    *ero%e Coen, D.S.1.
    -ary" Co"e, M.D.
    Arno"d Coo&er, M.D.
    Pa+" Cos(a, P.D.
    A"v A. Da", M.D.
    Car! E!sdor.er, M.D., P.D., M.S.1.
    Ed#ard F. Fo+")s, M.D., P.D.
    *on Frosc, M.D.
    1!""!a% ,o"ds(e!n, M.D.
    Sey%o+r L. Ha""ec), M.D.
    Ro'er( Hare, P.D.
    *+d!( Her%an, M.D.
    S(even -en Ho$e, M.D.
    Mard! Horo#!(/, M.D.
    S(e&en, 1. H+r(, P.D.
    S(even Hy"er, M.D.
    -aren *on, M.D.
    Pa(r!c!a *+dd, M.S.1. 2
    Car"es -ae"'er, M.D.
    Oren -a"+s, M.D.
    -enne( S. -end"er, M.D.
    O((o -ern'er$, M.D.
    Dona"d -!es"er, P.D.
    Dan!e" -"e!n, P.D.
    Dona"d F. -"e!n, M.D.
    Ar(+r -"e!n%an, M.D., P.D.
    Haro"d -oen!$s'er$, M.D.
    *ero%e -ro"", M.D.
    Marsa L!nean, P.D.
    Pa+" L!n)s, M.D.
    *on L!on, M.D.
    1. *on L!ves"ey, M.D.
    Ar%And Loran$er, P.D.
    S&encer Lyer"y, P.D.
    M!cae" Lyons, P.D.
    -. Roy Mac)en/!e, M.D.
    Ro$er Mac)!nnon, M.D.
    N!)o"as M7nos, M.D.
    *a%es Mas(erson, M.D.
    Ro'er( McCrae, P.D.
    To%as Mc,"asan, M.D.
    Ro'er( Dav!d M!""er, M.D., P.D.
    Les"!e Morey, P.D.
    O"e Mors, M.D.
    -a/+!sa Na)ao, M.D.
    H. ,eor$e N+rn'er$, M.D.
    *on O"da%, M.D.
    M+(a)a Ono, M.D.
    S(e&en L. O<"ey, P.D.
    *oe" Par!s, M.D.
    ,ordon Par)er, M.D.
    ,"en Pearson, M.D.
    -o) Lee Pen$, M.D.
    *. Cr!s(o&er Perry, M.D.
    E(e" Person, M.D.
    -a(ar!ne Anne P!""!&s, M.D.
    Pa+" P!")on!s, P.D.
    Harr!son Po&e, M.D.
    Car"es P+!!, M.D.
    *a%es Re!c, M.D., M.P.H.
    1!""!a% H. Re!d, M.D.
    Lee Ro'!ns, P.D.
    E"sa Ronn!n$s(a%, P.D.
    Loren Henry Ro(, M.D.
    Ro'er( R+e$$, M.D.
    Pedro R+!/, M.D.
    A. *on R+s, M.D.
    Marv!n Sc#ar(/, M.D.
    R!card Se"%an, M.D.
    -enne( S!"), M.D.
    Benne(( S!%on, M.D.
    R!card C. S!%ons, M.D.
    Er!) S!%onsen, M.D.
    Andre# E#dard S)odo" II, M.D.
    Pa+" Harr!s So"o.., M.D.
    S(e&en S(ern'ac, M.D.
    A"an S(one, M.D.
    M!cae" S(one, M.D.
    La#rence Tancred!, M.D.
    A"e< Tarno&o"s)y, M.D.
    A+)e Te""e$en, P.D.
    412 Anexa N

    Pe))a T!enar!, M.D. Svenn
    Tor$ensen, M.D. *ose&
    Tr!e'#asser, M.D. Ro'er(
    Tr!n$one, P.D. T!%o(y
    Tr+"", P.D. Pe(er Tyrer,
    M.D. L!ndsey T#eed,
    M.D. T. Bed!ran Us(+n,
    M.D. Per 3a$"+%, M.D. Sony a
    3a$"+%, M.D. ,eor$e 3a!""anr, M.D.
    Leonore B. 1a")er, Ed.D. Der%on(
    1a"s, M.B. *ac) 1!$$!ns, P.D.
    *erry 1!$$!ns, P.D. Mary C.
    Kanar!n!, Ed.D.
    Cons!"!er!! &en(r+ T+"'+rarea
    D!s.or!c7 Pre%ens(r+a"7
    E"!ssa P. Benede), M.D. Sara
    Ber$a, M.D. S+san *ane
    B"+%en(a", M.D. Lea *oan
    D!c)s(e!n, M.D. E""en 1.
    Free%an, P.D. Sery" ,a""an(,
    P.D. Les"!e ,!se, M.D. Ur!e"
    Ha"'re!c, M.D. *ean
    Ha%!"(on, M.D. M!ce""e
    Harr!son, M.D. Ro$er F.
    Has)e((, M.D. S(even -en
    Ho$e, M.D. S(e&en 1. H+r(,
    P.D. Renee *ons, B.A. 1.
    -eye, *r., M.D. Mar(a
    -!r)&a(r!c), M.D. Mar(a
    McC"!n(oc), P.D. Mar$are( L.
    Mo"!ne, P.D. Caro" C.
    Nade"son, M.D. Ho#ard
    Oso.s)y, M.D. Mary Bro#n
    Par"ee, P.D. *e.. Ra+sc, M.D.
    Ro'er( Re!d, M.D. R. Rodes,
    M.D. Ana R!vera4Tovar, P.D.
    ,a!" Ro'!nson, M.D. M!r!A%
    Rosen(a", M.D. Pe(er Roy4
    Byrne, M.D.
    Dav!d R+'!no#, M.D.
    Pa+"a Scn+rr, P.D.
    *on S(ee$e, M.D.
    Me!r S(e!ner, M.D., P.D.
    Donna S(e#ar(, M.D.
    Anna S(o+(, M.D.
    Leonore B. 1a")er, Ed.D.
    Dav!d Mo+n$s, M.D.
    (onsilierii pentru Tulburrile de
    interfa3 ale sistemelor psi-iatrice
    *Tulburrile de Adaptare2 9isociative2
    )actice2 de (ontrol al #mpulsului si
    Somatoforme2 si )actorii 6si-olo.ici
    care a.ec(ea/7 Cond!=!a Med!ca"7J
    Pa+" S. A&&e"'a+%, M.D.
    A""yson As"ey, D.S.1.
    Ar(+r *. Bars)y, M.D.
    Dav!d H. Bar"o#, P.D.
    *ona(on O. Bears, M.D.
    Dav!d Bear, M.D.
    ,a"e Beards"ey, M.D.
    S!dney Ben@a%!n, M.D., M.P!".
    -enne( Bo#ers, P.D.
    *on Brad.ord, M.D.
    Benner( Bra+n, M.D.
    E(/e" Cardena, P.D.
    *a%es C+, M.D.
    Ca(er!ne C"assen, P.D.
    P!""!& Coons, M.D.
    Do+$"as De(r!c), P.D.
    Ro'er( H. D#or)!n, P.D.
    Dav!d Fo")s, M.D.
    Fred Fran)e", M.D.
    Ed#ard Fr!sco"/, P.D.
    ,eor$e F+"+&, M.D.
    Ro""!n ,a""a$er, M.D.
    *e..rey ,e""er, M.D.
    Dan!e" 1. ,!""er(e, M.D.
    M!cae" ,. ,o"ds(e!n, M.D.
    3eera!nder ,o"!, M.B.
    Car"os A. ,on/a"e/, M.D.
    *+n!+s ,on/a"es, M.D.
    M!cae" I. ,ood, M.D.
    E/ra E. H. ,r!..!(, M.D.
    Sa%+e" B. ,+/e, M.D.
    Sey%o+r L. Ha""ec), M.D.
    olaboratorii DSM-
    IV
    41+


    A'raa% L. Ha"&ern, M.D., P.D.
    Ne"son Hend"er, M.S., M.D.
    Ernes( H!"$ard, P.D.
    S(even -en Ho$e, M.D. N
    *!%%!e C. Ho""and, M.D.
    Er!c Ho""ander, M.D.
    *a%es *. H+d/!a), M.D.
    *an!s H. *en)!ns, P.D.
    Ro$er -a(o", M.D.
    *. Dav!d -!n/!e, M.D.
    La+rence -!r%ayer, M.D.
    Ar(+r -"e!n%an, M.D., P.D.
    R!card -"+.(, M.D.
    Cery" -oo&%an, P.D.
    Dona"d S. -orn.e"d, M.D.
    -. Ran$a Ra%a -r!snan, M.D.
    *on -+r(/, M.D.
    Henry R. Les!e+r, P.D.
    *a%es Levenson, M.D.
    Ro'er(o Le#!s4Fernande/, M.D.
    *on L!on, M.D.
    K'!$n!e# *. L!&o#s)!, M.D.
    Don R. L!&s!((, M.D.
    R!card Lo#ens(e!n, M.D.
    *e..rey Ma((es, M.D.
    M. E!"een McNa%ara, M.D.
    Haro"d Mers)ey, M.D.
    M!cae" Moran, M.D.
    ,eor$e B. M+rray, M.D.
    *on Ne%!a, M.D.
    *e..rey Ne#corn, M.D.
    Ray%ond N!a+ra, P.D.
    Perry M. N!cass!o, P.D.
    Mar(!n Orne, M. D., P.D.
    -a"&ana Pa)!na(an, M.D.
    Ro'er( O. Pasna+, M.D.
    -o) Lee Pen, M.D.
    Sa%+e" 1. Perry III, M.D.
    ,ary Pe(erson, M.D.
    *on P"e#es, M.D.
    S(an"ey L. Por(no#, M.D., P.D.
    Fran) P+(na%, M.D.
    P!""!& *aco' Resn!c), M.D.
    R!card *. Rosen(a", M.D.
    Co"!n A. Ross, M.D.4
    *on K. Sad"er, M.D.
    S!r"ey Sanders, P.D.
    S(e&en M. Saravay, M.D.
    *ona(an F. s!"ver, M.D.
    Her'er( S&!e$e", M.D.
    Mar"ene S(e!'er$, M.D.
    Ro'er( S(e#ar(, D.S.1.
    Marv!n S#ar(/, M.D.
    Troy L. To%&son II, M.D.
    Mose Tore%, M.D.
    E"don T+n)s, M.D.
    1!""!a% L. 1e'', *r., M.D. Edeceda(J
    -enne( *ay 1e!ss, M.D.
    M!(ce" 1e!ss, M.D., P.D.
    Le#!s *o""y 1es(, M.D.
    Rona"d 1!nce", M.D.
    To%as Na(an 1!se, M.D.
    Denn!s 1o"., M.D.
    Derson Mo+n$, M.D.
    S(+ar( C. M+do.s)y, M.D.
    Sean M+(/y, M.D.
    (onsilierii pentru Sc-izofrenie /i
    alte Tulburri 6si-otice
    >av!er A%ador, P.D. S(e&an Arnd(,
    P.D. Pe(er Berner, M.D. Is(van B!((er,
    M.D. Dona"d 1. B"ac), M.D. Randy
    Bor+%, M.D. Ma"co% B. Bo#ers, *r.,
    M.D. H. B(e.an Braca, M.D. Ian
    Broc)!n$(on, M.D. 1!""!a% Car&en(er,
    M.D. R!card *. Cas(!""o, P.D. Dav!d
    Co&o"ov, M.D. La#rence A. D+nn,
    M.D. 1!""!a% Ede"", P.D. A)!ra
    F+@!na#a, M.D. Car"os A. ,on/a"es,
    M.D. *ac) ,or%an, M.D. I$or ,ran(,
    M.D. E/ra E. H. ,r!..!(, M.D.
    ,re(cen Haas, P.D. Mar(!n Harro#,
    P.D. S(even -en Ho$e, M.D. *an!s H.
    *en)!ns, P.D. D!"!& 3. *es(e, M.D.
    Marv!n -arno, M.D.
    5*7 Anexa N


    Ro'er( -ende"", M.D.
    An(ony F. Le%an, M.D., M.S.P.H.
    Ro'er(o Le#!s4Fernande/, M.D.
    Ro'er( L!'er%an, M.D.
    *e..rey L!e'er%an, M.D.
    M7r!o Ma@, M.D.
    *ose& P. McEvoy, M.D.
    Ma< Mc,ee, M.D.
    Pa(r!c) Mc,orry, M.B.B.S.
    Her'er( Me"(/er, M.D.
    A"an Me(/, M.D.
    *e..rey L. Me(/ner, M.D.
    Mar) R!card M+ne(/, M.D.
    A"!s(a!r M+nroe, M.D.
    -e!( Ne+c(er"e!n, P.D.
    M+@! O)a/a)!, M.D.
    A".onso Onr!veros, M.D., M.Sc.
    S(e!n O&@ords%oen, P.D.
    Ananda -. Pand+ran$!, M.D.
    ,od.rey Pear"son, M.D.
    De"'er( Ro'!nson, M.D.
    N!na Scoo"er, P.D.
    Larry S!ever, M.D.
    Sa%+e" S!r!s, M.D.
    *on S#eeney, P.D.
    Sa""y S/y%ans)!, D.O.
    Ma+r!c!o Toen, M.D.
    M!n$ Tso Ts+an$, M.D., P.D.
    M!cae" Ka+d!$, M.D.
    Cons!"!er!! &en(r+ T+"'+r7r!"e Se<+a"e
    *on Brad.ord, M.D.
    Ro'er( P. Ca'a@, M.D.
    Dona L. Dav!s, P.D.
    Par) E""!o(( D!e(/, M.D., P.D.
    Les"!e ,!se, M.D.
    A'raa% L. Ha"&ern, M.D., P.D.
    ,!"'er( Herd(, P.D.
    S(even -en Ho$e, M.D.
    He"en -a&"an, M.D.
    -o) Lee Pen$, M.D.
    Anna S(o+(, M.D.
    Cons!"!er!! &en(r+ T+"'+r7r!"e de
    So%n
    Ed#ard B!<"er, M.D. *ac)
    Ed!n$er, M.D. Car"es 1.
    Er#!n, M.D.
    E+$ene C. F"e(cer, M.D. A'raa%
    L. Ha"&ern, M.D., P.D. Pe(er H7+r!,
    P.D. An(ony -a"es, M.D. M!"(on
    -ra%er, M.D. Rocco Man.red!, M.D.
    ,a!" Mars, M.D. *e..rey L. Me(/ner,
    M.D. Harvey Mo"do.s)y, M.D.
    T!%o(y H. Mon), P.D. Ra"&
    Pasc+a"y, M.D., R.N. Ho#ard
    Ro..#ar$, M.D. To%as Ro(, P.D.
    A. *on R+s, M.D. Cons(an(!n R.
    So"da(os, M.D. Ed#ard S(e&ans)!,
    P.D. M!cae" Tor&y, M.D.
    (onsilierii pentru Tulburrile @n
    le.tur cu o Substan3
    Henry A'raa%, M.D.
    Cr!s(er AU$+"ander, M.D.
    Ar(+r A"(er%an, P.D.
    Ro"and A()!nson, M.D.
    To% Ba'or, P.D.
    ,eor$e Ba!"ey, M.D.
    *a%es B7r'!e, M.D.
    *e..rey Bedr!c), M.D.
    Pred -. Ber$er, M.D.
    *ac) D. B"a!ne, M.D.
    Se!"a B"+%e, M.D.
    R!card Bonn!e, *.D.
    -a("een B+co"/, P.D.
    *on Cacc!o"a, P.D.
    ,"or!ssa Can!no, P.D.
    1!""!a% D. C"ar), M.D.
    S(e&en D!n#!dd!e, M.D.
    ,r!..!( Ed#ards, M.D.
    Mar!an F!sc%an, P.D.
    R!card Frances, M.D.
    1!""!a% Frosc, M.D.
    Marc ,a"an(er, M.D.
    Fran) ,a#!n, M.D.
    Ed!( S. L!nans)y ,o%'er$, P.D.
    Enoc ,ord!s, M.D.
    Dav!d ,ore"!c), M.D.
    Br!d$e( ,ran(, P.D.
    Marc+s ,ran(, P.D.
    olaboratorii DSM-
    IV
    5*<


    Les(er ,r!ns&oon, M.D. A".red
    Har)"ey, M.D. *a%es Har(.ord,
    M.D. De'ora Has!n, P.D.
    S(even -en Ho$e, M.D. Ar(+r
    Hor(on, P.D. *on R. H+$es,
    M.D. M!cae" Ir#!n, M.D.
    *ero%e *a..e, M.D. Den!se
    -ende", P.D. Ed#ard
    -a+.%an, M.D. N Her'er(
    -e'er, M.D. To%as -os(en,
    M.D. Mary *ear%e -ree), M.D.
    *a%es Lan$en'+cer, P.D. Ed#ard
    D. Lev!n, P.D. Ben@a%!n L!&(/!n,
    M.D. *a%es Maddo<, M.D. Enr!0+e
    Madr!$a", M.D. Pe(er Mar(!n, M.D.
    Roy Ma(ey, M.D. 1ayne
    McFadden, M.D. To%as McLe""an,
    P.D. *ac) H. Mende"son, M.D.
    Ro$er Meyer, M.D. Nor%an M!""er,
    M.D. Ro'er( M!"nan, M.D.
    Mar!s(e"a Mon(e!ro, M.D. Ro'er( M. Morse, M.D.
    Dav!d F. Na.(o"o#!(/, M.D.
    Pa+" Na$y
    Car"es O2Br!en, M.D.
    ,"en Pearson, M.D.
    S(an(on Pee"e, P.D.
    He"en Pe((!na((!, P.D.
    Andr/e@ P!o(ro#s)!, M.D.
    R+%! Pr!ce, P.D.
    An(ony RadcU..e, M.D.
    Car"es R!ordan, M.D.
    *ed Rose, P.D..
    Br+ce Ro+nsav!""e, M.D.
    *on Sa+nders, M.D.
    S!dney H. Scno"", M.D.
    Car"es R. Sc+s(er, P.D.
    Bor!s Se$a", M.D.
    Roy S(e!n, M.D.
    Lee R. To#"e, P.D.
    *on Ts+an$, M.D.
    Haro"d Ursce"" HI, M.D.
    Der%o(( 1a"s, M.B.
    Ro'er( 1e!nre!', MD
    *ose& 1es(er%eyer, M.D. P.D,
    M.P.H.
    -enne( 1!n(ers, P.D. Se"don
    K!%'er$, M.D.
    Con&ilierii Grupului Operativ
    (onsilieri pentru 6robleme de
    (odificare
    Andrea A"'a+%4Fe!ns(e!n
    Mar$are( A%a(aya)+", M.B.A., R.R.A.
    A%y B"+%, M.P.H., R.R.A.
    De"ray ,reen, R.R.A.
    De'ora -. Hansen, A.R.T., C.C.S.
    Ro'er( A. Israe", M.P.H.
    L.Ann -!rner, C.C.S.
    Perr!anne L+r!e, M.D., M.P.H.
    S+e Meads, R.R.A.
    *a%es 1. To%&son, M.D. M.P.H.
    (onsilieri pentru 6robleme
    Transculrurale
    *+an Enr!0+e Me//!c, M.D., P.D.
    Ar(+r -"e!n%ann, M.D., P.D.
    Horac!o Fa're$a, *r., M.D.
    De"ores Parron, P.D. Byron
    ,ood, P.D. -e4M!n$ L!n, M.D.
    S&ero ManOon, P.D. ,"or!a
    *onson4Po#e"", M.D.
    3!c(or R. Ade'!%&e, M.D.
    Rena(o Dan!e" A"arcon, M.D.,M.P.H.
    1!""!a% Arroyo, M.D.
    Mor(on Be!ser, M.D.
    *a%es Bos(er, P.D.
    ,"or!ssa Can!no, M.D.
    Ian A"'er(o Can!no, M.D.
    R!card *. Cas(!""o, P.D.
    Freda Ce+n$, P.D.
    F5R Anexa N


    E""en Cor!n, P.D.
    Dona L. Dav!s, P.D.
    Ar%ando Fava//a, M.D.
    Candace F"e%!n$, P.D.
    Ed#ard F. Fo+")s, M.D., P.D.
    A(#ood ,a!nes, P.D.
    A"'er( ,a#, M.D.
    *a%es ,!''s, P.D.
    Car"os A. ,on/a"e/, M.D.
    E/ra E.H. ,r!..!(, M.D.
    Pe(er *. ,+arnacc!a, P.D.
    ,!"'er( Herd(, P.D.
    -!% Ho&&er, P.d.
    Dav!d H+..ord, P.D.
    Car"es H+$es, P.D.
    *an!s H. *en)!ns, P.D.
    Marv!n -arno, M.D. ]]]
    Mar!anne -as(r+&, M.D., P.D.
    *. Dav!d -!n/!e, M.D.
    La+rence -!r%ayer, M.D.
    Pa+" -oe$e", P.D.
    Ro'er( F. -ra+s, M.D.
    T!na -. Leonard4,reen, M.S., R.D.
    Ro'er(o Le#!s4Fernande/, M.D.
    T4M L!n, M.D.
    Ro"and L!(("e#ood, M.B., D.P!".
    Franc!s L+, M.D.
    Enr!0+e Madr!$a", M.D.
    Teresa O2Ne"", P.D.
    Ray%ond Pr!nce, M.D.
    *+an Ra%os, P.D.
    Cery" R!(en'a+$, P.D., M.P.H.
    L"oyd Ro$"er, P.D.
    1!""!a% H. Sac), M.D.
    Isan Sa""o+%, M.D., M.P.H.
    Nor%an Sar(or!+s, M.D., P.D.
    Ca(er!ne L. S!ss"a), P.D.
    Rona"d C. S!%ons, M.D., M.A.
    *eanne M. S&+r"oc), M.D.
    N!co"e((e Te+.e", P.D. 2
    *a%es 1. To%&son, M.D., M.P.H.
    1en4S!n$ Tsen$, M.D.
    M!(ce" 1e!ss, M.D., P. D.
    *ose& 1es(er%eyer, M.D., P.D.,
    M.P.H.
    Car"es 1!")!nson, M.D.
    Rona"d M. 1!n(ro', M.D.
    *ose& Ma%a%o(o, M.D.
    Cons!"!er!! &en(r+ Pro'"e%e"e de
    Fa%!"!eXRe"a=!ona"e
    *a%es A"e<ander, P.D. Ar(+r M.
    Bod!n, P.D. Ro'er( B+("er, M.D.
    Pa(r!c!a Ca%'er"a!n, P.D. Dan(e
    C!ce((!, P.D. *on C"ar)!n, P.D.
    Dan!e" Conv!n, M.D. Mar) R.
    ,!ns'er$, P.D. M!cae" *.
    ,o"ds(e!n, P.D. Her(a A. ,+((%an,
    M.D. M!cae" D. -an, P.D.
    Sandra -a&"an, M.D. F"orence
    -as"o#, P.D. *on F. -n+(son,
    P.D. *+dy Ma$!!, M.S.1. Dav!d
    M!")o#!(/, P.D. -. Dan!e" O2Leary,
    P.D. Dav!d O"son, P.D. Dav!d
    Pe"cov!(/, P.D. An$+s M. S(racan,
    P.D. Terry S. Tre&&er, P.D. Ly%an
    C. 1ynne, M.D., P.D. Ra%sy Massa,
    M.D.
    Cons!"!er!! &en(r+ Pro'"e%e"e
    Med!co4Le$a"e
    Pa+" S. A&&e"'a+%, M.D. *a%es C.
    Bec), M.D. Le#!s M. B"oo%!n$da"e,
    M.D. R!card Bonn!e, *.D. *e..rey
    Lee C+%%!n$s, M.D. *e..rey ,eUer,
    M.D. Ro'er( P. ,ranacer, M.D.,
    P.D. To%as Cordon ,+(e!", M.D.
    A'raa% L. Ha"&ern, M.D., P.D.
    S(even -en Ho$e, M.D. Sr+ar(
    -"e!n%an, M.D. *e..rey L. Me(/ner,
    M.D. Car"es A. Meyer, *r., M.D.
    Ro'er( Dav!d M!""er, M.D., P.D.
    Mar) R!card M+ne(/, M.D. S(an"ey
    L. Por(no#, M.D., P.D. P!""!&
    *aco' Resn!c), M.D. R!card Rosner,
    M.D.
    olaboratorii DSM-
    IV
    418


    Dan!e" 1. S+%an Larry H.
    S(ras'+r$er, M.D., P.D. -enne( *ay
    1e!ss, M.D. Ho#ard Konana, M.D.
    Cons!"!er!! &en(r+ T+"'+r7r!"e de
    M!Ocare !nd+se de Med!ca%en(e
    ,erard Addon!/!o, M.D. Lenard
    Ad"er, M.D. B+r( An$r!s(, M.D.
    Ross *. Ba"dessar!n!, M.D.
    S(an"ey N. Caro.., M.D. Dan!e"
    Casey, M.D. *e..rey Lee
    C+%%!n$s, M.D. ,eor$es
    ,ardos, M.D. A""en ,e"en'er$,
    M.D. *a%es *e..erson, M.D. D!"!&
    3. *es(e, M.D. *on M. -ane,
    M.D. Pa+" E. -ec), M.D. *a%es
    Levenson, M.D. S(e&an C.
    Mann, M.D. Ananda -.
    Pand+ran$!, M.D. Pa(r!c!a
    Rose'+c, M.D. 3!r$!n!a
    S+s%an, M.D. Pe(er 1e!den,
    M.D. Ra%sy Massa, M.D.
    Cons!"!er!! ,r+&+"+! O&era(!v
    &en(r+ DSM4I3
    Bor!s M. As(racan, M.D. Ro'er(
    AvAn(, M.D. *eane((e Ba!r, B.S.,
    M.B.A. 1. Ro'er( Beavers, M.D.
    *e..rey Bedr!c), M.D. Car! Be"", M.D.
    E""en Ber%an, M.D. E+$ene
    Broadead, M.D., P.D. La+ra Bro#n,
    P.D. Ro'er( P. Ca'a@, M.D. Ro'er(
    Caan, M.D. Ro'er( C!are""o, M.D.
    1!""!a% D. C"ar), M.D. S(even
    Coen4Co"e, M.D. Lee Co%'r!nc)4
    ,raa%, M.D. 3!c)y Conn, R.N.
    Harr!s Coo&er, P.D. M!cae"
    Cro+c, M.D.
    A"an Dan!e"s
    Fran) de,r+y, M.D.
    S+san D!%e4Meenan
    S(acy Donovan, B.A.
    R!card D+d"ey, M.D.
    S+/anne D#ora)4Pec)
    Br+ce E%ery, A.C.S.1.
    S&encer Fa"con, M.D.
    Lo+!s F!ne, M.D.
    S+san F!ne, M.A.
    R!(a F!nne$an, R.R.A.
    ,era"d H. F"a%%, M.D.
    La+r!e F"ynn, B.A.
    Ray%ond D. Fo#"er, P.D.
    R!card Frances, M.D.
    *ac) Froo%, M.D.
    Ro'er( 1. ,!'son, M.D.
    *+n!+s ,on/a"es, M.D.
    Ra&ae" S. ,ood, M.D.
    Ro'er( C. ,reen, M.D.
    Larry P. ,r!..!n, M.D.
    C"a!re ,r!..!n4France"", R.N.
    A".red Har)"ey, M.D.
    Nor%an B. Har(s(e!n, M.D.
    Ann Ho%ann, P.D.
    Teodore H+(c!nson, M.D.
    Da"e *onson, P.D.
    *on E. *oyner, M.D.
    Haro"d -a%!ne(/)y, M.D.
    Ira -a(/, M.D.
    *era"d -ay, M.D.
    -e""y -e""eer, M.D.
    He"ena -rae%er, P.D.
    *on *. LaFer"a, M.D.
    Mar!on Lan$er, P.D.
    Mar(a Lasse(er, R.R.A.
    P!"!& Lavor!, P.D.
    La#rence N. La/ar+s, M.D.
    Harr!e( Le."ey, P.D.
    *a%es Levenson, M.D.
    Fran) L!n$, M.D.
    Mac) L!&)!n, M.D.
    Don4Dav!d L+s(er%an, P.D.
    R!card M. Ma$ra#, M.D.
    -a(ryn Ma$r+der, P.D., M.P.H.
    Da"e Ma((e#s, M.D.
    C+c) M!"es, M.D.
    5*> Ane,a I


    Se"don I. M!""er, M.D.
    Pa+" D. Mo/"ey, M.D.
    -a(! Pa@er, M.D.
    *ose& Pa"o%'!, M.D.
    Ro'er( C. Par), M.D.
    E"a!ne P+r&e", M.S.1.
    Pe(er Ra'!ns, M.D.
    An(ony Radd!..e, M.D.
    R!card Rae, M.D.
    Pe(er Ra&o, M.D.
    Mar!"yn Rosenson, M.D.
    Marsa"" Ross%an, M.D.
    Dona"d *. Scer", M.D.
    S!dney H. Scno"", M.D.
    D!ana See'o"d, R.R.A.
    Car"es A. Sa%o!an, M.D., P.D.
    S(even Sar.s(e!n, M.D.
    *.,e$ory Sea
    A".red S)!nner, M.D.
    1!""!a% 1. Snave"y
    *ane( T. S&ence Leon S&ero..,
    M.D. E%an+e" S(e!nd"er,
    Me"v!n S(ern, M.D. *a%es E.
    S(r7!n, M.D. Rev. Pa+" C.
    To%"!nson M!cae" B. Un@e%
    *ero%e 3accaro, M.D. *eanne
    3an R!&er, A.R.T.
    A"an*.1a're),M.D. Lenore B.
    1a")er, Ed.D. S(even 1ar(%an,
    M.D. Ro'er( 1e!%!e', M.D.
    Ro'er( 1e!ns(oc), P.D. Bryan(
    1e"c, P.D. E"eanor 1!(e,
    P.D. Ro'er( L. 1!""!a%s, M.D.
    Mar) 1o"ra!c, M.D. Dav!d
    Mo+n$s, M.D.
    Con&ilierii interna!ionali
    ,r+&+" O&era(!v &en(r+ DSM4I3 a cer+( o&!n!a +ne! "ar$! ca(e$or!! de e<&er=! d!n
    (oa(e =7r!"e. Con(r!'+=!a e<&er=!"or d!n a"(e =7r! a a@+(a( "a as!$nrAre:sens!'!"!(7=!!
    c+"(+ra"e, "a a&"!ca'!"!(a(ea de c7(re &ro.es!on!O(!! =n s7n7(a(e %en(a"7 d!n a"(e =7r!
    O! "a o %a! %are co%&a(!'!"!(a(e c+ CIM45L. E<&er=!! d!n a"(e =7r! a+ cons!"!a( a(A(
    ,r+&+" O&era(!v, cA( s! ,r+&+r!"e de L+cr+.
    Cr!s(er AU$+"ander, M.D. ES+ed!aJ
    Pa+"o A"(er#a!n, M.D. EUr+$+ayJ
    An(on!o Andreo"!, M.D. EE"ve=!aJ
    *+"es An$s(,M.D. EE"ve=!aJ Ben$4A)e
    Ar%e"!+s, P.D. EE"ve=!aJ M7r!e
    s'er$, M.D. ES+ed!aJ To"7n! As+n!,
    M.D. EN!$er!aJ S!dney Ben@a%!n,
    M.D., M.P!". EAn$"!aJ
    Mar) Bere"o#!(/, M.D. EAn$"!aJ
    Pe(er Berner, M.D. EA+s(r!aJ A)se"
    Ber(e"sen, M.D. EDane%arcaJ Pe(er
    Be+%on(, M.D. EA+s(ra"!aJ Is(van
    B!((er, M.D. EUn$ar!aJ Ray
    B"ancard, P.D. ECanadaJ Dan!e"
    Bo'on EBe"$!aJ *ace) Bo%'a, M.D.
    EPo"on!aJ -enne( Bo#ers, P.D.
    ECanadaJ
    S+san Brad"ey, M.D. ECanadaJ *ac)
    Brandes, M.D. ECanadaJ Ian
    Broc)!n$(on, M.D. EAn$"!aJ ,raa%
    B+rro#s,M.D. EA+s(ra"!aJ Pa(r!c!a
    Casey,M.D. EIr"andaJ ,!ovann!
    Cassano, M.D. EI(a"!aJ Doo Mo+n$
    Co, M.D. ECoreeaJ Dav!d M. C"ar),
    P.D. EAn$"!aJ *on E. Coo&er, M.D.
    EAn$"!aJ Pe(er *. Coo&er, M.D.
    EAn$"!aJ Dav!d Co&o"ov, M.D.
    EA+s(ra"!aJ *or$e Cos(a e S!"va, M.D.
    EBra/!"!aJ Ar(+r H. Cr!s&, M.D.
    EAn$"!aJ S(an!s"a# Da'ro#s)!, M.D.
    EPo"on!aJ Adr!an Da.+nc!o, M.D.
    EAr$en(!naJ A"v A. Da", M.D.
    ENorve$!aJ Cr!s(!ne Dean, M.D.
    EAn$"!aJ Hors( D!""!n$, M.D.
    E,er%an!aJ
    olaboratorii DSM-
    IV
    F5F


    -e!( S(e&en Do'son, M.D. ECanadaJ
    ,r!..!( Ed#ards, M.D. EAn$"!aJ
    Cr!s(o&er Fa!r'+rn, M.D. EAn$"!aJ
    FranOo!s Ferrero, M.D. EE"ve=!aJ
    Man.red F!c(er, M.D. E,er%an!aJ
    Mar(!ne F"a%en(, M.D. EFran=aJ Cr!s
    Free%an, M.D. E:)<O=!aJ Haro"d
    Frey'er$er, M.D. E,er%an!aJ A)!ra
    F+@!na#a, M.D. E*a&on!aJ Pa+"
    ,ar.!n)e", M.D. ECanadaJ M!ce"
    ,e"der, M.D. EAn$"!aJ Se%yon
    ,"+/%an, M.D. E.os(a URSSJ *+d!( H.
    ,o"d, M.D. ECanadaJ Marc+s ,ran(,
    P.D. EE"ve=!aJ Her(a A. ,+((%an, M.
    D. ECanadaJ He!n/ Ha.ner, M. D.
    E,er%an!aJ Ro'er( Hare, P. D.
    ECanadaJ L!"y Hec(%an, M. D.
    ECanadaJ M!c!e" 1. Hen$eve"d, M. D.,
    P. D.
    EO"andaJ
    C. Pe(er Her%an, P. D. ECanadaJ
    Hans H!&&!+s, M. D. E,er%an!aJ
    1!""e% M. H!rs, M. D. EO"andaJ Teo
    Sen$ Hoc), M. D. ES!n$a&oreJ Hans 1.
    Hoe), M. D., P. D. EO"andaJ Mos!)o
    I)eda, M. D. E*a&on!aJ Assen *a'"ens)y,
    M. D. EB+"$ar!aJ A"e)sander *anca, M.
    D. EE"ve=!aJ P!"!&&e *ea%%e(, M. D.
    EFran=aJ -aren *on, M. D. EAn$"!aJ
    M!$+e" *or$e, M. D., P. D. EBra/!"!aJ
    Ross S. -a"+cy, M. D. EA+s(ra"!aJ
    Mar!anne -as(r+&, M. D., P. D.
    EDane%arcaJ
    He!n/ -a(scn!$, M. D. EA+s(r!aJ *+s(!n
    -enardy, P. D. EA+s(ra"!aJ Ro'er(
    -ende"", M. D. ESco=!aJ S!d -ennedy,
    M. D. ECanadaJ Renard -na''e, M. D.
    EE"ve=!aJ 3"ad!%!r -ova"ev, M. D. .E.os(a
    URSSJ Evsey -ras!), M. D. E.os(a
    URSSJ Mves LeCr+'!er, M. D. EFran=aJ
    P!erre Le!cner, M. D. ECanadaJ *!""
    Leo"'onne, M. D. EAn$"!aJ Bernard
    Lerer, M. D. EIsrae"J A+'rey Lev!n, M.
    D. EA.r!ca de S+dJ
    Pa+" L!n)s, M. D. ECanadaJ K'!$n!e#
    L!&o#s)!, M. D. ECanadaJ A"#yn
    L!s%an, M. D. EAn$"!aJ 1. *on
    L!ves"ey, M. D. ECanadaJ *. LR&e/4I'or,
    *r., M. D. ES&an!aJ M7r!o Ma@, M. D.
    EI(a"!aJ Fe"!ce L!e Ma) EC!naJ
    N!)o"as M7nos, M. D. E,rec!aJ Isaac
    Mar)s, M. D. EAn$"!aJ A"e<ander C.
    McFar"ane, M.B.B.S.
    EHonsJ, M. D. EA+s(ra"!aJ Pa(r!c)
    Mc,orry, M.B.B.S. EA+s(ra"!aJ *+"!en
    Mende"e#!c/, M. D. EBe"$!aJ -"a+s
    M!nde, M. D. ECanadaJ Harvey
    Mo"do.s)y, M. D. ECanadaJ Mar!s(e"a
    Mon(e!ro, M. D. EBra/!"!aJ S(+ar(
    Mon($o%ery, M. D. EAn$"!aJ O"e Mors,
    M. D. EDane%arcaJ A"!s(a!r M+nroe,
    M. D. ECanadaJ ,+"a% M+s(a.a, M. D.
    E-enyaJ Mos!'+%! Na)ane, M. D.
    E*a&on!aJ 1.A. No"en EO"andaJ C"aes
    Norr!n$, Dr. Med.Sc. ES+ed!aJ M+r!
    N+""er E.os(a URSSJ A%ed O)asa,
    M. D. EE$!&(J M+@! O)a/a)!, M. D.
    E*a&on!aJ M+(a)a Ono, M. D. E*a&on!aJ
    A".onso On(!veros, M. D., M.Sc.
    EMe<!cJ
    S(e!n O&@ords%oen, P. D. ENorve$!aJ
    *on Or"ey, M. D. EE"ve=!aJ2 Lars ,oran
    Os(, P. D. ES+ed!aJ S(e.ano Pa""an(!,
    M. D. EI(a"!aJ *oe", Par!s, M. D.
    ECanadaJ Cordon Par)er, M. D.
    EA+s(r!aJ E+$ene Pay)e", M. D.
    EAn$"!aJ -o) Lee Pen$, M. D.
    ES!n$a&oreJ U#e Henr!c) Pe(ers, M. D.
    E,er%an!aJ Car"o Pen!s, M. D. ES+ed!aJ
    P!erre P!co(, M. D. EFran=aJ Andr/e@
    P!o(ro#s)!, M. D. EPo"on!aJ -ar" P!r)e,
    M. D. E,er%an!aJ *ane( Po"!vy, P. D.
    ECanadaJ Car"es P+!!, M. D.
    EL+<e%'+r$J -ar! Py"))anen, M. D.
    EF!n"andaJ
    42E Ane,a I

    *+an Ra%on de "a F+en(e, M. D.
    EMe<!cJ
    Bever"ey Ra&ae", M. D. EA+s(ra"!aJ
    Ro'er( Re!d, M. D. ECanadaJ He"%+(
    Re%sc%!d( E,er%an!aJ N!"s
    Re((erso", M. D. ENorve$!aJ *ose& M.
    Rey, P. D. EA+s(ra"!aJ *e..rey C.
    R!cards, P. D. EA+s(ra"!aJ An(on!o A.
    R!//o"!, M. D. EI(a"!aJ Pa+" Ro'!nson,
    M. D. EAn$"!aJ B!r Mar(!n Ro(, M. D.
    EAn$"!aJ Byron Ro+r)e, P. D.
    ECanadaJ ,era"d R+sse"", M. D.
    EAn$"!aJ B!r M!cae" R+((er, M. D.
    EAn$"!aJ *av!er Saavedra, M. D. EPer+J
    Pa+" Sa")ovs)!s, P. D. EAn$"!aJ
    Nor%an Sar(or!+s, M. D., P. D.
    EE"ve=!aJ
    *on Sa+nders, M. D. EA+s(ra"!aJ
    Aar( H. Scene, M. D. EO*andaJ
    Marc+s F!n! Sc+"s!n$er, M. D.
    EDane%arcaJ *an Sco((, P. D.
    EAn$"!aJ R+'en Hernande/
    Serrano, M. D.
    E3ene/+e"aJ
    M!cae" Se&ard, M. D. EAn$"!aJ Er!)
    S!%onsen, M. D. EDane%arcaJ Cees *.
    S"oo.., M. D. EO"andaJ Cons(an(!n R.
    So"da(os, M. D. E,rec!aJ Kaava
    So"o%on, M. D. EIsrae"J Mar!n S(anc+,
    M. D. ERo%An!aJ Me!r S(e!ner, M. D.,
    P. D. ECanadaJ Donna S(e#ar(, M. D.
    ECanadaJ
    Er!c S(ro%$ren, M. D. EDane%arcaJ
    Pe(er S/a(%ar!, M. D. ECanadaJ ,eor$e
    S/%+)"er, M. D. EAn$"!aJ A"e<
    Tarno&o"s)y, M. D. ECanadaJ
    D+!s(o&er Tennan(, M. D. EA+s(ra"!aJ
    S(en Teander, M. D. ES+ed!aJ Pe))a
    T!enar!, M. D. EF!n"andaJ Svenn
    Tor$ensen, M. D. ENorve$!aJ Pe(er
    Tro#er, P. D. EAn$"!aJ E"don T+n)s,
    M. D. ECanadaJ Pe(er Tyrer, M. D.
    EAn$"!aJ T. Bed!ran Us(+n, M. D.
    EE"ve=!aJ Per 3a$"+%, M. D. ENorve$!aJ
    1a"(er 3andereyc)en, M. D. EBe"$!aJ
    *enny 3an Dr!%%e"en4-ra''e, M. D.
    EE"ve=!aJ
    *.T. van Mens, M. D. EO"andaJ Dav!d
    3ea"e, M.R.C.Psyc. EAn$"!aJ F. C.
    3er+"s( EO"andaJ Marc!o 3ers!an!, M.
    D. EBra/!"!aJ Mar(en 1. de 3r!es, M. D.
    EO"andaJ Der%on( 1a"s, M.B.
    EIr"andaJ 1!nny 1eeda4Manna), P. D.
    EO"andaJ
    *on S. 1erry, M. D. ENo+a Kee"and7J
    Hans U"r!c 1!((cen, P. D.
    E,er%an!aJ
    Ra%sy Massa, M. D. ECanadaJ Derson
    Mo+n$, M. D. EC!naJ M!cae" Ka+d!$,
    M. D. E,er%an!aJ *ose& Koar, M. D.
    EIsrae"J -enne( *. K+c)er, P. D.
    ECanadaJ Ro'er(o L"anos K+"oa$a, M.
    D. EPer+J
    Proie#tele $e te&tare .n teren #entrate pe DSM-IV
    Pro!ec(e"e de (es(are :n (eren e"a'ora(e de Ins(!(+(+" Na=!ona" de S7n7(a(e
    Men(a"7 :n co"a'orare c+ Ins(!(+(+" Na=!ona" &en(r+ A'+/+" de Dro$ s! Ins(!(+(+"
    Na=!ona" &en(r+ A'+/+" de A"coo" s! A"coo"!s% a+ .os( o s+rs7 e<(re% de
    !%&or(an(7 de da(e s! a+ con(r!'+!( :n %are %7s+r7 "a ca"!(a(ea DSM4I3. E<&r!%7%
    %+"=+%!r!"e noas(re "+! Darre" Re$!er, M.D., M.P.H., D!rec(or a" D!v!/!e! de
    E&!de%!o"o$!e s! Cerce(are Serv!c!!, s! "+! Car"es -ae'"er, M.D., Ins&ec(or de
    Pro!ec(, &en(r+ a@+(or+" s! &ro.es!on!s%+" "or. M+"=+%!%, de ase%enea, +r%7(or!"or
    &ar(!c!&an=! "a (es(area :n (erenQ
    #nvesti.ator principal
    A""en Frances, M. D.
    #nvesti.ator coBprincipal
    Haro"d A"an P!nc+s, M. D.
    olaboratorii DSM-
    IV
    421


    (oordonator al testrii @n teren
    Myr!a% -"!ne, M.S.
    Statistician (onsultant
    He"ena -rae%er, P. D.
    Testarea @n teren a Tulburrii de
    6ersonalitate Antisociale
    0irector de proiect To%an A.
    1!d!$er, P.D
    Coordonatori locali Ar(+r
    A"(er%an, P.D. Re%! *.
    Cadore(, M.D. Ro'er(
    Hare, P.D. Lee Ro'!ns,
    P.D. ,eor$e E. 1oody,
    M.D. Mary C. Kanar!n!,
    Ed.D.
    Testarea @n teren a Autismului si
    Tulburrilor de 9ezvoltare 6ervasiv
    0irector de proiect
    Fred 3o")%ar, M.D. Ede ase%enea, s!
    coordona(or "oca"J
    Coordonatori locali Ma$da
    Ca%&'e"", M.D. B. *.
    Free%an, P.D. A%!
    -"!n, P.D. Ca(er!ne
    Lord, P.D. E. R!(vo,
    M.D. B!r M!cae" R+((er,
    M.D. Er!c Sco&"er, P.
    Coordonatori locali, loc+ri *ol+ntare
    *oe" Bre$%an, M.D.
    *an B+!(e"aar, M.D.
    Soo C+r" Co, M.D.
    Er!c Fo%'o%nne, M.D.
    *oa0+!n F+en(es, M.D.
    Moss!e Ha((a', M.D.
    Mos!!)o Hos!no, M.D.
    *. -er'es!an, M.D.
    1!""!a% -"!ne, P.D.
    -a(er!ne Love"and, P.D.
    Bryna S!e$e", P.D.
    1endy S(one, M.D.
    Pe(er S/a(%ar!, M.D.
    L+d#!$ S/y%ans)!, M.D.
    -enne( To#'!n, M.D.
    *on S. 1erry, M.D.
    Testarea @n teren a Tulburrii de
    (omportament 9isruptiv
    0irector de proiect
    Ben@a%!n Laey, P.D. Ede ase%enea,
    s! coordona(or "oca"J
    Coordonatori locali R+sse""
    Bar)"ey, P.D. *ose&
    B!eder%an, M.D. Barry
    ,ar.!n)e", M.D. La+rence
    ,reen!"", M.D. ,eor$e
    Hynd, Ed.D. -e!(
    McB+rne((, P.D. *e..rey
    Ne#corn, M.D. To%as
    O""end!c), P.D.
    Coordonatori locali, loc+ri *ol+ntare
    Pa+" Fr!c), P.D. Pe(er *ensen,
    M.D. Lynn -erdy), P.D. *on
    R!c(ers, P.D.
    Coordonator de date
    Dorcas Pere/, B.A.
    Testarea @n teren a 9epresiei <aAore2
    9istimiei /i Tulburrii 9epresive
    <inore
    0irector de proiect
    Mar(!n B. -e""er, M.D. Ede ase%enea, s!
    coordona(or "oca"J
    Codirectori de proiect M!cae" B. F!rs(,
    M.D. *a%es -ocs!s, M.D. Ede
    ase%enea, s! coordona(or "oca"J
    Coordonatori locali Ro'er( M.A.
    H!rsc.e"d, M.D. Car"es Ho"/er,
    P.D. ,a'or -e!(ner, M.D. Dan!e"
    -"e!n, P.D. De'ora Mar!n, M.D.
    *a%es P. McC+""o+$, P.D. Ivan
    M!""er, P.D. Trac!e Sea, P.D.
    F99 Anexa N


    Coordonatori de date
    D!ane Han)s, M.A.
    Corde"!a R+sse"", B.A.
    Tes(area :n (eren a T+"'+r7r!!
    De&res!v4An<!oase M!<(e
    0irectori de proiect
    Dav!d H. Bar"o#, P.D. Ede ase%enea,
    s! coordona(or "oca"J M!cae"
    R. L!e'o#!(/, M.D. Ede
    ase%enea, s! coordona(or "oca"J
    R!card K!n'ar$, P. D. Ede ase%enea,
    s! coordona(or "oca"J
    Coordonatori locali P!" Bran("ey, P.
    D. E+$ene Broadead, M. D., P.
    D. 1ayne -a(on, M. D. *ean4P!erre
    Le&!ne, M. D. *e..rey C. R!cards,
    P. D. Pe(er Roy4Byrne, M. D.
    L!nda S(ree(, P. D. Mard@an
    Teeran:, PvO.
    Tes(area :n (eren a T+"'+r7r!!
    O'ses!vo4Co%&+"s!ve
    0irector de proiect
    Edna Foa, P.D. Ede ase%enea, s!
    coordona(or "oca"J
    Coordonatori locali *ane E!sen,
    M.D. 1ayne ,ood%an, M.D.
    He""a H!ss, P.D. Er!c
    Ho""ander, M.D. M!cae"
    *en!)e, M.D. M!cae" *.
    -o/a), P.D. S(even
    Ras%+ssen, M.D. *ose&
    R!cc!ard!, P.D. Pe$$y
    R!c(er, M.D. Bar'ara
    Ro('a+%, P.D.
    Tes(area :n (eren a Pan!c!!
    0irector de proiect A''y Fyer, M. D.
    Ede ase%enea, s! coordona(or
    "oca"J N
    Codirector de proiect *a%es C. Ba""en$er,
    M. D. Ede ase%enea, s! coordona(or
    "oca"J
    Coordonatori locali Dav!d
    H. Bar"o#, P. D.
    M!cae" Ho""!.!e"d, M. D.
    1ayne -a(on, M. D.
    R!card S#!nson, M. D.
    Analiti de date
    T!% Ca&%an, M. P!".
    Sa"va(ore Mann+//a, P. D.
    Coordonator de date H!"ary
    Rassn!c), M.A.
    Tes(area :n (eren a T+"'+r7r!! s(res+"
    Pos((ra+rna(!c
    0irector de proiect
    Dean -!"&a(r!c), P. D. Ede ase%enea,
    O! coordona(or "oca"J Besse" van
    der -o"), M. D. Ede
    ase%enea, O! coordona(or "oca"J
    Coordonatori locali *on
    Freedy, P. D. Sandra
    -a&"an, M. D. Dav!d
    Pe"cov!(/, P. D. Pa((y
    Res!c), P. D. He!d!
    Resn!c), P. D. S+san
    Ro(, P. D.
    Tes(area :n (eren a Sc!/o.ren!e!
    O! T+"'+r7r!"or Ps!o(!ce A.!ne
    0irectori de proiect
    Nancy Coover Andreasen, M.D., P.D.
    Ede ase%enea, s! coordona(or "oca"J
    M!cae" A. F"a+%, M.D. Ede ase%enea,
    s! coordona(or "oca"J
    Coordonatori locali >av!er
    A%ador, P.D. H. B(e.an
    Braca, M.D. 1!""!a% Ede"",
    P.D. *ac) Cor%an, M.D.
    -enne( S. -end"er, M.D.
    *e..rey L!e'er%an, M.D.
    To%as Mc,"asan, M.D.
    Ananda -. Pand+ran$!, M.D.
    De"'er( Ro'!nson, M.D.
    Coordonatori locali, loc+ri *ol+ntare
    Parr!c) Mc,orry, M.B.B.S.
    olaboratorii DSM-
    IV
    42+


    A".onso On(!veros, M.D., M.Sc.
    Ma+r!c!o Toen, M.D.
    Testarea @n teren a Tulburrilor de
    Somn
    0irectori de proiect
    Dan!e" B+ysse, M.D. Ede ase%enea,
    s! coordona(or "oca"J Dav!d *.
    -+&.er, M.D. Car"es F. Reyno"ds III,
    M.D.
    Coordonatori locali Ed#ard
    B!<"er, M.D. Pe(er H7+r!,
    P.D. An(ony -a"es, M.D.
    Rocco Man.red!, M.D.
    To%as Ro(, P.D. Ed#ard
    S(e&ans)!, P.D. M!cae"
    Tor&y, M.D.
    Coordonator date De''!e
    Mes!ano, B.S.
    Testarea @n teren a Tulburrii de
    Somatizare
    0irector de proiect
    C. Ro'er( C"on!n$er, M.D.
    Coordonatori locali Sa%+e" B.
    ,+/e, M. D. Ro$er -a(o",
    M. D. Rona"d L. Mar(!n, M.
    D. R!card S%!(, M. D.
    *a%es *. S(r7!n, M. D. Sean
    M+(/y, M. D.
    Testarea @n teren a Uzului unei
    Substan3e
    0irectori de proiect
    L!nda Co(("er, P. D. Ede ase%enea,
    s! coordona(or "oca"J *on E.
    He"/er, M. D. Marc A"an Sc+c)!(, M.
    D. Ede
    ase%enea, s! coordona(or "oca"J
    Coordonatori locali To%as
    Cro#"ey, M. D. *on R.
    H+$es, M. D. ,eor$e E.
    1oody, M. D.
    Coordonatori locali, loc+ri *ol+ntare *ean4
    P!erre Le&!ne, M. D.
    Proie#tul Ma#Art@ur $e reanali)are a $atelor
    Pro!ec(e"e de reana"!/are a da(e"or s+s=!n+(e de $eneroasa dona=!e a "+! *on D.
    and Ca(er!ne T. MacAr(+r Fo+nda(!on o.er7 o 'a/7 de da(e &en(r+ o cerce(are
    e<(ens!v7. M+"(e %+"=+%!r! "+! Den!s Pra$er de "a F+nda=!e &en(r+ !%ens+" s7+
    a@+(or. S!ncere"e noas(re a&rec!er! +r%7(oare"or &ersoane care a+ cond+s &ro!ec(e"e
    de reana"!/are a da(e"orQ
    #nvesti.ator principal
    A""en Frances, M.D.
    #nvesti.atori coprincipali
    Haro"d A"an P!nc+s, M.D.
    To%as A. 1!d!$er, P.D.
    Tulburrile anxioase
    Dav!d H. Bar"o#, P.D.
    De'ora C. Be!de", P.D.
    To%as B+r(on, B.A.
    M!ce""e ,. ,ras)e, P.D.
    ,eor$e C. C+r(!s, M.D. Pe(er
    A. D!Nardo, P.D.
    A''y Fyer, M.D. Ro'!n ,ar.!n)e",
    P.D. R!card He!%'er$, P.D.
    E"!/a'e( M. H!"", P.D. Cr!s(o&er
    D. Horn!n$, B.A. E#a"d Hor#a(,
    M.D., M.S.C. *a%es *onson, P.D.
    Edeceda(J Har"an *+s(er, P.D. 1ayne
    -a(on, M.D. ,era"d L. -"e%an, M.D.
    Edeceda(J -aren La#, B.A. Andre#
    Leon, P.D. M!cae" R. L!e'o#!(/,
    M.D. Sa"va(ore Mann+//a, P.D.
    42F Ane,a I


    *!"" Ma((!a, M.A. Eryn
    O'er"ander, M. D. S+san Ors!""o,
    M.A. Pe(er Roy4Byrne, M.D.
    Pa+" Sa")ovs)!s, P.D. Fran)"!n
    Scne!er, M.D. Sa%+e" M.
    T+rner, P.D. Myrna M.
    1e!ss%an, P.D. S+san I. 1o"),
    M.D. Ro'er( Kara(e, M.A.
    9eliriumul2 demen3a2 tulburrile
    amnestice si alte tulburri
    co.nitive
    M!cae" O. Co"v!n, M.D.
    Marsa"" Fo"s(e!n, M.D.
    ,ary L"oyd ,o(("!e', M.&.
    D!"!& 3. *es(e, M.D. S+e
    Lev)o.., D.S.C. Ben@a%!n
    L!&(/!n, M.D. ,eor$e 1.
    Re'o), P.D. Dav!d
    Sa"%on, P.D. Leon Ta",
    M.D.
    T+"'+r7r!"e d!a$nos(!ca(e de re$+"7
    &en(r+ &r!%a da(7 :n &er!oada de s+$ar,
    :n co&!"7r!e sa+ ado"escen=7
    Bro)s A&&"e$a(e, P.D. ,era"d
    A+$+s(, P. D. S+san *. Brad"ey,
    M.D. *oe" Bre$%an, M.D.
    Pa(r!c!a Coen, P.D. M!cae"
    F"ory, P.D. S+san Fo"s(e!n, M.D.
    Er!c Fo%'onne, M.D. Barry
    ,ar.!n)e", M.D. R!card ,reen,
    M.D., *.D. S(e&an!e M. ,reen,
    M.S. *ane E. Hood, M.A. -a(e
    -eenan, M.S. Ben@a%!n Laey,
    P.D. Mar!on Le'oyer, M.D. Ro".
    Loe'er, P.D. Ca(er!ne Lord,
    P.D. *on McLennan, M.D.
    Nancy M!nse#, M.D. Rea
    Pa+", P.D. Andre# P!c)"es,
    P.D. Ho#ard M. Re'ac, P.D.
    Mary F. R+sso, P.D. B!r M!cae"
    R+((er, M.D. Er!c Sco&"er, P.D.
    Cr!s(o&er To%as, M.D. Fred
    3o")%ar, M.D. -a(er!ne 1!""!a%s,
    P.D. -enne( *. K+c)er, P.D
    Tulburrile de comportament
    alimentar
    Arnord Anderson, M.D.
    Cr!s(o&er Fa!r'+rn, M.D.
    Mar(!ne F"a%en(, M.D. Pa+"
    ,ar.!n)e", M.D. Dean -!"&a(r!c),
    P.D. *a%es M!(ce"", M.D. ,.
    Terence 1!"son, P.D. S(even
    1onder"!c, M.D.
    Tulburrile afective
    ,re$ory Asn!s, M.D. Mar) S.
    Ba+er, M.D. D!ane Byn+%
    *ose& Ca"a'rese, M.D. 1!""!a%
    Corye"", M.D. Dav!d D+nner,
    M.D. EUen Fran), P.D. Las/"o
    ,y+"a!, M.D. Mar(!n B. -e""er,
    M.D. ?*arSes"Cocs!s, M.D.
    P!2& Lavor!, P.D. Mves
    LeCr+'!er, M.D. Ro'er( M. Pos(,
    M.D. Sa%+e" *. S!%%ens, P.D
    S(+ar( So(s)y, M.D. Dan L.
    T#eed, P.D. L!ndsey T#eed,
    M.D. Pe(er C. 1y'ro#, M.D.
    Saron Mo+n)!n
    Tulburrile de personalitate
    E%!" F. Coccaro, M.D. Mar)
    Dav!es, M.D. M!cae" B. F!rs(,
    M.D. Ro'er( Hare, P.D.
    Teodore M!"!on, P.D. 3!v!an
    M!(ro&o+"o+, M.A. Les"!e
    Morey, P.D.
    olaboratorii DSM-
    IV
    F9Y


    Br+ce P.o", M.D. Larry *. S!ever,
    M.D. *ere%y M. S!"ver%an, P.D.
    Andre# Ed#ard S)odo" II, M.D.
    T!%o(y Tr+"", P.D. To%as A.
    1!d!$er, P. Mary C. Kanar!n!, Ed.D.
    T+"'+rarea d!s.or!c7 &re%ens(r+a"7
    E""en Fran), P.D E""en 1.
    Free%an Les"!e ,!se, M.D.
    *+d!( H. ,o"d, M.D.
    Bar'ara Parry, M.D. Pa+"a
    Scn+rr, P.D. Sa""y
    Sever!no, M.D. *on S(ee$e,
    M.D. Me!r S(e!ner, M.D.,
    P.D.
    T+"'+r7r!"e &s!!a(r!ce de !n(er.a=7 a
    s!s(e%e"or E(+"'+r7r!"e de ada&(are,
    d!soc!a(!ve, .ac(!ce, de con(ro" a"
    !%&+"s+"+! s! so%a(o.or%e,
    s! .ac(or!! &s!o"o$!c! care a.ec(ea/7
    cond!=!a %ed!ca"7J
    Henry R. Les!e+r, M.D.
    *+an Enr!0+e Me//!c, M.D,, P.D.
    *e..rey Ne#corn,
    M.D. Dav!d A.
    S&!e$e", M.D. *a%es
    *. S(r7!n, M.D.
    Sc!/o.ren!a O! a"(e (+"'+r7r!
    &s!o(!ce
    Nancy Coover Andreasen, M.D.,
    P.D. ,re(cen Haas, P.D. *e..rey
    L!e'er%an, M.D. Pa(r!c) Mc,orry,
    M.B., B.S. -e!( Ne+c(er"e!n, P.D.
    Ma+r!c!o Toen, M.D.
    T+"'+r7r!"e de so%n
    Dan!e" B+ysse, M.D. Car"es,
    F. Reyno"ds III, M.D.
    T+"'+r7r!"e :n "e$7(+r7 c+ o s+'s(an=7
    *on Cacc!o"a, P.D.
    L!nda B. Co(("er, P.D.
    *on E. He"/er, M.D.
    R+%! Pr!ce, P.D.
    Lee Ro'!n, P.D.
    Marc A"an Sc+c)!(, M. D.
    ,eor$e E. 1oody,M.D.
    Te&tarea .n teren a vala-ilit(!ii 3Relia-ilitP6 /enerale
    &pon&ori)at( $e 'un$a!ia Ma#Art@ur
    C+% DSM4I3 es(e &+'"!ca(, +n &ro!ec( ad!=!ona" s&onsor!/a( de *on O. and
    Ca(er!ne T. MacAr(+r va o.er! !n.or%a=!! s+&"!%en(are re.er!(oare "a va"!d!(a(ea
    cr!(er!!"or DSM4I3. Pro!ec(+" de (es(are :n (eren :nre$!s(ra( &e v!deocase(7 es(e
    aO(e&(a( a .! (er%!na( :n 5FFY. M+"=+%!r!"e noas(re +r%7(oare"or &ersoane care a+
    &ar(!c!&a( "a &ro!ec(Q
    Inves(!$a(or! &r!nc!&a"!
    A""en Franes, M.D.
    *a%es 1. To%&son, M.D., M.P.H.
    Inves(!$a(or! co&r!nc!&a"!
    Haro"d A"an P!nc+s, M.D. M!cae" B.
    F!rs(, M.D. M!cae" A. F"a+%, M.D.
    An(ony F. Le%an, M.D., M.S.P.H.
    Par(!c!&an=! "a (es(are
    >av!er A%ador, P.D.
    Nancy Cover Andersen, M.D., P.D.
    F. M. Ba)er, M.D.
    Dona"d 1. B"ac), M.D.
    Car"os S. Cas(!""o, M.D.
    Sco(( C. C"ar), M.D.
    1!""!a% Corye"", M.D.
    L!sa B. D!<on, M.D.
    42> Anexa N


    *ac) E. Do#n!"", *r., M.D. -a(er!ne
    P. D+..y, M.D. *ean End!co((, P.D.
    M!cae" A. Fa+%an, M.D., P-.D.
    M!r!a% ,!''on, M.S.1. *ac)
    ,or%an, M.D. Pa+" E. Ho$s(en,
    M.D. M!cae" L. *e..r!es, M.D.
    Do+$"as Lan$'en, M.D. *ose&
    L!'er(o, M.D. Dav!d B. MaUo(, M.D.
    De" D. M!""er, Par%.D., M.D. Le#!s
    A. O&"er, M.D., P.D.
    *!"" A. RacBe!se", M.D. Ro'er( P.
    Sc#ar(/, M.D. Andre# Ed#ard
    S)odo" F, M.D. Dav!d H. S(ra+ss,
    M.D. Sco(( S(+ar(, M.D. *ane( B. 1.
    1.."!a%s, D.S.1. Ca(er!ne
    1ood%an, M.D.
    (oordonator de proiect
    *enn!.er Nor'ec), M.S.1.
    (onsultant :ideo
    3!ncen( C"ay(on, M.A.
    Parti#ipan!ii la %a)a $e e,per!i
    Ur%7(or!! re&re/!n(7 &ar(!c!&an=!! "a &ro!ec( :n %o%en(+" :n care DSM4I3 &"eca
    "a (!&ar. S4a an(!c!&a( c7 s! a"(e "oc+r! s! &ersoane se vor a"7(+ra &ro!ec(+"+!.
    *ona(an A"&er(, M.D.
    -a(er!ne A((a"a, M.D. Dav!d
    Avery, M.D. Mon!ca Ra%!re/
    Basco, P.D. Mar) S. Ba+er,
    M.D.
    Ede ase%enea, coordona(or "oca"J
    To%as F. Be"(/er, M.D. Me"an!e B!$$s,
    P.D. Ede ase%enea, Ecoordona(or "oca"J
    Ro'er( *. B!so&, M.D. Dan!e""e
    Bordea+, M.D. Ma"co"% B. Bo#ers, *r .,
    M.D. ,ary Br+ss, M.D. Pe(er B+c)"ey,
    M.D. De'ora S. Co#"ey, M.D. Br!an
    Co<, M.D. *a%es Dav!d, M.D.. Co""e((e
    De Marne..e, P. D. *+d!( Do$!n, M.D.
    Seda E'ra!%!, P.D. . *ane E!sen,
    M.D. . Ma+r!/!o Fava, M.D. Pa+"
    Federo.., M. D. Mar) -. F+"(on, M. D.
    D!e$o ,arc!aXBorre$+ero, M. D Roya
    ,ad!%!, M. D. Dav!d S. ,o"d'"oo%,
    M. D. Reed D. ,o"ds(e!n, P. D.
    Ede ase%enea, s! coordona(or "oca"J.
    M!cae" ,o"!n)o.., P. D.
    Pe(er ,oyer, M. D A"an M.
    ,r+en'er$, M. D. M!cae"
    Henry, M.D. Se"'y C. *aco's,
    M. D. *. *oe" *e..r!es, M. B.
    Ede ase%enea, s! coordona(or "oca"J
    Ser! *onson, P. D. -a("een -!%,
    M.D., M.P.H. Caro"yn M. Ma/+re,
    P.D.,
    Ede ase%enea, s! coordona(or "oca"J
    *ose& McEvoy, M.D. Arno"d
    Mern%aa., M.D. T!%o(y I. M+e""er,
    M. D. Andre# N!eren'er$?".D.
    M!cae" O((o, P.D M!ce""e Pa(o,
    M.D. *oe" Pava, M D. -a(ar!ne Ann
    P!2&s, M.D.
    Ede ase%enea, coordona(or "oca"J
    Mar) Po""a), M.D. Hora(!o Preva",
    M.D.
    Ede ase%enea, coordona(or "oca"J
    Dav!d 1. Preven, M.D.
    Ede ase%enea, coordona(or "oca"J
    R!card R!es, M. D. Ro'er( C. R!s!n$er,
    M.D. Ro'er( Ron!s, M.D *erro"d F.
    Rosen'a+%, M. D.
    Ede ase%enea, s! coordona(or "oca"J
    olaboratorii DSM-IV
    Pe(er Roy4Byrne, M. D. N
    Ede ase%enea, s! coordona(or "oca"J Mar)
    Sc%!d(, M.D.
    Ede ase%enea, s! coordona(or "oca"J S.
    Car"es Sc+"/, M. D. Br+ce Sc#ar(/, M. D.
    M!cae" Sc#ar(/, M. D.
    Ede ase%enea, s! coordona(or "oca"J
    M!cae" *. Sernya), M. D.
    R!card S#!nson, M. D.
    Mad+)ar H. Tr!ved!, M. D.
    Andrea #e!ss, M.D. -err!n
    1!(e, M.D. La#rence 1!"son,
    M. D. M!cae" Sc#ar(/, M. D.
    *on 1or(!n$(on, M. D. *oan
    Mo+ca, M. D.
    Alte or/ani)a!ii $e &(n(tate
    La de%ararea &ro!ec(+"+!, ,r+&+" O&era(!v &en(r+ DSM4I3 a !nv!(a( &es(e RL
    asoc!a=!! de s7n7(a(e s74s! dese%ne/e re&re/en(an=!! de "e$7(+r7 c+ ,r+&+" O&era(!v
    &en(r+ a con.!r%a desc!derea &roces+"+! de rev!/+!re &rec+% s! .a&(+" c7 es(e
    re&re/en(a(7 o var!e(a(e de &+nc(e de vedere. Asoc!a=!!"e "!s(a(e %a! @os s!4a+
    dese%na( re&re/en(an=!!, aceO(!a &r!%!nd :n %od re$+"a( co%+n!c7r! de "a
    ,r+&+r!"e de L+cr+ s! de "a ,r+&+(O&era(!v.
    A%er!can Acade%y o. C!"d and
    Ado"escen( Psyc!a(ry
    A%er!can Acade%y o. Fa%!"y
    Pys!c!ans
    A%er!can Acade%y o. Ped!a(r!cs
    A%er!can Acade%y o. Psyc!a(r!s( !n
    A"coo"!s% and Add!c(!ons A%er!can
    Acade%y o. Psyc!a(ry and
    (e La# A%er!can Assoc!a(!on
    .or ,er!a(r!e
    Psyc!a(ry A%er!can Assoc!a(!on .or
    %arr!a$e and
    Fa%!"y Tera&y A%er!can
    Assoc!a(!on o. Ca!r%en o.
    De&ar(%en(s o. Psyc!a(ry
    A%er!can Assoc!a(!on o. D!rec(ors o.
    Psyc!a(r!c Res!dency.Tra!n!n$
    A%er!can Assoc!a(!on o. Psyc!a(r!c
    Ad%!n!s(ra(ors
    A%er!can Board o. Fa%!"y Prac(!ce
    A%er!can Co""e$e o. O's(e(r!c!ans and
    ,!neco"o$!s(s
    A%er!can Co""e$e o. Psys!c!ans
    A%er!can ,ro+& Psyco(era&y
    Assoc!a(!on
    A%er!can Hea"( In.or%a(!on
    Mana$e%en( Assoc!a(!on A%er!can
    Med!ca" Soc!e(y on A"coo"
    and O(er Dr+$ De&endenc!es
    A%er!can N+rses2 Assoc!a(!on
    A%er!can Occ+&a(!ona" Tera&y
    Assoc!a(!on
    A%er!can Psycoana"y(!c Assoc!a(!on
    A%er!can Psyco"o$!ca" Assoc!a(!on
    A%er!can Psyco"o$!ca" Soc!e(y
    A%er!can Psycoso%a(!c Soc!e(y, Inc.
    A%er!can Soc!e(y .or Ado"escen(
    Psyc!a(ry Assoc!a(!on o.
    De&ar(%en(s o. Fa%!"y
    Med!c!ne Assoc!a(!on o. ,ay
    and Les'!an
    Psyc!a(r!s(s
    Assoc!a(!on o.\Men(a" Hea"( C"er$y
    Coa"!(!on .or (e Fa%!"y ,ro+& .or (e
    Advance%en( o.
    Psyc!a(ry
    Na(!ona" A""!ance .or (e Men(a""y 555
    Na(!ona" Assoc!a(!on o. Soc!a" 1or)ers
    Na(!ona" Assoc!a(!on o. 3e(erans A..a!rs
    C!e.s o. Psyc!a(ry Na(!ona"
    Cen(er .or Hea"( S(a(!s(!cs Na(!ona"
    Co+nc!" o. Co%%+n!(y Men(a"
    Hea"( Cen(ers Na(!ona"
    De&ress!ve and Man!e
    De&ress!ve Assoc!a(!on Na(!ona"
    Med!ca" Assoc!a(!on Na(!ona" Men(a"
    Hea"( Assoc!a(!on Soc!e(y o. ,enera"
    In(erna! Med!c!ne Soc!e(y o. Teacers o.
    Fa%!"y Med!c!ne 1or"d Hea"(
    Or$an!/a(!on

    Ane,a X
    onsilierii pentru revi(uirea
    textului DSM-IV
    Con&ilierii Grupului $e Lu#ru pentru
    revi)uirea te,tului Tul-ur(rilor An,ioa&e
    L!sa A%aya4*ac)son, M.D. Mar(!n M.
    An(ony, P.D. Dav!d Bar"o#, P.D. *.
    ,a!"e Bec), P.D. De'ora C. Be!de",
    P.D. To%as Bor)ovec, P.D. Br!an
    Co<, P.D. *ona(an R.T. Dav!dson,
    M.D. Ma((e# *. Fr!ed%an, M.D.,
    P.D.
    1ayne -a(on, M.D. M!cae" R.
    L!e'o#!(/,M.D. R. Br+ce Lyd!ard,
    P.D., M.D. R!card *. McNa""y,
    P.D. Pe(er P. Roy4B!rne, M.D.
    Pa+"a P. Scn+rr, P.D. Man+e"
    Tancer, M.D. S(even Tay"or, P.D.
    Con&ilierii Grupului $e Lu#ru
    pentru revi)uirea te,tului Deliriu"ului2 De"en!ei2
    Tul-ur(rilor A"ne&ti#e Ei al Altor Tul-ur(ri Co/nitive2
    Ei al Tul-ur(rilor Mentale Datorate
    Pnei Con$i!ii Me$i#ale Generale
    1!""!a% Bre!('ar(, M.D. Ben@a%!n L!&(/!n, M.D.
    Mar(!n Co"e, M.D. *aco'o E. M!n(/er, M.D.
    San.ord F!n)e", M.D. M!cae" -. Po&)!n, M.D.
    Marsa"" Fo"s(e!n, M.D. Pe(er 3. Ra'!ns, M.D.
    I$or ,ran(, M.D. ,ary 1. S%a"", M.D.
    *a%es Levenson, M.D. Fr!edr!c S(!e.e", M.D.
    S+san Lev)o.., Sc.D. ,ary *. T+c)er, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    tul-ur(rilor $ia/no&ti#ate $e re/ul( pentru pri"a $at(
    .n Perioa$a $e Su/ar2 .n Copil(rie &au .n A$ole&#en!(
    Ho#ard A'!)o.., P.D. De'ora C.
    Be!de", P.D. D!ane Beno!(, M.D.
    Bor!s B!r%aer, M.D, Caryn L.
    Car"son, M.D. ,a'r!e""e A. Car"son,
    M.D. Pa+" Fr!c),P.D. Cr!s(o&er
    ,!""'er$, M.D., P.D.
    Lara!ne Mas(ers ,"!dden, P.D.
    P!"!& C. -enda"", P.D, A.B.P.P.
    Ben@a%!n Laey, P.D.
    A"an L!nco"n, M.D.
    3era Loen!n$4Ba+c), M.D.
    Ca(er!ne Lord, P.D.
    Don Lyna%, P.D.
    -e!( McB+rne((, P.D.

    F9F
    F;L Anexa
    g


    ,ary Mes!'ov, P.D. Nancy
    M!nse#, M.D. Sa""y
    O/ono.., P.D. Rea Pa+",
    P.D. *on P!acen(!n!, P.D. *on
    Po%eroy, M.D. Byron Ro+r)e,
    F.R.S.C. B!r M!cae" R+((er, M.D.
    *on E. Sco#a"(er, M.D.
    Lary S!"ver, M.D. L+d#!)
    S/y%ans)!, M.D. D!$'y
    Tan(a%, F.R.C. Psyc. Lorna 1!n$,
    M.D. S+"a 1o".., F.R.C.P. *ose&
    1oo"s(on, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rilor $e Co"porta"ent Ali"entar
    1. S(e#ar( A$ras, M.D. Bar(on
    *. B"!nder, M.D., P.D. Cyn(!a
    M. B+H), P.D. Sco(( Cro#,
    M.D. M!cae" Dev"!n, M.D.
    Cr!s(o&er Fa!r'+rn, M.D.
    Pa+" ,ar.!n)e", M.D. -a(er!ne
    Ha)n!, M.D. Dav!d Her/o$,
    M.D. Hans 1. Hoe), M.D.,
    P.D. *a%es H+dson, M.D.
    Dav!d C. *!%erson, M.D.
    -enne( -end"er, M.D.
    S!n$ Lee, F.R.C. Psyc.
    Marsa D. Marc+s, P.D.
    Mar!on P. O"%s(ead, P.D.
    A"'er( S(+n)ard, M.D.
    Dav!d To'!n, P.D.
    *ane( Treas+re, M.D.
    1a"(er 3andereyc)en, M.D.,P.D.
    *oe" Ma$er, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rilor A%e#tive
    Ha$o& A)!s)a", M.D. Lor! L.
    A"(s+"er, M.D. Ross *.
    Ba"dessar!n!, M.D. *ose&
    Ca"a'rese, M.D. Dav!d L.
    D+nner, M.D. *ose& ,o"d'er$,
    M.D. Pa+" E. -ec), M.D.
    Dan!e" N. -"e!n, P.D. *a%es
    H. -ocs!s, M.D. E""en
    Le!'en"+.(, M.D. La#rence H.
    Pr!ce, M.D. ,re$ory S!%on,
    M.D. Andre# S(o"",M.D.
    -!%'er"y Mon)ers, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rilor $e Per&onalitate
    Ha$o& A)!s)a", M.D. A""en Frances, M.D.
    Ar(+r A"(er%an, P.D. *on ,+nderson, M.D.
    Lee Baer, P.D. Ro'er( Hare, P.D.
    Ro$er B"as.!e"d, P.D. Dan!e" N.-"e!n, P.D.
    Ro'er( Borns(e!n, P.D. Mar@or!e -"e!n, P.D.
    Pa+" Cos(a, P.D. Teodore M!"!on, P.D.
    onsilierii pentru revi(uirea textului
    DSM-IV
    54*


    ,era"d Nes(ad(,M.D. *on
    O"da%, M.D. *oe" Par!s, M.D.
    -a(ar!ne A. P!""!&s,M.D. Pa+"
    P!")on!s, P.D. *a%es Re!c,
    M.D., M.P.H. Lee Ro'!ns, P.D.
    E"sa Ronn!n$s(a%, P.D.
    Me$a% R+(er.ord, P.D. Lar:y
    S!ever,M.D. Ro'er( S&!(/er,
    M.D. T!%o(y Tr+"", P.D. Pe(er
    Tyrer, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rii Di&%ori#e Pre"en&truale
    *ean End!co((, M.D.
    E""en Free%an, P.D.
    *+d!( ,o"d, M.D. Ur!e"
    Ha"'re!c, M.D.
    Bar'ara Parry, M.D
    Dav!d R+'!no#, M.D.
    Nada 5. S(o("and, M.D., M.P.H.
    -!%'er"y Mon)ers, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    tul-ur(rilor $e inter%a!( ale &i&te"elor p&i@iatri#e
    Tul-ur(rile $e A$aptare2 Di&o#iative2 'a#ti#e2
    ale Controlului I"pul&ului &i So"ato%or"e2
    Ei 'a#torii P&i@olo/i#i #are a%e#tea)( Con$i!ia Me$i#al(6
    Dona"d 1. B"ac), M.D. M!cae"
    Bond, -.B. M.B. E"!/a'e( S.
    Bo#%an, M.D. *a%es D.
    Bre%ner, M.D. To%as Mar)a%
    Bro#n, M.D. E(/e" Cardena,
    P.D. P ,ary Cr!s(enson, M.D.
    C. Ro'er( C"on!n$er, M.D. P!"!&
    Coons,M.D. *.A. Co((er!"", M.D.
    A"an *. C+nn!en, M.D. S(+ar(
    E!sendra(, M.D. Dav!d A.
    F!s'a!n Dav!d Fo")s, M.D.
    3!c(or Fornar!, M.D. ,re$ory
    Fr!(/, M.D. Ma"on S. Ha"e, M.D.
    M!cae" *e""!ne), M.D. Ro$er
    -a(o", M.D. Na(an!e" -a(/,
    M.D. R!card -"+.(, M.D, Ro'er(
    Lado+ce+r, P.D. M!ce"
    Le@oye+<, M.D., P.D. Dav!d
    3ea"e, M.D. Ma((! 3!r))+nen,
    M.D., P.D.
    Henry Les!e+r8 P.D.
    Roy Meado#, M.D., F.R.C.P
    Haro"d Mers)ey, D.M., F.R.C.P. EC J
    *+an Me//!c, M.D., P.D.
    F+$en Ne/!ro$"+, P.D.
    !"!& N!nan, M.D,
    R+sse" Por(enoy, M.D.
    Basan( - P+r!, M.A., M.B., B.C!r.
    M.R.C. Psyc. Fran)
    P+(nas%, M.D. R!card
    Ro$ers, P.D. *a%es Rosen,
    P.D. R!card *. Rosen(a",
    M.D. Co"!n A. Ross, M.D.
    Loreen R+$"e, P.D. E"!na
    Saraso"a, M.D. Dan!e" *.
    S(e!n, M.B. Mar"ene
    S(e!n'er$, M.D. Ma+r!ce
    S(e!n'er$, M.D A"an
    S(o+de%!re, M.D. Mar$are(
    S(+'er, M.D. S+san S#edo,
    M.D. E"don T+n)s, M.D.
    To%as N. 1!se
    4+2 Anexa
    g

    Con&ilierii Grupului $e
    S#@i)o%reniei Ei
    Nancy Andreasen, MD., P.D.
    Dav!d Bra.., M.D M!cae"!ne
    Bresnaan, P.D. *!"" M.
    ,o"ds(e!n, P.D. M!cae" ,reen,
    P.D. *on Hs!ao, M.D. R!card
    -ee.e, P.D.
    Lu#ru pentru revi)uirea te,tului
    Altor Tul-ur(ri P&i@oti#e
    Do"ores Ma"as&!na, M.D, M.S.P.H.
    To%as Mc,"asan, M.D. Henry
    Nasra""a, M.D. *+d!( Ra&o&or(,
    M.D. Marc4Andre Roy, M.D. E/ra
    S+sser, M.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rilor Se,uale
    Ray B"ancard, P.D.
    S+san *. Brad"ey, M.D.
    Pe(er Fa$an, P.D.
    R!card ,reen, M.D., *.D.
    S(e&en Lev!ne, M.D.
    He!no F.L. Meyer4'a"'+r$, Dr. rer.na(.
    RA+" Sc!av!, M.D.
    Les"!e Scover, P.D.
    Con&ilierii Grupului $e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rilor $e So"n .
    Rona"d D. Cerv!n, M.D., M.S. *ac) Ed!n$er, P.D. Dav!d *. -+&.er,
    M.D. C"e(e -+s!da, M.D., P.D.
    -enne( L!cs(e!n, P.D. E%%an+e"
    M!$no(, M.D., P.D. T!%o(y H.
    Mon), P.D., D.Sc. Car"es Mor!n,
    P.D. D+en(!n Re$es(e!n, M.D.
    Mar(!n Re!(e, M.D.
    Car"es Reyno"ds, M.D. Leon
    Rosen(a", M.D. M!cae" Sa(e!a,
    M.D. Ed#ard S(e&ans)!, P.D.
    M!cae" Tor&y, M.D. A"e<andros
    3$on(/as, M.D. *a%es 1a"s,
    P.D. *on 1!n)e"%an, M.D.,
    P.D. Py""!s Kee, M.D., P.D.
    Con&ilierii Grupului$e Lu#ru pentru revi)uirea te,tului
    Tul-ur(rilor .n le/(tur( #u o Su-&tan!(
    Enoc ,ord!s, M.D. A. To%as McLe""an, P.D.
    Dav!d ,ore"!), M.D., P.D. Pe(er Na(an, P.D.
    Br!d$e( F. ,ran(, P.D. Br+ce Ro+sanv!""e, M.D.
    De'ora Has!n, P.D. ,eor$e 1oody, M.D.
    A"an Lesner, P.D.
    Index
    A's(!nen=a de s+'s(an=e, 9L5 E9L9J Ve;i, de
    asemenea, s+'s(an=e"e s&ec!.!ce
    d+&7 n+%e
    a'+/ sa+ ne$"!@are, Pro'"e%e de, A'+/+"
    .!/!c a" ad+"(+"+!, H;G A'+/+" .!/!c a"
    co&!"+"+!, H;G A'+/+" se<+a" a" ad+"(+"+!,
    H;G A'+/+" se<+a" a" co&!"+"+!, H;G
    Ne$"!@area co&!"+"+!, H;G A'+/ .!/!c
    E%a"(ra(areaJ de +n ad+"(, H;G de +n co&!",
    H;G A'+/+" se<+a" a" ad+"(+"+!, H;G a"
    co&!"+"+!, H;G A'+/+" de s+'s(an=e, 5FG
    E5FFJ Ve;i, de asemenea, s+'s(an=e"e
    s&ec!.!ce
    d+&7 n+%e Ac(!v!(a(ea
    !n(e"ec(+a"7. Ve;i ac(!v!(a(ea
    !n(e"ec(+a"7 "!%!nar7 ac+"(+ra=!e,
    Pro'"e%7 de, HI5 ada&(are, T+"'+r7r!"e
    de, RHF c+ ar!<!e(a(e, RGL ERG;J c+
    d!s&o/!=!e de&res!v7, RHF ERG;J c+
    &er(+r'are de cond+!(7, RGL ERG;J c+
    d!s&o/!=!e %!<(7, de&res!v7 O!
    an<!oas7, RGL ERG;J c+
    &er(+r'are %!<(7 de e%o=!! s!
    cond+!(7, RGL ERG;J nes&ec!.!ca(7, RGL
    ERG;J ado"escen(+"+!, Co%&or(a%en(+"
    an(!soc!a"
    a", HIL
    ad+"(+"+!, Co%&or(a%en(+" an(!soc!a" a", HIL
    a.ec(!ve, T+"'+r7r!"e, ;IY
    Ve;i, de asemenea, e&!soade"e a.ec(!ve
    Da(ora(e +ne! cond!=!! %ed!ca"e $enera"e,
    H5E &H5H)
    F7r7 a"(7 s&ec!.!ca=!e, I5L
    T+"'+rarea a.ec(!v7 !nd+s7 de o
    s+'s(an=7, ILY EILFJ
    T+"'+r7r!"e '!&o"are, ;G9
    T+"'+r7r!"e de&res!ve, ;RF
    A$o!a.o'!a, I;9 EI;;J
    c+ &an!c7, I;; EII5J
    .7r7 !s(or!c de &an!c7, II5 EII;J
    A)a(!s!a ac+(7,
    !nd+s7 de ne+ro"e&(!ce, H;Y, GLL EGL9J
    a"coo", T+"'+r7r!"e !nd+se de,
    A's(!nen=a, 95Y E95RJ
    A"(e (+"'+r7r!, 95H
    In(o<!ca=!a, 95I E95YJ
    a"coo", T+"'+r7r!"e +/+"+! de,
    A'+/+", 95I
    De&enden=a, 95; a"coo"+",
    T+"'+r7r!"e :n "e$7(+r7 c+,
    F7r7 a"(7 s&ec!.!ca=!e, 99;
    a"$!c7, T+"'+rarea
    Ve;i, de asemenea, (+"'+r7r!"e se<+a"e
    a"$!ce
    asoc!a(7 c+ o cond!=!e %ed!ca"7 $enera"7,
    IFG EYL;J
    asoc!a(7 c+ .ac(or! &s!o"o$!c!, IFG
    asoc!a(7 a(A( c+ o cond!=!e %ed!ca"7
    $enera"7, cA( s! c+ .ac(or! &s!o"o$!c!, IFG
    a"!%en(are, T+"'+rarea de.,. a &er!oade! de
    s+$ar sa+ a %!c!! co&!"7r!!, 5LH E5LGJ
    a"!%en(are s! co%&or(a%en( a"!%en(ar,
    T+"'+r7r!"e de... a"e &er!oade! de s+$ar sa+
    %!c!! co&!"7r!!, 5L;2
    P!ca, 5L; E5LYJ
    R+%!na=!a, 5LY E5LRJ
    T+"'+rarea de a"!%en(are a &er!oade! de
    s+$ar sa+ a %!c!! co&!"7r!!, 5LH E5LGJ
    A"/e!%er, De%en=a de (!&, 5YI E5YHJ
    a%.e(a%!na, T+"'+r7r!"e :n "e$7(+r7 c+., Esa+
    c+ s+'s(an=e s!%!"are a%.e(a%!ne!J 99;
    F7r7 a"(7 s&ec!.!ca=!e, 9;5
    a%.e(a%!na, T+"'+r7r!"e !nd+se de,
    A's(!nen=a, 99H E99GJ
    A"(e (+"'+r7r!, 99G
    In(o<!ca=!a, 99R E99HJ
    a%.e(a%!na, T+"'+r7r!"e +/+"+! de,
    A'+/+", 99Y
    De&enden=a, 99I
    a%nes(!ce, T+"'+r7r!"e
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, 5HY E5HHJ
    F7r7 a"(7 s&ec!.!ca=!e, 5HF
    F;;
    F;I Index


    T+"'+rarea a%nes(!c7 &ers!s(en(7 !nd+s7
    de o s+'s(an=7, 5HH E5HFJ
    A%ne/!a. Ve;i (+"'+r7r!"e a%nes(!ce8
    A%ne/!a d!soc!a(!v7 A%en/!a
    d!soc!a(!v7, Y9L EY9;J A%ne/!a
    &s!o$en7. Ve;i a%ne/!a
    d!soc!a(!v7
    Anore<!a nervoas7, YG; EYGFJ an(!soc!a"7,
    T+"'+rarea de &ersona"!(a(e, HL5
    EHLRJ An<!e(a(ea e<ces!v7 a co&!"7r!e!.
    Ve;i
    an<!e(a(ea $enera"!/a(7 An<!e(a(ea
    $enera"!/a(7 E!nc"+de an<!e(a(ea
    e<ces!v7 a co&!"7r!e!J, IH9 EIHRJ
    An<!e(a(ea de se&arare, 595 E59YJ
    An<!e(a(ea soc!a"7. Ve;i .o'!a soc!a"7
    Ean<!e(a(ea soc!a"7J An<!e(a(ea de
    v!s. 3e/! coO%ar+" an<!oase,
    T+"'+r7r!"e, I9F A$ora.o'!a, I;9
    EI;;J
    .7r7 !s(or!c de &an!c7, II5 EII;J Pan!ca
    c+, I;; EII5J An<!e(a(ea $enera"!/a(7
    E!nc"+de an<!e(a(ea e<ces!v7 a co&!"7r!e!,
    IH9 EIHRJ An<!e(a(ea de se&arare, 595
    E59YJ A(ac+" de &an!c7, I;L EI;9J
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, IHR EIHFJ F7r7 a"(7 s&ec!.!ca=!e,
    IGI Fo'!a soc!a"7 E(+"'+rarea an<!e(a(ea
    soc!a"7J, IYL EIYRJ Fo'!a s&ec!.!c7,
    II; EIIFJ Pan!ca, I;; EIIL4II5J c+
    a$ora.o'!e, I;; EII5J .7r7
    a$ora.o'!e, I;; EIILJ S(res+" ac+(,
    IRF EIH5J S(res+" &os((ra+%a(!c, IR;
    EIRHJ T+"'+rarea an<!oas7 !nd+s7 de
    o
    s+'s(an=7, IHF EIG;J
    T+"'+rarea o'ses!vo4co%&+"s!v7, IYR EIR9J
    an<!o"!(!ce"e, T+"'+r7r!"e :n "e$7(+r7 c+...
    Ve;i (+"'+r7r!"e :n "e$7(+r7 c+ seda(!4
    ve"e, !&no(!ce"e sa+ an<!o"!(!ce"e
    a&(!(+d!n!"or %o(or!!, T+"'+rarea, YR
    T+"'+rarea de de/vo"(are a coordon7r!!,
    YR EYGJ a&(!(+d!n!"or Oco"are,
    T+"'+r7r!"e...
    Ve;i (+"'+r7r!"e de :nv7=are ar(!c+"7r!!,
    T+"'+rarea de de/vo"(are a...
    Ve;i (+"'+rarea .ono"o$!c7 As&er$er,
    T+"'+rarea, GL EGIJ A(ac+" de &an!c7,
    I;L EI;9J a(!&!ce, S&ec!.!can(+" c+
    e"e%en(e... &en(r+ e&!sod+" a.ec(!v, I9L
    EI99J
    A+(!s%+" a(!&!c, GI a+(!s(7,
    T+"'+rarea, HL EHYJ
    Avers!+nea se<+a"7, YI5 EYI9J
    S
    ffffffffffffffffffffffffffffffff
    Ba"'!s%+", RH ERFJ
    '7r'a(+"+!, T+"'+rarea de erec=!e a, YIY EYIHJ
    Da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    YYG EYR5J
    '7r'a(+"+!. T+"'+rarea de or$as% a, YYL EYY9J
    '!&o"are, T+"'+r7r!"e, E;G9J F7r7 a"(7
    s&ec!.!ca=!e, ILL T+"'+rarea '!&o"ar7 I
    Ce" %a! recen( e&!sod de&res!v, ;G9
    E;F5J Ce" %a! recen( e&!sod
    !&o%an!aca",
    ;G9E;GGJ Ce" %a! recen( e&!sod
    %an!aca", ;G9
    E;GFJ
    Ce" %a! recen( e&!sod %!<(, ;G9 E;FLJ
    Ce" %a! recen( e&!sod nes&ec!.!ca(
    ;G9E;GGJ
    E&!sod %an!aca" +n!c, ;G9 E;GGJ T+"'+rarea
    '!&o"ar7 n Ee&!soade de&res!ve %a@ore
    rec+ren(e c+ e&!soade !&o%an!aca"eJ, ;F9
    E;FHJ T+"'+rarea (!c"o(!%!c7, ;FG EILLJ
    'order"!ne, T+"'+rarea de &ersona"!(a(e, HLR
    EH5LJ B+"!%!a nervoas7, YGF
    EYFIJ
    ca.e!na, A's(!nen=a de, HRI EHRYJ
    ca.e!na, T+"'+r7r!"e !nd+se de,
    A"(e (+"'+r7r!, 9;;
    In(o<!ca=!a, 9;9 E9;9J ca.e!na, T+"'+r7r!"e
    :n "e$7(+r7 c+, 9;5
    F7r7 a"(7 s&ec!.!ca=!e, 9;I
    canna'!s, T+"'+r7r!"e !nd+se de,
    A"(e (+"'+r7r!, 9;G
    In(o<!ca=!a, 9;H E9;GJ canna'!s+",
    T+"'+r7r!"e :n "e$7(+r7 c+, 9;I
    F7r7 a"(7 s&ec!.!ca=!e, 9I5
    canna'!s, T+"'+r7r!"e +/+"+! de,
    A'+/+", 9;R
    De&enden=a, 9;R
    ca(a(on!c, Sc!/o.ren!e de (!&, ;5Y E;5RJ
    ca(a(on!c7, T+"'+rarea,
    Da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    5GY E5GHJ ca(a(on!ce, S&ec!.!can(+" c+
    e"e%en(e...
    &en(r+ e&!sod+" a.ec(!v, I5G EI5GJ c!c"are
    ra&!d7, S&ec!.!can(+" c+... &en(r+
    Index
    F;Y


    (+"'+rarea a.ec(!v7, I9H EI9GJ
    c!c"o(!%!c7, T+"'+area, ;FG EILLJ
    c!rcad!an, T+"'+rarea r!(%+"+!... de so%n,
    R99 ER9FJ
    c!rc+%scr!se c+"(+ra", S!ndro%e"e, GFH4FL;
    coca!n7, T+"'+r7r!"e !nd+se de,
    A's(!nen=a, 9IY E9IRJ
    A"(e (+"'+r7r!, 9IR
    In(o<!ca=!a, 9II E9IYJ coca!na,
    T+"'+r7r!"e :n "e$7(+r7 c+, 9I5
    F7r7 a"(7 s&ec!.!ca=!e, 9YL
    coca!n7, T+"'+r7r!"e +/+"+! de,
    A'+/+", 9I;
    De&enden=a, 9I9
    Cod+r!"e ad!=!ona"e, HI;
    D!a$nos(!c sa+ cond!=!e a%Ana(7 &e a<a
    5,HI;
    D!a$nos(!c a%Ana( &e a<a II, HI;
    N!c! +n d!a$nos(!c sa+ cond!=!e &e a<a I,
    HI;
    N!c! +n d!a$nos(!c &e a<a II, HI;
    T+"'+rare %en(a"7 nes&ec!.!ca(7
    Enon&s!o(!c7J HI;
    co$n!(!ve, T+"'+r7r!"e,
    Ve;i, de asemenea, (+"'+r7r!"e a%nes(!ce,
    de"!r!+%+", de%en=a
    Dec"!n+" co$n!(!v :n "e$7(+r7 c+ e(a(ea,
    HIL
    F7r7 a"(7 s&ec!.!ca=!e, 5HF co%&or(a%en(
    a"!%en(ar, T+"'+r7r!"e de, YG;
    Ve;i, de asemenea, (+"'+r7r!"e de
    a"!%en(are a"e &er!oade! de s+$ar sa+
    a"e %!c!! co&!"7r!!
    Anore<!a nervoas7, YG; EYGFJ
    B+"!%!a nervoas7, YGF EYFIJ
    F7r7 a"(7 s&ec!.!ca=!e, YFI
    Co%&or(a%en(+" an(!soc!a"
    a" ad+"(+"+!, HIL
    a" co&!"+"+! sa+ ado"escen(+"+!, HIL
    co%&or(a%en( d!sr+&(!v, T+"'+r7r!"e de,
    3e/! (+"'+r7r!"e de co%&or(a%en(
    d!sr+&(!v s! de de.!c!( de a(en=!e
    co%+n!care, T+"'+r7r!"e de, YG
    Ba"'!s%+", RH ERFJ
    F7r7 a"(7 s&ec!.!ca=!e, RF
    T+"'+rarea .ono"o$!c7, RY ERRJ
    T+"'+rarea de "!%'a@ e<&res!v, YG ER5J
    T+"'+rarea %!<(7 de "!%'a@ e<&res!v s!
    rece&(!v, R9 ERIJ E+ne!J
    cond!=!! %ed!ca"e $enera"e
    De"!r!+% da(ora(, 5I5 E5I;J
    De%en=7 da(ora(7, 5YI45YG
    D!s.+nc=!e se<+a"7 da(ora(7, YYG EYR5J
    Mod!.!care de &ersona"!(a(e da(ora(7, 5GH
    E5FLJ
    Pro'"e%7 de re"a=!e :n "e$7(+r7 c+ o, H;H
    T+"'+rare a.ec(!v7 da(ora(7, IL5 EILIJ
    T+"'+rare a"$!c7 asoc!a(7 c+ o, IFGEYL;J
    T+"'+rare a%nes(!c7 da(ora(7, 5HY E5HHJ
    T+"'+rarea an<!oas7 da(ora(7, IHR EIHFJ
    T+"'+rare ca(a(on!c7 da(ora(7, 5GY E5GHJ
    T+"'+rare %en(a"7 da(ora(7, 5G5
    T+"'+rare %en(a"7 .7r7 a"(7 s&ec!.!ca=!e
    da(ora(7, 5FL
    T+"'+rare &s!o(!c7 da(ora(7, ;;I E;;GJ
    T+"'+rare de so%n da(ora(7, RY5 ERYIJ
    cond+!(7, T+"'+rarea de, F; EFGJ convers!e,
    T+"'+rarea de, IF9 EIFGJ coordon7r!!.
    T+"'+rarea de de/vo"(are a, YR
    EYGJ co&!"7r!e!, T+"'+rarea de/!n(e$ra(!v7
    a, HH
    EHFJ
    co&!"+"+!, Co%&or(a%en(+" an(!soc!a" a",HIL
    co&!"+"+! sa+ ado"escen(+"+!,
    Co%&or(a%en(+" an(!soc!a" a", HIL
    CoO%ar+", R;5 ER;IJ Cre+(/.e"d(4*a)o',
    De%en=7 da(ora(7 %a"ad!e!, 5RR E5RGJ
    cron!c, S&ec!.!can(+" de... &en(r+ e&!sod+"
    de&res!v %a@or, I5H EI5HJ cron!c, T!c+"
    %o(or sa+ voca", 55I E55YJ
    Dec"!n+" co$n!(!v :n "e$7(+r7 c+ e(a(ea, HIL
    de.!c!( de a(en=!e s! co%&or(a%en( d!sr+&(!v,
    T+"'+r7r!"e de, GY T+"'+rarea de
    co%&or(a%en( d!sr+&(!v
    .7r7 a"(7 s&ec!.!ca=!e, 5L; T+"'+rarea de
    cond+!(7, F; EFGJ T+"'+rarea
    !&erac(!v!(a(eXde.!c!( de a(en=!e, GY EF9J
    (!& co%'!na(, GH EF;J (!& &redo%!nan(
    !%&+"s!v4!&erac(!v,
    GH EF;J
    (!& &redo%!nan( !na(en(, GH EF;J
    T+"'+rarea !&erac(!v!(a(eXde.!c!( de
    a(en=!e .7r7 a"(7 s&ec!.!ca=!e, F;
    T+"'+rarea o&o/!=!on!s%+" &rovoca(or
    5LL E5L9J
    de.!c!( de a(en=!eX!&erac(!v!(a(e,
    T+"'+rarea, GY EF9J
    F7r7 a"(7 s&ec!.!ca=!e, F;
    de"!ran(7, T+"'+rarea, ;9; E;9FJ
    De"!r!+%, 5;R
    da(ora( +ne! cond!=!! %ed!ca"e $enera"e,
    5I5 E5I;J
    da(ora( +nor e(!o"o$!! %+"(!&"e, 5IR O IH?
    .7r7 a"(7 s&ec!.!ca=!e, 5IH !nd+s de o
    s+'s(an=7, 5I; E5IY45IRJ
    F;R Index

    De"!r!+%+", de%en=a, (+"'+r7r!"e a%nes(!ce
    s! a"(e (+"'+r7r! co$n!(!ve, De"!r!+%+",
    5;R De%en=a, 5IH
    T+"'+rarea co$n!(!v7 .7r7 a"(7
    s&ec!.!ca=!e, 5GL
    T+"'+r7r!"e a%nesr!ce, 5H9
    De%en=a, 5IH
    da(ora(7 a"(or cond!=!! %ed!ca"e $enera"e
    5R9,5RH E5RGJ
    %a"ad!a Cre+(/.e"d(4*a)o', 5RR E5RGJ
    %a"ad!a HT3, 5R; E5RGJ %a"ad!a
    H+n(!n$(on, 5RY E5RGJ %a"ad!a
    Par)!nson, 5RI E5RGJ %a"ad!a P!c),
    5RYE5RGJ (ra+%a(!s%+" cran!an, 5RI
    E5RGJ da(ora(7 +nor e(!o"o$!! %+"(!&"e,
    5HL
    E5H5J de%en=a &ers!s(en(7 !nd+s7
    de o
    s+'s(an=7, 5RG E5HLJ de (!& A"/e!%er,
    5YI E5YHJ .7r7 a"(7 s&ec!.!ca=!e, 5H5
    vasc+"ar7, 5YG E5R5J De%en=a vasc+"ar7, 5YG
    E5R5J de&enden(7, T+"'+rarea de
    &ersona"!(a(e,
    H95 EH9YJ
    De&enden(a de s+'s(an=e, 5F9 E5FHJ Ve;i, de
    asemenea, s+bstan(ele s&ec!.!ce
    d+&7 n+%e
    de&ersona"!/are, T+"'+rarea de, Y;L EY;9J
    de&res!v %a@or, E&!sod+", ;IF E;YRJ
    de&res!v7, T+"'+rarea de &ersona"!(a(e, HGG
    EHGFJ
    de&res!ve, T+"'+r7r!"e F7r7 a"(7
    s&ec!.!ca=!e, ;G5 T+"'+rarea
    d!s(!%!c7, ;HH E;GLJ T+"'+rarea
    de&res!v7 %a@or7, ;RF E&!sod +n!c,
    ;RF E;HYJ Rec+ren(7, ;RF E;HRJ
    de/or$an!/a(, Sc!/o.ren!e de (!&, ;5I E;5YJ
    de/vo"(are, T+"'+r7r!"e de, Ve;i (+"'+r7r!"e
    de :nv7=are, re(ardarea %en(a"7, (+"'+r7r!"e
    de de/vo"(are &ervas!ve D!a$nos(!c a%Ana(
    &e a<a II, HI; D!a$nos(!c sa+ cond!=!e
    a%Ana(7 &e a<a I,
    HI;
    D!sca"c+"!a ET+"'+rarea de ca"c+"J, Y; EYIJ
    D!s$ra.!a ET+"'+rarea e<&res!e! $ra.!ceJ, YI
    EYRJ D!s)!ne/!a
    (ard!v7,
    !nd+s7 de ne+ro"e&(!ce, H;R, GL; EGLYJ
    D!s"e<!a2ET+"'+rare de c!(!(J, Y5 EY;J
    d!s%or.!c7 cor&ora"7, T+"'+rarea, YLHTY5LJ
    d!soc!a(!ve, T+"'+r7r!"e, Y5F A%ne/!a
    d!soc!a(!v7, Y9L EY9;J F7r7 a"(7
    s&ec!.!ca=!e, Y;9 F+$a d!soc!a(!v7, Y9;
    EY9RJ T+"'+rarea de !den(!(a(e
    d!soc!a(!v7, Y9R
    EY9FJ
    T+"'+rarea de de&ersona"!/are, Y;L EY;9J
    D!s&are+n!e,
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    YYG EYR5J neda(ora(7 +ne! cond!=!!
    %ed!ca"e
    $enera"e, YYI EYYRJ
    D!sso%n!!"e, YFF
    F7r7 a"(7 s&ec!.!ca=!e, R9F H!&erso%n!e
    &r!%ar7, RLI ERLFJ Inso%n!e &r!%ar7,
    YFF ERLIJ Narco"e&s!e, RLF ER5YJ
    T+"'+rarea r!(%+"+! c!rcad!an de so%n,
    R99 ER9FJ T+"'+rare de so%n :n
    "e$7(+r7 c+
    res&!ra=!a, R5Y ER99F
    d!s(!%!c7, T+"'+rarea, ;HH E;GLJ
    Cr!(er!+" B de cerce(are a"(erna(!v, HHI
    EHHYJ
    D!s(on!a ac+(7,
    !nd+s7 de ne+ro"e&(!ce, H;Y, HFG EGLLJ
    Do"!+", HIL Dor!n=a se<+a"7 red+s7, Y;F
    EYI5J
    da(ora(7 +ne! cond!=!! %ed!ca"e $enera"e,
    YYG EYR5J dor!n=e!
    se<+a"e, T+"'+r7r!"e
    Dor!n=a se<+a"7 red+s7, Y;F EYI5J
    da(ora(7 +ne! cond!=!! %ed!ca"e
    2 $enera"e, YYG EYR5J
    Avers!+nea se<+a"7, YI5 EYI9J
    E.ec(e"e adverse a"e %ed!ca%en(e"or .7r7
    a"(7 s&ec!.!ca=!e, H;R E@ac+"area &recoce,
    YY9 EYYIJ e"!%!nare, T+"'+r7r!"e de. Ve;i
    enco&re/!s+"8
    en+re/!s+"
    Enco&re/!s+"
    c+ cons(!&a=!e O! !ncon(!nen=7 &r!n
    &rea&"!n, 55R E55GJ .7r7 cons(!&a=!e
    s! !ncon(!nen=7 &r!n
    &rea&"!n, 55R E55GJ En+re/!s+"
    Eneda(ora( +ne! cond!=!!
    %ed!ca"e $enera"eJ, 55G E595J
    E&!soade"e a.ec(!ve
    E&!sod+" de&res!v %a@or, ;IF E;YRJ
    E&!sod+" !&o%an!aca", ;RY E;RGJ
    E&!sod+" %an!aca", ;YH E;R9J
    E&!sod+" %!<(, ;R9 E;RYJ
    Index
    4+8


    erec=!e a '7r'a(+"+!, T+"'+rarea de, YIY
    EYIHJ da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e,
    YIY EYIHJ
    E(!o"o$!! %+"(!&"e
    De"!r!+% da(ora( +nor, 5IR E5IHJ
    De%en=7 da(ora(7 +nor, 5HL E5H5J
    ev!(an(7, T+"'+rarea de &ersona"!(a(e,
    H5G EH95J
    evo"+=!e "on$!(+d!na"7, S&e(!.!can=!! de, Ec+
    s! .7r7 rec+&erare !n(ere&!sod!c7 co%&"e(7J,
    &en(r+ (+"'+r7r!"e a.ec(!ve, I9I EI9YJ
    e<c!(a=!e, T+"'+r7r!"e de,
    Ve;i (+"'+r7r!"e de e<c!(a=!e se<+a"7
    e<c!(a=!e se<+a"7, T+"'+r7r!"e de,
    T+"'+rarea de erec=!e a '7r'a(+"+!, YIY EYIHJ
    da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, YYG EYR5J T+"'+rarea de
    e<c!(a=!e se<+a"7 a .e%e!!
    YI; EYIIJ
    E<!'!=!on!s%+", YRF EYRFJ e<&res!e!4
    $ra.!ce, T+"'+rarea, YI EYRJ
    .ac(!ce, T+"'+r7r!"e,
    c+ se%ne O! s!%&(o%e &redo%!nan(
    &s!o"o$!ce, Y5I EY5HJ
    c+ se%ne s! s!%&(o%e &redo%!nan(
    so%a(!ce, Y5I EY5HJ
    c+ se%ne O! s!%&(o%e &s!o"o$!ce s!
    so%a(!ce co%'!na(e, Y5Y EY5HJ
    .7r7 a"(7 s&ec!.!ca=!e, Y5H .ac(!ce &r!n
    &roc+r7, T+"'+rarea, HG5 EHG;J Fac(or!!
    &s!o"o$!c! care a.ec(ea/7 cond!=!a
    %ed!ca"7, H;5 EH;IJ
    .7r7 a"(7 s&ec!.!ca=!e,
    De"!r!+%, 5IH
    De%en=7, 5H5
    D!s.+nc=!e se<+a"7, YRY
    D!sso%n!e, R9F
    E.ec(e adverse a"e %ed!ca%en(e"or, H;R
    Para.!"!e, YHR
    Paraso%n!e, RII
    Pro'"e%7 re"a=!ona"7, H;H
    T!c, 55R
    T+"'+rare a.ec(!v7, I5L
    T+"'+rare a%nes(!c7, 5HF
    T+"'+rare an<!oas7, IGI
    T+"'+rare '!&o"ar7, ILL
    T+"'+rare co$n!(!v7, 5GL
    T+"'+rare de co%&or(a%en( a"!%en(ar,
    YFI
    T+"'+rare de co%&or(a%en( d!sr+&(!v, 5L;
    T+"'+rare de co%+n!care, RF T+"'+rare a
    con(ro"+"+! !%&+"s+"+!, RHH T+"'+rare de
    de/vo"(are &ervas!v7
    E!nc"+s!v a+(!s%+" a(!&!cJ, GI
    T+"'+rare de&res!v7, ;G5 T+"'+rare
    d!soc!a(!v7, Y;9 T+"'+rare .ac(!ce,
    Y5H T+"'+rare
    !&erac(!v!(a(eXde.!c!( de
    a(en=!e, F;
    T+"'+rare de !den(!(a(e se<+a"7, YG9
    T+"'+rare de :nv7=are, YR T+"'+rare :n
    "e$7(+r7 c+ a"coo"+", 99; T+"'+rare :n
    "e$7(+r7 c+ a"(7 s+'s(an=7
    Esa+ c+ o s+'s(an=7 nec+nosc+(7J, 9FY
    T+"'+rare :n "e$7(+r7 c+ a%.e(a%!na,
    9;5
    T+"'+rare :n "e$7(+r7 c+ ca.e!na, 9;I
    T+"'+rare :n "e$7(+r7 c+ canna'!s+",9I5
    T+"'+rare :n "e$7(+r7 c+ coca!na, 9YL
    T+"'+rare :n "e$7(+r7 c+ a"+c!no$ene"e,
    9YH
    T+"'+rare :n "e$7(+r7 c+ !na"an(e"e, 9R;
    T+"'+rare :n "e$7(+r7 c+ n!co(!n7, 9RF
    T+"'+rare :n "e$7(+r7 c+ o&!acee"e, 9HH
    T+"'+rare :n "e$7(+r7 c+ &encyc"!d!na
    Esa+ c+ o s+'s(an=7 s!%!"ar7
    &encyc"!d!ne!J, 9G; T+"'+rare :n
    "e$7(+r7 c+ seda(!ve"e, !&no(!ce"e sa+
    an<!o"!(!ce"e, 9F; T+"'+rare %en(a"7
    da(ora(7 +ne! cond!=!!
    %ed!ca"e $enera"e, 5FL T+"'+rare
    de %!Ocare !nd+s7 de
    %ed!ca%en(e, H;R, GLH T+"'+rare
    a &er!oade! de s+$ar, a
    co&!"7r!e! sa+ a ado"escen=e!, 5;I
    T+"'+rare de &ersona"!(a(e, H9F T+"'+rare
    &s!o(!c7, ;I; T+"'+rare se<+a"7, YG9
    T+"'+rare so%a(o.or%7, Y55 .e%e!!,
    T+"'+rarea de or$as% a, YIH EYIFJ .e%e!!,
    T+"'+rarea de e<c!(a=!e se<+a"7 a,
    YI; EYIIJ
    Fe(!O!s%+", YRF EYHLJ
    Transves(!c, YHI EYHYJ F"as'ac)s. Ve;i
    (+"'+rarea de &erce&=!e
    a"+c!no$en7 &ers!s(en(7E."as'ac)sJ
    Fo'!a s!%&"7. Ve;i .o'!a s&ec!.!c7 Fo'!a
    soc!a"7 Ean<!e(a(ea soc!a"7J, IYL EIYRJ Fo'!a
    s&ec!.!c7, II; EIIFJ Fo"!e a de+<. Ve;i
    (+"'+rarea &s!o(!c7
    !nd+s7 E:%&7r(7O!(7J,
    .ono"o$!c7, T+"'+rarea, RY ERRJ
    Fro((e+r!s%+", YHL EYHLJ F+$a.
    Ve;i .+$a d!soc!a(!v7
    F;G Index

    F+$a d!soc!a(!v7, Y9; EY9RJ
    F+$a &s!o$en7. Ve;i .+$a d!soc!a(!v7
    Lffffffffffffffffffffffffffffff
    a'!(+d!neXs(ereo(!&!e, T+"'+rarea
    Ve;i (+"'+rarea de %!Ocare s(er!M(.&A
    a+c!no$ene, T+"'+r7r!"e !nd+se de, A"(e
    (+"'+r7r!, 9YI In(o<!ca=!, 9Y9 E9Y;J T+"'+rare
    de &erce&=!e &ers!s(en(7
    a"+c!no$en7 E."as'ac)sJ, 9Y; E9YIJ
    a"+c!no$ene, T+"'+r7r!"e +/+"+! de,
    A'+/+", 9Y9 De&enden=a, 9Y5
    a"+c!no$ene"e, T+"'+r7r!"e :n "e$7(+r7 c+,
    .7r7 a"(7 s&ec!.!ca=!e, 9YH H!&erac(!v!(a(e.
    Ve;i (+"'+rarea !&erac(!4
    v!(a (eXde.!c!( dea(en=!e
    !&erac(!v!(a(eXde.!(!( de a(en=!e,
    T+"'+rarea GY EF9J
    .7r7 a"(7 s&ec!.!ca=!e, F;
    H!&erso%n!e
    !nd+s7 de o s+'s(an=7, RYY ERRLJ
    :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7,
    RIY ERYLJ
    &r!%ar7, RLI ERLF
    !&no(!ce"e, T+"'+r7r!"e :n "e$7(+r7 c+, Ve;i
    (+"'+r7r!"e :n "e$7(+ra c+ seda(!ve"e,
    !&no(!ce"e sa+ an<!o"!(!ce"e
    H!&ocondr!a, YLI EYLHJ !&o%an!aca",
    E&!sod+", ;RY E;RGJ !s(r!on!ca, T+"'+rarea
    de &ersona"!(a(e,
    H55 EH5IJ
    HI3, Ma"ad!a
    De%en=a da(ora(7, 5R; E5RGJ
    H+n(!n$(on, Ma"ad!a
    De%en=a da(ora(7, 5RY E5RGJ
    @]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    !den(!(a(e, Pro'"e%7 de, HI5 !den(a(e,
    T+"'+r7r!"e de, Ve;i (+"'+rarea de !den(!(a(e
    d!soc!a(!v7, (+"'+rarea de !den(!(a(e se<+a"7
    !den(a(e d!soc!a(!v7, T+"'+rarea de, Y9R EY9FJ
    !den(a(e se<+a"7, T+"'+rarea de, YHR EYG5J
    "a ado"escen=! sa+ ad+"=!, YG5
    "a co&!!, YG5
    .7r7 a"(7 s&ec!.!ca=!e, YG9 !%&+"s+"+!,
    T+"'+r7r!"e con(ro"+"+!.
    nedas!.!ca(e :n a"(7 &ar(e, RR;
    .7r7 a"(7 s&ec!.!ca=!e, RHH
    *oc+" de Oans7 &a(o"o$!c, RH5 ERHIJ
    -"e&(o%A%a, RRH ERRFJ
    P!ro%an!a, RRF ERH5J
    Tr!co(!"o%an!a, RHI ERHHJ
    T+"'+rarea e<&"o/!v7 !n(er%!(en(7, RR;
    ERRHJ !nd+s7 E:%&7r(7O!(7J, T+"'+rarea
    &s!o(!c7,
    ;;9 E;;IJ !na"an(e, T+"'+r7r!"e
    !nd+se de,
    A"(e (+"'+r7r!, 9RL
    In(o<!ca=!a, 9YF E9RLJ !na"an(e,
    T+"'+r7r!"e +/+"+! de
    A'+/+", 9YF
    De&enden=a, 9YG !na"an(e"e, T+"'+r7r!"e
    :n "e$7(+r7 c+, 9YH
    .7r7 a"(7 s&ec!.!ca=!e, 9R;
    Inso%n!e,
    !nd+s7 de o s+'s(an=7, RYY ERRRJ
    :n "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7,
    RIYERYLJ
    &r!%ar7, YFF ERLIJ !n(er%!(en(7.
    T+"'+rarea e<&"o/!v7,
    RR;ERRHJ
    In(o<!ca=!a, 5FF E9L5J
    Ve;i, de asemenea, s+'s(an=e"e s&ec!.!ce
    d+&7 n+%e
    :nv7=are, T+"'+r7r!"e de,
    D!sca"c+"!a, Y; EYIJ
    D!s$ra.!a, YI EYRJ
    D!s"e<!a, Y5 EY;J
    F7r7 a"(7 s&ec!.!ca=!e, YR
    Nfffffffffffffffffffffffffffffffffffff
    *oc+" de Oans7. Ve;i @oc+" de Oans7
    &a(o"o$!c,
    -"e&(o%an!a, RRH ERRFJ
    "!%'a@ e<&res!v, T+"'+rarea de, YG ER5J
    "!%!nar7, F+nc=!onare !n(e"ec(+a"7, HIL
    M]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
    %a@or, E&!sod+" de&res!v, ;IF E;YRJ
    s&er!.!can(+" cron8,BN EI5HJ
    s&er!.!can=!! se*eritate1psi-otic1
    re%!s!+ne, I55 EI5;J
    %a@or7. T+"'+rarea de&res!v7,
    E&!sod +n!c, ;RF E;HRJ
    Rec+ren(7, ;RF E;HYJ
    Ma"(ra(area
    ad+"(+"+!
    co&!"+"+!,
    Index
    F;F

    %an!aca", E&!sod+", ;YH E;R9J
    S&ec!.!can=!! se*eritate1psi-otic1remisi+ne
    I5; EI5YJ
    Masoc!s%+" se<+a", YH9 EYH;J %Anca(
    co%&+"s!v, T+"'+rarea de, HGY EHGHJ
    %ed!ca%en(e, T+"'+rarea !nd+s7 de,
    E.ec(e"e adverse a"e %ed!ca%en(e"or .7r7
    a"(7 s&ec!.!ca=!e, H;R %ed!ca%en(e,
    T+"'+r7r!"e de %!Ocare !nd+se de, H;I,HF5
    A)a(!s!a ac+(7 !nd+s7 de ne+ro"e&(!ce
    H;Y, GLL EGL9J
    D!s)!ne/!a (ard!v7 !nd+s7 de
    ne+ro"e&(!ce, H;R,GL; EGLYJ D!s(on!a
    ac+(7 !nd+s7 de ne+ro"e&(!ce,
    H;Y, HFG EGLLJ
    F7r7 a"(7 s&ec!.!ca=!e, H;R, GLH
    Par)!nson!s%+" !nd+s de ne+ro"e&(!ce,
    H;Y, HF9 EHFYJ S!ndro%+" ne+ro"e&(!c
    %a"!$n, H;Y, HFY
    EHFGJ
    Tre%or+" &os(+ra", H;R,GLY EGLHJ
    %e"anco"!ce, S&ec!.!can(+" c+ e"e%en(e,
    &en(r+ e&!sod+" a.ec(!v, I5F EI9LJ %en(a"7,
    T+"'+rare, .7r7 %a"(a s&ec!.!ca=!e I da(ora(7
    +ne! cond!=!! %ed!ca"e $enera"e,
    5FL
    %!nor7, T+"'+rare de&res!v7, HHY EHHHJ
    %!Ocare s(ereo(!&7, T+"'+rarea de, 5;5 E5;IJ
    %!<(, E&!sod+", ;R9 E;RYJ N
    s&ec!.!can=!! sever!(a(e X&s!o(!cX re%!4
    s!+neIjYEEI5RJ
    %!<(7, T+"'+rarea, de&res!v4an<!oas7, HGL EHG5J
    %!<(7, T+"'+rarea, de "!%'a@ e<&res!v s!
    rece&(!v, R9 ERIJ
    %odera(7, Re(ardarea %en(a"7, I; EIFJ
    Mod!.!carea de &ersona"!(a(e da(ora(7 +ne!
    cond!=!! %ed!ca"e $enera"e, 5GH E5FLJ
    %o(or, T!c+"... sa+ voca" cron!c. Ve;i (!c+"
    %o(or sa+ voca" cron!c %+"(!!n.arc(,
    De%en=a. Ve;i de%en=a
    vasc+"ar7 %+"(!&"7, T+"'+rare de
    &ersona"!(a(e. Ve;i
    (+"'+rarea de !den(!(a(e d!soc!a(!v7
    M+(!s%+" e"ec(!v. Ve;i %+(!s%+" se"ec(!v
    M+(!s%+" se"ec(!v, 59Y E59HJ
    F . .J .............
    ..........
    narc!s!s(!c7, T+"'+rarea de &ersona"!(a(e,
    H5I EH5HJ
    Narco"e&s!a, RLF ER5YJ ned!.eren=!a(,
    Sc!/o.ren!e de (!&, ;5R E;5RJ ned!.eren=!a(7,
    T+"'+rarea so%a(o.or%7,
    IFL EIF9J
    Ne$"!@area co&!"+"+!, H;G
    nes&ec!.!ca(7 Enon&s!o(!c7J, T+"'+rarea
    %en(a"7, HI;
    ne+ro"e&(!c %a"!$n, S!ndro%+", H;Y,HFY EHFGJ
    ne+ro"e&(!ce, T+"'+r7r!"e !nd+se de A)a(!s!a
    ac+(7, H;Y,GLL EGL9J D!s)!ne/!a (ard!v7,
    H;R,GL; EGLYJ D!s(on!a ac+(7, H;Y,HFG
    EGLLJ Par)!nson!s%+", H;Y,HF9 EHFYJ
    S!ndro%+" ne+ro"e&(!c %a"!$n, H;Y, HFY
    EHFGJ
    N!c! +n d!a$nos(!c &e a<a II, HI;
    N!c! +n d!a$nos(!c sa+ cond!=!e &e a<a I, HI;
    n!co(!n7, T+"'+r7r!"e :n "e$7(+r7 c+, 9RI F7r7
    a"(7 s&ec!.!ca=!e, 9RF
    n!co(!n7, T+"'+rarea !nd+s7 de,
    A's(!nen=a, 9RY E9RRJ
    n!co(!n7, T+"'+rarea +/+"+! de,
    De&enden=a, 9RI
    Nonco%&"!an=a "a (ra(a%en(, H;F
    o'ses!vo4co%&+"s!v7, T+"'+rarea, IYH EIR9J
    o'ses!vo4co%&+"s!v7, T+"'+rarea de
    &ersona"!(a(e, H9Y EH9FJ o&!acee, T+"'+r7r!"e
    !nd+se de, A's(!nen=a, 9H9 E9H;J A"(e
    (+"'+r7r!, 9HI In(o<!ca=!a, 9H5 E9H9J o&!acee,
    T+"'+r7r!"e +/+"+! de A'+/+", 9H5
    De&enden=a, 9HL o&!acee"e, T+"'+r7r!"e :n
    "e$7(+r7 c+, 9RF
    F7r7 a"(7 s&ec!.!ca=!e, 9HH o&o/!=!on!s%+"
    &rovoca(or, T+"'+rarea, 5LL
    E5L9J or$as%,
    T+"'+r7r!"e de,
    E@ac+"area &recoce, YY9 EYYIJ T+"'+rarea
    de or$as% a .e%e!!, YIH EYIFJ T+"'+rare
    de or$as% a '7r'a(+"+!, YYL
    EYY9J
    Or$as%+" !n!'a( a" '7r'a(+"+!. Ve;i
    (+"'+rarea de or$as% a '7r'a(+"+!
    Or$as%+" !n!'a( a" .e%e!!. Ve;i
    (+"'+rarea de or$as% a .e%e!!
    Pan!ca, I;; EIIL4II;J
    c+ a$ora.o'!e, I;; EIIL4II5J .7r7
    a$ora.o'!e, I;; EIIL4II5J
    Para.!"!!"e, YRR
    E<!'!=!on!s%+", YRF EYRFJ F7r7
    a"(7 s&ec!.!ca=!e, YHR
    FIL Index

    Fe(!O!s%+", YRF EYHLJ Fe(!O!s%+" (ransves(!c,
    YHI EYHYJ Fro((e+r!s%+", YHL EYHLJ
    Masoc!s%+" se<+a", YH9 EYH;J Pedo.!"!a,
    YH5 EYH9J Sad!s%+" se<+a", YH; EYHIJ
    3oye+r!s%+", YHY EYHYJ &arano!d,
    Sc!/o.ren!e de (!&, ;5; E;5IJ &arano!d7,
    T+"'+rarea de &ersona"!(a(e, RFL
    ERFIJ Par)!nson,
    Ma"ad!a
    De%en=a da(ora(7, 5RI E5RGJ
    Par)!nson!s%+"
    !nd+s de ne+ro"e&(!ce, H;Y, HF9 EHFGJ
    Paraso%n!!"e
    CoO%ar+", R;5 ER;IJ F7r7 a"(7 s&ec!.!ca=!e,
    RII So%na%'+"!s%+", R;F ERIIJ Teroare de
    so%n, R;I ER;FJ &as!v4a$res!v7, T+"'+rarea
    de &ersona"!(a(e, ET+"'+rarea de
    &ersona"!(a(e ne$a(!v!s(7J HGF EHF5J
    &a(o"o$!c, *oc+" de Oans7, RH5 ERHIJ
    Pedo.!"!a, YH5 EYH9J2 &ersona"!(a(e,
    T+"'+r7r!"e de, RGY ERGFJ F7r7 a"(7
    s&ec!.!ca=!e, H9F T+"'+rarea de
    &ersona"!(a(e an(!soc!a"7,
    HL5 EHLRJ T+"'+rarea de &ersona"!(a(e
    'order"!ne,
    HLR EH5LJ T+"'+rarea de &ersona"!(a(e
    de&enden(7,
    H95 EH9YJ T+"'+rarea de &ersona"!(a(e
    ev!(an(7,
    H5G EH95J T+"'+rarea de &ersona"!(a(e
    !s(r!on!c7,
    H55 EH5IJ T+"'+rarea de &ersona"!(a(e
    narr!s!s(!c7,
    H5I EH5HJ T+"'+rarea de &ersona"!(a(e
    o'ses!vo4
    co%&+"s!v7, H9Y EH9FJ T+"'+rarea de
    &ersona"!(a(e &arano!d7,
    RFL ERFIJ T+"'+rarea de &ersona"!(a(e
    sc!/o!d7,
    RFI ERFHJ T+"'+rarea de &ersona"!(a(e
    sc!/o(!&a"7,
    RFH EHL5J Pervas!v7, T+"'+rarea de
    de/vo"(are,
    F7r7 a"(7 s&ec!.!ca=!e, GI &ervas!ve,
    T+"'+r7r!"e de de/vo"(are, RF F7r7 a"(7
    s&ec!.!ca=!e E!nc"+/And s!
    a+(!s%+" a(!&!cJ GI T+"'+rarea As&er$er,
    GL EGIJ T+"'+rarea a+(!s(7, HL EHYJ
    T+"'+rarea de/!n(e$ra(!v7 a co&!"7r!e!, HH
    EHFJ
    T+"'+rarea Re((, HR EHHJ &encyd!d!na
    Esa+ o s+'s(an=7 s!%!"ar7
    &encyd!d!ne!J, T+"'+r7r!"e :n "e$7(+r7
    c+,9HG
    F7r7 a"(7 s&ec!.!ca=!e, 9G;
    &encyd!d!n7, T+"'+r7r!"e !nd+se de,
    A"(e (+"'+r7r!, 9G5
    In(o<!ca=!a, 9GL E9G5J &encyd!d!n7,
    T+"'+r7r!"e +/+"+! de
    A'+/+", 9HF
    De&enden=a, 9HF
    P!ca, 5L; E5LYJ P!c),
    Ma"ad!a
    De%en=a da(ora(7, 5RY E5RGJ P!ro%an!a,
    RRF ERH5J &o"!s+'s(an=a, T+"'+rare :n
    "e$7(+r7 c+
    De&enden=a de &o"!s+'s(an=7, 9F;
    &os(con(+/!ona"a, T+"'+rarea, HRL EHR5J
    &os(&ar(+%, S&ec!.!can(+" c+ de'+(...
    &en(r+ e&!sod+" a.ec(!v, I99 EI9;J
    &os(&s!o(!c7, T+"'+rarea de&res!v7... a
    sc!/o.ren!e!, HRH EHRGJ &os(+ra",
    Tre%or+"... !nd+s de %ed!ca%en(e,
    H;R,GLY EGLHJ &recoce E&re%a(+r7J
    E@ac+"area, YY9 EYYIJ &re%ens(r+a"7,
    T+"'+rarea d!s.or!c7,
    HH5 EHHIJ
    &r!%ar7, H!&erso%n!a, RLI ERLFJ
    &r!%ar7, Inso%n!a, YFF ERLIJ
    &r!%are, T+"'+r7r!"e de so%n,
    D!sso%n!!"e, YFG
    Paraso%n!!"e, R;L Pro'"e%7 de .a/7 de
    v!a=7, HI9 Pro'"e%7 &ro.es!ona"7, HI5
    Pro'"e%7 de re"a=!e :n(re .ra=!, H;H
    Pro'"e%7 de re"a=!e c+ &ar(ener+", H;H
    Pro'"e%7 de re"a=!e &7r!n(e4co&!", H;H
    Pro'"e%7 re"!$!oas7 sa+ s&!r!(+a"7, HI5
    Pro'"e%7 Oco"ar7, HI5
    Ve;i, de asemenea, (+"'+r7r!"e de :nv7=are
    Pro'"e%7 s&!r!(+a"7. Ve;i &ro'"e%7
    re"!$!oas7 sa+ s&!r!(+a"7, &roc+r7,
    T+"'+rarea .ac(!ce &r!n, &ro.+nd7,
    Re(ardarea %en(a"7, II EIFJ
    &s!o$en!c7, A%ne/!a. Ve;i a%ne/!a
    d!soc!a(!v7 &s!o"o$!c!, Fac(or!!... care
    a.ec(ea/7
    cond!=!a %ed!ca"7, &s!o(!ce,
    S&ec!.!can=! c+ e"e%en(e,
    E&!sod+" de&res!v %a@or, I55 EI5;J
    E&!sod+" %an!aca", I5; EI5YJ
    E&!sod+" %!<(, I5Y EI5RJ
    &s!o(!ce, T+"'+r7r!"e
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, ;;I E;;GJ
    Index
    4F1

    F7r7 a"(7 s&ec!.!ca=!e, ;I;2 Sc!/o.ren!a,
    9FG E;59J T+"'+rarea de"!ran(7, ;9;
    E;9FJ T+"'+rarea &s!o(!c7 !nd+s7, ;;9
    E;;IJ T+"'+rarea &s!o(!c7 !nd+s7 de o
    s+'s(an=7, ;;G E;I9J T+"'+rarea
    sc!/oa.ec(!v7, ;5F E;9;J T+"'+rarea
    sc!/o.ren!.or%7, ;5H E;5FJ
    reac(!v7, T+"'+rarea... de a(aOa%en( a
    &er!oade! de s+$ar sa+ a %!c!! co&!"7r!!,
    59H E5;LJ rec+ren(7, T+"'+rarea de&res!v7
    sc+r(7,
    HHG EHHFJ
    re"a=!e, Pro'"e%e de, H;R F7r7 a"(7
    s&ec!.!ca=!e, H;H :n "e$7(+r7 c+ o (+"'+rare
    %en(a"7 sa+ c+ o cond!=!e %ed!ca"7
    $enera"7, H;H Pro'"e%7 de re"a=!e
    :n(re2.ra=!, H;H Pro'"e%7 de re"a=!e &7r!n(e4
    co&!", H;H Pro'"e%7 de re"a=!e c+
    &ar(ener+", H;H res&!ra=!a, T+"'+rarea de
    so%n :n "e$7(+r7
    c+, R5Y ER99J
    Re(ardarea %en(a"7, I5 EIFJ
    %odera(7, I; EIFJ
    &ro.+nd7, II EIFJ sever7,
    I; EIFJ
    sever!(a(e nes&ec!.!ca(7, II EIFJ +Ooar7, I;
    EIFJ Re((, T+"'+rarea, HR EHHJ re/!d+a",
    Sc!/o.ren!e de (!&, ;5R E;5HJ r!(% so%n4
    v!$!"!(a(e, T+"'+rare de Ve;i (+"'+r7r!"e de
    r!(% c!rcad!an a"o so%n+"+! R+%!na=!a,
    5LY E5LRJ
    Sad!s%+" se<+a", YH; EYHIJ
    Sca"a de .+nc=!onare a a&7r7r!!, GLH4G5;
    Sca"a ,AF. Ve;i sca"a de eva"+are $"o'a"7 a
    .+nc=!on7r!! Sca"a de eva"+are $"o'a"7 a
    .+nc=!on7r!!
    ESE,FJ, ;I Sca"a de eva"+are $"o'a"7 a
    .+nc=!on7r!!
    soc!a"e s! &ro.es!ona"e ESE,FSPJ, G5H4G5G
    Sca"a de eva"+are $"o'a"7 a .+nc=!on7r!!
    re"a=!ona"e ESE,FRJ, G5I4G5R Sca"a
    SE,FR. Ve;i sca"a de eva"+are
    $"o'a"7 a .+nc=!on7r!! re"a=!ona"e,
    Sca"a SE,FSP. Ve;i sca"a de eva"+are
    $"o'a"7 a .+nc=!on7r!! soc!a"e s!
    &ro.es!ona"e
    sc!/oa.ec(!v7, T+"'+rarea, ;5F E;9;J
    Sc!/o.ren!a,
    Descr!&(or!! d!%ens!ona"! a"(erna(!v!,
    HRY EHRRJ
    (!& ca(a(on!c, ;5Y E;5RJ (!&
    de/or$an!/a(, ;5I E;5YJ (!&
    ned!.eren=!a(, ;5R E;5RJ (!& &arano!d,
    ;5;E;5IJ (!& re/!d+a", ;5R E;5HJ
    Sc!/o.ren!a s! a"(e (+"'+r7r! &s!o(!ce.
    Ve;i (+"'+r7r!"e &s!o(!ce8 sc!/o.ren!a
    sc!/o.ren!.or%7, T+"'+rarea, ;5H E;5FJ
    sc!/o!d7, T+"'+rarea de &ersona"!(a(e,
    RFI ERFHJ sc!/o(!&a"7, T+"'+rarea de
    &ersona"!(a(e,
    RFH EHL5J
    sc+r(7, T+"'+rarea &s!o(!c7, ;9F E;;9J
    seda(!ve, !&no(!ce sa+ an<!o"!(!ce,
    T+"'+r7r!"e !nd+se de, A's(!nen=a, 9GH
    E9GFJ A"(e (+"'+r7r!, 9GF In(o<!ca=!a,
    9GR E9GHJ seda(!ve,. !&no(!ce sa+
    an<!o"!(!ce, T+"'+r7r!"e +/+"+! de,
    A'+/+", 9GR De&enden(a, 9GY
    Seda(!ve"e, T+"'+r7r! :n "e$7(+r7 c+....2 3e/!
    (+"'+r7r!"e :n "e$7(+r7 c+ seda(!ve"e,
    !&no(!ce"e sa+ an<!o"!(!ce"e. seda(!ve"e,
    !&no(!ce"e sa+ an<!o"!(!ce"e, T+"'+r7r!"e :n
    "e$7(+r7 c+, 9GI
    F7r7 a"(7 s&ec!.!ca=!e, 9F; sever7,
    Re(ardare %en(a"7, I; EIFJ sever!(a(e
    nes&ec!.!ca(7, Re(ardare %en(a"7
    de, II EIFJ
    sever!(a!eX&s!o(!cXre%!s!+ne, S&ed.!can=!!...,
    &en(r+
    E&!sod+" de&res!v %a@or, I55 EI5;J E&!sod+"
    %an!aca", I5; EI5YJ E&!sod+" %!<(, I5Y EI5RJ
    se<+a"e, D!s.+nc=!!"e, Y;Y
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, YYG EYR5J
    D!s.+nc=!a se<+a"7 !nd+s7 de o
    s+'s(an=7, YR9 EYRYJ F7r7
    a"(7 s&ec!.!ca=!e, EYRYJ
    T+"'+r7r!"e se<+a"e d+reroase
    D!s&are+n!a
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, YYG EYR5J Neda(ora(7
    +ne! cond!=!! rnedaea(r
    $enera"e YYI EYYRJ
    3a$!n!s%+" Eneda(ora( !
    %ed!ca"e $enera"eJ,C
    FI9 Index

    T+"'+r7r!"e dor!n=e! se<+a"e
    Dor!n=a se<+a"7 red+s7, Y;F EYI5J
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, YYG EYR5J
    Avers!+nea se<+a"7, YI5 EYI9J
    T+"'+r7r!"e de e<c!(a=!e se<+a"7,
    T+"'+rarea de erec=!e a '7r'a(+"+!, YIY EYIHJ
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, YYG EYR5J T+"'+rarea de
    e<c!(a=!e se<+a"7 a .e%e!!,
    YI;EYIIJ
    T+"'+r7r!"e de or$as%
    E@ac+"area &recoce, YY9 EYYIJ T+"'+rarea
    de or$as% a '7r'a(+"+!, YYL
    EYY9J
    T+"'+rarea de or$as% a .e%e!!, YIH EYIFJ
    se<+a"e, T+"'+r7r!"e,
    Ve;i, de asemenea, &ara.!"!!"e, d!s.+nc=!!"e
    se<+a"e,
    F7r7 a"(7 s&ec!.!ca=!e, YG9 se<+a"e,
    T+"'+r7r!"e d+reroase Ea"$!ceJ
    D!s&are+n!a
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, YYG EYR5J Neda(ora(7 +ne!
    cond!=!! %ed!ca"e
    $enera"e, YYI EYYRJ 3a$!n!s%+"
    Eneda(ora( +ne! cond!=!!
    %ed!ca"e $enera"e, YYR EYYGJ
    se/on!er, S&ec!.!can(+" de &a((ern... &en(r+
    (+"'+rarea a.ec(!v7, I9R EI9HJ s!%&"7,
    T+"'+rarea de(er!ora(!v7 Esc!/o.ren!a
    s!%&"7J, HRF EHH5J S!%+"area, H;F
    so%ar!/are, T+"'+rarea de, IGR EIFLJ
    so%a(o.or%e, T+"'+r7r!"e, IGY F7r7 a"(7
    s&ec!.!ca=!e, Y55 H!&ocondr!a, YLI EYLHJ
    T+"'+rarea a"$!c7
    asoc!a(7 c+ o cond!=!e %ed!ca"7
    $enera"7, IFG EYL;J
    asoc!a(7 c+ .ac(or! &s!o"o$!c!, IFG EYL;J
    asoc!a(7 a(A( c+ o cond!=!e %ed!ca"7 cA(
    O! c+ .ac(or! &s!o"o$!c!, IFG EYL;J
    T+"'+rarea de convers!e, IF9 EIFGJ
    T+"'+rarea d!s%or.!c7 cor&ora"7, YLH EY5LJ
    T+"'+rarea de so%a(!/are, IGR EIFLJ
    T+"'+rarea so%a(o.or%7 ned!.eren=!a(7,
    IFL EIF9J so%n,
    T+"'+r7r!"e de, YFH
    Da(ora(7 +ne! cond!=!! %ed!ca"e
    $enera"e, RY5 ERYIJ de (!&
    !&erso%n!e, RY9 ERYIJ de (!&
    !nso%n!e, RY9 ERYIJ de (!&
    %!<(, RY9 ERYIJ .
    de (!& &araso%n!e, RY9 ERYIJ :n
    "e$7(+r7 c+ a"(7 (+"'+rare %en(a"7
    H!&erso%n!a :n "e$7(+r7 c+ a"(7
    (+"'+rare %en(a"7, RIY ERYLJ
    Inso%n!a :n "e$7(+r7 c+ a"(7 (+"'+rare
    %en(a"7, RIY ERYLJ T+"'+r7r!"e
    !nd+se de o s+'s(an=7, RYY
    ERRLJ T+"'+r7r!"e de so%n
    &r!%are,
    D!sso%n!!"e, YFG
    Paraso%n!!"e, R;L So%na%'+"!s%+", R;F
    ERIIJ S&ec!.!can=!! &en(r+ (+"'+r7r!"e
    a.ec(!ve, I5L S&ec!.!can(+" c+ c!c"are ra&!d7,
    I9H EI9GJ S&ed.!car((+" cron!c, I5H EI5HJ
    S&ec!.!can(+" c+ de'+( &os(&ar(+%, I99
    EI9;J
    S&ed.!canr+" c+ e"e%en(e a(!&!ce, I9L EI99J
    S&ec!.!can(+" c+ e"e%en(e ca(a(on!ce,
    I5H EI5GJ S&ed.!canr+" c+ e"e%en(e
    %e"anco"!ce,
    I5F EI9LJ S&ec!.!can(+" c+ &a((ern
    se/on!er, I9R
    EI9HJ S&ec!.!can=!! de evo"+=!e
    "on$!(+d!na"7
    Ec+ s! .7r7 rec+&erare !n(ere&!sod!c7
    co%&"e(7J I9I EI9YJ S&ec!.!can=!!
    sever!(a(eX&s!o(!cXre%!4
    s!+ne &en(r+
    E&!sod+" de&res!v %a@or, I55 EI5;J
    E&!sod+" %an!aca", I5; EI5YJ
    E&!sod+" %!<(, I5Y EI5RJ S(res+" ac+(,
    IRF EIH5J S(res. 3e/! s(res+" ac+( S(res+"
    &os((ra+%ar!c, IR; EIRHJ s+'s(an=7,
    T+"'+r7r!"e !nd+se de o, 5FF Ve;i, de
    asemenea, s+bstan(ele speci)ice
    d+&7 n+%e A's(!nen=a, 9L5 E9L9J
    De"!r!+%+", 5I; E5IY45IRJ De%en=a
    &ers!s(en(7, 5RG E5HLJ D!s.+nc=!a se<+a"7,
    YR9 EYRYJ In(o<!ca=!a, 5FF E9L5J
    T+"'+rarea a.ec(!v7, ILY EILFJ T+"'+rarea
    a%nes(!c7 &ers!s(en(7, 5HH
    E5HFJ
    T+"'+rarea an<!oas7, IHF EIG;J
    T+"'+rarea de &erce&=!e &ers!s(en(7
    a"+c!no$en7 E."as'ac)sJ, 9Y; E9YIJ
    T+"'+rarea &s!o(!c7, ;;G E;I9J T+"'+rarea
    de so%n, RYY ERRLJ s+'s(an=7, T+"'+r7r!"e :n
    "e$7(+r7 c+ o, 4 Ve;i, de asemenea, s+bstan(ele
    speci)ice
    d+&7 n+%e
    Index
    FI;

    A"(e (+"'+r7r! Esa+ (+"'+r7.44.
    nec+nosc+(eJ, 9FY
    s+'s(an=e, T+"'+r7r!"e +/+"+! +ne!, 5F9 Ve;i,
    de asemenea, s+bstan(ele speci)ice d+p6 n+me
    A'+/+", 5FG E5FFJ De&enden=a, 5F9 E5FHJ
    Oco"ar7, Pro'"e%7, HI5 3e/! de asemenea,
    (+"'+r7r!"e de :nv7=are
    Teroarea de so%n, R;I ER;FJ
    T!c+" (ran/!(or, 55Y E55RJ T!c+"
    %o(or sa+ voca" cron!c,
    T!c+r!"e, 5LF
    F7r7 a"(7 s&ec!.!ca=!e, 55R
    T!c+" voca" sa+ %o(or cron!c, 55I E55YJ
    T!c+" (ran/!(or, 55Y E55RJ
    T+"'+rarea To+re((e, 555 E55IJ
    To+re((e, T+"'+rarea, 555 E55IJ
    Transa d!soc!a(!v7, HG; EHGYJ
    (ransves(!c, Fe(!O!s%+", YHI EYHYJ
    Tra+%a(!s%+" cran!an
    De%en=a da(ora(7, 5RI E5RGJ Tre%or+".
    Ve;i (re%or+" &os(+ra", !nd+s de
    %ed!ca%en(e Tr!co(!"o%an!a, RHI ERHHJ
    T+"'+rare a &er!oade! de s+$ar, a co&!"7r!e!
    sa+ ado"escen=e! .7r7 a"(7 s&ec!.!ca=!e 5;I
    T+"'+r7r!"e d!a$nos(!ca(e de re$+"7 &en(r+
    &r!%a da(7 :n &er!oada de s+$ar, :n
    co&!"7r!e sa+ ado"escen=7, ;F
    An<!e(a(ea de se&arare, 595 E59YJ
    M+(!s%+" se"ec(!v, 59Y E59HJ
    Re(ardarea %en(a"7, I5
    T!c+r!"e, 5LF
    T+"'+rare a &er!oade! de s+$ar, a
    co&!"7r!e! sa+ ado"escen=e! .7r7 a"(7
    s&ec!.!ca=!e, 5;I
    T+"'+rarea a&(!(+d!n!"or %o(or!!, YR
    T+"'+rarea de %!Ocare s(ereo(!&7, 5;5
    E5;IJ
    T+"'+rarea reac(!v7 de a(aOa%en( a
    &er!oade! de s+$ar sa+ a %!c!!
    co&!"7r!!, 59H E5;LJ
    T+"'+r7r!"e de a"!%en(are O! de
    co%&or(a%en( a"!%en(ar a"e
    &er!oade! de s+$ar sa+ %!c!o!
    co&!"7r!!, 5L;
    T+"'+r7r!"e de co%+n!care, YG
    T+"'+r7r!"e de co%&or(a%en( d!sr+&(!v
    s! de de.!c!( de a(en=!e, GY
    T+"'+r7r!"e de de/vo"(are &ervas!v7, RF
    T+"'+r7r!"e de e"!%!nare, 55R
    T+"'+r7r!"e de :nv7=are, IF
    .
    +Ooar7, Re(ardarea %en(a"7, I; EIFJ +Ooar7,
    T+"'+rarea ne+roco$n!(!v7, HR9 EHRIJ
    3a$!n!s%+" Eneda(ora( +ne! cond!=!!
    %ed!ca"e $enera"eJ, YYR EYYGJ voca"e,
    T!c+r!"e, Ve;i (!c+" %o(or sa+ voca"
    cron!c 3oye+r!s%+", YHY
    EYHYJ

    a aceea/i editur
    %& (U!S 9$ A6A!#U#$:
    N 6rof. 9r. Aurel !omila B 6S#O#AT!#A2 ed. a 2Ba
    N 9r. <arian 6opa B (AJU #!#&A. A<#&T#!#
    AU <A# A6"!UT:
    V 9r. <arian 6opa B STU9## W# (;&T!#BUU##
    C7r=!"e &o( .! &roc+ra(e &r!n co%and7 (e"e.on!c7 "a (e". LHIYL;FRF9, "a
    adresa ed!(or+"+! Ec+ &"a(a "a &r!%!rea co"e(+"+!JQ Bd. BrAncovean+, nr.
    FH, '". MR, se. H, a&. HG, sec(or I, B+c+reO(! sa+ e4%a!"Q
    &o&a&%aroc%'.ro

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