fsiqiatriaSi gamoyenebuli medikamentebis klasifikacia
saSualebebi dainiSnos mxolod ramdenime dRiT. kli-
nicistma es unda ganumartos pacients da gaafrTxi-
los, rom SesaZloa wamlis Sewyvetas mohyves mousve-
nari Zilis ramdenime Rame, magram wamlis miReba ar
unda gavagrZeloT.
bavSvebisTvis saZileebis daniSvna ar aris gamar-
Tlebuli, garda Ramis SiSebis an somnambulizmis er-
Teuli gamonaklisebisa. sifrTxiliT unda daeniSnoT
saZileebi moxucebs, vinaidan RamiT sawolidan adgo-
misas maT SeiZleba gamoiwvion cnobierebis abneva,
rasac SesaZloa, mohyves sxeulis dazianeba. stacio-
narSi rutinuli gamoyenebis gamo bevri pacienti da-
mokidebuli xdeba saZileebze. sasurvelia, rom aseTi
rutinuli gamoyeneba Sewydes manam, sanam pacients bi-
naze gaweren.
britanuli saxelmZRvanelo principebis mixedviT
(UK National Institute for Clinical Excellence, 2004e) saZi-
le wamlebis miReba SeiZleba mxolod xanmokled,
gamomfitavi insomniis dros. amasTan, zopiklonis,
zolpidemis da zaleplonis gamoyeneba ar aris reko-
mendebuli, radgan ar arsebobs benzodiazepinebTan
maTi upiratesobis maCvenebeli faqtebi; aseve, maTi
maRali fasis gamo.
antifsiqozuri medikamentebi
ase ewodeba wamlebs, romlebic amcirebs fsiqomoto-
rul agznebas da akontrolebs fsiqozur simptomebs.
am preparatebis alternatiuli saxelebia neirolep-
tikebi da didi trankvilizatorebi. arc erTi es ter-
mini ar aris srulyofili. dasaxeleba _ neirolepti-
ki, asaxavs ufro wamlis gverdiT movlenebs da ara mis
Terapiul efeqts, xolo termini `didi trankviliza-
tori~, ar asaxavs maT yvelaze mniSvnelovan klinikur
moqmedebas. mocemul wignSi gamoyenebulia termini
`antifsiqozuri~, romelic britanuli farmacevtuli
cnobaridanaa aRebuli.
antifsiqozuri wamlebi ZiriTadad iniSneba haluci-
naciis, bodvis, aJitaciis da fsiqomotoruli agzne-
bis Sesamcireblad Sizofreniis, maniis an fsiqozis
cxrili 21.4 antifsiqozuri depo-preparatebis zogierTi farmakokinetikuri maxasiaTebeli
depo plazmaSi pikuri
koncentraciis dro (dRe)
flupenTiqsol-dekanoati 7-10
flufenazin-dekanoati 1-2
haloperidol-dekanoati 3-9
pipoTiazin-palmitati 9-10
zuklopenTiqsol-dekanoati 4-7
risperidonis gaxangrZlivebuli 28
moqmedebis inieqcia
adaptirebulia Taylor, 1999.
_ 569 _
dros. aseve, gamoiyeneba Sizofreniis recidivis pro-
filaqtikisTvis. 1952 wels, qlorpromazinis SemoRe-
bis Semdeg, Sizofreniis mkurnaloba mniSvnelovnad
gaumjobesda da gaCnda axali fsiqotropuli wamlebis
aRmoCenis SesaZlebloba, romlebic dReisTvis xelmi-
sawvdomia.
farmakologia
antifsiqozuri wamlebi (cxrili 21.2) axdens dofami-
nis receptorebis blokirebas. es miiCneva maTs Tera-
piul moqmedebad, rac dadasturda in vitro dofaminuri
receptorebis blokirebiT.
dofaminuri receptorebi sxvadasxva bioqimiur da
morfologiur qvetipebad iyofa. antifsiqozuri wa-
mlebis umetesoba mWidro kavSirs qmnis dofamin-D2
receptorTan, rac ganapirobebs antifsiqozur moq-
medebas da moZraobiTi darRvevis warmoSobas. pozi-
tronul-emisiuri tomografiuli (pet) kvlevis mona-
cemebis safuZvelze ivaraudeba, rom antifsiqozuri
efeqti miiRweva maSin, roca D2 receptorebis 60-70%
dakavebulia. ufro maRali donis SemTxvevaSi vlin-
deba eqstrapiramiduli moZraobiTi aSlilobebi da
hiperprolaqtinemia (Kapur et al., 1999).
gansxvaveba tipiur da atipiur antifsiqozur wam-
lebs Soris
termini atipiuri antifsiqozuri preparatebi SemoRe-
buli iqna imisTvis, rom ganesxvavebinaT erTmaneTis-
gan axali antifsiqozurebi iseTi Zveli preparatebis-
gan, rogorebicaa qlorpromazini da haloperidoli.
miuxedavad imisa, rom terminis _ `atipiuri~, gansazR-
vreba literaturaSi sxvadasxvaa, atipiuri antifsi-
qozurebis ZiriTadi maxasiaTebeli aris antifsiqozu-
ri efeqti eqstrapiramiduli gverdiTi moqmedebis ga-
reSe. es ganmarteba namdvilad ar aris srulyofili,
radgan aseTi moqmedeba aqvs, mag., haloperidolsac
sakmaod dabali doziT gamoyenebisas. erTi ram namd-
vilad sworia: atipiur antifsiqozurebs SedarebiT
naklebad aqvT eqstrapiramiduli gverdiTi moqmedeba
stabiluri mdgoma- daniSvnis ekvivalenturi
reobis dro (kvira) sixSire (kvira) doza (mg)
8 2 40
8 2 25
1 2 100
8-12 4 5
8 2 200
6 2 25
21 medikamenturi da sxva fizikuri mkurnaloba
Terapiuli dozebiT gamoyenebis dros.
aseve, iTvleba, rom atipiuri antifsiqozuri wamle-
bi tipiur preparatebTan SedarebiT, ufro metad au-
mjobesebs fsiqozis pozitiur da negatiur simptomebs.
maSin, roca atipiuri antifsiqozuri klozapinis Se-
mTxvevaSi es namdvilad asea, bolo dros warmoebuli
preparatebi am kriteriums ver akmayofilebs. am mxriv
gansakuTrebiT gamoirCeva amisulpiridi, risperidoni
da olanzapini (Davis et al., 2003). aumjobeseben Tu ara
kognitur unarebs Sizofreniis SemTxvevaSi atipiuri
antifsiqozurebi Zvel preparatebze ufro metad, jer
kidev aqtiuri kvlevis procesSia (Mortimer, 2004).
tipiuri (konvenciuri) antifsiqozuri prepa-
ratebis farmakologia
yvela es wamali dofaminis receptorebis efeqturi
antagonistia, magram bevr maTgans aqvs damatebiTi
farmakologiuri Tvisebebi, rac ganapirobebs gver-
diT efeqtebs.
fenoTiazinebi: gamoyofen fenoTiazinebis sam jgufs:
1. aminoalkilis naerTebi, rogoricaa qlorpromazini,
romelic alfa-1-adrenoreceptorebis, histamin-H1-
receptorebis da muskarinuli qolinerguli recep-
torebis antagonistia. alfa-1-adrenoreceptore-
bis da histamin-H1-receptorebis blokadis xarjze
qlorpromazins aqvs sedaciuri moqmedeba, amasTan,
alfa-1-adrenoreceptorebis blokada iwvevs hipo-
cxrili 21.5 antifsiqozuri wamlebis
zogierTi arasasurveli moqmedeba
antidofaminerguli efeqti
moZraobis darRvevebi:
w mwvave distonia
w akaTizia
w parkinsonizmi
w tardiuli diskinezia
antiadrenerguli efeqti
w sedacia
w posturuli hipotenzia
w eakulaciis inhibicia
antiqolinerguli efeqti
w piris simSrale
w ofldenis Semcireba
w Sardvis Sekaveba
w yabzoba
w bundovani mxedveloba
w glaukomis ganviTareba
sxva efeqtebi
w kardiuli ariTmia
w wonis mateba da diabeti
w amenorea
w galaqtorea
w hipoTermia
_ 570 _
tenzias. antiqolinerguli moqmedeba vlindeba pi-
ris simSraliT, Sardvis problemebiT da Sekrulo-
biT, xolo, meores mxriv, amcirebs eqstrapiramidu-
li gverdiTi efeqtis ganviTarebis albaTobas.
2. piperidinis naerTebi, rogorebicaa Tioridazini da
pipoTiazini, qlorpromazinis msgavsia, magram aqvT
Zlieri antimuskarinuli moqmedeba, ris gamoc nak-
lebad axlavT moZraobiTi darRvevebi.
3. piperazinis naerTebi, rogorebicaa trifluopera-
zini an flufenazini, yvelaze metad aris arCeviTad
dofaminuri receptorebis antagonisti, amitom nak-
lebad aqvT sedaciuri da metad _ eqstrapiramidu-
li efeqti.
TioqsanTenebi da butirofenonebi
TioqsanTenebs, rogorebicaa flupenTiqsoli da
klopenTiqsoli, aqvs fenoTiazinis msgavsi struqtu-
ra. Terapiuli efeqti waagavs piperazinis jgufi-
sas. butirofenonebs, maT Soris haloperidols, aqvs
gansxvavebuli struqtura, magram klinikurad Tioq-
sanTenebis msgavsia. isini dofaminis receptorebis an-
tagonistebia da naklebad moqmedebs sxva neirotras-
miterebis receptorebze. ar iwvevs sedacias, magram
xSiria eqstrapiramiduli gverdiTi moqmedeba.
atipiuri antifsiqozuri wamlebis farmakologia
(ix. cxrili 21.3)
seleqciurad D2 receptorebis antagonistebi. ati-
piur antifsiqozur preparatebs aqvT gansxvavebuli
farmakologia. ukanasknel xans gamoyofen 2 jgufs.
erTi esaa benzamidis warmoebulebi, rogorebicaa
sulpiridi da amisulpridi. es wamlebi gansakuTrebu-
li arCeviTobiT moqmedebs rogorc D2 receptorebis
antagonistebi da, dauzustebeli mizezis gamo, nakle-
bad iwvevs eqstrapiramidul moZraobiT darRvevebs;
am medikamentebs arc sedaciuri da antiqolinerguli
moqmedeba axasiaTebs; amasTan, iwvevs plazmaSi prola-
qtinis mniSvnelovan zrdas.
5-Ht2-D2 receptorebis antagonistebi. atipiuri an-
tifsiqozurebis meore did jgufs aqvs 5-HT2 recep-
torebis antagonisturi moqmedeba. sxva mxriv, am jgu-
fSi Semavali preparatebi mniSvnelovnad gansxvavde-
bian erTmaneTisgan, mag., D2 receptorebis blokirebis
unariT (Meltzer, 2004). risperidoni aris rogorc 5-HT2
receptorebis, aseve dofaminis D2 receptorebis an-
tagonisti. mas aseve aqvs alfa-1-adrenoreceptore-
bis blokirebis unari, rac iwvevs msubuq sedacias da
hipotenzias. zotepins risperidonis msgavsi farmako-
logiuri Tvisebebi aqvs, magram SedarebiT naklebia
5-HT2, vidre D2 receptorebze gavlena. mas aseve Zlie-
ri antihistaminuri moqmedeba axasiaTebs, ris gamoc
iwvevs wonaSi matebas.
olanzapini D2 receptorebis SedarebiT susti anta-
 fsiqiatriaSi gamoyenebuli medikamentebis klasifikacia
gonistia, vidre risperidoni, magram aqvs antiqoli-
nerguli da histamin-H1-receptorebis mablokirebeli
moqmedeba. amitom is Zlieri sedaciuri efeqtiT ga-
moirCeva. qvetiapini Tanamedrove 5-HT2 receptorebis
antagonistia SedarebiT sustad gamoxatuli D2 re-
ceptorebis blokirebis unariT. moZraobiTi darRve-
vebic SedarebiT iSviaTad viTardeba.
sertindoli 5-HT2 receptorebis antagonistia
sustad gamoxatuli D2 receptorebis antagonis-
turi moqmedebiT. sertindoli iwvevs klinikurad
mniSvnelovani Q-T intervalis gaxangrZlivebas
eleqtrokardiogramaze da misi gamoyeneba amJamad
SeCerebulia. ziprazidoni aris 5-HT2 da D2 recep-
torebis kidev erTi antagonisti, romlis klinikuri
gamocdac amJamad mimdinareobs. is gansxvavdeba sxva,
zemoT aRwerili 5-HT2/D2 receptorebis antago-
nistebisgan, radgan is, aseve, ukavSirdeba 5-HT1A
receptorebs da aris noradrenalinis ukumitacebis
inhibitori. ziprazidonis maxasiaTebeli gverdiTi
moqmedebaa somnolencia da Tavbrusxveva, magram igi
SedarebiT naklebad iwvevs wonis matebas. mas aqvs
Q-T intervalis gaxangrZlivebis tendencia da ami-
tom britaneTSi klinikur praqtikaSi misi gamoyeneba
akrZalulia. aripiprazoli aris dofaminis nawilo-
brivi agonisti, romelsac aqvs 5-HT2 receptorebis
mablokirebeli unari. mas aqvs gamaaqtivebeli gav-
lena da iseTi dofaminerguli gverdiTi moqmedeba,
rogoricaa insomnia, gulisreva da pirRebineba. is
naklebad iwvevs wonis matebas an eqstrapiramidul
simptomebs.
garkveuli TvalsazrisiT, es atipiuri preparatebi
Seqmnes klozapinis farmakologiuri efeqtis mis-
aRebad. es aris pirveli antifsiqozuri preparati,
romelic iZleva aSkara Sedegebs iseT SemTxvevebSi,
rodesac Cveulebrivi antifsiqozuri preparatebi
araefeqturia. amasTan, mas ar axasiaTebs gverdiTi
eqstrapiramiduli darRvevebi da amitomac miiCneva
atipiur antifsiqozur medikamentad (Kane et al., 1988).
klozapini aris dofaminis D2 receptorebis susti an-
tagonisti, magram aqvs Zlieri swrafva 5-Ht2 recep-
torebisadmi. is aseve ukavSirdeba sxva neirotrans-
miterebis receptorebsac, maT Soris H1-histaminis,
5-HT2, alfa-1-adrenergul da muskarinul qoliner-
gul receptorebs (Meltzer, 2004). sxvadasxva kvlevebSi
miuTiTeben Terapiuli plazmuri koncentraciis sx-
vadasxva cifrebze; misaRebi kompromisia 350-500 μg/l.
is, Tu ra aris klozapinis Zlieri efeqtis farma-
kologiuri safuZveli, bundovania. cnobilia, rom
klozapinis gamoyenebisas maRalia leikopeniis riski,
ris gamoc misi gamoyeneba SezRudulia. klozapiniT
mkurnalobis dros hematologiuri monitoringi ganx-
ilulia qvemoT.
_ 571 _
antifsiqozuri wamlebis gaxangrZlivebuli moq-
medebis formebi
antifsiqozuri wamlebis gaxangrZlivebuli moq-
medebis formebi rekomendebulia im pacientebisT-
vis, romlebsac recidivis prevenciisTvis mudmivad
sWirdebaT antifsiqozuri mkurnaloba, magram maTi
regularuli miReba garantirebuli ar aris. aseTi
`depo~ preparatebia flufenazin-dekanoati, flupen-
Tiqsol-dekanoati, zuklopenTiqsol-dekanoati, ha-
loperidol-dekanoati da pipoTiazin-palmitati. yo-
veli maTgani keTdeba kunTSi da zeTovani xsnaria.
zuklopenTiqsolis acetatis plazmuri koncentraci-
is piki miiRweva 1-2 dReSi da mas aqvs ufro xanmokle
moqmedeba sxva depo-preparatebTan SedarebiT. is
gamoiyeneba mwvave fsiqozis myisieri kontrolisT-
vis, Tumca, is, Tu ra upiratesoba aqvs mas sxva depo-
preparatebTan SedarebiT, dadgenili ar aris. amJamad
xelmisawvdomia risperidonis gaxangrZlivebuli moq-
medebis inieqciac.
farmakokinetika
antifsiqozuri preparatebi kargad absorbirdeba.
peroraluri miRebisas RviZlismieri metabolizmi
nawilobriv sruldeba, roca portuli sistemis gav-
liT preparati sisxlSi gadadis (pirveladi metabo-
lizmi). antifsiqozuri wamlebi advilad ukavSirdeba
cilebs.
amisulpridis garda, romelic ucvlelad gamoiyo-
fa TirkmelebiT, antifsiqozuri medikamentebi aqtiu-
rad metabolizdeba RviZlSi da warmoqmnis sxvadasxva
aqtiur da pasiur metabolitebs. mag., qlorpromazi-
nis micemis Semdeg, sisxlsa da SardSi aRmoCenilia 75
sxvadasxva metaboliti. metabolizmis aseTi sirTule
medikamentis plazmuri koncentraciis gansazRvris
klinikur mniSvnelobas akninebs da amitomac iSviaTad
gamoiyeneba. antifsiqozuri preparatebis umetesobis
naxevar-daSlis dro (daaxloebiT 20 sT) iZleva maTi
dReSi erTjeradad miRebis saSualebas. qvetiapins
aqvs 7-saaTiani naxevar-daSlis dro da rekomendebu-
lia misi dReSi orjeradi miReba.
depo-preparatebis farmakokinetikuri profili mni-
Svnelovnad gansxvavdeba standartuli preparatebis-
gan. yvela nivTierebisTvis, garda zuklopenTiqsolis
acetatisa, saWiroa ramdenime kvira plazmaSi stabi-
luri donis misaRwevad (cxrili 21.4). es niSnavs, rom
mkurnalobis Sewyvetis Semdegac recidivi SedarebiT
gvian viTardeba.
wamlebis urTierTqmedeba
antifsiqozuri wamlebi aZlierebs sxva centralur
sedatiur preparatebs. maT SeiZleba Seanelon tri-
cikluri antidepresantebis da antikonvulsante-
bis RviZlismieri metabolizmi da gamoiwvion maTi
21 medikamenturi da sxva fizikuri mkurnaloba
plazmuri koncentraciis momateba. qlorpromazinis
hipotenziurma efeqtma SeiZleba gaaZlieros antihi-
pertenziuli medikamentebis, maT Soris ACE-inhibi-
torebis, efeqti.
antifsiqozurma wamlebma, kerZod, pimozidma da
Tioridazonma, SeiZleba gamoiwvios Q-t intervalis
gaxangrZliveba, amitomac es medikamentebi ar unda
dainiSnos amave efeqtis mqone sxva wamlebTan, anti-
ariTmiul preparatebTan, astemizolTan da terfena-
dinTan, cisapridsa da triciklur antidepresanteb-
Tan erTad. aRwerilia gulis ariTmiis riskis moma-
teba pimozidis klaritromicinsa da eriTromicinTan
kombinirebisas. klozapini ar unda dainiSnos iseT
preparatTan erTad, romelic amcirebs leikocitebis
raodenobas, mag., karbamazepinTan, kotrimoqsazolsa
da penicilaminTan erTad. susi-ebi anelebs RviZl-
Si metabolizms da zrdis antifsiqozuri wamlebis
plazmur koncentracias, maT Soris haloperidolis,
risperidonisa da klozapinis.
arasasurveli efeqti
sxvadasxva antifsiqozuri wamlebis umetesobas aqvs
saerTo arasasurveli gverdiTi moqmedeba, rac ukav-
Sirdeba maTs antidofaminergul, antiadrenergul da
antiqolinergul moqmedebas (cxrili 21.5). TiToeuli
wamlis moqmedebis gacnoba SesaZlebelia britanul
farmacevtul cnobarSi. aq mocemulia mxolod xSirad
gamoyenebuli wamlebis gverdiTi moqmedebis zogadi
paternebi.
eqstrapiramiduli efeqtebi
aseTi efeqtebi dakavSirebulia bazalur gangliebze
(qerqqveSa kvanZebze) antidofaminergul moqmedebas-
Tan. ukve aRvniSneT, rom am preparatebis antidofa-
minerguli moqmedeba mezolimbur da mezokortikul
ubnebze gansazRvravs maTs Terapiul efeqts. atipiu-
ri preparatebi ufro metad moqmedeben am ukanasknel
velebze, vidre qerqqveSa kvanZebze da moZraobiTi
darRvevebic ufro iSviaTia. eqstrapiramiduli sis-
temis gamovlinebebi iyofa 4 jgufad (Barnes and Spen-
ce, 2000):
1. mwvave distonia _ viTardeba mkurnalobis dawyebi-
dan mokle droSi, upiratesad axalgazrda mamaka-
cebSi. SedarebiT xSiria butirofenonebis da fe-
noTiazinebidan piperazinis jfufis gamoyenebisas.
ZiriTadi niSnebia tortikolizi, enis protruzia,
grimasebi, opistotonusi da sxvadasxva tipis iseTi
qceva, romelic SeiZleba SecdomiT miCneul iqnes
isteriulad. kontroli miiRweva antiqolinerguli
medikamentebis frTxili kunTSiga ineqciiT.
2. akaTizia _ aris fizikuri mousvenrobisa da moZra-
obis survilis usiamovno SegrZneba, rac pacients
ar aZlevs gaCerebis saSualebas. SeiZleba aRiniSne-
_ 572 _
bodes aJitacia suiciduri ideaciiT. akaTizia Sei-
Zleba arasworad miviCnioT fsiqozis gauaresebad
da SecdomiT gavzardoT antifsiqozuri preparatis
doza. Cveulebriv, aseTi efeqti viTardeba mkur-
nalobis dawyebidan pirveli ori kviris manZilze,
Tumca, SeiZleba, ganviTardes ramdenime Tvis Sem-
degac. akaTizia srulad ver kontroldeba antipa-
rkinsonuli wamlebiT. beta-adrenoreceptorebis
antagonistebi da benzodiazepinis xanmokle kursi
SeiZleba efeqturi aRmoCndes. saukeTeso strate-
giaa antifsiqozuri wamlebis dozis SeZlebisdagva-
rad Semcireba.
3. parkinsonuli sindromi _ antifsiqozuri medika-
mentebiT gamowveul parkinsonul sindroms axasia-
Tebs akinezia, saxis amimia, siarulisas asocirebuli
moZraobebis simcire, rigidoba, tlanqi tremori,
moxrili poza da, mZime SemTxvevebSi, specifikuri
aCqarebuli, mokle da patara nabijebiT siaruli. es
sindromi umetesad Tavs iCens mkurnalobis dawye-
bidan ramdenime Tvis Semdeg da zogjer SeiZleba
spontanurad, antifsiqozuri wamlebis dozis Sem-
cirebis gareSec alagdes. simptomebis kontroli
SesaZlebelia antiparkinsonuli wamlebiT. miuxeda-
vad amisa, ar aris rekomendebuli antiparkinsonuli
wamlebis damateba rutinulad, profilaqtikisTvis,
radgan yvela pacientTan ar aris saWiro maTi ga-
moyeneba. amasTan, am tipis wamlebs zogjer arasa-
surveli moqmedebac aqvs _ SeiZleba gamoiwvios,
mag., mwvave organuli sindromi, gaauaresos an ga-
moaaSkaravos Tanmxlebi mogvianebiTi (tardiuli)
diskinezia.
4. tardiuli diskinezia _ sakmaod seriozuli garTu-
lebaa, radgan, sxva eqstrapiramiduli efeqtisgan
gansxvavebiT, antifsiqozuri wamlebis moxsnis Sem-
degac SeiZleba narCundeba. mas axasiaTebs ReWviTi
da woviTi moZraobebi, grimasebi, qoreoaTetozuri
moZraobebi da, iSviaTad, akaTizia. moZraobebi Ziri-
Tadad saxisaa, magram SesaZloa gavrceldes kidu-
rebsa da sasunTq kunTebze. es sindromi SeiZleba
ganviTardes antifsiqozuri medikamentebis miRebis
gareSec, magram ufro xSiria mkurnalobis dawye-
bidan ramdenime wlis Semdeg. igi zogjer SeiZle-
ba ganviTardes dofaminis receptorebis mabloki-
rebeli wamlebis sxva mizniT gamoyenebis drosac,
mag., kuW-nawlavis qronikuli problemebis dros
metoklopramidis miRebis SemTxvevaSi.
epidemiologia. tardiuli diskinezia ufro xSirad
emarTebaT qalebs, asakovan pirebs da im pacientebs,
romlebsac aqvT Tavis tvinis difuzuri paTologia.
guneb-ganwyobis aSlilobis diagnozi risk-faqtoria.
tardiuli diskinezia 2-dan 1 SemTxvevaSi antifsiqo-
zuri wamlebis Sewyvetis Semdeg qreba. misi sixSire
 fsiqiatriaSi gamoyenebuli medikamentebis klasifikacia
sxvadasxva kvleviT gansxvavebulia, magram Sizofre-
niis im SemTxvevebSi, romelTa mkurnalobisTvisac
xangrZlivad gamoiyeneba antifsiqozuri preparate-
bi, saSualod 20%-s Seadgens. arsebuli monacemebiT,
tardiuli diskineziis sixSire iseTi atipiuri antif-
siqozurebis xmarebis dros, rogorebicaa klozapini,
olanzapini da risperidoni, haloperidolTan Seda-
rebiT ufro dabalia (Kane, 2004; Jeste, 2004). miuxeda-
vad amisa, mainc arsebobs iSviaTi SemTxvevebi.
paTofiziologia. tardiuli diskineziis mizezi
dauzustebelia, Tumca, SesaZloa, es iyos xangrZlivi
dofaminerguli blokirebiT gamowveuli momatebuli
mgrZnobeloba dofaminis mimarT. am mosazrebas adas-
turebs is faqtic, rom tardiuli diskinezia mwvav-
deba antifsiqozuri preparatebis moxsnisa an anti-
qolinerguli antiparkinsonuli wamlebis daniSvnis
SemTxvevaSi (rac, savaraudod, bazalur gangliaSi
qolinerguli da dofaminerguli sistemebis Semdgomi
disbalansiT aixsneba).
mkurnaloba. tardiuli diskineziis samkurnalo be-
vri sxvadasxva meTodi arsebobs, magram arc erTi ar
aris universaluri. amitom mniSvnelovania, rom, ram-
denadac es SesaZlebelia, im pacientebs, romlebic mi-
drekilni arian amgvari garTulebisken, maqsimalurad
SeezRudoT xangrZlivi antifsiqozuri mkurnaloba.
amasTan, aseTi mkurnalobisas saWiroa monitorin-
gis Catareba, raTa droulad gamovlindes moZraobis
darRvevebi. diskineziis aRmoCenisTanave unda Sewydes
antifsiqozuri mkurnaloba, Tu fsiqikuri mdgomare-
oba iZleva amis saSualebas.
miuxedavad imisa, rom wamlis moxsnis Semdeg tar-
diuli diskinezia SeiZleba gauaresdes, xSirad isec
xdeba, rom ramdenime Tvis Semdeg mdgomareoba umjo-
besdeba. Tu diskinezia mainc grZeldeba an antifsi-
qozuri mkurnalobis Sewyveta SeuZlebelia, sasurve-
lia atipiuri preparatebis gamoyeneba, rogorebicaa
olanzapini an qvetiapini, romlebsac SedarebiT sus-
tad gamoxatuli dofamin-receptorebis antagonis-
turi moqmedeba axasiaTebT. wamlis Secvlam zog Se-
mTxvevaSi SeiZleba gamoiwvios remisia. sxva gamocdil
saSualebebs miekuTvneba E-vitamini, romlis efeqtu-
robis Sesaxebac urTierTgamomricxavi informacia
arsebobs.
tardiuli distonia
miuxedavad imisa, rom es ori darRveva SeiZleba Ta-
naarsebobdes, tardiuli diskinezia unda diferen-
cirdes tardiuli distoniisgan, romlis drosac mo-
ZraobiTi darRvevebi xangrZlivadaa SenarCunebuli.
tardiuli distonia sxva idiopaTuri distoniebisgan
_ blefarospazmisa an tortikolizisgan, klinikurad
ar gansxvavdeba. wamlismieri tardiuli distoniis
diagnozi ismeba maSin, roca pacienti iRebs dofaminis
_ 573 _
receptorebis blokators da ojaxuri anamnezi dis-
toniaze uaryofiTia. mkurnaloba, xSir SemTxvevaSi,
araefeqturia. distonia grZeldeba antifsiqozuri
wamlebis moxsnisa da antiqolinerguli wamlebis da-
niSvnis Semdegac. arsebobs monacemebi, rom mdgomare-
oba SeiZleba gaumjobesdes klozapiniT mkurnalobi-
sa da, aseve, Sesabamis kunTebSi botulinis toqsinis
lokaluri inieqciebiT.
antiadrenerguli moqmedeba
aseT moqmedebas miekuTvneba sedacia, posturuli hi-
potenzia refleqsuri taqikardiiT, cxviris gaWedi-
loba, eakulaciis inhibicia. arteriul wnevaze gavle-
na ZiriTadad kunTSi inieqciis dros vlindeba, Tumca
moxucebSi SeiZleba gamovlindes wamlis nebismieri
formiT miRebis dros.
antiqolinerguli moqmedeba
amgvar moqmedebas miekuTvneba piris simSrale, Sardis
Sekaveba, yabzoba, oflis gamoyofis Semcireba, bundo-
vani mxedveloba, iSviaTad _ glaukoma.
sxva moqmedeba
aRwerilia kardialuri gamtareblobiTi defeqtis
_ ariTmiis iSviaTi SemTxvevebi. ekg-cvlilebebidan
yvelaze xSiria Q-t intervalis gaxangrZliveba da
T-talRis cvlilebebi. pimozidis gamoyenebas axlavs
seriozuli kardiuli ariTmia. rekomendebulia dozis
SerCeva ekg-monitoringiT. kvlevebma gamoavlina Tio-
ridazinis gavlena Q-T intervalis gaxangrZlivebaze,
ris gamoc britaneTSi misi gamoyeneba SeizRuda.
SeiZleba ganviTardes guneb-ganwyobis daqveiTeba
da depresia, magram es rTuli Sesafasebelia, radgan
aranamkurnalevi Sizofreniis SemTxvevaSic SesaZloa
SevxvdeT depresiul periodebs. mezolimburi nawilis
dofaminuri receptorebis Warbi blokadis Sedegad
namdvilad SesaZlebelia ganviTardes anhedonia da
motivaciis daqveiTeba, rac iZleva depresiisa an Si-
zofreniis negatiuri simptomebis imitacias.
endokrinuli da metaboluri cvlilebebidan SeiZ-
leba ganviTardes wonis mateba, gansakuTrebiT qlor-
promazinis da atipiuri antifsiqozurebis, olanza-
pinis, zotepinisa da klozapinis, gamoyenebis dros
(cxrili 21.3). Sizofrenia TavisTavad ukavSirdeba
diabetis momatebul risks, romelic gansakuTrebiT
izrdeba antifsiqozuri preparatebis gamoyenebis
dros, rac nawilobriv ganpirobebulia Tanmxlebi
wonis matebiT. atipiuri antifsiqozuri preparatebi
ufro metad iwvevs glukozis mimarT tolerantobis
daqveiTebas, vidre konvenciuri antifsiqozuri wam-
lebi. aris Tu ara gansxvaveba atipiur preparatebs
Soris _ es davis sgania, Tumca, yvelaze metad gamoyo-
fen olanzapinsa da klozapins (Taylor, 2004).
21 medikamenturi da sxva fizikuri mkurnaloba
zogierT qals prolaqtinis donis momatebis gamo
SeiZleba ganuviTardes galaqtorea da amenorea li-
bidos daqveiTebiTa da seqsualuri disfunqciiT.
SesaZloa gaizardos osteoporozis riski. zogierTi
atipiuri preparati mniSvnelovnad ar zrdis prola-
qtinis dones (cxrili 21.3). hiperprolaqtinemiis ara-
sasurveli efeqtis Sesaxeb ix. Wieck, Haddad, 2004.
moxucebisTvis mniSvnelovani arasasurveli efeqtia
hipoTermia. zogi antifsiqozuri wamali, kerZod, ise-
Ti susti moqmedebis, rogorebicaa qlorpromazini da
klozapini, amcirebs gulyrebis zRurbls da epilef-
siis mqone pacientebis SemTxvevaSi zrdis gulyrebis
ganviTarebis sixSires. qlorpromaziniT xangrZlivma
mkurnalobam SeiZleba gamoiwvios fotosensitivo-
ba, pigmentis dagroveba kanSi, rqovanasa da brolSi,
xolo maRali dozebiT miRebulma Tioridazinma (>800
mg/dR) _ baduris degeneracia.
fenoTiazinebma, kerZod, qlorpromazinma, SeiZleba
gamoiwvios qolestazi siyviTliT, magram misi sixSire
dabalia (daaxloebiT 0, 1%). iSviaTia sisxlis ujre-
duli diskrazia, da umetesad gvxvdeba klozapinis Se-
mTxvevaSi. SesaZlebelia ganviTardes kanze gamonaya-
ri.
klozapinis arasasurveli efeqti
klozapinis gamoyeneba ukavSirdeba leikopeniis mniSv-
nelovan risks (daaxloebiT 2-3%), rac SeiZleba gadai-
zardos agranulocitozSi. pirveli 18 kviris ganma-
vlobaSi yovelkvireuli, xolo momdevno kvirebSi _ 2
kviraSi erTxel sisxlis saerTo analizis gadamowmeba
aucilebelia. erTi wlis Semdeg Semowmebis sixSire
SeiZleba Semcirdes da TveSi erTxel gakeTdes. ase-
Ti intensiuri monitoringiT aRmoCenili leikopeniis
SemTxvevaSi, unda moixsnas klozapini, rasac mohyve-
ba leikocitebis raodenobis aRdgena. aseTi midgoma
mniSvnelovnad amcirebs, magram ar xsnis, agranulo-
citozis progresirebis risks. Cveulebriv, rekomen-
debulia, rom klozapini gamoyenebul iqnes antifsi-
qozuri monoTerapiis saxiT. cxadia, ar unda moxdes
iseT preparatTan kombinireba, rogoricaa karbamaze-
pini, romelic aseve iwvevs leikocitebis raodenobis
Semcirebas.
Klozapini, sustad gamoxatuli dopaminis D2 recep-
torebis blokirebis gamo, naklebad iwvevs eqstrapi-
ramidul moZraobiT darRvevebs, maT Soris tardiul
diskinezias. is ar zrdis plazmaSi prolaqtinis dones,
Sesabamisad, galaqtoreac ar axlavs, magram SeiZleba
gamoiwvios hipersalivacia, Zilianoba, posturuli
hipotenzia, wonis mateba da hiperTermia. gulyrebi
SesaZloa mohyves maRali dozebis gamoyenebas. kloza-
pini sedaciuri nivTierebaa da klozapinsa da benzo-
diazepinebTan kombinirebisas, man SeiZleba gamoiwvios
sunTqviTi da cirkulaciuri problemebi. iSviaTad
_ 574 _
aRwerilia fataluri miokarditisa da miokardiopa-
Tiis SemTxvevebi. wonis mateba SeiZleba nawilobriv
ganapirobebdes diabetis riskis matebas (amerikis dia-
betis asociacia, 2004).
avTvisebiani neirolefsiuri sindromi
es iSviaTi, magram seriozuli garTuleba aReniSneba
pacientebis mcire nawils, gansakuTrebiT Zlieri an-
tifsiqozuri wamlebis miRebis dros. aRweril mdgo-
mareobaTa umetesoba aris garTuleba, romelic ga-
mowveulia Sizofreniis, SedarebiT iSviaTad, maniis,
depresiuli aSlilobisa da samedicino problemebis
Sedegad gaCenili fsiqozuri simptomebis samkurna-
lod daniSnuli antifsiqozuri preparatebiT. am sin-
dromisken midrekilebas iwvevs liTiumis kombinacia
antifsiqozur preparatebTan. antifsiqozuri prepa-
ratebis gamoyenebis SemTxvevaTa saerTo sixSire 0,
2%-s Seadgens.
sindromi, magram ara yovelTvis, pirvel 10 dReSi
vlindeba. klinikuri suraTi aCvenebs motoruli, fsi-
qikuri da avtonomiuri darRvevebis swraf ganviTa-
rebas (Cveulebriv 24-72 saaTSi), rasac axlavs hiper-
pireqsia:
w gamoxatuli motoruli simptomi aris kunTTa ge-
neralizebuli hipertonia. yelisa da gulmkerdis
kunTebis daWimulobam SeiZleba gamoiwvios disfa-
gia da dispnoe;
w fsiqikuri simptomebi moicavs akinezur mutizms,
stupors an cnobierebis daqveiTebas;
w hiperpireqsia viTardeba avtonomiuri darRvevebiT
_ arteriuli wnevis arastabilurobiT, taqikar-
diiT, Warbi oflianobiT, nerwyvdeniTa da Sardvis
SeukaveblobiT;
w sisxlSi kreatinin-fosfokinazas (kfk) done mkve-
Trad izrdeba da matulobs leikocitebis raode-
noba;
w meoradi garTulebebia pnevmonia, Tromboembolia,
kardiovaskuluri kolafsi da Tirkmlis ukmarisoba.
neirolepsiuri sindromis letalobis sixSire uka-
nasknel wlebSi Semcirda, magram mainc 10%-s aRwe-
vs. mdgomareoba swordeba oraluri neiroleptikis
Sewyvetidan 1-2 kviraSi, magram gaxangrZlivebuli mo-
qmedebis preparatis xmarebis SemTxvevaSi mdgomare-
obidan gamosvlis dro SeiZleba 2-3-jer gaizardos.
mdgomareobidan gamosvla upiratesad, magram ara yo-
velTvis, xdeba narCeni movlenebis gareSe.
diferenciuli diagnozia encefaliti da zogierT
qveyanaSi _ siTburi dakvra. antifsiqozuri wamlebis
SemoRebamde fiqsirdeboda msgavsi darRveva katato-
niiT, romelsac zogjer uwodebdnen mwvave letalur
katatonias. amgvari mdgomareoba, savaraudod, SeiZ-
leba ganviTardes nebismieri antifsiqozuri wamlis
 fsiqiatriaSi gamoyenebuli medikamentebis klasifikacia
gamoyenebisas, magram aRwerili SemTxvevebis umete-
soba ukavSirdeboda haloperidols da flufenazins;
aRwerilia atipiuri antifsiqozurebis, maT Soris
klozapinis, gamoyenebisasac. mizezi unda ukavSirde-
bodes Warb dofaminergul blokadas, magram is, Tu
ratom viTardeba mxolod pacientTa mcire nawilSi,
daudgenelia.
mkurnaloba simptomuria. unda moixsnas wamali, mo-
xdes pacientis gagrileba, SenarCundes siTxis balan-
si da CaerTos interkurentuli infeqciiis mkurnalo-
ba. efeqturi medikamenturi mkurnaloba ar arsebobs.
kunTTa daWimulobis mosaxsnelad SeiZleba diazepamis
gamoyeneba. avTvisebiani hiperTermiis SemTxvevaSi Sei-
Zleba moisinjos dantroleni. aseve, rekomendebulia
dofaminis agonisti bromokriptini. mZime SemTxveve-
bSi saWiroa intensiuri Terapia: intubacia, damxmare
sunTqva da Tirkmlis ukmarisobis koreqcia.
zog SemTxvevaSi, sindromis CaTavebis Semdeg, Sesa-
Zlebelia imave wamlis usafrTxo gamoyeneba, magram
mainc miiCneva, rom, Tu saWiroa antifsiqozurebis ga-
grZeleba, umjobesia mkurnaloba ganaxldes atipiuri
antifsiqozurebiT da daiwyos dabali doziT. sul
mcire, 2 kvira mainc unda gavides, sanam mkurnaloba
ganaxldeba.
antifsiqozuri wamlebis ukuCveneba
arsebobs mxolod mcire odenobis absoluturi uku-
Cveneba antifsiqozuri mkurnalobisTvis da yoveli
konkretuli wamlis SemTxvevaSi ukuCveneba sxvadasxva
SeiZleba iyos. nebismieri aseTi wamlis gamoyenebamde
sasurvelia, informacia moviZioT britanul farma-
cevtul cnobarSi. ukuCvenebebia: miasTenia, adisonis
daavadeba, glaukoma (Tu preparats aqvs mniSvnelovani
antiqolinerguli moqmedeba) da, klozapinis SemTxve-
vaSi, Zvlis tvinis funqciis darRvevis nebismieri
gamovlineba. Tu pacients daavadebuli aqvs RviZli,
mas ar unda daeniSnos qlorpromazini; aseve, sxva wam-
lebic sifrTxiliT unda SevurCioT. sifrTxilis da-
cvaa saWiro Tirkmlis daavadebis, kardio-vaskuluri
darRvevis, epilefsiis an seriozuli infeqciis dro-
sac. parkinsonis daavadebis mqone pacientebs zogjer,
dofaminerguli preparatebiT gamowveuli fsiqozuri
mdgomareobis koreqciisTvis esaWiroebaT antifsiqo-
zuri wamlebi. amgvar situaciaSi umjobesia atipiuri
preparatebis gamoyeneba. antifsiqozurma wamlebma
SeiZleba gamoiwvios moZraobis mZime darRvevebi da
cnobierebis moSla demenciis, kerZod, levis sxeule-
bis demenciis dros.
antifsiqozur wamlebs axlavs insultis ganviTare-
bis riski, amitomac cerebro-vaskuluri daavadebis
mqone pacientebs isini ar eniSnebaT, Tu fsiqiatriu-
li darRvevis gamo es aucilebeli ar aris. ukanaskne-
li monacemebiT, demenciis mqone pacientebTan rispe-
ridonis an olanzapinis gamoyenebisas insultis riski
sammagdeba da faqtiurad igivea, rac Zveli Taobis
antifsiqozuri wamlebis gamoyenebis dros (Herrman et
al., 2004).
dozireba
doza unda moergos individualur pacients da cvli-
leba unda ganxorcieldes TandaTanobiT. moxucebs,
Tavis tvinis dazianebis an epilefsiis mqone da fi-
zikurad dauZlurebul pacientebs unda daeniSnoT
dabali doza. konkretuli wamlis dozis moZieba Sesa-
Zlebelia britanul erovnul farmacevtul cnobarSi
an mwarmoeblis literaturaSi.
pet (pozitronul-emisiuri tomografia) kvleva
rekomendebulia antifsiqozuri wamlebis dabali do-
zebis gamoyeneba, rac nawilobriv efuZneba pet-kvle-
vebs, romelTa mixedviTac dofamin D2 receptorebis
adekvaturi blokireba (sul mcire, bazalur ganglie-
bSi mainc) miiRweva Cveulebrivi antifsiqozuri wam-
lebis dabali dozebiT _ mag., haloperidolis 5 mg-iT
(cxrili 21.6) (Farde et al., 1989; Kapur et al., 1999). axali
preparatebisTvis Sesabamisi pet-is monacemebi xelmi-
sawvdomia da iZleva dozebis mkafio rekomendaciebs.
umetes SemTxvevaSi, rekomendebuli dabali dozebi iZ-
leva adekvatur antifsiqozur efeqts. ufro maRali
doza ufro metad amSvidebs pacients, magram axlavs
mniSvnelovani arasasurveli movlenebi, romelTa na-
wilic sakmaod seriozulia (mag., kardiuli ariTmia).
miRebulia Sexeduleba, rom antifsiqozuri wamle-
bis zomieri dozebis benzodiazepinebTan kombinireba
ufro usafrTxo da efeqturia, vidre antifsiqozu-
rebis ufro maRali dozebi.
antifsiqozuri medikamentebi da uecari
sikvdilis riski
uecari, auxsneli sikvdilis antifsiqozur wamleb-
Tan kavSiri xangrZlivi debatebis Temaa. pacientebs,
romlebsac aqvT Sizofrenia da mkurnaloben antif-
siqozuri wamlebiT, ufro xSirad aReniSnebaT gulis
gaCereba da parkuWovani ariTmia, vidre sakontrolo
jgufis wevrebs. isini, aseve, ufro xSirad kvdebian
moxrCobis gamo (Hennesy et al., 2002; Ruschena et al.,
2003). yovelive es SeiZleba ukavSirdebodes avadmyo-
fobas an mkurnalobas. cnobilia, rom antifsiqozu-
rebi iwvevs gulis gamtareblobis cvlilebas, xolo
iseTi wamlebi, rogoricaa, mag., qlorpromazini _ hi-
potenzias. miuxedavad imisa, rom antifsiqozurebis
maRali doziT gamoyenebasa da uecar sikvdils Soris
kavSiri dazustebuli ar aris, mainc rekomendebulia,
klinikuri mdgomareobis mixedviT, maqsimalurad da-
bali dozebis SerCeva. mocemuli sferoSi Semavali
problemebi da didi doziT antifsiqozuri wamlebis

_ 575 _
21 medikamenturi da sxva fizikuri mkurnaloba
gamoyenebis sakiTxi ganxilulia Semdeg wyaroSi: Royal ri gza dasaSvebia haloperidolisa da lorazepamis
College of Psychiatrists, 1993. gamoyenebisas, magram mxolod gamonaklis SemTxveve-
zogierTi, xSirad xmarebuli peroraluri wamlebis bSi. Tu iniSneba haloperidoli, mwvave moZraobiTi
dozebi mocemulia cxrilSi 21.6. praqtikuli sakiTxebi darRvevis riskis Semcireba SesaZlebelia antiqoli-
am wamlebis dozebis Sesaxeb ganxilulia Semdeg nawilSi. nerguli preparatebiT. mniSvnelovania, rom Sefasdes
sunTqvis daTrgunvis albaToba, gansakuTrebiT moxu-
rCevebi, pacientis marTvis Sesaxeb
cebsa da dauZlurebul pacientebSi. xelmisawvdomi
gadaudebeli daxmareba unda iyos benzodiazepinebis antagonisti flumazeni-
antifsiqozuri wamlebi da benzodiazepinebi gamoiye- li (Taylor et al., 2003).
neba SizofreniiT, maniiT an organuli fsiqoziT ga- qvemoT mocemulia mwvave epizodis mqone pacien-
mowveuli fsiqomotoruli agznebis an sxva anomaliu- tis marTvasTan dakavSirebuli ramdenime praqtikuli
ri qcevis sakontrolod. Tu pacienti Zalian agzne- sakiTxi. qcevis darRvevebis gamovlenis adreul eta-
bulia da aqvs anomaliurad agresiuli qceva, Careva pze ar aris ioli maniis Sizofreniisgan diferenci-
qcevis SeZlebisdagvarad swraf kontrolze unda iyos reba; Tumca, unda SevZloT maTi gansxvaveba sxva same-
mimarTuli. Tanamedrove rekomendaciiT, upirateso- dicino mdgomareobiT gamowveuli meoradi fsiqozi-
ba eniWeba haloperidolis dabal dozas (2-5 mg), an sa da pirovnuli aSlilobebiT gamowveuli agresiis
lorazepams (1-4 mg) erTjeradad, an, saWiroebis Se- Setevebisgan. samedicino mdgomareobebs Soris gasa-
mTxvevaSi, maT kombinirebas. mwvave SemTxvevebis dros Tvaliswinebelia epilefsiuri statusi, qala-tvinis
mimarTaven olanzapinis (2, 5-10 mg) kunTSiga inieqciis travma, tranzitoruli globaluri amnezia da hipo-
formas, rogorc alternativas. olanzapinis kunTSi- glikemia. Tu pacienti Warbad moixmars alkohols, ar
ga gamoyenebisas, unda gaviTvaliswinoT ukuCvenebebi, unda daviviwyoT antifsiqozuri wamlebis da benzo-
gansakuTrebiT kardiovaskuluri daavadebebis mqone diazepinebis potenciuri sedaciuri efeqtis safr-
pacientebTan. kunTSiga olanzepini ar unda dainiSnos Txe. aseve, epilefsiuri statusis Semdeg gulyrebis
parenteralur benzodiazepinebTan erTad. maprovocirebeli antifsiqozuri wamlebi sifrTxi-
haloperidoli, olanzapini da lorazepami SeiZleba liT unda vixmaroT.
dainiSnos oralurad an parenteralurad (diazepami damatebiTi informaciis mosapoveblad ix. gv ??.
cudad absorbirdeba intramuskulurad). intravenu-
mwvave epizodis medikamenturi mkurnaloba
gadaudebeli daxmarebis aRmoCenis Semdeg an Tavi-
cxrili 21.6 zogierTi antifsiqozuri medika-
danve naklebad mwvave SemTxvevebSi mkurnaloba unda
mentis doza da D2 receptorebis blokireba
daiwyos oraluri antifsiqozurebis zomieri doze-
wamali doza maqsimalu- D2 receptore- biT. adekvaturad iTvleba haloperidoli 4-12 mg/dR
(oraluri) ri doza (mg) bis dakaveba in
vivo (%) [dRiu- gayofili ramdenime miRebaze, qlorpromazini 150-300
ri doza (mg)]* mg/dR, risperidoni 2-4 mg/dR an olanzapini 10 mg/dR.
qlorproma- 100 1000 80 [200] mkurnalobis adreul etapze raodenoba da dozebs
zini Soris intervali unda SeirCes yoveldRiuri saWiroebis
trifluo- 5 ? 80 [10] Sesabamisad, manam, sanam ar moxdeba yvelaze mwvave simp-
perazini tomebis kontroli. amdenad, regularuli erTjeradi
haloperi- 2 30 80 [4] an orjeradi doza iTvleba adekvatur reJimad. frTxi-
doli lad unda gakeTdes mwvave distoniuri reaqciebis moni-
flupentiq- 1 18 74 [10] toringi mkurnalobis adreul stadiaze. mkurnalobis
soli progresirebasTan erTad, yuradReba unda gamaxvildes
sulpiridi 200 2400 74 [800] parkinsonul gverdiT moqmedebaze da droulad daiwyos
antiparkinsonuli mkurnaloba. moxucebisa da dauZlu-
klozapini 60 900 65 [600]
rebuli pacientebis SemTxvevaSi aucilebelia tempera-
risperi- 2 16 75 [4] turisa da arteriuli wnevis kontroli, raTa droulad
doni
aRmovaCinoT hipoTermia an hipotenzia.
olanzapini 8 20 75 [15] miuxedavad imisa, rom pacientebi antifsiqozuri
aripipra- 5 30 80 [15] wamlebis dawyebidan ramdenime dReSi mSviddebian,
zoli fsiqozuri simptomebis gaumjobeseba TandaTanobiT,
maqsimaluri dozebi mocemulia britanuli erovnuli ramdenime kviraSi xdeba. dReisTvis saukeTeso midgo-
farmacevtuli cnobaris mixedviT
mad iTvleba antifsiqozuri wamlis zomier, stabilur
*Farde, 1989; Nyberg, Farde, 2000; Yokoi, 2002. doneze SenarCuneba da gaumjobesebis dasaCqareblad

_ 576 _
 fsiqiatriaSi gamoyenebuli medikamentebis klasifikacia
dozis SenarCuneba. im pacientebs, romlebsac mkurna-
lobis miuxedavad mainc aReniSnebaT SfoTva da dis-
tresi, antifsiqozuri wamlis dozis gazrdas, ajobe-
bs xanmokled davumatoT benzodiazepinebi.
Tanamedrove rekomendaciiT, atipiur antifsiqo-
zur wamlebs upiratesoba eniWeba, Tu aris:
w daavadebis pirveli epizodi;
w Terapiuli efeqti araadekvaturia;
w pacients aReniSneba arasasurveli gverdiTi moqme-
deba moZraobis darRvevis an hiperprolaqtinemiis
saxiT;
w klozapini naCvenebia sxva atipiuri fsiqozurebis
araefeqturobis an autanlobis dros.
medikamenturi mkurnaloba mwvave epizodis Semdeg
samedicino mdgomareobebiT gamowveuli meoradi ma-
niisa da mwvave fsiqozis epizodebi, Cveulebriv, ra-
mdenime kviraSi amoiwureba, xolo Sizofreniis dros
pacientebs esaWiroebaT xangrZlivi, ramdenimeTviani
an wliani mkurnaloba. aseTi SemanarCunebeli mkur-
naloba upiratesad gulisxmobs oraluri medikamen-
tebis dabali dozebiT mkurnalobis gagrZelebas. Tu
pacienti regularulad ar iRebs wamals, umjobesia
dainiSnos inieqciuri depo-preparatebi. mkurnalobis
dasawyisSi testuri dabali dozis mosinjviT dginde-
ba seriozuli gverdiTi moqmedebis riski (Taylor, 1999),
dakvirvebis safuZvelze ki _ Semdegi SemanarCunebe-
li doza. rogorc zemoT iyo aRniSnuli, depo-prepa-
ratebs aqvs xangrZlivi naxevar-daSlis dro, amitom
esaWiroba ramdenime kvira plazmaSi maqsimaluri kon-
centraciis misaRwevad. am Tvisebis gaTvaliswinebiT
unda SeirCes dozis momateba/daklebis tempi da Tan-
daTanobiT moixsnas oraluri antifsiqozurebi, roca
iniSneba depo-preparati.
mniSvnelovania umciresi dozis dadgena, romliTac
SesaZlebelia simptomebis kontroli. aucilebelia
narCeni simptomebisa da wamlis gverdiTi efeqtebis
mudmivi Sefaseba. ar aris sasurveli antiparkinso-
nuli wamlebis rutinuli gamoyeneba. saWiroebis Se-
mTxvevaSi unda dainiSnos depo-preparatis inieqcia
pirveli dReebis ganmavlobaSi (rodesac plazmuri
koncentracia yvelaze maRalia).
antiparkinsonuli medikamentebi
fsiqiatriaSi ar xdeba am wamlebis pirdapiri Tera-
piuli gamoyeneba, aramed ZiriTadad ixmareba tipiuri
antifsiqozuri wamlebis eqstrapiramiduli gverdiTi
moqmedebis kontrolisTvis.
farmakologia
idiopaTiuri parkinsonizmis samkurnalo wamlebidan
medikamentiT gamowveuli eqstrapiramiduli simpto-
_ 577 _
mebis samkurnalod mxolod antiqolinerguli prepa-
ratebi gamoiyeneba. es wamlebi, rogorc centraluri,
aseve periferiuli muskarinuli qolinerguli recep-
torebis antagonistebia. zogierTs aqvs antihistami-
nuri moqmedebac.
xelmisawvdomi preparatebi
xelmisawvdomia mravali antiqolinerguli wamali da
maT Soris mniSvnelovani gansxvaveba ar aris. zogier-
Ti avtori mainc upiratesobas aniWebs im preparate-
bs, romlebic seleqciurad, upiratesad muskarinuli
receptorebis M1 qvetipze moqmedebs. aseTia, mag.,
biperideni, romelsac naklebi periferiuli antiqo-
linerguli moqmedeba axlavs. aseve, gamoiyeneba sxva
preparatebi, rogorebicaa prociklidini da benzheq-
soli. orfenadrins da benztropins aqvs kombinirebu-
li histaminuri da antiqolinerguli moqmedeba.
farmakokinetika
am sferoSi mwiri monacemebi gvaqvs. iTvleba, rom
antiqolinerguli preparatebi kargad absorbirdeba
da aqtiurad metabolizdeba RviZlSi. aqtiurad ukav-
Sirdeba cilebs. naxevar-daSlis dro ZiriTadad 15-20
saaTia.
arasasurveli efeqti
didi doziT miRebam SeiZleba gamoiwvios mwvave or-
ganuli sindromi, gansakuTrebiT moxucebSi. misi an-
tiqolinerguli aqtivoba SeiZleba daematos antifsi-
qozuri wamlebis moqmedebas da gamoiwvios glaukoma,
xolo prostatis hiperplaziis mqone mamakacebSi _
Sardvis problemebi. aseve, SesaZlebelia gamovlindes
Zilianoba, piris simSrale da yabzoba. droTa ganma-
vlobaSi, Tu wamlis miReba grZeldeba, es simptomebi
mcirdeba.
Warbi dozis gamoyenebisas orfenadrini SeiZleba
ufro toqsiuri aRmoCndes, vidre sxva antiqoli-
nerguli wamlebi, xolo benztropinma SeiZleba ga-
moiwvios siTburi dakvra. yvela antiqolinergulma
wamalma SeiZleba gaamwvavos tardiuli diskinezia,
magram, savaraudod, ar unda iyos predispoziciuri
faqtori (Barnes, Spence; 2000).
wamlebis urTierTqmedeba
antiparkinsonuli medikamentebi iwvevs wamlebis me-
tabolizmSi monawile RviZlis enzimebis inducirebas
da, Sesabamisad, antifsiqozuri wamlebis plazmuri
koncentraciis garkveulad daqveiTebas. rogorc ukve
aRvniSneT, antiqolinerguli preparatebi aZlierebs
sxva iseTi wamlebis antiqolinergul moqmedebas, ro-
gorebicaa qlorpromazini da amitriptilini.
rCevebi pacientis marTvis Sesaxeb
rogorc aRvniSneT, antiqolinerguli wamlebi ar unda