yuradRebis deficitisa da hiperaqtivobis sindromi _ neirobiologiuri da neirofsiqologiuri aspeqtebi

 

 

ana kurtaniZe, maia kvantaliani.

    

     Tsu. medicinis fakulteti.

 

     

yuradRebis deficitisa da hiperaqtivobis sindromi (ADHD) metad aqtualuri subklinikuri mdgomareobaa mTels msoflioSi. misi damaxasiaTebeli da mTavari niSania yuradRebis daqveiTebuli done, rasac SeiZleba  axldes impulsuroba da hiperaqtivoba da risi mTavari mizezic aris tvinis disfunqciiT gamowveuli funqciuri moSlilobani.

      ADHD yvelaze metad gavrcelebulia pediatriul asakobriv jgufebSi, mag. amerikaSi 2 mln. bavSvi, saqarTveloSi _ 40, xolo mTels msoflioSi 3-5% bavSvebisa matarebelia am sindromis. natifi gamokvlevebiT dadginda, rom sqesis mixedviT ADHD- is gansxvavebuli mimdinareoba aqvs. aRweril ADHD-ian bavSvebSi umetesi vaJia, vidre gogona, magram gogonebSi gacilebiT mwvaved mimdinareobs.ADHD xSirad grZeldeba ymawvilobis periodSic an icvleba xarisxis mixedviT, rac saboloo jamSi daRs svams maT saerTo emociur mdgomareobas.

      diagnostikuri TvalsazrisiT arsebobs sami piroba, romlis meSveobiTac xdeba am sindromis identificireba, kerZod ADHD-iani bavSvebi SeiZleba avlendnen mxolod uyuradRebobas, impulsurobas an orives erTad. mag. aseTi bavSvebis interesi nebismieri sagnisaTvis daqveiTebulia, detalebze yuradrebas ar amaxvileben da daufiqreblad uSveben Secdomebs. isini iSviaTad iTvaliswineben ufrosebis rCeva-darigebebs, zedmetad gulmaviwyni arian, kiTxvebs svamen maSin, roca jer kidev ar mousmeniaT wayenebuli piroba bolomde, yovelTvis zedmetad agznebulni arian, rasac umetesad agresiulobiT gamoxataven. msgavsi simptomebi SiZleba  gamovlenili iqnas 7 wlamde, Semdeg isini icvleba xarisxobrivad asakTan SefardebiT, Tanac ar aqvs maTTvis mniSvneloba, Tu sad imyofebian: saxlSi, skolaSi, sxvadsxva sazog. Sekrebebze da sxva.

      1902 wels pirvelad jorj stilma aRwera 43 bavSvi (inglisSi)

gamoxatuli agresiiT, emociurobiT, yuradRebis daqveiTebiT, qceviTi aqtebis umarTaobiT. aRniSnulis mixedviT man gamoyo bavSvTa kategoriebi: TavSeukavebelni, urCni, RvarZlianni, usindisoni, saxifaToni da sxva. stilma Camoayaliba hipoTeza, romelic am darRvevebs xsnis “moraluri kontrolis deficitiT” anu dakvirvebaSi myof bavSvebs daqveiTebuli aqvT sakutari emociebis Tu qcevebis marTva, ris safuZvelzec iZleva nevrologiuri subtrati. Semdgom wlebSic mimdinaroebda kvlevebi bavSvebze romlebsac areniSnebodaT agresia, hipeaqtiuroba, zedmeti emociuroba da a.S da mxolod 1990 w-s SemoiRes termini “hiperaqtivoba da yuradRebis deficitis sindromi”, romelic aerTianebs yvela aRnisnul symptoms.

      msoflios mravali klinika eyrdnoba amerikuli fsiqiatriuli asociaciis mier mowodebul saxelmZRvanelos _ DSM ­–IV-is kriteriumebi, romelSic mocemulia detalurad damuSavebuli masala ADHD-is Sesaxeb.. kerZod masSi aRwerilia uyuradRebobis, hiperaqtivobis da impulsurobis qvekategoriebSi, ADHD-is nawilobriv remisiuli tipebi, rac kargadaa gamoxatuli mozardebSi. am SemTxvevaSi SedarebiT mcirdeba gamovlenil simptomTa ricxvi, magram meore mxriv, eqsperimentalurad dgindeba sxvadsxva mravalmxrivi funqciuri moSlilobani. diagnostikur kriteriumebSi gaTvaliswinebulia asakobrivi SeteviTi garTulebebi, romelTac progresuli xasiaTi aqvT, maT fonze mimdinare Zlier gamovlenili simptomebi, aseve mxedv. miRebuli sxva daavadebebi, romlebsac Tan axlavs ADHD-is msgavsi simptomatika.

      diagnostikuri TvalsazrisiT mniSvnelovania ADHD-is warmomSobi mizezebis gamokvleva. am sakiTxTan dakavSirebiT Seqmnilia ramodenime Teoria, mag: erT-erTis mixedviT yuradrebis deficiti da hiperaqtivoba gamoiwveva Tavis tramvebiT, infeqciebiT, tvinTan dakavSirebuli sxvadasxva garTulebebiT, Tumca am Teorias safuZvliani dasabuTeba ar gaaCnia. meore Teoriis mixedviT, aRn. sindromi dakavSirebulia alimentur problemebTan.

      orsulobis periodSi Tu ki ewevian Tambaqos, svamen alcohols, an Rebuloben narkotikul nivTierebebs, isini ADHD-is safrTxes uqmnian TavianT momaval Svilebs, rameTu es faqtorebi uaryofiTad moqmedeben nayofis Tavis tvinSi mimdinare nervuli kavSirebis Camoyalibebasa da ganviTarebaze, rac sabolood vlindeba fizikuri defeqtisa da inteleqtis daqveiTebiT.

      ADHD genetikuradac aris ganpirobebuli, dakvirvebebs axdendnen im ojaxebze, sadac mamebi bavSvobaSi ADHD-is matareblebi iyvnen. aRmoCnda, rom maTi Svilebi am sindromiT arian Sepyrobilni. amerikeli fsiqologis hauzeris gamokvlevebiT, aseT ojaxTa 1/3-Si sindromis mizezia Tireoiduli cvlis moSla, rac Tavis mxriv dakavSirebulia me-3q-Si moTavsebuli Tiroidreceptoris β- genis aberaciiT. ADHD-is genetikuri memkvidreobiTobis mkacr gavlenas am subklinik. mdgomareobis CamoyalibebaSi xels uwyobs iseTi cudi garemo pirobebi, rogoricaa: xSiri stresebi, ojaxuri daZabuloba, an daZabuloba saswavlo dawesebulebebSi da sxva. gasaTvaliswinebulia mSoblebis, maswavleblebis, garSemomyofTa damokidebuleba am bavSvebisadmi.

      amerikis gonebrivi janmrTelobis nacionaluri institutes TanamSromlebma magnituri rezonansuli (MR) imijingiT ADHD-ian bavSvebSi gamoavlines Tavis tvinis specifikuri ubnebis asimetriuloba:

  1. Semcirebulia damuxluli sxeulis wiba nawilis moculoba;
  2. Semcirebulia marjvena hemisferos winanawilis TeTri nivTierebis moculoba;
  3. Semcirebulia naTxemis moculoba;
  4. tvinis asimetria mciredaa gamoxatuli.

saqarTveloSi MR jerjerobiT ar aris gamoyenebuli.

      fotonuri an hozitronuli tomografiiT (SPET, PET) Catarebulma funqciurma imijingma farmakologiur manipulaciebTan erTad aCvena:

  1. prefrontalur korteqsSi da striatumSi Sesustebuli sisxlis nakadi da energiis moxmareba.
  2. darRvevebi kateqolaminergul sistemebSi.

3.       Sublis wilebSi daqveiTebulia glukozisa da Jangbadis moxmareba.

      am codnis safuZvelze Seiqmna ramodenime neiro-anatomiuri hipoTeza, romelTa mixedviTac adgili unda hqondes:

ü       Sublis wilebis moumwifeblobas.

ü       diencefalur disfunqcias.

ü       retikuluri aRmavali sistemis funqcionirebis daqveiTebas.

ü       frontaluri wilebis Semakavebeli gavlenis daqveiTebas.

ü       limburi sistemis arasrulfasovnebasa da desensitiurobas.

ü       neirostriatuli gzebis disfunqcias.

  amerikaSi (90-ian wlebSi) EEQ-Ti 16 ADHD-iani bavSvi gamoikvlies, romlebSic gamoikveTa ori jgufi: zedmetad agznebulni da piriqiT _ araagznebadi, inertuli pirebi. es diferenciacia gamowveulia noradrenerguli, dofaminerguli da nawilobriv seretoninerguli sistemebis mravalmxrivi cvlilebebiT. magaliTad, kateqolaminebisa da misi metabolitebis done sisxlSi, SardSi da sazurgtvine siTxeSi  SeiZleba iyos daqveiTebuli an momatebuli (ADHD-is umetes SemTxvevaSi momatebulia norepinefrinis done). ADHD-is dros impulsurobas nawilobriv gansazRvravs  seretonini, gansakuTrebiT ki agresiul formas, an kidev ADHD-ian bavSvebSi plazmis 3-meToqsi-4 hidroqsifenilkolis done gacilebiT dabalia, vidre im pirebSi, romlebsac ADHD-isTan erTad “swavlis uunarobiTac” (LD) arian daavadebulni.

      yuradRebis laboratotiulma sazomebma gviCvena, rom saerTod ADHD-iT daavadebul bavSvebs problemebi ar eqmnebaT informaciis miRebasTan (romelsac bevri uyuradRebobad miiCnevs), magram ufro metad aqvT informaciis Tanmimdevrul gadamuSavebis da saTanado pasuxis gacemis problema. Cven SegviZlia ase SevajamaTod  isini “yuradRebas ar aqceven” an iqcevian ise TiTqos “yuradRebis ar aqcevdnen”. es gaxlavT erT-erTi mosazreba, romelic dafuZnebulia swored winamdebare testebis SedegebSi, magram SeiZleba es problema sxvanairad davinaxoT.

      barkli _ neirofsiqologiuri kvlevebis Semdeg askvnis, rom ADHD _ upirveles yovlisa aris _ SemzRudveli qcevis ganviTarebis deficiti. misi hipoTezebiT  _ aRmasrulebeli funqciis 4 komponenti SeiZleba limitirebli iyos ADHD-ian individebSi. esenia (1) araverbaluri muSa mexsiereba; (2) verbaluri muSa mexsiereba; (3) TviT-regulacia; (4) rekonstitucia _ gadmocema. (ganvixiloT TiToeuli SemTxveva).

(1)                _ araverbaluri muSa mexsiereba _ warmoadgens informaciis aRqmis SesaZleblobas mxedvelobiT mexsirebaSi. misi SezRudvebi Tavs iCens siZneleebSi, rac xSirad ADHD-ian adamianebs gaaCniaT _ momavlis dagegmvasTan dakavSirebul qcevebSi da drois gacnobierebaSi.

(2)               _ verbaluri muSa mexsireba _ asaxavs “TviT-saubris” SesaZleblobas problemis gadaWris dros. SezRudvebs verbalur muSa mexsierebaSi mivyavarT limitirebul gagebisunarianobamde da wakiTxvis unaris siZneleebamde.

(3)                _ TviTregulacia _ asaxavs agznebis modulaciis SesaZleblobas da emociuri reaqciis siZlieres. “TviT-saubari” aris yvelaze mniSvnelovani TviTregulaciisaTvis. limitirebul TviTregulacias mivyavarT: Sinagani motivaciis gadaWarbebul aqtivobamde.

(4)               _ rekonstitucia (gadmocema) _ qcevis is komponentia, romelic mimarTulia informaciis daSlisa da xelaxla Sekrebis SesaZleblobisaken, raTa Seqmnas axali kombinaciebi da axali qceviTi Tanmimdevrobebi. limitirebulma rekonstituciam SeiZleba migviyvanos siZnelemde, romelic moicavs mizanmimaerTul  qceviti Tanmimdevrobis verbaluri da motoruli qcevebis organizacias da moqnilobas.

gamomdinare am daskvnebidan vadgenT,rom ADHD-ian bavSvebs  problemebi aqvT  informaciis sensorul gadamuSavebaSi da aRm. funqciaSi.

      da mainc ra aris is mTavari amosavali wertili mkurnalobisa, rasac SeiZleba dRes-dReisobiT davemyaroT? stimulatorebi, rogoric aris ritalini, silerti da diqsedrini, roca samedicino zedamxedvelobis qveS imyofebian, miCneulni arian sakmaod uasfrTxod bavSvebsa da mozardebSi. isini xSirad “amaRlebul” ganwyobaze ayeneben bavSvebs an piriqiT _ aagzneben maT. ufro xSirad ki mastimulireblebi exmarebian maT rom kontroli gauwion TavianT hiperaqtivobas, uyuradRebobas da sxva damangrevel qcevebs.

      sxvadasxva eqimi wamlebs gansxvavebuli gziT iyenebs. silerti _ mxolod erTi formiT gvxvdeba da misi moqmedeba 5-10 sT-mde grZeldeba. ritalini da diqsedrini _ ufro moklevadiani arian da 3 sT-s grZeldeba moqmedeba. moklevadiani preparatebis doza ufro praqtikulia bavSvebisaTvis romelTac wamali sWirdebaT skolis peroidSi an sxva gansakuTrebul SemTxvevebSi.

      10-idan 9 bavSvis mdgomareoba umjobesdeba erT-erT am stimulatoris gamoyenebiT. uefeqtobis SemTxvevaSi eqimis daxmarebiT SeiZleba SevcvaloT wamali an misi dozebi. SeiZleba gamoviyenoT sxva saxis medikamentebi _ anti depresantebi _  TandarTuli depresiis an gaRizianebis samkurnalod. an mag: klonidini SeiZleba gamoviyenot Tu stimulatorebi ver moqmedeben an maTi daniSvna ukunaCvenebia.

      zogi eqimi rekomendacias  iZleva, rom movuxsnaT bavSvs medikamentebi, zafxulis ardadegebze, roca yuradRebis koncetrireba  ar aris imdenad kritikuli. “wamlisagan dasveneba” karG Sedegs iZleva, Tuki bavSvs kvlav SeiZleba aqtiur saqmianobaSi CaerTos wamlis gareSe.

      imdenad, ramdenadac es wamlebi sasargebloni arian, ritalinma da sxva stimulatorebma gamoiwvies azrTa sxvadsxvaoba, gverdiT movlenebTan dakavSirebiT. mag: zogierTma bavSvma SeiZleba daiklos wonaSi, dakargos mada da droebiT zrdac SeiZleba SeCerdes, an daZinebaze SeeqmnaT problemebi, magram sxvebi amtkiceben, rom es gverdiTi movlenebi ufro nakleb mniSvnelovania vidre maT mier miRweuli Sedegebi. SeiZleba gverdiTi efeqtebi gamoiwvios dozis Semcirebam.

      swored imis gamo, rom am preparetbs gaaCniaT bevri gverdiTi efeqtebi, saqarTvelos farmakopeaTi isini akrZalulni arian da mkurnaloba moicavs mxolod individualur qceviT da kognitur Terapias. muSaoba midis: mSoblebTan, maswavleblebTan, bavSvebTan da 14-16 wlis asakisaTvis isini amCneven ZiriTadi simptomebis hiperaqtivobis, uyuradRebobis da impulsurobis mniSvnelovnad Sesustebas. (aSen baxis Skala)

      swrafi gankurnebis imedebi marTalia Sorsaa, magram iyeneben ra kvlevis uamrav meTods da iaraRs, mecnierebi iwyeben tvinis rolis Seswavlas ADHD-is dros. “tvinis gamosaxuleba” _ gvaZlevs ADHD-is mizezebis axal gegmas, anu veZioT qceviTi darRvevebis biologiuri da fiziologiuri substratebi. sxva gamokvlevis mizania ganisazRvros orsulobis da adreul bavSvobis pirobebi, romelTac SesaZloa gamoewviaT es darRvevebi tvinSi.

      MmSoblebisa da eqimebis daxmarebiT bavSvebi ADHD-iT, rac ufro izrdebian miT ufro SeswevT unari CaaxSon hiperaqtivoba da Secvalon is socialurad ufro misaRebi qceviT, rogoricaa fiz. varjiSebi. aRsaniSnavia, rom ADHD- sindromianTa naxevari “avadmyofobis” niSnebs avlens mozardobis asakSi, magram is mkurnaloba, rac exmareba bavSvebs, mizanSewonilia mozrdilebisaTvisac.

      sabolood, minda aRvniSno, rom kvlevebi dRes-dReisobiTac mimdinareobs am sindromis ukeT SeswavlisaTvis. jer kidev bevri ram aris gairkveveli, radgan mravali sakiTxi dakavSirebuli etiologiis specipikasTan da saukeTeso mkurnalobasTan, isev Riad rCeba. am etapze, Cveni mizania mirebuli codnis safuZvelze mivaRwioT Tu rogor aviciloT Tavidan igi, an sul cota _ rogor vumkurnaloT mas efeqturad.

 

     

informaciis wyaro:

 

1.    Diagnostic and Statistical Manual of Mental Disorders _ DSM IV

      2..  WWW. ADHD.yahoo. com.

 

Summary

 

                      Attention   Deficiti   Hyperactiviti    Disorder (ADHD)

AAnn  Kurtanidze,    Maia  Kvantaliani

 

ADHD, once called hyperkinesis or minimal brain dysfunction, is one of the most common mental disorders among children . It affects  3  to 5 percent of all children, perhaps as many as 2 million American children. Two to three times more boys than girls are affected. On the average, at least one child in every classroom in the United States needs help for the disorder. ADHD often continues into adolescence  and  adulthood, and can cause a lifetime of frustrated  dreams and emotional pain.

But there is help . . . and hope. In the last decade, scientists have learned much about  the course of the disorder   and are now able to identify and treat children, adolescents and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help  people with ADHD focus their  attention, build self-esteem, and function in new ways.

 

 

 

 

e-mail address: ina@posta.ge