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"= 7=0; C65 <5;0=E>;8N 8 <0=8N, AC<0AH5AB285 ?>A;5 >AB@KE ;8E>@04>G=KE 1>;57=59, ?>A;5 ?04CG59 8 @>4>2KE ?@>F5AA>2, 5<C 1K;8 8725AB=K B0:65 70?>9=K9 1@54 8 8AB5@8O, 0 87 >B45;L=KE A8<?B><>2  ?@54A5@45G=0O B>A:0 8 A;CE>2K5 30;;NF8=0F88. B 53> 27>@0 =5 CA:>;L7=C;> 7=0G5=85 ?A8E>?0B8G5A:>3> B5<?5@0<5=B0, :>B>@>5 =5 5ABL =0AB>OI55 ?><5H0B5;LAB2>". K45;5=85 =5:>B>@KE 1>;57=59 8??>:@0B>< 1K;> M<?8@8G5A:8<, >?8A0B5;L=K<, 0 ?@54AB028B5;O<8 :=84A:>9 H:>;K  C<>7@8B5;L=K<. 725AB=K5 2@0G8 4@52=53> <8@0 A:;5?804, &5;LA, @5B59, 2@5;89 1K;8 ?>A;54>20B5;O<8 8??>:@0B0 8 B0: 65, :0: 8 >=, M<?8@8:0<8. >A;5 4;8B5;L=>3> 70AB>O 2 !@54=85 25:0 2 ?5@8>4 >7@>645=8O =0G8=05BAO =>2K9 MB0? @0728B8O ?A8E80B@88. !=0G0;0 >= ?@>E>48; ?>4 7=0:>< :=84A:>9 H:>;K  A8AB5<0B8:8 ?A8E8G5A:8E 1>;57=59. > 2B>@>9 ?>;>28=5 XVI 2. F.Platter (1536 1614), ?A8E80B@ M?>E8 >7@>645=8O, A>740; ?5@2CN 2 8AB>@88 ?A8E80B@88 :;0AA8D8:0F8N ?A8E>7>2, A>AB>OICN 87 23 284>2 ?A8E8G5A:8E 1>;57=59, @07<5I5==KE 2 4 :;0AA0E. @8G8=K ?><5H0B5;LAB20 F.Platter ?>4@0745;O; =0 2=5H=85 8 2=CB@5==85. = ?@>O2;O; 8=B5@5A : A>AB>O=8O<, ?>3@0=8G=K< A ?A8E>70<8, >B=>A8<K< B5?5@L : <0;>9 ?A8E80B@88.  ?5@2>9 ?>;>28=5 XVII 2. P.Zacchia (1584 1659) ?@54;>68; A2>N :;0AA8D8:0F8N ?A8E8G5A:8E 1>;57=59, 2:;NG0NICN 3 :;0AA0, 15 284>2 8 14 @07=>284=>AB59. = 1K; >4=8< 87 >A=>20B5;59 AC451=>9 <548F8=K, 2:;NG0O AC451=CN ?A8E80B@8N.  B>< 65 25:5 T.Sydenham (1624 1689), 1;5ABOI5 ?@8<5=O2H89 38??>:@0B>2A:89 <5B>4 2 ?@0:B8:5, 2 B5>@88 A;54>20; :=84A:>9 H:>;5, AB@5<OAL A>740BL :;0AA8D8:0F8N 1>;57=59, ?>4>1=CN "AB5AB25==>9 A8AB5<0B8:5" K. Linnaeus (1758). = CB25@640;, GB> >48=0:>2K5 1>;57=8 ?@>B5:0NB A >4=8<8 8 B5<8 65 A8<?B><0<8 C @07;8G=KE ;8G=>AB59  "8 C 1>;L=>3> !>:@0B0, 8 C 848>B0".  1763 3. F.Boissier de Sauvages A>AB028; =>7>;>38G5A:CN A8AB5<C, 2:;NG0NICN 2400 1>;57=59, ?>4@0745;5==KE =0 :;0AAK, ?>@O4:8, A5<59AB20. A8E>70< >= >B25; 8-9 :;0AA, A>AB>OI89 87 3 >B45;>2, A>45@60I8E 27 284>2 1>;57=59. !@548 A>2@5<5==8:>2 F.Boissier de Sauvages 1K; @O4 2@0G59, ?>4@>1=> 8AA;54>202H8E >B45;L=K5 1>;57=8. !@548 =8E 2K45;O;AO Willis (1776), >?8A02H89 :;8=8G5A:CN :0@B8=C ?@>3@5AA82=>3> ?0@0;8G0. A. Bayle ?@87=0; Willis A2>8< ?@54H5AB25==8:><. V. Chiarugi (1793) 1K; ?@54H5AB25==8:>< H.Neumann, A>7402H53> 2 1860 3. CG5=85 > 548=>< ?A8E>75. W.Cullen (1754) B@0:B>20; ?A8E8G5A:85 1>;57=8 :0: AB@040=8O 3>;>2=>3> <>730, ?@>O2;ONI85AO 2 53> C3=5B5=88 8;8 2>71C645=88.  :>=F5 XVIII  ?5@2>9 ?>;>28=5 XIX 2. 3>A?>4AB2>20;8 8458 8??>:@0B0. ./. C4@>2 CB25@640;, GB> "=5B 1>;57=59, 0 5ABL 1>;L=K5". 57028A8<> >B =53> Ph. Pinel (1801) ?8A0;, GB> "G8A;> @>4>2 ?><5H0B5;LAB20 >3@0=8G5=>, => 2AB@5G0NI85AO 745AL 20@80=BK <>3CB C25;8G820BLAO 4> 15A:>=5G=>AB8". >74=55, 2 =0G0;5 XIX 2., Autenrieth (1805) C65 45;05B ?>?KB:C ?>:070BL @0728B85 ?A8E8G5A:8E 1>;57=59, >B<5G0O, GB> B5 8;8 8=K5 1>;57=5==K5 D>@<K =0ABC?0NB 2 >?@545;5==>9 ?>A;54>20B5;L=>AB8, ?@54AB02;OO A>1>9 725=LO >4=>9 F5?8. = ?8A0;, GB> 1>;57=L G0AB> =0G8=05BAO A 8?>E>=4@88 8 <5;0=E>;88, :>B>@K5 A<5=ONBAO ?><5H0B5;LAB2>< 8 A;01>C<85<; A;01>C<85< :>=G05BAO 1>;LH8=AB2> A;CG052 1@540. 1I85 ?0B>;>38 Broussais, Magendie, Muller B@0:B>20;8 1>;57=8 ?@58<CI5AB25==> :0: :>;8G5AB25==K5, 0 =5 :0G5AB25==K5 >B:;>=5=8O >B =>@<K. Broussais, 2 G0AB=>AB8, 8@>=878@>202H89 ?> ?>2>4C ;N1>9 ?>?KB:8 >?8A0=8O B8?8G=KE ?@>O2;5=89 8 B5G5=8O 1>;57=8, CB25@640;, GB> 3@C??K A8<?B><>2, B@0:BC5<K5 :0: 1>;57=8, ?@54AB02;ONB A>1>9 "<5B0D878G5A:>5 701;C645=85", B.5. >B=N4L =5 ?@8ACI55, =587<5==>5 A2>9AB2> 1>;57=8, 0 ?@>872>;L=CN 3@C??8@>2:C ?@>O2;5=89 ?0B>;>388. R. Virchow (1857) ?8A0;, GB> 1>;57=L  =5 =57028A8<0O A0<>AB>OB5;L=0O ACI=>ABL, 0 ;8HL <0=8D5AB0F8O 687=5==>3> ?@>F5AA0 2 87<5=5==KE CA;>28OE. H. Maudsley (1871) 8 W.Griesinger (1845) A>A@54>B>G820;8 A2>8 CA8;8O =0 8AA;54>20=88 >1I8E 70:>=><5@=>AB59 @0728B8O ?A8E8G5A:>3> @0AAB@>9AB20 8 53> @50;870F88 C >B45;L=KE 1>;L=KE.  A2O78 A MB8< H. Maudsley (1871) ?8A0;: "A>15==>AB8 ?A8E8G5A:>9 >@30=870F88 8;8 B5<?5@0<5=B0 8<5NB 1>;55 206=>5 7=0G5=85 4;O >?@545;5=8O D>@<K ?><5H0B5;LAB20, =565;8 ?@>872>4OI85 ?@8G8=K 1>;57=8. 8HL 2 @57C;LB0B5 40;5:> 70H54H53> ?><5H0B5;LAB20, :>340 ?@>872>4OI0O B2>@G5A:0O 45OB5;L=>ABL, 2KAH55 >B?@02;5=85 2KA>:>3> 8 74>@>2>3>. C<0, =825;8@C5BAO, B>340 2KABC?0NB >1I85 ?@87=0:8 ?><5H0B5;LAB20 4;O 2A5E 2>7@0AB>2 8 @07;8G=KE AB@0=". E. Esquirol (1837) 8 4@C385 02B>@K =0@O4C A C3;C1;5==K<8 ?A8E>?0B>;>38G5A:8<8 8AA;54>20=8O<8 ?KB0;8AL A8AB5<0B878@>20BL ?A8E8G5A:85 1>;57=8. !>74020;0AL @01>G0O :;0AA8D8:0F8O ?A8E8G5A:8E 1>;57=59 [Schtile G., 1880; Krafft-Ebing R., 1897], @07@010BK20;0AL >?8A0B5;L=0O :;0AA8D8:0F8O ?A8E>7>2 [>@A0:>2 !.!., 1887; 0=48=A:89 .%., 1890]. K;8 ?>?KB:8 A>740BL ?>A;54>20B5;L=CN MB8>;>38G5A:CN :;0AA8D8:0F8N ?A8E8G5A:>9 ?0B>;>388 [Morel ., 1852; Magnan V., 1891]. @0240, 8AB>@8: <548F8=K J.M. Guardia (1892) ?>74=55 ?8A0; ?> ?>2>4C :;0AA8D8:0F88 ?A8E8G5A:8E 1>;57=59: "> 5A;8 AB0=5< @0AA<0B@820BL @57C;LB0BK =>7>;>38G5A:8E A8AB5<, B> ?@8<5@, ?>40==K9 =>7>3@0D0<8, 1K; A:>@55 3815;5=, G5< ?>;575=, ?>B><C GB> =5A2>52@5<5==>5 ?@8<5=5=85 2 ?0B>;>388 <5B>4>2 :;0AA8D8:0F88, ?@8=OBKE 2 5AB5AB25==>9 8AB>@88, 4>;6=> =587156=> ?@825AB8 A;01K5 8 A0<>=045O==K5 C<K : AB@5<;5=8N A25AB8 7=0=85 A8<?B><>2 8 >B;8G8B5;L=KE ?@87=0:>2 : ?CAB>9 83@5 A;>2 8 A<5H0==>9 =><5=:;0BC@5". >;>65=85 @048:0;L=> 87<5=8;>AL ?>A;5 A5@88 >B:@KB89 >E0 8 0A-B5@0. K;8 =0945=K 2>71C48B5;8 @O40 8=D5:F8>==KE 1>;57=59: B8D0, BC15@:C;570, <0;O@88, E>;5@K, A8D8;8A0 8 4@., GB> 2A5;O;> =04564C =0 >B:@KB85 ?@8G8= 2A5E 1>;57=59. -B> ;53;> 2 >A=>2C =>7>;>38G5A:>9 A8AB5<K ?A8E8G5A:8E 1>;57=59 [Kraepelin ., 1883]. 0640O >B45;L=0O 1>;57=L  =>7>;>38G5A:0O 548=8F0  4>;6=0 >B25G0BL, ?> .Kraepelin, A;54CNI8< B@51>20=8O<: 548=0O ?@8G8=0, >48=0:>2K5 ?@>O2;5=8O, B5G5=85, 8AE>4 8 0=0B><8G5A:85 87<5=5=8O. 4=0:> MB>B ";8=59=K9 ?@8=F8?" [02K4>2A:89 .., 1962]  >4=0 ?@8G8=0 405B >48=0:>2K9 MDD5:B  =5 >?@0240;AO. K;8 >1=0@C65=K 10F8;;>=>A8B5;8, >AB02H85AO 2AN 687=L 74>@>2K<8; @07;8G=K5 A8<?B><K, B5G5=85 8 8AE>4 1>;57=8 C @07=KE ;8F, 70@065==KE >4=8< 8 B5< 65 2>71C48B5;5<, 8 =0>1>@>B, >48=0:>2>5 ?@>O2;5=85 ?0B>;>388, >1CA;>2;5==>9 @07=K<8 ?@8G8=0<8  B0: =07K205<0O M:28D8=0;L=>ABL (..02K4>2A:89). >4G0A >:07K20NBAO 38AB>;>38G5A:8 =5>B;8G8<K<8 BC15@:C;57=K5, ;5?@>7=K5, 1@CF5;;57=K5, A8D8;8B8G5A:85 3@0=C;5<K. "!?5F8D8G=>ABL C40;O5BAO >B =0A 5I5 40;LH5,  ?8A0; ..02K4>2A:89,  ?> <5@5 B>3> :0: <K C3;C1;O5<AO 2 F8B>;>38G5A:85 45B0;8, 2 >1;0ABL M;5:B@>==>9 <8:@>A:>?88". 5AA8<87< G. Schule 2 A5@548=5 XIX 2.: "@8 2A5< B>< ?@>3@5AA =0C:8 845B 25AL<0 <54;5==>  4> B0:>9 AB5?5=8 15A?@8AB@0AB=>5 =01;N45=85 AB@0405B ?>4 4>3<0B8G5A:8< O@<><, ;560I8< =0 2A59 =0H59 =0C:5"  >AB05BAO 0:BC0;L=K< 8 2 =0H8 4=8. A=>20=8O 4;O 2K45;5=8O A0<>AB>OB5;L=KE 1>;57=59 (=>7>;>38G5A:8E 548=8F) =5 B>;L:> 2 ?A8E80B@88, => 8 2 4@C38E 48AF8?;8=0E ?>-?@56=5<C :@09=5 <=>3>7=0G8<K. 1 MB><, 2 G0AB=>AB8, ?8H5B R.E. Kendell (1978) 2 A2>59 :=835, :0A0NI59AO 4803=>AB8:8 2 ?A8E80B@88: "Proctalgia fugax 8 Pruritus senilis ?@54AB02;ONB A>1>9 ;8HL A8<?B><K (?> 2>77@5=8O< :=84A:>9 H:>;K  1>;57=8). 83@5=L 8 1>;LH8=AB2> ?A8E8G5A:8E 701>;520=89 ACBL :;8=8G5A:85 A8=4@><K, :>=AB5;;OF8O A8<?B><>2 ?> T.Sydenham. 8B@0;L=K9 AB5=>7 8 E>;5F8AB8B 2K45;ONBAO, 8AE>4O 87 ?0B>D878>;>38G5A:>9 >A=>2K. ?CE>;8 2A5E 284>2 A8AB5<0B878@CNB, @C:>2>4AB2COAL 38AB>;>38G5A:8<8 40==K<8. "C15@:C;57 8 A8D8;8A  =0 >A=>25 10:B5@8>;>38G5A:8E 40==KE. >@D8@8O  18>E8<8G5A:8E 8AA;54>20=89. 80AB5=8O 3@028A  =0 >A=>20=88 D878>;>38G5A:>3> @0AAB@>9AB20 DC=:F89; 1>;57=L 0C=0  >A>15==>AB59 E@><>A><. ;0AA8D8:0F8O 1>;57=59 ?>E>60 =0 AB0@K9 4><, <51;8@>2:0 :>B>@>3> A>AB>8B 87 =>2>9 ?;0AB8:>2>9 <515;8, AB5:;0 ?@8 A>E@0=5=88 :><>4>2 2@5<5= "N4>@0 8 :@5A5; 28:B>@80=A:>9 M?>E8". 0728B85 <548F8=K ?>:070;>, GB> ?@8G8==>-A;54AB25==K5 >B=>H5=8O 2 2>7=8:=>25=88, B5G5=88 8 8AE>45 1>;57=59 7=0G8B5;L=> A;>6=55, G5< MB> ?@54AB02;O;8 A515 =5:>B>@K5 >A=>2>?>;>6=8:8 =0CG=>9 ?A8E80B@88, 2 G0AB=>AB8 E.Kraepelin. !8AB5<0 E.Kraepelin ?5@5AB0;0 A>>B25BAB2>20BL =5 B>;L:> C@>2=N =0C:8, => 8 :;8=8G5A:8< D0:B0<, :>B>@K5 2 =55 =5 C:;04K20;8AL.  :;0AA8D8:0F88 ?A8E8G5A:8E 1>;57=59 AB0;8 ?>O2;OBLAO B0:85 ?>=OB8O, :0: M:7>35==K5 @50:F88, A8<?B><0B8G5A:85 H87>D@5=88, A<5H0==K5 ?A8E>7K, ?0B>;>38G5A:>5 @0728B85 ;8G=>AB8, =52@>B8G5A:>5 @0728B85 8 B.?. 07=>>1@0785 ?@>O2;5=89, B5G5=8O 8 8AE>40 ?A8E8G5A:8E 1>;57=59 ?>72>;8;8 A. Hoche (1923) 2>>1I5 >B@8F0BL =>7>;>38N E.Kraepelin. A. Hoche ?8A0;, GB> 5AB5AB25==0O ?>B@51=>ABL C<0 2 C?>@O4>G820=88 =01;N405<KE O2;5=89 ;568B 2 >A=>25 ?>8A:0 >B45;L=KE 1>;57=59, =>, : A>60;5=8N, ?>4>1=0O AC1J5:B82=0O ?>B@51=>ABL ?>:0 =5 AB0=>28BAO @50;L=>ABLN. >AB865=8O 2 >1;0AB8 48DD5@5=F8@>2:8 >B45;L=KE =>7>;>38G5A:8E 548=8F >= A@02=820; A CA?5E>< ?5@5;820=8O <CB=>9 684:>AB8 87 >4=>3> A>AC40 2 4@C3>9. K45;5=85 =>7>;>38G5A:8E 548=8F ?A8E8G5A:8E 1>;57=59 >B@8F0; K.Jaspers (1913, 1923). = AG8B0;, GB> 845O ACI5AB2>20=8O =>7>;>38G5A:8E A0<>AB>OB5;L=KE 1>;57=59 2 459AB28B5;L=>AB8 5ABL 845O 2 :0=B>2A:>< A<KA;5, ACBL :>B>@>9 ?>AB83=CBL =52>7<>6=>, 81> >=0 ;568B 2 15A:>=5G=>AB8, E>BO 2<5AB5 A B5< A>45@68B >ICB8<K5 @57C;LB0BK 2 2845 M<?8@8G5A:8E 8AA;54>20=89. ! :@8B8:>9 A.Hoche 8 K.Jaspers 2 40;L=59H5< 2 7=0G8B5;L=>9 <5@5 A>3;0A8;AO 8 A0< E.Kraepelin.  1920 3. 2 A2>59 AB0BL5 "$>@<K ?@>O2;5=8O AC<0AH5AB28O" >= ?@87=020;, GB> 53> :;0AA8D8:0F8O @>48;0AL ?>4 2;8O=85< 1C@=KE CA?5E>2 <8:@>18>;>388. > E.Kraepelin >AB020;AO =0 ?@56=8E =>7>;>38G5A:8E ?>78F8OE, =5A<>B@O =0 B>, GB> 4;O >1>A=>20=8O =>7>;>38G5A:8E :0B53>@89 >= 8A?>;L7>20; >1I5?0B>;>38G5A:85 :@8B5@88 ?A8E8G5A:8E @0AAB@>9AB2. "0:8E :@8B5@852, =0720==KE 8< @538AB@0<8, >= 2K45;O; B@8. 5@2K9, =081>;55 ;53:89 284 @0AAB@>9AB2 ?A8E8G5A:>9 45OB5;L=>AB8 ?@>O2;O5BAO 0AB5=8G5A:8<8, =52@>B8G5A:8<8 8 0DD5:B82=K<8 @0AAB@>9AB20<8; 2B>@>9  H87>D@5=8G5A:8<8; B@5B89  @07=>>1@07=K<8 >@30=8G5A:8 >1CA;>2;5==K<8 87<5=5=8O<8. =0G5=85 MB8>;>38G5A:8 =5A?5F8D8G5A:>3>, >1I53> 2 ?@>O2;5=88 ?A8E8G5A:8E 1>;57=59 1K;> ?>A;54>20B5;L=> @0728B> K.Bonhoeffer (1909) 2 CG5=88 >1 M:7>35==>< B8?5 @50:F89. 0@O4C A 8=D5:F8>==K<8 >=> @0A?@>AB@0=O;>AL =0 8=B>:A8:0F8>==K5, A><0B>35==K5 8 B@02<0B8G5A:85 ?A8E>7K. 1I5?0B>;>38G5A:>5 7=0G5=85 MB>3> CG5=8O >1>A=>2K20;>AL CB25@645=8O<8 > B><, GB> 2>7459AB2CNI85 =0 <>73 A;01K5 2@54=>AB8 ?@>O2;ONBAO M=4>35==K<8 @0AAB@>9AB20<8, 0 8=B5=A82=> 459AB2CNI85  M:7>35==K<8 [Specht G., 1913].  20-5 3>4K XX AB>;5B8O E. Kretschmer (1922, 1930) 8 53> H:>;0, 0 B0:65 K. Birnbaum (1913) ?>?KB0;8AL A8=B578@>20BL =>7>;>38G5A:85 70:><5@=>AB8 8 ?@54AB02;5=8O > :>=AB8BCF8>=0;L=> >1CA;>2;5==>9 8E @50;870F88 C >B45;L=KE 1>;L=KE. -B> =0H;> 2K@065=85 2 <5@48<5=78>=0;L=>9 4803=>AB8:5 8 AB@C:BC@=>-0=0;8B8G5A:>< B>;:>20=88 8=48284C0;L=KE >A>15==>AB59 ?@>O2;5=89 ?A8E>70 (A<. =865).  B5G5=85 ?>A;54=8E 45AOB8;5B89 2 ?A8E80B@88 2=>2L AB0;8 ?@5>1;040BL 38??>:@0B>2A:85 8458. O4 8AA;54>20B5;59, ?@5645 2A53> K.Conrad (1959), 2K428=C;8 845N 548=>3> M=4>35==>3> ?A8E>70 2 2845 =5A:>;L:8E @07=>284=>AB59  =5?@5@K2=>-?@>3@5485=B=>9, ?@8ABC?>>1@07=>9, @5:C@@5=B=>9 8 F8:;>B8<8G5A:>9. #G5=8O > 1>;57=OE 8 1>;L=>< =5 8A:;NG0NB 4@C3 4@C30. -B> ?@>O2;5=85 480;5:B8G5A:>9 A2O78 >1I53> 8 >B45;L=>3>. 48=8G=>5, 5AB5AB25==>, 1>30G5 >1I53>, => >1I55 A>45@68B ACI5AB25==K5 70:>=><5@=>AB8 548=8G=>3>. @8=F8? >B >1I53> : G0AB=><C ;568B 2 >A=>25 A>2@5<5==>3> ?@5?>4020=8O <548F8=K. C4CI85 2@0G8 A=0G0;0 87CG0NB 1>;57=8 :0: B0:>2K5 2> 2@5<O D0:C;LB5BA:>3> :C@A0 B5@0?88 8 E8@C@388 (?;0B>=>2A:>5 =0?@02;5=85) 8 B>;L:> ?>B><, 2> 2@5<O 3>A?8B0;L=>3> :C@A0, ?>AB830NB >A>15==>AB8 @50;870F88 87CG5==KE 1>;57=59 C >B45;L=KE 1>;L=KE (38??>:@0B>2A:>5 =0?@02;5=85). ;8=8G5A:>5 87CG5=85 ?A8E>7>2 ?>72>;O5B >1=0@C68BL >48=0:>2K5 ?A8E>?0B>;>38G5A:85 A>AB>O=8O ?@8 =>7>;>38G5A:8 @07=KE ?A8E>70E. -B> >1AB>OB5;LAB2> 8 AB0;> ?>2>4>< : ?@87=0=8N ACI5AB2>20=8O ?A8E>?0B>;>38G5A:8E A8=4@><>2, =5 7028AOI8E >B =>7>;>38G5A:8E >A>15==>AB59 ?A8E8G5A:8E 1>;57=59. @>87>H;> =5GB> 2@>45 2>A:@5H5=8O A@54=525:>2>3> @50;87<0, CB25@6402H53> ACI5AB2>20=85 C=825@A0;89, =57028A8<KE >B >B45;L=KE 25I59. 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"48=>3>" ?A8E>70 2 ?@8@>45 =5B. N1>5 >1>1I5=85 2A5340 A2O70=> A> 7=0G8B5;L=K< >154=5=85< <=>38E A2>9AB2, ?@8ACI8E >B45;L=><C. '0AB=>?0B>;>38G5A:>5  8=48284C0;L=K5 ?@>O2;5=8O 1>;57=8 C >B45;L=KE 1>;L=KE  >1;0405B <=>38<8 A2>9AB20<8, :>B>@K5 =5 =0E>4OB >B@065=8O 2 >1I5?0B>;>38G5A:><. 4=0:> 7=0=85 >1I5?0B>;>38G5A:>3> ?>72>;O5B ;CGH5 2845BL, B>G=55 >F5=8BL, ?>7=0BL '0AB=>?0B>;>38G5A:>5  >A>1K5 A2>9AB20, 20@80F88 >B45;L=KE 1>;57=59, 157 :>B>@KE =5;L7O >1=0@C68BL 8E ?0B>35=57. '0AB=>?0B>;>38G5A:0O @50;870F8O C=825@A0;L=>9 D>@<K 2K@0605BAO 8 2 B><, GB> :064>9 =>7>;>38G5A:8 A0<>AB>OB5;L=>9 1>;57=8 ?@8ACI8 A2>8 D>@<K B5G5=8O. >7>;>38G5A:0O A0<>AB>OB5;L=>ABL 1>;57=8 2 F5;>< 2KO2;O5BAO 2 A>2>:C?=>AB8 2A5E >A>15==>AB59 55 @0728B8O, B.5. 2 A>1AB25==>< ?0B>:8=575. 064K9 MB0? ?@>O2;5=8O 1>;57=8 (AB0BCA 2 <><5=B 8AA;54>20=8O)  MB> ?@>4C:B 55 ?@54H5AB2CNI53> @0728B8O.  =5< 2 A2>N >G5@54L 70;>65=K (?>B5=F80;L=> >1CA;>2;5=K) >A>15==>AB8 40;L=59H53> B5G5=8O. -B> A2845B5;LAB2C5B > 548=AB25 48=0<8:8 8 AB0B8:8 1>;57=8.  MB>< >B=>H5=88 <>6=> A>A;0BLAO =0 L.Bertalanny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"0:>5 ;5G5=85 CABC?8;> <5AB> A>25@H5==> =>2><C 284C B5@0?88  ;5G5=8N ?A8E>D0@<0:>;>38G5A:8<8 A@54AB20<8, :>B>@K5 ?>72>;ONB 2>7459AB2>20BL =0 >?@545;5==K9 :@CB ?A8E8G5A:8E @0AAB@>9AB2 A ?><>ILN =59@>;5?B8G5A:8E, B8<>;5?B8G5A:8E ?@5?0@0B>2 8 B@0=:28;870B>@>2. @8<5=5=85 ;8B8O ?>72>;8;> ?>4>9B8 : MDD5:B82=>9 ?@>D8;0:B8:5 ?A8E8G5A:8E =0@CH5=89. >2K5 A?>A>1K ;5G5=8O A8;L=> 87<5=8;8 ?@>O2;5=8O 8 B5G5=85 A0<8E ?A8E8G5A:8E 1>;57=59 (B5@0?52B8G5A:89 ?0B><>@D>7), 0 B0:65 A?>A>1AB2>20;8 ?>=8<0=8N @O40 >A>15==>AB59 8E ?0B>35=570 (?>4B25@640O AB0@K9 0D>@87<: "5G5=85 ?><>305B ?>7=020BL ?@8@>4C 1>;57=59"). 7CG5=85 ACI=>AB8 ?A8E8G5A:8E 1>;57=59 ?>@>48;> @O4 :>=F5?F89. !@548 =8E >A>1>5 <5AB> 70=8<05B D878>;>38G5A:>5 CG5=85 ..02;>20 8 53> ?>A;54>20B5;59, M:A?5@8<5=B0;L=> 87CG02H8E ?A8E8G5A:85 A2>9AB20. !CBL 4@C38E =0?@02;5=89 A2>48BAO 2 :>=5G=>< AG5B5 : B>;:>20=8N ?A8E8G5A:>9 ?0B>;>388 ?@8 ?><>I8 C<>7@8B5;L=KE ?>=OB89 A>>B25BAB2CNI53> CG5=8O. !CI=>ABL ?A8E>70, ?> J.H.Jackson (1931), 70:;NG05BAO 2 48AA>;NF88 (@07;>65=88, 2K?045=88) 2KAH8E, 1>;55 48DD5@5=F8@>20==KE C@>2=59 ?A8E8G5A:>9 45OB5;L=>AB8 8 2KA2>1>645=88 =87H8E, 1>;55 ?@8<8B82=KE C@>2=59. A8E>7 =5 ?>@>6405B =>2KE O2;5=89. =8 ?@54AB02;ONB A>1>9 @57C;LB0B 2K?045=8O 45OB5;L=>AB8 2KAH8E C@>2=59 ("<8=CA-A8<?B><K") A 2KA2>1>645=85< 45OB5;L=>AB8 =87H8E C@>2=59 ("?;NA-A8<?B><K"). 59@>D878>;>38G5A:0O :>=F5?F8O ?@8405B 254CI55 7=0G5=85 2 ?@>8AE>645=88 ?A8E>70 2=5H=8< 2>7459AB28O<, 0 =5 :>=AB8BCF8>=0;L=><C ?@54@0A?>;>65=8N. =0 >A=>2K205BAO =0 40==KE M:A?5@8<5=B0;L=KE 8AA;54>20=89 A>AB>O=89 ?>;=>9 A5=A>@=>9 87>;OF88, ?@82>4OI59 : 2>7=8:=>25=8N AB@0E0, 30;;NF8=0F89 8 1@540. 815@=5B8G5A:0O :>=F5?F8O: ?A8E8G5A:>5 @0AAB@>9AB2>, ?> <=5=8N ?>A;54>20B5;59 MB>9 :>=F5?F88, <>65B 2>7=8:=CBL 2 @57C;LB0B5, 2>-?5@2KE, =0@CH5=8O @53C;OF88 (D8;LB@0) 8=D>@<0F88. #25;8G5=85 55 ?>ABC?;5=8O 2A;54AB285 45D5:B0 A5;5:F88 ?> 55 7=0G8<>AB8 ?@82>48B : 8=D>@<0F8>==>9 ?5@53@C7:5, :>340 8=D>@<0F8O =5 ?5@5@010BK205BAO.  @57C;LB0B5 2=5H=89 <8@ AB0=>28BAO AB@0==K<, =5>?@545;5==K<, ?>;=K< 7=0G5=8O 8 B@52>38. >-2B>@KE, A>3;0A=> MB>9 :>=F5?F88, ?A8E8G5A:0O 1>;57=L 2>7=8:05B 2 A2O78 A =5>1KG=>9 >F5=:>9 ?>2A54=52=KE 2?5G0B;5=89, GB> 2545B : 38?5@B@>D8@>20==><C ?5@56820=8N 8E 7=0G5=8O.  @57C;LB0B5 @0728205BAO A>AB>O=85 A25@E1>4@AB2>20=8O, ?@8 :>B>@>< ?@>8AE>48B 2>A?@8OB85 2A5E 2=5H=8E 2?5G0B;5=89. 5@48<5=78>=0;L=0O :>=F5?F8O [Gaupp ., 1902; Kretschmer E., 1922, 1930] B@0:BC5B 35=57 1@540 :0: @57C;LB0B A>G5B0=8O ?A8E>35==KE (@50:B82=KE) 8 M=4>35==KE D0:B>@>2. @54, ?> MB>9 :>=F5?F88, 2>7=8:05B 2 @57C;LB0B5 @0728B8O ;8G=>AB8 2 CA;>28OE >A>1KE 687=5==KE >1AB>OB5;LAB2 ?@8 M=4>35==>< ?@54@0A?>;>65=88 : =5<C. "8?8G=K< 4;O @0728B8O 1@540 . Kretschmer AG8B05B ?@8ACBAB285 8=3@5485=B>2, ?>4E>4OI8E :0: :;NG : 70<:C,  A:;040 E0@0:B5@0, A8BC0F88 8 687=5==>3> >?KB0. 5HB0;JB?A8E>;>38G5A:0O :>=F5?F8O ?A8E>70 (1@54>2>3>) >B@065=0 2 B@C40E . Conrad (1958). !>3;0A=> MB>9 :>=F5?F88, @0728B85 1@540 ?@>E>48B @O4 MB0?>2. 5@2K9 MB0?  B@5<0 ?@54AB02;O5B A>1>9 BO3>AB=>5 GC2AB2> =5>B2@0B8<> =042830NI59AO C3@>7K, B@52>6=>5 =0AB@>5=85 A ?5@56820=85< 87<5=5==>AB8 A0<>3> 1>;L=>3> 8 2=5H=53> <8@0, AB@0E><. 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A>>B25BAB288 A MB8<, =0?@8<5@, C 1>;L=KE H87>D@5=859 :>=AB0B8@C5BAO 87<5=5=85 1KB8O. !B>@>==8:8 MB>3> B5G5=8O 3>2>@OB >1 87<5=5=88 "=0;8G=>3> 1KB8O", ":><<C=8:0F88", "A>1AB25==>3> <8@0", GB> 2545B : ":@CH5=8N 687=8". @54 2 A>>B25BAB288 A B0:8<8 273;O40<8 ?@54AB02;O5B A>1>9 A0<>2K@065=85 H87>D@5=8G5A:>3> 1KB8O. =B@>?>;>38G5A:>5 =0?@02;5=85 B@0:BC5B ?A8E>7 :0: @57C;LB0B :@0E0 ?@82KG=>3> ACI5AB2>20=8O G5;>25:0. 450;8AB8G5A:0O ?@8@>40 MB>3> =0?@02;5=8O O2AB2C5B 87 >F5=>: .Jaspers (1953), :>B>@K9 ?8A0;, GB> >1@07 G5;>25:0, A;>682H89AO 2 0=B@>?>;>388, 2K@>A 87 3@5G5A:>9 D8;>A>D88, CG5=89 23CAB8=0, 8@:5@300@40, 0=B0, 535;O, 0 70B5< 8 8FH5. CE>2=K5 8 ?A8E>;>38G5A:85 <0AHB01K G5;>25:0 5I5 8 A53>4=O =54>AB0B>G=> CAB0=>2;5=K, 0 4>AB83=CBK9 C@>25=L 7=0=8O =5045:20B5= 4;O >F5=>: ACI5AB2>20=8O G5;>25:0 2 B>< A<KA;5, 2 :0:>< >= A51O >A>7=05B. A8E>0=0;87. A=>20B5;L ?A8E>0=0;870 S.Freud (1911) AB@5<8;AO 18>;>38G5A:8 >1>A=>20BL A2>N 3;C18==CN ?0=A5:AC0;L=CN ?A8E>;>38N. S.Freud B@0:B>20; G5;>25:0 :0: A5:AC0;L=>-45B5@<8=8@>20==>5 ACI5AB2>. @0<0B87< G5;>25G5A:>9 687=8, ?> 53> <=5=8N, A>AB>8B 2 =5?@8<8@8<>< :>=D;8:B5 <564C G5;>25:>< 8 F828;870F859, 2 0=B03>=8AB8G5A:>< ?@>B82>@5G88 <564C 15AA>7=0B5;L=K<8 2;5G5=8O<8 G5;>25:0 8 70?@5B0<8 :C;LBC@K, <564C AB@5<;5=85< G5;>25:0 : >ACI5AB2;5=8N A2>8E A:@KBKE 2;5G5=89 8 AB@0E>< =0@CH5=8O <>@0;L=KE 70?>25459 A5<L8, >1I5AB20. >@0;L=K9 48:B0B :C;LBC@K, ?> S.Freud, 70:;NG05BAO 2 D>@<C;5: ""0<, 345 1K;> "=>" (48:B0B 15AA>7=0B5;L=KE 2;5G5=89), 4>;6=> 1KBL /". > B>;:>20=8N S.Freud, ?A8E>7 =0ABC?05B B>340, :>340 / >A;01;5=>, 53> ?>A@54=8G5AB2> <564C B@51>20=85< "=>" 8 2=5H=8< <8@>< =5 >ACI5AB2;O5BAO.  @57C;LB0B5 / :0?8BC;8@C5B 8 453@048@C5B =0 @0==NN AB048N @0728B8O. / <>65B 45D>@<8@>20BLAO, @0AI5?;OBLAO, <>65B =0ABC?8BL @0742>5=85 /. ;02=K9 <5E0=87< 70I8BK 2 ?A8E>75 5ABL @53@5AA /. >;57=L /, ?@54AB02;ONI0O A>1>9 ACI=>ABL ?A8E>70, @07=K<8 ?>A;54>20B5;O<8 S.Freud >1JOA=O5BAO 25AL<0 @07;8G=>  @07;>65=85 /, 45D8F8B AB@C:BC@K /, 0@E087< /, M3>?0B8O, @0A?04 A8=B578@CNI59 DC=:F88 /, @53@5AA82=K9 @0A?04 /. > C.G.Jung (1921), ?A8E>7 ?@54AB02;O5B A>1>9 2K@065=85 0@E8B8?8G5A:>3> >1@07>20=8O :>;;5:B82=>3> 15AA>7=0B5;L=>3>. K. Jaspers (1913), :20;8D8F8@CO :>=F5?F8N S.Freud, 2 F5;>< >E0@0:B5@87>20; 55 :0: "?A524><8D>;>38N", @0A?@>AB@0=ONICN ?@8=F8? ?>=OB=KE A2O759 =0 2AN ?A8E8G5A:CN 45OB5;L=>ABL, => 83=>@8@CNICN 2 =59 @>;L :0C70;L=KE A2O759.  >B;8G85 >B :>=F5?F88 S.Freud F5=B@0;L=>9 ?@>1;5<>9 =5>D@59487<0 [Horney ., 1939, 1945; Sullivan S., 1932, 1962; Fromm E., 1941, 1970] AB0;8 >B=>H5=8O <564C ;N4L<8, <564C ;8G=>ABLN 8 >1I5AB2><, 2708<>>B=>H5=85 ?A8E>;>38G5A:8E 8 A>F80;L=KE D0:B>@>2. #A8;8O ?@54AB028B5;59 =5>D@59487<0 A>A@54>B>G8;8AL =0 :C;LBC@=KE 8 A>F80;L=KE CA;>28OE ACI5AB2>20=8O G5;>25:0, =0 8AA;54>20=88 2708<>A2O78 <564C ;8G=>ABLN 8 :C;LBC@>9. 5>D@59487< AB@5<8;AO : A>F80;L=>9 8 :C;LBC@0;L=>9 ?5@5>@85=B0F88 ?A8E>0=0;870, : ?@>1C645=8N A0<>A>7=0=8O ;8G=>AB8. AA;54>20=85 A0<>A>7=0=8O >1=0@C6820;> C G5;>25:0 ">A=>2=>9 :>=D;8:B", >1CA;>2;5==K9 15A?><>I=>ABLN G5;>25:0 2 <8@5, 53> =5A?>A>1=>ABLN >@85=B8@>20BLAO 2 <5=ONI8EAO CA;>28OE 687=8 8 ?>AB>O==K< ">A=>2=K< 15A?>:>9AB2><", A2O70==K< A >BG0O=85< 8 15A?><>I=>ABLN ACI5AB2>20=8O, :>B>@><C ?@>B82>AB>OB GC64K5 ?@8@>4=K5 8 A>F80;L=K5 A8;K. =8 A>740NB ?>AB>O==K5 ?@>B82>@5G8O <564C ?>B@51=>ABO<8 >B45;L=>3> G5;>25:0 8 2>7<>6=>ABO<8 8E C4>2;5B2>@5=8O 2 ACI5AB2CNI8E CA;>28OE. 07@K2 <564C ?>B@51=>ABO<8 8 8E C4>2;5B2>@5=85< 2K7K205B "15A?>:>9AB2>", 2>7=8:0NI55 2 <><5=B @>645=8O, ?@8 :>@<;5=88 @515=:0 <0B5@LN 2 2845 B@52>38 ?> ?>2>4C 2>7<>6=>9 CB@0BK 701>BK <0B5@8. >=D;8:B=0O A8BC0F8O 2>7=8:05B 2 @57C;LB0B5 =5A>>B25BAB28O <564C G5;>25G5A:8<8 ?>B@51=>ABO<8 8 ?@545;0<8 8E C4>2;5B2>@5=8O, GB> >1CA;>2;8205B ?0B>;>38N 2 D>@<5 "48=0<87< 48AA>F80F88". 7 AB@5<;5=8O A3;048BL 8;8 @07@5H8BL @0748@0NI85 G5;>25:0 ?@>B82>@5G8O G5;>25:, 70<5I0O "@50;L=>5" /, A>7405B 8450;878@>20==K9 >1@07  "8450;878@>20==>5" /. 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A>>B25BAB288 A MB8< B>;:>20=85 =52@>7>2 :0: A;54AB28O 2=CB@8;8G=>AB=KE :>=D;8:B>2 8 =0@CH5=8O >B=>H5=89 <564C ;N4L<8 1K;> 70<5=5=> >?@545;5=85< =52@>7>2 :0: @57C;LB0B0 @0AAB@>9AB2 2=CB@8?A8E8G5A:>9 687=8 G5;>25:0. =B8?A8E80B@8O. >A;54>20B5;8 0=B8?A8E80B@8G5A:>3> =0?@02;5=8O 2 A>2@5<5==>9 ?A8E80B@88 B@0:BCNB 2A5 >B:;>=5=8O 2 ?A8E8G5A:>9 45OB5;L=>AB8 G5;>25:0, 2?;>BL 4> ?A8E>70, =5 :0: ?@>O2;5=85 ?0B>;>388, 0 :0: >B@065=85 ?@8ACI53> 2A5<C G5;>25G5AB2C 8@@0F8>=0;L=>3> =0G0;0 ?A8E8G5A:>9 45OB5;L=>AB8 8 2K@065=85 ?@>B5AB0 ?@>B82 ACI5AB2CNI53> A>F80;L=>3> C:;040 [Foucault M., 1968]. !B>@>==8:8 0=B8?A8E80B@88 AB@5<OBAO : 2KO2;5=8N A:@KB>9 1@54>< "8AB8=K". > <=5=8N 0=B8?A8E80B@>2 [Szasz Th., 1961; Scheff T.J., 1966; Laing R.D., 1967; Cooper D., 1967, 8 4@.], A;54C5B =02A5340 >B:070BLAO >B <548F8=A:>3> >1A;C6820=8O 1>;L=KE 8, =0?@>B82, AB@5<8BLAO : ?>;=><C C4>2;5B2>@5=8N 8E 8=48284C0;L=KE 8 A>F80;L=KE =C64, 2 B>< G8A;5 8 2K@0605<KE 2 A>AB>O=88 ?A8E>70. =B8?A8E80B@K ?@87K20;8 : B@5BL59 @52>;NF88 2 ?A8E80B@88 (?5@2>9 AG8B05BAO A=OB85 A 1>;L=KE F5?59; 2B>@>9  ?>O2;5=85 ?A8E>0=0;8B8G5A:>9 B5>@88, O:>1K >A2>1>482H59 G5;>25:0 >B 53> ?>4A>7=0B5;L=KE ":><?;5:A>2"). 5A<>B@O =0 >B:@>25==CN =838;8AB8G=>ABL, 0=B8?A8E80B@8G5A:0O :>=F5?F8O 2 60-E 3>40E ?@8>1@5;0 7=0G8B5;L=CN ?>?C;O@=>ABL 2 !( 8 =5:>B>@KE AB@0=0E 0?04=>9 2@>?K. 4=0:> 55 2;8O=85 ?>GB8 ?@5:@0B8;>AL, G5<C 2 =5<0;>9 AB5?5=8 A?>A>1AB2>20;8 =5?@85<;5<K9 4;O 2@0G59 >B:07 >B ;5G51=>9 ?><>I8 1>;L=K< 8 CA?5E8 ?A8E>D0@<0:>;>38G5A:>9 B5@0?88.  ?@>F5AA5 @0728B8O ?A8E80B@88 2K45;8;8AL 8 A;>68;8AL >B45;L=K5 55 >B@0A;8: 45BA:0O ?A8E80B@8O, 35@80B@8G5A:0O ?A8E80B@8O (?A8E80B@8O ?>74=53> 2>7@0AB0), 18>;>38G5A:0O ?A8E80B@8O, A>F80;L=0O ?A8E80B@8O, 2>5==0O 8 AC451=0O ?A8E80B@8O, 0 B0:65 ?A8E>D0@<0:>;>38O.  <8@>2>9 ?A8E80B@88 2K45;O5BAO B0:65 :@>AA-:C;LBC@0;L=0O, 8;8 B@0=A:C;LBC@0;L=0O, ?A8E80B@8O.  MB>9 >1;0AB8, ?><8<> >1I5?@8=OBKE >1>7=0G5=89 A8<?B><>2 8 A8=4@><>2, H8@>:> 8A?>;L7CNB 8 B5@<8=K, >B@060NI85 MB=8G5A:85 8 8=K5 >A>15==>AB8 D5=><5=>;>388 ?A8E8G5A:8E @0AAB@>9AB2 (A<. Lexicon of crosscultural terms in mental health. Geneva, WHO, 1997). ;020 1. '!/ !%"/  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) A8E>?0B>;>38O  MB> @0745; ?A8E80B@88, F5;L :>B>@>3>  87CG5=85 >1I8E 70:>=><5@=>AB59 8 ?@8@>4K ?A8E8G5A:8E @0AAB@>9AB2. >A:>;L:C >1I0O ?A8E>?0B>;>38O O2;O5BAO @0745;>< CG5=8O > 701>;520=8OE G5;>25:0, 745AL 045:20B=0 B5@<8=>;>38O, 8A?>;L7C5<0O 2 >1I59 <548F8=5: A8<?B><, A8=4@><, A<5=0 A8=4@><>2. B=>H5=85 : ?A8E>?0B>;>388 ?@54AB028B5;59 @07;8G=KE ?A8E80B@8G5A:8E =0?@02;5=89 :0: 2 ?@>H;><, B0: 8 2 =0AB>OI5< @07;8G=>. O4 8AA;54>20B5;59, :0: 8 K.Jaspers, AG8B0NB >1ICN ?A8E>?0B>;>38N B5>@859 ?A8E80B@88, 2 B> 2@5<O :0: 7040G59 G0AB=>9 ?A8E80B@88, ?> 8E <=5=8N, O2;O5BAO @5H5=85 G8AB> ?@0:B8G5A:8E 7040G. 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AB@C:BC@5 45?@5AA82=KE A>AB>O=89 A 1@54>< 8 30;;NF8=0F8O<8 1>;LH>5 <5AB> 70=8<0NB :0B0B>=8G5A:85 @0AAB@>9AB20  >B >B45;L=KE ?@>O2;5=89 2 2845 ?>2KH5=8O B>=CA0 <CA:C;0BC@K, =530B8287<0 4> 2K@065==KE :0@B8= AC1ABC?>@0 8 ABC?>@0. !>>B=>H5=8O A>1AB25==> 0DD5:B82=KE @0AAB@>9AB2 8 @0AAB@>9AB2, 2KE>4OI8E 70 3@0=8FK >1;830B=KE A8<?B><>2 45?@5AA88, ?>-@07=><C @0AA<0B@820NBAO 8AA;54>20B5;O<8: >4=8 ?>;030NB, GB> @0AAB@>9AB20 =50DD5:B82=>3> :@C30 2>7=8:0NB =57028A8<> >B 0DD5:B82=KE =0@CH5=89 [Kein D., Tailor E.et al., 1988; Seivewrigt N., Tyrer P., 1990], 4@C385 AG8B0NB 0DD5:B82=K5 @0AAB@>9AB20 2B>@8G=K<8 ?> A@02=5=8N A 1>;55 BO65;K<8 ?A8E>?0B>;>38G5A:8<8 O2;5=8O<8 [Akiskal H., 1983; Kruger E., Nitzsche M., Kunl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B5?5@L 2 :0:>9-B> <5@5 =5 ?>B5@O;> 7=0G5=8O 402=55 2KA:07K20=85 H.Maudsley (1871): "@8G8=K ?><5H0B5;LAB20, >1K:=>25==> ?5@5G8A;O5<K5 02B>@0<8, B0: >1I8 8 =5>?@545;5==K, GB> 25AL<0 B@C4=> ?@8 2AB@5G5 ;8F>< : ;8FC A 4>AB>25@=K< A;CG05< ?><5H0B5;LAB20 8 ?@8 2A5E 1;03>?@8OB=KE CA;>28OE 8AA;54>20=8O A =5A><=5==>ABLN >?@545;8BL ?@8G8=K 1>;57=8".  ?A8E80B@88, :0: 8 2> 2A59 >AB0;L=>9 ?0B>;>388, A2O7L <564C ?@8G8=>9 8 A;54AB285< ?@54AB02;O5B A0<CN =58725AB=CN >1;0ABL [Griesinger W., 1886]. ;O 2>7=8:=>25=8O ?A8E8G5A:>9 1>;57=8, :0: 8 2AO:>9 4@C3>9, @5H0NI55 7=0G5=85 8<5NB B5 2=5H=85 8 2=CB@5==85 CA;>28O, 2 :>B>@KE 459AB2C5B ?@8G8=0. @8G8=0 2K7K205B 1>;57=L =5 2A5340, =5 D0B0;L=>, 0 ;8HL ?@8 AB5G5=88 @O40 >1AB>OB5;LAB2, ?@8G5< 4;O @07=KE ?@8G8= 7=0G5=85 CA;>289, >?@545;ONI8E 8E 459AB285, @07;8G=>. -B> :0A05BAO 2A5E ?@8G8=, 2?;>BL 4> 2>71C48B5;59 8=D5:F8>==KE 1>;57=59. 48= 284 8=D5:F88, ?>?02 2 >@30=87<, ?>GB8 =587156=> 2K7K205B 1>;57=L (2>71C48B5;L GC<K, >A?K), 4@C385 8=D5:F8>==K5 1>;57=8 @072820NBAO ;8HL 2 A>>B25BAB2CNI8E CA;>28OE (A:0@;0B8=0, 3@8??, 48DB5@8O, 4875=B5@8O). 5 :064>5 8=D8F8@>20=85 2K7K205B 1>;57=L, 2 A2>N >G5@54L =5 :0640O 8=D5:F8>==0O 1>;57=L ?@82>48B : ?A8E>7C. 7 MB>3> A;54C5B, GB> ";8=59=>5" ?>=8<0=85 MB8>;>388 =5 >1JOA=O5B 2AN A;>6=>ABL 2>7=8:=>25=8O ?A8E8G5A:8E 1>;57=59, :0:, 2?@>G5<, 8 ;N1KE 4@C38E [02K4>2A:89 .., 1962]. 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causa externa) AB0=>28BAO 2=CB@5==59 (causa interna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"0:, A2>52@5<5==> =0G0B>5 8=B5=A82=>5 ;5G5=85 8=D5:F8>==KE 1>;57=59 0=B818>B8:0<8, AC;LD0=8;0<84=K<8 ?@5?0@0B0<8 ?@54C?@56405B @0728B85 45;8@8O, 2 B>< G8A;5 8 ?@8 M=4>35==>< ?@54@0A?>;>65=88 : =5<C. ! =0G0;>< 0A5?B8G5A:>3> 2545=8O @>4>2 G8A;> A5?B8G5A:8E ?>A;5@>4>2KE ?A8E>7>2 A=878;>AL 2> <=>3> @07 2> 2A5E AB@0=0E. >7>;>38G5A:0O A0<>AB>OB5;L=>ABL :064>9 >B45;L=>9 ?A8E8G5A:>9 1>;57=8 >?@545;O5BAO 548=AB2>< MB8>;>388 8 ?0B>35=570 (>7>;>38O  :;0AA8D8:0F8O 1>;57=59 (3@5G. nosos  1>;57=L).  :;0AA8D8:0F88 682>B=KE 8 @0AB5=89 C?>B@51;ONB >1>7=0G5=85 taxonomia (3@5G. taxis  ?>@O4>: @0A?>;>65=8O, nomos  70:>=). ><5=:;0BC@0 ?@54AB02;O5B A>1>9 ?5@5G5=L :0B53>@89 8;8 >1>7=0G5=89. @8 A>AB02;5=88 A>1AB25==> :;0AA8D8:0F88 =5>1E>48<> >?@545;8BL :0B53>@88 ?> >1I8< 8 G0AB=K< ?@87=0:0<; :0B53>@88 CAB0=02;820NBAO ?> ?>@O4:>2><C (A5<59AB2>, @>4, 284) 8;8 85@0@E8G5A:><C ?@8=F8?C [Kendell R.E., 1978].). =0G5 3>2>@O, =>7>;>38G5A:8 A0<>AB>OB5;L=0O ?A8E8G5A:0O 1>;57=L (=>7>;>38G5A:0O 548=8F0) A:;04K205BAO B>;L:> 87 B5E A;CG052 701>;520=8O, :>B>@K5 2>7=8:0NB 2 @57C;LB0B5 459AB28O >48=0:>2>9 ?@8G8=K 8 >1=0@C6820NB >48=0:>2K5 <5E0=87<K @0728B8O. 01>;520=8O, 2>7=8:0NI85 >B >4=>9 ?@8G8=K, => A @07=K< <5E0=87<>< @0728B8O, =5;L7O >1J548=8BL 2 =>7>;>38G5A:8 A0<>AB>OB5;L=CN 1>;57=L. @8<5@>< B0:8E MB8>;>38G5A:8 >4=>@>4=KE, => =>7>;>38G5A:8 @07=KE 1>;57=59 <>3CB 1KBL A8D8;8B8G5A:89 ?A8E>7, A?8==0O ACE>B:0, ?@>3@5AA82=K9 ?0@0;8G. A5 MB8 701>;520=8O 2>7=8:0NB 2 @57C;LB0B5 A8D8;8B8G5A:>9 8=D5:F88, => 8E ?0B>35=57 A>25@H5==> @07;8G5=, GB> 8 45;05B 8E =>7>;>38G5A:8 @07=K<8 1>;57=O<8. "> 65 <>6=> A:070BL > 15;>9 3>@OG:5, :>@A0:>2A:>< ?A8E>75, 0;:>3>;L=>< 1@545, @52=>AB8, 0;:>3>;L=>< 30;;NF8=>75: 8E MB8>;>38O 548=0  E@>=8G5A:89 0;:>3>;87<, => ?0B>35=57 @07;8G5=, ?>MB><C :0640O ?@54AB02;O5B A>1>9 A0<>AB>OB5;L=CN 1>;57=L. !>25@H5==> B0: 65 =5;L7O @0AA<0B@820BL 2 :0G5AB25 =>7>;>38G5A:8 548=>9 1>;57=8 701>;520=8O A >4=8< ?0B>35=57><, => @07;8G=>9 MB8>;>3859. 0B>35=57 45;8@8O >48=0:>2 8 ?@8 E@>=8G5A:>< 0;:>3>;87<5, 8 ?@8 @52<0B87<5, 8 ?@8 ?5;;03@5, => 53> MB8>;>38O @07;8G=0.  A>>B25BAB288 A MB8< 2K45;ONBAO A0<>AB>OB5;L=K5 1>;57=8 (>B45;L=K5 =>7>;>38G5A:85 548=8FK): 15;0O 3>@OG:0, @52<0B8G5A:89 ?A8E>7, ?5;;03@>7=K9 ?A8E>7. 48=AB2> MB8>;>388 8 ?0B>35=570 CAB0=>2;5=> 2 =0AB>OI55 2@5<O 40;5:> =5 ?@8 2A5E ?A8E8G5A:8E 1>;57=OE: 2 >4=8E A;CG0OE =0945=0 ?@8G8=0, => 5I5 =5 8AA;54>20= ?0B>35=57; 2 4@C38E 1>;55 A>25@H5==> 87CG5= ?0B>35=57, => =58725AB=0 MB8>;>38O. =>385 ?A8E8G5A:85 701>;520=8O 2K45;5=K 2 :0G5AB25 =>7>;>38G5A:8E 548=8F ;8HL =0 >A=>20=88 548=>>1@078O :;8=8G5A:>3> 2K@065=8O. "0:>5 CAB0=>2;5=85 =>7>;>38G5A:>9 A0<>AB>OB5;L=>AB8 1>;57=59 >1>A=>2K205BAO B5<, GB> :;8=8G5A:85 ?@>O2;5=8O, 8E @0728B85 8 8AE>4 ?@54AB02;ONB A>1>9 2=5H=55 2K@065=85 >A>15==>AB59 ?0B>35=570 8 ?0B>:8=570 701>;520=8O 8, A;54>20B5;L=>, :>A25==> >B@060NB 8 53> MB8>;>38G5A:85 >A>15==>AB8. AB>@8G5A:8< ?@8<5@>< MB>3> <>65B 1KBL ?@>3@5AA82=K9 ?0@0;8G, :>B>@K9 2 A5@548=5 XIX 2. 2K45;8;8 :0: =>7>;>38G5A:CN 548=8FC B>;L:> =0 >A=>20=88 40==KE :;8=8G5A:>3> >1A;54>20=8O. #AB0=>2;5=85 2 =0G0;5 XX 2. 53> A8D8;8B8G5A:>9 MB8>;>388 8 ?0B>35=570, >B;8G0NI53>AO >B 4@C38E D>@< A8D8;8A0 &!, ?>4B25@48;> =>7>;>38G5A:CN A0<>AB>OB5;L=>ABL MB>9 1>;57=8, >1>A=>20==CN A=0G0;0 8A:;NG8B5;L=> :;8=8G5A:8< <5B>4><. !B>;L 7=0G8B5;L=>5 @07;8G85 2 7=0=88 ?@8@>4K >B45;L=KE ?A8E8G5A:8E 1>;57=59 >B@0605B 8 8AB>@8N @0728B8O, 8 A>2@5<5==>5 A>AB>O=85 ?A8E80B@88. 5A><=5==>, GB> 40;L=59H89 ?@>3@5AA 2 8AA;54>20=88 ?0B>35=570, MB8>;>388 8 :;8=8G5A:>9 :0@B8=K ?A8E8G5A:8E 1>;57=59 2=5A5B 40;L=59H85 ACI5AB25==K5 :>@@5:B82K 2 A>2@5<5==CN =>7>;>38G5A:CN :;0AA8D8:0F8N 1>;57=59. Nosos 8 pathos (>A?@>872545=> 2 A>:@0I5==>< 2845 ?> :=.: "(87>D@5=8O. C;LB848AF8?;8=0@=>5 8AA;54>20=85".  .: 548F8=0, 1972.  !. 5 15.). Nosos  1>;57=5==K9 ?@>F5AA, 48=0<8G5A:>5, B5:CI55 >1@07>20=85; pathos  ?0B>;>38G5A:>5 A>AB>O=85, AB>9:85 87<5=5=8O, @57C;LB0B ?0B>;>38G5A:8E ?@>F5AA>2 8;8 ?>@>:, >B:;>=5=85 @0728B8O. Nosos 8 pathos =5 @0745;5=K 65AB:>9 3@0=8F59. 5@5E>4 >4=>3> A>AB>O=8O 2 4@C3>5 <>6=> >1=0@C68BL M:A?5@8<5=B0;L=K< ?CB5<, <>45;8@>20BL. >2B>@=0O A5=A818;870F8O 682>B=>3> : :0:><C-=81C4L 15;:C, 4>2545=85 GC2AB28B5;L=>AB8 : =5<C 4> 2KAH59 AB5?5=8, 5I5 =5 2K7K205B C 682>B=>3> 1>;57=8 2 :;8=8:>-0=0B><8G5A:>< ?>=8<0=88, 0 A>7405B ;8HL 3>B>2=>ABL : =59 2 2845 =>2KE @50:B82=KE A?>A>1=>AB59 =0 >A=>25 ACI5AB2CNI8E D878>;>38G5A:8E 284>2KE 8 8=48284C0;L=KE ?@54?>AK;>: [02K4>2A:89 .., 1962]. @8 2K7K20=88 C B>3> 65 682>B=>3> D5=><5=0 <5AB=>9 8;8 >1I59 0=0D8;0:A88 ?>4>1=>3> @>40 2=>2L 2>7=8:H85 <5E0=87<K @50;87CNBAO, A>74020O C65 1>;57=L. 0 >A=>20=88 ?@82545==KE 40==KE .. 02K4>2A:89 CB25@640;, GB> ACI5AB2>20=85 ?0B>35=5B8G5A:8E <5E0=87<>2 A;54C5B AB@>3> >B;8G0BL >B =0;8G8O ?0B>;>38G5A:>3> ?@>F5AA0, B.5. pathos 8 nosos =5 B>645AB25==K. 0B>35=5B8G5A:85 <5E0=87<K 70:;NG0NBAO ;8HL 2 2>7<>6=>AB8 ?0B>;>38G5A:>3> ?@>F5AA0.  pathos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laude, H87>?0B88 E.Bleuler, H87>D@5=8G5A:89 A?5:B@ S.Kety, P.Wender, D.Rosenthal. ?>;=5 2>7<>6=>, GB> =8 >4=> 87 CAB0=>2;5==KE 2 =0AB>OI55 2@5<O 18>;>38G5A:8<8 8AA;54>20=8O<8 >B:;>=5=89 2 45OB5;L=>AB8 >@30=87<0 1>;L=>3> H87>D@5=859 =5 >B=>A8BAO : ?@>O2;5=8O< A>1AB25==> ?@>F5AAC0;L=>3> @0728B8O 1>;57=8, 0 ?@54AB02;O5B A>1>9 ?@87=0:, AB83<0B pathos, 480B570. @8<5=8B5;L=> : H87>D@5=88 @5GL 845B > ?0B>;>38G5A:>9, B.5. H87>D@5=8G5A:>9, :>=AB8BCF88, > G5< 2?5@2K5 2 1914 3. A:070; .. 0==CH:8= 2 AB0BL5 ">AB0=>2:0 2>?@>A0 > H87>D@5=8G5A:>9 :>=AB8BCF88". Nosos 8 pathos =5 B>645AB25==K, => 8E 01A>;NB=>5 >B;8G85, ?@>B82>?>AB02;5=85 1K;> 1K >H81>G=K<.  ?@>H;>< >B5G5AB25==K5 ?A8E80B@K 4>AB0B>G=> 01A>;NB8AB5:>-:@8B8G5A:8 >B=>A8;8AL : :>=F5?F88 E.Kretschmer >1 8A:;NG8B5;L=> :>;8G5AB25==>< >B;8G88 H87>8488 >B H87>D@5=88. 564C B5< 70A;C30 E.Kretschmer, 0 B0:65 E.Bleuler, I.Berze, E.Stransky 8 4@C38E 8AA;54>20B5;59 70:;NG05BAO 2 B><, GB> >=8 >1=0@C68;8 8 >?8A0;8 =0;8G85 ?>G2K (8AB>:>2) 2 2845 H87>8488, ;0B5=B=>9 H87>D@5=88, =0 :>B>@>9 ?>4 2;8O=85< 5I5 =5 8725AB=KE =0< CA;>289 :@8AB0;;87C5BAO 2 >3@0=8G5==>< G8A;5 A;CG052 H87>D@5=8G5A:89 ?@>F5AA.  1941 3. > A>>B=>H5=88 H87>84=>9 :>=AB8BCF88 8 H87>D@5=88 ?8A0; J.Wyrsch. A5 MB8 02B>@K >?8AK20;8 =>A8B5;59 ?0B>35=5B8G5A:8E <5E0=87<>2 H87>D@5=88, A>45@60I8E 2 A515 ?@54?>AK;:8 4;O 55 @0728B8O :0: 1>;57=8. .. 02K4>2A:89 ?>AB>O==> ?>4G5@:820;, GB> ?0B>;>38G5A:85 ?@>F5AAK C G5;>25:0 2>7=8:;8 2 >B40;5==K5 M?>E8 :0: ?@>4C:B =54>AB0B>G=>3> ?@8A?>A>1;5=8O G5;>25:0 : >:@C60NI59 A@545 (A>F80;L=>9 8 ?@8@>4=>9); <=>385 87 1>;57=59 G5;>25:0 =0A;54AB25==> 70:@5?;5=K, ?@>O2;5=85 @O40 87 =8E >1CA;>2;5=> >=B>35=5B8G5A:8<8 D0:B>@0<8  45BAB2>, ?>;>2>5 A>7@520=85, AB0@>ABL. !.. 02K45=:>2, 8AA;54CO ?0B>35=57 =52@>70 =02O7G82>AB8, B0:65 AG8B0;, GB> 1>;57=5==K5 D0:B>@K =52@>7>2 2>7=8:;8 2 >1I5AB25 >G5=L 402=> 8 2?>;=5 25@>OB=>, GB> >B =8E =5 1K; A2>1>45= 8 4>8AB>@8G5A:89 G5;>25:.  A25B5 5AB5AB25==>-8AB>@8G5A:>3> 8 18>;>38G5A:>3> ?>=8<0=8O ?@>1;5< <548F8=K 15AA?>@=>, GB> 1>;57=8 2>7=8:;8 A ?5@2K<8 ?@87=0:0<8 687=8 =0 5<;5, GB> 1>;57=L 5ABL O2;5=85 5AB5AB25==>5, ?@8A?>A>18B5;L=>5 (!..>B:8= (&8B. >@>4C;8= $. . !..>B:8= 8 =52@>35==0O B5>@8O <548F8=K.  ., 1953.), ". !>:>;LA:89 (&8B. 02K4>2A:89 .. @>1;5<K ?@8G8==>AB8 2 ?A8E80B@88. -B8>;>38O.  ., 1962. - 176 A.)). -B> ?@8A?>A>1;5=85 G@572KG09=> 20@8015;L=>. 80?07>= 53> @0A?@>AB@0=O5BAO >B >B:;>=5=8O, >1>7=0G05<>3> 0:F5=BC0F859, 2K@065==>9 AB83<0B870F859, 480B57><, 4> :0G5AB25==KE >B;8G89, 7=0<5=CNI8E A>1>9 ?@52@0I5=85 ?0B>35=5B8G5A:8E <5E0=87<>2 2 ?0B>35=5B8G5A:89 ?@>F5AA (?0B>:8=57). @82545==K5 A>?>AB02;5=8O ?>72>;ONB @0AA<0B@820BL nosos 8 pathos 2 548=AB25, =5A<>B@O =0 8E :0G5AB25==>5 >B;8G85. "5?5@L C65 <=>3>;5B=89 >?KB ?>:070;, GB> =081>;55 >?@0240==>5 8AA;54>20=85 H87>D@5=88, :0:, 2?@>G5<, 8 <=>38E 4@C38E 1>;57=59, 2>7<>6=>, 5A;8 >=>, 2>-?5@2KE, =5 >3@0=8G8205BAO AB0B8:>9, => ?>AB>O==> A>G5B05BAO A 48=0<8:>9, A BI0B5;L=K< 8AA;54>20=85< 2A5E >A>15==>AB59 B5G5=8O; 2>-2B>@KE, :>340 >=> =5 >3@0=8G8205BAO :;8=8G5A:>9 :0@B8=>9, 0 AB0=>28BAO :;8=8:>-18>;>38G5A:8<; 2-B@5BL8E, :>340 >=> =5 >3@0=8G8205BAO 8AA;54>20=85< B>;L:> 701>;52H53>, 0 @0A?@>AB@0=O5BAO ?> 2>7<>6=>AB8 =0 <=>38E @>4AB25==8:>2, B.5. 8AA;54>20=85 nosos A>G5B05BAO A 87CG5=85< pathos. "0:>9 ?>4E>4 >B:@K205B =081>;LH85 2>7<>6=>AB8 4;O CAB0=>2;5=8O :0: ?0B>35=5B8G5A:8E <5E0=87<>2, B0: 8 ?@8G8=, ?@52@0I0NI8E 8E 2 ?0B>:8=57. >2>@O > nosos 8 pathos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puncta adherentia. =>340 <564C B0:8<8 ?@>B82>;560I8<8 <5<1@0=0<8 284=0 ?;0AB8=:0 =5A:>;L:> C?;>B=5==>3> 8;8 A5B5284=>3> <56:;5B>G=>3> 25I5AB20, @0A?>;>65=85 :>B>@>3> A>>B25BAB2C5B 1C4CI59 A8=0?B8G5A:>9 I5;8. ?8A0==K5 ?@>F5AAK E>@>H> 284=K C65 C M<1@8>=>2 7 8 =54. @0728B8O [20=LH8=0 .., 1976]. 0 AB0488 9 10 =54., :@><5 :>=B0:B>2 B8?0 puncta adherentia, C65 8<5NBAO 8 0A8<<5B@8G=K5 :>=B0:BK A 1>;LH8< CB>;I5=85< >4=>9 87 <5<1@0= (?>ABA8=0?B8G5A:>9) 8 ?>O2;5=85< 21;878 :>=B0:B0 ?C7K@L:>2 @07=>9 25;8G8=K.  40;L=59H5< ?@>8AE>48B =5 B>;L:> 48DD5@5=F8@>2:0, => 8 C25;8G5=85 G8A;0 A8=0?A>2 8 <>6=> 2845BL A0<K5 @07=K5 AB0488 8E D>@<8@>20=8O. !;54C5B ?>4G5@:=CBL, GB> A8=0?AK ?5@2>=0G0;L=> >1@07CNBAO 2 871KB>G=>< :>;8G5AB25, 0 70B5< ?> <5@5 C25;8G5=8O A?5F8D8G=>AB8 DC=:F88 >B45;L=KE :;5B>: 8 >1@07C5<KE 8<8 AB@C:BC@ <>730 ?@>8AE>48B C40;5=85 (M;8<8=0F8O) ";8H=8E" :>=B0:B>2 [Huttenlocher R.R. et al., 1982]. #AB0=>2;5=85 ?5@2KE <56:;5B>G=KE :>=B0:B>2 =0 5-9 =545;5 M<1@8>35=570 A;C68B A2>53> @>40 3@0=8F59 2 >=B>35=575 =5@2=>9 :;5B:8  =0G0;>< 55 ?5@5E>40 87 AB0488 =59@>1;0AB0 2 AB048N N=>3> =59@>=0 [8;>E8= .., 1983]. >A;5 ?@8>1@5B5=8O ?5@2KE A8=0?B8G5A:8E A2O759 =59@>= C65 AB0=>28BAO G0ABLN >?@545;5==>9 DC=:F8>=0;L=>9 A8AB5<K, :>B>@0O AB8<C;8@C5B 55 40;L=59H55 @0728B85 8 48DD5@5=F8@>2:C. > 8 A0<8 A8=0?AK >:07K20NB 2;8O=85 =0 0:A>= =59@>=0: >1@07>20=85 8E >7=0G05B :>=5F @>AB0 ?> <5E0=87<C ":>=B0:B=>3> B>@<>65=8O" ("contact inhibition"). 0: C:07K205B E.J.Ebel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uttenlocher P.R., 1984]. >;55 B>3>, >B<5G05BAO 3815;L G0AB8 0:A>=>2 8 45=4@8B>2 ?@8 A>E@0==>AB8 B5;0 :;5B:8, GB> AG8B05BAO 206=K< M;5<5=B>< D>@<8@>20=8O ?@>2>4OI8E ?CB59 8 2A5E 284>2 <56:;5B>G=KE A2O759, >15A?5G5==KE A8=0?B8G5A:8<8 :>=B0:B0<8. !CI5AB2CNB 40==K5 > B><, GB> 2 =5:>B>@KE >B45;0E &! 4535=5@8@C5B 4> 50 % A8=0?A>2 B>;L:> 2 B5G5=85 2-9 ?>AB=0B0;L=>9 =545;8.  @01>B0E 65 I.Feinberg (1972, 1983) ?@82>4OBAO 40==K5 > B><, GB> C<5=LH5=85 G8A;0 A8=0?A>2 2 :>@5 3>;>2=>3> <>730 G5;>25:0 ?@>8AE>48B 8 2 2>7@0AB5 <564C 2 8 16 3>40<8, ?@8G5< >A>15==> 70<5B=K5 A42838 B0:>3> @>40 (?>B5@O 4> 40 % A8=0?A>2) 8<5NB <5AB> <564C ?>74=8< 45BA:8< 8 @0==8< ?>4@>AB:>2K< ?5@8>4><. @8 MB>< 70BO3820=85 8;8 CA:>@5=85 ?C15@B0B=>3> ?5@8>40 70:0=G8205BAO A>>B25BAB25==> G@57<5@=K< A=865=85< G8A;0 A8=0?A>2 8;8, =0?@>B82, >1@07>20=85< 871KB:0 8E. >;;0B5@0;L=K9 A?@>CB8=3 A >1@07>20=85< =>2KE 0:A>==KE B5@<8=0;59 A2O70= A ?>O2;5=85< =>2KE A8=0?B8G5A:8E :>=B0:B>2. 06=> >B<5B8BL, GB> A?@>CB8=3 >B<5G05BAO =5 B>;L:> 2 ?@>F5AA5 @0728B8O <>730, => 8 :0: @50:F8O 7@5;>3> <>730 =0 ?>2@5645=85. >=OB85 ?;0AB8G=>AB8 =5@2=>9 A8AB5<K H8@>:> @0A?@>AB@0=5=> 2 A>2@5<5==>9 DC=:F8>=0;L=>9 =59@>0=0B><88.  MB>< A;CG05 8<55BAO 2 284C A?>A>1=>ABL =5@2=>9 A8AB5<K : DC=:F8>=0;L=K< 8 AB@C:BC@=K< ?5@5AB@>9:0< =5 B>;L:> 2 2845 C65 >E0@0:B5@87>20==KE @50:F89 2 ?@>F5AA5 @0728B8O 8 A>7@520=8O <>73>2KE AB@C:BC@ (:>;;0B5@0;L=K9 A?@>CB8=3 8 B.?.), => 8 ?CB5< 87<5=5=89 2 A8AB5<5 <56:;5B>G=KE :>=B0:B>2, 0 B0:65 2 @57C;LB0B5 ?5@5AB@>9:8 DC=:F88 =59@>E8<8G5A:8E A8AB5< =0 C@>2=5 =59@>B@0=A<8BB5@>2. ;0AB8G=>ABL =5@2=>9 A8AB5<K =5 2A5340 <>65B >F5=820BLAO ?>;>68B5;L=>. =0 <>65B 8<5BL 8 >B@8F0B5;L=K5 ?>A;54AB28O, 81> ?>4 2;8O=85< B5E 8;8 8=KE 2@54=>AB59 =0 MB0?5 @0728B8O <>730 <>3CB 2>7=8:0BL B0: =07K205<K5 >H81>G=K5 <56:;5B>G=K5 A2O78 (neuronal misconnections), :>B>@K< A59G0A ?@8405BAO >?@545;5==>5 7=0G5=85 2 @0728B88 M=4>35==>9 ?A8E8G5A:>9 ?0B>;>388 [Goldman R., 1989]. 59@>D878>;>38O: >A=>2=K5 <5B>4K, ?@8=F8?K 8E 8A?>;L7>20=8O 8 >F5=:8 @57C;LB0B>2  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) 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K @0AA<>B@8< M;5:B@>M=F5D0;>3@0D8N (2 B>< G8A;5 ?@85<K :>;8G5AB25==>9, :><?LNB5@878@>20==>9 >1@01>B:8 M;5:B@>M=F5D0;>3@0<<  --), M;5:B@>D878>;>38G5A:85 8AA;54>20=8O A=0 (?>;8A><=>3@0D8N), 2K720==K5 ?>B5=F80;K (), <03=8B>M=F5D0;>3@0D8N, @5>M=F5D0;>3@0D8N 8 C;LB@072C:>2K5 <5B>4K 8AA;54>20=8O. -B8 <5B>4K ?>72>;ONB ?@O<> 8;8 :>A25==> >F5=820BL DC=:F8>=0;L=>5 A>AB>O=85 &!. -;5:B@>M=F5D0;>3@0D8O. -- ?@54AB02;O5B A>1>9 70?8AL 18>M;5:B@8G5A:>9 0:B82=>AB8 <>730, @538AB@8@C5<>9 A ?>25@E=>AB8 A:0;L?0. !>3;0A=> A>2@5<5==K< ?@54AB02;5=8O< [CA5;L=8:>2 .., 1976; Elul A., 1972; Nunez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til T.M. et al., 1991]. -- >B@0605B A>2<5AB=CN 0:B82=>ABL 1>;LH>3> G8A;0 =5@2=KE M;5<5=B>2, ?>MB><C ?> :0@B8=5 -- <>6=> AC48BL > @568<5 @01>BK CG0AB:0 =5@2=>9 A5B8, @0A?>;>65==>3> ?>4 >B2>4OI8< M;5:B@>4><. 1KG=> 8A?>;L7C5BAO AB0=40@B=>5 ?> 564C=0@>4=>9 A8AB5<5 10 20 [Jasper H., 1965] @0A?>;>65=85 =0 A:0;L?5 7=0G8B5;L=>3> G8A;0 M;5:B@>4>2 (>1KG=> >B 8 4> 21), GB> 405B 2>7<>6=>ABL >F5=8BL ?> -- DC=:F8>=0;L=>5 A>AB>O=85 >A=>2=KE A5=A>@=KE, <>B>@=KE 8 0AA>F80B82=KE 7>= :>@K 8 8E ?>4:>@:>2KE ?@>5:F89.  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aurer . et 0!., 1989; Giannitrapani D. et al., 1991; Iznak A.F. et al., 1992], 2 7>=0E A =0@CH5==K< <>73>2K< :@>2>>1@0I5=85< [Nagata ., 1990], ?@8 >?CE>;OE 3>;>2=>3> <>730 [>;4K@520 .., 1994];  45A8=E@>=870F8O -- 2 2845 C3=5B5=8O -@8B<0 8 ?>2KH5=8O A>45@60=8O -0:B82=>AB8. =0 2>7=8:05B ?@8 0@0E=>848B0E, ?>2KH5=88 2=CB@8G5@5?=>3> 402;5=8O, F5@51@>20A:C;O@=KE @0AAB@>9AB20E, <83@5=8 [8<:8=0 A.M., ><>=B>28G .., 1966];  "C?;>I5=85" --, 2:;NG0NI55 C3=5B5=85 0<?;8BC4K -- 8 ?>=865==>5 A>45@60=85 2KA>:>G0AB>B=>9 0:B82=>AB8. -B> 8<55B <5AB>, =0?@8<5@, ?@8 0B@>D8G5A:8E ?@>F5AA0E [Maurer . et al., 1989], =04 ?>25@E=>AB=> @0A?>;>65==>9 >?CE>;LN 8;8 2 >1;0AB8 AC14C@0;L=>9 35<0B><K [Moulton R. et al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enfield W., Jasper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almi "., Ruuskanen-Uoti H., 1993], D>=>AB8<C;OF8N (B>=K, I5;G:8), 38?5@25=B8;OF8N. 565 8A?>;L7CNBAO 45?@820F8O A=0, =5?@5@K2=0O 70?8AL -- 8 4@C38E D878>;>38G5A:8E ?0@0<5B@>2 2> 2@5<O A=0 (?>;8A><=>3@0D8O) 8;8 2 B5G5=85 ACB>: (---<>=8B>@8=3), ?@8 2K?>;=5=88 @07;8G=KE ?5@F5?B82=>-:>3=8B82=KE 7040G, D0@<0:>;>38G5A:85 ?@>1K [Striano S. et al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ibbs F.A., 1952; Penfield W., Jasper H.H., 1954; Andersen P., Andersson S.A., 1968; Evans C.R., Mulholland T.B., 1969; Nagata K., 1990]. >;8G5AB25==0O (F8D@>20O, :><?LNB5@=0O, "1571C<06=0O") M;5:B@>M=F5D0;>3@0D8O 2>7=8:;0 2 A2O78 A 1C@=K< @0728B85< M;5:B@>==>-2KG8A;8B5;L=>9 B5E=8:8 8 A2845B5;LAB2C5B > ?@>3@5AA5 MB>3> <5B>40 8AA;54>20=89. 0G0;> 40==><C <5B>4C ?>;>68;8 @01>BK W.G.Walter (1958) 8 ..820=>20 (1960), A>7402H8E M=F5D0;>A:>?  ?@81>@, :>B>@K9 =0 A25B>2>< B01;> (2 1>;55 ?>74=8E 25@A8OE  =0 M:@0=5 M;5:B@>==>-;CG52>9 B@C1:8) 2 2845 B>G5:, A25BOI8EAO A @07=>9 O@:>ABLN, >B>1@060; :0@BC @0A?@545;5=8O 0<?;8BC4 -- =0 A:0;L?5.  40;L=59H5< <5B>4 1K; CA>25@H5=AB2>20= O?>=A:8<8 CG5=K<8 [Matsuoka S., 1989], @50;87>202H8<8 53> =0 1075 ?5@2KE ;01>@0B>@=KE 8 ?5@A>=0;L=KE <8=8- 8 <8:@>--. 4=0:> H8@>:CN 8725AB=>ABL :>;8G5AB25==0O -- ?@8>1@5;0 ?>A;5 >?8A0=8O F.H.Duffy 8 A>02B. (1979) <5B>40 ":0@B8@>20=8O M;5:B@8G5A:>9 0:B82=>AB8 <>730" (Brain electrical activity mapping  BEAM). !8AB5<K :>;8G5AB25==>3> 0=0;870 8 B>?>3@0D8G5A:>3> :0@B8@>20=8O -- 2:;NG0NB CA8;8B5;L -- A F8D@>2K<8 D8;LB@0<8 (G0I5 2A53> C?@02;O5<K5 ?@>3@0<<=K<8 A@54AB20<8), 0=0;>3>-F8D@>2>9 ?@5>1@07>20B5;L 4;O 70?8A8 A83=0;>2 -- =0 <03=8B=K5 8;8 8=K5 =>A8B5;8 8=D>@<0F88 2 F8D@>2>9 D>@<5, F5=B@0;L=K9 ?@>F5AA>@ (>1KG=> A5@89=K9 ?5@A>=0;L=K9 :><?LNB5@), >ACI5AB2;ONI89 A?5F80;L=K5 284K 0=0;870 -- (A?5:B@0;L=>-:>35@5=B=K9, ?5@8>4><5B@8G5A:89, =5;8=59=K9) 8 A@54AB20 >B>1@065=8O 8=D>@<0F88 (2845><>=8B>@, ?@8=B5@K 8 B.?.). @>3@0<<=>5 >15A?5G5=85, :@><5 B>3>, ?>445@68205B 107C 40==KE, >15A?5G8205B 8E AB0B8AB8G5A:CN >1@01>B:C, 0 B0:65 A>45@68B B5:AB>2>9 8 3@0D8G5A:89 @540:B>@K 4;O ?>43>B>2:8 70:;NG5=89 8 8;;NAB@0F89, :>B>@K5 2K2>4OBAO 2 2845 =03;O4=KE ":0@B" <>730, ?>=OB=KE 4065 =5A?5F80;8ABC 2 >1;0AB8 M;5:B@>M=F5D0;>3@0D88. >;8G5AB25==0O M;5:B@>M=F5D0;>3@0D8O ?>72>;O5B 1>;55 B>G=>, G5< ?@8 287C0;L=>< 0=0;875 --, >?@545;OBL ;>:0;870F8N >G03>2 ?0B>;>38G5A:>9 0:B82=>AB8 ?@8 M?8;5?A88 8 @07;8G=KE =52@>;>38G5A:8E 8 A>AC48ABKE @0AAB@>9AB20E, 2KO2;OBL =0@CH5=8O 0<?;8BC4=>-G0AB>B=KE E0@0:B5@8AB8: 8 ?@>AB@0=AB25==>9 >@30=870F88 -- ?@8 @O45 ?A8E8G5A:8E @0AAB@>9AB2, :>;8G5AB25==> >F5=820BL 2;8O=85 B5@0?88 (2 B>< G8A;5 ?A8E>D0@<0:>B5@0?88) =0 DC=:F8>=0;L=>5 A>AB>O=85 <>730, 0 B0:65 >ACI5AB2;OBL 02B><0B8G5A:CN 4803=>AB8:C =5:>B>@KE @0AAB@>9AB2 8/8;8 DC=:F8>=0;L=KE A>AB>O=89 74>@>2>3> G5;>25:0 ?> ---?0@0<5B@0<. !@548 >G5284=KE ?@58<CI5AB2 <5B>40 :>;8G5AB25==>9 M;5:B@>M=F5D0;>3@0D88 <>6=> =0720BL A;54CNI85 55 2>7<>6=>AB8: <=>3>:@0B=>5 2>A?@>872545=85 70?8A8 -- A @07=K< CA8;5=85< 8 @07=>9 2@5<5==>9 @0725@B:>9 ("A:>@>ABLN"); ?@O<>5 8 >1@0B=>5 "A:0=8@>20=85" >B45;L=KE D@03<5=B>2 70?8A8 4;O >?@545;5=8O D>:CA>2 ?0B>;>38G5A:>9 0:B82=>AB8; ?@5>1@07>20=85 <>=>?>;O@=> 70?8A0==>3> D@03<5=B0 -- 2 ;N1K5 18?>;O@=K5 <>=B068; 02B><0B8G5A:>5 8;8 @CG=>5 CAB@0=5=85 0@B5D0:B>2 70?8A8 (2 B>< G8A;5 55 F8D@>2>9 D8;LB@0F88), GB> >A>15==> 206=> ?@8 --->1A;54>20=88 45B59 <;04H53> 2>7@0AB0, 0 B0:65 ?>68;KE 8 15A?>:>9=KE ?A8E8G5A:8 1>;L=KE; 70?8AL >G5=L 45B0;878@>20==KE, <=>3>:0=0;L=KE (4> 256) 8;8 >G5=L 4;8B5;L=KE (4> 1 ACB.) D@03<5=B>2 -- [Gevins A., 1993]; 0=0;87 =87:>0<?;8BC4=KE 284>2 ---0:B82=>AB8 8 C7:8E G0AB>B=KE ?>;>A 2=CB@8 B@048F8>==KE G0AB>B=KE 480?07>=>2 --, :>;8G5AB25==>9 >F5=:8 AE>4AB20 8 @07;8G8O 0:B82=>AB8 2 @07=KE >B2545=8OE (<56?>;CH0@=>9 0A8<<5B@88, :>@@5;OF88 0<?;8BC4, :>35@5=B=>AB8), GB> 1K;> ?@0:B8G5A:8 =54>ABC?=> ?@8 287C0;L=>< 0=0;875 -- [>=0E>2 .. 8 4@., 1983, 1990; CA8=>2 B.C., @8=45;L .., 1987; !2845@A:0O .., 1987, 1990; !B@5;5F .., 1990].  INCLUDEPICTURE "http://psychiatry.ru/library/lib/5/71.png" \* MERGEFORMATINET  A5 MB8 ?@58<CI5AB20 ?>72>;ONB ACI5AB25==> A>:@0B8BL 2@5<O 70?8A8, @57:> ?>2KH0NB 25@>OB=>ABL 2KO2;5=8O >B:;>=5=89 -- >B "=>@<K" 8 B>G=>ABL >?@545;5=8O 8AB>G=8:>2 ?0B>;>38G5A:>9 ---0:B82=>AB8 [John E.R., 1989; Rodin E., 1994]. @><5 B>3>, <5B>4 :>;8G5AB25==>9 M;5:B@>M=F5D0;>3@0D88 >15A?5G8205B A@02=5=85 8=48284C0;L=KE -- A :><<5@G5A:8<8 8;8 A>740==K<8 A0<8< ?>;L7>20B5;5< 1070<8 =>@<0B82=KE 40==KE (2>7@0AB=>9 =>@<K, @07=KE 284>2 ?0B>;>388 8 B.?.) A F5;LN 48DD5@5=F80;L=>-4803=>AB8G5A:8E CB>G=5=89 [John E.R., 1989], 48=0<8G5A:89 <>=8B>@8=3 -- 2 ?@>F5AA5 ;5G5=8O A >1J5:B82=>9 :>;8G5AB25==>9 >F5=:>9 2;8O=8O ?A8E>D0@<?@5?0@0B>2 =0 DC=:F8>=0;L=>5 A>AB>O=85 <>730  :>;8G5AB25==0O D0@<0:>--- [Itil ". et 0l., 1974, 1986, 1991], E@0=5=85 >3@><=KE >1J5<>2 ---8=D>@<0F88 2 2845 ?0G:8 <8=80BN@=KE 48A:5B 8;8 :><?0:B-48A:>2. 57C;LB0BK :>;8G5AB25==>3> 0=0;870 -- <>3CB 1KBL 2K40=K =5 B>;L:> 2 D>@<5 B01;8F, => 8 2 2845 =03;O4=>9 F25B=>9 ":0@BK <>730" (?>MB><C <5B>4 8 ?>;CG8; =0720=85 ":0@B8@>20=85 <>730"  brain mapping), ?>=OB=>9 4065 =5A?5F80;8ABC ?> M;5:B@>M=F5D0;>3@0D88 (@8A. 13). -B8 :0@BK C4>1=> A@02=820BL A @57C;LB0B0<8 @07=KE <5B>4>2 :><?LNB5@=>9 B><>3@0D88  @5=B35=>2A:>9, O45@=>-<03=8B=>-@57>=0=A=>9 8 ?>78B@>==>-M<8AA8>==>9, 0 B0:65 A >F5=:0<8 ;>:0;L=>3> <>73>2>3> :@>2>B>:0 8 40==K<8 =59@>?A8E>;>38G5A:>3> B5AB8@>20=8O. "5< A0<K< A>7405BAO 2>7<>6=>ABL ?@O<> A>?>AB02;OBL AB@C:BC@=K5 8 DC=:F8>=0;L=K5 =0@CH5=8O 45OB5;L=>AB8 <>730. 06=K< H03>< 2 @0728B88 :>;8G5AB25==>9 M;5:B@>M=F5D0;>3@0D88 O28;>AL A>740=85 ?@>3@0<<=>3> >15A?5G5=8O 4;O >?@545;5=8O 2=CB@8<>73>2>9 ;>:0;870F88 48?>;L=KE 8AB>G=8:>2 =081>;55 2KA>:>0<?;8BC4=KE :><?>=5=B>2 --. >A;54=8< 4>AB865=85< 2 MB>9 >1;0AB8 O2;O5BAO @07@01>B:0 ?@>3@0<<K, A>2<5I0NI59 <03=8B=>-@57>=0=A=K5 8 M;5:B@>M=F5D0;>3@0D8G5A:85 :0@BK <>730 :>=:@5B=>3> G5;>25:0 A CG5B>< 8=48284C0;L=>9 D>@<K G5@5?0 8 B>?>3@0D88 <>73>2KE AB@C:BC@.  7028A8<>AB8 >B :>=:@5B=>9 :;8=8G5A:>9 8;8 8AA;54>20B5;LA:>9 7040G8 <>6=> @5:><5=4>20BL 8A?>;L7>20=85 =5A:>;L:8E >A=>2=KE 20@80=B>2 :><?LNB5@=>3> 0=0;870 -- 8 ?>AB@>5=8O ---:0@B <>730 [N5@ . ., 1992]. ;O ;>:0;L=>9 4803=>AB8:8 =0@CH5=89 45OB5;L=>AB8 <>730 ?@8 M?8;5?A88, @07;8G=KE =0@CH5=8OE <>73>2>3> :@>2>B>:0, >?CE>;OE, ;>:0;L=KE 2>A?0;8B5;L=KE ?@>F5AA0E 3>;>2=>3> <>730, G5@5?=>-<>73>2>9 B@02<5, @07=KE B8?0E 45<5=F89 ?>74=53> 2>7@0AB0 =081>;55 F5;5A>>1@07=> ?>AB@>5=85 A?5:B@0;L=KE :0@B --, :0: ?5@5:@K20NI8E 25AL G0AB>B=K9 480?07>= -- (0,5 30 F), B0: 8 >A>15==> <=>65AB25==KE :0@B A?5:B@0;L=>9 <>I=>AB8 -- 2 C7:8E G0AB>B=KE ?>4480?07>=0E (>B 0,5 4> 30 F, A H03>< 1 1,5 F). 0;8G85 ;>:0;L=KE "?OB5=" =0 B0:8E ---:0@B0E 2 >4=>< (8;8 B5< 1>;55 2 =5A:>;L:8E) G0AB>B=KE ?>4480?07>=0E ?>72>;O5B ?@54?>;030BL =0;8G85 >G030 2 MB>9 >1;0AB8 :>@K <>730 8;8 2 A>>B25BAB2CNI59 ?>4:>@:>2>9 ?@>5:F8>==>9 7>=5. @8 =0;8G88 =0 -- D078G5A:8E 8;8 ?0@>:A87<0;L=KE ?@>O2;5=89 (M?8;5?B8G5A:8E @07@O4>2 8 :><?;5:A>2, ?>;8<>@D=KE 2A?KH5: 8 B.?.) 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"0:>9 284 --->1A;54>20=8O 2>7<>65= 4;O 1>;LH8=AB20 ?0F85=B>2. @8<5=5=85 @07;8G=KE DC=:F8>=0;L=KE ?@>1, 157CA;>2=>, ?>2KH05B 8=D>@<0B82=>ABL --->1A;54>20=8O, => C25;8G8205B 2@5<O, =5>1E>48<>5 4;O @538AB@0F88 8 0=0;870 --, 2545B : CB><;5=8N ?0F85=B0, 0 B0:65 <>65B 1KBL A>?@O65=> A @8A:>< ?@>2>:0F88 AC4>@>6=KE ?@8ABC?>2 (=0?@8<5@, 38?5@25=B8;OF8O 8;8 @8B<8G5A:0O D>B>AB8<C;OF8O) [Striano S. et al., 1992; Salmi "., Ruuskanen-Uoti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til T.M., 1974, 1986]. 5>1E>48<> ?>4G5@:=CBL, GB> <5B>4K :>;8G5AB25==>9 M;5:B@>M=F5D0;>3@0D88, >1;040O @O4>< =5A><=5==KE ?@58<CI5AB2 ?5@54 287C0;L=K< 0=0;87>< --, =5 ;8H5=K @O40 >3@0=8G5=89 [N5@ . ., 1992; Fisch B.J., Pedley T.A., 1989]. @5645 2A53> =081>;55 G0AB> ?@8<5=ONI89AO <5B>4 ?@5>1@07>20=8O $C@L5 >1;0405B >B=>A8B5;L=> =87:>9 ?><5E>CAB>9G82>ABLN (?> A@02=5=8N, =0?@8<5@, A ?5@8>4><5B@8G5A:8< ?5@28G=K< 0=0;87>< --). -B> >1AB>OB5;LAB2> B@51C5B >B 8AA;54>20B5;O 5I5 1>;55 2KA>:>9 :20;8D8:0F88, G5< ?@8 @CB8==>< --->1A;54>20=88: B>G=>3> 8 AB0=40@B=>3> @0A?>;>65=8O M;5:B@>4>2, @0A?>7=020=8O 8 CAB@0=5=8O ?@8G8= 8=4CAB@80;L=KE ?><5E 8 D878>;>38G5A:8E 0@B5D0:B>2, A>1;N45=8O CA;>289 @538AB@0F88 8 ?@8<5=5=8O DC=:F8>=0;L=KE ?@>1, 3@0<>B=>9 8=B5@?@5B0F88 40==KE -- ?@8 @07;8G=KE A?>A>10E >B2545=8O 8 0=0;870. KO2;5=85 A?5F8D8G5A:8E 20@80=B>2 2>;=>2KE D>@< 8 D078G5A:8 ?@>O2;ONI8EAO :><?>=5=B>2 =0 -- (?@5645 2A53> M?8;5?B8D>@<=KE) ?>:0 5I5 =0<=>3> C25@5==55 ?@>872>48BAO ?@8 55 287C0;L=>< 0=0;875. >MB><C <5B>4K 287C0;L=>3> 8 :>;8G5AB25==>3> 0=0;870 -- A;54C5B @0AA<0B@820BL :0: 2708<>4>?>;=ONI85. 0==K5, ?>;CG5==K5 =0 @07=KE A8AB5<0E :><?LNB5@=>3> 0=0;870 8 B>?>3@0D8G5A:>3> :0@B8@>20=8O --, 40;5:> =5 2A5340 8 =5 ?>;=>ABLN A>2<5AB8<K. -B> 70B@C4=O5B A>740=85 1>;LH8E 107 40==KE 8, A;54>20B5;L=>, 2KO2;5=85 =>7>;>38G5A:8 8;8 A8=4@><>;>38G5A:8 A?5F8D8G5A:8E :>;8G5AB25==KE E0@0:B5@8AB8: --.  8725AB=>9 <5@5 ?>A;54=55 70B@C4=5=85 ?@5>4>;5205BAO ?CB5< >@30=870F88 <C;LB8F5=B@>2KE 8AA;54>20=89 A 8A?>;L7>20=85< >4=>B8?=>9 0??0@0BC@K [Itil ". et 0l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osse R.B. et al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echtschaffen A., Kales A., 1968]. 54;5==>2>;=>2K5 AB0488 A=0 >?@545;ONBAO ?> 8-0:B82=>AB8 8 A>==K< 25@5B5=0< =0 --, 0 REM-D070  ?> 45A8=E@>=870F88 --, ?>O2;5=8N 1KAB@KE 42865=89 3;07 8 3;C1>:><C A=865=8N <KH5G=>3> B>=CA0. @><5 B>3>, G0AB> @538AB@8@CNBAO M;5:B@>:0@48>3@0<<0 (-), 4KE0B5;L=K5 42865=8O, , B5<?5@0BC@0 :>68 8 =0AKI5=85 :@>28 :8A;>@>4>< (A ?><>ILN CH=>3> D>B>40BG8:0). A5 MB8 ?>:070B5;8 ?>72>;ONB >F5=8BL 2>7<>6=K5 2535B0B82=K5 @0AAB@>9AB20 2> 2@5<O REM-D07K A=0. !>:@0I5=85 ;0B5=B=>AB8 REM-D07K A=0 8 @0==55 ?@>1C645=85 CB@>< O2;ONBAO CAB0=>2;5==K<8 18>;>38G5A:8<8 <0@:5@0<8 45?@5AA88 8 <0=88 [Hudson J.I. et al., 1988]. >;8A><=>3@0D8O B0:65 405B 2>7<>6=>ABL 48DD5@5=F8@>20BL 45?@5AA8N 8 45?@5AA82=CN ?A524>45<5=F8N C ?>68;KE ?0F85=B>2 [Reynolds C.F. et al., 1988], >1J5:B82=> 2KO28BL 15AA>==8FC, =0@:>;5?A8N, A><=0<1C;87<, =>G=K5 :>H<0@K (?0=8G5A:85 0B0:8), 0?=>M, M?8;5?B8G5A:85 ?@8ABC?K. 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MB>< A;CG05 8A?>;L7C5BAO A;54CNI0O D>@<C;0:  = lg(N)/[lg(2) + 1]. 0B5< >?@545;O5BAO @8A:>2K9 ?5@8>4, 345 C:07K20NBAO 53> =0G0;> (xj) 8 :>=5F (E2). >A;5 MB>3> 2KG8A;ONBAO 25A>2K5 :>MDD8F85=BK 4;O :064>3> 2>7@0AB=>3> :;0AA0 [Larsson J., Sjogren "., 1954] ?> D>@<C;5: Wi = (Xi - X1)/(X2 - %i), 345 xi  A5@548=0 A>>B25BAB2CNI53> (i) 2>7@0AB=>3> :;0AA0. >@184=K9 @8A: 2KG8A;O5BAO ?> D>@<C;5:  INCLUDEPICTURE "http://psychiatry.ru/library/lib/5/161.png" \* MERGEFORMATINET  345 nj  G8A;> 8=48284>2 2 A>>B25BAB2CNI5< (i)- 2>7@0AB=>< :;0AA5 157 ?@87=0:0, 4  >1I55 G8A;> 8=48284>2 2 2K1>@:5 A ?@87=0:><. ;O 2A5E 8=48284>2, 2>7@0AB :>B>@KE <5=LH5 =0G0;0 @8A:>2>3> ?5@8>40, W = 0, B.5. 2A5 8=48284K A <5=LH8< 2>7@0AB>< =5 CG8BK20NBAO. ;O 8=48284>2, 2>7@0AB :>B>@KE ?@52KH05B :>=5F @8A:>2>3> ?5@8>40, W = 1, B.5. 8E G8A;> CG8BK205BAO 157 87<5=5=8O. "0:>9 ?>4E>4 ?>72>;O5B ?@>25AB8 ;8=59=CN :>@@5:F8N 2>7@0AB=>9 7028A8<>AB8 ?@>O2;5=8O ?@87=0:0 0=0;>38G=> B><C, :0: MB> 45;05BAO ?@8 M;8<8=0F88 2>7@0AB=>9 :><?>=5=BK 87<5=G82>AB8 A ?><>ILN C@02=5=8O ;8=59=>9 @53@5AA88. @8 @01>B5 A A5<59=K<8 40==K<8 :>@@5:F8O 2>7@0AB=>9 7028A8<>AB8 ?@>2>48BAO B0:65. 5=50;>38G5A:89 <5B>4  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) ;8=8:>-35=50;>38G5A:89 <5B>4 G0I5 4@C38E 8A?>;L7C5BAO 2 35=5B8:5 ?A8E8G5A:8E 1>;57=59. 3> ACI=>ABL A>AB>8B 2 ?@>A;56820=88 2 @>4>A;>2=KE ?@>O2;5=89 ?0B>;>38G5A:8E ?@87=0:>2 A ?><>ILN ?@85<>2 :;8=8G5A:>3> >1A;54>20=8O A C:070=85< B8?0 @>4AB25==KE A2O759 <564C G;5=0<8 A5<59. -B>B <5B>4 8A?>;L7C5BAO 4;O CAB0=>2;5=8O B8?0 =0A;54>20=8O 1>;57=8 8;8 >B45;L=>3> ?@87=0:0, >?@545;5=8O <5AB>?>;>65=8O 35=>2 =0 E@><>A><0E, >F5=:8 @8A:0 ?@>O2;5=8O ?A8E8G5A:>9 ?0B>;>388 ?@8 <548:>-35=5B8G5A:>< :>=AC;LB8@>20=88.  35=50;>38G5A:>< <5B>45 <>6=> 2K45;8BL 2 MB0?0  MB0? 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A;8 CAB0=>2;5=>, GB> 87CG05<0O ?0B>;>38O 8<55B 35=5B8G5A:CN ?@8@>4C, B> =0 A;54CNI5< MB0?5 @5H05BAO 7040G0 CAB0=>2;5=8O B8?0 =0A;54>20=8O. !;54C5B >1@0B8BL 2=8<0=85 =0 B>, GB> B8? =0A;54>20=8O CAB0=02;8205BAO =5 ?> >4=>9, 0 ?> 3@C??5 @>4>A;>2=KE. >4@>1=>5 >?8A0=85 @>4>A;>2=>9 8<55B 7=0G5=85 4;O >F5=:8 @8A:0 ?@>O2;5=8O ?0B>;>388 C :>=:@5B=>3> G;5=0 B>9 8;8 8=>9 A5<L8, B.5. ?@8 ?@>2545=88 <548:>-35=5B8G5A:>3> :>=AC;LB8@>20=8O. @8 87CG5=88 @07;8G89 <564C 8=482840<8 ?> ;N1><C ?@87=0:C 2>7=8:05B 2>?@>A > ?@8G8==KE D0:B>@0E B0:8E @07;8G89. >MB><C 2 35=5B8:5 ?A8E8G5A:8E 701>;520=89 H8@>:> 8A?>;L7C5BAO <5B>4 >F5=:8 A>>B=>A8B5;L=>3> 2:;040 35=5B8G5A:8E 8 A@54>2KE D0:B>@>2 2 <568=48284C0;L=K5 @07;8G8O ?> ?>425@65==>AB8 B><C 8;8 8=><C 701>;520=8N. -B>B <5B>4 >A=>20= =0 ?@54?>;>65=88, GB> D5=>B8?8G5A:>5 (=01;N405<>5) 7=0G5=85 ?@87=0:0 C :064>3> 8=482840 O2;O5BAO @57C;LB0B>< 2;8O=8O 35=>B8?0 8=482840 8 B5E CA;>289 A@54K, 2 :>B>@KE ?@>8AE>48B 53> @0728B85. 4=0:> C :>=:@5B=>3> G5;>25:0 >?@545;8BL MB> ?@0:B8G5A:8 =52>7<>6=>. >MB><C 22>4OBAO A>>B25BAB2CNI85 >1>1I5==K5 ?>:070B5;8 4;O 2A5E ;N459, ?>72>;ONI85 70B5< 2 A@54=5< >?@545;8BL A>>B=>H5=85 35=5B8G5A:>3> 8 A@54>2>3> 2;8O=8O =0 >B45;L=>3> 8=482840. -B0 7040G0 @5H05BAO =0 >A=>25 22545=8O B0:>3> AB0B8AB8G5A:>3> ?>:070B5;O, :0: 48A?5@A8O ?@87=0:0, :>B>@K9 2 35=5B8:5 =07K20NB D5=>B8?8G5A:0O 48A?5@A8O (Vp). I INCLUDEPICTURE "http://psychiatry.ru/library/lib/5/170.png" \* MERGEFORMATINET  8A. 16. @0D8G5A:>5 87>1@065=85 @>4>A;>2=>9, ?@8=OB>5 2 35=5B8:5.  - ?@8<5@ A5<L8 87 3 ?>:>;5=89 (>1JOA=5=85 2 B5:AB5);  - >A=>2=K5 >1>7=0G5=8O, 8A?>;L7C5<K5 2 @>4>A;>2=KE. $5=>B8?8G5A:0O 48A?5@A8O <>65B 1KBL ?@54AB02;5=0 2 2845 AC<<K 42CE 48A?5@A89, >4=0 87 :>B>@KE E0@0:B5@87C5B @07=>>1@0785, >1CA;>2;5==>5 2;8O=85< 35=5B8G5A:8E D0:B>@>2 (VG), 0 4@C30O  2;8O=85 A@54>2KE D0:B>@>2 (VE): VP = VG + VE. ! ?@82545==K<8 ?>:070B5;O<8 A2O70=K B0:85 ?>=OB8O, :0: ?>:070B5;L "35=5B8G5A:>3> @07=>>1@078O" (G): G = VG/VP 8 ?>:070B5;L "A@54>2>3> @07=>>1@078O" ():  = VE/VP.  C:070==KE D>@<C;0E A8<2>;K >1>7=0G0NB ?5@2K5 1C:2K 0=3;89A:8E A;>2: V  20@80=A0 (variance), P  D5=>B8?8G5A:0O (phenotypic), G  35=5B8G5A:0O (genetic),   A@54>20O (environmental). > <=>38E A;CG0OE 7=0G8B5;L=K9 8=B5@5A ?@54AB02;O5B =5 B>;L:> >1I0O >F5=:0 @>;8 35=5B8G5A:8E 8 A@54>2KE D0:B>@>2, => 8 >B45;L=K5 :><?>=5=BK 48A?5@A88, >1CA;>2;5==K5 B0:8<8 D0:B>@0<8.  35=5B8G5A:>9 A>AB02;ONI59 >1KG=> 2K45;ONB :><?>=5=BC, :>B>@0O E0@0:B5@87C5B 2;8O=85 >B45;L=KE 0;;5;59 35=>2 (GA)  0448B82=CN (additive) 35=5B8G5A:CN :><?>=5=BC, 8;8 :>MDD8F85=B =0A;54C5<>AB8 (h2), 8 2;8O=85 ?0@ 0;;5;59, :>B>@>5 E0@0:B5@87C5B 2=CB@8;>:CA=>5 2708<>459AB285  4><8=0=B=CN (dominant) 35=5B8G5A:CN :><?>=5=BC (GD). !@54>20O :><?>=5=B0 48A?5@A88 B0:65 <>65B 1KBL ?@54AB02;5=0 2 2845 =5A:>;L:8E A>AB02;ONI8E, 8;8 :><?>=5=B. @5645 2A53> 2K45;ONB :><?>=5=BC 48A?5@A88, :>B>@0O >1CA;>2;5=0 2;8O=85< A@54K 8 459AB2C5B AE>4=K< >1@07>< =0 3@C??C 8=48284>2. -B> 2;8O=85 B0: =07K205<KE A8AB5<0B8G5A:8E (common) A@54>2KE D0:B>@>2 (A), :>B>@K5 2 A2>N >G5@54L <>3CB 1KBL ?>4@0745;5=K B0:65 =0 >B45;L=K5 B8?K. @C30O 3@C??0 MDD5:B>2 A@54>2KE D0:B>@>2 E0@0:B5@87C5BAO B5<, GB> >=8 459AB2CNB =0 8=482840 A;CG09=K< >1@07><; A>>B25BAB2CNI0O :><?>=5=B0 A@54>2>9 48A?5@A88 >1>7=0G05BAO Ew. 0AA<>B@5==K5 ?>:070B5;8 35=5B8G5A:>9 8 A@54>2>9 45B5@<8=0F88, A>AB02;OO 206=59HCN G0ABL 35=5B8G5A:>3> 0=0;870 2 ?A8E80B@88, >4=0:>, =5 >B25G0NB 2 ?>;=>9 <5@5 =0 2>?@>A > 2;8O=88 35=5B8G5A:8E 8 A@54>2KE D0:B>@>2 =0 ?@>O2;5=8O ?@87=0:0 C :>=:@5B=>3> G5;>25:0. 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"0:8< >1@07><, ?>:070B5;L 35=5B8G5A:>9 45B5@<8=0F88 >B@0605B 2;8O=85 35=5B8G5A:8E D0:B>@>2 =0 <568=48284C0;L=>5 @07=>>1@0785, 0 =5 2>>1I5 =0 =0;8G85 35=5B8G5A:8E <5E0=87<>2 45B5@<8=0F88 ?@87=0:>2. >MDD8F85=BK =0A;54C5<>AB8 E0@0:B5@87CNB ?>?C;OF8N, 8 4;O >4=>3> 8 B>3> 65 701>;520=8O 8;8 ?@87=0:0 >=8 <>3CB 8<5BL @07=K5 7=0G5=8O 2 7028A8<>AB8 >B :>=:@5B=KE @07;8G89 2 AB@C:BC@5 ?>?C;OF89, =0?@8<5@ 2 7028A8<>AB8 >B @07;8G89 2 G0AB>B0E 35=>B8?>2.  35=5B8:5 ?A8E8G5A:8E 1>;57=59 >A=>2=K< ?>4E>4>< 4;O >F5=:8 2;8O=8O 35=5B8G5A:8E 8 A@54>2KE D0:B>@>2 =0 <568=48284C0;L=K5 @07;8G8O O2;O5BAO 0=0;87 :>@@5;OF89 <564C @>4AB25==8:0<8. !?>A>1K 2KG8A;5=8O :>MDD8F85=B>2 [8;L8= ."., "@C1=8:>2 .., 0=N:>2 .., 1984] 7028AOB >B E0@0:B5@0 @0A?@545;5=8O D5=>B8?8G5A:8E 7=0G5=89 0=0;878@C5<KE ?@87=0:>2 (:>;8G5AB25==K5, 0;LB5@=0B82=K5 =><8=0;L=>-48E>B><8G5A:85 8;8 :2078=5?@5@K2=K5) 8 B8?0 @>4AB25==8:>2. 0 >A=>25 :>=F5?F88 845=B8G=>AB8 35=>2 ?> ?@>8AE>645=8N CAB0=>2;5=> A>>B=>H5=85 35=5B8G5A:8E :><?>=5=B 48A?5@A88 2 :>@@5;OF8OE <564C @>4AB25==8:0<8. ;O :>@@5;OF88 2 ?0@0E @>48B5;L  @515=>: (ROP)( A>:@0I5=85 ">@" >B 0=3;. offspring (?>B><>:, @515=>:) 8 parent (@>48B5;L); "sb"  >B siblings (1@0BLO 8 A5AB@K)) 8<55BAO A;54CNI55 A>>B=>H5=85: ROP = @8 8AA;54>20=8OE 1K;8 ?>;CG5=K @57C;LB0BK ?> ?>425@65==>AB8 : @O4C ?A8E8G5A:8E 701>;520=89. >MDD8F85=B :>@@5;OF88 <564C @>4AB25==8:0<8 ?5@2>9 AB5?5=8 @>4AB20 ?> ?>425@65==>AB8 : H87>D@5=88, ?> ?>A;54=8< 40==K<, @025= 0,35, 8 A>>B25BAB25==> =0A;54C5<>ABL ?>425@65==>AB8 : H87>D@5=88 4>AB0B>G=> 2KA>:0  70 % [Kendler K.S., Diel S.R., 1993]. 57C;LB0BK 8AA;54>20=89 ?> 35=5B8G5A:>9 45B5@<8=0F88 ?>425@65==>AB8 : M?8;5?A88 ?@8 8A?>;L7>20=88 @07=KE :@8B5@852 >?@545;5=8O D5=>B8?0 "M?8;5?A8O" B0:65 C:07K20NB =0 2KA>:CN =0A;54C5<>ABL MB>3> 701>;520=8O (50 78 %) [ 8F=5@ .!., 1985]. 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K >AB0=>28<AO =0 =081>;55 ?>74=8E @01>B0E. >A<5@B=>5 87CG5=85 B:0=8 <>730 1>;L=KE H87>D@5=859 70G0ABCN 1K;> >@85=B8@>20=> =0 87CG5=85 =0@CH5=89 >1<5=0 <>=>0<8=>2 2 >A=>2=KE 4>D0<8=5@38G5A:8E AB@C:BC@0E <>730 1>;L=KE  =83@>AB@80B=>9 <57M=F5D0;L=>-:>@:>2>9 8 <57M=F5D0;L=>-;8<18G5A:>9 8 4@. 5A<>B@O =0 ?@>B82>@5G82>ABL, ?>;CG5==K5 @57C;LB0BK A2845B5;LAB2CNB >1 >B=>A8B5;L=>< ?>2KH5=88 0:B82=>AB8 <57>;8<18G5A:8E AB@C:BC@ <>730 8 A=865=88 0:B82=>AB8 @O40 >B45;>2 :>@K [Davies K.L. et al., 1991].  ?>A;54=85 3>4K MB>B 2K2>4 ?>;CG8; C1548B5;L=>5 ?>4B25@645=85 2 A2O78 A @07@01>B:>9 <5B>4>2 ?@8687=5==>9 287C0;870F88 <>73>2KE AB@C:BC@; @538AB@0F88 @538>=0;L=>3> :@>2>>1@0I5=8O, :><?LNB5@=>9 @5=B35=>2A:>9 B><>3@0D88 ("), <03=8B=>-@57>=0=A=>9 B><>3@0D88 ( "), ?>78B@>==>9 M<8AA8>==>9 B><>3@0D88 (-") 8 4@.  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KA>:89 C@>25=L  2 AK2>@>B:5 :@>28 1>;L=KE H87>D@5=859, :0: ?@028;>, A=8605BAO ?@8 ?@>2545=88 B5@0?88 8 C;CGH5=88 8E ?A8E8G5A:>3> A>AB>O=8O. -B>B C@>25=L <0:A8<0;L=> 2KA>: C 3@C??K 1>;L=KE A 2K@065==K<8 =530B82=K<8 @0AAB@>9AB20<8 8 C25;8G5==K<8 @07<5@0<8 65;C4>G:>2 <>730 (?> 40==K< ").  >4=>9 87 ?@>2545==KE @01>B C@>25=L  2 AK2>@>B:5 :@>28 1>;L=KE E@>=8G5A:>9 H87>D@5=859 87<5@O;8 =0 ?@>BO65=88 3>40. #AB0=>2;5=>, GB> 2KA>:89 C@>25=L  2 @02=>9 <5@5 :>@@5;8@C5B A 2K@065==>ABLN :0: ?>78B82=>9, B0: 8 =530B82=>9 A8<?B><0B8:8 [Suzuki . et al., 1994].  ?>A;54=85 3>4K ?KB0NBAO 8A?>;L7>20BL 87<5@5=85 :>=F5=B@0F88  2 AK2>@>B:5 :@>28 1>;L=KE H87>D@5=859 8;8 87<5=5=85 MB>3> C@>2=O 2 ?5@2CN =545;N B5@0?88 4;O ?@>3=>70 B5@0?88 [Duncan E. et 0!., 1993; Akiyama . et al., 1995]. 4=>2@5<5==> @07@010BK20NBAO ?>4E>4K, ?>72>;ONI85 2KG;5=8BL BC G0ABL  AK2>@>B:8 :@>28, :>B>@0O >B@0605B 0:B82=>ABL >1<5=0 4>D0<8=0 2 B:0=8 <>730 [Ainin F. et al., 1995]. 5>4=>:@0B=> ?@>2>48;>AL ?>A<5@B=>5 87CG5=85 2 B:0=8 <>730 1>;L=KE H87>D@5=859 4@C3>3> 206=>3> <5B01>;8B0 4>D0<8=0  $# (A<. @8A.17).  >4=>< 87 BI0B5;L=> ?@>2545==KE 8AA;54>20=89, 2K?>;=5==>< =0 2KA>:>< <5B>48G5A:>< C@>2=5, 1K;> ?>:070=> 7=0G8B5;L=>5 A=865=85 A>45@60=8O $# 2 :>@5 ?5@54=59 ?>OA=>9 8728;8=K (g.ant. cingulate) ?@8 H87>D@5=88, =5 A2O70==>5 A ?@54H5AB2CNI59 B5@0?859, 2>7@0AB>< 1>;L=>3>, ?@>4>;68B5;L=>ABLN E@0=5=8O ?@>1 B:0=8 2 70<>@>65==>< A>AB>O=88. -B>B >B45; <>730 ?@82;5: 2=8<0=85 8AA;54>20B5;59 2 A2O78 A B5<, GB> 53> M;5:B@8G5A:0O AB8<C;OF8O ?@82>48B : 2>7=8:=>25=8N 30;;NF8=0F89 8 =530B8287<C, 0 @07@CH5=85  : 03@5AA82=><C ?>2545=8N 8 @0728B8N H87>D@5=>?>4>1=KE A>AB>O=89. !=865=85 4>D0<8=0 8  2 MB>9 B:0=8 =5 2KO2;5=>. 5 1K;> >B<5G5=> B0:65 87<5=5=89 2 A>45@60=88 =>@04@5=0;8=0 8 53> <5B01>;8B>2. @82545==K5 40==K5 A>3;0ACNBAO A 2KO2;5==K< RJ.Wyatt 8 4@. 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B5@0?88 2KO28;> 4>AB>25@=CN :>@@5;OF8N <564C 1;>:04>9 DA2 8 C;CGH5=85< A>AB>O=8O 1>;L=KE; @0728B85 65 M:AB@0?8@0<84=KE =0@CH5=89 G5B:> 0AA>F88@>20;>AL A G@57<5@=>9 1;>:04>9 MB8E @5F5?B>@>2 [Nordstrom A.-L. et al., 1993]. B<5G5=> B0:65 A=865=85 A>45@60=8O DA1P 2 :>@5 1>;L=KE H87>D@5=859, =5 ?>425@302H8EAO @0=55 ;5:0@AB25==>9 B5@0?88 [Karlsson P. et al., 1996].  @0==8E @048>;830=4=KE 8AA;54>20=8OE 2KO2;O;8AL 2A5 <5AB0 A?5F8D8G5A:>3> A2O7K20=8O <5480B>@0, 2:;NG0O :0: @5F5?B>@K : <5480B>@0<, B0: 8 15;:>2K5 :><?;5:AK, 2K?>;=ONI85 2 ?@>F5AA0E >1@0B=>3> 70E20B0 <54803>@0 DC=:F8N B@0=A?>@B5@0. 3@0=8G5=85 <5B>40 1K;> ?@5>4>;5=> 1;03>40@O A8=B57C ;830=4>2, 8718@0B5;L=> A2O7K20NI8EAO ;8HL A B@0=A?>@B5@0<8, => =5 A <5480B>@=K<8 @5F5?B>@0<8. 7CG5=85 A>45@60=8O 8 A2>9AB2 4>D0<8=>2>3> B@0=A?>@B5@0 ?@5D@>=B0;L=>9 :>@K 1>;L=KE H87>D@5=859 =5 2KO28;> :0:8E-;81> >B:;>=5=89 >B =>@<K [Hitry A. et al., 1994]. <5AB5 A B5< 1K;> >1=0@C65=>, GB> A 2>7@0AB>< 53> ?;>B=>ABL 2 ?@5D@>=B0;L=>9 :>@5 C 74>@>2KE =5 <5=O5BAO, 0 C 1>;L=KE H87>D@5=859  C1K205B [Hitry . et 0!., 1995]. =0;>38G=>5 87CG5=85 A>45@60=8O MB>3> B@0=A?>@B5@0 2 42CE :>@B8:0;L=KE >1;0ABOE (?>;5 10 ;>1=>9 :>@K 8 ?>;5 24 :>@K ?5@54=59 ?>OA=>9 8728;8=K) ?>:070;> >BACBAB285 @07;8G89 <564C 1>;L=K<8 8 74>@>2K<8 2 ?5@2>9 87 C:070==KE AB@C:BC@ 8 42C:@0B=>5 A=865=85 ?;>B=>AB8 2 ?>OA=>9 :>@5 1>;L=KE, =5 A>?@>2>640NI55AO 87<5=5=85< 53> A@>4AB20 : ;830=4C [Hitry A., Wyatt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each K.P. et 0!., 1995]. 0: C65 >B<5G0;>AL, ?;>B=>ABL @5F5?B>@>2 =5?>AB>O==0 8 7028A8B >B DC=:F8>=0;L=>3> A>AB>O=8O =59@>=0. ;O >F5=:8 48=0<8:8 =59@>=0;L=KE @5F5?B>@>2 2 ?>A;54=55 2@5<O ?@81530NB : >?@545;5=8N A:>@>AB8 8E A8=B570, 87<5@OO A MB>9 F5;LN A>45@60=85 < , :>48@CNI59 AB@C:BC@C A>>B25BAB2CNI53> @5F5?B>@0. '8A;> B0:8E <>;5:C;O@=>-18>;>38G5A:8E 8AA;54>20=89 =525;8:>.  :0G5AB25 ?@8<5@0 ?@82545< @01>BC ?> >?@545;5=8N A>45@60=8O <  A5@>B>=8=>2>3> @5F5?B>@0 B8?0 5-"1 =0 A@570E ?@5D@>=B0;L=>9 :>@K, :>@K ?>OA=>9 8728;8=K 8 M=B>@80;L=>9 :>@5 C 1>;L=KE H87>D@5=859. >2KH5==>5 ?> A@02=5=8N A =>@<>9 A>45@60=85 <  1K;> 2KO2;5=> B>;L:> 2> 2B>@>9 87 ?5@5G8A;5==KE AB@C:BC@ :0: C =5;5G5=KE, B0: 8 =0E>482H8EAO =0 ;5:0@AB25==>9 B5@0?88 1>;L=KE. 5A<>B@O =0 >B<5G5==K5 CA?5E8 2 45;5 87CG5=8O @5F5?B>@=>3> C@>2=O ?@>F5AA>2 A8=0?B8G5A:>9 ?5@540G8, <=>385 0A?5:BK <5E0=87<0 459AB28O ?A8E>B@>?=KE ?@5?0@0B>2 (0 A;54>20B5;L=>, 8 ACI5AB2> ?@>F5AA>2, =>@<0;87C5<KE A 8E ?><>ILN) >AB0NBAO =58725AB=K<8. 06=59H8< 87 =8E O2;O5BAO 70?074K20=85 B5@0?52B8G5A:>3> MDD5:B0: >= ?@>O2;O5BAO =5 2 <><5=B <0:A8<0;L=>3> A2O7K20=8O @5F5?B>@>< <>;5:C; ;5:0@AB25==>3> ?@5?0@0B0, 0 A?CABO 2 4 =54. G5284=>, 2 B5G5=85 MB>3> 2@5<5=8 2 B:0=8 <>730 1>;L=>3> ?@>8AE>4OB :0:85-B> 040?B82=K5 ?5@5AB@>9:8, =5 2KO2;O5<K5 <5B>40<8, :>B>@K5 ?@8<5=ONB 2 CA;>28OE :;8=8:8. AA;54>20=8O, ?@>2>48<K5 2 ;01>@0B>@88 (=0 682>B=KE, :C;LBC@5 =5@2=>9 B:0=8), A2>1>4=K >B C:070==KE >3@0=8G5=89. =8 2KO28;8 <5E0=87<K, 83@0NI85, ?> 2A59 25@>OB=>AB8, 206=CN @>;L 2 @50;870F88 B5@0?52B8G5A:8E MDD5:B>2 ;5:0@AB25==KE ?@5?0@0B>2. -B> 2 ?5@2CN >G5@54L O2;5=8O 3><>;>38G5A:>9 8 35B5@>;>38G5A:>9 45A5=B870F88 @5F5?B>@=KE ">B25B>2" =59@>=0 =0 459AB285 <5480B>@0. ><>;>38G5A:0O 45A5=B870F8O ?@>O2;O5BAO 2 B><, GB> G@57<5@=0O "?5@53@C7:0" @5F5?B>@0 :0:8<-;81> <5480B>@>< ?5@52>48B 53> 2 =50:B82=>5 A>AB>O=85, E>BO >= A>E@0=O5B ?@56=NN A?>A>1=>ABL A2O7K20BLAO A <>;5:C;0<8 <5480B>@0. @8 35B5@>;>38G5A:>9 45A5=B870F88 "?5@53@C7:0" @5F5?B>@0, 0DD8==>3> : :0:><C-;81> >4=><C <5480B>@C, 2K7K205B 8=0:B820F8N =5 B>;L:> MB>3> @5F5?B>@0, => 8 <=>38E 4@C38E 0DD8==KE : 8=K< <5480B>@0< @5F5?B>@>2 ?>ABA8=0?B8G5A:>9 <5<1@0=K. 5A5=B870F8O 02-04@5=>@5F5?B>@>2 B@><1>F8B>2 =5>4=>:@0B=> 2KO2;O;0AL ?@8 <>=>?>;O@=KE 45?@5AA8OE, E>BO G8A;> 02-  (2 ?5@5AG5B0 =0 1 B@><1>F8B) C MB8E 1>;L=KE ?> A@02=5=8N A =>@<>9 1K;> ?>2KH5=>.  8AA;54>20=8OE, ?@>2545==KE =0 682>B=KE, ?>:070=>, GB> ?@>4>;68B5;L=>5 22545=85 0=B845?@5AA0=B>2 >1;53G05B A8=0?B8G5A:CN ?5@540GC, >ACI5AB2;O5<CN A CG0AB85< A5@>B>=8=>2KE @5F5?B>@>2 B8?0 5-"1, 8 ?@82>48B : 45A5=B870F88 -04@5=>- 8 5-"2 @5F5?B>@>2 [Lesch K.P. et al., 1992].  @07;8G=KE >B45;0E <>730 MB8E 682>B=KE >1=0@C65=K 87<5=5=8O A>45@60=8O < , :>48@CNI59 0<8=>:8A;>B=CN ?>A;54>20B5;L=>ABL -AC1J548=8FK G-15;:0. 5@>OB=>, 70B@03820NI85 G-15;:8 87<5=5=8O O2;ONBAO >4=>9 87 <>;5:C;O@=KE >A=>2 040?B82=KE 87<5=5=89 A8=0?B8G5A:>9 ?5@540G8, >1CA;>2;820NI8E B5@0?52B8G5A:89 MDD5:B 0=B845?@5AA0=B>2.  ?>A;54=85 3>4K 2>7@>A 8=B5@5A : E>;8=5@38G5A:>9 A8AB5<5 <>730. R.Tandon 8 A>02B. (1991) ?@825;8 40==K5, A2845B5;LAB2CNI85 > A2O78 ?>2KH5==>9 0:B82=>AB8 MB>9 A8AB5<K A =530B82=K<8 A8<?B><0<8 8 55 A=865=88 C 1>;L=KE, =0E>4OI8EAO 2 >AB@>< ?A8E>B8G5A:>< A>AB>O=88. >?>;=8B5;L=K< >A=>20=85< : 2>7@0AB0=8N MB>3> 8=B5@5A0 ?>A;C68;8 ?>2KH5==>5 ?@8AB@0AB85 1>;L=KE H87>D@5=859 : =8:>B8=C [de Leon J. et al., 1995], A?>A>1=>ABL MB>3> A>548=5=8O =>@<0;87>20BL @O4 =0@CH5==KE C 1>;L=KE 8 8E @>4AB25==8:>2 DC=:F89, =0?@8<5@ @50;870F8N G0AB> 8A?>;L7C5<>3> 2 =59@>D878>;>38G5A:8E 8AA;54>20=8OE ?>:070B5;O  ?;02=KE ?@>A;56820NI8E 42865=89 3;070 [Braff D.E., 1993; Levy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eane V.O. et al., 1994]. 725AB=0 ;8HL >4=0 @01>B0, ?>A2OI5==0O 87CG5=8N =87:>0DD8==KE =8:>B8=>2KE 0F5B8;E>;8=>2KE @5F5?B>@>2 ?@8 H87>D@5=88. >A<5@B=>5 87CG5=85 A>45@60=8O MB8E @5F5?B>@>2 2 B:0=8 <>730 1>;L=KE H87>D@5=859 2KO28;> A=865=85 8E G8A;0 2 @09>=0 ! 0<<>=>20 @>30 8 1>;55 7=0G8B5;L=>5  2 7C1G0B>9 8728;8=5, GB> <>65B ?@82>48BL, ?> <=5=8N 02B>@>2 @01>BK, : 2>7=8:=>25=8N >B<5G5==KE 2KH5 DC=:F8>=0;L=KE @0AAB@>9AB2 [Freedman R. et al., 1995]. >?@>A > 2>7<>6=>< 2>2;5G5=88 3;CB0<0B5@38G5A:>9 A8AB5<K 2 ?0B>D878>;>38G5A:85 ?@>F5AAK ?@8 H87>D@5=88 O2;O5BAO 2 =0AB>OI55 2@5<O ?@54<5B>< 8=B5=A82=>3> 87CG5=8O. = 1K; ?>AB02;5= 2 A2O78 A >1=0@C65=85< A=865==>3> A>45@60=8O 3;CB0<0B0 2 F5@51@>A?8=0;L=>9 684:>AB8 1>;L=KE H87>D@5=859 [Kim V.S., 1980] 8 ?@8>1@5; 4>AB0B>G=CN 0:BC0;L=>ABL, :>340 1K;> ?>:070=>, GB> D5=F8:;848=  =5:>=:C@5=B=K9 0=B03>=8AB N-<5B8;-D-0A?0@038=>2>9 :8A;>BK, =5>1@0B8<> 1;>:8@CNI89 B0: =07K205<K5 N-<5B8;-D-0A?0@B0=B=K5 @5F5?B>@K (NMDA-@5F5?B>@K), 2K7K205B H87>D@5=>?>4>1=K5 @0AAB@>9AB20.  =0AB>OI5<C 2@5<5=8 ?@54;>65=> =5A:>;L:> @07;8G=KE 38?>B57, :0A0NI8EAO 2>7<>6=>9 @>;8 3;CB0<0B5@38G5A:>9 A8AB5<K ?@8 H87>D@5=88 [Lieberman J., 1993], 2 G0AB=>AB8, A2O70==KE A 4>D0<8=5@38G5A:>9 A8AB5<>9 [Healy D.J. et al., 1995]. 4=0:> ?@O<K5 ?>4B25@645=8O MB8E 38?>B57 =5<=>3>G8A;5==K. 4=8 8AA;54>20B5;8 C:07K20NB =0 C<5=LH5=85 A2O7K20=8O 3;CB0<0B0 2 @O45 >B45;>2 :>@K 3>;>2=>3> <>730 1>;L=KE [Kerwin R.W. et al., 1990], 4@C385  =0 2>7@0AB0=85 A?5F8D8G5A:>3> A2O7K20=8O 3;CB0<0B0 2 ;>1=>9 :>@5 [Deakin J.F. et al., 1989] 8 2>7@0AB0=85 ?;>B=>AB8 D5=F8:;848=-A2O7K20NI8E NMDA @5F5?B>@>2  2 >@18B0;L=>9 >1;0AB8 ;>1=>9 :>@K, 0 B0:65 A=865==CN M:A?@5AA8N 35=0 3;CB0<0B=>3> @5F5?B>@0 2 38??>:0<?5 <>730 1>;L=KE H87>D@5=859 [Collings J. et al., 1991]. 7CG5=85 M:A?@5AA88 35=0 3;CB0<0B=>3> @5F5?B>@0 2 ;>1=>9 (?>;5 10) 8 28A>G=>9 4>;5 (?>;5 22) :>@K 2KO28;> A=865=85 A>>B25BAB2CNI59 <  ;8HL 2 28A>G=>9 :>@5, :>@@5;8@CNI55 A BO65ABLN :>3=8B82=KE @0AAB@>9AB2 [Humphries C.R. et al., 1996]. B<5G5=> B0:65 7=0G8B5;L=>5 A=865=85 A>45@60=8O 3;CB0<0B0 2 25@E=59 28A>G=>9 8728;8=5 8 C3;>2>9 8728;8=5 [Toru M. et al., 1991]. 06=0O 4>?>;=8B5;L=0O 8=D>@<0F8O ?@8 @0AA<>B@5=88 MB>3> 2>?@>A0 1K;0 ?>;CG5=0 1;03>40@O 87CG5=8N <5E0=87<0 459AB28O 0B8?8G=>3> =59@>;5?B8:0 :;>70?8=0 (;5?>=5:A0), :>B>@K9 2708<>459AB2C5B =5 A 4>D0<8=>2K< @5F5?B>@>< B8?0 DA2, 0 A 4>D0<8=>2K< @5F5?B>@>< DA1 8 A5@>B>=8=>2K< @5F5?B>@>< 5-"2 [Meltzer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tevens J., 1995]. @8 >1AC645=88 ?@>F5AA0 A8=0?B8G5A:>9 ?5@540G8 =5 1K;8 @0AA<>B@5=K 2 45B0;OE <5E0=87<K D>@<8@>20=8O A8=0?B8G5A:8E ?C7K@L:>2 8 M:7>F8B>70. =8 G@572KG09=> A;>6=K 8 =54>AB0B>G=> 87CG5=K. 564C B5< 8725AB=0 8E 206=0O @>;L 2 ?@>F5AA0E, :>B>@K5 @0AA<0B@820NBAO A53>4=O 2 :0G5AB25 >A=>2K 4>;3>2@5<5==>9 ?0<OB8. #AB0=>2;5=> B0:65 ACI5AB25==>5 CG0AB85 2 MB8E ?@>F5AA0E <=>3>G8A;5==KE 15;:>2 ?@5A8=0?A0, 2 B>< G8A;5 A8=0?A8=>2 8 A8=0?B>D878=0. !8=0?A8=K  15;:8 ?@5A8=0?B8G5A:>9 <5<1@0=K, CG0AB2CNI85 2 4>;3>2@5<5==>9 ?>B5=F80F88, 2 B> 2@5<O :0: A8=0?B>D878= =5>1E>48< 4;O ?@8:@5?;5=8O A8=0?B8G5A:>3> ?C7K@L:0 : :;5B>G=>9 <5<1@0=5. 7CG5=85 A>45@60=8O A8=0?A8=0 1 8 A8=0?B>D878=0 2KO28;> 7=0G8B5;L=>5 A=865=85 ?5@2>3> 87 =8E 2 B:0=8 <>730 1>;L=KE H87>D@5=859 [Browning M.D. et al., 1993]. 0==0O @01>B0 7=0<5=C5B A>1>9 =>2K9 H03 2 87CG5=88 <>;5:C;O@=KE <5E0=87<>2 A8=0?B8G5A:>9 ?5@540G8 ?@8 M=4>35==KE ?A8E>70E. !45;0==K5 55 02B>@0<8 2K2>4K E>@>H> A>3;0ACNBAO A @57C;LB0B0<8 1>;55 ?>74=53> 87CG5=8O =0@CH5=89 A8=0?B8G5A:>9 ?5@540G8 C <KH59-<CB0=B>2, ;8H5==KE A8=0?A8=0 1 [Sudhof T.C., 1995]. =>3>G8A;5==K5 =01;N45=8O :;8=8F8AB>2 A2845B5;LAB2CNB > B><, GB> ?@54@0A?>;>65=85 : 701>;520=8N H87>D@5=859 >BG0AB8 A2O70=> A =54>@0728B85< 8;8 0=><0;L=K< @0728B85< <>730, 0 2>7<>6=>  >B45;L=KE 53> AB@C:BC@.  ?>4B25@645=85 MB>3> ?@54AB02;5=8O ?@82>4OBAO <=>3>G8A;5==K5 <>@D>;>38G5A:85 =01;N45=8O 8 @57C;LB0BK ?@8687=5==>3> 87CG5=8O <>730 1>;L=KE A>2@5<5==K<8 <5B>40<8 :><?LNB5@=>9 B><>3@0D88 [Bogerts ., 1991; 1993; Benes P.M., 1993; Gurr R.E., Pearlson C.D., 1993].  ?>A;54=55 2@5<O >B:@KBK =>2K5 ?>4E>4K : 87CG5=8N MB>3> 2>?@>A0. K;> ?>:070=>, GB> A:>@>ABL @>AB0 D81@>1;0AB>2 :>68 1>;L=KE H87>D@5=859 2 CA;>28OE :C;LBC@K B:0=8 (=0 7-5 ACB:8 :C;LB828@>20=8O) ?@8 459AB288 =0 =8E >A=>2=>3> D0:B>@0 @>AB0 D81@>1;0AB>2 ($ $), 83@0NI53> G@572KG09=> 206=CN @>;L 2 :>=B@>;5 @>AB0 =59@>=>2, 8E 48DD5@5=F80F88 8 <83@0F88, 7=0G8B5;L=> A=865=0 ?> A@02=5=8N A> A:>@>ABLN @>AB0 D81@>1;0AB>2 :>68 74>@>2KE ;N459 [Mikoepjea S. et al., 1995]. KO2;5=0 2KA>:0O :>@@5;OF8O <564C A=865=85< A:>@>AB8 @>AB0 D81@>1;0AB>2 1>;L=>3> 8 >1J5<>< 53> <>730. > ACI5AB2C 0=0;>38G=K5 @57C;LB0BK 1K;8 ?>;CG5=K ?@8 ?5@5A04:5 :CA>G:>2 B:0=8 38??>:0<?0 8 :>@K ?;>4>2 (01>@B82=K9 <0B5@80;, I B@8<5AB@ 15@5<5==>AB8), ?>;CG5==KE >B <0B5@59, 1>;L=KE H87>D@5=859, 2 ?5@54=NN :0<5@C 3;070 8<<C=>0@50:B82=KE :@KA [Freedman R. et al., 1992, 1994]. 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INCLUDEPICTURE "http://psychiatry.ru/library/lib/5/251.png" \* MERGEFORMATINET  >2>@>645==K9 @515=>: ?@0:B8G5A:8 =5 8<55B A>1AB25==KE Ig 8 C@>25=L 8E 2 AK2>@>B:5 2 >A=>2=>< >1CA;>2;5= =0;8G85< Ig, ?>;CG5==KE >B <0B5@8 (>=8 A?>A>1=K ?@>E>48BL G5@57 ?;0F5=B0@=K9 10@L5@). !> 2@5<5=5< 2 7028A8<>AB8 >B ?>;C?5@8>40 687=8 :064>3> Ig C@>25=L 53> 2 AK2>@>B:5 :@>28 @515=:0 ?0405B 4> <8=8<C<0. -B> >1KG=> ?@>8AE>48B 2 2>7@0AB5 12 14 =54. ?>AB=0B0;L=>9 687=8. -B8< >1JOA=O5BAO BO65;>5 B5G5=85 <=>38E 8=D5:F89 C 45B59 MB>3> 2>7@0AB0 2 >B;8G85 >B =>2>@>645==KE, :>B>@K5 1>;55 8;8 <5=55 70I8I5=K Ig, ?>;CG5==K<8 >B <0B5@8. ! 2>7@0AB>< C@>25=L Ig =0@0AB05B: IgG 4>AB830NB E0@0:B5@=>3> 4;O 27@>A;KE C@>2=O : 3 3>40<, IgM  : 6 <5A., IgE 8 Ig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ausset 1K;8 >B:@KBK C G5;>25:0 0=B835=K B:0=52>9 A>2<5AB8<>AB8 (human leukocyte antigen system)  A8AB5<0 HLA, ACI5AB25==> @0AH8@82H0O ?@54AB02;5=8O > A8AB5<5 38AB>A>2<5AB8<>AB8, :>B>@0O 4> MB>3> 1K;0 8725AB=0 ;8HL C 682>B=KE. 5GL 245B > B0: =07K205<>< 1>;LH>< :><?;5:A5 38AB>A>2<5AB8<>AB8 (major histocompatibility complex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http://psychiatry.ru/library/lib/5/252.png" \* MERGEFORMATINET  "0:8< >1@07>< 2 :><?;5:A5 HLA 2K45;ONB 5 35=5B8G5A:8E AB@C:BC@=KE 548=8F  AC1;>:CAK , , !, D 8 DR. =B835=K, ?@8=04;560I85 ?5@2K< 3 8 ?>A;54=5<C AC1;>:CA0<, 2KO2;ONBAO A5@>;>38G5A:8< ?CB5<. =B835=K AC1;>:CA0 HLA-D 2KO2;ONBAO ?>A@54AB2>< @50:F88 A<5H0==>9 :C;LBC@K ;8<D>F8B>2. ;O :;8=8G5A:>3> @CB8==>3> B8?8@>20=8O 4> ?>A;54=53> 2@5<5=8 >A>1>5 7=0G5=85 8<5;> 2KO2;5=85 0=B835=>2 AC1;>:CA>2 HLA-A 8 HLA-B :0: =081>;55 87CG5==KE, 4;O :>B>@KE ?>;CG5=K 7=0G8<K5 :;8=8G5A:85 0AA>F80F88.  1980 3. ?>GB8 ?>;=>ABLN 1K;8 2KO2;5=K 0=B835=K, 2E>4OI85 2 AC1;>:CA HLA-A (20 45B5@<8=0=B) 8 HLA-B (40 45B5@<8=0=B). 0<5G5=>, GB> =>A8B5;LAB2> >?@545;5==KE HLA-0=B835=>2 ?@8 =5:>B>@KE 1>;57=OE 2AB@5G05BAO A ?>2KH5==>9 G0AB>B>9, GB> A2845B5;LAB2C5B > 35=5B8G5A:8 45B5@<8=8@>20==>9 ?@54@0A?>;>65==>AB8, "70?@>3@0<<8@>20==>< @8A:5" ?>@0605<>AB8 G5;>25:0 A>>B25BAB2CNI8< 701>;520=85<. !0<>9 45<>=AB@0B82=>9, 01A>;NB=> 4>AB>25@=>9 4;O 2A5E @0A>2KE 3@C?? O2;O5BAO 0AA>F80F8O HLA-B27 A 0=:8;>78@CNI8< A?>=48;8B><: A@548 1>;L=KE 81 97 % O2;ONBAO =>A8B5;O<8 HIA-27, B>340 :0: A@548 74>@>2KE  B>;L:> 4 12 %. >:070B5;L >B=>A8B5;L=>3> @8A:0 ?@8 MB>9 ?0B>;>388 G@572KG09=> 2KA>:  ?@81;8605BAO : 100 %. #65 ?@>2545=> >3@><=>5 :>;8G5AB2> @01>B ?> 87CG5=8N A2O78 <564C HLA-0=B835=0<8 8 @07;8G=K<8 701>;520=8O<8, >4=0:> =8 2 >4=>< A;CG05 =5 1K;> 2KO2;5=> AB>;L G5B:>9 A2O78, :0: ?@8 C?><O=CB>< 701>;520=88.  ;8B5@0BC@5 >G5=L <=>3> ?@>B82>@5G82KE @57C;LB0B>2, :>B>@K5 <>3CB 1KBL >1CA;>2;5=K @07=K<8 D0:B>@0<8 (2 B>< G8A;5 MB=8G5A:8<8). "5< =5 <5=55 8AA;54>20=8O 2 MB>< =0?@02;5=88 ?@>4>;60NBAO. 708<>459AB285 8<<C==>9, =5@2=>9 8 M=4>:@8==>9 A8AB5<.  ?>A;54=85 3>4K 7=0G8B5;L=>5 @0728B85 ?>;CG8;> =0?@02;5=85 8AA;54>20=89, A2O70==>5 A 87CG5=85< 2708<>459AB28O 8 2708<>>1CA;>2;5==>AB8 DC=:F8>=8@>20=8O 8<<C==>9, =5@2=>9 8 M=4>:@8==>9 A8AB5<. > =5402=53> 2@5<5=8 AG8B0;>AL, GB> >A=>2=0O @>;L 2 @50;870F88 2708<>459AB28O <564C =59@>M=4>:@8==>9 8 8<<C==>9 A8AB5<0<8 ?@8=04;568B :0B5E>;0<8=0<, 0F5B8;E>;8=C 8 3;N:>:>@B8:>84=K< 3>@<>=0<.  40;L=59H5< ?>O28;>AL 4>AB0B>G=>5 :>;8G5AB2> M:A?5@8<5=B0;L=KE 40==KE > <>4C;8@CNI5< 2;8O=88 =0 8<<C==K9 >B25B B0:8E ?5?B84=KE 3>@<>=>2, :0: ", A><0B>B@>?8=, 0@38=8=-207>?@5AA8=, >:A8B>F8=, B8@5>B@>?8=, 25I5AB2> P, 207>0:B82=K9 8=B5AB8=0;L=K9 ?5?B84 8 4@. >:070=>, GB> 2 8<<C=>@53C;OF88 ?@8=8<0NB CG0AB85 M=4>@D8=K 8 M=:5D0;8=K. #AB0=>2;5=>, GB> DC=:F8O 8<<C==>9 A8AB5<K @53C;8@C5BAO B0:8<8 <>73>2K<8 AB@C:BC@0<8, :0: 38?>B0;0<CA, 38?>D87, <8=40;8=0, 25=B@0;L=>5 ?>;5 ?>:@KH:8 8 4@., 0 B0:65 =59@>E8<8G5A:8<8 A8AB5<0<8 <>730  4>D0<8=5@38G5A:>9, A5@>B>=8=5@38G5A:>9 8 4@. 0 >A=>25 A>>B25BAB2CNI8E 40==KE 2>7=8:;> ?@54?>;>65=85 > ACI5AB2>20=88 8<<C==KE @0AAB@>9AB2, >1CA;>2;5==KE =0@CH5=85< =5@2=>9 @53C;OF88 [@K60=>2A:89 .., 030520 !.., 1998]. ;NG52K< 725=>< 0??0@0B0 @53C;OF88 O2;O5BAO 38?>B0;0<CA. = A2O70= A> 2A5<8 725=LO<8 0??0@0B0 8 405B =0G0;> A;>6=><C MDD5@5=B=><C ?CB8 ?5@540G8 F5=B@0;L=KE =59@>@53C;OB>@=KE 2;8O=89 =0 8<<C=>:><?5B5=B=K5 :;5B:8, :>B>@K5 >1;040NB A>>B25BAB2CNI8<8 @5F5?B>@0<8 : =59@>-B@0=A<8BB5@0<, =59@>?5?B840<, 0 B0:65 : 3>@<>=0< M=4>:@8==KE 65;57 [>2K@8= .., >6:8=0 .., 1991; (E8=5: -.., 1993]. KO2;5=K :>=:@5B=K5 <5480B>@K, A ?><>ILN :>B>@KE @50;87C5BAO 2708<>A2O7L <564C 8<<C=>:><?5B5=B=K<8 8 =5@2=K<8 :;5B:0<8. 0: C65 C?><8=0;>AL, 1>;LH>5 7=0G5=85 8<5;> >B:@KB85 2 <>735 M=4>35==KE <>@D8=>?>4>1=KE A>548=5=89 8 @5F5?B>@>2 : =8<. 5GL 845B > 3@C??5 =59@>?5?B84>2  >?8>84=KE ?5?B84>2. K;8 >B:@KBK 8<<C=><>4C;8@CNI85 A2>9AB20 =59@>?5?B84>2, GB> ?>72>;8;> ACI5AB25==> 4>?>;=8BL ?@54AB02;5=8O > <5E0=87<0E ?5@540G8 A83=0;>2 >B =5@2=>9 A8AB5<K : 8<<C==>9. 0 8<<C=>:><?5B5=B=KE :;5B:0E >1=0@C65=K @5F5?B>@K :> <=>38< 8725AB=K< =59@>?5?B840<, GB> 4>:07K205B 8E CG0AB85 2 @50;870F88 MDD5@5=B=>3> 725=0 =59@>8<<C==>3> 2708<>459AB28O.  B> 65 2@5<O 4>;3> >AB020;AO =5OA=K< 2>?@>A > <5E0=87<0E >1@0B=>9 A2O78  >B 8<<C==>9 A8AB5<K : =5@2=>9. 8HL 2 80-5 3>4K 1K;0 >1=0@C65=0 ?@>4C:F8O @O40 3>@<>=>2 8 >?8>84=KE ?5?B84>2 8<<C=>:><?5B5=B=K<8 :;5B:0<8, 4>:070=0 2>7<>6=>ABL 459AB28O <5480B>@>2 8<<C=8B5B0 =0 =5@2=K5 :;5B:8 [5B@>2 P.. 8 4@., 1986; 8E09;>20 .. 8 4@., 1987; Hall N. et al., 1986; Smith E. et al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http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) 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AA;54>20=85 DC=:F8>=0;L=>9 0:B82=>AB8 -;8<D>F8B>2. ?@545;ONB ?> C@>2=N ?@>;8D5@0B82=>9 0:B82=>AB8 MB8E ;8<D>F8B>2 2 ?@8ACBAB288 <8B>35=0 ;0:>=>A0 (pookweed mitogen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orer 8 OGorman 2 <>48D8:0F88 .. @>=470 (1964). #'! !!/ !%'!%  (87>D@5=8O.  40 60-5 3>4K 8<<C=>;>38O H87>D@5=88 ?@54AB02;O;0 A>1>9 ?@5645 2A53> 8=D5:F8>==CN 8<<C=>;>38N.  MB8 3>4K @07@010BK20;8AL 2 >A=>2=>< 8=D5:F8>==K5 B5>@88 H87>D@5=88 [ K10A .., !B0IC: .., 1958; "@>O= .., (8;L<0= P.M., 1958; 0;;8A ..., 1959; '8AB>28G .!., 1962; Kopeloff N., 1941; Rosenow E., 1948; Buscaino V., 1958; Gurassa W., Fi-cischhacker H., 1958;]. > >=8 =5 ?>4B25@48;8AL =5 B>;L:> 2 ?@O<KE 8<<C-=>;>38G5A:8E M:A?5@8<5=B0E, => 8 2 :;8=8:5. 0 A<5=C 8=D5:F8>==K< 38?>B570< ?@8H;8 ?@54AB02;5=8O > 28@CA=>9 MB8>;>388 H87>D@5=88. 8@CA=0O 38?>B570 H87>D@5=88 2?5@2K5 1K;0 AD>@<C;8@>20=0 K.Menninger (1928) 8 E.Goodall (1932) ?>A;5 ?0=45<88 3@8??0 8 M?845<88 ;5B0@38G5A:>3> M=F5D0;8B0 2 1918 3., :>340 1K;> 70@538AB@8@>20=> 1>;LH>5 :>;8G5AB2> H87>D@5=>?>4>1=KE ?A8E>7>2, A2O70==KE A MB8<8 8=D5:F8O<8. 0 >A=>20=88 40==KE B5E ;5B 1K;> A45;0=> ?@54?>;>65=85, GB> H87>D@5=8O 2>7=8:05B 2 @57C;LB0B5 =5>1KG=>9 @50:F88 701>;52H53> =0 8725AB=K9 28@CA (GB> =01;N40;8 2> 2@5<O C?><O=CB>9 M?845<88) 8;8 >=0 2K7K205BAO 5I5 =5 845=B8D8F8@>20==K< =59@>B@>?=K< 28@CA><.  ?>A;54=85 3>4K ?>O28;8AL 8AA;54>20=8O, 2 :>B>@KE 2 :0G5AB25 D0:B>@>2 @8A:0 4;O H87>D@5=88 @0AA<0B@820;0AL 2>7<>6=>ABL :>=B0:B0 A 28@CA=>9 8=D5:F859 (2 A2O78 A M?845<859, 8=D5:F8>==K<8 701>;520=8O<8 1@0BL52 8 A5AB5@, @>645=85< 2 78<=55 2@5<O, A:CG5==>ABLN ?@>6820=8O A5<L8) 2 ?@5=0B0;L=>< ?5@8>45 8;8 2 @0==5< 45BA:>< 2>7@0AB5 [Yolken R.H., Torrey E.F., 1995]. 57C;LB0BK B0:8E 8AA;54>20=89 >:070;8AL =5C1548B5;L=K<8 8 25AL<0 ?@>B82>@5G82K<8.  =5:>B>@KE 87 =8E [Westeigaard T. et al., 1998] ?@54?>;>65=85 > B><, GB> 2>7=8:=>25=85 H87>D@5=88 <>65B 1KBL A2O70=> A C:070==K< :>=B0:B>< 2 ?@5=0B0;L=>< ?5@8>45 =5 ?>4B25@6405BAO 1>;55 >?@545;5==>.  @0<:0E 65 A>1AB25==> 28@CA=>9 38?>B57K @07@010BK20;>AL =5A:>;L:> =0?@02;5=89. !>3;0A=> >4=><C 87 =8E, 28@CA 8=4CF8@C5B 87<5=5=85 8<<C=>;>38G5A:>9 @50:B82=>AB8 1>;L=KE H87>D@5=859. -B> A>>B25BAB2C5B =0;8G8N 2 AK2>@>B:5 :@>28 1>;L=KE 0=B8B5; : @07;8G=K< 28@CA0< [0A8;L520 .., 1988; Libikova H., 1983]. @C3>5 =0?@02;5=85 8AA;54>20=89 ?@54?>;030;> ?>8A:8 4>:070B5;LAB2 ?@8ACBAB28O 28@CA0 2 B:0=8 <>730 1>;L=KE H87>D@5=859 [>@>7>2 .., 1954; >@>7>2 .., 1954, 1957; >AB@8:>2 .., 9D0 .., 1987].  @0<:0E B@5BL53> =0?@02;5=8O 8AA;54>20=89 87CG0;AO F8B>B>:A8G5A:89 MDD5:B AK2>@>B:8 :@>28 8 F5@51@>A?8=0;L=>9 684:>AB8 1>;L=KE H87>D@5=859 (?@54?>;>68B5;L=> A2O70==K9 A ?@8ACBAB285< 2 >@30=87<5 1>;L=>3> 28@CA>2) =0 @07;8G=K5 B5AB->1J5:BK 2 CA;>28OE in vivo 8 in vitro [0@B0=O= .., 1968; Baker H.F. et al., 1983]. 0:>=5F, =5;L7O =5 C?><O=CBL >1 8AA;54>20=8OE, 2 >A=>25 :>B>@KE ;568B 87CG5=85 2708<>459AB28O "35=  28@CA=K9 035=B", @>;L :>B>@>3> 4>:070=0 ?@8 @0728B88 ?>;8><85;8B0 [Crow "., 1987]. 57C;LB0BK <=>38E 70A;C6820NI8E 2=8<0=8O 2 MB>9 >1;0AB8 @01>B =5 ?>;CG8;8 ?>4B25@645=8O 8 ?>:0 ?@O<KE 4>:070B5;LAB2 @>;8 28@CA>2 2 MB8>;>388 8 ?0B>35=575 H87>D@5=88 =5B. "5< =5 <5=55 MB>B 2>?@>A =5 A=OB ?>;=>ABLN A ?>25AB:8 4=O, >A>15==> 2 A25B5 40==KE > <54;5==KE 28@CA0E [Gajdusek D.C., 1978].  30 60-E 3>40E @O4 @01>B 1K; ?>A2OI5= =5A?5F8D8G5A:><C 8<<C=8B5BC. =8 1K;8 =0?@02;5=K 2 >A=>2=>< =0 ?@>25@:C @0A?@>AB@0=5==>3> <=5=8O > B><, GB> @50:B82=>ABL C 1>;L=KE H87>D@5=859, 2 B>< G8A;5 8<<C=>;>38G5A:0O, A=865=0. > ?>;CG5==K5 40==K5 >:070;8AL :@09=5 ?@>B82>@5G82K<8 [-15@B .., (0?8@> .., 1934; ;5AA> .., 1941; 5@18:>2 .., 1956, 1958, 1960; C@528G .., 1967; >=AB0=B8=>20 ".., 1968, 8 4@.]. :070;>AL, GB> 8<<C=>;>38G5A:0O @50:B82=>ABL <>65B 1KBL ?>2KH5=0 ?@8 >4=8E D>@<0E ?A8E>70 8 A=865=0 ?@8 4@C38E. -B> 7028A8B >B AB0488 1>;57=8, 55 D>@<K, ;5G5=8O 8 8=48284C0;L=KE >A>15==>AB59 ?0F85=B0, => =5 >?@545;O5B :;8=8G5A:85 8 18>;>38G5A:85 >A>15==>AB8 H87>D@5=88 :0: 1>;57=8 2 F5;><. >;55 F5==>9 2 =0CG=>< >B=>H5=88 >:070;0AL ?>O282H0OAO 2 60-5 3>4K 0CB>8<<C==0O 38?>B570 H87>D@5=88. A=>2>9 4;O D>@<C;8@>20=8O MB>9 38?>B57K ?>A;C68;8 40==K5 >B5G5AB25==KE 8 0<5@8:0=A:8E 8AA;54>20B5;59 > =0;8G88 2 :@>28 1>;L=KE H87>D@5=859 0=B8B5; : :><?>=5=B0< <>730  ?@>B82><>73>2KE 0=B8B5;. 5@2K5 8AA;54>20=8O ?@>F5AA>2 0CB>8<<C=870F88 : 0=B835=0< =5@2=>9 B:0=8 >B=>AOBAO : =0G0;C XX 2. KA;L > 2>7<>6=>9 @>;8 O2;5=89 0CB>8<<C=8B5B0 ?@8 ?A8E8G5A:8E 701>;520=8OE ?@8=04;568B ..%>@>H:> (1912). 0 >A=>25 87CG5=8O 0=B835==KE A2>9AB2 =5@2=>9 B:0=8 >= ?@54?>;>68;, GB> ?@8 =5:>B>@KE CA;>28OE (B@02<0, 8=D5:F8O) :><?>=5=BK <>73>2>9 B:0=8 G5;>25:0 <>3CB AB0BL 0CB>0=B835=0<8 8 2K720BL >1@07>20=85 0CB>0=B8B5;, :>B>@K5 >= =07K20; "=59@>F8B>B>:A8=0<8". @54?>;>65=8O > @>;8 0CB>8<<C=870F88 2 @0728B88 ?A8E8G5A:8E 1>;57=59 2KA:07K20;8 B0:65 ..@0A=CH:8= (1920) 8 .. !=5A0@52 (1934). 4=0:> <5B>48G5A:89 C@>25=L 8AA;54>20=89 B5E ;5B =5 ?>72>;O; @0728BL MB8 8458. 8HL 2 60 70-5 3>4K XX 2. 1K;8 ?>;CG5=K D0:BK, ?>4B25@640NI85 ACI5AB25==CN @>;L 0CB>8<<C==KE ?@>F5AA>2 2 ?0B>35=575 H87>D@5=88. ;02=K9 87 MB8E D0:B>2  ?>O2;5=85 2 :@>28 <>73>2KE 0=B835=>2 8 0=B8B5; : <>73>2>9 B:0=8 [C7=5F>20 .., !5<5=>2 !.$., 1961; 0@B0=O= .., 1968; >;OA:8=0 .., CH=5@ !.., 1969, 1972; >?>20 .., 1969; Lehman-Facius H., 1937, 1939; Koizumi S. et al., 1956, 1958; Jezkova Z., Scalickova O., 1961; Fessel W., 1962; Heath R. et al., 1962, 1970]. -B8 40==K5 1K;8 ?>4B25@645=K ?> <5=LH59 <5@5 2 42CE 45AOB:0E 8AA;54>20=89, ?@>2545==KE 2 @07;8G=KE ;01>@0B>@8OE. >O28;8AL B0:65 4>:070B5;LAB20, GB> >1@07>20=85 ?@>B82><>73>2KE 0=B8B5; =5 >1CA;>2;5=> ?@8ACBAB285< 2 >@30=87<5 ?A8E>B@>?=KE ?@5?0@0B>2 8 8E <5B01>;8B>2.  A2O78 A 2KO2;5=85< C 1>;L=KE H87>D@5=859 2 :@>28 <>73>2KE 0=B835=>2 8 ?@>B82><>73>2KE 0=B8B5; 2>7=8:05B 2>?@>A > 2>7<>6=>AB8 >B=5A5=8O H87>D@5=88 : 0CB>8<<C==K< 701>;520=8O<.  :;0AA8G5A:>< 20@80=B5 >1 0CB>8<<C==>9 ?@8@>45 B>9 8;8 8=>9 1>;57=8 A;54C5B AC48BL ?> @O4C :@8B5@852: 1) 0CB>0=B8B5;0 8;8 A5=A818;878@>20==K5 ;8<D>F8BK 4>;6=K >1=0@C6820BLAO 2> 2A5E A;CG0OE 701>;520=8O, E>BO 1K =0 >B45;L=KE AB048OE 53> @0728B8O (?@8 MB>< =0;8G85 0=B8B5; 8;8 A5=A818;878@>20==KE ;8<D>F8B>2 4>;6=> 1KBL 4>:070=> 2 @07=KE @50:F8OE A CAB0=>2;5=85< 8<<C=>3;>1C;8=>2>9 ?@8@>4K 0=B8B5;); 2) 4>;65= 1KBL >1=0@C65= 8 >E0@0:B5@87>20= 0CB>0=B835= (8;8 0CB>0=B835=K), 2K7K20NI89 0CB>8<<C==CN @50:F8N; 3) 1>;57=L 4>;6=0 1KBL A<>45;8@>20=0 M:A?5@8<5=B0;L=> A ?><>ILN 8<<C=>;>38G5A:8E <5B>4>2; 4) 4>;6=0 1KBL ?>:070=0 2>7<>6=>ABL ?5@5=>A0 1>;57=8 8;8 254CI53> ?0B>;>38G5A:>3> A8=4@><0 2 4@C3>9 >@30=87< ?>A@54AB2>< AK2>@>B>G=KE 0=B8B5; 8;8 ;8<D>84=KE :;5B>:, 27OBKE 87 ?>@065==>3> >@30=87<0. ! MB8E ?>78F89 H87>D@5=8N =5;L7O A C25@5==>ABLN >B=5AB8 : 0CB>8<<C==K< 701>;520=8O<, ?>MB><C ?@028;L=55 3>2>@8BL > H87>D@5=88 :0: > 1>;57=8, A>?@>2>640NI59AO 0CB>8<<C==K<8 @50:F8O<8,  >1 0CB>8<<C==>< :><?>=5=B5 55 ?0B>35=570.  =0AB>OI5<C 2@5<5=8 AD>@<8@>20;8AL 420 3;02=KE =0?@02;5=8O 2 8<<C=>;>388 H87>D@5=88: 87CG5=85 @>;8 <>73>A?5F8D8G5A:8E 15;:>2 2 <5E0=87<0E D>@<8@>20=8O 0CB>8<<C==KE @50:F89 8 8AA;54>20=85 >A>15==>AB59 8<<C=>;>38G5A:8 :><?5B5=B=KE :;5B>: ?@8 MB>< 701>;520=88. 7CG5=85 <>73>A?5F8D8G5A:8E 15;:>2. 081>;55 ?;>4>B2>@=K<8 ?@8 87CG5=88 15;:>2 <>730 >:070;8AL <5B>4K A>2@5<5==>9 8<<C=>E8<88 8 8<<C=>38AB>E8<88, :>B>@K5 ?>72>;ONB 845=B8D8F8@>20BL >B45;L=K5 15;:8 2 @07;8G=KE AB@C:BC@0E =5@2=>9 A8AB5<K =0 B:0=52><, :;5B>G=>< 8 AC1:;5B>G=>< C@>2=OE [C@10520 .(., 1970, 1971; !B0@>AB8=0 .., !28@84>2 !.., 1979]. K45;5=85 B0:8E <>73>A?5F8D8G5A:8E 15;:>2 8 8A?>;L7>20=85 8E 2 A>>B25BAB2CNI8E 8<<C=>;>38G5A:8E @50:F8OE A>740NB >A=>2C 4;O 2KO2;5=8O =5 B>;L:> <>73>2KE 0=B835=>2, 70?CA:0NI8E 0CB>8<<C==K5 @50:F88, => 8 4;O ;>:0;870F88 <5AB0 459AB28O ?@>B82><>73>2KE 0CB>0=B8B5;.  MB8E 8AA;54>20=8OE 1>;LH>5 7=0G5=85 8<55B AB5?5=L >G8AB:8 0=B835==KE ?@5?0@0B>2 [3=0B>2 !.. 8 4@., 1977; '5E>=8= .., 1990, 1991]. 0=55 2 A5@>;>38G5A:8E @50:F8OE 2 :0G5AB25 0=B835=>2 ?@8<5=O;8 ?@5?0@0BK, ?>;CG5==K5 ?@8 =87:>A:>@>AB=>< F5=B@8DC38@>20=88 (4> 10 000 g) 3><>35=0B0 <>73>2>9 B:0=8. "0:85 ?@5?0@0BK, 5AB5AB25==>, A>45@60;8 :0: <5<1@0==K5, B0: 8 2>4>@0AB2>@8<K5 0=B835=K. 0B5<, 8A?>;L7CO F5=B@8DC38@>20=85 ?@8 100 000 g, 2 :0G5AB25 0=B835==KE ?@5?0@0B>2 AB0;8 8A?>;L7>20BL D@0:F88 8 F5;L=K9 M:AB@0:B 2>4>@0AB2>@8<KE 15;:>2 <>73>2>9 B:0=8. -B8 0=B835==K5 ?@5?0@0BK C65 =5 A>45@60;8 A2O70==KE A <5<1@0=0<8 0=B835==KE 45B5@<8=0=B. K;> CAB0=>2;5=>, GB> 1>;55 G8ABK5 ?@5?0@0BK 0=B835=>2 A?>A>1AB2CNB ?>2KH5=8N G0AB>BK 2KO2;5=8O ?@>B82><>73>2KE 0=B8B5; 2 AK2>@>B:5 :@>28 1>;L=KE. 0A;C68205B 2=8<0=8O B0:65 B>B D0:B, GB> ?@8 8A?>;L7>20=88 1>;55 G8ABKE ?@5?0@0B>2 <>73>A?5F8D8G5A:8E 0=B835=>2 <>6=> 2KO28BL 8<<C=>;>38G5A:85 @07;8G8O <564C >B45;L=K<8 701>;520=8O<8, =0?@8<5@ <564C =52@>;>38G5A:8<8 8 ?A8E8G5A:8<8. "0:, ?@8 H87>D@5=88 ?@>B82><>73>2K5 0=B8B5;0 >1=0@C6820NBAO 1>;55 G0AB> : 15;:0< 10-9 D@0:F88, A>45@60I59 <>73>A?5F8D8G5A:85 15;:8 14-3-2, 10-40-4, 0;LD0-1- 8 0;JD0-2-3;8:>?@>B584K, : :>B>@>9 ?@8 @0AA5O==>< 8 1>:>2>< 0<8>B@>D8G5A:>< A:;5@>75 0=B8B5;0 =5 2KO2;ONBAO 8;8 2KO2;ONBAO >G5=L @54:> 8 2 =87:>< B8B@5. 0>1>@>B, ?@8 >1A;54>20=88 =52@>;>38G5A:8E 1>;L=KE =081>;55 0:B82=0O 2 8<<C=>;>38G5A:8E @50:F8OE 2-O D@0:F8O, :>B>@0O A>45@68B >A=>2=K5 15;:8, >:07K205BAO =50:B82=>9 C 1>;L=KE H87>D@5=859 [>;OA:8=0 .., C@10520 .(., 1979; 3=0B>2 !.., 1985]. 5:>B>@K5 8AA;54>20B5;8, 8A?>;L7CO 8<<C=>D5@<5=B=K9 <5B>4 8 <>73>A?5F8D8G5A:85 15;:8 8 @O4 3;8:>?@>B584>2 2 :0G5AB25 0=B835=>2, ?@8H;8 : 2K2>4C, GB> ?>;>68B5;L=0O @50:F8O =0 MB8 0=B835=K ?@8 B5AB8@>20=88 AK2>@>B:8 :@>28 1>;L=KE H87>D@5=859 <>65B @0AA<0B@820BLAO :0: <0@:5@ ?>;><:8 35<0B>M=F5D0;8G5A:>3> 10@L5@0 ?@8 MB>< 701>;520=88 ['5E>=8= .., 1991].  ?>A;54=85 3>4K 2=8<0=85 8AA;54>20B5;59 AB0;8 ?@82;5:0BL 0=B8B8<8G5A:85 0=B8B5;0. B:@KB85 >1I8E 0=B835=>2 2 <>735 8 28;>G:>2>9 65;575 G5;>25:0 8 682>B=KE [Reif A., Alien J., 1964] ?>A;C68;> B>;G:>< 4;O 8AA;54>20=89, A2O70==KE A 87CG5=85< 0=B8B8<8G5A:8E 0=B8B5; ?@8 H87>D@5=88. K;> CAB0=>2;5=>, GB> B0:85 0=B8B5;0 >1=0@C6820NBAO 2 AK2>@>B:5 :@>28 :0: C 1>;L=KE H87>D@5=859, B0: 8 C 74>@>2KE ;N459, => 8E C@>25=L C 1>;L=KE >:070;AO 7=0G8B5;L=> 2KH5 [C@8O .., ><0H=520 .., 1974; 07=8=0 ".., 1977; >;OA:8=0 .. 8 4@., 1980]. >74=55 1K;> 2KO2;5=>, GB> C@>25=L 0=B8B8<8G5A:8E 0=B8B5; 7028A8B >B 4;8B5;L=>AB8 701>;520=8O: C@>25=L 8E 8 G0AB>B0 2KO2;5=8O ?>2KH5=K ?@8 4;8B5;L=>AB8 701>;520=8O 4> 5 ;5B; 0 1>;LH8< A@>:0< 1>;57=8, :0: ?@028;>, A>>B25BAB2CNB =87:85 C@>2=8 0=B8B5; 8 =87:0O G0AB>B0 8E >1=0@C65=8O. =K<8 A;>20<8, G5< <5=LH5 4;8B5;L=>ABL H87>D@5=8G5A:>3> ?@>F5AA0, B5< 1>;LH5 25@>OB=>ABL 2KO2;5=8O 2KA>:>3> C@>2=O 0=B8B8<8G5A:8E 0=B8B5;. !>?>AB02;5=85 G0AB>BK 8 2@5<5=8 ?>O2;5=8O ?@>B82><>73>2KE 8 0=B8B8<8G5A:8E 0=B8B5; 2 AK2>@>B:5 :@>28 1>;L=KE H87>D@5=859 ?>72>;8;> ?@54?>;>68BL, GB> 2 >@30=87<5 1>;L=>3> A=0G0;0 ?>O2;ONBAO 0=B8B8<8G5A:85 0=B8B5;0, 0 70B5< ?@>B82><>73>2K5. =B8B8<8G5A:>9 0:B82=>ABLN >1;040NB IgG, IgM 8 IgA; ?@8 MB>< 2 AK2>@>B:5 :@>28 1>;L=KE H87>D@5=859 :>=F5=B@0F8O 0=B8B5; IgG 8 IgM ?>2KH5=0 ?> A@02=5=8N A B0:>2>9 C 74>@>2KE. K;> CAB0=>2;5=>, GB> C@>25=L 0=B8B5; IgG 8 IgA O2;O5BAO 25AL<0 20@8015;L=>9 E0@0:B5@8AB8:>9 8 7028A8B 3;02=K< >1@07>< >B 2=5H=8E D0:B>@>2; C@>25=L 35=5B8G5A:>3> 45B5@<8=8@>20=8O 2 MB>< A;CG05 =5 ?@52KH05B 40 %. ! MB>9 B>G:8 7@5=8O, ?>2KH5=85 :>=F5=B@0F88 0=B8B8<8G5A:>3> IgG 2 AK2>@>B:5 :@>28 1>;L=KE H87>D@5=859 A;54C5B @0AA<0B@820BL :0: >B@065=85 B5:CI53> 1>;57=5==>3> ?@>F5AA0. > :>=F5=B@0F8O 0=B8B8<8G5A:>3> IgM 45B5@<8=8@C5BAO 35=5B8G5A:8<8 D0:B>@0<8, 81> :>MDD8F85=B =0A;54>20=8O 2 MB>< A;CG05 @025= 80 %.  A2O78 A MB8< 5ABL >A=>20=8O ?@54?>;030BL, GB> ?>2KH5=85 A>45@60=8O 0=B8B8<8G5A:>3> IgM O2;O5BAO :><?>=5=B>< =0A;54AB25==>3> ?@54@0A?>;>65=8O : @0728B8N H87>D@5=88 8 ACI5AB25==K< D0:B>@><, >?@545;ONI8< <0=8D5AB0F8N 701>;520=8O 8 >A>15==>AB8 53> B5G5=8O. AA;54>20=85 8<<C=>;>38G5A:8 :><?5B5=B=KE :;5B>: (;8<D>F8B>2) 1>;L=KE.  =0G0;5 60-E 3>4>2 1K;8 >?C1;8:>20=K 40==K5 > ACI5AB2>20=88 2 ?5@8D5@8G5A:>9 :@>28 1>;L=KE <>@D>;>38G5A:8 87<5=5==KE ;8<D>F8B>2 8;8 0B8?8G=KE ;8<D>F8B>2. 5GL 845B >1 87<5=5=88 AB@C:BC@K E@><0B8=0 8E O4@0 [Kamp H.V., 1962; Fessel W.J., Hirata-Hibi M., 1963].  A>2@5<5==KE @01>B0E 2> <=>3>< ?>2B>@ONBAO @0=55 ?>;CG5==K5 @57C;LB0BK, => >B<5G0NBAO ACI5AB25==K5 :;8=8:>-8<<C=>;>38G5A:85 :>@@5;OF88 [Hirata-Hibi M. et 0!., 1982, 1987; Takahahi . et al., 1985].  G0AB=>AB8, 2 >B;8G85 >B @0=55 ?>;CG5==KE 40==KE > ?>O2;5=88 0B8?8G=KE :;5B>: ?@58<CI5AB25==> C ?0F85=B>2, =0E>4OI8EAO 2 >AB@>< ?A8E>B8G5A:>< A>AB>O=88, B.5. 2 =0G0;5 1>;57=8 8;8 55 >1>AB@5=88, =5 >1=0@C65=> :0:>9-;81> A2O78 <564C ?>O2;5=85< 0B8?8G=KE ;8<D>F8B>2 8 MB0?>< B5G5=8O H87>D@5=88 [DeLisi L.E. et al., 1983]. @8G8=K ?>O2;5=8O 2 :@>28 1>;L=KE H87>D@5=859 ;8<D>F8B>2 A 87<5=5==>9 <>@D>;>3859 4> A8E ?>@ =5 OA=K. !CI5AB2C5B <=5=85, GB> MB> A2O70=> A 0CB>8<<C==K< ?@>F5AA><. -B0 A2O7L 2?>;=5 25@>OB=0, ?>A:>;L:C =5:>B>@K5 02B>@K =0E>48;8 0B8?8G=K5 ;8<D>F8BK ?@8 B0:8E :;0AA8G5A:8E 0CB>8<<C==KE 701>;520=8OE, :0: @52<0B>84=K9 0@B@8B, <80AB5=8O (myasthenia gravis), A8AB5<=0O :@0A=0O 2>;G0=:0 [Hirata-Hibi M. et al., 1987]. @C385 8AA;54>20B5;8 ?@54?>;030NB, GB> ?>O2;5=85 0B8?8G=KE ;8<D>F8B>2 ?@8 H87>D@5=88 A2O70=> A MDD5:B>< ?A8E>B@>?=KE ?@5?0@0B>2, 8A?>;L7C5<KE 4;O ;5G5=8O 1>;L=KE [Fieve R.R., Blumental ., Little ., 1966]. M.Hirata-Hibi 8 A>02B. (1982) >B@8F0NB MB> ?@54?>;>65=85, >A=>2K20OAL =0 B><, GB> 0B8?8G=K5 :;5B:8 >1=0@C6820NBAO =5 B>;L:> C ;5G5=KE 1>;L=KE, => 8 C 8E 74>@>2KE @>4AB25==8:>2. 06=K< @0745;>< 87CG5=8O A>AB>O=8O 8<<C=>;>38G5A:8 :><?5B5=B=KE :;5B>: ?@8 H87>D@5=88 O28;>AL 8AA;54>20=85 :>;8G5AB25==KE A>>B=>H5=89 8 DC=:F8>=0;L=KE >A>15==>AB59 "-;8<D>F8B>2 8 8E AC1?>?C;OF89. 0==K5 8AA;54>20=89 :@09=5 ?@>B82>@5G82K. 4=>9 87 ?@8G8= =5>4=>7=0G=>AB8 ?>;CG5==KE @57C;LB0B>2 <>65B 1KBL @07;8G85 2 :;8=8G5A:>9 2K1>@:5 >1A;54C5<KE 1>;L=KE. !;54C5B >B<5B8BL =54>AB0B>G=> 48DD5@5=F8@>20==K9 ?>4E>4 : :;8=8G5A:>9 E0@0:B5@8AB8:5 1>;L=KE: 1>;L=K5 A E@>=8G5A:8< B5G5=85< 8 =0E>4OI85AO 2 >AB@>< ?A8E>B8G5A:>< A>AB>O=88 8=>340 0=0;878@CNBAO :0: >4=0 3@C??0, ?@8 MB>< G0AB> =5 CG8BK205BAO :;8=8G5A:>5 A>AB>O=85 1>;L=>3> =0 <><5=B >1A;54>20=8O (?@8ABC?, @5<8AA8O). 5 ?@8=8<0NBAO 2> 2=8<0=85 @07;8G=K5 AB@5AA>2K5 A8BC0F88 (=0?@8<5@, 3>A?8B0;870F8O), :>B>@K5, :0: 8725AB=>, <>3CB >:07K20BL 7=0G8B5;L=>5 2;8O=85 =0 DC=:F8>=8@>20=85 8<<C==>9 A8AB5<K. '8A;> "-;8<D>F8B>2, "-E5;?5@>2 8 "-AC?@5AA>@>2 C 1>;L=KE H87>D@5=859 2 F5;>< =5 >B;8G05BAO >B MB8E ?>:070B5;59 C 74>@>2KE. B;8G8O 2KO2;ONBAO ?@8 @0745;5=88 >1I59 3@C??K 1>;L=KE H87>D@5=859 ?> :;8=8G5A:8< D>@<0< 701>;520=8O.  3@C??5 1>;L=KE ?0@0=>84=>9 H87>D@5=859 1K;8 2KO2;5=K C25;8G5=85 G8A;0 "-E5;?5@>2 8 C<5=LH5=85 G8A;0 "-AC?@5AA>@>2, 2 3@C??5 1>;L=KE <0;>?@>3@5485=B=>9 H87>D@5=859 >1=0@C65=> C<5=LH5=85 >1I53> G8A;0 "-;8<D>F8B>2; G8A;> 65 :;5B>:-:8;;5@>2 C 1>;L=KE 2A5E 3@C?? =5 >B;8G0;>AL >B B0:>2>3> C 74>@>2KE. @8 87CG5=88 DC=:F8>=0;L=>3> A>AB>O=8O "-;8<D>F8B>2 C 1>;L=KE H87>D@5=859 >1=0@C65=> A=865=85 ?@>;8D5@0B82=>9 0:B82=>AB8 "-;8<D>F8B>2 2 >B25B =0 AB8<C;OF8N =5A?5F8D8G5A:8<8 <8B>35=0<8 [>;OA:8=0 .., 82>20@>20 .., 1974; $5B8A>20 ".., 1978; >;OA:8=0 .., C@10520 .(., 1979]. >;55 B>3>, 0:B82=K< 8=4C:B>@>< A=865==>9 ?@>;8D5@0B82=>9 0:B82=>AB8 "-;8<D>F8B>2 >:070;0AL AK2>@>B:0 :@>28 1>;L=>3> 8 ?@8ACBAB2>202H85 2 =59 0=B8B8<8G5A:85 0=B8B5;0 [010O= .., 1977; 82>20@>20 .., 07=8=0 ".., 1977]. #?><O=CBK5 02B>@K 2 <>45;L=KE >?KB0E in vitro ?@>45<>=AB@8@>20;8 B>@<>7OI55 459AB285 AK2>@>B:8 :@>28 1>;L=>3> H87>D@5=859 =0 ;8<D>F8BK ?5@8D5@8G5A:>9 :@>28 74>@>2>3> G5;>25:0: ?@>;8D5@0B82=0O 0:B82=>ABL MB8E :;5B>: 2 >B25B =0 =5A?5F8D8G5A:85 <8B>35=K (D8B>35<033;NB8=8=, :>=:0=020;8= ) 2 ?@8ACBAB288 AK2>@>B:8 :@>28 1>;L=>3> H87>D@5=859 >:070;0AL 4>AB>25@=> A=865==>9 ?> A@02=5=8N A B0:>2>9 2 ?@8ACBAB288 0CB>;>38G=>9 AK2>@>B:8. -B> 40;> >A=>20=85 ?@54?>;>68BL, GB> 2 A=865=88 ?@>;8D5@0B82=>9 0:B82=>AB8 ;8<D>F8B>2 ?@8 H87>D@5=88 >?@545;5==CN @>;L 83@0NB 0=B8B8<8G5A:85 0=B8B5;0. "0:85 0=B8B5;0, 0:B82=> 2708<>459AB2CO A 0=B835=0<8 "-:;5B>:, <>3CB A;C68BL ?@5?OBAB285< 4;O 2708<>459AB28O <8B>35=0 A ?>25@E=>AB=K<8 AB@C:BC@0<8 MB8E 65 :;5B>:. =0;>38G=>5 459AB285 <>3CB >:07K20BL 8 ?@>B82><>73>2K5 0=B8B5;0, :>B>@K5 2 A8;C >1I=>AB8 0=B835=>2 <>730 8 28;>G:>2>9 65;57K (B8<CA0) B0:65 1C4CB 2708<>459AB2>20BL A "-;8<D>F8B0<8. !0<> ?>402;5=85 0=B8B5;0<8 A?>A>1=>AB8 ;8<D>F8B>2 >B25G0BL ?@>;8D5@0F859 =0 AB8<C;OF8N <8B>35=0<8 <>65B 1KBL >1CA;>2;5=> :0: ?@O<K< M:@0=8@>20=85< 0=B8B5;0<8 @5F5?B>@>2 4;O <8B>35=>2, B0: 8 F8B>B>:A8G5A:8< 459AB285< 0=B8B5; =0 G0ABL ?>?C;OF88 "-:;5B>: (=5;L7O 8A:;NG8BL 8 A>ACI5AB2>20=85 8;8 ?>A;54>20B5;L=>5 ?@>O2;5=85 >1>8E MB8E ?@>F5AA>2 ?> <5@5 @0728B8O H87>D@5=8G5A:>3> ?A8E>70). 0==K5 > A=865=88 DC=:F8>=0;L=>9 0:B82=>AB8 "-;8<D>F8B>2 :@>28 ?@8 H87>D@5=88 1K;8 ?>;=>ABLN ?>4B25@645=K 2> <=>38E @01>B0E [Schin-dler L. et al., 1985; Muller N. et al., 1986; Ganguli R. et al., 1987, 1989; Moises H.W. et al., 1987; Theodoropoulou-Vaidaki S. et al., 1988]. 0: C65 >B<5G0;>AL, >4=>9 87 DC=:F89 "-;8<D>F8B>2 O2;O5BAO ?@>4C:F8O -2. B<5G5=> 7=0G8B5;L=>5 A=865=85 ?@>4C:F88 -2 ;8<D>F8B0<8 :@>28 C 1>;L=KE H87>D@5=859 ?> A@02=5=8N A B0:>2K< C 74>@>2KE [!5:8@8=0 ".. 8 4@., 1989; Villeman F. et al., 1986, 1987; Ganguli R. et al., 1987, 1989; Kolyaskina G.I. et al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olyaskina G.I. et al., 1987, 1989, 1990; Theodoropoulou-Vaidaki S. et al., 1988]. K;> CAB0=>2;5=>, GB> :>;8G5AB2> -:;5B>: 2 ?5@8D5@8G5A:>9 :@>28 1>;L=KE H87>D@5=859 ?>2KH5=> 8 ?@8 MB>< 7=0G8B5;L=> C25;8G5=> G8A;> -:;5B>:, A8=B578@CNI8E 8<<C=>3;>1C;8=K [Mach M.D., Schutt !., 1983, 1985; Kolyaskina G.I. et al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in vitro =59@>;5?B8:>2 =0 DC=:F8>=0;L=CN 0:B82=>ABL ;8<D>F8B>2 :@>28 74>@>2KE ?>:070;>, GB> 0<8=078= 8 <065?B8; 8=3818@CNB ?@>;8D5@0B82=CN 0:B82=>ABL MB8E :;5B>: [8B:528G !.., 1981], 0 AB5;078= B>@<>78B =5 B>;L:> ?@>;8D5@0B82=CN 0:B82=>ABL "-;8<D>F8B>2, => 8 ?@>4C:F8N 8<8 -2 [=4@>A>20 .., 1991]. 7CG5=85 2;8O=8O ?A8E>B@>?=KE ?@5?0@0B>2 =0 G8A;> "-AC?@5AA>@>2 8 C@>25=L 0=B8B8<8G5A:8E IgG 8 IgM C 1>;L=KE H87>D@5=859 ?>72>;8;> 2KO28BL 87<5=5=8O 0=0;>38G=>9 =0?@02;5==>AB8  A=865=85 G8A;0 "-AC?@5AA>@>2 C 1>;L=KE ?@8 ?@>4>;68B5;L=>< ;5G5=88 ?A8E>B@>?=K<8 ?@5?0@0B0<8, G0AB8G=>5 2>AAB0=>2;5=85 8E G8A;0 G5@57 3 =54 ?>A;5 ?@5:@0I5=8O ;5G5=8O 8 ?>2B>@=>5 A=865=85 G5@57 3 =54 ?>A;5 2>7>1=>2;5=8O ;5G5=8O. 5A:>;L:> 8=K5 40==K5 1K;8 ?>;CG5=K ?@8 87CG5=88 C@>2=O 0=B8B8<8G5A:8E IgG 8 IgM C B5E 65 1>;L=KE. #@>25=L IgG 8 IgM 1K; 2KA>:8< C 1>;L=KE, ?>AB>O==> (2 B5G5=85 3>40) ?@8=8<0NI8E ?A8E>B@>?=K5 ?@5?0@0BK, 7=0G8B5;L=> A=860;AO ?>A;5 ?@5:@0I5=8O ;5G5=8O 8 2=>2L ?>4=8<0;AO ?>A;5 53> 2>7>1=>2;5=8O ;5G5=8O. "0:8< >1@07><, 8A:;NG8BL 2;8O=85 ?A8E>B@>?=KE ?@5?0@0B>2 8 8E <5B01>;8B>2 =0 <5E0=87<K, ?@82>4OI85 : 87<5=5=8O< 8<<C==>9 A8AB5<K 1>;L=>3> H87>D@5=859, =5;L7O, E>BO, A =0H59 B>G:8 7@5=8O, B0:>5 2;8O=85 B>;L:> ?>4G5@:8205B ?0B>35=5B8G5A:CN ACI=>ABL :0: 8<<C=>;>38G5A:8E A4283>2, B0: 8 459AB28O 0=B8?A8E>B8G5A:8E ;5G51=KE A@54AB2. !8AB5<0 HLA 8 H87>D@5=8O. 0==KE > G5B:>9 8 E>@>H> 2>A?@>872>48<>9 A2O78 0=B835=>2 HLA-A8AB5<K A :0:8<-;81> ?A8E8G5A:8< 701>;520=85<, 2 B>< G8A;5 8 A H87>D@5=859, ?>:0 =5 ?>;CG5=>, 0 8<5NI85AO  25AL<0 ?@>B82>@5G82K [8B:528G !.., 1980; Grow R.R. et al., 1979]. 0 <0B5@80;5 H254A:>9 8 G5HA:>9 ?>?C;OF89 >1=0@C65=0 ?>;>68B5;L=0O 0AA>F80F8O H87>D@5=88 A HLA-A9 [Eberhard G., Franzen G., Low ., 1975; Ivanyi D. et al., 1976, 1978]. B0;LO=A:85 02B>@K [Cazzulo C.L. et al., 1974; Smeraldi E., 1978], 87CG02H85 =0A5;5=85 A2>59 AB@0=K, CAB0=>28;8 ?>2KH5=85 G0AB>BK HLA-A11 8 A=865=85 G0AB>BK A3 8 10 A@548 1>;L=KE H87>D@5=859.  G5HA:>9 ?>?C;OF88, ?><8<> ?>;>68B5;L=>9 0AA>F80F88 1>;57=8 A 9, =0945=0 B0:65 0AA>F80F8O 1>;57=8 A 28 8 A 0=B835=0<8 B@5BL53> AC1;>:CA0 HLA  CW4. 5:>B>@0O @07=>@5G82>ABL 40==KE >B=>A8B5;L=> A2O78 H87>D@5=88 A C?><O=CBK<8 0=B835=0<8 A8AB5<K HLA =5 8A:;NG05B 2>7<>6=>ABL 2KO2;5=8O 2 40;L=59H5< B0:>9 A2O78 A 0=B835=0<8 42CE 4@C38E AC1;>:CA>2 HLA-A8AB5<K  D 8;8 !. B0;LO=A:85 02B>@K ?>;CG8;8 40==K5 >1 MDD5:B82=>AB8 B5@0?88 ?A8E>B@>?=K<8 ?@5?0@0B0<8 2 7028A8<>AB8 >B D5=>B8?0 HLA: 1>;55 MDD5:B82=>9 >:070;0AL B5@0?8O 1>;L=KE H87>D@5=859, 8<5NI8E 2 D5=>B8?5 0=B835= HLA-A1 8 <5=55 MDD5:B82=>9 C 1>;L=KE A HLA-A2. !2O78 @0AA<0B@8205<KE 0=B835=>2 A B5@0?859 :0A0;8AL 8 F.Melzer 8 4@. (1989), :>B>@K5 @0AA<0B@820;8 =0;8G85 HLA-D44 :0: D0:B>@ @8A:0 @0728B8O ?@8 H87>D@5=88 =59@>;5?B8G5A:>3> ?0@:8=A>=87<0. > ?>?KB:8 P.Wright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rkan M. et al., 1996]. =8 87CG0;8 G0AB>BC @0A?@545;5=8O HLA-0=B835=>2 C 1>;L=KE A ?0@0=>84=>9 8 =548DD5@5=F8@>20==>9 D>@<0<8 H87>D@5=88. !B0B8AB8G5A:8 7=0G8<>5 C25;8G5=85 G0AB>BK HLA-A10,  8 29 8 AB0B8AB8G5A:8 7=0G8<>5 C<5=LH5=85 G0AB>BK HLA-A2 1K;8 2KO2;5=K 2 >1I59 3@C??5 1>;L=KE H87>D@5=859 ?> A@02=5=8N A B0:>2K<8 C 74>@>2KE. !E>4=K5 @57C;LB0BK 2 >B=>H5=88 ?5@2KE 42CE 0=B835=>2 ?>;CG8;8 >4=>2@5<5==> M.E.Ozcan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olden R.J., Pakula I.S., Mooney Ph.A., 1997]. A=>2=CN @>;L 2 @0728B88 0DD5:B82=KE =0@CH5=89 02B>@K MB>9 38?>B57K >B2>4OB 2708<>459AB28N 8=AC;8=0, F8B>:8=>2 (15;:>2 >AB@>9 D07K 2>A?0;5=8O, 8=B5@;59:8=>2, 8=B5@D5@>=>2) 8 >?8>84=KE ?5?B84>2 A ?>A;54CNI8< 8E 2;8O=85< =0 M=5@35B8G5A:89 <5B01>;87< 2 <>735 8 =59@>B@0=A<8AA8N. 4=0:> MB0 38?>B570 B@51C5B ?>4B25@645=8O 8 CB>G=5=8O. <5AB5 A B5< 5I5 4> ?>O2;5=8O C?><O=CB>9 38?>B57K 2 MB>9 >1;0AB8 8<5;8AL 70A;C6820NI85 2=8<0=8O @01>BK.  @O45 8AA;54>20=89 1K;> CAB0=>2;5=>, GB> ?@8 45?@5AA88 7=0G8B5;L=> A=860NBAO ?>:070B5;8 :;5B>G=>3> 8<<C=8B5B0 ?> A@02=5=8N A B0:>2K<8 C 74>@>2KE [Maes M. et al., 1989, 1992; Irwin M. et al., 1990; Hickie I. et al., 1993, 1995]. 2B>@K MB8E @01>B 2KA:070;8 ?@54?>;>65=85, GB> >1=0@C65==K5 8<<C==K5 A42838 <>3CB >B@060BL B0:85 =0@CH5=8O 8<<C==>3> AB0BCA0, :>B>@K5 >?@545;ONB 1>;55 G0AB>5 2>7=8:=>25=85 C 1>;L=KE 45?@5AA859 @07=>>1@07=KE 701>;520=89, A2O70==KE A =0@CH5=85< DC=:F88 8<<C==>9 A8AB5<K (@0:0, 8=D5:F8>==KE 1>;57=59 8 B.?.).  ?>A;54CNI8E ?C1;8:0F8OE MB8 40==K5 =5 ?>4B25@48;8AL. 4=>2@5<5==> A MB8< 1K;8 ?>;CG5=K @57C;LB0BK, A2845B5;LAB2CNI85 > =0;8G88 ?@8 45?@5AA88 ?@87=0:>2 0:B820F88 8<<C==>9 A8AB5<K  C<5@5==>3> ;59:>F8B>70, =59B@>D8;88 8 <>=>F8B>70 [Maes M. et al., 1992; Joyce P.R. et al., 1992]; ?>2KH5==>9 ?@>4C:F88 -1 2 AB8<C;8@>20==KE <8B>35=>< :C;LBC@0E ;8<D>F8B>2 :@>28 8 2 ?;07<5 [Maes M. et al., 1991; 1993]; ?>2KH5==>3> C@>2=O @0AB2>@8<KE @5F5?B>@>2 : -2 2 AK2>@>B:5 :@>28 [Maes M. et al., 1991, 1992, 1993]; 0:B820F88 -A8AB5<K 8<<C=8B5B0 8 ?>2KH5==>3> B8B@0 0CB>0=B8B5; : D>AD>;8?840< [Maes M. et al., 1992, 1993]; 1>;55 2KA>:>3> C@>2=O ?@>AB03;0=48=>2 [Calabrese J.R. et al., 1986]; C25;8G5=8O C@>2=O IgM, IgG, !- 8 !4-:><?>=5=B>2 :><?;5<5=B0 [Joyce P.R. et al., 1992]; A?5F8D8G5A:>3> 87<5=5=8O 15;:>2 >AB@>9 D07K 2>A?0;5=8O, :>B>@>5 E0@0:B5@87C5BAO 38?5@30?B>3;>1C;8=5<859 8 38?>B@0=AD5@@8=5<859 [Maes M. et al., 1993]. @8 87CG5=88 G8A;0 "-;8<D>F8B>2 (8 8E ?>4:;0AA>2) 8 -;8<D>F8B>2 1K;> >1=0@C65=>, GB> C 1>;L=KE 45?@5AA859 C25;8G820NBAO ?@>?>@F8O 8 01A>;NB=>5 G8A;> "-;8<D>F8B>2-E5;?5@>2, C<5=LH05BAO G8A;> "-;8<D>F8B>2-AC?@5AA>@>2 8 A>>B25BAB25==> C25;8G8205BAO ?>:070B5;L A>>B=>H5=8O "-E5;?5@K/"-AC?@5AA>@K ?> A@02=5=8N A B0:>2K< C 74>@>2KE. @8 MB>< 87<5=5=85 C?><O=CBKE ?0@0<5B@>2 =081>;55 2K@065=> C 1>;L=KE 45?@5AA859, @578AB5=B=KE : ?@>2>48<>9 B5@0?88 0=B845?@5AA0=B0<8: 87CG5==K5 ?>:070B5;8 >B;8G0;8AL >B B0:>2KE =5 B>;L:> C 74>@>2KE, => 8 1>;L=KE 45?@5AA859, 045:20B=> @5038@CNI8E =0 ?@>2>48<CN B5@0?8N [Maes M. et al., 1977]. @8 87CG5=88 ?@>;8D5@0B82=>9 0:B82=>AB8 ;8<D>F8B>2 2 >B25B =0 <8B>35=K C 1>;L=KE 1>;LH>9 45?@5AA859 1K;8 ?>;CG5=K ?@>B82>?>;>6=K5 @57C;LB0BK, 81> 2 ?>;>28=5 @01>B 1K;> CAB0=>2;5=> A=865=85 DC=:F8>=0;L=KE A?>A>1=>AB59 :;5B>: C 1>;L=KE ?> A@02=5=8N A B0:>2K<8 C 74>@>2KE [Caldwell C.L., Irwin M., Lohr J., 1991; Inglot A.D. et al., 1994; Maes M., 1995], 0 2 4@C3>9 ?>;>28=5 B0:8E @07;8G89 >1=0@C65=> =5 1K;>, => 2 >4=>9 87 @01>B 1K;0 2KO2;5=0 AB0B8AB8G5A:8 7=0G8<0O >1@0B=0O :>@@5;OF8O <564C C@>2=5< 8=4CF8@>20==>9 <8B>35=>< ?@>;8D5@0F88 ;8<D>F8B>2 8 BO65ABLN 45?@5AA88 [Maes M. et al., 1993]. :B82=>ABL 8 G8A;> 5AB5AB25==KE :8;;5@>2 ?@8 45?@5AA88 7=0G8B5;L=> A=865=K [Irwin M. et al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ayne R., Rolfs M.K., 1958; Perris !., 1968; Bennahum DA. et al., 1976; Shapiro R.W. et al., 1976; Covaerts A., Mendlewicz J., Verbanck P., 1977; Julien R.A. et al., 1977; Stember R.H., Fieve R.R., 1977; Rafaelsen O.J. et al., 1978; Beckman L., 1978; Johnson G., 1978; Smeraldi E. et al., 1978; Zvolsky P. et al., 1978]. ;O MB>9 F5;8 1@0;8 ?>:070B5;8 A8AB5<K HLA. >;CG5==K5 ?@8 87CG5=88 <0=80:0;L=>-45?@5AA82=>3> ?A8E>70 40==K5 >:070;8AL 25AL<0 =5>?@545;5==K<8, 8 G5B:> 2KO2;O5<>9 0AA>F80F88 :0:8E-;81> 0=B835=>2 HLA-A8AB5<K A MB8< 701>;520=85< 8;8 A >4=8< 87 53> 20@80=B>2 CAB0=>2;5=> =5 1K;>. >7<>6=>, 0AA>F80F88 0=B835=>2 HLA-A8AB5<K A <0=80:0;L=>-45?@5AA82=K< ?A8E>7>< >?>A@54>20=K =5:>B>@K<8 MB=8G5A:8<8 D0:B>@0<8, :>B>@K5 >1KG=> =5 CG8BK20NBAO. 0AA<0B@820O 8<<C==K9 AB0BCA 1>;L=KE A 0DD5:B82=K<8 @0AAB@>9AB20<8, =5;L7O =5 70<5B8BL, GB> C 1>;L=KE A 0DD5:B82=K<8 =0@CH5=8O<8, >A>15==> A 18?>;O@=K<8, G0AB> >1=0@C68205BAO 0CB>8<<C==K9 B8@5>848B 8 2KO2;ONBAO 0=B8B8@5>84=K5 0=B8B5;0 [Nemeroff Ch.. et 0l., 1991]. > 0=B8B8@5>84=K5 0=B8B5;0 ?>O2;ONBAO 8 ?@8 ;5G5=88 0DD5:B82=KE @0AAB@>9AB2 :0@1>=0B>< ;8B8O [Emersen C.H. et al., 1973; Lindstedt G. et al., 1977; Albrecht J., Hopf U., 1982; Lazarus J.H. et al., 1982], A :>B>@K< A2O7K20NB 2>7=8:=>25=85 38?>B8@5>8487<0 [Smigan L. et al., 1984; Calabresc J.R. et al., 1985; Myers D.H. et al., 1985].  @O45 @01>B 1K;8 A45;0=K ?>?KB:8 87CG8BL 0=B8B8@5>84=K5 0CB>0=B8B5;0 4> =0G0;0 8 ?>A;5 B5@0?88 :0@1>=0B>< ;8B8O. 4=0:> >=8 ?@>45<>=AB@8@>20;8 >BACBAB285 A2O78 <564C MB8<8 ?0@0<5B@0<8 [Smigan L. et al., 1984; Myers D.H. et al., 1985; Haggerty J. et al., 1990; Spivak B. et al., 1991; Rapaport M.H. et al., 1994]. >A:>;L:C 3>@<>=K :>@K =04?>G5G=8:>2 (:>@B87>; 8 4@.) O2;ONBAO 8<<C=>AC?@5AA>@0<8, @O4 @01>B 1K; ?>A2OI5= 87CG5=8N A2O78 MB>3> 725=0 M=4>:@8==>9 A8AB5<K A 8<<C==K< AB0BCA>< ?@8 0DD5:B82=KE 701>;520=8OE. >A;54=85 40==K5 A2845B5;LAB2CNB > B><, GB> AB5@>84K =04?>G5G=8:>2 >:07K20NB =5 B>;L:> AC?@5AA8@CNI55, => 8 <>4C;8@CNI55 2;8O=85 =0 8<<C==CN A8AB5<C.  A2O78 A =0;8G85< 40==KE, ?>4B25@640NI8E 206=CN 8 :><?;5:A=CN @>;L =59@>M=4>:@8==>9 A8AB5<K 2 @53C;OF88 8<<C==>9 @50:F88, F5;5A>>1@07=> ?@>2545=85 A?5F80;L=KE 8AA;54>20=89, =0?@02;5==KE =0 87CG5=85 2708<>459AB28O =59@>M=4>:@8==>9 8 8<<C==>9 A8AB5< C 1>;L=KE A 0DD5:B82=K<8 =0@CH5=8O<8. !B0@5=85 8 1>;57=L ;LF359<5@0.  ;8B5@0BC@5 8<5NBAO A2545=8O > B><, GB> 2>7@0AB=K5 87<5=5=8O 8<<C==>9 A8AB5<K =0G8=0NBAO 4>2>;L=> @0=>  2 30-;5B=5< 2>7@0AB5 [CB5=:> .., 1993]. =8 ?@5645 2A53> :0A0NBAO ?>?C;OF88 "-;8<D>F8B>2. "0:85 A42838, 5AB5AB25==>, @0AA<0B@820NBAO <=>38<8 CG5=K<8 :0: A;54AB285 8=2>;NF88 28;>G:>2>9 65;57K, =0G8=0NI59AO 2 MB>< 2>7@0AB5.  A2O78 A MB8< A;54C5B =0?><=8BL, GB> B8<CA7028A8<K5 "-;8<D>F8BK A>AB02;ONB 70 % 2A5E ;8<D>F8B>2 8<<C==>9 A8AB5<K.  40;L=59H5< 2>7@0AB=K5 87<5=5=8O 8<<C==>9 A8AB5<K ?@>O2;ONBAO 2 A=865=88 3C<>@0;L=>3> 8 :;5B>G=>3> 8<<C==>3> >B25B0 =0 GC65@>4=K5 0=B835=K, C25;8G5=88 G0AB>BK 2>7=8:=>25=8O 8 2K@065==>AB8 :;5B>G=KE 8 3C<>@0;L=KE 0CB>8<<C==KE @50:F89, C<5=LH5=88 A?>A>1=>AB8 : @0728B8N 8<<C=>;>38G5A:>9 B>;5@0=B=>AB8, ?>2KH5=88 C@>2=O F8@:C;8@CNI8E 8<<C==KE :><?;5:A>2. >A;54=55 <>65B 1KBL A2O70=> :0: A 18>;>38G5A:8<8 8 D878:>-E8<8G5A:8<8 >A>15==>ABO<8 8<<C==KE :><?;5:A>2, 70B@C4=ONI8<8 8E ?>3;>I5=85 :;5B:0<8 A8AB5<K <>=>=C:;50@=KE D03>F8B>2, B0: 8 A 2>7@0AB=K<8 87<5=5=8O<8 A0<8E <>=>=C:;50@=KE D03>F8B>2 [CB5=:> .., "5@5H8=0 .., 1992; >;OA:8=0 .. 8 4@., 1996; Ennist D.L., 1990]. 5:>B>@K5 02B>@K ['5:=52 !.., >20;LGC: .., 1987; '5@54552 .., >20;LGC: .., 1991; CB5=:> .., "5@5H8=0 .., 1992; CB5=:> .., 1993; >;OA:8=0 .. 8 4@., 1996] >B<5G0NB, GB> 2 ?@>F5AA5 AB0@5=8O >@30=87<0 >1=0@C68205BAO =5:>B>@>5 A=865=85 :0: >1I53> G8A;0 ;8<D>F8B>2 2 ?5@8D5@8G5A:>9 :@>28, B0: 8 :>;8G5AB20 "-;8<D>F8B>2, 87<5=5=85 A>>B=>H5=8O "-E5;?5@>2/"-AC?@5AA>@>2, A=865=85 A?>A>1=>AB8 ;8<D>F8B>2 : ?@>;8D5@0F88 ?@8 8E AB8<C;OF88 0=B835=0<8, <8B>35=0<8 8 ?@>4C:F88 -1 8 -2. @54AB02;ONB 8=B5@5A 8AA;54>20=8O, A2O70==K5 A 87CG5=85< @>;8 A8AB5<K 8<<C=8B5B0 2 >15A?5G5=88 687=545OB5;L=>AB8 >@30=87<0 =0 @07=KE MB0?0E 53> 687=8 ?> ?>:070B5;N 7028A8<>AB8 2>7@0AB=>9 A<5@B=>AB8 8 8<<C==>9 @50:B82=>AB8 [CB5=:> .., 1993]. 08<5=LH5<C ?>:070B5;N A<5@B=>AB8 2 ?C15@B0B=>< 2>7@0AB5 (11 12 ;5B) A>>B25BAB2CNB =082KAH0O A?>A>1=>ABL : 8<<C==><C >B25BC =0 GC65@>4=K5 0=B835=K 8 =08<5=LH0O A?>A>1=>ABL : @0728B8N 0CB>8<<C==KE @50:F89. 2B>@K ?>4G5@:820NB, GB> ?@8 87CG5=88 8<<C=>;>38G5A:8E ?0@0<5B@>2 C ;N459, 4>682H8E 4> 3;C1>:>9 AB0@>AB8, A;54C5B 8<5BL 2 284C, GB> 2 MB>B ?5@8>4 =0G8=05B A:07K20BLAO MDD5:B ?>?C;OF8>==>9 A5;5:F88: 2> 27OB>9 4;O 8AA;54>20=8O 2K1>@:5 >AB0NBAO B>;L:> =081>;55 74>@>2K5 8=48284CC<K, >B=>AOI85AO : B0: =07K205<>9 8<<C=>;>38G5A:>9 M;8B5. 725AB=>, =0?@8<5@, GB> 8<<C=>;>38G5A:85 ?>:070B5;8 C :;8=8G5A:8 74>@>2KE ;8F AB0@H5 90 ;5B >:07K20NBAO =0<=>3> ;CGH5, G5< C ;N459 ?@54K4CI53> 45AOB8;5B8O 687=8. =>340 >=8 A>>B25BAB2CNB ?>:070B5;O< 50-;5B=8E. G5284=>, GB> 4> AB>;L ?@5:;>==>3> 2>7@0AB0 4>6820NB ;8HL ;N48 A =081>;55 A>E@0==>9 8<<C==>9 A8AB5<>9.  A2O78 A 40==K<8 >1 87<5=5=88 DC=:F88 8<<C==>9 A8AB5<K 2 ?@>F5AA5 AB0@5=8O 2>7=8:;8 8 ?@54?>;>65=8O >1 CG0AB88 8<<C==KE <5E0=87<>2 2 @0728B88 1>;57=59 3>;>2=>3> <>730, A 45 ?@>4>;65=85 @8687=5==0O 287C0;870F8O <>73>2KE AB@C:BC@.  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. 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K45;5==K9 ?5@2>=0G0;L=> ?@8 A>AC48AB>9 45<5=F88 [Hachinski V.C. et al., 1987] ;59:>0@08>78A, :0: >:070;>AL, O2;O5BAO <>@D>;>38G5A:8 25AL<0 35B5@>35==K< 8 <>65B 2AB@5G0BLAO ?@8 A0<KE @07;8G=KE >@30=8G5A:8E 8 B0: =07K205<KE DC=:F8>=0;L=KE 8 ?A8E8G5A:8E 701>;520=8OE, 0 B0:65 C ?A8E8G5A:8 74>@>2KE ;8F AB0@G5A:>3> 2>7@0AB0. @C38< D5=><5=>< A=865=8O <>73>2>9 ?;>B=>AB8, 2AB@5G0NI8<AO C ;8F A ?A8E8G5A:>9 ?0B>;>3859 (3;02=K< >1@07>< ?>74=53> 2>7@0AB0), O2;ONBAO :@C?=K5, A@54=59 25;8G8=K 8 <5;:85 (;0:C=0@=K5) >G038 8H5<8G5A:>3> E0@0:B5@0. !;54C5B >A>1> ?>4G5@:=CBL, GB> >F5=:0 4803=>AB8G5A:>3> 7=0G5=8O 2KH5C:070==KE B><>3@0D8G5A:8E D5=><5=>2 (<>73>2>9 0B@>D88, ;59:>0@08>78A0 8 8H5<8G5A:8E >G03>2), 2AB@5G0NI8EAO ?@8 ?A8E8G5A:8E 701>;520=8OE, 4>;6=0 ?@>2>48BLAO =5 B>;L:> ?@8 >1O70B5;L=>< A>?>AB02;5=88 A 8E :;8=8G5A:>9 :0@B8=>9, => 8 A CG5B>< 2>7@0AB0 1>;L=>3>. 03=8B=>-@57>=0=A=0O A?5:B@>A:>?8O ( !). !CBL <5B>40 70:;NG05BAO 2 A?5:B@0;L=>< 0=0;875 @57>=0=A=KE A83=0;>2 (@57>=0=A=KE G0AB>B) @O40 0B><>2 [B0:8E :0: D>AD>@ (31 ), =0B@89 (23Na), C3;5@>4 (13!) 8 4@.], 2E>4OI8E 2 A>AB02 A>548=5=89, >ACI5AB2;ONI8E 206=59H85 <>73>2K5 DC=:F88. ;03>40@O MB><C A ?><>ILN  ! 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"0:, 28A>G=>-B5<5==0O 0:F5=BC0F8O 0B@>D88, AG8B0NI0OAO E0@0:B5@=>9 (=0 >A=>20=88 ?0B>38AB>;>38G5A:8E 8AA;54>20=89) 4;O , >B<5G05BAO =5 1>;55 G5< C 15 % 1>;L=KE, AB@040NI8E C:070==K< =54C3><, >1A;54>20==KE <5B>4>< ", ?@8G5< =57028A8<> >B 2>7@0AB0 =0G0;0 701>;520=8O.  >AB0;L=KE 65 A;CG0OE G0I5 2A53> =01;N405BAO 48DDC7=0O :>@:>20O 0B@>D8O, 0 2 10 % A;CG052  ?@58<CI5AB25==0O 0B@>D8O ;>1=>9 4>;8.  2/3 A;CG052 :>@:>20O 8 ?>4:>@:>20O 0B@>D88 2K@065=K ?@8<5@=> 2 >48=0:>2>9 AB5?5=8, C >AB0;L=KE 1>;L=KE A @02=>9 G0AB>B>9 =01;N405BAO ?@58<CI5AB25==0O 0:F5=BC0F8O :>@:>2>9 ;81> ?>4:>@:>2>9 0B@>D88. @8 =0G0;L=KE 45<5=F8OE 1>;55 G5< 2 50 % A;CG052 0B@>D8O 1K205B C<5@5==> 2K@065==>9 8;8 4065 2K@065==>9. > BO65;K5 AB5?5=8 45<5=F88, ?> 40==K< "/ ", G0AB> =5 >B;8G0NBAO >B C<5@5==KE. @8<5@=> C 1/3 1>;L=KE >1=0@C68205BAO D5=><5= ;59:>0@08>78A0, G0AB>B0 :>B>@>3> =0@0AB05B A C25;8G5=85< 2>7@0AB0 1>;L=KE. >GB8 2 20 % A;CG052 =01;N40NBAO =51>;LH85 8H5<8G5A:85 >G038, C:07K20NI85 =0 =0;8G85 0:F5AA>@=>3> A>AC48AB>3> ?>@065=8O <>730. 0 8=8F80;L=KE AB048OE 1>;57=8 8;8 ?@8 <O3:>9 D>@<5 A;01>C<8O =5@54:> 2>7=8:05B ?@>1;5<0 >B3@0=8G5=8O MB8E A;CG052 >B =>@<0;L=>9 2>7@0AB=>9 0B@>D88. 1=0456820NI85 @57C;LB0BK 2 MB>< ?;0=5 ?>;CG5=K ?@8 >1J5<=>< 87<5@5=88 25;8G8=K 38??>:0<?0 [Drayer . ., 1988] 8;8 @0AAB>O=8O <564C :@NG:0<8 38??>:0<?0 (interuncal distance) [Dahlbeck S.W. et al., 1991] =0  "-87>1@065=8OE, GB> ?>72>;O5B >B3@0=8G8BL 2>7@0AB=CN =>@<C >B =0G0;L=KE ?@>O2;5=89 . >;LH59 4803=>AB8G5A:>9 MDD5:B82=>ABLN ?> A@02=5=8N A "/ " >1;0405B -". 0 A0<KE @0==8E AB048OE 701>;520=8O, :>340 70<5B=K5 ?@87=0:8 0B@>D88 <>3CB >BACBAB2>20BL. -" 2KO2;O5B E0@0:B5@=K5 4;O  >1;0AB8 @54C:F88 <>73>2>3> <5B01>;87<0, =081>;55 2K@065==K5 2 B5<5==>-28A>G=>9 0AA>F80B82=>9 :>@5, GB> B0:65 ?><>305B 48DD5@5=F8@>20BL  >B 4@C38E 45<5=F88 [Heiss W. et al., 1994]. #AB0=>2;5=>, GB> @07=8F0 2 ?>:070B5;OE <>73>2>3> :@>2>B>:0 <564C B8?8G=> ?>@0605<K<8 8 8=B0:B=K<8 >1;0ABO<8 <>730 ?@8  <5=55 G5B:0 C 1>;L=KE A5=8;L=>3>, G5< ?@5A5=8;L=>3>, 2>7@0AB0 [Mielke R. et al., 1992]. @8 MB>< C 1>;L=KE A5=8;L=>3> 2>7@0AB0 =01;N405BAO 1>;55 @0A?@>AB@0=5==>5 A=865=85 <5B01>;87<0 3;N:>7K, 0 C 1>;L=KE ?@5A5=8;L=>3> 2>7@0AB0 ?@58<CI5AB25==> 2 ;>1=>9 8 ;>1=>-B5<5==>9 >1;0AB8. -" ?><>305B >B3@0=8G8BL  >B ?>74=8E 45?@5AA89 A O2;5=8O<8 C<AB25==>9 =5A>AB>OB5;L=>AB8 ("45?@5AA82=0O ?A524>45<5=F8O"): ?@8 ?>A;54=59 ?>:070B5;8 <5B01>;87<0 =>@<0;L=K5. @><5 B>3>, 40==K5, ?>;CG5==K5 A ?><>ILN MB>3> <5B>40, ?>72>;ONB ?@>3=>78@>20BL B5<? ?@>3@5AA8@>20=8O 45<5=F88: >= 1>;55 2KA>: ?@8 38?><5B01>;87<5 2 704=528A>G=>9 8 ?5@28G=>9 7@8B5;L=>9 :>@5 [Jacust W. et al., 1996]. >;57=L 8:0 (). ;O MB>3> 701>;520=8O, ?> 40==K< "/ "->1A;54>20=8O [Groen J., 1982], B8?8G=0 18;0B5@0;L=0O, ?@58<CI5AB25==> ;>1=>-28A>G=0O 0B@>D8O, :>B>@0O ?>O2;O5BAO @0=LH5, G5< ?@8 . 0 -" >1=0@C68205BAO =081>;55 2K@065==0O @54C:F8O <5B01>;87<0 2 ;>1=KE 4>;OE (G0AB> 0A8<<5B@8G=0O): <5=LH0O 2 28A>G=KE 8 <8=8<0;L=0O  2 B5<5==KE 4>;OE, 0 B0:65 2 1070;L=KE 30=3;8OE 8 B0;0<CA5 [Kamo H. et 0!., 1987]. -B> ?>72>;O5B 48DD5@5=F8@>20BL  =0 A@54=8E 55 AB048OE >B , :>340 8E :;8=8G5A:85 ?@>O2;5=8O 1K20NB AE>4=K<8. %>@5O 5=B8=3B>=0. 0@O4C A ?@87=0:0<8 48DDC7=>9 :>@:>2>-?>4:>@:>2>9 0B@>D88 "- 8 >A>15==>  "-40==K5 (2 :>@>=0@=>9 ?@>5:F88) C:07K20NB =0 C<5=LH5=85 3>;>2:8 E2>AB0B>3> O4@0, GB> <>65B >1=0@C6820BLAO ?@8 @0==8E ?@87=0:0E 701>;520=8O [Sartor ., 1992] 4065 2 ?@5A8<?B><0B8G5A:>9 AB0488. # 50 % 1>;L=KE 2KO2;O5BAO 0B@>D8O putamen. 0 -"  @54C:F8O <5B01>;87<0 3;N:>7K 2 neostriatum C65 =0 @0==8E AB048OE 701>;520=8O, @0A?@>AB@0=ONI0OAO ?> <5@5 53> ?@>3@5AA8@>20=8O =0 E2>AB0B>5 O4@>, putamen, 0 ?>765  =0 :>@C <>730 [Kuhl D.E. et al., 1984]. >A:>;L:C <5B01>;8G5A:85 =0@CH5=8O ?@54H5AB2CNB :;8=8G5A:>9 <0=8D5AB0F88 1>;57=8, 40==K5 -" 40NB 2>7<>6=>ABL 845=B8D8F8@>20BL ;8F A @8A:>< 701>;520=8O 2 A5<LOE, >BO3>I5==KE E>@559 5=B8=3B>=0 [Hayden M.R. et al., 1987; Maziotta J. et al., 1987]. >;57=L 0@:8=A>=0.  A;CG0OE MB>9 1>;57=8, A>?@>2>640NI8EAO 45<5=F859, 40==K5 "/ ", 0 B0:65 -" 1K20NB AE>4=K A A>>B25BAB2CNI8<8 ?>:070B5;O<8, =01;N40NI8<8AO ?@8  [Kuhl D.E. et al., 1985]. >;57=L @59FD5;L40 /:>10.  MB8E A;CG0OE E0@0:B5@=0 1KAB@> ?@>3@5AA8@CNI0O 2=CB@5==OO 8 =0@C6=0O 384@>F5D0;8O =0 ", :>B>@0O <>65B A>G5B0BLAO A ?5@825=B@8:C;O@=K< ;59:>0@08>78A>< [Lung !., 1990]. @8 -"-8AA;54>20=88 >1=0@C68205BAO 48DDC7=K9 8;8 18B5<?>@0;L=K9 38?><5B01>;87<, AE>4=K9 A B0:>2K< ?@8  [Friedland R., 1984]. B<5G05BAO 38?5@8=B5=A82=>ABL A83=0;0 "2 2 1070;L=KE 30=3;8OE (?> 40==K<  ") [Weerasinghl S. et al., 1996]. ;:>3>;L=0O 45<5=F8O. ><8<> =5A?5F8D8G5A:>9 48DDC7=>9 :>@:>2>-?>4:>@:>2>9 0B@>D88, ?@8 "/ "->1A;54>20=88 2KO2;O5BAO >A>1> 70<5B=>5 @0AH8@5=85 III 65;C4>G:0 8 =5@54:> 0B@>D8O =>65: <>AB0.  "-40==K5 <>3CB C:07K20BL =0 A=865=85 ?;>B=>AB8 25I5AB20 <>730 2 <5480;L=>< B0;0<CA5, 38?>B0;0<CA5, <0<8;;O@=KE B5;0E. >7<>6=0 G0AB8G=0O >1@0B8<>ABL 0B@>D88.  MB8E A;CG0OE ?@8 ?@>2545=88 -" =5 >1=0@C68205BAO A=865=8O ?>:070B5;59 >1I53> <>73>2>3> <5B01>;87<0, => 2KO2;O5BAO >B=>A8B5;L=K9 38?><5B01>;87< 2 <548>D@>=B0;L=>9 >1;0AB8 [Lung !., 1990]. >@<>B5=782=0O 384@>F5D0;8O. =0G8<>ABL 4803=>AB8:8 MB>3> A@02=8B5;L=> @54:>3> 701>;520=8O >1CA;>2;5=0 B5<, GB> >=> <>65B 8<8B8@>20BL =5:>B>@K5 D>@<K 45<5=F88 ?>74=53> 2>7@0AB0 (, , M=F5D0;>?0B8N 8=A20=35@0), => ?@8 A2>52@5<5==>< 2KO2;5=88 25AL<0 CA?5H=> ;5G8BAO E8@C@38G5A:8<8 <5B>40<8.  A;CG0OE =>@<>B5=782=>9 384@>F5D0;88 40==K5 "/ "->1A;54>20=8O A2845B5;LAB2CNB > =0;8G88 2=CB@5==59 384@>F5D0;88 2 A>G5B0=88 A <0;> 8;8 2>2A5 =5 87<5=5==K< 2=5H=8< ;8:2>@=K< ?@>AB@0=AB2>< ?@8 70<5B=> @0AH8@5==KE 28A>G=KE @>30E. 5@54=85 @>30 <>3CB ?@8>1@5B0BL >:@C3;CN D>@<C. =>340 >1=0@C68205BAO C7:0O ?>;>A:0 ;59:>0@08>78A0 ?> :@0O< 1>:>2KE 65;C4>G:>2, C:07K20NI0O =0 B@0=AAC40B F5@51@>A?8=0;L=>9 684:>AB8 G5@57 AB5=:C 65;C4>G:>2. BACBAB285 >BG5B;82>3> ;8:2>@>B>:0 G5@57 A8;L2852 2>4>?@>2>4, ?> 40==K<  ", O2;O5BAO D0:B><, =5 ?>4B25@640NI8< 4803=>7 =>@<>B5=782=>9 384@>F5D0;88 [Lung !., 1990; Sartor ., 1992]. -" ?>72>;O5B 2KO28BL >BG5B;82>5 C<5=LH5=85 :>@:>2>3> <5B01>;87<0, 3;>10;L=>3> 2 >B;8G85 >B40==KE ?@8  [Lung !., 1990]. A;8 2>7=8:05B ?>4>7@5=85 =0 =>@<>B5=782=CN 384@>F5D0;8N, >1O70B5;L=> ?@>2545=85 F8AB5@=>3@0D88, :>B>@0O ?><>305B >1=0@C68BL 7=0G8B5;L=CN 7045@6:C ;8:2>@>B>:0 2 65;C4>G:0E ?@8 >BACBAB288 =0:>?;5=8O :>=B@0AB0 ?0@0A038BB0;L=>. -?8;5?B8G5A:85 ?@8?04:8. # ;8F A M?8;5?B8G5A:8<8 ?@8?04:0<8 "/  "-40==K5 G0I5 2A53> A2845B5;LAB2CNB >1 >G03>2>9 ?0B>;>388 <>730 (40 60 % A;CG052). >;L=>9 A M?8;5?B8G5A:8<8 ?@8?04:0<8 4>;65= >1O70B5;L=> >1A;54>20BLAO <5B>40<8 =59@>287C0;870F88 (?@54?>GB8B5;L=0  "). -B> =5 B>;L:> 206=> 4;O 8A:;NG5=8O 701>;520=89, ?@8 :>B>@KE B@51C5BAO =5<54;5==>5 E8@C@38G5A:>5 2<5H0B5;LAB2> (>?CE>;L, 35<0B><0, 0=52@87<0), => 8 4;O 2KO2;5=8O M?8;5?B>35==KE >G03>2, >1CA;>2;5==KE ;>:0;L=K<8 87<5=5=8O<8 <>73>2>9 B:0=8 2>A?0;8B5;L=>3>, B@02<0B8G5A:>3> 8 4535=5@0B82=>3> E0@0:B5@0, ?>A:>;L:C 2 MB8E A;CG0OE <>65B 1KBL ?>AB02;5= 2>?@>A > F5;5A>>1@07=>AB8 8E C40;5=8O 2 ?;0=>2>< ?>@O4:5. $C=:F8>=0;L=K5 ?A8E8G5A:85 @0AAB@>9AB20. @8<5=5=85 <5B>4>2 =59@>287C0;870F88 ?@8 DC=:F8>=0;L=KE ?A8E8G5A:8E @0AAB@>9AB20E 8<55B A2>59 F5;LN ?>;CG5=85 :;8=8:>-0=0B><8G5A:8E, :;8=8:>-DC=:F8>=0;L=KE 8 :;8=8:>-=59@>E8<8G5A:8E :>@@5;OF89 4;O @0A:@KB8O ?0B>35=5B8G5A:8E <5E0=87<>2 MB8E @0AAB@>9AB2, GB> <>65B B0:65 A?>A>1AB2>20BL 2K45;5=8N 8E <>73>2KE <0@:5@>2, 8E B8?>;>38G5A:><C ?>4@0745;5=8N, 87CG5=8N 35=5B8G5A:8E 70:>=><5@=>AB59 8 B.4.  =0AB>OI5<C 2@5<5=8 =0AG8BK20NBAO C65 A>B=8 8AA;54>20=89, 2:;NG0NI8E D0:B8G5A:8 2A5 @07=>284=>AB8 DC=:F8>=0;L=KE ?A8E8G5A:8E @0AAB@>9AB2 (H87>D@5=8N, 45?@5AA88, B@52>6=K5 8 D>18G5A:85 A><0B878@>20==K5 @0AAB@>9AB20, ?>74=85 1@54>2K5 ?A8E>7K 8 B.4.). 5A<>B@O =0 B> GB> @57C;LB0BK MB8E 8AA;54>20=89 25AL<0 =5>4=>@>4=K 8 4065 ?@>B82>@5G82K, 2 F5;>< ?@8 MB>< >1=0@C68205BAO O2=0O B5=45=F8O : ?>2KH5==>9 G0AB>B5 2KO2;5=8O =5A?5F8D8G5A:8E 87<5=5=89, 70:;NG0NI8EAO 2 @538>=0;L=>9 8;8 3;>10;L=>9 <>73>2>9 0B@>D88 ?@8 =081>;55 @0A?@>AB@0=5==KE ?A8E8G5A:8E 701>;520=8OE (@0AH8@5=85 1>:>2KE 8 III 65;C4>G:0  ?@8 H87>D@5=88 8 45?@5AA8OE, ?@87=0:8 C<5=LH5=8O >1J5<0 ;>1=>9 4>;8  ?@8 H87>D@5=88 A A>>B25BAB2CNI59 @54C:F859 <>73>2>3> :@>2>B>:0 8 <5B01>;87<0). -B8 8AA;54>20=8O A?>A>1AB2>20;8 2K42865=8N =>2KE ?0B>35=5B8G5A:8E 38?>B57, :0A0NI8EAO @0728B8O H87>D@5=88 (>=B>35=5B8G5A:0O 38?>B570 D.Weinberger, 1987) 8 ?@8=F8?>2 55 :;0AA8D8:0F88 (?>78B82=0O 8 =530B82=0O H87>D@5=8O T.Grow, 1982), 0 B0:65 ?>2KH5=8N 8=B5@5A0 : =59@><>@D>;>388 MB8E 701>;520=89. @8 45?@5AA8OE >1=0@C68205BAO A=865=85 <5B01>;87<0 2 ?5@54=8E >B45;0E ;52>9 35<8AD5@K, :>B>@>5 <>65B G0AB8G=> C;CGH0BLAO ?>A;5 =0ABC?;5=8O :;8=8G5A:>9 @5<8AA88. @C385 ?A8E8G5A:85 @0AAB@>9AB20. 0B0B>=8G5A:89 A8=4@><, >A>15==> @072820NI89AO 2?5@2K5 ?>A;5 40 ;5B, <>65B 1KBL 2K720= >@30=8G5A:8< 701>;520=85< 3>;>2=>3> <>730 (8=AC;LB><, >?CE>;LN). >MB><C 1>;L=K5 A B0: =07K205<>9 ?>74=59 :0B0B>=859 4>;6=K ?>4;560BL "- 8;8  "->1A;54>20=8N. @>2545=85 ?>A;54=8E F5;5A>>1@07=> B0:65 ?@8 >AB@> @07282H8EAO A>AB>O=8OE A?CB0==>AB8 157 ?@87=0:>2 A><0B8G5A:>3> 701>;520=8O.  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AB0BLO .Tyrer 8 .Mackay "(87>D@5=8O: 1>;LH5 =5 DC=:F8>=0;L=K9 ?A8E>7", 0 B0:65 2KA:07K20=85 G.P.Reynolds (1989), :>B>@K9 AG5; 2>7<>6=K< 3>2>@8BL > AB8@0=88 3@0=8F <564C "DC=:F8>=0;L=K<8" 8 ">@30=8G5A:8<8" ?A8E>70<8. 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"0:8< >1@07><, 70;>65=K >A=>2K ?@52@0I5=8O =59@>0=0B><88 87 >?8A0B5;L=>9 =0C:8 2 =0C:C B>G=CN, ?>72>;ONICN :>;8G5AB25==> 2K@060BL 87<5=5=8O 2 =5@2=>9 B:0=8 =0 A25B>2>< 8 C;LB@0AB@C:BC@=>< C@>2=5 8 C;02;820BL A42838, :>B>@K5 =5 <>3CB 1KBL 2KO2;5=K ?@8 287C0;L=>9 >F5=:5.  =0AB>OI55 2@5<O 845B 8=B5=A82=>5 =0:>?;5=85 A>>B25BAB2CNI8E DC=40<5=B0;L=KE 8 :;8=8:>-0=0B><8G5A:8E 40==KE [5;8G5=:> .., 1989; @;>2A:0O .., #@0=>20 ., 1990; #@0=>20 . 8 4@., 1997; 1999; Scheibel A.B. et al., 1981; Bogerts . et al., 1983, 1986; Benes P.M. et al., 1986; Casanova M.F. et al., 1988, 1990, 8 4@.]. !CI5AB25==>9 >A>15==>ABLN =0CG=KE 8AA;54>20=89 2 >1;0AB8 =59@><>@D>;>388 ?A8E8G5A:8E 1>;57=59 O2;O5BAO B0:65 @0728B85 ?>4E>4>2, >@85=B8@>20==KE =0 =59@>E8<8G5A:85 A8AB5<K <>730 (4>D0<8=5@38G5A:CN, A5@>B>=8=5@38G5A:CN 8 4@.) 8 8E @5F5?B>@K, :>B>@K< >B2>48BAO 254CI0O @>;L 2 ?0B>35=575 <=>38E ?A8E8G5A:8E 1>;57=59 8 <5E0=87<5 459AB28O 8A?>;L7C5<KE 4;O 8E ;5G5=8O ?A8E>D0@<0:>;>38G5A:8E A@54AB2 [#@0=>20 ., 1995, 1998; Falkai P. et al., 1997; Reynolds G.P., Beasley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SADS-C 8A?>;L7CNB ?@8 >F5=:5 MDD5:B82=>AB8 ;5G5=8O. =0 4>AB0B>G=> ?@>AB0 2 @01>B5 8 2:;NG05B 7 AC1H:0; (D0:B>@>2): 4;O 45?@5AA88 (16 ?@87=0:>2), M=4>35==KE G5@B (10 ?@87=0:>2), <0=88 (5 ?@87=0:>2), B@52>38 (3 ?@87=0:0), 30;;NF8=0F89 8 1@54>2KE @0AAB@>9AB2 (10 ?@87=0:>2), A<5H0==>9 ?0B>;>388 (8 ?@87=0:>2) 8 H:0;C 0<8;LB>=0 (17 ?@87=0:>2). 064K9 87 ?@87=0:>2 <>65B 8A?>;L7>20BLAO 1>;55 G5< 2 >4=>< D0:B>@5. 803=>AB8G5A:0O LN:0AB;A:0O H:0;0 45?@5AA89 (Newcastle diagnostic depression scale) 1K;0 @07@01>B0=0 . Corney A A>02B. 4;O 48DD5@5=F80F88 M=4>35==>9 8 =5M=4>35==>9 (=52@>B8G5A:>9, @50:B82=>9) 45?@5AA89. @54AB02;5=0 2 42CE <>48D8:0F8OE, N1 (1965) 8 N11 (1971). ><8<> A8<?B><>2 A>1AB25==> 45?@5AA88 (157@04>AB=>ABL, B@52>30, 8458 >AC645=8O, 28=K, =838;8AB8G5A:89 1@54, ?A8E><>B>@=0O 70B>@<>65==>ABL, ACB>G=>5 87<5=5=85 A0<>GC2AB28O), H:0;K 87 LN:0AB;0 2:;NG0NB ?@87=0:8 =0@CH5=8O A=0 (@0==55 ?@>1C645=85), A=865=8O <0AAK B5;0, AB5?5=L 045:20B=>AB8 ;8G=>AB=>3> @5038@>20=8O, <5E0=87<K 2>7=8:=>25=8O 45?@5AA88 (045:20B=>ABL ?A8E>35=88, "@50:B82=>ABL" 45?@5AA88), 0 B0:65 0=0<=5AB8G5A:85 40==K5 (4;8B5;L=>ABL 8 ?>AB>O=AB2> 45?@5AA88, 2=570?=>ABL =0G0;0, =0;8G85 ?@54H5AB2CNI8E M?87>4>2 45?@5AA88). 7 :064KE 10 ?@87=0:>2 2 >1>8E 20@80=B0E H:0;K A>2?040NB B>;L:> 4  B@52>30, =838;8AB8G5A:89 1@54, ?A8E><>B>@=>5 B>@<>65=85 8 =5045:20B=>ABL ?A8E>35=88. 064K9 87 ?@87=0:>2 @0=68@>20= ?> AB5?5=8 2K@065==>AB8 2 3@040F8OE >B 0 4> 2, 0 :064>9 3@040F88 A>>B25BAB2CNB ?@82545==K5 BCB 65 (2 >B45;L=>< AB>;18:5) 8E @07=K5 G8A;>2K5 >F5=:8 (@07=K9 25A), ?@54AB02;5==K5 A> 7=0:>< + 8;8  . '8A;>2K5 >F5=:8 4065 4;O A>2?040NI8E ?@87=0:>2 2 <>48D8:0F8OE N1 8 N11 @07;8G=K. > AC<<5 G8A;>2KE >F5=>: 8 ?@>2>48BAO 4803=>AB8:0 45?@5AA88.  @57C;LB0B5 ?> N1 4803=>AB8G5A:89 AG5B 4;O M=4>35==>9 45?@5AA88 A>AB02;O5B >+6, 4;O 4803=>AB8G5A:8 A><=8B5;L=>9 45?@5AA88  +5,5, 4;O =5M=4>35==>9  <+5. > <>48D8:0F88 N11 MB>B 4803=>AB8G5A:89 AG5B @025= A>>B25BAB25==> <-20, >B -19 4> -12, >-11. @82545==K5 H:0;K 8A?>;L7CNB 4;O 2K45;5=8O 3><>35==KE 3@C?? 1>;L=KE A>3;0A=> 4803=>AB8G5A:8< :@8B5@8O< >B1>@0 ?0F85=B>2 4;O 8AA;54>20=8O, 0 B0:65 4;O >F5=:8 BO65AB8 A>AB>O=8O ?@8 ?@>2545=88 ?A8E>D0@<0:>;>38G5A:8E 8 :;8=8:>-18>;>38G5A:8E 8AA;54>20=89 45?@5AA89. 0 >A=>25 ?@87=0:>2 H:0; N1 8 N11 ?>AB@>5=0 H:0;0 45?@5AA89  (WHO depression scale), @5:><5=4>20==0O 4;O ?@>2545=8O ?>8A:>2KE 8AA;54>20=89 8 4803=>AB8G5A:>9 >F5=:8 A>AB>O=8O 1>;L=KE [Sartorius N., 1978]. =0 A>AB>8B 87 17 ?@87=0:>2 (2 =55 22545= 4>?>;=8B5;L=K9 ?@87=0: "8?>E>=4@8G5A:89 1@54 8/8;8 1@54 ?@5A;54>20=8O") 8 ?@8<5=O5BAO ?> B><C 65 ?@8=F8?C, GB> 8 H:0;K 87 LN:0AB;0. ;O >?8A0=8O 8 >F5=:8 45?@5AA82=KE !>AB>O=89  1K;0 @07@01>B0=0 :0@B0 AB0=40@B87>20==>9 >F5=:8 ?0F85=B>2 A 45?@5AA82=K<8 @0AAB@>9AB20<8 (Schedule for a standardized Assessment of Patients with depressive disorders  SADD). =0 A>45@68B 4 @0745;0: >1I85 A2545=8O > 1>;L=>< (845=B8D8:0F8O 1>;L=>3>) (@0745; 1); A2545=8O > ;5G5=88 ?@54H5AB2CNI53> M?87>40 1>;57=8 (@0745; 3); 4803=>7 ?>  8 >F5=:0 BO65AB8 A>AB>O=8O 1>;L=>3> (@0745; 4). 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'B>1K A>1;NAB8 :>@@5:B=>ABL, C=8D8F8@>20BL CA;>28O 70?>;=5=8O H:0; 8 A>E@0=8BL >1J5:B82=>ABL >F5=:8 A>AB>O=8O 1>;L=>3>, @5:><5=4C5BAO ?@>872>48BL >1A;54>20=85 1>;L=>3> 2 >4=> 8 B> 65 2@5<O ACB>:, >4=8< 8 B5< 65 8AA;54>20B5;5< 8 4@., GB> >1KG=> >13>20@8205BAO 8 D8:A8@C5BAO 2 ?@>B>:>;5. 07;8G0NB H:0;K, :>B>@K5 ?@8<5=ONBAO :0: 4;O >F5=:8 >B45;L=KE @0AAB@>9AB2 (45?@5AA88, ?A8E>B8G5A:>9 A8<?B><0B8:8, B@52>6=KE A>AB>O=89, =530B82=KE H87>D@5=8G5A:8E 87<5=5=89), B0: 8 4;O >F5=:8 8E 2 A>2>:C?=>AB8. (:0;K 4;O >F5=:8 ?A8E8G5A:>3> AB0BCA0 (:0;0 >F5=:8 ?A8E8G5A:>3> AB0BCA0 (Present state examination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arpenter 8 J.Strauss @07@01>B0;8 4803=>AB8G5A:CN H:0;C H87>D@5=88, 8725AB=CN :0: 4803=>AB8G5A:0O H:0;0 0@?5=B5@0 [Carpenter W., 1976]. =0 A>45@68B 12 ?A8E>?0B>;>38G5A:8E ?@87=0:>2, 2K45;5==KE 87 H:0;K PSE, :>@@5;8@CNI8E (8;8 =5B) A 4803=>7>< H87>D@5=88. ?@545;O5BAO :>;8G5AB2> ?@87=0:>2, 8<5NI8EAO C :064>3> 1>;L=>3>. A;8 C 1>;L=>3> >B<5G0NBAO ?@87=0:8, 8A:;NG0NI85 4803=>7 H87>D@5=88 (>=8 ?><5G5=K 7=0:>< " "), B> 2 AC<<C ?@87=0:>2 >=8 =5 2E>4OB, 0 >BACBAB285 :064>3> 87 =8E 70AG8BK205BAO :0: >48= ?@87=0:, A2845B5;LAB2CNI89 > =0;8G88 H87>D@5=88. 803=>7 H87>D@5=88 ?>4B25@6405BAO >1I8< :>;8G5AB2>< ?@87=0:>2 =5 <5=LH5 8. 803=>AB8G5A:0O F5==>ABL 40==>9 H:0;K >B=>A8B5;L=0, => >=0 8A?>;L7C5BAO 4;O >1J5:B82870F88 :@8B5@852 >B1>@0 1>;L=KE 2 <C;LB8F5=B@>2KE 8AA;54>20=8OE.  1996 3. 2 B45;5 ?A8E8G5A:>3> 74>@>2LO  1K; @07@01>B0= =>2K9 "8=AB@C<5=B" - H:0;0 :;8=8G5A:>9 >F5=:8 2 =59@>?A8E80B@88 (Schedules for Clinical Assessment in Neuropsychiatry  SCAN).  =59 90% A>AB02;O5B PSE 8 ?@82>48BAO :>=B@>;L=K9 ?5@5G5=L A3@C??8@>20==KE ?@87=0:>2 (Item group check-list) 8 H:0;0 >F5=:8 :;8=8G5A:>9 48=0<8:8 A>AB>O=8O 1>;L=>3> (Clinical history schedule). SCAN AB0=>28BAO >A=>2=K< 4>:C<5=B>< ?@8 ?@>2545=88 :;8=8G5A:8E 8AA;54>20=89  =0@O4C A> AB@C:BC@8@>20==K< <564C=0@>4=K< 4803=>AB8G5A:8< >?@>A=8:>< (Corn-posit international Diagnostic Interview  CIDI), ?@54=07=0G5==K< 4;O ?@>2545=8O M?845<8>;>38G5A:8E ?@>3@0<<. >AB0B>G=> H8@>:>5 @0A?@>AB@0=5=85 ?>;CG8;0 :>@>B:0O ?A8E80B@8G5A:0O >F5=>G=0O H:0;0 (Brief Psychiatric rating Scale  BPRS), @07@01>B0==0O J.F.Overall 8 D.Gorchem 2 1962 3.  AB0=40@B=>9 25@A88 >=0 A>45@68B 18 ?A8E>?0B>;>38G5A:8E (?A8E>B8G5A:8E) ?@87=0:>2, >F5=8205<KE 2 7 3@040F8OE BO65AB8. BPRS H8@>:> 8A?>;L7C5BAO 2 ?A8E80B@88, >A>15==> 2 ?A8E>D0@<0:>;>38G5A:8E 8AA;54>20=8OE 4;O >?@545;5=8O 48=0<8:8 8=B5=A82=>AB8 ?A8E>?0B>;>38G5A:8E @0AAB@>9AB2 ?@8 ;5G5=88 0=B845?@5AA0=B0<8, B@0=:28;870B>@0<8 8 >A>15==> =59@>;5?B8:0<8. 0 >A=>25 BPRS 2>7<>6=> :;0AA8D8F8@>20BL :;8=8G5A:89 <0B5@80; ?@8 >B1>@5 3><>35==KE 3@C?? 1>;L=KE 2 :;8=8:>-18>;>38G5A:8E 8AA;54>20=8OE, 0 B0:65 >?@545;OBL ?CB5< D0:B>@=>3> 0=0;870 C45;L=K9 25A A8=4@><>2 2 ?A8E8G5A:>< A>AB>O=88 1>;L=>3>. J.Overall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ndersen (1982). (:0;0 >F5=:8 ?>78B82=KE A8<?B><>2 (Scale for the Assessment of positive symptoms  SAPS) 2:;NG05B 34 A8<?B><0: 30;;NF8=0F88, 8;;N788, 03@5AA82=>5 ?>2545=85, ?>78B82=K5 @0AAB@>9AB20 <KH;5=8O 8 4@., :064K9 87 :>B>@KE >F5=8205BAO ?> AB5?5=8 2K@065==>AB8 >B 0 4> 5. (:0;0 >F5=:8 =530B82=KE A8<?B><>2 (Scale for the Assessment of negative symptoms  SANS) A>45@68B 25 ?@87=0:>2, 2:;NG0NI8E 0DD5:B82=>5 C?;>I5=85, 0;>38N, 01C;8N-0?0B8N, 0=354>=8N-0A>F80;L=>ABL 8 B.?. 064K9 87 ?@87=0:>2 B0:65 >F5=8205BAO ?> AB5?5=8 BO65AB8 >B 0 4> 5. 15 H:0;K 4>?>;=ONB 4@C3 4@C30. =8 >A>15==> G0AB> 8A?>;L7CNBAO 2 ?A8E>D0@<0:>;>38G5A:8E 8AA;54>20=8OE 4;O >?@545;5=8O MDD5:B82=>AB8 ;5G5=8O. SANS 4>?>;=O5B H:0;0 >F5=:8 <KH;5=8O, @5G8 8 A?>A>1=>AB8 : >1I5=8N (Scale for the Assessment of thought, language and communication  TLC), @07@01>B0==0O B>65 N.Andreasen (1986). =0 2:;NG05B 20 ?@87=0:>2, >?8A0==KE :>;8G5AB25==> 2 3@040F8OE >B 0 4> 4 10;;>2. 081>;55 ?>?C;O@=>9 8 ?>;CG82H59 <564C=0@>4=>5 ?@87=0=85 ?@8 :;8=8G5A:>< 87CG5=88 459AB28O =59@>;5?B8:>2 8 4@C38E <5B>4>2 ;5G5=8O H87>D@5=88 O2;O5BAO H:0;0 ?>78B82=KE 8 =530B82=KE A8=4@><>2 (Positive and Negative Syndrome Scale  PANSS), A>AB02;5==0O S.R.Kay, L.A.Opler, A.Fiszbein 2 1986 3. -B0 H:0;0 A>AB>8B 87 3 H:0;, :0640O 87 :>B>@KE <>65B 8A?>;L7>20BLAO 8 A0<>AB>OB5;L=>. (:0;0 ?>78B82=KE (positive) @0AAB@>9AB2 ( ) 2:;NG05B 7 A8<?B><>2 ( 1 7): 1@54, =0@CH5=85 <KH;5=8O, 30;;NF8=0F88, 2>71C645=85, 8458 25;8G8O, 8458 ?@5A;54>20=8O, 2@06451=>ABL. (:0;0 =530B82=KE (negative) @0AAB@>9AB2 (N) 2:;NG05B B>65 7 ?@87=0:>2 (N1 7): ?@8BC?;5==K9 0DD5:B, M<>F8>=0;L=0O >B3>@>65==>ABL, B@C4=>AB8 >1I5=8O, ?0AA82=>-0?0B8G5A:0O A>F80;L=0O >B3>@>65==>ABL, =0@CH5=85 01AB@0:B=>3> <KH;5=8O 8 A?>=B0==>AB8 @5G8, AB5@5>B8?=>ABL <KH;5=8O. (:0;0 >1I8E (general) ?A8E>?0B>;>38G5A:8E A8=4@><>2 (G) A>AB>8B 87 16 A8<?B><>2, =5 2>H54H8E 2 ?5@2K5 2 H:0;K (1 16). 064K9 87 ?A8E>?0B>;>38G5A:8E 8 D5=><5=>;>38G5A:8E ?@87=0:>2 2A5E B@5E H:0; 2 PANSS >F5=8205BAO ?> AB5?5=8 2K@065==>AB8 2 3@040F8OE >B 1 4> 7 10;;>2.  :064>9 87 MB8E H:0; ?@8;>65= B0:65 3;>AA0@89 AB0=40@B878@>20==>9 >F5=:8 2K@065==>AB8 :064>3> ?@87=0:0, GB> ?>2KH05B 8E =0456=>ABL 8 A>?>AB028<>ABL @57C;LB0B>2 A 40==K<8 4@C38E 8AA;54>20B5;59. F5=:0 BO65AB8 A>AB>O=8O ?@>2>48BAO :0: 2 F5;>< ?> PANSS, B0: 8 >B45;L=> ?> A>AB02;ONI8< 55 B@5< H:0;0<. (:0;0 0<8;LB>=0 4;O >F5=:8 45?@5AA88 (Hamilton psychiatric rating scale for depression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ontgomery Asberg Depression Rating Scale, MADRS). (:0;0 ?@54=07=0G5=0 4;O >?5@0B82=>9 >F5=:8 BO65AB8 45?@5AA88 8 55 87<5=5=8O 2 ?@>F5AA5 B5@0?88. =0 8A?>;L7C5BAO 4;O >F5=:8 @57C;LB0B>2 ;5G5=8O ?@8 B5@0?52B8G5A:8E 8AA;54>20=8OE. MADRS ?@>AB0 8 C4>1=0 2 ?@8<5=5=88, 8A?>;L7>20BL 55 <>3CB :0: ?A8E80B@K, B0: 8 2@0G8 >1I59 ?@0:B8:8, ?A8E>;>38, 0 B0:65 <548F8=A:85 A5AB@K. =0 A>45@68B 2A53> 10 >A=>2=KE ?@87=0:>2 45?@5AA88, >F5=8205<KE ?> 6-10;;L=>9 A8AB5<5: :064K9 ?@87=0: A=0165= :@0B:8< 3;>AA0@85< 8 >F5=8205BAO >B 0 4> 6 2 A>>B25BAB288 A =0@0AB0=85< BO65AB8 A8<?B><0. (:0;0 ?@83>4=0 4;O @01>BK A <0;K<8 2K1>@:0<8. (:0;0 &C=30 4;O A0<>>F5=:8 45?@5AA88 (The Zung self-rating depression scale) 1K;0 >?C1;8:>20=0 2 1965 3. 2 5;8:>1@8B0=88 8 2 ?>A;54CNI5< ?>;CG8;0 <564C=0@>4=>5 ?@87=0=85. =0 @07@01>B0=0 =0 >A=>25 4803=>AB8G5A:8E :@8B5@852 45?@5AA88 8 @57C;LB0B>2 >?@>A0 ?0F85=B>2 A MB8< @0AAB@>9AB2><. F5=:0 BO65AB8 45?@5AA88 ?> =59 ?@>2>48BAO =0 >A=>25 A0<>>F5=:8 ?0F85=B0. (:0;0 A>45@68B 20 2>?@>A>2, =0 :064K9 87 :>B>@KE ?0F85=B 405B >B25B ?> G0AB>B5 2>7=8:=>25=8O C =53> B>3> 8;8 8=>3> ?@87=0:0, @0=68@>20==>9 2 G5BK@5E 3@040F8OE: ":@09=5 @54:>", "@54:>", "G0AB>" 8 "1>;LHCN G0ABL 2@5<5=8 8;8 ?>AB>O==>". @8 0=0;875 @57C;LB0B>2 >F5=:0 ?@>2>48BAO ?> A5<8 D0:B>@0<, A>45@60I8< 3@C??K A8<?B><>2, >B@060NI8E GC2AB2> 4CH52=>9 >?CAB>H5==>AB8, @0AAB@>9AB2> =0AB@>5=8O, >1I85 A><0B8G5A:85 8 A?5F8D8G5A:85 A><0B8G5A:85 A8<?B><K, A8<?B><K ?A8E><>B>@=KE =0@CH5=89, AC8F840;L=K5 <KA;8 8 @074@068B5;L=>ABL/=5@5H8B5;L=>ABL. (:0;0 &C=30 8A?>;L7C5BAO 4;O :;8=8G5A:>9 4803=>AB8:8 45?@5AA88, 0 B0:65 ?@8 ?@>2545=88 :;8=8G5A:8E 8A?KB0=89 0=B845?@5AA82=KE A@54AB2. 0 >A=>25 HAM-D 2 1980 3. 1K;0 @07@01>B0=0 4;O >F5=:8 AB5?5=8 BO65AB8 45?@5AA82=>3> A>AB>O=8O H:0;0 <5;0=E>;88 5:0 8 0D05;LA>=0 (The Bech  Rafaelson Melancholia Scale, BRMES). =0 A>AB>8B 87  ?@87=0:>2, 0:F5=B8@>20==KE =0 48DD5@5=F80F88 A8<?B><>2 A=865=8O <>B>@=>9 8 25@10;L=>9 0:B82=>AB8, 0 B0:65 8=B5;;5:BC0;L=>9 8 M<>F8>=0;L=>9 70B>@<>65==>AB8. 064K9 ?@87=0: >F5=8205BAO 2 3@040F88 >B 0 4> 4. > B0:><C 65 ?@8=F8?C MB8<8 02B>@0<8 @0=55 (1979) 1K;0 @07@01>B0=0 H:0;0 <0=89 (The Bech  Rafaelsen Mania Scale, BRMAS) 4;O 87<5@5=8O BO65AB8 <0=80:0;L=KE A>AB>O=89. =0 B0:65 2:;NG05B 11 ?@87=0:>2 2 AB5?5=OE BO65AB8 >B 0 4> 4, A@548 :>B>@KE =0 ?5@2>< <5AB5 AB>OB A8<?B><K ?>2KH5=8O <>B>@=>9 8 25@10;L=>9 0:B82=>AB8, M<>F8>=0;L=K9 ?>4J5< 8 8=B5;;5:BC0;L=>5 (@5G52>5) CA:>@5=85. 15 H:0;K A=0165=K 3;>AA0@8O<8 4;O @0AH8D@>2:8 D5=><5=>;>38G5A:>3> A>45@60=8O :064>3> ?@87=0:0 8 :@8B5@8O<8 >F5=:8 8E BO65AB8. <55B 1>;55 A0<>AB>OB5;L=>5 7=0G5=85 8 G0I5 8A?>;L7C5BAO H:0;0 B@52>38 0<8;LB>=0 (Hamilton Anxiety Scale  -), A>740==0O 2 1959 3. =0 ?@54=07=0G5=0 4;O >F5=:8 8=B5=A82=>AB8 =52@>B8G5A:8E B@52>6=KE @0AAB@>9AB2 8 2:;NG05B 14 =01>@>2 ?@87=0:>2, 2 :064>< 87 :>B>@KE A3@C??8@>20=K @>4AB25==K5 A8<?B><K (:064K9 87 =8E >F5=8205BAO ?> AB5?5=8 BO65AB8 2 3@040F8OE >B 1 4> 4). - 8A?>;L7CNB H8@>:> 2 ?A8E>D0@<0:>;>38G5A:8E 8AA;54>20=8OE. R.P.Snaith =0 >A=>25 - A>740; C:>@>G5==CN H:0;C B@52>38 (Clinical anxiety scale  CAS), 708<AB2>202 B>;L:> 5 55 ?@87=0:>2, 8 ?>:070; AB>;L 65 E>@>H85 @57C;LB0BK ?@8 55 8A?>;L7>20=88 (:0: 8 ?@8 -) 4;O >F5=:8 BO65AB8 B@52>6=>3> A>AB>O=8O. (:0;0 A0<>>F5=:8 B@52>38 &C=30 (The Zung self-rating anxiety scale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ovy anxiety Scale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isher Symptom Check List-Neuroleptics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einrichs 8 A>02B. (1984) 1K;0 @07@01>B0=0 H:0;0 :0G5AB20 687=8 (The Quality of Life Scale  QLS). =0 A>45@68B 21 ?@87=0:, >F5=8205<K9 ?> @57C;LB0B0< ?>;CAB@C:BC@8@>20==>3> 8=B5@2LN, 8 ?@54=07=0G5=0 4;O >F5=:8 AB5?5=8 2K@065==>AB8 45D8F8B0@=KE A8<?B><>2 H87>D@5=88 8 8E 48=0<8:8 2 ?@>F5AA5 ;5G5=8O =59@>;5?B8:0<8. (:0;0 >1I53> :;8=8G5A:>3> 2?5G0B;5=8O (Clinical Global ImpressionScale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ebster Rating Scale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bnormal involuntary Movement Scale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tructured adverse effects rating Scale  SARS), @07@01>B0==0O 2 0@;>2>< C=825@A8B5B5 2 @035 M.Arda, V.Filip 8 K.Soucek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ide-Effect Rating Scale) @07@01>B0=0 2 1987 3. A:0=48=02A:8<8 8AA;54>20B5;O<8 O.Lingjaerde, UG Ahlfors, P.Bech 4;O >F5=:8 ?5@5=>A8<>AB8 ;5:0@AB2 ?@8 8E :;8=8G5A:>< 8A?KB0=88 (?>;=>5 =0720=85 H:0;K "Udvald for Kliniske Undersogelser Scale"). (8@>:> 8A?>;L7CNBAO 55 <>48D8F8@>20==K5 25@A88 4;O 8AA;54>20=8O >B45;L=KE :;0AA>2 ?A8E>B@>?=KE A@54AB2. "0:, H:0;0 4;O 87CG5=8O 0=B845?@5AA0=B>2 A>45@68B A?8A>: 87 26 ?>1>G=KE MDD5:B>2 8, :@><5 B>3>, 3@0DC "@C385 ?>1>G=K5 MDD5:BK". 0;8G85 8 AB5?5=L 2K@065==>AB8 :064>3> 87 =8E >F5=8205BAO 2 10;;0E >B 0 4> 3. (:0;0 ?>1>G=KE MDD5:B>2 A15@30 (Rating Scale for Side Effects Asberg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heehan Clinical Anxiety Rating Scale). -B0 H:0;0 A>45@68B 35 ?C=:B>2 (A8<?B><>2), >E20BK20NI8E ?@0:B8G5A:8 25AL A?5:B@ :;8=8G5A:8E ?@>O2;5=89 ?0B>;>38G5A:>9 B@52>38 (D>18G5A:8E, >1A5AA82=KE, 8=A><=8G5A:8E, 2535B0B82=KE, 0;38G5A:8E 8 4@.) 8 4@C38E ?A8E8G5A:8E @0AAB@>9AB2 (45?5@A>=0;870F8O, 8?>E>=4@8O, 45?@5AA8O). !8<?B><K @0=68@CNBAO ?> AB5?5=8 BO65AB8 >B 0 4> 4 (0  >BACBAB285 A8<?B><0; 1  A;010O AB5?5=L; 2  A@54=OO AB5?5=L; 3  BO65;0O AB5?5=L; 4  :@09=5 BO65;0O AB5?5=L). 064K9 A8<?B>< >F5=8205BAO ?> A>AB>O=8N ?0F85=B0 2 B5G5=85 1 =54., ?@54H5AB2CNI59 70?>;=5=8N H:0;K 8 70B5< >?@545;O5BAO A@54=OO AB5?5=L BO65AB8 A8<?B><>2 (A CG5B>< G0AB>BK 53> ?@>O2;5=89) 70 C:070==K9 ?5@8>4. >A;5 70?>;=5=8O H:0;K @0AAG8BK205BAO AC<<0@=K9 10;;. (:0;0 D>189 0@:A0 (8E0=0 (Marks Sheehan Phobia Scale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heehan Panic and Anticipatory Anxiety Scale  PAAS). -B0 H:0;0 1K;0 @07@01>B0=0 4;O 8AA;54>20=8O 42CE 0A?5:B>2 ?0=8G5A:>3> @0AAB@>9AB20, >F5=:8 @O40 ?>:070B5;59 ?0=8G5A:8E 0B0: () 8 2K@065==>AB8 B@52>38 >6840=8O.  A>>B25BAB288 A :>=F5?F859 D.V.Sheehan 8 K.Sheehan (1983) ?0=8G5A:85 0B0:8 ?> A8<?B><0B8:5 48DD5@5=F8@CNBAO =0 @0725@=CBK5 8 >3@0=8G5==K5.  >A=>2C B0:>3> @0745;5=8O 70;>65=K 4803=>AB8G5A:85 :@8B5@88 ?0=8G5A:>9 0B0:8 DSM-III 8 ?>A;54CNI8E 25@A89 MB>9 :;0AA8D8:0F88: 4 A8<?B><0 8 1>;55 A>>B25BAB2CNB @0725@=CB>9 ; <5=55 4 A8<?B><>2  >3@0=8G5==>9 . #:070==K5 20@80=BK  2 A2>N >G5@54L ?>4@0745;ONBAO =0 A8BC0F8>==K5 8 A?>=B0==K5. (:0;0 ?>72>;O5B >F5=820BL 4 B8?0 ?0=8G5A:8E 0B0:: "@0725@=CBK5 A8BC0F8>==K5 ", "@0725@=CBK5 A?>=B0==K5 ", ">3@0=8G5==K5 ?> A8<?B><0B8:5 A8BC0F8>==K5 " 8 ">3@0=8G5==K5 ?> A8<?B><0B8:5 A?>=B0==K5 ". 8DD5@5=F8@>20==0O >F5=:0 :064>3> 87 4 ?>4B8?>2  2:;NG05B A@54=55 G8A;> 8 A@54=NN 8=B5=A82=>ABL  (>B 0 4> 10) 70 1 =54., ?@54H5AB2CNICN >1A;54>20=8N. B45;L=> >?@545;O5BAO BO65ABL B@52>38 >6840=8O, A>?CBAB2CNI59  (70 B>B 65 ?5@8>4), :>B>@0O 2K@0605BAO ?5@8>4>< 2@5<5=8 2 A>AB>O=88 1>4@AB2>20=8O, 70=OBK< A>AB>O=85< >?0A5=8O 2>7<>6=>3> @0728B8O >G5@54=>9  8;8 >?0A5=8O<8 >:070BLAO 2 A8BC0F8OE, >1KG=> ?@>2>F8@CNI8E 55 D>@<8@>20=85. (:0;0 >1A5AA89 8 :><?C;LA89 5;5 @0C=0 (Yale Brown Obsessive-compulsive Scale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esponse to illness questionnaire  RIQ) [Pritchard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ospital anxiety and depression scale  HAD) [Zigmond A.S., Snaith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achinski ischemia scale) 8;8 55 <>48D8F8@>20==K9 20@80=B (Modified Hachinski ischemia scale) A>AB>OB 87 8 ?C=:B>2. =0G8<>ABL :064>3> 87 MB8E ?C=:B>2 >F5=8205BAO 1 2 10;;0<8. !C<<0@=0O >F5=:0 ?> H:0;5, ?@52KH0NI0O 6 10;;>2, A2845B5;LAB2C5B ?@8 2KO2;5=88 C 1>;L=>3> :>3=8B82=KE (<=5AB8:>-8=B5;;5:BC0;L=KE) @0AAB@>9AB2 > 1>;LH>9 25@>OB=>AB8 <C;LB88=D0@:B=>9 (A>AC48AB>9) 45<5=F88; >F5=:0 <5=55 4 10;;>2  > 25@>OB=>AB8 45<5=F88 0;LF359<5@>2A:>3> B8?0, 0 ?@><56CB>G=K9 20@80=B (>B 4 4> 6 10;;>2)  > 25@>OB=>AB8 A>G5B0==>9 (A>AC48AB>-0;LF359<5@>2A:>9) ?0B>;>388. ;O 845=B8D8:0F88 45?@5AA88 C ?>68;KE 1>;L=KE =0@O4C A H8@>:> ?@8<5=O5<>9 2 ?A8E80B@88 H:0;>9 0<8;LB>=0 8A?>;L7C5BAO H:0;0 >@=5;;0 (Cornell scale for depression in dementia) [Alexopoulous G.S. et al., 1988]. =0 A>AB>8B 87 19 ?@87=0:>2, :>B>@K5 A>AB02;5=K B0:8< >1@07><, GB> <>3CB >F5=820BLAO =0 >A=>25 =01;N45=8O =5 B>;L:> 2@0G0, => 8 ;8F0, >:07K20NI53> ?><>IL 1>;L=><C. K@065==>ABL :064>3> 87 ?@87=0:>2 >F5=8205BAO 3 3@040F8O<8 (>BACBAB285, ;53:0O/C<5@5==0O 8 BO65;0O).  ?>A;54=55 2@5<O 4;O 4803=>AB8G5A:>9 >F5=:8 1>;L=KE 8A?>;L7CNBAO =5 B>;L:> ?5@5G8A;5==K5 4803=>AB8G5A:85 H:0;K, => 8 548=K5 4803=>AB8G5A:85 :@8B5@88, G0I5 2A53> DSM-IV [ , 1994] 8;8 -10 [WHO, 1992], 0 B0:65 4803=>AB8G5A:85 :@8B5@88, @07@01>B0==K5 <564C=0@>4=K<8 M:A?5@B=K<8 3@C??0<8, =0?@8<5@ NINCDS/ADRDA-:@8B5@881  4;O :;8=8G5A:>9 4803=>AB8:8 1>;57=8 ;LF359<5@0 [McKhann G. et al., 1984]; NINCDS/AIREN-:@8B5@88 (NINCDS/ADRDA  National Institute for Neurological and Communicative Disorders and Stroke; Alzheimers Disease and Related Disorders Association (0F8>=0;L=K9 8=AB8BCB =52@>;>38G5A:8E, 8=D5:F8>==KE 1>;57=59 8 8=AC;LB0; AA>F80F8O 1>;57=8 ;LF359<5@0 8 0AA>F88@>20==KE A =59 @0AAB@>9AB2))  4;O 4803=>AB8:8 A>AC48AB>9 45<5=F88 [Roman G.C. et al., 1993], :@8B5@88 Lind Manchester  4;O 4803=>AB8:8 45<5=F88 ;>1=>-28A>G=>3> (DFT) B8?0 [Bran A. et al., 1994]. $C=:F8>=0;L=K5 H:0;K ?@8<5=ONBAO 4;O >F5=:8 BO65AB8 @0AAB@>9AB2 :>3=8B82=KE DC=:F89 8 A>F80;L=>9 457040?B0F88 ?0F85=B>2, B.5. 4;O >F5=:8 AB0488 45<5=F88. 081>;55 G0AB> 4;O C:070==>9 F5;8 8A?>;L7C5BAO (:0;0 >1I53> CEC4H5=8O A>AB>O=8O (Global Deterioration Scale  GDS) [Reisberg . et al., 1982]. -B0 A5<87=0G=0O H:0;0 >F5=:8 AB5?5=8 BO65AB8 45<5=F88  >B >BACBAB28O 87<5=5=89 (0) 4> <0:A8<0;L=> BO65;>9 AB0488 (7) G5@57 ?@><56CB>G=K5 AB0488 =0@0AB0=8O BO65AB8 @0AAB@>9AB2. !>AB>O=85 1>;L=>3> 2 A>>B25BAB288 A MB>9 H:0;>9 >F5=8205BAO :;8=8F8AB>< A CG5B>< 2A5E 8<5NI8EAO 2 53> @0A?>@O65=88 8AB>G=8:>2 8=D>@<0F88. ;O >F5=:8 AB5?5=8 BO65AB8 (8;8 AB0488) 45<5=F88 ?@8<5=O5BAO B0: 65 "(:0;0 AB0489 @0728B8O 45<5=F88" (Clinical Dementia Rating  CDR) [Morris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andoz Clinical Assessment Geriatric  SCAG) [Shader RL. et al., 1974] A>AB>8B 87 19 ?>:070B5;59, 2 A>>B25BAB288 A :>B>@K<8 >F5=820NBAO =5 B>;L:> :>3=8B82=K5 A8<?B><K, => 8 0DD5:B82=K5 =0@CH5=8O, A><0B8G5A:85 60;>1K 8 2>7<>6=>AB8 A0<>>1A;C6820=8O. F5=:0 405BAO :;8=8F8AB>< 2 A>>B25BAB288 A A5<810;;L=>9 AB5?5=LN 2K@065==>AB8 @0AAB@>9AB2. 5:>B>@K5 4@C385 DC=:F8>=0;L=K5 H:0;K, :0: 8 H:0;0 SCAG, ?>72>;ONB >1J5:B82=> >F5=820BL (:;8=8F8AB>< 8;8 <548F8=A:>9 A5AB@>9) @07;8G=K5 0A?5:BK ?A8E8G5A:>3> DC=:F8>=8@>20=8O ?0F85=B>2. 0?@8<5@, "H:0;0 Gottfries  Brane  Steen  GBS", @07@01>B0==0O C.C.Gotfries 2 1982 3., ?>72>;O5B :>;8G5AB25==> (?> A5<810;;L=>9 H:0;5) >F5=820BL A>AB>O=85 8=B5;;5:BC0;L=KE DC=:F89, M<>F8>=0;L=>9 AD5@K, <>B>@8:8 8 =5:>B>@KE ?A8E>B8G5A:8E ?@>O2;5=89. ! ?><>ILN "(:0;K NOS GER" (Nurses Observation Scale for Geriatric Patients), A>740==>9 R.Spiege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nstrumental Activities of Daily Living  IADL), H:0;0 >A=>2=>9 0:B82=>AB8 2 ?>2A54=52=>9 687=8 (basic ADL), H:0;0 D878G5A:>3> A0<>>1A;C6820=8O (Physical Self-Maintenance Scale  PSMS) [Lawton M., Brady E., 1969] 8 4@. A?>;L7>20=85 B0:8E H:0; >A>15==> 206=> 4;O >F5=:8 48=0<8:8 ?A8E8G5A:>3> A>AB>O=8O ?0F85=B>2 A 2K@065==>9 8 BO65;>9 AB5?5=LN 45<5=F88. >2545=G5A:85 H:0;K ?>72>;ONB 40BL :>;8G5AB25==CN >F5=:C =0@CH5=89 ?>2545=8O 8 ?A8E>?0B>;>38G5A:8E @0AAB@>9AB2 (1@540, 30;;NF8=0F89, 45?@5AA88 8 4@.). ;O MB>9 F5;8 =081>;55 G0AB> 8A?>;L7CNBAO: :>@>B:0O ?A8E80B@8G5A:0O >F5=>G=0O H:0;0 (Brief Psychiatric Rating Scale - BPRS) [Overall J.E., Gorham D.R., 1962], H:0;0 >F5=:8 =5:>3=8B82=KE DC=:F89 ?@8 1>;57=8 ;LF359<5@0 (ADAS non-cognitive subscale ADAS-non-cog); H:0;0 >F5=:8 ?>2545=8O 1>;L=KE A 45<5=F859  CERAD BRSD (Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for AD) [Tariot P.N. et al, 1995] 8 4@. A8E><5B@8G5A:85 H:0;K ?@8<5=ONBAO 4;O >?@545;5=8O 2K@065==>AB8 @07;8G=KE :><?>=5=B>2 <=5AB8:>-8=B5;;5:BC0;L=>3> (:>3=8B82=>3>) A=865=8O, 2 B>< G8A;5 ?0<OB8, >@85=B8@>2:8, 8=B5;;5:BC0;L=KE DC=:F89, @5G8, ?8AL<0, GB5=8O, AG5B0, ?@0:A8A0 8 >?B8:>-?@>AB@0=AB25==>9 45OB5;L=>AB8. 081>;55 H8@>:> @0A?@>AB@0=5=K A;54CNI85 H:0;K. 8=8B5AB >F5=:8 ?A8E8G5A:>3> A>AB>O=8O (Mini-mental scale examination  MMSE)  :>@>B:0O AB@C:BC@8@>20==0O H:0;0 >F5=:8 :>3=8B82=KE DC=:F89, :>B>@0O ?>72>;O5B 2KO28BL A8=4@>< :;8=8G5A:8 2K@065==>9 45<5=F88 (?@8 >F5=:5 =865 16 10;;>2) 8;8 ;53:>3> A=865=8O :>3=8B82=KE DC=:F89 (>F5=:0 >B 24 4> 16 10;;>2) ?@8 <0:A8<0;L=>< ?>:070B5;5 (30 10;;>2). F5=:0, ?@52KH0NI0O 28 10;;>2, A>>B25BAB2C5B >1KG=> 2>7@0AB=>9 =>@<5, 0 480?07>= >F5=>: >B 25 4> 28 10;;>2 <>65B A2845B5;LAB2>20BL > =0G0;L=><, B.5. A0<>< ;53:>< C@>2=5 A=865=8O <=5AB8:>-8=B5;;5:BC0;L=KE DC=:F89. 4=0:> ?@82545==K5 7=0G5=8O :>;8G5AB25==KE ?>:070B5;59 O2;ONBAO AC3C1> >@85=B8@>2>G=K<8 2284C 1>;LH8E :C;LBC@0;L=KE @07;8G89 8AE>4=KE (B.5. A>>B25BAB2CNI8E =>@<5) ?>:070B5;59, 0 B0:65 2 A2O78 A 2;8O=85< =0 =8E >1@07>20B5;L=>3> C@>2=O ?0F85=B>2. (8@>:>5 ?@8<5=5=85 =0E>48B H:0;0 >F5=:8 :>3=8B82=KE DC=:F89 ?@8 1>;57=8 ;LF359<5@0 (ADAS-cog), A>740==0O W.G.Rosen 8 A>02B. 2 1984 3., 2 B>< G8A;5 ?@8 >F5=:5 B5@0?52B8G5A:8E MDD5:B>2 ;5:0@AB25==KE A@54AB2. (:0;0 ?@54AB02;O5B A>1>9 10B0@5N :>@>B:8E 8=48284C0;L=KE B5AB>2, A ?><>ILN :>B>@KE 8AA;54CNBAO ?0<OBL, @07;8G=K5 ?0@0<5B@K DC=:F88 @5G8, :>=AB@C:B82=K9 8 8450B>@=K9 ?@0:A8A 8 B.?. K?>;=5=85 MB8E B5AB>2 4>2>;L=> B@C4>5<:>5, >=> 70=8<05B ?@8<5@=> 1 G. ;O >F5=:8 A>AB>O=8O :>3=8B82=KE DC=:F89 ?@8<5=ONBAO 8 B0:85 H:0;K, :0: Blessed-Roth Dementia Scale, Mattis Dementia Rating Scale, Syndrom Kurz ;020 7. "5@0?8O ?A8E8G5A:8E 1>;57=59 A=>2=K5 ?@8=F8?K 8 284K B5@0?88 2 ?A8E80B@88.  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) ;020 7 " / !%'!%  !>2@5<5==>5 ;5G5=85 ?A8E8G5A:8E 701>;520=89 ?@54?>;0305B :><?;5:A=>5 ?@8<5=5=85 @07;8G=KE <5B>4>2. 8>;>38G5A:CN B5@0?8N, :0: ?@028;>, A>G5B0NB A ?A8E>B5@0?859 8 <5@>?@8OB8O<8 ?> A>F80;L=>-B@C4>2>9 @5018;8B0F88 1>;L=KE. !+  &+  + "   !%"  !>>B=>H5=85 C:070==KE <5B>4>2 B5@0?52B8G5A:>3> 2>7459AB28O 87<5=O5BAO 2 7028A8<>AB8 >B MB0?0 701>;520=8O. A;8 2 ?5@8>4 <0=8D5AB0F88 ?A8E>70 ?@5>1;040NB <548:0<5=B>7=K5 <5B>4K ;5G5=8O, B> ?> <5@5 C<5=LH5=8O >AB@>BK A>AB>O=8O, >1@0B=>3> @0728B8O ?A8E>?0B>;>38G5A:8E @0AAB@>9AB2 8 AB0=>2;5=8O @5<8AA88 2A5 1>;LH55 7=0G5=85 ?@8>1@5B0NB ?A8E>B5@0?52B8G5A:85 <5B>4K, <5@K A>F80;L=>9 @5040?B0F88 8 2>AAB0=>2;5=85 B@C4>2KE =02K:>2. #A?5E B5@0?88 2> <=>3>< 7028A8B >B 2>7<>6=>AB8 <0:A8<0;L=>9 040?B0F88 ;5G51=KE <5@>?@8OB89 : >A>15==>ABO< :;8=8G5A:8E ?@>O2;5=89 1>;57=8. 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oirault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ampo LA. et al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'!/ " / "5@<8=>< "18>;>38G5A:0O B5@0?8O" B@048F8>==> >1>7=0G0NB <5B>4K ;5G51=>3> 2>7459AB28O =0 18>;>38G5A:85 ?@>F5AAK, ;560I85 2 >A=>25 ?A8E8G5A:8E =0@CH5=89. 8>;>38G5A:0O B5@0?8O O2;O5BAO >A=>2=K< <5B>4>< ;5G5=8O M=4>35==KE 8 >@30=8G5A:8E ?A8E8G5A:8E 701>;520=89, 2 B>< G8A;5 A8<?B><0B8G5A:8E 8 0;:>3>;L=KE ?A8E>7>2, M?8;5?A88; >=0 8A?>;L7C5BAO 4;O :C?8@>20=8O ?A8E8G5A:8E =0@CH5=89 ?>3@0=8G=>3> C@>2=O  =52@>B8G5A:8E, 48AB8<8G5A:8E 8 ?A8E>A><0B8G5A:8E @0AAB@>9AB2, 0 B0:65 ?0B>E0@0:B5@>;>38G5A:8E 45280F89, >B=>AOI8EAO : :@C3C @0AAB@>9AB2 ;8G=>AB8 (?A8E>?0B89). =0, :0: ?@028;>, 2E>48B 2 :><?;5:A <5@>?@8OB89, =0?@02;5==KE =0 2>AAB0=>2;5=85 74>@>2LO 8 A>F80;L=CN @5018;8B0F8N ?A8E8G5A:8 1>;L=KE.  MB>B :><?;5:A =0@O4C A 18>;>38G5A:>9 B5@0?859 2E>4OB @07;8G=K5 D>@<K ?A8E>B5@0?88, 2 B>< G8A;5 ?A8E>:>@@5:F8O, 8 4@C385 ;5G51=K5 2>7459AB28O. 8>;>38G5A:0O B5@0?8O 15@5B A2>5 =0G0;> A <0;O@8>B5@0?88, ?@8<5=5==>9 J.Wagner-Jauregg (1918) 4;O ;5G5=8O ?@>3@5AA82=>3> ?0@0;8G0 8 22545=8O 2 ?@0:B8:C <5B>40 =0@:>B8G5A:>3> A=0 J.Klaesi 2 1922 3. &5;CN M?>EC 2 @0728B88 18>;>38G5A:>9 B5@0?88 A>AB028;8 H>:>2K5 <5B>4K  8=AC;8=>:><0B>7=0O B5@0?8O [Sakel M., 1935], 2?5@2K5 ?@8<5=5==0O 2 >AA88 .!. @>=D5;L4>< 8 -./.(B5@=15@3><; <548:0<5=B>7=0O AC4>@>6=0O [Meduna L., 1937] 8 M;5:B@>AC4>@>6=0O B5@0?8O [Carletti ., 1938; Bini L., 1938], @0A?@>AB@0=5=8N :>B>@>9 2 >AA88 A?>A>1AB2>20;8 8AA;54>20=8O ./. !5@59A:>3> 8 ./. >BHB59=0; 0B@>?8=>:><0B>7=0O B5@0?8O [068= .$., 1984; Forrer S., 1950].  ?>A;54=85 45AOB8;5B8O 8=B5@5A : H>:>2K< <5B>40< (70 8A:;NG5=85< M;5:B@>AC4>@>6=>9 B5@0?88) 7=0G8B5;L=> A=878;AO. =8 A59G0A @54:> ?@8<5=ONBAO 2 :;8=8G5A:>9 ?@0:B8:5. 8@>35==0O B5@0?8O (<0;O@8>B5@0?8O, AC;LD>78=>B5@0?8O, ;5G5=85 A ?><>ILN ?8@>35=0;0), 8A?>;L7C5<0O 4;O ;5G5=8O ?A8E8G5A:8E @0AAB@>9AB2 =0 ?@>BO65=88 A2KH5 50 ;5B, 2 =0AB>OI55 2@5<O B0:65 ?>GB8 =5 =0E>48B ?@8<5=5=8O. 5 2>H;8 2 H8@>:CN :;8=8G5A:CN ?@0:B8:C 8 B5@0?8O A=>< (2:;NG0O M;5:B@>A>=), 485B>-@073@C7>G=0O B5@0?8O, ?A8E>E8@C@38O. > >4=>2@5<5==> ?>O28;8AL <5B>4K ;5G5=8O O@:8< A25B>< (D>B>B5@0?8O), 45?@820F859 A=0. >;55 2A53> 18>;>38G5A:0O B5@0?8O A2O70=0 A ?@8<5=5=85< ;5:0@AB25==KE A@54AB2  ?A8E>B@>?=KE ?@5?0@0B>2, 3>@<>=>2, 28B0<8=>2 8 4@. A=>2=K< <5B>4>< 18>;>38G5A:>3> ;5G5=8O ?A8E8G5A:8E @0AAB@>9AB2 O2;O5BAO ?A8E>D0@<0:>;>38G5A:0O B5@0?8O. A8E>D0@<0:>;>38G5A:0O B5@0?8O. AB>@8O ?A8E>D0@<0:>;>388  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) !%$ '!/ " / AB>@8O ?A8E>D0@<0:>;>388 !>2@5<5==0O ?A8E>D0@<0:>;>38O 15@5B A2>5 =0G0;> A 40-E 3>4>2 XX 2., :>340 4;O ;5G5=8O 2A5E ?A8E8G5A:8E @0AAB@>9AB2 AB0;8 ?@8<5=OBL 0=B838AB0<8==K5 25I5AB20 A 2K@065==K< A540B82=K< 459AB285<. !@548 =8E >A=>2=K< ?@5?0@0B>< AG8B0;AO ?@><5B078= (D5=53@0=). >A;54>202H89 70B5< ?5@52>@>B 2 ?A8E>D0@<0:>;>388 A2O70= A 8<5=5< D@0=FC7A:>3> CG5=>3> P.Chapentier, :>B>@K9 2 1950 3. A8=B578@>20; ?5@2K9 =59@>;5?B8:  E;>@?@><078=.  1952 3. H.Laborit ?>:070;, GB> E;>@?@><078= 8<55B 7=0G8B5;L=> 1>;55 2K@065==>5 F5=B@0;L=>5 459AB285, G5< 2A5 8725AB=K5 2 B> 2@5<O ;5:0@AB25==K5 A@54AB20, 2 B>< G8A;5 ?@><5B078=.  ?5@2KE @01>B0E H.Laborit E0@0:B5@87>20; E;>@?@><078= :0: <>I=K9 AB018;870B>@ 2535B0B82=>9 =5@2=>9 A8AB5<K. >765 >= >1=0@C68; C=8:0;L=>5 A2>9AB2> E;>@?@><078=0  53> A?>A>1=>ABL A?5F8D8G5A:8 2;8OBL =0 A8<?B><0B8:C ?A8E>70. >GB8 >4=>2@5<5==> A MB8< 1K;8 >?C1;8:>20=K @01>BK >1 MDD5:B82=>AB8 E;>@?@><078=0 ?@8 <0=80:0;L=KE A>AB>O=8OE [Hamon J., 1952]. (8@>:85 :;8=8G5A:85 8AA;54>20=8O ?@5?0@0B0 1K;8 ?@>2545=K D@0=FC7A:8<8 ?A8E80B@0<8 J.Hamon, I.Parire, I.Vellur (1952), :>B>@K5 CB>G=8;8 A?5:B@ 53> B5@0?52B8G5A:>3> 459AB28O. J.Delay 8 P.Deniker 2 1952 3. 225;8 ?>=OB85 "=59@>;8B8G5A:>9 B5@0?88", 2 A2O78 A G5< ?@5?0@0B0< A 0=B8?A8E>B8G5A:>9 0:B82=>ABLN 1K;> 40=> =0720=85 "=59@>;8B8:8". 2C<O 3>40<8 ?>765 H.Steck (1954) >1=0@C68;, GB> ?@8 ?@8<5=5=88 E;>@?@><078=0 2>7=8:0NB =59@>B@>?=K5 ?>1>G=K5 MDD5:BK 2 2845 ?0@:8=A>=>?>4>1=KE 38?5@:8=5B8G5A:8E 8 0:8=5B8G5A:8E =0@CH5=89. -B8 =01;N45=8O 40;8 >A=>20=85 J.Delay 8 P.Deniker 87<5=8BL =0720=85 3@C??K ;5:0@AB25==KE A@54AB2, : :>B>@>9 >B=>A8;AO E;>@?@><078=,  "=59@>;8B8:8" AB0;8 =07K20BLAO "=59@>;5?B8:0<8". B>@>9 206=59H89 =59@>;5?B8: 30;>?5@84>; ?>O28;AO 2 1958 3. = 1K; @07@01>B0= P.Janssen 2 5;L388.  >AA88 E;>@?@><078= 1K; A8=B578@>20= B0:65 2 50-E 3>40E ..)C:8=>9 2> A5A>N7=>< =0CG=>-8AA;54>20B5;LA:>< E8<8:>-D0@<0F52B8G5A:>< 8=AB8BCB5 8=<54?@><0 !!!  ?>4 =0720=85< "0<8=078=" 8 ?>4@>1=> D0@<0:>;>38G5A:8 87CG5= ..0H:>2A:8<.  ?A8E80B@8G5A:>9 :;8=8:5 E;>@?@><078= 2?5@2K5 1K; ?@8<5=5= 8 87CG5= =0 :0D54@5 ?A8E80B@88 &5=B@0;L=>3> 8=AB8BCB0 CA>25@H5=AB2>20=8O 2@0G59, :>B>@>9 @C:>2>48; 2 1954 3. ..!=56=52A:89 ["0@0A>2 .., 1959].  E>45 40;L=59H53> 87CG5=8O @07;8G=KE =59@>;5?B8:>2 ..!=56=52A:89 @07@01>B0; 48DD5@5=F8@>20==K5 ?>:070=8O : 8E ?@8<5=5=8N 8 225; 2 ?@0:B8:C A8AB5<C ?>445@6820NI59 =59@>;5?B8G5A:>9 B5@0?88.  ?>A;54CNI5< ./.2@CF:8< 8 53> A>B@C4=8:0<8 1K; @07@01>B0= @O4 <5B>48: A@02=8B5;L=>3> 8AA;54>20=8O =>2KE =59@>;5?B8:>2. ;03>40@O CA8;8O< MB8E CG5=KE, 0 B0:65 <=>38E 4@C38E 8AA;54>20B5;59, =59@>;5?B8:8 2 =0H59 AB@0=5, :0: 8 2> 2A59 <8@>2>9 ?A8E80B@88, 70=O;8 254CI55 <5AB> 2 ?A8E80B@8G5A:>9 ;5G51=>9 ?@0:B8:5. AB>@8O 0=B845?@5AA0=B>2 =0G0;0AL 2 1957 3. A >1=0@C65=8O 0=B845?@5AA82=KE A2>9AB2 C =5:>B>@KE ?@>B82>BC15@:C;57=KE ?@5?0@0B>2. A?>;L7>20BL MB>B "?>1>G=K9" MDD5:B 4;O ;5G5=8O 45?@5AA88 ?@54;>68; N.Kline. > A>2@5<5==K< ?@54AB02;5=8O< > <5E0=87<5 459AB28O MB8 0=B845?@5AA0=BK <>3;8 1KBL >B=5A5=K : 3@C??5 8=3818B>@>2 <>=>0<8=>:A8407K ().  MB>B 65 ?5@8>4 1K;8 2KO2;5=K 0=B845?@5AA82=K5 A2>9AB20 C 25I5AB2, E8<8G5A:8 AE>4=KE A E;>@?@><078=><, B@8F8:;8G5A:8E 0=B845?@5AA0=B>2 (8<8?@0<8= 8 4@.).  1955 3. H259F0@A:89 ?A8E80B@ R.Kuhn ?>;CG8; ?>;>68B5;L=K5 @57C;LB0BK ?@8 ;5G5=88 8<8?@0<8=>< 1>;L=KE H87>D@5=859, 0 2 1958 3.  M=4>35==>9 45?@5AA859. 5E0=87< 0=B845?@5AA82=>3> 459AB28O ?@5?0@0B>2 MB>9 3@C??K 1K; CAB0=>2;5= 8 >?8A0= 2 1960 3. 0<5@8:0=A:8< 8AA;54>20B5;5< J.Axelrod. = ?>:070;, GB> =59@>E8<8G5A:>9 >A=>2>9 0=B845?@5AA82=>3> 459AB28O B@8F8:;8G5A:8E ?@5?0@0B>2 O2;O5BAO ?@O<>5 2;8O=85 MB8E 25I5AB2 =0 ?@5A8=0?B8G5A:89 70E20B A5@>B>=8=0 8 =>@04@5=0;8=0 2 A8=0?A0E =59@>=>2 &! 8 ?>;CG8; 70 MB> 8AA;54>20=85 >15;52A:CN ?@5<8N.  ?>A;54CNI5< ?>O28;8AL 4@C385 0=B845?@5AA0=BK. 5@2K9 >@838=0;L=K9 >B5G5AB25==K9 0=B845?@5AA0=B  070D5=, :0: 8 0<8=078=, 1K; @07@01>B0= 2 ;01>@0B>@88, 2>73;02;O5<>9 ..)C:8=>9 8 2 C?><8=02H5<AO @0=55 8=AB8BCB5 87CG5= ..0H:>2A:8<. >74=55 ..0H:>2A:89 A>740; B5B@0F8:;8G5A:89 0=B845?@5AA0=B  ?8@;8=4>; (?8@0784>;).  1954 3. R.Sternbach A8=B578@>20; ?5@2K9 15=7>48075?8=>2K9 B@0=:28;870B>@  E;>@48075?>:A84, 2KA>:CN B5@0?52B8G5A:CN 0:B82=>ABL :>B>@>3> 2 >B=>H5=88 B@52>38 2 B>< 65 3>4C >1=0@C68; F.Berger. 5@2K9 >B5G5AB25==K9 B@0=:28;870B>@ D5=075?0< 1K; A>740= ?>74=55  2 1970 3. .. >30BA:8<, ... 8E;O52K< 8 ".. ;83C;L 2 ;01>@0B>@88 .. 0:CA>20 =AB8BCB0 D0@<0:>;>388  !!! .  CA;>28OE ?A8E80B@8G5A:>9 :;8=8:8 >= 1K; ?>4@>1=> 8AA;54>20= 2 1979 3. ./. 2@CF:8< 8 ...;5:A0=4@>2A:8<.  =>2><C ?>:>;5=8N B@0=:28;870B>@>2, ?>O282H8EAO 2 80-5 3>4K, >B=>AOBAO ?@5?0@0BK A =0?@02;5==K< 459AB285<: A ?@5>1;040=85< 38?=>B8G5A:>3> MDD5:B0 (B@807>;0<, 7>;?845<), 0=:A8>;8B8G5A:>3> 459AB28O 2 A>G5B0=88 A M;5<5=B0<8 0=B845?@5AA82=>3> MDD5:B0 (0;?@07>;0<). 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A8=4@><0. ;O >?8A0=8O @07;8G89 2 8=B5=A82=>AB8 459AB28O =59@>;5?B8:>2 8A?>;L7C5BAO ?>=OB85 <>I=>AB8, 8;8 ?>B5=B=>AB8, ?@5?0@0B0, :>B>@>5 >B@0605B A>>B=>H5=85 4>7K 8 MDD5:B0: G5< <5=LH5 MDD5:B82=0O 4>70, B5< 1>;LH5 ?>B5=B=>ABL ?@5?0@0B0 (=0?@8<5@, B@8D;N?5@078= >1;0405B 1>;LH59 ?>B5=B=>ABLN, G5< E;>@?@><078=) (A ?>=OB85< "<>I=>ABL =59@>;5?B8:0" B5A=> A2O70=> ?>=OB85 "E;>@?@><078=>2K9 M:2820;5=B", :>B>@>5 1K;> 22545=> J.M.Davis (1974). >A;54=55 >B@0605B =5>1E>48<>ABL A>740=8O AB0=40@B=>3> ?>:070B5;O 4;O A>?>AB02;5=8O <>I=>AB8 459AB28O @07;8G=KE =59@>;5?B8:>2 8 >1I59 "=03@C7:8" =59@>;5?B8:0<8 C >4=>3> 1>;L=>3>. %;>@?@><078=>2K9 M:2820;5=B ?@54AB02;O5B A>1>9 M<?8@8G5A:8 CAB0=>2;5==CN 4>7C =59@>;5?B8:0, M:2820;5=B=CN ?> A8;5 459AB28O 100 <3 (Davis J.M., 1974] 8;8 500 <3 [Cornwall P.L. et al., 1996] E;>@?@><078=0. %;>@?@><078=>2K9 M:2820;5=B 8A?>;L7C5BAO 2 :;8=8G5A:>9 ?A8E>D0@<0:>;>388 [Fioritti A., 1997; Tyson P.J. et al., 1998] 8 >A>15==> H8@>:>  2 18>;>38G5A:>9 ?A8E80B@88, :>340 B@51C5BAO C=8D8F8@>20BL >F5=:C D0@<0:>B5@0?88 C @07=KE ?0F85=B>2 4> =0G0;0 8AA;54>20=8O 8;8 ?@>25AB8 >1>1I5==CN >F5=:C 55 2;8O=8O =0 B>B 8;8 8=>9 18>;>38G5A:89 ?>:070B5;L 8 B.?. 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"  =AC;8=>B5@0?8O. -B>B 284 B5@0?88 2 =0AB>OI55 2@5<O ?@8<5=O5BAO >G5=L @54:>. >A;5 H8@>:>3> 2=54@5=8O 2 ?A8E80B@8G5A:CN ?@0:B8:C ?A8E>B@>?=KE A@54AB2 ?>:070=8O : 8=AC;8=>B5@0?88 7=0G8B5;L=> AC78;8AL. -B> >1JOA=O5BAO =5 B>;L:> 1>;55 H8@>:8< A?5:B@>< 8 :;8=8G5A:>9 48DD5@5=F8@>20==>ABLN 459AB28O ?A8E>D0@<0:>;>38G5A:8E ?@5?0@0B>2, => 8 B5<, GB> 8=AC;8=H>:>2>5 ;5G5=85 ?> A@02=5=8N A ?A8E>D0@<0:>B5@0?859 8<55B 1>;LH5 A><0B8G5A:8E ?@>B82>?>:070=89 8 1>;LH89 @8A: @0728B8O BO65;KE >A;>6=5=89. @><5 B>3>, >=> 8 B5E=8G5A:8 1>;55 A;>6=>. %>BO 8=AC;8=H>:>20O B5@0?8O 2 A>2@5<5==>9 ?A8E80B@88 =5 8A:;NG5=0 ?>;=>ABLN [>@:8=0 .., 0:>A8=0 .., 8G:> .., 1995; Ayd F.J., 1995], >=0 C65 =5 C?><8=05BAO :0: 0:BC0;L=K9 <5B>4 ;5G5=8O 2 ?>A;54=8E @C:>2>4AB20E ?> ?A8E80B@88 [>?>2 ..., 84 .., 1997; Kaplan H.I., Sadock B.J., 1996]. >:070=8O : MB><C 284C B5@0?88 >3@0=8G820NBAO 2 >A=>2=>< A;CG0O<8 @578AB5=B=>AB8 : ?A8E>D0@<0:>;>38G5A:8< A@54AB20< 4;O 55 ?@5>4>;5=8O [Lokshin P., 1995]. =>340 38?>3;8:5<8G5A:85 4>7K 8=AC;8=0 8A?>;L7CNB 2 :><?;5:A=>9 B5@0?88 =0@O4C A ?A8E>B@>?=K<8 ?@5?0@0B0<8, ?A8E>B5@0?859 8 4@C38<8 <5B>40<8 ;5G5=8O. A=>2=0O <5B>48:0 ?@>2545=8O 8=AC;8=H>:>2>9 B5@0?88 A> 2@5<5=8 55 22545=8O 2 ?A8E80B@8G5A:CN ?@0:B8:C [Sakel M., 1935] =5 ?@5B5@?5;0 ACI5AB25==KE 87<5=5=89. 5G5=85 A>AB>8B 2 5654=52=>< 22545=88 ?>AB5?5==> C25;8G820NI8EAO 4>7 8=AC;8=0 (=0G8=0O A 4  8 C25;8G820O 4>7C =0 4  5654=52=>) 4> 4>AB865=8O :><0B>7=>3> A>AB>O=8O. ><0B>7=0O 4>70 8=AC;8=0 AC3C1> 8=48284C0;L=0 (G0I5 2A53> 2 ?@545;0E 60 150 ). >;8G5AB2> :><0B>7=KE A>AB>O=89 =0 :C@A ;5G5=8O :>;51;5BAO >B 15 4> 40. $>B>B5@0?8O. 5G5=85 O@:8< 15;K< A25B>< (0=3;. "bright light therapy"), 8;8 D>B>B5@0?8O, O2;O5BAO >B=>A8B5;L=> =>2K< <5B>4>< 2 ?A8E80B@88, E>BO C?><8=0=8O > =5< 8<5NBAO 2 B@C40E @50B5CA0  2@0G0, 682H53> 2> II 2. 4> =.M., :>B>@K9 A2O7K20; ?>=865==>5 =0AB@>5=85 78<>9 A 45D8F8B>< 4=52=>3> A25B0 8 ?@>?8AK20; ?0F85=B0< A>;=5G=K5 20==K [!>;>2L520 .., $8H<0= ./., 1996; Roffer R., 1991]. 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A5 MB> 1;5ABOI85 ?@8<5@K @01>B, >B=>AOI8EAO A>>B25BAB25==> : >?8A0B5;L=>9, 0=0;8B8G5A:>9 8 B@0=A:C;LBC@0;L=>9 M?845<8>;>388. &5;5=0?@02;5==K5 M?845<8>;>38G5A:85 8AA;54>20=8O AB0;8 ?@>2>48BLAO B>340, :>340 ?A8E80B@K >A>7=0;8 F5==>ABL M?845<8>;>388 :0: =0C:8, :>340 1K;8 AD>@<C;8@>20=K 55 F5;L, ?@54<5B 8 <5B>4. @8=OB> AG8B0BL, GB> ?5@2K5 H038 2 D>@<8@>20=88 M?845<8>;>38G5A:>3> =0?@02;5=8O 2 87CG5=88 ?A8E8G5A:8E 701>;520=89 >B=>AOBAO : 1956 3. -B> >B@065=> 2 :=835 D.D.Reid (1960), :>B>@0O ?>A;C68;0 >A=>2>9 4;O @5:><5=40F88 M:A?5@B>2  >1 >@30=870F88 <564C=0@>4=KE ?@>3@0<< M?845<8>;>38G5A:>3> 87CG5=8O ?A8E8G5A:8E 701>;520=89.  8AB>@88 ?A8E80B@8G5A:8E M?845<8>;>38G5A:8E 8AA;54>20=89 <>6=> 2K45;8BL >B45;L=K5 ?5@8>4K, >B;8G0NI85AO =0?@02;5==>ABLN 2=8<0=8O =0 >?@545;5==K5 D0:B>@K. ;8B5;L=>5 2@5<O 1>;LH8=AB2> M?845<8>;>38G5A:8E @01>B 1K;> ?>A2OI5=> ?>8A:0< MB8>;>38G5A:8E D0:B>@>2 ?A8E8G5A:8E 701>;520=89, >A>15==> M=4>35==KE. 7CG0;0AL 8E G0AB>B0 2 @07=KE A>F80;L=KE 3@C??0E, C ;8F @07=>3> 2>7@0AB0 8 ?>;0, C ;8F A @07=>9 =0A;54AB25==>ABLN, 2 A5<LOE A @07;8G=K<8 <>45;O<8 2708<>>B=>H5=89 <564C 45BL<8 8 @>48B5;O<8 (>A>15==> <564C 45BL<8 8 <0B5@LN), C ;8F, ?5@5=5AH8E B> 8;8 8=>5 M:7>35==>5 2>7459AB285 (=0?@8<5@, ?A8E>35=8N 8;8 G5@5?=>-<>73>2CN B@02<C), 8 4@. %>BO MB8>;>38O M=4>35==KE ?A8E>7>2 >AB0;0AL =5OA=>9, 7=0=8O > =8E ACI5AB25==> >1>30B8;8AL. 0?@8<5@, <>6=> AG8B0BL 4>:070==K<, GB> 1>;LHCN @>;L 2 @0728B88 M=4>35==KE 701>;520=89 83@0NB 35=5B8G5A:89 8 4@C385 18>;>38G5A:85 D0:B>@K (B0:85, :0: ?>; 8 2>7@0AB). >-2848<><C, 4>AB0B>G=> 7=0G8B5;5= 2:;04 8 B0: =07K205<KE A@54>2KE D0:B>@>2, E>BO ?>-?@56=5<C B@C4=> A:070BL, =0A:>;L:> >= ACI5AB25= 8 :0:85 8<5==> D0:B>@K 8<5NB =081>;LH55 7=0G5=85. -B8 8AA;54>20=8O ?@>4>;60NBAO 8 A59G0A. > <=>38E @01>B0E >B@065=K B0: =07K205<K5 B@0=A:C;LBC@0;L=K5 M?845<8>;>38G5A:85 8AA;54>20=8O.  8E >A=>25 ;568B 38?>B570, GB> 2 A>>1I5AB20E, @07;8G0NI8EAO <564C A>1>9 :C;LBC@0;L=>, <>3CB 1KBL 7=0G8B5;L=K5 @07;8G8O 2 G0AB>B5 8 :;8=8G5A:>9 :0@B8=5 ?A8E8G5A:8E @0AAB@>9AB2. 06=59H8< @57C;LB0B>< MB8E @01>B AB0;> ?>=8<0=85 =5>1E>48<>AB8 8<5BL AB0=40@B=K5 8=AB@C<5=BK 8AA;54>20=8O 8 4803=>AB8:8, ?>B><C GB> 8<5==> 8E >BACBAB285 ?@82>48;> : 2KO2;5=8N <=>38E @07;8G89. -B> ?@825;> : A>740=8N <=>3>G8A;5==KE AB0=40@B87>20==KE ?@>F54C@ >A<>B@0 1>;L=KE 8 845=B8D8:0F88 8E A>AB>O=89 (:;8=8G5A:8E H:0; 8 B.?.). 0A?@>AB@0=5=85 :><?LNB5@>2, :>B>@>5 A5@L57=> ?>2;8O;> =0 <KH;5=85 8AA;54>20B5;59, AB0;> 4>?>;=8B5;L=>9 ?@54?>AK;:>9 : D>@<0;870F88 MB8E ?@>F54C@. 0728B85 M?845<8>;>38G5A:8E ?A8E80B@8G5A:8E 8AA;54>20=89 2 >AA88 H;> =5A:>;L:> 4@C38< ?CB5<. !@548 <=>38E ?@8G8= <>6=> C:070BL 8 >1>A>1;5==>ABL >B5G5AB25==>9 ?A8E80B@88, 8 1>;LH55, G5< =0 0?045, 2=8<0=85 : :;8=8G5A:>9 :0@B8=5 ?A8E8G5A:8E @0AAB@>9AB2, 8 A2O70==K5 A MB8< 7=0G8B5;L=K5 CA?5E8 2 87CG5=88 B5G5=8O =5:>B>@KE 701>;520=89, >A>15==> H87>D@5=88. >MB><C H8@>:85 8AA;54>20=8O 2 >1;0AB8 M?845<8>;>388 M=4>35==KE ?A8E>7>2, =0G02H85AO 2 A5@548=5 60-E 3>4>2, A A0<>3> =0G0;0 1K;8 >@85=B8@>20=K =0 2KOA=5=85 ?@58<CI5AB25==> :;8=8G5A:8E ?@>1;5<. # MB>3> ?CB8 1K;8 A2>8 4>AB>8=AB20 8 =54>AB0B:8. 3> 4>AB>8=AB20 A45;0;8 2>7<>6=K< ?>;CG5=85 ACI5AB25==KE =>2KE 7=0=89 > 70:>=><5@=>ABOE B5G5=8O M=4>35==KE ?A8E>7>2, 0 53> =54>AB0B:8 >1CA;>28;8 B@C4=>ABL A>?>AB028<>AB8 @57C;LB0B>2 >B5G5AB25==KE 8AA;54>20=89 A @57C;LB0B0<8 @01>B 70@C156=KE 02B>@>2. 5@2>=0G0;L=0O 845O, ;560I0O 2 >A=>25 >B5G5AB25==KE @01>B 2 >1;0AB8 M?845<8>;>388 ?A8E8G5A:8E @0AAB@>9AB2, 70:;NG0;0AL 2 B><, GB>1K ?@>25@8BL 8 CB>G=8BL 4>AB865=8O :;8=8:8 =5 =0 >3@0=8G5==>< 8 BI0B5;L=> >B>1@0==>< <0B5@80;5, 0 =0 1075 <0AA>2>3> >1A;54>20=8O 1>;L=KE, B.5. 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"0:, =52K1>@>G=K< <5B>4>< <>6=> 87CG0BL B0:>9 >1I89 2>?@>A, :0: @0A?@>AB@0=5==>ABL H87>D@5=88, => ?@8 8AA;54>20=88 2;8O=8O >B45;L=KE D0:B>@>2 (?>;0, 2>7@0AB0 8 B.4.) =0 @8A: 2>7=8:=>25=8O ?@8ABC?0 1>;57=8 2>7=8:0NB B@C4=>AB8, 81> ?@8 A>>B25BAB2CNI5< >B1>@5 2 :064>9 ?>43@C??5 <>65B >:070BLAO 2A53> =5A:>;L:> =01;N45=89, 0 @0AH8@5=85 <0B5@80;0 <>65B ?>B@51>20BL A;8H:>< 1>;LH>3> 2@5<5=8. "0:8< >1@07><, B0: 8;8 8=0G5 1>;55 C7:0O 7040G0 AB0=>28BAO 2A5 B@C4=55 4;O 0=0;870. G5284=>, GB> 3830=BA:89 B@C4, 70B@0G8205<K9 =0 =0:>?;5=85 <0B5@80;0, =0 :0:><-B> MB0?5 ?5@5AB05B >?@024K20BL A51O. ;O B>3> GB>1K 1>;55 @0F8>=0;L=> 8A?>;L7>20BL 8<5NI85AO C 8AA;54>20B5;O =01;N45=8O, =5>1E>48<> E>@>H> 7=0BL A>2@5<5==CN B5>@5B8G5A:CN M?845<8>;>38N, 55 >A=>2=K5 B5@<8=K, ?>=OB8O, <5B>4K >1@01>B:8 40==KE. A=>2=K5 ?>=OB8O  HYPERLINK "http://psychiatry.ru/library/lib/show.php4?id=28" 1I0O ?A8E80B@8O "830=>2 .!. (?>4. @54.) @5645 2A53> A;54C5B >1AC48BL ?>=OB8O "701>;5205<>ABL" 8 "1>;57=5==>ABL". 01>;5205<>ABLN (incidence  2 70@C156=>9 ;8B5@0BC@5) ?@8=OB> =07K20BL G8A;> =>2KE A;CG052 1>;57=8, 2>7=8:H8E 2 40==>9 3@C??5 =0A5;5=8O 2 548=8FC 2@5<5=8, G0I5 2A53>  2 3>4. >:070B5;L 701>;5205<>AB8 2K@0605BAO G8A;>< B0:8E A;CG052 =0 100, 1000, 10 000 8;8 =0 100 000 =0A5;5=8O. >;57=5==>ABL (8;8 @0A?@>AB@0=5==>ABL, prevalence  2 70@C156=>9 ;8B5@0BC@5)  MB> G8A;> 1>;L=KE A 87CG05<K< 701>;520=85<, :>B>@>5 8<55BAO 2 >?@545;5==>< =0A5;5=88 2 40==>5 2@5<O. 0: 8 ?>:070B5;L 701>;5205<>AB8, ?>:070B5;L 1>;57=5==>AB8 @0AAG8BK205BAO =0 100, 1000, 10 000 8;8 100 000 =0A5;5=8O. >A:>;L:C G8A;> 8<5NI8EAO A@548 =0A5;5=8O 1>;L=KE 3>@074> 1>;LH5, G5< G8A;> 2=>2L 701>;52H8E (2> 2AO:>< A;CG05 A ?A8E8G5A:8<8 701>;520=8O<8), ?>:070B5;L @0A?@>AB@0=5==>AB8 G0I5 2A53> @0AAG8BK205BAO =0 1000, 0 ?>:070B5;L 701>;5205<>AB8  =0 100 000 =0A5;5=8O. @8 @0AG5B5 ?>:070B5;O 1>;57=5==>AB8, :0: C65 3>2>@8;>AL, @5GL 845B > G8A;5 1>;L=KE A@548 =0A5;5=8O.  ?>A;54=85 3>4K ?@54?@8=8<0NBAO ?>?KB:8 CB>G=8BL ?>=OB85 "1>;L=>9": 254L C >4=8E ?A8E8G5A:>5 @0AAB@>9AB2> <>65B =01;N40BLAO A59G0A, C 4@C38E  2 ?@>H;><. >MB><C 2 A>2@5<5==>9 ;8B5@0BC@5 @07;8G0NB @0A?@>AB@0=5==>ABL 2 <><5=B >1A;54>20=8O (point prevalence), B.5. ?>:070B5;L, >B@060NI89 G8A;> ;8F, 8<5NI8E 87CG05<>5 ?A8E8G5A:>5 @0AAB@>9AB2> 2 40==>5 2@5<O; 3>48G=CN @0A?@>AB@0=5==>ABL (year prevalence)  ?>:070B5;L, >B@060NI89 G8A;> ;8F, 8<52H8E 40==>5 @0AAB@>9AB2> 2 ;N1>9 ?5@8>4 ?@>4>;68B5;L=>ABLN 3>4, ?@54H5AB2>202H53> <><5=BC >1A;54>20=8O; @0A?@>AB@0=5==>ABL 2 B5G5=85 687=8 (life prevalence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life prevalence. A;8 =C6=> CAB0=>28BL, C :0:>3> G8A;0 1>;L=KE ?>A;54=OO 45?@5AA8O >B<5G0;0AL 2 B5G5=85 ?>A;54=53> 3>40 (year prevalence), ?>:070B5;L A>AB028B 1,03 =0 1000, B.5. C<5=LH8BAO ?>GB8 =0 1/4. 0:>=5F, 5A;8 65;0B5;L=> 7=0BL point prevalence (2 40==>< A;CG05  G8A;> 1>;L=KE, A>AB>O=85 :>B>@KE >?@545;O;>AL 45?@5AA859 2 <><5=B >A<>B@0), B> ?>:070B5;L A>AB028B B>;L:> 0,36 =0 1000. !CI5AB2C5B >1AB>OB5;LAB2>, :>B>@>5 =5>1E>48<> ?@8=8<0BL 2> 2=8<0=85, @01>B0O A ?>:070B5;O<8 @0A?@>AB@0=5==>AB8 8 701>;5205<>AB8. A;8 @0A?@>AB@0=5==>ABL H87>D@5=88 2 >4=>< 3>@>45 A>AB02;O5B 10 =0 1000 =0A5;5=8O, 0 2 4@C3><  3 =0 1000, B> MB> >B=N4L =5 >7=0G05B, GB> 2 ?>A;54=5< ;N48 @565 1>;5NB H87>D@5=859; MB> <>65B >7=0G0BL 8 B>, GB> 2> 2B>@>< A;CG05 ?A8E80B@8G5A:0O A;C610 2KO2;O5B <5=LH5 1>;L=KE. >7<>6=>, GB> ?A8E80B@K 2 MB8E 3>@>40E ?@845@6820NBAO @07=KE 4803=>AB8G5A:8E :@8B5@852. >A;54=OO B@C4=>ABL ?@5>4>;5205BAO A ?><>ILN AB0=40@B87>20==KE 8=AB@C<5=B>2 4803=>AB8:8, A2>4OI8E : <8=8<C<C 2;8O=85 ;8G=KE 4803=>AB8G5A:8E ?>78F89 8AA;54>20B5;O.  ;N1>< A;CG05 >1>7=0G5=85 :@8B5@852 4803=>AB8:8 (:0: 8 2A5E 4@C38E :@8B5@852 >B1>@0 A;CG052, 2>H54H8E 2 8AA;54>20=85) O2;O5BAO >1O70B5;L=K< <5B>48G5A:8< B@51>20=85<, :>B>@>5 A;54C5B CG8BK20BL ?@8 M?845<8>;>38G5A:>< 8AA;54>20=88. 725AB=>, GB> @07=K5 ?A8E80B@8G5A:85 A;C61K 2KO2;ONB @07=>5 G8A;> 1>;L=KE. -B> >1J5:B82=K9 8 ?@8 A>2@5<5==>< C@>2=5 7=0=89 =5?@5>4>;8<K9 D0:B, A :>B>@K< ?@8E>48BAO AG8B0BLAO. !:>;L:>-B> 1>;L=KE 2A5340 >AB0NBAO =5 2KO2;5==K<8 8, ?>-2848<><C, =5 ACI5AB2C5B <5B>40, :>B>@K9 ?><>3 1K 8E 2A5E 2KO28BL. K;> <=>3> ?>?KB>: 2KOA=8BL ?>:070B5;L "8AB8==>9", "?>;=>9", "8AG5@?0==>9" 1>;57=5==>AB8. #A?5E 2A5E MB8E ?>?KB>: >B=>A8B5;5=.  1>;LH8=AB25 M?845<8>;>38G5A:8E @01>B, 3>2>@O > @0A?@>AB@0=5==>AB8 1>;57=8, 02B>@K 8<5NB 2 284C G8A;> 1>;L=KE, >1@0B82H8EAO 70 ?><>ILN. !CI5AB2CNB @01>BK, 02B>@K :>B>@KE >?8@0NBAO =0 40==K5, ?>;CG5==K5 ?@8 ?>3>;>2=KE >A<>B@0E 2K1>@>G=KE 3@C?? =0A5;5=8O; B0:85 ?>:070B5;8 >1KG=> 1K20NB 1>;LH8<8. ABL @01>BK, >B@060NI85 ?>?KB:8 B5>@5B8G5A:8 2KG8A;8BL ?>:070B5;L @0A?@>AB@0=5==>AB8 M=4>35==KE ?A8E>7>2 (2848<>, MB> 548=AB25==K9 A?>A>1 ?>;CG8BL ?@54AB02;5=85 >1 8E "8AB8==>9" @0A?@>AB@0=5==>AB8). A5 MB8 70<5G0=8O >B=>AOBAO 8 : ?>:070B5;N 701>;5205<>AB8. @8 @0AG5B5 MB>3> ?>:070B5;O ?@8E>48BAO >1@0I0BL 2=8<0=85 8 =0 B>, :>3> AG8B0BL 701>;52H8< 2 40==>< 3>4C. '0AB> ?@87=0NB 701>;52H8<8 B5E, :B> 2?5@2K5 >1@0B8;AO 70 ?><>ILN. A;8 @5GL 845B >1 >1I5< ?>:070B5;5 701>;5205<>AB8, B> MB> <>65B 1KBL 4>?CAB8<>, ?>B><C GB> G8A;> =>2KE A;CG052 1>;LH8=AB20 ?A8E8G5A:8E @0AAB@>9AB2 (2 G0AB=>AB8, M=4>35==KE 701>;520=89) 87 3>40 2 3>4 1>;55 8;8 <5=55 ?>AB>O==>. > >G5=L G0AB> 701>;5205<>ABL @0AAG8BK205BAO =5 2 F5;><, 0, =0?@8<5@, ?> >B=>H5=8N : >?@545;5==><C 2>7@0ABC.  B0:>< A;CG05 AC48BL > =59 ?> >1@0I05<>AB8 >?0A=>, ?>B><C GB>, :0: 8725AB=>, <=>385 1>;L=K5 >1@0I0NBAO : 2@0GC =5 A@07C. ;8=8:>-M?845<8>;>38G5A:89 <5B>4 ?>72>;O5B A?@028BLAO A MB>9 B@C4=>ABLN, ?>B><C GB> ?@8 >1A;54>20=88 1>;L=>3> 2@0G AB0@05BAO (=0A:>;L:> MB> 2>7<>6=>) 2KOA=8BL, :>340 2>7=8:;8 ?5@2K5 ?@87=0:8 1>;57=8. @8 4@C38E <5B>40E A1>@0 40==KE 70 =0G0;> 701>;520=8O =5@54:> ?@8E>48BAO ?@8=8<0BL 40BC ?5@2>3> >1@0I5=8O, 8 ?>MB><C ?>:070B5;8 ?>;CG0NBAO 3>@074> <5=55 =0456=K<8. -?845<8>;>3 >G5=L G0AB> AB0;:8205BAO A ?>=OB8O<8 "@8A:" 8 "25@>OB=>ABL". =8 >G5=L 1;87:8 8 2 1>;LH8=AB25 A;CG052 >7=0G0NB ?>GB8 >4=> 8 B> 65. 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"0:, A.B.Hollingshead 8 F.G.Redlich (1958), >1A;54>202H85 =0A5;5=85 3.LN %M25=, ?>:070;8, GB> >B45;L=K5 ?A8E8G5A:85 @0AAB@>9AB20 2AB@5G0NBAO A @07=>9 G0AB>B>9 2 @07=KE A>F80;L=KE A;>OE. > A8E ?>@ ACI5AB2C5B <=>65AB2> 38?>B57, AB@5<OI8EAO >1JOA=8BL MB>B =5A><=5==K9 D0:B. @>3@0<<0 0F8>=0;L=>3> 8=AB8BCB0 ?A8E8G5A:>3> 74>@>2LO !( (NRP, National Reporting Program), 2 A>>B25BAB288 A :>B>@>9 87CG0;8AL ?0F85=BK ?A8E80B@8G5A:8E 1>;L=8F, ?>72>;8;0 >F5=8BL 2;8O=85 >@30=870F8>==KE D0:B>@>2 =0 G8A;> 3>A?8B0;878@>20==KE 1>;L=KE: 2 ?@>F5AA5 B0: =07K205<>9 458=AB8BC0;870F88 G8A;> 3>A?8B0;878@>20==KE C<5=LH8;>AL A 559 000 2 1955 3. 4> 116 000 2 1984 3. [Reiger D., Burke J., 1989]. AA;54>20=8O ?>:070;8, GB> C 20 30 % ?0F85=B>2 2@0G59 >1I59 ?@0:B8:8 8<5;8AL ?A8E8G5A:85 @0AAB@>9AB20 [Kielholz P., Podinger W. et al., 1982]. @8<5@>< <=>3>;5B=53> 8AA;54>20=8O M?845<8>;>388 H87>D@5=88 O2;ONBAO @01>BK, ?@>2>482H85AO A 1965 3. 2 =AB8BCB5 ?A8E80B@88  !!! . 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'8A;> 1>;L=KE A @07=K<8 ?A8E8G5A:8<8 701>;520=8O<8, 70@538AB@8@>20==K<8 2 1996 3>4C 01>;520=85 1I55 G8A;> 1>;L=KE 0A?@545;5=85 ?> ?>;C, 2 % 0A?@545;5=85 ?> 2>7@0AB=K< 3@C??0<, 2 % <C6G8=K 65=I8=K 0-14 15-17 18-19 20-59 60 8 AB0@H5 A8E8G5A:85 @0AAB@>9AB20, 2A5 D>@<K 3784423 55.1 44.9 22.6 6,3 4,4 25,1 14,7 A8E>7K 1097070 48,9 51,1 2,1 1,2 1,5 66,6 28,6 !B0@G5A:>3> 2>7@0AB0 128640 40,0 60,0 0,0 0,0 0,0 29,3* 76,1 50:B82=K5 33720 46,1 53,9 2,6 2,1 3,8 72,6 18,9 (87>D@5=8O 606743 50,0 50,0 0,6 0,7 1,4 79,0 18,2 -?8;5?A8O 104895 53,2 46,8 6,9 3,3 3,2 65,6 21,0 5?A8E>B8G5A:85 @0AAB@>9AB20 1783434 53,6 46,4 33,0 5,8 3,8 46,1 11,4 52@>7K 500018 40,2 59,8 15,1 3,7 3,3 68,0 9,8 A8E>?0B8O 124957 69,8 30,2 11,7 8,2 8,3 62,7 9,0 !?5F8D8G5A:85 A8<?B>< 8 A8=4@>< 369966 64,9 35,1 84,9 5,8 1,8 6,0 1,5 50:B82=K5 A>AB>O=8O 56203 45,3 54,7 15,8 8,6 7,2 58,7 9,7 A8E>A><0B8G5A:85 A>AB>O=8O 115493 40,1 59,9 15,2 4,9 3,5 60,8 15,5 -?8;5?A8O 157 ?A8E>70 8 A;01>C<8O 158999 53,7 46,3 18,0 7,1 4,2 57,6 13,1 !>AC48ABK5 701>;520=8O <>730 123821 43,6 56,4 2,0 1,1 1,4 51,1 44,3 @C385 >@30=8G5A:85 ?>@065=8O &! 313359 65,5 34,5 38,9 9,0 5,0 39,2 7,9 #<AB25==0O >BAB0;>ABL (>;83>D@5=8O) 903919 65,6 34,4 27,2 13,3 8,9 46,3 4,4 518;L=>ABL 713821 67,6 32,4 28,3 13,9 9,3 44,8 3,8 * - B>;L:> C ;N459 AB0@H5 55 ;5B -B8 40==K5 >B@060NB 8 AB@C:BC@C ?A8E8G5A:>9 701>;5205<>AB8. >;55 ?>4@>1=K5 A2545=8O > 701>;5205<>AB8 8 @0A?@>AB@0=5==>AB8 >B45;L=KE 701>;520=89 40=K 2 A>>B25BAB2CNI8E 3;020E.  70:;NG5=85 :>A=5<AO 7028A8<>AB8 G8A;0 2KO2;O5<KE 1>;L=KE >B >A>15==>AB59 >@30=870F88 ?A8E80B@8G5A:>9 ?><>I8, 55 4>ABC?=>AB8, N@848G5A:>9 >A=>2K 8 273;O4>2 =0 ?A8E80B@8G5A:CN A;C61C, 3>A?>4AB2CNI8E 2 >1I5AB25==>< A>7=0=88. ;O MB>3> @0AA<>B@8< G8A;> 1>;L=KE, =01;N405<KE ?A8E80B@8G5A:>9 A;C61>9 >AA88 2 ?>A;54=85 3>4K (=5 2:;NG5=K A;CG08 C<AB25==>9 >BAB0;>AB8). -B8 40==K5 >B@065=K =0 @8A. 27.  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"0:, : :>=FC ?@>H;>3> AB>;5B8O @0A?@>AB@0=5==>ABL ?A8E8G5A:8E 701>;520=89 =0 1000 =0A5;5=8O 2 @;0=488 A>AB02;O;0 5,51, 2 =3;88 3,36, 2 5@<0=88  2,27, 2> $@0=F88  2,6.  E>45 ?@>2545=8O ?5@5?8A59 1K;0 2KO2;5=0 8=B5@5A=0O 70:>=><5@=>ABL, 8<5NI0O =5?>A@54AB25==>5 >B=>H5=85 : >@30=870F88 1>;L=8G=>3> 45;0. :070;>AL, GB> 2 E>@>H> >@30=87>20==KE 1>;L=8F0E G8A;> 1>;L=KE 5653>4=> C25;8G820;>AL =0 5 %, GB> B@51>20;> CG5B0 MB>3> ?>:070B5;O ?@8 ?;0=8@>20=88 ?><>I8.  >?8AK205<K9 ?5@8>4 87 :064KE 100 4CH52=>1>;L=KE 2 ?A8E80B@8G5A:8E 1>;L=8F0E (>B;0=488 =0E>48;>AL 80 1>;L=KE, 2 =3;88 73,8 1>;L=>3>, 2 5@<0=88 59,2 1>;L=>3>. ;O A@02=5=8O C:065<, GB> MB>B ?>:070B5;L 2 75<A:8E 3C15@=8OE >AA88 A>AB028; 16,9 [/:>25=:> .., 1909]. 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ansella M., 1986]. %0@0:B5@=>9 G5@B>9 8B0;LO=A:>9 ?A8E80B@8G5A:>9 @5D>@<K 1978 3. 1K;> B>, GB> 2K?8A:0 ?A8E8G5A:8 1>;L=KE 87 ?A8E80B@8G5A:8E 1>;L=8F 8 ?5@5E>4 : 2=51>;L=8G=K< D>@<0< ?><>I8 4>;6=K 1K;8 ?@>8AE>48BL ?>AB5?5==>, 0 =5 >4=><><5=B=>, :0: MB> ?KB0;8AL A45;0BL 0<5@8:0=A:85 ?A8E80B@K.  40==>< A;CG05 @5GL 845B > B><, GB> ?@>F5AA A>:@0I5=8O C45;L=>3> 25A0 AB0F8>=0@=>9 ?A8E80B@8G5A:>9 ?><>I8 >?5@560; A>740=85 0;LB5@=0B82=KE D>@< 2=51>;L=8G=>9 ?><>I8 2K?8AK205<K< 87 ?A8E80B@8G5A:8E 3>A?8B0;59 1>;L=K<. @>2545==K5 2 ?5@8>4 458=AB8BCF8>=0;870F88 A?5F80;L=K5 8AA;54>20=8O ?>:070;8, GB> 2 @57C;LB0B5 <0AA>2>3> 70:@KB8O ?A8E80B@8G5A:8E AB0F8>=0@>2 >3@><=>5 :>;8G5AB2> ?A8E8G5A:8 1>;L=KE (4> 70 %) ?>?>;=8;8 0@<8N 1574><=KE [Meyerson A.T., Herman G.S., 1983].  :>=5G=>< 8B>35 >@30=87C5<K5 2 60-5 3>4K 2 !( 2=51>;L=8G=K5 ?A8E80B@8G5A:85 A;C61K 2 D>@<5 B5@@8B>@80;L=KE F5=B@>2 >:070;8AL =5 3>B>2K<8 : ?@85<C >3@><=>3> ?>B>:0 ?>ABC?0NI8E : =8< 1>;L=K<. 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risca P., 1921], >=8 ?5@5=5A;8 MB>B ?@8=F8? =0 ?A8E80B@8N. 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O=20@5 1963 3. ?> ?@54;>65=8N ?@57845=B0 !( 5==548 :>=3@5AA>< 1K;0 CB25@645=0 ?@>3@0<<0 >1I5AB25==>9 ?>445@6:8 ?A8E8G5A:8 1>;L=KE 8 8740= 0:>= >1 >E@0=5 ?A8E8G5A:>3> 74>@>2LO =0A5;5=8O, 2 A>>B25BAB288 A :>B>@K< ?A8E80B@8G5A:0O ?><>IL 4>;6=0 AB0BL ;53:>4>ABC?=>9, >:07K20BLAO =0 <5AB0E 8 2:;NG0BL 2A5 =5>1E>48<K5 725=LO. ;O MB>9 F5;8 =0G0;8 A>74020BLAO @538>=0;L=K5 F5=B@K >E@0=K ?A8E8G5A:>3> 74>@>2LO (!!), 2 A>AB02 :>B>@KE 2E>48;8 CG@5645=8O AB0F8>=0@=>3>, 0<1C;0B>@=>3>, ?>;CAB0F8>=0@=>3> B8?0, =5>B;>6=>9 B5@0?88 8 4@. ;O 2K?>;=5=8O MB>9 ?@>3@0<<K 1K;8 2K45;5=K 7=0G8B5;L=K5 0AA83=>20=8O. !> 2@5<5=5< >:070;>AL, GB>, =5A<>B@O =0 ?@8=OBK5 <5@K, 7=0G8B5;L=0O G0ABL 1>;L=KE, AB@040NI8E BO65;K<8 D>@<0<8 ?A8E8G5A:8E 701>;520=89, =5>1E>48<>9 ?><>I8 8 ?>445@6:8 =5 ?>;CG0;8. 58=AB8BCF8>=0;870F8O, > :>B>@>9 H;0 @5GL @0=55, A?>A>1AB2>20;0 >@30=870F88 2 A>AB025 1>;L=8F >1I53> B8?0 ?A8E80B@8G5A:8E >B45;5=89 4;O :@0B:>A@>G=>9 3>A?8B0;870F88, A>740=8N H8@>:>9 A5B8 @07;8G=KE 2=51>;L=8G=KE D>@< ?><>I8  :>=AC;LB0B82=KE :;8=8: 8 F5=B@>2, ">B:@KBKE" CG@5645=89 4;O 1>;L=KE A E@>=8G5A:8< B5G5=85< ?A8E8G5A:8E 701>;520=89, ?>;CAB0F8>=0@>2, A?5F80;L=KE :;C1>2, F5=B@>2 @5018;8B0F88 8 B@C4>B5@0?88. =0G8B5;L=>5 <5AB> ?@8 MB>< >B2>48;>AL A>740=8N >1I5AB25==KE D>@< A>F80;L=>9 ?>445@6:8 ?A8E8G5A:8 1>;L=KE. !B0;8 2>7=8:0BL >1I5AB25==K5 42865=8O ?> >:070=8N ?><>I8 ";N4O< C;8FK", A>74020;8AL @07=K5 :><8B5BK, 0AA>F80F88, 45OB5;L=>ABL :>B>@KE 1K;0 =0?@02;5=0 =0 >@30=870F8N ?@8NB>2, C1568I 4;O >48=>:8E 8 A5<59=KE 1574><=KE, AB@040NI8E ?A8E8G5A:8<8 701>;520=8O<8. K;8 A>740=K A?5F80;L=K5 <>18;L=K5 3@C??K A>F80;L=KE @01>B=8:>2, @5018;8B>;>3>2, >1O70==>ABLN :>B>@KE 1K; ?>8A: 4;O MB8E ?0F85=B>2 45H52KE 3>AB8=8F, @5AB>@0=>2, 2 :>B>@KE 8E ?>4>?5G=K5 70 C<5@5==CN ?;0BC 87 2K45;O5<>3> 3>AC40@AB2>< ?>A>18O <>3;8 68BL, ?>;CG0BL @53C;O@=>5 ?8B0=85, =5>1E>48<CN ?A8E80B@8G5A:CN 8 4@C385 284K ?><>I8. 8HL : A5@548=5 80-E 3>4>2 C40;>AL 4>18BLAO 2K?>;=5=8O ?@>3@0<<K :><<C=0;L=>9 ?>445@6:8 ?A8E8G5A:8 1>;L=K<, 2 :>B>@CN 1K;8 2>2;5G5=K 2A5 50 HB0B>2 AB@0=K. !;54C5B ?>4G5@:=CBL, GB> 2 :>=5G=>< 8B>35 3>AC40@AB25==0O ?@>3@0<<0 >1I5AB25==>9 ?><>I8 1>;L=K< >1J548=8;0 CA8;8O @07@>7=5==KE A;C61 @07;8G=KE 254><AB2 (74@02>>E@0=5=8O, A>F80;L=>9 ?><>I8, >1@07>20=8O, ?@02>>E@0=8B5;L=KE >@30=>2 8 4@.).  @57C;LB0B5 ?@>2545==>9 @01>BK C40;>AL A=878BL G8A;> 1>;L=KE A 4;8B5;L=K<8 A@>:0<8 3>A?8B0;870F89 =0 60 %. =0;>38G=0O @01>B0 =0G0;0 ?@>2>48BLAO A 20-E 3>4>2 XX AB>;5B8O 8 2 4@C38E AB@0=0E (0=040, 2AB@0;8O, $@0=F8O, =3;8O, 5@<0=8O 8 4@.). "0:, 2> $@0=F88 =0@O4C A >@30=870F859 A?5F80;L=KE :>;>=89 4;O 2K74>@02;820NI8E 1>;L=KE ?A8E>70<8 8 =52@>B8:>2 A>74020;8AL A?5F80;L=K5 ?C=:BK B8?0 ?A8E80B@8G5A:8E :>=AC;LB0F89 8 0<1C;0B>@89, 345 >:07K20;0AL <548F8=A:0O, A>F80;L=0O 8 4@C385 284K ?><>I8 ?@>6820NI8< 2 >1I5AB25 ?A8E8G5A:8 1>;L=K<.  5@<0=88 1K;> A>740=> 42865=85 ">B:@KB>9 ?><>I8" (offene fursorge).  =5< CG0AB2>20;8 D8;0=B@>?8G5A:85 >@30=870F88, G0AB=K5 :><8B5BK 8 CG@5645=8O 0<1C;0B>@=>3> B8?0, G8A;> :>B>@KE 2 AB@0=5 4>AB830;> 200.  8E 7040GC 2E>48;> >:070=85 =5 B>;L:> A>1AB25==> ?A8E80B@8G5A:>9, => 8 <548:>-?A8E>;>38G5A:>9, A>F80;L=>-1KB>2>9 8 4@C38E 284>2 ?><>I8 [Roemer H. et al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oodall >@30=87>20; 4=52=>5 ?@51K20=85 ?A8E8G5A:8 1>;L=KE 2 >4=>< 87 A0=0B>@852 3.>AB>=0. =0;>38G=0O @01>B0 1K;0 ?@>45;0=0 2 =3;88 H.Boyle, A>7402H59 2 1938 3. 2 65=A:>< 3>A?8B0;5 3. %>C2 @568< 4=52=>3> ?@51K20=8O ?A8E8G5A:8 1>;L=KE. <5NBAO B0:65 C:070=8O =0 B>, GB> ?5@2K9 70@C156=K9 4=52=>9 AB0F8>=0@ 1K; A>740= D.Cameron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achrach L.L., 1979; Dibella G. et al., 1982; Mezcuita J., 1982]. 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Simon (1927), AG8B02H89 2:;NG5=85 ?A8E8G5A:8 1>;L=>3> 2 :>;;5:B82=CN B@C4>2CN 45OB5;L=>ABL <>I=K< D0:B>@>< AB8<C;OF88 53> A>F80;L=>9 0:B82=>AB8 8 ?@5>4>;5=8O O2;5=89 ?0B>;>38G5A:>9 ?A8E>A>F80;L=>9 040?B0F88 : =51;03>?@8OB=>9 2=CB@81>;L=8G=>9 A@545. @54;>65==0O 8< A8AB5<0 2 =5A:>;L:> 87<5=5==>< 2845 ?>;CG8;0 H8@>:CN 8725AB=>ABL 2 ?>A;52>5==K5 3>4K ?>4 =0720=8O<8 "B5@0?8O 70=OB>ABLN" (occupational therapy); "?@><KH;5==0O B5@0?8O", 8;8 "?@><KH;5==0O @5018;8B0F8O" (industrial therapy, industrial rehabilitation). 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