Каплан Г.И. Клиническая психиатрия

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[hevgh]h \uy\eyxlky kemoh\u_ ]ZeexpbgZpbb wlh gZ\h^bl gZ fukev h gZebqbb

aehmihlj_[e_gby Zedh]he_f b ke_^m_l \_klb jZkkijhk \ wlhf gZijZ\e_gbb Gb`_

i_j_qbke_gu^bZ]ghklbq_kdb_djbl_jbbhj]Zgbq_kdh]h]ZeexpbghaZ

<ujZ`_ggu_mklhcqb\u_bebh[jZlbfu_]ZeexpbgZpbb

;

Bf_xlky nZdlu ba bklhjbb [he_agb bkke_^h\Zgby nbabq_kdbo khklhygbc b

eZ[hjZlhjguo ZgZebah\ h gZebqbb ki_pbnbq_kdh]h hj]Zgbq_kdh]h nZdlhjZ beb

nZdlhjh\ dhlhju_ fh]ml [ulv wlbheh]bq_kdhc ijbqbghc jZkkljhckl\Z < ?keb wlZ

kbfilhfZlbdZihy\ey_lkyg_lhevdh\ i_jbh^^_ebjby

L?Q?GB?B IJH=GHA

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aZ[he_\ZgbyGZqZehh[uqghhkljh_Z h[sZyijh^he`bl_evghklv²g_kdhevdh^g_cbeb

g_^_evbebdZd\ kemqZ_ijb_fZ]Zeexpbgh]_gh\h]jZgbqb\Z_lkyg_kdhevdbfbqZkZfb

M g_dhlhjuo [hevguo ]Zeexpbgha klZgh\blky ojhgbq_kdbf gZijbf_j ij b g_e_q_ghc

dZlZjZdl_beb]emohl_y\eyxs_cky\lhjbqgufijhy\e_gb_fhlhkde_jhaZ< g_dhlhjuo

kemqZyohkljuc]ZeexpbghajZa\b\Z_lky\ ^_ebjbc

>BNN?J?GPB:EVGUC>B:=GHA

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]Zeexpbgha_ k\yaZg k ]ZeexpbgZpbyfb bg_ ghkbl mklhcqb\h]h oZjZdl_jZ Ijb

hj]Zgbq_kdhf [j_^h\hf kbg^jhf_ [j_^ mklhcqb\uc b h[uqgh gh kbl

kbkl_fZlbabjh\Zgguc oZjZdl_j ?keb bf__l f_klh khkms_kl\h\Zgb_ dZd \ujZ`_ggh]h

[j_^ZlZdb \ujZ`_gguo]ZeexpbgZpbckh]eZkgh>FRD\wlhfkemqZ_bf_xlf_klh

h[ZjZkkljhckl\Zb hj]Zgbq_kdbc[j_^h\uckbg^jhfb hj]Zgbq_kdbc]ZeexpbghaFh]ml

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dhgnZ[meypbyo =bigZ]h]bq_kdb_ b ]bighihfibq_kdb_ ]ZeexpbgZpbb gZ[ex^Zxlky

lhevdh\ fhf_gli_j_^aZkuiZgb_f[hevgh]hbebi_j_^_]hijh[m`^_gb_f

Wibe_ikby hkh[_ggh l_lZ\bkhqgZy lZd`_ fh`_l khijh\h`^Zlvky eb[h

kemoh\ufbeb[hajbl_evgufb]ZeexpbgZpbyfbLZdb_]ZeexpbgZpbbh[uqghy\eyxlky

qZklvx ij biZ^dZ b khijh\h`^Zxlky ^jm]bfb hkh[_gghklyfb oZjZdl_jgufb ^ey

ijbiZ^dh\hgbiZjhdkbafZevgub ihy\eyxlky\ khklhygbbj_^mpbjh\Zggh]hkhagZgby

:edh]hevguc ]Zeexpbgha hlebqZ_lky hl [_ehc ]hjyqdb l_f qlh ijb ]Zeexpbgha_ g_l

gZjmr_gbc kh klhjhgu k_gkhjghc kn_ju =ZeexpbgZpbb ijb [_ehc ]hjyqd_ qZs_

[u\Zxl ajbl_evgufb q_f kemoh\ufb b mkbeb\Zxlky ghqvx =ZeexpbgZpbb fh]ml

bf_lvf_klhijbrbahnj_gbbb jZkkljhckl\ZogZkljh_gbyghwlb]ZeexpbgZpbbkljh]h

mdeZ^u\Zxlky \ jZfdb ^Zgguo aZ[he_\Zgbc Z ki_pbnbq_kdbc nZdlhj ijb wlhf

hlkmlkl\m_l

E?Q?GB?

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[hevgh]h ]hkiblZebabjh\Zlv _keb hg gZim]Zg b [j_^bl K ihfhsvx Zglbikbobq_kdhc

l_jZibbgZijbf_j]Zehi_jb^hefh`ghh[e_]qblv]ZeexpbgZpbbZkihfhsvxkj_^kl\

kgb`Zxsbolj_\h]mgZijbf_j^bZa_iZffh`ghdmibjh\ZlvZ`blZpbx

HJ=:GBQ?KDBC;J?>H<HCKBG>JHF

HIJ?>?E?GB?

Hj]Zgbq_kdbc[j_^h\hckbg^jhfoZjZdl_jbam_lkygZebqb_f\ujZ`_ggh]h[j_^Z\

khklhygbb ihegh]h [h^jkl\h\Zgby b Ze_jlghklb bfh`gh hlq_leb\h ijhke_^blv

h[mkeh\e_gghklv^_ckl\b_fba\_klgh]hhj]Zgbq_kdh]hnZdlhjZ

WIB>?FBHEH=BY

Bf__lky\k_]hebrvg_kdhevdhwib^_fbheh]bq_kdbobkke_^h\Zgbcihk\ys_gguo

\hagbdgh\_gbx beb ^hfbgbjh\Zgbx wlh]h jZkkljhckl\Z ;j_^h\hc kbg^jhf dhlhjuc

khijh\h`^Z_lkeh`gu_iZjpbZevgu_ijbiZ^db[he__qZklhgZ[ex^Z_lkym `_gsbgq_f

mfm`qbg

WLBHEH=BY

Ijb_f e_dZjkl\_gguo \_s_kl\ y\ey_lky gZb[he__ qZklhc ijbqbghc wlh]h

jZkkljhckl\ZP_eucjy^obfbq_kdbo\_s_kl\hkh[_gghZfn_lZfbgudhghiey]Zrbr

]Zeexpbgh]_gub dhdZbgfh]ml\ua\Zlv^Zgguckbg^jhfKbg^jhfqZklhghg_\k_]^Z

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ihke_jZa\blbynbabq_kdh]haZ[he_\ZgbyIjb

ih\j_`^_gbyofha]h\hcldZgb\dexqZy\bkhqgu_^hebb ^jm]b_hl^_eufha]Zhkh[_ggh

ijZ\h]hihemrZjbyb iZjb_lZevghc^hebqZklhjZa\b\Z_lky[j_^Kh]eZkgh'60,,,5m

g_dhlhjuo ebp kljZ^Zxsbo \bkhqghc wibe_ikb_c gZ[ex^Z_lky bgl_jbdlZevguc

\dexq_gguc \ ijbiZ^hd [j_^h\hc kbg^jhf dhlhjuc hq_gv ihoh` gZ ijhy\e_gb_

rbahnj_gbb< '60,,,5 h ibkZglZd`_iZjZghb^guchj]Zgbq_kdbc[j_^h\hckbg^jhf

dhlhjucbgh]^Z\klj_qZ_lkyijbohj__=_glbg]lhgZ

DEBGBQ?KDB?IJHY<E?GBYB >B:=GHA

Kms_kl\_gghchkh[_gghklvxhj]Zgbq_kdh]h[j_^h\h]hkbg^jhfZy\ey_lkygZebqb_

[j_^Z\ khklhygbbihegh]h[h^jkl\h\ZgbyDhe_[Zgby\ mjh\g_khagZgby hlkmlkl\mxl

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kbkl_fZlbabjh\Zgguf beb njZ]f_glZjguf _]h kh^_j`Zgb_ jZaghh[jZagh fh`_l

gZ[ex^Zlvky[j_^ij_ke_^h\Zgby]jZg^bhaghklvfuke_cZ lZd`_gZjy^mk gbfbb [j_^

j_\ghklb GZb[he__ qZklh h^gZdh \klj_qZ_lky [j_^ ij_ke_^h\Zgby >ey ^bZ]ghklbdb

kbg^jhfZ g_h[oh^bfh \uy\blv hj]Zgbq_kdbc nZdlhj ihy\e_gb_ dhlhjh]h

ij_^r_kl\h\ZehgZqZemkbg^jhfZb dhlhjucfh`_lkqblZlvkywlbheh]bq_kdhcijbqbghc

jZa\blbywlh]hkbg^jhfZ;hevghcfh`_lgZoh^blvky\ khklhygbbkimlZgghklb\u]ey^bl

g_jyreb\ufbebkljZgguf

M wlbo [hevguo j_qv khkdZevau\ZxsZy fZehihgylgZy fh`_l gZ[ex^Zlvky dZd

]bi_jZdlb\ghklv lZd b ZiZlby GZkljh_gb_ h[uqgh [u\Z_l ^bknhjbq_kdbf Gb`_

i_j_qbke_gu ^bZ]ghklbq_kdb_ djbl_jbb hj]Zgbq_kdh]h [j_^h\h]h kbg^jhfZ D

^bZ]ghklbq_kdbfdjbl_jbyfhlghkylky

<ujZ`_gguc[j_^

;

GZebqb_k\_^_gbc ba bklhjbb [he_agb nbabq_kdh]h bkke_^h\Zgbyb ZgZebah\

eZ[hjZlhjguo bkke_^h\Zgbc ih^l\_j`^Zxsbo ki_pbnbq_kdbc hj]Zgbq_kdbc nZdlhj

beb nZdlhju dhlhju_ fh]ml jZkkfZljb\Zlvky dZd wlbheh]bq_kdb k\yaZggu_ k

jZkkljhckl\hf<Ijhy\e_gb_jZkkljhckl\Zg_lhevdh\h\j_fy^_ebjby

>BNN?J?GPB:EVGUC>B:=GHA

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kbg^jhfhf b iZjZghb^ghc rbahnj_gb_c GZijbf_j aehmihlj_[e_gb_ Zfn_lZfbghf

fh`_l \ua\Zlv khklhygb_ oZjZdl_jbamxs__ky \ukhdh kbkl_fZlbabjh\Zgghc kbkl_fhc

[j_^Zij_ke_^h\ZgbydhlhjucoZjZdl_j_gb^eyZdlb\ghcnZaurbahnj_gbb< hlebqb_

hl iZjZghb^ghc rbahnj_gbb h^gZdh ]ZeexpbgZpbb ijb hj]Zgbq_kdhf [j_^h\hf

kbg^jhf_ [he__ qZklh ajbl_evgu_ q_f kemoh\u_ :nn_dl m [hevguo lZd`_ [he__

Z^_d\Zl_g b ijhp_kk fure_gby [he__ khojZg_g Ihfh]Z_l ih klZ\blv ^bZ]gha lZd`_

agZgb_h ki_pbnbq_kdhfhj]Zgbq_kdhfnZdlhj_dhlhjucdZdba\_klghfh`_l\ua\Zlv

[j_^h\hc ikboha gZebqb_ lZdh]h nZdlhjZ k\b^_l_evkl\m_l ijhlb\ g_hj]Zgbq_kdh]h

ikbohlbq_kdh]h jZkkljhckl\Z Kh]eZkgh '60,,,5 i_j\h_ \hagbdgh\_gb_ [j_^Z \

\hajZkl_ klZjr_  e_l ijb hlkmlkl\bb mdZaZgbc gZ aZ[he_\Zgb_ rbahnj_gb_c beb

[j_^h\ufjZkkljhckl\hfk\b^_l_evkl\m_lh g_h[oh^bfhklb\_klbihbkdhj]Zgbq_kdh]h

[j_^h\h]h kbg^jhfZ Ykgh qlh _keb bf__lky ij_^iheh`_gb_ h \hafh`ghf gZebqbb

hj]Zgbq_kdh]h nZdlhjZ m [hevgh]h k g_hj]Zgbq_kdbf ikbohahf \k_ `_ ke_^m_l \_klb

ihbkdwlh]hnZdlhjZ

>_ebjbc k\yaZg k baf_g_gb_f mjh\gy khagZgby Ijb ^_f_gpbb h[gZjm`b\Zxlky

agZqbl_evgu_ gZjmr_gby bgl_ee_dlZ Hj]Zgbq_kdbc ]Zeexpbgha khijh\h`^Z_lky

mklhcqb\ufb b \ujZ`_ggufb ]ZeexpbgZpbyfb Ijb lj_\h`ghklb hj]Zgbq_kdh]h

ijhbkoh`^_gby hlkmlkl\mxl b ]ZeexpbgZpbb b [j_^ Ijb jZkkljhckl\_ gZkljh_gby

hj]Zgbq_kdh]h oZjZdl_jZ h[gZjm`b\Zxl lbibqgu_ gZjmr_gby gZkljh_gby Z [j_^h\u_

beb]ZeexpbgZlhjgu_ijhy\e_gbyk\yaZguk kh^_j`Zgb_fjZkkljhckl\ZgZkljh_gby

E?Q?GB?

E_q_gb_ kbg^jhfZ k\yaZgh k mkljZg_gb_f b e_q_gb_f ijbqbgu e_`Zs_c \_]h

hkgh\_ Djhf_ lh]h ijbf_gy_lky kbfilhfZlbq_kdZy l_jZiby dhlhjZy \dexqZ_l f_ju

ijbf_gy_fu_d [hevgufrbahnj_gb_cb [j_^h\ufbjZkkljhckl\Zfb ² g_cjhe_ilbdb

moh^beb]hkiblZebaZpbyZ lZd`_ikbohl_jZibx

KBG>JHFJ:KKLJHCKL<:G:KLJH?GBYHJ=:GBQ?KDH=HO:J:DL?J:

HIJ?>?E?GB?

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oZjZdl_jbam_lky eb[h ^_ij_kkb\guf eb[h fZgbZdZevguf gZkljh_gb_f hlq_leb\h

k\yaZggufk ^_ckl\b_fhj]Zgbq_kdh]hnZdlhjZ

WLBHEH=BY

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hj]Zgbq_kdh]hoZjZdl_jZ

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[he_agv]bi_jiZjZlbj_hb^baf

 Bgn_dpbhggu_ aZ[he_\Zgby ]jbii bgn_dpbhgguc fhghgmde_ha

bgn_dpbhgguc]_iZlbl\bjmkgZyig_\fhgby

 I_jgbpbhagZyZg_fby

 DZjpbghfZih^`_em^hqghc`_e_au

 Himohebfha]Z

 Kbkl_fgZydjZkgZy\heqZgdZ

 IZjdbgkhgbaf

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 G_cjhkbnbebk

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L?Q?GB?B IJH=GHA

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oZjZdl_jZ

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hkgh\gh]hjZkkljhckl\Z

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ikbohl_jZiby

KBG>JHFJ:KKLJHCKL<EBQGHKLBHJ=:GBQ?KDH=HO:J:DL?J:

HIJ?>?E?GB?

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h[mkeh\eb\Zxs_caZ[he_\Zgb_

WLBHEH=BY

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DEBGBQ?KDB?IJHY<E?GBYB >B:=GHA

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