Каплан Г.И. Клиническая психиатрия

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h[gZjm`_ggufb k ihfhsvx f_lh^Z DL b gZebqb_f g_]Zlb\ghc kbfilhfZlbdb beb

kbfilhfh\ ^_nbpblZ nmgdpbc fha]Z g_j\guo b ikbobq_kdbo gZjmr_gbc [hevrh]h

dhebq_kl\Z g_\jheh]bq_kdbo hldehg_gbc m\_ebq_gby qbkeZ wdkljZibjZfb^guo

kbfilhfh\ \ j_amevlZl_ e_q_gby Zglbikbohlbq_kdbfb kj_^kl\Zfb [he__ keZ[hc

ijbkihkh[ey_fhklb \ ij_fhj[b^_ ih\ur_gby ^_evlZZdlb\ghklb \WW= b \hafh`gh

[hevr_]h qbkeZ kmbpb^Zevguo ihiulhd <ukdZau\Z_lky gZ^_`^Z qlh ih f_j_

memqr_gby l_ogheh]bb y^_jghfZ]gblgh]h j_ahgZgkZ wlb bkke_^h\Zgby [m^ml

jZkrbj_guqlhfh`_lh[_ki_qblv\uy\e_gb_[he__ki_pbnbq_kdbofha]h\uoh[eZkl_c

Bkke_^h\Zgb_f_lZ[hebafZfha]h\hcldZgbm [hevguorbahnj_gb_cijhba\h^blky

k ihfhsvx f_lh^h\ baf_j_gby j_]bhgZevgh]h fha]h\h]h djh\hlhdZ b ihabljhgghc

wfbkkbhgghc lhfh]jZnbb IWL H[Z wlb f_lh^Z khijy`_gu k fgh`_kl\hf

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kdZgbjh\Zgbb f_lh^hf IWL h[gZjm`_gh ihgb`_gb_ f_lZ[hebafZ njhglZevghc ^heb

kgb`_gb_ f_lZ[hebafZ iZjb_lZevghc ^heb hldehg_gby \ eZl_jZevguo jZaebqbyo Z

lZd`_ hlghkbl_evgh \ukhdbc f_lZ[hebaf \ aZ^gbo hl^_eZo fha]Z < bkke_^h\Zgbyo

ijh\_^_gguo f_lh^hf  hlf_qZ_lky kgb`_gb_ mjh\gy djh\hlhdZ \h njhglZevguo

h[eZklyo \ ihdh_ m\_ebq_gb_ djh\hlhdZ \ iZjb_lZevguo h[eZklyo b ihgb`_gb_

djh\hlhdZ fha]Z \p_ehf <kZfuo ih ke_^gbo jZ[hlZo ijh\_^_gh bkke_^h\Zgb_

ikboheh]bq_kdhc Zdlb\Zpbb b ijh^_fhgkljbjh\ZgZ g_kihkh[ghklv [hevgh]h

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DL fh`gh ij bclb d \u\h^m h gZebqbb [he__ \ujZ`_gghc ^bknmgdpbb njhglZevghc

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njhglZevghc^hebfh`_ly\blvkyj_amevlZlhfiZlheh]bbbf_xs_cky\ ^jm]hch[eZklb

fha]Z

We_dljhnbabheh]by

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Zdlb\Zpbb gZijbf_j ijb ^_ijb\Zpbb kgZ mf_gvr_gZ ZevnZZdlb\ghklv b m\_ebq_gZ

l_lZ b ^_evlZZdlb\ghklv \hafh`gh [he__ \ujZ`_gZ wibe_ilbnhjfgZy Zdlb\ghklv Z

lZd`_ih\b^bfhfmbf__lf_klhij_h[eZ^Zgb_e_\hklhjhgg_ciZlheh]bbBkke_^h\Zgby

\ua\Zgguo ihl_gpbZeh\ \p_ehf mdZau\Zxl gZ ih\ur_gb_ Zfieblm^u jZggbo

dhfihg_glh\ b ihgb`_gb_ Zfieblm^u iha^gbo dhfihg_glh\ Wlm jZagbpm fh`gh

h[tykgblv l_f qlh ohly [hevgu_ rbahnj_gb_c [he__ qm\kl\bl_evgu d k_gkhjghc

dhjdh\uomjh\gyo

>jm]b_ we_dljhnbabheh]bq_kdb_ f_lh^u \dexqZxl bkke_^h\Zgb_ j_amevlZlh\ hl

\`b\e_gby]em[bgguowe_dljh^h\b dhebq_kl\_ggucZgZebaWW=< h^ghfkhh[s_gbb

k^_eZgghfih^ Zggufihemq_ggufhl\`b\e_gguo\ ebf[bq_kdmxkbkl_fmwe_dljh^h\

mdZau\Z_lky qlh m [hevguo rbahnj_gb_c h[gZjm`b\Z_lky kiZcdh\Zy Zdlb\ghklv

dhlhjZydhjj_ebjm_lk ikbohlbq_kdbfih\_^_gb_fh^gZdhdhgljhevgu_



bkke_^h\Zgby gZ a^hjh\uo ex^yo hlkmlkl\mx l Dhebq_kl\_ggu_ bkke_^h\Zgby WW= m

[hevguo rbahnj_gb_c ihdZaZeb Qlh mgbo bf__l f_klh ih\ur_gb_ f_^e_gghc

Zdlb\ghklb njhglZevguo ^he_c b \hafh`gh ih\ur_gb_ [ukljhc Zdlb\ghklb

iZjb_lZevguo ^he_c Wlb j_amevlZlu dhebq_kl\_ggh]h ZgZebaZ WW= gm`^Zxlky \

ih^l\_j`^_gbb

Ikbohg_cjhbffmgheh]bybikbohg_cjhwg^hdjbgheh]by

< gZklhys__\j_fy\k_

[hevr__ jZkijhkljZg_gb_ ihemqZ_l lhqdZ aj_gby hlhf qlh \ wlbheh]bb g_dhlhjuo

g_j\guo [he_ag_c gZijbf_j jZkk_yggh]h kde_jhaZ [he_agb :evp]_cf_jZ b

^jh`Zl_evgh]hiZjZebqZhij_^_e_ggmxjhevb]jZxlbgn_dpbbgZijbf_jf_^e_gguc

\bjmk GZ hkgh\Zgbb wlbo ^Zgguo fh`gh ij_^iheh`blv qlh \ g_dhlhjuo kemqZyo

rbahnj_gbb \ wlbheh]bq_kdbc nZdlhj \oh^bl lZd`_ \hajhkr__ qbkeh nbabq_kdbo

ZghfZebcijbjh`^_gbb hkeh`g_gbcijb [_j_f_gghklbb jh^Zokh\iZ^_gb_\j_f_gb

k_ahgghklb jh`^_gby k jZkijhkljZg_gghklvx \bjmkguo bgn_dpbc \wlh \j_fy

gZdhie_gb_ kemqZ_\ aZ[he_\Zgby kj_^b \ajhkeuo ih\lhjgu_ ]hkiblZebaZpbb

g_\jheh]bq_kdb_gZjmr_gbykh\iZ^Zxsb_k i_j_g_k_ggufb\ ijhrehfbgn_dpbyfbb

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b^_glbnbdZpbydZdhceb[hhij_^_e_gghcbgn_dpbbhlkmlkl\m xl

Bffmgheh]bq_kdb_ hldehg_gby gZ[ex^Zxsb_ky ijb rbahnj_gbb ke_^mxsb_

gZebqb_ Zlbibqguo ebfnhpblh\ ihgb`_gb_ qbkeZ de_lhddbee_jh\ b\ZjbZ[_evguc

mjh\_gv bffmgh]eh[mebgh\ Wlb ^Zggu_ fh`gh bgl_jij_lbjh\Zlv ihjZaghfm

bgn_dpby kZfZ ih k_[_ \uau\Z_l dZd ikbobq_kdb_ jZkkljhckl\Z lZd b gZjmr_gb_

bffmgbl_lZ bgn_dpby fh`_l \uau\Zlv Zmlhbffmggmx j_Zdpbx \ hij_^_e_gguo

fha]h\uo h[eZklyo i_j\bqgu_ bffmggu_ gZjmr_gby fh]ml \uau\Zlv Zmlhbffmggu_

j_Zdpbbfha]Z

Ijb rbahnj_gbb gZ[ex^Zxlky b ikbohwg^hdjbggu_ gZjmr_gby Ohly \

[hevrbgkl\_jZ[hlbf_xlky^Zggu_hlhfqlhmjh\_gvijh eZdlbgZijbrbahnj_gbbg_

gZjmr_g \ hl^_evguo bkke_^h\Zgbyo h[gZjm`_gu dhjj_eypbb ihablb\ghc

kbfilhfZlbdb k ihgb`_gb_f mjh\g_c ijheZdlbgZ ;he__ mklhcqb\u_ j_amevlZlu

dZkZxlkyihgb`_gbymjh\g_cexl_bgbabjmxs_]h]hjfhgZnheebdmehklbfmebjmxs_]h

]hjfhgZ dhlhjh_ \hafh`gh dhjj_ebjm_l k \hajZklhf gZqZeZ b ^ebl_evghklvx

aZ[he_\Zgby Djhf_ lh]h \^\mo jZ[hlZo bf_xlky ^Zggu_ h lhjfh`_gbb \u^_e_gby

ijheZdlbgZb ]hjfhgZjhklZ\hl\_lgZklbfmeypbx]hgZ^hljhibgjbebabg]]hjfhgZbeb

lbj_hljhibgjbebabg] ]hjfhgZ dhlhjh_ bgh]^Z dhjj_ebjm_l k gZebqb_f g_]Zlb\ghc

kbfilhfZlbdb

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ijb rbahnj_gbb y\ey_lky ij_^iheh`_gb_ h iZlheh]bq_kdhf baf_g_gbb ]bihlZeZfmkZ

kljmdlmjghf beb g_cjhobfbq_kdhf =bi_jnmgdpb_c ^hnZfbg_j]bq_kdbo kbkl_f

gZijbf_j fh`gh h[tykgblv fgh]b_ j_amevlZlu k\b^_l_evkl\mxsb_ h gZjmr_gbb

g_cjhwg^hdjbgguonmgdpbc

Bgl_]jZpby [bheh]bq_kdbo l_hjbc

IkbobZlju iulZxlky bkihevah\Zlv^Zggu_

[bheh]bq_kdbobkke_^h\Zgbcijbrbahnj_gbb^eyhij_^_e_gbyehdZebaZpbbihjZ`_gby

lZd`_dZdwlh^_eZebg_\jhiZlheh]bijbf_gyy^Zggu_g_\jheh]bq_kdh]hbkke_^h\Zgby

^ey hij_^_e_gby hqZ]Z ih\j_`^_gby ^h ihy\e_gby f_lh^Z DL Hkgh\ghc bgl_j_k

\uau\Zxl ^\_ h[eZklb ² njhglZevgZy ^hey b ebf[bq_kdZy kbkl_fZ IhjZ`_gb_

njhglZevghc ^heb ih^l\_j`^Z_lky f_lh^Zfb kdZgbjh\Zgby fha]Z

we_dljhnbabheh]bq_kdbfb ^Zggufb b j_amevlZlZfb g_cjhikboheh]bq_kdbo

bkke_^h\Zgbc IhjZ`_gb_ ebf[bq_kdhc kbkl_fu ih^l\_j`^Z_lky fhjnheh]bq_kdbfb

bkke_^h\Zgbyfb^Zggufbihemq_ggufbhl\`b\e_gguo\fha]we_dljh^h\

>jm]b_h[eZklbfha]Z lZd`_ \h\e_q_gu \ iZlheh]bq_kdbc ijhp_kk H ihjZ`_gbb

[ZaZevguo ]Zg]eb_\ fh`gh km^blv gZ hkgh\Zgbb ^\b]Zl_evguo jZkkljhckl\ dhlhju_

h[uqgh gZ[ex^Zxlky m ikbohlbq_kdbo [hevguo GZjmr_gby i_j_jZ[hldb k_gkhjghc

bgnhjfZpbbbffmggu_b wg^hdjbggu_jZkkljhckl\Zb m\_ebq_gb_`_em^hqdh\

fha]Z mdZau\Zxl gZ ihjZ`_gb_ ]bihlZeZfmkZ b lZeZfm kZ >_]_g_jZlb\gu_ baf_g_gby

q_j\yfha`_qdZhij_^_ey_fu_k ihfhsvxDLk\b^_l_evkl\mxlh i_j\bqghfihjZ`_gbb

wlhckljmdlmjuJZaghh[jZab_ij_^iheZ]Z_fuoehdZebaZpbcih\j_`^_gbykhhl\_lkl\m_l

]_l_jh]_gghcfh^_ebwlbheh]bbrbahnj_gbb

We_dljhnbabheh]bq_kdb_ l_hjbb nhdmkbjmxlky gZ gZjmr_gbb ijhp_kkZ

i_j_jZ[hldb klbfmevghc bgnhjfZpbb b eZl_jZebaZpbb GZ hkgh\Zgbb ^_nbpblZ

\uy\eyxsboky \ g_dhlhjuo we_dljhnbabheh]bq_kdbo bkke_^h\Zgbyo kha^Zgu l_hjbb

ih^l\_j`^Zxlky\hajZklZgb_fqbkeZikbohah\ijb\bkhqghcwibe_ikbbk hqZ]hf\e_\hf

ihemrZjbbgZebqb_fgZjmr_gbcj_qbm [hevguorbahnj_gb_cbl_fnZdlhfqlhkj_^b

[hevguo rbahnj_gb_c [hevr_ e_\r_c Bf_xlky lZd`_ l_hjbb ihklmebjmxsb_

gZjmr_gb_ f_`ihemrZjgh]h \aZbfh^_ckl\by ijb sbahnj_gbb bijb bkke_^h\Zgbyo

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\uy\ey_lkym\_ebq_gb_lhesbgufhahebklh]hl_eZ

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]bihl_a_ bf__l f_klh hlghkbl_evgh ki_pbnbq_kdZy fhe_dmeyjgZy iZlheh]by \

qZklghklbgZjmr_gb_kljmdlmjug_dhlhjuoij hl_bgh\gZijbf_jn_jf_glh\Bf_xlky

nZdlu k\b^_l_evkl\mxsb_h fhjnheh]bq_kdboih\j_`^_gbyo ldZgb fha]Z \ua\Zgguo

bgn_dpbhggufb ^_]_g_jZlb\gufb b ljZ\fZlbq_kdbfb ijhp_kkZfb Lh qlh ljZ\fZ

y\ey_lky wlbheh]bq_kdbf nZdlhjhf ih^l\_j`^Z_lky gZebqb_f [hevrh]h qbkeZ

ij_gZlZevguo gZijbf_j djh\hl_q_gb_ i_jbgZlZevguo gZijbf_j ^ebl_evgZy

i_j_]jmadZ b g_hgZlZevguo gZijbf_j km^hjh]b hkeh`g_gbc kj_^b ebp dhlhju_

\ihke_^kl\bb aZ[he_eb rbahnj_gb_c G_ba\_klgh y\ey_lky eb ljZ\fZ ij bqbgguf

nZdlhjhfbeb`_hgZ\uau\Z_ldZdmxeb[hiZlheh]bxm [_j_f_gghc`_gsbgudhlhjZy

aZl_f jh`^Z_l j_[_gdZ [hevgh]h rbahnj_gb_c Hlf_q_gh qlh m fhghab]hlguo

[ebag_ph\ ^bkdhj^Zglguo \ hlghr_gbb rbahnj_gbb h[gZjm`b\Z_lky l_g^_gpby d

^bkdhj^Zglghklb b\ hlghr_gbb ijZ\hbeb e_\hjmdhklb qlh mdZau\Z_l gZ gZebqb_

ihjZ`_gbyf ha]Zm [ebag_pZ[hevgh]hrbahnj_gb_c

=?G?LBD:

< oh^_ bkke_^h\Zgbc ihk\ys_gguo ]_g_lbd_ rbahnj_gbb h[gZjm`_gu ^Zggu_

khhl\_lkl\mxsb_ ]bihl_a_ h gZebqbb ]_g_lbq_kdh]h [ZabkZ rbahnj_gbb

k\b^_l_evkl\mxsb_ hlhf qlh ]_gu ihjZ`_ggh]h km[t_dlZ kha^Zxl