Каплан Г.И. Клиническая психиатрия

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^_kylbe_lbyh[hkljyykvk \hajZklhf²ly`_ehc^_ij_kkbbb f_eZgohebb

Wlb ebpZ ohjhrh kijZ\eyxlky k jZ[hlhc ]^_ gm`gZ f_lh^bq_kdZy ^_^mdlb\gZy

beb bah[bemxsZy ^_lZeyfb ^_yl_evghklv gh hgb g_kihkh[gu kijZ\blvky k

g_h`b^Zggufb i_j_f_gZfb bbo ebqgZy `bagv fh`_l hklZ\Zlvky imklhc Lbibqgufb

^ey wlbo ebqghkl_c y\eyxlky ly`_eu_ ^_ij_kkb\gu_ khklhygby hkh[_ggh \ iha^g_f

\hajZkl_

>bnn_j_gpbZevguc ^bZ]gha

Dh]^Z bf_xl f_klh h[k_kkbb beb dhfimevkbb

h[k_kkb\ghdhfimevkc\gh_ jZkkljhckl\h ^he`gh h[hagZqZlvky ih Hkb , <hafh`gh

kZfuf ljm^guf [u\Z_l hlebqblv Zf[meZlhjguo ebp k h[k_kkb\ghdhfimevkb\gufb

q_jlZfb hl ebp kljZ^Zxsbo h[k_kkb\ghdhfimevkb\gufb jZkkljhckl\Zfb ebqghklb

Ihke_^gbc^bZ]ghaklZ\blky l_f [hevguf dhlhju_ bf_xl agZqbl_evgu_gZjmr_gby\

ijhn_kkbhgZevghc ^_yl_evghklb b khpbZevghc mki_rghklb < g_dhlhjuo kemqZyo k

ebqghklgufb jZkkljhckl\Zfb khkms_kl\mxl iZjZghb^gu_ b rbahb^gu_ gZjmr_gby b

_kebwlhlZdke_^m_lklZ\blvh[Z^bZ]ghaZ

E_q_gb_

< hlebqb_hljZkkljhckl\ebqghklb^jm]bolbih\[hevgu_k h[k_kkb\gh

dhfimevkb\gufb jZkkljhckl\Zfb qZklh hkhagZxl qlh hgb kljZ^Zxl bbsml k\hc

kh[kl\_gguc f_lh^ e_q_gby I_j_lj_gbjh\Zggu_ qj_af_jgh khpbZevgu_ h[k_kkb\gh

dhfimevkb\gu_ ebqghklb hq_gv p_gyl f_lh^ k\h[h^guo ZkkhpbZpbc b g_^bj_dlb\gmx

l_jZibx H^gZdh e_q_gb_ wlbo [hevguo qZklh lj_[m_l ^ebl_evgh]h \j_f_gb b [u\Z_l

keh`gufihkdhevdmqZklhgZludZ_lkygZijhlb\hi_j_ghk

Bgh]^Z g_dhlhjuc wnn_dl ^Zxl ]jmiih\Zy b ih\_^_gq_kdZy l_jZiby < h[hbo

kemqZyo kms_kl\m_l \hafh`ghklv ij_j\Zlv lZdh]h [hevgh]h \ k_j_^bg_ dmjkZ e_q_gby

_keb hgb ^Zxl ^_aZ^Zilb\gu_ j_amevlZlu b \aZbfhhlghr_gbyª Ij_^hl\jZsZy

aZ\_jr_gb_boijb\uqgh]hih\_^_gbyfh`gh\ua\Zlvm gbolj_\h]mb ih^hajbl_evghklv

ihhlghr_gbxd h[mq_gbxgh\ufkljZl_]byfgZijZ\e_ggufgZlhqlh[ukijZ\blvkyk

kblmZpb_c ;hevgu_ lZd`_ ^he`gu ihemqZlv ijyfh_ \hagZ]jZ`^_gb_ aZ baf_g_gb_ \

]jmiih\hcl_jZibbqlhg_kdhevdhf_g__j_Zevgh\ bg^b\b^mZevghcl_jZibb

DehgZa_iZfy\ey_lky[_gah^bZa_ibghfk Zglbdhg\mevkb\guf^_ckl\b_fdhlhjuc

j_^mpbjm_l kbfilhfu ly`_eh]h h[k_kkb\ghdhfimevkb\gh]h jZkkljhckl\Z

gZ[ex^Zxs_]hkym g_dhlhjuo[hevguoDZdhcwnn_dlhgbhdZau\Zxlijbebqghklguo

jZkkljhckl\Zog_ba\_klgh

I:KKB<GH:=J?KKB<G:YEBQGHKLV

Hij_^_e_gb_

IZkkb\ghZ]j_kkb\gZy ebqghklv oZjZdl_jbam_lky

h[kljmdpbhgbafhfhldeZ^u\Zgb_fgZ^he]bckjhdmijyfkl\hfb g_ijh^mdlb\ghklvx

LZdh_ih\_^_gb__klvijhy\e_gb_ih^e_`Zs_cZ]j_kkbbdhlhjZy\ujZ`Z_lkyiZkkb\guf

h[jZahf

Wib^_fbheh]by

< hlghr_gbb wib^_fbheh]bb ^Zggh]h jZkkljhckl\Z k\_^_gbc

g_lIj_h[eZ^ZxsbcihegZke_^kl\_gghklvb jZkijhkljZg_gghklvlZd`_g_ba\_klgu

Debgbq_kdb_ijhy\e_gby

IZkkb\ghZ]j_kkb\gu_ebqghklboZjZdl_jbamxlkyl_f

qlh hldeZ^u\Zxl khijhlb\eyxlky lj_[h\Zgbyf g_f_^e_ggh ^_ckl\h\Zlv gZoh^yl

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hldZau\Zxlkyhlij_ju\Zgbyhlghr_gbcaZ\bkbfhklbM gbohlkmlkl\m_lgZklhcqb\hklv

bhgb g_ \iheg_ ihgbfZxl k\hb kh[kl\_ggu_ `_eZgby b ihlj_[ghklb Hgb g_ aZ^Zxl

gm`guo \hijhkh\hlhf qlh hl gbo `^mlbfh]ml klZgh\blvky lj_\h`gufbdh]^Z bo

ijbgm`^Zxl ^_ckl\h\Zlv beb dh]^Z bo h[uqgZy aZsblZ aZdexqZxsZyky \ ih\hjhl_

]g_\ZgZkZfbok_[yjZajmrZ_lky

< f_`ebqghklguo hlghr_gbyo iZkkb\ghZ]j_kkb\gu_ ebqghklb iulZxlky

fZgbimebjh\ZlvkZfbfbkh[hcklZ\yk_[y\ iheh`_gb_aZ\bkbfhklb ghboiZkkb\gh_

ijbqbgyxs__ ms_j[ ih\_^_gb_ qZklh i_j_`b\Z_lky ^jm]bfb dZd dZjZl_evgh_ b

fZgbimeylb\gh_ >jm]b_ ^he`gu \uihegylv ihjmq_gby b g_klb aZ gbo ijb\uqgmx

hl\_lkl\_gghklv>jmavyb \jZqbihiZ^Zxlky\ k_lbiulZykvmkihdhblv[hevgh]hdh]^Z

hg ]h\hjbl hlhf qlh k gbf g_kijZ\_^eb\h h[jZsZxlky ;ebadb_ k\yab k iZkkb\gh

Z]j_kkb\gufb ebqghklyfb j_^dh [u\Zxl kihdhcgufb beb kqZkleb\ufb Ihkdhevdm

iZkkb\ghZ]j_kkb\gu_ ebqghklb qZs_ kdehggu d \hafms_gbx q_f d m^h\e_l\hj_gbx

hgbgbdh]^Zg_]h\hjylqlh[ubfohl_ehkvqlh[uihemqblvjZ^hklv

Kh]eZkgh '60,,,5 ebpZ kwlbf jZkkljhckl\hf ebr_gu kZfhm\_j_gghklb b

h[uqgh i_kkbfbklbqgu \ hlghr_gbb k\h_]h [m^ms_]h Gb`_ ijb\h^ylky

^bZ]ghklbq_kdb_djbl_jbb^eyiZkkb\ghZ]j_kkb\guojZkkljhckl\ebqghklb

Mklhcqb\uc iZll_jg iZkkb\gh]h khijhlb\e_gby lj_[h\Zgbyf Z^_d\Zlgh

^_ckl\h\Zlv \ khpbZevghf b ijhn_kkbhgZevghf ieZg_ gZqbgZxsbcky \ jZgg_c

fheh^hklb b ijhy\eyxsbcky \ jZaebqguo `bl_ckdbo kblmZpbyo dZd mdZau\Z_lky ih

f_gvr_cf_j_  bake_^mxsbo

 hlly]b\Zgb_l_hldeZ^u\Zgb_gZ^he]bckjhdlh]hqlhg_h[oh^bfhk^_eZlv

qlh[ug_ij_\ukblvij_^_evguckjhd

 klZgh\blky m]jxfuf jZa^jZ`bl_evguf beb gZqbgZ_l kihjblv dh]^Z ijhkyl

k^_eZlvqlhgb[m^vqlhhgbebhgZg_ohq_l

 dZ`_lkyqlhjZ[hlZ_lgZjhqghf_^e_gghbebiehoh\uihegyyaZ^Zgbydhlhju_

hgbebhgZg_ohq_l^_eZlv

 ijhl_klm_l[_a^hklZlhqguohkgh\Zgbcijhlb\lh]hqlh

^jm]b_ydh[uij_^ty\eyxldg_cbebdg_fmqj_af_jgu_lj_[h\Zgby

 iheZ]Z_lqlhhgbebhgZ^_eZxljZ[hlmgZfgh]hemqr_q_f^jm]b_^mfZxlqlh

hgbebhgZ^_eZxl

 hl\_j]Z_l ih e_agu_ ij_^eh`_gby dZd [u hg beb hgZ fh]eb memqrblv k\hx

jZ[hlm

 ijhlb\hklhblmkbebyf^jm]bog_^_eZyk\hxqZklvjZ[hluhldhlhjhcaZ\bkbl

h[sbcmki_o

 [_ahkgh\Zgbydjblbdm_lbeb\ujZ`Z_lij_aj_gb_dex^yfdhlhju_aZgbfZxl

\b^gh_iheh`_gb_

L_q_gb_ b ijh]gha

< ijb\h^bfhf h[ke_^h\Zgbb mqZkl\h\Zeh  iZkkb\gh

Z]j_kkb\guo]hkiblZebabjh\Zgguo[hevguohgbh[ke_^h\Zebkv\ kj_^g_f\ l_q_gb_ 

e_l M  ba gbo [ueh i_j\bqgh ^bZ]ghklbjh\Zgh iZkkb\ghZ]j_kkb\gh_ jZkkljhckl\h

ebqghklb m  lZd`_ bf_e f_klh Zedh]hebaf m  hlf_qZebkv debgbq_kdb_ ijbagZdb

^_ij_kkbbKj_^b  baijb\_^_gguo[hevguom [uebmklhcqb\u_ikbobq_kdb_

gZjmr_gby Zm  iZlheh]bq_kdbo kbfilhfh\ g_ [ueh ;hevrbgkl\h dZaZebkv

lj_\h`gufb jZa^jZ`bl_evgufb b ^_ij_kkb\gufb ij_^ty\eyebkv fgh`_kl\_ggu_

khfZlbq_kdb_ `Zeh[u Lhevdh   \k_ \j_fy jZ[hlZeb beb \_eb ^hfZrg__

ohayckl\h Ohly qZklh hlf_qZehkv ij_g_[j_`_gb_ qm\kl\hf hl\_lkl\_gghklb b

lbibqgufb[uebkmbpb^Zevgu_ihiuldblhevdh  [hevghckh\_jrbekmbpb^Ohly 

 [ueb ih\lhjgh ]hkiblZebabjh\Zgu lhevdh  [hevguo [ueb gZa\Zgu

rbahnj_gbdZfb

>bnn_j_gpbZevguc ^bZ]gha

IZkkb\ghZ]j_kkb\gu_ ebqghklgu_ jZkkljhckl\Z

gm`gh ^bnn_j_gpbjh\Zlv hl bkl_jbq_kdbo b ih]jZgbqguo h^gZdh iZkkb\gh

Z]j_kkb\gu_ ebqghklb f_g__ djZkhqgu_ ^jZfZlbqgu_ Znn_dlb\gu_ b \g_rg_

Z]j_kkb\gu_q_fbkl_jbq_kdb_b ih]jZgbqgu_ebqghklbgh^bZ]ghaklZ\blkykh]eZkgh

'60,,,5 ebpZfklZjr_  e_l

E_q_gb_

IZkkb\ghZ]j_kkb\gu_ [hevgu_ dhlhju_ ihemqZxl ih^^_j`b\Zxsmx

ikbohl_jZibx ^Zxl ohjhrb_ j_amevlZlu H^gZdh ikbohl_jZiby [hevguo k iZkkb\gh

Z]j_kkb\gufbebqghklgufbjZkkljhckl\Zfbbf__lfgh]heh\mr_d^ey\uiheg_gbybo

lj_[h\ZgbcqZklhijboh^blkyih^dj_ieylvboiZlheh]bxghhldZaZlvbf\ ih^^_j`d_

agZqblhl\_j]gmlvboL_jZibylZdbfh[jZahfklZgh\blkyf_klhfkjZ`_gby\ dhlhjhf

[hevghc \hafmsZ_lky \jZqhf hl dhlhjh]h hg beb hgZ ohlyl klZlv aZ\bkbfufb M

iZkkb\ghZ]j_kkb\guo [hevguo \Z`gh e_qblv kmbpb^Zevgu_ gZf_j_gby lZd `_ dZd

ex[u_ \g_rgb_ \ujZ`_gby ]g_\Z Zg_ lZd dZd e_qbeb [u ihl_jx h[t_dlZ ijb

i_j\bqghc^_ij_kkbb

:glb^_ij_kkZglu ke_^m_l gZagZqZlv lhevdh lh]^Z dh]^Z bf_xlky debgbq_kdb_

mdZaZgby gZ ^_ij_kkbx b dh]^Z \hafh`gu kmbpb^Zevgu_ ihiuldb <jZq ^he`_g

ij_^\b^_lv\hafh`gu_ihke_^kl\byiZkkb\ghZ]j_kkb\gh]hih\_^_gbyihf_j_lh]hdZd

hgb \hagbdZxl b mdZau\Zlv gZ gbo [hevghfm LZdZy dhgnjhglZpby fh`_l hdZaZlvky

[he__ihe_aghc^eybaf_g_gbyih\_^_gby[hevgh]hq_fboijZ\bevgZybgl_jij_lZpby

J:KKLJHCKL<: EBQGHKLB GB=>? ;HE?? G? DE:KKBNBPBJM?FU?

>JM=H?G:A<:GB?HLKMLKL<M?L>GH

JZkkljhckl\h ebqghklb gb]^_ [he__ g_ deZkkbnbpbjm_fh_ \dexqZ_l l_

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