مرض القلق

160 ﻣﺮض اﻟﻘﻠﻖ 9876543210 Maprotiline /fehwithyehisolated /behisolated/alefisolated/rehfinal/tahmedial/dadinitial/alefisolatedPhenelzine /tehmarbutafinal/yehmedial/seenmedial/noonmedial/lamwithjeeminitial/alefisolated /tehmarbutaisolated/wawisolated/rehisolated/thalfinal/laminitial/aleffinal/behinitial /rehisolated/wawfinal/ainmedial/sheenmedial/laminitial/alefisolatedTranylcypromine Imipramine Maprotiline Trazodone Energizing /tehmarbutafinal/tahmedial/sheenmedial/noonmedial/meeminitial /tehisolated/alefisolated/yehwithrehfinal/thehinitial/alefwithhamzaabovefinal/tehinitialPhenelzine effectsTranylcypromine Imipramine Maprotiline Trazodone Hypertensive reaction with tyraminePhenelzine Tranylcypromine Subjectively unpleasant sidePhenelzine Tranylcypromine Alprazolam (/tehmarbutafinal/yehmedial/laminitial/aleffinal/jeemwithmeeminitial/alefisolated /tehmarbutafinal/fehmedial/sadmedial/behinitial) /aleffinal/yehmedial/sadmedial/khahmedial/sheeninitial /dadfinal/yehinitial/rehfinal/lamwithmeeminitial/alefisolatedImipramine Maprotiline Trazodone Tranylcypromine /tehisolated/aleffinal/jeemmedial/noonmedial/sheenmedial/tehmedial/laminitial/alefisolated /behfinal/behmedial/seenmedial/yehinitial /yehwithrehfinal/thehinitial/alefwithhamzaabovefinal/tehinitialImipramine Maprotiline Orgasmic dysfunction Phenelzine Tranylcypromine /tehmarbutafinal/yehmedial/hehmedial/sheenmedial/laminitial/alefisolated /tehmarbutaisolated/dalisolated/aleffinal/yehinitial/zainisolated /tehmarbutafinal/laminitial/aleffinal/ainmedial/fehmedial/laminitial/alefisolated /tehisolated/aleffinal/aininitial/rehfinal/lamwithjeeminitial/alefisolated /yehfinal/tahinitial/aleffinal/ainmedial/tehinitial /dalfinal/noonmedial/aininitial /tehmarbutafinal/yehmedial/behmedial/nooninitial/aleffinal/lamwithjeeminitial/alefisolated /tehisolated/alefisolated/yehwithrehfinal/thehinitial/alefwithhamzaabovefinal/tehmedial/laminitial/alefisolated /arabicindicdigitone/arabicindicdigitzero /lamfinal/kafmedial/sheeninitial /ainfinal/behinitial/aleffinal/tehinitial 10 Increased appetite Trazodone Imipramine Seizure inducing effect /meemisolated/dalfinal/laminitial/alefisolated /tahfinal/ghainmedial/dadinitial /ainisolated/aleffinal/fehmedial/tehinitial/rehisolated/alefisolated /yehwithnoonfinal/meeminitial/alefisolated/yehwithrehfinal/tehmedial/laminitial/alefisolated /tehmarbutaisolated/dalisolated/aleffinal/meeminitial /lamisolated/wawisolated/aleffinal/noonmedial/tehinitial /dalfinal/noonmedial/aininitial effects (overall) /aleffinal/behwithhehinitial /rehfinal/ainmedial/sheenmedial/yehinitial /tehmarbutafinal/hehmedial/yehinitial/rehfinal/kafinitial /tehmarbutafinal/yehmedial/behmedial/nooninitial/aleffinal/jeeminitial /tehisolated/alefisolated/yehwithrehfinal/thehinitial/alefwithhamzaabovefinal/tehinitial

161 اﻟﻬﺪف اﻷول: ﻫﺪف ﺑﻴﻮﻟﻮﺟﻲ 9876543210 /noonfinal/yehinitial/zainfinal/lammedial/yehmedial/noonmedial/yehmedial/fehinitialPhenelzine Tranylcypromine /yehwithnoonfinal/meeminitial/wawisolated/behwithrehfinal/yehinitial/aleffinal/seeninitial /lamfinal/yehmedial/nooninitial/alefisolated/rehfinal/tehinitial Imipramine Maprotiline Alprazolam Phenelzine Tranylcypromine Alprazolam Imipramine Maprotiline Trazodone Phenelzine Tranylcypromine Imipramine Maprotiline Trazodone Phenelzine Tranylcypromine Imipramine Maprotiline Trazodone Antichol /tehisolated/alefisolated/yehwithrehfinal/thehinitial/alefwithhamzaabovefinal/tehinitialPhenelzine lengric /tehmarbutaisolated/dalisolated/aleffinal/dadmedial/meeminitialTranylcypromine effects /zainisolated/aleffinal/hehmedial/jeemmedial/lammedial/laminitialImipramine /behwithyehfinal/sadmedial/ainmedial/laminitial/alefisolatedMaprotiline /yehisolated/wawisolated/aleffinal/thehmedial/behmedial/seenwithmeeminitial/alefisolated/rehisolated/aleffinal/behmedial/laminitial/alefisolatedTrazodone Figure 10 side effects at effective doses 10 /fehisolated/wawfinal/qafinitial/wawfinal/laminitial/alefisolated /dalfinal/noonmedial/aininitial /tahfinal/ghainmedial/dadmedial/laminitial/alefisolated /dadisolated/aleffinal/fehmedial/noonwithkhahinitial/alefisolated Alprazolam Headache /ainisolated/alefisolated/dalfinal/sadmedial/laminitial/alefisolated Constipation /kafisolated/aleffinal/seenmedial/meeminitial/lamwithalefisolated/alefisolated Tachycardia /behfinal/lammedial/qafmedial/laminitial/alefisolated /tehmarbutafinal/aininitial/rehfinal/seeninitial Trazodone /meemisolated/lamwithalefisolated/wawisolated/zainisolated/alefisolated/behwithrehfinal/laminitial/alefwithhamzaaboveisolated /yehwithnoonfinal/meeminitial/alefisolated/behwithrehfinal/yehmedial/meeminitial/alefwithhamzabelowisolated /yehwithnoonfinal/lammedial/yehmedial/tehinitial/wawisolated/rehfinal/behinitial/aleffinal/meeminitial /noonisolated/wawisolated/dalisolated/wawisolated/zainisolated/alefisolated/rehfinal/tehinitial Sedation /rehfinal/yehinitial/dalfinal/khahmedial/tehmedial/laminitial/aleffinal/behinitial /rehisolated/wawfinal/ainmedial/sheenmedial/laminitial/alefisolated Postural Hypotenion

162 ﻣﺮض اﻟﻘﻠﻖ أﻛﺜﺮ أﻫﻤﻴﺔ ﻣﻦ ﺣﻴﺚ ﻧﺘﻴﺠﺔ اﻟﻌﻼج ﻣﻦ ﻧﻮع اﻟﺪواء اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺴﺘﻌﻤﻞ. ﻓﻜﺜﻴﺮا ﻣﺎ ﻳﺤﺎل إﻟﻰ اﻷﻃﺒﺎء اﻟﻤﺨﺘﺼﻼءﺿﺐضﻹﳉحﻞ ﻓﻲ ﻫﺬا اﻻﺿﻄﺮاب ﻣﺮﺿﻰ ﻇﻠﻮا ﻳﻌﺎﳉﻮن ﺑﺎﻟﻌﺪﻳـﺪ ﻣﻦ اﻷدوﻳﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺬﻛﻮرة ﻓﻲ اﻟﻘﺎﺋﻤﺔ وﻟﻜﻨﻬـﻢ ﻻ ﻳـﺰاﻟـﻮن ﻳـﺸـﻜـﻮن ﻣـﻦ اﻷﻋـﺮاض. وﻋﻨﺪﺋﺬ ﻳﺮﻛﺰ اﻟﻤﺨﺘﺺ اﻧﺘﺒﺎﻫﻪ ﻋﻠﻰ اﻟﺘﺤﺪﻳﺪ اﻟﺪﻗﻴﻖ ﻟﻠﺠﺮﻋﺔءﺼﳋﺼض أو ﻳﻨﻘﺺ ﻣﻨﻬﺎ ﻛﻲ ﻳﺤﻘﻖ اﻟﺘﺤﺴﻦ اﻟﺬي ﻛﺎن ﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻔﺮوض أن ﻳﺤﺪت ﻣﻦ ﻗﺒﻞ ذﻟﻚ. وﻏﺎﻟﺒﺎ ﻣﺎ ﺗﻜﻮن اﻟﺰﻳﺎدات اﻟﻘﻠﻴﻠﺔ ﻫﻲ ﻛﻞ ﻣﺎ ﻧﺤﺘﺎج إﻟﻴﻪ. ﺛﻢ ﻗﺎﻋﺪة ﻋﺎﻣﺔ أﺧﺮى ﻫﻲ أن اﳉﺮﻋﺔ اﻟﺘﻲ ﻳـﺤـﺼـﻞ ﺑـﻬـﺎ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺮﻳـﺾ ﻋـﻠـﻰ أﻧﺴﺐ ﲢﺴﻦ ﻫﻲ اﳉﺮﻋﺔ اﻟﺘﻲ ﻳﺸﻌﺮ ﻣﻌﻬﺎ ﺑﺒﻌﺾ اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻌـﺘـﺎدة ﻟﻠﺪواء. ﻓﺈذا ﻟﻢ ﻳﺸﻌﺮ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ ﺑﺄي ﻣﻦ ﻫﺬه اﻷﻋﺮاض اﳉﺎﻧﺒﻴﺔءﺼﳋﺼض أﻓﻀﻞ ﺟﺮﻋﺔ ﻟﺘﺤﻘﻴﻖ اﻟﻔﺎﺋﺪة اﻟﻜﺎﻣﻠﺔ. وإﻼءﺿﺐﺐﺤﺿﻖﺤﻞﺎ ﺗﻜﻤﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻬﺎرة ﻓﻲ اﻟﺘﺤﺪﻳﺪ اﻟﺪﻗﻴﻖ ﻟﻠﺠﺮﻋﺔ ﻻﻋﺘﺼﺎر أﻗﺼـﻰ اﻟـﻔـﺎﺋـﺪة دون إﺣـﺪاث ﻗـﺪر ﻛـﺒـﻴـﺮ ﺟـﺪا ﻣـﻦ اﻵﺛـﺎر اﳉﺎﻧﺒﻴﺔ. واﳉﺮﻋﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺒـﺪﺋـﻴـﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻌـﺘـﺎدة ﻟـﻌـﻘـﺎر أﻟـﺒـﺮازوﻻم )alprazolam( ﻫﻲ ﻧـﺼـﻒ ﻣﻠﻴﺠﺮام ﺛﻼث ﻣﺮات ﻳﻮﻣﻴﺎ. وﺗﺆﺧﺬ اﳉـﺮﻋـﺔ ﺑـﻌـﺪ اﻻﻧـﺘـﻬـﺎء ﻣـﻦ ﻛـﻞ وﺟـﺒـﺔ. وﺣﻼءﺿﺐضﻹﳉحﻞ ﺗﺆﺧﺬ اﳉﺮﻋﺎت ﺑﻌﺪ اﻟﻄـﻌـﺎم ﻳـﻜـﻮن اﻣـﺘـﺼـﺎص اﻟـﺪواء أﺑـﻄـﺄ ﻛـﻤـﺎ أن ﻣﺴﺘﻮاه ﻓﻲ اﻟﺪم ﻻ ﻳﺒﻠﻎ ﻗﻤﺔ اﻻرﺗﻔﺎع. واﻟﻨﺘﻴﺠﺔ أن ﻳﻘﻞ ﻇﻬﻮر اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ - وﺧﺼﻮﺻﺎ اﻟﺸﻌﻮر ﺑﺎﻟﻨﻌﺎس -ءﺼﳋﺼض ﺣﺪ ﻣﺎ. وﻼءﺿﺐضﺠؤﻞﻜﻦ - ﺑﻌﺪ ﺗﻨﺎول اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ ﻧﺼﻒ ﻣﻠﻴﺠﺮام ﺛﻼث ﻣﺮات ﻳﻮﻣﻴﺎ ﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪة ﻳﻮﻣﻼءﺿﺐضﻹﳉحﻞ - أن ﺗﺰاد اﳉﺮﻋﺔ ﻼءﺿﺐؤثضﺾﻞـﻌـﺪل ﻧـﺼـﻒ ﻣـﻠـﻴـﺠـﺮام ﻛـﻞ ﻳـﻮﻣـﻼءﺿﺐضﻹﳉحﻞءﺼﳋﺼض اﻹﺿﺎﻓﻴﺔ إﻟﻰ إﺣﺪى اﳉﺮﻋﺎت اﻟﻘﺎﺋﻤﺔ. أﻣﺎ اﳉﺮﻋﺔ اﻟﻼزﻣﺔ ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﺄﺛﻴﺮات ﻃﻴﺒﺔ ﻓﻲ اﻟـﻌـﻼج ﻓـﺘـﺘـﺮاوح ﺑﻼءﺿﺐضﻹﳉحﻞ ﺛﻼﺛﺔ وﺗﺴﻌﺔ ﻣﻠﻴﺠﺮاﻣﺎت ﻳﻮﻣﻴﺎ. وﻳﺒﻠﻎ ﻣـﺘـﻮﺳـﻂ اﳉـﺮﻋـﺔ اﻟـﻼزﻣـﺔ ﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻨـﻊ ﻧﻮﺑﺎت اﻟﻬﻠﻊ ﻓﻲ اﻟﺪراﺳﺎت ﺣﺘﻰ اﻵن ﺳﺘﺔ ﻣﻠﻴﺠﺮاﻣﺎت ﻳﻮﻣﻴـﺎ. وﺣـﻼءﺿﺐضﻹﳉحﻞ ﺗـﺼـﻞ اﳉﺮﻋﺔ إﻟﻰ ﻣﻌﺪل ﻣﻠﻴﺠﺮاﻣﻼءﺿﺐضﻹﳉحﻞ ﺛﻼث ﻣﺮات ﻳﻮﻣﻴﺎ ﺗﻀﺎف اﳉﺮﻋﺎت اﻹﺿﺎﻓﻴﺔ ﺑﺼﻔﺔ ﻋﺎﻣﺔ ﻋﻨﺪ اﻟﻨﻮم. واﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ اﻟﺮﺋﻴﺴﺔ ﻫﻲ اﻟﻨﻌﺎسءﺼﳋﺼض ﻋﻨﺪ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺸﻲءﺼﳋﺼضslurring of speech(ءﺼﳋﺼض ﻣﻬﺘﺎج وﻧﻘﺺ ﻓﻲ اﻟﺪاﻓﻌﻴﺔ )lack of motivation(. واﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ ﻗﺪ ﻳﺤﺘﺎﺟﻮن إﻟﻰ

163 اﻟﻬﺪف اﻷول: ﻫﺪف ﺑﻴﻮﻟﻮﺟﻲ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮور ﻓﻲ ﻣﺴﺘـﻮﻳـﻼءﺿﺐضﻹﳉحﻞ أو ﺛـﻼﺛـﺔ وﻫـﻢ ﻳـﺠـﺘـﺎزون ﻣـﺮاﺣـﻞ اﻟـﺘـﺤـﻤـﻞ أو اﻹﻃـﺎﻗـﺔ )tolerance( إﻟﻰ أن ﻳﻬﺘﺪوا إﻟﻰ اﳉﺮﻋﺔ اﻷﻓﻀﻞ ﺑﻌﺪ ﻓﺘﺮة ﺗﺘﺮاوح ﺑﻼءﺿﺐضﻹﳉحﻞ أﺳﺒﻮع وﺛﻼﺛﺔ أﺳﺎﺑﻴﻊ. وﻗﺪ ﻳﺤﺘﺎج اﻷﻣﺮ إﻟﻰ زﻳﺎدة اﳉﺮﻋﺔ إذا ﺗﻮﻗﻔﺖ اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ واﻧﻌﺪﻣﺖ اﻟﻔﺎﺋﺪة اﻟﺘﻲ ﻛﺎﻧﺖ ﺗﺼﺎﺣﺐ ﺟﺮﻋﺔ ﻓﻌﺎﻟﺔ ﺳﺎﺑﻘﺔ. ﻓﺈذا ﻇﻞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ ﻋﻠﻰ اﳉﺮﻋﺔ اﻷﻓﻀﻞ ﻣﻦ أﻟﺒﺮوزوﻻم ﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪة أﺳﺒﻮﻋﻼءﺿﺐضﻹﳉحﻞ أو ﺛﻼﺛﺔ أﺳﺎﺑﻴﻊ ﻛﺎن ﻋﻠﻰ اﻟﻄﺒﻴﺐ أن ﻳﻘﺪر إن ﻛﺎن ﻗﺪ وﺻﻞ إﻟﻰ درﺟﺔ ﻛﺎﻓﻴﺔ ﻣﻦ (.٩اﻟﺸﻔﺎء )اﻧﻈﺮ ﺷﻜﻞ ﻓﺈن ﻛﺎن اﻟﺸﻔﺎء ﺗﺎﻣﺎءﺼﳋﺼض ﺑﻼءﺿﺐضﻹﳉحﻞ ﺳﺘﺔ ﺷﻬﻮر واﺛﻨﻰ ﻋﺸﺮ ﺷﻬﺮا أﺧﺮى. ﺣﺘﻰ إذا أﺣﺲ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ ﺑﺎﺳﺘﻌﺪاده ﻟﻼﺳﺘﻐﻨﺎء ﻋﻦ اﻟﺪواء ﻓﻲ اﻟﻨﻬﺎﻳﺔ ﺧﻔﻀﺖ اﳉﺮﻋﺔ ﺑﺒﻂء ﻼءﺿﺐؤثضﺾﻞﻌﺪل ﻳﺘﺮاوح ﺑﻼءﺿﺐضﻹﳉحﻞ ﻧﺼﻒ ﻣﻠﻴﺠﺮام وﻣﻠﻴﺠﺮام ﻛﻞ أﺳﺒﻮع. ﻓﺈﻧﻪ ﻻ ﻳﻨﺒﻐﻲ إﻳﻘﺎف أي دواء ﻳﺴﺘﺨﺪم ﻓﻲ ﻋﻼج اﻟﻘﻠﻖ ﻓﺠﺄة ﻋﻠﻰ اﻹﻃﻼقءﺼﳋﺼض ذﻟﻚ إﻟﻰ زﻳﺎدة ﺗﻨﺸﻴﻂ اﳊﺎﻟﺔ ﺛﺎﻧﻴﺔ أو إﻟﻰ ﻇﻬﻮر آﺛﺎر اﻻﻧﺴﺤﺎب ﻣﻦ اﻟﻌﻘﺎر ﺑﻞ إﻟﻰ اﻟﺘﺸﻨﺠﺎت ﻛﺬﻟﻚ. وأﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﺪواء ﻓﻴﻨﻴـﻠـﺰاﻳـﻦ phenelzine٥١ ﻓﺈن اﳉﺮﻋﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺒﺪﺋﻴﺔ ﻫـﻲ ﻣﻠﻴﺠﺮام ﻛﻞ ﺛﻼﺛﺔ أﻳﺎم أو أرﺑﻌﺔ.٥١ﻣﻠﻴﺠﺮام ﻳﻮﻣﻴﺎ. ﺛﻢ ﺗﺰداد اﳉﺮﻋﺔ ﻼءﺿﺐؤثضﺾﻞﻌﺪل ﻣﻠﻴﺠﺮام ﺛﻼث ﻣﺮات ﻳﻮﻣﻴﺎ ﺗﺰداد ﻛﻞ أﺳﺒﻮع٥١وﺑﻌﺪ أن ﺗﺼﻞ اﳉﺮﻋﺔ إﻟﻰ ﻣﻠﻴﺠﺮام إﻟﻰ أن ﺗﻈﻬﺮ ﺑﻌﺾ اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ اﻟﺸﺎﺋﻌـﺔ اﻟـﻨـﻤـﻄـﻴـﺔءﺼﳋﺼض وﻋﻨﺪﻣﺎ ﻳﺼﻞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ إﻟﻰ ﺟﺮﻋﺔ ﺗﺆدي إﻟﻰ ﻧﺘﻴﺠﺔ ﻃﻴﺒﺔءﺼﳋﺼض ﻳﻬﺒﻂ ﺿﻐﻂ اﻟﺪم ﻋﻨﺪه ﻗﻠﻴﻼ وﻫﻮ واﻗﻒ )ﻋﻨﺪ ﻣﻘﺎرﻧﺘﻪ ﺑﻀـﻐـﻂ اﻟـﺪم وﻫـﻮ ﺟﺎﻟﺲ ﻣﺴﺘﺮﻳﺢ(. وﻟﻬﺬا اﻟﺴﺒﺐ ﻧﻨﺼﺢ ﺑﻘﻴﺎس ﺿﻐﻂ اﻟﺪم ﻋﻨﺪ اﳉﻠـﻮس وﻋـﻨـﺪ اﻟـﻮﻗـﻮفءﺼﳋﺼض وﺑﺎﻻﺣﺘﻔﺎظ ﺑﺴﺠﻞ دﻗﻴﻖ ﻟﺬﻟﻚ ﺑﺎﻧﺘﻈﺎم )ﻼءﺿﺐضﺠؤﻞﻜﻦ ﲢﺼﻴﻞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺰﻳﺪ ﻣﻦ اﻟﺘﻔﺼﻴﻼت ﻋﻦ اﺳﺘﺨﺪام ﻛﺎﺑﺤﺎت اﻷﻣﻴﻨﺎت اﻷﺣﺎدﻳﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺆﻛﺴﺪة وﻋﻦ آﺛﺎرﻫﺎ اﳉﺎﻧﺒﻴﺔ ﻓﻲ اﻟﻌﻼج اﻟﺴﻴﻜﻴﺎﺗﺮيءﺼﳋﺼض اﻷدوﻳﺔ اﻷﺧﺮى وآﺛﺎرﻫﺎ اﳉﺎﻧﺒﻴﺔ ﻣﺜﻞ ﻣﻀﺎدات اﻻﻛﺘﺌﺎب اﻟﺜﻼﺛﻴﺔ اﻟﺪاﺋـﺮﻳـﺔ ﻣﻦ ﻗﺎﺋﻤﺔ اﻟﻘﺮاءات أو اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺼﺎدر اﻹﺿﺎﻓﻴﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺜﺒﺘﺔ ﻓﻲ آﺧﺮ اﻟﻜﺘﺎب(. إن وﺟﻮد ﺑﻌﺾ اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ اﻟﺸﺎﺋﻌﺔ ﻓﻲ ﺟﻤﻴﻊ ﻫﺬه اﻷدوﻳﺔ أﻣﺮ ﺿﺮوري ﻓﻲ اﻟﻌﺎدة ﻟﻀﻤﺎن وﺻﻮل اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺮﻳـﺾ إﻟـﻰ اﳉـﺮﻋـﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻨـﺎﺳـﺒـﺔ. ﻛـﻤـﺎ أن اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻬـﺎرة

164 ﻣﺮض اﻟﻘﻠﻖ اﻹﻛﻠﻴﻨﻴﻜﻴﺔ واﻟﺘﻌﺪﻳﻞ اﳊﺮﻳﺺ أﻣﺮان أﺳﺎﺳﻴﺎن ﻟﻠﻮﺻﻮل إﻟﻰ ﺗﻮازن ﻣﺮﻳﺢ ﺑﻼءﺿﺐضﻹﳉحﻞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺰاﻳﺎ واﻵﺛﺎر اﳉﺎﻧﺒﻲ . وﻟﻌﻠﻪ ﻣﻦ اﻹﻧﺼﺎف أن ﻧﻘﻮل-ﻓﻲ ﻫﺬه اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺣﻠﺔ اﻟﺘﺎرﻳﺨﻴﺔ ﻣﻦ ﻇﻬﻮر ﻫﺬه اﻷدوﻳﺔ-أن اﳉﺮﻋﺎت اﻟﺘﻲ ﺗﻮﺻﻒ ﻓﻲ أﻛﺜﺮ اﻷﺣـﻴـﺎن ﳒـﺪﻫـﺎ ﻏـﻴـﺮ ﻣـﻼﺋـﻤـﺔ ﻼءﺿﺐضﺠﳉﺠﻞﺎﻣﺎ ﻟﻠﻮﺻﻮل إﻟﻰ أﺣﺴﻦ اﻟﻨﺘـﺎﺋـﺞ. أي أن ﻛـﻼ ﻣـﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺮﻳـﺾ واﻟـﻄـﺒـﻴـﺐ ﻓـﻲ ﺣﺎﺟﺔ إﻟﻰ اﻟﺼﺒﺮ واﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺜﺎﺑﺮة إﻟﻰ أن ﻳﺘﺤﻘﻖ اﻟﻬﺪف وﻫﻮ أﻧﺴﺐ ﺟﺮﻋﺔ ﻼءﺿﺐؤزةﻞﻜﻨﺔ ﺗﺴﺘﺨﺪم ﻋﻠﻰ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪى اﻟﻄﻮﻳﻞ. ﺗﻮﻋﻴﺔ اﳌﺮﻳﺾ Educating The Patient) اﻷدوﻳﺔ اﻟﻔﻌﺎﻟﺔ ﻓﻲ ﻫﺬا اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮض ﻻ ﻼءﺿﺐضﺠؤﻞﻜﻦ ﻟﻠﻄﺒﻴﺐ وﺻﻔﻬﺎءﺼﳋﺼض ﺗﻨﺎوﻟﻬﺎ ﻛﻴﻔﻤﺎ اﺗﻔﻖ. ﺻﺤﻴﺢ أن أي ﻃﺒﻴﺐ ﻳﺴﺘﻄﻴﻊ أن ﻳﺼﻔﻬﺎ ﺑﺎﻟﻄﺒﻊ. وﻼءﺿﺐؤزةﻞﺎ ﻳﺪﻋﻮ إﻟﻰ اﻟﻄﻤﺄﻧﻴﻨﺔ - ﻋﻠﻰ ﻛـﻞ ﺣـﺎل - أن ﻧـﻌـﺮف أن ﻫـﻨـﺎك ﻣـﺨـﺘـﺼـﻼءﺿﺐضﻹﳉحﻞ ﻓـﻲ اﻟﻄﺐ ﻳﺴﻤﻮن ﻣﺨﺘﺼﻼءﺿﺐضﻹﳉحﻞ ﻓﻲ اﻟﻌـﻘـﺎﻗـﻴـﺮ اﻟـﻨـﻔـﺴـﻴـﺔ )psychopharm acologists( ﻳﻨﻔﻘﻮن ﺟﻞ وﻗﺘﻬﻢ ﻓﻲ ﻋﻼج اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ ﺑﻬﺬه اﻷدوﻳﺔءﺼﳋﺼض ﻓﻲ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻴﺪانءﺼﳋﺼض اﻟﻨﻔﺴﻴﺔ ﺑﺎﻷدوﻳﺔ اﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ اﻟﻌﻘﻞ أو اﳉﻬﺎز اﻟـﻌـﺼـﺒـﻲ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺮﻛـﺰيءﺼﳋﺼض ﺟﻤﻴﻌﺎ ﻋﻠﻰ اﻟﺘﻘﺮﻳﺐ ﻣﻦ اﻷﻃﺒﺎء اﻟﺬﻳﻦ ﺗﺨﺼﺼﻮا أوﻻ ﻓﻲ اﻟﻄﺐ اﻟـﻨـﻔـﺴـﻲ )psychiatry(ءﺼﳋﺼض وﻋﻠﻰ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ اﻟﺬﻳﻦ ﻳﺮﻳﺪون اﻻﺳﺘﻔﺎدة ﻣﻦ ﺧﺒﺮة ﻫﺆﻻء اﻟﻤﺨﺘﺼﻼءﺿﺐضﻹﳉحﻞ اﺗﺒﺎع اﻟﻨﻈﺎم اﻟﺘﺎﻟﻲ: ﺣﺪد ﻣﻜﺎن أﻗﺮب ﻛﻠﻴﺔ ﻟـﻠـﻄـﺐءﺼﳋﺼض اﻟﻨﻔﺴﻲ داﺧﻞ ﺗﻠﻚ اﻟﻜﻠﻴﺔ اﻟﻄﺒﻴﺔ )أﻏﻠﺐ ﻛﻠﻴﺎت اﻟﻄﺐ ﻓﻲ اﻟﻮﻻﻳﺎت اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺘﺤـﺪة ﻓﻴﻬﺎ أﻗﺴﺎم ﻟﻠﻄﺐ اﻟﻨﻔﺴﻲ ﻣﻮﺟﻮدة ﻓﻲ ﻣﺴﺘﺸﻔﻴﺎت ﺗﻌﻠﻴﻤﻴﺔ ﺟﺎﻣﻌﻴﺔ ﻋﺪﻳﺪة وﻗﺮﻳﺒﺔ(. ﺛﻢ اﺳﺘﺸﺮ واﺣﺪا ﻣﻦ أﻋﻀﺎء ﻫﻴﺌﺔ اﻟﺘﺪرﻳﺲ ﻓﻲ وﺣﺪات ﻋﻠﻢ اﻟﻌﻘﺎﻗـﻴـﺮ اﻟﻨﻔﺴﻴﺔ داﺧﻞ ﺗﻠﻚ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺴﺘﺸﻔﻴﺎت. وﻗﺪ ﻳﻘﺪﻣﻮن اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺴﺎﻋﺪة ﺑﺄﻧﻔﺴﻬـﻢءﺼﳋﺼض ﻛﺎﻧﻮا ﻓﻲ ﻣﻜﺎن ﺑﻌﻴﺪ ﺟﺪا ﻓﺴﻮف ﻳﺤﻴﻠﻮن اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ إﻟﻰ زﻣﻴﻞ ﻛـﻒء ﻓـﻲ ﻋـﻠـﻢ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻨﻔﺴﻴﺔ ﻳﻜﻮن أﻗﺮب إﻟﻰ ﺑﻴﺖ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ. إن ﻛﺜﻴﺮا ﻣﻦ اﻷﻃﺒﺎء اﻟﻨﻔﺴﻴﻼءﺿﺐضﻹﳉحﻞ )psychiatrists( اﻵن ﻣﺪرﺑﻮن ﺗﺪرﻳﺒﺎ ﺟﻴﺪا

165 اﻟﻬﺪف اﻷول: ﻫﺪف ﺑﻴﻮﻟﻮﺟﻲ ﻓﻲ ﻋﻠﻢ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻨﻔﺴﻴﺔ وﻼءﺿﺐضﺠؤﻞﻜﻨﻬﻢ أن ﻳﻜﻮﻧﻮا ﻧﺎﻓﻌﻼءﺿﺐضﻹﳉحﻞ ﺟﺪا. أﻣﺎ اﻟﻤﺨﺘﺼﻮن اﻟﻨﻔﺴﻴﻮن )psychologists( ﻓﻠﻴﺲ ﻟﺪﻳﻬﻢ ﺷﻬﺎدة ﺑﻜﺎﻟﻮرﻳﻮس ﻓﻲ اﻟﻄﺐ أو ﺗﺪرﻳﺐ ﻃﺒﻲ ﻣﺜﻞ اﻷﻃﺒﺎء اﻟﻨﻔﺴﻴﻼءﺿﺐضﻹﳉحﻞءﺼﳋﺼض ﻟﻬﻢ ﺑﻮﺻﻒ اﻷدوﻳﺔ. وﻟﻜﻨﻬﻢ - ﻣﻊ ذﻟﻚ - ﻣﺪرﺑﻮن ﺗﺪرﻳﺒﺎ ﺟﻴﺪا ﻓﻲ ﻛﺜﻴﺮ ﻣـﻦ اﻷﺣﻴﺎن ﻋﻠﻰ اﻟﻌﻼج اﻟﺴﻠﻮﻛﻲ. وﻏﺎﻟﺒﺎ ﻣﺎ ﻳﻜﻮن ﻫﺬا اﻟﻨﻮع ﻣﻦ اﻟﻌﻼج ﻧﺎﻓﻌﺎ - ﻛﻤﺎ ﺳﻨﺮى ﻓﻲ اﻟﻔﺼﻞ اﻟﺘﺎﻟﻲ - وﺧﺼﻮﺻﺎ ﺑﻌﺪ أن ﺗﺘﻢ ﺳﻴﻄﺮة اﻟـﺪواء ﻋـﻠـﻰ اﻟﻨﻮﺑﺎت اﻟﺘﻠﻘﺎﺋﻴﺔ. وﻳﺴﺘﻄﻴﻊ اﻟﻤﺨﺘﺼﻮن ﻓﻲ اﻟﻌﻼج اﻟﺴﻠﻮﻛﻲ أن ﻳﻀﻴﻔﻮا - ﻓﻲ أﺣﻴﺎن ﻛﺜﻴﺮة - ﺑﻌﺪا إﺿﺎﻓﻴﺎ إﻟﻰ ﲢﺴﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺮﻳـﺾءﺼﳋﺼض ﺑﺼﻔﺔ ﺧﺎﺻﺔ ﻓﻲ اﻟﺘﻐﻠﺐ ﻋﻠﻰ اﻟﻔﻮﺑﻴﺎ أو اﻟﻤﺨﺎوف اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻴﺔ. وﻳﻌﻤﻞ ﻛﺜﻴﺮ ﻣﻦ اﻟﻤﺨﺘﺼﻼءﺿﺐضﻹﳉحﻞ اﻟﻨﻔﺴﻴﻼءﺿﺐضﻹﳉحﻞ اﻵن ﻣﻊ اﻷﻃﺒﺎء اﻟﻨﻔﺴﻴﻼءﺿﺐضﻹﳉحﻞ ﻛﻔﺮﻳﻖ. وﻋﻨﺪﺋﺬ ﻳﺼﻒ اﻟﻄﺒﻴﺐ اﻟﻨﻔﺴﻲ اﻷدوﻳﺔ اﻟﻔﻌﺎﻟﺔ وﻳﺘﺎﺑﻌﻬﺎ. ﺑﻴﻨﻤﺎ ﻳﺴﺎﻋـﺪ اﻟﻤﺨﺘﺺ اﻟﻨﻔﺴـﻲ ﻓـﻲ ﺗـﻘـﺪﻼءﺿﺐ اﳊﺎﺟﺔ. وﻣﻦ اﻟﺮاﺟﺢ أن ﻳﺸﻤﻞ ﻣﺜﻞ ﻫـﺬا اﻟـﻔـﺮﻳـﻖ ﻣـﺨـﺘـﺼـﻼءﺿﺐضﻹﳉحﻞ ذوي ﻣـﻌـﺮﻓـﺔ ووﻋﻲ ﻼءﺿﺐؤثضﺾﻞﺠﺎﻻت اﳋﺒﺮة ﻋﻨﺪ أﺻﺤﺎب اﻟﺘﺨﺼﺼﺎت اﻷﺧﺮى. وﻻ ﻳﺨﺘﻠﻒ وﺻﻒ اﻟﻌﻘﺎﻗﻴﺮ ﻓﻲ ﻣﺮض اﻟﻘﻠﻖ ﻋﻦ وﺻﻒ اﻹﻧﺴﻮﻟﻼءﺿﺐضﻹﳉحﻞ ﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ داء اﻟﺒﻮل اﻟﺴﻜﺮي. ﻓﻌﻠﻰ ﻣﺮﺿﻰ داء اﻟﺒﻮل اﻟﺴﻜﺮي أن ﻳﺘﻌﻠﻤﻮا اﻟﻜﺜﻴﺮ وأن ﻳﺘﻌﺎوﻧﻮا ﺗﻌﺎوﻧﺎ وﺛﻴﻘﺎ ﻣﻊ اﻟﻔﺮﻳﻖ اﻟﻄﺒﻲ ﻛﻲ ﻳﺤﺼـﻠـﻮا ﻋـﻠـﻰ أﻓـﻀـﻞ ﺳـﻴـﻄـﺮة ﻼءﺿﺐؤزةﻞﻜﻨﺔ ﻋﻠﻰ ﻣﺮﺿﻬﻢ ﺑﺪاء اﻟﺒﻮل اﻟﺴﻜﺮي. إن أوﻗﺎت اﳊﻘﻦ ﺑﺎﻹﻧﺴﻮﻟﻼءﺿﺐضﻹﳉحﻞ أﺛﻨﺎء اﻟﻴﻮمءﺼﳋﺼض اﻷوﻗﺎتءﺼﳋﺼض أوﻟﺌﻚ اﻋﺘﺒﺎرات ﻫﺎﻣﺔ. وﺗﻨﺒﻐﻲ اﻟﻌﻨﺎﻳﺔ - إﺿﺎﻓﺔ إﻟﻰ ذﻟﻚ - ﻼءﺿﺐؤثضﺾﻞﺴﺘﻮى اﻟﺮﻳﺎﺿﺔ وﺷﺮب اﻟﻜﻤﻴﺎت اﻟﻜﺎﻓﻴﺔ ﻣﻦ اﻟﺴﻮاﺋﻞ. ﻓﻬﺬه اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺘﺎﺑﻌﺔ اﻟﻮاﻋﻴﺔ-ﻓﻲ أﻏﻠﺐ اﻷﻣﺮاض اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺰﻣﻨﺔ-ﻟـﻠـﺪواءءﺼﳋﺼض ﻣﺮﻳﺾ ﻣﺴﺘﻨﻴﺮ ﻫﻲ اﻟﺘﻲ ﺗﺆدي إﻟﻰ اﻟﻔﺎرق ﺑﻼءﺿﺐضﻹﳉحﻞ ﻧﺘﻴﺠﺔ ﻣـﺘـﻮﺳـﻄـﺔ أو ﻧـﺘـﻴـﺠـﺔ ﻃﻴﺒﺔ ﻟﻠﻌﻼج. وﻋﻼج ﻣﺮض اﻟﻘﻠﻖ أﻣﺮ ﻣﺸﺎﺑﻪ ﺟﺪا. إن اﻟﻮﻗﺖ اﻟﺬي ﻳﻘﻀﻴﻪ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ ﻣﻊ اﻟﻄﺒﻴﺐ ﻓﻲ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮاﺣﻞ اﻷوﻟﻰ ﻟﻠﻌﻼج ﻟﻪ ﺟﺰاء ﻃﻴﺐ. إذ ﺳﻮف ﻳﺤﺪد اﻟﻄﺒﻴﺐ اﻹﻃﺎر اﻟﻌﺎم وﻳﻨﺎﻗﺶ اﺳﺘﺮاﺗﻴﺠﻴﺔ اﻟﻌﻼج واﺧﺘﻴﺎر اﻟﺪواء. ﻋﻠﻰ أن ﻛﺜﻴﺮا ﻣﻦ اﻷﻃﺒﺎء ﻳﻘـﺪﻣـﻮن إرﺷـﺎدات ﻣـﻜـﺘـﻮﺑـﺔ ﻋـﻦ ﻛﻴﻔﻴﺔ اﻻﺑﺘﺪاء ﺑﺎﳉﺮﻋﺔ وزﻳﺎدﺗﻬﺎءﺼﳋﺼض

166 ﻣﺮض اﻟﻘﻠﻖ اﻟﺘﺼﺮف ﻓﻲ اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ اﻟﻤﺨﺘﻠﻔﺔ واﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺸﻜﻼت اﻟﺘﻲ ﺗﻈﻬﺮ ﻋﺎدة. ﺻﺤﻴﺢ أﻧﻪ ﻗﺪ ﻳﺰﻋﺞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮء ﻓﻲ ﺑﺎدءﳉﻈﺿثﺿضﻹؤﻈﺿﺿﺾعﺿﺐﺿﻂﻞ اﻷﻣﺮ أن ﻳﺪرك اﺣﺘﻤﺎل وﻗﻮع آﺛﺎر ﺟﺎﻧﺒﻴﺔءﺼﳋﺼض ﻣﻦ اﻟﺴﻬﻞ-ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ ذﻟﻚ-أن ﻳﺘﻌﻠﻢ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳـﺾ أي ﻫـﺬه اﻵﺛـﺎر ﻳـﻜـﻮن ﻣـﻦ اﻟﺪﻻﺋﻞ اﳊﺴﻨﺔ ﻋﻠﻰ اﳉﺮﻋﺔ اﻟﺼﺤﻴﺤـﺔءﺼﳋﺼض ﻣﺰﻋﺠﺎ. إن اﻟﻮﻗﺖ اﻟﺬي ﻳﻨﻔﻘﻪ اﻟﻄﺒﻴﺐ واﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ ﻓﻲ ﻫﺬه اﻷﻣﻮر ﻻ ﻳﺨﻔﻒ اﻻﻧﺸﻐﺎل واﻟﻘﻠﻖ ﻋﻠﻰ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪى اﻟﻄﻮﻳﻞ ﻓﺤﺴﺐءﺼﳋﺼض ﻣﺘﻌﺎوﻧﻼءﺿﺐضﻹﳉحﻞ ﻓﻲ اﻟﻌﻼج. وﻫﺬا ﻳﺰﻳﺪ ﻣﻦ اﻟﻔﺮص اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺘﺎﺣﺔ ﻟﻠﻤﺮﻳﺾ ﻓﻲ اﺗﺒﺎع إرﺷﺎدات اﻟﻄﺒﻴﺐ وﻓﻲ اﻟﺘﻌﺎون ﻣﻌﻪ-ﻻ اﻟﻮﻗﻮف ﺿﺪه-ﻓﻲ ﺳﺒﻴﻞ ﲢﻘﻴﻖ أﻓﻀﻞ ﻧﺘﻴﺠـﺔ ﻼءﺿﺐؤزةﻞـﻜـﻨـﺔءﺼﳋﺼض ﻳﺰﻳﺪ ﻣﻦ ﻓﻬﻢ اﻟﻄﺒﻴﺐ ﻟﻠﻤﺮﻳﺾ. وﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ ﻣﻦ ﻳﺠﺪ ﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻔﻴـﺪ أن ﻳـﻘـﻮم ﺑﻜﺘﺎﺑﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺬﻛﺮاتءﺼﳋﺼض وﻫﺬا ﻣﻦ ﺷﺄﻧﻪ أن ﻳﺴﺠﻞ ﺗﻔﺼﻴﻼت اﻟﺘﻌﻠﻴﻤﺎت ﺑﺪﻗﺔ وﺑﻄﺮﻳﻘﺔ ﺗﻮﻓﺮ اﻟﻮﻗﺖ أﻳﻀﺎ. إن زﻳﺎدة اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻌﺮﻓﺔ ﺑﺎﳊﺎﻟﺔ وﻋﻼﺟﻬﺎ ﻣﻔﻴﺪة ﻓﻲ اﻟﻌﺎدة ﻋﻠﻰ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪى اﻟﻄﻮﻳﻞ. وﻗﺪ ﻳﺨﺎف اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ أﺣﻴﺎﻧﺎ ﻣﻦ ﺑﻌﺾ ﻣﺎ ﻳﻘﺮؤوﻧﻪءﺼﳋﺼض ﻳﺪرﻛﻮن أن ﻣﺰاﻳﺎ ﻫﺬه اﻷﻧﻮاع ﻣﻦ اﻟﻌﻼج ﺗـﺮﺟـﺢ ﻛـﺜـﻴـﺮا ﻋـﻠـﻰ ﻋـﻴـﻮﺑـﻬـﺎ. ﻛـﻤـﺎ ﻳﺘﺄﻛﺪون ﻣﻦ أن أﻃﺒﺎءﻫﻢ ﺣﺮﻳﺼﻮن ﻋﻠﻰ ﺣﻤﺎﻳﺘﻬﻢ ﻣﻦ اﻟﻀﺮر. ﻛﻤﺎ أن إدارة اﻟﻐﺬاء واﻟﺪواء ﺗﻘﻮم - ﺑﺎﻟﺘﺎﻟﻲ - ﻋﻠﻰ ﺣﻤﺎﻳﺔ ﻣﺼﺎﻟﺢ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ اﻟﺼﺤﻴﺔءﺼﳋﺼض اﻟﺪوام اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻌﻠﻮﻣﺎت اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺘﺎﺣﺔ ﻋﻦ اﻵﺛﺎر اﳉـﺎﻧـﺒـﻴـﺔ ﻛـﻲ ﲢـﻤـﻲ اﳉـﻤـﻬـﻮر ﻣـﻦ أي أﺧﻄﺎر ﻛﺒﻴﺮة. وﻗﺪ رأﻳﻨﺎ-ﻓﻲ اﻟﻔﺼﻞ اﻟﺴﺎﺑﻊ ﻋﺸﺮ ﻋﻦ اﻷﻫﺪاف اﻷرﺑﻌﺔ ﻟﻠﻌﻼج-ﻛﻴﻒ أن آدم ﺑﺤﺚ ﻋﻦ ﻣﻌﻠﻮﻣﺎت أﻛﺜﺮ ﺗﻔﺼﻴﻼ ﻋﻦ ﻣﺮض اﻟﻘﻠﻖ وﻋﻼﺟﻪ. وﻟﻜﻦ ﻛﺜﻴﺮا ﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ ﻻ ﻳﺪرﻛﻮن ﻣﺪى ﺳﻬﻮﻟـﺔ اﻟـﺒـﺤـﺚ ﻋـﻦ أﻓـﻀـﻞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻌـﻠـﻮﻣـﺎت ﻧـﻮﻋـﺎ. وﻏﺎﻟﺒﺎ ﻣﺎ ﻳﺆدي اﻟﺘﻌﺎون ﻣﻊ واﺣﺪ ﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪرﺑﻼءﺿﺐضﻹﳉحﻞ ﻣﻦ أﻣﻨﺎء اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻜﺘﺒﺎت إﻟﻰ اﻟﻌﺜﻮر ﻋﻠﻰ ﻣﻌﻠﻮﻣﺎت ﻛﺜﻴﺮة ﺗﻔﻴﺪ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ أو اﻟﻌﺎﺋﻠﺔ. وﻟﺬﻟﻚ وﺟﺐ أﻻ ﻧﺜﺒﻂ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻰ ﻋﻦ ﻗﺮاءة اﻟﻤﺠﻼت واﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮاﺟﻊ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺘﺎﺣﺔ ﻟﻸﻃﺒﺎء واﻟﻤﺨﺘﺼﻼءﺿﺐضﻹﳉحﻞ. وﻏﺎﻟﺒﺎ ﻣﺎ ﻳﺪﻫﺶ اﻟﻨﺎس ﺣﻼءﺿﺐضﻹﳉحﻞ ﻳﻌﻠﻤﻮن ﻣﺪى ﻗﺪرﺗﻬﻢ ﻋﻠﻰ ﻣﺘﺎﺑﻌﺔ اﻟﻜﺜﻴﺮ ﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺎدة اﻟﻄﺒﻴﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻨﺸﻮرة.

167 اﻟﻬﺪف اﻷول: ﻫﺪف ﺑﻴﻮﻟﻮﺟﻲ إﻧﻨﺎ ﻧﻌﻴﺶ ﻓﻲ ﻋﺼﺮ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻌﻠﻮﻣﺎت-أو ﻗﺪ ﻧﻘﻮل ﻓﻲ ﺛﻮرة ﻣـﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻌـﻠـﻮﻣـﺎت-وﻟـﻴـﺲ ﻫﻨﺎك ﻣﻦ ﺳﺒﺐ ﻼءﺿﺐضﺠؤﻞﻨﻊ اﻹﻧﺴﺎن اﻟـﻌـﺎدي ﻣـﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺸـﺎرﻛـﺔ. وﻗـﺪ ﻳـﺸـﻌـﺮ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺮﺿـﻰ ﺑﺨﻴﺒﺔ اﻷﻣﻞ-ﻋﻨﺪ ﻗﺮاءة أﻣﺜﺎل ﻫﺬه اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮاﺟﻊ أﺣﻴﺎﻧﺎ-ﻣﻦ ﺗﻌﺪد اﻵراء أو ﺣـﺘـﻰ ﻣﻦ ﻣﺪى اﻻﺧﺘﻼف ﺣﻮل أي ﻣﻮﺿﻮع. ﻟﻜﻨﻬﻢ ﺳﺮﻋﺎن ﻣﺎ ﻳﺪرﻛﻮن أن ﻫﺬا ﺟﺰء ﻣﻦ ﻣﻨﻬﺞ اﻟﻌﻠﻢ أو اﻟﻄﺮﻳﻘﺔ اﻟﻌﻠﻤﻴﺔ. ﻓﻬﻨﺎك ﺻـﺮاع داﺋـﻢ ﺑـﻼءﺿﺐضﻹﳉحﻞ وﺟـﻬـﺘـﻲ ﻧـﻈـﺮ ﻣﺘﻌﺎرﺿﺘﻼءﺿﺐضﻹﳉحﻞءﺼﳋﺼض إﻟﻰ إﺟﻤﺎع ﺟﺪﻳﺪ ﻋﻠﻰ اﻟﺮأي. وﻟﻜﻦ اﻟﻌﻤﻠﻴﺔ ﺗﺘﻄﻮر داﺋﻤﺎ وﺗﺘﺤﺴﻦ وﺗـﺒـﺤـﺚ ﺑﺎﺳﺘﻤﺮار ﻋﻦ ﻣﺰﻳﺪ ﻣﻦ اﻟﺪﻗﺔ واﻟﺼﺪق. وﺳﻮف ﺗﺰداد أﻫﻤﻴﺔ ﺗﻌﻠﻴﻢ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ وإرﺷﺎده ﻓﻲ اﻟﺴﻨﻮات اﻟﻘﺎدﻣﺔ. وﻗﺪ ﻗﻴﻞ إن ﻗﻠﻴﻼ ﻣﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻌﺮﻓﺔ ﺷﻲء ﺧﻄﻴﺮ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ ﻓﻲ اﻟﻄﺐ. وأﻓﻀﻞ ﻋﻼج ﻟﻬﺬه اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺸﻜﻠﺔ ﻫﻮ ﺗﻘﺪﻼءﺿﺐ ﻋﻦ اﳊﺼﻮل ﻋﻠﻴﻬﺎ ﻓﻲ اﶈﻞ اﻷول. ﻣﺘﺎﺑﻌﺔ اﻻﺳﺘﺠﺎﺑﺔ واﳌﻀﺎﻋﻔﺎت Monitoring Response And complications) » اﻟﻄﺒﻴﺐ. وﻫﻤﺎ ﺑﺴﻴﻄـﺎن ﺑـﺼـﻮرة ﺧـﺎدﻋـﺔءﺼﳋﺼض وﺑﺘﺠﺎﻫﻠﻬﻤﺎ. ﻟﻜﻦ ﻫﺬﻳﻦ اﻟﺴﺆاﻟﻼءﺿﺐضﻹﳉحﻞ ﻳﻔﺘﺤﺎن ﻣﺴﺘﻮدﻋﺎ ﻫﺎﺋﻼءﺼﳋﺼض ﻋﻠﻰ ﻣﻌﻠﻮﻣﺎت أﻧﻔﻊ وأﻛﺜﺮ ﻗﻴﻤﺔءﺼﳋﺼض اﺣﺘﻤﺎل اﻟﻮﺻﻮل إﻟﻰ ﻋﻼج ﻃﻴـﺐ. وﻟـﺬﻟـﻚ ﻓـﻨـﺤـﻦ ﻓـﻲ ﺣـﺎﺟـﺔ إﻟـﻰ ﻣـﻘـﻴـﺎس واﺿﺢ ﻣﺤﺪد ﻧﻘﻴﺲ ﺑﻪ ﺣﺎﻟﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ وﻧﺘﺘﺒﻊ ﺑﻪ اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ واﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻀﺎﻋﻔﺎت. ﻣﺘﺎﺑﻌﺔ اﻟﺘﺤﺴﻦ اﻟﻌﺎم Monitoring Overall improvement) إن أﺑﺴﻂ ﻃﺮﻳﻘﺔ ﻓﻲ ﻗﻴﺎس اﻟﺘﺤﺴﻦ ﻫﻲ اﺳﺘﺨﺪام. ﻣﻘﻴﺎس ﻋﺎم ﻟﻠﺘﺤﺴﻦ )Global lmprovement Scale. وﻳﺘﻢ ﺗﻘﺪﻼءﺿﺐ درﺟﺎﺗﻪ ﻛﻞ أﺳﺒﻮع )أو ﻋﻠﻰ ﻓﺘﺮات ﻣﻨﺘﻈﻤﺔ(. ﺛﻢ ﻳﺴﻬﻞ ﺑﻌﺪ اﻧﻘﻀﺎء ﺑـﻀـﻌـﺔ (.٢١أﺳﺎﺑﻴﻊ رﺳﻢ اﻟﺮﻗﻢ ﻋﻠﻰ ﺧﻂ ﺑﻴﺎﻧﻲ ﻛﻤﺎ ﻫﻮ ﻣﺒﻼءﺿﺐضﻹﳉحﻞ ﻓﻲ اﻟﺸﻜﻞ رﻗﻢ ) وﻣﻦ اﻟﺴﻬﻞ-ﻓﻲ ﶈﺔ واﺣﺪة-أن ﻧﺮى ﻣﺪى ﻣـﺎ ﻼءﺿﺐﺤﻵﺠﳉعﻞ ﲢـﻘـﻴـﻘـﻪءﺼﳋﺼض

168 ﻣﺮض اﻟﻘﻠﻖ INSTRUCTIONS : Circle number that best describes your situation .noonfinal.seenmedial.tehwithhahinitial.meemfinal.yehmedial.zahmedial.aininitial.tehmarbutaisolated.dalisolated.wawfinal.ainmedial.laminitial.alefisolated .lamwithalefmaksuraisolated.alefwithhamzabelowisolated.tehmarbutafinal.laminitial.aleffinal.lamwithhahinitial.alefisolated.tehmarbutafinal.yehmedial.ainmedial.yehmedial.behmedial.tahmedial.laminitial.alefisolated Si nce starting this treatment my overall prigress is : Markedly /yehwithrehfinal/behmedial/kafinitial Major Figure 11, Patients' and Physicians' .hamzaisolated.aleffinal.behmedial.tahinitial.lamwithalefhamzaaboveisolatedd.alefisolated.wawisolated .alefmaksurafinal.dadinitial.rehfinal.lamwithmeeminitial.alefisolated .hehfinal.meeminitial.dalfinal.khahmedial.tehmedial.seenmedial.yehinitial .meemisolated.aleffinal.ainmedial.laminitial.alefisolated .seenfinal.seenmedial.jeemmedial.tehmedial.laminitial.alefisolated .seenisolated.aleffinal.yehmedial.qafmedial.meeminitial (.arabicindicdigitone.arabicindicdigitone) .lamfinal.kafmedial.sheeninitial Global Improvement Scale now . A Litle Improve-ment /wawisolated/alefwithhamzaaboveisolated /yehwithrehfinal/yehmedial/ghainmedial/tehinitial /lamwithalefisolated/jeemisolated/lamwithaleffinal/ainmedial/laminitial/alefisolated /hamzaisolated/dalfinal/behinitialtreatment Back toNormal A little /lamwithaleffinal/yehmedial/lammedial/qafinitial /hamzaisolated/wawfinal/seeninitial/alefwithhamzaaboveisolated Moderately /tahfinal/seeninitial/wawfinal/tehmedial/meeminitial A little /lamfinal/yehmedial/lammedial/qafinitial /noonfinal/seenmedial/tehwithhahinitial Unchan ged or start of Markedly Moderately /tehmarbutafinal/jeeminitial/rehisolated/dalfinal/behinitial /alefwithhamzaaboveisolated/wawfinal/seeninitial/alefwithhamzaaboveisolated/tehmarbutafinal/tahmedial/seeninitial/wawfinal/tehmedial/meeminitial /tehmarbutafinal/jeeminitial/rehisolated/dalfinal/behinitial/tehmarbutaisolated/yehwithrehfinal/behmedial/kafinitial -10 WORSE.alefwithhamzaaboveisolated.wawfinal.seeninitial.alefwithhamzaaboveisolated .lamwithalefmaksuraisolated.alefwithhamzabelowisolated .fehfinal.sadinitial.wawisolated .noonfinal.seenmedial.hahinitial.alefwithhamzaaboveisolated .yehwithnoonfinal.behmedial.yehinitial .yehisolated.thalfinal.laminitial.alefisolated .meemfinal.qafinitial.rehfinal.laminitial.alefisolated .lamisolated.wawfinal.hahinitial .tehmarbutaisolated.rehfinal.yehwithhamzaaboveinitial.alefisolated.dalisolated .meemfinal.seeninitial.rehisolated.alefisolated : .tehisolated.aleffinal.meemmedial.yehmedial.lammedial.ainmedial.tehinitial : .meemisolated.aleffinal.ainmedial.laminitial.alefisolated .yehfinal.meeminitial.dalfinal.qafmedial.tehinitial .hahfinal.behmedial.sadinitial.alefwithhamzaaboveisolated .jeemisolated.lamwithaleffinal.ainmedial.laminitial.alefisolated .tehmarbutafinal.yehinitial.alefisolated.dalfinal.behinitial .thalfinal.noonmedial.meeminitial .noonisolated.lamwithalefmaddaaboveisolatedd.alefisolated .arabickaffinal.tehmedial.laminitial.aleffinal.lamwithhahinitial -4 -7 -8 -9 +4 -5 -6 +3 +2 +1 0 -1 -2 -3 +6 IMPROVED +5.noonfinal.seenmedial.hahinitial.

boveisolatedd.alefisolated .arabickaffinal.tehmedial.laminitial.aleffinal.lamwithhahinitial -4 -7 -8 -9 +4 -5 -6 +3 +2 +1 0 -1 -2 -3 +6 IMPROVED +5.noonfinal.seenmedial.hahinitial.alefwithhamzaaboveisolated .lamwithalefmaksuraisolated.alefwithhamzabelowisolated +10 +9 +8 +7 /alefwithhamzaaboveisolated/wawfinal/seeninitial/alefwithhamzaaboveisolated /lamwithalefisolated - /alefisolated/dalfinal/jeeminitial /arabickaffinal/laminitial/thalisolated /noonfinal/meeminitialVery BadCould No t Be Worse /tehmarbutaisolated/yehwithrehfinal/behmedial/kafinitial /tehmarbutafinal/jeeminitial/rehisolated/dalfinal/behinitial

169 اﻟﻬﺪف اﻷول: ﻫﺪف ﺑﻴﻮﻟﻮﺟﻲ ﻛﺬﻟﻚ أن ﻧﺮى اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺴﺎﻓﺔ اﻟﺘﻲ ﻣﺎزال ﻋﺒﻮرﻫﺎ واﺟﺒﺎ. ﻓﻴﺮﻛﺰ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ واﻟﻄﺒﻴـﺐ اﻫﺘﻤﺎﻣﻬﻤﺎ ﻋﻠﻰ ﻫﺬه اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺴﺎﻓﺔ وﻳﺤﺪدان ﺑﺪﻗﺔ ﻣﺎ اﻟﺬي ﻳﻨﺒﻐﻲ ﻋﻤﻠﻪ وأﻓـﻀـﻞ اﻟﻄﺮق إﻟﻰ أداﺋﻪ. إن ﻫﺬا اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮض ﻟﻴﺲ ﻫﻴﻨﺎ-ﻛﻤﺎ رأﻳﻨﺎ ﻓﻲ اﻟﻔﺼﻮل اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺘﻘﺪﻣﺔ-ﻼءﺿﺐضﺠؤﻞﻴـﺰه ﻋـﺮض أو ﻋﺮﺿﺎنءﺼﳋﺼض ﻛﻞ اﻻﻫﺘﻤﺎم ﻋﻠﻰ ﻋﺮض واﺣﺪ وﻛﺄﻧﻪ اﳊﺎﻟﺔ ﻛﻠﻬﺎ. وإﻼءﺿﺐﺐﺤﺿﻖﺤﻞﺎ ﲢﺘﺎج ﻛﻞ اﳉﻮاﻧﺐ إﻟﻰ اﻻﻫﺘﻤﺎم ﺑﻬﺎ ﻟﻮ أردﻧﺎ ﻟﻠﻤﺮض أن ﻳﺘﻢ ﻋﻼﺟﻪ ﻋﻼﺟﺎ ﻓﻌﺎﻻ. وﻟﻮ أﻧﻨﺎ ﻗﺴﻨﺎ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺸﻜﻠﺔ ﺑﻜﻞ ﺟﺎﻧﺒﻬﺎ ﻷﺻﺒﺢ ﻣﻦ اﻟﻮاﺟﺐ أن ﺗﺴﺘﺠﻴﺐ اﳉﻮاﻧﺐ ﻛﻠﻬـﺎ إن ﻛـﺎن اﻟﻌﻼج ﻃﻴﺒﺎ. ﻓﻤﺎ ﻫﻲ ﺟﻮاﻧﺐ اﻻﺿﻄﺮاب اﻟﺘﻲ ﻳﻜﻮن ﻣﻦ اﻟﻨﺎﻓﻊ ﻗﻴﺎﺳـﻬـﺎ? ﻣـﻦ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﻔـﻴـﺪ ﺗﻠﺨﻴﺺ ﺗﻠﻚ اﳉﻮاﻧﺐ اﻟﺘﻲ ﻼءﺿﺐضﺠؤﻞﻜﻦ ﻗﻴﺎﺳﻬﺎ ﻣﻨﻔﺼﻠـﺔءﺼﳋﺼض اﻟﻌﻼج ﻓﻲ ﻋﻤﻠﻪ وﻫﻲ: Unchangedﻻ ﺗﻐﻴﻴﺮ

170 ﻣﺮض اﻟﻘﻠﻖ - اﻷﻋﺮاض - اﻟﻨﻮﺑﺎت ﻧﻔﺴﻬﺎ - اﻟﻤﺨﺎوف اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻴﺔ أو اﻟﻔﻮﺑﻴﺎ - اﻟﻌﺠﺰ اﻟﻨﺎﺷﺊ - اﻵﺛﺎر اﳉﺎﻧﺒﻴﺔ ﻟﻠﻌﻼج ﺑﺎﻟﺪواء ﻣﺘﺎﺑﻌﺔ اﻷﻋﺮاض Monitoring Symptoms) ﻼءﺿﺐضﺠؤﻞﻜﻦ ﻗﻴﺎس اﻷﻋﺮاض ﺑﺎﺳﺘﺨﺪام ﻣﻘﻴﺎس اﻟﻘﻠﻖ اﻟﻘﺎﺋﻢ ﻋﻠﻰ ﺗﻘﺪﻳﺮ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ (.أﻣﺎ اﳉﺰء اﻷول ﻣﻦ ﻫﺬا اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻘﻴﺎس ﻓﻴﻌﻄﻴـﻨـﺎ ﺗـﻘـﺪﻳـﺮا٧ﻟﺬاﺗﻪ. )اﻧﻈﺮ ﺷـﻜـﻞ ﻟﻨﻮﺑﺎت اﻷﻋﺮاض اﻟﺘﻲ ﲢﺪث ﺑﺎﻧﺘﻈﺎمءﺼﳋﺼض ﺗﻘﺪﻳﺮا ﻣﺨﺘﻠﻔﺎ ﻟﻜﻞ ﻣﻦ أﻧﻮاع اﻟﻔﻮﺑﻴﺎ أو اﻟﻤﺨﺎوف اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﺿﻴـﺔ اﻟـﺮﺋـﻴـﺴـﺔ وذﻟـﻚ ﺣﺴﺐ ﻣﻘﺪار اﻟﻘﻠﻖ اﻟﺬي ﻳﻌﺎﻧﻴﻪ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺮﻳﺾ ﻓﻲ ﻛﻞ واﺣﺪ ﻣﻨﻬﺎ. واﻟﻬﺪف ﻫﻮ أن ﺗﺴﺘﻤﺮ ﻓﻲ ﺗﺨﻔﻴﺾ اﻟﺘﻘﺪﻳﺮ ﺣﺘﻰ ﺗﻬﺒﻂ أﻧﻮاع اﻟﻔﻮﺑﻴﺎ أو اﻟﻤﺨﺎوف ﺟﻤﻴﻌﺎ إﻟﻰ اﻟﺼﻔﺮ أو ﻗﺮﻳﺒﺎ ﻣﻨﻪ. وﻫﺬا ﻳﺰودك ﻼءﺿﺐؤثضﺾﻞﻘﻴﺎس ﻋﻦ ﻣﺪى اﻟﺘﺤﺴﻦ ﻓﻲ ﺣﺎﻟﺘﻚ. ﻣﺘﺎﺑﻌﺔ اﻟﻨﻮﺑﺎت Monitoring Attacks) ﻼءﺿﺐضﺠؤﻞﻜﻦ ﻗﻴﺎس ﻧﻮﺑﺎت اﻟﻬﻠﻊ واﻟﻘﻠﻖ ﺑﺎﺳﺘﺨﺪام ﺑـﺮ وﻓـﻴـﻞ اﻟـﻨـﻮﺑـﺔ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺒـﻼءﺿﺐضﻹﳉحﻞ ﻓـﻲ ﻓﻴﻤﻜﻦ اﺳﺘﺨﺪاﻣﻪ دﻟﻴﻼ ﻟﻠﺘﻤﻴـﻴـﺰ ﻣـﺎ ﺑـﻼءﺿﺐضﻹﳉحﻞ اﻟـﻨـﻮﺑـﺎت٨١. وأﻣﺎ ﺷﻜـﻞ ٣١ﺷﻜـﻞ اﻟﻤﺨﺘﻠﻔﺔ. ﻓﻔﻲ اﳉﺰء )أ( ﻋﻠﻴﻚ أن ﺗﺄﺧﺬ ﻓﻲ اﻋﺘﺒﺎرك اﻟﻨﻮﺑﺎت اﻟﺘﻲ ﺗﺄﺗﻲ ﻣﻊ ﻗﻠﻴﻞ ﻣﻦ اﻻﺳﺘﺜﺎرة أو ﺑﻐﻴﺮ اﺳﺘﺜﺎرة. وﺗﺴﺠﻞ اﻟﻨﻮﺑﺎت اﻟﺘﻲ ﺗﺼﺎﺣﺒﻬـﺎ ﺛـﻼﺛـﺔ أﻋﺮاض أو أﻛﺜﺮ ﲢﺪث ﻣﻌﺎ ﻓﻲ اﻟﻮاﻗﻌﺔ ﻧﻔﺴﻬﺎ ﻋﻠﻰ أﻧﻬـﺎ ﻧـﻮﺑـﺎت ﻫـﻠـﻊ ﻏـﻴـﺮ ﻣﺘﻮﻗﻌﺔ. وأﻣﺎ اﻟﻨﻮﺑﺎت اﻟﺘﻲ ﺗﺼﻴﺐ ﻋﻀﻮا أو ﻋﻀﻮﻳﻦ ﻓﻲ اﳉﺴﻢ ﻓﻬﻲ ﺗﻌـﺪ ﻧﻮﺑﺎت ﺗﻠﻘﺎﺋﻴﺔ ﺑﺴﻴﻄﺔ ﻫﻴﻨﺔ. وأﻣﺎ ﺟﺰء )ب( ﻓﻬﻮ ﻣﺨﺼﺺ ﻟﺘﺴﺠﻴﻞ ﻧﻮﺑﺎت اﻟﻘﻠﻖ اﻟﺘﻲ ﺗﺮﺗﺒﻂ ﻼءﺿﺐؤثضﺾﻞﻮاﻗﻒ واﺿﺤﺔ ﻣﺤﺪدة ﺗﺨﺸﺎﻫﺎ وﺗﺘﻔﺎدﻫﺎ. ﻓﺘﺤﺴﺐ ﺿﻤﻦ أو اﻟﺘﻮﻗﻌﻲ ﺗﺨﺸﺎﻫﺎ وﺗﺘﻔﺎدﻫﺎ. وأﻣﺎ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻮﺟﺎت اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻔﺎﺟﺌﺔ ﻣﻦ اﻟﻬﻠﻊ اﻟﺘﻲ ﲢﺪث ﺣﻼءﺿﺐضﻹﳉحﻞ ﺗﻜﻮن ﻓﻲ ﻣﻮﻗﻒ ﻣﺨﻴﻒ ﻓﻴﻜﻮن ﺗﺴﺠﻴﻠﻬﺎ ﻋﻠﻰ أﻧﻬﺎ ﻧﻮﺑﺎت ﻫﻠﻊ ﻣﻮﻗﻔﻴﺔ )situational.( ﻓﺈذا ﻛﻨﺖ ﻣﺜﻼ ﺗﺨﺸﻰ اﻷﺳﻮاق اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺰدﺣﻤـﺔ ﻓـﻘـﺪ ﲢـﺲ ﺑـﺎﻟـﻘـﻠـﻖ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞـﺘـﺰاﻳـﺪ

171 اﻟﻬﺪف اﻷول: ﻫﺪف ﺑﻴﻮﻟﻮﺟﻲ وأﻧﺖ ﺗﻘﺘﺮب ﻣﻨﻬﺎ وﺗﺘﺴﺎءل ﻓﻬﺬه ﻧﻮﺑﺔ ﻗﻠﻖ ﺗﻮﻗﻌﻲ. أﻣﺎ إن ذﻫﺒﺖ ﻋﻨﺪﺋﺬ إﻟﻰ اﻟـﺴـﻮق ﺛـﻢ أﺻـﺎﺑـﺘـﻚ ﺑـﻌـﺪ ﺑﻀﻊ دﻗﺎﺋﻖ ﻣﻮﺟﺔ ﻣﻔﺎﺟﺌﺔ ﻣﻦ اﻟﻬﻠﻊ ﻛﺎﻧﺖ ﺗﻠﻚ ﻧﻮﺑﺔ ﻫﻠﻊ ﻣﻮﻗﻔﻴﺔ. وﻏﺎﻟﺒﺎ ﻣﺎ ﺗﻀﺎف ﻧﻮﺑﺎت اﻟﻬﻠﻊ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻮﻗﻔﻴﺔ )Situational panic attacks( إﻟﻰ اﻟﻘﻠﻖ اﻻﺳﺘﺒﺎﻗﻰ أو اﻟﺘﻮﻗﻌﻲ )anticipatory anxiety.( وﻗﺪ ﺗﺮﻏﺐ ﻓﻲ ﺗﺴﺠﻴﻞ اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﺪة اﻟﺘﻲ ﺗﺴﺘﻐﺮﻗﻬﺎ ﻛﻞ ﻧﻮﺑﺔ ﻣﺘﻮﺳﻄﺔ ﻣﻦ ﻫـﺬه اﻷﻧﻮاع اﻷرﺑﻌﺔ ﻣﻦ اﻟﻨﻮﺑﺎت ﺣﺘﻰ وﻟﻮ ﺗﻐﻴﺮتءﺼﳋﺼض ( إذ ﺗﻜﻮن اﻟﻌﺸﺮة ﻫﻲ أﻛﺒﺮ٠١ﺗﻐﻴﺮت. وﺗﻘﺪر اﻟﺸﺪة ﻓﻲ أﻗﺼﺎﻫﺎ ﺑﺎﻟﺪرﺟﺔ ) درﺟﺔ ﻼءﺿﺐؤزةﻞﻜﻨﺔ. أﻣﺎ درﺟﺔ اﻟﺼﻔﺮ ﻋﻠﻰ ﻫﺬا اﻼءﺿﺐﻂﻖإﳉةﻵعﻞﻘﻴﺎس ﻓﻬـﻲ اﻻﺳـﺘـﺮﺧـﺎء اﻟـﺘـﺎم. وﻛﻠﻤﺎ ﲢﺴﻨﺖ ﺣﺎﻟﺘﻚ ﻣﻊ اﻟﻌﻼجءﺼﳋﺼض ﻓﺸﻴﺌﺎءﺼﳋﺼض dalisolated/dalfinal/ainmedial/laminitial/alefisolated/dalisolated/dalfinal/ainmedial/laminitial/alefisolated/tahfinal/seeninitial/wawfinal/tehmedial/meeminitial/tahfinal/seeninitial/wawfinal/tehmedial/meeminitial /fehwithyehisolated/fehwithyehisolated/noonfinal/meeminitial/zainfinal/laminitial/alefisolated/tehmarbutaisolated/dalfinal/sheenmedial/laminitial/alefisolated /ainisolated/wawfinal/behmedial/seeninitial/lamwithalefhamzaaboveisolatedd/alefisolated/rehfinal/hehmedial/sheenmedial/laminitial/alefisolated(/qaffinal/yehwithhamzaaboveinitial/aleffinal/qafinitial/dalfinal/laminitial/aleffinal/behinitial)/rehfinal/fehmedial/sadinitial /noonfinal/meeminitial) /yehfinal/dadinitial/aleffinal/lamwithmeeminitial/alefisolated/yehfinal/dadinitial/aleffinal/lamwithmeeminitial/alefisolated(/tehmarbutaisolated/rehfinal/sheenmedial/aininitial /lamwithalefmaksuraisolated/alefwithhamzabelowisolated Panic Attacks /ainfinal/lammedial/lamwithhehinitial/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial : /fathatanisolated /alefisolated/hamzaisolated/zainfinal/jeeminitial /arabiccomma /tehmarbutafinal/yehmedial/fehmedial/qafinitial/wawfinal/lamwithmeeminitial/alefisolated /ainfinal/lammedial/lamwithhehinitial/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial * (Situational Panic Attacks) /wawisolated/alefwithhamzaaboveisolated /tehmarbutafinal/thehinitial/lamwithaleffinal/thehinitial /ainfinal/meeminitial /yehfinal/yehwithhamzaaboveinitial/aleffinal/jeemmedial/fehmedial/laminitial/alefisolated /qaffinal/lammedial/qafmedial/laminitial/alefisolated /noonfinal/meeminitial /tehisolated/aleffinal/behinitial/wawfinal/nooninitial /wawisolated/alefwithhamzaaboveisolated /fehfinal/qafinitial/wawfinal/meeminitial /fehwithyehisolated /noonisolated/wawfinal/kafmedial/tehinitial /yehwithnoonfinal/hahinitial /thehisolated/dalfinal/tehwithhahinitial /dadisolated/alefisolated/rehfinal/aininitial/alefwithhamzaaboveisolated /tehmarbutafinal/ainmedial/behinitial/rehisolated/alefwithhamzaaboveisolated /arabickaffinal/tehinitial/behwithrehfinal/khahinitial /noonfinal/meeminitial /zainisolated/wawfinal/yehwithjeeminitial /fehfinal/qafinitial/wawfinal/meeminitial /fehwithyehisolated /lamisolated/wawfinal/khahinitial/dalfinal/laminitial/alefisolated /arabickaffinal/sheeninitial/wawisolated /alefmaksurafinal/lammedial/aininitial /tehmarbutafinal/behinitial/wawfinal/noonmedial/laminitial/alefisolated /behfinal/behmedial/seenmedial/yehinitial /noonisolated/alefwithhamzaaboveisolated

nal/lammedial/aininitial /tehmarbutafinal/behinitial/wawfinal/noonmedial/laminitial/alefisolated /behfinal/behmedial/seenmedial/yehinitial /noonisolated/alefwithhamzaaboveisolated /qaffinal/lammedial/qafmedial/laminitial/alefisolated/wawisolated /ainfinal/lammedial/lamwithhehinitial/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial /seenisolated/aleffinal/yehmedial/qafmedial/meeminitial /arabicindicdigitone/arabicindicdigitthree /lamfinal/kafmedial/sheeninitial (Panic and Anxiety Attack Scale)

172 ﻣﺮض اﻟﻘﻠﻖ dalisolated/dalfinal/ainmedial/laminitial/alefisolated/dalisolated/dalfinal/ainmedial/laminitial/alefisolated/tahfinal/seeninitial/wawfinal/tehmedial/meeminitial/tahfinal/seeninitial/wawfinal/tehmedial/meeminitial /fehwithyehisolated/fehwithyehisolated/noonfinal/meeminitial/zainfinal/laminitial/alefisolated/tehmarbutaisolated/dalfinal/sheenmedial/laminitial/alefisolated /ainisolated/wawfinal/behmedial/seeninitial/lamwithalefhamzaaboveisolatedd/alefisolated/rehfinal/hehmedial/sheenmedial/laminitial/alefisolated(/qaffinal/yehwithhamzaaboveinitial/aleffinal/qafinitial/dalfinal/laminitial/aleffinal/behinitial)/rehfinal/fehmedial/sadinitial /noonfinal/meeminitial) /yehfinal/dadinitial/aleffinal/lamwithmeeminitial/alefisolated/yehfinal/dadinitial/aleffinal/lamwithmeeminitial/alefisolated(/tehmarbutaisolated/rehfinal/sheenmedial/aininitial /lamwithalefmaksuraisolated/alefwithhamzabelowisolated /ainfinal/qafinitial/wawfinal/tehmedial/lamwithmeeminitial/alefisolated /yehwithrehfinal/ghaininitial /ainfinal/lammedial/lamwithhehinitial/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial * (Unexpected Panic Attacks) /tehmarbutafinal/thehinitial/lamwithaleffinal/thehinitial /ainfinal/meeminitial /qaffinal/lammedial/qafmedial/laminitial/alefisolated /noonfinal/meeminitial /tehmarbutafinal/ainmedial/qafinitial/wawfinal/tehmedial/meeminitial /yehwithrehfinal/ghaininitial /tehmarbutafinal/yehmedial/yehwithhamzaaboveinitial/aleffinal/jeemmedial/fehinitial /tehisolated/aleffinal/behinitial/wawfinal/nooninitial /yehwithrehfinal/ghainmedial/behinitial /wawisolated/alefwithhamzaaboveisolated /tehmarbutafinal/lammedial/yehmedial/lammedial/qafinitial /tehmarbutaisolated/rehisolated/aleffinal/thehmedial/tehmedial/seeninitial/aleffinal/behinitial /thehisolated/dalfinal/tehwithhahinitial /dadisolated/alefisolated/rehfinal/aininitial/alefwithhamzaaboveisolated /tehmarbutafinal/ainmedial/behinitial/rehisolated/alefwithhamzaaboveisolated /wawisolated/alefwithhamzaaboveisolated /noonisolated/alefwithhamzaaboveisolated /zainisolated/wawfinal/yehwithjeeminitial /fehfinal/qafinitial/wawfinal/meeminitial /fehwithyehisolated /noonisolated/wawfinal/kafmedial/tehinitial /lamwithalefisolated /yehwithnoonfinal/hahinitial /yehisolated/alefwithhamzaaboveisolated) /tehmarbutaisolated/rehisolated/aleffinal/thehmedial/tehmedial/seeninitial/alefisolated . (/tehmarbutafinal/behinitial/wawfinal/noonmedial/laminitial/alefisolated /behfinal/behmedial/seenmedial/yehinitial /tehmarbutaisolated/dalisolated/wawisolated/dalfinal/lamwithmeemwithhahinitial/alefisolated /dadisolated/alefisolated/rehfinal/aininitial/lamwithalefhamzaaboveisolatedd/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial : /behisolated /hamzaisolated/zainfinal/jeeminitial (Limited Symptom Attacks) /tehmarbutafinal/yehmedial/fehmedial/qafinitial/wawfinal/lamwithmeeminitial/alefisolated /tehmarbutaisolated/dalisolated/wawisolated/dalfinal/lamwithmeemwithhahinitial/alefisolated /dadisolated/alefisolated/rehfinal/aininitial/lamwithalefhamzaaboveisolatedd/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial * Situational limited symptom) (attacks

olated/alefisolated/rehfinal/aininitial/lamwithalefhamzaaboveisolatedd/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial * Situational limited symptom) (attacks /yehwithnoonfinal/dadinitial/rehfinal/aininitial /wawisolated/alefwithhamzaaboveisolated /dadisolated/rehfinal/ainmedial/behinitial /tehmarbutaisolated/dalisolated/wawisolated/dalfinal/meemwithhahinitial /tehmarbutafinal/yehmedial/yehwithhamzaaboveinitial/aleffinal/jeemmedial/fehinitial /tehisolated/aleffinal/behinitial/wawfinal/nooninitial /arabickaffinal/sheeninitial/wawisolated /alefmaksurafinal/lammedial/aininitial /wawisolated/alefwithhamzaaboveisolated /fehfinal/qafinitial/wawfinal/meeminitial /fehwithyehisolated /noonisolated/wawfinal/kafmedial/tehinitial /yehwithnoonfinal/hahinitial /thehisolated/dalfinal/tehwithhahinitial /behfinal/behmedial/seenmedial/yehinitial /noonisolated/alefwithhamzaaboveisolated /arabickaffinal/tehinitial/behwithrehfinal/khahinitial /noonfinal/meeminitial /zainisolated/wawfinal/yehwithjeeminitial /fehfinal/qafinitial/wawfinal/meeminitial /fehwithyehisolated /lamisolated/wawfinal/khahinitial/dalfinal/laminitial/alefisolated . /tehmarbutafinal/behinitial/wawfinal/noonmedial/laminitial/alefisolated /tehmarbutafinal/ainmedial/qafinitial/wawfinal/tehmedial/lamwithmeeminitial/alefisolated /yehwithrehfinal/ghaininitial /tehmarbutaisolated/dalisolated/wawisolated/dalfinal/lamwithmeemwithhahinitial/alefisolated /dadisolated/alefisolated/rehfinal/aininitial/lamwithalefhamzaaboveisolatedd/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial * /yehwithnoonfinal/dadinitial/rehfinal/aininitial /wawisolated/alefwithhamzaaboveisolated /dadisolated/rehfinal/ainmedial/behinitial /tehmarbutaisolated/dalisolated/wawisolated/dalfinal/meemwithhahinitial /tehmarbutafinal/yehmedial/yehwithhamzaaboveinitial/aleffinal/jeemmedial/fehinitial /tehisolated/aleffinal/behinitial/wawfinal/nooninitial /lamwithalefisolated /yehisolated/alefwithhamzaaboveisolated) /tehmarbutaisolated/rehisolated/aleffinal/thehmedial/tehmedial/seeninitial/alefisolated /yehwithrehfinal/ghainmedial/behinitial /wawisolated/alefwithhamzaaboveisolated /tehmarbutafinal/lammedial/yehmedial/lammedial/qafinitial /tehmarbutaisolated/rehisolated/aleffinal/thehmedial/tehmedial/seeninitial/aleffinal/behinitial /thehisolated/dalfinal/tehwithhahinitial /behfinal/behmedial/seenmedial/yehinitial /noonisolated/alefwithhamzaaboveisolated /arabickaffinal/tehinitial/behwithrehfinal/khahinitial /noonfinal/meeminitial /zainisolated/wawfinal/yehwithjeeminitial /fehfinal/qafinitial/wawfinal/meeminitial /fehwithyehisolated /noonisolated/wawfinal/kafmedial/tehinitial (/tehmarbutafinal/behinitial/wawfinal/noonmedial/laminitial/alefisolated . /yehfinal/qafinitial/aleffinal/behmedial/tehmedial/seeninitial/lamwithalefisolated/alefisolated /wawisolated/alefwithhamzaaboveisolated /yehfinal/ainmedial/qafinitial/wawfinal/tehmedial/laminitial/alefisolated /qaffinal/lammedial/qafmedial/laminitial/alefisolated /tehisolated/aleffinal/behinitial/wawfinal/nooninitial : /jeemisolated /hamzaisolated/zainfinal/jeeminitial