izindaba

Isifo sosizi esihlala isikhathi eside siyisifo sokucindezeleka ngemva kokushona kothandekayo, lapho umuntu ezwa usizi olungapheli, olujulile isikhathi eside kunalokho obekulindelwe yimikhuba yezenhlalo, yamasiko, noma yenkolo. Cishe amaphesenti amathathu kuya kwayi-10 abantu aba nenkinga yokuba lusizi isikhathi eside ngemva kokushona okungokwemvelo kothandekayo, kodwa isenzakalo siba sikhulu lapho kushona ingane noma umlingani, noma lapho othandekayo eshona kungazelelwe. Ukucindezeleka, ukukhathazeka kanye ne-post-traumatic stress disorder kufanele kuhlolwe ekuhlolweni komtholampilo. I-psychotherapy esekelwe ebufakazini yosizi iyona ndlela yokwelapha eyinhloko. Umgomo uwukusiza iziguli zamukele ukuthi abathandekayo bazo abasekho unomphela, ziphile ukuphila okunenjongo nokwanelisayo ngaphandle komufi, futhi kancane kancane ziqede izinkumbulo zazo zomufi.

Icala
Owesifazane ongumfelokazi oneminyaka engu-55 ubudala wavakashela udokotela wakhe ezinyangeni ezingu-18 ngemva kokushona komyeni wakhe ngokuzuma kwenhliziyo. Selokhu kwashona umyeni wakhe, usizi alukadamba nakancane. Wayengayekile ukucabanga ngomyeni wakhe futhi engakholwa ukuthi akasekho. Ngisho nalapho esanda kugubha ukuphothula kwendodakazi yakhe ekolishi, isizungu nokulangazelela umyeni wakhe akuzange kuphele. Wayeka ukuzihlanganisa nabanye abashadile ngoba kwamphatha kabi kakhulu ukukhumbula ukuthi umyeni wakhe akasekho. Wayekhala aze alale njalo ebusuku, ecabanga elokhu ecabanga ukuthi kwakufanele akubone kanjani kusengaphambili ukufa kwakhe, nokuthi ufisa kanjani ukufa. Wayenomlando wesifo sikashukela kanye nezikhathi ezimbili zokucindezeleka okukhulu. Ukuhlola okwengeziwe kwembula ukwenyuka okuncane kwamazinga kashukela egazini kanye nokuzuza kwesisindo okungu-4.5kg (10lb). Usizi lwesiguli kufanele luhlolwe futhi lwelashwe kanjani?

Inkinga yomtholampilo
Odokotela abelapha iziguli ezisosizini banethuba lokusiza, kodwa ngokuvamile bayehluleka ukukuthatha. Ezinye zalezi ziguli zihlushwa isifo sosizi isikhathi eside. Usizi lwabo lugcwele indawo yonke futhi lukhulu, futhi luhlala isikhathi eside kunalokho abantu abaningi abashonelwe ngokuvamile abaqala ukuhileleka ekuphileni futhi usizi luyadamba. Abantu abanenkinga yosizi isikhathi eside bangase babonise ubuhlungu obukhulu obungokomzwelo obuhlobene nokushona kothandekayo, futhi babe nobunzima bokubona ngeso lengqondo noma iyiphi incazelo yesikhathi esizayo ngemva kokuba umuntu engasekho. Bangase babe nobunzima ekuphileni kwansuku zonke futhi bangase babe nemicabango yokuzibulala noma ukuziphatha. Abanye abantu bakholelwa ukuthi ukufa komuntu osondelene nabo kusho ukuthi ukuphila kwabo sekuphelile, futhi kuncane abangakwenza ngakho. Bangase bazibambe kanzima futhi bacabange ukuthi kufanele bafihle ukudabuka kwabo. Abangane nomndeni nabo bacindezelekile ngoba isiguli besilokhu sicabanga ngomufi kuphela futhi asinasithakazelo ebuhlotsheni bamanje nemisebenzi, futhi bangase batshele isiguli ukuthi “sikhohlwe” siqhubeke.
Isifo sosizi esithatha isikhathi eside siwukuhlonza okusha okuhlukanisayo, futhi ulwazi mayelana nezimpawu zalo nokwelashwa akukaziwa kabanzi. Odokotela bangase bangaqeqeshelwa ukubona ukuphazamiseka kosizi okuthatha isikhathi eside futhi bangase bangazi ukuthi bangakunikeza kanjani ukwelashwa okuphumelelayo noma ukwesekwa okusekelwe ebufakazini. Umqedazwe we-COVID-19 kanye nezincwadi ezikhulayo eziphathelene nokuxilongwa kosizi oluthatha isikhathi eside kukhulise ukunaka kokuthi odokotela kufanele babone futhi baphendule kanjani osizini nakwezinye izinkinga ezingokomzwelo ezihlobene nokushona kothandekayo.
Ekubuyekezweni kwe-11 kwe-International Statistical Classification of Diseases and Related Health Problems (ICD-11) ngo-2019, i-World Health Organization (WHO) kanye ne-American Psychiatric Association (American Psychiatric Association)
Ngo-2022, uhlelo Lwesihlanu lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ngokwehlukana lwengeze indlela yokuxilonga esemthethweni yokuphazamiseka kosizi okuhlala isikhathi eside. Amagama asetshenziswe ngaphambilini ahlanganisa usizi oluyinkimbinkimbi, ukushonelwa okuyinkimbinkimbi okuphikelelayo, kanye nosizi olubuhlungu, lwe-pathological, noma olungaxazululiwe. Izimpawu zokuphazamiseka kosizi okuthatha isikhathi eside zihlanganisa ukulangazelela okukhulu, ukuphimisela, noma ukuhlupha oshonile, okuhambisana nokunye ukubonakaliswa kosizi okuphikelelayo, okunamandla, nokugcwele yonke indawo.
Izimpawu zokuphazamiseka kosizi okuthatha isikhathi eside kufanele ziqhubeke isikhathi eside (≥ izinyanga ezingu-6 ngokwemibandela ye-ICD-11 kanye nezinyanga ezingu-≥12 ngokwemibandela ye-DSM-5), zibangele ukucindezeleka okuphawulekayo emtholampilo noma ukonakala kokusebenza, futhi zidlule okulindelwe yiqembu lesiguli lamasiko, lenkolo, noma lezenhlalo ngenxa yosizi. I-ICD-11 inikeza izibonelo zezimpawu eziyinhloko zokucindezeleka ngokomzwelo, njengokudabuka, umuzwa wecala, intukuthelo, ukungakwazi ukuzwa imizwelo eyakhayo, ukuba ndikindiki ngokomzwelo, ukuphika noma ubunzima bokwamukela ukushona kothandekayo, ukuzwa ukulahlekelwa ingxenye yakho, nokunciphisa ukubamba iqhaza kwezenhlalo noma kweminye imisebenzi. Indlela yokuxilonga ye-DSM-5 yesifo esidabukisayo esithatha isikhathi eside idinga okungenani izimpawu ezintathu kweziyisishiyagalombili ezilandelayo: ubuhlungu obukhulu obungokomzwelo, ukuba ndikindiki, isizungu esikhulu, ukulahlekelwa ukuzazi (ukubhujiswa kobunikazi), ukungakholelwa, ukugwema izinto ezibakhumbuza abathandekayo abangasekho phakade, ubunzima bokuphinde bahlanganyele emisebenzini nasebudlelwaneni, nomuzwa wokuthi ukuphila akunanjongo.
Ucwaningo lusikisela ukuthi isilinganiso sabantu abasuka ku-3% kuya ku-10% abake baba nesihlobo bafa ngenxa yezizathu ezingokwemvelo bahlushwa isifo sosizi esithatha isikhathi eside, futhi izinga liphakeme ngokuphindwe izikhathi eziningana kubantu abaye babulawa isihlobo ngenxa yokuzibulala, ukubulawa, izingozi, izinhlekelele zemvelo, noma ezinye izimbangela ezingalindelekile ezingalindelekile. Ocwaningweni lwemithi yangaphakathi nedatha yomtholampilo wezempilo yengqondo, izinga elibikiwe lalingaphezu kokuphindwe kabili izinga elibikwe kuhlolo olungenhla. Ithebula 1 libala izici eziyingozi zokuphazamiseka kosizi okuhlala isikhathi eside kanye nezinkomba ezingaba khona zalesi sifo.

Ukulahlekelwa umuntu osondelene naye ngokujulile phakade kungase kucindezele kakhulu futhi kudale uchungechunge lwezinguquko ezilimazayo ezingokwengqondo nezenhlalo oshonelwe okufanele azivumelanise nazo. Usizi luyindlela evamile yokusabela lapho kushonelwa othandekayo, kodwa ayikho indlela yendawo yonke yokudabuka noma yokwamukela ukuba ngokoqobo kokufa. Ngokuhamba kwesikhathi, abantu abaningi abashonelwe bathola indlela yokwamukela leli qiniso elisha futhi baqhubeke nempilo yabo. Njengoba abantu bejwayela izinguquko zokuphila, bavame ukuntengantenga phakathi kokubhekana nobuhlungu obungokomzwelo futhi bakubeke ngemuva kwabo okwesikhashana. Njengoba benza kanjalo, usizi luya kuncipha, kodwa lulokhu lushubile futhi ngezinye izikhathi luba namandla, ikakhulukazi ngezinsuku zokukhumbula kanye nezinye izikhathi ezikhumbuza abantu abashonile.
Kubantu abanenkinga yosizi isikhathi eside, noma kunjalo, inqubo yokuzivumelanisa nezimo ingahlehliswa, futhi usizi luhlala lushubile futhi lugcwele. Ukugwema ngokweqile izinto ezibakhumbuza ukuthi abathandekayo babo bahambe unomphela, futhi ukuphenduka ngokuphindaphindiwe ukuze bacabange isimo esihlukile kuyizithiyo ezivamile, njengokuzigxeka kanye nentukuthelo, ubunzima bokulawula imizwa, nokucindezeleka okuqhubekayo. Ukuphazamiseka kosizi okuhlala isikhathi eside kuhlotshaniswa nokwanda kohlu lwezifo ezingokomzimba nezingokwengqondo. Ukuphazamiseka kokudabuka okuhlala isikhathi eside kungamisa ukuphila komuntu, kwenze kube nzima ukwakha noma ukulondoloza ubudlelwano obunenjongo, kuthinte ukusebenza kwezenhlalo nezomsebenzi, kukhiqize imizwa yokuphelelwa ithemba, kanye nemibono nokuziphatha kokuzibulala.

Isu nobufakazi

Ulwazi mayelana nokushona kwakamuva kwesihlobo kanye nomthelela wako kufanele kube yingxenye yeqoqo lomlando womtholampilo. Ukusesha amarekhodi ezokwelapha ngokushona kothandekayo nokubuza ukuthi isiguli siqhuba kanjani ngemva kokufa kungavula ingxoxo mayelana nosizi kanye nokuvama kwalo, ubude besikhathi, ukuqina, ukwanda, kanye nomthelela emandleni esiguli okusebenza. Ukuhlolwa komtholampilo kufanele kufake ukubuyekezwa kwezimpawu zesiguli ezingokomzimba nezingokomzwelo ngemva kokushona kothandekayo, izimo zengqondo nezezokwelapha zamanje nezesikhathi esidlule, ukusetshenziswa kotshwala nezidakamizwa, imicabango yokuzibulala nokuziphatha, ukusekelwa nokusebenza komphakathi kwamanje, umlando wokwelashwa, kanye nokuhlolwa kwesimo sengqondo. Ukuphazamiseka kosizi okuhlala isikhathi eside kufanele kucatshangelwe uma ezinyangeni eziyisithupha ngemva kokushona kothandekayo, usizi lwalowo muntu lusathinta kakhulu ukuphila kwakhe kwansuku zonke.
Kunamathuluzi alula, aqinisekiswe kahle, anamaphuzu esiguli atholakalayo ukuze kuhlolwe kafushane ukuphazamiseka kosizi okuthatha isikhathi eside. Okulula kakhulu Uhlu Lwemibuzo Olufushane Losizi olunezinto ezinhlanu (Uhlu Lwemibuzo Olufushane Losizi; Ibanga, 0 kuya ku-10, elinamaphuzu aphelele aphakeme abonisa isidingo sokuqhubeka nokuhlolwa kwesifo sosizi esithatha isikhathi eside) Amaphuzu angaphezu kuka-4 (bheka isithasiselo esengeziwe, esitholakala ngombhalo ogcwele walesi sihloko ku-NEJM.org). Ngaphezu kwalokho, uma kunezinto eziyi-13 zosizi olude -13-R (Olunwetshiwe
Usizi-13-R; Amaphuzu angu-≥30 abonisa izimpawu zokuphazamiseka kosizi okuhlala isikhathi eside njengoba kuchazwe yi-DSM-5. Nokho, kusadingeka izingxoxo zomtholampilo ukuze kuqinisekiswe lesi sifo. Uma i-Inventory yezinto ezingu-19 ze-Complicated Grief (Inventory of Complicated Grief; Ububanzi buyi-0 kuya ku-76, namaphuzu aphezulu abonisa izimpawu zosizi ezinzima kakhulu ezihlala isikhathi eside.) Izikolo ezingaphezulu kuka-25 kungenzeka zibe ukucindezeleka okubangela inkinga, futhi ithuluzi lifakazelwa ukuqapha izinguquko ngokuhamba kwesikhathi. I-Clinical Global Impression Scale, elinganiselwe ngabahlengikazi futhi igxile ezimpawu ezihlobene nosizi, iyindlela elula nephumelelayo yokuhlola ubukhulu bosizi ngokuhamba kwesikhathi.
Izingxoxo zomtholampilo neziguli zituswa ukuze kwenziwe ukuxilongwa kokugcina kokuphazamiseka kosizi okuhlala isikhathi eside, okuhlanganisa ukuhlonza okuhlukile kanye nohlelo lokwelapha (bheka Ithebula 2 ukuze uthole isiqondiso somtholampilo mayelana nomlando wokushona kwezihlobo nabangane kanye nezingxoxo zomtholampilo ukuze uthole izimpawu zokuphazamiseka kokudabuka okuthatha isikhathi eside). Ukuxilongwa okuhlukile kokuphazamiseka kosizi okuhlala isikhathi eside kuhlanganisa usizi oluvamile oluqhubekayo kanye nezinye izifo zengqondo ezitholakalayo. Ukuphazamiseka kosizi okuhlala isikhathi eside kungase kuhlotshaniswe nezinye iziyaluyalu, ikakhulukazi ukucindezeleka okukhulu, ukucindezeleka kwangemva kwenhlekelele (PTSD), nokuphazamiseka kokukhathazeka; I-Comorbidities ingase futhi yandulela ukuqala kokugula okuhlala isikhathi eside, futhi ingase ikhulise ukuthambekela kokugula okuhlala isikhathi eside. Uhlu lwemibuzo lwesiguli lungahlola izifo ezihambisanayo, okuhlanganisa ukuthambekela kokuzibulala. Esinye isilinganiso esinconywayo nesisetshenziswa kabanzi semibono nokuziphatha kokuzibulala Isikali Sesilinganiso Sokuzibulala Sase-Columbia (esibuza imibuzo enjengokuthi “Wake wafisa yini ukuthi ngabe ufile, noma ungalala ungaphinde uvuke?”). Futhi “Uke waba nemicabango yokuzibulala ngempela?” ).

Kukhona ukudideka emibikweni yabezindaba naphakathi kwabanye ochwepheshe bezokunakekelwa kwempilo mayelana nomehluko phakathi kokuphazamiseka kosizi okuhlala isikhathi eside kanye nosizi oluvamile oluqhubekayo. Lokhu kudideka kuyaqondakala ngoba usizi nokulangazelela kothandekayo ngemva kokufa kwakhe kungaqhubeka isikhathi eside, futhi noma yiziphi izimpawu zesifo sosizi esihlala isikhathi eside esibhalwe ku-ICD-11 noma i-DSM-5 singaqhubeka. Usizi olwengeziwe luvame ukwenzeka ngezinsuku zesikhumbuzo, amaholide omndeni, noma izikhumbuzo zokushona kothandekayo. Lapho isiguli sibuzwa ngomufi, kungase kuvuswe imizwelo, kuhlanganise nezinyembezi.
Odokotela kufanele baqaphele ukuthi akuwona wonke usizi oluqhubekayo oluyinkomba yokuxilongwa kosizi oluthatha isikhathi eside. Ekuphazamisekeni kosizi okuthatha isikhathi eside, imicabango nemizwelo ngomufi nokucindezeleka okungokomzwelo okuhlobene nosizi kungahlala ebuchosheni, kuqhubeke, kushube futhi kusakazeke kangangokuba kuphazamise ikhono lomuntu lokubamba iqhaza ebuhlotsheni obunenjongo nemisebenzi, ngisho nabantu ababaziyo nababathandayo.

Umgomo oyisisekelo wokwelapha isifo sosizi esithatha isikhathi eside uwukusiza iziguli ukuba zifunde ukwamukela ukuthi abathandekayo bazo abasekho phakade, ukuze baphile ukuphila okunenjongo nokwanelisayo ngaphandle kwalowo owashona, futhi zivumele izinkumbulo nemicabango yomuntu oshonile kudambe. Ubufakazi obuvela ezinhlolweni eziningi ezilawulwa ngokungahleliwe eziqhathanisa namaqembu okungenelela asebenzayo kanye nezilawuli zohlu lokulinda (okungukuthi, iziguli ezinikezwe ngezikhathi ezithile ukuze zithole ukungenelela okusebenzayo noma zibekwe ohlwini lokulinda) zisekela ukuphumelela kokungenelela kwesikhashana, okuhlosiwe kwe-psychotherapy futhi incoma kakhulu ukwelashwa kweziguli. Ukuhlaziywa kwe-meta kwezivivinyo ezingu-22 nabahlanganyeli abangu-2,952 kubonise ukuthi ukwelashwa kokuziphatha kwengqondo okugxile kugridi kube nomthelela omaphakathi kuya omkhulu ekwehliseni izimpawu zosizi (amasayizi omphumela ajwayelekile alinganiswa kusetshenziswa i-Hedges 'G ayengu-0.65 ekupheleni kokungenelela kanye no-0.9 ekulandeleni).
Ukwelapha isifo sosizi esithatha isikhathi eside kugxile ekusizeni iziguli zamukele ukushona kothandekayo futhi ziphinde zikwazi ukuphila ukuphila okunenjongo. Ukwelapha okubuhlungu okuhlala isikhathi eside kuyindlela ebanzi egcizelela ukulalela okunengqondo futhi kuhlanganisa izingxoxo ezikhuthazayo, i-psychoeducation esebenzisanayo, nochungechunge lwemisebenzi yokuhlangenwe nakho ngokulandelana okuhleliwe kumaseshini angu-16, kanye ngesonto. Ukwelapha kuwukwelashwa kokuqala okwakhiwa ngenxa yosizi oluthatha isikhathi eside futhi njengamanje kunesisekelo sobufakazi obuqine kakhulu. Izindlela zokwelapha ezimbalwa zokuziphatha kwengqondo ezithatha indlela efanayo futhi zigxile osizini nazo zibonise ukusebenza kahle.
Ukungenelela kokuphazamiseka kokudabuka okuthatha isikhathi eside kugxile ekusizeni iziguli ukuba zamukele ukushona kothandekayo nokubhekana nezithiyo ezihlangabezana nazo. Ukungenelela okuningi kuhilela nokusiza iziguli ukuthi ziphinde zikwazi ukuphila impilo ejabulisayo (njengokuthola izithakazelo ezinamandla noma izindinganiso eziyinhloko kanye nokusekela ukuhlanganyela kwazo emisebenzini ehlobene). Ithebula lesi-3 libala okuqukethwe nezinjongo zalezi zindlela zokwelapha.

Izilingo ezintathu ezilawulwa ngokungahleliwe ezihlola ukwandiswa kokwelashwa kosizi uma kuqhathaniswa nokwelashwa okuphumelelayo kokucindezeleka kwabonisa ukuthi ukwandiswa kokwelashwa kosizi kwakuphakeme kakhulu. Imiphumela yokuhlolwa komshayeli iphakamise ukuthi ukwelulwa kokwelashwa kosizi kwakuphakeme kunokwelashwa okuhlangene kwabantu ngenxa yokucindezeleka, futhi isilingo sokuqala esalandela esingahleliwe saqinisekisa lokhu okutholakele, okubonisa izinga lokuphendula lomtholampilo lama-51% ekwandiseni ukwelashwa kosizi. Izinga lokuphendula lomtholampilo lokwelapha phakathi kwabantu lalingu-28% (P=0.02) (impendulo yomtholampilo ichazwa ngokuthi "ithuthukiswe kakhulu" noma "ethuthuke kakhulu" ku-Clinical Composite Impression Scale). Ukuhlolwa kwesibili kwaqinisekisa le miphumela kubantu abadala asebekhulile (iminyaka yobudala eyisilinganiso, iminyaka engama-66), lapho u-71% weziguli ezithola ukwelashwa isikhathi eside ngenxa yosizi kanye nama-32% athola ukwelashwa okuphakathi kwabantu athole impendulo yomtholampilo (P<0.001).
Ukuhlolwa kwesithathu, ucwaningo olwenziwa ezikhungweni zokuhlola ezine, kuqhathanise i-citalopram ye-antidepressant ne-placebo ngokuhambisana nokwelashwa kokugula okudabukisayo okuhlala isikhathi eside noma ukwelapha okugxile ekuzileni; Imiphumela ibonise ukuthi izinga lokuphendula lokwelashwa kosizi olude oluhlanganiswe ne-placebo (83%) laliphezulu kunalelo lokwelashwa okugxilile komtholampilo okuhlanganiswe ne-citalopram (69%) (P=0.05) ne-placebo (54%) (P<0.01). Ngaphezu kwalokho, awukho umehluko ekusebenzeni kahle phakathi kwe-citalopram ne-placebo uma isetshenziswa ngokuhambisana nokwelashwa okugxilwe ekulileni noma ngokwelashwa kosizi olude. Kodwa-ke, i-citalopram ehlanganiswe nokwelashwa kokucindezeleka isikhathi eside kwanciphisa kakhulu izimpawu zokucindezeleka ezihambisanayo, kuyilapho i-citalopram ehlanganiswe nokwelashwa okugxile ekulileni akuzange kwenzeke.
Ukwelashwa kosizi okuhlala isikhathi eside kuhlanganisa isu lokwelapha lokuchayeka esandisiwe elisetshenziselwa i-PTSD (elikhuthaza isiguli ukuthi sicubungule ukushona komuntu esimthandayo futhi sinciphise ukugwema) sibe imodeli ephatha usizi olude njengesifo sokucindezeleka sangemva kokufa. Ukungenelela kufaka phakathi ukuqinisa ubudlelwano, ukusebenza ngaphakathi kwemingcele yezindinganiso zomuntu siqu kanye nemigomo yomuntu siqu, kanye nokuthuthukisa umuzwa wokuxhumana nomufi. Enye idatha iphakamisa ukuthi ukwelashwa kwengqondo-yokuziphatha kwe-PTSD kungase kungasebenzi kahle uma kungagxili osizini, nokuthi amasu okuchayeka okufana ne-PTSD angase asebenze ngezindlela ezihlukene ekwandiseni ukuphazamiseka kosizi. Kunezindlela zokwelapha ezimbalwa ezigxile ekudabukeni ezisebenzisa ukwelapha ngendlela efanayo kwengqondo futhi ezisebenza kahle kubantu ngabanye nasemaqenjini kanye nasekuphazamisekeni kosizi okuhlala isikhathi eside ezinganeni.
Kwabahlengikazi abangakwazi ukunikeza ukunakekelwa okusekelwe ebufakazini, sincoma ukuthi bathumele iziguli noma nini lapho kungenzeka futhi balandele iziguli masonto onke noma njalo ngemva kwesonto ngalinye, njengoba kudingekile, besebenzisa izinyathelo ezilula zokusekela ezigxile osizini (Ithebula 4). I-Telemedicine kanye nokwelashwa kwe-inthanethi okuziqondise ngesiguli kungase futhi kube izindlela eziphumelelayo zokuthuthukisa ukufinyelela ekunakekelweni, kodwa ukusekelwa okuvumelanayo okuvela kubelaphi kuyadingeka ezifundweni zezindlela zokwelapha eziqondiswe wena, ezingase zidingeke ukuze kwandiswe imiphumela yokwelashwa. Ezigulini ezingaphenduli ekwelashweni kwengqondo okusekelwe ebufakazini bokuphazamiseka kokudabuka okuhlala isikhathi eside, kufanele kuhlolwe kabusha ukuze kuhlonzwe ukugula okungokomzimba noma kwengqondo okungase kubangele izimpawu, ikakhulukazi lezo ezingasingathwa ngempumelelo ngokungenelela okuhlosiwe, okufana ne-PTSD, ukucindezeleka, ukukhathazeka, ukuphazamiseka kokulala, nokuphazamiseka kokusebenzisa izidakamizwa.

Ezigulini ezinezimpawu ezithambile noma ezingahlangabezani nomkhawulo, futhi okwamanje ezingakwazi ukufinyelela ekwelapheni okusekelwe ebufakazini bokuphazamiseka kosizi okuhlala isikhathi eside, odokotela bangasiza ekulawuleni usizi okusekelayo. Ithebula lesi-4 libala izindlela ezilula zokusebenzisa lezi zindlela zokwelapha.
Ukulalela kanye nokwejwayelekile usizi kuyizisekelo eziyisisekelo. Imfundo yengqondo echaza ukuphazamiseka kosizi okuhlala isikhathi eside, ukuhlobana kwakho nosizi oluvamile, nokuthi yini engasiza ngokuvamile inikeza iziguli ukuthula kwengqondo futhi zingazisiza zizizwe zinesizungu futhi zinethemba elikhulu lokuthi usizo luyatholakala. Ukubandakanya amalungu omndeni noma abangani abaseduze emfundweni engokwengqondo mayelana nokuphazamiseka kokudabuka okuthatha isikhathi eside kungathuthukisa ikhono labo lokunikeza ukusekela nozwela kogulayo.
Ukwenza kucace ezigulini ukuthi umgomo wethu uwukuthuthukisa inqubo yemvelo, ukuzisiza zifunde ukuphila ngaphandle komuntu oshonile, nokubhekana nezinkinga eziphazamisa le nqubo kungase kusize iziguli zibambe iqhaza ekwelashweni kwazo. Odokotela bangakhuthaza iziguli kanye nemindeni yazo ukuba zamukele usizi njengempendulo engokwemvelo lapho kushonelwa othandekayo, futhi bangasikiseli ukuthi usizi seluphelile. Kubalulekile ukuthi iziguli zingesabi ukuthi zizocelwa ukuba ziyeke imishanguzo ngokukhohlwa, ukuqhubeka noma ukushiya abathandekayo. Odokotela bangasiza iziguli zibone ukuthi ukuzama ukujwayela iqiniso lokuthi othandekayo ushonile kunganciphisa usizi lwazo futhi kudale umuzwa owanelisayo wokuqhubeka nokuxhumana nomufi.

Isizinda sokungaqiniseki
Okwamanje azikho izifundo ezanele ze-neurobiological ezicacisa i-pathogenesis yokuphazamiseka kokudabuka okuhlala isikhathi eside, azikho izidakamizwa noma ezinye izindlela zokwelapha ze-neurophysiological eziye zaboniswa ukuthi zisebenza ngempumelelo ezimpawu zesifo sosizi ezithatha isikhathi eside ekuhlolweni komtholampilo okulindelwe, futhi azikho izidakamizwa ezihlolwe ngokugcwele. Ucwaningo olulodwa kuphela olulindelekile, olungahleliwe, olulawulwa yi-placebo lwesidakamizwa lwatholakala ezincwadini, futhi njengoba kushiwo ngaphambili, lolu cwaningo aluzange lufakazele ukuthi i-citalopram yayisebenza kahle ekwandiseni izimpawu zesifo sosizi, kodwa lapho ihlanganiswa nokwelashwa kokucindezeleka okuqhubeka isikhathi eside, kwaba nomthelela omkhulu ezimpawu ezihlangene zokucindezeleka. Ngokusobala, ucwaningo olwengeziwe luyadingeka.
Ukuze unqume ukusebenza kahle kokwelashwa kwedijithali, kuyadingeka ukwenza izivivinyo ngamaqembu okulawula afanele kanye namandla ezibalo anele. Ngaphezu kwalokho, izinga lokuxilongwa kwesifo sosizi esihlala isikhathi eside lihlala lingaqinisekile ngenxa yokuntuleka kwezifundo ezifanayo ze-epidemiological kanye nokwehluka okubanzi kwamazinga okuxilongwa ngenxa yezimo ezihlukene zokufa.