nhau

Kushungurudzika kwenguva refu ipfungwa yepfungwa mushure mekufa kwemudiwa, umo munhu anonzwa achienderera, kushungurudzika kwakanyanya kwenguva yakareba kupfuura inotarisirwa nemagariro evanhu, tsika, kana chitendero. Inenge 3 kusvika ku10 muzana yevanhu vanova nehosha yenhamo yenguva refu pashure porufu rwomudiwa rwomuzvarirwo, asi chiitiko chacho chinokura apo mwana kana kuti mudiwa anofa, kana kuti apo mudiwa anofa zvisingatarisirwi. Kuora mwoyo, kuzvidya mwoyo uye post-traumatic stress disorder inofanira kuongororwa mukuongororwa kwekliniki. Evidence-based psychotherapy yekushungurudzika ndiyo yekutanga kurapwa. Chinangwa ndechokubatsira varwere kuti vabvume kuti vadiwa vavo vaenda zvachose, kurarama upenyu hune chinangwa uye hunogutsa vasina mushakabvu, uye kuti zvishoma nezvishoma vasiye ndangariro dzavo dzemufi.

Nyaya
Mumwe mukadzi ane makore 55 okukura akafirwa akashanyira chiremba wake mwedzi 18 pashure pokunge murume wake afa kamwe kamwe nemwoyo. Kubva zvakafa murume wake, shungu dzake hadzina kumbopera. Haana kurega kufunga nezvemurume wake uye akatadza kudavira kuti akanga aenda. Kunyange paakapemberera kupedza chikoro kwemwanasikana wake munguva pfupi yapfuura, kusurukirwa uye kushuva murume wake hazvina kupera. Akarega kushamwaridzana nevamwe vakaroorana nokuti zvakamushungurudza zvikuru kuyeuka kuti murume wake akanga asisipo. Aichema kurara husiku hwega hwega, achifunga kasingaperi kuti aifanira kunge afanoona sei rufu rwake, uye kuti dai afa sei. Akanga ane nhoroondo yechirwere cheshuga uye nguva mbiri dzekuora mwoyo kukuru. Kumwe kuongorora kwakaratidza kuwedzera kudiki kwemashuga eropa uye 4.5kg (10lb) uremu kuwedzera. Kusuruvara kwomurwere kunofanira kuongororwa uye kurapwa sei?

Dambudziko rekiriniki
Vanachiremba vanorapa varwere vari kuchema vane mukana wekubatsira, asi kazhinji vanokundikana kuutora. Vamwe vevarwere ava vanotambura nekushungurudzika kwenguva refu. Kushungurudzika kwavo kwakapararira uye kwakanyanya, uye kunotora nguva yakareba kupfuura iyo vanhu vazhinji vakafirwa vanowanzotanga kuitazve muhupenyu uye kushungurudzika kunoserera. Vanhu vane chirwere cheshungu kwenguva refu vanogona kuratidza kurwadziwa kwakanyanya mupfungwa kwakabatana nerufu rwemudiwa, uye vane dambudziko rekuona chero remangwana remangwana mushure mekunge munhu aenda. Vanogona kusangana nematambudziko muhupenyu hwezuva nezuva uye vangave vaine pfungwa dzekuzviuraya kana maitiro. Vamwe vanhu vanodavira kuti kufa kwomumwe munhu wepedyo kunoreva kuti upenyu hwavo pachavo hwapera, uye hapana zvakawanda zvavanogona kuita nezvazvo. Vanogona kuzviomesera vofunga kuti vanofanira kuvanza kusuruvara kwavo. Shamwari nemhuri vanonetsekawo nemhaka yokuti murwere anga achingofunga bedzi pamusoro pomushakabvu uye haafariri zvikuru ukama hwazvino nemibato, uye vangaudza murwere kuti “zvikanganwe” ndokupfuurira.
Kushungurudzika kwenguva refu chirwere chitsva chechirwere, uye ruzivo nezve zviratidzo uye kurapwa hachisati chazivikanwa zvakanyanya. Vanachiremba vanogona kunge vasina kudzidziswa kuziva chirwere cheshungu chakareba uye vangasaziva nzira yekupa kurapa kunoshanda kana tsigiro-yakavakirwa. Denda reCCIDID-19 uye nekukura kwemabhuku ekuongororwa kwechirwere cheshungu chakawedzera kutarisisa kuti varapi vanofanira kuziva uye kupindura sei kusuwa uye mamwe matambudziko epfungwa ane chekuita nerufu rwemudiwa.
MuKudzokororwa kwegumi neimwe yeInternational Statistical Classification yeZvirwere uye Hutano Hwakabatana Matambudziko (ICD-11) muna 2019, iyo World Health Organisation (WHO) uye American Psychiatric Association (American Psychiatric Association)
Muna 2022, iyo yechishanu edition yeDiagnostic uye Statistical Manual yeMental Disorders (DSM-5) yakapatsanuka yakawedzera nzira yekuongorora yakarongwa yekurebesa kushungurudzika. Mazwi aimboshandiswa anosanganisira kusuwa kwakaoma, kufirwa kunoramba kuripo, uye kushungurudza, kurwara, kana kusuwa kusingagadziriswe. Zviratidzo zvekushungurudzika kwenguva refu zvinosanganisira kushuvira zvakanyanya, kutsvagiridza, kana kushungurudza mufi, zvichiperekedzwa nezvimwe zvinoramba zvichiratidza kusuruvara, zvakanyanya, uye zvinopararira.
Zviratidzo zvekushungurudzika kwenguva refu zvinofanirwa kuenderera kwenguva yakati (≥6 mwedzi maererano neICD-11 maitiro uye ≥12 mwedzi maererano neDSM-5 maitiro), zvinokonzera kushungurudzika kwakanyanya kwekliniki kana kukanganisa kwebasa, uye kudarika zvinotarisirwa neboka remurwere, tsika, chitendero, kana hukama hwemagariro evanhu. ICD-11 inopa mienzaniso yezviratidzo zvikuru zvekushungurudzika mupfungwa, zvakadai sekusuwa, mhosva, kutsamwa, kusakwanisa kunzwa manzwiro akanaka, kupera kwepfungwa, kuramba kana kuomerwa kubvuma rufu rwemudiwa, kunzwa kurasikirwa kwechikamu chako pachako, uye kuderedza kubatanidzwa mumagariro evanhu kana mamwe mabasa. Iyo DSM-5 yekuongorora maitiro ekushungurudzika kwenguva refu kwekutambudzika kunoda zvishoma zvitatu zvezvinotevera zviratidzo zvisere: kurwadziwa kwakanyanya mupfungwa, kupera simba, kusurukirwa kwakanyanya, kurasikirwa kwekuzviziva (kuparadzwa kwekuzivikanwa), kusatenda, kudzivisa zvinhu zvinovayeuchidza nezvevanoda avo vaenda nekusingaperi, kunetseka kuitazve mabasa uye hukama, uye kunzwa kuti upenyu hahuna chinangwa.
Zvidzidzo zvinoratidza kuti avhareji ye3% kusvika ku10% yevanhu vakave nehama yakafa nekuda kwezvikonzero zvechisikigo vanotambura nekushungurudzika kwenguva refu, uye mwero wacho wakapetwa kanoverengeka muvanhu vane hama inofa nekuzviuraya, kuuraya, tsaona, njodzi dzinongoitika dzoga, kana zvimwe zvikonzero zvisingatarisirwi. Muchidzidzo chemushonga wemukati uye data yekiriniki yehutano hwepfungwa, mwero wakashumwa waive wakapetwa kaviri chiyero chakataurwa muongororo iri pamusoro. Tafura 1 inodonongodza njodzi dzinokonzeresa kushushikana kwenguva refu uye zviratidzo zvinogoneka zvechirwere ichi.

Kurasikirwa nemumwe munhu waanoshamwaridzana naye zvachose kunogona kushungurudza zvakanyanya uye kuumba nhevedzano yekuchinja kwepfungwa nemagariro kunoparadza kunofanira kujairana neakafirwa. Kuchema kunowanzoitika kurufu rwomudiwa, asi hapana nzira yepasi rose yokuchema kana kuti kubvuma chokwadi chorufu. Nokufamba kwenguva, vanhu vakawanda vakafirwa vanowana nzira yokubvuma chokwadi chitsva ichi voenderera mberi noupenyu hwavo. Sezvo vanhu vachichinjira kuhupenyu hunochinja, vanowanzo chinja pakati pekutarisana nemarwadzo epfungwa uye nekumboisa shure kwavo. Pavanenge vachidaro, kusimba kweshungu kunodzikira, asi kunongoramba kuchiwedzera uye dzimwe nguva kunowedzera, kunyanya pamhemberero dzegore negore uye dzimwe nguva dzinoyeuchidza vanhu nezvemushakabvu.
Kune vanhu vane chirwere chekutambudzika kwenguva refu, zvisinei, maitiro ekugadzirisa anogona kuderedzwa, uye kusuruvara kunoramba kwakanyanya uye kwakapararira. Kunyanya kudzivisa zvinhu zvinovayeuchidza kuti vadikani vavo vaenda zvachose, uye kutendeuka uye pamusoro pekufungidzira mamiriro akasiyana-siyana zvipingamupinyi zvinowanzoitika, sekuzvipa mhosva uye kutsamwa, kuoma kudzora manzwiro, uye kugara uchinetseka. Kushungurudzika kwenguva refu kunobatanidzwa nekuwedzera kwehuwandu hwezvirwere zvemuviri uye zvepfungwa. Chirwere cheshungu kwenguva refu chinogona kuita kuti upenyu hwomunhu humire, huite kuti huve hwakaoma kuumba kana kuchengetedza ukama hune chinangwa, hunokanganisa kushanda kwevanhu uye unyanzvi, hunoita kuti unzwe usina tariro, uye pfungwa dzokuzviuraya uye maitiro.

Strategy nehumbowo

Ruzivo rwekufa kuchangobva kuitika kwehama uye zvarinoita zvinofanirwa kuve chikamu chekuunganidzwa kwenhoroondo yekiriniki. Kutsvaga zvinyorwa zvekurapa zverufu rwemudiwa uye kubvunza kuti murwere ari kuita sei mushure merufu kunogona kuvhura nhaurirano pamusoro pekuchema uye kuwanda kwaro, nguva, kusimba, kupararira, uye kukanganisa kugona kwemurwere kushanda. Kuongororwa kwekiriniki kunofanirwa kusanganisira kuongororwa kwezviratidzo zvemuviri uye zvepfungwa zvemurwere mushure mekufa kwemudiwa, ikozvino uye yapfuura mamiriro epfungwa uye ekurapa, doro uye kushandisa zvinodhaka, pfungwa dzekuzviuraya nemafambiro, rutsigiro rwemagariro uye kushanda, nhoroondo yekurapa, uye kuongorora mamiriro epfungwa. Kusuruvara kwenguva refu kunofanira kurangarirwa kana mwedzi mitanhatu pashure porufu rwomudiwa, kusuruvara kwomunhu kuchiri kutapura zvakakomba upenyu hwavo hwezuva nezuva.
Kune maturusi akareruka, akanyatso simbiswa, ane murwere ane zvibodzwa anowanikwa pakuongororwa kwenguva pfupi kwekushungurudzika kwenguva refu. Chiri nyore ndechezvinhu zvishanu Mubvunzo Wekuchema Muchidimbu (Mubvunzo Mupfupi weKuchema; Range, 0 kusvika gumi, ine zvibodzwa zvepamusoro zvinoratidza kudiwa kwekuwedzera kuongororwa kwechirwere cheshungu chakareba) Chibodzwa chepamusoro kupfuura 4 (ona apendikisi yekuwedzera, inowanika nerugwaro rwakazara rwechinyorwa chino paNEJM.org). Mukuwedzera, kana paine zvinhu gumi nezvitatu zveKusuwa Kwenguva refu -13-R (Yakareba
Kushungurudzika-13-R; Nhamba ye ≥30 inoratidza zviratidzo zvekushungurudzika kwenguva refu kwekushungurudzika sezvinotsanangurwa neDSM-5. Nekudaro, kubvunzurudzwa kwekiriniki kuchiri kudikanwa kusimbisa chirwere. Kana iyo 19-chinhu Inventory of Complicated Grief (Inventory of Complicated Grief; The range is 0 kusvika 76, ine chiyero chepamusoro chinoratidza zviratidzo zvakakomba zvakanyanya kwenguva refu.) Zvikamu pamusoro pe25 zvinogona kunge zviri kushungurudza kunokonzera dambudziko, uye chimbo chacho chinopupurirwa kutarisa kuchinja kwekufamba kwenguva. The Clinical Global Impression Scale, iyo inotarwa nevarapi uye inotarisa zviratidzo zvine chekuita nekusuwa, inzira iri nyore uye inoshanda yekuongorora kuoma kweshungu nekufamba kwenguva.
Kubvunzurudzwa kwekiriniki nevarwere kunokurudzirwa kuita kuongororwa kwekupedzisira kwekushungurudzika kwenguva refu, kusanganisira kusiyanisa kuongororwa uye chirongwa chekurapa (ona Tafura 2 yehutungamiri hwekliniki pamusoro penhoroondo yekufa kwehama neshamwari uye kubvunzurudzwa kwekiriniki yezviratidzo zvekushungurudzika kwenguva refu). Kuongororwa kwakasiyana kwechirwere cheshungu kwenguva refu kunosanganisira kusuruvara kunoramba kuripo pamwe chete nezvimwe zvirwere zvepfungwa zvinoonekwa. Kushungurudzika kwenguva refu kunogona kusanganiswa nezvimwe zvirwere, kunyanya kuora mwoyo kukuru, post-traumatic stress disorder (PTSD), uye kushungurudzika kwepfungwa; Comorbidities inogonawo kutangira kutanga kwekushungurudzika kwenguva refu, uye inogona kuwedzera mukana wekushungurudzika kwenguva refu. Mibvunzo yemurwere inogona kuongorora comorbidities, kusanganisira kuda kuzviuraya. Imwe chiyero chinokurudzirwa uye chinoshandiswa zvakanyanya chekuda kuzviuraya uye maitiro ndeye Columbia Suicide Severity Rating Scale (iyo inobvunza mibvunzo yakadai seyokuti "Wakamboshuva here kuti dai wakafa, kana kuti ungarara uye usingazomuki?"). Uye "Wakambove nepfungwa dzekuzviuraya here?" )

Pane kuvhiringika mumishumo yenhau uye pakati pevamwe vashandi vehutano nezve mutsauko uripo pakati pekushungurudzika kwenguva refu uye kusuwa kunoramba kuripo. Kuvhiringidzika uku kunonzwisisika nokuti kusuruvara uye kushuva kwemudiwa mushure mekufa kwavo kunogona kuramba kwenguva yakareba, uye chero zviratidzo zvekushungurudzika kwenguva refu zvakanyorwa muICD-11 kana DSM-5 zvinogona kupfuurira. Kushungurudzika kwakanyanya kunowanzoitika pamisi yegore, mazororo emhuri, kana zviyeuchidzo zvekufa kwemudiwa. Apo murwere anobvunzwa nezvomushakabvu, mirangariro inogona kumutswa, kubatanidza misodzi.
Vanachiremba vanofanira kucherechedza kuti havasi vose vanoramba vachisuwa zvinoratidza kuongororwa kwechirwere cheshungu kwenguva refu. Mukushungurudzika kwenguva refu, pfungwa uye manzwiro pamusoro pemufi uye kushungurudzika mupfungwa kunobatanidza nekushungurudzika kunogona kutora uropi, kupfuurira, kuva kwakanyanya uye kwakapararira zvokuti zvinokanganisa kukwanisa kwomunhu kutora chikamu muukama hune chinangwa uye mabasa, kunyange nevanhu vavanoziva uye vanoda.

Vavariro huru yokurapwa kwehosha yenhamo yenguva refu ndeyokubetsera varwere kudzidza kugamuchira kuti vadiwa vavo vaenda nokusingaperi, kuti vagorarama upenyu hune revo uye hunogutsa pasina munhu akafa, uye kurega ndangariro nemirangariro zvomunhu akafa zviserera. Uchapupu hunobva mumiedzo yakawanda inodzorwa neinorongeka ichienzanisa mapoka anopindira anoshingaira uye kumirira-rondedzero yekudzora (kureva, varwere vanongoerekana vapiwa kuti vagamuchire kupindira kwakasimba kana kuiswa pachirongwa chekumirira) inotsigira kushanda kwenguva pfupi, inotarirwa psychotherapy kupindira uye inokurudzira zvakasimba kurapwa kwevarwere. Meta-kuongororwa kwemiedzo makumi maviri nembiri nevatori vechikamu 2,952 yakaratidza kuti grid-yakatarisana necognitive behavioral therapy ine mwero kusvika kune yakakura mhedzisiro pakuderedza kusuruvara zviratidzo (yakajairwa maitiro saizi akayerwa uchishandisa Hedges 'G aive 0.65 pakupera kwekupindira uye 0.9 pakutevera-up).
Kurapa kwechirwere chenhamo kwenguva refu kunonangana pakubatsira varwere kuti vabvume kufa kwomudiwa uye kuwanazve simba rokurarama upenyu hune chinangwa. Kushungurudzika kwenguva refu Disorder therapy inzira yakazara inosimbisa kuteerera kwemoyo wese uye inosanganisira kubvunzurudza kwekukurudzira, psychoeducation inopindirana, uye nhevedzano yezviitiko zvinosangana mukutevedzana kwakarongwa pamusoro pezvikamu gumi nematanhatu, kamwe pasvondo. Kurapa ndiko kurapwa kwekutanga kugadzirwa kwenguva refu yekushungurudzika uye parizvino ine hwaro hwehumboo hwakasimba. Mishonga yakawanda yekuziva-maitiro inotora nzira yakafanana uye inotarisa kusuruvara yakaratidzawo kushanda.
Kupindira kwechirwere cheshungu kwenguva refu kunotarisa pakubatsira varwere kuti vagamuchire kufa kwemudiwa uye kugadzirisa zvipingamupinyi zvavanosangana nazvo. Kupindira kwakawanda kunosanganisira kubatsira varwere kuti vadzore kugona kwavo kutungamira hupenyu hunofadza (sekuwana zvishuwo zvakasimba kana zvakakosha zvakakosha uye kutsigira kubatanidzwa kwavo muzviitiko zvine hukama). Tafura 3 inoronga zviri mukati uye zvinangwa zvekurapa uku.

Miedzo mitatu yakarongeka yakarongeka inoongorora kurebesa kwechirwere chekushungurudzika kurapa kana ichienzaniswa nekurapa kunoshanda kwekuora mwoyo kwakaratidza kuti kurebesa kwechirwere cheshungu kurapa kwaive kwakanyanya. Pilot miedzo yemigumisiro yakaratidza kuti kurebesa kwechirwere cheshungu kurapa kwaive kwakakwirira kudarika kurapa kwevanhu kwekuora mwoyo, uye yekutanga yakatevera muedzo we randomized yakasimbisa kuwanikwa uku, ichiratidza kliniki yekupindura chiyero che 51% chekuwedzera kwechirwere chekushungurudzika kwechirwere. Chirwere chekupindura kwekiriniki yekurapa kwevanhu pakati pevanhu chaive 28% (P = 0.02) (mhinduro yekiriniki inotsanangurwa se "yakavandudzwa zvakanyanya" kana "yakavandudzwa zvakanyanya" paClinical Composite Impression Scale). Chiyedzo chechipiri chakasimbisa mhedzisiro iyi kune vakura (kureva zera, makore 66), umo 71% yevarwere vanotora nguva refu yekushungurudzika kurapwa uye 32% vachiwana kurapwa kwevanhu vakawana mhinduro yekiriniki (P <0.001).
Muedzo wechitatu, chidzidzo chakaitwa panzvimbo ina dzekuedza, yakaenzanisa antidepressant citalopram ne placebo pamwe chete nechirwere chekutambudzika kwenguva refu kana kuchema-yakatarisa kliniki therapy; Mhedzisiro yacho yakaratidza kuti mwero wekupindura wenguva refu yekushungurudzika kurapa kwakasanganiswa ne placebo (83%) yaive yakakwira kupfuura iyo yekuchema yakatarisana nekiriniki kurapwa yakasanganiswa necitalopram (69%) (P = 0.05) uye placebo (54%) (P <0.01). Pamusoro pezvo, pakanga pasina mutsauko mukubudirira pakati pecitalopram neplacebo kana ichishandiswa pamwe chete nekuchema-yakatarisana nekiriniki kurapa kana nekurebesa kusuruvara kusagadzikana kurapwa. Nekudaro, citalopram yakasanganiswa nekurebesa kushungurudzika kwechirwere kurapwa kwakaderedza zvakanyanya concomitant depressive zviratidzo, nepo citalopram yakasanganiswa nekuchema-yakatarisana nekiriniki kurapwa haina.
Kushungurudzika kwenguva refu Disorder therapy inosanganisira yakawedzera exposure therapy zano rinoshandiswa kune PTSD (iyo inokurudzira murwere kugadzirisa rufu rwemudiwa uye kuderedza kunzvenga) kuita modhi inobata kusuruvara kwenguva refu senge mushure mekufa kunetseka kusagadzikana. Kupindira kunosanganisirawo kusimbisa hukama, kushanda mukati mezvisungo zvehunhu uye zvinangwa zvemunhu, uye kusimudzira pfungwa yekubatana nemufi. Imwe data inoratidza kuti cognitive-behavioral therapy yePTSD inogona kunge isinganyanyi kushanda kana isingatarise kusuwa, uye kuti PTSD-senge nzira dzekufumura dzinogona kushanda nenzira dzakasiyana mukurebesa kushungurudzika. Kune akati wandei anonangana nerusuruvaro anoshandisa akafanana cognitive behavioral therapy uye anobatsira vanhu nemapoka pamwe chete nekushungurudzika kwenguva refu muvana.
Kune varapi vasingakwanisi kupa humbowo hunotarisirwa, tinokurudzira kuti vatumire varwere pose pazvinenge zvichiita uye vatevere nevarwere vhiki nevhiki kana imwe vhiki imwe neimwe, sezvinodiwa, vachishandisa nzira dzakareruka dzinotsigira dzinotarisa kushungurudzika (Table Tafura 4). Telemedicine uye murwere anozvitungamira pamhepo kurapwa anogona zvakare kuve nzira dzinoshanda dzekuvandudza kuwana kwekutarisirwa, asi asynchronous rutsigiro kubva kune varapi hunodiwa muzvidzidzo zvekuzvitungamira kurapa nzira, izvo zvingave zvakakosha kukwirisa mhedzisiro yekurapa. Kune varwere vasingapindure kune humbowo-based psychotherapy nekuda kwekushungurudzika kwenguva refu kwekushungurudzika, kuongororwazve kunofanirwa kuitwa kuti kuone chirwere chemuviri kana chepfungwa chingave chiri kukonzera zviratidzo, kunyanya izvo zvinogona kugadziriswa zvinobudirira nekunangwa kupindira, kwakadai sePTSD, kushushikana, kuzvidya mwoyo, kusagadzikana kwekurara, uye kusagadzikana kwekushandisa zvinodhaka.

Kune varwere vane zviratidzo zvakapfava kana vasingasangane nechikumbaridzo, uye avo parizvino vasina mukana wekurapa-kwakavakirwa kurapwa kwechirwere cheshungu kwenguva refu, varapi vanogona kubatsira nerutsigiro rwekusuwa. Tafura 4 inoronga nzira dziri nyore dzekushandisa idzi marapirwo.
Kuteerera uye kudzikamisa kusuwa ndizvo zvakakosha. Dzidzo yepfungwa inotsanangura kusagadzikana kwekushungurudzika kwenguva refu, hukama hwayo nekusuwa kwese, uye chii chinogona kubatsira kazhinji chinopa varwere rugare rwepfungwa uye inogona kuvabatsira kuti vanzwe kusurukirwa uye kuwedzera tariro yekuti rubatsiro rwuripo. Kubatanidza nhengo dzemhuri kana shamwari dzepedyo mudzidzo yepfungwa nezvechirwere chenguva refu chinogona kuvandudza kugona kwavo kupa tsigiro uye tsitsi kune anorwara.
Kujekesa kuvarwere kuti chinangwa chedu ndechekusimudzira maitiro echisikigo, kuvabatsira kudzidza kurarama vasina mufi, uye kugadzirisa nyaya dzinokanganisa chirongwa ichi zvinogona kubatsira varwere kutora chikamu mukurapwa kwavo. Varapi vanogona kukurudzira varwere nemhuri dzavo kuti vagamuchire kusuwa semhinduro yechisikigo parufu rwomudiwa, uye kwete kutaura kuti kusuwa kwapera. Zvakakosha kuti varwere vasatye kuti vanozonzi vasiye kurapwa nekukanganwa, kuenderera mberi kana kusiya vadikani. Vanachiremba vanogona kubatsira varwere kuziva kuti kuedza kujairana nechokwadi chokuti mudiwa afa kunogona kuderedza kushungurudzika kwavo uye kuunza pfungwa inogutsa yekuenderera mberi nekubatana nemufi.

Domain of uncertainty
Parizvino hapana zvidzidzo zvakakwana zveurourobiological zvinojekesa pathogenesis yekushungurudzika kwenguva refu, hapana mishonga kana imwe neurophysiological therapies iyo yakaratidza kuti inoshanda kune kwenguva refu yekushungurudzika zviratidzo zviratidzo mune zvinotarisirwa kukiriniki miedzo, uye hapana zvinodhaka zvakaedzwa zvizere. Imwe chete inotarisirwa, randomized, placebo-controlled controlled study yemishonga yakawanikwa mumabhuku, uye sezvakambotaurwa, chidzidzo ichi hachina kuratidza kuti citalopram yakanga inobudirira mukuwedzera zviratidzo zvekushungurudzika kwekushungurudzika, asi kana yakabatanidzwa nekurebesa marwadzo ekushungurudzika kwechirwere, yakave nemigumisiro yakakura pane zvakasanganiswa zviratidzo zvekuora mwoyo. Sezviri pachena, kunzvera kwakawanda kunodiwa.
Kuti uone kushanda kwedhijitari therapy, zvinodikanwa kuita miedzo nemapoka ekutonga akakodzera uye simba rakakwana rehuwandu. Pamusoro pezvo, chiyero chekuongororwa kwechirwere cheshungu kwenguva refu chinoramba chisina chokwadi nekuda kwekushaikwa kweyunifomu epidemiological zvidzidzo uye kusiyanisa kwakakura kwehuwandu hwekuongorora nekuda kwemamiriro akasiyana erufu.