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1. Zornberg GL, Pope HG. Treatment of depression in bipolar disorder: new directions for
research. J Clin Psychopharmacol 1993;13:397-408
2. The Database of Abstracts of Reviews of Effectiveness (University of York), Database
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disorder. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD003013. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated
frequently
4. Poolsup N, Li Wan Po A, de Oliveira IR. Systematic overview of lithium treatment in
acute mania. Journal of Clinical Pharmacy and Therapeutics 2000;25:139-56.
5. The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.:
DARE-20001134. In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software
6. Dardennes R, Even C, Bange F, Heim A. Carbamazepine and lithium in the prophylaxis
of bipolar disorders. Br J Psychiatr 1995;166:378-381
8. Macritchie KAN, Geddes JR, Scott J, Haslam DRS, Goodwin GM. Valproic acid,
valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane
Database Syst Rev. 2004;(2):CD003196
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and carbamazepine in the treatment of mania: a statistical meta-analysis. European
Psychopharmacology 1996;6:245-252
10.The Database of Abstracts of Reviews of Effectiveness (University of York), Database
.
11.Muller-Oerlinghausen B, Berghfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7
1. EBM Guidelines, 28.6.2004, www.ebm-guidelines.com

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1. University of York. Centre for Reviews and Dissemination. Brief interventions and alcohol
use. Effective Health Care 1993;1:13
3. Kahan M, Wilson L, Becker L. Physician-based interventions with problem drinkers. Can
Med Ass J 1995;152:851-859
5. Poikolainen K. Effectiveness of brief interventions to reduce alcohol intake in primary
health care populations. Preventive Medicine 1999;28:503-509
7. Freemantle N, Song F, Sheldon T, Long A. Brief interventions and alcohol use. York: NHS
Centre for Reviews and Dissemination. NHS Centre for Reviews and Dissemination
(NHSCRD). ISBN: 0965 0288. Effectiv Health Care. 1993. 13.
8. The Health Technology Assessment Database, Database no.: HTA-950035. In: The
Cochrane Library, Issue 1, 2001. Oxford: Update Software
9. Wells-Parker E, Bangert-Drowns R, McMillen R, Willians M. Final results from a metaanalysis of remedial interventions with drink/drive offenders. Addiction 1995;90:907926
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1. Hampton HL. Care of the woman who has been raped. N engl j med 1995; 332: 234237
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1. Inouye SK. The dilemma of delirium: Clinical and research controversies regarding
diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med
1994;97:278-287
2. Johnson JC et al. Using DSM-III criteria to diagnose delirium in elderly general medical
patients. J Gerontology 1990;45:M113-9
3. Erkinjuntti T et al. Dementia among medical patients. Evaluation of consecutive 2000
admissions. Arch Intern Med 1986;146:1923-6
4. Cole mg et al. Systematic intervention for elderly inpatients with delirium: a randomized
trial. Can Med Assoc J 1994;151:965-70
5. OKeeffe S, Lavan J, The Prognostic significance of delirium in Older hospitalized
patients. J Am Geriatr Soc 1997;45:174-8
6. Williams MA et al. Predictors of acute confusional states in hospitalized elderly. Res
Nurs Health 1985;8:31-40
7. Rogers MP et al. Delirium after elective orthopedic surgery: Risk factors and natural
history. Int J Psychiatr Med 1989;19:109-21
8. Williams-Russo P et al. Post-operative delirium: predictors and prognosis in elderly
orthopedic patients. J Am Geriatr Soc 1992:40:759-67
9. Marcantonio ER et al. A clinical prediction rule for delirium after elective noncardiac
surgery. JAMA 1994;271:134-9
10.Inoye SK et al. A predictive model for delirium in hospitalized elderly medical patients
based on admission characteristics. Ann Intern Med 1993;119:474-81
11.Williams-Russo et al. Cognitive effects after epidural vs. general anesthesia in older
adults. A randomized trial. JAMA 1995;274:44-50
12.Francis J. Delirium in older patients. J Am Geriatr Soc 1992;40:829-39
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1984;14:181-8
14.Inouye SK et al. Clarifying confusion: The confusion assessment method, a new method
for detection of delirium. Ann Intern Med 1990;113:941-8
15.Gustafsson Y et al. Underdiagnosis and poor documentation of acute confusional states
in elderly hip fracture patients. J Am Geriatr Soc 1991;39:760-5
16.Thomas RI et al. A prospective study of delirium and prolonged hospital stay. Arch Gen
Psychiatr 1988;45:937-40
17.Rockwood.K. Acute confusion in elderly medical patients. J Am Geriatr Soc 1989;37:150-4
18.Francis J et al. A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097101
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hospitalized patients. Arch Intern Med 1992;152:334-40
20.Jitapunkl S et al. Delirium in newly admitted elderly patients. A prospective study. Q J
Med, New Ser 1992;83:307-14
21.Koponen H et al. A prospective study of delirium patients admitted to a psychiatric
hospital. Psychol Med 1993;23:103-9
22.Breibart W et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in
the treatment of delirium in hospitalized AIDS patients. Am J Psychiatr 1996;153:231-7
23.Owens JF, Hutelmyer CM. The effect of postoperative intervention on delirium in cardiac
surgical patients. Nurs Res 1982;31:60-2
24.Schindler et al. Beneficial effects of psychiatric intervention on recovery after coronary
artery bypass graft surgery. Gen Hosp Psychiatr 1989;11:358-64
651
652
25.Williams-Russo MA et al. Reducing acute confusional states in elderly patients with hip
fractures. Res Nurs Health 1985;8:329-37
26.Gustafsson Y et al. A geriatric-anesthesiologic program to reduce acute confusional states
in elderly patients treated for femoral neck fractures. J Am Geriatr Soc 1991;39:655-62
27.Wanich CK et al. Functional status outcomes of a nursing intervention in hospitalized
elderly. Image 1992;24:201-7
28.Cole mg, Primeau FJ, Elie LM. Delirium: prevention, treatment and outcome studies.
Journal of Geriatric Psychiatry and Neurology 1998;11:126-137
29.Tune L. The role of antipsychotics in treating delirium. Curr Psychiatry Rep 2002;4(3):209-12
2. 3
3. 2007
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1. Tam EM, Lam RW, Levitt AJ. Treatment of seasonal affective disorder: a review. J
PsychiatryRev Can Psych 1995;40:457-466
3. Lee TM, Chan CC, Paterson JG, Janzen HL, Blaschko CA. Spectral properties of
phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatr Scand
1997;96:117-121
5. Lee TM, Chan CC. Dose-response relationship of phototherapy for seasonal affective
disorder: a meta-analysis. Acta Psychiatrica Scandinavica 1999;99:315-323
7. Kato PM, Mann TA. A synthesis of psychological interventions for the berieved. Clinical
Psychology Review 1999;19:275-296
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3. 2007
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1. Selective serotonin reuptake inhibitors (SSRI) in the treatment of elderly depressed

patients: a qualitative analysis of the literature on their efficacy and side-effects.
International Clinical Psychopharmacology 1996;11:165-175
3. Mittman N, Herrmann N, Einarson TR et al. The efficacy, safety and tolerability
of antidepressants in late life depression: a meta-analysis. J Affect Disorders
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Club 1993;119:45
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in elderly. The Cochrane Database of Systematic Reviews, Cochrane Library number:
frequently
6. Banerjee S, Shamash K, Macdonald AJ, Mann AH. Randomized controlled trial of effect
of intervention by psychogeriatric team on depression in frail elderly people at home.
BMJ 1996;313:1058-61
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treatments for depressed older patients: a meta-analysis and overview of recent findings.
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9. Cuijpers P. Psychological outreach programmes for the depressed elderly: a metaanalysis of effects and dropout. Int J Geriatr Psychiatr 1998;13:41-48
2. 3
3. 2007
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1. Gavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetes.
An epidemiological evaluation. Diab Care 1993;16:1167-78
2. Kugler J, Seelbach H, Kruskemper GM. Effects of rehabilitation exercise programmes
on anxiety and depression in coronary patients: a meta-analysis. Br J Clin Psych
1994;33:401-10
3. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total
mortality in a community sample. Circulation 1996;93:1976-80
4. Frasure-Smith N, Lesp,rance F, Talajic M. Depression and 18-month prognosis after
myocardial infarction. Circulation 1995;91:999-1005
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6. Harvey SA, Black KJ. The dexamethasone suppression test for diagnosing depression
in stroke patients. Ann Clin Psychiatr 1996;8:35-39
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, (-C).
1. Casacalenda N, Boulenger JP. Pharmacologic treatments effective in both generalized

anxiety disorder and major depressive disorder: clinical and theoretical implications.
Canadian Journal of Psychiatry 1998;43:722-730
3. Dolovich LR, Addis A, Vaillancourt RJ et al. Benzodiazepine use in pregnancy and
major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ
1998;317:839-843
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2003;(1): CD003383.
6. Liebowitz M, Gelenberg A, Munjack D. Venlafaxine extended release vs, placebo and
paroxetine in social anxiety disorder. Arch Gen Psychiatry 2005;62:190198
.
669
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(-D).
1. Martinon-Torres G, Fioravanti M, Grimley Evans J. Trazodone for agitation in dementia.

The Cochrane Database of Systematic Reviews, Cochrane Library Number: CD004990.
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associated with clozapine. Lancet 1999;354:1841-1845
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3. 2007
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.
1. Gowing L, Ali R, White J. Buprenorfine for the management of opioid withdrawal. The
Cochrane Database of Systematic Reviews, Cochrane Library number: CD002025. In:
The Cochrane Library, Issue 3, 2002. Oxford: Update Software. Updated frequently
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syndrome: a critical analysis of evidence. Biology of the Neonate 1997;71:345356
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dependence. The Cochrane Database of Systematic Reviews, Cochrane Library
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3. 2007
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review of randomized clinical trials. Gen Hosp Psychiatr 1995;17:414-424
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3. 2007
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716
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, ziprasidone (-C).

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,
(-D).
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17
18
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20
Cytidinediphosphocholine
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722
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1. Harrington R, Whittaker J, Shoebridge P. Psychological treatment of depression in

children and adolescents: a review of treatment research. Br J Psychiatr 1998;173:291298
3. Hazell P, OConnell D, Heathcote D, Henry D. Tricyclic drugs for depression in children
and adolescents. The Cochrane Database of Systematic Reviews, Cochrane Library
Updated frequently
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1. Woolfenden SR, Williams K, Peat J. Family and parenting interventions in children and
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2. Montgomery P. Media-based behavioural treatments for behavioural disorders in
children. The Cochrane Database of Systematic Reviews, Cochrane Library number:
frequently
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naturalistic follow-up study. J Am Acad Child Adolesc Psychiatry 1996;35:1145-1155
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depressed affect and suicidal behaviors. J Child Psychol Psychiatry 1997;38:921-929
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18-years-olds. Australian and New Zealand J Psychiatry 1994;28:87-99
4. Marttunen M. Adolescent suicide in Finland. Publications of the National Public Health
Institute. KTL A2. T-Print Ky, Hyvink 1994
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Depressive disorders in childhood II. A longitudinal study of the risk for a subsequet
major depression. Arch Gen Psychiatry 1984;41:643-649
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Association, Washington, DC 1987
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depression: A review of the past 10 years. Part II J Am Child Adolesc Psychiatry
777
778
1996;31:1575-1583
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Clinical outcome after short-term psychotherapy for adolescents with major depressive
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reuptake inhibitors in children and adolescents. J Am Acad Child Adolesc Psychiatry
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and adolescents: a review of treatment research. Br J Psychiatr 1998;173:291-298
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depressive symptoms during adolescence: a review and meta-analysis. Journal of the
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Clinical Child Psychology 2001; 30:33-47.

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1. Kinzl J, Biebl W, Herold M. Significance of vomiting for hyperamylasemia and sialadenosis

in patients with eating disorders. Int J Eat Disord 1993;13:117-124
2. Meta-analysis of cognitive-behavioural treatment studies for bulimia. Clin Psychol
Review 1997;17:703-718
4. Whittal ML, Agras WS, Gould RA. Bulimia nervosa: a meta-analysis of psychosocial and
pharmacological treatments. Behaviour Therapy 1999;30:117-135
6. Bacaltchuk J, Hay P. Antidepressants versus placebo for people with bulimia nervosa.
7. Jimerson DC, Herzog DB, Brotman AW. Pharmacologic approaches in the treatment of
eating disorders. Harward Review of Psychiatry 1993;1:82-93

9. Schoemaker C. Does early intervention improve the prognosis in anorexia nervosaa
systematic review of the treatment-outcome literature. Int J Eating Disorders 1997;21:1-15
11.Bacaltchuk J, Hay P, Trefiglio R. Antidepressants versus psychological treatments and
their combination for bulimia nervosa. The Cochrane Database of Systematic Reviews,
Update Software. Updated frequently
12.Meads C, Gold L, Burls A, Jobanputra P. In-patient versus out-patient care for eating
disorders. Birmingham: The University of Birmingham, Department of Public Health and
Epidemiology. Report number; 17. 1999. 1-58.
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1. Davis A, Barnford J, Wilson I, Ramkalawan T, Forshaw M, Wright S. A critical review of

the role of neonatal hearing screening in the detection of congenital hearing impairment.
Health Technology Assessment 1997;1:1-177
3. Barlow J, Stewart-Brown S, Fletcher J. Systematic review of the school entry medical
examination. Archives of Diseases in Childhood 1998;78:301-311
5. Roberts I, Kramer M, Suissa S. Does home visiting prevent childhood injury: a systematic
review of randomised controlled trials. BMJ 1996;312:29-33
7. Preventing childhood unintentional injurieswhat works? A literature review. Injury
Prevention 1996;2:140-149
9. Pollitt RJ, Green A, McCabe CJ, Booth A, Cooper NJ, Leonard JV, Nicholl J, Nicholson
P, Tunaley JR. Neonatal screening for inborn errors of metabolism: cost, yield and
outcome. Health Techn Assess 1997;1:1-203
11.Speller V, Mulligan JA, Law C, Foot B. Preventing injury in children and young people: a
review of the literature and current practice. Wessex Institute of Public Health Medicine
1995;1-61
13.Coleman P, Munro J, Nicholl J, Harper R, Kent G, Wild D. The effectiveness of
interventions to prevent accidental injury to young persons aged 1524 years: a review
of the evidence. Medical Care Research Unit 1996, pp. 1-89
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837
838
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aa a aa (-B) aaa a a a a a a .
a a a a a
a a.
, aa a aa a. a, a a a a a aa a aa a
aaa a (-B).
a aaa a a a a aaa
a a a a - a a a a a
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a a a aaaa a a
a a a a a.
a a aa a
aa. a a a a a a aa a a a
a.
1. Smith GR Jr, Rost K, Kashner TM. A trial of the effect of standarized psychiatric
consultation on health outcomes and costs in somatizing patients. Arch Gen Psychiatry
1995;52:238-43
2. Speckens AE, van Hemert AM, Spinhoven P et al. Cognitive behavioural therapy
for medically unexplained physical symptoms: a randomized controlled trial. BMJ
1995;311:1328-32
3. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized
controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in
adults, excluding headache. Pain 1999;80:1-13
5. Fishbain DA, Cutler RB, Rosomoff RS. Do antidepressants have an analgesic effect
in psychogenic pain and somatoform pain disorder: a meta-analysis. Psychosomatic
Medicine 1998;60:503-509
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839
840
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a a a a a a aa a aa a . aaa aa a aa a.
a a aa a a a
a a (methylphenidate47 (-B), dextroamphetamine48
magnesium pemoline49).
aaa a a aa a aa aaa
a a, a a aa a aa
a aa a a aaa.
aa aa a aaa a a
a a .
47 .
48 .
49 .
Carbamazepine a a a a a a/ a
a (-C).
a aa a, a
methylphenidate a a a a a a a
a/ a a (-D).
Methylphenidate50 a - a a
a a a (-B).
a a a a
(-C).
Clonidine a a a a a a a/ a a. a, a a a a a, a aa (-B).
Atomoxetine51 a a a a a a a a/ a a, a a a a a a aa aa (-A).
1. Silva RR, Munoz DM, Alper M. Carbamazepine use in children and adolescents with
features of attention-deficit hyperactivity disorder: a meta-analysis. J Am Acad Child
Adolesc Psych 1996;35:352-358
3. Higgins ES. A comparative analysis of antidepressants and stimulants for the treatment
of adults with attention-deficit hyperactivity disorder. Journal of Family Practice
1999;48:15-20
5. Shukla VK, Otten N. Assessment of attention deficit/hyperactivity disorder therapy: a
Canadian perspective. Ottawa: Canadian Coordinating Office for Health Technology
Assessment/ Office Canadien de Coordination de l Evaluation des Technologies de
la Sant,. Alberta Heritage Foundation for Medical Research (AHFMR). 12039012.
Technology Overview. 1999. 11.
7. Jadad AR, Boyle M, Cunningham C, Kim M, Schachar R. Treatment of attention-deficit/
hyperactivity disorder. Rockville, MD, USA: Agency for Healthcare Research and Quality.
Evidence Report/Tech. 1999. 1-341.
9. Ramchandani P, Joughin C, Zwi M. Attention deficit hyperactivity disorder in children.
Clinical Evidence 2002;7:262-271
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844
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():

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aa;
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aa a aa a, a aa,
a a a.
a a a a (aa aa)
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aa;
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aaa a a a a a a
. , aaa aa a a a a 6 , aa a a a.
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(-IV) aaa a aa a aaa
a, a.
845
846
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a a aa aaa.
a a a a a a .
aa a a aa aa.
a a a aaa a.
a a
a a aa a a ,
a aaa aa.
a.
a a a aaa a (a ,
a, a aa a a a aa, a a a).
:
aa
aa aa a a aaa aa a a aa, a aaaa.

(a) aa a aa aaa a aa a ( a aa ).
a a a aa aa aa
aa aa a.
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a a, -aa aa aaa a aa a a a.
aaaa
a aaa a aa a a a a : a a a aa a a .
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();
-a ;
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a-a ( a), clonidine
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a a a a -a a aa
a.
1. Post-traumatic stress disorder. Psych Clin N Am 1994;17:nr 2 (6/94)

2. Yehuda R (ed.) Psychological trauma. Review of psychiatry series. American Psychiatric
Press Inc, Washington DC, 1998
3. Sporner T (Ed.) Stressbewltigung und Psychotraumatologie im humanitren Hilfseinsatz.
Beitrge Wehrmedizin und Wehrpharmazie, Band 10. Beta Verlag, Bonn 1997
4. The ICD-10 Classification of mental and behavioural disorders. Clinical descriptions and
diagnostic guidelines. WHO, Geneva 1992
5. Diagnostic and statistical manual of mental disorders, fourth edition (DMS-IV). American
Psychiatric Association, Washington DC, 1994
6. Van Etten ML, Taylor S. Comparative efficacy of treatments for posttraumatic stress
disorder: a meta-analysis. Clinical Psychology and Psychotherapy 1998;5:126-144
8. Stein DJ, Zungu-Dirwayi N, van der Linden GJH, Seedat S. Pharmacotherapy for
posttraumatic stress disorder. The Cochrane Database of Systematic Reviews,
Update Software. Updated frequently
9. Rose S, Bisson J, Wessely S. Psychological debriefing for preventing post traumatic
stress disorder (PTSD). The Cochrane Database of Systematic Reviews, Cochrane
Software. Updated frequently.
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848
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6 .
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aa a aa a .
aa a aaaaa aa. a a a a aa a aa a aa a a a
a aa .

2. a a a aa a a 3
3. aa 2007 a
849
850
851
852
Algoritam 1. Te{ka depresija kaj vozrasni lica vo primarnata nega

1
SOMNEVAWE ZA POSTOEWE NA GOLEMA DEPRESIJA
A
PRESTAVUVAWE (POKRAJ TAGATA)
- POVE]EKRATNI SOMATSKI BOLKI I POJAVI (na primer: > 5 pojavi, pove}e od eden organski
sistem so otsastvo na fizi~ki naodi): ZDEBELUVAWE/SLABEEWE, BLAGA DEMENCIJA
- ZAMOR/NARU[UVAWE NA SPIEWETO
- PROMENI NA RABOTA I/ILI ME\UÔVE^KITE ODNOSI

V
RIZI^NI FAKTORI
- ISTORIJA NA POGOLEMA DEPRESIJA I/ILI ZLOUPOTREBA NA SUPSTANCI
- NARU[ENO RASPOLO@ENIE (DISTIMIJA)
2
DIJAGNOZA I ODREDUVAWE NA DEPRESIJATA PREKU KLINI^KO INTERVJU
VKLUÛVAJ]I:
A
DSM-IV TR KRITERIUMOT
V
ISTORIJA NA POSTOE^KATA BOLEST (POJAVA I GOLEMINA NA
SIMPTOMITE, FUNKCIONALNO NARU[UVAWE, PRETHODNI POJAVI I
PSIHOLO[KOSOCIJALNI PREDIZVIKUBAÎ NA STRES)
S
POSTOJANA ZDRAVSTVENA ISTORIJA, POSEBNO BOLEST KOJA MO@E DA
PREDIZVIKA DEPRESIJA
D
PROVERKA DALI IMA ZLOUPOTREBA NA SUPSTANCI, NAPU[TAWE ILI
LEKOVI KOI MO@E DA PREDIZVIKAAT DEPRESIJA
E
PSIHIJATRISKI KOMORBIDET
IMA 5 DSM-IV TR
KRITERIUMI?
NE
DA
DA SE ZEMAT VO
PREDVID DRUGI
RASTROJSTVA NA
RASPOLO@ENIETO,
ANKSIOZNI ILI
SOMATOFORMNI
RASTROJSTVA
ZLOUPOTREBA NA
SUPSTANCI ILI
PSIHIJATRISKI
KOMORBIDET,
POSEBNO BIPOLARNO
RASTROJSTVO?
DA
NE
MEDICINSKI
KOMORBIDITET
I/ILI POSEBNA
POJAVA?
VOVED NA
BIHEJVIORISTI^KI/
HEMISKI SREDSTVA
9
DA
10
8
DA
UTVRDUVAWE NA
SEKUNDARNI TE
PRIÎNI I/ILI DA SE
USVOI PLAN ZA
POSEBNI POJAVI I
DA SE NAPRAVI NOVA
PROCENKA
NE
PSIHIJATRISKA
VONREDNA
SOSTOJBA?
14
DA
PRODOL@UVAWE I
TRETMAN SO ODR@UVAWE
OD 6-12 MESECI
PODTIPOVI
- ATIPI^NO POGOPEMO
DEPRESIVNO RASTROJSTVO
- POGOLEMO DEPRESIVNO
RASTROJSTVO SO PSIHOTI^NI
RASTROJSTVA
- MELANHOLI^NI
- EDUCIRAWE I ANGA@IRAWE NA PACIENTOT

- FORMIRAWE NA PLAN ZA TRETMANOT (ako postoi pod-tip,
moè da se odredi posebna terapija)
- ODREDUVAWE NA PLAN ZA SLEDEWE NA SOSTOJBATA
DALI PACIENTOT
REAGIRA SOODVETNO?
PREGLED SO 2 PRA[AWA
DALI VO POSLEDNIOT MESEC
STE BILE ZAGRI@ENI OD:
1.
MALIOT INTERES ILI
NEZADOVOLSTVO OD VR[EWE NA
RABOTITE?
2.
PADNATI ÛVSTVA,
DEPRESIVNOST ILI
BEZNADE@NOST?
KARAKTERISTIKI
- SEZONSKI AFEKTIVNI
NE
11
DSM-IV TR KRITERIUM za
pojava na te{ka depresija
Mora da ima vkupno 5 simptomi vo
tek na najmalku 2 nedeli. Eden od
simptomite mora da bide
depresivno raspoloènie ili
gubitok na interes
1 Depresivno raspoloènie
2 Zabeleìtelno namalen interes
ili zadovolstvo vo site ili re~isi
site aktivnosti
3 Zna~itelno poka~uvawe/
namaluvawe na teìnata (>5%), ili
zgolemuvawe/namaluvawe na
apetitot
4 Nesonica ili prekumerno
spiewe
5 Psihomotorna voznemiranost
ili retardiranost
6 Zamor ili nedostig od energija
7 ûvstvo na bezvrednost ili
nesoodvetna vina
8 Namalena koncentracija ili
nere{itelnost
9 Povratni misli nza smrta ili
samoubistvo
12
NE
13
- KATATONI^NI
- POSLE-PORODILNI
ODREDUVAWE NA DOZATA, TRAEWETO, TIPOT I PRIFA]AWETO NA

LEKOT I/ILI PSIHOTERAPIJATA. DA SE RAZGLEDA I TO^NOSTA
NA DIJAGNOZATA ILI VLIJANIETO NA KOMORBIDETITE
PRIMENA DRUGI STRATEGII
- TERAPIJA NA PROMENA
- TERAPIJA NA ZGOLEMUVAWE
- DRUGI BIOLO[KI TERAPII
- DODAVAWE I/ILI MODIFIKUVAWE NA PSIHOTERAPIJA
- POINTENZIVNO / POVISOKO NIVO NA PSIHOTERAPIJA
853
Algoritam 2. Izbor na modaliteti za tretman na te{ko depresivno rastrojstvo
DALI TREBA DA SE PRIMENI ODREDENA

EFEKTIVNA PSIHOTERAPIJA?
BLAGI DO UMERENI DEPRESII: SO PRIMENA NA
EDINE^NA ILI KOMBINIRANA TERAPIJA
UMERENI DO JAKI DEPRESII: VO KOMBINACIJA
SO EDUKACIJAILI EST AKO SE VA@NI
PSIHOSOCIJALNITE ISHODI I AKO TOA SE
1.
DA NE SE VKLUÛVA
POSEBNA
EFEKTIVNA
PSIHOTERAPIJA VO
PLANOT ZA TRETMAN.
NE
ODI NA PRA[AWE 2
DA
VKLUÎ ODREDENA
EFEKTIVNA
PSIHOTERAPIJA VO
PLANOT ZA TRETMAN
. ODI NA PRA[AWE 2
PREFERIRA.
DALI ]E SE DAVAAT LEKOVI?
BLAGI DEPRESII: AKO SE PREFERIRA, EDINE^NA
TERAPIJA
UMERENA DO JAKA DEPRESIJA: SO ILI BEZ
POSEBNA EFEKTIVNA PSIHOTERAPIJA VO KOLKU NE
E PREDVIDENO EST
PSIHOTI^NI DEPRESII: KOMBINACIJA OD
ANTIPSIHOTI^NI LEKOVI I N ANTIDEPRESANTI
ILI EST
2.
DA NE SE
VKLUÛVAAT LEKOVI
VO PLANOT ZA
TRETMAN. ODI NA
PRA[AWE 3
NE
VKLUÛVA ZEMAWE
NA LEKOVI VO
PLANOT ZA
TERAPIJA I
PRODOL@UVAWE SO
DRUGI VIDOVI NA
TRETMAN
3.
DA NE SE
VKLUÛVAAT LEKOVI
I ODREDENA
EFEKTIVNA
PSIHOTERAPIJA VO
PLANOT ZA TRETMAN.
ODI NA PRA[AWE 4
DA NE SE VKLUÛVA
EST VO PLANOT ZA
TRETMAN I
PRODOL@UVAWE SO
DRUGI VIDOVI
NE
NE
DALI SE PREDVIDUVA DAVAWE NA LEKOVI I

ODREDENA EFEKTIVNA PSIHOTERAPIJA?
BLAGA DEPRESIJA
AKO SE PREFERIRA, KOMBINACIJA OD TRETMANI
ISTORIJA NA DELUMNA REAKCIJA DO EDINEÊN
MODALITET
SLABA USOGLASENOST
UMERENA DO TE[KA DEPRESIJA
ZNAÂJNI PSIHOSOCIJALNI ISHODI
PROBLEMI SO LU\ETO
RASTROJSTVO NA LI^NOSTA
SLABA USOGLASENOST
DA
4. DALI SE PREDVIDUVA EST?

HRONI^NA, UMERENA DO TE[KA DEPRESIJA: SO
ILI BEZ ODREDENA EFEKTIVNA PSIHOTERAPIJA AKO
TOA GO PREFERIRA PACIENTOT
JAKA DEPRESIJA I BILO KOE OD SLEDNOTO:
PSIHOTI^NI KARAKTERISTIKI
PACIENTOT GO PREFERIRA TOA
PRETHODNO PREFERIRANO REAGIRAWE,
POTREBA OD BRZO REAGIRAWE NA
ANTIDEPRESANT, INTOLERANCIJA I
ZEMAWE NA LEKOVI
PRODOL@UVAWE SO DRUGI VIDOVI NA TERAPIJA
DA
DA
VKLUÛVA ZEMAWE
NA LEKOVI I
ODREDENA
EFEKTIVNA
PSIHOTERAPIJA VO
PLANOT ZA TRETMAN
I PRODOL@UVAWE
SO DRUGI VIDOVI NA
TRETMAN
VKLUÛVA EST VO
PLANOT ZA TRETMAN
I PRODOL@UVAWE
SO DRUGI VIDOVI NA
TRETMAN
854
Algoritam 3. Akutna faza na tretman na te{ko depresivno rastrojstvo
START NA OBIDOT
DAVAWE NA LEKOVI I/ILI PSIHOTERAPIJA
AKO NEMA REAKCIJA I KLINI^KO POGOLEMO
OPRAVDUVAWE DA NE SE ZEME VO PREDVID
SLEDNOTO:
ZGOLEMUVAWE NA DOZATA NA LEKOT
ZGOLEMUVAWE NA INTENZITETOT NA
PSIHOTERAPIJATA
EST
4-8 NEDELI: POVTORNA PROCENKA ZA

ADEKVATNOSTA NA REAGIRAWETO NA LEKOT
NEMA REAKCIJA
AKO PACIENTOT
KOJ PRIMA LEK
SMETA NA:
- PROMENA NA
ANTIDEPRESIV
- DODAVAWE ILI
PROMENA VO
PSIHOTERAPIJA
- EST
AKO PACIENTOT
KOJ PRIMA LEK
SMETA NA:
- DODAVAWE ILI
PROMENA NA LEKOT
DELUMNA REAKCIJA
AKO PACIENTOT KOJ
PRIMA LEK SMETA NA:
- PROMENA NA DOZATA
- ZGOLEMUVAWE NA
ANTIDEPRESIVOT
- PROMENA NA
ANTIDEPRESANTOT
- DODAVAWE ILI
PROMENA VO
PSIHOTERAPIJA
- EST
CELOSNA REAKCIJA
- ODI NA
PRODOL@UVAWE NA
PLANOT ZA TRETMAN
AKO PACIENTOT KOJ

PRIMA LEK SMETA NA:
- PROMENA NA
INTENZITETOT NA
PSIHOTERAPIJATA
- PROMENA NA TIPOT
NA PSIHOTERAPIJA
- DODAVAWE ILI
PROMENA VO ZEMAWE
NA LEKOVI
DOPOLNITELNI 4-8 NEDELI: POVTORNA PROCENKA NA ADEKVATNOSTA NA

REAGIRAWETO
MENTOR
- STEPEN NA
OPASNOSTA KON SEBE I
KON DRUGITE
- SIMPTOMATSKI
STATUS
- FUNKCIONALEN
STATUS
- REAGIRA NA
TRETMANOT
- NESAKANI
POSLEDICI
(vidi gorna {ema)
-
USOGLASENOST
- ZNACI NA
PREFRLAWE VO MANIJA
- DRUGI MENTALNI
RASTROJSTVA,
VKLUÛVAJ]I
ZLOUPOTREBA NA
ALKOHOL I DRUGI
SUPSTANCI
- OP[TI
MEDICINSKI
KOMORBIDITETI
855
Algoritam 4a.Spravuvawe so te{ko depresivno rastrojstvo kaj vozrasnite lica vo primarnata nega.
A1 Po~etno procenuvawe
1
STAROST NA PACIENTOT
> 18 SO SOMNE@ ZA
DEPRESIJA POJAVENA VO
PRIMARNATA NEGA (A)
2
PROVERKA NA OPASNOST (C)
3
NESTABILNA
ITNA
SOSTOJBA?
DA
OBEZBEDUVAWE NA SOODVETNA NEGA

ILI UPAT ZA STABILIZIRAWE. DA SE
POSTAPI PREMA ZAKONSKATA
REGULATIVA (C)
NE
5
DOBIVAWE NA ISTORIJATA (VKLUÛVAJ]I
PSIHIJATRISKI, BRA^NA SOSTOJBA, SEMEJSTVO,
VOENA OBVRSKA, FIZI^KA I SEKSUALNA
ZLOUPOTREBA VO MINATOTO), FIZI^KO
ISPITUVAWE I LABORATORISKI TESTOVI.
ISPITUVAWE NA MENTALNIOT STATUS (MYE).
KORISTENI LEKOVI (VKLUÛVAJ]I
NEPREPI[ANI LEKOVI I TREVKI) (D)
POTVRDENI ZNACI I SIMPTOMI NA DEPRESIJA (E)
6
NESTABILNA
ITNA
SOSTOJBA?
DA
ODI NA
ALGORITAM A2
NE
POTVRDA NA FUNKCIONALNATA
NESPOSOBNOST (F)
8
NESTABILNA
ITNA SOSTOJBA?
NE
10
TRETIRAWE I SLEDEWE
PREMA UKA@ANOTO
DA
UPAT VO POSEBNA
USTANOVA ZA
MENTALNO ZDRAVJE
ZA NADVORE[NI
PACIENTI, MODUL V
856
Algoritam 4b. Spravuvawe so te{ko depresivno rastrojstvo kaj vozrasnite lica vo primarnata nega.
A2 Vospostavuvawe na dijagnoza
PRODOL@UVAWE OD A1
11
PACIENT SO SIMPTOMI
NA DEPRESIJA (A)
14
ZEMAWE VO PREDVID NA
MO@NOST ZA UPAT VO USTANOVA
ZA MENTALNO ZDRAVJE ZA
NADVORE[NI PACIENTI, MODUL
V. PRODOL@UVAWE NA
MEDICINSKATA NEGA PREMA
UKA@ANOTO
12
DALI PACIENTOT
E ZAKANA ZA SEBE
I DRUGITE? (G)
13
NE
IMA LI DOKAZ
ZA PSIHOZA (H)
15
DA
NE
IMA LI DOKAZ ZA
UPOTREBA NA
SUPSTANCI? (I)
17
DA
16
DA SE KORISTI UPATSTVO ZA
RASTROJSTVO OD UPOTREBA
NA SUPSTANCI (SUD)
DA
NE
DALI LEKOVITE PREDIZVIKUVAAT

ILI PRIDONESUVAAT ZA POJAVA
NA SIMPTOMI? (J)
DALI ZDRAVSTVENATA SOSTOJBA
PRIDONESUVA ZA POJAVA NA
SIMPTOMITE? (K)
NE
18
LEKARSKI TRETMAN
I SLEDEWE PREMA
NAVEDENOTO
DA
19
DALI
SIMPTOMITE
NA DEPRESIJA
SE POVLEÊNI?
NE
20
PRODOL@UVAWE
ALGORITAM A3
DA
PRODOL@UVAWE SO
MEDICINSKO
SLEDEWE PREMA
UKA@ANOTO
857
Algoritam 4v. Spravuvawe so te{ko depresivno rastrojstvo kaj vozrasnite lica vo primarnata nega.
A3 Po~etno procenuvawe i tretman
PRODOL@UVAWE OD A2
21
ODREDUVAWE I
DOKUMENTIRAWE NA
DSM-IV KRITERIUMOT ZA
GOLEMO DEPRESIVNO
RASTROJSTVO (MDD) (L)
22
IMA LI DOKAZ ZA
PSIHOTI^NI
KARAKTERISTIKI,
MANIJA VO MINATOTO
ILI HIPOMANIJA? (M)
23
NE
GO ZADOVOLUVA DSM-IV
KRITERIUMOT ZA MDD ? (L)
24
DA
NE
POSLE 1 GODINA
NOVA PROCENKA
NE
DA
NE
25
32
34
GO ZADOVOLUVA DSM-IV
KRITERIUMOT ZA MDD ? (L)
RAZGLEDUVAWE NA OPCIITE ZA
TRETMAN I PREFERENCIITE NA
PACIENTOT. OBEZBEDUVAWE NA
EDUKACIJA NA PACIENTOT I
SEMEJSTVOTO
IMA LI SOMNEVAWA ZA
MENTALNOTO ZDRAVJE NA
PACIENTOT ? (I)
DA
33
26
TRETMAN PREMA
ODREDENOTO ILI MO@EN
UPAT VO USTANUVA ZA
MENATLNO ZDRAVJE
NEMO@NOST ZA TRETMAN
NA PACIENTOT VO
PRIMARNA NEGA? (P)
27
29
PRODOL@UVAWE
ALGORITAM A4
ZAPO^NUVAWE SO
FARMAKOTERAPIJA (Y)
NE
DALI FARMAKOTERAPIJA
E SOODVETNA I DALI
PACIENTOT SAKA DA
ZEMA LEK? (R)
DA
31
28
NE
DALI SE PREFERIRA
PSIHOTERAPIJA, DALI E
SOODVETNA I NA
RASPOLAGAWE? (Q)
30
DA
NE
SLEDEWE 1-2 NEDELI I

MONITORING DALI IM A
PROMENA VO SOSTOJBATA NA
PACIENTOT
DA
UPAT VO USTANOVA
ZA MENTALNO
ZDRAVJE ZA
NADVORE[NI
PACIENTI, MODUL V
858
Algoritam 4g. Spravuvawe so te{ko depresivno rastrojstvo kaj vozrasnite lica vo primarnata nega.
A4 Sledewe na tretmanot
35
PACIENT SO MDD NA TERAPIJA
VO PRIMARNA NEGA
36
SLEDEWE NA TRETMANOT NA 1-2
NEDELI. PROVERKA NA
PRIDR@ANOSTA I NA
NESAKANITE POSLEDICI (U)
37
PROVERKA NA DELUVAWETO ZA
4-6 NEDELI (V)
38
OÎGLEDNO
PODOBRUVAWE?
39
NE
NE[TO
PODOBRENO?
40
DA
NE
NEMA
PODOBRUVAWE
I TRETMAN SO
TEKOVNOTO
RE[ENIE?
47
DA
41
PRILAGODUVAWE NA
TRETMANOT PREMA
UTVRDENOTO (W)
DA
42
NE
PRODOL@UVAWE OD
U[TE 6 NEDELI.
POTVRDA NA NAODOT ZA
12 NEDELI
DEPRESIJATA E
VLO[ENA
46
POVTORNA PROCENKA,
KONSULTACII ILI UPAT
VO DISPANZER,
AMBULANTA ILI CENTAR
ZA MENTALNO ZDREVJE,
MODEL V
NE
44
43
POVLEKUVAWE? (H)
DA
VOSPOSTAVUVAWE NA
PRODOL@ETOK I FAZA NA
ODR@UVAWE NA TRETMANOT.
SLEDEWE VKLUÛVAJ]I
PREVENCIJA OD POVTORNO
POJAVUVAWE I EDUKACIJA NA
PACIENTOT/SEMEJSTVOTO (Y)
45
PRODOL@UVAWE SO TRETMANOT
VO PRIMARNATA NEGA ILI
PREMA ODREDENOTO
859
Algoritam 5. B Spravuvawe so te{ko depresivno rastrojstvo vo dispanzeri, ambulanti,polikliniki, centri za

mentalno zdravje
1
PACIENT SO SOMNE@ ZA
DEPRESIJA UTVRDENA VO
USTANOVA ZA POSEBNA
NEGA ZA MENTALNO
ZDRAVJE ZA NADVORE[NI
PACIENTI (A)
2
PROVERKA NA OPASNOST (B)
UPAT VO USTANOVA ZA MENTALNO

ZDRAVJE ZA VNATRE[NI PACIENTI,
MODUL (C).
POSTAPKA PREMA ZAKONSKI
DA
BARA LI PACINETOT
HOSPITALIZACIJA? (S)
OVLASTUVAWA (D)
NE
5
DOBIVAWE BA ISTORIJATA (VKLUÛVAJ]I
PSIHIJATRISKI, BRA^NA SOSTOJBA, SEMEJSTVO,
VOENA OBVRSKA, FIZI^KA I SEKSUALNA
ZLOUPOTREBA VO MINATOTO), FIZI^KO
ISPITUVAWE I LABORATORISKI TESTOVI.
ISPOITUVAWE NA MENTALNIOT STATUS (MSE).
KORISTENI LEKOVI (VKLUÛVAJ]I
NEPREPI[ANI LEKOVI I TREVKI) (E)
POTVRDNI ZNACI I SIMPTOMI NA DEPRESIJA (F)
DALI PACIENTOT IMA NA

RASPOLAGAWE SISTEM NA
PODR[KA (SIGUREN
PRESTOJ, PREVOZ, DRUGI
POTREBI PREMA AXIS IV) ? (G)
NE
SREDUVAWE ZA
BEZBEDNO DOMUVAWE I/
ILI SOODVETEN PREVOZ
DA
IMA LI DOKAZ
ZA ZLOUPOTREBA
NA SUPSTANCI ?
UPAT ZA PRIMARNA NEGA ILI

KONSULTACIJA KAJ SPECIJALIST
DA
(Koristi SUD smernici)
NE
12
10
DALI LEKOVITE
PREDIZVIKUVAAT ILI
PRIDONESUVAAT ZA
SIMPTOMITE ? (H)
11
NE
DALI LEÊWETO
PRIDONESUVA ZA
SIMPTOMITE (J)
13
UPAT ZA PRIMARNA NEGA ILI

DA KONSULTACIJA KAJ SPECIJALIST
ZA LEKARSKI TRETMANT I SLEDEWE
PREMA UKA@ANOTO
DA
NE
IMA LI SIMPTOMI
NA PSIHOZA?
NE
Prodolùva
14
DA
POSTAPKA PREMA
NAVEDENOTO (Upotreba na
Smernici za psihoaza)
860
15
24
DALI GO
ZADOVOLUVA
KRITERIUMOT
DSM-IV ZA MDD?
(K)
NE
DA
16
DALI PACIENTOT
E KOMPLEKSEN
SLUÂJ KOJ VE]E
SE LEÊL OD
DEPRESIJA? (M)
17
DA
NE
21
UPAT DO
OBEZBEDUVAÔ
T NA PRIMARNA
NEGA VO VRSKA
SO SLEDEWETO
ZA PACIENT KOJ
PRETHODNO IMAL
DEPRESIJA: DA SE
PREDVIDI DELUMNA
HOSPITALIZACIJA
19
MODIFIKUVAWE,
ODR@UVAWE ILI
ZAPO^NUVAWE NA
INTERDISCIPLINAREN
PLAN ZA TRETMAN
22
MO@E LI PACIENTOT
DA BIDE SLEDEN VO
PRIMARNATA NEGA? (R)
DA
ZA PACIENTI KOI SE
NA TRETMAN: PROVERKA
NA PRIFA]AWETO,
REAKCIJA, I NESAKANI
POSLEDICI
18
RAZGLEDUVAWE NA OPCII ZA TRETMAN I

PREFERENCI NA PACIENTOT (R).
ZAPO^NUVAWE NA INTERDISCIPLINAREN
PLAN ZA TRETMAN (O).
OBEZBEDUVAWE NA EDUKACIJA NA
PACIENBTOT/SEMEJSTVOTO (Q)
23
TRETIRAWE NA NE-MDD
RASTROJSTVO NA
SOODVETEN NAÎN (L)
NE
20
SLEDEWE NA TRETMANOT NA 1-2

NEDELI. PROVERKA NA
PRIFA]AWETO I NESAKANITE
POSLEDICI (Y)
25
26
REAKCIJA ZA
4-6 NEDELI? (T)
31
UPAT ZA SLU@BA ZA
MENTALNO ZDRAVJE
NA VNATRE[EN
PACIENT, MODUL (S)
DALI PACIENTOT GO
ZADOVOLUVA
KRITERIUMOT ZA
HOSPITALIZACIJA (W)
34
POVRAT
NA 16
33
DA
NE
DALI E OVA PRV

SLUÂJ NA
DEPRESIJA ?
NE
DALI IMALO
PORANO OTPOR NA
TRETMANOT? (X)
36
NE
POVTORNA
PROCENA/
VO PREDVID I
KONSULTACIJA (Y)
30
27
POVLEKUVAWE?
(U)
DA
28
VOVEDUVAWE NA
PRODOL@UVAWE I
ODR@UVAWE NA
TRETMANOT, SLEDEWE
SO PREVENCIJA I
EDUKACIJA NA
PACIENTOT/
SEMEJSTVOTO (V)
29
35
DA
PROVERKA NA 12
NEDELI
NE
32
DA
DA
PRODOL@UVAWE
VO PRIMARNA
NEGA ILI
TEKOVNATA
OPREDELBA
NE
POVTORNA
PROCENKA
POVRAT NA 15
861
Algoritam 6. C Te{ko depresivno rastrojstvo vo bolni~ki ustanovi

1
PACIENT PRIMEN VO BOLNI^KA USTANOVA
SO DIJAGNOZA NA TE[KO DEPRESIVNO
RASTROJSTVO (MDD) (A)
2
PROVERKA ZA POSTOEWE NA RIZIK I
NESTABILNA ZDRAVSTVENA SOSTOJBA (B)
NESTABILNA
ZDRAVSTVENA
SOSTOJBA?
TRETMAN ILI
UPAT ZA
STABILIZACIJA
DA
NE
VISOK RIZIK OD
SAMOUBISTVO,
NASILSTVO ILI
POTREBNI SE DRUGI
MERKI? (S)
PRIMENA NA
BEZBEDONOSNI MERKI..
POSTAPKA PREMA
POTREBATA
DA
NE
7
DOBIVAWE NA ISTORIJATA (VKLUÛVAJ]I PSIHIJATRISKI
BOLESTI, BRA^NA SOSTOJBA, SEMEJSTVO, VOENA OBVRSKA,
FIZI^KA I SEKSUALNA ZLOUPOTREBA, UPOTREBA NA
SUPSTANCI).
ISPITUVAWE NA MENTALNIOT STATUS (MSE) I OP[TATA
PROVERKA NA FUNKCIONIRAWETO (GAF) ILI AXIS V OD DSM-IV.
FIZI^KO ISPITUVAWE, LABORATORISKI TESTOVI I DRUGI
STUDII PREMA UKA@ANOTO (D)
DALI
ZDRAVSTVENATA
SOSTOJBA
PRIDONESUVA NA
SIMPTOMITE?
SPRAVUVAWE ILI SREDUVAWE

NA KONSULTACIJA SO
MEDICINSKA SLU@BA ZA
DIJAGNOSTICIRAWE I
SPROVEDUVAWE NA MERKI
DA
10
NE
PODOBRENI
DEPRESIVNI
SIMPTOMI?
NE
13
14
PROBLEMATI^NA
UPOTREBA NA
SUPSTANCI?
NE
DA
DA
SPRAVUVAWE SO AKUTNATA
INTOKSIKACIJA I
PROBLEMI NA
POVLEKUVAWE NA PLANOT
ZA TRETMAN
15
NE
16
POTVRDUVAWE NA
DIJAGNOZATA ZA
MDD
PODOBRENI
DEPRESIVNI
SIMPTOMI?
DA
11
PRVOÊN PLAN
ZA OTPU[TAWE
12
POTREBNO E
SLEDEWE
Prodolùva
862
17
22
DALI GO
ZADOVOLUVA
KRITERIUMOT
DSM-IV ZA MDD? (K)
KONSTATIRAWE NA
DRUGI DIJAGNOZI I
SPRAVUVAWE PREMA
NAVEDENOTO
NE
DA
18
IDENTIFIKUVAWE I
TRETMAN NA DEPRESIJATA
DODEKA SE TRETIRAAT
KOMORBIDNITE SOSTOJBI (G)
19
KOMPLETEN INTERDISCIPLINAREN PLAN ZA TRETMAN:.
DAVAWE NA LEKOVI, SOODVETNA PSIHOTERAPIJA, DRUGI
PSIHOSOCIJALNI INTERVENCII
DA SE ZEME VO PREDVID KOMORBIDITETOT,.AKO GO IMA I
PREFERIRAWETO NA PACIENTOT (N) POÊTOK ZA PLANIRAWE
NA OTPU[TAWETO I EDUKACIJA NA PACIENTOT/SEMEJSTVOTO (I)
20
21
GAF ILI SMRTNOSTA

DOVOLNI ZA POTVRDA
ZA PRODOL@ENA
HOSPITALIZACIJA? (J)
OTPU[TAWE NA SOODVETNO
MENTALNO ZDRASTVENO NIVO NA
NEGA ZA NADVORE[EN PACIENT.
PROGRAMIRANI SOSTANOCI ZA
SLEDEWE NA SOSTOJBATA (K)
DA
23
IMA LI
INDIKACII
ZA EST (L)
25
NE
24
DA
VO PREDVID EST
NE
PO^NUVAWE SO
FARMAKOTERAPIJ
A ILI EST, PREMA
UKA@ANOTO (M)
27
26
GAF ILI SMRTNOSTA
DOVOLNI ZA POTVRDA
ZA PRODOL@ENA
HOSPITALIZACIJA? (J)
28
NE
POVTORNA
PROCENA/
VO PREDVID I
KONSULTACIJA (Y)
DA
OTPU[TAWE NA SOODVETNO
MENTALNO ZDRASTVENO NIVO NA
NEGA ZA NADVORE[EN PACIENT
(VKLUÛVAJ]I DELUMNA
HOSPITALIZACIJA ILI @IVEWE
POD NADZOR). . PROGRAMIRANI
SOSTANOCI ZA SLEDEWE NA
SOSTOJBATA
863
Algoritam 7. Spravuvawe so nesakani posledici od zemawe na lekovi
INFORMIRAWE NA PACIENTOT ZA MO@NITE NESAKANI

POSLEDICI, VKLUÛVAJ]I GI I TIE KOI IMAAT
POTREBA OD NEPOSREDNA INTERVENCIJA
SLEDEWE ZA DA SE VIDI DALI IMA NESAKANI

POSLEDICI
AKO IMA PROBLEMATI^NI NESAKANI POSLEDICI DA SE ZEMAT VO

PREDVID SLEDNITE OPCII
SLEDEWE I ÊKAWE (AKO NEMA NEPOSREDEN MEDICINSKI
RIZIK)
PROMENA NA DOZATA NA LEKOT, ZAÊSTENOSTA ILI VREMETO NA
ZEMAWE NA LEKOT
PROMENA SO ZEMAWE NA DRUG LEK
DA SE PREDVIDI ODREDEN TRETMAN ZA NESAKANITE POSLEDICI
PRODLO@UVAWE NA SLEDEWETO ZA DA SE VIDI DALI IMA NESAKANI

POSLEDICI . DA SE POSVETI POSEBNO VNIMANIE NA SLEDNOTO:
MEDICINSKIOT RIZIK
INTERFERENCIJA SO USOGLASUVAWETO
ZADOVOLSTVO NA PACIENTOT
864
Algoritam 8. Farmakolo{ki tretman na {izofrenija vo akutna faza

GRUPA 1:
GRUPA 2:
GRUPA 3:
Tipi~ni antipsihotici
Atipi~ni antipsihotici, kako Amisulpride,
Olanzapine, Quetiapine, Risperidone
Clozapine
Klini~ka istorija
Fizi~ko ispituvawe
Pregled na lekovite
Osnovni ispituvawa
Dijagnoza na {izofrenija
Grupa 1 / Grupa 2
Soodveten odgovor
bez nepodnoslivi
sporedni efekti
Prodolùvawe
Soodveten odgovor
bez nepodnoslivi
sporedni efekti
Prodolùvawe
Soodveten odgovor so
nepodnoslivi sporedni
efekti
Nesoodveten
odgovor
Malo podobruvawe
Odbir na drug lek od

grupite 1 i 2,
Prefrluvawe na Grupa
2 ako se so problemi od
ERYE, razviena
diskinezija, ili
zgolemen prolaktin
Izbor na drug lek

od grupite 1/2
Depo antipsihotik
Soodveten odgovor
so nepodnoslivi
sporedni efekti
Nesoodveten
odgovor
Izbor na drug lek od grupite 1/2/3
Soodveten odgovor
bez nepodnoslivi
sporedni efekti
Izbor na drug lek od grupite 1/2/3
Soodveten odgovor
so nepodnoslivi
sporedni efekti
Izbor na drug lek od grupite 1/2/3. Da se

zeme vo predvid primena na EST i
strategija na poka~uvawe na dozata na
lekot
865
Algoritam 9. Algoritam za ocenuvawe na dete so op{to zaostanuvawe vo razvojot
1. Dobivawe na detalna istorija i ispituvawe

2. Upatuvawe na ispituvawe na sluhot i vidot
3. Da se napravat studii za metabolizmot/T4 ako ne e napraven op{tiot pregled na
novoroden~eto
4. Ako ima istorija na somnevawe na napad ili epilepti~en sindrom, da se napravi EKG.
5. Da se napravi pregled za proverka na postoewe na autizam ili naru{uvawe vo govorot.
Ima li blizok ~len vo semejstvoto so op{t zastoj vo razvojot (brat ili sestra,
tetka ili ~i~ko, nekoj od prvite bratu~edi)
A. Zaradi poznato rastrojstvo vo metabolizmot, genetsko rastrojstvo ili
rastrojstvo na strukturalniot nerven sistem?
B. Nerazjasneto op{to zaostanuvawe vo razvojot?
A/V
DA
A/V
A. Pravewe na posebni
testovi za soodvetnoto
rastrojstvo
B. Pravewe na
citogenetski pregled i
na testovi za
subtelomeri~ki izmeni
AKO
TESTOVITE
SE (-)
NE
Dali ima karakteristiki koi sigeriraat na

odredena dijagnoza?
A.
Dali ima vo istorijatot ili vo
fizi~kite naodi (dismorfi~ni svojstva) koi
sugeriraat na Down-ov, fragilen H ili Rett-ov
sindrom, drugi geneti~ki rastrojstva ili
hipotiroidizam?
B.
Dali ima vo istorijatot (Intrapartum
asphyxia) ili vo fizi~kite naodi (mikrocefalija,
mozo~na odzemenost, àri{ta) ili àri{ni napadi
koi naveduvaat na CNS povreda ili deformacija?
C.
Dali deteto ima bilo kakvi
neindifikuvani rizi~ni faktori za prekumerna
izloènost na olovo vo okolinata spored
vaè~kite tekovni smernici?
D.
Dali ima gubitok ili regresija vo
klu~nite preodni momenti na razvojot, istorijat na
roditelsko krvno srodstvo, porano neobjasnet
gubitok na dete ili pove}ekratni pometnuvawa?
NE
DA
A
Posebni testovi
za soodvetnoto
rastrojstvo
B
Se preferira
MRI pregled
namesto ST
C
Pregled
na olovo
D
Detalna
procena so:
1. MRI
2. Testirawe na
metabolizmot
3. EEG
4. Citogenetski
pregled
5. Genetska
konsultacija
Postepena procenka
1. MRI
2. Citogenetski
pregled/Fragilen H
3. Testirawe na
metabolizmot
4. Test na
subtelomeri~ki
izmeni
5. Test na Rett-ov
sindrom
866
Algoritam 10. Algoritam na parametri vo praksa
PRVO NIVO:
RUTINSKI NADZOR NA RAZVOJOT
OD STRANA NA SITE VKLUÊNI PRI SEKOJA VIZITA NA DETETO, kako pedijatri, ASQ, Cdis, ili
BRIGANCE
POTPOLNI INDIKACII ZA ITNA PROCENKA
Posle 12 meseci nema mrmorewe, ili vperuvawe ili drugi znaci

Do 16 mesec nema kaàno nieden zbor
Do 24 meseci nema re~eno niedna re~enica od 2 zbora (ne kako odjek)
BILO KAKOV gubiyok na BILO KAKOV jazik ili dru{tvena sposobnost na BILO KOJA vozrast
NE POMINUVA
POMINUVA
Povtoren pregled pri slednata vizita
LABORATORISKI ISPITUVAWA
Formalno audiolo{ko ispituvawe. Pregled na olovo ako

ima èlba za jadewa koi ne se upotrebuvaat vo ishranata
POSEBNO ISPITUVAWE ZA AUTIZAM
SNAT, Pra{alnik za ispituvawe na autizam

(avstraliska skala za Asperger-ov sindrom, PDDST-II-Faza 1)
NE POMINUVA
Upat za RANA INTERVENCIJA

ili vo lokalen {kolski oddel
Odi na Nivo 2
POMINUVA
Upat na nivo 2
VTORO NIVO: DIJAGNOZA I PROCENKA NA AUTIZMOT

Formalni proceduri na dijagnoza od strana na iskusen klini~ki lekar
Istorijat i nevrolo{ka procena
Posebni procenki za odreduvawe na razvojniot profil
Dopolnitelno laboratorisko ispituvawe samo ako e potrebno
867
STABILNA FAZA
STABILIZACIONA FAZA
AKUTNA FAZA
Algoritam 11. Skraten referenten vodi~
INFORMACIJA I EDUKACIJA
Informacija za semejstvata i za
neguvatelite
V za bolesta, pri~ina za bolesta, tek na

bolesta, tretman i uslugite, vklu~uvaj}i
gi grupite za podr{ka
Informacijata treba da e dadena od strana
A na iskusno zdravstveno stru~no lice
Programa za edukacija na pacienti
V so davawe na informacii za bolesta i za

korista i nesakanite posledici od lekovite
SEMEJNA INTERVENCIJA
Programa za semejna intervencija se
A primenuva kaj soodvetni slu~ai posle
procenkata
Programata treba da opfati:
- programa za edukacija
- analiza na semejnite odnosi i
A funkcionirawe
- semejni sesii za zapoznavawe so
konstatiranite problemi
- grupa za podr{ka na rodninite
Programi za intervencija realizirani od
A strana na stru~ni zdravstveni obu~eni lica

KOGNITIVNO-BIHEJVIORALNA TERAPIJA
Kognitivno-bihejvioristi~kata terapija treba da se
A predvidi kaj simptomi na psihoza koja e bolna i otporna na

konvencionalen tretman
OP[TI PREPORAKI
S
Tretmanot na poedinci so {izofrenija bara koordiniran

multidisciplinaren priod
Planot za nega treba da gi specificira site aspekti na negata koja treba

da se dade
Treba da se prevzeme nega za da se izbegnat seopfatni stresni intervencii

koi moàt da rezultiraat vo vlo{uvawe na psihoti~nite simptomi
Semejstvata i neguvatelite treba da se vklu~at od samiot po~etok (so

soglasnost na pacientot)
868
Algoritam 12. Dvièwe na obedinetata nega na vnatre{en pacient
FAZA 1
Priem/Procenka
FAZA 2
Identifikacija na
primarnite potrebi
(su{tina na negata)
FAZA 3
Vtora procenka i
planirawe na negata
FAZA 1
Sobirawe informacii
FAZA 2
Gradewe na odnosot
FAZA 3
Prvo procenuvawe
FAZA 4
Tretman
FAZA 4
MDT pregled
FAZA 5
Mese~en/3-mese~en
detalen pregled
FAZA 5
Pregled
FAZA 6
Ponatamo{no
procenuvawe
FAZA 6
Soglasnost za
tretmanot
FAZA 7
Proces na pregled na
soglasnosta za tretman
FAZA 8
Otsastvo
FAZA 9
Otpu{tawe
FAZA 7
Planirawe na
otpu{taweto
869
Algoritam 12a. Faza 1- Priem/procenuvawe

Ako pacientot e upaten od
RMO/SHO tie moàt, ako
sakaat, da go napravat
priemniot pregled i planot
za tretman za vreme na
nivniot pregled. Istoto
nema potreba da da se pravi
pri priemot
Den Prvi
Pacientot prifaten za priem
Zadràn prema Odredbata za

mentalno zdravje?
Dobra Praksa-zadràn
prema MNA. Dali ASW e vo
sostojba da mu dade na
pacientot kopija od
kni{kata so negovite prava?
Ako ne, kopija treba da se
dade vo prva prilika i
barawe
Kompleten
lekarski karton
so kratka
istorija
Dobra Praksa- tamu kade
SRA osnoven pregled ne bil
nikoga{ napraven, istiot
treba da se napravi vo
soodvetno rok. Vo
formularot R2 e kratka
istorija koja se koristi ako
Osnovniot SRA go nema ili
ne e napraven
Kartonot na pacientot
daden na denot na priemot
Semejstvoto informirano
za priemot
Kopija od informacijata za
ASW procenkata
NE
Poznat pacient
DA
Kompleten lekarski
formular za priem R2
Su{tina na negata Sredba i

dobredojde nasoka kon oddelenie
Fizi~ko ispituvawe, 2 ~asa (R4)
Prviot list popolnet so

soglasnost za koristewe na
informacijata, 2 ~asa (R1)
Kopija od prvata strana za

zdravstveniot karton
Dobra Praksa- odgovornost

za negata vklu~uvaj}i go
deteto i mileni~eto
Poseta na sestra MVYE, 2

~asa R3
Vo zavisnost od starosta/
fizi~koto zdravje da se zeme
vo predvid dali treba da se
razgleda DNAR baraweto
Popolnuvawe na formular
14 i zapo~nuvawe na 14dneven ciklus na pregled
Formular R11
Po~etok na progresot
NE
Karton na neguvatelot pri

prvata vizita
Dobra Praksa- SRA

soglasnosta da ja dade
informacijata treba da se
proveri i kompletira, da se
zeme vo predvid vreden sovet
i osiguruvawe.
DA
Proverka na priemot 3 ~asa
Pregled za rizi~nost, nivo

na posmatrawe,
kompletirano na R4, 6 ~asa
FAZA 2
Koordinatorot na negata
informiran za priemot
Barani se zabele{ki
Zabele{ki za
kompletiraweto
Dobra Praksa- intervju so
lekar i sestra vo isto
vreme za da se namali
duplirawe na pra{awata i
za da se usoglasi planot za
priem
Dobra Praksa- Pregled na
rizi~nost i nivo na
posmatrawe usoglasen so
priemniot lekar i sestra
870
Algoritam 12b. Faza 2- Identifikuvawe na primarnite potrebi
Den Vtori
Od FAZA 1
Dali e ova povtoren priem za

pomalku od 28 dena?
DA
Pregled na postoe~kiot R5
formular i proverka dali
ima promeni
NE
Pregled na potrebite od
celosna osnovna nega, 48 ~asa
(R5)
Patokaz kon drugite oddeli/

agencii za bilo kakvi
zabeleàni problemi
Dobra Praksa-se
primenuva kaj stari
lica ili ako toa
klini~ki se bara
Bezbednost
Mini mentalna sostojba,

48 ~asa
Socijala
Mentalno zdravje
Fizi~ko zdravje
Samo-nega
Identifikuva primarni potrebi
Dobra PraksaPacientot treba da go

potpi{e planot za
nega ako se soglasi a
kopija se dava na
pacientot. Ako ne e
taka pri~inata da se
vnese vo zabele{kite
Napi{an prv plan za nega vo

oddelenie (48 ~asa), R17
Ponuda za neformalna sredba so
neguvatelite/rodnina, ako e
shodno
Kon FAZA 3
Dobra Praksanazna~enata sestra treba

da se prestavi na
neguvatelot i rodninite
u{te pri priemot. Da se
ostavi mesto za toa na
priemniot list na
neguvatelot
871
Algoritam 12v. Faza 3- Identifikuvawe na sekundarnite potrebi i planirawe na negata
Od FAZA 2
Dopolnitelni procenki
soglasno na navedenoto vo
Osnovite na negata i MVYE
Upatuvawe na
rabotna terapija
Upatuvawe na
fizio/sportska
terapija
Vidi vo nasokata na
dvièwe na OT
vnatre{en pacient
MDT pregledot kompletiran od

strana na pacientot, slu`bata
na sestri i ANR
Bezbednost
Socijala
Mentalno zdravje
Fizi~ko zdravje
Identifikuva sekundarni potrebi
Zapo~nati primarnite
intervencii
Utvrdeni ostanatite
intervencii
Kompletiran MDT
pregledot, 10 dena (R6)
Kon FAZA 4
Samo-nega
872
Algoritam 12g. Faza 4- MDT Pregled
Od FAZA 3
Nazna~enata sestra vr{i

MVYE/Pregled na rizi~nost
Pregledan planot za nega od
sestrite
MDT pregledot kompletiran
od strana na pacientot,
slu`bata na sestri i ANR
MDT Pregled
najmnogu 7 dena
Potvrda na
dvièweto na
tretmanot
Dobra Praksa-Sestrite i
ANR personalot treba da
gi dostavuvaat izve{taite
i preporakite do MDT
preku MDT pregledot.
Ovoj pregled se dava na
pacientot (i na
neguvatelot, tamu kade e
toa soodvetno). Pacientot
treba da se ohrabri vo
pregledot da dade
komentar za negoviot
napredok.
Dobra Praksa-Dobro e da
se vklu~at i stavovite na
neguvatelite za progresot,
primedbite i za sekakvi
pra{awa kako del od
sevkupnata priprema na
oddelenieto
Potvrda/
prodolùvawe
Zapo~nata
posebnata nasoka
na tretmanot
Potvrda na
dvièweto na
tretmanot
Vtor del od MDT

pregledot zavr{en
Zapo~nuva 7-dnevniot
ciklus na pregled
Kon FAZA 5
Kopija dadena na
pacientot
873
Algoritam 12d. Faza 5- Mese~en/ 3-mese~en pregled
Od FAZA 4
Dali pacientot bil primen

pove}e od 4 nedeli?
NE
DA
Ili 3 meseci od
posledniot
potpoln pregled,
odnosno 6, 9 meseci
Dali pacientot bil primen

pove}e od 3 meseci?
DA
Nazna~enata sestra go
zavr{uva noviot pregled
na osnovna nega, R5
NE
na osnovna nega, R5
na osnovna nega, R5
Kompletno medicinsko
ispituvawe, R5
kompletira MVYE
Barawe za izve{taj za
napredokot od ostanatite
stru~ni lica opfateni so
rabotnite mesta
Nazna~eniot OT dava
izve{taj za napredokot
Bezbednost
Socijala
Mentalno zdravje
Fizi~ko zdravje
Sportskata aktivnost/
fizioterapijata davaat
izve{taj za napredokot
Samo-nega
Potrebite razjasneti
Negata razgledana na MDT sostanokot

so koordinatorot na negata
Ciklusot se povtoruva
na 4 nedeli
Kon FAZA 6
Dobra Praksa-da se
povika neguvatelot i
ostanatiot personal/
semejstvoto, ako e toa
soodvetno
874
Algoritam 12|. Faza 6- Soglasnost za tretman sprema Odredbite za mentalno zdravje

Od FAZA 5
Pacientot gi prima
prepi{anite lekovi/ tretman
DA
Dali pacientot e zadràn
prema MNA?
NE
Prodolùvawe so
prepi{aniot lek ili tretman
DA
Dali pacientot e
zadràn
za 3 ili pove}e
posledovatelni meseci
prema MNA?
NE
DA
Dali pacientot moè
i saka da dade soglasnost
za prodolùvawe
na tretmanot?
DA
RMO kompletiran
Formular 38
NE
Dali
tretmanot e
itno potreben?
RMO moè da ja koristi

sekcijata 62 od MNA se
dodeka ne dojde SOAD
DA
NE
RMO treba da go
kompletira formularot
GPT R16 Sekcija 62 za
iten tretman i da go
dostavi do MNA
administratorot
RMO bara vtoro

mislewe od lekarot
Informirawe na
MNA administratorot
SOAD go kompletira
formularot 39
Ako vo bilo koj moment posle

kompletirawe na MNA
formularot 38 pacientot ja
povle~e svojata soglasnost, ili
ima promena vo negovata
sostojba treba da se dobie SOAD
Formularite dostaveni do Zdravstvenata

slu`ba na razgleduvawe
Kopija od MNA formularot se popolnuva
vo kartonot na pacientot i se priloùva
Koga se kompletirani
formularite 38 i 39 da
se proveri dali, ako se
koristi, PRN e vklu~en
na formularot
Pred da se po~ne so davawe na lek da se

proveri prepi{anoto e vo soglasnost
so formularite 38 ili 39
Prepi{aniot lek ili tretman
moè da se dade
Zapo~nuvawe na 2-nedelen
proces na pregled
Kon FAZA 7
875
Algoritam 12e. Faza 7- Soglasnost za tretman/ Sekcija na zapis na Pregledot na ciklusot

Od FAZA 6
Eden od personalot go
kompletira naodot posle
Prvata i Tretata nedela od
mesecot
Site zadràni pacienti se
vlezeni vo formularot za
pregledi
Karton so sekcija za pregled
(GPT-R11) MNA formular
38/39 i kartoni so recepturi
Dali ima
zabele`zno propusti
vo formularot
38/39 i R-?
DA
RMO ili SOAD koregiran

vedna{. Propustot vedna{
da se koregira
NE
Vedna{ kontaktirani
Sestrata/Upravitelot na
oddelot za da go koregiraat
propustot
DA
Dali propustite
se vneseni vo bolni~kiot
karton?
NE
Otstapkata vnesena vo
formularot za pregled
Lekot koj ne e prepi{an

soglasno na formularot,
metodot ili opsegot na
formularot 38 ili 39 ne
smee da se dava. Mora da se
dade iten sovet za postapka
Formularite za pregled se
vra}aat kaj soodvetnoto lice
Otstapkata zabeleàna vo
formularite za pregled
sporedena so prethodnite
nedelni formulari za da se
vidi dali ima anomalii
Prezemena aktivnost za
lekuvawe ako se
konstatirani anomalii
Kon FAZA 8
Otstapuvaweto
zabeleàno vo
formularot za pregled
876
Algoritam 12`. Faza 8- Proces na otsustvo

Od FAZA 7
Razgledana mo`nost za otsustvo

Pred da se razgleda otsustvoto
- Dali e razgledano so RMO i koordinatorot na negata?
- Dali e otsustvoto soodvetno/bezbedno?
- Dali imaat dovolno finansiski sredstva/hrana, itn za
vreme na otsustvoto?
- Dali ima opfateno obvrski na detski/drug neguvatel ?
- Dali neguvatelot e konsultiran?
- Dali e nareden TTO?
- Dali pacientot moè da go koristi TTO?
- Dali ima mesto za razgleduvawe na drugi rizici?
- Dali se razgledani planovi za nepredvideni opkolnosti
so pacientot kako i za nega ako rabotite pojdat vo pogre{na
nasoka za vreme na otsustvoto?
Dali e
otsustvoto pogolemo
od 7 dena
DA
Da se pobara plan za
nega za SRA otpust
NE
Zadràn
prema MNA?
DA
RMO ja kompletira
sekcijata 17 od
formularot za otpust R7
NE
Informiran koordinatorot
na negata
Dobra praksa- Dali

pacientot moè da se
spravi samiot so zemawe na
lekovite? Da se razgovara
so apoteka za soodvetna
pomo{/raspredelbata
Dobra praksa- Ako se odi na

podolgo otsustvo da se napravi
SRA plan za nega, koj moè da se
nare~e Plan za nega za vvreme na
otsustvo. Toj se popolnuva od
koordinatorot na negata po
razgovor so personalot na
oddelenieto
Dobra praksa- Ako otsustvoto e
pod pridru`ba toa se naveduva, koj
pridruùva, so bilo kakvi posebni
ograni~uvawa. Ako liceto koe
pridruùva ne e vraboten na
Staratelstvoto tie treba da se
informiraat za prirodata na
sostojbata i nivnata odgovornost
Dobra praksa- da se informira
za otsustvoto Dnevnata bolnica/
resursniot centar
Pred zapo~nuvawe na otsustvoto, Oddelenskiot

personal proveruva i voveduva vo kartonot
- Kade odat
- O~ekuvano vreme/datum na vra}awe
- Dali planiranoto otsustvo e vo parametrite na
propi{ano otsustvo, ako e zadràn spored MNA
- Bilo kakvi primedbi za mentalnata sostojba/
odnesuvaweto
- Dali TTO e dobien i razjasnet
- Dali e daden bilo kakov sovet
- Personalot na dol`nost, vo o~ekuvanoto vreme na
vra}awe, e svesen za rizikot/nepredvidenite okolnosti
ako ne se vratat
Koga se vra}a nazad, Oddelenskiot personal proveruva i voveduva vo

kartonot
Kade oti{le?
Kakvo bilo otsustvoto od gledna to~ka na pacientot?
Kako otsustvoto pominalo od gledna to~ka na neguvatelite? (ako se ima stav)
Dali imalo bilo kakvi problemi?
Kon FAZA 9
877
Algoritam 12z. Faza 9- Otpu{tawe
Dobra Praksa-Dali }e
ima neguvatel koj }e go
gleda pacientot posle
otpu{taweto? Proverka
dali e zavr{eno so
odobruvaweto od
neguvatelite
Prigovor protiv MNA?
Dobra Praksa- Ako
pacientot e vo proces na
prigovor na MNA
izolacija, da se pripremi
Plan za nega SRA pred da
se odrì sostanokot vo
vrska so prigovorot. Toa
moè da e i interen SRA
plan za nega
Od FAZA 8
Dobra Praksa-Sekcija 25A

navedena? Pripremata
treba da zapo~ne {tom e
zapo~nata rasprava za
otpu{tawe
Predvideno otpu{tawe
Dobra Praksa-Pregledot
za rizik na vnatre{niot
pacient ne e prifatliv za
zaednicata ako se bara
isapituvawe na rizik za
otpu{tawe koe treba da se
organizira so SMNT so
pomo{ na Procesot za
proverka na rizik SRA
Informiran
koordinatorot na negata
Koordinatorot na negata ili
nazna~enata sestra bara
pacientot da ja proceni
svojata sostojba SRA 14
Ima
indikacija
za rizik?
DA
Barawe SMNT da go
proceni SRA rizikot
NE
Dobra Praksa-Site koi se
vklu~eni vo negata,
vklu~uvaj}i ja primarnata
nega i dnevniot centar/
bolnica, da obezbedat
prodolùvawe na negata
vo momentot na otpu{tawe
Standarden SRA
pobaran od SS
Pro{iren SRA/
117 sostanok
Za denot na otpu{tawe da se informira

koordinatorot na negata, GP, bliskiot
rodnina i ostanatite angiìrani stru~ni lica
Pacientot otpu{ten
Koppija do Oddelenieto
i Zdravstveniot karton
(priloèn na sostojbata
vo negata vo krevet)
Dobra Praksa-MNA
izolacija? Ako bliskiot
rodnina e informiran i
vnesen vo izve{tajot,
toga{ Zdravstvenata
slu`ba ne mora da dostavi
zvani~no pismo
Kompletiran formularot
za otpu{tawe (R8)
Vnesuvawe na denot
na otpu{tawe od
oddelenieto
Dobra PraksaSostanoci za sledewe

na sostojbata.
Visok rizik, ako se
konstatira vo rok od 48
~asa posle
otpu{taweto?
Nizok rizik, treba da
se identifikuva vo rok
od 7 dena.
Sostanok so
nadvore{en pacient
treba da e za 14 dena
Karton za sledewe daden na
pacientot so datumot na
stanuvawe na nadvore{en
pacient, so brojot i krizite
Formularot TTO za otpust

dostaven do GP od strana na
slu`benik na oddelenieto
na denot na otpu{tawe
878
Algoritam 12y. Proces na vodewe na dosie
Da se konstatira deka e dostaven sekade

GPT R23, so informirawe na personalot,
kako i bankata, slu`bata i medicinskiot
centar da go potpi{at dosieto.
Na po~etokot na sekoja kalendrska godina

sekoj klini~ki del ima nov formular za
potpi{uvawe na dosieata
Sekoj ~len od personalot go popolnuva vo

formularot negovite podatoci
Upravitelot na oddelenieto/
Koordinatorot na smena gi potsetuvaat
sekoj nov personal /slu`ba/banka da go
kompletira potpi{uvaweto na dosieta
Na kraj od sekoja godina formularite se

nosat na ~uvawe vo soodveten del za ~uvawe
na zdravstvenite dosiea.
Racionalen pristap
So postojana rotacija na personalot, zaedno so promena na
imiwata i na potpisite, bitno e dosijeata da bidat aùrirani so
tekovnite potpi{uvawa i so prvobitnoto upotrebeno vo sekoja
odredena zona. So toa pristapot e lesen za potrebite na
istraùvawe na àlbite i pregledite.
879
Algoritam 13. Planirawe na otpu{taweto
Prigovor na MNA?
Dobra Praksa-Ako
pacientot e vo postapka na
prigovor na MNA
izolacijata pripremite za
otpu{tawe se pravat
Klasifikuvano
otpu{tawe ?
DA
Planirani aktivnosti
Formirawe na zaednica
NE
Kompletiran
izve{tajot za
otpu{tawe
Odrùvawe na
vrska so MDT
Odrùvawe na
vrska so
Koordinatorot
na negata/
zaednicata
U~estvo na
SRA
planiraweto
na negata
Pacient
880
PRIBIRAWE
INFORMACII
Pacientot primen
SOBIRAWE NA
INFORMACII
Pregled za rizik
Priemni procenuvawa
Lekarski priem (R2),

fizi~ki priem (R4),
mentalna sostojba i
odnesuvawe, proverka na
rizikot (R3), Proverka na
potrebite za osnovna nega
(R5) kompletirani; 48 ~asa
Vklu~uvawe na neguvatel
Personal na oddelenie
MDT
Soodvetno
za prviot?
NE
Za 24 ~asa povtorna
proverka
DA
GRADEWE
NA ODNOS
Nevolen za angaìrawe
Prv kontakt
NE
Sposoben
za angaìrawe?
NE
Za 48 ~asa povtorna
proverka
DA
Dobra Praksa-Nazna~en
OT za odrùvawe na
redoven kontakt i da
gradi odnos ako tie
ostanuvaat nevolni pri
soodvetnoto povtorno
angaìrawe vo fazata na
otpu{tawe
Dobra Praksa-Nazna~en
OT za odrùvawe na
redoven kontakt i da
gradi odnos
881
TRETMAN
PRVO^NO PROCENUVAWE
Prvo~na OT
procenka i cel
Upat za psiho/
sportska terapija
Potrebna podr{ka za
rabotnite aktivnosti
pri samo-negata
Golema
Sredna
Mala
Potreba od intenzivna
individualna podr{ka za
da moè da se angaìra
Potreba od mal stimul od

sredinata so maksimalna
podr{ka na personalot 3:1
Sposoben da tolerira
rabotna grupa, potreba od
minimalna podr{ka
Sposoben
ili saka da e vo
zatvorena grupa?
Prisatvo vo
otvorena grupa
Individualna rabota
NE
DA
U~estvo vo
zatvorteni grupi
Dobra
Praksa-Vtoro
mislewe za
MNA ne se
dava pred ova
Sredba so OT/TI
DA
Ekstra
individualna
rabota?
NE
Po~nuva individualnata
rabota
Dobra Praksa- 7
rabotni dena
Kompletirano
Koristewe na
pregled
882
PREGLEDANORAZGLEDANO SO
MDT
TRETMAN
Dobra PraksaRazgledano na
MDT pregledot
Spremen
da odi?
DA
Tretman
NE
Sosema
DA
Sposoben
da razmisluva za
sebe?
PONATAMO[NI
PROVERKI
NE
Ponatamo{ni
procenuvawa?
NE
DA
Motivacija
VQ
Komunikacija
Proverka
Motorna
ACIS
Proces
Doma{na poseta/
individualno
AMPS
Ponatamo{na
OT procenka?
Sredina
DA
NE
Dopolnitelen
izvedben
kapacitet?
NE
Tretman
DA
Upat na soodveten
tretman
883
Algoritam 17. Dijagnoza i procenka na dete so rastrojstvo na hiperaktivnost/nedostatok na vnimanie (ADHD)
SE PRIJAVUVA
DETE SO
DIJAGNOZA
NA ADHD
1
Vidi UPATSTVA ZA KLINI^KA POSTAPKA, Dijagnoza i procenka na
dete so rastrojstvo na hiperaktivnost/nedostatok na vnimanie (ADHD)
2
A.
B.
C.
LEKAR VO KLINIKA, RODITELI, DETE I NASTAVNIK:

UTVRDUVAWE NA CELITE
IZRABOTKA NA DETALEN PLAN ZA TRETMAN
PROCENKA ZA REAKCIJA NA PLANOT ZA TRETMAN
1. LEKARI VO KLINIKA ZA PRIMARNA NEGA

ODREDUVAAT PLAN ZA TRETMAN NA ADHD
KAKO HRONI^NA SOSTOJBA
2. LEKAROT PREPORAÛVA STIMULATIVNI LEKOVI
I/ILI BIHEJVIORISTI^KA TERAPIJA ZA DA SE
PODOBRI KRAJNIOT ISHOD
4
DALI E ADEKVATNA
REAKCIJATA NA
PLANOT ZA TRETMAN?
NE
DALI DETETO PRIMA

STIMALATIVNI LEKOVI?
DA
1. DA SE PREDVIDI DODAVAWE NA
STIMULATIVNI LEKOVI.
2. ZAJAKNUVAWE NA
BIHEJVIORISTI^KATA TERAPIJA
NE
DA
KLINI^KIOT LEKAR VR[I

RUTINSKO SLEDEWE
ODI NA 2S
KLINI^KIOT LEKAR
POVREMENO OBEZBEDUVA
POSTOJANO SLEDEWE NA
REZULTATOT I NA
SPROTIVNITE EFEKTI
1
DA
DALI E ADEKVATNA
REAKCIJATA NA
PLANOT ZA TRETMAN?
1. DA SE PREDVIDI DAVAWE NA
STIMULATIVNI LEKOVI.
2. ZAJAKNUVAWE NA
BIHEJVIORISTI^KATA TERAPIJA
NE
DALI SE PROBANI SITE

STIMULATIVNI LEKOVI?
DA
NE
9
ODI NA 2S
10
DALI E DOBRA PODR[KATA
NA STIMULATIVNITE LEKOVI
ILI BIHEJVIRIOSTI^KATA
TERAPIJA?
NE
DA
11
ODI NA 2V,S
12
13
NE
DALI
DIJAGNOZATA
E TO^NA?
IZLEZ OD PROCEDURATA I
VOSPOSTAVUVAWE NA
SOODVETEN TRETMAN
DA
15
14
DALI SE OPFATENI I
DRUGI POSTOE^KI
SOSTOJBI?
DA
NE
17
KLINI^KIOT LEKAR GI
PROCENUVA I GI TRETIRA
DRUGITE POSTOE^KI SOSTOJBI
DALI SE KRAJNITE
SIMPTOMI SOODVETNI?
NE
DA
16
KLINI^KITE LEKARI
PREDVIDUVAAT DRUGI LEKOVI
OTKAKO E NAPRAVEN OBID SO
SITE STIMULANTI
884
Algoritam 18. Dijagnoza i spravuvawe so rastrojstvoto na hiperaktivnost/nedostig na vnimanie vo

primarnata nega kaj deca od {kolska vozrast i adolescenti. Algoritam za procenuvawe
1
PROBLEMI VO
ODNESUVAWE SO UÊWETO
(SOMNE@ ZA ADHD)
DA
IMA LI
KRIZI?
PROCENKA I/
ILI UPAT
NE
PROCENKA ZA POSTOEWE NA OSNOVNITE

KARAKTERISTIKI NA ADHD SO POMO[ NA
KRITERIUMOT DSM-IV:DSM-PC:
- SIMPTOMI
- NAVALA NA BOLESTA
- TRAEWE
- PRODORNOST
- NARU[UVAWE
5
PREGLED DALI IMA DRUGI PRIMARNI SOSTOJBI I
KOMORBIDETI VKLUÛVAJ]I GI I SITE SLEDNI:
A BIOMEDICINSKI USLOVI
B EMOCIONALNO/PSIHIJATRISKI PROBLEMI
C
D
E
SEMEJNI/PSIHOSOCIJALNI PROBLEMI
PROBLEMI SO GOVOROT/JAZIKOT
AKADEMSKI/PROBLEMI SO UÊWETO
6
IMA LI SOMNE@
ZA DRUGI
PRIMARNI
SOSTOJBI ILI
KOMORBIDETI?
DA
NE
UTVRDUVAWE DALI IMA SOMNITELNI USLOVI I

KOMORBIDETI:
A BIOMEDICINSKI USLOVI
B
C
D
E
EMOCIONALNO/PSIHIJATRISKI PROBLEMI
SEMEJNI/PSIHOSOCIJALNI PROBLEMI
PROBLEMI SO GOVOROT/JAZIKOT
AKADEMSKI/PROBLEMI SO UÊWETO
8
12
NADVOR OD
UPATSTVATA.
POTREBA OD
PONATAMO[NO
ISPITUVAWE
PRIMARNA DIJAGNOZA
RAZLI^NA OD ADHD [TO SE
ODNESUVA NA SIMPTOMITE?
NE
11
NE
13
DA
POPTVRDEN
DSM-IV:DSM-PC
KRITERIUM ?
NE
DA
FORMULACIJA NA
DIJAGNOZATA NA
ADHD (vidi Algoritam
za spravuvawe)
14
10
NE
IDENTIFIKUVAN
SOODVETEN
KOMORBIDET?
DA
POTREBNA
SUBSPECIJALISTI^KA
KONSULTACIJA ZA ADHD
LEKARSKO SREDUVAWE?
DA
KOORDINACIJA NA
NEGATA SO
SUBSPECIJALNOSTITE,
KAKO E UKA@ANO
15
NADVOR OD UPATSTVATA.
KOORDINACIJA NA NEGATA
SO SUBSPECIJALNOSTITE
KAKO E UKA@ANO
885
Algoritam 19. Dijagnoza i spravuvawe so rastrojstvoto na hiperaktivnost/nedostig na vnimanie vo

primarnata nega kaj deca na {kolska vozrast i adolescenti. Algoritam za spravuvawe
16
FORMULIRAWE NA
DIJAGNOZATA ZA ADHD
(vidi Algoritam za Procenuvawe)
17
MULTIMODALITETNO SPRAVUVAWE
KOORDINIRANO OD LEKAR VO PRIMARNA NEGA
18
EDUKACIJA NA KLU^NITE LICA
19
20
21
STRATEGII FOKUSIRANI NA
RODITELITE/SEMEJSTVOTO
- GRUPA ZA PODR[KA NA ADHD
DETSKI INTERVENCII
- OBUÛVAWE NA SOCIJALNI VE[TINI
- GRUPI ZA ZASTAPUVAWE
- OBUÛVAWE NA RODITELSKATA
- OBUÛVAWE ZA UÊWE/ORGANIZIRAWE
[KOLSKI INTERVENCII
- INSTRUKTIVNI
PRILAGODUVAWA NA NASTAVEN
PROGRAM
- STRATEGII ZA RE[AVAWE NA PROBLEM
SPREMNOST
POSTOJAT KOMORBIDETI
- UPAT ZA PSIHOTERAPIJA, AKO E
- UPAT ZA PSIHOTERAPIJA,
SEMEJNA TERAPIJA , TOA [TO E
POTREBNO
POTREBNO
- SOODVETNO MEDICINSKO
SPRAVUVAWE SO KOMORBIDNATA
SOSTOJBA
- PROMENI VO ODNESUVAWETO
- PO POTREBA, POSEBNI
EDUKATIVNI USLUGI
- PO UKA@ANOTO TERAPIJA NA
GOVOROT/JAZIKOT
22
UPOTREBA NA
LEKOVI
POTVRDENA I
PO@ELUVANA?
NE
DA
23
LEKOVI OD PRV RED:

- PLACEBO
- SLOBODEN IZBOR
25
24
USPE[NI OBIDI SO
PSIHOSTIMULANTI ?
NE
OBID SO
ALTERNATIVEN
LEK?
DA
NE
27
ODR@UVAWE I
PRODOL@UVAWE
NA NEGATA
28
NE
29
SE POJAVUVA
KOMORBIDNA
SOSTOJBA ?
DA
DETERMINIRAWE NA
KOMORBIDNATA SOSTOJBA
(vidi Algoritam za Procenuvawe)
DA
26
NADVOR OD UPATSTVOTO
(DA SE NAPRAVAT
SUBSPECIJALISTI^KI
KONSULTACII)
886
Algoritam 20. Preventivni uslugi na decata i adolescentite

1
PACIENTOT KONTAKTIRA
SO KLINIKATA
2
PACIENTOT DOA\A VO POSETA
3
DA
PREVENTIVNA
POSETA?
NE
PREGLED ZA POTREBA OD
PREVENTIVNA NEGA
VKLUÛVAJ]I I UTVRDUVAWE
NA RIZIK ZA ZDRAVJETO
UTVRDUVAWE NA PRIÎNATA ZA
POSETATA I PREGLED ZA
POTREBITE OD PRIORITETNA
PREVENTIVNA NEGA (VIDI 5a)
6
UTVRDENI
POTREBITE ZA
PREVENTIVNA
NEGA ?
NE
DA
STATUS NA ZDRAVSTVENIOT
KARTON I A@URIRAWE
8
POSTAVUVAWE
NA RASPORED ?
PACIENTOT SE
SOGLASUVA NA
INTERVENCII?
DA
NE
NE
10
RASPOLO@EN
KLINI^KI LEKAR
11
PREVZEMAWE NA
DEJSTVIJA
12
13
DALI IMA DRUGI

POTREBI ?
14
NE
PROCENUVAWETO ZAVR[ENO
PACIENTOT A@URIRAN
DA
UTVRDUVAWE NA
OSTANATITE POTREBI
DA

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. Buprenorphine naloxone (-B)

Codergocrine mesylate (hydergine) (-C)30 .

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(DSM III R):

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clomipramine33 imipramine34. , fluoxetine

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