19

E 2

H


25% . , , , , . ,
. , 10%
. 20%
.
. ,
. 1990 10% -
(DALYs), .
12% 2000. 2020

15%. , ,
, , , , Alzheimer,
. -
,
,
, , ,
, .

21

,
/ .
,
. , , . , ,
, . , ,
. .
.
, .
,
( 1.3).
,
, , . ,
. ,
.
"ICD-10 : " (WHO 1992b)
( 2.1).
(WHO 1993a).
, .
,
, .
, .

22

Y 2001

. , ,
, .
. -

2.1 O ICD-10



"ICD-10
: "1.

,
- .. Alzheimer, delirium.

- ..
, .
,
- .. , , .
( ) -
, .
,
- .. , .

,



:
,
1
2
3

2. ,
,
V (F)
(ICD-10)3,

, , , Alzheimer, .

.
, -

. V ICD-10

.

,

,

,

.


ICD-10 :

.. ,
.

- .. , .
- .. .
-..
, .

-..
, , .

" "

. ,
,
, ,

,
Alzheimer
, Parkinson,
,

,

, , .

: , , (1992). , .
The ICD -10 classification of mental and behavioural disorders: diagnostic criteria for research (1993a). Geneva, World Health Organization.
International statistical classification of diseases and related health problems. Tenth revision 1992 (ICD-10). Vol.1: Tabular list. Vol.2: Instruction manual. Vol.3:
Alphabetical index (1992a). Geneva, World Health Organization.

, , ,
. .
, .
, .
. , , 70%
90% (Wittchen et al. 1991, Wing et al. 1974, Who 1992, APA 1994, Andrews et al 1995).

, , .

, , .

E
.
,
.
.
. .
, , .

, , 10% (GBD 2000). 450 .
, ,
, ,
, , ,
, .
( ) , (
)
(
). .
,
.
.
ICD-10, .
, ,
25% (Regier et al. 1988; Wells et al. 1989; Almeida-Filho et al. 1997).

23

24

Y 2001

.
. ,
, ,
, .

.

IAT
.
,
, .

,
, . 14
(Ustun & Sartorius 1995, Goldberg & Lecrubier 1995), 3
: ,
, . , (
24%) , ( 2.1). , . ,
. .

,
.
. , , .
.
. ,
,
.
,
(Pai & Kapur 1982; Fadden et al. 1987; Winefield & Harvey
1994). , , ,

(WHO 1997).
, ,
.

2.1 ...

,
,
,
,
,
,
,
,
,
,
,
,
,
,
,

%
11,6
6,4
9,1
6,1
15,9
4,2
11,2
16,9
2,6
13,7
15,8
29,5
6,3
4,0
4,7

%
0,9
14,9
8,5
9,0
6,4
2,9
7,9
7,1
5,0
11,9
22,6
18,7
2,1
1,9
3,7

%
1,0
1,0
1,4
5,3
3,4
0,4
7,2
2,2
3,7
4,3
4,1
2,5
1,5
1,1
0,5

( CIDI)
%
16,4
19,2
22,4
18,3
23,9
9,5
23,6
24,8
9,4
26,3
35,5
52,5
11,9
7,3
9,8

10,4

7,9

2,7

24,0

CIDI:Composite International Diagnostic Interview.

: Goldberg DP, Lecrubier Y (1995). Form and frequency of mental disorders across centers. In: Ustun TB, Sartorius
N, eds. Mental illness in general health care: an international study. Chichester, John Wiley & Sons on behalf of
WHO: 323-334.

,
. , , ,
,
(Gallagher & Mechanic 1996).
,
. , .
, , .
.
.
, , ( ) ,
"" .

. ( )
( ) ( ).
, ,
,
. , .

25

26

Y 2001

' Global Burden of
Disease' (GBD). GBD 2000 2.2.
1990,
10,5% DALYs (. 2.2 )
.
. 2000 12,3% DALYs (
2.1). 20
DALYs , 15-44 ( 2.2).
DALYs, ,
(Vos & Mathers 2000).
, . 2.2 E Y N. 2000
1993
,



(GBD)1
(Global burden of disease
study - :
GBD). ,



,
,


(diasbility-adjusted life years
- DALYs)- GBD2,3.
DALY
,
, 1
2

. DALY

,
( )



,

.
DALY

Murray & Lopez (2000)4.

GBD
2000, ( GBD
2000),

, 135
,
,
, ,


GBD 30
.
DALYs


(: Years of
life lost - YLL) -
(:
Years of life lived with
Disability - YLD), . DALY

(:
potential years of life lost PYLL)

"" ,
.

GBD ,
,


,



.

GBD 2000
2002.

World Bank (1993). World development report 1993: investing in health. New York, Oxford University Press for the World Bank.
Murray CJL, Lopez AD, eds (1996a). The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk
factors in 1990 and projected to 2020. Cambridge, MA, Harvard School of Public Health on behalf of the World Health Organization and the World
Bank ( Global Burden of Disease and Injury Series, Vol. I).
Murray CJL, Lopez AD (1996b). Global health statistics. Cambridge, MA, Harvard School of Public Health (Global Burden of Disease and injury Series,
Vol. II).
Murray CJL, Lopez AD (2000). Progress and directions in refining the global burden of disease approach: a response to Williams. Health Economics, 9:6982.

15% 2020 (Murray & Lopez

1996a). DALYs - 2.1.
,
GBD 2000 30,8% - .
, 12% .

20 , :
,
, , , Alzheimer
, ( 2.3).

. , , ,

, . ,
17,6%
- .

GBD 2000 DALYs - ,

, . , ,
,
,

.

2.1 H ,
OY, 2000.

(DALYs)
DALYs

(YLDs)
YLDs

12

31

18

A
24

43

B N A
11

27

A M
20

43

E
11

27

N A

, ,
.
,
.

27

15

31

E
:
3

28

Y 2001

, ,
,
.
, ,
. (Rice et al. 1990)
2,5% .

- 23,2% (Meerding et al 1998)
22% (Patel & Knapp 1998) .
2.2 K (DALYs) , 15-44
, 2000
K ,

1
2
3 HIV/ AIDS
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
15-44

6,4
6,2
6,1
4,4
4,2
3,8
3,1
2,8
2,7
2,4
2,3
2,2
1,9
1,8
1,7
1,3
1,3
1,3
1,1
1,1

1 HIV/ AIDS
13,0
2 8,6
3
4,9
4
3,9
5
3,0
6
2,7
7
2,6
8
2,6
9 2,5
10
2,3
11 2,0
12
1,5
13
1,5
14
1,4
15
1,3
16
1,3
17 -
1,2
18
1,2
19
1,2
20
1,2

1
2
3 HIV/ AIDS
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
15-44

6,4
6,4
5,8
4,2
4,2
4,0
3,4
3,0
2,9
2,5
2,4
2,2
2,1
1,8
1,8
1,6
1,5
1,5
1,5
1,4

1 HIV/ AIDS
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

2,1
7,7
6,7
5,1
4,5
3,7
3,0
2,5
2,4
2,1
2.0
1.9
.7
1.7
1.6
1.6
1.5
1.5
1.4
1.1

1 HIV/ AIDS
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
, 15-44

1 HIV/ AIDS
2
3
4
5
6
7
8 -
9
10
11
12
13
14
15
16
17
18
19
20

T (. 3 ) .

6,5
6,4
6,0
5,5
4,2
3,3
3,2
3,0
2,2
2,1
2,1
2,0
2,0
1,7
1,5
1,4
1,2
1,1
1,1
1,1

13,9
10,6
3,2
3,2
2,8
2,7
2,5
2,5
2,4
2,1
2,0
2,0
1,9
1,6
1,5
1,5
1,4
1,3
1,2
1,1

29

2.3 K (YLDs) 14-44 , 2000.

,

1
2
3
4
5
6
7
8
9
10
11
12
13 Alzheimer
14
15
16
17
18 HIV/ AIDS
19
20
, 15-44

1
2
3
4
5
6
7 HIV/ AIDS
8
9
10
11
12
13
14
15
16
17
18
19
20

11,9
4,6
4,5
3,3
3,1
3,0
2,8
2,8
2,5
2,1
2,1
2,0
2,0
1,9
1,8
1,7
1,7
1,5
1,4
1,4

16,4
5,5
4,9
4,9
4,7
3,8
2,8
2,4
2,3
2,3
2,2
2,1
2,0
1,9
1,9
1,8
1,6
1,6
1,4
1,2

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16 Alzheimer
17
18 HIV/ AIDS
19
20
15-44

9,7
5,5
5,1
4,1
3,8
3,3
3,0
2,7
2,6
2,5
2,3
2,2
2,2
1,9
1,8
1,8
1,7
1,6
1,6
1,6

1
2
3
4
5
6
7
8 HIV/ AIDS
9
10
11
12
13
14
15
16
17
18
19
20

13,9
10,1
5,0
5,0
4,2
4,1
3,8
3,2
3,0
2,6
2,5
2,4
2,1
2,1
1,6
1,6
1,3
1,3
1,2
1,1

1
2
3
4
5
6
7
8
9 Alzheimer
10
11
12
13
14
15
16
17
18
19
20
, 15-44

14,0
4,9
4,2
3,5
2,9
2,7
2,4
2,3
2,2
2,1
2,0
2,0
1,9
1,8
1,8
1,8
1,8
1,6
1,6
1,6

1 18,6
2
5,4
3
4,8
4
4,4
5
4,0
6
3,6
7
3,3
8
3,1
9
2,8
10 HIV/ AIDS
2,5
11
2,5
12
2,3
13
2,2
14
2,1
15 1,5
16
1,4
17
1,4
18
1,4
19
1,4
20
1,3

T (. 3 ) .

,
,
, .
,
, . ,
. ,
( )
,
(Chisholm et al. 2000).

30

Y 2001

,
.

.
,
(Quality of life
Instruments [QOL]) (Lehman et al. 1998). ,
(Orley
et al. 1998). (UK700 Group 1999).
,
. ,
, . ,
(UK700 group 1999).
.
,
(Mendlowicz & Stein 2000, Orley & Kuyken
1994).

. .
, . , . .
, , , ,
Alzheimer, . .
VI ICD-10,
. ,
.
, . ,
, . ,
.
, , , ,

( 3)
( 4).

, . , , , .
. ,
,
.
( 1.3). , .
. GBD 2000
1,9% 3,2% , 5,8% 9,5%
12 . .
GBD 2000
,
, . 4,4%
DALYs 11,9% - ,
. 15-44 , 8,6% DALYs. ,
. 2020,
, 5,7% ,
DALYs. DALYs
.
.
,
. (Lewinsohn et al. 1993).
.
, . 20%
, , (Thornicroft
& Sartorious 1993), .
, , 35%
60% 12 .
45 .
. 15 20% (Goodwin &Jamison 1990) ( ) . ,
.
,
, ,
. GBD 2000, 0,4%.
, ,
, 20 .

31

32

Y 2001

, , , , , , , , , . , , .
. ,
, , ,
,
.
( ) , .
, . ,
6 15,1%
(World Bank 1999).
1 3 , 1,2 .
2025, 1,6 .
1990,
1998.
8,4 2020 10 2030.
: 50%, 1,6 2,4 , 1,1 1990 4,2 2020 (Murray & Lopez
1997).

,
.
. 2.3
.
. ( ) 1,7% ,
GBD 2000. 2,8% 0,5%
.
, 5% .

(Jernigan et al. 2000; Riley & Marshall 1999; WHO 1999)
(WHO 2000b). ,
, .

. GBD (Murray & Lopez 1996a)
1,5% 3,5% DALYs.
( ) ( ), .
.

33

2.3 K

.







,
.



.


,

86%. 1,2,3.



1
2

3
4
5

6
7
8
9

41%,
22,5%
, 44%

.4

5

6.



,

.


,
-

7.



,

.




,

.8




,
.9

:
.

,

.
,

,



.
,




.

Huges JR et al. (1986). Prevalence of smoking among psychiatric outpatients. American Journal of Psychiatry, 143 : 993-997.
Goff DC et al. (1992). Cigarette smoking in schizophrenia : relationship to psychopathology and medication side-effects. American Journal of Psychiatry,
149: 1189-1194.
True WR et al. (1999). Common genetic vulnerability for nicotine and alcohol dependence in men. Archives of General Psychiatry, 56 : 655-661.
Lasser K et al (2000). Smoking and mental illness : a population-based prevalence study. Journal of the American Medical Association, 284 : 2606-2610.
Castellanos FX et al. (1994). Quantitative morphology of the caudate nucleus in attention deficit hyperactivity disorder. American Journal of Psychiatry,
151(12):1791-1796.
Pomerleau OF et al. (1995).Cigarette smoking in adult patients diagnosed with attention deficit hyperactivity disorder. Journal of Substance Abuse, 7(3): 363-368.
Goodman E, Capitman J (2000).Depressive symptoms and cigarette smoking among teens. Pediatrics 106(4) : 748-755.
Harris J et al. (2000). Changes in cigarette smoking among alcohol and drug misusers during inpatient detoxification. Addiction Biology : 5:443-450.
Barta A (2000). Tobacco use and smoking cessation in the psychiatric patient. Forschritte de Neurologie-Psychiatrie, 68: 80-92.

,
148 , 19
(Harwood et al 1998). , 18,4
, 2,7% .
,
1% (Collins & Lapsely 1996;
Rice et al. 1991). 1998,
51
, 35
(New Mexico Department of Health 2001). -

34

Y 2001

.
,
, . , , , . 0,4% 4%,
. GBD 2000 0,25%.
, C, HIV.
, 5 . HIV
20-80% . HIV,
(UNAIDS 2000).
( ) 0,4% GBD 2000.

98 (Harwood et al 1998).

.
. ,
.
, ,
.
,
, ,
, .
( ), , ,
, "" ,

, .

, , . , ,
(Leshner 1997; McLellan et al. 2000). , , .

,
. . , -

, -.

. ,
(""), .
, . , ,
. ,
, ,
.
, , , . .
,
,
.
GBD 2000 0,4%,
. 14
, (Ustun et al. 1999).
GBD, 1,1 %
DALYs 2,8% - . . 1991, 19 46 .
,
. :
, , . . (Pai & Kapur 1982). (Kulhara & Wig
1978; Thara & Eaton 1996). ,
, 2 63%
, 37% (Jablensky et al. 1992).

,
.
,
. ,
30% ,
(Radomsky et al. 1999). 10%
(Caldwell & Gottesman 1990). , 10 .

. ,

35

36

Y 2001

.
,
. ,
, ,
.
: ,
, ,
, . , , ,
(Senanayake & Roman 1993).
. . ,
. .
GBD 2000 37
.
, 50 . 80% , .
, , . GBD 2000 , 0,5% . , ,
. , , ,
.
, ,
.
, .

ALZHEIMER
Alzheimer .
Alzheimer ICD-10. , , , , , , . , , . Alzheimer , .
. ,
. Alzheimer 65
, . , (,
5 ).
, .
Alzheimer . 65 ,
,
(. . ). (1-5%), . GBD
2000, Alzheimer 0,6%.
60 5% 6%

. ,
Alzheimer, .
Alzheimer ,
. ,
,
, (Drouet et al. 2000, Cuajungco & Lees 1997).
GBD 2000, DALYs 0,84% -
2,0%. , , 20 .
Alzheimer (Rice et al. 1993),
(Brookmeyer & Gray 2000).
2000 536 1,75
.

OHTIKH KA
,
, , , . ,
.
,

. (
50-69), ( 35-49), ( 20-34),
( 20).
, , . 1% 3%, , 0,3%. ,
,
.
, (Sankar et al. 1998).
, ,
(Delange 2000).

. .
,

.

, ,
.
. ,
(The Surgeon General of the United States) (DHHS
2001) ,
, . ,

37

38

Y 2001

, .
, , , .
ICD-10 :
. (), (.. ).
, ,
. . ,
4% (Spagna et al. 2000). ,
, ( ICD-10), 2.2:
( DSM
-
IV, APA 1994), . ,

()
(%)
1
.

1-15
17,7
, 2
12-15
20,7
.
3

1-16
12,8

,
4
12-15
15,0

.
5
8,11,15
21,7
2.2. 6
1-15
22,5
,
7
1-15
21,0
10-20% .
1
Tadesse B et al. (1999). Childhood behavioural disorders in Ambo district,

Western Ethiopia: I. Prevalence estimates. Acta Psychiatrica Scandinavica,
.
100 (Suppl): 92-97.
2

Weyerer S et al. (1988). Prevalence and treatment of psychiatric disorders
in 3-14 year-old children: results of a representative field study in the small
rural town region of Traunstein, Upper Bavaria. Acta Psychiatrica
. ,
Scandinavica, 77: 290-296.
3
Indian Council of Medical Research (2001). Epidemiological study of child
, ,
and adolescent psychiatric disorders in urban and rural areas. New Delhi,
. ICMR (unpublished data).
, 4
Morita H et al. (1993). Psychiatric disorders in secondary school children.
, Journal of Child Psychology and Psychiatry, 34: 317-332.
.
5
Gomez - Beneyto M et al. (1994). Prevalence of mental disorders among

children in Valencia, Spain. Acta Psychiatrica Scandinavica, 89: 352-357.

6
Steinhausen HC et al. (1998). Prevalence of child and adolescent psychiatric

disorders: the Zurich Epidemiological Study. Acta Psychiatrica Scandinavica,
. 98: 262-271.
,
7
Shaffer D et al. (1996). The NIMH Diagnostic Interview Schedule for
, Children version 2.3 (DISC- 2.3): description acceptability, prevalence rates,
, and performance in the MECA study. Journal of the American Academy
of Child and Adolescent Psychiatry, 35: 865-877.
.

.
,
. ,
.
,
(Geerlings et al. 2000)).
(Kessler et al. 1994)
, 79% . , 21%
. ,
14% .
, .
.
(Zimmerman et al. 2000). , . , 30% 90%
(Gossop et al. 1998).
(65% Rachliesel et al. 1999).
(12-50%) .

, . .

. . 53
, , 15,1 100.000 1996. 24,0 100.000
6,8 100.000.
, 3,5 1.
30 , 39
1970-1996, ,
,
, .
, .
100 .
, 15 .
62% 17% , 5,3% , 2.4. : , ,
, . , . 3,4 100.000
14,0 100.000 34,0 100.000 .

39

40

Y 2001

, , . ( ), . , ,
. ,

. ,
( , . . ,
, , ).
, (.. ). , ,
(.. ),
(.. ).
(.. ) (. . ,
) (. . ) - . , , ,
(.. ).
.
15-34.
2.5, 15-34 .

. . 20 .
, , 814.000
2000. 1,3 DALYs GBD 2000.

A (%)

2.4
, 100 .
70
+61.9
60

+54.0

50
40
30
20
+13.2
10

+5.3
-5.3

0
-10

-14.3

-20
-30

-17.2
M
81-83/93-95

I
80/95

P
HA
I
K
O
79-81/93-95 80-82/96-98 80-82/95-97 80-82/95-97 88-90/96-98

2.5 H , E K. 15 - 34 . 1998.

( )

1
2

1 1
2
2

3
3

3
( )

(
)

( )

( )

1
2
3

1
2
3

1
2
3

, , , , , , , , , ,
, , , , , , , FYROM, , , , , , , , , , .

Cause of death statistics and vital rates, civil registration systems and alternative sources of information. World
Health Statistics Annual 1993, Geneva, WHO, 1994 (Section A/B: China 11-17)

,
. ,
.

(Rossow 2000).
, ,
.
, , (Wintemute et al. 1999). 54%
1997 (Rosenberg et al. 1999).
,
. ,
.

-

,
.

41

42

Y 2001

, , , ,
, . , .

, , , ,
, . , , ,
(Patel et al. 1999). , 2: 1 ,
3: 1 (Costello et al. 1996). 15
,
2,1: 1
, 1,4: 1 (Kohn et al. 1998).
,
(WHO International Consortium of Psychiatric Epidemiology 2000). 2.6
, .

A ( / )

2.6 E ,
.

2.0

1.5

1.0

0.5

0.0

A1

O4

HA5

Z6

Awas M et al. (1999). Major mental disorders in Butajira, Southern Ethiopia. Acta Psychiatrica Scandinavica, 100
(Suppl 397): 56-64.
2
Lindeman S et al. (2000). The 12-month prevalence and risk factors for major depressive episode in Finland:
representative sample of 5993 adults. Acta Psychiatrica Scandinavica, 102: 178-184.
3
Wittchen HU et al. (1998). Prevalence of mental disorders and psychological impairments in adolescents and
young adults. Psychological Medicine, 28: 109-126.
4
Bijl RV et al. (1998). Prevalence of Psychiatric disorders in the general population: results of the Netherlands
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Kessler RC et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States.
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Abas MA, Broadhead JC (1997). Depression and anxiety among women in an urban setting in Zimbabwe.
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of Clinical Epidemiologists. This survey questioned women about "severe physical violence"
akimi M et al. (2001). Silence for the sake of harmony: domestic violence and womens health in Central Java. Yogyakarta, Indonesia, Program for
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