iindaba

Intlungu ehlala ixesha elide yi-stress syndrome emva kokusweleka komntu amthandayo, apho umntu azive ethe gqolo, ebuhlungu kakhulu ixesha elide kunokuba bekulindelwe ngokwentlalo, ngokwenkcubeko okanye ngokwenkolo. Malunga ne-3 ukuya kwi-10 ekhulwini labantu baba nengxaki yokuba sentlungwini ixesha elide emva kokufelwa ngokwemvelo komntu abamthandayo, kodwa iziganeko ziba nkulu xa umntwana okanye iqabane lisifa, okanye xa umntu abamthandayo esifa ngequbuliso. Ukuxinezeleka, ukuxhalaba kunye nokuphazamiseka kwengxaki emva kokuphazamiseka kufuneka kuhlolwe kuvavanyo lweklinikhi. Unyango lwengqondo olusekelwe kubungqina kwintlungu lolona nyango luphambili. Usukelo kukunceda abaguli bayamkele into yokuba abantu babo ababathandayo abasekho ngonaphakade, baphile ubomi obunentsingiselo nobanelisayo ngaphandle komfi, yaye ngokuthe ngcembe baziphelise iinkumbulo zabo ngomfi.

Ityala
Umhlolokazi oneminyaka engama-55 ubudala watyelela ugqirha wakhe kwiinyanga ezili-18 emva kokufa komyeni wakhe ngequbuliso. Ukususela ekuswelekeni komyeni wakhe, intlungu yakhe ayizange iphele tu. Wayengayekanga ukucinga ngomyeni wakhe yaye wayengakholelwa ukuba akasekho. Kwanaxa ebesandul’ ukubhiyozela ukuphumelela kwentombi yakhe ekholejini, ubulolo nokulangazelela umyeni wakhe akuzange kuphele. Wayeka ukunxulumana nezinye izibini kuba kwakumenza buhlungu gqitha ukukhumbula ukuba umyeni wakhe akasekho. Wayelila de alale ubusuku ngabunye, ecinga ngokuphindaphindiweyo ngendlela awayefanele akubone ngayo kwangaphambili ukufa kwakhe, nendlela awayenqwenela ukufa ngayo. Wayenesifo seswekile kunye namaxesha amabini okudakumba okukhulu. Uvavanyo olongezelelweyo lubonakalise ukunyuka okuncinci kumanqanaba eswekile yegazi kunye ne-4.5kg (10lb) yokuzuza ubunzima. Ifanele ihlolwe ize iphathwe njani intlungu yomguli?

Ingxaki yeklinikhi
Oogqirha abanyanga abaguli abasentlungwini banethuba lokunceda, kodwa bahlala besilela ukuyithatha. Ezinye zezi zigulana zithwaxwa yintlungu ehlala ixesha elide. Intlungu yabo ixhaphakile kwaye inzulu, kwaye ihlala ixesha elide kunokuba uninzi lwabantu abafelweyo ludla ngokuqala ukuphinda lubandakanyeke ebomini kwaye intlungu iyadamba. Abantu abanengxaki yokukhathazeka ixesha elide banokubonisa intlungu ebuhlungu yeemvakalelo ezinxulumene nokufa komntu othandekayo, kwaye babe nobunzima bokubona nayiphi na intsingiselo yexesha elizayo emva kokuba umntu ehambile. Basenokuba nobunzima kubomi bemihla ngemihla yaye basenokuba neengcinga zokuzibulala okanye ukuziphatha. Abanye abantu bakholelwa ukuba ukufa komntu osondeleyo kubo kuthetha ukuba ubomi babo buphelile, yaye akukho nto ingako banokuyenza ngaloo nto. Basenokuzibhokoxa baze bacinge ukuba bafanele balufihle usizi lwabo. Abahlobo nentsapho nabo badandathekile ngenxa yokuba umguli ebecinga kuphela ngomfi yaye akanamdla ungako kulwalamano lwangoku nezinto ezenziwayo, yaye zisenokuxelela isigulana ukuba “silibale” size sidlulele phambili.
Ukuphazamiseka okuhlala ixesha elide kukuxilongwa okutsha, kwaye ulwazi malunga neempawu kunye nonyango alukaziwa ngokubanzi. Oogqirha banokungaqeqeshelwa ukuqaphela ukuphazamiseka kwexesha elide kwaye banokungazi ukuba banikezela njani ngonyango olusebenzayo okanye inkxaso esekelwe kubungqina. Ubhubhani we-COVID-19 kunye noncwadi olukhulayo malunga nokuxilongwa kokuphazamiseka kwexesha elide lunyuse ingqwalasela kwindlela abezonyango ekufuneka beyiqaphele kwaye baphendule ngayo kwintlungu kunye nezinye iingxaki zeemvakalelo ezinxulumene nokusweleka komntu othandekayo.
Kuhlaziyo lwe-11 lwe-International Statistical Classification of Diseases and Related Health Problems (ICD-11) ngo-2019, i-World Health Organization (WHO) kunye ne-American Psychiatric Association (American Psychiatric Association)
Ngo-2022, ushicilelo lwesihlanu lweNcwadana yoDiagnostic kunye neStatistical Manual yeMental Disorders (DSM-5) yongeza ngokwahlukileyo iindlela zokuxilonga ezisesikweni zokuphazamiseka kwentlungu ixesha elide. Amagama ebekade esetyenziswa ngaphambili abandakanya intlungu enzima, ukufelwa okuzingisileyo, kunye nentlungu ebuhlungu, yokugula, okanye intlungu engasonjululwanga. Iimpawu zentlungu ehlala ixesha elide iquka ukuqumba kakhulu, ukumlangazelela, okanye ukungcungcuthekisa ofileyo, ekhatshwa zezinye iimbonakaliso zentlungu eziqhubekayo, eziqatha, nezixhaphakileyo.
Iimpawu zokuphazamiseka kwexesha elide kufuneka ziqhubeke ixesha elide (≥6 iinyanga ngokwemiqathango ye-ICD-11 kunye ne-≥12 iinyanga ngokwemiqathango ye-DSM-5), kubangele uxinzelelo olubalulekileyo lweklinikhi okanye ukukhubazeka komsebenzi, kwaye ugqithise ukulindela kweqela lenkcubeko, inkolo, okanye intlalo yesigulane ngenxa yentlungu. I-ICD-11 inika imizekelo yeempawu eziphambili zokukhathazeka ngokweemvakalelo, ezifana nokudabuka, ukuziva unetyala, umsindo, ukungakwazi ukuva iimvakalelo ezintle, ukuphazamiseka ngokweemvakalelo, ukukhanyela okanye ubunzima bokuvuma ukufa komntu othandekayo, ukuziva ulahlekelwe yinxalenye yakho, kunye nokunciphisa inxaxheba kwintlalontle okanye eminye imisebenzi. I-DSM-5 i-criteria yokuxilonga i-diagnostic disorder disorder idinga ubuncinane ezintathu kwezi mpawu zisibhozo zilandelayo: intlungu enzulu yeemvakalelo, ukuphazamiseka, isithukuthezi esinzulu, ukulahlekelwa ukuqonda (ukutshatyalaliswa kwesazisi), ukungakholelwa, ukuphepha izinto ezikhumbuza abo babathandayo abaye bahamba ngonaphakade, ubunzima bokuphinda babandakanyeke kwimisebenzi kunye nobudlelwane, kunye nemvakalelo yokuba ubomi abunantsingiselo.
Uphando lubonisa ukuba umyinge we-3% ukuya kwi-10% yabantu abaye baba nesalamane esifa ngenxa yezizathu zemvelo bahlaselwa yintlungu ehlala ixesha elide, kwaye umlinganiselo uphindwe kaninzi kubantu abaye babulawa isalamane ngenxa yokuzibulala, ukubulawa, iingozi, iintlekele zemvelo, okanye ezinye oonobangela bequbuliso obungalindelekanga. Kuphononongo lwamayeza angaphakathi kunye neenkcukacha zeklinikhi yezempilo yengqondo, izinga elixeliweyo lalingaphezu kokuphindwe kabini kwezinga elichazwe kolu phando lungentla. Itheyibhile yoku-1 idwelisa izinto ezinobungozi bokuphazamiseka kwexesha elide kunye nezibonakaliso ezinokuthi zenzeke.

Ukuphulukana nomntu osondelelene naye ngokunzulu ngonaphakade kunokuba luxinzelelo kakhulu kwaye kudala uthotho lweenguqu ezibuhlungu ngokwasengqondweni nangokwentlalo ekufuneka lowo ufelweyo aziqhelanise nazo. Intlungu yintsabelo eqhelekileyo ekufelweni komntu omthandayo, kodwa ayikho indlela yehlabathi lonke yokuba buhlungu okanye ukuyamkela into yokwenene yokufa. Ngokuhamba kwexesha, abantu abaninzi abafelweyo bafumana indlela yokwamkela le nyaniso intsha baze baqhubeke nobomi. Njengoko abantu beziqhelanisa nokutshintsha kobomi, bahlala beguquguquka phakathi kokujongana nentlungu yeemvakalelo kunye nokuyibeka emva kwabo okwethutyana. Njengoko besenjenjalo, intlungu yentlungu iya iyancipha, kodwa ithi ngamaxesha athile ibe qatha yaye maxa wambi iba qatha, ngakumbi ngeentsuku zesikhumbuzo nangezinye izihlandlo ezikhumbuza abantu ngomfi.
Kubantu abanengxaki yokukhathazeka ixesha elide, nangona kunjalo, inkqubo yokulungelelanisa inokutshatyalaliswa, kwaye intlungu ihlala inamandla kwaye ixhaphake. Ukuphepha ngokugqithiseleyo izinto ezibakhumbuza ukuba abathandekayo babo bahambe ngonaphakade, kwaye ukuguquka ngokuphindaphindiweyo ukucinga imeko eyahlukileyo yimiqobo eqhelekileyo, njengokuba ukuzigxeka kunye nomsindo, ubunzima bokulawula iimvakalelo, kunye noxinzelelo oluqhubekayo. Ukuphazamiseka kwexesha elide kunxulunyaniswa nokwanda koluhlu lwezigulo zomzimba nezengqondo. Ukukhathazeka ixesha elide kunokubeka ubomi bomntu ebumnyameni, kwenze kube nzima ukwakha okanye ukugcina ulwalamano olunentsingiselo, kuchaphazela ukusebenza kwentlalo nobugcisa, ukuvelisa iimvakalelo zokungabi nathemba, neengcinga nokuziphatha kokuzibulala.

Isicwangciso kunye nobungqina

Ulwazi malunga nokusweleka kwamva nje kwesalamane kunye nempembelelo yako kufuneka ibe yinxalenye yengqokelela yembali yeklinikhi. Ukukhangela iirekhodi zonyango zokusweleka komntu othandekayo kunye nokubuza ukuba isigulane siqhuba njani emva kokufa kunokuvula incoko malunga nentlungu kunye nokuphindaphinda kwayo, ubude bexesha, ubukhulu, ukusasazeka, kunye nefuthe kumandla okusebenza kwesigulana. Uvavanyo lwezonyango kufuneka lubandakanye ukuphononongwa kweempawu zomzimba kunye neemvakalelo zesigulana emva kokufa komntu othandekayo, iimeko zangoku kunye nezidlulileyo zengqondo kunye neemeko zonyango, ukusetyenziswa kotywala kunye neziyobisi, iingcamango zokuzibulala kunye nokuziphatha, inkxaso yangoku yentlalo kunye nokusebenza, imbali yonyango, kunye nokuhlolwa kwesimo sengqondo. Intlungu ehlala ixesha elide ifanele iqwalaselwe ukuba kwiinyanga ezintandathu emva kokufa komntu othandekayo, intlungu yomntu isabuchaphazela kakhulu ubomi bakhe bemihla ngemihla.
Kukho izixhobo ezilula, eziqinisekisiweyo, ezinikwe isigulana ezifumanekayo zovavanyo olufutshane lokuphazamiseka kwentlungu ixesha elide. Eyona nto ilula yiNcwadana yeNgcaciso yeNgcaciso emifutshane (i-Questionnaire yeNgcaciso emfutshane; Uluhlu, i-0 ukuya kwi-10, kunye namanqaku aphezulu aphezulu abonisa imfuneko yokuphononongwa ngakumbi kwesifo esibuhlungu esihlala ixesha elide) Amanqaku aphezulu kune-4 (jonga isihlomelo esongezelelweyo, esifumaneka ngombhalo opheleleyo weli nqaku kwi-NEJM.org). Ukongeza, ukuba kukho izinto ze-13 zentlungu engapheliyo -13-R (Ixesha elide
Usizi-13-R; Inqaku le-≥30 libonisa iimpawu zokuphazamiseka kwexesha elide njengoko kuchazwe yi-DSM-5. Nangona kunjalo, udliwano-ndlebe lweklinikhi lusafuneka ukuze kuqinisekiswe isifo. Ukuba i-19-into ye-Inventory of Complicated Grief (I-Inventory of Complicated Grief; Uluhlu luyi-0 ukuya kwi-76, kunye namanqaku aphezulu abonisa iimpawu ezibuhlungu kakhulu ezibuhlungu ezide.) Amanqaku angaphezulu kwe-25 anokuthi abe yinkxwaleko ebangela ingxaki, kwaye isixhobo sibonakaliswe ukubeka iliso utshintsho kwixesha elide. I-Clinical Global Impression Scale, elinganiswe ngabagqirha kwaye igxininise kwiimpawu ezinxulumene nentlungu, yindlela elula nesebenzayo yokuvavanya ubunzima bentlungu ngexesha.
Udliwano-ndlebe lwezonyango kunye nezigulana ziyacetyiswa ukuba zenze ukuxilongwa kokugqibela kokuphazamiseka kwexesha elide, kubandakanywa ukuxilongwa okungafaniyo kunye nesicwangciso sonyango (jonga iTheyibhile 2 yesikhokelo seklinikhi kwimbali yokufa kwezihlobo kunye nabahlobo kunye nodliwano-ndlebe lweklinikhi ngeempawu zokuphazamiseka kwexesha elide). Ukuxilongwa ngokwahlukileyo kokuphazamiseka kwexesha elide kubandakanya intlungu eqhelekileyo eqhubekayo kunye nezinye izifo zengqondo ezinokufunyaniswa. Ukukhathazeka kwexesha elide kunokudibaniswa nezinye iziphazamiso, ngakumbi ukudakumba okukhulu, ukuphazamiseka kwengxaki emva kokuphazamiseka (PTSD), kunye neengxaki zokuxhalabisa; Ii-Comorbidities zisenokuthi zandulela ukuqala kokuphazamiseka kwexesha elide, kwaye zinokwandisa ukuchaphazeleka kwintlungu ehlala ixesha elide. Uluhlu lwemibuzo yezigulana lunokukhangela izinto eziye zadibana nazo, kubandakanywa notyekelo lokuzibulala. Omnye umlinganiselo ocetyiswayo nosetyenziswa ngokubanzi wengcamango yokuzibulala kunye nokuziphatha sisiGaba sokuKhawuka kokuzibulala kweColumbia (ebuza imibuzo efana nothi “Ngaba wakha wanqwenela ukuba ubufile, okanye ubuya kulala ungaze uvuke?”). Kwaye "Ngaba ukhe waba neengcinga zokuzibulala?" ).

Kukho ukudideka kwiingxelo zeendaba kunye naphakathi kwabanye abaqeqeshi bezempilo malunga nokwahlukana phakathi kokuphazamiseka kwexesha elide kunye nentlungu eqhelekileyo eqhubekayo. Oku kubhideka kuyaqondakala ngenxa yokuba intlungu kunye nokukhumbula umntu othandekayo emva kokufa kwabo kunokuqhubeka ixesha elide, kwaye nayiphi na impawu zentlungu engapheliyo edweliswe kwi-ICD-11 okanye i-DSM-5 inokuqhubeka. Intlungu eyongezelelekileyo ihlala isenzeka ngezikhumbuzo, iiholide zosapho, okanye izikhumbuzo zokusweleka komntu omthandayo. Xa isigulana sibuzwa ngomfi, iimvakalelo zinokuvuswa, kuquka iinyembezi.
Oogqirha kufuneka baqaphele ukuba ayizizo zonke iintlungu eziqhubekayo ezibonisa ukuxilongwa kokuphazamiseka kwexesha elide. Kwintlungu ehlala ixesha elide, iingcinga kunye neemvakalelo malunga nomfi kunye nonxunguphalo lweemvakalelo olunxulunyaniswa nentlungu lunokungena engqondweni, luzingise, lube qatha kwaye lugqugqise kangangokuba luphazamise amandla omntu okuthatha inxaxheba kubudlelwane obunentsingiselo nemisebenzi, nkqu nabantu ababaziyo nababathandayo.

Olona sukelo lusisiseko lonyango lwesifo esibuhlungu esihlala ixesha elide kukunceda abaguli bafunde ukwamkela ukuba abo babathandayo abasekho ngonaphakade, ukuze baphile ubomi obunentsingiselo nobanelisayo ngaphandle kwalowo uswelekileyo, ziyeke iinkumbulo neengcinga zomntu ofileyo. Ubungqina obuvela kwizilingo ezininzi ezilawulwa ngokungahleliwe ngokuthelekisa amaqela ongenelelo asebenzayo kunye nolawulo lokulinda (oko kukuthi, izigulane ezabelwa ngokungenamkhethe ukufumana ungenelelo olusebenzayo okanye zibekwe kuluhlu lokulinda) zixhasa ukuphumelela kwexesha elifutshane, ukungenelela kwengqondo ekujoliswe kuyo kwaye incoma kakhulu unyango kwizigulane. Uhlalutyo lwe-meta lwezilingo ze-22 kunye nabathathi-nxaxheba be-2,952 lubonise ukuba unyango lwe-grid-focusing cognitive behavioral therapy lunempembelelo ephakathi ukuya enkulu ekunciphiseni iimpawu zentlungu (ubungakanani besiphumo esiqhelekileyo esilinganiswe ngokusebenzisa i-Hedges 'G yayiyi-0.65 ekupheleni kokungenelela kunye ne-0.9 ekulandeleni).
Unyango lwentlungu ehlala ixesha elide lujolise ekuncedeni izigulana zamkele ukufa komntu esimthandayo zize ziphinde ziphile ubomi obunenjongo. Ubuhlungu bexesha elide I-Disorder therapy yindlela ebanzi egxininisa ukuphulaphula ngengqondo esebenzayo kwaye ibandakanya udliwano-ndlebe olukhuthazayo, i-psychoeducation esebenzayo, kunye nochungechunge lwemisebenzi yamava ngokulandelelana okucwangcisiweyo kwiiseshoni ze-16, kanye ngeveki. Unyango lunyango lokuqala oluphuhlisiwe ngenxa yokuphazamiseka kwexesha elide kwaye okwangoku lunobungqina obuqinileyo. Iindlela ezininzi zokwelapha zengqondo-zokuziphatha ezithatha indlela efanayo kunye nokugxila kwintlungu nazo zibonise ukusebenza kakuhle.
Amanyathelo okungenelela kwintlungu ehlala ixesha elide ajolise ekuncedeni izigulana ukuba zivumelane nokusweleka komntu esimthandayo kunye nokujongana nemiqobo abadibana nayo. Uninzi longenelelo lubandakanya ukunceda izigulane ukuba ziphinde zikwazi ukukhokela ubomi obonwabileyo (njengokufumana izinto ezinomdla oqinileyo okanye imilinganiselo ephambili kunye nokuxhasa ukuthatha kwabo inxaxheba kwimisebenzi ehambelanayo). Itheyibhile 3 idwelisa iziqulatho kunye neenjongo zolu nyango.

Izilingo ezithathu ezilawulwa ngokungenamkhethe ezivavanya ukolulwa konyango lokuphazamiseka kwentlungu xa kuthelekiswa nonyango olusebenzayo lokudakumba lubonise ukuba ukongezwa konyango lokuphazamiseka kwentlungu kwakuphezulu kakhulu. Iziphumo zolingo lolingo zicebise ukuba ukongezwa konyango lokuphazamiseka kwentlungu kwakuphezulu kunonyango loluntu lokudakumba, kwaye ulingo lokuqala olwalandelayo lwaqinisekisa oku kufunyanisiweyo, lubonisa inqanaba lokuphendula leklinikhi le-51% ukongezwa konyango lokuphazamiseka kwentlungu. Ireyithi yempendulo yeklinikhi yonyango oluphakathi kwabangama-28% (P = 0.02) (impendulo yeklinikhi ichazwa ngokuthi "iphuculwe kakhulu" okanye "iphuculwe kakhulu" kwi-Clinical Composite Impression Scale). Ulingo lwesibini lwaqinisekisa ezi ziphumo kubantu abadala (iminyaka yobudala, iminyaka eyi-66), apho i-71% yezigulane ezifumana unyango olude lwentlungu kunye ne-32% efumana unyango phakathi kwabantu iphumelele impendulo yeklinikhi (P <0.001).
Ulingo lwesithathu, uphononongo oluqhutywe kumaziko olingo amane, luthelekisa i-citalopram ye-antidepressant kunye ne-placebo ngokudibanisa nonyango olude lwentlungu okanye unyango lweklinikhi olugxile ekuzileni; Iziphumo zibonise ukuba izinga lokuphendula lonyango lwexesha elide lwentlungu edibeneyo kunye ne-placebo (i-83%) yayiphezulu kuneyonyango yonyango egxininisekileyo edibeneyo kunye ne-citalopram (69%) (P = 0.05) kunye ne-placebo (54%) (P <0.01). Ukongeza, akukho mahluko ekusebenzeni kakuhle phakathi kwe-citalopram kunye ne-placebo xa isetyenziswe ngokudityaniswa nonyango olugxile ekuzileni okanye kunyango lwexesha elide lokuphazamiseka kwentlungu. Nangona kunjalo, i-citalopram idityaniswe nonyango lwexesha elide lokuphazamiseka kwentlungu yanciphisa kakhulu iimpawu zokudakumba, ngelixa i-citalopram idityaniswe nonyango olugxile ekuzilweni lwekliniki aluzange luyenze.
Ubuhlungu bexesha elide Unyango lwe-Disorder therapy lubandakanya isicwangciso sonyango esandisiweyo sonyango esisetyenziselwa i-PTSD (ekhuthaza isigulane ukuba siqhubele phambili ukufa komntu othandekayo kunye nokunciphisa ukuphepha) kwimodeli ephethe intlungu ehlala ixesha elide njengengxaki yokudandatheka emva kokufa. Ungenelelo lukwabandakanya ukomeleza ubudlelwane, ukusebenza ngaphakathi kwemida yemilinganiselo yobuqu kunye neenjongo zobuqu, kunye nokuphucula imvakalelo yokunxibelelana nomntu obhubhileyo. Ezinye iinkcukacha zibonisa ukuba unyango lwe-cognitive-behavioral lwe-PTSD lusenokungasebenzi kakuhle ukuba alugxininisi kwintlungu, kunye nokuba izicwangciso zokuvezwa ezifana ne-PTSD zinokusebenza ngeendlela ezahlukeneyo ekwandiseni ukuphazamiseka kwentlungu. Kukho iindlela ezininzi zonyango ezigxile lusizi ezisebenzisa unyango olufanayo lokuziphatha kwaye lusebenza kubantu kunye namaqela kunye nokuphazamiseka kwexesha elide ebantwaneni.
Kubagqirha abangakwaziyo ukubonelela ngononophelo olusekelwe kubungqina, sincoma ukuba bathumele izigulane xa kunokwenzeka kwaye balandele izigulane ngeveki okanye ngeveki nganye, njengoko kufunekayo, usebenzisa iindlela ezilula zokuxhasa ezijoliswe kwintlungu (Itheyibhile 4). I-Telemedicine kunye ne-self-directed therapy kwi-intanethi inokuba yindlela esebenzayo yokuphucula ukufikelela kukhathalelo, kodwa inkxaso ye-asynchronous evela kwiingcali zonyango iyadingeka kwizifundo zeendlela zonyango ezizikhokelayo, ezinokuthi zibe yimfuneko ukwandisa iziphumo zonyango. Kwizigulane ezingaphenduliyo kwi-psychotherapy esekelwe kubungqina bokuphazamiseka kwexesha elide lentlungu, ukuvavanywa kwakhona kufuneka kuqhutywe ukuchonga ukugula ngokomzimba okanye kwengqondo enokuthi ibangele iimpawu, ngakumbi ezo zinokujongwa ngempumelelo ngeendlela ezijoliswe kuzo, ezifana ne-PTSD, ukudandatheka, ukuxhalaba, ukuphazamiseka kokulala, kunye nokuphazamiseka kokusetyenziswa kweziyobisi.

Kwizigulane ezineempawu ezibuthathaka okanye ezingahlangabezani nomqobo, kwaye okwangoku azikwazi ukufikelela kunyango olusekelwe kubungqina bokuphazamiseka kwexesha elide lentlungu, oogqirha banokunceda ekulawuleni usizi oluxhasayo. Uluhlu lwesi-4 ludwelisa iindlela ezilula zokusebenzisa olu nyango.
Ukuphulaphula kunye nokugcina intlungu kwintsilelo zizinto ezisisiseko. Imfundo yengqondo echaza ukuphazamiseka kwexesha elide, unxulumano lwayo kunye nentlungu eqhelekileyo, kunye nento enokunceda idla ngokunika izigulana uxolo lwengqondo kwaye inokubanceda bazive bengamalolo kwaye banethemba lokuba uncedo luyafumaneka. Ukubandakanya amalungu entsapho okanye abahlobo abasenyongweni kwimfundo yezengqondo malunga nokuphazamiseka okuhlala ixesha elide kunokuphucula amandla abo okubonelela ngenkxaso novelwano kumntu ogulayo.
Ukwenza kucace kwizigulane ukuba injongo yethu kukuqhubela phambili inkqubo yendalo, ukubanceda bafunde ukuhlala ngaphandle komfi, kunye nokujongana nemiba ephazamisa le nkqubo kunokunceda izigulane zithathe inxaxheba kunyango lwazo. Oogqirha banokukhuthaza izigulane kunye neentsapho zabo ukuba zamkele intlungu njengempendulo yendalo yokusweleka komntu othandekayo, kwaye bangacebisi ukuba intlungu iphelile. Kubalulekile ukuba izigulana zingoyiki ukuba ziya kucelwa ukuba ziluyeke unyango ngokulibala, ukuqhubela phambili okanye ukushiya ngasemva abo babathandayo. Oogqirha banokunceda abaguli baqonde ukuba ukuzama ukuhlengahlengisa isibakala sokuba umntu omthandayo uswelekile kunokunciphisa intlungu yabo kuze kudale imvakalelo eyanelisayo yokuqhubeka benxibelelana nomntu ofileyo.

Domain of ukungaqiniseki
Okwangoku akukho zifundo zaneleyo ze-neurobiological ezicacisa i-pathogenesis yokuphazamiseka kwexesha elide lentlungu, akukho ziyobisi okanye ezinye iindlela zonyango eziye zaboniswa ukuba zisebenza kwiimpawu zokuphazamiseka kwexesha elide kwiimvavanyo zeklinikhi ezilindelekileyo, kwaye akukho machiza avavanywe ngokupheleleyo. Uphononongo olunye kuphela olulindelekileyo, olungakhethiyo, olulawulwa yi-placebo lwechiza lufunyenwe kuncwadi, kwaye njengoko kukhankanyiwe ngaphambili, olu phononongo aluzange lubonise ukuba i-citalopram yayisebenza kakuhle ekwandiseni iimpawu zokuphazamiseka kwentlungu, kodwa xa idityaniswa nokwandisa unyango lwesifo sosizi, ibe nempembelelo enkulu kwiimpawu ezidityanisiweyo zokudakumba. Ngokucacileyo, uphando olungakumbi luyafuneka.
Ukuze unqume ukusebenza konyango lwedijithali, kuyimfuneko ukuqhuba iimvavanyo kunye namaqela alawulayo afanelekileyo kunye namandla aneleyo ezibalo. Ukongeza, izinga lokuxilongwa kwentlungu ehlala ixesha elide lihlala lingaqinisekanga ngenxa yokungabikho kwezifundo ezifanayo ze-epidemiological kunye nokwahluka okubanzi kumazinga okuxilongwa ngenxa yeemeko ezahlukeneyo zokufa.