nkhani

Chisoni chokhalitsa ndi matenda ovutika maganizo pambuyo pa imfa ya wokondedwa, pamene munthuyo amakhala ndi chisoni chosalekeza kwa nthawi yaitali kuposa momwe amayembekezera chifukwa cha chikhalidwe, chikhalidwe, kapena chipembedzo. Pafupifupi 3 mpaka 10 peresenti ya anthu amakhala ndi vuto lachisoni kwa nthaŵi yaitali pambuyo pa imfa yachibadwa ya wokondedwa, koma zochitika zimachuluka pamene mwana kapena wokondedwa wamwalira, kapena pamene wokondedwa wamwalira mwadzidzidzi. Kupsinjika maganizo, nkhawa komanso kupsinjika maganizo pambuyo pa zoopsa ziyenera kuyesedwa pakuwunika kwachipatala. Psychotherapy yozikidwa paumboni yachisoni ndiyo chithandizo choyambirira. Cholinga chake ndi kuthandiza odwala kuvomereza kuti okondedwa awo apita kwamuyaya, kukhala ndi moyo watanthauzo ndi wokhutiritsa popanda wakufayo, ndi kuthetsa pang’onopang’ono kukumbukira wakufayo.

Nkhani
Mayi wina wamasiye wazaka 55 anapita kwa dokotala wake miyezi 18 mwamuna wake atamwalira mwadzidzidzi chifukwa cha mtima. Kuyambira nthawi imene mwamuna wake anamwalira, chisoni chake sichinachepe. Iye sanasiye kuganizira za mwamuna wake ndipo sanakhulupirire kuti wapita. Ngakhale pamene anakondwerera posachedwapa pamene mwana wake wamkazi wamaliza maphunziro awo ku koleji, kusungulumwa kwake ndi kulakalaka mwamuna wake sizinathe. Anasiya kucheza ndi mabanja ena chifukwa zinamumvetsa chisoni kwambiri kukumbukira kuti mwamuna wake kulibe. Ankalira mpaka kugona usiku uliwonse, akuganizira mobwereza bwereza za mmene akanaoneratu imfa yake, ndiponso mmene ankafunira akanafa. Anali ndi matenda a shuga komanso kuvutika maganizo kwakukulu kawiri. Kuwunika kwina kunawonetsa kuwonjezeka pang'ono kwa shuga m'magazi ndi 4.5kg (10lb) kulemera. Kodi chisoni cha wodwalayo chiyenera kuyesedwa bwanji ndi kuthandizidwa?

Vuto lachipatala
Madokotala omwe amathandizira odwala omwe ali ndi chisoni amakhala ndi mwayi wothandizira, koma nthawi zambiri amalephera kutero. Ena mwa odwalawa amakhala ndi vuto lachisoni kwa nthawi yayitali. Chisoni chawo n’chofalikira ndiponso chokulirapo, ndipo chimatenga nthaŵi yaitali kuposa mmene anthu ambiri ofedwa amayambira kuyambiranso moyo wake ndipo chisonicho chimatha. Anthu amene ali ndi vuto lachisoni kwa nthaŵi yaitali angasonyeze kuwawa koopsa kwa m’maganizo kogwirizana ndi imfa ya wokondedwa, ndipo amavutika kulingalira tanthauzo la m’tsogolo munthuyo atachoka. Akhoza kukumana ndi zovuta pamoyo watsiku ndi tsiku ndipo angakhale ndi maganizo ofuna kudzipha. Anthu ena amakhulupirira kuti imfa ya munthu amene amayandikana naye kwambiri imatanthauza kuti moyo wawo watha, ndipo palibe chimene angachite kuti athetse vutoli. Angakhale odziuma mtima ndi kuganiza kuti abise chisoni chawo. Mabwenzi ndi achibale nawonso amavutika maganizo chifukwa chakuti wodwalayo wakhala akungoganizira za wakufayo ndipo alibe chidwi kwenikweni ndi maunansi ndi zochita za masiku ano, ndipo angauze wodwalayo kuti “aiwale” n’kupitiriza.
Chisoni chokhalitsa ndi matenda atsopano, ndipo chidziwitso chokhudza zizindikiro zake ndi chithandizo chake sichinadziwikebe. Madokotala sangaphunzitsidwe kuzindikira vuto lachisoni lomwe limatenga nthawi yayitali ndipo sangadziwe momwe angaperekere chithandizo choyenera kapena chithandizo chochokera ku umboni. Mliri wa COVID-19 komanso mabuku omwe akuchulukirachulukira onena za matenda obwera chifukwa chachisoni kwa nthawi yayitali awonjezera chidwi cha momwe asing'anga amayenera kuzindikira ndikuyankhira chisoni ndi mavuto ena am'maganizo okhudzana ndi imfa ya wokondedwa.
Mu 11th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) mu 2019, World Health Organisation (WHO) ndi American Psychiatric Association (American Psychiatric Association)
Mu 2022, kope lachisanu la Diagnostic and Statistical Manual of Mental Disorders (DSM-5) padera linawonjezera njira zodziwira matenda okhalitsa achisoni. Mawu omwe amagwiritsidwa ntchito m'mbuyomu akuphatikizapo chisoni chovuta, kuferedwa kosalekeza, komanso kupwetekedwa mtima, matenda, kapena chisoni chosathetsedwa. Zizindikiro za vuto lachisoni lomwe limatenga nthawi yayitali ndi monga kulakalaka kwambiri, kulira, kapena kuvutitsa wakufayo, limodzi ndi mawonetseredwe ena osalekeza, amphamvu, komanso ofala.
Zizindikiro za kusokonezeka kwachisoni kwanthawi yayitali ziyenera kukhalapo kwa nthawi yayitali (≥ miyezi 6 molingana ndi njira za ICD-11 ndi ≥miyezi 12 molingana ndi njira za DSM-5), zimayambitsa kupsinjika kwakukulu kapena kuwonongeka kwa ntchito, ndikupitilira zomwe zimayembekeza za chikhalidwe, chipembedzo, kapena gulu la wodwalayo chifukwa chachisoni. ICD-11 imapereka zitsanzo za zizindikiro zazikulu za kupsinjika maganizo, monga chisoni, kudziimba mlandu, mkwiyo, kulephera kukhala ndi maganizo abwino, kukhumudwa maganizo, kukana kapena kuvutika kuvomereza imfa ya wokondedwa, kumva kutaya gawo lanu, ndi kuchepetsa kutenga nawo mbali pazochitika zamagulu kapena zochitika zina. Njira zodziwira matenda a DSM-5 pazovuta zanthawi yayitali zimafuna zosachepera zitatu mwa zizindikiro zisanu ndi zitatu zotsatirazi: kupweteka kwambiri m'maganizo, dzanzi, kusungulumwa kwambiri, kutaya chidziwitso (kuwonongeka kwa chidziwitso), kusakhulupirira, kupewa zinthu zomwe zimawakumbutsa za okondedwa omwe apita kwamuyaya, kuvutika kuchitanso ntchito ndi maubwenzi, ndi kumverera kuti moyo ulibe tanthauzo.
Kafukufuku akusonyeza kuti pafupifupi 3% mpaka 10% ya anthu amene wachibale amamwalira chifukwa chachibadwa amakhala ndi vuto lachisoni kwa nthawi yaitali, ndipo chiwerengerochi chimakhala chokwera kangapo mwa anthu omwe achibale awo amafa chifukwa cha kudzipha, kupha, ngozi, masoka achilengedwe, kapena zifukwa zina mwadzidzidzi. Pakufufuza zachipatala chamkati ndi deta yachipatala cha umoyo wamaganizo, mlingo womwe unanenedwa unali woposa kawiri mlingo womwe unanenedwa mu kafukufuku pamwambapa. Gulu 1 limatchula zifukwa zomwe zimayambitsa kusokonezeka kwachisoni kwanthawi yayitali komanso zomwe zingayambitse vutoli.

Kutaya munthu amene mumamukonda kwamuyaya kungakhale kodetsa nkhawa kwambiri ndipo kungayambitse kusintha kwakukulu m'maganizo ndi m'makhalidwe kumene wofedwayo ayenera kuzolowera. Chisoni ndicho kachitidwe kofala pa imfa ya wokondedwa, koma palibe njira yapadziko lonse yochitira chisoni kapena kuvomereza chenicheni cha imfayo. M’kupita kwa nthaŵi, ambiri ofedwa amapeza njira yovomerezera chenicheni chatsopanochi ndi kupitiriza ndi moyo wawo. Pamene anthu amasintha kusintha kwa moyo, nthawi zambiri amasinthasintha pakati pa kukumana ndi zowawa zamaganizo ndikuzisiya kwa kanthawi. Akamatero, chisonicho chimachepa, koma chimangokulirakulirabe ndipo nthawi zina chimakula kwambiri, makamaka pa zikondwerero ndi zochitika zina zimene zimakumbutsa anthu za wakufayo.
Komabe, kwa anthu omwe ali ndi vuto lachisoni kwa nthawi yayitali, njira yosinthira ikhoza kuthetsedwa, ndipo chisoni chimakhalabe chokulirapo komanso chofalikira. Kupewa kwambiri zinthu zomwe zimawakumbutsa kuti okondedwa awo apita kwamuyaya, ndipo kutembenukira mobwerezabwereza kuti aganizire zochitika zosiyana ndizo zopinga zofala, monga kudziimba mlandu ndi mkwiyo, kuvutika kulamulira maganizo, ndi kupsinjika maganizo kosalekeza. Kusokonezeka kwachisoni kwanthawi yayitali kumalumikizidwa ndi kuchuluka kwa matenda osiyanasiyana amthupi ndi m'maganizo. Kusokonezeka kwachisoni kwa nthawi yaitali kungapangitse moyo wa munthu kukhala wodekha, kupangitsa kukhala kovuta kupanga kapena kusunga maubwenzi opindulitsa, kusokoneza kagwiridwe ka ntchito ka anthu, kutulutsa malingaliro opanda chiyembekezo, ndi malingaliro odzipha ndi khalidwe.

Njira ndi umboni

Zambiri zokhudza imfa yaposachedwapa ya wachibale ndi zotsatira zake ziyenera kukhala mbali ya mbiri yachipatala. Kufufuza zolemba zachipatala za imfa ya wokondedwa ndi kufunsa momwe wodwalayo akuyendera pambuyo pa imfa kungatsegule kukambirana zachisoni ndi kuchuluka kwake, nthawi, mphamvu, kufalikira, ndi momwe wodwalayo amatha kugwira ntchito. Kuwunika kwachipatala kuyenera kuphatikizapo kuwunika momwe wodwalayo alili m'thupi ndi m'maganizo pambuyo pa imfa ya wokondedwa wake, matenda a maganizo amakono ndi akale, kumwa mowa ndi mankhwala osokoneza bongo, malingaliro odzipha ndi makhalidwe, chithandizo chamakono ndi momwe amagwirira ntchito, mbiri ya chithandizo, ndi kufufuza momwe maganizo ake alili. Kusokonezeka kwachisoni kwautali kuyenera kuganiziridwa ngati miyezi isanu ndi umodzi pambuyo pa imfa ya wokondedwa, chisoni cha munthuyo chikukhudzabe kwambiri moyo wawo watsiku ndi tsiku.
Pali zida zosavuta, zovomerezeka bwino, zopatsa odwala zomwe zilipo zowunikira mwachidule za vuto lachisoni lomwe limatenga nthawi yayitali. Chosavuta kwambiri ndi mafunso asanu achidule a Chisoni (Funso Lachidule la Chisoni; Range, 0 mpaka 10, ndi chiwerengero chapamwamba chosonyeza kufunikira kwa kuunikanso kwa nthawi yayitali yachisoni) Zolemba zapamwamba kuposa 4 (onani zowonjezera zowonjezera, zomwe zilipo ndi malemba onse a nkhaniyi pa NEJM.org). Kuphatikiza apo, ngati pali zinthu 13 za Chisoni Chokhalitsa -13-R (Yotalika
Chisoni-13-R; Kuchuluka kwa ≥30 kumawonetsa zizindikiro za kusokonezeka kwachisoni kwanthawi yayitali monga momwe DSM-5 imafotokozera. Komabe, kuyankhulana kwachipatala kumafunikabe kuti atsimikizire matendawa. Ngati 19-item Inventory of Complicated Grief (Inventory of Complicated Grief; Mtunduwu ndi 0 mpaka 76, ndi chiwerengero chapamwamba chomwe chimasonyeza zizindikiro zachisoni chautali kwambiri.) Zolemba pamwamba pa 25 zikhoza kukhala zovuta zomwe zimayambitsa vutoli, ndipo chidacho chimatsimikiziridwa kuti chiyang'anire kusintha kwa nthawi. The Clinical Global Impression Scale, yomwe imayesedwa ndi madokotala ndipo imayang'ana kwambiri zizindikiro zomwe zimagwirizanitsidwa ndi chisoni, ndi njira yosavuta komanso yothandiza yowunika kuopsa kwa chisoni pakapita nthawi.
Kuyankhulana kwachipatala ndi odwala kumalimbikitsidwa kuti adziwe kuti ali ndi vuto lachisoni kwanthawi yayitali, kuphatikiza kuzindikirika kosiyana ndi dongosolo lamankhwala (onani Table 2 kuti mupeze chiwongolero chachipatala pa mbiri ya imfa ya achibale ndi abwenzi komanso zoyankhulana zachipatala kuti mupeze zizindikiro zanthawi yayitali yachisoni). Kuzindikira kosiyanitsidwa kwa vuto lachisoni kwanthawi yayitali kumaphatikizapo chisoni chosalekeza komanso matenda ena am'maganizo. Kusokonezeka kwachisoni kwa nthawi yaitali kungagwirizane ndi zovuta zina, makamaka kuvutika maganizo kwakukulu, PTSD, ndi matenda ovutika maganizo; Matenda a comorbidities angayambitsenso kuyambika kwa vuto lachisoni kwa nthawi yayitali, ndipo angapangitse kuti munthu akhale ndi vuto lachisoni kwa nthawi yayitali. Mafunso a odwala amatha kuyang'ana za comorbidities, kuphatikizapo chizolowezi chofuna kudzipha. Muyeso umodzi wovomerezeka ndi wogwiritsidwa ntchito mofala wa malingaliro odzipha ndi khalidwe la Columbia Suicide Severity Rating Scale (lomwe limafunsa mafunso onga akuti “Kodi munalakalaka mutafa, kapena kuti mukanagona osadzuka?”). Ndipo "Kodi mwakhala ndi malingaliro ofuna kudzipha?" ).

Pali chisokonezo m'malipoti azama TV komanso pakati pa akatswiri ena azachipatala ponena za kusiyana pakati pa vuto lachisoni lalitali ndi chisoni chosalekeza. Chisokonezochi ndi chomveka chifukwa chisoni ndi mphuno ya wokondedwa pambuyo pa imfa yawo ikhoza kukhalapo kwa nthawi yaitali, ndipo zizindikiro zilizonse za matenda achisoni omwe amalembedwa mu ICD-11 kapena DSM-5 akhoza kupitirira. Chisoni chokulirapo nthawi zambiri chimachitika pazikumbukiro, tchuthi chabanja, kapena zikumbutso za imfa ya wokondedwa. Pamene wodwala afunsidwa za wakufayo, maganizo angadzutse, kuphatikizapo misozi.
Madokotala ayenera kuzindikira kuti sikukhala ndi chisoni konse komwe kumawonetsa kuti munthu ali ndi vuto lachisoni kwa nthawi yayitali. Pakusokonezeka kwachisoni kwanthawi yayitali, malingaliro ndi malingaliro okhudza wakufayo komanso kupsinjika kwamalingaliro komwe kumakhudzana ndi chisoni kumatha kutenga ubongo, kulimbikira, kukhala kokulirapo komanso kufalikira kotero kuti zimasokoneza kuthekera kwa munthuyo kutenga nawo mbali mu ubale watanthauzo ndi zochitika, ngakhale ndi anthu omwe amawadziwa ndi kuwakonda.

Cholinga chachikulu cha chithandizo cha matenda achisoni chautali ndicho kuthandiza odwala kuphunzira kuvomereza kuti okondedwa awo apita kwamuyaya, kuti akhale ndi moyo watanthauzo ndi wokhutiritsa popanda munthu amene wamwalirayo, ndi kusiya zikumbukiro ndi malingaliro a munthu amene wamwalirayo. Umboni wochokera ku mayesero angapo olamulidwa mwachisawawa poyerekeza ndi magulu ochitapo kanthu ndi maulamuliro odikirira (ie, odwala mwachisawawa omwe amaperekedwa kuti alandire chithandizo chogwira ntchito kapena kuikidwa pamndandanda wodikirira) amathandizira kuti pakhale kuthandizira kwanthawi yayitali, kutsata njira za psychotherapy ndipo amalimbikitsa kwambiri chithandizo kwa odwala. Kuwunika kwa mayeso 22 ndi otenga nawo gawo 2,952 kunawonetsa kuti chithandizo choyang'ana pa gridi chinali ndi zotsatira zochepetsetsa pakuchepetsa zizindikiro zachisoni (makulidwe okhazikika omwe amayezedwa pogwiritsa ntchito Hedges 'G anali 0.65 kumapeto kwa kulowererapo ndi 0.9 pakutsata).
Chithandizo cha matenda achisoni chokhalitsa chimagogomezera kuthandiza odwala kuvomereza imfa ya wokondedwa ndi kukhalanso ndi moyo watanthauzo. Thandizo la Chisoni Chotalikirapo ndi njira yokwanira yomwe imagogomezera kumvetsera mwachidwi komanso kumaphatikizapo kuyankhulana kolimbikitsa, maphunziro okhudzana ndi psychoeducation, ndi mndandanda wa zochitika zomwe zinakonzedwa motsatizana ndi magawo a 16, kamodzi pa sabata. Chithandizochi ndi chithandizo choyamba chomwe chimapangidwa chifukwa chazovuta zachisoni chomwe chatenga nthawi yayitali ndipo pakadali pano chili ndi umboni wamphamvu kwambiri. Thandizo lachidziwitso-makhalidwe angapo omwe amatenga njira yofananira ndikuganizira zachisoni awonetsanso mphamvu.
Njira zothandizira odwala omwe ali ndi chisoni kwanthawi yayitali amayang'ana kwambiri kuthandiza odwala kuti azindikire imfa ya wokondedwa wawo komanso kuthana ndi zopinga zomwe amakumana nazo. Zothandizira zambiri zimaphatikizaponso kuthandiza odwala kuti ayambenso kukhala ndi moyo wosangalala (monga kupeza zokonda zamphamvu kapena mfundo zazikuluzikulu ndikuthandizira kutenga nawo mbali pazochitika zokhudzana nazo). Gulu 3 likuwonetsa zomwe zili ndi zolinga za mankhwalawa.

Mayesero atatu oyendetsedwa mwachisawawa omwe amayesa kutalika kwa chithandizo chachisoni poyerekeza ndi chithandizo chamankhwala chachisoni adawonetsa kuti kutalika kwa chithandizo chachisoni kunali kopambana kwambiri. Zotsatira za mayeso oyendetsa ndege zikuwonetsa kuti kutalika kwa chithandizo cha matenda achisoni kunali kopambana kuposa chithandizo cha anthu ovutika maganizo, ndipo chiyeso choyamba chotsatira mwachisawawa chinatsimikizira izi, kusonyeza kuyankha kwachipatala kwa 51% pakutalikitsa chithandizo chachisoni. Kuyankha kwachipatala kwa chithandizo chamankhwala ndi 28% (P = 0.02) (kuyankha kwachipatala kumatanthauzidwa kuti "kwabwino kwambiri" kapena "kwabwino kwambiri" pa Clinical Composite Impression Scale). Chiyeso chachiwiri chinatsimikizira zotsatira izi mwa achikulire (zaka zocheperako, zaka 66), momwe 71% ya odwala omwe amalandila chithandizo chanthawi yayitali komanso 32% omwe amalandila chithandizo chamankhwala amapeza mayankho azachipatala (P <0.001).
Chiyeso chachitatu, kafukufuku wopangidwa m'malo anayi oyesera, poyerekeza ndi antidepressant citalopram ndi placebo kuphatikiza ndi chithandizo chanthawi yayitali chachisoni kapena chithandizo chamankhwala cholira; Zotsatira zake zidawonetsa kuti kuyankhidwa kwa chithandizo chanthawi yayitali chachisoni chophatikizidwa ndi placebo (83%) chinali chokwera kuposa chamankhwala olira maliro ophatikizidwa ndi citalopram (69%) (P = 0.05) ndi placebo (54%) (P <0.01). Kuphatikiza apo, panalibe kusiyana kwamphamvu pakati pa citalopram ndi placebo ikagwiritsidwa ntchito limodzi ndi chithandizo chamankhwala chokhazikika chachisoni kapena chithandizo chanthawi yayitali chachisoni. Komabe, citalopram yophatikizidwa ndi chithandizo chanthawi yayitali chachisoni chachepetsa kwambiri zizindikiro za kukhumudwa, pomwe citalopram kuphatikiza ndi chithandizo chamaliro chokhazikika sanatero.
Thandizo lokhalitsa lachisoni la Disorder therapy limaphatikizapo njira yowonjezera yowonjezera yochizira PTSD (yomwe imalimbikitsa wodwalayo kuti athetse imfa ya wokondedwa wake ndi kuchepetsa kupeŵa) kukhala chitsanzo chomwe chimasamalira chisoni cha nthawi yaitali monga vuto lachisokonezo cha pambuyo pa imfa. Zothandizira zimaphatikizaponso kulimbikitsa maubwenzi, kugwira ntchito mkati mwa zikhalidwe zaumwini ndi zolinga zaumwini, komanso kulimbikitsa mgwirizano ndi wakufayo. Deta ina imasonyeza kuti chithandizo chamaganizo-khalidwe la PTSD chingakhale chochepa ngati sichiyang'ana pa chisoni, komanso kuti njira zowonetsera PTSD ngati njira zowonetsera PTSD zingagwire ntchito m'njira zosiyanasiyana pofuna kutalikitsa vuto lachisoni. Pali njira zingapo zochiritsira zolunjika zachisoni zomwe zimagwiritsa ntchito njira yofananira yozindikira komanso yothandiza kwa anthu pawokha komanso magulu, komanso kusokonezeka kwachisoni kwa nthawi yayitali kwa ana.
Kwa madokotala omwe sangathe kupereka chithandizo chozikidwa pa umboni, timalimbikitsa kuti atumize odwala nthawi zonse ndikutsatira odwala mlungu uliwonse kapena sabata iliyonse, ngati pakufunika, pogwiritsa ntchito njira zosavuta zothandizira zomwe zimayang'ana chisoni (Table 4). Telemedicine ndi chithandizo chamankhwala chodzipangira odwala pa intaneti chingakhalenso njira zothandiza zopezera chithandizo, koma thandizo losasunthika kuchokera kwa ochiritsa likufunika pakufufuza njira zodzipangira nokha, zomwe zingakhale zofunikira kuti mukwaniritse zotsatira za chithandizo. Kwa odwala omwe sayankha ku psychotherapy yochokera ku umboni chifukwa cha kusokonezeka kwachisoni kwanthawi yayitali, kuwunikanso kuyenera kuchitidwa kuti azindikire matenda amthupi kapena amisala omwe angayambitse zizindikiro, makamaka zomwe zitha kuthetsedwa bwino ndi njira zomwe zakhudzidwa, monga PTSD, kukhumudwa, nkhawa, kusokonezeka kwa kugona, ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo.

Kwa odwala omwe ali ndi zizindikiro zochepa kapena omwe sakukwaniritsa malire, komanso omwe pakali pano alibe mwayi wopeza chithandizo chozikidwa pa umboni wa matenda obwera chifukwa chachisoni, madokotala angathandize kuthana ndi chisoni. Gulu 4 limatchula njira zosavuta zogwiritsira ntchito mankhwalawa.
Kumvetsera ndi kukhazikika kwachisoni ndizofunikira kwambiri. Maphunziro a maganizo omwe amafotokoza za kusokonezeka kwachisoni kwa nthawi yaitali, ubale wake ndi chisoni wamba, ndi zomwe zingathandize kaŵirikaŵiri amapatsa odwala mtendere wamaganizo ndipo angawathandize kuti asakhale osungulumwa komanso kukhala ndi chiyembekezo chakuti chithandizo chilipo. Kuphatikizira achibale kapena mabwenzi apamtima pa maphunziro a zamaganizo okhudza kuvutika kwachisoni kwanthaŵi yaitali kungawongolere luso lawo lopereka chithandizo ndi chifundo kwa wodwalayo.
Kufotokozera odwala kuti cholinga chathu ndi kupititsa patsogolo zochitika zachilengedwe, kuwathandiza kuphunzira kukhala popanda wakufayo, ndi kuthetsa mavuto omwe amasokoneza njirayi kungathandize odwala kutenga nawo mbali pa chithandizo chawo. Madokotala amatha kulimbikitsa odwala ndi mabanja awo kuvomereza chisoni ngati yankho lachibadwa pa imfa ya wokondedwa, osati kunena kuti chisoni chatha. Ndikofunika kuti odwala asaope kuti adzafunsidwa kusiya chithandizo mwa kuiwala, kusuntha kapena kusiya okondedwa awo. Madokotala angathandize odwala kuzindikira kuti kuyesa kuzoloŵera kuti wokondedwa wawo wamwalira kungachepetse chisoni chawo ndi kupanga lingaliro lokhutiritsa la kupitirizabe kugwirizana ndi wakufayo.

Domain of kusatsimikizika
Pakali pano palibe maphunziro okwanira a neurobiological omwe amamveketsa bwino za matenda obwera chifukwa chachisoni chotalikirapo, palibe mankhwala kapena njira zina zochiritsira za neurophysiological zomwe zawonetsedwa kuti ndizothandiza pazizindikiro zachisoni chotalikirapo pamayesero omwe akuyembekezeka, komanso palibe mankhwala oyesedwa mokwanira. Phunziro limodzi lokha loyembekezeredwa, losasinthika, loyendetsedwa ndi placebo la mankhwalawa linapezeka m'mabuku, ndipo monga tafotokozera kale, phunziroli silinatsimikizire kuti citalopram inali yothandiza pakutalikitsa zizindikiro za vuto lachisoni, koma pamene ikuphatikizidwa ndi chithandizo chotalikirapo cha matenda achisoni, chinali ndi zotsatira zazikulu pa zizindikiro za kuvutika maganizo. Mwachionekere, kufufuza kowonjezereka n’kofunika.
Kuti mudziwe mphamvu ya chithandizo cha digito, m'pofunika kuchita mayesero ndi magulu olamulira oyenera komanso mphamvu zokwanira zowerengera. Kuphatikiza apo, kuchuluka kwa matenda omwe amatenga nthawi yayitali kumakhalabe kosatsimikizika chifukwa chosowa maphunziro ofanana a miliri komanso kusiyanasiyana kwa ziwerengero za matenda chifukwa cha zochitika zosiyanasiyana za imfa.