Abubuwan da ke haifar da hawan cocaine: ƙayyadadden ƙwayoyin neuroanatomical ga masu amfani da ƙwayoyi da ƙwayoyin ƙwayoyi (2000). - inaddamar da ƙwaƙwalwa zuwa alamun hawan cocaine kama da kunnawa zuwa batsa

An tabbatar da mahimmancin ƙwarewa a cikin abubuwan da ke addabar drugan adam (1-3). Ana tunanin sha'awar ƙwayoyi a matsayin ƙasa mai ƙarfi mai karfafawa ko kuma sha'awar sha'awa wacce ke tilasta mai amfani da koko don neman cocaine. Koyaya, takamammen hanyoyin fasahar, masu tasiri da fahimta, wadanda ke neman sha'awar magunguna, da abubuwan da suke yanke hukunci, da alaƙar da ta kai ga shan miyagun ƙwayoyi masu cikakken bayani. Phenomenologically, masu amfani da ruwan hoda suna bayar da rahoton cewa sha'awar ta faru sau biyu a rana (tare da kowane abin da ya shafi na kusan minti 20 ko lessasa da [4]), yana da tsananin ,arfin yawa, kuma ana iya jawo shi ta hanyoyi da yawa. Misali, maganin cocaine na iya sake dawo da martabar maganin cocaine a cikin beraye (5) kuma an nuna shi don jawo sha'awar mutane don ƙarin hodar Iblis (6). Dabarun da aka gindaya na dakin gwaje-gwaje wadanda ke haifar da damuwa kwanannan an nuna su suna haifar da sha'awar kai-da-kai game da masu maye a cocaine. (7). Har ila yau, binciken binciken ya nuna cewa alamomin muhalli da ke da nasaba da miyagun ƙwayoyi na iya taimakawa wajen shawo kan masu amfani da miyagun ƙwayoyi (3, 8, 9) kuma cewa karfin irin wannan cuwa-cuwa yana da kyau da dangantaka da tsananin tsananin dokin (10). Budurwa da abokan aiki (8) bayar da rahoton cewa masu amfani da kokenan suna ambatawa akai-akai kamar yadda masu sha'awar sifofin waje suke kama da kudi ko kuma amfani da miyagun ƙwayoyi da aboki da abubuwan cikin gida kamar dysphoria. Wani bincike game da abubuwan da ke tantance rikicewar cocaine ya lura cewa 34% na sake komawa ya biyo bayan haɗuwa da ƙwaƙwalwar ƙwayoyi, kuma 11% ya biyo bayan kula da kuɗi (11). Koyaya, wuraren ba da jijiyoyin kai da tsarin tunani na da alhakin haifar da kuma kula da sha'awar hodar Iblis da yadda zasu sha bamban da sauran jihohin da ke motsa hankali ba su da kyau. Irin waɗannan bayanan za su bayyana da mahimmanci don haɓaka sabon halayyar da magunguna don maganin kyankyasai, yanayin da ya zama mafi gaggawa kamar yadda tsarin maganin warkewa na yanzu ba shi da cikakken tasiri ga yawancin mutanen da ke neman magani. Hanyoyin da ba su da kulawa da jijiyoyin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa yanzu suna ba da damar da za su iya gano alamun neuroanatomical na waɗannan abubuwan da suka shafi tunanin mutum.

Binciken neuroimaging na baya ya haifar da yankuna da yawa na cortical da kuma subcortical a cikin sha'awar magungunan mutane, ciki har da tsarin prefrontal da limbic. Misali, an bayar da rahoto game da muhimmiyar ma'amala tsakanin cutar kai-da-kai da gubar glucose na yanki a cikin prefrontal da orbitofrontal cortex (12). Maas da abokan aiki sun lura da irin wannan gaban aikin (13), wanda ta hanyar ingantaccen tasirin maganadisu (fMRI) ya ba da rahoton gagarumar kunnawa a cikin hagu na prefrontal cortex da kashin na ciki wanda ya dace da gabatarwar abubuwan da ke da alaka da koken. Hakanan an ba da rahoton cewa wuraren amfani da cocaine, dangane da abubuwan tsaka tsaki, ya haifar da karuwa a cikin ƙwayoyin haɓakar glucose na yankuna a cikin farkon yanayin, medial orbitofrontal, retrosplenial, peristriate, da kuma wasu lokuta na lokaci da ƙarshen yankuna (14). An samo mahimmancin daidaituwa na 0.60 ko mafi girma tsakanin matakan sha'awar kai-da-kai da haɓakar glucose na yanki a cikin ƙwaƙwalwar prefrontal cortex, cerebellum, da loial medial lobe, musamman amygdala. Sauran karatuttukan neuroimaging sun sake yin kwazo da gaban hannu da naƙasasshen ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa (15-17). Yana iya ɗauka cewa hoton da ke fitowa game da haɗarin ƙwaƙwalwar ƙwayar cuta yana nuna halartar yawancin hanyoyin fahimtar juna da motsin rai da ke aiki a cikin kide-kide don samar da ƙwarewar gwaninta.

Determinationudurin cewa an jawo sha'awar ne ta hanyar fallasa abubuwan da ke da alaka da hodar Iblis yana buƙatar a cika wasu ka'idoji. An gabatar da shawarar yadda ya kamata ya zama ya dace da yawan jama'a da kuma abubuwan da ake amfani da su a ciki, ana lura da shi a cikin masu amfani da koko amma ba a cikin kwaskwarimar kwalliyar ta cocaine da kuma martani ga kwalliyar koken ba amma a'a, a'a, sahihan dalilai masu alaka da opiate (18). Muna ba da shawarar cewa dacewar abin da aka ƙayyade na takamaiman matakin ya dogara ne akan zaɓin mutum na abubuwan kwatantawa. Misali, karuwa mai amfani na iya zama wani bangare na sha'awar kayan kwalliya. Duk da yake yana iya zama da mihimmanci a buƙaci wannan karɓar ta azabtar da ƙarancin tsinkaye (misali, kayan aikin musamman, kamar yadda Ehrman et al ya nuna. [19]), mutum zai iya tsammanin irin wannan martani ga sauran ƙwarin gwiwa (misali, motsawar jima'i). Tabbas, matsayin da amsawar neuroanatomical game da abubuwan cocaine ana misalta shi da amsa ga sauran abubuwan motsawar, tambaya ce ta bude wacce zata haskaka wasu matakai (gama gari) duka biyun biyun. Har zuwa wannan, binciken da akeyi yanzu ya nemi sanin ko idan aka gano yadda ake amfani da maganin koko a yayin da aka fallasa abubuwan da ke da alaka da kokenan zai zama na musamman ga masu amfani da maganin koko (watau ba a yanayin kwatankwacin kwayoyi ba). watau, ba ba don tsaka tsaka tsaki ba) amma watakila a raba shi da abubuwan da ke haifar da ƙwayar cuta.

batutuwa

Gaba ɗaya, 24 gogaggen masu amfani da hodar Iblis da kuma kwatancen kwatancin lafiya na 18 sun shiga cikin wannan binciken. An dauki nauyin karatun abubuwan ta hanyar tallace-tallace na jaridar gida kuma an biya su saboda hallara. An bincika masu amfani da ruwan hoda saboda kawai waɗanda ke hanyar babban hanyar maganin cocaine sun kasance ta hanyar shan sigari (crack) shan sigari. Babu batun da ya dace da kowane irin yanayi na Ilimin halin kwakwalwa banda cin zarafin cocaine ko dogaro. Masu amfani da hodar Iblis goma sha bakwai (14 maza da mata uku; ma'ana shekaru = 34 shekaru, kewayon haihuwa = 27 – 44) da kuma abubuwan da aka kwatanta na 14 (maza tara da mata biyar; ma'ana shekaru = 26 shekaru, kewayon zamani = 19 – 39) sun wuce duk na rabauta Ka'idodi kuma an haɗa su cikin nazarin fMRI. Daga cikin masu amfani da cocaine na 17, tara sun kasance Caucasian, takwas kuma 'yan asalin Amurkawa ne; 13 sun kasance masu hannun dama na dama, ɗayan hagu ne, uku sun cika bakin jini. Daga cikin batutuwa masu kwatantawa na 14, 12 sun kasance Caucasian, ɗayan Asiya ne, ɗayan kuma Yalanci ne; 13 sun kasance masu hannun dama na dama, kuma an hagu ɗaya na hagu. Masu amfani da maganin cocaine sun shafe tsawon shekaru 11 na amfani da hodar Iblis (kewayon = 2 – 25) tare da matsakaiciyar kudin cocaine na wata $ 1,025 (kewayon = $ 150 – $ 5,000). Tsarin kwatancen ya ba da rahoton tarihin amfani da hodar Iblis. Bayan cikakken bayanin, dukkan abubuwan da aka bayar sun ba da sanarwar rubutacciyar sanarwa don shiga cikin wannan binciken, wanda kwamitin bita na jami'ar Medical University of Wisconsin ya amince da shi.

hanya

Bayan isowa rukunin MRI, kowane batun ya cika fom na yarda kuma an karɓi umarni don, kuma an aiwatar da shi, aikin ƙwaƙwalwar ajiyar aiki wanda za'a yi yayin zaman yin binciken. Sassan fina-finai na bidiyo da aikin ƙwaƙwalwar ajiyar aiki an sake tsara su akan allo a ƙafafun taken kuma an kalle su da taimakon gilashin fitilu a ciki na murfin mitar rediyo. An sadar da tattaunawar bidiyon ga batutuwa ta hanyar iska ta hanyar filastik filastik waɗanda aka haɗa ta cikin kunn kunne waɗanda ke haifar da amo na na'urar daukar hotan takardu. An yi amfani da fina-finai uku tare da abun ciki daban-daban. Fim din cocaine ya nuna wasu Ba’amurke maza biyu ‘yan Afirka da ke tattaunawa da takamaiman magani yayin shan sigin“ cocaine ”(wanda a zahiri benzocaine ya yi kama da wainar ƙwayoyi) da shan“ barasa ”(wanda ruwa ne a cikin kwalbar kwal). Maza sun kasance gogaggun masu amfani da hodar Iblis; fim ɗin an yi shi ne tare da tattaunawa tare, da sake dubawa, da yawa daga cikin masu amfani da cocaine na yanzu da na yanzu don tabbatar da amincin. Tfim] insa ya imagesunshi hotunan waje; fim din jima'i ya ƙunshi takamaiman aikin gungun maza. Kowane fim yana minti na 4 a cikin tsawon lokaci, kuma kowane ɗayan ya riga ya wuce gaban allo na 3 mintina allo mara kyau. Duk al'amuran farko sun ga fim ɗin yanayin, kuma an daidaita jerin finafinan jima'i da na cocaine a duk fannoni. Nan da nan bayan kowane fim, batutuwa sun yi aikin ƙwaƙwalwar ajiyar aikin aikin hangen nesa na mintuna 5. Sabili da haka, kowane saiti na sa ido ya ƙunshi lokacin hutawa na mintina na 3, wani fim na minti na 4, da kuma aikin ƙwaƙwalwar ajiyar aiki na mintina na 5. Bayan gwajin ƙwaƙwalwar ajiyar aiki wanda ya biyo bayan kowane fim, batutuwa sun kammala gwajin rahoton kai-tsaye wanda ke kimanta amsawa ga abin da suka gabata na fim ɗin. Tambayoyi sun mayar da hankali kan martani game da batun fim ɗin (Table 1). Aikin ƙwaƙwalwar ajiyar aiki ya zama maƙasudi biyu: a matsayin mai jan hankali don rage duk wani abu mai cike da sha'awar magana tsakanin fina-finai da azaman bincike don gano tasirin sha'awar aiwatar da aikin fahimi da kunna kwakwalwa. Sakamakon wannan yanki na gwajin zai ba da rahoton wani wuri.

Ba za mu iya sarrafawa ba don rawar da tsammanin samun ko dai ko cocaine ko jima'i bayan binciken na iya kasancewa akan batutuwa. Dukkanin masu amfani da maganin sunadaran sun sami taƙaitaccen magani na "magana-ƙasa" bayan aikin sikandire kuma ba'a basu izinin barin asibiti ba har sai masu ilimin hauka sun tabbatar cewa basu da kwaɗar maganin cocaine. A wani binciken da ya gabata (20), babu ƙarin amfani da miyagun ƙwayoyi da ke biyo baya ga shiga cikin gwajin ƙwaƙwalwar ƙwaƙwalwar ƙwayar cuta, wanda ke ba da rahoton canji kaɗan daga yanayin da ake amfani da shi na maganin miyagun ƙwayoyi zuwa mahallin duniyar gaske.

FMRI Tsarin Binciken

Wereungiyoyi iri-iri na SNUMX-mm sagittal masu rufe kwakwalwa gaba ɗaya an tattara su ta hanyar amfani da matsanancin tebur-echo, echo-planar pulse jerin (TE = 7 msec; TR = 40 msec; filin kallo = 6000 cm; 24 × 64 matrix; in- ƙuduri na jirgin sama = 64 × 3.75 mm). Dukkanin binciken da aka gudanar akan na'urar daukar hotan takardu ta 3.75-T Signa (GE Medical Systems, Milwaukee) sanye take da 1.5-cm diamita na ciki uku-axis gida gradent coil da kuma ƙarshen-capped digo sauƙaƙe nau'in mitar rediyo kai madaidaiciya. (21). An yi amfani da takalmin ɗamara don iyakance motsin kai a cikin coil. Resolutionaukar matakan mitar rediyo wanda aka ambata ana samun saƙo a cikin tsayayyen hotunan ana amfani da su kafin hotunan hoto masu amfani don ba da damar ƙirar asalin aikin ɗan adam na aiki.

fMRI Nazarin

Dukkanin bayanan an gudanar dashi tare da kunshin kayan aikin AFNI version 2.2 (22). Gyara aikin injin jirgin sama da kuma gano tushen algorithms an fara amfani dasu ga bayanan aikin. Abubuwan da finafinan fMRI suka tsara don fim har yanzu suna da tsinkayar kai tsaye kamar yadda aka tsara ta hanyar kallon fim an cire su daga sharhin fim ɗin. Yawan masu amfani da ruwan hoda da kwatancen batutuwan da aka haɗa a cikin ƙididdigar aikin kowane fim an gabatar dasu a Table 1. Gaba ɗaya, 47% na finafinan masu amfani da ruwan hoda da 57% na finafinan batutuwa masu kwatanci sun kasance waɗanda ake iya bincika su. Fitar da 40% na finafinan masu amfani da koko da 35% na finafinan batutuwa masu kwatancen sun kasance ne saboda motsi, tare da ragowar abubuwan da aka danganta ga matsalolin fasaha a cikin bayanan. Dukkanin masu amfani da maganin hodarwar sun haɗa cikin mahimmancin fim ɗin cocaine masu amfani na yanzu, kuma ba wanda ya sami magani.

Makonni na farko na 7.5 (hotunan 75) na kowane saurin binciken an haɗa su a cikin binciken fMRI na yanzu. Wannan ya haɗa da ƙayyadadden lokacin minti na 3, fim ɗin minti na 4, da kuma lokacin hutawa na farko na 30-na biyu na aikin ƙwaƙwalwar ajiyar aiki mai zuwa. Don rarrabe amsawar muryar voxel, siginar fMRI da aka samu a wannan lokacin na mintuna ta 7.5 an daidaita su tare da rarraba beta akan madaidaitan per-voxel ta hanyar amfani da wata hanyar farfadowa da ba ta tsari ba. (23) (Figure 1). An zaɓi rarrabcin beta akan filaye na ƙasa, an ba da jerin kewayon lokaci daban-daban wanda zai iya yin ƙira. Lokaci na farko na samfurin beta an tilasta shi ya faru tsakanin mintuna 1.5 bayan fara bidiyo, kuma ya dace da layi mafi kyau ga jerin lokaci kafin wannan lokacin fara. Sauran sigogi na rarrabawa na beta (yawan lambobi masu yawa da ke faruwa [k] da kuma masu bayyana biyu [α, β]) ()Figure 1) ba a tsaurara matakan tsari domin a sami kyakkyawan tsarin da zai dace da kowane jerin lokutan wayoyi. An tsara jerin jerin lokacin lokacin don cire duk lokuta na sama sama da 0.01 Hz kafin yin tallan kayan da ba na zamani ba, tunda binciken farko ya nuna cewa sauye-sauye masu yawa a cikin jerin lokuta na bayanai galibi kan shafi ingancin samfurin da bai dace ba. Ga kowane wutsiya, an bayyana yankin ƙarƙashin tsarin samfurin beta a matsayin kashi na yankin a ƙarƙashin mafi kyawun layin fitarwa (ƙaddamarwar maras kyau da ke wakiltar ba da martani). Wannan adadin yankin da aka yi amfani da shi a wuyan sashi ya yi aiki a matsayin kimanta girman martanin da aka bayar a cikin fim ɗin (Figure 1). Adadin yanki a ƙarƙashin ɓakakken siffofin aikin aikin an sauya su zuwa tsarin daidaitawa na daidaiton yanayin aiki (24) kuma ya bazu ko'ina ta amfani da cikakken faɗin 4.2-mm a rabin iyakar isotropic gaussian tace. Wadannan hotuna masu aikin ana kiransu daga baya azaman taswirar kunnawa kuma anyi amfani dasu ga binciken ƙungiyar mai zuwa.

Fassarar Alƙaluma

An yi gwajin t-aya guda ɗaya akan cutarwar mara amfani ta rashin inganci da aka aikata akan yawan yankin yankin a ƙarƙashin ƙa'idodin masu amfani da maganin cocaine suna kallon fim ɗin cocaine. Wannan gwajin t, wanda aka ƙaddara tare da darajar darajar hikima ta 0.0025 da ƙuduri cewa kowane babban fayil ya kasance wani ɓangare na babban adadin 100-μl na adadin kujeru masu mahimmanci (kusan daidai yake da girman sikastan da aka samo asali), an gano voxels waɗanda ya nuna mayar da martani ga fim din cocaine a cikin masu amfani da cocaine. Abubuwan da ke tattare da haɗuwa da babbar hanyar hikima da ƙaramin babban gungu an bayyana su a wani wuri (25). Theungiyoyin gwagwarmaya waɗanda suka tsira daga waɗannan ka'idodi sun ayyana wurare masu aiki don amfani don tsarin kwatancen masu zuwa.

Don tantance idan amsawar waɗannan yankuna ya kasance na musamman ga masu amfani da maganin ƙwaƙwalwa (ƙididdigar yawan jama'a), yankuna masu amfani da ruwan hodar a yayin bayyanar fim ɗin cocaine an ɗora su a kan taswirar gwagwarmayar kwatancen yayin gwajin fim ɗin cocaine, kuma an gwada yankuna ban sha'awa ta amfani da gwaje-gwajen t-t-biyu. Don sanin idan amsar waɗannan yankuna masu amfani ya kasance takamaiman ga fim ɗin cocaine (ƙayyadaddun abun ciki), yankuna masu amfani da ruwan hodar a yayin bayyanar fim ɗin cocaine an ɗora su a kan taswirar kunnawa na masu amfani da koko a yayin bayyanar fim ɗin yanayin. , da gwaje-gwajen t idan aka kwatanta ma'anar kunnawa masu ma'ana. A ƙarshe, don sanin idan waɗannan yankuna na ban sha'awa suma ba'a kunna su ba, ƙwaƙƙwaran hanzari (ƙayyadaddun abun ciki), yankuna masu amfani da maganin cocaine a yayin bayyanar fim ɗin cocaine an ɗora su akan taswirar kunnawa na masu amfani da cocaine da kwatancen batutuwa yayin bayyanar fim din jima'i. An yi gwajin rarrabewa don kowane kwatankwacin yadda yanayin aikin keɓancewa daga ƙididdigar aiki ya bar kaɗan batutuwa tare da cikakken bayanan don ba da damar cikakken bincike na bambance bambancen.

Amsar Batsa da Yanayi

Don gano wuraren da aka kunna yayin kallon fim ɗin jima'i, gwajin t-t ɗaya t-t t a kan kyakyawan sakamako mara amfani da aka yi akan taswirar kunnawa masu amfani da maganin cocaine da kwatancen batutuwa. Kowane an yi masa shinge tare da darajar p-hikimar p na 0.0025 da kuma ma'aunin gungu na 100-μl, kamar yadda aka bayyana a baya. Don sauƙaƙe gwajin ƙididdiga tsakanin rukunonin biyu, an haɗa waɗannan taswira don haɗar da wutsiya idan ta kasance mai mahimmanci a kowane taswira. An yi gwaje-gwajen t-biyu masu gwada masu amfani da abubuwan kwatanta kwatankwacin su akan abubuwan kunnawa na kowane tarin wannan taswirar hade. An gudanar da jerin dabaru iri ɗaya don fim ɗin yanayin.

results

Matakan rahoton kai

Table 1 ya ƙunshi adadin groupwararrun nau'ikan Likert na tambayoyin da aka tambaya bayan kowane fim. Bayanai sun nuna cewa fim din cocaine ya sami nasarar haifar da yanayin sha'awar masu amfani da maganin cocaine. Misali, masu amfani da koko sun bayar da rahoton cewa suna son fim din cocaine fiye da abubuwan kwatancen yayin da ba sa banbanci da kwatancen batutuwa kan yadda suke son dabi'ar ko fina-finan jima'i. An lura da irin wannan tsarin don yadda finafinai suke farin ciki da ƙarfin su kuma, matuƙar, kowane fim ya sa sun so shan sigari. Masu amfani da ruwan hodar sun kuma bayar da rahoton gajiya mai yawa fiye da abubuwan kwatancen bayan fim na cocaine kawai. Don sauƙaƙe ƙarin kwatancen dangane da waɗannan martani ga fim ɗin cocaine, an lasafta maƙasudin maƙasudi mai tarin yawa. Tambayoyi biyar da suka banbanta masu amfani da ruwan hoda da kwatancen batutuwan da suka biyo bayan nunawa ga fim din cocaine amma ba a zabi sauran finafinan biyun da ke nuna kwazo ba. Abinda ake buƙata mai ɗorewa shine jimlar waɗannan tambayoyin guda biyar (an gaji matakin farko na gajiya daga 10 kamar ba'a rage lambar gajiya kamar ƙaru tare da haɓaka sha'awa). Darasi na yawan sha'awar ya ba mu damar gwadawa idan bambance-bambancen sha'awar hodar sun kasance tsakanin rabe ko hade da abubuwan da kuma yin gwaji don sakamakon fim.

Craididdigar yawan sha'awar da aka samu ya bambanta tsakanin duk masu amfani da hodar iblis (N = 23; bayanan batutuwa ɗaya ya ɓace) da batutuwa masu kwatanta (N = 18) waɗanda suka kalli fim ɗin hodar (t = 6.7, df = 39, p <0.0001) da kamar yadda tsakanin waɗannan batutuwa waɗanda aka haɗa su a cikin nazarin aikin fim na cocaine (t = 6.4, df = 21, p <0.0001). Analyarin nazarin ya nuna cewa masu amfani da hodar iblis ba tare da yin nazarin aikin fim na cocaine ba saboda motsin kai ba su da bambanci da na masu binciken da ke cikin rahoton da aka ruwaito (t = 1.9, df = 17, p = 0.07). A gaskiya ma, batutuwa da aka haɗa a cikin nazarin aikin sun ba da rahoton ƙimar ƙira mafi girma (27.7 a kan 20.5), saboda haka kawar da damuwar zaɓin zaɓi a cikin bincikenmu inda batutuwan da suka fi so suka fi yawa sun motsa. Nazarin tasirin fim a cikin masu amfani da hodar iblis waɗanda suka kalli fim ɗin hodar kafin ko bayan fim ɗin jima'i ba a bayyana bambancin ra'ayi ba. Wannan gaskiya ne ga duk masu amfani da hodar iblis (t = 0.4, df = 21, p = 0.73) kuma ga waɗanda aka haɗa a cikin aikin nazarin finafinan hodar iblis (t = 0.1, df = 9, p = 0.91). An kirga kwatankwacin kwatankwacin kwatankwacin don martani game da fim ɗin jima'i (watau, yadda batutuwa suka fi son fim ɗin jima'i, suka ba shi kuzari, da sauransu) da kuma fim ɗin yanayi (watau, yawancin batutuwa da ke son fim ɗin yanayi, sun sami kuzari daga shi, da sauransu). NAkwai mahimman bambance-bambance na kungiyar da aka samo tare da gwaje-gwajen gwaji na jima'i ko fim na yanayin ko dai lokacin da duk abubuwan batutuwa ko kuma waɗannan batutuwan da aka haɗa a cikin aikin nazarin finafinai masu aiki.

Binciken Nazarin Aiki: Tsarin Cocaine

Ga masu amfani da ruwan hodar, yankuna 19 na ban sha'awa sun nuna mahimmancin martani yayin bayyanar fim ɗin cocaine (Table 2). Waɗannan su ne mafi yawa daga cikin fayel na gaba da naƙasa, galibi ana barinsu a cikin gadaje, kuma sun haɗa da tsakiya, mara baya, na tsakiya, da manyan kanshi na gaba da na baya da na baya. An ga jujjuyawar na biyun a cikin ƙananan na parietal lobule, kuma an kunna kunnawar tazara a cikin tsararren lokaci. Sauran bangarorin ban sha'awa an lura dasu a cikin haƙarƙan dama da subcortically, a cikin ƙwayar caudate / tsakiya kuma zuwa ga tsakiya na thalamus.

Yawancin (13 na 19) na waɗannan yankuna na ban sha'awa sun nuna babban ƙarfin gwagwarmaya a cikin masu amfani da hodar Iblis fiye da kwatancen batutuwa lokacin da aka gwada kunnawa ta hanyar fim ɗin cocaine (Table 3 da kuma Figure 2). Wadannan yankuna na 13 masu ban sha'awa suma sun nuna matukar ƙarfin aiki ga masu amfani da murfin cocaine suna kallon fim ɗin cocaine idan aka kwatanta da masu amfani da cocaine suna kallon fim ɗin yanayin. Ta hanyar kasancewa ba a cikin kwatancen lamuran da ake kallon fim ɗin kwaya iri ɗaya ba kuma ba kasance cikin masu amfani da ke duba abubuwan fim ɗin yanayin ba, waɗannan sakamakon suna magana da ƙayyadaddun waɗannan yankuna na 13 don sha'awar cocaine.

Bayan haka, kawai 'yan kaɗan daga cikin waɗannan yankuna na ban sha'awa (huɗu na 19) sun nuna mahimmancin bambanci sosai lokacin da aka gwada masu amfani da cocaine a kan masu amfani da cocaine a kan fim ɗin jima'i, kuma ɗayan waɗannan hudun, wanda ke cikin hagu na baya na gaba, ba muhimmanci a ko dai na biyu baya kwatancen (Table 3). Ragowar yankuna uku masu ban sha'awa, waɗanda suke da mahimmanci a cikin duka kwatancinta guda uku, sun kasance akan tsakiya na cingulate gyrus, ƙarancin ƙwalƙwalwar ƙarewar ƙarewar ƙuruciya, da kuma ƙwallon baya na hagu / gefen baya. A ƙarshe, kawai hudu daga cikin yankuna na 19 masu ban sha'awa sun nuna bambance-bambance masu mahimmanci tsakanin masu amfani da maganin cocaine suna kallon fim ɗin cocaine da kwatancen batutuwa suna kallon fim din jima'i. Dukkanin yankuna hudun da ke nuna sha'awa sun nuna kwazo sosai a cikin masu amfani da cocaine amma guda daya, wanda yake a cikin mafi ƙarancin parietal lobule, ya kuma kasance mai mahimmanci a cikin kwatancen baya. Ragowar yankuna uku na sha'awar suna cikin dama na gaba na gaba na gaba, na ƙasan ƙoshin parietal lobule, da kuma gaban gaba na thalamus. A yayin fassara waɗannan sakamakon, ya kamata a san cewa waɗannan tsakanin-tsakanin-da tsakanin fim ɗin ana iya nuna bambanci ga taswirar kunnawa masu amfani da maganin cocaine da ke kallon fim ɗin cocaine, tunda wannan yanayin ne yake ayyana yanayin yanki.

Nazarin Ayyukan Aiki: Films da Jigilar Yanayi

Irin wannan yankuna an kunna su a cikin masu amfani da maganin cocaine da kwatancen batutuwa lokacin da suka kalli fim din jima'i. Waɗannan sun haɗa da babban gaban gaba (na tsakiya, babba, da na baya na gaban ciki), na baya da na baya, da na baya, na farin jini, na thalamic, na occipital, da na cerebellar. Observedarin ƙarin gungu (36 a kan 25), wanda ya haɗa da babban adadin girma (8,942 μl a kan 5,280 μl), kuma samun ingantaccen kunnawa (0.24% a kan 0.20%) an lura da su a cikin kwatancen lamuran sama da masu amfani da koko. Combinedungiyoyi masu aiki waɗanda aka haɗa su biyu kuma an yi gwaje-gwaje na t waɗanda aka kwatanta da idan aka kwatanta ƙungiyyun biyu a kan ma'anar gwagwarmaya na kowane ɗayan haɗin. Daga cikin gungu na 52 a cikin wannan taswirar taswirar, 29 ya nuna bambance-bambance masu mahimmanci, kuma na waɗannan, 23 ya nuna babban aiki mai ƙarfi a cikin kwatancen kwatancen fiye da masu amfani da cocaine. Gyara Bonferroni (p≤0.001), mai garantin ne da aka ba shi babban adadin gwajin ƙididdigar daban, ya rage adadin manyan bambance-bambance zuwa 10. Rabin waɗannan gungu sun kasance a cikin fawayen gaban, kuma rabi suna cikin cerebellum, cingior na cingulate, da parietal lobes (Table 4). Daga cikin waɗannan gungu na 10, tara sun nuna babban aiki a cikin kwatancen lamuran sama da na masu amfani da cocaine. Ba da izini ga gaskiyar cewa abubuwan kwatancen sun ba da ƙarin ƙungiyoyi a cikin taswirar haɗuwa da lissafin kuɗi don babban adadin gwaje-gwaje na ƙididdiga, waɗannan ƙididdigar sun nuna mafi girman martani ga ɓangaren kwatancen batutuwa ga fim ɗin jima'i fiye da yadda masu amfani da cocaine suka nuna. Wannan ya bambanta da sakamakon binciken finafinan cocaine.

Yankuna kalilan ne suka yi tasiri sosai a ko dai masu amfani da cocaine (ɓangarori huɗu) ko kuma kwatancen kwatancen (ɓangarori biyu) lokacin kallon fim ɗin yanayin.. Twoungiyoyi guda biyu, waɗanda ke cikin haɓakar dama na dama da kuma fusus ɗin gyus na dama, sun kasance mafi mahimmanci a cikin kwatancen batutuwa fiye da masu amfani da maganin cocaine, yayin da wasu biyu, suna kan dama na gaba na gaba na gaba ɗaya (yankin Brodmann na 9) da na hagu na baya na gyrus (yankin Brodmann 3), ya nuna sabanin tsarin.

tattaunawa

Fassarar Neuroanatomical na Cue-Induced Cocaine Craving

Abubuwan sha'awar Cocaine suna da alaƙa da fa'idar aiki na cortical wanda ya kasance mai daidaituwa tare da rahotannin neuroimaging na baya game da sha'awar ƙwayoyi da ƙwayoyi. Duka dorsolateral prefrontal (12-15) da kunna murfin ciki (13, 15-17, 26) an akai-akai gani. Learfafa pole na ɗan lokaci yayi daidai da rahoton kwanan nan na ƙara yawan ƙwayar ƙwayar cuta a cikin yankin a yayin da masu amfani da ruwan hodar suka kalli fim na cocaine dangane da fim ɗin yanayi. (17), da gamaetal lobe kunnawa da suka shafi sha'awar hodar Iblis ma an ba da rahoto (14, 26).

Muna fassara rarrabuwa da rarrabuwa a cikin masu amfani da hodarwar a matsayin shaida ga gudummawar da yawa, daban-daban matakai na kwakwalwa, da fahimta da kuma tausaya, don ƙirƙirar jihar sha'awar. Misali, da aka bayar da cewa yawancin binciken neuroimaging sun lura da hadin gwiwar gaban-kai da parietal yayin aiki mai kwakwalwa (27-30) da kuma bukatar ayyuka da hankali (31, 32), kunnawa da aka gani a cikin wadannan tsarin a cikin binciken da ake gabatarwa na iya ba da shawarar halartar ƙwaƙwalwar ajiyar ƙwaƙwalwar gaban gaba a cikin sha'awar ko ƙara girman hankali ga fim ɗin cocaine ta masu amfani. Abinda ke tattare da wannan binciken shine cewa sanya hankalin mai amfani da miyagun ƙwayoyi da kuma abubuwan da yake haifar da abubuwan da suka shafi miyagun ƙwayoyi, waɗanda ke sulhu a tsakanin ƙwaƙwalwar ajiyar aiki, na iya zama mai mahimmanci ga farawa da kuma kula da yanayin sha'awar. Irin wannan binciken na iya yin magana da dacewar hanyoyin samun warkewa waɗanda ke neman magance matsalar ƙwaƙwalwar ƙwaƙwalwa ta hanyar jan hankali da dabarun maimaitawa.

An lura da kunna matsalar murfin ciki sau da yawa a yayin sha'awar cocaine kuma ana tunanin zai taka muhimmiyar rawa a cikin fahimta da tasiri mai aiki (33, 34). A bita ta musayar musanya ayyukan gwagwarmaya na fahimi / ayyukan motsa jiki da kuma motsa rai / alama ce ta sanya tsohuwar ta kasance a cikin yankin da ke kunshe wanda ya hada da kunna sikelin cingire da aka lura a cikin binciken da akeyi. (35). Posner da Rothbart (36) sun ba da shawarar cewa cingulate yana taka muhimmiyar rawa a cikin ikon aiwatarwa ko aiwatar da jihohi masu tausayawa. An gabatar da yankuna na gaba na tsakiya don rage hanyoyin motsa rai (37, 38), wanda zai iya yin bayani game da yunƙurin da aka gani a cikin waɗannan yankuna a cikin masu amfani da ƙwaƙwalwar cocaine a yayin fim na cocaine, zato wanda aka goyan bayan aikin gaban gaban gaban bangarorin biyu a lokacin fim ɗin jima'i. A cikin nazarin karatun da suka shafi fim-da tunanin da aka haifar da su tare da damuwa na gaba, Reiman (39) ƙarasa da cewa bangaran gwiwan cingulate da medial prefrontal yankin (Brodmann ta yankin 9) shiga cikin "m gwaninta na, m mayar da hankali ga, ko hali amsa ga tashin hankali halin da ake ciki." Yana da kyau a yanke shawara, sabili da haka, cewa na baya cingulate da medial ayyukan gaban-gaba na wannan karatun yanzu suna nuna halartar waɗannan hanyoyin ne na hankali da jan hankali a cikin sha'awar hodar Iblis.

Yankin na gaba wanda aka kunna yayin sha'awar hodar na iya yin nuni ga halartar yanayin fitar da yanayi ko "martani," tunda wannan yankin an nuna cewa ya fi aiki sosai a cikin hulda tare da gishirin sarkar da hauhawar jini. batutuwa (40). A madadin, Vogt da abokan aiki (34) sanya matsayin kimantawa a cikin kimantawa cikin mahalli da kuma aikin ƙwaƙwalwar ajiya ga mahaifa. An taɓa lura da kunna aiki na baya-baya yayin sha'awar cue-inagu (14) da lokacin gabatar da kalmomin masu alaƙa da barazanar (41) kuma a dukkanin bangarorin biyu an fassara shi don yin tunani game da tsarin ƙwaƙwalwar ajiyar ƙwaƙwalwar ajiyar, ya dace da shawarar cewa wannan yanki na iya kasancewa takamaiman shiga cikin tunanin tunawa da tunanin (42).

Aikin horarwa na aikin tunani ga gwagwarmayar yankuna hasashe ne kuma yana jiran gamsarwa daga gwaje-gwajen da ke magance takamaiman aikin wani aikin hankali a cikin aikin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa. Ko da yake, yanayin kunnawa wanda aka lura ya zama na musamman ga masu amfani da ruwan hoda da kuma abubuwan da fim din hodar ya nuna cewa an nuna gamsashshiyar hanyar da aka gano ta sauran gwaje-gwajen a batutuwa masu amfani da kwayoyi. . Ya kamata a sa rai cewa hanyoyin fahimi da tasiri wadanda aka riga aka bayyana su a cikin hanyoyin gwajin maganin cuta iri daya ne da ake gudanar da shi ta hanyar kwakwalwar kwakwalwa guda daya wacce amsawar ta haifar.

Kwatantawa Da Amsawa da Abubuwan jima'i

Ga masu amfani da hodar Iblis, ityan tsirarun wuraren shahararrun shafuka masu ban sha'awa sun bambanta da kunnawa dangane da hodar koken da jima'i. Bayan haka, hudu daga cikin shafukan yanar gizon da ake nema sun banbanta da kunnawa yayin da aka banbance su da abubuwan da aka kwatancen abubuwan da aka gabatar game da sha'awar jima'i. Gabaɗaya, waɗannan binciken suna ba da rahoton haɗuwa da yawa a cikin ƙwaƙwalwar kwakwalwa wacce ke ɗaukar nauyin martani ga ƙaddamar da maganin cocaine da sauran abubuwan motsa jiki, na motsa jiki. Wannan rabe-raben ya hada da dukkanin yankuna gaban gabanin, mafi yawan yankuna gabancin ragowar, da kuma mafi yawan yankuna mara karfi. Kodayake yanki daya kawai mai ban sha'awa, wanda yake a gefen dama na parietal lobule, ya zama mafi ƙayyadaddun buƙatun kokawar ta hanyar kasancewa mai mahimmanci a cikin duk kwatancen da aka shirya, zamu yi taka tsantsan game da ƙarasa da cewa shine tushen asalin koyon ƙwaƙwalwar ƙwaƙwalwa. Maimakon haka, muna fassara waɗannan sakamakon da ma'anar cewa waɗancan yankuna na ban sha'awa da aka gano su a matsayin abubuwan ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa, yawancin sun kasance masu karɓa ga sauran abubuwan motsa jiki kuma sun kasance don duka masu amfani da miyagun ƙwayoyi da batutuwa masu amfani da kwayoyi. Wannan ba lallai bane ya rage aikin waɗannan yankuna marasa ƙarancin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa amma a maimakon haka yana ba da shawara cewa ba a samar da amsar cocaine ta hanyar keɓaɓɓe ta musamman ga mai amfani da maganin. Maimakon haka, shine abin da ke kunna wannan kebul ɗin wanda ya sha bamban ga mai amfani da cocaine. Cikakken fahimta game da waɗannan madaidaiciyar martani na iya ba da haske game da yadda tsawaita amfani da cocaine ke shafar tsarin kwakwalwa na yau da kullun don sha'awar kuma yana haifar da mummunar cuta da aka sani da maye gurbin maganin ƙwaƙwalwa.

An ba da shawarar cewa ikon cocaine na iya tashi daga ikonta don kunna tsarin maganin dopamine na mesocorticolimbic kai tsaye (43). An yi nuni da cewa mallakin cocaine na kai-tsaye a cikin berayen yana haifar da ƙimar lamuran haɓaka kwakwalwa yayin haɓakawa mai zuwa. (44). Ta hanya iri ɗaya, amfani da magunguna na yau da kullun na iya rage ƙarfin ƙarfafa tasirin yanayi; ba zato ba tsammani, masu amfani da kwayoyi masu ƙwarewa suna bayar da rahoton fifiko na hodar Iblis akan jima'i. A cikin binciken da ake gabatarwa yanzu, yawancin yankuna da aka gano a matsayin wuraren da ake sha'awar hodar Iblis suna aiki kamar haka ta hanyar motsawar jima'i (mafi dacewa, ba su da bambanci sosai a cikin kunnawa tsakanin finafinan biyu). Bayan haka kuma, masu amfani da kokenin sun nuna karancin kunnawa dangi da kwatancen batutuwa a cikin martanin da suka shafi fim din jima'i. Wadannan binciken na iya samun mahimman sakamako na asibiti. Idan sha'awar cocaine ta kasance ta hanyar kwakwalwar guda ɗaya wacce aka kunna ta "ta hanyar halitta" mai lada / motsawar motsawa, to wannan na iya haifar da sake fasalin "al'ada" da zaɓin motsa rai (45). Idan cocaine ba wai kawai aiwatar da aiki ba amma yana daidaita da'irar kwakwalwa, don haka yana haifar da sake komawa zuwa abubuwan da ake so a zuciyarsu, to wannan na iya samun babban sakamako ga shawarar masu amfani da maganin. Amsar da aka bayar game da lada na yau da kullun na iya karuwa yayin da take cikin tsananin sha'awar hakan, don haka ana kara ciyar da takamaiman sha'awar maganin koko.

Ya kamata a sani cewa ƙaramar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa ta masu amfani da ruwan hoda ga kwatankwacin jima'i kwatankwacin batutuwan da aka kwatanta ba a bayyana su a cikin rahoton kai-tsaye da suka biyo bayan fim ɗin jima'i wanda a gaba ɗaya, ba a lura da bambance-bambance tsakanin ƙungiyoyin ba. Possibilityayan abu shine cewa masu amfani, waɗanda sun riga sun faɗi gaskiya game da amfani da miyagun ƙwayoyi, sun kasance masu gaskiya a cikin fahimtar fim ɗin jima'i (shawarar shine cewa abubuwan kwatancen da aka gwada sun nuna girman yadda suke son fim ɗin jima'i). Ganin cewa tambayoyin bayar da rahoton kansu an gina su ne tare da tantance fim din cocaine a gaba, ingantaccen bincike na kowane tasiri na fim, alal misali, wanda ya tabbatar da darajar cocaine ta hanyar jima'i (kamar yadda aka tilasta shi) a tsakanin wane fim, jima'i ko hodar Iblis, don ci gaba da kallo), na iya haifar da alamun nuna halayen da suka haskaka ayyukan kwakwalwa. Wata hanyar fassarar na iya karɓar kwatankwacin yanayin a matsayin alamar “al'ada,” sane (watau magana ce) da ma'anar abubuwan jima'i amma iya lalata yanayin jiyya don jin daɗinsa, tare da nuna cewa wannan "halin ko yanayin" sakamakon shekarun amfani da miyagun ƙwayoyi.

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