Njikọ dị n'etiti nsogbu nchịkwa mkpali na nhụjuanya-nrụrụ mgbagha: ntụle nchọpụta na n'ọdịnihu dị (2009)

Nsogbu nchịkwa mkpali (ICDs) bụ otu ọnọdụ dị iche iche jikọtara ya na nchọpụta nchọpụta site na ihe isi ike nke iguzogide "mkpali, mbanye, ma ọ bụ ọnwụnwa ime ihe na-emerụ mmadụ ahụ ma ọ bụ ndị ọzọ." Ndị ICD dị iche iche na-ekerịta ihe gbasara ahụike, phenomenological na bayoloji nwere nsogbu mgbakasị ahụ (OCD) nke tụrụ aro na enwere ike ịchịkọta nsogbu ndị a ọnụ. Agbanyeghị, data ndị ọzọ na-egosi ọdịiche dị ukwuu n'etiti OCD na ICD. N'isiokwu a, a na-enyocha ihe gbasara ahụike, phenomenological na bayoloji nke ICD nkịtị ma jiri ya tụnyere nke OCD. Data dị na-egosi nnukwu ọdịiche dị n'etiti ICD na OCD nke na-atụ aro nhazi nke onwe. Achọpụtara oghere nchọcha dị adị yana ụzọ maka nyocha n'ọdịnihu tụrụ aro.

3.1. Phenomenology na Epidemiology

Ihe data dị na-egosi na ọ bụ ezie na myirịta dị n'etiti IED na OCD, nnukwu ndịiche dị. A na-eji IED eme ihe na-eme ugboro ugboro nke iwe iwe na-adabaghị na nrụgide psychosocial na / ma ọ bụ mkpasu iwe na adịghị agụta ya nke ọma site na nsogbu uche ọzọ, site na ọnọdụ ahụike na-emekọ ihe, ma ọ bụ mmetụta physiological nke ọgwụ ma ọ bụ ihe ọzọ nwere mmetụta psychotropic. (Kọmitii Òtù Na-ahụ Maka Ọrịa Uche America na Nomenclature na Statistics, 2000). IED nwere ike ịbụ ugboro ugboro, ntinye aka, na-adịgide adịgide ma na-emegharị dịka OCD, mana ọ na-abụkarị akụkụ. N'adịghị ka mmanye na OCD, oke iwe na IED anaghị emekarị na nzaghachi maka mkpasu iwe. Agression bụ nke a na-emeghị atụmatụ ma na-eme n'ebughị ụzọ chee echiche nke ọma (Grant na Potenza, 2006). Mkpesa na IED dị iche na mmanye na OCD n'ihi na ọ nwere ike ịbụ ihe na-enye afọ ojuju ma na-esonyere ya na obi ụtọ kama site na mbelata nchekasị; Otú ọ dị, dị ka mmanye OCD, a pụrụ ịghọta omume ike ike dị ka ihe na-enye nsogbu (McElroy et al., 1998).

Nlebanya eserese nke ndị ọrịa uche (psychiatric)Monopolis na ọdụm, 1983) na ajụjụ ọnụ ụlọ ọgwụ (Felthous et al., 1991) kwuru atụmatụ zuru oke nke IED site na 1% ruo 3% na ntọala psychiatric (Olvera, 2002). Nnyocha e mere n'oge na-adịbeghị anya banyere ndị okenye na-agwọ ọrịa uche chọpụtara na 6.4% na 6.9% nwere IED ugbu a na ndụ ha niile, n'otu n'otu.Grant et al., 2005). Ọmụmụ ihe dị iche iche nke ndị nọ n'afọ iri na ụma chọpụtara na ọnụ ọgụgụ buru ibu nke isiokwu (12.7%) zutere ụkpụrụ maka IED (Grant et al., na pịa). N'ime ma ndị okenye na ndị nọ n'afọ iri na ụma ọmụmụ, nchoputa nke IED ka a chọpụtara na-esochi nyocha na ajụjụ ọnụ. Nchọpụta ndị a na-egosi na IED, dị ka ndị ICD ndị ọzọ, na-emekarị ka a chọpụtaghị ya ma si otú a na-emekarị ka ọ bụrụ ọgwụgwọ adịghị echere. Atụmatụ IED na nlele obodo na-atụ aro na IED bụ ihe a na-ahụkarị. Dịka ọmụmaatụ, otu nnyocha obodo chọpụtara 11.1% nke ndụ niile na-agbasa na 3.2% 1 ọnwa (otu ọnwa).Cocarro et al., 2004). N'ime ọmụmụ NCS-R, atụmatụ ndụ ndụ na ọnwa 12 nke DSM-IV IED bụ 7.3% na 3.9%, n'otu n'otu (Kessler et al., 2006). Ọnụ, ọmụmụ ihe ndị a na-egosi na IED na-adịkarị karịa OCD.

N'akụkụ ụfọdụ, njirimara ụlọ ọgwụ na usoro nke IED yiri nke nsogbu ndị ọzọ ejiri njikwa adịghị mma (dịka ọmụmaatụ, nsogbu iji ọgwụ eme ihe) karịa nke OCD. N'adịghị ka OCD, nke enwere ihe dịka 1: 1 oke nwoke na nwanyị (Robins na Regier, 1991) ma ọ bụ ntakịrị oke ụmụ nwanyị (Mohammadi et al., 2004; Grabe et al., 2006), E ji ihe dị ka 2:1 na-achị ụmụ nwoke (IED).Grant na Potenza, 2006; Kessler et al., 2006). Afọ na mmalite maka DSM-IV IED ọnụ ọgụgụ kasị elu n'ime afọ iri na ụma, dị mbụ maka ụmụ nwoke karịa ụmụ nwanyị, ma buru ụzọ karịa maka ọtụtụ nsogbu ndị na-emekarị na IED (lee n'okpuru ebe a), ma ewezuga nsogbu nchekasị phobic (lee n'okpuru).Kessler et al., 2006). N'otu aka ahụ, ọtụtụ ndị mmadụ (49%) na-akọ na mgbaàmà OCD na-amalite n'oge nwata ma ọ bụ n'oge uto na ọtụtụ (75%) na-akọ mmalite tupu afọ 25 (XNUMX).Robins na Regier, 1991). Na IED, omume ike ike na-eme n'ihe fọrọ nke nta ka ọ bụrụ iri afọ niile nke ndụ na-amalite n'ime afọ iri mbụ, na-arị elu n'ime afọ iri nke atọ, na-ebelata nwayọọ nwayọọ ka afọ iri nke anọ gasịrị, ma na-ejedebe na obere ma ọ bụ enweghị mkpesa n'ime afọ iri asatọ.Cocarro et al., 2004). Mmekọrịta sociodemographic nke ndụ IED gụnyere agụmakwụkwọ dị ala, ịlụ di na nwunye, na inwe obere ego ezinụlọ (Kessler et al., 2006). N'ụzọ dị iche, OCD egosighi njikọ doro anya na ọkwa agụmakwụkwọ yana ndị lụrụ di na nwunye na-adịkarịghị enwe mmekpa ahụ (Robins na Regier, 1991).

3.2. Ọgba aghara na-emekọ ọnụ

Dị ka ICD ndị ọzọ (Potenza, 2007), IED na-enwekarị nsogbu uche ndị ọzọ gụnyere OCD. Akọpụtara nchoputa mbụ site na nlele ụlọ ọgwụ. Otu nnyocha kọrọ OCD na 22% nke ndị mmadụ nwere IED (McElroy et al., 1998). Atụmatụ IED na nlele ụlọ ọgwụ nke isiokwu nwere OCD sitere na ihe dịka 2% ruo ihe dịka 10%du Toit et al., 2005; Fontenelle et al., 2005). Na NCS-R, ọnụ ọgụgụ ka ukwuu (81.8%) nke ndị ọrịa nwere IED akọwapụtara nke ọma n'oge ndụ ha zutere ụkpụrụ maka opekata mpe otu nsogbu DSM-IV ndụ ọzọ (Kessler et al., 2006). Achọpụtara ụdị ọrịa uche dị iche iche na njikọta na IED gụnyere ọnọdụ, nchekasị, njikwa mkpali na nsogbu iji ọgwụ eme ihe (Kessler et al., 2006). N'ime ndị nwere nkọwa zuru ezu IED, 4.4% zutere ụkpụrụ maka OCD. Oke ihe ndabara (OR) maka nkọwapụta nke ọma IED na njikọ OCD bụ 2.5 (95% oge ntụkwasị obi (CI): 1.1-5.7). N'ime otu akọwapụtara nke ọma, ọ nweghị ọdịiche dị ịrịba ama na ogo njikọ dị n'etiti IED na OCD (OR: 1.1; 95% CI: 0.2-6.9). N'ụzọ dị iche, nsogbu nchekasị zuru oke, ICD niile na ọtụtụ nsogbu iji ọgwụ eme ihe gosipụtara OR dị elu nke ukwuu maka IED nke ọma na nke akọwapụtara nke ọma, na-atụ aro mmekọrịta chiri anya n'etiti nsogbu ndị a na ma ụdị IED dị obere ma dị njọ.Kessler et al., 2006).

3.3. Akụkọ Ezinụlọ na Genetics

Ọ bụ ezie na ọmụmụ ihe na-egosi na omume mkpasu iwe na ime ihe ike na-egosi nnyefe ezinụlọ (Halperin et al., 2003; Kreek et al., 2005), ole na ole ọmụmụ gbasara mkpụrụ ndụ ihe nketa ma ọ bụ akụkọ ezinụlọ ka emechara n'ime ndị nwere IED. Ọtụtụ usoro nyocha achọpụtala ezinụlọ sociopathy na mmegide dị ka ihe egwu dị oke egwu maka nnọgidesi ike nke iwe iwe nwata n'ime oge uto na ntozu.Cadoret et al., 1995; Frick et al., 1990). Ejikọtala ụkpụrụ ezinaụlọ nke omume mkpasu iwe na ọrụ serotonin etiti (lee neurobiology n'okpuru) (Halperin et al., 2003). Akụkọ ezinụlọ nke ndị mmadụ nwere IED bụ ọnụ ọgụgụ dị elu nke ọnọdụ ọnọdụ, iji ọgwụ eme ihe na nsogbu nchịkwa mkpali ndị ọzọ (McElroy et al., 1998). Nnyocha njikọ mkpụrụ ndụ ihe nketa hụrụ njikọ dị n'etiti ụdị allelic nke serotonin (5HT) 1B gene receptor gene na mmanya na-egbu egbu na ndị na-eme ihe ike / ndị na-anụ ọkụ n'obi bụ ndị zutere njirisi ma ọ bụ maka nsogbu àgwà mmadụ ma ọ bụ IED.Lappalainen et al., 1998). N'ụzọ dị iche, onye na-anabata 5HT 1B etinyeghị aka na ọmụmụ mkpụrụ ndụ ihe nketa nke OCD, ọ bụ ezie na ọtụtụ mkpụrụ ndụ ihe nketa metụtara 5HT (dịka ọmụmaatụ, ndị na-etinye 5HT 1D na 5HT 2A receptors na 5HT transporter), etinyere ya na ụfọdụ ma ọ bụghị ha niile. ọmụmụ banyere OCD (Hemmings na Stein, 2006).

3.4. Neurobiology: Ụdị anụmanụ na ọmụmụ mmadụ

Ọtụtụ sistemụ neurotransmitter na mpaghara ụbụrụ na-enye aka na iwe iwe ọkụ. Ụdị anụmanụ emetụtala ọtụtụ usoro ihe ndị dị ndụ na ndị na-ahụ maka ụbụrụ gụnyere ndị metụtara testosterone, gamma-amino butyric acid, nitric oxide, monoamine oxidase, glutamate, dopamine na serotonin.Olivier na Young, 2002; Korff na Harvey, 2006). N'ime usoro ndị a, ihe ndị a kapịrị ọnụ yiri ka ọ dị mkpa. Dịka ọmụmaatụ, data siri ike na-emetụta onye na-anabata 5HT 1B na mkpasu iwe na ụmụ oke; ụmụ oke knockout enweghị onye na-anabata ya na-egosi oke iwe nke anụ ahụ (Saudou et al., 1994). Nchọpụta ndị a kwekọrọ na ọmụmụ mmadụ nke na-etinye onye na-anabata ya na mmanya na-egbu egbu.Lappalainen et al., 1998). Ọ bụ ezie na ụfọdụ n'ime otu usoro ahụ (dịka, 5HT, dopamine) dị mkpa ma IED na OCD, ha yiri ka ha na-etinye aka n'ụzọ dị iche iche. Dịka ọmụmaatụ, mmebi nke mkpụrụ ndụ ihe nketa na-edobe onye na-anabata 5HT 2C na onye na-ebugharị dopamine na-emepụta àgwà stereotypic yiri OCD (Korff na Harvey, 2006), ma e jiri ya tụnyere njikwa nnabata 5HT 1B nke dabara na IED. Ọdịiche nke mkpụrụ ndụ ihe nketa na ụdị mkpụrụ ndụ ihe nketa metụtara 5HT na-emekarị (dịka ọmụmaatụ, nke onye na-ebugharị 5HT) na-emetụta usoro 5HT jikọtara ya na mkpasu iwe.Mannelli et al., 2006).

Ọmụmụ ihe ole na ole enyochala neurobiology nke IED na ụmụ mmadụ, na ndị dịnụ achọpụtabeghị ọdịiche dị n'etiti otu. Dịka ọmụmaatụ, ihe ọmụmụ spectroscopy resonance magnetik nke chọpụtara ọdịiche dị na bipolar na-eto eto na ihe nchịkwa na usoro myoinositol ahụghị ọdịiche dị n'etiti ndị nọ n'afọ iri na ụma na ndị na-enweghị IED.Davanzo et al., 2003). Ọ bụ ezie na e meela ọmụmụ ole na ole n'ime ndị nwere IED, ọtụtụ enyochala ndị nwere mkpasu iwe. Ọtụtụ usoro ndu, gụnyere ndị metụtara opiates, vasopressin, testosterone, catecholamines (norepinephrine, dopamine), na 5HT, ka achọpụtara dị ka ihe na-enye aka na mmegide mmadụ.Coccaro na Siever, 2002). Otu n'ime nchoputa a na-emegharịkarị bụ na ọkwa dị ala nke 5HT (karịsịa nke 5HT metabolite 5-hydroxy indole acetic acid) na ndị na-eme ihe ike.Coccaro na Siever, 2002; Williams na Potenza, na akwụkwọ akụkọ). Ọ bụ ezie na usoro 5HT etinyela aka na OCD, ọdịdị nke ntinye aka dị iche, dịka a na-ekpe ikpe site na nsonaazụ nke ọmụmụ ihe ịma aka ọgwụ. Nlekọta nke ọgwụ serotonergic meta-chlorophenylpiperazine (m-CPP, 5HT1 na 5HT2 agonist na-anabata ya).Potenza na Hollander, 2002) na fenfluramine (ọgwụ na-ebute 5HT ntọhapụ na inwe post-synaptic 5HT omumeCurzon na Gibson, 1999)) jikọtara ya na mmụba nke mgbaàmà OC yana nkwalite prolactin ntọhapụ na isiokwu nwere OCD (Hollander et al., 1991; Monteleone et al., 1997; Gross-Isseroff et al., 2004). Agbanyeghị, otu ụmụaka na ndị okenye ji mkpasu iwe na-egosipụta nzaghachi prolactin na-enweghị isi na m-CPP na fenfluramine.Cocarro et al., 1997; Halperin et al., 2003; Ọhụrụ et al., 2004b; Patkar et al., 2006). Nchọpụta ndị a kwekọrọ na ndị sitere na primates, bụ nke a kọwapụtara mmekọrịta dị n'etiti mkpasu iwe na ọrụ serotonergic (Tiefenbacher et al., 2003)

Ọmụmụ ihe onyonyo nke ụbụrụ ewepụtala nghọta na pathophysiology nke iwe iwe ọkụ n'ime mmadụ. Nkwekọrịta na ọrụ maka ventromedial prefrontal cortex (vmPFC, mpaghara gụnyere medial orbital frontal cortex)Bechara, 2003)) n'ime mkpebi na ikpe ọha na eze na omume (Damasio, 1994; Anderson et al., 1999; Bechara, 2003), ndị mmadụ nwere mkpasu iwe na-egosi obere mbelata nke vmPFC. Dịka ọmụmaatụ, n'etiti ndị nwere ịda mbà n'obi, ndị nwere iwe iwe gosipụtara mmekọrịta dị n'etiti ọbara ụbụrụ mpaghara na vmPFC ekpe na amygdala hapụrụ n'oge iwe iwe, ebe isiokwu ndị na-enweghị iwe iwe emeghị.Dougherty et al., 2004). Akụkụ nke ọrụ vmPFC dị ka ihe metụtara mkpasu iwe na-egosi njikọ na ọrụ 5HT. Ndị mmadụ n'otu n'otu nwere iwe iwe ma e jiri ya tụnyere ndị na-enweghị nzaghachi hemodynamic na-enweghị isi na ọgwụ serotonergic fenfluramine (Siever et al., 1999na m-CPP (Ọhụrụ et al., 2002). Ndị mmadụ n'otu n'otu nwere mkpasu iwe na-egosikwa mbelata 5HT dị na ihu cingulate cortex, gụnyere n'ime akụkụ ventral gụnyere na vmPFC (Frankle et al., 2005). 5HT reuptake inhibitor (SRI) fluoxetine na-abawanye metabolism n'ime orbitofrontal cortex.Ọhụrụ et al., 2004a). Ọ bụ ezie na arụrụ ọrụ cortical orbitofrontal etinyela aka na OCD, ụdị ntinye aka ya dị iche na nke ahụ na mkpasu iwe. Kpọmkwem, n'ụzọ pụtara ìhè na mbelata ọrụ vmPFC jikọtara ya na mkpasu iwe, mmụba nke cortical-striato-thalamo-cortical sekit, gụnyere mpaghara orbitofrontal metụtara vmPFC, etinyerela ya ugboro ugboro na OCD (Korff na Harvey, 2006; Mataix-Cols na van den Heuvel, 2006). Agbanyeghị, otu obere obere ndị nwere OCD na-egosi ịgbalite sekit a dị iche iche. Dịka ọmụmaatụ, n'oge ọmụmụ ihe mgbaàmà fMRI na-akpasu iwe, ndị mmadụ na-asa OCD gosipụtara ịgbalite vmPFC na caudate siri ike, ndị na-enyocha OCD gosipụtara ọrụ siri ike nke putamen/globus pallidus, thalamus, na dorsal cortical area, na ndị nwere hoarding gosipụtara OCD ike ọrụ. nke precentral gyrus na orbitofrontal cortexMataix-Col et al., 2004).

3.5. Ọgwụ na ọgwụgwọ omume na ntinye aka

Nnwale ụlọọgwụ ole na ole enyochala ịdị irè na nnabata ọgwụ na ọgwụgwọ IED. A kọwo ọgwụ ndị na-egbochi ụgbọ njem serotonin (ma ndị SRI dịtụ aka na ndị na-abụghị ndị a na-ahọrọ dị ka sertraline na venlafaxine, n'otu n'otu) ma ọ bụrụ na akụkọ na-enyere ndị mmadụ aka na IED (n'otu n'otu).McElroy et al., 1998; Federi, 1999). Ọ bụ ezie na nchọpụta a nwere ike igosi myirịta na iji SRI na-agwọ OCD, doses ndị a na-arụ na-adịkarị ala karịa nke a na-ejikarị na OCD (Denis, 2006). Dịka ọmụmaatụ, n'otu usoro ikpe metụtara isiokwu IED, a na-enye sertraline na 50-100 mg / ụbọchị.Federi, 1999) kama mgbe ahụ doses na-eru nso 200 mg / ụbọchị na-ejikarị maka OCD. Ọrụ maka SRI na ọgwụgwọ IED kwekọrọ na ịdị irè ha n'ịchụso mkpasu iwe na-adịghị mma (Coccaro na Kavoussi, 1997; Reist et al., 2003). A kọwo ọgwụ na-eme ka ọnọdụ obi dị ka lithium na valproic acid nyere aka na ọmụmụ ọgwụgwọ IED mepere emepe (McElroy et al., 1998), kwekọrọ na nchoputa sitere na ụfọdụ mana ọ bụghị ọmụmụ ihe niile nke ndị a na ndị ọzọ na-eme ka ọnọdụ ọnọdụ ọnọdụ (carbamazepine, phenytoin) na-ezubere iche maka mkpasu iwe.Olvera, 2002; Dell'Osso et al., 2006; Grant na Potenza, 2006). Otú ọ dị, lithium enweghị ike dị ka ihe na-eme ka ọ dịkwuo elu na ọgwụgwọ OCD.McDougle et al., 1991), ọ bụ ezie na ụfọdụ ọgwụ antipsychotic (dịka ọmụmaatụ, olanzapine, risperidone) nwere ihe ndị na-eme ka ọnọdụ ọnọdụ dịkwuo mma egosila ịdị irè na ịbawanye nzaghachi SRI na OCD refractory.Denis, 2006). Ụfọdụ ọgwụ antipsychotic adịwokwa irè n'ịgwọ mkpasu iwe na ọmụmụ ihe a na-achịkwa.Nchọpụta et al., 2001; Buitelaar et al., 2001). Alfa-adrenergic agonists na beta-adrenergic antagonists egosila ụfọdụ nkwa n'ịchụso mkpasu iwe.Olvera, 2002; Dell'Osso et al., 2006; Grant na Potenza, 2006), ebe ọ nweghị ọrụ maka ọgwụ ndị a egosipụtara na ọgwụgwọ OCD (Denis, 2006). Ejikọtara ọnụ, n'agbanyeghị na data maka IED nwere oke, ozi dị adị na-egosi na myirịta dị na ọgwụgwọ ọgwụ nke IED na OCD karịrị nnukwu ndịiche.

Ihe omuma sitere na ule psychotherapy maka ndi mmadu nwere IED nwere oke, na aro na nlebara anya nke uche na ọgwụgwọ omume nwere ike inye aka maka ufodu ndi mmadu.Grant na Potenza, 2006). Ọmụmụ ihe dị ntakịrị metụtara ọnụ ọgụgụ dị nta nke isiokwu ahụbeghị ọganihu dị ukwuu metụtara otu, di na nwunye ma ọ bụ ọgwụgwọ ezinụlọ (McElroy et al., 1998). N'ihe gbasara omume ime ihe ike, ọmụmụ ihe a na-achịkwa nke omume omume gụnyere CBT, ọgwụgwọ otu, ọgwụgwọ ezinụlọ na ọzụzụ ọzụzụ mmekọrịta ọha na eze na-akọ ụfọdụ irè maka ndị ọrịa na-eme ihe ike (Alpert na Spilman, 1997). Usoro ọgwụgwọ ndị a dị iche na mkpughe na ụzọ mgbochi nzaghachi nke dị irè na ọgwụgwọ OCD (Neziroglu et al., 2006). Ya mere, dị ka data pharmacotherapy, nchọpụta ọgwụgwọ omume na-egosi ọdịiche dị ukwuu n'etiti IED na OCD.

3.6. Echiche omenala

Àgwà omenaala n'akparamàgwà ndị na-eme ihe ike mere ka a tụlee ya na IED, ọ bụ ezie na e mewo ntakịrị nyocha usoro n'usoro gbasara mmetụta nke ihe omenala. Otu ụdị iwe iwe, ihe omume amok, bụ ihe e ji mara oke ike, ime ihe ike a na-achịkwaghị achịkwa, nke a na-ejikọta ya na amnesia, na nke a na-ahụkarị na mba ndịda ọwụwa anyanwụ Eshia.Kọmitii Òtù Na-ahụ Maka Ọrịa Uche America na Nomenclature na Statistics, 2000). Oke nke IED yitere amok episodes ma ọ bụ nghọta ya nwere ikike nyocha. Ọ bụ ezie na OCD na-apụta n'ofe agbụrụ / agbụrụ na mpaghara mpaghara (Karno et al., 1988; Mohammadi et al., 2004), Omenala dị iche iche dị mkpa ịtụle ebe ọ bụ na ụkpụrụ omenala metụtara ụdị omume dị iche iche nwere ike ịdị iche (Kọmitii Òtù Na-ahụ Maka Ọrịa Uche America na Nomenclature na Statistics, 2000). Ọ bụ ezie na echiche omenala dị maka ma IED na OCD, ọdịdị nke mkpakọrịta dị n'etiti ihe omenala omenala na nsogbu abụọ ahụ yiri ka ọ dị iche.

4.1. Phenomenology na Epidemiology

Edebere PG ka ọ nọchite anya ma ọrịa OC-spectrum na ihe riri ahụ na-enweghị ọgwụ, yana data dị iji kwado categorization ọ bụla (Hollander na Wong, 1995; Potenza et al., 2001). Ọ bụ ezie na categorizations ndị a abụghị ndị na-ekewapụ onwe ha, ha nwere mmetụta dị mkpa na usoro ọmụmụ na ụlọ ọgwụ (Tamminga na Nestler, 2006). Echiche na-emegharị ugboro ugboro, na-akpali akpali gbasara ịgba chaa chaa na PG na-ekekọrịta atụmatụ na mkparị na OCD. Dịka OCD, PG bụ omume ugboro ugboro. Na PG, a na-eme omume ịgba chaa chaa na ịgba chaa chaa (dịka ọmụmaatụ, nkwarụ, ịnweta ego ịgba chaa chaa, wdg) ugboro ugboro (Potenza et al., 2001). Dị ka ọ dị na OCD, omume ndị a na-emetụtakarị akụkụ ndị dị mkpa nke ịrụ ọrụ (Kọmitii Òtù Na-ahụ Maka Ọrịa Uche America na Nomenclature na Statistics, 2000). N'adịghị ka omume ego-dyystonic metụtara OCD, ịgba chaa chaa na PG na-abụkarị ego-syntonic ma ọ bụ hedonic na okike, ọ bụ ezie na ka oge na-aga, ụtọ nke a na-enweta site na ịgba chaa chaa nwere ike ibelata. N'akụkụ a, ịgba chaa chaa na PG nwere ike ịdị ka iji ọgwụ eme ihe na ịdabere na ọgwụ ọjọọ, nke a na myirịta ndị ọzọ phenomenological tụrụ aro na PG nwere ike ịnọchite anya "eriri omume" (Holden, 2001; Petry, 2006; Potenza, 2006). A kọwo ihe omume telescoping maka PG na ọgwụ na ịṅụ mmanya na-aba n'anya nke ụmụ nwanyị na nkezi na-amalite na-akpa àgwà metụtara nsogbu na afọ ọzọ ma na-enwe ọganihu ngwa ngwa ("telescope") karịa ka ụmụ nwoke na-enwe nsogbu nsogbu (Potenza et al., 2001; Tavares et al., 2001). Ọnụ ọgụgụ nke ndị ikom: ndị inyom nwere PG (ihe dịka 2: 1) yiri nke ahụ na ịṅụ ọgwụ ọjọọ na ịṅụ mmanya na-aba n'anya karịa oke a hụrụ na OCD (ihe dịka 1: 1) (Potenza et al., 2001; Petry, 2006; Potenza, 2006). Ihe data dị na usoro ọmụmụ ụlọ ọgwụ nke PG na ịdabere na ihe na-atụ aro myirịta, yana ọnụ ọgụgụ ndị na-adịghị ahụkebe n'oge nwata, ọnụ ọgụgụ dị elu n'oge uto na ntorobịa na ọnụ ọgụgụ dị ala na ndị okenye.Chambers na Potenza, 2003; Potenza, 2006). Usoro ndị a dị iche na nke a hụrụ na OCD. Dịka ọmụmaatụ, na mmalite OCD n'oge nwata bụ ihe a na-ahụkarị (Kọmitii Òtù Na-ahụ Maka Ọrịa Uche America na Nomenclature na Statistics, 2000). Ọtụtụ njirisi nchọpụta agbakwunyere maka PG na-egosipụta nke ọma nke ndị ahụ maka ịdabere n'ihe, gụnyere akụkụ nke ndidi, nkwụghachi ụgwọ, mbọ na-emerighị nke ọma ugboro ugboro iji belata ma ọ bụ kwụsị, yana nnyonye anya na akụkụ ndị dị mkpa nke ndụ. Usoro mmadụ na-atụ aro na ndị mmadụ nwere PG, dị ka ndị nwere ihe na-adabere na ihe, bụ ihe na-akpali akpali ma na-achọ mmetụta.Blaszczynski et al., 1997; Potenza et al., 2003b) ebe ndị nwere OCD na-ezere mmerụ ahụ karịa (Hollander na Wong, 1995; Anholt et al., 2004). Ya mere, n'agbanyeghị na enwere myirịta dị n'etiti PG na OCD, ndị dị n'etiti PG na ịdabere na ihe na-apụtawanye ike.

4.2. Ọgba aghara na-emekọ ọnụ

Nnyocha nke ihe nlele ụlọ ọgwụ na-egosi ọnụ ọgụgụ dị elu nke mmekọrịta dị n'etiti PG na ọtụtụ nsogbu nke internalizing na mpụga, gụnyere ma ọnọdụ Axis I na Axis II (Crockford na el-Guebaly, 1998; Potenza, 2007). Data sitere na nlele obodo na-egosikwa ọnụ ọgụgụ dị elu nke nsogbu ndị na-emekọ ihe ọnụ. Dịka ọmụmaatụ, data sitere na St. Louis Epidemiologic Catchment Area (ECA) achọpụtara ọnụ ọgụgụ dị elu dị n'etiti nsogbu / ịgba chaa chaa na-akpata ịda mbà n'obi na nnukwu ịda mbà n'obi, nsogbu nchekasị (phobias, somatization), nsogbu ịṅụ ọgwụ ọjọọ (nicotine dabere na ịṅụbiga mmanya ókè / ịdabere na ya), nsogbu nke psychotic, na nsogbu ịkpa ókè agbụrụCunningham-Williams et al., 1998). Ahụrụ oke 0.6 enweghị oke n'etiti nsogbu / ịgba chaa chaa na OCD (Cunningham-Williams et al., 1998). Ihe atụ ndị ọzọ buru ibu nke obodo (dịka ọmụmaatụ, ihe atụ nke ejima nwoke na ndekọ Vietnam Era Twin (VET)) egosikwala mkpakọrịta dị elu n'etiti PG na ọnọdụ, nchekasị, iji ọgwụ eme ihe, na nsogbu ndị na-emegide ọha.Potenza et al., 2005). N'oge na-adịbeghị anya, data sitere na NESARC gosipụtara oke ohere dị elu maka PG na njikọ ya na ọtụtụ nsogbu axis I na axis II gụnyere mmanya na-aba n'anya, nicotine na ịdabere na ọgwụ ndị ọzọ, nsogbu ọnọdụ ọnọdụ (gụnyere manic na ịda mbà n'obi), nsogbu nchekasị (gụnyere ụjọ, phobic na nchekasị zuru oke), na nsogbu ndị mmadụ (gụnyere ndị na-ezere, dabere, mkpasu iwe, paranoid, schizoid, histrionic, and antisocial)Petry et al., 2005). N'ime NESARC ma ọ bụ VET sample bụ nyocha nyocha nke OCD nwetara. Ya mere, data dabere na obodo dị ugbu a na-egosi njikọ siri ike n'etiti PG na ọtụtụ nsogbu uche ndị ọzọ karịa dị n'etiti PG na OCD.

4.3. Akụkọ Ezinụlọ na Genetics

Ọmụmụ ejima na-egosi na PG nwere oke ihe nketa. Nnyocha nke ụmụ ejima abụọ 3,359 kwubiri na ihe nketa kọwara site na 35% ruo 54% nke ụgwọ maka PG (Eisen et al., 1998; Shah et al., 2005). Nchọpụta ndị a kwekọrọ na ọmụmụ akụkọ ihe mere eme ezinụlọ pere mpe nke atụmatụ PG na ndị ikwu probands nwere PG bụ 9%, nke dị elu karịa ọnụego 1% a na-ahụkarị na ọha mmadụ.Black et al., 2003). N'ikwekọ na data dị na nsogbu ndị na-emekọ ihe ọnụ, ọmụmụ akụkọ ihe mere eme ezinụlọ adịghị egosi ọnụ ọgụgụ dị elu nke PG n'etiti ndị òtù ezinụlọ nke probands nwere OCD (Hollander et al., 1997; Bienvenu et al., 2000). Na-ekwekọkwa n'ụkpụrụ nke nsogbu ndị na-emekọ ihe ọnụ bụ ndị a na-ahụ n'omume ndị mmadụ dabere (Cunningham-Williams et al., 1998; Petry et al., 2005), data sitere na ndekọ VET na-egosi oke mkpụrụ ndụ ihe nketa na onyinye gburugburu ebe obibi na PG yana njikọ ya na ịdabere na mmanya na-aba n'anya (Slutske et al., 2000) na omume megidere ọha mmadụ (Slutske et al., 2001). N'iji atụnyere, ndakọrịta dị n'etiti PG na nnukwu ịda mbà n'obi bụ ihe na-ebutekarị n'ihe gbasara mkpụrụ ndụ ihe nketa (Potenza et al., 2005). A kọbeghị ọmụmụ ihe yiri nke ahụ na-enyocha mmekọrịta dị n'etiti PG na OCD.

Ọmụmụ mkpụrụ ndụ ndị Candidates atụwo aro na ọtụtụ ụdị allelic na-emekarị na-enye aka na PG (Ibanez et al., 2003; Shah et al., 2004). A na-ejikọta Taq-A1 polymorphism nke mkpụrụ ndụ ihe nketa nke D2 dopamine na PG, nsogbu nlebara anya hyperactivity, ọrịa Tourette, mmanya na ịṅụ ọgwụ ọjọọ / ịdabere na ya, omume ndị na-emegide ọha na eze, na nchịkwa mgbochi na-adịghị mma.Blum et al., 1996; Ọbịa, 1998; Ponce et al., 2003; Rodriguez-Jimenez et al., 2006). Ọdịiche dị iche iche nke allelic gụnyere ndị nọ na mkpụrụ ndụ ihe nketa maka D1 dopamine receptor, monoamine oxidase A enzyme, na onye na-ebugharị 5HT, n'etiti ndị ọzọ, etinyela aka na PG.Perez de Castro et al., 1997; Ọbịa, 1998; Perez de Castro et al., 1999; Ọbịbịa et al., 2001; Ibanez et al., 2003; Shah et al., 2004; Williams na Potenza, na akwụkwọ akụkọ). Ọ bụ ezie na ụfọdụ n'ime otu ụdị allelic dị iche iche (dịka ọmụmaatụ, variants nke 5HT transporter gene) etinyewo aka na OCD na PG, ọdịdị nke mkpakọrịta ahụ dị iche iche, na ogologo oge a na-ahụ anya na OCD na obere mkpirisi a chọtara na mkpakọrịta. PG (Ibanez et al., 2003; Hemmings na Stein, 2006). Ọzọkwa, nchoputa ndị dị na OCD adịghị ekwekọ, na ọtụtụ ọmụmụ na-emetụta allele na ndị ọzọ adịghị (Hemmings na Stein, 2006). Ọtụtụ mmachi dị na ọmụmụ mkpụrụ ndụ ihe nketa emere ruo taa na PG. Dịka ọmụmaatụ, ụfọdụ ọmụmụ etinyeghị nyocha nyocha ma ọ bụ tụlere ọdịiche dị na agbụrụ / agbụrụ dị n'etiti otu. N'ihi ya, ekwesịrị ka a na-ewere ọmụmụ ihe ndị a dị ka nke mbụ, yana ọrụ ndị ọzọ dị mkpa iji chọpụta onyinye mkpụrụ ndụ ihe nketa na PG na otú ha si atụnyere ma dị iche na ndị na-adabere na OCD.

4.4. Neurobiology: Ụdị anụmanụ na ọmụmụ mmadụ

Ọ bụ ezie na e guzobebeghị ụdị anụmanụ nke PG kwa se, sekit frontostriatal etinyere n'ụdị dị iche iche n'ọrụ ndị metụtara oke mkpali.Jentsch na Taylor, 1999; Schultz et al., 2000; Everitt na Robbins, 2005). Ihe sekit a etinyekwala aka na ọmụmụ mmadụ gbasara PG (Potenza, 2001; Potenza, 2006; Williams na Potenza, na akwụkwọ akụkọ). Ọmụmụ ihe onyonyo ụbụrụ nke ndị mmadụ nwere PG etinyela vmPFC n'oge agụụ ịgba chaa chaa (Potenza et al., 2003b), njikwa ọgụgụ isi (Potenza et al., 2003a), na ịgba chaa chaa simulated (Reuter et al., 2005). N'ihe ndị na-abụghị PG, mpaghara ụbụrụ a na-etinye aka na usoro ọgụgụ isi metụtara ịgba chaa chaa, gụnyere nhazi ụgwọ ọrụ (Knutson et al., 2001; McClure et al., 2004) na ime mkpebi n'ihe egwu-ụgwọ ọrụ (Bechara et al., 1998; Bechara et al., 1999; Bechara, 2003). Nnyocha nke arụmọrụ na ọrụ neurocognitive na-elekwasị anya na usoro ndị a ekpughere ọdịiche dị n'etiti PG na njikwa ntụnyere isiokwu (Petry na Casarella, 1999; Petry, 2001; Cavedini et al., 2002a). Achọpụtala ihe dị iche n'etiti PG na isiokwu nchịkwa na arụmọrụ ime mkpebi (Cavedini et al., 2002a) na ndịiche ndị a yiri nke dị n'etiti OCD na isiokwu nchịkwa (Cavedini et al., 2002b) na ndị dị n'etiti ndị na-adabere na ọgwụ na nchịkwa (Bechara, 2003). Agbanyeghị, arụ ọrụ ụbụrụ na-akpata esemokwu dị n'etiti isiokwu-otu na ọrụ ime mkpebi enyochabeghị ozugbo. Nyere na mmụba nke sekit frontostriatal a na-ahụta ugboro ugboro na OCD (Mataix-Cols na van den Heuvel, 2006) na mbelata arụ ọrụ hụrụ na PG (Reuter et al., 2005; Potenza, 2006), nyocha otu oge nke PG, OCD, ọgwụ dabere na isiokwu nchịkwa na njikọ akwara nke usoro ọgụgụ isi metụtara otu isiokwu ndị a dị mkpa.

Ọmụmụ ihe ịma aka nke ọgwụ emetụtala ọtụtụ sistemụ neurotransmitter na PG, gụnyere 5HT, dopamine, norepinephrine opioid na sistemu ndị ọzọ.Potenza, 2001; Potenza na Hollander, 2002; Chambers na Potenza, 2003). Ọtụtụ n'ime usoro ndị a na-etinye aka na ọrịa uche ndị ọzọ gụnyere OCD, nke data na-egosi ntinye aka nke 5HT na usoro dopamine kwadoro nke ọma (Paul et al., 2002). Otú ọ dị, data na-egosi ọdịiche dị na ọdịdị nke ntinye aka nke usoro ndị a na PG na OCD. Nnyocha na isiokwu OCD nke ndị ọrụ pro-serotonergic dị ka m-CPP na-egosi na ọnụ ọgụgụ dị ukwuu (ihe dị ka 50%) na-akọ na ọ na-akawanye njọ nke mgbaàmà na-esote ihe ịma aka ọgwụ.Paul et al., 2002). N'ụzọ dị iche, ndị nwere PG nwere ike ịkọ nzaghachi euphoric ma ọ bụ "elu" nye ndị ọrụ pro-serotonergic (Potenza na Hollander, 2002). Nchọpụta ndị a abụghị naanị na-akwado nchoputa onyonyo nke ụbụrụ nke ihe atụ ndị yiri ya na-egosi ọdịiche dị n'etiti otu dị iche iche nke valences dị iche na OCD na PG (Potenza et al., 2003b), ma na-atụkwa aro na akụkụ ụfọdụ nke impulsivity (dịka ọmụmaatụ, ndị metụtara euphoria n'ihe metụtara mmechi) nwere ike jikọta ya na akụkụ ụfọdụ nke usoro 5HT.

4.5. Ọgwụ na ọgwụgwọ omume na ntinye aka

N'ime afọ iri gara aga nghọta anyị maka ọgwụgwọ dị mma ma dị irè maka PG agaala nke ọma (Grant na Potenza, 2004; Grant na Potenza, 2007; Brewer et al., na pịa). Ma myirịta na ndịiche pụtara ìhè n'ihe gbasara ọgwụgwọ ọgwụ maka PG na OCD. Usoro ọgwụgwọ mbụ maka OCD gụnyere iji SRI, ọgwụ ndị egosipụtara n'ọtụtụ ebe a na-achịkwa ebebo, nnwale ụlọ ọgwụ na-enweghị usoro (RCT) ka ọ dị irè (Denis, 2006). Ọrụ maka SRI na ọgwụgwọ PG adịchaghị nke ọma. Ọ bụ ezie na ọtụtụ RCT achọpụtala SRI dị ka fluvoxamine na paroxetine dị elu karịa placebo na ọgwụgwọ PG.Hollander et al., 2000; Kim et al., 2002), ndị ọzọ ahụbeghị mmetụta dị mkpa na ndekọ ọnụ ọgụgụ (Blanco et al., 2002; Grant et al., 2003). Nchọpụta ndị a na-egosi na enwere ihe dị mkpa nke onye ọ bụla metụtara nsonaazụ ọgwụgwọ na otu ndị nwere PG. Ịtụle nsogbu ndị na-emekọ ihe ọnụ nwere ike ịbụ otu ụzọ maka nduzi ọgwụ ọgwụ (pharmacotherapies).Hollander et al., 2004; Potenza, 2007). Dịka ọmụmaatụ, nnyocha e mere n'oge na-adịbeghị anya banyere escitalopram na ọgwụgwọ PG na nchekasị na-emekọ ihe na-achọpụta mbelata nchekasị na mgbaàmà ịgba chaa chaa n'oge ọgwụgwọ na-emeghe (Grant na Potenza, 2006b). N'ime ndị na-anata ọgwụ na-arụsi ọrụ ike n'oge oge nkwụsị nke okpukpu abụọ, a na-edobe nzaghachi ụlọ ọgwụ; N'ụzọ dị iche, ọgwụgwọ placebo jikọtara ya na mgbaàmà na-akawanye njọ (Grant na Potenza, 2006b). Data na-apụta na-atụ aro ọrụ maka ọgwụgwọ glutamatergic na ọgwụgwọ nke ma OCD na PG (Denis, 2006; Ego, 2006). Agbanyeghị, a ga-atụle nsonaazụ sitere na nnwale ndị a na ọtụtụ ọgwụ ọgwụ ndị ọzọ nke PG nke ọma nyere oke oke dị ka obere nha nha na oge ọgwụgwọ dị mkpụmkpụ. Ekwesịrị ịkpachara anya maka nchoputa akara ngosi mepere emepe nyere ọnụego nzaghachi placebo dị elu hụrụ na ọmụmụ PG.Grant na Potenza, 2004).

Nsonaazụ nke nnwale ọgwụ ọgwụ ndị ọzọ na-egosi ọdịiche dị n'etiti PG na OCD. Dịka ọmụmaatụ, a chọpụtala na ndị na-emegide opioid dị ka naltrexone na nalmefene dị elu karịa placebo na ọgwụgwọ PG.Kim et al., 2000; Grant et al., 2006b). N'ụzọ dị iche, opioid antagonist naloxone ejikọtara ya na mgbakasị mgbaàmà na OCD (Insel na Pickar, 1983; Keuler et al., 1996). Ebe ndị na-eme ka ọnọdụ ọnọdụ dị ka lithium nwere ike inye aka na otu isiokwu nwere PG (Hollander et al., 2005), arụmọrụ ha na OCD yiri ka a na-enyo enyo (McDougle et al., 1991). Ebe ọgwụ antipsychotic nke na-emegide ndị na-anabata D2 dopamine (dịka, haloperidol, risperidone na olanzapine) egosila ịdị irè dị ka ihe na-emewanyewanye na OCD.Denis, 2006), data dị adị anaghị akwado ọrụ maka ọgwụ ndị a na ọgwụgwọ PG (Grant na Potenza, 2004).

Data na-egosi na ọgwụgwọ omume nwere ọrụ dị mkpa na ọgwụgwọ PG na OCD. Agbanyeghị, mmemme omume ndị akọwapụtara dị iche. Na PG, ihe omume 12-step Gamblers Anonymous (GA) bụ ihe a na-ekwu na ọ bụ ntinye aka na-ejikarị eme ihe yana data dị adị na-atụ aro na ndị na-aga na-aga nke ọma karịa ndị na-adịghị.Petry, 2005; Brewer et al., na pịa). Ogologo nke nke a na-anọchi anya mmetụta ọgwụgwọ n'ezie ma ọ bụ na-egosipụta enweghị mmasị na nhọrọ (ya bụ, ndị na-akwali ịnọ na GA na-akpalikwa ịghara ịgba chaa chaa) na-enye ohere nyocha ọzọ. GA, ntinye aka nwere oke oke akụ na ụba, ka emebere ka Alcoholics Anonymous. Enweghị usoro ihe omume 12 a haziri ahazi maka ma ọ bụ kwenyere na ọ ga-enyere ndị mmadụ nwere OCD aka. Usoro ọgwụgwọ omume na-enyere ndị mmadụ n'otu n'otu nwere PG aka gụnyere nkwalite mkpali ma ọ bụ ajụjụ ọnụ na ọgwụgwọ omume ọgụgụ isi (Sylvain et al., 1997; Hodgins et al., 2001; Petry et al., 2006; Grant na Potenza, 2007; Brewer et al., na pịa). A na-eme ka usoro ndị a bụrụ nke a na-egosipụta na ọ dị mma n'ịgwọ ọgwụ riri ahụ (Miller, 1995; Carroll et al., 1998) karịa usoro mgbochi ikpughe / nzaghachi nke dị irè maka ịgwọ OCD (Hohagen et al., 1998; Neziroglu et al., 2006).

4.6. Echiche omenala

Ma PG na OCD dị na omenala. Ọdịiche dị n'ọdịnala metụtara nnabata ọha mmadụ na nnweta nke ịgba chaa chaa iwu kwadoro nwere ike imetụta ọnụego PG.Shaffer et al., 1999). Dị ka ọ dị na OCD, a na-ahụta atụmatụ ndị yiri nke PG na ọmụmụ ihe gburugburu ụwa (Cunningham-Williams na Cottler, 2001; Abbott et al., 2004). Ka o sina dị, ụfọdụ ndị mmadụ (dịka ọmụmaatụ, ndị mbata na ndịda ọwụwa anyanwụ Eshia (Petry, 2003)) nwere nnukwu nsogbu ịgba chaa chaa. Ezi ihe kpatara nchoputa ndị a chọrọ nyocha ọzọ. Onyinye gburugburu ebe obibi nke nwere ike ịdị iche n'ọdịbendị ma tinye aka na PG nwere ike ịdị iche na ndị na-enye aka na OCD, mana ọ dị mkpa nyocha karịa iji nyochaa echiche a ozugbo.

Na-akwado akụkụ nke: (1) National Institute on Drug Abuse (R01-DA019039); (2) Nnyocha ahụike ụmụ nwanyị na Yale; na (3) Ngalaba Veterans Affairs US VISN1 MIRECC. na REAP.

Nkwupụta Nkwupụta Onye Nkwusa: Nke a bụ faịlụ PDF nke ihe odide a na-akwadoghị nke akwadora maka mbipụta. Dịka ọrụ nke ndị ahịa anyị, anyị na-enye nsụgharị mbụ nke ihe odide ahụ. Ihe odide a ga-enwe ngbanwe, nhazi, na nyochaa ihe kpatara ya tupu e bipụ ya na nke ikpeazụ ya. Biko rịba ama na n'oge mmepụta usoro njehie nwere ike ịchọta nke nwere ike imetụta ọdịnaya ahụ, ihe niile gbasara iwu na-emetụta akwụkwọ akụkọ ahụ.

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