Kugonana kwa pa Intaneti kugwiritsidwa ntchito ndi Naltrexone (2008)

Comments: Naltrexone ndi wotsutsana ndi opioid receptor amene amagwiritsidwa ntchito makamaka mu kayendetsedwe ka chidindo cha mowa ndi kudalira kwa opioid. Nkhaniyi ili ndi ndondomeko yabwino kwambiri yokhudza kumwa mankhwala osokoneza bongo komanso kuledzera.

ndi Michael Bostwick, MD ndi Jeffrey A. Bucci, MD

pitani: 10.4065 / 83.2.226

Mayo Clinic Proceedings, February 2008 vol. 83 no. 2 226-230

Onani pa intaneti

Nkhani Yowonekera

  1. MFUNDO YOCHITA
  2. KUKANGANANI
  3. POMALIZA

Kusagwira ntchito bwino kwa malo ophunzitsira ubongo kumamveka bwino kuti kumapangitsa kuti munthu akhale ndi vuto lililonse. Opangidwa ndi masolimbic olimbikitsa masisitimu oyenda, malo opatsa mphotho amayang'anira machitidwe onse omwe chilimbikitso chimakhala ndi gawo lalikulu, kuphatikiza kupeza chakudya, kulera achinyamata, komanso kugonana. Povulaza magwiridwe antchito, zinthu zofunika kupulumuka zitha kukhala zofunikira kwambiri mukamayesedwa ndi kukopa kwa zinthu zosokoneza bongo kapena machitidwe. Dopamine ndimitsempha yama neurotransmitter yoyendetsa machitidwe abwinobwino komanso osokoneza. Ma neurotransmitters ena amasintha kuchuluka kwa dopamine yomwe imatulutsidwa chifukwa chotsitsimutsa, ndikulimba mtima komwe kumatsimikizika chifukwa cha kukula kwa dopamine. Opiate (mwina amkati kapena okhalitsa) amapereka chitsanzo kwa otsogolera oterewa. Wolembedwa kuti athetse uchidakwa, naltrexone imatchinga ma opiates kuti athe kuwonjezera kumasulidwa kwa dopamine. Nkhaniyi ikuwunikanso momwe naltrexone imagwirira ntchito mu mphotho ndikulongosola kagwiritsidwe ntchito ka naltrexone pothetsa chizolowezi chomangokhalira kukonda zolaula pa intaneti.

GABA (γ-aminobutyric asidi), ISC (zolimbikitsa anthu oyendetsa magalimoto), MAB (zinakhudza khalidwe losinthika), MRE (chochitika chokhudzidwa), NAc (nucleus accumbens), PFC (prefrontal cortex), VTA (malo amtunda)

Kudalirika

UNdibwino kuti mukuwerenga: Pulogalamu yamakono yothandiza kuti anthu azikhala ndi moyo wabwino kwambiri. Kuchokera mukatikati mwa ubongo wa ubongo, umagwirizanitsa zowonjezera zowonjezera kufunafuna moyo wotere monga chakudya, kusamalira ana, ndi kugonana.1 Pamene chizoloŵezi chimafika, mphotho zina zopindula zimayikidwa pazolimbikitsa magulu oyendetsa magetsi (ISC) kuti zisawononge makhalidwe omwe amafunikira kuti apulumuke. Owonjezereka, madokotala amakumana ndi odwala omwe amakhala ndi makhalidwe oipa.

Momwe ma neuroscience amafotokozeranso za zomwe zimapangitsa kuti munthu akhale ndi chizolowezi chomwa mankhwala osokoneza bongo, zimawonekeratu kuti malo operewera pantchito amakhala ofala pamakhalidwe onse okakamiza, kaya kumwa mankhwala osokoneza bongo, kudya mopitirira muyeso, kutchova juga, kapena kuchita zachiwerewere mopitirira muyeso.2, 3 Ngakhale kuti mwangozi-khalidwe lachiwerewere lopanda phindu silinaphunzire pang'ono,4 zimakhala zomveka kuti pharmacotherapies yogwira mosiyana ndi mtundu umodzi wa chizoloŵezi choledzera ingathe kulimbana ndi mitundu ina. Mchitidwe uliwonse uli ndi zovuta ndi zowonetseratu, komabe njira yomaliza ya onse imaphatikizapo kusintha kwa ntchito za dopaminergic kudzera m'matope a ventral tegmental (VTA).3, 5

VTA yakhala yowonongeka ndi mankhwala osokoneza bongo, ndipo naltrexone, opiate receptor blocker yomwe ikuvomerezedwa ndi Food and Drug Administration chifukwa cha chithandizo chauchidakwa, ndi chitsanzo cha mankhwala omwe angakhale othandiza kuthetsa makhalidwe ambiri oledzera.6 Poletsa kuthekera kwa ma opioid amkati omwe amachititsa kuti dopamine amasulidwe poyankha mphotho, naltrexone imathandizira kuzimitsa mphotho yomwe ilandire mphothoyo. Timapereka mlandu wa naltrexone woyenera kuti achepetse kugwiritsa ntchito intaneti mokhutiritsa chilakolako chogonana. Maola omwe wodwalayo adathera polimbikitsa chidwi cha cyber adatsika, ndipo magwiridwe antchito am'maganizo adasintha bwino ndikugwiritsa ntchito naltrexone.

MFUNDO YOCHITA

Bungwe la Mayo Clinic Institutional Review Board livomereza kuvomereza mlanduwu.

Wodwala wamwamuna kwa nthawi yoyamba amapita kwa katswiri wazamisala (JMB) ali ndi zaka 24, ndikumufotokozera kuti, "Ndabwera kuti ndigonere. Wadya moyo wanga wonse. ” Ankaopa kutaya banja komanso ntchito ngati sakanatha kukhala ndi nkhawa kwambiri ndi zolaula za pa intaneti. Amakhala maola ambiri tsiku lililonse akucheza pa intaneti, akuchita masewera olimbitsa thupi, ndipo nthawi zina amakumana ndi anthu omwe amalankhula nawo pa intaneti mwachisawawa, mosadziteteza.

Pazaka zotsatira za 7, wodwala wagwera mobwerezabwereza ndi kunja kwa chithandizo. Anayesayesa matenda opatsirana pogonana, gulu limodzi ndi psychotherapy, Kugonana ndi Anonymous, ndi uphungu wa abusa, koma mpaka naltrexone mayesero adachita bwino popewera kugwiritsira ntchito Intaneti. Pamene anasiya naltrexone, zofuna zake zinabwerera. Pamene anatenga naltrexone kachiwiri, iwo adatha.

Kuyambira ali ndi zaka 10, atazindikira "agazini yakuda" ya agogo ake, wodwalayo anali ndi chilakolako chofuna zolaula. Ali ndi zaka pafupifupi 900, adagonana pafoni kudzera pa ma kirediti kadi komanso ma foni 24 amalonda. Pofotokoza kuti anali wokonda kuseweretsa maliseche, adalembetsanso zikhulupiriro zachikhristu zosasinthasintha. Chifukwa chovutitsidwa ndi machitidwe ake, adati zachiwerewerezo zidachokera "mwanjira zina zoyipa" za satana. " Atamaliza sukulu yasekondale, adagwira ntchito yotsatsa yomwe imaphatikizapo kuyenda usiku wonse. Onse kuntchito komanso pamaulendo, amagwiritsa ntchito kompyuta yake osati pazinthu zokhudzana ndi bizinesi komanso komanso pa "kuyenda" pa intaneti (mwachitsanzo, kufunafuna zochitika zosangalatsa). Maulendo amabizinesi amakhala ndi maola ambiri azisangalalo pa intaneti ndikulimbikitsidwa kwambiri kuti mupite kumakalabu azovala. Ndi maola XNUMX pa intaneti kuofesi yake, nthawi zambiri ankakonda kugwiritsa ntchito intaneti usiku wonse. Anayamba kulolerana, kusiya gawolo pokhapokha atakakamizidwa ndi kutopa. Pazokhudzana ndi chiwerewere, adati, "Linali dzenje la gehena. Sindikhutira, koma ndidapitabe komweko.

Poganiza kuti wodwalayo atha kukhala ndi vuto losokoneza bongo, dotolo wake wamankhwala adamupatsa sertraline pamlingo wapa 100 mg / d. Pomwe malingaliro a wodwalayo komanso kudzidalira kwake kumachepetsa komanso kukwiya kumachepa, kuchepa koyamba pazilakolako zakugonana sikunapitilize. Adasiya kumwa sertraline ndipo adasiya ubale wake ndi wamisala kwa chaka chimodzi.

Pamene wodwalayo adabwerera kuchipatala, amatha kupitirira maola a 8 pa intaneti pamasewera, kuseweretsa maliseche mpaka kupsa mtima kapena kutopa kumatha. Anali ndi "zibwenzi" zambiri zomwe zinkaphatikizapo intaneti zomwe zimaphatikizapo kugonana kosatetezeka ndipo sankagwirizana kwambiri ndi mkazi wake chifukwa choopa kutumiza matenda a nyama. Iye adataya ntchito zingapo chifukwa cha zokolola zosauka kuyambira nthawi yomwe ankachita zofuna zake panthawi ya ntchito. Ananena za chisangalalo chochuluka kuchokera ku kugonana kokha koma kukhumudwa kwakukulu ponena za kusakhoza kudziletsa yekha. Pamene mankhwala a sertraline anabwezeretsedwa, mtima wake unasintha, koma adakalibe "wopanda mphamvu yakukaniza zowonjezera" ndipo adalekezanso chithandizo.

Wodwalayo atapezekanso patatha zaka ziwiri, kusokonezeka kwaukwati, komanso ntchito ina yomwe adataya, dotoloyu adalimbikitsa kuwonjezera naltrexone kuchipatala cha sertraline. (Sertraline tsopano inawoneka yofunikira pakukhumudwa kosalekeza.) Pasanathe sabata limodzi akuchiritsidwa ndi 2 mg / d ya naltrexone ya mkamwa, wodwalayo adanenanso za "kusiyana kwakukulu pamalingaliro azakugonana. Sindinkakhumudwa nthawi zonse. Zinali ngati paradaiso. ” Lingaliro lake la "chisangalalo chachikulu" munthawi yocheza pa intaneti lidachepetsedwa, ndipo adapeza kuthekera kokana m'malo mongogonjera zokhumba. Mpaka pomwe mlingo wa naltrexone ufike ku 50 mg / d pomwe adanenapo kuti ali ndi ziwongolero zonse. Atayesera yekha kuti amwe mankhwalawa, adamva kuti ataya mphamvu pa 150 / d. Anapita pa intaneti kuti adziyese yekha, adakumana ndi anthu omwe angagone nawo, ndipo adafika mgalimoto yake asanaganize bwino za kucheza ndi anthu. Nthawi ino, kubwerera ku 25 mg ya naltrexone inali yokwanira kuti athetse chilakolako chake chogonana.

Pazaka zopitilira zitatu zomwe adalandira sertraline ndi naltrexone, adatsala pang'ono kumasulidwa kuzizindikiro zakukhumudwa ndikugwiritsa ntchito intaneti mokakamiza, monga iye mwini adanenera: "Nthawi zina ndimazembera, koma sindimachita izi, Sindikufuna kukumana ndi aliyense. ” Monga phindu lina, wapeza kuti kumwa mopitirira muyeso kutaya chidwi chake. Sanagone mowa zaka zitatu ndipo wavomereza kuti "sangamwe osamwa kwambiri." Amakhalabe wokwatiwa, ngakhale zili zomvetsa chisoni. Wakhala akugwirabe ntchito yapaukadauloyi kwazaka zopitilira 3 ndipo amanyadira pantchito yake.

KUKANGANANI

Cholinga cha zokambiranazi, chizolowezi choledzeretsa chimakhala ngati makhalidwe opondereza omwe amapitirizabe ngakhale mavuto aakulu pa ntchito yaumwini, chikhalidwe, kapena ntchito.7 Zizolowezi zoterezi zimaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo, kudya kwambiri, kudya zakudya zolimbitsa thupi, kudzipukuta, komanso kutchova juga.6 Zikhoza kukhala zokhuza kugonana, kuphatikizapo zochitika kapena malingaliro omwe timaganizira kuti nkhaniyi ndi yogwiritsa ntchito kwambiri Intaneti.8 Maganizo awa oledzeretsa amakhala osiyana ndi machitidwe a matenda a maganizo, omwe amakhulupirira kuti matenda onsewa ndi "zovuta zowonongeka" ndi chizoloŵezi choyendetsa.3, 6 Kuwonjezeka kumvetsetsa zazitsulo zazitsulo kumagwirizana ndi izi. Hyman5 kuitanitsa chizoloŵezi "kutengeka kwa zizindikiro za njira zapamwamba za kuphunzira ndi kukumbukira zomwe mwachizoloŵezi zimawongolera makhalidwe okhudzana ndi kufunafuna mphotho ndi zomwe zikuwatsimikiziridwa." Ndiwo woyendetsa maulendo osokoneza bongo omwe amachititsa kusintha khalidwe (MAB) - malingaliro otsogolera zolinga kuti akwaniritse zolinga zamoyo zomwe zimakhala zofunikira-kuledzera kumagonjetsa.

Muzithunzi zosiyana kuchokera ku zithunzi zamakono zowonongeka kwa mavidiyo ndi malo oyankhulana, intaneti ndi chitukuko chokwanira chogonana ndi chikoka kwa anthu ambiri otchedwa anthu wamba, malingaliro a makhalidwe abwino-kapena kutanthauzira-zolaula pambali. Kodi ntchito yeniyeni ya chinthu kapena ntchito yokhutiritsa payekha imakhala yotani? Pochita chidwi kwambiri ndi kugwiritsira ntchito mopambanitsa komanso zotsatira zake zovuta komanso zapadera zomwe adalimbikitsa, wodwala amene akufotokozedwa m'nkhaniyi akupereka chitsanzo chosonyeza kuti ali ndi vutoli.

An MAB ali ndi 2 zigawo zotsatizana.9 Yoyamba ndi kuyambitsa zolimbikitsa zomwe zimakhudzidwa ndi mabungwe ophunzirira kuntchito ya kunja. Izi zimapangitsa chachiwiri: cholinga-chotsogolera chikhalidwe choyankhidwa-chomwe Stahl10 amachitcha "masoka apamwamba." Basic MABs ndizochita khama kuti apeze chakudya, madzi, kugonana, ndi pogona. Ma MABS omwe ali ndi zovuta zokhudzana ndi maganizo amaphatikizapo kufunafuna kukhala ndi chibwenzi, chikhalidwe cha anthu, kapena kukwaniritsa ntchito.

Msewu wa neural womwe ukugwiritsira ntchito mawu a MAB (malo opatsa mphotho) amatchedwanso ISC, chifukwa mtengo umene umaperekedwa kuchitsimikizo (umphumphu wake) umapangitsa chilimbikitso (kukula kwa khalidwe lachithupi chomwe chimayambitsa).5, 11 Zomwe zimapangitsa kuti zinthu zikhale zolimbikitsana zimaphatikizapo VTA, nucleus accumbens (NAc), prefrontal cortex (PFC), ndi amygdala, aliyense ali ndi udindo wolemba MAB (chithunzi). Kawirikawiri ku ntchito ya ISC muzochitika zachilengedwe ndi zakumwa zolaula ndi dopamine kumasulidwa ku NAc-yotchedwa kuponderezedwa muzochitika zochokera ku VTA.3, 5 Dopaminergic zimayambira ku VTA mpaka NAc ndizofunikira kwambiri za ISC zomwe zimagwirizanitsa ndi zizindikiro zamagetsi pakati pa zigawo zonse za ISC. Amygdala ndi PFC amapereka zofunikira.5 Amygdala amapereka valence yosautsa kapena yosangalatsayi-njira yothandizira-kuchitapo kanthu, ndipo PFC imapanga mphamvu ndi kulingalira kwa kayendedwe ka khalidwe.9, 12 Mipingo yokondweretsa mphotoyi imachenjeza zamoyo pamene buku lachidziwitso limawonekera ndipo limakumbukira mayanjano ophunziridwa pamene palibe buku lopitirizabe koma komabe likulimbikitsa kwambiri stimulus recurs.5, 9, 12

Chithunzi choledzera

 

 

Pachifanizo chaubongo, ma incentive salience circry (ISC) amakhala ndi ventral tegmental area (VTA) yolozera ku nucleus accumbens (NAc). NAc imalandira zolowetsa modulatory kuchokera ku preortal cortex (PFC), amygdala (A), ndi hippocampus (HC). Bokosi A likuwonetsa zolaula zapaintaneti zomwe zimayambitsa kutulutsa ma opioid amkati omwe amalimbikitsa kutulutsa kwa dopamine (DA) mu ISC zonse mwachindunji kapena m'njira zina. Amagwira ntchito molunjika pa ma interneuron ndikumangiriza ma opioid receptors omwe amasokoneza kutulutsa kwa x -aminobutyric acid (GABA). Posaponderezedwanso ndi GABA, VTA imatumiza NAC kutsanulidwa kwa DA. Zithunzi zolaula zimakula. Bokosi B likuwonetsa momwe naltrexone imalepheretsa onse NAc ndi interneuron opioid receptors. Zoyeserera za DA sizilimbikitsidwanso, kaya mwachindunji kapena m'njira zina, zomwe zimapangitsa kuti chidwi cha zolaula chiwonongeke. (Yotengedwa ndi chilolezo kuchokera ku Macmillan Publishers Ltd: Nature Neuroscience, 2 copyright 2.)

The ISC sichigwira ntchito padera. Kafukufuku wochuluka wa nyama amasonyeza mankhwala omwe amapezeka m'madera osiyanasiyana omwe amachititsa kuti ISC iwonongeke, kuphatikizapo okosiodergic, nicotinic, cannabinoid, ndi mankhwala ena.11, 13 Njira za Opiodergic za ISC zili ndi mapulogalamu ovomerezeka pa NAc palokha omwe amalepheretsa mwachindunji kutulutsa dopamine2 komanso za μ-opiate receptors pazitsulo zamkati zomwe zimafalitsa kapena kutseka γ-aminobutyric asidi (GABA) ndipo kawirikawiri amaletsa dopamine kumasulidwa ku VTA dopaminergic neurons.1, 5, 7, 14 Ngati opiates (endorphins) otheka kwambiri kapena opiates osiyana kwambiri (morphine ndi zotengedwa zake) amamangiriza kumalandira, GABA kumasulidwa kumachepa. Ophika amapewa njira zowonongeka, ndipo ma dopamine akuwonjezeka mu VTA.3

 

Zomwe thupi lachilendo limayambitsa likuwoneka kuti zimayambitsa ntchito yolakwika ya ISC. Kawirikawiri pamasom'manja, chochitika cholimbikitsa (MRE), monga njala kapena kukakamiza kugonana, chimayambitsa kumasulidwa kosatha kwa opiate komwe kumayambitsa ma dopamine. The ISC ikuyankhidwa ndi MAB ndipo pamapeto pake kusintha kwa maselo komwe kumapangitsanso mabungwe omwe amaphunzira nthawi yaitali ndi chochitikacho. Kusintha kwa mapuloteniwa kumapangitsa kuti munthu ayambe kuchita zinthu mofulumizitsa ngati chochitikacho chikuchitika, ndipo kawirikawiri, amachititsa kuti MRE ayambe kusokonezeka ndipo potsirizira pake amazimitsa VTA dopamine kumasulidwa. Dopamine kumasulidwa sikuli kofunikira kuti thupi likhale ndi MABs ofunika kuti apulumuke.

Mankhwala osokoneza bongo kapena ntchito zimakhudza ISC mosiyana ndi MREs mu zochitika zobwerezabwereza sizizimitsa dopamine kumasulidwa.9 Kuwonjezera pamenepo, mankhwala osokoneza bongo amatha kuthetsa zochitika zachilengedwe pogwiritsa ntchito njira zambiri zowonjezera dopamine.5, 9 Kuwombera koopsa kumabweretsa zotsatira, ndi kumasulidwa kwa dopamine komwe kumapangitsa kufunika kokhala ndi zofuna zapadera komanso zosafunika kwenikweni ku zikhalidwe zoyenera kugwira ntchito ndi kupulumuka.3, 5, 12, 15

Kukhoza kugawira mtengo wapatali kwa mankhwala ndi kukhoza kukana kuyitana kwake kwa siren-zonsezi zogwirira ntchito-ziri zowonongeka ndi mankhwala osokoneza bongo.12 Hyman analemba kuti: "Kufunafuna mankhwala osokoneza bongo kumachititsa kuti makolo asamanyalanyaze ana, omwe kale anali omvera malamulo kuti azichita zachiwawa, komanso anthu omwe ali ndi matenda oledzeretsa kapena oledzera omwe amamwa mowa komanso kusuta fodya."5 Zoperewera za PFC zimakhala zozindikira ndi chiweruzo cholakwika zomwe zikugwirizana ndi makhalidwewa.7

Zomwe zimagwiritsidwa ntchito ngati mankhwalawa monga wotsutsana ndi morphine-receptor anttreist naltrexone woperekedwa kwa wodwalayo akhoza kusokoneza zoletsedwa za dopamine crescendo zomwe zimayambitsa kupatsidwa mphamvu ndi kuyanjanitsa ntchito kuti zikhale zosagwirizana. Naltrexone imalepheretsa mauthenga a morphine, motsogolere kuwonjezereka kwa GABA khosi ndi kuchepetsa mayendedwe a NAc dopamine kupyolera mwa njira zolunjika komanso zosadziwika.2 Potsirizira pake, kudzera pakukhumudwitsidwa pang'onopang'ono, kutaya mtima kwa chizolowezi kumayenera kuchepa.15, 16

Mwachidule, kusintha kwa ma cell mu PFC kumapangitsa kuti chidwi chazomwe zimachitika chifukwa chogwiritsa ntchito mankhwala osokoneza bongo, kuchepa kwa chidwi chosagwiritsa ntchito mankhwala osokoneza bongo, ndikuchepetsa chidwi chotsatira zomwe zitsogozedwa ndi zolinga zapakati pa kupulumuka. Kuphatikiza pa kuvomerezedwa ndi naltrexone kuchokera ku Food and Drug Administration pochiza uchidakwa, malipoti angapo osindikizidwa awonetsa kuthekera kwake kothana ndi njuga zamatenda, kudzivulaza, kleptomania, komanso chizolowezi chogonana.8, 14, 17, 18, 19, 20 Tikukhulupirira kuti ichi ndi kufotokoza koyambirira kwa kagwiritsidwe kake kolimbana ndi kugonana kwa pa Intaneti. Kusintha20 anafufuza makamaka momwe mphamvu ya naltrexone imathandizira kuchepetsa chiwerewere komanso mchitidwe wogonana pakati pa achinyamata omwe amatsutsidwa ndi zolakwa monga kugwiririra, kugona nyama, komanso kugonana ndi ana aang'ono. Pomwe amalandira mankhwala pakati pa 100 ndi 200 mg / d, ambiri omwe akutenga nawo mbali adafotokoza kuchepa kwadzutsa, kuseweretsa maliseche, komanso malingaliro azakugonana, komanso kuwongolera zolakalaka zakugonana.20 Pofotokoza umboni wa kafukufuku wa makoswe, Ryback amatsimikizira kuti PFC imagwirizanitsa pakati pa dopaminergic ndi opioid systems, potsirizira kuti "mtundu wina wa opioid wokhazikika umawoneka wofunikira kwambiri kuti ukhale wogwira ntchito komanso wogonana."20

POMALIZA

Wodwalayo anali ndi mavuto kuyambira nthawi yomwe amawonongera zolaula pa intaneti komanso zotulukapo zake, monga mimba yosafunikira komanso matenda opatsirana pogonana, pomwe zochitika zake zimafotokozedwera kwa amuna kapena akazi omwe sanakwatirane. Kuphatikiza naltrexone pamankhwala omwe kale anali ndi serotonin reuptake inhibitor yomwe idagwirizana ndikuchepa kwamphamvu ndikumaliza kuthana ndi zizindikiritso zake, ndikubwezeretsanso chikhalidwe, ntchito, komanso ntchito zake. Ndi naltrexone yokhala ndi ma morphine receptors pa ma GABAergic interneurons omwe amaletsa VTA dopaminergic neurons, timaganiza kuti ma peptide amtundu wa opiate sanalimbikitsenso machitidwe ake okakamiza pa intaneti. Ngakhale poyambilira adapitilizabe kulakalaka izi, monga zikuwonekera pamayeso ake, sanazipezenso zopanda phindu. Kulimba mtima kwa zomwe zimapangitsa kuchititsa zachiwerewere pa intaneti kudatsika mpaka kutha kwa zomwe adachita atangotenga kapena kusiya. Mosayembekezereka koma osadabwitsa, adapeza kuti samasangalalanso ndikumwa mowa kwambiri. Kafukufuku wowonjezereka amafunikira kuti titsimikizire kuti zomwe tawonera zitha kupangidwira kwa odwala ena ndikufotokozera momwe naltrexone imazimitsira chizolowezi.

ZOKHUDZA

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