MAFUNSO: ASAM yatsopano yotanthauzira kuti "kuledzera" (Ogasiti 2011) yathetsa mkangano wokhudzana ndi zizolowezi zomwe zilipo, kuphatikiza zakugonana komanso zolaula. Kutanthauzira kwatsopano kumeneku, komwe kumaphatikizapo zizolowezi zamakhalidwe, monga chakudya, kutchova juga ndi kugonana, ASAM mosakayikira imanena kuti zizolowezi zamakhalidwe zimaphatikizaponso kusintha kwamaubongo komanso njira za neural monga momwe zimakhalira ndi mankhwala osokoneza bongo. Timakhulupirira kuti zolaula pa intaneti siziyenera kukhala pansi pa ambulera yogonana. Amuna ambiri omwe amakonda kugwiritsa ntchito zolaula sakanakhala osokoneza bongo akadakhala kuti anali asanakhalepo pa intaneti. (Ndalongosola zonena za zizolowezi zina zakakhalidwe.)
- ZOCHITIKA (2013) - National Institute of Mental Health (NIMH): DSM ndi yopanda pake komanso yosatha.
- ZOCHITIKA (2016) - Mapepala owunikiridwa ndi anzawo wolemba DSM-5 membala wa gulu la ntchito Richard Krueger MD: Kuzindikira za kugonana kapena kugonana kumagwiritsidwa ntchito pogwiritsa ntchito ICD-10 ndi DSM-5 ngakhale kukanidwa kwa matendawa ndi American Psychiatric Association
- ZOCHITIKA (2018) - Kodi munthu amadziwa bwanji? Mankhwala omwe amagwiritsidwa ntchito kwambiri padziko lonse, Mayiko Akumayiko Onse a Matenda (ICD-11), ali ndi matenda atsopano woyenera kuchita zolaula kapena kuledzera: "Kugonana Kwachiwerewere. ”(2018)
Lumikizani ku webusaiti ya ASAM
- Mafunso a ASAM pa tanthauzo: Tanthauzo la ASAM la Chizolowezi - Mafunso Ofunsidwa Kawirikawiri (2011)
- ASAM Press Release pa tanthauzo latsopano: ASAM Press Release (2011)
- Nkhani yabwino pa tanthauzo ndi ndondomeko ya ndondomeko: Akatswiri Opambana aku America (ASAM) Atulutsa Chidule Chatsopano Tanthauzo la Chizolowezi (2011)
Nkhani ziwiri ndi YBOP kuchokera ku 2011:
- Gwiritsani Ntchito Mabuku Athu: Ma Docs Amachepetsa Kugonjetsa Khalidwe lachiwerewere (2011). American Society of Addiction Medicine amavomereza kusagwirizana ndi DSM
- Kodi Mumakopeka ndi Zolaula? Funsani ASAM (2011). Ogwiritsira ntchito zithunzi akufotokoza zomwe zimakonda kuti azigwedezeka
Mapeto a mzere wa DSM:
Ndondomeko ya ndondomeko ya boma: Tanthauzo la Chizolowezi (Long Version)
Kuledzera ndi matenda oyamba, osachiritsika a mphotho ya ubongo, chilimbikitso, kukumbukira ndi kufananizira. Kuledzera kumakhudza ma neurotransication ndi kuyanjana mkati mwa maubwino aubongo, kuphatikiza maukonde omwe amapangika, ma cortex a cortex, ubongo wa basal ndi amygdala, kuti magawo olimbikitsawa asinthidwe ndikuwonetsa, omwe mwina sangaphatikizepo mowa komanso kugwiritsa ntchito mankhwala ena, , machitidwe okhudzana ndi kudzisamalira. [Ndipo] uchidakwa umakhudzanso ma neurotransication ndi zochitika pakati pa ma cortical ndi hippocampal circuits ndi magawo a mphoto ya muubongo, kotero kuti kukumbukira kukumbukira kopitilira mphotho (monga chakudya, kugonana, mowa ndi mankhwala ena) amachititsa kuti anthu azikhala ndi khalidwe lachilengedwe komanso kuti azikhala ndi chilakolako chogonjetsa.
Neurobiology ya chizolowezi chophatikizira imaphatikizapo zochulukirapo kuposa minyewa yamaubwino ya mphotho. (1) Khola lakumaso kwaubongo komanso kulumikizana kwazinthu zoyera pakati pa kotekisi yakutsogolo ndi madera amphotho, chilimbikitso ndi kukumbukira ndizofunikira pakuwonetsa kuwongolera kosintha, kuwongolera kosintha , komanso kufunafuna mphotho (zomwe nthawi zambiri zimachitikira munthu wokhudzidwayo ngati chikhumbo chokhala "wabwinobwino") kumawoneka pakumwa-ngakhale zovuta zoyipa zomwe zimadza chifukwa chogwiritsa ntchito mankhwala osokoneza bongo komanso machitidwe ena osokoneza bongo.
Kutsogolo kwa nkhokwe ndizofunikira popewa kulowerera komanso kuthandiza anthu kuti akuchedwa kuzengereza. Anthu omwe ali ndi vuto losokoneza bongo akaonetsa mavuto posintha kukhutira, pamakhala chiyembekezo chamanjazi. Frontal lobe morphology, kulumikizidwa ndi magwiridwe antchito adakali mu nyengo ya kusasamba paubwana ndi ukalamba, ndikuyamba kugwiritsa ntchito mankhwala osokoneza bongo ndichinthu chinanso chofunikira kwambiri pakulimbikitsa kusuta. Akatswiri ambiri a mitsempha amakhulupirira kuti kukula kwa morphology ndi komwe kumapangitsa kukhudzana ndi zinthu zofunikira kwambiri kukhala chinthu chofunikira kwambiri.
Zinthu zamtunduwu zimaphatikizapo pafupifupi theka la mwayi woti munthu akhoza kuyamba kuledzera. Zinthu zachilengedwe zimagwirizana ndi biology ya munthu ndipo zimakhudza momwe zimayambira. Zochita zomwe munthu amapeza (kupyolera mu kulera kapena zochitika zina zam'tsogolo) zingakhudze momwe maseŵero a chibadwa amathandizira ku makhalidwe ndi zina zowonongeka. Chikhalidwe chimathandizanso momwe chizoloŵezi chimayambira pa anthu omwe ali ndi chiopsezo cha chilengedwe kuti akule bwino.
Zina mwa zinthu zomwe zingapangitse maonekedwe a zizoloŵezi, zomwe zimatsogolere kuwonetseredwe kachipangizo-machitidwe-auzimu ndi uzimu, kuphatikizapo:
a. Kupezeka kwa vuto lalikulu lachilengedwe m'ntchito ya madera a mphotho, monga mankhwala ndi makhalidwe omwe amalimbikitsa mphoto ntchito ndizofunidwa monga zolimbikitsira;
b. Kubwereza mobwerezabwereza kugwiritsira ntchito mankhwala osokoneza bongo kapena makhalidwe ena oledzera, kuchititsa kuti munthu asagwiritsire ntchito mankhwala osokoneza bongo omwe amachititsa kuti asakhale ndi vuto loletsa kugwiritsa ntchito mankhwala osokoneza bongo kapena kuchita nawo zizoloŵezi zoipa;
c. Zosokoneza maganizo ndi zosokoneza, zomwe zimapangitsa kuti anthu asamvetsetse, komanso amalephera kuthetsa malingaliro awo, zomwe zimapangitsa kuti azidzipusitsa;
d. Kusokonezeka kwa chithandizo cha umoyo wabwino ndi mavuto mu maubwenzi apamtima omwe amakhudza chitukuko kapena zotsatira zokhutira;
e. Kuwonetsa zoopsa kapena zopanikizika zomwe zimapangitsa munthu kuthana ndi maluso;
f. Kusokonezeka mukutanthawuza, cholinga ndi zikhalidwe zomwe zimatsogolera maganizo, kuganiza ndi khalidwe;
g. Kusiyanitsa pakati pa munthu ndi kudzikonda, ndi ena komanso oposa (otchedwa Mulungu ndi ambiri, Mphamvu Zapamwamba ndi magulu a 12-, kapena chidziwitso cha ena); ndi
h. Kupezeka kwa matenda omwe amachititsa kuti anthu azigwiritsira ntchito mankhwala kapena makhalidwe ena oledzera.
Kuledzeretsa kumakhala ndi ABCDE (onani #2 pansipa):
a. Kulephera kusasintha nthawi zonse;
b. Kusokonezeka mu Kuchita Makhalidwe;
c. Kukonda; kapena kuwonjezeka kwa "njala" ya mankhwala kapena zochitika zowonjezera;
d. Kulepheretsa kuvomereza mavuto aakulu ndi maubwenzi ndi zochita zawo; ndi
e. Yankho losagwira ntchito pamtima.
Mphamvu zakunja zomwe zimapangitsa kuti chilakolako chofuna kugwiritsidwa ntchito komanso kugwiritsa ntchito mankhwala osokoneza bongo chikhalepo, komanso kuonjezera chizoloŵezi chochita nawo mwazizolowezi zina zomwe zingakhale zovuta, komanso chizoloŵezi choledzera, ndi hippocampus kukhala yofunika kukumbukira zochitika zam'mbuyomu kapena zam'tsogolo, komanso amygdala kukhala ofunika pokhala ndi cholinga chofuna kusankha makhalidwe okhudzana ndi zochitika zakale.
Ngakhale ena amakhulupirira kuti kusiyana pakati pa omwe ali ndi chizolowezi choledzeretsa, ndi iwo amene sali, ndi kuchuluka kwa kapenanso kumwa mowa mwauchidakwa, Kuchita zolaula (monga kutchova njuga kapena kugwiritsa ntchito ndalama) (3), kapena kulandira mphotho zina zakunja (monga chakudya kapena kugonana), Mbali ya khalidwe lachizolowezi ndi khalidwe labwino lomwe munthuyo amachitira zinthu zoterezi, zopanikizika komanso zachilengedwe. Zomwe zimachititsa kuti anthu omwe ali ndi chizolowezi chogwiritsa ntchito mankhwala osokoneza bongo azipindula ndizopindulitsa, ndikumangirira ndi zotsatira za mphotho (mwachitsanzo, kumwa mowa ndi kugwiritsa ntchito mankhwala osokoneza bongo). Mawonetseredwewa amatha kupezeka mwadzidzidzi kapena mopupuluma, monga kusokoneza maganizo.
Chiopsezo chokhazikika ndi / kapena kubwereza kubwereranso, pambuyo pa nthawi ya kudziletsa, ndi chinthu china chofunika kwambiri cha kuledzera. Izi zingayambidwe chifukwa chokhala ndi zinthu zopindulitsa komanso makhalidwe abwino, poyang'ana zochitika zachilengedwe zomwe zingagwiritsidwe ntchito, komanso poyesedwa ndi maganizo oponderezedwa omwe amachititsa ntchito yowonjezereka m'madera ozungulira ubongo. (4)
Kuledzera kuli vuto lalikulu mu ntchito yogwira ntchito, yomwe imawonekera m'mavuto ndi malingaliro, kuphunzira, kutengeka, kukhudzidwa, ndi chiweruzo. Anthu omwe ali ndi chizoloŵezi chowongolera nthawi zambiri amawonetsa kukhala okonzeka kuchepetsa makhalidwe awo osayenerera ngakhale kulimbikitsa nkhawa zomwe zimafotokozedwa ndi ena ambiri m'miyoyo yawo; ndi kuwonetsa kuti akusowa kuyamikira kuchuluka kwa mavuto okhudzidwa ndi mavuto. Zomwe zimakhalapobe kuti zikhoza kukhala zovuta kwambiri, zimakhala zovuta kwambiri kuti zikhale zovuta kwambiri, zomwe zimachititsa kuti achinyamata azikhala ndi "chiopsezo chachikulu" kuphatikizapo kumwa mowa kapena kugwiritsa ntchito mankhwala osokoneza bongo. Kugwedeza kwakukulu kapena chikhumbo chogwiritsa ntchito zinthu kapena kukhala ndi makhalidwe opindulitsa, omwe amawonedwa kwa odwala ambiri omwe ali ndi chizolowezi choledzeretsa, amatsindika zochitika zovuta kapena zosavomerezeka za matendawa. Uku ndiko kugwirizanitsa ndi "kusowa mphamvu" pa kuledzeretsa ndi "kusalephereka" kwa moyo, monga momwe akufotokozera mu Step 1 ya mapulogalamu a 12 Steps.
Kuledzera sikungokhala vuto la khalidwe. Zizindikiro za chizoloŵezi zimaphatikizapo mbali za khalidwe la munthu, malingaliro, malingaliro, ndi kuyanjana ndi ena, kuphatikizapo kuthekera kwaumunthu kulumikizana ndi mamembala a banja lawo, kwa anthu ammudzi wawo, kudziko lawo laumaganizo, ndi zinthu zomwe zimadutsa tsiku ndi tsiku zochitika.
Ziwonetsero za zizoloŵezi ndi zovuta za vutoli, makamaka chifukwa cholephera kulamulira, zingaphatikizepo:
a. Kugwiritsira ntchito mopitirira muyeso komanso / kapena kuchita nawo zizoloŵezi zoipa, pafupipafupi komanso / kapena kuchulukirapo kuposa momwe munthuyo amafunira, nthawi zambiri kumagwirizana ndi chilakolako chopitirirabe cha kuyesayesa kayendetsedwe ka khalidwe;
b. Nthawi yambiri yawonongeka pogwiritsa ntchito mankhwala kapena kubwezeretsa zotsatira za kugwiritsiridwa ntchito kwa mankhwala ndi / kapena kuchita nawo zizoloŵezi zoledzera, zomwe zimakhudza kwambiri ntchito zokhudzana ndi chikhalidwe cha anthu komanso ntchito (mwachitsanzo chitukuko cha mavuto a chiyanjano kapena kunyalanyaza maudindo kunyumba, sukulu kapena ntchito );
c. Kupitiliza kugwiritsidwa ntchito ndi / kapena kuchita nawo malingaliro oledzera, ngakhale kukhalapo kwa mavuto kapena thupi lokhazikika kapena lobwerezabwereza lomwe likhoza kuchitidwa kapena kuwonjezeka ndi kugwiritsira ntchito mankhwala ndi / kapena makhalidwe ololedwa;
d. Kuwonetseratu zochitika zokhudzana ndi khalidwe labwino zoganizira za mphoto zomwe ziri mbali ya chizolowezi; ndi
e. Zikuwoneka kuti alibe luso komanso / kapena wokonzeka kutenga zochitika zodzikongoletsera, ngakhale kuvomereza mavuto.
Kusintha kwa chidziwitso kuledzera kungaphatikizepo:
a. Kutanganidwa ndi kugwiritsa ntchito mankhwala;
b. Kuwongolera kwazomwe zimapindula ndi zowonongeka zomwe zikugwirizana ndi mankhwala osokoneza bongo kapena opindulitsa; ndi
c. Chikhulupiriro chosagwirizana kuti mavuto omwe amakumana nawo m'moyo amakhala okhudzidwa ndi zifukwa zina osati kukhala zowonongeka zowonongeka.
Kusintha kwakumva kwauchidakwa kungaphatikizepo:
a. Kuwonjezeka kwa nkhawa, dysphoria ndi kupweteka mtima;
b. Kuchulukitsa mphamvu kwa opanikizana zomwe zimagwirizanitsidwa ndi kulembedwera kwa maganizo opanikizika a ubongo, kotero kuti "zinthu zimawoneka zolemetsa" chifukwa; ndi
c. Zovuta pozindikiritsa malingaliro, kusiyanitsa pakati pa kumverera ndi kumverera kwa thupi kumangirira, ndi kufotokoza malingaliro kwa anthu ena (nthawi zina amatchedwa alexithymia).
Zomwe zimachititsa kuti munthu aziledzera n'zovuta kwambiri. Anthu ena amamwa mowa kapena mankhwala osokoneza bongo kapena amatsata mphotho zina chifukwa amafuna "kulimbitsa bwino" kapena kukhala ndi maganizo abwino ("euphoria"). Ena amayesetsa kugwiritsira ntchito mankhwala kapena mphoto zina chifukwa adapeza mpumulo kuchokera kuzinthu zosokoneza maganizo ("dysphoria"), zomwe zimapangitsa kuti "kusamalidwa bwino." Pambuyo pa zoyamba za mphotho ndi mpumulo, pali vuto losagwirizana ndi vutoli zomwe zikugwirizana ndi kuumirira kwa chiyanjano ndi makhalidwe oledzera.
Mkhalidwe woledzera si wofanana ndi boma laledzera. Munthu aliyense akakumana ndi zakumwa zoledzera mowa mwauchidakwa kapena mankhwala ena, kapena pamene munthu sagwiritsa ntchito mankhwala osokoneza bongo monga kumatchova njuga kapena kudya, wina akhoza kukhala ndi "mkulu", amadziona kuti ndi "wabwino" mkhalidwe wogwirizana ndi kuwonjezeka kwa dopamine ndi opioid peptide ntchito mu madera a mphoto. Pambuyo pazochitika zoterezi, pali ubongo wokhudzana ndi ubongo, momwe mphoto ikugwira ntchito sikuti imangobwereranso ku chiyambi, koma nthawi zambiri imatsika pansi pamasamba oyambirira. Izi sizikudziwikiratu ndi munthu aliyense ndipo sizikugwirizana ndi kuwonongeka kwa ntchito.
Popita nthawi, zokumana nazo mobwerezabwereza ndi kugwiritsa ntchito mankhwala osokoneza bongo kapena zizolowezi zowonjezera thupi sizimagwirizanitsidwa ndi ntchito zomwe zikuchulukirachulukira zolandira mphoto ndipo sizabwino. Munthu akangosiya kugwiritsa ntchito mankhwala osokoneza bongo kapena machitidwe ofananirako, pamakhala nkhawa, kukwiya, kusowa kwa chidwi ndi zochitika zokhudzana ndi mtima, zokhudzana ndi mphotho yayitali komanso kufunsidwa kwa ubongo ndi kupsinjika kwamaganizidwe amakono, komwe kumalumikizidwa ndi kudzipatula ku magulu onse azachipatala a mankhwala osokoneza bongo. Ngakhale kulolerana kumakulirakulira kufikira “kumtunda,” kulolerako sikumakhazikika pamalingaliro “otsika” ogwirizana ndi kuzungulira kwa kuledzera ndi kudzipatula.
Chifukwa chake, pakukonda, anthu mobwerezabwereza amayesa kupanga "apamwamba" - koma zomwe zimawakhudza kwambiri ndizakuya komanso kuzama. Ngakhale aliyense "angafune" kukwera ", omwe ali ndi chizolowezi chomwa mowa mwauchidakwa amamva" chosowa "chogwiritsa ntchito mankhwala osokoneza bongo kapena chizolowezi choledzera kuti athe kuyesa kuthana ndi nkhawa zawo kapena zizindikiritso zakuthupi zakusuta. Anthu omwe ali ndi chizolowezi chomwa mowa mwauchidakwa amagwiritsira ntchito mankhwala osokoneza bongo ngakhale atha kuwapangitsa kuti asamve bwino, nthawi zina pambuyo pofunafuna "mphotho." (5) Ngakhale anthu azikhalidwe zilizonse angasankhe "kukwera" kuchokera kwa wina ndi mnzake ntchito, ndikofunikira kuzindikira kuti kuledzera si ntchito yokhayo yomwe munthu angasankhe. Mwachidule, kuledzera si vuto.
Monga chizoloŵezi ndi matenda aakulu, nthawi zobwereza, zomwe zingasokoneze mitsempha ya chikhululukiro, ndizofala zomwe zimachitika mowa. Ndifunikanso kuzindikira kuti kubwerera ku mankhwala osokoneza bongo kapena kupindula kwa mphotho sikungapeweke.
Njira zothandizira kuchipatala zingakhale zothandiza kuthetsa vutoli. Pewani kufufuza kwa makhalidwe omwe ali nawo payekha komanso nthawi zina, nthawi zina kuphatikizapo zotsatira za khalidwe la kubwezeretsa khalidwe, zingapangitse zotsatira zowonjezera. Kuchita nawo ntchito zotsitsimula zaumoyo zomwe zimalimbikitsa udindo wa munthu ndi udindo, kulumikizana ndi ena, ndi kukula kwaumwini kumathandizanso kuti ayambe kuchira. Ndikofunika kuzindikira kuti kuledzera kungayambitse kulemala kapena kufa msanga, makamaka ngati sanasamalidwe kapena kupatsidwa mankhwala osayenera.
Njira zamomwe ubongo ndi khalidwe zimayankhira ndi mankhwala osokoneza bongo komanso kukhala ndi chizoloŵezi chokhala ndi zizoloŵezi zoledzeretsa ndizosiyana pazigawo zam'tsogolo za chizolowezi choledzeretsa kusiyana ndi magawo oyambirira, kusonyeza kupita patsogolo, komwe sikungakhale koonekera kwambiri. Monga momwe zilili ndi matenda ena akuluakulu, chikhalidwechi chiyenera kuyang'aniridwa ndi kuyendetsedwa pakapita nthawi kuti:
a. Kuchepetsa mafupipafupi ndi mphamvu za kubwereranso;
b. Nthawi zolimbikitsa za kukhululukidwa; ndi
c. Konzekerani msinkhu wa ntchitoyo pa nthawi ya kukhululukidwa.
Nthawi zina kumwa mowa, mankhwala amatha kusintha zotsatira za mankhwala. Nthawi zambiri mowa, kuphatikizapo kukonzanso maganizo ndi chisamaliro chokhazikika ndi mankhwala opatsirana pogwiritsa ntchito umboni amapereka zotsatira zabwino. Kukonza matenda kwachilendo n'kofunika kuti kuchepetsedwa kwa zigawo za kubwereranso ndi zotsatira zake. Kuchiza kwauchidakwa kumapulumutsa miyoyo †
Oledzeretsa ogwira ntchito ndi anthu omwe akuchidziwitso amadziwa chiyembekezo chomwe chimapezeka. Kubwezeretsa kulipo ngakhale kwa anthu omwe poyamba sangathe kuzindikira chiyembekezo, makamaka pamene cholinga chake chikugwirizanitsa zotsatira za thanzi la matenda oledzeretsa. Monga momwe zimakhalire ndi thanzi labwino, kudziletsa nokha, ndi kuthandizana, ndikofunika kwambiri kuti muthe kuchipatala. Thandizo la anzanga monga limene likupezeka muzochita zosiyanasiyana "zothandizira" zimapindulitsa kukulitsa thanzi labwino ndi zotsatira zogwira ntchito. ‡
Kuchokera ku chizolowezi choledzeretsa kumapindula bwino pogwiritsa ntchito kudzigwirizanitsa, kuthandizana, komanso kusamalira akatswiri omwe amaphunzitsidwa ndi akatswiri odziwika bwino.
Mawu ofotokozera a ASAM:
1. Nthenda ya ubongo ya mphotho yakhala ikudziwika bwino kwa zaka makumi ambiri, pamene matenda opatsirana mowa amadziwikabe. Odwala ambiri aphunzira za mphotho zomwe zikuphatikizapo zochitika kuchokera ku ventral tegmental (VTA) ya ubongo, kupyolera mu mndandanda wa median forebrain (MFB), ndi kutha kwa nucleus accumbens (Nuc Acc), momwe dopamine neurons ali otchuka. Nthenda yamakono yatsopano imadziwa kuti mapuloteni a mphotho amaphatikizaponso maulendo olemera omwe amayendetsa phokosolo loyambira ku nucleus accumbens ndi basal forebrain. Ndilo gawo loyendetsera malipiro omwe amalembedwa, komanso kumene madalitso ofunika kwambiri monga chakudya, kuthamanga, kugonana, ndi kukulitsa kumawathandiza kukhala olimbikitsa komanso opatsa moyo.
Mowa, nicotine, mankhwala ena ndipo kutchova njuga kumayendetsa khalidwe kumayambitsa zotsatira zake pochita mphotho yomweyo yomwe ikupezeka mu ubongo kupanga chakudya ndi kugonana, mwachitsanzo, kulimbikitsa kwambiri. Zotsatira zina, monga kuledzeretsa ndi kukhumudwa kwapakati pa mphotho, zimachokera ku ntchito yoyendetsa mphoto. Ngakhale kumwa mowa ndi kuchotsa bwino kumamvetsetsa kupyolera mu kuyesa mphotho zowonjezereka, kumvetsetsa kuledzera kumafuna kumvetsetsa mndandanda wambiri wa maulendo a neural omwe amaphatikizapo zowonongeka komanso midbrain. Kusankhidwa kwa madalitso ena, kuyang'ana ndi madalitso ena, kuchitapo kanthu pazomwe zimayambitsa kupindula, ndikupangitsa anthu kuti azigwiritsa ntchito mowa ndi mankhwala ena ndi / kapena kufunafuna mphotho zina, kuphatikizapo malo ambiri a ubongo kunja kwa mphotho yokhayokha.
2. Zinthu zisanuzi sizikukonzekera ndi ASAM kuti zigwiritsidwe ntchito ngati “njira zakuzindikira” kuti mudziwe ngati vuto lilipo kapena ayi. Ngakhale kuti zikhalidwe izi zimapezeka nthawi zambiri mchitidwe woledzeretsa, mosasamala kanthu za mankhwala osokoneza bongo omwe amagwiritsidwa ntchito mozunguza kapena mphotho yomwe akugwiritsidwa ntchito, chiwerengero chilichonse sichingafanane pazochitika zonse. Kupezeka kwa chizolowezi choledzeretsa kumafuna kudziwa zambiri, zokhudzana ndi maganizo, chikhalidwe ndi zauzimu ndi akatswiri ophunzitsidwa ndi ovomerezeka.
3. M'chikalatachi, mawu oti "zizolowezi zosokoneza bongo" amatanthauza zizolowezi zomwe zimapindulitsa kwambiri ndipo zimakonda kupezeka nthawi zambiri. Kudziwonetsera pamakhalidwe amenewa, monganso momwe zimakhalira ndikupezeka ndi mankhwala opindulitsa, ndikuthandizira pakumwa mankhwala osokoneza bongo m'malo mochititsa kuti munthu akhale osokoneza bongo. Mkhalidwe wa anatomy yaubongo ndi physiology ndizomwe zimayambitsa zomwe zimayambitsa kusokoneza bongo. Chifukwa chake, mu chikalatachi, mawu oti "zizolowezi zosokoneza bongo" satanthauza zikhalidwe zosavomerezeka kapena zosavomerezeka pagulu, zomwe zimatha kupezeka nthawi zambiri. Makhalidwe, monga kusakhulupirika, kuphwanya mfundo zamakhalidwe abwino kapena zokomera ena, zachiwawa ndi zina zambiri, zitha kukhala gawo lazowonjezera; izi zimawoneka bwino ngati zovuta zomwe zimadza chifukwa chopewa kuledzera.
4. Matenda a ubongo (ozungulira ubongo omwe amagwira nawo ntchito) ndi physiology (omwe amachititsa kuti anthu asamangokhalira kugwiritsira ntchito mankhwalawa) mwa njira zitatu izi zomwe zimayambanso kubwezeretsedwa (kubwezeretsa mankhwala osokoneza bongo kapena kubwezeretsa mphoto) kufufuza.
- Kubwereranso komwe kumayambitsidwa chifukwa chogwiritsa ntchito mankhwala osokoneza bongo / opindulitsa, kuphatikiza mowa, zimakhudza ma nyukiliya omwe amapezeka ndi VTA-MFB-Nuc Acc neural axis (mesolimbic dopaminergic "incentive salience circry" - onani mawu am'munsi 2 pamwambapa). Kubwezeretsanso komwe kumabweretsa mphotho kumayambitsidwanso ndi ma circut a glutamatergic omwe amayang'ana ku ma nucleus omwe amapezeka kuchokera kumtunda wakutsogolo.
- Kubwereranso kumeneku kumayambidwa chifukwa chodziwika ndi chikhalidwe chochokera ku chilengedwe chimaphatikizapo maulendo a glutamate, omwe amachokera kutsogolo, kutsogolo, hippocampus ndi amygdala kukonzekera kuti zikhale zolimbikitsa zowonongeka.
- Kubwereranso kumeneku kumayambidwa chifukwa chokumana ndi zovuta zomwe zimachitika kumaphatikizapo maulendo opanikizika a ubongo kupitirira hypothalamic-pituitary-adrenal axis yomwe imadziwika bwino kwambiri kuti ndiyo maziko a dongosolo la maganizo la endocrine. Pali zinthu ziwiri zomwe zimayambitsa kubwezeretsa ubongo wa ubongo - imodzi imachokera ku noradrenergic nucleus A2 yomwe imayambira kumapeto kwa ubongo ndi mapulani ku hypothalamus, nucleus accumbens, frontal cortex, ndi pedi la bedi la stria terminalis, ndipo amagwiritsa ntchito norepinephrine monga neurotransmitter yake; Zina zimachokera pakatikati mwa amygdala, mapulani ku bedi la stria terminalalis ndipo amagwiritsa ntchito corticotrophin-release factor (CRF) monga neurotransmitter.
5. Mphoto yofunafuna mwanzeru (yotchulidwa mu Short Version ya tanthauzo la ASAM) motero ili ndi zigawo zingapo. Sikuti mulingo wokhudzidwa ndi mphothoyo (mwachitsanzo, kuchuluka kwa mankhwala) kapena kuchuluka kapena kufotokozera kwachidziwikire kumene kumachitika. Mwakuwonjeza, kufunafuna mphotho kumapitirirabe, ngakhale pali zovuta m'moyo zomwe zimadziunjikira chifukwa chamakhalidwe olowerera, ngakhale kuchita nawo zikhalidwe kumatha kusangalatsa. Momwemonso, m'magawo oyambirirawo, kapena ngakhale mawonekedwe akunja atawonekera, kugwiritsa ntchito mankhwala osokoneza bongo kapena kuchita zikhalidwe zosokoneza bongo zitha kukhala kuyesa kupeza mpumulo ku dysphoria; pomwe matendawa atadutsa, kudziwika kuti ali ndi zizolowezi zokhoza kupitilira apobe ngakhale zikhalidwe siziperekanso mpumulo.
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