Kunenepa kwambiri (Silver Spring). 2011 Aug, 19 (8): 1601-8. onetsani: 10.1038 / oby.2011.27. Epub 2011 Feb 24.
Wang GJ, Geliebter A, Volkow ND, Telang FW, Logan J, Jayne MC, Galanti K, Selig PA, Han H, Zhu W, Wong CT, Fowler JS.
gwero
Dipatimenti ya Zamankhwala, Laboratory Laboratory National, ku Upton, New York, USA. [imelo ndiotetezedwa]
Kudalirika
Anthu omwe ali ndi matenda oledzera (BED) amawononga zakudya zambiri nthawi yayitali. Nthenda ya ubongo ya BED imamveka bwino. Ubongo wa dopamine, womwe umayambitsa chikoka cha kudya, umakhala wogwirizana. Tinawona momwe ubongo umagwirira ntchito polimbikitsa anthu kudya chakudya. Positron emission tomography (PET) amayang'ana ndi [11C] raclopride zinachitidwa mu 10 obedi BED ndi 8 omwe amawombera opanda BED.
Kusintha kwa extracellular dopamine mu striatum poyankha chakudya chokhudzana ndi zakudya zoperewera chakudya chinayesedwa pambuyo pa placebo ndi pambuyo pakamwa mankhwala a methylphenidate (MPH), mankhwala omwe amachititsa kuti dopamine reuptake transporter isamalire ndipo motero amalimbikitsa chizindikiro cha dopamine. Ngakhale kusalowerera ndale (kopanda kapena MPH) kapena chakudya chomwe chimapangitsa munthu atapatsidwa malo okhala ndi placebo chinawonjezerapo dopamine ya extracellular.
Chakudya chimene chimapangitsa munthu atapatsidwa ndi MPH chimawonjezeka kwambiri kuwonjezera dopamine m'magazi odyera koma osadya chakudyas.
Dopamine ikuwonjezeka muzimenezi zimagwirizana kwambiri ndi kudya mowa kwambiri koma osati ndi BMI. Zotsatira izi zimasonyeza kuti dopamine ndiurotransmission mu zovuta monga kukhala ofunika kwa neurobiology ya BED.
Kusagwirizana pakati pa BMI ndi kusintha kwa dopamine kumasonyeza kuti dopamine amasulidwa pa se Sitikuneneratu BMI mkati mwa gulu la anthu olemera koma kuti limaneneratu kuti kudya zakudya zolimbitsa thupi.
MAU OYAMBA
Matenda obwera chifukwa cha kudya (BED) amadziwika ndi zizindikiro za kudya chakudya chokwanira komanso kutaya mphamvu. Zimapezeka pafupifupi 0.7-4% ya anthu ambiri komanso za 30% mwa omvera kwambiri omwe amapita kumapulogalamu oletsa kulemera (1). Odyera odyera odyera amadya kwambiri zopatsa mphamvu kuposa odyera odzaza kwambiri omwe amafunsidwa kudya mpaka atadzaza kwambiri, kudya mowa, kapena kudya moyenera (2). Odyera mowa kwambiri amakhala ndi pulogalamu yapamwamba yochepetsetsa pulogalamu ya kulemera kwa thupi ndikukumana ndi matenda awo kwa nthawi yaitali.
Zinthu zambiri zimayendetsa kudya chakudya kuphatikizapo zofuna za caloric ndi kulimbitsa mayankho ku chakudya, chomwe chimaphatikizapo kulumikiza komanso mayankho ogwirizana (3). Dopamine ndi imodzi mwa ziwalo za m'mimba zomwe zimakhudzana ndi khalidwe lodyetsa, ndipo kugwiritsidwa ntchito kwa mankhwala kumakhala ndi zotsatira pa kudya (4). Maphunziro ojambula ubongo ndi positron emission tomography (PET) ndi [11C] raclopride anasonyeza kuti chilakolako cha chakudya pakuwonetsa zakudya zopatsa thanzi, popanda kudya, chinkagwirizanitsidwa ndi kutaya dopamine kumasulidwa (5). Kuchuluka kwa dopamine kumasulidwa kunagwirizananso ndi kuwerengera kwa chisangalalo cha chakudya pambuyo pa kudya chakudya chimene mumaikonda (6). Maphunzirowa akugwirizana ndi ntchito ya dopamine poyendetsa zakudya kudzera mwa kugawa chakudya chokwanira komanso chokhutiritsa chakudya (4). Iwo anali atatsimikiziridwa kuti mwa anthu, ntchito yochepa ya dopamine ingapangitse munthu kuti azidya mopitirira malire ngati njira yothetsera kuchepa kwa ntchito ya dopaminergic (7). Ndipotu, mu kafukufuku amene anachitika m'mabuku ovuta kwambiri, tinalengeza kuti kuchepa kwa dopamine D2 receptors, komwe kunatsimikiziridwa kuti zidzasokoneza chizindikiro cha dopamine (8). Ntchito yosawonongeka ya dopaminergic yasonyezedwanso mu makoswe amtundu wambiri wokhutira kwambiri ndipo yatumizidwa kuti azidya kwambiri (9). Dopamine amachititsa chidwi ndi mphoto zozungulira, choncho kusowa kwa dopamine m'mabuku owonjezera kungapangitse kuti matenda adziwe ngati njira yothetsera kuchepa kwa maulendowa.
Anthu omwe ali ndi BED amadziwika ndi kukakamiza kudya ndi kukhudzidwa (10), zomwe zimagwirizana mofanana ndi kugwiritsira ntchito mankhwala osokoneza bongo komanso osagwiritsa ntchito molakwikas (11). FOod ndi mphamvu zowonjezera zachilengedwe, ndipo kusala kudya kungapangitse patsogolo zotsatira zake zabwino (12). Dopamine imakhala yofunikira pozindikiritsa kulimbika kwa zinthu zosiyanasiyana zomwe zimayesa kusankhidwa kwapadera pa fasting (13). Zina mwa zakudya zopatsa thanzi monga shuga ndi mafuta a chimanga zingapangitse kusungunuka mwadzidzidzi muzinthu zomwe zimakumbukira zomwe zimawonedwa ndi kumwa mankhwala osokoneza bongo (4,14). Monga momwe ziliri ndi mankhwala osokoneza bongo, kumeza shuga kumawonjezera dopamine mu nucleus accumbens (14). Mwachitsanzo, pamene makoswe amapatsidwa mwayi wothetsera shuga, amamwa mowa mwauchidakwa, kumasula dopamine mu nucleus accumbens, yofanana ndi yomwe imapezeka mu zinyama zokhudzana ndi mankhwala. (14). Kukoma kwa shuga, kopanda zakudya zopatsa thanzi, kungathandizenso kumasulidwa kwa dopamine (15).
Kugwiritsa ntchito PET ndi [11C] raclopride, tinasonyeza kuti zooneka bwino komanso zooneka bwino ndi chakudya chokoma mtima zinapanga dopamine yochulukirapo m'thupi lachilendo chodziwika bwino lomwe linali chakudya choyenera ku 16 h (5). Kutulutsidwa kwa dopamine kunagwirizanitsidwa kwambiri ndi kuwonjezeka kwa kudzidzimva kwa njala ndi chilakolako cha chakudya. Zotsatirazi zinapereka umboni wa yankho lovomerezeka lokhazikika muzitsulo zowonongeka.
Pano, timayesa lingaliro loti anthu ambiri omwe ali ndi BED angasonyeze kuti ali ndi mayankho olimbitsa thupi okhudzana ndi zakudya zowonjezera poyerekeza ndi maphunziro omwe sali a BED. Pofuna kusintha kusintha kwa dopamine komwe kunayambitsa matenda, tinagwiritsa ntchito PET ndi [11C] raclopride ndi paradigm yomwe imagwiritsidwa ntchito kale (5). Kumvetsetsa njira zopezera ubongo zomwe zimayambitsa zokondweretsa zakudya zimapereka zofunikira zothandizira anthu kuti azitsatira khalidwe lawo losadya.
NJIRA NDI MFUNDO
ophunzira
Mapologalamu oyendetsera ntchito ku Stony Brook University (Stony Brook, NY) / Laboratory ya National Brookhaven (Upton, NY), ndi St. Luke's-Roosevelt Hospital (New York, NY) adavomereza malamulowa. Chidziwitso chodziwitsidwa chinalembedwa pambuyo pofufuza njirayi. Nkhani khumi zathanzi ndi BMI (makilogalamu / m2)> 30 ndi DSM IV (Diagnostic and Statistical Manual of Mental Disorder-Fourth Edition) atapezeka ndi BED adalembedwera kafukufukuyu. Gulu lolamulira (n = 8) inali ndi maphunziro onenepa kwambiri (BMI> 30) omwe sankagwirizana ndi BED. Njira zochotsera magulu onse awiriwa zinali: Kudya kwambiri gulu la BED), kugwiritsa ntchito mankhwala (s) opatsirana omwe angakhudze ubongo, m'masabata awiri apitawa, matenda omwe angasinthe magwiridwe antchito, matenda amtima ndi matenda ashuga, kupwetekedwa mutu ndikusowa chidziwitso > 5 min. Kuyezetsa mkodzo kwa mankhwala osokoneza bongo (kuphatikizapo phencyclidine, cocaine, amphetamine, opiates, barbiturates, benzodiazepine ndi tetrahydrocannabinol) adachitidwa kuti athandize kusowa kwa mankhwala osokoneza bongo.
Psychological diagnosis
Ophunzirawo analembedwanso ndikusindikizidwa m'maganizo pa St Luke's-Roosevelt Hospital kwa BED pogwiritsa ntchito Eating Disorder Examination, kuyankhulana kwachipatala chomwe chinasinthidwa ku BED (16). Anamaliza kumaliza Zung Depression Scale (17,18), ndi Gormally Binge Eating Scale (19), zomwe zimasonyeza makhalidwe okhudzana ndi kudya ndi maganizo.
Kupanga phunziro
Nkhanizo zidapemphedwa kudzaza bukhu la mafunso, lomwe liri ndi mfundo zotsatirazi pa tsiku la kuyang'ana: chiwerengero cha chidwi chachikulu pa chakudya; mndandanda wa zakudya zomwe mumazikonda; mndandanda wa zakudya zonunkhira zomwe zinayambitsa chilakolako; mndandanda wa zakudya zonunkhira zomwe zimachepetsa chilakolako; ndi ndondomeko ya mndandanda wa zakudya zomwe zimakonda zofuna zawo kuchokera pa 1 mpaka 10, 10 kukhala wapamwamba kwambiri. Zakudya zomwe zili ndi zilembo zazikuluzikulu zinaperekedwa pa phunziroli panthawi yachisokonezo cha zakudya.
Zigawozo zinayesedwa kangapo ndi [11C] raclopride masiku awiri osiyana pansi pa zifukwa zotsatirazi (Chithunzi 1): Tsiku loyamba la kuphunzira, loyamba [11C] rafipride scan anayamba kuyambika 70 min pambuyo pa placebo wamlomo (puloteni ya dicalcium phosphate) popanda kulowerera nawo mbali.placebo). Yachiwiri [11C] racoppride scan anayamba kuyambitsidwa 70 min pambuyo poyendetsedwa ndi mankhwala a methylphenidate (MPH: 20 mg) ndi chakudya choyenera (chakudyamph) za 2 h ndi 20 min pambuyo pa jekeseni ya radiotracer yoyamba. Pa tsiku lachiwiri la kuphunzira, yoyamba [11C] rafipride scan inatengedwa 70 min pambuyo pa placebo wamlomo (puloteni ya dicalcium phosphate) ndi zakudya zowonjezera (chakudyaplacebo). Yachiwiri [11C] rafipride scan anayamba 70 min pambuyo poyendetsa kwa MPH (20 mg) popanda kulowerera nawo mbalimph) za 2 hs ndi 20 min pambuyo pa jekeseni ya radiotracer yoyamba. Tidasankha mlingo wa MPH (20 mg oral), zomwe tidawonetsa kale kuti tiwonjezere kuwonjezeka kwakukulu mu msinkhu wotere wa dopamine mu nkhani zowonjezera panthawi yopatsa chakudya (5). Zakudya zonse komanso zopanda ndale zinayambika pafupi ndi 10 min isanafike ndi jekeseni ya radiotracer ndipo inapitirira kwa pafupifupi 40 min. Nkhanizi sizinadziwe kaya zinalandira malobo kapena MPH. Kuonjezera apo, dongosolo la masiku ophunzirira linali losiyana ndi losiyana ndi maphunziro.
Mndandanda wa phunziro la phunzirolo. PET, positron emission tomography.
Kwa chikhalidwe chokhazikitsa chakudya, chakudya chinalimbikitsidwa kuti chikhale ndi fungo labwino, ndipo nkhanizo zinaperekedwa ndi izo kuti athe kuziwona ndi kuzikununkhira. Swab ya cotoni yomwe inaphatikizidwa ndi chakudya inayikidwa pa malirime awo kuti amve kukoma kwake. Chakudya chopatsidwa chinaperekedwa kwa minda ya 4 ndipo kenako nkusinthanitsa ndi chatsopano. Kukoma, kununkhiza, ndi kuyang'ana kwa chakudya kunapitilira pa zokondweretsa. Nkhanizo zidapemphedwa kufotokoza zakudya zomwe amazikonda kwambiri komanso momwe amafunira kuzidya pamene amaperekedwa ndi zakudya zomwe adaziwonetsa kuti ndizozikonda. Chifukwa chosakhudzidwa ndi ndale, maphunziro amaperekedwa ndi zithunzi, masewero, ndi zovala kuti athe kuziwona ndi kuziwotcha ndikukambirana nawo panthawi yachisokonezo. Tinagwiritsanso ntchito swab ya thonje yomwe imaphatikizidwa ndi kukoma kosalowerera (monga zitsulo kapena pulasitiki), zomwe zinayikidwa pa malirime awo. Zakudya ndi zopanda ndale zinayambika 10 min chisanafike jekeseni ya ma radiotracer ndipo zinapitilira kwa chiwerengero cha 40 min. Kwa masiku onse a phunziro, nkhaniyi inapemphedwa kuti idye chakudya cha 7: 00 madzulo madzulo a tsiku la phunziro ndikufotokozera ku malo opangira zithunzi ku 8: 30 am.
Makhalidwe ndi mtima
Phunziro la PET, ophunzira adalangizidwa kuti azitha kuyankha pamlomo pa chiwerengero chilichonse pogwiritsa ntchito chiwerengero chonse pakati pa 1 ndi 10 chifukwa cha "njala" ndi "chilakolako cha chakudya" chomwe chinaperekedwa musanayambe kukonda chakudya Pakati pa mphindi 4 kwa chiwerengero cha 40 min. Kuonjezerapo, kupweteka kwa magazi ndi kuthamanga kwa magazi kumalo a placebo / MPH, 30 min, 60 min (asanalowerere / kudyetsa chakudya), ndiye kuti 3 min iliyonse panthawi yopatsa chakudya / osalowerera kwa 42 min.
PET imawunika
Zigawo zinalembedwa ndi [11C] raclopride pogwiritsa ntchito pulogalamu ya PET ya Siemens HR +. Tsatanetsatane wa ndondomeko zowonongeka kwa mitu yotsatila ndi yowonongeka, kutuluka kwa ma radiotracer ndi zofalitsa ndi kutulutsa zofalitsa zinafalitsidwa (5). Mwachidule, zithunzi zamphamvu zinatengedwa mwamsanga pambuyo pa jekeseni ya XUUMX-3 mCi ya [11C] raclopride kwa chiwerengero cha 60 min. Mankhwala a magazi anapezeka kuti ayese ndondomeko ya plasma ya MPH musanafike pa 30, 60, 90, ndi 120 min pambuyo pa MPH. Mavuto a plasma a MPH adakambidwa pa laboratori ya Dr Thomas Cooper (Nathan Kline Institute, Orangeburg, NY).
Kusanthula kwazithunzi
Zigawo za chidwi ndi dorsal striatum (caudate, putamen), ventral striatum, ndi cerebellum zinafotokozedwa ndi malire opangidwa kuchokera ku mapulogalamu a ubongo omwe timasindikizapo kale (5). Mwachidule, madera okondweredwa amayamba kufotokozedwa pazowonjezera mwachidule [11C] chithunzi cha raclopride (zithunzi zomwe zinapezedwa pakati pa 15 ndi 54 min) ndipo kenako zinakonzedweratu [11C] mafano a raclopride kuti apange nthawi yothandizira nthawi ya zigawo zomenyera (caudate, putamen, ndi ventral striatum) ndi cerebellum. Zochita za nthawi imeneyi zothandizira minofu, pamodzi ndi nthawi ya ntchito yosintha yosasintha mu pulasitiki inagwiritsidwa ntchito powerengera [11C] raclopride akusintha nthawi zonse kuchokera ku plasma kupita ku ubongo (K1) ndi mulingo wathunthu wagawuni wogawa (VT), zomwe zimagwirizana ndi kuyeza kwa chiŵerengero cha minofu yosungiramo ndondomeko ya plasma, mu striatum ndi cerebellum pogwiritsa ntchito njira yowonetsera njira zowonongeka (20). Chiŵerengero cha VT mu striatum kupita ku VT mu cerebellum zimagwirizana ndi mphamvu yosamalidwa bwino (BPND) + 1 komwe BPND ndi mu vivo kulumikiza mphamvu zomwe zili zofanana ndi chiwerengero cha malo omwe ali ndi maofesi a Bavail / Kd. N'zosatheka kuti BPND pakuti raclopride imakhudzidwa ndi kusintha kwa magazi m'magazi, koma kuti tipeze mwayi umenewu K1 (yomwe ili ntchito ya kutuluka kwa magazi) inkawerengedwa kuti ndiyomwe yayambira ndi maphunziro a MPH omwe anali ndi magazi ojambulira magazi poika deta ku chitsanzo chimodzi cha chipinda (21). Chitsanzo chimodzi cha chipinda chinagwiritsidwa ntchito pazitsulo zonse ndi madera a D2 ofunika.
Yankho lakula kwa chakudya (ndi placebo kapena MPH) linatchulidwa ngati kusiyana kwake BMax/Kd ponena za kusalowerera ndaleplacebo chikhalidwe, chomwe chinali chikhalidwe chomwe chinagwiritsidwa ntchito ngati maziko. Mofananamo, kuyankhidwa kwa MPH ndi kukakamiza kusalowerera ndale (kugwiritsidwa ntchito ngati zotsatira za MPH) kunatsimikiziridwa ngati kusiyana kwa BPND ndi chikhalidwe chosalowerera / placebo.
Kusanthula deta
Kusiyanitsa kwa miyezo ya K1 pakati pa placebo ndi MPH inayesedwa pogwiritsidwa ntchito pawiri t-ndipo. Kusiyana kwa BPND pakati pa zikhalidwe zinayesedwa pogwiritsira ntchito 2 × 2 kupanga machitidwe (mtundu wa mankhwala ndi mankhwala) ndi kugwirizanitsa gulu pogwiritsa ntchito mtundu wosiyanasiyana wa ANOVA. Zopereka zokhudzana ndi amuna ndi zaka komanso zaka ndi BMI zinaganiziridwa muchitsanzo cha ANOVA. Tsamba lolemba-zinthu zinagwiritsidwa ntchito podziwa kuti ndi zifukwa ziti zomwe zotsatirazo zimasiyana ndi chikhalidwe choyambirira (kusalowerera ndaleplacebo). Lowani zolemba Kufufuza kwa mphamvu kwa zitsanzo zogwirizanitsa t-ndizo zowonongeka kambirimbiri ndi zochitika mobwerezabwereza ANOVA zinachitidwa. Zotsatira za kukondweretsa chakudya pa zochitika zokhudzana ndi khalidwe lawo zinayesedwa poyerekeza zomwe anazipeza musanayambe kukondweretsa ndi zinthu zambiri zomwe zinapezedwa pakati pa 15 ndi 40 min pambuyo poyambitsa kulowetsamo pogwiritsa ntchito njira zobwerezabwereza ANOVA. Zotsatira za kuyambitsa chakudya pamaganizo a mtima zinayesedwa poyerekeza zomwe zisanachitike malobo / MPH, musanayambe kugwiritsidwa ntchito (60 min pambuyo pa placebo / MPH), ndipo chiwerengero chopezeka pakati pa 3 ndi 42 min pambuyo poyambitsa zokopa pogwiritsa ntchito mobwerezabwereza Makhalidwe a ANOVA. Pearson mankhwala ogwirizanitsa ntchito anagwiritsidwa ntchito poyesa mgwirizano pakati pa kusintha kwa zakudya zomwe zimayambitsa kusintha kwa BPND ndi magawo monga zotsatira za khalidwe la kukondweretsa chakudya, kuyankha mtima kwa mtima (kuthamanga kwa magazi ndi kuthamanga kwa magazi), kuchuluka kwa kudya kwambiri, msinkhu, ndi BMI, komanso pakati pa MPH-kuchititsa kusintha kwa BPND ndi magawo monga maganizo a mtima, zaka, ndi BMI. Mayi Pearson amagwirizananso pakati pa kusintha kwa dopamine ndi MPH pamene amaperekedwa ndi kusakhudzidwa ndi ndale. Kusintha kumene kumaperekedwa ndi zakudya zowonjezera chakudya komanso magawo monga zotsatira za kudya, zakudya zambiri, mayankho a mtima, zaka, ndi BMI.
ZINTHU
Odyera khumi odyera ndi odyera asanu ndi atatu osadyerako analembedwera ku phunziroli. Magulu onsewa anali ofanana m'zaka, BMI, ziwerengero zovutika maganizo, zaka za maphunziro ndi zachuma (Gulu 1). Odyera odyerawo anali ndi ziwerengero zapamwamba kwambiri za Gormally Binge Eating Scale (P <0.000001).
Zizindikiro za ophunzira ophunzira
Kupititsa patsogolo chakudya kumapangitsa njala ndikulakalaka kudya chakudya chodyera (P <0.001, P <0.001, motsatana) ndi osadya osadya (P <0.05, yopanda tanthauzo, motsatana) mu placebo komanso m'kamwa MPH (omwa mowa mwauchidakwa: P <0.05, osati yofunika; osadya mowa: P <0.05, P <0.05) mikhalidwe, motsatana (Gulu 2). Komabe, kuwonjezeka kwazomwe zimapereka malipoti pa nthawi yopatsa chakudya (popanda kapena MPH) sikunali kusiyana pakati pa odyera zakudya ndi osadya.
Kudzimva zofuna za njala ndi chilakolako cha chakudya pambuyo pa chakudya chokakamiza (FS) mu odyera ndi osadya
Kupititsa patsogolo chakudya kunapangitsa kuti anthu azidya zakudya zambiri (+ 6 ± 7%, P = 0.04) ndi osadya (+ 2 ± 2%, P = 0.02) mu chikhalidwe cha placebo (Gulu 3). Kuyerekeza pakati pa kusokonezeka kwa systolic kusintha pakusangalatsa kwa chakudya ndi kusakakamiza kusalowerera sikunali kosiyana ndi odyera zakudya komanso osadya zakudya (kuyesedwa ndi kugwirizanitsa). Panthawi yopatsa chakudya, kuthamanga kwa magazi kunachepetsedwa mwa anthu osadya (P = 0.02) mu placebo koma osati odyera. Kupanikizika kwa magazi kunayambira pa 60 min (musanayambe kulowerera ndale) Pambuyo pa MPH wodwala m'kamwa anthu osadya ankawonetsa mphamvu ya systolic yowonjezera (P = 0.002), yomwe idapitilira panthawi yosakondera (P = 0.004). Komabe, kupweteka kwa mankhwala m'thupi mwa anthu osadya sikunasinthe pamene anayeza asanayambe kudya (60 min pambuyo pa MPH), ndipo mphamvu ya systolic siinali yosiyana kwambiri pakati pa maphunzirowo.
Magulu amatanthauza kuchuluka kwa kuthamanga kwa magazi ndi kuthamanga kwa magazi kwa zifukwa zinayi zoyesera zazomwe zimayambira, asanayambe kulowerera ndale / panthawi yopanda gawo / chakudya
Mavuto a magazi a MPH sanali osiyana pakati pa magulu onse awiriwa panthawi yomwe salowerera ndalemph (odyera mowa: 6.75 ± 2.33, osadya zakudya: 6.07 ± 2.72) ndi chakudyamph (odyera mowa: 6.6 ± 2.83, osadya zakudya: 6.03 ± 2.48).
K1 Zomwe zimayambira m'madera ambiri omwe amawoneka kuti ndi a placebo ndi a MPH anali 0.101 ± 0.02 ndi 0.11 ± 0.026 (chakudya chodyera zakudya), 0.09 ± 0.014 ndi 0.0927 ± 0.02 (odyera mowa-osalowerera), 0.107 ± 0.029 ndi 0.106 ± 0.03 (osadya -Kudya), 0.093 ± 0.012 ndi 0.098 ± 0.011 (osadya-osalowerera). Ambiri% kusintha kwa magulu anali + 8%, + 4%, -0.6%, ndi + 5%, motsatira. Kusiyana kwa K1 Miyezo inali yofunikira kwa odyera zakudya: chakudyaplacebo vs. chakudyamph (P <0.01) ndi omwe samadya mopanda malire: osalowerera ndale placebo kutsutsanamph (P <0.03).
Mzere woyamba (ndale)placebo) Dopamine D2 receptor kupezeka sikunali pakati pa odyera kudya ndi osadya ndi osagwirizana ndipo sanali ogwirizana ndi BMI kapena Zung maganizo maganizo. Zosakhudzana ndi ndale kapena zakudya zomwe zimakhudza poperekedwa ndi placebo zinapangitsa dopamine yowonjezera m'malo osadya. Kupititsa patsogolo ndale komwe kumaperekedwa ndi MPH (ndale)mph, mankhwala osokoneza bongo, P = 0.003; chiwerengero cha kukula kwa Cohen's d = 1.63 ndi mphamvu = 99.99% pa chiwerengero cha 0.05, ndi mphamvu = 99.96% pa chiwerengero cha 0.05 / 3 ndi kukonzedwa kambirimbiri), koma osati zakudya zoperekedwa ndi MPH (chakudyamph), anawonjezera kwambiri dopamine kumasulidwa muzinthu zomwe sizidya. Omwe amamwa mowa kwambiri, osasunthira ndale ngakhale popanda MPH (ndale)mph) kwambiri anawonjezeka dopamine kumasulidwa. Zakudya zoperekedwa ndi MPH (chakudyamph) poyerekeza ndi chiyambi (osalowerera ndale)placebo) adawonetsa kwambiri kutulutsidwa kwa dopamine mwa odyera zakudya m'madzi (P = 0.003; kuchuluka kwa zotsatira zake, Cohen's = 1.30) ndi putamen (P = 0.05; kuchuluka kwa zotsatira kukula = 0.74). Zakudya zoperekedwa ndi placebo (chakudyaplacebo) sizinapangitse kusiyana kwakukulu pakati pa odyetsa zakudya ndi osadya (osakaniza ndi kugwirizana). Ngakhale MPH yosasunthira mbali (ndale)mph) zinapangitsa kuti anthu ambiri asamadye zakudya zamadzimadzi koma osati odyera, kusagwirizana sikunali kofunikira (kujambulidwa ndi kugwirizana kwa matenda). Poyerekeza ndi zakudya zoperekedwa ndi MPH (chakudyamph) motsutsana ndi chiyambi (osalowerera ndale)placebo), odyera mowa kwambiri anali atamasulidwa kwambiri kusiyana ndi odyera osadya omwe amatha kudya (kuyesa ndi kugonana, P = 0.026, Gulu 4 ndi Chithunzi 2 kuchuluka kwa zotsatira kukula = 0.79). Komabe, kusiyana kwa putamen kapena ventral striatum sikunali kofunikira.
Chithunzi chogawa chiwerengero cha kufalitsa [11C] raclopride pa mlingo wa striatum kwa mmodzi mwa odyera mowa ndi mmodzi mwa osadya omwe akudya zinthu zowonongeka anayi: kutengeka kwa ndale ndi malo a mouthbo, kutsegula kwina kulikonse ndi mankhwala a methylphenidate (MPH), chakudya ...
Magulu otanthawuza magulu a mphamvu zomangirira (BPND) pazifukwa zinayi zoyesera ndipo peresenti zimasintha kwa osalowerera ndaleplacebo chikhalidwe cha phokoso lokhazikika, putamen, ndi ventral striatum
Panalibe mgwirizano pakati pa chakudyaplacebo mkhalidwe ndi zozizwitsa zodzipatula, mayankho a mtima, zambiri za kudya kwambiri, zaka kapena BMI. Poyerekeza ndi maphunziro onse, nkhani zomwe zili ndi zikuluzikulu za BMI zinkakhala ndi m'munsi mwa mapiritsi a MPH (plasma)n = 18, r = 0.57, P <0.01). Kuchulukanso kwa striatal dopamine kumasulidwa pamitu yonse yopanda ndalemph Chikhalidwe sichinagwirizane ndi kudzidzimva yekha, kuyankha kwa mtima, kuwerengera kwa kudya kwambiri, pulasitiki ya MPH, zaka, ndi BMI. Kuwonjezeka kwa dopamine kumamasulidwa ku maphunziro onse mu chakudya chochepamph Chikhalidwe chinagwirizanitsidwa ndi kuopsa kwa Mchitidwe Wambiri wa Binge Eating Scale (n = 18, r = 0.49, P <0.03, Chithunzi 3) koma osati ndi BMI, mndandanda wa MPH wa plasma, magawo odziwika okha, mapemphero a mtima, ndi zaka. Palibe zotsatira za kugonana zomwe zinawonetsedwa mu magawo awa.
Mgwirizano pakati pa dopamine kumasulidwa (kusinthika mwazomwe zimakhala zomangamanga (BPND)) pamutu waukulu wa maphunziro onse pansi pa chakudyamph Mkhalidwe ndi zambiri za Kukula Kwambiri Kwambiri Binge (n = 18, r = 0.49, P <0.03). MPH, methylphenidate. ...
KUKANGANANI
Kafukufukuyu anawonetsa kuti odyera odyera odzaza kwambiri anali ndi kuchulukanso kwakukulu kwa nthenda ya extracellular dopamine m'kati mwachangu panthawi yopatsa chakudya pamene dopamine opititsa katundu anali otsekedwa ndi oyang'anira MPH, kusiyana ndi osadya. Mosiyana ndi zimenezo, ventral striatum kumene kampeni accumbens ilipo siinali yosiyana pakati pa gululos. Dopamine mu nucleus accumbens yapezeka kuti imakhudza zomwe zimachititsa kuti anthu azikhala ndi mankhwala osokoneza bongo komanso mankhwala osokoneza bongo (22). Kafukufuku wa zinyama anasonyeza kuti kuyembekezera mphoto yomwe ikuyandikira kuchokera ku zakudya zowonjezera zakudya zowonjezereka za mesotelencephalic dopamine neurons, ndipo dopamine yokonzedweratu mu nucleus accumbens inali yaikulu pamaso pa chiwonongeko chokhazikika chomwe chimasonyeza kuwona chakudya pokhapokha mutapereka chakudya chosayembekezereka (23). Nucleus accumbens imaphatikizapo zowonjezera zomwe zimachokera ku malo omwe ali ndi chilakolako chokhudzana ndi kudya ndi mphotho kuti ayambe njira zoyenerar (24). Kuwongolera kwake kunaneneratu mphotho yomweyo. Mosiyana ndi zimenezo, kupweteka kwa chiwembu ndikofunikira pakupanga makhalidwe abwino ndipo zakhala zikuwonetsedwa kuti ndikhala mkhalapakati wamkulu muzogwiritsa ntchito mankhwala osokoneza bongo. (25). Dorsal striatum imathandizira kuti anthu azikhala ndi chizoloŵezi choyankhira chizoloŵezi, pomwe khalidwe limakhala lokhazikika ndipo silingayendetsedwe ndi chiyanjano cha zotsatira (26). Pamene chiwonetsero chimakonzekeretsa mphoto yomwe ikubwera, kuwombera kwa dopamine neurons kumachitika pambuyo potsitsimula mphoto, osati pambuyo pa mphotho yokha (27). Zolemba zamagetsi m'mabulu m'kati mwace, zimasonyeza kuti ntchito yake ikhoza kudalira zotsatira za ntchito (28). Komabe, chikhulupilirochi chikukhulupiriridwa kuti chimaphatikizapo kuchitapo kanthu zomwe zingabweretse mphotho koma osati pokonza mphotho pa se (29).
Mu phunziro ili, BMI siyinali yosiyana pakati pa osbinge ndi odyera. Komabe, zolemba zambiri pa kudya mowa kwambiri zimadya kwambiri kuposa anthu odyera zakudya monga momwe amayembekezera. Zomwe Zidya Zambiri Zambiri Zambiri Zidali zogwirizanitsidwa ndi dopamine ya extracellular yowonjezereka panthawi yopatsa chakudya. Anthu omwe ali ndi zakumwa zambiri zakudya kwambiri amakhala ndi dopamine yowonjezera yowonjezereka panthawi yopatsa chakudya kusiyana ndi omwe ali ndi zochepa. Kafukufuku wam'mbuyomo amasonyeza kuti odyera odyera odzaza ndi odyera amatha kukhala owonjezera m'madera ozungulira ndi operesal cortical kusiyana ndi odyera osadya kwambiri panthawi yopatsa chakudya (30,31). Odyera mowa ankasonyeza mayankho akuluakulu pamtundu wamakono owonetsetsa pakhomo pamene akuwona zithunzi za chakudya, zomwe zimagwirizana ndi mphotho yawo yokhudzidwa (30). Phunziro lapitalo pogwiritsa ntchito PET-18F-fluorodeoxyglucose ndi chakudya chomwecho chokongoletsa paradigm, tinasonyeza kuti muzochitika zozizira zolimbitsa thupi, kutsegulira kwapadera kunkagwirizana ndi chikhumbo chowonjezeka cha chakudya (32). Mankhwala ochotsa misozi / mesocortical dopamine, omwe makamaka amachokera kumalo otchedwa ventral tegmental, malo osungirako zachilendo ndi ma corticales (oprontal and orbitofrontal cortices (33). Choncho, kuyendetsa kumadera amenewa kumatha kusonyeza zotsatira zochepa za kuchitidwa kwa dopaminergic.
Mosiyana ndi odyera odzaza kwambiri, odyera ochepa omwe sakhala odyera sanawonjezerepo mazira owonjezera a dopamine mu striatum panthawi yopatsa chakudya. Kugwiritsa ntchito PET- [11C] raclopride ndi chakudya chomwecho chokhazikitsa chakudya cha paradigm kuti tione kusintha kwa dopamine yowonongeka kwa zakudya zoperewera, tawonetsa kuwonjezeka kwakukulu (+ 12%) mu extracellular dopamine mu dorsal striatum (5). N'zotheka kuti maphunziro ovuta kwambiri akhoza kukhala ndi dongosolo lochepa la dopamine (+ 8% mwa odyera zakudya zambiri komanso + 1% mwa obese osadya). Kufufuza zojambula kwa anthu ndi zinyama kuchokera ku labotore yathu ndi ena, kunasonyeza kupititsa patsogolo m'madera a ubongo okhudzana ndi kukonzetsa chakudya mwa anthu ovuta kwambiri. Mwapadera kugwiritsa ntchito PET ndi 18F-fluorodeoxyglucose, tinasonyeza kuti maphunziro ovuta kwambiri omwe anali otupa anali ndipamwamba kwambiri kuposa kagwiritsidwe kake ka shuga koyambitsa matenda (popanda kukakamiza) mu khungu lachidziwitso lokha lokha lokha kuposa maphunziro omwe sali obese (34). Kafukufuku wogwiritsira ntchito maginito oponyera chiwonetsero cha atsikana achichepere anawonetsa kuti atsikana omwe anali ovuta kwambiri ankalowetsedwa kwambiri mu insula komanso chosakanikirana ndi zakudya zakuthengo chifukwa choyembekezera chakudya choyenera komanso chakudya chokwanira kusiyana ndi atsikana ochepa (35). Maphunziro otsogolera ochokera ku gulu lathu adawonetsa kuti kusakaniza chakudya (kuyang'ana ndi kununkhira popanda kudya) kumapangitsa kuti thalamic iyambe kuyendetsedwa ndi makoswe oposa Zucker kuposa ma littermates oonda (36). Zigawo zowonjezeredwazi zikuphatikizidwa m'zinthu zowona (somatosensory, visual cortices, thalamus) ndi hedonic (insula) mbali ya chakudya cues. Kutsitsimula kwa dopamine kumasonyeza kusamalitsa komanso kumapangitsa kuti chikhalidwe chikhale bwino (37). Mmene Dopamine amagwiritsira ntchito mankhwala osokoneza bongo m'zinthu zamakono ndi thalamus kuti zakudya zowonjezera zikhoza kuwonjezera mphamvu zawo, zomwe zingathandize kuti mapangidwe a chakudya ndi zakudya zokhudzana ndi chilengedwe azigwirizana. Maphunziro a maginito a magnetic resonance kuphunzira kwa atsikana achikulire (35) anawonetsa kuti atsikana okhwima amakhala ndi ziwalo zambiri mu ubongo zomwe zimakhudzana ndi zovuta komanso zakudya zamagetsi. Komabe, atsikana omwe ali ovuta kwambiri adasonyezanso kuchepa kwachangu chifukwa cha chakudya, chomwe chingasonyeze kuti palibe njira yothetsera dopamine yomwe ingawonjezere chiopsezo chawo chodyera (35).
Pano, tikuwonetsa kuti mankhwala opatsirana a MPH (20 mg) amawonjezereka kwambiri dopamine yochuluka m'magazi osadya koma osati odyera. Komabe, dopamine ikuwonjezeka sizinali zosiyana kwambiri pakati pa magulu. Kupeza kwathu koyambirira mu nkhani zowonongeka bwino zikuwonetsa kuti MPH siidapangitse mavuto ofooketsa mtima, ofanana ndi zomwe apeza pa phunziro lino, komanso kuwonjezeka kwa MPH-kubala kwa dopamine kukulirapo pamene MPH inapatsidwa mwachangu (kuwonetsa chakudya chowonekera pamene chakudya kunyansidwa, ndalama) kusiyana ndi pamene waperekedwa ndi zokopa zandale (5,38). Zotsatirazi zikhoza kusonyeza zotsatira zokhudzana ndi nkhani ya MPH (dopamine imachulukitsa zotsatira kuchokera ku dopamine transporter blockade ndi kumasulidwa mwadzidzidzi dopamine). Dopamine yowonjezereka ikuwonjezeka ikachitika pokhapokha ngati pali mphamvu yosautsa yomwe mwina imapangitsa dopamine cell kuwombera anthu odyera. Zomwe tikupezazi zikufanana ndi zomwe timaphunzira pa nkhani za cocaine zomwe zimapangitsa MPH-kulakalaka kukhumba pokhapokha ngati ataperekedwa ndi mankhwala a cocaine (39). Chifukwa chomwe sitinasamalire dopamine kumawonjezeka pamene MPH inaperekedwa ndi zakudya zosafunika kwenikweni. N'zotheka kuti pamene MPH ikukweza zotsatira za zofooketsa zofooketsa (monga odyera zakudya) sizikhoza kutero kuti zikhale zamphamvu (monga momwe zilili zolemera). N'zotheka kuti dopamine yochepa komanso yaing'ono imakula chifukwa cha MPH ingakhale yokwanira kuletsa dopamine kumasulidwa kudzera Dopamine D2 autoreceptors ndi kuonetsetsa kuti pulogalamu ya dopamine yowonongeka ikugwirizana ndi chakudya cholimbikitsa.
Kugwiritsiridwa ntchito kwa MPH kumalongosola kuti kuthekera kwa kusintha kwa magazi kukuchitika panthawi yopikisana. Izi ndizovuta kokha mu kulingalira kwa BPND ngati kusintha kumachitika pakasankhidwa pambuyo pa MPH. Ngati kuthamanga kuli kwakukulu koma nthawi zonse panthawi yopikisana, sipadzakhala zotsatira pa VT. Slifstein et al. yasonyezera kuti cholakwika chachikulu mu VT kulingalira kudzachitika ndi kusintha kwakukulu kofulumira kutuluka mkati mwa maminiti angapo ochepa mutatha kulandira jekeseni (21). Komabe, iwo asonyeza kuti kwa kenitic magawo omwe amadziwika ndi fallypride, kusintha kwa 60% kutuluka kumabweretsa mwadzidzidzi kumabweretsa kusiyana kochepa mu VT. Kuyambira K1 pakuti raclopride ndi yaying'ono kusiyana ndi yopanda malire, kusintha kwa kayendedwe kameneko sikukhala ndi zotsatira zochepa pazomwe zimachitika. Komanso mlingo wa MPH umaperekedwa pamlomo osati mwa jekeseni, kotero kuti kusintha kulikonse koyendetsedwe kumayenera kukhala kopitirira. Kuyambira kusintha kwa K1 anali akudyera kudya, akuyerekeza chakudyaplacebo ndi chakudyamph, tikhoza kunena kuti kusintha K1 analibe zotsatira pa VT popeza sizinasinthe. Kwa osadya, osayerekezeraplacebo komanso kulowerera ndalemph, kusintha kwakukulu ku K1 anali 5%, omwe sangayembekezere kukhala ndi udindo wa kusintha kulikonse kowonedwa mu VT. Chifukwa cha kusiyana kochepa kwa K1 zomwe tawona mu phunziro ili, timaganiza kuti kusintha kulikonse kwa BPND sanali chifukwa cha kusintha kwa magazi.
Phunziroli liri ndi malire ena. Choyamba, zotsatira za kukondweretsa chakudya zokha sizinali zokwanira kuti ayankhe mayankho omwe angapezeke ndi PET- [11C] njira ya raclopride. Tinayenera kugwiritsa ntchito mlingo wochepa wa MPH, womwe umathandiza kuti anthu azitengako dopamine, kuti apititse patsogolo dopamine (5). Choncho, sitingathe kuyankhulana pakati pa MPH ndi kuyanjana ndi chakudya. Komabe, kulephera kuwona kuti mgwirizano pakati pa dopamine umasinthidwa ndi MPH pakati pa magulu awiriwa pamene waperekedwa ndi kusonkhezera kwa ndale kumapereka umboni wakuti zotsatira za MPH zimayendetsedwa ndi chikhalidwe chokhazikitsa chakudya. Chachiwiri, popeza maphunziro onse analandira mlingo womwewo wa MPH, anthu ambiri omwe ali ndi BMI anali ndi ma PH. Komabe, maphunziro omwe ali ndi BMI akulu sanawonetsetse kuti akutsitsa dopamine m'munsi kuti asamasulidwe ndi MPH kapena ndale ya MPH, yomwe imapereka umboni wakuti MPH zotsatirazi zimayendetsedwa ndi chakudya. Chachitatu, pofuna kupewa mizere yowonjezereka, maphunzirowo adatsirizidwa masiku a 2, omwe amachititsa kuti anthu asokonezeke ndi zotsatira zake. Chachinai, kusintha kwa ventral striatum sikunali kusiyana pakati pa zikhalidwe, zomwe zikhoza kuwonetsa kuchepetsa kugwirizanitsa kwa nkhanizi ku chakudya chomwe iwo ankadziwa kuti sangadye. Komabe, kuchuluka kwa kusintha kwa madera okhudzidwa kumeneku kunasintha kwambiri, komwe kungabwere chifukwa cha kusuntha pa zokondweretsa chakudya / MPH ndi mapangidwe a dera lopitirira chisankho cha PET. Popeza kuti phunziroli linkachitika pang'onopang'ono zosiyana siyana (zaka zosiyana, zogonana, ndi BMI) sitingathe kuwonetsa kuti kusowa kwa kagulu kachitidwe ka reactivity kwa ventral striatum kunachokera ku mphamvu zochepa zowerengetsera. Chingwe china chinali chakuti sitinathetse nthawi ya kusamba kumene maphunzirowo ankachitidwa kapena sitinayese mahomoni a gonadal. Kutha msambo kungakhudze ubongo ku chakudya chifukwa chithunzi cha secretion pa nthawi ya ovini yasonyezedwa kuti chikhudze khalidwe la kudya; Mwachitsanzo, amayi amadya zambiri panthawi ya luteal komanso kumwezi kusiyana ndi mapulogalamu a follicular ndi periovulatory (40).
Mwachidule, iyi ndiyo phunziro loyamba pogwiritsira ntchito PET poyeza kusintha kwa ubongo wa dopamine panthawi yopatsa chakudya mu zakudya zodyera. Zotsatira izi zimapereka umboni wa kusagwirizanitsidwa kwa phokoso lokhazikika mu matenda a BED. Popeza kuti kudya mowa mwauchidakwa sikunapezeke kokha mwa anthu olemera kwambiri, kufufuza kwina kuli koyenera kufufuza zinthu zokhudzana ndi ubongo zomwe zingathe kusiyanitsa odyetsa obedi ndi osobese.
ZIZINDIKIRO
Phunziro la positron la tomography (PET) linapangidwa ku Laboratory ya Laboratory ya Brookhaven ndi thandizo la chithandizo kuchokera ku US Department of Energy OBER (DE-ACO2-76CH00016) ndipo mothandizidwa ndi gawo la National Institute of Health: R01DA6278 (G.-JW ), R01DA06891 (G.-JW), Intramural Research Program ya National Institute on Alcohol and Alcohol Abuse, Z01AA000550 (NDV, FT, MJ) ndi M01RR10710 (General Clinical Research Center ku Stony Brook University). Zipangizo zophunzirira pa chipatala cha St Luka's-Roosevelt zinathandizidwa mbali zina ndi R01DK068603 (AG) ndi R001DK074046 (AG). Kuwongolera ndi kuwonetsetsa maganizo m'maganizo ku St Luka's-Roosevelt Hospital. Tikuthokoza David Schlyer ndi Michael Schueller chifukwa cha ntchito za cyclotron; Donald Warner, David Alexoff ndi Paul Vaska pa ntchito za PET; Richard Ferrieri, Colleen Shea, Youwen Xu, Lisa Muench ndi Payton King pofuna kukonzekera ndi kufufuza, Karen Apelskog-Torres kuti aphunzire kukonzekera, komanso Barbara Hubbard ndi Pauline Carter kuti azisamalira odwala.
Mawu a M'munsi
ONANI
G.-JW akusimba kuti adalandira ndalama zothandizira ndi kufufuza ndalama kuchokera ku Orexigen Therapeutics Inc ;; JSF, AG, KG, HH, MJ, JL, PS, FT, ND, CTW, WZ adanena kuti palibe kutsutsana.
ZOKHUDZA
1. Dymek-Valentine M, Rienecke-Hoste R, Alverdy J. Kufufuza kwa matenda odyera odyera odwala odwala kwambiri omwe amaonedwa kuti ndi opweteka kwambiri: SCID motsutsana ndi QEWP-R. Idyani Matenda a Kulemera. 2004; 9: 211-216. [Adasankhidwa]
2. Geliebter A, Hassid G, Hashim SA. Chakudya choyesera chodyera mu odyetsa odyera okhudzana kwambiri ndi maonekedwe ndi chiwerewere. Int J Eat Disord. 2001; 29: 488-494. [Adasankhidwa]
3. Mietus-Snyder ML, Lustig RH. Ubwana wambiri kunenepa: kumakhala "katatu kamangidwe" Annu Rev Med. 2008; 59: 147-162. [Adasankhidwa]
4. Bello NT, Hajnal A. Dopamine komanso kudya mowa mwauchidakwa. Pharmacol Biochem Behav. 2010; 97: 25-33. [Nkhani yaulere ya PMC] [Adasankhidwa]
5. Volkow ND, Wang GJ, Fowler JS, et al. "Nonhedonic" chakudya chokhudzana ndi anthu chimaphatikizapo dopamine mu dorsal striatum ndipo methylphenidate ikuwonjezera zotsatirazi. Sinthasintha. 2002; 44: 175-180. [Adasankhidwa]
6. DM yaing'onoting'ono, Jones-Gotman M, Dagher A. Kudyetsa-kutulutsa dopamine kumasulidwa mu dorsal striatum yothandizana ndi chakudya chosangalatsa chiwerengero cha odzipereka odzipereka. Neuroimage. 2003; 19: 1709-1715. [Adasankhidwa]
7. Blum K, Sheridan PJ, Wood RC, et al. D2 dopamine receptor jini ndizomwe zimapangitsa kuti mphotho ikhale yochepa. JR Soc Med. 1996; 89: 396-400. [Nkhani yaulere ya PMC] [Adasankhidwa]
8. Volkow ND, Chang L, Wang GJ, et al. Mlingo wotsika wa ubongo wa D2 m'mapatala a methamphetamine: oyanjana ndi metabolism mu orbitofrontal cortex. Am J Psychiatry. 2001; 158: 2015-2021. [Adasankhidwa]
9. Thanos PK, Michaelides M, Piyis YK, Wang GJ, Volkow ND. Kuletsedwa kwa zakudya kumayambitsa dopamine D2 receptor (D2R) mu khola la kunenepa kwambiri monga momwe amachitira ndi kujambula mu-vivo muPET ([11C] raclopride) ndi mu-vitro ([3H] spiperone). Sinthasintha. 2008; 62: 50-61. [Adasankhidwa]
10. Galanti K, Gluck ME, Geliebter A. Yesetsani kudya chakudya chokwanira mu zakudya zowonongeka kwambiri pokhudzana ndi kukhudzidwa ndi kukhudzidwa. Int J Eat Disord. 2007; 40: 727-732. [Adasankhidwa]
11. Wang GJ, Volkow ND, Thanos PK, Fowler JS. Kufanana pakati pa kunenepa kwambiri ndi mankhwala osokoneza bongo monga momwe ziwonetsedwera ndi kujambula kogwira ntchito: ndemanga ya ndondomeko. J Addict Dis. 2004; 23: 39-53. [Adasankhidwa]
12. Cameron JD, Goldfield GS, Cyr MJ, Doucet E. Zotsatira za kuchepa kwa caloric nthawi yaitali kumapangitsa kulemera-kutaya pa zakudya hedonics ndi kulimbikitsa. Physiol Behav. 2008; 94: 474-480. [Adasankhidwa]
13. Carr KD. Kudyetsa chakudya chokwanira: kuonjezera zotsatira pa mphotho ya mankhwala ndi chizindikiro chowonetsa. Physiol Behav. 2007; 91: 459-472. [Adasankhidwa]
14. Avena NM, Rada P, Hoebel BG. Shuga ndi mafuta oledzeretsa amasiyana kwambiri ndi khalidwe lachizolowezi. J Nutriti. 2009; 139: 623-628. [Nkhani yaulere ya PMC] [Adasankhidwa]
15. Avena NM, Rada P, Moise N, Hoebel BG. Shamrose ya sucrose yomwe imadyetsa pulogalamu yoledzera imatulutsa dopamine mobwerezabwereza ndipo imathetsa yankho la acetylcholine satiety. Neuroscience. 2006; 139: 813-820. [Adasankhidwa]
16. Cooper Z, Cooper PJ, Fairburn CG. Kuwona kwa matenda odwala matenda ndi zolemba zake. Br J Psychiatry. 1989; 154: 807-812. [Adasankhidwa]
17. Zung WW, Richards CB, MJ Mfupi. Kudzikonda nokha kuvutika maganizo mu kliniki yapatala. Kuonjezeretsanso kwa SDS. Arch Gen Psychiatry. 1965; 13: 508-515. [Adasankhidwa]
18. Schaefer A, Brown J, Watson CG, et al. Kuyerekeza ndi zofunikira za Beck, Zung, ndi MMPI Scress Depression Scales. J Consult Kliniki Psychol. 1985; 53: 415-418. [Adasankhidwa]
19. Mwachizoloŵezi J, Black S, Daston S, Rardin D. Kuwunika kwa kudya mowa kwambiri kumadya pakati pa anthu ovuta kwambiri. Chizolowezi Behav. 1982; 7: 47-55. [Adasankhidwa]
20. Logan J, Fowler JS, Volkow ND, et al. Kusanthula kwapadera kwa radioligand yomwe imasinthidwa kuchokera ku nthawi-ntchito zoyeza zomwe zimagwiritsidwa ntchito kwa [N-11C-methyl] - (-) - pake zofufuza za PET mu maphunziro aumunthu. J Cereb Blood Flow Metab. 1990; 10: 740-747. [Adasankhidwa]
21. Slifstein M, Narendran R, Hwang DR, et al. Mmene amphetamine amachitira [18] F mu vivo kulumikiza ku D (2) receptors m'madera ovuta komanso ochepa omwe amapezeka m'mimba ya ubongo: Single bolus ndi bolus kuphatikizapo maphunziro opatsirana nthawi zonse. Sinthasintha. 2004; 54: 46-63. [Adasankhidwa]
22. Peciña S, Smith KS, Berridge KC. Malo otentha a Hedonic mu ubongo. Wasayansi. 2006; 12: 500-511. [Adasankhidwa]
23. Schultz W. Neural coding ya malipiro apadera malingana ndi chiphunzitso cha nyama, masewera a masewera, chiwerengero cha tizilombo toyambitsa matenda ndi zamoyo za chilengedwe. Curr Opin Neurobiol. 2004; 14: 139-147. [Adasankhidwa]
24. Weiss F. Neurobiology ya chilakolako chofuna, kupatsidwa malipiro ndi kubwereranso. Curr Opin Pharmacol. 2005; 5: 9-19. [Adasankhidwa]
25. Gerdeman GL, Partridge JG, Lupica CR, DM wokonda. Zingakhale chizoloŵezi chopanga: mankhwala osokoneza bongo komanso mapuloteni osokoneza bongo. Miyambo ya Neurosci. 2003; 26: 184-192. [Adasankhidwa]
26. Vanderschuren LJ, Di Ciano P, Everitt BJ. Kuphatikizidwa kwa mankhwala osokoneza bongo omwe amachititsa kuti cocaine ilamulidwe. J Neurosci. 2005; 25: 8665-8670. [Adasankhidwa]
27. Schultz W, Preuschoff K, Camerer C, et al. Zizindikiro zomveka za neural zikuwonetsa mphotho yosatsimikizika. Philos Trans R Soc Lond, B, Biol Sci. 2008; 363: 3801-3811. [Nkhani yaulere ya PMC] [Adasankhidwa]
28. Schultz W, Tremblay L, Hollerman JR. Kukonzekera mphoto ku primate orbitofrontal cortex ndi basal ganglia. Cereb Cortex. 2000; 10: 272-284. [Adasankhidwa]
29. Tricomi EM, Delgado MR, Fiez JA. Kusinthasintha kwazomwe ntchito yosachita mwachidwi. Neuron. 2004; 41: 281-292. [Adasankhidwa]
30. Schienle A, Schäfer A, Hermann A, Vaitl D. Matenda odyera Bongo: kupereka mphotho zokhudzana ndi ubongo ndi kuwonetsa ubongo ku zithunzi za chakudya. Biol Psychiatry. 2009; 65: 654-661. [Adasankhidwa]
31. Geliebter A, Ladell T, Logan M, et al. Kukhala wokhudzidwa ndi chakudya chokwanira mu odyera odzaza ndi odyera kwambiri pogwiritsa ntchito MRI yogwira ntchito. Kudya. 2006; 46: 31-35. [Adasankhidwa]
32. Wang GJ, Volkow ND, Telang F, et al. Kuwonetsera kuzinthu zowonongeka kwa zakudya kumayambitsa ubongo waumunthu. Neuroimage. 2004; 21: 1790-1797. [Adasankhidwa]
33. Swanson LW. Zomwe zimagwiritsidwa ntchito pazomwe zimapangidwira m'madera ozungulira. Bongo Res Bull. 1982; 9: 321-353. [Adasankhidwa]
34. Wang GJ, Volkow ND, Felder C, ndi al. Ntchito yopuma yopititsa patsogolo ya cortex yovomerezeka pamlomo muzovuta kwambiri. Neuroreport. 2002; 13: 1151-1155. [Adasankhidwa]
35. Stice E, Spoor S, Bohon C, Veldhuizen MG, Small DM. Kulankhulana kwa mphotho kuchokera ku chakudya cha zakudya ndi kuyembekezera chakudya chokwanira kunenepa kwambiri: phunziro lopangira maginito la kujambula zithunzi. J Abnorm Psychol. 2008; 117: 924-935. [Nkhani yaulere ya PMC] [Adasankhidwa]
36. Thanos PK, Michaelides M, Gispert JD, et al. Kusiyanasiyana kumayankhidwa ndi zakudya zomwe zimakhudza mtundu wa makoswe wa kunenepa kwambiri: mu-vivo kufufuza kwa ubongo wa shuga m'magazi. Int J Obes (London) 2008; 32: 1171-1179. [Nkhani yaulere ya PMC] [Adasankhidwa]
37. Zink CF, Pagnoni G, Martin ME, Dhamala M, Berns GS. Kuyankha kwa anthu kumbuyo kwa zovuta zosafuna kubwezeretsa. J Neurosci. 2003; 23: 8092-8097. [Adasankhidwa]
38. Volkow ND, Wang GJ, Fowler JS, et al. Umboni wakuti methylphenidate umapangitsa kuti ntchito ya masamu ikwaniritsidwe mwa kuwonjezera dopamine mu ubongo waumunthu. Am J Psychiatry. 2004; 161: 1173-1180. [Adasankhidwa]
39. Volkow ND, Wang GJ, Telang F, et al. Dopamine imawonjezeka mu striatum sichimakakamiza anthu omwe amachitira nkhanza za cocaine pokhapokha atagwirizana ndi cocaine. Neuroimage. 2008; 39: 1266-1273. [Nkhani yaulere ya PMC] [Adasankhidwa]
40. Reed SC, Levin FR, Evans SM. Kusintha kwa chikhalidwe, chidziwitso komanso chilakolako chakumapeto kwa nthawi yomwe amayamba kumaliseche kwa amayi omwe ali ndi PMDD (matenda osokoneza bongo). 2008; 54: 185-193. [Nkhani yaulere ya PMC] [Adasankhidwa]