Kukonzekera kwa Misonkho Kwa Anthu Omwe Ali Omwe Ali ndi Zopanda Kulimbana ndi Matenda Odwala (2013)

. Zolemba zolemba; ilipo mu PMC 2014 May 1.

Lofalitsidwa mu mawonekedwe omaliza omaliza monga:

PMCID: PMC3686098

NIHMSID: NIHMS466498

Kudalirika

Background

Gawo lofunika kwambiri pa kufufuza kwa kunenepa kumaphatikizapo kudziwa kuti njira zopezera mphotho zopanda thanzi zimakhala zosiyana kwambiri ndi magulu a anthu ochepa kwambiri.

Njira

Anthu okwana makumi asanu ndi anayi olemera kwambiri omwe akufunafuna chithandizo cha matenda oledzeretsa (BED) amafanizidwa ndi anthu ochepa omwe ali ndi 19 osakhala BED (X) ndi 19 (LC) pamene akuchita malipiro / ntchito yotaya ndalama zomwe zimayambitsa zida zowonongeka ndi zotsatira zapakati pazigawo zamagetsi zamagetsi kuganiza. Kusiyana kwa kuyambitsidwa kwa chigawo kudasanthuledwa m'magulu a BED, OB, ndi LC panthawi yopereka mphoto / kutayika, kuyembekezera, ndi chidziwitso.

Results

Pogwirizana ndi gulu la LC, gulu la OB linasonyeza kuchuluka kwa chiwopsezo chowopsa komanso chowopsa chachitetezo cha puloteni pamakanthawi oyembekezera. Mosiyana ndi gulu, gulu la BED lofanana ndi gulu la OB linawonetsa kuti ntchito yochepetsera ntchito yochepetsetsa yochepetsetsa yocheperako ikuchepa. Palibe kusiyana komwe kunachitika pakati pa magulu a BED ndi LC mu ventral striatum.

Mawuwo

Kusagwirizana kulipo pakati pa anthu ovuta kwambiri ponena za neural correlates ya mphoto / kutaya processing. Kusiyana kwa Neural m'magulu olekanitsa ndi kunenepa kumasonyeza kuti njira zingapo, zosiyana zingakhale zofunikira pakukweza njira zothandizira ndi zachithandizo za kunenepa kwambiri.

Keywords: Kudya matenda osokoneza bongo, fMRI, grey oyenda pansi, insula, kunenepa kwambiri, mphoto, ventral striatum

Machitidwe a mphoto ya Neural-kudzera mwa kukonza chilakolako, kulemera kwa malamulo, ndi kuyanjidwa kwa mankhwala-zakhala zikukhudzidwa ndi kunenepa kwambiri (-). Komabe, kufufuza kwa anthu ochulukirapo kwawonetsetsa kuti kulimbikitsana komanso kudzichepetsa kwapadera pamagulu okhudzana ndi chakudya (-). Zomwe zikuoneka ngati zosagwirizana zingagwirizane ndi kusiyana pakati pa anthu ovuta kwambiri (). Kunenepa kwambiri kumagwirizanitsidwa ndi mitundu yosiyana ya makhalidwe osokonezeka. Mwachitsanzo, magulu olemera kwambiri ndi matenda oledzera (BED) amasiyana ndi omwe ali ndi vuto la kunenepa kwambiri pazinthu zamaganizo ndi zamaganizo (). Mtsutso wamakono ulipo pokhudzana ndi kugwiritsidwa ntchito kwa "zakudya zowonjezera" kumakhalidwe abwino; ngakhale akatswiri ena akutsutsana ndi kusowa umboni (), ena amalingalira kuti zomangamanga zikuwoneka zogwirizana kwambiri ndi magulu ena ochepa, monga BED (,).

Zomwe zikuwoneka zosagwirizana zingasonyeze zolephera kuti zitha kusokoneza magawo okhudzana ndi kuyembekezera ndi processing processing (). Kupindula kwakukulu kumagwirizanitsa ndi ntchito ya ventral strira (VS), pomwe ntchito yowonjezereka ya cortex imagwiridwa ndi chidziwitso cha mphotho kapena zotsatira za mphoto processing (-). Maphunziro a zakudya omwe amachititsa kuti anthu asamangoganizira zofuna zawo, amapereka chidziwitso chowonjezereka ku VS, midbrain, amygdala, ndi thalamus pokhudzana ndi kugwiritsira ntchito mphoto kwa anthu abwino (,). Chakudya chogwiritsidwa ntchito chogwiritsidwa ntchito chokhudzana ndi ntchito yaikulu mu orbitofrontal cortex (OFC) ndi insula, ndi kuwonjezeka kwakumvera komwe kumachitika mwa anthu olemera kwambiri (,,). Pofuna kunenepa kwambiri, kusiyana kwakukulu-kotheka kumakhala kofunika kwambiri, chifukwa kudya kwa mphamvu kumawoneka kwakukulu chifukwa cha kuyembekezera mwachidwi m'malo mogwiritsira ntchito zakudya (). Kulimbitsa chiyembekezero cha chakudya cha mphotho chimayesedwa ngati chiwopsezo chodyera anthu olemera kwambiri (,).

Pakalipano, maphunziro opanga zidziwitso zosiyanitsa zoyembekezereka / kugwiritsidwa ntchito kosamalidwa ndi anthu osadya kudya amapereka zovuta zambiri. Omwe, okhudzana ndi wotsamira, anthu amasonyeza ntchito yowonjezereka ku insula ndi yocheperako gyrus (IFG) panthawi ya kuyembekezera chakudya (). Komabe, mu bulimia nervosa, matenda omwe amadziwika ndi kudya, kudya chakudya mwachidwi kumagwirizanitsa ndi kuchepa kwachitukuko, komanso anthu osadya.). Zochitika zowonongeka zimagwirizanitsidwa ndi mphoto yokonza ntchito (-,,), ndikusintha mayankho okhudzidwa akukhudzana ndi kunenepa kwambiri ndi kupindula; Komabe, ngakhale kuti kafukufuku wina akuwonetsa ntchito yochepetsetsa pambuyo poti chakudya chodetsa nkhaŵa chimakhudza anthu olemera kwambiri,,,,).

Mofananamo, chizoloŵezi chowongolera mabuku chimaphatikizapo zotsatira zooneka ngati zosamveka mu mphoto yokonza, ngakhale posiyanitsa ziyembekezero / zida zowonongeka. Mwachitsanzo, ntchito yowonongeka yakhala ikudziwika mu kudalira kocaine panthawi yoganizira (), pamene kuchepetsa kuyankha kwa VS mayankho akudziwika modalira mowa () komanso kutchova njuga (). Kusiyana kumeneku kungagwirizane ndi mavuto ena, malingaliro / kulingalira, kufunafuna mankhwala, kapena kufotokoza mwachidule kwa VS; Kusiyanitsa kwina kungagwirizane ndi mitundu yowonjezera (mwachitsanzo, zokhudzana ndi chiwerewere / zosagwirizana).

Ngakhale kuti kafukufuku wochuluka wokhudzana ndi matenda a ubongo amafufuza mphoto zomwe zimakhudzana ndi zakudya zomwe zimawathandiza kudya zakudya zambirimbiri, pali njala ya kafukufuku wotsalira zopanda chakudya m'kulemera kwambiri (,). Kumvetsetsa mphotho yowonjezereka yowonjezera kunenepa ndikofunika, chifukwa kusintha kwa magawo oyang'anira mphoto kungayimire kusokonezeka kwa kudya kosokonezeka. Kafukufuku wamakono amagwiritsira ntchito kujambula kwa maginito (fMRI) yogwiritsa ntchito maginito (fMRI) kuyesa kukonza mphoto ya ndalama pa kuyembekezera ndi kulandira mphoto / kuperewera kwa anthu ovuta kwambiri omwe alibe BED komanso gulu lopindulitsa (LC). Matenda odyera kudya amasiyana kwambiri ndi mitundu yambiri ya kunenepa kwambiri ndi matenda ovutika m'maganizo ambiri, maonekedwe a thupi, maganizo, ndi odwala matenda a maganizo (,,). Komabe, pakadali pano, kafukufuku wina wokhawokha omwe amachititsa kuti matenda a ubongo asinthe, asanthula zochitika zokhudzana ndi matendawa. Oyamba anawona kusiyana kwa okhudzidwa kwambiri a BED okhudzana ndi kulemera kwa anthu olemera kwambiri komanso osopa kwambiri popanda BED mu mayankho a zowonongeka zamtundu wa cortex (vmPFC) ku chakudya cha chakudya (). Posachedwapa, tawona kusiyana pakati pa ubongo pakati pa anthu ovuta kwambiri omwe alibe BED panthawi ya ntchito yolamulira, ndi gulu la BED lomwe likuwonetsa kuchepa kwa IFG, vmPFC, ndi insula ().

Kuti tifufuze kusiyana kwakukulu kwa anthu ovuta kwambiri omwe alibe ndi BED, tinagwiritsira ntchito ntchito yochepetsera ndalama (MIDT) yogwiritsira ntchito ndalama kuti tiganizire ntchito yoperekera /,,,,). Tinaganiza kuti gulu la BED lingasonyeze kuchepa kuyankha kwa VS panthawi yoyembekezera, pamene gulu la OB lingasonyeze ntchito yowonjezera VS yokhudzana ndi gulu la LC. Tinaganiza kuti, mogwirizana ndi maphunziro a fMRI mu bulimia (), pamapeto pake gulu la BED lingasonyeze kuchepa kwa vmPFC, insula, thalamus, ndi ntchito ya IFG yotsutsana ndi magulu omwe si a BED. Zofanana ndi magulu a BED ndi OB anayesedwa, opatsidwa mwayi wofanana pakati pa anthu olemera kwambiri m'magulu a neural correlates of processing processing.

Njira ndi Zipangizo

ophunzira

Ophunzirawa anali ndi akuluakulu a 57 a 19-64 a zaka (zaka zowonjezera: 38.9, 34 akazi), kumene 64.9% (n = 37) yodziwika ngati Caucasus, 29.0% (n = 17) yodziwika ngati African American, 5.3% (n = 3) yodziwika ngati Wachibadwidwe wa America, ndipo 1.8% (n = 1) yodziwika ngati Asia American; 5.3% (n = 3) adzizindikiritsa okha ngati Aspanya, ndipo 94.7% (n = 54) akudziwika ngati osakhala Achipanishi. Chidziwitso cha chiwerengero cha anthu chikupezeka Gulu 1 ndi Supplement 1. Zaka zakhala zikuphatikizidwa ngati magawo osiyana pakati pa kusiyana kwa gulu, kusiyana kwa gulu pa zaka komanso kuyang'anira zotsatira zokhudzana ndi zaka. Thupi la misala ya thupi (BMI) mu gulu la BED linachokera ku 30.1 mpaka 44.1. Gulu la OB linaphatikizapo anthu a 19 omwe ali ndi BMI kuyambira 30.4 mpaka 41.6 ndipo gulu la LC linali ndi anthu a 19 omwe ali ndi BMIs kuyambira 20.4 mpaka 24.6. Mabungwe a BED ndi OB sanali osiyana ndi BMI, ndipo monga momwe zinalili, maguluwa anali ndi BMIs apamwamba kuposa gulu la LC.

Gulu 1 

Dongosolo la Ophatikizapo Anthu ndi BMI

Gulu lophwanyidwa la BED linapangidwa ndi otsogolera odwala omwe ali ndi 19 omwe analembetsa mayeso oyesedwa kuti apeze mayeso a miyezi ya 4 ya sibutramine ndi thandizo la cognitivebehavioral, lokha kapena kuphatikiza. Potsatira ndondomeko yoyamba yomwe ikufotokozedwa apa, ophunzira adalandira fMRI protocol asanayambe mankhwala, omwe adaperekedwa kwa miyezi 4. Mndandanda wa DSM-5 wa BED (www.dsm5.org) anagwiritsidwa ntchito poonetsetsa kuti anthu onse omwe ali m'gulu la BED anakwaniritsa zoyenera, koma palibe aliyense m'magulu a OB kapena a LC omwe anali ndi mbiri kapena zochitika zamakono zodyera kudya kapena makhalidwe ena osadetsedwa.

Njira

MIDT

Otsatira onse anamaliza MIDT; ntchito ndi njira zoyesera zifotokozedwa kwina kulikonse (,) komanso mu njira za Supplement 1.

FMRI Kupeza ndi Kufufuza

Zithunzi zinapangidwa ndi Siemens TIM Trio 3T MRI machitidwe (Siemens, Malvern, Pennsylvania). Kupeza zithunzi ndi njira zowonongolera zili mu Supplement 1. Zithunzi zogwiritsidwa ntchito zinkakonzedweratu ndi SPM5 (Laboratory Functional Imaging Laboratory, London, UK), yovomerezeka ku template ya Montreal-Neurological-Institute ndipo idasinthidwa ndi 6-mm mmera wochuluka kwambiri. Chitsanzo cha msinkhu woyamba chinkachitidwa ndi kugwirana kwakukulu () kuti achepetse mphamvu ya maofesi apamwamba (). Kutsitsimula ndi magawo a mafayuluta apamwamba akuphatikizidwa ngati zina zowonjezera zosakhudzidwa. Phukusi lofufuza za Neuroelf (www.neuroelf.net) anagwiritsidwa ntchito poyesa zotsatira zowonongeka. Kukonzekera kwa kufanizirana kochuluka kunayendetsedwa ndi Monte-Carlo kufotokoza (mwachitsanzo, AlphaSim), pamodzi ndi njira zogwirizana ndi voxel ndi masango kuti ziwonongeke pakhomo la 5%. Kuti tiyang'ane zochitika za ubongo zomwe zimagwira ntchito, tinasiyanitsa: 1) kuyembekezera kuti phindu la ndalama likuyembekezeredwa ndi kuyembekezera kuti palibe zotsatira za ndalama (A1) ndi kuyembekezera magawo a A2 (A1Win ndi A2Win); 2) kuyembekezera kuwonongeka kwa ndalama kapena kuyembekezera kuti palibe ndalama zotsatila pa A1 ndi A2 phases (A1Loss ndi A2Loss, potsatira); 3) "Kugonjetsa" ndi "Kusalowerera" mayesero a zotsatira (OCWin); ndi 4) "Mavuto" ndi "Osalowerera" mayesero omaliza (OCLoss). Onani Supplement 1 kuti mudziwe zambiri ndi Balodis Et al. () kufotokoza dongosolo la mayesero. Pofufuza kusiyana pakati pa magulu, timafanizira ntchito mu BED, OB, ndi magulu a LC pa A1Win, A2Win, OCWin, A1Loss, A2Loss, ndi OCLoss mwanzeru t mayesero. Kuphatikiza pa zosiyana zonse za ubongo, kufufuza kwa 2 kuderalo kunkachitidwa. Kufufuza kumeneku kunayang'ana pa VS, ndi makonzedwe a meta-analytical of the circuit circuits recruited panthawi ya kuyerekezera ndalama (Chithunzi 2) () ndipo ikugwirizana kuphatikizapo nucleus accumbens (Chithunzi 3) ().

Chithunzi 2 

Chiwonetsero cha Coronal cha madera omwe amathandiza chidwi (ROIs) ndi makonzedwe olembedwa ndi Knutson ndi Greer (). (A) Mawanga a Buluu amasonyeza mbali ya 5-mm kuzungulira kumbali ya kumanzere [-12, 10, -2] ndi mbali [10, 8, 2]. (B ...
Chithunzi 3 

Maonekedwe a Coronal a ROI okhudzidwa ndi otsogolera omwe ali ndi makonzedwe okhudzana ndi mapindu opeza zomwe Breit anachita Et al. (). (A) Mawanga a Buluu amasonyeza 6 mm mmphepete mwazungulira striratum kumanzere (-12, 7, -10) ndi kumanja (12, 7, -10) ...

Results

Kusiyanitsa kwa A1 ndi khalidwe ndi zotsatira zabwino zowonjezera zimapezeka mu Supplement 1, kupatsidwa malire a malo ndi kufunikira kwa magawo a A2 ndi OC pofuna kusintha mankhwala osokoneza bongo. Kuphatikizanso apo, kuphatikiza zolemba zolemba zomwe zikugwiritsidwa ntchito m'magulu osiyanasiyana (mabungwe a BED + OB ophatikizidwa) amalembedwa Gulu la S2 mu Supplement 1. Kusiyana kwa magulu onse kumatchulidwa Gulu 1. Zotsatirazi, zotsatira zimasonyeza ndikufotokozera kusiyana kwa magulu okhudzana ndi malingaliro athu (mwachitsanzo, malo a fronto-striatal). Zotsatira za kafukufuku wa chigawo-cha-chidwi zikuwonetsedwa Zizindikiro 2 ndi And33.

Otsutsana ndi LC

Onani Chithunzi 1A ndi Gulu 2.

Chithunzi 1 

Kusiyana kwa magulu pa Zokakamiza za Ndalama Zowonongeka M'madera a ventral fronto-striatal mwa anthu ovuta kwambiri omwe ali ndi matenda oledzeretsa (BED) (n = 19), olemera kwambiri omwe alibe BED (OB) (n = 19), ndi kuyeretsa kowoneka (LC) (n = 19) gulu pa z = -17, ...
Gulu 2 

Kusiyana kwa Gulu Pa MIDT

A2Win

Panthawi ya A2Win, OB-LC imasiyanitsa zowonetseratu zachulukidwe zomwe zikuchitika mu IFG yolondola poyambira mpaka ku OFC komanso mu thalamus yomwe ikukwera mpaka ku caudate, VS (Chithunzi 2C, Chithunzi 3C), ndi hypothalamus.

A2Loss

Panthawi ya A2Loss, OB-LC imasiyanitsa ntchito yowonjezera ntchito ku IFG ya kumanzere ikukwera padera mpaka IFG, OFC, ndi vmPFC; Grey yowongoka bwino yomwe ikukwera kamodzi pakati pa gyrus yoyamba ndi IFG; ndipo kuchoka pakatikatikatikati chachitsipa nigra kupitilira pakati pamtima wofiira ndi penti ya lentiform.

OCWin

Pakati pa OCWin, OB-LC yotsutsana ikuwonetsa ntchito yocheperachepera ya gyrus yomwe ili kumanzere ikuyenderera mpaka kumbuyo pakati pa grey.

OCLoss

Pakati pa OCLoss, OB-LC zosiyana zimasonyeza ntchito yochepetsedwa mu gyrus yakum'mbuyo yoyenda ikupita ku gyrus yapakati ndi postcentral gyrus.

BED Kusiyana ndi LC

Onani Chithunzi 1B ndi Gulu 2.

A2Win

Pakati pa A2Win, BED-LC zosiyana zimasonyeza ntchito yowonjezereka yowonjezereka pofika pofika kumbuyo pakati pa gyrus, insula, ndi claustrum ndi kumanzere kugwiritsira gyrus akuwonjezera kuti akapeze (Chithunzi 2D). Ntchito yochepetsedwa inkawonetsedwa mu gryrus yapakati.

A2Loss

Panthawi ya A2Loss, BED-LC kusiyana kunasonyeza kuti ntchito yowonjezereka ikuwonjezeka mpaka IFG. Ntchito yochepetsedwa kwambiri inkaonekera pakati pa gyrus yomwe ili pakatikati yomwe ikuyendetsa gryrus.

OCWin

Pakati pa OCWin, BED-LC zosiyana zimasonyeza ntchito kuchepa ntchito mu yabwino yabwino gyrus galasi kufitikira insula, kulingalira gyrus, ndi pambuyo; Gulu la Greyrus, la Vune, lachangu, la greyrus, la cuneus, la gyrus lapamwamba / la pakati, ndi anthu amtundu; Zachiwiri zotsatizana zimakhala zikuyenda bwino mpaka kumapeto kwa IFG, zozizwitsa, ndi zowonongeka; gyrus yoyenda pakati; ndi VS yoyenera.

OCLoss

Pa OCLoss, kusiyana kwa BED-LC kunasonyeza kuti ntchito yocheperachepera yocheperako ikupita ku gyrus yolondola, yomwe imachokera kumbali ina, yomwe imachokera kumtunda, kumbuyo komweko, komanso kumbuyo komweko; Grey yowona bwino yowonjezereka yowonjezereka yopita ku gyrus yam'nyengo yam'mbuyo, grey, ndi insula; nsomba yochoka kumalo otsetsereka yomwe ikukwera kwa gyrus yoyambira ndi gyrus postcentral; Kuchokera kumbuyo komwe kumayambira kufalikira kwa gyrus, zigawo ziwiri, ndi cuneus; ndi midbrain yolondola yopita kwa thalamus ndi amtundu.

BED Kusiyana ndi OB

Onani Chithunzi 1C ndi Gulu 2.

A2Win

Pakati pa A2Win, kusiyana kwa BED-OB kunkawonetsa ntchito yocheperachepera m'katikati mwa lentiform yomwe ikukwera ma bilaterally kwa VS (Chithunzi 2B, Chithunzi 3B), hypothalamus, thalamus, caudate, putamen, ndi nucleus yofiira ya midbrain; mu gyrus yolondola yowonjezereka mwachindunji kwa gyrus yapakati / yopambana; sitima yolondola yomwe ikukwera kwa gyrus yapamwamba; ndi gyrus yomwe ili kumanzere ikuyandikira kwa IFG.

A2Loss

Pakati pa A2Loss, kusiyana kwa BED-OB kunasonyeza kuti ntchito yocheperapo imakhala yochepa m'katikati mwa mzere wofiira womwe umayambira ku Thalamus, VS limodzi, ndi substantia nigra; Gyrus ya m'kati mwake imayambira ku gyrus, kutuluka kwa gyrus, kutsika kochepa kwambiri, grey, ndi grey; nsomba yochoka kumtunda yomwe ikukwera kwa gyrus yapamwamba; Gyrus pakati pamtunda akuyang'ana kumbali yeniyeni yeniyeni yeniyeni; ndipo anasiya gyrus ya precentral ikufika ku gyrus poststral.

OCWin

Pakati pa OCWin, kusiyana kwa BED-OB kunasonyeza kuti ntchito yocheperapo imakhala yochepa kwambiri mu insula, phokoso la lentiform, para-hippocampal gyrus, cuneus, thalamus, ndi gyrus yapamwamba; Grey yowona bwino yomwe ikupita ku insula, greyrus, ndi IFG; Gyrus yoyendetsera bwino yomwe imayambira ku VS, yachiwiri, ndi zina zotere; ndipo anasiya caudate.

OCLoss

Pakati pa OCLoss, kusiyana kwa BED-OB kunasonyeza kuti palibe kusiyana kwa gulu m'madera a fronto-striatal (Gulu 1 kulemba kusiyana kwa gulu).

Kukambirana

Kusiyanitsa kwakukulu kunachitika pakati pa magulu a BED, OB, ndi LC m'njira zomwe zinatsimikizira pang'onopang'ono malingaliro athu: kusiyana kwakukulu kosiyana mu VS kunawonedwa panthawi ya kupambana kwa A2 mu BED-OB (koma osati BED-LC) ikusiyana; Kusiyana kwa BED-OB pazigawozi kunawonetsa kuchepetsa VS mayankho ku BED, pamene zosiyana za OB-LC zinkasonyeza kuyankha kwa VS ku OB. Zitsanzozi zimagwirizananso ndi kusiyana pakati pa gulu pakati pa midbrain, thalamus, ndi amygdala, kutanthauza kusagwirizana kwa anthu omwe amagwira ntchito molakwika komanso /,). Zotsatira za kukonza kwa ophunzira a BED zinagwirizanitsidwa ndi ntchito yochepetsetsa komanso yochepetsetsa yomwe ikugwirizana ndi magulu onse omwe si a BED. Zomwe zimaphatikizidwa ndi zamoyo zimayambitsidwa pano pokhudzana ndi kusiyana pakati pa gulu pa nthawi yoyembekezera komanso zotsatira za mphotho.

Chiyembekezo Choyembekezera

Mogwirizana ndi malingaliro athu, kukonzekera mwachidwi kunagwirizanitsidwa ndi ntchito yochepa ya VS ku BED kwa otsogolera OB. Mosiyana ndi zimenezi, OB-LC imasiyanitsa zomwe zinawunikira kuwonjezereka kwa anthu ogwira ntchito ku VS panthawi imeneyi m'mabungwe a OB. Kuwonjezera apo, kuwonetsera kwa BED-OB kosiyana kunkaonekera pakati pa midbrain, amygdala, ndi thalamus-madera omwe anawonekera kale pa chakudya chowoneka ngati chakudya chokhazikika pakadalirika pokhudzana ndi njira zopindulitsa (,). Zotsatira izi zimapereka tsatanetsatane wa zizindikiro zooneka ngati zosakondweretsa zokhudzana ndi zowonjezera zowonjezereka zowonongeka ndi kuwonetsa kufunikira kwa kusiyanitsa pakati pa kunenepa kwamtundu wambiri ndi kuyembekezera-zotsatira za mphotho. VS, makamaka nucleus accumbens, yakhala ikukhudzidwa kwambiri ndi mphoto yokonzedwanso, makamaka momwe ikukhudzira kusintha kwa chikhalidwe ndi zolinga-zoyendetsera khalidwe (-). Zomwe takumana nazo zowonjezera kuchepa kwa gulu la BED, potsata gulu la OB, kudutsa kwa A2 kupambana / kuperewera kwapadera kumagwirizana ndi zotsatira za MIDT mwa anthu ena omwe amadziwika ndi mavuto a kuthamanga, kuphatikizapo omwe ali ndi vuto la kutchova njuga, vuto la kusowa chidwi / kusokonezeka , kudalira mowa, ndi mbiri zabwino za banja zauchidakwa (,,,,). Zofanana ndi zovuta zokhudzana ndi kutchova njuga (), chiwerengero cha frontostriatal chonyenga mwa ophunzira a BED chinali chocheperapo gawo kusiyana ndi chiwonetsero. Ntchito yochepa ya fronto-epatalatal inachitika muziyembekezero zonse ndi zotsatira za zotsatira ndi kupambana ndi kuwonongeka kwa chikhalidwe (Chithunzi 1), kuwonetsera mu BED njira yowonjezera ya kuperewera kwa mphoto ndi kuperewera kwa fronto-striatal. Kuonjezera apo, kusiyana kwa BED-LC ndi BED-OB kunapanga kusiyana kofanana pakati pa zotsatira za MIDT, makamaka m'madera osasunthika ndi othawa. Komabe, kusiyana kochepa m'madera a fronto-striatal panthawi yoyembekezera mu BED-LC kusiyanitsa kumasonyeza kuti gulu la BED lingadziwike bwino kwambiri ndi kusintha kwa zotsatira zake, pamene gulu la OB limasiyanitsidwa chifukwa chokhala osakhudzidwa panthawi yomwe akuyembekezera.

Kufunika kwa Zizolowezi Zowonongeka

Kuwonongeka koyenera kugwiritsidwa ntchito kungayimire chithunzithunzi chofunikira pa chitukuko cha BED. "Mphoto yoperewera kwa mphoto" amachititsa kuti anthu omwe ali ndi malipiro ochepa omwe angapereke mphoto ya neurocircuitry amatha kudya chakudya kapena kukhala ndi zizolowezi zoledzeretsa pofuna kuyambitsa ntchito m'madera awa (). Mayankho okhudza midbrain omwe amachititsa chidwi ndi nigra m'zigawo zonse za A2W ndi A2L mu BED-OB ndi zosiyana ndi zochitika za OB-LC zimasonyeza kusintha kwa dopaminergic neural pathways. Ndipotu, VS, hypothalamus, thalamus, ndi prefrontal cortex zimayimira malo ambiri omwe amapezeka mu mesocorticolimbic dopamine dongosolo, mogwirizana ndi ntchito ya mphuno ya mpweya mu mphoto processing (,). Ngakhale kuti fMRI sitingathe kufotokozera kusintha kwa dopamine, mgwirizano wa fMRI ndi positron emission tomography amasonyeza ntchito yowonjezereka ya dopaminergic m'madera oyandikana ndi maboma amtundu wa anthu monga aliyense akuyembekeza ndi kulandira mphotho ya ndalama (). Kusintha kwa Dopaminergic kumapezeka mu BED (-), komanso kutaya kwa dopamine panthawi yopatsa chakudya kumagwirizana ndi kuchepetsa zakudya (). Ngakhale zili choncho, chitsanzo cha BED-hypo-active / OB-hyperactive dopaminergic chingawonongeke kayendedwe kake; kusintha kungagwirizane ndi magawo ena okhudza matenda, kotero kuti kusungunuka kwapachiyambi kwa dongosolo lino kungakhale kuchepetsedwa ndi kudya kwambiri mafuta kapena shuga.-). Mogwirizana ndi chiphunzitso cholimbikitsana, mphamvu ya hedonic (mwachitsanzo, "kukonda") ya kugwiritsira ntchito mopitirira malire ikhoza kuchepetsedwa pambuyo pa kugwiritsiridwa ntchito mowa, pamene mphamvu yolimbikitsa (mwachitsanzo, "kufuna") ikuwonjezeka. Phunziro laposachedwapa, ophunzira a BED adachepetsa kuganizira mwachidwi kofanana ndi gulu la OB kuti liwononge ndalama; ndizotheka kuti kuwonetsa zakudya zamtundu wa chakudya (mwachitsanzo, matenda osokoneza bongo) zingapangitse ntchito kuntaneti (fronto-striatal networks)).

Mosiyana ndi gulu la BED, zosiyana za gulu la OB-LC zinkapezeka m'zigawo zoyembekezera. Zomwe zapezeka mu gulu la OB (lifupi ndi LC) lawonjezeka la mediation / lateral OFC, striatum, amygdala, ndi hippocampal polojekiti yowonongeka ikugwirizana ndi machitidwe ofanana omwe amavomerezedwa pakuwonetsedwa kwa chakudya () ndikuthandizira lingaliro la kuyembekezera kwakukulu mu gulu lino.

Zojambula Zotsatira

Mogwirizana ndi malingaliro athu, otsogolera BED anasonyeza kuti ntchito yocheperako ikuchepa m'madera oyandikana ndi apolisi pamapeto pa zotsatira, potsata magulu awiri a OB ndi a LC. Zotsatirazi zimagwirizana ndi mauthenga omwe ali ndi bulimia, omwe anthu amawonetsa ntchito yochepetsetsa pakati pa gyrus, insula, ndi gyrus yoyenera pa nthawi yokadya (). Kuonjezerapo, vmPFC ndi insula pa atrophy zimagwirizanitsa ndi zokakamiza kudya zamaliseche (). Mu BED-OB ndi BED-LC ikusiyanitsa, kuchepa kwa chiwerengero cha zigawo zomwe zikuchitika ku dziko la IFG kumaonekera kwa ophunzira a BED. Chilumbachi chimakhala chimbudzi choyambirira koma chimakhudzidwa ndi chizindikiro cha homeostatic (-). Choncho, zotsatira zimathandizira lingaliro la kusintha kwapadera kwa mphoto ku BED. Kudziwa zokhudzana ndi kugonana pakati pa anthu kudzera m'magulu a insula, makamaka pakukonzekera zotsatira, kumatanthawuza kuti sangathe kuphatikizapo malipiro okhudzana ndi zomwe zilipo panopa. Kuonjezera apo, IFG imakhudzidwa ndi kugwirizana pakati pa kuganizira ndi kukakamiza kupanga nthawi yoletsa mphamvu (-); Choncho gulu lonse linachepetsa IFG ndi chizindikiro cha insula chikhoza kukhala ndi tanthauzo lakumva chizindikiro cha njala / satiety.

Mphamvu, Zolepheretsa, ndi Malangizo Atsogolomu

Kudziwa kwathu, phunziro la tsopano ndilo kufufuza koyamba kwa FMRI ku machitidwe opangira malipiro osiyanasiyana pambali ya mphotho ndi pakati pa magulu a kunenepa kwambiri, kuphatikizapo omwe ali ndi BED. Kugwiritsiridwa ntchito kwa pulodigm yokonzera mphotho m'magulu ovuta kwambiri kusonyeza khalidwe losiyana la kudya kumapereka chidziwitso chokwanira pa zamoyo zomwe zingakhalepo panthawi iliyonse. Mwa njira iyi, phunziro la tsopano likufotokozera ma correlates enieni okhudzana ndi kudya-khalidwe labwino kwa omwe akukhudzana ndi kunenepa kwambiri. Kuwonjezera apo, ntchito ya fMRI imapereka mpata wofufuza njira zogwiritsira ntchito zomwe zimagwirizanitsidwa ndi njira zowonjezera / zowonongeka zomwe zingalimbikitse miyambo yoyenera kudya.

Kuphunzira kwatsopano kuli kochepa ndi zifukwa zingapo. Chiwerengero chochepa cha amuna omwe ali m'gulu la BED chinapangitsa kuti asamvetse kusiyana kwa kusiyana pakati pa amuna ndi akazi; Kusamalira kudya mafunso opezeka m'magulu onse kungathenso kuzindikira zina zofunika kuzidya. Kafukufuku wammbuyo awonetsa zosiyana zokhudzana ndi kuchepa kwa BED mu zitsanzo zachipatala ndi zitsanzo za anthu (); Choncho, nkutheka kuti chikhalidwe chofuna chithandizo cha mankhwala chinasiyanitsa BED kuchokera m'magulu a OB ndi a LC. Zina mwazochitika zonse za ubongo sizipulumuka kukonzedwe kowonongeka kwa Bonferroni kwa mafanizidwe angapo okhudza magawo asanu ndi limodzi a MIDT ndi magulu atatu owonetsa.

Kafukufuku wamtsogolo angapitirize kufufuza zochitika zapakati pa BED ndi magulu a OB; mu zofukufuku zomwe zachitika panopa zomwe zikupezeka m'madera ena ochepa kwambiri omwe amapezeka m'mbuyo komanso m'mbuyo (Gulu la S2 mu Supplement 1). Kuonjezerapo, kusiyana kwakukulu pakati pa magulu olemera kwambiri ku BED-LC ndi OB-LC akusiyana. Madera a Concordant amapezeka makamaka panthawi zochitika komanso m'madera ena omwe amapezeka m'mbuyo, kuphatikizapo zochepetsetsa, zomwe zimachitika, komanso zochitika zapakati pazitsamba. Midzi izi zikuphatikizidwa mu kuyembekezera mphotho ndi kuyang'anira chidwi; Mwachitsanzo, kugwiritsidwa ntchito posakhalitsa kumaphatikizapo mbali yowonetsera kusinthika kwa chilengedwe, kuphatikizapo zotsatira za mphoto, ndi ntchito yowonjezera yomwe ikufanana ndi kusintha kwa maiko akunja kapena kusintha kwa chilengedwe (). Ntchito yowonongeka m'maderawa m'magulu ovuta kwambiri amasonyeza kusintha kwa chidwi ndi zolimbikitsa pazochitika pamapeto.

Zotsatira zamtsogolo ziyeneranso kufufuza kusiyana komwe kumakhudzana ndi chiwerewere, kusuta fodya, ndi khalidwe lofuna chithandizo kwa anthu ovuta kwambiri. Gawo lina lofunika lidzaphatikizapo kumvetsetsa momwe machitidwe a neural amayendera ndi njira za homeostatic (,) komanso kuwonetsanso izi ku nthawi / kunenepa kwa kunenepa kwambiri komanso / kapena BED. Maphunziro a kutalika kwapadera angaperekenso chithandizo cha msinkhu pakati pa kusintha kwa kulemera ndi kupindula kwa kayendedwe ka kayendedwe kake ndi kuzindikira zolemba zomwe zimakhudzana ndi chakudya chokwanira chisanafike chitukuko cha kunenepa kwambiri. Ngakhale kuti zochitika zamakono zatsopano sizingasankhe ngati kusiyana kumeneku ndi chifukwa kapena kunenepa kwambiri kapena kudya zakudya zowonjezera, komabe zimakhudzidwa kwambiri ndi chithandizo cha kunenepa kwambiri. Mankhwala othandiza kugwiritsira ntchito mankhwala a corticostriatal akhoza kuimira njira zofunikira zothandizira BED. Zowonjezereka kwambiri, zotsatirazi zikusonyeza kufunika kwa ndondomeko za umoyo pakukhazikitsa zakudya zamtengo wapatali zokhudzana ndi shuga zomwe zingasinthe kusamalitsa kwa omwe ali pa chiopsezo chodyera kudya ndi kunenepa kwambiri ().

Mawuwo

Phunziro la tsopano likuimira sitepe yofunikira pofufuza magulu a anthu omwe ali ndi kunenepa kwambiri komanso ubongo wokhudzana ndi zosagwiritsa ntchito mphoto. Zotsatira za kuchepetsedwa kwa cortico-bereatal processing kwa ophunzira a BED mwa chiyembekezero ndi zotsatira za mphoto zokhudzana ndi gulu la OB ndi LC zikusonyeza kuchepa kwa magulu okhudzana ndi malipiro okhudzidwa ndi kudzipatula. Deta imeneyi imaperekanso umboni wa kusintha kwa mapulogalamu oyendetsa mapulogalamu opatsirana pogwiritsa ntchito mphoto zolimbana ndi zovuta zina, monga kutchova njuga ndi kudalira mowa. Kuphatikizidwa kwa magulu awiri a BED ndi OB akuyimira chinthu chofunikira pakuwona momwe makhalidwe ovuta amathandizira kuti munthu akhale wochuluka kwambiri. Zonsezi, zomwe zapeza tsopano zikusonyeza kuti mbali zina zopangidwa ndi neural substrates zimakhala zopindulitsa pokonza kusiyanitsa zigawo zina za anthu olemera kwambiri. Deta iyi ikhoza kumvetsetsa pa zooneka zochititsa chidwi za ntchito ya VS mu kufufuza kwa kunenepa kwambiri.

 

Zowonjezera Zowonjezera

zowonjezera zakuthupi

Kuvomereza

Thandizo linaperekedwa ndi madalitso otsatirawa: Amaphunziro a National Institutes of Health (NIH) amapereka R01-DA019039, P20-DA027844, P50-AA012870, R01-DA020908, R01-AA016599, RXXUMUM-AA1, K017539-DA12, R00167 DK01, PL073542-DA1 , ndi 024859K2 DK24. Tikuvomereza Scott Bullock, Jessica Montoya, Naaila Panjwani, Monica Solorzano, Jocelyn Topf, Katie VanBuskirk, Rachel Barnes, ndi Robin Masheb kuti awathandize. Zomwe zili m'bukuli ndizo udindo wa olemba ndipo sizikuimira mawonedwe ovomerezeka a mabungwe onse opereka ndalama.

Dr. Potenza adafunsira ndikulangiza Boehringer Ingelheim; amafunsidwa ndipo ali ndi zokonda zachuma ku Somaxon; adalandira thandizo lofufuzira kuchokera ku NIH, Veterans Administration, Mohegan Sun Casino, National Center for Responsible Gaming ndi bungwe loyanjana ndi Institute for Research on Gambling Disorder, Forest Laboratories, Psyadon, Ortho-McNeil, Oy-Control / Biotie, ndi mankhwala a GlaxoSmithKline; adachita nawo kafukufuku, kutumiza, kapena kufunsa patelefoni zokhudzana ndi mankhwala osokoneza bongo, zovuta zowongolera, kapena mitu ina yazaumoyo; adafunsira maofesi azamalamulo ndi ofesi ya federoli pamilandu yokhudzana ndi zovuta zowongolera; imapereka chithandizo chamankhwala ku Connecticut department of Mental Health and Addiction Services Vuto la Kutchova Njuga; adachita ndemanga za NIH ndi mabungwe ena; amapatsidwa maphunziro apamwamba, kupitiliza zochitika zamankhwala, ndi malo ena azachipatala kapena asayansi; ndipo adapanga mabuku kapena mitu yamabuku ofalitsa amalemba azaumoyo.

Mawu a M'munsi

 

Olemba ena onse amanena kuti palibe zofuna zachuma kapena zovuta zotsutsana.

 

 

Zowonjezera zakutchulidwa m'nkhaniyi zapezeka pa intaneti http://dx.doi.org/10.1016/j.biopsych.2013.01.014.

 

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