Kusintha kwa neural correlates ya mphoto ndi kukonzanso ntchito panthawi yopangidwira-makina fMRI mu kutchova njuga ndikudalira cacaine (2014)

. Zolemba zolemba; ilipo mu PMC 2015 Dec 1.

PMCID: PMC4266109

NIHMSID: NIHMS640482

Kudalirika

Background

Anthu omwe ali ndi vuto la kutchova njuga kapena omwe amagwiritsa ntchito mankhwala osokoneza bongo amawonetsa kusintha kofananako popereka mphoto pazoyeserera zovuta zomwe zimagawidwa mu mavuto osokoneza bongo. Kafukufuku wowonjezera pazosintha wamba komanso zapadera pakubwezeretsa mphoto muzochitika zokhudzana ndi zinthu komanso zosagwirizana ndi zinthu zomwe zimagwiritsidwa ntchito pazinthu zina zimatha kuzindikira zofunikira za neural zomwe zingayang'anitsidwe pakupanga chithandizo cha zovuta izi.

Njira

Kuti mufufuze mphotho yothandizirana pakubwera kwa juga ya pathological, slot-makina a fMRI ntchito idachitidwa ndi magulu atatu (omwe ali ndi njuga yama pathological, kudalira kocaini komanso kusokonezeka; N = 24 iliyonse) kudziwa momwe magulu awiri omwe amakhalira ndi zosokoneza (osakhala- zokhudzana ndi zinthu komanso zokhudzana ndi zinthu) zimawonetsa kufanana ndi zosiyana mokhudzana wina ndi mnzake komanso gulu lomwe silinaloledwere panthawi yolakalaka ndikutsata zotsatira zopambana, kutaya ndi 'kusowa'.

Results

Anthu omwe ali ndi njuga zam'magazi kapena kudalira cocaine poyerekeza ndi omwe alibe vuto lawonetseredwe kokondweretsedwa m'magawo a mesolimbic ndi malo otetezedwa, ochita masewera olimbitsa thupi omwe akuwonetsa chidwi chachikulu akuwonetsa kuyembekezera kopindulitsa komanso omwe amadalira cocaine akuwonetsa kuyembekezera kopanda pake. Palibe zitsanzo zamankhwala zomwe sizinawonetse kuyankha kwamankhwala kapena zamankhwala zomwe zimawonedwa motsatila zotsatira zakuphonya kwa anthu ochita nawo zofananira.

Mawuwo

Kusintha mukuyembekezerera kukonzekera kumatha kuzindikira kukondera kwa mphotho ndi zovuta-zatsoka. Zotsatira zodziwika komanso zapadera pa kutchova juga kwa pathological ndi kudalira kwa cocaine pokhudzana ndi mphotho yoyyembekezerera komanso kukonza kwakanthawi kotayika kumapereka lingaliro zomwe zimagawidwa pazinthu zomwe zimayang'aniridwa mwa kuchitapo kanthu kapena zamankhwala pamankhwala osokoneza bongo.

Keywords: kusuta, fMRI, njuga zamatenda, kudalira kwa cocaine, pafupi-kuphonya

1. DZIWANI

Omwe ali ndi vuto la kutchova njuga komanso kugwiritsa ntchito mankhwala osokoneza bongo (SUDs) amawonetsa kufanana kwa mitsempha, makamaka pakulimbitsa / mphotho / zolimbikitsira kufalitsa (; ). Makamaka, ntchito yolowerera yodutsa thupi ndi yodutsa thupi imawoneka ponseponse pazovuta ndipo imakhala yogwirizana ndi mitundu ya zizolowezi zomwe zimaphatikizana ndi zinthu zokhudzana ndi zinthu komanso zosagwirizana ndi zinthu (). Komabe, momwe kuchuluka kapena kukhazikika kwa kayendedwe ka mphotho kumawonedwera mu njuga zamatenda (PG; vuto la kutchova njuga ku DSM-5) ndi ma SUD adatsutsidwa, ndi deta yosonyeza kuti nkhaniyo (mwachitsanzo, kutchova juga kwa PG kapena zinthu za ma SUD) Itha kuwona ngati kutseguka kwawonekera kapena kopepuka; ; ). Kafukufuku wopitilira muzosinthidwa zomwe zimagawidwa mu PG ndi SUD zomwe zimaganizira zoterezi zingathandize kuzindikira zomwe zimayang'ana mu chitukuko cha chithandizo cha zovuta izi (; ; ).

Makina otchovera njuga yamagetsi (EGMs), omwe amatchedwa kuti makina a slot, ndi njira yotchera njuga yomwe ena amati ndi njuga yolowerera kwambiri (), ngakhale izi zidatsutsana). Zowoneka mwapadera za EGM zidatchulidwa kuti zitha kukhala zazowona m'malingaliro mwakuti zimatha kutsogolera kapena kulumikizana ndi zidziwitso zokhudzana ndi kutchova njuga ndikuthandizira kulimbikitsa kuphunzira ndi kutchova njuga kosalekeza (; ). Chimodzi mwazinthu zotere ndi zochitika za 'pafupi-padera', zochitika zokhudzana ndi kutchova njuga zomwe nthawi zambiri zimakumana ndi njuga ya EGM. Chofotokozedwa ngati zotayika zomwe zimawonedwa kuti ndi "pafupi" kuchita bwino (), zotsatira zapafupipafupi zimachitika pamene onse kupatula amodzi mwa ma reel akuwonetsa zofananira (mwachitsanzo, AAB). Ngakhale mtengo wamtengo wapatali wazotsatira zaposachedwa zikufanana ndi zotayika zina, zotsatira zakuphonya zimayenderana ndi kuchuluka kwachilengedwe.; ), komanso m'malo othandizira labotale, imatha kutalikitsa nthawi yayitali yamasewera mu nthawi zonse komanso nthawi zonse osewera (; ; ; ). Zitsanzo za momwe zotsatira zaposachedwa zingalimbikitsire kupitiriza kutchova juga zikuwonetsa kuti izi zitha kulimbikitsa zikhulupiriro zolakwika zokhudzana ndi kutchova njuga zokhudzana ndi luso ndi malingaliro onyenga (; ) ndikuthandizira makina olimbitsa thupi kudzera mu ntchito mu mphotho / kulimbitsa (; ).

Kafukufuku wam'mbuyomu pomwe otchova juga mwa apo ndi apo omwe amatenga nawo mbali pamasewera otsegula pamakina amapeza kuti kutumiza zotsatira zakuphonya pafupi ndi kutayika kwathunthu (mwachitsanzo, zotsatira za makina omwe kulibe chizindikiro) zomwe zimayenderana ndi kuchuluka mkati mwa mphotho / kulimbikitsa kufalitsa masisitini kuphatikiza ma cyral striatum, insula, ndi midbrain (; ). Momwemonso, anthu omwe ali ndi vuto lotchova juga adawonetseranso zochulukirapo mu zigawo zokhudzana ndi mphotho atapereka kufo yapafupi (,, kulimbikitsa zotsatira zakuphonya kumatha kulimbikitsa kupitiliza njuga kudzera pakulimbikitsidwa (ngakhale ndalama zitayika). Komabe, mwa anthu omwe ali ndi PG kapena SUDs, magulu omwe apezeka kuti awonetse kusintha kosinthika kwa masinthidwe a neural pakagwiridwe kake ka mphotho / kuwonongeka; ; ; ; ; ), sizikudziwika ngati ntchito za neural zomwe zimapangidwa ndikuchitika kwakaposachedwa zidzakhala zofanana kapena zosiyana m'magulu onse omwe ali ndi mankhwala osokoneza bongo.

Kafukufuku waposachedwa wa fMRI wa zokumana nazo zaposachedwa adayang'ana za kusiyana pakati pa chizindikiro cha neural chomwe chidayambitsidwa ndikupambana, kutaya ndi zotsatira zaposachedwa (; ; ). Komabe, mayankho okhudzana ndi neural amakhudzidwa ndimaphunziro oyeserera, ndipo chiyanjanochi chimawonetsedwa panthawi yoyembekezera (; ; ; ). PG ndi SUD zimalumikizana ndi kusiyana pakukonzekera kulandira mphotho (; ; ; ; ) ndipo motero kuvomerezedwa koyenera.

Poyeserera pakadali pano, fMRI idagwiritsidwa ntchito kufufuza ntchito za neural zogwirizana ndi kuyembekezera mphotho ndi zotsatira zaposachedwa pomwe anthu omwe ali ndi PG, kudalira kwa cocaine (CD; cocaine-use disorder in DSM-5) ndipo palibe vuto lomwe lidachita choyeseza 'atatu- wheel 'slot-Machine FMRI ntchito. Tidayesa kusiyana pakati pa gulu muzochitika zonse zaubongo zogwirizana ndi mitundu iwiri ya zotsatira zaposachedwa (zosayenerana komanso kufananizidwa pafupi ndi zomwe zaposedwa, onani Gawo 2.2.) Poyerekeza ndi zina zomwe zinatayika. Tinali ndi malingaliro opikisana. Zogwirizana ndi zitsanzo za njuga yokhudzana ndi juga komanso kupatsidwa mphoto kwa Hypersensitivity ku PG (; ; ), tidaganiza kuti anthu omwe ali ndi PG awonetse chiyembekezo chowonjezereka komanso zochitika zaposachedwa mu zochitika zamayendedwe am'maofesi komanso polankhula poyerekeza ndi CD komanso owerenga ofananirako (HC). Kapenanso, ngati mphotho / zolimbitsa / njira zolimbikitsira zidagawidwa pa PG ndi CD, tinali ndi lingaliro lopikisana kuti magulu onsewa awonetse chiyembekezo chodalirika komanso ntchito yaposachedwa poyenda mozungulira mozungulira komanso mozungulira kwa ochita nawo.

2. ZIDA NDI NJIRA

2.1. Ophunzira

Ophatikizira adaphatikiza anthu a 24 omwe ali ndi PG, 24 yokhala ndi CD, komanso 24 HC payokha (Gulu 1) atalemba m'deralo (New Haven, CT) dera. Onse omwe adachitapo kafukufuku adayesedwa kuti athe kupeza mayeso a DSM-IV pogwiritsa ntchito zoyankhulana zapachipatala (SCID; ()). Njira zochotsera zakuphatikizika ndi kukhalapo kapena mbiri ya vuto la psychotic kapena matenda azachipatala omwe angasokoneze kuthekera kotenga nawo mbali pazowunikira, kuwunikira kapena maprosesa a fMRI. Kuunika kwa poizoni wa zakodzo pazinthu zosavomerezeka kunkachitika panthawi yopanga sikani. Njira zonse zophunzirira zidavomerezedwa ndi Komiti Yofufuzira Anthu ya Yale. Ophunzira adapereka chidziwitso cholemba.

Gulu 1 

Makhalidwe otenga nawo mbali komanso magwiridwe antchito

2.2. Ntchito zoyeserera-za makina

Ophunzira adachita makina oyendetsa makompyuta, opanga ma-reel-slot, opangidwira fMRI (Chithunzi 1). Pamasewera aliwonse, ophatikizika adakankhira batani pomwe atatu onse atatu "adasinthika" adayamba kusintha mosinthasintha kudzera pazithunzithunzi zisanu ndi chimodzi za zipatso zilizonse 200ms kuti ayesere kuluka kwa makina oyendetsa. Kuti tikulitse chiyembekezo komanso zotsatira za zoyipa zaposachedwa ndi zotulukapo zina, ma reelwo adayima moteronso kuyambira kumanzere kupita kumanzere (). Colinearity ya zochitika idachepetsedwa pogwiritsa ntchito kulumikizana kwa ma spel spins ndi ma inter-test omwe amaperekedwa mwapadera pakati pa 2 ndi 10s, ndi avareji a 6s, pamasewera apakati pa 18s.

Chithunzi 1 

Makina oyeserera makina ojambula ndi mitundu yazotsatira.

Zotsatira zinaperekedwa mu amodzi mwa malamulo anayi a pseudorandom omwe anakonzedweratu (magulu onse), ndikupereka pafupifupi 17% (malinga ndi kuchuluka kosintha kwa 1: 6) kupambana (mwachitsanzo, AAA), motsatizana ndi kufupika (mwachitsanzo, AAB) ndi omwe sanali- zotsatizana (mwachitsanzo, WA, ABB). Zotsatira zakuwonongeka kwathunthu (mwachitsanzo, ABC) zidaperekedwa pa 50% yotsalira (kuchuluka kwa 1: 2). Ntchito yotsatsa makina idachitidwa mu sikani mwanjira ziwiri zotsatizana za 30 mumaseweredwe aliwonse. Ochita nawo maphunzirowa anapatsidwa chida cha $ 5 kuti ayambe gawo lirilonse, analipira $ 0.10 pa juga iliyonse kuti apeze mwayi wopeza $ 1, $ 2 kapena mphoto $ 3, ndipo adalipira ma winnings awo onse magawo onsewa (kuyambira $ 23- $ 25) kuphatikiza pamalipiro okhazikika ochita nawo.

Ntchito yotsatsa makina idapereka njira yanthawi yochitapo kanthu poyambitsa kutchova juga zotsatila zosiyana, zoyesedwa kuyambira nthawi yoyambira kuti ayambe kuyankha. Nthawi zakumayambiriro kwake zidazindikirika ndi mtundu wa zotsatira pogwiritsa ntchito kusintha kwa z-alama monga zidafotokozedwera kale (), kuchotsa 3.4% yonse ya deta isanawerengere omwe angatenge nawo. Ma ANOVA omwe amagwiritsidwa ntchito mobwerezabwereza adagwiritsidwa ntchito kuti awone kusiyana kwa nthawi yoyambira ndikuwongolera kuphwanya kosagwirizana pogwiritsa ntchito kuyerekezera kwa Greenhouse-Geisser.

2.3. kupeza kwa fMRI, kukonza zithunzi ndi ziwerengero

Chifukwa cha kukweza kwa zida, kupeza zithunzi kunachitika pamakina awiri a Nokia Trio 3T (Nokia AG, Erlangen, Germany), pafupifupi theka la gulu lililonse lomwe limayang'ana pa maginito onse limasunthidwa pamagetsi alionse. Njira zogulira zinthu ndi mndandanda zidagwiritsidwa ntchito pamagnesi onse. Zithunzi zogwira ntchito adazisonkhanitsa pogwiritsa ntchito chithunzi cha echo-planar gradient echo pulse sequence (nthawi yobwereza / nthawi ya echo: 1500 / 27ms, flip angle 60 °, gawo lakuwona: 22 x 22cm, 64 × 64mm in-ndege resolution , Makulidwe amagawo a 3.4mm, magawo a 3.4). Kuyendetsa kulikonse kumagwira ntchito kumaphatikizapo nthawi yopuma ya 5s yomwe idachotsedwa usanapangidwe pazithunzi.

Kusintha kwa malo kunachitika pogwiritsa ntchito SPM8 (Wellcome Functional Imaging Laboratory, London, UK). Ntchito zothandizira zinapangidwira payekhapayekha ndikuwunika mayendedwe amutu wopitilira voxel imodzi. Zoyeserera zojambulidwa pagawo lililonse zimagwiritsidwa ntchito popanga buku lachifaniziro lomwe linkagwiritsidwa ntchito pozikonza ngati Montreal Neurological Institute (MNI) malo oyimira. Magawo a kusintha kwa magawo a aliyense wogwiritsidwa ntchito adayikidwa pazofanana ndi magawo omwe amagwiritsidwa ntchito ngati mawonekedwe osinthika a spatial oyambitsa ma isometric voxel a 3 x 3 × 3mm. Zithunzi zoyendetsedwa pamakonzedwe ake zimakonzedwa ndi 6mm yodzaza ndi theka -utali-patali. Mwa okwanira 84 omwe adamaliza kupanga ma slot-Machine-task scanning, omwe anali nawo pa 12 sanatchulidwe chifukwa chowonjezera.

Kusanthula kwa magwiridwe antchito kunachitika pogwiritsa ntchito mitundu yofananira. Mitundu yoyambira (yochita nawo) imaphatikizapo ma regressor okhudzana ndi 13. Izi zikuphatikiza ndi regressor zokhudzana ndi zochitika (mwachitsanzo, nthawi = 0s) zotsogola kuti ayambitse kutchova njuga, mayankho, kuyimitsa koyamba, mayimidwe oyambiranso amakhala ndi zofananira kapena zosayerekezeka, ndi makonzedwe anayi azotsatira (omwe afotokozedwa pamwambapa) operekedwa kachitatu- reel kusiya. Kuphatikiza apo, ma regressor adaphatikizidwanso pakadutsa pakati pamaimidwe oyimira m'mbuyo (mwachitsanzo, ma 2-10s nthawi yoyambira isanachitike komanso pambuyo poyimitsa koyamba, ndikutsatira kuyimitsanso kwachiwiri pomwe chitsulo chomaliza chimangotuluka ndi zofananira kapena zosafananizidwa) pamiyala iwiri yoyambirira). Mtengo womwe ungakhale ndi mphotho yapadera unaphatikizidwanso monga regametric regressor pazogwiritsidwa ntchito poimitsa mtsogolo ndi zochitika zina. Pomaliza, magawo asanu ndi amodzi omwe amachitika chifukwa cha kukonza zithunzi anaphatikizidwa pamalowo. Zithunzi zosiyanidwa pakati pa zochitika zosangalatsa zidawerengedwa kwa aliyense mwa omwe adatenga nawo gawo ndipo adalowa mumitundu yotsatila yachiwiri kuti awone kusiyana pakati pa magulu.

Kusanthula kwachiwiri kwachitika chifukwa cha chidwi chilichonse pogwiritsa ntchito mapangidwe a 3-group (group), omwe anaphatikiza ma covariate kuti azitha kuwongolera zomwe zimapangitsa kuti matsenga azitha komanso azikhalidwe pazakugawana, zaka ndi IQ (Shipley Institute of Living Scale, SILS; ). Zochita zapakati pazokhudzana ndi zochitika zomwe zachitika kwa ophunzira onse adayesedwa pogwiritsa ntchito cholakwika cha banja laling'ono (FWE) cholumikizira () za PFWE<0.05 (masango ochulukirapo kuposa ma voxel ophatikiza 125) agwiritsidwa ntchito pamlingo wa voxel P<0.01. Poyang'ana zotsatira zazikulu zamagulu, masango ochepa omwe adapulumuka pakukonzekera kumeneku, motero gawo limodzi lofananira PFWE<0.05 (masango ochulukirapo kuposa ma voxels ophatikiza 189) adagwiritsidwa ntchito pazotsatira zamaubongo athunthu amasiyana kwamagulu pochepetsa milingo ya voxel P<0.02. Kuphatikiza apo, gawo limodzi lomwe silinakhazikitsidwe P<0.05 (masango ochulukirapo kuposa ma voxels opanga 44) adagwiritsidwa ntchito pamlingo wofanana wa voxel P<0.02 zotsatira kuti muwone kusiyanasiyana kwamphamvu kwamagulu pazochitika zachigawo.

Pafupifupi mayankho BONSE m'magulu odziwika adatengedwa kuti aliyense payekhapayekha awone kusiyana kwa magulu awiriawiri ndi gulu lonse. Zizindikiro zapafupipafupi za gulu lililonse zimayesedwanso kuti ziwone ngati magulu osiyanasiyana akugwiritsa ntchito mosagwirizana ndi zakumwa zina zaukali (Mowa Wodziwika Wodziwika ndi Vutoli, AUDIT; ) ndi kugwiritsa ntchito fodya (Kuyesa kwa Fagerstrom kwa Nicotine Dependence, FTND; ), komanso mutatha kupatula anthu anayi okhala ndi CD omwe adalemba mbiri yakale ya PG. Kusiyana kwakukulu kwamagulu kunapulumuka mayesowa owonjezera pa P<0.05. Kusanthula kwazomwe zinagwiritsidwa ntchito pofufuza ubale pakati pa mayankho a BOLD ndi zochitika zamankhwala zosakhudzidwa (Barratt Impulsivity Scale, BIS; ()), kukhumudwa (Beck Depression Inventory, BDI; ); zovuta-kutchova njuga (South Oaks Gging Screen, SOGS; ), malingaliro okhudzana ndi kutchova juga (Mulingo Wogwirizana Ndi Juga, GRCS; ) ndi matenda osakhalitsa; komabe, palibe mabungwe omwe adatsalira kusintha kosiyana kofananirana.

3. ZINTHU

3.1. Makhalidwe otenga nawo mbali komanso magwiridwe antchito

Makhalidwe a ophunzira amatengedwa mwachidule Gulu 1. Mwachidule, Ophunzira PG ndi HC sanasiyane pazaka kapena kuyerekezera IQ (t1,46's <1.6, P's> 0.10). Omwe atenga nawo mbali pa CD anali achikulire kuposa omwe anali nawo pa HC (t1,46= 3.80, P<0.001) ndi kuyerekezera kwapakati poyerekeza IQ kuposa onse PG (t1,46= 2.37, P= 0.022) ndi HC (t1,46= 4.24, P<0.001) magulu.

Ophunzira PG anena zavuta kwambiri-kutchova njuga kwa nthawi yayitali kuposa CD (t1,46= 8.24, P<0.001) ndi HC (t1,46= 16.40, P<0.001) ophunzira (Gulu 1). Ochita nawo PG adawonetsa zochitika zingapo monga kutchera njuga (mwachitsanzo, ma lottery, masewera a kasino, kubetchera pamasewera), kuchita masewera olimbitsa thupi pafupipafupi kwa 2.7 (SD = 1.9) zochitika zosiyanasiyana zotchovera njuga (Supplemental Table S11). Ophunzira anayi a PG adatinso kutchova juga kwavuta, pomwe atatu mwa anthuwa adatinso akutenga nawo mbali pa zochitika zambiri za njuga. Omwe atenga nawo mbali pa CD adanenapo za zovuta zomwe zimachitika pakubwera kwa JC (t1,46= 2.69, P= 0.01). Osewera ma CD anayi adanenapo za mbiri ya moyo (siyomwe ilipo) ya PG (SOGS = 5 kapena kuposa). Zambiri zomwe mabungwe omwe ali ndi vuto la kutchova njuga a HC amakumana nazo (SOGS kuyambira 0 mpaka 1) zimawonetsa kuzunzika kwakanthawi kochepa ndipo amagwirizana ndi anthu ambiri (). Otsatira a PG ndi CD sanasiyane pa nthawi yamavuto, kusuta fodya, kumwa mowa (t1,46's <1.7, P's> 0.1) kapena mafupipafupi azomwe zimachitika nthawi yayitali kukhumudwa kwakukulu (Gulu 1).

Nthawi zingapo zoyambitsa makina owotcha sizinasiyane pakati pamagulu (Gulu 1). Opezekapo, nthawi zoyambira zinasiyana ndi zotsatira zam'mbuyo (F1.7,120.0= 18.27, P<0.001; Chithunzi Chowonjezera S12,, ndi nthawi zoyambira kutsatira zotsatira zopambana kukhala zazikulu kuposa zotsatira zotsatira zina zonse (F1,69's> 17.0, P<0.001). Kupumulitsako kwakanthawi kothandizirako kunawonedwapo kale panthawi yotchovera njuga makina olowetsa (; Gulu 1). Nthawi zoyambira kutsatira zomwe sizinatsatidwe zidali mwachangu kuposa zotayika zonse pazomwe zidachitidwa (F1,69= 4.17, P= 0.04). Nthawi zoyambira zotsatila zofunikira zinasiyananso ndi zina zomwe sizinatchulidwe kapena kutaya kwathunthu mwa onse ochita nawo (F1,69's <0.7, P's> 0.4). Panalibe kusiyana kwamagulu nthawi yayitali kapena kufupikitsa nthawi yoyambira (F2,69's = 0.5, P's> 0.6).

3.2. Risiti yolandila

Ngakhale maumboni oyimbira amayang'ana kwambiri kuyembekezera komanso kukonza kwakanthawi, tinayang'ana zochitika zogwirizana ndi zotsatira zopambana kuti titsimikizire zofunikira kuti zitheke poyankha mayankho okhudzana ndi mphotho, ndipo tidasanthula kusiyana kwamagulu kuti tipeze zochitika zosinthidwa zogwirizana ndi kukonza mphotho. Kukonza zolandirira mphotho kunayesedwa pambuyo pakupereka zotsatira zopambana zokhudzana ndi ubongo wosasinthika (mwachitsanzo, AAA vs bas bas bas infosed). Magulu onse adawonetsa zochitika zachigawo m'magawo okhazikitsa zolandira mphotho () kuphatikizapo cyral striatum, midbrain, amygdala, insula, and ventromedial pre mbeleal, cingulate, and parietal cortices (Chithunzi 2; Gulu 2). Panalibe zotsatira zazikulu za gulu muma BOLD zigawo poyankha zotsatira zopambana, kaya mwaukadaulo konsekonse kapena kopanda masango osagwirizana.

Chithunzi 2 

Kulandila mphoto. Ubongo wathunthu, masangoPFWE<0.05) mayankho pazotsatira zopambana pamakina oyeserera (mwachitsanzo, AAA) mwa onse omwe akutenga nawo mbali
Gulu 2 

Pafupifupi ntchito zam'magazi zogwirizana ndi zochitika zamagetsi pamakina.

3.3. Chiyembekezo

Kusiyana kwamalingaliro mukuyembekeza kulandira mphotho kunayesedwa poyerekeza zochitika munthawi ya kulumikizana kwachitatu pomwe mawonekedwe ofananira kapena osafananitsidwa adawonetsedwa pama reels awiri oyambira (mwachitsanzo, AA? Vs AB?). Ndiye kuti, zochitika zomwe zimakhudzana ndikuyembekeza zotsatira zopindulitsa zimafanizidwa ndi ntchito yolumikizana ndi zoyembekezera zina zotayika. Kudutsa magulu onse, kuyembekezera mphotho yomwe ingachitike kunalumikizidwa ndi zochitika zowonjezereka mu striatum, insula, midbrain, anterior cingulate, apakati ndi apamwamba a kutsogolo kotengera komanso kotengera parietal kotsika (Chithunzi 3a; Gulu 2). Panali zotsatira zazikulu zamagulu m'magawo angapo (Chithunzi 3b; Gulu 3), makamaka potris striatum, midbrain, and insula lamanja. Kufufuzidwanso kwazomwe zikuyembekezeredwa payekhapayekha kudavumbulutsa kulumikizana kwa magulu m'magawo awa kuphatikiza gawo laling'ono la porral striatum (F2,64= 9.62, P<0.001), ndi PG yokhudzana ndi omwe akutenga nawo mbali HC akuwonetsa chiyembekezo chowonjezeka cha mphotho, ndipo CD yokhudzana ndi omwe akuchita nawo PG ndi HC akuwonetsa kuchepa kwachidziwikire (Chithunzi 3c). Mitundu yofananira yakuyembekeza-mphoto-chiyembekezo choyembekezeredwa mu PG, ndikuchepetsa kuyembekezera kutayika mu CD, adalipo kumadera a midbrain, insular and cortical.

Chithunzi 3 

Kukonzekereratu. Phunziro loyembekezeka ndi ubongo wonse mwa ophunzira onse (a) okonzedwa (PFWE<0.05) pakhomo pomwe mukuwonerera ma reel omaliza akutembenuka pomwe ma reel awiri oyamba akuwonetsa zizindikilo zofananira (mwachitsanzo, AA ?; kuwonetsa ...
Gulu 3 

Kusiyana kwa magulu ammagulu mu zochitika zaubongo zogwirizana ndi zochitika za makina owonetsa

3.4. Pafupifupi kuchepa kukonza

Kusiyana kwamagulu mumakina oyandikira kumayesedwa pogwiritsa ntchito magawo awiri. Choyamba, kufananizira pakati pa zotsatira zosakwaniritsidwa komanso zosowa mwatsatanetsatane (mwachitsanzo, WA / ABB vs ABC) zidapangidwa kuti ziyang'ane kusiyana kochita muzochitika pambuyo popereka zotsatira mu njuga zomwe zidataika kale pa reel-stop. Mwa kuwongolera kusiyana kulikonse pakumayembekezera kwa kutchova njuga (mwachitsanzo, zotsatira zonse ziwiri zimatayika zina), izi zimasiyanitsa zochitika zaubongo zomwe zimakhudzana ndi zolakwika zomwe sizikhala zotsatizana zomwe zikuphatikizidwa ngati 'pafupi' ndi zotsatira zopambana. Ponsepo pa anthu onse omwe sanachite nawo izi mosemphana ndi zomwe zidachitika adalumikizidwa ndi mayankho ochulukirapo mu zigawo zakutsogolo komanso zotsalira za cingate cortex komanso zigawo zotsika kwambiri za parietal (Chithunzi 4a; Gulu 2). Panali zotsatira zoyipa zamagulu pazinthu zosakhudzana ndi zochitika mu dorsomedial and ventromedial frontal cortex pamadongosolo osalondola (Chithunzi 4b; Gulu 3). Kufufuza kwazotayika zinaonetsa kulumikizana kwa magulu m'magawo awa kuphatikiza gawo laling'ono la ventromedial pre mapemaal cortex (F2,64= 8.72, P<0.001). HC yokhudzana ndi omwe adatenga nawo gawo pa PG adawonetsa mayankho olakwika pambuyo poti sanachite motsatana, pomwe CD yokhudzana ndi omwe akutenga nawo mbali HC adawonetsa mayankho olakwika pambuyo poti ataya zonse (Chithunzi 4c). Zachidziwikire, anthu omwe ali ndi PG sanawonetse mayankho osiyana ndi omwe amatsata osagwirizana ndi kuwonongeka kwathunthu kumadera oyambira.

Chithunzi 4 

Makina osayendera pafupi. Chiyerekezo cha ubongo wathunthu poyerekeza ndi zomwe zapezeka posagwirizana (mwachitsanzo, ABB / ABA) poyerekeza ndi zotayika zonse (mwachitsanzo, ABC) pa onse omwe akuchita nawo (a) pazokonzedwa-m'magulu (PFWE<0.05) pakhomo. Gulu ...

Chachiwiri, kusiyana pakukonzedwa kwapafupifupi kunayesedwa poyerekeza zochitika zotsatizana ndi zotsatira zoyipa zotsatizana ndi zochitika zotsalira zosasinthika kwachiwiri (mwachitsanzo, AAB vs AB). Kusiyanaku kumawongolera chidziwitso cha kutayika, ndipo motero kumalekanitsa zochitika zomwe zimakhudzana ndi kutaya kachitatu-kumbuyo kumangirizidwa ngati 'pafupi' ndi zotsatira zopambana kuposa kutaya kwakubwezeretsedwera kumbuyo kwachiwiri. Ophunzira nawo limodzi, zotsatira za kuphonya mosiyanasiyana zidalumikizidwa ndikuwonjezereka kwa zochitika mu mizimu yolumikizana kufikira pachipinda chotsatira (Chithunzi 5a; Gulu 2). Zotsatira zazikulu zagululo zidadziwika madera angapo pamalo opanda ubongo, osakwaniritsidwa, kuphatikiza kumanja kwa mkati, kumanzere kumanja, kumanzere kwa kutsogolo kwa girus ndi kumadera akumanja a parietala (Chithunzi 5b; Gulu 3). HC wokhudzana ndi PG ndi ochita nawo CD adawonetsera zochulukirapo poyankha zotsatira zakuphonya kudutsa masango onse omwe adadziwika kuphatikiza ndi porral striatum (Chithunzi 5c). Anthu omwe ali ndi PG ndi CD sanawonetse zotsatizana zotsatila zotsatizana poyerekeza ndi maimidwe oyimitsanso.

Chithunzi 5 

Makina ofanana posachedwa. Chiyerekezo chaubongo wathunthu poyerekeza ndi zomwe zaphonya (mwachitsanzo, AAB) poyerekeza ndi zachiwiri zosafanizidwa (mwachitsanzo, AB), kutaya zochitika kwa onse omwe akuchita nawo (a) pokonza masango (PFWE<0.05) pakhomo. Gulu ...

4. YAMBIRANI

Kafukufuku wapano adafufuza zomwe zidachitika pamasinthidwe a mphotho / kutayika mu PG ndi CD pofufuza zochitika zamaubongo nthawi yoganizira mphotho ndikutsatira zotsatira zaposachedwa pakugwira ntchito yoyeseza makina oyendetsa. Anthu omwe ali ndi PG omwe ali pachiwonetsero cha CD ndi HC omwe adawonetsera chiwonetsero chazinthu zomwe zikuwoneka bwino mu zigawo zomwe zimaphatikizidwa ndi cyral striatum, insula, ndi prelineal cortex, zogwirizana ndi zitsanzo zomwe kutchova juga kumachitika mu PG kutsegulira kwamayendedwe a mphotho; ; ). Anthu omwe ali ndi CD yokhudzana ndi PG ndi HC onse adawonetsa kuthekera kwakukulu pakuyembekezeredwa kwakutaya kumadera okhudzana ndi mphotho. Kusiyana kwamagulu pamafotokozedwe aposachedwa kunawonedwa m'madera ogwiririra ndi ovuta, pomwe magulu a PG ndi ma CD akuwonetsa momwe adakhazikitsidwira gawo lotsatira la porral striatum kuti azitsatira zotsatira za miss zomwe zikugwirizana ndi otenga nawo mbali. Zotsatira zakusiyana kwakuchulukirapo pakuwongolera zochitika zokhudzana ndi kutaya mu PG ndi CD zikuwonetsa kuti magwiridwe antchito a ubongo (kuphatikiza mawu am'kati mwa minyewa) omwe amagwiritsidwa ntchito pazokambirana amalandila pazowonjezerera komanso zosagwiritsidwa ntchito pazinthu zina. Kukula kwa zomwe izi zingagwirizane ndi chiopsezo chazovuta, kupita patsogolo ndi kuchira kumapangitsa kufufuza kwina.

4.1. Mphoto yomwe mukuyembekeza ndi kukonza kwakonzedwe

Zotsatira zolimba kwambiri phunziroli zidawonedwa zisanachitike zotsatira zamakina oyendetsa, pomwe PG ndi ma CD akuwonetsera zosinthika pamavomerezedwe, makamaka munthawi ya stralatum, insula, medical komanso infort frontor cortex poyerekeza ndi otenga nawo mbali a HC . Zotsatira zonse ziwiri zaumoyo zinawonetsa zochitika zomwe zikuthandizira makina omwe anali oyembekezeka kwambiri pakuyembekeza mphotho yoyenera poyerekeza ndi kutayika. Komabe, zogwirizana ndi ma hypotheses ndi kafukufuku wakale (), anthu omwe ali ndi PG adawonetsera zochulukirapo poyembekezera zotsatira zopambana. Poyerekeza, anthu omwe ali ndi CD adawonetsa kudzimva kwakukulu pakuyembekezera zotsatira zotayika. Zotsatirazi zikuwonetsa kuti ngakhale izi zomwe zimagwirizana ndi zinthu zomwe siziri zogwirizana ndi zinthu zomwe siziri zogwirizana ndi zinthu zomwe zimadziwika ndi kukomoka mu njira zomwe zimayang'anira mphoto, pali zovuta zina zokhudzana ndi valence (mphotho zotsutsana ndi kutaya) pamachitidwe okhudzana ndi kutchova juga.

Kuyembekezeredwa kwakanthawi mu zinthu zonse izi ndi zosakhudzana ndi zinthu zomwe zingagwiritsidwe ntchito zimakhudzana ndi zofunika kuchita pachipatala (mwachitsanzo, zolakalaka, zolimbikitsa kapena zoyendetsa). Mu PG, njira zoyendetsera zotsogola zitha kukhala ndi gawo linalake loti anthu adzalandire mphotho zokhudzana ndi kutchova juga, kuposa malipiro azachuma omwe amapezeka kunja kwa njuga (). Kukula kwa momwe kusinthaku kungathandizire kukhala ndi zizolowezi zovulaza njuga, kuphatikizapo kuthamangitsa njuga komanso nthawi yayitali, olowetsa mayeso amafunsa mwachangu.

Izi zikuwoneka bwino pakubwera kwa mphotho zokhudzana ndi kutchova njuga (mwachitsanzo, mphotho zoopsa komanso zosatsimikizika) sizikuwoneka ngati zowerengera CD. M'malo mwake, owerenga ma CD adawonetsa chidwi pakuyembekezera zotsatira zakawonongeka. Kuchepetsa kuyerekezera kwakutaya pakubwera kwa mphotho kwa ogwiritsa ntchito cocaine adanenedwapo kale pamalingaliro a njuga (). Kuchokera pamalingaliro amachitidwe othandizira, izi zimapangitsa njira zomwe zikuyembekezeredwa zokhudzana ndi olimbikitsanso omwe amagwiritsa ntchito zinthu zogwiritsidwa ntchito popanga zinthu atha kukhala olimbikitsidwa kwambiri ndi kusapezeka kwa mphoto zandalama (ndipo chifukwa chake kulibe mphoto yayikulu, yokhudzana ndi mankhwala) kuposa kuyembekezera zopeza ndalama. Zomwe apezazi zikuwonetseranso njira yomwe anthu omwe ali ndi CD angayambitse vuto la njuga ().

4.2. Kupita pompopompo ndi kutaya zotsatira

Tidasanthula ntchito zamaubongo zomwe zimagwirizanitsidwa ndi kukonzanso pafupi-pompo posankha magawo awiri a 'karibu-ness': makina owonetsera makina a kutayika kwina (mwachitsanzo, ABB / ABA vs ABC), ndi chidziwitso chakanthawi chotayika (mwachitsanzo. , AAB vs AB). Zogwirizana ndi kafukufuku wakale (; ), Ophunzira HC adawonetsera zochulukirapo mu zigawo zokhazikika komanso zowoneka bwino pambuyo popereka zotsatira zaposachedwa; komabe, izi zidawonedwa potsatira zotsatira zoyandikira pafupi zokha. Izi zikuwonetsa kufunikira kolimbikitsa zotsatira zakaphonya pafupi ndi anthu osagwiritsa ntchito pang'ono chabe kumangolekezera kwakanthawi kwakanthawi kochepa, m'malo modikira chizindikiro chokhacho. Mosiyana ndi ma hypotheses, kuyankha kuzotsatira zaposachedwa, zotsatizana kapena zosatsatizana, sizinakokomezere mwa omwe anali nawo pa PG, ndipo sikunawonedwe mwa owerenga CD.

Kuwonongeka pakuchita zinthu zokhudzana ndi kutchova juga kungakhale kofunikira kwambiri ku PG chifukwa vutoli limadziwika ndi kutchova juga mosasamala kanthu za zotsatirapo zoyipa zomwe zimachitika kawirikawiri komanso kuwonongeka kwakukulu. Omwe atenga nawo mbali pa CD kapena HC omwe akuwonetsedwa amakhala akuwunika mayankho aubongo nthawi zonse, kuwonetsa kuti zotsatira zaposachedwa ndi zotayika zitha kukhala zochepa ku PG. Zitsanzo zathu za anthu omwe ali ndi vuto la PG zikuyimira chiwerengero cha anthu omwe ali ndi mbiri yotchovera njuga zambiri motero angadziwe zambiri zakutha kwakanthawi komanso kutaya zotsatira zokhudzana ndi juga. Ngakhale vuto la PG silinalumikizidwe ndi mayankho a neural mu kafukufuku waposachedwa, ndizotheka kuti kuwonetsedwa mobwerezabwereza ndi zotsatira zaposachedwa ndi zotayika zimayambitsa / mayankho osamveka pakapita nthawi. Kafukufuku wowonjezereka amafunikira kuti amvetsetse bwino momwe magwiritsidwe antchito amawonongeka mu PG ndi momwe zizindikirazi zingalumikizidwe ndi kuchuluka kwa zochitika za njuga, kupanga zisankho zowonongeka, kuzindikira zokhudzana ndi njuga ndi machitidwe othamangitsa.

Zofanana ndi zomwe zimawonedwa panthawi yomwe akuyembekezeredwa, CD yokhudzana ndi omwe anali nawo pa HC adawonetsa molakwika pakuwonetsa mphotho / kulimbikitsa poyendetsa zotsatira zotsatidwa. Kafukufuku wam'mbuyo akuwonetsa kuti kusanthula kwachuma kwazomwe zimawonongeka kwambiri kuposa momwe zimapindulira zimasiyanitsa ndizomwe zimagwiritsidwa ntchito kale ndi omwe amagwiritsa ntchito cocaine (; ). Magulu onse ochita nawo gawo, kuwonongeka kwakanthawi sikunalumikizidwe ndi kuyerekezera kwapadera kwa IQ kapena zodandaula m'magawo odziwika, kuwonetsa kuti kusiyana kwamagulu komwe kumachitika pakubwera pazotsatira zina sikungakhale kwakukhudzana kwambiri ndi kuwonongeka kwazomwe tikufuna kudziwa kapena kusintha kwa malingaliro. Malipoti okhudzana ndi kukhumudwitsidwa ndi kukhumudwitsidwa poyankha zotsatira sizinatenge, ndipo anthu omwe ali ndi CD atha kupeza zotsatira zotayika zonse sizosangalatsa kuposa omwe ali ndi omwe ali ndi PG ndi HC. Ofanana ndi omwe atenga nawo mbali pa PG, ma CD omwe ali pachiwonetsero cha HC sanawonetse mayankho okokomeza kutsatira zotsatira zaposachedwa pakuwunika kwaposachedwa bongo. Kufanana pakati pa gulu la PG ndi ma CD kukuwonetsa njira yomwe imagwirira ntchito limodzi pakukonza zomwe zitha kutayika posaganizira zotsatira zakuphonya komanso kufufuza kwina.

4.3. Mphamvu ndi Zofooka

Komwe kufufuza kwam'mbuyomu kwa mphotho- komanso kuchepa kwakanthawi komwe kumachitika mwa anthu omwe ali ndi vuto lotchova juga kunagwiritsa ntchito kapangidwe ka zinthu mwa anthu omwe akunena zovuta zamiseche (SOGS 1 to 19) () ndi gawo lowolowa manja lotanthauzira zovuta zamtundu wa juga (SOGS> 2) (), kafukufuku waposachedwa adafufuza za anthu omwe ali ndi matenda a PG ndi ma CD malinga ndi njira yoyesera ya DSM-IV. Tidatinso mawonekedwe awiri azotsatira zopezekeratu (zotsatizana komanso zosatsata), ndikuwonetsa kuti mayankho olimbikitsa a neural omwe adawonedwa kale mu zitsanzo zosagwirizana ndi zomwe zimachitika pokhapokha potsatira zotsatira zaposachedwa kwambiri.

Ngakhale kukula kwa zitsanzo za anthu a 72 ndizochulukirapo kuposa zitsanzo zina zomwe zinafufuzidwa posachedwa, pali zitsanzo zazing'ono mkati mwa gulu lililonse lazidziwitso (komabe mu n = 24 pagulu lililonse), ndikuchepetsa kuti deta inasonkhanitsidwa pamagetsi awiri. Zogwirizana ndi kafukufuku wakale wam'mbuyomu fMRI, kusiyanasiyana komwe kumachitika ndi zotsatira zamagetsi zamagetsi kunali kochepa poyerekeza ndi kusiyana komwe kumayenderana ndi kusiyana kwa mitu yapakati (; ). Mwachitsanzo, ponena za kuyambitsa kutsata pambuyo pakupereka zotsatira zopambana mu Chithunzi 2, kusiyana kwapakati pamutu kumakhala chifukwa cha 31.4% ya kusiyana konse mkati mwamalemba (kutanthauza, pakati pa kuthamanga) kusanthula kwa 3.1%, komanso kusiyana pakati pa maginito ndi chifukwa cha kusiyana kwa ma 2.2%, ndi 63.4% ya kusiyanasiyana. Ziwerengero zakusiyana uku zikufanana ndi kafukufuku wapitawo ndipo zikusonyeza kuti kusiyana kulikonse pakati pa maginito sikunathandize kwenikweni pazotsatira zomwe zanenedwa.

Otsatira pa CD sanali odziwa zambiri pa msinkhu komanso IQ kwa otenga nawo mbali pa PG kapena HC; komabe, panalibe umboni kuti kusiyana kumeneku kunakhudza zopeza zazikulu. Makina opanga makina amatha kuchepetsa kuchuluka kwa zomwe zapezeka pakugulitsa ma EGM omwe nthawi zambiri amakhala ndi osewera othamanga ndikuphatikiza mawonekedwe ena ovuta. Poganizira za kuchepa kwa mphotho yomwe yachedwa kulandira mphotho kwa anthu omwe ali chidakwa (; ,, kutopa kwakutali pantchito yomwe ilipo kumafuna kafukufuku wowonjezera. Sitinatorere zokumana nazo za 'kuyandikana,' kukhumudwitsidwa, kapena kufuna kupitiliza kutchova juga panthawi yogwira ntchito kuti tithe kutengera zochitika zenizeni zenizeni padziko lonse lapansi. Kuphatikiza apo, palibe ubale pakati pa zochitika zaubongo ndi momwe ungakhalire, zovuta kuwina njuga, kapena kuzindikira zokhudzana ndi kutchova njuga (mukamayang'anira kusiyana kwamagulu m'magawo awa) zidawonedwa. Pomaliza, ngakhale zotsatira za kusanthula kwaubongo kwathunthu zimaperekedwa m'malo opangira magulu osakanikirana, njira zina monga dera la kusanthula lingakhale ndi chidwi ndi kusintha kwakanthawi kochepa, kusintha kwanuko mu siginthi ya BOLD ndikuzindikira kusiyana kwamagulu ena mu ntchito ya ubongo. Mayendedwe amtsogolo amathanso kuwunika mayendedwe omwe amapezeka pamaubwino onse ndi kuwononga ndalama () ndi momwe njirazi zimasinthidwira mwa anthu omwe ali ndi zizolowezi.

Zotsatira za 4.3

Anthu omwe ali ndi PG komanso anthu omwe ali ndi ma SUD amagawana masinthidwe amomwe amathandizira pakupanga mphotho / kuwonongeka. M'malo otchovera njuga, makina a PG ndi CD adawonetsera zosinthika zomwe zimayanjana ndi zomwe sizingachitike. Umboni wam'mbuyomu wam'mbuyo komanso kuchuluka kwa PG ndi CD zimapereka chiwopsezo chogawana ndi mavutowa. Kusintha kosiyanitsa pamalingaliro oyembekezera kulandira mphotho / kutayika kungawonetse kusinthika kochokera pazinthu zapakati pa PG ndi CD. Kafukufuku wopitiliza kufufuza njira zolimbikitsira mu PG ndi SUDs, komanso m'malo omwe ali pachiwopsezo, angakupatseni chidziwitso pakukula kwa njira zoyeserera zopewera komanso kuchitapo kanthu.

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Mfundo

  • Kutchova njuga komanso vuto la kugwiritsa ntchito mankhwala osokoneza bongo kumawonetsanso kusintha komwe kumabweretsa mphoto.
  • Timasanthula kuwongolera mphoto pogwiritsa ntchito fMRI panthawi yamagetsi yamagetsi yamagetsi.
  • Anthu omwe ali ndi vuto losokoneza bongo adawonetsa zochita zowonjezera.
  • Anthu omwe ali ndi njuga zamatenda a ziwonetsero sanawonetse zochita zonga mphotho.
  • Zomwe zimagawidwa ndi zina zapadera zokhudzana ndi mphotho zitha kugwiritsidwa ntchito pochiza anthu osokoneza bongo.

 

Zowonjezera Zowonjezera

Kuvomereza

Udindo Wachuma. Kufufuzaku kunathandizidwa ndi ena mwa zopereka za NIH kuchokera ku NIDA (R01 DA019039, P20 DA027844, K24 DA017899) ndi NIAAA (T32 AA015496), Connecticut State Department of Mental Health and Addictions Services, ku Connecticut Mental Health Center, mphatso yaku Unstricric Center. kasino wa Mohegan Sun, ndi Yale Guga Center of Research Excellence Award kulandira kuchokera ku National Center for Responsible Gaming. Mabungwe azandalama sanapereke ndemanga kapena ndemanga zomwe zalembedwa, ndipo zomwe zalembedwazo zikuwonetsa zopereka ndi malingaliro a alembowo ndipo sizikuwonetsa malingaliro a mabungwe othandizira.

Olembawa angafune kuvomereza thandizo laukadaulo loperekedwa ndi a Andrew Bourne, Scott Bullock, Matthew Lim, Karen A. Martin, Hedy Sarofin, Ruobing Sha, Monica Solorzano ndi Sarah W. Yip.

Mawu a M'munsi

☆Zowonjezera ingapezeke ndikupeza pulogalamu yapaintaneti pa http://dx.doi.org ndi kulowa Doi:…

1Zowonjezera ingapezeke ndikupeza pulogalamu yapaintaneti pa http://dx.doi.org ndi kulowa Doi:…

2Zowonjezera ingapezeke ndikupeza pulogalamu yapaintaneti pa http://dx.doi.org ndi kulowa Doi:…

Opereka. Mad. Worhunsky, Rogers ndi Potenza adaganizira ndipo adapanga kafukufukuyu. Olemba onse adathandizira pakuphunzira. Mad. Worhunsky, Mailson ndi Potenza adayang'anira omwe akutenga nawo mbali pophunzira ndi kusonkhanitsa deta. Mad. Worhunsky, Rogers ndi Potenza adathandizira ndikuwunikira kusanthula deta. Dr. Worhunsky ndiye adalemba zolemba zoyambirira ndi Drs. Malison, Rogers, ndi Potenza adatanthauziranso kutanthauzira kovuta, mayankho, ndikusintha pamanja. Olemba onse adavomereza zolemba zomaliza.

 

Mikangano Yachidwi. Olembawo akuti palibe kusokonezeka kwa chidwi ndi zomwe zalembedwa pamanja awa. Dr. Potenza alandila thandizo la ndalama kapena kulipila izi: Dr. Potenza adakambilana ndi kulangiza Boehringer Ingelheim, Ironwood, Lundbeck ndi iNSYS; adafunsira ndipo ali ndi zokonda zachuma ku Somaxon; walandila thandizo kuchokera ku Mohegan Sun Casino, National Center for Responsible Gaming, Forest Laboratories, Ortho-McNeil, Oy-Control / Biotie, Psyadon, Glaxo-SmithKline, National Institutes of Health and Veteran's Administration; adachita nawo kafukufuku, kutumiza makalata kapena kulumikizana ndi matelefoni zokhudzana ndi kusuta kwa mankhwala osokoneza bongo, zovuta zowongolera kapena mutu wina wazokhudzaumoyo; yafunsira ku maofesi amilandu ndi ofesi yaboma yotchinjiriza anthu pankhani zokhudzana ndi zovuta zoyeserera; imapereka chisamaliro chachipatala mu Connecticut Department of Mental Health and Addiction Services Vuto la Kutchova Njuga Dongosolo; yachita ntchito zowunikira za National Institutes of Health ndi mabungwe ena; ali ndi magawo azakonza alendo; wapereka zokambirana m'miyeso yayikulu, zochitika za CME ndi malo ena azachipatala kapena asayansi; ndipo yatulutsa mabuku kapena machaputala a buku kwa ofalitsa malembedwe amisala.

 

 

Chodzikanira cha Wosindikiza: Imeneyi ndi fayilo ya PDF ya zolembedwa zosavomerezeka zomwe zavomerezedwa kuti zifalitsidwe. Monga ntchito kwa makasitomala athu ife tikupereka malemba oyambirira a zolembedwazo. Mipukutuyi idzayambanso kujambula, kufotokozera, ndi kubwereza umboni umene umapezekapo musanatulutsidwe mawonekedwe ake omalizira. Chonde dziwani kuti panthawi yopanga zolakwika zingapezeke zomwe zingakhudze zomwe zili, komanso zotsutsana ndi malamulo zomwe zimagwiritsidwa ntchito pa magaziniyo.

 

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