Zojambula Zoganizira Ubongo mu Kutchova Njuga (2010)

Nkhaniyi yakhala wotchulidwa ndi nkhani zina mu PMC.

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Kudalirika

Nkhaniyi ikuwunikanso kafukufuku wapa neuroimaging wokhudza kutchova juga kwa pathological (PG). Chifukwa chofanana pakati pa kudalira zinthu ndi PG, Kafukufuku wa PG wagwiritsa ntchito njira zofanana ndi zomwe zimagwiritsidwa ntchito pofufuza zamisala yogwiritsa ntchito zinthu, kuyang'ana pa mphotho ndi kuzindikira kulanga, kubwezera cue, kufunsa, komanso kupanga zisankho. Kuwunikira uku kukuwonetsa kuti PG imagwirizanitsidwa nthawi zonse ndi kukhazikika kwa mesolimbic-prefrontal cortex ku mphotho zopanda pake, pomwe madera awa akuwonetsa kuyambitsa kuchititsa chidwi pokhudzana ndi zoyeserera zokhudzana ndi njuga pazovuta zowonetsedwa. Zochepa ndizodziwika, chifukwa chake kafukufuku wofunikira akufunika pakuwongolera ndi kupanga zisankho mu PG. Ndemanga iyi imaliza ndi kukambirana zokhudzana ndi zovuta komanso zatsopano zomwe zachitika pakufufuza kwa njuga ya ma neurobiological ndi ndemanga pazomwe akutanthauza pakuthandizira kwa PG.

Keywords: Kutchova njuga kwachikhalidwe, Zowonjezera, Neuroimaging, Neuropsychology

Introduction

Mchitidwe wa njuga ukakhala wokakamizidwa, umayamba kusokoneza maubwenzi, ndikuyipa machitidwe amtundu kapena ntchito, umanenedwa kuti pathological njuga (PG). Ngakhale PG imatchulidwa ngati vuto loteteza anthu ku DSM-IV, nthawi zambiri imawonedwa ngati chizolowezi chotsatira kapena chibadwa chifukwa cha majini, endophenotypic, komanso phenotypic imafanana ndi kudalira zinthu. Mwachitsanzo, njira zodziwira matenda a PG zimakhala ngati zodalira katundu, ndipo mavuto onsewa akuwonetsa mawonekedwe ofanana a comorbidity [1], chiwopsezo cha majini, ndi mayankho azithandizo zapadera za pharmacologic [2].

Kufufuza PG ngati njira yachizolowezi chowonekera kumawoneka bwino chifukwa kungawunikire momwe machitidwe owonera angapangire ndikusokoneza ntchito ya ubongo, popanda zotsutsana ndi zinthu za (neurotoxic). Komanso, kumvetsetsa bwino za neurobiological maziko a PG kungathandize kukonza mankhwalawa.

Poganizira kufanana pakati pa PG ndi kudalira kwa zinthu, kafukufuku wa PG wapanga kulingalira ndikugwiritsa ntchito magawo ofanana ndi omwe amagwiritsidwa ntchito pakufufuza zinthu zosokoneza bongo (SUD). Malingaliro amakono apanga njira zinayi zofunika kuzindikira zomwe zingakhale zofunikanso kwa PG. Yoyamba mwa izi ndi kulandira mphotho ndi kukonza zilango ndi ubale wake ndi chikhalidwe. Njira yachiwiri ndikuchulukirachulukira kwa njuga zomwe nthawi zambiri zimadzetsa chilimbikitso champhamvu kapena kukhumba njuga. Chachitatu ndi kusakhazikika chifukwa chakhala chikuwonetsedwa ngati njira yochepetsera kupezeka kwa PG komanso chifukwa cha zovuta za njuga. Njira yachinayi ndi yopanga zisankho zambiri chifukwa otchova njuga amapitiliza kutchova njuga poyang'anizana ndi zotsatira zoyipa.

Ngakhale maphunziro a neuropsychological mu PG adanenanso mosasinthasintha zochitika m'magawo awa [3, 4••], kukhazikitsa njira za neuroimaging kungoyambira kumene pofotokozera za neurobiology ya PG. Mukuwunikaku, zomwe zapezeka mu PG zimakambidwa pogwiritsa ntchito njira zinayi zomwe tafotokozanso ngati mfundo za bungwe.

Kutengera njira zakusaka zomwe zidagwiritsidwa ntchito pakuwunika kwaposachedwa kwa van Holst et al. [4••], yomwe inaphatikiza maphunziro a 10 neuroimaging omwe adasindikizidwa kuyambira 2005, tidasinthanso kusankhidwa uku ndi maphunziro atatu omwe adasindikizidwa kapena kutumizidwa kuyambira pomwe anawunikiranso (mwachitsanzo, 2009-2010). Kuphatikiza apo, timakambirana zovuta komanso zochitika zatsopano pazakafukufuku wa kutchova njuga ndikuwunikira tanthauzo lawo pochiza PG.

Mphotho ndi Chilango Kuzindikira

Kukhala ndi chikhalidwe chamachitidwe ndi njira yofunika yomwe imakhudzidwa ndi chitukuko cha kutchova juga chifukwa njuga imagwira ntchito molingana ndi njira yolimbikitsira [5]. Kusiyana kwamakhalidwe kumadalira mphotho zapadera ndi kumverera kwachilango, zomwe zimaphunziridwa mu PG nthawi zambiri ndi luso la neuroimaging.

Reuter et al. [6] anayerekezera mayankho ogwira ntchito a MRI (fMRI) a oksijeni wamagazi (BOLD) omwe amagwirizana ndi mphotho ndi zochitika zamalangizo mu 12 njirayi zam'mbuyomu komanso ma 12 otsogolera ozilamulira (NCs) pogwiritsa ntchito paradigm yolosera. Anatinso zochitika zotsika za cyral striatal and ventromedial prefrontal cortex (VMPFC) m'masewera otchova juga pomwe amalandila ndalama zodziyerekeza ndi zowongolera. Zotsatira zofananazi zidanenedwa mu kafukufuku wochitika ndi de Ruiter et al. [7•], yemwe adagwiritsa ntchito njira yosinthira mogwirizana ndikuwunika zotsatira za mphotho ndi chilango pa mikhalidwe yotsatira. Dongosolo loyimilira lomwe limakhudzana ndi phindu la ndalama lidawonetsa kuti otchovera njuga (n = 19) anali ndi kolowera kotsika koyambira koyenda pang'onopang'ono kuti apeze ndalama kuposa ma NCs (n  = 19). Kuphatikiza apo, kafukufukuyu adawonetsa chidwi chotsika ndi kutayika kwachuma mwa otchova njuga kuposa omwe ali pakati pa NCs. Pomwe Reuter et al. [6] adapeza kusiyana makamaka mumagawo oyambira am'kati mwa kortortal, de Ruiter ndi anzathu [7•] adanenanso zakusiyana makamaka madera oyendetsa ndege asanachitike. Pokambirana, de Ruiter et al. [7•] adawonetsa kuti kusowa kwa zopezeka za VMPFC mwina kudali chifukwa chakuchepa kwa chizindikiro komwe kumachitika chifukwa cha kutayika kwa minofu m'magawo awa.

Chifukwa chake, ochita kubera zam'magazi adapezeka kuti achepetsa ma cyral striatum ndi activral pre actival panthawi yopanda phindu komanso yolanga poyerekeza ndi ma NCs [6, 7•], kuyika yankho lolakwika pamitsempha yaubwino komanso kuwonongeka kwa otchova njuga. Zomwe zidanenedwa zachepetsa mphamvu yokhala ndi ntchito yothandizira podutsa striatum poyankha zochitika zopanda pake komanso zowalanga zomwe zimapezeka ndi Reuter et al. [6] ndizofanana ndi zomwe zapezeka mu SUDs [8, 9]. Kuphatikiza apo, malingaliro ambiri osokoneza bongo adanena kuti kudalira kwa zinthu kumadziwika ndi kuchepa kwa basal ganglia dopaminergic kufalitsa chitukuko cha machitidwe osokoneza bongo, ndikuti kugwiritsa ntchito mankhwala mobwerezabwereza kumapangitsa kutsitsidwa kwina kwa dopamine (DA) komwe kumakhudzana ndi kuchepa kwa chidwi chofuna kupatsa mphotho [10]. Mwakugwirizana ndi malingaliro awa, kwatsimikiziridwa kuti otchova njuga amatha kufunafuna zochitika zopindulitsa kuti alipeze dziko la anononic lomwe likufanana ndi la anthu odalira mankhwala [11]. Komabe, kuchokera pazomwe zilipo pa PG, sizikudziwikiratu ngati kuchepa kwa mphotho ndi chidziwitso cha chilango ndi zotsatira kapena kuyambitsa kwa njuga.

Reactivity

Kuphatikiza pa kusapeza bwino kwadongosolo, chizindikiro chodziwika bwino cha PG ndikulimba kwamphamvu kwa kutchova juga, komwe nthawi zambiri kumadzetsa kuyambiranso kwa njuga. Ngakhale kulakalaka komanso kusinthanso kwa cue kwaphunziridwa kwambiri ndi luso la neuroimaging mu SUDs, maphunziro ochepa okha mu PG adasindikizidwa.

Kafukufuku woyamba wa fMRI pazokonda kutchova juga adalembedwa mu 2003 [12]. Ndikuwona kanema wa njuga wopangidwa kuti apangitse anthu kutengeka ndi kutchova juga (ochita sewero omwe amayesa kukhudzidwa mtima [mwachitsanzo, achimwemwe, okwiya]) omwe akutsatiridwa ndi omwe akuwongolera kuyendetsa kupita pa kasino ndikumverera kwa juga), ochita nawo kafukufuku adapemphedwa akanikizire batani pomwe adakumana ndi zofuna kutchova juga. Munthawi zotere zomwe zikulakalaka zambiri, gulu la PG (n = 10) adawonetsa kuchepa pang'ono mu cingate gyrus, (orbito) frontal cortex, caudate, basal ganglia, ndi madera a thalamic poyerekeza ndi gulu la NC (n = 11). Posachedwa, olembawo adasanthulanso zomwe adapeza mu 2003 kuti adziwe ngati zoyeserera za otchova njuga (n = 10) ndi ogwiritsa ntchito mankhwala a cocaine (n = 9) adasiyana ndi omwe amatchova njuga (n = 11) ndi NCs (n = 6) osagwiritsa ntchito cocaine [13]. Kuwona zochitika zokhudzana ndi vuto laukadaulo poyerekeza ndi mawonekedwe osalowerera m'ndale zimapangitsa kuti ntchito zichuluke mkati mwakachetechete komanso dorsal anterior cingate cortex ndi ufulu otsika parietal lobule, ndikuchepa kochuluka kwa otchova njuga poyerekeza ndi otchova juga, komanso kuchuluka kwa ogwiritsa ntchito cocaine poyerekeza ndi ma NC . Zotsatira izi zikuwonetsa zotsatira zoyipa mwa anthu omwe ali ndi SUD poyerekeza ndi omwe ali ndi chizolowezi chomakonda.

Mosiyana ndi izi, kafukufuku wa fMRI cue reactivity wolemba ndi Crockford et al. [14] adapeza yankho lapamwamba la BOLD kumanja kwa dorsolateral prefrontal cortex (DLPFC), girus yodzaza kumaso, medical frontal gyrus, dera lamanzere la parahippocampal, ndikusiyaortortortort cortex poyankha njuga zomwe zimayambitsa kutchova njuga (n = 10) poyerekeza ndi NCs (n  = 11). Kuphatikiza apo, dorsal visual processing stream idayambitsidwa mwa otchova njuga pomwe amawonera makanema otchova juga, pomwe mtsinje wowonera wamkati udayambitsidwa pakuwongolera pomwe amawonera makanemawa. Olembawo adati zigawo zamaubongo zomwe zimayambitsidwa mwa otchova njuga poyerekeza ndi ma NC omwe amakhala ndi gawo lalikulu lomwe limalumikizidwa ndi netiweki ya DLPFC, yomwe imalumikizidwa ndi mayankho mikhalidwe.

Pakafukufuku waposachedwa, Goudriaan et al. [15] adawonetsa ubongo wofanananso ndi ubongo wogwira ntchito monga idanenedwa ndi Crockford et al. [14] mwa otchova njuga (n = 17) poyerekeza ndi NCs (n  = 17). Pakafukufuku wa fMRI, omwe adatenga nawo mbali adawona zithunzi za juga ndi zithunzi zosalowerera pamene akuyesedwa. Mukamawona zithunzi zamtundu wa juga poyerekeza ndi zithunzi zosalowerera ndale, maiko awiri apamwamba a parahippocampal gyrus, amygdala wamanja, ndi zochitika zolondola za DLPFC zidapezeka mwa otchova njuga omwe ali pafupi ndi ma NC. Kuphatikiza apo, ubale wabwino unapezedwa pakati pakulakalaka kutchova juga mutatha kusinkhasinkha omwe ali ndi vuto la kutchova juga ndi BOLD kuyambitsa kolowera koyambirira, kumanzere koyambirira, ndikusiya mutu wonyentchera mukamawona zithunzi za juga motsutsana ndi zithunzi zosalowerera ndale.

Pomaliza, mu kafukufuku waposachedwa wa njuga, ma 12 omwe amatchova njuga komanso ma 12 pafupipafupi (nonproblem) otchova juga adapemphedwa kusewera masewera a njuga yakuda pomwe ma fMRI scans amapezeka [16]. Masewerawa anali ndi mayesero omwe ali pachiwopsezo chachikulu chotayika komanso mayesero okhala ndi chiopsezo chochepa chotaya. Ovuta otchova njuga adawonetsa kuwonjezeka kwa zigawo zam'madzi zowoneka bwino, zotsogola komanso zodalirika pamayeso omwe ali pachiwopsezo chachikulu ndikuchepera kwa zigawo izi pamayeso omwe ali pachiwopsezo chochepa, pomwe njira yotsutsana idawonedwa mwa otchova njuga pafupipafupi. Miedl ndi anzawo [16] adanena kuti njira yakutsogolo-parietal yodziwika panthawi yoyeserera yoopsa poyerekeza ndi mayeso ochepera pamavuto otchova njuga imawonetsa kukumbukira komwe kumayambitsidwa ndi misewu yokhudzana ndi njuga. Adatinso kuti oopsa atha kukhala chizolowezi chomenya anthu otchova juga, pomwe otetezeka amatanthauza kuti "otetezeka" mwa omwe amakhala otchova juga nthawi zambiri. Chosangalatsa ndichakuti, otchova njuga amawonetsa zochitika zapamwamba mu malo achitetezo oyambira pansi ndi parietal poyerekeza ndi otchova njuga pafupipafupi pomwe akupambana poyerekeza ndi kutaya ndalama, network yomwe nthawi zambiri imalumikizana ndi ntchito yayikulu. Komabe, zochitika mu zigawo zam'manja pomwe zimapambana poyerekeza ndi kutaya ndalama zinali zofanana, zomwe ndizosemphana ndi zomwe zidapeza poyambirira pazokonza mphoto mu maphunziro a Reuter et al. [6] ndi de Ruiter et al. [7•]. Kusiyana kwa ma paradigms olemba ntchito kumatha kufotokozera zakusiyana pakati pa maphunzirowa: pomwe pagulu la anthu akuda a Miedl ndi anzawo [16], zotsatira zopambana zimayenera kuwerengedwa ndi omwe ali nawo pamalowo (kuwerengera zomwe zili pamakhadi) asanazindikire kuti wopambana kapena wotayika adakumana nazo, m'maphunziro a Reuter et al. [6] ndi de Ruiter et al. [7•], ma wins kapena zotayika adawonetsedwa pazenera ndipo motero adakumana nazo nthawi yomweyo. Chifukwa chake, mowerengera wolemba Miedl et al. [16], zovuta zowonjezera zolimbikitsira komanso zinthu zazidziwitso mu mphotho ndi kutaya zomwe zakumana nazo mwina zayambitsa kukonza kwa mphotho ndikuchepetsa mwayi wopeza kusiyana kwamagulu.

Chifukwa chake, kafukufuku wa cue reacaction ku PG afotokoza zotsatira zotsutsana. Tiyenera kudziwa, komabe, kuti zomwe Potenza et al. [12, 13] ndizovuta kutanthauzira chifukwa cha makanema ovuta omwe amagwiritsidwa ntchito kupangira kutchova juga. Kumbali inayi, ntchito yowonjezereka poyankha ma njuga omwe ali patsogolo pa cortex, malo a parahippocampal, ndi occipital cortex yomwe a Cockford et al. [14], Goudriaan et al. [15], ndi Miedl et al. [16] ndizofanana ndi zotsatira za parue reactivity paradigms m'maphunziro a SUD [17, 18]. Komabe, mosiyana ndi maphunziro a SUD, kulimbikira kwamphamvu pakulankhula kwa njuga kumangonenedwa mu imodzi ya maphunziro a njuga a cue reactivity [15]. Kafukufuku wamtsogolo akuyenera kuganizira mtundu wa zoyambitsa zomwe zimapangitsa chidwi kwambiri (monga, zithunzi ndi mafilimu). Chimodzi mwazomwe chingachepetse mphamvu kuti tipeze kusiyana kwachulukidwe mu maphunziro a PG mosiyana ndi maphunziro a SUD ndikuti njuga ikhoza kukhala ndi zochitika zamtundu wa njuga (mwachitsanzo, makina olowera, makina olowera, akavalo othamanga), Zina mwatsatanetsatane pazinthu zomwe zikulunjidwa (mwachitsanzo, cocaine, chamba) motero zimapangitsa ubongo kukhala wogwira ntchito mwa ambiri mwa ophunzira a SUD. Kusankha mitundu yakutchova juga pamayendedwe oyambitsanso ndikuchepetsa kuphatikizidwa kwa njira yina yotchovera juga kumatha kubweretsa kufanana kwatsatanetsatane ndi matenda a PG ndipo zotsatira zake zingayambitse kuyambitsa ubongo kwambiri poyankha machitidwe a PG.

Kuchita Mwamagetsi Mumatenda a Matenda

Kusunthika nthawi zambiri kumakhala kofanana ndi ma disinhibition, boma lomwe nthawi zambiri zowongolera zomwe zimapondereza zokha kapena mayankho obwezera osakwanira sangakwaniritse zomwe zikufunika [19]. Disinhibition alandila chidwi chachikulu pakufufuza kwazolowera m'zaka zaposachedwa chifukwa chazindikiridwa ngati mtundu wa endophenotype waanthu omwe ali pachiwopsezo cha SUD ndi PG [20]. Chinthu chinanso chomwe chimapangitsa chidwi chachikulu chomwe chimafotokozedwa pafupipafupi m'maphunziro a neurocognitive ndikuchepetsa: Kusankha mphoto zazing'ono m'malo mochedwetsa mphotho zazikulu. Gawoli liyankhidwa m'gawo lotsatira pankhani yopanga zisankho. Tsoka ilo, maphunziro a neuroimaging omwe amafufuza ma neural correlates of impulsivity / disinhibition ku PG ndi ochepa.

Phunziro lokhalo la FMRI lofalitsidwa mpaka pano, Potenza et al. [21] adagwiritsa ntchito ntchito ya mtundu wa Stroop kuyesa kulepheretsa kuzindikira - kutanthauza kuti, kuyankha kwamphamvu (kutulutsa kogwirizira; kuwerenga mawu) poyerekeza ndi kutchula mtundu womwe mawuwo adasindikizidwa (kusalimbikitsa) - mu 13 njuga zamatenda 11 NCs. Otchova njuga adawonetsa kutsegukira kumanzere pakati komanso kutsogolo kwa kutsogolo kwa gyri poyerekeza ndi gulu la NC pochita zolakwika ndi zotsutsana nazo.

Mwachidule, ngakhale maphunziro angapo a neuropsychological awonetsa kukhudzika kwapamwamba m'matupi amtundu wa [22, 23], pakadali pano, kafukufuku wokhazikika wokhazikika woletsa. Chifukwa chake, maphunziro owonjezera a neuroimaging ali ndi zofunikira, makamaka ndi kuchuluka kwakukulu ndikuwunika kwa mitundu yosiyanasiyana ya kuyimbira kwa otchovera njuga.

Kupanga Maganizo pa Kutchova Njuga

Ochita juga pamatenda ndi odwala a SUD amawonetsa njira yopangira chisankho yodziwidwa ndi zotsatira zoyipa zazitali kuti apeze chisangalalo kapena mpumulo ku mayiko osavomerezeka omwe ali ndi vuto lawo.24]. Njira zingapo zazidziwitso komanso zamaganizidwe zimatha kukhudza kupanga zisankho. Kuyika pachiwopsezo, kukumana ndi kuwunika pang'onopang'ono kupambana ndi kutayika, komanso kufunikira kwapezeka kuti kukuthandizira pakupanga zisankho zazikulu [25]. Kuphatikiza apo, zovuta zomwe amagwira - makamaka kusachedwa kusinthika kwachilengedwe, zalumikizidwa ndi kusokonezeka pakupanga zisankho [26].

Mu kafukufuku waposachedwa wokhudzana ndi zomwe zachitika (ERP) [27], ma neurophysiologic malumikizidwe opanga chisankho pamasewera akuda adayesedwa. Ovuta kutchova njuga makumi awiri ndi 21 NCs adasewera masewera osokoneza makompyuta ndipo adayenera kusankha ngati "amenya" kapena "kukhala" khadi kuti afike pafupi momwe angathere, koma osaposa nsonga za 21. Pamalo ovuta a 16 point, otchova juga adasankha nthawi zambiri kuposa ma NC kuti apitilizabe kusewera. Kuphatikiza apo, otchova njuga adawonetsa kukwera kwakukulu mu ERPs, choyendetsedwa ndi mawu mwa cholembera chakumanzere, kuposa ma NCs atachita bwino "kugunda" ku 16. Chifukwa chake, otchova juga adawonetsa chiwopsezo chowonjezereka komanso kuyankha mwamphamvu ku (infrequent) zotsatira zabwino pamachitidwe awa poyerekeza ndi ma NC. Chosangalatsa ndichakuti, palibe kusiyana kwa mitsempha yomwe imawonedwa pakati pa magulu panthawi yoyesedwa.

Mpaka pano, palibe maphunziro ena okondweretsa omwe amayang'ana njira zopangira chisankho mu otchova njuga omwe adalembedwa. Komabe, kafukufuku wina wa fMRI adagwiritsa ntchito mtundu wa Iowa Ginja Task (IGT) kuti afufuze za kupanga zisankho mu NCs (n = 16), anthu omwe amadalira mankhwala (SD; n = 20) ndi anthu omwe amadalira mankhwala osokoneza bongo omwe ali ndi mavuto a comorbid njuga (SDPG; n = 20) [28]. IGT idapangidwa kuti izitsatira posankha zochita zenizeni pamoyo [29]. Ophunzirawo anapatsidwa makadi anayi azithunzi pamakompyuta omwe amayenera kusankha khadi. Khadi lililonse lomwe likujambulidwa limatha kukhala ndi mphotho, koma nthawi zina, khadi limatha. Chifukwa chake, ma desiki ena amabweretsa zosowa pamapeto pake, ndipo ena amabweretsa phindu. Cholinga cha masewerawa chinali kupambana ndalama zambiri momwe zingathere. Ngakhale ma SDPG ankakonda kuchita bwino kuposa ma SDs ndi ma NCs, kusiyana kumeneku sikunali kofunikira kwambiri pamawonekedwe. Ma SD ndi SDPG pawokha adawonetsa ntchito zochepa za VMPFC poyerekeza ndi ma NCs pochita IGT. Kuphatikiza apo, gulu la SD lidawonetsa ntchito zowongolera kwambiri posankha zochita kuposa magulu a SDPG ndi NC. Olembawo adanenetsa kuti ntchito yayikulu kwambiri ya kotekisi yoyambirira mu SDPG poyerekeza ndi ma SD ikhoza kuwonetsa kutchova juga pamasewera a juga, chifukwa IGT imafanana ndi masewera a juga. Tsoka ilo, kafukufukuyu sanaphatikizepo gulu lochita juga la pathological popanda ma comorbid SUDs. Zotsatira izi zikuwonetsa kuti comorbid PG siimayenderana ndi kusokonekera kowonjezereka pakupanga zisankho mu SD, kupeza kosagwirizana ndi kafukufuku wamanjenje amtundu wa juga wa ma psychological, ma SUD, ndi ma NCs [23]. Zotsatira zoyipa izi zitha kufotokozedwa ndikuti Tanabe et al. [28] idagwiritsa ntchito mtundu wosinthidwa wa IGT womwe umaletsa kusankha motsatizana kuchokera pamapanga ena, potero kuwongolera zosankha zolondola m'magulu a SD pochotsa kufunikira kwa kusinthasintha kwazidziwikire komwe kungakhale kosalakwitsa kwa otchova njuga [26, 30].

Mawuwo

Kafukufuku wowunikira akuwonetsa kuti otchova juga wazakutsogolo akuwonetsa kuchepa kwa mayankho BOLD kuti asapindule ndikulanga zomwe zimapangitsa kuti azikhala ndi mwayi wochita zabwino komanso VMPFC [6, 7•]. Zachidziwikire, mayankho osamveka ngati awa sanawonedwe mu otchova juga omwe akwanitsa kusewera njuga yeniyeni panthawi yopambana ndi kutaya ndalama [16]. Kafukufuku atatu mwa anayi omwe amapanga chidwi ndi kubwerezabwereza kwa otchova njuga kwawoko adawonetsa kuwonjezereka kwa magwiridwe antchito ndikuyenda mokhudzana ndi njuga [14-16], pomwe zotsatira za kafukufuku wina, zomwe zidanenanso kuti kuchepa kwa ubongo mkati mwakukhumba paradigm, zidali zovuta kutanthauzira chifukwa cha zovuta zolimbikitsira zomwe zimagwiritsidwa ntchito [12, 13]. Njira zamaubongo zomwe zimayambiranso kutchera mu machitidwe otchova njuga sizidziwikiratu, ndipo chimodzimodzi ndi zomwe zikuwoneka kuti zikuwoneka kuti zikuwonetsa kuthekera ndi kudziwitsidwa kwa otchova njuga. Kuphatikiza apo, pomwe chiwerengero chachikulu cha maphunziro am'matumbo amtundu wa kusokonekera chawonetsa kuti otsegula m'matumbo amalephera m'njira zingapo zoletsa (mwachitsanzo, kusefa zidziwitso zopanda pake, kuletsa mayankho omwe akupitilizabe, ndikuchepetsa kuchepa [4••]), pakadali pano, kafukufuku m'modzi yekha wa fMRI pa kusokonezedwa ndi Stroop mu ochita katemera wa pathological adalembedwa [21]. Momwemonso, ngakhale maphunziro a mitsempha asonyeza kuti kupangitsa kusankha pakati pa otchova njuga [4••], yomwe imagwirizana ndi zomwe zapezeka muzodalira zinthu [31], Phunziro limodzi lokha la ERP lokhudza kupanga zisankho mu otchova njuga lilipo [27]. Kafukufuku womalizayu adawonetsa kuti otchova njuga amawonetsa chizolowezi chowopsa pa njuga kuposa ma NC, komanso kuti zisankho zopambana koma zowopsa zimayenderana ndi zochitika zambiri mu anterior cingulate cortex. Pomaliza, kafukufuku wa fMRI wofufuza zisankho pogwiritsa ntchito IGT adawonetsa zochitika zapamwamba kwambiri za kutsogolo kwa kotekisi pakuchita zisankho kwa anthu omwe amadalira mankhwala omwe ali ndi vuto la kutchova njuga.

Zotsatira zachipatala

Ngakhale kuchuluka kwa maphunziro apadera a neuroimaging opanga kutchova njuga akadali ocheperako, maphunziro a fMRI awonetsa zonse kuchepa mu njira za mesolimbic mumayendedwe azithunzithunzi ophatikizana ndi a cyral striatum, amygdala, ndi VMPFC pomwe otchova njuga akukumana ndi mphotho ndi kukonza, koma osati ayi. akakhala pa vuto la njuga. Izi magawo aubongo amaganiza kuti amatenga gawo lalikulu pakuphatikiza magwiridwe antchito ndi zotsatira za machitidwe mwa anthu athanzi. Chifukwa VMPFC idalira malongosoledwe a DA kuchokera ku ziwalo zina kuphatikiza chidziwitso, kusokonezeka kwa chipatala cha DA kumapangitsa kuti vuto la VMPFC lisamayende bwino m'miseche yakuthengo. Komabe, machitidwe ena ambiri a ma neurotransmitter amathanso kuchita nawo kanthu ndipo amatha kulumikizana pakukonzekera mayankho abwino ndi oyipa. Mwachitsanzo, ma opiate amadziwika kuti amawonjezera kutulutsidwa kwa DA mu njira za mphoto ya ubongo, ndipo opiate antagonists omwe amachepetsa kutulutsidwa kwa dopamine (mwachitsanzo, naltrexone ndi nalmefene), apezeka kuti amachepetsa kukhudzidwa kwa mphotho ndipo mwina akuwonjezera kukhudzidwa kwachilango [32]. Izi mwina ndizomwe zimapangitsa opiate antagonists kukhala othandiza kwambiri pochiza PG kuposa placebo [33]. Kugwira ntchito kwa opiate antagonists kukuwonetsa kuti kuloza dongosolo laubongo kungakhale njira yopindulitsa polimbana ndi zikhumbo ku PG, zofanana ndi maphunziro a chidakwa ndi kudalira kwa amphetamine [34]. Mofananamo, ma pharmacologic othandizira modulating glutamate ntchito (mwachitsanzo, N-acetylcysteine) okhala ndi zotsatira zodziwika pamakina amalipiro adathandizanso kuchepetsa kutchova njuga kwa otchova njuga [35].

Kuwongolera komanso kuwongolera mosavutikira kwayang'aniridwa ndi kusankha kwa serotonin reuptake inhibitors (SSRIs) mu zovuta zowongolera [36]. Chithandizo cha SSRI chakhala ndi zotulukapo zosakanikirana za otchova njuga [36]. Komabe, kukhalapo kapena kusakhalapo kwa vuto la comorbid nthawi zambiri kumatha kuumba kuyipa kwa mankhwala omwe amagwiritsidwa ntchito pochiza PG. Pomwe ma SSRIs monga fluvoxamine amatha kukhala othandizika pochiza omwe ali ndi vuto la kutaya mtima kapena vuto lodziwika bwino, sangakhale chithandizo chamankhwala ogwiritsira ntchito njuga omwe ali ndi comorbid chidwi-deficit / hyperacaction disorder. Mankhwala othandizira kupanga chisankho ndi ntchito yayikulu sakhazikika, mwina chifukwa chovuta kwa ntchitozi. Chifukwa chake, kuthekera kwakukulu kwa othandizira ozindikira monga modafinil kuyenera kukhala kofunikira m'maphunziro amtsogolo a PG [37]. Cactitive-behagenic mankhwala amathandizanso pochiza PG [38]. Kafukufuku wamtsogolo akuyenera kufotokozera ngati kuphatikiza kwa pharmacotherapy ndi chithandizo chamaganizidwe kungapangitse kuchuluka kwamachimo mu PG kuposa chithandizo chokha chokha.

Malangizo Otsogolera

Kufanana kwazomwe zikuchitika komanso kuyankha kothandizika kwa pharmacologic mu PG ndi SUD zikuwoneka kuti zikuwonetsa pachiwopsezo chodziwika bwino chamakhalidwe olowerera, ndipo mwina njira zamtundu wofananira zomwe zimayambira PG ndi SUD. Izi zofananira zimapereka lingaliro kuti lisinthe gulu la PG ngati vuto la kuwongolera kuwongolera ku gulu latsopano la PG ngati chizolowezi chamachitidwe mu DSM-V. Komabe, kafukufuku wowonjezereka akufunika kuti afotokozere za kufanana ndi kusiyana kwa mitsempha pakati pa SUDs ndi PG, ndipo maphunziro ofananitsa mwachindunji zovuta izi kwa wina ndi mnzake komanso ku magulu a NC akuwoneka kuti akufunika.

Komanso, zofanana ndi njira zomwe zimagwiritsidwa ntchito pofufuza za SUD, kafukufuku wamtsogolo wa PG wophatikiza zovuta zamapiritsi ndi njira zamakono zothandizirana zimathandizira pakuwunikira njira zamtundu wa PG. Mwachitsanzo, naltrexone ikhoza kugwiritsidwa ntchito kuwongolera opiate mu kafukufuku wa fMRI pa mphotho ndi kupweteka kwa kulangidwa, kuzindikira kwa cue, ndikukhumba.

Kugwiritsa ntchito njira za "state-of-the-art" monga ma "state-of-the-art" monga kufotokozera mobwerezabwereza (transTitive transcranial magnetic stimulation (rTMS)) kumathandizanso kufotokozera za mbali zosiyanasiyana zaubongo zomwe zimapezeka mu fMRI paradigms mu njuga. Mwachitsanzo, gawo lofunikira la DLPFC popewa kubwereranso m'mayendedwe linathandizidwa ndi kafukufuku wa rTMS owonetsa kuti kukondoweza kwambiri kwa DLPFC mwa omwe kale anali osuta kumayambitsa kuyambiranso kutsika ndikukhumba kusuta poyerekeza ndi omwe kale anali osuta omwe adalandira sham rTMS [39]. Kuphatikiza apo, ma RTMS a preortal cortex adawonetsedwa kuti asinthe ntchito yamtsogolo pamavuto osokoneza bongo [40], ngakhale zotsatira zazitali za kubwereranso sizinakhazikike bwino. Kugwiritsa ntchito mapangidwe otere kungatidziwitse kutengera momwe ubongo umagwirira ntchito zomwe zimakhudzidwa kwambiri ndi machitidwe osokoneza bongo ndipo pambuyo pake zingatipatse njira zatsopano zothandizira PG.

Njira ina yosangalatsa ndikugwiritsa ntchito neurofeedback mu PG. Pophunzitsa anthu kusintha magwiridwe antchito a ubongo, titha kuyesa kuti tidziwe momwe izi zimakhudzira njuga. Njira imeneyi yakhala ikugwiritsidwa kale ntchito pochiza vuto la chidwi-deficit / hyperacaction disorder [41] ndipo itha kukhala yothandiza mu PG. Mwachitsanzo, maphunziro awonetsa ntchito zofunikira kwambiri mu PG [6, 7•, 21], ndi maphunziro a neurofeedback atha kuyang'ana kwambiri masanjidwe oyang'anira kutsogola kwa elero. Mwa kuyang'ana ntchito yoyambirira isanakwane, ntchito zogwirira ntchito zimatha kuphunzitsidwa, zomwe zingapangitse kusintha kwazidziwitso, motero, kutha kuyambiranso kuyambanso pamene kulakalaka kuchitika.

Chosangalatsa ndichakuti, kafukufuku ochulukirachulukira akuti chitukuko cha PG pochiza matenda a Parkinson (PD). PD imadziwika ndi kutayika kwa ma dopaminergic neurons mu ma mesolimbic ndi mesocortical network, ndipo chithandizo ndi agonists a DA chikugwirizana ndi machitidwe omwe amafunafuna mphotho monga PG, kugula mokakamiza, ndi kudziwitsa [42]. Makhalidwe awa amawonetsera kusintha kwa ntchito zamagulu a dopaminergic. Kafukufuku wa Neuroimaging wanena kuti kuchepa kwa ntchito mu mesolimbic njira panthawi yopeza ndalama mu PD [43], zofanana ndi zomwe zapezedwa mu PG ndi zina zowonjezera. Kuphatikiza apo, kumanga kwa D2 / D3 kumanenedwa mu kafukufuku waposachedwa wa positron mu PD ndi comorbid PG poyerekeza ndi gulu lolamulira lomwe lili ndi PD yokha [44•]. Komanso, Eisenegger et al. [45•] adapeza kuti anthu athanzi omwe amanyamula chikuto chimodzi cha 7-kubwereza DRD4 DA receptor alile adawonetsa kuchuluka kwakuchuluka kwa juga pambuyo pa kukopa kwa dopaminergic ndi L-DOPA. Zotsatira izi zikuwonetsa kuti kusintha kwamtundu mu DRD4 jini imatha kudziwa kutchova juga kwa munthu chifukwa chogwiritsa ntchito mankhwala osokoneza bongo. Izi zowunikira zikugwirizana ndi vuto la kuchepa kwa mphotho [46]. Izi zimakhazikitsa boma losakhalitsa la hypodopaminergic lomwe limapereka anthu omwe ali pachiwopsezo cha kukondweretsedwa poyambitsa kuyendetsa galimoto yopeza zinthu zabwino kapena zizolowezi zowonjezera dopaminergic zochitika muubwino wamaubongo. Kafukufuku wamtsogolo wofufuza kukomoka kwa dopaminergic komanso kuyenderana ndi ma genetic mu PD odwala omwe alibe komanso PG atha kutithandizira kuti timvetsetse zomwe zimapangitsa kuti anthu azikhala ndi makhalidwe osokoneza bongo.

Kafukufuku wowonjezera amafunikanso chimodzimodzi kuti afufuze za chiyembekezo cha omwe ali otchova njuga kuti afotokozere za mphotho yovomerezeka ndi momwe ziliri zolanga, chifukwa izi zitha kukhala zokhudzana ndi kuyembekezera kopitilira muyeso m'malo mozindikira zenizeni za mphotho ndi kutayika. Mwachitsanzo, wotchova juga amatha kukondera poganiza kuti mwina apambana chifukwa choti ali pachiwonetsero cha juga kumadzetsa kubwereranso muubongo, kukulitsa kutulutsidwa kwa DA mu mesolimbic circ. Kutsatsa komweko chifukwa cha DA komwe kumathandizika kukhoza kuyambitsa kusokonezedwa kwa mayendedwe olondola chifukwa kusintha kwa phasic kwa DA ndikofunikira pakuwonetsa kalembedwe [47]. Chifukwa chake, mwakukonzanso kwa cue, ziyembekezo zimalembedwa molakwika ndipo zimatha kupitiliza kutchova juga ngakhale atayika kwambiri. Kuphatikiza apo, malingaliro abwinobwino akuyembekezeredwa ndi malingaliro opotoka, monga zikhulupiriro zolakwika zokhudzana ndi mwayi wopambana [48].

Masewera otchova njuga amaganiza kuti amalimbikitsa zinthu zina zomwe zingachititse chidaliro cha mwayi wopambana, mwakutero kulimbikitsa kutchova juga. Mu kafukufuku waposachedwa wa fMRI, Clark et al. [49••] adafufuza ziwiri mwa zinthu izi: kudziwongolera pawokha pamasewera ndi zochitika zaposachedwa kupambana mu NCs. Zochitika zopambana-pafupi ndiz zochitika zomwe zotsatira zosakwanira ndizovomerezeka kwa jackpot, monga momwe ma cherries awiri amawonetsedwa pamzere wolipira makina olipiritsa, ndipo chitumbuwa chomaliza chimatha malo amodzi pansipa kapena pamwamba pa mzere wolipira. Chosangalatsa ndichakuti, zotsatira zapafupifupi zidayambitsa mabwalo am'nyumba ndi m'malo ogwiritsira ntchito ndalama zomwe zimayankhanso ndalama. Kupeza kotereku kumatha kupereka chidziwitso munjira zomwe zimapangitsa kupitiliza njuga ngakhale lingaliro kuti munthu ataya ndalama pakapita nthawi. Kufufuza kwamtsogolo kuyenera kufotokozera zomwe zapezazi kuti zitithandizenso kumvetsetsa kusintha kwa kutchova juga kumavuto a kutchova juga ndi kuthekera kowonekera kwa mikhalidwe ina yamasewera.

Gawo lomaliza la chitukuko chamtsogolo ndi lingaliro la kukana kukula kwa zizolowezi zowonjezera. Blaszczynski ndi Nower [5] adalongosola gulu la otchova njuga popanda ma comorbidities komanso matenda ochepa. Gulu locheperako kwambiri la njuga linkaganiziridwanso kuti lingathe kuthana ndi mavuto awo otchova juga popanda kuchitapo kanthu pazithandizo zamankhwala. Kusanthula m'magulu osiyanasiyana aotchova njirayi kumatha kupereka chidziwitso mu ntchito za neuropsychological zomwe zimateteza motsutsana ndi vuto la kutchova juga komanso / kapena kutayikiranso. Zinthu zamaubongo zomwe zimakhudzidwa momveka bwino mu PG komanso zomwe zimatha kutsogolera nthawi ya PG ndi ntchito zoyendetsa, kuphatikizapo kupanga zisankho ndi kukakamizidwa; kukonzanso; kupatsa chidwi ndi malingaliro olakwika. Kuchokera pa kuwunikira kwa maphunziro a neuroimaging, zikuwonekeratu kuti ma neuronal maziko a ntchito izi sanadziwike mwatsatanetsatane. Komabe, ziwopsezo zam'mitsempha izi zimatha kuyambitsa maphunziro a PG kuphatikiza ndi zochitika zamaganizidwe, monga kukhumba kukhudzika ndi luso lothana ndi zovuta; zinthu zachilengedwe (mwachitsanzo, kufalikira kwa mwayi wa njuga); ndi majini. Momwe zinthu izi zimalumikizirana sizikudziwika kwenikweni. Kuzindikira izi ndi momwe zimathandizirana ndikofunikira kwambiri chifukwa kulowererapo kwa zoopsazi kungathe kutsogolera njira zopewera kupewa.

Kuvomereza

Ruth J. van Holst amathandizidwa ndi zopereka zomwe zimachokera ku Amsterdam Brain Imaging Platform. Dr. Goudriaan amathandizidwa ndi kafukufuku wofufuza watsopano (Veni pereka no. 91676084) kuchokera ku Netherlands Organisation for Health Research and Development.

Kuwulura Palibe zovuta zotsutsana zogwirizana ndi nkhaniyi.

Tsegulani Nkhaniyi ikugawidwa pansi pa malamulo a Creative Commons Attribution Osagulitsa Zamalonda omwe amalola kuti ntchito iliyonse yosagulitsa ntchito, kufalitsa, ndi kubalana mulimonsemo, pokhapokha olemba oyambirira ndi chitsimikizo akuyamikiridwa.

Zothandizira

Mapepala ofunika kwambiri, omwe asindikizidwa posachedwa, awonetsedwa monga: • Chofunikira •• Chofunika kwambiri

1. Petry NM, Stinson FS, Grant BF. Comorbidity ya DSM-IV pathological njuga ndi zovuta zina zamaganizidwe: zotsatira zochokera ku National Epidemiologic Survey pa Mowa ndi Zina Zogwirizana. J Clin Psychiatry. 2005; 66: 564-574. doi: 10.4088 / JCP.v66n0504. [Adasankhidwa] [Cross Ref]
2. Petry NM. Kusokonezeka kwa kutchova juga ndi kugwiritsa ntchito zinthu: zomwe zikuchitika komanso njira zamtsogolo. Ndine J Addict. 2007; 16: 1-9. doi: 10.1080 / 10550490601077668. [Adasankhidwa] [Cross Ref]
3. Goudriaan AE, Oosterlaan J, Beurs E, et al. Kutchova juga kwachidziwitso: kuwunikira kwathunthu zomwe zapezeka muzoyambira. Neurosci Biobehav Rev. 2004; 28: 123-141. doi: 10.1016 / j.neubiorev.2004.03.001. [Adasankhidwa] [Cross Ref]
4. Holst RJ, Brink W, Veltman DJ, Goudriaan AE. Chifukwa chake otchova juga akulephera kupambana: kuwunika kozindikira mozama komanso kopatsa chidwi pakupeza njuga. Neurosci Biobehav Rev. 2010; 34: 87-107. doi: 10.1016 / j.neubiorev.2009.07.007. [Adasankhidwa] [Cross Ref]
5. Blaszczynski A, Mpandamachokero L. Mtundu wa njira yamavuto ndi kutchova njuga kwa pathological. Kuledzera. 2002; 97: 487-499. doi: 10.1046 / j.1360-0443.2002.00015.x. [Adasankhidwa] [Cross Ref]
6. Reuter J, Raedler T, Rose M, et al. Kutchova njuga kwachikhalidwe kumalumikizidwa ndikuyambitsa kuchepa kwa machitidwe a mesolimbic mphotho. Nat Neurosci. 2005; 8: 147-148. doi: 10.1038 / nn1378. [Adasankhidwa] [Cross Ref]
7. Ruiter MB, Veltman DJ, Goudriaan AE, et al. Kupirira ndikuyankha komanso chidwi cham'mbuyo chazinthu cham'mbuyo kuti chipatse mphotho ndi kulanga omwe ali ndi vuto la kutchova juga. Neuropsychopharmacology. 2009; 34: 1027-1038. doi: 10.1038 / npp.2008.175. [Adasankhidwa] [Cross Ref]
8. Heinz A, Wrase J, Kahnt T, et al. Kutseguka kwa ubongo komwe kumachitika chifukwa cha kukondweretsedwa bwino kumalumikizidwa ndi chiopsezo chochepa cha kubwereranso ku zoledzeretsa zakumwa zoledzeretsa. Mowa Clin Exp Res. 2007; 31: 1138-1147. doi: 10.1111 / j.1530-0277.2007.00406.x. [Adasankhidwa] [Cross Ref]
9. Analemba J, Schlagenhauf F, Kienast T, et al. Kuwonongeka kwa mphotho kumayanjana ndi zakumwa zoledzeretsa zoledzera. Chikhulupiriro. 2007; 35: 787-794. doi: 10.1016 / j.neuroimage.2006.11.043. [Adasankhidwa] [Cross Ref]
10. Goldstein RZ, Volkow ND. Kugwiritsa ntchito mankhwala osokoneza bongo komanso maziko ake a neurobiological: umboni wa neuroimaging wokhudzana ndi khola lam'maso. Ndine J Psychiatry. 2002; 159: 1642-1652. doi: 10.1176 / appi.ajp.159.10.1642. [Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
11. Robinson TE, Berridge KC. Unikani. Chikhumbo chofuna kukopa zolimbikitsa izi: mavuto ena apano. Philos Trans R Soc Lond B Biol Sci. 2008; 363: 3137-3146. doi: 10.1098 / rstb.2008.0093. [Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
12. Potenza MN, Steinberg MA, Skudlarski P, et al. Kutchova juga kumathandizira kutchova njuga: kuphunzira maginidwe opatsa chidwi a maginito. Psychi Psychiatry. 2003; 60: 828-836. doi: 10.1001 / archpsyc.60.8.828. [Adasankhidwa] [Cross Ref]
13. Potenza MN. Unikani. The neurobiology ya pathological njuga komanso kugwiritsa ntchito mankhwala osokoneza bongo: kuwunikira mwachidule ndikupeza kwatsopano. Philos Trans R Soc Lond B Biol Sci. 2008; 363: 3181-3189. doi: 10.1098 / rstb.2008.0100. [Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
14. Crockford DN, Goodyear B, Edward J, et al. Cue-anayambitsa bongo muzochita za juga. Psychology ya Biol. 2005; 58: 787-795. doi: 10.1016 / j.biopsych.2005.04.037. [Adasankhidwa] [Cross Ref]
15. Goudriaan AE, de Ruiter MB, van den Brink W, et al: Maganizo oyendetsera ubongo omwe amaphatikizana ndi kuchulukitsa kwa cue ndikulakalaka otchova njuga ovuta, osuta kwambiri ndikuwongolera athanzi: kafukufuku wa fMRI. Adani a Biol 2010 (osindikiza). [Nkhani yaulere ya PMC] [Adasankhidwa]
16. Miedl SF, Fehr T, Meyer G, et al. Malangizo a Neurobiological a vuto la kutchova juga pamachitidwe abodza akuda malinga ndi fMRI. Psychiatry Res. 2010; 181: 165-173. doi: 10.1016 / j.pscychresns.2009.11.008. [Adasankhidwa] [Cross Ref]
17. George MS, Anton RF, Bloomer C, et al. Kachitidwe ka preortalal cortex ndi anterior thalamus pamawu omvera pokhudzana ndi zoledzeretsa zokhudzana ndi mowa. Psychi Psychiatry. 2001; 58: 345-352. doi: 10.1001 / archpsyc.58.4.345. [Adasankhidwa] [Cross Ref]
18. Analemba J, Grusser SM, Klein S, et al. Kukula kwa zokhudzana ndi zakumwa zoledzeretsa komanso kuyambitsa ubongo kuyambitsa zidakwa. Eur Psychiatry. 2002; 17: 287-291. doi: 10.1016 / S0924-9338 (02) 00676-4. [Adasankhidwa] [Cross Ref]
19. Aron AR. Maziko a neural of inhibition mu cactitive control. Wodziwa zakulera. 2007; 13: 214-228. doi: 10.1177 / 1073858407299288. [Adasankhidwa] [Cross Ref]
20. Verdejo-Garcia A, Lawrence AJ, Clark L. Impulsivity ngati chisonyezo chokhala pachiwopsezo cha zovuta zogwiritsa ntchito mankhwala osokoneza bongo: kuwunikira zomwe zapezedwa kuchokera ku kafukufuku yemwe ali pachiwopsezo chachikulu, otchova njuga ndi maphunziro amtundu wa majini. Neurosci Biobehav Rev. 2008; 32: 777-810. doi: 10.1016 / j.neubiorev.2007.11.003. [Adasankhidwa] [Cross Ref]
21. Potenza MN, Leung HC, Blumberg HP, et al. Kafukufuku wa FMRI Stroop wa ntchito ya ventromedial prefrontal cortical mu otchovera njuga. Ndine J Psychiatry. 2003; 160: 1990-1994. doi: 10.1176 / appi.ajp.160.11.1990. [Adasankhidwa] [Cross Ref]
22. Goudriaan AE, Oosterlaan J, Beurs E, et al. Ntchito za Neurocognitive mu njuga zamatenda: kuyerekezera ndi kudalira kwa mowa, Tourette syndrome ndi kuwongolera wamba. Kuledzera. 2006; 101: 534-547. doi: 10.1111 / j.1360-0443.2006.01380.x. [Adasankhidwa] [Cross Ref]
23. Petry NM. Kugwiritsa ntchito mankhwala osokoneza bongo, kutchova njuga zam'magazi, komanso kuchita zinthu mopupuluma. Kudwala Mowa. 2001; 63: 29-38. doi: 10.1016 / S0376-8716 (00) 00188-5. [Adasankhidwa] [Cross Ref]
24. Yechiam E, Busemeyer JR, Stout JC, et al. Kugwiritsa ntchito zitsanzo zazidziwitso kukhazikitsa maubwenzi apakati pa zovuta za neuropsychological ndi zoperewera za kusankha kwa anthu. Psychol Sci. 2005; 16: 973-978. doi: 10.1111 / j.1467-9280.2005.01646.x. [Adasankhidwa] [Cross Ref]
25. Krawczyk DC. Zopereka za preortal cortex ku maziko a neural pakupanga chisankho chaumunthu. Neurosci Biobehav Rev. 2002; 26: 631-664. doi: 10.1016 / S0149-7634 (02) 00021-0. [Adasankhidwa] [Cross Ref]
26. Clark L, Cools R, Robbins TW. The neuropsychology ya ventral prefrontal cortex: kusankha zochita komanso kuphunzira mobwerezabwereza. Kuzindikira Bongo. 2004; 55: 41-53. doi: 10.1016 / S0278-2626 (03) 00284-7. [Adasankhidwa] [Cross Ref]
27. Hewig J, Kretschmer N, Trippe RH, et al. Hypersensitivity kuti mupindule nawo otchova njuga. Psychology ya Biol. 2010; 67: 781-783. doi: 10.1016 / j.biopsych.2009.11.009. [Adasankhidwa] [Cross Ref]
28. Tanabe J, Thompson L, Claus E, et al. Kuchita koyambirira kwa kotekisi kumakhala kotsika poyendetsa njuga ndi ogwiritsa ntchito mankhwalawa panthawi yopanga chisankho. Hum Brain Mapa. 2007; 28: 1276-1286. doi: 10.1002 / hbm.20344. [Adasankhidwa] [Cross Ref]
29. Bechara A, Damasio H, Tranel D, et al. Kusankha mwanzeru musanadziwe njira yabwino. Sayansi. 1997; 275: 1293-1295. doi: 10.1126 / science.275.5304.1293. [Adasankhidwa] [Cross Ref]
30. Brand M, Kalbe E, Labudda K, et al. Kupanga zisankho mu zovuta kwa odwala omwe ali ndi juga ya pathological. Psychiatry Res. 2005; 133: 91-99. doi: 10.1016 / j.psychres.2004.10.003. [Adasankhidwa] [Cross Ref]
31. Dom G, Wilde B, Hulstijn W, et al. Zisankho zopanga zisankho kwa odwala omwe amadalira mowa wopanda kapena comorbid. Mowa Clin Exp Res. 2006; 30: 1670-1677. doi: 10.1111 / j.1530-0277.2006.00202.x. [Adasankhidwa] [Cross Ref]
32. Petrovic P, Pleger B, Seymour B, et al. : Kuletsa ntchito yapakati ya opiate modulates zotsatira za hedonic ndi yankho lakunja kwa kuyankha kumaphindu ndi kutayika. J Neurosci. 2008; 28: 10509-10516. doi: 10.1523 / JNEUROSCI.2807-08.2008. [Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
33. Grant JE, Kim SW, Hartman BK. Kafukufuku wachiwiri wakhungu, wolowera m'malo mwa opiate antagonist naltrexone pothana ndi zovuta zamatenda amisala. J Clin Psychiatry. 2008; 69: 783-789. doi: 10.4088 / JCP.v69n0511. [Adasankhidwa] [Cross Ref]
34. O'Brien CP. Mankhwala othandizira kupewetsa matenda obwezeretsanso: Magulu atsopano a mankhwalawa. Ndine J Psychiatry. 2005; 162: 1423-1431. doi: 10.1176 / appi.ajp.162.8.1423. [Adasankhidwa] [Cross Ref]
35. Grant JE, Kim SW, Odlaug BL. N-acetyl cysteine, wothandizirana ndi glutamate, pochotsa njuga zamatenda: kafukufuku woyendetsa. Psychology ya Biol. 2007; 62: 652-657. doi: 10.1016 / j.biopsych.2006.11.021. [Adasankhidwa] [Cross Ref]
36. Hollander E, Sood E, Pallanti S, et al. Pharmacological zochizira njuga. J Gambl Stud. 2005; 21: 99-110. doi: 10.1007 / s10899-004-1932-8. [Adasankhidwa] [Cross Ref]
37. Minzenberg MJ, Carter CS. Modafinil: kuwunika kochita zamitsempha ndi zotsatira zazidziwitso. Neuropsychopharmacology. 2008; 33: 1477-1502. doi: 10.1038 / sj.npp.1301534. [Adasankhidwa] [Cross Ref]
38. Petry NM, Ammerman Y, Bohl J, et al. Chithandizo chazidziwitso kwa otchovera njuga. J Funsani Clin Psychol. 2006; 74: 555-567. doi: 10.1037 / 0022-006X.74.3.555. [Adasankhidwa] [Cross Ref]
39. Amiaz R, Levy D, Vainiger D, et al. Kubwereza pafupipafupi kwambiri kwamagetsi kukondoweza pamtunda wa dorsolateral prefrontal cortex kumachepetsa kulakalaka kwa ndudu ndi kumwa. Kuledzera. 2009; 104: 653-660. doi: 10.1111 / j.1360-0443.2008.02448.x. [Adasankhidwa] [Cross Ref]
40. Barr MS, Fitzgerald PB, Farzan F, et al. Kukondoweza kwamphamvu ya transcranial kumvetsetsa pathophysiology ndi chithandizo cha zovuta zamagwiritsidwe ntchito ka zinthu. Kugwiritsa Ntchito Mankhwala Osokoneza bongo a Curr Rev. 2008; 1: 328-339. doi: 10.2174 / 1874473710801030328. [Adasankhidwa] [Cross Ref]
41. Arns M, Ridder S, Strehl U, et al. Kugwiritsa ntchito kwa mankhwalawa a neurofeedback mu ADHD: zotsatira za kusazindikira, kutsimikiza, ndi kusokoneza: kusanthula meta. Clin EEG Neurosci. 2009; 40: 180-189. [Adasankhidwa]
42. Torta DM, Castelli L. Mphotho panjira yamatenda a Parkinson: zovuta zazamankhwala. Psychiatry Clin Neurosci. 2008; 62: 203-213. doi: 10.1111 / j.1440-1819.2008.01756.x. [Adasankhidwa] [Cross Ref]
43. Thiel A, Hilker R, Kessler J, et al. Kukhazikitsa kwa basal ganglia malupu a idiopathic Parkinson matenda: kafukufuku wa PET. J Neural Transm. 2003; 110: 1289-1301. doi: 10.1007 / s00702-003-0041-7. [Adasankhidwa] [Cross Ref]
44. Amayendetsa TD, Miyasaki J, Zurowski M, et al. Kutulutsidwa kwa striatal dopamine kumasulidwa kwa odwala a Parkinsonia omwe ali ndi njuga yamatenda: kuphunzira [11C] raclopride PET. Ubongo. 2009; 132: 1376-1385. doi: 10.1093 / ubongo / awp054. [Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
45. Eisenegger C, Knoch D, Ebstein RP, et al. Dopamine receptor D4 polymorphism imalosera za zotsatira za L-DOPA pamakhalidwe a juga. Psychology ya Biol. 2010; 67: 702-706. doi: 10.1016 / j.biopsych.2009.09.021. [Adasankhidwa] [Cross Ref]
46. Blum K, Braverman ER, Holder JM, et al. Reward defence syndrome: chitsanzo cha biogenetic pakuzindikiritsa komanso kuchiza matenda okakamiza, osokoneza bongo komanso okakamiza. J Mankhwala Othandizira. 2000; 32 (Suppl): i-112. [Adasankhidwa]
47. Schultz W. Behaisheral dopamine signals. Amakonda Neurosci. 2007; 30: 203-210. doi: 10.1016 / j.tins.2007.03.007. [Adasankhidwa] [Cross Ref]
48. Toneatto T, Blitz-Miller T, Calderwood K, et al. Zosokoneza zokhudzana ndi kutchova juga. J Gambl Stud. 1997; 13: 253-266. doi: 10.1023 / A: 1024983300428. [Adasankhidwa] [Cross Ref]
49. Clark L, Lawrence AJ, Astley-Jones F, et al. Kutchova njuga pafupi-tulo kumakulitsa chidwi cholimbikitsa kutchova njuga ndi kulembanso ziwalo zokhudzana ndi ubongo. Neuron. 2009; 61: 481-490. doi: 10.1016 / j.neuron.2008.12.031. [Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]