Chizoloŵezi. 2012 Oct; 107 (10): 1726-34. onetsani: 10.1111 / j.1360-0443.2011.03546.x. Epub 2011 Oct 10.
el-guebaly n1, Mudry T, Zohar J, Tavares H, Potenza MN.
Kudalirika
ZOYENERA:
Kufotokozera, pa nkhani ya DSM-V, momwe kuganizira zachinyengo ndi kukakamizidwa kumayambira pakuganizira za kutchova njuga (PG).
ZITSANZO:
Kufufuza zolemba zovomerezeka za umboni pazokhazikitsidwa zowerengedweratu za PG monga mankhwala osokoneza bongo.
ZOKHUDZA:
Zomwe zapezazi zikuphatikiza: (i) mitundu yazowonetsa yomwe ikuwonetsa kusunthika kochokera pakukakamizidwa kupita kukakamizidwa komwe kumakhudzana ndi matenda obwerera m'mbuyo komanso kuwonongeka kwa dichotomy ya ego-syntonic / ego-dystonic; (ii) ma neurotransmitter wamba (dopamine, serotonin) zopereka ku PG ndi zovuta zogwiritsa ntchito mankhwala (SUDs); (iii) chithandizo chothandizira kupatsirana kwa ma neurocircuitry pakati pa 'machitidwe' ndi zosokoneza bongo komanso kusiyana pakati pa matenda osokoneza bongo (OCD), zovuta zowongolera (ICDs) ndi SUDs; (iv) zofufuza zamtundu zomwe zimagwirizana kwambiri ndi mapangidwe a endophenotypic monga kukakamizidwa komanso kutengeka mtima kuposa zovuta zamisala; (v) njira zamaganizidwe monga kupewa kupewa kuzindikiritsa kuyanjana kwapakati pa SUDs ndi PG kuposa OCD; (vi) zidziwitso zam'magulu ndi zamankhwala zochirikiza mgwirizano wapakati pa SUDs ndi PG kuposa OCD. Njira zochiritsira zosinthika, monga chithandizo chakuwonekera, zimawoneka ngati zogwira ntchito ku OCD, PG kapena SUDs, ndikuwonetsa zina mwazovuta pamatenda.
MAFUNSO:
PG imafanana mofanana ndi SUDs kusiyana ndi OCD. Mofananamo ndi kufufuza za kusaganizira, maphunziro a kukakamizidwa amakhulupirira zokhudzana ndi maphunziro, kusiyana ndi matenda ndi PG, SUDs, ndi OCD.
Introduction
Mtsutso ulipo ponena zoyenera kuganizira za kutchova njuga (PG) monga chilakolako chofuna kuthamangitsidwa, matenda osokoneza bongo kapena osokoneza bongo (1;2) monga zizindikiro za kusaganizira, kukakamiza, ndi kuledzera zimapezeka mu PG (3). Mtsutso uwu uli panthawi yake monga Kusanthula ndi Buku Lophatikiza la Mavuto a Mitsempha
(DSM-5) ikukula (4;5). Kusintha kumeneku kumaphatikizapo kukonzanso kwa PG ku gawo la Impulse Control Disorders (ICDs) kuti likhale limodzi mwa "Zoledzeretsa ndi Matenda Okhudzana" (1) komanso matenda osokoneza bongo (OCD) omwe amachokera ku matenda odwala matenda ovutika maganizo (matenda ovutika maganizo).6), kumene ma ICD amadziwika ndi kugula zinthu zambiri, kugwiritsa ntchito intaneti, kapena khalidwe logonana lingaphatikizidwe (7). Kuchokera ku kusintha kumeneku kumapangitsa kuti anthu ayambe kuledzera ndi kukakamizidwa pakufufuza ma ICD mkati mwa dzina latsopano. Pano ife tikuyang'ana zomwe zingatheke kuchitika pakukakamizika ndi kuledzeretsa poyenderana ndi PG, matenda osokoneza bongo (SUDs), ndi OCD pamodzi ndi zochitika zozizwitsa komanso zokhudzana ndi matenda, komanso kukambirana za mankhwala.
Zomwe zimagwirizana pakati pa matanthauzo ndi zofunikira
Chidziwitso cha kudzidalira kwadongosolo mu DSM-IV-TR ndi chakuti "ntchito ikupitirirabe ngakhale kudziŵa kukhala ndi vuto lopitiriza kapena lachidziwitso la thupi kapena la maganizo" (8). Mawu oledzeretsa amalepheretsa chisokonezo chokhudzana ndi mtundu wodalirika wodalirika (mwachitsanzo, monga momwe anthu amachitira ndi odwala beta-adrenergic oopsa). Ndi zigawo zokhudzana ndi kuchepetsa kudziletsa komanso kukhumba (9), kumwa mowa kumaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo ngakhale kuti zotsatira zake zimakhala zoipa (10), kutanthauza kuti mankhwala osokoneza bongo samangogwiritsa ntchito mankhwala osokoneza bongo (11;12). Mofanana ndi mankhwala osokoneza bongo, PG ingaphatikizepo mobwerezabwereza kuyesayesa, kuchepetsa, kapena kusiya njuga; kudzimva wosasamala kapena wokwiya pamene akuyesera kuchepetsa kapena kusiya njuga; ndi kuchepetsa kuthekera kokana kuganiza kuti muthe kutchova njuga ngakhale zotsatira zoyipa kapena zovuta za kutchova njuga (8).
Kuumirizidwa mu OCD kumaphatikizapo kuchita mobwerezabwereza zochita mozoloŵera kupeŵa zotsatira zowonongeka, zomwe zimabweretsa kuwonongeka kwa ntchito (13;14;15). Lingaliro la chikhalidwe cha maganizo limagwirizanitsa zochitika zotsutsana ndi zovuta, zidziwitso zomwe zonsezi zimadziwika ndi kukayikira kosatha pa zomwe mumaganiza ndi makhalidwe anu, kusakayika, kumverera kosakwanira ndi kusokoneza chiopsezo. Zinthu zoterezi zimapangidwa kuti zikhale ndi umunthu, chomwe chimatchedwa khalidwe la anankastic. Chikhalidwe chosatha cha khalidweli chidzayankha kuti kawirikawiri amafunika kubwereza makhalidwe enieni kuti apeze zovuta zamuyaya, motero kuwonetsa kumangirira (16). Kufanana kwa zochitika zowonjezereka zokhudzana ndi OCD, ICDs ndi zakumwa zoledzeretsa zingaphatikizepo kugwirizana mwa makhalidwe omwe akuwoneka ngati olimbikitsa kuti achepetse kapena kuchepetsa mavuto (8), nkhawa kapena nkhawa musanayambe kutenga nawo mbali muzochita, ndikupulumutsidwa nthawi ndi kutsatira zotsatira za makhalidwe (9).
Zochitika zokhudzana ndi kukakamiza
a. Kodi pali kusintha kokakamiza?
Zizoloŵezi zoledzera zingapo zimapangitsa kuti munthu asamangokhalira kuchita zinthu monyanyira, amachokera ku zolimbikitsa zoyambirira zolimbikitsa kuti pakhale njira zowonjezera komanso zowonjezera (9;17-21). Matenda afupipafupi omwe amatha kupezeka, omwe amachititsa kuti anthu azidalira kwambiri, kudzera m'mawu osokoneza maganizo (mwachitsanzo, matenda a dysphoria, nkhawa, kusakwiya) pamene njira yothetsera mankhwala kapena mankhwala osokoneza bongo imaletsedwa. Dziko loipa limeneli lingapangitse kukakamizika kupyolera mwachinyengo (9;20;22).
b. Kodi ndi osiyana bwanji ndi ego-syntonic / ego-dystonic dichotomy?
Ngakhale kuti pangakhale zochitika zofanana ndizo mu PG, OCD, ndi mankhwala osokoneza bongo, palinso kusiyana. Zizolowezi zamtundu ndi makhalidwe monga PG zimatchulidwa kuti ego-syntonic, kutanthauza kuti nthawi zambiri zimayamba ndi "zokondweretsa, kukondweretsa, kapena chithandizo pa nthawi yochita"8). Mu OCD, makhalidwe okhwimitsa nthawi zambiri amatha kuthetsa kapena kuthetsa maganizo ndikuchepetsa mavuto ndi nkhawa zokhudzana ndi obsessions (8). Malamulo amenewa amadziwika ngati chikhalidwe cha chilengedwe. Choncho, zolimbikitsa zomwe zimayambitsa zizoloŵezi zoletsedwa ndi OCD zingakhale zosiyana. Komabe, zizoloŵezi zoledzera zingakhale zochepetsetsa kwambiri komanso nthawi zina, chifukwa khalidwe kapena zotsatira za mankhwala zimakhala zosangalatsa komanso zozoloŵera kapena zovuta (9;20;22-24). Mofananamo, kunena za makakamizo a OCD monga "osasangalatsa" sangakhale nthawi zonse, monga momwe ana aliri OCD, kapena anthu othandizira angapeze atatha "kuyeretsa bwino" kapena kukhutira pokonzekera kufikira "ntchito itatha" (25).
c. Kulekerera ndi Kutaya
Kupezeka kwa kulekerera kungakhale kufanana kwina pakati pa mankhwala osokoneza bongo, PG, ndi OCD, mothandizidwa kuti ayambe kuchulukitsa chizoloŵezi cha kubwereza nthawi.26;27). Chilakolako kapena chilakolako pamene mukupewa makhalidwe angakhale ofanana ndi zilakolako zokhudzana ndi mankhwala osokoneza bongo (mankhwala osokoneza bongo (1). Kusintha kwa kugwiritsira ntchito mankhwala osokoneza bongo kunayambanso kuganiziridwa pokhudzana ndi matenda opatsirana, komwe mobwereza mobwerezabwereza kugwiritsa ntchito mankhwala osokoneza bongo kulimbikitsanso kuti "kufuna," kumagwirizanitsa ndi kugwiritsira ntchito, kumalowetsa "kukhumba" kapena kuyankha kwa hedonic (28).
Zomwe zimapangitsa kuti munthu asamangokhalira kukakamizidwa
a. Othandizira anthu
Mitundu yambiri ya neurotransmitter imathandizira kuledzera ndi PG, zambiri zomwe zimakhudzidwa ndi OCD; Komabe, deta imasonyeza kusiyana kwa momwe machitidwewa alili mu PG ndi OCD (23).
Serotonin (5-HT) imathandiza kuti munthu asamayese khalidwe labwino komanso dopamine (DA) kuti aphunzire, athandizidwe, komanso kuti adziwe zopindulitsa, kuphatikizapo mphotho (29). Mavuto a zachipatala omwe ali ndi machitidwe a 5-HT ndi dopamine (30-34) amasonyeza kusiyana kwa momwe machitidwewa alili mu OCD poyerekeza ndi PG ndi SUDs. Kutsata zovuta ndi serotonergic agonist ngati cholinga-chlorophenyl piperazine (m-CPP), odwala oCD amafotokoza kuwonjezereka kwa zizindikiro za OC (33). Anthu omwe ali ndi PG amatha kufotokozera kuyankha kwapamwamba kapena "kutsika" kwa m-CPP, mofanana ndi mayankho omwe amapezeka m'mabuku oledzera (31).
b. Neurocircuitry
Deta ya Neuroimaging imathandizira kugwiritsidwa ntchito kwa neurocircuitry ya makhalidwe ndi mankhwala osokoneza bongo omwe amawonekera mosiyana ndi OCD (20). Dera la Frontostriatal limapangitsa kuti munthu asasankhe kuchita zinthu mopitirira muyeso.18) ndi PG (35;36). Kulephera kwa magalimoto othamanga-thalamo-cortical, okhudzidwa ndi khalidwe lolimbikira, angayese chifukwa chogwiritsa ntchito mankhwala osokoneza bongo mowa mwauchidakwa (37).
Ma Circuit-striatal circuits amapezeka mu OCD, ICD ku Parkinson's disease (PD), ndi machitidwe ofuna kukonda cocaine (38). Mu chitsanzo chimodzi (38), njira yowonongeka yomwe imakhudzidwa ndi zokakamiza zimagwirizana ndi ndondomeko yoyendetsera kayendetsedwe ka ntchito. Mu ICD mu PD, kusamvana pakati pa limbic ndi motor cortical systems, mbali zina zokhudza PD matenda ndi / kapena DA mankhwala othandizira kuti athetse matenda, akhoza kukhalapo (39). Kugwiritsa ntchito mankhwala osokoneza bongo, kusayenerera kwa kayendetsedwe ka mankhwala ndi magalimoto kungakhale kosasinthika m'kupita kwanthawi, kusunthira kuchoka kumalo osokoneza bongo (40-42).
Kulakalaka zinthu zakuthupi ndi zakumwa zolakwitsa zimagwirizanitsidwa ndi kuchepetsa mphamvu yowonongeka (ventral striatal activation)43), zofanana ndi zomwe zimachitika panthawi yopereka mphoto kapena ngati njuga mu PG ndi uchidakwa (44;45). Kutchova njuga kugwira ntchito kungachititse kuti DA atuluke mu ventral striatum mwa anthu omwe ali ndi PD ndi PG kusiyana ndi anthu omwe ali ndi PD okha (46), yankho lofanana ndi limene linagwiritsidwa ntchito ndi mankhwala osokoneza bongo kapena mankhwala osokoneza bongo omwe amamwa mankhwala osokoneza bongo (47) kapena pa maphunziro a PD amene amamwa mankhwala osokoneza bongo a DA mobwerezabwereza (48). Kuwonjezereka kwapadera kwa frontostriatal kumayendetsedwe kazitsulo ku OCD (49), pamene kuchepetsa kuchepa kwawoneka mu PG (50), kuwonetsa kufunikira kofufuza kawirikawiri za PG, OCD, ogonjera mankhwala ndi maphunziro (23).
Koob ndi Volkow (9) amanena kuti kutengeka mtima kumayambitsa magawo oyambirira a chizolowezi choledzeretsa, ndipo kukhudzidwa pamodzi ndi kukakamiza kumayambitsa magawo amtsogolo. Amapanga magawo atatu a chizoloŵezi choyambitsa chizoloŵezi: 'kumwa mowa / kumwa mowa,' kuchotsa / kusokoneza ', ndi' kuganizira / kuyembekezera '(kukhumba). Mu chitsanzo chawo, gawo la ventral tegmental ndi ventral striatum zimathandizira kwambiri kumwa mowa mwauchidakwa, amygdala (kuphatikizapo madera a amygdala, stria terminalis ndi nucleus accumbens) zimathandiza kwambiri kuti kuchotsa / kusokoneza chiwonongeko, komanso kukhumudwa siteji imaphatikizapo makina ogawidwa kwambiri omwe amagwiritsidwa ntchito ndi orbitofrontal cortex-dorsal striatum, prefrontal cortex, amolgadal amygdala, ndi hippocampus. Chilumbachi chimapangitsa munthu kukhala ndi chilakolako chofuna kugwiritsira ntchito zida zowonongeka, kumalo osokoneza bongo, kuponderezana kwapadera, komanso kuperewera kwapakati pazirombo zochepa, komanso matenda osokoneza bongo omwe amachititsa kuti pakhale vutoli9;22).
Kuchokera kwa nthawi yayitali kuchoka mu PG ndikoyenera kuti kuchoka kwa maganizo kunenedwa mu PG (1;51). Kuwonjezera apo, kutchova njuga kumayendedwe kachisokonezo cha maganizo (24) komanso kuthana ndi nkhawa zatchulidwa monga zitsanzo za PG (52). Mofananamo, kugwiritsa ntchito mankhwala osokoneza bongo ndi makhalidwe okhwima mu OCD kungathandize kuchepetsa mavuto (8).
Lubman et al. (53) zindikirani kuti ngakhale pali zofanana pa zochitika zachipatala ndi zofooka zokhudzana ndi khalidwe loletsa kulephera ndi OCD, ntchito zomwe zimagwira ntchito m'madera oletsedwa ndizosiyana kwambiri, zikuwonetseratu kusiyana pakati pa zidziwitso zazikulu zokhudzana ndi vuto lililonse (53-56). Zomwe zimachitika pang'onopang'ono zokhudzana ndi chizoloŵezi choledzera zingakhale zogwirizana ndi zochepa za m'tsogolomu komanso kuchepa kwa kukana kuchita zokhudzana ndi mankhwala, pamene ku OCD, dongosololi likhoza kukhala lotayirira, mwinamwake chifukwa chakuti anthu akuda nkhaŵa kwambiri za zotsatira za mtsogolo (53).
c. Zowonongeka za chibadwa ndi zowonjezereka
Ophunzira a gene ophunzirira za PG amawunikira maulendo a SUDs ndi machitidwe oletsa kutetezedwa (23). Maphunziro ena koma osaphunzira ena asokoneza mtundu wa Taq-A1 polymorphism wa jini yomwe imakumbidwa ndi DA D2 receptor (57-59). Zosiyanasiyana za 5HT zotengera galimoto zakhudzidwa ndi OCD ndi PG, koma chikhalidwe cha mabungwe amasiyana (23), ndi nthawi yaitali yomwe imapezeka pamodzi ndi OCD ndi mphindi yayitali yomwe imapezeka pamodzi ndi PG (60;61).
Pochirikiza OCSDs, kafukufuku wa masango omwe anachitidwa kwa odwala omwe ali ndi OCD anapeza magulu a 3 osiyana (62). Masangowa amatchedwa: kusowa mphotho (kuphatikizapo trichotillomania, matenda a Tourette, kutchova njuga, komanso matenda okhudza kugonana); kukhudzidwa (kuphatikizapo kugula zakudya, kleptomania, matenda odyera, kudzivulaza, ndi matenda osokoneza bongo); ndi somatic (kuphatikizapo thupi dysmorphic disorder ndi hypochondriasis). Palibe omwe ankagwirizana ndi mtundu wina uliwonse wa mafuko omwe anaphunzira. Zochitika za m'tsogolo zamtunduwu ziyenera kuganizira miyezo ya makhalidwe (kukakamiza ndi kukhudzidwa) ndi zowonjezereka (63). Matenda oterewa amatha kuyesa zizindikiro zomwe zimakhala zovuta zomwe zimakhala zosavuta kuziyeza kusiyana ndi zovuta zowonongeka zowonongeka kapena zomwe zimayimilira zimagwirizana kwambiri ndi matenda a matenda a matenda (psychiatric disorders)64). Chifukwa chakuti kafukufuku wamakono opatsirana m'maganizo ndi ochepa, deta yochepa imapezeka (65).
Kuphatikizidwa kwapadera kwa madera angapo a cortical, kuphatikizapo orbitofrontal cortex panthawi yophunzira molakwika odwala OCD ndi achibale awo osagwirizana nawo, apezeka. Mu kafukufuku wofufuza zoletsa kupewera mphamvu, OCD amayesa komanso osagwirizana ndi achibale awo amasonyeza kuti amadziwika bwino kuti amatha kusintha maganizo awo. Zoperewerazi zingayimire optophenotypes kwa OCD ndi zofanana (65;66).
Mu paradigm yoletsa kuyendetsa galimoto (ntchito yoyimitsa - SST), onse odwala OCD ndi abale awo omwe sanakhudzidwe ndikuwonetsa kuwongolera koyendetsa magalimoto, komwe kumawongoleredwa ndi kuchepa kwa nthawi yayitali poyimitsa kayendedwe ka nthawi (SSRT), komanso kutalika kwa nthawi yayitali kumalumikizidwa ndi onse awiri ochepetsa imvi mu orbitofrontal cortex ndi kumanja koyang'ana kutsogolo kotekisi (madera omwe amagwirizana ndi OCD ndi SST activation, motsatana) ndikuwonjezera kuchuluka kwa imvi m'malo a striatum, cingate, ndi parietal cortex (67). Zotsatirazi zimatsutsana ndi zoyamba za MRI endophenotype zomwe zimayanjanirana ndi banja, ndipo mwina zamoyo, zoopsa za OCD-zokhudzana ndi kukhudzidwa. Deta imasonyeza kuti zoterezi zimatha kukhala zofunikira kwa PG ndi SUDs (24).
Zowonjezereka za kukakamiza
a. Maganizo a maganizo
Anthu omwe ali ndi OCD amapenda kwambiri pa zovuta zowonongeka (68;68), pamene iwo omwe ali ndi PG akuyandikana kwambiri ndi omwe ali ndi SUDs, akuwongolera kwambiri zowonongeka ndi kufunafuna zachilendo (20;50;69). Komabe, anthu ena omwe ali ndi OCD amasonyeza kusokonezeka maganizo (70), komanso anthu omwe ali ndi PG kapena OCD asonyeza kuti ali ndi chidwi chodziletsa komanso kuwonongeka kolakwika, kutanthauza kugwirizana kovuta pakati pa kukhudzidwa ndi kukhudzidwa (23;71). Pakati pa OCSDs, Hollander ndi Wong (72) Anapanga dongosolo lokonzekera bwino lomwe limapangitsa kuti odwala azivutika kwambiri ndi matenda a maganizo a OCD pamakani ovuta kwambiri komanso osagwirizana ndi anthu. Komabe, zochitika zokhudzana ndi kukhudzidwa ndi zovuta zokhudzana ndi vutoli zimayambitsa vutoli. Phunziro la PG ndi OCD (71) adafuna kupanga mpangidwe wa Impulsive-Compulsive spectrum mu miyeso iŵiri yosiyana, yopereka madera atatu a psychopathological: kwambiri, osaganizira kwambiri (OCD), ndi opanikizika (PG).
Kupanga zisankho kuli koyenera kwa PG, OCD, ndi SUDs (23). Zosiyana zofanana pakupanga zisankho zomwe zikuwonetsa kuti zimakhala zovuta kupanga zosokoneza panthaŵi ya njuga ntchito ya ntchito ikupezeka pakati pa maphunziro ndi omwe ali ndi PG (73), OCD (74), ndi SUDs (75). Komabe, kufufuza kwina kwapeza kupanga chisankho kuti chikhale cholimba mu OCD ngakhale kuwonongeka kwa ntchito zina (76;77). Kulephera kwa kusintha kwa zotsatirazi kungasonyeze kusagwirizana kwa OCD, ndipo kufufuza kwina kuli kofunika kufufuza kukakamizidwa ndi kupanga chisankho.
b. Zovuta zomwe zimachitika
Zitsanzo zachipatala komanso zam'deralo zimasonyeza kuti PG imagwirizanitsa ndi matenda osiyanasiyana a I-II, omwe ali ndi mayanjano amphamvu ndi a SUDs (78-81). Mwamwayi, kufufuza kwa OCD sikunapezeke konse. Kufufuza kwa St. Louis Epidemiologic Catchment Area (ECA), pamene maonekedwe osiyana kwambiri (ORs) anawonetsedwa pakati pa vuto la kutchova njuga / kuthamanga ndi SUDs, OR osakweza OR ya 0.6 inawonetsedwa pakati pa vuto la kutchova njuga /82).
Ngakhale kuti PG ndi OCD mwina sangakhale ndi mgwirizano wamphamvu, amagawana zovuta. Mu National Comorbidity Survey Replication, a subsample of 2073 omwe anafunsidwa anayesedwa kwa OCD (83). Oposa theka la anthu omwe anafunsidwa adanena kuti akumana ndi zovuta za moyo kapena makakamizo, koma ochepa chabe a omwe anafunsidwa anakumana ndi zofunikira za DSM-IV za moyo (2.3%) kapena 12 mwezi (1.2%) OCD. OCD inagwirizanitsidwa ndi zovuta kwambiri, ndi mabungwe amphamvu kwambiri omwe amatha kusokoneza maganizo (nkhawa ndi maganizo) ndi zovuta za ICDs ndi SUDs. Zonsezi, zomwe zikupeza zikusonyeza kufunikira kwa zochitika za OCD, PG, ndi zina zoledzeretsa zamtundu ndi khalidwe la anthu mu kufufuza kwa anthu ndi kufufuza zambiri za maubwenzi awo.
Yankho la mankhwala
a. Pharmacotherapies
Ngakhale kuti palibe mankhwala omwe amasonyezedwa kuti ali ndi PG, magulu atatu apadera afufuzidwa: ophioid antagonists, maganizo stabilizers, ndi serotonin reuptake inhibitors (SRIs) (84;85). Otsutsana ndi opioid monga naltrexone amachepetsa nthawi ya kumwa mowa komanso mwayi woledzeretsa kumwa mowa kwambiri (86;87). Opioid antagonists amawonekeranso othandiza pa chithandizo cha PG (1;88-90). Poyankha odwala opioid mankhwala amapezeka kwambiri mwachangu pakati pa anthu ndi banja mbiri ya uchidakwa (91), chithandizo chokhudzana ndi mankhwala okhudzidwa ndi mankhwala okhudzidwa ndi mankhwala, mwinamwake chokhudzana ndi chilakolako kapena zolimbikitsana, akufotokozedwa.
Zofanana zokhudzana ndi chithandizo pakati pa PG ndi SUDs zikutsutsana ndi zofufuza za OCD. Naltrexone sichimakhudza kwambiri OCD (92) ndipo zingapangitse zizindikiro (93;94). Makhalidwe olimbitsa thupi monga lithiamu angakhale othandiza pochiza PG (95-97) koma osati OCD (98). Mankhwala oletsa antipsychotic omwe amachititsa DA D2-like receptors (haloperidol, risperidone ndi olanzapine) asonyeza kuti akugwira ntchito monga owonjezera opangira mu OCD (99), koma wasonyeza zotsatira zolakwika mu mayesero olamulira placebo mu PG (100-102) ndi kuonjezera zifukwa zokwera mpira mu PG (103).
Ma ARV amasonyezedwa pochiza OCD (99) koma akhala ndi zotsatira zosiyana kwa PG ndi SUDs (23). Njira zina zowononga zowonongeka zapeza fluvoxamine ndi paroxetine kukhala apamwamba kuposa malobo pochiza PG (104;105), ndipo ena alibe (106;107). Kusiyanasiyana kwa mankhwala a pharmacotherapy pa PG kumalimbikitsa kuthetsa mavuto omwe amabwera nawo, monga nkhawa (108), pochiza PG (79;109), ndi kuchepa kwapakati pa PG zonse ndi madera omwe akugwirizanitsa awonedwa (96;108).
Maphunziro awiri omwe amachititsa kuti munthu asamangidwe (modafinil) mu PG adalimbikitsa magulu awiri (103). Anthu omwe ali ndi chidwi chodziwika bwino amasonyeza kuchepa kwa zida zowonongeka, kupanga zosankha zoopsa, kukhudzidwa, komanso mayankho okhudzana ndi juga. Anthu omwe ali ndi maganizo ochepa kwambiri amasonyeza zambiri pazitsulo zonsezi, kutanthauza kusintha kwapadera kwa modafinil komwe kumasiyanitsa pakati pa anthu otsika ndi otsika kwambiri omwe ali ndi PG. Izi zikuwonetsa kusagwirizana pakati pa PG, zomwe zingathe kufotokoza zotsatira zowoneka ngati zotsutsana m'mayesero odwala. Deta ina imasonyeza kuti kutengeka kungayimire chithandizo chofunika pa PG (110;111). Dera lodziwika limatanthauzanso ntchito za mankhwala a glutamatergic pochiza OCD, PG, ndi SUDs (99;112;113), mwinamwake kupyolera muzolowera zokhudzana ndi zovuta zokhudzana ndi kukhudzidwa (mwachitsanzo, kusamvetsetsana kwa chidziwitso) (114), ngakhale kuti zotsatira ziyenera kumasuliridwa mosamala.
b. Zomwe Mungachite
Njira zothandizira zothandizira kuchipatala zingathandizenso PG ndi OCD (115;116). Njira zothandizira komanso zolimbikitsa, kuphatikizapo Kulimbikitsana Kwachangu (MI) ndi Cognitive Behavior Therapy (CBT) zasonyezedwa kuti zothandiza kuchiza SUDs ndi PG (85;117-120). Kupezeka kwa Achinyamata Achigawenga Anonymous (GA), omwe amatsatiridwa ndi Alcoholics Anonymous (AA), akugwirizana ndi zotsatira zabwino kwa anthu omwe akugwira nawo ntchito yotchova njuga (121). OCD wakhala akuchiritsidwa pogwiritsa ntchito njira zowonongeka / zowonongeka (122;123), ndi njira zofanana zoganizira njira zoperekera chilakolako chachinyengo zimathandizira PG (124-127).
Chidule ndi Mapeto
Palipakati pakati pa PG ndi SUDs ndi kukakamizidwa kuimira chinthu chofunika kwambiri chokhazikika. Ngakhale kuti OCD ndi zizolowezi zingakhale zofanana, zimawoneka mosiyana, zimakhala zochepa kuposa momwe zimayendera komanso zimasiyana ndi kulemekeza kwa mankhwala (128). Komabe, monga kukhudzidwa mtima, kukakamizidwa monga zomangamanga ndizofunikira kuunika m'mabuku amtsogolo a ICDs, SUDs ndi OCD (42;129;130).
Ponena za zizoloŵezi zowonongeka, PG ikhoza kukhala yodwala yokha yomwe ili ndi deta yomwe ilipo kuti ipite patsogolo ndi chikhalidwe monga mankhwala osokoneza bongo (1). Zizolowezi zamakhalidwe zimakhala zofunikira kwambiri pa kafukufuku wamtsogolo. Zizolowezi za makhalidwe zikhoza kukhala zosiyana kapena zosiyana wina ndi mnzake pa phenotypical ndi neurobiological levels ndi ma data omwe akusonyeza onse awiri (131). N'kutheka kuti monga OCD ndi matenda ena aumoyo, vuto lililonse la khalidwe lidzaimira matenda osagwirizana (132;133). Kuwonongeka kotereku kuyenera kuzindikiritsidwa pamene kufufuzira zochitika zenizeni za matendawa ndi chitukuko cha njira zabwino zothandizira ndi zothandizira. Maphunziro a chithandizo cha matenda a neurobiological angathandize kumvetsa kutentha kwa magazi komanso kutsogolera chithandizo cha mankhwala. Zolingalira komanso khalidwe labwino zimayandikira magulu ozindikiritsa zozizwitsa komanso kuzindikira kuti zamoyo zimangokhalapo zokhazokha. Zitsanzo zamakono zatsopano zoganiza kuti kumangidwe sizomwe zimagwirizana (134;135). Kukakamizidwa kumakhala kosiyanasiyana, ndi zigawo zikuluzikulu zomwe zimagwira ntchito molimbikitsana, kubwerezabwereza kachitidwe kachitidwe. Kutha kukakamizidwa, monga kutengeka, kungakhale chizindikiro chofunika kwambiri kwa ICDs, SUDs ndi OCD (42; 129; 130.) Monga endophenotype imayimira mkhalapakati womanga pakati pa zovuta ndi matenda a genotypes, amatha kuyang'anitsitsa zowonjezera zamoyo ndikukhala ndi zolinga zothandiza kupewa ndi kuchiza zochitika.
Kuvomereza
Papepalali linapangidwa mothandizidwa ndi thandizo la kayendedwe ka ndalama zoperekedwa ndi Alberta Gaming Research Institute ndipo mbali ina yothandizidwa ndi NIH zopereka R01 DA019039, R01 DA020908, RL1 AA017539, RC1 DA028279, P20 DA027844, VA VISN1 MIRECC, ndi National Center Ku Gaming Yogwira Ntchito ndi Institute of Research on Gambling Disorders.
Mawu a M'munsi
Statement Concise: Kuphatikizidwa kwa kukhudzidwa ndi matenda osokoneza maganizo (makamaka kutchova njuga), kusokonezeka kwakukulu ndi kuledzeretsa kumafufuzidwa. Ngakhale kuti malingaliro oterewa amatha kufufuzidwa ndi kufotokozedwa pokhudzana ndi matendawa, kusakakamizidwa kwakhala kopanda kuphunzira bwino. Zokhudzana ndi matenda a chizungu ndi zokhudzana ndi matenda akufotokozedwa.
Chidziwitso cha chidwi:
Dr. Nady el-Guebaly alibe mpikisano wa zachuma zofuna kufotokoza motsatira zomwe zili pamwambowu.
Tanya Mudry alibe mpikisano wa zachuma wosangalatsa kuti afotokoze za zomwe zili pamwambowu.
Dr. Zohar walandira ndalama zopeza kafukufuku komanso ndalama zowonjezera kuchokera ku Lundbeck komanso ndalama zopangira kafukufuku komanso ndalama zowonjezera kuchokera kwa Servier.
Dr. Tavares adalandira thandizo lofufuzira kafukufuku wochokera ku Cristalia, Roche, ndi Sandoz pa udindo wake monga Purezidenti wa National Association of Gambling and Other Impulse Control Disorders ku Brazil.
Dr. Potenza walandira thandizo lofufuza kafukufuku wochokera ku Mohegan Sun Casino, National Center for Gaming Responsible Gaming ndi bungwe lake la Institute for Research on Gambling Disorders (mabungwe osewerera njuga omwe amalandira ndalama); adafunsira ndipo adalangiza Boehringer Ingelheim; adafunsira ndipo ali ndi ndalama ku Somaxon; ndi Forest Laboratories, Ortho-McNeil, Oy-Control / Biotie, Glaxo-SmithKline ndi Psyadon mankhwala.
Mndandanda Wothandizira