Kuwonongeka kwa chidziwitso chokhudzidwa ndi vuto la kutchova njuga: Kukonzekera mwatsatanetsatane ndi meta-analysis (2017)

Maphunziro a Neuroscience & Biobehaal

Volume 84, January 2018, masamba 204-217

• Tim van Timmeren^{a, b,,} ,
• Lowani pa G. Daams^c,
• A Ruth J. van Holst^{a, b, d, 1},
• Anna E. Goudriaan^{a, b, e, 1}

https://doi.org/10.1016/j.neubiorev.2017.11.022

Mfundo

• Kukakamizidwa kumaganiziridwa kuti ndi vuto pakati pavuto la kutchova juga.

• Komabe, sizikudziwika ngati izi zikuwonetsedwa ndi kugwira ntchito kwakukhudzana ndi mitsempha yolumikizana yokhudzana ndi mitsempha.

• Kuti tipeze umboni wofufuza, tinayendera mwatsatanetsatane komanso kuwunika meta.

• Tinazindikira maphunziro a 30 akuyesa ntchito ya neuropsychological.

• Kufufuza kwa meta kunawululira zakuperewera kwa anthu omwe ali ndi vuto la kutchova juga motsutsana ndi oyendetsa bwino.

Kudalirika

Kukakamizidwa ndichimodzi mwazovuta zamankhwala osokoneza bongo, kuphatikiza vuto la kutchova juga. Komabe, sizikudziwika bwinobwino kuti kukakamira kutchova juga kumalumikizidwa bwanji ndi magwiridwe antchito okhudzana ndi kukakamira. Apa, tikufotokozera mwachidule ndikupanga umboni wakukakamiza, monga kuwunikiridwa ndi ntchito zokhudzana ndi kukakamizidwa, mwa anthu omwe ali ndi vuto la kutchova juga poyerekeza ndi kuwongolera koyenera (HCs). Maphunziro onse a 29, okhala ndi zotsatira za ntchito za 41, adaphatikizidwa pakuwunika mwatsatanetsatane; Masamba a 32 (n = Anthu 1072 omwe ali ndi vuto la kutchova juga; n = 1312 HCs) adaphatikizidwanso pakuwunika kwa meta, kochitidwa pachidziwitso chilichonse padera. Kusanthula kwathu kwa meta kumawonetsa zoperewera zazikulu mwa anthu omwe ali ndi vuto la kutchova juga pakusinthasintha kwazindikiritso, kusintha kosunthika, komanso chidwi. Ponseponse, zotsatirazi zikugwirizana ndi lingaliro loti kuchepa kwokhudzana ndi kukakamizidwa kumadziwika ndi vuto la kutchova juga. Mgwirizanowu ungapereke kulumikizana kotheka pakati pa zolakwika pantchito yayikulu yokhudzana ndi kukakamizidwa. Timakambirana za kufunikira kwa zotsatirazi, tanthauzo lake pakumvetsetsa kwathu kwamatenda amtundu wa juga komanso momwe amathandizira pamatenda am'magazi komanso zovuta zina zakukakamizidwa.

Keywords

• Njuga zachikhalidwe;
• Malonda;
• Kusinthasintha kwazindikiritso;
• Ntchito zoyendetsa;
• Kubwerera m'mbuyo;
• Ntchito ya Stroop;
• Ntchito ya Wisconsin kadi;
• Intra-owonjezera mawonekedwe osunthira;
• Ntchito yopanga njanji;
• Zochita zamisala yamagetsi;
• Kuphunzira mwadzidzidzi;
• Kusintha kwanzeru

1. Introduction

1.1. Champingo

Kutchova juga kwachikhalidwe kwapangidwa posachedwa ngati chizolowezi chamakhalidwe ndikupangidwanso kuti Kusuta Kwamagetsi (DSM-5; Association of Psychiatric Association, 2013). Chisankho ichi chinali chokhazikitsidwa ndi kufanana kwachipatala ndi minyewa yokhala ndi vuto logwiritsa ntchito mankhwala (Fauth-Bühler Et al., 2017 ;  Romanczuk-Seiferth Et al., 2014). Zofanana ndi kusuta kwa mankhwala osokoneza bongo, zizindikiritso zamavuto amtundu wa juga zimaphatikizapo kuyesayesa mobwerezabwereza kuti musiye njuga, kumva kupumula kapena kusakwiya mukayesa kusiya ndikuchepetsa kuthekera kwa kusiya njuga ngakhale mutakhala ndi zotsatirapo zoipa za njuga. Vuto la kutchova juga lidawerengedwa kale ngati vuto lotha kusokoneza ndipo lakhala likugwirizana ndi kusokonekera kwambiri (Verdejo-García et al., 2008). Tsopano pamene njuga imayesedwanso monga chizolowezi chamakhalidwe, pali kufunikira kowonjezereka pakuyang'ana pazolumikizidwa zamakhalidwewo, zomwe zingakhale pakati pakumvetsetsa kwa matenda amiseche (mwachitsanzo. El-Guebaly et al., 2012; Leeman ndi Potenza, 2012,, komanso kuzolowera kwambiri.

Kuledzera kumatha kuonedwa ngati mathero kumapeto kosinthira: kuchokera ku cholinga choyambirira-chotsogozedwa kudzera munzolowera mpaka pakulimbikitsa kukakamira kumene (Everitt and Robbins, 2005). Mitundu yaukatswiri wazakumwa zomwe zimatsindikanso zokhudzana ndi kuchoka pakukakamizidwa kupita pakukakamizidwa (El-Guebaly et al., 2012). Mafunso odzidziwitsa omwe amayesa chizolowezi cholimbikitsa iziAnton Et al., 1995; Blaszczynski, 1999; Bottesi Et al., 2014 ;  Vollstädt-Klein Et al., 2015). Kuphatikiza apo, pakuwonjezera pakukakamiza kugwiritsa ntchito mankhwala osokoneza bongo, zovuta zomwe zimakhudzana ndi zochitika zapamwamba zokhudzana ndi kukakamira, monga mayendedwe olimbitsa thupi kapena kusazindikira, zingakhale zofanananso ndi vuto laukadaulo (Fineberg et al., 2014). Chifukwa vuto la kutchova juga lingakhale mtundu wa chizolowezi chosagwiritsa ntchito mankhwala osokoneza bongo, limapereka mwayi wofufuza kukakamizidwa ngati mtundu wa endophenotype wokonda kugwiritsa ntchito mankhwala osokoneza bongo. Makhalidwe ena, monga chakudya, kugonana, komanso kugwiritsa ntchito intaneti, atha kukhala okakamizidwa (Morris ndi Voon, 2016). Komabe, machitidwe awa anali kunja kwa kuwunikira kwaposachedwa, popeza sakuphatikizidwa ndi gulu la 'Substance-and Addictive Disways' mu DSM-5 chifukwa cha kafukufuku wosakwanira.

Kafukufuku wofufuzira kukakamira, mwachitsanzo, kuchita kobwerezabwereza ngakhale zotsatirapo zoyipa, mwa anthu omwe ali ndi vuto la kutchova njuga ndi ochepa. Izi zitha kukhala chifukwa cha zovuta zomwe zili pamakonzedwe ake. Zowonadi, kukakamizidwa kumatha kufotokozedwa m'njira zosiyanasiyana, zomwe zimawoneka ngati zosiyana pakati pamavuto ndi mafotokozedwe (Yücel ndi Fontenelle, 2012). Zofunikira, ndipo motsutsana ndi kukakamira, kuchuluka kwa zida zofufuzira kuti athe kuyesa kuona kuzunzika kuli kochepa. Chifukwa chake akunenedwa kuti, ngakhale ndichothandiza ngati lingaliro la asing'anga, kukakamira "ndizovuta kwambiri komanso ndizosokoneza pakafukufuku wa kafukufuku wamutuwu" (Yücel ndi Fontenelle, 2012). Kumbali ina, matanthauzidwe atsopano okakamiza afunsidwa omwe amapereka chifukwa cha kuchuluka kwake komanso kupereka mwayi wophunzira mwadongosolo njira zomwe zimathandizira kuchita mokakamiza (mwachitsanzo. Fineberg Et al., 2010 ;  Dalley Et al., 2011).

Khalidwe lokakamiza limachitika chifukwa cha kusokonezeka m'njira zosiyanasiyana zazidziwitso, kuphatikizapo chidwi, malingaliro, komanso kuyendetsa mayendedwe a mota kapena kuzindikira. Kafukufuku waposachedwa wa kukakamizidwa ndi akatswiri mu ntchitoyi afotokoza momwe angaumirizidwe kugawika magawo anayi osiyana a mitsempha: kusinthika kokhudzana ndi chidziwitso, ntchito / kusunthasuntha, kusamalira chidwi, kuletsa chidwi, komanso kuphunzira chizolowezi (Fineberg et al., 2014). Iliyonse ya madambidwewa imakhala ndi gawo lina lokakamizika ndi malire amodzi a neural (Fineberg et al., 2014) ndipo imatha kugwiriridwa ntchito ndi mitundu yachilendo yamitsempha (onani Gulu 1). Chimodzi mwazinthu zofunikira kwambiri pakukakamiza, makamaka zimagwirizananso ndi kubwereza, ndikulephera kusintha momwe zinthu ziliri. Ntchito zokhudzana ndi kusanthula kosinthika (mu) kusinthasintha mwina (i) kuwongolera zochitika zadzidzidzi, zomwe zimatengera kuphunzira / kusakhazikika (kusinthasintha kokhudzana ndi kuzindikira), (ii) kuwongolera mayendedwe othandizirana (chidwi) ) kuyesa kuthekera kwoletsa chidwi chamtsogolo, choyankha chokha (mwachangu kapena mwachidwi) (Fineberg et al., 2014). Chinthu chinanso chomwe chingapangitse kukakamizidwa ndi (iv) kudalira kwambiri kuphunzira pakukhala ndi chizolowezi: chizolowezi chochita zomwe nthawi zambiri chimabwerezedwa kuti chizikhala chokha komanso chosaganizira zolinga. Pazifukwa zokhazikika, tidasankha kugwiritsa ntchito magawo anayi awa ngati chilinganizo chokonzekera ndikufufuza umboni wokhudzidwa ndi vuto la kutchova juga.

Gulu 1.

Magawo anayi a kukakamizidwa.

GD = Kutchova Juga; RT = Nthawi Yoyankhira.

a

Magawo kuchokera Fineberg et al. (2014).

Zosankha pazithunzi

1.2. Zolinga

Cholinga chachikulu cha kubwereza kwatsatanetsatane ndikusanthula kwa meta ndikubwereza mwachidule ndikuphatikiza, kwanthawi yoyamba, umboni wopatsa chidwi wazovuta pazakakamizika zokhudzana ndi neuropsychological muzovuta zamtundu wa juga. Chifukwa chake, tidayamba kuyankha funso lotsatira (kutsatira njira za PICO): mwa anthu omwe ali ndi vuto la kutchova juga, kodi pali umboni wazomwe zikuchitika, poyerekeza ndi ma HC, monga akuwunikira pakuyang'anira mitsempha? Kuti izi zitheke, tidasanthula mwatsatanetsatane mabuku omwe ali ndi vuto la kutchova juga kuti muphatikize maphunziro onse oyesera omwe amayeza imodzi mwazinthu zinayi zakukakamiza (Gulu 1). Kuphatikiza apo, kusanthula kwa meta kunachitika pa ntchito zonse zopezeka mkati mwa domain iliyonse (ndi maphunziro ochepa a 3 pa ntchito iliyonse) kufupikitsa chidziwitso chomwe chilipo. Tidawerengera kuti ntchito zokhudzana ndi neuropsychological ndizovuta mkati mwa anthu omwe ali ndi vuto la kutchova njuga poyerekeza ndi ma HC.

2. Njira

Kuwunikira mwadongosolo uku ndi kusanthula kwa meta kunachitika ndikufotokozeredwa malinga ndi Zokonda Kugawana Zinthu Zowunika mwadongosolo komanso malangizo a Meta-Analyser for Protocols 2015 (PRISMA-P 2015) malangizo (Moher et al., 2015) ndipo adalembetsedwa ku PROSPERO International Prospective Register of Systematic Reviews (crd.york.ac.uk/prospero, nambala yolembetsa: CRD42016050530). Ndondomeko ya PRISMA for Protocols (PRISMA-P) yowunikiranso imaphatikizidwanso mu Fayilo yowonjezera ya 1.

2.1. Zidziwitso ndi njira yosaka

Tinayamba posaka WHO International Clinical Trials Registry Platform (WHO ICTRP) ndi ClinicalTrials.gov kuyesa mayeso omwe angakhale ovomerezeka. Zolemba zoyambilira zidasakidwa pogwiritsa ntchito Ovid MEDLINE, Embase ndi PsycINFO. Kusaka kumeneku kunachitika mu Ogasiti 2016 ndikuwonjezeredwa mu February 2017.

Kafukufuku wowunikira adazindikira lingaliro lotsatira [] kuphatikiza: [Kusokonezeka kwa juga] NDIPO [[kukakamizidwa] AU [mayeso a neuropsychological] OR [anayesa magawo oyesera] Pambuyo pake, malingaliro ofunikawa adasinthidwa pachidutswa chilichonse cha bukhu lopezeka pogwiritsa ntchito mawu oyenera (olamulidwa), malo osakira achidziwitso. Mwaona Zowonjezera A (Zowonjezera) pazakukwaniritsa mwatsatanetsatane.

Dziwani kuti ntchito zomwe zimayesa chisankho mwachindunji sizinayang'anitsidwe, chifukwa zosiyana pakati pa anthu omwe ali ndi vuto la kutchova juga ndi ma HC siziri (zofunikira) zokhudzana ndi kusinthasintha kwazomwe zimachitika pamtundu uliwonse, koma makamaka pazokonda pakokha ndipo, motero, sizothandiza kwa mtanda-diagnostic endophenotype wa kukakamiza. Kuphatikiza apo, kusokonezeka kwakangokhudza chisokonezo kumatha kuwonetsa njira zingapo zoyambira (Munda ndi Cox, 2008). Pazifukwa izi, sitinaganizirepo kuphatikiza ntchito ngati ntchito ya njuga yeniyeni ya Stroop kapena ntchito ya Jot-Probe Task.

2.2. Njira zoyenera

Kafukufuku wosankhidwa amayenera kukwaniritsa njira zotsatirazi: kuphunziraku kunaphatikizapo maphunziro aumunthu wazaka za 18-65; phunziroli lidaphatikizapo odwala a DSM-5 Kutchova Juga Disorder, DSM-III, DSM-III-R kapena DSM-IV Pathological Amiseche kapena otchova juga omwe ali ndi SOGS pachimake kuposa 5; phunziroli lidaphatikizapo gulu loyendetsa bwino; ndipo phunziroli linali ndi zochepa za 10 maphunziro pagulu lililonse. Kuphatikiza apo, maphunziro adayenera kuphatikizira ntchito yoyesera kapena paradigm kuti ayese gawo la kukakamizidwa, monga momwe madera anayi (Gulu 1). Zolemba zoyambirira zidaphatikizidwa mosasamala chilankhulo, chaka chosindikizira, mtundu wofalitsa, kapena mtundu wa kufalitsa. Mndandanda wathunthu wamalembedwe adatumizidwa ku EndNote X7 kuti achotse zobwereza ndipo pambuyo pake adatumizidwa ku Rayyan (Elmagarmid et al., 2014) pamutu ndi kuwunika pang'ono.

2.3. Kusankha kuphunzira

Maudindo ndi zolemba za maphunziro onse omwe adadziwika adawonetsedwa mosadalira kuti ayenerere olemba awiri (TvT ndi RJvH). Zolakwika zilizonse pakati pazisankho za owunikirazo zidathetsedwa pokambirana mpaka mgwirizano utakwaniritsidwa (<1% yazolemba). Zolemba zosankhidwazo zinawerengedwa mokwanira, kuti awone ngati njira zonse zophatikizira zakwaniritsidwa. Tidawunika mwakhama zofalitsa zobwereza kapena kugwiritsanso ntchito ka dataset komweko ndipo, tikakumana nawo, dataset yaposachedwa kwambiri kapena yathunthu idagwiritsidwa ntchito.

2.4. Kutulutsa kwa deta ndi mtundu wowerengera

Zotsatirazi zidatengedwa kuchokera ku zomwe zasankhidwa: kuchuluka kwa anthu komanso momwe amathandizira polemba (kukula, jenda, zaka, matenda azachipatala, kuopsa kwa kutchova njuga); mtundu wa kuyesa kwa mitsempha yogwiritsidwa ntchito; kuchuluka kwa zotsatira; chachikulu zotsatira za phunziroli; magawo oyesera, njira ndi kupatuka kwofananira ndi zambiri zowerengera kuchokera pazomwe zimapangitsa kukula kwake kukhala kwakukulu (onani Gulu 2, Gulu 3 ;  Gulu 4). Ngati magawo oyesera oyambira anali osiyana ndi maphunziro ena pogwiritsa ntchito ntchito yomweyo yanzeru, timalumikizana ndi olemba. Kafukufuku awiri sanatengedwe pawunikidwe mwatsatanetsatane komanso kuwunika kwa meta chifukwa kumasulira kwa magawo omwe adanenedwa sikunadziwike bwino ndipo sikunamveke bwino.

Gulu 2.

Kuwunikira mwachidule kunaphatikizapo maphunziro omwe ali mkati mwazonse zokhudzana ndi mayendedwe achilengedwe a Contingency.

achiduleChiwerengero cha anthu: GD = Kutchova Njuga Odwala omwe ali ndi Matenda; HC = Kuwongolera Kwathanzi; ND = Odwala Omwe Amadalira Chikonga; CD = Odwala a Cocaine Odalira; AD = Odwala Omwe Amamwa Mowa; Odwala a TS = Tourette Syndrome; BN = odwala a Bulimia Nervosa; OCD = Odwala-Obsessive-Compulsive Disorder; Odwala a IAD = Internet Addiction Disorder; IGD = Odwala Masewera Omwe Amasewera pa intaneti; PrGs = Ovuta Otchova Juga; Male = Mwamuna; Female = Mkazi;? = jenda silinafotokozedwe. Kuyeza Kwachipatala: DSM = Diagnostic and Statistical Manual of Mental Disways; SOGS = Screen yaku South Oaks Kutchova Juga; PGSI = Vuto la Kutchova Njuga Kovuta; SCID = Mafunso Okonzekera Achipatala a DSM; NODS = Screen Screen Diagnostic yamavuto Kutchova Juga. Ntchito: PRLT = Ntchito Yosintha Pobwereza; CPT = Ntchito Yosewerera Khadi; DRLT = Ntchito Zosintha Zosintha Zotsimikiza; CLT = Ntchito Yophunzirira Mwadzidzidzi; WCST = Wisconsin Kusanja Khadi; IED = Zowonjezera Zowonjezera Zowonjezera; TMT = Ntchito Yopanga Njira. Zotsatira za zotsatira: RT = Nthawi Yoyeserera; * = zosokoneza zinawerengedwa ngati: [#mitu yachitatu - - ((#Words × #Colors) / (# Words + #Colors))]; TMT_B = Gawo Loyeserera Panjira B. GD vs HC: GD <HC imawonetsa odwala a GD akuchita moyipa kwambiri kuposa ma HC.

Zosankha pazithunzi

Ma raters awiri (NMS ndi JMK) adavotera kafukufuku aliyense payekha payokha kuti adziwe mtundu wa 8 zovomerezeka zowunikira njira, kusankha ndikusankhira tsankho. Mndandanda womwe udagwiritsidwa ntchito kale (Thompson ndi al., 2016), zomwe zidakhazikitsidwa pazinthu zochokera ku Cochrane Collaboration, malangizo a PRISMA, ndi malangizo a PEDro, zidasinthidwa ndikuchotsa zinthu zomwe zimayesa kusanthula kwa magulu ndi njira zochititsira khungu, chifukwa izi sizinali zogwirizana ndi maphunziro omwe adawunikidwa pakubwereza kwaposachedwa (zinthu za 5). Maumboni otsimikizirika adafotokozedwa kukhala apamwamba (mfundo za 6-8), zapakati (3-5 point) kapena otsika (0-2 point).

2.5. Kusanthula kwa deta ndi kaphatikizidwe

Chifukwa maphunziro osiyanasiyana adagwiritsa ntchito mayeso osiyanasiyana komanso magawo a mayeso, zosiyanitsa zimatanthawuza zosiyana (ma SMD) mu kukula kwake g) adawerengedwa kuti aone kusiyana pakati pa anthu omwe ali ndi vuto la kutchova juga ndi ma HC pamaphunziro onse. Izi ndi zofanana ndi za a Cohen d koma ndikukonzekera zokonda zazing'ono, ndipo zotsatira zake zitha kutanthauziridwa kuti zikuwonetsa zazing'ono (g = 0.2-0.5), sing'anga (g = 0.5-0.8) kapena mphamvu yayikulu (g> 0.8). Mipanda ' g idalembedwa kotero kuti malingaliro abwino amawonetsa kuchita bwino mu HCs poyerekeza ndi anthu omwe ali ndi vuto la kutchova njuga. Kukula kwa zotsatira kumawerengedwa pogwiritsa ntchito njira zoyambira (zosasinthika); ngati kuli kotheka, zolakwika zokhazokha zidasinthidwa ndikupatuka kwazomwezo (zomwe zikuwonetsedwa pamtundu wofanana)

Pomwe ntchito iliyonse yokhudzidwa ndi ubongo imayesa mbali ina ya 'kukakamiza' ndipo popeza pali kusiyana kwakukulu pamayeso awo, kuwunika kwa meta kunkachitidwa pa ntchito iliyonse payokha. Kuti muphatikizidwe pakuwunika kwa meta, maphunziro osachepera 3 pa ntchito amafunikira. Chifukwa cha kuyerekezera kwakanthawi pakati pa zitsanzo zamaphunziro ndi kusiyanasiyana kwa njira, mitundu yazotsatira zosagwiritsidwa ntchito idagwiritsidwa ntchito pakuwunika kwapakati pagulu. Mulingo wofunikira wa p <0.05 (miyendo iwiri) idagwiritsidwa ntchito. Kupezeka kwa heterogeneity kunayesedwa pogwiritsa ntchito Q ya Cochran ndipo kukula kwake kukuyerekeza kuti ndikugwiritsa ntchito I², omwe angatanthauzidwe ngati gawo lamasinthidwe amtundu chifukwa cha heterogeneity. Kwa ntchito zomwe zidaphatikizapo maphunziro asanu kapena kupitilira apo, kusanthula kwa meta kunachitika ndi zaka, jenda, IQ komanso kuzunza njuga mwamphamvu ngati ochita masewera olimbitsa thupi. Tidagwiritsa ntchito kusiyana pakati pa zaka, jenda, ndi IQ (kuwerengetsa pogwiritsa ntchito Cohen's d) monga povariate pakuwunika meta-regression. Kusanthula konse kunachitika pogwiritsa ntchito Comprehensive Meta-Analysis V2 (CMA, Bio-Englewood, New Jersey, US).

3. Zotsatira

3.1. Maphunziro omwe adadziwika

Kusaka koyambirira kunazindikira maphunziro apadera a 5521, omwe 29 ikhoza kuphatikizidwanso ndemanga iyi. Chith. 1 ikuwonetsa Chithunzi cha PRISMA Flow chosonyeza momwe zisankho zimasankhidwira. Chiwerengero cha maphunziro omwe sanatulutsidwe pambuyo polemba zonse chifukwa cha "Ntchito yolakwika yolingalira" ndi yayikulu kwambiri chifukwa kafukufuku wogwiritsa ntchito Iowa Gambling Task (n = 20) anali asanatulutsidwe pakuwunika kwina. Izi sizinaperekedwe pakuwunika kwathunthu, komabe, chifukwa sizimagwirizana ndi magawo anayi aliwonse okakamiza. Kuphatikiza apo, poyambirira tinkafuna kuphatikiza mafunso okakamiza, chifukwa chake awa adaphatikizidwa pakusaka ndikusankhidwa pamutu komanso kuwunika kosadziwika. Komabe, tidapewa kuphatikiza kudzifunsa mafunso kumapeto kotsiriza: mayankho amafunso sizomwe zimakhala zoyambira zoyambira ndipo kafukufuku nthawi zambiri samafotokoza kugwiritsa ntchito mafunso ngati awa. Chifukwa chake, mwayi wosowa maphunziro omwe anali ndi mafunso anali wokulirapo, zomwe zidapangitsa kuti zisakhale zophatikizika mwadongosolo komanso mozama.

Fanizo la 1. 

Flowchart akuwonetsa kuchuluka kwa zolemba zomwe zadziwika ndi zomwe zidaphatikizidwa komanso sizimaphatikizidwa pagawo lililonse lofufuzira. Mu maphunziro ena, ntchito zambiri zowunikira zidanenedwa kuti zitha kuphatikizidwa pakuwunika kwa meta. Chifukwa chake, kuchuluka kwa zotsatira ndi ma database ndizokwera kuposa kuchuluka kwa maphunziro.

Zosankha za zithunzi

The 29 idaphatikiza maphunziro omwe anali ndi n = 1072 onse omwe ali ndi vuto la kutchova juga ndi n = 1312 HCs. Ngakhale kuti si maphunziro onse omwe adayesa otchova juga omwe amathandizidwa kapena adapezeka kuti ali ndi vuto lotchova juga (lotchulidwa mu Matebulo 3-5), sitinangophatikiza maphunziro omwe adayesa otchova juga omwe adakwera kwambiri kuposa omwe adadulidwa pamafunso otchova njuga. Chifukwa chake, tiwatchula ngati anthu omwe ali ndi vuto la kutchova juga m'malemba onsewo. Mapangidwe abwino anali "apakatikati" pamaphunziro atatu komanso "okwera" pamaphunziro a 26 (Supplementary Table 1). M'magawo otsatirawa, ogawidwa m'magawo anayi, timafotokoza ntchito iliyonse ndi magawo ake oyesa; perekani chidule cha zomwe mwapeza; ndi kupereka zotsatira za kusanthula kwa meta. Gulu 2, Gulu 3 ;  Gulu 4 fotokozerani mwatsatanetsatane maphunziro omwe amaphatikizidwa patsamba lililonse. Kwa ntchito zamanja zomwe zimapangidwa ndi 3 kapena maphunziro ochulukirapo, kusanthula kwa meta kunachitika; ziwembu zomwe akuwonetsedwa Chith. 2, Chith. 3 ;  Chith. 4.

Gulu 3.

Kuwunikira mwachidule kunaphatikizapo maphunziro mkati mwa Task / chidwi chopanga chosintha.

Kuti muwone mndandanda wathunthu wazidule: onani Gulu 2.

Zosankha pazithunzi

Gulu 4.

Zambiri zinaphatikizapo maphunziro mkati mwa Attentional bias / disengagement domain.

Kuti muwone mndandanda wathunthu wazidule: onani Gulu 2.

Zosankha pazithunzi

Fanizo la 2. 

Kukonzekera nkhalango posinthira mwachidule kukula kwa kusiyana (A) Ntchito Yoyeserera Kuphunzira Kwambiri ndi (B) Ntchito ya Card Perseveration pakati pa odwala GD ndi HCs. * Palibe kupatuka kwofananira komwe kudanenedwa mu kafukufukuyu, koma kopangidwa molingana ndi Standard Error. Kukula kwa mabwalo kumawonetsera kuchuluka kwa maphunziro pamalingaliro opangika. Daimondi imawonetsa kukula kwake konse.

Zosankha za zithunzi

Fanizo la 3. 

Kukonzekera nkhalango posinthira mwachidule kukula kwa kusiyana (A) Ntchito Yotengera Ngongole ya Wisconsin Card ndi (B) intra Extra Dimensional Set Shift pakati pa odwala GD ndi HCs. Kukula kwa mabwalo kumawonetsera kuchuluka kwa maphunziro pamalingaliro opangika. Daimondi imawonetsa kukula kwake konse.

Zosankha za zithunzi

Fanizo la 4. 

Kukonzekera nkhalango posinthira mwachidule kukula kwa kusiyana (A) Ntchito ya Stroop ndi (B) Trail Kupanga Mayeso pakati pa odwala GD ndi HCs. * Palibe kupatuka kwofananira komwe kudanenedwa mu kafukufukuyu, koma kopangidwa molingana ndi Standard Error. Kukula kwa mabwalo kumawonetsera kuchuluka kwa maphunziro pamalingaliro opangika. Daimondi imawonetsa kukula kwake konse.

Zosankha za zithunzi

3.2. Kusintha kokhudzana ndi zochitika mwadzidzidzi

Kusinthasintha kwokhudzana ndi zadzidzidzi kumakhudzanso kuphunzira ulamuliro komanso kusintha kwa machitidwe pambuyo pakusintha kwa malamulo pogwiritsa ntchito mayankho oyesa. Phunziro motero liyenera kuphunzira ndi kusaphunzitsika mosasintha. Mu maphunziro omwe anaphatikizidwawa, ntchito zinayi zidadziwika zomwe zidakwaniritsa malongosoledwe awa: Probabilistic Reversal Learning Task, Card Playing Task, Deterministic Reversal Learning Task ndi Continental Study Task.

3.2.1. Ntchito yongobwereka yophunzitsira

Mu Probabilistic Reversal Learning Task (PRLT; Cools et al., 2002), mitu imasankha pakati (nthawi zambiri) zoyambitsa ziwiri ndikuphunzira kuti imodzi mwasankha ziwiri ndizabwino 'pomwe inayo ndi yoyipa'. Zomwe zimatsitsimutsazi zikuwonetseratu zotsatira (mwachidziwikire), monga 70% ya nthawi yomwe mayankho ake ali olondola komanso 30% ya nthawi yomwe mayankho ake ndiabodza. Pambuyo pophunzira kusankha bwino pakati pa chabwino ndi choyipa, lamulo limasintha (mwachitsanzo, kusinthika) ndipo wophunzirayo afunikira kusintha mogwirizana ndi lamulo latsopanolo. Mitundu yosiyanasiyana ya ntchitoyi imagwiritsidwa ntchito, ndikubweza zomwe zikuchitika mwina pazoyeserera zingapo kapena pambuyo poyankha zolondola zingapo. Kutengera mphindi yobwerera, kupirira kungawonekere ndi kuchuluka kwa zisankho zolondola pambuyo pakusintha kwa lamulo, kuchuluka kwa obwezeretsedwa kapena kuchuluka kwa ndalama zomwe mwapeza (munthawi zonse, kuchuluka kotsika kumawonetsa kupirira kwakukulu).

Kafukufuku anayi adadziwika omwe amagwiritsa ntchito PRLT m'magulu omwe ali ndi vuto la kutchova njuga. M'maphunziro awiri (Boog Et al., 2014 ;  de Ruiter Et al., 2009) Anthu omwe ali ndi vuto la kutchova juga adawonetsa kuyeserera, pomwe ena awiriwa (Torres Et al., 2013 ;  Verdejo-García Et al., 2015) palibe zovuta zazikulu zamakhalidwe zomwe zidawonedwa pa ntchitoyi. Ngakhale mitundu yosiyanasiyana ya PRLT idagwiritsidwa ntchito pa kafukufuku aliyense (onani Gulu 2), anali ofanana ndi kuyesa 'kupirira' chifukwa chake, maphunziro onse adaphatikizidwa pakuwunika meta.

Zambiri zamaphunziro anayi onse, kuphatikiza anthu onse a 77 omwe ali ndi vuto la kutchova juga ndi ma 79 HC, adaphatikizidwa ndipo sanawonetse kuwonongeka kulikonse pa PRLT pakati pa anthu omwe ali ndi vuto la kutchova juga ndi ma HC (size size = 0.479; Z-value = 1.452; p = 0.144) (Chith. 2A). Komabe, pantchitoyi, kusagwirizana kwakukulu kunkawonetsedwa (Q = 11.7, p <0.01, I² = 74%) (Gulu lowonjezera 2). Kusagwirizana kumeneku sikunafotokozeredwe bwino ndi zinthu zilizonse zomwe zimaganiziridwa mu meta-regression (jenda, zaka, IQ komanso kutchova juga, zomwe zinali zofanana ndi maphunziro onse), koma zitha kuwonetsa kuti zotsatira zakusiyana kwa PRLT zidanenedwa mu phunziro lililonse.

3.2.2. Ntchito kusewera yamakadi

Mu ntchito ya Card Carding (kapena Perseveration) (CPT; Newman et al., 1987), wophunzirayo amapatsidwa bolodi la makhadi ndipo amauzidwa kuti khadi yakumaso imalandira ndalama ndipo khadi yamanambala yataya ndalama. Wophunzirayo ayenera kusankha, poyesedwa, ngati apitiliza kusewera kapena kusiya ntchitoyo. Mukapitiliza, khadi limasandulika zomwe zimapangitsa kuti mupambane (mwachitsanzo, khadi yakumaso itasinthidwa) kapena kutaya (mwachitsanzo, pomwe khadi manambala yasinthidwa) ndalama zina. Poyamba, chiwonetsero cha kupambana-kutayika ndichokwera (mwachitsanzo 90%), koma chiwerengerochi chimachepa ndi 10% pambuyo pamayeso aliwonse a 10, mpaka 0%. Ndikofunika kupitiliza kusewera mayesero 40-60 kenako ndikusiya kusewera. Zotsatira za ntchitoyi ndi kuchuluka kwa makhadi omwe asinthidwa; kupitiliza kusewera pomwe chiwonetsero cha kupambana-ndi-kutayika sichikhala chabwino (> mayesero 60) chikuwonetsa kupirira.

Tapeza maphunziro atatu omwe adagwiritsa ntchito CPT m'magulu amiseche. Kafukufuku onse adapeza kusiyana kwakukulu pakati pa anthu omwe ali ndi vuto la kutchova njuga ndi ma HC, omwe ali ndi anthu ochulukirapo omwe ali ndi vuto la kutchova njuga pogwiritsa ntchito njira (yosasinthika) yosankha makhadi (Ophwanya Et al., 2012; Goudriaan Et al., 2005 ;  Thompson ndi Corr, 2013). Zambiri zamaphunziro onse atatuwa, kuphatikiza anthu okwana 155 omwe ali ndi vuto la kutchova juga ndi ma 123 HC, adaphatikizidwa kuti awulule zovuta zomwe anthu omwe ali ndi vuto la kutchova juga amakhala olimbikira kuposa ma HCs (size size = 0.569; Z = 3.776, p <0.001 ) (Chith. 2B). Heterogeneity inali yotsika kwambiri (Q = 1.0, p = 0.60, ine² = 0%) (Gulu lowonjezera 2).

3.2.3. Ntchito zina

Ntchito zina ziwiri zowunikira kusinthasintha kwazomwe zimachitika mwa anthu omwe ali ndi vuto la kutchova njuga motsutsana ndi ma HC zidadziwika: Deterministic Reversal Learning Task (DRLT; Janssen et al., 2015) ndi Ntchito Yophunzirira ya Contingency (CLT; Vanes et al., 2014).

DRLT ndi yofanana ndi PRLT koma yowongoka bwino, monga momwe chidatsutsirocho chimaneneratu zotsatila (mwachitsanzo mphotho kapena chilango) m'malo mokakamiza. Muyeso wazotsatira zazikulu ndi zolakwika pambuyo poti zisinthe, zolakwika zambiri zitatha posonyeza kuyankha. Janssen et al. (2015) sananene kuti pali vuto lililonse lokhudza anthu omwe ali ndi vuto la kutchova njuga motsutsana ndi ma HC pa ntchitoyi.

CLT imagwirizana ndi DRLT koma imakhala ndi zochitika zina zinayi, gawo limodzi lokhalo, ndi gawo lowonjezera. Zolakwitsa pakupitilira mgawo lomasuliridwalo zimamasuliridwa kuti zikuwonetsa kusazindikira. Vanes et al. (2014) sanapeze kusiyana kwakukulu mu kuchuluka kwa zolakwitsa pakati pa anthu omwe ali ndi vuto la kutchova njuga ndi ma HC.

3.3. Ntchito / kusunthira kwa chidwi

Ntchito kapena kusintha kosunthira kumafuna kuthekera kosintha pafupipafupi pakati pa ntchito kapena mitundu yoyankhira. Zimaphatikizapo kusankhidwa kowonera ndi kusamalira chidwi ndikusintha. Pomwe ntchito zokhudzana ndi chizindikiritso zokhudzana ndi mwadzidzidzi zimakhala ndi masinthidwe munthawi imodzi, ntchito / chidwi chosunthira chidwi chimakhudza ma seti angapo (mwachitsanzo, mtundu, nambala kapena mawonekedwe). Izi zimafunikira kuti munthu athe chidwi chake pazinthu zosiyanasiyana. Ntchito zitatu zonse zidadziwika mu dawuniyi: ntchito ya Wisconsin Card Sorting Task, Intra-Extra Dimensional Set-Shift ndi Switch Task.

3.3.1. Mayeso a Wisconsin

Mayeso Oseketsa a Wisconsin Card (WCST; Heaton et al., 1981) ndi ntchito yodziwika bwino kwambiri yosintha anthu. Wophunzirayo akufunsidwa kuti asankhe makadi oyankha molingana ndi mitundu itatu yazosiyanasiyana (mtundu, mawonekedwe, ndi nambala). Lamuloli limapezedwa pogwiritsa ntchito mayankho omwe aperekedwa poyankha chilichonse. Pambuyo pamanambala angapo okhazikika, lamulo limasinthidwa ndipo wophunzirayo asunthire njira yatsopano yophatikiza. Magawo oyeserera akuphatikiza kuchuluka kwa magulu omwe anamaliza, kuchuluka kwa zolakwika ndipo - ndizofunikira kwambiri pazokakamizidwa - kuchuluka kwa zolakwitsa (mwachitsanzo zolakwika pambuyo pakusintha kwa lamulo).

Kafukufuku asanu ndi anayi mwa anthu omwe ali ndi vuto la kutchova juga pogwiritsa ntchito ntchitoyi adapezeka, pomwe maphunziro asanu ndi atatu adanenanso zakusavomerezeka kwa anthu omwe ali ndi vuto la kutchova juga motsutsana ndi ma HC pamayeso amodzi (osati kupirira kwenikweni). Kuphatikiza maphunziro onse kuphatikiza anthu okwana 274 omwe ali ndi vuto la kutchova juga ndi ma 342 HC, zotsatira zazikuluzikulu zidapezeka, ndi anthu omwe ali ndi vuto la kutchova juga omwe amalakwitsa zolimbikira kuposa ma HCs (size size = 0.518; Z = 5.895, p <0.001) (Chith. 3A). Heterogeneity inali yotsika (Q = 10.9, p = 0.28, ine² = 17%) (Gulu lowonjezera 2).

3.3.2. Intran-owonjezera mawonekedwe osunthira (IED)

Mu ntchito ya Intra-Extra Dimensional Set-Shift (IED) (Robbins et al., 1998), zoyambitsa ziwiri zimaperekedwa. Chimodzi cholondola ndi chimodzi cholakwika. Pogwiritsa ntchito zowonekera, wophunzirayo amagwira chimodzi mwa ziwonetsero ziwiri ndikupatsidwa mayankho. Pambuyo poyeserera koyenera kasanu ndi kamodzi, zoyeserera ndi / kapena malamulo amasintha: poyamba, zoyesererazi zimapangidwa ndi 'gawo limodzi' (kutanthauza mawonekedwe akudzazidwa ndi utoto) ndipo zosinthazo zimakhala zozungulira (kutanthauza kuchokera ku mawonekedwe amodzala ndi utoto wina. mawonekedwe). Pambuyo pake, zisangalalozo zimapangidwa ndi "miyeso" iwiri (mwachitsanzo, mawonekedwe akudzazidwa ndi utoto ndi mizere yoyera) ndipo, gawo lomaliza, zosintha zimakhala zowonjezera (kutanthauza kuyambira paz mawonekedwe akakhala ma mzere oyera). Magawo oyeserera akuphatikiza kuchuluka kwa magawo omwe anamalizidwa, kuchuluka kwa zolakwika zozungulira, kuchuluka kwa zolakwika zowonjezera ndipo, zomwe zimafotokozedwa nthawi zonse m'maphunzirowa ndikuwonetsa kuyankha molimbika, kuchuluka kwa zolakwa.

M'maphunziro anayi omwe amagwiritsa ntchito IED, atatu adapeza kuti anthu omwe ali ndi vuto la kutchova juga amalakwitsa kwambiri kuposa HCs (Choi Et al., 2014; Odlaug Et al., 2011 ;  Patterson Et al., 2006) ndipo kafukufuku mmodzi sanapeze kusiyana kwamagulu (Manning et al., 2013). Kafukufuku wina pogwiritsa ntchito mtundu wakale wa IED (Patterson et al., 2006) sanaphatikizidwe pakuwunika kwa meta chifukwa kunanenedweratu za mayeso ena. Kuphatikiza maphunziro ena atatuwa ndi anthu onse 91 omwe ali ndi vuto la kutchova juga ndi ma 180 HC adawonetsa kuwonongeka kwakukulu mwa anthu omwe ali ndi vuto la kutchova juga pa IED (size size = 0.412, Z = 2.046, p = 0.041) (Chith. 3B). Heterogeneity inali yotsika (Q = 3.71, p = 0.16, ine² = 46%) (Gulu lowonjezera 2).

3.3.3. Kusintha ntchito

Mukugwira Ntchito (Sohn et al., 2000), kalata ndi digito zimawonetsedwa nthawi imodzi mumtundu wofiira kapena wabuluu. Kutengera mtundu wa zizindikirozi, wophunzirayo amalangizidwa kuti azingoyang'ana zilembo (zofiira) kapena digito (buluu). Kutengera ngati lembalo / nambala ndi la Consonant / losamvetseka kapena lilo /, wolankhulayo akuyenera akanikizire kumanzere / kumanja, motsatana. Kusinthasintha kwazindikiridwe kumayesedwa poyerekeza kulondola ndi nthawi ya mayesero otsatirana ndi kusintha kwa utoto ndi omwe utatha mtundu kubwereza. Phunziro lokhalo logwiritsira ntchito ntchitoyi (van Timmeren et al., 2016) sanapeze kusiyana kwakukulu pakugwira ntchito pakati pa anthu omwe ali ndi vuto la kutchova njuga ndi ma HC.

3.4. Chosamala / kukondera

Kukonda kapena kusasamala kumafuna kuthekera kuchitapo kanthu pazokopa zachilengedwe kwinaku tikunyalanyaza ena. Kusinthasintha kwazindikiritso, apa, kumatanthauzidwa ndi luso la mutu wolepheretsa kuyendetsa patsogolo, mosadukiza. Kulephera kudziletsa kuyankha mwanjira yomweyo kungayambitse zovuta. Ulalo pakati pa chidwi ndi kusinthasintha kwazacidziwitso zitha kukhala zomveka bwino kuposa momwe zinaliri m'mbuyomu ndipo ndi nkhani yotsutsana muzolemba (Izquierdo et al., 2017,, monga kusamalira mwachidwi kumatha kudaliranso ntchito zina zazikulu. Zotsatira zomwe zili patsamba lino zikukhudzana ndi kukakamizika mosadziwika. Ntchito zomwe zidaphatikizidwa pachiwonetserochi ndi Stroop (Colour-Mawu Interaction) Ntchito ndi Trail kupanga Mayeso.

3.4.1. Ntchito yotsogola

Ntchito ya Stroop (Stroop, 1935) ndi ntchito yamtundu wa neuropsychological yomwe imafuna chisamaliro chosankhidwa, kusinthasintha kwazindikiritso komanso kudziletsa. Mu ntchitoyi, wophunzirayo amaperekedwa ndi mawu amtundu (mwachitsanzo wofiyira), omwe amasindikizidwa amtundu womwewo (wosakanikira) kapena utoto wosiyana (wosavomerezeka). Kenako wophunzirayo afunsidwa kuti atchule utoto wa inki wa mawu awa. Manambala osokoneza nthawi zambiri amagwiritsidwa ntchito ngati gawo loyesa kwa Stroop Task ndikuwonetsa kuwonjezeka kwa nthawi yomwe imachitika chifukwa chakuwona mawu osavomerezeka poyerekeza ndi mawu ophatikizika. Kuwona kosokoneza kumeneku (makamaka pang'ono) kumatengera kulepheretsa kuyankha kwakanthawi kuti kuwerenga mawu. Kulephera kuletsa izi zodziwikiratu kumatha kubweretsa kusinthasintha ndipo kutsegulaku kungawoneke ngati kusinthasintha kwa kuzindikira. Komabe, kulowererapo kumadalira njira zina zamunthuzanso, monga chidwi komanso kuyankha mwachangu. Zowonadi, kugwira ntchito pa Stroop ntchito imadziwikanso kuti ikuwonetsa (kuyendetsa) galimoto.

Mwa zolembedwa za 12 zomwe zidagwiritsa ntchito ntchito ya Stroop, zisanu ndi ziwiri zidapeza zovuta zowonongeka kwa anthu omwe ali ndi vuto la kutchova njuga poyerekeza ndi ma HC, pomwe asanu sanatero. Pazowunikira meta, kafukufuku atatu sanachotsedwe chifukwa nthawi zokhazo zomwe zidanenedwa ndipo sanapeze cholowera chosokoneza (De Wilde Et al., 2013; McCusker ndi Gettings, 1997 ;  Potenza Et al., 2003). Pakufufuza kumodzi, cholozera chosokoneza chingawerengeredwe potengera nthawi zomwe zimanenedwa (zosakwanira - zonena; Lai et al., 2011). Mwa maphunziro anayi osachotsedwawa, awiri adanenanso zoyipa zoyipa kwambiri mwa anthu omwe ali ndi vuto la kutchova juga, pomwe awiri enawo sananene kuti palibe kusiyana kwamagulu. Zambiri zamaphunziro asanu ndi anayi otsala, kuphatikiza anthu a 337 omwe ali ndi vuto la kutchova juga ndi ma 404 HC, adasonkhanitsidwa ndikuwulula zomwe zachitika ndi omwe ali ndi vuto la kutchova juga omwe akuwonetsa zovuta zosokoneza pantchito ya Stroop poyerekeza ndi ma HCs (size size = 0.331, Z = 2.575, p = 0.01) (Chith. 4A). Komabe, panali kusiyanasiyana kwakukulu komwe kumayimiriridwa ndi kuchuluka kwa Q-scores (Q = 19.5, p <0.01) ndi zolimbitsa I² (59%) (Gulu lowonjezera 2). Zotsatirazi sizinafotokozeredwe ndi zina mwazosintha zomwe tidaganizira mu meta-regression (zonse p> 0.05), koma zitha kuwonetsanso zosagwirizana za zomwe zachitika, chifukwa sizinali nthawi zonse kufotokozedwa momwe ma index osokonekera amaphatikizidwa pamaphunziro onse.

3.4.2. Njira zoyeserera

The Trail kupanga Mayeso (TMT; Reitan, 1992) ndi pepala ndi cholembera, momwe wochita nawo mbali amalangizidwa kulumikiza zigawo zotsatizana mwachangu momwe zingakhalirebe molondola. Ili ndi magawo awiri: pagawo loyamba (A) mipherezero yonse ndi manambala (1, 2, 3, etc.) ndipo amene akutenga nawo mbali ayenera kulumikizitsa manambala motsatizana; pagawo lachiwiri (B) mipherezero ndi zilembo ndi manambala ndipo wophunzirayo amalangizidwa kuti azilumikiza iwo motsatana (1, A, 2, B, etc.). Izi zimafuna kuti phunziroli likulepheretse zolumikizira zokha kuti zizilumikizira manambala kapena zilembo kuti (1, 2, 3, kapena A, B, C, ndi zina), m'malo motengera izi. Kuchuluka kwa nthawi yokwanira kumaliza gawo lachiwiri la mayesowo (TMT-B) kukuwonetsa kusinthasintha kwazidziwitso komanso zovuta kukumbukira. Ngakhale kusiyana kwa BA ndi chidziwitso chowonekera cha kusinthasintha kwazindikiritso (Sanchez-Cubillo et al., 2009), TMT-B inali yodziwika bwino kwambiri pamaphunziro omwe adaphatikizidwa ndipo, ndiye zotsatira zake zomwe tidagwiritsa ntchito pakuwunika meta. Dziwani kuti taphatikiza ndi TMT-B mu domain ya Attentional bias / disengagement chifukwa kuthetsa ntchito iyi kumafuna kulepheretsa kuyankha kwadongosolo. Komabe, kusunthira kwa chidwi kumafunikiranso kuti mumalize ntchitoyi chifukwa chake ikhoza kuyikidwa pansi pa Task / Attentional Set-Shifting domain.

Kafukufuku m'modzi yekha mwa anayi omwe adagwiritsa ntchito TMT-B adapeza kusiyana kwakukulu pakati pa anthu omwe ali ndi vuto la kutchova juga ndi ma HC, pomwe otchova njuga amachita zoyipa kwambiri. Kuphatikiza maphunziro anayi awa pakuwunika meta, ndi anthu onse a 118 omwe ali ndi vuto la kutchova juga ndi ma 165 HC, tidapeza kuti anthu omwe ali ndi vuto la kutchova juga adachita zoyipa kwambiri pa TMT-B kuposa ma HCs (size size = 0.270, Z-score = 2.175, p = 0.030) (Chith. 4B). Heterogeneity inali yotsika (Q = 6.26, p <0.18, I² = 36%) (Gulu lowonjezera 2).

3.5. Kuphunzira chizolowezi

Kuphunzira chizolowezi chimakhala ndi chizolowezi chochita zinthu ngati chimangozichita mobwerezabwereza. Malinga ndi malingaliro ophunzirira oyanjana, kuphunzira kwamathandizidwe kumatha kuthandizidwa ndi machitidwe owongolera omwe ali ndi zolinga ndi azomwe amachita (Balleine ndi Dickinson, 1998). M'mbuyomu, zochita zimapangidwa ndikusinthidwa malinga ndi zotsatira zake. Popita nthawi, machitidwe omwe amakhazikika amayamba kupereka machitidwe mosintha ndipo zochita zimatsutsana ndi zotsatirazi, m'malo mwake zimadalira zovuta zothandizira. Khalidwe lokakamiza limatha kukhala chifukwa chakuwongolera komwe kumayendetsedwa ndi zolinga kapena chizolowezi chomangokhala. Mawunikidwe a kuphunzira kwa chizolowezi ayenera kuphatikiza kulunjika kwa njira ziwiri ziti zomwe zikuwongolera khalidweli. Kupirira pama paradig pophunzira mobwerezabwereza, mwachitsanzo, kumaphatikizaponso maphunziro olipiritsa malinga ndi mayanjano olimbikitsa zotsatira, koma zitha kukhala zotsatira za machitidwe onsewa (Izquierdo et al., 2017). Zitsanzo za ntchito zomwe zimayesedwa kuti ziyesere kuphunzira ndi masewera abwino opatsa zipatso (de Wit et al., 2009) komanso ntchito ziwiri (Daw et al., 2011).

Ngakhale kuphunzira chizolowezi kumapangidwa kuti achite gawo lofunikira pakusintha kuchoka ku zolinga zomwe zikuyembekezeredwa kupita kuzikakamizo, palibe maphunziro omwe adawonetsedwa omwe amayesa kuphunzira mu vuto la njuga.

4. Kukambirana

4.1. Zokambirana zambiri

Tidawunikiratu mabuku athu ndikuchita meta-kusanthula kwamaphunziro oyesa kukhudzika ndi vuto la neuropsychological mu vuto la njuga motsutsana ndi ma HC. Kukakamizidwa kudagawidwa m'magawo anayi osiyana omwe amayimira magawo osiyanasiyana azikhalidwe zolimbikitsa zomwe zimayesedwa ndi ntchito zosiyanasiyana za neuropsychological (Gulu 1). Tidapeza kuti anthu omwe ali ndi vuto la kutchova njuga, poyerekeza ndi ma HC, amawonetsa kuchepa kwa magwiridwe antchito osiyanasiyana okhudzana ndi mitsempha. Ngakhale pali kusiyana pakati pa ntchito zina, umboni womwe ukupezeka umawonetsa kuchepa kwa magwiridwe antchito pakati pa omwe ali ndi vuto la kutchova njuga poyerekeza ndi ma HC. Zotsatirazi zizikambidwa kaye pachigawo chilichonse chokhazikitsidwa musanakambirane momasuka.

M'dongosolo losintha mwazinthu zodziwika mwadzidzidzi, ntchitozi zimawonetsa zotsatira zosakanikirana (Chith. 2). Zotsatira kuchokera ku kafukufuku wogwiritsa ntchito PRLT sizinawonetse kusasinthika kwofunikira kwa anthu omwe ali ndi vuto la kutchova njuga; komabe, izi zitha kukhala chifukwa cha kukula kochepa pang'ono. China chomwe chingalepheretse zotsatirazi ndi kusiyanasiyana pakuyesa ndi magawo azotsatira pakati pa kafukufukuyu, zomwe zimawonetsedwanso ndi kukula kwakukulu kwa heterogeneity komwe kwapezeka. Pa CPT, kuwonongeka kwakukulu koyerekeza ndi kukula kwapakati kwakupezeka mwa omwe ali ndi vuto la kutchova njuga motsutsana ndi HC. Zotsatira izi zitha kukhala zofunikira kwambiri kuchipatala, chifukwa ntchito yovutikira pantchito iyi yawonetsa kuti ikudziwikiratu za kuyambiranso kwa anthu omwe ali ndi vuto la kutchova njuga (Goudriaan et al., 2008) ndi zoperewera zofananira zidanenedwa m'mavuto osokoneza bongo (Martin et al., 2000). Chosangalatsa ndichakuti, kuyankha kolimbikira pantchitoyi kumawoneka ngati kwachilendo mukamawonjezera kuyankha kolozera kwa 5 (Thompson ndi Corr, 2013). Kutanthauzira kumodzi kungakhale kuti kuyankha modzikakamiza kuli mwa kuyankha molumikizana. Kafukufuku wina adapeza kuti pomwe HCs imachepetsa kuyankha mofulumira atataya, anthu omwe ali ndi vuto la kutchova juga samatero (Goudriaan et al., 2005). Izi, kachiwiri, zitha kufotokozedwa ndikuyankha mosakakamiza, monga momwe zimanenedwera nthawi zambiri pamavuto a juga (Verdejo-García et al., 2008). Kuyanjana pakati pamakhalidwe okakamiza komanso okakamiza ndi mutu womwe tidzabwerenso pambuyo pake pokambirana.

Maphunziro omwe akupezeka akuyesa / kusunthira kwakanthawi kukuwonetsa mawonekedwe osasintha kwambiri: mu maphunziro onse, anthu omwe ali ndi vuto la kutchova juga amachita zoyipa kuposa zowongolera (Chith. 3). Zotsatira zakuwunika meta zikuwonetsa kusowa kochita bwino ndi kukula kwakakulu mwa anthu omwe ali ndi vuto la kutchova juga motsutsana ndi ma HC pa WCST komanso IED. Ma paramu oyesedwa onenedwa pantchito izi amakhala osasinthika kwambiri, omwe amawonekeranso ndi kuchepa kwa heterogeneity mkati mwa domain lino. Kutengedwa palimodzi, zotsatirazi zimapereka umboni wokwanira wa kuchepa kwa magwiridwe antchito pakusintha kwanzeru kwa anthu omwe ali ndi vuto la kutchova juga. Izi zikulimbikitsidwa ndi kafukufuku waposachedwa pogwiritsa ntchito zitsanzo zambiri zosagwiritsidwa ntchito mwazovuta za omwe amatchova njuga pafupipafupi zomwe zimawonetsa kulumikizana koyenera pakati pa zolakwa za IED ndi miyeso yosiyanasiyana yaukali, kuphatikizapo njira za DSM-5 (Leppink et al., 2016). Komabe, maphunziro omwe amayesera kuneneratu zotsatira zamankhwala atengera ntchito ya WCST mwa anthu omwe ali ndi vuto la kutchova juga (Rossini-Dib et al., 2015) kapena zovuta zogwiritsa ntchito mankhwala (Aharonovich et al., 2006) alephera.

Pazinthu zonse ziwiri zomwe zimaphatikizidwa mkati mwa kusamala mwachinyengo / kusasamala kwina, zolakwika zazikulu zakugwirira ntchito zimapezeka mwa anthu omwe ali ndi vuto la kutchova juga, okhala ndi kukula kwakang'ono mpaka pakati (Chith. 4). Zotsatira pa ntchito ya Stroop, komabe, ziyenera kutanthauziridwa mosamala popeza heterogeneity inali yokwera. Izi sizingathe kufotokozedwa ndi kuwerengetsa zaka, kugonana, IQ kapena kutsegula kwamiseche pakuwunika kwa meta-regression.

Zotsatira zake, zikuwonetsa kuti anthu omwe ali ndi vuto la kutchova juga amawonetsa mikhalidwe yolimba yomwe siigwirizana mwachindunji ndi machitidwe a juga payokha. Zolakwika izi zimatha kuphatikizidwa ndikukula ndi kukonza kwa njuga. Mwachitsanzo, kulephera kusunthira chidwi, kapena chizolowezi chochita pakaphunziridwa, zitha kupereka chiwopsezo chotukuka mikhalidwe yotukakamiza kutchova juga. Kuphatikiza apo, kuchepa kwa magwiridwe antchito awa kungakhale chifukwa cha kutchova juga kosasinthika. Munthawi zonsezi, izi zitha kukhala zokhudzana ndi zovuta zomwe zimayambitsa kusiya njuga, popeza maphunziro ambiri amayesa anthu omwe ali ndi vuto la kutchova juga omwe anali mankhwalawa. Ubale womwe ungakhalepo pakati pa zotsatira za chithandizo ndi ntchito pazogwirazi uyenera kuphunziridwa kwambiri (Goudriaan et al., 2008) chifukwa izi zimatha kupereka njira zothandizira kupewa komanso kuchitira achire. Chosangalatsa ndichakuti, njira yofananira yoperewera pantchito za neurocognitive ilipo mwa odwala OCD, vuto la prototypical la kukakamiza: kuwunika kwa meta posachedwa kwapezedwa kusowa kwakukulu pa WCST, IED, Stroop task ndi TMT-B (Shin et al., 2014). Kuchepa mphamvu pantchito izi kumawoneka kuti kukukulira mavuto ena okakamiza.

Njira zopatsa chidwi zakhala zikugwiritsidwa ntchito pofufuza momwe ma neural amathandizira kusinthasintha kwazinthu, kusintha kosunthika ndi chidwi chazosangalatsa mu maphunziro oyendetsa bwino. Magawo omwe amagwiritsidwa ntchito ndi magawo amenewa amaphatikizapo orbitofrontal cortex (OFC), malo ochezera (vlPFC), ventromedial (vmPFC) ndi dorsolateral prefrontal cortex (dlPFC) ndi basal ganglia (Fineberg Et al., 2010 ;  Izquierdo Et al., 2017). Mosadabwitsa, mayankho abwinobwino mu zigawo zofananira adawonedwa mu vuto la kutchova njuga akafunsidwa ndi ntchito yoyang'anira madera amtunduwu (omwe awunikiridwa posachedwa ndi Moccia et al., 2017). Kafukufuku wophatikizidwa mu kuwunikaku adasanthulanso magwiridwe antchito aubongo mwa anthu omwe ali ndi vuto la kutchova njuga ndi ma HC pomwe maphunziro anali kuchita ntchito zokhudzana ndi zovuta. Panthawi ya Stroop, anthu omwe ali ndi vuto la kutchova juga adawonetsa kuchepa kwa vmPFC ntchito (Potenza et al., 2003), pomwe ntchito ya vlPFC yatsika idanenedwa pa PRLT (de Ruiter Et al., 2009 ;  Verdejo-García Et al., 2015). Kafukufuku wa EEG adapeza zododometsa zomwe zimapangitsa anthu omwe ali ndi vuto la kutchova njuga nthawi ya PRLT (Torres et al., 2013). Kuchepa kwa zinthu yoyera pakati pa dlPFC ndi basal ganglia, kofunika kwambiri kuti munthu azisinthasintha, adawonedwa mwa anthu omwe ali ndi vuto la kutchova njuga (van Timmeren et al., 2016), ngakhale izi sizinali zokhudzana mwachindunji ndi kuchitira kwa chidwi kwantchito. Umboni womwe ulipo pakubwezeretsa kutchova juga umasinthika kumayang'ana anthu omwe ali ndi vuto la kutchova juga omwe akuwonetsa kuchepa kwa ntchito kwa ubongo ndi kapangidwe kake m'magawo omwe ndi ofunikira kuti azisinthasintha, azisintha, komanso azisamala.

Njira zama neurochemical zomwe zimathandizira kukakamiza sizimamveka bwino, ngakhale dopamine ndi serotonin amaganiziridwa kuti azichita mbali zazikulu (Fineberg et al., 2010). Kafukufuku wam'mbuyomu mwa anthu ndi nyama adawonetsa motsimikiza kuti kusinthasintha kwazidziwitso kumakhudzidwa komanso kusakhudzidwa ndi zonse za dopamine ndi serotonin. Mwachitsanzo, baseline dopamine synthesis uwezo mwa anthu amachititsa chidwi cha kusintha kwa maphunziro, pomwe zotsatira za mankhwala opatsirana ndi dopaminergic zimadaliranso pamagawo oyambira (Cools et al., 2009). Kuthana ndi dopamine kufooka kwa nyani, Komano, sikumakhudza kuphunzira mobwerezabwereza, pomwe kufooka kwa serotonin kumalepheretsa kusinthika osati kusunthira chidwi pokhazikika (Clarke Et al., 2007 ;  Clarke Et al., 2005). Glutamate yathandizidwanso pakuphunzira mobwerezabwereza komanso mitundu ina ya kusinthika kwanzeru, koma zotsatira zakhala zikutsutsana (Izquierdo et al., 2017) Pazovuta za kutchova juga, kafukufuku wina wanena kuti kuchuluka kwa ma dopamine kwasintha, koma zomwe zapezeka sizikugwirizana (Boileau Et al., 2013 ;  van Holst Et al., 2017) ndipo zochepa ndizodziwika za ntchito ya neurotransmitter pokhudzana ndi ntchito ya mitsempha. Pakadali pano, kafukufuku m'modzi yekha adafufuza mwachindunji ntchito ya dopamine komanso zokhudzana ndi kusinthanso kuphunzira (DRLT) mwa anthu omwe ali ndi vuto la kutchova njuga. Janssen et al. (2015) adapeza kuti, monga momwe amayembekezera, oyang'anira a sulpride (a D2-receptor antagonist) adapangitsa kuti pakhale mwayi wopindulitsa komanso wophunzitsidwa ndi zilango zamalamulo. Mwa anthu omwe ali ndi vuto la kutchova juga, komabe, sulpride sinakhale ndi vuto lililonse poyerekeza ndi placebo. Komanso, kafukufuku woyendetsa ndege adawona kuti kayendedwe ka memantine, wogwirizira wa NMDA-receptor omwe amachepetsa kusefukira kwa glutamate, amathandizira kusinthasintha kwazindikiritso (monga kuyesedwa ndi IED) ndikuyambitsa kuchepa kwa kutchova juga (Grant et al., 2010). Poganizira za kuchepa kwa maphunziro omwe amafufuza njira zamitsempha zamagetsi zomwe zimathandizira pakukakamiza mu vuto la kutchova njuga, kufufuza zochulukirapo kumafunikira.

4.2. Zolepheretsa ndi malingaliro pazotsatira zamtsogolo

Cholinga chachikulu cha kuwunikaku mwatsatanetsatane ndikusanthula kwa meta kunali kufupikitsa ndi kuphatikiza umboni wa kusokonekera kwa machitidwe a neuropsychological mu vuto la njuga lomwe lingakhale lofanana ndi kukakamiza. Komabe, kukakamizika ndi njira zovuta zopangidwira ndipo njira zowumiriza zimatha kuchitika pazifukwa zina zomwe sizinayesedwe mukuwunikaku. Zodziwika zomwe zimathandizira pakukakamiza pazinthu zomwe zimapangitsa kuti azikhala ndi nkhawa ndizovuta komanso nkhawa (Koob ndi Le Moal, 2008); Poyamba, mchitidwewo umatha kukhala ngati njira yokomera, kenako kulolerana kumakupeza koma machitidwewo atha kupitilira ngati njira yochepetsera kusasangalala. Motsogozedwa ndi zoyambitsa zoyambitsa, machitidwe oterewa amatha kumapeto kwake, kukakamizidwa mwachangu, osazindikira. Sitinawunikenso ubale komanso mgwirizano pakati pa kukakamizidwa ndi kukakamizidwa, mwachitsanzo, kuchita zinthu mwachangu musanayang'anenso. Kuchita zinthu mwachangu ndi machitidwe ophatikizika, omwe nthawi zambiri amakhudzidwa ndi chiopsezo- komanso kufunafuna mphotho, pomwe kukakamizidwa kumakhala kopanda phindu komanso kumayanjana ndi kupewa (Fineberg et al., 2010). Komabe, malingaliro onsewa amagawana kumvekera kwa kusakhoza kuwongolera, ndipo onsewa atha kulephera pakuwongolera kwawongoleredwe ka 'pamwamba-pansi'Dalley et al., 2011). Zinthu zonsezi zimatha kugwiranso ntchito: kukakamiza kumatha kuganiziridwanso poyankha mosakakamiza, kuwonetseredwa ndi kukhudzika kwakukulu mu makoswe akuneneratu kufunafuna kokakamiza (Belin et al., 2008). Chifukwa chake, kunyengerera kumatha kuyamba kukhala okakamira ndipo izi ndi njira zosangalatsa zakufufuzira mtsogolo.

Ngakhale njira zopimira zimakonda kuonedwa ngati zikhalidwe, pamakhala zovuta zina zochepera pamaasewera, zomwe zimayambitsa zovuta, zovuta zakumaso, kapena zovuta zina zomwe zitha kukhala chifukwa cha vuto la kutchova juga. Kuphatikiza apo, kukakamizidwa palokha kumatha kudalira boma (kutanthauza kukhudzana ndi matenda kapena gawo) motero akuti ndi chinthu chosasunthika chomwe sichingakhale mtundu wa endophenotype (Yücel ndi Fontenelle, 2012). Komabe, kukakamizidwa kumaonedwa ngati mkhalidwe wopusitsa womwe uli ndi vuto lalikulu la endophenotype (Robbins et al., 2012). Maphunziro a Longitudinal amafunikira kuti athane ndi mavuto awa.

Monga kukakamizika inali gawo lathu loyamba lachifundo, sitinawunikire zolakwika zina, zosakakamiza za neuropsychological mu vuto la kutchova njuga. Chifukwa chake, sitinganene chilichonse chokhudza kuphatikiza kwathu zomwe zimachitika pakuchita mokakamiza (motsutsana ndi zosakakamiza) zamagetsi omwe amagwira ntchito muvuto la kutchova juga. Kuphatikiza apo, ntchito zamanju izi zimakhudzanso njira zina (zos-) zamphamvu pakuwongolera: mwachitsanzo, kusintha ntchito ya IED pakati pa mitundu ndi mawonekedwe imafunanso kukonzanso kowoneka (Miyake et al., 2000).

Ngakhale ili ndi gawo lofunikira kwambiri monga 'chida chomangira' chamakhalidwe azokakamira, ogwirizana ndi zosokoneza bongo (Everitt ndi Robbins, 2015), pali kusowa kwathunthu kwa kafukufuku woyesera wofufuza kuphunzira muzovuta za juga. Chifukwa chake, ngati vuto la kutchova juga limadziwika ndi kuphunzira mozolowera lidakali funso lotseguka. Ngakhale ntchito zambiri zokhudzana ndi kuphunzira zizolowezi komanso chizolowezi zabwera kuchokera ku maphunziro a nyama, kafukufuku waposachedwa wanena za zovuta zomwe zimachitika pakupanga zizolowezi zogwiritsa ntchito mankhwala osokoneza bongo pakati pa anthu. Kafukufuku wam'mbuyomu wasonyeza kuchuluka kwa kuphunzira pa chizolowezi monga kumwa mowa (Sjoerds et al., 2013) ndi odwala omwe amadalira mankhwala a cocaineErsche et al., 2016). Kuwongolera komwe kumatsitsidwa kwa cholinga cholumikizidwa-kumakhala kolumikizidwa ndi 'zovuta zakakamizika' (kuphatikiza kudya matenda ovutika kudya, kusokonezeka-kukakamizika kwa mavuto komanso kugwiritsa ntchito mankhwala osokoneza bongo; Voon et al., 2014); kudalira mowa (Sebold et al., 2014, koma onani Sebold et al., 2017); ndi chizindikiro cha kuphatikizika kwa mawonekedwe okakamiza ndi malingaliro osakanika pamitundu yayikulu ya maphunziro owongolera athanzi (Gillan et al., 2016).

Njira yathu imapereka njira zofufuzira ndi kuzindikira lingaliro lokakamizika trans-wosazindikira, komwe kumathandizanso kulosera za chiopsezo ndikutsata machitidwe othandizira komanso mankhwala Robbins et al., 2012). Kafukufuku wamtsogolo amalimbikitsidwa kuti apange kufananizidwa pakati pa vuto la kutchova juga ndi 'zovuta zina zokakamiza'. CPT, WCST, ndi IED zimawoneka kuti ndizovuta kwambiri kusankha zoperewera, makamaka mwa anthu omwe ali ndi vuto la kutchova njuga. Ngakhale zinali zosakwanira kuti tiwunikenso izi mwadongosolo, kafukufuku wina wophatikizidwa muchiwunikachi anayerekezera anthu omwe ali ndi vuto la kutchova juga ndi zovuta zogwiritsa ntchito mankhwala ( Albein-Urios Et al., 2012; Choi Et al., 2014; de Ruiter Et al., 2009; Goudriaan Et al., 2006; Goudriaan Et al., 2005; Torres Et al., 2013; Vanes Et al., 2014 ;  Verdejo-García Et al., 2015), zizolowezi zamakhalidwe ( Choi Et al., 2014 ;  Zhou Et al., 2016) kapena matenda ochititsa chidwi kwambiri (Hur et al., 2012). Mwambiri, maphunziro awa amawonetsa zoperewera pamagulu omwe ali ofanana ndi ( Albein-Urios Et al., 2012; Goudriaan Et al., 2006; Goudriaan Et al., 2005; Psa Et al., 2012; Vanes Et al., 2014 ;  Zhou Et al., 2016) kapena kuposa (Choi et al., 2014) kuposa omwe ali ndi vuto la kutchova juga.

Pamavuto otchova njuga, otchova juga amathanso kugawidwa m'magulu ang'onoang'ono. Kafukufuku wam'mbuyomu wachita izi m'njira zingapo: kutengera zomwe amakonda kutchova juga (mwachitsanzo, makina olowera kapena kasino; Goudriaan et al., 2005), yozikidwa pa comorbidity kapena mawonekedwe a umunthu (mwachitsanzo, kukhumudwa, kufunafuna kapena kusakopa; Álvarez-Moya et al., 2010), kapena kutengera zomwe amalimbikitsa kutchova juga (mwachitsanzo, kuthana ndi nkhawa kapena kukhumudwa; Stewart et al., 2008). Pakuyerekeza kusinthasintha kwazomwe zachitika, kafukufuku wina adapeza kuti otchova juga pa kasino adapirira kwambiri pa CPT, pomwe otchova makina ogwiritsira ntchito makina amagwiritsa ntchito njira (yovutitsanso) (Goudriaan et al., 2005). Kafukufuku wamtsogolo atha kuzindikira mitundu yamagulu, yamagulu amisala (mkati ndi pakati pamavuto amisala) mwa kufufuza momwe magwiridwe antchito amtunduwu amagwirira ntchito komanso momwe munthu aliyense amagwirira ntchito. Njira imodzi yokwaniritsira odwala komanso kumvetsetsa njira zomwe zimapangitsa kuti ntchito ikhale yovuta, ndikugwiritsa ntchito njira zosavuta, mwachitsanzo, 'computational psychiatry' (Akulu Et al., 2016 ;  Maia ndi Frank, 2011). Kuti tisiyanitse magawo angapo a ntchito yolumikizana yokhudzana ndi kukakamiza yomwe singatengeke pogwiritsa ntchito njira zamakedzana, zitha kukhala zopindulitsa ku (re) kusanthula deta yomwe ilipo pogwiritsa ntchito mitundu ya ma computational (Lesage et al., 2017).

4.3. Kutsiliza

Mu kuwunikaku kwatsatanetsatane komanso kusanthula kwa meta, tafufuza magawo anayi a mitsempha omwe amawonedwa kuti ndi othandizira makamaka pakukakamiza muzovuta za juga. Kuti izi zitheke, tidasankha zochita zomwe zimayesa ntchito zazikulu zomwe zikuwonetsa chilichonse cha zinthuzi. Zotsatira zake zoyenera komanso zochulukirapo zikuonetsa kuti anthu omwe ali ndi vuto la kutchova juga, akuwonetsa kusowa kwa magwiridwe antchito, kusinthasintha, komanso chidwi, ngakhale kuti palibe kafukufuku yemwe amafufuza chizolowezi chogwiritsa ntchito vuto la njuga. Pazonsezi, izi zimathandizira lingaliro loti vuto la kutchova juga limadziwika ndi kukhudzika kwokhudzana ndi kukhudzika kwa mitsempha, monga momwe zimaperekedwera pakupirira komanso kuzindikira kusinthika. Komabe, monga tanena kale, kupanga mapu amtundu wa neuropsychological pamagawo osiyana amakakamizika nthawi zonse kumakhala kovuta. Chifukwa chake, kufunika kwatsalira ndikukonzanso ndikutanthauzira kutanthauzira komanso kugawa pakukakamiza, zomwe zingathandize kupititsa patsogolo kafukufukuyu.

Kupatula kuti ndizofunikira pakuvutika kwa kutchova juga palokha, zomwe zapezazi zingakhale ndi tanthauzo lalikulu. Poona vuto la kutchova juga ngati chizolowezi chomwe chimafanana ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo popanda zovuta zoyipitsidwa ndi kayendetsedwe ka mankhwala, zotsatirazi zimachirikiza malingaliro omwe akukhudzika kwa kukakamizika amalosera zamakhalidwe oyenera (Leeman ndi Potenza, 2012). Mwakutero, zimapereka kulumikizana komwe kungakhalepo pakati pa kusokonezeka mu ntchito zotsogola zokhudzana ndi kukakamizidwa kuchitapo kanthu komanso kusatetezeka kwa chizolowezi ndipo zingathandizire kukhazikitsa endophenotype yamavuto okhudzana ndi kukakamira (Gottesman ndi Gould, 2003).

Support

Kafukufukuyu adathandizidwa ndi thandizo lochokera ku The European Foundation for Alcohol Research (ERAB), [nambala yothandizira EA 10 27 "Kusintha ubongo wosavutikira: kafukufuku wa neuromodulation pakudalira kwa mowa"] komanso ndi VIDI (NWO-ZonMw) thandizo [ nambala ya 91713354] kupita ku AEG. Othandizira awa analibe mphamvu pa pepalalo.

Olemba onse adawunikiranso mozama zomwe zalembedweratu ndipo adavomereza zomaliza kuti zitha kufalitsidwa.

Mikangano ya chidwi

Palibe.

Zothokoza

Ndife othokoza kwambiri prof. Dr. Wim van den Brink chifukwa chamtengo wapatali. Tili othokoza a José C. Perales, Kelsie T. Forbush ndi Lieneke K. Janssen chifukwa cha mayankho awo othandiza pazofunsa za data; ndi Jente M. Klok ndi Nikki M. Spaan popereka ziwonetsero zabwino za maphunziro omwe anaphatikizidwa.