MAFUNSO: Zikuwonekeratu kuchokera ku kafukufukuyu kuti njuga zamatenda amawonetsa matenda a neurobiology okhudzana ndi zosokoneza bongo. Adapeza kuchepa kwa madera oyendetsera mphotho muzowina ndi zotayika, mosiyana ndi kuwongolera kwanthawi zonse. Kupeza kwina ndikuti zoyambitsa zofunikira zaumwini sizinayambitse oyendetsa mphotho. Izinso zimapezeka mu zizolowezi zosokoneza bongo. DSM yatsopano idzawonetsa kutchova juga kwa matenda osokoneza bongo ngati chizolowezi.
Hum Brain Mapa. 2010 Nov; 31 (11): 1802-12.
de Greck M, Enzi B, Prösch U, Gantman A, Tempelmann C, Northoff G.
Dipatimenti ya Psychology ku Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. [imelo ndiotetezedwa]
ZOKHUDZA
Omwe amatchova juga amakopeka ndikutanganidwa kwambiri ndi kutchova juga, komwe kumabweretsa kunyalanyaza zokopa, zokonda, ndi machitidwe omwe kale anali ofunikira. Matenda a Neurobiologically omwe amayendetsa mphotho amayendetsa njuga zamatenda. Kuti tiwone kuyanjana kwa zomwe zapezedwa, tidasanthula otchova juga a 16 osagwiritsa ntchito mankhwala pogwiritsa ntchito fMRI paradigm yomwe imaphatikizapo ntchito ziwiri zosiyana: kuwunika kofunikira kwaumwini ndi ntchito yamalipiro yomwe imagwira ntchito ngati malo othandiza. Omwe amatchova juga adawulula kuchepa kwa kuchepa panthawi yazachuma pamagawo ena amphatso zathu, maukosi amanzere amanzere ndi ma putamen akumanzere. Kuphatikiza apo, pomwe otchova njuga amawona kufunikira kwakufunika kwakumunthu, tidapeza kuchepa kwa zochitika zamitsempha m'magawo athu onse ampikisano, kuphatikiza ma nucleus accumbens ndi kumanzere kwa ventral putamen cortex poyerekeza ndi kuwongolera koyenera. Tidawonetsa kwa nthawi yoyamba zomwe zasintha zochitika za ma neuronal pakuzungulira kwamalipiro panthawi yofunikira mwa otchova njuga. Zomwe tapeza zitha kupereka chidziwitso chatsopano pamalingaliro am'maganizo aomwe otchova njuga amatanganidwa ndi kutchova juga.
MAU OYAMBA
'' Simunamve bwino, 'iye anatero. '' Simunataye moyo, zokonda zanu zokha komanso zomwe mukuchita, gulu lanu monga munthu komanso nzika, anzanu (ndipo mudali nawo onsewo) - simunangosiya chilichonse chomwe mungafune moyo, kupatula kupambana pa mpikisano - mwasiya nazo zokumbukira. ''
Dostoyevsky, Gambler, 1867
Wolemba mabuku waku Russia Dostoyevsky akufotokoza ziwiri mwazizindikiro zazikulu za kutchova juga kwa m'matenda, zomwe akatswiri azamisala masiku ano amakhala ngati amalakalaka kutchova juga komanso kunyalanyaza zofuna zawo zomwe anali zodzikondweretsa kale. Zolemba zamakono zodziwitsa [DSM-IV, American Psychiatric Association, 1994; ICD-10, World Health Organisation, 1992] imayerekezera kutchova njuga ngati matenda osokoneza bongo. Komabe, zomwe zimafanana ndi zovuta zomwe zimapangitsa, monga kumwa mowa mwauchidakwa komanso kumwa mankhwala osokoneza bongo a cocaine, amalola kuti pakhale malingaliro atsopano. Kutchova juga kwachidziwitso kumatha kuwonedwa ngati vuto losagwirizana ndi vuto losagwirizana [Reuter et al., 2005].
Kugawidwa kwa njuga yamatenda am'magazi monga vuto losagwirizana ndi vuto losagwirizana ndi malingaliro osokoneza bongo kumawonetsa zodetsa nkhawa zokhudzana ndi mphotho monga omwe ali osokoneza bongo. Zoterezi zapezeka mu nyukiliya (NacC) / ventral striatum (VS), putamen, ventromedial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC), dera la ventral tegmental (VTA) [mwachidule onani Knutson ndi Gibbs, 2007 ; McClure et al., 2004; O'Doherty, 2004; chifukwa cha mayanjano osokoneza bongo komanso zokongoletsa mphoto onani Martin-Soelch et al., 2001; Volkow et al., 2004, 2007a]. Reuter et al. [2005] inafufuza zochitika zama neuronal za otchovera njuga pogwiritsa ntchito kulingalira kwa khadi ndi fMRI. Pakulandila ndalama, adapeza kusintha kwa mitsempha m'magawo a otchova njuga kuphatikiza VS yoyenera ndi VMPF poyerekeza ndi maphunziro oyendetsa bwino. Kuphatikiza apo, olemba adapeza kusiyana kwakumapeto kwa zochita za mitsempha pakati pakupeza ndalama ndi kutayika m'mituyi.
Potenza et al. [2003], yemwe amafufuza otchova jekeseni a pathological akugwira ntchito ya Stroop, adapeza kuti ntchito ya VMPFC yafupika. Komabe mu kafukufuku wosiyana, dera lomwelo lidawonetsa zochulukira muzochita za juga nthawi yayitali jack ntchito yokhala ndi mphotho yazachuma poyerekeza ndi ntchito yomweyo popanda iyo [Hollander et al., 2005]. Pakuwonetsedwa pazakuchita njuga, zochitika zochepetsetsa za madera ena monga OFC, thalamus, ndi basal ganglia, adawonedwanso [Potenza et al., 2003]. Zotsatira izi zitha kuphatikizidwa ndi zomwe zapezeka mu matenda okhudzana ndi zinthu monga kumwa mowa mwauchidakwa komanso kugwiritsa ntchito mankhwala osokoneza bongo a cocaine. Monga otchova njuga, odwala zidakwa adawonetsa kuchepa kwa mitsempha mu VS panthawi yopeza ndalama [Wrase et al. 2007] ndikuchepetsa ntchito ya dopamine ya striatal panthawi yogwira methylphenidate monga amayeza ndi PET kugwiritsa ntchito [11C] -raclopride [Volkow et al., 2007b]. Odwala omwe ali ndi Cocaine adawonetsa kuchepa kwa ntchito ya neuronal panthawi yamalipiro azachuma ku OFC, lateral prefrontal cortex, ndi mesencephalon pakati pa ena [Goldstein et al., 2007]. Pomaliza, Tanabe et al. [2007] yawonetsa zochitika zosinthika za neuronal panthawi yopanga zisankho mu ventromedial pre mbeleal cortex ndi madera ena, kuwonetsa kufanana kwa njuga yama pathological ndi zovuta zina zosokoneza.
Kutengedwa palimodzi, zomwe apezazi zikuwonetsa kufunikira kwakufunika kwa kubwereketsa njuga pamagetsi amtundu komanso kufanana ndi zovuta zina zomwe zimakonda. Malinga ndi Reuter et al. [2005], kuyika pang'ono kotere kwa mphotho kumatha kuwonetsa modabwitsa. Izi zimathandizanso kukulitsa mwayi wokhutira ndi olimbitsa monga njuga, cocaine, kapena mankhwala ena ozunza kuti alandire gawo lokwanira la magwiridwe antchito.
Chizindikiro china chochititsa chidwi cha kutchova juga kwa matenda ndi kusinthika kofunikira pakufunika kwanu. Odwala amatanganidwa kwambiri ndi kutchova juga motero amayamba kunyalanyaza zolimbikitsa zomwe ena amachita kale. Mwamaganizidwe, kuunika kwa kufunikira kwaumwini kapena kukhudzana kwanu, monga momwe maphunziro am'mbuyomu adatchulira [de Greck et al., 2008, 2009; Kelley et al., 2002; Northoff ndi Bermpohl, 2004; Northoff et al., 2006; Phan et al., 2004], akufotokoza kufunikira kwake komanso momwe anthu amakhalira pafupi ndi iwo omwe amakumana ndi zolimbikitsa. Neurobiologically, ntchito zomwe zimakhudzana ndi malingaliro okhudzana ndi kudzikonda, chifukwa chake kufunikira kwamunthu kwakhudza zigawo kuchokera kumadera amalipiro monga NACC, VTA, ndi VMPFC [de Greck et al., 2008; Northoff et al., 2006; Northoff et al., 2007; Phan et al., 2004].
Kufunsidwa kwa kufananizidwa kwa mphotho chifukwa cha kukhudzika kwakukulu kumabweretsa funso lofunika pakati pa kukonza kwa mphotho ndi kukonza zoyenera kuchita. Pakufufuza koyambirira kwa gulu lathu, ntchito zofunikira kwambiri zomwe zimapangitsa zochitika za neuronal makamaka zigawo zomwe zimakhudzidwa ndi ntchito yamalipiro m'maphunziro athanzi [de Greck et al., 2008]. Posachedwa, gulu lathu anapezanso kuti odwala omwe amamwa zidakwa adawonetsa kuchepa kwa ntchito ya neuronal mu malipo circry (mwachitsanzo, kumanzere ndi kumanja kwa NACC / VS, VTA, VMPFC) pakaunikira zoyeserera ndizofunikira kwambiri poyerekeza ndi kuwongolera wathanzi [de Greck et al., 2009] kuwonetsa kuti kusintha kwa machitidwe kumachitika chifukwa cholephera kugwira ntchito pakulipila malipiro pakaunikira kokuthandizira kwakukulu.
Cholinga chathu chachikulu chinali kuphunzira kuti tipeze mayendedwe abwinobwino a anthu otchova njuga. Mwachindunji, tidagwiritsa ntchito paradigm kuti tifufuze momwe ntchito ya neuronal imayendera pobwereketsa za ochita kubera zam'mbuyomu pantchito yonse yolipira yopanga ndalama ndi zotayika, komanso pantchito yomwe imafuna kuti adziyang'anire pawokha, zomwe maphunziro ake adavota , chakudya kapena mowa, monga zamtengo wapamwamba kapena wotsika. Malingaliro athu anali awiriawiri. Choyamba, timayembekezera kubwereza zomwe Reuter et al. [2005] powonetsa kuti ma pathologist omwe amawonetsa ma pathological akuwonetsa kuchepa kwa ntchito ya neuronal m'magawo amphatso panthawi ya mphotho. Komanso, timafuna kuwonjezera zomwe zapezazo posiyanitsa zopindulitsa ndi zotayika. Timalosera kuchepa kwapang'onopang'ono panthawi yazopeza zachuma komanso kuchepa pang'ono pakukayika ndalama. Chachiwiri, potengera zidziwitso za kuchipatala komanso zomwe tapeza mu zakumwa zoledzeretsa [de Greck et al., 2009], tidayambitsa zochitika zosokonekera pamalipiro oyang'anira panthawi ya kuwunika makamaka pokhudzana kwambiri ndi kutchova njuga poyerekeza ndi kuwongolera koyenera.
KUKANGANANI
Tinafufuza mayendedwe amalipiro pakuwunika kufunikira kwa otchovera njuga. Kubwereza zomwe Reuter et al. [2005], otchovera njuga adawonetsa kuchepa kwa ntchito ya neuronal mu NACC yapakati ndipo asiyira mbali yamkati panthawi yamalipiro. Kupitilira zomwe tapezazi, tawonetsa kuti otchova juga wazakutsogolo adawonetsa kusintha m'magawo amphatso yomweyo pakaunikidwe kofunikira poyerekeza ndi maphunziro abwino. Kutengedwa palimodzi, ife, kwanthawi yoyamba, tikuwonetsa zonyansa zam'mimba mukulipiritsa kufatsa kwa otchova jekisoni panthawi yowunikira kufunikira kwake.
Kusintha Kwa Mphoto Kuzungulira Pathological Gambler Pa Nthawi Yopanda Ndalama ndi Zotayika
Zambiri zathu ndizogwirizana ndi zomwe Reuter et al. [2005] yemwe wapeza kusiyana kwakumapeto kwa zochitika za neuronal panthawi yopambana ndalama komanso kutayika. Kuphatikiza pa izi tinatha kuwonjezera zotsatira zawo m'njira ziwiri. Choyamba, tidawonetsa kuti kusiyana kwa ntchito ya ma neuronal pakati pa opambana ndi kutayika kumayambira pakuwoneka wofooka kwambiri mu NACC yakumanzere ndi gawo lamanzere lamanzere pazinthu zotayika osati kuchokera kuntchito yaying'ono panthawi yopambana.
Kusintha mu Mphoto Zazungulira Pathological Gambler Panthawi Yowunikira Kukhudzika Kwaumwini
Zotsatira zochititsa chidwi za kafukufuku wathu zimakhudza kusintha kwa ubongo mu nthawi ya kuwunika kwa ogwiritsira ntchito njuga. Monga momwe timayembekezera tinapeza kuchepa kwakukulu kwa zochitika za mitsempha m'magawo atatu a mphotho (kumanzere ndi kumanja kwa NACC, lamanzere lamanzere) pakuwunikira kukondweretsa kwakukulu. Zotsatira izi zikugwirizana ndi malingaliro athu komanso zimapangitsa kuchepa kwa mitsempha yowongolera pamalipiro omasulira omwe amatchova juga panthawi yogwira ntchito kwambiri. Zomwe tapezazi zikugwirizana ndi zam'mbuyomu zomwe gulu lathu lidakali ndi zidakwa zomwe zimawonetsa kuchepa kwa minyewa poyang'anira mphoto pomwe akuwona zoyeserera zakufunika kwambiri [de Greck et al., 2009]. Komanso monga mwa zidakwa zakumwa, izi kuchepa kwa minyewa munthawi yake yokhudzana ndi kutchova njuga ndizoyenerana ndi kuwunika kwakanthawi kokhudzana ndi chikhalidwe chamunthu chofunikira kuyambira chizolowezi chofunikira kwambiri mpaka kutchova juga monga ntchito yokhayo payekha. Kungoganiza kumeneku kumathandizidwa ndi kupezeka kwathu komwe akuti otchova njuga amatchulidwa kuti amatchova juga nthawi zambiri amakhala odzikwaniritsa okha poyerekeza ndi maphunziro athanzi.
Chofunika kwambiri, zomwe tapeza zikuwonetsa kwa nthawi yoyamba kuti kusintha kwazamankhwala ndi kachitidwe kamalingaliro ka kufunikira kwaumwini kungafanane ndi kusokonezeka kwa mitsempha yolimbitsa thupi pakubweza. Komanso, zomwe zimapangidwa kuti ndizofunikira kwambiri pamapeto pake zimalephera kuchititsa ma neuronal kugwira ntchito yamalipiro. Chifukwa chake, molingana ndi zolemba zam'mbuyomu [Reuter et al., 2005], wina anganene kuti chifukwa chakuwoneka kuti akulephera kulimbikitsa mayendedwe awo olimbikitsidwa ndi zolimbikitsa zokhudzana kwambiri ndi izi, odwala awa atha kukakamizidwa kufunafuna zochitika zomwe zingalimbikitse kwambiri monga kutchova juga kapena kugwiritsa ntchito mankhwala osokoneza bongo kuti apange machitidwe oyambira oyambira momwe amapezera mphotho.
Zofooka za Mbadwa
Pomaliza, tiyenera kuganizira njira zomwe ophunzira ake sangathe kuphunzira. Choyambirira komanso chofunikira, lingaliro lofunikirana kapena lokha kukhala lokhazikika lingamveke kukhala losamveka bwino komanso / kapena motsutsana. Tinagwiritsira ntchito lingaliro kuchokera ku maphunziro am'mbuyomu pazokhudza kukhudzana kwanu komanso kudziyanjana [de Greck et al., 2008, 2009; Northoff ndi Bermpohl, 2004; Northoff et al., 2006, 2007] yomwe idalola maphunziro kuti afotokozere momveka bwino ngati kupangitsika komwe kunaperekedwa kunali kofunika kwambiri kapena kotsika. Ngakhale lingaliro ili la kufunika kwake ndi njira yofalikira, komabe tidasankha kukhazikitsa gawo lathu.
POMALIZA
Phunziroli, tawonetsa gawo lofunikira la kupatsana mphotho mumasewera a njuga. Ochita kutchova juga samangowonetsa kuchepa kwa ntchito ya mitsempha munjira zoperekera mphoto (kumanzere kumanja ndi kumanja kwa NACC, kumanzere kwamitsempha yamkati) pazopeza ndalama komanso zotayika, komanso, komanso kwakukulu, pakuwunikira chidwi ndi kukhudzika kwakukulu. Ngakhale maphunziro opatsa chidwi amaonetsa ntchito zambiri pobwereketsa bwino ndalama pakaunikiridwe kake, oyendetsa njuga amalephera kuwonjezeka. Zotsatira izi zitha kupezeka kuti, m'kupita kwanthawi zitha kupezeka kuti zikugwirizana ndi kuwunika kwa zina zomwe zikuchitika (zomwe kale zinali zofunikira) komanso kuchuluka kwathunthu pakutchova juga.
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