Kusokonezeka (Matendawo kapena Vuto) Kutchova Njuga ndi Axis I Matenda a Maganizo: Zotsatira Kuchokera ku National Epidemiological Survey Surveillance and Poor Conditions (2011)

MAFUNSO: Kafukufuku wapadera wamtali. Ndinazindikira kuti kutchova juga kwa pathological kumatha kubweretsa zovuta zamagetsi, PTSD, nkhawa, ndi zina, 3 zaka pambuyo pake. Mwanjira ina, chizolowezi chimayambitsa kusokonezeka kwa malingaliro, m'malo mopsinjika ndi zomwe zikuwoneka ngati vuto. Tiyenera kukhala osamala kuganiza kuti zovuta zam'maganizo komanso zamaganizidwe zimakhalapo kale. 

Ndine J Epidemiol. 2011 Jun 1; 173 (11): 1289-1297.

Idasindikizidwa pa intaneti 2011 Apr 5. do:  10.1093 / aje / kwr017

PMCID: PMC3139964

Nkhaniyi yakhala wotchulidwa ndi nkhani zina mu PMC.

Pitani ku:

Kudalirika

Cholinga cha olemba paphunziroli chinali kuwunika momwe magwiridwe osokoneza bongo ali pachiwopsezo chotsatira chodziwikiratu Kusanthula ndi Buku Lophatikiza la Mavuto a Mitsempha, Kutulutsa Kwachinayi, Axis I matenda osokoneza bongo atasinthira zochitika zamankhwala, moyo wokhudzana ndi thanzi, komanso zochitika zovuta m'moyo. Omwe anakhazikika mmadera ochokera kumayimidwe oyimira mayiko a US (n = 33,231) adafunsidwa mu 2000-2001 ndi 2004-2005.

Kutchova juga kwa zaka zam'mbuyomo kumayenderana ndi kupezeka kwa vuto lililonse lamisala la Axis I, vuto la kusokonezeka kwa maganizo, kusokonezeka kwa mitsempha, nkhawa yamavuto, nkhawa yamavuto obwera pambuyo pake, vuto lililonse logwiritsa ntchito mankhwala osokoneza bongo, mavuto obwera chifukwa cha mowa a mitundu yosiyanasiyana.

Pambuyo pakusintha kwakanthawi kachipatala, moyo wokhudzana ndi thanzi, komanso zochitika zaposachedwa kwambiri m'moyo, kutchova juga kosasinthika kunakhalabe kokhudzana kwambiri ndi vuto la kusokonekera kwa mitsempha, kusokonezeka kwa nkhawa, kusokonezeka kwa zovuta zam'mbuyo, zovuta za kumwa mowa, komanso kudalira mowa. Zotsatira zakuchipatala pazomwe zapezazi ndikuti opereka chithandizo akuyenera kuwunikira odwala otchova juga kuti asokonezeke, nkhawa, komanso kugwiritsa ntchito mankhwala osokoneza bongo ndikuwunika momwe zinthu zina zingakhudzire mtsogolo.

Keywords: comorbidity, njuga, kusokonezeka kwa malingaliro

Kutchova njuga, komwe kumadziwika kuti kumatanganidwa kwambiri ndi kutchova juga, kulephera kudziletsa, "kuthamangitsa" kuwonongeka, ndikupitiliza juga, ndi imodzi mwazovuta zomwe zimayambitsa vuto Kusanthula ndi Buku Lophatikiza la Mavuto a Mitsempha, Kutulutsa Kwachinayi (DSM-IV). Kutengera kufufuzidwa kwa anthu ammudzi, kuwerengera komwe kumachitika pakubwera kwa njuga kwa moyo wonse akuti kuyambira 0.4% mpaka 4.0% ku United States (1-3). Kugawikaku nthawi zambiri kumatanthawuza anthu omwe amakumana ndi 5 yosachepera ya DSM-IV njira ya njuga yamatumbo (4). "Kutchova njuga yamavuto" ndi mawu omwe amagwiritsidwa ntchito pofotokoza za juga ya 3 kapena 4 DSM-IV m'malo mwa njira ya 5, kuwonetsa kuti mchitidwe wa njuga ndi wovuta koma umaperewera pakuzindikira njuga. Kafukufuku waposachedwa waposachedwa akuti pafupifupi 2.5% ya anthu ku United States ndi Canada akwaniritsa njira zobweretsera njuga zovuta (5). Mavuto onse awiriwa komanso njuga zam'magazi zimalumikizidwa ndi mtengo wokwanira wa anthu, mabanja awo, ndi gulu (6, 7); Chifukwa chake, kuchokera pakuwona zaumoyo wa anthu, ndikofunikira kupenda makhalidwe a juga a 2 awa. Chifukwa chake, mu phunziroli tidawona njuga komanso zovuta za njerewere limodzi (mwachitsanzo, kutchova juga mosasiyanitsa) monga kutha kwakumapeto kwa chizolowezi chomapitiliza juga, chomwe chachitika m'maphunziro am'mbuyomu8, 9).

Ngakhale kafukufuku wakale adanenanso kuti pali mgwirizano pakati pa kutchova juga ndi DSM-IV Axis I matenda amisala (1, 2, 10, 11), momwe magawo omwe amagwiritsidwira ntchito mu kafukufukuyu anathandizira kuti ofufuzawo akhazikitse dongosolo lakanthawi kwakanthawi pakati pamavuto amiseche ndi zovuta zamisala, ngakhale m'modzi mwa maphunziro amenewo adagwiritsa ntchito zaka zoyambiranso kuti akhazikitse dongosolo lakale (2). Kuphatikiza apo, chifukwa njuga yosasinthika imalumikizidwa ndi kuyendetsa bwino ntchito (12, 13,, kuchepetsa moyo (12-14,, makamaka zamankhwala (12,, ndi ziwopsezo zambiri zokumana ndi zochitika za moyo zovuta ngati kusowa kwa ntchito, chisudzulo, ndi kufalikira (7), zinthu zomwezi zimapezekanso kuti zimagwirizanitsidwa ndi matenda a Axis I (15-17). Chifukwa chake, chifukwa izi zimatha kukhala ndi vuto pa kusokonezeka kwa kutchova juga komanso matenda a Axis I, ndikofunikira kuti zinthu zododometsazi zizilamulidwa pakuwunika maubwenzi omwe ali ndi vuto la kutchova juga ndi matenda amisala. Mpaka pano, maphunziro apakati pano sanasinthe pazinthu zofunika izi (1, 2, 10). Kudzaza mipata iyi, tidali kuyesa mayanjano am'mbuyomu omwe adasokonezeka kale ndi zovuta za Axis I zamisala yokhudzana ndi malingaliro a 3 pambuyo pake, titatha kusintha magwiridwe antchito aumoyo, zikhalidwe zamankhwala, moyo wokhudzana ndi thanzi, ndi zochitika zovuta m'moyo.

ZIDA NDI NJIRA

Chiwerengero cha ophunzira

Tinagwiritsa ntchito mafunde ochokera mafunde 1 (2000-2001) ndi 2 (2004-2005) la National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Wave 1 wa NESARC adafufuza zitsanzo zoyimira za anthu wamba a 43,093 azaka za 18 kapena okalamba omwe akukhala m'mabanja aku US, akuwonjezera anthu akuda ndi a ku Spain ndi akulu achinyamata azaka za 18-24 (18, 19). Pambuyo kupatula omwe amafunsidwa omwe sanayenere kuyesedwa ndi mafunde a 2 chifukwa anali atamwalira (n = 1,403), adachotsedwa kapena anali ndi nkhawa kapena ziwalo (n = 781), kapena anali akugwira ntchito mokhala ndi gulu lankhondo nthawi yonse yotsatira (n = 950), wave 2 idachitika zaka 3 pambuyo pake; kuchuluka kwakuyankha kunali 86.7%, kuwonetsa kuyankhulana kwapamaso kwa 34,653. Zambiri za Wave 2 zidalemedwa kuti ziwonetse mawonekedwe a NESARC, kuwerengetsa ndalama zochulukirapo, kusayankha, komanso kukhalapo kwa nthawi iliyonse yamafunde a 1 NESARC kapena matenda ena amisala; Kusintha kumeneku kunachitika ponse pa banja komanso paudindo wina aliyense (20). Zambiri zolemera pamenepo zidasinthidwa kuti ziyimire anthu wamba ku United States pokhudzana ndi kusintha kwa chikhalidwe cha anthu pamaziko a 2000 decennial US Census. Chifukwa chakusowa kwa zina zomwe zimaphatikizidwa mu kafukufukuyu, tinayang'ana kwambiri maphunziro a 33,231 pakuwunikaku.

Njira

DSM-IV yazindikira za matenda amisala omwe adayesedwa ndi Alcohol Use Disorder and Associated Disability Interview schedule — DSM-IV Version (AUDADIS-IV) (21,, wave 2 mtundu (22), yomwe idapangidwa kuti idzagwiritsidwe ntchito ndi akatswiri owafunsa mafunso. Matenda amisala a Axis I adawunikidwa chimodzimodzi m'mafunde 1 ndi ma 2 matembenuzidwe a AUDADIS-IV, kupatula mafelemu a nthawi. Nthawi yamoyo komanso 12-mwezi wazofufuza zamavuto amisala adapezeka mu wave 1, pomwe 12-mwezi ndi 3-wazaka wazaka zowunikira adawerengedwa ngati wave 2. Pakufufuzira zochitika, okhawo omwe amafunsidwa omwe sanadziwe matenda omwe anafunsidwa pachiwonetsero cha maziko ndi omwe adaphatikizidwa pakuwunikira, ndipo kudalirika kwakukulu kunali kuzindikira kwa 3 wazaka zazaka zamankhwala ku wave 2. Palibe malamulo azolowera kuwunika omwe amagwiritsidwa ntchito panjira iliyonse, kupatula kuti kuwunika kwazomwe kumagwiritsidwa ntchito pazomwe zimapangitsa kuti pakhale kusokonezeka kwakukulu komanso kusokonezeka kwa kupuma.

Mu mafunde 1 ndi 2, kusokonezeka kwapamtima kwa DSM-IV kunaphatikizapo kusokonezeka kwakukulu, dysthymic disorder, ndi bipolar (I kapena II) matenda. Mavuto a nkhawa akuphatikizidwa ndi mantha a nkhawa (omwe ali ndi kapenaorororbia), phokoso laling'ono ndi achindunji, nkhawa yamavuto ambiri, komanso vuto la nkhawa ya posttraumatic (PTSD). Njira za AUDADIS-IV zomwe zimagwiritsidwa ntchito kuti zizindikire izi zimafotokozedwa mwatsatanetsatane kwina (21, 23-28). Kuyeserera kwa mayeso (maappu a kappa) a AUDADIS-IV amawunika amomwe amachititsa nkhawa komanso nkhawa m'magulu ambiri komanso mawonekedwe azachipatala amachokera pamwambwende kupita pazabwino (κ = 0.40-0.77) (29-31). Kutsimikizika kotembenukira kunali kwabwino kwa mawonekedwe onse amisala komanso nkhawa21, 24-26, 28, 32-34), ndipo kufufuzaku kunawonetsa mgwirizano wabwino (κ = 0.64-0.68) ndi reappraisals ya psychiatrist (29).

Mafunso ochulukirapo mu AUDADIS-IV adavomereza njira ya DSM-IV yodalira nikotini, kumwa mowa mwauchidakwa komanso kugwiritsa ntchito mankhwala osokoneza bongo, komanso kudalira magawo a 10 a zinthu (amphetamines, opioids, sedatives, tranquilizer, cocaine, inhalants / sol sol, hallucinogens, cannabis , heroin, ndi mankhwala ena). Kuzindikira koyeserera kwa DSM-IV kunapangitsa kukhalapo kwa 1 kapena zambiri za njira za 4, pomwe njira yothetsera kudalira kwa DSM-IV imafuna kuti 3 kapena zambiri za njira zotsalira za 7 zikwaniritsidwe. Kudalirika komwe kumayesedwa kwa AUDADIS-IV pazovuta za kugwiritsidwa ntchito kwa mankhwala kwapezeka kuti kumakhala kwabwino kwambiri (κ = 0.70-0.91) pama sampuli azachipatala komanso anthu ambiri (29-31, 35-37). Kusintha kotheka, kusankhana, ndikupanga kuvomerezedwa kwa njira yogwiritsira ntchito mankhwala a AUDADIS-IV zalembedwa bwino (38-41), kuphatikizapo zolembedwa mu World Health Organisation / National Institutes of Health International Study on Reliability and Validity (42-47), komwe kuthandizidwanso kwachipatala kunawonetsa kuvomerezeka koyenera kwa DSM-IV mowa wokhudzidwa ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo (κ = 0.54-0.76) (29, 42).

Zambiri zokhudzana ndi momwe woyankhayo adasokoneza njuga adazipeza pogwiritsa ntchito njira ya 10 DSM-IV yofotokozera njira zopezera njuga zamatumbo. Zogwirizana ndi maphunziro am'mbuyomu pogwiritsa ntchito data ya NESARC (10, 48-51), kufufuza kwa njuga kwa mwezi wa 12 kwa mwezi umodzi kumafuna kuti wofunsayo akwaniritse njira zosachepera za 3 za chaka chatha ndikuti wanena kuti kutchova juga nthawi zosachepera 5 chaka chatha. Onse omwe sanayang'aniridwe kuti anali ndi vuto la kutchova njuga adawagawa ngati otchova njuga osawerengera, kuphatikiza omwe sanatchogone konse pamoyo wawo. Kusasinthika kwamkati pazinthu zonse za chizindikiritso ndi njira za njuga zamatumbo zinali zabwino kwambiri, ndipo kuvomerezeka kwa sikeloyo kunakhazikitsidwa (1).

Zosiyanasiyana za Sociodemographic, kuphatikizapo kugonana, zaka, maukwati, gawo la maphunziro, mtundu / fuko, ndalama zapabanja, ndi ntchito pa wave 1, zidaphatikizidwa pamitunduyi. Kuphatikiza apo, machitidwe azachipatala, moyo wokhudzana ndi thanzi, komanso zochitika zovuta m'moyo pa wave 1 zidaphatikizidwanso ngati zinthu zosokoneza m'mitunduyi. NESARC idasanthula kuchuluka kwa zaka zapitazo zamankhwala a 11: arteriosulinosis, matenda oopsa, matenda ena a chiwindi, angina, tachycardia, kulowetsedwa kwa myocardial, matenda ena amtima, zilonda zam'mimba, gastritis, ndi nyamakazi. Omwe adafunsidwa adafunsidwa ngati dokotala kapena katswiri wina wazachipatala adazindikira matendawa. Moyo wokhudzana ndiumoyo unayesedwa pogwiritsa ntchito Short Form 12 Health Survey — Version 2 (SF-12) (52). Matupi achidule am'magazi SF-12 zowerengera zinawerengedwa. Mndandanda wazomwe zachitika 12 m'moyo waposachedwa (zomwe zidachitika mchaka chathachi asanafike funde 1) zidaphatikizidwanso. Zochitika 12 zovuta pamoyo zinali: kumwalira kwa wachibale kapena bwenzi lapamtima; kudwala kwambiri kapena kuvulala kwa abale kapena abwenzi apamtima; kusamukira nyumba yatsopano kapena kukhala ndi achibale atsopano; kuchotsedwa ntchito kapena kuchotsedwa ntchito; osakhala pantchito ndikusaka ntchito kwa mwezi wopitilira 1; kukhala ndi vuto ndi bwana kapena mnzako; kusintha kwa ntchito, maudindo antchito, kapena nthawi yogwira ntchito; kulekana kapena kusudzulana kapena kutha ndi chibwenzi chokhazikika; kukhala ndi vuto ndi mnansi, mnzako, kapena wachibale; kukumana ndi mavuto azachuma; kulowa m'mavuto ndi apolisi, kumangidwa, kapena kutumizidwa kundende (mwina wotenga nawo mbali kapena wachibale); ndikukhala wozunzidwa (mwina wochita nawo kapena wachibale).

Njira zobwereza

Anthu anachulukitsa kuchuluka kwa anthu omwe anafunsidwa mafunso osiyanasiyana popanda kuwalimbikitsa kutchova juga. Mitundu yoyendetsera zinthu yoyendetsedwa bwino inali yoyenera kuyesa mayanjano osakanikirana ndi chikhalidwe chilichonse cha anthu. Kuphatikiza apo, ma 5 magawo azomwe amalemba pamalonda adagwiritsidwa ntchito kuti awone kuyanjana pakati pa zaka zapitazi zomwe zimagwiritsa ntchito njuga pamasewera ndi zovuta zamkati, nkhawa, ndi zovuta zogwiritsa ntchito pazinthu zamagetsi pazaka zotsatila za 3 zaka. omwe amafunsidwa okha omwe sanazindikire moyo wawo wonse pazovuta zomwe amafunsidwa pa wave 2 adaphatikizidwa pakuwunikira). Mitundu yoyamba yasinthidwa mokha mikhalidwe yamakhalidwe omwe amawerengera phunziroli. Kuphatikiza pa chikhalidwe cha anthu komanso chikhalidwe chazomwe zazindikira za vutoli lomwe likufunsidwa, mitundu yachiwiri, yachitatu, komanso yachinayi imasinthidwanso kupezeka kwa mawonekedwe azachipatala a 1, zowerengera za SF-11 zowerengera zaumoyo komanso zokhudzana ndi thanzi, komanso zochitika za 12 zosautsa m'moyo, . Mtundu womaliza nthawi imodzimodzi udaphatikizapo onse omwe atchulidwa pamwambapa.

Zambiri zidasanthulidwa ndi SUDAAN 9.0 (Research Triangle Institute, Research Triangle Park, North Carolina), pulogalamu yamapulogalamu yomwe imagwiritsa ntchito Taylor mndandanda wazolowera kusintha momwe angapangire njira yovuta ya NESARC. Kuti tisinthe pamayeso angapo owerengera, timayika mulingo wofunikira pamayeso onse ku P <0.01 kuchepetsa zolakwika zamtundu wa I ndikuwonjezera mwayi woti zotsatilazi zidzafotokozedwenso pamaphunziro amtsogolo. Zolakwitsa zonse komanso kudalira kwa 99% kudasinthidwa pakukonzekera kwamakanema 2 NESARC.

ZINTHU

Kukula konse kwa njuga zosasinthika mu phunziroli panali 0.60% (99% chidaliro: 0.51, 0.71). Zomwe zimapezeka pakubwera kwa juga pakati pa amuna ndi akazi omwe anali ofunsidwa ndi 0.82% (99% chidule pakudzikhulupirira: 0.66, 1.02), ndi 0.40% (99% chidule chodalirika: 0.30, 0.53), motsatana. Gulu 1 imapereka kufalitsa kwa mitundu yosiyanasiyana ya mitundu ya anthu omwe ali ndi njuga zopanda ena osazungulira. Kusokonekera kwa zinthu zodziwikiratu kunawonetsa kusiyana kwakukulu pakati pa otayika osagwirizana komanso osagwirizana pa kugonana, maphunziro, ndi mtundu / fuko. Kukhala munthu wamkazi kumachepetsa zovuta za kutchova juga. Ponena za kuchuluka kwa maphunziro, kukhala ndi maphunziro aku yunivesite, kuyerekeza ndi kukhala ndi maphunziro ochepera pasukulu yasekondale, kunachepetsa zovuta za kutchova njuga. Pomaliza, kukhala wachi Spanish wokhala mzungu kunalumikizananso ndi kumachepetsa kwa mayendedwe osatha a njuga. Kusiyana kwakukulu komwe sikunapezeke pazaka, banja, ndalama zapantchito, kapena ntchito.

Gulu 1.  

Makhalidwe a Sociodemographic a Anthu Omwe Ali ndi Njuga Zosasinthika za Zaka Zakale (n = 33,231), Kafukufuku wa National Epidemiologic pa Mowa ndi Zogwirizana, 2000-2005a

Gulu 2 imapereka ziwonetsero zosagwirizana ndi ubale pakati pa zaka zam'mbuyomu zomwe zakhala zikutha njuga, monga zimayesedwa ndi wave 1, komanso zochitika za matenda amisala ya Axis I m'masiku otsata a 3. Pambuyo pakusintha kwa chikhalidwe cha anthu omwe amayeza ma wave 1, anthu omwe anena kuti chaka chatha njuga yasokonezeka amatha kwambiri kukhala ndi vuto lililonse la matenda amisala a Axis I, vuto la kusokonezeka kwa maganizo, kusokonezeka kwa mitsempha, kusokonezeka kwa nkhawa, PTSD , vuto la kugwiritsa ntchito moledzera, komanso vuto lodalira zakumwa zoledzeretsa mkati mwa zaka zotsatila za 3. Kuyanjana kwa magwirikwidwe osagwirizana ndi vuto la kupumula kunakhala kopanda tanthauzo pambuyo pakusintha kowonjezereka kwa kukhalapo kwa zovuta zamankhwala za 11 pama wave 1. Kuyanjana kwakukulu kwa magwirikwidwe osokonezeka omwe ali ndi vuto la kupuma kwa matenda osokoneza bongo komanso vuto lililonse logwiritsa ntchito mankhwala osokoneza bongo silinalinso lofunika kwambiri patatha kusintha kwina kwa zotsatira zaumoyo wa SF-12.

Gulu 2.  

Zomwe Zachitika Zaka Zitatu Za DSM-IV Axis I Kusokonezeka Kwa Maganizo ndi Zokhudzana ndi Odds Ratios, lojambulidwa ndi Matenda Osewerera Njuga (n = 33,231), Kafukufuku wa National Epidemiologic pa Mowa ndi Zogwirizana, 2000-2005

Tidasintha zomwe takumana nazo pazovuta za 12 m'mbuyomu chaka chisanafike wave 1, maubale omwe abwera chifukwa cha kutchova juga ndi vuto lililonse la Axis I, vuto la kupuma, komanso vuto lililonse logwiritsa ntchito mankhwala limakhala losapindulitsa. M'mitundu yotsiriza yomwe imasinthika mosiyanasiyana pakasinthidwe ka mtundu wa anthu, kupezeka kwa njira zakuchipatala za 11, kuchuluka kwa zochitika zaumoyo wa SF-12, komanso zovuta za m'moyo zama 12, magwiridwe osagwirizana anakhalabe ogwirizana kwambiri ndi kusokonezeka kwa mitsempha, kusokonezeka kwa nkhawa, PTSD , mavuto obwera chifukwa chomwa mowa, komanso kudalira mowa.

KUKANGANANI

Kafukufuku wopitilira pamiyeso wapeza chiyanjano chofunikira pakati pa magalimoto osokoneza bongo ndi DSM-IV Axis I matenda osokoneza bongo (1, 2, 10, 11, 51). Kafukufuku wapano ndiwachiwonetsero chifukwa amatithandizira kumvetsetsa kwakasokonezeka kwa kutchova njuga pogwiritsa ntchito woyimira dziko, wobiriwira, kapangidwe kofufuzira pomwe tikugwirizananso kusintha kosiyanasiyana kosokoneza komwe kumadziwika kuti kumalumikizana ndi vuto la kutchova njuga komanso matenda amisala. Zotsatira zazikuluzikulu zakufufuzaku ndikuti 1) njuga zakale za 1 zomwe zidasokonekera zaka zapitazo zimalumikizidwa ndi zovuta zowonjezereka za zovuta zina zamisala za Axis I pazotsatira za 3 pambuyo pake ndi 2) maubwenzi ambiri ofunikabe adakhalapo pambuyo pake kusintha kwamodzimodzi pakasinthidwe kazovuta kosiyanasiyana, kuphatikiza zochitika zamankhwala, zochitika zamankhwala, kuchepa kwaumoyo wathanzi, ndi zochitika zina zovuta m'moyo.

Pakufufuza kwaposachedwa, kutchova juga kosagwirizana kumangolosera za matenda ena amisala, makamaka, kusokonezeka kwa kupuma, vuto la nkhawa, PTSD, vuto la kugwiritsa ntchito mowa, komanso vuto la kudalira mowa, komanso vuto lililonse la Axis I, matenda amiseche, mankhwala osokoneza bongo. Kupatula zochepa chabe (vuto lililonse la Axis I, vuto lililonse logwiritsa ntchito mankhwala, ndi kusokonezeka kwa maubweya), maubwenzi ofunikawa adatsalirabe ngakhale titasintha zonse zomwe zimasinthanitsa; Kusintha kochititsa nthumanzi sikunayankhe chifukwa cha maubwenzi awa ndipo samatha kufotokoza mgwirizano pakati pa kusuta kwa njuga komanso vuto la matenda amisala a Axis I. Zotsatira izi zikuwonetsa kuti kupezeka kwa kutchova njuga komwe kumatha kusokonezeka kumatha kulosera zam'tsogolo zovuta zilizonse, nkhawa zamatenda ambiri, PTSD, kumwa mowa kapena kudalira pang'ono ndipo mwina sangayambire kupsinjika, kukomoka, kusokonezeka, kusuta phobia , kudalira kwa chikonga, ndi zovuta zogwiritsa ntchito mankhwala. Malongosoledwe othekera amachitidwe awa pazomwe zapezekazi sangathe kudziwa zambiri zomwe zikupezeka, koma kufufuzanso mtsogolomo pamakina oyambira kungakhale kokondweretsa.

Zotsatira izi zikufanana ndi kafukufuku wakale wamgwirizano wapakati pakubedwa kwa njuga ndi zovuta za Axis I zomwe zidagwiritsa ntchito zidziwitso zakale komanso zidziwitso zakubadwa koyambira (2). Mu kafukufukuyu, zidapezeka kuti vuto la kutchova juga limalosera za kusinthaku, PTSD, nkhawa zilizonse, chidakwa kapena kudalira mankhwala osokoneza bongo, kudalira kwa chikumbumtima, vuto lililonse logwiritsa ntchito mankhwala, komanso vuto lililonse posintha zaka, kugonana, ndi mtundu / fuko, ngakhale kuti zomwe zapezazi ziyenera kutanthauziridwa mosamala chifukwa chodalira data yomwe ikubwezeretseka. Ngakhale zimachitika pakati pa kafukufuku wakaleyu (2) ndi zomwe zapezedwa, kafukufuku wapanoyo akutithandizanso kumvetsetsa kwathu ubale womwe ulipo pakati pa kutchova juga ndi Axis I ndikusokonekera ndikugwiritsa ntchito njira zazitali, zoyembekezeka, kuphatikizidwa kwa zinthu zingapo zomwe zingakhale zosokoneza, ndikuwunika kwa zovuta zakumwa ndi kugwiritsa ntchito mankhwala osokoneza bongo.

Zachidziwikire, ubale wapakati pa magwiridwe osagwirizana ndi vuto la kumwa mowa anali wopezekeratu m'zitsanzo zonse. Komabe, ubale wamphamvu pakati pa magwirikwiyiti osagwirizana ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo silinapezeke mumitundu iliyonse. Zotsatira izi zikuwunikira kufunika kokuwerenga zakumwa zoledzeretsa ndi kugwiritsa ntchito mankhwala osokoneza bongo m'magulu osiyanasiyana m'malo mongowerengera gulu lonse logwiritsa ntchito mankhwala. Maubwenzi apakati pa juga osagwirizana ndi mowa komanso kugwiritsa ntchito mankhwala osokoneza bongo sangakhale omwewo, omwe ali ndi tanthauzo lalikulu pa mfundo zaumoyo wa anthu zokhudzana ndi malamulo a njuga ndi mowa. Zitha kuti kumwa mowa kumachitika kawiri kawiri kumachitika ndi juga poyerekeza ndi kugwiritsa ntchito mankhwala osokoneza bongo, chifukwa mowa ndi chinthu chovomerezeka chomwe chimagulitsidwa pamalo a juga. Malo ena otchova juga amaloleza kumwa mowa pamene malo otchovera juga amaloledwa kugwiritsa ntchito malo oledzera omwe amaloledwa kumwa, kutanthauza kuti wosuta amayamba kumwa mowa usanayambe kapena utatha. Kuphatikizana komwe kumachitika mu njuga ndi mowa kumatha kufotokozera chifukwa chomwe njuga zosasakanikirana zimangophatikizidwa ndi zovuta zowonjezereka zamavuto osokoneza bongo. Gulu lazogwiritsa ntchito zinthu lokha silingathe kudziwa kusiyana komwe kulipo mu zibwenzi izi.

Malinga ndi zaumoyo wa anthu, zomwe zapezeka mu kafukufukuyu ndizofunikira chifukwa zikuwonetsa kuti mavuto amtundu wa juga amatha kubweretsa zovuta zina m'maganizo. Kulephera kuwongolera machitidwe anu otchova juga ndikuyamba kukhala ndi vuto lotchova juga kumatha kubweretsa mavuto pamoyo wamunthu. Anthu omwe ali ndi vuto lalikulu lotchova juga nthawi zambiri amafotokoza zovuta monga kuwononga ndalama zambiri kutchova juga kuposa momwe amafunira, kulephera kusiya kapena kusiya njuga, komanso kutchova juga kuiwala zovuta kapena kukhumudwa, ndipo nthawi zambiri amalemba kuti kutchova juga kwabweretsa mavuto abwenzi ndi abale (53). Matenda okhudzana ndi njuga zomwe zawonongeka amatha kubweretsa nkhawa komanso nkhawa zomwe zingayambitse vuto, kuda nkhawa, komanso mavuto obwera chifukwa chogwiritsa ntchito zinthu. Momwemonso, kwa anthu ena kutchova juga kumatha kukhala njira yovuta yolimbana ndi mavuto am'maganizo, kuphatikizapo kukhumudwa kapena kuda nkhawa, komwe kumakulitsa mavuto ndi Zizindikiro, zomwe zimatsogolera kukumana ndi zovuta zina zamaganizidwe a Axis I.

Kafukufuku wowonjezeranso pakati pa ubale wakanthawi pakati pa kutaya njuga ndi Axis I wamavuto amisala ndikofunikira chifukwa ndizothekanso kuti matenda amisala a Axis I amayamba kale kapena nthawi yomweyo ndi mavuto amtundu wa juga. Zambiri zomwe zilipo zokhudzana ndi mgwirizano wapakanthawi wa ubale uno (54). Mwachitsanzo, kafukufuku wina waposachedwa adapeza kuti kuvutika maganizo kunali kotheka kuchitika asanachitike mavuto a njuga pambuyo pake (55), kuwonetsa kuti anthu ena amatha kugwiritsa ntchito njuga ngati njira yovomerezeka yopewera vuto lakelo, pomwe ena amatha kukhumudwa chifukwa cha zovuta zawo zotchova juga. Kessler el al.'s (2) Kafukufuku wa 2008 adawonetsa kuti kuwonjezera pamavuto otchova juga oneneratu zakusokonekera kwa nkhawa, nkhawa, komanso kugwiritsa ntchito mankhwala osokoneza bongo nthawi zina, njuga zamatenda zimapezekanso pambuyo pa matenda amisala angapo a DSM-IV, kuphatikiza nkhawa, malingaliro, kudziletsa, komanso zinthu zina zovuta zamagwiritsidwe, kwa anthu ena. Kuyesa ubale wobwereza wama Axis I wamavuto amisala omwe ali ndi vuto lotchova juga sikunatheke mu kafukufuku wapano, chifukwa njuga zimayesedwa kokha koyambirira. Izi ndizocheperako poyerekeza kafukufuku wapano.

Mphamvu zakufufuzira pano zikuphatikiza kugwiritsa ntchito chitsanzo chachikulu, choimira dziko lonse; kapangidwe ka kuphunzira kotenga nthawi yayitali; njira zofunsira kumaso; kuphatikizidwa kwa zida zodalirika zodziwikirira; ndi kusintha kwamodzimodzi kwa zosinthika zingapo zomwe zingakhale zosokoneza. Komabe, zomwe zapezeka paphunziro lilipoli ziyenera kuganiziridwa molingana ndi zolephera zingapo. Choyamba, zonse zokhudzana ndi matenda amisala adapangidwa mwa kuyankhulana koyenera kochitidwa ndi omwe adafunsidwa mafunso, komabe njira iyi yowunikira siyingafanane ndi kuyesedwa koyesedwa ndi dokotala wazachipatala wodziwa ntchito. Chachiwiri, machitidwe azachipatala adakhazikitsidwa podzidziwitsa okha za matenda omwe adokotala adawapeza ndipo sanatsimikizidwe kuchokera kochokera pawokha. Ngakhale njirayi imagwiritsidwa ntchito pakufufuza kwina njuga (56), ndizotheka kuti anthu ena adanenanso zachipatala zomwe sizingafanane ndi zomwe dokotala adziwa. Kuphatikiza apo, kusanena zina mwazotheka mwina kumachitika ngati wofunsayo ali ndi vutoli koma anali asanapatsidwe kuti adziwe za dokotala. Matenda khumi ndi anayi adayesedwa mu izi, koma izi sizikuyimira mndandanda wonse. Chachitatu, zochitika zingapo pamoyo zowunika zidawunikidwa pakadali pano, koma mndandanda wazomwe zimapangitsa kuti moyo ukhale wopanikizika suwonedwa ngati wokwanira. Chachinayi, kuwunika kwa kutchova juga pamavuto oyambira sikungalolere kuyesedwa kwa ubale wobwereza wamavuto amisala a Axis I ndi zomwe zachitika kapena kutchova juga kosalekeza. Pomaliza, matenda opatsirana amisala adayesedwa poyambira ngati amodzi mwa ma covariates omwe tidagwiritsa ntchito pakuwunika kwathu, koma zomwe adazipeza pamoyo wawo zidadzidziwika zokha ndipo motero amatha kukumbukira kukondera.

Zotsatira zakufukufuku wapano ndizofunika pazachipatala. Zotsatira za kafukufukuyu zimapereka umboni woti kutchova juga kosokonezeka kumatha kubweretsa zochitika komanso kusokonekera kwa matenda a Axis I ndikuti maubwenzi ofunikirawa sangathe kufotokozedwa ndimitundu ya anthu, zikhalidwe zamankhwala, kuchepa kwa moyo wathanzi, kapena zochitika zovuta pamoyo. Othandizira amafunika kuwunika otchova juga pamavuto amisala, nkhawa, komanso kugwiritsa ntchito mankhwala osokoneza bongo ndikuwunika zizindikiritso zakukula kwa zovuta zamtsogolo. Chifukwa mavuto amtundu wa juga ndi comorbid Axis I amisala amisala atha kulumikizidwa, zikuwoneka kuti chithandizo chamankhwala chitha kuchepa ngati mavuto amtundu wa juga amathandizidwa padera pomwe matenda ena amisala, kuphatikiza nkhawa, nkhawa, komanso kugwiritsa ntchito mankhwala osokoneza bongo, kulipo. Kwa anthu ena, kutchova juga kumatha kubweretsa zovuta kapena nkhawa kapena kufunitsitsa kumwa mowa kuti athane ndi mavuto. Kuyeserera kuchitapo kanthu kuthana ndi machitidwe otchova juga okha osayang'ana pazokhudzana ndi nkhawa, zizindikiritso, kapena zizolowezi zakumwa kumatha kudzetsa chithandizo chochepa. Chofunikanso, ndikofunikira kupanga mankhwala othandizira omwe angagwirizane ndi zosowa zaumoyo wamunthu ndikuwunikanso mosamalitsa mankhwalawa kuti athe kutsimikizika pogwiritsa ntchito njira zozikira umboni.

Kuvomereza

Mabungwe olemba: Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China (Kee-Lee Chou); ndi Departments of Community Health Science, Psychiatry, and Family Social Science, University of Manitoba, Winnipeg, Manitoba, Canada (Tracie O. Afifi).

National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) idachitidwa ndikuthandizidwa ndi National Institute on Alcohol Abuse and Alcoholism (NIAAA), mothandizidwa ndi National Institute on Drug Abuse.

Olembawa amathokoza NIAAA ndi oyimira m'minda ya US Census Bureau omwe adayang'anira zokambirana za NESARC ndikupangitsa kuti zithandizire.

Dr. Kee-Lee Chou anali ndi mwayi wodziwa zambiri mu phunziroli ndipo amatenga nawo mwayi pakukhudzika kwa chidziwitsocho komanso kulondola kwa kafukufukuyo.

Mikangano yosangalatsa: palibe amene adalengeza.

Zakumapeto

achidule

AUDADIS-IVMafuta Ogwiritsira Ntchito Mowa Komanso Ndondomeko ya Mafunso Osiyanasiyana a DSM-IV
DSM-IVKufufuza ndi Kusanthula Buku la Mavuto a Mitsempha, Chachinayi
NESARCKafukufuku wa National Epidemiologic pazokhudza Mowa ndi Zinthu Zina Zogwirizana
PTSDposttraumatic stress disorder
SF-12Short Fomu 12 Health Survey — Version 2

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