Matenda a njuga ndi zizoloŵezi zina zamakhalidwe: kuzindikira ndi chithandizo (2015)

Harv Rev Psychiatry. 2015 Mar-Apr; 23(2):134-46. doi: 10.1097/HRP.0000000000000051.

Yau YH¹, Potenza MN.

Kudalirika

Ogwiritsa ntchito mankhwala osokoneza bongo komanso anthu akuzindikira kuti zizolowezi zina zosagwiritsa ntchito mankhwala osokoneza bongo-monga kutchova juga, kugwiritsa ntchito intaneti, kusewera masewera apakanema, kugonana, kudya, komanso kugula-zimafanana ndi kudalira mowa ndi mankhwala osokoneza bongo. Umboni womwe ukukula ukuwonetsa kuti mikhalidwe imeneyi imafuna kuti anthu aziganiza ngati osakonda kapena osagwiritsa ntchito "zizolowezi" ndipo zatsogolera mgulu latsopanoli la "Zinthu Zokhudzana ndi Zinthu Zosokoneza Bongo" mu DSM-5. Pakadali pano, vuto lokhala njuga lokha ndilomwe lidayikidwa m'gululi, osakhala ndi chidziwitso chokwanira cha zizolowezi zina zoyeserera kuti aphatikizidwe. Kuwunikaku kukufotokozera mwachidule kupita patsogolo kwaposachedwa kwakumvetsetsa kwathu kwamakhalidwe, kumafotokozera zamankhwala, ndikuwunikira mayendedwe amtsogolo. Umboni wapano ukusonyeza kuti pakati pa zizolowezi zina zokhudzana ndi machitidwe ndi zosokoneza bongo mu phenomenology, epidemiology, comorbidity, njira za neurobiological, zopereka za majini, mayankho azithandizo, komanso kuyesetsa kupewa. Kusiyana kulinso. Kuzindikira zizolowezi zamakhalidwe ndikukhala ndi njira zoyenera zowunikira ndizofunikira kuti tiwonjezere kuzindikira za zovuta izi ndikupititsa patsogolo njira zopewera ndi chithandizo.

Keywords: chizolowezi chamakhalidwe, kuzindikira, kutchova njuga, kusokonezeka kwa masewera pa intaneti, ma neurobiology

Zowonongera zakhala zikufunsidwa kuti zikhale ndi zigawo zingapo zomasulira: (1) kupitilizabe kuchita zinthu mosasamala kanthu za zotsatirapo zoyipa, (2) kuchepa kudziletsa pakuchita zinthu, (3) kukakamiza kuchitapo kanthu mchitidwewu, ndi (4) chidwi kulimbikitsa kapena kusirira mtundu usanayambe kuchita zomwezo.^1-3 Ngakhale, kwa nthawi yayitali, mawuwo osokoneza limangotanthauza kutanthauza zakumwa zoledzeretsa komanso zosokoneza bongo, liwu lachi Latin (onjezera) kuchokera kumene idachokera kuti⁴ Ofufuzawo ndi ena adazindikira posachedwapa kuti machitidwe ena amafanana ndi kudalira mowa komanso kugwiritsa ntchito mankhwala osokoneza bongo, ndipo apeza zomwe zikuwonetsa kuti mikhalidwe imeneyi ndiyofunika kuti iwoneke ngati yopanda pake kapena zikhalidwe.^1,5,6 Lingaliro limakhalabe lotsutsana. Kuchita nawo kwambiri zinthu monga kutchova njuga, kugwiritsa ntchito intaneti, kusewera masewera apakanema, kugonana, kudya, komanso kugula zinthu kungayimirane ndi vuto.⁷ Ochepa ochepa a anthu omwe amawonetsa machitidwe oterewa amawonetsa kuti akuchita chibwenzi kapena mokakamiza.^8,9

Pali maumboni angapo osinthika akuwonetsa kuwonekera pakati pa mikhalidwe iyi ndi kudalira kwa mankhwala malinga ndi kutengera kwachipatala (mwachitsanzo, kulakalaka, kulolerana, zizindikiro za kusiya), comorbidity, mbiri ya neurobiological, heritability, ndi chithandizo.^9,10 Kuphatikiza apo, zikhalidwe ndi zosokoneza bongo zimagawana zinthu zambiri m'mbiri yachilengedwe, phenomenology, ndi zotsatira zoyipa. Mitundu yonseyi ya kuledzera nthawi zambiri imayamba ndi unyamata kapena uchikulire, ndipo ziwonetsero zambiri m'magulu azaka kuposa akulu akulu.¹¹ Mitundu yonse iyi yaukadaulo ili ndi mbiri yachilengedwe yomwe imatha kuwonetsa mozama komanso mobwerezabwereza, ndipo m'njira zonsezi, anthu ambiri amadzichitira okha zinthu popanda kulandira chithandizo.¹²

Pali zambiri zomwe zikuyenera kumvedwa, komabe, m'gawo latsopanoli lazomwe anthu amakonda kuchita. Kuphatikiza apo, pali mipata yambiri pakati pa kafukufuku wamtsogolo ndi kagwiritsidwe ntchito kake pochita kapena ndondomeko zamagulu. Kuphika kumeneku, mwanjira ina, kukuwonekera kwa anthu pakuwonera zikhalidwe. Pomwe kugwiritsa ntchito mankhwala osokoneza bongo kumakhala ndi zovuta komanso zovuta zoyipa, zomwe zimakhudzana ndi zizolowezi (mwachitsanzo, kusabereka mkati mwa banja,^13,14 kumangidwa¹⁵ ophunzira kusukulu zakale,¹⁶ mavuto azachuma^17,18) nthawi zambiri samanyalanyazidwa ngakhale zitawakhudza bwanji anthu ambiri. Kuphatikiza apo, chifukwa choti kuchita zina zomwe zingakhale zowoneka bwino zimatha kuchita komanso zimasinthasintha, anthu omwe amatha kusintha njira zolakwika atha kuwoneka ngati ofooka ndikuyamba kusala. Chifukwa chake, kufufuza, kupewa, ndi kuyesetsa kuchitira chithandizo kuyenera kuthandizidwa, ndipo kuyesetsa kwamaphunziro kumakulitsidwa.

MISANGANO YA DSM-5

Kukhazikitsa dzina laling'ono ndi njira zomwe anthu angatsatire pokonda kuchita zinthu zina zabwino zimawonjezera kuthekera kwathu ndikuzindikira kupezeka kwawo. Munthawi yachisanu yomwe yatulutsidwa Kusanthula ndi Buku Lophatikiza la Mavuto a Mitsempha (DSM-5),¹⁹ Kusintha kwakukulu ndikudziyanjananso kwa njuga ya m'magazi (yotchedwa "njuga zosasinthika") kuchokera ku gulu la "Impulse Control Disways Not Pena Kuli Gulu Lanu" kukhala m'gulu latsopanoli la "Zogwirizana Ndi Zogwirizana". Nthawi yatsopano ndi gululi, ndi malo awo m'bukhu latsopanoli, zimawonjezera kukhulupilira kwamalingaliro azikhalidwe; Anthu atha kukhala okakamira komanso osachita nawo zinthu zina zomwe sizimakhudzana ndi zakumwa zamankhwala osayenera, ndipo machitidwe awa atha kufotokozeredwa mkati mwa chizolowezi chomangosinirana mawu ngati mawu osiyana amodzimodzi.² Ngakhale kutchova juga kosagwirizana ndi vuto lokhalo lomwe limaphatikizidwa m'chigawo chachikulu cha DSM-5, zina zambiri zaphatikizidwa mu gawo lachitatu-gawo la DSM-5 momwe mikhalidwe yomwe imafunikira kufufuza kwina. Makamaka, gulu la olemba la DSM-5 lalemba "vuto la masewera a pa intaneti" ngati munthu wofuna kulowa nawo m'gululi. Ngakhale kuphatikizidwa kwa vutoli kwakanthawi kovomerezeka kwa DSM-5 kuyimira patsogolo, kufunikira kwa kugwiritsidwa ntchito kwamavuto pa intaneti komanso masewera olakwika kungakhale kopanda pake; zotsatila zake zitha kukhala mipata pakufufuza pamavuto ogwiritsa ntchito intaneti omwe sagwirizana ndi masewera (mwachitsanzo, malo ochezera a pa Intaneti) kapena pamasewera ovuta omwe sagwirizana ndi kugwiritsa ntchito intaneti.²⁰

Ndemanga iyi ionetsa zomwe zapezeka posachedwa zaubongo, ma genetic, ndi chithandizo chamankhwala pazakumwa zamakhalidwe. Atsindika za njuga zosasinthika popeza ndi njira yabwino yophunzirira mpaka pano. Zizolowezi zina zokhudzana ndi chikhalidwe, ngakhale kuti sizinaphunzire bwino, zakhala zikulandiridwa kuchokera kwa ofufuza ndi asing'anga ndipo zidzafotokozedwanso muwuniwu. Kenako tikambirana kufanana ndi kusiyana pakati pa zizolowezi zokhudzana ndi zosokoneza bongo ndi zomwe zimagwiritsidwa ntchito pazinthu zina.

NJIRA

Kufufuza mabuku kunachitika pogwiritsa ntchito nkhokwe ya PubMed yolemba nkhani za Chingerezi zokhudzana ndi zomwe amakonda. Malipoti a milandu ndi maphunziro omwe ali ndi zowerengera zosakwanira sizinaperekedwenso kuwunikaku. Chifukwa cha mawu ochulukirapo omwe amagwiritsidwa ntchito pofotokozera mkhalidwe uliwonse, zinthu zosaka zinaphatikizapo mayina ambiri omwe amapezeka m'mabuku. Mwachitsanzo, kufufuzidwa kunapangidwa ngati "kugwiritsa ntchito intaneti," "kugwiritsa ntchito intaneti", komanso "kugwiritsa ntchito intaneti zovuta." Ndikofunikira kudziwa kuti zitsanzo zomwe zapezeka mufukufukuyu ndizochepa komanso momwe njira zomwe amagwiritsira ntchito pofotokozera kuzindikira kumasiyana pakati pa maphunziro. Kusiyana kwa njira uku kuyenera kuganiziridwanso mukamasulira zomwe zapezedwa.

UTHENGA WABWINO NDI EPIDEMIOLOGY

Kutchova njuga kosokonezeka kumatha kuphatikizira chidwi chambiri ndi njuga, kutchova juga ndi ndalama zochulukirapo kuti mulandire kuchuluka komweko kwa zomwe mukufuna (kulekerera), kuyesayesa mobwerezabwereza kosayendetsa kapena kusiya kutchova njuga, kusabwezera kapena kukwiya mukamayesa kusiya njuga (kuchotsa), ndi kusokoneza njuga pamagawo akuluakulu amoyo wogwira ntchito. Milandu imaphatikizaponso kutchova juga kuti uchoke mdera lamtundu wa gysphoric, kutchova juga kuti ukalandire zotayidwa zokhudzana ndi juga posachedwapa ("kuthamangitsa"), kugona pachibwenzi chachikulu, ndi kudalira ena kuti alipire ndalama za juga. Kusintha kwakukulu pakufotokozeredwa kachipatala ka DSM-5 pamavuto amtundu wa njuga ndikuti adachotsa kufunika koti munthu azichita zinthu zosaloledwa kuti amalipire njuga.¹⁹ Kuphatikiza apo, poyambira njira yophatikizira inachepetsedwa kuchokera ku 5 ya 10 mpaka 4 ya 9; cholowa chatsopanochi chimaganiziridwa kuti chithandizira kuti magawo azikhala olondola komanso kuti achepetse zovuta zabodza. Komabe, kusiyana komwe kulipo pang'onopang'ono kwa vuto la kutchova juga (4 ya njira ya 9) ndi zovuta zamagwiritsidwe ntchito ka zinthu (SUDs; 2 ya njira ya 11) mwina zingachepetse kuchuluka kwa chiwopsezo ndi vuto la kutchova juga. Maphunziro a Epidemiological omwe agwiritsa ntchito zida zowunikira ngati South Oaks Gcane Screen²¹ atulutsa zambiri kuchuluka kuposa zomwe amagwiritsa ntchito omwe ali ndi DSM.^20,22,23 Dongosolo la Meta-analytic likuwonetsa kuti kuchuluka kwa njuga zakale za anthu achikulire omwe ali ndi vuto lakale kumakhala pakati pa 0.1% mpaka 2.7%.²⁴ Chiyerekezo cha osagwiritsa ntchito njuga pakati pa ophunzira aku koleji amawoneka apamwamba, akuti pa kafukufuku wina pa 7.89%.²⁵

Matanthauzidwe azikhalidwe zina zomwe amagwiritsa ntchito kawirikawiri amagwiritsa ntchito njira za DSM pakugulitsa njuga yosasangalatsa ngati pepala.^26,27 Mwachitsanzo, Mafunso a Diagnostic Mafunso²⁸ likupereka njira zotsatirazi zokhudzana ndi vuto la kugwiritsa ntchito intaneti: kusiya, kulekerera, kuganizira kwambiri intaneti, nthawi yayitali kuposa momwe mumagwiritsira ntchito intaneti, kuyika pachiwopsezo ku ubale kapena ntchito zokhudzana ndi kugwiritsa ntchito intaneti, kunama pankhani yogwiritsa ntchito intaneti, komanso kuyesayesa mobwerezabwereza kuyesa kuyimitsa intaneti gwiritsani ntchito. Komabe, kusiyana ndi zoyeserera, komanso kuperewera kwa njira zomwe anthu angavomereze pazomwe zingagwiritsidwe ntchito, zitha kuchititsa kuti kuwerengera kosiyana kwa mankhwala osokoneza bongo ku intaneti. Ziwerengero za achinyamata zafika pa 4.0% mpaka 19.1%, ndipo kwa akulu, kuyambira 0.7% mpaka 18.3%.²⁹ Momwemonso, kuwerengera kosiyanasiyana kwa kuchuluka (komwe kumayambira makamaka kwa kamiseche komwe kwasokonekera) kwatchulidwa chifukwa chosewera makanema ovuta pakati pa achinyamata (4.2% -20.0%), ndipo kulingalira kwa achikulire (11.9%) kukugwanso pamlingo womwewo .²⁹

ZOCHITITSA ZA CO-OCCURRING

Zambiri kuchokera ku US National Comorbidity Survey Replication —kufufuza komwe kumachokera ku US ndi anthu omwe anafunsidwa 9282-akuti 0.6% ya omwe amafunsidwa adakwaniritsa njira zomwe zimapangitsa kuti moyo ukhale wosagawanika kwa nthawi yonseyi (2.3% idanenanso zoyeserera chimodzi); Mwa iwo, 96% adakumana ndi zodzudzulidwa kamodzi pazanthawi zina za matenda amisala, ndipo 49% adachitidwapo chithandizo chamankhwala ena amisala.³⁰ Mitengo yapamwamba yolumikizana pakati pamakhalidwe ndi zosokoneza bongo yawonekera; kuwunika kwaposachedwa kwa meta kukusonyeza kuti kupezeka kwa 57.5% pakati pa magwiridwe osagwirizana ndi makonda osokoneza bongo.²⁴ Pakati pa anthu omwe ali ndi ma SUD, zovuta zamagetsi zomwe zidasungidwa zidakwezedwa katatu.³¹ Komanso, zovuta za vuto lomwa mowa mwauchidakwa zinawonjezeka kanayi pomwe kutchova juga kosatha kulipo.³² Zitsanzo zamankhwala zamakhalidwe ena osokoneza bongo zimawonetsa kuti kuphatikiza ma SUD ndizofala.³³ Pakufufuza kwa ophunzira aku koleji a 2453, anthu omwe akwaniritsa njira zothandizira kuti azitha kugwiritsa ntchito mankhwala osokoneza bongo pa intaneti anali pafupifupi kawiri kawiriwomwe anganene zakumwa zoledzeretsa, atatha kuyang'anira jenda, zaka, komanso kukhumudwa.³⁴ Kutengedwa palimodzi, zomwe apezazi zikuwonetsa kuti zosokoneza bongo zitha kugawana pathophysiology yofanana ndi ma SUD.¹⁰

Kutchova juga kosasinthika kumapangidwanso nthawi zambiri ndimikhalidwe yosiyanasiyana yamisala, kuphatikizira kudziwongolera, kusinthasintha, kuda nkhawa, komanso mavuto amunthu.^8,23,35,36 Adanenedwa kuti kusokonezeka kwa malingaliro ndi nkhawa zimayambira mavuto a njuga,³⁰ zomwe zitha kuwoneka ngati njira yolowerera yolakwika.³⁷ Kafukufuku wa Longitudinal akuwonetsa, kuti, kutchova juga kosasinthika kumalumikizidwa ndi zochitika (zovuta zatsopano), kusokonezeka kwa nkhawa, ndi ma SUD,³⁸ ndi zochitika za ma SUD zimasinthidwa ndi jenda.³⁹ Kuphatikiza apo, mavuto onse azachipatala komanso zovuta zamagulu amisala zimayenderana ndi kutchova njuga, makamaka pakati pa achikulire.^39,40 Kukhalapo kapena kusapezeka kwa zochitika zomwe zikuchitika ndizofunikira kuganizira posankha njira zamankhwala.⁴¹

KUDZIWA ZOPHUNZITSIRA KUKHALA NDI CHIPHUNZITSO CHA DZIKO

Zofunika kwambiri pazokonda ndi magawo a chilimbikitso, kukonza mphotho, ndi kupanga chisankho.^42-44 Izi zimayimira endophenotypes, kapena zapakatikati zapakati, zomwe zitha kutsatidwa pakufufuza kwachilengedwe pakuwonetsa zovuta komanso zosagwirizana ndi zinthu zomwe zimagwiritsidwa ntchito pazinthu zina ndipo zimatha kukhala zofunikira ngati zitha kupewa.⁴⁵

umunthu

Anthu omwe ali ndi chikhalidwe ndi zinthu zomwe amakonda kugwiritsa ntchito mankhwala osokoneza bongo amakhala ndi mwayi wodziwonetsa yekha zodzikakamiza, komanso zotsika popewa kuvulaza.^46,47 Zina zimawonetsa, komabe, kuti anthu omwe ali ndi vuto losokoneza bongo la pa intaneti, kusewera mavidiyo ovuta, kapena kutchova njuga mosayenerera angawonetse kupewa kwambiri,^29,48 kulimbikitsa kusiyana pakati pa anthu omwe ali ndi zosowa. Kukula kwa momwe zizolowezi zakakhalidwe popewa kuvulaza zingasunthire (mwachitsanzo, nthawi yayitali) kapena zosiyana (mwachitsanzo, malinga ndi dera kapena zinthu zina) zimapangitsa kuti kafukufuku wina awonjezeke.

Kafukufuku wina akuwonetsa kuti machitidwe a kukakamira nthawi zambiri amakhala apamwamba pakati pa anthu omwe ali ndi zizolowezi zikhalidwe.^31,49 Zotsatira zake, ena amaganiza zokonda kusintha pamawonekedwe osakakamiza.⁵⁰ Kukakamizidwa kumayimira chizolowezi chochita zinthu mobwerezabwereza kuti tipewe zotsatira zoyipa, ngakhale mchitidwe womwewo ungatibweretsere zotsatirapo zoipa.⁵¹ Ngakhale kunyengerera konse komanso kukakamizika kumatanthauza kuwongolera mosavutikira, zomwe zaposachedwa zikusonyeza mgwirizano wovuta pakati pa zinthu ziwirizi chifukwa amakhudzana ndi zovuta (OCDs) komanso malingaliro azikhalidwe. Mwachitsanzo, ngakhale magulu omwe ali ndi njuga zosagwirizana kapena omwe ali ndi OCD onse ali ndi ziwonetsero zazikulu pakukakamizidwa, pakati pa otchova juga pazovuta izi amawoneka kuti sangathe kuyendetsa bwino ntchito zamaganizidwe komanso kukakamiza komanso kuda nkhawa ndi kulephera kuwongolera magalimoto.⁵² Mosiyana ndi izi, maphunziro a OCD amakonda kukhala opanda mbiri pamadera ambiri.⁵³

Kuzindikira

Njira zoyesera zodziwitsira komanso kupanga zisankho zikugwirizana bwino ndi kuopsa kwa kutchova juga⁵⁴ ndipo atha kuneneratu kuyambiranso kutchova njuga.⁵⁵ Ofanana ndi anthu omwe ali ndi ma SUDs, anthu omwe ali ndi vuto lotchova juga asonyeza kuwonongeka popanga zisankho zowoneka bwino komanso kuwonetsa kusayerekezereka poyerekeza ndi machitidwe olamulira.⁵⁶ Kuwonongeka koyipa pa Ntchito Yotchovera Juga ya Iowa, yomwe imawunika kupanga zisankho / zopatsa mphoto, yawoneka pakati pa anthu omwe ali ndi vuto lotchova njuga komanso chidakwa.⁵⁷ Mosiyana ndi izi, kafukufuku wa anthu omwe ali ndi vuto la intaneti sanawonetse kusowa kolowera pakuchita zisankho pa Iowa Masewera a Kutchova Njuga.⁵⁸

Kuyesa kuwongolera kapena kuthetsa machitidwe omwe ali ndi chizolowezi chakutsogolo chitha chifukwa cha mphotho yake kapena zotsatira zoyipa zomwe zimagwiritsidwa ntchito - kutanthauza kuchepa kwakanthawi. Njirayi itha kuyanjanitsidwa kudzera pakuchepa kwa chiwongolero chazomwe zimapangitsa kuti azichita zinthu zosokoneza.⁵⁹ Anthu omwe ali ndi njuga zosasinthika komanso ma SUD amawonetsa kuchotsera kwakanthawi mphotho; Mwanjira ina, amatha kusankha zazing'ono, zabwino zomwe zimapindulitsa kale kuposa zazikulu zomwe zimadza pambuyo pake.^60,61 Ngakhale deta zina zimanena kuti anthu omwe ali ndi ma SUDs amachita bwino (kuwonetsa kuchepetsedwa pang'ono) kuposa anthu omwe ali ndi ma SUD aposachedwa, zina zimatsimikizira kuti palibe kusiyana kwakukulu.⁶⁰ Kafukufuku waposachedwa akuwonetsa kuti kuchotsera kuchepa sikunasiyane mwa anthu omwe ali ndi vuto la kutchova njuga ndi chaka chimodzi.⁶²

Neurochemistry

Dopamine idakhudzidwa ndikuphunzira, kulimbikitsa, mawonekedwe a masisitere, ndi kukonza kwa mphotho ndi zotayika (kuphatikiza kuyembekezera [kulosera kwa mphotho] ndi kuyimira malingaliro awo).⁶³ Popeza kufunikira kwa kuchuluka kwa ziwonetserozo mu dopaminergic pagawo la mphotho, kuphatikizapo zolingalira kuchokera kudera laling'ono mpaka panjira yanyumba ku SUDs⁶³-Mawu okhudzana ndi zizolowezi zokhudzana ndi chikhalidwe komanso zochitika zokhudzana ndi izi zikuyang'ana kwambiri pakuwunika kufalikira kwa dopamine. Kafukufuku waposachedwa wapamtundu umodzi waposachedwa wapakatikati akuwonetsa kuti kusintha kwa dopamine pamasewera olowera pa masewera apakompyuta oyenda njinga yamoto⁶⁴ amafananizidwa ndi zomwe zimapangidwa ndi psychostimulant mankhwala monga amphetamine ⁶⁵ ndi methylphenidate.⁶⁶ Phunziro limodzi laling'ono pogwiritsa ntchito positron emission tomography ndi tracer [¹¹C] raclopride, kutulutsidwa kwa dopamine mu ventral striatum kumalumikizidwa bwino ndi Iowa Kutchova Juga Task pamasewera olamulidwa amoyo koma moipa mwa anthu omwe ali ndi njuga zosagwirizana,⁶⁷ ndikuwonetsa kuti kutulutsidwa kwa dopamine kungatengedwe pakupanga zisankho zofunikira komanso zoyipa. Ngakhale ntchito ya njuga sinayipire kusiyana ukulu (ie, [¹¹C] kuthamangitsidwa pamtunda wa njinga pakati pa otchova njuga ndi olamulira, pakati pa otchova juga omwe asintha⁶⁸ ndi chisangalalo chogonjera.⁶⁹

Ofanana ndi anthu omwe ali ndi ma SUD,⁷⁰ yachepetsa kupezeka kwa D2 / D3 mu striatum kwawonedwa mwa anthu omwe ali ndi vuto la intaneti⁷¹ komanso mwa anthu⁷² ndi mbewa^73,74 ndi kunenepa kwambiri. Mwachitsanzo, makoswe onenepa (koma osakhazikika makoswe) adalekerera zolandilira za D2, ndipo kudya kwawo kwakudya sikunasokonezedwe ndi kusokoneza kapena kubwezera.⁷⁵ Kafukufuku yemweyo adapezanso kuti ma weltivirus-Mediated knockdown of striatal D2 receptors adakulitsa kukula kwa zoperewera ngati mphotho yaukonda komanso kuyambika kwa chakudya chokakamiza ngati chakudya m'makoma omwe amapezeka ndi zakudya zabwino,⁷⁶ zomwe zikutanthauza kupindulitsa phindu. Kafukufuku waposachedwa adayang'ana chizindikiro ichi pakati pa otchova juga omwe asintha.^69,77,78 Ngakhale kuti panali kusiyana kwakukulu pakati pa gulu mu D2 / D3 receptor kupezeka kwa malo opumirako kunawonedwa, pakati pa otayika omwe adagulitsika dopamine receptor kupezeka kunali komwe kumakhudzana ndi kusokonekera kokhudzana ndi kusokonekera (“kufulumira”) mkati mwa striatum⁷⁷ komanso ogwirizana ndi zovuta zovuta-kutchova njuga mkatikati mwa dorsal striatum.⁷⁸ Gawo lenileni la dopamine mu vuto la kutchova njuga likupitilizabe kutsutsana,⁷⁹ koma chitsanzo chozikidwa pamaphunziro mu makoswe ndipo anthu akuwonetsa maudindo osiyanasiyana a D2, D3, ndi D4 dopamine receptors, ndi ma D3 receptors mu substantia nigra ikukhudzana ndi zovuta-kutulutsa njuga komanso kusokonekera, ndikugwirizanitsidwa ndi kutulutsidwa kwakukulu kwa dopamine mu dorsal striatum.^78,80-82

Mankhwala a Dopamine receptor agonist adalumikizidwa ndi kutaya njuga komanso zikhalidwe zina mwa odwala omwe ali ndi matenda a Parkinson.^83-85 Komabe, zinthu zina (kuphatikiza msinkhu poyambika kwa Parkinson, maukwati, ndi malo) zimathandizira pakulumikizana pakati pazokakamira pamatenda ndi matenda a Parkinson, kuwonetsa madera angapo omwe amathandizira.⁸³ Kuphatikiza apo, mankhwala omwe ali ndi dopamine antagonist katundu sanawonetse ntchito pothandiza kutchova njuga kosatha.^86,87 Zotsatira izi, molumikizana ndi zomwe zikuwonetsa kuyambitsa kwa kutchova juga kwa mankhwala omwe amalimbikitsa ndikutchingira D2-ngati dopamine receptor,^88,89 afalitsa mafunso okhudzana ndi kuchuluka kwa dopamine kuti athetse njuga.⁷⁹ Komabe, zidziwitso zaposachedwa zikusonyeza kuti kusiyanitsa zolowera kuchokera ku D2, D3, ndi D4 receptors zitha kumveketsa gawo la dopamine mu pathophysiology ya njuga yosagawanika.^80,82

Umboni ulipo pakuphatikizidwa kwa serotonergic pazinthu zomwe anthu amakonda. Serotonin imakhudzidwa ndimalingaliro, chidwi, kusankha zochita, kuwongolera mayendedwe, komanso kuletsa kuchita zinthu. Kugwiritsa ntchito serotonin kogwiritsa ntchito kumatha kuyendetsa pakati pazochita zina komanso kulowerera mu njuga yopanda tanthauzo.^8,67,69 Kutchova juga kosokonezeka kwalumikizidwa ndi kuchepetsedwa kwa serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) mu madzi a cerebrospinal.⁹⁰ Zochitika zochepa kwambiri za othandiza kupatsidwa zinthu za m'magazi a glueletase oxidase (MAO) (zimayang'ana ngati cholemba chapadera cha ntchito ya serotonin) mwa amuna omwe ali ndi njuga zosasamalidwa^91,92 yapereka chithandizo chowonjezera cha kukomoka kwa serotonergic. Kumangidwa kwa striatal kwa ligand yokhala ndi mgwirizano wapamwamba wa serotonin 1B receptor yolumikizana ndi zovuta zovuta-kutchova njuga pakati pa anthu omwe ali ndi vuto lotchova njuga.⁹³ Zotsatira izi ndizogwirizana ndi zomwe zimachokera m'maphunziro ovuta omwe amagwiritsa ntchito meta-chlorophenylpiperazine (m-CPP), agonist woperewera yemwe ali ndi mgwirizano wapamwamba wa serotonin 1B receptor. Izi zimawunikira mayankho osiyanasiyana mwachilengedwe komanso machitidwe mwa anthu omwe ali ndi zikhalidwe kapena zosokoneza bongo (poyerekeza ndi omwe alibe) poyankha m-CPP.⁴⁷

Zochepa ndizodziwika ponena za kukhulupirika kwa ma neurotransmitter ena pazikhalidwe zawo. Mimbulu yodutsa ya hypothalamic-pituitary-adrenal komanso magulu ochulukirapo azisangalalo amawonedwa mu kutchova juga kosayerekezeka.⁹⁴ Noradrenaline atha kutenga nawo mbali pazokopa zokhudzana ndi juga.^95,96 Otsutsana ndi Opioid (mwachitsanzo, naltrexone, nalmefene) awonetsa kukwezeka kwapamwamba kwa placebo m'mayesero azachipatala ambiri mosasankha.^41,97,98

Njira zama Neural

Kafukufuku wa Neuroimaging akuwonetsa kugawana ma neurocircuitry (makamaka kuphatikiza zigawo zakutsogolo ndi zodandaula) pakati pazolankhula ndi zosokoneza bongo. Kafukufuku wogwiritsa ntchito zopangira mphoto ndi ntchito yopanga zisankho adazindikira zopereka zofunika kuchokera ku subcortical (mwachitsanzo, striatum) ndi madera ozungulira, makamaka makulidwe am'kati mwa chimbudzi (vmPFC). Pakati pa otchova juga osasiyana, kuwongolera koyenera, onse adatsika^99-102 ndi kuchuluka kwa vmPFC¹⁰³ adanenedwa munthawi yopanga njuga komanso kupanga zisankho. Momwemonso, zoyeserera njuga zimanenedwa kuti zimalumikizana ndi zonse ziwiri zachepa¹⁰⁴ ndi kuwonjezeka^105,106 ntchito ya vmPFC mu otchova juga osasinthika. Zomwe zapezeka m'maphunzirowa zitha kukhala chifukwa cha ntchito zomwe zidagwiritsidwa ntchito, anthu adaphunzira, kapena zina.^99,107,108 Kuthekera kwakukulu kwa madera ena oyambira ndi oyambira ganglia, kuphatikizapo amygdala, panthawi yopanga chiwerewere ku Iowa Tigogo wa Masewera awonedwa pakati pa otchova njuga.¹⁰³ Ngakhale deta ndizochepa pa zosokoneza zina, maphunziro angapo aposachedwa akuwonetsa kuthandizira kwa magawo aubongo ogwirizana ndi kuwonetsedwa kwa mankhwala osokoneza bongo. Anthu omwe amasewera World of Warcraft (masewera osewera, ambiri, ochita masewera pa intaneti) kuposa maola a 30 pa sabata, poyerekeza ndi osewera opanda masewera (kusewera maola ochepera a 2 patsiku) akuwonetsa kwambiri orbitof mbeleal, dorsolateral pre mbeleal, anterior cingulate, ndi nucleus imasinthitsa kuchitapo kanthu mukakumana ndi masewera amasewera.¹⁰⁹ Pafukufuku wapadera, kuyambitsa ntchito mu medial orbitofrontal cortex, anterior cingate, ndi amygdala poyankha kulandira zomwe akuyembekezeredwa kuti adalandireko zidaphatikizidwa ndi zambiri zomwe zidagwiritsidwa ntchito pakudya.¹¹⁰

Monga tanena kale, njira ya mesolimbic (yomwe nthawi zambiri imadziwika kuti "njira yolandirira mphoto") kuchokera mdera lomwe limalowera m'malo opangira gawo laukazitini yakhala ikuwoneka m'zinthu komanso zikhalidwe.^111,112 Achichepere amachepetsa kwambiri kayendedwe ka ndalama pakati paotchova njuga^99,100 ndipo adachita juga.¹⁰¹ Mukutchova juga zodziwonetsa, otchova juga osasinthika akuwonetsa kuchepa kwa magwiridwe antchito¹¹³ ndi dorsal¹¹⁴ striatum poyerekeza ndi oyendetsa athanzi. Kuphatikiza apo, zochitika zonse ziwiri zamkati mwa masewera olimbitsa thupi ndi vmPFC zinali zolumikizana kwambiri ndi zovuta zovuta pamasewera a njuga panthawi zovuta kutchova juga.¹⁰¹ Poyerekeza izi zomwe zapezeka mu njuga zosasamalidwa, kafukufuku wamalingaliro aposachedwa aposachedwa adapeza cholimba champhamvu cholumikizira ntchito pakati pa ogulitsa mokakamiza (motsutsana ndi zowongolera) pachigawo choyambirira chogulitsa zogulitsa zinthu zambiri.¹¹⁵

Mosiyana ndi zomwe zapezeka kwa odwala omwe ali ndi ma SUD,¹¹⁶ Kafukufuku wokhudzana ndi zitsanzo zazing'ono za otchova juga omwe sanasungidweko sanawonetse kusiyana kwakukulu pazinthu zoyera kapena zotuwa kuchokera kuzowongolera,^117,118 natanthauza kuti kusiyanasiyana kwamawonekedwe omwe amapezeka mu SUDs kungayimire kuyimitsidwa kotheka kwa mankhwalawa. Zambiri zaposachedwa kwambiri pogwiritsa ntchito zitsanzo zokulirapo, zikuwonetsa mavidiyo ang'onoang'ono amygdalar ndi hippocampal mwa anthu omwe ali ndi njuga zosagwirizana, zofanana ndi zomwe zapezeka mu SUDs.¹¹⁹ Kupeza kovuta komwe kumapangitsa kuti anthu aziona ngati mfundo zosavomerezeka zikuwonetsa kuchepa kwa magonedwe oyenera - kuwonetsa kuchepa kwa nkhani yoyera - m'magawo kuphatikiza ma corpus callosum omwe ali otchovera njuga.^118,120 Kafukufuku akuwonetsa kuchepa konse kwa kusokonekera kwa njira zopezeka munjira zikuluzikulu zoyera komanso kapangidwe kazinthu zodetsa nkhawa zomwe zimagwiritsa ntchito intaneti.¹²¹ Komabe, zotsatira zoyipa zawonekeranso kuti ndizotheka kugwiritsa ntchito intaneti¹²² ndi matenda oopsa.¹²³

Nkhani Za M'banja ndi Mbiri Yabanja

Kafukufuku wakale akuti zinthu zamtunduwu zimatha kuthandizira kwambiri pakuwonjezera kuwopsa kwa kutchova njuga.^124,125 Zambiri kuchokera kwa aamuna onse a Vietnam Era Twin Registry zikuyerekeza kuchuluka kwa kutchova juga kwa 50% -60%,^126,127 kuchuluka komwe kungafanane ndi kuchuluka kwa anthu omwe amwa mankhwala osokoneza bongo.¹²⁸ Kafukufuku wotsatira wamapasa achikazi akuti kuchuluka kwa kusiyanasiyana kwa zovuta pakubedwa kwa njuga kumakhala kofanana mu azimayi ndi abambo.^124,129 Maphunziro ang'onoang'ono a mabanja omwe ali ndi njuga zosaloledwa,¹³⁰ Hypersexual matenda,¹³¹ komanso kukakamira kogula¹³² awona kuti abale omwe ali ndi madigiri oyamba a ma proands anali ndi miyezo yayitali kwambiri ya moyo wa SUDs, kukhumudwa, ndi zovuta zina zamaganizidwe, kulimbikitsa ubale wamtundu pakati pa mikhalidwe iyi.

Kafukufuku wochepera wamankhwala osokoneza bongo omwe adachitapo kale zachitika. Ma polymorphisms abadwa amagwirizana kwambiri ndi kufalikira kwa dopamine (mwachitsanzo, DRD2 Taq1A1, yomwe imayanjana ndi matenda osokoneza bongo ndi Ayi 1) adalumikizidwa ndi njuga zosasangalatsa^133,134 ndi kusewera kwamavidiyo kovuta.¹³⁵ Kafukufuku wina amathandizira kuti mitundu ya majini yotumizira ya serotonin (mwachitsanzo, 5HTTLPR ndi MAO-A) mu njuga zosaloledwa ^92,136 komanso vuto lokonda kugwiritsa ntchito intaneti.¹³⁷ Maphunzirowa, komabe, anali ndi zitsanzo zazing'ono ndipo sanayankhe zazovuta (mwachitsanzo, zokhudzana ndi kusiyana kwamafuko ndi mafuko pakati pamagulu). Kafukufuku waposachedwa waposachedwa akuti palibe mutu umodzi wa nucleotide polymorphism womwe unakwaniritsa tanthauzo lalikulu la kutchova njuga.¹³⁸ Kafukufuku wowonjezereka amafunikira kuti agwirizane zamtundu komanso zochitika zamtunduwu zomwe zimagwirizana ndi zizolowezi zamakhalidwe, ndizinthu zapakatikati ngati kulowetsedwa mwina kuyimira zofunika.^45,128

Malangizo Osiyanasiyana

Zolemba zomwe zilipo zikuwonetsa kuchuluka pakati pazokonda ndi zinthu zokhudzana ndi zinthu zomwe zatulutsidwa pamwambapa, ndikuwonetsa kuti magwiridwe awiriwa akhoza kuyimira mawu amodzi pagulu limodzi. Komabe, kusiyana kumawonekeranso. Ngakhale lingaliro lamakhalidwe ochita zikhalidwe likuwoneka kuti likuwonekera kwambiri m'mabuku, umboni wa sayansi ndi wopatsa mphamvu ukadali wosakwanira kuti zovuta izi zithandizidwe ngati gawo limodzi la gulu lathunthu. Zovuta zomwe zili mu chidziwitso chathu ziyenera kuthetsedwa kuti tidziwe ngati zizolowezi kapena zomwe zimagwirizana ndi zinthuzi zikuyimira mitundu iwiri kapena ngati ali mawu osiyanitsa ena. Kuphatikiza apo, kudziwitsa payokha kungakhale kothandiza m'mankhwala chifukwa anthu amatha kupezeka kwa akatswiri omwe ali ndi vuto pazovuta zina. Ngakhale zili choncho, zochulukirapo pakati pamavuto zikusonyeza kuti chithandizo chamankhwala cha ma SUD chitha kukhalanso chothandiza pakukonda zamakhalidwe.

MITU YA NKHANI

Njira zochizira bongo zitha kugawidwa m'magawo atatu. Choyamba, gawo logulitsanso thupi likufuna kukwaniritsa kudziletsa mosavomerezeka komwe kumachepetsa zizindikiro zochoka mwachangu (mwachitsanzo, kuda nkhawa, kusakwiya, komanso kusakhazikika pamalingaliro, komwe kumatha kupezeka muzochita komanso zosokoneza bongo). Gawo loyamba leli lingaphatikizepo mankhwala othandizira kusintha. Gawo lachiwiri ndi lachiwongola dzanja, lomwe likutsimikizira kukulitsa kulimbikitsidwa kopewera kuyambiranso, kuphunzira njira zothanirana ndi zikhumbo, ndikupanga machitidwe atsopano, amakhalidwe abwino omwe atha kusintha m'malo mwake. Gawo ili lingaphatikizire mankhwala ndi njira zochiritsira. Chachitatu, kupewa kubwezeretsanso kumalimbikitsa kukhalabe osadziletsa kwakanthawi. Gawo lotsiriza lino mwina ndizovuta kwambiri kukwaniritsa, ndi chidwi cholimba, chitsitsimutso cha maphunziro omwe aphatikizidwa ogwirizanitsa zochitika za hedonic ndi machitidwe osokoneza, komanso ziyeso zomwe zingaopseze njira yobwezerera, kuyambira kunja (mwachitsanzo, anthu, malo) ndi mkati ( mwachitsanzo, kuyambiranso chibwenzi, kupsinjika, kusamvana pakati pa anthu, zisonyezo za malingaliro a comorbid). Mayesero ambiri azachipatala omwe amakhalapo ndi vutoli akhazikika pazotsatira zazifupi.

Kulowerera Kwa Psychopharmacological

Palibe mankhwala amene alandila kuvomerezedwa ku United States ngati chithandizo chakutha njuga. Komabe, zoyesedwa kawiri-kawiri, zoyesedwa ndi placebo za ma pharmacological othandizira osiyanasiyana zawonetsa kuphatikiza kwa mankhwala othandizira ku placebo.^41,139

Pakadali pano, mankhwalawa omwe ali ndi chithandizo champhamvu kwambiri ndizotsutsana ndi opioid receptor antagonists (mwachitsanzo, naltrexone, nalmefene). Mankhwalawa agwiritsidwa ntchito pakuwongolera odwala - makamaka opiate-) ndi odwala omwe amadalira mowa kwa zaka zambiri^140,141 ndipo awunikiridwa posachedwa pochotsa njuga zomwe zasokonekera komanso zizolowezi zina zamakhalidwe. Kafukufuku m'modzi yemwe adachita khungu adawona kufunikira kwa naltrexone pakuchepetsa chidwi chofuna kutchova juga, malingaliro otchova njuga, ndi machitidwe a njuga; makamaka, anthu omwe amafotokoza kuchuluka kwa kutchova juga amayankha makamaka chithandizo.⁹⁷ Zotsatira izi zakhala zikuwonetsedwanso m'maphunziro akulu, atali,¹⁴² ndi kukonza zabwino zitha kupitilira pambuyo kulimbana ndi naltrexone.¹⁴³ Mlingo wa mankhwala ukhoza kukhala chinthu chofunikira kuti mukwaniritse kusintha. Mlingo wambiri (100-200 mg / day) wa naltrexone anachepetsa bwino ma symtpoms a hypersexual chisokonezo ndi zovuta kukakamiza kukagula;^144-146 adabweranso, atatsata izi.¹⁴⁴ M'mayeso awiri akulu, ophatikizidwa ndi mitundu yambiri, akhungu okhaokha, ma XmUMX mg / tsiku) omwe akuwonetsa kusiyana kwakukulu kuchokera ku placebo potsatira zotsatira zamatenda otayika.^98,147 Zina zimawunikira, komabe, kuti mitundu yotsika (mwachitsanzo, 50 mg ya naltrexone) imakhala yokwanira ndikugwirizana ndi zovuta zochepa.^142,147 Makamaka, kulimba kwa kuthekera kwa njuga komanso mbiri yakale yaukadaulo yolumikizidwa ndi zotsatira za mankhwala opatsirana opagana mu zovuta zotchova njuga (ndikulimbikitsidwa kwambiri poyambira chithandizo komanso mbiri yabwino yabanja yokhala ndi zakumwa zoledzeretsa zomwe zimagwirizanitsidwa ndi zotsatira zabwino za mankhwala a naltrexone kapena nalmefene), Kukhazikitsa kusiyana pakati pa mayankho pazamankhwala.¹⁴⁸ Momwe mayankho amathandizidwe angagwirizanitse ndi majini enaake - monga tafotokozera pakuyankha kwa zakumwa zoledzeretsa za naltrexone¹⁴⁹- zimawerengera zowonjezera.

Pankhani ya chakudya, kafukufuku wosaneneka ananena kuti kuchuluka kwa odwala omwe ali ndi vuto lodziwika bwino laxxone kumawonjezera kumwa kwa shuga komanso zizindikiro zodziwonetsa zodziwikiratu monga kuphatikiza ndi nkhawa ya maze, kulumikizana mano, komanso kugwedezeka mutu - pamiyendo yotseka shuga itatha nyengo yodziletsa.^150-152 Zotsatira izi sizinapatsidwe makoswe pazakudya zamafuta kwambiri.¹⁵³ Kuchita bwino kwa odana ndi opioid ngati naltrexone pothana ndi vuto la zakudya sikuyenera kuwunikiridwa muzinthu za anthu koma kuyenera kuthandizidwa.

Ngakhale kusankha ma serotonin reuptake inhibitors (SSRIs) anali amodzi mwa mankhwala oyamba omwe amagwiritsidwa ntchito pochotsa njuga zosasangalatsa, kuyesedwa kwa zamankhwala koyesa ma SSRI kwawonetsa zotsatira zosakanikirana pazikhalidwe komanso kuzolowera zinthu.⁴⁹ Fluvoxamine ndi paroxetine adanenedwa kuti ndi apamwamba kuposa placebo m'mayesero angapo^154,155 koma osati mwa ena.^156,157 Kuchita bwino kumasiyananso pakati pazokakamira pamakhalidwe. Citalopram, SSRI ina, adapezeka akuthandiza kuchepetsa kuchepa kwa ziwopsezo zamagulu abambo ogonana amuna kapena akazi okhaokha¹⁵⁸ koma, mwa anthu omwe ali ndi vuto lokonda kugwiritsa ntchito intaneti, sanachepetse kuchuluka kwa maola omwe amagwiritsidwa ntchito pa intaneti kapena kusintha magwiridwe antchito apadziko lonse lapansi.¹⁵⁹ Chithandizo cha SSRI chimakhalabe malo othandizira kufufuza,^8,41 ndikufufuzanso kwina kuyenera kuyesa kugwiritsidwa ntchito kwa zamankhwala kwa ma SSRIs pa njuga zosaloledwa komanso zina zikhalidwe.

Chithandizo cha glutamatergic chawonetsa lonjezo losakanizika mumayeso ang'onoang'ono owongoleredwa. N-acetyl cysteine yawonetsa mphamvu yoyambira yonse ngati wothandizirana yekha¹⁶⁰ komanso molumikizana ndi machitidwe othandizira.¹⁶¹ A Topiramate, komabe, sanawonetse kusiyana kulikonse kwa placebo pochotsa njuga zosasangalatsa.¹⁶² Kuphatikiza apo, zotsatira za izi komanso mayeso ena ambiri a pharmacotherapy okhudzana ndi zizolowezi zamakhalidwe ndizochepa chifukwa cha mayeso ang'onoang'ono komanso zovuta zazifupi.

Zochita Zamakhalidwe

Meta-kusanthula njira zochizira matenda amisala yokhala ndi vuto la kutchova juga zosasinthika akuti zitha kuchititsa kuti pakhale kusintha kwakukulu. Zotsatira zabwino zitha kusungidwa (ngakhale pang'ono) pazotsatira zazaka ziwiri.¹⁶³

Njira imodzi yomwe idapeza thandizo kuchokera ku mayeso omwe adachitika mwachisawawa ndi chidziwitso cha machitidwe owoneka bwino (CBT). Njira yokhazikika iyi, yolunjika pamavuto imayang'ana, panjira yovuta, yolumikizira njira zosaganiza komanso zikhulupiriro zomwe zimaganiziridwa kuti zimakhazikitsa mikhalidwe yokakamiza. Pochita mankhwala, odwala amaphunzira kenako kugwiritsa ntchito maluso ndi njira zosinthira masinthidwe awo ndikusokoneza machitidwe awo osokoneza bongo.^164,165 Othandizira amawongolera kusintha kwa malingaliro osagwira ntchito, momwe amagwirira ntchito, komanso njira zina mwazidziwitso pochita zinthu zina machitidwe osiyanasiyana komanso njira zotsatirika, zowonekera bwino, zatsatanetsatane. CBT ndi yophatikiza koma mwanjira imakhala ikusunga zolemba za zochitika zazikulu ndi malingaliro, malingaliro, ndi machitidwe; kujambula malingaliro, malingaliro, malingaliro, ndi zikhulupiriro zomwe zingakhale zolakwika; kuyesa njira zatsopano zamakhalidwe ndi zochita (mwachitsanzo, kusintha kusewera masewera apakanema ndi zochitika zapanja); ndipo, pankhani ya kutchova juga kosaloledwa komanso kugula zinthu mokakamiza, njira zophunzirira kusamalira bwino ndalama.¹⁶⁶ Zinthu zoterezi ndizofunikira pakudziletsa koma ndizofunikiranso kupewa kupewa. Njira zochiritsira zomwe zimagwiritsidwa ntchito zimatha kukhala zosiyana malinga ndi mtundu wa wodwala kapena vuto. Mwachitsanzo, odwala omwe akuvutika kuwongolera zokhumba atha kugwiritsa ntchito ma module omwe amaphunzitsa njira zothandiza kuthana ndi zikhumbo. Njira za CBT zili ndi umboni wamphamvu kwambiri pazanjira zilizonse zokhudzana ndi psychotherapeutic,¹⁶⁷ ndikuwunikira meta kosasinthika, mayeso oyendetsedwa owonetsa kuwongolera pamitundu yokhudzana ndi kutchova juga pambuyo pa chithandizo komanso kutsatira zotsatila za otchova njuga.¹⁶³ Mwa anthu omwe ali ndi vuto logwiritsa ntchito intaneti, CBT yawonetsa kuchita bwino pochepetsa nthawi yogwiritsidwa ntchito pa intaneti, kukonza maubale, kukulitsa zochitika zapaintaneti, ndikuwonjezera mwayi wopewa kugwiritsa ntchito intaneti zovuta.¹⁶⁸

Kuphatikiza pa chithandizo chachipatala monga CBT, njira zodzithandizira zilipo. Ngakhale zosankha zotere zapezeka kuti ndizopindulitsa kwa anthu osiyanasiyana, akhoza kukhala okopa kwambiri kwa anthu omwe sakwaniritsa njira zodziwonera za njuga zomwe zakhala zikuwononga komanso omwe amapeza chithandizo cha psychotherapeutic chili chodula kapena chovuta kwambiri.¹⁶⁹ Kafukufuku waposachedwa akuwonetsa kuti mapulogalamu omwe ali pa intaneti angathandize kuchepetsa zizolowezi zamagetsi zomwe zasokonezeka, kuphatikiza pazotsatira wazaka zitatu.¹⁷⁰ Gulu lotchuka lodzithandiza lokhala ndi othandizana nawo ndi a Gambler's Anonymous (GA). Kutengera njira ya 12 ya Alcoholics Anonymous, GA ikugogomezera kudzipereka pakudziletsa, komwe kumathandizidwa ndi gulu lothandizidwa ndi ozindikira omwe ali ndi gulu ("othandizira"). Masitepewo akuphatikizira kuvomereza kulephera kwa ulamuliro pa njuga; kuzindikira mphamvu yapamwamba yomwe imapereka mphamvu; kuwunika zolakwika zakale (mothandizidwa ndi wondithandizira kapena membala waluso) ndikusintha; kuphunzira kukhala moyo watsopano wokhala ndi malamulo atsopano; komanso kuthandiza ndikutengera uthengawo kwa otchova njuga ena.¹⁷¹ Chosangalatsa ndichakuti, anthu omwe ali ndi (osachita) mbiri yakale yopezeka pa GA amatha kuwonetsa zovuta zakutchova njuga, zaka zambiri zamavuto a juga, ndi ngongole zazikulu pakuyamba kulandira (zina) chithandizo.¹⁷² GA yawonetsedwa kuti ili ndi zotsatira zabwino kwa omwe amabwera ndi magawo osiyanasiyana a kubedwa kwa njuga;¹⁷³ Komabe, ziwongola dzanja nthawi zambiri zimakhala zokwera.¹⁷⁴ Mapindu a GA atha kuwonjezeka ndi adjunctive personalised tiba, ndipo njira ziwiri izi, zikaphatikizidwa, zitha kukhala zothandiza pakulimbikitsa kupitiliza kwa chithandizo.¹⁷⁵ Kuwunikira kwa Meta kukuwonetsa njira zina zodzithandizira (mwachitsanzo, mabuku othandizira ndi ma audiotapes) zimawonetsanso zotsatira zabwino mu njuga zosagwirizana ndipo ndizabwino kuposa zopanda chithandizo kapena placebo. Zotsatira zabwino, komabe, sizolimba ngati njira zina zodziwikiratu mphamvu zolimbitsa thupi.¹⁶³

Kufunsidwa mwachidule kapena kupititsa patsogolo, ngakhale pang'ono chabe ngati njira yolumikizirana patelefoni ya 15-sikuwonetsedwa kuti ndizothandiza koma maphunziro angapo awonetsedwa kuti ndi othandiza kuposa njira zina zazitali komanso zazitali.¹⁷⁶ Zolimbikitsira kuchitapo kanthu zimakhazikika pakufufuza ndikusintha momwe chiyembekezo cha wodwalayo chimasinthira, ndi cholinga chothandizira kutsogolera chidwi komanso kudzidalira polimbana ndi mavuto pamavuto. Kuchitapo kanthu koteroko kumatha kukhala njira yotsika mtengo, yosungira chuma komanso kungakhale kothandiza kwambiri kwa anthu omwe safuna chithandizo chachitali chifukwa chodana, manyazi, kapena nkhawa zandalama.

Ngakhale njira zopatsirana moyenera komanso zamankhwala sizidziwika bwinobwino, kumvetsetsa bwino kwa izo kumatha kupereka chidziwitso pakuwunika kwazomwe zimathandizira ndikuthandizira pakukula kwa chithandizo chamankhwala komanso pofananira ndi anthu ena. Pali njira zambiri zochiritsira zabwino zomwe zidatchulidwa pakadali pano. Mwachitsanzo, kutengapo gawo pazabwino za mabanja kwawonetsedwa kukhala kopindulitsa pochiza ma SUD¹⁷⁷ ndipo itha kukhala yothandizanso chimodzimodzi pothana ndi zizolowezi zoipa. Kuphatikiza apo, phenotypic heterogeneity imakhalapo mu mtundu uliwonse wa zizolowezi, ndipo kuzindikira magulu ochepa omwe akukhudzidwa ndi matenda akadali ntchito yofunika. Kuyesa mayendedwe enieni, ofotokozedwa bwino mu njira zosasankhidwa, zoyesedwa ndizofunikanso pakutsimikizira njira zamankhwala. Neurocircuitry yokhudzana ndi njira zina zachikhalidwe zakhazikitsidwa.¹⁷⁸ Kuphatikizidwa kwa kuyezetsa kwakanthawi ndi kubwezeretsa pakubwezeretsa m'mayesero azachipatala kumayimira gawo lotsatira lofunikira pakuyesa ma hypotheses awa.

Njira Zophatikiza

Ngakhale kupita patsogolo kwakwaniritsidwa pozindikira ndikupanga njira zabwino zochiritsira zamankhwala komanso chikhalidwe, palibe chithandizo chomwe chilipo chokha chokha. Kuphatikiza mankhwala othandizira kungathandizire kuthana ndi zofooka zilizonse pazomwe mungagwiritse ntchito ndipo kungapangitse zotsatira zabwino za chithandizo. Mayeso oyamba pogwiritsa ntchito njira zophatikizira adabweretsa zotsatira zosakanikirana, ndipo zotsatira zabwino zanenedwa chifukwa cha kutchova juga kosavomerezeka.¹⁶¹

Kubwezeretsa Kwachilengedwe

Kubwereza kwalephera kuyeserera kutchova juga kumayambitsa chizindikiritso cha kutchova juga kosadziwika bwino, zomwe zimadziwika kuti vuto la kutchova juga limatha kukhala lolimba komanso logwirizana ndi kubwereza kosiyanasiyana. Zatsopano zimatsutsa lingaliro ili, komabe, chifukwa zikuwonetsa kusinthasintha kwa zovuta zamtundu wa juga, kuwonetsa njira yofupikira, yamachitidwe.^1,12,179 Chithandizo chazachilendo sizachilendo (ochepera 10%) mwa anthu omwe amakwaniritsa njuga zosapweteketsa ena amafuna chithandizo chamankhwala),^180,181 zifukwa zomwe zafotokozedwera posafuna chithandizo chamankhwala zimaphatikizapo kukana, kuchita manyazi, komanso kufunitsitsa kuthana ndi vutoli palokha.¹⁸² Kafukufuku wautali wochepa kwambiri amapezeka pa njira zachilengedwe zotengera njuga zosasinthika, komanso ochepera pazikhalidwe zina. Umboni wina ukusonyeza kuti achinyamata nthawi zambiri amalowera m'mavuto a juga.¹⁸³ Ngakhale maphunziro ochepa achindunji, obwereza omwe adachitika kale, adatinso kuchitapo kanthu, ndizomveka kunena kuti chithandizo chitha kukhala chofunikira pakudziletsa.

Njira zopewera

Njira zopewera kupewa ndikofunika kuthana ndi zizolowezi zowonera. Mtengo kwa anthu amakhalidwe otere atha kuchepetsedwa pokhazikitsa ndi kukhazikitsa njira zophunzitsira zabwino zomwe zimalimbikitsa chidwi chazathu zokhudzana ndi machitidwewa komanso zodziwitsa anthu azaumoyo za kufunika kowunikira komanso kuwongolera momwe amathandizidwira. Ndondomeko ziyenera kulimbikitsa kutenga nawo mbali pazinthu izi ndikupititsa patsogolo mwayi wowalandira. Popeza kuchuluka kwa zizolowezi pakati pa achinyamata,¹⁸⁴ mapulogalamu opewera kusukulu atha kukhala othandiza kwambiri.

ZINSINSI zina

Zidakwa zimasiyana. Kuvomerezeka kwa anthu, kupezeka kwa chinthu, komanso kufalikira kwa machitidwe ake zimayimira malingaliro ofunikira othandizira. Chizolowezi chilichonse cha machitidwe chimatha kuyimira kupangika kwapadera, ndi ma subtypes ena omwe atha kukhala osiyana ndi zochitika zamaganizidwe. Mitundu yosiyanasiyana ya kutchova juga (mwachitsanzo, kubetchera ndi kutsutsana, kubetcha pamasewera) ndi malo osiyanasiyana (mwachitsanzo, kasino) kungakhale ndi chiopsezo chosiyanasiyana chakugulitsa njuga yosagwirizana.^185,186 Mofananamo, mitundu yosiyanasiyana ya masewera amasewera (mwachitsanzo, wamkulu pamasewera pa intaneti, chithunzi ndi njira, zochita), mitundu yosiyanasiyana yogwiritsira ntchito intaneti (mwachitsanzo, malo ochezera, imelo, mabulogu), ndi mitundu yosiyanasiyana yazakudya (mwachitsanzo, shuga, mafuta) itha kukhala ndi njira zosiyira zosiyanasiyana zomwe zingagwiritsidwe ntchito m'njira zosiyanasiyana. Kusiyana koteroko ndikofunikira kuilingalira, ndikuthandizira kufufuza kwina.

KUYAMBIRA MAFUNSO

Ngakhale atapita patsogolo kwambiri pakufufuza, zosokoneza bongo sizimamveka bwino. Kumvetsetsa kwathu njira zoyenera, zolekeredwera bwino zamankhwala komanso njira zamakhalidwe azolowera zamatsenga zimatsalira kwambiri pakumvetsetsa kwathu pochiza matenda amtundu wina waukulu wa neuropsychiatric. Popeza kulemera kwaumoyo komanso mayendedwe amachitidwe amakhalidwe awa (mwachitsanzo, mtengo woyerekeza wamitengo yosungidwa mu United States ndi $ 53.8 biliyoni),¹⁸⁷ Kupanga ndi kukonza njira zopewera ndi chithandizo ndikofunikira. Kukhazikitsidwa kwa ma screens azaumoyo komanso zida zoyesera zowunikira kuti mudziwike osiyanasiyana pazomwe mungachite kuti muthandizidwe zingathandize kuchepetsa nkhawa zaumoyo wa anthu. Kafukufuku wowonjezera pazoyeserera zamankhwala zamankhwala zamankhwala komanso zikhalidwe zamakhalidwe ofunikira ndizofunikira. Kafukufuku wopitilira atha kuthandizanso kudziwa njira zatsopano zamankhwala ndipo zithandizanso kudziwa kusiyana komwe kungagwiritsidwe ntchito kuwongolera njira zochiritsira zosankhidwa. Ngakhale pali kusiyana, kufalikira pakati pazokonda ndi zosokoneza bongo kukuwonetsa kuti kafukufuku wokhutira pamapeto pake angadziwitse kumvetsetsa wakale. Kudzera mukufufuza kwakanthawi kogwirizana ndi zomwe zidapezeka kuti zidaletsa kugwiritsa ntchito mankhwala osokoneza bongo, malingaliro, chithandizo, komanso kupewa komanso malingaliro okhudzana ndi zizolowezi zamakhalidwe azikhalidwe zingayende mtsogolo mwachangu-kuchepetsa, kuwonongera kwa thanzi la anthu komanso kuthana ndi mavuto a anthu mikhalidwe imeneyi.

Kuvomereza

Zothandizidwa, mwa zina, ndi National Institute on Drug Abuse sap nos. P20 DA027844, R01 DA018647, R01 DA035058, ndi P50 DA09241, National Center for Responsible Gaming, Connecticut State Department of Mental Health and Addictions Services, ndi Connecticut Mental Health Center (onse a Dr. Potenza).

Mawu a M'munsi

Kulengeza zofuna: Potenza adafunsapo mankhwala a Lundbeck, Ironwood, Shire, ndi INSYS ndi RiverMend Health; adalandira thandizo lofufuzira kuchokera ku Mohegan Sun Casino, Psyadon Pharmaceuticals, ndi National Center for a Responsible Gossip; adachita nawo kafukufuku, makalata, kapena kulankhulana pafoni okhudzana ndi kugwiritsa ntchito mankhwala osokoneza bongo, zovuta zowongolera, kapena mitu ina yokhudzaumoyo; ndipo yafunsira kwa njuga, zalamulo, ndi mabungwe aboma pankhani zokhudzana ndi kukakamira kapena zovuta zopewera. Mabungwe azandalama sanapereke ndemanga kapena ndemanga zomwe zalembedwa, zomwe zimawonetsera zopereka ndi malingaliro a olemba osati malingaliro a mabungwe othandizira.

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