Kulimbana ndi vuto lakutchova juga: kodi chidziwitso chiti chingatiuze chiyani? (2014)

Kudalirika

Kutchova juga, kudziletsa, komanso kusakhazikika: pa juga ndi lingaliro la kudziletsa

Kutchova njuga kwa Pathological (PG) kuli ndi njira yofalikira kumayiko akumadzulo, kuyerekezera kuchokera ku 1.4% (kuchuluka kwa moyo wonse) ku USA, mpaka 2% ku Canada (Welte et al., 2002; Cox et al., 2005). Mitengo ya prevaleness ndi yofanana komanso yosasunthika pakati pa mayiko kudutsa zida zamafukufuku (Stucki ndi Rihs-Middel, 2007), ndi chiwopsezo chowazungulira 3% ya PG ndikuvuta njuga (PrG) palimodzi.

Kuwongolera kuzindikirika kwa chidwi chofuna kuchita zikhalidwe zosokoneza bongo ndi khalidwe lalikulu la PG. Ndipakati pake phenomenology ya PG monga afotokozedwera mu njira zingapo zodziwira matenda a PG (mwachitsanzo, kuyesayesa kosalephera kuwongolera, kuchepetsa, kapena kusiya njuga). Kutanthauziridwa kuchokera mu mawonekedwe amanjenje, lingaliro lokhazikika la kuwongolera kuzindikira limatha kufotokozedwa ngati kuthekera koongolera zochita zanu. Kuwongolera kwazidziwitso kumatha kugawidwa munjira zingapo (monga) kufotokozera mayankho (monga kutanthauzira poyeserera, kuyesedwa ndi ntchito ngati siginecha) komanso kutaya chidziwitso chosafunikira (chotchedwa kulowerera mwaumbuli ndi ntchito monga Stroop task). Pakuyimira kowonekera kwa chiwongolero chazindikiritso, mawu akuti "kukakamiza" amagwiritsidwa ntchito pafupipafupi, kuwonetsa chizolowezi chochita zomwe akufuna, kuwonetsa mikhalidwe yomwe ili yodziwika mwa kusalingalira pang'ono, kusalingalira, kapena kuganizira zotsatira zake (Daruna ndi Barnes, 1993). Impulivity ndi nyumba yopangidwa mwaluso yomwe nthawi zambiri imapangidwa kuti ikhale "yosakakamiza", yodziwika ndi kuchepetsedwa kwagalimoto ndi "chisankho chosayendetsa", choyimiriridwa ndi mtima wofuna kulandira mphotho yomweyo posachedwa, zazikulu, kapena zopindulitsa kwambiri posankha Njira zopangira (Lane et al., 2003; Reynolds, 2006; Reynolds et al., 2006; Broos et al., 2012). Kulephera kuyankha koyipa kumaganiziridwa kuti kumayambitsa vuto losakakamiza, ndipo kuchepa kwa kuzindikira kwayendetsedwa ngati chidziwitso cha chiopsezo cha endophenotypic pazovuta zaposachedwa m'zaka zaposachedwa.

Kafukufuku wambiri wodzifotokoza komanso kafukufuku wa neurocognitive ku PG akuwonetsa kukhudzika kwakukulu pazinthu monga Barratt Impulsiveness Scale, kapena Eysenck's and Impulsiveness Questionnaire (Eysenck et al., 1985) ndikuchepetsa kuwongolera kwa chidziwitso monga zikuwonetsera kuchepetsera kuyankha koyankha, kulowererapo kwazindikiritso, ndikuchepetsa ntchito zowunikira (zowunika onani: Goudriaan et al., 2004; Verdejo-Garcia et al., 2008; van Holst et al., 2010a, b). Mwachidziwikire, kuchepetsa kuchepa kwa zomwe munthu akuchita kungapangitse kuti pakhale chiwopsezo chachikulu chokhala ndi PrG kapena PG, chifukwa mwachitsanzo, kuchepa kwa chiwongolero kuyankha mayankho (choletsa kuyankha) kungalumikizidwe ndi kupita patsogolo kwambiri mu PrG chifukwa chakuchepa mphamvu kwa lekani kutchova juga ndalama zikatha. Mofananamo, kuthekera kosokonekera kwa kuzindikira kotereku kukhoza kupangitsa kuti munthu atha kunyalanyaza njuga zachilengedwe. Mwachitsanzo, kuwona kusokonezedwa ndi chidwi chochuluka kumatha kubweretsa chidwi chochuluka pakutsatsa kutchova juga, zomwe zingapangitse mwayi wambiri wa kutchova juga, pomwe kuchepa kwa chizindikiritso kumatha kutsitsa kuthekera kwa kuleka kutchova njuga ngakhale kutayika kwambiri.

Ndemanga zingapo zidasindikizidwa kale ndi cholinga chakuwongolera kuzindikira kapena kuperewera kwa PG (van Holst et al., 2010a, b; Conversano et al., 2012; Leeman ndi Potenza, 2012). Ndemanga iyi imayang'ana maphunziro aposachedwa kwambiri a neurocognitive and neuroimaging omwe asindikizidwa mu PG ndi PrG. Makamaka, kuwunikiraku kumayang'ananso maphunziro owunikira pazinthu zoyeserera (mwachitsanzo, kubwerezanso kwacue), zochitika zam'maganizo (mwachitsanzo, kukakamizidwa), ndi maphunziro owonjezera omwe amakambirana momwe kulumikizana kumachitika pakati pazidziwitso komanso njira zophunzitsira.

Pomwe kutanthauzira komveka kwa PG kulipo, kukwaniritsidwa kwa (kawirikawiri kwaposachedwa kwambiri kwa) njira za DSM za kuzindikira za PG, palibe tanthauzo lomveka bwino la PrG. Nthawi zambiri, PrG imatengera mtundu wovuta kwambiri wa PG, kapena umagwiritsidwa ntchito ngati palibe matenda azachipatala omwe angatsimikizidwe, chifukwa chotsogozedwa kwa mafunso m'malo mofunsidwa mwachipatala. Kafukufuku wina amatanthauzira PrG ndi kuchuluka kwa 5 kapena kupitilira apo pa South Oaks Gging Screen (SOGS) kapena ndi X XUMX kapena wapamwamba pa mtundu waufupi wa SOGS (Slutske et al., 2005). Mu maphunziro ena otchova juga omwe amathandizira njuga zovuta, ndipo amakwaniritsa njira zinayi za njira za PG, amatchulidwa kuti otchova njuga (Scherrer et al., 2005,, kapena gulu lonse lawerengedwa limatchulidwa kuti "otchova juga mavuto" pomwe onse omwe samalandira chithandizo samakwaniritsa njira zisanu kapena kuposerapo (mwachitsanzo, de Ruiter et al., 2012). Mukuwunikanso kotero, PrG imagwiritsidwa ntchito, pomwe palibe chidziwitso chomwe chimaperekedwa pakuwunika DSM kwa PG, koma pofunsa mafunso amawonetsa kuti PrG ilipo.

Malinga ndi Conversano et al. (2012), Kafukufuku angapo akuwonetsa kuchepa kuwongolera kuzindikira mu PG monga zikuwonetsedwera pakuyimitsa ntchito, Ntchito za Go-NoGo, komanso pogwira ntchito ya Stroop. Ledgerwood et al. (2012) Komabe adayesa zoletsa poyankha ndi Stroop ndikuyimitsa ntchito ya siginolo, ndipo sananene kuti pali kusiyana pakati pa otchova njuga ndi kuwongolera pazintchitozi, koma kusiyana kunalipo pokonzekera ntchito (Tower of London) komanso mu kusinthasintha kwazindikiritso (Chiyeso cha Mapangidwe a Khadi la Wisconsin). Momwe mayeserowa adaphatikizira onse otchova juga omwe amathandizidwa (osakhala mankhwalawa) komanso ochita zofunafuna chithandizo chamankhwala, kusiyana kwina ndi maphunziro ena kungakhale kokhudzana ndi mbiri yozindikira yomwe siyabwino pofunafuna otchova njuga. Zowonadi, mu kafukufuku wina wochitika ndi gulu lomweli lokonda kuponderezana (Barratt impulsivity Scale), zikhalidwe zosavomerezeka za chaka chatha, kusokonezeka kwapansi ndi zovuta zamisala, komanso chidwi chochepa ndi kutchova juga chinalipo pagulu la anthu ogwidwa ndi zigawenga za m'magulu a anthu ogwirira matenda ozunza odwala. (Knezevic ndi Ledgerwood, 2012).

Ngakhale kuchuluka kwa maphunziro a neuropsychological omwe akuwonetsa kuchepa kwa kuzindikira kwachilengedwe, kuchuluka kwa maphunziro a neuroimaging omwe amayang'ana kwambiri zamagetsi othandizira ozindikira amachepa kwambiri chifukwa chake maphunziro onse okhudzana ndikuwongolera kuzindikira amakambidwa pano. Pakufufuza kwa Potenza et al. ntchito ya Stroop idayendetsedwa mu kafukufuku wa fMRI mu masewera otchova juga a 14 ndi ma 13 oyang'anira athanzi (HCs) (Potenza et al., 2003a). Kuyankhidwa kwa BOLD poyankha kumanzere kwa ventC komanso wamkulu wa OFC adanenedwa kuti anali otchova juga kuyerekeza ndi ma HC, ngakhale anali osagwirizana. Kusowa kwa machitidwewa mwina kuyenderana ndi mtundu womwe unasinthidwa wa Stroop womwe unagwiritsidwa ntchito: kutchula chete mitundu ya zilembo ndi machitidwe amachitidwe omwe amayeza podzidziwitsa za omwe atenga nawo mbali atachita ntchito ya Stroop. Mu kafukufuku waposachedwa ndi de Ruiter et al. (2012), kuchepa kwa kuyankha kwa neural pambuyo pazolephera zolephera kunapezeka mu anterior cingrate cortex (ACC) mu 17 vuto lotchova juga poyerekeza ndi 17 HCs. Zowona, ntchito yochepetsedwa idawonekanso pambuyo pazoletsa bwino m'magawo ofananawo (kumanja kwa dorso-medial PFC kumalire pa ACC) HCs. Phunziroli, lofanana ndi kafukufuku wa Potenza et al. - palibenso kusiyana pakati pa gulu la PrG poyerekeza ndi ma HC, omwe atha kukhala okhudzana ndi zovuta zamagetsi chifukwa cha zitsanzo zazing'ono za maphunziro a fMRI mu PrG ndi PG poyerekeza ndi maphunziro a neuropsychological. Kafukufuku onsewa a fMRI pa kayendedwe kazachilengedwe mu PG ndi PrG akuwonetsa kuti kuchepa kwa magawo angapo oyambira komanso a ACC akuwonetsa kuti magwiridwe antchito oyang'anira ubongo amachepa mu PG ndi PrG poyerekeza ndi ma HC. Zotsatirazi zimapangitsa kuti kuchepa kwa ntchito zamtsogolo kumathandizira pathophysiology ya PG ndi PrG, momwe kuchepa kwamphamvu pakulamulira kutchova juga kuli pakati.

Mzere wina wamaphunziro ukuwonetsa kuti kukhudzidwa kumathandizanso pa gawo lofunikira pakukula kwa PrG. Kafukufuku wautali wazaka zapakati pa achinyamata ndi achikulire ochokera ku gulu lofufuza kuchokera ku Montreal ku Canada akuwonetsa kuti kuchuluka kwazomwe zimayambitsa kutchera njuga komanso kwa PrG (Vitaro et al., 1997, 1999; Wanner et al., 2009; Dussault et al., 2011). Makamaka, kuchuluka kwazovuta zomwe zimalumikizidwa ndi miyeso yayikulu ya PrG (Vitaro et al., 1997). Mu kafukufuku wina waposachedwa, kulumikizana kwabwino pakati pa kusokonezeka pazaka 14 ndi zofooka zowonekera komanso zovuta zamtundu wa juga pazaka 17 zidakhalapo (Dussault et al., 2011). Kafukufuku wina wogwiritsa ntchito zitsanzo zachimuna ziwiri zam'magulu, zikhalidwe zokhudzana ndi kudziletsa komanso okhudzana ndi anzawo anali okhudzana ndi PrG, komanso kugwiritsa ntchito mankhwala osokoneza bongo komanso ulesi, zomwe zikuwonetsa zinthu zomwe zili pachiwopsezo chokhala pachiwopsezo cha zovuta zingapo zakunja (Wanner et al., 2009). Maphunzirowa adayang'ana paubwana ndi gawo lolosera la kuyeserera kwa PrG; Posachedwa maphunziro awiri akuluakulu obadwa kumene kwa anthu obadwa nawo, amafufuza za kukakamizidwa kuubwana ndi PrG panthawi yaukalamba. Mmodzi mwa maphunziro awa (Shenassa et al., 2012), akatswiri azamisala adavotera machitidwe osachita manyazi komanso amanyazi / okhumudwa ali ndi zaka 7, ndipo adafananizana ndi izi pomwe adatinso PrG ngati achikulire, pakutsatira. Pomwe machitidwe okakamiza pa msinkhu 7 idaneneratu PrG, machitidwe amanyazi / okhumudwa sanalosere PrG atakula, mu gulu logwirizana la US la ana 958 ochokera ku Collaborative Perinatal Project. Phunziro lalikulu la kubadwa kwa a cohort kuchokera ku Dunedin, New Zealand, kusinthasintha kunayesedwa ali ndi zaka 3, ndipo kutchova juga kosasinthika kunayesedwa pamzinda uwu pomwe 21 yakale ndi 32. Zodabwitsa ndizakuti, ana omwe ali ndi (mwamakhalidwe komanso mwamalingaliro) osapsa mtima pomwe anali ndi zaka za 3, anali owonjezera kuwirikiza kawiri poyerekeza ndi umboni womwe wasokoneza kutchova juga, poyerekeza ndi ana omwe adasinthidwa bwino pazaka za 3. Ubwenziwu udalimba kwambiri mwa anyamata poyerekeza ndi atsikana (Slutske et al., 2012). Kafukufuku wina wowerengeka akuwonetsa kuti kunyinyirika ndikudziwikanso kosavomerezeka pakuchita njuga (Pagani et al., 2009; Vitaro ndi Wanner, 2011).

Pomaliza, kuchokera pamzera uno wamaphunziro, pali umboni wamphamvu kuti kunyengerera ndi kuchepa kwa kayendedwe ka zinthu zimachita gawo lofunika kwambiri kuyambira pakuchita nawo njuga mpaka kukulitsa ndi kupitiriza kutchova juga ndi PrG.

Popeza ili ndi gawo lofunikira la kuwongolera kwamalingaliro polimbikitsa kutchova juga ndi PrG, zomwe zikuwoneka kuchokera ku maphunziro a kubadwa kwa cohort, maphunziro a neurocognitive, maphunziro ochulukirapo a PrG ndi PG ayenera kuyang'ana kuwongolera kuzindikira, kuti athandizire kuzindikira komwe mitsempha ya minofu ingachepetse kuwongolera kwazidziwitso pamavuto. kutchova juga. Chifukwa chake, kuwerengera zochitika pakati pa (riwaya) zamaganizidwe am'maganizo, zamankhwala, kapena ma neuromodulation mu PG, ndi momwe zimawachitikira pa neurocircuitry of ccinitive control mu PG, ndi malo ofunikira kwambiri pakuphunzira zam'tsogolo ndi maphunziro azachipatala a PG (mwatsatanetsatane mu gawo la Zokambirana ).

Ziri pa cue? Maphunziro a Cue-reacaction pamavuto amatchova njuga

Poyerekeza ndi ochepa maphunziro a neuroimaging pa cognitive control kapena impulivity mu PG ndi PrG, mutu wa machitidwe a neural machitidwe a cue-reactivity ku PG ndi PrG amaphunziridwa bwino. Maphunziro asanu a neuroimaging pa cue-reactivity mu PG ndi PrG (Potenza et al., 2003b; Crockford et al., 2005; Goudriaan et al., 2010; Miedl et al., 2010; Wölfling et al., 2011) ndi maphunziro angapo omwe amayang'ana pa kukhudzanso kwa cue okhudzana ndi kulakalaka kwapang'onopang'ono ndi / kapena mayankho apadera a PrGs alipo (Freidenberg et al., 2002; Kushner et al., 2007; Sodano ndi Wulfert, 2010). Pa mulandu wa kubelenga, tulangilila pa fipusho fya kusambililako.

Mwa maphunziro asanu a neuroimaging a PG ndi PrG okhudzana ndi kukonzanso kwa cue, woyamba (Potenza et al., 2003b) adagwiritsanso ntchito kanema wophatikizidwa ndi makanema opangidwa kuti apangitse anthu kutchova njuga. Mu makanema awa, ochita sewerawo adatsata zochitika pamalingaliro (mwachitsanzo, achimwemwe, achisoni), pomwe ochita sewerowo adafotokozera kuyendetsa kupita kapena kukwera pa kasino ndikumva kubera. Mu phunziroli, nthawi zomwe ophunzira adakumana nazo adakawunikira ma 10 otsegula m'matumbo poyerekeza ndi HC khumi ndi imodzi. M'nthawi zonse, izi zinali zisanachitike njuga zenizeni zomwe zidakhalapo ndipo poyankha zomwe ochita masewerawa adawafotokozera momwe akumvera (mwachitsanzo, zochitika za njuga). Kutsegulira kochepa mu cingulate gyrus, (orbito) frontal cortex (OFC), caudate, basal ganglia, ndi madera a thalamic analipo mu ma 10 a ma pathological a geological poyerekeza ndi ma 11 HC. Kafukufuku wina wogwiritsa ntchito makanema okhudzana ndi kutchova juga kuti apatse reacit cue-reactivity, ma 10 otsegula m'matumbo ndi ma 10 HC adayerekezedwa ndikuyankha kwa ubongo pamavidiyo okhudzana ndi kutchova njuga poyerekeza ndi kuwonera makanema okhudzana ndi chilengedwe (Crockford et al., 2005). Ma activation okwera m'malo a dorsal pre mbeleal, malo otsika kwambiri, malo opangira parahippocampal, ndi occipital lobe amapezeka mwa otchova njuga poyerekeza ndi ma HC. Mu kafukufuku wotsatira wa fMRI cue-reacaction, Goudriaan et al. (2010) adapeza zochulukira za zigawo zofananira poyerekeza ma 17 otsogola a m'magazi a 17 HC amagwiritsa ntchito zokhudzana ndi juga ndi zithunzi zosagwirizana. Phunziro lomalizali, ubale wabwino wapezeka pakati pakulakalaka kutchova juga kwa otchova njuga ndi zochitika za zigawo zamtsogolo ndi za parahippocampal powonera zithunzi za njuga motsutsana ndi zithunzi zosaloŵerera m'nkhondo. Mu kafukufuku wa EEG wolemba Wölfling et al. (2011), Otsogolera a 15 a pathological achifanizo ndi ma 15 HC pazoyankha za EEG pazithunzi zamtundu wa juga poyerekeza ndi zithunzi zosaganizira, zabwino komanso zoipa. Poyerekeza ndi HCs, otchova njuga amawonetsa kuthekera kwakutali kwakanthawi (LPPs) kochititsidwa ndi kutchova njuga poyerekeza ndi zisankho zandale, koma akuwonetsedwa ndi LPPs pazithunzi zosalimbikitsa. Mosiyana ndi izi, ku HCs panali kuyankha kwakukulu pakuyambitsa zabwino komanso zoyipa poyerekeza ndi zomwe sizimalowerera ndale komanso kutchova juga. Ma LPP apamwamba adalipo pama electrodes a parietal, chapakati, ndi kutsogolo mu PG poyerekeza ndi HCs, kutanthauziridwa monga kuyankha kwakukulu kwa psychophysiological kulinga kutchova juga pamasewera a njuga.

Pomaliza, mu fMRI yowerengera kufananizira kuyankha kwa ubongo kumayendedwe oopsa omwe amakhala pachiwopsezo cha ma 12 otchova juga aku 12 HCs, otchova njuga adawonetsa kuyankha kwakanthawi kwa BOLD m'magawo a thalamic, owonekera kutsogolo, komanso apamwamba mayesero, pomwe chizindikiro chakuchepa kwa zigawo izi panthawi ya mayeso ochepera. Njira yotsatirayi idawonedwa mu otchova juga osavuta (Miedl et al., 2010). Olembawo akuti njira yoyendetsera parietal iyi pamayesero owopsa kwambiri poyerekeza ndi mayeso ochepera pamavuto otchova njuga imawonetsa kukumbukira komwe kumayambitsa kulowerera, komwe kumayambitsa chidwi ndi njuga. Zotsatira za kafukufukuyu zikuwonetsa kuti kuwononga kwambiri omwe ali pachiwopsezo kumatha kukhala kosangalatsa kwa otchova njuga, kupatsa chidwi chofanizira komanso kukhumba, pomwe kuwotcha kwazing'ono, kuyimira mwayi wopeza ndalama zochepa kumabweretsa chiyembekezo champhamvu mu omwe otchova njuga. Kutanthauzira kotheka kwa kuyankha kwatsika kwa ma wage omwe ali pachiwopsezo chovuta kwambiri pamasewera ovuta, atha kukhala kuti izi zimachitika chifukwa cha kuchepa kwamphamvu kwa mphotho chifukwa cha kuyankha kolakwika kwaubongo pazopeza ndalama zochepa.

Pofotokoza mwachidule maphunziro obwereza mu PG ndi PrG, chithunzi chosinthika chikuwonekera pokhudzana ndi maphunziro omwe amagwiritsa ntchito zithunzi zolaula kapena makanema otchova njuga — omwe amaphatikizidwapo zochitika zenizeni. M'maphunzirowa, kuyankha mosadukiza mu dera la stonto-striatal mphiri komanso malo aubongo okhudzana ndi chisamaliro chokhudza kutchova juga amapezeka mu otchovera njuga / otchova njuga poyerekeza ndi HCs (Crockford et al., 2005; Goudriaan et al., 2010; Miedl et al., 2010; Wölfling et al., 2011). Mosiyana ndi izi, mu kafukufukuyu yemwe amagwiritsa ntchito zochitika zomwe zimapangitsa kupsinjika, zotsatiridwa ndi mafotokozedwe ofunitsitsa kuchita nawo njuga, adachepetsa kuyankha m'mayendedwe aku fronto-striatal circry adapezeka (Potenza et al., 2003b). Izi zikutanthauza kuti kubwereza komwe kumachitika chifukwa cha kutchova juga kumadzetsa mphotho- komanso kulimbikitsa zochitika zokhudzana ndi kutsata njirazi kungapangitse mwayi wotchova njuga. Kumbali ina, kusokonekera kwa zinthu zomwe zadzetsedwa ndi zovuta zomwe zitha kubweretsa gawo lochepa mu mphotho yomweyo- komanso zolimbikitsidwa zokhudzana ndi zochitika zamagetsi, zomwe zimapangitsa kuti azilakalaka kutchova juga, kuti athetse vuto lomwe lingathe muzochitika zabwino ( kapena anhedonia). Omwe adapeza kuchepa kwaufulu wa zinthu zam'mbuyo (Potenza et al., 2003b) ikukhudzana ndi "allostatic" nkhawa yamavuto (mwachitsanzo, dysphoria, nkhawa, kusakwiya) kuwonetsa chidwi chodzichotsa pakubwera ngati matenda a Koob ndi Le Moal komanso monga chaphatikizidwa posachedwa ndi ndemanga ya Koob ndi Volkow (2010). Zotsatira zotsala za neuroimging poyankha njuga zokhudzana ndi kutchova juga zimayenderana ndi chidwi komanso chiyembekezo chofuna kuchita nawo zinthu zomwe zingawakhumudwitse. Chifukwa chake, kuwonjezeka kuwonjezeka kwa njira yolipirira yaubongo ku njuga zamtunduwu komanso kuchepa kwa mayankho amachitidwe a mphotho kumachitidwe osokoneza omwe akuyembekeza kutchova juga kumatha kubweretsa kukhumba komanso (kuyambiranso) njuga. Kuphatikiza uku kumagwirizana komanso kafukufuku wamakhalidwe ndi Kushner et al. (2007), pomwe kuchepa kwa cue kudanenedweratu pambuyo pake

Pamodzi, kafukufukuyu wamaganizidwe othandizira komanso malingaliro osokoneza bongo akuwonetsa kuti gawo lofunika kuti lifufuze mu PG ndi PrG ndiye kulumikizana pakati pamachitidwe abwino osinthika ndi malingaliro osasangalatsa a malingaliro / kukonzanso kupsinjika, komanso onse ofuna njuga. Kuchokera ku maphunziro omwe amayerekezera kutchova njuga ndi zomwe zimayambitsa kusatenga mbali, kuwonekeranso kumaso kwakumaso kwokhudzana ndi kuchuluka kwa kubwezeretsanso chidwi kukuwonekera. Komabe, udindo wa amygdala ndi malingaliro osakhazikika am'malingaliro (mwachitsanzo, monga "motivational draal syndrome") pakulakalaka ndikukayambiranso ku PG ndi PrG uyenera kulandiranso chidwi chowonjezera.

Gawo la "kudzipatula / zoipa" gawo lamadongosolo osokoneza bongo, omwe amaphatikizidwanso machitidwe olowerera chifukwa cha zotsatira zoyipa kapena zotsatira zoyipa, kuti muchepetse kuchoka ndi / kapena kukhudza koyipa (Koob ndi Volkow, 2010) ikhoza kulumikizidwa ndi otchova njuga omwe ali pachiwopsezo chovuta kwambiri, chimodzi mwazinthu zitatu zamavuto otchova njuga, monga momwe Blaszczynski ndi Nower (2002) komanso yodziwika ndi kupanikizika kochita kupsinjika ndi kusintha kwa njira monga njira yopita ku PrG (Blaszczynski ndi Nower, 2002). Gawo la "kutanganidwa" / gawo la chizolowezi chomwe anthu amakonda, omwe amadziwika kuti ali ndi chidwi chodziwikiratu, amalumikizana ndi gulu la "antisocial, impulsivist" la otchova juga monga akufotokozera Blaszczynski ndi Nower (2002). Amalongosola gawo lomaliza la otchova juga omwe amadziwika ndi kukhudzika kwakukulu, komanso chikhalidwe chamakhalidwe monga ADHD ndi kugwiritsa ntchito mankhwala osokoneza bongo, omwe amalimbikitsa ndikufulumizitsa njira zapamwamba komanso zogwira ntchito popanga PrG (Blaszczynski ndi Nower, 2002). Pakadali pano, ma subgepes atatu awa a ma juga a pathological sanaphunziridwe mopatsa chidwi: Ledgerwood ndi Petry adafufuza ma subtypes atatu amtunduwu mkati mwa gulu la otchovera njuga a 229, omwe adazikidwa pazofunsa mafunso. Ngakhale ma subtypes anali osiyana pa kuwuma kwa PrG, kutumizira anthu ochepa sananenere kuti ayankhe mosiyanasiyana. Kafukufuku zingapo zimawonetsa kusiyana pakati pa otchova njuga komanso ovuta pamavuto. Mwachitsanzo, kafukufuku waposachedwa (Steinberg et al., 2011), phokoso losalamulirika (kupweteketsa nkhawa) kunapangitsa kuti kuchepa kukondetsa kutchova juga m'mavuto otchova njuga, pomwe kumawonjezera kulakalaka kumwa mowa m'magulu otchova njuga, ogwiritsa ntchito moledzera osayanjanitsika komanso ma HC. Kupeza kumeneku, ngakhale mu kachigawo kakang'ono (Othandizira pa 12 pagulu lililonse lazachipatala), zikuwonetsa kuti kusintha kosiyanasiyana pakulakalaka zizolowezi zosiyanasiyana zomwe zimapangitsa kuti zibweretse nkhawa zimatha chifukwa cha kupsinjika (apa: kutchova juga ndi kumwa mowa) Pakufufuza kwanu (Elman et al., 2010) muyezo wokhazikika wokhudzana ndi kutchova juga m'mavuto otchova njuga inali njira yolembetsera tsiku ndi tsiku, kuwonetsa ubale wabwino pakati pa kupsinjika ndi kukhumba njuga. Chosangalatsa ndichakuti, mu kafukufuku waposachedwa yemwe adakumana ndi zovuta za yohimbine, chidwi champhamvu chamanzere poyankha yohimbine pazinthu zonse zinayi za PG chidawonetsedwa, pomwe izi sizidapezeke mu ma HC asanuwo, ndikuwonetsa kukhudzidwa kwa zamankhwala mu ubongo a otchova njuga. Chifukwa chake, maphunziro omwe amayang'ana pa ubale pakati pa kukonzanso kuphatikizika ndi magwiridwe antchito, kutchova njuga, ndi machitidwe a njuga amafunikira, kuti tifotokozere bwino zomwe zimalimbikitsa kuti tichotse (kusinthanso kupsinjika) ndi chidwi / kuyembekezera (gawo la cue) kuzungulira kwa chizolowezi mu PG ndi PrG. Kutengera ndi zotsatira za kafukufukuyu wamakhalidwe ndi kuthupi, komanso zotsatira zoyipa zochokera pa kafukufukuyu yemwe amayang'ana kwambiri zomwe zing'onozing'ono zazomwe zimatchova njuga (Ledgerwood ndi Petry, 2010), zikuwonekeratu kuti kafukufuku wambiri (neuro) wachilengedwe amafunika pogulitsa PG. Zitha kuchitika kuti vuto limodzi la otchova njuga limadziwika kuti omwe amatchova njuga amayamba chifukwa cha zovuta zoyipa (ndi vuto la amygdala ngati njira ya neural) ndi vuto lina lotchova njuga lomwe limalimbikitsa kutchova njuga (ndi hyperactive orbitofronto-striatal circry limagwirira. Kugonjera kumene kwa otchova njuga kochokera mu endophenotype (kukhudzanso / kupsinjika maganizo motsutsana / kukhudzika / kukhudzika kwa njuga) titha kufananizidwa ndi ma subtypes atatu monga Nower and Blaszczynski (2010): mwamakhalidwe, osachedwa kutengeka komanso okhudzidwa.

Ngakhale ochepa maphunziro a neuroscience pa kukonzanso kupanikizika mu PG ndi PrG alipo, nkhani yofananira ndiyopezeka kapena kuwonjezeka kumvetsetsa kwamaphunziro mu maphunziro a neuroimaging ku PG ndi PrG, ndipo maphunziro awa tikambirana motsatira.

Kuchulukitsa kapena kuchepa kwa kumvetsetsa kwamabvuto amatchova njuga: kodi zonse zili pamasewera kapena zonse ndi ndalama?

Lingaliro lodziwika bwino lokonda zamankhwala ndiloti anthu omwe amadalira mankhwala omwe ali ndi vuto la kuchepa kwa mphotho, omwe amawapangitsa kuti azitsatira zolimbikitsa (kutanthauza, mankhwala) kuti athane ndi vuto ili (Comings and Blum, 2000). Tiye woyamba maphunziro a fMRI ku PG yokhazikika pakuwongolera mphoto afotokoza zotsatira zogwirizana ndi kuchepa kwa mphothoyo. Mwachitsanzo, poyankha phindu la ndalama poyerekeza ndi kutayika kwa ndalama omwe amatchova njuga adawonetsa kulumikizidwa kolondola kwa chotupa cha porral striatum ndi porral pre mbeleal cortex (Reuter et al., 2005). Chimodzimodzinso kukhazikitsa kwa kotala koyambirira kwamakedzana kudalipo ndi njira yodziwitsa pomwe ochita masewera otchova njuga amatha kupambana kapena kutaya ndalama malinga ndi momwe amagwirira ntchito (de Ruiter et al., 2009).

Posachedwa, kafukufuku wofufuza zambiri magawo osiyanasiyana a kukonza mphotho zachitika. Kugwiritsa ntchito ntchito yosinthitsa ndalama yolimbikitsira (MID) (Knutson et al., 2000) momwe mitu imayenera kuyankhira mwachangu kuti mutenge mfundo / ndalama kapena kuti muchepetse mfundo / ndalama, kutchova njuga kwawonetsa kuyankha kwakanthawi kothandizirana pamalipiro komanso poyankha phindu la ndalama (Balodis et al., 2012; Choi et al., 2012). Pomwe zotsatira za maphunziro awiriwa ndizogwirizana ndi kuchepa kwa mphotho, kafukufuku wina wa fMRI adapeza mayankho akuwoneka kuti akuyembekeza mphotho kapena atalandira mphoto m'magawo okhudzana ndi ubongo wa fronto-striatal.

Mwachitsanzo, pogwiritsa ntchito masewera osankha a probabilistic kutengera njira zomwe akuyembekezera, ochita masewera olimbitsa thupi adawonetsa ntchito yayikulu kwambiri panthawi yolingalira mphotho zazikulu poyerekeza ndi mphotho zazing'ono (van Holst et al., 2012c). Kuphatikiza apo, otchova njuga kuyerekeza ndi zowongolera adawonetsa zochitika zapamwamba mu dorsal striatum ndi OFC pamtengo wokhudzana ndi phindu. Hyper-reactivity pambuyo polandila ndalama mu bets zomwe zimayikidwa pachiwopsezo chachikulu chinapezekanso mu medial frontal cortex ndi kafukufuku wa ERP pogwiritsa ntchito ntchito ya jack jack (Hewig et al., 2010). Mu kafukufuku wa fMRI wolemba Miedl et al. (2012) kuyika mtengo kwamagwiritsidwe akuchepetsa komanso kuchotsera kuthekera kwa otchova njuga ndi HCs zinafufuzidwa. Mtengo wogwirizana ndi ntchito iliyonse unapangidwa kwa aliyense payekhapayekha payekhapayekha komanso wolumikizidwa ndi zochitika zaubongo mu ventral striatum. Poyerekeza ndi zowongolera, otchova jekeseni a pathological adawonetsa chiwonetsero chachikulu chamtengo wapamtunda pazinthu zochepetsera, koma kuyimitsidwa kotsika kwa chiwonetsero chamtengo panthawi ya ntchito yotsitsa ya probabilistic. Izi zikuwonetsa kuti otchovera njuga amawunika zofunikira mosiyanasiyana kuposa kuwongolera. Zotsatirazi zikuwonetsa kuti kusankha kopanda pake pokhudzana ndi mphotho yomwe ikachedwa mtsogolo m'mavuto otchova juga zitha kukhala zokhudzana ndi kukhoma mitundu.

Pakadali pano sizikudziwika ngati PG imagwirizanitsidwa ndi hyper- kapena hypo-shughuli mumayendedwe olipira poyankha zochitika zachuma, nkhani yofananayo yomwe ili ndi mabuku odalira zinthu (Hommer et al., 2011). Nkhani zingapo zothandiza zimatha kufotokozera zomwe zapezeka mu hyper- kapena hypo-shughuli pazopeza zabwino zomwe zapezeka mu maphunziro omwe atchulidwa pamwambapa. Mwachitsanzo, mu MID ntchito maphunziro ayenera kuyankha mwachangu momwe angathere kuti akalandire mphotho pomwe ntchito yomwe van Holst et al. (2012c) Omvera sangakhale ndi mphamvu pa zopambana zawo kapena zotayika. Kusiyana uku mukulamulira zotsatira za ntchito kukadatha kusokoneza mayankho anthawi ya ntchito. Kuphatikiza apo, mawonekedwe ojambula pamaphunziro awiriwa adasiyananso kwambiri; ntchito ya MID yogwiritsidwa ntchito pochita kafukufuku ndi Balodis et al. (2012) adagwiritsa ntchito zithunzi zosagwiritsa ntchito ndalama, ntchito yomwe van Holst et al. (2012c) adakhala ndi makadi osewera osewera ndi ndalama za Euro ndi ngongole. Izi zokhudzana ndi kutchova juga zitha kubweretsa mayankho obwereza omwe amachititsa kuti madera ena asokonekere (onani zokambirana: Leyton ndi Vezina, 2012; van Holst et al., 2012c, d). Lingaliro ili lonena za kuchepa kwa kubwereza-bwereza komwe kulibe miyambo yomwe ingagwiritsidwe ntchito, ndipo kuchuluka kwa malingaliro abwenzi pamankhwala osokoneza bongo omwe adagwirizana ndi zomwe a Leyton ndi Vezina adawunikira mozama.2013).

Kuperewera kwa mphoto kwa malingaliro osokoneza bongo kwalandila thandizo lochuluka kuchokera ku maphunziro a PET omwe amayesa dopamine kugwira ntchito, mosonyeza kuwonetsa kwapansi kwa dopamine D2 / D3 receptor yomanga m'maphunziro omwe amadalira mankhwala (Martinez et al., 2004, 2005, 2011; Volkow et al., 2004, 2008; Lee ndi al., 2009). Ngakhale D2 / D3 receptor yomwe imamangitsa zomwe zimayambitsa PG sizikudziwika bwino chifukwa njira za PET zangogwiritsidwa ntchito posachedwapa mu PG. Pakadali pano, palibe kusiyana kwakukulu pakumanga kwa DA pamayendedwe otetezedwa a pathological poyerekeza ndi ma HC akuwoneka kuti alipo (Linnet et al., 2010; Joutsa et al., 2012; Boileau et al., 2013) koma kafukufuku wina akuwonetsa kuyanjana pakati pa kumanga kwa DA ndi kutchova juga komanso kusasimbika (Clark et al., 2012; Boileau et al., 2013). Kuphatikiza apo, Kafukufuku wopima PET woyeza ntchito ya DA panthawi yogwira ntchito yotchova juga ku Iowa adapeza kuti kutulutsidwa kwa DA mu kutchova juga kwa mzere kunali kokhudzana ndi kusangalala (Linnet et al., 2011a) ndikuyenda bwino (Linnet et al., 2011b). Zotsatira zonsezi zikusonyeza udindo wa kumangidwa kwa DA mosavomerezeka mu PG koma osafanana ndi omwe amapezeka mumankhwala osokoneza bongo omwe amatsimikiza momveka bwino omwe amamangidwa (Clark ndi Limbrick-Oldfield, 2013). Zosowa pamabuku ndi maphunziro omwe amayesa kukhazikika kwa kapangidwe ka DA kapangidwe kake: maphunziro omwe analipo amangoyang'ana pazinthu zokhudzana ndi kupezeka kwa boma D DANNXX / 2 receptor. Kafukufuku wopima mphamvu ya kaphatikizidwe ka DA amatha kuyesa kuyerekezera kwapamwamba pa kapangidwe ka DA mu PG ndi PrG. Mapangidwe apamwamba a DA atha kubweretsa dopaminergic yapamwamba kusinthanso mukakumana ndi miyambo yokhudzana ndi chizolowezi (mwachitsanzo, masewera, ndalama, ngozi). Kuphatikiza apo, maphunziro a PG amapanga mwachindunji DA komanso kuyeza mayankho a fMRI BOLD pakuwongolera mphotho atha kupereka chidziwitso chofunikira pokhudzana ndi udindo wa DA mu PG.

Hypothesis yina, yotsatira kufooka kwa mphotho ya PG ndi PrG ndikuti, yofanana ndi zovuta zogwiritsa ntchito zinthu (SUDs; Robinson ndi Berridge, 2001, 2008), otchovera njuga komanso otchova njuga amavutika ndi kuthekera kwakuthekera kwa njuga zokhudzana ndi njuga. Kukulitsa kopitilira muyeso kwa njira zamtundu wa juga kumatha kukhala kwamphamvu kwambiri kotero kuti kumakokomeza kupendekera kwina kwa magwero ena amphatso, kumabweretsa kusayenerakukulimbikitsidwa. Kuti mupeze ngati otchova juga azitha kuvutika chifukwa chakusowa kwa mphotho kapena kusayenda mokwanira, Sescousse et al. (2013) ndinayerekezera mayankho a neural pazotsatira zonse zachuma komanso mphotho zoyambira (zithunzi zosavomerezeka) mu otchova njuga komanso ma HC. Mogwirizana ndi mfundo yotsirizirayi, hypo-reacaction idawonedwa pamakhalidwe olakwika, mosiyana ndi kubwerezabwereza kumalipiro azachuma, kuwonetsa kukhudzika kosapindulitsa kwa PG. Tikutenga maphunziro onse pamwambapa, pa nthawi iyi zikuwoneka kuti ochita kutchova juga samadwala chifukwa chakuchepa kwa mphotho koma kuti otchova njuga omwe ali ndi chizolowezi chomwenso ali ndi kuyeserera kosiyana ndi zoyeserera zokhudzana ndi kutchova njuga, zomwe mwina zimachitika chifukwa chakukulimbikitsani kwakukondweretsa kwa njuga.

Kafukufuku waposachedwa wa fMRI adaganizira kwambiri za kutchova njuga. Izi ndizofunikira chifukwa otchova njuga nthawi zambiri amakhala ndi malingaliro osiyanasiyana okhudza masewera amtundu wa juga (Toneatto et al., 1997; Toneatto, 1999; Clark, 2010; Goodie ndi Fortune, 2013). Mwachitsanzo, otchova njuga amadziwika kuti amakhulupirira zabodza kuti akhoza kuyambitsa zotsatira zamasewera ("kunyenga kwa ulamuliro") (Langer, 1975). Zochitika zosiyanasiyana zamasewera mwamwayi zimathandizira kusankhana uku (Griffiths, 1993), mwachitsanzo zochitika "zaposachedwa" (Kassinove ndi Schare, 2001). Zotsatira zapafupi kapena zophonya-pafupi (zomwe zimatayikiratu) zimachitika pamene mbali ziwiri za makina owotcha zikuwonetsa chizindikiro chimodzi ndipo gudumu lachitatu likuwonetsa chizindikiro pamwambapa kapena pansi pa mzere wolipira. Kafukufuku wofufuza zotsatira zapafupi ndi zotsatira za otchova njuga adapeza kuti kuyankha kwa ubongo pazotsatira zaposachedwa (poyerekeza ndi zotsatira zakusowa kwathunthu) kuyambitsa magawo a mphotho zamaubongo monga striatum ndi cortex ya insort monga momwe zimapindulira (Chase ndi Clark, 2010). Habib ndi Dixon (2010) adapeza kuti zotsatira zakuphonya kumabweretsa mayankho owoneka ngati opambana mu ubongo, pomwe ma HC adayendetsa ubongo womwe umalumikizidwa ndi kutayika kwakukulu. Maphunzirowa amathandizira kuti amvetsetse bwino zamtundu wa masewera a juga komanso momwe amagwirira ntchito pamitsempha yake.

Kodi kuchulukitsa kwa njuga komwe kumakhudzana ndi njuga kumatha kupangitsa kuti anthu asamagwire bwino ntchito?

Chitsanzo champhamvu kwambiri komanso chokhazikitsidwa ndi mitsempha yodalira mankhwala, Impaired Response Inhibition and Salience Attribution (I-RISA), imafotokoza kuti kugwiritsa ntchito mankhwala mobwerezabwereza kumayambitsa kusintha kosiyanasiyana m'magawo a neuronal omwe amakhudzidwa kukumbukira, kusunthira, komanso kudziwitsa (Volkow et .,. 2003). Ngati munthu wagwiritsa ntchito mankhwala osokoneza bongo, kukumbukira zochitika izi zimasungidwa ngati mayanjano pakati pa zolimbikitsazo ndi zokumana nazo zabwino (zosangalatsa) kapena zoyipa (zosintha), zopangidwa ndi dopaminergic activation yoyambitsidwa ndi mankhwala ozunza. Izi zimapangitsa kukhala ndi mwayi wopezeka (komanso wanthawi yayitali) wa mankhwalawo komanso njira zake zomwe zimagwirizana ndi zomwe zimapangitsa kuti masoka achepetse mphamvu zachilengedwe zolimbitsa thupi (Volkow et al., 2003). Kuphatikiza apo, mtundu wa I-RISA umaganizira kuchepa kwa chiwongolero (disinhibition) pa mankhwala osokoneza bongo chifukwa champhamvu chokhala ndi zolakwika zomwe zakhala zikupezeka kale (monga zafotokozedwera mu gawo la 1 yowunikiridwayo), yomwe imapatsa anthu omwe ali ndi vuto losokoneza bongo omwe ali pachiwopsezo kuti ayambenso kuchita zosokoneza. .

M'mavuto osokoneza bongo kuphatikiza PG, pali umboni kuti machitidwe onse othandizira komanso othandizira amakhala omvera kwambiri pazinthu zoyenera. Mwachitsanzo, kafukufuku wasonyeza kuti miyambo yokhudzana ndi chizolowezi chosokoneza bongo imakopa chidwi chambiri kuposa zoyambira zina zodziwikiratu, zomwe zimadziwika kuti "chidwi cha" (McCusker ndi Gettings, 1997; Boyer ndi Dickerson, 2003; M'munda ndi Cox, 2008). Monga tafotokozera mu gawo la "cue reacaction" pa kuwunikiraku, pakuwunika njuga, kuwongolera kulabadira kwa njirayi kumayendedwe okhudzana ndi kutchova njuga ("cue reacction") yapezekanso m'malo aubongo okhudzana ndi zoyeserera pokonza ndi kuzindikira (amygdala, basal ganglia, ventrolateral pre mbeleal cortex ndi dorsolateral prefrontal cortex; Crockford et al., 2005; Goudriaan et al., 2010).

Monga tafotokozera mgawo loyambirira la kuwunikaku, PG imalumikizidwa ndi kuwongolera kuzindikira. Komabe momwe kuwongolera kwazidziwitso kumalumikizirana ndi njira zoyeserera kudakali koyenera kufufuza. Posachedwa, kafukufuku wayamba kuyesa kuyanjana pakati pa kuwongolera kuzindikira ndi mawonekedwe a masisitere ku PG. Mu umodzi mwaphunziro lathu laposachedwa, tidalemba ntchito yosinthika ya Go / NoGo mwa kuphatikiza magawo olimbikitsira othandizira (kutchova juga, abwino komanso oyipa), kuwonjezera pa gawo logwirizana la osagwirizana ndi otchova njuga ndi ma HC (van Holst et al., 2012b). Omwe adapemphedwa adapemphedwa kuyankha kapena kuletsa yankho la mitundu inayake yokhala ndi mawonekedwe osiyanitsa amtundu, kulola kufufuzidwa kwa kuyanjana pakati pa zopinga zamagalimoto ndi mawonekedwe aulesi. Pomwe sitinapeze kusiyana pamakhalidwe oyeserera pazovuta zoletsa, omwe amatchova njuga amafananizidwa ndi kuwongolera adawonetsa dorsolateral pre peleal ndi ACC. Mosiyana ndi izi, panthawi ya kutchova juga ndi zithunzi zabwino zovuta za otchova juga adapanga zolakwika zochepa zoletsa kuposa zowongolera ndikuwonetsa kuchepetsedwa kwa dorsolateral prefrontal ndi ACC. Kafukufukuyu akuwonetsa kuti otchovera njuga amadalira ntchito zaubongo kuti azigwiranso ntchito zomwezo panthawi yokana kulowererapo. Komabe, pamalingaliro okhudzana ndi kutchova njuga kapena malingaliro oyenera amawoneka kuti ali amathandizidwa, monga akuwonetsera ndi kuchepa kwa ntchito yaubongo ndi zolakwika zochepa zoletsa zolakwika mwa otchovera njuga. Kafukufuku kuchokera pa kafukufukuyu a Go / NoGo adakonzedwanso kuti ayese zotsatira za kukhudzika kwa magwiritsidwe antchito ogwirizana paintchitoyo (van Holst et al., 2012a). Monga zikuyembekezeka, choletsa kuyankha kokwanira chinali chokhudzana ndi kulumikizana kwazomwe zimachitika m'magawo a dorsal executive system komanso kulumikizana kochita bwino pakati pa oyang'anira dorsal wamkulu ndi dongosolo lothandizira pakati pa onse ma HC ndi otchova njuga. Poyerekeza ndi HCs, otchova juga amawonetsa kulumikizana kwamphamvu pakati pa dorsal executive system ndikuwongolera ntchito panthawi yolowera njuga. Zotsatirazi zikuwonetsa kuti kuwonjezereka kwa olondola pamiseche panthawi yomwe amatchova njuga kunalumikizidwa ndi kulumikizana kowonjezereka ndi dorsal Executive system (van Holst et al., 2012a). Zikuwoneka kuti ntchito ya DA ikugwira ntchito yofunika pazotsatira izi. Kukondoweza kolimba kumathandizira kufalitsa kwa DA mu mesolimbic system (Siessmeier et al., 2006; Kienast et al., 2008) ndipo DA imadziwika kuti imagwiritsa ntchito preortalal cortex kugwira ntchito (Robbins and Arnsten, 2009). Zowonadi mwa anthu, kufalitsa kwa DA kumakhudza kulumikizana kwazotheka mkati mwa malungo a corticostriatal thalamic (Honey et al., 2003; Cole et al., 2013). Kafukufuku wowonjezereka akufunika kutifotokozere bwino mgwirizano pakati pa zoyambitsa, DA ndi kuwongolera kuzindikira mu PG. Pa zomwe tanena kale a Leyton ndi Vezina (2013), fanizo likufunsidwa lomwe limagwirizanitsa mayankho a mayankho amtunduwu motsutsana ndi mayendedwe owonetsa. Chofunika kwambiri pamalingaliro ake ndi lingaliro loti ntchito zochepa zomwe zimapangitsa kuti zinthu zizikhala zotsogola, pomwe pali zochitika zambiri (pomwe mankhwala osokoneza bongo alipo) cholinga cholimba ndikuyendetsa kuti mulandire mphotho. Zotsatira zomwe zidawunikidwa pamwambapa (van Holst et al., 2012a, b) khalani ndi bwino motere: magwiridwe antchito anali bwino pamavuto otchova njuga mikhalidwe yabwino ndi njuga, ndipo kulumikizidwa kwazinthu zambiri kunapezeka ndi dorsal executive system pamavuto otchova njuga. Izi zitha kukhala chizindikiritso cha anthu otchova njuga omwe amakhala ovuta kuwayendetsa, pokhapokha ngati pali zifukwa zabwino komanso zamtundu wa Go / NoGo.

Ndikofunikira kuchipatala kuti mufufuze ngati ntchito zowonjezereka mu dongosolo la mphotho zilidi ndi mphamvu yobwezeretsa pang'onopang'ono cortex yotsogola pamavuto otchova njuga. Izi zitha kuyesedwa ndi zovuta zama pharmacological kapena powonjezera zochitika mu dongosolo la mphotho kwanuko, mwachitsanzo pogwiritsa ntchito nthawi ya fMRI neurofeedback (deCharms, 2008) kapena Transcranial Magnetic Stimulation (TMS; Feil and Zangen, 2010). Komabe, tikupangira kuti kusunthika kwakukometsa kopindulitsa kumathandizanso wolumala kugwira ntchito. Mwachitsanzo, chidwi chachikulu chikapatsidwa chidwi chazomwe zimayambitsa, izi zitha kuchititsa kuti oyang'anira (Pessoa, 2008). Kufunafuna mphotho yolimbikitsa komanso kuyendetsa bwino mphotho zomwe zingatheke kumatha kukhala lingaliro lofunikira pomvetsetsa chifukwa chake ntchito zomwe zili ndi zochitika zotsogola zimawonetsa kuchepa kwa chizindikiritso (Brand et al., 2005; Goudriaan et al., 2005, 2006; Labudda et al., 2007; Tanabe et al., 2007; de Ruiter et al., 2009).

Chidule pakupeza mwachidule: kudziletsa, kudziwonetsera, kupereka chidwi pakubwera kosiyanasiyana kwa kutchova juga, komanso kulumikizana pakati pa kudziletsa komanso kulimbikitsa chidwi

Poyesera kuti mumvetsetse zambiri pazokhudza maphunziro omwe apendedwa, zikuwonekeratu kuti pamitu ina, zopezeka zokhazikika zakhazikitsidwa pazaka zambiri. Mwachitsanzo, lingaliro la kuchuluka kosakhudzika mu PG ndi PrG ndikokhazikika ndipo maphunziro oyamba mwachisawawa akuwonetsa kuti kusunthika kumeneku kumayendetsedwa ndi kuchepa koyambirira komanso kugwira ntchito kwa ACC. Ndizodziwikiratu kuti gawo la magwiridwe antchito mu PG limafunikira maphunziro owonjezera kuti afufuze kuti ndi zinthu ziti zomwe zimakhudzidwa kwambiri. Kafukufuku wamtsogolo wa reuroimaging akuwonetsa kuti pamene njuga zamtundu wa juga zikupezeka, njira yolimbikitsira ubongo imagwira ntchito kwambiri mu PG ndi PrG, monga zikuwonekeranso pakukwera kwakukulu kwa parahippocampal, amygdala, basal ganglia, ndi OFC activation. Ponena ndi kukhudzidwa kwa mphotho ya neural yolimbikitsidwa kapena kuchepa kwa chidwi chamalipiro, maphunziro oyamba akuwoneka kuti akuwonetsa kuti pomwe kulimbikitsidwa kwina kotulutsa kaubwino muubwino kulipo kuyembekezera kupambana kapena mukukumana ndi ngozi zotchova njuga, kuchepa kwa mphotho kumachepetsa kukhalanso komweku pambuyo kuwina ndi / kapena kutaya ndalama. Pomaliza, kulumikizana kwa cue-reacction ndi control kwazidziwitso kukuwonetsa kuti kuyambitsa kwazinthu zowongolera zazovuta mu otchova juga kungalimbikitsidwe poyambitsa gawo loyendetsa. Komabe, izi zikufunika kubwerezabwereza, ndipo udindo wa DA pakuthandizira kapena kuchepetsa kuwongolera kuzindikira mu PG uyenera kupitilizidwa.

Kuchiritsa kwachipatala

Cactitive behaviation (CBT) yokhudza otchova njuga amayang'ana kwambiri za kuchitapo kanthu komanso kawonedwe kuti athetse kukopeka kwa mchitidwe wa njuga ndipo awonetsedwa kuti ndi othandiza pantchito ya PG (Petry, 2006; Petry et al., 2006), ngakhale kuyambiranso kudakali kochulukirapo, kuyambira pafupifupi 50-60% m'maphunziro azachipatala, mitengo yodziletsa mosalekeza kwa chaka chotsika ngati 6% (Hodgins et al., 2005; Hodgins ndi El Guebaly, 2010). Chifukwa chake, padakali mwayi wowongolera kwambiri zotsatira za mankhwala a PG / PrG. CBT ikuyang'ana pa kupititsa patsogolo mphamvu yakuzindikira pa kutchova juga, komanso kusintha kwa chizoloŵezi chomachita juga chifukwa chokumana ndi zomwe anthu akuchita njuga kapena kukhumba. Njira zapadera zomwe zimagwiritsidwa ntchito ku CBT kwa PG ndi PrG zimaphatikizapo njira zophunzirira kuthana ndi mavuto, kugwiritsa ntchito njira zowongolera, komanso kuthana ndi mavuto pachiwopsezo chogwiritsa ntchito njira zamakhalidwe, mwachitsanzo pamakhadi azadzidzidzi. Chifukwa chake, mu CBT ya PG ndi PrG, gawo lalikulu la kulowererapo limatengera kugwira ntchito kwa oyang'anira pakukhazikitsa njira ndi malingaliro pamalingaliro. M'mavuto ena amisala, maphunziro a neuroimaging awonetsa kuti kusiyana pakumagwira ntchito kwaubwino wamankhwala kungalosere zotsatira za chithandizo cha CBT. Mwachitsanzo, kuwongolera kwakanthawi kwa ubongo kugwira ntchito munthawi yoletsa kuyankha kumayambitsa kuyankha kwabwino kwa CBT chifukwa cha kupsinjika kwa kupsinjika kwa thupi (Falconer et al., 2013). Kuchulukitsa kwazomwe zikuchitika mu PFC ya ventromedial komanso zotsatira za valence pazantchito zam'maganizo (mwachitsanzo, ntchito zowopseza) mu (anterior) temporal lobe, ACC ndi DLPFC zimalimbikitsa kupambana kwa chithandizo chazovuta zazikulu zosautsa (Ritchey et al., 2011) komanso pamavuto azovuta zamagulu (Klumpp et al., 2013). Zotsatira izi sizingangonena kuti ntchito zamaubongo zitha kukhala zofunika kwambiri pakuwonetsa mwayi wopeza bwino ndi CBT, komanso zikuwonetsa kufunikira kwa kuchitapo kanthu kwatsopano komwe kumayambitsa zovuta za neurobiological za PG ndi PrG. Mwa kuphunzira ntchito zaubongo zomwe ndi biomarkers pakuchita bwino kwa CBT mu PG ndikuwongolera kusintha kwa ubongo kwa ma neuromodulation kapena ma pharmacological, zotsatira za chithandizo cha PG ndi PrG zimatha kuyenda bwino.

Njira zingapo zomwe zimayang'aniridwa pachiwopsezo cha neurobiological cha PG ndi PrG ndikulonjeza ndipo zitha kuchititsa zotsatira zowonjezereka zamankhwala poyanjana ndikusintha ntchito zomwe ndizofunikira kuti CBT ipambane. Posachedwa, kulowererapo kwa neuromodulation kwapeza chidwi ndi kafukufuku wa mankhwala osokoneza bongo. Makamaka, njira zamaubongo monga kubwereza Transcranial Magnetic Stimulation (rTMS) ndi transcranial Direct Current Stimulation (tDCS) zidawunikiridwa pakuwunika kwa meta (Jansen et al., 2013). Kuchokera pakuwunika meta kumeneku, kukula kwakanthawi kochepa kwapezeka kuti kumapangitsidwe ndi ma rTMS kapena tDCS kuti muchepetse kulakalaka zinthu kapena zakudya zapamwamba. Mu kafukufuku wokhala ndi magawo angapo a rTMS mu osuta a 48, 10 tsiku lililonse yogwira rTMS yogwira ntchito pa DLPFC idapangitsa kuchepa kwa kusuta kwa fodya komanso kudalira kwa chikonga, poyerekeza ndi chikhalidwe chowongolera cha sham rTMS (Amiaz et al., 2009). Zogwirizana ndi neurostimulation, EEG neurofeedback mu SUDs yapeza chidwi chatsopano, maphunziro ena akuwonetsa zotsatira zabwino za maphunziro a EEG neurofeedback pakudalira kwa cocaine (Horrell et al., 2010) kudalira opiate (Dehghani-Arani et al., 2013). Chifukwa chake, kulowererapo kwa neurostimulation kapena neurofeedback ku PG ndi PrG ndikonzanso, kuti mufufuze ngati kulowererapo kwa neurostimulation kumathandizanso kuti munthu akhale ndi vutoli.

Monga njira yomwe siyingakhale yopanda mankhwala, kusintha kwamphamvu mu PG kutha kuyang'aniridwa ndi "chidwi retraining" (MacLeod et al., 2002; Achinyamata et al., 2006). Panthawi yomwe odwala omwe akuchita chidwi ndi anzawo amawathandizanso kusintha malingaliro awo pochita ntchito zamakompyuta, potero amachepetsa kusintha kwa malingaliro ndi kusintha zizolowezi zawo. Kulumikizana kwina kukuthandizira kubwereza komwe kumagwiritsa ntchito zochita zokha, momwe njira yolumikizirana ndi zizolowezi zokhudzana ndi bongo imaletsedwera kupewa kupewa (Wiers et al., 2006, 2010; Schoenmaker et al., 2007). Pazovuta za kumwa mowa, zotsatira kuchokera pazomwe zachitidwazo zikulonjeza (Wsters et al., 2006, 2010). Komabe, zolowererazi sizinayesedwebe mu PG ndipo zotsatira zazitali za chidwi ndi kuchitapo kanthu poyeserera sizikupezeka ndipo zikuyenera kuyesedwa pakufufuza kwamtsogolo.

Kuphatikizira kwa pharmacological

Kuphatikiza pa kuthekera kwa kuchepa kwa mitsempha, kuchepa kwa mitsempha komanso kulowererapo kwa chidwi, njira zingapo zomwe zikulonjeza njira zamankhwala zochizira PG zanenedwa (kuti muwone van den Brink, 2012). Zotsatira za Neurobiological zikuwonetsa gawo lofunikira kwambiri la njira ya mesolimbic, yopanga cyral striatum, ndi ventromedial prefrontal cortex (VMPFC) mu PG. Chifukwa VMPFC ndi kapangidwe kamene kamadalira malingana ndi malankhulidwe a DA omwe amalumikizana ndi miyendo kuti aphatikize chidziwitso, kusinthanitsa kwa DA kungakhale chinyengo chachikulu chomwe chimayambitsa kusowa kwa VMPFC ku PG. Komabe, machitidwe ena ambiri a ma neurotransmitter amathanso kuchita nawo kanthu ndipo amatha kulumikizana pakukonzekera mayankho abwino ndi oyipa. Mwachitsanzo, ma opiate amadziwika kuti amawonjezera kutulutsidwa kwa DA mu njira ya mphotho, ndipo opiate antagonists naltrexone ndi nalmefene, omwe amadziwika kuti amachepetsa kumasulidwa kwa DA, amapezeka kuti amachepetsa kukhudzidwa kwa mphotho ndipo mwina akuwonjezera kukhudzidwa kwachilango komanso (Petrovic et al. , 2008). Komanso, chithandizo ndi opiate antagonists chawonetsedwa kuti chothandiza mu PG ndikuchepetsa zofuna za juga (Kim ndi Grant, 2001; Kim et al., 2001; Modesto-Lowe ndi Van Kirk, 2002; Grant et al., 2008a, b, 2010b).

Pomwe zosokoneza bongo, mankhwala osokoneza bongo komanso zovuta zomwe zimakhudzana ndi mankhwala zimatha kupangitsa kuti DA imasulidwe mu ventral striatum ndikulimbikitsanso kumwa panthawi yomwe akupezeka ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo, osatha kudya mankhwala osokoneza bongo kumalumikizidwa ndi neuroadaptation ya glutamatergic neurotransication mu ventral ndi dorsal striatum ndi limbic cortex (McFarland et al., 2003). Kuphatikiza apo, kuwonekera kwa cue kwapezeka kuti kumadalira ma processor a glutamatergic neurons kuchokera ku preortal cortex kupita ku nucleus accumbens (LaLumiere ndi Kalivas, 2008). Kuletsa kutulutsidwa kwa glutamate kwalepheretsa mikhalidwe yofunafuna mankhwala mu nyama komanso anthu omwe amadalira zinthu za anthu (Krupitsky et al., 2007; Mann et al., 2008; Rösner et al., 2008). Chifukwa chake, zotsatira zoyambirira zabwino kuchokera ku maphunziro oyendetsa ndege ndi N-acetyl cysteine ​​(Grant et al., 2007) ndi memantine (Grant et al., 2010a), yomwe imasinthasintha dongosolo la glutamate, maphunziro owonjezera omwe amafufuza zotsatira za izi glutamate zowongolera pazamankhwala a PG.

Kuphatikiza pa kuwongolera magwiridwe antchito ndikuchepetsa chidwi chakufuna kwa ma neuromodulation kapena njira zamankhwala, posachedwapa, chidwi cha chidwi cha zinthu zoteteza chakula. Mwachitsanzo, kutsika pang'ono ndi luso la kuthana ndi zovuta zakulumikizidwa ndi zotsatira zabwino za ma SUD. Chifukwa chake, osati kungoyang'ana pa zinthu zowopsa, komanso gawo la zinthu zoteteza ndi kusinthasintha kwachilengedwe komwe kumalimbikitsa izi kungalimbikitse kumvetsetsa kwathu kwa ubale wamaubongo ndi njira zopangira ndikuchira kuchokera ku PG ndi PrG. Kugwiritsa ntchito moyenera pa ziwopsezo zonse komanso zoteteza kungakhale kuwunikira magwiridwe antchito aubongo ndi ubongo munthawi ya chithandizo, fufuzani kuti ndi ziti zomwe zimagwira mosazungulira, ndipo zimagwira ntchito zina zomwe zimafunikira kuchokera kuzomwe zachitika monga kuphunzitsidwa kwazidziwitso, kuphunzitsira kwa ubongo, kapena kulowererapo kwa mankhwala.

Mawuwo

PG ndi PrG ndizodziwikiratu kuti zimagwirizanitsidwa ndi ubongo komanso ubongo. Makamaka, kukakamizidwa kwapamwamba komanso kusokonekera kwa magwiridwe antchito kulipo, komwe kumalumikizidwa ndikuchepa kwa magwiridwe olimbitsa bongo mu ubongo, monga ACC ndi dorsolateral prefrontal cortex. Kuphatikiza apo, ntchito zogwira mtima zimakhudzidwa, zomwe zimagwirizanitsidwa ndi magwiridwe antchito ammadera am'mbali komanso thalamo-striatal circry, yolumikizana ndi cortex yakutsogolo. Kafukufuku wowonjezereka amafunikira kuti athe kufufuza momwe zimakhalira pakati pa zochita zamunthu komanso zoyeserera, monga kuphatikiza kwa njuga mumagwiridwe antchito nthawi zina kumathandizanso ntchito zamunthu wazidziwitso. Kufufuza kuyenera kwa kulowererapo kwazinthu zomwe zimayang'ana machitidwe amtunduwu, monga neuromodulation, maphunziro othandizira, komanso kulowererapo kwa zamankhwala, ndizofunikira kuti tifufuze momwe zingathere kusintha zotsatira za chithandizo. Kuphatikiza apo, kafukufuku wofufuza zomwe zingateteze komanso kubwezeretsanso komwe kumayambitsa zoopsa kungathe kuwonetsa njira zomwe akuyenera kutsata kuti akwaniritse njira ya PG.

Zopereka za wolemba

Anna E. Goudriaan, Murat Yücel, ndi a Ruth J. van Holst anathandizira kuti awunikenso, Anna E. Goudriaan ndi a Ruth J. van Holst adalemba zolemba pamanja, Anna E. Goudriaan, a Ruth J. van Holst, ndi Murat Yücel adasinthiratu ntchitoyi mozama kuti adziwe zambiri. Kuvomerezedwa komaliza kwa mtundu womwe udasindikizidwe kunaperekedwa ndi olemba onse ndipo olemba onse amavomereza kuti adzayankhidwe pazinthu zonse za ntchitoyi pakuwonetsetsa kuti mafunso okhudzana ndi kulondola kapena kukhulupirika kwa gawo lililonse la ntchitoyi amafufuzidwa ndikuyankhidwa.

Kusamvana kwa mawu achidwi

Olembawo akunena kuti kufufuza kunkachitika popanda mgwirizano uliwonse wa zamalonda kapena zachuma zomwe zingatengedwe kuti zingatheke kukangana.

Zothandizira