Kutchova njuga pamatenda: matenda a neurobiological ndi matenda (2011)

Nyuzipepala ya Britain of Psychiatry (2011) 199: 87-89

do: 10.1192 / bjp.bp.110.088146

  1. Henrietta Bowden-Jones, MRCPsych, DOccMed, MD
  1. Luke Clark, DPhil

+ Kugwirizana kwa Wolemba

  1. Imperial College London, ndi Chipatala cha Matenda Akulimbana ndi Vutoli, Central North West NHS Foundation Trust
  2. Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, UK

+ Zolemba za Mlembi

  • A Henrietta Bowden-Jones (ojambulidwa) ndi Woyambitsa ndi Woyang'anira Wachipatala cha Matenda Akulimbana ndi Mavuto ku National, ndi wolankhulira zovuta pamalonda a Royal College of Psychiatrists. Luke Clark ndi katswiri wama zamaganizo ku Yunivesite ya Cambridge.

  • Malembo: Dr Henrietta Bowden-Jones, Chipatala cha National Matchuna Akutchova Njala, 1 Frith Street, London W1D 3HZ, UK. Imelo: [imelo ndiotetezedwa]

Kudalirika

Kuphatikizidwa kwa kutchova juga kwa mankhwala ndi mankhwala osokoneza bongo mu DSM-5 yomwe ikubwerayi kumalimbikitsa chiwonetsero chazomwe zikuwonetsa kufanana kwa mikhalidwe iyi, komanso kuwunikira momwe dziko likuyendera pakubwera kwa njuga komanso njira zomwe zilipo pakalipano.

Kutchova njuga kwachidziwitso kunayambitsidwa ngati gawo la zamaganizidwe mu DSM-III ku 1980, ndipo pazosintha ziwiri zapitazi, adalembedwa mu Impulse Control Disways pambali pa pyromania ndi trichotillomania. Tsopano, mu kukonzekera kwa DSM-5 yomwe ikubwera, kulengezanso molimba mtima kulengezedwa, komwe njuga yamtundu wa mankhwalawa imayendetsedwa limodzi ndi zovuta zamankhwala osokoneza bongo. Idzasandutsidwanso 'kutchova njuga', ndipo gululi limasinthidwa kukhala 'lozolowera' komanso mavuto okhudzana nalo '.

Kusintha kumeneku sikopanda phokoso pakati pa ofufuza a njuga ndi akatswiri omwe ali m'munda wazovuta.1,2 Zisankho za DSM-5 Work Gulu ndizodziwikiratu pamizere ingapo yotsimikizira pakati pa kutchova juga kwa pathological ndi zovuta zogwiritsa ntchito mankhwala.3 Pankhani yachipatala, ndizodziwika bwino kuti otchova njuga amawonetsa kuti amasiya (kutaya mtima poyesa kuyimitsa kapena kuchepetsa kuchuluka kwa kutchova juga), ndi zizindikilo zololekerera (chizolowezi chomachita njuga chapamwamba komanso chapamwamba), zonsezi ndi zimawoneka ngati zikhalidwe zosokoneza. Mawonekedwe a comorbidities pamatendawa ndi ofanana kwambiri, ndipo mozungulira 30-50% ya otchova jekeseni a pathological akupezeka molakwika.4 Zowopsa zomwe zadziwika zimaphatikizidwa, kuphatikizapo majini omwe amachititsa kuti azimayi azigwiritsa ntchito dopamine, komanso mikhalidwe yomwe ili yolumikizidwa.5 Kuphatikiza apo, mankhwala ovomerezeka kwambiri a mankhwala amtundu wa juga wa opaleid ndi antagonists opioid (mwachitsanzo naltrexone);6 Mankhwala omwe poyambapo amayesedwa munjira zamtundu wa njuga chifukwa chogwira ntchito bwino pakudalira mankhwala osokoneza bongo.

Maganizo a njuga zosasinthika

DSM-5 Work Group idasamaliranso mosamala pa kafukufuku waposachedwa pa pathophysiology yoyambira ya kutchova juga kosatha. Kafukufuku wa Neuropsychological mu ochita masewera amtundu wa cell awona kusowa kochita kupanga zisankho zowopsa, zomwe zimafanana ndi zosintha zomwe zimawoneka mwa odwala omwe ali ndi zotupa za muubongo zowonongeka ndi zotumphukira za posteralial prefrontal cortex. Ochita masewera othamangitsa amtundu wa masewera amaika ma wager apamwamba pazosankha zotheka,7 Sangasankhe dala mochedwa posakhutira nthawi yomweyo,8 ndipo amavutika kuti aphunzire njira yabwino pamayeso omwe amapeza kwakanthawi kochepa kuchokera kuzilango zazitali.9 Zizindikiro izi zimatikumbutsa, pamlingo wazachipatala, za kuthekera kwawo pakuwunika ziwopsezo zosaopsa komanso kusewera kosalekeza ngakhale atakhala ndi ngongole zambiri. M'mavuto ogwiritsa ntchito mankhwala, mitsempha iyi imakhala yofunikira kulosera zotsatira za chithandizo cha nthawi yochepa.10 Komabe, zowerengera za neuropsychological sizikhala ndi tanthauzo losagwirizana ndi zovuta izi, chifukwa kuchepa kumeneku kungagwiritsidwenso ntchito kuthandizira kufalitsa njuga zamatenda limodzi ndi vuto la kusokonekera kwa chidwi ndi kupuma kwa chidwi.

Kusanthula kwa neuropsychological tsopano kumakwaniritsidwa ndi maphunziro a neuroimaging omwe amawunikira mwachindunji magawo apansi aubongo. Potenza ndi anzawo11 agwiritsa ntchito maginito ogwiritsira ntchito magwiridwe antchito kuyang'anira mayankho muubongo pomwe otchova njuga amayang'ana mavidiyo otchovera juga ndikuchita zodziletsa. Achidakwa a Cocaine mu labu lawo akhala akuchita njira zofananirana ndi scanner. Magulu onse awiriwa adawonetsa kulephera kwa dera la ventromedial prefrontal cortex nthawi zonse ziwiri, mosiyana ndi kuwongolera kwaumoyo.11 Kafukufuku wodzipatula anali ndi otchovera njuga amatsiriza masewera osavuta a makhadi omwe amatha kupambana kapena kutaya € 5 pachiyeso chilichonse. Mayankho muubongo omwe amakhala ndi dopamine olemera kwambiri m'mabokosiwo adathandizidwa, ndipo zina mwazosintha izi zinali zofanana ndi zovuta zakutchova njuga.12 Pamene ntchito zoyambitsa maphunziro awa zikakhala zowonjezereka, zikuwonetsa kuti kumatha kuzindikira zina mwakabisira zomwe zimawoneka m'mitima yamavuto, monga zotsatira za zotsatira zaposachedwa5 ndi kuwathamangitsa.13 Komabe, ziyenera kudziwikanso kuti maphunziro owonjezera awa ndi ochepa, owerengeka amagwiritsidwa ntchito, ndipo zomwe apezazo zingayambenso kudutsa zovuta zingapo ndikuwonetsa pathophysiology yogawana ndi mikhalidwe yambiri.

Malingaliro a neurobiological awa ali pachiwopsezo choganizira kuti otchova njuga amayimira gulu lofanana. Izi sizingakhale zoona. The Pathways Model yofotokozedwa ndi Blaszczynski & Nower14 (ngakhale sichikudziwikiratu) amagwiritsa ntchito njira zitatu mu kutchova juga. Anthu pagulu loyamba alibe zikhalidwe zowopseza; M'malo mwake zovuta zawo za kutchova njuga zawonetsedwa ndi malingaliro amasewera omwewo, ndipo mwina chifukwa cha 'kupambana kwakukulu' koyambirira pantchito zawo zotchovera juga. Gulu lachiwirili limakhala ndi nkhawa kapena nkhawa, ndipo anthuwa amayamba kutchova juga ngati njira yothawira kapena kuti athetse mavuto amtimawo. Gulu lachitatu lomwe lili ndi malingaliro osokonekera komanso osakanikirana, omwe amatsogozedwa ndi umboni wa neuropsychological wokhudzana ndi kutsogola kotekisi, ndipo itha kukhala gulu ili lomwe limadziwika mu maphunziro a neurobiological m'magulu azachipatala ofotokozedwa pamwambapa.

Zisankho pakuwunika njuga zamatenda

Zosintha zina ziwiri pakupezeka kwa kutchova juga kwa pathological ndizotheka mu DSM-5. Chisankho chofuna kutchulanso matendawo 'njuga zosasinthika' chachitika chifukwa cha kusokonezeka pakati pa mawu akuti njuga kwaumoyo ndi 'kutchova njuga'. Dongosolo la epidemiological15 awonetse kuti kuvulaza kwakukulu kuchokera mu njuga kumapezeka mwa anthu ambiri omwe samakumana ndi kudulidwa kwa DSM-IV kwa zizindikiro zisanu kuchokera pa khumi omwe atchulidwa, zomwe zikuwapangitsa ena kugwiritsa ntchito mawu oti 'otchova njuga' mwanjira ina. Lipoti la Briteni Gale Prevalence Survey16 adatenga gawo lopumira kwambiri la zizindikiro zitatu za DSM kuti adziwe 'njuga yamavuto' (onani pansipa). Ataganizira kuthetsa kusiyana pakati pa 'mankhwala osokoneza bongo' ndi 'kudalira', DSM-5 Work Gulu ikupitilizabe kupereka umboni wazomwe zayikidwa poyipa kuti adziwe njuga yomwe yasokonekera.

Kusintha kwina ndikuchotsedwa kwa imodzi mwazomwezi, komwe amafunsa ngati amene akuchita juga sanachite chilichonse chosemphana ndi juga yawo. Kuphatikiza pa zenizeni zenizeni zomwe anthu angakhale osafuna kuziwonetsa izi, kafukufuku wofufuzira awiri awonetsa kuti chinthuchi chimangokhala chodalirika ndi otchova njuga ovuta kwambiri omwe amakwaniritsa kale zina zambiri zomwe zalembedwa, ndipo mwakutero, 'zolakwika izi' 'chinthucho chimawonjezera mphamvu zochepa za tsankho.15,17 Komabe, mawu awa atengedwa kuchokera ku ntchito m'magulu akuluakulu, ndipo zikuwoneka kuti chinthu chovomerezeka chikhoza kukhala chothandiza kwambiri pamanambala ena monga achinyamata.2 Zomwe takumana nazo kuchipatala zikuwonetsa kuti zitha kukhala zothandiza kwambiri kuwunikira ngati mzere wazikhalidwe zomwe zikuyenda molakwika zadutsidwa pofunafuna ndalama zanjuga.

Chipatala cha Dziko Cha Matenda Akulimbana Ndi Mavuto

Malangizo apadziko lonse lapansi monga DSM amayenera kuganiziridwa pamlingo wadziko lonse, makamaka panjira ya juga mkati mwa anthu aku Britain. The 2007 Briteni Njuga Prevalence Survey16 anapeza kuti 68% mwa omwe adafunsidwa kuti adatchova juga chaka chatha, zomwe zikufanana ndi nthawi ya moyo ya 78% yomwe inanenedwapo mu kafukufuku ku US.18 Zachidziwikire, kutchova juga ndi gawo lalikulu lazosangalatsa ndipo likondweretsa anthu ambiri. Mitundu yofala kwambiri ya kutchova njuga ku UK ndi National Lottery, makadi oyika zikwakwa, kuthamanga kwa akavalo, ndi makina otsetsereka. Pamagetsi omwe asokonekera, kuchuluka kwa kutchova njuga kwa DSM kunali 1-2% pakuwunika meta-North America,19 ndipo kuchuluka kwazaka zambiri zovuta kutchova juga kunali 0.6% mu kafukufuku wa 2007 waku Britain. Lipoti lochokera ku 2010 ku Britain Guga Prevalence Survey likuwonetsa kuchuluka kwa kutchova juga kwa 73% ya akulu. Kukula kwa njuga zamavuto kwachulukanso mpaka pakufika pakuyerekeza 0.9% ya anthu. Kusanthula kwamtsogolo kwa deta kudzayang'ana kwambiri kutchova juga kwa intaneti komanso mavuto ake.20

Chipatala cha Nationalavuta Gging Clinic chinatsegulidwa mu Okutobala 2008 ngati malo oyamba a National Health Service omwe adakhazikitsidwa kuti athe kuchiza otchova njuga. Panthawi yolemba, talandira zoposa 700 zochokera, kuchokera ku UK konse. Njira yothandizira mankhwalawa ndi yaumboni, komanso yodziwika bwino (CBT)21 zothandizidwa ndi mabanja komanso upangiri wa ngongole. Kuvomereza njira zingapo kuti mukhale njuga yamavuto, timapereka magawo angapo a kulowererapo, kuyambira pama sabata angapo a gulu la CBT osatha 9-12 masabata kufikira chithandizo chomwe chimapangidwira chithandizo kwa makasitomala amodzi. Gulu lathu la multidisciplinary limakhala ndi akatswiri azamisala, azamisala, othandizira mabanja komanso alangizi azachuma, onse omwe amagwira ntchito molingana ndi ma protocol okhazikika. Chipatalachi chimakhala ndi chidwi chofufuzira, zojambula ndizowonjezera ndipo zomwe zapezedwa zakonzeka. Kuti mumve zambiri, kapena kuti mutumizireni, chonde onani tsamba lathu www.cnwl.nhs.uk/gambule.html kapena imelo yathu pa imelo [imelo ndiotetezedwa].

Zotsatira zamtsogolo

Tikhulupirira kuti malingaliro a DSM-5 a kubwezeretsanso matchuthi adzatchuka ndi otchova njuga komanso magulu othandizira njuga, omwe adaganiza kuti kutchova juga ndi machitidwe osokoneza bongo omwe ali ndi vuto lofanana ndi mankhwala osokoneza bongo. Kusintha kwazomwe zikuchitika kungapangitse ndalama zofufuzira m'derali, popeza ofufuza a juga angapindule ndi ndalama zokhazikitsidwa ndi kafukufuku wazolowera. Koma, zowonadi, zovuta zazowunikira zimawukitsidwanso zenizeni zenizeni, ndipo akatswiri ena okonda mankhwala osokoneza bongo amatsutsa zosinthazi.1 Zina zomwe anthu omwe ali mgululi amakhala ndi mwayi wogula, masewera akusewera pa intaneti komanso chizolowezi cha intaneti,22 koma pokonzekera DSM-5, zolemba zofufuzira pamikhalidweyi zidawerengedwa kuti sizinapangidwe kuti zikhale maziko aumboni. Ngati tivomereza kuti kutchova juga ndikosuta, ndiye kuti ndimasewera amtundu wanji omwe amathandizira kuti azigwiritsa ntchito bwino ubongo? Poyankha funso ili, tidzakhala oyenera kuweruza mtsogolo momwe mikhalidwe ina iyenera kuwonjezeredwera pazokonda zamakhalidwe.

ndalama

HB-J. ndipo LC alandila ndalama kuchokera ku Medical Research Council (thandizo G0802725). LC ilandiranso ndalama kuchokera ku Royal Society zofufuzira njira zamagetsi zamagetsi. Chipatala cha Nationalavuta Njuga chachipatala chimalipiridwa ndi boma lotsogolera njuga.

Mawu a M'munsi

  • Chidziwitso cha chidwi

    H. BJ. ndi Woyambitsa ndi Woyang'anira wa National Mavuto a Kutchova Njuga Clinic, ndi membala wa boma la Responsible Gging Strategy Board komanso wolankhulira za njuga ku Royal College of Psychiatrists.

  • Adalandira October 6, 2010.
  • Kukonzanso kunalandira February 3, 2011.
  • Adalandira February 23, 2011.

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