Kuthana ndi kutchova njuga ndi kukakamiza kugula: kodi zimakhala zovuta kwambiri? (2010)

Dialogues Clin Neurosci. 2010;12(2):175-85.

Donald W. Black, MD*

Donald W. Black, Department of Psychiatry, University of Iowa Roy J. ndi Lucille A. Carver College of Medicine, Iowa City, Iowa, USA;

Martha Shaw, BA

Martha Shaw, Dipatimenti ya Psychiatry, University of Iowa Roy J. ndi Lucille A. Carver College of Medicine, Iowa City, Iowa, USA;

Pitani ku:

Kudalirika

Kugula kovutikira konse (CB) ndi gululi ya pathological (PG) afunsidwa ngati mamembala amisala yokhudzana ndi kusokonekera kwa zinthu (OCD). Hypothesis yowoneka bwino inayambira koyambirira kwa 1990s ndipo yapeza chithandizo chokwanira, ngakhale kuti panali umboni wopanda umboni. Chidwi ndi chidwi ichi chakhala chovuta kwambiri chifukwa ofufuza ena adalimbikitsa kupanga mtundu watsopano womwe umaphatikizapo zovuta izi mu DSM-5, yomwe ikukula. Munkhaniyi, olemba amafotokoza komwe kumachokera zojambula zowoneka ngati zowoneka bwino (OC) komanso momwe zimakhalira mwatsatanetsatane, kuwerenganso zonse ziwiri za CB ndi PG, ndikukambirana zomwe mwatsatanetsatane ndikuthandizira ndi kutsutsana ndi mawonekedwe a OC. Matenda onsewa akufotokozedwa malinga ndi mbiri yawo, tanthauzo, gulu, phenomenology, mbiri ya mabanja, pathophysiology, ndi kayendedwe ka zamankhwala. Olembawo akuti: (i) CB ndi PG mwina sizigwirizana ndi OCD, ndipo palibe umboni wokwanira kuti uwayike mu mawonekedwe a OC ku DSM-V; (ii) PG iyenera kukhalabe ndi zovuta zowongolera (ICDs); ndi (iii) kuzindikiridwa kwatsopano kwa CB kuyenera kupangidwa ndi kulembedwa ngati ICD.

Keywords: kugula mokakamiza, njuga zam'magazi, mawonekedwe owoneka-okakamiza, chisokonezo chowongolera, kusokoneza bongo

M'mbuyomu ma 1990, chidwi chinayamba kukula mozungulira lingaliro la mawonekedwe owoneka-okakamiza (OC). Hollander ndi ena1-3 adalemba za chiwonetsero chachikulu cha zovuta zokhudzana ndi obsessive-activive disorder (OCD). Kutengera zomwe adakumana nazo monga wofufuza za OCD, Hollander adawona kuti OCD ndi yomwe ili pachimake pa chiwonetserochi, ndipo adafotokoza kukula kwake ndikuwonjezereka ndi zovuta zina zamagetsi. Matendawa amatengedwa kuti amagona motsutsana ndi kukakamira, kusatsimikizika vs kutsimikizika, komanso kuzindikira ... (magwiridwe). Lingaliro lakuwonetseratu la OC lidalandiridwa mwachangu ndi ofufuza ena chifukwa limapereka njira yatsopano yoganizira za ubale pakati pa zovuta zambiri zonyalanyaza, ndipo mwina kupereka njira zatsopano zamankhwala.4,5 Osati ofufuza onse agwirizana, ndipo ndemanga zingapo zovuta zawonekera.6-9

Ngakhale adatsutsidwa, lingaliro la gulu la zovuta lomwe likugwirizana ndi OCD limakhalabe losangalatsa kwambiri. Lingaliro loti zovuta zimakhudzana ndizofunikira pamaqhinga, ndipo chifukwa chiyani gulu la zovuta osati zokhudzana ndi OCD? Funso tsopano ndilofunika kwambiri chifukwa omwe ali ndi udindo wopanga kope la Buku Lophatikiza ndi Kuwerenga kwa Mavuto a Mitsempha (DSM-5) ayenera kusankha kuti apange gulu logawikana la OCD komanso zovuta zomwe zingakhalepo, kapena asunge OCD ndi zovuta zomwe zikutheka. Ngati apanga gulu latsopano la mawonekedwe a OC adzafunika kudziwa kukula kwake.

Malire a sipekitiramu wa OC akula kapena kutengera malingana ndi malingaliro a wofufuzayo. Amanenedwa kuti akuphatikizanso zovuta zakudziletsa monga kutchova juga kwa pathological (PG), trichotillomania, ndi kleptomania; Matenda a Tourette ndi matenda ena; zovuta zamakhalidwe (mwachitsanzo, kusokonekera kwamalire); hypochondriasis ndi matenda a dysmorphic body; mavuto a kudya; ndi zovuta zingapo zomwe sizikudziwika pakadali pano DSM-IV-TR 10 monga kugula mokakamiza (CB) ndi chizolowezi chogonana.1-4 Ofufuza ochepa omwe apereka umboni wotsimikizira ubale pakati pa omwe ali ndi vutoli. Mwambiri, umboni wotere ukhoza kuphatikiza kuyerekezera kwa phenomenology, mbiri yachilengedwe, mbiri ya mabanja, zolembera zazoyambira, komanso kuyankha kwamankhwala.11

OCD ili ndi malo ofunika pakatikati pa sipekitiramu. Yopangidwira mkati DSM-IV-TR 10 ngati vuto lakuda nkhawa, OCD ndiyosadalira nkhawa zina zamagulu mu International Classization of Diseases (ICD),12 ndipo mkangano wamphamvu waperekedwa ndi Zohar et al13 chifukwa kudzipatula kwake pamavuto awa. Choyamba, OCD nthawi zambiri imayamba paubwana, pomwe mavuto ena ali ndi vuto pambuyo pake. OCD ili ndi magawanidwe pafupifupi ofanana, mosiyana ndi zovuta zina, zomwe zimapezeka kwambiri mwa azimayi. Kafukufuku wokhudzana ndi malingaliro a zamagetsi akuwonetsa kuti, mosiyana ndi zovuta zina, anthu omwe ali ndi OCD nthawi zambiri samakhala ndi kuchuluka kwa mankhwala osokoneza bongo. Maphunziro a mabanja sanawonetse ubale woyenera pakati pa OCD ndi zovuta zina zovuta. Bry circry yomwe imagwirizira OCD imawoneka yosiyana ndi yomwe imakhudzanso zovuta zina. Pomaliza, OCD ndi yapadera pofotokoza kuyankha kwake kwa serotonin reuptake inhibitors (SSRIs), pomwe mankhwala a noradrenergic, othandizika pamavuto amisala, komanso ogwira mtima pamavuto othandizira nkhawa, samagwira ntchito kwenikweni ku OCD. Komabe, ma benzodiazepines, omwe samakhudza kwambiri OCD, nthawi zambiri amakhala othandiza pamavuto ena omwe amakhala ndi nkhawa. Komanso, Zohar et al13 ati kuti kuzindikira chiwonetserochi kungathandizire kusintha magawidwe, ndikupangitsa kufotokozera bwino za endophenotype ndi zolembera zomwe zimadziwika ndi mikhalidwe imeneyi, ndikuti gulu labwino limatha kupeza njira zina zachithandizo.

Gawo kuchokera kuthekera kwa mawonekedwe a OC, sipanakhale njira yosasintha yogawa zovuta ndi zokakamiza. Pomwe ena amanyoza "chithandizo chamankhwala" chamakhalidwe oyipa monga CB,14 Zokambirana zidayang'ana makamaka momwe mavutowa amayenera kugawidwa, ubale wawo ndi zovuta zina zowoneka bwino za OC, komanso ngati ena mwa iwo amangoyimilira ngati zovuta zakudziyimira pawokha (mwachitsanzo, CB, machitidwe okakamiza pakugonana).

Njira zamagulu ena zatsimikizira mgwirizano wa vuto lochita kuwonongedwa kwa OC ndi kukhumudwa kapena kusokonezeka kwa zochitika zina, ku zovuta zomwe zimayambitsa vuto (ICDs), kapena zovuta zomwe zimawonjezera. Posachedwa, akuti zina mwazovuta zina zomwe zimaphatikizidwa mu mawonekedwe a OC ziyenera kuyikidwa mkati mwa gulu latsopano lazophatikizira lomwe limaphatikiza zomwe zimapangitsa kukhala ndizolakwika ndi zinthu.15 “Kuchita zachiwerewere” kumaphatikizapo zovuta zomwe National Institute on Drug Abuse (NIDA) zimawona ngati zitsanzo zabwino zokhudzana ndi zosokoneza bongo chifukwa siziperewera chifukwa chakupezeka kwina.

Poganizira izi, nkhaniyi ikunena za PG ndi CB. Kodi mavutowa ndi gawo limodzi la mawonekedwe a OC monga akufotokozera ndi a Hollander ndi ogwira nawo ntchito? Kodi amaonedwa moyenera ngati vuto la kuwongolera kusokonekera (ICDs) kapena zowonjezera? Kodi ndizogwirizana? Mafunso awa ndi enanso adzawunikiridwa tikamafufuza za CB, PG, ndi mawonekedwe a OC.

Kugula mokakamiza

CB yafotokozedwa mu nomenclature yamisala kwa zaka pafupifupi 100. Dokotala wazamisala waku Germany Emil Kraepelin16 adalemba za kugula kosagwirizana ndi kachitidwe kogwiritsa ntchito ndalama kotchedwa oniomania ("Kugula mania"). Pambuyo pake adalankhulidwa ndi katswiri wazamisala wama Swiss Eugen Bleuler17 mwa ake Lehrbuch der Psychiatrie:

Monga gawo lomaliza, Kraepelin akutchula za amisili ogula (oniomaniacs) omwe ngakhale kugula kumakhala kokakamiza ndipo kumabweretsa ngongole zopanda pake za ngongole ndikuchedwa kulipilirabe mpaka tsoka litawongolera pang'ono - pang'ono konse konse chifukwa samavomereza zonse ngongole zawo. …. Zomwe zimachitika ndikuthamangira; sangachitire mwina, zomwe nthawi zina zimawonekeranso poti ngakhale atakhala kuti alibe nzeru kusukulu, odwala sangathe kuganiza mwanjira ina ndikulingalira zovuta zomwe angachite chifukwa cha zomwe akuchita, komanso mwayi woti asachite. ” (p 540).

Kraepelin ndi Bleuler aliyense amaganiza kuti "kugula mania" ndi chitsanzo cha a zokopa zogwira ntchito or misala yopanda pake, ndikuyiyika pambali pa kleptomania ndi pyromania. Atha kukhala kuti adakhudzidwa ndi wazamisala waku France a Jean Esquirol18 lingaliro loyambirira la monomania, nthawi yomwe amagwiritsa ntchito pofotokoza anthu wamba omwe anali ndi vuto lotenga matenda.

CB idakopa chidwi pang'ono mpaka ma 1980 omalizira komanso ma 1990 oyambirira pomwe ofufuza amachitidwe ogula adawonetsa kuti vutoli likufalikira19-21 ndipo maphunziro ofotokozera adawonekera m'mabuku azamisala.22-25 McElroy et al22 idapanga tanthauzo lantchito lomwe limaphatikizapo kuzindikira ndi machitidwe a CB. Kutanthauzira kwawo kumafunikira umboni wakuwonongeka chifukwa chazovuta zodziwika bwino, kusokonekera kwa magwiridwe antchito, kapena mavuto azachuma / azamalamulo. Kuphatikiza apo, matendawa sanatchulidwe chifukwa cha mania kapena hypomania. Mafotokozedwe ena abwera kuchokera kwa ofufuza zamakhalidwe a ogula kapena akatswiri azama psychology. Faber ndi O'Guinn26 adafotokoza kuti matendawa ndi "kugula kosagwirizana ndi zomwe ena amaganiza kuti ogula sangathe kusiya kapena kusintha momwe amachitira" (p 738). Edward,27 Kasitomala wina, akuti kugula mopitilira muyeso ndi "njira yachilendo yogulira ndi kuwononga ndalama momwe wogula akuvutikira amakhala ndi chilimbikitso chosalamulirika, chosatha komanso chobwerezabwereza kugula ndi kuwononga (ntchito)… monga njira yothanirana ndi nkhawa komanso nkhawa. ” (tsamba 67). Dittmar28 imalongosola zinthu zitatu zazikuluzikulu: kukopa kosagwedezeka, kulephera kudziletsa, kupitilizabe ngakhale utakumana ndi zovuta. Ofufuza ena ochita nawo malonda amaganiza kuti CB ili mbali imodzi yamakhalidwe osagwiritsa ntchito ogula, zomwe zimaphatikizapo kutchova juga kwa m'matenda, kuba m'masitolo, ndi kuchitira nkhanza ngongole).29

CB siyikuphatikizidwa ndi onse a DSM-IV-TR10 kapena World Health Organisation Kugawidwa Kwa Matenda Padziko Lonse, Khumi Khumi.12 Kaya muphatikize CB mu DSM-5 akukambirana.30 McElroy et al23 Nenani kuti njira yogula yogwiritsa ntchito ikhoza kukhala yokhudzana ndi "kusintha kwamphamvu, kukakamiza kapena kukakamiza zowongolera." Lejoyeux et al31 adalumikiza ndi zovuta zam'mutu. Ena amaganiza kuti CB ndi yokhudzana ndi zovuta zomwe zimagwiritsidwa ntchito pazomwe zimagwiritsidwa ntchito.32,33 Ena amati gulu la CB ndi vuto losalamulira34 kapena vuto la kusangalala.35

Faber ndi O'Guinn26 akuti kuchuluka kwa CB pakati pa 1.8% ndi 8.1% ya anthu wamba, kutengera zotsatira zakufufuza kwamakalata momwe Compulsive Buying Scale (CBS) idatumizidwira kwa anthu a 292 osankhidwa kuti agwirizane ndi kuchuluka kwa anthu wamba a Illinois . (Chiyerekezo chapamwamba komanso chotsika chikuwonetsa kuchuluka kwa mayikidwe a CB.) Posachedwa, Koran et al36 anagwiritsa ntchito CBS kuzindikira ogula mokakamizidwa pofufuza kwama foni a akulu a 2513 US, ndikuyerekeza kuchuluka kwa 5.8% ya omwe adayankha. Grant et al37 anagwiritsa ntchito MIDI kuyesa CBD ndikuwonetsa kuchuluka kwa kuchuluka kwa 9.3% pakati pa 204 mobvomerezedwa mobwerezabwereza.

CB ili ndi poyambira kumapeto kwa achinyamata / ma 20 apakati pa zaka zapakati, zomwe zingagwirizane ndi kutulutsidwa kuchokera ku banja la nyukiliya, komanso zaka zomwe anthu angayambitse ngongole.34 Kafukufuku akuwonetsa kuti 80% mpaka 94% ya anthu omwe ali ndi CBD ndi azimayi.38 Mosiyana ndi izi, Koran et al36 adanenanso kuti kufalikira kwa CBD mu kafukufuku wawo wapafoni woyeserera kunali pafupifupi kwa amuna ndi akazi (5.5% ndi 6.0%, motsatana). Kupeza kwawo kukuwonetsa kuti kusiyana pakati pa amuna ndi akazi kungakhale kwachilendo, mwakuti azimayi amavomereza mosavuta zinthu zomwe sizachilendo kugula kuposa amuna. Amuna nthawi zambiri amafotokoza kuti kugula kwawo kovutirapo ndi "kusonkhanitsa."

Zambiri kuchokera ku maphunziro azachipatala zimatsimikizira kuchuluka kwamankhwala opatsirana amisala, makamaka masinthidwe (21% mpaka 100%), nkhawa (41% mpaka 80%), kugwiritsidwa ntchito kwa zinthu (21% mpaka 46%), ndi zovuta za kudya (8% mpaka 35 %).38 Zovuta zowongolera zoyeserera ndizofala (21% mpaka 40%). Pafupipafupi pamavuto a Axis II mwa anthu omwe ali ndi CB adayesedwa ndi Schlosser et al25 kugwiritsa ntchito chida chodzithandizira komanso kufunsa mafunso. Pafupifupi 60% ya maphunziro a 46 adakumana ndi vuto losachepera limodzi laumunthu pogwiritsa ntchito zida zonse ziwiri. Zovuta zomwe zimadziwika kwambiri ndizomwe zinali mitundu yowoneka-yowonera (22%), kupewa (15%), ndi mitundu ya ma line (15%).

Chithunzi chosiyanitsa komanso chosasimbika cha wogulitsa mokakamiza chatuluka. Chakuda39 wafotokoza magawo anayi kuphatikiza: (i) kuyembekezera; (ii) kukonzekera; (iii) kugula; ndi (iv) kuwononga ndalama. Gawo loyamba, munthu yemwe ali ndi CB amakhala wotanganidwa ndi kukhala ndi chinthu, kapena kugula. Izi zimatsatiridwa ndi gawo lokonzekera momwe mapulani amapangidwira. Gawoli likutsatiridwa ndi zomwe zinachitika pogula, zomwe anthu ambiri omwe ali ndi CB amafotokoza kuti ndizosangalatsa kwambiri.25 Mchitidwewo umamalizidwa ndi kugula, nthawi zambiri kumatsatiridwa ndikumangodandaula kapena kukhumudwa.36

Mwina chodziwika bwino cha CB ndikutanganidwa ndi kugula ndi kuwononga ndalama. Izi nthawi zambiri zimamupangitsa kuti azitha maola ambiri sabata iliyonse akuchita izi.24,25 Anthu omwe ali ndi CB nthawi zambiri amafotokoza zovuta zowonjezereka kapena nkhawa zomwe zimatsitsimuka kugula kugula. Khalidwe la CB limachitika chaka chonse, koma limatha kukhala zovuta kwambiri panthawi ya Khrisimasi ndi tchuthi china, komanso masiku ozungulira a mabanja ndi abwenzi. Ogula okakamira amakhala ndi chidwi ndi zinthu za ogula monga zovala, nsapato, zaluso, zodzikongoletsera, mphatso, zodzoladzola, ndi ma CD (kapena ma DVD)24,25 CB siyikugwirizana kwenikweni ndi mulingo waluntha kapena maphunziro, ndipo idalembedwa mwa anthu anzeru.40 Chimodzimodzinso, ndalama zimayenderana kwenikweni ndi CB, chifukwa anthu omwe ali ndi ndalama zochepa amakhala otangwanika kwambiri pogula zinthu ndi kuwononga ndalama ngati anthu olemera.38,40

Nataraajan ndi Goff42 adazindikira zinthu ziwiri zomwe zikuyimira ku CB: (i) kugula kapena kulakalaka, ndi (ii) kuchuluka kwa kugula. Pachitsanzo chawo, ogula akakamiza amaphatikiza kukakamira kwakukulu ndi zochepa. Kuwona kumeneku kumagwirizana ndi malipoti azaachipatala kuti ogula omwe amangokakamira kugula zinthu amakhala ndi chidwi chogula ndi kuwononga ndalama ndipo amayesa kukana zofuna zawo, nthawi zambiri koma osachita bwino.24,38

Kafukufuku wopatsirana akuwonetsa kuti matendawa ndi osachika, ngakhale akusinthasintha kukula kwake komanso kulimba kwake.22,25 Aboujaoude et al43 adati anthu omwe adalandira chithandizo chamankhwala a citalopram ayenera kuti amakhalabe akhululukidwa zaka zotsatila za 1, ndikuwonetsa kuti chithandizo chitha kusintha mbiri yachilengedweyi. Lejoyeux et al44 nenani kuti CB imagwirizana ndi zoyesayesa zodzipha, ngakhale palibe malipoti a chisokonezo omwe amatsogolera kuti adziphe.

Pali umboni kuti CB imayendayenda m'mabanja ndipo m'mabanjawa mumadandaula, nkhawa, komanso kugwiritsa ntchito mankhwala osokoneza bongo kupitilira kuchuluka kwa anthu. Black et al45 anagwiritsa ntchito mbiri yakale ya banja kuti ayese abale a 137 omwe anali achibale a 31 omwe ali ndi CB. Achibale anali othekera kwambiri kuposa omwe mu gulu loyerekeza amakhala ndi nkhawa, uchidakwa, vuto la kugwiritsa ntchito mankhwala osokoneza bongo, "vuto lililonse la matenda amisala" komanso "odwala matenda amisala." CB idadziwika pafupifupi abale achi 10%. koma sanayesedwe mu gulu lofananiza.

Ziphunzitso za Neurobiologic zimangoyang'ana pakusokonekera kwa mitsempha, makamaka kuphatikiza ma serotonergic, dopaminergic, kapena opioid. Selection serotonin reuptake inhibitors (SSRIs) yakhala ikugwiritsidwa ntchito pochiza CB,46-50 mwa zina chifukwa cha kufanana pakati pa CB ndi OCD, vuto lomwe limadziwika kuti limayankha ma SSRIs. Dopamine adayesedwa kuti achite nawo gawo la "kudalira kwamalipiro," omwe akuti amalimbikitsa zamakhalidwe, monga CB ndi PG15 Nkhani zomwe zikusonyeza kupindula ndi zomwe opioid antagonist naltrexone achititsa kuti anthu azingoganiza za zomwe opioid receptors51 Palibe umboni uliwonse, komabe, wochirikiza gawo la machitidwe a ma neurotransmitter awa mu etiology ya CB.

Chifukwa chakuti CB imachitika makamaka m'maiko otukuka, zikhalidwe ndi chikhalidwe chakhala zikufotokozedwa ngati zikuyambitsa kapena kupititsa patsogolo vutoli.39 Chochititsa chidwi, Neuner et al52 adanena kuti kufalikira kwa CB ku Germany kumawonjezeka ndikumalumikizananso, ndikuwonetsa kuti zokhudzana ndi chikhalidwe cha anthu zingathandizire kukulitsa CB. Izi zingaphatikizepo kupezeka kwa msika wogulitsa, kupezeka kwa katundu, ngongole zomwe zimapezeka mosavuta, komanso ndalama zomwe zingatayike.14

Palibe njira zochiritsira zodziwika bwino, ndipo onse othandizira ma psychotherapy ndi mankhwala akhala akulimbikitsidwa. Kafukufuku wambiri amafotokoza za chithandizo cha psychoanalytic cha CB.53-55 Posachedwa, zitsanzo zamtundu wa matenda ogwirira (CBT) apangidwira CB, ambiri a iwo amagwiritsa ntchito gulu56,57 Mitchell et al57 anapeza kuti gulu la CBT linapanga kusintha kwakukulu poyerekeza ndi mndandanda woyembekezera paphunziro la woyendetsa ndege la 12-sabata. Kupititsa patsogolo kwabwino kwa CBT kumasungidwa pakutsatira kwa 6-mwezi. Benson58 wakonza dongosolo lodzithandiza lokha lomwe lingagwiritsidwe ntchito ndi anthu komanso magulu.

Maphunziro a chithandizo chamankhwala omwe amagwiritsa ntchito psychotropic apanga zotsatira zosakanikirana. Malipoti oyambilira apereka lingaliro la ma antidepressants pochiza CB22,23 Black et al46 adanenapo zotsatira za kuyeserera kolemba komwe anthu omwe anapatsidwa fluvoxamine adapeza phindu. Mayeso awiri olamulira mosasinthika omwe adasankhidwa mwachangu (RCTs) adawona kuti chithandizo cha fluvoxamine sichabwinonso kuposa placebo.47,48 Koran et al51 Pambuyo pake adanenanso kuti maphunziro omwe ali ndi CB adasintha ndi citalopram yotsegula. Mu kafukufuku wotsatira, maphunziro adalandira cholembera chotseguka; omwe adawerengedwa kuti akuyankha adasinthidwa mwanjira ya citalopram kapena placebo. Zizindikiro zogulitsa zolimba zomwe zidabwezedwa mu maphunziro a 5 / 8 (62.5%) yopatsidwa placebo poyerekeza ndi 0 / 7 yemwe adapitiliza kutenga citalopram. Muyeso wodziletsa wofananira, ascitalopram sanadzilekanitse ndi placebo.52 Chifukwa zomwe zapezedwa ndikuphunzira ndimankhwala osakanikirana, palibe malangizo othandizidwa mothandizidwa molimbika. Mayeso a Openlabel atulutsa zotsatira zabwino, koma ma RCT sanatero. Kutanthauzira kwa maphunzirowa kumakhala kovuta chifukwa cha kuyankha kwa placebo mpaka 64%.47

Kutchova njuga

PG ikuwonjezedwa kuti ndivuto lalikulu lathanzi labwino.59 PG ikuyerekeza kuwononga ndalama pafupifupi 5 biliyoni pachaka ndi zowonjezera za 40 biliyoni pachaka cha moyo wotchipa pantchito yochepetsedwa, ntchito zachitukuko, ndi kutayika kwa omwe adamwalira. Vutoli limasokoneza kwambiri moyo kuphatikiza pa mgwirizano wake ndi zovuta zamisala zama psychor, kusokonezeka kwa malingaliro, komanso kudzipha.59-61 Mavuto okhudzana ndi banja amaphatikizapo mavuto azachuma, kuzunza ana ndi okwatirana, kusudzulana ndi kulekanitsidwa.61

Ngakhale kuti zovuta zanjuga zakhala zikuvomerezeka kwa zaka zambiri, nthawi zambiri sizinkachitidwa chidwi ndi anthu amisala. Bleuler,17 kutchula Kraepelin,16 amatchedwa PG, kapena "juga mania," a kukopa kwapadera chisokonezo. Makhalidwe a PG adayamba kuwonetsedwa mu 1980 mu DSM-III. 62 Njira zake zidasinthidwa kenako, ndipo DSM-IV-TR, 10 amatsatiridwa ndi omwe amagwiritsidwa ntchito pazinthu zodalira ndikugogomezera mawonekedwe a kulolerana ndi kusiya. PG imadziwika kuti "kutchova juga kosalekeza komanso kobwerezabwereza (njira A) yomwe imasokoneza zomwe munthu akuchita, banja, kapena ntchito ..." Makhalidwe khumi olakwika omwe adasankhidwa adatchulidwa, ndipo> 5 amafunikira kuti adziwe. Njira zake zimayang'ana kwambiri pakulephera kuwongolera njuga; kuwonongeka kwapang'onopang'ono kwa matendawa; ndikupitiliza ngakhale zotsatirapo zoyipa. Matendawa amatha kupangidwa pokhapokha ngati mania atachotsedwa (Criterion B). Poyesera kugwirizanitsa njira zopangira mayina ndi kuyeza, Shaffer ndi Hall63 adapanga dongosolo la generic multilevel lomwe tsopano limalandiridwa kwambiri ndi ochita juga.

PG pakali pano imasankhidwa kukhala vuto la kuwongolera utsogoleri mkati DSM-IV-TR. 10 Kumbali imodzi, ofufuza ena anena kuti PG ikugwirizana ndi OCD,1,64 komabe ena amatsutsana ndi ubale wotere.65 Komabe, PG imadziwika kuti ndi vuto losokoneza bongo.66,67 Posachedwa afunsidwa ngati ofuna kuphatikizidwa kuti aphatikizidwe mgulu latsopano la "zikhalidwe zina." 15 Ziwerengero zaposachedwa za kuchuluka kwa moyo wa PG kuyambira 1.2% mpaka 3.4% ponseponse.68,69 Mitengo ya presonce yawuka m'malo omwe kupezeka kwa njuga kwachuluka.70.71 Kafukufuku wapadziko lonse adawonetsa kuti kupezeka kwa kasino mkati mwa ma 50 maili kumalumikizidwa ndi kuchuluka kwapawiri kawiri kwa kuchuluka kwa PG.59 Khalidwe la kutchova njuga nthawi zambiri limayamba unyamata, pomwe PG imayamba ndi ma 20 kapena ma 30 oyambirira,72 ngakhale zimatha kuyambira nthawi iliyonse kudzera mu senescence. Mitengo ya PG ndiyokwera kwambiri mwa abambo, koma kusiyana pakati pa amuna ndi akazi kumakhala kochepa kwambiri.PG imayamba pambuyo pake mwa azimayi komabe ikupita patsogolo mwachangu ("telescoping") kuposa amuna,73 pamlingo wofanana ndi womwe udawonedwa m'mavuto a mowa. Anthu omwe ali pachiwopsezo akuphatikizapo achikulire omwe ali ndi thanzi la misala kapena ogwiritsa ntchito mankhwala osokoneza bongo, anthu omwe adamangidwa, anthu aku Africa-America, komanso anthu ochezeka pazachuma.74,75

Kafukufuku sanatsimikizire ma PG, koma mwina kusiyana komwe kukufotokozedwa kwambiri ndi pakati pa "ofuna kuthawa" ndi "osaka malingaliro." 76 Ofuna kuthawa nthawi zambiri amakhala okalamba omwe amatchova njuga kuchokera ku nkhawa, kukhumudwa, kapena kutaya nthawi, ndikusankha njuga zazing'onoting'ono monga makina olowetsa zinthu. Ofunafuna zowerengera amakonda kukhala achichepere, ndipo amakonda chisangalalo cha masewera amakhadi kapena masewera apathebulo omwe amafunikira kulowererapo.76 Blaszczynski ndi Nower77 afotokoza njira ya "njira" zomwe zimaphatikizira zachilengedwe, chitukuko, kuzindikira, ndi zina zomwe zimayambitsa kutchova juga kosagwirizana. Adziwitsa anthu am'magulu atatu: a) otchova njuga mwamakhalidwe; b) otchova njuga osatetezeka; ndi c) otchova juga osavomerezeka. Omwe amakhala ndi chizolowezi chokhala ndi chizolowezi alibe chizolowezi choganiza za psychopathology, koma amapanga ziganizo zoyipa ponena za kutchova juga. Omwe ali pachiwopsezo chotchova juga amavutika ndi nkhawa kapena nkhawa, komanso amakhala ndi mbiri yoipa. Pomaliza, otchova njuga, osaganizira omwe amangokhala osokonezeka amasokonezeka kwambiri ndipo amakhala ndi vuto la umunthu wosakhudzika komanso kusokonekera komwe kumaonetsa kusokonezeka kwa mitsempha.

Psorchiatric comorbidity ndi lamulo, osati okhawo, mwa anthu omwe ali ndi PG. Kafukufuku wothandizidwa m'deralo komanso kuchipatala akuwonetsa kuti kusokonezeka kwamagwiritsidwe ntchito ka mankhwala, kusokonezeka kwa malingaliro, ndi zovuta zamunthu ndizofala kwambiri mwa anthu omwe ali ndi PG.78 M'masampulu azachipatala, kuchokera ku 25% mpaka 63% ya otchova njuga amakumana ndi moyo wopezeka ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo.79 Mofananamo, kuchokera ku 9% mpaka 16% ya omwe amagwiritsa ntchito mankhwala osokoneza bongo ndi otchova njuga.79 PG imaphatikizidwanso ndikuwonjezereka kwa zovuta zamagetsi, ndipo 13% yonse mpaka 78% ya anthu omwe ali ndi juga ya pathological akuti akukumana ndi vuto la kusokonezeka kwa mitsempha.79 Kumbali inayi, odwala omwe ali ndi vuto la kusokonezeka kwa mafupa sanapezeke kuti ali ndi mitengo yapamwamba ya PG.

Mitengo yamavuto ena obwera chifukwa cha kuwongolera (ICD) amawonekera kwambiri mwa anthu omwe ali ndi njuga zam'mimbamo kuposa

ambiri. Ofufuzawo anena kuti kuchuluka kwa 18% mpaka 43% kwa ICD imodzi kapena zingapo.79 CB imawoneka ngati ICD yotsogola kwambiri mwa anthu omwe ali ndi PG, mwina chifukwa zovuta zonsezi zimagawana chidwi, kukhutiritsa ndalama, komanso kusinthana ndalama. Omvera omwe ali ndi ICD imodzi akuwoneka kuti akhoza kukhala ndi ina, zomwe zikusonyeza kuwonjezereka pakati pawo.

Mavuto aumunthu amakhala ponseponse pakati pa anthu omwe ali ndi PG, makamaka omwe ali ndi "cluster B." Vuto laumunthu lodziwika bwino limadziwika kuti limagwirizana kwambiri ndi PG, mwina chifukwa umbanda ndi njuga zimachitika kawirikawiri, mitengo yake kuyambira 15% mpaka 40%.79,80 Pafupifupi kafukufuku mmodzi wa anthu omwe ali ndi vuto lodziwonetsa kuti ali ndi vuto lodana ndi anthu akuwonetsa kuchuluka kwa PG.81

PG ambiri amaganiza kuti ndi yopanda matenda komanso yopita patsogolo.82,83 Kuwona kumeneku kumakhudzidwa DSM-IV-TR10 yomwe imafotokoza kuti gawo lofunikira la PG ndi "kutchova juga kosalekeza komanso kobwerezabwereza… komwe kumasokoneza zofuna zanu, banja, kapena ntchito zamanja" (p 671). Malingaliro awa adakhudzidwa ndikuwona kwa apainiya kwa Custer84 yemwe adafotokoza PG ngati matenda opita patsogolo, omwe amayamba ndi a gawo lopambana, kenako n gawo lotayika, ndi gawo lakukhumudwa. Gawo lomaliza, kusiya, zinayimira kukhumudwa.85 Ena amati otchova njuga ambiri "amapambana" koyambirira koyambirira kwa ntchito zawo zotchova juga zomwe zimawatsogolera ku zizolowezi zawo. Magawo anayi a Custer a PG adalandiridwa kwambiri ngakhale kulibe chidziwitso chazambiri.

Ntchito yaposachedwa ikuwunikitsanso malingaliro awa. LaPlante et al86 adawunikiranso maphunziro asanu87-91 omwe anakwaniritsa momwe amafotokozera malipoti autali onena za kutchova juga omwe sanakhudzidwe ndi mankhwala. LaPlante et al anena kuti, kuchokera pa maphunziro anayi omwe anali ndi ma 3 otchova juga (mwachitsanzo, anthu omwe ali ndi PG), otchova juga ambiri adakhala otukuka, ndipo adasunthira kutsikira, ndikuti mitengo ya kusintha kwa magulu "idali yayikulu kuposa 29%. ”Zotsatira zinali zofanana pamlingo wa 2 (mwachitsanzo," pachiwopsezo ") otchova juga. Iwo omwe anali msinkhu wa 0 ku 1 kutchova juga pamsika sakanakhala kuti akhoza kupita pamlingo wapamwamba (kutanthauza zowawa kwambiri), komanso modzi yekha,91 maphunziro adafotokoza kuti otchova juga ochepa a 2 asintha pofika msinkhu 1. La Plante et al86 mumaliza kuti kafukufukuyu akutsutsa lingaliro loti PG ndiyosatheka, ndikuwuza kuti otchova juga ambiri amangokhala bwino, monganso ambiri omwe ali zidakwa. Zomwe apezazo zikuwonetsa kuti iwo amene satchova njuga kapena kutchova njuga popanda mavuto amakhala wopanda vuto; iwo omwe ali ndi vuto la kutchova juga amasuntha kuchoka pamlingo wina kupita ku wina, ngakhale njira zambiri zikupita patsogolo.

Zambiri zaku mbiri ya mabanja zimafotokoza kuti vuto la PG, kusokonezeka kwa maganizo, komanso zovuta kugwiritsa ntchito mankhwala osokoneza bongo zili ponseponse pakati pa abale a anthu omwe ali ndi PG kuposa anthu wamba.92,93 Kafukufuku wamaphunziro amatchulanso kuti kutchova juga kuli ndi chinthu china chothandiza.94 Kafukufuku wogwira ntchito akuwonetsa kuti pakati pa anthu omwe ali ndi PG, kutchova juga kumabweretsa chidwi cha kutchova njuga komanso kusintha kwakanthawi kwakanthawi kachitidwe kaubongo patsogolo, kolimba, ndi ziwalo zam'manja, ndikuwonetsa kuti mwina njuga imatha kuyimira ntchito ya frontolimbic.95

Pali mgwirizano pang'ono pa chithandizo choyenera cha PG. Ndi anthu ochepa omwe ali ndi PG omwe amafuna chithandizo,96 ndipo mpaka posachedwapa chithandizo chamankhwala chikuwoneka kuti chikuchita nawo Gambler Anonymous (GA), pulogalamu ya 12 yotsatiridwa ndi Alcoholics Anonymous. Kupezeka ku GA ndi kwaulere ndipo machaputala amapezeka ku US konse, koma zotsatirazi ndizosawoneka bwino komanso zokhumudwitsa.97 Mapulogalamu othandizira odwala komanso othandizira odwala omwe ali ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo apangidwa, ndipo ndi othandiza kwa ena98,99 Komabe, mapulogalamuwa sapezeka kwa anthu ambiri omwe ali ndi PG chifukwa cha geography kapena kusowa kwa mwayi (mwachitsanzo, inshuwaransi / chuma). Posachedwa, kufunsa kwa mafunso a CBT ndi zoyeserera zakonzedwa njira zoperekera chithandizo.100 Mapulogalamu odziyimira pawokha alandilanso ndipo akuwoneka kuti akupindulitsa odwala osankhidwa.101 Ngakhale malamulo amasiyana, nthawi zambiri amatenga kudzipatula paokha paka kanthawi kochepa pochita kumangidwa chifukwa chophwanya lamulo. Maphunziro a chithandizo chamankhwala apeza mphamvu kwambiri, koma zotsatira zake ndizosagwirizana. Mwachidule, okonda opioid naltrexone ndi nalmefene anali apamwamba kuposa placebo m'mayesero olamulidwa mwachisawawa (RCTs)102,103 koma mayesero olamulidwa a paroxetine ndi bupropion anali osalimbikitsa.104,105 Kafukufuku wotseguka wa nefazodone, citalopram, carbamazepine, ndi escitalopram akhala akulimbikitsa, koma akuyenera kutsatiridwa ndi maphunziro opatsidwa mokwanira komanso owongoleredwa.106-109

Ubwenzi wapakati pa CB / PG ndi OCD

Chiyanjano pakati pa CB / PG ndi OCD sichikudziwikabe. Kuphatikizidwa kwa CB ndi PG mkati mwa mawonekedwe owonekera a OC, ngakhale kuli kodabwitsa, kumakhazikitsidwa pamalingaliro osatsata. Momwe mavutowa amayenera kugawidwa akhala akutsutsana kwazaka pafupifupi 100. Malingaliro adakondera kuphatikizidwa kwawo pakati pamavuto oyendetsa. Pazifukwa zakale, komanso chifukwa chosowa chidziwitso chodabwitsa, tikukhulupirira kuti zovuta ziwirizi ziyenera kukhalabe ndi ma ICD mpaka umboni wotsimikizika uthandizire kuphatikizidwa kwawo mwina ndi zovuta zowonetsa kapena mawonekedwe a OC.

Kulumikizana koonekeratu pakati pa CB ndi PG ndi OCD ndichinthu chodabwitsa. Matenda aliwonse amaphatikizapo kubwerezabwereza komwe kumachitika poyankha malingaliro komanso zolimbikitsa; Kuchita khalidweli - kwakanthawi - kudzakwaniritsa chilimbikitso, komanso / kapena kuchepetsa kupsinjika ndi kuda nkhawa zomwe zidalipo kale. Komabe, kusiyana kwakukulu pakati pa CB / PG ndi OCD ndikuti machitidwe (kugula, kutchova juga) amalingaliridwa ego-syntonic; ndiye kuti, amawonedwa ngati osangalatsa komanso abwino, pomwe makhalidwe omwe amaphatikizidwa ndi OCD samakhalapo, ndipo pafupifupi odwala onse amafuna kuwachotsa. Sichoncho chifukwa chogula ndi kutchova njuga: munthu yemwe ali ndi CB kapena PG amapeza zizolowezi zake kukhala zosangalatsa kwambiri, ndipo amangofuna kusiya zizolowezerozi ngati zotsatila zake zoyipa zipitilira kukula. Omwe akutsutsana ndi mawonekedwe a OC amalozera pakuwonjeza pakati pa zovuta izi ndi OCD. Kafukufuku wa Comorbidity apeza kuti m'masampulu azachipatala kuchokera ku 3% mpaka 35% ya anthu omwe ali ndi CB ali ndi comorbid OCD.22,46 M'malo mwake, kupezeka kwa CB kumadziwika ndi odwala ena OCD,110,111 makamaka iwo amene amasintha. Hoarding ndi chizindikiro chapadera chomwe chimaphatikizapo kupeza ndi kulephera kutaya, zinthu zomwe sizigwiritsidwa ntchito kwenikweni kapena mtengo.112 Komabe, mosiyana ndi zinthu zomwe zimasungidwa ndi zomwe zimasungidwa kale, zinthu zomwe zidagulidwa ndi munthu yemwe ali ndi CB sizopanda pake kapena zopanda ntchito.

Nthawi zambiri CB imawoneka ngati comorbid ndi ma ICD. Black ndi Moyer80 ndi Grant ndi Kim72 aliyense anasimba mitengo yokwera ya CB mwa zitsanzo za otchova njuga (23% ndi 8%, motsatana). Momwemonso, zovuta zina zowongolera zoyeserera ndizofala pakati pa ogulitsa okakamiza.39 Maphunziro a Comorbidity a PG ndiosakanikirana kwambiri, ngakhale nthawi zambiri amapereka lipoti yayikulu ya OCD kuposa anthu ambiri. Zoterezi zikuwoneka kuti sizowona. Kufanizira kwa Axis II kukuwonetsa kuti zovuta zomwe zimayambitsidwa ndi OCD ndizovuta za "cluster C". Ngakhale palibe matenda a axis II omwe amayambitsidwa ndi PG kapena CB, matenda a "cluster B" amawonekera mopitilira, makamaka vuto laumunthu.

Atafufuza mwachindunji machitidwe a OC a anthu omwe ali ndi PG adapeza kuti omwe ali ndi PG adakwera kwambiri kuposa omwe alibe masikelo omwe amayesa mawonekedwe a OC.64 CB ndi PG imagawananso mawonekedwe apamwamba.19,113

Umboni wina ukhoza kuchokera ku maphunziro a mabanja a CB, PG, kapena OCD. Pali maphunziro apabanja ochepa okhudzana ndi mavutowa, ndipo palibe omwe amathandizira ubale wapabanja pakati pamavuto awa. Phunziro lokhalo lolamuliridwa ndi banja lokhalo la CB, Black et al45 sanapeze ubale ndi OCD. M'maphunziro awiri a mabanja, imodzi yomwe imagwiritsa ntchito njira ya mbiri yabanja, inayo pogwiritsa ntchito njira yofunsira mabanja, ofufuzawo sanathe kukhazikitsa mgwirizano pakati pa PG ndi OCD.114,115

Kuyang'ana kulumikizano uku kudzera mu maphunziro a mabanja a OCD kwalephereranso kulumikizana. Ngakhale Black et al114 komanso Bienvenu et al115 adatha kukhazikitsa ubale wapabanja pakati pa OCD ndi PG.

Zofanana ndi demographic nthawi zambiri zimagwiritsidwa ntchito kunena kuti zovuta zitha kulumikizidwa, mwachitsanzo chakuti zovuta zonse zakumwa zoledzeretsa ndi kusokonekera kwa umunthu zimapezeka makamaka mwa amuna. Komabe, palibenso kufanana pakati pa magawoli pakati pa amuna ndi akazi. Ndi PG pali makulidwe omveka amphongo; ndi CB wamkazi kukonzekera; ndi OCD, kugawa amuna ndi akazi kumagawananso chimodzimodzi.

Ngati zovuta izi zinali zokhudzana, mbiri yawo yachilengedwe ndi njira zawo zitha kufanana. CB ndi OCD zikuwoneka kuti zimakhala ndi chiyambi kumapeto kwa zaka zapakati pa 10 kapena 20s. PG ikuwoneka kuti imayamba pang'ono pang'ono, ndipo amayi omwe akutenga vutoli mochedwa kwambiri kuposa abambo, koma amakhala ndi maphunziro achidule kuyambira pomwe amayamba kutchova juga mpaka kuyamba vuto. Izi ndizomwe zimawoneka ndimavuto amowa, koma osati OCD. Ndi CB, PG, ndi OCD onse amaonedwa ngati operewera, koma kufananako kumayima pamenepo. Kwa CB ndi PG, pomwe kulibe maphunziro osamalitsa, autali, deta imanena kuti vutoli limatha kukhala episodic, ndiye kuti, lingalipire kutalika kwakutali malinga ndi kuchuluka kwa zinthu zakunja monga kuwopa zotsatira, mwachitsanzo, kusowa ndalama. kapena kusudzulana, kapena kusowa kwa ndalama; OCD samakonda kutaya. Pankhani yakuwopseza kudzipha, a PG adanenedwa kuti ali ndi chiwopsezo cha kuyesa kudzipha ndikumaliza kudzipha; ndi CB, pamakhala malipoti osonyeza kuti amafuna kudzipha, koma sanadziphe; ndi OCD, zosakanikazo ndizosakanikirana, koma pazonse, chiopsezo chodzipha kwathunthu chimayesedwa chochepa.

Apanso, munthu akaganiza zoyankha pamankhwala, OCD amadziwika kuyankha bwino ma serotonin reuptake inhibitor antidepressants, komanso chidziwitso chamankhwala ochizira. CB ndi PG alibe yankho lomveka bwino pa mankhwala, ndipo chidziwitso chamankhwala cholimba kwambiri chikuwonetsa kuti PG imatha kuyankha kwa otsutsana ndi opioid. Onse awiri a CB ndi PG akuti amayankhidwa ku CBT, koma kukwanira komanso kuyankha kwake ndikosiyana ndi zomwe zidawonedwa ndi OCD.

Kukhalapo kwa zolembedwa zofananira zofananira ndi njira ina yowunika kulumikizana pakati pamavuto. Ntchitoyi imalephereka chifukwa chakuti zonsezi sizikhala ndi zodalirika. Komabe, kafukufuku wa magwiridwe antchito olimbitsa thupi a FGRI (FMRI) ogwirira ntchito akuwonetsa kuti matendawa akuwonetsa chizolowezi chogwirira ntchito kumadera ena oyang'anirana ndi kutsogoloku. Potenza et al86 tanthauzirani izi ngati umboni wa kufanana kwa njira zaubongo mu PG ndi mankhwala osokoneza bongo, pomwe mbali yotsutsana ndi kukhazikika kwa ubongo imapezeka mu OCD. Momwemonso, Goodriaan et al116 onaninso kafukufuku wokhudzana ndi majeremusi amtundu wa PG. Amaliza kunena kuti pali umboni wosokoneza bongo womwe umakhudza dopamine (DA), serotonin, ndi norepinephrine; ndipo "... zikugwirizana ndi zomwe zapezedwa ndi kutseguka kwaubongo munjira zopezera mphotho, pomwe DA ndiwofalitsa wofunikira" (p 134). Dopamine amadziwika kuti amatenga gawo lofunikira pakulakalaka ndikuchoka pamavuto ogwiritsa ntchito mankhwala osokoneza bongo. Ngakhale kutengera kwa ubongo mu OCD sikunafotokozeredwe bwino, makina apakati a serotonin ndi omwe amaphunzira kwambiri. Izi mwina ndi chifukwa chakulimba kwa ma SSRIs pochiza OCD.

Pazonse, maphunziro a neuropsychological a PG akuwonetsa kuti otchova jekeseni a m'matumbo awonongera magwiridwe antchito angapo kuphatikizapo kupatsa chidwi, kuchotsera, komanso kupanga chisankho.115-117 Ndi OCD, kufufuza kwa neuropsychological sikugwirizana kwenikweni; Pali umboni wa kuyimitsidwa-mayankho kosavomerezeka komanso kusintha kosasunthika, koma umboni wochepa wa kusinthika komwe kumachitika pophunzira komanso kupanga zisankho.118 Pazidziwitso zathu, palibe maphunziro a neuropsychological a anthu omwe ali ndi CB.

Njira zina zosankhira ena

Ngati CB ndi PG sizili gawo la OC, kodi ayenera kuyikidwa kuti? Chifukwa palibe umboni uliwonse wosonyeza kuti munthu angakhale ndi vuto la kusokonezeka kwa malingaliro, kuthekera kuti atha kungathetsedwe. Pa njira zomwe zatsalira, ofuna kusankha ayenera kuphatikiza PG ndi CB ndi ma ICD, kapena kuwasunthira ku gulu lomwe likukhudzana ndi zovuta zogwiritsa ntchito mankhwala osokoneza bongo.

Kusunga PG ndi CB ndi ma ICD ndiyo njira yosavuta: PG imayesedwa kale ngati ICD, pomwe CB sinaphatikizidwe pakadali pano DSM-IV-TR, m'mbuyomu amadziwika kuti ndi vuto losasangalatsa. Onse PG ndi CB amagawana zokhudzana ndi zamankhwala zomwe zimakhudzana ndi kukhalapo kwa osatsutsika, ma -onic-syntonic omwe amalimbikitsa kuyankha kwamachitidwe. Kuyankha (mwachitsanzo, kutchova juga, kugula zinthu) kumakwaniritsa kukakamizika komanso / kwakanthawi kumachepetsa nkhawa kapena nkhawa, koma nthawi zambiri kumatsatiridwa ndikudziimba mlandu kapena kuchita manyazi, ndipo pamapeto pake kumabweretsa zotsatira zoyipa, zotsatirazi. Makhalidwewo ndi achikale kapena aposachedwa, ndipo amatha kutulutsa mowolowa manja, nthawi zina poyankha zochitika zakunja. Zaka zoyambira ndi kugawa amuna zimasiyana, monga tafotokozera kale. Mwinanso, CB ikhoza kuonedwa ngati yofanana ndi PG, chifukwa imakonda kugawidwa pakati pa amuna: amuna ambiri makamaka mwa omwe ali ndi PG; azimayi ambiri pakati pa omwe ali ndi CB. Onsewa akuwoneka ngati akuyankha ku CBT, komabe alibe yankho lomveka bwino la mankhwala; Ma SSRIs samatulutsa kusintha kosasintha. Kafukufuku wa Comorbidity akuwonetsedwa pakati pamavuto, chifukwa kuchuluka kosawerengeka kwa omwe amatchova njuga ali ndi CB komanso mosemphanitsa.

Komabe, deta imafotokoza zambiri zokhudzana ndi zovuta zogwiritsidwa ntchito pazinthu. PG ndi CB zonse zimagwirizanitsidwa ndi zolakalaka zomwe sizili zosiyana ndi zomwe zimanenedwera ndi omwe amagwiritsa ntchito mankhwala osokoneza bongo; PG imadziwika kuti imatulutsa chizindikiro cha “kusiya” pamene wotchova njuga waletsedwa,119 ngakhale izi sizinaphunzire mu CB. Kafukufuku akuwonetsa kuti anthu omwe ali ndi PG kapena CB nthawi zambiri amakhala ndi zovuta zogwiritsa ntchito mankhwala a comorbid. Mosiyananso, ogwiritsa ntchito mankhwala osokoneza bongo ali ndi mitengo yambiri ya PG; palibe deta yofanana ndi ya CB. Kafukufuku wamabanja akuwonetsa kuti achibale a probands omwe ali ndi PG kapena CB ali ndi matenda ambiri amisala, makamaka mowa komanso mavuto osokoneza bongo. Komanso, Slutske et al94 adanenanso kuti, potengera mapasa amapasa, PG ikuwoneka kuti ikukhudzana ndi zovuta zogwiritsa ntchito mankhwala osokoneza bongo komanso vuto la umunthu. Pomaliza, monga tanena kale, maphunziro owonjezera, komanso ma neurotransmitter ndi kafukufuku wamatenda amtundu wa PG akuwonetsa ubale ndi zovuta zogwiritsa ntchito mankhwalawa.116 Izi zimathandizira kuphatikizidwa kwa PG komanso mwina CB yomwe ili ndi gulu la "zizolowezi zamakhalidwe," zomwe mwina zimakhala ndi zovuta zamagulu ogwiritsa ntchito, koma sizigwirizana ndi OCD.

Mawuwo

Ndemangazi zikuwonetsa kuti CB ndi PG mwina sangafunikire kuphatikizidwa mu mawonekedwe a OC. Mawunikidwe sanapangidwe kuti aweruze zoyenera za lingaliro la OC.

M'malo mwake, tanena kuti zikuwoneka kuti pali umboni wokwanira wotsimikizira kukhalapo kwa mawonekedwe ochepa a OC omwe atha kuphatikizira kusokonezeka kwa thupi, matenda a Tourette, trichotillomania, OCD ya subclinical, komanso mwina mavuto okonzekera.8,120 Ngakhale pali zofanana zapamwamba kwambiri zapakati pa CB / PG ndi OCD, umboni wina ukusonyeza kuti sizogwirizana: kugawa amuna ndi akazi, zaka zoyambira, ndi kumene; maphunziro a comorbidity; neuroimaging, neurotransmitter, ndi maphunziro a neuropsychological; ndi kuyankha kwamankhwala. Tikhulupirira kuti PG ndi CB ndiwothandizirana, ngakhale amagawa amuna mosiyanasiyana. Komanso, tikukhulupirira kuti pakakhala umboni watsopano komanso wotsimikizika, PG iyenera kukhalabe m'gulu la ICD. Pomaliza, timakhulupirira kuti CB ndi vuto komanso lodziwika bwino lomwe lomwe liyenera kuphatikizidwa DSM-5, ndipo iyenera kuphatikizidwa ndi ma ICD.

Kusankhidwa ndi zilembo

  • CB
  • kukakamiza kugula
  • ICD
  • kusamvetsetsa kwamphamvu
  • OC
  • okakamira
  • OCD
  • matenda osokoneza maganizo
  • PG
  • kutchova njuga
  • SSRI
  • kusankha serotonin reuptake inhibitor

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