Kufanana ndi kusiyana pakati pa kutchova juga kwazomwe zimachitika ndi zovuta zogwiritsa ntchito pazinthu: kuyang'ana kwambiri pakukakamizidwa ndi kukakamizidwa (2012)

Psychopharmacology (Berl). 2012 Jan; 219 (2): 469-90. doi: 10.1007 / s00213-011-2550-7. Epub 2011 Nov 5.

Kufanana ndi Kusiyanitsa pakati Pamagetsi Amatenda a Magazi ndi Zovuta Zogwiritsa Ntchito: Kuyang'ana pa Kupendekera Kwambiri ndi Kukakamizidwa

Robert F. Leeman^{*,, 1} ndi Marc N. Potenza^1,2

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Mtundu womaliza wa chosindikiza wa nkhaniyi ukupezeka pa Psychopharmacology (Berl)

Onani zina mwa PMC zomwe anatchulapo nkhani yosindikizidwa.

Pitani ku:

Kudalirika

Malingaliro

Kutchova juga kwa matenda (PG) posachedwa kwawonetsedwa kuti ndi "mwamakhalidwe" kapena osagwiritsa ntchito mankhwala osokoneza bongo. Kufanizira kwa mawonekedwe a PG ndi zovuta zogwiritsa ntchito pazinthu zamagetsi (SUDs) kuli ndi chithandizo chamankhwala ndipo zitha kuthandiza kupititsa patsogolo kafukufuku wamtsogolo pa izi. Maubwenzi apadera ndi kukakamizidwa komanso kukakamizidwa kumatha kukhala pakati pakumvetsetsa PG ndi SUDs.

Zolinga

Kuti mufananitse ndikusiyanitsa zomwe zapeza kafukufuku mu PG ndi SUDs zokhudzana ndi ntchito zamanjeru, kugwira ntchito kwa ubongo ndi ma neurochemistry, zomwe zimayang'ana pakukakamiza komanso kukakamizidwa.

Results

Kufanana kambiri kunapezeka pakati pa PG ndi SUDs, kuphatikiza kusayenda bwino pa ntchito za mitsempha, makamaka pokhudzana ndi kusankha kosakakamiza komanso mayankho okhudzika ndi zochitika zokakamiza (mwachitsanzo, kulimbikira poyankha ndi kuchitapo kanthu ndi ubale womwe watayika ku zolinga kapena mphotho). Zomwe zapezeka zikuwonetsa kukhudzidwa komwe kumakhudzanso zigawo zaubongo, kuphatikiza ma polypedial prefrontal cortex (PFC) ndi striatum ndi ma neurotransmitter ofanana, kuphatikizapo dopaminergic ndi serotonergic. Pali zinthu zina zapadera zomwe zimatha kuwonetsa kukhudzidwa kwachidziwikire kapena kuzowonekera kwazinthu zina.

Mawuwo

Zonsezi ndizosiyana pakati pa PG ndi SUDs. Kuzindikira kufanana kumeneku kungapangitse chitukuko cha mankhwalawa pazowonjezera zilizonse, pomwe kumvetsetsa kosiyana kumatha kupereka chidziwitso pakukula kwa chithandizo cha zovuta zina. Kusiyana kwamunthu payekha pazinthu zosakhudzidwa komanso kukakamizidwa kumatha kuyimira zofunika mu endophenotypic njira zopewetsera njira zopewera ndi kuchiza.

Keywords: Ntchito Yoyeserera Kutchova Juga, kuchedwa kuchotsera, kutsetsereka, mowa, cocaine, dopamine, serotonin, glutamate, frontal cortex, striatum

Pitani ku:

Introduction

Ngakhale njuga zam'magazi (PG) pakadali pano zimayikidwa mu Diagnostic and Statistical Manual (DSM-IV zolemba zowunikira, APA 2000) monga vuto la control impulse control (ICD), kufanana pakati pa PG ndi vuto la kugwiritsa ntchito zinthu (SUDs) kwadziwika. Kudalira kwa mankhwala osokoneza bongo ndi PG zonsezi zimaphatikizapo njira zodziwira matenda omwe akupitilizidwa ngakhale atakumana ndi zovuta, kulolera, kudzipereka mobwerezabwereza kuti ayesere kapena kusiya (APA 2000; Holden 2001; Wareham ndi Potenza, 2010). Popeza izi ndizofanana ndi zachilengedwe zokhudzana ndi PG ndi SUDs, pali kusintha kosinthira lingaliro la PG ngati "mwamakhalidwe" kapena osagwiritsa ntchito mankhwala osokoneza bongo (Frascella et al. 2010; Holden 2001; Petry 2006; Potenza 2006; 2008) pogawana m'magawo a DSM-V (Holden 2010). Kafukufuku wa SUD sangakhale wokomera wa PG, kuwerengetsa kwa PG kungatithandizenso kumvetsetsa kwathu komanso kafukufuku wamtsogolo pazovuta zaukadaulo. PG imapereka mwayi wophunzira zizolowezi zopanda pake popanda kusokonezedwa ndi neurotoxicity yokhudzana ndi kugwiritsa ntchito kwambiri mankhwala osokoneza bongo (Lawrence et al. 2009b; Pallanti et al. 2010; Verdejo-Garcia et al. 2008).

Impulsivity, chopangidwa chamtundu wambiri ndi zogwirizana ndi zochitika zamiseru zambirimbiri kuphatikiza PG ndi SUDs (Leeman et al. 2009; Petry 2007,, yatanthauzidwa ngati "cholingalira chamachitidwe achangu, osakonzekereratu amakhudzidwe amkati kapena kunja kwakukhudzidwa ndi zotsatirapo zoyipa zomwe zimachitika chifukwa chotsatira munthu wokakamizidwayo kapena ena" (Brewer ndi Potenza 2008; Moeller et al. 2001). Kuyankha mopatsa mphotho, mwakuwononga chabe, mwaulesi, ndikuchepetsa kulangidwa, zakhala zikugwirizana ndi kunyengerera (Patterson ndi Newman 1993). Posachedwa, nyumbayi idagawika padera, kuphatikiza mayankho ndi mitundu yosankha (Dalley et al. 2011; Potenza ndi de Wit 2010; Winstanley et al. 2004). Izi zidapezeka kuti zimalumikizana mosiyanasiyana ndi machitidwe osiyanasiyana azikhalidwe zosokoneza (Dick et al., 2010; Verdejo-Garcia et al., 2008; Whiteside & Lynam, 2001).

Ndipo akuti maupangiri a SUDs amafunika kusintha kuchoka ku kukhala achikale kwambiri komanso okakamizidwa kukhala azikhalidwe zowonjezereka komanso amakakamizika (Brewer ndi Potenza 2008; Dalley et al. 2011; Everitt ndi Robbins 2005; Fineberg et al. 2010; Koob & LeMoal, 1997; Potenza 2008). Dalley et al. (2011, p. 680) imalongosola machitidwe okakamiza kuti ndi "zochita zosagwirizana ndi zomwe zikupitilira, sizigwirizana pachiwonetsero chonse ndipo nthawi zambiri zimabweretsa zotsatirapo zosayenera." Kafukufuku akuwonetsa kuti monga kukakamiza, kuchita zinthu modzipereka kumakhala kofanana m'njira zambiri (Fineberg et al. 2010). Dalley et al. (2011) adazindikira zofunikira ziwiri, zodzilekanitsa pazomwe zimatanthauzira: kulimbikira kapena kupirira komanso zochita zomwe sizikugwirizana pachiwonetsero chonse. Zowonjezera zodziyimira pawokha kapena zokhudzana ndi izi zitha kukhalapo poti kudziwonetsa kukakamizidwa kudalowa mu magawo angapo kuphatikiza omwe akukhudzidwa ndi kuwongolera malingaliro ndi zochita, ndipo izi zitha kugwirizana ndi zochitika zamatenda amisala ndi malingaliroBlanco et al. 2009).

Kuthamanga onse komanso kukakamizidwa kumawoneka ndi zovuta pakudziletsa (Stein ndi Hollander 1995) ndipo itha kukhala yofanana mu mafashoni ovomerezeka kukhala ofananirako koma opanga zosiyana (mwachitsanzo, kufunafuna malingaliro, kutenga ziwopsezo, kupanga zisankho). Pazokhudzana ndi zovuta zamankhwala, kugwiritsa ntchito mankhwala mosasuntha ngakhale mukudziwa kuvulazidwa, komwe kumakhudzana ndi tanthauzo la kutsimikizika ndi kukakamizidwa, ndi njira yodaliraAPA, 2000) ndikuwona ngati gawo lofunikira pakuphatikizira (O'Brien et al. 2006). Kusiyanitsa kwakukulu pakati pa kupangidwaku ndikuti ngakhale kuti kunyinyirika nthawi zambiri kumaganiziridwa kuti kumakhala kopititsa patsogolo kufunafuna mphotho (Patterson ndi Newman, 1993), kuchitapo kanthu mokakamizidwa kumachitidwa mwachangu ndi mphotho yayitali (Everitt ndi Robbins, 2005; Fontenelle et al. 2011).

Umboni ukusonyeza kuti kunyengerera ndi kulosera kwakutali kwa SUDs (Hick et al. 2010; Mezzich et al. 2007). Kuphatikiza apo, kufanana kwakukulu pakudziwonetsa komwe kumachitika pakati pa abale olimbikitsana komanso osagwirizana kuposa omwe siogwirizana ndi omwe akuwonetsa kuti kukhudzika ndi mtundu wa endophenotype womwe ungakhale pachiwopsezo cha SUD (Ersche et al. 2010). Popeza kufunikira kwakukhudzidwa ndi ma SUDs, komanso umboni kuti iwo omwe ali ndi PG amakonda kukhala ndi mendulo kwambiri pamayendedwe oponderezedwa, kuwunika mwatsatanetsatane kufanana ndi kusiyana pankhani yankho ndi kusankhidwa kosavuta mu PG ndi SUDs ndikofunikira. Umboni wotsimikizika mu PG wabwera chifukwa chogwiritsa ntchito malipoti akudziwonera nokha (mwachitsanzo, Petry 2001a) ndikuwona kuyimitsidwa kwakukulu pakuyimitsidwa ndi chizindikiritso china (monga, Goudriaan et al. 2006b) ndi kusankhidwa kwachangu pantchito zakuchepetsa (mwachitsanzo, Petry ndi Casarella 1999). Zofanana zitha kuwonetsa kuti ma SUD ndi PG amadziwika ndi zochitika zowopsa, zomwe zikusonyeza kuti chithandizo chomwe chimapezeka kuti ndi chothandiza kwa ma SUD chitha kukhalanso ndi thandizo ku PG. Mosiyana ndi izi, kusiyana pakati pa zochitika kumatha kuwonetsa kusayikirana komwe kumayambitsa zovuta, kapena zinthu zokhudzana ndi nthawi ya zovuta zina (mwachitsanzo, kutulutsa kwakanthawi kapena kosaletseka kuzinthu zina) ndikuwonetsa njira zapadera zamankhwala pazomwe munthu akonda.

Zofanana ndi kusiyanasiyana pakati pa PG ndi SUDs zimatha kuyesedwa pokhudzana ndi kugwira ntchito kwa mitsempha, komanso ntchito yamaubongo kapena ntchito ya neurotransmitter. Madera ozungulira kwawoko ndi ozungulira ali ofunikira makamaka. Madera ozungulira, makamaka malo olowera (mwachitsanzo, malo am'kati mwa mpweya [vmPFC] ndi orbitofrontal cortex [OFC]), adakhudzidwa pakuwongolera mphotho komanso pakuwonjezera kungachititse chidwi ndi kukakamira ku PG ndi SUDs (Brewer ndi Potenza 2008; Fineberg et al. 2010). The striatum (makamaka ma nyukiliya asungidwe [NAcc] mu ventral striatum) ndi gawo lina lofunika kuyankha bwino komanso kuyendetsa mokakamiza ndipo lingathandizire kwambiri pakupanga zizolowezi ndi kukakamiza (Everitt ndi Robbins 2005; Kalivas 2009; Volkow et al., 2007b). Ponena za ma neurochemistry oyenerera, dopamine ndi serontonin alandila chidwi chochuluka. Ntchito ya Dopaminergic imathandizira pakubweretsa zopindulitsa pazinthu zowonjezera (mwachitsanzo, Schultz 2011), machitidwe a njuga (mwachitsanzo, Campbell-Meiklejohn et al. 2011), komanso kusakhazikika (Buckholtz et al. 2010). Maumboni angapo a umboni amalumikiza serotonin ntchito ku PG (Fineberg et al. 2010) ndi ma SUD (Ratsma et al. 2002). Maudindo a opioidergic ndi gluatamatergic system adakhudzidwa mu SUDs (Kalivas 2009; Volkow 2010) ndi PG (Grant et al. 2007; Grant et al. 2008a;). Ma opioid achilendo amathandizira pazabwino zopindulitsa pazinthu zowonjezera (Volkow 2010), ndipo izi zimakhudza kusinthika kwa mesolimbic dopamine ntchito kudzera mwaopakatikati mwa GABAergic methaneBrewer ndi Potenza 2008). Glutamate, neurotransmitter yosangalatsa komanso GABA precursor (Brewer ndi Potenza 2008; Holmes 2011), yafunsidwa kuti idzayanjane ndi ofuna mphotho mu ma SUDs (Kalivas ndi Volkow 2005) adapatsa mphamvu zake pa mesolimbic dopamine ntchito (Geisler et al. 2007; Grant et al. 2010), makamaka ku NAcc (Kalivas ndi Volkow 2005; McFarland et al., 2003). Kukula kwa glutamate homeostasis kumathandizanso kuti tichite zinthu zina mokakamiza (Kalivas 2009). Dongosolo la adrenergic litha kukhala ndi gawo loti lithandizire pa mphotho yolingana ndi mankhwalaWeinshenker ndi Schroeder 2007) ndi mankhwala a adrenergic atha kukhala ndi vuto pakukhudzidwa (Chamberlain et al. 2007) motero akhoza kukhala okhudzana ndi PG ndi SUDs.

Monga SUDs, zakhala zikuwonetsedwa kuti kusunthika kwakukakamiza kumachitika ndi PG (Brewer ndi Potenza, 2008). Momwe zidziwitso zokhazika chidwi zimathandizira poganiza izi ndi mutu wa kafukufuku komanso kufunikira kwamankhwala. Ngati kusunthika kwofananira ndi kukakamiza kukuchitika mu PG, kuchitira umboni kwa kuyeserera pakubweza maphunziro, mwachitsanzo (mwachitsanzo, de Ruiter et al. 2009), zitha kuwonetsa kukwera kwambiri kwa zovuta za PG. Mwinanso, kukakamizidwa kumadziwika ndi PG kumayambiriro, pomwe kuwongolera pang'ono ntchito zoterezi kumatha kukhala chiwopsezo chokhala ndi mavuto otchova njuga. Ngakhale kafukufuku wokhudzana ndi kukakamizidwa samapangidwa monga momwe amachitira kufunsa (Fineberg et al. 2010), kuwunika kwa umboni womwe ulipo kungasonyeze kufanana kwakukulu ndi kusiyana pakati pa PG ndi SUDs.

Kuphatikiza pa kukakamizidwa ndi kukakamizidwa, zogwirizana zokhudzana ndi chiopsezo / kupanga mphotho ndizofunikira chifukwa njuga nthawi zambiri imaphatikizapo kusankha kwamtunduwu. Ntchito zina zamitsempha zomwe zimapangidwa kuti ziwonetsetse chisankho / kupanga zisankho (mwachitsanzo, Iowa Ginja Task [IGT], Bechara et al. 1994amaganizidwanso kuti angatenge mbali yoyankha komanso kusankhika mtima, komanso kupirira ndi zotsatira zakakamizidwe kazotsatira (Verdejo-Garcia et al. 2008). Chifukwa chake, ndikofunikira kulingalira ntchito zowopsa / za mphotho monga momwe zitha kuyesa kuchuluka kwa chidwi. IGT ndi mayeso apakompyuta oika pachiwopsezo / popanga mphotho momwe otenga nawo mbali amakoka khadi limodzi pamayeso a 100 kuchokera kumodzi mwa ma desiki anayi. Chojambula chilichonse chimabweretsa mphoto ya ndalama ndi / kapena zilango. Ngakhale ophunzirawo amalangizidwa kuti ma desiki ena akhoza kukhala abwino kuposa ena, sakudziwa kuti awiriwo ndi opindulitsa, omwe amapangitsa kuti ndalama zazing'ono, zokhazikika komanso zolakwika zazing'ono zitheke, azipeza phindu lalitali, ndipo ziwiri ndizopindulitsa, zimaphatikizapo kupambana kwakukulu ndi kupitilira kutaya kwakukulu, kulolera kutayika kwakanthawi. Kuchita bwino kwambiri kumafuna kuchepa kwa kusankhika popeza kusankha kuchokera pamadongosolo opindulitsa kumabweretsa mwayi wopeza phindu lalitali, pamalipiro akulu (Dymond et al. 2010). Kuchita bwino kwambiri kumaphatikizanso mbali zina za kuphunzira mobwerezabwereza (Achinyamata ndi Farah 2005), yomwe ndi kuthekera kokuwona kusintha kwa zochitika zadzidzidzi ndikusintha momwe munthu akuchitira (mwachitsanzo, kusapirira; Clark et al. 2004).

Poyerekeza ndi kusiyanitsa PG ndi SUDs, ndikofunikira kuzindikira kusinthasintha pazowonjezera pazinthu zosiyanasiyana. Makhalidwe angapo amagwira ntchito pakudalira pazinthu zonse, zomwe zikuwonetsedwa ndikugwiritsa ntchito nkhanza zomwezo komanso njira zodalira zinthu zonse za DSM-IV-TR (APA 2000). Pali, panthawi imodzimodzi, kusiyana mumachitidwe azachipatala omwe amadalira zinthu zosiyanasiyana (Fisher and Roget 2008a; 2008b). Momwemonso, magawo a PG amafanana ndi kudalira pazinthu zina kuposa zina. Mwachitsanzo, umboni ukusonyeza kuti PG imakhala yofanana kwambiri ndi kudalira mowa, kuphatikiza zofananira ndi kukakamizidwa (Lawrence et al. 2009a; Roger et al. 2010). Fotokozani mwachitsanzo chosiyana ndi ichi, zomwe zapezeka zikuwonetsa kuchepa kwa kuwonongeka kwakanthawi kovomerezeka poyankha ndikusankha zochita pa ntchito monga IGT mu ogwiritsa ntchito MDMA (Verdejo-Garcia et al. 2008) ikuwonetsa kuthekera kwakuti mawonekedwe azachipatala omwe amakhudzidwa ndi vuto la MDMA ogwiritsira ntchito amatha kusiyana ndi omwe amagwirizana ndi PG.

Behaviors omwe akuwonetsa ma ICD mu Parkinson's Disease (PD) amapereka chitsanzo pophunzira kusokonekera komanso kukakamizidwa mu PG ndi SUDs. PD ndi chikhalidwe chodziwika ndi kuchepa kwa dopaminergic neuronal ndipo nthawi zambiri amathandizidwa ndi dopamine replap Therapies (DRTs) zomwe zimaphatikizapo ma dopamine agonists monga pramipexole kapena ropinirole ndi levodopa, prequoror biochemical to dopamine (Linazasoro 2009; Potenza et al. 2007; Voon et al. 2007). Mankhwalawa adapangidwa kuti azitsogolera ku "dopamine overdosing" ndi ma ICD mwa odwala ena (awunikiridwa mu Leeman ndi Potenza 2011). Ma ICD amawoneka ochulukirapo pakati pa omwe ali ndi PD kuposa omwe alibe (Kenagil et al. 2010; Weintraub et al. 2010). Pomwe maDRTs adalumikizana ndi ma ICD mu PD, umboni umapereka malingaliro osakhala a PD (mwachitsanzo, mbiri ya banja yakumwa zakumwa zoledzeretsa, malo okhala ndi ukwati ndi malo ena) zimagwirizananso ndi ma ICD ku PD (Leeman ndi Potenza 2011; Weintraub et al. 2010). Chifukwa chake ma ICD mu PD amapereka mtundu wogwirizana ndi sayansi; mwachitsanzo, pofufuza zomwe zimapangitsa dopaminergic. Nthawi yomweyo, momwe izi zimapezera kuchuluka kwa anthu omwe si a PD ziyenera kuganiziridwa mosamala ndikupatsidwa kusintha kwa neural komwe kumayenderana ndi PD, mankhwala omwe amagwiritsidwa ntchito pochiza PD, ndi zina zomwe zimayenderana ndi vutoli. PG ndi ICD yophunzitsidwa bwino kwambiri pa anthu onse komanso kwa PD (Evans et al. 2009). Chifukwa chake, pakhala pali mayeso angapo opanga zisankho zopatsa chiopsezo zokhudzana ndi kutchova juga kwa odwala PD (mwachitsanzo, Kobayakawa et al. 2010; Pagonabarraga et al. 2007).

Ndemanga iyi ili ndi magawo atatu omwe apangidwa kuti apeze ntchito za ubongo, ntchito ya ubongo ndi ubongo. Mu gawo la ma neurocognitive, timakambirana zotsatira zokhudzana ndi kuyankha, kufunsa, kufunikira, kuwopsa / kupanga zisankho zabwino ndi zina zambiri zokhudzana ndi malingaliro. Timayang'ana zomwe zapezeka ku PG ndikuyerekeza ndikusiyanitsa ndi zomwe zapezeka kuchokera ku maphunziro a SUD. Zotsatira za SUD nthawi zambiri zimadziwika malinga ndi zomwe zikufunsidwa. Pomwe zingagwiritsidwe ntchito, zomwe zimapezeka pamasamba achikulire athanzi zimayankhulidwa koyamba, ndikutsatiridwa ndi kafukufuku m'masampulu omwe si a PD, akumaliza ndi maphunziro a PD. Njira yofananira imatengedwa gawo la ubongo. Pakukambirana kwathu pa kukakamizika, timasiyanitsa kupirira pama fomu ofala pakuwonetsa zotsatira; komabe, zakhalidwe ndi kudziwonetsa nokha za kukakamiza sikunapangidwebe pozindikira kuti ndi lakuthwa kwambiri monga momwe amalembera mabuku. Ponena za ma neurochemistry, mipata yofufuzira ilipo yomwe imalepheretsa dongosolo mwatsatanetsatane. Timaliza ndi malingaliro a maphunziro amtsogolo.

Pitani ku:

Ntchito za Neococitiveitive kuwunika kukakamira, kukakamizidwa ndi chiwopsezo / kupanga zisankho

Zotsatira zokhudzana ndi ntchito za mitsempha zapereka umboni wofanana pakati pa PG ndi SUDs pokhudzana ndi magawo a kusankha ndi kuyankha mwamphamvu, kukakamizidwa ndi chisankho / kupanga zisankho. Kusiyana kwina kwapezekanso, pokhudzana ndi zoyambira zazoyang'anira ndi zovuta zomwe zingapangidwe popanga zisankho.

Impulivity mu PG

Kuyankha mwamphamvu

Anthu omwe ali ndi PG apezeka kuti ndi osiyana ndi omwe alibe poyankha. Pochita / ayi (mwachitsanzo, Marczinski ndi Fillmore 2003), ophunzirawo amaphunzitsidwa kuti ayankhe mtundu wina wothandizira (“pita”) komanso kuti aletse kuyankha kwina ("osapita '). Ntchito zoyimitsa (mwachitsanzo, Logan 1994) gawani zolemba ndi ntchito zopita / osapita pokhapokha pamayeso ochepa, mayankho a "pitani" amayenera kuletsedwa nthawi yomweyo pamakhala mawu oti "kuyimitsa". Nthawi yayitali pochita mayesero oimiridwa amadziwika kuti akuwonetsa zovuta zowonjezera zomwe zimapangitsa kuti mayankho asanafike. Otsatira a PG anali ndi nthawi yayitali pakuyesa mayeso pamayimidwe oyimitsa (Goudriaan et al. 2006b; Grant et al. 2010). Komabe, Lawrence et al. (2009b) sananene kusiyana kantchito yayikulu pakati pa ochita nawo PG ndi maphunziro owongolera wathanzi Rodriguez-Jimenez et al. (2006) adanenanso kuchepa kwakukulu kwa okhawo omwe ali ndi ADHD. Otsatira a PG anali ndi zolakwika zambiri zowongolera pamachitidwe opita / osapita (Fuentes et al. 2006; Goudriaan et al. 2005).

Kusankha kusanyinyirika

Chimodzi mwazinthu zomwe zimapangitsa chidwi ndi kusinthaku kwakanthawi kapenanso kuchepetsedwa, zomwe zimathandizira kumadera ena kumathandizidwa poyerekeza ndi othandizira (Bickel ndi Marsch 2001). Kusankha kuchita zodabwitsazi kumatanthauza kusankha kwakanthawi (mwachitsanzo, kukhala “okwera”) mochedwa (mwachitsanzo, kugwira ntchito bwino) kulimbitsa (Dalley et al. 2011), kupanga kuchotsera kuchepa kumagwirizana ndi zosokoneza. Ophunzira PG adachotsa mphotho mochuluka kwambiri kuposa kuwongolera pa ntchito yomwe adasankha pakati pa zazing'ono, zazifupi komanso zazikulu, zopatsa za distal pa ma index index (Dixon et al. 2003; Petry 2001b; Petry ndi Casarella 1999).

Kukakamira kwazisankho kuyerekezeranso odwala a PD omwe alibe komanso opanda ma ICD ogwiritsa ntchito Ntchito Yodziwitsa Pochita (EDT; Reynolds ndi Schiffbauer 2004). EDT yochokera pakompyuta ndi ntchito yosankha pakati kapena pang'ono yomwe imawunika kuchotsera kwakanthawi kochepa. Poyesereranso chilichonse, ophunzira amatenga pakati pa kuchuluka komwe kumachedwetsedwa komanso kopitilira muyeso ndi kusintha komwe kuli kotsimikizika ndikuperekedwa nthawi yomweyo. Kuthekera kolandira kuchuluka kwazomwe kumakhalabe kosasinthasintha pamayeso onse, ndipo kuchedwa kulandira ndalama zambiri kumasiyananso. Mukamatenga dopamine agonists, odwala PD omwe ali ndi ma ICD adapanga zisankho zokakamiza kwambiri kuposa omwe alibe ma ICD (Voon et al. 2010). Popeza gawo la kanthawi ka EDT, nthawi yamomwe mumayesedwanso imayesedwanso. Odwala omwe ali ndi ma ICD anali ndi zochita msanga pafupipafupi komanso m'mayesero amakulu pa EDT kuposa omwe alibe ma ICD. Chifukwa chake, kusiyana pamalingaliro a ICD kungaphatikizire kusankha komanso kuyankha kwakanthawi.

Zina zoyenerera

Zizolowezi zosagwiritsa ntchito kuunikanso zimatha kukhala zosankha komanso kuyankha modzidzimutsa chifukwa chinyezimiro cholakwika chimaphatikizapo kupanga zisankho mwachangu popanda chidziwitso chokwanira (Verdejo-Garcia et al. 2008). Pa ntchito yopereka zitsanzo, Lawrence et al. (2009b) anapeza kuti omwe anali nawo pa PG sanawonetse pang'ono poyerekeza ndi maphunziro.

Kuyang'anira ndi kukumbukira ntchito ndi ntchito zazikulu zomwe zikugwirizana ndi kukhudzidwa (Finn 2002; Rugle ndi Melamed 1993). Zotsatira zikusonyeza kuti omwe ali ndi PG opanda ma SUD a co-morbid sangakhale ndi vuto lalikulu ndi kukumbukira kukumbukira (Cavedini et al., 2002; Goudriaan et al. 2006b; Lawrence et al. 2009b) kapena chisamaliro (Maraziti et al. 2008a; Rugle ndi Melamed 1993). Kuzindikira kovuta kumatha kukhudzidwa mu PG, koma ntchito zoyambilira sizingasinthe kwambiri (Goudriaan et al. 2006b; Lawrence et al. 2009b; Potenza, 2009).

Zofanana ndi kusiyanasiyana pankhani yankho komanso kusankhidwa kwa ma SUDs vs. PG

Zotsatira zikusonyeza kuti kuyankha kumakhala kokwezeka m'm SUDs. Nthawi zina zoyesayesa za mayimidwe opumira zimapezeka mu cocaine (Fillmore ndi Rush 2002; Li et al. 2006) ndi kudalira mowa (Goudriaan et al. 2006b; Lawrence et al. 2009a; 2009b) ndi nkhanza za methamphetamine (Monterosso et al. 2005). Anthu omwe amadalira mowa adawonetsanso zolakwika zambiri kuposa zoyeserera pakuyenda / osapita (Goudriaan et al. 2005; Kamarajan et al. 2005), monga ogwiritsa ntchito mankhwala a cocaine (Moeller et al. 2004; Verdejo-Garcia et al. 2007). Kupeza koyipa (Lawrence et al. 2009b) ndi zotsatira zoyenera ku PG (Rodriguez-Jimenez et al. 2006), ngakhale zili choncho, zotsatira zambiri zimathandizira kuyankha kwakanthawi mu PG ndi SUDs.

Omwe ali ndi ma SUD osiyanasiyana apezeka kuti amachotsa mphotho mochedwa kuposa zowongolera (onani Bickel et al. 2007 kuwunikira). Kudalira mowaLawrence et al. 2009b) ndi amphetamine ndi opiate ntchito (Clark et al. 2006) zalumikizidwa ndi zovuta ndi chiwonetsero chazovuta, zofanana ndi zomwe zapezeka ku PG.

Mosiyana ndi izi, kusiyana mu ntchito yayikulu kwapezeka pakati pa PG ndi SUDs. Anthu omwe ali ndi ma SUD nthawi zambiri amathandizira kukumbukira kukumbukira (Cavedini et al. 2002; Lawrence et al. 2009b) komanso zovutaDe Wit 2009) kuposa omwe ali ndi PG. Zotsatira izi zikuwonetsa kusazindikira kwazinthu zambiri mu SUDs monga kudalira mowa kuposa PG (Lawrence et al. 2009b), yomwe imatha kukhala chifukwa cha vuto la neurotoxicity kuyambira nthawi yayitali yogwiritsa ntchito zinthu (Dalley et al. 2011). Chifukwa chake, kusazindikira kwanzeru kungachititse kuti pakhale chidwi chambiri pakupanga mankhwala a SUDs kuposa PG (Bickel et al. 2011; Wexler 2011).

Mwachidule, umboni umapereka lingaliro lokwera komanso kuyankha kwamphamvu pakati pa omwe ali ndi PG ndi omwe ali ndi ma SUD poyerekeza ndi maphunziro olamulira bwino. Mosiyana ndi izi, kusamala ndi kusowa kwa kukumbukira kwa ntchito kungakhale kovuta kwambiri mu SUDs (mwachitsanzo, mowa) kuposa PG (onani. Gulu 1).

Gulu 1

Kufanana ndi kusiyana pakati pa kutchova juga kwa pathological (PG) ndi zovuta zamagwiritsidwe ntchito ka zinthu (SUDs) pokhudzana ndi zotsatira za ntchito ya neurocognitive (onani mawu kuti mumve zambiri)

Kukakamizidwa mu PG

Zotsatira zambiri zosindikizidwa zikutsimikizira kukakamira, makamaka kulimbikira poyankha, mu PG. Poyerekeza ndikuwongolera maphunziro, anthu omwe ali ndi PG awonetsa kulimbika kwakukulu pakuchita pakusewera makadi (Goudriaan et al. 2005). Ntchitoyi imaphatikizapo zisankho zingapo zokhudzana ndi kusewera kapena khadi. M'magawo otsatizana, kuchuluka kwa kupambana kumakhadi otayika kumachepa; Chifukwa chake, lingaliro labwino kwambiri limaphatikizapo kusankha kusewera pafupipafupi m'magawo ang'onoang'ono. Ntchitoyi idayang'aniridwa ngati kuyesa kukakamira, kupatsidwa mawonekedwe kuti ayese kupirira poyeserera komanso chifukwa kusewera pafupipafupi pamabulidwe apambuyo pake ngakhale kuwongolera kwakukulu kungawonetse kukula kwa zotsatira. Komabe, ndiyinso ntchito yopanga chisankho / mphoto. Ovuta otchova juga adawonetsa kupirira pa ntchito yapakompyuta, yopititsa patsogolo maphunziro. Ophunzira adawonetsedwa ndi zokopa ziwiri. Kuyankha kukondoweza kumodzi adalangidwa pomwe kuyankha kwina kudalitsidwanso mu chiwonetsero cha 80: 20 ratio. Zomwe zidakhala zabwino komanso zoyipa zomwe zidapatsidwanso mphamvu zidasinthiratu pambuyo pamayeso angapo (de Ruiter et al. 2009). Omwe ali ndi PG analinso ndi zolakwika zochuluka kuposa maulamuliro pa intradimensional / extradimensional set shifting (IDED) task (Grant et al. 2010) kuchokera ku Cambridge Neuropsychological Test automated Battery (CANTAB; Downes et al. 1989; Sahakian ndi Owen, 1992). IDED ndi ntchito yopanga magawo angapo momwe ochita nawo poyambira amatsatira chimodzi mwazigawo ziwiri ndipo, potengera mayankho, ayenera kudziwa yankho lolondola. Mu gawo lachiwiri, kuyankha molondola kumasuntha. Mu magawo apambuyo, kukondoweza kwa mawonekedwe kumawonjezeredwa komanso kusintha kofanana ndi komwe kulimbikitsa kwa mzere kumachitika molondola (kusintha kosiyanasiyana). Pamapeto omaliza, kusintha kosintha kumachitika komwe kulondola poyankha kumadalira kusankha mawonekedwe oyenera, osati mzere woyenera.

Pali zotsatira zosiyana pankhani yofananizira pakati pa omwe amatenga nawo mbali pa PG ndi kuwongolera kwaumoyo pa Wiscons Card Card Sorting Task (WCST; Grant ndi Berg 1948; Heaton et al. 1993), gawo linanso la kusinthasintha kwazindikiritso. Pa WCST, otenga nawo mbali amafanana ndi makadi olimbikitsira (monga, nambala, mtundu, kapena mawonekedwe) omwe sanafotokozeredwe. Ophunzira atatha kudziwa ntchitoyi pamayeso ndi zolakwika zochokera pazowunikira, lamulo limasunthidwa ndikusintha kuyenera kuchitika malinga ndi gawo lina. Maraziti et al. (2008a) anapeza kuti omwe anali nawo pa PG adapanga zolakwitsa zowonjezereka kuposa zoyendetsa bwino, koma Goudriaan et al. (2006b) sanapeze kusiyana kwakukulu pakati pa ochita nawo PG ndikuwongolera zolakwitsa pakupirira.

Zofanana ndi zosiyana pankhani yakakamizidwe mu SUDs vs. PG

Zofanana ndi PG, zotsatira zingapo za ntchito za neurocognitive zimapatsa kuyankha mu SUDs, ngakhale zomwe zapezeka zidagwirizana kwambiri mu PG. Zotsatira zomwe zikuwonetsa kulimbika poyankha sizinachitike ndi mankhwala onse m'maphunziro onse. Omwe amagwiritsa ntchito mankhwala osokoneza bongo a cocaine kwambiri adalakwitsa kwambiri kuposa kuwongolera zinthu zina zomwe zingabweretse maphunziro anu obwereza (Camchong et al. 2011; Ersche et al. 2008), ngakhale ogwiritsa ntchito amphetamine, ogwiritsa ntchito opiate ndi omwe kale anali osuta mankhwala a cocaine sanasiyane ndi ma control (Ersche et al. 2008). Ogwiritsa ntchito amphetamine / methamphetamine pano akuwonetsa kuyankha poyankha pa ntchito ya IDED (Ersche ndi Sahakian 2007), ngakhale Ersche et al. (2006) sanapeze kusiyana kwakukulu pakati pa anthu olamulira ndi omwe amadalira amphetamine pakadali pano, kudalira kwa opiate kapena ogwiritsa kale amphetamines ndi / kapena opiates. Anthu odalira Cocaine awonetsa kupirira kwakukulu pa WCST, (Woicik et al. 2011) koma zapezanso zoyipa poyerekeza pakati pa olamulira athanzi ndi anthu omwe amadalira mowa (Goudriaan et al. 2006b).

Ponena za kusiyana pakati pa PG ndi SUDs, Goudriaan et al. (2005) ananena kuti mosiyana ndi ma PG, omwe anali ndi vuto lopilira pa masewera akusewera, anthu omwe amadalira mowa adakonda kusewera mosamala. De Ruiter et al. (2009) akuti omwe amasuta adakumana ndi vuto lotchova njuga pamaphunziro obwerezabwereza, koma monga maphunziro a PG, adakwaniritsidwa ndi owongolera.

Mwachidule, zotsatira zambiri zimapereka kuyankha mu PG. Zotsatira zina zikusonyeza zomwezo mu SUD; komabe, palinso zolakwika zingapo. Izi zikusonyeza kuti kupirira kuyankha kumatha kukhala kwachilengedwe kwa PG kuposa SUD (Gulu 1).

Zowopsa / kusankha kwa chidziwitso mu PG

Kafukufuku zingapo tsopano zachitika poyerekeza omwe atenga nawo mbali pa PG ndi oyang'anira athanzi pa IGT. Poyerekeza ndikuwongolera maphunziro, iwo omwe ali ndi PG amachita mosavomerezeka (mwachitsanzo, Cavedini et al. 2002; Goudriaan et al. 2005; 2006a; Petry 2001a). Makamaka, Ophunzira nawo PG apezeka kuti sanawongolere momwe amagwirira ntchito pambuyo pake.Goudriaan et al. 2005; 2006a) m'njira momwe anthu achikulire athanzi amakonda (Bechara ndi Damasio 2002). Chifukwa chake, zidziwitsozi ndizogwirizana ndi lingaliro loti kupirira poyankha - mwina kumakhudzana ndikusunga mayankho osankhidwa mogwirizana ndi zomwe akufuna mphotho yayikulu posachedwa kapena osaphunzira kapena kusintha machitidwe pakakhala zotayika-mwina amafotokozera magwiridwe antchito a IGT pakati pa omwe ali ndi PG (Achinyamata ndi Farah 2005). Popeza kulephera kupewa kutaya kwakukulu mu IGT kuyambira pachiwonetsero kungakhale kuwonetsa kukhudzika kwa zotsatira, ntchito ya IGT imawoneka yokhudzana ndi zovuta komanso kukakamizidwa.

Kuphatikiza pa kukhala pachiwopsezo / ntchito yolandira mphotho, IGT imafunikira kuphunzira kochokera momwe ophunzira ayenera kuzindikira kuti ndi ma desiki ati omwe ndiabwino komanso osavomerezeka ndikupanga zisankho zotsatira. Mosiyana ndi izi, a Cambridge Gamble Test (CGT) apakompyuta amaunikira chisankho / kupanga zisankho popanda chinthu chophunzirira (Rogers et al. 1999). Poyeserera kulikonse, ophunzira amatengedwa mabokosi ofiira a 10 kapena abuluu. Chiwerengero cha mabokosi amtundu uliwonse amasiyanasiyana pamayesero. Ophunzira amafunsidwa kuti azilingalira ngati chizindikiro chobisika chiri kumbuyo kwa bokosi lofiira kapena lamtambo; Chifukwa chake, kuchuluka kwamabokosi amtundu uliwonse ndi chisonyezero cha kuthekera. Ophunzira akuyenera kusankha magawo angapo kuchokera kubanki yawo omwe angafune kubetcha poyankha. Kubeteka kotheka kumawonetsedwa ndi kompyuta ndikusintha kapena kutsika kokulira. Kubetchera kwakukulu pakuyesera kumayesedwa kukuwonetsa kuvuta pang'ono kuyembekezera kukula kochepa, koyenera. Zotsalira zazifupi za kusankha poyankha koyambirira komanso kubetchera kokulirapo pakuyesa kovuta kungakhale kuzindikiritsa kuyankhidwa. Kafukufuku waposachedwa, iwo omwe ali ndi PG kubetcha kwambiri kuposa kuwongolera ngakhale atakhala kuti ali pantchito ndipo atha kutaya mfundo zawo zonse. Panalibe kusiyana kwakukulu pakayankho kotsirizira (Lawrence et al. 2009b).

Zofanana ndi kusiyanasiyana pakupanga zisankho pachiwopsezo / mphotho mu SUDs vs. PG

Zotsatira zambiri zamagetsi zimatsimikizira kufanana pakati pa PG ndi SUDs. Pakanthawi, magwiridwe oyipa a IGT awonedwa mu SUDs (Bechara ndi Damasio 2002): KuledzeraGoudriaan et al. 2005; Kim et al. atolankhani), kugwiritsa ntchito chamba kwambiri (Whitlow et al. 2004), cocaine (Grant et al. 2000) kudalira opiate (Lemenager et al. 2011).

Pakhala pali zovuta zobisika pa kagwiridwe ka IGT. Omwe amatenga zakumwa zoledzeretsa adawongolera pang'ono poyerekeza ndi omwe amakhala nawo pa PG, amenenso adayankha mwachangu kuposa anthu omwe amadalira mowa, zomwe zikuwoneka kuti zikuwathandiza kwambiri (Goudriaan et al. 2005). PG ndi omwe amadalira mowa adachita mosiyanasiyana pa CGT mu kafukufuku waposachedwa. Omvera omwe amadalira mowa adayika ma beti akuluakulu kuposa oyendetsa bwino koma pakubwera mayeso ndipo sanali othekera kwambiri kuposa kuwongolera athanzi kutaya mfundo zawo zonse (Lawrence et al. 2009b). Chifukwa chake, pomwe onse a PG komanso omwe amadalira mowa adachita m'njira yowonetsa kuyipa, kuyendetsa gulu la PG kudachoka modzikakamiza. Kusiyana kwachidziwikire pa CGT kwapezekanso mwa ozunza opiate (Rogers et al. 1999), ngakhale maphunziro ena adawonetsa kusawuka kwa ogwiritsa ntchito opiate (Ersche et al. 2006; Fishbein et al. 2007) ndi ozunza amphetamine, poyerekeza ndi machitidwe olamulira (Rogers et al. 1999).

Mwachidule, zomwe zapezeka zawonetsa kuti iwo omwe ali ndi PG komanso kudalira zinthu zingapo zosiyanasiyana amachita moipa kuposa momwe amalamulira pa IGT. Kafukufuku wocheperapo adachitidwa ndi CGT. Zomwe zapezedwa pano zikuwonetsa kuti omwe ali ndi PG amachita zolakwika kuposa zowongolera zomwe zapezedwa makamaka zikuwonetsa zofanana, zosachita bwino pakati pa ogwiritsa ntchito mankhwala ndi omwe ali ndi ma SUD osiyanasiyana. Pomwe pakufunika kufufuza zochulukirapo, iwo omwe ali ndi PG komanso SUD atha kukhala ndi zovuta zina zapadera za IGT (mwachitsanzo, kuphunzira mobwerera)Gulu 1).

Chidule cha zomwe zapezedwa ndi mitsempha

Zotsatira zokhudzana ndi kuzindikira zimawonetsa kufanana pakati pa PG ndi SUDs pokhudzana ndi chiopsezo / kupanga zisankho, kusankha ndi kuyankha mosadukiza komanso kusinthika kwazinthu zokhudzana ndi kukakamizidwa. Kupatula komwe kungakhalepo ndi CGT ndi kusiyanasiyana kwapang'ono pa IGT, kuwonetsa kuti ntchito zina zokhudzana ndi juga zitha kuwerengetsa zoperewera ku PG. Zotsatira zokhudzana ndi ntchito za Neurocognitive zikuwonetsa kuti kukakamira ndizoyenera kwa onse PG ndi SUDs ngakhale zomwe zapezedwa sizinasinthidwe kwenikweni mu SUDs. Magwiridwe a ntchito yolamulira akuwonetsa zowonongeka zazikuru mu ma SUD kuposa PG. Zonsezi, zomwe takambiranazi zikuonetsa kufanana ndi kusiyana pakati pa omwe ali ndi PG ndi omwe ali ndi ma SUD, kusiyana komwe kukuwonetsa zovuta kapena zovuta zakugwiritsira ntchito mankhwala osokoneza bongo (Potenza 2009).

Pitani ku:

Ntchito yamaubongo oyeserera, kukakamizidwa ndi chiwopsezo / kupanga zisankho zabwino

Neuroimaging yapereka chidziwitso pazopereka zam'madera kuti azikhala ndi chidwi, kukakamiza komanso chisankho / kupanga zisankho mu PG ndi SUDs, ndikupereka malangizo a chitukuko cha mankhwala. Gawoli liziwona makamaka zomwe zapezedwa zikuwongolera mbali zakutsogolo ndi zoyeserera. Madera ena aubongo ndi kukhulupirika kwa nkhani yoyera azikambirana mwachidule.

Frontal cortical zochita ku PG

Kusakhudzidwa

Pomwe chidwi chochulukirachulukira chomwe chapezeka m'mabuku a PG chawonetsa momwe ntchito ikuyendera panthawi yamavuto / mphotho, kulibe chidwi chambiri pantchito yowunikira zomwe zimapangitsa chidwi. Mu kafukufuku wa fMRI, omwe ali ndi PG adachepetsa ntchito mu vmPFC poyerekeza zowongolera panthawi ya Stroop color-mawu osokoneza ntchito, omwe amayenderana ndi kuwongolera kuzindikira komanso kuyankha poyankha (Potenza et al 2003a). Pofufuza waposachedwa, de Ruiter et al. (molemba) adapeza kutseguka kochepa panthawi yoyimitsa-ntchito mu dorsomedial prefrontal cortex (dmPFC) pamavuto otchova njuga poyerekeza ndi kuwongolera wathanzi, komabe panalibe kusiyana kwakukulu pakugwira ntchito. Njira iyi imagwiritsidwa ntchito polephera komanso zolepheretsa kuyankha bwino. Palibe maphunziro omwe adapezedwa akufufuza zochitika zapatsogola zomwe zimakhudzana ndi kusankha kwa PG.

Kukhwima

Ngakhale ntchito yokhazikika yosinthira imagwirizanitsidwa ndi zochita za PFrol (vlPFC) (Hampshire ndi Owen 2006), otchova njuga adawonetsa kulimba poyankha mobwerezabwereza, zomwe zidali zokhudzana ndi kuchepetsedwa mu vlPFC yoyenera mu fMRI potsatira kupeza ndi kutayika pamakompyuta, ntchito yopititsa patsogolo kuphunzira (de Ruiter et al. 2009). Kafukufuku wammuna amagwirizana kwambiri ndi zomwe zimawakakamiza ngakhale amagwiritsa ntchito ntchito yopanga zoopsa / mphotho (IGT) (Achinyamata ndi Farah 2005). Ophunzira omwe ali ndi zotupa za vmPFC ndi dorsolateral prefrontal cortex (dlPFC) adayesedwa pa IGT yodziwika komanso mtundu wina womwe poyambirira amachokera pamalo osavomerezeka adatayika kwambiri, potero ananyalanyaza kufunika kobwereza kuphunzira mu IGT yokhazikika. Pomwe omwe ali ndi zotupa za vmPFC amachita zoyipa pa IGT yokhayo, omwe ali ndi zotupa za dlPFC sanachite bwino pamitundu yonseyi. Chifukwa chake, zovuta zomwe amakumana nazo omwe ali ndi vmPFC zowonongeka zimawoneka zokhudzana kwambiri ndi kuchepa kwaphunziro, pomwe kuwonongeka kwa dlPFC kumakhudzana ndi zovuta zambiri. IGT yosinthayo mwina idalumikizana kwambiri pazotsatira za zotsatira koma kusapilira komwe adapatsidwa sikunayambira pachiyambi. Iwo omwe ali ndi vuto la dlPFC amatha kukhudzidwa kwambiri makamaka pakukakamizidwa.

Ngozi / kuwongolera zisankho

Malo angapo oyang'ana kumakona adayikidwa pakuwongolera mphotho mu kutchova njuga. Akuluakulu opezeka bwino apezeka kuti atha kuyambitsa vmPFC limodzi ndi madera ena apatsogola pa IGT (Li et al. 2010). Mosiyana ndi izi, anthu omwe ali ndi zotupa mu vmPFC amakonda kuchita bwino pa IGT (Bechara et al. 1994; 1998) ndi iwo omwe ali ndi vmPFC zowonongeka nawonso sanachite bwino pa CGT, makamaka akupanga ma bets okwera kwambiri, mosasamala kanthu za zovuta zakupambana.Clark et al. 2008). Kubwezeretsa uku kumagwirizana ndi gawo la vmPFC posankha njira zosiyira mosavomerezeka (Clark et al. 2008).

"Kuthamangitsa" (mwachitsanzo, kupitiliza kutchova juga, nthawi zambiri pochulukitsa, kuti achiretse) ndichizolowezi chazinthu zokhudzana ndi kutchova njuga (Campbell-Meiklejohn et al. 2008). Ntchito yothamangitsa, yokhala ndi mwayi wa "kuwongolera kapena wopanda kanthu" pambuyo poti ataye ziwonetsero, idagwiritsidwa ntchito mu kafukufuku wa fMRI wophatikizapo omwe ali ndi thanzi labwino. Ophunzira adayamba ndi mtengo wamalingaliro opatsa chidwi komanso mwayi wokonda kubwezerera ndalama zomwe zidatayika. Wins idatsogolera kuchotsedwa kwa ndalama zomwe zidatayika pomwe kutaya kumatsatiridwa ndi kusankha kwina kusiya kapena kusewera ndi mwayi wopambananso ndalama zomwe zidatayika mozungulira. Zisankho zothamangitsa zomwe zidawonongeka zinali zogwirizana ndi kuchuluka kwa vmPFC, pomwe zisankho zakusiya zinali zogwirizana ndi njira ina yothandizira. Olembawo adawona kuti vmPFC ndi madera ena ochititsidwa kale amagwirizanitsidwa ndikuyimira zotsatira zabwino (Campbell-Meiklejohn et al. 2008).

Mwa anthu omwe ali ndi PG, ntchito yochepetsetsa idapezeka mu vmPFC panthawi yolosera yomwe olemba nawo adasankha pakati pa makadi awiri akusewera amitundu yosiyanasiyana okhala ndi makadi ofiira omwe amapereka mphoto ya ndalama ndi makhadi ena omwe amalipira chindapusa. Malumikizano ofunikira adapezeka pakati pa kudzimitsa m'derali komanso zovuta zamtundu wa njuga (Reuter et al. 2005). Vuto la kutchova njuga kwambiri lidapangidwanso moyenera komanso molakwika pakati pa ochita nawo gawo la PG panthawi yamakina oyendetsa makina (mwachitsanzo, ochita nawo masewera adavotera zowonetsera kuwina).Habib ndi Dixon, 2010). Nthawi zina, otchova njuga amatanthauzira pafupi ndi zopambana kuti zikhale zothandiza pofufuza mwayi wopambana wina komanso kukulitsa ma bets omwe akubwera.

Kusinthira ku zolemba za PD, mu kafukufuku wa fMRI wophatikiza odwala PD okha opanda ma ICD, omwe adatenga nawo mbali adagwira nawo ntchito yopanga mphoto yamakompyuta pakompyuta. Ophunzira adasankha mtundu womwe adaganiza kuti mpira umatsika pakati pamanenedwe anayi (25% mwayi wopambana) mu theka la mayesero komanso pakati pa mitundu itatu ya mitundu (75% mwayi wopambana) mu theka linalo. Winnings adalipira ndalama kumapeto. Dopamine agonist, koma osati levodopa, makonzedwe adalumikizidwa ndi kuchuluka kwa activation mu OFC kuyankha kuchokera pantchito yonse komanso panthawi yotsimikizaVan Eimeren et al. 2009). Mu positron emission tomography (PET) ya odwala a PD omwe adapatsidwa dopamine agonist akutsatira kosakhalitsa, ntchito za neural zimayesedwa pamasewera a ikhadi la probabilistic. Mtundu wa ndemanga zoperekedwa ndi masewerawa sunatanthauze zotsatira. Odwala a PD omwe ali ndi PG adawonetsa kuchepa kwa magwiridwe anthawi monga OFC ndi rostral cingrate, pomwe odwala PD opanda PG adawonetsa kuwonjezereka kumadera awa (van Eimeren et al. 2010) zofanana ndi kafukufuku wakale wa gululi (van Eimeren et al 2009). Olembawo adaganiza kuti hypoactivation mu gulu la PD / PG ikuwonetsa kuwongolera kopanda mphamvu (van Eimeren et al. 2010). Chimodzimodzinso, mu kafukufuku wa FMRI, ophunzira adamaliza ntchito ndi ndalama kuti atenge ndalama zowona kapena kutchova njuga kwa ndalama yayikulu (zonsezo zimasiyana pamlanduwu mpaka poyeserera) poyambira "kupeza" momwe adayambira ndi $ 0 mtengo kapena "kutaya" momwe adayambira pangozi. Odwala a PD omwe anali ndi ma ICD anali ndi ntchito zotsika za OFC panthawi ya "phindu" (momwe njuga zazikulu zimapangidwira) kuposa "zotayika" (pomwe njuga zazing'ono zimapangidwa). Njira yotsutsana ndi izi idachitikadi kwa odwala PD opanda ma ICD (Voon et al. 2011).

Zofanana ndi kusiyanasiyana kwa zochitika zapambali mu SUDs vs PG

Pakuwongolera kuyankhidwa, poyerekeza ndi zomwe PG wapeza (Potenza et al. 2003a) omwe ali ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo a cocaine adawonetsa hypo-activation ku OFC panthawi ya Stroop yomwe inachitika pa fMRI (Goldstein et al. 2007b). Panthawi yoyimitsa, de Ruiter et al. (molemba) adapeza hypoactivation yofanana ndi ya dmPFC mwa omwe amasuta pomwe adakumana ndi otchova njuga. Chifukwa chake, kutsegulira kwapamwamba mu PFC / OFC kumatha kuwonetsa kuyankhidwa kwamphamvu mu PG ndi SUDs. Ponena za kukakamira, de Ruiter et al. (2009) anapeza kuti otchova njuga komanso omwe amasuta amawonetsa kukhudzika kwa vlPFC ndi mayankho otayika pantchito yophunzitsanso ya probabilistic.

Pali zofananira pokhudzana ndi kuchepetsedwa kwa chikhazikitso chakumaso komwe kumangirizidwa kuti mupindule poyankha mu PG ndi SUDs. Pakafukufuku wa FMRI, ophunzirawo adakanikiza kuti asakanikizire batani molingana ndi malangizo omwe aperekedwa pazotsatira zitatu za mphotho ya ndalama. Ozunza Cocaine adawonetsa kuchepa kwa zigawo mu OFC ndi PFC pakusiyanitsa kwa mtengo wamagwiritsidwe kazomwe amayesa poyerekeza ndi zowongolera (Goldstein et al. 2007a). Poyerekeza ndi zowongolera, ogwiritsa ntchito mankhwala osokoneza bongo a cocaine anali ndi mphamvu yolowerera kumanja kwa OFC komanso kuyambitsa mphamvu pang'ono m'malo a PFC (madera a dorsolateral ndi medial) pa IGT (Bolla et al. 2003). Kafukufuku wina wa fMRI, ngakhale adachita ntchito yomweyo ndikufanizira zowongolera, iwo omwe ali ndi comorbid PG komanso kudalira zinthu ndi omwe amadalira zinthu zimangowonetsa kuchepa ku vmPFC pomwe akusewera zosinthana ndi IGT. Pazosinthazi, kompyuta idasankha chosema ndipo wophatikizayo adasankha kusewera kapena ayi. Kupatula komwe kunali muzochitika pomwe chosankha chosavomerezeka chimasankhidwa (mwachitsanzo, mphotho yayikulu ndi chilango chachikulu). M'mayesowa, iwo omwe ali ndi PG komanso kudalira zinthu anali ndi mphamvu kwambiri kuposa zowongolera (Tanabe et al. 2007).

Mwachidule, zomwe zapezazi zikuwunikira mbali zofunikira kwambiri pantchito yamakina am'mimbidwe, makamaka m'malo opangira zinthu panthaka, pantchito zokhudzana ndi kunyengerera, kukakamiza komanso kupanga zisankho zowopsa. Zotsatira mu PG zikufanana ndi zomwe zapezeka mu SUDs.

Zochitika mu StGat

Kusakhudzidwa

de Ruiter et al. (molemba) sananene za kusiyana kwakukulu pakati pa otchova njuga, osuta komanso owongolera oyendetsa bwino panthawi ya ntchito.

Kukhwima

de Ruiter et al. (2009) sananene zakusiyana kwakukulu pakati pa otchova njuga, osuta fodya komanso oyendetsa bwino pankhondo yoyendetsedwa panthawi yophunzirira mobwerezabwereza.

Ngozi / kuwongolera zisankho

Kafukufuku wokhudza chiopsezo / mphotho komanso kutchova juga kwa anthu athanzi labwino amapereka njira zoyenera poyerekeza ndi maphunziro a iwo omwe ali ndi PG. Li et al. (2010) adapeza umboni wolimbikitsa kuchitapo kanthu pogwiritsa ntchito fMRI pa IGT. M'maphunziro ena a fMRI, pamakina amakina opanga makina omwe amapanga makina opanga "pafupi ndi", achikulire athanzi (Clark et al. 2009) ndi gulu lotukuka la otchova njuga (Chase ndi Clark 2010) adayambitsa stralatum ya ventral panthawi yopambana ndi "misses" (mwachitsanzo, pamene reel imayimitsa malo amodzi kutali ndi win). Dorsal striatal shughuli (mwachitsanzo, caudate) adawonedwa panthawi yolingalira pamalonda a pakompyuta njuga momwe achikulire athanzi, atatsatira chithunzithunzi, adafunsidwa kuti apange chisankho mwachangu ngati angasankhe njuga zazing'onoting'ono kapena zazikulu (Cohen et al. 2005).

Pakufufuza kwa fMRI pogwiritsa ntchito “kapu” yapakompyuta momwe ochita nawo adasankhira kapena kusachita juga ndikusankha kapu yokhudzana ndi ndalama kapena kutaya, achikulire athanzi amakonda kubetchera akutsata mosapambana . Ophunzira adachita ngozi zambiri atayika, pomwe adayang'ana kuwonetsa kuchepa kwa magawo onse awiri (Xue et al. 2011). Mofananamo, m'zaka zomwe tatchulazi "kutaya kuthamangitsa" paradigm yoyesedwa ndi Campbell-Meiklejohn et al. (2008), achikulire athanzi adayambitsa zochitika zapakati panthawi yoti asathamangitse. Chifukwa chake, chodabwitsa, kuti mu thanzi la achikulire omwe ali ndi thanzi labwino kuchuluka kwa zochitika zogwirira ntchito zimagwirizanitsidwa ndi zosankha zowopsa komanso zovuta, ndipo kafukufuku wamtsogolo ayenera kufufuza kuti ndi zinthu ziti (chibadwa, zachilengedwe) zomwe zingathandizire kukulitsa kapena kuchepa kwa zochitika pakubwera kwa juga.

Matenda a Striatal adakhudzidwa ndi PG. Pallanti et al. (2010) adanenanso kuti omwe ali ndi PG anali ndi metabolism yotsika ya glucose yotsika komanso magawo apamwamba mu dorsal striatum kuposa oyang'anira athanzi. Mu kafukufuku wina (Linnet et al. 2011), Opanga PG sanasiyane kwambiri ndi kuwongolera wathanzi mu kupezeka kwa D2-ngati receptor mu ventral striatum pamsewu. Ophunzira PG awonetsa kuchepa kwa zochitika munthawi ya khadi yolingalira njuga yokhudzana ndi mphotho ya ndalama ndi chindapusa ndi kulumikizana kwakukulu pakati pa kuyambitsirana mdera lino komanso zovuta zovuta kutchova njuga (Reuter et al. 2005). Malinga ndi olemba awa, kukondoweza-kwina mu ventral striatum kungawonetse kuchepa kwa chidwi kuti mupindule. Panthawi yolemba ntchito, Habib ndi Dixon (2010) adapeza kuchuluka kwa dorsal striatal zochitika "mochedwa" mu maphunziro a PG, koma osawongolera, ndikuchepetsa zochitika za PG. Motsutsana, Miedl et al. (2010) adapeza chidziwitso chowonjezeka cha pakati pa mayeso opambana pamayendedwe akuda pakati pavuto komanso otchova njuga nthawi zina amagwiritsa ntchito fMRI. Kugwiritsa ntchito PET, Linnet et al. (2011) adapeza ubale wabwino pakati pa kutulutsidwa kwapalepala kwa dopamine komanso kusangalatsidwa podzidzimutsa mu PG pa IGT, ndikuwonetsa kuti ntchitoyi ikhoza kukumana ndi zokumana nazo zabwino mutatchova njuga. Kupeza kumeneku kungathandize kufotokozera kuwona kwa kuchepa kwa magwiridwe antchito am'mimba mwa otenga nawo mbali pa PG koma kukulitsa kuyambitsa kuphunzira kumakhudzana ndi zovuta komanso otchova njuga nthawi zina (Miedl et al. 2010) omwe mwina sanakulirepo kulolera mwamphamvu zotsatira zabwino za juga. Kusiyana kwa ma stentatal kwa Ventral kungaphatikizeponso ma neurotransmitters ena kuposa dopamine pakuwonjezeka kwa 5HT1B receptor kupezeka mu ventral striatum kwapezeka kuti kukukwaniritsa zovuta za kutchova njuga ku PG (Potenza et al. atolankhani).

Kafukufuku wa PET wa ochita nawo PG mu PD awonetsa kusiyana mu njira za transral za transral striatal dopamine transporter (Cilia et al 2010) ndi kupezeka kwapansi kwa D2 ngati receptor mu ventral striatum (Steeves et al. 2009) pakuwunika osagwiritsa ntchito mankhwala a agonist usiku wonse. Zotsatira zina pakati pa odwala PD omwe ali ndi ICD (Rao et al. 2010) ndikuwonetsa kuchepetsedwa kwa zochitika zapakati pa cyntatal poyerekeza ndi odwala omwe alibe ma ICD, onse poyambira komanso panthawi ya Balloon Analogue Risk Task (BART; Lejuez et al. 2002). Odwala a ICD omwe adayesedwa pa dopamine agonists adawonetsa kukhudzika kwa chiwopsezo pantchito yodziika pachiwopsezo ndikuchepetsa zochitika za striatal zochita (Voon et al. 2011).

Zofanana ndi kusiyanasiyana muzochitika mu studat vs. PG

Monga mu PG, zomwe zapezeka zikuwonetsa kuti zatsitsa ntchito zina mothandizidwa ndi zinthu komanso kukhala ndi ma SUD. Pazochedwa kuchepetsa ndalama zolimbikitsa ntchito (MIDT), kuyembekezera kugwiranso ntchito ndalama kumalumikizidwa ndi kuchepa kwa ntchito ya padral mu chidaliro cha mowa (Beck et al. 2009; Hommer 2004; Fotokozani et al. 2007) ndi mwa omwe amasuta achinyamataPeters et al. 2011), zofanana ndi zomwe zapezedwa mu PG (Potenza 2011). M'magulu onse omwe amadalira mowa ndi PG, kuwongolera kwa cyral panthawi yolandira malipiro kumalumikizana molakwika ndi kudziwonetsa komwe kumachitika (Beck et al. 2009; Potenza 2011). Zotsatira zopezeka pamakina ena zidanenedwapo kuti zimakhudzidwa ndi zinthu monga mu PG (Miedl et al. 2010). Kuchulukitsa kwa zochitika zapakati panthawi yolandira mphoto kunapezeka mwa ogwiritsa ntchito ma cannabis (Nestor et al. 2010) ndi kudalira kwa cocaine (Jia et al. 2011).

Kupezeka kwa kupezeka kwa serotonin 5HT1B receptor kupezeka kwa ventral striatum mukudalira mowa (Hu et al., 2010) imayenderana ndi zomwe zapezeka mu PG (Potenza et al. atolankhani). Ntchito ya 5HT1B receptor yapezeka kuti iziyang'anira ma neurotransmitters ambiri, kuphatikizapo dopamine, mu ventral striatum (Yan ndi Yan 2001a; b).

Ngakhale kupezeka kwapafupipafupi kwa D2-ngati receptor mu striatum kwawonedwa mu nkhanza zolimbikitsira (Volkow et al. 2003) komanso maiko osagwiritsa ntchito mankhwala omwe amagawana zamankhwala osokoneza bongo (mwachitsanzo, kunenepa kwambiri [Wang et al. 2001]), zopeza zoyambirira sizinasinthe mu PG (Linnet et al. 2011). Kusiyana kwa zochitika mu PG zokhudzana ndi PD kumatha kutchera makulidwe azigawo za striatum (Cilia et al 2010; Frosini et al. 2010; O'Sullivan neri Al. 2011; Steeves et al. 2009). Umboni wochepa womwe ukupezeka ukuonetsa kuchepa kwa ma dorsal striatum ku PG (Habib ndi Dixon 2010; Pallanti et al. 2010). Momwemonso, dorsal striatal hyperacaction yawonekanso mukudalira kwa zinthu (mwachitsanzo, cocaine; Volkow et al. 2006).

Mwachidule, kupumula kwa boma kwawonedwa mu zochitika zonse za mkati ndi dorsal mu PG ndi SUDs. Ngakhale kafukufuku wambiri akuwonetsa kuti kuchepa kwa mphamvu ya kaperekedwe ka kayendetsedwe kazinthu mu njira zomwe zimayambitsa chiopsezo / kupereka mphotho mu PG, zomwe zapezeka sizimagwirizana kwambiri ndi mankhwala osokoneza bongo, ndikuti, mwa zinthu zina, kupezeka kwa mankhwalawa kungapangitse ntchito yokhudzana ndi zochitika zina.

Ntchito zina za ubongo / zigawo zikuluzikulu

The anterior cingulate cortex (ACC), yomwe ndi gawo la nthambi yamphamvu, imagwirizananso ndi amygdala ndipo imaganiziridwa kuti imakhala ndi maudindo mu kagwiritsidwe kake ka kayendetsedwe kazinthu (Childress et al. 1999), kuzindikira zamaganizo (Botvinick et al. 2004), choletsa kuyankha (Dalley et al. 2011), makamaka makamaka ku PG, kuthamangitsa (Campbell-Meiklejohn et al. 2008). Zotsatira zikuonetsa kuti ACC itha kutenga nawo mbali popanga zisankho zowopsa pakati pa omwe ali ndi ma SUD (Fishbein et al. 2005).

The insula, yokhazikika pakuwongolera, ikugwirizana ndi chiopsezo / kulipira mphoto. Ili ndi njira yolumikizirana kwambiri ndi vmPFC, amygdala ndi ventral striatum, ndikupangitsa kuti ikhale yokhoza bwino popanga chisankho pamalingaliro (Clark et al., 2008). Akuluakulu athanzi amayambitsa kulowerera mu ntchito zamtundu wa juga (Cohen et al. 2005; Li et al. 2010) ndikuyembekeza mphoto.Beck et al. 2009; Cohen et al. 2005) ndipo kuwonongeka kwa insula kumalumikizidwa ndi kusintha kosakwanira pakubetcha (Clark et al. 2008). Insulayo ingathandizenso kupeza zopindulitsa popeza yakhazikitsidwa mwa achikulire athanzi poyankha "zoyipa zapafupi" ndipo adapambana ndipo izi zidalumikizidwa ndi chikhumbo chofuna kuchita nawo gawo lotchovera njuga (Clark et al. 2009). Miedl et al. (2010) opeza omwe amatchova njuga nthawi zina adayambitsa chida nthawi yoyeserera. Mu ma SUD, de Ruiter et al. (2009) anapeza kuti osuta adayambitsa insulini poyankha phindu la ndalama.

Choyera cha nkhani yoyera

Kukhulupirika kwazinthu zoyera, zomwe mwina zikuchitika chifukwa cha kukhudzika kwa mankhwala osokoneza bongo kapena kuwonetsa kusiyana kwa anthu, zawonedwera molumikizana ndi kugwiritsa ntchito kwambiri mankhwala osokoneza bongo komanso kudalira, pazotsatira zina zomwe zikuwonetsa kuyanjana ndi kusokonezeka (Verdejo-Garcia et al. 2008). Mu PG, mitengo yochepetsedwa ya anisotropy (FA) idapezeka kumanzere ndi kumanja kwa Corpus callosum ndipo idalumikizidwa ndi miyambo yosangalatsa (Yip et al. atolankhani). Kukhulupirika kwazinthu zoyera ku PG kumapitilira pamayendedwe owerengera chifukwa chodalira mowa. Kukhulupirika kwazinthu zoyera kumawonedwa bwino mwa anthu omwe amamwa kwambiri mowa kuphatikizapo achinyamata omwe amamwa kwambiriMcQueeny et al. 2009) ndi achikulire omwe amadalira mowa (Pfeff)um et al. 2000). Kukhulupirika kwazinthu zayinso komwe kumalumikizidwa ndi kukhudzidwa kwakudalira mankhwala, ngakhale osagwirizana. Mukudalira kwa cocaine, FA yochepetsedwa idalumikizidwa ndi ma scores apamwamba pa Barratt Impulsiveness Scale (BIS-11; Patton et al. 1995) (Lim et al. 2008; onani Moeller et al. 2005 Zotsatira zoyipa).

Chidule

Madera angapo aubongo, kuphatikiza ma cortices apatsogolo, ma striatum ndi insula, adakhudzidwa ndi PG ndi SUDs. Mkhalidwe wolondola wa zomwe zikuchitikazo zikuwonetsa zonse kufanana ndi kusiyana (Gulu 2). Kupitilira apo, momwe ubongo amagwirira ntchito mogwirizana ndi kukakamira ndi kukakamizidwa pamatendawo akuyamba kuyesedwa mwadongosolo.

Gulu 2

Kufanana ndi kusiyana pakati pamatenda amtundu wa pathological (PG) ndi vuto la kugwiritsidwa ntchito kwa zinthu (SUDs) pokhudzana ndi zotsatira za kafukufuku wamaubongo zokhudzana ndi kukakamizidwa ndi kukakamizidwa (onani mawu kuti mumve zambiri)

Pitani ku:

Neurochemistry yokhazikika, kukakamizidwa ndi chiwopsezo / kupanga zisankho

Makina angapo a neurotransmitter adalumikizidwa ndi kukakamizidwa, kukakamizidwa ndi chiwopsezo / kupanga zisankho mu PG ndi SUDs. Mokulira, zopereka za dopaminergic ndi serotonergic zakhala zikufufuzidwa bwino kwambiri, pofufuza zambiri zofufuza ntchito ya dopamine pazaka zingapo zapitazi. Mwakutero, ma transmit awiri awa ndi omwe azikhala gawo lino. Njira za opioidergic, glutamatergic, and noradrenergic zidzayendetsedwa mwachidule.

Dopamine mu PG

Kuchuluka kwa momwe dopaminergic ntchito imathandizira kuti ayambe kukakamiza komanso kukakamizidwa ku PG alandila mayeso pang'ono. Kugwiritsa ntchito mtundu wa rat IGT, pro-dopaminergic ndi pro-adrenergic agent amphetamine adalumikizidwa ndikuwonjezereka poyankha, pomwe D2 / D3 agonist quinpirole ndi D1 antagonist SCH23390 onse adagwirizanitsidwa ndi kuchepa pakupirira (Zeeb et al. 2009).

Kafukufuku wofufuza momwe kuwongolera kwa dopamine pa chiwopsezo / kupanga zisankho mu zitsanzo za anthu zimasonyezera gawo la dopamine mu mphotho yokhudzana ndi juga komanso kulimbikitsidwa. Pa ntchito yoyerekeza "kuthamangitsa", D2-like receptor agonist pramipexole idalumikizidwa ndi kuchuluka kwakukulu pakuwona kufunika kwa zotayika zomwe zimathamangitsidwa ndikuchepera pakuzindikira kufunika kwa zotayika zomwe sizithamangitsidwa, ndikuwonetsa kuwonjezeka kwa phindu lodziwika la mphotho ndi kuchepetsa kulangidwa (Campbell-Meiklejohn et al. 2011). Mu mtundu wamakina ogwiritsaWinstanley et al. 2011). Mu mtundu wa rat IGT wokhala ndi zotsatira zotsutsana, amphetamine adakulitsa kusankha kwachiwiri mwamphamvu kwambiri, akumapereka mphotho yayikulu kwambiri komanso chilango chotsika kwambiri (Zeeb et al. 2009). Ngakhale makoswe amatsatiridwa ndikulandila mphotho pa amphetamine, mankhwalawo atha kuwonjezera kuchulukitsa kwa zilango.

Ponena za mayanjano pakati pa zoopsa / kupanga mphotho ndi ntchito ya dopaminergic ku PG, omwe akutenga nawo mbali pa PG omwe amasuliridwa panjira ya dralitis ya cyral panthawi ya IGT adanenanso za chisangalalo kuposa maphunziro owongolera athanzi (Linnet et al. 2011). Zotsatira zikuwonetseranso kufunikira kwa kusiyana kwapadera payokhapokha ngati omwe anali nawo pa 8 / 18 PG okha omwe adapeza zomwe zikuwonetsa kutulutsidwa kwa dopamine (Linnet et al. 2011).

Mavuto obwera chifukwa cha dopamine atha kukhala osiyana pakati pa omwe ali ndi mavuto otchovera njuga. Amphetamine chinawonjezera chilimbikitso cha kutchova njuga pamavuto otchova njuga komanso kutha kwa zovuta zamtundu wa juga zinali zokhudzana ndi kukula kwa zotsatira zabwino za amphetamine ndi makulidwe osonkhezera kutchova njuga (Zack ndi Poulos 2004). Pakhala zikuwoneka ngati zotsutsana ndi dopamine antagonists. D2-ngati receptor antagonist haloperidol inachepetsa chizolowezi cha opanga nawo PG kubetcha mokwiya kutsatira kubweza komwe kumagwira ntchito pamakina a slot (Tremblay et al. 2011). Komabe, kafukufuku wina, haloperidol adawonjezera zotsatira zake zabwino komanso adalakalaka kutchova njuga ku PG (Zack ndi Poulos 2007). Zotsatirazi zingathandize kufotokoza zomwe zapezeka ndizoyesa zamankhwala zosokoneza bongo zomwe zili ndi D2-like receptor antagonism (mwachitsanzo, olanzapine; Fong neri Al. 2008; McElroy et al. 2008) mu PG. Zotsatira izi zikuwonetsa ubale wovuta pakati pa D2-ngati dopamine receptor ntchito komanso zolimbikitsa zokhudzana ndi juga.

Kafukufuku mu PD akuwunikiranso mayanjano pakati pamachitidwe olandila mphotho ndi dopamine (Leeman ndi Potenza 2011). Zosintha muzovuta / zolandira mphotho zitha kuphatikizidwa ndi mankhwala a dopaminergic (Frank et al. 2004; Kobayakawa et al 2010; Pagonabarraga et al 2007) komanso, monga mabuku omwe si a PD (Zack ndi Poulos 2004; 2007), yolumikizidwa mosiyanasiyana kwa iwo omwe alibe komanso opanda ma ICD (Bodi et al. 2009; Housden et al. 2010). Kuyesedwa ku DRTs, Cilia et al. (2010) adapeza yachepetsa striatal dopamine transporter yomanga mu PD odwala omwe ali ndi PG, ndikuwonetsa kuchuluka kwa synaptic dopamine, kuchepetsedwa kwa mesolimbic dopamine ntchito, kapena kuchepa ma protein a cell transporter protein. Anayesedwanso ku DRTs, kuthamangitsidwa mu raclopride mu ventral striatum panthawi yantchito ya juga inali yayikulu mu PD odwala omwe ali ndi PG kuposa odwala PD popanda, mogwirizana ndi kutulutsidwa kwakukulu kwa dopamine poyanjana ndi PG (Steeves et al. 2009).

Kugwiritsa ntchito kwa DRT ndi ICD kwalumikizananso ndi kusankha kosakakamiza komanso njira zoyankha kwa odwala a PD. Odwala a PD omwe ali ndi ma ICD oyesedwa ku DRT anali othekera kuposa maphunziro owongolera wathanzi komanso odwala PD opanda ma ICD kuti akonde kulandira mphotho zomwe zikupezeka mwachangu pantchito yotayika (Housden et al. 2010). Poyerekeza mkati mwa maphunziro omwe odwala adayesedwa ndi kusiya mankhwala, kugwiritsa ntchito dopamine agonist kumalumikizidwa ndi zosankha zowonjezera pa EDT mwa iwo omwe ali ndi ICD, koma osati mwa omwe alibe (Voon et al., 2010). Mosiyana ndi izi, ndi chitsanzo chosakhala cha PD, Hamidovic et al. (2008) sanapeze chisonkhezero chachikulu cha dopamine agonist pramipexole pakupirira komanso magwiridwe osankhika komanso ntchito zoyankha.

Zofanana ndi kusiyanasiyana kwa zopereka za dopaminergic ku PG ndi SUDs

Dopamine adapangidwa kuti athandizire kuchepetsa kuchotsera ma SUDs (Schultz 2011). Kuphatikizidwa kwa Dopamine posankha mosakakamiza komanso kuyankha ku PG sikunalandire chidwi chofufuzira muma zitsanzo omwe si a PD. Pomwe chopereka cha dopamine pakukakamiza mu SUDs chanenedwapo (Schultz 2011), ntchito yaying'ono yafufuza udindo wa dopamine pakukakamizidwa ku PG.

Zofanana zimakhalapo pokhudzana ndi kutenga gawo la dopamine mu PG ndi SUDs. Monga kutchova juga, kugwiritsa ntchito mankhwala kumayenderana ndi kutulutsidwa kwa dopamine (Ritz et al. 1987,, yothandizidwa ndi zopezedwa zaposachedwa kuchokera ku PET yowerengera zakumwa kwa anthu osadalira (Urban et al. 2010). Nthawi yomweyo, kusiyana kwa mayankho a dopamine kwatchulidwa mu PG (Linnet et al. 2011) ndi SUD (Volkow 2010) zitsanzo. Monga kutchova juga, dopamine imatha kuyimira pakati komanso popindulitsa ndi mankhwala (Goldstein ndi Volkow 2002). Kufunafuna ndi kutenga komwe kungachitike kungapangitsidwe gawo mwa kuchepa kwa striatal dopamine D2-like receptors (Volkow et al. 2003). Ponena za kutchova juga, Zack ndi Poulos (2007) adanena kuti haloperidol idayambitsa kuchepa kwa D2-ngati receptor kupezeka pakati pa ochita nawo PG, omwe, amakhulupirira, adabweretsa zotsatira zopindulitsa, ngakhale kuti malingaliro awa sanawunikidwe mwachindunji pakuphunzira kwawo.

PG ikhoza kusiyana ndi zomwe zidagwiritsidwa ntchito pazakumwa zina pazokhudza dopaminergic poyankha pamankhwala ena. Amphetamine sanakulitse chilimbikitso cha anthu omwe amamwa mabvuto monga momwe adalimbikitsira kutchova juga ku PG (Zack ndi Poulos 2004).

Serotonin mu PG

Kufufuza koyambirira kwachitika muubwenzi pakati pa kunyengerera, kukakamiza ndi chithandizo chotsatira kumayesedwa kuchipatala kuti ayese kuyesa kwa kusankha kwa serotonin reuptake inhibitor (SSRI) ya PG. Poyesedwa ndi chipala -Blanco et al. 2009), kudziwonetsa kuti ndiwofulumira pa tsamba la Mafunso la EysenckuntuEysenck et al. 1985) ndi zambiri pazakulephera kwa chiwongolero cha zochita za malingaliro a Padua Inventory (Sanavio 1988), ndemanga yodzipatsa wekha kuzolowera komanso kukakamiza, adalumikizidwa ndi zovuta za kutchova juga poyambira kulandira chithandizo ndikuchepa kumapeto kwa chithandizo. Zosintha pamavuto akuchuluka kwa njuga (yoyesedwa ndi Yale-Brown Obsession Compulsion Scale Modified for Pathological Gging [PG-YBOCS]; Pallanti et al. 2005) zinali zokhudzana ndi kusintha kwa kusawakakamiza kokha, kuwonetsa kuti kusintha kwa zisonyezo zamtchireki kumalumikizidwa kwambiri ndikusintha kwa kukakamizidwa kuposa kukakamizidwa (Blanco et al. 2009).

Zotsatira zochokera ku maphunziro a neurochemical zikuwonetsa ntchito ya serotonergic ntchito mu PG. Mitundu yotsika ya serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) yapezeka m'masampweya amadzimadzi a cerebrospinal kuchokera ku maphunziro omwe ali ndi PG (Nordin ndi Eklundh 1999). Mu PG ndikuwongolera athanzi, ³H-paroxetine ([³H] -Par) yomangiriza ku zigawo zamapulatini idagwiritsidwa ntchito pofufuza za serotonin transporter (SERT), mapuloteni omwe amawongolera ndende ya synaptic serotonin kudzera pamabizinesi obwezeretsanso. Maimidwe apamwamba omangira anali otsika kwambiri mu maphunziro a PG, ndikuwonetsa kutengapo gawo kwa serotonin ku PG (Maraziti et al. 2008b). Kupangidwa kwa meta-chlorophenylpiperazine (mCPP), kuphatikiza kwa serotonin agonist wokhala ndi zinthu zapamwamba za 5HT1 ndi 5HT2 receptors, lipoti lanzeru la "high" kapena buzz mwa anthu omwe ali ndi PG. Mosiyana ndi izi, nkhani zowongolera zimakonda kuyankha mochokera ku mCPP (DeCaria et al. 1998; Pallanti et al. 2006). Kuyankha kwamasamba opanda vuto ku sumatriptan, 5-HT1B receptor agonist, yawonekeranso ku PG (Pallanti et al. 2010,, pomwe chiwonetsero chakukula kwa mahomoni chawoneka mu mitu yolamulira (Herdman et al. 1994).

Zotsatira zamatenda azachipatala a SSRIs (mwachitsanzo, fluvoxamine ndi paroxetine), zasakanikirana (zabwino: Hollander et al. 2000; Kim et al. 2002; zoipa: Blanco et al. 2002; Grant et al. 2003; Saiz-Ruiz et al. 2005) ndi zotsatira za olanzapine, mankhwala omwe ali ndi 5HT2 receptor antagonistic katundu, anali opanda (Fong neri Al. 2008; McElroy et al. 2008). Ngakhale zabwino zomwe zimapezeka zimathandizira gawo la serotonin ku PG, zomwe zaphatikizidwa zikuwonetsa kuti kusiyanasiyana kumathandizira kusinthasintha kwa mphamvu ya SSRIs pochizira PG.

Zofanana ndi kusiyanasiyana kwa zopereka za serotonergic ku SUDs ndi PG

Kafukufuku wa Neurochemical amawonetsa kufanana kwa serotonergic mu PG ndi SUDs. Monga ku PG, otsika a 5-HIAA adapezeka akudalira mowa (Zingwe-Aime et al. 1996; Ratsma et al. 2002). Monga mu PG, makonzedwe a mCPP adautsa malipoti a omwe ali “odzipereka” moledzera.Krystal et al., 1994). Kuyankha kwakanenepa kwa mahomoni ku sumatriptan kwawonedwa pakudalira kwa mowa (Vescovi ndi Coiro 1997) ndi PG. Popeza kuti ma mCPP ndi ma sumatriptin target serotonin 5HT1B receptors, akuganiza kuti mwina zofanana ndi zovuta zamachitidwe amtundu komanso machitidwe mu PG ndi kudalira kwa mowa kumayendetsedwa kudzera pa receptor iyi. PET imaphunzira ndi 5HT1B ligand yosankha [¹¹C] P943 yathandizira kuti 5HT1B receptor function mu PG komanso kudalira mowa (Hu et al 2010; Potenza et al. atolankhani). Omwe amatengera zakumwa zoledzeretsa adawonetsa kuthekera kwakukulu kuposa kuwongolera ndi zovuta zamtundu wa juga zomwe zimagwirizana bwino ndi zomangamanga mu PG, ndikuwonetsa kupezeka kwa 5HT1B receptor kupezeka kungathandizire pazinthu zosagwiritsa ntchito mankhwala osokoneza bongo.

Zotsatira zosakanikirana zachipatala zosakanikirana ndi ma serotonergic othandizira ku PG ndizofanana ndi zotsatira za ma SUD. Ma SSRI onse (Torrens et al. 2005) ndi olanzapine (Amato et al. 2010; Guardia et al. 2004) awonetsa kukhudzika pang'ono pochizira ma SUDs.

Kusiyana kwa mgwirizano pakati pa ntchito ya serotonin ndi njuga ndi chikhalidwe chogwiritsa ntchito zinthu zingakhalepo. Tryptophan depletion, womwe umapangitsa kuchepa kwapakati pa serotonin ndi kusintha kwa ma cell a serotonin, anali wokhudzana ndi "kutaya kuthamangitsidwa" mu njuga yoyesedwa (Campbell-Meiklejohn et al. 2011). Mwa iwo omwe ali pachiwopsezo chachikulu cha kudalira mowa, tryptophan depletion yalumikizidwa ndi kuyankha kambiri, koma osati kusankha, kusakhazikika (Crean et al. 2002; LeMarquand et al. 1999). Zotsatira izi zikuwonetsa kuchepa kwa tryptophan, ndipo pakuwonjezera, ntchito ya serotonin, imatha kukhudza mwanjira zina popanga zisankho komanso kukakamizidwa. Momwe izi zimafikira pakufufuzira kwa PG ndi SUDs.

Ma opioids mu PG

Mitundu yokwera ya opoid opaid beta-endorphin amamangirizidwa kutchova juga ndi machitidwe okhudzana nawo (Shinohara et al. 1999). Pakadali pano, olimbana ndi opioid ali ndi chithandizo champhamvu pakati pa othandizira a pharmacotherapeutic a PG. Mkulu mankhwala naltrexone anali apamwamba kuposa placebo ndipo ndiwothandiza kwambiri kwa iwo amene amafotokoza mwamphamvu njuga zamtundu woyambiraKim et al. 2001). Poyesedwa ndi masamba ambiri a nalmefene, ma 25mg ndi 50mg adalumikizidwa ndi kuchepa kwakukulu mu PG-YBOCS zambiri kuposa placebo. Komabe, ngakhale imagwira mtima, 50mg ndi 100mg zidagwirizanitsidwa ndi zochitika zovuta komanso kuleka kwamankhwala ambiri (Grant et al. 2006). Mu kuyeserera kwa naltrexone mu odwala a PG omwe amafotokoza makamaka kutchova juga komwe kumayendetsedwa, kuchepetsa kwakukulu kunapezeka pamavuto akuchuluka kwa njuga, kuchuluka kwa PG-YBOCS, zodzitchukitsa zomwe zimadziwikitsa komanso machitidwe a juga (Grant et al. 2008a). Kafukufuku wotsatira wa naltrexone koyambirira ndi mbiri ya nalmefene yokhudzana ndi mbiri ya mabanja yakumwa zakumwa zoledzeretsa poyankha bwino chithandizo (Grant et al. 2008b). Kafukufuku wotsatira adapeza kuti mwa maphunziro omwe amalandila mankhwala othandizira, nalmefene anali bwino kuposa placebo, ngakhale kutsimikizira-kuphatikiza kuphatikiza koyambirira (placebo-lead-in) kusiya kunali kosalimbikitsa (Grant et al. 2011). Chifukwa chake, zotsatira za mayeso anayi osankhidwa mwadzidzidzi, oyeserera opioid adapereka zotsatira zabwino zokhudzana ndikuchepetsa zovuta za kutchova njuga ndipo izi zikuwoneka kwambiri pakati pa iwo omwe ali ndi banja la zakumwa zoledzeretsa kapena zolimbikitsa njuga. Motsutsana, Toneatto et al. (2009) sananene phindu lililonse kwa naltrexone pa placebo pochiritsira pamodzi vuto la kumwa mowa ndi PG. Ngakhale naltrexone idalumikizidwa ndi kuchepa kwa kutchova juga ndi kumwa mowa, panali yankho lolimba la placebo, ndipo maphunziro omwe adapangidwa kuti ayembekezere ndi kuwerengera mokwanira mayankho a placebo pakupezeka kwa odwala omwe akuwoneka kuti ali ovomerezeka.

Zofanana ndi zosiyana m'magulu a opioidergic ku SUDs ndi PG

Zotsatira zamankhwala ndizotsatira za okonda opioid a PG amatsata zotsatira zabwino za ma SUD, makamaka mowa ndi kudalira kwa opiate. Naltrexone imathandiza poletsa zotsatira zabwino za opiates. Kulephera kwake mayesero azithandizo kumawoneka okhudzana ndi kusatsatira m'malo mothandizidwa ndi pharmacologic (Lobmaier et al. 2008; Minozzi et al. 2011). Naltrexone, molumikizana ndi psychosocial therapy, awonetsa kugwiritsidwa ntchito bwino pakuchepetsa kumwa kwauchidakwa (Rosner et al. 2010), ngakhale pakhala ziyeso zoyipa (mwachitsanzo, Krystal et al. 2001). Njira zomwe naltrexone imathandizira zimaphatikizanso kuchepetsa kukakamira kumwa (Monti et al. 1999; Palfai et al. 1999). Chifukwa chake, zomwe zapezeka zikuwonetsa kuti naltrexone imatha kuchepetsa kukakamiza mu PG ndi kumwa zovuta. Umboni umanenanso za zotsatira za naltrexone mu PG ndi kudalira kwa mowa (Krishnan-Sarin et al. 2007) itha kukhala yolimba kwambiri pakati pa iwo omwe ali ndi banja loledzera.

Ngakhale pali umboni wa gawo la ntchito ya opioid mu mphotho yokhudzana ndi kugwiritsidwa ntchito kwa zinthu, ntchito za opioid sizingathandizire kukulimbikitsani pakumvera kapena mbali iliyonse ya kutsutsika mokulira. Mosiyana ndi zomwe zapezeka ndi amphetamine, naltrexone inachepetsa kumwa mowa mwa njira ya mbewa koma sinalephereke pakuchita kusankha mosaganizira kapena mwachidwi pantchito yoletsa (Oberlin et al. 2010). Chimodzimodzinso pantchito yachedwetsa mphotho, opioid antagonist naloxone sanakhale ndi vuto pakuchita chisankho mosakakamiza, koma sanasangalatse kuyankha pazosankha zisanu zosankha zochita nthawi yayitali (Wiskerke et al. 2011).

Glutamate ku PG

Open-label n-acetyl cysteine (NAC), omwe ndi glutamatergic nutriceutical, adalumikizidwa ndi kuchepa kwakukulu muvuto la kutchova njuga. Zosintha izi zinkangokulira gawo logulika khungu.Grant et al., 2007). NAC akukhulupirira kuti imabwezeretsa ndende ya extracellular glutamate ndende ndikuwongolera ma neurotransication kumagawo kuphatikiza ndi ventral striatum.

Kuchepetsa kuchuluka kwa PG-YBOCS ndikuchepetsa kutchova juga kunadziwika ndi memantine-open labeline, N-methyl d-aspartate receptor antagonist (Grant et al. 2010). Ngakhale nthawi yomuyimira-sanayende bwino, kuyeserera kwa maphunziro a PG poyeseraku sikunafanane ndi kwa owongolera. Pakati pa maphunziro a PG, panali kuwongolera kwakukulu kumapeto kwa chithandizo mu ntchito ya IDED. Kuchepa kwa zolakwika zambiri pa IDED kuyambira chithandizo chisanachitike - Kupeza kumeneku mwina kwachitika chifukwa cha kusinthasintha kwa glutamatergic neurotransication mu PFC chifukwa cha memantine (van Wageningen et al., 2010), ngakhale lingaliro ili silinawunikidwe mwachindunji. Chifukwa chake, memantine itha kuchepetsa kukhudzidwa ndipo mwina kukakamizidwa kwambiri mu PG, ndipo maphunziro akulu, owongoleredwa akuwonetsedwa.

Zofanana ndi kusiyanasiyana kwa zopereka za glutamatergic kwa SUDs ndi PG

Mankhwala omwe amasintha glutamate neurotransication angachepetse kutchova juga komanso kugwiritsa ntchito mankhwala osokoneza bongo. Zotsatira zofananirana ndi kutchova njuga, NAC idalumikizidwa ndi kufunafuna kochepa mu makoswe omwe amaphunzitsidwa kuti azidzipatsa okha cocaine (Baker et al. 2003) ndikuchepetsa mphamvu yogwiritsa ntchito ma heroin mu makoswe (Zhou ndi Kalivas 2008). NAC ikhoza kuchepetsa ndudu (Knackstedt et al. 2009) Kugwiritsa ntchito chamba ndi kulakalaka anthu (Grey et al. 2010). Memantine atha kukhala ndi gawo pothandizira kudalira mowa. M'maphunziro a anthu omwe amamwa mowa, memantine adalumikizidwa ndimayendedwe ochepetsa (Krupitsky et al. 2007). Kuchuluka kwa momwe Memantine amagwiritsidwira ntchito pakukhudzidwa kwa kugwiritsidwa ntchito kwa zinthu kudzera pakukakamiza kapena kukakamizidwa sizikudziwika, makamaka chifukwa chakuti memantine amachepetsa kumwa mowa popanda mbewa popanda kusokoneza chidwi kapena chisankho chololeza pantchito yochepetsera (Oberlin et al. 2010).

Umboni ukusonyeza kuti kusasamala mu glotamate neurotransication kumatha kupangitsa kukhala wopanda chidwi komanso wokakamiza mu PG yonseyo (Grant et al. 2010) ndi ma SUD (Kalivas 2009). Malinga ndi izi, zomwe apeza zikuwonetsa kuti mankhwala omwe amasinthira glutamate neurotransication angapangitse kuti achepetse kuchitapo kanthu komanso mokakamiza mu PG ndi SUDs (Grant et al. 2010; Kalivas 2009).

Norepinephrine mu PG ndi SUDs

Norepinephrine, yomwe yalumikizidwa ndi chisangalalo, yapezeka ikuwonjezeka panthawi yamtundu wa juga (Shinohara et al. 1999), kuphatikiza anthu omwe ali ndi PG, yogwirizana ndi kukwezedwa kwa milingo yapaderadera ngati kugunda kwamtima (Meyer et al. 2004). Anthu omwe ali ndi PG apezeka m'malo osatchova juga kuti azikhala ndi ma adrenergic othandizira ndi ma metabolites awo (Roy et al. 1988; 1989). Popeza madongosolo a adrenergic amatha kuyimira pakati zotsatira zabwino zamakhalidwe oluluza (Weinshenker ndi Schroeder 2007) ndi mankhwala a adrenergic angapangitse kusokonekera (Chamberlain et al. 2007) ndi zotsatira za chithandizo mu SUDs (Jobes et al. atolankhani; Shaham et al. 2000; Sinha et al. 2007), pakufunika ntchito yochulukirapo kuti ifufuze ubale pakati pa adrenergic machitidwe ndi othandizira ku PG komanso monga okhudzana ndi kukakamizidwa komanso kukakamizidwa.

Chidule

Umboni umathandizira ma dopamine, serotonin, opioids, glutamate ndi norepinephrine mu PG ndi SUDs (Gulu 3). Kuchulukana kumakhalapo nthawi zambiri, makamaka kudalirika kwa PG ndi mowa.

Gulu 3

Kufanana ndi kusiyana pakati pa njuga zam'magazi (PG) ndi zovuta zamagwiritsidwe ntchito ka zinthu (SUDs) zokhudzana ndi zotsatira za kafukufuku wa neurotransmitter (onani mfundo zambiri)

Pitani ku:

Mayendedwe amtsogolo a kafukufuku wokhudzana ndi kukakamira komanso kukakamizidwa mu SUD ndi PG

Izi zikuwunikira njira zingapo za kafukufuku wamtsogolo. Izi zikuphatikiza kuneneratu za chiopsezo cha PG ndi SUDs, zitsanzo za ma labotale ndi maphunziro azachipatala.

Ponena za kusatetemera, maphunziro omwe akuphatikizapo magulu omwe ali pachiwopsezo cha PG (mwachitsanzo, iwo omwe ali ndi mbiri yabwino ya mabanja a izi kapena ma ICD ena), pamizere ya maphunziro ofanana mu ma SUDs (mwachitsanzo, LeMarquand et al. 1999,, ikhoza kupereka chidziwitso chofunikira pokhudzana ndi mawonekedwe omwe akuphatikizidwa ndi chiopsezo chotukula PG. Komanso kafukufuku wautali kwa iwo omwe ali pachiwopsezo chachikulu komanso omwe ali ndi PG, SUDs ndi onse, mwa anthu komanso mitundu ya nyama, atha kupereka chidziwitso chofunikira pokhudzana ndi chiwopsezo ndi chiopsezo, komanso mbiri yachilengedwe yazovuta izi.

Kafukufuku wamtsogolo atha kupangidwira kuthana ndi zovuta komanso zotsutsana pazokhudzana ndi dopaminergic ndi serotonergic zochitika mu SUDs ndi PG, komanso chikhalidwe cha ma activation m'malo osiyanasiyana a ubongo mu PG ndi SUDs. Kufufuza koteroko kumatha kusokoneza mitundu ingapo ya kulingalira (PET, fMRI, infusingor tensor imaging) kumvetsetsa bwino ubale pakati pa mitsempha, magwiridwe antchito komanso kuyera kwa nkhani yoyera. Njira zowunikira zapamwamba zitha kuyika ntchito kuti zofufuzira magwiridwe antchito nthawi ya fMRI zokhudzana ndi ntchito ya ntchito ndi kulingalira kwinanso.

Chovuta pakufananitsa zotsatira za kafukufuku wa PG ndi SUD ndikuti kafukufuku wa ma labotale mu SUDs (Haney 2009) zimabwera motsutsana ndi kubwereza zomwe zimagwiritsidwa ntchito ngati zomwe PG amachita pakubwereza njuga. Ngakhale zinthu zenizeni zitha kuperekedwa, maphunziro ambiri a juga amagwiritsa ntchito ntchito yoyeserera. Pomwe maphunziro ena (mwachitsanzo, Breen ndi Zuckerman 1999) tagwiritsa ntchito ndalama zenizeni, izi zakhala zosowa. Zambiri zimafotokoza za kugwiritsa ntchito ndalama zosiyanitsa ndi zongoyerekeza zimatha kuyambitsa mayankho olingana ndi a neural (Hollander et al. 2005). M'zaka zaposachedwa, pakhala pakupita patsogolo koyerekeza magawo a kutchova juga (mwachitsanzo, zitsanzo za "pafupi kuphonya" ndi "kuthamangitsa" zochitika). Mitundu iyi ikhoza kugwiritsidwa ntchito m'maphunziro ochulukirapo a PG komanso maphunziro a labotale opanga mankhwala ofanana ndi zomwe zachitika m'ma SUDs (mwachitsanzo, O'malal et al. 2002). Kafukufuku wa PG ndi SUD angapindule mwakukula kwa mitundu yambiri ya anthu ndi nyama pazinthu zomwe zingawathandize. Kupita kwaposachedwa kwamitundu ya zinyama ku PG (Rivalan et al. 2009; Winstanley et al. 2011; Zeeb et al. 2009) ikulonjeza. Ngati makoswe kapena mbewa zitha kupangika mwanjira yosankha kapena kukhazikitsa njuga m'njira zokomera PG, monga mitundu ya SUD (mwachitsanzo, mowa womwe umakonda makoswe; Bell et al. 2006,, amaimira zida zamphamvu zofufuzira.

Kafukufuku owonjezera pazinthu zokhudzidwa ndi kukakamiza kuyenera kuchitika onse mu PG ndi SUDs. Maubwenzi apakati pa kutsimikizika ndi kukakamizidwa samamvetseka bwino ndipo akuyenera kuwunikiridwa mopitilira (Blanco et al., 2009; Dalley et al. 2011). Ntchito yotsatira ikufunika kufotokoza momveka bwino komanso kufotokozera za kuzungulira kwazovutaDalley et al. 2011; Fineberg et al. 2010), pamodzi ndi mizere yofananira ya ntchito yochitidwira m'mabuku amisala (onani Dick et al. 2010). Makamaka, njira zodzionera nokha ndi ntchito zamaubongo zomwe zimatha kupatula mbali zazokakamira monga kupilira poyankha ndi kusinthitsa zotsatira kungakhale kothandiza. Kufufuza kwakanema kuti mupeze ma neurochemistry ndi ubongo wogwira ntchito mozama komanso kukakamizidwa mu PG ndi SUDs zingakhale zaphindu, monganso kupitiliza kufufuza kwa izi kwa anthu ndi mitundu ya nyama. Makamaka, kugwiritsa ntchito kudziwuza nokha komanso njira zina zoyeserera komanso kukakamizidwa pakuyesa kwa a PG ndi SUDs zitha kupereka chidziwitso chofunikira kwambiri chokhudza kumvetsetsa momwe mankhwalawa amagwirira ntchito komanso omwe chithandizo chamankhwala chimagwira bwino kwambiri (Potenza et al 2011).

Pitani ku:

Kuvomereza

Ntchitoyi idathandizidwa ndi NIH (K01 AA 019694, K05 AA014715, R01 DA019039, P20 DA027844, RC1 DA028279), VA VISN1 MIRECC, dipatimenti ya Connecticut ya Dental Award ndi Chowonjezerapo cha Outline. National Center for Responsible Gaming ndi bungwe lake logwirizana Lofufuza Zokhudza Kutchova Njuga. Zomwe zalembedwa pamanja ndi udindo wa olemba okha sikuti zikuyimira malingaliro a bungwe lililonse lothandizira ndalama.

Pitani ku:

Mawu a M'munsi

Zowulula: Olembawo akuti alibe mikangano pazachuma pankhani yokhudza zomwe zalembedwa pamanja awa. Dr. Potenza alandila thandizo la ndalama kapena kulipila izi: Dr. Potenza adakambilana ndikupangira Boehringer Ingelheim; adafunsira ndipo ali ndi zokonda zachuma ku Somaxon; walandira thandizo lakufufuza kuchokera ku National Institutes of Health, Veteran's Administration, Mohegan Sun Casino, National Center for Responsible Gaming ndi bungwe lake logwirizana ndi Research for Gossip Disrupt, and Psyadon, Forest Laboratories, Ortho-McNeil, Oy-Control / Biotie ndi Glaxo-SmithKline mankhwala; adachita nawo kafukufuku, kutumiza makalata kapena kulumikizana ndi matelefoni zokhudzana ndi kusuta kwa mankhwala osokoneza bongo, zovuta zowongolera kapena mutu wina wazokhudzaumoyo; yafunsira ku maofesi amilandu ndi ofesi yaboma yotchinjiriza anthu pankhani zokhudzana ndi zovuta zoyeserera; imapereka chisamaliro chachipatala mu Connecticut Department of Mental Health and Addiction Services Vuto la Kutchova Njuga Dongosolo; yachita ntchito zowunikira za National Institutes of Health ndi mabungwe ena; ali ndi magawo azakonza alendo; wapereka zokambirana m'miyeso yayikulu, zochitika za CME ndi malo ena azachipatala kapena asayansi; ndipo yatulutsa mabuku kapena machaputala a buku kwa ofalitsa malembedwe amisala.

Pitani ku:

Zothandizira

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Zofanana ndi kusiyana pakati pa kutchova njuga ndi vuto la kugwiritsira ntchito mankhwala: kuganizira za kukhudzika ndi kukakamiza (2012)

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