Kusokonezeka kwa Masewera a pa intaneti pa Achinyamata Okhala ndi Matenda a Psychiatric: Mauthenga Awiri A Nkhani Zogwiritsa Ntchito Pulogalamu Yopangira Zambiri (2019)

Front Psychiatry. 2019; 10: 336.

Idasindikizidwa pa intaneti 2019 May 10. do: 10.3389 / fpsyt.2019.00336

PMCID: PMC6524313

PMID: 31133904

Xavier Benarous, 1, 2, * Pierre Morales, 3 Hanna Mayer, 1 Cosmin Iancu, 1 Yves Edel, 3 ndi David Cohen 1, 4

Kudalirika

Vuto la masewera a pa intaneti (IGD) lakhala likuchita zotsutsana pamalingaliro osiyanasiyana okhudzana ndi kupezeka kwachipatala monga vuto lakudziyimira pawokha. Mtsutsowu waphatikizanso zokambirana zokhudzana ndi mgwirizano pakati pa masewera ovuta, zovuta zamisala, komanso mawonekedwe ndi umunthu. Pepala ili limafotokoza za njira yolimbikitsira yoyerekeza masewera olakwika a pa intaneti yomwe idauziridwa ndi chithandizo cha achinyamata awiri omwe ali ndi vuto. Ma vignette awiri azachipatala akuwonetsa njira za chitukuko: "njira yolowera mkati" kudzera kukulitsa nkhawa zakudziko, kupewa mtima ndi malingaliro; ndi "njira yakunja" yokhala ndi malingaliro ochepa oponderezedwa. M'magawo onse awiri azachipatala, zovuta zophatikizika zidagwira gawo lalikulu kuti amvetsetse magulu omwe ali pachiwopsezo ndikukwaniritsa zomwe zimayambitsa IGD, ndipo machitidwe amasewera amawoneka ngati njira zenizeni zakudziwongolera kudziletsa kwa achinyamata awiriwa. Zowunikira pazachipatalazi zimachirikiza lingaliro loti kugwiritsa ntchito masewera olimbitsa thupi kumavuta muubwana kuyenera kuwonedwa ndi njira yachitukuko, kuphatikiza mbali zazikulu za chitukuko cha m'maganizo zomwe zikuyimira zofunika pakuchitapo kanthu pochizira.

Keywords: Vuto la masewera a pa intaneti, kugwiritsa ntchito molakwika masewera, kugwiritsa ntchito bongo, kusokoneza bongo, kusokoneza chikhalidwe, kusokoneza malingaliro, kudzipatula, achinyamata

Background

Kusokonezeka kwa Masewera a pa intaneti

Mu 2013 bungwe la American Psychiatric Association lidaphatikizanso Matenda a pa Intaneti (IGD) muzowonjezera za Buku Lophatikiza ndi Kuwerenga, Fifth Edition (DSM-5) ikuvomereza kuti maphunziro ena azichitidwa (). Kutsatira malingaliro a DSM-5, matenda a masewera (GD) adangophatikizidwa ngati bungwe lozindikira matenda mu 11th edition la International Classification of Diseases () potanthauza masewera a pa intaneti komanso pa intaneti ndikujambula kusiyana pakati pa GD ndi masewera oopsa. Kukula kwa IGD / GD akuyerekeza pakati pa 1.2% ndi 5.5% mwa achinyamata, ndipo kugwiritsa ntchito zovuta pamasewera kungadandaule za 1 pa achinyamata a 10 omwe amasewera masewera a kanema ().

Zovuta zambiri zafotokozedwa za kuzindikiritsa kwa DSM-5 IGD kapena CIM-11 GD ngati mabungwe azachipatala a discrete (-). Olembawo adazindikira zovuta zingapo zomwe zimayang'ana pa njira yodziwira matenda omwe ali nawo komanso zovuta zawo. Izi zikuphatikiza kutsimikizika kwa njira zodziwonera za pakalipano, kufalikira kwa vutoli kuti liphatikizire masewera osasewera pa intaneti (mwachitsanzo, media media), komanso chiopsezo chogwiritsa ntchito kwambiri zochitika wamba (, , ). Zonse pambali, kafukufuku wopatsa chidwi wasonyeza kuti kuchita mosalekeza kapena machitidwe omwe amakhalapo pamwambo kumalumikizidwa ndi kuchuluka kwa psychopathology kwa achinyamata monga nkhawa za pagulu, kusokonezeka kwa chisangalalo, chisokonezo chokhala ndi chidwi, kusokonezeka kwa zovuta, komanso zikhalidwe zomwe zimapangitsa munthu kukhala ndi vuto (, ). Zotsatira izi ndizogwirizana pakati pa kafukufuku yemwe anachitika mu zitsanzo zamagulu (-), Achinyamata olemba anzawo pa intaneti (), ndi anthu ofuna thandizo (, ).

Kafukufuku wa Longitudinal adathandizira ubale wapaderadera pakati pa IGD ndi mavuto azachipatala m'maganizo a achinyamata (-), mwachitsanzo, machitidwe a psychopathological, monga kukakamizidwa, amawonjezera chiopsezo cha IGD; nawonso, nthawi yamasewera owonetsa masewerawa imaneneratu kuopsa kwa zizindikiro zosautsa za 2 patapita zaka zaunyamata ().

Njira Yotengera Yogwiritsa Ntchito Masewera Olakwika pa intaneti mwa Achinyamata

Kukula kuubwana kumaimira nthawi yokhala pachiwopsezo cha kukhazikika kwa zizolowezi zowonjezereka ndi chiwopsezo cha zomwe zimachitika pakusintha kukhala ukalamba (). Pachitukuko, achinyamata amakhala ndi chidwi chodziwunikira pawokha komanso kudziwika kudzera mu magulu azomwe akuchita. Kufunika kophatikiza zingapo, komanso zotsutsana, zofuna ndi chitukuko zitha kubweretsa mikangano yapakati komanso kuvutika kwamalingaliro (). Munkhaniyi, zizolowezi zonyansa zimatha kutuluka ngati njira yopezera chidziwitso chatsopano cha gulu la anzawo ndikuchepetsa nkhawa (). Pomwe malo oyambira azolowera nthawi zambiri amakhala paunyamata, thupi limakhazikika muubwana, makamaka zinthu zomwe zimakhalapo kalekale komanso zovuta zazidziwitso ndi chikhalidwe cha anthu (, , ).

Monga momwe zimagwirira ntchito mu DSM-5, tanthauzo la IGD limateteza malingaliro aliwonse otukuka. Kodi kufunikira kachipatala, njira zachilengedwe, ndi njira zochiritsira za IGD zimasiyana bwanji zaka? Zowonadi, munthu angaganize kuti kuthana ndi kugwiritsa ntchito molakwika masewera kumadalira momwe mchitidwewu umasokonezera kusintha kwamakono komwe kumachitika pakuwoneka kwachilengedwenso (mwachitsanzo, kusasitsa kwa ubongo), kuzindikira (mwachitsanzo, kudziwika kwamalingaliro, kuyimitsa galimoto), zamaganizidwe (mwachitsanzo, kudziwika kapangidwe ndi kapangidwe ka magwiridwe antchito), ndi chilengedwe (mwachitsanzo, kupambana kwamaphunziro / ukadaulo, maubale ndi ubale) pazenera linalake. Mawonekedwe otukula amayang'ana kwambiri pamene ndi momwe zinthu zomwe zimawonongeka zimasokoneza ndipo zimatha kukhala njira zowoneka bwino zogwiritsira ntchito molakwika ndi / kapena psychopathology.

Achinyamata Omwe Ali Ndi Mavuto Aakulu a zamaganizidwe

Zambiri mwa zomwe zimagwiritsidwa ntchito molakwika pa masewera a achinyamata mu achinyamata zimachokera ku maphunziro omwe amapezeka mwa anthu ambiri, zitsanzo za pa intaneti, kapena zipatala zapadera. Malipoti anecdotal okha omwe alipo okhudzana ndi achinyamata omwe ali ndi vuto lalikulu la misala (, ). Komabe, mgulu lomaliza lino, kuchuluka kwa zovuta zamaphunziro, kuchoka pagulu, komanso kuwonongeka kwa zizindikiro zomwe zimadziwika mkati zimawayika pachiwopsezo chachikulu chotenga kugwiritsa ntchito molakwika masewera. Kuphatikiza apo, ngati masewera a pa intaneti atasokoneza molakwika njira za matenda amisala kwa achinyamata omwe ali ndi vuto lalikulu la matenda amisala, kuzindikira ndikuchiza matenda apawiri kungayimire chifanizo chofunikira kuchipatala.

Zolinga

Mu pepala ili, tidayang'ana pofotokoza milandu iwiri ya IGD mwa achinyamata omwe ali ndi vuto lalikulu la misala pogwiritsa ntchito njira yachitukuko. Tidayesera kuwonetsa kusiyana pakati pa chikhalidwe chamasewera, psychopathology, ndi chilengedwe. Njira zachitukuko zomwe zimayambira pachiwopsezo ndikukwaniritsa zofunika zimakambitsidwira aliyense wa vignette zokhudzana ndi zomwe zilipo zokhudzana ndi kugwiritsidwa ntchito molakwika pa intaneti kwa achinyamata.

Njira

Phunziroli ndi gawo lakufufuza kwakukulu pa ubale womwe ulipo pakati pamavuto osokoneza bongo ndi psychopathology pakati pa achinyamata omwe ali ndi vuto lalikulu la matenda amisala (). Otenga nawo mbali ndi achinyamata (12-18 wazaka) wogonekedwa m'Dipatimenti ya Ana ndi Adolescent Psychiatry ku Pitié-Salpêtrière University Hospital ku Paris. Ma Vignette adasankhidwa ndi gulu la amisala komanso chipatala cholumikizirana ndi chipatala. M'mawu otsalawa, tagwiritsa ntchito gulu la DSM-5 kutanthauza zovuta za GD komanso matenda amisala. Kuvomerezedwa kodziwitsa kunapezeka kuchokera kwa makolo / omwe amawasamalira mwalamulo kuti milanduyi ifalitsidwe. Kupereka malipoti a milanduyi kumatsatira Ndondomeko ya CARE ().

Case Presentation 1

Chidziwitso cha Odwala ndi Zomwe Zapezeka Pazachipatala

A anali mwana wazaka 13 wazaka zam'mbuyomu yemwe amalumikizidwa ku chipinda chachipatala kuti amuchotsere kwambiri sukulu ndi chaka chimodzi ndi theka. Sanakhale ndi matenda amisala kapena mbiri yakale. Ankakhala ndi mchimwene wake yemwe amapasa ndi mayi ake. Abambo adamwalira zaka 2 zapitazo kuchokera ku khansa ya m'mapapo. Amapasa amabadwa asanabadwe pamasabata a 34, koma sanachedwe pakupezeka kwa psychomotor.

Pambuyo pa imfa ya abambo ake, A adayamba kudzipatula komanso kudzipatula. Nthawi yomweyo, adayamba kusewera pamasewera omanga pakompyuta yake. Nthawi yomwe takhala tikugwira ntchitoyi idakulirakulira, ndipo wodwalayo adasiya sukulu ndi zina. Chaka chatha, A adasewera 10 mpaka 12 h patsiku popanda nthawi yopanda kusewera kwakutali kuposa tsiku limodzi. Popanda masewera, A anali wokwiya, wobwezera, komanso wamwano. Kuphatikiza apo, kusewera sikunaphatikizepo mayanjano aliwonse (mwachitsanzo, forum kapena mpikisano wapaintaneti). M'miyezi isanu ndi umodzi yapita, anali atangokhala mchipinda chake (kupatula ukhondo) amakhala pafupifupi nthawi yonse yamasana akusewera masewerawa. Kuyesera konse kwa banja kumuthandiza kuti achepetse masewerawa kwalephera. Wodwalayo adakana mwamphamvu kukumana ndi akatswiri azaumoyo, ndipo popita kunyumba, amakhala atatsekedwa m'chipinda chake.

Kuzindikira Kwamzeru ndi Psychopathological

Povomereza, wodwalayo adawoneka ngati mwana wosakhazikika. Amawoneka wachisoni komanso wopanda mawu ndi mawu ochepa. Mawu ake anali amodzi komanso ofewa kwambiri ndikupumira pang'ono, makamaka, osafuna kunena za zomwe anali kuganiza. A anali mosamala kwambiri kusankha mawu oyankha mafunso. Adanenanso zakunyada komanso kusowa chidwi ndi malo omwe amakhala. Kusintha kwake sikunatengeke ndi zochitika zakunja. Adafotokozanso motere kuti anali wolumala mmalo mokhumudwa. Palibe lipoti la chiyembekezo kapena malingaliro opanda chiyembekezo; Komabe, sanathe kudzipanga mtsogolo ndipo analibe chowalimbikitsa kuti achite zinthu zina kupatula masewera. Kugona ndi kusowa chilonda zidasungidwa ndipo palibe chinyengo chomwe chidanenedwa. Kuzindikiritsa kwa kusakhazikika kwachisokonezo (F34.1) kunapangidwa ().

Asanayambike vuto lokhumudwitsa lomwe lilipoli, A zovuta za m'maganizo ndi pakati pa anthu. Adagawana zomwe anakumana nazo pokhapokha nthawi zina ndipo sanazengereze kupempha thandizo pazoyambira kapena zosafunikira. Monga mwana amamufotokozera kuti nthawi zambiri amakhala wamanyazi m'malo atsopano komanso osadziwika bwino, omwe ali ndi njira zochepa zowongolera momwe akumvera. Kuletsedwa kwa nkhope ndi mawu zimakhudza, poyambirira kutanthauziridwa ngati chizindikiro cha kukhumudwa, adanenedwa kuyambira ali aang'ono.

Pakufunsidwa kwa zamankhwala, mayi a A adapereka malingaliro osazindikira. Mawu ake ndi nkhope yake zidawonetsa chisoni chachikulu, koma sankafuna kufotokoza momwe akumvera. Mafunso okhudzana ndi maubwenzi apabanja, momwe aliyense m'banjamo amathandizira, komanso zovuta za m'maganizo a A sanathetsedwe. Sanatchulepo za phobia wake womwe tidapeza patapita nthawi yayitali kuchokera kuchipatala. M'malo mwake, zidadziwika kuti kupezeka kwa abale omwe amathandizira pa ntchito yopereka chithandizo kwa odwala kwa atsikana okhaokha ndi njira yokhayo yolumikizirana. Pazokhudzana ndi masewera, adamva kuti sangathe kuyang'anira momwe amasewera. Anavomera kulandira chitsogozo chamakhalidwe koma sanathe kugwiritsa ntchito malingaliro aliwonse. Cholinga chake chosinthira momwe zinthu ziliri kunyumba zimawoneka zochepa.

Zochita Zachithandizo, Kutsatira, ndi Zotsatira

A adathandizidwa ndi antidepressant, kusankha serotonin reuptake inhibitor (SSRI), sertraline mpaka 75 mg / tsiku. Mu wadi, adachita nawo zochitika zosiyanasiyana ndi ma inpatient ena pofuna kupititsa patsogolo zokumana nazo zabwino ndi akulu ndi anzawo. Amawoneka womasuka komanso wolankhula ndi ogwira ntchito zachipatala komanso ndi achinyamata ena kuposa nthawi yomwe azachipatala adafunsidwa. Anali ndi gulu lothandizira sabata ndi gulu la zovuta zamakhalidwe ndi zosokoneza bongo. Wodwalayo adayamba kuwerenga kuwerenga kwa maola angapo patsiku.

Pambuyo pa masabata a 4, wodwalayo adamva bwino pang'onopang'ono. Nthawi yololeza kunyumba, A amafotokozedwa kuti ndiwosintha komanso mwamphamvu. Anayamba kusangalala ndi zokonda zawo limodzi ndi abale ena ndipo adafunafuna chibwenzi pokonzekera nkhomaliro kumapeto kwa sabata ndi achinyamata omwe adakumana kuchipatala. Pang'onopang'ono, adakhala nthawi yocheperako akusewera masewera apakanema (mozungulira 2 h patsiku) wopanda nkhawa osasewera.

Ngakhale kukonza kwazachipatala komanso kuthandizira, onse A ndi amayi ake amawoneka kuti sangathe kuzindikira zakunja kapena zamkati zomwe zimayambitsa chisokonezo cha A komanso kugwiritsidwa ntchito molakwika ndi masewera. Sanatchule nkhawa iliyonse yomwe ingayambenso. Kwa onse awiriwa, malingaliro am'mbuyomu kapena mtsogolo sizinali zosatheka kapena zinali zosatheka. Mwachitsanzo, ngakhale atakhala chaka ndi theka osakhala pasukulu, A ndi amayi ake adakana kusintha masinthidwe onse kusukulu. Wodwalayo amawona kubwereza kalasi ngati kumapangitsa kuti achite manyazi komanso anakana kubwerera kusukulu. Kupitilira apo, malingaliro othandizira monga kupulumutsira chisamaliro cha tsiku ndi tsiku kapena psychotherapy yamtundu wina adatsika mwaulemu kwa wodwalayo.

Atatulutsa, wodwalayo amakhala ndi nthawi yosungidwa kumalo osamalira odwala ndipo adayamba sukulu yatsopano. Pambuyo pa masabata a 10, amayi adatipeza kuti afotokozere kuti mwana wawo wakana kutsatira chisamaliro chapadera, sanapitenso kusukulu, ndipo anasiya kucheza ndi anthu ochita masewera olakwika.

Kugwirizana Kwachithandizo

Chitani Pakati Pakati pa Mavuto Akumva ndi Kusagwiritsa Ntchito Masewera

Mu vignette iyi, zizindikiro za nkhawa / zosokoneza ndi kugwiritsa ntchito molakwika masewera a pa intaneti zimakonzedwa bwino: kuchepa kwa kuopsa kwa zizindikiro zosinthika kunalumikizidwa ndi machitidwe ochepera a masewera, ndipo "kuyambiranso" mu masewerawa akulu kunachitika ndikuyambiranso kwa nkhawa. Kuyanjana kotereku kwawonetsedwa bwino (, , ). M'maphunziro amtundu wautali, kugwiritsa ntchito masewera a kanema wa pathological kumanenedweratu ndi nkhawa (kuphatikiza phobia yachilengedwe) ndi zizindikiro zowoneka (, , ). Kuyanjana kotereku pakati pa kugwiritsidwa ntchito molakwika ndi zizindikiro za nkhawa / zammwetu kumatha kubweretsa pang'onopang'ono kuzungulira kwa zizindikiritso zapakati pake ().

Kuphatikiza Kwosatetezedwa Monga Chophatikizika Chowonongera

Apa, tidayesa matenda omwe amagwirizana ndi vuto logwirizana (F94.1) () zokhudzana ndi zovuta za A zoyambira ndikuyankha mayanjano ambiri mwanjira zokhazikika zomwe zimawonedwa mosalekeza kuyambira ali mwana. Kuphatikiza apo, njira yolerera kusamalidwa kwachidziwikire inali yovuta kwambiri pakuwunika zovuta zomwe mayiwo angazindikire ndikudziwitsa zakukhosi kwake ndi za ana ake.

Mwa ana omwe ali ndi vuto loti asalumikizidwe, mawonekedwe ochepetsa nkhawa apezeka (). Ana awa samawonetsa kuwawa chifukwa chodzipatula ndipo samanyalanyaza wowasamalira kapena amamuthawa pakubwerera kwawo. Chachikulu () adalangiza kuti ana awa adayesetsa kupewetsa wosasamala osasamala chifukwa chopewa zovuta komanso kuti akhalebe wodziletsa. Kupewera kwa chikhalidwe chilichonse chatsopano mwa ana omwe ali ndi vuto lodziletsa kumapangitsa kuti asadzidalire komanso kuti akhale ndi vuto kudzera kusowa kwa mwayi wophunzirira maluso ndi omwe amamuthandiza ().

Achichepere ndi achinyamata omwe ali ndi vuto kugwiritsa ntchito intaneti ali ndi mwayi wokhala ndi chikhalidwe chosakhazikika (-). Kafukufuku waku Italy adawona kuti mawonekedwe othandizira amathandizira gawo lalikulu (13%) pakusiyana kwamakhalidwe ambiri owonetsa mwa ophunzira aku koleji (). Makhalidwe ena am'malingaliro omwe adanenedwa mu vignette iyi ya chipatala, monga kuthamanga kwambiri kwa psycho-kuuma, kuwongolera malingaliro ndi anthu, komanso kusinthasintha kwokhudzana ndi ubale, amadziwikanso ngati chiopsezo choyambitsa kuyambitsa masewera osokoneza bongo kwa achinyamata., ). Kafukufuku m'modzi amathandizira izi pakukula, monga olemba adazindikira kuti kudziphatika / umunthu mwa achikulire achinyamata zimathandizira pakukhudzana kwaubwenzi wabanja pakachitika IGD (). Mu zokambiranazi, timafotokoza mwatsatanetsatane momwe kupewa komanso kupewa kucheza ndi anthu ngati vuto lomwe likupitirirabe kwa wodwalayo yemwe ali ndi vuto lodzitchinjiriza lomwe limapangitsa kuti pakhale vuto loti azisinthasintha.

Case Presentation 2

Chidziwitso cha Odwala ndi Zomwe Zapezeka Pazachipatala

B anali mwana wazaka za 15 yemwe amatchulidwa kuchipinda cholowera zolakwika zamakhalidwe oyipa atachotsedwa sukulu. Ankakhala ndi mchimwene wake wa 10 wazaka zazing'ono komanso abale awiri: (20 wazaka XXUMX). Makolo anali opatukana ngakhale amakhala limodzi. B anali atadziwika kawirikawiri pamikangano yayikulu komanso kumenyana pakati pawo. Makolo onsewa anali osagwira ntchito. Abambo ake anali ndi chizolowezi chomwa mowa osaphunzitsidwa ndipo mayi ake analibe zikhalidwe zam'mbuyomu. Banjali lidatsatiridwa ndi ntchito zothandizira anthu kuyambira B anali 30.

Mimba ya wodwalayo inali yovuta chifukwa cha matenda osokoneza bongo komanso kumwa mwa apo ndi apo kwa amayi. B anabadwa asanakwane kumasabata a 35 masabata. Anachedwa kuyambiranso (mawu oyamba zaka 2) komanso zovuta zamagalimoto. Atalowa kalasi yoyamba, zinkamuvuta kuti amvetse malangizo a mawu komanso kuchita zochitika za graphomotor. Kugawika komanso kusokonezeka kwa malingaliro kunawonekeranso. Ali ndi zaka 6, mayeso a Wechsler Preschool ndi Primary Scale of Intelligence (WPPSI-III) adapeza ntchito yopanga modabwitsa m'malo osiyanasiyana (Verbal IQ = 100, Performance IQ = 75). Ali ndi zaka 7, wodwalayo adawerengedwa ku banja losamalira makolo omwe ali ndi ana okhazikika kumalo ophunzitsira kwa achinyamata omwe ali ndi mavuto azikhalidwe. Kuwongolera pakulamulira kwamalingaliro kunadziwika.

Ali ndi zaka 13, B adakumana ndi zovuta zingapo pamoyo (kumangidwa kwa mchimwene wake wamwamuna, adasiya chisamaliro kuti abwerere kwawo, ndikusintha timu yoyenda nawo). Anayamba kuzunza anzawo komanso akulu omwe amakwiya tsiku lililonse. Mankhwala osiyanasiyana adayesedwa popanda kusintha kapena pang'ono: tiapridum (m'badwo woyamba antipsychotic) mpaka 15 mg / tsiku, carbamazepine mpaka 200 mg / tsiku, risperidone pang'onopang'ono idakwera mpaka 4 mg / tsiku. B adasiyidwa m'malo ake ophunzitsira atakwiya ndi membala wazamaphunziro. Kuyambira pamenepo, wodwalayo amakhala kunyumba tsiku lonse. Anawafotokozeranso kuti samakwiya kwambiri chifukwa cha kupsa mtima kosalekeza. Adawakwiyira komanso kuwakwiyira makolo ake pomukhumudwitsa ndipo adayesa kukakamiza mnansi pambuyo pa chiletso. Munthawi imeneyi, B adasamalira zokonda zake machitidwe ake, mwachitsanzo, kusamalira nyama kapena kuphika.

Anawonjezera nthawi pakompyuta yake atachotsedwa sukulu. Amakonda kusewera Masewera Ochita Masewero ndi Masewera a Munthu Woyamba Kuwombera, ndi zochitika zachiwawa. Masewera osewerera tsiku lililonse amatenga 2-6 h, nthawi zina usiku. Amatha kuwonera makanema apaintaneti maola angapo, zojambula zamwana kapena makanema achiwawa. B ankamwa tsiku ndi tsiku nthawi zambiri amakhala ndi kapu imodzi ya vinyo kapena chidebe cha mowa chomwa mowa mwauchidakwa pafupifupi mwezi uliwonse (mwachitsanzo, 10 g ya mowa tsiku lililonse kapena mayunitsi 8.75 pa sabata pafupifupi). Anafotokoza kuti mowa ndi njira yothetsera "bata". Zachidziwikire, wodwalayo anali wotsutsa kwambiri vuto lakumwa kwa abambo ake, kudzudzula kulephera kwa abambo ake ataledzera kuti amusamalire. Amakhalanso ndi chizolowezi chogwiritsa ntchito mankhwala osokoneza bongo (amasuta cholowa chimodzi miyezi iwiri iliyonse).

Kuzindikira Kwamzeru ndi Psychopathological

Pakufunsidwa payekha, B anali wodekha. Adafotokozanso zakudedwa, kupitiriza kupsa mtima komanso kukwiya ndi okalamba ("nkhawa, manyazi ndi mkwiyo nthawi yomweyo"). Adanenanso kuti adakumana ndi ziwopsezo zankhanza kunyumba komanso nthawi zambiri amayenera kusamalira abambo ake oledzera. Padziko lonse lapansi, adalongosola mkhalidwe wakunyalanyaza kwakuthupi ndi kwamalingaliro kunyumba. B adawonetsa nkhawa pazotsatira za machitidwe ake komanso tsogolo lake (akufuna kukhala wophika). Amawopa "kukwiya nthawi zonse" atatuluka m'chipatala kapena mavuto ngati omwewo angadzabwererenso ndi mchimwene wake wachinyamata. Kugona ndi kusilira zimasungidwa.

Mchipindacho anali kucheza ndi achinyamata ena ochepa. Amakhala wovuta kwambiri kuchita nawo masewera olimbitsa thupi ndipo nthawi zambiri ankakanidwa ndi gulu akamasewera masewera a bolodi. Amamasuka ndi odwala ang'onoang'ono omwe ankakonda nawo nyama. Pomwe adakhala ndi nkhawa, wodwalayo adafunafuna chithandizo kuchokera kwa achikulire omwe ali ndi machitidwe owopseza kapena owopseza. Amatha kugunda khoma, pawindo, kapenanso pa mipando yopanda tanthauzo.

Kuunika kwa Psychomotor kunawonetsa umboni wa chitukuko cholumikizira matenda (F82) (): mayeso a magalimoto ambiri ndi magwirizano anali pa 0.1 percentile, mayeso ophatikiza mayeso a visuomotor anali ochepa kwambiri, ndipo anali ndi kupatuka koyambira kwa −7 kwa luso lolemba ( Gulu 1 ). Kuyesedwa kwa chilankhulo kunawonetsa umboni wa dyslexia yayikulu (Kuwerenga kwa Matenda, F315.0) yokhala ndi kuthekera kwazofoka m'malankhulidwe apakamwa koma kusakwanira kwambiri kuwerenga ( Gulu 2 ). Kuzindikira kwa kusokonezeka kwa vuto la kusokonekera kwa misala (F34.8) muubwana wokhala ndi zovuta zophunzira zingapo (chitukuko cha mgwirizano, dyslexia, dysgraphia) adakhazikitsidwa ndikufotokozera wodwalayo ndi makolo ake.

Gulu 1

Kuyesa kwa Psychomotor kochitidwa ndi B.

ntchitoNyimbo
Luso Lamagetsi Ofika Ponseponse: M-ABC-2
 Chiwerengero chazomwe zili pamanja14 (1st % ile)
 Malingaliro ochepa a mpira14 (16th % ile)
 Makhalidwe osakhazikika okhazikika9 (0.1st % ile)
 Malipiro onse37 (0.1st % ile)
Gnosopraxis: EMG
 Kusuntha kwa manja kutsanzira7.5 / 10 (−2.98 SD)
 Zala zonyamula kutsanzira3 / 16 (+ 0.42 SD)
Chithunzi cha Thupi
 Mayeso a GHDTDA = zaka 7.25
 Mayeso a Berges somatognosiaKupambana
Kuwona kopenya ndi luso la kuphatikiza ma mota: DTPV-2
 Magalimoto ochepetsa kuzindikira36 (32nd % ile)
 Kuphatikizika kwamaso owonera27 (27th % ile)
Zojambula
 BHK-ado37 (−7 SD)
 Kuyesa kwama motor-benderDA = zaka 6.0
Ntchito zamaguluu
 Ntchito yoyang'anira zamagalimoto (Soubiran)Zalephera
 Ntchito yowonera-zowonera (Soubiran)Zalephera
 Kujambula (Stambak)Zalephera

DA, zaka zachitukuko; SD, kupatuka koyenera; M-ABC, Battery Assessment Battery ya Ana; EMG, Evaluation de la Motricité Gnosopraxique; GHDT, Goodenough-Harris Kuyesa Kuyesa; DTPV-2, Kukula kwa kuyeserera kwa Visual Perception 2nd kope; BHK-ado, Bender test, Bender Visual-motor Gestalt Test.

Gulu 2

Kuyesa kwamalingaliro, pakamwa, ndi kulemba kolemba komwe kumachitika ndi B.

ntchitoNyimbo
Mlingo wanzeru wa Wechsler wa ana-IV
 Ndemanga yakumvetsetsa kwamawu
 Mndandanda wazolingalira
 Ntchito index kukumbukira
 Kusanthula liwiro la liwiro
Phonology
 Kubwereza monosyllabic (EDA)DA = zaka 6
 Kuletsa fonimu yomaliza (EDA)DA = zaka 9
Semantic
 Phwando lovomerezeka (EDA)DA = zaka 9
 Chithunzi chodziwika (EVIP)DA = zaka 13
 Chipembedzo cha zithunzi (EDA)DA = zaka 9
 Kutanthauzira kwamalingaliro (DEN 48)- 1.9 SD poyerekeza ndi 8th gawo la kalasi
Morphosyntax
 Kumvetsetsa kwa syntax (EDA)DA = zaka 9
 Kutsiriza sentensi (EDA)DA = zaka 9
kuwerenga
 Kuwerenga mawu mu 1 min (LUM)- 1.6 SD poyerekeza ndi 2nd gawo la kalasi
 Kuwerenga lembaDA = zaka 6
kulemba
 Chithunzi (L2MA2)- 1 ET poyerekeza ndi 6th gawo la kalasi
 Kusindikiza kwamalembaDA = zaka 6

EDA, Examen des Dyslexies Acquises; EVIP, Échelle de vocabulaire en images Peabody; DEN 48, Epreuve de dénomination pour enfants; LUM, Lecture en Une Minute; L2MA2, chilankhulo, chilankhulo, kukumbukira, chidwi.

Zochita Zachithandizo, Kutsatira, ndi Zotsatira

Mankhwalawa ndi carbamazepine anathetsedwa ndipo risperidone idachepetsedwa mpaka 2 mg / tsiku, mlingo womwe umagwiritsidwa ntchito kwambiri mwa achinyamata omwe ali ndi makhalidwe osokoneza (). Benzodiazepine, diazepam, adawonjezedwa chifukwa cha nkhawa. Wodwalayo adayambitsanso kukonzanso kwa psychomotor muutumiki (kupumula kwamagulu a sabata ndi magawo amtundu). Kufunika kwa chithandizo champhamvu cholozera anafotokozera makolo. Kuphatikiza ndi ntchito zothandizirana ndi anthu kunali kofunikira kwambiri kuchipatala. Anamuperekeza ku khothi la achinyamata komwe chigamulo chinakhazikitsidwa. Sabata yathayi yakuchipatala, adayendera malo okhala.

Kusintha kwakukulu kwa kachipatala kunawonedwa panthawi yakuchipatala ndikuchepa kwa zovuta zamakhalidwe. Pakutulutsa, B sanatchulenso njira zodziwunzira za IGD, ndipo palibe kuchitapo kanthu kwakofunikira. Pambuyo pa miyezi isanu ndi umodzi, B sinathenso kuwonetsa kukhumudwa kapena kuthandizira.

Kugwirizana Kwachithandizo

Chitanipo Pakati Pazosokoneza Zochita ndi Masewera Olakwika

Tapeza mu vignette iyi ubale pakati pamakhalidwe osokoneza bongo ndikugwiritsa ntchito molakwika masewera olingana ndi zolemba zomwe zikupezeka mu achinyamata., , , , ). Kafukufuku waku Spain adawonetsa kuti kuvulaza komwe kumapangitsa matenda kukhala njira yodziwika kwambiri yomwe imapezeka ndi IGD pamavuto azachipatala (). Zikuwoneka kuti IGD imalumikizidwa ndi mitundu yolimbirana komanso yolimbikitsa (yolimbikitsa) ya achinyamata. Wartberg et al. () adazindikira kuti pagulu lalikulu la achinyamata, omwe amadzinenera okha IGD anali okonda kuthana ndi mavuto, machitidwe osagwirizana, komanso kaganizidwe ka SDQ, pakuwunikiridwa.

Kuphatikiza Kwazovuta, Emysional Dysregulation, and Impulsivity

Malongosoledwe a njira yokhazikika ya wodwala B yothana ndi zopsinjika zam'malingaliro kuyambira ali mwana anali osokoneza kwambiri vuto loletsa nkhawa (lomwe limatchulidwanso kuti limagwirizana). Ana omwe ali ndi nkhawa yokhala ndi nkhawa yokhala ndi vuto lodzikakamiza amawonetsa kuvutika kwambiri podzipatula ndipo amakhala ndi chidwi chachikulu pakamabwera wowasamalira (). Muubwana wapakati, ana otere amatha kukhala ndi "kuwongolera" machitidwe (mwachitsanzo, obwezeretsanso) pa owasamalira. Kuwonetsera mkwiyo kapena kusathandiza kwa wowasamalira pa kugwirizananso kwaonedwa ngati njira yokhayo yopezera chisamaliro pothandizira posamalira mwachidwiyo ().

Kusalephera kolosera kwa mayankho a wowasamalira, monga wopezeka m'mabanja la B, sikunalole ana kukulitsa chiyembekezo chodalirika pamakhalidwe a akulu. Zotsatira zake, ana awa sanakhale ndi chiyembekezo chodalira kuthekera kwawo kutanthauzira chikhalidwe chawo: ali ndi zovuta zambiri, kuyembekezera molondola komanso kumasulira zomwe zimawakhudza (mwachitsanzo, nkhope) ndikumvetsetsa kwawo malingaliro ().

Mfundo yakuti ana awa akhazikika mu dziko losakhazikika kwa iwo ndipo sakhala ndi zovuta kuti akhale "ofanana" ndi momwe ena amakhudzidwira mtima akufotokozera zovuta zomwe zingakhale ndi njira zabwino zowongolera momwe akumvera komanso zovuta zambiri zokhudzana ndi chikhalidwe (mwachitsanzo, machitidwe otsutsana, kulekerera bwino kukhumudwitsa, mkwiyo, kupsa mtima, kukanidwa ndi anzanga) (, ).

Mlingo wotsika kwambiri wamalingaliro okhudzidwa muubwana ndi chiopsezo chachikulu cha zovuta zamakhalidwe kwa achinyamata, kuphatikizapo GD ndi zovuta zokhudzana ndi intaneti (, , , ). Achinyamata omwe ali ndi vuto kuwongolera zakukhosi kwawo amatha kuchita izi mobwerezabwereza kupewa kapena kuwongolera malingaliro ndi malingaliro osalimbikitsa kapena kupititsa patsogolo malingaliro abwino (). Mu zokambiranazi, tikufotokozera momwe njira zosavomerezeka zazomvera zimatha kuyimira zovuta zomwe zimagawidwa palimodzi komanso oyimira pakati pa ubale pakati pa psychopathology ndi kugwiritsidwa ntchito molakwika kwa wodwala.

Kukambirana

Njira Yapakatikati Yogwiritsa Ntchito Masewera Olakwika

Tikupezeka Chithunzi 1 kuona kwathunthu ubale womwe ulipo pakati pa chiwopsezo ndikusunga zomwe zimagwiritsidwa ntchito molakwika pakusewera kwa vidiyo A. Tikuwonetsa kuti a) chizolowezi chopewera kusakhazikika ngati khanda, b) Zizindikiro zakukhazikika paubwana, komanso c) kuvutika maganizo kosalekeza paubwana woyambirira anali mawonekedwe apadera a njira yodziwika yotukuka yovomerezeka ndi nkhawa / zovuta zamavuto. Potengera kuthekera kwawina ndi malo osinthika bwino, wodwala wathu adatha kugwiritsa ntchito njira zoyenera zothetsera mavuto aumwana. Paunyamata, zochitika zovuta za m'mabanja (kutayika kwa chithandizo cha abambo, kukhumudwa kwa amayi) komanso zovuta zomwe zimakhalapo ndi zibwenzi zimapangitsa kuti asavutike kutengera gulu la anzawo kuti apangire chikhalidwe chodziwika bwino komanso chinsinsi.

Fayilo yakunja yomwe ili ndi chithunzi, fanizo, etc. dzina la chinthu ndi fpsyt-10-00336-g001.jpg

Njira yotsogola yomwe imatsogolera pakugwiritsa ntchito kwambiri masewera a odwala A.

Masewera atha kuonedwa ngati njira yolakwika yolumikizirana kuti tipewe kuyanjana ndi anthu kuti tiwone ngati owopsa kapena osatsimikizika, pomwe wodwala wathu akukonda kukhutira kwamasewera ngati njira ina yolumikizirana. Pojambula Zithunzi (), masewera a masewera "monga chopinga komanso cholowa mmalo mwa maubale. ”Kenako, masewera amasewera ambiri komanso zotsatila zake zimapangitsa kuti asamadzikayikire komanso azikhala wokhumudwa. Kuphatikiza kwa ziyembekezo zabwino zokhudzana ndi masewera komanso kupewa / kukhudzika mtima pakukonzekera IGD zikuwoneka kuti zikuwoneka munkhaniyi monga zasonyezedwera mwa akulu ().

Njira Yapadera Yogwiritsa Ntchito Masewera Olakwika

Tikupezeka Chithunzi 2 njira yokhazikika yotsogola yomwe imatsogolera ku kugwiritsa ntchito molakwika masewera. Tidawerengera kuti a) zovuta za kusukulu, makamaka pamlingo wamavuto ophunzirira, komanso b) Mavuto azachilengedwe, kuphatikizapo kuperewera kwa thandizo la makolo ndi kuyang'aniridwa ndi makolo, zinali zofunika kwambiri kuwongolera ziwopsezo zomwe zimachitika kunja ndikugwiritsa ntchito molakwika masewera. Ngakhale zovuta zakuzindikira monga kuchepetsedwa kwa ntchito yayikulu zakhala zikuchitika kuyambira zaka zam'mbuyo pasukulu yamaphunziro, zovuta zake malinga ndi kuthekera kwachuma zimatha kukulirakulira ndi ukalamba pamalingaliro owonjezereka a chiyembekezo cha anthu ndi maphunziro. Mokulira ndikuti zovuta zomwe zimachitika mu kuzindikira ndi kuyendetsa galimoto mosachedwa kulipira zimabweretsa zovuta zambiri (mwachitsanzo, kusukulu, kubanja) zomwe zidapangitsa kuti wodwalayo azikhala ndi nkhawa, azikhumudwitsidwa, komanso asakwiye "). M'mabuku akuluakuluwa mavutowa amawoneka kuti amathandizidwa ndi zinthu zoyambirira nthawi yopuma () ndi ntchito yochedwetsa ().

Fayilo yakunja yomwe ili ndi chithunzi, fanizo, etc. dzina la chinthu ndi fpsyt-10-00336-g002.jpg

Njira yotsogola yomwe imatsogolera pakugwiritsa ntchito kwambiri masewera kwa wodwala B.

Zinthu zoyambilira zaku chilengedwe kapena zamtundu zomwe zimakhudza kusintha kwamitsempha komanso chizindikiritso zimatha kuchita zambiri pakubwera kwa psychopathology ndi kusewera masewera olimbitsa thupi mwamavuto. Poyamba, zinthu zokhudzana ndi chibadwa zimatha kunenedwa kuti abambo a B adapezeka kuti ali ndi vuto la kugwiritsa ntchito mowa komanso kuchuluka kwa zinthu zomwe zimachitika chifukwa cha zosokoneza bongo komanso zokhudzana ndi zosokoneza bongo (). Kachiwiri, kutsegulira zakumwa za fetal kumatha kusokoneza dongosolo la B lomwe limayambitsa matenda oyamba kwambiri omwe amachititsa kuti azitha kuzindikira zinthu zomwe zimapangitsa kuti azitha kuzindikira. Chachitatu, zokumana nazo zoyambilira komanso kunyalanyaza zimathandizanso kuti ziwonongetse kusuntha kwa minyewa ndi luso la kuzindikira ().

Munkhani iyi, titha kunena kuti kufunafuna kwa B kwa chisangalalo chaposachedwa kudzera pamasewera kungakhale chifukwa cha njira zoyeserera zokhazokha munjira yomwe njira zina zodzigwiritsira ntchito mwanjira zodziletsa (mwachitsanzo, kuyang'anira, kufunafuna chithandizo) osakwanira. Kugwiritsa ntchito malingaliro am'maganizo, machitidwe a masewera amatha kuwonedwa ngati cholowa m'malo ena achisangalalo panthawi ino pachinthu (mwachitsanzo, ubale wosauka ndi ubale) komanso wothandizirana ndi zosakwanira kusachita bwino maphunziro kapena maphunziro) (, ). Kuchepetsa kwa omwe amagwirizira a B pamasewera kungafotokozeredwe ndi kufunika koletsa zomwe zingapangitse chisangalalo / kusakondweretsa pazochepa zake komanso potengera zinthu zina m'deralo. Malamulo a masewerawa akuvomerezeka mwina amamveka bwino kwa B ndikuwoneka kuti ndi "abwino" kuposa malamulo akunja.

Zotsatira Za Kliniki Ndi Kafukufuku

A zovuta kuvomereza momwe akumvera komanso kufotokoza malingaliro osemphana ndi chisamaliro, chizolowezi kwa achinyamata omwe ali ndi vuto lolumikizana, zosokoneza ubale wamankhwala ndi njira yomatira). Kulimbitsa kotsika kofunikira komanso kufunitsitsa kusintha kumawoneka ngati zifukwa zazikulu zakulephera kwa psychotherapy kwa achinyamata omwe ali ndi IGD (, ). Ma psychotherapies omwe ali ndi malangizo othandiza amakhala achidwi kwambiri kwa achinyamata omwe ali ndi IGD monga psychotherapy yothandizidwa ndi,, psychotherapy yochokera m'maganizo (), ndi zojambula zamakhalidwe olimbitsa thupi (). Njira zoterezi zimalimbikitsa kuzindikira kwa mtima ndi malingaliro a munthu (mwachitsanzo, kwa A) kapena kukhala ndi chiyembekezo cha ubale (mwachitsanzo, kwa B) zomwe zimathandizira kutchulika kowonjezereka kwa zosokoneza zomwe zimachitika kawiri kawiri ().

Kodi ntchito yakugonekedwa m'chipatala ndi yotani? Kupatukana ndi gawo lomwe amakhala nalo nthawi zonse kunamuthandiza kusiya chizolowezi chomakonda kusewera, koma kuyambiranso kunachitika patangodutsa nthawi yayitali kuchipatala. Kugwiritsira ntchito kuchipatala kwa achinyamata omwe ali ndi vuto laukali si mwayi woletsa zachiwerewere komanso kupititsa patsogolo chidziwitso cha wachinyamata ndi banja lake zokhudzana ndi zomwe zimapangitsa kuti asasunge chiopsezo cha mkati ndi kunja.). Monga tawonera apa, nkhani yolumikizira nthawi zambiri imalumikizidwa ndi zinthu za banja za IGD zomwe zingayenerere kulowererapo: kukhumudwa kwa makolo (), nkhawa za makolo (,, osauka othandizira achibale (), kapena kulumikizidwa motetezedwa ndi makolo (, ).

Ena anena kuti zovuta za m'mabanja zimatha kukhala ndi gawo lopangitsa kuti IGD ibwere mwa achinyamata. Achinyamata omwe ali ndi vuto laintaneti sanasangalale ndi mabanja awo ndipo amawona kuti makolo awo samawathandiza kwenikweni komanso amawakonda ndikawayerekezera ndi achinyamata omwe alibe vuto lililonse pa intaneti (). Xu et al. () yopezeka mwachitsanzo cha achinyamata a 5,122 kuti maubwenzi ndi kulumikizana kwaubwana zimayenderana kwambiri ndi kukula kwa chizolowezi cha achinyamata cha pa intaneti. Kwa Lam (), Kugwiritsidwa ntchito molakwika pa intaneti kumatha kuwoneka ngati kuyesa kubwezera kulumikizana kwazovuta ndi kholo limodzi, makamaka ngati kholo la psychopathology la makolo. Pankhani yonyalanyaza kwambiri kwamalingaliro, monga banja la B, kusewera makanema kumawoneka ngati gawo limodzi lokhalo losangalatsa komanso lodziwikiratu la chisangalalo m'banja momwe akuluakulu sanachitepo kanthu komanso kupezeka kwa ana awo.

Pomaliza, monga zikuwonetsera pazochitika ziwiri zam'chipatala izi, kuwunika mozama za chilengedwe ndi mbiri yachitukuko ndikofunikira kwambiri kuti tipeze zovuta zomwe zimapangitsa kuti psychopathology ya wodwala ikhale / komanso njira zoyipa zamavuto. Achinyamata omwe ali ndi zovuta zophunzirira zingapo amatha kuimira anthu omwe ali pachiwopsezo chachikulu cha IGD poganizira zomwe zimapangitsa kuti masewera asamagwiritse ntchito molakwika, mwachitsanzo, kulephera kwamaphunziro, kuthekera pamalingaliro okhudzana ndi chikhalidwe, komanso kuchedwa pantchito yayikulu.

Kutsiliza

Timalimbikitsa kufunikira kulingalira njira zakukhazikika zomwe zimayambitsa mgwirizano pakati pa psychopathology ndi / kapena kugwiritsidwa ntchito molakwika kwa achinyamata omwe ali ndi IGD. Njira "yokhazikitsidwa mkati" komanso "yodziwika" yakumagwiritsidwe ntchito molakwika kudzera kuyambika kwa kusiyana, koma kwinaku kukuwonekera, kusokonezeka kwa zamaganizidwe ndi zinthu zachilengedwe kwatchulidwa Zizindikiro 1 ndi 2 . Masewera olimbitsa thupi amatha kuwoneka ngati njira zenizeni zakudziwongolera mokha mwa achinyamata omwe ali ndi vuto lodziphatikiza. Kuganizira zina zomwe zili pachiwopsezo, monga mawonekedwe osatetezeka komanso kukomoka kwa mtima, zitha kuimira mwayi wofunika kwa achinyamata omwe ali ndi vuto lakawiri.

Zopereka za Wolemba

XB ndi DC adathandizira kwambiri pakumanga ndi kupanga ntchitoyo. XB, PM, CI, ndi HM adathandizira kwambiri kupeza, kusanthula, kapena kumasulira kwa deta. XB idalemba ntchitoyi kapena kuisinthanso mozama kuti ikhale yanzeru. XB, PM, YE, DC, CI, ndi HM adapereka chilolezo chotsiriza kuti mtunduwo udalitsidwe. XB, PM, YE, DC, CI, ndi HM adavomereza kuyankha mlandu pazinthu zonse za ntchitoyi pakuonetsetsa kuti mafunso okhudzana ndi kulondola kapena kukhulupirika kwa gawo lililonse la ntchitoyi amafufuzidwa ndikuyankhidwa.

ndalama

Tili othokoza ndi mtima wonse mabungwe omwe athandizira pa ntchitoyi. MILDECA), ndi l'Observatoire National des Jeux (ODJ) ("IReSP-15-Prevention-11").

Kutsutsana kwa Chidwi

Kafukufukuyu adachitidwa posakhala ndi ubale wina uliwonse wamalonda kapena ndalama womwe ungatchulidwe ngati kusamvana kwa chidwi.

Zothandizira

1. Association of Psychiatric Association Buku lodziŵitsa komanso lowerengera la matenda a m'maganizo. 5th kope. American Psychiatric Association; (2013). 10.1176 / appi.books.9780890425596 [CrossRef] []
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