Psychiatry Yamakono, February 2018 wolemba Jon E. Grant, JD, MD, MPH, Pulofesa - department of Psychiatry and Behaeveal Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
Khalidwe lachiwerewere lachiwerewere (CSB), lomwe limatchedwanso kugonana kapena kugonana kwachiwerewere, limadziwika mobwerezabwereza ndi kuganizira kwambiri za kugonana, zofuna, ndi makhalidwe omwe akumuvutitsa munthuyo kapena / kapena chifukwa cha kuwonongeka kwa maganizo. Anthu omwe ali ndi CSB amazindikira kuti khalidwe lawo la kugonana limakhala lovuta koma sangathe kuliletsa. CSB ingaphatikizepo malingaliro ndi zolimbikitsanso kuwonjezera kapena m'malo mwa khalidwe koma ziyenera kuchititsa kuti pakhale mavuto aakulu ndi zosokoneza pamoyo wa tsiku ndi tsiku kuti akhale odwala.
Chifukwa cha kusowa kwa maphunziro akuluakulu a anthu okhudzidwa ndi matenda a Edzi omwe akuyang'ana CSB, kufalikira kwake pakati pa akuluakulu sikudziwika. Kafukufuku wa odwala matenda a 204 a matenda a mthupi anapeza kufalikira kwa 4.4%,1 pamene kafukufuku wakuyunivesite akuwonetsa kuchuluka kwa CSB pa pafupifupi 2%.2 Ena akuganiza kuti kufalikira kuli pakati pa 3% mpaka 6% ya anthu akuluakulu ku United States,3,4 ndi amuna omwe ali ochuluka (≥80%) a anthu okhudzidwa.5
CSB kawirikawiri imakula kumapeto kwa zaka zaunyamata / akuluakulu, ndipo ambiri omwe amapereka chithandizo ndi amuna.5 Mafotokozedwe akuti, kuphatikizapo kuvutika maganizo, chimwemwe, ndi kusungulumwa, kungayambitse CSB.6 Anthu ambiri amafotokoza kuti amasokonezeka pamene akuchita zokhudzana ndi makhalidwe a CSB, pamene ena amanena kuti ndi ofunika, amphamvu, okondwa, kapena okondweretsedwa.
Chifukwa chiyani CSB ndivuta kuidziwa
Ngakhale kuti CSB ingakhale yofala, nthawi zambiri imakhala yopanda kufufuza. Kawirikawiri khalidwe ili lovuta kwambiri silipezeka chifukwa cha:
- Manyazi ndi chinsinsi. Kunyada ndi manyazi, zomwe ndizofunikira kwa CSB, zikuwoneka kuti zikufotokozera, mwazigawo, chifukwa chake odwala ochepa amadzipereka zokhudzana ndi khalidweli pokhapokha atapemphedwa.1
- Wodwala wopanda nzeru. Odwala nthawi zambiri sadziwa kuti khalidwe lawo likhoza kuchiritsidwa bwino.
- Wachipatala alibe nzeru. Ochepa odziwa zaumoyo ali ndi maphunziro kapena maphunziro ku CSB. Kusamvetsetsa kwa CSB kungakhale chifukwa cha kumvetsetsa kwathu kochepa ponena za malire a chikhalidwe chogonana. Kuphatikiza apo, mndandanda wa CSB ndi wosadziwika komanso wosagwirizana (Bokosi7-9), komanso chiweruzo cha makhalidwe abwino nthawi zambiri chimakhudzidwa kumvetsetsa khalidwe la kugonana.10
Kuwonetsa khalidwe lochita zachiwerewere
[Bokosi] Malingaliro osiyanasiyana aperekedwa kuti awononge khalidwe lachiwerewere (CSB). Zingakhale zokhudzana ndi matenda osokoneza bongo (OCD), kupanga "zovuta zowonongeka;" kuvutika maganizo ("matenda osokoneza maganizo")7,8; kapena ngati chizindikiro cha mavuto a ubale, chibwenzi, ndi kudzidalira. Kugwirizanitsa CSB mkati mwa zovuta zowonongeka kapena zosangalatsa zimachokera ku zizindikiro zofanana, zovuta, mbiri ya banja, ndi mayankho a mankhwala. Mofananamo ndi anthu omwe ali ndi OCD, odwala CSB amapereka malingaliro obwerezabwereza ndi makhalidwe. Mosiyana ndi OCD, khalidwe la chiwerewere la CSB ndi lokondweretsa ndipo nthawi zambiri limayendetsedwa ndi zilakolako kapena zolimbikitsa. Chifukwa cha izi, CSB ikhonza kugawana nawo zinthu zovuta kugwiritsira ntchito mankhwala, ndipo yachititsa kuti chikhalidwe cha chiwerewere chikhale choledzeretsa. Palinso kutsutsana kwakukulu pa momwe mungamvetsetse gululi la zizindikiro ndi makhalidwe - monga matenda osiyana kapena ngati chizindikiro cha vuto lalikulu. DSM-5 sanapeze chifukwa chokwanira chosonyeza kugonana monga matenda a maganizo.9
Palibe mgwirizano pa zofunikira zogonana
Kuzindikira molondola kuti CSB ndi yovuta chifukwa cha kusagwirizana pankhani ya matenda a matendawa. Christenson et al11 adayambitsa zofunikira za CSB monga gawo lalikulu la kafukufuku wokhudzana ndi kusokoneza maganizo. Anagwiritsira ntchito zizindikiro zotsatirazi za 2 kuti azindikire CSB: (1) machitidwe ogonana kapena osagwirizana ndi kugonana kapena zofuna zogonana / zofuna kugonana, ndipo (2) makhalidwe amenewa kapena maganizo / zolimbikitsa zimabweretsa mavuto aakulu, chikhalidwe cha anthu kapena ntchito , kapena zotsatira za malamulo ndi zachuma.11,12
Pa DSM-5 ndondomeko yowonetseratu, njira yachiwiri yothetsera vutoli inakonzedwanso ku matenda a hypersexual. Pogwiritsa ntchito njira zogonana zokhudzana ndi kugonana, munthu angakumane ndi matendawa ngati ≥3 ya zotsatirazi inavomerezedwa pa nthawi ya mwezi wa 6: (a) nthawi yowonongeka ndi kugonana, zolimbikitsa, kapena khalidwe limasokoneza mobwerezabwereza zina (osati zachiwerewere ) zolinga, ntchito, ndi maudindo; (b) kubwereza kugonana mobwerezabwereza, kuchenjeza, kapena kukhala ndi makhalidwe poyankha zovuta zowonongeka; (c) kubwereza kugonana mobwerezabwereza, kudandaula, kapena makhalidwe pokana zovuta zamoyo; (d) kubwerezabwereza koma kusayesa kuthetsa kapena kuchepetsa kwambiri malingaliro ogonana, zolimbikitsa, kapena makhalidwe; ndi (e) kuchita mobwerezabwereza zizolowezi zogonana ndikunyalanyaza chiopsezo cha kuvulaza thupi kapena kwa ena.9
Ma 2 awa omwe amayankha kuti athe kupeza matendawa ndi ofanana. Zonsezi zikusonyeza kuti zifukwa zazikuluzikulu zimakhudzana ndi zilakolako za kugonana kapena makhalidwe omwe ali ovuta kuwongolera ndi omwe amachititsa kusokonekera kwa maganizo. Kusiyanasiyana kwa zofunikira, komabe, kungapangitse mitengo yosiyanasiyana ya matenda a CSB; Choncho, kafufuzidwe kafukufuku adzafunikanso kudziwa njira yowunikira yomwe ikuwonetsa matenda a neurobiology omwe ali pansi pa CSB.
Pewani kusokoneza maganizo
Musanayambe kudziwa za CSB, ndizofunikira kuti madokotala aziganizira ngati akunyansidwa ndi "zotsatirapo zoipa," kuvutika, kapena kuwonongeka kwa chikhalidwe chifukwa chonyalanyaza khalidwe linalake la kugonana. Kuwonjezera apo, tikuyenera kuonetsetsa kuti sitikugonana ndi miyezo yosiyana ndi makhalidwe ena (mwachitsanzo, pali zinthu zambiri zomwe timachita zomwe zimabweretsa zotsatira zoipa koma samapanga matenda a maganizo, monga kulowerera zochepa zosankha za zakudya). Kuwonjezera pamenepo, makhalidwe okhudzana ndi kugonana angagwirizane ndi ndondomeko yobwera kwa LGBTQ, mavuto a chiyanjano, kapena chiwerewere. Choncho, khalidweli liyenera kuyesedwa mmalo mwazifukwa za chilengedwe.
Kusiyanitsa mitundu
Matenda osiyanasiyana a matenda a maganizo angaphatikizepo khalidwe logonana mochuluka ngati mbali ya zochitika zawo zachipatala, ndipo ndikofunikira kusiyanitsa khalidweli ndi CSB.
Matenda a bipolar. Kugonana kwakukulu kungayambitse ngati gawo lachidziwitso cha matenda ochititsa munthu kusinthasintha maganizo. Ngati vuto lachiwerewere limayambanso pamene munthu ali wokhazikika, munthuyo akhoza kukhala ndi vuto la CSB ndi matenda a bipolar. Kusiyanitsa uku ndikofunikira chifukwa chithandizo cha matenda a maganizo ochititsa munthu kusinthasintha zochitika nthawi zambiri amakhala osiyana kwa CSB, chifukwa antiticvulants ali ndi zochitika zomwe zimatsimikizira ntchito yawo mu CSB.
Kugwiritsira ntchito mankhwala osokoneza bongo. Mchitidwe wogonana wochuluka ungathe kuchitika pamene munthu akugwiritsa ntchito mankhwala, makamaka zolimbikitsa monga cocaine ndi amphetamines.13 Ngati khalidwe lachiwerewere silichitika pamene munthuyo sakugwiritsa ntchito mankhwala osokoneza bongo, ndiye kuti matenda oyenera sangakhale CSB.
Matenda osokoneza maganizo (OCD). Anthu omwe ali ndi OCD nthawi zambiri amakhala okhudzidwa ndi nkhani za kugonana ndikuganiza kuti amaganiza zogonana kwambiri.14 Ngakhale odwala omwe ali ndi OCD angakhale okhudzidwa ndi maganizo a kugonana, kusiyana kwakukulu ndikuti anthu omwe ali ndi lipoti la CSB amasangalala ndi malingalirowa ndipo amapeza chisangalalo ndi khalidwe, pomwe zochitika za kugonana za OCD zimaonedwa zosasangalatsa.
Matenda ena zomwe zingayambitse khalidwe lachiwerewere limaphatikizapo matenda osokoneza bongo, vuto la kuchepa nkhawa / matenda osokoneza bongo, vuto la autism spectrum, ndi matenda opsinjika maganizo.
Zovuta za mankhwala. Ndikofunika kumufunsa wodwalayo ngati iye (a) anayamba CSB atayamba mankhwala. Mankhwala ena (mwachitsanzo, mankhwala a matenda a Parkinson kapena matenda osagwira mwendo, kapena aripiprazole kuti awononge matenda ovutika maganizo kapena psychosis) angachititse odwala kukhala ndi vuto logonana.15,16 Ngati khalidwe la kugonana limachepetsa kapena limasiya pamene mankhwala akucheperachepera kapena mankhwala atayimitsidwa, matenda a CSB sangakhale oyenera.
Kugonjetsedwa kuli wamba
Kafukufuku akusonyeza kuti pafupifupi theka la akuluakulu omwe ali ndi CSB amakumana ndi matenda osachepera a 1 ena a maganizo, monga maganizo, nkhawa, kugwiritsa ntchito mankhwala, kuthamanga, kapena kusokonezeka kwa umunthu. Kufufuza kwa amuna omwe ali ndi CSB (N = 103) kunapeza kuti 71% inakwaniritsa zofunikira za matenda a maganizo, 40% chifukwa cha matenda ovutika maganizo, 41% chifukwa cha matenda osokoneza bongo, ndi 24% chifukwa cha matenda osokoneza bongo monga vuto la juga.17 Choncho, kuti mutha kuchiza CSB, odwala amathandizanso kuti aganizire momwe angagwiritsire ntchito kugonana.
Mavuto omwe amapezeka nawo azachidwi amakhalanso ofala pakati pa anthu omwe ali ndi CSB. Mavuto azachipatala angaphatikizepo kutenga mimba zosafuna, matenda opatsirana pogonana, ndi HIV / AIDS. Choncho, kuchiza matenda okhudza maganizo ndi kupereka maphunziro okhudzana ndi kugonana, ndi kutumiza kwa akatswiri apadera, nthawi zambiri ndi mbali ya chithandizo cha CSB.
Kutsegula ndi kuzindikira
Kafukufuku wina yemwe anafanizira ophunzira ndi opanda CSB adapeza kuti ophunzira omwe ali ndi CSB anali ndi ntchito yopambana mu ventral striatum, anterior cingulate cortex, ndi amygdala yokhudzana ndi kayendetsedwe ka ntchito ya MRI.18 Zotsatirazi zikuwonetsa zofanana zofanana ndi zochitika zowonjezera zomwe zimawonedwa kwa odwala omwe amamwa mankhwala osokoneza bongo atagwiritsidwa ntchito pogwiritsa ntchito mankhwala osokoneza bongo. Kafukufuku wina wokhudzana ndi kugonana kwa azimayi omwe akugonana ndi kugonana pogonana pogwiritsa ntchito zojambula zowonongeka, adanena kuti kusiyana kwa chigawo choyera chapamwamba m'derali kunali kwakukulu kwa odwala omwe ali ndi CSB.18Kafukufukuyu adawonetsanso kuti panali kusiyana kolakwika pakati pa zofalitsa zomwe zimapezeka pamalo odziwika ndi chiwerengero chachikulu cha zizindikiro za CSB monga maulendo a zolimbikitsa kapena makhalidwe.
Pogwiritsa ntchito kuzindikira, kuyambanso kuyang'ana kwa achinyamata omwe ali ndi CSB poyerekeza ndi kulamulira bwino sikupeza kusiyana kulikonse pakati pa magulu osiyanasiyana ntchito, ngakhale kuti kusanthula kumeneku kunatchulidwa kosavuta kuganizira mu CSB.18
Njira zochizira
Anthu ambiri omwe ali ndi CSB sakufuna kuwatumiza kwa odwala awo, ndipo ambiri azimayi savutika kulankhula zakugonana ndi odwala awo, chifukwa cha kusowa maphunziro.19 Odwala ali ndi mwayi wokambirana nkhaniyi pamene akulandira chithandizo cha nkhawa, kuvutika maganizo, kapena kugwiritsa ntchito mankhwala osokoneza bongo. Choncho, odwala ayenera kulingalira kuti khalidwe la kugonana lingagwirizane ndi njira yothetsera vuto, zotsatira zowopsya, kapena chikhalidwe choipa mwa odwala awa.
Pharmacologic mankhwala
Umboni wa mankhwala a pharmacologic wa CSB uli ndi kafukufuku wochepa, wotsegula-ma label, mndandanda wa masewero, kapena zofufuza zowonjezereka, kupatula ku 1 kawiri-khungu, kafukufuku wolamuliridwa ndi placebo. Malinga ndi umboni umenewu, pakhoza kukhala njira zosiyanasiyana zamankhwala zothandizira odwala omwe ali ndi CSB; Komabe, palibe mankhwala ovomerezeka a FDA a CSB.
Mankhwala opatsirana pogonana. Chimodzi mwazinthu zolembedwa bwino kwambiri zamankhwala othandizira mankhwala a CSB ndizosankha serotonin reuptake inhibitors (SSRIs). Kafukufuku wowerengeka wowerengera komanso mndandanda wazomwe zanenedwa zakufunika kwa ma SSRIs pochepetsa zizindikiro za CSB.20-23 Citalopram, chithandizo chokha cha CSB chomwe chayesedwa pogwiritsa ntchito njira zamagwiridwe, zomwe zimagwiritsidwa ntchito pa malobo, zinagwirizanitsidwa ndi kuchepa kwakukulu kwa zizindikiro za CSB, kuphatikizapo chilakolako chogonana / kuyendetsa galimoto, chizoloŵezi cha maliseche, ndi zolaula zimagwiritsidwa ntchito.24
Kuphatikiza pa SSRIs, malipoti ena owonjezera amasonyeza kuti magulu ena a antidepressants, monga serotonin-norepinephrine inhibitors and tricyclic antidepressants, kapena zokopa zingakhale zopindulitsa mukamachitira CSB.25 Malipoti angapo amasonyeza kusintha kwakukulu kwa zizindikiro za CSB pogwiritsa ntchito clomipramine.22 Phunziro lapadera la nefazodone linanenanso kuti lingakhale njira yosamalira CSB. Odwala amavomereza kuti kuchepetsa chiopsezo cha chiwerewere / kukakamizidwa pamene akugwira nefazodone ndikumanena kuti palibe vuto lalikulu la kugonana.26 Chinthu chimodzi chotchedwa nefazodone, Serzone, chinkagwirizanitsidwa ndi mavuto osawoneka koma amphamvu a chiwindi ndipo anachotsedwa ku msika wa US ku 2004.
Ngakhale umboni wina woyambirira wonena za kugwiritsira ntchito mankhwala opatsirana pogonana, makamaka SSRIs, kuti uchite chithandizo cha CSB waganiza kuti mankhwalawa akhoza kukhala opindulitsa, zomwe zimawoneka sizingatheke, ndi zowonongeka zokhazokha za 1 ndi malipoti okhawo omwe amamwa mankhwalawa.
Naltrexone, wotsutsana ndi opioid, walandira chithandizo kuchokera ku milandu yomwe ilipo, maphunziro otukuka, ndi kufufuza mobwerezabwereza.17,27 Ngakhale umboni wa kugwiritsidwa ntchito kwa naltrexone mu CSB uli wongopeka ku malipoti ndi zochitika zowonjezera, zotsatira zakhala zabwino. Naltrexone yawonetseka imachepetsedwa mu mphamvu ya CSB pamene imagwiritsidwa ntchito ngati monotherapy komanso ikagwiritsidwa ntchito kuphatikizapo mankhwala ena.
Ma anticonvulsants. Malipoti angapo akuti ma anticonvulsants ena atha kukhala othandiza pochiza CSB. Topiramate ikhoza kukhala yothandiza kwambiri.28 Mankhwala ena amathandiza kuti CSB ikhale yopindulitsa ngati mayinawa ndi valproic acid, lamotrigine, ndi levetiracetam.18
Psychotherapy
Umboni wothandizira mitundu ina ya psychotherapy ya CSB ndi yochepa ndipo makamaka ikuchokera ku maphunziro osayendetsedwa ndi malipoti.
Chidziwitso chamakhalidwe (CBT) ndi imodzi mwanjira zomwe psychotherapy imathandizira CSB. Kafukufuku wosalamulirika ndi malipoti apadera apeza kuti CBT ndiyothandiza kwa CSB, ngakhale njira zake zasiyanasiyana.
Milandu ingapo yomwe inapeza kuti kuphatikiza CBT ndi zokambirana zokakamiza zinagwirizanitsidwa ndi kuchepetsa kwakukulu muzochitika zogonana, monga nthawi zambiri za kugonana ndi nthawi yambiri yogwiritsira ntchito Intaneti pa nthawi ya ntchito.29,30 Gulu la CBT lawonetsedwanso kukhala lothandiza kwa CSB.31
Kulandila ndi kudzipereka kuchipatala (ACT) walandila chithandizo choyambirira, ndi 1 kafukufuku wosalamulirika ndi kafukufuku wowongolera 1.32,33 Kuphunzira koyendetsa ntchito kumagwiritsa ntchito magawo a 12 a munthu ACT poyerekeza ndi mndandanda wa mndandanda wa zodikira.32Kusintha kwa zizindikiro za CSB kunasungidwa kwa miyezi 3. Zonsezi zowonongeka pa zolaula za pa Intaneti zikugwiritsidwa ntchito ngati 92% mwamsanga patha phunzirolo, ndipo 86% pambuyo pa miyezi 3.
Chithandizo chaukwati / ubale chakhala chikugwiritsidwa ntchito bwino munthawi zingapo komanso malipoti, ngakhale kuti palibe kafukufuku amene awunika momwe angagwiritsire ntchito CSB pogwiritsa ntchito njira zosasinthika. Mu lipoti la 1, wofufuzayo adapeza kuti kutenga nawo mbali pazochita zogonana pabanja kudapangitsa kuti zinthu ziziyenda bwino chaka chimodzi ndi magawo 1.34
pansi Line
Kafukufuku wamakono komanso kusowa kwazomwe zimakhazikitsidwa zingapangitse khalidwe lachiwerewere (CSB) kuti likhale lovuta kuti lidziwe bwino ndikulimbana. Umboni woyambirira umasonyeza kuti mankhwala ena opatsirana pogonana komanso matenda opatsirana pogonana angachepetse zizindikiro za CSB.
Zothandizira zokhudzana
Zidutswa PJ. Kuchokera mumthunzi: kumvetsetsa chiwerewere. 3rd ed. Center City, MN: Hazelden Publishing; 2001.
Drug Brand Names
Aripiprazole • Limbikitsani
Citalopram • Celexa
Clomipramine • Anafranil
Lamotrigine • Lamictal
Levetiracetam • Keppra
Naltrexone • Revia
Topiramate • Topamax
Valproic acid • Valproic
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