Kupanga zisankho mu Kutchova Juga, Zovuta Zolaula Gwiritsani Ntchito, ndi Binge-Eating Disorder: Zofanana ndi Kusiyana (2021)

Cholinga cha Kubwereza

Kuwunikaku pakadali pano kumayesera kupereka chiwonetsero chazonse chazovuta zamatenda amisala yotchova njuga (GD), kugwiritsa ntchito zolaula zovuta (PPU), ndi vuto la kudya kwambiri (BED), makamaka pazomwe zimachitika popanga zisankho.

Zotsatira Zatsopano

GD, PPU, ndi BED adalumikizidwa ndi zovuta zopanga zisankho zomwe zili pachiwopsezo komanso kusadziwika. Zinthu monga luntha, kutengeka mtima, kusiyanasiyana pakati pa anthu, kusokonekera kwazindikiritso, comorbidities, kapena kudzutsa kumatha kupanga njira zopangira zisankho mwa anthuwa.

Chidule

Zofooka pakupanga zisankho zimawoneka ngati gawo logawanika lazovuta izi. Komabe, pali othandizira osiyanasiyana pamlingo womwe mawonekedwe osiyanasiyana angakhudzire kupanga zisankho. Chifukwa chake, kafukufuku wopanga zisankho atha kupereka umboni wofunikira pakumvetsetsa zosokoneza bongo ndi zovuta zina zomwe zimakhala ndizizindikiro zosokoneza bongo.

Zizolowezi zakakhalidwe ndi mavuto akudya (EDs) ndizofunikira kwambiri pazokhudza thanzi la anthu padziko lonse lapansi [1]. Kuwonjezeka kwa mwayi wamtundu wa juga (ndikuloleza kutchova juga pa intaneti m'malo ambiri), kupezeka komanso kupezeka kwa zinthu zolaula, komanso kukhazikika kwa zizolowezi zodyera zomwe zimakhudzana kwambiri ndi moyo wongokhala komanso kupezeka kwa zakudya zopatsa thanzi kwambiri zakhudza mikhalidwe ndi zovuta zina (makamaka vuto la kutchova juga (GD) komanso kugwiritsa ntchito zolaula zovuta (PPU)) ndi ma ED (makamaka vuto la kudya kwambiri (BED)) [2,3,4].

Njira zodziwikiratu zomwe zimayambitsa zovuta zogwiritsa ntchito mankhwala osokoneza bongo (ma SUD monga mowa, cocaine, ndi ma opioid) ndi zovuta kapena zosokoneza bongo kapena machitidwe (monga GD ndi PPU) akuti [5,6,7,8, 9••]. Zomwe zimagawidwa pakati pa zosokoneza bongo ndi ma ED zafotokozedwanso, makamaka kuphatikiza kuwongolera kwazidziwitso kwapamwamba [10,11,12] ndikukonza-mpaka-pansi [13, 14] zosintha. Anthu omwe ali ndi zovuta izi nthawi zambiri amawonetsa kuwongolera kuzindikira komanso kupanga zisankho zoyipa12, 15,16,17]. Zofooka pakupanga zisankho komanso kuphunzira mozindikira zolinga zapezeka pamavuto angapo; Chifukwa chake, atha kuwerengedwa kuti ndiotengera matenda opatsirana pogonana [18,19,20]. Makamaka, akuti njira izi zimapezeka mwa anthu omwe ali ndi zizolowezi zamakhalidwe (mwachitsanzo, munthawi ziwirizi ndi mitundu ina ya zosokoneza)21,22,23,24].

Ponena za mtundu wa zosokoneza bongo, GD yawerengedwa mozama kwambiri ndipo yawerengedwa m'gulu "zovuta zokhudzana ndi zosokoneza bongo" za Diagnostic and Statistical Manual of Mental Disorder (DSM-5) [1]. Komabe, pankhani ya BED makamaka PPU, zolemba zomwe zilipo ndizochepa, makamaka pakudziwitsa za ubongo ndi neuroscience. Kumvetsetsa kwamachitidwe amisala omwe amayambitsa matenda amisalawa akuchedwa kuchepa, ndipo mitundu ingapo yama neurobiological yasankhidwa, ndi omwe akhala akutenga chisankho kukhala chofunikira [23, 25, 26].

Kafukufuku waposachedwa akuwonetsa mtundu wa BED wofotokozera biopsychosocial, pomwe zinthu zosiyanasiyana (monga chiwopsezo chopeza mphotho ya chakudya, kupsinjika kwakanthawi, ndi zina mwazakudya zopangidwa kwambiri zomwe zili ndi mafuta ndi shuga wambiri) zitha kulimbikitsa machitidwe osavomerezeka ndi kusintha kwa milingo ya dopamine, kuwongolera kuphunzira kwamakhalidwe olakwika [27]. Chifukwa chake, olemba ena amati kudya zakudya zina zopatsa mphamvu kwambiri komanso mankhwala osokoneza bongo kumatulutsa mayankho ofanana ndi amitsempha, olumikizidwa ndi mphotho zofananira ndi dopamine [28, 29], ndipo atha kuthandizira kukulitsa chizolowezi [30]. Zinthu zofananira ndi ma neurobiological zadziwika pakati pa BED ndi GD [31, 32], monga kuchepa kwa zochitika zapakati pazomwe zimachitika panthawi yopanga mphotho, zomwe zitha kuonedwa kuti ndi bizinesi yothandizidwa ndi mankhwala osokoneza bongo [33]. BED yawonetsanso kufanana ndi kusuta kwa zakudya, monga kuchepa kwa kuwongolera magwiritsidwe, kumwa mopitilira muyeso komanso kupitiliza kumwa ngakhale zitakhala zovuta, komanso zovuta zochepetsera kuchuluka kapena kuchuluka kwa zakumwa [34,35,36].

Pali kutsutsana kwakukulu ngati PPU ndi zizolowezi zakugonana (CSBs) makamaka ziyenera kuonedwa ngati zosokoneza (37••, 38). Matenda a CSB (CSBD) adangophatikizidwa posinthanso khumi ndi chimodzi cha International Classification of Diseases (ICD-11) ngati vuto lodziletsa [39]. Zofanana pakati pa CSBD ndi zosokoneza bongo zafotokozedwa, ndikulephera kuwongolera, kugwiritsa ntchito mosalekeza ngakhale zitakhala zovuta, komanso zizolowezi zosankha zowopsa zitha kugawidwa (37••, 40). Pomwe olemba ena adatsutsa izi potengera kufanana pamachitidwe amisala ndi zina - monga kuthekera kotenga gawo lamalipiro ndi masekondi oyambilira poyendetsa chidziwitso pakuwongolera kwamphamvu zamaubongo - kuti CSBD ndi PPU ziziwerengedwa kuti ndizovuta zina [41], anthu amakonda kutsutsana pankhani yokhudza zolaula.

Mtundu wakumwa mankhwalawa umafunikira zambiri zamatenda opatsirana pogonana. Kusagwirizana pamalingaliro amtunduwu kwalepheretsa BED makamaka PPU kukhala gawo lalikulu pazokambirana zamankhwala. Chifukwa chake, kuwunikiraku kukuyesa kupereka chiwonetsero chazonse chazovuta zamachitidwe amisala, makamaka pazomwe zimapanga zisankho [42].

DSM-5 imakhazikitsa madera asanu ndi amodzi amisala omwe aphunziridwa pamayendedwe osokoneza bongo ndi ma ED: chidwi chovuta, kuzindikira chikhalidwe, kuphunzira ndi kukumbukira, chilankhulo, magwiridwe antchito amagetsi, ndi ntchito yayikulu [1, 43]. Mwa iwo, chidwi chapadera chaperekedwa kwa oyang'anira, kusanja mapulani, kusinthasintha kuzindikira, kuletsa, kuyankha mayankho, ndikupanga zisankho [44••, 45, 46].

Kukhazikika kwa malingaliro pakupanga zisankho kumakhala kotsutsana ndipo kwadzetsa matanthauzidwe osakanikirana, kulepheretsa kufalikira kwa zotsatira. Zisankho, ngakhale zomwe zimalumikizidwa ndi zomwe zitha kukhala zosokoneza bongo, zimadza chifukwa cha mpikisano pakati pazinthu zingapo zomwe zingachitike pakuwonetsera kwamakhalidwe [47]. Makhalidwe azida amatha kukhala osatekeseka chifukwa chazovuta zanthawi yayitali, ngati atha kukhala zizolowezi [47]. Chifukwa chake, kupanga zisankho kumatha kumveka ngati njira zingapo zomwe zimalimbikitsa kusankha kwamakhalidwe abwino kwambiri, kulingalira njira zina zomwe zingachitike [48]. Kupanga zisankho kumatha kuphatikizira kuzolowera kapena "zongowerengedwa" ndikuchita dala [49]. Zoyambazi nthawi zambiri zimakhala zachangu komanso zopepuka, pomwe njira zoyang'anira oyang'anira nthawi zambiri zimadalira zolinga, pang'onopang'ono, komanso zolimbikira [50]. Njira zoyendetsera ntchito zitha kuloleza anthu kuti apewe kusokoneza chidziwitso cha chilengedwe ndikuletsa zochita kapena zizolowezi [50, 51]. Komabe, kuwonongeka kwa njira zoyendetsera oyang'anira izi kumatha kubweretsa kuyambitsa njira zomwe zimawongolera machitidwe [50].

Kusiyanitsa kwachitika pakupanga zisankho moyenera komanso moopsa pachiwopsezo [52, 53]. Popanga zisankho pangozi, amayesedwa ndi ntchito monga Columbia Card Task [54] ndi Ntchito Yotchova Juga Yotsogola [52], anthu ali ndi chidziwitso pazotheka komanso malamulo omveka okhudzana ndi njira iliyonse. Chifukwa chake, njira zopangira zisankho zitha kukhala ndi kulingalira kwakukulu. Komabe, zosankha mosamveka bwino zikusowa chidziwitso chazotheka kapena zotulukapo zake. Chifukwa chake, zokumana nazo zamaganizidwe zimatha kuthandizira kwambiri pakuwunika zilango zomwe zingachitike kapena mphotho yolumikizidwa ndi njira iliyonse. Nthawi zambiri amakhala osatsimikizika, amatha kuwonedwa kuti ndi obwezera kwambiri [55], ndipo amalumikizidwa ndi njira zowoneka bwino. Zisankho mosamveka bwino zimayesedwa nthawi zambiri pogwiritsa ntchito Iowa Gambling Task (IGT), pomwe zisankho zimatha kubweretsa mphotho zaposachedwa komanso zabwino zomwe zimakhudzana ndikutayika kwakanthawi. IGT imakhudzanso kuphunzira. Kugwira ntchito molakwika pa IGT nthawi zambiri kumakhudza chidwi cha mphotho yomweyo, osaphunzira kapena kulingalira zotayika [44••]. Chifukwa chake, zomwe zapezedwa pakupanga zisankho mosamveka bwino zomwe zikuphatikizidwa pakuwunikaku zidagwiritsa ntchito IGT ngati chida chachikulu chowunikira.

Kutengeka mtima ndikupanga zisankho ndizogwirizana, ndipo maphunziro ena amaphatikiza-kuchotsera-kuchotsera ndikupanga zisankho. Kuchotsera kwakanthawi kumakhudzana ndi kusankha kosakakamizidwa [56] ndipo amatanthauza chizolowezi chosankha zabwino-zazing'ono zomwe amalandila kuposa zomwe adzalandire pambuyo pake [56, 57]. Pomwe ntchito zochedwetsa pantchito zimakhudza kupanga zisankho, zimakhudza kusankha kwamodzi mwa mphotho ziwiri zamitundu yosiyanitsidwa munthawi. Anthu omwe ali ndi zisankho zabwino kwambiri amakhala ndi zizolowezi zambiri zosaganizira zomwe zingachitike kwakanthawi chifukwa cha zisankho zawo ndikuyang'ana pamalipiro akanthawi kochepa [58].

Kuwunikaku kukuyang'ana pakupanga zisankho mikhalidwe itatu: GD, PPU, ndi BED. Malire enieni pakati pamapangidwe opanga zisankho komanso kusakhudzidwa ndi chisankho sichosiyana kwenikweni. M'mbuyomuyi, tiwunikanso kupanga zisankho mosamvetsetseka monga momwe kuyerekezera ndi IGT ndikupangira zisankho pansi pazowoneka bwino poyerekeza ndi ntchito zochedwetsa. Tinalemba zomwe tapeza (Table 1).

Kupanga zisankho ndi GD

Njira zopangira zisankho zomwe zimalimbikitsa kutchova juga zimafanana ndi zomwe zimasankhidwa tsiku ndi tsiku [59]. Amatha kulingaliridwa ngati zisankho za mtengo / phindu, kutengera kusankha pakati pa chiopsezo chotaya zinthu zamtengo wapatali ndikupeza mphotho yayikulu [59]. Mwambiri, anthu amakonda kusankha kutchova juga pachiwopsezo kuposa njira zosamveka, chifukwa popanga zisankho, kusamvetsetsa nthawi zambiri kumawoneka kochenjera kuposa chiwopsezo [55]. Komabe, kusiyanasiyana kwamakhalidwe kapena zizolowezi (mwachitsanzo, kulanga osakhudzidwa ndikufunafuna chidwi) ndi zinthu zazidziwitso (mwachitsanzo, kusintha kusakhazikika kwamaphunziro) kumatha kukopa kupanga zisankho mwa anthu omwe ali ndi GD [60]. Kuphatikiza apo, ngakhale zovuta zakusintha monga msinkhu, kugonana, kapena mulingo wamaphunziro sizimalumikizidwa mwachindunji ndi zoperewera pakupanga zisankho mu GD [58], zomwe zimaphatikizapo luntha, kutengeka mtima, kusintha kwa chikhalidwe cha anthu, kusokonekera kwazindikiritso, kusanthula kwazidziwitso, zovuta, kutalika kwa kudziletsa, kapena kuukitsa kungapangitsenso kupanga zisankho [50, 55, 58, 61, 62].

Zomwe anthu amakhala nazo komanso momwe akumvera nthawi zambiri zimaphatikizidwa pakupanga zisankho. Kafukufuku waposachedwa wowunika njira zopangira zisankho mwa osewera poker, adawona kuti ophunzira atakwiya, amapanga zisankho zosavomerezeka [61]. Kuphatikiza apo, mayendedwe amtundu wina wamtundu wa juga, makamaka kudziwika kwa anthu ena omwe amatchova juga (mwachitsanzo, poker), atha kukhala ndi mphamvu yayikulu pakufotokozera momwe akumvera komanso kupanga zisankho [61].

Pakuwunika momwe gawo lodzutsira pachiwopsezo komanso kusamvana pakupanga zisankho, kusiyana kwakukulu kwawonedwa. Pazisankho zomwe zili pachiwopsezo, kukondera nthawi zambiri kumayenderana ndi kusankha zosankha zotetezeka, pomwe chiwopsezo chili chachikulu ndipo mwayi wopambana ndi wotsika, motero kuchepa kwamakhalidwe otchova juga [55]. Komabe, pankhani ya zisankho mosamveka bwino, chidwi chimatha kukhala chosiyana ndipo nthawi zambiri chimakhala chokhudzana ndi kuchuluka kwa njuga [55]. Chifukwa chake, kudzutsa kumatha kukhazikitsa malingaliro amtengo wapatali pazisankho zokhudzana ndi kusatsimikizika kwakukulu kapena pang'ono [55].

Anthu omwe ali ndi vuto la kutchova juga nthawi zambiri amabetcherana ndalama zochulukirapo ndipo amakhala ndi zovuta zosiya kubetcha, ndipo malo olamulira ndi malo olakalaka atha kupanga zisankho zanjuga. Maphunziro ozindikira omwe amaphatikizira kuyimitsidwa poyankha amatha kusintha ndalama zomwe angalandire, komanso kusiya zikhalidwe zomwe zitha kupitirira kutchova juga [50].

Njira zopangira zisankho pamalingaliro a GD zitha kuphatikizaponso zikhulupiriro zolakwika komanso zopotoka zomwe zingalimbikitse kudzidalira mopitilira muyeso pakulosera ndikuwongolera zopambana ndi zotayika, kukana mwayi ndi mwayi, ndikupanga ziyembekezo zazikulu zopambana [63,64,65,66]. Kusiyanasiyana kwa kusiyana pakati pa amuna ndi akazi kunasinthidwa [67], azimayi akuwonetsa kuganiza zamatsenga komanso kuzengeleza ndikuchedwetsa kuyanjanitsa kuyanjana kwamalingaliro amatsenga ndi GD. Kusiyana kokhudzana ndi jenda kumatha kufotokoza zomwe akazi amakonda kuti azidalira mwayi kuposa luso lotchova juga [67].

Kugwiritsa ntchito njira zopitilira muyeso zolimbikitsa komanso kuwerengera zalembedwa mu GD, pomwe anthu akuwonetsa kufunafuna chiwopsezo chachikulu ndikuyang'ana mphotho zawo [68, 69]. Zikhoterero ziwirizi zimatha kupanga chisankho ndikuchepetsa kuchotsera [68,69,70]. Makamaka, kulumikizana pakati pofunafuna zoopsa komanso kuchotsera kuchotsera kumayendetsedwa ndi udindo wa GD, ndipo zomwe zimayambitsa matendawa, monga kuwongolera mphamvu, zitha kuthandizira [68]. Kafukufuku wina adawonetsanso kufunikira kwa zinthu monga zaka zakubadwa pakati pa kuchepa kuchotsera ndi GD, ndi achinyamata omwe akuwonetsa ubale pakati pa mitundu yosakhudzidwa [71].

Kafukufuku wopanga zisankho ku Laboratory akuwonetsa kuti anthu omwe ali ndi GD amawonetsa zovuta pakapangidwe ka zisankho onse ali pachiwopsezo komanso kusadziwika. Amachita bwino kwambiri poyerekeza ndi IGT (ngakhale sizinali choncho nthawi zonse [72]), posankha mphotho zakanthawi kochepa, ngakhale sizikhala zopindulitsa kwakanthawi, kuwonetsa kusaganizira zotsatira zamtsogolo zamachitidwe awo otchova juga [73,74,75,76]. Ngakhale amapanga zisankho zovuta, anthu omwe ali ndi GD nthawi zambiri amaphunzira kuchokera kuzoyankha pang'onopang'ono kuposa zomwe amafananizira [77, 78]. Kupanga zisankho zoyipa pa IGT kumatha kukhala ndi machitidwe othamangitsa anthu [74]. Olemba ena apeza kuti ubale wapakati pa magwiridwe antchito a IGT ndi kuuma kwa GD umayanjanitsidwa ndi kuthamangitsidwa, kuthekera kopitiliza kubetcha poyesa kubweza zomwe zidatayika kale [74]. Ena anena kuti kupanga zisankho zoyipa kumatha kuphatikizira kuchepa kwa ma signatal panthawi yamalipiro ndi chiyembekezo cha kutayika ndipo zitha kugwira ntchito kwa anthu omwe ali ndi GD opanda kapena [72]. Achinyamata, kulumikizana pakati pakupanga zisankho zovuta ndi kutchova juga pamavuto kunawonedwa [64]. Kupanga zisankho zoyipa pa IGT kumalumikizidwa ndi kutanthauzira kosokonekera, kusokonekera kwazindikiritso komwe kumadziwika ndi zizolowezi zogwirizanitsa zotayika ndi mwayi komanso zopindulitsa ndi luso laumwini. Zinthu ziwirizi, kuphatikiza pakumwa mowa, zinali zotsogola zamphamvu zakuvuta-kutchova juga kwa achinyamata.

Ngakhale maphunziro ambiri pakupanga zisankho mu GD adayang'ana kwambiri pazotsatira zomwe zimachitika pakusankha, kusiyanasiyana kwamomwe anthu amayankhira poyankha kumathandizanso [79•]. Mitundu yopangira zisankho imakhudzana ndi masitayelo ozindikira, ndipo zomveka, zowoneka bwino, zodalira, zopewera, ndi masitayelo amomwe afotokozedwera [80, 81]. Kukhazikika pamavuto otchova juga kwakhala kogwirizana kwambiri ndi njira zopangira zisankho mwadzidzidzi komanso zoyipa pakupanga zisankho muubwana [79•]. Chifukwa chake, kutchova juga kwamavuto kumatha kuphatikizidwa ndi zosankha zopanda nzeru komanso zosasintha.

Pamodzi, izi zikuwonetsa kuti kupanga zisankho ndikofunikira mu GD. Komabe, sikofunikira kugwiritsira ntchito njira zopangira zisankho zowopsa ngati gawo la GD kokha, chifukwa zitha kuyimira mtundu wapakati wa phenotype wopezeka pama pathologies [59].

Kupanga zisankho ndi PPU

Udindo wapadera pakudzutsa pakupanga zisankho pangozi ndi kusamvetseka sikunaphunzirepo kawirikawiri ku PPU [82, 83]. Kugonana kumatha kukopa chidwi chazakugonana; Chifukwa chake, mayankho pokhudzana ndi zachiwerewere, monga zolaula kapena zoyambitsa zina zogonana, ndizofunikira kuziwona pakupanga chisankho [84].

Kafukufuku woyeserera wopanga zisankho zogonana adachitika [85], kuphatikiza pakukopa chilakolako chogonana popereka zithunzi zokhala ndi zolaula [86]. Mtundu wosinthidwa wa IGT unaphatikizira zithunzi zosaloledwa komanso zogonana. Zithunzi zachiwerewere zikagwirizanitsidwa ndi njira zina zosavomerezeka, kupanga zisankho kunali koipa kuposa momwe zimakhalira ndi njira zopindulitsa, makamaka kwa anthu omwe anali atadzutsidwa kwambiri. Zokonda popanga zisankho pazithunzi zogonana zitha kuphatikizidwa ndi ma drive olandila ndikukhalabe osangalala. Chifukwa chake, zofuna zogonana zitha kukhala zosokoneza, kutsogolera anthu, makamaka omwe ali ndi chilakolako chogonana, kunyalanyaza mayankho omwe amaperekedwa ndi ntchitoyi popanga zisankho.

Kugonana pachiwopsezo mukakhala ndi chilakolako champhamvu chitha kugwiranso ntchito pakati pa amuna ndi akazi. Kugonana kumatha kukhudza kuwunika koopsa pazochitika zakugonana ndikuwona zabwino ndi zovuta zamakhalidwe omwe asankhidwa. Zotsatira za "myopia yogonana" itha kukhala yofanana ndi "myopia yoledzera" ndikuwonjezera kutenga ziwopsezo [84]. Mu kafukufuku wina [87], pamene chilakolako chogonana chinakula, zotsatira zakumwa zoledzeretsa pakuchita chiopsezo (pamenepa, zolinga zogonana osaziteteza) zinali zamphamvu.

Poyerekeza anthu omwe amagwiritsa ntchito zolaula kapena zosangalatsa zina ndi omwe ali ndi PPU, kusiyana kosankha mopupuluma kunawonedwa [88]. Zotsatira izi zikugwirizana ndi mayanjano pakati pa kukakamira ndi kuuma kwa PPU komwe tafotokozera koyambirira [89]. Kafukufuku wamtali akuwonetsa kuti anthu amapatsidwa mphotho nthawi yomweyo chifukwa chogwiritsa ntchito zolaula, zomwe zitha kuneneratu kuti kuchotseredwa kwakanthawi kwakanthawi. Kuphatikiza apo, zolaula zomwe zimagwiritsidwa ntchito popanga zisankho zitha kukhala nthawi yayitali kuposa nthawi yogonana [17]. Zotsatira izi zikugwirizana ndi zomwe zikukhudzana ndi zolaula zomwe zitha kukhala pa mphotho [90]. Kuphatikiza apo, kudziletsa pa kusagwiritsa ntchito zolaula kumachepetsa kuchepetsedwa kuchotsera kuposa njira zina, monga kudziletsa pakudya [17].

Pankhani yamavuto azakugonana, chimodzimodzi ndi GD, akuti malingaliro okonda kuzindikira amathandizira pakupanga zisankho mu PPU, mogwirizana ndi chidwi chazomwe zimapangitsa chidwi chazakugonana [91]. Anthu omwe adanenanso za chizolowezi chogonana ndi anthu pa intaneti akuwonetsa kukondera / kupewa zomwe zimayambitsa zolaula [92]. Chiyanjano pakati pa PPU ndi njira zopewera kufotokozedwa chinafotokozedwa [92]. Kuwonongeka kwazidziwitso kumawonekeranso pomwe anthu omwe ali ndi vuto logonana pa intaneti akukumana ndi zovuta zambiri kuphatikiza zolaula komanso zosakhudzidwa ndi ndale [93]. Zotsatira izi zidakulutsidwa posachedwa mwa ophunzira achimuna aku koleji omwe amagwiritsa ntchito zolaula; PPU idalumikizidwa kwambiri kufulumira kwa kuyandikira kuposa kupewa zoyambitsa zolaula, zomwe zimapangitsa kuti anthu aziona ngati zolaula komanso zabwino94•]. Zotsatira zofananazi zanenedwa posachedwa mwa ophunzira azimayi aku koleji [95]. M'maphunziro ena, kudzutsidwa ndi chilakolako chodziseweretsa maliseche kumachepetsa kudzidalira kopewa kupewa zolaula ngakhale mwa anthu omwe zithunzi zolaula zimagwiritsidwa ntchito kamodzi kapena pang'ono pamlungu [96]. Olemba ena amaganiza kuti zochitika zokhudzana ndi mphotho zomwe zimakhudzidwa ndi PPU zimapangitsa kuti pakapita nthawi chikhumbo chachikulu chofuna kukopeka kwachilendo kwachilendo [97]. Komabe, ena akuganiza kuti zitha kuwonedwa ngati chofunikira osati chifukwa cha PPU [97]. Chifukwa chake, kafukufuku amafunika kuti muwone momwe kupanga zisankho kumakhudzira kuyambika kapena kukonza kwa PPU.

Pomaliza, pakuwunika mayanjano omwe ali pakati pazakugonana ndi kutchova juga mwa anthu ambiri, zanenedwa kuti kuphatikiza zomwe zimapangitsa kuti anthu azigonana zachepetsa kusiyana pakati pa zopindulitsa ndi zotayika zokhudzana ndi kutchova juga, pomwe kukwezedwa kowonjezeka kumawonekera pazolowera. Kupezeka kwa zolimbikitsa zakugonana kumatha kupangitsa kuti zotayika zokhudzana ndi kutchova juga ziziwoneke ngati zopanda pake [82].

Kupanga zisankho ndi BED

Kupanga zisankho zaphindu mukamadya ndikuwunika zomwe zingachitike kwa nthawi yayitali ndikofunikira chifukwa chakukula kwa chakudya chokoma ndi kuchuluka kwa kunenepa kwambiri padziko lonse lapansi [98, 99]. Kugwiritsa ntchito njira zopangira zisankho zofunikira ndikofunikira makamaka kwa BED, makamaka pankhani yakudya kwambiri [98].

Anthu omwe ali ndi BED nthawi zambiri amati amadzimva kuti sangathe kuwongolera chakudya chawo [26]. Anthu omwe ali ndi BED amatha kugwiritsa ntchito njira zovuta kupanga zisankho [16]. Makamaka, anthu omwe ali ndi BED atha kuwonetsa kusintha kosintha pakati pazisankho zomwe zingayambitse kusintha kwamakhalidwe, zomwe zikuwonetsa kukondera pazisankho zofufuzira potengera zochitika zazikulu [16]. Chifukwa chake, kufufuza kwina pakupanga zisankho mu BED ndikofunikira [16, 100].

Ponena za kupanga zisankho pachiwopsezo, anthu omwe ali ndi BED omwe anali onenepa kwambiri kapena onenepa kwambiri amapanga zisankho zowopsa poyerekeza ndi omwe alibe BED omwe anali onenepa kwambiri kapena onenepa kwambiri monga zikuwonetsedwera ndikuchita pamasewera a dayisi (GDT), yomwe imafotokoza kuthekera kowoneka bwino ndikupereka mayankho kwa ophunzira [98]. Anthu omwe ali ndi BED adawonetseranso kufunafuna chiwopsezo chachikulu poyembekezera mphotho ya ndalama [101]. Chifukwa chake, BED itha kuphatikizira kusankhana koperewera kwa mphotho ndi zizolowezi zowonetsetsa kuti kufunikira kofunikira kukhala kogwirizana ndi zomwe zingachitike (ndiye kuti, akawona kuti mwina mphotho yomwe ingakhale yoposa yomwe ingachitike) [101, 102].

Poyesa kupanga zisankho mosamvetsetseka ndi IGT, odwala omwe ali ndi BED amapeza zocheperako, kuwonetsa chizolowezi chopanga zisankho zoyipa, poyerekeza ndi omwe alibe BED, komanso zovuta pakusintha mayankho omwe amalandila atapanga zisankho [103, 104]. Mukamaphunzira za anthu onenepa kwambiri popanda BED, onsewa amawonetsa ntchito zofananira [102]. Kuphatikiza apo, kuuma kwa BED kumagwirizana bwino ndi kuchuluka kwa kuwonongeka kwa njira zopangira zisankho [105].

Ponena za kuchedwa kuchotsera, anthu omwe ali ndi BED motsutsana ndi omwe alibe amakonda kuchotsera mphotho kwambiri [26, 106]. Kuphatikiza apo, chizolowezichi chimadutsa magawo ena, monga chakudya, ndalama, kutikita minofu, kapena kungokhala pansi [107]. Kuchuluka kwakuchedwa kuchotsera kwawonedwa mwa anthu omwe ali ndi kunenepa kwambiri, omwe alibe BED. Pankhani ya kunenepa kwambiri, kuchotsera kwakanthawi kocheperako kumawonedwa ngati nawonso ali ndi BED, poyerekeza ndi anthu omwe alibe kunenepa kwambiri kwa BED [102]. Chifukwa chake, mgwirizano pakati pa BED, kuopsa kwa kunenepa kwambiri, komanso kupanga zisankho molakwika akuti "102]. Olemba ena adatsimikiza kuti pankhani ya BED, lingaliro lokhazikika pakukakamizidwa komanso zovuta pakulamulira machitidwe (kudziyesa wokha) zitha kukhala zofunikira kwambiri kuposa kupanga zisankho mozindikira (ntchito yopupuluma) [108]. Zomwe anthu amakonda pakulandila kwakanthawi kochepa, kuchotsera zomwe zingachitike kwakanthawi, zitha kufotokozera zomwe zimachitika pakudya mopitirira muyeso, komwe kumakhudzana ndi kutaya mphamvu, ngakhale anthu atayamba kukumana ndi zovuta, monga kunenepa kapena malingaliro wolakwa [109].

Ngakhale izi zapezeka, kafukufuku wowunika BED ndikupanga zisankho ndi ochepa komanso osagwirizana [109], kotero ayenera kutanthauziridwa mosamala. Kuphatikiza apo, zomwe zapezedwa pakulephera kupanga zisankho zitha kukhala zosafunikira kwenikweni kwa achinyamata omwe ali ndi BED, monga momwe kafukufuku waposachedwa wa ma EDs akuwonetsera [110, 111]. Kuthekera kulipo koti njira zopangira zisankho zimakhalabe zolimba kumayambiriro kwa BED [111], ngakhale izi zimafunikanso kuwunikanso. Pakapita nthawi komanso pakukula, anthu omwe ali ndi BED amatha kukhala ndi zisokonezo pakupanga zisankho poyankha njira zopindulitsa za chakudya [111].

Khalidwe lodyera moyenera limatha kuyendetsedwa ndikusintha kwamitsempha kambiri komwe kumakhudzana ndi kupanga zisankho komanso kusakhazikika komanso kukakamizidwa, komanso magawo ena amisala [26]. Olemba ena amafotokoza, komabe, kuti m'ma ED, kuwonongeka kumeneku pakupanga zisankho kumatha kuchepa odwala akamachira, ndikupanga zisankho mofanana ndi omwe sanakhudzidwe. Chifukwa chake, kupanga zisankho kumatha kukhala kosavuta ndikuwongoleredwa pochita nawo BED [112].

Zoperewera ndi Kafukufuku Wotsatira

Cholepheretsa pakadali pano pankhani yazidziwitso, makamaka pakupanga zisankho, ndi kupezeka kwa ntchito zingapo ndi mitundu, yomwe ingalepheretse kufanananso kwa zotsatira pamaphunziro onse. Kafukufuku wowonjezera amafunikira kuti mumvetsetse gawo lenileni la tsambali mu GD, PPU, ndi BED. Kusiyana kwamalingaliro pakupanga zisankho kumathandizanso kuchepetsa kuwunika kwa nyumbayi. Kugawika pakati pazisankho zomwe zili pachiwopsezo ndi kusamvana sikunayankhidwe m'maphunziro onse, ndipo zida zingapo zama neuropsychological zakhala zikugwiritsidwa ntchito kuwunika njira zonse ziwirizi, zomwe zitha kupezeka pamlingo wina. Kuphatikiza apo, kuyerekezera mwachindunji pakati pa magulu atatu azachipatala ndizovuta chifukwa zolembedwazo zimayang'ana mbali zosiyanasiyana zomwe zingakhudze kupanga zisankho. Chifukwa chake, kafukufuku wamtsogolo akuyeneranso kuthana ndi izi pakukonzekera ndikuwunika. Pomaliza, ziyenera kudziwika kuti zomwe apeza mu labotale mwina sizingatanthauze zenizeni zenizeni, ndipo izi ziyenera kuwunikidwa.

Kumvetsetsa kupanga zisankho kuli ndi tanthauzo lofunikira pakuwunika ndi chithandizo cha anthu omwe ali ndi GD, PPU, ndi BED. Zosintha zofananira pakupanga zisankho pachiwopsezo ndi kusamveka bwino, komanso kuchotsera kwakanthawi kambiri, zalembedwa mu GD, BED, ndi PPU. Zotsatirazi zikuthandizira mawonekedwe opatsirana pogonana omwe angakhale othandiza pothana ndi zovuta. Komabe, pali mipata yoyenera pazolemba popanga zisankho pamagulu atatu azachipatalawa, ndipo kufananiza mwachindunji kwa maguluwa pakupanga zisankho kungapindule pofufuza mwachindunji zomwe zapangidwa mofananamo mikhalidwe yonseyi.