Ubale pakati pa zilakolako zamaganizo, zachiwerewere, zachiwerewere ndi makhalidwe: kuwonetseratu mwatsatanetsatane kafukufuku ndi zoyembekezereka maphunziro mwa anthu (2019)

1. Introduction

(a) Zochokera pamakhalidwe olimbikitsa kuchita zachiwerewere

Impulivity, yomwe imafotokozedwa ngati chizolowezi chomachita mwachangu kapena mwachangu mwachangu ndi zotsatirapo zake zamtsogolo [1,2], zimathandizira kusokonezeka kwamisala yambiri yamagetsi komanso mawonekedwe amachitidwe oopsa okhudzana ndi thanzi. Matenda ambiri amisala ndi malingaliro okhudzana omwe amakhalapo pamodzi, ndi machitidwe owopsa ogonana omwe ali zitsanzo ziwiri [3]. Khalidwe lowonjezera [4] amatanthauzidwa ngati kugwiritsa ntchito zinthu [5] ndi zina zomwe zitha kupanga mawonekedwe ndipo zitha kuchitika mopitilira muyeso chifukwa chakuwonongeka kwawo. Khalidwe logonana mwakuya limaphatikizapo zochitika zogonana zomwe sizitetezedwa, ndi abwenzi angapo kapena amuna wamba, komanso / kapena kugwiritsa ntchito mankhwala osokoneza bongo [6].

Pali zofanana zingapo pakati pa kusatengeka, kuzolowera komanso kugonana. Pa milingo yotsika-pang'ono, kukakamizidwa, kuzolowera komanso kuchita zachiwerewere zonse ndizofanana. M'malo otsika, kunyinyirika kungawonedwe ngati chizolowezi wamba [7]. Mowa, makamaka, umawonedwa ngati wofanana ndi mikangano yogwira mtima yokhudza ngati kumwa moyenera kungakhale ndi phindu lakuthupi [8]. Momwemonso, kugonana komwe kumakhala pachiwopsezo ndikucheperachepera pamaukakamizo kumakhala kofunika mu maubale achikondi ndi kubereka [9]. Umboni ukusonyeza kuti kunyengerera kumathandizira osati kungoyambitsa (kuphatikiza zoyambirira) zamakhalidwe oluluzika komanso zachiwerewere komanso kupititsa patsogolo mikhalidwe iyi [10,11]. Kupititsa patsogolo zikachitika, zizolowezi zokhudzana ndi kugonana komanso kugonana zitha kukhala zovuta m'mavuto [12-14].

Makamaka, kugwiritsa ntchito mankhwala osokoneza bongo ndi machitidwe ogonana omwe amapitilira muyeso wambiri amatha kuchitika ngakhale atakhala ndi mavuto. Izi zikuwoneka mu tanthauzo lamavuto ogwiritsa ntchito mankhwala osokoneza bongo (SUDs): kugwiritsa ntchito mankhwala omwe amapezeka mobwerezabwereza omwe amachititsa kuwonongeka kwakukulu kuphatikizapo matenda, kulemala ndi kulephera kukwaniritsa maudindo [15]. Momwemonso, machitidwe okakamiza pakugonana amasonyezedwa ndi kupsinjika kwakukulu ndi / kapena kusokonezeka pazinthu zina zogwiritsa ntchito ma psychosocial [9,10]. Kuphatikiza apo, pakakhala kunyinyirika, kuzolowera komanso kugonana.1-3,9-11]. Awiri a DSM-5 (Kufufuza ndi Kuwerenga Buku la Mental Disorders-5) Njira za SUD (mwachitsanzo, kugwiritsa ntchito zinthu zochulukirapo kapena kwa nthawi yayitali kuposa momwe mukufunira; zovuta pakuchepetsa kapena kusiya kugwiritsa ntchito.)15]) zokhudzana ndi kusowa bwino kwa kayendetsedwe kazinthu. Njira zowongolera zakumwa zoledzeretsa zimagwiritsa ntchito bwino momwe zimakhalira [16]. Kuphatikiza apo, kufunsa ndi gawo limodzi la machitidwe angapo amisala omwe amagwirizananso kwambiri ndi chiopsezo chogonana, momwe kudziyang'anira pawokha kumadandaula15].

Kukhudzidwa kwa zotsatira zoyipa zomwe zimayimira kugwiritsidwa ntchito kovuta kwa zinthu zogonana ndi chikhalidwe chogonana ndi gawo lachifotokozero cha kusokonekera [1,2]. Koma pomwe kuchita zinthu mopanda ulemu kumafanana ndi phindu la mphotho ndi zotsatira zabwino [17], kulimbikitsidwa kwamakhalidwe oyenera komanso zachiwerewere kumatha kuchitika ngakhale kuti zabwino zake zimakhala zowonongeka pakapita nthawi. Kusintha uku kukuimira kusintha kwachikhalidwe komwe kumadziwika ndi kukakamizidwa kupita kokakamizidwa kapena kakhalidwe [9,18,19]. Khalidwe lokakamiza limafotokozedwa ngati zochita zosayenera zochitika zomwe zikupitilira ngakhale osagwirizana ndi cholinga chonse, nthawi zambiri zimabweretsa zotsatirapo zoyipa [20]. Chifukwa cha kufalikira kwa zolinga ndi zotsatira zake, zotsatira zake zizikulirakulira chifukwa chodzichitira nkhanza komanso / kapena machitidwe ogonana.

Kuphatikiza pa kutenga nawo mbali pakukakamiza komanso mchitidwe wogonana, zizolowezi zomwe zimapangitsa kuti munthu akhale ndi chizolowezi chomangokhalira kukondanso zimatha kukulitsa chidwi [3,10] ndikutsogolera machitidwe ogonana, kuphatikiza zoopsa [11]. Maubwenzi apakati pa kugwiritsa ntchito mankhwala osokoneza bongo ndi chiwerewere choopsa chitha kupitilizidwa ndi kuchepa kwa kupezeka kwa makondomu [11]. Kuyankha mosadukiza poyerekeza ndi gawo lina la kunyinyirika [21].

(b) Kuchita zinthu mwachangu ngati zomangamanga

Kafukufuku wokhudzana ndi kunyinyirika kuyenera kuvomereza chilengedwe chake chovuta kuphatikizidwa. Kusiyanitsa pakati pothamangitsidwa ngati boma lakanthawi kochepa, kolimbikitsidwa ndi kugwiritsa ntchito mankhwala osokoneza bongo ndi zina zokondweretsa, komanso chizolowezi chodziwika bwino kwa nthawi yayitali komanso modutsa zimathandizidwa mwamphamvu [10]. Makamaka, onsewonse / ndipo kakhalidwe komanso kukakamizidwa kumayiko kungachititse chidwi chamakhalidwe ndi kugonana [10,11]. Ngakhale mawonekedwe osatsimikizika ali osiyana mu maphunziro onse, nthawi zambiri samalumikizana mwamphamvu wina ndi mnzake [10,21]. Gawoli lodziwika bwino la magwiridwe amtunduwu, lochirikizidwa ndi kusanthula kwakanthawi kotsimikizira [21], ili pakati pa kuyankha, kusankha ndi kusachita mwachangu ndi umboni kwa awiriwa omwe amabwera makamaka kuchokera kuzidziwitso komanso omasulira ake odzilemba.

Kuperekera mayankho kwatanthauzidwa kuti kupangitsika kuchitapo kanthu zomwe sizikugwirizana ndi zomwe zikufunika masiku ano zachilengedwe [22] komanso monga zovuta zoletsa mayankho [1]. Kukhazikika kwa chisankho kumafotokozedwa kukhala wofunitsitsa kuchepa kapena kuthekera kulekerera nthawi zambiri kumaphatikizapo kuchotsera kuchepa: zokonda zazing'onoting'ono, posachedwa zokulirapo, mphoto zamtsogolo [21]. Kugwiritsa ntchito mankhwala osokoneza bongo ngakhale mutakhala ndi zotsatirapo zoipa kumathandizanso kuti munthu akhale ndi mwayi wopeza mphoto yayitali mwachangu [21]. Kapangidwe kogwirizana ndi kuchotsera kothekera, komwe kumaphatikizapo zokonda zazikulirapo, zochepa pazochepa zazing'ono, mphotho zina zambiri [23]. Pomwe kuyankha kumachitika [22] ndi kuchotsera kotheka [23,24] ali ndi chidwi ndi zotsatira zoyipa za zinthu, kuchepetsedwa kuchotsera, makamaka zoyerekeza ndi ndalama zenizeni, zikuwoneka ngati kusiyana kokhazikika, ndikuchita payekha [10]. Mosiyana ndi magwiridwe antchito, malipoti anuwo amatenga malingaliro a anthu pazomwe amakonda [10]. Mlingo wa UPPS Impulsive Behaeve, wotchuka wokhala ndi chidwi, amawunika kufunafuna, osakonzekera, osapirira, komanso pazovuta komanso zosalimbikitsa (mwachitsanzo, kuyambitsa kumachokera ku mayiko abwino ndi osavomerezeka oyanjana,)25,26]. Kunja kwa UPPS, malingaliro ndi umboni zimawonetsa kuti kufunafuna kwamalingaliro ndi kogwirizana koma komanga kosiyana [21].

(c) Kubwereza kwadongosolo komwe kuli

Kuphatikizika kovuta komanso kufunsa mafunso okhudzana ndi ubale pakati pa kunyengerera, zochita zowonjezera komanso zogonana zimapangitsa kuti kafukufuku awunike zomwe zimaphatikizapo magawo atatuwa onse pakupita kwa nthawi (kuyembekezera / kutalika kapena kuyesa, mu labotale). Kuwunikira kotereku kungakupatseni chidziwitso pakuwongolera komwe kumachitika ngati chotsatira kapena zotsatira zamakhalidwe olakwika kapena zachiwerewere podziwitsa zomwe zimayambitsa ubale, zochitika zamatenda komanso zochitika zomwe zikuchitika. Mitu iyi, yomwe ili ndi chithandizo chazachipatala komanso zaumoyo wa anthu, ndizomwe tikuwunikira pakuwunika kwatsopano kwa mabuku aposachedwa. Popeza kufunikira kwa kusintha kosinthika kukhala njira zamakhalidwe ovuta komanso kukhudzidwa kogwirizana ndi kusintha kosunthika, ndikofunikira kusiyanitsa pakati pa maphunziro omwe amayesa machitidwe pamunsi komanso mwamphamvu. Powunikira kusiyanitsa uku, tilingalira za maubale omwe ali pachiwopsezo ndi kuchitapo kanthu nthawi zambiri komanso zovuta.

(d) Kuzindikira kwakumaso ndi kubadwa

Popeza kufunikira kwa nkhani zopatsa chidwi pakubwereza kwaposachedwa, kafukufuku wokhudzana ndi neuroimaging ndi / kapena genetics ali ndi mwayi wapadera. Impulivity imaphatikizapo kusokonezeka kwa njira zosiyanasiyana zamatumbo kuphatikizapo kugwirizanitsa kwa magalimoto ndi njira zazidziwitso, kuzindikira ndi chidwi [10]. Mwachilengedwe, kukhudzidwa kumatha kudziwitsidwa ndi kuwongolera kwamphamvu kwambiri kwazomwe zimayendetsedwa ndi ena kapena / kapena kuchita kwambiri mu kufalitsa kwa mphotho ya fronto-striatal [3]. Zonsezi komanso ma SUD zimatha kuphatikizira dopaminergic neurons yomwe imayambira kuchokera ku gawo lachiberekero mpaka kupita ku nucleus accumbens (NAc) [3,27]. Khalidwe lowoneka bwino komanso mphotho zachilengedwe monga zachiwerewere zimawoneka kuti zimabweretsa zochitika zofananira zadongosolo kumadera kuphatikizira amygdala, hippocampus ndi frontor cortex [27].

Zotsatira zamtundu / banja zimalumikizidwa ndi kulowerera mu maphunziro a anthu ndi nyama [3]. Achibale a anthu omwe ali ndi ma SUD amakhala ndi chidwi chachikulu kuposa omwe sanayanjane nawo, olamulira nawo [28]. M'maphunziro akulu, zovuta za ma genetic zokhala ndi ma SUDs, kufunikira kwake komanso zokhudzana nazo (makhalidwe / antisocial botho kusokonezeka) zikuwoneka kuti zikuchuluka [29].

2. Njira

Tidawunikiranso zolemba zaposachedwa, zamunthu zokhudzana ndi ubale pakati pazomwe zimayambitsa chidwi komanso zochita zawo zachiwerewere komanso nthawi yayitali. Tinadziletsa kuti tifufuze kuphatikiza chimodzi mwa zinthu zitatuzi. Timangokhala ndi maphunziro ochepa omwe amaphatikizidwa kumayambiriro kuja. Kafukufuku omwe amayesa zochitika zokhudzana ndi zochitika zokha monga kusokonezeka-kuwongolera, kusokoneza chiopsezo, kapena kufunafuna malingaliro21]). Kafukufuku wonena za momwe aliri ndi kachirombo ka HIV popanda zotsalira zilizonse zokhudzana ndi kugonana sanatengeredwe. Popeza kuchuluka kwa malingaliro pazokhudza izi, kuphatikiza ndemanga zambiri za gulu lathu (mwachitsanzo [30]), timangochepetsa mabuku omwe amafalitsidwa kuchokera ku 2013 mtsogolo. Poganizira zomwe tidawunikira pakuwunikaku, tidayesanso maphunziro omwe amayesa maubwenzi awa kwakanthawi, kuphatikiza pofupikitsa (mwachitsanzo, zoyesa zamankhwala) kapena nthawi yayitali (mwachitsanzo, maphunziro owonera kapena mayendedwe ataliatali). Chifukwa chake, maphunziro apakatikati sanaperekedwe.

Tidayang'ana m'mabuku pogwiritsa ntchito PubMed and PsycInfo database pazosinthidwa ndi anzanu, zolemba m'Chingerezi. Zosankha zonse ziwiri zinafufuzidwa ndi mawu awa: 'impulsiv *', 'go go go', 'go stop', 'kuchepa kuchotsera', 'barratt', 'upps', 'mowa', 'mankhwala osokoneza bongo', 'addict *', 'HIV', 'kugonana' komanso 'kugonana koopsa.' Tidayang'ana m'magulu atatu; Chifukwa chake, mawu amodzi omwe amaimira chilichonse mwa zinthu zitatuzi anaphatikizidwa pakufufuza kulikonse ndi zotulutsidwa zonse. Kupatula obwereza, kusaka kwatulutsa mapepala a 420 kuti aunikiridwe mu Epulo 2018.

Olemba awiri adasanthula zotsatira zoyambirira pazotsatira zotsatirazi: (1) muyeso wa kusakhazikika; (2) muyeso wamakhalidwe olowerera; (3) muyeso wamakhalidwe azakugonana; (4) kapangidwe kazophunzira (zoyeserera, zoyembekezera / zowonera zazitali kapena kuyesa kwachipatala); ndi (5) kuphatikiza anthu omwe akutenga nawo mbali. Choyamba, mitu ndi zolemba papepala lililonse zidawunikiridwa kuti athetse maphunziro momveka bwino osakwaniritsa chimodzi kapena zingapo. Zolemba zonse zomwe zidatsalira zidawunikiridwa ndikudalirika kwamphamvu pakadali pano (Cohen's kappa = 0.83). Kusamvana kunathetsedwa pokambirana. Kuwunikiraku kwathunthu kudapangitsa kuti mapepala a 29 asindikizidwe kuchokera m'maphunziro 28 a makolo (chithunzi 1).

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Olemba atatu adawunikira zambiri kuchokera pamapepala otsala. Zambiri zotsatirazi zidachotsedwa: (1) size samp; (2) azimayi onse omwe amatenga nawo mbali; (3) njira zophatikizira / kupatula; (4) kapangidwe ka kafukufuku; (5) magulu owerengera ndi mikhalidwe; (6) zomwe zapezeka zikuwonetsa kukakamiza komanso zizolowezi zowonera; (7) zomwe zapezeka zikuwonetsa kukakamiza ndi zochitika zogonana; (8) zomwe zapezeka zokhudzana ndi chidakwa komanso chikhalidwe; ndi (9) pazotsatira zonse zitatu.

Zomwe zachitika pakuwunika mwadongosolo uku zidakhazikitsidwa panjira ya PRISMA [31]; Komabe, masitepe okhudzana ndi m'badwo wazotsatira za kuchuluka kwake sanakwaniritsidwe. Mitundu yosiyanasiyana ya njira ndi mitundu yeniyeni yophatikiza yomwe iphatikizidwa ndi maphunziro omwe asankhidwa mukuwunikaku sanawerengere meta-kusanthula kapena kulingalira kwina kwa kuchuluka kwa zotsatira. Zowopsa zakusankha mosakondera sizinatengedwenso chifukwa cha kusowa kwa mayeso olamulidwa mosakhalitsa omwe akuphatikizidwenso ndikuwunika komanso chifukwa mitundu ya zoyeserera zomwe zidaphatikizidwa mu kuwunikiraku sizimaloleza kuti wofufuzira aliyense adziwe.

3. Zotsatira

Chifukwa cha lingaliro lamlengalenga, takhazikika pakufotokoza kwa malembedwe oyenera kwambiri, mwachidule tebulo 1; komabe, zotsatira zonse zowunikira zili pazinthu zowonjezera zamagetsi, tebulo S1. Zotsatira zimayikidwa m'magulu potengera zomwe zimakhudzidwa (kuchita zinthu mosakakamiza ndi zomwe zimawonjezera; zochita mwamtopola komanso zogonana; machitidwe owonetsa komanso kugonana; kapena ubale pakati pa onse atatu). Muma gulu awa, zotsatira zinalekanitsidwa malinga ndi kuzunza kwa zomwe zanenedwazo. Timagwiritsa ntchito mawu akuti 'kulosera' kutanthauza zidziwitso zazitali kutanthauza chinthu chimodzi chopita ku chinthu china. Zotsatira zamtundu komanso neuroimaging, kukhala wapadera, zidanenedwa m'magawo awo.

(a) Kuchita zinthu mopupuluma komanso mwamakhalidwe

(i) Kusintha ndi kugwiritsa ntchito zinthu

Kugwiritsa ntchito chidziwitso kuchokera ku Philadelphia Trajectory Study, sinthani pakapita nthawi podzinena 'kuchita zinthu osaganizira' zokhudzana kwambiri ndi kuchuluka kwa nthawi yogwiritsa ntchito mowa nthawi yomweyo [40]. Mu kafukufuku omwewo, zovuta zakuchedwa kukhutiritsa pa ntchito yodulira ndalama sizinakhudzidwe kwambiri ndi kumwa komweko, koma zinali ndi ubale wapakati pa kumwa kwambiri (mwachitsanzo, kumamwa kawiri kapena kupitirira kwa amuna, anayi kapena kupitilira apo kwa akazi opanda nthawi yokwanira). Mu kafukufuku woyembekezera wa mwezi wa 18 omwe amalembetsa amuna achikulire omwe amagonana ndi amuna, achangu komanso osafunikira komanso kufuna kudziwa zakumwa zomwe zanenedweratu (kumwa pafupipafupi kukhala ndi zakumwa zisanu kapena zingapo mkati mwa nthawi ya 2 h) kufunafuna chinyamata kunanenedweratu45]. Mu kafukufuku woyembekezeredwa, kulembetsa ana aamuna aku koleji aamuna, otsogola, odziwonetsa okha omwe adayesedwa chaka chawo choyamba cha koleji adaneneratu kuti azidzamwa kawiri kawiri 1 pambuyo pake [41].

Dongosolo la zakumwa zoledzera mu kafukufuku woyeserera wa labotale silinakhudzane kwambiri ndi kukakamizidwa (momwe munthu akumvera kukhala wokakamira, wolimba mtima, ndi zina zotero pakadali pano) -odziwonetsa yekha pamankhwala ena okhudzana ndi kugonana kwa achinyamata, amuna kapena akazi okhaokha, osamwa vuto [35].

Mwa oledzera omwe amakhala nthawi zina, kuyamwa kwamankhwala ogwirira ntchito kumalumikizidwa ndi kuchotsera pang'ono pamitengo ya ziphuphu zama hypothetical kuposa placebo (mwachitsanzo, kuchepa kwa chidwi). Komabe, mu kafukufuku womwewo, mowa sunalimbikitse kwambiri kuchepetsedwa kwa ndalama zenizeni kapena zachinyengo [24].

(ii) Kusokonezeka ndi vuto la kugwiritsa ntchito / kugwiritsidwa ntchito

Pakafukufuku woyeserera wosakhudzana ndi kayendetsedwe ka zinthu poyerekeza ndi omwe akukwaniritsa njira zomwe DSM-IV amadalira zakumwa zoledzeretsa ndi mitu yankhanza, kusiyana pakati pa gulu pankhani yochepetsera ndalama kunanenedwa [38].

Ma labotale othandizira odwala omwe ali ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo a cocaine adayambanso kupeza phindu lochulukitsa komanso kuchotsera mankhwala a cocaine monga momwe zimakhalira ndi ena mwa omwe amamwa zakumwa za kafukufukuyu. Kuphatikiza apo, kuchuluka kwa mowa pa kuchotsera kotheka sikunachitike ndi cocaine [39].

(iii) Chidule

Zotsatira zikugwirizana ndi mfundo yoti kudziwonetsa mochulukirapo, kudzidziwitsa kumayenderana ndi kumwa kwambiri komanso kumwa kwambiri. Komabe, umboni wothandizira maubwenzi omwe amamwa mowa ndikuwonongeka kwakumwa kosagwiritsidwa ntchito mosachedwa amasakanikirana. Zakumwa zoledzeretsa koma osagwiritsa ntchito cocaine zimapangitsa kuchotsera ndalama, koma osazengereza kuchotsera ndalama.

(b) Kuchita zinthu mosaganizira komanso zogonana

(i) Kuthamangitsidwa komanso kugonana

Mwa ophunzira oyamba ophunzira chaka chotsatira omwe amakhala akuyembekeza kuti azidzipanga okha mwezi uliwonse, kuchita chidwi komwe kunanenedweratu kunanenedwa kugonana mkamwa (ndizotsatira zomwe zimapangitsa chidwi chofuna kumva). Kufunsanso zaubongo komanso zogwirizana ndi pafupipafupi pakugonana -36]. Mu Philadelphia Trajectory Study, kukumbukira kochita zolimba kunaneneratu mwayi wokhala wogonana (makamaka osatetezedwa) potsatira, wolumikizidwa ndi magawo otsika 'ochita mosaganizira' komanso magonedwe akulu ochulukirapo, magawo awiri okokomeza [40]. Mu kafukufuku omwewo, kuvomerezedwa kwakukulu kwa 'kuchita mosaganizira' komwe kumalumikizana ndi kugonana kosatetezeka. Panapezanso zotsimikizira zachabe. Mwa ophunzira omwe amagonana asanakwatirane, osachita kudziwika, amadzidziwitsa okha kapena kufuna-funa kugwiritsa ntchito kondomu pakufufuza komwe kumachitika pazaka za 1 chaka chilichonse [48].

Kafukufuku wambiri wokhudzana ndi kulowerera pakukonda kugwiritsa ntchito Gwiritsani Ntchito Kuleza Kugonana Kwachisembwere (SDDT) [51]. Pogwira ntchitoyi, ophunzira amafunsidwa kuti ndi anthu ati pazithunzi zomwe angaganize zogonana, zongoyerekeza, kutengera mawonekedwe okha, bola chilengedwe chinali cholondola ndipo amakonda umunthu wa munthuyo. Ophunzira alangizidwa kuti aganize kuti ndi osakwatiwa ndipo amapezeka popanda mwayi woyembekezera. Mwa omwe adasankhidwa, omwe akutenga nawo mbali amalangizidwa kuti asankhe anthu anayi omwe angafune (1) ndi ochepera (2) kufuna kugonana ndikusankha anthu omwe amawazindikira (3) osachepera (4) omwe ali ndi matenda opatsirana pogonana. (Matenda opatsirana pogonana). Ophunzirawo amafunsidwa mafunso angapo asanu ndi atatu owonera-analogue a aliyense wa iwo. Funso loyambilira limasiyana kuchokera pa 0 kuwonetsa zogonana mwachangu popanda kondomu kwa 100 yowonetsa zogonana posachedwa ndi kondomu. Mafunso pambuyo pake amasunga zonena za 0 ndikusintha zonena za 100 kuti ziwonjezere kuchedwa kwa kugonana ndi kondomu. Pazotsatira zokhudzana ndi ntchitoyi, tidaganizira mayankho a mafunso awa okhudzana ndi kugonana komanso kuchita zachiwerewere. Mu zitsanzo zamankhwala azimayi omwe ali ndi vuto la opioid, omwe amadziwika kuti amadziwika kuti ali ndi vuto,52] yokhudzana kwambiri ndi kusakhala ndi chidwi chodikirira kugonana komwe kutetezedwa ndi kondomu (kutanthauza kuchotsera kwakukulu pakugonana). Komabe, mu kafukufuku womwewo, zotsatira zachabe zomwe zidanenedwa pakati pa kuchotsedwera pakugonana ndi kuchotsera ndalama [37]. Zotsatira zofananira za kuchotsera kwa ndalama zimanenedwa mwa anthu omwe ali ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo a cocaine [53]. Mosiyana ndi zomwe zanenedwatu zodzipangitsa nokha [52], zopanda pake zosafunikira zidanenedwa pakati pa kudziwonetsa kwakukulu komanso kuchotsedwera kochita zogonana mwa akulu akulu [33].

(ii) Kuchita zachiwawa komanso kuchita zachiwerewere

Mwa ophunzira pasukulu yaumuna, odziwikiratu, odziwonetsa okha chaka choyamba cha koleji adaneneratu za nkhanza zachiwerewere (mwachitsanzo, kugonana kosafunikira, kukakamizidwa, kuyesedwa ndi kumaliza kugwiriridwa) kuyesedwa ndi chaka chachitatu cha koleji [41]. Zosachita kunena mokhazikika, zodziwonetseranso zokhudzana ndi kudzimbidwa kochita zachiwerewere pakati pa amuna achichepere akulu omwe adanenedwa pakuchitika kwa miyezi itatu [34]. Momwemonso, pakufufuza kwakanthawi zaka zambirimbiri za 4 ku koleji, magulu ochepa a abambo omaliza maphunziro omwe adagwiritsa ntchito njira zamitundumitundu zosinthika onse adanenapo zambiri kuposa omwe sanachitire chipongwe chifukwa cha zomwe amadzinenera okha kuphatikiza kudziwonetsa okha. Kuphatikiza apo, omwe agwirizira kugwiriridwa mwamphamvu anakweza kwambiri izi pazinthu zowonongekerazi kuposa mitundu ina ya olakwa [50].

M'malingaliro a kafukufuku woyeserera, wowerengetsa zakumwa zoledzeretsa, ubale womwe unadzinenedwe weomwe wachita zachiwerewere ndi cholinga chokana kugwiritsa ntchito kondomu zidaperekedwa ndi kudzidziwitsa komwe boma limachita [35].

(iii) Chidule

Pofufuza / zoyembekezera, zodziwikiratu, zodziwikiratu, zidanenedweratu zakugonana kuphatikiza popanda kondomu, ngakhale panali zomwe sizinachitike. Panalinso umboni wa kulumikizana pakati pa kudziletsa, kudziimba mlandu komanso kuchotsera kuchepa kwa chiwerewere (kutanthauza kuti anali wofunitsitsa kudikirira kondomu) pofufuza zoyeserera komabe kunapezeka kuti sizinapezeke kanthu. Kuchotsera kuchepa kwa ndalama sikunali kogwirizana kwambiri ndi kuchotsera kozengereza pakugonana. Kupenyerera / kuyembekezera komanso kuyesera komwe kwalumikizidwa kumapangitsa kuti achite zachiwerewere.

(c) Kuchita zachiwerewere

(i) Kugwiritsa ntchito mankhwala osokoneza bongo komanso kugonana

Mwa omaliza maphunziro achimuna a chaka chatha mu kafukufuku yemwe amakhala ndi malipoti a mwezi uliwonse, kumwa kwambiri ndi chamba kugwiritsa ntchito ziwonetsero zoyerekeza kuchita komanso kulandira pakamwa komanso kumaliseche [36]. Pakufufuza kwakanthawi kochepa komwe kumalembetsa ana omwe sanachite zachiwerewere, oledzera ochepetsetsa omwe adanenedweratu molingana ndi chiwerewere (makamaka azimayi), koma pamene kuledzera kumawonjezeka, mwayi wogonana wosatetezeka ukuwonjezeka kwambiri.46]. Mwa ogonana ophunzira azaka zoyambira chaka chimodzi, kumwa mowa mwauchidakwa (uliwonse kapena wolemera) kunali kotheka kuchita zachiwerewere ndi omwe sazidziwa bwino. Izi sizinali choncho chamba, chomwe chimalumikizidwa ndi kuchepa kwa kugonana kwakutetezedwa m'magulu okhazikika [48].

Pakafukufuku woyesa wa labotale wophatikiza kuyendetsa zakumwa zoledzeretsa anthu omwe alibe vuto lomwa mowa, ochita nawo masewerawa adasankha zithunzi zambiri zosonyeza anthu ogonana nawo omwe amaganiza zolakwika atamwa moyerekeza ndi placebo. Mowa umaphatikizidwanso ndi kuwonjezeka komwe kumanenedwa kosalimbikitsa / kosangalatsa kwa kugonana / chikhumbo [24]. Phunziro lina labotale lolembetsa anthu omwe amamwa mowa popanda vuto la kugwiritsa ntchito chidakwa, kuledzera kumalumikizidwa mwachindunji ndi cholinga chokana kugwiritsa ntchito kondomu [35]. Mu kafukufuku wina wasayansi wa anthu ochita zachiwerewere, makamaka omwe amakhala achigololo (ambiri omwe amamwa kwambiri), kuledzera kumalumikizidwa ndi cholinga chogonana mosadziteteza [49].

(ii) Kugwiritsa ntchito mankhwala osokoneza bongo komanso kuchita zachiwerewere

Mwa omaliza maphunziro a chaka choyamba, kumwa mozama kotsukidwa komwe kumayenderana ndi chiwerewere chomwe chingachitike [41]. Kafukufuku wina, omwe amachititsa kuti azimayi omwe sanakwanitse kuchita zachiwerewere komanso omwe anali ovuta kuwamenya anali othekera kwambiri kuposa omwe amakakamiza anzawo kuti anene zakumwa kale.50]. Zotsatira zopezeka Null zidanenedwa pakati pa kumwa mowa ndi kuzunzidwanso pogonana [43] ndi kusokonekera [34] pakati pa achinyamata achikulire m'maphunziro ena.

(iii) Chidule

M'maphunziro owonera, kumwa kulikonse komanso kumwa kwambiri, mpaka pang'ono, kugwiritsa ntchito chamba kunali kogwirizana ndi mitundu yosiyanasiyana yogonana kuphatikiza kugonana kwa riskier. Kafukufuku woyeserera wa labotale adapereka umboni wamphamvu kuti zakumwa zoledzeretsa zimaphatikizidwa ndi cholinga chogonana mosadziteteza. Zachidziwikire, kafukufukuyu adaphatikiza zomwe zapezeketsa mowa zomwe zimapangitsa kuti achite zogonana ngakhale kuti ziwonetserozi zimawonjezeka modzidzimutsa pankhani zokhudzana ndi kugonana. Kafukufuku wowonera adaperekanso umboni womwe umagwirizanitsa mowa ndi mitundu yamtopola, komabe pali zomwe sizinapezeke.

(d) Kuchita zinthu motengeka, mwachidwi komanso mwakugonana

(i) Kuthamangitsidwa, kugwiritsa ntchito mankhwala osokoneza bongo komanso kugonana

Ubale womwe takambirana uja pakati pa kusintha kosachita zinthu osaganizira komanso zogonana, makamaka osagwiritsa ntchito kondomu mu Philadelphia Trajectory Study idasinthidwa pang'ono ndi kusintha kwa kumwa mowa [40]. Ponena za kudziletsa, pakati pa achinyamata achikulire omwe amagonana ndi abambo, ubale pakati pa kusalidwa ndi kumwa kwambiri ndikumwa zogonana osatetezedwa kunali kwamphamvu pakati pa omwe amadzinenera kuti ali ndi nkhawa kapena akuyenera [45]. Zomwe talongosola masiku ano zomwe zanenedwa zolumikizana ndi kuledzera kumawonjezereka ndi kugonana kosadziteteza zimayendetsedwa ndi ophunzira asukulu zam'maphunziro omwe ali ndi malire otsika mwamphamvu yolamulira [46]. Komabe, mwa ophunzira omwe amagonana asanakwatirane, osachita kudziwonetsa modzidzimutsa okha, kufunsa mwamphamvu komanso kufuna-funa kunanenedwa pa maubale angapo pakati pa kumwa mowa ndi kondomu [48].

Kafukufuku woyeserera osakhudzana ndi kayendetsedwe kazinthu, kudziwonetsa tokha zinthu zomwe zimagwiritsidwa ntchito zokhudzana kwambiri ndi kuchotsera kwakukulu kwa kugonana pa SDDT pakati pa achinyamata [33]. Kuphatikiza apo, anthu omwe amagwiritsa ntchito mankhwala osokoneza bongo a cocaine akuwonetsa kuchotsera kwambiri pa SDDT kuposa omwe akutenga nawo mbali, pazomwe zikuwonetsa kuti kugwiritsa ntchito mankhwala osokoneza bongo a cocaine kumalumikizidwa ndi zomwe zimapangitsa kuti asiye kugwiritsa ntchito kondomu [42]. Kugwiritsa ntchito mankhwala osokoneza bongo a cocaine kumasulira kukhala kutanthauza kugwiritsidwa ntchito moperewera, nthawi zambiri pamikhalidwe yocheza popanda kuchitapo kanthu komanso kuwonongeka kwa chipatala.

Mwa omwe amamwa nthawi ndi nthawi, oyang'anira zakumwa zoledzeretsa zimagwiritsidwa ntchito ndi kuchepetsedwa kwakukulu pakugonana. Kafukufuku yemweyo adayesa mtundu wotsika womwe umatanthauzika wa matenda omwe ali ndi matenda opatsirana pogonana. Kutsatira mowa, poyerekeza ndi placebo, otenga nawo mbali amatha kuvomereza zoopsa za matenda opatsirana pogonana. Zotsatira zofananazi zidanenedwa mu kafukufuku yemwe watchulidwa kale uja wa cocaine chifukwa cha kuchepetsedwa ndi ntchito zomwe zingachitike [39]. Mosiyana ndi izi, pakufufuza komwe takambirana apa kwa ogonana, makamaka amuna kapena akazi okhaokha [49], panalibe maubwenzi apakati pa kuchotsera ndalama [54] ndi mitundu ina yonse yowerengera potsatira kumwa mowa.

(ii) Kuthamangitsidwa, kugwiritsa ntchito zinthu zovuta ndi kugonana

Ophatikizidwa omwe ali ndi vuto lakumwa mowa [38], vuto la kugwiritsa ntchito opioid [37] ndi matenda ogwiritsira ntchito cocaine [42] yawonetsa kuchotsera kozengereza pakugonana pa SDDT kuposa omwe adawongolera.

(iii) Kuchita zinthu mwachisawawa, kugwiritsa ntchito mankhwala osokoneza bongo komanso kuchita zachiwerewere

Mwa omaliza maphunziro apachimayi, ambiri, odziwikiratu adaneneratu kuti akhoza kuchitidwanso zachipongwe, ngakhale atawerengera mavuto okhudzana ndi uchidakwa komanso kugwiritsa ntchito chamba [43].

(iv) Chidule

Kafukufuku wowonera / oyembekezera adathandizira ubale pakati pa anthu omwe amamwa, kumwa kwambiri ndikuledzera; ambiri, odziwonetsa okha kukhudzidwa; ndi kugonana kosadziteteza. Komabe, zotsimikizika zenizeni ndi zomwe zapezedwa zokhudzana ndi kuyimira pakati kapena kusinthira mosiyanasiyana pamaphunziro onse, kumachepetsa kufikira momwe lingaliro lenileni lingafikire. Kafukufuku woyeserera adapereka zotsatira zosasintha zomwe kugwiritsa ntchito zinthu zambiri komanso ma SUD zimagwirizanitsidwa ndi kuchotsera kochedwetsa zakugonana ndikuwonetsetsa kuti zakumwa zoledzeretsa zimaphatikizidwanso ndi kuchulukitsidwa kopitilira kugonana. Maubwenzi kuchotsera ndalama sikunali kolimba. Zotsatira zochepa zomwe zimapezeka mwa azimayi omaliza maphunziro a akazi zimalimbikitsa kukhudzidwa kwakukulu ndikuzunzidwa pamwambapa kuposa gawo la chamba komanso kumwa mowa mwauchidakwa.

4. Maphunziro amtundu komanso neuroimaging

Zambiri zamomwe zimapangidwira momwe kumwa mowa kumathandizira kuti ngozi zogonana zisavute. Ndemanga yathu idapereka maphunziro awiri oyenerera omwe ali ndi tanthauzo lotsatira. Kusanthula kwa ma genetic kunaphatikizidwa mu kafukufuku wamtunda wautali momwe omwe ophunzira amawunika koyambirira pachaka chawo choyamba ngati ophunzira oyamba [32]. Adagwiritsa ntchito 'phenotyping' kufotokozera zakunja zomwe zimaphatikizidwa ndi kugwiritsidwa ntchito molakwa, kugwiritsa ntchito mankhwala osokoneza bongo, kuyika magwiridwe antchito komanso kuchita chiwerewere ku 3281 single nucleotide polymorphisms (SNPs) mumitundu ya 104 yomwe yakhala ikugwirizana ndi kudalira mowa. Adanenanso kuyanjana kwakukulu pakati pa mayanjano pakati pa SNPs ndi zomwe zimapangitsa kunja, ngakhale kuti sizigwiritsa ntchito molakwika, kusakhazikika kapena kuchita zachiwerewere zoopsa pamodzi. Izi zikusonyeza kuti mayanjano pakati pa anthu omwe amadalira zakumwa zoledzeretsa komanso mitundu ina yakunja, kuphatikiza kugwiritsa ntchito molakwika zinthu zina, kukhudzika mtima ndi chiwerewere choopsa, zimayambitsa gawo limodzi pazinthu zodziwika bwino, ngakhale kuti majini sangakhale ndi vuto pakati pa mitundu yapadera ya mawonekedwe akunja. Pakafukufuku wina, kuwunika kwa majini-ndi-kudalira-kachilombo ka majini kunapangitsa kuti chizindikiritso cha LHPP rs34997829 [44], yomwe yalumikizidwa ndi zochitika zina zamagetsi [55]. Panali kulumikizana kwakukulu kotero kuti ubale wapakati pa LHPP rs34997829 ndi matenda opatsirana pogonana unasinthidwa ndikuwunika komwe kumadalira zakumwa zoledzeretsa, motero kutsimikizira kufunikira kwa SNP iyi pakugonana komanso vuto lomwa mowa. Kenako ofufuzawo adachitanso kafukufuku wina wotsatila ndipo adapeza C allele wa LHPP rs34997829 yokhudzana ndi mawonekedwe amachitidwe a neural m'magawo ogwirizana ndi kusokonekera (onani zowonjezera zamagetsi, tebulo S1). Mu kafukufuku wina wa fMRI, kuchuluka kwa chikhumbo chogonana komwe kumayenderana ndi zochitika zapakati pa dorsal anterior cingulate cortex (dACC) pakati pa amuna amuna ogonana amuna kapena akazi okha osachita mokakamiza. Kuwonetsa makanema okhudzana ndi kugonana kumalumikizidwa ndi kutsegulidwa kwakukulu kwa dACC, ventral striatum ndi amygdala mwa amuna omwe poyerekeza ndi osachita zogonana, komanso kulumikizana kwazinthu mkati mwa zigawo zomwe zimagwirizanitsidwa ndi chilakolako chogonana / kukhumba kwakukulu mu amuna omwe akukakamira. machitidwe azakugonana [47]. Kafukufuku waposachedwa kwambiri yemwe sanaphatikizidwe mu ndemanga yathu adapeza zochitika zapamwamba kwambiri zokhudzana ndi zithunzi zolaula kwa amuna omwe ali ndi vuto logwiritsa ntchito zolaula poyerekeza ndi omwe alibe [56]. Kugwiritsa ntchito zolaula pamavuto kwalumikizidwa ndi kutsimikizika kwakukulu pofufuza koyambirira [57]. Chizindikiro chodalira mpweya (okhathamira wamagetsi-m'magazi) mkati mwa chigawo chino chinali cholumikizidwa ndi nthawi yoyankha kuzinthu zolaula ndi chikhalidwe chamakhalidwe [56]. DACC, ventral striatum ndi amygdala agwirizanitsidwa ndi kubwezeretsanso kwa mankhwala osokoneza bongo komanso mbali zina zobwezera m'maphunziro am'mbuyomu [30,58]. Mwachidule, zomwe zimapezeka muubwino komanso zopatsa chidwi zimafotokoza zomwe zimachitika pokhudzana ndi chibadwa komanso ntchito zina zosagwirizana ndi magawo azinthu zazikulu zaubongo zomwe zimayambitsa ubale pakati pa kuchititsa chidwi, kuzolowera komanso kugonana.

5. Kukambirana

Chodabwitsa kwambiri ndizomwe zimapezeka kwambiri pakupenda kwathu ndi kuchuluka kwa kulosera kwakudziwikiratu. Kutengera ndi mtengo wake, njirazi ziyenera kuphatikizidwa muzofufuza zonse zokhudzana ndi zosokoneza bongo kapena machitidwe achiwerewere. Chosangalatsa, chodzidzimutsa pachokha chinali chongoyerekeza cha zotsatira zina zomwe zimanenedwa kuti zimachita zachiwerewere komanso zotsatira zakugonana pamaphunziro ndi zolinga zomwe zingakhale zoopsa, zogonana zogonana mu labotore [36,37,40,45]. Makamaka, mu maphunziro owonera, kukhudzidwa kwakukulu kunaneneratu ziwopsezo zonse zogonana ndi anyamata komanso kuvutitsidwa pakati pa akazi [34,41,43,50]. Njira iyi ikuwonetsa kuti kukhudzidwa kwakukulu kumaneneratu zochitika zogonana zomwe sizingagwiritsidwe ntchito, zomwe zimayendetsedwa gawo limodzi mwakuyembekeza kapena mphotho yeniyeni, ndi machitidwe azakugonana omwe angakhale okakamizidwa mwachilengedwe (mwachitsanzo zimachitika ngakhale zotsatirapo zoyipa komanso kuti sizingakhale zabwino). Unyamata wachinyamata omwe akuchita nawo maphunziro awa ndiwodziwika; Chifukwa chake, maubwenzi apakati pa kuchitirana chidwi komanso kuchita zachiwerewere / zochitika zogonana sizingatenge zaka zambiri kuti zitheke. Ngakhale kuti kafukufuku wopitilira kulembetsa amuna ndi akazi onse amafunikira, zotsatira zoyambirira zikusonyeza kuti zotsatirazi zimakhala za amuna ndi akazi achichepere.

Zomwe zapezekazi zikuthandizira kuwunika koyambirira kwa kusokonezeka kwapawiri pakati pa kuvuta ndi kugwiritsa ntchito zinthu [38,40,41,45]. Kuphatikiza kwa mowa mu labotale kunkagwirizana ndi kuchotsedwa kwa ndalama [24] ndi kuchedwa kwakukulu pakugonana ndi kuchotsera [24,39], zomwe zimakhudzana ndi kukakamira komanso zizolowezi zokhudzana ndi chiwerewere (ie chosatetezeka).

M'maphunziro owonera, kumwa kwambiri kunaneneratu zachiwerewere [36,46,48]. Ngakhale anaphatikizidwa m'maphunziro ochepa, kugwiritsidwa ntchito kwa chamba kumalumikizidwanso ndi zogonana, ndizopezeka zochepa zomwe zimagwirizanitsa kugwiritsa ntchito chamba kuti zitha kukhala ndi chiopsezo cha kugonana [36,48]. Pazofufuza zamankhwala oledzera, mowa samalumikizidwa osati zongofuna kuchita zogonana komanso komanso zambiri zomwe zanenedwe kuti sizinachite bwino [24]. Izi zikuwonjezera mwayi woti kugwiritsa ntchito moledzera, ngakhale pakati pa omwe alibe zovuta zakumwa zoledzeretsa, zitha kuyambitsa zochitika zogonana zomwe zitha kuonedwa ngati zowumiriza. Kuthekera uku kuyenera kuyankhidwa pakufufuza kwamtsogolo. Kumwa kwambiri kumagwirizananso ndi zachiwerewere [50], ngakhale zomwe zapezazi sizinali zogwirizana monga momwe anadziwitsira, kudziwikitsa mwachangu. Maubwenziwa akuwonetsa kuti kupewa kapena kuchitira nkhanza zogonana, kulimbana ndi zizolowezi zozikika kudzera mu mankhwala, kuchitapo kanthu kapena zina zonse zingakhale zopindulitsa.

Pazipezeka zomwe zikuthandizira maubwenzi pakati pa kusakhudzika komanso zizolowezi zokhudzana ndi chiwerewere komanso zokhudzana ndi kugonana kuchokera ku maphunziro ochepa omwe adaphatikiza miyeso ya zitatu zonsezi. Komabe, kuwonjezera pa maphunziro awa omwe anali ochepa, adaphatikiza miyeso yosiyanasiyana komanso maganizidwe osiyanasiyana pokhudzana ndi ubale pakati pa ophatikizira (mwachitsanzo okhudzana ndi kusinthitsa kapena kuyimira pakati). Maphunziro owonjezera mtsogolo akuyenera kuphatikiza miyeso itatu yonseyi. Kuphatikiza apo, SDDT ndi chida chofunikira chofufuzira kusiyana komwe kulipo pakati pa ena (mwachitsanzo, omwe ali ndi vuto lopanda mowa) ndikuwunikira zotsatira za kayendetsedwe ka zinthu mu labotale pofuna kukhazikitsa malingaliro osafunikira komanso oopsa pakugonana.

Nkhani zogonana ndi zochitika zogonana ndi amuna kapena akazi omwe si amuna kapena akazi okhaokha ndizoyenera; Komabe, ndi kafukufuku m'modzi yekha yemwe adayambitsa nkhaniyi. Phunziroli lidalembetsa amuna okha omwe amagonana ndi amuna. Phunziroli lidakweza nkhani yofunika yokhudza maubwenzi apakati pa anthu omwe ali ndi vuto logontha ndi zakumwa zoledzeretsa komanso zotsatila zomwe zimabweretsa chiwerewere, ponena kuti maubalewo amakhala olimba pakati pa anthu omwe akuwonetsa kukhudzidwa kwakukulu. Zili zakuti anthu omwe amachita mopupuluma amatha kukumana ndi vuto loyipa. Nkhani izi ziyenera kuyang'aniridwa mopitilira ndipo, ngati kuli koyenera, maphunziro ochulukirapo ayenera kulembetsa onse omwe akuchita zachiwerewere ndi omwe ali amuna kapena akazi okhaokha kuti alole kufananizidwa pakati pa magulu awa.

Zotsatira za genetics ndi neuroimaging ndizochepa, koma kafukufuku wophatikizidwa akuwonetsa SNPs zomwe zimagwirizana nthawi imodzi ndi kupangitsa chidwi komanso zizolowezi komanso chikhalidwe [32,44]. Momwemonso, zambiri zomwe zimapezeka mu neuroimaging zimapangitsa zigawo zaubongo zogwirizana ndi zinthu zitatu zonsezi, kuvumbulidwa pakupuma komanso pomaliza ntchito zogwirizana ndi kunyengerera komanso zogonana [44,47]. Makamaka, Voon ndi anzawo adanenanso kuti kulumikizana pakati pa dACC, ventral striatum ndi amygdala, omwe amafotokozeranso kusokonekera kwa mankhwala osokoneza bongo komanso kukopa, zomwe zimagwirizana kwambiri ndi chilakolako chogonana kuposa kukonda amuna omwe ali ndi chikhalidwe champhamvu chogonana [47,59]. Izi zikusonyeza kuti chinthu chofunikira pakukakamizidwa ndichofunika kwa oyanjana pakati pa kukakamira, kuzolowera komanso zokhudzana ndi kugonana. Kafukufuku wa genetic and neuroimaging ndi njira zomwe zimayenera kugwiritsidwanso ntchito popititsa patsogolo chidziwitso cha mitundu komanso magwiridwe antchito apadera ndi tanthauzo la mankhwalawa.

Ndemanga zomwe zidapezekazi zidali ndi malire kuphatikiza kusowa kwa zinthu zomwe zikuphatikiza vuto la kugwiritsidwa ntchito kwa zinthu zogwiritsidwa ntchito pakugonana / kuchitidwa zachipongwe komanso kusowa chonena pazomwe zakupezazi zikuyankhula mwachindunji ndi ubale pakati pa anthu atatu omwe ali ndi chidwi. Ntchito zogwira poyankha zinali kugwiritsidwa ntchito pang'ono. Kafukufukuyu pano sanawonekenso chifukwa chakuwona momwe anthu akusokonezera umunthu wawo komanso / kapena kuwunikira pakugwira nawo ntchito pakuwunika ndi kusanthula kwaukatswiri. Makhalidwe ndi zogonana zimangowona ngati zofunikira pazotsatira zake. Ngakhale izi ndizofunika, kafukufuku adayeseza kunyalanyaza machitidwe ogonana, zokondweretsa, zolinga ndi zina zokhudzana ndi momwe angathere poyambira kugwiritsa ntchito mankhwala osokoneza bongo kapena zomwe amachita. Kuwunikiranso sikunaphatikizepo maphunziro a zithunzi, ndipo izi ziyenera kufufuzidwa mtsogolo.

6. Kutsiliza

Zotsatira zakawunikidwe zaposachedwa zimatsutsa mwamphamvu kufunika kodzidziwitsa, kufunikira kwakukulu. Zachidziwikire, zomwe zapezazi zinaphatikizapo maubale okhudzana ndi chiwerewere komanso kuzunzidwanso, zotsatira zomwe zitha kuwonedwa kuti ndizofunikira pakukakamizidwa. Malipoti a kukhudzidwa kwakukulu ayenera kuphatikizidwa muzofufuza zonse zamtsogolo zokhudzana ndi machitidwe osokoneza bongo kapena kugonana. Kuledzera kwa mowa kumalumikizidwa ndi kuchotsera kwa ndalama pamodzi ndi kuthekera ndi kuchepetsedwa kuchotsedwa kwa zochitika zachiwerewere komanso kukulitsa zomwe zimapangitsa kuchita zachiwerewere kuphatikizapo zinthu zomwe zimawakakamiza. Zotsatira zakuwunikiraku zikugwirizana ndi kufunika kwa SDDT popanda komanso kuyang'anira zinthu mu labotale.

Ndemanga yomwe idapezekayi idazindikira mipata ingapo yofufuzira, kuphatikizapo kufunikira kwa maphunziro owonjezereka: kupereka lipoti pazamaubwenzi pakati pazinthu zomwe zimayambitsa chidwi komanso kuzolowera komanso kugonana; kulemba anthu amuna ndi akazi (komanso amuna osinthana) ndikuyesa kusiyana pakati pa zomwe amuna ndi akazi akuchita; kufufuza kusiyana komwe kungachitike pokhudzana ndi malingaliro okonda kugonana / zomwe amakonda kuchita pogonana ndi amuna kapena akazi anzawo; kuphunzira mitundu ya zokonda zogonana; kugwiritsa ntchito poyankha; ndikuphatikizira kuyesa kwa ma genetic ndi neuroimaging. Kafukufuku wamtsogolo wokhudzana ndi zinthu zitatu zonsezi nthawi imodzi akuyenera kuphatikiza zinthu zina osati mowa (kuphatikizapo fodya) limodzi ndi zovuta za njuga. Pokhudzana ndi izi, vuto lakosewera, komanso vuto lachiwerewere, lakhala likuphatikizidwa mgulu la khumi ndi limodzi la International Classization of matenda [60], ndipo masewera a masewera olimbitsa thupi ndi zolaula azitha kulumikizidwa munjira zopindulitsa [59]. Chifukwa chake, maubwenzi ovuta kuphatikiza kugwiritsa ntchito mankhwala osokoneza bongo ndi kulolerana pankhaniyi kumapangitsa kufufuza kwina.

Ngakhale zotsatira za kayendetsedwe ka zinthu (makamaka mowa) pakukhudzidwa ndi boma komanso zochitika zachiwerewere zakhala zikufufuzidwa pafupipafupi, makamaka osakhalapo anali maphunziro omwe amawunika kukhudzidwa kwa boma ndi kugwiritsidwa ntchito kwa zinthu chifukwa cha kukondweretsedwa kwa chilakolako chogonana, kudzuka, etc. kukhudzidwa kwa zinthu zosagwiritsidwa ntchito pazinthu zomwe zimayambitsa kukhudzidwa kwa boma ndi kugwiritsa ntchito zinthu (mwachitsanzo kupsinjika [61]). Zochita zogonana monga zomwe zimayambitsa chidwi chambiri komanso kugwiritsa ntchito mankhwala osokoneza bongo ziyenera kuyang'aniridwa pamaphunziro amtsogolo.

Potseka, kunyinyirika (makamaka, kudziwikiratu, kudziwuza) nthawi zambiri kumaneneratu zochitika zamakhalidwe oyenera komanso ogonana pamitundu yosiyanasiyana, zokhala ndi zovuta komanso kukakamizidwa kuchita izi. Kumwa moledzera nthawi zambiri kumawonjezera mikhalidwe yopanda chidwi, kuphatikizira zokonda kuchita zogonana komanso zomwe zitha kukakamiza. Ndemanga zomwe zapezekazi zidapeza mipata ingapo yomwe ikanayang'aniridwa mtsogolo mtsogolo.

Kupezeka kwa deta

Zowonjezera zomwe zidakwezedwa monga zinthu zowonjezera zamagetsi.

Zopereka za olemba

RFL, BHPR ndi NMG adathandizira kuwunikira mabuku. RFL idalemba zolemba zoyambirira pamanja ndi thandizo kuchokera ku BHPR ndi NMG; MNP idasinthanso zolemba pamanja ndikuyang'ana za kuwunikiranso ndi RFL Olemba onse adavomereza komaliza kuti zitha kusindikizidwa.

Zosangalatsa zovuta

Tikulengeza kuti tilibe nazo mpikisano. Dr Potenza awulula zotsatirazi. Dr Potenza adafunsira Shire, INSYS, Rivermend Health, Opiant / Lightlake Therapeutics ndi Jazz Pharmaceuticals; adalandira thandizo lofufuzira (kwa Yale) kuchokera ku Mohegan Sun Casino ndi National Center for Responsible Gaming; adachita nawo kafukufuku, kutumiza makalata kapena kulumikizana ndi matelefoni zokhudzana ndi kugwiritsa ntchito mankhwala osokoneza bongo, zovuta zowongolera kapena nkhani zina zamankhwala; adafunsana ndi / kapena adalangiza njuga ndi mabungwe amilandu pazinthu zokhudzana ndi kusokonezeka / kudziletsa; apereka chithandizo chachipatala mu pulogalamu yovutikira njuga; yachita zowunikira adakonza magazini ndi magawo a magazini; 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.

ndalama

Ndemanga iyi idathandizidwa ndi ndalama zochokera ku State of Florida, thandizo lochokera ku National Center for Advancing Translational Science of the National Institutes of Health under University of Florida Clinical and Translational Science Awards TL1TR001428 ndi UL1TR001427 ku NMG ndi NIH zopereka R21 AA023368 ndi UH2 AA026214 ndi UH01 AA035508 ndi UH50 AA09241 RFLMNP idathandizidwa ndi National Center for Responsible Gaming (Center of Excellence Girection), Dongosolo la Connecticut of Mental Health and Addiction Services, la Connecticut Council pavuto la Kutchova Juga ndi NIH (R01 DA026437, P01 DA039136, R01 DA040699, R21 DAXNXX DA040138, R03 DA045289 ndi RXNUMX DAXNUMX).

Mawu a M'munsi

Gawo limodzi la 14 pamutu wankhani 'Kutenga pachiwopsezo ndi kuchita zinthu mosafunikira: Zinthu zofunika kuzipeza, malingaliro ake ndi zotsatira zake zamatenda'.

Zinthu zowonjezera zamagetsi zimapezeka pa intaneti pa https://doi.org/10.6084/m9.figshare.c.4309340.