Zvinonyadzisira Zvinokanganisa: A Neuroscience Perspective (2011)

1. Dhipatimendi reNeurosurgery, University of Texas Health Science Center muSan Antonio, San Antonio, TX, USA
2. Dhipatimendi reNeurosurgery, University of Texas School of Law, Austin, TX, USA

Correspondence Address:
Clark Watts
Dhipatimendi reNeurosurgery, University of Texas School of Law, Austin, TX, USA

DOI:10.4103 / 2152-7806.76977

© 2011 Hilton DL Iri ibhuku rakasununguka-rinoparidzirwa pasi pemitemo yeChina Creative Commons Attribution License, iyo inobvumira kushandiswa kusingabvumirwi, kugoverwa, uye kubereka mune chero zvingasvibirira, zvakapa munyori wepakutanga uye chitubu.

Chinhu chakakosha chekutsanangurira uku ndechokuti zvose zvinodhakwa zvinokonzera, pamwe nekukemikemikari kuchinja muuropi, maitiro ehutano uye hutachiona hunoita kuti zviratidzo zvakasiyana-siyana zvehutano husina kunaka zvakanyorwa pamwe chete zvakanyorwa kunyengedzwa kwehana. Muchi syndromes idzi, chiremera chakakosha, chinoderedzwa kusvika tsanangudzo yaro yakajeka, inokanganisa "braking system" yeuropi. Vanonyatsozivikanwa kumakiriniki eurosiasayendisiti, zvikurukuru neurologist uye neurosurgeons, nokuti anowanikwawo nemaronda, kurohwa, uye kushungurudzika. Zvechokwadi, kutendeseka, kurasikirwa kwemashure ekutonga kwepamberi kunonyanya kuoneka mushure mekutsvaira, kwakaratidzwa neatrophy inofambira mberi ye lobe yapamberi inoonekwa mu serial MRI inoongorora kwenguva.

Kunyange zvazvo zvikamu zvakakosha zvekunyengedzera kwe syndromes-kusagadzikana, kusagadzikana, kushanda kwepfungwa, kutadza kutonga-kunotsanangurwa zvakanaka, zvizhinji zvehutano hazvizivikanwe. Imwe inotaridzika kune iyi inonyadzisa nyika ndeye kufanana kwavo nekuwana kune vakarovedza varwere. Kutaura nehupenzi, Fowler and said. akati, "zvidzidzo zvevarwere zvinoratidza kuderedzwa kwemaitiro emagetsi mumasitositofrontal cortex, nzvimbo yeuropi ... [yakatsigirwa] ... kuita sarudzo, pane kungofungidzira, zvisarudzo. Varwere vane kukuvadzwa kunorwadza kunharaunda iyi yeuropi vanoratidza matambudziko-kushungurudza, kusaruramisira kwemigumisiro yeramangwana, kusakwanisa kudzivisa mhinduro dzisina kukodzera dzakafanana nevaya vanocherechedza mune zvinodhaka zvinodhaka."[ 8 ] (kusimbisa kuwedzera).

Muna 2002, chidzidzo chekushaya zvinokonzerwa nekodhaine chakaratidza kurasikirwa kwemazwi akaenzana munzvimbo dzakasiyana dzeuropi, kusanganisira lobe frontal. [ 9 ] Purogiramu yekudzidza yaiva MRI-based protocol, voxel-based morphometry (VBM), uko 1 mm cubes yeuropi yakanatswa uye inofananidzwa. Chimwe chidzidzo cheVBM chakabudiswa mu 2004 pa methamphetamine, ine zviwanikwa zvakafanana. [ 27 ] Kunyange zvazvo zvichifadza, zvitsva izvi zvingasashamisika kune musayendisiti kana mutongi, sezvo aya ari "madhiragi chaiwo" anoshandiswa zvisina kururama. Kunyange zvakadaro, zvakanga zvakakosha kuti kusvuta kunogona kubudisa kuenzanisa, kuchinja kwehutano muuropi.

Zvimwe zvinodzidzisa ndezvakawanikwa zvakafanana zvinoratidzwa nekushungurudzwa kwemaitiro ezvakaberekwa zvehupenyu, kudya, zvichiita kuti uwedzere uye kuneta. Muna 2006, chidzidzo cheVBM chakabudiswa chichitarisa zvakananga nekunyanyisa, uye zvigumisiro zvakange zvakafanana nekocaine uye methamphetamine zvidzidzo. [ 20 ] Kudzidza kunobata muviri kwakaratidza nzvimbo dzakasiyana-siyana dzekurasikirwa kwevhesi, kunyanya mumaruva epamberi, nzvimbo dzine chokuita nokutonga uye kutonga. Ichi chidzidzo chakakosha mukuratidza kukanganisa kunooneka mune zvakasikwa zvekusagadzikana kwepanyama, asi zvinopesana nehuwandu hunodhaka hunodhaka. Uyezve, zviri nyore kugamuchira intuitively nokuti migumisiro yekudya kudya inogona kuonekwa mumunhu akaoma.

Kudya, zvechokwadi, kunokosha kumunhu mumwe nomumwe kupona, zvakakosha kuti upone yezvisikwa. Chimwe chiitiko chinodiwa pakupona kwezvipenyu ndechekuita zvepabonde, kutarisa kunotungamirira kumibvunzo yakawanda yemibvunzo yakabva mubasa rinorema. Zvingawanikwa here kuonekwa mukudya zvinodhaka zvinowanikwa mukuita zvepabonde zvakanyanya? Ko zvepabonde zvingave zvinokanganisa mu pfungwa yeuroyoiro here? Kana zvakadaro, pane izvo zvinowanzobatanidzwa nehutachiona hwematoriki hunoonekwa mune huropi hunoonekwa nezvimwe zvinodhaka here? Kuongorora kwemazuva ano kunotsigira huwandu huri kukura hwokuti kuita zvepabonde zvekunyengera kunogona kunge kuri kukanganisa. Muna 2007, chidzidzo cheVBM kubva kuGermany chakatarisa zvakananga pedophilia, uye chakaratidza zvakafanana kufanana nekuwana cocaine, methamphetamine, nekudzidza kwekuneta. [ 25 ] Inopedzisa kwekutanga kuti kugombedzerwa kwepabonde kunogona kukonzera kuchinja kwemuviri, kutomic muuropi, chiratidzo cheuropi chinodhaka. Chirongwa chekutanga chakaratidzika kuratidzika kusina kushanda zvakakwana nevarwere vasingakwanisi kudzora tsika yavo yepabonde. [ 16 ] Chidzidzo ichi chakashandiswa kuparadzanisa MRI kuti iongorore basa rekushandura kwehutano kuburikidza nemuchena. Yakaratidza kusakosha mune imwe nzvimbo yakatarisa nzvimbo, nzvimbo inobatanidzwa nekumanikidza.

Makumi gumi apfuura Dr. Howard Shaffer paHarvard akanyora, "Ndakanga ndine dambudziko rakawanda nevandaifambidzana navo pandakakurudzira kuti kuwanda kwekudhakwa kunokonzerwa nekuziva ... kudzokorora, kukwirira-mafungiro, hukuru-hukuru ruzivo. Asi zvakajeka kuti kusagadzikana-kureva kuti, kuchinja mumagetsi emagetsi anobatsira kubatsiridza hutano-kunoitika kunyange pasina kushandiswa kwemishonga. "[ 13 ] Munguva pfupi yapfuura akanyora, "Kunyange zvazvo zvichibvira kukakavadzana kana tichifanira kusanganisira zvinhu kana kushandiswa kwemishonga mukati meumambo hwekudhakwa, zvepamutemo pane zvishoma. Kungofanana nekushandiswa kwezvinhu zvakanyanyisa kunokonzera kunyengedza kwemamorikari kunotsvaka nzvimbo dzinogamuchirwa mukati meuropi, mabasa evanhu anokurudzira kuitika kwemaurotransmitter. Basa rezvinhu izvi zvinowanzoitika psychoactive zvinhu zvinogona kugadziriswa sezvinokosha vamiririri vevakawanda vanoita zvinodhaka. "[ 24 ]

Muna 2005, Dr. Eric Nestler akanyora pepa rakakosha rinorondedzera kukanganisa kwose sekusavhiringidza kwemazisolimbic mibairo yeuropi. Zvinodhaka zvinowanikwa apo migwagwa yemufaro / mibayiro inopambwa nemishonga yakawandisa yakadai seye cocaine kana opioids, kana nehutachiona hunodiwa uye inofanirwa kupona sekudya uye zvepabonde. Izvo zvinokonzerwa nedopaminergic zvinosanganisira nzvimbo ye ventral tegmental uye maitiro ayo kune nucleus accumbens nedzimwe nzvimbo dzinouraya. Akanyora kuti, "Kuwedzera uchapupu hunoratidza kuti VTA-NAc nenzira uye dzimwe nzvimbo dzinotaurwa pamusoro apa zvakafanana, pamwe chete muchikamu, maitiro akanaka akanaka emigumisiro yemuviri, zvakadai sekudya, zvepabonde uye kushamwaridzana kwevanhu. Idzi nzvimbo idzi dzakave dzakabatanidzwa mune izvo zvinonzi 'zvinokonzerwa nemasikirwo' (kureva, kumanikidzirwa kushandiswa kwemaropafadzo ezvisikwa) zvakadai sekurara kwekudya, kubhejera kwepabonde, uye zvepabonde zvepabonde. Zvakawanikwa kare zvinoratidza kuti nzira dzakagadziriswa dzinogona kuve dzakabatanidzwa: (muenzaniso ndeye) kukurudzirwa kwepamusoro-soro kunoitika pakati pezvipo zvepanyama uye zvinodhaka zvekushungurudzwa. "[ 18 ]

Izvi zvinotarisirwa kuitika (kana kuti zvakasikwa) zvinodhaka zvinodiwa zvinotarisa kushandiswa kwemagetsi kushandiswa kwemazisolimbic salience nzira. Kungofanana nekunyatsorongedzerwa kwemishonga kunokonzera kuderedza dopamine receptors mu nucleus inowanikwa mukudhakwa, uchapupu hunotsigira kushanda kwenguva refu neurotransmitter inokonzera chirwere chakafanana.

Yakaisvonaka yeRoyal Society yeLondon, yakatangwa mu1660s, inobudisa shanduro yakareba kwazvo yesayenzi mune zvenyika. Mumagazini yakangobva ku Philosophical Transactions of the Royal Society, hurumende yemazuva ano yekunzwisisa kukanganisa yakave yakarondedzerwa sezvo yakakurukurwa nedzimwe nyika inotungamirira kudhakwa kwevasayendisiti pamusangano weSosaiti. Musoro webhuku rekubudisa mharidzo yaiti musangano waiva "Irourobiology yekudhakwa-itsva vistas." Zvinonakidza, zvezvinyorwa zve17, zviviri zvakanyatsotarisana nehupupuriro hwekusagadzikana kwepanyama: pathologic kubheja [ 23 ] uye kudya kwazvo. [ 28 ] Peji yechitatu, kutarisa mhando dzemhuka dzezvinodhaka uye zvepanyama zvinodhaka, zvine chokuita neDeltaFosB. [ 19 ] DeltaFosB ipurotini yakadzidziswa naNestler iyo inoratidzika kunge inopfuura-inoratidzwa mumapurisa emakwenzi akapindwa muropa. Yakatanga kuwanikwa mumakwenzi ezvinyorwa akadzidziswa mukushandisa zvinodhaka [ 17 ] asi ikozvino yakawanikwa mukasius accumbens yakabatana nepamusoro-kushandiswa kwezvipo zvepanyama. [ 18 ] Pepanhau rechangobva kuongorora reDeltaFosB uye basa rayo mukudarika-kushandiswa kwezvikomborero zviviri zvepanyama, kudya, uye zvepabonde, zvinopedzisa: ... basa rakaratidzwa apa rinopa uchapupu hwokuti, kunze kwezvinodhaka zvekushungurudzwa, zvipo zvepanyama zvinokonzera ΔFosB mazinga muNac ... zvigumisiro zvedu zvinokonzera kukanganisa kuti ΔFosB kuiswa mu NAC inogona kunge inopindira kwete zvimwe chete zvinokosha zvezvinodhakwa zvinodhaka, asiwo zvimwe zvezvinhu zvinonzi zvinodhaka zvinokonzerwa nekugadzirisa kushandiswa kwezvipo zvepanyama. [ 29 ]

Kunyange zvakakosha mapepa emangwana akabudiswa mu2010 achitsanangura zvinokonzerwa nekuita zvepabonde neuroplasticity. Mune rumwe ruzivo, ruzivo rwepabonde rwaratidzwa kuratidza kuchinjwa mukati mepinini spiny neuroni mu nucleus inowanikwa zvakafanana kune inowanikwa nezvinodhaka zvekushungurudzwa. [ 21 ] Chimwe chidzidzo chakawana kuti zvepabonde zvinowedzera DeltaFosB mu nucleus accumbens, uye inoshandisa basa semurevereri mumarangariro emhando yepanyika. Ichi chidzidzo chakawanawo kuti kunyanya kufungidzira kweDeltaFosB kwakakonzera hypersexual syndrome. [ 22 ] Sezvakataurwa naDkt. Nestler, DeltaFosB inogona kuva "biomarker kuti iongorore kushandiswa kwemunhu mupiro wemitambo, uyewo chiyero chekuti munhu 'akarehwa', zvose panguva yekuvandudzwa kwechirwere uye kupfuurira kwaro kunonoka panguva yekuregererwa kwenguva refu kana kurapwa. "[ 22 ]

Dr. Nora Volkow, Mutungamiriri weNational Institute on Drug Abuse (NIDA), uye mumwe wevasayendisiti vakawanda vakaparidzirwa uye vanoremekedzwa mundima yekudhakwa ndeyekuti, pakuziva kuchinja kwekunzwisisa kushandiswa kwezvinhu zvakasikwa, kurudzira kushandura zita iyo NIDA kuNational Institute pamusoro Zvirwere Zvokurwisa, sezvinotaurwa mumagazini sainzi: "NIDA Mutevedzeri Nora Volkow akafungawo kuti zita redzimhosva rake rinofanira kusanganisira zvinodhaka zvakadai sekuona zvinonyadzisira, kubhejera, uye kudya, anodaro NIDA mutungamiri Glen Hanson. 'Anoda kutumira shoko rokuti [isu tinofanira] kutarisa munda wose.' "[ 7 ] (kusimbisa kuwedzera).

Nehuchapupu hunoramba huchiwedzera hwokuti kudya kwekudya kunogona kuve kusagadzikana kwechokwadi sezvinotsanangurwa nekuchinja kunogona kuoneka, kunovhenekera munzvimbo dzechimbichimba, nzvimbo yedu yekucherechedza dambudziko iri iri kuwedzera zvakakodzera. Asi hutano hwepabonde, pamwe nehutano hwakanaka, hunoitwa zvishoma nezvishoma mukurwisana kwesayenzi. Izvi zvakave pachena mushure mekudzidza kweHogg kwakabudiswa mu1997, iyo yakaratidza kudarika kwegore re 20 mune tarisiro yehupenyu yevanhurume vevanhukadzi. 12 ] Vanyori, sezviri pachena kunzwa manzwiro emagariro evanhu, vakabudisa tsananguro kuti varege kunyorwa izvo zvavakadana kuti "kurambana". [ 11 ] Kuti nyanzvi yezvesayenzi ingabudisa kubvunzurudza kwakadaro kwezvinhu zvakakoshawo. Tinotenda, zvisinei, nedzimwe nheyo yakatangira iyo nguva yekutanga kukurukurirana kukuru pamusoro pekutengesa zvepabonde uye zvikamu zvayo sekuona zvinonyadzisira.

Izvo zvinonzi DSM-5, yakagadzirirwa kuparidzira muna May we2014, iri mune iyi kuwedzera kutsva kuongororwa kweHypersexual Disorder, iyo inosanganisira kunetseka, kushungurudza zvinonyadzisira kunoshandisa. [ 1 ] Bhostwick naBucci, mumushumo wavo kunze kweMayo Clinic pavanorapa kushungurudzwa kwezvinonyadzisira zveIndaneti ne naltrexone, akanyora kuti "... mashandisirwo emagetsi mu ((zvinonyadzisira) anodhaka aPCC anowedzera kuwedzera kwekunyadzisa kwezvinodhaka, zvinopedzisira zvisizvo zvekusagadzirisa zvinodhaka , uye kuderedza kufarira kutsvaga chinangwa-chinotungamirirwa mabasa epakati pekupona. "[ 3 ]

Mune 2006 pasi pekuona zvinonyadzisa mari yaive 97 mabhiriyoni emadhora, kupfuura Microsoft, Google, Amazon, eBay, Yahoo, Apple, uye Netflix pamwe chete. [ 14 ] Izvi hazvirevi, zvisingaoneki, asi kune chido chekuita kuti zvisizvo zviitiko zvevanhu uye zvebiologic zvinokonzerwa nekuona zvinonyadzisira. Indasitiri yekuita zvepabonde yakabudirira yakajeka chero chipi zvacho chinopesana nekuona zvinonyadzisira sekubva mune zvechitendero / tsika; ivo vanobva vabvisa izvi zvinopesana seChitatu Chiri Kupikiswa. Kana kushaya zvinonyadzisira kunotaridzika zvakajeka, uchapupu hunoratidza kuti hunoita kuti hukuvadze vanhu pamusoro pekubatana-vaviri. [ 2 ] Kuwirirana (85%) pakati pekutarisa vana zvinonyadzisira uye kupindira muhukama hwepabonde nevana zvakaratidzwa naBourke naHernandez. [ 4 ] Kuoma kwehurukuro inongororwa pamusoro pezvokukurukurwa kwechinyorwa ichi zvakare inofananidzwa nekuedza kuderedza deta iyi pane zvekugarisana nevanhu. [ 15 ] Meta yakakurumidza kuongorora naHald and said. rinotsigira zvakasimba uye rinojekesa dhenda yapfuura ichiratidza kuwirirana pamusoro pezvinonyadzisira zvinokonzera chisimba maitiro pamusoro pevakadzi. [ 10 ] Nezvinyorwa zvakasimba izvi, hazvirevi kuti hazvifaniri kutarisa kuvepo kwekugona kukonzera mune izvi. Kudzokorora deta iyi muchirevo chekushandiswa kwemaitiro ikozvino kunyanya maererano; 87% yezera rekukoroji varume vanoona zvinonyadzisira, 50% vhiki nevhiki ne20 zuva rega rega kana rimwe zuva rimwe nerimwe, ne31% yevakadzi vachionawo. [ 5 ] Mhedziso yekufananidza yezvinonyadzisira pamusoro pekuita zvepabonde kune vechidiki yakaratidzwawo. [ 6 ]

Zvechokwadi basa redu sevanorapa rinoratidzira kuti tinogona kuita zvakawanda kuongorora nekubata zvirwere zvevanhu zvine chokuita nechinhu ichocho chitsva chekuita kana kushandiswa kwepanyama, zvikurukuru zvichipiwa kukura kwehumwe uchapupu hunotsigira neural basis yezvose zvinodhaka. Sezvatinoona kusagadzikana kwezvokudya seine biologic basis, pasina maitiro ekugadzirisa tsika kana izwi rakakosha, izwi ndiro nguva yatakatarisa zvinonyadzisira uye dzimwe nzira dzekuita zvepabonde nechinangwa chimwechete. Pari zvino, zvinetso zvepabonde zvinoita kuti vatungamiri vezvinonyadzisira varambe vachiita zvekuita mumatare ehurumende kana munzvimbo dzekutonga. [ 26 ] Nyaya iyi haisi chikumbiro chekuchinja maitiro acho chero nguva pfupi. Icho chirevo chinoda kukurudzira kuongororwa nemishonga munharaunda uye kliniki neuroscience inyanzvi zvakananga yebasa rekurapwa mune kutungamirirwa kwekudhakwa kwehutachiona hwekuona zvinonyadzisira.

Mukupedzisa pfungwa iyi, Public Health profile yezvinonyadzisira inogona kubatsira. Chero humwe huporofita hwakadaro nehupenyu hwahwo huchave hwakakosha nekuda kwehutano hwemazuva ano hwekuziva nezvekudhakwa uye nzvimbo inowanikwa. Tafura 1 iri kuedza kupa mamiriro akadaro emhosva yezvinonyadzisira, achishandisa semuenzaniso kufungisisa kwekuparara kwekorira muLondon mu1854, apo kunzwisisa kweHurumende hwehutano hwekodera nemishonga pamwe zvichida sepakutanga sekuona zvinonyadzisira nhasi. Nekucherechedza mupiro mukuru webhizimisi rezvinhu zvekuona zvinonyadzisira izvo zvichange zvichitarisirwa kuburikidza nehurumende dzisingabatsiri, zvinoratidzawo nzvimbo yekurapa mukutarisira kwekusvuta.