YBOP Faallooyinka: Fikradda qabatinka akhlaaqda ayaa muran ku ah qaar ka mid ah daaweeyayaasha iyo khabiirada jinsiga. Si kastaba ha noqotee, waxay u caddahay cilmi-baarayaasha in balwadaha akhlaaqdu ay sababaan isbeddellada maskaxda ee muraayadaha daroogada daroogada. Tani waa inay noqotaa, maadaama daroogada oo dhan ay sameyn karto ay tahay kordhin ama ka hortag farsamo jir ahaaneed oo caadi ah. Farsamooyinka maandooriyaha ayaa mar horeba ku jira maskaxda - isku xidhka ayaa ah tusaale muhiim ah. Markaa waxay u taagan tahay inay sababto in dabeecadaha ku lug leh kicinta sare ee farsamooyinkaas ay sidoo kale leeyihiin awood ay ku hogaamiyaan isbeddelada maskaxda ee la xiriira balwadda.
Background:
Dabeecado dhowr ah, ka sokow cunista walxaha nafsaaniga ah, waxay soo saaraan abaalmarin muddo-gaaban ah oo laga yaabo inay keento dabeecad joogto ah, in kasta oo aqoonta cawaaqib xumada, ie, ay hoos u dhigtay xakamaynta dhaqanka. Cilladahaas taariikh ahaan waxaa siyaabo kala duwan loogu fahmay. Mid ka mid ah aragtida ayaa ku dhejisa cilladahaas inay u jiifaan si xoog ah oo qasab ah, iyada oo qaarna loo qoondeeyey inay yihiin ciladaha xakameynta kicinta. Kala beddelka, laakiin aan isdhaafsanayn, fikirka ayaa u tixgeliya ciladaha kuwa aan walax lahayn ama balwadaha "habdhaqanka". Ujeeddooyinka: U sheeg wadahadalka ku saabsan xiriirka ka dhexeeya walxaha nafsaaniga ah iyo balwadaha akhlaaqda. Hababka: Waxaan dib u eegis ku sameynaa xogta muujineysa isku ekaanshaha iyo kala duwanaanshaha u dhexeeya khalkhalka xakameynta kicinta ama balwadaha akhlaaqda iyo balwadaha mukhaadaraadka. Mawduucani wuxuu si gaar ah ugu habboon yahay kala-soocidda ugu wanaagsan ee cilladahaas daabacaadda shanaad ee soo socota ee Ururka Cilmi-nafsiga Mareykanka ee Cudurka Cilmi-baarista iyo Buugga Tirakoobka ee Dhibaatooyinka Maskaxda (DSMV). Natiijooyinka: Caddeynta kobaca waxay soo jeedinaysaa in ciyaalku ay isku midka yihiin macaamiishu, oo ay ka mid yihiin taariikhda dabiiciga ah, ficil-celinta, dulqaad, ciribtirka, ku-darsiga hiddaha, hababka neurobiiga, iyo jawaab-celinta daaweynta, taageerada DSM-V Task Force soo jeediyay qayb cusub ee daroogada iyo cudurada la xariira taas oo ku jirta labadaba isticmaalka walxaha isticmaalka walxaha iyo walxaha aan la isticmaalin. Xogta hadda jirta ayaa soo jeedinaysa in qaybtaan la isku daro ay ku habboon tahay khamaarka cudurada iyo waxyaabo kale oo waxtar u leh akhbaaraadka akhlaaqda, sida, isticmaalka internetka. Waxaa hadda jira xog aan ku filnayn si loo caddeeyo nooc kasta oo ka mid ah waxyaabaha la soo jeediyey ee la soo jeediyey. Gabagabada iyo Cilmi-cilmi Siyaasadeed: Qoondaynta saxda ah ee macaamilka akhlaaqda ama xakamaynta kicinta wax-qabadku waxay leedahay saameyn ballaaran oo lagu hormarinayo istiraatiijiyada ka hortagga iyo daaweynta.
Cinwaanka u dir Dr. David A. Gorelick, 251 Bayview Boulevard, Baltimore, MD 21224, USA. E-mail: [emailka waa la ilaaliyay] Macnaheedu waa qabatimida habdhaqanka, kala saarid, ogaanshaha, khalkhalka xakamaynta kicinta, khalkhalka isticmaalka maandooriyaha
HORDHAC
Dabeecado dhowr ah, ka sokow cunista walxaha nafsaaniga ah, waxay soo saaraan abaalmarin waqti-gaaban ah oo laga yaabo inay keento dabeecad joogto ah inkasta oo ay aqoon u leedahay cawaaqib xumada, ie, hoos u dhigidda xakamaynta dhaqanka. Xakamaynta dhimistu waa fikrad qeexaysa asaasiga ah ee ku tiirsanaanta walaxda maskaxda ama balwadda. Isku ekaantan ayaa dhalisay fikradda ah waxyaabaha aan maandooriyaha ahayn ama balwadaha "dabeecadda" ah, tusaale ahaan, syndromes la mid ah balwadda maandooriyaha, laakiin leh feejignaan xagga dabeecadda ah oo aan ka ahayn cunista walax maskaxeed. Fikradda qabatinka akhlaaqda waxay leedahay xoogaa qiimeyn caafimaad oo cilmiyaysan iyo mid caafimaad, laakiin weli waa muran. Arimaha ku saabsan balwadaha akhlaaqda ayaa hadda laga doodayaa iyada oo la tixraacayo qaabka Buug-tilmaameedka iyo Buug-tirakoobka ee Dhibaatooyinka Maskaxda Shanaad (DSM-V) (1, 2)
Qaar ka mid ah macaamilka akhlaaqda ayaa loo maleynayaa in ay la mid yihiin kuwa la mid ah walxaha mukhaadaraadka. Tilmaame-barashada iyo tirakoobka hadda, Daabacaad afaraad (DSM-IV-TR) wuxuu u qoondeeyey shuruudaha lagu ogaanayo cudur-sidaha (tusaale ahaan, khamaarka ciridka, kleptomania), isaga oo u calaamadeynaya inay yihiin cilado xakameysan, oo ah qayb ka mid ah cudurrada isticmaalka maandooriyaha. Dabeecadaha kale (ama xakamaynta xakameynta kicinta) ayaa loo tixgeliyey in lagu daro iibsashada DSM-compulsive soo iibsanaya, maqaarka maqaarka, baaritaanka jinsiga (ficillada aan caadiga ahayn), qalabka xad-dhaafka ah, ciyaaraha kombiyuutarka / ciyaarta ciyaaraha, iyo isticmaalka internetka. Dabeecadaha ay ku jiraan inay ku daraan akhbaarta akhlaaqda waxay weli u furan yihiin dood (3). Dhammaan ma ahan xakamaynta xakameynta kicinta, ama cilladaha ay ku sifoobaan dareen diidmo, waa in loo tixgeliyaa inay tahay mabaa'diida akhlaaqda. Inkastoo qaar badan oo ka mid ah cudurrada kantaroolka xakameynaya (sida, khamaarka cudurada, kleptomania) ay u muuqdaan in ay wadaagaan astaamaha muhiimka ah ee macaamiishu, qaar kale, sida isdabajooga qarxa, maaha. Iyadoo rajada laga qabo in ay ka qaybqaato dooddan, qodobkan wuxuu dib u eegayaa caddaynta udhexeeya udhexeeya caadooyinka habdhaqanka iyo dhibaatooyinka isticmaalka walxaha, farqiga u dhaxeeya xanuunka khasabka ah, iyo qeexaya aagagga hubin la'aanta cilmi-baarista mustaqbalka. Waxay sidoo kale u adeegtaa hordhac ahaan qoraallada ku habboon ee arrintan ku saabsan, kuwaas oo dib u eegaya dabeecadaha khatarta ah ee suuban ee faahfaahsan.
KOOXAHA KOOXAHA ADEEGYADA MUWAADINKA AH: XIDHIIDHA LAGA HELI KARO XADIIDKA ISTICMAALKA ISTICMAALKA
Qodobka muhiimka ah ee mukhaadaraadka akhlaaqda waa fashilka in laga hortago kacaan, wadid, ama jahwareer si loo fuliyo ficil u nugul qofka ama dadka kale (4). Maan-qaadis kasta oo dabiiciga ah waxaa lagu gartaa habdhaqanka soo noqnoqda oo leh qaabkan muhiimka ah ee ku jira aag gaar ah. Ka-qaybgalka dib-u-celinta ee dabeecadahaas ayaa ugu dambeyntii faragalin ku sameeya shaqooyinka kale. Sidaa daraadeed, xayiraadaha anshaxeedku waxay u egtahay dhibaatooyinka isticmaalka maandooriyaha. Shakhsiyaadka leh macaamilka maandooriyeyaasha waxay dhibaatooyinka ka sheegaan inay iska caabinayaan rabitaanka cabitaanka ama isticmaalka mukhaadaraadka.
Dabeecadaha akhlaaqda iyo mukhaadaraadka waxay leeyihiin egyihiin badan oo taariikhda dabiiciga ah, cilmiga jir ahaaneed, iyo cawaaqib xumo. Labaduba waxay leeyihiin bilawga qaan-gaarnimada iyo qaan-gaarnimada dhalinyarada iyo heerar ka sareeya kooxahaan da 'ahaan marka loo eego kuwa waaweyn (5). Labaduba waxay leeyihiin taariikh dabiici ah oo laga yaabo inay soo bandhigaan qaabab dabadheeraad ah, oo soo noqnoqonaya, laakiin dad badan oo iskood uga soo kabanaya ayagoon helin daaweyn rasmi ah (waxa loogu yeero "iskaa wax u qabso") (6).
Balwadaha akhlaaqda waxaa badanaa ka horreeya dareenka "kacsanaan ama kacsanaan ka hor inta aan ficilka la sameyn" iyo "raaxo, raali ahaansho, ama gargaar waqtiga ficilka la sameynayo" (4). Dabeecadda ego-syntonic ee dabeecadahaani waxay khibrad ahaan la mid tahay waayo-aragnimada dabeecadaha isticmaalka maandooriyaha. Si kastaba ha noqotee, labadaba dabeecadaha iyo walxaha mukhaadaraadka labadaba waxay noqon karaan kuwo aan yareyn oo isdaba-joog ah iyo ego-dystonic waqti ka dib, maaddaama dabeecadda (oo ay ku jiraan walax qaadashada) lafteeda ay noqoto mid aan fiicnayn oo ka sii badan caado ama qasab (2, 7), ama noqda mid ku yar dhiirigelin wax ku ool ah iyo in badan oo ka mid ah xoojinta diidmada (tusaale, ka-gargaaridda dysphoria ama ka-noqoshada).
Akhlaaqda iyo balwadaha mukhaadaraadka waxay leeyihiin iskumid la mid ah. Dad badan oo qaba balwadaha akhlaaqda waxay soo sheegaan rabitaan ama xaalad xamaasad leh kahor intaanay bilaabin dhaqanka, sida shakhsiyaadka qaba dhibaatooyinka isticmaalka maandooriyaha kahor isticmaalka mukhaadaraadka. Intaa waxaa sii dheer, dabeecadahaani waxay badanaa yareeyaan welwelka waxayna keenaan xaalad niyadda wanaagsan ama "sare," oo la mid ah walxaha maandooriyaha. Dareemida shucuurta waxay gacan ka geysan kartaa jahwareerka xagga dabeecadaha iyo dhibaatooyinka isticmaalka mukhaadaraadka labadaba (8). Dad badan oo leh khamaarista cudurada wadnaha, kleptomania, dabeecadaha galmada ee qasabka ah, iyo iibsashada qasabka ah ayaa soo sheegaya hoos udhaca saameyntan niyadda wanaagsan ee leh dabeecadaha soo noqnoqda ama baahida loo qabo in la kordhiyo xoojinta dabeecada si loo gaaro saameyn isku mid ah, oo la mid ah dulqaadka (9-11) . Dad badan oo qaba balwadahaan akhlaaqda ah sidoo kale waxay soo sheegaan xaalad dysphoric ah iyagoo ka fogaanaya dabeecadaha, oo la mid ah ka noqoshada. Si kastaba ha noqotee, si ka duwan ka-noqoshada maandooriyaha, ma jiraan wax warbixinno ah oo ku saabsan jir ahaaneed oo caan ah ama caafimaad ahaan ka-noqoshada khatarta ah ee ka-macaamilka akhlaaqda.
Khamaarista nafsadda, oo si baaxad leh loo barto mabaadi'da akhlaaqda, waxay si faahfaahin dheeraad ah u faahfaahinaysaa xiriirka habdhaqanka habdhaqanka iyo dhibaatooyinka isticmaalka walxaha (eeg sidoo kale Wareham iyo Potenza, arrintan). Khamaarka boodhka wuxuu inta badan ka bilaabmaa carruurnimada ama qaan-gaarnimada, oo leh ragga raba in ay bilaabaan da'da hore (5, 12), oo muujinaya qaabka dhibaatooyinka isticmaalka maandooriyaha. Heerarka sare ee khamaarka cudurada wadnaha ayaa lagu arkay ragga, iyada oo leh dhacdo teleskoping ah oo lagu arkay dumarka (sida, haweenku waxay leeyihiin marxalado hore oo ah habdhaqan-takoorka, laakiin muddo ka horeysa xilliga ka-qaybgalka bilawga ah ee qabatinka) (13). Xaaladda telescoping ayaa si ballaaran loo diiwaangeliyay noocyo kala duwan oo isticmaalka maandooriyaha ah (14).
Sida dhibaatooyinka isticmaalka maandooriyaha, dhibaatooyinka maaliyadeed iyo kuwa guurku waxay ku badan yihiin caadifada akhlaaqda. Shakhsiyaadka leh daroogada akhlaaqda, sida kuwa leh macaamilka maandooriyaha, waxay badanaa samayn doonaan falal sharci darro ah, sida xatooyo, xatooyo, iyo inay qoraan shaashado xun, si ay u qaataan dabeecadooda khatarta ah ama la tacaalaan cawaaqibka dabeecadda (15).
Personality
Shakhsiyaadka leh habdhaqanka akhlaaqda iyo kuwa leh dhibaatooyinka isticmaalka maandooriyaha labadoodaba waxay sare u qaadaan tallaabooyinka is-qadarin la'aanta iyo dareen-raadinta oo guud ahaan hoos u dhigta cabbiridda ka-hortagga waxyeellada (16-20). Si kastaba ha noqotee, shakhsiyaadka leh qaar ka mid ah qabatimaadka akhlaaqda, sida isticmaalka internetka ama khamaarka xannibaadaha, ayaa sidoo kale laga yaabaa inay soo sheegaan heerarka sare ee ka hortagga waxyeelada (21) (eeg sidoo kale Weinstein iyo Lejoyeux, arrintan). Cilmi-baarisyo kale ayaa soo jeediyay in dhinacyada nafsiga, khilaafaadka dadka, iyo is-hanjabaadda ay dhammaantood ka ciyaari karaan doorka ku-xidhnaanshaha internetka (eeg Weinstein iyo Lejoyeux, arrintan). Taa bedelkeeda, shakhsiyaadka qaba cilladda qasabka ah ee caadiga ah waxay guud ahaan sare u qaadaan tallaabooyinka ka hortagga waxyeelada iyo yaraanta dareenka (17, 21). Shakhsiyaadka leh habdhaqanka akhlaaqda ayaa sidoo kale waxay sare u qaadaan tallaabooyinka isdhaafsiga, laakiin kuwani waxay ku xaddidnaan karaan kantaroolka naafada ee hawlaha maskaxda iyo walwalka ku saabsan inay lumiso xakamaynta dabeecadaha dhaqdhaqaaqa (22). Dhibaatada la xakameynayo jawaabaha gawaarida (dareen diidmo) waxaa laga helaa shakhsiyaadka qaba xanuunka qasabka ah ee maqaarka iyo maqaarka cudurada neefsiga (ficil-celin anshaxeed oo lala xiriiriyo xiriirka khatarta ah ee ku xiran cilladda feker-xumada), halka awoodda garashada (fekerka ah ee wax ku biirinta) xanuunka khasabka ah (23, 24).
TABLE 1. Qiyaasaha noolaanshaha ee dhibaatooyinka isticmaalka maandooriyaha ee mukhaadaraadka akhlaaqda.
Khamaarka nafsadda ah 35% -63%
Kleptomania 23% -50%
Maqaarka maqaarka ee 38%
Dabeecadaha galmada ee qasabka ah 64%
Isticmaalka internetka 38%
Iibsashada iibka 21% -46% Isha: (102).
Iskudhinimo
Inkasta oo daraasadaha wakiillada qaranka ee badankood aan lagu darin qiimeynta waxyaabaha la xariira dabeecadda, macluumaadka jiritaanka epidemiyeed waxay taageertaa xiriirka ka dhexeeya khamaarka cudurada khamaarka iyo isticmaalka walaxaha isticmaalka, oo leh heerar sare oo isku-dhafan oo dhinac walba ah (25, 26). Daraasadda St. Louis Epidemiologic Catchment Area (ECA) ayaa lagu ogaaday in heerarka sare ee isku dhafan ee dhibaatooyinka isticmaalka maandooriyaha (oo ay ku jiraan ku-tiirsanaanta nikotiinka) iyo khamaarka cudurada, oo leh saamiga ugu sarreeya ee guud ahaan lagu arko khamaarka, isticmaalka khamriga isticmaalka, 25). Daraasad faafin ah oo Canadian Canadian ah ayaa lagu qiyaasay in halista khatarta ee khamriga isticmaalka khamrigu uu kordhay 3.8-laab marka khamaarka khalkhalka la xaday (27). Shakhsiyaadka leh walxaha ku tiirsanaanta, khatarta ah khamaarka aadka u sarreeya ee khamaarka aadka u sarreeya wuxuu ahaa 2.9 times higher (28). Qiyaasaha boqolleyda oo ka bilaabma 3.3 illaa 23.1 ayaa laga soo sheegayaa cudurada khamaarka iyo isticmaalka khamriga ee daraasadaha ku saleysan dadweynaha Maraykanka (25, 29). Isticmaalka internetku wuxuu la xidhiidhaa isticmaalka khamriga (waxyeellada xad dhaafka ah ee 1.84) ee daraasadda ardayda 2,453, ka dib kantaroolka jinsiga, da'da iyo niyadjabka (30).
Shaybaarada xannaanada ee waxyaabaha kale ee daroogada dabeecada ah waxay soo jeedinayaan in isku-jirku ku dhaco xaaladaha isticmaalka maandooriyaha uu yahay mid caadi ah (Jaantus 1). Natiijooyinkaasi waxay soo jeedinayaan in waxyaabaha la xariira dabeecadda ay wadaagi karaan wadno-xanuunka caadiga ah ee leh dhibaatooyinka isticmaalka walaxda.
Si kastaba ha noqotee, xogta ku saabsan isticmaalka maandooriyaha waa in si taxadar leh loo fasiraa sababtoo ah ururada dariska ah ayaa laga yaabaa inay muujiyaan heer dabeecadeed (tusaale ahaan, isticmaalka khamrigu wuxuu joojiyaa dabeecado aan habooneyn, oo ay ku jiraan kuwa loo aqoonsaday inay yihiin wax la qabatimo) ama heerka cudurrada (tusaale, miyir-qabka akhlaaqda wuxuu bilaabmaa ka dib markii la daaweeyo khamriga, oo laga yaabo inay bedelaan cabitaanka). Khamaarayaasha dhibaatada leh ee isticmaalka khamrigu badanaa waxay leeyihiin khatar badan oo khamaar iyo dhibaatooyin nafsaani ah oo ka yimaada khamaarka marka loo eego kuwa aan lahayn taariikhda isticmaalka khamriga (31), iyo qaan-gaarrada udhexeeya khamriga badan ee khamriga waxay u badan tahay inay khamaaraan inta badan kuwa aan ahayn (32), soo jeedinta isdhexgalka habdhaqanka ee khamriga iyo khamaarka. Taa bedelkeeda, natiijo isku mid ah oo la xidhiidha isticmaalka nicotinku waxay muujinaysaa isdhexgalka isdabajoogga, sida xaqiiqda ah in dadka qaangaarka ah ee qaba khamaarka noolaha ee hadda jira ama ka hor sigaar cabbayaashu ay si aad ah u xoogan ku dhiirrigeliyaan inay khamaaraan (33). Khamaarayaasha dhibaatada isticmaala maalin kasta tubaakada waxay u badan tahay inay qabaan dhibaatooyinka isticmaalka khamriga iyo daroogada (34).
Xanuunada kale ee maskaxda, sida xanuunka niyadjabka weyn, xanuunka laba-cirifoodka, cilladda qasabka ah ee qasabka ah, iyo feejignaanta maqnaanshaha cillad-darrada, ayaa sidoo kale inta badan lagu soo wargaliyaa habdhaqanka habdhaqanka (35, 36) (eeg sidoo kaleWeinstein iyo Lejoyeux, arrintan). Si kastaba ha noqotee, in badan oo ka mid ah daraasaddan isdhexgalka waxay ku saleysneyd shay-baarka daaweynta. Xadka illaa natiijooyinka laga helayo natiijooyinka guud ee shaybaarada bulshada waa la go'aamiyaa.
Neurocognition
Cudurrada dabeecadda iyo dhibaatooyinka isticmaalka maandooriyaha ayaa yeelan kara sifooyinka guud ee garashada. Labada qof ee khamaarayaasha cudurada iyo shakhsiyaadka leh dhibaatooyinka isticmaalka maandooriyuhu waxay si caadi ah u qiimeeyaan abaalmarinta (37) waxayna fulinayaan hawlaha go'aan qaadashada (38) sida Iowa Khamaarista Hawlaha, oo ah barbaariye qiimeynaya go'aan qaadashada khatarta ah (39). Taa bedelkeeda, daraasad ku saabsan shakhsiyaadka leh isticmaalka maandooriyeyaasha internetka ma muujin wax khasaare ah oo ku yimaada go'aan qaadashada Iowa Khamaarista (40). Daraasad adigoo isticmaalaya batteriyaal dhameystiran oo ku saabsan 49 khamaarayaasha pathologists, 48 maadooyinka khamriga ku tiirsan, iyo 49 waxay ogaadeen in khamaarayaasha iyo khamriga labadaba ay muujiyeen hoos u dhigis waxqabad ee baaritaannada xakamaynta, dabacsanaanta garashada iyo hawlaha qorshaynta, laakiin aan lahayn kala duwanaansho imtixaannada hawl fulinta (41).
Nidaamka Noocyada Cudurrada Naaseed
Qayb ka mid ah suugaanta suugaanta ayaa ka tarjumaysa nidaamyo badan oo neurotransmitter ah (sida, serotonergic, dopaminergic, noradrenerger, opioidergic) oo ku jira fayaqooshada dabeecadaha dabeecadaha iyo dhibaatooyinka isticmaalka walaxda (42). Gaar ahaan, serotonin (5-HT), oo ku lug leh ka hortagga dabeecadda, iyo dopamine, oo ku lug leh barashada, dhiirigelinta, iyo salience ee xayawaanka, oo ay ku jiraan abaal-marinnada, waxay si weyn u-kordhin karaan labada nooc ee xanuunada (42, 43).
Caddeynta kaqaybgalka akotonerka ee ku-takooridda akhlaaqda iyo isticmaalka walaxda isticmaalka mukhaadaraadka waxay ka timaaddaa qaybo ka mid ah daraasaadka unugyada miyirka oogaamin oxidase B (MAO-B), taas oo xiriir la leh heerarka dheecaanka maskaxda (CSF) ee 5-hydroxyindole acetic acid (5-HIAA, metabolit ee 5-HT) waxaana loo tixgeliyaa calaamad muujinaysa 5-HT. Heerarka hoose ee CSN 5-HIAA waxay ku xiran yihiin heerar sare oo dareen-celin iyo dareen-raadin ah waxaana laga helay khamaaraha cudurada khamaarka iyo isticmaalka walaxaha (44). Daraasadaha cilmi baarista ah ee farmashiyada ee qiyaasta jawaabta hoormoonka ka dib marka la maamulo daawooyinka serotonergic waxay sidoo kale bixiyaan caddayn ku saabsan xanuunka serotonergic ee labadaba daroogada dabeecada iyo xaaladaha isticmaalka walaxda (45).
Isticmaalka marxaladaha ku-celcelinta maandooriyaha ama ka-qaybgalka aalkolada dabeecadda ka dib marka lagu dhiirri-geliyo waxay ka tarjumaysaa geedi socod midaysan. Daraasooyinka durugsan iyo kiliinikooyinka ayaa waxay soo jeedinayaan in habka aaladda noolaha ah ee loogu talagalay cudurrada dhiirrigelinta ah ay ku lug yeelanayaan habka waxqabadka soo-galinta ee soo galaya qaybta xuduudaha ee ventral space / nucleus accumbens / xudunta wareegga xudunta (46, 47). Goobta ku-meel-gaadhka ah ee ventral-ka waxaa ku jira nuoroyo sii dopamine si ay u soo saaraan nukleus galbeedka iyo kortex xagal hoose. Isbeddelka ku dhaca wadooyinka dopaminergic waxaa lagu soo jeediyay in ay ka soo jeedaan raadinta abaal-marin (khamaar, daroogo) oo kiciya daadinta dopamine oo soo saaraan dareen raaxo ah (48).
Caddeymo kooban oo ka yimid daraasadaha neerogirnimada ayaa waxay taageertaa nuucyada kala duwan ee habdhaqanka habdhaqanka iyo isticmaalka walxaha isticmaalka walxaha (7). Hoosudhaca dhaqdhaqaaqa kore ee xarumaha hore ee dhexdhexaadka ah (vmPFC) ayaa lala xiriiriyay go'aan qaadasho aan fiicnayn oo qiimayn halis ah oo lagu qiimeeyo iyo iyadoo la yareeyay jawaabaha khamaarka ee qamaarka cudurada wadnaha (49). Sidoo kale, waxqabadka vmPFC aan caadi ahayn ayaa laga helay dadka qaba dhibaatooyinka isticmaalka maandooriyaha (50). Dhaqdhaqaaqa maskaxda ee ciyaaraha maskaxda ee ciyaaraha internetka waxay ku dhacaan gobollada maskaxda ah (orbitofrontal, horjoogaha dorsolateral, xuubka hore, nucleus accumbens) sida kudhaca maskaxda ku xirnayd nacaybka maskaxda ee daroogooyinka daroogada (51) (eeg sidoo kale Weinstein iyo Lejoyeux, tan arrin).
Cilmi-baarista sawir-maskaxeed waxay soo jeedineysaa in dariiqa loo yaqaan 'dopaminergic mesolimbic' ee ka imanaya aagga marinka mareenka loo yaqaan 'nucleus accumbens' uu ku lug yeelan karo dhibaatooyinka isticmaalka maandooriyaha iyo khamaarka noolaha. Mawduucyada khamaarka noolaha waxay muujiyeen waxqabadka yar ee wadnaha neerfaha ee fMRI iyadoo la sameynayo khamaar la shayaadiyey marka loo eego maareynta maadooyinka (52), oo la mid ah u fiirsashada maadooyinka aalkolada ku tiirsan marka la sameynayo abaalmarinta lacageed (53). Hoosudhaca firfircoonaanta marinka mareenka ayaa sidoo kale lagu soo koobay damacyada la xiriira walaxda iyo balwadaha akhlaaqda (42). Ka-qaybgalka hawsha khamaarka waxay umuuqataa inay muujineyso sii deyn ballaaran oo loo yaqaan 'dopamine' oo loo yaqaan 'ventral striatum' ee shakhsiyaadka qaba cudurka Parkinson (PD) iyo khamaarka noolaha marka loo eego shakhsiyaadka qaba PD oo keliya (54), jawaab la mid ah tan ay soo bandhigeen daroogada ama daroogada la isku daray ee daroogada balwadaha leh (55)
Ka qayb qaadashada dopamine ee macaamilka akhlaaqda ayaa sidoo kale soo jeedineysa daraasadaha bukaanka daawada PD (56, 57). Laba daraasadood ee bukaanka qaba PD waxay heleen in wax ka badan 6% ay la kulmeen daroogo cusub oo la xariira habdhaqanka akhlaaqda ama xakameynta kumbuyuutarka (tusaale ahaan, khamaarista cudurada, xannibaadda galmada), oo leh heerar aad u sarreeya oo qaata daawada dopamine agonist (58, 59). Qiyaasta levo-dopa oo ka sarreeya waxa ay la xiriirtay suurtagalnimada in la helo wax qabad daro (59). Ka soo horjeeda waxa laga filan karo ka qayb qaadashada dopamine, antagonistayaasha dopamine D2 / D3 reseptors waxay kor u qaadaan dhiirigelinta iyo dabeecadaha la xiriira khamaarka ee dadka aan ka tirsanayn PDP ee leh khamaarka cudurada (60) oo aan waxtar u lahayn daaweynta khamaarka wadnaha (61, 62) . Cilmi-baaris dheeraad ah ayaa loo baahanyahay si loo caddeeyo doorka saxda ah ee dopamine ee khamaarka noolaha iyo waxyaabaha kale ee dabeecadaha la xiriira.
Taariikhda Qoyska iyo Genetics
Taariikhda qoyseedka qooyska / daraasaadka genetics ee daroogada dabeecadda ayaa loogu talagalay kooxo ku haboon (7). Daraasad qoys oo yar oo la socota khamaarista cudurada (63), kleptomania (64), ama iibsashada khasabka ah (65) ee mid waliba helay in asxaabta heerka koowaad ee probamadu ay si aad ah u sarreeyaan heerarka nolosha ee khamriga iyo dhibaatooyinka kale ee isticmaalka walxaha, iyo niyadjabka iyo cudurrada kale ee dhimirka, marka loo eego maadooyinka kontoroolka. Daraasadahan kantaroolka ah ee qoysku waxay taageeraan aragtida ah in macaamilada akhlaaq daradu ay yeelan karto xiriir hidde ah oo ku saabsan jirooyinka isticmaalka maandooriyaha.
Xubnaha hidaha iyo saamiga bay'ada ee dabeecadaha gaarka ah iyo jirrooyinka ayaa lagu qiyaasi karaa iyadoo la isbarbardhigayo isku dheelitirnaanta iyaga oo isku mid ah (monozygotic) Daraasad lagu sameeyay lab / dhedig oo lab ah oo la adeegsaday Vietnam Era Twin Registry, 12%% 20% ee khatarta hidde-gelyada khatarta ah ee khamaarka cudurada iyo 3% 8% ee isbeddelka deegaanka ee aan khatarta lahayn ee khatarta loogu talagalay khamaarka cudurada ayaa lagu xisaabtamay khatarta khamriga Isticmaal xanuunka (66). Saddex meelood labo (64%) oo ka mid ah isku-dhafka ka dhexeeya khamaarka jirada iyo khamriga isticmaalka khamrigu wuxuu sabab u yahay gen oo saameynaya labadaba, taas oo soo jeedinaysa in lagu soo rogo hoos-u-dhacyada hidaha ee labada xaaladood. Natiijooyinkaasi waxay la mid yihiin kuwa soo jeedinaya tabarrooyinka caadiga ah ee hidde-shuureedka ah ee noocyada kala duwan ee isticmaalka walxaha isticmaalka (67).
Waxaa jira daraasado hidde ah oo jimicsi ah oo ku saabsan macaamilka akhlaaqda. D2A1 allele ee hiddaha dopamine dopamine DNA (DRD2) wuxuu kordhiyaa inta jeer ee ka yimaada shakhsiyaadka qaba khamaar la'aanta khamaarista qamaarka iyo khalkhalka isticmaalka walxaha khatarta ah (2). Qaar ka mid ah DRD68 hoyga hal nucleotide polymorphisms (SNPs) ayaa lala xiriiriyey shakhsiyaadka shakhsiyaadka ah ee niyad-jabka iyo iskuduwida tijaabinta dabeecadda xakamaynta ee tabaruceyaasha caafimaadka leh (2), laakiin kuwaan looma qiimeyn dadka qaba dabeecadaha akhlaaqda. Isticmaalayaasha internet-ka ee xad-dhaafka ah waxay lahaayeen faafin dheer oo ka mid ah aleel dheer (SS) ee hidda-wadaha xanuunka serotonin (69HTTLPR) marka loo eego kontoroolka caafimaadka qaba, taasina waxay la xiriirtay ka fogaansho waxyeello weyn (5) (eeg sidoo kaleWeinstein iyo Lejoyeux, arrintan).
Ka jawaab celinta Daaweynta
Xayeysiinta dabeecadda iyo dhibaatooyinka isticmaalka maandoriyaha badanaaba waxay u jawaabaan si isku mid ah daaweynta isku midka ah, labadaba nafsaani-bulsho iyo farshaxanka labadaba. Nidaamka 12-talaabooyinka isdabajoogga, kobcinta dhiirigelinta, iyo daaweynta dabiiciga ah ee sida caadiga ah loo isticmaalo daaweynta jirooyinka isticmaalka maandooriyaha ayaa si guul ah loo isticmaalay si loo daaweeyo khamaarka noolaha, dabeecadda galmada, kleptomania, maqaarka maqaarka, iyo iibsashada qasabka (71-74) . Dhibaatooyinka nafsaani-bulshadeed ee labadaba dabeecadaha dabeecadda iyo isticmaalka maandooriyeyaasha labadaba waxay ku tiirsan yihiin dib-u-celinta dib-u-celinta oo dhiirigelineysa in la joojiyo iyadoo la aqoonsanayo qaababka xadgudubka, ka fogaanshaha ama la qabsashada xaaladaha halista sare leh, iyo samaynta isbeddel qaab nololeed oo xoojiya dabeecadaha caafimaad qabta. Taa bedelkeeda, daaweynta nafsaani-bulsheed ee guuleysiga ah ee loo yaqaan 'obsessivecompulsive disorder' ayaa xoogga saaray xeeladaha ka hortagga soo-saarka iyo jawaab-celinta (2).
Ma jiraan wax daawooyin ah oo la ansixiyey daaweynta dabeecadaha akhlaaqda, laakiin daawooyinka qaarkood oo muujiyay ballan qaadka daaweynta walxaha isticmaalka maandooriyaha ayaa sidoo kale muujiyay ballanqaad ku saabsan daaweynta waxyaabaha la xariira akhlaaqda (75). Naltrexone, oo ah mujinqadeeyaha maqaarka ee mu-opioid oo ay ansixisay Maamulka Cuntada iyo Dawooyinka ee Mareykanka ee ku saabsan daaweynta khamriga iyo ku-tiirsanaanta opioid, waxay muujisay waxtarka ku jira tijaabooyinka kiliinikada ee kontaroolida daaweynta qamaarka cudurada qaaxada iyo kleptomania (76-79), iyo balanqaadkii kantaroolka daraasaadka iibsashada qasabka ah (80), dabeecadda galmada ee qasabka ah (81), isticmaalka internetka (82), iyo maqaarka maqaarka (83). Natiijooyinkani waxay soo jeedinayaan in dukaamada M-opioid ay door muhiim ah ka ciyaari karaan macaamilka akhlaaqda marka ay ku sameeyaan xaaladaha isticmaalka walxaha, oo laga yaabo inay ku dhacaan habka dopaminergic patholimbic. Taas bedelkeeda, naloxone antagonist anti-Nacoxone gaaban oo fal-galka ah ee m-opioid-ka ayaa sii kordhaya calaamadaha xannuunada obsessive-compulsive (84).
Daawooyinka wax ka beddelaya hawlaha glutamatergic ayaa sidoo kale loo isticmaalay in lagu daaweeyo labalabaynta akhlaaqda iyo walxaha ku tiirsanaanta. Topiramate, oo ah anticonvulsant oo ka horjeeda AMPA nooc ka mid ah daaweenta glutamate (oo ka mid ah ficilada kale), ayaa muujiyay ballanqaad daraasado muujinaya daraasado furan oo la xidhiidha khamaarista quwadda, iibsashada qasabka, iyo maqaarka (compulsive skin picking) (85), iyo sidoo kale waxtarka yaraynta khamriga (86 ), sigaarka (87), iyo kookeynta (88). N-Acetyl Cysteine, amino acid oo dib u soo celineysa xoojinta glacamate ee xajmiga nucleus, dhiirigelinta khamaarka iyo dabeecada hal daraasad ee qamaarayaasha cudurada (89), iyo waxay yareyneysaa kookeynta cocaine (90) iyo isticmaalka kookaynta (91) ee ku jira cocaine addicts. Daraasooyinkan waxay soo jeedinayaan in qaabka glutamatergic ee dopaminergic ee ku jira sumadaha nucleus wuxuu noqon karaa mid ka mid ah habka caadiga ah ee qabatinka dabeecadda iyo dhibaatooyinka isticmaalka walxaha (92).
Arrimaha Diinta
Kaliya hal qabatin dabeecadeed, khamaarka noolaha, ayaa ah cilad lagu aqoonsaday DSM-IV iyo ICD-10. Astaamaheeda ogaanshaha ogaanshaha waxay la mid yihiin feker ahaan kuwa la xariira ku xadgudubka / ku tiirsanaanta maandooriyaha, yacni, ku mashquulida dabeecada, hoos u dhigida awooda xakameynta dhaqanka, dulqaadka, ka noqoshada, iyo cawaaqib xumada nafsiyeed ee bulshada. Kooxda Task Force DSM-V waxay soo jeediyeen in khamaarista cudurada wadata laga qaado kala soocideeda hada oo ah khalkhal xakamaynta kicinta loona qoondeeyo qaab cusub oo si toos ah loogu magac daray "Maandooriyeyaasha iyo Xanuunada La Xiriira," oo ay ku jiri doonaan labadaba dhibaatooyinka isticmaalka maandooriyaha iyo "balwadaha aan walxaha lahayn" (www.dsm5). org, waxaa la helay Febraayo 10, 2010). Isbedelka kaliya ee la soo jeediyey ee ah shuruudaha lagu ogaanayo cudurka waa hoos u dhigista shuruudaha ku saabsan guddinta falalka sharci darrada ah ee lagu maalgelinayo khamaarka, taas oo lagu ogaadey inay ku baahsan tahay saameyn yar iyo saameyn yar oo ku saabsan ogaanshaha cudurka.
Noocyada kale ee akhbaaraadka dabeecada ah ayaa soo jeediyay shuruudaha ogaanshaha, oo ay ku jiraan iibsashada qasabka ah (93), isticmaalka internetka (94), daroogada fiidiyowga / kombiyuuterka (95), isticmaalka jinsiga (96), iyo dharka xad-dhaafka ah (fiiri Kouroush et al., Arrintan) . Kuwani waxay badanaa ku saleysan yihiin shuruudaha jira ee DSM-IV ee ku saabsan isticmaalka mukhaadaraadka ama ku-tiirsanaanta, tusaale ahaan, waqti aad u badan oo lagu qaato dabeecadda, iskuday la isku dayay in lagu yareeyo ama joojiyo dabeecadda, hoos u dhigo xakameynta dabeecada, dulqaadka, ka-noqoshada, iyo maskaxda cawaaqibka. Kooxda shaqada ee 'DSM-V Mortality-Related Disorders' waxay tixgelinayaan dhawr ka mid ah waxyaabaha maan-adeegsiga ah ee lagu daro DSM-V, gaar ahaan kuwa ku xaddiga isticmaalka internetka (www.dsm5.org; helitaanka Feb. 10, 2010). Si kastaba ha noqotee, in badan oo ka mid ah cudurrada, waxaa jira xog yar ama aan haysanin xogta shuruudaha cudurka; waxay hadda yihiin kuwa ugu faa'iido badan sida qalabka sahanka ee lagu qiyaaso dhibaatada ka jirta dhibaatada.
Mid ka mid ah su'aasha lagu ogaanayo suugaanta ayaa ah meesha ay dabiicadaha caadifadda ah (iyo walaxda maandooriyaha) hoos u dhigaan cabbir la'aanta-isku-qasbashada (97), taas oo ah, ma waxay u badan yihiin sida xanuunka kantaroolka ah ee xakamaynta ama jirrado khasab ah? Qaar waxay ku doodeen in qaabkani qaab-dhismeedkiisu hooseeyo uu aad u fudud yahay, iyo in is-beddelka iyo qasdiggu uu ka dhigan yahay cabbirada qiyaasta ah, halkii ay ka soo horjeesan lahaayeen cabirada hal-hal (98). Iyada oo la tixraacayo doodda dambe ayaa ah natiijooyin sida isbeddel weyn oo ku yimaada heerka dareen la'aanta ah ee dadka qaba habdhaqanka habdhaqanka, kala duwanaansho laga yaabo inay la xiriirto jawaabta daaweynta daawooyinka xayawaanka (48, 99).
Marka la eego DSM-IV, isticmaalka walxaha (isticmaalka walaxaha isticmaalka) waa qayb madax-bannaan, halka khamaarka cudurada ee loo yaqaan 'pathological gambling' loo aqoonsan yahay khalkhalka kantaroolka, oo la mid ah tusaale ahaan, pyromania iyo kleptomania. ICD-10 waxay qeexaysaa khamaarka cudurada "caddaaladda iyo caqliga", laakiin wuxuu aqoonsan yahay in "dhaqanka uusan ahayn mid khasab ku ah farsamada farsamada", inkastoo mararka qaarkood loo yaqaan "khamaar qasab ah."
Arrin la xiriirta ayaa ah ururka, ama isu-geynta, haddii ay jirto, ka mid ah balwadaha akhlaaqda ee kala duwan. Falanqeyn kooxeed oo ku saabsan isbeddelada dadka iyo kiliinikada ee bukaanada 210 ee leh jahwareerka aasaasiga ah ee qasabka ah ayaa aqoonsaday laba qaybood oo kala duwan oo bukaanno leh dabeecad qabatin leh (100): bukaanada leh khamaarista cudurada ama galmada ("hypersexuality") waxay lahaayeen da 'hore oo bilow ah waxayna u badan tahay lab, marka loo eego bukaanka leh dukaamaysiga khasabka ah. Daraasad dheeri ah ayaa loo baahan yahay si loo xaqiijiyo loona kordhiyo natiijadan. Hal dariiqo oo cilmi baaris ah oo si weyn uga qayb qaadan kara goobta waxay noqon doontaa qiimeyn dhammaystiran oo ballaaran, noocyo kala geddisan, koox si fiican u sifaysan oo shakhsiyaad leh dabeecado kala duwan iyo balwado maandooriye ah marka loo eego qaybaha kaladuwan ee niyadjabka iyo qasab ahaanta labadaba cilmi nafsi (garasho) iyo dabeecad ( mootooyinka) domains, tusaale ahaan, dareen u lahaanshaha abaalmarinta dib u dhigista (dhimista ku meel gaarka ah ee abaalmarinta), go'aan qaadashada halista-abaalmarinta, qallafsanaanta fikradda ah, jawaab celinta degdegga ah, jawaab celinta adkeysiga, ka hortagga jawaab celinta, iyo barashada rogista.
Gebogebada iyo natiijooyinka
Caddaynta sii kordheysa waxay muujineysaa in balwadaha akhlaaqda ay u egyihiin waxyaabaha maandooriyeyaasha ah ee xayndaabyo badan, oo ay ku jiraan taariikhda dabiiciga ah (dabadheeraad ah, koorsooyin soo noqnoqonaya oo leh dhacdooyin aad u sarreeya iyo baahsanaanta dhalinyarada iyo dhalinyarada), cilmu-nafsiga (ujeedo gaar ah, sarkhaan [“sare”], iyo ka noqosho), dulqaad , isku-buuqsanaanta, ku-darsashada hidda-wadaha, farsamooyinka neerfaha (oo leh doorka maskaxda glutamatergic, opioidergic, serotonergic, iyo dopamine mesolimbic systems), iyo jawaab-celinta daaweynta. Si kastaba ha noqotee, xogta jirta ayaa aad ugu ballaaran khamaarka noolaha (eeg Wareham iyo Potenza, arrintan), oo leh xog kooban oo ku saabsan iibsashada qasabka ah (eeg Lejoyeaux iyo Weinstein, arrintan), balwadda internetka (eeg Weinstein iyo Lejoyeaux, arrintan), iyo qabatinka fiidiyowga / kumbuyuutarka (fiiri Weinstein, arrintan), iyo ku dhowaad xog kama hano qaadin akhlaaqda kale sida balwadda galmada (eeg Garcia iyo Thibaut, arrintan), qabatinka jacaylka (eeg Reynaud, arrintan), maqaarka cudurada laqaadayo (eeg Odlaug iyo Grant, arrintan), ama maqaar-dhaaf xad-dhaaf ah (eeg Kouroush et al., Arrintaan).
Waxaa jira caddayn ku filan oo lagu doonayo in la tixgeliyo marka la tixgelinayo khamaarka nafsadda ee loo yaqaan 'non-substance or dependence behavior'; DSM-V Task Force ayaa soo jeediyay in ay u kala wareejiyaan kala-soocitaankooda DSM-V oo ka yimaada khalkhalka xakamaynta kicinta illaa xad-dhaafka iyo xanuunada la xidhiidha (nooc cusub oo ku jira maaddooyinka la isku daro iyo kuwa aan walax ahayn). Xaaladda hadda jirta ee aqoonta, khaasatan maqnaanshaha shuruudaha lagu ogaanayo ogaanshaha iyo daraasaddaha mustaqbalka, wali waa waqti hore in la tixgeliyo waxyaabaha kale ee macaamilka akhlaaqda ah sida cilladaha madax-bannaan oo buuxa, inta badanna u kala dhigaan dhammaantood sida la mid ah macaamilka maandooriyaha, sida xakamaynta xakamaynta caqliga. Daraasad cilmi baaris ah oo mustaqbalka ah, oo ay ku jiraan daraasadaha aadanaha iyo xayawaanka (101), ayaa loo baahan yahay in la keeno aqoontayada akhbaaraadka akhbaaraadka habdhaqanka si loo eego heerka maadada walxaha, gaar ahaan meelaha ku yaal genetics, neurobiology (oo ay ku jiraan sawiridda maskaxda), iyo daaweyn.
Mahadnaq
Taageerada Barnaamijka Cilmi-baarista Intramural, Xarumaha Qaranka ee Halefka, Machadka Qaranka ee Xad-gudubka Daroogada (DAG); NIH (NIDA) waxay bixisaa R01 DA019139 (MNP) iyo RC1 DA028279 (JEG); iyo Minnesota iyo Yale Xarumaha Sare ee Cilmi-baarista Khamaarista, oo ay taageerto Xarunta Qaranka ee Ciyaaraha Maskaxda iyo Machadka Cilmi-baarista ee Khamaarista Khamaarista. Dr. Weinstein waxaa taageera Israel Institute of Psychobiology. Waxyaabaha qoraalku ka kooban yahay kaliya ayaa masuul ka ah qorayaasha oo aan daruuri ahayn inay metelaan ra'yiga rasmiga ah ee Xarunta Qaranka ee Masuulka Masuulka ama Machadka Cilmi-baarista Khamaarista Khamaarista ama mid kasta oo ka mid ah hay'adaha kale ee maalgelinta.
Cadeynta Miisaanka
Dhammaan qoraalladu wax war ah kama soo saarin xiisaha ku jira qodobkan. Dr. Grant waxa uu helay deeqo cilmi-baaris ah oo ka timid NIMH, NIDA, Xarunta Qaranka ee Masuulka Masuulka ah iyo Machadka Farsamada ee Cilmi-baarista Khamaarista Khamaarista, iyo Daawooyinka Xoolaha. Dr. Grant wuxuu helayaa magdhow sanadle ah oo ka socda Springer Publishing si uu u noqdo joornaalka Tifaftiraha Daraasaadka Daraasaadka Khamaarista, wuxuu sameeyey dib u eegis ku saabsan NIH iyo Ururka Khamaarka Ontario (Ontario Association of Bahming Fairs), wuxuu helay warqad ka timid Jaamacadda Oxford University Press, Washington Publishing, Inc. , Norton Press, iyo McGraw Hill, waxay ka heshay sharaf ka yimid Jaamacadda Indiana University Medical University, Jaamacadda Koonfurta Florida, Mayo Medical School, Bulshada California ee Daaweynta Maandooriyaha, Gobolka Arizona, Gobolka Massachusetts, Gobolka Oregon, Gobolka Nova Scotia, iyo Gobolka Alberta. Dr. Grant waxa uu magdhow u heley sidii lataliye dhinaca xafiisyada sharciga ah oo ku saabsan arrimaha la xiriira cudurrada kantaroolka ah. Dr. Potenza wuxuu taageero lacageed ama magdhow u helay arrimaha soo socda: la taliyaha iyo lataliye Boehringer Ingelheim; danaha dhaqaale ee Somaxon; Taageerada cilmi-baarista ee Machadka Qaranka ee Caafimaadka, Waaxda Hawlaha Ciidamda, Waaxda Qaranka ee Dagaalka, Mohegan Sun Casino, Xarunta Qaranka ee Masuulka Masuulka ah iyo Machadka Cilmi-baarista ee Cilmi-baarista Khamaarista Khamaarista, iyo Sheybaarada Xoolaha; wuxuu ka qaybqaatay baadhitaano, boosto ama la-talin telefoon oo la xidhiidha daroogada maandooriyaha, xakamaynta xakamaynta daroogada, ama mawduucyo caafimaad oo kale; waxay la tashatay xafiisyada sharciga ee arrimaha la xiriira daroogooyinka ama xakamaynta xeeladaynta kicinta; wuxuu bixiyay daryeelka bukaanka ee Waaxda Connecticut ee Adeegyada Khamaarista Khamaarka ee Adeegyada Caafimaadka Maskaxda iyo Adeegga Maandooriyaha; waxayna soo saartay buugag ama cutubyo buugaag ah oo loogu talagalay daabacayaasha qoraalada caafimaadka maskaxda. Dr.Weinstein wuxuu helay deeqo cilmi-baaris ah oo ka timid Hay'adda La-dagaallanka Mukhaadaraadka ee Israel, Machadka Qaran ee Is-bahaysiga Nabdoonaanta ee Ismaciilka, Cilmi-baaraha Sare ee Wasaaradda Caafimaadka, iyo Rashi Trust (Paris, Faransiiska) iyo khidmadaha mukhadaraadka daroogada Wasaaradda Waxbarashada ee Israa'iil. Dr. Gorelick ma sheegayo maalgelin la'aan ama khilaafyo xiiso leh.
tixraacyada
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