Mokhoa oa ho ntlafatsa methapo ea methapo ea tšusumetso nakong ea bocha: Nako ea bohlokoa ea ho lemalla ho lemala (2003)

Am J Psychiatry. 2003 June; 160(6): 1041-1052.
 
PMCID: PMC2919168
R. Andrew Chambers, MD, Jane R. Taylor, Ph.D., le Marc N. Potenza, MD, Ph.D.

inahaneloang

sepheo

Boithuto ba Epidemiological bo bonts'a hore ho etsa liteko ka lithethefatsi tse lemalloang le ho qala ha mathata a lemallo ho hlile ho shebane haholo le lilemong tsa bocha le ho ba motho e monyane lilemong. Bangoli ba hlalosa datha ea mantlha le ea bongaka e tšehetsang neurodevelopment ea bongoana e le nako ea bohlokoa ea bioloji ea ho ba kotsing ea ho lekola lintho le ho fumana mathata a tšebeliso ea lithethefatsi.

Method

Bangoli ba ile ba lekola lingoliloeng tsa morao-rao mabapi le ts'ebetso ea methapo ea methapo, ho susumetsa le ho lemalla, le ho tsepamisa maikutlo lithutong tse etsang lipatlisiso tsa bongoana ba bongoaneng.

Results

Adodecent neurodevelopment e etsahala libakeng tsa boko tse amanang le tšusumetso, ho hloka matla, le bokhoba. Tšusumetso ea bocha le / kapa mokhoa o mocha oa ho batla joalo ka mokhoa oa phetoho o ka hlalosoa ka karolo e 'ngoe ke liphetoho tsa kholo ho mekhoa e ikemetseng ea cortical le subcortical monoaminergic. Ts'ebetso tsena tsa nts'etsopele li ka khothaletsa litheko tsa ho ithuta tsa ho ikamahanya le maemo a batho ba baholo empa hape li ka fana ka tlokotsi e kholo liketsong tse lemalloang tsa lithethefatsi.

Nahanisisa

Phuputso ea liphetoho tse ntlafalitsoeng ho li-neurocircuitry tse kenyelletsoeng taolong ea tšusumetso e na le litlamorao tsa bohlokoa bakeng sa ho utloisisa boits'oaro ba bongoana, ho ba kotsing ea ho lemalla, le thibelo ea ho lemalla bokhobeng le ho ba motho e moholo.

Mathata a ts'ebeliso ea lithethefatsi ke sesosa se ka sehloohong sa ho senyeha ha bophelo bo botle ba bongaka, ho shoa ha batho le litšenyehelo tsa bophelo bo botle United States (1). Ho fumaneha ha lintho le litloaelo tsa maemo a bophelo sechabeng ho ama ho ata ha mathata a tšebeliso ea lithethefatsi (2). Maikutlo a mararo a maholo a fana ka maikutlo a hore nako ea bongoana le ho ba motho e moholo lilemong tsa mantlha ke lihokelo tsa tšebeliso ea lithethefatsi le lits'ebeliso tsa lithethefatsi, tse sebetsanang le litloaelo tsa moetlo le lintho. Taba ea pele, bacha le batho ba baholo lilemong ba bonts'a litekanyetso tse phahameng tsa teko ea tšebeliso ea litheko le tšebeliso ea litheko ho feta batho ba baholo, joalo ka ha ho bontšitsoe ke liphuputso tsa palo e akaretsang ea batho ba qalang lilemo tse mashome a mabeli tse fetileng le ka ts'ebeliso ea mekhoa e meng ea tlhahlobo (3-5). Taba ea bobeli, mathata a lemalloang ho batho ba baholo hangata a qala ho ba bohlankana kapa boroetsana.6, 7). Mohlala, batho ba baholo ba tsubang ba US ba qala ho tsuba pele ba tsofala 18 (8), 'me ho qala ho tsuba letsatsi le letsatsi ha ho tloaelehe ka mor'a lilemo tsa 25 (9). Ho feta 40% ea batho ba lemaletseng joala ba baholo ba ba le matšoao a amanang le bokhoba ba tahi pakeng tsa 15 le 19, le 80% ea linyeoe tsohle tsa botahoa li qalang pele ho lilemo tsa 30 (10). Nako ea bohareng ea ho qaleha ha tšebeliso ea lithethefatsi tse seng molaong ho batho ba nang le bothata ba tšebeliso ea lithethefatsi ke lilemo tsa 16, ka 50% ea linyeoe tse qalang pakeng tsa lilemo tsa 15 le 18 le ts'ebetso e sa tloaelehang ka mor'a lilemo tsa 20 (3). Taba ea boraro, tšimoloho ea tšebeliso ea lithethefatsi esale pele e bolela ho teba le ho putlama ha moriana, ho kenyelletsa ts'ebeliso ea - le mathata a ts'ebeliso ea lithethefatsi a amanang le lintho tse ngata (6, 11, 12). Leha lipatlisiso tsa lefutso li bonts'a ho ata ha mathata a ts'ebeliso ea lithethefatsi ho basali ho feta lithuto tsa basali ho theosa le lilemo, litekanyetso tsena tse ikhethileng tsa lilemo li bonoa lihlopheng tse nyane tsa banna le basali, ho fana ka maikutlo a ho ba teng hoa mabaka a ikemetseng bothateng ba nts'etsopele ea mathata a ts'ebeliso ea lithethefatsi. (4, 13).

Lintho tse peli tsa bohlokoa tlhahisong ea liphatsa tsa lefutso ke tekanyo ea 1) / tekanyo ea lithethefatsi le 2) ho ba kotsing ea ho lemalla ho fuoa lithethefatsi ka tekanyo e lekantsoeng ea tšebeliso ea lithethefatsi (14, 15). Ho utloisisa hore na ntlha e le 'ngoe kapa tse peli li kholo ho bohlankana ho bohlokoa ho hlalosa ho qaleha ha mathata a ts'ebeliso ea lithethefatsi. Le ha litšusumetso tsa setso, lithaka le lelapa li kenya letsoho ho fumaneheng ha lithethefatsi le ho etsa liteko litlhahlobong (16), lintlha tse 'maloa li fana ka maikutlo a hore likarolo tsa bophelo ba bongoana ka boyona ha li ikarabelle ka botlalo bakeng sa tšebeliso e kholo ea lithethefatsi. Le ha ho bapatsa le ho fumaneha ha lithethefatsi tsa molao (joala le nikotine) ho atile ho lihlopha tsa lilemo sechabeng sa Amerika 'me li fuoa tumello ea molao feela bakeng sa batho ba baholo, ho qala ha mathata a tšebeliso ea lithethefatsi tse amanang le lithethefatsi tsena ho kenelletse lilemong tsa bocha le ho ba motho e monyane lilemong' me ha li eketsehe. ka mokhoa o kopaneng le lilemo tse ntseng li eketseha. Europe, moo litloaelo tsa bacha le litekanyetso tsa sechaba mabapi le lintho tse fapaneng li fapaneng le tsa United States, ts'oaetso le mathata a amanang le ts'ebeliso ea lithethefatsi hangata a hlaha hangata ho bacha le ho batho ba baholo ba bacha (17, 18).

Lintho tse amanang le lefutso le liphatsa tsa lefutso ka har'a batho ho nahanoa hore li fokotsa monyetla oa ho pepesetsoa lithethefatsi tse hlokahalang bakeng sa "ho phunya switch" ho tloha litekong tsa ts'ebeliso ea lithethefatsi tse lemalloang (15). Bopaki bo ntseng bo eketseha ba kliniki bo bontša hore nako ea bocha e emela nako ea ho ba tlokotsing ea tlhaho ea tlhaho le thepa e kenelletseng ea lintho tse seng molaong le tse seng molaong. Mohlala, bacha ba bontša tsoelo-pele e hlakileng ea tšebeliso e seng molaong ea lithethefatsi ho feta batho ba baholo (4, 19). Leha a tsuba lisakerete tse nyane ho feta batho ba baholo, bacha ba bonts'a litekanyetso tse phahameng tsa ts'ebeliso maemong a tšoanang a ts'ebeliso (20), mme leha litekanyetso tsa tšebeliso ea joala li ts'oana lilemong tsohle tsa bocha le botsofaling, litekanyetso tsa tlhekefetso / ts'oaetso li fapana ka tsela e fapaneng le lilemo.5). Sengoliloeng sena se lekola bopaki ba mantlha le ba bongaka ba hore bana ba kena lilemong tsa bocha e le nako ea tlokotsi ea ho lemalla. Ho etsa boitšoaro ho bonahala ho bonahala ka ho nkeha maikutlo le ho etsa liqeto tse fokolang ho hlalosoa e le litšobotsi tse tloaelehileng tsa bocha tse tsamaellanang le nts'etsopele ea li-circry tsa "activate" tse amehang ho pathophysiology ea bokhoba. Liketsahalo tsa nts'etsopele tse tataisang ho khanna ho khothaletsa ho ithuta ka liphihlelo tsa batho ba baholo ka nako e ts'oanang li ka eketsa tlokotsi ho litlamorao tsa litla-morao tsa lithethefatsi tse tlatsetsang, tse lebisang khatellong ea tšebeliso ea lithethefatsi.

Eya ho:

Ho susumetsa le ho etsa liqeto

Ho ata ha mathata a tšebeliso ea lithethefatsi ho phahame ho batho ba baholo ba nang le lefu la kelello, mathata a maholo a amanang le mathata, mathata a botho le meeli ea meeli, le papali ea chelete ea methapo (2, 3, 10, 21, 22). Bacha ba nang le mefuta e hlalosoang kapa e hlalosoang ka botlalo ea mathata ana le bona ba na le mathata a ts'ebeliso ea lithethefatsi (23-25). Mekhatlo ea maloetse ana a kelello le bohlankana bo nang le mathata a ts'ebeliso ea lithethefatsi e bonts'a hore ts'ebetso e tloaelehileng ea ts'ebetso ea boko e ka beha kotsing ea ts'ebeliso ea ts'ebeliso ea lithethefatsi maemong ana a fapaneng. Mekgwa ena e ka bonahala e le sepheo sa bongaka se akaretsang kapa boits'oaro bo fetang bocha, mafu a kelello, kapa sehlopha sa ts'ebeliso ea lithethefatsi. Taolo ea tšusumetso e mpe e sa bonahaleng e emela e 'ngoe ea sepheo se joalo (23, 26, 27). Joalo ka ha ho e-na le litlatsetso tse ling tse hlalosang lefapheng la bongaka ba kelello, moelelo o hlakileng oa ho se tsitsinyehe le kamano ea oona litsobotsi tsa bocha kapa tsa ho ts'oasa maikutlo ke tse nyane. Ho fapanyetsanoe ka mefuta-futa ea khatello ea maikutlo, ho latela tekanyo ea kliniki le ts'ebetso ea libaka tse ikhethang tsa boko tse hlahlojoang (28). Mona re theha boiphetetso e le boits'oaro bo tataisoang ke sepheo bo khetholloang ka kahlolo e mpe ho fihlela meputso, joalo ka lithethefatsi tse lemalloang, thobalano, lijo, matla a sechaba (ka pefo), chelete, kapa lisebelisoa tse ling (27, 28). Ka tlhaloso ena, boits'oaro bo sa tsotelleng ka kakaretso bo lebisa liphellong tse mpe kapa tse mpe; boits'oaro bo khetholloang ka ho batla bocha ha bo naqeto kapa ho etsa liqeto tse fosahetseng ho ka nkuoa e le ntho e qobelloang (29).

Mathata a kelello a amanang le ts'ebetso ea moputso le tšebeliso ea litheko tsa tšebeliso ea lithethefatsi a amahanngoa le ho hloka matla (3, 27, 28, 30). Lisebelisoa tse lekanyang ho nka liqeto li bonts'a ho hloka toka e le khetho ea likhetho tse phahameng / tse nang le melemo e fokolang kapa meputso e tlase kapele ho feta meputso e liehang ho feta (phokotso ea nakoana) (31, 32). Mekhoa ea karabelo e potlakileng e fumanoe e amana le mathata a taolo ea tšusumetso, mathata a ts'ebeliso ea lithethefatsi, le tlhahlobo ea kelello le lefu la khatello ea maikutlo le / kapa tšebeliso ea tšebeliso ea lithethefatsi (comorbidity).26, 33). Leha lisebelisoa tse tšoanang li e-so sebelisoe lilemong tsa bocha, ho batla ho kenella le / kapa ho batla ntho e ncha ho sa tloaelehang ho bonoa ho eketseha lilemong tsa bocha le ho fokotseha ha motho a le lilemo (34, 35).

Ho utloisisa kamano pakeng tsa ho qhekella le mathata a ts'ebeliso ea lithethefatsi ho ka paka hore ho bohlokoa ho utloisisa pathogenesis ea mathata a ts'ebeliso ea lithethefatsi le ho ata ha tsona maemong a ikhethang a kliniki, ho kenyeletsa le bohlankana. Conceptualizations ea bongaka syndromes ea ts'ebeliso ea ts'ebeliso ea lithethefatsi le taolo e mpe ea ts'usumetso kapa likarolo tsa ho etsa liqeto li bontša mefuta e ts'oanang ea psychopathology e khothalletsoang. Batho ba nang le taolo e fokolang ea tšusumetso ha ba na tšekamelo e khahlisang ea ho etsa boits'oaro bo khetholloang ka litholoana tse telele tsa nako e telele. Ka mokhoa o ts'oanang, lintho tse lemalloang li kopantsoe hammoho le tšusumetso ea lik'hemik'hale le phetoho ea methapo ea methapo methapong ea tšusumetso ea boko, e lebisang tšebeliso e eketsehileng ea lithethefatsi ka litšenyehelo tsa liphetho tsa sechaba le tsa mosebetsi (15). Likhakanyo tsa maikutlo tsa bongaka tsa ho potlaka le ho lemalla ho latela litekanyetso tse sa sebetseng tsa ts'ebetso li ka bonts'a mekhoa e tloaelehileng ea neurobiological e kenyelletsang ts'ebetso ea methapo ea methapo.

Eya ho:

Neurocircuitry of Motivational Substrates

Ho utloisisa sebopeho le tšebetso ea lits'ebetso tsa ts'ebetso ea boko li ka fana ka leseli la bohlokoa mabapi le mangolo pakeng tsa ho qhekella, kotsi ea mathata a ts'ebeliso ea lithethefatsi, le bohlankana. Khothatso e ka hlalosoa e le ts'ebetso ea boko e sebetsang "ho kenya" tlhahisoleseling mabapi le boemo bo kahare ba tikoloho le mothokantle le ho bonts'a "tlhahiso"36). Sebakeng sa ts'ebetso e le sesebelisoa se bonolo sa Reflex se hlahisang boitšoaro bo sa hlakang ka karabelo ea tšusumetso e matla, khothatso e kenyelletsa ts'ebetso ea taelo e phahameng e hlophiselitsoeng ho hlophisa boits'oaro ho ntlafatsa pholoho (37). Boitšoaro bo tataisoang ke sepheo bo kenyelletsa ho kopanya tlhahisoleseling mabapi le linaha tse fetohang tse fapaneng tsa ka hare (mohlala, tlala, takatso ea thobalano, kapa bohloko) le maemo a tikoloho (ho kenyelletsa le menyetla ea lisebelisoa kapa ea ho beleha, ho ba teng ha kotsi) ho hlahiseng karabelo e ntle ea boits'oaro (31). Ho kenyelletsa ho rarahana hona, lipheo tse ngata tsa ho pholoha li ka ba tsa bohlokoa ka nako e ts'oanang empa ka boikemisetso li ka fihlella sebakeng le nako, 'me ho ka ba le lipalo tse kholo tsa maano a boitšoaro a atlehileng ho fihlella e le' ngoe kapa tse ling tsa lipheo tsena. Ts'ebetso ea methapo e khothalletsang kelello ka hona e lokela ho kenyelletsa mekhoa e ka emelang likoloi tse tsamaeang tse ling mme ea beha pele le ho khetha lits'oants'o tse loketseng bakeng sa ts'ebetso (36, 38).

Translos neuroscience e se e qala ho hlahisa bopaki ba neurobiological bo tšehetsang likhopolo tsena tsa kelello. Bohlokoa ba tšusumetso ho matla a thuto ea ho iphetola ha lintho bo ka bolela esale pele hore likarolo tse ngata tsa boko lia ameha, kamora mokhatlo o hlophisitsoeng oa boiketsiso le bo sebetsang o bolokiloeng ho mefuta eohle. Boithuto ba liphoofolo le ba batho bo supa ho ba teng ha potoloho ea mantlha e kenyelletsang cortex ea pele le "ventral striatum" e nang le phihlello ka kotlolloho le ts'usumetso ea meaho ea "tlhahiso"37). Sistimi ena e kantle e ts'ehetsoa ke potoloho ea bobeli e khothatsang e fanang ka lintlha tse ngata tsa "tlhahiso" ea kutlo ka mekhoa e tobileng ea axonal e fetohang likarolo tsa sepheo sa mantlha sa (Setšoantšo sa 1) (39-41). Mohlala, hippocampus le amygdala li fana ka mohopolo oa maemo le lintlha tse amanang le tšusumetso e khothalletsoang (31, 39, 42, 43), ha methapo ea kutlo ea "hypothalamic" le "septal" e fana ka tlhaiso-leseling e amanang le boits'oaro bo potlakileng kapa bo nang le tlhaho, bo kang ho kenella ka phepo, ho loana le karabelo ea ho ikatisa (44).

Tšoantšiso 1  

Mekhatlo e Meholo e Akaretsang ea Boroko e Akarelletsoa Haholo Kutulong, ho Etsang Liqeto le ho lemeng lithethefatsing.a

Liphumano tsa morao-rao li supa li-circray tse susumetsang tsa mantlha e le tse nang le palo ea li-neurons tse khonang ho hlahisa lipaterone tsa ho thunya tse ka kenyeletsang likarolo tse ngata tsa mekotla e khothalletsoang kapa tse khannoang tse khannoang (45). Lipontšo tsena li etsahala har'a li-envirles tsa neuronal tse hokahantsoeng ke likarolo tse tšoanang tsa projeke ea axonal ho tloha pele ho cortex ho ea ho ventral striatum (li-nucleus li bokellana ho "portral globus pallidus") ho thalamus le ho khutlela cortex (46, 47) (Setšoantšo sa 1 'me Setšoantšo sa 2). Li-cortical-striatal-thalamic-cortical loops li hlalosoa li ts'oana hobane likarolo tse ikhethileng tsa preortal cortex (mohlala, projeke ea anterior cingulate, ventromedial, le dorsolateral) li etsa likarolo tse ikhethileng kahare ho striatum, eo ka nako e 'ngoe e bolokang karohano e itseng lipakaneng tsa ho le thalamus le khutlela cortex (48). Bopaki ba anatomical le ba neurophysiological bo bonts'a hore mekhoa ea ho thunya ea li-envirles tsa neuronal kahare ho likarolo tse ikhethang tsa striatum li tsamaellana le mekhoa ea ho thunya ho li-subortal cortex tse ikhethang.42, 49). Ka lehlakoreng le leng, mekhoa ea ho thunya ka har'a li-nucleus tse bokellaneng le li-cortex tsa pele li susumetsoa ke ho kenella ha glutamatergic ho tsoa hippocampus le amygdala, ho fana ka maikutlo a hore tlhekefetso ho likarolo tsena tsa distal e ka hlahisa mafu a kelello le mathata a susumetsang (50). Hobane lipopae li na le tšusumetso e tobileng litsing tsa makoloi le likoloi tsa makoloi, ts'ebetso ea tsona e khetholla ka kotlolloho libaka tse susumetsang le tlhahiso ea boitšoaro (39, 44). Li bokelloa ka bongata ba γ-aminobutyric acid (GABA) -cic inhibitory neurons ka har'a striatum li buisana ka mekhoa ea boipheliso e kopaneng ea nako le nako e fanang ka maikutlo a bokhoni bo phahameng ba marang-rang a neural ho kenyelletsa palo e kholo ea mekhoa e meng e sa sebetseng ea ho thunya e ka sebetsang joalo ka lithibelo tsa moaho tse kopanetsoeng ea likoloi tse khabisitsoeng ka makhetlo a mangata, tse ntlafalitsoeng haholo (39, 47, 51-67).

Tšoantšiso 2  

Li-cortical-Striatal-Thalamic-Cortical Loops tse ka hare ho sephethephethe sa mathomo tse kentsoeng ho phatlalatso ea lipeipi tse susumetsoang le liketsahalo tse sa ts'oaneng le tsa ho nka qeto ka sepheo sa ho etsa liqeto.a

Bopaki bo felletseng bo fana ka maikutlo a hore li-drive tsa "neurocircuitry encoding" tsa likoloi tse susumetsoang tse sa susumetsoang li ka latela liketsahalo tsa neurobiological tse tlang pele le ho khetha lits'oants'o tse khothalletsoang bakeng sa ts'ebetso ea boits'oaro. Likarolo tse ikhethileng tsa neural li amana le ho khothaletsa (ho eketsa menyetla ea ts'ebetso) kapa ho thibela likhahla tse susumetsoang. Lits'oants'o tsa repertoire e susumetsang, ho kenyelletsa mefuta e mengata ea ho susumetsoa le ho lemalla, ka hona, hangata e ka bonts'a tšebelisano e mpe kapa ts'ebetso e sa tloaelehang ea lits'ebetso tsa ts'ebetso tse khothatsang kapa tse thibelitsoeng e le karolo ea mantlha ea tšusumetso ea mantlha (41, 52). Tumellanong le khopolo ena, lithuto tse entsoeng ka neano li hlahisa libaka tse tloaelehileng tsa maemo a tlase a bophelo le kotlo ea pele ea maikutlo le ts'ebetso ea kelello ea ho nka liqeto le ts'ebetso ea meriana ea lithethefatsi tse lemalloang (53). Ho fumana tlhahlobo-leseling ena ka botlalo, ho tla hlalosoa lintlha tse hlakileng tse amanang le tšusumetso, 'me li lateloe ke tlhahlobo ea liphetoho tse tseleng ena nakong ea bohlankana.

Likarolo tsa Khothatso ea Khaso

Ho lokolloa ha dopamine ho striatum ke ketsahalo ea mantlha e amanang le phetoho ea lits'oants'o tse kentsoeng ts'ebetsong, tse sebetsang joalo ka letšoao la "ho ea" (54). Ho lokolloa ha dopamine kahare ho "ventral striatum" (nucleus accumbens) le dorsal striatum (caudate putamen) ho ts'oaroa ke matšoao a thabo a tsoang cortex le libakeng tse ling tse khothalletsang ts'ebetso ea dopamine neuron sebakeng sa ventral tegmental le substantia nigra, ka ho latellana (55, 56) (Setšoantšo sa 1). Leha ho le joalo, likarolo tsa ventral le dorsal li amana le maemo a fapaneng a ts'ebetso ea thepa ea motlakase. Ho lokolloa ha dopamine ka har'a dorsal striatum, e kenyellelitsoeng ho pathogeneis ea lefu la Parkinson, haholo-holo e amana le ho qala le ho phalla hoa ketsahalo ea konkreite e ntle le boits'oaro bo tloaelehileng.57). Ka lehlakoreng le leng, ho lokolloa ha dopamine ka har'a li-bokellase tsa nucleus ho amahanngoa le tšusumetso ea susumetso, moputso oa subjential, cognition ea kelello (le monahano) le ho ithuta ka boitšoaro bo bocha (43, 46, 58). Mokhoa o tobileng oo ho lokolloang dopamine ho kenyelletsoang phetolelong ea mohopolo ketsong o sa tsejoe. Mosebetsi o mong o bonts'a hore ho tsoa ha dopamine ho ama ka kotloloho mekhoa ea ho thunya ea li-neuronal ensembles tse bokellaneng mme li susumetsa karabelo ea tsona ho kenelletseng ha glutamatergic ho tsoa cortex, amygdala, le hippocampus (51, 59) (Setšoantšo sa 2B). Phumano ena e fana ka maikutlo a hore lintlha tsa boipiletso, tse tlatselletsang mohopolo le tse amanang le maemo, tse lebisang molokong oa lipapatso tsa lits'oants'o tse susumetsoang, li ts'oaroa ke tokollo ea dopamine striatum, hore litsi tse theohelang tlaase li ka amohela le ho nka bohato ka tlhaiso-leseling e susumetsang (51, 59, 60). Ka hona, liso tsa neurotoxic tsa preortalal cortex, amygdala, kapa hippocampus alter repertoires tsa boitšoaro bo hlohlelletsoang ke pharmacological ea tlhahiso ea dopamine ho li-nucleus accumbens (61-63).

Mefuta e mengata e fapaneng ea tšusumetso e bontšitsoe ho eketsa dopamine ho li-nucleus accumbens. Tsena li kenyelletsa liketso tsa pharmacological tsa lithethefatsi tse lematsang (ho kenyeletsa nikotini, joala, koae, amphetamine, opiates, cannabis), meputso ea tlhaho (lijo, thobalano, kapa lisebelisoa tse ling), maikutlo a amanang le moputso le maemo (papali ea video), le khatello ea maikutlo kapa sepheo se khopisang (43, 64-67). Tlhokomeliso ea tikoloho e bohlokoa bakeng sa phihlello e nepahetseng ea lisebelisoa tsa moputso, le sepheo sa ho batla le ho fuputsa tse sa tsejoeng ka bohona ke sepheo se matla sa (43). Pale e ncha ea tikoloho e baka ho tsoa ha dopamine ea "cyral".68) hape, joalo ka lithethefatsi tse lemalloang, e hlahisa boitšoaro ba locomotor liphoofolong tsa laboratori (69). Novelty, e hlahisitsoeng ka mokhoa oa maemo a sa lebelloang kapa tšusumetso ea tikoloho, hammoho le lithethefatsi tse tlatsetsang, e khothatsa haholo (70). Meputso e fanoang ka nako e khuts'oane, feshene, kapa lifeshene tse sa lebelloang li na le bokhoni bo matla ho feta liteko tse phetoa ho boloka dopamine e thunya le boits'oaro bo nang le moputso (71, 72). Ho fapana le moo, boits'oaro bo botle kapa boits'oaro bo ithutoang hantle bo ithutoang tlasa maemo a lebelloang bo fetoha tlase ho ts'enyo ea tlhahiso ea li-nucleus accumbens dopamine. Ka hona, tšusumetso e tobileng ea pharmacological ea dopamine lits'ebetso tse kopantsoeng le lithethefatsi tse tlatsetsang ho bonahala e tšoana le / kapa e sebetsa ka mokhoa o kopaneng le matla a tlhaho a ho susumetsa a kopantseng tlholeho ea tikoloho.

Ts'ebetso ea bobeli ea bohlokoa ea dopamine, hammoho le ts'ebetso ea ho bokellana ha glutamatergic ho bokellase ba nucleus le ts'ebetso e makatsang ea GABA-ergic ea li-neurons tsa nucleus, e kenyelletsa boikemisetso ba lipontšo tsa nako e tlang le khetho ea likhetho tsa likoloi tse khothalletsoang. Thutong e amanang le moputso, boitšoaro ba nako e tlang bo bonoa ho latela liphihlelo tsa nakong e fetileng tse amanang le meputso ka mekhoa ea liphetoho tsa neuroplastic ho li-neurus tsa nucleus73). Ho lokolloa ha dopamine e hlahisoang ke lithethefatsi ka makhetlo a mangata ho etsa hore ho be le liphetoho liprotheineng tsa selefouno tse kenyelletsang methapo ea methapo ea methapo, polelo ea tlhaho, le boqapi ba maqhubu (15). Phetisetso ea Dopamine ho li-nucleus accumbens le libaka tsa pele tsa cortex tse fihlella ho li-nucleus bokellitsoeng e bile le tšusumetso mekhoeng ea ho ithuta le polasetiki, ho kenyelletsa liphetoho lipapisong tsa nako e telele le morphology ea lifate tsa neuronal dendritic (74-77). Ts'ebetso tsena tsa neuroplastic li ka ba le tšusumetso ea boits'oaro ba boitshwaro, moo drive e khothalletsoang e amanang le moputso e bang matla le ho feta ha moelelo oo oa moputso o phetoa hangata (78, 79). Sensitization, joalo ka keketseho ea sepheo sa mantlha se amanang le moputso o itseng o amanang le moputso o itseng o kenyelletsoeng, o hlahisa boitšoaro bo ikhethang ba ho fumana moputso bo ntseng bo thatafala le ho feta (78). Ka tsela ena, ts'ebetso ea mananeo a dopamine e ka sebetsa mosebetsi oa nako e telele oa ho fokotsa kapa ho shebisa repertoire ea li-driver drive tsa motho ka mong.

Likarolo tsa Inhibitory Motivation

Khaello ea ts'ebetso kapa sebopeho sa lits'ebetso tsa inhibitory li amahanngoa le ts'ebetso ea likoti tse khothalletsoang tse nkoang li le bohlasoa kapa li sa nepahala. Holimo ho tsena ke ts'ebetso ea methapo ea methapo ea methapo (serotonin (5-HT)) le likarolo tsa pele tsa cortex ea li-activation circry (Setšoantšo sa 1). Mehato ea ts'ebetso ea kelello ea 5-HT e fokotsehileng e amahanngoa le boits'oaro bo sa potlakiseng, ho kenyelletsa le pefo ea ka ntle le ho ikemela, ho ipolaea, ho qala mollo, le papali ea chelete ea methapo (80-82). Kotsi ea pharmacological ea lits'ebetso tsa 5-HT ho liphoofolo e baka karabelo e sa potlakiseng thutong e amanang le moputso le khothatso e susumetsang (83). Ka lehlakoreng le leng, li-pro-serotonergic agents li fokotsa khatello ea sechaba le ho hloka matla ho liphoofolo le batho (84, 85). Leha mekhoa ea liphumano tsena e sa hlakisoe ka botlalo, merero ea 5-HT e tsoang mohubung raphae nuclei ho potoloho ea ts'usumetso, ho kenyelletsa le sebaka sa likarolo tse ka hare tsa mokoloko, li-bokono tsa nucleus, cortex ea pele, amygdala, le hippocampus, li hlaha li ameha (55, 86).

Pele ho moo mosebetsi oa cortex o amanang le taolo ea litšusumetso. E ngotsoe pele ho 1848, tšenyo ho cortex ea ventromedial pele e baka ts'ebetso e atileng ea ts'usumetso e amanang le ho hloka botsitso, ho etsa liqeto tse fosahetseng le moralo oa motsamaisi, le ho se tsotelle mekhoa e metle ea sechaba (87). Taolo ea tšusumetso e senyehileng e tlalehiloe kamora nako maemong a mangata a neuropsychiatric (mohlala, mathata a botho bo sa hlonepheng, mathata a amanang le mathata, lefu la kelello, likotsi tsa tšebeliso ea lithethefatsi, dementias, le likotsi tsa ts'ebetso ea boko) tse bonts'itsoeng ka mehato e sa tloaelehang ea ts'ebetso ea cortex ea pele.26, 30, 88-90).

Litla-morao tsa pele tsa cortex li amahanngoa le kotsi e kholo ea ho ba le mathata a ts'ebeliso ea lithethefatsi, mohlomong ho kenyelletsa liphetoho lipotsong tse susumetsang tsa lithethefatsi tse lematsang. Boithuto ba kliniki bo bonts'a botsoalle ba ho lemala ha boko bo mahlonoko, hangata bo kenyelletsa cortex ea pele, bo nang le ts'ebeliso e matla ea tšebeliso ea lithethefatsi mme bo fana ka maikutlo a hore ho qala ha e 'ngoe ea lintlha tsena feela ho eketsa kotsi ho tse ling (91-93). Ts'ebetso e sa sebetseng kapa e sa tloaelehang ea cortex ea pele ea nonspecific le eona e tsebahala hangata bathong ba nang le mathata a tšebeliso ea lithethefatsi (94-97). Tumellanong le lipatlisiso tsena tsa bongaka, likotsi tsa pele tsa cortex ho likhoto li ka tiisa ho matlafatsoa ha koae nakong ea boitaolo.98, 99).

Patlisiso ea tšebelisano ea corticostriatal e bonts'a mokhoa oa ho hloka taolo ea cortex ea pele, o hlahisang ho kenella le ho ba kotsing e kholo bakeng sa mathata a tšebeliso ea lithethefatsi. Merero e khahlisang ea glutamatergic e tsoang ho cortex ea pele ho bokelloa ba nyutlelie le sebaka sa sepheo sa likarolo tse matla tsa tšusumetso e susumetsa ho lokolloa ha dopamine, ho thunya ha neuronal le lits'ebetso tsa neuroplastic ho li-nucleus accumbens (39, 100, 101). Likhokahano tsena tsa anatomical le tšebetso li bonts'a hore cortex ea pele e kenyelletsa moemeli, ho bolaoa, le thibelo ea lits'oants'o tse susumetsang ka mekhoa e susumetsang ea ho thunya ha neural ensemble ho li-nucleus accumbens. Ho kenyelletsa ha cortex ea pele kapa litlatsetso tsa eona tsa nucleus bokelletso ba 1) ho fetola mefuta e fapaneng ea lipontšo tsa sephetho sa drive ho li-nucleus accumbens, 2) ho fetola mekhoa ea likarabo ho pholletsa le li-nucleus accumbens tsa neuronal ho ea "ho ea" e fanoeng ke dopamine protx , e hlahisang menyetla e kholo ea ts'ebetso ea lits'oants'o tse susumetsang tse itseng, le / kapa 3) e sitisa ts'ebetso ea li-neuroplastic ho li-nucleus tsa li-nucleus tseo ka tloaelo li neng li ka fokotsa matla a lits'oants'o tse susumetsoang tse nkoang li sa tšoanelehe ke boiphihlelo ba pele. Ts'ebetso e mpe ea pele ea cortex, ho sa tsotelehe mofuta o ikhethang oa ts'ebetso, e ka eketsa menyetla ea ho etsa lits'oants'o tse sa lokang tse nkuoang ka tleliniki e le tse sa potlakang. Ka mokhoa o ts'oanang, ho se sebetse hantle ha tšohanyetso ea cortex ho ka baka 1) sephetho sa tšusumetso e khethehileng ea meputso e fanoeng ke litlamorao tsa lithethefatsi le / kapa 2) tsoelo-pele e sa sebetseng ea litlamorao tsa lithethefatsi tse susumetsang tse susumetsang maikutlo le phetoho ea ho batla lithethefatsi ka thoko (102, 103). Kahoo, ho senyeha ha lits'ebetso tsa ts'ebetso ea ts'usumetso ea matla a matla a ts'usumetso ea ts'usumetso ea ts'usumetso e matla ho ka eketsa ho potlaka le kotsi ea mathata a ts'ebeliso ea lithethefatsi. Liphetoho tsa Neurodevelopalal nakong ea bocha e lebisang maemong ana li ka hlahisa tlokotsing ea ho lemalla.

Eya ho:

Nako ea ho khothaletsa Neurocircuitry nakong ea bocha

Phetoho e kholo ea kelello ea kelello le kelello e etsahala lilemong tsa bocha. Bacha ba ba le mekhoa e kang ea batho ba baholo e kang ea ho ba le tlhalohanyo le ea maikutlo (104, 105) mme o hlohlelle ho susumetsoa ke kholo ea tikoloho ea batho ba baholo (106). Bongoaneng, tšusumetso ea ho bapala e khothaletsa ho ithuta ho sa kopaneleng mabapi le liphihlelo tsa batho ba baholo, ts'ebetso e fokotsang liphetho tse senyang (43). Bocheng, tšusumetso ea ho bapala e tsoela pele molemong oa ho nka karolo lipapatsong tsa batho ba baholo ba sa tsebeng letho, ntle le melemo ea tsebo e fumanehang ea ho tataisa liqeto (107). Ho ea ka pono ea batho ba baholo, boitšoaro bo bonoa ba bongoaneng bo khannoang ke bocha bo ka utloahala bo se na kahlolo e ntle ebile bo sa susumetse (34, 35).

Likarolo tsa Khothatso ea Khaso

Liphetoho tsa nts'etsopele maemong a mantlha a ts'usumetso nakong ea bocha li ka khothaletsa boits'oaro bo batlang bo sa tloaelehang le ho eketsa lits'ebetso tsa ts'usumetso. Mathata a amanang le neuropsychiatric a kenyelletsang tšebetso ea dopamine e bohareng a latela mekhoa ea ntlafatso e lumellanang le maikutlo ana. Mathata a Tic, a tšoaroang ke ho thibela tšebetso ea dopamine, a atile haholo bongoaneng le bohlankaneng ba bongoaneng 'me a tloaetse ho ikoahlaela ho ba motho e moholo.108). Ho fapana le hoo, ts'oaetso ea lefu la Parkinson, e kenyeletsang ts'ebetso e fokolang ea dopamine, e eketseha le botsofaling (57). Hore maikutlo ana a bontša lihlooho tsa kholo tsa ntšetso-pele li tšehetsoa ke lithuto tsa liphoofolo tse bonts'ang phapang ea boitšoaro ba bongoaneng bo kenyeletsang ts'ebetso ea dopamine system (109). Likhoto tsa lilemong tsa bocha li bonts'a boitšoaro bo atolositsoeng mohaleng o bulehileng oa boithabiso ebile o etsa papali ea boithabiso ho feta likhoto tse nyane le tse kholo (110). Likhoto tsa lilemong tsa bocha li bonts'a hypicponsivity ea methapo ho lioping tsa "opropamine "le" hypopensitivity "ho" dopamine blockade ", e fana ka maikutlo a hore sisteme ea bona ea dopamine e sebetsa mochini o haufi le siling e sebetsang pele ho phephetso ea meriana.110). Limpha tsa bocha li bonts'a khetho e kholo ea tikoloho ho feta litoeba tsa batho ba baholo (111). Ka kalafo ea amphetamine, batho ba baholo ba bonts'a ho eketseha ha litakatso tse ncha le lipontšo tsa bacha ba lilemong tsa bocha li fokotseha, ba khetha tikoloho eo ba neng ba e tseba pele pele e tsamaisoa ka phepelo ea amphetamine (111). Likhoto tsa lilemong tsa bocha li bonts'a maikutlo a maholo a boits'oaro le tokollo ea dopamine kamora ho entoa ka makhetlo a mangata ho feta likhoto tse kholo (112, 113). Ka kopanelo, liphumano tsena li fana ka maikutlo a hore teko ea lilemong tsa bocha le ho ba tlokotsing ea lithethefatsi tse tlatsetsang li kenyelletsa phapang ea tsoelo-pele ea tšebetso ea dopamine system le sensitization.

Phapang pakeng tsa maemo a phahameng tsamaisong ea dopamine e ntlafatsang le litsamaiso tsa inhibitory 5-HT li ka kenya letsoho molemong oa bongoaneng oa ho batla / ho qhekella. Maemo a CSF a dopamine le 5-HT metabolites a fokotseha nakong ea bongoana mme a fokotseha ho fihla maemong a batho ba baholo ka lilemo tsa 16 (114). Leha ho le joalo, karo-karolelano ea dopamine metabolite Homovanillic acid ho 5-HT metabolite 5-hydroxyindole-acetic acid e eketseha, ho fana ka tlhahiso ea dopamine e phahameng haholo ho phetoho ea 5-HT (114). Ho litšoene, letsoalo la dopamine e nang le mathata a emelang pele ho cortex ea pele e eketseha ho tloha halofong ea motho e moholo ka halofo ea likhoeli tsa 6 ho isa maemong a batho ba baholo ka ho ba moroetsana oa lilemong tsa bocha (2 lilemo), ha letsoalo la tlatsetso ea dopamine axonal le hoo e ka bang makhetlo a mararo ho feta. of 5-HT (115). Ka lehlakoreng le leng, libaka tsa tlhahiso ea 5-HT li-neuron tsa preortal cortex li fihla maemong a batho ba baholo ka beke ea bobeli kamora ho hlaha (115). Ka kopanelo, liphumano tsena li bonts'a hore lilemo tsa bocha li kanna tsa bonts'oa ke ts'ebetso e kholo lits'ebetsong tsa dopamine tsa papatso ho feta lits'ebetsong tsa 5-HT tsa inhibitory.

Liphetoho tsa lihormone tsa lilemong tsa bocha tse amang potoloho ea bobeli tse khothatsang le tsona li ka kenya letsoho ts'ebetsong ea ntlafatso ea lits'ebetso tsa dopamine. Li-receptor tsa steroid tse arolelanang litlamorao tse matla tsa neuroplastic li bontšoa haholo hippocampus le hypothalamus (116, 117). Nchafatso ea Neuroplastic nakong ea ho kena bohlankaneng e ka fetola lipontšo tsa maikutlo a susumetsang a mantlha mehahong ena, 'me ea fetola sebopeho sa li-drive tse khothalelitsoeng seterekeng sa mantlha se susumetsang (118, 119). Mohlala, likhahla tsa lihormone tsa thobalano li kenya letsoho ho matlafatsong e kholo ea thobalano, maikutlo a susumetsang a thobalano le tlhoko ea sechaba, tlholisano ea thobalano le tlhaselo ea bocha.43, 120, 121).

Ts'ebetso ea Hippocampal e ka ba ea bohlokoa ho liphetoho tse amanang le thobalano le li-hormone mokhoeng o tloahelehileng oa ho ithuta. Ka ho hokahana ho pharaletseng le cortex, hippocampus e bapisa maemo a potileng a tikoloho le mehopolo ea nakong e fetileng ho bona boiqapelo ba tikoloho (122). Tlhahisoleseling e phetoang e ka kenngoa ho litheolelo tse susumetsang ka mokhoa oa hippocampal regulation of amplitude kapa tšusumetso ea ho nyekeloa hoa dopamine ka har'a li-bokono tsa nucleus kapa ka tšusumetso e tobileng ea ts'ebetso ea methapo ea methapo ea methapo ea methapo (51, 123, 124). Mohopolo ona o lumellana le datha ea anatomical le ea 'mele e bonts'a hore hippocampal senya liphetoho tse fetisang dopamine e lokolle ka har'a li-nucleus accumbens le karabelo ea boitšoaro lithutong tse ncha (69). Ka bobeli, tlhaiso-leseling ena e fana ka maikutlo a mokhoa oo ka oona maemo a lihormone maemong a itseng a bophelo (bongoaneng, bocheng, ho ba motho e moholo) a ka susumetsang ts'ebetso ea dopamine ea ho phahamisa boitšoaro hore bo fetohe boitshwarong bo hloahloa le ho feta.

Likarolo tsa Inhibitory Motivation

Liphetoho ho li-substrates tsa khothaletso tse khothalletsoang li etsahala ka nako e ts'oanang le liketsahalo tsa nts'etsopele ho cortex ea pele. Nakong ea bocha, cortex ea pele e e-so ka e ntlafatsa mesebetsi e mengata e fapaneng ea kelello e ka kenyelletsang matla a eona a ho thibela litšusumetso. Mehato ea ts'ebetso ea cortex ea pele, ho kenyelletsa mosebetsi oa ho hopola, ho rarolla mathata, ho nahana ka mokhoa o hlakileng, le menahano e tsitsitseng, ho ntlafala haholo nakong ea bohlankana.104, 105, 125). Leha bokhoni ba ho thibela likarabo tsa psychomotor bo ntlafala ho tloha bongoaneng, ho hola ka bohlankana ba morao (126), mehato e tobileng haholoanyane ea ho susumetsoa ke bohlankana (mohlala, ho etsa liqeto) e lula e sa qheleloa ka thoko.

Liphetoho ho sebopeho sa bokong 'me li sebetsa ka nako e tšoanang le liphetoho tsa tšebetso ea kelello. Nakong eohle ea bocha, ho bonoa liphetoho mokhoeng oa EEG oa tšebetso ea cortical le likarabo ho susumetsang maikutlo.104, 127). Ho tloha matsatsing a 6 ho 12, karo-karolelano ea "ventricle" ea morao-rao ho molumo oa boko e lula e le kamehla; e ntan'o eketseha ka botsitso ho tloha lilemong tsa 12 ho isa 18 (128). Ho tloha matsatsing a 4 ho isa ho 17, ho na le keketseho e tsoelang pele ea letsoalo la litaba tse tšoeu ka pele ho cortex, mohlomong ka lebaka la kholo ea methapo ea kutlo le li-diameter tsa axonal le ho kenya letsoho ho matlafatseng ts'ebetso ea ts'ebetso e ka bang teng (129). Liphetoho tsa metabolism ea boko tse bonts'a li-neuroplasticity le ts'ebetso ea tlhahiso ea litaba le tsona lia hlokomeloa. Lefats'eng ka bophara, boko bo eketsa ts'ebeliso ea matla, bo bapisa maemo a batho ba baholo ka lilemo tsa 2, bo eketseha ka makhetlo a mabeli ho feta maemo a batho ba baholo ka lilemo tsa 9, le ho theohela maemong a batho ba baholo qetellong ea bocha (130, 131). Ha ho bapisoa le libaka tse tlasa libaka tse tlase, libaka tse cortical li theoha ka mokhoa o ts'oanang oa maemo a leholimo a phello ea metabolic mme li bonts'a liphetoho tsena hamorao, 'me libaka tsa phetoho tsa pele-pele li fetoha.131).

Liphetoho tsa nts'etsopele ea kholo ho cortex ea pele e bapisoa le liphetoho tsa neuroplastic, joalo ka ha ho bontšoa ke methapo ea ts'ebetso ea dendritic, li-synapses, le myelination, litekanyetso tsa motsoako oa methapo ea kutlo, le ho hlaha ha mekhoa ea ho tsebahala ea batho ba baholo (129, 132-134). Ho theoha hoa ts'ebetso ea metabolic libakeng tse ka pele le tse ling tsa cortical ho ka bonts'a ho roka ha synaptic, moo litheko li etsahalang ka likhokahanyo tse jang matla a matla a li-neuronal tse sa fetiseng ka botlalo tlhahisoleseling e mabapi le boiphihlelo bo bokellanang. Ka cortex ea pele ho motho, letsoalo la synaptic libakeng tse kholo tsa kamohelo ea axonal le eketseha ho 17 × 108 ka limilimithara3 lipakeng tsa lilemo tsa 1 le 5 mme e theohela maemong a batho ba baholo ba 11 × 108 ka limilimithara3 ka ho ba lilemong tsa bocha135). Ho roka ha Synaptic ho litšoene tsa lilemong tsa bocha ho etsahala likarolong tse ngata tsa cortical microarchitecture tse bontšang litlamorao ho ts'ebetso ea tlhahisoleseling.134). Phokotso ho li-converter tsa cortex pele li kholo bakeng sa li-axon tse tsoang libakeng tsa cortical tsa lehae ho fapana le li-cortices tsa mokhatlo tse hole mme li khothalletsoa ho bonts'a keketseho e ts'oanang ea ho ts'eptjoa ha lipotoloho tsa preortal cortex tsa sebakeng sa tlhaiso-leseling tse sebetsitsoeng haholo.125). Karolo ena e ka lumella ts'ebetso ea holimo-tlase, moo repertoire e kholo, e rarahaneng ea boiphihlelo bo fetileng e bolokiloeng mohahong o hole e nang le tšusumetso e kholo ea likomporo (134). Ho itšireletsa ha matla lilemong tsa bocha ho fokotseha ho kenella ka tsela e nyakallisang le e thibelang (136). Phokotso ena e hanyetsanang e ka eketsa botsitso ba mekhoa ea ho thunya ea li-neuron tsa cortical (137) le ho ntlafatsa bokhoni ba ho kopanya li-neurons tsa pele tsa cortex tsa mollo ka mokhoa o tsitsitseng, o kopaneng (134, 138), e nolofalletsa ho boloka nako e khuts'oanyane ea palo e eketsehang ea tlhaiso-leseling. Tumellanong le mohopolo ona, ts'ebetso e ntlafalitsoeng ea ts'ebetso ea ho hopola litšoene tsa bongoaneng e tsamaisana hantle le liperesente tsa li-neuron tsa pele tsa cortex tse bonts'ang ts'ebetso e tsitsitseng nakong ea ts'ebetso ea ho lieha (139).

Metsoalle ea marang-rang ea Neural e fana ka maikutlo a hore keketseho ea khokahano ea cortical bongoaneng e lateloang ke ho theoha hoa maemo a batho ba baholo ho feta bocha ho bonts'a ts'ebetso ea bokhoni ba ho ithuta, bo tsamaellanang le ho fokotseha ha maemo a phetoho ea neuroplastic (125, 140). Ts'ebetso tsena li khetholla phapano lipakeng tsa bokhoni ba ho ithuta tlhaiso-leseling e ncha le ho e sebelisa le ho hlakisa tlhaiso-leseling eo u ithutileng eona (140). Ha tlhahisoleseling e bokelletsoeng e hokahana ka har'a marang-rang a neural, litekanyetso tsa ho ithuta, kapa bokhoni ba li-neuroplasticity joalo ka ha bo emeloa ke palo ea likhokahano tsa synaptic, e lokela ho fokotseha, e felle ka sistimi e sebetsang ho thibela tahlehelo ea tlhaiso-leseling e ithutileng pele (140). Khokahano ea Synaptic le lits'ebetso tse ling tsa ntšetso-pele ea cortex ea pele, e lumellanang le sepheo se matla sa boiphihlelo ba batho ba baholo, li ka sebetsa hammoho ho thusa ho fumana bocha ba kutlwisiso e hlakileng le e hlakileng ea tikoloho. Khokahano ea cortex ea pele e tla tsamaisoa ke litheko tse susumetsang tsa ho nka karolo lipapatsong tse tšoanang le tsa batho ba baholo, qetellong e lebisa ho motheong o nang le boiphihlelo o tataisang ts'ebetso ea liqeto tse "loketseng" haholoanyane.

Eya ho:

Nahanisisa

Adodecent neurodevelopment e kenyelletsa liphetoho mokhatlong oa boko le ts'ebetso e khetholloang ke tšusumetso e kholo ea likhakanyo tsa ts'usumetso ea ts'ebetso molemong oa likarolo tse nyane tsa inhibitory. Morero o matla oa ho susumetsa boiphihlelo ba nov, hammoho le sistimi e sa laoleheng ea taolo, e ka reroa ts'ebetsong ea liketso tse potlakisang le boits'oaro bo kotsi, ho kenyelletsa liteko le tšebeliso e mpe ea lithethefatsi tse lematsang. Ka mokhoa o ts'oanang, mafu a kelello a hangata a kopaneng le mathata a ts'ebeliso ea lithethefatsi hangata a kenyelletsa tšusumetso ea dyscontrol haholo ho bonts'a mekhoa e fokolang ea ts'ireletso e fokolang le / kapa ts'ebeliso ea matla a ts'ebetso ea methapo ea methapo ea methapo. Nakong ea bocha bo tloaelehileng, ts'ebetso ea methapo ea kutlo e kenang maemong a phetoho e tšoanang le maemo ana. Litlamorao tse ikhethileng tsa ts'ebeliso ea litlhare tsa lithethefatsi tse lemalloang lits'ebetsong tsa dopamine li ka potlakisa nakong ea linako tsena tsa nts'etsopele, ho ntlafatsa tsoelo-pele kapa ho tšoarella ha liphetoho tsa neural tse tlisoang ke bokhoba.

Moelelo o moholo oa mohlala ona ke hore mathata a ts'ebeliso ea lithethefatsi ke lits'oaetso tsa methapo ea methapo. Kahoo, lipatlisiso le kalafo tse shebileng bacha le batho ba baholo li ka thusa batho ba lilemo tsohle ka mathata a tšebeliso ea lithethefatsi. Tšobotsi e ngoe ea likarolo tse ikhethang tsa ts'ebetso ea methapo ea methapo e kenang bongoaneng ba bongoana (ho kenyeletsoa dopamine ea subcortical le preortal cortex le likarolo tse ling tse amanang le eona) e ka senola mekhoa e arohaneng e amanang le bong kapa karohano e amanang le bokuli ba kelello bothateng ba tlokotsing ea tšebeliso ea lithethefatsi. Kameho ea litloaelo ho psychopharmacology ea bana le ea lilemong tsa bocha mabapi le nts'etsopele ea li-neurocircuitry tse susumetsang le kotsi ea likotsi tsa ts'ebeliso ea lithethefatsi ha e sa qaptjoa. Lintlha tse lekantsoeng li teng, ka bongata ba tlhaiso-leseling e tsoang litlalehong tsa ts'ebeliso ea li-psychostimulants bakeng sa ts'oaetso ea ho fokola ha tlhokomelo ea kelello. Liphumano li fana ka maikutlo a ts'ireletso khahlanong le mathata a ts'ebeliso ea lithethefatsi lihlopheng tse ikhethileng tsa tlhahlobo kapa li-subgroups mme ho ka etsahala hore ho be le litlamorao tse mpe ho ba bang (141-144).

Patlisiso e eketsehileng ea hlokahala ho leka mekhoa le sephetho sa mofuta ona. Bopaki ba kamano pakeng tsa ho kenella le ho ba kotsing ea mathata a ts'ebeliso ea lithethefatsi maemong ohle a kliniki, ho kenyelletsa ho ba lilemong tsa bocha le / kapa mafu a kelello, bo matla empa bo amana haholo. Patlisiso e kopaneng le mekhoa e mengata e hlokahala ho hlahloba ka kotloloho likamano tse khothalelitsoeng. Mefuta ea liphoofolo ea ho susumetsoa le ho lemalla ho itaola ka lithethefatsi e lokela ho lekoa ka har'a lithuto ka mekhoa e mahareng le e telele. Mekhoa ea liphatsa tsa lefutso, limolek'hule, ts'oaetso ea methapo ea kutlo le methapo ea kutlo e lokela ho sebelisoa ho mehlala ena ho khetholla likarolo tse tloaelehileng le tse ikhethang tsa ts'usumetso ea "circry" e susumetsang ts'usumetso le ho lemalla. Mekhelo e sa sebetseng ea potoloho ea mantlha e kenyelletsang, e kenyelletsang mela e mengata ea tlhaiso-leseling, e ka hlokoa ho hlahloba liketsahalo tse maemong a neural tse sa ithutoang habonolo lipatlisisong tse seng tsa tlhaho tsa tlhaho.

Ka lebaka la boteng bo reriloeng ba mekhoa ea boko eo ka tloaelo e hlahisang khatello ea maikutlo le kotsi ea mathata a ts'ebeliso ea lithethefatsi maloetseng a kelello ao hape a hlahang hangata ha a le lilemong tsa bocha, e ntse e tlameha ho tsejoa ho fihlela boiphihlelo ba bohlankana ba ho hloka ts'ebeliso ea lithethefatsi 1) bo bonts'a ponahatso ea pele ea motho e moholo li-syndromes tsa mafu a kelello tse fanang ka kotsi e kholo ea mathata a ts'ebeliso ea lithethefatsi le / kapa 2) li supa kotsi e kholo ho lihlopha tsohle tsa bohlankana. Mohlomong menyetla ea bobeli e etsahala, e hlahisa tlokotsing e kholo ea mathata a ts'ebeliso ea lithethefatsi ho bacha bohle empa e le tekanyo e kholo ho bacha ba sekametseng kelellong. Tlhaloso e joalo e kanna ea lumellana le ho ba teng hoa kotsi ea liphatsa tsa lefutso le tikoloho le lintho tse sirelletsang tse sebetsang ka kopanelo le liphetoho tsa nakoana tsa nts'etsopele ea ts'ebetso ea boko ho hlahisa maemo a itseng a tlokotsing ea ho lemalla. Ha ho sekaseka monehelo o lekantsoeng oa menyetla ena, mokhoa oa liphoofolo oa tšitiso ea tšebeliso ea lithethefatsi lithutong nakong ea methati e fapaneng ea nts'etsopele, ka linako tse ling tsa tlhahlobo ea lithethefatsi tsa bongoana, e tla ba tsa bohlokoa, ho kenyelletsa tšebeliso ea mehlala ea liphoofolo tsa lefu la kelello le thepa. sebedisa mathata. Lithuto tsa bongaka tsa nako e telele, haholoholo tse sebelisang mehato ea sepheo sa ho potlaka le ho etsa liqeto le ho sebelisa mahlale a liphatsa tsa lefutso le a sebetsang, li tla ba le bohlokoa bo boholo ho utloisisa tlokotsi ea tlhekefetso ho lihlopha tsohle tsa batho ba lilemong tsa bocha lilemong tsa bocha tse kulang le tsa mafu a kelello.31). Ts'oaetso ea lihlopha tse tlase tsa bohlankana tse nang le ts'oaetso e phahameng ea mathata a ts'ebeliso ea lithethefatsi, nts'etsopele ea maano a thibelo a thehiloeng holim'a bopaki, le ntlafatso ea kalafo ea litlhare tsa mafu a kelello le kelello ke lintlha tsa bohlokoa tseo motho a ka li latelang ho fokotsa tšusumetso e kholo ea mathata a ts'ebeliso ea lithethefatsi ho sechaba.

Eya ho:

lumela hore baa fokola

E ts'ehetsoe ke Mokhatlo oa Veterans Administration Special Neuroscience Research Fsoci Grant le lithuso tse tsoang ho National Alliance bakeng sa Patlisiso mabapi le Schizophrenia le khatello ea maikutlo (Mocha e mocha oa lipatlisiso), Setsi sa Naha sa Ts'ebeliso ea Lithethefatsi (DA-11717, DA-00167), Mokhatlo oa Amerika oa Psychiatric Association (DA -00366), le Setsi sa Naha sa Papali e Ikarabellang.

Bangoli ba leboha George Heninger ka litlhaloso tse ngotsoeng ka letsoho.

Eya ho:

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