Na J Psychiatry. Sengoli se ngotsoeng ka letsoho; e fumaneha ho PMC Mots'eanong 1, 2014.
E hatisitsoe ka mokhoa o qetelle o hlophisitsoeng e le:
Na J Psychiatry. Mots'eanong 2013; 58 (5): 260–273.
PMCID: PMC3762982
NIHMSID: NIHMS504038
Robert F. Leeman, Ph.D.1 'me Marc N. Potenza, MD, Ph.D.1,2
Sheba lihlooho tse ling ho PMC hore Qotsa sehlooho se hatisitsoeng.
inahaneloang
Tlhahlobo ena e akaretsa liphuputso tsa methapo ea kutlo le liphatsa tsa lefutso litlamong tsa boitšoaro, e ts'oana le liphetho tse amanang le mathata a ts'ebeliso ea lithethefatsi mme e fana ka litlhahiso bakeng sa lipatlisiso tsa kamoso. Lingoloa tse mabapi le ts'ebetso ea boko, ts'ebetso ea methapo ea kutlo le nalane ea lelapa / liphuputso tsa lefutso bakeng sa boitšoaro bo hlephileng bo amanang le papali ea chelete, ts'ebeliso ea inthanete, papali ea video, ho ea mabenkeleng, kleptomania le thobalano li ile tsa hlahlojoa. Lithethefatsi tsa boitšoaro li kenyelletsa ho se sebetse hantle libakeng tse 'maloa tsa boko, haholo-holo cortex e ka pele le striatum. Liphuputso tse tsoang lithutong tsa litšoantšo tse kenyelletsang mesebetsi ea boits'oaro li ka ts'oana ho feta lithuto tsa boitšisinyo. Liphetho tsa pele li bontša phapang ea taba e tšoeu le e putsoa. Liphuputso tsa Neurochemical li fana ka maikutlo a likarolo tsa sistimi ea dopaminergic le serotonergic, empa litholoana tsa liteko tsa bongaka li bonahala li lekana. Ha e ntse e lekantsoe, nalane ea lelapa / tlhaiso-leseling ea lefutso e ts'ehetsa botsitso ba papali ea chelete ea papali ea chelete le hore ba nang le ts'ebeliso ea boitšoaro ba na le monyetla oa ho ba le setho se haufi sa lelapa se nang le mofuta o mong oa psychopathology. Ho tšoana ho teng lipakeng tsa nalane ea methapo ea kutlo le liphatsa tsa lefutso / nalane ea lelapa litlamong tsa lithethefatsi le tse seng tsa lithethefatsi, ho fana ka maikutlo a hore ho kenella ka mokhoa o qobelloang mekhoeng ena ea boitšoaro ho ka baka lithethefatsi. Liphetho tsa ho fihla joale li na le moeli, haholo bakeng sa ho ea mabenkeleng, kleptomania le boitšoaro ba thobalano. Kutloisiso ea liphatsa tsa lefutso e qalong. Ho fanoa ka litsamaiso tsa lipatlisiso tsa nako e tlang.
Selelekela
Lihlopha tsa boitšoaro tse nang le litšobotsi tsa hedonic (bonyane qalong) ho kenyelletsa papali ea chelete, mabenkeleng, boits'oaro ba thobalano, ts'ebeliso ea inthanete le papali ea papali ea video li ka lebisa ho keneng ka mokhoa o qobelloang har'a batho ba fokolang. Maemong a fetelletseng, boits'oaro bona bo nkuoa e le "mathata a taolo ea tšusumetso eseng libakeng tse ling a arotsoeng" ho DSM-IV-TR1, Leha ho le joalo, li kanna tsa nkuoa e le lithethefatsi tse seng tsa lithethefatsi kapa tsa "boits'oaro"2-7. Ha papali ea chelete, ho ea mabenkeleng, thobalano, papali le tšebeliso ea inthanete e le boitšoaro bo tloaelehileng, ho kanna ha ba thata ho khetholla pakeng tsa ho nka karolo ho tloaelehileng le ho fetelletseng.5. Liphephetso tse ling li ka bakoa ke ho se ts'oanehe ho hoholo ho li-syndromes tsa lithethefatsi tsa boitšoaro, ho thatafatsa likarolo tsa bona8. Mekhoa ea ho lemalla boitšoaro (ho bapisoa le lithethefatsi) ha e utloisisoe hantle, hobane hobane mefuta ea liphoofolo e thusitseng ho utloisisa mathata a ts'ebeliso ea lithethefatsi9,10 ha lia otloloha kapa ha li tsoele pele bakeng sa litlolo tsa boitšoaro8,11,12.
Lithethefatsi tsa boitšoaro li arolelana likarolo tsa bohlokoa le lithethefatsi tsa lithethefatsi. Tsena li kenyelletsa taolo e senyehileng ea boitlamo, boitlamo bo tsoelang pele leha ho bile le litlamorao tse mpe le litakatso kapa litakatso6,13. Boitšoaro bo hlephileng le lithethefatsi li etsahala hangata14,15 mme ho na le ho ts'oana ho tsoelapele ha mathata (mohlala, maemo a holimo a maemo a bacha le batho ba baholo ba lilemong tsa bocha, tšusumetso e mpe ea ho matlafatsa le ketsahalo ea "telescoping" e bonoang ho basali6,16).
Likarolo tse tšoanang tsa neurobiological li tlasa litlamorao tsa lithethefatsi le boits'oaro8,17,18, e nang le likarolo tse tloaelehileng tse amanang le ts'ehetso ea sefapano, ts'ebetso ea boko le methapo ea methapo8. Ho hlohlelletsa sefapano ho kenyelletsa ho feto-fetoha ha maemo a kelello moo ho pepesehela sethethefatsi se seng khafetsa ho lebisang karabong e matla ho e 'ngoe8. Mabapi le lithethefatsi tse seng tahi, ho pepesehela ts'ebetsong ea tlhekefetso ho ka lebisa tlhokomelong ea moputso oa tlhaho le ka tsela e fapaneng8,19-21. Boholo boo liphuputso tsena li atolosetsang ho boitšoaro bo joalo ka papali ea chelete bo tiisa lipatlisiso tse ling. Lithethefatsi tsohle tsa tlhekefetso li ama "potoloho ea moputso" ea boko, ka tsela ea mesolimbic dopamine e bohlokoa haholo. Tsela ena e kenyelletsa li-dopaminergic neurons tse tlohang sebakeng sa ventral tegmental ho ea nucleus accumbens (NAc)22-25. Litekanyo tsa dopamine tse phahameng haholo kapa tse tlase haholo li na le matla 'me li ka lebisa liketsong tse sa tsitsang le tse kotsi tse kenyeletsang ts'ebeliso e mpe ea lithethefatsi26. Meputso ea tlhaho le lintho tse hlekefetsoang li bonahala li baka tšebetso e ts'oanang ho potoloho ea meputso le libaka tse hokahaneng, ho kenyeletsoa amygdala, hippocampus le frontal cortex8.
Liphetho tsa nalane ea liphatsa tsa lefutso le tsa lelapa, le ha li lekanyelitsoe litlamong tsa boits'oaro, li fana ka bopaki bo bong ba ho tšoana lipakeng tsa boitšoaro le lithethefatsi27. Ho fokola pakeng tsa boits'oaro le boits'oaro ba lithethefatsi le maemo a mang a kelello ho bonahala ho kenyelletsa mabaka a liphatsa tsa lefutso15,27-30.
Tlhatlhobo ea hajoale e shebile bopaki ba nalobiological le liphatsa tsa lefutso / nalane ea lelapa bo mabapi le ho lemalla boitšoaro. Kamora ho hlalosa mekhoa ea rona, re bua ka ts'ebetso ea boko (Lethathamo 1), litsamaiso tsa neurotransmitter (Lethathamo 2) le nalane ea lelapa / liphetho tsa lefutso (Lethathamo 3) e amanang le mekhoa e tšeletseng ea boitšoaro: papali ea chelete haholo-holo; tšebeliso e mpe ea inthanete le papali ea video e bapalang ka lekhetlo la bobeli; mme sa boraro, ho reka ka qobello, kleptomania le bosodoma. Re totobatsa ho tšoana le ho se tšoane ka liphetho tsa bokhoba ba lithethefatsi, hlalosa liqeto le ho fana ka litlhahiso bakeng sa lipatlisiso tse tlang. Epidemiology le liphuputso tsa bongaka li sebetsoa hakhutšoanyane; leha ho le joalo, litlhahlobo tse 'maloa tsa morao-rao2,31 le bophahamo ba modumo e hlophisitsoeng14 li tšohlile lihlooho tsena. Re khethile lithuto tse amang feela barupeluoa ba phetseng hantle kapa Parkinson's Disease (PD). Le ha lithuto tsa PD li fana ka mohlala o sebetsang bakeng sa ho lemalla boitšoaro, hore na liphetho tsena li sebetsa hakae ho palo e kholo ea bakuli bao e seng PD ha e na bonnete (bona 32,33).
mekhoa
Patlo ea lingoliloeng e ile ea etsoa ka Mots'eanong 2012 ho sebelisoa Medline le Google Scholar. Patlo e ngoe le e ngoe e ne e etsoa ka polelo e akaretsang ea ho batla (neuro *, MRI, PET, imaging le genet *) le poleloana ea ho batla e 'ngoe ea tse latelang tsa boitšoaro (mantsoe a ho batlisisa masakaneng): papali ea chelete (gambl *), mabenkeleng (mabenkele a qobelloang , ho lemalla ho reka *, ho reka ka qobello), kleptomania (kleptomania, utsoa), boits'oaro ba thobalano (thobalano e tlamang) Ho fanoe ka meeli ea sebaka le lihlooho tse ngata tse hlahlojoang, lintlha tse nkoang li le bohlokoa haholo lia koaheloa.
Papali ea papali ea chelete (PG)
Likarabo tsa Neurobiological ho cue induction le boits'oaro ba mesebetsi e lekolang taolo ea ts'ebeliso ea kelello, papali ea chelete e etsisitsoeng, taolo ea tšusumetso, ho etsa liqeto / ho etsa liqeto le ho sebetsana le moputso ho tlalehiloe ho PG. Liphuputso tse bonts'ang ho tšoana le phapang lipakeng tsa PG le lithethefatsi tsa lithethefatsi li sa tsoa hlahlojoa haufinyane18.
Ts'ebetso ea boko ho PG
Boholo ba lithuto tsa neuroimaging li kentse maikutlo libakeng tse ka pele tsa cortical le striatum, hammoho le libaka tse ling. Ka kakaretso, liphuputso tse mabapi le ts'ebetso ea boko tse sebetsanang le ts'ebetso ea ts'ebetso li 'nile tsa fetoha ho feta liphuputso tse entsoeng ka boqhetseke.
Liphuputso tse entsoeng ka boqhetseke li fana ka maikutlo a ho se sebetse hantle libakeng tse ka pele, leha ho sa hlaka hore na ho se sebetse hantle ho joang. Mesebetsing ea ho pepesa, cec (khahlanong le taolo) barupeluoa ba bonts'itse ts'ebetso e fokotsehileng ho li-cortices tsa ventrolateral le ventromedial prefrontal (vlPFC le vmPFC7,34), leha lithuto tse ling tsa tlhahiso-leseling ho batho ba nang le bothata ba papali ea chelete35 le PG36 li bontšitse keketseho ea ts'ebetso e ka pele. Liphapang tse bonahalang liphuputsong tsa lithuto li ka amana le moralo oa mesebetsi le mekhoa ea tlhahlobo. Boithuto bo nang le litšoantšo tse entsoeng nakong ea ts'ebetso ea kelello bo bontšitse ts'ebetso e fokotsehileng libakeng tse ka pele tse kang vmPFC ho PG37-40 le ha ho ntse ho tlalehiloe ts'ebetso e tobileng bothateng / PG le eona e tlalehiloe41,42.
Liphuputso tse ngata li qobella striatum ho PG. Ho fumanoe phokotso ea metabolism ea tsoekere e tsoang malapeng le ho eketsa metabolism ho dorsal striatum sebakeng sa phomolo ho fumanoe har'a bakuli ba PG ba nang le lefu la ho ferekana kelellong le kopaneng.43. Leha ho le joalo, ho PET (positron emission tomography) liphuputsong tsa ho phomola, ha ho phapang e kholo e fumanoeng lipakeng tsa PG le li-control tse phetseng hantle ho receptor ea D244,45 kapa ho fumaneha ha li-receptor tsa serotonin 1B ho ventral le dorsal striata, leha maemong a ho qetela ho fumaneha ha receptor ho amana le bothata ba ho becha ka bothata ho ventral striatum / pallidum46. Liphuputsong tse sebetsang tsa matla a khoheli-resonance-imaging (fMRI) nakong ea ho pepesetsoa papali ea chelete ea papali ea chelete, ts'ebetso e fokotsehileng e bonoe kahare7 le dorsal striatum47 ho PG (khahlanong le taolo); leha ho le joalo, ho bile le liphetho tse mpe ho ventral striatum ho PG / mathata a ho becha35,36. Mabapi le ts'ebetso e amanang le ts'ebetso ea mosebetsi, liphetho tse ngata li bonts'a ts'ebetso e fokotsehileng ea ventral ho PG (khahlano le bao e seng PG)38,40,48 ka bopaki bo bong ba ts'ebetso e phahameng ea mokokotlo42,48. Liphapang tse ling tsa liphuputso lipakeng tsa lithuto li kanna tsa bakoa ke mesebetsi e itseng e sebelisitsoeng. Hape, liphapang tse mabapi le tšebetso ea tlhaho ea tlhaho e ka amanang le lihlopha tsa lithuto joalo ka ha lithuto tse ling li kenyelletsa bothata ba ho becha49 kapa mathata a kopaneng a papali ea chelete / lihlopha tsa PG41 ba ka bang le likarabo tse fapaneng tsa bioloji. Liphuputso tse tsoang ho Linnet et al.44,45 fana ka maikutlo a phapang ea motho ka mong ka hore sampole ea PG e ne e arotsoe ka ho lekana lipakeng tsa ba bonts'itseng mme ba sa bonts'a tokollo e phahameng ea dopamine ho ventral striatum nakong ea Iowa Gask Task. Liphuputso tse lekantsoeng tse nang le mesebetsi e amanang le ho se ts'oenyehe ha li bonts'a phapang e kholo ts'ebetsong ea ts'ebetso nakong ea polao le taolo50,51.
Mabapi le libaka tse ling tsa boko, lithuto tsa PG (khahlanong le taolo) li fapana mesebetsing ea ACC kamora ho pepesetsoa papali ea papali ea chelete7,34. Phokotso e fokolisitsoeng ea insular ho PG nakong ea tlhahiso ea cue7 'me ho sebetsoa ha meputso ho tlalehiloe40. Botšepehi ba taba e tšoeu bo futsanehileng bo amana le ho hloka maikutlo52 mme e fumanoe har'a ba nang le PG ha e bapisoa le taolo libakeng tse kenyeletsang corpus collosum53,54. Liphetho tse mpe li fumanoe bakeng sa phapang ea taba e tšoeu le e putsoa pakeng tsa PG le taolo53.
Ka bokhutšoanyane, liphetho tse ngata tsa ho nka litšoantšo ho PG li amme libaka tse ka pele tsa cortical le striatum. Mesebetsi e amanang le kotsi / moputso, papali ea chelete le taolo ea ts'ebeliso ea maikutlo li bonts'a ts'ebetso e fokotsehileng ho PG libakeng tse ka pele le ventral striatum khafetsa. Liphetho tsa pejana li fana ka maikutlo a ho fokotsa ts'ebetso ea li-insula le boits'oaro bo bobe ba taba e tšoeu ho PG.
Ketsahalo ea Neurotransmitter ho PG
Liphuputso tse ngata li amana le dopamine le serotonin, leha li-neurotransmitters tse ling li kentsoe letsoho. Le ha ho se sebetse hantle ha dopamine ho entsoe hypothesised bakeng sa PG55, liphuputso ha lia phethahala hakaalo. Lintlha44,45 fana ka maikutlo a phapang ea motho ka mong ho PG le lihlopha tsa taolo ea ho lokolloa ha dopamine nakong ea Mosebetsi oa Ho becha oa Iowa empa ha ho na motheo oa phapang lipakeng tsa sehlopha mabapi le ho fumaneha ha mofuta oa D2. Leha li-PG le lihlopha tsa taolo li bontšitse tokollo e ts'oanang ea dopamine nakong ea ts'ebetso ea mochini oa mochini oa ts'ebetso, ts'ebetso ea dopamine e tsamaellanang le bothata ba ho becha ka bothata ho PG.56 Tsamaiso ea Amphetamine e eketsehile mabaka a ho becha har'a mathata a papali ea chelete57. Doper-haloperidol e kang mohanyetsi oa D2 le eona e amahanngoa le lithahasello tse ntseng li eketseha tsa papali ea chelete ho PG58, leha liphapang li bonahala li le bohlokoa59. Liphapang tsa motho ka mong li ka hlalosa liphuputso tse mpe tsa liteko tsa bongaka ka lithethefatsi tse kang tsa bahanyetsi ba D260,61.
Liphuputso tse tsoang liphuputsong tsa methapo ea pelo ka mekhoa e fapaneng li fana ka maikutlo a phapang ts'ebetsong ea serotonergic lipakeng tsa lithuto le taolo ea PG18,62-67. Liphuputso tsa liteko tsa bongaka tse amanang le serotonin-reuptake inhibitors (SRIs) le mohanyetsi oa 5HT2-receptor li bile mpe kapa li tsoakane60,61,68-72. Le ha lithuto tsa methapo ea pelo li bontša ho se sebetse ha serotonergic ho PG, liphetho tse fapaneng tsa bongaka li fana ka maikutlo a liphapang tsa bohlokoa tsa motho ka mong.
Mabapi le li-neurotransmitters tse ling, liphetho tse ngata tse nepahetseng tsa liteko tsa kliniki le liteko tsa bahanyetsi ba opiate73-76 (bona 77 bakeng sa liphetho tse mpe) fana ka maikutlo a ho nka karolo ha opioidergic ho PG. Bopaki ba pele ba katleho ea meriana e fetolang ho fetisoa ha methapo ea pelo78,79 fana ka maikutlo a hore glutamate e ka kenya letsoho ho itšoara ka mokhoa o sa tsitsang le o qobelloang le sephetho sa kalafo ho PG79. Methati e phahameng ea liakhente tsa adrenergic le metabolite ea tsona e bonoe ho PG80,81. Litekanyo tsa norepinephrine lia eketseha ho batho ba nang le bothata ba papali ea chelete nakong ea papali ea chelete82. Likarabo tse sa sebetseng tsa kholo ea li-hormone ho clonidine li bonoe ho PG83, e ka bonts'ang sephiri se phahameng sa noradrenergic.
Nalane ea lelapa / liphatsa tsa lefutso ho PG
Liphuputso tse peli li bontša hore liphatsa tsa lefutso li ka tlatsetsa ho feta maemo a tikoloho mathateng a papali ea chelete15,84,85. Likhakanyo tsa PG tsa botsitso li tloha ho 50-60%15, ka menehelo e ntseng e eketseha ea lefutso e bonoang ka bothata bo boholo ba bothata ba papali ea chelete86. Boithuto ba limolek'hule bo fumana litlamorao tse nyane tse tlatsetsang liphatseng tsa lefutso tse ngata87. Mekhatlo lipakeng tsa PG le mefuta e fapaneng ea liphatsa tsa lefutso e amanang le phetiso ea dopamine (mohlala, DRD2) e fumanoe88-92 (empa o ya bona93 bakeng sa liphetho tse mpe). Mofuta o mong sebakeng sa ts'ehetso ea liphatsa tsa lefutso tsa serotonin5-HTTLPR) e amahanngoa le PG ho banna94 le monoamine oxidase A (MAO-A) hara banna ba nang le PG e matla95,96. Lithuto tsena li na le meeli e mengata e amanang le boholo ba sampole, sampole sebopeho le mekhoa ea tlhahlobo, 'me lintlha tsena li ka amana le ho se lumellane ha ho pheta-pheta.
Ts'ebeliso ea inthanete e qobelloang
Ts'ebetso ea boko ts'ebeliso e qobelloang ea inthanete
Phuputsong ea naha ea phomolo ea fMRI, homogeneity e eketsehileng ea lebatooa e fumanoe har'a basebelisi ba inthanete ba qobelloang libakeng tse ka pele (mohlala, gyrus e ka pele e holimo) le libaka tse ling (mohlala, parahippocampus). Keketseho ea homogeneity ea tikoloho e ka bonts'a khokahano e kholo lipakeng tsa libaka tsena. Kaha libaka tse ngata tse amehang ke likarolo tsa "potoloho ea moputso," liphetho tsena li matlafalitse kutloisiso ea ho putsa har'a basebelisi ba inthanete ba qobelloang97.
Thutong e nyane, ea phomolo ea mmuso ea fMRI le PET, phokotso ea phumano ea D2-like receptor e fumanoe ho dorsal striatum, ka likamano tse fosahetseng lipakeng tsa matla a tlamang sebakeng sena le mehato e itlalehang ea ho lemalla inthanete. Ha ho na bopaki ba ho se sebetse hantle ho ventral striatum bo fumanoeng98.
Mabapi le libaka tse ling tsa boko, ACC e ile ea ameha thutong e boletsoeng ka holimo ea keketseho ea tikoloho ea tikoloho ea sebaka sa phomolo har'a basebelisi ba inthanete ba qobelloang97. Botšepehi bo bobe ba litaba tse tšoeu le ho se tšoane ha lintho ka bohlooho / bophahamo ba molumo li bonoe ho basebelisi ba inthanete ba qobelloang (khahlano le taolo). Ho sebelisa imaging-tensor imaging (DTI), FA e tlase ho orbitofrontal cortex, corpus collosum le cingulum li bonoe ho basebelisi ba inthanete ba qobelloang (khahlano le taolo)99. Ho sebelisa MRI, letsoai le tlase la taba e bohlooho le fumanoe libakeng tse hokahantsoeng le taolo ea maikutlo ho kenyeletsoa le ACC, posterior cingulate, insula le lingual gyrus100. Phuputsong e arohaneng, litekanyetso tse fokotsoang tsa FA li fumanoe ho parahippocampal gyrus101 le ho fokotsa molumo o bonoang ho cerebellum, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC) le ACC. Litaba tsa bohlooho tsa tikoloho li hokahane hampe le nako ea ho lemalla inthanete101. Liphuputso tsena li haufi haholo hore ts'ebeliso e qobelloang ea inthanete e ka baka phokotso ea lintho tse bohlooho kapa hore batho ba nang le bongata bo tlase ba taba ba ka ba le monyetla oa ho lemalla inthanete.
Ka bokhutšoanyane, liphuputso tsa pejana li fana ka maikutlo a hore homogeneity ea tikoloho libakeng tse ka pele, e fokolitse phumaneho ea D2-like receptor ho dorsal striatum, botšepehi bo sa hlonepheng ba litaba tse tšoeu le phapano ea taba ea bohlooho / bophahamo ba molumo bo amang libaka tse amehang ho sebetseng ha moputso le maikutlo.
Ketsahalo ea Neurotransmitter ts'ebelisong e qobelloang ea inthanete
Phuputsong e nyane ea SPECT, mopalami oa dopamine o bonahala a hlahisoa maemong a tlase ho striatum har'a banna ba baholo ba batona ba nang le ts'ebeliso e qobelloang ea inthanete, ha ba bapisoa le taolo102. Mabapi le liphetho tsa liteko tsa bongaka, ha ho so be le lithuto tse laoloang tsa kalafo ea meriana5.
Nalane ea lelapa / liphatsa tsa lefutso ts'ebeliso ea inthanete
Basebelisi ba inthanete ba nang le bothata ba ho qoba likotsi khafetsa ba ne ba nka sekhahla se khuts'oane sa mofuta o mong sebakeng sa ts'ehetso sa lefapha la likh'outu bakeng sa morekisi oa serotonin (SS-5-HTTLPR), sekhetho se tloaelehileng le har'a bakuli ba nang le khatello ea maikutlo103.
Ho bapala lipapali tsa video
Re arotse lintho tse fumanoeng mabapi le lipapali tsa video ho tse amanang le ts'ebeliso ea inthanete. Leha ho le joalo, lipatlisiso tsa neurobiological mabapi le papali ea papali ea video e qobelloang hangata li kenyelletsa lipapali tse thehiloeng marang-rang; ka hona, liphetho tsa papali ea video li ke ke tsa aroloa ka ho hlaka le liphetho tsa inthanete.
Ts'ebetso ea boko lipapaling tse qobelloang tsa video
Ho sebelisa PET ea boemo ba phomolo, metabolism e eketsehileng e fumanoe ho gyrus e bohareng ea orbitofrontal, e ka bonts'ang ts'ebetso ea ts'ebeliso ea kelello104. Phokotso ea metabolism e fokotsehile e fumanoe ho precentral gyrus, e ka bonts'ang ho hloka kutloalo liphellong tse mpe104. Lithutong tsa ho pepeseha ha maikutlo, liphetoho tse kholo tsa pele le kamora ho bonts'a ts'ebetso e eketsehileng li ile tsa bonoa ho basebelisi ba inthanete ba qobelloang (khahlano le taolo) ho orbitofrontal cortex (OFC), medial frontal cortex le dlPFC105. Thutong e latelang, liphetoho tse kholo tsa pele ho / post-cue li ile tsa bonoa ho dlPFC har'a libapali tsa hajoale tse qobelloang ha li bapisoa le taolo106. FMRI ea pele le kamora 'kalafo nakong ea ho qhekelloa e ile ea kenyelletsoa tekong ea bupropion e bulehileng107. Joalo ka lithuto tse ling, ts'ebetso e matla e fumanoe ho dlPFC (khahlano le taolo), mme ts'ebetso ea dlPFC e fokotseha kamora nako ea kalafo ea libeke tse 6. Phuputsong ea fMRI e hokahantsoeng le mosebetsi oa ho hakanya o thehiloeng khomphuteng o kenyelletsang ho hapa chelete le tahlehelo, ts'ebetso e kholo ho OFC e fumanoe litekong tsa ho hlola har'a basebelisi ba inthanete ba qobelloang, ka lebaka la kutlo e phahameng ea moputso108.
Mabapi le ts'ebetso ea bokhachane, metabolism e eketsehileng e fumanoe ka lehlakoreng le letšehali104. Ts'ebetso e kholo ea ts'ebetso ea kamora 'ho tseba e fumanoe ho NAc e nepahetseng le caudate e nepahetseng ho libapali tsa papali tse qobelloang ha li bapisoa le taolo nakong ea fMRI105.
ACC le insula le tsona li kentsoe letsoho lipapaling tse qobelloang tsa video. Thutong ea induction ea fMRI106, Ketsahalo e kholo ea kamora ho tseba e fumanoe ho ACC har'a libapali tse qobelloang. Nakong ea mosebetsi oa ho hakanya moputso, ho fokotseha ha ts'ebetso ea ACC ho fumanoe nakong ea liteko tsa tahlehelo ho li-gamers tsa video tse qobelloang (khahlano le taolo), ho fana ka maikutlo a boikaketsi ho tahlehelo108. Mosebetsi o eketsehileng oa insular o fumanoe o phomotse104. Bapalami ba papali ba qobelloang ba bonts'itse molumo o eketsehileng ho thalamus empa ba fokotsa molumo maemong a tlase, bohareng le ka letsohong le letšehali a tlase gipri ea occipital109.
Ka bokhutšoanyane, liphuputso tse fumanoeng mecheng ea libapali tsa papali ea banna e qalang e le bacha li fana ka maikutlo a keketseho ea mesebetsi nakong ea phomolo, lithutong le nakong ea ts'ebetso ea moputso libakeng tse ka pele, striatum le libaka tse ling, le ho fokotsa kutloisiso liphellong tsa tahlehelo. Liphumano tsa keketseho ea mesebetsi li bonahala li hanyetsana le liphuputso tse ngata tsa thuto ea PG. Libaka tse amehang papaling ea video e qobelloang li bonahala li kenya letsoho ho sebetsaneng le moputso, taolo ea tšusumetso le mohopolo.
Ketsahalo ea Neurotransmitter lipapaling tse qobelloang tsa video
Ho hlahisitsoe karolo ea ho se sebetse hantle ha dopaminergic110. Liphuputso tsa lefutso tse tlalehiloeng ka tlase li lumellana le menehelo ea dopaminergic ea papali ea papali ea video e qobelloang110.
Nalane ea lelapa / liphatsa tsa lefutso lipapaling tse qobelloang tsa video
Ho entsoe lipatlisiso tse lekantsoeng tsa lefutso la limolek'hule. Mefuta e fapaneng ea mefuta ea DRD2 Taq1A1 allele tse amanang le ho fetoloa ha lets'oao la dopamine ho khothalelitsoe ho kenya letsoho papaling ea video e qobelloang. Har'a bapalami ba batona, alq ea Taq1A1 e ne e amana le ho ipapisa le moputso o phahameng o itlalehang110. Mefuta e fapaneng ea lefutso le kenyang catechol-o-methyl transferase (COMTtse 'nileng tsa ameha phetisong ea lithethefatsi le lithethefatsi111 le tsona li tlalehiloe li atile haholo lipapaling tse tlamang110.
Mabenkele a qobelloang
Ts'ebetso ea boko mabenkeleng a qobelloang
Phuputsong ea haufinyane112, bareki ba qobelloang le taolo e phetseng hantle li ile tsa bapisoa le mosebetsi oa mekhahlelo e mengata ea ho reka113 nakong ea fMRI. Nakong ea karolo ea pele ea tlhahiso ea lihlahisoa, bareki ba qobelloang ba bonts'itse ts'ebetso e matla ho NAc ho feta taolo. Nakong ea karolo e latelang ea tlhahiso ea litheko, bareki ba qobelloang ba bonts'itse ts'ebetso e nyane ea insula le ACC ho feta taolo, eo ea ho qetela e ileng ea buloa ka matla le ho feta ke bareki ba qobelloang nakong ea qeto.
Ketsahalo ea Neurotransmitter mabenkeleng a qobelloang
Liphetho tse ntle li bonoe ka citalopram tekong e nyane e bulehileng114. Nyeoe e latelang e nyane e qalileng ka nako e bulehileng e lateloang ke tsamaiso e laoloang ka mapheo a mabeli a foufetseng har'a ba arabileng e hlahisitse litholoana tse ling tse ntle tsa citalopram115. Liphuputso tsena li fane ka tšehetso ea nakoana bakeng sa ho se sebetse hantle ha serotonergic mabenkeleng a qobelloang. Leha ho le joalo, liphetho tse mpe ka li-SRIs tse ling (mohlala, fluvoxamine,116,117 escitalopram118phahamisa lipotso mabapi le ts'ebeliso ea bongaka ea li-SRIs bakeng sa ho reka ka mokhoa o qobelloang.
Nalane ea lelapa / liphatsa tsa lefutso mabenkeleng a qobelloang
Lintlha tse fokolang li fana ka maikutlo a hore bareki ba qobelloang ba na le monyetla oa ho ba le litho tse haufi tsa malapa le psychopathology119,120. Ha ho phapang e bonoeng ho maqhubu a liphatsa tsa lefutso tse peli tsa serotonin (5-HTT) polymorphisms ho batho ba nang le ntle le ho qobelloa ho ea mabenkeleng121.
Kleptomania
Ts'ebetso ea boko ka kleptomania
Botšepehi bo mabapi le taba e tšoeu bo futsanehileng libakeng tsa ventromedial prefrontal cortical bo bonoe ho kleptomania122.
Ketsahalo ea Neurotransmitter ho kleptomania
Liphuputso tse mabapi le ho se sebetse ha serotonergic ha li lumellane. Ho tlalehiloe lipalo tse tlase tsa bajaki ba tsamaisang li-serotonin ho kleptomania123,124, ho fana ka maikutlo a ho se sebetse ha serotonergic; Leha ho le joalo, liphetho tse mpe tse tsoang ho liteko tse nyane tse foufetseng tse laoloang ke placebo tse amang ba arabelang li-open-label li tlalehiloe bakeng sa escitalopram125. Litholoana tse ntle tekong e nyane ea bofofu ba naltrexone126 e fana ka maikutlo a ho nka karolo ha opioidergic.
Boitšoaro bo bobe ba ho kopanela liphate
Ts'ebetso ea boko liketsong tse qobelloang tsa thobalano
Boithuto ba ho qobelloa ho kopanela liphate bo fokotsoe. Phuputsong ea DTI129, Batho ka bomong ba nang le khatello ea thobalano ba ne ba na le sebaka se tlase se phahameng se ka pele se bolelang phapang ha e bapisoa le taolo. Liphuputso tsena ha lia latela liphetho tsa liphetho tsa lithuto tse ling tsa boitšoaro bo hlephileng53,54,99,101,122.
Ketsahalo ea Neurotransmitter ka boitšoaro bo qobelloang ba thobalano
Litholoana tse ntle tsa citalopram thutong e laoloang ea li-placebo tse foufetseng habeli ka boits'oaro bo qobelloang ba thobalano ho banna ba bong bo tšoanang le ba bong bo fapaneng e fana ka maikutlo a ho se sebetse hantle ha serotonergic130.
Nalane ea lelapa / liphatsa tsa lefutso ka boitšoaro bo qobelloang ba thobalano
Liphuputso tse fokolang li fana ka maikutlo a hore karolo e phahameng ea ba nang le boitšoaro bo hlephileng ba thobalano ba na le motsoali ea nang le boemo bo ts'oanang131. Liphuputso li bonts'a litloaelo tsa batho ba etsang thobalano ho ba le beng ka bona ba maemo a pele ba nang le mathata a ts'ebeliso ea lithethefatsi (SUDs)131.
Ho tšoana le ho se tšoane le sephetho sa ts'ebeliso ea lithethefatsi
Liphuputso tsa Neurobiological litlamong tsa boits'oaro li lula li le nyane mme lintlha li fokola haholo bakeng sa mabenkele a qobelloang, kleptomania le boits'oaro bo qobelloang ba thobalano. Leha ho le joalo, tlhaiso-leseling e fumanehang e fana ka bopaki ba ho holofala ha methapo ea kutlo ka kakaretso, e tšoanang le liphetho tsa SUD. Lisebelisoa tsa 1, , 22 'me Le33 e na le tlhaiso-leseling e bapisang bokhoba ba boitšoaro le li-SUD.
Liphuputso tsa botšepehi bo futsanehileng ba litaba tse tšoeu mohlomong e bile tsona tse tlatsetsang ka ho fetisisa lipakeng tsa ntho132,133 le bokhoba ba boitšoaro53,54,99,101,122 (empa o ya bona129 bakeng sa liphetho tse bonahalang li hanyetsana). Tsebo ea ts'ebetso ea kelello e fella ka SUDs50,51,134,135 le PG40,50,51,136 ba khothalelitse ts'ebetso e fokotsehileng libakeng tse ka pele. Liphuputso tse kenyelletsang likarolo tsa ho etsa liqeto tsa kotsi / moputso (ho kenyeletsoa le ho sebetsoa ha meputso), empa ha ho le joalo ha li joalo ho tsoa mesebetsing ea khatello ea maikutlo, li tloaetse ho bonts'a ts'ebetso e fokotsang ea ho kenella kahare ho PG38,40,48 le li-SUDs137-140, leha ho bile le liphetho tse bonahalang li hanyetsa41,141,142. Liphuputso li tloaetse ho bonts'a ts'ebetso e eketsehileng ho dorsal striatum litlamong tsa boitšoaro43,48 le li-SUDs143,144.
Bopaki bo mabapi le ts'ebetso ea methapo ea kutlo litlamong tsa boitšoaro le li-SUD bo tloaetse ho tlatsana. Bopaki ba Neurochemical bo hlahisitse phokotso ea mopalami oa dopamine le phumaneho ea receptor ea D2 joalo ka phomolo98,102,145,146 le ho lokolloa ha dopamine nakong ea ketsahalo e amanang le boitšoaro bo lemalloang147,148, leha ho bile le liphetho tse bonahalang li thulana maemong a phomolo ho PG44,45 le li-SUDs149, mme liphapang tsa batho ka bomong li bonahala li le bohlokoa ho lokolloeng ha dopamine44,45,150. Liphuputso tsa Neurochemical li fana ka maikutlo a hore phapang ea serotonergic ha e bapisoa le taolo har'a ba nang le lithethefatsi62-66,124 le li-SUDs151-153. Liphetho tsa bongaka le bahanyetsi ba dopamine60,61,154-156 le meriana e shebileng litsamaiso tsa serotonin (haholo-holo li-SRI68-72,157-159) li bontšitse liphetho tse mpe kapa tse tsoakaneng litlamong tsa boitšoaro le li-SUD. Liphetho tsa bongaka tse amanang le bahanyetsi ba opioid li tloaetse ho ba ntle bakeng sa mefuta ka bobeli ea maemo40,45,73-76,126,160-162. Liphetho tse lekantsoeng le li-probes tsa pharmacologic li fana ka maikutlo a karolo ea ketsahalo ea glutamatergic ho PG78,79 le li-SUDs163,164. Liphuputso tsa Neurochemical le tsa bongaka li fana ka maikutlo a karolo e ka bang teng bakeng sa ts'ebetso ea norandrenergic ho PG80-83 le li-SUDs165-167.
Liphatsa tsa lefutso (haholo-holo limolek'hule) le bopaki ba nalane ea lelapa li lekanyelitsoe litlamong tsa boitšoaro. Leha ho le joalo, bopaki bo fumanehang bo fana ka boiphihlelo bo matla ba PG15,84. Bakeng sa lithethefatsi tse ling tsa boitšoaro, ho na le bopaki bo bontšang likotsi tsa lelapa ho feta maemo a kelello71,110,119,120,127,128,131. Li-SUD li bonahala li le bohlokoa haholo27,168.
Bopaki bo tsoang liphuputsong tsa ho qhekella le ho phomola ha maemo a mmuso ha bo sa hlaka ebile ho bonahala bo hanyetsana. Liphetho tsa ho phomola le boemo ba ho qhekella lipapaling tse qobelloang tsa video li khothalelitse ts'ebetso e eketsehileng libakeng tse ngata tsa boko104-106,169. Ho bile le sephetho se bonahalang eka se loantšana mathateng / PG le lithuto tsa ho qhekella tsa SUD bakeng sa ho tsoaloa ka bobeli (ho becha)7,35; SUD7,143,144,170) le ts'ebetso e tobileng171,172. Liphapang lipakeng tsa lithuto ka litšobotsi tsa motho ea nkang karolo le lintlha tse ling tsa sethala li ka kenya letsoho liphellong tsena tse fapaneng171,172. Ntle le moo, phokotso ea ho lokolloa ha dopamine ka lebaka la ts'ebeliso ea lithethefatsi ha ts'ebeliso e mpefala173 e kanna ea lebisa ho heterogeneity ts'ebetsong ea ventral-striatal ho feta bankakarolo lithutong tsa SUD.
Ka kakaretso, lintlha li fana ka maikutlo a ho se sebetse ha neurobiological litlamong tsa boitšoaro le li-SUD. Tse ling tsa liphetho tse tlatselletsang li kentse botšepehi ba taba e tšoeu, ts'ebetso ea boko nakong ea ts'ebetso ea ts'ebetso ea ts'ebetso, ts'ebetso ea methapo ea kutlo le kholo ea tlhaho.
Liphetho le lipatlisiso tsa nako e tlang
Patlisiso mabapi le neurobiology le liphatsa tsa lefutso tsa boitšoaro bo hlephileng e potlakile lilemong tsa morao tjena, haholo-holo ho PG, ts'ebeliso e qobelloang ea inthanete le papali ea boithabiso ea video. Likheo tsebong li ntse li le teng mme lipatlisiso mabapi le litlolo tse ling tsa boitšoaro li fokotsoe. Phuputso e seng e le teng e fana ka maikutlo a tšoanang lipakeng tsa lithethefatsi le boits'oaro. Liphuputso tse ling tsa lefutso, haholo-holo limolek'hule, li ka ba bohlokoa ho hlaloseng ho tšoana le phapang lipakeng tsa litloaelo tsa boits'oaro le lipakeng tsa litloaelo tsa boits'oaro le li-SUD. Neuroimaging e se e qalile ho fana ka leseli mabapi le ho tšoana le phapang. Ho hlokahala lipatlisiso tse ling, ho kenyelletsa mefuta e mengata e fapaneng ea mesebetsi ea kutloisiso174. Le ha mekhoa e tloahelehileng e bile bohlokoa, mekhoa e meng ea ho sekaseka e kang ea likhomphutha174 e kanna ea bontša ka ho ts'oanang ho ts'oana le li-SUDs.
Meriana ea liteko tsa lipatlisiso le liphekolo tse bontšitsoeng bakeng sa li-SUD li qalile feela. Boithuto bo amang batho ba nang le ts'ebeliso e mpe ea boits'oaro le lithethefatsi bo ka ntlafatsa kutloisiso ea rona ea bokhoba le ho nts'etsapele nts'etsopele ea kalafo. Basali hangata ba qheleloa ka thoko kapa ha ba emeloe ka tlase lithutong tsa bokhoba ba boits'oaro, haholo lithutong tsa liphatsa tsa lefutso le lipatlisisong tsa papali ea papali ea video. Boithuto ba nako e tlang bo lokela ho kenyelletsa basali le ho lekola hore na liketsahalo tse fapaneng tse amanang le ho lemalla boitšoaro li sebetsa ho banna le basali joang.
Kaha ho lemaletse boitšoaro, haholoholo bo amanang le papali ea chelete, ts'ebeliso ea inthanete le papali ea video, li bonahala li le bohlokoa ho bacha le ho batho ba baholo2,101,110, lithuto tsa longitudinal li ka ba tsa bohlokoa. Lintlha tsa Epidemiologic li lekanyelitsoe litlamong tsa boitšoaro ntle le PG. Liphuputso tsa naha le tsa machabeng tse lekolang ho ata ha litlatsetso tse ngata tsa boitšoaro li ka matlafatsa tsebo ea rona mabapi le hore na maemo ana a ama batho ho isa kae bophelong. Mekhoa e lumellanoeng ka mokhoa o ts'oanang ea tlhahlobo le lisebelisoa tsa tlhahlobo e tla thusa ho bapisa lipatlisisong.
Litlhahiso tsa meriana
- Addict Ho lemalla boitšoaro ho khetholloa ka ho se sebetse hantle libakeng tse ngata tsa boko le litsamaisong tsa methapo ea kutlo.
- ■ Nalane ea lelapa / liphumano tsa lefutso li fana ka maikutlo a botsitso ba papali ea chelete ea ho becha le mafu a kelello malapeng a batho ba nang le lithethefatsi
- ■ Liphuputso li bontša ho tšoana lipakeng tsa liphuputso tsa methapo ea kutlo le liphatsa tsa lefutso litlamong tsa lithethefatsi le boitšoaro.
- ■ Lintlha li ts'ehetsa likhopolo tsa ho kenella ka mokhoa o fetelletseng mekhoeng eo e seng ea lithethefatsi e le bokhoba.
sheba mefokolo ea:
- Data Lintlha tse teng litlamong tse seng tsa lithethefatsi kapa tsa boitšoaro li na le moeli.
- Litaba li na le moeli haholo bakeng sa mabenkele a qobelloang, kleptomania le boitšoaro bo hlephileng ba thobalano.
- ■ Liphuputso tsa lefutso ke tsa pele haholo ebile li fokola.
lumela hore baa fokola
Mosebetsi ona o ne o tšehelitsoe ka karolo e 'ngoe ke NIH (K01 AA 019694, K05 AA014715, R01 DA019039, P20 DA027844, RC1 DA028279, RL1 AA017539), VA VISN1 MIRECC, Lefapha la Connecticut la Mental Health and Addiction Services le Setsi sa Patlisiso e Khabane. Moputso o tsoang Setsing sa Naha sa Papali e Ikarabellang le Setsi sa ona sa kopanelo sa Patlisiso ka Mathata a Ho becha. Likahare tsa buka e ngotsoeng ka letsoho ke boikarabello ba bangoli feela mme ha se hakaalo hore li emela maikutlo a semmuso a mekhatlo efe kapa efe ea lichelete.
Mongolo o botlaaseng ba leqephe
Liphatlalatso: Bangoli ba tlaleha hore ha ba na likhohlano tsa lichelete mabapi le litaba tsa mongolo ona. Ngaka Potenza o fumane tšehetso ea lichelete kapa matšeliso bakeng sa tse latelang: Dr. Potenza o buisane le ho eletsa Boehringer Ingelheim; e buisane le lithahasello tsa lichelete ho Somaxon; e amohetse tšehetso ea lipatlisiso ho tsoa ho Setsi sa Naha sa Bophelo, Tsamaiso ea Veteran, Mohegan Sun Casino, Setsi sa Naha sa Lipapali Tse Ikarabellang le Setsi sa Tsamaiso sa Ts'ebetso ea Lipatlisiso mabapi le Mathata a Boloi, le Psyadon, Laboratories tsa Meru, Ortho-McNeil, Oy-Control / Biotie le Glaxo-SmithKline litlhare; o nkile karolo lipatlisisong, liposong tsa mangolo kapa lipuisanong tsa mehala tse amanang le tšebeliso ea lithethefatsi, mathata a taolo ea tšusumetso kapa lihlooho tse ling tsa bophelo; e buisane le liofisi tsa molao le ofisi ea mmuelli oa mmuso litabeng tse amanang le mathata a taolo ea tšusumetso; e fana ka tlhokomelo ea bongaka Lefapheng la Connecticut la Bophelo bo Botle ba kelello le lits'ebeletso tsa tlhekefetso ea mathata a boloi; e entse tlhahlobo ea lithuso bakeng sa Setsi sa Naha sa Bophelo le mekhatlo e meng; e na le likarolo tsa likoranta tse hlophisitsoeng ke baeti; e fane ka lipuo tsa thuto lithutong tse ntle, liketsahalong tsa CME le libakeng tse ling tsa bongaka kapa tsa saense; mme e hlahisitse libuka kapa likhaolo tsa buka bakeng sa baphatlalatsi ba mangolo a bophelo bo botle ba kelello.
References