Curr Neurol Neurosci Rep. 2013 Oct;13(10):386. doi: 10.1007/s11910-013-0386-8.
Chelete ea CC1, van Eimeren T.
inahaneloang
Mathata a qobelloang a susumetsang maikutlo a kang papali ea chelete, bosodoma, ho ja hampe le ho ea mabenkeleng ke litlamorao tsa kalafo ea dopaminergic bakeng sa lefu la Parkinson. Ka bongata bo tlase, mathata ana a boetse a hlaha sechabeng ka kakaretso. Patlisiso lilemong tsa morao tjena e fumane hore boits'oaro bona ba boits'oaro bo arolelana likarolo tse ts'oanang le tsa mathata a ts'ebeliso ea lithethefatsi (SUD), e lebisitseng ho poleloana "litloaelo tsa boits'oaro". Joalo ka li-SUDs, boits'oaro bo tšoauoa ka ho khanna ka mokhoa o qobelloang ho ea le ho holofala ha boitšoaro. Ntle le moo, lithuto tsa liphoofolo le meriana, lipatlisiso ho palo ea mafu a Parkinson, le liphuputso tsa neuroimaging li bonts'a neurobiology e tloaelehileng ea boits'oaro bo lemalloang. Liphetoho tse amanang le lithethefatsi li bonoa haholo tsamaisong ea dopaminergic ea potoloho ea mesocorticolimbic, eo ho thoeng ke moputso. Mona re thathamisa se fumanoeng ke neurobiological mabapi le litlolo tsa boitšoaro tse shebaneng le lits'ebetso tsa dopaminergic, re li amahanya le likhopolo tsa SUD, 'me re leke ho aha mohopolo oa ho kopanya liphatsa tsa lefutso, neuroimaging, le sephetho sa boits'oaro.
Keywords: Litla-morao tsa boitšoaro, ho becha ka Pathological, ho ja ka mokhoa o feteletseng, ho reka ka mokhoa o qobelloang, khatello ea maikutlo, mathata a tšebeliso ea lithethefatsi, potoloho ea Mesocorticolimbic, Reward system, Dopamine, Parkinson, lefu la Parkinson, Neurobiology, mabaka a kotsi, mathata a taolo ea tšusumetso, ts'ebetso ea kelello
Selelekela
Lilemong tse leshome tse fetileng, liphuputso tse ngata tse khahlisang li fane ka leseli la kutloisiso e ncha ea methapo ea kutlo ea mathata a boits'oaro a ho qhekella, joalo ka papali ea chelete. Ka holim'a tsohle, karolo ea bohlokoa ea neurotransmitter dopamine e totobalitsoe. Hoo e ka bang bakuli ba 14% ba nang le lefu la Parkinson (PD) ba fumanang meriana ea dopaminergic ba ba le mathata a ho qhekella, a kang papali ea chelete, bosodoma, ho ja le ho itlopa joala le ho reka ka thata.1•]. Le ha ho sa atisehe, mathata ana a hlaha hape ho bongata (bao e seng PD), ka linako tse ling ho thoe ke "mathata a teng ka tšohanyetso", "mathata a taolo ea ts'usumetso" (ICDs, kapa "litloaelo tsa boits'oaro," mme a ka li beoe kahar'a DSM-IV-TR joalo ka li-ICD, leha e le papali ea chelete feela e boletseng litekanyetso [2]. Ho ile ha fumaneha hore, leha ho ne ho ngotsoe bongolo bo fapaneng, mathata a kang ho becha ha methapo, ho ba le moea o mongata, ho itlopa joala ho reka, ho reka ka bongata le ho sebelisa inthanete ho arolelana likarolo tse ling tsa bohlokoa ka mathata a tšebeliso ea lithethefatsi (SUDs) [3]. Boitšoaro, lintho hammoho le bokhoba ba boits'oaro bo bonts'oa ke ho itlhahisa ho lithethefatsi / boits'oaro bo itseng mme ka linako tse ling ho iphapanya ha ho khothaletsoa tlhaho. Lintho tse ling tse ts'oanang ke ho lakatsa ho ja ntho kapa ho etsa lintho ka mekhahlelo ea ho itima lintho le ho sitoa ho emisa boitšoaro bo kotsi [3]. Ho na le bopaki bo bongata ba hore mekhoa ena e fetelletseng le e matlafatsang e kenyelletsa "dopaminergic" system ea moputso, joalo ka lintho tsohle tsa tlhekefetso (bakeng sa tlhahlobo, bona [4]). Ka lebaka la ho ts'oana ho joalo ka phenomenology le neurobiology, ho bile le tlhahiso ea ho khetholla li-ICD tse ngata e le bokhoba ba boitšoaro ho DSM-V, leha ho le joalo ke papali ea marang-rang feela e isitsoeng karolong ea "bokhoba le mathata a amanang le eona" a DSM-V [4].
Phekolo e nepahetseng le thibelo ea li-ICD li itšetleha ka kutloisiso e ntle ea hore na mekhoa ena ea methapo e qala joang. Ntlha e 'ngoe ea bohlokoa ea ho qala ke neurobiology e tloaelehileng le ho ts'oana ha bokhoba. Ka hona, re tla qala ka ho hlalosa neuroanatomy ea ts'ebetso ea moputso le phetoho ea eona litlamong tsa litheko le boits'oaro. Kamora nako, re tla leka ho hlakisa lintho tse rerang esale pele le ho li amahanya mabapi le bokhoba ba boitšoaro ho PD le batho bao e seng PD, re shebane le neuroimaging le dopamine. Kamora nako, re tla hlalosa melaoana ea neurobiological ea dopaminergic endophenotype e ka bang kotsing ea ho holisa li-ICD / litloaelo tsa boits'oaro.
Seketsoana ea Bokhoba ba ho Buella
Ho bile le lipatlisiso tse pharaletseng mabapi le motheo oa neurobiological oa SUDs (bakeng sa tlhahlobo, bona [5]). Mona, re bontša likhetla tsa neuroanatomical tse kenyelletsang ho nts'etsopele le ho hlokomela makhoba a lithethefatsi le litlamorao tsa boitšoaro.
Neuroanatomy ea "Moputso" oa Mesocorticolimbic
Lithethefatsi le tse ling tse thabisang li susumetsa ho etsa lintho tse khothatsang mokokotlong oa mesocorticolimbic, seo ho thoeng ke moputso oa kamohelo, e kenyelletsang ventral striatum [VS; ho kenyelletsa le nucleus accumbens (NAcc)], orbitofrontal cortex (OFC), anterior cingrate cortex (ACC), amygdala, le hippocampus [5] (empa bona le [6]). Litšusumetso tsa novel, li-reinforcos tsa tlhaho tse kang ho ja le ho kopanela liphate, le likhothaletso tse seng tsa tlhaho li lebisa ho phasic ea dopamine ho tloha sebakeng sa ventral tegmental ho ea ho Nacc, amygdala, le hippocampus [7]. Letshwao lena la dopaminergic le kanna la bonts'a mosifa mme la phahamisa ho ithuta ho kopaneng. Amygdala le OFC mohlomong ba bapala karolo ea bohlokoa ho hokahanya litumelo tsa ho bolela moputso le maikutlo a monate a hlahisitsoeng ke moputso oa 'nete [8]. OFC e kenella ho kenyeletsa ho kenyeletsa le ho nchafatsa boleng ba moputso (e amanang) le [8]. Dopaminergic neuromodulation ka har'a mpa e bonahala e ntlafatsa mohopolo oa nako e telele oa hippocampus e le hore mehopolo le maemo a amanang le moputso a ananeloe ka ts'epahalo maemong a kamora [7]. ACC, ka lehlakoreng le leng, e kenyellelitsoe ho hokahanya meputso le liketso mme ka hona e na le karolo ea maikutlo a khethollo ea ketso kamora ho fana ka meputso [9]. Ka bokong bo phetseng hantle, boits'oaro bo lebisitsoeng ho moputso bo laoloa ka mokhoa o ts'oanang ke litšusumetso tsa inhibitory tsa preortal cortex (PFC). Mona, ho kenyelletsa maikutlo a fapaneng, mehopolo, lipheo le boemo ba mmele (mohlala, phepelo ea phepo e nepahetseng) li tlameha ho hokahanngoa ho kenyelletsa ts'ebetso e lekaneng [10]. E fetisa ka OFC le ACC, litšusumetso tse holimo-tlase li fihla libakeng tsa mesolimbic hape mme li laole sepheo se batlang meputso [9].
Le ha ts'ebetso ho potoloho ea mesocorticolimbic e itšetleha haholo ka phetiso ea dopaminergic, lits'ebetso tse ling tsa neurotransmitter le tsona li bapala karolo ea bohlokoa. Ho nahanoa hore "ho rata" meputso ho hlahisoa ke ho hlohlelletsa μ-opioid mme o sebelisana haufi-ufi le tsamaiso ea dopaminergic ho NAcc le ventral pallidum [11]. Ho feta moo, coactivation ea dopamine D1 li-receptors le NMDA lits'ebetsong tsa corticolimbic striatal circuits li kanna tsa hlokahala bakeng sa ho ithuta ka moputso oa ho ithuta [12]. Litekanyetso tsa GABAergic tse tsoang mohatleng oa "ventral tegmental area" / "rostromedial tegmental nucleus" ho ea sebakeng se haufi sa "ventral tegmental" le "substantia nigra" li bonahala eka ke tšenyo e kholo bakeng sa lits'ebetso tsa dopaminergic [13].
Sistimi e Fetotsoeng - Potoloho ea Lithethefatsi
Maemo a tlhekefetso a ka bonoa e le litlatsetso tse matla tsa maiketsetso. Ba baka tokollo e matla ea dopamine e sa luleng kapele joalo ka meputso ea tlhaho [5, 14]. Matšoao a dopaminergic bohareng ba mpa a ho nahanoa hore a bonahatsa sesosa sa bohlasoa mme ka hona a bea boleng bo khothatsang linthong tse lemalloang le ho susumetsa boits'ebetso bo khahlisang mohopolo o amanang le ona [5]. Boemo ba bonohe bo phahameng bo bontšoa ke ts'ebetso e matla ea sistimi ea moputso kamora lits'ebetso tse amanang le lithethefatsi (mohlala, joala bo bona botlolo ea biri) [15]. Boemong ba polelo ea maemo, litloaelo li ba tšusumetso ea ts'usumetso e sa reroang (ke hore, ntho kapa boitšoaro). Ho na le lithuto tse fokolang mabapi le ho nchafatsoa hoa cue litabeng tsa boits'oaro, mme liphetho li hanana ebile ha li tšoane kamehla le lithuto tsa SUD [16-19]. Sena se ka bakoa ke mekhoa le mekhoa ea ho khelosa [20]. Bokhobeng ba lithethefatsi le tšebeliso ea lithethefatsi, boitšoaro bo khothalletsoang bo susumetsoa ke ho "batla" kapa "ho lakatsa" ts'usumetso e sa reroang [5, 18, 21]. Ho pepesetsoa khafetsa tšusumetsong e sa reroang ka mokhoa o sa lebelloang ho lebisa ho matlafatsong ea ts'ebetso ea mesolimbic dopaminergic ka tšusumetso ea matla a libaka tsa bongoana tsa pele [9] (Bona sa feiga. 1). Tumellanong le tlhahiso ena, lithuto tse nang le litheko tsa lithethefatsi le / kapa lithahasello tsa boitšoaro li bonts'oa ka taolo e fokotsehileng ea tšusumetso, joalo ka ha poleloana e reng "impulse control disorder" (ICD) e bolela [22-24]. Ha u lekoa, tšusumetso ea ho sebelisa sethethefatsi kapa ho etsa boitšoaro e khahlano le boiteko ba ho laola boitšoaro bo bobe. Nakong ea ts'ebetso ea bokhoba, boitšoaro bo neng bo sa qete hangata bo fetoha tloaelo. Likhopolo tse amanang le SUD li fana ka maikutlo a hore nakong ea ho theha tloaelo, ts'ebetso e hlahisoang ke ts'usumetso e nang le maemo e tloha ho khetla ea NAcc ho ea mantlha a eona ebe qetellong e ea likarolong tse tlase tsa striatum le Associative hammoho le sensorimotor corticostriatal circuits [7]. Hape ho li-ICD, ho fumanoe tse fumanoeng tse supang phetoho e joalo [25].
Likhopolo holima nts'etsopele ea bokhoba ba tahi
Tlhahlobo ea morao-rao e bontšitse likhopolo tsa mantlha mabapi le nts'etsopele ea li-SUDs [26]. The phaello ea moputso e bolela hore ho fetoha hoa mofuta o itseng ho lebisa ho D2 letsoalo la receptor tsamaisong ea methapo ea maoto [27]. Ka hona, batho ba hlaselehang habonolo ba ikutloa ba sa phutholoha 'me ba hloka ho khothatsoa ka matla ho khutlisetsa boemo ba dopamine maemong a tloaelehileng le ho phomola [27]. Robinson le Berridge [15. Sephetho ke hypersensitivity ho litlamorao tse susumetsang tsa lithethefatsi le tšusumetso e amanang le lithethefatsi. Leha ho na le bopaki bo bongata bo emelang khopolo ea ho hlasimolla, ha e hlalose hore na hobaneng ba bang ba hlaseleha habonolo ho feta ba bang. Goldstein le Volkow [28] a ntšetsa pele tšibollo ea karabelo e fokolisang le tšenyo ea mothofatso (I-RISA) ea tšebeliso e kopantseng tšebeliso e ntlafalitsoeng ea sesapo le tšitiso e mpe. Joalo ka Blum et al. [27], ba beha taba ea hore D2 khaello ea li-receptor e ikarabella tšebeliso ea lithethefatsi le boitšoaro bo batlang meputso [28].
Karolong ena, re nkile setšoantšo se rerileng sa meaho le lipotoloho tse amehang ts'ebetsong ea meputso le ho lemalla. Likarolong tse latelang, re tla totobatsa liphetho tsa neurobiological litabeng tsa boitšoaro bo bobe le ho li hokahana le likhopolo tsa tlhabollo ea bokhoba.
Lintlha tse amanang le Nts'etsopele ea Litloaelo tsa Boitšoaro
Motho e mong le e mong o na le tsamaiso ea moputso, empa ha se motho e mong le e mong ea arabelang meputso ka tekanyo e tšoanang. Batho ba bangata haholo ba becha nako le nako, 'me kaofela ha rona re ja, re reka kapa re etsa thobalano khafetsa kapa tlase. Empa ke mang ea tla lemalla? Tlhatlhobo ea lintlha tseo ho nahanoang hore li susumetsa mofuta oa genesis le nts'etsopele ea litabatabelo tsa boits'oaro li fanoa ho Fig. 2.
Liphatsa tsa lefutso
Likhakanyo tsa botsitso ho li-SUD li tloha ho 40 ho isa ho 70% [29]. Patlisiso lefapheng la litlhekefetso tsa boits'oaro ha e na palo e kholo ebile e shebana le papali ea chelete. Phuputso e 'ngoe e kholo e bontšitse hore litšusumetso tsa lefutso li ikarabella ho 37-55% ea ho fapana ha papali ea chelete ea papali ea chelete [30]. Lithuto tse ling tse peli, leha ho le joalo, li fumanoe li le tlase [31] kapa phahameng haholo [32] litefiso tsa lefutso. Ho na le mabaka a 'maloa a entseng hore tlhahlobo ea ts'usumetso ea liphatsa tsa lefutso mabapi le nts'etsopele ea li-ICD e rarahane haholo ebile e le multidimensional. Taba ea pele, polelo le tšusumetso ea liphatsa tsa lefutso li itšetlehile ka tšusumetso ea tikoloho le boipheliso (epigenetics) [29]. Taba ea bobeli, liphumano li bonts'a feela hore li-polymorphism tse ling li ama nts'etsopele ea mekhoa le / kapa ho fumaneha ha li-neurotransmitters, tseo ka nako e 'ngoe li boletseng tlhekefetso ea litekanyetso ho isa bohōleng bo itseng. Taba ea boraro, hangata li-polymorphism li khothaletsa bokhoba ba ts'ebeliso ea litšebelisano ha bo sebelisana le li-polymorphism tse ling.
Bakeng sa puisano e qaqileng ea litloaelano lipakeng tsa liphatsa tsa lefutso le li-ICD ho lipalo tsa PD le tse seng tsa PD, re bua ka litlhahlobo tse peli tsa morao-rao tse fanang ka kakaretso ea genetics litlamong tsa boits'oaro [33, 34]. Ka bokhutšoanyane, lithuto li fana ka maikutlo a ho hlaseloa ha liphatsa tsa lefutso haholo-holo mabapi le li-polymorphisms tse susumetsang phetiso ea dopaminergic, mohlala, dopamine transporter polymorphism SLCA3 kapa D2 polymorphism Taq1A. Empa hape liphihlelo tsa liphatsa tsa lefutso tse khethollang catecholaminergic, serotonergic, glutamatergic le opioid li bontšitsoe li rera esale pele bakeng sa li-ICD le / kapa mekhoa e amanang le eona.
Li-neurotransmitters
Joalokaha ho boletsoe pejana, ho fumaneha le ho sebetsa ha li-neurotransmitters ho latela ts'ebelisano ea tikoloho. Tse ling tsa litlamorao tse hlahisoang ke tsona li bonahala e le tšekamelo ea ho hlaolela ho lemalla (boitsoaro) ho feta ba bang. Ka ho shebisisa dopamine, karolo ena e fana ka kakaretso ea ts'ebetso ea neurotransmitter e fetotsoeng mesebetsing ea bokhoba ba boitšoaro.
Dopamine
Ka lebaka la ho haelloa ke lithuto tse tla nka nako e telele, hangata ho thata ho tseba hore na phapang ea methapo ea kutlo e tla pele kapa e latela nts'etsopele ea litloaelo tsa boits'oaro. Leha ho le joalo, liphumano li bonts'a hore litlolo tsa botona kapa botšehali tse tlisoang ke liphatsa tsa lefutso li lebisa ho boits'oaro bo amanang le methapo mme bo baka tsitsipano e eketsehileng tsamaisong ea dopaminergic. Boithuto bo lebisang tlhokomelo ho D2 receptor gene e fana ka maikutlo a hore mofuta oa A1 allele oa Taq1A polymorphism o etsa boemo bo khetholloang ka ho fokotseha ho fumaneha ha D2 receptors in the striatum [27]. Ntle le moo, ho na le liphumano tse fumanoang hore batho ba betšang ba pathological le batho ba nang le methapo ea tšebeliso ea methapo kapa tšebeliso ea lithethefatsi tsa inthanete ba fokotsehile [11C] lebala la marang-rang la li-raclopride35-37]. Leha ho le joalo, liphetho tsa PET li kanna tsa bonts'a ho theoha hoa ts'ebetso ha barekisi ba dopamine kapa li-receptor kapa maemo a mang a phahameng a synaptic dopamine. Kahoo, ho lula ho sa hlaka hore na ho na le "basal hypodopaminergic state" joalokaha e hlahisitsoe ke "tlhaelo ea moputso" kapa "boemo ba hyperdopaminergic" joalo ka ha ho khothalelitsoe ke sensotization hypothesis [15]. Ho fapana le liphumano tsena, lithuto tse ling tsa ho becha ha li-pathological [38, 39••] le lipatlisiso le bakuli ba PD ba nang le li-ICD ha baa ka ba fumana tlamo e fapaneng ea tlasa motheo ha e bapisoa le taolo [40••].
Li-Neurotransmitters tse ling
Leha motho a ka nahana hore mesebetsi e meng ea li-neurotransmitter e fetotsoe bokhobeng [24], bopaki hangata bo haella lithutong tsa pele ho tsa bongaka kapa tsa meriana ho li-SUDs.
Pheko ea antagonist ea opioid e ka ba kalafo e sebetsang ho li-ICD tse 'maloa, tse ka ipapisitseng le tšusumetso ea "midbrain" ept-opioid receptor e bakang thibelo ea GABA le tokollo ea dopamine e hlahang [41-44]. Mabapi le serotonin le ICD, ho na le liphetho tse tsoakaneng mabapi le lithuto tsa kalafo ka kalafo ea serotoninergic [24]. Leha ho le joalo, Cools et al. [45] fana ka tlhahiso ea hore le ha dopamine e sebeletsa ho khothaletsa ts'ebetso ea ts'ebetso ho batla meputso, serotonin e sebeletsa ho thibela liketso ha kotlo e ka hlaha. Lithuto tsa Preclinical ho SUDs li bonts'a hore phetiso e fetotsoeng ea glutamatergic e tlohang ho PFC ho ea ho Nacc e baka ho tsepamisa maikutlo ho phehellang hoa boitšoaro ho susumetsoang ka tšebeliso ea lithethefatsi [46]. Ho na le bopaki bo fokolang feela ho tsoa ho liteko tsa preclinical le lithuto tsa meriana tseo glutamatergic le meriana ea GABAergic e sebetsang ka mokhoa o atlehileng (litloaelo)47-50].
Hajoale, monehelo oa li-neurotransmitters litabeng tsa boitšoaro le bokhoba ba lithethefatsi li utloisisoa hamolemo bakeng sa dopamine.
Liphumano tse nang le sephetho
Mona, re totobatsa sephetho se hlakileng sa mesebetsi e fetotsoeng ea boko le boitšoaro bo fetelletseng bo amanang le ts'ebetso ea moputso molemong oa litheko tsa boits'oaro. Kaha dopamine e nkuoa e kentse letsoho mesebetsing e mengata ea bohlokoa ts'ebetsong ea moputso, re tla tsepamisa mohopolo motheong oa dopaminergic.
Moputso le Phello ea Kotlo
Boikutlo bo fetotsoeng ba moputso ka lebaka la liphetoho tšebetsong ea dopamine ke karolo e kholo ea likhopolo tsohle tse lemalloang, empa e ntse e sa utloisisoe hantle [51]. Ho khutsufatsa sephetho ho thata kaha ho na le meralo e mengata e fapaneng ea ho ithuta, hangata ho haelloa ke khethollo e nepahetseng lipakeng tsa pono e bonolo ea moputso le mekhahlelo e fapaneng ea thuto ea moputso.
Meputso e sa boleloang esale pele le litheko tsa moputso esale pele li etsa hore ho be le keketseho ea phasic ponong ea dopaminergic, athe tebello e sa lebelloang empa e sa fumanoa (e boetse e bitsoa phoso e boletsoeng esale pele) kapa tahlehelo e sa lebelloang e lateloa ke ho fokotseha hoa tšusumetso ea tonic striatal dopamine receptor [51, 52]. Boikutlo ba khafetsa ba moputso ka hona bo ka hlahisa ts'ebetso e hokahana le ho bolela esale pele meputso le liphoso tsa eona, ke ho re, ts'ebetso ea meputso e sa lebelloang le meputso ea meputso le deactivation bakeng sa meputso kapa tahlehelo e setseng.
Meputso e boletsoeng esale pele e bonahala e phahamisa ts'ebetso e fokolang haholo ho PFC e nang le bothata ho bakuli ba nang le li-ICD joalo ka ha e lekantsoe le mosebetsi oa ho lieha ho khothaletsa chelete lithutong tse peli [53, 54•]. Mabapi le moputso o sa reroang, phuputso e fumane hore barupeluoa bohle ba bonts'itse ts'ebetso ea VS e kholo ho arabeleng moputso ho feta likotlo, empa ba betšang ba pathological ba ne ba na le ts'ebetso e tlase maemong a nepahetseng ho feta taolo [25]. Leha ho le joalo, ha ho hlake hore na phapang ena maikutlong a meputso e bakoa ke karabelo e sa nepahalang ea meputso kapa tahlehelo kapa bobeli ba tsona. Haholo-holo, dopamine agonists e ile ea bontšoa e fokotseha kutloelo-bohloko ea moputso ho bakuli ba PD haholo-holo e bakiloeng ke ho felisoa ha litšebeletso kamora tahlehelo e sa lebelloang [55]. Batho ba nang le ts'ebeliso ea ts'ebeliso ea inthanete ba bontšitse ts'ebetso e ntlafalitsoeng ea OFC ho latela meputso e sa boleloang empa ba fokotsa ts'ebetso ea ACC kamora tahlehelo [56].
Boitšoaro bo nang le boitsoaro, bo fetotsoeng bo tlisa boithuto bo matlafatsang. Boithuto bo 'maloa bo bontšitse hore batho ba nang le bothata ba ho becha kapa ba ho itlopa lijo ka mokhoa o litšila ba bontšitse moputso o fokolang le thuto ea kotlo [57-59]. Ts'ebetso papaling ea karete e nang le moputso o sa reroang le ho ithuta ka kotlo e amanang le ts'ebetso ea potoloho ea methapo e kenyelletsang dorsolateral PFC, insula, posterior cingulate cortex, OFC, sebaka sa ventCedial PFC, VS le ACC / tlatsetso ea sebaka sa koloi ho batho ba phetseng hantle. Hona le lithuto tse fokolang feela tse ntlafatsang ho ithuta ho matlafatsang lithahasellong tsa boitšoaro. Phuputso e le 'ngoe ea PET papaling ea papali ea methapo ea methapo e fumane ho lokolloa ha dopamine e ngata ho VS e tsamaeang le thabo e phahameng le ha e sa sebetse hantle.60]. Matla et al. [61] e bontšitse hore papali ea chelete ea ho becha e bonts'a ts'ebetso e eketsehileng ts'ebetsong ea caudate, tokelo ea OFC, le amygdala / hippocampus nakong ea liteko tse phahameng, tse ka bonts'ang litšenyehelo tse kholo tsa meputso ea chelete.
Liphetho tse ling li bonts'a batho ba nang le boits'oaro ba boits'oaro ba boitšoaro ba bontša karabelo e sa nepahalang ho fumana meputso e boletsoeng esale pele. Leha ho le joalo, ha ho tluoa ho ho ithuta, liphetho li fana ka maikutlo a fokotsang kutloisiso ea tahlehelo le kutloisiso e sa khaotseng kapa e phahameng ea ho fumana. Mabapi le likhopolo tsa tlhekefetso, liphumano tsena li tsamaellana le mohopolo oa tšusumetso, hobane o bolela esale pele mokhoa oa hypersensitive mesolimbic dopaminergic, ke hore, methati e matla ea semelo. Karabelo e sa nepahalang ho moputso o boletsoeng esale pele e ne e ka lumellana le ho haelloa ke moputso; fokotsa maikutlo a tahlehelo ka tahlehelo, leha ho le joalo, a hana.
Reage Reacuction
Tumellanong le mohopolo le liphumano ho SUDs [5, 15], lithuto tse 'maloa tsa bokhoba ba boitšoaro bo bonts'a ho ntlafala hoa mesocorticolimbic ho mekhoa e amanang e amanang le maikutlo a ho lakatsa kapa ho batla. Ho bakuli ba PD ba nang le li-ICD ha ba bapisoa le ba se nang li-ICD, O'Sullivan et al. [40••] o fumane kholo e kholo ea striatal dopamine e latelang ho latela lits'ebetso tse amanang le ho fapana le mekhoa ea ho se nke lehlakore. Bakuli ba PD Hypersexual ba amohelang le ba sa amohelang meriana ea dopaminergic ba bontšitse ts'ebetso e matlafalitsoeng ho arabela lintlha tse amanang le thobalano ho limbic cortex, paralimbic cortex, cyort cortex, occipital cortex, cortex ea somatosensory, le PFC ha e bapisoa le bakuli ba PD ntle le ICD [62]. Keketseho ea tšebetso ho ACC, posterior cingrate cortex, OFC, le VS li hokahane hantle le takatso ea botona le botšehali ea ho kopanela liphate.
Boithuto bo bong ba li-ICD bo bonts'itse ho eketseha ha dopamine libakeng tsa dorsal striatal kapa activation ka pele, occipital, le parahippocampal cortices ho arabela cices [63-66]. Ka lehlakoreng le leng, thuto e le 'ngoe e sebetsang ea MRI e sebelisang livideo tsa maemo a papali ea papali ea chelete e fumanoeng e fokotsehile ts'ebetsong ho PFC le OFC, caudate / basal ganglia, le thalamus ea lithuto tse nang le papali ea papali ea methapo ea maoto ho bapisoa le taolo [18].
Lithuto tse peli tsa morao-rao tse sebetsang tsa MRI tse nang le papali ea chelete eo eseng ea PD le lithuto tse nang le bothata ba ho ja li boetse li fana ka sephetho se fapaneng kaha se fumane ho fokotseha ha ts'ebetso ho VS nakong ea tebello ea katleho le tahlehelo ka bobeli [54•, 67]. Lebaka e ka ba hobane lithuto tsena li sebelisitse meralo e bonts'ang tebello e latelang ka kotlolloho (mohlala, mosebetsi oa ho liehisa chelete), athe lithuto tse boletsoeng pele li ne li susumetsoa ke tšusumetso (mohlala, litšoantšo tsa lijo bakeng sa ba jang tse jang).
Ho kgutsufatsa, sephetho se matla empa lithuto tse ngata li fana ka maikutlo a eketsehileng a ntlafatso ea cue ho striatum le / kapa PFC, ka mokhoa o ts'oanang le ho li-SUD.
Monyetla le ho lieha ho theola
Ha e le li-SUDs, bakuli ba nang le li-ICD ba bonts'a ho beha kotsing ea ho beha / ho fokotsa litheolelo, mohlala, ho ea batla moputso o moholo empa o fokolang, mme eseng bakeng sa o monyane empa o le mosesane haholo [68-73], le ho fetoloa hoa theolelo ea ho lieha, ke ho khetha meputso e menyane kapele ho feta e liehang ho lieha [71, 74-77]. Bakuli ba PD ba nang le li-ICD, leha ho le joalo, ba ne ba sa fapana le taolo thutong e le 'ngoe [78]. Maemo ana ka bobeli a amana le maikutlo a meputso a fetotsoeng le phumano (ho hloka taolo e holimo-tlase) [79]. Ka hona, libaka tsa boko tse kenyellelitsoeng ho boleng ba theko (ventromedial PFC, OFC, le VS) le taolo ea kelello (PFC ea morao-rao le ACC) li kanna tsa se sebetse hantle ha lits'oants'o tsa ho lieha kapa ho theola ho ka bang teng joalo ka ha ho fumanoe tlatsong [79]. Phuputso e 'ngoe e fumane hore ts'ebetso ho VS le OFC bakeng sa meputso ea probabilistic e hokahane hanyane ka boleng ba subjective ho ba betang ha bo bapisoa le taolo [71]. Ka mokhoa o makatsang, bakuli ba PD ba nang le li-ICD ba fumanang li-dopamine agonists ba ne ba na le ts'ebetso e fokolang ea VS e amanang le ho nka kotsi e hlakileng [70]. Ho liehisa ho theola, leha ho le joalo, ts'ebetso ho VS le OFC e ikopantseng e matla le boleng ba subjective ho ba betang ha bo bapisoa le taolo [70].
Ho akaretsa, ho na le bopaki ba hore menyetla le litheolelo tsa ho lieha li fetotsoe ho li-ICD. Ho feta moo, lithuto tsa neuroimaging li bonts'a tšebetso e fetotsoeng ho OFC le VS ho li-ICD nakong ea theolelo.
Impulsivity / Disinhibition le Tiisetso
Impulsivity and disinhibition hangata e sebelisoa ka mokhoa o ts'oanang ha ho buuoa ka taolo ea taolo e tlase ea PFC [80]. Ka har'a tlhaloso ena, thibelo e senyehileng e bonoa ho li-SUD tse ngata mme e amana le hypoactive dorsal ACC le dorsolateral PFC [9, 81]. Bakuli ba hlahang ka thobalano le bakuli ba PD ba nang le li-ICD le bona ba bonts'a mathata a teng mesebetsing e kang ho emisa mosebetsi oa ho emisa, ho ea ka ho se tsamaee, le mosebetsi oa Stroop o kenyelletsang taolo ea inhibitory [58, 81-84]. Empa ho boetse ho na le lithuto tse sa kang tsa fumana phapang ea boitšoaro lipakeng tsa ba bechang kapa ba lemaletseng lithethefatsi le marang-rang [85-88] kapa bakuli ba PD ba nang le li-ICD le taolo ea PD [89]. Mabapi le phapang ea ts'ebetso ea bokong, liphumano li bonts'a ts'ebetso e fokotsehileng ho "ventromedial" kapa "dorsomedial"85, 90] (empa bona [88]). Ha a hatisa karolo ea dopamine, phuputso e 'ngoe e fumane hore nakong ea papali ea karete e nang le karabo ea bohlasoa, meriana ea dopaminergic e fokolitse libaka tsa boko tse kentsoeng taolong ea tšusumetso ho khetheha ho bakuli ba PD ba nang le papali ea methapo ea mali [91•]. Sena se lumellana le mohopolo oa hore phello ea meriana ea dopaminergic e kanna ea latela maemo a fapaneng a dopamine ea mantlha ho bakuli le lits'ebetso tsa ICD (sa feiga. 3) [92].
Ntho e 'ngoe e atisang ho amahanngoa le bokhoba ba litheko le litloaelo tsa boitšoaro ke phehello ea ho arabela [84, 93, 94], ke hore, ho se khone ho fetola boitšoaro leha sena se ka ba se lekane. Lithutong tse phetseng hantle, ho ithuta ka mokhoa o fapaneng, e leng, ho tloaela mekhoa e metle, ho hira PFC e sepetlele. Ka mokhoa o tšoanang, phuputso e le 'ngoe e fumane karabelo e tlase ea PFC e nepahetseng ha e hapile le ho lahleheloa ke chelete e amanang le tiisetso ea karabo mosebetsing o fetolang oa ho ithuta ho batjari ba methapo [95].
Ka mokhoa o ts'oanang le disinhibition, mamello e hokahane le mosebetsi o fetotsoeng oa dopaminergic le serotoninergic [45]. Leha ho le joalo, tiisetso lithutong tse feto-fetohang hangata e hlahlojoa ka mesebetsi e lekanang ka nako e le 'ngoe e lekanyang kotsi ea ho nka kotsi kapa ho e bolaea. Ka hona, ha ho hlake hore na litšitiso tsena li ka aroloa.
Lits'oants'o, li-Comorbidities le Liketsahalo tsa Bophelo
Litšobotsi tse amanang le bokhoba ba litheko le boits'oaro lithutong tsa PD le tse seng tsa PD li kenyelletsa tšusumetso ea maikutlo le bohlanya le ho batla maikutlo [3, 78]. Litšobotsi tsena ha li ikemetseng liketsahalong tse boletsoeng ka holimo, hobane ho ts'oarana le ho batla lintho tse ncha ho amana haufi le litsamaiso tsa phetisetso ea dopaminergic le serotonergic [96-98].
Ha e le li-comorbidities, li-SUD, khatello ea maikutlo, ho ferekana ha kelello, ho lemalla ho sa feleng, mathata a ho tšoenyeha le khatello ea maikutlo e fokolang hangata li bonoa hammoho le bokhoba ba boitšoaro ho batho ba PD le bao e seng PD [3, 78]. Haufinyane re fumane hore li-ICD ho bakuli ba PD li joalo ka batho bao e seng PD [99-101] - e kopantsoe le alexithymia (ho sitoa ho tseba le ho hlalosa maikutlo a motho) (KS Goerlich, CC Probst, LM Mariha, K. Witt, G. Deuschl, B. Möller, le T. van Eimeren, 2013, tlhaiso-leseling).
Lintho tse amanang le tikoloho joalo ka tšusumetso ea bokhachane le liketsahalo tsa bohlokoa tsa bophelo ha lia lokela ho nyahlatsoa e le mabaka a kotsi bakeng sa nts'etsopele ea litloaelo tsa boits'oaro. Boemo bo eketsehileng ba testosterone ea fetus, ka mohlala, bo amahantsoe le ho arabela ka mokhoa o hlakileng ho striatum le ho eketseha ha mekhoa ea boitšoaro ho bana [102]. Liketsahalo tse sithabetsang tsa bophelo bongoaneng li fumanoe li bolela esale pele hore ho tla ba bonolo ho etsa joalo [29]. Ho pepesoa ha khatello ea maikutlo botsofaling ho tsejoa ho bapala karolo ea bohlokoa ho hlaha le ho tsubella hape, har'a mekhoa e meng ka ho fetisa phetiso ea dopaminergic [29].
Synopsis ea Patlo
Pele re akaretsa lipatlisiso, re lokela ho amohela mefokolo e meng kaofela. Taba ea mantlha ke hore ho na le lithuto tse fokolang haholo tse amanang le bakuli ba rekang ka thata kapa ba tloaetseng ho etsa thobalano, ka hona bopaki bo thehiloe ho papali ea chelete ea ho becha le ho se sebetse hanyane ka hanyane ho lemeng le lithethefatsi tsa inthanete. Ntle le moo, ho na le khaello e kholo ea lithuto tsa boits'oaro. Ka lebaka leo, ha re tsebe hore na lintho tse fumanoeng li baka kapa che.
Ka kakaretso, datha ea ho lemalla boits'oaro e bontša mokhoa o ts'oanang le oa neurobiology ho SUDs. Liphumano li bonts'a recopor e tlase ea dopamine e tlamang ho striatum [35-37], e bonts'a mohlomong boemo bo fokotsang ba "receptor density" kapa "dopamine" e phahameng. Karabelo e sosobaneng ea meputso e boletsoeng esale pele e ka ba sesupo sa ho theoha ha maikutlo ho meputso e "tloaelehileng", kapa e ka hlaha ketsahalong e kholo ea mantlha [53, 54•]. Phahamiso e matla ea ts'ebetso ea mesocorticolimbic kamora mekhoa e amanang le bokhoba ba tahi [40••, 56, 62-66] e buella dopaminergic hypersensitivity. Fokotsa maikutlo a tahlehelo ea tahlehelo le litheko tse tlase tsa ho ithuta tahlehelo [55, 56, 103] bontša ho haella ha tekanyetso ea tekanyetso ea dopamine ea tonic eo hangata e hlahang nakong ea kotlo. Ntle le moo, lithuto tse nang le ts'oaetso ea boits'oaro li bonts'a ho senyeha ha thibelo le mesebetsi e fetotsoeng ea ho ithuta e amanang le mosebetsi o fokotsehileng ho PFC ea maqhubu le dorsolateral PFC [58, 81-85, 90]. Boikutlo bo fetotsoeng ba meputso hammoho le taolo e tlase e tlase le ho ikamahanya le kotsi e kholo ea ho nka le ho theola ho theola [68-77].
Ka kakaretso, liphetho li supa hantle sebopeho sa tšekamelo ea litšepe tse phahameng le tse sitisang ho thibeloa joalo ka ha ho hlahisitsoe ke mofuta oa I-RISA oa SUDs [28]. Potso ea hore na ke hobane'ng ha batho ba bang ba theha li-ICD mme ba bang ba ntse ba sa bulehe. Bopaki bo bongata bo bontša hore na dopaminergic e kotsing ea ho fela ea endophenotype (sheba sa feiga. 3): Ho nka mefuta ea dopamine ea phasic le tonic e sebetsang ho striatum le PFC [92, 104], motho a ka kholoa hore motho ea ikhethileng a fana ka maikutlo a hore dopamine e phahame ho feta litekong [33]. Tonic dopamine e sebetsa ka ho khetheha D2 li-receptors, athe phasic dopamine e hlohlelletsa D1 receptors [104]. Maemo a dopamine ea tonic ea khale a ne a ka hlalosa bofokoli ba pele ho lithahasello tsa boits'oaro, kaha tonic D e ntseng e eketseha2 ts'usumetso e bonts'itsoe ho amohela litlatsetso tsa PFC mme e ne e tsamaellana le tšebetso e fokotsitsoeng ea PFC [5, 104]. Kotlo, leha ho le joalo, e ne e ke ke ea lebisa phokotso e lekaneng ea litekanyetso tsa dopamine ea tonic mme ka hona e sitisa ho ithuta kotlo. Ho phatloha ho hoholo hoa menyako ea Suprathreshold ho thusa ho matlafatsa tloaelo. Liphetho tsa lithuto ho sechaba sa PD li tšehetsa bohlokoa ba palo ea dopamine e eketsehang, kaha li-dopamine agonists li phahamisa boemo ba dopamine ba tonic.
Ho joalo, mohlala ona ke ho nolofatsa ho feteletseng, eseng feela mabapi le phetisetso ea dopaminergic, empa hape hobane e nyatsa menehelo ea li-neurotransmitters tse ling. Le ha ho le joalo, mohlala ona oa "dopaminergic" o kotsing ea ho beha kotsi o thehiloe ho bopaki bo amanang le bongaka 'me o ka tsebisa lipatlisiso le nts'etsopele ea maano a phekolo.
Liphetho le Litataiso tsa Nako e Tlang
Lits'ebetso tsa Opioid li tlameha ho shebeloa haufi-ufi haholo, hobane li buisana le boiphihlelo ba hedonic, li sebelisana le litsamaiso tsa dopaminergic, mme li ka bapala karolo ea bohlokoa litakatsong tsa motho ka mong tse lebisang tlatsong e itseng. Tumellanong le sena, tšebelisano e rarahaneng ea li-neurotransmitter tse amanang le bokhoba ba tahi e lokela ho ba karolo ea bohlokoa ea lipatlisiso tsa nako e tlang. Kamora nako, re hloka lithuto tse ntle tsa bolelele ho hlapolla lisosa tsa liphetho. Mona, liphetho tse lebelletsoeng haholo tsa matsapa a machabeng (mohlala, IMAGEN, http://www.imagen-europe.com) ka tšepo re tla fana ka likarabo tsa bohlokoa.
Ho ananela
Thilo van Eimeren o fumane tšehetso ea lithuso ho Mokhatlo oa Leibniz.
Ho tsamaellana le Litataiso tsa melao ea boitšoaro
ᅟ
Khohlano ea Thahasello
Catharina C. Probst o phatlalatsa hore ha a na likhohlano tsa phaello.
Thilo van Eimeren e bile moeletsi oa CHDI Foundation, o hiriloe ke mmuso oa Jeremane, mme o amohetse litšenyehelo tsa ho etela / bolulo tse koahetsoeng ke mekhatlo e mengata ea lipatlisiso.
Litokelo tsa Botho le tsa Litlhapi le tsebisoang tumello
Sengoloa sena ha se na lithuto leha e le life tsa batho kapa tsa liphoofolo tse entsoeng ke lingoli.
Mongolo o botlaaseng ba leqephe
Sengoloa sena ke karolo ea pokello ea sehlooho ka Ho se nahane
Boitsebiso ba bafani
Catharina C. Mohlomong, Mohala: 
+ 49-431-5975504+ 49-431-5975504Fekse: + 49-431-5975855, Email: [imeile e sirelelitsoe].
Thilo van Eimeren, Mohono: + 49-431-5978807+ 49-431-5978807Fekse: + 49-431-5975809, Email: [imeile e sirelelitsoe].
References
Litokomane tse thahasellisang, tse hatisitsoeng morao tjena, li 'nile tsa totobatsoa e le: • Tsa bohlokoa •• Tsa bohlokoa haholo
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