LITLHAHISO: Hlahloba ka ho hlaka ho hlakisa OCD litlamong tsa boitšoaro.
E hatisitsoe Inthaneteng 2007 July 3. doi: 10.1016 / j.bcp.2007.06.043
inahaneloang
IMathata a taolo ea mpulse (ICDs), ho kenyelletsa papali ea chelete ea ho becha, trichotillomania, kleptomania le tse ling, ho nahanoa hore li ka robala ka bongata bo qobelloang. Lintlha tsa morao-rao li bontšitse hore mathata ana a ka nkuoa a lemalla. Mona re lekola metheo ea liphatsa tsa lefutso le methapo ea kutlo ea mathata a taolo ea tšusumetso mme re nahane ka mathata a kahara meralo ena e sa amaneng ka ho felletseng.
Selelekela
Matšoenyeho a Taolo ea Tšusumetso
Mathata a tloaelehileng a taolo ea tšusumetso ea maikutlo (ICDs) ao ho nang le litekanyetso tsa tlhahlobo ho Diagnostic and Statistical Manual (DSM-IV-TR) a kenyelletsa papali ea chelete ea papali ea chelete (PG), kleptomania, pyromania, boloetse ba ho phatloha ba nakoana, trichotillomania le ICD tse sa hlalosoang ka tsela e 'ngoe [1]. Ho hlahisitsoe mekhoa ea li-ICD tse ling (ho qobella ho reka, ho sebelisa marang-rang ka mathata, boitšoaro bo hlephileng ba thobalano, le ho khetha letlalo ka mokhoa o qobelloang)2, 3]. Litšobotsi tsa mantlha tsa li-ICD li kenyelletsa ho kenya letsoho khafetsa kapa ho qobella boits'oaro bo itseng (mohlala, ho becha, ho hula moriri) leha ho bile le litlamorao, taolo e fokotsehileng holima boits'oaro bo nang le mathata, le tsitsipano kapa takatso ea takatso ea maikutlo pele o kenella boitšoarong [2].
Li-ICD le Bokhoba
Li-ICD li 'nile tsa nahanoa hore li ka robala holim'a pherekano e sa nkeheng maikutlo [4], e emelang mathata a pharalletseng a qobelloang a qobelloang (OC) [5, 6]. Le ha batho ba nang le li-ICD ba etsa boits'oaro bo pheta-phetoang, hangata ba e-na le litakatso tse matla tse amanang, boits'oaro hangata bo amana le bo khahlisang kapa bo khahlisang, athe boits'oaro kapa litloaelo tse pheta-phetoang ho OC disorder (OCD) hangata li egodystonic [7, 8]. Batho ba nang le li-ICD hangata ba fumana mehato e phahameng ea ho se ts'oenyehe le tse ling tse amanang le tsona tse kang ho batla maikutlo empa batho ba nang le OCD hangata ba fumana lintlha tse phahameng tsa ho qoba likotsi [8-12]. Mekhoa ea ho lemoha li-ICD joalo ka PG li kopana le tse amanang le ts'ebeliso ea lithethefatsi, ka litekanyetso tse ikhethileng tse amanang le mamello, ho hula, ho leka makhetlo a sa atleheng ho fokotsa kapa ho tlohela, le ho kena-kenana le likarolo tse kholo tsa bophelo bo sebetsang [1]. Joalokaha ho hlalositsoe ka tlase, ho na le ho tšoana ho hongata ha methapo ea kutlo le liphatsa tsa lefutso lipakeng tsa li-ICD le lithethefatsi. Kahoo, li-ICD li ka nkuoa e le "ho lemalla boitšoaro"[13-16].
Bokhoba: Kakaretso
Ho entsoe lipatlisiso tse batsi mabapi le metheo ea methapo ea kutlo ea nts'etsopele le tlhokomelo ea lithethefatsi (e hlahlobisitsoe ho [17-19]). Maikutlo a hlahang a bokhoba ba tahi a kenyelletsa sethethefatsi kapa boits'oaro bo fumanang boiphihlelo ka ho matlafatsa, ka liphetoho tse latelang ka mekhoa ea ho ithuta e iputsitseng meputsong hore e be tloaelo kapa boitlamo.19].
Boemo ba ho ba le takatso ea boithapollo ke taba ea bohlokoa maemong a pele a ts'ebeliso ea lithethefatsi. Boemo ba tlholisano, bo hlalosoang e le "ts'ebetso eo ka eona meputso e mecha e ithutoang le ho fumana boits'oaro bo matlafatsang," e kenyelletsa maemo a tikoloho a amanang haufi le nako le lits'ebetso tsa ho lemalla [20]. Lits'ebetso tse 'maloa tsa neuroanatomical tse bohlokoa ts'ebetsong ena ea maemo li kenyelletsa amygdala, e bohlokoa ho abeng bohlokoa ba maikutlo le mekhatlo e ithutoang lipakeng tsa tšusumetso e amehang le e sa nke lehlakore.17, 21], orbitofrontal cortex (OFC), eo lithutong tsa liphoofolo e khothalelitsoeng ho kenyelletsa litebello tsa sephetho le ka likhokahano tsa eona tse matla tsa anatomiki le basolateral amygdala (BLA) e ka tsamaisa thuto e kopaneng ho amygdala, le anterior cingulate cortex (ACC) eo e kentsoe letsoho ho ithuteng ka khethollo le taolo ea kutloisiso [22]. Meetso e meng ea bohlokoa ts'ebetsong ena e kenyelletsa hippocampus, e fanang ka mohopolo oa maemo a amanang le tšusumetso ea ts'usumetso, le li-hypothalamic le septal nuclei, tse fanang ka tlhaiso-leseling e amanang le boits'oaro ba khale ba ts'usumetso joaloka ho khanna ka thobalano le ho kenella ka limatlafatsi [23, 24]. Hammoho, likarolo tsena le tse amanang le tsona li na le methapo ea methapo e amanang le boits'oaro ba boits'oaro. Ha boits'oaro bo matlafatsang bo ntse bo ipeha tlaase ho ba amanang le lithethefatsi nakong ea ts'ebetso ea ts'ebeliso ea lithethefatsi, ho kanna ha etsahala hore liphetoho sebopehong le ts'ebetsong ea libaka tsena li kenya letsoho ho kenelleng ho fetelletseng mekhoeng ea boits'oaro e bohareng ba li-ICD.
E bohlokoa hape maemong le ho lemalleng ke li-nucleus accumbens (NAcc), e nang le khetla le konokono. Khetla, ka tsela e ikhethileng ea ho itšireletsa le sebaka sa karoloana ea moea, e bohlokoa molemong oa ho tsitsisa botsitso, athe mantlha e ameha haholo ho bonts'eng boits'oaro bo ithutoang ho arabela lits'oants'o tse bolelang liketsahalo tse ts'oanang le ts'ehetso / matlafatso ea maemo [17, 19]. Sebaka sa ventral tegmental area (VTA), se nang le likhakanyo tsa dopaminergic ho amygdala, NAcc le prefrontal cortex (PFC, e kenyeletsang OFC le ACC), e thusa mekhatlo e ithutileng ka liketsahalo tse khothatsang ka phasic dopamine (DA) [25, 26]. Dopaminergic neurons lia thibeloa, mohlomong ka thorsus medial thalamus (habenula), ha meputso e lebelletsoeng e sa etsahale [27, 28]. Ho 'nile ha etsoa tlhahiso ea hore mokhahlelong oa ho qetela oa bokhoba ba tahi, tšusumetso e kholo litlamong tsa boits'oaro bo tsoang lipotong tsa corticostriatal tse kenyelletsang ventral striatum ho li-circuits tse kenyelletsang dorsal striatum, eo esale e ameha ho thehoeng ha litloaelo (bona ka tlase) [29, 30].
Ho sebelisa striatum e le ho tsepamisa maikutlo, ho ka hlahisoa mohlala oo ho oona boemo ba takatso ea botona bo qalang ho shell ea NAcc ka litlatsetso tse tsoang ho hippocampus, VTA (eo le eona e fumanang thuso ho tsoa khubung ea mantlha ea amygdala), le PFC, "liphetoho" ho maemo matlafatso mokokotlong oa NAcc ka litlatsetso tse tsoang ho BLA le PFC, 'me qetellong e fetoha sebopeho sa tloaelo ho dorsal striatum ka ho kenya letsoho ho tsoa ho sensorimotor cortices le libaka tse ling tse kang septal hypothalamus [19, 23]. Liphetoho tsena li kenyelletsa libaka tsa limbic, associative le sensorimotor tsa striatum, ka ho latellana (bona palo 1A). Dorsal striatum le globus pallidus (ka ho kenya letsoho ho tsoa mokokotlong oa NAcc) li sebetsa ho thalamus e ntan'o iphelisa ka likarolo tsa cortical. Ka har'a sebopeho sena sa anatomiki, liphatsa tsa lefutso le neurobiology ea li-ICD lia hlahlojoa. Ntle le moo, leha ho na le ho kenella ho hoholo ha neurocircuitry le neurotransmitter ho kenella maemong a fapaneng a tahi, lits'ebetso tsena li hlahisoa ka tatellano e batlang e ts'oana le sebopeho sa phetoho se boletsoeng kaholimo.
Lipalo tsa batho ba nang le lithethefatsi le li-ICD
Ha e le hantle liphatsa tsa lefutso li fana ka tlatsetso ea pele ts'ebetsong ea bokhoba ba tahi, kaha li supa bofokoli ba mantlha bakeng sa lits'ebetso tse tloaelehileng tsa boits'oaro. Liphuputso tsa liphatsa tsa lefutso tsa li-ICD li fana ka maikutlo a ho ts'oana le lithethefatsi tse ling [31]. Liphuputso tsa malapa le mafahla tsa lefu la seoa li hakantse hore menehelo ea lefutso e ikarabella ho 60% ea phapang e leng kotsing ea ho lemalla lithethefatsi [32, 33]. Ka mokhoa o ts'oanang menehelo e matla ea liphatsa tsa lefutso e fumanoe bakeng sa PG. Ho sebelisoa lintlha tse tsoang ho ngoliso ea Vietnam Era Twin (VET), lintlha tsa lefutso li hakantsoe hore li ikarabella lipakeng tsa 35% le 54% ea mokoloto oa matšoao a DSM-III-R ho PG [34]. Tekanyo ea boiphihlelo e ts'oana le ea mafu a mang a kelello ho kenyeletsoa mathata a ts'ebeliso ea lithethefatsi: ho sampole e ts'oanang, 34% ea phapang e kotsing ea ts'ebeliso ea lithethefatsi e bakiloe ke liphatsa tsa lefutso [35]. Phuputso e 'ngoe ea ngoliso ea VET e lekotseng nalane ea bophelo bohle ea PG le ts'ebeliso ea joala ka tlhahlobo e hlophisitsoeng mme e lekantse boholo ba kotsi ea tikoloho le liphatsa tsa lefutso tsa PG e arolelanoang le ts'epahalo ea joala. Bangoli ba fumane hore karolo e kholo ea kotsi bakeng sa tleliniki ea PG (12-20% ea liphatsa tsa lefutso le 3-8% ea tikoloho) e tlalehiloe ke kotsi ea ts'ebeliso ea joala [36]. Phuputsong e ileng ea latela ea baahi ba tšoanang, Slutske le basebetsi-'moho le bona ba fumane kamano e kholo lipakeng tsa PG le boits'oaro bo sa tsotelleng, mme mokhatlo ona o hlalosoa haholo ke liphatsa tsa lefutso [37]. Liphuputso tsena li fana ka maikutlo a hore li-ICD tse kang PG li amana le ho itšetleha ka joala le boits'oaro bo sa tsotelleng sechaba, 'me li ka hokahanngoa ka litsela tse tloaelehileng tse kang ho qhekella (bona ka tlase). Le ha e le tsa pele, tlhaiso-leseling ena e fana ka maikutlo a hore joalo ka lithethefatsi tsa lithethefatsi, mabaka a liphatsa tsa lefutso a kenya letsoho haholo ho pathophysiology ea li-ICD. Menehelo e ikhethileng ea lefutso e amanang le li-neurotransmitters tse amehang ho li-ICD e hlalositsoe ka tlase.
Ho se tsitsisehe
Ho se tsotelle ho amana le mathata a mangata a kelello, ho kenyeletsoa li-ICD le lithethefatsi tsa lithethefatsi [38]. Nakong ea ts'ebetso ea ho lemalla lithethefatsi, ho se ts'oanehe ho kenya letsoho mehatong ea pele joalo ka liteko tsa lithethefatsi. Tšoaneleho e na le likarolo tse ngata; Mohlala, phuputso e 'ngoe e supile likarolo tse' ne (ho potlaka, ho hloka tekanyetso, ho hloka mamello, le ho batla maikutlo.39]) athe mehato e meng e hlophisitsoeng ea ho hlohlelletsoa ho etsa likarolo tse tharo (likarolo tsa Barratt Impulsivity Scale li ba likarolo tsa ts'ebeliso, tsa motlakase le tsa moralo le sekhahla sa khatello ea maikutlo sa Eysenck hore e be libaka tse ikhethileng, tsa ho potlaka le tsa kutloelo-bohloko [40, 41]). Moeller le basebetsi-'moho le eena ba hlalositse ho se ts'oane le maikutlo e le "mokhoa o lebisang liphellong tse potlakileng, tse sa reroang ho tšusumetso ea kahare kapa kantle [ka ho fokotseha] mabapi le litlamorao tse mpe tsa karabelo ena ho motho ea potlakileng kapa ho ba bang [42]. ” Hammoho, liphuputso tsena li fana ka maikutlo a ho se ts'oenyehe ke moaho o rarahaneng, o nang le likarolo tse ngata. Ka mokhoa o ts'oanang, tlhaiso-leseling e tsoang liphuputsong tsa batho le tsa liphoofolo e fana ka maikutlo a hore libaka tse ngata tsa boko le sistimi ea methapo ea kutlo li kenya letsoho ho itšoareng hampe nakong ea ts'ebeliso e mpe ea lithethefatsi32, 43].
Dopamine, Impulsivity le li-ICD
Joalokaha ho hlalositsoe kaholimo, dopamine e bohlokoa molemong oa ts'ebeliso ea bokhoba ba tahi le lintlheng tse ling hamorao. Sistimi ea Dopaminergic e kentsoe letsoho ho se ts'oenyeheng le li-ICD. Li-psychostimulants tse kang amphetamine e susumetsa dopamine le litsamaiso tse ling tsa biogenic mme ke mekhoa ea kalafo e sebetsang bakeng sa khaello ea khatello ea maikutlo (ADHD), lefu le nang le tšusumetso e le karolo ea mantlha. Ts'oaetso ea sistimi ea NAcc DA e kentsoe letsoho ho ADHD [44]. Sistimi ea Dopaminergic le eona e kenya letsoho lits'ebetsong tse lemalloang. Ho fumaneha ho sa feleng ha D2 receptor ho boetse ho tlalehiloe ho batho ba hlekefetsang k'hok'heine likhoeli tse 'maloa kamora ho tlosa' mele, mme ho fumaneha hona ho amahanngoa le ho fokotseha ha metabolism ho OFC har'a libaka tse ling tsa boko joalo ka cingulate gyrus [18, 45]. Mehato ea mantlha ea motheo ea phumaneho ea mokelikeli oa DA D2 ea ho fumana lithethefatsi lihloohong tse sa lemalloang e bolela esale pele hore methylphenidate e rata lithethefatsi, e ts'ehetsa khopolo-taba ea hore ho fumaneha ha li-receptor tse tlase tsa D2 ho hokahanya ho ba kotsing ea ho lemalla lithethefatsi [46]. Ho ts'ehetsa, phokotso ea phallo ea receptor ea D2 (mohlomong ka lebaka la ho fokotseha ha linomoro tsa li-receptor ho fapana le ho eketseha ha DA) e ile ea bonoa ho ventral striatum ea likhoto tse matla haholo, mme ho fumaneha hona ho ne ho bolela esale pele litekanyetso tse phahameng tsa boits'oaro ba "cocaine" e kenang methapong [47]. Ho fumaneha ha li-receptor tse tlase tsa D2 ho striatum ho boetse ho boletse esale pele hore ts'ebeliso ea "cocaine" e eketsehileng e tla latela ke litšoene [48]. Boholo boo liphuputso tsena li amanang le ho se ts'oenyehe le li-ICD li hloka tlhahlobo e tobileng.
DA e ka kena lipakeng ho putsa kapa ho matlafatsa likarolo tsa papali ea chelete, mme DA e kentsoe letsoho ho PG [49]. Maemo a fokotsehileng a DA le keketseho ea eona ea metabolites 3,4-dihydroxyphenylacetic acid (DOPAC) le homovanillic acid (HVA) li fumanoe ho CSF ea batho ba bapalang papali ea chelete [50], leha liphuputso tsena li ne li se li sa bonoe ha ho lokisoa sekhahla sa phallo ea CSF [51]. Amphetamine, sethethefatsi se eketsang li-catecholamine tse kantle ho lisele le 5-HT ka pherekano ea vesicular, thibelo ea reuptake, ntlafatso ea synthesis ea DA, le thibelo ea monoamine oxidase (MAO) [52], litefiso tse fapaneng bakeng sa boitšoaro ba papali ea chelete ho batho ba nang le bothata ba papali ea chelete, empa eseng bakeng sa tšebeliso ea joala ho batho ba noang bothata [53]. Liphuputso tsena li fana ka maikutlo a karolo ea DA (le / kapa litsela tse ling tsa aminergic) ho pathophysiology ea PG kaha lithethefatsi tse nang le mekhoa e ts'oanang ea ts'ebetso li ka feta pele bakeng sa ho khutlisetsoa ha lithethefatsi tse ling sehlopheng seo (ke hore amphetamine bakeng sa k'hok'heine) [54, 55].
Litlaleho tse 'maloa li hokahantse tšebeliso ea agonist ea DA ho Lefu la Parkinson (PD) le PG le boits'oaro bo bong ba ICD joalo ka libakeng tsa thobalano le ho ja [56-60]. Phuputso ea haufinyane ea bakuli ba PD ba 272 ba ileng ba hlahlojoa le ho hlahlojoa bakeng sa li-ICD ba fumane mekhatlo e ts'oanang e matla ho li-agonists tsa DA tse nang le PG le li-ICD tse ling [61]. Nalane ea ICD pele PD e qala e ne e amahanngoa le ICD ea hajoale. Litekanyetso tsa letsatsi le letsatsi tsa levo-dopa li lekana le bakuli ba nang le ICD ho feta ba se nang. Phuputso e lebelletsoeng ea bakuli ba 297 ba nang le PD ba hlahlobetsoeng ho ata ha bophelo ba PG e boetse e fumane setsoalle lipakeng tsa ts'ebeliso ea agonist ea DA le PG [62]. Le ha ho ne ho se mokhatlo o neng o bonoa le agonist subtype, mokhatlo o tsamaisanang le tsamaiso ea levodopa ka nako e le 'ngoe o ile oa bonoa, o fana ka maikutlo a phello ea tekanyetso e felletseng kapa phello ea pele ea levodopa [62]. Kahoo, tlhaiso-leseling e seng e le teng e fana ka maikutlo a hore li-agonists tsa DA, haholo-holo ho batho ba kotsing ea li-ICD, li amahanngoa le PG le li-ICD tse ling, hape li hokahanya sistimi ea DA le li-ICD.
Liphuputso tsa lefutso li hokahantse liphatsa tsa lefutso tse 'maloa le ho se ts'oenyehe le ho lemalla lithethefatsi, ho kenyeletsoa le liphatsa tsa lefutso tse kenyelletsang mokamo oa DA D4DRD4le mopalami oa DA (SLC6A3) [32, 63, 64ADHD e fumaneha haholo, 'me menehelo ea liphatsa tsa lefutso e bakang kotsi e ka bang 80% ea lefu lena,' me har'a mefuta e amehang ka ho fetisisa ea lefutso e amanang le ADHD ke DRD4 le SLC6A3 mefuta-futa [65]. Mefuta e meng ea DA e joalo ka DRD5 e hokahantsoe le ADHD hape [65]. Lithuto tse peli li fumane mokhatlo oa li-polymorphisms tsa DRD4 le PG [66, 67]. Ntle le moo, D2A1 boemo ba kamohelo ea D2 bo kentse letsoho ts'ebelisong e mpe ea lithethefatsi, ho ja hampe le ho tsuba63, 68], mme e fumanoe ka makhetlo a mabeli a phahameng lithutong tse nang le PG ha e bapisoa le litsamaiso [69]. Lintlha tse boletsoeng kaholimo li fana ka maikutlo a hore liphatsa tsa lefutso le tlhahiso e sebetsang, menehelo ea dopaminergic ho likarolo tse susumetsang tsa li-ICD le lithethefatsi tse ling. Leha ho le joalo, ho hlokahala lithuto tse ling ho pheta-pheta le ho holisa liphuputso tsena, haholo ha ho etsoa lipatlisiso tsa menehelo ea DA ho mehato ea botho ea ho se ts'oanelehe kapa ho aha likhopolo tse amanang le thuto e kang ho batla lintho tse ncha ho bontšitse liphetho tse fapaneng kamanong ea bona le liphatsa tsa lefutso tsa DA [70].
Molao oa Dopaminergic le li-ICD: Likarolo tsa γ-aminobutyric acid (GABA) le Glutamate
γ-aminobutyric acid (GABA) ke methapo ea kutlo e ka sehloohong e thibelang methapo bokong. E entsoe ka methapo ea methapo e tsoang ho glutamate ke enzyme glutamate decarboxylase. Ho na le bopaki ba khokahano ea anatomic le ts'ebetso pakeng tsa GABA le lits'ebetso tsa dopaminergic hammoho le ts'ehetso e ntseng e eketseha bakeng sa litlamorao tsa ho feto-fetoha ha litsamaiso tsa GABAergic ho mathata a ts'ebeliso ea lithethefatsi [71]. Mohlala, tiagabine, GABA reuptake inhibitor e sebelisitsoeng haholo ho phekola ho oa, e bonts'itse matla a pele ho ts'ebeliso ea koae ea cocaine [72], mme o na le tlaleho ea nyeoe, e bonts'itsoeng ho thusa ka taolo ea mabifi a sa tsitsang [73]. Glutamate, neurotransmitter e nyarosang le selelekela sa GABA le eona e kentsoe letsoho litlamong hammoho le li-ICD.
Lithutong tsa pele ho nako, litekanyetso tsa glutamate kahare ho NAcc mediate boits'oaro ba ho batla moputso [74]. Ho lokolloa ha nonvesicular glutamate ho tsoa ho cysteine / glutamate antiporters ho bonts'itsoe e le mohloli o ka sehloohong oa "glutamate" e kantle ho lisele ho NAcc; e hlophisa ho lokolloa ha vesicular glutamate le dopamine ka ho hlohlelletsa sehlopha sa glutamate 2/3 metabotropic glutamate receptors [75, 76]. N-acetylcysteine (NAC), cysteine pro-drug, e eketsa litekanyo tsa extracellular tsa glutamate, mohlomong ka ho hlohlelletsa li-inhibitor metabotropic glutamate receptors, ka hona e fokotsa ho tsoa ha synaptic ea glutamate. E bonts'itse matla a pele ho ts'ebeliso ea koae ea cocaine [77] le PG [78]. Ha li kopantsoe hammoho, tlhaiso-leseling ena e fana ka maikutlo a likarolo tse ka bang teng bakeng sa litsamaiso tsa glutamatergic le GABAergic litlamong tsa lithethefatsi le boits'oaro.
Serotonin, Impulsivity le li-ICD
Joalo ka DA, GABA le glutamate, karolo ea serotonin (5-HT) e ts'ehetsoa ke ho se ts'oarehe, li-ICD le lithethefatsi tsa lithethefatsi. Morero oa li-neuron tsa Serotonergic o theha mokokotlo oa "dorsal raphe" bokong ho ea libakeng tse kenyeletsang hippocampus, frontal cortex le amygdala. Mefuteng ea liphoofolo, pherekano ea forebrain 5-HT e bonts'itsoe e lebisa ho khetho e sa tsitsang, ha 5-HT agonist fenfluramine e fokotsa boits'oaro bo joalo [79, 80]. Ntle le moo, lesion ea rat raphe e baka khetho ea nakoana bakeng sa meputso e potlakileng [81]. Bahanyetsi ba khethiloeng ba 5-HT ha ba bapisoa ba bonts'itse khothaletso ea khetho ea boits'oaro [82]. Karolo ea likarolo tse ikhethileng tsa sisteme ea serotonin e tšehetsoa ke liphetho tsa ho hlohlelletsoa ho hoholo ha makoloi ho 5-HT1B litoeba tse kokotoang [83]. Tryptophan depletion, e theolelang maemo a 5-HT (ka ho fokotseha ho fokotsehang ho 5-HT metabolites ho cerebrospinal fluid (CSF)), e eketsa ho ts'oenyeha ha makoloi (lipalo tse tsoelang pele tsa liteko tse tšoanang), empa eseng khetho e potlakileng (ho lieha ho theola litheko) bathong [84, 85]. Lithutong tse nang le nalane ea lelapa ea joala, tryptophan depletion e fokotsa boits'oaro ba boits'oaro (Stop Task) empa ha ea ka ea susumetsa ho lieha ho theola84]. Maemo a tlase a 5-HT metabolite 5-hydroxyindolacetic acid (5-HIAA) a fumanoe ho batho ba nang le litšobotsi tse sa tsitsang [86, 87], le bokhoba ba tahi pele ho nako [64]. Maemo a tlase a CSF 5-HIAA le ona a hokahantsoe le boits'oaro ba ho ipeha kotsing liphoofolong; mohlala, litšoene li nka nako e teletsana ho tlola merung [88]. Ha ho kopantsoe hammoho, mela e mengata ea bopaki e tšehetsa karolo ea 5-HT ho fapakaneng ho se ts'oanehe, leha lipatlisiso tse ling li hlokahala ho khetholla likarolo tse itseng tsa sistimi ea 5-HT tse tlatsetsang likarolong tse itseng tsa ho se ts'oenyehe.
Sistimi ea 5-HT e kentsoe letsoho ho li-ICD. Le ha banna ba nang le PG khahlano le ba se nang letho ba sa bontše phapang e kholo ho 5-HT kapa 5-HIAA disampoleng tsa CSF [50, 89, 90], maemo a 5-HIAA a fumanoe a le tlase ho ba nang le PG ha ba laola bakeng sa ho tlanya nako (e ileng ea eketsoa sehlopheng sa PG) [51]. Metachlorophenylpiperazine (m-CPP), metabolite ea trazodone e sebetsa joalo ka agonist 'me e na le kamano e phahameng bakeng sa li-receptor tsa 5-HT (haholo-holo 5-HT2c, e bileng le karolo ho kenellelaneng ha likarolo tsa maikutlo, boitšoaro ba matšoenyeho le ts'ebetso ea neuroendocrine [91]). Tsamaiso ea m-CPP e tlalehiloe e hlahisa boits'oaro bo "phahameng" le ho eketsa maemo a prolactin (ts'ebetso e nahanoang hore e buelletsoe ke postsynaptic 5-HT1A / 2A / 2C li-receptors) lihloohong tse nang le PG ha li bapisoa le lihlooho tsa taolo ntle le PG [92]. Karabelo ena ea boikokobetso e ts'oana le e tlalehiloeng ke mathata a mang ao ho ona boits'oaro ba ho nkeha maikutlo kapa bo qobelloang bo hlahelletseng, ho kenyeletsoa le bothata ba ho se tsotelle sechaba93], bothata ba moeli oa moeli [94], ts'ebeliso ea koae [95], le tšebeliso e mpe ea joala kapa ho itšepa [96].
Ntle le liphephetso tsa litlhare, lithuto tsa lefutso li kentse sistimi ea 5-HT ka ho se ts'oanelehe le li-ICD. A TPH1 (tryptophan hydroxylase 1, e kenyeletsang enzyme bakeng sa mohato o lekanyetsang sekhahla tlhahiso ea 5-HT) phapang ea liphatsa tsa lefutso e fumanoe e amahanngoa le ho fokotsa 5-HIAA ho CSF le boits'oaro ba ho ipolaea ho batlōli ba molao ba mabifi [97]. Liphatsa tse ling tsa serotonergic li hokahantsoe le ho se ts'oenyehe le ho lemalla lithethefatsi 'me li kenyeletsa SERT (SLC6A4) le MAOA [32]. Polymorphism e sebakeng sa ts'ehetso ea lefutso la motho la serotonin transporter (SLC6A4) Ho khouta mefuta e mekhutšoane le e telele ea protheine (e nang le mofuta o mokhuts'oane o hlahisang protheine e fokolang) e amahanngoa le likarolo tse 'maloa tsa psychopathology, ho kenyeletsoa neuroticism, matšoenyeho le khatello ea maikutlo.98-102], leha lithuto tsa morao-rao li hlahisitse lipotso mabapi le matla le bonnete ba mekhatlo ena [103-105]. SLC6A4 phapang e ka kenya letsoho ho li-ICD joalo ka ha mokhatlo o tlalehiloe lipakeng tsa SLC6A4 allele e khuts'oane le PG ho banna empa eseng basali106]. Kamora nako, lithuto tse amanang le mehlala e menyenyane ea lithuto li tlalehile ka mokhoa o sa lumellaneng lipakeng tsa liphatsa tsa lefutso tsa serotonin le monoamine oxidase le li-ICD tse kang PG, ho reka ka qobello le trichotillomania [107-109]. Lithuto tse ling li sebelisa lisampole tse kholo le liteko tse hlokolosi (mohlala, tsa tlhahlobo) li tla thusa ho batlisisa liphatsa tsa lefutso tsa lelapa le pharalletseng la li-ICD.
Lithuto tsa kalafo ea li-serotonergic agents li hlahisitse litholoana tse fapaneng mabapi le ts'ebetso ea kalafo ea li-ICD [110-113]. Liteko tsa kliniki tse laoloang ke "placebo" tse laoloang ke "placebo" tsa li-serotonin reuptake inhibitors (SSRIs) li hlahisitse litholoana tse fapaneng, ka li-RCT tse ling li bonts'a katleho e fetang ea placebo [114, 115] le ba bang eseng [116, 117]. Liphuputso tse ngata li bontšitse ntlafatso ea bongaka pele ho kalafo lihlopheng tse phekotsoeng ka litlhare le li-placebo. Melemo ena e fana ka maikutlo a kalafo kapa karabelo ea "placebo" ho fapana le ho fumana melemo e itseng ea moriana o sebetsang, leha phapang ea morao-rao lipakeng tsa lihlopha liphuputsong tse ling e fana ka maikutlo a litlamorao tse sebetsang tsa meriana. Lithutong tse 'maloa tsa trichotillomania, ha ho phapang e kholo e bonoeng lipakeng tsa kalafo ea fluoxetine le placebo [111]. Phuputsong e sa reroang ea citalopram vs.118]. Liphuputso tse peli tsa letsoho le tšoanang, tse laoloang tsa fluvoxamine kalafong ea ho reka ka qobello ha li bontše phapang lipakeng tsa lithethefatsi tse sebetsang le placebo [119, 120], empa phuputso ea libeke tse supileng tsa citalopram e bulehileng e lateloang ke libeke tse robong tsa tlhaiso-leseling e bonts'itse ntlafatso ea sethethefatsi se sebetsang ha se bapisoa le placebo [121]. Tlaleho ea nyeoe e khothalelitse katleho ea escitalopram, le SSRI kalafong ea ts'ebeliso e nang le mathata a marang-rang, empa lithuto tse ling li hloka ho etsoa mabapi le ts'ebetso ea kalafo (le tlhahlobo) ea lefu lena [113]. Ha ho kopantsoe, liphuputso li fana ka maikutlo a hore li-SSRI li sebeletsa batho ba bang ba nang le li-ICD empa eseng ba bang. Liphuputso tsena li fana ka maikutlo a hore likarolo tse ikhethileng tsa motho ka mong (mohlala, likarolo tsa lefutso kapa mathata a kopaneng joalo ka ho tšoenyeha kapa khatello ea maikutlo) a ka thusa ho tataisa khetho ea kalafo e nepahetseng [122].
Joalokaha ho hlalositsoe kaholimo, ho se ts'oanehe ho tlatsetsa ho li-ICD le ho lemalla lithethefatsi. Ho ka etsahala hore ho se ts'oenyehe ho na le menehelo e ikhethang ho li-ICD ka bomong le ho lemalla lithethefatsi joalo ka ha ho le joalo ka likarolo tsa ts'ebetso ea ts'ebetso ea kelello [123]. Ntle le moo, joalo ka ho se ts'oenyehe, ho tšoana lipakeng tsa li-ICD le lithethefatsi li teng libakeng tse ling, joalo ka ho etsa liqeto le ho sebetsana le khatello ea maikutlo, mme libaka tsena li nkuoa ka tlase.
Tekolo ea Moputso, Ho etsa liqeto, le Ventral Prefrontal Cortex (PFC)
Hang ha boitšoaro bo fetetse ka nqane ho methati ea pele ea boithuto bo kopanetsoeng, taolo ea phethahatso holim'a ts'ebetsong ea eona e ba ea bohlokoa le ho feta. Libaka tsa PFC li kenya letsoho ho nkeng liqeto mathateng a taolo ea tšusumetso le ho lemalla lithethefatsi. OFC e supa boleng bo lekanyelitsoeng ba tšusumetso ea moputso [124, 125], ts'ebetso e karolo e buelletsoeng ke sistimi ea 5-HT. OFC e thusa ho feto-fetoha ha mohopolo ka ho khothaletsa ntlafatso ea khokahano e kopanyang libakeng tse tlase tsa boko joalo ka amygdala [126]. Ntle le moo, gyrus e ka tlase e ka pele / dorsolateral PFC e bohlokoa ho fetoleng tlhokomelo, e kenyang bokhoni ba ho hanela tlhaiso-leseling e kenang joalo ka ho nahana ka lithethefatsi / boits'oaro [127]. OFC, ho kenyeletsoa le PFC (vmPFC) e kenang kahare, e kenya letsoho ho sebetseng le ho bolela lintho esale pele [128, 129]. Bafo ba nang le liso tsa vmPFC ba bontša likhaello molemong oa ho rala, hangata ba etsa liqeto tse lebisang liphellong tse mpe [130]. Ntle le moo, lithuto tsena li sebetsa hampe ho feta ho bapisa lihlooho ho Iowa Gambling Task (IGT), mohato o ntlafalitsoeng oa ho fuputsa moputso o monyane hanghang le kotlo ea nakoana e amanang le phaello ea nako e telele khahlanong le moputso o moholo oa hanghang le kotlo ea nakoana e amanang le nako e telele- tahlehelo ea nako [131].
Lihlooho tse nang le mathata a ts'ebeliso ea lithethefatsi hangata li bonts'a ts'ebetso e mpe ho IGT [132], mme ts'ebetso ena e mpe e amana le phokotso ea phallo ea mali ho vmPFC le libaka tse ling tsa cortical [133-136]. Batho ba nang le PG le bona ba khetha hampe ha ba bapisoa le taolo ea IGT [12, 137]. Batho ba nang le PG ba khetha habonolo meputso e tlase ea chelete eo ba e ts'episitsoeng hanghang ho feta meputso e phahameng ea chelete e ts'episitsoeng kamora ho lieha nako ("ho fokotsa litheolelo") ha ho bapisoa le litaba tsa taolo [138]. Theolelo ea nakoana ea meputso e bonts'itsoe e le kapele haholo ho batho ba nang le PG ba nang le mathata a ts'ebeliso ea lithethefatsi, e lumellanang le mekhoa e tlatsetsang bothateng bo bong le bo bong ka mokhoa oa tlatsetso kapa oa tšebelisano [138]. Ho se sebetse ha lipotoloho tsa vmPFC ho ka kenya letsoho phapang ena ea boits'oaro lipakeng tsa PG le lihlooho tsa taolo, joalo ka ha ho bonahala ho le joalo ka ho lemalla lithethefatsi. Ho fokotsehile ha ts'ebetso ea vmPFC ho bonoe ho lithuto tsa PG nakong ea tlhahiso ea mekhoa ea papali ea chelete [9], ts'ebetso ea Stroop Colour-Word Interference Task [139], le papali ea chelete e etsisitsoeng [140]. Thutong ena ea ho qetela, ts'ebetso ea vmPFC e hokahane hampe le ho tiea ha papali ea chelete har'a lithuto tsa PG. Hammoho, lintlha tsena li fana ka maikutlo a karolo ea bohlokoa bakeng sa vmPFC ho PG. Lithuto tsa nako e tlang li tla thusa ho hlakisa hore na tse fumanoang li fetela ho li-ICD tse ling hakae.
Batho ba itšetlehileng ka lithethefatsi ba bontša ho se tloaelehang ho OFC. E ts'oana le batho ba nang le tšenyo ho OFC, bafo ba nang le ts'ehetso e matlafatsang ba bonts'a liqeto tse nepahetseng, ka ho nahanisisa ka nako e telele pele ho khetho ea khetho [141]. Ho fokotseha ha ts'ebetso ea OFC le cingulate gyrus ho amahanngoa le ts'ebeliso e sa foleng ea cocaine [142]. Ts'ebetso e mpe ea `` drug-word drug '' Stroop task e hokahana le hypoactivation ea OFC ho batho ba lemaletseng cocaine "142]. Ha li kopantsoe, lintlha tsena li fana ka maikutlo a hore libaka tsa PFC li bohlokoa ha ho etsoa liqeto.
Ho etsa liqeto, ho susumetsoa ke maikutlo le Amygdala
Mosebetsi oa Amygdala o kenya letsoho haholo ho etsa liqeto le ho se ts'oenyehe. Amygdala e amohela kenyelletso ea serotonergic le dopaminergic ho tsoa ho raphe le VTA ka tatellano, mme ts'ebetso ea eona e laoloa ke tekano lipakeng tsa nyakallo e susumetsoang ke glutamate le thibelo ea GABA-mediated [143, 144]. Amygdala e nka karolo ho sebetsaneng le mohopolong oa maikutlo a maikutlo. Ho latela somatic marker hypothesis (e bolelang hore ho etsa liqeto ho itšetleha ka likaroloana tsa methapo ea kutlo tse laolang homeostasis, maikutlo le maikutlo), likarabo tse matla tsa tšusumetso li hlahisoa ke likarolo tsa makoloi a visceral joalo ka hypothalamus le brain autonomic brainstem nuclei [127]. Amygdala e sebetsa 'moho le vmPFC / OFC ha ho etsoa liqeto, ha sebaka se seng le se seng se kenya letsoho ka mokhoa o fapaneng. Ka litoeba, liso tsa excitotoxic tsa BLA li khothaletsa khetho e potlakileng mosebetsing oa ho matlafatsa o liehang [145]. Ho batho, lihlooho tse nang le tšenyo ea vmPFC le lihlooho tse nang le tšenyo ea amygdalar ka bobeli li bonts'a bofokoli ba ho etsa liqeto ho IGT [146]. Leha ho le joalo, likarabo tsa boikemelo (tse lekantsoeng ke karabelo ea boits'oaro ba letlalo) ho phaello kapa tahlehelo e kholo ea chelete li haelloa ke batho ba nang le liso tsa amygdalar tse kopaneng; ka lehlakoreng le leng, likarabo tsena li nepahetse ho bakuli ba nang le tšenyo ea vmPFC [146]. Leha ho le joalo, lebelletse likarabo tsa boits'oaro ba letlalo nakong ea ts'ebetso ea IGT li bonts'a mokhoa o fapaneng: lihlooho tse nang le ts'enyo ea vmPFC li bontša bofokoli, athe tse nang le ts'enyo ea amygdalar li bonts'a likarabo tse tloaelehileng. Hammoho, liphuputso tsena tse etsahalang ka mokhoa o sa tloaelehang oa amygdala-ventral striatum li ka susumetsa ho se ts'oenyehe lits'ebetsong tse lemalloang, mohlomong ka lebaka la tšusumetso ea boleng ba khothatso ea lits'oants'o [148]. Ho batho ba lemaletseng lithethefatsi, likarabo tse fetelletseng tsa boipuso li bakoa ke litlhahiso tsa lithethefatsi [149]. Ketsahalo e sa tloaelehang ea amygdalar e ka susumetsoa ke mefuta e fapaneng ea liphatsa tsa lefutso liphatseng tsa 5-HT100]. Karolo ea amygdala ho li-ICD ha e so batlisisoe ka kotloloho.
Tloaelo ea Tloaelo
Ha boits'oaro bo fetoha ho tloha ho ithuteng ka mafolofolo ho ea karabong e tloaelehileng, taolo e fetoha ho tsoa marang-rang a kopaneng a cortico-basal ganglia a kenyelletsang PFC le ventral striatum ho ea dorsomedial striatum / caudate ebe ho ea marang-rang a sensorotor cortico-basal ganglia a amanang le dorsolateral striatum / putamen ( bona Setšoantšo sa 1b) [29]. Ho tlatlapa boitšoaro ho fetola ts'ebetso ho tloha ho dorsolateral PFC mme ho isa ho putamen le motor cortices [150, 151]. Ka bokhoba ba tahi, ho ipusa ka makhetlo a mangata ha litšoene ho amana le tsoelo-pele ea ts'ebetso ea ventral striatum ho kenella ho dorsal striatum [152]. Ha boits'oaro bo se bo tloaela, bo susumetsoa ke maemo, likarolo tsa bohlokoa tsa ts'ebeliso ea ts'ebeliso ea lithethefatsi, li ka baka karabelo ea litloaelo ho fapana le ts'ebetso e lebisitsoeng ho sepheo [153]. Karabelo ena ea phapang e ka susumetsoa ka tsela e sa tobang ke NAcc ka likhakanyo tsa eona ho VTA / substantia nigra e nang le tlatsetso e latelang ea dopaminergic ho tloha ho ea morao ho ea marangrang a sensorimotor [154]. Ho kenella ha mohanyetsi ea kopaneng oa DA ea alpha-flupenthixol ho dorsal striatum empa eseng moahong oa NAcc ho fokotsa ts'ehetso ea cocaine e fumanehang mefuteng ea liphoofolo.155]. Tlhatlhobo e tlase ea li-receptor tsa D2 DA e bonoe pele ho ventral ebe kamora moo e ts'oaroa ke litšoene tse sebelisang k'hok'heine, ho latela maikutlo a entsoeng le batho ba hlekefetsang batho ba sa foleng ba cocaine.156, 157].
Li-ICD li hlalositsoe ho latela mokhoa oa ho itloaetsa [158]. Joalo ka ho lemalla lithethefatsi, ho senyeha ha lipotoloho tse tsoaloang hoa ameha mathateng ana. Mohlala, phuputsong ea papali ea chelete e etsisitsoeng, batho ba nang le PG ba bonts'itse liphapang tsa ts'ebetso ea ts'ebetso ea ho tsoala ha e bapisoa le litaba tsa taolo, mme ts'ebetso e ne e amana le ho tiea ha papali ea chelete [140]. Lintlha tsa pele le tsona li kenyelletsa ts'ebetso ea pelehi litakatsong tsa papali ea chelete ho PG le litakatsong tsa cocaine tse itšetlehileng ka koae [159]. Bophahamo ba putamenal bo fokotsehileng bo bonoe lihloohong tse nang le trichotillomania ha e bapisoa le lihlooho tsa taolo, leha bohlokoa ba ts'ebetso ea phapang ena ea anatomiki bo hloka lipatlisiso tse ling [160]. Ho tsoa boitsebisong bona, khopolo-taba e ka hahuoa hore liketso tse tataisoang ke sepheo li fetela ho tloha ho ithuteng ka mafolofolo ho ea karabong e sa sebetseng, e itloaetseng ho li-ICD ka mokhoa o ts'oanang le o bonoang ke batho ba lemaletseng lithethefatsi.
Boikarabello ba khatello ea maikutlo le li-ICD
Liketsahalo tse sithabetsang le khatello ea maikutlo khafetsa li kenya letsoho ho khutlela ts'ebelisong ea lithethefatsi har'a batho ba nang le ts'ebeliso ea opiate le cocaine [161, 162]. Bopaki ba bongaka bo bontšang hore khatello ea maikutlo e matla e lebisa ho eketseha hoa taolo ea hau ea lithethefatsi tse kang amphetamines [163], cocaine [164, 165] le joala [166, 167]. Mekhoa e amanang le khatello ea maikutlo e bohlokoa molemong oa ho qala lithethefatsi le ho ata ha tsona joalo ka mathata a sa foleng [168]. Ho pepesetsoa khatello ea maikutlo ho hlahisa boemo bo eketsehileng ba ho tsoha le ho tšoana le lithethefatsi ka botsona [169]. Lithethefatsi tse 'maloa tsa tlhekefetso, joalo ka li-psychostimulants [170-172] le joala [173] etsa hore ho be le khatello ea kelello le axPA ea HPA. Ka litoeba, li-opioid li matlafatsa selekane sa HPA, empa litlamorao tse fapaneng li bonoa liphoofolong tse nyane, ho kenyeletsoa le batho (tse hlahlojoang ho [174]). Ho feta moo, li-benzodiazepine li bontšitsoe ho fokotsa ts'ebetso ea HPA bathong [175] Ha ts'ebetso ea axPA ea HPA e eketsa phetisetso ea mesolimbic dopamine, ho pepesehela khatello ea maikutlo ho ka fana ka karoloana e tloaelehileng ea methapo eo khatello ea maikutlo e ntlafatsang boitšoaro ba ho batla lithethefatsi [169]. Likhatello tse amanang le khatello ea maikutlo, joalo ka thibelo le tšitiso, li eketsa tokollo ea NAcc DA [176, 177]. Ho ba le khatello ea maikutlo e bakoang ke khatello ea maikutlo ho batho ba lemaletseng kalafo ba kenya ts'ebetsong striatum le ho fokotsa ts'ebetso ea ts'ebetso ho anterior cingulate. Liphuputso tsena li fana ka maikutlo a karolo ea khatello ea maikutlo ts'ebetsong ea pele ho ts'ebetso le ho nka karolo ka nako e le 'ngoe ea lipotoloho tsa tloaelo ho lemalla [178]. Hore na liphetoho tsena li amana hakae le ho se ts'oane le / kapa ho nka liqeto tse seng ntle ho hloka lipatlisiso tse ling [179].
Liphuputso tsa batho ba nang le li-ICD li hlahisitse liphetho tse fapaneng mabapi le ho nka karolo ha litsela tsa khatello ea maikutlo mathateng ana [180]. Mohlala, maemo a CSF a corticotrophin-releasing hormone (CRH) a ne a sa fapane lithutong tse nang le PG ha a bapisoa le litsamaiso [89]. Keketseho ea nakoana ea cortisol e hlokometse liphuputsong tsa papali ea chelete ea baithaopi ba thaothoang likasinong ba nang le bothata ba papali ea chelete ba bonts'ang boholo bo ts'oanang ba karabelo ho taolo [181-183]. Liketsahalo tse sithabetsang tsa bophelo joalo ka ts'itiso e mpe ea bophelo ba pele li kentsoe ho PG joalo ka ha ba le lemalla lithethefatsi [177]. Hammoho, tlhaiso-leseling ena e fana ka maikutlo a hore ho tla ba bohlokoa ho lekola mekhoa e tobileng eo khatello ea maikutlo le eona e tlatsetsang ho pathophysiology ea li-ICD.
Li-opioids, khatello ea maikutlo le li-ICD
Li-opioid li hlophisa mesolimbic DA litseleng tsa VTA ka ho kenya ts'ebetsong li-opioid receptors ho li-interneuron tsa bobeli tse bakang hyperpolarization le thibelo ea GABA ho lokolloa li-neuron tsa mantlha (li-dopaminergic output neurons) ka lebaka leo ho eketsoa ha DA ho eketsehileng [184]. Leha ho le joalo, ts'ebetso ea li-κ opioid receptors ho li-neuron tsa mantlha e baka tšitiso ea bona e tobileng [185]. Haufinyane ho bonts'itsoe hore opioid receptor activation (κ vs. μ) ka mokhoa o fapaneng e thibela mesolimbic neurons ho latela lipheo tsa bona tsa sepheo (Nacc vs. BLA) [186]. Sisteme ea opioid e ts'oarellang, ka μ le κ opioid receptors, e thibela tonis ea HPA ka mokhoa o khahlisang, e fana ka maikutlo a hore karabelo ea tlhaho e tlatselletsa ho lemaleng.32]. Ho tšehetsa khopolo-taba ena, litoeba tse haelloang ke mu opioid receptor gene (OPRM1) a se ke a bontša morphine analgesia kapa khetho ea sebaka [187].
Polymorphisms ka OPRM1 di amahanngwa le phapano e tlamang ho di-endorphin (ka mohlala, dikhoutu tse fapaneng tsa A118G tsa seamohedi se tlamang le ho kenya tshebetsong ha protheine ya sona ya G e kopantsweng le ka hare e lokisang kanale ya potasiamo [188]). Mofuta o fapaneng oa A118G o amahanngoa le ts'epahalo ea opioid [32], 'Me lihlooho tse nang le mofuta ona li bontšitse likarabo tse ntle ho naltrexone bakeng sa kalafo ea ts'ebeliso ea joala [64, 189]. Haplotypes ea lefutso la kappa opioid receptor (OPRK1) le sebaka se khothalletsang selelekela sa eona sa pele sa ligand, prodynorphin, le sona se amahanngoa le ts'epahalo ea opiate le lithethefatsi tse ling [33].
Ho becha kapa boits'oaro bo amanang le tsona bo 'nile ba amahanngoa le maemo a phahameng a mali a opioid ea ho qetela β-endorphin [190]. Ha ba fuoa mekhoa ea bona ea tšebetso [191] le katleho ea kalafo ea joala le ts'ebeliso ea joala [192], bahanyetsi ba li-opioid receptor ba 'nile ba hlahlojoa kalafong ea li-ICD. Naltrexone e bonts'itse bophahamo ba placebo thutong ea sebaka se le seng sa PG [193], le nalmefene, mohanyetsi oa nako e telele oa opioid, o bonts'itse bophahamo ba placebo thutong e kholo e foufetseng habeli, e shebaneng haholo le lithuto tsa PG [194]. Naltrexone e bonts'itse molemo molemong oa lithuto tsa boits'oaro bo qobelloang ba thobalano [195] le liteko tse ngoliloeng ka bolokolohi tsa batloli ba thobalano ba lilemong tsa bocha [196]. Naltrexone e bonts'itse matla a pele ho ho reka ka qobello [121]. Lintlha tsena li fana ka maikutlo a hore, lits'ebetso tsa opioid li bohlokoa litlamong tsa lik'hemik'hale le boits'oaro. Ha li-opioid li susumetsa marang-rang a mangata a methapo le litsela tse amanang le khatello ea maikutlo, lithuto tsa nako e tlang li kanna tsa hlalosa mekhoa ea bona e nepahetseng ea ts'ebetso ho li-ICD.
Liphetho le Litataiso tsa Nako e Tlang
Lintlha tse hlahang mabapi le neurobiology ea ho se ts'oarehe le li-ICD li fana ka maikutlo a tšoanang le a lithethefatsi tsa lithethefatsi. Leha liphuputso tse fokolang li fupulitse li-ICD ho feta tse lemalloang ke lithethefatsi (mme lithuto tse ngata tse seng li le teng li batlisitse PG), data ea liphatsa tsa lefutso, boits'oaro le kalafo e ama litsamaiso tse ngata tsa methapo ea kutlo le lipotoloho tsa neuronal ho theheng le ho hlokomeleng bokhoba ba boitšoaro. Leha ho na le khatelo-pele ena, likhang li ntse li le teng mabapi le nosology le pathophysiology ea mantlha ea li-ICD tse itseng.
Li-endophenotypes li fana ka leseli ho etiology ea mathata mme tlhaiso-leseling e joalo e ka tsebisa likarolo tsa mathata. Maikutlo a Endophenotypic a mafu a kelello a joalo ka khatello ea maikutlo le schizophrenia a ntse a hlaha [197, 198]. Li-endophenotypes ke "likarolo tse ka bonoang tse sa bonoeng ke leihlo le le leng" mme e kanna ea ba neuropsychological, endocrinological, cognitive, neuroanatomical kapa biochemical ka tlhaho. Li-endophenotypes li tsebisa kutloisiso ea liphatsa tsa lefutso tse bakang ts'oaetso ea mafu ka ho tsepamisa maikutlo ho likarolo tse ikhethileng tsa bioloji ho fapana le likarolo tsa tlhatlhobo ea mafu a kelello tseo hangata li fapaneng ka tlhaho198]. Ha tse ling li ntse li tsebahala ka sebopeho le semelo sa li-ICD, maikutlo a endophenotypic a likarolo tsa ona tsa mantlha a ka hlaha. Mohlala, ho se ts'oenyehe, likarohano tsa endocrine ho khatello ea maikutlo, kapa likarolo tsa eona li ka emela li-endophenotypes tsa bohlokoa bakeng sa PG, li-ICD tse ling le lithethefatsi tsa lithethefatsi. Ho khetholla li-endophenotypes ho lokela ho thusa ho khetholla likaroloana tsa mathata (tse ipapisitseng le liphatsa tsa lefutso le tse ling), qetellong li hlompha sebopeho, tlhahlobo le kalafo e nepahetseng. Liphetoho tsa mehato e ts'oanang ea endophenotypic li kanna tsa lebelloa hore li tsamaee le ntlafatso ea matšoao bakeng sa li-ICD le lithethefatsi tsa lithethefatsi. Li-endophenotypes tse amanang le bongaka li ka tataisa nts'etsopele ea mefuta ea liphoofolo ea mafu ana e tla qetella e re thusitse ho utloisisa etiology ea li-ICD le lithethefatsi tsa lithethefatsi, ho theha maano a sebetsang a thibelo le ho ntlafatsa mekhoa ea kalafo ea boits'oaro le litlhare.
lumela hore baa fokola
Re rata ho leboha Ngaka Christopher Pittenger ka tlhahlobisiso ea hae e phethahetseng le litlhaloso tse thusang mabapi le buka ena e ngotsoeng ka letsoho. Ts'ehetso ea lipatlisiso tsena e fanoe ke thuso ea NIH ea T32-MH19961 Thupelo ea Patlisiso ea Kliniki ea Neuroscience ho Psychiatry (JAB), Setsi sa Phuputso sa Varela Grant (JAB), Setsi sa Naha sa Tlhekefetso ea Lithethefatsi se R01-DA019039 (MNP) le R01- DA020908 (MNP), Patlisiso ea Basali ea Bophelo Yale (MNP), le VA VISN1 MIRECC (MNP) le REAP (MNP).
Mongolo o botlaaseng ba leqephe
Boitlhotlhollo ba Mohoeletsi: Ena ke faele ea PDF ea mongolo o ngotsoeng ka letsoho o sa amoheloang o amoheletsoeng bakeng sa ho hatisoa. Joaloka tšebeletso ho bareki ba rona re fana ka phetolelo ena ea pele ea mongolo o ngotsoeng ka letsoho. Mongolo o ngotsoeng ka letsoho o tla ba le ho kopitsa, ho kenya lihlopha le ho hlahloba bopaki bo hlahang pele o hatisoa ka mokhoa oa oona oa ho qetela. Ka kopo hlokomela hore nakong ea mekhoa ea tlhahiso ea lihlahisoa e ka fumanoa e ka amang litaba, le litsebiso tsohle tsa molao tse sebetsang koranteng e amanang le eona.
References
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