The Neurobiology of Material le Mehavioral Addictions (2006)

Likarolo tse Tloaelehileng tsa Litloaelo tsa Boitšoaro: Kamano le Mathata a Ts'ebeliso ea Lithethefatsi

Karolo ea bohlokoa ea ho lemalla boitšoaro ke ho hloleha ho hanela tšusumetso, ho khanna, kapa moleko oa ho etsa ketso e kotsi ho motho kapa ho ba bang (4). Bokhoba bo bong le bo bong ba boits'oaro bo khetholloa ke mokhoa o iphetang oa boits'oaro o nang le tšobotsi ena ea bohlokoa kahare ho sebaka se itseng. Ho kenella khafetsa mekhoeng ena ea boitšoaro qetellong ho sitisa ts'ebetso ea libaka tse ling. Ntlheng ena, bokhoba ba boitšoaro bo tšoana le mathata a ts'ebeliso ea lithethefatsi. Batho ba nang le makhoba a lithethefatsi ba tlaleha mathata a ho hanela takatso ea ho noa kapa ho sebelisa lithethefatsi.

Litloaelo tsa boits'oaro le lithethefatsi li na le lintho tse ngata tse tšoanang nalaneng ea tlholeho, liketsahalo tsa tlhaho le litlamorao tse mpe. Ka bobeli li qalile lilemong tsa bocha le bocha ba lilemong tsa bocha le litheko tse phahameng lihlopheng tsena tsa lilemo ho feta tsa batho ba baholo.5). Ka bobeli li na le nalane ea tlhaho e ka bonts'ang mekhoa e sa foleng, e khutlang hape, empa batho ba bangata ba hlaphoheloa ka bo bona ntle le kalafo ea semmuso (eo ho thoeng ke "ho ithaopa" ho tlohela)6).

Bokhoba ba boitšoaro hangata bo etelloa pele ke maikutlo a "khatello ea maikutlo kapa ho tsosoa takatso pele o etsa ketso eo" le "monyaka, khotsofalo kapa phomolo ka nako ea ho e etsa" (4). Sebopeho sa boits'oaro ba boits'oaro bona se ts'oana le boiphihlelo ba boits'oaro ba ts'ebeliso ea lithethefatsi. Sena se fapana le boits'oaro bo matla ba khatello ea maikutlo. Leha ho le joalo, litloaelo tse peli tsa boits'oaro le lithethefatsi li ka fetoha tsa ego-syntonic le tse ling tsa ego-dystonic ha nako e ntse e tsamaea, joalo ka ha boits'oaro (ho kenyeletsoa le ho nka lithethefatsi) ka bo bona ha bo khahlise ebile ke tloaelo kapa qobello (2,7), kapa e susumetsoa hanyane ka matlafatso e ntle mme e matlafatsoa ke ho matlafatsoa hampe (mohlala, phomolo ea dysphoria kapa ho hula).

Litloaelo tsa boits'oaro le lithethefatsi li na le ho ts'oana ho ts'oanang. Batho ba bangata ba nang le boitšoaro bo hlephileng ba tlaleha boemo ba takatso kapa takatso pele ba qala boitšoaro, joalo ka batho ba nang le mathata a ts'ebeliso ea lithethefatsi pele ba sebelisa lithethefatsi. Ntle le moo, boits'oaro bona hangata bo fokotsa ho tšoenyeha mme bo felle ka boemo bo botle ba maikutlo kapa "bo phahameng", bo ts'oanang le botahoa ba lithethefatsi. Ho senyeha maikutlong ho ka tlatsetsa litakatsong tsa mathata a boitšoaro le tšebeliso ea lithethefatsi (8). Batho ba bangata ba nang le papali ea chelete, kleptomania, boitšoaro bo hlephileng ba thobalano, le tlaleho ea ho reka e qobelloang ba fokotseha liphellong tsena tse ntle tsa maikutlo ka boits'oaro bo phetoang kapa tlhoko ea ho eketsa matla a boitšoaro ho fihlela maikutlo a tšoanang, a ts'oanang le mamello (9-11). Batho ba bangata ba nang le mekhoa ena ea boits'oaro ba boetse ba tlaleha boemo ba dysphoric ha ba ntse ba qoba boits'oaro, bo ts'oanang le ho khaotsa. Leha ho le joalo, ho fapana le ho tlohela lithethefatsi, ha ho na litlaleho tsa maemo a hlahelletseng a bophelo bo botle ba 'mele kapa a tebileng a bongaka a ho tlohella boitšoaro bo hlephileng.

Papali ea chelete, e ithutoang ka botlalo ka litlamorao tsa boits'oaro, e fana ka leseli le eketsehileng mabapi le kamano ea litlolo tsa boitšoaro le mathata a ts'ebeliso ea lithethefatsi (bona le Wareham le Potenza, taba ena). Ho becha ka bolotsana hangata ho qala bongoaneng kapa bocheng, mme banna ba tloaetse ho qala ba sa le banyenyane (5,12), Ho etsisa mohlala oa mathata a ts'ebeliso ea lithethefatsi. Sekhahla se phahameng sa papali ea chelete ea papali ea chelete se bonoa ho banna, ka ts'ebetso ea telescoping e bonoang ho basali (ke hore, basali ba na le boits'oaro ba mantlha ba boitšoaro bo hlephileng, empa ba bontšitse nako ea nako ho tloha ts'ebetsong ea pele ho ba lemalla) (13). Ketsahalo ea sebonela-hōle e tlalehiloe haholo ka mathata a fapaneng a ts'ebeliso ea lithethefatsi (14).

Joalo ka mathata a ts'ebeliso ea lithethefatsi, mathata a lichelete le a lenyalo a tloaelehile litlamong tsa boitšoaro. Batho ba nang le makhoba a boitšoaro, joalo ka ba lemaletseng lithethefatsi, hangata ba etsa liketso tse seng molaong, joalo ka bosholu, bosholu ba lichelete, le ho ngola licheke tse mpe, ho tšehetsa boitšoaro ba bona bo lemalloang kapa ho sebetsana ka katleho le litlamorao tsa boits'oaro (15).

botho

Batho ba nang le lithethefatsi le boits'oaro le ba nang le mathata a ts'ebeliso ea lithethefatsi ba fumana lintlha tse phahameng molemong oa ho itlaleha le ho batla maikutlo 'me ka kakaretso ba le tlase mehatong ea ho qoba kotsi (16-20). Leha ho le joalo, batho ba nang le mekhoa e meng ea boitšoaro, joalo ka ho lemalla marang-rang kapa papali ea chelete, le bona ba ka tlaleha maemo a phahameng a ho qoba likotsi (21; bona le Weinstein le Lejoyeux, taba ena). Phuputso e 'ngoe e bontšitse hore likarolo tsa psychoticism, likhohlano tsa batho ba bang le boits'oaro li ka bapala karolo ea ho lemalla inthanete (bona Weinstein le Lejoyeux, taba ena). Ka lehlakoreng le leng, batho ba nang le bothata ba ho qobella ho qobella batho ho phela hangata ba fumana lintlha tse phahameng mehatong ea ho qoba likotsi le ho se tsotelle (17,21). Batho ba nang le lithethefatsi tse itšoereng hampe le bona ba fumana mehato e phahameng ea ho qobelloa, empa tsena li ka fokotsoa ke taolo e senyehileng ea mesebetsi ea kelello le matšoenyeho a ho lahleheloa ke taolo holim'a boits'oaro ba makoloi (22). Ho sitisoa ha likarabo tsa makoloi (ho se ts'oenyehe) ho fumanoe ho batho ba nang le bothata ba ho qobella ho hlohlelletsa maikutlo le ho khetha letlalo (e leng boitšoaro bo hlephileng bo nang le likhokahano tse haufi-ufi le bothata ba ho qobella ho qobella), athe ho se tsitse ha kutloisiso (ho nahanoang hore ho kenya letsoho ho qobelloeng) ho ne ho lekanyelitsoe ho fetelletseng ho hloka taolo ea khatello ea kelello (23,24).

Ho itšoara hampe

Le ha lithuto tse ngata tse emelang naha ka bophara li sa kenyellelitse tlhahlobo ea boits'oaro ba boits'oaro, tlhaiso-leseling e teng ea lefu la mafu e ts'ehetsa kamano lipakeng tsa papali ea chelete le mathata a ts'ebeliso ea lithethefatsi, ka lipalo tse phahameng tsa ketsahalo e ngoe le e ngoe (25,26). Phuputso ea St.Louis Epidemiologic Catchment Area (ECA) e fumane sekhahla se phahameng sa ketsahalo ea ts'ebeliso ea lithethefatsi (ho kenyeletsoa ts'epahalo ea nicotine) le papali ea chelete, e nang le likhaohano tse phahameng ka ho fetesisa tse atisang ho bonoa lipakeng tsa papali ea chelete, mathata a ts'ebeliso ea joala le bothata ba botho.25). Phuputso ea Canada ea mafu a seoa e hakantsoe hore kotsi e lekanyelitsoeng ea ts'ebeliso ea joala e eketsehile makhetlo a 3.8 ha papali ea chelete e sa sebetseng e le teng (27). Har'a batho ba nang le ts'ebeliso ea lithethefatsi, kotsi ea ho becha ka mokhoa o itekanetseng ho isa boemong bo phahameng e bile makhetlo a 2.9 ho feta (28). Lipalo-palo tse pakeng tsa 3.3 le 23.1 li tlalehiloe lipakeng tsa papali ea chelete le ts'ebeliso ea joala lithutong tse thehiloeng ho baahi ba US (25; 29). Bokhoba ba inthanete bo ne bo amahanngoa le ts'ebeliso e mpe ea joala (e leng karolelano ea 1.84) phuputsong ea baithuti ba koleche ba 2,453, kamora ho laola bong, lilemo le khatello ea maikutlo (30).

Mehlala ea meriana ea litloaelo tse ling tsa boitšoaro e fana ka maikutlo a hore ketsahalo e kopaneng le mathata a ts'ebeliso ea lithethefatsi e tloaelehileLethathamo 1). Liphuputso tsena li fana ka maikutlo a hore litlolo tsa boitšoaro li ka arolelana lefu le tloaelehileng le nang le mathata a ts'ebeliso ea lithethefatsi.

Lethathamo 1

Litekanyo tsa bophelo bohle ba ts'ebeliso ea lithethefatsi litlamong tsa boitšoaro

Leha ho le joalo, tlhaiso-leseling e mabapi le ts'ebeliso ea lithethefatsi e tlameha ho hlalosoa ka hloko hobane mekhatlo efe kapa efe ea lisosa e ka hlaha maemong a boits'oaro (mohlala, tšebeliso ea joala e thibela mekhoa e mengata e sa lokelang, ho kenyeletsoa le e tsejoang e le e lemalloang) mohlala. Boitšoaro bo hlephileng bo qala kamora kalafo ea joala, mohlomong e le sebaka sa ho noa). Mathata a ho becha a sebelisang joala khafetsa a na le matla a maholo a ho becha le mathata a kelello le a kelello a bakoang ke papali ea chelete ho feta ba senang nalane ea tšebeliso ea joala (31), 'Me bacha ba itekanetseng ho ea noang khafetsa ba na le monyetla oa ho becha khafetsa ho feta bao e seng (32), e fana ka maikutlo a tšebelisano lipakeng tsa joala le papali ea chelete. Ka lehlakoreng le leng, tlhahiso e ts'oanang mabapi le ts'ebeliso ea nikotine e fana ka maikutlo a ho sebelisana ha syndromal, joalo ka taba ea hore batho ba baholo ba nang le papali ea chelete ba tsubang hona joale kapa ba tsubang pejana ba na le litakatso tse matla ho feta tsa ho becha (33). Ba nang le bothata ba papali ea chelete ba sebelisang koae letsatsi le letsatsi ba na le mathata a ho sebelisa joala le lithethefatsi (34).

Mathata a mang a kelello, a kang khatello e kholo ea maikutlo, lefu la ho ferekana kelellong, khatello ea kelello e tlisoang ke khatello ea maikutlo, le khatello ea kelello ea ho se tsotelle, le tsona li tlalehoa hangata li tsamaisana le litlamorao tsa boitšoaro (35,36; bona le Weinstein le Lejoyeux, taba ena). Leha ho le joalo, bongata ba lithuto tsena tsa comorbidity li ne li ipapisitse le mehlala ea bongaka. Tekanyo eo liphuputso tsena li akaretsang ka eona ho mehlala ea sechaba e ntse e lokela ho tsejoa.

Ho tseba

Lithethefatsi le boits'oaro ba ts'ebeliso ea lithethefatsi li ka ba le likarolo tse tloaelehileng tsa kutloisiso. Bobeli ba papali ea chelete le batho ba nang le mathata a ts'ebeliso ea lithethefatsi ba theola meputso ka potlako (37) le ho etsa hampe mesebetsing ea ho etsa liqeto (38joalo ka mosebetsi oa papali ea chelete oa Iowa, paradigm e lekolang ho etsa liqeto ka moputso oa kotsi (39). Ka lehlakoreng le leng, phuputso ea batho ba nang le bokhoba ba inthanete ha ea bontša likhaello tse joalo ha ho etsoa liqeto ho Iowa Papali ea Papali ea chelete (40). Phuputso e sebelisang betri e felletseng ea methapo ea kutlo ho bapalami ba papali ea chelete ba 49, bafo ba itširelitseng joala ba 48, le taolo ea 49 ba fumane hore batho ba bechang le makhoba a tahi ka bobeli ba bonts'itse ts'ebetso e fokotsehileng litekong tsa thibelo, ho fetoha ha kelello le mesebetsi ea ho rala, empa ba ne ba se na phapang litekong tsa tshebetso ya phethahatso (41).

Mekhoa e tloaelehileng ea Neurobiological

Bongata ba lingoliloeng bo hola bo kenyelletsa litsamaiso tse ngata tsa methapo ea kutlo (mohlala, serotonergic, dopaminergic, noradrenergic, opioidergic) ho pathophysiology ea boitšoaro bo hlephileng le mathata a ts'ebeliso ea lithethefatsi (42). Haholo-holo, serotonin (5-HT), e amanang le thibelo ea boits'oaro ,, le dopamine, e amanang le ho ithuta, tšusumetso le botsitso ba tšusumetso, ho kenyeletsoa le meputso ,, e ka kenya letsoho haholo ho lihlopha tse peli tsa mathata (42,43).

Bopaki ba ho nka karolo ha serotonergic litlamong tsa boitšoaro le ts'ebetsong ea ts'ebeliso ea lithethefatsi bo hlaha ka bongata ho tsoa lipatlisisong tsa tšebetso ea platelet monoamine oxidase B (MAO-B), e hokahanang le maemo a cerebrospinal fluid (CSF) a 5-hydroxyindole acetic acid (5-HIAA, metabolite ea 5-HT) mme e nkuoa e le lets'oao la pherekano la ts'ebetso ea 5-HT. Maemo a tlase a CSF 5-HIAA a hokahana le maemo a phahameng a ho se ts'oenyehe le ho batla maikutlo 'me a fumanoe mathateng a ho becha le mathata a ts'ebeliso ea lithethefatsi (44). Phephetso ea thuto ea bongaka e lekanyang karabelo ea lihormone kamora ho sebelisoa ha lithethefatsi tsa serotonergic le eona e fana ka bopaki ba ho se sebetse ha serotonergic litlamong tsa boitšoaro le mathata a ts'ebeliso ea lithethefatsi45).

Ts'ebeliso e pheta-phetoang ea lintho kapa ho kenella boitšoarong bo hlephileng kamora tšusumetso e kanna ea bonts'a ts'ebetso ea bonngoe. Lithuto tsa kalafo le tsa bongaka li fana ka maikutlo a hore mochini oa mantlha oa likokoana-hloko bakeng sa mathata a susumetsoang ke takatso o kanna oa kenyelletsa ts'ebetso ea moputso o kenang o kenang ke ventral tegmental area / nucleus accumbens / orbital frontal cortex circuit (46,47). Sebaka sa sekhahla sa ventral se na le li-neuron tse lokollang dopamine ho li-nucleus accumbens le orbital frontal cortex. Liphetoho litseleng tsa dopaminergic li hlahisitsoe e le motheo oa ho batla meputso (papali ea chelete, lithethefatsi) tse bakang ho lokolloa ha dopamine le ho hlahisa maikutlo a thabo (48).

Bopaki bo lekantsoeng bo tsoang liphuputsong tsa neuroimaging bo ts'ehetsa methapo ea methapo e arolelanoang ea boits'oaro le boits'oaro ba ts'ebeliso ea lithethefatsi (7). Ts'ebetso e fokotsehileng ea ventral medial prefrontal cortex (vmPFC) e hokahantsoe le ho nka liqeto ka potlako litlhahlobong tsa meputso ea likotsi le ka karabelo e fokotsehileng ea mekhoa ea papali ea chelete ho batho ba papali ea papali ea chelete (49). Ka mokhoa o ts'oanang ts'ebetso e sa tloaelehang ea vmPFC e fumanoe ho batho ba nang le mathata a ts'ebeliso ea lithethefatsi (50). Ts'ebetsong ea ts'ebetso ea kelello e amanang le papali ea papali ea papali ea papali ea inthanete e hlaha libakeng tse tšoanang tsa boko (orbitofrontal, dorsolateral prefrontal, anterior cingulate, nucleus accumbens) joalo ka ts'ebeliso ea kelello e amanang le ts'oaetso ea lithethefatsi ho makhoba a lithethefatsi (51; bona le Weinstein le Lejoyeux, taba ena ).

Patlisiso ea ho nka litšoantšo tsa boko e fana ka maikutlo a hore tsela ea dopaminergic mesolimbic e tsoang sebakeng sa karoloana ea karoloana ea karolo e ka kenang mathateng ka bobeli a ts'ebeliso ea lithethefatsi le papali ea chelete. Bafo ba nang le papali ea chelete ea papali ea chelete ba bonts'itse ts'ebetso e nyane ea ventral striatal neuronal le fMRI ha ba ntse ba etsa papali ea papali ea chelete ho feta lithuto tse laoloang (52), e ts'oanang le maikutlo a lithuto tse itšetlehileng ka joala ha o sebetsana le meputso ea chelete (53). Ho fokotseha ha ts'ebetso ea ts'ebetso ea ho tsoaloa ha matla ho boetse ho ameha litakatsong tse amanang le lithethefatsi le boitšoaro bo hlephileng (41). Ho nka karolo mosebetsing oa papali ea chelete ho bonahala ho etsa hore dopamine e lokolloe haholo ho ventral striatum ho batho ba nang le lefu la Parkinson (PD) le papali ea chelete ho feta batho ba nang le PD feela (54), karabo e ts'oanang le e hlahisitsoeng ke lithethefatsi kapa lithethefatsi tse amanang le lithethefatsi ()55).

Ho nka karolo ha dopamine litlamong tsa boitšoaro ho boetse ho hlahisoa ke lithuto tsa bakuli ba PD ba nang le meriana (56,57). Liphuputso tse peli tsa bakuli ba nang le PD li fumane hore ba fetang 6% ba bile le ts'oaetso e ncha ea boits'oaro kapa ts'oaetso ea taolo ea maikutlo (mohlala, papali ea papali ea chelete, ho lemalla thobalano), ka lipalo tse phahameng haholo ho ba sebelisang meriana ea dopamine agonist (58,59). Tekanyo e phahameng ea levo-dopa dose e ne e amahanngoa le monyetla o moholo oa ho ba le boitšoaro bo hlephileng (59). Ho fapana le se ka lebelloang ho nka karolo ha dopamine, bahanyetsi ba li-receptor tsa dopamine D2 / D3 ba ntlafatsa tšusumetso le boits'oaro bo amanang le papali ea chelete ho batho bao e seng PD ba nang le papali ea chelete ea ho becha (60) 'me ha ba na matla a ho phekola papali ea chelete e mpe (61,62). Liphuputso tse ling li tlameha ho hlakisa karolo e nepahetseng ea dopamine ho becheng ea mafu le litloaelo tse ling tsa boitšoaro.

Histori ea Lelapa le Genetics

Lithuto tsa nalane ea lelapa / liphatsa tsa lefutso tse fokolang haholo li entsoe ka lihlopha tse loketseng tsa taolo (7). Lithuto tse nyane tsa lelapa tsa li-probands tse nang le papali ea chelete ea mafu63lefu la tsoekere (kleptomania),64), kapa ho reka ka qobello (65) e mong le e mong o fumane hore beng ka eena ba li-proband ba na le litekanyetso tse phahameng haholo bophelong ba joala le mathata a mang a ts'ebeliso ea lithethefatsi, le khatello ea maikutlo le mathata a mang a kelello, ho feta lihlooho tse laoloang. Lithuto tsena tsa malapa tse laoloang li tšehetsa maikutlo a hore litlolo tsa boitšoaro li ka ba le kamano ea lefutso le mathata a ts'ebeliso ea lithethefatsi.

Menehelo ea liphatsa tsa lefutso le tikoloho mekhoeng e ikhethileng ea boitšoaro le mathata li ka hakanyetsoa ka ho bapisa concordance ea tsona ka mafahla a tšoanang (monozygotic) le mafahla a morabe (dizygotic). Phuputsong ea mafahla a banna a sebelisang Vietnam Era Twin Registry, 12% ho isa ho 20% ea phapang ea liphatsa tsa lefutso e kotsing ea ho becha ho kula 'me 3% ho isa ho 8% ea phapano e sa amaneng ea tikoloho e kotsing ea papali ea chelete e tlalehiloe ka kotsi ea joala mathata a ts'ebeliso (66). Likarolo tse peli ho tse tharo (64%) tsa ketsahalo e kopaneng lipakeng tsa papali ea chelete le mathata a ts'ebeliso ea joala li bakiloe ke liphatsa tsa lefutso tse susumetsang mathata ana ka bobeli, ho fana ka maikutlo a hore li kopana le lipehelo tsa lefutso tsa maemo ka bobeli. Liphuputso tsena li ts'oana le tse fanang ka maikutlo a hore menehelo e tloaelehileng ea lefutso ho mefuta e fapaneng ea mathata a ts'ebeliso ea lithethefatsi (67).

Ho na le lithuto tse fokolang haholo tsa limolek'hule tsa litlolo tsa boitšoaro. Phallo ea D2A1 ea D2 dopamine receptor gene (DRD2) e eketseha khafetsa ho tsoa ho batho ba nang le bothata ba ho becha ho ea ho papali ea chelete le ho becha ho kopaneng le mathata a ts'ebeliso ea lithethefatsi (68). Mefuta e mengata ea liphatsa tsa lefutso tsa li-nucleotide polymorphisms (SNPs) tse 'maloa tsa DRD2 li amahanngoa le litekanyetso tsa botho tsa ho se ts'oenyehe le mehato ea liteko ea boits'oaro ba boits'oaro ho baithaopi ba phetseng hantle69), empa tsena ha li so ka li hlahlojoa ho batho ba nang le mekhoa e metle ea boitšoaro. Basebelisi ba inthanete ba fetelletseng ba ne ba na le maqhubu a phahameng a letsoho le lelelele (SS) la lefutso la serotonin transporter (5HTTLPR) ho feta taolo e phetseng hantle, mme sena se ne se amahanngoa le ho qoba kotsi e kholo (70; bona hape Weinstein le Lejoyeux, taba ena).

Karabelo ea Phekolo

Bokhoba ba boitšoaro le mathata a ts'ebeliso ea lithethefatsi hangata li arabela hantle kalafong e ts'oanang, tsa kelello le tsa meriana. Mekhoa ea boithaopo ea mehato e 12, ntlafatso ea khothatso, le mekhoa ea boits'oaro ea boits'oaro e sebelisetsoang ho sebetsana le mathata a ts'ebeliso ea lithethefatsi e sebelisitsoe ka katleho ho phekola papali ea chelete, boitšoaro bo hlephileng ba thobalano, kleptomania, ho khetha letlalo, le ho reka ka qobello (71-74). Lits'ebetso tsa kelello bakeng sa bokhoba ba boitšoaro le mathata a ts'ebeliso ea lithethefatsi hangata li itšetleha ka mofuta oa thibelo o khutlang o khothalletsang ho ithiba ka ho supa mekhoa ea tlhekefetso, ho qoba kapa ho sebetsana le maemo a kotsi, le ho etsa liphetoho mokhoeng oa bophelo o matlafatsang boitšoaro bo botle. Ka lehlakoreng le leng, kalafo e atlehileng ea kelello le boits'oaro bakeng sa khatello ea maikutlo e tlamang e hatisa maano a thibelo ea ho pepeseha le ho arabela (2).

Ha ho na meriana e lumelloang hajoale bakeng sa kalafo ea litlolo tsa boitšoaro, empa meriana e meng e bontšitseng ts'episo ea ho phekola mathata a ts'ebeliso ea lithethefatsi e boetse e bonts'a ts'episo ea ho phekola bokhoba ba boitšoaro (75). Naltrexone, mohanyetsi oa li-mu-opioid receptor tse amoheloang ke Tsamaiso ea Lijo le Lithethefatsi ea US bakeng sa kalafo ea joala le ts'ebeliso ea opioid, e bonts'itse katleho litekong tse laoloang tsa bongaka bakeng sa kalafo ea papali ea chelete le kleptomania (76-79), le ts'episo ea lithuto tse sa laoleheng tsa ho reka ka qobello (80), boitšoaro bo qobelloang ba thobalano (81), ho lemalla marang-rang (82), le ho khetha letlalo la pathologic (83). Liphuputso tsena li fana ka maikutlo a hore li-mu-opioid receptors li bapala karolo e ts'oanang litlamong tsa boitšoaro joalo ka ha li etsa ka mathata a ts'ebeliso ea lithethefatsi, mohlomong ka ho feto-fetoha ha tsela ea dopaminergic mesolimbic. Ka lehlakoreng le leng, mohanyetsi ea sebetsang haufinyane oa mu-opioid receptor naloxone o mpefatsa matšoao a ho hloka taolo ho fetelletseng (84).

Meriana e fetolang tšebetso ea glutamatergic le eona e sebelisitsoe ho alafa ho lemalla boitšoaro le ho itšetleha ka lithethefatsi. Topiramate, anti-convulsant e thibelang AMPA subtype ea glutamate receptor (hara tse ling tsa liketso), e bonts'itse ts'episo ho lithuto tse bulehileng tsa papali ea chelete, ho reka ka qobello le ho khetha letlalo ka mokhoa o qobelloang (85, hammoho le katleho ea ho fokotsa joala (86sakerete (87), le cocaine (88sebedisa. N-acetyl cysteine, amino acid e khutlisetsang mahloriso a kantle ho sele ka har'a li-nucleus accumbens, e fokotsa litakatso le papali ea papali ea chelete phuputsong e le 'ngoe ea batho ba bapalang papali ea chelete (89), mme e fokotsa takatso ea k'hok'heine (90le tšebeliso ea k'hok'heine (91) ho batho ba lemaletseng koae. Liphuputso tsena li fana ka maikutlo a hore ho feto-fetoha ha molumo oa molumo oa molumo oa lentsoe oa dopaminergic ka li-nucleus accumbens e kanna ea ba mochini o tloaelehileng ho lemalleng boitšoaro le mathata a ts'ebeliso ea lithethefatsi (92).

Mathata a ho hlahloba

Ho lemalla boitšoaro bo le bong feela, papali ea chelete ea ho becha, ke tlhahlobo e tsejoang ho DSM-IV le ICD-10. Mekhoa ea eona ea ho hlahloba e tšoana hantle le ea ts'ebeliso e mpe ea lithethefatsi / ts'ebeliso ea lithethefatsi, ke ho re, ho ameha haholo ka boits'oaro, ho fokotsa bokhoni ba ho laola boits'oaro, mamello, ho ikhula le litlamorao tse mpe tsa kelello. DSM-V Task Force e khothalelitse ho tlosa papali ea chelete ho tloha sehlopheng sa eona sa hajoale e le bothata ba taolo ea tšusumetso ho ea ho sehlopha se secha se bitsoang "Litlhare le Mathata a Amanang," a ka kenyeletsang mathata a ts'ebeliso ea lithethefatsi le "lithahasello tse seng tsa lithethefatsi" (www.dsm5.org, e fihletsoe ka la 10 Hlakola, 2010). Phetoho e le 'ngoe feela ea mantlha ea tlhatlhobo ke ho lahla moelelo mabapi le ts'ebetso ea liketso tse seng molaong ho tšehetsa papali ea chelete, e fumanoeng e na le bongata bo tlase ebile bo na le phello e nyane ho fumanoeng.

Lithethefatsi tse ling tse 'maloa tsa boits'oaro li hlahisitse litekanyetso tsa tlhahlobo, ho kenyeletsoa ho reka ka qobello (93), Lithethefatsi tsa Inthanete (94), Bokhoba ba papali ea video / khomphutha (95), Bokhoba ba thobalano (96), le ho sesa ka mokhoa o fetelletseng (bona Kouroush et al., Taba ena). Hangata tsena li ipapisitse le litekanyetso tsa DSM-IV tse teng tsa ts'ebeliso e mpe ea lithethefatsi kapa ts'ebeliso e mpe ea lithethefatsi, mohlala, nako e fetelletseng e sebelisitsoeng boits'oarong, boiteko bo phetoang bo sa atleheng ba ho fokotsa kapa ho emisa boits'oaro, ho fokotsa taolo ea boits'oaro, mamello, ho khaotsa le boits'oaro bo bobe ba kelello. liphello. Sehlopha sa basebetsi sa DSM-V se amanang le Mathata a amanang le Lithethefatsi se ntse se nahana ka tse 'maloa tsa lithethefatsi tsena tseo e seng tsa lithethefatsi hore li kenngoe DSM-V, ka ho khetheha ho buuoa ka bokhoba ba inthanete (www.dsm5.org; e fihliloe ka la 10 Hlakola, 2010). Leha ho le joalo, bakeng sa mathata a mangata, ho na le tlhaiso-leseling e nyane kapa ha e na netefatso bakeng sa litekanyetso tsena tsa tlhahlobo. hajoale li bohlokoa haholo joaloka lisebelisoa tsa lipatlisiso ho hakanya ho ata ha bothata.

Potso e le 'ngoe ea tlhahlobo e hlahisitsoeng ka har'a lingoliloeng ke ea moo ho lemalla boitšoaro (le ho lemalla lithethefatsi) ho oelang holima khatello ea maikutlo (97), ke hore, na li tšoana haholo le mathata a ho laola maikutlo kapa mathata a feteletseng a qobelloang? Ba bang ba phehile khang ea hore mokhoa ona o kopaneng o kopaneng o bonolo haholo, mme ho se tsotelle le ho qobelloa ho emela litekanyo tsa orthogonal, ho fapana le lipalo tse fapaneng tse fapaneng.98). Tumellanong le khang ea morao-rao ke liphuputso tse kang phapang e kholo ea boemo ba ho se tsotelle har'a batho ba nang le boits'oaro ba boits'oaro, phapang e ka amanang le karabelo ea kalafo ea litlama (48, 99).

Ho DSM-IV, ho lemalla lithethefatsi (mathata a ts'ebeliso ea lithethefatsi) ke sehlopha se ikemetseng, ha papali ea chelete e nkuoa e le lefu la taolo ea tšusumetso, joalo ka mohlala, pyromania le kleptomania. ICD-10 e khetholla papali ea chelete e le lefu la "tloaelo le tšusumetso", empa e amohela hore "boitšoaro ha bo qobelloe ka tsela ea mahlale," leha ka linako tse ling e bitsoa "ho qobella ho becha."

Taba e amanang le eona ke mokhatlo, kapa ho bokellana, haeba ho le teng, har'a litloaelo tse fapaneng tsa boitšoaro. Tlhatlhobo ea sehlopha ea lipalo tsa palo ea batho le tsa bongaka ho bakuli ba 210 ba nang le bothata ba mantlha ba ho qobella ho qobella ho hloaea ho khetholla lihlopha tse peli tse arohaneng tsa bakuli ba lemaletseng boits'oaro (100): Bakuli ba nang le papali ea chelete ea ho becha kapa bokhoba ba thobalano ("bosodoma") ba ne ba na le lilemo tsa pele mme ba ne ba ka ba banna haholo, ha ba bapisoa le bakuli ba mabenkeleng a qobelloang. Patlisiso e ngoe e ea hlokahala ho netefatsa le ho holisa se fumanoeng. Mokhoa o mong oa ho etsa lipatlisiso o ka tlatsetsang haholo tšimong e ka ba tlhahlobo e felletseng ea sehlopha se seholo, se fapaneng, se tsebahalang sa batho ba nang le mekhoa e fapaneng ea boits'oaro le lithethefatsi ho latela likarolo tse fapaneng tsa ho se ts'oenyehe le ho qobelloa kelellong ka bobeli (kelello) le boits'oaro ( motor), mohlala, kutloelo-bohloko ea ho putsa moputso (theolelo ea nakoana), ho etsa liqeto tsa moputso oa ho ipeha kotsing, ho ba le maikutlo a thata, ho arabela pele ho nako, ho arabela ka mamello, ho thibela likarabo le ho fetola thuto.

E tšehelitsoe ke Lenaneo la Patlisiso ea kahare ho Setso, Mekhatlo ea Naha ea Bophelo, Setsi sa Naha sa Tlhekefetso ea Lithethefatsi; NIH (NIDA) e fana ka R01 DA019139 (MNP) le RC1 DA028279 (JEG); le Minnesota le Yale Centers of Excellence ho Phuputso ea Ho becha, e tšehelitsoeng ke Setsi sa Naha sa Lipapali tse Ikarabellang le Setsi sa sona sa Patlisiso mabapi le Mathata a Papali ea Chelete. Dr. Weinstein o tšehelitsoe ke Setsi sa Naha sa Isiraele sa Psychobiology. Likahare tsa buka e ngotsoeng ka letsoho ke boikarabello ba bangoli ebile ha se maikutlo a semmuso a Setsi sa Naha sa Lipapali tse Ikarabellang kapa Setsi sa Lipatlisiso ka Mathata a Papali ea Chelete kapa efe kapa efe ea mekhatlo e meng ea lichelete.