Ho otla sepheo: Ho nahanisisa ka Tlhahlobo e sa Tšoaneng Ha U Phekola Batho ka Bothata ba Tšebeliso ea Litšoantšo Tsa Bootsoa (2018). (Tlhatlhobo ea mofuta oa Grubbs oa boits'oaro bo hlephileng)

Litlaleho tsa Boits'oaro ba Botona le Botšehali

, Buka ea 48, Khatiso ea 2, pp 431-435 |

https://link.springer.com/article/10.1007%2Fs10508-018-1301-9

Shane W. Kraus, Patricia J. Sweeney

Grubbs, Perry, Wilt, le Reid (2018a) o hlahisitse mohlala oa ho utloisisa mathata a batho ka bomong ka litšoantšo tsa bootsoa ka lebaka la boits'oaro bo hlephileng (PPMI). Haholo-holo, ba fana ka maikutlo a hore basebelisi ba bang ba litšoantšo tse manyala tse hlephisang boitšoaro ba na le khatello ea maikutlo le mathata a mang hobane boits'oaro ba bona ha bo lumellane le melao ea bona ea boitšoaro (ke hore, boitšoaro bo hlephileng), mme lipatlisiso tse fetileng li fane ka ts'ehetso ea mofuta ona o reriloeng (Grubbs, Exline, Pargament, Volk, & Lindberg, 2017; Grubbs, Wilt, Exline, Pargament, & Kraus, 2018b; Volk, Thomas, Sosin, Jacob, & Moen, 2016).

Sehloohong sa bona, Grubbs et al. (2018a) o ile a fana ka litsela tse peli bakeng sa tšebeliso e mpe ea litšoantšo tsa bootsoa. Tsela ea 1 e bontša hore mathata a amanang le litšoantšo tse manyala tse hlephisang boitšoaro a bakoa ke ho senya (e leng, tšebeliso e qobelloang), 'me Pathway 2 e hlalosa mathata a litšoantšo tsa bootsoa ka lebaka la boitšoaro bo hlephileng ba boitšoaro. Litsela tsena ka bobeli li na le phihlelo ea boipheliso eo re lumellanang le eona ke taba ea bohlokoa ho rarolla batho ba batlang phekolo bakeng sa tšebeliso e mpe ea litšoantšo tsa bootsoa. Mokhoa oa rona oa bongaka, re hlokometse hore boiphihlelo bo ikhethang ba mahlomola, bo bakoang ke ho tšoenyeha ha matšoenyeho, lihlong, le / kapa molato, hangata ke tšusumetso ho bareki ba batlang thuso. Leha ho le joalo, e le hore ho fanoe ka litlhahiso tse nepahetseng tsa phekolo bakeng sa batho ka bomong, ho kopanyelletsa le ba ikhethang hore ke "batho ba lemaletseng ho kopanela liphate," re lokela ho fumana hore na ba ka laola boitšoaro ba bona ba thobalano joang. Re fumane hore bareki ba bangata ba batlang phekolo ea ho sheba litšoantšo tse manyala tse hlephisang boitšoaro ba tlaleha mahlomola a maholo hammoho le boiteko bo bongata bo hlōlehileng ba ho itekanya kapa ho itšoara boitšoarong, liphihlelo tse mpe kapa liphello tse bohloko ka tšebeliso ea bona, le ho tsoela pele ba sebelisa ho sa tsotellehe hore na ha ba thabele hakae.

Moralo oa tlhatlhobo o mabapi le boits'oaro bo qobelloang ba thobalano (CSB) o phehiloe khang haholo lilemong tsa morao tjena (Kraus, Voon, & Potenza, 2016b). CSB e nkoa e le ho lemalla ho kopanela liphate (Matloana, 2001), bosodoma (Kafka, 2010), Takatso ea thobalano (Bancroft & Vukadinovic, 2004) Ho lemalla boitšoaro (Kor, Fogel, Reid, & Potenza, 2013). Ha moqoqo o ntse o hatela pele, re ananela mathata a hlahisoang ke bafuputsi ba bangata (Moser, 2013;; Winters, 2010) mabapi le monyetla oa ho kenella ho feteletseng ho ho kenella liketsong tsa thobalano khafetsa, ke ka hona re lumelang hore ho bohlokoa ho batla boteng ba mekhoa ea boits'oaro kapa lits'oants'o tse ling tsa sepheo sa hore liketso tsa thobalano khafetsa li thata ebile ha li laolehe (Kraus, Martino, & Potenza, 2016a).

Joalokaha ho boletsoe ke Kraus et al. (2018), Ho etsa lipatlisiso tse ling ka tlhaiso-leseling e matla ho hlokahala ho ts'ehetsa nts'etsopele ea moralo o nepahetseng oa tlhahlobo ea CSB, ho kenyeletsoa ts'ebeliso e fetelletseng ea litšoantšo tsa bootsoa (Gola & Potenza, 2018; Walton le Bhullar, 2018). Ho phaella moo, re lumellana le Grubbs et al. (2018a) kutloisiso ea hona joale ea ho lemalla ho sheba litšoantšo tsa bootsoa ho na le meeli ea mekhoa ho tloha lithuto tsa pele e bile teng linaheng tsa Bophirimela, linaheng tse tsoetseng pele tse nang le mekhoa e mengata ea Bokreste. Ena ke tšenyo e kholo ea ho hlahloba hore na litšoantšo tse tsosang takatso tsa botona kapa botšehali tse senyehileng li hlalositsoe joang ho latela mekhoa, mekhoa ea bohlokoa le lits'ebeletso tsa batho ba tsoang litsong tse ling tsa setso li ka fapana le litebello tsa Europe tsa Bophirimela tsa Bophirimela mabapi le litšoantšo tsa bootsoa le litloaelo tse ling tsa thobalano . Lipatlisiso tse ling tse mabapi le tšebeliso e mpe ea litšoantšo tsa bootsoa li hlokahalang ho netefatsa hore litekanyetso tsa ho hlahloba ha li nepahale feela empa li boetse li fetoleloa ho pholletsa le litso.

Bothata ba ho Kopanela Liphate ka ho Kopanela Liphate (CSBD): Lintlha tsa Tlhahlobo ea ho Fapana ka Tsela e sa Tšoaneng

Morao tjena, Mokhatlo oa Lefatše oa Bophelo (2018) ho kgothaletswa ho kenyelletsa CSBD lenaneong le tlang la 11th la Kemiso ea Machaba ea Maloetse (6C72). Ho ile ha nkoa mokhoa o tsitsitseng, 'me CSBD e ne e khetholloa e le lefu la ho laola maikutlo ka lebaka la bopaki hobane lipatlisiso ha li e-s'o le matla ka ho lekaneng ho li hlahisa e le boitšoaro bo hlephileng. Ka lebaka leo, litekanyetso tsa CSBD li kenyeletsa tse latelang:

CSBD e khetholloa ka mokhoa o sa khaotseng oa ho hloleha ho laola litabatabelo tse matla, tse pheta-phetoang tsa thobalano kapa litakatso tse hlahisang boits'oaro bo pheta-phetoang ba thobalano. Matšoao a ka kenyelletsa ho pheta-pheta liketso tsa thobalano ho ba ntho ea mantlha bophelong ba motho hoo a ka hlokomolohang bophelo bo botle le tlhokomelo ea motho kapa lithahasello tse ling, mesebetsi le boikarabello; boiteko bo bongata bo sa atleheng ba ho fokotsa boits'oaro bo pheta-phetoang ba thobalano; mme a tsoela pele ka boits'oaro bo pheta-phetoang ba motabo ho sa natsoe litlamorao kapa a fumana khotsofalo e nyane. Mohlala oa ho hloleha ho laola litabatabelo tse matla, tsa thobalano kapa litakatso tse hlahisang boits'oaro bo pheta-phetoang ba thobalano o bonahala nako e telele (mohlala, likhoeli tse 6 kapa ho feta), mme o baka khatello ea maikutlo kapa ho senyeha ho hoholo ho motho ka mong, lelapa, sechaba, thuto, mosebetsing, kapa libakeng tse ling tsa bohlokoa tsa tšebetso. Matšoenyeho a amanang ka ho felletseng le likahlolo tsa boitšoaro le ho se amoheloe ke litakatso tsa thobalano, litakatso, kapa boits'oaro ha a lekana ho fihlela tlhoko ena (Mokhatlo oa Lefatše oa Bophelo, 2018).

Tlhompho ea CSBD e pheta-pheta ho hlōleha ho leka ho laola kapa ho thibela boitšoaro ba ho kopanela liphate bo bakang mahlomola le ho holofala ho ts'oetsong, mme "ho tsieleha kelellong ka lebaka la boitšoaro ba thobalano ka bolona ha bo lumelle hore motho a hlahlojoe ke CSBD" (Kraus et al., 2018, leq. 109). Tsena ke lintlha tsa bohlokoa tseo u lokelang ho li hlahloba metseng ea meriana moo lisebelisoa tsa bohlokoa bakeng sa moralo ofe kapa ofe o atlehang oa ho nahana ka morero le kalafo ea phekolo li qala ka ho hlahloba ka ho feletseng le ho khetholla se nepahetseng. Re hlahisitse algorithm ka feiga. 1 ho thusa lingaka lingaka hore li nahane ka katleho le litsela tsa phekolo bakeng sa bareki ba hlahisang litšoantšo tse tsosang takatso ka bothata.

E le ho thusa kutloisiso, joale re tla tšohla mehlala e meraro ea bareki ba sebele ba neng ba batla phekolo bakeng sa ho sebelisa litšoantšo tse manyala tse hlephisang boitšoaro Lefapheng la Veterans Affairs (VA) sepetlele se khethehileng sa bophelo bo botle ba kelello. Mehlala ena e 'nile ea khetholloa e le hore e sireletse bolotsana ba bareki.

Setšoantšo sa 1

Litšoantšo tse litšila tse tsosang takatso li sebelisa mokhoa oa phekolo

Motho ka mong le PPMI le CSBD

Mong S ke monna eo e leng khale a le lilemo li kaholimo ho tse peli, monna ea bong bo fapaneng le monna ea se nang molekane ea sebetsang ka nakoana ha a ntse a le kolecheng. O ntse a phekoloa setsing sa bongaka sa VA bakeng sa khatello ea maikutlo le khatello ea maikutlo e amanang le ntoa ea sesole. Monghali S le eena o ile a batla kalafo hobane a itsebahatsa e le "lekhoba la thobalano le thobalano" mme a tlaleha hore o sebelisa litšoantšo tsa bootsoa ho tloha ha a le lilemong tsa bocha. O boletse hore o sebelisa litšoantšo tsa bootsoa letsatsi le letsatsi. O hlalositse liteko tse ngata tsa ho khaotsa ho sebelisa litšoantšo tsa bootsoa hammoho le ho etsa thobalano le batho bao a ba tloaetseng le barekisi ba lefshoang. Monghali S o ile a itlhalosa e le Mokreste oa moevangeli ea ntlafalitsoeng mme a re litšoantšo tsa hae tsa bootsoa le boits'oaro bo bong ba thobalano li "hlabisang lihlong" hape "li moetsalibe" ho eena tse bakileng khatello ea kelello e kholo. Mong S o hanne kalafo efe kapa efe ea nakong e fetileng ea CSBD empa a tlaleha hore o ile sehlopheng sa banna ba kereke bakeng sa tšehetso ka lebaka la ts'ebeliso ea hae ea litšoantšo tsa bootsoa.

Nakong ea kliniki, likarabo tsa Monghali S ha li hlahlojoa li latela mokhoa oa bohareng oa setšoantšo sa Fig. 1. O ile a lumella PPMI kaha mekhoa ea hae ea ho kopanela liphate e ne e sa lumellane le tumelo ea hae. Ka histori ea hae le tlaleho ea mathata a hona joale, o ile a boela a kopana le maemo a feletseng a CSBD. Ka bomalimabe, Monghali S ha aa ka a kenella kalafo e latelang ka tleliniki ea rona hobane a thahasella ho batla thuso ka kereke ea hae feela. Pele ho felisoa ka nako e telele, litlhahiso tsa phekolo ea Monghali S li kenyelelitse ho fana ka meriana (naltrexone) ho rarolla litakatso tsa hae le ho fana ka phekolo ea boitšoaro bo botle ho rarolla litumelo le mekhoa ea boitšoaro e entseng hore a se ke a sebelisa litšoantšo tse litšila tse tsosang takatso.

Motho ka mong le CSBD Feela

Mong D ke lesole la Caucasus, monna le mosali ba bong bo fapaneng le monna ea nyetsoeng lilemong tsa hae tsa 30 tse nang le nalane ea khatello ea maikutlo ea ipolelang hore o "lemaletse litšoantšo tsa bootsoa" O qalile ho sebelisa litšoantšo tse manyala tse hlephisang boitšoaro khafetsa lilemong tsa hae tsa bocha mme o ne a lula a ipholla litho tsa botona kapa botšehali lilemong tse 10 tse fetileng, haholo-holo a shebella litšoantšo tse manyala tse hlephisang boitšoaro nako e telele ha mosali oa hae a ea mosebetsing. O ile a tlaleha thobalano e khotsofatsang le mosali oa hae leha a ne a nahana hore ts'ebeliso ea hae ea litšoantšo tsa bootsoa e mo sitisa ho ba haufi le kamano le eena. Mong D o hlalositse ts'ebeliso ea hae ea litšoantšo tsa bootsoa e le ntho e qobelloang mme a tlaleha hore ha a khotsofale. O ile a tlaleha litakatso tse matla tsa ho shebella litšoantšo tsa bootsoa kamora matsatsi a 'maloa a bohloki tse ileng tsa baka tšebeliso ea hae.

Nakong ea kliniki, Monghali D ha aa ka a lumellana le mahlomola ka lebaka la PPMI empa o ile a ba le bothata ba ho laola litšoantšo tsa hae tsa bootsoa. O ile a hlahlojoa a ba a fumanoa a finyella litekanyetso tse feletseng tsa ICD-11 bakeng sa CSBD joalokaha ho bontšitsoe ka setšoantšo sa feiga. 1. Mong D o ile a fuoa meriana (naltrexone, 50 mg / ka letsatsi), hape a nka karolo mananeong ka bomong a kalafo ea boits'oaro ea ts'ebeliso ea lithethefatsi tse neng li fetotsoe ho sebetsana le ts'ebeliso e mpe ea litšoantšo tsa bootsoa. Nakong ea kalafo, Monghali D o ile a fokotsa tšebeliso ea hae ea litšoantšo tsa bootsoa mme a sebetsana ka katleho le litakatso tsa hae. O boetse a tlaleha keketseho ea ho etsa lintho tse khahlisang le mosali oa hae le metsoalle joalo ka ho hahlaula maoto le ho nka maeto.

Motho ka mong le PPMI Feela

Mong Z ke mohlabani ea loanang oa banna ba bong bo fapaneng ba Caucasus, ea lilemong tsa bo-40 ea seng a nyetse lilemo tse 'maloa. O sebetsa mme o na le ngoana a le mong. Mong Z o ile a tlaleha nalane ea khatello ea maikutlo hape a sebelisa litšoantšo tse manyala tse hlephisang boitšoaro nako le nako lilemong tse 20 tse fetileng tse lebisitseng likhohlanong le balekane ba ratanang, ho kenyeletsoa le mosali oa hae oa hajoale. O hanne ho sebelisa litšoantšo tsa bootsoa nakong eo a neng a kopanela liphate le mosali oa hae, empa a re ha a na kamano e haufi le eena lilemong tse 'maloa. Hajoale, o ne a shebella litšoantšo tsa bootsoa hanngoe kapa habeli ka beke ho ipholla litho tsa botona kapa botšehali empa a hana bothata ba ho emisa kapa ho fokotsa. O tlalehile a sebelisa litšoantšo tsa bootsoa haholo hobane a sena mokhoa o mong oa thobalano, empa ts'ebeliso ea hae ea litšoantšo tsa bootsoa e etsa hore a ikutloe a "tšabeha" hape a "nyonyeha" hobane boits'oaro ba hae bo ne bo sa lumellane le tumelo ea hae mabapi le hore na banna "ba lokela ho itšoara joang" maemong a lenyalo. O ile a ba le khatello ea maikutlo e kholo, haholoholo khatello ea maikutlo, e amanang le boemo ba ho hloka taolo lipakeng tsa litekanyetso tsa hae le boitšoaro ba hae ba thobalano.

Nakong ea kliniki, Monghali Z o ile a bolela hore ha a e-s'o batle phekolo bakeng sa taba ena pele. O ile a lumellana le liphihlelo tsa mahlomola tsa mahlomola ka lebaka la PPMI 'me a kopana le lits'oaetso tsa lefu la ho tepella maikutlo le mathata a ho tšoenyeha empa eseng CSBD e emeloang ka setšoantšo sa feiga. 1. Tlhahlobo ka bomong e ne e lebisitse ho fokotsa ho tšoenyeha ha Monghali Z mabapi le ho qala thobalano le mosali oa hae. Monghali Z le mosali oa hae ba ile ba boela ba kenya letsoho litleleniking tsa banyalani moo setsebi se ileng sa fana ka liketsahalo tse khahlisang tsa thobalano ho banyalani ba lokelang ho li etsa ha li ntse li eketsa puisano ea tsona. Monghali Z o ile a re ho fokotseha ha litšoantšo tsa bootsoa ho sebelisoa ha eena le mosali oa hae ba qala ho ba le kamano e haufi le 'mele. O ile a boela a tlaleha hore puisano e eketsehile le mosali oa hae hammoho le ho fokotsa khatello ea kelello le matšoenyeho a ileng a etsa hore a tlohele phekolo.

Maikutlo a ho qetela

Sepheo sa rona ka tlhaloso ena ke ho tsoela pele ka lipuisano tse hlokahalang mabapi le ho hlahlojoa ha basebeletsi ba batlang phekolo bakeng sa tšebeliso e mpe ea litšoantšo tsa bootsoa. Joalokaha ho builoe ke Grubbs et al. (2018a), Sehlooho sa boits'oaro bo hlephileng bo bohlokoa ha ho etsoa qeto ea hore na moreki ea nang le bothata ba litšoantšo tse manyala tse hlephisang boitšoaro o sebetsana le litekanyetso tsa ICD-11 tsa CSBD. Bopaki bo fana ka maikutlo a hore batho ba bang ba tlaleha litaba tsa bohlokoa tse lekanyetsang le / kapa ho laola ts'ebeliso ea bona ea litšoantšo tse manyala tse hlephisang boitšoaro tse lebisang khatellong le ho holofala libakeng tse ngata tsa ts'ebetso ea kelello (Kraus, Potenza, Martino, & Grant, 2015b). Ka ho khoneha ho kenngoa ha CSBD ho ICD-11 le ho ata ha litšoantšo tse manyala tse hlephisang boitšoaro ho sebelisoa linaheng tse ngata tsa Bophirimela, re lebelletse hore batho ba bangata ba tla batla phekolo ea litšoantšo tse manyala tse hlephisang boitšoaro ba sebelisa nakong e tlang. Leha ho le joalo, hase bohle ba batlang phekolo bakeng sa litšoantšo tse manyala tse hlephisang boitšoaro ba sebelisa litšoantšo tsa bootsoa li tla finyella litekanyetso tsa CSBD. Joalokaha ho boletsoe pejana, ho utloisisa mabaka a liqeto tsa bareki bakeng sa ho batla thuso bakeng sa tšebeliso e mpe ea litšoantšo tse manyala tse hlephisang boitšoaro e tla ba habohlokoa e le hore ka ho nepahetseng re tsebe hore na basebetsi ba fumane mangolo a nepahetseng a ho hlahloba le ho alafa.

Joalokaha ho totobalitsoe ke mehlala ea bareki ba rona, ho hlokahala hore re khetholle mofuta oa mathata a ts'ebeliso ea litšoantšo tsa bootsoa bakeng sa tlhakiso ea tlhatlhobo le litlhahiso tse nepahetseng tsa kalafo tse tla fanoa. Litlhare tse 'maloa li se li entsoe le ho lekoa bakeng sa CSB, ho kenyeletsoa ts'ebeliso e thata ea litšoantšo tsa bootsoa. Bopaki ba pele bo ts'ehetsa ts'ebeliso ea kalafo ea boits'oaro ea boits'oaro (Hallberg, Kaldo, Arver, Dhejne, & Öberg, 2017), kalafo ea boitlamo ba kamohelo (Crosby & Twohig, 2016) kapa mekhoa e nang le kelello (Brem, Shorey, Anderson, & Stuart, 2017; Fumana Ream, Bramen, Anderson, & Cohen, 2014). Ntle le moo, ho na le bopaki bo bong bo tšehetsang boits'oaro ba litlhare (Gola & Potenza, 2016; Klein, Rettenberger, & Briken, 2014; Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015a; Raymond, Grant, le Coleman, 2010). Joalokaha ho bontšoa mehlala ea rona ea bareki le Fig. 1, bareki ba nang le bothata ba ho sheba litšoantšo tse manyala tse hlephisang boitšoaro ba sebelisa lipolelo tse fapaneng tsa tlhokomelo le mabaka a ho batla thuso. Ka hona, lipatlisiso tsa nakong e tlang li hlokahala ho ntlafatsa mekhoa ea phekolo e loketseng ho sebetsana le ho rarahaneng le mekhahlelo ea litaba tse bakang tšebeliso e mpe ea litšoantšo tsa bootsoa.

Notes

dithuso tsa ditjhelete

Mosebetsi ona o tšehetsoa ke Lefapha la Veterans Affairs, Lekala la Bophelo ba Veterans, Lekala la Bophelo bo Botle ba Machaba, LIHLOOHO, le Thuto ea Meriana ea VISN 1 New England.

Tumellanong le Melao-motheo ea Boits'oaro

Khohlano ea thahasello

Bangoli ha ba na likhohlano tsa thahasello ho tsebisa litaba tsa thuto ea morao tjena. Maikutlo a hlalositsoeng ke a bangoli 'me ha ho joalo ho bonahatsa boemo kapa leano la Lefapha la Veterans Affairs, USA.

Boemo bo amohelehang

Melao eohle ea boits'oaro e ile ea lateloa ho ea ka se hlokahalang ke Lefapha la Boemo ba Maqheku. Sehlooho sena ha se na lithuto leha e le life tsa lihlooho tsa batho kapa tsa liphoofolo tse entsoeng ke mangolo. Tšebeliso ea li-vignettes tse hlalositsoeng ka morao li kenyelelitsoe bakeng sa lithupelo feela.

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