Na ho lemaletse lijo ho teng? Tlhaloso ea phenomenological e thehiloeng ho lihlopha tsa mafu a kelello tsa mafu a amanang le lithethefatsi le tahi (2012)

2012; 5 (2): 165-79. doi: 10.1159 / 000338310. Epub 2012 Apr 19.

Albayrak O1, Wölfle SM, Hebebrand J.

inahaneloang

Likamano lipakeng tsa ho ja ho tlōla, tšebeliso e mpe ea lithethefatsi le (ho itšoara hampe) li baka likhang. Mefuta ea bokhoba ba meriana e seng e thehiloe hona joale e amana le mathata a ts'ebeliso ea lithethefatsi feela. Empa Buka ea Pele ea Ts'oaetso le Lipalopalo bakeng sa Mathata a Kelello V (DSM V) e fana ka maikutlo a ho tlosa sehlopha se fetileng sa 'Mathata a Amanang le Lithethefatsi' ka 'Ho Lemalla le Mathata a Amanang', ka hona e le lekhetlo la pele ho lumella ho hlahlojoa ha bokhoba ba boitšoaro. Nakong e fetileng lingaka tsa mafu a kelello le litsebi tsa kelello ba ne ba le leqe ho hlophisa le ho hlophisa poleloana ea ho lemalla boitšoaro. Leha ho le joalo, ho na le phapang e pharalletseng lipakeng tsa ho lemalla lik'hemik'hale le boits'oaro ho kenyeletsoa likarolo tsa phenomenological, kalafo, liphatsa tsa lefutso le neurobiological. Hoa thahasellisa ho bontša hore hormone leptin ka boeona e na le phello e hlakileng tsamaisong ea moputso, ka hona e fana ka maikutlo a khokahano e sa tobang lipakeng tsa ho ja ho tlōla le ho lemalla 'lik'hemik'hale'. Kahoo, batho ba nang le leptin ba ka khetholloa e le litekanyetso tse khotsofatsang tsa bokhoba ba lijo. Tlhahlobisong ea rona re qala ka ho lekola liphuputso tsa kelello ka lik'hemik'hale (tse thehiloeng ho lithethefatsi) mme kamora moo re lemaletseng boits'oaro ho sekaseka ho kopana. Re tšohla bonnete ba ts'oaetso ea bokhoba ba lijo, boo ka mohopolo bo ka bang ka lik'hemik'hale le / kapa ka boits'oaro.

Selelekela

Kamano pakeng tsa ho ja haholo, tšebeliso e mpe ea lithethefatsi le ho lemalla boitšoaro ke ho ngangisana. Bafuputsi ba bang ba phehile khang ea ho kopanyelletsa ho ja ho tlōla meleng ea ho sebelisoa ha lithethefatsi [mohlala [1,2]; tse ling li fana ka tlhahiso ea hore ho nkeloe lijo tse eketsehileng tse amanang le botenya kapa mathata a ho ja e le ho lemalla boitšoaro [3]. Ho ikopanya ha mathata a ho sebelisa lithethefatsi ho fana ka maikutlo a mofuta oa ts'oaetso ea lik'hemik'hale eo hona joale ho seng le bopaki bo lekaneng feela; lik'hemik'hale tse hlalositsoeng lijong tsa letsatsi le letsatsi tse ka etsang hore motho a lemalle ho lemalla ho lemala ka ho tlamella mefuta e khethehileng ea methapo ea methapo ea methapo e sa fumanoe. Leha ho le joalo, ho na le bopaki bo bontšang hore ho lemalla lijo ho ka talingoa e le mokhoa o tobileng oa ho lemalla boitšoaro boemong bo itseng ba batho ba feteletseng. Metsing e latelang, re tšohla lintlha tsa ho hlahloba ka bobeli mathata a tšebeliso ea lithethefatsi le mathata a boits'oaro ba boitšoaro bo bobe haholo a totobatsang likarolo tsa bona tsa bongaka. Lihlooho tse ling ka har'a makasine ena e ikhethang li tla hlalosa likarolo tsa neurobiological tsa ho lemalla lijo.

Kakaretso ea Lik'hemik'hale (Meriana)

Mefuta e tsitsitseng ea ho lemalla lithethefatsi e amana le mathata a ho sebelisa lithethefatsi. Setsi sa Sechaba sa Tlhekefetso ea Lithethefatsi [4] e fana ka tlhaloso e latelang: 'Ho lemalla joala ho hlalosoa e le lefu le sa foleng, le khutlang hape la bokooa le khetholloang ke ho batla lithethefatsi ho qobella le ho sebelisa, ho sa tsotellehe liphello tse kotsi'. Khaolong ea V 'Mathata a kelello le a boits'oaro' a Sekhetho sa Machaba sa Litlhare le Mathata a Amanang le Bophelo, 10th Revision (ICD-10; Mokhatlo oa Lefatše oa Bophelo, 1992 [5]) 'Mathata a kelello le a boitšoaro ka lebaka la tšebeliso ea lithethefatsi' (F10-F19) ke e 'ngoe ea likarolo tse leshome tse ka sehloohong tsa ho hlahloba. ICD-10 e bua haholo ka mathata a kelello le a boitšoaro (bona tafole 1). Lenaneong la bobeli la ho khetholla mafu a kelello le sebelisoang khafetsa le bitsoang "Manual" le "Statistical Manual of Mental Disorders" (DSM), khatiso ea 4th, Text Revised (DSM-IV-TR), e hatisitsoeng ke American Psychiatric Association (APA) ka 2000 [6], 'Matšoenyeho a amanang le' mele e boetse e emela e 'ngoe ea likarolo tse kholo tsa ho hlahloba. Ho ea ka merero ea lihlopha ka bobeli, bothata bo bong le bo bong bo amanang le lithethefatsi bo arotsoe ka litlhoko tse kholo tsa tlhokomelo ea bophelo (tafoleng 2;; bona tafole 3 le tafoleng 4 bakeng sa mekhoa e fapaneng ea mekhoa ea DSM-IV). Matšoao a ho tahoa le ho khaotsa ho fapana ho ka fapana ka ntho e itseng ho ea ka liphello tsa 'mele le kelellong tsa tšebeliso ea lithethefatsi.

Tafole 1

ICD-10 F10-19 e le mathata a kelello le a boitšoaro ka lebaka la tšebeliso ea tšebeliso ea lithethefatsi [5]

http://www.karger.com/WebMaterial/ShowPic/207827

 

Tafole 2

Mathata a amanang le lithethefatsi a ICD-10 le DSM-IV [5,6,7]

http://www.karger.com/WebMaterial/ShowPic/207826

 

Tafole 3

Tekanyetso ea DSM IV-TR bakeng sa tšebeliso e mpe ea lithethefatsi [7]

http://www.karger.com/WebMaterial/ShowPic/207825

 

Tafole 4

Tekanyetso ea DSM IV-TR bakeng sa ho itšetleha ka lintho tse itseng [7]

http://www.karger.com/WebMaterial/ShowPic/207824

DSM-V [7] e tla nkela sebaka sa DSM ea kajeno (DSM-IV-TR) ho 2013; lihlopha tsa mosebetsi tse fapaneng hona joale li buisana ka mokhoa oa ho hlophisa le ho sebetsana hantle le mathata a kelello le mekhoa ea bona e thehiloeng linthong tsa morao-rao tse fumanoeng. Ka mor'a lipuisano tse pharaletseng tsa lentsoe 'ho lemalla' meriana, mosebetsi oa DSM-V oa Matšoao a ho Sebelisa Mathata o entse tlhahiso ea ho boela o reha sehlooho se fetileng Sehlopha se fetileng sa Mathata a Amanang le Tlhekefetso le Mathata a Amanang [8]. Tšebeliso ea lentsoe 'ho itšetleha' hona joale e lekanyelitsoe ho itšetlehile ka tsa bophelo, e leng karabelo e tloaelehileng ho litekanyetso tse ngata tsa lithethefatsi le meriana. Haeba ho loketse, phekolo ea meriana ka lithethefatsi e laetsoeng e akarelletsa ho mamella le / kapa matšoao a ho tlohela; tsena ha lia lokela ho baloa bakeng sa ho fumanoa ha bothata ba ho sebelisa lithethefatsi. Habohlokoa, mosebetsi oa DSM-V oa Matšoao a Matšoao a ho Sebelisa Mathata o khothalletsa ho kopanya tlhekefetso le ho itšetleha ka boloetse bo le bong bo bakoang ke ts'oaetso ea ho sebelisoa ha lithethefatsi, ho na le litekanyetso tse peli tse hlokahalang bakeng sa ho hlahlojoa (tafole 5). Keletso ena e ne e le har'a mabaka a mang, a thehiloeng ho mathata a fapaneng le tlhekefetso ho tloha ho itšetlehile ka ho itšetlehile ka botšepehi le botšepehi bo fokolang ba DSM-IV ho hlahlojoa ha lithethefatsi hampe. Mokhoa oa hona joale oa ho hlekefetsa le ho itšetleha ka DSM-IV ho ka nkoa e le ho theha moralo o se nang moeli, ka mokhoa o hlekefetsang le oa ho itšetleha ka oona o kenngoa kahare ho tekanyo e matla ea sekhahla [8].

Tafole 5

Mekhoa ea DSM-5 ea pele bakeng sa khatello ea lithethefatsi [8]

http://www.karger.com/WebMaterial/ShowPic/207823

Joalokaha ho bontšoa ke puisano e ka hare ho sehlopha sa mosebetsi sa DSM V tsa Matšoao a Matšoao, likarolo tsa mathata a kelello li fetoha phetoho e bontšang tsoelo-pele ea lipatlisiso tse matla. Khatisong ea pele ea APA's Diagnostic le Statistical Manual ea Mental Disorders (1952) [9], tšebeliso e mpe ea lithethefatsi le lithethefatsi li ne li arotsoe tlas'a Matšoenyeho a Botho ba Batho, tse neng li nkoa li bakoa ke mathata a tebileng a kelello kapa mefokolo ea boitšoaro. Lilemong tse fetileng tsa 60 re bone ho sebelisa meriana ea lithethefatsi ho tse peli tsa molao (nicotine le joala) le lithethefatsi tsohle tse seng molaong. Ka lebaka leo, khopolo ea ho lemala e le ea bohlokoa haholo ho sebelisa nicotine kapa joala ka boeona ka boeona e entse hore ho be le bothata ba ho sebelisa lithethefatsi tse fapaneng ka liphello tse kholo bakeng sa maikutlo a sechaba mabapi le lits'ilaetso tsena, phekolo ea bona, litšenyehelo tsa tlhokomelo ea bophelo bo botle le tse sa tobang, le thibelo. Meriana e ne e le har'a lisosa tse ling, tse matlafalitsoeng ke ho phethahala ha liphello tse bohloko tsa bongaka tsa ho itšetleha ha linokoe le tahi. Boiteko ba mohlala ho indasteri ea koae ho fokotsa kapa ho fokotsa likotsi tsa ho tsuba-ho bakoa ke maloetse a kang kankere ea matšoafo le mafu a pelo e tsebahala haholo; tšusumetso ea indasteri ea koae ka morero e ntse e tsoela pele [10]. Ka hona, ho utloisisa hore na likhoebo li susumetsa morero joang ka hona ke karolo ea bohlokoa ea lipatlisiso tsa bophelo bo botle ba sechaba ka ho lemalla lithethefatsi tsa molao [11].

Kemiso ea Boitšoaro ba Tšebeliso ea Boitšoaro

Lentsoe lena le lemalla ho lemalla boitšoaro bo sa tsoa etsoa; ha e e-s'o fumanoe ho amoheloa ka molao meriana: Ka hona, leha e le ICD-10 kapa DSM-IV-TR e kenyelletsa sehlopha se fapaneng sa ho hlahloba. Litsebi tsa kelello le litsebi tsa kelello li 'nile tsa tsilatsila ho hlophisa le ho khetholla mathata a joalo. Re lumela hore lisosa tse 'maloa li tlatsetsa ts'ebetsong ena:

i) Histori ea morao-rao ea mathata a ho sebelisoa ha lithethefatsi e bontša hore phetoho e tsoang mohopolong oa bothata ba boitšoaro bo bontšang bofokoli ba botho ba lefu la ho lemalla ho nka nako; mokhoa ona o hloka hore ho be le puisano le ho kopanya tumellano pakeng tsa meriana le sechaba ka kakaretso.

ii) Ho na le ts'ebetso e tloaelehileng ea ho phekola meriana le ho feta ka ho fetisa mekhoa ea ho ipolaea, hobane e ka talingoa e le karolo ea bofelo ba nako e fetisitsoeng ea nako e sebelisetsoang ho latela mekhoa ea letsatsi le letsatsi. Ka lebaka leo, tlhaloso ea mathata a fapaneng e hloka tlhaloso ea mekhoa ea ho thibela kapa ea khaola. Ho fapana le ho lemalla lik'hemik'hale, ho kenngoa ha ntho e itseng, e ka tiisoang habonolo (ke hore, ho ikemisetsa ho ba le lithethefatsi tse fapa-fapaneng le / kapa metabolites ea tsona ka serum le morong), ha ho hlokahale. Ka ho totobetseng, mekhabiso e bonolo ea mathata a joalo e ne e tla fella ka liphesente tse phahameng tsa baahi ba phethahatsang litekanyetso tsa ho hlahloba bakeng sa mathata a fapaneng a ho lemalla boitšoaro. Batho ba joalo ba ne ba tla fumana tekanyetso ea ho hlahlojoa le phekolo e ka 'nang ea kenya litšenyehelo tse phahameng mekhoeng ea tlhokomelo ea bophelo ea naha.

iii) Ho tšoana le boemo ba lithethefatsi tsa molao, mekhoa e fapaneng ea boitšoaro e phehelloa ke karolo e phahameng ea baahi, kahoo e baka mathata ho batho ka bomong le mekhatlong ea sechaba ho lemoha mekhoa e feteletseng ea boitšoaro joaloka mathata. Ho thata ho utloisisa hore batho ba bang ba fetang mesebetsing e tobileng ba ka senyeha ka mokhoa o tebileng bophelong ba bona ba letsatsi le leng le le leng.

iv) Theknoloji ea morao-rao le mecha ea phatlalatso le tlaleho ea bona ea bonolo ea ho fumana litsela tse ling tsa 'boitšoaro bo hlephileng' (inthanete) kapa ho ba thusa haholo (ho fumana li-websaete tsa litšoantšo tsa bootsoa). Ka hona, bothata ba tšebeliso ea bona e feteletseng ke e ncha 'me ka potlako e ntse e e-ba litaelo tsa romana; ho etsa lipatlisiso ho latela li-lags tse ka mor'a morao ha li bapisoa le tsona ka mathata a sebelisoang ke lithethefatsi.

v) Ho ikakhela ka setotsoana mesebetsing e tobileng ho atisa ho kopana le mathata a sa tšoaneng a kelello, ao ho sa nkoang letho kahare ho tahiloeng. Ka mohlala, papali ea papali ea chelete kapa thepa ea marang-rang e ka bonahala ka hare ho moelelo oa ketsahalo e tebileng ea khatello kapa boloetse bo feteletseng ba ho qobella motho; ka mokhoa o joalo, boitšoaro bo feteletseng bo bonahala eka ke letšoao kapa epiphenomenon ea lefu lena le ka sehloohong. Pono e le 'ngoe e baka mathata a ho lemalla boitšoaro bo hlephileng ba ho lemalla boitšoaro bo hlephileng ba ho laola maikutlo, ho na le mathata a mang a ho laola maikutlo a mangata [12].

Sehlopha sa Basebetsi sa DSM-V [8] Haufinyane tjena o entse tlhahiso ea hore ho hlahlojoa papali ea chelete ea Pathological (Disordered) (tafole 6) ho sebelisoa reclassified ho tsoa ho Impulse-Control Disorders Ha ho Tse ling ho Tsebisang 'ho sehlopha sa libuka tse nang le bothata le ho ba le mathata a amanang le [13]. Papali ea papali ea chelete e ne e nkoa e le e tloaelehileng litabeng tsa bongaka, etiology (ho akarelletsa le liphatsa tsa lefutso), ho nyenyefatsa, thuto ea mafu, le kalafo ka Matšoao a ho Sebelisa Lijo, ka hona ho lumellana le ts'ebetsong ena [mohlala [14,15]. Ts'ebetsong ena e bontša bohlokoa ba ho fetola maikutlo ho tsebo ea mantlha ea kelello ea lefu lena, e leng ho kenyelletsanoang le ho ts'oaroa ha sehlopha sa ts'oaetso. Hona joale, papali ea papali ea chelete e lokela ho ba eona feela tšoaetso ea ho lemalla boitšoaro molaeng oa DSM V oa ho hlahloba 'Tlhekefetso le Mathata a Amanang'. Leha ho le joalo, ts'ebetso ena e tla boela e ntlafatse lipatlisiso le lipuisano mabapi le tlhaloso ea lithethefatsi tse eketsehileng tsa boitšoaro ka har'a sehlopha sena sa ho hlahloba.

Tafole 6

Ho fanoe ka mekhoa ea DSM V ea papali ea chelete ea ho kula (pathological) e sa sebetsaneng le bothata ba ho lemala le mathata a amanang le ona [8]

http://www.karger.com/WebMaterial/ShowPic/207822

Tlhekefetso e ka hlalosoa e le ho mamella ho sa tloaelehang le ho itšetleha ka ntho e itseng ea kelello or tloaelo ea ho phela [16]. Ho lemalla boitšoaro bo hlephileng ho bolela ho tsoela pele ho kopanela le mosebetsi ho sa tsotellehe liphello tse mpe tse amanang le eona; thabo le thabo li ne li ka 'na tsa batloa ka lekhetlo la pele, leha ho le joalo ka nako e telele ho kenella mosebetsing ho hlokahala hore u ikutloe u tloaelehile [17]. Ka hona, mesebetsi e fapaneng e na le bokhoni ba ho lemalla (mohlala, papali ea chelete, marang-rang, lipapali tsa k'homphieutha, mosebetsi, boikoetliso, liketso tsa thobalano, ho ja lijo tse ngata), tse ling tsa tsona li amana le litlhoko tsa tlhaho tsa homeostatic (mohlala, ho ja). Boits'oaro bo ka sebetsang ka bobeli ho hlahisa thabo le ho fana ka khatholoho boemong bo sa thabiseng ba ka hare bo etsoa ka mokhoa o khetholloang ke i) ho hlōleha ho laola boitšoaro (ho hloka matla) le ii) ho tsoelapele ka boitšoaro ho sa tsotellehe liphello tse mpe tse mpe (ho se tsotelle)15]. Mantsoe a sebelisetsoang ho khetholla boloetse ba ho lemalla ke 'ho itšetleha' le 'ho qobelloa'. Ho itšepa ho akarelletsa mokhoa oa ho pheta-pheta o ikemiselitseng ho finyella boemo bo khabisang ba ka hare ka ho khotsofatsa litlhoko. Mantsoeng a thuto ea boits'oaro le boitšoaro, mokhoa oo ho itšetlehe ka ho itšetleha ka boithatelo ho susumetsang boitšoaro ho boleloa hore o matlafatsoa hantle. Ho qobelloa ho kenyelletsa boiteko ba ho qoba kapa ho qoba boemo bo sa thabiseng le bo ferekanyang ka hare (mohlala, ho tšoenyeha, ho sareloa, molato, ho hlajoa ke lihlong, khalefo). Sena se lumellana le paradigm e matlafatsang, eo liphello tse mpe li nkiloeng ka hloko. E 'ngoe ea likarolo tse khethollang mathata a ho lemalla ke ho kopana ha khotsofalo le ho baleha boemong bo sa thabiseng ba ka hare. Ka lebaka leo, khopolo ea ho lemala e emela mokhoa oa ho itšetleha le ho qobelloa [15].

Ho kopana pakeng tsa Lik'hemik'hale le Boitšoaro ba Tlhekefetso

Ke lintho life tse tloaelehileng tsa ho lemalla boitšoaro le lik'hemik'hale? Ke haholo-holo khopolo ea mokhoa o lemalloang oa ho lemalla, o amanang le o amang bophelo ba motho ka bomong, mme o bokella mefuta eohle ea mekhoa ea ho lemala. Mokhoa oa ho lemalla ho lemalla haholo-holo ke ho itšetleha ka boikhathollo ho ea (ho bonahala eka ho itšireletsa le ho itšepa) khato ea ka ntle e le ho laola boemo ba ka hare. Boitšoaro ba boitšoaro le lithethefatsi bo tšoana: Bobeli ba na le takatso ea ho kopanela mekhoeng ea bona ea boitšoaro; ba ikutloa ba sa phutholoha haeba ba thibeloa ho e tlatsa ka lebaka la matšoao a ho lakatsa le ho khaotsa. Matšoao a mang a ho khaotsa (mohlala, matšoenyeho) a tšoana le ho ba lemallo le mekhoa e itseng ea lik'hemik'hale ha ba bang (mohlala, mahlo a mahlo le ho thothomela ka ho tlohela opiate)17,18].

E entsoe et al. [19] o hlahisitse mehaho e supileng e lemalang dintho kapa mesebetsi (ho kenyelletsa lijo le papali ea chelete) e tšoanang:

i) Matla a ntho e itseng / ts'ebetso ea ho sebetsa e le motlakase oa ho thusa hape.

ii) Mamello e amohelehang - ho sebelisoa khafetsa ho ka fella ka katleho e fokolang ea ntho / ts'ebetso.

iii) Ntlafatso ea ho itšetleha ka ho sebelisoa khafetsa; haeba sesebelisoa sena se sa fumanehe kapa mosebetsi o ke ke oa phehelloa matšoao a ho tlohela a etsa hore ho sebelisoe nako e eketsehileng.

iv) Ho fapana ka mokhoa o fapaneng: Motsoako / ts'ebetso e atisa ho hlahisa boemo ba pele bo tsitsitseng (euphoria), e lateloang ke boemo bo seng bo hanyetsang (dysphoria).

v) Matla a sesebelisoa / ts'ebetso ea ho sebetsa e le ts'ebetso e ntle ea Pavlovian e sa etsoang.

vi) Matla a linaha tse fapa-fapaneng (kakaretso e tsosang, khatello ea kelello, bohloko, maikutlo) ho susumetsa tšebeliso ea lisebelisuoa kapa ho kenya letsoho mosebetsing o fapaneng.

vii) Boits'oaro ba 'mele le lik'hemik'hale' bo ka 'na ba susumelitsoe ke lipolelo tse ka hare, tse kang boithati, ho tepella maikutlong kapa boiketlo ba bophelo, le lits'ebetso tse ka ntle, tse kang libaka kapa batho. Litlhoko tsa batho ka bomong li tla fapana ho itšetlehile ka mofuta o mong le o mong le oa lik'hemik'hale le tsa boitšoaro.

Tlhokomelo ea kalafo

Ho latela maikutlo a phekolo, mefuta e fapa-fapaneng ea ho lemalla boitšoaro le lik'hemik'hale e na le mokhoa oa eona oa ho khutlela morao. Inthanete e lemalla ho ithuta ho kopanela likamano ho sa tsotellehe mekhoa ea ho qoba sechaba; bacha ba tsubang ba lokela ho ba le tsebo ea ho re 'che' ntle le ho khopisa kapa ho lahleheloa ke maemo; 'me batho ba jang lijo ba lokela ho ithuta ho sebelisa tsebo e fapaneng ea ho sebetsana le boemo ba ho fokotsa likorale. Empa likarolo tse ka hare tseo boemo ba ho lemala bo bonahalang bo tšoana le ho feta mathateng a sa tšoaneng. Batho ba nang le mefuta eohle ea litloaelo ba ka 'na ba atleha ha ba ikutloa ba soabile, ba tšoenyehile, ba halefile, ebile ba hatelloa. Tšobotsi e 'ngoe ea phekolo e tloaelehileng litabeng tsohle tsa ho lemalla ho lemalla ho ba le bothata ke hore bakuli ba lokela ho ithuta ho utloisisa hore na maikutlo kapa maemo a hlahisa kapa a eketsa takatso ea bona le ho ba le mekhoa e meng ea ho thibela ho noa joala kapa ho kenya letsoho mesebetsing e fapaneng. Haeba ts'oaetso e eme nako e telele 'me e boloka mokuli a nka karolo e kholo ea letsatsi, motho ea joalo o tla tlameha ho tšohla mokhoa oa ho sebelisa nako ea ho boela hape [18,19].

Ho Hloka kelello ea kelello

Bakeng sa bakuli ba nang le mathata a ho sebelisoa ha lithethefatsi, bothata ba mafu a kelello ke molao ho e-na le ho ba boemong bo khethehileng. Mathata a kelello a atisa ho ba teng pele ho ts'ebeliso ea lithethefatsi, empa a ka boela a hlaha ka mor'a ho qala ha eona. Mekhoa ea likamano tsa batho ba babeli kapa likamano tsa nakoana ka nako e le 'ngoe ke karolo ea puisano ena e rarahaneng [20]. Boitšoaro, matšoenyeho, le mathata a boitšoaro li emela lihlopha tse tloaelehileng ka ho fetisisa. Monyetla oa ho ba le khatello ea kelello ea khatello ea kelello kapa khatello ea kelello ho batho ba baholo ba nang le ts'oaetso ea lithethefatsi / joala ke linako tse ling tsa 2-3 tse phahametseng batho ba bangata [21]. Ka mokhoa o ts'oanang, mefuta e mengata ea mafu a kelello a sebetsana le lithethefatsi tsa boitšoaro. Ka mohlala, tšebeliso ea marang-rang ea batho ba nang le lefuba kapa batho ba itšetlehileng ka inthanete ba phahamisitse litekanyetso tsa ho tepella maikutlong kapa khatello ea tlhokomelo / lefu la ho kula (ADHD) [22]. Mathata a ho qetela a boetse a hlaha khafetsa haholo ka mathata a sebelisoang ke lithethefatsi.

Likokoana-hloko tsa lefutso

Liphuputso tsa malapa le mafahla li hakantsoe hore menehelo ea liphatsa tsa lefutso e ikarabella ho 60% ea phapang pakeng tsa kotsi ea lithethefatsi [23,24]. Ka mokhoa o ts'oanang menehelo e matla ea liphatsa tsa lefutso ka boholo ba 35-54% e fumanehetse bakeng sa papali ea chelete (PG) [25]. Ho latela bopaki bo bongata ba bopaki bo tsoang liphuputsong tsa lelapa, tsa mafahla le tsa ho amohela bana tse bontšang hore liphatsa tsa lefutso li na le mathata a mangata a ho lemala [26], hoa thahasellisa ho tsepamisa maikutlo lipatlisisong tse fanang ka bopaki ba liphatsa tsa lefutso tse tloaelehileng tsa diathesis tsa lik'hemik'hale le boitšoaro bo hlephileng ba boitšoaro. Ho itšetlehile ka tlhahlobo ea litlaleho tsa bophelo bohle ba PG le ho itšetleha ka joala ka tekanyo eo tikoloho le liphatsa tsa lefutso tsa PG li neng li arolelanoa le ho itšetleha ka joala ho 'nile ha hakanngoa: Karolo e kholo ea kotsi ea tlhahlobo ea PG (12-20% ea genetic le 3-8 % ea maemo a tikoloho) a tlalehoa ke kotsi ea ho itšetleha ka joala [27]. Lintho tse amanang le liphatsa tsa lefutso li boetse li phetha karolo ea litšobotsi tsa botho le boitšoaro bo amanang le ho eketseha ha liteko tse nang le lithethefatsi (e leng, ho qalisoa): ho batla mokhoa o tsitsitseng, ho susumetsa maikutlo, ho arabela khatellong ea maikutlo, empa le lisosa tsa mafu a kelello joaloka ADHD, ho kula ha boitšoaro, boikutlo ba maikutlo le matšoenyeho [26.]

Ho ba teng ha Neurobiological

Mehlala ea li-neurobiological bakeng sa ho hlaolela ho itšetleha kapa ho lemalla metsoako ea lik'hemik'hale kapa motho ea itšoereng ka mokhoa oa boitšoaro e atisa ho khetholla sesosa se tloaelehileng [22,28]. Li-neurotransmitters tse fapaneng (mohlala, dopamine, glutamate, norepinephrine) li na le tšusumetso ho nts'etsopele kapa boemo ba ho lemala kapa ho itšetleha ka eona. Li-neurons tsa Dopaminergic, tse tsoang sebakeng sa ventral tegmental (VTA) synapse ka hare ho nucleus accumbens (NAcc), e theha letsoho le leholo la tsamaiso ea tlhaho ea boko, eo e nang le liphello tse khotsofatsang tsa boitšoaro bo kang ho ja lijo, likamano tsa sechaba le thobalano. [29,30]. E 'ngoe ea li-neurotransmitter, glutamate, e le ntho e ntle ka ho fetisisa ea phekolo ea methapo ea mali e amanang le mekhoa ea ho susumetsa, ho lemalla lithethefatsi le mathata a ho laola maikutlo [31]. Liphuputso tse ling li bontša hore litekanyetso tsa glutamate ka hare ho NAcc lipakeng tsa moputso o batlang boitšoaro. Ho phaella moo, norepinephrine e na le tsusumetso ea mesebetsi e mengata ea bokopi ho kenyeletsa ho tsosoa, ho ela hloko, ho ithuta, ho arabela maikutlo, le liphello tse nang le melemo [32]. Leha ho le joalo, potoloho ea ho matlafatsa moputso hase feela ea bohlokoa bakeng sa boitšoaro bo hlephileng. E boetse e amehile ho maemo a mang a kelello (mohlala, schizophrenia) [33].

Leptin, e leng pontšo e kholo ea matla a nako e telele, e etsa hore ho sebelisoe li-neural libakeng tse bohlokoa tse hlaselang, ho fana ka maikutlo a hore hormone e sebetsana le lipotoloho tsa neural tse fanang ka lijo tse fokolang maikutlo a lijo, ha li ntse li ntlafatsa karabo ea lipontšo tsa satiety tse hlahisoang nakong ea lijo . Leptin e bonahala e phetha karolo e mengata tsamaisong ea mesolimbic dopamine. E khothalletsa hore ho be le liphetoho tse rarahaneng tsa tsamaiso ea dopamine ea mesolimbic khahlanong le lithethefatsi tse lemalang. Kahoo, leptin ka boeona e susumetsa tsamaiso ea moputso [34]. Ho hanyetsa Leptin ho bakoa ke ho sa feleng ho fetisisang ha pontso ea andixictic leptin ea anorexictic tabeng ea botenya, e ka 'nang ea lebisa pontsong e fokolang ea ho fokotseha ha maikutlo a lijo tsa moputso; letšoao la anorexigen leptin le emisoa.

Ho tsoela pele ho ja haholo ho ka nkoa e le mokhoa oa ho lemalla. Li-leptin le ghrelin li na le li-hormone tse susumetsang molao oa hypothalamic oa homeostasis ea ho ja lijo le matla le ho khothalletsa ho ja lijo le tlala, ka ho latellana. Liphuputso tse 'maloa li ngotse hore ghrelin e boetse e sebetsana le likarolo tsa tsamaiso ea moputso oa dopaminergic, mohlala, VTA le NAcc. Ho thahasellisang ke hore lihomone tsena ka bobeli li 'nile tsa memeloa hore li phethe karolo ea ho noa joala le ho ba le k'hok'heine [35,36,37,38]. Ka lebaka leo, li-hormone tsena li ka nkoa e le ho theha kamano ea likokoana-hloko pakeng tsa 'lik'hemik'hale' me e lemalla lijo.

Ntho e 'ngoe e susumetsang tsamaiso ea moputso ke khatello ea maikutlo. E sebetsana le motsoako oa hypothalamic-pituitary-adrenal (HPA) ka ho lokolloa ha motsoako oa corticotrophin-release (CRF), e bontsitsoeng ho susumelletsa tšebetso ea tsamaiso ea VTA, NAcc le dopaminergic. Physiologically, CRF ho lokolloa e laoloa ka e-negative-feedback loop ka tlhahiso ea cortisol. Ho imeloa kelellong ho etsa hore CRF le cortisol e ngata haholoanyane, ka tsela eo ho felisoe maikutlo a fosahetseng-maikutlo [39]. Ho lumeloa hore ho fokotsa marang-rang oa motlakase oa HPA ho lebisa mokhoeng o matla oa ho matlafatsa 'me ho ka' na ha eketsa kotsi ea ho lemalla ho lemala [40,41].

botenya

Botenya ke boloetse bo rarahaneng haholo, boo ka ho hlaka bo hlokang tikoloho e khothalletsang ho noa matla a matla le / kapa boemo bo tlase ba ho ikoetlisa. Libakeng tse nang le lijo tse fapa-fapaneng, tse monate, tse theko e tlaase, le tse fumanehang habonolo liphatsa tsa lefutso, ho ka etsahala hore hape ho hlokahala ho apara boima bo feteletseng. Ho ikamahanya ha boima ba 'mele bo phahameng - ho nahanoa hore 50% kapa ho feta ha ho khetholla ha BMI ka kakaretso ho ka hlalosoa ka liphatsa tsa lefutso. Leha ho le joalo, loci e tsejoang ka nako e tloaelehileng ea logen e hlalosa feela karolo e nyenyane ea phapang ea BMI [42,43]. Ho ja ho tlōla ho bolela ho sebelisa matla ho feta chelete e sebelisoang. Batho ba nang le matla a phomolo a fokolang a sebelisoang le / kapa boemong bo tlaase ba ho ikoetlisa ba ka ja haholo 'me kahoo ba nona boima ho sa tsotellehe hore na karolo e tloaelehileng ea likarolo ke eng. Ho batho ba bangata ba batenya haholo ho feta ho feta ho feta nako e telele; ka lebaka leo, tekanyo ea ho ba botenya ho bacha ba baholo e batla e le tlaase ho feta batho ba baholo ba lilemo li bohareng [44,45,46,47,48]. Haeba ka mohlala motlakase oa letsatsi le leng le le leng ke karolo ea 20 kcal, boima ba 'mele bo lekanyelitsoeng bo tla eketseha butle ka nako ea bophelo [45]. Tlhaloso ea ho lemalla ho lemalla e le tlhaloso ea ketsahalo e tloaelehileng ea mofuta ona oa botenya e bonahala e le ntho e sa lokelang. Tlhekefetso e boetse e ke ke ea hlaseloa habonolo e le tlhaloso ea mathata a tsejoang haholo a ho boloka boima ba 'mele ka mor'a lijo. Ho nchafatsa matla a boleng bo boholo ba liphello tsa ho fetoha ha lijo, ho kenyeletsa lijo tse eketsehileng le tlala le ho fokotseha ha chelete ho fokotsa matla a ho sebelisoa ha matla a motlakase. Bophelo ba kelello le ho hlahloba boitšoaro ba nako e telele bo khetholla batho bao ka katleho ba bolokang boima ba 'mele bo fokotsehileng [49.]

Ka lebaka la temohisiso eo re e fumaneng ka taolo ea boima ba 'mele le boima ba' mele, ho thata ho fumana moeli pakeng tsa ho lemalla lijo le ho ba le takatso ea lijo tse ngata kapa tlala. Ka hona, bakuli ba haelloang ke leptin ba bontša takatso ea lijo, ho khaotsa le ho ja haholo ho tloha boseeng [50]; boitšoaro ba bona ho pholletsa le letsatsi bo shebana le ho batla le ho kenya lijo. Ho hlakile hore ba tla phethahatsa litekanyetso tsa ho hlahlojoa ha bothata ba tšebeliso ea lithethefatsi (tafole 7) haese feela hobane bokhoba ba bona bo sebetsa ho lijo ka kakaretso, eseng sehlahisoa se itseng, ntho e itseng kapa 'lik'hemik'hale'.

Tafole 7

Ho fanoe ka mekhoa ea DSM-5 bakeng sa khatello ea ho itlopa joala [8]

http://www.karger.com/WebMaterial/ShowPic/207821

Liphetoho tsa lefutso le liphatsa tsa lefutso tsa melanocortin tsa 4 le tsona li fumanoe li fella ka ho ja haholo [51], ho sa tsotellehe bonyane ho feta lihlooho tse fokolang tsa leptin. Ho ka 'na ha etsahala hore liphello tsa polygen li ekelle le ho eketsa takatso ea lijo / tlala, ho ja lijo tse matlafatsang le ho ntlafatsoa ha botenya. Haeba e bakoa ke liphatsa tsa lefutso kapa mabaka a mang (mohlala, hypoxia e bakang tšenyo ea boko, takatso ea boko) takatso ea lijo / tlala ea motho ke karolong e ka holimo ea tlhahiso e tloaelehileng, sena se ka etsa hore tsamaiso ea hae ea moputso e itšetlehe haholo ka mantlha ea li-neuropeptides, li-neurotransmitters le lihomone tse amanang le ho laola mokhoa oa ho ja. Ka tsela eo, 'boitšoaro bo hlephileng' bo ka etsoa.

Hona joale, bulimia nervosa (BN) le bothata ba ho ja joala (BED), eo ho ka etsahala hore e fumane boemo ba boloetse bo tloaelehileng ba ho ja ho DSM V [52], ke tsona feela mathata a kelello a nang le likarolo tse jereng tse tšoanang le ho lemala (bona tafole 7 bakeng sa mekhoa ea ho hlahloba DSM-5 bakeng sa BED). Lintlha tse ka sehloohong tsa mathata ana a ho ja li thehiloe lijong tsa ho ja lijo tse ngata tse amanang le boiphihlelo bo ikhethang ba ho hloka taolo. Leha ho le joalo, ho fapana le bakuli ba nang le BED, molao-tekano (mohlala, ho hloekisa) ke karolo e hlaheletseng ea BN [7,53]. Nakong ea bakuli ba BED ba nang le bothata ba botenya ba tloaelehileng ba tloaelehile. Leha ho le joalo, botsoalle le botenya bo fetotsoe motseng; ho latela thuto ea lefu la seoa, ke tse peli feela ho tse tharo tsa litaba tsa BED li ne li le bobebe [bakeng sa ho hlahloba bona [53,54]. Mefuta e meng ea boitšoaro bo sa tloaelehang ba ho ja bo kang bosiu ba ho ja le ho fula e 'nile ea hlalosoa, e ka' nang ea e-ba teng ho latela maemo a ho lemalla. Mokhoa oa hona joale oa classise DSM-IV-TR leha ho le joalo o lumella feela ho hlahlojoa ke lefu la ho ja ha hoa ka ha hlalosoa bakeng sa BED le mefuta e meng e sa tšoaneng ea ho ja mekhoa ea bohlokoa ba kliniki. Hoa thahasellisa ho buisana ka maikutlo a ho khetholla BED e le mokhoa oa ho lemala DSM-V. Sena se ne se tla khothalletsa bafuputsi hore ba batlisise ka ho eketsehileng ho kopana le ho lemala le ho sebelisa melao-motheo ea phekolo, e sebelisoang hangata merianeng e lemalang [33].

Ho tlōla ho feteletseng ha lijo tse monate le li-fluids tse bonngoeng lijong tsa ho ja lijo tse ngata li ka 'na tsa e-ba pontšo ea mokhoa o ka sehloohong oa ho etsa likokoana-hloko tse tšoanang le oa ho lemala [55,56]. Sephetho sena se tsoa ho bopaki bo eketsehang ba bopaki ba hore mathata a amanang le lithethefatsi le botenya bo kopanetsoeng li arolelana mekhoa e tloaelehileng ea methapo ea majoe [57]. Ka tsela eo, ka likhoto tse ngata haholo, boiponyo ba tsamaiso ea moputso bo hlaha ka lebaka la phetisetso e fokolang ea dopamine setsing sa moputso sa boko bo latelang bongata bo feteletseng ba li-caloric, e leng se lebisang ho ho ja ho tlōla ho joalo ka litoeba [58]. Mekhoa ena e mebe haholo e arabelang ka likhoto tse feteletseng e ka hlaha ka ho senyeha ha lijo ho bakoang ke ho senya lijo ka ho hlahisa li-dopamine D2. Ho feteletsoa ha lithethefatsi tsa tlhekefetso ka tsela e tšoanang ho fokotsa ts'oaetso ea lefu la dopamine ea D2, e etsang hore moputso o se ke oa e-ba le tšusumetso e mpe, 'me e etsa hore ho be le mekhoa e metle ea ho sebelisa lithethefatsi [59,60]. Ka ho ts'oanang, lithuto tsa batho tsa ho nahana ka litšoantšo li bontšitse hore lihlooho tse matla li ka 'na tsa e-ba le mathata a dopaminergic tse laolang tsamaiso ea neuronal e amanang le moputso oa tlhokomelo, boemo bo botle, le taolo [61]. Empa hajoale ha ho hlaka hore na li fumanoa ke lintlha life kapa limela tsa litholoana tsa ho ja haholo.

Ho lokolloa ha li-endorphin ha li bapisoa haholo [62] e senola hore poleloana e tloaelehileng ea lik'hemik'hale ka boeona ha e hloke hore ntho eo e be lik'hemik'hale tse sa tloaelehang. Haeba 'lik'hemik'hale' tse sa tsitsang li ka lemalla maemo a itseng 'me / kapa ho batho ba joalo, ba joalo ba ka' na ba emela kamano pakeng tsa lithethefatsi le boitšoaro bo hlephileng. Tšebelisano ea takatso ea lijo, tlala, satiation, le satiety le tsamaiso ea moputso e ka talingoa e le motheo oa tsoelo-pele ea ho ja meriana. Esita le batho ba jang matla ho sa tsotellehe ho se lapile ba qalile ho fetola mekhoa e rarahaneng ea tsamaiso ea motheo, eo ka khopolo e neng e ka khona ho qalisa le ho boloka lithethefatsi. Lintho tse fapaneng tsa kelello li ka akarelletsa ho ba le boithati, khatello ea kelello, maikutlo a nyahamisang le tse ling tse joalo. Leha ho le joalo, e tlameha ho totobatsa ka ho hlaka hore, ka lebaka la ho ba sieo ha tlhaloso e sebetsang ea ho lemalla lijo, hona joale ha ho khonehe ho hlahloba hore na ho nepahala le ho tšepahala ho na le mofuta ofe oa ho hlahloba. Ka lebaka leo, pele ho nako ho nahana ka ho lemalla lijo ka har'a mekhoa ea ho hlahloba mafu ka kelello. Liphuputso li hlokeha ho hlahisa matšoao a hlakileng, li-psychopathology tse amanang le likarabo tsa phekolo [33].

Re itšetlehile haholo-holo ka ho lemalla ho ja lijo tse lemalloang. Leha ho le joalo, hobane lentsoe "lijo" le bolela mofuta o sa tšoaneng oa likarolo tse fapaneng tsa lijo, e be limatlafatsi tsa tlhaho (mohlala, mafura, tsoekere) kapa lihlahisoa tse ling tsa lijo (mohlala, li-preservatives), ke habohlokoa ho utloisisa mofuta oa mekhoa e ka sehloohong e amanang le ho lemalla lijo bakeng sa ho batlisisa hore na likarolo tsena tse lekaneng tsa limatlafatsi ka boeona li bonts'a matlafatsa mekhoa ea boitšoaro 'me kahoo li na le menyetla ea ho lebisa liphetoho tsa neurobiological tsamaisong ea moputso, e lekanang le lisebelisoa tsa tlhekefetso e kang heroine, cocaine, joala kapa nicotine. Ka hona, motsoako oa limatlafatsi o lokela ho kenngoa karolong ea oro-gastro-intestinal ka boeena kapa e le sebopeho se tobileng sa metabolite tšitiso ea mali-ea bokooa le ho senola liphello tsa ho matlafatsa ka ho ts'ebetswa ha tsamaiso ea moputso. Ha e le hantle, setsi sa lithuto tsa liphoofolo tse fapa-fapaneng ka liphello tsa tsoekere ka mahlaseli a dopamine a qalang ho tloha ho VTA ho ea NAcc e amehang mesebetsing ea ts'ireletso [63] 'me ho boleloa hore ho na le tšusumetso e susumelletsang mohopolo oa ho tsuba [64]. Extracellular dopamine ka keketseho ea NAcc ka mor'a hore ho sebelisoe lithethefatsi tse sebelisoang hampe [65,66]. Likokoana-hloko tse senyehileng lijo-thollo le tse feptjoang ka 10% li-sucrose dilution le chow li hlahisa mokhoa oa ho itlopa ka ho ja. Ho tšoana le ho noa lithethefatsi, likhoto tsena li lokolla extracellular dopamine ka NAcc, nako le nako ha li e-ja joala (e leng, sucrose), athe phetoho ena ea dopamine holim'a phepo ea tsoekere e phunyeletse liphoofolong tse laolang ho fepa tsoekere ea libitum le chow [67]. Ho ja ka nako e sa lekanyetsoang ha 25% e nang le tsoekere e nang le mahlaseli a mangata le likhoele tse nang le likhoto ho ile ha senola matšoao a boitšoaro le a methapo ea ho itšetleha ka opioid [68,69].

Lithuto tsa liphoofolo tse boletsoeng ka holimo li ne li sebelisa glucose kapa li-sucrose ka likhahla tse kopantsoeng le ho thibela lijo. Le hoja liteko tsena li ka lebisa tlhokomelo ea meriana ea ts'oaetso, ho fapana le lithethefatsi tsa tlhekefetso, ha ho na bopaki ba sebopeho se itseng sa lik'hemik'hale sa phepo e nepahetseng se lebisang mekhoeng ea neurobiological e bakoang ke lithethefatsi. Ho sa tsotellehe lithuto tse thehiloeng ho thibelo ea lijo tse ka hare, ha re tsebe letoto la lithuto tsa liphoofolo, ho sa tsotellehe liteko tsa botho, tse bontšang khafetsa karolo e entsoeng ea limatlafatsi ka likaroloana tsa lik'hemik'hale ho etsa liphetoho tsamaisong ea moputso e tšoanang le e hlalosoang bakeng sa lithethefatsi. Batho ba feteletseng ka ho feteletseng ha ba tsoele pele ho ea molek'hule e le 'ngoe ea lijo kapa lijo tse itseng tse itekanetseng; lijo tse nang le lik'habohaedreite le / kapa mafura li na le mefuta e mengata.

Lijo Lijo

Ho totobetse hore ho thata haholo ho hlahloba litšobotsi tse khotsofatsang tsa karolo e le 'ngoe ea limatlafatsi ho batho. Poleloana 'ho lemalla lijo' e sebelisoa ka ho khetheha tabeng ea lijo tse ntlafalitsoeng haholo tse sebelisoang ke indasteri, tse kang lino tse monate kapa lijo tse mafura haholo [1]. Mofuta ona oa lijo ha o mohla o nang le motsoako o le mong feela. Ho 'nile ha etsoa boiteko ba ho theha mekhoa ea laboratori ho hlahloba bokhoni ba ho lemalla lijo tse nang le lik'habohaedreite' liketsing tsa lik'habohaedreite '[69]. Ho nahanngoa hore lik'habohaedreite li ja lijo tse nang le limatlafatsi tse nang le lik'habohaedreite boemong bo tepeletseng maikutlo kapa bo fokolang ba mongobo e le ho ntlafatsa boemo ba bona bo tlase ba bokooa, ho fana ka maikutlo a hore lik'habohaedreite li lebisa mekhoeng e sebelisanang le insulin, e leng se ka eketsang ho nyoloha ha tryptophan ka bokong ho fapana boemong bo tlase ba bokooa ba serotonin. Liteko tsena [mohlala [70], leha ho le joalo, u se ke ua hlōla mefokolo ea mekhoa ea metsoako 'me u se ke ua lebisa tlhokomelong ea mokhoa o khotsofatsang oa lik'habohaedreite.

Ha e le hantle, litsebi tsa kelello li khetholla likarolo tse peli tsa meputso, ho "batla" le ho "rata", le ho qetella ho bua ka karolo ea hedonic e khotsofatsang ea ntho kapa boitšoaro-eo ho nahanoang hore e bakoa ke tsamaiso ea opioid - ho susumelletseha ho susumelletsa motho hore a batle lithethefatsi kapa a phehelle boitšoaro bo ikhethileng, bo nahannoang hore bo nahanngoa ka sephahla sa VTA-NAcc sa dopaminergic [71]. Ho bonahala eka hoa utloahala hore 'ho lemalla lijo' ho ka 'na ha boleloa hore ke karolo ea' ho batla 'ea moputso oa lijo. Ho totobetse hore ho na le 'ho hloka' ntle ho 'ho rata', ke hore, ho ja joala ke phihlelo e sa thabiseng, moo motho ka boomo a batlang le ho kenya lijo tse ngata.

Le hoja lipolelo tse boletsoeng ka holimo li tla tšehetsa khopolo ea ho lemalla lijo e le mokhoa oa boits'oaro, 'me eseng lik'hemik'hale, ho lemalla, re lokela ho hlokomela se bolelang. Ka kakaretso, ts'ebetso leha e le efe ea homeostatic ea motho e nang le phello molemong oa moputso o tla tšoaneleha ho kenya monyetla oa ho nts'etsopele ea ho lemalla boitšoaro. Mehlala e kenyelletsa thobalano le boithabiso ba 'mele. Ka sebele, ho kopanela liphate le ho lemalla ho lemalla ho hlalositsoe libukeng tsa mafu a kelello. Ho lemalloa joalo ho ka bakoa ke lihlooho tse fapaneng tse fapaneng le ho arohanngoa ha boitšoaro bo joalo (matla a ho kopanela liphate, ts'ebetso e phahameng ea 'mele), e leng tekanyo ea motho ka mong e ke keng ea laoloa ka ho lekaneng ntle le ho holofala kapa liphello tse kotsi. Ho lemalla joalo ho ka boela ha e-ba teng ka ho ithuta ho matlafatsa mekhoa e nepahetseng le e mpe ea boitšoaro.

Qetello le Patlisiso e tlang

Re buile haholo ka ho lemalla lijo ho amanang le ho lemalla lik'hemik'hale le boitšoaro. Ka lebaka la bopaki ba hona joale bo fokolang ba boitšoaro bo hlephileng ba metsoako ea lijo kapa lihlahisoa, hona joale re fihlela qeto ea hore ho lemalla lijo ho ka khethoa ka ho fetisisa e le ho lemalla boitšoaro nakong ena. Leha ho le joalo, hobane ha hoa lekaneng (e leng,, e ka tšeptjoang le e nepahetseng) data mabapi le litekanyetso tsa eona tsa ho hlahloba, re ke ke ra khothaletsa ho eketsa 'ho lemalla lijo' e le mokhatlo oa ho hlahloba DSM-V [33]. Li-neuropeptides tse sa feleng, li-neurotransmitters le lihomone, tse lokolloa ha ho kenngoa lijo, li ka fana ka kamano pakeng tsa lik'hemik'hale le boitšoaro bo hlephileng ba ho itšoara. Matlotlo a khotsofatsang a lijo ke a mangata ka mor'a ho lahleheloa ke lijo ho feta lihlahisoa tse satiated. Re pheha khang ea hore, hobane mefuta e mengata ea botenya e thehiloe ka tekanyo e fokolang ea ho ja haholo 'me ka tsela eo e fetoha butle-butle ka nako, ke feela ho kopana le ho ja lijo tse sa tloaelehang le tse tloaelehileng nakong ea bophelo bo botle (hona joale li khetholloa ka bothata ba ho ja lijo ) e lumella hore ho hlahlojoe e le ho lemalla lijo. Ka maikutlo a rona, likaroloana tsa botenya tse amanang le phekolo e nepahetseng ea phekolo ea meriana li ka nkoa ka moelelo oa ho lemalla lijo. Ha e le hantle, lipatlisiso tse eketsehileng mabapi le boitšoaro bo hlephileng ba ho ja lijo le mekhoa ea phepo ea lijo, haholo-holo tse amanang le ho ja ho ja ho hlokahala hore ho hlahlojoe hore na tse ling tsa mekhoa e meholo ea ho itima lijo tse sa hlalosoang hantle li ke ke tsa hlophisoa hamolemo ka har'a taolo ea machaba a DSM V a nang le mathata a amanang le mathata a amanang le ona. Ka hona, sepheo se lokela ho ba ho ja lijo tse ngata ka ho fetisisa, ho sa tsotellehe hore na se etsahala likarolong tse nang le kapa ntle le tumello ea molao. Lipatlisiso tse eketsehileng tsa phekolo ea likokoana-hloko tsa liphoofolo le batho li hlokeha ho matlafatsa khopolo ea hore ho ja haholo ho ka nkoa e le ho lemalla boitšoaro. Ho ja ho thehiloe setsing se rarahaneng haholo sa mekhoa ea bophelo, ea kelello le ea methapo ea pelo. Ponahalo ea ponahalo, maikutlo a ho utloa bohloko, mokhoa oa lijo, boemo boo lijo bo emeloang ho bona, boemo ba motho ka boeona ba maikutlo le boemo ba motho ka boeona ba matla le taolo ea phepo e na le tšusumetso ea hore na batho ba ja joang le hore na ba ja joang. Re etsa qeto ea hore ho ja ho ja ho ka 'na ha nkoa e le ho lemalla lijo meleng e nyenyane ea batho ba bangata haholo.

Tlhaloso ea Phatlalatso

Bangoli ba ile ba bolela hore ha ho na likhohlano tsa thahasello.

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