Ke Hobane'ng ha ho Ruta ho Etsa Lijo ho Botenya le Phekolo ea Tsona? (2014)

Psy Psychology. 2014; 5: 164.

E hatisitsoe Inthaneteng 2014 Nov 19. doi:  10.3389 / fpsyt.2014.00164

PMCID: PMC4237037

Sehlooho sena se bile teng e boletsoeng ke lihlooho tse ling ho PMC.

Litakatso li emela lipolao tse matla tse susumetsoang ke litakatso tse tebileng tse amanang le tebello ea ho ja lintho tse hlahisang monyaka kapa ho etsa boits'oaro bo bobe ba hedonic. Ha ho nahanoa ka takatso ea lijo le hore na e ka sebelisoa joang lijong, tlhahlobo e khuts'oane ea nalane ea ho lakatsa kahare ho sethala e tsotellang e bonahala e loketse. Batho ba litso tse ngata ho bonahala ba nka litakatso maemong a fapaneng ka nako, leha ho bile le khanyetso, ho latela tlhahlobo ea liphetolelo le lexicalization ho lipuo, hore ho lakatsa ho ka hloleha ho fetolela kantle ho Yuropa le Amerika Leboea, leha ho na le ho ts'oana ha ts'ebeliso ea ho lakatsa le bokhoba ba taolo libakeng tsohle tsa ts'ebeliso (1). Lentsoe "ho lakatsa" le nkiloe moheleng oa khale oa Senyesemane oa ho kopa1. Kamora nako, polelo ea ho lakatsa e ile ea hokahana le mekhoa e mengata ea ts'ebeliso ea lithethefatsi. Mohlala, mathoasong a lekholo la leshome le metso e robong la lilemo, ha ho buuoa ka mokhoa o hlakileng oa tšebeliso e mpe ea lino tse tahang, lebitso dipsomania (le fetoletsoeng ho tsoa lentsoeng la Sejeremane) Trunksucht, kapa bokhoba ba tahi) bo hlalositsoe ho hlalosa botaoa ba joala e le boemo bo khetholloang ka takatso ea ho tsoela pele ho taha (2). Ho Buddhism, poleloana tan.hā hangata e fetoleloa ho bolela ho lakatsa (leha phetolelo ea eona ea sebele e le "lenyora"), e nang le kāmatan.hā (kelello-craving) e hlalosang tšusumetso e matla ea ho ba le maikutlo a monate kapa menyaka ea maikutlo2. Ho Buddhism, tan.hā e bonoa e le mofuta oa takatso e sa tsebeng letho le sesosa sa mahlomola le linaha tse mpe tse amehang, 'me mekhoa e meng ea hajoale ea ho utloisisa mekhoa ea phekolo le ho nts'etsapele nts'etsopele ea kalafo ka ho lemalla e kenyelletsa ho nahana ka ho lakatsa ho latela maemo a Buddha (3, 4). Kahoo, khokahano lipakeng tsa litakatso le lits'ebetso tse mpe li kenyelletsa litlatsetso li na le pale e telele ho litso tse ngata.

Litakatsong tsa hona joale tsa kelello tsa litumelo, litakatso li nkuoa e le karolo ea bohlokoa. Leha mathata a tšebeliso ea lithethefatsi a kenyellelitsoe khatisong ea buka ea Diagnostic and Statistical Manual, phetoho e tlohang ho DSM-IV ho ea DSM-5 e kenyelletsa kenyelletso ea tlhahlobo e kenyelletsang ea sepheo sa ho sibolla mathata a ts'ebeliso ea lithethefatsi (5, 6). Ntle le keketseho ea morao-rao ea ho lakatsa litekanyetso tsa semolao tsa ts'ebeliso ea lithethefatsi, takatso ea nako e telele e 'nile ea nkuoa e le karolo ea bohlokoa le e bohlokoa tlhatlong ea tšebeliso ea lithethefatsi. Ka mohlala, ho lakatsa ho hokahantsoe le mekhoa ea bohlokoa ea ho etsa kalafo liphetho tsa kalafo [mohlala, naltrexone kalafong ea ts'epahalo ea joala (7)] le mekhoa ea phekolo ea boits'oaro [mohlala, kalafo ea kelello8)] bakeng sa bokhoba ba lithethefatsi. Liphumano tse hokahanyang liphetho le litlamorao tsa kalafo li boetse li sebetsa le liketsong tse sa tlisoang ke lithethefatsi kapa litloaelo tsa boits'oaro; mohlala, ho batho ba nang le ts'oaetso ea ho becha ea methapo ea kutlo ba amohelang li-opioid-receptor antagonists (naltrexone kapa nalmefene), batho ba nang le litakatso tse matla tsa ho becha kapa litakatso tsa ho qala kalafo ba ka khona ho hlahisa sephetho se betere sa kalafo (9).

Leha ho na le bohlokoa bo ananeloang haholo ba ho lakatsa lits'oants'o tsa ts'ebeliso ea lithethefatsi le kalafo ea bona, bohlokoa ba likarolo tsa bokhoba ba taolo, ho kenyelletsa takatso ea ho ja, boits'oaro bo amanang le ho ja ka mokhoa o feteletseng [mohlala, botenya kapa bothata ba ho ja ka ho fetesisa (BED)] bo feta. phehisano le sehlooho sa ngangisano e kholo (10-13). Bafuputsi ba bang ba boletse hore botsitso ba matla bo lula bo le bohlokoa ho boteng le hore ho lemalla kapa ho ts'oaroa ke lintho tse amanang le tsona li ka emela karolo e nyane (13). Bafuputsi ba bang ba boletse hore tikoloho e fetohang ka potlako ea lijo e ka kenya letsoho keketseho ea botena bo hlokometsoeng lilemong tse fetileng tsa 30-40 (14). Haholo-holo, ha ho fanoa ka bongata le ho fumaneha ha lijo tse theko e phahameng, ho ka etsahala hore tšusumetso ea ho ja lijo tse matlafatsoang haholo, mme mohlomong likarolo tse kholo tsa eona e nkile karolo e kholo ho tlatseng phepelong ea boitshwaro ba ho ja ho feta lilemong tse fetileng ha tšusumetso ea ho ja e ka ba le e hokahane haufi haholo le tsosoloso ea matla (15). Kahoo, ho hlahloba mefuta e meng e amanang le bokhoba, joalo ka ho lakatsa lijo, kaha e amana le botenya le maemo a mang a amanang le lijo ho bonahala a loketse.

Boithuto bo bongata le bo fapaneng bo fana ka maikutlo a hore litakatso tsa lijo li kanna tsa fapana ka ho hlaka bakeng sa ho utloisisa likarolo tsa botena le mefuta e amanang le ho ja ho sa feleng e kang BED. Ka tlholeho le ka bongaka, batho ba bangata ba nang le mathata a ho ja ho tlola le tlaleho ea BED ba batla le ho ea lihlopheng tse kang Overeaters Anonymous le mananeo a mang a ts'ebetso ea 12-addiction16). Bafuputsi ba thehile mehato e tobileng ea ho lekola tšebeliso ea tlhekefetso ea lijo [mohlala, Yale Food Addiction Scale, e 'nileng ea etsoa lipatlisiso le ho netefatsoa ho isa lihlopheng tse fapaneng ho pholletsa le lihlopha tsa bongaka, lilemo, morabe le setso.17-22)] le, haholoholo, mefuta e fapaneng le likarolo tsa "takatso ea lijo" (23-25) molemong oa ho etsa lipatlisiso ka kamano le likhato tse loketseng. Mohlala, takatso ea lijo e hokahantsoe le index ea boima ba 'mele le tšebeliso ea mefuta e mengata ea lijo (tse monate, tse mafura a mangata, lik'habohaedreite / lijo tsa linaleli le lijo tse potlakileng ho batho ba lulang tikolohong ea sechaba (26) le ho lihlopha tse fapaneng tsa lithuto tse seng tsa bongaka le tsa bongaka tsa batho ba latelang lithibelo tsa lijo (27-29). Litakatso tsa lijo le tsona li ka khetholla lipakeng tsa li-jaji tse atlehileng le tse sa atleheng (30, 31). Lintho tse amanang le tikoloho joalo ka khatello ea maikutlo li ka baka litakatso tsa lijo le ho susumetsa boits'oaro ba ho ja (32), mme litlamorao tse joalo li ka sebetsa haholo ho basali (33, 34).

Habohlokoa, likamano lipakeng tsa litakatso tsa lijo le mehato e loketseng ea kliniki li ka fapana ka lihlopha tse itseng (25). Mohlala, lithuto li tlalehile liphapang tse kholo litakatsong tsa lijo le likarolo tse amanang tsa tleliniki lipakeng tsa batho ba batenya ba nang le BED (ntle le BED).24, 25, 35, 36). Joalokaha ho lebelletsoe, batho ba lumellang matšoao a "bokhoba ba lijo" le bona ba tlaleha litakatso tse phahameng tsa lijo (37). E lumellana le lipatlisiso tse ling tse bontšang ho ts'oana ha litakatso tsa boitšoaro bo fapaneng ba ho khatholla le ho lemalla (38), lipatlisiso li fumane ho tšoana litakatsong tsa lijo pakeng tsa basali ba nang le botenya le basali ba tsubang koae (39) le khafetsa mathata a tšebeliso ea lithethefatsi har'a basali ba batenya ba nang le BED ba tsubang ho feta ba sa tsubeng (40).

Kamano lipakeng tsa litakatso tsa lijo le mefuta e fapaneng ea bioloji mohlomong e fapaneng ho lihlopha tse itseng le eona e tlalehiloe. Mohlala, likarabo tse batlang takatso ea lijo lithahasellong tsa lijo tse ratoang haholo li ne li amahanngoa le mehato ea ho itšireletsa ha insulin ho batho ba nang le botenya empa eseng ho tse boima ba 'mele o boima, ka ts'ebetso ea ts'ebetso ea boko ea methapo-kholo e sebelisang kamano ena sehlopheng se nang le botenya (41). Liphumano tsena li bonts'a mokhoa oa tlhaho oa ho hanyetsa insulin le litakatso tsa lijo ho botenya tse ka kenyeletsang thalamus, e leng sebaka se bontšitsoeng se fapana le batho ba batenya le ba manonyeletso ka ho fumaneha ha li-transporter tsa norepinephrine (42). Kahoo re leka ho nahana hore lithethefatsi tse lebisang litsamaiso tsa noradrenergic li ka ba molemo ho tobisa litakatso tsa lijo bothateng ba botenya, leha sena se ntse se nahanisisa 'me se tiisa hore lipatlisiso li ntse li tsoela pele. Leha ho le joalo, lits'ebetso tse ling [mohlala, tse kenyeletsang ho lokolloa ha dopamine (43)] hlaha ka mokhoa o fapaneng le takatso ea lijo tse batloang ke botenya, ho fana ka maikutlo mabapi le menehelo e tsoang litsong tse ngata tsa tlhaho le litakatsong tsa lijo. Litsela tse ling, tse sa khetholleng, li bonahala li hokahane le litakatso tsa lijo le ts'ebetso ea ts'ebetso ea ts'ebetso ea boko ho batho ba motenya le ba sa batleng. Mohlala, satiety lipid oleoylethanolamide ka tlhaho e hlaha e hokahane ka mokhoa o fapaneng le mehato ea boima ba 'mele ho batho ba batenya le ba fokolang le ho bonts'a likamano tse fapaneng le ts'ebetso e kenelletseng mabapi le ts'ebetso ea lijo (44). Ntle le moo, lisebelisoa tsa limolek'hule tse hokahaneng le taolo ea takatso ea lijo le tikoloho ea 'mele (mohlala, leptin, ghrelin) li hlaha ka mokhoa o fapaneng le ts'ebetso ea ts'ebetso ea ts'ebetso ea boko ho litekanyetso tsa lijo ho batho ba sa sebetseng haholo le mathata a ts'ebeliso ea lithethefatsi (45, 46). Liphumano tsena li hlahisa monyetla oa hore mekhoa e tloaelehileng e ka tlatsetsa litakatso tsa botena le mathata a ts'ebeliso ea lithethefatsi. Tumellanong le monyetla ona, tlhahlobo ea meta-datha ea monahano oa bongo e fana ka maikutlo a liphallelo tse tloaelehileng tsa libaka tse ngata tsa boko ho litakatso tsa lithethefatsi le lijo (47). Maemo ana a tloaelehileng a na le litlamorao bakeng sa nts'etsopele ea kalafo ka hore kalafo e ka sebetsa ho mathata a mangata a kenyeletsang ho lakatsa. Tumellanong le mohopolo ona, datha e fana ka maikutlo a hore ts'ebetso ea ts'ebetso ea boko (mohlala, ka ts'oaetso ea methapo ea methapo ea methapo) e ka fokotsa litakatso tsa lijo joalo ka ha li etsa litakatso tsa lithethefatsi (48).

Litakatso tsa lijo li kanna tsa sebetsa ka ho khetheha ho batho ba nang le botenya le mathata a ho ja, mme ho kenella ho itseng ho lebisitse ho taolo ea litakatso tsa lijo. Mohlala, ho lakatsa lijo pele ho ts'oaetso ea lijo ho hokahane le ts'ebeliso ea lijo ho botenya le maemo a phahameng ho BED, ho phahamisa monyetla oa hore e reretsoe ho phekola lefu lena (36). Haholo-holo, Tsamaiso ea Lijo le Lithethefatsi United States e sa tsoa amohela tumellano e ncha ea meriana ea naltrexone le bupropion bakeng sa kalafo ea botena. Sena se latela lithuto tse 'maloa tse kholo tse tlalehang hore motsoako oa meriana ena e' meli, eo ho nahanoang hore e 'ngoe le e' ngoe e na le litlamorao tse khahlano le ho lakatsa, o ne o sebetsa hantle ho khothaletsa ho theoha hoa boima ba bakuli ba batenya haholo (mohlala, Ref. (49, 50)]. Leha ho le joalo, ho fihlela joale, meriana e meng e mengata e neng e nahana ho fokotsa litakatso e bile le litlamorao ho bakuli ba batenya haholo ba nang le BED51-53). Phuputso e 'ngoe e fumane hore kalafo ea boits'oaro ea kelello e amahanngoa le sephetho se ntlafatsang sa kalafo le ho fokotsa litakatso tsa lijo ho batho ba batenya haholo ba ntseng ba buuoa ka tlung ea bariatric (54), 'me tlhahlobo e' ngoe e fumane hore ho fetola mokhoa oa ho phekola ka mokhoa oa ho ja ka ho kenyelletsa tlhokomeliso ea takatso ea lijo le ho sebetsana ka katleho ho felletse ka fokotsa phokotso e kholo ea ho ja ka mokhoa o feteletseng ho bakuli ba nang le bulimia mothosa (55). E lumellana le maikutlo a Mabuddha a ho lakatsa ho hlalositsoe ka holimo, mekhoa e thehiloeng kelellong e bontšitse tšepiso mabapi le ho fokotsa litakatso tsa lijo lithutong tse ling (56le boima (57). Leha ho le joalo, lithuto tse ling li bonahala li sa tšepise haholo (58), ho phahamisa monyetla oa hore ho ka ba le phapang e 'ngoe mabapi le hore na ke mang ea ka arabelang hantle lipuisanong tsena [mohlala, mohlomong mabapi le maemo a khatello ea lijo (59) kapa kotsing ea ho ba teng hoa lijo (60), ka monyetla oa liphapang tse amanang le bong le tsona li netefatsa ho nahanoa (61)]. Tekanyo eo mekhoa ea boits'oaro e shebileng ho lakatsa takatso le mekhoa ea ho sebetsana le ho lakatsa takatso e ntle e sebetsa hantle kalafong ea botenya le ho ja ka thata lihlopheng tse fapaneng tsa batho ba hlokang ho etsa lipatlisiso tse eketsehileng [mohlala, (55)]. Ts'ebetso e 'ngoe, tšusumetso e tobileng ea hona joale ea cortex e tlang pele, e fumanoe lithutong tse' maloa ho fokotsa takatso ka nakoana (haholo-holo ho batho ba sa tsubeng) le ho ba thusa ho hanela tšebeliso ea lijo (62, 63), leha lithuto tse kholo le tse hlophisehileng li lokeloa ho lekola ts'ehetso ea bongaka ea mokhoa ona.

Takatso ea lijo e re e boetse e fana ka ts'usumetso ho latela maemo a ntlafatso. Mohlala, ha ho pepesetsoa lijo tsa sehlopha sa bana, bacha le batho ba baholo, botsofe bo ne bo amahanngoa le takatso e tlase, ho haptjoa ha striatum le ho hloa molemong oa cortex ea pele le ho kopanya ho hoholo pele.64). Bacha ba boetse ba bontšitse ts'ebetso e fokolang ea cortical ho araba mekhoa ea lijo eo ba e ratang haholo ha e bapisoa le batho ba baholo (41, 65), le lihlopha tse itseng tsa bacha ba tlokotsing (mohlala, ba nang le pepenene ea cocaine) ba bonts'a phapang ea karabelo ea litla-morao tsa litheko tsa lijo tse ratoang haholo (66). Litlamorao tsa liphumano tsena tse fumanoeng tsa neurodevelopmental tse hlahlobang likarabo ho lithahasello tsa lijo tse ratoang haholo le likarabo tse tlisoang ke ho lakatsa boima ba morao le nts'etsopele (kapa che) ea botena kapa mathata a ho ja e sa ntsane e hlakisoa hantle.

Ka bokhutšoanyane, ho lakatsa lijo ho bonahala e le moaho oa bohlokoa o lokelang ho nahanoa, haholoholo tikolohong ea hona joale ea lijo. Mekhoa e ka shebang litabatabelo tsa lijo ka nepo e na le litlamorao tse kholo ho nts'etsopeleng ea bophelo bo botle ba sechaba le mathata a bophelo bo amanang le ho nona.

Tlhōlisano ea Tlhaloso

Ngaka Potenza o tlaleha hore ha ho likhohlano tse amanang le litaba tsa buka ena e ngotsoeng ka letsoho. O amohetse tšehetso ea lichelete kapa matšeliso bakeng sa tse latelang: Dr. Potenza o buisane le ho eletsa Somaxon, Boehringer Ingelheim, Lundbeck, Ironwood, Shire, le INSYS; e amohetse tšehetso ea lipatlisiso ho tsoa ho Setsi sa Naha sa Bophelo, Tsamaiso ea Veteran, Mohegan Sun Casino, Setsi sa Naha sa Lipapali Tse Ikarabellang, le Liofisi tsa Litlhare, Ortho-McNeil, Oy-Control / Biotie, Glaxo-SmithKline, le Psyadon litlhare; o nkile karolo lipatlisisong, liposong tsa mangolo, kapa lipuisanong tsa mehala tse amanang le tšebeliso ea lithethefatsi, mathata a taolo ea tšusumetso kapa lihlooho tse ling tsa bophelo bo botle; e buisane le liofisi tsa molao le ofisi ea mmuelli oa mmuso litabeng tse amanang le mathata a taolo ea tšusumetso; e fana ka tlhokomelo ea bongaka Lefapheng la Connecticut la Bophelo bo Botle ba kelello le lits'ebeletso tsa tlhekefetso ea mathata a boloi; e entse tlhahlobo ea lithuso bakeng sa Setsi sa Naha sa Bophelo le mekhatlo e meng; e na le likarolo tsa likoranta tse hlophisitsoeng le baeti; e fane ka lipuo tsa thuto lithutong tse ntle, liketsahalong tsa CME, le libakeng tse ling tsa bongaka kapa tsa saense; mme e hlahisitse libuka kapa likhaolo tsa buka bakeng sa baphatlalatsi ba mangolo a bophelo bo botle ba kelello. Dr. Grilo o tlaleha hore ha ho likhohlano tse khahlisang mabapi le buka ena e ngotsoeng ka letsoho. Dr. Grilo o tlaleha hore o fumane tšehetso ea lipatlisiso ho tsoa ho Setsi sa Naha sa Bophelo le Liphuputso tsa Bongaka, o amohetse honaria bakeng sa lipapatso le lithuto tse phahameng liunivesithing le likopanong tsa litsebi, o fumane honaria bakeng sa liketsahalo le lipuo tsa CME, o amohetse honaria bakeng sa barutehi Karolo ea litaba tsa bongoli ba khatiso, e amohetse litefiso tsa boeletsi le tsa boeletsi ho Shire, 'me e amohetse libuka bakeng sa libuka tsa thuto.

lumela hore baa fokola

National Institute On Drug Abuse (NIDA) e fana ka lithuso P50 DA09241, P20 DA027844 le R01 DA035058, Setsi sa phano e ntle e tsoang Setsing sa Naha sa Lipapali tse Ikarabellang, le Setsi sa Naha sa Lefu la Ts'oaetso le Ts'oaetso le Mafu a (NIDDK) se fa K24 DK. Likateng tsa buka e ngotsoeng ka letsoho li hlahisitsoe ka boithatelo ho tsoa ho batho ka bomong ho mekhatlo ea lithuso tsa lichelete mme li kanna tsa se emele maikutlo a mekhatlo ea lichelete.

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