Ke J Addict. 2009 Nov-Dec; 18 (6): 439-51.
Danielle Barry, Ph.D., Megan Clarke, Ed.M., le Nancy M. Petry, Ph.D.
Univesithi ea Setsi sa Bophelo sa Connecticut, Farmington, Connecticut
Lengolo la aterese ho Dr. Barry, Calhoun Cardiovascular Center-Behaeveal Health (MC 3944), Setsi sa Univesithi sa Connecticut, 263 Farmington Avenue, Farmington, CT 06030-3944, Fono: 860-679-6664 Imeile: [imeile e sirelelitsoe]
inahaneloang
Ho nona haholo ke bothata bo boholo ba bophelo ba sechaba mme ho tsebahala hore ho thata ho bo phekola. Ho na le lintho tse ngata tse ts'oanang lipakeng tsa botenya / ho ja ho feta tekano le ho lemalla joala le lithethefatsi. Pampiri ena e bua ka ho tšoana lipakeng tsa botenya le mathata a ho lemalla, ho kenyelletsa litšobotsi tse tloaelehileng tsa motho, li-syndromes tsa boitšoaro bo litšila le methapo ea boko. Le ha ho e-na le phapang ea bohlokoa lipakeng tsa ho ja ho tlola tekano le boits'oaro bo bong ba tahi, mokhoa o lemalloang oa ho ja ho tlatsa o ka atleha ho tsebisa thibelo le kalafo ea botena.
Mantsoe a bohlokoa: Ho nona haholo, ho ja ho feta tekano, ho lemalla, mathata a ts'ebeliso ea lithethefatsi
Lilemong tsa morao tjena, ho ata ha botena le ho tšoenyeha ka tšusumetso ea tsona ho bophelo bo botle ba sechaba ho eketsehile haholo. United States, 33% ea banna le 35% ea basali ba ile ba khetholloa e le batenya haholo, ba na le index ea boima ba 'mele (BMI) ea 30 kapa ho feta, ka 2005-2006.1 Maemong a mangata, botenya bo bakoa ke ho se leka-lekane ha kalori- palo Lik'halori tse sebelisitsoeng li feta palo ea likhalori tse sebelisitsoeng.2, 3 Mekhoa ea ho lula ka nakoana le ho fumaneha ha theko e tlase, lijo tse teteaneng tsa likhalori li tlatsetsa ho se lekalekaneng ho matla, 4 empa ke eng e etsang hore batho ba je lijo tse ngata ho feta kamoo ba hlokang ho phela? Leha ho na le kamano e bonahalang e le bonolo lipakeng tsa teka-tekano ea matla le boima ba 'mele, botenya ke boemo bo rarahaneng le ba bohanyetsi. Ho ja ho tloha khale ho 'nile ha tšoantšoa le ho lemalla lithethefatsi le joala mohopolong o tummeng.5 Ha theknoloji e ncha ea ho ithuta ka ts'ebetso ea boko e se e hlahile, bo-rasaense ba se ba qalile ho etsa lipatlisiso tse tebileng tsa hore ho ja ho feta tekano e ka ba mofuta oa boits'oaro.
Ka setso, poleloana ena e ne e sebelisoa ho kenella ka bongata linthong tse lebisang ho ho its'etleha 'meleng, ho bontšoa ka mamello le ho ikhula.5 Ho kenella ka hare ho boitšoaro bo joalo ka papali ea chelete, thobalano, kapa ho ja ho ne ho sa nkoe e le tšibollo ea' nete, hobane ho etsa sena. boits'oaro bo ne bo nkuoa e le ba kelello feela. Moetso oa khopolo ea litheko tsa lithethefatsi o se o qalile ho fetoha, leha ho le joalo, ka mohopolo o ntseng o eketseha oa ts'ebeliso ea litheko ho fapana le thepa ea lik'hemik'hale tsa lintho ka boeona.7 Ho boetse ho hlakile hore ho pheta-pheta ho etsa lintho tse ngata ho ka lebisa ho liphetoho tsa mmele bokong bo ts'oanang le bo bonoang ho batho ba itšetlehileng ka lithethefatsi.6 Ho latela mehlala ea morao-rao, bokhoba ke sesupo se ka hlahisoang ka boits'oaro bo fapaneng ba boitšoaro.8 Ho tšofala e kanna ea ba e 'ngoe ea mekhoa eo.
Pampiri ena e hlahloba lingoliloeng tse ts'ehetsang kamano lipakeng tsa botena le bokhoba ba lithethefatsi, 'me e bua ka bopaki ba ho khaotsa ho lemalla. Taba ea mantlha, re sebetsana le hore na botenya / tšohanyetso li lokela ho nkuoa e le bokuli ba kelello le litekanyetso tse tšoanang tsa tlhahlobo ea mafu a tšebeliso ea lithethefatsi. Joale re buisana ka litlamorao tsa lithuto tsa mafu a seoa le a kliniki a bonts'ang likamano tse ntle le tse mpe lipakeng tsa botena le botena ba tšebeliso ea lithethefatsi ho bongata ka kakaretso. Ka mor'a moo re hlahloba litšobotsi tsa bohlokoa le mekhoa e ka 'nang ea sebetsa ea boko e amanang le ho ja ho tlatsa le ho lemalla joala le ho supa phapang ea bohlokoa lipakeng tsa ho tšela joala le ho lemalla lithethefatsi le joala. Kamora nako, re tšohla litlamorao tsa mohlala oa ho lemalla ho tlola tekano ho thibela le ho phekola botena.
A. NA HO MAMELA KE SEBETSA SA BOTSOANG HANGATA?
Ho nona haholo ho tsamaisana le mathata a mangata a bongaka, mme ho phekola botenya ho ka fella ka bophelo bo ntlafalitsoeng.9 Ka mantsoe a mang, kalafo ea botenya e bonolo: fokotsa ho ja haholo le ho eketsa ts'ebetso ea 'mele. Leha ho le joalo ke batho ba fokolang feela ba batenya ka bongata ba fihlelang ho fokotsa boima ba 'mele,' me ke ba fokolang ba khonang ho theola boima ba 'mele. Phapang ena e fana ka maikutlo a hore tšusumetso ea ho ja lijo tse fetang se hlokahalang ho boloka tšebetso ea 'mele e ka feta maikutlo a mang.
Buka ea Diagnostic and Statistical Manual of Mental Disallen (DSM-IV) 10 ea ho itšetleha ka lintho e bonahala e na le bonnete ba kantle ha e sebelisoa ho ts'ebetsong e feteletseng e ka lebisang botenya. Hangata batho ba batenya haholo ba ja ho feta kamoo ba neng ba rerile kateng 'me hangata ba etsa boiteko bo sa atleheng ba ho laola ho nona ho feta tekano. Ho nona haholo ho ka fokotsa bokhoni ba motho ba ho nka karolo linthong tse felletseng tsa boithabiso, mesebetsing le boithabisong. Batho ba bangata ba tsoela pele ho ja ho feta tekano le hoja ba tseba hore ho ja ho feta tekano ho baka ho nona haholo 'me ho ka baka mathata a tebileng a bophelo bo botle. Ho tšoana hona ho lebisitse ho tlhahiso ea hore botenya, kapa ho nona ho bo bakang, ho kenyelletsoa ho DSM-V e tlang, le mekhoa ea tlhahlobo e lekantsoeng ho ba ts'epahalletseng lintho.11, 12 DSM-IV hajoale e kenyelletsa tlhahlobo ea mafu a kotsi ea Binge. e hlokang tahlehelo ea taolo holim'a tšebeliso ea lijo le tšebeliso ea lijo tse ngata ka nako e khuts'oane ea nako.10 Ha hona joale ha ho na sehlopha sa tlhahlobo ea kalafo e sa foleng. Bafuputsi ba bang ba bontšitse ho ts'oenyeha ka ho qaptjoa hoa tlhahlobo e 'ngoe ea methapo e amanang le “Ho Laola Kelello” kapa “Ho Tloha Bophelong.” Ba supa hore lijo, ho fapana le lithethefatsi le joala, li bohlokoa bakeng sa bophelo, hore ho ka se khone ho ila lijo. , le hore matšoao a 'mele a ho its'etleha joalo ka ho mamella, ho tlohela, le ho lakatsa lijo ha li hlahelle hantle kapa hona ho utloisisoa ka nako ena.13
Lethathamo la 1 le bonts'a litekanyetso tsa DSM-IV tsa ho its'etleha hoa ntho le matšoao a tšoanang a ho ba le mathata a kelello a "Ho Khatholla Motho", a bonts'a ho tšoana le ho se tšoane ho teng lipakeng tsa ho ho ja ho tlontlolloang ka lijo le litheko. Ho hlakile hore ha se batho bohle ba nonneng kapa ba batenya haholo ba ka etsang lintho tsena. Sebakeng sena, bothata bona bo ka fokotsang karolo ea batho ba nonneng haholo le ba batenya ho feta tekano ba bonts'ang tahlehelo e sa feleng ea taolo ea ho nona ho feta tekano, e ts'oanang le ts'ebeliso ea mathata a ts'ebeliso ea lithethefatsi.
TABLE 1 - Mekhoa ea DSM-IV ea tlhahlobo ea ts'ebeliso ea lithethefatsi le litekanyetso tse tšoanang bakeng sa bothata bo ka bang teng ba ho ja ho tlōla
Morero oa ts'ebeliso ea lithethefatsi - Tokelo e ts'oanang le ea "ho ja hampe ho feta tekano"
1. Ho mamella, ho kenyelletsa tlhokeho ea ntho e ngata ho fihlella phello e ts'oanang kapa phello e fokotsehileng ha u sebelisa tekanyo e lekanang ea ntho ka nako.
Mohlala: Motho ea itšetlehileng ka joala ha a ikutloe a tahiloe kamora ho qeta ho jella 6-pack kaofela ka shoalane.
2. Ho ikhula, ho kenyelletsa le matšoao a tloaelo a matšoao a ho tlisoang bakeng sa ntho e itseng kapa ts'ebeliso ea ntho kapa e ts'oanang ho imolla kapa ho thibela matšoao ao.
Mohlala: Heroin e itšetlehileng ka boiphihlelo ba hae ba dysphoria, ho nyekeloa, ho ruruha le ho hloka boroko ha a sa khone ho fumana heroin, ho nka oxycontin ho lefa.
3. Hangata motho ka mong o nka karolo ea ntho ho feta kamoo a rerileng kapa e nka nako e telele ho feta kamoo ho neng ho reriloe.
Mohlala: Joala o rera ho emisa bareng ea lehae bakeng sa biri e le 'ngoe, o qetella a lutse ho fihlela a koala ebe o nooa makhetlo a' maloa.
4. Boiteko bo sa atleheng ba ho fokotsa tšebeliso ea lithethefatsi kapa takatso e tsoelang pele ea ho etsa joalo.
Mohlala: Kokonate ea motho ea tšepileng koae o pheta likano khafetsa tsa ho khaotsa ho li sebelisa qalong ea letsatsi, empa o qetella a li sebelisitse qetellong ea letsatsi.
5. Nako e ngata e sebelisoang e le ho fumana, ho sebelisa, kapa ho hlaphoheloa tšebelisong ea thepa.
Mohlala: Motho ea its'epahallang oa cannabis o qeta lihora tse ngata a letsetsa mabitso a hae a mangata ho fumana matekoane a fumanehang, o tsamaea lihora tse 2 ho e fumana, ebe o tsuba boholo ba beke.
6. Ho tlohela motho ka mong kapa ho fokotsa mesebetsi ea boiketlo ba sechaba, mosebetsi kapa boikarabello ba lelapa, le lithahasello tsa boithabiso bakeng sa ho sebelisa lintho.
Mohlala: Motho ea sebelisang lithethefatsi o khaotsa ho tloaelana le metsoalle e sa sebeliseng lithethefatsi.
7. Ts'ebeliso ea lithethefatsi e ntse e tsoela pele leha ho na le mathata a amanang le 'mele le kelello.
Mohlala: Motho ea lemaletseng joala o tsoela pele ho noa kamora ho fumanoa ke lefu la khatello ea mali le liso tsa ka mpeng.
1. Mamello ea 'mele ha e na monyetla, empa batho ba bang ba ikutloa ba hloka lijo tse ngata hore ba ikutloe ba khotsofetse.
Mohlala: Motho ea nonneng kapa o motenya haholo o ikutloa a lapile ka mor'a lijo tse ngata.
2. Ho bapisoa le ho nyekeloa hoa maikutlo ha ho so bonoe, empa batho ba jang lijo le batho ba bang ba sitoang ho ja ba amehile ka lijo, 'me batho ba bang ba sebelisa lintho tse kang nicotine kapa lintho tse matlafatsang ho hatisa takatso ea lijo.
Mohlala: Dieter e ikutloa e le leqeba ebile e tepelletse maikutlo, e tsuba kapa e nooa lino tse tahiloeng bakeng sa ho iphetetsa.
3. Lijo hangata li jeoa ka bongata kapa ka nako e telele ho feta kamoo li neng li reretsoe.
Mohlala: Dieter e rera ho ba le tšebeletso e le 'ngoe e nyane ea ice cream, empa e qetella ka ho ja pint e felletseng.
4. Hangata batho ba nkoang ho feta tekano ba lakatsa ho fokotsa kapa ho laola hore na ba ja hakae kapa hona ho leka ho ja hanyane.
Mohlala: Lijo tse phetoang khafetsa, tse sa atleheng, kapa ho fokotsa boima ba 'mele ka mor'a lijo tse atlehileng, ke ntho e tloaelehileng ho batho ba bangata ba batenya haholo.
5. Basebelisi ba ka qeta nako e ngata ba reka lijo, ho ja le ho fepa, le ho fola litlamorao tsa 'mele le kelello tsa ho nona haholo (mohlala, ho nyekeloa pelo, letsoalo la ho ja haholo)
Mohlala: Ho ja lijo tse bobebe tse ngata ho pholletsa le letsatsi ho eketsa kapa ho e-na le ho ja kamehla.
6. Mesebetsi e mengata e ka tloheloa kapa ea fokotsoa ka lebaka la ho ja ho tlola tekano (ke hore, botenya) le ho tsamaisana le ho fokotseha ha motsamao, ho eketsa matšoenyeho a sechaba, jj.
Mohlala: E mong o tlohela ho nka karolo lipapaling kapa ho ea lebopong ka lebaka la lihlong ka boima ba 'mele.
7. Ho ikoetlisa ho tsoela pele le ha ho na le mathata a amanang le 'mele le kelello.
Mohlala: Ho nona ho tsoela pele ho ja pompong ka mor'a ho fumanoa ke lefu la tsoekere la mofuta oa II
B. LITLHOHONOLOFATSO TSE BATLANG TSE NGOTSOENG LI TSOELA PELE LE TLHOKOMELISO
Haeba re nahana hore ho nona ho tlola tekano ke lefu le lemalloang le hore ho nona ho feta tekano ho ka ba teng bathong ba nang le boima ba 'mele bo phahameng, re ka lebella ho fumana likamano tse ntle pakeng tsa botenya le tšebeliso ea lithethefatsi ho bongata ka kakaretso le mehlala ea kliniki. Ka lehlakoreng le leng, ho ja ho feta tekano le ho sebelisa lintho ho ka khotsofatsa litlhoko tse tšoanang tsa 'mele kapa tsa kelello, ho etsa hore batho ba jang haholo ba se ke ba tloaela ho etsa lintho tse ling tse lemalloang.
1. Liphumano ho Sampuli tsa Epidemiological
Lithuto tsa Epidemiological tse hlahlobang likamano lipakeng tsa botena le bothateng ba tšebeliso ea lithethefatsi li hlahisa litholoana tse makatsang, tse akaretsang ho Tafole ea 2. O sebelisa sampole ea batho ba fetang 40,000 ba tsoang ho National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Petry et al.14 o fumane maemo a phahameng a bophelo ba mathata a tšebeliso ea joala ka ho eketsa BMI ho tloha mokhatlong o feteletseng le ho eketseha ka mefuta eohle ea BMI. Ho lekola tlhaiso-leseling e tšoanang ka thoko ka bong ho bonts'itse tlhaselo e phahameng ea nako e telele ea ts'ebeliso e mpe ea joala le ho ts'epahalla banna ba batenya haholo le ba batenya ho fapana le banna ba boima ba 'mele, ho se na kamano pakeng tsa BMI le bophelo bohle ba ts'ebeliso ea lino tse tahang ho basali. ba ne ba le monyetleng oa ho tlaleha ts'ebeliso e mpe ea joala ea selemo se fetileng ho feta balekane ba bona ba tloaelehileng ba boima ba 'mele.15 Phuputso e ileng ea lekola ba arabileng ho tsoa linaheng tsa 15 e fumane kamano pakeng tsa botenya le ho fokotsa monyetla oa mathata a tšebeliso ea joala a selemo se fetileng United States empa eseng linaha tse ling tsa 13 kapa sampole ka kakaretso.12 Likamano tse fapaneng tse boneng nako ea bophelo bohle le mathata a ts'ebeliso ea joala ea selemo se fetileng16-14 li phahamisa monyetla oa hore ho hlaphoheloa ho tsoa bothateng ba tšebeliso ea joala ho eketsa tlokotsi ho boima ba mmele. Tumellanong le khopolo ena, John et al.16 o ile a fumana kotsi e eketsehileng ea ho ba motenya ka ho feteletseng har'a batho bao e neng e se linohe tse tahang tsa banna hona joale. Phapang ea bong e ka supa mekhoa e fapaneng ea ho nooa har'a basali le banna, ha banna ba eketsa likhalori tsa joala lijong tsa bona mme basali ba kenya likhalori tsa joala mohloling o mong oa matla.17
Tafole ea 2 - Mekhatlo lipakeng tsa mathata a ts'ebeliso ea lithethefatsi le index ea boima ba 'mele (BMI) lithutong tsa lefu la seoa
Ho Sebelisa Mathata
(BMI = 25.0-29.9) Botenya
(BMI ≥30.0)
Mehlala ea Epidemiologic
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Mathata a Tšebeliso ea Joala
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Barry & Petry (2008)
Ts'ebeliso e mpe ea joala ea bophelo bohle e ntle ho banna e nepahetseng ho banna
Ho itšetleha ka joala bophelong bohle ho na le tšepo ho banna ho banna
Tlhekefetso ea joala ea selemo se fetileng e mpe ho basali e mpe ho basali
Ho itšetleha ka joala selemong se fetileng ha ho na mokhatlo
John et al. (2005)
Basebelisi ba Hajoale ba Boima bo tahang ha ba na mokhatlo
Basebelisi ba pele ba joala bo matla ba ne ba se na kamano le banna
Petry et al. (2008
Tšebeliso e mpe ea joala ea bophelo bohle
Ho itšetleha ka bophelo ba joala ha ho na mokhatlo
Tlhekefetso ea joala selemong se fetileng ha ho na mokhatlo
Ho itšetleha ka joala selemong se fetileng ha ho na mokhatlo
Scott et al. (2008)
Selemo se fetileng Ho itšetleha ka joala ho nepahetse ho US feela
________________________________________
Mathata a sa Lekaneng a Ts'ebeliso ea Lithethefatsi
________________________________________
Petry et al. (2008)
Mathata a bophelo bohle a ts'ebeliso ea lithethefatsi ha ho na mokhatlo
Mathata a Selemo se Fetileng a Ts'ebeliso ea Lithethefatsi ha ho na mokhatlo le mokhatlo
Pickering et al. (2007)
Tlhekefetso ea lithethefatsi selemong se fetileng ha ho na mokhatlo o nang le mokhatlo
Selemo se fetileng Ho itšetleha ka lithethefatsi ha ho na negative
Simon et al. (2006)
Sesebelisoa sa bophelo bohle Sebelisa ho hloka taolo
ha ho na Associb
________________________________________
Ho Iketla hoa Nikotine
________________________________________
Barry & Petry (2008)
Lifetime Nicotine Dependence e fosahetse ho banna / e ntle ho basali e mpe ho banna
Selemong se fetileng Nicotine Dependence e fosahetse ho banna hampe
Chiolero et al. (2007)
Batho ba tsubang hajoale ha ba na setsoalle
Batho ba neng ba tsuba pele ba na le maikutlo a nepahetseng ka banna
John et al. (2006)
Batho ba tsubang hajoale ha ho na mokhatlo ha ho na mokhatlo
Batho ba neng ba tsuba pele ba na le maikutlo a matle
Pickering et al. (2007)
Selemong se fetileng Nicotine Dependence e fosahetse ho banna ba fosahetseng mena
Zimlichman et al. (2005)
Batho ba tsubang hajoale ha ho na setsoalle se nepahetseng
Kamano lipakeng tsa BMI le mathata a tšebeliso ea lithethefatsi tse seng molaong ho thata haholo ho li supa, hobane lithuto tsa mafu a seoa ho kenyelletsa palo e kholo ea batho ba nang le mathata a ts'ebeliso ea lithethefatsi. Simon le basebetsi-mmoho19 ba fumane ho nona haholo ho amahanngoa le monyetla o fokolang oa tlhahlobo ea tšebeliso ea lithethefatsi bophelo bohle, sehlopha se kenyelletsang mathata a ts'ebeliso ea lithethefatsi le joala. Phuputso e le 'ngoe e sebelisang data ea NESARC le ho laola khatello ea bophelo le maemo a kalafo a fumanoeng botenya bo ne bo amahanngoa le menyetla e tlase ea tlhahlobo ea ts'ebeliso ea lithethefatsi ea selemo se fetileng empa e se tlhahlobo ea lilemo tse fetileng ea ts'ebeliso e mpe ea lithethefatsi.20 Ts'ebetso e tšoanang ntle le ho laola khatello ea bophelo 'me maemo a bongaka a fumane ho se na kamano lipakeng tsa boima ba' mele le mathata a tšebeliso ea lithethefatsi, nakong ea bophelo kapa selemong se fetileng.14
Lithuto tsa Epidemiological tsa likamano lipakeng tsa botena le boteng ba nicotine le tsona li hlahisa litholoana tse fapaneng. Har'a banna, John et al.21 o fumane setsoalle pakeng tsa ho nona haholo kapa botenya le pale ea ho tsuba letsatsi le letsatsi empa eseng ho tsuba ha joale. Leha ho le joalo, lithuto tse ling li fumana kamano e mpe lipakeng tsa boima ba 'mele le menyetla ea bophelo ba nicotine ba nakong e fetileng har'a banna.15, 20 Ka lehlakoreng le leng, phuputso e' ngoe e fumane batho ba tsubang hona joale ba nang le kotsi ea ho tepella ho batho ba sa tsubeng, empa ba le kotsing ea ho tepella. eketseha ka palo ea lisakerete ka letsatsi ho batho ba tsubang.22 Phuputso e entsoeng ho batho ba baholo ba bacha ea tsubang ho batho ba batenya ho feta tekano le ba tsubang boima ba bona bo tloaelehileng, le batho ba tsubang ka ho feteletseng ba tsuba lisakerete tse ngata ka letsatsi ho feta ba tsubang ho feta tekano kapa ba tloaelehileng ba tsubang.23
2. Liphumano ho Sampole ea Clinical
Litefiso tsa mathata a ts'ebeliso ea lithethefatsi li phahame haholo ho bakuli ba batlang kalafo bakeng sa botenya, empa litekanyetso tsa boima bo feteletseng le botenya ho bakuli ba fumanang kalafo bakeng sa mathata a ts'ebeliso ea lithethefatsi li tšoana le sechaba ka kakaretso. Liphumano ho tsoa ho sampole ea bongaka li akaretsoa ho Tafole 3.
Tafole ea 3 - Mekhatlo lipakeng tsa mathata a ts'ebeliso ea lithethefatsi le boima ba 'mele mecheng ea bongaka
Boithuto bo hlahloba litheko tsa ts'ebeliso ea lithethefatsi
mathata a ho bakuli ba batlang kalafo ea botenya.
________________________________________
Kalarchian et al. (2007)
Nako efe kapa efe ea bophelo ba ho sebelisa litheko tsa bophelo
tsietsi ho feta palo e akaretsang
Ts'ebeliso e 'ngoe le e' ngoe ea Selemo se Fetileng Sebelisa bakuli ba nang le mathata a ho ikoetlisa ka boima ba 'mele
tsietsi ho feta palo e akaretsang
Kleiner et al. (2004)
Joala selemong se fetileng. Sebelisa bakuli ba laolang boima ba basali litheko tse tlase tsa ts'ebeliso ea joala ea selemo se fetileng ho feta ka kakaretso
Warren et al. (2005)
Selemong se fetileng Marijuana Sebelisa bakuli ba laolang boima ba basali litheko tse tlase tsa ts'ebeliso ea mariha ea mariha le bmi e ntseng e eketseha
________________________________________
Boithuto bo hlahlobang litekanyo tsa ho nona haholo / botenya
ka ho sebelisa litlolo tsa tlhekefetso
________________________________________
Jarvis et al. (2007)
Bokhoba ba ho itlopa joala ho bakuli ba nang le ts'oaetso ea bolulo bakeng sa bakuli ba fetang boima ba 'mele ho feta tekano le batho ba bangata
Rajs et al. (2004)
Lits'ebetso tse se nang litlolo tsa lithethefatsi tse sa sebeliseng lithethefatsi tse seng molaong tsa batho ba nang le lithethefatsi tse fetang tekano le botenya tse ka bapisoang le bongata ka kakaretso
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Kalarchian et al., O fumane hore 32.6% ea bakuli ba sebetsanang le opereishene ea bariatric e tlaleha nalane ea bophelo bohle ba bothata bofe kapa bofe ba ts'ebeliso ea lithethefatsi, 24 ho feta tekanyo e habeli e hlokometsoeng ho bongata ka kakaretso.25 Ba fumane phapang e makatsang lipakeng tsa bophelo le ts'oaetso ea hona joale ea tšebeliso ea lithethefatsi. mathata a har'a bakuli ba buoang ka bariatric - ke 1.7% feela e tlalehileng bothata ba hona joale ba tšebeliso ea lithethefatsi. Le ha tatellano ea tatellano ea liketsahalo tsa bothateng ba botona kapa botšehali e sa sebelisoe, phapang ena e makatsang ea bophelo ba batho le ea selemong se fetileng e hlahisa monyetla oa ho eketsa tšebeliso ea lithethefatsi hara batho ba bang.24 Chati ea basali ba batlang kalafo ea taolo ea boima ba mmele ba fumana litheko tse tlase tsa joala le ts'ebeliso ea mariha tsa selemo se fetileng ka boima ba 'mele bo ntseng bo eketseha.26, 27
Ha ho hlahlojoa likamano tse kopaneng, 54% ea bakuli tsamaisong ea kalafo ea joala ea bolulo e ne e le boima bo feteletseng kapa ba batenya.28 Patlisiso ea mofu oa setopo e tsoang Sweden e fumane 45% ea batho ba hlokahetseng ba nang le mathata a ts'ebeliso e seng molaong ea lithethefatsi ba ne ba le boima bo feteletseng kapa ba batenya, ha ba bapisoa le kakaretso ea Sweden tekanyo.29
Ka kakaretso, phapang e fumanoeng lipatlisisong ka bophara linthong tsohle le lithutong tsohle e etsa hore ho be thata ho fihlela liqeto tse tiileng mabapi le likamano tse ka bang teng lipakeng tsa botena le lithethefatsi. Ho bohlokoa ho hlokomela hore likamano li thatafalloa ke litlamorao tse fapaneng tsa 'mele tsa lintho tse fapaneng ho boima ba' mele. Tai, ho fapana le lithethefatsi tse seng molaong le nicotine, e na le likhalori, tse ka eketsang boima ba 'mele bo phahameng.18 Nicotine e eketsa metabolism, 30 e ka kenya letsoho ho fokotsa boima ba' mele.
C. LITLHAKISO TSA BOPHELO LI BONAHALA LE HO BONAHALA
Leha ho na le pherekano e fumanoeng ea lefu la pherekano, lipatlisiso tse reretsoeng ho utloisisa liphapang tse eketsang tlokotsi ea botena le mafu a bokhoba li senola litšobotsi tse tšoanang tsa motho, menyetla ea litšitiso tse sitisang boitšoaro, le tlhekefetso e sebetsang ea bokong. Lintho tsena tse tšoanang li akaretsoa ho Tafole 3.
1. Litšobotsi tsa Botho
Lithuto tse 'maloa li sebelisitse Temperament and Character Inventory (TCI) 31 ho lekanya litšobotsi tsa botho ho bakuli ba batenya le ba batenya le bakuli ba bangata ba nang le ts'ebeliso ea lithethefatsi. Sekala tse peli tsa TCI li bonts'itse mekhatlo e nang le botenya le mathata a ts'ebeliso ea lithethefatsi. Sekala se secha sa ho batla se bonts'a thabo ha motho a araba rialo kapa sepheo se monate. Sekala sa boits'oaro se lekola ho amohela, boikarabello, ho tataisoa ha sepheo, le boitaolo. Ho TCI, batho ba batenya ho feta tekano ba ka ba le lintlha tse ngata tse phahameng tsa ho batla ho ba le litekanyetso tse phahameng tsa ho itataisa.32 Barupeluoa ba taolo ea boima bo fetang tekano ba sa atleheng ho theola boima ba mmele ho feta ba nang le maemo a tlase.32
Phumano e tšoanang e bonoa har'a baahi ba sebelisang lithethefatsi hampe. Batho ba itšetlehileng ka lithethefatsi ba na le lintlha tse ngata tse phahameng tse batlang boleng bo phahameng ba ho itaola ho feta batho ba senang ts'ebeliso ea lithethefatsi.33, Bakuli ba 34 Bakuli ba nang le ts'oaetso ea litheko ba fumaneha haholo ho feta tekano ea ho batla lintho ea TCI. .35 Har'a batho ba nang le nalane ea malapa ea botahoa, ba nang le lintlha tse phahameng ho feta tsa ho batla bocha ba ka fumanoa ba e-na le ts'ebeliso ea lino tse tahang, leha e le hore bo-ralitaba ba sa tsebeng hore na ho tla joang hore motho a be le ts'ebeliso ea joala ho batho ba se nang kotsi ea lelapa .36
Basali ba tloaelehileng ba boima ba boima ba 'mele ba nang le takatso e matla ea ho ja ba na le monyetla oa ho tlaleha nalane ea tšebeliso e mpe ea joala kapa ho ts'epa le ho fumana lintlha tse holimo ho sepheo sa ho tsoma sa TCI.37 Liphetho tsena li fana ka maikutlo a hore tloaelo e tsitsitseng ea ho arabela ka matla lithutong tse ncha li ka etsa hore boiphihlelo ba ho ja lijo tse monate le / kapa ho sebelisa lithethefatsi tse khahlisang haholoanyane, ho eketsa menyetla ea ho itšepa ho feta tekano. Ho itaola ho ka lumella motho ka mong ho thibela kapa tšekamelo ea ho ja ho tlola tekanyo le tšebeliso ea lithethefatsi, ho fokotsa ho ba kotsing ea botena kapa lithethefatsi.
Batho ba boima bo feteletseng le ba batenya haholo ba nang le matšoao a ho ja ho feta tekano ba ne ba e-na le litheko tse phahameng ho feta tekano ea motho mme ba jele sejo se eketsehileng sa metsi kamora ho potlaka ha hora ea 8.38, lintlha tsa 39 Impulsivity li ile tsa hokahanngoa le palo ea tlatsetso ea lijo tse jeoang.38 Lithuto tse ling li sebelisa Iowa Gossip Task (IGT) 40, tekanyo ea ho se ts'oanelehe le ho etsa liqeto tse hlokang ho sitisoa ha likarabo tse sa potlakeheng. Batho ba boima bo feteletseng le ba batenya haholo ba sebetsa hampe ho IGT ho feta lithaka tse tloaelehileng tsa boima ba 'mele, 41 mme ka mokhoa o ts'oanang le batho ba nang le mathata a ts'ebeliso ea lithethefatsi.42 Phokotso ea ho lieha ke mokhoa o khethiloeng bakeng sa meputso e nyane kapele ha o bapisoa le meputso e meholo e liehileng, e le tšusumetso. Basali ba batona ba bonts'a theolelo e kholo ea theolelo ho feta basali ba tloaelehileng ba boima, leha boima ba 'mele bo sa amanngoe le theolelo ea ho lieha ho banna.43
Mathata a ts'ebeliso ea lithethefatsi a boetse a amahanngoa le lintlha tse phahameng tsa mehato ea ho hobosoa.44, 45 Batho ka bomong ba itšetlehileng ka joala kapa lithethefatsi ha ba sebetse hantle haholo ho IGT ho fapana le batho ba sa ts'oaneng le lithethefatsi ba sa sebeliseng lithethefatsi.46-49 IGT.50 Batho ba nang le mathata a tšebeliso ea koae, lithethefatsi le tšebeliso ea joala ba na le litheko tse phahameng tsa ho lieha ho feta ho laoloa ntle le taolo ea ts'ebeliso ea lithethefatsi.51-54 Liphumano tsena li fana ka maikutlo a hore ho se khone ho hatella litšusumetso ho bapala karolo ea ho tlola matla le ho lemalla.38
2. Litloaelano le Disrupttive Behaeve Dis shida
Bana ba nang le mathata a boits'oaro a khetholloang ke ho se tsotelle le ho se tsotelle, joalo ka khaello ea khatello ea maikutlo (ADHD) le boits'oaro ba boitšoaro, ba bonahala ba le kotsing e kholo ea ho lemalla joala hammoho le ho nona haholo le botenya ho mehlala ea bongaka le ea sechaba. ho nkeha maikutlo ho feta lithaka tsa bona tse tloaelehileng tsa boima. 55 Bashemane ba nang le boima bo feteletseng ba tlaleha bothata bo boholo ba ho tsepamisa maikutlo, 'me bashanyana le banana ba nang le boima bo feteletseng ba tlaleha bothata ba ho suthisa tlhokomelo ha ba bapisoa le bana ba tloaelehileng ba boima. Batho ba baholo ba alafeloa botenya, ADHD e atile haholo, haholoholo ho ba batenya haholo (BMI> 56) .57 Ho basali ba baholo, matšoao a ADHD a amahanngoa le ho ja ho tlōla, hoo le hona ho amanang le BMI e phahameng.
Ka mokhoa o ts'oanang, litekanyetso tsa ADHD le mathata a boitšoaro li boetse li phahamisoa haholo har'a bakuli ba fumanang kalafo bakeng sa mathata a ts'ebeliso ea lithethefatsi.61 Liphuputso tse lebelletsoeng li fana ka maikutlo a hore ADHD bongoaneng e eketsa menyetla ea ho qala ts'ebeliso ea lithethefatsi ka lilemo tsa 14 le ho nts'etsapele ho ts'epahalla ha nicotine le joala le ts'ebeliso ea ts'ebeliso ea matekoane ka lilemo. 18.56 ADHD, mathata a boitšoaro, le mathata a ts'ebeliso ea lithethefatsi hangata a nahanoa hore a emetse lipontšo tse fapaneng tsa mofuta o kengoang khubung ea kantle.62 Liphetho tse hlalositsoeng ka holimo li fana ka maikutlo a hore ho nona haholo le botena le tsona li ka kenyelletsoa ho saense ea ntle. Mohopolo oa bokuli bo ka thoko bo ka thusang ho hlalosa ho hlonama hara mathata a ikhethang le likamano lipakeng tsa mathata a boitšoaro ba bongoana le bokhoba ba botena kapa botena ho motho e moholo .62
Mathata a kantle ho naha a hokahantsoe le bofokoli ba mesebetsi ea motsamaisi, ho kenyelletsa ho itšireletsa, ho itlhokomela le ho rala.63, 64 Ho hlahlobua ho latela mohlala oa bokhoni ba ts'ebetso ea bofokoli hantle joalo ka ha bo kenyelletsa ho ja lijo, karohano ea ho itlhokomela takatso ea lijo, le ho sitoa ho lebella litlamorao (ke hore, boima ba mmele). Boithuto ba morao-rao bo fumana bofokoli bo phahameng ho feta ba motho ha bo bapisoa le batho ba tloaelehileng ba boima ba 'mele.65, 66 Ka mokhoa o ts'oanang, mefokolo ea ts'ebetso e atisoa ke mefuta ea mathata a ts'ebeliso ea lithethefatsi.67-69
3. Mekhoa ea Brain
Mathata a ts'ebeliso ea lits'ebeliso tsa lithethefatsi a bonahala a hlaha lipakeng tsa boko tse khothalletsang boits'oaro bo hlokahalang bakeng sa ho pholoha, ho kenyelletsa ho ja le ho kopanela liphate. Li-neurotransmitters libakeng tsena tsa boko li tsotella thepa e matlafatsang ea lijo empa li boetse li arabela lik'hemik'haleng tsa lintho tse ferekanyang kelello.70, 71 Lilemo tse leshome tse fetileng li bone keketso le ntlafatso ea mekhoa ea ho nahana ka bokong e senotseng mekhoa e tloaelehileng ea ts'ebetso ea methapo e sebelisang tšebeliso e mpe ea ts'ebeliso ea mali le ts'ebeliso ea lithethefatsi. .72
Ho matlafatsa litlamorao tsa lithethefatsi le lijo ho hlaha mesebetsing ea li-neuronal ka har'a sisteme ea mesocorticolimbic dopamine, ho kenyelletsa le sebaka sa ventral sa likarolo moo methapo ea sele ea dopaminergic neuron e simolohang teng, le "basal forebrain" (haholo-holo li-nucleus accumbens, amygdala, le frontal le limbic cortices), moo dopamine e lokolloa ka har'a li-synapses.73, 74
Ho ja lijo, haholo-holo tšebeliso ea lijo tse matlafatsang haholo le tse letsoai, ho matlafatsa tšebetso ea dopamine, ka ho otloloha kapa ka kotloloho ka ts'ebetso ho li-neurotransmitter tse ling, ho theha maikutlo a tlatsetso a thabo le khotsofalo.75 Ho thibela li-receptor tsa dopamine ho eketsa takatso ea lijo mme ho baka boima ba mmele, ho fana ka maikutlo a hore ho nona ho feta tekano e kanna ea ba mats'oao a ho koala sekheo sa ho tšoaea karabelo e khahlisang ea lijo. Recopor ea dopamine e amanang haholo le boits'oaro ba ho ja ke subtype 2 (D2) receptor.70 Wang le basebetsi-mmoho76 ba sebelisitse positron emission tomography (PET) ho bapisa tšebetso ea metabolic bokong ba batho ba leshome ba nang le botenya ka ho fetesisa ho batho ba leshome ba tloaelehileng. Batho ba nang le Obese ba ne ba e-na le li-receptor tse fokolang tsa dopamine D2 ho feta balekane ba bona ba boima ba 'mele, mme tse phahameng tsa mmele oa motho ka mong, li-receptor tse fokolang tsa D2 li ile tsa bonoa.76 Liphetho tsena li supa hore ts'ebetso ea dopamine e tlase e ka ba ts'ebetso ea ho ba kotsing ea botena joalo ka batho ba nang le D2 e fokolang. li-receptors li tlameha ho ja ho feta ho bona melemo ea ho ja lijo. Ntle le moo, bafuputsi ba bang ba hlokometse hore mamello ho litlamorao tse monate tsa lijo li ka hlaha ho tsoa ho ho ja ho sa feleng haeba maemo a phahameng a dopamine a lebisa ho tlase ha li-receptor tsa dopamine.72
Hoa tšoana le lijo, lithethefatsi tsa tlhekefetso li hlohlelletsa ho lokolloa ha dopamine tsamaisong ea mesocorticolimbic dopamine, 77 e bakang boiphihlelo bo ikhethileng ba monyaka le euphoria e etsang hore tšebeliso ea lithethefatsi e matlafatse haholo.78 Neuroimaging patlisiso e fana ka maikutlo a hore taolo ea lithethefatsi tse matla e eketsa ho lokolloa ha dopamine ho tsoa ho li-neuron, empa D2 ho fumaneha ha li-receptor le hona ho fokotsehile haholo bokong ba batho ba nang le mathata a ts'ebeliso e mpe ea lithethefatsi le joala.79 Ka hona ho bonahala eka taolo e sa foleng ea lithethefatsi e lebisa ho fokotseha ho hoholo hoa tšebetso ea dopaminergic ka nako ka ho theoha ha karabelo ka lebaka la tšusumetso e mpe ea dopamine.
Bafuputsi ba bang ba tšoaelitse "Reward Deficiency Syndrome" e tsejoang ke lipalo tse tlase tsa D2 receptors le maikemisetso a ho kenya letsoho ka mokhoa o phehellang boits'oarong bo khotsofatsang, joalo ka tšebeliso ea lithethefatsi le ho ja.72 80 Mefuta e meng ea liphatsa tsa lefutso le tikoloho e kenya letsoho tlokotsing ea boits'oaro bo itseng bo qobelloang. . Mohlala, batho ba batenya haholo ba na le keketseho e kholo mosebetsing oa boko ho arabela melomong, molomo, le maleme, e leng se ka etsang hore ho ja ho be monate haholo .81 Ho pepesehela le ho fumaneha hoa lijo tse phahameng tsa khalori khahlano le lithethefatsi kapa joala le ho kopana le boiphihlelo bo monate Boitšoaro bo ka ama khetho e ikhethileng ea ho tiisa hape.
Liphumano tse mabapi le litšobotsi tse tloaelehileng tsa botho, mathata a ts'ebetso ea ts'ebetso, le ts'ebetso ea ts'ebetso ea boko li ts'ehetsa mokhoa o lemalloang oa botenya le ho fana ka leseli bakeng sa mathata a batho ba batenya ha ba leka ho theola boima ba 'mele. Ho lemoha ho se tšoane ha batho kotsing ea ho ba le mathata a tšebeliso ea lithethefatsi ho na le kutloisiso e tsoetseng pele ea lithethefatsi, 'me mohlala o ts'oanang oa ho nona ho feta tekano o ka ba le thuso ho utloisisa nts'etsopele ea botona.
D. DIFFERENCES EBETSE TLHALOSO LE TLHOKOMELISO
Leha ho na le lintho tse ngata tse ts'oanang lipakeng tsa botenya le bokhoba ba lithethefatsi, ho boetse ho na le phapang ea bohlokoa. Mohlala oa ho lemalla botenya o nka hore ho nona ke sesosa se ka sehloohong sa botenya. Le ha botenya hangata bo amahanngoa le takatso ea lijo e kholo ho feta e hlokahalang ho boloka boima ba 'mele bo tloaelehileng, batho ba fapana haholo ka litlhoko tsa bona tsa caloric, mme metabolism ea motho e hanana le liphetoho tse kholo ho boima ba' mele ka ho feto-fetoha le liphetoho phetohong ea lijo.82
1. Phapang ka kakaretso
Lithethefatsi tse tlatsetsang ha li sebetse ka sepheo se setle sa homeostatic kapa ho ba le bana.77 Ka lehlakoreng le leng, lijo lia hlokahala bakeng sa ho phela.13 Ho na le bopaki ba hore palo ea lijo tse jeoang ke motho ea tloaelehileng ha li eketsehe haholo ha litekanyetso tsa botena li eketsehile. liteng tsa phepo e nepahetseng ea lijo le ho fokotseha hoa ts'ebetso ea 'mele e ka ba karolo ea bohlokoa ho boima ba' mele bo phahameng.83 Ho tsoa ponong ea ho iphetola ha lintho, tšenyo ke mokhoa o iketelletsang oa ho pholoha le ho ikatisa ka ho khutlisa mabenkele a matla a felletseng ka ts'ebetso e boima ea 'mele.84 E kanna ea ke feela ho fokotseha ho potlakileng ha litlhoko tsa matla a motho, hammoho le phumaneho e kholo ea lijo, tse eketsang boitšoaro bo bobe sechabeng sa sejoale-joale. Leha litlamorao tsa lithethefatsi le joala li kenyelletsa phokotso ea bohloko, ho phomola, ho hlasimolla kelello, esita le tahlehelo e nyane ea ts'ilafalo, ho ka khothaletsa ho pholoha le ho ikatisa ha ho sebelisoa ka tekano, ho thata ho tseba phaello e pholohileng e hlahisoang ke ho itlopa joala ka lithethefatsi kapa joala, joalo joalo Ho hang ha e fanoa ke ho ja ho tlola. Ebile, ts'ebeliso e ngata ea joala le ts'ebeliso ea lithethefatsi e fokotsa ho ikoetlisa ka ho nyahamisa maikutlo empa e le maikutlo a sa fetoheng joaloka tšabo.85
2. Karolo ea Leptin ho latsoa takatso ea lijo le 'mele
Bofokoli ba botenya le ts'ebeliso ea lithethefatsi ke bonyane lefa e le karolo e itseng. Leptin ea hormone e patiloe ke linama tse mafura, 'me ha mafura a eketsoa' meleng, likokoana-hloko li arabela ka ho ja hanyane.86 Leptin ka hona ho bonahala e le molaoli oa bohlokoa oa boima ba 'mele.87, 88 Batho ba bang ba batenya ba na le phetoho ea liphatsa tsa lefutso e fokotsang leptin tlhahiso, e ba sitisa ho laola takatso ea lijo ka lebaka la mafura a mangata a 'mele. Batho ba nang le khaello ea leptin ba na le matla ho feta takatso e tloaelehileng mme ba ikutloa ba lapile ka nako e telele. Bakeng sa bona, ho ja ho feta tekano ha ho amane le thabo le moputso, empa karabelo litekatsong tse sa nepahalang tsa tlala. Ho fokotsa mafura a 'mele ho lebisa ho theoheng ha tlhahiso ea leptin le ho eketseha ha takatso ea lijo, mohlomong ho hlalosa lebaka la ho fokotsa boima ba' mele ka nako e telele ho le thata hakalo.89 Leha ho le joalo, joalo ka ho theoha hoa li-receptors tsa D2 tse nahanoang hore li etsahala ha mosebetsi oa dopamine o eketseha, kutloisiso ea leptin e hlaha ho fokotseha ka maemo a phahameng a ts'ebetso. Ho nona ho feta tekano ho ka 'na ha tsoela pele kamora ho fumana boima ba' mele esita le ho batho ka bomong ntle le bofokoli bo neng bo le teng ba leptin kaha methapo ea bona ea kelello e sa amehe haholo ka letšoao la leptin ho fokotsa tahi.90, 91
Ho fapana le dopamine, e amehang mesebetsing e mengata e putsa, leptin e bonahala e amana ka kotloloho le taolo ea lijo le boima ba 'mele. Leha ho le joalo, litekanyetso tse phahameng tsa leptin li 'nile tsa amahanngoa le litakatso tsa joala nakong ea ho tlohela joala, ho lebisang mohopolong oa hore leptin e sebelisana le ts'ebetso ea moputso oa boko ho hlahisa litlamorao ho lijo le tšebeliso ea joala.92
3. Ghrelin
Ghrelin ke hormone ea peptide e patiloeng ke mpa e tsosang takatso ea lijo.93 maemo a Ghrelin a phahame ha mpa e se na letho mme e theoha ho latela lijo.94, maemo a 95 Ghrelin a amana hantle le maikutlo a tlala, le tsamaiso ea methapo ea methapo ea mmele ea ghrelin e hohelang tlala le lijo. ho kenella bathong.93 Maemo a potolohang a ghrelin maling a amanang le boima ba 'mele ho batho, mme ho theoha hoa boima ba' mele ka ho fokotseha hoa maemo a ghrelin, ho fana ka maikutlo a hore ghrelin e kentse letsoho taolong le tlhokomelong ea boima ba 'mele.95 Batho ba nang le' nete ba bonts'a litlolo ho phapang e fapaneng ea ghrelin, le khatello ea ghrelin maling e phahame haholo hara batho ba nang le lefu la Prader-Willi, boemo bo tšoaeang takatso ea lijo le botena bo feteletseng.96 Liphuputso tsena li fana ka maikutlo a hore tlhekefetso ho secretion ea ghrelin e ka lebisa ho nona le ho nona haholo. Ghrelin, joalo ka leptin, le eona e ka bapala karolo ea mathata a tšebeliso ea joala. Batho ba itšetlehileng ka joala ba na le maemo a phahameng haholo a ghrelin ho feta batho ba sa itšetleheng ka joala, 'me maemo a ghrelin a eketseha nakong ea ho khaotsa joala .97 Ho fapana le leptin, leha ho le joalo, maemo a ghrelin ha a bonahale a amana le litakatso tsa joala .97
Feela joalo ka ha tlhekefetso ho secretion ea leptin le ghrelin e bonahala e amana haholo le bothata ba ho ja ho e-na le mathata a tšebeliso ea lithethefatsi, ho na le liphatlalatso tse ling tse amanang le tšebeliso ea lithethefatsi. Mohlala, mefuta e tsebahalang ka ho fetisisa ea liphatsa tsa lefutso e amang bokhoba ba tahi ke mofuta oa joala le aldehyde dehydrogenase tse khethollang bokhoni ba motho ba ho tšela joala.98 Mofuta o mong le o mong o na le allele o lebisang ho bokelleng ha acetaldehyde, metabolite e nang le chefo e bakang karabelo e sa thabiseng ea lebelo le motsoako. Batho ba bangata ba nang le allele ea ho qoba joala.99 Phapang ena ea liphatsa tsa lefutso e arabelang ka mokhoa o ikhethileng oa ts'ebeliso ea lik'hemik'hale tsa joala ha e na ho tšoana le ho nona.
Liphapang tse boletsoeng ka holimo li bontša hore mokhoa oa ho lemalla ho ja ho feta tekano ha o na mabaka a lekaneng a likarolo tse ling tsa botenya. Ntle le moo, ho na le litšobotsi tsa bokhoba ba lithethefatsi tsa joala le lithethefatsi tse fapaneng ka ntho e itseng98 'me li sa bonahale li na le taba ea ho ja ho feta tekano.
E. LITLHAKISO TSA HO FIHLA LE TEMISETSO EA BOPHELO
Le ha ho nona ho feta tekano ho fapana ka mekhoa e meng e lemalloang, ho ts'oana ho hongata ho ka fana ka litlhahiso tsa thibelo le kalafo. Bakeng sa batho ba bang, bokhoba ba lithethefatsi e ka ba boemo bo sa foleng, bo boelang hape, bo hlokang taolo ea bophelo bohle ho thibela ho khutla.100 Haeba botenya bo hlaha ka mokhoa o lemalloang oa ho ja, re ka nahana hore bonyane batho ba tlase ba nang le boima ba 'mele ba tla hloka taolo ea bophelo bohle boits'oaro ba ho ja bakeng sa ho boloka tahlehelo ea bona.
1. Thibelo Ka lebaka la liphephetso tsa ho phekola bokhoba ba joala, liteko tsa thibelo e kanna ea ba tsela e ntle ea ho fokotsa litlamorao tsa boits'oaro bo bobe ho batho ka bomong le sechabeng. Mohlala, ho khaotsa ho tsuba ho thata haholo, empa litekanyetso tsa ho tsuba li theohile haholo lekholong la ho qetela la lilemo ka lebaka la boiteko ba ho thibela le ho kenya letsoho ho etsa hore ho tsuba ho be thata.6 Thuto ka kotsi ea ho tsuba e qala sekolong sa mathomo, mme lingaka li lebelletsoe ho botsa mabapi le ho tsuba, eletsa bakuli ka likotsi tsa eona le ho ba fa leseli mabapi le ho tlohela koae. Ha ho molaong ho rekisa koae ho bana, mme lisakerete lia laoloa ebe li lefisoa lekhetho ho li etsa hore li se ke tsa fumaneha, haholoholo ho bacha. Ho tsuba ho thibetsoe libakeng tse ngata tsa sechaba liprofinseng tse ngata. Ka nako e tšoanang le liphetoho tsena, litekanyetso tsa ho tsuba li theohile ho 42% ho 1965 ho 21% ho 2004.101
Ho khothalelitsoe boiteko bo tšoanang ho thibela botenya. Lithuto mabapi le ho ja ka mokhoa o phetseng hantle le khalori le lijo tse nang le mafura li ka fuoa bana le batsoali ba bona ho ba thusa ho rala lijo tse phetseng hantle.102 Bafuputsi le litsebi tsa maano a sechaba ba khothalelitse ho thibela thekiso ea lijo tse bobebe le lino tse bonolo ho bana, haholo likolong , ho lefa lekhetho le se nang phepo, lijo tse nang le khalori e phahameng, le ho fana ka lijo tse fanang ka lijo tse phetseng hantle joalo ka litholoana le meroho. lipalangoang tsa sechaba.
2. Litlhare tsa kalafo Meriana e sebetsang ho fokotsa tšebeliso ea lithethefatsi e boetse e sebetsa hantle bakeng sa ho fokotsa takatso ea lijo. Topiramate e nahanoa hore e thibela ho ntshwa ha dopamine ka hara sisteme ea mesocorticolic, ka hona e fokotsa litlamorao tse monate tsa joala.105 Topiramate ka mokhoa o ts'oanang e bonahala e sebetsa hantle ho hlahiseng boima ba 'mele ho batho ba batenya haholo.106
Rimonabant, sethethefatsi se thibelang li-cannabanoid receptors, se 'nile sa lekoa e le kalafo bakeng sa mathata ohle a ts'ebeliso ea lithethefatsi le botenya.107 Lipatlisiso tsa pele li khothalelitse e ne e sebetsa e le kalafo bakeng sa ts'ebeliso ea nicotine le joala, hammoho le ho fokotsa ts'ebeliso ea lijo le ho ntlafatsa lipid le maemo a tsoekere ea mali ho bakuli ba batenya haholo.108 Leha ho le joalo, rimonabant e ne e amahanngoa le ts'oaetso e kholo ea litla-morao tse matla tsa kelello, e lebisang ho Tsamaiso ea Lijo le Lithethefatsi ea US ho hana tumello ea eona.109
3. Litlhare tsa boitšoaro Mekhoa e meng ea kalafo ea ho lemalla lithethefatsi e ka boetse ea thusa batho ba batenya ho laola ho ja haholo. Mehlala ea liphekolo tse ka sebetsang bakeng la botena le mathata a ts'ebeliso ea lithethefatsi li kenyeletsa kalafo ea boits'oaro bo botle, mananeo a bohato ba 12, le taolo ea maemo a tšohanyetso.
a. Phekolo ea Boitšoaro ea Cognitive Litlhare tsa kalafo ea Cognitive-boitšoaro (CBT) bakeng sa bokhoba ba lithethefatsi le joala li ithutile haholo. CBT e ipapisitse le mohopolo oa thuto ea kahisano le maikutlo a hore boitšoaro bo kenelletseng bo ithutoa.110, 111 Mohato oa pele oa CBT ke litekolo tse hlakileng tsa menahano, maikutlo le litumelo tse kenyang tšebeliso ea lithethefatsi. Phekolo ea CBT e shebana haholo le koetliso ea bareki ho fetola menahano le maikutlo le ho ntlafatsa bokhoni ba ho lemoha le ho sebetsana le litakatso, lisosa le khatello ea tšebeliso, le ho rera esale pele maemo a eketsang kotsi ea ts'ebeliso ea lithethefatsi.112 Thibelo ea ho khutla ke karolo ea bohlokoa ea CBT le lipuisano tsa CBT.113 CBT li sebelisitsoe ka botlalo ho joala, koae le mathata a tšebeliso ea matekoane.114-120
Litlhare tsa CBT tsa ho nona ka kakaretso li kenyelletsa likarolo tse tharo, phetoho ea lijo, ho eketsa ts'ebetso ea 'mele, le mekhoa ea phekolo ea boits'oaro e kang ho ipehela lipheo, ho itlhahloba, taolo ea khothatso le boits'oaro ba boits'oaro.121-125 Ntle le ho fokotsa boima ba' mele, sepheo sa Litšebelisano tsa boits'oaro bo botle ba kelello ke liphetoho tsa mokhoa oa bophelo tse eketsang tahlehelo ea menyetla li tla bolokeha. E ts'oanang le CBT bakeng sa mathata a tšebeliso ea lithethefatsi, bareki ba rutoa ho khetholla menahano le maikutlo a kenyang letsoho ho ho ja ho feta tekano, mme ba rutoa tsebo ea ho thibela le ho sebetsana le ho oela hape. Lits'ebetso tsa boits'oaro ba kelello tse bonts'itseng li bonts'itse katleho ho holiseng tahlehelo ea boima ba 'mele.126-129
b. Lihlopha tsa Mehato e 12 Lihlopha tsa ho ithusa tse thehiloeng ho Alcoholics Anonymous (AA) ke tse ling tsa lipuisano tse sebelisoang haholo bakeng sa batho ba lekang ho hlola lithethefatsi tsa joala le lithethefatsi. Lihlopha tsena, tse shebileng ho tlatsa mehato e leshome le metso e 'meli ea ho hlaphoheloa, li thehiloe ho mohlala oa bokhoba e le bokuli ba' mele, ba kelello le ba moea.130 Lits'ebetso tsa mantlha tsa AA le lihlopha tsa bohato ba 12 bakeng sa mathata a ts'ebeliso ea lithethefatsi (Narcotic Anonymous, Cocaine Anonymous) ke kamohelo le boinehelo. Barupeluoa ba khothalletsoa ho amohela taba ea hore ba tšoeroe ke lefu le sa foleng, le tsoetseng pele, leo ho se nang pheko, le hore ho ila joala kapa lithethefatsi ke tsona feela mokhoa o mong oa ho lemalla. Barupeluoa ba kopuoa ho nehelana ka thato ea bona ho "matla a phahameng." Ho ikopanya le lino tse tahang kapa lithethefatsi ke karolo ea bohlokoa ea lihlopha tsa methati ea 12.
Barupeluoa ba fuoa motšehetsi, hangata e le setho se nang le boiphihlelo se nang le nalane ea ho hlaphoheloa, ea ka ba thusang mathateng a ho hlola temallo.
Overeaters Anonymous (OA) ke lenaneo la bohato la 12 le nkang botenya e le sesupo se le seng sa ho qhekella ho tlola tekano, le ho nona ka matla joalo ka joala, ho nkoa e le lefu le lemaletseng.131 joalo ka AA le lihlopha tse ling tsa mehato ea 12, OA e hatisa kelello le kelello. likarolo tsa semoea tsa ho ja ho feta tekano le ho shebana le botsoalle, ho amohela, ho lemoha meeli ea matla, ho inehela ho matla a phahameng, le ho nka "lethathamo la boitšoaro" molemong oa ho tseba litaba tse ka thusang ho lahleheloa ke taolo ea ho ja. Le ha ho itlopa joala ho hlalosoa habonolo joalo ka ho qoba ts'ebeliso e felletseng ea joala, litlhaloso li bonolo ho feta ho OA, kaha ho itima lijo ho ke ke ha khoneha. Litho tse ling li hana ho ja lijo tse itseng tseo ho nahanoang hore li baka ho nona haholo, joalo ka tsoekere e hloekisitsoeng, ha tse ling li ithaopa ho hana ho ja haholo kapa ho itlopa lijo. Leha ho na le botumo ba lihlopha tsa bohato ba 12, ha ho na lipatlisiso tse fokolang tse phatlalalitsoeng tse lekang katleho kapa katleho ea OA e le kalafo ea ho nona haholo le botenya.
c. Tsamaiso ea Tšohanyetso Tsamaiso ea maemo a tšohanyetso (CM) ke ts'ebetso e ipapisitseng le melaoana ea boemo ba ts'ebetso e fanang ka likhothaletso tse bonahalang bakeng sa boits'oaro bo totobetseng joalo ka ho ila lithethefatsi, joala kapa nicotine. Likarolo tsa mantlha tsa CM ke ho khetholla mokhoa o lebisitsoeng (mohlala, ho itšoaea lithethefatsi), ho fumana tekanyetso ea boits'oaro (mohlala, mohlala o sa nepahalang oa moroto), le ho fana ka matlafatso nako le nako ha boits'oaro ba sepheo bo fumanoa. CM e sebelisang li-voucher tse fapanyetsanoang bakeng sa thepa le litšebeletso e sebelitse hantle haholo ho nts'etsopeleng ho boloka kalafo ea ho lemalla le ho eketsa nako ea ho ila lintho tse fapaneng.132-134 CM135 Cize e thehiloeng moputsong e fokotsa litšenyehelo tsa ho fana ka thepa ea thepa ka ho sebelisa meputso e le ho tiisa. . Ka CM e thehiloeng moputsong, batho ka bomong ba lumelloa ho hula likarete ho tsoa sekotlolo nako le nako ha ba bontša boitšoaro bo lebisitsoeng. Ho kenella ho tloaelehileng, hoo e ka bang 50% ea likarete li baka meputso, eo boholo ba eona e leng $ 1, ka menyetla e nyane ea ho hapa likhau tse ka bang $ 20 kapa $ 100. CM e thehiloeng moputsong e bonts'itse katleho ea ho ntlafatsa sephetho kalafong ea koae, amphetamine / methamphetamine, opiate, joala, le mathata a ts'ebeliso ea nikotine.136-143
Ka lebaka la ts'ebetso ea eona ha e sebelisoa ho mefuta e mengata ea mathata a ts'ebeliso ea lithethefatsi, CM e kanna ea ba kalafo e sebetsang bakeng sa ho fokotsa ho nona haholo le ho khothaletsa ho theola boima ba 'mele. Matlafatso e ka fanoa bakeng sa ho fihlela boima ba 'mele, hammoho le mesebetsi e amanang le ho theola boima ba' mele e kang ho boloka lijo le lijo tsa 'mele, ho reka le ho pheha lijo tse nepahetseng, ho bala lik'hilojule le ho fokotsa ho kenella ha khalori le ho ikoetlisa. Mekhoa ea CM ea ho theola boima ba 'mele e atlehile har'a bana.144, 145 Ha joale re na le lithuto tse ntseng li tsoela pele ho lekola ho sebetsa hoa CM ho khothaletsa ho theola boima ba batho ba baholo.
F. KHOTSO
Har'a ho tšoenyeha ho ntseng ho hola ka litekanyetso tsa botenya le katleho e lekanyelitsoeng ea kalafo ea ho theola boima ba 'mele, ho hlokahala kutloisiso e khōloanyane ea boits'oaro bo tlatsetsang ho foleng ka boima ba' mele. Ho na le 'mele o ntseng o hola oa bopaki ba ho ts'ehetsa ho tšoana ho teng lipakeng tsa tšenyo e ngata le tšebeliso ea lithethefatsi, ho kenyelletsa le menyetla e tloaelehileng lipuisanong tsa matšoao, li-comorbidities, boitšoaro le botho, le mekhoa ea tlhaho. Le ha phapang e ntse e le teng, mohlala oa ts'ebeliso e matla ea ho ja ho feta tekano o fana ka mohopolo o matla oa ho utloisisa botenya le mathata a amehang ho laoleng lijo.
Mohlala oa lefu la bokhoba ba lithethefatsi o fokolitse tse ling tsa litlolo tse tlisoang ke ho lemalla lithethefatsi le joala 'me o hanana le maikutlo a hore li emela liphoso tsa boitšoaro.146 Ho shebella mathata a ts'ebeliso ea lithethefatsi e le mathata a kelello ho thusa ho utloisisa haholoanyane boits'oaro bo hlephileng bo kenyelletsang lithahasellong tse mpe. tahlehelo ea taolo. Ka mokhoa o ts'oanang, batho ba batenya ho feta tekano ba khethollotsoe haholo mme boima ba bona bo feteletseng hangata bo talingoa e le sesupo sa ho hloka boikarabelo le bofokoli ba boitšoaro .147 Ho nona hangata ho tšoaroa joalo ka bokuli, 'me kalafo ea botenya hangata e kenyelletsa ho fokotsa bongata ba lijo tse jeoang. Leha ho le joalo, ha ho na puisano e nyane mabapi le monyetla oa hore bonyane setho sa batho ba batenya ho feta tekano se ka ba le bothata ba mafu a kelello bo ba thatafalletsang ho fokotsa ts'ebeliso ea lijo, joalo ka ha ho le thata ho batho ba nang le joala kapa ba ts'ehetsoeng ke lithethefatsi. tšebeliso ea lintho tseo. A mang a phapang lipakeng tsa ho nona ho feta tekanyo le ho itšetleha ka lithethefatsi ho ka ba le litlamorao litlhaloso tse tlang tsa mathata a ts'ebeliso ea lithethefatsi. Mamello ea 'mele le ho ikarola e se e hlaheletse ho lipontšo tsa ho ts'epahalla lintho, empa ha e sa le taba ea ho tlola tekano. Leha ho ka pheha khang ea hore sena se fokolisa taba ea hore ho be le tšenyo ea ho lemalla, ho kanna ha re mohlala oa hona joale oa ts'ebeliso ea litheko o beha haholo matšoao ana. Tsoelo-pele ho kutloisiso ea methapo ea boko ea moputso e ka fetisetsa mohopolo matšoao a mang, joalo ka tahlehelo ea taolo le ho sitoa ho thibela ts'ebeliso.
Moetso oa bokhoba ba ho ja ho feta tekano o ka tsebisa boiteko ba thibelo le kalafo ho kokobetsa ho ata ha botenya, hammoho le litlamorao tsa bongaka, tsa kelello le tsa setjhaba tsa bothata bona bo ntseng bo eketseha ba bophelo bo botle ba sechaba. Joalo ka nikotine, joala le lithethefatsi, ho fokotsa lijo tse nang le lik'hilojule tse ngata ebile e le boleng bo botle ba phepo e ka ba e 'ngoe ea litsela tse atlehang tsa ho fokotsa ho nona ho feta tekano. Phekolo ea meriana e etsang hore ho ja ho tlola ho se ruise melemo e mengata, le boits'oaro bo fanang ka meputso e meng, le eona e ka sebetsa. Tšebelisano e 'ngoe lipakeng tsa litsebi lefapheng la botenya le bokhoba ba lithethefatsi li ka hlahisa litholoana ho nts'etsapele mekhoa e nepahetseng ea boits'oaro bo feteletseng le ho e sebelisa ho rala mekhoa e metle ea ho fokotsa botenya.
LITLHAKU TSE 4 - Litšobotsi tse tloaelehileng ho batho ba nang le botenya / botenya le mathata a ts'ebeliso ea lithethefatsi
Litšobotsi tsa Botho
• Lipalo tse phahamisitsoeng lethathamong la batho ba batlang bocha ba Temperament and Character Inventory (TCI)
• Lipalo tse tlase molemong oa boits'oaro ba TCI
• Likolo tse phahameng haholo mabapi le mekhoa ea ho itlaleha.
• Likolo tse futsanehileng ho mosebetsi oa papali ea chelete ea Iowa.
• Likhetho tsa moputso o monyane o potlakileng oa ho lieha ho lieha ho mosebetsi o fokotsoang.
Mathata a Khahlano le Boitšoaro
• Litefiso tse phahameng tsa Attention Deficit Hyperacaction Disorder
• Litefiso tse phahameng tsa Pherekano ea Boitšoaro
• Mefokolo mabapi le liteko tsa tšebetso e phahameng.
Mekhoa ea Brain
• Ho tšebelisa matla le ho sebelisa lithethefatsi ho matlafatsa tsamaiso ea mesoporticolimbic dopamine
• Palo ea li-receptor tsa dopamine tsa D2 li fokotsehile ho tloha maemong a tloaelehileng matsohong a batho ba batenya le basebelisi ba lithethefatsi tse sa foleng, ho fana ka maikutlo a ho theoha ha li-receptors ka ts'usumetso e sa feleng ea sistimi ea dopamine.
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