Tlhahlobo ea bothata ba ho becha le mathata a ho sebelisa lithethefatsi (2016)

bangodi Rash CJ, Weinstock J, Van Patten R

Carla J Rash,1 Jeremiah Weinstock,2 Ryan Van Patten2

1Setsi sa Cardiology sa Calhoun - Bophelo bo Botle, Bophelo bo Botle ba UConn, Farmington, CT, USA; 2Lefapha la Psychology, Univesithi ea Saint Louis, St Louis, MO, USA

Sekhetho:

Khatisong ea bohlano ea Buka ea ho hlahloba le ea Statistical ea Mathata a kelello (DSM-5), bokuli ba ho becha bo arotsoe ho tloha karolong ea "Impulse Control Disorder" ho ea karolong e sa tsoa atolosoa ea "Lits'ebeletso tse amanang le tlhekefetso le tlhekefetso". Ka ts'ebetso ena, bothata ba papali ea chelete ea ho becha e se e le tšibollo ea pele ea boitšoaro bo sa tsotelleng, e bolelang likarolo tse ngata tse arolelanoang lipakeng tsa bothata ba ho becha le mathata a tšebeliso ea lithethefatsi. Tlhahlobo ena e hlahloba ho tšoana hona le phapang lipakeng tsa papali ea chelete le mathata a amanang le lithethefatsi. Tlhahlobo ea tšoaetso, ho hlaka, ho hlaka ka liphatsa tsa lefutso le 'mele, le mekhoa ea kalafo e tšohloa.

Keywords: papali ea methapo ea kelello, papali ea chelete ea bothata, ho lemalla litabeng tsa boitšoaro, lintlha tsa transdiagnostic, lefu la ho lemalla
 

Selelekela

Boloetse ba ho becha (GD) ke mokhoa o sa khaotseng oa ho becha o bakang ho senyeha kapa khatello ea maikutlo.1 Bakeng sa ho fihlela litekanyetso, batho ka bomong ba tlameha ho bonts'a matšoao a mane kapa ho feta a robong nakong ea likhoeli tsa 12. GD e ka hlahisa e le episodic kapa e ntse e phehella mme e lekantsoe e le bonolo, e leka-lekaneng, kapa e tebile ho latela palo ea matšoao a emeng. Khatisong ea bohlano ea Buka ea ho hlahloba le ea Statistical ea Mathata a kelello (DSM-5),1 ts'ebeliso ea ho becha ha methapo ea methapo e ile ea reoa GD 'me ea aroloa hape ho tloha taolong ea taolo ea tšusumetso ho ea ho lefu le amanang le bokhoba, e totobatsang maikutlo a nako e telele a GD e le tšibollo. Likhokahano lipakeng tsa GD le tahi le tšebeliso ea lithethefatsi (AUD / DUD) li ngata ebile li kenyelletsa tlhahlobo ea tlhahlobo ea kalafo, litekanyetso tse phahameng tsa comorbidity, underpinnings ea liphatsa tsa lefutso, litlamorao tse tšoanang tsa neurobiological, le mekhoa e tloaelehileng ea kalafo. Bakeng sa maikutlo a tlhatlhobo ena, AUD e bua ka ts'ebeliso e mpe ea tahi kapa ho itšepa 'me DUD e bua ka ts'ebeliso e mpe ea lithethefatsi kapa tlhekefetso e seng molaong (e se nang boloi, e senang joala) ntle le ha ho boletsoe ka tsela e ngoe. Ha ho nahanoa ka ho nchafatsoa ha GD e le tšibollo ea pele ea litheko tse sa sebeliseng lithethefatsi, pampiri ena e tla fana ka setšoantšo se akaretsang sa likhokahano tse ka bang teng lipakeng tsa GD le AUD / DUD ho tloha etiology ho ea ho mekhoa ea phekolo ka ho totobatsa libaka tse anngoeng ke DSM-5 sehlopha.

Tlhahlobo ea ho hlahloba

Ho na le sebaka se pharaletseng se hahelletsoeng ka mohaho DSM-5 GD le AUD / DUD, ba fuoe seo ea mantlha DSM-III litekanyetso tsa papali ea chelete li ne li etsoa haholo motheong oa litheko tsa nako eo.2 Leha ho le joalo, ho na le phapang ea bohlokoa literekeng tsena tse peli tsa tlhahlobo ea mafu, 'me ka lebaka leo, the DSM-5 Sehlopha sa Ts'ebeliso ea Lithethefatsi (SUD) Sehlopha sa basebetsi se khothalelitse ho amohela DSM-IV Litekanyetso tsa GD tse nang le liphetoho ntle le ho feto-fetoha le maemo a SUD a GD.3 In Lethathamo 1, re thathamisa maemo a GD le AUD, re totobatsa ho fetela kapa lintho tse ling tse tšoanang. Lintho tse nang le phapang e matla ka ho fetelletseng e kenyelletsa ho mamella, ho tlosa, taolo ea taolo, le litlamorao tse mpe. Mabapi le kaho ea morao-rao, GD e na le ntho e le 'ngoe e amanang le tšusumetso e mpe litsing tsa sechaba, tsa thuto, kapa tsa mosebetsi; bakeng sa AUD, lintho tse 'ne li hlalosa litšusumetso tse mpe litsing tse fapaneng tsa bophelo (mohlala, bophelo bo botle ba kelello, bophelo bo botle ba' mele). Litekanyetso tsa AUD / DUD tse kentsoeng, ho kenyelletsoa le lintho tsena tse mpe tse mpe, li ka hlahlojoa bakeng sa bofokoli bo bong hape le monyetla oa ho hlophisoa bocha likhatisong tsa DSM tsa nakong e tlang,3 ka ho etsa joalo ho thusa ho bonts'a phumano e kholo lipakeng tsa mafu a lemallo. Ka lehlakoreng le leng, ntho e mpe ea litla-morao tsa GD e kanna ea eketsoa ho kenyelletsa libaka tse ling tse amanang le bophelo bo botle ba kelello, boo hangata bo nang le tšusumetso e mpe ho ba nang le lefu lena.4,5 Haholo-holo, litekanyetso ka bobeli tsa comorbidity6 kotsi ea ho ipolaea le liteko7,8 ba bontšitsoe hore ba phahame ho batho ba nang le GD.

 
Tafole 1 Papiso ea DSM-5 bothata ba ho becha le litloaelo tsa tšebeliso ea joala
Sesebelisoa: DSM-5, Buka ea Bokhokahanyi le Boitsebiso ba Mathata a Kelellokhatiso ea bohlano.

Karolo ea bobeli e arolelanoang ea tlhahlobo ea mafu ke ho lokisa boitšoaro bo lemallang. Ho GD, ho aha hona ho boleloa e le ho ameha ka ho becha, 'me e bua ka ho fokotsa liphihlelo tsa nakong e fetileng tsa papali ea chelete, ho rala liphihlelo tsa nakong e tlang tsa papali ea chelete le mekhoa e metle ea ho tšehetsa papali ea chelete. Bakeng sa AUD, ntho e ka bapisoang le ho qeta nako e ngata ho fumana, ho sebelisa, kapa ho hlaphoheloa ts'ebelisong ea joala e tsamaellana le likarolo tse ling tsa tlhophiso tse hlahang nthong ea GD. Leha ho le joalo, ntho ea AUD ha e sebetsane ka botlalo le karolo ea kelello ea ho tsotella e bonts'itsoeng ho GD. Ntho e lakatsang ho tsoa lits'ebetsong tsa joala, e ncha ho DSM-5, e ka hapa karolo ea moaho ona oa kelello. Ntho e lakatsang ha ea ka ea eketsoa ho litekanyetso tsa GD, tse sa sebetsaneng ka ho hlakileng le litakatso. Leha bopaki bo supa hore litakatso li tloaelehile hara batho ba nang le GD9,10 le hore li amana le boitšoaro ba papali ea chelete,11,12 Potso ea hore na litakatso ke tsona khubu ea ts'oaetso ea GD, joalo ka ho SUD, e ntse e sa arabeloe. Lintho tse setseng, tse 'ne ho tsoa ho GD le e le' ngoe ho tsoa ho AUD, ha li na sekala se lekanang ho seteraeke se seng le se seng mme li totobatsa likarolo tse ikhethang tsa pherekano e ngoe le e ngoe (mohlala, ho lelekisa tahlehelo). Lipotso li sala mabapi le hore na ho loants'a mekhoa ea GD ho beha mohlala o haufi haholoanyane oa litekanyetso tsa SUD ho na le molemo bakeng sa ho hlahloba lefu la GD le bakeng sa tlhahlobo ea tlhahlobo kahare ho karolo.

Ho ata

AUD e bonts'a litekanyetso tse phahameng tsa tšoaetso e amanang le maemo a mang a mangata a kelello. Mohlala, nako ea bophelo le litekanyetso tsa ho hlaseloa tsa selemo se fetileng tsa AUD e ne e le 30.3% le 8.5%, ka ho latellana, Thutong ea Sechaba ea Epidemiologic mabapi le Joala le Maemo a amanang le ona (NESARC).13 Litefiso tsena li phahame haholo ho feta litekanyetso tsa tlhaselo ea DUD efe kapa efe e sa tsubeng (nako ea bophelo: 10.3%, selemo se fetileng: 2.0%) le khatello e kholo ea khatello ea maikutlo (bophelo: 13.2%, selemong se fetileng: 5.3%).13 Liphetho tse tsoang ho sampole tse emelang naha li hakanya ho ata ha GD ka ~ 1% –2% ea mekhoa ea bophelo ea kopano le halofo ea mekhoa ea seboka selemong se fetileng.14-17 Bacha, botona ba botona le botšehali, boemo bo tlase ba moruo, le boemo ba lenyalo bo sa lefelloeng (ke hore, ha ho mohla ba kileng ba nyala, ba hlalana, ba arohana, bahlolohali) ke lipalo tse tloaelehileng tse arolelanoang ke batho ba nang le GD le AUD / DUD.13,15-17

Tšibollo ea tšoaetso

ka DSM-5, monyako oa ts'oaetso bakeng sa GD o theotsoe ho tloha ho mekhoa e mehlano ho e leshome ho ea mokhoeng oa hona joale oa litekanyetso tse 'ne tsa tse robong.1 Liphetoho tse entsoeng ke DSM-5 Sehlopha sa SUD Work ho ea ho litekanyetso tsa GD li ne li etselitsoe ho fokotsa sekhahla sa litekanyetso ha li ntse li ntlafatsa ho nepahala ha tlhahlobo ea mafu.18 Le ha ho le joalo, keketseho e nyane ea litekanyetso tsa boteng ba GD e ka ba joalo DSM-5 mekhoa ea amoheloa. Mohlala, ka mohlala oa baahi ba ntlo ba US ba khethiloeng ka mokhoa o sa reroang (N = 2,417), litekanyetso tsa tšoaetso ea GD li eketsehile ho tloha 0.1% ho 0.2% li sebelisa DSM-5 mekhoa.19 Mehlala e tsoang maemong a bophelo bo botle ba ho becha le bona e tla ameha. Bokapele ba GD bo eketsehile ho tloha 81.2% tlasa DSM-IV ho 90.3% sebelisa DSM-5 Litekanyetso lipakeng tsa Bareki ba Boloi ba Virg West (N = 2,750) ba bitsa mohala oa thuso ea papali ea chelete.8

Leha ho na le monyetla o fokolang, phapang e sa feleng lipakeng tsa SUD le GD mabapi le lits'oaetso tsa tlhahlobo le kananelo ea mefuta e bobebe ea lefu lena.8,20 bakeng sa DSM-5 Litekanyetso tsa SUD, tse kopanyang DSM-IV tlhekefetso ea lithethefatsi le lintho tse itšetlehileng ka eona ho lefu le le leng la tlhahlobo, ke matšoao a mabeli kapa a fetang a leshome le motso o mong feela a hlokahalang bakeng sa tlhahlobo. Ho teba ho bontšoa ka matšoao a bobebe (matšoao a 2-3), a lekaneng (matšoao a 4-5), le matšoao a tebileng (a tšeletseng kapa ho feta), a sa nepahalang ka matšoao a matla a GD: bonolo (4-5), e leka-lekaneng (6-- Matšoao a 7), le a tebileng (matšoao a 8-9).

Haeba litekanyetso tsa GD li ne li ka tsamaisoa ka kotlolloho ka mora mekhoa ea SUD ka monyako oa eona o tlase, tekanyo ea tlhaselo ea GD e ne e tla nyoloha haholo, e le 2% e eketsehileng ea batho ba nang le mathata a bophelo ba ho becha ka mokhoa o ikhethileng.14,15 Ho nahanoa ka phetoho e joalo, leha ho na le tšusumetso e ka bang teng palong ea batho ba bangata, e kanna ea amoheloa haeba batho ba nang le matšoao a tlase a GD ba na le maemo a tebileng a ho sithabeha kapa ho lemala ho latela AUD / SUD e bonolo mme haeba ba rua molemo tsebong le kalafong. Lithuto tse 'maloa li na le litlamorao tse mpe tse amanang le papali ea chelete e fokolang, ho kenyelletsa le kotsi e eketsehileng ea ho hlasimoloha,6,21 mathata a lichelete le mokoloto o amanang le papali ea chelete,8 le monahano oa ho ipolaea le liteko.7 Ha ho fanoa ka litlamorao tsena tsa bohlokoa, hammoho le litheko tse phahameng tsa comorbidity lipakeng tsa AUD / DUD le GD (tse tšohliloeng karolong e latelang), ho ts'oana ha litekanyetso tsena ho ka thusa lingaka ka ho sebelisa mekhoa e le 'ngoe le litekanyetso tse tebileng tsa mathata.

Ho itšoara hampe

GD le mathata a kelello

Comorbidity le mafu a mang a kelello, ho kenyeletsa le lithethefatsi tse ling, e tloaelehile ho AUD / DUD le GD. Boholo ba 96% ea batho ba nang le bophelo bohle ba GD le bona ba kopana le maemo a bonyane lefu le leng la kelello la bophelo bohle.6,15 Litefiso tsa bophelo bohle ba mafu a mangata a kelello li phahamisoa har'a ba nang le GD,16 ka moea (49% –56%)15,16 le matšoenyeho (41% –60%)15,16 mathata le AUD (73%)16 le DUD (38%)16 ho ba teng haholo.15 Mathata a botho a boetse a atile haholo har'a ba nang le GD16 le ho ata ha mathata a mangata a comorbid le hona ho eketseha. Haholo-holo, thutong e nkang likarolo.15 batho ba nang le GD e ne e le linako tsa 30 hangata tsa ho ba le mathata a mangata a kelello (a mararo kapa ho feta) a bophelo bohle ba kelello ha a bapisoa le a se nang GD. Ntle le moo, tlhahlobo ena ea morao-rao e bonts'a hore boholo ba "comorbidity" ena (74%) boa ba teng pele mme e ka ba sesosa sa kotsi ea nts'etsopele ea GD ho fapana le ho sebetsa ka GD e le sesosa sa kotsi bakeng sa nts'etsopele ea mafu a mang a kelello. Leha ho le joalo, lithuto tsa nako e telele tse tlang,22,23 e leng molemo ho theheng tatellano ea nakoana ea ho qala ha pherekano, e fana ka maikutlo a hore GD ea selemo se fetileng e amana le nts'etsopele e latelang ea maemo a macha a kelello ho kenyelletsa mohono, matšoenyeho le AUD. Kotsi ea ho ba le mafu a macha e bonahala e amana le ho teba ha boitšoaro ba papali ea chelete,23 le ba bechang, ba kotsing e kholo ea ho qaleha ha bokuli bo bocha ba comorbid ha bo bapisoa le bothata kapa papali ea papali ea chelete. Ka kakaretso lingoliloeng li ts'ehetsa kamano ea motho ea mabapi le maikutlo a hae mabapi le ho hlonama hoo mafu a kelello a ka sebetsang e le mabaka a tlhabollo, a ka sebetsa e le lintlha tsa tlhokomelo ho GD, mme a ka hlaha ka lebaka la GD.15,22,24

GD le AUD / DUD

Kamano ea GD le mathata a mang a bokhoba e thehiloe hantle. Likhakanyo tsa meta-analytics tse thehiloeng ho baahi li bonts'a litekanyetso tse phahameng tsa nako ea bophelo ea AUD le DUD comorbidity hara mathata a bophelo le ho becha ha methapo ea methapo, ka 28% ea ba bechang ba tlalehang AUD le 17% e tlaleha DUD e seng molaong.25 Tekanyetso ena ea tšoaetso e utloisisoa hamolemo ka ho bapisa phapang ea litekanyetso tsa tlhahlobo ea SUD / DUD har'a ba nang le GD. Mohlala, ho Welte et al17 ho ithuta, 25% ea ba nang le GD ba ile ba kopana le litekanyetso tsa ts'ebeliso ea joala ea hajoale, athe ke 1.4% feela ea ba se nang GD ba neng ba lemaletse joala. Ho tiisa lipuisano tsa mefuta-futa ea lihlahisoa tse bonts'itsoeng pejana, ho ba teng ha mafu a mahlakore a mabeli, joalo ka AUD e tšoanang le GD, ho amahanngoa le kotsi e eketsehileng ea mathata a kelello a bapisoang le ho ba teng ha GD ntle le AUD.26

AUD le DUD le tsona li atile haholo har'a batho ba batlang ho becha ho feta bathong ka kakaretso, ba nang le mekhoa e mengata ea liboka ea liboka tsa 41% bophelong ba AUD le 21% ea li-SUDs tse sa nooang ho kenyelletsa ho itšetleha ka nicotine.27 Comorbid DUD e fana ka sephetho sa papali ea chelete e le hore ba se nang nalane ea bophelo ba DUD ba makhetlo a 2.6 ba na le monyetla o moholo oa ho fumana nako ea likhoeli tsa 3 ea ho tlohela papali ea chelete ha e bapisoa le ba nang le DUD ea bophelo bohle.28 thuto e 'ngoe29 e fana ka maikutlo a hore esita le ho ba nang le bophelo ba AUD / DUD, bongata (58%) ba batlang ts'ebeliso ea papali ea papali ea chelete ba sebelisa joala kapa lintho tse seng molaong selemong se tlang pele ba amoheloa kalafo ea papali ea chelete. Ka lehlohonolo, tšebeliso e mpe ea lino tse tahang tse kotsi (tse fetang 14 lino tse tloaelehileng / beke kapa 4 / letsatsi bakeng sa ba batona; lino tse fetang tsa 7 / beke kapa lino tsa 3 / letsatsi bakeng sa basali) li bonahala li fokotseha nakong ea kalafo ea papali ea chelete,30 mme phokotso ea tlhaho ea tšebeliso ea joala e kanna ea ntlafatsoa ka ho kenyelletsoa ha mehato e mokhuts'oanyane ea ts'ebeliso ea joala liphekellong tsa papali ea chelete. Litlhare tse joalo li ka fokotsa monyetla oa ho fetela maemong a ts'ebeliso e mpe ea ts'ebeliso ea joala, boteng ba bona bo amanang le ho ts'oaroa ha papali ea chelete.28 Liphetoho tsena tse tšoanang tsa tšebeliso ea joala le papali ea chelete li bontša hore boitšoaro bona bo ka ba le tšusumetso ha nako e ntse e feta.

Ha ho fanoa ka litekanyetso tse phahameng tsa tšoaetso le phello ea comorbid DUD le AUD litlamorao tsa papali ea chelete, ho kenyeletsoa lits'ebetso tsa tlhahlobo ea AUD le DUD ts'ebetsong ea bongaka e khothalletsoa ho bakuli ba nang le GD. Tlhatlhobo, e hlahlobang bakeng sa papali ea chelete e batang har'a ba batlang tlhekefetso ea lithethefatsi, le eona e lokela ho ba teng. Hoo e batlang e le 15% ea ba batlang kalafo ea AUD / DUD ba fihlela mekhoa ea bophelo ea GD mme 11% e kopana le mekhoa ea hona joale ea GD.31 Har'a bakuli ba nkang opioid, litheko tsa GD li kanna tsa ba holimo le ho feta,31 'me bothata ba papali ea chelete bo amahanngoa le karabelo e futsanehileng ea kalafo ea tlhekefetso ea lithethefatsi hara bakuli bana.32 Kahanyo ea tlhahlobo ea papali ea chelete ea ho becha le lits'ebetso tsa ts'ebetso ea tlhekefetso ea lithethefatsi e ka ntlafatsa eseng feela bothata ba papali ea chelete, empa le liphetho tsa kalafo tsa AUD / DUD. Ntle le moo, batho ba bangata ba nang le AUD / DUD ba khona ho itlopa joala le lithethefatsi, empa ba sitoa ho laola papali ea chelete ea bona.29 ho fana ka maikutlo a kalafo e tobileng kapa a kopaneng a ka 'na a hlokahala bakeng sa katleho ea kalafo ea mathata a mabeli maemong a phekolo ea tlhekefetso ea lithethefatsi.

Mofuta oa GD

Sebopeho sa liphatsa tsa lefutso tsa motho ka mong se ka beha kotsi e kholo kholisong ea SUD le GD. Karolo ea ho fapana ka lebaka la liphatsa tsa lefutso ho tloha 0.39 bakeng sa hallucinogens ho 0.72 bakeng sa koae.33 Melemo ea GD e kahara mofuta ona ho 0.50-0.60 mme e tšoana le litekanyetso tsa heritability bakeng sa joala le opiates.34 Mosebetsi oa morao-rao oa theoretical35 holima tsoelo-pele ho tloha bonyenyaneng ho fihlela bokhobeng bo fana ka maikutlo a hore menehelo ea liphatsa tsa lefutso e bapala karolo e kholo mehatong ea morao ea ts'ebetso ea bokhoba (mohlala, tahlehelo ea taolo), athe liphihlelo tsa tikoloho li bonahala li tsamaisana le ho pepesa le liteko.36,37 Linehelo tsena tsa tikoloho ho tseko e ka bang kotsing ea ho holisa GD li tlalehiloe ka lebaka la 38% –65% ea phapang e teng liphatseng tsa boitšoaro ba papali ea chelete.38 le ho emela ntlha ea bohlokoa ea ho utloisisa nts'etsopele ea bokuli bona. Lintlha tse ikhethang tsa tikoloho tse tsejoang e le mabaka a kotsi bakeng sa GD li kenyeletsa ho hlekefetsoa ha bana,39 boitšoaro ba motsoali ba ho becha le ho beha leihlo,40-42 amohela tloaelo ea ho becha,40 le lintlha tsa boemo bo joalo ka bonolo ba ho theha papali ea papali ea chelete le lintlha tsa moputso.43

Boholo ba kotsi ea ho lemalla lithethefatsi ha bo sa hlalosehe ebile bo arolelanoa linthong tsohle. Kotsi ena e arolelanoang e kanna ea hlahisoa ke mefuta e pharalletseng e kang ho hobosoa le ho ama hampe, tse nang le liphatsa tsa lefutso mme li ka sebetsa e le mabaka a kotsi bakeng sa ts'ebeliso ea lithethefatsi.44 Ha ho kotsi feela hore likotsi tse tsamaisanang le tlhekefetso le tse mpe li ama lintho tse khahlapetsang, empa sengoloa hape se fana ka maikutlo a hore lintlha tsena ke mabaka a tlatselletsang a nts'etsopele ea mathata a mang a kantle a kantle ho naha, ho kenyeletsoa le GD.34,45 Mohlala, thuto e lebelletsoeng ea tsoelo-pele24 o khothalelitse hore 1) ho susumetsoa ke bohlankana ho susumetsa tsoelo-pele ea mathata a marang-rang le mathata a ho itlosa bolutu, le hore 2) matšoao ana a mabeli a ka nako eo a phaellana ho feta bohlankana le boroetsaneng. Ntle le moo, mabapi le lipatlisiso tsa mechini, boteng ba taqiti ea Taq A1 ea dopamine receptor D2 polymorphism e hokahantsoe le GD le AUD.46 Allele ena e amahanngoa le ho eketseha ha khatello ho mesebetsi ea methapo,47 e fana ka tlhahiso ea hore bonyane karolo ea karohano ea liphatsa tsa lefutso e arolelanoang lipakeng tsa GD le ts'oaetso ea joala (12% –20%)48 e bakoa ke tšekamelo ea liphatsa tsa lefutso e lebisang tlhahisong e ka tlase e ho susumetsang.

Ha e kopantsoe hammoho, liphetho tsena li fana ka tšehetso bakeng sa mofuta oa bokhoba ba tahi, bo emisang hore lintho tse fapaneng tsa bokhoba ba tsona li arolelana li-diatheses tsa mantlha le sequelae.37 Leha sephetho sa sephetho se fetoha (mohlala, ho se laolehe ho becha le tšebeliso ea heroin e sa laoloang), litekanyetso tse tlase tsa tlholeho li atoloha haholo, li bonts'a mohopolo oa tšebeliso ea maemo, eo ho eona batho ba nang le semelo se ts'oanang ka kotsi le mabaka a ts'ireletso ba nang le liphetho tse fapaneng tsa nts'etsopele.49

Neurobiology

Tsela e tlohang liphatseng tsa lefutso ho ea boits'oarong, e pheta-phetoang, 'me e fetoloa maemong a mahareng ke li-neural circry, tse hahiloeng haholo ka tsela ea ts'ebetso ea liphatsa tsa lefutso le e sebetsang ho laola boitšoaro ba phenotypic. Mohlala, mesocorticolimbic dopamine pathway modulates boleng ba moputso oa lintho tse lemalloang le boits'oaro.35 Lithuto tse 'maloa tsa GD le DUD li qapile litlatsetso tsa liphatsa tsa lefutso likarolong tse fapaneng tsa tsela ena, ho kenyelletsa le letsoalo la li-receptor tsa D2 le boholo ba tokollo ea dopamine, tse bolelang esale pele karabelo ea subdon ea hedonic.50

Joalo ka ha lipehelo tsa liphatsa tsa lefutso ho ts'ebetso li kopane, ts'ebetso ea ts'ebeliso ea lithethefatsi e rarahane haholo hore e ka bapaloa ke neurocircuit e le 'ngoe. Marang-rang a mang a kenyelletsang ts'ebetsong ea bokhoba ba joala a kenyelletsa tsela ea nigrostriatal,51 the hypothalamic-pituitary-adrenal (HPA) axis,52 insula,53 le libaka tse ngata tsa preortal cortex (PFC).54 E le mofuta o pharaletseng oa ts'ebeliso ea tahi, Koob le Le Moal36 e hatisitse boteng ba bobeli ba 1) ka hare ho li-neuroadaptations, tse khetholloang ke moputso o phahamisitsoeng oa moputso (ke hore, mamello) e arolelanoang ka phokotso mosebetsing oa ventral striatum dopamine, hammoho le 2) lipakeng tsa li-neuroadaptations tse kahare lits'ebetso (mohlala, li-axis tsa HPA, amygdala tse atolositsoeng) li ntse li sebetsa ka mokhoa o matla, li baka maemo a amang a mabe (ke hore, ho ntsha, ho lakatsa) ha ho sena ntho / boitšoaro. Liphetoho tsena tse noanoadaptive li lumellana le likhopolo tse ngata tsa kholo ea tsoelo-pele ea ho lemalla35 'me e ka fetoloa holima tšusumetso ea matla a ho susumetsa ntle le ho qobelloha moo ho kenya letsoho boits'ebetsong ba bokhoba ho hlahisoang ke takatso e susumetsoang ke sepheo sa liphello tsa hedonic. Boitšoaro bo latelang bo latela nts'etsopele ea mamello le liphetoho tse kholo ho li-neurocircuitry tsa bohlokoa, mme, ho fapana le ho kopanela pele, ho khannoa ke takatso ea nakoana, e khothalletsoang ea ho fumana ho tšoenyeha le tšusumetso e mpe (ke hore, fokotsa takatso, qoba ho khaotsa). Bopaki bo fana ka maikutlo a hore tšebeliso ea lithethefatsi tse sa feleng e senya marangrang a PFC a bohlokoa bakeng sa phetisetso e phahameng ea boitšoaro, e fokotsa bokhoni ba ho sebelisa taolo ea thibelo e hlokahalang bakeng sa ho thibela bootsoa.55 Tšenyo ena e setseng e kanna ea thusa ho hlalosa hore na hobaneng mekhoa e meng e lemalletseng e ka ba teng kamora ho khaotsa ho ba le ts'ebetso ea ho lemalla le hore na ke hobaneng ha e ka khutla ka mor'a nako ea ho tlohela ho ka ba teng ha GD e kopane le DUD.

Koob le Le Moal's36 li-modular converter tse nang le ts'ehetso ea ho kenya letsoho ha litheko tsa mantlha tsa ts'ebeliso ea lithethefatsi pele, ho lateloa ke ho eketseha ha molumo oa dorsal striatum ha litekanyetso tse joalo li qala ho eketsa moputso oa hedonic e le mothati oa bohlokoa oa boits'oaro.56 Moelelong ona, batho ka bomong ba ba le litakatso tse latelang makhetlo a mabeli a bonts'ang maikutlo a lerato (mohlala, "pssht" ea biri e ka) le litloaelo tsa boits'oaro (mohlala, tšebeliso ea joala) ka ts'ebetso ea maemo a khale. Kamora nako, ho amoheloa ha linaha tse phephetsang (mohlala, litakatso, ho khaotsa) tse amanang le boits'oaro ba bokhoba e ba sesosa sa mantlha sa ho khina ho tsoela pele ho kenella liketsong. Ho khahlisang, tšenyo ho subregion ea insula, e nang le boikarabello ba ho lekola maemo a hare le maikutlo a maikutlo, e tlosa boiphihlelo ba ho lakatsa.57

Ntle le ts'ebetso, mohloli o mong oa bohlokoa oa neurobiological oa sesebelisoa se khahlanong le moputso ke axis ea HPA. Tsela ena ea neuroendocrine e sitisoa ke ho pepesehela lintho khafetsa, le nakong ea papali ea papali ea chelete,58 e fetolang bokhoni ba eona ba ho sebetsa ka nepo le ka nepo.52 Liphetoho ho axis ea HPA e hlahisoang ke tšebeliso ea lithethefatsi khafetsa li kenyelletsa keketseho ho potoloha li-hormone tsa adrenocorticotropic le corticosterone. Liphetoho tsena li etsa hore batho ba lemaletseng khatello ea maikutlo ba be le khatello ea maikutlo haholo le nako e telele ho feta ba bang36 mme li lebise keketseho ea nako e telele ea ho ts'oenyeha ha bona litlamorao tse mpe tsa khatello ea maikutlo.59 Ntle le moo, liphetoho tse joalo ho axis ea HPA li nkuoa pakeng tsa litsamaiso tse teng pakeng tsa ts'ebetso ea bokhoba, hobane ts'ebetso ea ts'ebetso ea karabelo ea khatello ea methapo e kopanya boiphihlelo ba ho lakatsa le ho bolela esale pele.59

Leha Koob le Le Moal's36 mohlala o hlophisitsoe ho pota-pota lintho, bopaki bo hlahang bo hokahanya liemahale tse kentsoeng ho ts'ehelong ea lithethefatsi ho GD le. Mohlala, phetoho e sa bonahaleng e khothalletsang - e kenang DUD le eona e etsahala ho GD.60 Ntle le moo, ka molek'hule, bopaki bo supa hore li-receptors tsa dopamine D2 li etsa mosebetsi oa ho putsa sekhahla sa papali ea chelete ka bobeli61 le tšebeliso ea lithethefatsi.62 Mabapi le tšusumetso ea dopaminergic ho GD, dopamine agonists, hangata e sebelisoang e le pharmacotherapy bakeng sa batho ba nang le lefu la Parkinson le syndrome ea leoto le sa foleng, e ka lebisa ho kenelletseng mekhoeng ea hedonic e joalo ka hypersexourse le papali ea chelete, ka mokhoa o hlakileng ka mokhoa oa dysamine oa tsela ea moputso oa dopamine.63 Ka lehlakoreng le leng, pharmacotherapy e nang le bahanyetsi ba dopamine e bontšitse katleho e itseng ho phekoleng ho itšetleha ha joala,64 leha bopaki bo ntse bo tšehetsa tšebetso ea mokhoa ona ho GD.65,66 Qetellong, joalo ka DUD, ho se khone hoa batho ba nang le GD ho bonts'a taolo e nepahetseng ea ts'usumetso e ka tlase ho ka bakoa ke ho eketseha ha keketseho ea ts'ebetso ea methapo ea kutloelo-bohloko nakong ea papali ea chelete,67 hammoho le lits'ebetso tsa khatello ea maikutlo58 hammoho le ts'ebetso e fokotsehileng li-network tsa bohlokoa tsa PFC.68

Le ha ho na le tsoelo-pele e kholo ea ho hlakisa ts'ebetso ea methapo ea kutlo ea GD le DUD, ho sa na le mosebetsi o mongata o lokelang ho etsoa. Leha ho entsoe mats'oao a ho kenyelletsa GD ho mefuta ea DUD, lingoliloeng tsa GD li ntse li haelloa ke kutloisiso e felletseng le e felletseng ea karolo ea dopamine nts'etsopele ea lefu lena, e thibelang ho kenyelletsoa ha eona ka botlalo mefuteng ena e pharalletseng ea temallo. .35-36 Ho feta moo, ho hlakile hore li-neurotransmitters ka thoko ho dopamine li kenya letsoho haholo ts'ebetsong ea ho lemalla.54 empa bopaki bo matla ba ho kenyelletsa serotonin, norepinephrine, le glutamate ho GD ha bo bonahale.69

Ho tseba

Mathata a bokhoba a atisang ho amahanngoa le bofokoli ba kelello, leha ho le joalo ho na le phapang e kholo lithutong tse bonoang ho ipapisitse le ntho e itseng e hlekefelitsoeng, hammoho le botebo le bokhopo ba ts'ebeliso. Bathong ba nang le bokhoba ba tahi, khaello e hlaha meahong ea mesebetsi e metle (EFs) le bokhoni ba ho bona lintho, athe bokhoni bo bong bo kang puo le makoloi a tebileng ha bo bolokehe.70 Ka lehlohonolo, litšitiso tsena tse hlahisoang ke tšebeliso e sa foleng li ka ntlafatsoa hanyane ka hanyane ka ho ila nako e telele. Batho ba nang le GD le bona ba bonts'a bofokoli ho li-EF,71 ho kenyelletsa ho nka liqeto,72 taolo ea inhibitory,73 le maemo a kelello;74 leha ho le joalo, ha ho na lipatlisiso tse etsoang ho tla fihlela joale tse ileng tsa hlahloba phello ea ho tlohella nako e telele papaling ea chelete ka mefokolo ena. Potso e 'ngoe e sa rarolloang ho lingoliloeng tsena e bua ka hore na liphoso tsena tsa methapo ea kutlo li teng ka tšohanyetso kapa hore na li supa litlamorao tsa liphetoho tsa mmele ka lebaka la boitšoaro bo bobe. Lithuto tse 'maloa ho GD le ts'ehetso ea joala ka kakaretso li ts'ehetsa ho ba teng ha khatello ea maikutlo ka nakoana ho palo e kholo ea batho ba nang le ts'oaetso, le hoja lintlha tse tsoang lipatlisisong tsena li bonts'a ho senyeha ho hoholo ho li-EF tse joalo ka ho hopola lintlha hara batho ba nang le ts'ebeliso ea joala ha ba bapisoa le ba nang le GD,75 mohlomong e fana ka tlhahiso ea hore ho kenella ka mokhoa o sa feleng oa "ethanol" ho senya potoloho ea "PFC". Ntle le moo, converter e nang le liphumano tsa methapo ea kutlo, tlhaiso-leseling ea tlaleho e bontša hore tšusumetso ea tšenyo e batla e phahame ho GD, e fana ka bopaki bo ikemetseng, bo bongata ba liphokotso tsa taolo ea thibelo ea thibelo liphihlelong tsa bohlasoa.73,76

Ka kakaretso, lintlha tse fumanoeng mabapi le bofokoli ba methapo ea kutlo li mabapi le bofokoli ba methapo ea kutlo li na le tlhaiso-leseling, haholo-holo mabapi le lipatlisiso moo GD e sebelisoang e le mohlala oa boitšoaro ba ho lemalla ho araba lipotso tse ikhethang.75 Leha ho le joalo, moeli oa bohlokoa o ntseng o phehella ho lingoliloeng tsena ke tsoelopele ea mesebetsi e hlokolosi e sebelisoang lithutong tsohle, e fokotsang lipapiso tse tobileng le tlhahlobo e akaretsang.77 Habohlokoa, moeli ona oa lipatlisiso o ntse o le lilemong tsa bocha, mme ha o ntse o tsoela pele ho hola, papiso e nepahetseng haholoanyane ea profiles ea neurocognitive e ka etsoa pakeng tsa batho ba nang le GD le ba sebelisang lintho tse joalo ka joala. Ho pheta liphumano ho etsa mesebetsi e ts'oanang le ho kenya letsoho meralo e meng e lebelletsoeng e telele74 e tla tiisa kutloisiso ea rona ea ho qhekelloa le lihlahisoa tse ling tsa bohlokoa tsa kelello ha li ntse li amana le GD le DUD.

Treatment

Hoo e ka bang karolo ea boraro ea batho ba nang le GD le kotara e le 'ngoe ea ba nang le ts'oaetso ea joala e tla fola ka tlhaho ntle le tlhoko ea kalafo.78,79 Ba bang ba tla fetohela mekhoeng ea kalafo ho kenyelletsa thuso ea boits'ireletso le ts'ehetso ea lithaka, ho kena lipuisanong tse khutšoane le tse susumetsang, le kalafo ea kelello (CBT) bakeng sa ho khutlisa taolo ea boits'oaro ba bona ba tlhekefetso. Mekhoa ena ea phekolo ea ho becha e thehiloe haholo ho ba lemaletseng tahi le lithethefatsi, 'me lipatlisiso li fana ka maikutlo a hore batho ba becha,80 joalo ka batho ba lemaletseng lithethefatsi tse amanang le joala.81 rua molemo ka mehato e joalo. Empa, kalafo ea papali ea chelete ha e fumanehe hohle. Karolong e latelang, re buisana ka bokhutšoanyane ka mekhoa e tloaelehileng ea ho kenella bakeng sa mathata a lithethefatsi le a ho becha.

Lenaneo la ho hlaphoheloa la 12-Step

Alcoholics Anonymous (AA) ke sehlopha sa ts'ehetso se etelletsoeng pele ke lithaka bakeng sa ba nang le mathata a tšebeliso ea joala. Likopano tsa AA li fumaneha haholo US mme lipatlisiso li bonts'a hore ho nka karolo ho atile ebile ho amana le sephetho se ntlafalitsoeng. Kelly et al82 ba ile ba latela bakuli ba lemaletseng joala ba khothaletsoang ho kenella lihlopheng tsa tšehetso kamora ho ts'oaroa ke kalafo e tsoang kantle mme 79% e fihletse lihlopha tsena selemong sa pele. Ho nka karolo ho ile ha fokotseha empa ho ile ha sala ho le bohlokoa lilemong tsa bobeli tsa (54%) le tsa boraro (54%) mme e ne e amana le liphetho tse ntle tsa ho nooa. Lithuto tse ling83,84 fana ka maikutlo a hore melemo ea ho nka karolo ha AA e kanna ea ba hantle ha bakuli ba kenella ho AA ka concert le kalafo ea profeshenale le hore ho nka karolo ha AA e ka ba karolo ea bohlokoa ho hlaphoheloeng ha nako e telele.

Gambler anonymous (GA) e ipapisitse le filosofi ea bohato ba 12 e qapiloeng ke AA, mme e tiisa melao-motheo e mengata e fumanoang ho AA, ho kenyelletsa tloaelo ea ho ila feela, ho amohela mohlala oa lefu le ho lemalla bokuli. GA e bonahala e thusa ba nang le khatello e matla ea tahi,85 empa litšobotsi tse boletsoeng ka holimo (mohlala, tšekamelo ea ho ila) li ka fokotsa ho ipiletsa ha batho ba itseng. Ha ho na datha e nyane ho GA joalo ka kalafo e emeng e le mong, empa lithuto tse teng85-87 fana ka tlhahiso ea hore melemo ea GA joalo ka ts'ebetso e le 'ngoe e bonolo, mohlomong e le litlamorao tsa litefiso tse phahameng tsa ho theoha. Leha ho le joalo, ho nka karolo ha GA concert le kalafo ea litsebi ho bonahala ho matlafatsa sephetho sa kalafo.88 'me e ntse e le karolo ea khothatso ea lingaka tse ling tse fanang ka litsebi tsa bongaka.89

Thuso

Litlhare tse thusang ho itlhahisa li fana ka melemo e mengata e sa fumaneheng likopanong tsa bohato ba 12 kapa mekhoa e fanoeng ka boiphihlelo joaloka boinotši, ho boloka litšenyehelo, ho ba bonolo le ho fihlella.90 Bibliotherapy bakeng sa mathata a joala e hlahisa boholo bo nyane ho isa bohareng ha bo bapisoa le ho se be le taolo ea kalafo, e ka sebetsa hantle ka mokhoa o tšoanang le ts'ebetso e pharalletseng, 'me ho bonahala e lebisa tlhokomelo ea melemo ea kalafo nako e telele.91 Bibliotherapy e boetse e lekantsoe bakeng sa bothata ba papali ea chelete 'me e na le molemo bakeng sa ba becha ka tsela e sa tobang le ba sa laoloeng.92 Leha ho le joalo, teko e laoloang ka mokhoa o hlophisitsoeng (RCT)93 le tlhahlobo ea eona ea khoeli ea 2494 fana ka maikutlo a hore ho kopana le litsebi tsa bongaka tse fokolang e ka ba karolo ea bohlokoa ea ho sebelisa Biomotherapy bakeng sa mathata a papali ea chelete.

Ho kenella ka morero

Litšebelisano tse susumetsang e kanna ea ba khetho e nepahetseng bakeng sa ba lemaletseng takatso ea ho fetola boitšoaro kapa ba batlang kalafo. Tlhatlhobo ea Meta ea 55 e sa reroang kapa e sa rereloang e etselitsoe lithuto tse finyeletseng hore sepheo sa ts'ebetso bakeng sa ba nang le AUD / DUD se lebisa phokotso e kholo lithutong tsa tšebeliso ea lino tse tahang le lithethefatsi tse amanang le ho se be le taolo ea kalafo le liphetho tse tšoanang ha li bapisoa le kalafo tse ling tse sebetsang.95 Ka mokhoa o ts'oanang, mekhoa ea ts'usumetso ke ts'ebetso e sebetsang bakeng sa mathata a papali ea chelete. RCT e bonts'itse hore ts'ebetso ea ts'ebetso ea motsamaisi o le mong oa ~ 75 metsotso e ka sebetsa hantle har'a bathetsi ba mathata ho fokotsa khafetsa papali ea chelete le liranta tse lefelloang ha li bapisoa le tlhahlobo ea taolo, ka litlamorao tse fihlang ho fihlela selemo ka mor'a ts'ebetso.96 Mefuta e meng e lekantsoeng ea nako (mohlala, metsotso ea 10-15), ho kenyelletsa le likeletso tse khuts'oanyane le karabo ea motho ka mong, e bonts'a ts'episo ea ho fetola boits'oaro bo bong ba ho becha ho ba nang le bothata kapa papali ea chelete e senyehileng.97,98 Ho khahlisang ke hore lifomate tse pharalletseng (mohlala, likarolo tse 'ne) tsa ntlafatso ea boikemisetso tse kopaneng le CBT ha li ntlafatse ka nepo liphetho tse amanang le lifomate tsa nako e le' ngoe kapa tsa seboka se le seng ho li-RCT tsa batho ba nang le bothata kapa papali ea chelete e sa abuoang e tsoang sechabeng.98 le moithuti oa koleche99 baahi. Tšusumetso ena e kanna ea kenyelletsa ho kenyelletsoa ha ba becha ba sa tsebeng letho ka lithuto tsena, ba kanna ba se ke ba hloka kapa ba lakatsa kalafo e pharaletseng. Bakeng sa ba bang, haholo-holo ba nang le GD, kalafo e fanoeng ka boiphihlelo ea nako e telele e ka hlokahala bakeng sa phetoho ea boitšoaro.

Litlhare tsa kelello le / kapa mekhoa ea boits'oaro

Boholo bo tsamaisitsoeng, CBT e tataisoang ke tataiso e ntlafatsa liphetho tse amanang le GA kapa li-bibliotherapy tse ikemetseng ho ba nang le GD ho li-RCT.86,88 Leha ho le joalo, ka RCT100 e kenyelletsang ho becha ha barutoana ba kolecheng ba maemo a boima, 4- ho 6-siti boemo ba CBT ha boa ka ba hlahisa sephetho se ntlafalitsoeng se lumellanang le karolo e le 'ngoe ea karabelo ea motho. Lithuto tse ling tse hlahlobang sebopeho (sehlopha se bapisoang le motho ka mong) kapa lipapiso tsa CBT le mefuta e meng ea kalafo e sebetsang ka kakaretso ha li fumane phapang lipakeng tsa lihlopha tsa papiso.101-103 Lintho tsena tse fumanoeng li fana ka bopaki ba kalafo ea ho ts'epa joala.104

Le ha CBT bakeng sa papali ea chelete e ts'oana haholo le CBT bakeng sa kalafo ea tlhekefetso ea lithethefatsi, litlhare tsa kelello tse shebileng ka ho hlaka likelellong tse sothehileng tse amanang le papali ea chelete li ikhethang haholo ka litaba. Litlhare tsena hangata li kenyelletsa ho ikopanya le lingaka tse ngata (mohlala, ho fihlela li-20) le ho bonts'a melemo e matla mabapi le taolo ea lenane.105,106 Leha ho le joalo, liphetho tsena li tla hloka ho phetoa ho sebelisoa mehlala e meholo le ho sebelisa tlhahlobo e ikemiselitseng, joalo ka lithuto tsena105,106 kantle ho batho ba ileng ba tlohela kalafo e ileng ea fella ka litlamorao tsa kalafo. E tšoana le lithuto tse ling tse fumanang liphapang tse fokolang lipakeng tsa kalafo ea papali ea chelete,101 RCT107 e bapisitseng kalafo ea kelello le mefuta e meng ea kalafo e sebetsang (mohlala, lipuisano tse susumetsang, kalafo ea boits'oaro) le tlhahlobo e sebelisitsoeng ea ho phekola ha ea fumana phapang e kholo litlamorao tsa papali ea chelete papaling ea bongaka.

Ka kakaretso, AUD / DUD le lipatlisiso tsa kalafo ea kalafo ea papali ea chelete ho fihlela joale li bontša hore ha ho na sebopeho se le seng kapa mokhoa o nepahetseng. Ho fapana le hoo, ho bonahala eka kalafo e mengata e na le molemo, ha ho e-na le phapang e fokolang pakeng tsa kalafo e sebetsang ha e loantšana. Kahoo, batho ba lemaletseng lithethefatsi ba batlang takatso ea ho phekoloa ba na le likhetho tse ngata tse fumanehang ho bona ho latela khetho, litlhoko, mohlomong le boteng ba bothata ba bona. Ho ea pele, mekhoa ea phekolo e ka hloka ho kenyelletsa litaba tse akaretsang tse rarollang maikutlo a phahameng pakeng tsa GD le mafu a mang a kelello, ho kenyelletsa, ho tšoenyeha, maikutlo, botho, joala le mathata a lithethefatsi.22 Bopaki bo fana ka maikutlo a hore matšoao a kelello a arabela le ho ntlafatsa nakong ea kalafo ea papali ea chelete.108 Leha ho le joalo, sebaka sa ntlafatso e eketsehileng matšoao a kelello se ntse se le har'a ba nang le litlatsetso tse matla,109 Ho fana ka maikutlo a hore batho bana ba hloka litaba tse ikhethang le tse kopaneng ho rarolla maemo a komorbid.

fihlela qeto e

Phephetso e kholo ho hokahanngoeng ka botlalo le likotsi ho GD le AUD / DUD e amana le mofuta oa tlhaho oa lipatlisiso mabapi le mathata a amanang le bokhoba boo GD e leng tšimo ea maikutlo le tlhoko ea chelete ha e bapisoa le litumelo tse ling.110 Leha ho le joalo, lipatlisiso tsa morao-rao li se li qalile ho hlakisa tsoelo-pele ea GD,111 fana ka maikutlo a hore etiology ea GD e rarahane, epigenetic, mme e kenyelletsa bongata ba bo-proximal ba proximal le distal. Ho feta moo, mehlala ena e tšoana le ea tlhaho ho tsoelo-pele ea li-psychopathology tsa AUD / DUD, li fana ka maikutlo a bohlokoa a ho fetellana le maemo a tloaelehileng a kotsi. Ha bopaki bo ntse bo bokellana, re khona ho kopanya lipatlisiso tsa mashome a lilemo ho mefuta e mengata e akaretsang ea ho lemalla37 e kenyelletsang litlatsetso tsa boits'oaro bo joalo ka GD.

Patlisiso e rarollang lipotso tse kang likotsi le litšenyehelo tsa moruo tse amanang le papali ea chelete e tlase le hore na barekisi ba boitšoaro bo bobe ba na le litlamorao tse mpe ho latela mefuta e bonolo ea tlhahlobo ea AUD / DUD ea hlokahala. Lithuto tsena li tla ba bohlokoa bakeng sa litlhahlobo tsa DSM tsa nakong e tlang mabapi le liqeto mabapi le hore na u ka etsa mohlala oa litekanyetso tsa GD le likamo tse haufi haholoanyane ho tseo bakeng sa AUD / DUD. Bohlokoa bo bong ba ho etsa lipatlisiso ke lipatlisiso tsa mekhoa ea kalafo, kalafo e kopaneng haholo e sebetsanang le mathata a comorbid kapa dysfunctions tse ka tlase (mohlala, ho qhekella). Sekhahla se phahameng sa comorbidity se fana ka maikutlo a hore liphekolo tse joalo tse kopaneng ke sebaka sa tlhokahalo e kholo ebile li na le bokhoni bo boholo. Ka bomalimabe, lingoliloeng tsa kalafo ea GD ha li ntlafatsoe hantle ntlheng ena ho fapana le bokhoba bo bong.

Mabapi le boikoetliso ba bongaka, re khothaletsa ho hlahlobisisa mathata a kelello a sa tsubeng har'a batho ba batlang kalafo bakeng sa mathata a papali ea chelete. Ho hlahlojoa ha mekhoa ea mafu a kelello har'a ba tsubang ba batlang kalafo ho ka thusa bakuli bana ho fumana kalafo e hlokahalang bakeng sa mathata a comorbid kapele mme ba na le monyetla oa ho ntlafatsa karabelo ho GD le lefu la Comorbid ha kalafo e joalo e fanoa ka nako e le ngoe kapa ka tsela e kopaneng. Ntle le moo, ka har'a litleliniki tsa kalafo tsa AUD / DUD, ho ata ha bothata ba papali ea chelete papaling ena ho fana ka maikutlo a hore tlhahlobo e hlophisitsoeng ea mathata a papali ea chelete e loketse.31,112

GD, joalo ka tšibollo ea pele ea boits'oaro bo sa tsubeng, e beha moeli oa ho nahana ka mathata a mang e le bokhoba ba boitšoaro nakong e tlang. Joalokaha ho hlahlojoa, GD e arolelana likarolo tse ngata ho libaka tse ngata le AUD / DUD, e lebisa bafuputsi ba bang37 ho kenya mohlala oa ts'oaetso ea bokhoba ba tahi, e totobatsang maikutlo a tlisoang ke litekanyetso tse fapaneng tsa papatso (mohlala, ho becha ho sa laoleheng, tšebeliso ea joala kapa tšebeliso ea koae). Bafuputsi le lingaka ka ho tšoanang ba lokela ho ikarabella bakeng sa ho ba le phapanyetsano e kholo maemong ana ha ba conceptualizing psychopathology ka sepheo se fapaneng sa ho theha lithuto tsa lipatlisiso, tlhahlobo ea matšoao a kliniki, le ho rera kalafo.

lumela hore baa fokola

Litokisetso tsa tlaleho ena li tšehelitsoe karolo ea lithuso tsa NIH: P60-AA003510, R01-AA021446, R21-DA031897, R01-DA-033411-01A1, le Setsi sa Naha sa Phano e Ikarabellang ea Gaming.

senoloa ha

Bangoli ba tlaleha hore ha ho lintoa tse thahasellisang mosebetsing ona.

 

References

1.Mokhatlo oa Maiketsetso oa Amerika. Buka ea ho hlahloba le ea Statistical ea Mathata a kelello. 5th ed. Washington, DC: Mokhatlo oa Amerika oa Psychiatric, 2013.
2.Lesieur HR, Rosenthal RJ. Papali ea papali ea thuto ea tlhaho: tlhahlobo ea lingoliloeng (e lokiselitsoeng Mokhatlo oa Amerika oa Thupelo ea kelello bakeng sa Komiti ea DSM-IV mabapi le mathata a taolo ea litšusumetso tse seng a nkuoe sebakeng se seng) J Gambl Stud. 1991;7(1):5–39.
3.Schuckit MA. Sekhutlo sa Mohlophisi: DSM-5 - e se e loketse kapa che, ke ena ea tla. J Stud Joala Lithethefatsi. 2013;74(5):661–663.
4.Weinstock J, Burton S, Rash CJ, et al. Barekisi ba ho kenella kalafong ea papali ea chelete ea ho becha: datha e tsoang ho West Virginia Gamblers Aid Network. Psychol Addict Behav. 2011;25(2):372–379.
5.Weinstock J, Scott TL, Burton S, et al. Maikutlo a hona joale a ho ipolaea ho bashebelli ba hoeletsang thuso. Tlhahiso ea Resict Res. 2014;22(5):398–406.
6.Bischof A, Meyer C, Bischof G, Kastirke N, John U, Rumpf H. Comorbid Axis I-mafu a lipakeng tsa lithuto tse nang le bothata ba methapo, kapa bothata ba ho becha bo kotsing ho tsoa ho sechaba ka kakaretso Jeremane: litholoana tsa thuto ea PAGE. Resp Psychiatry. 2013;210(3):1065–1070.
7.Moghaddam JF, Yoon G, Dickerson DL, Kim SW, Westemeyer J. Suicidal mohopolo le liteko tsa ho ipolaea ka lihlopha tse hlano tse nang le mekhahlelo e fapaneng ea papali ea chelete: lintlha tse fumanoeng ho tsoa ho "National Epidemiologic Survey" mabapi le joala le maemo a amanang le ona. Ke J Addict. 2015; 24: 292-298.
8.Weinstock J, Rash CJ, Burton S, et al. Tlhahlobo ea liphetoho tsa DSM-5 tse ntlafalitsoeng ho papali ea papali ea methapo ea methapo mohlaleng oa thuso. J Clin Psychol. 2013;69(12):1305–1314.
9.Morasco B, Weinstock J, Ledgerwood LM, Petry NM. Lintlha tsa kelello tse khothalletsang le tse thibelang papali ea chelete ea papali ea chelete. Cogn Behav Prac. 2007; 14: 206-217.
10.Tavares H, Zilberman ML, Hodgins DC, el-Guebaly N. Papiso ea ho lakatsa lipakeng tsa motjeko oa liphatsa tsa lefutso le lino tse tahang. Mofuta Oa Kliniki. 2005;29(8):1427–1431.
11.Ashrafioun L, Kostek J, Ziegelmeyer E. Ho lekola ponaletso ea kamora 'chate le ho ikamahanya le eona ho lekantsoe ka chelete e itseng mosebetsing o ikhethileng oa ho becha. J Behav Addict. 2013; 2(3):133–137.
12.Monyane oa Mom, Wohl MJA. Lebaka la ho becha ka ho becha: netefatso ea psychometric le liphetho tsa boitšoaro. Psychol Addict Behav. 2009;23(3):512–522.
13.Hasin DS, Grant BF. Patlisiso ea Sechaba ea Epidemiologic mabapi le Joala le Maemo a amanang le Eona (NESARC) Waves 1 le 2: tlhahlobo le kakaretso ea lintho tse fumanoeng. Psychiki Psychiki Psychiatr Epidemiol. Epub 2015 Pherekhong 26.
14.Gerstein D, Volberg RA, Toce MT, et al. Kameho ea papali ea chelete ea ho becha le thuto ea boitšoaro: Tlaleha ho Khomishene ea Boithuto ea Kameho ea Lipapali ea Naha. Chicago, IL: Setsi sa Naha sa Lipatlisiso sa Maikutlo, 1999.
15.Kessler RC, Hwang I, LaBrie R, et al. Ho ata le ho kopanngoa ha papali ea papali ea DSM-IV ho phetisetso ea National Comorbidity Survey Replication. Psychol Med. 2008;38(9):1351–1360.
16.Petry NM, Stinson FS, Grant BF. Comorbidity ea DSM-IV ea ho becha ha methapo ea methapo le mafu a mang a kelello: liphetho tse tsoang ho National Epidemiological Survey on Alcohol and maemong a amanang le ona. J Clinic Psychiatry. 2005; 66: 564-574.
17.Welte J, Barnes G, Wieczorek W, Tidwell MC. Litaba tsa joala le papali ea chelete har'a batho ba baholo ba US: ho ata, mekhoa ea batho le mekhoa ea ho hlapolla. J O Ithuta Joala. 2001; 62: 706-712.
18.Petry NM, Blanco C, Auriacombe M, et al. Tlhahlobo le maikutlo a liphetoho tse reriloeng bakeng sa papali ea chelete ea ho becha ho DSM-5. J Gambl Stud. 2014; 30: 493-502.
19.Petry NM, Blanco C, Stinchfield R, Volberg R. Tlhahlobo e matla ea liphetoho tse reriloeng bakeng sa tlhahlobo ea ho becha ho DSM-5. lemalla ntho e. 2012; 108: 575-581.
20.Weinstock J, Rash CJ. Litlamorao tsa tleleniki le lipatlisiso mabapi le bothata ba ho becha ho DSM-5. Khothalletsa hore u bala Curr Addict Rep. 2014; 1: 159-165.
21.Brewer JA, Potenza MN, Desai RA. Kamano e arohaneng lipakeng tsa bothata le papali ea methapo ea methapo le mafu a kelello ho batho ba nang le ts'ebeliso e mpe ea joala kapa ba ts'ehetsang ntle le ts'ebeliso ea ts'ebeliso e mpe ea tahi. CNS Spectrum. 2010; 1: 33-44.
22.Chou KL, Afifi TO. Mathata a kelello a ferekaneng (a amanang le mathata a bophelo kapa bothata) le mathata a kelello: diphetho ho tsoa ho National Epidemiological Survey on Alcohol and maemong a amanang le ona. Am J Epidemiol. 2011;173(11):1289–1297.
23.Parhami I, Mojtabai RM, Rosenthal RJ, Afifi TO, Fong TW. Ho becha le ho qala ha mafu a kelello a hlabang: thuto e telele e hlahlobang botebo. J Psychiatr Itloaetse. 2014; 20: 207-219.
24.Dussault F, Brendgen M, Vitaro F, Wanner B, Tremblay RE. Lihokela tsa nako e telele lipakeng tsa ho kena bohlasoa, mathata a papali ea chelete le matšoao a sithabetsang: mohlala o fetohang ho tloha lilemong tsa bocha ho fihlela ho ba motho ea moholo. J Ngaka Psychol Psychiatr. 2011; 52: 130-138.
25.Lorines FK, Cowlishaw S, Thomas SA. Ho ba teng ha mathata a comorbid bothateng le boteng ba methapo: tlhahlobo e hlophisehileng le tlhahlobo ea meta-lithuto tsa sechaba. lemalla ntho e. 2011; 106: 490-498.
26.Abdollahnejad R, Delfabbro P, Denson L. Psychiatric comorbidity bothateng le bothateng ba methapo: ho fuputsa ts'usumetso e mpefatsang ea mathata a ts'ebeliso ea joala. Moemeli oa Behav. 2014; 39: 566-572.
27.Dowling NA, Colishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Ho ba haufi le mathata a bophelo bo botle ba kelello ho tsa bongaka ho batho ba batlang ho becha: tlhahlobo e hlophisehileng le tlhahlobo ea meta. Psychology ea Aust NZ J. 2015;49(6):519–539.
28.Hodgins DC, el-Guebaly N. Tšusumetso ea ts'ebeliso ea ts'ebeliso ea thepa le mathata a maikutlo mabapi le sephetho ho tsoa ho papali ea papali ea methapo ea mali: ho latela lilemo tse hlano. J Gambl Stud. 2010;26(1):117–127.
29.Kausch O. Mehlala ea tlhekefetso ea lithethefatsi har'a batho ba tsubang ba batlang meriana. J Tšoara Tlhekefetso. 2003; 25: 263-270.
30.Rash CJ, Weinstock J, Petry NM. Mekhoa ea ho noha ea ba lemaletseng ho becha pele ho nako le ka mor'a kalafo ea papali ea chelete. Psychol Addict Behav. 2011;25(4):664–674.
31.Cowlishaw S, Merkouris S, Chapman A, Radermacher H. Ho tsitsa le ho becha ha mathata litlamong tsa tšebeliso ea lithethefatsi: tlhahlobo e hlophisitsoeng le tlhahlobo ea meta. J Tšoara Tlhekefetso. 2014; 46: 98-105.
32.Ledgerwood DM, Downey KK. Kamano lipakeng tsa papali ea chelete ea tšebeliso ea chelete le tšebeliso ea lithethefatsi ho baahi ba tlhokomelo ea methadone. Moemeli oa Behav. 2002;27(4):483–491.
33.Goldman D, Oroszi G, Ducci F. Liphatsa tsa lefutso: ho senola mefuta. Nat Rev Genet. 2005;6(7):521–532.
34.Lobo DS, Kennedy JL. Likarolo tsa lefutso tsa papali ea papali ea papali ea chelete: bothata bo rarahaneng bo nang le tšoaetso ea liphatsa tsa lefutso. lemalla ntho e. 2009;104(9):1454–1465.
35.Piazza PV, Deroche-Gamonet V. Khopolo-taba e akaretsang ea phetoho ea ho lemalla. Psychopharmacol. 2013;229(3):387–413.
36.Koob GF, Le Moal M. Tlatsetso le ts'ebetso ea boikoetliso ba kelello. Annu Rev Psychol. 2008; 59: 29-53.
37.Shaffer HJ, LaPlante DA, LaBrie RA, Kidman RC, Donato AN, Stanton MV. Mabapi le mohlala oa ho lemalla: litlhaloso tse ngata, etiology e tloaelehileng. Harv Rev Psychiki. 2004;12(6): 367–374.
38.Shah KR, Eisen SA, Xian H, Potenza MN. Lithuto tsa genetic tsa papali ea papali ea methapo ea methapo: tlhahlobo ea mekhoa le ho hlahlobisisa lintlha ho tsoa lenaneong la mafahla la Vietnam. J Gambl Stud. 2005;21(2):179–203.
39.Hodgins DC, Schopflocher DP, el-Guebaly N, et al. Kameho e lipakeng tsa tlhekefetso ea bana le mathata a papali ea chelete papaling ea banna le basali ba baholo. Psychol Addict Behav. 2010; 24 (3): 548.
40.Raylu N, TSI ea Oei. Papali ea Pathological: Tlhahlobo e felletseng. Clin Psychol Rev. 2002;22(7):1009–1061.
41.Schreiber L, Odlaug BL, Kim SW, Grant JE. Litšobotsi tsa batho ba betšang ba pathological le motsoali ea behang papali ea chelete. Ke J Addict. 2009;18(6):462–469.
42.Lee GP, Stuart EA, Ialongo NS, Martins SS. Lits'oants'o tsa tlhahlobo ea botsoali le ho becha har'a sehlopha sa bacha ba litoropong tse telele. lemalla ntho e. 2014;109(6):977–985.
43.Wood RTA, Griffiths MD, Parke J. Tšusumetso ea mesebetsi le litšobotsi tsa basebelisi ho ts'ebetso ea nnete ea nnete. CyberPsychol Behav. 2007;10(3):354–361.
44.Verdejo-García A, Lawrence AJ, Clark L. Impulsivity e le lets'oao le kotsing ea ho lemalla ts'ebeliso ea lithethefatsi: tekolo ea liphumano tse tsoang lipatlisisong tse kotsing e kholo, li-gambler tsa mathata le lithuto tsa mokhatlo oa liphatsa tsa lefutso. Neurosci Biobehav. 2008;32(4):777–810.
45.Slutske WS, Eisen S, Xian H, et al. Phuputso e entsoeng ka bobeli ea kamano lipakeng tsa papali ea papali ea chelete ea ho becha le ho se utloisisehe bathong. J Abnorm Psychol. 2001;110(2):297–308.
46.Comings DE, Gade Andavolu R, Gonzalez N, et al. Kameho e tlatsetsang ea liphatsa tsa lefutso tsa neurotransmitter papaling ea papali ea chelete. Clin Genet. 2001;60(2):107–116.
47.Rodriguez-Jimenez R, Avila C, Ponce G, et al. Pholororphism ea TaqIA e hokahaneng le mofuta oa DRD2 e amana le tlhokomelo e tlase le taolo e fokolang ea thibelo ho bakuli ba joala. Eur Psychiatry. 2006;21(1):66–69.
48.Slutske WS, Eisen S, 'nete WR, Lyons MJ, Goldberg J, Tsuang M. Kotsi e tloaelehileng ea liphatsa tsa lefutso ea ho becha le ho itšetleha ka joala ho banna. Arch Gen Psychiatry. 2000;57(7):666–673.
49.Beauchaine TP, Neuhaus E, Brenner SL, Gatzke-Kopp L. Ho na le mabaka a leshome a ho hlahloba mekhoa ea likokoana-hloko lipatlisisong tsa thibelo le ho kenella. Dev Psychopathol. 2008;20(3):745–774.
50.Jentsch JD, Pennington ZT. Moputso, o sitisitsoe: taolo ea inhibitory le bohlokoa ba eona ho lits'oants'o. Neuropharmacol. 2014; 76 (Karolo B): 479-486.
51.RA ea bohlale. Likarolo tsa nigrostriatal-eseng feela mesocorticolimbic-dopamine ka moputso le bokhoba. Trends Neurosci. 2009;32(10): 517–524.
52.Zhou Y, Proudnikov D, Yuferov V, Kreek MJ. Liphetoho tse bakoang ke lithethefatsi le liphatsa tsa lefutso litsamaisong tse arabelang khatello ea maikutlo: litlamorao bakeng sa mafu a khethehileng a lemallo. Resin ea Boko. 2010; 1314: 235-252.
53.Naqvi NH, Bechara A. Sehlekehleke se ipatileng sa temallo: insula. Trends Neurosci. 2009;32(1):56–67.
54.Volkow ND, Baler RD. Saense ea tlatsetso: ho senola ho rarahana ha methapo ea kutlo. Neuropharmacol. 2014; 76: 235-249.
55.Volkow ND, Wang GJ, Fowler JS, Tomasi D, Telang F. Tlatsetso: ntle le dopamine moputso oa potoloho. Proc Natl Acad Sci. 2011;108(37): 15037–15042.
56.Volkow ND, Wang GJ, Telang F, et al. Litlhaku tsa Cocaine le dopamine ka dorsal striatum: mokhoa oa ho lakatsa ho tsuba ha cocaine. J Neurosci. 2006;26(24):6583–6588.
57.Naqvi NH, Rudrauf D, Damasio H, Bechara A. Ho senyeha hoa ts'ebetso ho sitisa ho lemalla ho tsuba koae. Science. 2007;315(5811): 531–334.
58.Meyer G, Schwertfeger J, Exton MS, et al. Karabelo ea Neuroendocrine ho papali ea papali ea casino ho barekisi ba mathata. Psychoneuroendocrinology. 2004;29(10):1272–1280.
59.Sinha R. khatello ea maikutlo e lebisa joang kotsing ea ho ts'oaroa joala hape? Tebello ea Tai. 2012;34(4):432–440.
60.Brewer JA, Potenza MN (2008). Neurobiology le genetics ea mathata a laoloang ke tšusumetso: likamano le bokhoba ba lithethefatsi. Biochem Pharmacol. 2008;75(1):63–75.
61.Zack M, Poulos CX. Mohanyetsi oa D2 o phahamisa liphello tse thabisang le tse khahlang tsa papali ea papali ea lipapali tsa papali ea papali ea chelete. Neuropsychopharmacology. 2007;32(8):1678–1686.
62.Volkow ND, Wang GJ, Fowler JS, et al. Matlafatso a matlafatsang a li-psychostimulants ho batho a amahanngoa le ho eketseha ha dopamine ea kelello le ho lula ha li-receptor tsa D2. J Pharmacol Exp Ther. 1999;291(1):409–415.
63.Mokhanni-Dunckley ED, Noble BN, Hentz JG, et al. Ho becha le ho eketsa takatso ea thobalano le meriana ea dopaminergic ho syndrome ea maoto a sa phomoleng. Clin Neuropharmacol. 2007;30(5):249–255.
64.Hutchison KE, Ray L, Sandman E, et al. Matla a olanzapine ho litakatso le tšebeliso ea joala. Neuropsychopharmacology. 2006;31(6):1310–1317.
65.Fong T, Kalechstein A, Bernhard B, Rosenthal R, Rugle L. Tlhahlobo e laoloang ka bobeli e foufetseng, e nang le li-placebo ea olanzapine bakeng sa ho phekola batho ba bapala papali ea chelete ea poker. Pharmacol Biochem Behav. 2008;89(3):298–303.
66.McElroy SL, Nelson EB, Welge JA, Kaehler L, Keck PE. Olanzapine kalafong ea papali ea ho becha ha methapo ea maoto: teko e mpe e laoloang ka mokhoa o seng molaong. J Clinic Psychiatry. 2008;69(3):433–440.
67.Krueger TH, schedulelowski M, Meyer G. Cortisol le litekanyo tsa sekhahla sa pelo nakong ea papali ea papali ea casino mabapi le ho ts'oenyeha. Neuropsychobiology. 2005;52(4):206–211.
68.Potenza MN, Leung HC, Blumberg HP, et al. Tlhahlobo ea mosebetsi oa FMRI Stroop ea ts'ebetso ea methapo ea methapo ea methapo ho tsa bataki. Am J Psychiatry. 2003;160(11):1990–1994.
69.Leeman RF, Potenza MN. Ho tšoana le phapang lipakeng tsa papali ea ho becha ha methapo ea tšebeliso ea methapo le tšebeliso ea lithethefatsi: ho tsepamisa maikutlo ho qobelloang le ho qobelloeng. Psychopharmacol. 2012;219(2):469–490.
70.Stavro K, Pelletier J, Potvin S. Ho pharalla le ho boloka liphoso tsa kelello tse lemaletseng bokhobeng ba joala: tlhahlobo ea meta. Ho lemalla Moferefere. 2013;18(2):203–213.
71.Ledgerwood DM, Alessi SM, Phoenix N, Petry NM. Teko ea boits'oaro ea ho se ts'oenyehe ho batho ba betšang ba pathological le ntle le litheko tsa ts'ebeliso ea lithethefatsi khahlano le taolo e ntle. Lithethefatsi. 2009;105(1):89–96.
72.Brand M, Kalbe E, Labudda K, Fujiwara E, Kessler J, Markowitsch HJ. Phokotso ea ho etsa liqeto ho bakuli ba nang le papali ea ho becha. Resp Psychiatry. 2005;133(1):91–99.
73.Fuentes D, Tavares H, Artes R, Gorenstein C. Mehato ea boithati le ea neuropsychological ea ho ts'oaroa ha papali ea papali ea chelete. J IntNeuropsychol Soc. 2006;12(06):907–912.
74.Vitaro F, Ensultult L, Tremblay RE. Ho susumetsa ho bolela esale pele bothata ba ho becha ho batona ba lilemong tsa bocha ba SES. lemalla ntho e. 1999;94(4): 565–575.
75.Lawrence AJ, Luty J, Bogdan NA, Sahakian BJ, Clark L. Mathata a papali ea chelete a arolelana liphoso tsa ho etsa liqeto tse sa potlakang le batho ba ikemiselitseng joala. lemalla ntho e. 2009;104(6):1006–1015.
76.Slutske WS, Caspi A, Moffitt TE, Poulton R. Botho le papali ea mathata: tlhahlobo e lebelletsoeng ea sehlopha sa tsoalo sa batho ba baholo. Arch Gen Psychiatry. 2005;62(7):769–775.
77.Goudriaan AE, Oosterlaan J, de Beurs E, Van den Brink W. Pathological ea papali ea chelete: tlhahlobo e felletseng ea liphetho tsa biobehahlangual. Neurosci Biobehav Rev. 2004;28(2):123–141.
78.Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ. Pholoso ho tsoa ho ts'ebetso ea joala ea DSM-IV: United States, 2001-2002. lemalla ntho e. 2005;100(3):281–292.
79.Slutske WS. Ho hlaphoheloa ha tlhaho le ho batla phekolo ka papali ea chelete: liphello tsa lipatlisiso tse peli tsa naha tsa US. Am J Psychiatry. 2006;163(2):297–302.
80.Rash CJ, Petry NM. Phekolo ea kelello bakeng sa bothata ba papali ea chelete. Psychol Res Behav Manag. 2014; 7: 285-295.
81.Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. Tlhahlobo ea meta-analytic ea ho kenella ha kelello le kelello bakeng sa mathata a tšebeliso ea lithethefatsi. Am J Psychiatry. 2008;165(2):179–187.
82.Kelly JF, Stout RL, Zywiak W, Schneider R. Phuputso ea selemo sa 3 ea ho kenya letsoho ha sehlopha sa batho ba lemaletseng joala ka mor'a ts'ebollo e matla ea kalafo. Mofuta Oa Kliniki. 2006;30(8):1381–1392.
83.Moos RH, Moos BS. Ho nka karolo kalafong le ho tsejoeng ka joala: ho lateloa ha lilemo tsa 16 tsa batho ba sa ithutoang. J Clin Psychol. 2006;62(6):735–750.
84.Moos RH, Moos BS. Mekhoa ea ho kenella ho lino tse tahang e sa tsejoe: litlamorao tsa ho nka karolo le ho hlakoloa. Mofuta Oa Kliniki. 2005;29(10):1858–1868.
85.Petry NM. Litsela le likhokahano tsa Bacha ba sa tsebeng ho ba teng lipakeng tsa papali ea papali ea papali ea papali ea chelete. Moemeli oa Behav. 2003;28(6):1049–1062.
86.Grant JE, Donahue CB, Odlaug BL, Kim SW, Miller MJ, Petry NM. Tabatabelo ea ho nahana le ho hlongoa lipotso bakeng sa papali ea papali ea kelello: liteko tse laoloang ka mokhoa o ikhethileng. Br J Psychiatry. 2009;195(3):266–267.
87.Stewart RM, brown RI. Phuputso e entsoeng mabapi le papali ea chelete. Br J Psychiatry. 1988;152(2):284–288.
88.Petry NM, Ammerman Y, Bohl J, et al. Phekolo ea kelello ea boitšoaro bakeng sa ba bechang. Jonana Clin Psychol. 2006;74(3):555–556.
89.Petry NM. Papali ea Tlhaho: Etiology, Ccomorbidity, le Treatment. Washington, DC: Mokhatlo oa American Psychological; 2005.
90.Gainbury S, Blaszczynski A. Boitlhokomelo bo ikemetseng ba marang-rang bakeng sa kalafo ea papali ea papali ea chelete. Int Gambl Stud. 2011; 11: 289-308.
91.Apodaca TR, Miller WR. Tlhahlobo ea meta mabapi le katleho ea bibliotherapy bakeng sa mathata a joala. J Clin Psychol. 2003;59(3): 289–304.
92.LaBrie RA, Peller AJ, LaPlante DA, et al. Ts'ebetso e khutšoane ea ho ithusa bakeng sa mathata a papali ea chelete: teko ea multisite e sa sebetseng. Ke J Orthopsychiatry. 2012;82(2):278–289.
93.Hodgins DC, Currie SR, el-Guebaly N. Khothaletso e khothatsang le kalafo ea ho ithusa bakeng sa papali ea chelete. Jonana Clin Psychol. 2001;69(1):50–57.
94.Hodgins DC, Currie S, el-Guebaly N, Peden N. Litlhahiso tse khothatsang tsa nakoana bakeng sa ho becha ka bothata: ho latela khoeli ea 24. Pyschol Addict Behav. 2004;18(3):293–296.
95.Smedslund G, Berg RC, Hammerstrøm KT, et al. Puisano e susumetsang ea tlhekefetso ea lithethefatsi. Cochrane Database Syst Rev. 2011; (5): CD008063.
96.Diskin KM, Hodgins DC. Teko e laoloang ka mokhoa o hlophisitsoeng oa nako e le 'ngoe ea ts'usumetso ea batšosi ba amehang. Behav Res Ther. 2009;47(5):382–388.
97.Cunningham JA, Hodgins DC, Toneatto T, Rai A, CCRley J. Pilot boithuto ba ho kenella ha maikutlo ho batho ba betang mathata. Behav Ther. 2009;40(3):219–224.
98.Petry NM, Weinstock J, Ledgerwood DM, Morasco B. Teko e sa reroang ea ho kenella hanyane ka hanyane bakeng sa bothata le bataki ba methapo ea methapo. Jonts'a Clin Pscyhol. 2008;76(2):318–328.
99.Petry NM, Weinstock J, Morasco BJ, Ledgerwood DM. Ho kenella hanyane ka hofitisisa ho khothaletso bakeng sa batsomi ba bothata ba koleche. lemalla ntho e. 2009;104(9):1569–1578.
100.Larimer ME, Baahelani C, Lostutter TW, et al. Tlhahlobo e khutšoane ea tšusumetso le mekhoa ea boits'oaro e hlokolosi ea boitšoaro bakeng sa thibelo ea papali ea chelete e felisitsoeng: teko ea bongaka e sa sebetseng. lemalla ntho e. 2011;107(6):1148–1158.
101.Carlbring P, Jonsson J, Josephson H, puisano ea lipotso le sehlopha sa ts'ebetso ea kelello mabapi le kalafo ea bothata le papali ea methapo: teko e laoloang ka boomo. Cogn Behav Ther. 2010;39(2):92–103.
102.Dowling N, Smith D, Thomas T. Papiso ea boits'oaro ba motho ka mong le sehlopha-boits'oaro bakeng sa papali ea papali ea papali ea basali. Behav Res Ther. 2007;45(9):2192–2202.
103.Jimenez-Murcia S, Aymami N, Gomez-Peña M, et al. Na ho pepesetsoa le ho thibela karabelo ho ntlafatsa liphetho tsa sehlopha sa boikoetliso ba 'mele bakeng sa papali ea chelete ea banna? Br J Clin Psychol. 2012;51(1):54–71.
104.Sehlopha sa Lipatlisiso sa Papali ea Projeke. Ho tsamaisana le liphekolo tsa botaoa ba joala ho li-heterogeneity tsa bareki: litlamorao tsa ho nooa ha projeke. J Stud Joala. 1997; 58: 7-29.
105.Ladouceur R, Sylvain C, Boutin C, et al. Phekolo ea kelello ea ho becha ha methapo ea methapo. J Nerv Ment Dis. 2001;189(11):774–780.
106.Ladouceur R, Sylvain C, Boutin C, Lachance S, Douet C, Leblond J. Sehlopha sa kalafo bakeng sa papali ea papali ea papali ea kelello: mokhoa oa ho lemoha. Behav Res Ther. 2003;41(5):587–596.
107.Toneatto T, Gunaratne M. Na kalafo ea litlokotsi tsa kelello e ntlafatsa sephetho sa tliliniki bakeng sa papali ea chelete? J Contemp Psychother. 2009; 39: 221-229.
108.Jiminez-Murcia S, Granero R, Fernandez-Aranda F, et al. Barekisi ba sephetho har'a ba betšang ba pathological ba fumana kalafo ea boits'oaro ea kelello. Euro Adict Res. 2015; 21: 169-178.
109.Moghaddam JF, Campos MD, Myo C, Reid RC, Fong TW. Tlhahlobo ea nako e telele ea khatello ea maikutlo har'a lingaka tsa ho becha. J Gambl Stud. 2015;31(4):1245–1255.
110.Petry NM, Blanco C. Liphihlelo tsa naha tsa papali ea chelete United States: Nalane e tla ipheta? lemalla ntho e. 2012;108(6):1032–1037.
111.Blanco C, Hanania J, Petry NM, et al. Ho litekanyetso tse ntlafalitsoeng tsa papali ea papali ea methapo ea methapo. lemalla ntho e. 2015;110(8): 1340–1351.
112.Li-tomoso E, Marotta J, Weinstock J. Ho senya jeme libakeng tsa kalafo tsa tšebeliso ea lithethefatsi: tlhoko e sa hlokahaleng. J Khotso Dis. 2014;33(2):163–173.