LITLHAHISO: Ho hlakile ho tsoa phuputsong ena hore papali ea chelete ea papali ea chelete e bonts'a methapo ea pelo ea lithethefatsi. Ba fumane meputso e fokotsehileng ea moputso le ho lahleheloa, ho fapana le taolo e tloaelehileng. Sephetho se seng ke hore litlhahiso tsa bohlokoa tsa motho ka mong ha lia ka tsa etsa hore potoloho ea moputso e sebetse. Sena le sona se fumanoa litlamong tsa lithethefatsi. DSM e ncha e tla khetholla papali ea chelete e le bokhoba.
Hum Brain Mapp. 2010 Nov; 31 (11): 1802-12.
de Greck M, Enzi B, Prösch U, Gantman A, Tempelmann C, Northoff G.
Lefapha la Psychiatry ho Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Jeremane. [imeile e sirelelitsoe]
HO HLOKA
Batho ba bapalang papali ea chelete ba khahlisoa ke ho ameha haholo ka papali ea chelete, e lebisang ho hlokomoloheng litšusumetso, lithahasello le boits'oaro tse neng li le bohlokoa haholo. Likokoana-hloko tsa Neurobiologically lipotolohong tsa moputso li bapala papali ea chelete. Ho lekola botsoalle ba liphetho tseo ka bobeli, re batlisitse batho ba papali ea papali ea chelete ba 16 ba sa sebetseng ba sebelisang paradigm ea fMRI e kenyelletsang mesebetsi e 'meli e fapaneng: tekolo ea bohlokoa ba motho ka mong le mosebetsi oa moputso o neng o sebetsa joalo ka sesebedisoa sa lehae. Batho ba bapalang papali ea chelete ba senola ho fokotseha ha ts'ebetso nakong ea liketsahalo tsa tahlehelo ea chelete libakeng tse ling tsa mantlha tsa moputso oa rona, li-nucleus accumbens le li-putamen tsa leqeleng. Ntle le moo, ha bapalami ba likokoana-hloko ba ne ba nka tšusumetso ea boleng bo phahameng ba botho, re fumane ts'ebetso e fokotsehileng ea methapo ea kutlo libakeng tsohle tsa rona tsa mantlha tsa moputso, ho kenyeletsoa li-nucleus accumbens le cortex ea ventral putamen cortex ha e bapisoa le taolo e phetseng hantle. Re bonts'itse ka lekhetlo la pele hore re fetotse tšebetso ea methapo ea kutlo lipotolohong tsa moputso nakong ea bohlokoa ba batho ba papali ea papali ea chelete. Seo re se fumaneng se ka fana ka leseli le lecha motheong oa methapo ea kelello ea papali ea chelete ea papali ea chelete ea papali ea chelete.
SELELEKELA
O ile a araba: 'U se u sa utloisisehe.' '' Ha u lahlile bophelo feela, lithahasello tsa hau le tsa sechaba sa heno, mosebetsi oa hau joaloka monna le moahi, metsoalle ea hau (mme u bile le eona e tšoanang) - ha u lahlile feela sepheo se seng le se seng ho bophelo, ntle le ho hapa papali ea chelete — u se u lahlile le tseo u li hopolang. ''
Dostoyevsky, The Gambler, 1867
Sengoli sa Russia sa Dostoyevsky se hlalosa matšoao a mabeli a mantlha a papali ea chelete ea ho becha, eo litsebi tsa kelello tsa mehleng ena li ka reng e le takatso ea papali ea chelete le ho se tsotelle ho hoholo ka lithahasello tsa bao e neng e se tsa boithati pele. Libuka tsa tlhahlobo ea hajoale [DSM-IV, Mokhatlo oa Amerika oa Psychiatric, 1994; ICD-10, Mokhatlo oa Lefatše oa Bophelo, 1992] e khetholla ho becha ha methapo e le bothata ba taolo ea tšusumetso. Leha ho le joalo, ho tšoana le mathata a lemallo, a joalo ka bokhoba ba tahi le ts'ebeliso ea koae, a lumella pono e ncha. Ho becha ka tsela ea tlhaho ho ka nkoa e le bokuli bo sa tsubelleheng bo amanang le tšebeliso e mpe ea kelello [Reuter et al., 2005].
Tlhophiso ea papali ea papali ea chelete ea boloi e le bothata ba ho lemalla joala bo sa tsotelleng e fana ka maikutlo a tlhekefetso ho ho potoloha ha meputso joalo ka batho ba lemaletseng lithethefatsi. Litla-morao tse joalo li fumanoe ho nucleus accumbens (NACC) / ventral striatum (VS), putamen, ventromedial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC), sebaka sa ventral tegmental (VTA) [bakeng sa setšoantšo se akaretsang sa Knutson le Gibbs, 2007 ; McClure et al., 2004; O'Doherty, 2004; bakeng sa mokhatlo oa mathata a bokhoba ba ho lemalla le ho potoloha meputso bona Martin-Soelch et al., 2001; Volkow et al., 2004, 2007a]. Reuter et al. [2005] e fuputse ts'ebetso ea li-neuronal ea batsomi ba methapo ba sebelisa karete ea ho nahana ka karete le fMRI. Nakong ea kamohelo ea moputso oa chelete, ba fumane ts'ebetso e fetotsoeng ea neuronal ka har'a potoloho ea moputso oa ba becha ka methapo ho kenyeletsa VS le VMPF e nepahetseng ha ba bapisoa le lithuto tse laolehileng. Ho feta moo, bangoli ba fumane phapang e fokotsehileng ea tšebetso ea methapo pakeng tsa katleho ea chelete le tahlehelo lithutong tsena.
Potenza et al. [2003], ea ileng a etsa lipatlisiso ka ho becha ha li-pathological a etsang mosebetsi oa Stroop, le eena o fumane ho fokotsoe ke mosebetsi oa VMPFC. Leha ho le joalo thutong e fapaneng, sebaka se le seng se bonts'itse ts'ebetso e eketsehileng ho barekisi ba methapo ea methapo nakong ea mosebetsi o motle oa jack ka moputso oa chelete ha e bapisoa le mosebetsi o le mong ntle le eona [Hollander et al., 2005]. Nakong ea tlhahiso ea lits'oants'o tsa papali ea chelete, ts'ebetso e fokotsehileng ea libaka tse ling tse kang OFC, thalamus, le basal ganglia, e boetse e hlokometsoe [Potenza et al., 2003]. Liphetho tsena li kanna tsa tlatselletsoa ka liphetho tsa mafu a amanang le lithethefatsi tse kang botaoa le bokhoba ba koae. Joalo ka ho becha ha bakuli ba bakuli ba joala, bakuli ba tahi ba bontšitse ho fokotseha hoa ts'ebetso ea neuronal ho VS nakong ea katleho ea chelete [Wrase et al. 2007] le ho fokotsa mesebetsi ea dopamine ea "striatal dopamine" nakong ea ts'ebeliso ea methylphenidate joalokaha e lekantsoe le PET o sebelisa [11C] -raclopride [Volkow et al., 2007b]. Bakuli ba lemaletseng koae ba bontšitse ho fokotseha ha tšebetso ea methapo nakong ea meputso ea chelete ho OFC, cortex ea morao-rao ea pele, le mesencephalon har'a ba bang [Goldstein et al., 2007]. Qetellong, Tanabe et al. [2007] e bontšitse ts'ebetso e fetotsoeng ea neuronal nakong ea ho etsa liqeto ho cortex ea ventromedial pele le libakeng tse ling, e bonts'a ho ts'oana ha ts'ebetso ea marang-rang ea methapo le mafu a mang a lemallo.
Ha li kopantsoe, liphuputso tsena li bonts'a bohlokoa ba bohlokoa ba ho potoloha ka mokhoa oa papali ea chelete ea ho becha le ho tšoana le eona mathateng a mang a lemalloang. Ho latela Reuter et al. [2005], karabelo e fokotsoang joalo ea ho fumana moputso e ka baka phello e sa feleng ea ho se khotsofale. Sena le sona se ka eketsa kotsi ea ho batla ho khotsofatsoa ke barekisi ba matla joalo ka papali ea chelete, koae, kapa lithethefatsi tse ling tsa tlhekefetso ho fumana maemo a lekaneng a ts'ebetso libakeng tsa moputso.
Letšoao le leng le tsotehang la papali ea chelete ea ho becha ke ho fetoha hoa maemo ho lokelang. Bakuli ba ntse ba ameha haholo ka papali ea chelete, kahoo ba qala ho hlokomoloha mekhoa le litloaelo tse ling tse neng li itšepa pele. Ka kelello, tlhahlobo ea bohlokoa ba botho kapa boits'oaro, joalo ka ha lithuto tse fetileng li e bitsitse [de Greck et al., 2008, 2009; Kelley et al., 2002; Northoff le Bermpohl, 2004; Northoff et al., 2006; Phan et al., 2004], e hlalosa hore na lithuto li bohlokoa hakae ebile li haufi hakae le tsona. Neurobiologically, mesebetsi e kenyang mohopolo oa boits'oaro, ka hona, ho tšoaneleha ha botho ho amme likarolo ho tsoa ho meputso e kang NACC, VTA, le VMPFC [de Greck et al., 2008; Northoff et al., 2006; Northoff et al., 2007; Phan et al., 2004].
Ho bokelloa ha litefiso tsa meputso ka ho susumetsoa ke botebo bo phahameng ho hlahisa potso ea kamano e ts'oanang lipakeng tsa ts'ebetso ea moputso le ts'ebetso ea litabatabelo tsa motho ka mong. Phuputsong e neng e entsoe ke sehlopha sa rona, mesebetsi ea ho ikamahanya le maemo a phahameng e hlohlelletsang tšebetso ea li-neuronal hantle makaleng a kentsoeng ts'ebetsong ea moputso lithutong tse phetseng hantle [de Greck et al., 2008]. Haufinyane, sehlopha sa rona hape ka fumana hore bakuli ba joala ba bonts'itse ts'ebetso ea neuronal e fokotsehileng ho li-circry tsa moputso (ke hore, NOKC / VS, VTA, VMPFC) nakong ea tekolo ea maikutlo le maemo a phahameng a motho ha a bapisoa le taolo e ntle ea bophelo [de Greck et al., 2009] e bonts'a hore liphetoho tse hlakileng tsa boitšoaro li bakoa ke ho hloka ts'ebetso ho potoloho ea moputso nakong ea tekolo ea bohlokoa ba bohlokoa bo boholo ba motho.
Morero o akaretsang oa thuto ea rona e ne e le ho hlahloba motheo oa neural oa phetoho e sa tloaelehang ea bohlokoa ba ho ikamahanya le moputso ho batho ba sa tsubeng ho sa hlokahaleng ba sa tsubeng. Haholo-holo re sebelisitse paradigm ho fuputsa tšebetso ea methapo ea methapo ea litefiso tsa papali ea chelete ka nako ea mosebetsi oa moputso o amanang le moputso le tahlehelo ea chelete, le nakong ea mosebetsi o hlokang ho hlahlojoa mabapi le ho ikamahanya le maemo, moo lithuto li faneng ka lintlha tse fapaneng tse nang le litšoantšo tsa papali ea papali ea chelete. , lijo kapa joala, e le tsa bohlokoa bo phahameng kapa bo tlase ba motho. Mehopolo ea rona e ne e le likarolo tse peli. Taba ea mantlha, re ne re lebelletse ho pheta liphetho tsa Reuter et al. [2005] ka ho bonts'a hore liphatsa tsa lefutso la pathological li bonts'a ts'ebetso ea neuronal libakeng tsa moputso nakong ea mosebetsi oa moputso. Ho feta moo, re ne re lebelletse ho holisa liphumano tsena ka ho khetholla lipakeng tsa tahlehelo le tahlehelo. Re bolela esale pele ts'ebetso e fokolang nakong ea phaello ea chelete le ho se sebetse hantle nakong ea tahlehelo ea chelete. Taba ea bobeli, re ipapisitse le matšoao a bakuli le seo re se fumaneng ho tahi ea tahi [de Greck et al., 2009], re ileng ra ferekanya tšebetso e ferekaneng nakong ea tlhahlobo ka kotlolloho e mabapi le boleng bo phahameng ba motho ea sebelisang papali ea papali ea chelete ha a bapisoa le taolo e phetseng hantle.
TŠOHLOA
Re fuputse liphatlalatso tsa moputso nakong ea tekolo ea bohlokoa ba motho ho papali ea papali ea chelete. Ho pheta liphetho tsa Reuter et al. [2005], libapali tsa boloetse ba methapo ea methapo ea methapo li bontšitse tšebetso e fokolisitsoeng ea li-neuronal ho NACC e ikhethileng mme ba tlohetse letsopa le leholo nakong ea mosebetsi oa moputso. Ha re eketsa liphumano tsena, re bonts'itse hore babali ba marang-rang ba ts'ebelisanang le 'mele ba bonts'itse liphetoho tse fokotsang literekeng tse tšoanang tsa moputso nakong ea tlhahlobo ea bohlokoa ba motho ha ba bapisoa le lithuto tse phetseng hantle. Ha re momahane, rona, ka lekhetlo la pele, re bonts'a lits'oants'o tsa neuronal tsa ho putsa ho potoloha ha batho ba betang ka methapo nakong ea boikoetliso ba bohlokoa ba motho.
Liphetoho tsa potoloho ea meputso ho batho ba bolaeang lipilisi nakong ea likotlo le tahlehelo ea chelete
Lintlha tsa rona li lumellana le se fumanoeng ke Reuter et al. [2005] ea fumaneng phapang e fokotsehileng ea tšebetso ea li-neuronal nakong ea moputso le tahlehelo ea chelete. Ntle le sena re ile ra khona ho holisa liphetho tsa bona ka litsela tse peli. Taba ea mantlha, re bonts'itse hore phapang e fokotsehang ea tšebetso ea li-neuronal pakeng tsa ho hloloa le tahlehelo e bakoa ke ho se sebetse hantle ho leseling la NACC le lekhopho le letšehali nakong ea liketsahalo-ho fapana le ho tloha ts'ebetsong e nyane nakong ea liketsahalo tsa win.
Liphetoho ho Circuitry of Pathological Gambler Nakong ea Tlhatlhobo ea Bohlokoa ba Motho
Liphetho tse makatsang tsa boithuto ba rona li bua ka phetoho ea ts'ebetso ea boko nakong ea tekolo ea bohlokoa ba botho ho papali ea papali ea chelete. Joalo ka ha ho lebelletsoe re fumane khaello e kholo ea ts'ebetso ea li-neuronal libakeng tsa rona tsa meputso tse tharo (NACC ea ka ho le letšehali le le letšehali, setamen ka ho le letšehali) nakong ea tekolo ea ts'usumetso e nang le bohlokoa bo phahameng ba botho. Liphumano tsena li tsamaellana le tšibollo ea rona ea maikutlo le ho fokotsa ho ts'oaroa ha methapo ea kutlo ho bakuli ba lemaletseng papali ea chelete nakong ea mesebetsi e amanang haholo le motho ka mong. Liphumano tsa rona tsa morao-rao li tlatselletsa tse fetileng sehlopheng sa rona moo bakuli ba tahi le bona ba bonts'itseng mesebetsi e fokotsang ea li-neuronal tsamaisong ea meputso ha ba ntse ba shebelletse maikutlo a bohlokoa a phahameng a motho [de Greck et al., 2009]. Hape joalo ka bakuli ba joala, ts'ebetso ena e fokolisitsoeng ea li-neuronal nakong ea ho ts'oara ho amanang le papali ea papali ea papali ea chelete e hantle ho latela pono ea bongaka ea phetoho e kholo ea kamano ea hae ea pele ho tloha litloaelong tsa pele tsa bohlokoa ho isa papaling ea papali ea chelete. Khopolo ena e tšehetsoa ke boitšoaro ba rona ba ho fumana hore bats'oaruoa ba papali ea papali ea thobalano ba khothalletsoa papali ea chelete haholoholo ha ba bapisoa le lithuto tse phetseng hantle.
Habohlokoa ka ho fetisisa, seo re se fumaneng se bontša ka lekhetlo la pele hore liphetoho tsena tsa bongaka le boits'oaro ka pono ea bohlokoa ba motho li ka tsamaellana le ts'ebetso ea ts'ebetso ea neuronal nakong ea moputso maemong a amanang le methapo ea kutlo. Ho feta moo, tse susumetsang tse nkuoeng e le tsa bohlokoa haholo qetellong li hloleha ho susumetsa tšebetso ea methapo ea methapo tsamaisong ea meputso. Ka hona, tumellanong le lipositi tse fetileng [Reuter et al., 2005], motho a ka nahana hore ka lebaka la ho se khone ho tsosa moputso oa bona ka ho khothaletsa le bakuli ba amanang haholo le bona, bakuli bana ba ka qobelloa ho batla maemo a fanang ka matlafatso e matla. joalo ka papali ea chelete kapa lithethefatsi ho theha mesebetsi e lekaneng ea mantlha tsamaisong ea meputso.
Meeli ea Tekanyetso
Qetellong, re tlameha ho nahana ka meeli ea mokhoa oa ho ithuta oa rona. Pele ho tsohle, mohopolo oa bohlokoa ba hau kapa oa ho its'oara o ka utloahala o sa hlaka hantle ka mokhoa o hlakileng kapa ka mokhoa o hlakileng. Re sebelisitse mohopolo ho tsoa lithutong tse fetileng mabapi le bohlokoa ba botho le ho ipapisa le eena [de Greck et al., 2008, 2009; Northoff le Bermpohl, 2004; Northoff et al., 2006, 2007] e lumelletseng lithuto ho bontša ka ho hlaka hore na khothatso e hlahisitsoeng e ne e le ea maemo a holimo kapa a tlase a motho. Leha mohopolo ona oa bohlokoa oa rona e le mokhoa o pharalletseng, leha ho le joalo re nkile qeto ea ho o sebelisa ka paradigm ea rona.
QETELLO
Thutong ena, re bontšitse karolo ea bohlokoa ea ho potoloha ha meputso papaling ea papali ea chelete. Barekisi ba mafu a kelello ha ba bonts'e feela mosebetsi o fokolisang oa tšebetso ea methapo ho li-circry tsa moputso (ka ho le letona le ka ho le letona NACC, ventral putamen) nakong ea moputso le tahlehelo ea chelete, empa hape le haholo - nakong ea tekolo ea ts'usumetso e nang le bohlokoa bo phahameng ba motho. Le ha lithuto tse phetseng hantle li bonts'a ts'ebetso e phahameng ho potatsong ea moputso nakong ea tlhahlobo ea maikutlo a bohlokoa ka ho khetheha, batho ba betang ba nang le ts'oaetso ea methapo ea methapo ba haelloa ke keketseho ea tšebetso ea methapo. Liphumano tsena li ka fumaneha hore li tsamaisane le tlhaiso ea bongaka ea ho se tsotelle hoa liketso tse ling tsa pele (tse loketseng) le ho ameha ka ho fetelletseng ka papali ea chelete.
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