Ho sebetsana le bothata ba papali ea papali ea chelete: ke eng e ka re bolellang li-neuroscience? (2014)

inahaneloang

Papali ea chelete, taolo ea kelello, le ho tsitsipana: ho papali ea chelete le mohopolo oa boitšoaro

Papali ea theknoloji ea pathological (PG) e na le ts'oaetso e tsitsitseng linaheng tse ka bophirima, ka likhakanyo tse simolohang ho 1.4% (phetoho ea bophelo bohle) USA, ho 2% naheng ea Canada (Welte et al., 2002; Cox et al., 2005). Litefiso tsa prevalence lia tšoana ebile li tsitsitse lipakeng tsa linaha le lisebelisoa tsa lipatlisiso (Stucki le Rihs-Middel, 2007), ka sekhahla se eketsehang ho potoloha 3% bakeng sa PG le papali ea chelete ea mathata (PrG) hammoho.

Taolo e khethiloeng ea ho laola takatso ea ho etsa lintho tse lemalloang ke tšobotsi e bohareng ea PG. E bohareng ba phenomenology ea PG joalo ka ha ho hlalositsoe mekhoa e mengata ea tlhahlobo ea PG (mohlala, boiteko bo sa atleheng ho laola, ho fokotsa, kapa ho emisa papali ea chelete). Ho hlalosoa ho tsoa ho pono ea methapo, maikutlo a akaretsang a taolo ea kelello a ka hlalosoa e le bokhoni ba ho laola liketso tsa motho. Taolo ea kelello e ka aroloa lits'ebetsong tse 'maloa (tse ka tlase) joalo ka bokhoni ba ho thibela likarabo tse itlhahelang (tse boletsoeng e le thibelo ea karabo, e lekantsoeng ka mesebetsi e kang mosebetsi oa ho emisa) le bokhoni ba ho iphapanyetsa leseli le sa kenelleng la ho kena-kenana (le bitsoang tšitiso ea kelello e lekantsoeng ka mesebetsi e joalo ka mosebetsi oa Stroop). Mabapi le boemeli ba polelo ea taolo ea kelello, lentsoe "ho qobella" le sebelisoa khafetsa, ho bontša tloaelo ea ho etsa thato, ho bontša boitšoaro bo khetholloang ho sa nahanoa kapa ho sa nahanoe ka letho, ho nahanisisa, kapa ho nahanisisa ka litlamorao (Daruna le Barnes, 1993). Ho susumetsa ke moaho o hlophisitsoeng o nang le mekhahlelo e mengata eo hangata e hlophiselitsoeng mohopolo oa "ketso e sa tsitsang", e tšoaeang ho fokotsoa ha thibelo ea makoloi le "khetho e sa tsitsang", e emeloang ke tebo ea ho amohela meputso kapele ka lebaka la moputso o liehang, o moholo, kapa o motle ho feta qeto Mekhahlelo ea ho etsa (Lane et al., 2003; Reynolds, 2006; Reynolds et al., 2006; Broos et al., 2012). Ho sitisoa ha karabo e sa senyeheng ho nahanoa hore e ka ba sebopeho sa boitšoaro bo sa tsitsang, 'me taolo e fokotsehileng ea ts'ebeliso ea kelello e hlahisitsoe e le sesupo sa ho ba kotsing ea ho ba kotsing ea likoluoa ​​tse lemalloang lilemong tsa morao tjena.

Boithuto bo bongata ba boits'oaro le litlhahlobo tsa neurocognitive ho PG li bonts'a ho eketseha ho matla ka mehato e kang Barratt Impulsiveness Scale, kapa lipotso tsa Eysenck le Impulsiveness (Eysenck et al., 1985) le taolo e fokotsehileng ea taolo ea kelello joalo ka ha ho pakahatsoa ho thibelo ea karabelo e fokotsehileng, ho kena-kenana le temohisiso le mesebetsi e fokotsang ho hlahloba (bakeng sa litlhahlobo bona: Goudriaan et al., 2004; Verdejo-Garcia et al., 2008; van Holst et al., 2010a, b). Ka karolelano, taolo e fokotsehileng ea boitšoaro ba motho e ka lebisa tlokotsing e kholo ea ho nts'etsapele PrG kapa PG, hobane ka mohlala taolo e fokotsehileng ea ho thibela likarabo (inhibition reaction) e ka amahanngoa le tsoelo-pele e potlakileng ho PrG ka lebaka la bokhoni bo fokotsehileng ba tlohella papali ea chelete ha chelete ea motho e fela. Ka mokhoa o ts'oanang, bokhoni bo fokolisang ba tšitiso ea kelello bo ka lebisa tlhokomelong e fokotsehileng ea ho se tsotelle mekhoa ea ho becha tikolohong. Mohlala, ho ba le ts'itiso e phahameng ea kelello ho ka lebisa ho karabelo e phahameng ho lipapatso tsa papali ea chelete ea ho becha, ho ka lebisang menyetla e phahameng ea ho etsa papali ea papali ea chelete, athe taolo e theotsoeng ea kelello e ka fella ka ho fokotsa bokhoni ba ho emisa ho becha le ha ho na le tahlehelo e phahameng.

Litlhahlobo tse 'maloa li se li phatlalalitsoe ka ho shebana le lithuto tsa taolo ea khatello ea kelello kapa lithuto tsa khatello ea maikutlo ho PG (van Holst et al., 2010a, b; Conversano et al., 2012; Leeman le Potenza, 2012). Tlhahlobo ena e shebisisa lithuto tsa morao-rao tsa morao-rao tse phatlalalitsoeng ho PG le PrG. Haholo-holo, tekolo ena e boetse e shebisisa lithuto tse natefisang maikutlo (mohlala, ho boelana hape), mesebetsi ea kelello (mohlala, ho qholotsoa) le lithutong tse ncha tse rarollang tšebelisano lipakeng tsa lits'ebetso tsa kelello le tse susumetsang.

Le ha tlhaloso e hlakileng ea PG e le teng, phethahatso ea (hangata mofuta oa morao-rao oa) tlhahlobo ea DSM ea tlhahlobo ea PG, ha ho na tlhaloso e hlakileng ea PrG. Ka tloaelo, PrG e bua ka mofuta o sa tsitsang oa PG, kapa e sebelisoa ha ho sa fumanoe tlhahlobo ea bongaka, ka lebaka la tsamaiso ea lipampiri tsa lipotso ho e-na le lipuisano tsa kliniki tse hlophisitsoeng. Boithuto bo bong bo hlalosa PrG ka sekhahla sa 5 kapa se phahameng ho South Oaks Gurb Screen (SOGS) kapa ka palo ea 3 kapa e phahameng ho mofuta o mokhuts'oane oa SOGS (Slutske et al., 2005). Boithutong bo bong ba papali ea chelete ba sebelisang kalafo bakeng sa papali ea chelete e thata, 'me ba phethahatsa litekanyetso tse' ne tsa maemo a PG, ba hlalosoa e le barekisi ba mathata (Scherrer et al., 2005), kapa sehlopha sohle se ithutoang se hlalosoa e le "barekisi ba mathata" ha se bohle ba nkang kalafo ba phethisang litekanyetso tse hlano kapa ho feta tsa PG (mohlala, de Ruiter et al., 2012). Thutong ena, ho sebelisitsoe PrG, ha ho fanoe ka tlhahisoleseling mabapi le tlhahlobo ea DSM ea PG, empa ha dintlha tsa lipotso li bontša hore PrG e teng.

Joalokaha ho phethoa ho Conversano et al. (2012), lithuto tse 'maloa li bonts'a taolo e fokotsehileng ea kelello ho PG joalo ka ha e bonahatsoa ke mesebetsi ea ho emisa, Mesebetsi ea Go-NoGo, hape le ts'ebetsong ea mosebetsi oa Stroop. Ledgerwood et al. (2012) leha ho le joalo e lekotse karohano ea karabo ka mosebetsi oa lets'oao la Stroop le ho emisa, mme ha e tlalehe liphapang lipakeng tsa papali ea papali ea chelete le taolo ea mesebetsi ena, empa liphapang li ne li le teng mesebetsing ea ho rala (Tora ea London) le tlhahlobisong ea maemo a kelello (Tlhahlobo ea Card Card ea ho hlopha). Kaha sampole e kenyelletsa ba bechang, bao eseng ba kalafo, le ba batlang ho tsubella ka lebaka la kalafo, ho se utloane ho ka bang teng maemong a fapaneng le boithuto ba bong bo bobe bo sa tsubeng. Ehlile, phuputsong e 'ngoe e entsoeng ke sehlopha se le seng sa khatello ea maikutlo (Barratt impulsivity Scale), boits'oaro bo seng molaong ba selemong se fetileng, khatello ea maikutlo e tlase le mathata a dysthymic, le ho tsepamisa maikutlo ho fokolang ka papali ea chelete li ne li le teng ho tsa papali ea papali ea methapo ea methapo ea methapo ea mafu ho tsa kalafo. (Knezevic le Ledgerwood, 2012).

Leha palo ea lithuto tsa neuropsychological e bonts'a taolo e fokotsehileng ea taolo ea kelello, lipalo tsa lithuto tsa neuroimaging tse shebaneng le mekhoa ea neural e theotsoeng taolo e tlase ea kelello e fokola haholo mme ka hona lithuto tsohle tse amanang le taolo ea taolo ea kelello li tšohloa mona. Thutong e entsoeng ke Potenza et al. mosebetsi oa Stroop o ile oa tsamaisoa thutong ea fMRI ho li-gambler tsa 14 tsa methapo ea methapo le taolo ea 13 e phetseng hantle (HCs) (Potenza et al., 2003a). Karabelo ea BOLD e arotsoeng ho PFC e ka lehlakoreng le letšehali le ho feta OFC e tlalehiloe ho barekisi ba pathological ha ba bapisoa le li-HC, leha ho ne ho se na phapang ea boitšoaro. Khaello ena ea phapang ea boitšoaro e kanna ea ba e amana le mofuta o fetotsoeng oa Stroop o neng o sebelisoa: ho reha ka khutso mebala ea litlhaku le ts'ebetso ea boits'oaro e lekantsoeng ka boits'oaro ba barupeluoa ka mor'a ho etsa mosebetsi oa Stroop. Phuputsong e sa tsoa etsoa ke de Ruiter et al. (2012), ho fokotseha ha karabelo ea neural ka mor'a ho thibelloa ho thibelitsoeng ho fumanoe ho anterior cingrate cortex (ACC) ho li-gambler tsa bothata ba 17 ha li bapisoa le 17 HCs. Ehlile, ts'ebetso e fokotsehileng e ile ea boela ea bonoa kamora ho thibeloa hoa katleho libakeng tse tšoanang (li-dCso-medial PFC tse moeling oa ACC) li-HC. Thutong ena-e ts'oanang le thuto ea Potenza et al. - ha ho liphapang tsa boitšoaro tse fumanoeng bakeng sa sehlopha sa PrG ha se bapisoa le li-HC, tse ka amanang le litaba tsa matla ka lebaka la mehlala e nyane ea lithuto tsa fMRI ho PrG le PG ha li bapisoa le lithuto tsa neuropsychological. Ka bobeli lithuto tsena tsa FMRI mabapi le taolo ea kelello ho PG le PrG li bonts'a hore ho fokotseha ts'ebetso ea libaka tse 'maloa tsa pele le tsa ACC li bonts'a hore mesebetsi ea boko ea kelello e amanang le ts'ebeliso ea kelello e fokotsehile ho PG le PrG ha e bapisoa le li-HC. Liphetho tsena li fana ka maikutlo a hore ho fokotseha hoa tšebetso ea pele ho ka kenya letsoho ho pathophysiology ea PG le PrG, moo ho fokotsang taolo ea boitšoaro ba papali ea papali ea chelete.

Mofuta o mong oa lithuto o bonts'a hore ho itlhahisa ho boetse ho bapala karolo ea bohlokoa e le sesosa sa tlokotsi bakeng sa nts'etsopele ea PrG. Lithuto tse 'maloa tsa nako e telele ho bacha le batho ba baholo ba tsoang sehlopheng sa lipatlisiso se tsoang Montreal naheng ea Canada li bonts'a hore boemo ba bohlasoa bo bolela esale pele ka papali ea papali ea chelete le ea PrG (Vitaro et al., 1997, 1999; Wanner et al., 2009; Dussault et al., 2011). Ka ho khetheha, maemo a ntseng a eketseha a ho hloka matla a ne a amana le maemo a phahameng a PrG (Vitaro et al., 1997). Phuputsong e 'ngoe ea morao tjena, khokahano e ntle ea ponelo-pele pakeng tsa ho qhekella ka nako ea 14 le matšoao a sithabetsang le mathata a papali ea chelete ka lilemo tsa 17 o ne a le teng (Dussault et al., 2011). Phuputsong e 'ngoe ho sebelisoa mehlala e' meli ea sechaba sa banna, litloaelo tsa boits'oaro le lithaka tse khelohileng li ne li amana le PrG, empa le tšebeliso ea lithethefatsi le bosoasoi, li bonts'a mabaka a tšoanang a kotsi ea ho ba kotsing ea mekhoa e mengata ea kantle ea mathata (Wanner et al., 2009). Lithuto tsena li tsepamisitse maikutlo bongoaneng le Karolong e boletsoeng pele ea ho potlaka ho PrG; haufinyane tjena lithuto tse peli tse kholo tsa tsoalo e telele, li fuputse karolo ea ho potlakisa bongoaneng le PrG nakong ea ho ba motho e moholo. E 'ngoe ea lithuto tsena (Shenassa et al., 2012), litsebi tsa kelello li lekile boits'oaro bo potlakileng le bo lihlong / bo sithabetseng ha ba le lilemo tsa 7, mme ba amana le sena ka nako eohle ea ho itlaleha ha PrG e le batho ba baholo, ka ho latela. Ha boitšoaro bo sa tsitsang ka nako ea 7 bo ne bo boletse esale pele PrG, boitšoaro bo lihlong / bo sithabetsang ha bo a ka ba bolela PrG ka ho ba motho e moholo, ho sehlopha sena sa bana ba 958 ba US ba tsoang Collaborative Perinatal Project. Phuputsong e kholo ea tsoalo e tsoang Dunedin, New Zealand, ho ile ha hlahlojoa maikutlo ka moea a le lilemo li 3, 'me papali ea chelete e sa sebetseng e ile ea hlahlojoa cohort ena ha 21 e tsofetseng le 32 li le lilemo li. Ho makatsang ke hore bana ba nang le (boits'oaro le maikutlo) ba sa laoleheng ha ba le lilemo tsa 3, ba ne ba le makhetlo a fetang a mabeli ho bonahatsa bopaki bo senyehileng ba ho becha, ha ba bapisoa le bana ba neng ba fetohile hantle lilemong tsa 3. Kamano ena e matla le ho bashanyana ha e bapisoa le banana (Slutske et al., 2012). Lithuto tse ling tse 'maloa li bonts'a hore ho kenella hape ke sesupo sa ho kenella papaling ea papali ea chelete (Pagani et al., 2009; Vitaro le Wanner, 2011).

Qetellong, ho tsoa lenaneong lena la lithuto, ho na le bopaki bo matla ba hore ho susumetsa le ho fokotseha ha taolo ea boitšoaro ho bapala karolo ea bohlokoa ho nts'etsapele ho kenya letsoho papaling ea chelete ho ea ho nts'etsopele le phehello ea papali ea chelete ea kotsi ea ho becha le PrG.

Ka lebaka la karolo ena ea bohlokoahali ea taolo ea kelello ho nts'etsopeleng papali ea chelete le PrG, tse netefalitsoeng ho tsoa ho lithuto tsa sehlopha sa tsoalo, lithuto tsa ts'ebetso ea kelello, lithuto tse ngata tsa morao-rao tsa PrG le PG li lokela ho shebana le taolo ea kelello, ho hlakisa mekhoa ea methapo ea kutlo e ka fokotsang taolo ea kelello molemong oa mathata. papali ea chelete. Kahoo, ho ithuta tšebelisano lipakeng tsa (ano) khopolo ea mahlale, tšebeliso ea methapo ea methapo ea kutlo, kapa phello ea methapo ho PG, le phello ea tsona ho methapo ea kutlo ea taolo ea kelello ho PG, ke sebaka se loketseng haholo bakeng sa lithuto tsa phetoho ea nakong e tlang le lithuto tsa tlhabollo ea bongaka ho PG (e hlalositsoeng karolong ea Puisano ).

O lutse ka kotloloho? Lithuto tsa cue-reactivity tsa papali ea chelete ea ho becha

Ha ho bapisoa le palo e nyane ea lithuto tsa neuroimaging mabapi le taolo ea kelello kapa ho ts'oaroa ha PG le PrG, sehlooho sa mekhoa ea neural ea cue-reactivity ho PG le PrG e ithutile hantle. Lithuto tse hlano tsa neuroimaging mabapi le ntlafatso ea cue ho PG le PrG (Potenza et al., 2003b; Crockford et al., 2005; Goudriaan et al., 2010; Miedl et al., 2010; Wölfling et al., 2011) le lithuto tse 'maloa tse shebaneng le ho hlophisoa bocha ba cue amanang le ho lakatsa le / kapa karabelo ea' mele ho PrGs li teng (Freidenberg et al., 2002; Kushner et al., 2007; Sodano le Wulfert, 2010). Molemong oa tlhahlobo ena, re tsepamisitse maikutlo ho seo a se fumaneng.

Ho lithuto tse hlano tsa neuroimaging tse PG le PrG tse amanang le ho nchafatsoa hoa lesela, ea pele (Potenza et al., 2003b) o sebelisitse "cue reacaction paradigm" e kenyelelitsoeng livideo tse etselitsoeng ho tsosa bahanyetsi ba maikutlo le ba susumetsang papaling ea chelete. Livideo tsena, batšoantšisi ba ile ba etsisa maemo a maikutlo (mohlala, ba thabile, ba hloname), ka mor'a moo motšoantšisi a hlalositseng ho khanna kapa ho tsamaea ka har'a kasino le ho utloa maikutlo a papali ea chelete. Thutong ena, linako tseo barupeluoa ba bileng le takatso ea ho li batla ba ile ba hlahlojoa bakeng sa papali ea methapo ea methapo ea 10 ha e bapisoa le li-HC tse leshome le motso o mong. Maemong kaofela, hona e ne e le pele litloaelo tsa 'nete tsa papali ea chelete li le teng le ho arabela litlhaloso tsa batšoantšisi ka boemo ba maikutlo (ke hore, maemo a papali ea papali ea chelete). Ts'ebetso e fokolang ho cingrate gyrus, (orbito) frontal cortex (OFC), caudate, basal ganglia, le libaka tsa thalamic e ne e le teng ho libapali tsa 10 tsa li-pathological ha li bapisoa le li-XCUMX HC. Phuputsong e 'ngoe e sebelisang livideo tse amanang le papali ea chelete ho elicit cue-reacaction, 11 metlae ea methapo ea kutlo le 10 HC e ile ea bapisoa le karabelo ea boko ho livideo tsena tse amanang le papali ea chelete ha li bapisoa le ho shebella livideo tse amanang le tlhaho (Crockford et al., 2005). Ts'ebetso e phahameng libakeng tsa dorsal pele, libakeng tse ka tlasa tlaase, libaka tsa parahippocampal, le occipital lobe e fumanoe ho barekisi ba pathological ha ba bapisoa le li-HC. Phuputsong e ileng ea latela ea fMRI cue-reacaction, Goudriaan et al. (2010) o fumane ts'ebetso e phahameng ea libaka tse tšoanang ha a bapisa 17 gigler pathological vs 17 HCs sebelisa litšoantšo tse amanang le ho becha le papali ea chelete. Thutong ena ea hoqetela, kamano e ntle e fumanoe pakeng tsa ho lakatsa ho becha ho papali ea papali ea chelete le ts'ebetso ea libaka tsa pele le tsa parahippocampal ha u shebella litšoantšo tsa papali ea chelete mabapi le litšoantšo tse sa jeleng paate. Thutong ea EEG ea Wölfling et al. (2011), Baetsi ba methapo ea methapo ea 15 ba ne ba bapisoa le 15 HC mabapi le karabelo ea EEG ho litšoantšo tsa papali ea chelete ha li bapisoa le litšoantšo tse ntle tsa maikutlo. Ha ho bapisoa le li-HCs, libapali tsa papali ea methapo ea methapo li bonts'itse bokhoni bo boholo ba nako e telele (LPPs) bo khothalletsoang ke papali ea papali ea chelete ha e bapisoa le tšusumetso e sa nkeng lehlakore, empa e bonts'a LPP tse ts'oanang le tsa litšoantšiso tse mpe le tse ntle tsa maikutlo. Ho fapana le hoo, ho li-HC ho bile le karabelo e kholo ho e susumetsang e ntle le e mpe ha e bapisoa le sepheo sa ho se nke lehlakore le sa papali ea chelete. Li-LPP tse phahameng li ne li le teng ka har'a li-electrode tsa parietal, bohareng le tse ka pele ho li-PG ha li bapisoa le li-HC, tse hlalosoang e le karabelo e phahameng ea kelello ea kelello ea kelello ho ea ho papali ea papali ea papali ea papali ea chelete.

Kamora nako, thutong ea fMRI e bapisang karabelo ea boko ho maemo a kotsing e phahameng ea ho becha maemong a kotsi a 12 papali ea chelete ea 12, li-beta tsa bothata li bontšitse karabelo e eketsehang ea BOLD libakeng tsa thalamic, tse tlase le tse phahameng tsa nakoana nakong ea likotsi tse phahameng. liteko, athe letšoao le fokotseha libakeng tsena nakong ea liteko tse tlase tse neng li le teng. Mokhoa o mong o fapaneng o ile oa bonoa ho barekisi bao e seng bothata (Miedl et al., 2010). Bangoli ba pheha khang ea hore mokhoa ona oa tšebetso o kenelletseng nakong ea liteko tse phahameng haholo ha o bapisoa le liteko tse tlase tse tsoang ho barekisi ba mathata a bonts'a ts'ebetso ea memori e kenelletseng ea tlhekefetso, e bakoang ke mekhoa e amanang le papali ea chelete. Se fumanoeng ke thuto ena se fana ka maikutlo a hore li-wager tse kotsing e phahameng li ka hohela ho ba bechang, 'me li etsa hore motho a ts'oenyehe hape a hloloheloe, athe li-wager tse kotsing e tlase, tse emelang monyetla o moholo oa ho hapa chelete e nyane li ka lebisa meputso e holimo ho tse seng. mathata a becha. Tlhaloso e ka bang teng ea karabelo e fokotsehileng ea li-wager tse kotsing e tlase ho barekisi ba bothata, e kanna ea ba hore sena se bakoa ke tebello e fokotsang ea moputso ka lebaka la karabelo e sa hlakang ea kelello ho meputso e tlaase ea chelete.

Ha re akaretsa lithuto tse natefeloang ka ho nchafatsoa hoa PG le PrG, ho hlaha setšoantšo se fetohelang mabapi le lithuto tse sebelisang litšoantšo tsa ho becha kapa lifilimi tsa ho becha — tseo ho tsona ho kenyelitsoeng litšoantšo tsa papali ea chelete. Lithutong tsena, ho arabela ka mokhoa o hlakileng maemong a potoloho ea moputso oa fronto-striatal le libaka tsa boko tse amanang le ts'ebetso ea tlhokomelo mabapi le maikutlo a papali ea papali ea chelete li teng ho lingaka tsa motjeko oa marang-rang / bothata ba papali ea chelete ha bo bapisoa le li-HCs (Crockford et al., 2005; Goudriaan et al., 2010; Miedl et al., 2010; Wölfling et al., 2011). Ho fapana le hoo, thutong e le 'ngoe e sebelisang maemo a bakang khatello ea maikutlo, e lateloang ke litlhaloso tse boletsoeng ka ho hlaka tsa ho batla ho etsa papali ea chelete, ho fokotseha karabelo ho arohaneng le litaba tsa potoloho ea litereke ke (Potenza et al., 2003b). Liphumano tsena li fana ka maikutlo a hore tšebeliso ea cue e hlahisoang ke papali ea papali ea chelete e tlisa moputso- le khothatso e amanang le potoloho kahoo e ka eketsa monyetla oa ho etsa papali ea chelete. Ka lehlakoreng le leng, maemo a nyahamisang a khothalletsoang ke maemo a sithabetsang a ka baka ts'ebetso e fokotsang moputsong o le mong- le khothatso e amanang le papali ea papali ea papali ea chelete, eo ka mora eona e ka tsosang takatso ea papali ea chelete, e le ho kokobetsa bofokoli bona boiphihlelo ba moputso ( kapa anhedonia). Ea o fumaneng ho fokotseha hoa bophelo ba kereke e fokolisitsoeng (Potenza et al., 2003b) e amana le boemo ba maikutlo bo bobe ba "allostatic" (mohlala, dysphoria, ho tšoenyeha, ho teneha) ho bonts'a boemo ba maikutlo ba ho hula sepheo ha bo pheteloa ke Koob le Le Moal le ha bo sa tsoa kopanngoa le maikutlo ke Koob le Volkow (2010). Liphumano tse setseng tsa neuroimging mabapi le mekhoa ea papali ea chelete li amana le ho nahanisisa le tebello ea ho etsa boitšoaro bo bobe, bo khetholloang ka ho lakatsa. Kahoo, karabelo e eketsehileng ea ts'ebetso ea moputso oa boko ho mekhoa ea papali ea chelete hammoho le ho fokotseha ha ts'ebetso ea moputso ho litheko tse tsosang khatello ka tebello ea papali ea chelete ho ka lebisa ho ho lakatseng le (ho boela ho) papali ea papali ea chelete. Motsoako ona o boetse o tsamaisana le thuto ea boitšoaro e entsoeng ke Kushner et al. (2007), eo ho eona ho fokotseng ts'ebetso ea cue hape ho tlalehiloeng kamora ho ho hlaseloa ka mokhoa o fosahetseng.

Ka bobeli, lithuto tsena tsa cue-reacaction le litumelo tsa bokhoba ba taolo li bonts'a hore sebaka sa bohlokoa sa ho etsa lipatlisiso ho PG le PrG ke sehokelo lipakeng tsa maemo a monate a bophelo le maemo a mabe a maikutlo / khatello ea maikutlo, le ka bobeli takatso ea papali ea papali ea chelete le papali ea chelete. Ho tloha lithutong tse bapisoang le tšusumetso ea papali ea chelete le ho hlohlelletsa ho se nke lehlakore, ho totobala ho tsoaloa hape hoa mekhahlelo e amanang le khokahano ea cue hape. Leha ho le joalo, karolo ea li-amygdala le maikutlo a seng monate a maikutlo a maikutlo (ke hore, e le "susumetso ea ho ntša maikutlo") ho hohelleng takatso le ho oela hape ho PG le PrG e lokela ho fumana tlhokomelo e eketsehileng ea lipatlisiso.

Karolo ea "ho tlosoa / e mpe" karolo ea potoloho ea bokhoba ba tai, e kenyelletsang ho kenya letsoho boits'oarong bo botle ka lebaka la litlamorao tsa ho tlohela kapa ho ama hampe, e le ho fokotsa ho tlohela le / kapa ho ama hampe (Koob le Volkow, 2010) e ka hokahanngoa le mothating oa papali ea mathata a hlaselehang maikutlong, e leng e 'ngoe ea lintlha tse tharo tse tlase tsa ba becha ka mathata, joalo ka ha ho hlahisitsoe ke Blaszczynski le Nower (2002) hape e tšoauoa ka khatello ea maikutlo le maikutlo a fosahetseng joalo ka tsela e lebang PrG (Blaszczynski le Nower, 2002). Karolo ea "preoccupation / tebello" ea potoloho ea bokhoba ba tahi, e khetholloang ka tlhokomelo e matla le ho phephella ho mabapi le litheko tse amanang le ts'ebeliso e mpe ea likhokahano, e hokahana le sehlopha sa "antisocial, impulsivist" sa barekisi ba mathata joalo ka ha ho hlalositsoe ke Blaszczynski le Nower (2002). Ba hlalosa sehlopha sa morao-rao sa bothata ba papali ea chelete ha bo bapisoa le ho ba le tšusumetso e phahameng, le boits'oaro bo potlakileng ba bongaka bo kang ADHD le ts'ebeliso e mpe ea lithethefatsi, e khothalletsang le ho potlakisa lits'ebetso tsa maemo a mantlha le a sebetsang ho nts'etsapele PrG (Blaszczynski le Nower, 2002). Ho tla fihlela joale, li-subtypes tsena tse tharo tsa basomi ba li-pathological ha li e-so ithute ka mokhoa o matla: Ledgerwood le Petry ba fuputse li-subtypes tsena tse tharo tsa papali ea chelete ka har'a sehlopha sa libapali tsa 229 tsa pathological, tse neng li thehiloe ho lipotso tsa boits'oaro. Le ha li-subtypes li ne li fapana ka botebo ba boleng ba PrG, ho romella ka tlase ha hoa ka ha bolela karabelo ea karohano e fapaneng. Lithuto tse 'maloa tsa boits'oaro li bonts'a phapang lipakeng tsa ba bechang le mathata le li-HCs nakong ea khatello ea maikutlo. Mohlala, phuputsong e sa tsoa etsoa (Steinberg et al., 2011), lerata le sa laoloang (khatello ea maikutlo) le ile la etsa hore a fokotse takatso ea papali ea chelete papaling ea chelete, ha e ntse e eketseha takatso ea ts'ebeliso ea joala ho barekisi ba mathata, barupeluoa ba noeleng joala le HC. Ho fumana sena, leha e le ka sampole e nyane (barupeluoa ba 12 sehlopheng se seng le se seng sa kliniki), e bonts'a hore liphetoho tse fapaneng tsa ho lakatsa mekhoa e fapaneng ea bokhoba ba litlamorao li ka bakoa ke khatello ea maikutlo (mona: papali ea chelete ea joala le tšebeliso ea joala). Thutong ea ho itlaleha (Elman et al., 2010) tekanyetso feela e amanang le litabatabelo tsa papali ea chelete papaling ea chelete e ne e le lethathamo la khatello ea maikutlo letsatsi le leng le le leng, le bonts'ang kamano e ntle pakeng tsa khatello ea maikutlo le takatso ea papali ea chelete. Ho khahlisang, liphuputsong tsa morao tjena tsa boithuto ba phepelo ea meriana le yohimbine, ts'ebetso ea bohlokoa ea amygdala ha e araba yohimbine lithutong tsohle tse 'ne tsa PG e hlokometsoe, athe ts'ebetso ena e ne e se teng ho li-HC tse hlano, e fana ka maikutlo a hore khatello ea kelello e bakile khatello ea maikutlo bokong. ea ba bechang. Kahoo, lithuto tse shebaneng le kamano lipakeng tsa khatello ea maikutlo le ho ts'oara papali ea chelete, lithahasello tsa papali ea chelete, le boitšoaro ba papali ea chelete, lia hlokahala, bakeng sa ho hlakisa boits'oaro ba ts'ebetso ea ho tlosa / ho se ame (khatello ea maikutlo) le tlhoko / tebello (cue reactivity) ea potoloho ea ts'ebeliso ea lithethefatsi ho PG le PrG. Ho ipapisitse le liphetho tsa lithuto tsena tsa boits'oaro le tsa 'mele, le ho fumanwa ho fosahetseng ho tsoa thutong e le' ngoe e shebaneng le lintlha tse tharo tse tlase tsa ba betšang ba li-pathological (Ledgerwood le Petry, 2010), ho hlakile hore ho hlokahala lipatlisiso tsa bioloji tse ngata (neuro) ho ts'oaroa ha PG. Mohlomong ho ka ba le bothata bo bong ba papali ea chelete ea ho becha e lemalloang bakeng sa papali ea chelete e hlaha ka lebaka la litla-morao tse mpe (le lits'oants'o tsa amygdala ke mochine oa neural) le bothata bo bong ba papali ea papali ea chelete moo ho khothalletsoang ho tsoa papaling ea papali ea chelete (ka hyperactive orbitofronto-striatal circry mochini o ka tlasa motheo oa neural). Tlhahiso ena e tlisoang ke batho ba behang papali ea methapo ea kutlo e thehiloeng ho endophenotype (e mpe e amehang / khatello ea maikutlo hape e amehang / e amang ka ho teba / papali ea chelete ea ho becha) e ka bapisoa le tse ling tse tharo tse hlalositsoeng ke Nower le Blaszczynski (2010): Boits'oarong bo maemong, boits'oarong maikutlong le bohlohlelletsong.

Leha palo e fokolang ea lithuto tsa neuroscience mabapi le ho etsa khatello ea maikutlo hape ho PG le PrG li le teng, taba e amanang le eona ke ho ba teng ha moputso oa meputso e eketsehileng kapa e fokotsehileng lithutong tse ncha tsa Puro le PrG, 'me lithuto tsena li tla tšohloa kamora moo.

Tlhahiso ea moputso e feteletseng kapa e fokotsehileng bothateng ba bothata: na kaofela ho papaling kapa ho chelete eohle?

Khopolo-taba e tsebahalang ea ho lemalla ke hore batho ba lemaletseng lintho tse itseng ba na le lefu la khaello ea moputso, e ba etsang hore ba phehelle (haholo-holo lithethefatsi) ho hlola bofokoli bona (Comings le Blum, 2000). To qalile lithuto tsa fMRI ho PG tse shebileng ts'ebetso ea moputso li tlalehile liphetho tse lumellanang le maikutlo a joalo a fokotsehileng a moputso. Mohlala, ho araba phaello ea chelete ho bapisoa le tahlehelo ea chelete ea papali ea chelete ea papali ea chelete, e bonts'itse ts'ebetso e hlakileng ea ts'ebetso ea "ventral striatum" le "cortex" ea ventral pele. (Reuter et al., 2005). Ts'ebetso e ts'oanang ea ts'ebetso ea "cortices" ea pele e neng e kentsoe kahare e ne e le teng ka paradigm ea kelello eo ho becha mathata a ka fumanang kapa a lahleheloa ke chelete ho latela ts'ebetso ea bona (de Ruiter et al., 2009).

Haufinyane tjena, ho bile le liphuputso tse qaqileng haholoanyane mekhahlelo e fapaneng ea ts'ebetso ea moputso li tsamaisitsoe. U sebelisa mosebetsi o fetotsoeng motheong oa ts'ebetso ea tšusumetso ea chelete (MID) (Knutson et al., 2000) eo ho eona lithuto li lokelang ho etsa likarabo tse potlakileng ho fumana lintlha / chelete kapa ho thibela ho lahleheloa ke lintlha / chelete, bakuli ba ts'ebetso ea papali ea chelete ba bontšitse likarabo tse fumanehang tsa boemo ba leholimo nakong ea tebello e kholo ea moputso hammoho le karabelo ea ho fumana chelete (Balodis et al., 2012; Choi et al., 2012). Le ha litholoana tsa lithuto tsena tse peli li tsamaisana le phokotso ea khaello ea moputso, lithuto tse ling tsa fMRI li fumane likarabo tse eketsehileng ka tebello ea moputso kapa kamora ho fumana moputso libakeng tsa boko tse amanang le moputso oa fronto-striatal.

Mohlala, ho sebelisa papali ea khetho ea probabilistic ho etsa mohlala oa ts'ebetso e lebelletsoeng, basomi ba methapo ea methapo ba bonts'itse ts'ebetso e kholo ea dorsal striatum nakong ea tebello ea meputso e meholo ha e bapisoa le meputso e nyane (van Holst et al., 2012c). Ntle le moo, bats'oari ba pathological bapisoa le taolo ba bonts'itse ts'ebetso e phahameng ho dorsal striatum le OFC bakeng sa boleng bo lebelletsoeng bo amanang le phaello. Hyper-reactivity kamora ho amohela meputso ea chelete ka li-bets tse kotsing e kholo e ile ea fumanoa le kalafong ea methapo ea kapele le thuto ea ERP e sebelisang mosebetsi oa jack e ntšo (Hewig et al., 2010). Thutong ea fMRI ea Miedl et al. (2012) Coding ea boleng bo tlase bakeng sa ho theola litheko le ho theola litheko ho baroetsana ba methapo le li-HC li ile tsa hlahlojoa. Boleng ba subjential bakeng sa mosebetsi o mong le o mong bo ne bo lekantsoe bakeng sa karolo e 'ngoe le e' ngoe 'me bo hokahane le ts'ebetso ea boko ho "ventral striatum". Ha ho bapisoa le lits'ebetso, libapali tsa 'mele tse sebelisang papali ea chelete li ile tsa bonts'a ponts'o e kholo ea "subjential value" ka sepheo sa ho theola litšenyehelo, empa tlhahiso ea boleng bo tlase nakong ea mosebetsi oa ho theola litheko. Sena se bonts'a hore basomi ba methapo ea kutlo ba hlahloba boleng le menyetla ka ho fapana ho fapana le taolo. Liphetho tsena li fana ka maikutlo a hore boits'oaro bo sa tloaelehang mabapi le meputso e tlang ho lieha ho barekisi ba mathata bo ka amana le boleng bo fapaneng ba ho ngola.

Mothating ona ha ho rarolloe hore na PG e amahanngoa le ts'ebetso ea hyper- kapa hypo-potolohong ea moputso ho arabela likhatisong tsa chelete, bothata bo ts'oanang bo nang le lingoliloeng tsa ho itšetleha ka lintho (Hommer et al., 2011). Litaba tse 'maloa tsa mokhoa li ka hlalosa litlatsetso tsa hyper- kapa hypo-task ho potoloho ea moputso e fumanoeng lithutong tse boletsoeng ka holimo. Mohlala, ho MID task lihlooho li tlameha ho araba ka potlako kamoo ho ka khonehang ho sepheo sa ho fumana moputso athe mosebetsing o sebelisitsoeng ke van Holst et al. (2012c) lithuto ha li na tšusumetso ea ho hloloa hoa bona kapa tahlehelo ea bona. Phapano ena ea taolo liphetho tsa mosebetsi e kanna ea ba le tšusumetso ho likarabo tsa mosebetsi nakong ea mosebetsi. Ntle le moo, sebopeho sa litšoantšo tsa lithuto tsena tse peli le sona se ne se fapane haholo; mosebetsi oa MID o sebelisitsoeng thutong ke Balodis et al. (2012) o sebelisitse litšoantšo tse sa sebeliseng chelete, e leng mosebetsi oa van Holst et al. (2012c) e bontšitse likarete tsa ho bapala tse tloaelehileng le licheleteng tsa Euro le likoloto. Litloaelo tsena tse amanang le papali ea chelete li ka etsa hore likarabo tsa boiphihlelo li hape hape tse lebisang ho ho hloka kutloelo-pele libakeng tsa litereke (bona lipuisano: Leyton le Vezina, 2012; van Holst et al., 2012c, d). Khopolo-taba ena e mabapi le ho fokotseha ho ts'oaroa ha mokhoa oa ts'ebetso ha ho se na litumelo tse amehang, le ts'ebetso e kholo ea boitsebahatso ha ho e-na le litheko tse loketseng tsa tumello e sa tsoa hlahlojoa ka botebo ke Leyton le Vezina (2013).

Hypothesis ea khaello ea moputso ea ho lemalla e fumane tšehetso e kholo ho tsoa ho lithuto tsa PET tse lekanyang dopamine e sebetsang, e sa fetoheng e bonts'a bokhoni bo tlase ba dopamine D2 / D3 receptor e tlamang lithutong tse itšetlehileng ka lithethefatsi (Martinez et al., 2004, 2005, 2011; Volkow et al., 2004, 2008; Lee et al., 2009). Hore na li-receptor tsena tsa D2 / D3 tse tlamang PG ha e sa hlaka hobane mekhoa ea PET e sa tsoa sebelisoa ho PG. Hajoale, ha ho na phapang e kholo litabeng tsa mantlha tsa DA tse tlamang ho becha ha li bapisoa le li-HC ho bonahala li le teng (Linnet et al., 2010; Joutsa et al., 2012; Boileau et al., 2013) empa lithuto tse ling li supa khokahano e nepahetseng lipakeng tsa DA tse tlamang le ho becha ho teba le ho se tsitse (Clark et al., 2012; Boileau et al., 2013). Holim'a moo, Phuputso ea PET e lekanyang ts'ebetso ea DA nakong ea mosebetsi oa papali ea Iowa e fumane hore ho lokolloa ha DA ho batšoantšisi ba pathological ho amana le thabo (Linnet et al., 2011a) le ts'ebetso e mpe (Linnet et al., 2011b). Ka kakaretso, liphetho tsena li fana ka maikutlo a karolo ea tlamahano e sa tloaelehang ea DA ho PG empa eseng ho isa tekanyong e lekanang le e fumanoang ts'ebelisong ea lithethefatsi eo ho eona ho nang le bokhoni bo hlakileng ba tlama bo tlalehang. (Clark le Limbrick-Oldfield, 2013). Ha ho na letho ka har'a lingoliloeng ke liphuputso tse lekanyang botsitso ba maiketsetso a DA: lithuto tse teng li shebile feela likarolo tse amanang le ho fumaneha ha DA D 2 / 3. Boithuto bo lekanyang bokhoni ba DA synthesis bo ka leka hypothesis ea bokhoni bo phahameng ba syntheishene ea DA ho PG le PrG. Mokhoa o phahameng oa DA o ka lebisa ho dopaminergic e phahameng reacciation ha u tobana le litloaelo tse amanang le bokhoba ba ho lemalla (mohlala, lipapali, chelete, kotsi). Ntle le moo, lithuto tsa PG li laola ka kotloloho DA le ho lekanya likarabo tsa fMRI BOLD nakong ea ts'ebetso ea moputso li ka fana ka tlhaiso-leseling ea bohlokoa mabapi le karolo ea karolo ea DA ho PG.

Khopolo-taba e 'ngoe e haufi le khakanyo ea khaello ea moputso bakeng sa PG le PrG ke hore, e ts'oanang le mathata a ts'ebeliso ea lithethefatsi (SUDs; Robinson le Berridge, 2001, 2008), barekisi ba ts'ebeliso ea kelello le ba betšang ba nang le bothata ba bothata bo boholo ba ts'usumetso ea mekhoa e amanang le papali ea chelete. Sena se matlafalitseng litšusumetso tsa mekhoa ea papali ea chelete ea ho becha se ka ba matla hoo se fetisang litšusumetso tse ling tsa meputso e meng, sa lebisang ho se leka-lekaneng hoa tšusumetso. Ho etsa liteko tsa hore na ba bechang ba ho tsuba ba ka ba le bothata ba khaello ea moputso kapa ho se leka-lekane ha litšusumetso tsa boithati, Sescousse et al. (2013) bapisa likarabo tsa neural ho moruo oa chelete le meputsong ea mantlha (litšoantšo tse tsosang takatso) ho barekisi ba maiketsetso le li-HC. Tumellanong le khopolo-taba ea morao-rao, hypo-reactivity e ile ea bonoa bakeng sa mekhoa ea boitšoaro bo bobe, ho fapana le ho khutlisetsoa ho tloaelehileng meputsong ea lichelete, ho bonts'a tšusumetso e sa leka-lekaneng ea tšusumetso ho PG. Ho nkile lithuto tsohle tse kaholimo 'moho, ka nako ena ho bonahala e le monyetla o moholo oa hore bathekatsi ba se nang mathata a khaello ea moputso ka kakaretso empa barekisi ba ts'ebeliso ea kelello ba na le ts'ebeliso e fapaneng ea tšusumetso e amanang le papali ea chelete, mohlomong ba bakoa ke ts'usumetso e matla ea ts'usumetso ea papali ea papali ea chelete.

Haufinyane lithuto tsa fMRI li shebile likhethong tse ikhethileng tse amanang le ho becha. Sena se bohlokoa hobane hangata barekisi ba mathata a bontša mefuta e mengata ea khethollo mabapi le lipapali tsa papali ea chelete (Toneatto et al., 1997; Toneatto, 1999; Clark, 2010; Lumela le lehlohonolo, 2013). Mohlala, ba bechang ba tsebahala ka ho lumela hore ba ka susumetsa menyetla ea lipapatso ("bolotsana ba taolo") (Langer, 1975). Likarolo tse fapaneng tsa bohlokoa tsa lipapali tsa menyetla li khothalletsa leeme lena (Griffiths, 1993), joalo ka mohlala liketsahalo tsa "haufi-miss" (Kassinove le Schare, 2001). Liphumano tsena tse haufi-ufi kapa tse haufi le tahlehelo (tseo ha e le hantle li lahlehileng) li etsahala ha mochini o sekoti o ts'oanang o bontša letšoao le tšoanang le lebili la boraro le bonts'ang letšoao le kaholimo kapa ka tlase ho mola o lefang. Phuputso e ileng ea etsa lipatlisiso mabapi le litla-morao tsa mathata ho becha tsa mathata e fumane hore likarabo tsa boko nakong ea ha li sa fumane litholoana tse ntle haholo (ha li bapisoa le sepheo se felletseng) tse hlahisitseng libaka tsa moputso oa boko tse kang striatum le cortex ea insular joaloka nakong ea sephetho sa katleho.Chase le Clark, 2010). Habib le Dixon (2010) e fumane hore liphetho tsa haufinyane li lebisa karabong e kholo ea boloi ho tsa papali ea papali ea chelete, athe li-HC li ile tsa kenya tšebetsong likarolo tsa boko tse amanang le tahlehelo e kholo. Lithuto tsena li kenya letsoho kutloisisong e ntle ea bokhoba ba lipapali tsa papali ea chelete le ts'ebetso ea eona e ka tlase ea neuronal.

Na litšusumetso tse matlafatsang tsa papali ea chelete tse amanang le papali ea chelete li ka lebisa tahlehelong ea boitšoaro?

Mohlala o nang le tšusumetso ebile o thehiloe ka matla oa ts'ebetso ea ts'ebeliso ea ts'ebeliso ea thepa, Impaired Response Inhibition and Salience Attribution (I-RISA), e fana ka maikutlo a hore tšebeliso ea lithethefatsi tse phetoang e tsosa letoto la liphetoho maemong a methapo ea methapo e amanang le mohopolo, ho susumetsa le taolo ea kelello (Volkow et al., 2003). Haeba motho a sebelisitse lithethefatsi, mehopolo ea liketsahalo tsena e bolokiloe e le setsoalle lipakeng tsa khothatso le liphihlelo tse monate (tse monate) kapa tse mpe (tse khopisang), tse tataisoang ke ts'ebetso ea dopaminergic e bakiloeng ke lithethefatsi tsa tlhekefetso. Sena se etsa hore ho be le sesapo se ntlafalitsoeng (sa nako e telele) sa lithethefatsi le litheko tse tsamaisanang le sona ka litšenyehelo tsa litšila tse theotsoeng bakeng sa bathusi ba tlhaho (Volkow et al., 2003). Ntle le moo, mofuta oa I-RISA o nka tahlehelo ea taolo (disinhibition) holim'a lithethefatsi ka lebaka la bofokoli bo ntlafalitsoeng le bofokoli bo neng bo le teng pele (joalo ka ha ho hlalositsoe karolong ea 1 ea tlhahlobo), e fanang ka batho ba nang le bothata ba ho lemalla ho ts'oaroa ka ts'ebeliso ea ts'ebeliso ea boitšoaro bo bobe. .

Mathateng a ho lemalla ho kenyeletsa PG, ho na le bopaki ba hore litsamaiso tse tsamaeang ka bobeli le tse khothatsang li ela hloko haholo litlatsetso tse loketseng. Mohlala, liphuputso li bonts'itse hore litloaelo tse amanang le bokhoba ba ho hohela li hohela tlhokomelo ho feta ts'usumetso e 'ngoe e ikhethang, ketsahalo e tsejoang e le "ingqalelo ea leeme" (McCusker le Gettings, 1997; Boyer le Dickerson, 2003; Masimong le Cox, 2008). Joalokaha ho hlalositsoe karolong ea "cue reacaction" ea tlhahlobo ena, ho batlana le mathata, ho ntlafatsa karabo ea boko ho litloaelo tse amanang le papali ea chelete ("cue reacction") le hona ho fumanoe libakeng tsa boko tse amanang le ts'ebetso ea susumetso le taolo ea kelello (amygdala, basal ganglia, cortex ea boemo bo holimo ea pele le ea dorsolateral pele ho li-cortex; Crockford et al., 2005; Goudriaan et al., 2010).

Joalokaha ho tšohliloe karolong ea pele ea tlhahlobo ena, PG e amahanngoa le taolo ea kelello e senyehileng. Leha ho le joalo hore na taolo ea kelello e sebelisana joang le lits'ebetso tse susumetsang e sa ntse e le lipatlisiso. Haufinyane tjena, lithuto li se li qalile ho leka tšebelisano pakeng tsa taolo ea kelello le boitsibollo ho PG. Ho e 'ngoe ea lithuto tsa rona tsa morao-rao, re sebelisitse mosebetsi o fetotsoeng oa Go / NoGo ka ho kenyelletsa li-block tsa activative activus (papali ea chelete, e ntle le e seng ntle), ho tlatselletsa ho litekanyetso tse tloaelehileng tsa ho se nke lehlakore litabeng tsa papali ea chelete le li-HC (van Holst et al., 2012b). Lintho li ile tsa kopuoa ho araba kapa ho hanela karabo ea mefuta e khethehileng ea litšoantšo tse nang le maikutlo a fapaneng, ho lumella lipatlisiso tsa tšebelisano lipakeng tsa thibelo ea makoloi le sebopeho sa sesosa. Moo re sa fumaneng phapang ea boitšoaro litekong tsa thibelo ea karabelo e sa nkeng lehlakore, ba betang ka bothata ha ba bapisoa le taolo ba bonts'a ts'ebetso ea dorsolateral pele le ts'ebetso ea ACC. Ho fapana le hoo, nakong ea papali ea chelete le papali e ntle ea litšoantšo, basekete ba ile ba etsa liphoso tsa thibelo e fokolang ho feta taolo mme ba bonts'a ts'ebetso e fokotseng ea dorsolateral prefrontal le ACC. Boithuto bona bo bonts'itse hore bashebelli ba "pathological" ba ts'epahalla mesebetsing ea boko ho fumana katleho e ts'oanang nakong ea thibelo ea karabelo e sa nke lehlakore. Leha ho le joalo, ho inhibition e amanang le papali ea papali ea chelete kapa e ntle ho bonahala ho le joalo e thusitsoe, joalo ka ha ho bonts'itsoe ke ts'ebetso e tlase ea boko le liphoso tse fokolang tsa karabelo ho batšabeli ba methapo. Lintlha tse tsoang thutong ena ea Go / NoGo li ile tsa hlahlojoa hape ho leka sephetho sa tšusumetso ea ts'ebelisano le mekhoa ea khokahano e sebetsang nakong ea mosebetsi (van Holst et al., 2012a). Joalo ka ha ho lebelletsoe, thibelo e lekaneng ea karabo e ne e amana le ho hokahana ho sebetsang kahare ho likarolo tse ka tlase tsa sistimi e kholo ea dorsal hammoho le kgokahano e sebetsang pakeng tsa molaoli ea phahameng oa dorsal le mokhoa oa tšebetso oa ventral ka bobeli ho li-HC le boloi ba bothata. Ha ho bapisoa le li-HCs, barekisi ba bothata ba ile ba bonts'a khokahanyo e matla pakeng tsa sistimi e kholo ea dorsal le ho nepahala ha mesebetsi nakong ea ho thibela boemo ba papali ea chelete. Liphumano tsena li fana ka maikutlo a hore ho eketseha ho nepahala ha batsomi ba li-pathological nakong ea maemo a papali ea chelete ho ne ho amahanngoa le ho hokahana ho eketsehileng le tsamaiso e kholo ea dorsal (van Holst et al., 2012a). Ho bonahala eka ts'ebetso ea DA e bapala karolo ea bohlokoa ho tse fumanoeng. Lisosa tse susumetsang li matlafatsa phetiso ea DA tsamaisong ea mesolimbic (Siessmeier et al., 2006; Kienast et al., 2008) mme DA e tsejoa ho fetola ts'ebetso ea cortex ea pele (Robbins le Arnsten, 2009). Ka 'nete bathong, ho fetisoa ha DA ho na le phello ea ho hokahano ho sebetsang kahare ho li-loops tsa corticostriatal thalamic (Honey et al., 2003; Cole et al., 2013). Ho hlokahala patlisiso e eketsehileng ho hlakisa tšebelisano lipakeng tsa susumetso, DA le taolo ea kelello ho PG. Thutisong e boletsoeng pejana ke Leyton le Vezina (2013), ho khothaletsoa mohlala o kopanyang tšusumetso ea likarabo tsena tse fapaneng tsa maikutlo ho hlahisa maikutlo a boitšoaro bo bobe. Bohlokoa mohlaleng oa hae ke mohopolo oa hore ts'ebetso e tlase ea boits'oaro e lebisa ho se khonehe ho tsitsitseng maikemisetso a lebisitsoeng ho sepheo, athe boteng ba ts'ebetso e kholo (ha litekanyetso tsa lithethefatsi li le teng) mohopolo o tsitsitseng le ho khanna ho fumana moputso o teng. Se fumanoeng se lekotsoe ka holimo (van Holst et al., 2012a, b) lekana mohlala ona hantle: ts'ebetso e ntlafalitsoeng e ne e le teng lipapaling tsa papali ea chelete maemong a matle le a papali ea chelete, 'me khokahano e sebetsang ea ts'ebetso e ile ea fumaneha le sistimi e kholo ea dorsal e mabenkeleng a bothata ba ho becha. Sena e ka ba sesupo sa hore maemong a tloaelehileng maemong a mabe a ts'ebetso ea bophelo bo tlase ba ts'ebeliso e mpe ea ts'ebetso, moo ho nang le lintlha tsa bohlokoa tse khothatsang maemong a monate le a papali ea chelete ea Go / NoGo.

Ho bohlokoa kliniking ho etsa lipatlisiso tse eketsehileng hore na tšebetso e eketsehang tsamaisong ea moputso e hlile e na le phello ea nakoana ea ho khutlisa cortex e sebetsang pele ho ba bechang. Sena se ka lekoa ke mathata a meriana kapa ka ho ntlafatsa tšebetso tsamaisong ea moputso sebakeng sa heno, mohlala ka ho sebelisa nako ea sebele ea fMRI neurofeedback (deCharms, 2008) kapa Transcranial Magnetic Stimulation (TMS; Feil and Zangen, 2010). Leha ho le joalo, re fana ka maikutlo a hore ho ba le monyetla oa ho ba le ts'usumetso e khotsofatsang ho ka lebisa ho haele hantle tshebetso ya mosebetsi. Mohlala, ha tlhokomelo e ngata e abeloa ho susumetsoa ke maikutlo, sena se ka etsa hore ho khutlisoe taolo e phahameng ea taolo (Pessoa, 2008). Mokhoa o ntlafalitsoeng oa ho batla moputso le karabelo e ntlafalitsoeng ea meputso e ka bang teng e ka ba mohopolo oa bohlokoa ho utloisisa hore na hobaneng mesebetsing e nang le papali ea maemo a marang-rang e bonts'a ts'ebetso ea kelello e fokolang (Brand et al., 2005; Goudriaan et al., 2005, 2006; Labudda et al., 2007; Tanabe et al., 2007; de Ruiter et al., 2009).

Kakaretso ea sephetho se fumanehang: boits'oaro, ho etsa lintho ka bocha, ho khotsofatsa maikutlo mehatong e fapaneng ea papali ea chelete, le tšebelisano lipakeng tsa boitšoaro le tšusumetso e matla.

Ha re leka ho fihlela sephetho se akaretsang mabapi le lithuto tse hlahlojoang, ho hlakile hore bakeng sa lihlooho tse ling, lipatlisiso tse lumellanang li thehiloe ka lilemo. Mohlala, khopolo ea ho eketseha ho hoholo ho PG le PrG e tiisitsoe ka thata mme lithuto tsa pele tse entsoeng ka neano li bonts'a hore ts'usumetso ena e phahameng e tsamaisana le ho fokotseha hoa ts'ebetso ea pele le ho sebetsa ha ACC. Ho hlakile hore lefapha la ts'ebetso ea kelello ho PG le hloka lithuto tse matlafatso ho fumana hore na ke mesebetsi efe ea kelello e amehang ka ho fetisisa. Boithuto ba thuto ea morao-rao e amanang le "Neuroimaging" e bonts'a hore ha lits'ebetso tsa ho becha li le teng, ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso e sebetsa haholo ho PG le PrG, joalo ka ha ho bonahala ho ts'ebetso ea maemo a holimo ea parahippocampal, amygdala, basal ganglia le ts'ebetso ea OFC. Mabapi le maikutlo a ntlafalitsoeng a moputso oa neural kapa ho fokotseha ha maikutlo a moputso, lithuto tsa pele li bonahala li bonts'a hore ha ts'ebetso e ntlafalitsoeng ea ts'ebetso ea moputso oa boko e le teng ka har'a tebello ea ho hapa kapa ho ba maemong a kotsi a ho becha, ho fokotseha karabelo ea moputso ho teng potolohong e tšoanang ka mor'a ho hlola le / kapa ho lahleheloa ke chelete. Kamora nako, tšebelisano ea taolo ea cue-reactivity le taolo ea kelello e bonts'a hore ts'ebetso ea ts'ebetso ea taolo ea kutlo ho bataki ba mathata e ka matlafatsoa ka ho kenya tšebetsong potoloho e susumetsang. Leha ho le joalo, sepheo sena se hloka ho pheta-pheta, le karolo ea DA ho tataisa le ho theola taolo ea kelello ho PG e lokeloa ke ho ithutoa hape.

Litlamorao tsa tleleniki

Phekolo ea boits'oaro ea methapo ea kutlo (CBT) bakeng sa babapali ba nang le bothata e shebane le ho kenella molemong oa boits'oaro ho fokotsa sekhahla sa ts'ebetso ea papali ea chelete mme o bontšitsoe hore o sebetsa hantle kalafong ea PG (Petry, 2006; Petry et al., 2006), leha ho khutlela morao e ntse e le ntho e phahameng, ho tloha ho 50-60% lithutong tsa kalafo, ka litekanyetso tsa ho khaotsa ho tsoelang pele bakeng sa selemo se tlase joalo ka 6% (Hodgins et al., 2005; Hodgins le el Guebaly, 2010). Kahoo, sebaka sa ntlafatso e kholo liphethong tsa kalafo bakeng sa PG / PrG. CBT e shebane le ho holisa taolo ea taolo ea ho becha mabapi le papali ea chelete, le phetoho mokhoeng oa ho etsa papali ea papali ea chelete ka lebaka la ho kopana le mekhoa ea ho becha kapa ho lakatsa. Mekhoa e ikhethileng e sebelisitsoeng ho CBT bakeng sa PG le PrG e kenyelletsa maano a ho sebetsana le ho sebetsana le maemo, ho sebelisa mekhoa ea taolo ea ho susumetsa, le ho sebetsana le maemo a kotsi ka ho sebelisa maano a boits'oaro, mohlala ka likarete tsa tšohanyetso. Kahoo, ho CBT bakeng sa PG le PrG, karolo e kholo ea ho kenella e itšetleha ka ho kenya letsoho mesebetsi e metle ka ho kenya tšebetsong maano a boitšoaro le taolo ea maikutlo. Mathateng a mang a kelello, lithuto tsa neuroimaging li bontšitse hore ho se tšoane ha tšebetso ea boko pele ho kalafo ho ka bolela litlamorao tsa kalafo ea CBT. Mohlala, ts'ebetso e ntlafalitsoeng ea ts'ebetso ea ts'ebetso ea boko nakong ea mosebetsi oa ho thibela karabelo e hlahisitse karabelo e ntle ho CBT ho latela khatello ea maikutlo e sithabetsang (Falconer et al., 2013). Keketseho ea ts'ebetso ea mantlha ho PFC ea ventromedial le litlamorao tsa mesebetsi ea maikutlo (mohlala, mesebetsi ea ts'okelo ea sechaba) ho "anterior) temporal lobe, ACC le DLPFC e khothaletsa katleho ea kalafo ho ruruha e kholo ea khatello ea maikutlo (Ritchey et al., 2011) le bothateng ba matšoenyeho a sechaba (Klumpp et al., 2013). Liphumano tsena ha li fane feela ka tlhahiso ea hore ts'ebetso ea boko e ka ba li-biomarker tse ncha tsa bohlokoa bakeng sa ho bonts'a monyetla oa katleho ea kalafo ka CBT, empa hape e supa boleng bo ka ba teng ba lipallo tse ncha tse lebisang bofokoli ba neurobiological ba PG le PrG. Ka ho ithuta mesebetsi ea boko e leng li-biomarkers bakeng sa katleho ea CBT ho PG le ho ntlafatsa mesebetsi ena ea boko ka ho kenella ka methapo kapa ho kenella lipakeng tsa meriana, litlamorao tsa kalafo bakeng sa PG le PrG li ka ntlafala.

Ho kenella ka makhetlo a 'maloa ho lebisitsoeng ho tlokotsi ea neurobiological ea PG le PrG hoa tšepisa ebile ho ka fella ka litlamorao tsa kalafo ka ho sebelisana le ho ntlafatsa mesebetsi eo e leng tlhoko ea katleho ea CBT. Haufinyane, ho kenella ha li-neuromodulation ho fumane thahasello ho lipatlisiso tsa bokhoba ba tahi. Ka ho khetheha, mekhoa ea neurostimulation joalo ka phetisetso ea Transcranial Magnetic Stimulation (rTMS) le transcranial Direct Current Stimulation (tDCS) e ile ea hlahlojoa bocha meta-analysis (Jansen et al., 2013). Ho tsoa tlhahlobisong ena ea meta, ho fumanoe saese ea boholo bo mahareng bakeng sa ts'ebetso ea methapo ea kutlo le rTMS kapa tDCS ho fokotsa ho lakatsa lintho kapa lijo tse matlafatsang. Phuputsong e nang le likarolo tse ngata tsa li-rTMS ho batho ba tsubang boima ba 48, mananeo a letsatsi le letsatsi a 10 ea RTMS e sebetsang ho feta DLPFC e bakile ts'ebeliso e fokotsang tšebeliso ea koae le ts'ebeliso ea nicotine, ha e bapisoa le boemo ba taolo ba sham rTMS (Amiaz et al., 2009). E amanang le neurostimulation, EEG neurofeedback ho SUDs e sa tsoa fumana phaello e nchafalitsoeng, ka lithuto tse ling tsa lifofane tse bonts'ang liphetho tse ntle tsa thupelo ea li-neurofeedback tsa EEG ho latela ts'ebeliso ea koae (Horrell et al., 2010) le ts'ehetso ea opiate (Dehghani-Arani et al., 2013). Kahoo, ho kenella ka ts'ebetso ea neurostimulation kapa neurofeedback ho PG le PrG le tsona ho lokiselitsoe, ho etsa lipatlisiso tsa hore na ho kenella ka tšebetso ea methapo ea kutlo le hona ho na le ts'episo mokhoeng ona oa boitšoaro.

Joalo ka ha e ka ba tšebelisano e seng ea bongaka, liphetoho lits'ebetsong tse susumetsang ho PG li ka lebisoa ke "ho bala ka hloko" (MacLeod et al., 2002; Wires et al., 2006). Nakong ea tlhokomelo e potlakileng bakuli ba koetliselitsoe ho fetola maikutlo a bona ka ho etsa mesebetsi ea khomphutha, ka tsela eo ba ikemiseditse ho fokotsa ho etsa lintho hape ho fetola boits'oaro. Ho kena lipakeng ho amana le mekhoa e meng ea boiketsetso eo ho eona boitšoaro bo lebisang bokhobeng ba boitšoaro bo amanang le bokhoba ba boitšoaro bo sa khaotseng. 2006, 2010; Schoenmaker et al., 2007). Mathateng a ts'ebeliso ea joala, litholoana tse tsoang liphelisanong tse khothalelitsoeng lia tšepisa (Wires et al., 2006, 2010). Leha ho le joalo, lipuisano tsena ha li so ho lekoa ho PG le litlamorao tsa nako e telele tsa tlhokomelo le ts'ebetso ea ts'ebetso ea liketso ha li e-so fumanehe mme li hloka ho hlahlojoa lipatlisiso tsa nako e tlang.

Ho kenella hoa meriana

Ntle le bokhoni ba ts'ebetso ea methapo ea kutlo, ts'ebetso ea neurofeedback le tlhokomelo e khutsitseng, ho tlalehiloe lithibelo tse ngata tse ts'episang tsa kalafo bakeng sa kalafo ea PG (bakeng sa tlhahlobo ea bona van den Brink, 2012). Liphumano tsa Neurobiological li bonts'a karolo ea bohlokoa ea tsela ea mesolimbic, e kenyelletsang seterral striatum, le ventromedial prefrontal cortex (VMPFC) ho PG. Hobane VMPFC ke sebopeho se itšetlehileng haholo ka likhakanyo tsa DA tse sebetsanang le likarolo tsa maoto ho kopanya tlhahisoleseling, phetisetso e mpe ea DA e ka ba sesosa se haellang sa tlatsetso ea VMPFC ho PG. Leha ho le joalo, lits'ebetso tse ling tse ngata tsa neurotransmitter li kanna tsa ameha hape 'me li ka sebelisana nakong ea ts'ebetso ea maikutlo a mabe le a fosahetseng. Mohlala, opiates e tsejoa ho eketsa tokollo ea DA tseleng ea moputso, mme bahanyetsi ba opiate naltrexone le nalmefene, eo ho tsejoang hore e fokotse ho lokolloa ha DA, ba fumanoe ba fokotsa maikutlo a meputso mme mohlomong ba eketsa kutloisiso ea kotlo hape (Petrovic et al. , 2008). Ntle le moo, kalafo e mabapi le bahanyetsi ba opiate e bontšitsoe hore e sebetsa ho PG le ho fokotsa takatso ea papali ea chelete (Kim le Grant, 2001; Kim et al., 2001; Modesto-Lowe le Van Kirk, 2002; Grant et al., 2008a, b, 2010b).

Moo ho lemaletseng lithethefatsi, lithethefatsi le tšusumetso e amanang le lithethefatsi li ka etsa hore DA e lokolloe mokokotlong oa "ventral striatum" le ho tiisa tšebeliso ea lithethefatsi nakong ea phihlello ea bothata ba tšebeliso ea lithethefatsi, e sa foleng ho ja lithethefatsi ho tsamaisana le neuroadaptation ea glutamatergic neurotransication ho ventral le dorsal striatum le limbic cortex (McFarland et al., 2003). Ntle le moo, ho pepesetsoa hoa cue ho fumanoe ho latela lipakanyo tsa li-neurons tsa glutamatergic ho tloha pele ho cortex ea pele ho isa ho li-nucleus accumbens (LaLumiere le Kalivas, 2008). Ho thibela ho lokolloa ha glutamate ho thibetse boits'oaro ba ho batla lithethefatsi ho liphoofolo le ho batho ba itšetlehileng ka litheko tsa batho (Krupitsky et al., 2007; Mann et al., 2008; Rösner et al., 2008). Ka hona, litholoana tsa pele tse tšepisang li tsoa ho lithuto tsa sefofane se nang le N-acetyl cysteine ​​(Grant et al., 2007) le memantine (Grant et al., 2010a), e fetolang mokhoa oa glutamate, lithuto tse kholo tse netefatsang litlamorao tsa metsoako ena e laolang glutamate kalafong ea PG.

Ntle le tsepamiso ea ho ntlafatsa mesebetsi ea kelello le ho fokotsa litakatso tsa methapo ea kutlo kapa mekhoa ea meriana, haufinyane, thahasello ea tšusumetso ea lintlha tsa ts'ireletso e se e holile. Mohlala, ho hloka matla ho tlase le bokhoni ba ho sebetsana ka katleho le bophelo bo hokahane le sephetho se nepahetseng haholoanyane bakeng sa li-SUD. Kahoo, re seke ra shebana feela le maemo a kotsi, empa hape le karolo ea lintho tse sirelletsang le tse fapaneng tsa tikoloho tse li khothalletsang li ka holisa kutloisiso ea rona ea likamano tsa boits'oaro ba kelello le litsela tsa ho holisa le ho hlaphoheloa ho tsoa ho PG le PrG. Sesebelisoa se ka 'nang sa tsepamisa maikutlo linthong tse peli tse ka bang kotsi le ho itšireletsa e ka ba ho lekola mesebetsi ea kelello le ts'usumetso nakong ea kalafo, etsa lipatlisiso hore na li sebetsa ka mokhoa o ikemetseng, le tse sebetsang li hloka tlatsetso ho tsoa lipuisanong tsa lipale tse kang boikoetliso ba kelello, ts'ebetso ea methapo ea kutlo, kapa ts'ebetso ea meriana.

Nahanisisa

PG le PrG ka ho hlakileng li amahanngoa le phapang ea kelello le e susumetsang ea ts'ebetso ea neuropsychological le bokong. Ka ho khetheha, ts'usumetso e phahameng le ts'ebetso e phahameng ea ts'ebetso e teng, e amanang le ho fokotseha hoa ts'ebetso ea potoloho ea kelello ho bokong, joalo ka ACC le dorsolateral prefrontal cortex. Ntle le moo, ts'ebetso ea ts'usumetso e ameha, e amanang le ts'ebetso e fapaneng libakeng tsa pele le literekeng tsa thalamo-striatal, tse hokahanang le "cortex" e ka pele. Ho hlokahala patlisiso e eketsehileng ho lekola tšebelisano lipakeng tsa mesebetsi ea kelello le e susumetsang, joalo ka ha motsoako oa likhakanyo tsa ho becha ka linako tse ling o ntlafatsa mesebetsi ea kelello. Ho etsa lipatlisiso tsa ts'ebetso ea ts'ebetso ea lipale tse fumanehang ho mekhoa ea methapo ea kutlo, joalo ka neuromodulation, koetliso ea kelello, le ho kenella hoa meriana Ntle le moo, patlisiso e shebaneng le lintlha tsa ts'ireletso le ho hlaphoheloa ha lintho tse kotsing ho ka supa mekhoa e lokelang ho ikemisetsa ho ntlafatsa tsela ea PG.

Menehelo ea Mongoli

Anna E. Goudriaan, Murat Yücel, le Ruth J. van Holst ba kentse letsoho tlhophisong ea tlhahlobo, Anna E. Goudriaan le Ruth J. van Holst ba qopile likarolo tsa buka e ngotsoeng ka letsoho, Anna E. Goudriaan, Ruth J. van Holst, le Murat Yücel o ile a ntlafatsa mosebetsi ona ka mokhoa o hlakileng bakeng sa litaba tsa bohlokoa tsa mahlale. Tumello ea ho qetela ea phetolelo e tla phatlalatsoa e fanoe ke bangoli bohle mme bangoli bohle ba lumela ho ikarabella bakeng sa likarolo tsohle tsa mosebetsi ho netefatsa hore lipotso tse amanang le ho nepahala kapa botsitso ba karolo efe kapa efe ea mosebetsi li hlahlojoa ka nepo.

Khohlano ea polelo ea thahasello

Bangoli ba bolela hore lipatlisiso li ne li etsoa ka ho se be le likamano leha e le life tsa khoebo kapa tsa lichelete tse ka nkoang e le khohlano e ka 'nang ea e-ba le thahasello.

References