Bothata ba papali ea chelete: phetoho ea neurobiological le ea meriana (2011)

Koranta ea Brithani ea Psychiatry (2011) 199: 87-89

doi: 10.1192 / bjp.bp.110.088146

  1. Henrietta Bowden-Jones, MRCPsych, DOccMed, MD
  1. Luke Clark, DPhil

+ Boikarabello ba Mongoli

  1. Imperial College London, le Tleliniking ea Bothata ea Papali ea Mathata, Central North West NHS Foundation Trust
  2. Setsi sa Behavial and Clinical Neuroscience Institute, Lefapha la Tlhahlobo ea Psychology, Univesithi ea Cambridge, UK

+ Lintlha tsa Sengoli

  • Henrietta Bowden-Jones (ea setšoantšong) ke Mothehi le Motsamaisi oa Setsi sa Teko ea Papali ea Bothata ea Naha, le 'muelli oa bothata ba papali ea chelete bakeng sa Royal College of Psychiatrists. Luke Clark ke setsebi sa kelello Univesithing ea Cambridge.

  • Ngollano: Ngaka Henrietta Bowden-Jones, Kliniki ea Sechaba ea Papali ea Papali ea Chelete, Seterata sa 1 Frith, London W1D 3HZ, UK. Email: [imeile e sirelelitsoe]

inahaneloang

Khokahano e kopantsoeng ea ho ts'oaroa hoa marang-rang le lithethefatsi tsa lithethefatsi ho DSM-5 e hlahisa kakaretso ea lintlha tsa neurobiological tse bonts'a ho tšoana lipakeng tsa maemo ana, le tlhaiso-leseling ka mekhoa ea naha ea boits'oaro ba papali ea chelete le phepelo ea hona joale ea kalafo.

Ho betla papali ea kelello ho ile ha hlahisoa e le setsi sa mafu a kelello ho DSM-III ho 1980, 'me bakeng sa likhatiso tse peli tse fetileng, e thathamisitsoe ho Ts'usumetso ea Liphapang tsa Impulse haufi le pyromania le trichotillomania. Joale, boitekong ba DSM-5 e tlang, ho phatlalalitsoe ka mokhoa o hlakileng, moo ho becha ho ka tsubelletsang haufi le bothata ba tšebeliso ea lithethefatsi le joala. E tla reoa lebitso la papali ea chelete 'me karolo eo ka boeona e tla fetoha' lithethefatsi le mathata a amanang '.

Liphetoho tsena li baka phehisano lipakeng tsa bafuputsi ba papali ea papali ea chelete le litsebi lefapheng la litheko.1,2 Liqeto tsa Sehlopha sa Ts'ebetso sa DSM-5 li hlalositsoe mefuteng e mengata ea bopaki bakeng sa ho tsubella lipakeng tsa papali ea papali ea chelete ea methapo le mathata a tšebeliso ea lithethefatsi..3 Mabapi le polelo ea bongaka, ho tsejoa hantle hore bats'oari ba pathological ba bonts'a matšoao a ho tlohela (ho teneha ha ba leka ho emisa kapa ho theola tekanyo ea papali ea chelete), le matšoao a mamello (tšekamelo ea ho becha ka bongata le lipalo tse phahameng), tseo ka bobeli e leng nkoa e le matšoao a bokhoba ba tahi. Sebopeho sa li-comorbidities bakeng sa likhathatso se tšoana haholo, mme ho pota 30-50% ea ba betšang ba pathological ba bile le tšebeliso e mpe ea lithethefatsi.4 Ho fumanoe lintlha tse tloaelehileng tsa kotsi, ho kenyelletsa matšoao a lefutso a susumetsang phetisetso ea dopamine, le litšobotsi tse amanang le ho se tsitse.5 Ntle le moo, meriana e netefalitsoeng ka ho fetisisa bakeng sa papali ea papali ea chelete ea ho becha ke bahanyetsi ba opioid (mohlala naltrexone);6 lithethefatsi tse neng li lekoa pele ho papali ea papali ea methapo ho latela ts'ebetso ea tsona ts'ebelisong ea lithethefatsi le joala.

Mekhoa ea boloi ea ho becha e sa sebetseng hantle

Sehlopha sa Ts'ebetso sa DSM-5 se boetse se hlokometse ka hloko lipatlisiso tsa morao-rao mabapi le motheo oa pathophysiology ea papali ea chelete e senyehileng. Lithuto tsa Neuropsychological ho basomi ba methapo ea methapo ba bonts'itse bofokoli ba mantlha ho etsa liqeto tse kotsi, tse tšoanang le liphetoho tse bonoang ho bakuli ba nang le liso tsa boko le tšenyo ea "cortex" ea "ventromalial prefrontal cortex". Bacha ba papali ea chelete ba beha liqeto tse phahameng liqetong tse bonolo tse ka bang teng,7 ha ba na monyetla oa ho khetha meputso e liehang ho feta khotsofalo ea hanghang,8 mme ba sokola ho ithuta mokhoa o motle oa tlhahlobo e fumanang phaello ea nako e khuts'oane khahlano le likotlo tsa nako e telele.9 Matšoao ana a re hopotsa, maemong a kliniki, ka boikemisetso ba bona ba ho lekola tlhahlobo e tlase ea kotsi le papali e phehellang ha ba le mokoloto o ntseng o eketseha. Mathateng a ts'ebeliso ea lithethefatsi, methati ena ea methapo e na le bohlokoa ba ho bolela sephetho sa kalafo tsa nakoana.10 Leha ho le joalo, datha ea neuropsychological ha e na litlamorao tse sa utloahaleng bakeng sa ho hlophisa mathata ana, kaha mefokolo ena e ka sebelisoa ka mokhoa o ts'oanang ho ts'ehetsa ho khetholla ha ts'ebeliso ea ts'ebeliso ea ts'ebeliso ea methapo ea methapo hammoho le khatello ea kelello e ka fokotsang ts'ebetso ea kelello kapa lefu la ho ferekanya kelello.

Patlisiso ea neuropsychological joale e tlatselletsoa ke lithuto tsa neuroimaging tse bonesisang ka kotloloho likarolo tse ka tlase tsa boko. Potenza le basebetsi mmoho11 ba sebelisitse monahano o sebetsang oa boloi ho bona hore na likarabo tsa boko li hokae ha ba becha ka methapo ea kutlo ba shebelletse livideo tsa papali ea chelete 'me ba etsa mesebetsi ea boitšoaro. Bokhoba ba koae ka har'a lab bona bo entse lintho tse tšoanang le bona mochineng oa khatiso. Lihlopha tsena ka bobeli li bonts'itse ho amoheloa ha tikoloho ea "ventromedial prefrontal cortex" ka nako ea ts'ebetso ka bobeli, ho fapana le taolo e phetseng hantle.11 Phuputso e ikhethileng e ne e na le bashebelli ba pathological ba tlatsang papali ea karete e bonolo moo ba ka hlolang kapa ba lahleheloa ke € 5 tekong ka 'ngoe. Likarabo tsa boko mokotleng oa moputso oa dopamine li ile tsa bonts'oa, 'me tse ling tsa liphetoho tsena li ne li lekana le bosholu ba papali ea chelete.12 Ha mesebetsi ea ts'ebetso lithutong tsena e ntse e phahama haholoanyane, ho bonahala ho khona ho hlakola tse ling tsa litlatsetso tse potelletseng tse bonoang ho barekisi ba mathateng, joalo ka phello ea sephetho se haufi haholo.5 le liqeto tse lelekisang tahlehelo.13 Leha ho le joalo, ho lokela ho hlokomeloe hore lithuto tsena tse natefisang maikutlo li fokola ka palo, li sebelisitse palo e nyane ea barupeluoa, 'me liphetho li ka fokotsa mathata a mangata mme ea fana ka tlhahiso ea hore pathophysiology e arolelanoang ka maemo a mangata.

Lits'ebetso tsena tsa neurobiological li beha kotsi ea ho nka hore batho ba papali ea papali ea chelete ba emela sehlopha se ts'oanang. Sena ha se bonahale e le 'nete. The Pathways Model e hlalositsoe ke Blaszczynski & Nower14 (Le ha e e-so netefatsoe ka botlalo) e kholoa ka mekhoa e meraro ea papali ea chelete. Batho ba sehlopha sa pele ha ba na bofokoli bo boletsoeng esale pele; ho e-na le hoo, mathata a bona a papali ea chelete a bontšitsoe ke bokhoni ba kelello ba lipapali tseo ka bo bona, 'me mohlomong ke boiphihlelo ba "win great" pejana mesebetsing ea bona ea papali ea chelete. Sehlopha sa bobeli se tloaetse ho tepella maikutlo kapa ho tšoenyeha, mme batho bana ba qala ho becha e le mokhoa oa ho baleha kapa oa ho fokotsa mathata ana a maikutlo. Sehlopha sa boraro se leng teng se nang le litšekamelo tsa ho hlonama le se sa kenelle, se tsamaeang le bopaki ba neuropsychological ba ho kenella ka kotloloho ea cortex, mme e kanna ea ba sehlotšoana sena se bontšitsoeng lithutong tsa neurobiological lihlopheng tsa lingaka tse hlalositsoeng ka holimo.

Liqeto tse mabapi le ts'oaetso ea ho becha ha methapo ea methapo

Liphetoho tse ling hape tse peli ho fumanoeng ha ho becha li-pathological li ka etsahala ho DSM-5. Qeto ea ho reha bokuli lebitso, 'papali ea chelete e felisitsoeng' e hlahisitsoe ke pherekano lipakeng tsa mantsoe a reng papali ea papali ea papali ea chelete le 'papali ea chelete'. Lintlha tsa Epidemiological15 bonts'a hore ho na le likotsi tse ngata tse bakoang ke papali ea chelete ho batho ba bangata ba sa kopaneng le ho emisoa hoa DSM-matšoao a mahlano ho tsoa ho ba leshome ba boletsoeng, 'me ho etsa hore ba bang ba sebelise lentsoe' bothata ba ho becha 'ka tsela e itseng ntle le khethollo. Patlisiso ea Brithani ea Pele ho Kamore16 e amohetse mokhoa o lokollang oa matšoao a mararo a DSM bakeng sa ho lemoha 'bothata ba ho becha' (bona ka tlase). Ha e se e rerile ho felisa phapano e akaretsang lipakeng tsa 'tlhekefetso ea lithethefatsi' le 'ho its'etleha', sehlopha sa tšebetso sa DSM-5 se ntse se tsoela pele ho hlahisa bopaki mabapi le tšibollo e nepahetseng ea monyako oa ho fumana ho becha ho sa ts'oaneng.

Phetoho e 'ngoe ke ho tlosoa hoa e' ngoe ea lintlha tse leshome, tse botsang hore na motho ea bechang o entse liketso life tse seng molaong ho tšehetsa papali ea chelete ea bona. Ntle le ntlha e totobetseng ea hore batho ba kanna ba hana ho senola tlhahisoleseling ena, liphuputso tse peli tsa mafu a seoa li bonts'itse hore ntho ena e ts'episoa feela ka ts'ebeliso e matla ea basomi ba methapo ba seng ba ntse ba kopane le tse ling tsa litekanyetso tse ling tse thathamisitsoeng, 'me ka lebaka leo, liketso tse seng molaong Ntho e eketsa matla a khethollo.15,17 Le ha ho le joalo, sephetho sena se nkiloe mosebetsing bathong ba baholo, 'me ho ka nahanoa hore ntho eo e seng molaong e ka ba le ts'ebeliso e ngata bathong ba itseng joalo ka bacha.2 Liphihlelo tsa rona tsa tleliniki li fana ka maikutlo a hore ho ka ba molemo haholo ho lekola hore na moeli oa ts'ebetso ea botlokotsebe o felisitsoe ho lelekisa chelete ea papali ea chelete.

Tleliniki ea Bothata ba Papali ea Chelete

Litataiso tsa machabeng joalo ka DSM li lokela ho tsotelloa boemong ba naha, maemong a tobileng a papali ea chelete papaling ea Brithani. Patlisiso ea Brithani ea Papali ea Papali ea Brithani ea 200716 e fumane hore 68% ea bao ho buisanoeng le bona ba tlalehileng ho becha selemong se fetileng, se ts'oanang le sekhahla sa bophelo sa 78% se tlalehiloeng tlhahlobong ea Amerika.18 Ho hlakile hore papali ea chelete ke lekala le leholo la indasteri ea boithabiso 'me e hohela batho ba bangata. Mefuta e atileng ka ho fetisisa ea papali ea chelete ea ho becha UK ke Loto ea Sechaba, likarete tsa ho qhekella, mabelo a lipere, le metjeko ea li-slot. Bakeng sa papali ea chelete e jeleng setsi, ho ata ha papali ea chelete ea DSM e ne e le 1-2% tlhahlobisong ea meta-Amerika Leboea,19 le keketseho ea lilemo tse fetileng ea mathata a ho becha e ne e le 0.6% lithutong tsa Borithane tsa 2007. Tlaleho e tsoang ho 2010 ea Brithani ea Papali ea Papali ea Papali ea Chelete e bonts'a kholo ea lilemong tse fetileng ea ho becha e nyolohetse ho 73% ea batho ba baholo. Ho ata ha ho becha ha mathata ho boetse ho nyolohetse ho batho ba hakanyetsoang ba 0.9%. Tlhahlobo ea bokamoso ba data e tla sheba haufi-ufi papaling ea marang-rang le likotsi tsa eona.20

Tleliniki ea Naha ea Ho becha ka Bothata e ile ea buloa ka Mphalane 2008 joalo ka setsi sa pele sa National Health Service se thehiloe ka kotloloho ho phekola ba bechang. Nakong ea ho ngola, re amohetse lingoloa tse fetang tsa 700, ho tsoa UK. Mokhoa oa kalafo o thehiloe holim'a bopaki, ka mokhoa o qalang oa bohloeki21 e tlatsana le kalafo ea lelapa le tlhabollo ea likoloto. Ho amohela mekhoa e mengata ea ho becha ha mathata, re fana ka mehato e mengata ea ho kenella, ho tloha libekeng tsa beke le beke tsa 9-12 ho ea ho phekolo e etselitsoeng bareki ba nang le lefu lena. Sehlopha sa rona sa multidisciplinary se na le litsebi tsa kelello, lingaka tsa kelello, lingaka tsa malapa le baeletsi ba lichelete, bohle ba sebetsang ho latela liprothokiso tse emeng. Tleliniki e boloka mohopolo o tiileng oa ho etsa lipatlisiso, ho rekota data ho pharalla le liphetho tsa pele li se li ntse li itokisetsa. Bakeng sa tlhaiso-leseling e eketsehileng, kapa ho fetisa, ka kopo bona sebaka sa rona sa marang-rang www.cnwl.nhs.uk/gtery.html kapa u romelle mangolo ho rona [imeile e sirelelitsoe].

Litsela tsa nakong e tlang

Rea lumela hore litlhahiso tsa DSM-5 tsa ho ikatisa hape li tla ratoa ke batho ba betang lipapatso le lihlopha tsa tšehetso ea papali ea chelete, bao e leng khale ba nka ho becha e le mokhoa o lemalloang o nang le ts'ebeliso e ts'oanang ea lithethefatsi kapa joala. Liphetoho tse etselitsoeng batho ba sa tsebeng letho li ka eketsa chelete ea patlisiso sebakeng seo, kaha bafuputsi ba papali ea chelete ba ka una molemo ho tsoa mekhatlong e tšehetsang lipatlisiso tsa bokhoba ba mofuta o mong (mohlala, Leano la morao-rao la Phuputso ea Bongaka ea Bongaka). Empa, ehlile, litaba tse tebileng tsa thuto-kholo li boetse li hlahisoa ka mofuta oa 'nete oa bokhoba,' me litsebi tse ling tsa bokhoba ba lithethefatsi li hanana le liphetoho tsena.1 Liketso tse ling tsa boits'oaro tsa likhetho li teng ka mokhoa oa ho reka ka mokhoa o qobelloang, papali ea videogame e feteletseng ea inthanete le bokhoba ba marang-rang,22 empa ha ho hlophisoa DSM-5, lingoliloeng tsa lipatlisiso ka maemo ana li ne li nkuoa e le tsa nakoana pele ho netefatsoa ka lebaka la bopaki. Haeba re amohela hore papali ea chelete e lemaletse, ke lintlha life tsa kelello tsa lipapali tsa papali ea papali ea chelete tse ba thusang ho sebelisa lits'ebetso tsa kelello ka katleho e kholo? Ka ho araba potso ena, re tla beoa hamolemo ho ahlola nakong e tlang hore na maemo a mang a lokela ho eketsoa litlamong tsa boitšoaro.

dithuso tsa ditjhelete

HB-J. mme LC e fumane chelete ho tsoa ho Lekhotla la Patlisiso ea bongaka (thuso G0802725). LC e boetse e amohela chelete ea lithuso ho tsoa ho Royal Society bakeng sa lipatlisiso ka mekhoa ea boko ea ho becha. Kliniki ea Naha ea Papali ea Chelete ea Matekoane e tšehelitsoe ke letlole le ikarabellang la papali ea chelete.

Mongolo o botlaaseng ba leqephe

  • Phatlalatso ea phaello

    H. BJ. ke Mothehi le Motsamaisi oa Kliniki ea Naha ea Papali ea Chelete ea Matekoane, ke setho sa Boto ea Leano la Boikarabello ba Boikarabello ba mmuso le 'muelli oa mathata a papali ea chelete bakeng sa Royal College of Psychiatrists.

  • Re amohetse October 6, 2010.
  • Nchafatso e amohetse ka February 3, 2011.
  • E amohetse ka February 23, 2011.

References

    1. Holden C

    . Qeto ea ho beha litheko tsa boits'oaro ho DSM-V e reriloeng. Science 2010; 327: 935.

    1. Mitzner GB,
    2. Whelan JP,
    3. Meyers AW

    . Maikutlo a tsoang metsong: liphetoho tse reriloeng ho sehlopha sa DSM-V sa papali ea papali ea chelete. J Gambl Stud 2010; Oct 24 (Epub pele ho khatiso).

    1. Potenza MN

    . Na mathata a lemalloang a lokela ho kenyelletsa maemo a amanang le lintho tse sa amaneng le lithethefatsi? lemalla ntho e 2006; 101 (Suppl 1): 142-51.

    1. Petry NM,
    2. Stinson FS,
    3. Grant BF

    . Comorbidity ea DSM-IV ea ho becha ha methapo ea methapo le mafu a mang a kelello: liphetho tse tsoang ho National Epidemiologic Survey on Alcohol and maemong a amanang le ona. J Clinic Psychiatry 2005; 66: 564-74.

    1. Clark L

    . Ho etsa liqeto nakong ea papali ea chelete: ho kopanya mekhoa ea kelello le kelello. Filos Trans R Soc Lond B Biol Sci 2010; 365: 319-30.

    1. Grant JE,
    2. Kim SW,
    3. Hartman BK

    . Phuputso e sa laoloeng habeli, e laoloang ke placebo ea opiate antagonist naltrexone kalafong ea litabatabelo tsa methapo ea kutlo. J Clinic Psychiatry 2008; 69: 783-9.

    1. Lawrence AJ,
    2. Luty J,
    3. Bogdan NA,
    4. Sahakian BJ,
    5. Clark L

    . Barekisi ba mabenkele ba arolelana liphoso ha ba etsa liqeto tse sa potlakiseheng le batho ba itšetlehileng ka joala. lemalla ntho e 2009; 104: 1006-15.

    1. Petry NM

    . Batho ba betang ka mokhoa oa tlhaho, ba nang le mathata a ts'ebeliso ea lithethefatsi ntle le litheko, ba fokotsa meputso ka litheko tse phahameng. J Abnorm Psychol 2001; 110: 482-7.

    1. Goudriaan AE,
    2. Oosterlaan J,
    3. de Beurs E,
    4. van den Brink W

    . Mesebetsi ea Neococitive ea ho becha ha methapo ea methapo: papiso le ts'ebeliso ea lino tse tahang, lefu la Tourette le taolo e tloaelehileng. lemalla ntho e 2006; 101: 534-47.

    1. Bowden-Jones H,
    2. McPhillips M,
    3. Roger R,
    4. Hutton S,
    5. Joyce E

    . Ho nka kotsi ka liteko tse mabapi le ho se sebetse hantle ha motho a le mothating oa ho hloka cortex, ho bolela esale pele hore o tla khutla hape ho latela ts'ebeliso ea joala: thuto ea sefofane. J Neuropsychiatry Clin Neurosci 2005; 17: 417-20.

    1. Potenza MN

    . The neurobiology ea pathological ho becha le ho lemalla lithethefatsi: kakaretso le liphetho tse ncha. Filos Trans R Soc Lond B Biol Sci 2008; 363: 3181-9.

    1. Reuter J,
    2. Raedler T,
    3. Rose M,
    4. Letsoho la ka,
    5. Glascher J,
    6. Buchel C

    . Ho becha ha pathological ho hokahanngoa le ts'ebetso e fokolitsoeng ea sisteme ea moputso oa mesolimbic. Nat Neurosci 2005; 8: 147-8.

    1. Campbell-Meiklejohn DK,
    2. Woolrich MW,
    3. Passingham RE,
    4. Rogers RD

    . Ho tseba nako ea ho emisa: methapo ea boko ea ho lelekisa tahlehelo. Biol Psychiatry 2008; 63: 293-300.

    1. Blaszczynski A,
    2. Monyane L

    . Mohlala oa bothata le papali ea papali ea methapo. lemalla ntho e 2002; 97: 487-99.

    1. Ho-Gerstein M,
    2. Gerstein DR,
    3. Volberg RA

    . Sehlopha se phahameng sa mathata a papali ea chelete papaling ea sechaba. lemalla ntho e 2003; 98: 1661-72.

    1. Wardle H,
    2. Sproston K,
    3. Erens B,
    4. Orford J,
    5. Mokhahlelo M,
    6. Constantine R,
    7. et al a

    . Patlisiso ea Brithani ea Kamore ea Brithani ea 2007. Setsi sa Naha sa Patlo ea Sechaba, 2007.

    1. Matla DR,
    2. Kahler CW

    . Teko ea tlhahlobo ea mathata a papali ea chelete a sebelisang DSM-IV. lemalla ntho e 2007; 102: 713-21.

    1. Kessler RC,
    2. Hwang I,
    3. LaBrie R,
    4. Petukhova M,
    5. Sampson NA,
    6. Mariha KC,
    7. et al a

    . DSM-IV ea ho becha ha methapo ea kutlo ho National Comorbidity Survey Replication. Psychol Med 2008; 38: 1351-60.

    1. Shaffer HJ,
    2. Holo MN,
    3. Vander Bilt J

    . Ho hakanya sekhahla sa boitšoaro bo hlephileng ba ho becha United States le Canada: mofuta oa lipatlisiso. Am J Bophelo ba Sechaba 1999; 89: 1369-76.

    1. Wardle H,
    2. Boemo A,
    3. Spence S,
    4. Orford J,
    5. Volberg R,
    6. Jotangia D,
    7. et al a

    . Patlisiso ea Brithani ea Kamore ea Brithani ea 2010. Setsi sa Naha sa Patlo ea Sechaba, 2011.

    1. Hing P,
    2. Thibelo N

    . Tlhahlobo le tlhahlobo-leseling ea ts'ebetso ea ts'ebeliso ea kelello ho fokotsa bothata ba papali ea chelete: ho loha bethe ea rona? Behav Res Ther 2009; 47: 592-607.

    1. Thibela JJ

    . Litaba tsa DSM-V: bokhoba ba marang-rang. Am J Psychiatry 2008; 165: 306-7.

Lihlooho tse qotsitsoeng sehloohong sena