Psychopharmacology (Berl). 2012 Jan; 219 (2): 469-90. doi: 10.1007 / s00213-011-2550-7. Epub 2011 Nov 5.
Ho tšoana le phapang lipakeng tsa Pherekano ea Ho Becha ka Tebello ea Tlhaho le Mathata a Ts'ebeliso ea Lithethefatsi: O Shebana le Ho Ts'oenyeha le ho Ts'oenyeha
Robert F. Leeman*, 1 'me Marc N. Potenza1,2
Boitsebiso ba Mongoli ► Tlhahisoleseding ea Copyright le License ►
Moetso oa khatiso oa ho qetela oa mohatisi o fumaneha ho Psychopharmacology (Berl)
Sheba lihlooho tse ling ho PMC hore Qotsa sehlooho se hatisitsoeng.
inahaneloang
Tlhaloso
Papali ea chelete ea bongoaneng (PG) e sa tsoa nkoa e le “boitšoaro bo botle” kapa bokhoba ba lithethefatsi. Papiso ea litšobotsi tsa PG le mathata a ts'ebeliso ea lithethefatsi (SUDs) e na le tokiso ea bongaka 'me e ka thusa ho nts'etsapele lipatlisiso tsa nako e tlang ka maemo ana. Likamano tse ikhethileng tsa ho susumetsoa le ho qobelloa e ka ba karolo ea kutloisiso ea PG le SUDs.
maikemisetso
Ho bapisa le ho bapisa lipatlisiso tsa lipatlisiso ho PG le SUDs tse mabapi le mesebetsi ea methapo, ts'ebetso ea ts'ebetso ea boko le ts'ebetso ea methapo ea kutlo, e shebaneng le ho ts'oaroa le ho qobelloa.
Results
Ho ts'oana ho fapaneng ho fumanoe lipakeng tsa PG le SUDs, ho kenyelletsa ts'ebetso e mpe mesebetsing ea li-neurocognitive, ka ho khetheha mabapi le khetho e sa tsitsang le karabelo ea karabelo le likarolo tse qobelloang (mohlala, tiisetso ea karabelo le ketso e fokotsitseng kamano ho lipheo kapa moputso). Liphumano li fana ka maikutlo a ho se sebetse hantle ho kenyelletsang libaka tse tšoanang tsa boko, ho kenyelletsa le "cortex" ea ventromedial prefrontal cortex (PFC) le striatum le li-neurotransmitter tse tšoanang, ho kenyeletsa dopaminergic le serotonergic Ho na le likarolo tse ikhethileng tse ka bonts'ang litšusumetso tsa ho pepeseha ho matla kapa ho sa foleng ka lintho tse itseng.
Nahanisisa
Ho fapana le ho se tšoane ho teng lipakeng tsa PG le SUDs. Ho utloisisa lintho tsena ka nepo ho ka tsamaisa nts'etsopele ea kalafo ho pholletsa le lithethefatsi, athe ho fapana ka kutloisiso ho ka fana ka leseli mabapi le nts'etsopele ea kalafo bakeng sa mathata a itseng. Phapang e ikhethileng ea motho ka mong molemong oa ho se tsitsinyehe le ho qobelloa ho ka emela lipheo tsa bohlokoa tsa endophenotypic bakeng sa maano a thibelo le kalafo.
Keywords: Mosebetsi oa ho becha oa Iowa, ho theola litheko, ho chechisa, joala, koae, dopamine, serotonin, glutamate, lebota le ka pele
Selelekela
Le ha ho buuoa ka methapo ea methapo ea kutlo (PG) ha joale e arotsoe ho Diagnostic and Statistical Manual (ntlafatso ea mongolo oa DSM, IV APA 2000) joalo ka bothata ba taolo ea tšusumetso (ICD), ho lumellana pakeng tsa PG le mathata a ts'ebeliso ea lithethefatsi (SUDs) ho hlokometsoe. Ho itšetleha ka lithethefatsi le PG ka bobeli ho kenyelletsa lintlha tsa tlhahlobo mabapi le boitlamo bo tsoelang pele ntle le litlamorao tse mpe, mamello, ho ikhula le ho phehella ho leka ho fokotsa kapa ho tlohela (APA 2000; Holden 2001; Wareham le Potenza, 2010). Ha ho fanoa ka lintlha tsena tse ts'oanang le tsa biological mabapi le PG le SUDs, ho bile le phetoho molemong oa ho nka PG e le "boitsoaro" kapa tšebeliso e seng ea lithethefatsi (Frascella et al. 2010; Holden 2001; Petry 2006; Potenza 2006; 2008) ka ho hlophisoa ka bocha ho DSM-V (Holden 2010). Ha ho etsahale feela hore tlhahlobo ea SUD e ka ba mohlala bakeng sa PG, ho ithuta ha PG ho ka boela ha tsebisa kutloisiso ea rona le lipatlisiso tsa nako e tlang mabapi le bokhoba ba lithethefatsi. PG e fana ka monyetla oa ho ithuta boits'oaro ba bokhoba ba ts'ebeliso ntle le ho ferekanngoa ke ts'ebetso ea methapo e amanang le tšebeliso ea lithethefatsi tse mpe kapa tse sa foleng (Lawrence et al. 2009b; Pallanti et al. 2010; Verdejo-Garcia et al. 2008).
Impulsivity, moaho o nang le likarolo tse ngata o amanang le maemo a kelello a mangata ho kenyeletsa PG le SUDs (Leeman et al. 2009; Petry 2007), e hlalositsoe e le "tebello ea ts'ebetso e potlakileng, e sa reroang pusong ea kahare kapa kantle ka ho fokotseha mabapi le litlamorao tse mpe tsa karabelo ena ho motho ea tsuellang kapa ba bang" (Brewer le Potenza 2008; Moeller et al. 2001). Boikarabello ba ho fana ka moputso ka litšenyehelo tsa boitšoaro bo sa reroang, bo sitisang boitšoaro le ho fokotsa karabelo kotulong, bo amana le ho qhekelloa (Patterson le Newman 1993). Haufinyane, moaho o arotsoe likarolo tse ikhethileng, ho kenyeletsoa likarabo le mefuta ea khetho (Dalley et al. 2011; Potenza le de Wit 2010; Winstanley et al. 2004). Likarolo tsena li fumanoe li amana ka tsela e fapaneng le likarolo tse fapaneng tsa boitšoaro bo lemalloang (Dick et al., 2010; Verdejo-Garcia et al., 2008; Whiteside le Lynam, 2001).
Ho bile le tlhahiso ea hore ts'ebetso ea li-SUDs e kenyelletsa phetoho ho tloha ho susumetsoa ke bocha le ho susumetsoa habonolo ho fetisoang ke tloaelo le ho qobelloa (Brewer le Potenza 2008; Dalley et al. 2011; Everitt le Robbins 2005; Fineberg et al. 2010; Koob & LeMoal, 1997; Potenza 2008). Dalley et al. (2011, leq. 680) e hlalosa boits'oaro bo qobelloang e le "liketso tse sa lokelang boemo bo phehellang, ha li na kamano e hlakileng ho sepheo se felletseng 'me hangata e baka litlamorao tse sa rateheng." Boitsebiso bo fana ka maikutlo a hore joaloka ho tsitsipana, ho qobelloa ho na le likarolo tse ngata (Fineberg et al. 2010). Dalley et al. (2011) ho supa lintlha tsa bohlokoa tse peli, tse sa hlakoheng molekaneng ka tlhaloso ea tsona: ho phehella kapa ho tiisetsa le liketso tse se nang kamano e hlakileng ho sepheo se akaretsang. Ho na le lintlha tse ling tse ikemetseng kapa tse amanang le tsona ha mehato ea ho itlaleha ea ts'usumetso e kenelletse masimong a mangata ho kenyelletsa le tse amanang le taolo e mpe ea menahano le boits'oaro, mme tsena li ka amana le likarolo tsa bongaka tse amanang le boits'oaro ba kelello le maemo a kelello (Blanco et al. 2009).
Ho susumetsa ka bobeli le ho qobelloa ho bonahala e le mathata a boitšoaro.Stein le Hollander 1995) hape e ka amana le lifilimi tse thata ho lingoloa tse tšoanang empa e le tse fapaneng (mohlala, ho batla maikutlo, ho nka likotsi, ho etsa liqeto). Mabapi le litlamorao tsa tlhabollo ea bongaka, ts'ebeliso e mpe ea tšebeliso ea lithethefatsi leha e le tsebo ea kotsi, e amanang le litlhaloso tsa ho susumetsoa le ho qobelloa, ke mokhoa oa ho its'etleha (APA, 2000) mme e nkile karolo ea mantlha ea tlatsetso (O'Brien et al. 2006). Phapang ea bohlokoa lipakeng tsa li-construx ke hore le ha ho susumetsoa hangata ho nkoa ho nka khato e potlakileng ea ho lelekisa moputso (Patterson le Newman, 1993), ketso e qobelloang hangata e etsoa ka mokhoa o fokotsehileng mabapi le moputso (Everitt le Robbins, 2005; Fontenelle et al. 2011).
Bopaki bo fana ka maikutlo a hore ho potlaka ho joalo ke ponelo-pele e telele ea li-SUDs (Hick et al. 2010; Mezzich et al. 2007). Ho feta moo, ho tšoana ho hoholo ka boiketsetso bo ipolelang pakeng tsa bana ba motho ba haufi le ba bang ntle le batho ba sa amaneng le bona ho fana ka maikutlo a hore maikutlo a ho hloka matla ke mofuta oa endophenot o ka bang kotsi bakeng sa SUD (Ersche et al. 2010). Ha ho fanoa ka bohlokoa ba ho qobelloa ho li-SUDs, hammoho le bopaki ba hore ba nang le PG ba tloaetse ho fumana lintlha haholo maemong a bohloka, tlhahlobo e hlophisehileng ea ho ts'oana le ho se tšoane mabapi le karabelo le khetho e potlakileng ho PG le SUDs lia hlokahala. Bopaki ba ho potlaka ho PG bo tsoa ho ts'ebeliso ea litlaleho tsa boithati (mohlala, Petry 2001a) le ho bona ho hloka matla ha karabo ea ho emisa le ho etsa lintho tse ling tse joalo (mohlala, Goudriaan et al. 2006b) le boiketlo ba khetho mabapi le mesebetsi ea theolelo ea ho lieha (mohlala, Petry le Casarella 1999). Lintho tse ts'oanang li ka bonts'a hore li-SUD le PG li tšoauoa ka lintlha tse fetang tekano, tse fanang ka maikutlo a hore kalafo e fumanoeng e sebetsa bakeng sa li-SUD le eona e ka ba le ts'ebeliso ho PG. Ka lehlakoreng le leng, phapang lipakeng tsa maemo e ka bonts'a karohano maemong a kotsi bakeng sa maemo, kapa lintlha tse amanang le nako ea mafu a itseng (mohlala, ho pepesoa ha lintho tse sa feleng kapa tse sa feleng) le ho supa mekhoa e ikhethileng ea kalafo bakeng sa bokhoba ba motho ka mong.
Ho tšoana le ho fapana lipakeng tsa PG le SUDs ho ka hlahlojoa mabapi le ts'ebetso ea ts'ebetso ea methapo ea kutlo, hammoho le ts'ebetso e nepahetseng ea ts'ebetso ea ts'ebetso ea mokokotlo kapa ts'ebetso ea methapo ea methapo. Libaka tse ling tsa tikoloho le litereke ke tsa bohlokoa ka ho khetheha. Likarolo tse ka pele tsa cortical, haholo libaka tse kenang ka hare (mohlala, li-cortex tsa [li-ventmedial prefrontal cortex [OFC]), li bile le tšusumetso ho karabelo ea moputso le ka ho eketsoa ka mokhoa o ts'oanelang ho susumetsa le ho potlaka ho PG le SUDs (Brewer le Potenza 2008; Fineberg et al. 2010). The striatum (haholo-holo li-nucleus accumbens [NAcc] sebakeng sa ventral striatum) ke sebaka se seng sa bohlokoa se arabelloang ke moputso le ho khannoa ha sepheo mme se ka kenya letsoho ho bohlokoa ho theheng tloaelo le ho qobelloang (Everitt le Robbins 2005; Kalivas 2009; Volkow et al., 2007b). Mabapi le neurochemistry e amehang, dopamine le serontonin li fumane tlhokomelo e ngata ea lipatlisiso. Ts'ebetso ea dopaminergic e thusa ho hlahisa melemo e khotsofatsang ea lintho tse lemalloang (mohlala, Schultz 2011), boits'oaro ba papali ea chelete (mohlala, Campbell-Meiklejohn et al. 2011), le impulsivity (Buckholtz et al. 2010). Litsela tse ngata tsa bopaki li hokahanya tšebetso ea serotonin le PG (Fineberg et al. 2010) le li-SUD (Ratsma et al. 2002). Likarolo tsa li-opioidergic le gluatamatergic system li bile le tšusumetso ho li-SUDs (Kalivas 2009; Volkow 2010) le PG (Grant et al. 2007; Grant et al. 2008a;). Li-opioid tsa tlhaho li kenya letsoho melemong e khotsofatsang ea lintho tse lemalloang (Volkow 2010), mme phello ena e ka kenyelletsa modumo oa tšebetso ea mesolimbic dopamine ka methapo e bohareng ea GABAergic (Brewer le Potenza 2008). Glutamate, neurotransmitter e thabisang le selelekela sa GABA (Brewer le Potenza 2008; Holmes 2011), ho hlahisitsoe tlhahisoleseling ea ho batla moputso ho li-SUDs (Kalivas le Volkow 2005) e filoe ts'usumetso ea eona ts'ebetsong ea mesolimbic dopamine (Geisler et al. 2007; Grant et al. 2010), haholo-holo ho NAcc (Kalivas le Volkow 2005; McFarland et al., 2003). Bohlokoa ho glutamate homeostasis le bona bo ka kenya letsoho ho etseng khato e matla litekatsong tsa bokhoba ba tahi (Kalivas 2009). Lisebelisoa tsa adrenergic li ka ba le karolo ho arolelanang moputso o amanang le lithethefatsi (Weinshenker le Schroeder 2007) le lithethefatsi tsa adrenergic li ka ba le tšusumetso ho impulsivity (Chamberlain et al. 2007) ka hona li ka sebetsa ho PG le SUDs.
Joalo ka SUDs, ho netefalitsoe hore phetoho ea ho se qobelloe ho e qobella e ka etsahala ka PG (Brewer le Potenza, 2008). Boemo ba data bo hlasimollang bo ts'ehetsa maikutlo ana ke sehlooho sa lipatlisiso le bohlokoa ba tleliniki. Haeba phetoho e ts'oanang ea ho qobella ho sebetsa ka mokhoa o ts'oanang ho ts'usumetso e hlaha ho PG, ts'oaetso ea ts'ebetso ea tiisetso ea karabelo mesebetsing ea ho feto-fetoha ha maemo, mohlala (mohlala, de Ruiter et al. 2009), e kanna ea bonts'a boemo bo holimo ba PG boima. Ntle le moo, ho qobelloa ho ka khetholla PG haholo pele, ha ts'ebetso e nyane mesebetsing e joalo e ka ba sesupo sa kotsi ea ho ba le mathata a papali ea chelete. Leha lipatlisiso tse amanang le ho qobella ha li tsoele pele joalo ka ha ho etselitsoe ho susumetsa (Fineberg et al. 2010), tlhahlobo ea bopaki bo fumanehang e ka supa ho tšoana le liphapang tsa bohlokoa lipakeng tsa PG le SUD.
Ntle le ho susumetsoa le ho qobelloa, ho aha liqeto tse amanang le kotsi / ho etsa liqeto ho ea bohlokoa ka hore papali ea chelete hangata e kenyeletsa mofuta oa liqeto. Mesebetsi e meng ea li-neurocognitive e etselitsoeng ho lekola ho etsa liqeto tse kotsi / mohlala (mohlala, Iowa Gask Task [IGT], Bechara et al. 1994) hape ho nahanoa hore e nka likarolo tsa karabelo le ho susumetsoa ha khetho, hammoho le tiisetso le ho qobelloa ha sephetho sa sephetho (Verdejo-Garcia et al. 2008). Kahoo, ho bohlokoa ho nahana ka mesebetsi ea kotsi / moputso e le mokhoa oa ho lekanya mefuta e mengata ea phaello. IGT ke teko e etsoang ka har'a komporo ea ho nka qeto ea likotsi / moputso moo barupeluoa ba hulang karete e le 'ngoe bakeng sa teko ea 100 ho e' ngoe ea litulo tse 'ne. Moralo o mong le o mong o hlahisa moputso oa chelete le / kapa likotlo. Leha barupeluoa ba laetsoe hore li-desks tse ling li ka ba betere ho feta tse ling, ha ba tsebe ka ho hlaka hore tse peli li na le molemo, li lebisa ho tahlehelo e nyane, e tsitsitseng le tahlehelo e nyane, ho fana ka melemo ea nako e telele, 'me tse peli li sa sebetse, li kenyelletsa moputso o moholo le phetisetso. tahlehelo e kholo, e fanang ka tahlehelo ea nako e telele. Ts'ebetso e ntle e hloka ho fokotseha ha khetho hobane ho khethoa ho litheko tse ntle ho kenyelletsa phaello e ntle ea nako e telele bakeng sa meputso e meholo e potlakileng (Dymond et al. 2010). Ts'ebetso e nepahetseng e kenyelletsa lintlha tsa ho ithuta tse sa fetoheng (Fellows le Farah 2005), e leng bokhoni ba ho lemoha liphetoho maemong a maemo a tšohanyetso le ho fetola boitšoaro ba motho ho latela (ke hore, ho hloka mamello; Clark et al. 2004).
Ha u bapisa PG le ho bapisa li-SUD, ho bohlokoa ho hlokomela phapang pakeng tsa litheko tsa lintho tse fapaneng. Litšobotsi tse 'maloa li sebetsa ho itšetleha ka lintho tsohle, ho khothaletsoa ts'ebeliso ea tlhekefetso e ts'oanang le litekanyetso tsa ho itšetleha ka lintho tsohle ho DSM-IV-TR (APA 2000). Ho na le, ka nako e ts'oanang, phapang lipakeng tsa litšobotsi tsa kliniki tsa ho itšepa lintho tse fapaneng (Fisher and Roget 2008a; 2008b). Ka mokhoa o ts'oanang, likarolo tsa PG li ts'oana le likarolo tsa ho itšetleha ka lintho tse ling ho feta tse ling. Mohlala, bopaki bo supa hore PG e tšoana hantle le ho ts'epa joala, ho kenyelletsa le ho ts'oana ho amanang le ho ho hloka (Lawrence et al. 2009a; Roger et al. 2010). Ho fana ka mohlala o fapaneng, liphumano li fana ka maikutlo a ho haella ha ho senyeha ho itseng mabapi le thibelo ea karabo le ho etsa liqeto mesebetsing e kang IGT ho basebelisi ba MDMA (Verdejo-Garcia et al. 2008) e fana ka maikutlo a monyetla oa hore litšobotsi tsa kliniki tse amanang le ts'ebeliso ea mathata a MDMA li ka fapana le tse amanang le PG.
Lipontšo tsa Behaviors tse supang li-ICD ho Maloetse a Parkinson (PD) li fana ka mohlala bakeng sa ho ithuta ho ts'oaroa le ho qobelloa ho PG le SUDs. PD ke boemo bo khetholloang ke tahlehelo ea dopaminergic neuronal mme hangata e phekoloa ka kalafo ea dopamine (DRTs) e kenyelletsang dopamine agonists tse kang pramipexole kapa ropinirole le levodopa, selelekela sa biochemical ho dopamine (Linazasoro 2009; Potenza et al. 2007; Voon et al. 2007). Meriana ena e filoe meriana e felletseng ho lebisa ho "dopamine overdosing" le li-ICD ho bakuli ba bang (e hlahlojoe ho Leeman le Potenza 2011). Li-ICD li bonahala li atile haholo har'a ba nang le PD ho feta ho ba se nang (Kenagil et al. 2010; Weintraub et al. 2010). Le ha li-DRTs li hokahane le li-ICD ho PD, bopaki bo fana ka lintlha tseo e seng tsa PD (mohlala, nalane ea lelapa ea joala, boemo ba lenyalo le sebaka seo le sona se amanang le li-ICD ho PD (Leeman le Potenza 2011; Weintraub et al. 2010). Kahoo li-ICD ho PD li fana ka mohlala o nepahetseng oa thuto le saense; mohlala, bakeng sa ho etsa lipatlisiso ka litšusumetso tsa dopaminergic. Ka nako e ts'oanang, hore na liphumano tsena li fetela ho palo ea batho bao e seng PD ho lokela ho nkuoa ka hloko ho fuoa liphetoho tsa neural tse amanang le PD, meriana e sebelisitsoeng ho phekola PD, le lintlha tse ling tse amanang le ts'oaetso ena. PG ke ka tsela e makatsang e le ICD e ithutileng hantle ho fetisisa ho baahi ka kakaretso le ho ba nang le PD (Evans et al. 2009). Ka hona, ho bile le liteko tse ngata tsa ho etsa liqeto tse bakang likotsi tse amanang le ho becha ho bakuli ba PD (mohlala, Kobayakawa et al. 2010; Pagonabarraga et al. 2007).
Tlhahlobo ena e entsoe ka likarolo tse tharo tse fumaneng liphumano tse kenyelletsang mesebetsi ea methapo, ts'ebetso ea boko le ts'ebetso ea methapo ea kutlo. Karolong ea mesebetsi e amanang le methapo ea kutlo, re tšohla liphetho tse amanang le ho ts'oaroa ke karabelo, ho susumetsoa ha khetho, ho qobelloa, ho beha / ho etsa liqeto ka moputso le litlatsetso tse ling tse amanang le tsona. Re sebetsana le lipatlisiso tsa PG ebe rea li bapisa le ho li bapisa le liphetho tsa lithuto tsa SUD. Liphumano tsa SUD hangata li khetholloa ho latela ntho eo ho buuoang ka eona. Moo ho hlokahalang, liphumano ho tsoa mehlala ea batho ba baholo ba phetseng hantle li rarolloa pele, ebe ho lateloa ke lithuto lithutong tse seng tsa PD tsa kliniki, ho phethela ka lithuto tsa PD. Ho sebelisoa mokhoa o tšoanang karolong ea tšebetso ea boko. Puisanong ea rona ea ho qobelloa, re khetholla phapang pakeng tsa liforomo tsa phumano ea sephetho ha ho khonahala; leha ho le joalo, mekhoa ea boits'oaro le ea ho itlaleha ea boitšisinyo ha e so hlahisoe ka demarcation e bohale joalo ka lingoliloeng tse tlamang. Mabapi le neurochemistry, likheo tsa lipatlisiso li teng tse fokotsang tlhaloso e hlophisehileng ka botlalo. Re phethela ka litlhahiso bakeng sa lithuto tsa nako e tlang.
Mesebetsi e se nang boikemisetso ea ho hlahloba ho ts'oaroa, ho qobelloa le kotsi / ho etsa liqeto
Liphumano tse kenyelletsang mesebetsi ea methapo ea kutlo li fane ka bopaki ba ho tšoana pakeng tsa PG le SUD mabapi le likarolo tsa khetho le karabelo ea ho arabela, ho qobelloa le ho etsa liqeto tsa kotsi / moputso. Ho bile le liphapang tse ling hape mabapi le ts'ebetso ea mantlha ea botsamaisi le likarolo tsa kotsi / ho etsa liqeto.
Ho potlakela ho PG
Boiphetetso
Batho ba nang le PG ba fumanoe ba fapane le ba se nang karabelo ea karabelo. Mesebetsing ea ho ea / ho se ee (mohlala, Marczinski le Fillmore 2003), barupeluoa ba koetliselitsoe ho araba mofuta o mong oa khothatso ("ho ea") le ho thibela karabelo ho e 'ngoe e khothalletsang ("ho se ee"). Mesebetsi ea ho emisa (mohlala, Logan 1994) arolelana likarolo ka mesebetsi ea ho ea / ho se ee ntle le ha ho etsoa liteko tse nyane, karabo ea "ho ea" e tlameha ho thibeloa hang hang ha "letšoao la ho emisa" le hlaha. Linako tse telele tsa karabelo ea liteko tsa ho emisoa li nahanoa hore ke sesupo sa mathata a maholo a thibelang likarabo tsa pele. Barupeluoa ba PG ba bile le linako tse arohaneng tsa liteko tsa ho emisa mosebetsing oa ho emisa (Goudriaan et al. 2006b; Grant et al. 2010). Empa, Lawrence et al. (2009b) ha e tlalehe liphapang tse kholo tsa tšebetso ea ho emisa pakeng tsa barupeluoa ba PG le lithuto tsa taolo e phetseng hantle le Rodriguez-Jimenez et al. (2006) e tlalehile liphokotso tse kholo tsa ts'ebetso ho ba nang le ADHD e hlahang feela. Barupeluoa ba PG ba ne ba e-na le taolo e eketsehileng ea liphoso tsa komisi mosebetsing oa ho ea / ho se tsamaee (Fuentes et al. 2006; Goudriaan et al. 2005).
Khetho ea mokokotlo
Karolo e le 'ngoe ea ho susumetsoa ke khetho ke ho theola sekhahla sa nakoana kapa ho lieha, ntho e etsahalang eo ho eona ho matlafatsoang lits'oants'o tsa naha ho fokotsoang ha ho bapisoa le ba khothalletsoang hang-hang (Bickel le Marsch 2001). Khetho ea ho etsa boits'oaro bo bobebe e kenyelletsa khetho ea ho potlaka (mohlala, ho "phahama") ho lieha (mohlala, ts'ebetso e ntle ea ts'ebetso)Dalley et al. 2011), ho etsa hore theolelo ea ho liehisa ho amanang le litabatabelo. Barupeluoa ba PG ba theoletse meputso e lieha haholo ho feta taolo mosebetsing oo ba o khethileng lipakeng tsa meputso e menyenyane, e potlakileng le e kholo, ea distal hypothetical ka likarete tsa index (Dixon et al. 2003; Petry 2001b; Petry le Casarella 1999).
Tšusumetso ea boikhethelo e boetse e bapisoa ho bakuli ba PD ba nang le li-ICD ntle le ba sa sebeliseng Tlhahlobo ea Polelo ea Bohlokoa (EDT; Reynolds le Schiffbauer 2004). EDT e thehiloeng ho komporo ke mosebetsi oa boikhethelo oa nako le nako o lekolang litheolelo tsa nakoana tsa nakoana. Tekong e 'ngoe le e' ngoe, barupeluoa ba khetha pakeng tsa tekanyo e tloaelehileng e liehang le probabilistic le tjhelete e fetohang e lokiselitsoeng 'me e fanoa hanghang. Monyetla oa ho fumana palo e tloaelehileng o lula o ts'oana ho li-block tsohle tsa liteko, mme ho lieha ho fumana palo e tloaelehileng ho fapana ka li-block. Ha u nka li-agonists tsa dopamine, bakuli ba PD ba nang le li-ICD ba entse likhetho tse potlakileng ho feta tse se nang li-ICD (Voon et al. 2010). Ka lebaka la karolo ea nakoana ea EDT, nako ea ho arabela le eona e lekantsoe. Bakuli ba nang le li-ICD ba bile le linako tse potlakileng tsa karabelo ka kakaretso le litekong tse phahameng tsa ntoa ho EDT ho feta tse se nang li-ICD. Kahoo, liphapang tse ipapisitseng le boemo ba ICD li ka kenyelletsa khetho le khetho ea karabelo.
Mefuta e meng e amehang
Litloaelo tsa ho se sebelise ponaletso li ka ba le khetho le ho hloka karabelo hobane ho nahana hampe ho kenyeletsa ho etsa liqeto kapele ntle le tlhaiso-leseling e lekaneng (Verdejo-Garcia et al. 2008). Mosebetsing oa mohlala oa tlhaiso-leseling, Lawrence et al. (2009b) ba fumane hore barupeluoa ba PG ba kentse letsoho ponong e nyane ho feta lithuto tse laoloang.
Tlhokomeliso le mohopolo oa ho sebetsa ke mesebetsi ea mantlha ea bolaoli e amanang le ho potlaka (Finn 2002; Rugle le Melamed 1993). Liphumano li fana ka maikutlo a hore ba nang le PG ntle le li-SUD tse se nang Co-morbid ba ka nna ba se be le mathata a maholo ka mohopolo o sebetsang (Cavedini et al., 2002; Goudriaan et al. 2006b; Lawrence et al. 2009bkapa tlhokomelo (Maraziti et al. 2008a; Rugle le Melamed 1993). Ho lemoha lintho tse rarahaneng ho ka ameha ho PG, empa mesebetsi ea mantlha ea bolaoli e kanna ea se amehe haholo (Goudriaan et al. 2006b; Lawrence et al. 2009b; Potenza, 2009).
Ho tšoana le ho se tšoane mabapi le karabelo le ho hloka khetho ho SUDs vs. PG
Liphumano li bonts'a hore khatello ea karabelo e phahamisitsoe ho li-SUD. Linako tse telele tsa ho etsa liteko tsa ho emisa li fumanoe cocaine (Fillmore le Rush 2002; Li et al. 2006) le ho itšepa joala (Goudriaan et al. 2006b; Lawrence et al. 2009a; 2009b) le tlhekefetso ea methamphetamine (Monterosso et al. 2005). Batho ba itšetlehileng ka joala le bona ba bonts'itse liphoso tse ngata ho feta taolo ea ho ea / ho se ee (Goudriaan et al. 2005; Kamarajan et al. 2005), joalo ka basebelisi ba koaeMoeller et al. 2004; Verdejo-Garcia et al. 2007). Ho fumana hampeLawrence et al. 2009b) le sephetho se tšoanelehang ho PG (Rodriguez-Jimenez et al. 2006) Leha ho le joalo, liphetho tse ngata li ts'ehetsa karabelo ea karabelo ho PG le SUDs ka bobeli.
Ba nang le li-SUD tse fapaneng ba fumanoe ba theola litheolelo tse liehang ho feta ho laola (bona Bickel et al. 2007 bakeng sa tlhahlobo). Ho itšetleha ka joala (Lawrence et al. 2009b) le ts'ebeliso ea amphetamine le opiate (Clark et al. 2006) li hokahantsoe le mathata a ho bonts'a mofuthu, tse tšoanang le liphumano ho PG.
Ka lehlakoreng le leng, liphapang tsa tšebetso e phahameng li fumanoe lipakeng tsa PG le SUDs. Batho ba nang le li-SUD hangata ba etsa hore ho be le mohopolo o sebetsang haholoanyane (Cavedini et al. 2002; Lawrence et al. 2009b) le mathata a ho tsotella (De Wit 2009) ho feta ba nang le PG. Liphumano tsena li fana ka maikutlo a ho hloka kelello ho tebileng ho li-SUD tse joalo ka ho ts'epa joala ho feta ho PG (Lawrence et al. 2009b), e kanna ea hlahisoa ke neurotoxicity ho tloha tšebeliso ea nako e telele ea lithethefatsi (Dalley et al. 2011). Ka hona, ho se sebetse hantle hoa kelello ho ka etsa hore ho nahanoe haholo nts'etsopele ea kalafo bakeng sa li-SUD ho feta bakeng sa PG (Bickel et al. 2011; Wexler 2011).
Ho kgutsufatsa, bopaki bo bonts'a khetho e phahameng le ho hloka karabelo ho ba nang le PG le ba nang le li-SUD ha ho bapisoa le lithuto tse laolehileng tse phetseng hantle. Ho fapana le hoo, ho tsepamisa mohopolo le ho haelloa ke ho hopola lintlha ho ka 'na ha e-ba boima ho SUDs (mohlala, joala) ho feta ho PG (bona Lethathamo 1).
Ho tšoana le phapang lipakeng tsa papali ea motjeko oa 'mele (PG) le mathata a tšebeliso ea lithethefatsi (SUDs) mabapi le liphetho tsa ts'ebetso ea ts'ebetso ea methapo (bona mongolo bakeng sa lintlha)
Ho qobella ho PG
Lipatlisiso tse ngata tse phatlalalitsoeng li fana ka maikutlo a hore na ho hloka boikitlaetso ho matla hakae, haholo ho mamella karabelo ho PG. Ha ho bapisoa le ho laola lithuto, batho ba nang le PG ba bonts'a mamello e kholo mosebetsing oa ho bapala karete (Goudriaan et al. 2005). Mosebetsi ona o kenyelletsa likhetho tse 'maloa mabapi le hore na u bapala karete kapa che. Libetheng tse latellanang, tekanyo ea win ho likarete tsa tahlehelo ea fokotseha; ka hona, leano le nepahetseng le kenyelletsa ho etsa qeto ea ho bapala hangata ho libetara tse tlang. Mosebetsi o ne o khethiloe e le ho hlahloba ho lekana, ho fuoe sebopeho sa ho lekanya mamello le karabo hobane ho tsoela pele ho bapala khafetsa lithulong tsa morao le ha ho na le monyetla o moholo oa kotlo ho ka bonts'a sephetho sa sephetho. Empa, hape ke mosebetsi oa ho etsa liqeto tsa kotsi / moputso. Mathata a papali ea chelete a bonts'a mamello mosebetsing oa ho ithuta o fetotsoeng ka komporo. Barupeluoa ba ile ba hlahisoa ka lintlha tse peli tse bonoang. Karabelo ho khothatso e le 'ngoe e ile ea fuoa kotlo ha karabelo ho e' ngoe e ne e putsoa ka karolelano ea 80: 20 ratio. Liphetoho tse ileng tsa putsoa le ho fuoa kotlo li ile tsa khutla kamora letoto la liteko (de Ruiter et al. 2009). Ba nang le PG le bona ba ne ba e-na le liphoso tse ngata ho feta lithuto tse laoloang ho intradimensional / extradimensional set shifting (IDED) task (Grant et al. 2010) ho tsoa ho Cambridge Neuropsychological Test automated Battery (CANTAB; Downes et al. 1989; Sahakian le Owen, 1992). IDED ke mosebetsi oa mekhahlelo e mengata eo barupeluoa ba arabelang ho e le 'ngoe ea lintlha tse peli,' me ba ipapisitse le maikutlo ba lokelang ho tseba hore na karabo e nepahetseng ke efe. Boemong ba bobeli, karabelo e nepahetseng ea fetoha. Mehatong ea kamora nako, ho hlohlelletsa sebopeho le liphetoho tse tšoanang mabapi le hore na sefutho sa mola se nepahetse se etsahala ka tsela efe (liphetoho tse teng). Maemong a hoqetela, phetoho ea extradimensional e etsahala moo ho nepahala ha karabelo ho latela khetho ea sebopeho se nepahetseng, eseng mola o nepahetseng.
Ho na le liphumano tse fapaneng mabapi le papiso lipakeng tsa barupeluoa ba PG le taolo e phetseng hantle ho Wisconsin Card Sorting Task (WCST; Grant le Berg 1948; Heaton et al. 1993), mohato o mong oa ho tenyetseha ha kelello. Ho WCST, barupeluoa ba bapisa likarete tsa khothatso ka bophahamo (ke hore, palo, mmala, kapa sebopeho) tseo ba sa li bolelloang. Kamora hore barupeluoa ba sebetse mosebetsi ka mokhoa oa phoso le phoso ho latela maikutlo, molao o fetohe 'me o hlophisehe o tlameha ho etsoa ho latela boholo bo fapaneng. Maraziti et al. (2008a) ba fumane hore barupeluoa ba PG ba entse liphoso tsa mamello ho feta taolo e ntle, empa Goudriaan et al. (2006b) ha a fumana phapano ea bohlokoa lipakeng tsa barupeluoa ba PG le taolo liphosong tsa mamello.
Ho tšoana le ho se tšoane mabapi le ho qobelloa ho li-SUDs vs. PG
Hoa tšoana le PG, lipatlisiso tse 'maloa tsa tšebetso ea methapo ea kutlo li bonts'a mamello ea karabelo ho li-SUD, leha liphumano li sa lumellane haholo ho PG. Liphumano tse bonts'ang mamello ea karabelo ha li e-so fumanoe le lithethefatsi tsohle lithutong tsohle. Basebelisi ba koae ba sa foleng ba ile ba etsa liphoso tse mamellang haholo ho feta lithuto tse amanang le mesebetsi e fetotsoeng ea ho ithuta (Camchong et al. 2011; Ersche et al. 2008), leha basebelisi ba amphetamine ba sa foleng, basebelisi ba opiate le basebelisi ba khale ba cocaine ba ne ba sa fapana le litaba tsa taolo (Ersche et al. 2008). Basebelisi ba hajoale ba amphetamine / methamphetamine ba bontšitse tiisetso ea karabelo mosebetsing oa IDED (Ersche le Sahakian 2007), leha Ersche et al. (2006) ha ea fumana phapang ea bohlokoa lipakeng tsa lithuto tsa taolo le ba nang le ts'oaetso ea amphetamine ea hona joale, ho ts'epa opiate kapa basebelisi ba nakong e fetileng ba amphetamines le / kapa opiates. Batho ba itšetlehileng ka Cocaine ba bontšitse mamello e kholo ho WCST, (Woicik et al. 2011) empa ho bile le liphumano tse mpe kamora ho bapisoa lipakeng tsa taolo e phetseng hantle le batho ba its'ireletsoang ka joala ho feta (Goudriaan et al. 2006b).
Mabapi le phapang lipakeng tsa PG le SUDs, Goudriaan et al. (2005) e tlaleha hore ho fapana le li-PG, tse neng li thatafalloa ke ho tiisetsa ho bapala papali ea karete, batho ba neng ba lemaletse joala ba ne ba tloaetse ho bapala ka thata. De Ruiter et al. (2009) ho tlaleha hore batho ba tsubang ba natefalitse mathata a ho ithuta ka ho feto-fetoha, empa joaloka lithuto tsa PG, ba ile ba fetoloa ke lithuto tse laoloang.
Ho akaretsa, lintlha tse ngata tse fumanoeng li fana ka tlhahiso ea karabelo ho PG. Liphumano tse ling li fana ka maikutlo a tšoanang ho SUD; leha ho le joalo, ho boetse ho na le liphumano tse 'maloa tse fosahetseng. Sena se fana ka maikutlo a hore tiisetso ea karabelo e kanna ea ba karolo ea tlhaho ea PG ho feta ea SUD (Lethathamo 1).
Ho etsa qeto ka kotsi / moputso ho PG
Hona joale ho entsoe lithuto tse 'maloa ho bapisa barupeluoa ba PG le taolo e phetseng hantle ho IGT. Ha ho bapisoa le lithuto, ba nang le PG ba etsa hampe (mohlala, Cavedini et al. 2002; Goudriaan et al. 2005; 2006a; Petry 2001a). Haholo-holo, barupeluoa ba PG ba fumanoe ba sa ntlafatse ts'ebetso ea bona maemong a morao a mosebetsi (Goudriaan et al. 2005; 2006a) ka tsela eo batho ba baholo ba phetseng hantle ba tloaetseng ho (Bechara le Damasio 2002). Kahoo, lintlha tsena li tsamaellana le mohopolo oa hore mamello ea karabelo- mohlomong e amana le ho boloka mokhoa oa ho khetha o arabelang o lumellanang le likhetho tsa moputso o moholo kapele kapa ho se ithute kapa ho fetola boits'oaro maemong a ho lahleheloa ke sephetho-karolo e 'ngoe e hlalosa ts'ebetso e mpe ea IGT har'a ba nang le PG (Fellows le Farah 2005). Ha ho hloleha ho qoba tahlehelo e kholo ho IGT ho tloha qalong e ka ba sesupo sa phello ea sephetho, ts'ebetso ea IGT e hlaha e amana le likarolo tsa ho susumetsoa le ho qobelloa.
Ntle le ho ba mosebetsi oa kotsi / moputso, IGT e hloka ho ithuta ka botlalo kaha barupeluoa ba tlameha ho lemoha hore na ke litsi life tse ntle le tse mpe mme ba etse likhetho tse latelang. Ho fapana le hoo, k'homphieutha ea "Cambridge Gamble Test" (CGT) ea k'homphieutha e lekola liqeto tsa ho etsa liqeto tse kotsi / ntle le karolo ea ho ithuta (Roger et al. 1999). Teko e 'ngoe le e' ngoe, barupeluoa ba hlahisoa ka mabokose a bofubelu a 10 kapa a putsoa. Palo ea mabokose a mebala ka 'ngoe e fapana ho ea ka liteko. Barupeluoa ba kopuoa ho hakanya hore na letshwao le patiloeng le behiloe kamora lebokose le khubelu kapa le boputsoa; ka hona, palo ea mabokose a 'mala o mong le o mong ke sesupo sa monyetla oa ho khoneha. Barupeluoa ba tlameha ho etsa qeto ea hore na ba batla ho becha ka lintlha life ho tsoa bankeng ea bona. Li-bets tse khonehang li hlahisoa ke komporo ka liphetoho tse nyolohang kapa tse theohelang. Ho becha ho feta litekong tse theohelang ke sesupo sa hore ho na le bothata ba ho emela bethe e nyane hape e bonolo. Litsela tse khutšoane tsa khetho ea karabelo ea pele le ho betha tse kholo ho liteko tse fokotsehileng e ka ba sesupo sa karabelo. Phuputsong ea morao tjena, ba nang le betting ea PG ho feta taolo ho sa tsotelehe maemo a mosebetsi mme ba na le menyetla ea ho lahleheloa ke lintlha tsohle tsa bona. Ho ne ho se na phapang ea bohlokoa molemong oa karabelo (Lawrence et al. 2009b).
Ho ts'oana le ho fapana ha liqeto tse amanang le kotsi / ho etsa liqeto ho SUDs vs. PG
Liphetho tse ngata tsa papali ea papali ea chelete li bontša ho tšoana pakeng tsa PG le SUDs. Kamehla, ts'ebetso e mpe ea IGT e hlokometsoe ho SUDs (Bechara le Damasio 2002): tšebeliso e mpe ea joala le ho itšetleha ka (Goudriaan et al. 2005; Kim et al. ka khatiso), tšebeliso ea mariha ea mariha (Whitlow et al. 2004), cocaine (Grant et al. 2000) le ho itšetleha ka opiate (Lemenager et al. 2011).
Ho bile le liphapang tse poteletseng ts'ebetsong ea IGT. Barupeluoa ba noang joala ba bontšitse ntlafatso e nyane ho feta barupeluoa ba PG, ba arabileng ka potlako ho feta batho ba ts'ehetsoeng joala, e leng sesupo sa ho itšunya-tšunya ho hoholo (Goudriaan et al. 2005). Barupeluoa ba PG le joala ba noang joala ba entse ka tsela e fapaneng CGT thupelong ea morao tjena. Barupeluoa ba ts'ebelitseng joala ba behile li-bets tse kholo ho feta taolo e phetseng hantle empa ba le litekong tse tlase feela mme ba ne ba se na monyetla oa ho feta taolo e phetseng hantle ho lahleheloa ke lintlha tsohle tsa bona (Lawrence et al. 2009b). Kahoo, ha barupeluoa ba babeli ba PG le joala ba ts'ebelise joala ba etsa ka mokhoa o bonts'ang ho susumetsoa ke karabelo, ts'ebetso ea barupeluoa ba PG e tlohile haholo ho litsamaiso tse tloaelehileng. Liphapang tse sa reng letho ho CGT le tsona li fumanoe ho bahlorisi ba opiate (Roger et al. 1999), leha lithuto tse ling li bonts'itse ts'ebetso e futsanehileng ho basebelisi ba opiate (Ersche et al. 2006; Fishbein et al. 2007) le bafebi ba amphetamine, bapisoa le lithuto tse laoloang (Roger et al. 1999).
Ho akaretsa, lipatlisiso li bontšitse hore ba nang le PG le ho itšetleha ka lintho tse fapaneng tse fapaneng ba sebetsa hampe ho feta taolo ho IGT. Ho entsoe lithuto tse fokolang le CGT. Liphello ho fihlela joale li fana ka maikutlo a hore ba nang le PG ba sebetsa hampe ho feta taolo e fumanoeng e bonts'a ts'ebeliso e ts'oanang, e sa sebetseng hara basebelisi ba lithethefatsi le ba nang le li-SUD tse fapaneng. Ha ho ntse ho hlokahala lipatlisiso tse ling, ba nang le PG le SUD ba ka ba le bothata bo itseng le likarolo tse ikhethang tsa IGT (mohlala, ho khutlela morao)Lethathamo 1).
Kakaretso ea sephetho sa tšebetso
Liphumano tsa mosebetsi tse sa boneng li bonts'a ho ts'oana lipakeng tsa PG le SUD mabapi le ho nka qeto, ho khetha le ho fana ka maikutlo le ho fetoha habonolo ha kelello ho amanang le ho qobelloa. Ntle le mabaka a ka bang teng a kenyelletsa CGT le liphapang tse poteletseng ho IGT, ho fana ka maikutlo a hore mesebetsi e meng e amanang le papali ea chelete e ka lekanya bofokoli bo itseng ho PG. Liphumano tsa mesebetsi e sa hlokeng letho li bonts'a ho qobella ho bohlokoa ho li-PG le li-SUD leha liphumano li sa ka tsa lumellana ka tsela e batlang e tšoana le tsa li-SUD. Ts'ebetso ea mesebetsi e sebetsang ea botsamaisi e supa ho senyeha ho hoholo ho li-SUD ho feta ho PG. Ka kopanelo, liphumano tsena li bonts'a ho tšoana le ho fapana lipakeng tsa ba nang le PG le ba nang le li-SUD, ka phapang mohlomong e bonts'a bofokoli bo itseng kapa litlamorao tsa ts'ebeliso e mpe ea lithethefatsi (Potenza 2009).
Ts'ebetso ea Brain e tlasa ts'usumetso, ho qobelloa le kotsi / ho etsa liqeto
Neuroimaging e fane ka leseli mabapi le menehelo ea lebatooa ea ho susumetsoa, ho qobelloa le ho etsa liqeto tsa kotsi ho PG le SUDs, ho fana ka tataiso bakeng sa nts'etsopele ea kalafo. Karolo ena e tla shebana haholo le se fumaneng se hohela li-cortices tsa pele le maemo. Likarolo tse ling tsa boko le ho ts'epahala hoa taba tse tšoeu li tla rarolloa hanyane.
Ts'ebetso ea sefahleho sa bohare ho PG
Ho se tsitsisehe
Boholo ba tlhokomelo e entsoeng ho lingoliloeng tse entsoeng ka mokhoa oa neuroimaging ho PG li shebile mekhoa ea ts'ebetso nakong ea mesebetsi ea kotsi / moputso, ha ho fanoe ka tlhokomelo e nyane mesebetsing e lekolang likarolo tsa ho ho hloka. Phuputsong ea fMRI, barupeluoa ba nang le PG ba ne ba fokotse ts'ebetso ho vmPFC bapisoa le taolo nakong ea ts'ebetso ea ho kena-kenana le mebala ea Stroop, e amanang le taolo ea kelello le ho susumetsoa ke karabelo (Potenza et al 2003a). Patlisisong ea morao tjena, de Ruiter et al. (ka khatiso) e fumane ts'ebetso e fokolang nakong ea mosebetsi oa ho emisa ka dorsomedial prefrontal cortex (dmPFC) mathateng a papali ea chelete ha a bapisoa le taolo e phetseng hantle, leha ho ne ho sena phapang e kholo mosebetsing oa mosebetsi. Mokhoa ona o sebelisitsoe ha o atlehile hammoho le thibelo e atlehileng ea karabo. Ha ho lithuto tse fumanoeng tse batlisisang mesebetsi ea kapele ea cortical e amanang le tšusumetso ea khetho ho PG.
Ho qobelloa
Leha ts'ebetso e tloaelehileng ea ho feto-fetoha ha mosebetsi e ntse e amahanngoa le ts'ebetso ea polokelo ea motlakase (vlPFC) (Hampshire le Owen 2006), barekisi ba bothata ba bontšitse mamello e matla ea karabelo nakong ea thuto e feto-fetohang, e neng e amana le ts'ebetso e fokotsehileng ho vlPFC e nepahetseng ho fMRI kamora ho fumana phaello le tahlehelo nakong ea mosebetsi oa ho ithuta oa khomphutha, oa ho khutlisade Ruiter et al. 2009). Boithuto ba lesion bo amana haufi-ufi le likarolo tsa ho qobelloha leha ho sebelisoa ts'ebetso ea ho etsa liqeto tsa kotsi / moputso (IGT) (Fellows le Farah 2005). Barupeluoa ba nang le marapo a vmPFC le dorsolateral pre mapemaal cortex (dlPFC) ba ile ba lekoa ho IGT e tloaelehileng le phetolelo e 'ngoe eo qalong e tsoang lithetleng tse mpe e ileng ea hlahisa tahlehelo e kholo, ka hona ba hlokomoloha tlhokeho ea ho khutlela morao thutong ho IGT e tloaelehileng. Ha barupeluoa ba nang le lesapo la vmPFC ba sebelitse hampe ho IGT e tloaelehileng feela, ba nang le lesapo la dlPFC ha ba sebetse hantle liphetolelong tsena ka bobeli. Kahoo, mathata a tobaneng le ba nang le ts'enyo ea vmPFC a bonahala a amana haholo le bofokoli ba ho ithuta bocha, ha ts'enyehelo ea dlPFC e amana le mathata a mangata. IGT e fapaneng e kanna ea ba e kenelletse haufi haholoanyane tekong ea sephetho empa mamello e sa fuoeng kotlo e qalile ho tloha qalong. Ba nang le bothata ba ho se sebetse hantle tsa dlPFC ba ka ameha hampe haholo mabapi le ho qobelloa.
Ho etsa qeto ka kotsi / moputso
Libaka tse ngata tsa kapele tsa cortical li kentsoe ts'ebetsong ea moputso papaling ea chelete. Batho ba baholo ba phetseng hantle ba fumanoe ba kenya tšebetsong vmPFC hammoho le libaka tse ling tsa kapele tsa cortical nakong ea IGT (Li et al. 2010). Ka lehlakoreng le leng, batho ba nang le liso ho vmPFC ba tloaetse ho sebetsa hampe ho IGT (Bechara et al. 1994; 1998) le ba nang le ts'enyo ea vmPFC le bona ha ba sebetse hantle CGT, ka ho khetheha ba etsa li-bets tse phahameng ho feta, ho sa tsotelehe menyetla ea ho hapa (Clark et al. 2008). Phetho ena e lumellana le karolo e tloaelehileng ea vmPFC ho khetholla khetho mabapi le likhetho tse bolokiloeng tlasa kotsi (Clark et al. 2008).
"Ho lahleheloa ke ho lelekisa" (ke hore, papali ea chelete e tsoetseng pele, hangata ka bongata, ho fumana tahlehelo) ke tloaelo ea kelello / ea boitšoaro e amanang haholo le papali ea chelete (Campbell-Meiklejohn et al. 2008). Mosebetsi oa ho leleka tahlehelo, o kenyang monyetla oa "ho se sebetse letho" kapa ho latela tahlehelo ea matsoho, o ile oa sebelisoa thutong ea fMRI e kenyelletsang barupeluoa ba phetseng hantle. Barupeluoa ba ile ba qala ka chelete ea boikaketsi le monyetla oa ho ts'oasa chelete e lahlehileng. Merero e lebisitse ho feliseng chelete e lahlehileng athe tahlehelo e ile ea lateloa ke khetho e 'ngoe ea ho tlohela kapa ho bapala ka monyetla oa ho khutlisa chelete e lahlehileng nakong eo. Liqeto tsa ho lelekisa tahlehelo li ne li amana le ts'ebetso e eketsehileng ea vmPFC, ha liqeto tsa ho tlohela li ne li amana le mokhoa o fapaneng oa ts'ebetso. Bangoli ba hlokometse hore vmPFC le libaka tse ling tse ts'ebetso li tloaetse ho amahanngoa le boemeli ba liphetho tse lebelletsoeng tse ntle (Campbell-Meiklejohn et al. 2008).
Bathong ba nang le PG, ts'ebetso e fokotsehileng e fumanoe vmPFC nakong ea mosebetsi oa ho hakanya moo litho tsa sehlopha li ileng tsa khetha pakeng tsa likarete tse peli tsa mebala e fapaneng le likarete tse khubelu tse fanang ka moputso oa chelete le likarete tse ling tse fanang ka kotlo ea chelete. Ho fumanoe likhohlano tsa bohlokoa tse fapaneng pakeng tsa ts'ebetso sebakeng sena le bothata bo boholo ba ho becha (Reuter et al. 2005). Bothata ba papali ea chelete ea ho becha le bona bo ile ba hokahanngoa ka botebo le ho se sebetse hantle ka hare ho litho tsa PG nakong ea mosebetsi oa ho lekanya mochini (ke hore, barupeluoa ba lekantsoeng lipapatso mabapi le ho atamelana) tse etselitsoeng ho etsa mohlala oa ketsahalo ea "haufi le"Habib le Dixon, 2010). Ka linako tse ling, ba bechang ba toloka haufi le ho hapa hore e ka ba thuto e mabapi le monyetla oa papali e latelang le ho eketsa li-bets tse tlang.
Ho fetohela sengoloa sa PD, thutong ea fMRI e amang bakuli ba PD feela ba se nang li-ICD, barupeluoa ba ile ba nka karolo mosebetsing oa moputso oa computer oa roulette-typabilistic nakong ea ho hlahlojoa. Barupeluoa ba ile ba khetha mmala oo ba neng ba nahana hore bolo e tla theohela har'a menyetla e mene e le 'ngoe (25% monyetla oa ho hlola) halofo ea liteko le har'a mefuta e mene ea mebala (75% monyetla oa ho hapa) karolong e' ngoe. Winnings e ne e lefuoa ka chelete qetellong. Dopamine agonist, empa eseng levodopa, tsamaiso e ne e hokahane le ts'ebetso e eketsehang ho OFC ho fana ka maikutlo ho tsoa mosebetsing ka kakaretso le nakong ea ho lahleheloa ke maikutlo ka ho khetheha (Van Eimeren et al. 2009). Phuputsong ea positron emission tomography (PET) ea bakuli ba PD e fuoeng ngaka ea dopamine ka mor'a ho itima boroko, mesebetsi ea neural e ile ea lekoa nakong ea papali ea karete ea karabo ea probabilistic. Mofuta oa maikutlo o fanoeng ke papali ha oa ka oa susumetsa sephetho. Bakuli ba PD ba nang le PG ba bonts'itse ts'ebetso e fokotsehile libakeng tse kang ea forC ea morao le ea costral, ha bakuli ba PD ba se nang PG ba bonts'itse ts'ebetso e eketsehileng libakeng tsena (van Eimeren et al. 2010) tse tšoanang le thuto ea sehlopha sena sa pele (van Eimeren et al 2009). Bangoli ba ile ba nahana hore hypoactivation sehlopheng sa PD / PG e ne e supa taolo e fokolang ea tšusumetso (van Eimeren et al. 2010). Ka mokhoa o tšoanang, thutong ea fMRI, barupeluoa ba qetile mosebetsi ka likhetho tsa ho nka chelete e itseng kapa ho becha ka chelete e ngata haholo (lipalo ka bobeli li fapana ho tloha tekong ho ea tekong) tlasa maemo a "phaello" ao ba qalileng ka 'ona ka $ 0 kapa boemo ba "tahlehelo" boo ba qalileng sebakeng se fosahetseng. Bakuli ba PD ba nang le li-ICD ba ne ba e-na le ts'ebetso e tlase ea OFC nakong ea boemo ba "phaello" (eo ho eona hangata likotsi li neng li etsoa) ho feta boemong ba "tahlehelo" (ha ho ne ho etsoa lipapatso tse nyane). Mokhoa o fapaneng oa ts'ebetso o ne o le joalo ho bakuli ba PD ntle le ICDs (Voon et al. 2011).
Ho ts'oana le ho se tšoane ha tšebetso ea ka pele ea cortical ho li-SUDs vs. PG
Mabapi le ho ts'oaroa ke karabelo, ka ho tsamaellana le liphetho tsa PG (Potenza et al. 2003a) ba nang le mathata a ts'ebeliso ea koae ba bontšitse ts'ebetso ea hypo-activation ho OFC nakong ea mosebetsi oa Stroop o neng o etsoa nakong ea fMRI (Goldstein et al. 2007b). Nakong ea mosebetsi oa ho emisa, de Ruiter et al. (ka khatiso) ba fumane hypoactivation e tšoanang ea dmPFC ho batho ba tsubang ha ba ntse ba fumana ho le mothating oa ho becha. Kahoo, ts'ebetso e tlase ho PFC / OFC e ka supa karabelo e sa potlakang ho PG le SUDs. Mabapi le ho qobelloa, de Ruiter et al. (2009) o fumane hore barekisi ba mathateng le ba tsubang ba bonts'a hypoactivation ho vlPFC ka karabelo ea tahlehelo mosebetsing oa ho khutlisa oa ho ithuta.
Ho na le ho tšoana ho latela ts'ebetso e fokotsitsoeng ea kapele ea cortical e tlameletsoeng ho putsa karabelo ho PG le SUDs. Phuputsong ea FMRI, barupeluoa ba ile ba hatella kapa ba hanela ho tobetsa konopo ho latela litaelo tlasa mehatla e meraro ea moputso oa chelete bakeng sa ho latela. Ba hlekefetsang cocoaine ba bonts'itse karabelo ea tikoloho ho OFC le PFC ho fapana ho boleng ba chelete litekong ho bapisoa le taolo (Goldstein et al. 2007a). Ha ho bapisoa le lits'ebetso, batho ba hlekefetsang koae ba ne ba e-na le ts'ebetso e matla ka ho le letona la OFC le ts'ebetso e fokolang libakeng tsa PFC (libaka tsa dorsolateral le medial) nakong ea IGT (Bolla et al. 2003). Phuputsong e 'ngoe ea fMRI, leha ho e-na le ts'ebetso e ts'oanang ea mosebetsi mme e bapisoa le taolo, ba nang le pororbid PG le ts'ehetso ea litheko le ba nang le ts'oaetso ea lintho feela ba bonts'itse ts'ebetso e matla ho vmPFC ha ba ntse ba bapala mofuta oa IGT. Ka phapang ena, komporo e ile ea khetha mokatong ebe motho ea nkang karolo ea khetha ho bapala kapa tjhe. Mokhelo o ne o le maemong ao ho neng ho khethoa moetlo o sa lokelang (ke hore, moputso o phahameng le kotlo e phahameng). Litekong tsena, ba nang le PG le ho itšetleha ka lintho ba ne ba le ts'ebetso e matla ho feta taolo (Tanabe et al. 2007).
Ka bokhutšoanyane, liphumano tsena li totobatsa likarolo tsa ts'ebetso ea pele ho cortical, haholo-holo likarolo tsa ventrolateral le tsa ventromedial, mesebetsing e amanang le ho susumetsoa, ho qobelloa le ho etsa liqeto tsa meputso. Liphumano ho PG li tšoana le se fumaneng ho li-SUD.
Ts'ebetso ea Striatal ho PG
Ho se tsitsisehe
de Ruiter et al. (ka khatiso) ha baa ka ba fana ka liphapang tse kholo har'a ba bechang, ba tsubang le ba nang le taolo e phetseng hantle nakong ea mosebetsi oa ho emisa.
Ho qobelloa
de Ruiter et al. (2009) ha a tlaleha liphapang tse kholo har'a ba bechang, ba tsubang, le taolo e phetseng hantle ts'ebetsong ea metsamao nakong ea thuto e feto-fetohang.
Ho etsa qeto ka kotsi / moputso
Boithuto ba kotsi / moputso le papali ea chelete ho batho ba baholo ba phetseng hantle li fane ka metheo ea ho bapisoa le lithuto tsa ba nang le PG. Li et al. (2010) o fumane bopaki ba ts'ebetso ea ts'ebetso ea "ventri stalatal activation" e sebelisang fMRI nakong ea IGT. Lithutong tse ling tsa fMRI, nakong ea mochine o ikhethileng oa computer o ileng oa etsoa ho etsa mohlala oa “haufi” le batho ba baholo ba phetseng hantle (Clark et al. 2009) le sehlopha se matla sa ba bechang (Chase le Clark 2010) activated stralatum ea "ventral striatum" nakong ea win le "misses" (ke hore, ha reel e emisa sebaka se le seng hore e fihle ho win). Ts'ebetso ea boikwetliso ea Dorsal (ke hore, caudate) e ile ea bonoa nakong ea tebello ea moputso mosebetsing oa likhomphutha oa ho becha moo batho ba baholo ba phetseng hantle, kamora ho latela setšoantšo, ba ileng ba botsoa hore ba etse liqeto tse potlakileng tsa hore na ba khetha likhechana tse nyane kapa tse kholo (Cohen et al. 2005).
Phuputsong ea fMRI e sebelisang "mosebetsi oa" senoelo "o sebelisitsoeng ka har'a komporo moo barupeluoa ba khethileng ho khetha ho becha kapa ho se ts'oarelle ebe ba khetha senoelo se amanang le phaello kapa tahlehelo ea chelete, batho ba baholo ba phetseng hantle ba ne ba tloaetse ho becha ka mokhoa o hlokolosi, o neng o amana le ts'ebetso ea dorsal le ventral striatal . Barupeluoa ba ile ba ikemisetsa ho beha likotsi tse ngata kamora tahlehelo, ha ba rata ho bonts'a ts'ebetso e fokotsoang libakeng ka bobeli (Xue et al. 2011). Ka mokhoa o ts'oanang, palong e boletsoeng ka holimo ea "tahlehelo ea ho lahleha" e lekantsoeng ke Campbell-Meiklejohn et al. (2008), batho ba baholo ba phetseng hantle ba ile ba kenya letsoho ts'ebetsong nakong ea liqeto tsa ho se ba lelekise. Ka hona, ho a makatsa hore ho batho ba baholo ba phetseng hantle mosebetsi o mongata oa tšebetso o kopane le liqeto tse nkang kotsi le lipatlisiso, 'me lithuto tsa nako e tlang li lokela ho etsa lipatlisiso ho latela hore na lintlha tse itseng (liphatsa tsa lefutso, tikoloho) li ka kenya letsoho le ho matlafatseng ts'ebetso ea ts'ebetso ea papali nakong ea boitšoaro ba papali ea chelete.
Ho hloka taolo ea Striatal ho bile le phello ho PG. Pallanti et al. (2010) ho tlalehiloe hore ba nang le PG ba ne ba e-na le metabolism ea "glucose" e ka tlase e tlase le litekanyetso tse phahameng ho dorsal striatum ho feta taolo e phetseng hantle. Thutong e fapaneng (Linnet et al. 2011), Barupeluoa ba PG ba ne ba sa fapana haholo le taolo e phetseng hantle ho phumaneho ea D2-like receptor ka har'a ventral striatum. Barupeluoa ba PG ba bonts'itse mosebetsi o fokolang oa ho bapala ka nako ea karete e hakanya mosebetsi oa papali ea chelete e kenyelletsang moputso le kotlo le likhohlano tse kholo pakeng tsa ts'ebetso sebakeng sena le bothata bo boholo ba papali ea chelete ea papali ea chelete.Reuter et al. 2005). Ho latela bangoli bana, ho susumetsoa ka tlase ho "ventral striatum" ho ka bonts'a maikutlo a fokotsehileng a ho fumana moputso. Nakong ea mosebetsi oa ho lekanya mochine, Habib le Dixon (2010) ba fumane tšebetso e eketsehileng ea dorsal striatal nakong ea "mehopolo e haufi" lithutong tsa PG, empa eseng ka har'a taolo, le ho fokotsa ts'ebetso ea "port" ea Pri. Ka papiso, Miedl et al. (2010) ka fumana lets'oao le ntseng le eketseha ka nako ea liteko nakong ea liteko tsa win nakong ea ho hlapela ka har'a botsotsi le ho becha ka linako tse ling ba sebelisa fMRI. U sebelisa PET, Linnet et al. (2011) o fumane likamano tse ntle tsa maikutlo lipakeng tsa ho lokolloa ha dopamine ea ventral striatal dopamine le boithatelo bo ipoletseng ho PG nakong ea IGT, ho fana ka tlhahiso ea hore ketsahalo ena e kanna ea khangoa ke liphihlelo tsa phello e ntle nakong ea papali ea chelete. Ho fumana sena ho ka thusa ho hlalosa maikutlo a ts'ebetso e fokotsehileng ea ts'ebetso ea litho tsa sehlopha sa PG empa ho eketsa ts'ebetso lithutong tse kenyeletsang bothata le ho becha ka linako tse ling (Miedl et al. 2010) eo mohlomong a sa kang a ba le mamello e matla ho isa liphellong tse monate tsa papali ea chelete. Phapang pakeng tsa striatal e ka boela ea kenyelletsa li-neurotransmitters ntle le dopamine ha keketseho ea 5HT1B e fumaneha kahare ho proral striatum e fumanoe e sebetsana le bothata bo tebileng ba ho becha ho PG (Potenza et al. ka khatiso).
Phuputso ea mantlha ea PET ea barupeluoa ba PG ho PD e bonts'itse phapang mehatong ea transporter ea transral ea striatal dopamine (Cilia et al 2010) le phumano e tlase ea D2-joaloka receptor ho ventral striatum (Steeves et al. 2009) litekong tse latelang kamora ho itima litlhare tsa meriana ea agonist. Liphumano tse ling har'a bakuli ba PD ba nang le li-ICD (Rao et al. 2010) fana ka tlhahiso ea mesebetsi e fokotsoang ea boemo ba moea ba ho bapisoa le bakuli ba se nang li-ICD, ka nako ea motheo le nakong ea Balloon Analogue Risk Task (BART; Lejuez et al. 2002). Bakuli ba ICD ba lekiloeng ho dopamine agonists ba bontšitse ho eketseha ha kutloelo-bohloko nakong ea mosebetsi o nkang kotsi le ho fokotsa ts'ebetso ea "cyri striatal shughuli"Voon et al. 2011).
Ho ts'oana le ho se tšoane ha tšebetso ea litoro ho SUDs vs. PG
Joalo ka PG, liphumano li fana ka maikutlo a fokotswa ketso ea maemo a marang-rang ka karabelo ea moputso ho tse sebelisang lintho le ho ba le liSUD. Ts'ebetsong ea ho lieha ea tšusumetso ea chelete (MIDT), tebello ea ho sebeletsa moputso oa chelete e ne e amana le ho fokotseha hoa ts'ebetso ea moea oa ts'ebetso ho latela ts'ebeliso ea joala (Beck et al. 2009; Hommer 2004; Hlakola et al. 2007) le ho bacha ba tsubang (Peters et al. 2011), joalo ka liphetho ho PG (Potenza 2011). Maemong a mabeli a ts'ebeliso ea joala le PG, ts'ebetso ea ts'ebetso ea moea nakong ea ts'episo e lumellana le ho itlhahisa ho tlalehiloeng (Beck et al. 2009; Potenza 2011). Ho fumanoe lits'oants'o tse tebilengMiedl et al. 2010). Keketseho e kholo ea mosebetsi oa "cyri stalatal" nakong ea tebello ea moputso e fumanoe ho basebelisi ba boima ba cannabis (Nestor et al. 2010) le ts'ehetso ea koaeJia et al. 2011).
Ho fumanwa ha serotonin e phahameng ea 5HT1B receptor fumaneha ka har'a ventral striatum ka ts'ebeliso ea joala (Hu et al., 2010) e lumellana le liphetho tsa boemo ba leholimo bo fumanehang ho PG (Potenza et al. ka khatiso). Ts'ebetso ea li-receptor ea 5HT1B e fumanoe ho laola li-neurotransmitters tse ngata, ho kenyelletsa le dopamine, ho ventral striatum (Yan le Yan 2001a; b).
Ha a ntse a fokotseha ho fumaneha ha "receptor" e kang D2 mo striatum e bontšitsoe tlhekefetsong e matlafatsang (Volkow et al. 2003) hammoho le linaha tseo e seng lithethefatsi tse arolelanang likarolo tsa bokhoba ba motho (mohlala, botenya)Wang et al. 2001]), liphumano tsa mantlha ha li so fetohe ho PG (Linnet et al. 2011). Phapang ea tšebetso ho PG e amanang le PD e ka tsebahala ka ho khetheha ho likarolo tsa "striatum"Cilia et al 2010; Frosini et al. 2010; O'Sullivan le al. 2011; Steeves et al. 2009). Bopaki bo fumanehang bo fumanehang bo bontša ho ferekana ha dorsal striatum ho PG (Habib le Dixon 2010; Pallanti et al. 2010). Ka mokhoa o ts'oanang, dorsal striatal hyperactivity le eona e hlokometsoe ho ts'ehetso ea litheko (mohlala, cocaine; Volkow et al. 2006).
Ka kakaretso, ho se sebetse hantle ha 'muso ho hlokometsoe lits'ebetsong tsa kahare le tsa bohloa ho PG le SUDs. Le ha lithuto tse ngata li fana ka maikutlo a fokotsehileng a ts'ebetso ea ts'ebetso ea "ventral striatum" lits'ebetsong tse kenyang sephetho sa qeto ea meputso / moputso ho PG, liphumano ha li na ho ts'oana ha tlatsetso ea lithethefatsi, ho fana ka maikutlo a hore, har'a lintho tse ling, tlhahiso ea lithethefatsi e ka baka ts'ebetso ea ts'ebetso le tšebetso e amanang le eona.
Ts'ebetso e 'ngoe ea boko / likarolo tsa bohlokoa
The anterior cingulate cortex (ACC), e leng karolo ea methapo ea methapo, e tsamaisanang le amygdala hape ho nahanoa hore e na le likarolo tse amanang le maikutlo le maikutlo (Ngaka ea bana et al. 1999), taolo ea kelello (Botvinick et al. 2004), thibelo ea karabo (Dalley et al. 2011), mme ka bohlokoa bo khethehileng ho PG, ho lelekisa tahlehelo (Campbell-Meiklejohn et al. 2008). Liphumano li bontša hore ACC e ka bapala karolo ea ho etsa liqeto tse kotsi har'a ba nang le li-SUDs (Fishbein et al. 2005).
The e leng sehlekehleke, e kenelletseng ts'ebetsong ea ho sebetsana le litaba tsa tlhahlobo, e bohlokoa ho ts'ebetso ea kotsi / moputso. E na le likhokahano tse pharalletseng tsa phepelo le vmPFC, amygdala le ventral striatum, e etsa hore e be boemong bo loketseng ho kenya letsoho ho etseng liqeto tsa maikutlo (Clark et al., 2008). Batho ba baholo ba phetseng hantle ba kenya tšebetsong mosebetsi oa ho becha (Cohen et al. 2005; Li et al. 2010) le ka tebello ea moputso (Beck et al. 2009; Cohen et al. 2005) le tšenyo ea insula e amana le liphetoho tse mpe litloaelong tsa ho becha (Clark et al. 2008). Insula e ka tlatsetsa ho litlamorao kaha e hlahisitsoe ho batho ba phetseng hantle ka lebaka la "mehoo e haufi" le ho hapa mme ts'ebetso ena e ne e kopantsoe le takatso ea ho nka karolo mosebetsing oa papali ea chelete (Clark et al. 2009). Miedl et al. (2010) o ile a fumana ka linako tse ling barekisi ba ne ba kenya ts'ebetsong insamara nakong ea papiso ea botsitso. Ho li-SUDs, de Ruiter et al. (2009) ba fumane hore batho ba tsubang ba ne ba kenya ts'ebetsong chelete e ngata ka lebaka la phaello.
Bothata ba taba tse tšoeu
Bothata bo bobe ba litaba tse tšoeu, bo ka bakoang ke ts'ebetso ea amanang le lithethefatsi kapa ho bontša phapang e fapaneng, bo bonoe kamanong le tšebeliso e mpe ea lithethefatsi le ho its'etleha, liphuputsong tse ling li fana ka maikutlo a likamano le ts'usumetso e mpe (Verdejo-Garcia et al. 2008). Ho PG, litekanyetso tse fokolitsoeng tsa "anisotropy" (FA) li fumanoe karolong e ka letsohong le letšehali la corpus callosum 'me li ne li amana le mehato ea ho batla monate (Yip et al. ka khatiso). Bothata bo bobe ba litaba tse tšoeu ho PG bo ile ba phehella ho etsa li-account bakeng sa ts'ebeliso ea joala pele. Bothata bo bobe ba litaba tse tšoeu bo bonoe hantle ho basebelisi ba noang haholo ho kenyeletsa le bacha ba noang haholo (McQueeny et al. 2009le batho ba baholo ba itšebelitseng joala (Pfeff)um et al. 2000). Ho tšepahala litaba tse tšoeu ho boetse ho amahanngoa le ho ts'oaroa ha ts'ebeliso ea lithethefatsi, le ha e le hantle. Ho itšetleha ka koae, FA e fokotsehileng e ne e amahanngoa le lintlha tse phahameng ho Scratt Impulsiveness Scale (BIS-11; Patton et al. 1995) (Lim et al. 2008;; bona Moeller et al. 2005 bakeng sa liphetho tse mpe).
Summary
Likarolo tse ngata tsa boko, ho kenyelletsa le li-cortices tsa pele, striatum le insula, li hlahisitsoe ho PG le SUDs. Sebopeho se nepahetseng sa tšenyehelo se bontša ho tšoana le ho se tšoane ho tšoanang (Lethathamo 2). Ho feta moo, hore na ts'ebetso ea ts'ebetso ea ts'ebetso ea boko e amana joang le ho qobelloa le mathata matsatsing ana e mpa e qala ho hlahlojoa ka mokhoa o hlophisehileng.
Ho tšoana le phapang lipakeng tsa ho becha ha methapo ea kutlo (PG) le mathata a ts'ebeliso ea lithethefatsi (SUDs) mabapi le lipatlisiso tsa tšebetso ea boko tse amanang le ho ts'oaroa le ho qobelloa (sheba mongolo bakeng sa lintlha)
Neurochemistry e tlasa khatello ea maikutlo, ho qobelloa le kotsi / ho etsa liqeto
Lits'ebetso tse 'maloa tsa neurotransmitter li hokahane le ho ts'oaroa, ho qobelloa le ho etsa liqeto tsa meputso / ho fumana moputso ho PG le SUDs. Ka mokhoa o khahlisang, liphallelo tsa dopaminergic le serotonergic li fuputsoe hantle haholo, ka lipatlisiso tse ngata tsa ho etsa lipatlisiso tsa dopamine lilemong tse 'maloa tse fetileng. Kahoo, li-transmit tsena tse peli e tla ba tsona sehloho sa karolo ena. Litsamaiso tsa opioidergic, glutamatergic, le noradrenergic li tla sebetsoa ka bokhutšoanyane.
Dopamine ho PG
Tekanyo eo ts'ebetso ea dopaminergic e kenyang letsoho ho eona le ho qobelloa ho PG ha e fumane tlhahlobo e hlophisitsoeng e nyane. U sebelisa mofuta oa rat oa IGT, amphetamine ea pro-dopaminergic le pro-adrenergic e kopantsoe le keketseho ea karabelo ea mamello, ha D2 / D3 agonist quinpirole le D1 antagonist SCH23390 ka bobeli li ne li amana le ho fokotseha ha mamello (Zeeb et al. 2009).
Boithuto bo lekolang tšusumetso ea ho laola ka tlhabollo ea dopamine ho kotsi / ho etsa liqeto meputsong mehlala ea batho e fana ka maikutlo a karolo ea dopamine moputsong o amanang le papali ea chelete. Ka mohlala oa "ho lelekisa tahlehelo", D2-like receptor agonist pramipexole e ne e amahantsoe le keketseho e kholo ea pono ea boleng ba tahlehelo e lelekiloeng le ho fokotseha ha boleng bo lemohuoeng ba tahlehelo e sa lelekisoe, ho fana ka maikutlo a keketseho ea boleng bo nahannoeng ba meputso le phokotso ea kotlo (Campbell-Meiklejohn et al. 2011). Ka har'a mochini oa litekete tsa litekanyetso, ho ile ha fumanoa likarabo tsa "haufi le" tse nang le D2-like receptor agonist quinpirole le amphetamine empa eseng ka D1-like receptor agonist SKF 81297 (Winstanley et al. 2011). Ka mofuta oa rat oa IGT o fumaneng liphetho tse fapaneng, amphetamine e ile ea eketsa khetho ea khetho ea bobeli e matla, e fana ka moputso oa bobeli o moholo le kotlo e tlase (Zeeb et al. 2009). Ha likhoto li ntse li lelekisa le ho fumana meputso ho amphetamine, sethethefatsi sena se kanna sa eketsa tlhekefetso ea kotlo.
Mabapi le likamano lipakeng tsa kotsi le ho etsa liqeto ho dopaminergic ho PG, barupeluoa bao ba PG ba nang le ts'ebetso ea dopamine ea ventral striatal dopamine nakong ea IGT ba tlaleha thabo e kholo ho feta lithuto tse laoloang ka bophelo bo botle (Linnet et al. 2011). Liphetho li boetse li bonts'a bohlokoa ba ho fapana ha batho ka bomong e le feela barupeluoa ba 8 / 18 PG ba bileng le liphetho tse khothatsang tsa ho lokolloa ha dopamine (Linnet et al. 2011).
Tšusumetso ea bosholu ba dopamine e kanna ea fapana har'a ba nang le mathata a ho becha. Amphetamine e ile ea eketsa tšusumetso ea papali ea chelete papaling ea chelete le mathata a papali ea chelete ea ho becha e ne e amana le boholo ba litlamorao tse ntle tsa amphetamine le litekanyetso tsa khothatso ea ho becha (Zack le Poulos 2004). Ho bile le lipatlisiso tse shebahalang li hanyetsana le bahanyetsi ba dopamine. DopNistX-like receptor antagonist haloperidol e fokotse tšekamelo ea barupeluoa ba PG ho becha ka mokhoa o mabifi kamora ho lefa ha mosebetsi oa mochini oa slot (Tremblay et al. 2011). Leha ho le joalo, thutong e 'ngoe, haloperidol e ile ea eketsa litlhahlobo tse ntle tse tlalehiloeng mme ea eketsa takatso ea ho becha ho PG (Zack le Poulos 2007). Liphetho tsena li ka thusa ho hlalosa liphetho tse mpe tsa teko ea bongaka bakeng sa lithethefatsi tse nang le li-antagonism tsa D2-like receptor antagon (mohlala, olanzapine; Fong et al. 2008; McElroy et al. 2008) ho PG. Liphumano tsena li fana ka maikutlo a kamano e rarahaneng lipakeng tsa D2-like dopamine receptor function le sepheo se amanang le papali ea chelete.
Boithuto ho PD bo boetse bo supa kamano lipakeng tsa karabelo ea moputso le dopamine (Leeman le Potenza 2011). Liphetoho likhethong tsa likotsi / meputso li ka amahanngoa le meriana ea dopaminergic (Frank et al. 2004; Kobayakawa et al 2010; Pagonabarraga et al 2007) le, joalo ka lingoliloeng tse seng tsa PD (Zack le Poulos 2004; 2007), e amanang ka mokhoa o fapaneng le ba nang le li-ICD le ba se nang tsona ((Bodi et al. 2009; Housden et al. 2010). E lekoa ho li-DRTs, Cilia et al. (2010) fumanoa fokotsehile striatal dopamine transporter e tlamang ho bakuli ba PD ba nang le PG, ho fana ka maikutlo a maemo a holimo a dopamine ea synaptic, ts'ebetso ea mesolimbic dopamine e fokotsang, kapa litekanyetso tsa protheine tsa cell-surface tse fokotsang. E boetse e lekoa ho li-DRTs, ho fallisoa ha raclopride ka har'a terri striatum nakong ea mosebetsi oa papali ea chelete e ne e le kholo ho bakuli ba PD ba nang le PG ho feta ho bakuli ba PD ntle le tumellano e kholo ea tokollo ea dopamine ka kopanelo le PG (Steeves et al. 2009).
Ts'ebeliso ea DRT le boemo ba ICD le tsona li amahantsoe le khetho e sa potlakeloang le mekhoa ea ho arabela ho bakuli ba PD. Bakuli ba PD ba nang le li-ICD ba lekoa ho DRT ba ne ba le monyetla o moholo ho feta lithuto tse laolehileng le bakuli ba PD ba se nang li-ICD ho khetha meputso e fumanehang hanghang mosebetsing oa ho theola ka potlako (Housden et al. 2010). Papisong e ka hare eo ho eona bakuli ba ileng ba lekoa le ho tlohela meriana, ts'ebeliso ea dopamine agonist e ne e amahanngoa le likhetho tse tlamang ho EDT ho ba nang le li-ICD, empa eseng ho ba se nang (Voon et al., 2010). Ho fapana le moo, mohlala o seng oa PD, Hamidovic et al. (2008) ha e na tšusumetso e kholo ea dopamine agonist pramipexole mabapi le mamello le ts'ebetso ea khetho e potlakileng le mesebetsi ea karabelo.
Ho ts'oana le ho se tšoane ho monehelo oa dopaminergic ho PG le SUDs
Dopamine e thehiloe ka bongata ho kenya letsoho ho fokotseng theolelo ho li-SUDs (Schultz 2011). Ho nka karolo ha Dopamine ka khetho e sa qobelloeng le karabelo ho PG ha e-so fumane tlhokomelo ea lipatlisiso ka disampole tse seng tsa PD. Ha monehelo oa dopamine ho qobelloang ho li-SUDs o ntse o tlalehiloe (Schultz 2011), mosebetsi o monyane o hlahlobile karolo ea karolo ea dopamine ho qobelloang ho PG.
Ho tšoana ho teng mabapi le ho nka karolo ha dopamine ho PG le SUDs. Joalo ka papali ea chelete, tšebeliso ea lithethefatsi e 'nile ea amahanngoa le ho lokolloa ha dopamine (Ritz et al. 1987), e tšehelitsoeng ke liphumano tsa moraorao ho tsoa thutong ea PET ea taolo ea joala ho batho ba sa its'epahalleng (Urban et al. 2010). Ka nako e ts'oanang, liphapang tsa motho ka mong tsa likarabo tsa dopamine li fumanoe ho PG (Linnet et al. 2011) le SUD (Volkow 2010) disampole. Joalo ka papali ea chelete, dopamine e kanna ea thusa ho matlafatsa le ho hlahisa melemo ea lithethefatsi (Goldstein le Volkow 2002). Ho batla le ho nka lintho tse tsoelang pele ho ka ntlafatsoa ka karolo e fokotsoang ea li-striatal dopamine D2-like receptors (Volkow et al. 2003). Mabapi le papali ea chelete, Zack le Poulos (2007) ba pheha khang ea hore haloperidol e lebisitse ho fokotseng ho fumaneha ha li-receptor tsa D2 har'a barupeluoa ba PG, bao, ba neng ba lumela, ho lebisa liphellong tse matlafatsang, le ha maikutlo ana a sa ka a hlahlojoa ka kotloloho thutong ea bona.
PG e kanna ea fapana le ho lemalla lithethefatsi mabapi le karabelo ea dopaminergic ho manong a itseng. Amphetamine ha a ka a eketsa khothatso ea ho noha ho lino tse noang joalo ka ha e khothaletsa ho becha ho PG (Zack le Poulos 2004).
Serotonin ho PG
Patlisiso ea pele e entsoe likamanong pakeng tsa ho ts'oaroa, ho qobelloa le sephetho sa kalafo tekong ea bongaka ho leka ho sebetsa ha serotonin reuptake inhibitor (SSRI) e khethiloeng. Teko e laoloang ke paroxetine e laoloang ke placebo (Blanco et al. 2009), ho itlaleha ho susumetsoa ho Potso ea Botho ba Eysenck (Eysenck et al. 1985le lintlha ho taolo e senyehileng ea mesebetsi ea kelello subscale ea Padua Inventory (Sanavio 1988), tekanyo ea boits'oaro ea litakatso le litabatabelo, li ne li hokahanngoa le bothata ba papali ea chelete ea ho becha qalong ea kalafo mme bo fokotsehile qetellong ea kalafo. Liphetoho bothateng ba papali ea chelete ea ho becha (e lekantsoeng ke Yale-Brown Obsession Compulsion Scale Modified bakeng sa Papali ea Papali ea Papali ea Pathological [PG-YBOCS]); Pallanti et al. 2005) li ne li amana le liphetoho tsa ho hobosoa feela, ho fana ka maikutlo a hore liphetoho matšoao a papali ea chelete li ne li hokahane haholo le liphetoho tse bang teng ho feta bohlasoaBlanco et al. 2009).
Liphumano tse tsoang liphuputsong tsa methapo ea kutlo li bonts'a karolo ea tšebetso ea serotonergic ho PG. Maemo a tlase a serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) a fumanoe ka disampole tsa fluorospinal fluid ho tsoa lithutong tse nang le PG (Nordin le Eklundh 1999). Ho PG le taolo e phetseng hantle, 3H-paroxetine ([3H] -Par) e kopantseng le li-membrane tsa liplatele e sebelisitsoe ho etsa lipatlisiso ka serotonin transporter (SERT), protheine e lekolang mahloriso a synaptic serotonin ka methapo ea ho pheta-pheta. Boleng ba boleng bo tlamang ba ne bo le tlase lithutong tsa PG, ho fana ka maikutlo a ho nka karolo ha serotonin ho PG (Maraziti et al. 2008b). Tsamaiso ea meta-chlorophenylpiperazine (mCPP), agonist e kopaneng ea serotonin e nang le li-affinities tse phahameng tsa 5HT1 le 5HT2 receptors, litlaleho tse ntle tsa "high" kapa buzz ho batho ba nang le PG. Ho fapana le hoo, lithuto tsa taolo li tloaetse ho tlaleha likarabo tse phetoang ho MCPP (DeCaria et al. 1998; Pallanti et al. 2006). Karabelo ea lihormone tse sa sebetseng hantle tsa sumatriptan, 5-HT1B receptor agonist, e boetse e bonoe ho PG (Pallanti et al. 2010), athe kholo e nts'etsopele ea kholo ea kholo e bontšitsoe lithutong tsa taolo (Herdman et al. 1994).
Liphumano tsa liteko tsa tleleniki tsa li-SSRIs (mohlala, fluvoxamine le paroxetine) li se li tsoakane. Hollander et al. 2000; Kim et al. 2002; hampe: Blanco et al. 2002; Grant et al. 2003; Saiz-Ruiz et al. 2005) le sephetho ka olanzapine, sethethefatsi se nang le thepa ea ho hanyetsa ea 5HT2, se ne se le mpe (Fong et al. 2008; McElroy et al. 2008). Le ha liphumano tse ntle li tšehetsa karolo ea serotonin ho PG, liphetho tse kopaneng li fana ka maikutlo a hore liphapang tse fapaneng li kenya letsoho ho fapana hoa ts'ebetso ea li-SSRI kalafong ea PG.
Ho ts'oana le ho fapana ha monehelo oa serotonergic ho li-SUD le PG
Lithuto tsa Neurochemical li fana ka maikutlo a tšoanang a serotonergic ho PG le SUDs. Joalo ka PG, maemo a tlase a 5-HIAA a fumanoe ts'ehelanong ea joala (Fils-Aime et al. 1996; Ratsma et al. 2002). Joalo ka PG, tsamaiso ea mCPP e etsa litlaleho tsa “phahameng” bokhoba ba joala bo tahang (Krystal et al., 1994). Karabelo ea lihormone tsa kholo e foufalitsoeng ho sumatriptan e se e bonoe ka ts'ebeliso ea lino tse tahang (Vescovi le Coiro 1997) le PG. Ka lebaka la li-receptor tsa mCPP le kakaretso ea sephetho sa kakaretso sa li-tarotonin 5HT1B, e ho leka ho hakanya hore likarabo tse tšoanang tse sa tloaelehang tsa biochemical le boitšoaro ho PG le ts'ehetso ea joala li kopantsoe ka li-receptor tsena. Lithuto tsa PET tse nang le 5HT1B ligand [11C] P943 e na le ts'ebetso e kholo ea 5HT1B receptor ho PG le ho itšepa joala (Hu et al 2010; Potenza et al. ka khatiso). Barupeluoa ba ts'ebelisanang le joala ba bonts'a bokhoni bo matla ho feta taolo le bothata ba papali ea chelete ha bo bapisoa hantle le lintho tse ka tlamang ho PG, ba fana ka tlhahiso ea hore tlhaelo ea 5HT1B e fumanehang e ka kenya letsoho ho lemeleng lintho tse sa amaneng le lithethefatsi.
Liphetho tse kopaneng tsa teko ea kliniki tse nang le li-serotonergic agents ho PG li ts'oana le sephetho ho li-SUD. Ka bobeli li-SSRI (Torrens et al. 2005) le olanzapine (Amato et al. 2010; Guardia et al. 2004) li bontšitse katleho e fokolang kalafong ea li-SUDs.
Phapang likamanong pakeng tsa ts'ebetso ea serotonin le papali ea chelete le boitšoaro ba tšebeliso ea lithethefatsi le tsona e ka ba teng. Tryptophan depletion, e lebisang maemong a khutsitseng a serotonin le e fetotsoeng serotonin neurotransication, e ne e amana le "tahlehelo e tlase ea ho lahleha" papaling ea chelete e etselitsoeng (Campbell-Meiklejohn et al. 2011). Har'a ba kotsing e kholo ea ts'ebeliso ea lino tse tahang, tryptophan depletion e amahanngoa le karabelo e eketsehileng, empa eseng khetho, ho susumetsa (Crean et al. 2002; LeMarquand et al. 1999). Liphumano tsena li bonts'a ho theoha ha tryptophan, mme ka ho atolosoa, ts'ebetso ea serotonin, e ka susumetsa ka mokhoa o fapaneng likarolo tsa ho etsa liqeto le ho hohela. Hore na lipatlisiso tsena li atoloha ho kae ho etsa lipatlisiso tsa warna tsa PG le SUDs.
Li-opioids ho PG
Maemo a phahamisitsoeng a endo native opioid beta-endorphin a hokahane le papali ea chelete le boits'oaro bo amanang (Shinohara et al. 1999). Hajoale, bahanyetsi ba opioid ba na le tšehetso e matla ho fetisisa har'a li-pharmacotherapeutic agents tsa PG. Pilisi e phahameng ea naltrexone e ne e phahame ho feta placebo mme e sebetsa hantle haholo ho tse tlalehang litakatso tse matla tsa ho becha qalong ea kalafo (Kim et al. 2001). Tekong ea libaka tse ngata tsa nalmefene, litekanyetso tsa 25mg le 50mg li ne li amahanngoa le ho fokotseha ho hoholo hoa lintlha tsa PG-YBOCS ho feta placebo. Leha ho le joalo, le ha e sebetsa hantle, tekanyetso ea 50mg le 100mg li ne li amana le liketsahalo tse bohloko le ho khaotsa kalafo ho feta (Grant et al. 2006). Litekong tsa naltrexone ho bakuli ba PG ba tlaleha ho becha ho khothalletsoang ke papali ea chelete, ho fokotsoe haholo lipakeng tsa bothata ba papali ea chelete ea ho becha, lintlha tsa PG-YBOCS, lithahasello tse ipolelang le boitšoaro ba papali ea chelete (Grant et al. 2008a). Tlhahlobo e latelang ea naltrexone ea morao-rao le nalmefene ya data e amanang le nalane ea malapa ea joala ho karabelo e ntle ea kalafo (Grant et al. 2008b). Phuputso e latelang e fumane hore hara lithuto tse fumanang meriana e sebetsang, nalmefene e ne e phahame ho feta placebo, leha tlhahlobo ea sepheo sa ho phekola ho kenyelletsa ho tsoa (placebo-lead-in) e ne e le mpe (Grant et al. 2011). Kahoo, sephetho sa liteko tse 'ne tsa e-ba teng, liteko tsa bongaka tsa bahanyetsi ba opioid li hlahisitse liphetho tse ntle mabapi le ho fokotsa bothata ba papali ea chelete' me phello ena e bonahala e le matla haholo ho ba nang le nalane ea lelapa ea joala kapa litabatabelo tse matla tsa papali ea chelete. Ka papiso, Toneatto et al. (2009) ha e tlalehe monyetla oa bohlokoa oa naltrexone holim'a placebo bakeng sa kalafo e kopanang ea tahi ea tšebeliso ea joala le PG. Le ha naltrexone e ne e amana le ho fokotseha ha papali ea chelete le tšebeliso ea joala, ho bile le karabelo e matla ea placebo, 'me lithuto tse etselitsoeng ho lebella le ho ikarabella ka nepo bakeng sa likarabo tsa placebo lipuisanong tsa mokuli tse etsahalang li bonahala li lokelehile.
Ho ts'oana le ho fapana ha monehelo oa opioidergic ho li-SUD le PG
Liphetho tsa teko ea kliniki le bahanyetsi ba opioid ba PG ba latela liphetho tse ngata tse ntle bakeng sa li-SUD, haholo-holo joala le ho ts'epa opiate. Naltrexone e sebetsa ho thibela sephetho se khotsofatsang sa opiates. Ho se atlehe ha hae litekong tsa kalafo ho bonahala ho amana le ho se lumellane ho e-na le katleho ea pharmacologic (Lobmaier et al. 2008; Minozzi et al. 2011). Naltrexone, hammoho le kalafo ea kelello, o bontšitse katleho ho phokotso ea tšebeliso ea joala (Rosner et al. 2010), leha ho bile le liteko tse mpe (mohlala, Krystal et al. 2001). Mekhoa ea katleho ea naltrexone e kenyelletsa phokotso lithutong tsa ho noa (Monti et al. 1999; Palfai et al. 1999). Kahoo, liphumano li fana ka maikutlo a hore naltrexone e ka fokotsa likeletso ho PG le ho nwa bothata. Bopaki bo boetse bo supa litlamorao tsa naltrexone ho PG le ho itšepa joala (Krishnan-Sarin et al. 2007) e ka ba matla haholo hara ba nang le nalane ea lelapa ea botahoa.
Leha ho na le bopaki ba karolo ea mosebetsi oa opioid moputsong o amanang ka kotloloho le ts'ebeliso ea lithethefatsi, ts'ebetso ea opioid e kanna ea se ke ea kenya letsoho ka matla ho putsa ho arabela kapa likarolo tsohle tsa ho qobelloa ka botlalo. Ho fapana le se fumanoeng le amphetamine, naltrexone e fokotse ts'ebeliso ea joala ka mokhoa oa panya empa ha ea ka ea e-ba le phello e hlakileng boikhethong bo sa tsotelleng kapa tlhokomelo mosebetsing o fokotsang mosebetsi (Oberlin et al. 2010). Ka mokhoa o ts'oanang, mosebetsing o lietsitsoeng oa moputso, opioid antagonist naloxone ha ea ka ea ba le phello e ntle boikhethollong, empa e bile ts'usumetso e ntle ho ts'ebetso ea nako ea bohlano ea karabelo ea nako ea bohlano (Wiskerke et al. 2011).
Glutamate ho PG
Open-label n-acetyl cysteine (NAC), e leng phepo e nepahetseng ea nama, e ne e amahanngoa le ho fokotseha ho hoholo hoa bothata ba ho becha haholo. Liphetoho tsena li ile tsa phehella molemong oa ho khaoloa ka mahlo a mabeli, ka boholo bo boholo ba phello (Grant et al., 2007). NAC ho lumeloa hore e khutlisetsa khatello ea maikutlo le lihlahisoa tsa methapo ea methapo libakeng tse kenyeletsang ventral striatum.
Phokotso ho lipalo tsa PG-YBOCS le ho fokotseha ha papali ea chelete ho ile ha bonoa ka memantine e bulehileng-e-lebitso, mohanyetsi oa N-methyl d-aspartate receptor antagonist (Grant et al. 2010). Le ha nako ea ho emisa ka lets'oao ha e ea ka ea ntlafala haholo, ts'ebetso ea lithuto tsa PG tekong e ile ea fela ha e sa fapana le ea lithuto tse laoloang. Har'a lithuto tsa PG, ho bile le ntlafatso ea bohlokoa qetellong ea kalafo ts'ebetsong ea IDED. Phokotso ea lipalo tsa liphoso tsa IDED ho tloha pele ho kalafo li ile tsa hokahanngoa haholo le bothata bo tebileng ba ho becha. Ho fumana sena e kanna ea ba ho bakoa ke ho feto-fetoha ha methapo ea kutlo ea glutamatergic ho PFC ka lebaka la memantine (van Wageningen et al., 2010), le ha e le monahano ona o ne o sa hlahlojoa ka kotloloho. Ka hona, memantine e ka fokotsa likarolo tsa ho se ts'oenyehe mme mohlomong le ho qobelloa haholo ho PG, mme lithuto tse kholo, tse laoloang li bontšoa.
Ho tšoana le phapang ea monehelo oa glutamatergic ho li-SUD le PG
Mithethefatsi e fetolang glutamate neurotransication e ka fokotsa ho becha le tšebeliso ea lithethefatsi. Liphumano tse tšoanang tsa papali ea chelete, NAC e ne e amahanngoa le ho batla moputso ho likhoto tse koetliselitsoeng ho ikhalemela koae (Baker et al. 2003) le ho fokotsoeng ha takatso ea lithethefatsi tsa heroin ho litoeba (Zhou le Kalivas 2008). NAC e ka fokotsa ho tsuba (Knackstedt et al. 2009) tšebeliso ea matekoane le ho lakatsa batho (Gray et al. 2010). Memantine le eona e ka ba le karolo ea ho phekola ho ts'epa joala. Lithutong tsa taolo ea joala ea batho, memantine e ne e amahanngoa le litlamorao tse ntle tse fokolisitsoeng tsa (Krupitsky et al. 2007). Hore na memantine e fana ka tšusumetso e kae tšebelisong ea lithethefatsi ka ts'usumetso ea ho susumetsoa kapa ho qobelloa ha e hlake, haholo-holo ho fanoa ka hore memantine e fokotse ts'ebeliso ea lino tse tahang ka litoeba ntle le ho susumetsa tlhokomelo kapa khetho e potlakileng mosebetsing oa ho fokotsa litšenyehelo (Oberlin et al. 2010).
Bopaki bo fana ka maikutlo a hore ho se leka-lekane ha glutamate neurotransication ho ka mpefatsa boitšoaro bo sa potlakiseng le bo qobelloang ho PG ka bobeli ()Grant et al. 2010) le li-SUD (Kalivas 2009). Ka lebaka leo, liphuputso li fana ka maikutlo a hore meriana e fetolang glutamate neurotransication e ka lebisa ho ts'ebetsong e sa potlakileng le e qobelloang ho PG le SUDs (Grant et al. 2010; Kalivas 2009).
Norepinephrine ho PG le SUDs
Norepinephrine, e neng e hokahantsoe le ho tsosa, e fumanoe e eketseha nakong ea boitšoaro ba papali ea chelete (Shinohara et al. 1999), ho kenyelletsoa le batho ba nang le PG, e lumellanang le maemo a phahameng a maemo a peto a sekhahla sa pelo (Meyer et al. 2004). Batho ba nang le PG ba fumanoe maemong ao e seng a papali ea chelete hore ba be le mehato e phahameng ea li-adrenergic agents le metabolites ea bona.Roy et al. 1988; 1989). Ho latela hore lits'ebetso tsa adrenergic li ka thusa lipakeng tsa litlamorao tsa boits'oaro bo lematsang (Weinshenker le Schroeder 2007) le lithethefatsi tsa adrenergic li ka susumetsa ho ts'oaroa ke matla (Chamberlain et al. 2007) le sephetho sa kalafo ho SUDs (Jobes et al. ka khatiso; Shaham et al. 2000; Sinha et al. 2007), ho hlokahala mosebetsi o mongata ho lekola likamano lipakeng tsa lits'ebetso tsa adrenergic le liakhente ho PG le joalo ka ha li amana le ho qobelloa le ho qobelloa.
Summary
Bopaki bo tšehetsa likarolo tsa dopamine, serotonin, opioids, glutamate le norepinephrine ho PG le SUDs (Lethathamo 3). Ho na le lintho tse ngata tse etsahalang khafetsa maemong a mangata, haholo-holo ts'ebeliso ea PG le joala.
Ho tšoana le phapang lipakeng tsa ho becha ha methapo ea kutlo (PG) le mathata a ts'ebeliso ea lithethefatsi (SUDs) mabapi le lipatlisiso tsa tsamaiso ea methapo ea methapo (bona mongolo bakeng sa lintlha)
Lits'oants'o tsa nako e tlang tsa lipatlisiso tse amanang le ho susumetsoa le ho qobelloa ho SUD le PG
Tlhahlobo ena e fana ka maikutlo a mefuta e mengata ea lipatlisiso tsa nako e tlang. Tsena li kenyelletsa phatlalatso ea kotsi bakeng sa PG le SUDs, mehlala ea laboratori le lithuto tsa kalafo.
Mabapi le ho ba kotsing, lithuto tse kenyeletsang lihlopha tse nyane tsa batho ba kotsing ea ho tšoaroa ke PG (mohlala, ba nang le nalane e ntle ea lelapa ea sena kapa li-ICD tse ling), hammoho le lithuto tse tšoanang ho SUDs (mohlala, LeMarquand et al. 1999), e ka fana ka leseli la bohlokoa mabapi le litšobotsi tse amanang le kotsi ea ho holisa PG. Hape, lithuto tsa nako e telele ho ba leng kotsing e kholo le ba nang le PG, SUD le bobeli, bathong hammoho le mehlaleng ea liphoofolo, li ka fana ka tlhaiso-leseling ea bohlokoa mabapi le kotsi le ho ba kotsing, hammoho le nalane ea tlhaho ea mathata ana.
Lithuto tsa nako e tlang li ka etsoa ho sebetsana le liphetho tse rarahaneng le tse fapaneng mabapi le ts'ebetso ea dopaminergic le serotonergic ho SUDs le PG, hammoho le mofuta oa ts'ebetso libakeng tse fapaneng tsa boko ho PG le SUDs. Patlisiso e joalo e ka kena-kenana le mekhoa e mengata ea ho nahana (PET, fMRI, imaging tensor imaging) ho utloisisa hamolemo likamano lipakeng tsa neurochemistry, activation activation and white suala botšepehi. Mekhoa ea litekanyetso e tsoetseng pele e ka sebelisoa data ho etsa lipatlisiso ts'ebetsong e kopantsoeng nakong ea fMRI mabapi le ts'ebetso ea mosebetsi le lipono tse ling le mehato e loketseng ea bongaka.
Phephetso ea ho bapisa liphetho lipatlisisong tsa PG le SUD ke hore lipatlisiso tsa laboratori ho SUDs (Haney 2009) ka mokhoa o ts'oanang oa ho kopitsa ts'ebeliso ea litheko tsa nnete ho feta kamoo lipatlisiso tsa PG li phetang papali ea papali ea chelete ea 'nete. Leha lintho tsa nnete li ka tsamaisoa, lithuto tse ngata tsa papali ea chelete li sebelisa mesebetsi e etselitsoeng. Ha lithuto tse ling (mohlala, Breen le Zuckerman 1999) Ba sebelisitse chelete ea 'nete. Tlhahisoleseling e fana ka maikutlo a tšebeliso ea chelete ea 'nete ha e bapisoa le tšebeliso ea maikutlo e ka susumetsa likarabo tsa subjential le neural (Hollander et al. 2005). Lilemong tsa morao tjena, ho bile le tsoelo-pele ea ho etsa mehlala ea papali ea papali ea chelete (mohlala, mehlala ea "haufi le" le "ho lelekisa" liketsahalo). Mefuta ena e ka sebelisoa lithutong tse ngata tsa PG le lithutong tsa laboratori tsa nts'etsopele ea meriana e tšoanang le se entsoeng ho SUDs (mohlala, O'Malley et al. 2002). Patlisiso ea PG le SUD e ka una molemo ho ntlafatso ea mefuta e mengata ea batho le liphoofolo ea likarolo tsa bokhoba. Tsoelo-pele ea morao-rao ea mehlala ea liphoofolo ho PG (Rivalan et al. 2009; Winstanley et al. 2011; Zeeb et al. 2009) ea tšepisa. Haeba likhoto kapa litoeba li ka hlahisoa ka mokhoa o ikhethileng kapa tsa genetic ka mokhoa oa ho becha ka mokhoa o khahlisang PG, joalo ka mehlala ea SUD (mohlala, joala bo ratang likhoto; Bell et al. 2006), ba ne ba tla emela lisebelisoa tse matla tsa ho etsa lipatlisiso.
Patlisiso e eketsehileng mabapi le likarolo tsa ho susumetsoa le ho qobelloa e lokela ho etsoa ka bobeli ho PG le SUDs. Kamano lipakeng tsa ho susumetsoa le ho qobelloa ho utloisisoa hantle 'me e lokela ho hlahlojoa ho ea pele (Blanco et al., 2009; Dalley et al. 2011). Mosebetsi o latelang oa hlokahala ho hlalosa ka mokhoa o hlakileng le ho hlakisa mohopolo oa bohlokoa oa ho qobelloa (Dalley et al. 2011; Fineberg et al. 2010), mmoho le mehato e ts'oanang ea mosebetsi o etsoang ho lingoliloeng tsa impulsivity (bona Dick et al. 2010). Haholo-holo, mekhoa ea ho itlaleha le mesebetsi ea methapo e ka khethollang likarolo tsa ho qobelloa joalo ka phehello ea karabelo le tlhahiso ea sephetho e ka ba molemo haholo. Patlisiso e mabapi le ho tsebahatsa ts'ebetso ea methapo ea kutlo le ts'ebetso ea ts'ebetso ea ts'ebetso ea mokokotlo le ts'usumetso ho PG le SUDs e ka ba tsa bohlokoa, joalo ka ha ho ne ho tsoelapele ka lipatlisiso tsa liemahale tsena ho batho le mehlala ea liphoofolo. Haholo-holo tšebeliso ea litlaleho tsa boits'oaro le litloaelo tsa boits'oaro le ho potlaka litekong tsa bongaka bakeng sa PG le SUDs li ka fana ka tlhaiso-leseling e bohlokoa ea kliniki bakeng sa ho utloisisa hore na kalafo e sebetsa joang le hore na liphekolo tse khethehileng li sebetsa hantle ho eng (Potenza et al 2011).
lumela hore baa fokola
Mosebetsi ona o ne o tšehelitsoe ke karolo ea NiH (K01 AA 019694, K05 AA014715, R01 DA019039, P20 DA027844, RC1 DA028279), Lefapha la VA VISN1 MIRECC, Lefapha la Khakanyo ea Tlatsetso ea Tlholeho le Tlatsetso ea Motheo le Tlatsetso ea Tlatsetso. Setsi sa Naha sa Lipapali se Ikarabellang le Setsi sa lona se kopaneng sa Patlisiso mabapi le Mathata a Papali ea Chelete. Likateng tsa buka e ngotsoeng ka letsoho ke feela boikarabello ba bangoli 'me ha ho hlile ha li emetse maikutlo a semmuso a mekhatlo efe kapa efe ea lichelete.
Mongolo o botlaaseng ba leqephe
Liphatlalatso: Bangoli ba tlaleha hore ha ba na likhohlano tsa lichelete mabapi le litaba tsa mongolo ona. Ngaka Potenza o fumane tšehetso ea lichelete kapa matšeliso bakeng sa tse latelang: Dr. Potenza o buisane le ho eletsa Boehringer Ingelheim; e buisane le lithahasello tsa lichelete ho Somaxon; e amohetse tšehetso ea lipatlisiso ho tsoa ho Setsi sa Naha sa Bophelo, Tsamaiso ea Veteran, Mohegan Sun Casino, Setsi sa Naha sa Lipapali Tse Ikarabellang le Setsi sa Tsamaiso sa Ts'ebetso ea Lipatlisiso mabapi le Mathata a Boloi, le Psyadon, Laboratories tsa Meru, Ortho-McNeil, Oy-Control / Biotie le Glaxo-SmithKline litlhare; o nkile karolo lipatlisisong, liposong tsa mangolo kapa lipuisanong tsa mehala tse amanang le tšebeliso ea lithethefatsi, mathata a taolo ea tšusumetso kapa lihlooho tse ling tsa bophelo; e buisane le liofisi tsa molao le ofisi ea mmuelli oa mmuso litabeng tse amanang le mathata a taolo ea tšusumetso; e fana ka tlhokomelo ea bongaka Lefapheng la Connecticut la Bophelo bo Botle ba kelello le lits'ebeletso tsa tlhekefetso ea mathata a boloi; e entse tlhahlobo ea lithuso bakeng sa Setsi sa Naha sa Bophelo le mekhatlo e meng; e na le likarolo tsa likoranta tse hlophisitsoeng ke baeti; e fane ka lipuo tsa thuto lithutong tse ntle, liketsahalong tsa CME le libakeng tse ling tsa bongaka kapa tsa saense; mme e hlahisitse libuka kapa likhaolo tsa buka bakeng sa baphatlalatsi ba mangolo a bophelo bo botle ba kelello.
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