Kamano pakeng tsa mathata a ho laola maikutlo le khatello e feteletseng ea ho qobella maikutlo: kutloisiso ea morao-rao le lipatlisiso tsa lipatlisiso (2009)

Mathata a taolo ea Impulse control (ICDs) a theha sehlopha sa maemo a hokahantsoeng ka ho hlaka ka lebaka la mathata a ho hanela "tšusumetso, ho khanna, kapa moleko oa ho etsa ketso e kotsi ho motho kapa ho batho ba bang." Li-ICD tse ikhethang li arolelana likarolo tsa bongaka, tsa tlhaho le tsa tlhaho. le disessive-activive disorder (OCD) tse khothalelitseng hore mathata ana a ka aroloa hammoho. Leha ho le joalo, datha tse ling li fana ka maikutlo a phapang e kholo lipakeng tsa OCD le ICD. Sengolomong sena, likarolo tsa bongaka, tse hlollang le tsa tlhaho tsa li-ICD tse hlophisitsoeng hantle lia hlahlojoa ebe li bapisoa le ho bapisoa le tsa OCD. Lintlha tse fumanehang li bonts'a phapang e kholo lipakeng tsa li-ICD le OCD tse fanang ka maikutlo a mekha e ikemetseng. Ho na le likheo tsa lipatlisiso tse ntseng li le teng le menyetla ea ho etsa lipatlisiso tsa nako e tlang.

3.1. Phenomenology le Epidemiology

Lintlha tse teng li fana ka maikutlo a hore leha ho na le ho tšoana pakeng tsa IED le OCD, ho na le phapang e kholo. IED e tšoauoa ke liketsahalo tse etsahalang khafetsa tse sa lumellaneng le khatello ea maikutlo le / kapa ho tsosoa 'me li sa tlaleheloe hamolemo ke bokuli bo bong ba kelello, ka maemo a bongaka a kalafo, kapa ka litlamorao tsa mmele tsa lithethefatsi kapa ntho e ngoe e nang le thepa ea kelello. (Komiti ea Mokhatlo oa Amerika oa Psychiatric mabapi le Nomenclature le Statistics, 2000). IED e kanna ea pheta-pheta, ea makatsa, ea phehella le ho pheta-pheta joalo ka OCD, empa hangata e ba sehlohlolong. Ho fapana le likhothaletso ho OCD, ho tlakoloha ka bohale ho IED hangata ha ho etsahale ka lebaka la ho teneha. Khalefo hangata ha e ea hlophisoa mme e etsahala ntle le ho nahana esale pele (Grant le Potenza, 2006a). Ho ts'oenyeha ho IED ho fapana le ho qobelloa ho OCD ka hore e kanna ea khotsofatsa ebile ea tsamaisana le nyakallo ho fapana le ho fokotsa khatello ea maikutlo; leha ho le joalo, joalo ka khatello ea OCD, liketso tse mabifi li ka bonoa e le khatello ea maikutlo (McElroy et al., 1998).

Tlhahlobo ea chart ea lingaka tsa mafu a kelello (Monopolis le Tau, 1983) le lipuisano tsa tliliniki (Felthous et al., 1991) litekanyetso tsa kholo ea IED tse tsoang ho 1% ho 3% maemong a kelello (Olvera, 2002). Phuputso ea morao-rao ea li-inpatients tsa kelello tsa batho ba baholo e fumane hore 6.4% le 6.9% li ne li na le IED ea hona joale le ea bophelo, ka ho latellana (Grant et al., 2005). Phuputso e arohaneng ea lingaka tsa kelello tsa bongoana e fumane karolo e kholo ea lithuto (12.7%) e fihletseng litekanyetso tsa IED (Grant et al., Ka ho tobetsa). Ka bobeli lithutong tsa bongaka ba batho ba baholo le ba lilemong tsa bocha, ho hlahlojoa ha IED ho ile ha supoa feela kamora ho hlahlobisisa le ho hlahlobeloa lipotso. Liphumano tsena li fana ka maikutlo a hore IED, joalo ka li-ICD tse ling, hangata ha e lemohuoe kahoo ha e ea rereloa kalafo. Khakanyo ea IED mehlaleng ea sechaba e khothaletsa hore IED e tloaelehile. Mohlala, thuto e le 'ngoe ea sechaba e fumane ho ata ha bophelo ba 11.1% le keketseho ea khoeli ea 3.2% 1 (Cocarro et al., 2004). Thutong ea NCS-R, tekanyetso ea nako ea bophelo le 12 ea khoeli le khoeli ea DSM-IV IED e ne e le 7.3% le 3.9%, ka ho latellana (Kessler et al., 2006). Hammoho, lithuto tsena li fana ka maikutlo a hore IED e tloaelehile haholo ho feta OCD.

Ka tsela e itseng, litšobotsi tsa kliniki le tsela ea IED e ts'oana le ea mafu a mang a khetholloang ka taolo e sa sebetseng (mohlala, mathata a tšebeliso ea lithethefatsi) ho feta a OCD. Ho fapana le OCD, eo ho eona ho nang le tekanyo e ka bang 1: 1 karolelano ea monna le mosali (Robins le Regier, 1991) kapa ho ba motšehaliMohammadi et al., 2004; Grabe et al., 2006), IED e tšoauoa ke 2 e ka bang motho: 1 predominance ea banna (Grant le Potenza, 2006a; Kessler et al., 2006). Nako ea ho qala ha tlhōrō ea DSM-IV IED lilemong tsa bocha, esale pele ho banna ho feta basali, mme e le pejana ho mathata a mangata a hlahang khafetsa le IED (bona ka tlase), ntle le mathata a matšoenyeho a phobic (Kessler et al., 2006). Ka mokhoa o ts'oanang, batho ba bangata (49%) ba tlaleha matšoao a OCD nakong ea bongoana kapa lilemong tsa bocha le bongata (75%) ea ho tlaleha pele ho lilemo 25 (Robins le Regier, 1991). Ho IED, boitšoaro bo mabifi bo hlaha hoo e ka bang mashome a lilemo kaofela a bophelo bo qalang lilemong tse leshome tse qalang, bo hola ka selemo sa boraro, bo fokotseha butle-butle ka mor'a lilemo tse nne, 'me bo fihla sehlohlolong se senotsoeng kapa se sa tlaleheloang lilemong tse leshome tse robeli (Cocarro et al., 2004). Liphetoho tsa litaba tsa bophelo ba IED tsa bophelo ba sechaba li kenyelletsa boemo bo tlase ba thuto, ho nyaloa le ho ba le chelete e tlase ea lelapa (Kessler et al., 2006). Ka lehlakoreng le leng, OCD ha e bonts'e botsoalle bo hlakileng le batho ba nyalaneng ebile ha ba na mathata a batho ba nyalaneng (Robins le Regier, 1991).

3.2. Mathata a Kopaneng

Joalo ka li-ICD tse ling (Potenza, 2007), IED e kopana khafetsa le mathata a mang a kelello ho kenyeletsa le OCD. Liphumano tsa pele li tlalehiloe ho tsoa ho mehlala ea lingaka. Phuputso e le 'ngoe e tlalehile OCD ho 22% ea batho ba nang le IED (McElroy et al., 1998). Khakanyo ea IED ka har'a li-sampuli tsa kliniki tsa lithuto tse nang le OCD li tlohile ho tloha ho 2% ho isa ho 10% (du Toit et al., 2005; Fontenelle et al., 2005). Ho NCS-R, bongata (81.8%) ea bakuli ba hlalosoang ka nako eohle bophelo ba IED ba ile ba kopana le maemo a bonyane bo bong ba bophelo ba DSM-IV (Kessler et al., 2006). Ho ile ha fumanoa mathata a mangata a kelello a amanang le IED ho kenyelletsa le maikutlo, ho tšoenyeha, taolo ea tšusumetso le mathata a ts'ebeliso ea lithethefatsi (Kessler et al., 2006). Har'a batho ba nang le IED e hlalositsoeng haholo, 4.4% e fihletse mekhoa ea OCD. Karolelano ea maiketsetso (OR) bakeng sa IED e hlalositsoeng ka botlalo kopanong le OCD e ne e le 2.5 (95% boiketlo ba nako ea ho itšepa (CI): 1.1-5.7). Ka har'a sehlopha se hlalositsoeng ka botlalo, ho ne ho se na phapang ea bohlokoa pakeng tsa tekanyo ea botsoalle pakeng tsa IED e hlalositsoeng ka kotloloho le OCD (OR: 1.1; 95% CI: 0.2-6.9). Ho fapana le hoo, ho ba le bothata ba ho tšoenyeha ka kakaretso, li-ICD tsohle le mathata a ts'ebeliso ea lithethefatsi li bonts'itse likarolo tse phahameng tsa AU bakeng sa IED ka bophara le ka mokhoa o hlakileng, ho fana ka maikutlo a kamano e haufi haholo pakeng tsa mathata ana le mefuta e fokolang le e matla ea IED (Kessler et al., 2006).

3.3. Nalane ea Lelapa le Lipalo

Leha lithuto li fana ka maikutlo a hore boits'oaro bo susumetsang le bo mabifi bo bontša phetisetso ea lelapa (Halperin et al., 2003; Kreek et al., 2005), lithuto tse fokolang tsa nalane kapa tsa malapa li entsoe ho batho ba nang le IED. Ho na le lintlha tse ngata tsa lipatlisiso tse bonts'itseng boiketlo ba lelapa le bohlasoa e le lintho tse ka bakang kotsi ea ho phehella ho ba mabifi ho ngoana ho fihlela lilemong tsa bocha le ho ba motho e moholo.Cadoret et al., 1995; Frick et al., 1990). Mokhoa oa lelapa oa boits'oaro bo mabifi o amahantsoe le ts'ebetso ea serotonin e bohareng (bona li-neurobiology ka tlase) (Halperin et al., 2003). Nalane ea lelapa ea batho ba nang le IED e tšoauoa ka maemo a phahameng a ho feto-fetoha ha maikutlo, tšebeliso ea lithethefatsi le mathata a mang a taolo ea ho susumetsa (McElroy et al., 1998). Phuputso ea kamano ea liphatsa tsa lefutso e fumane kamano lipakeng tsa mofuta o mong oa mofuta oa serotonin (5HT) 1B receptor gene le bokhoba ba tahi ho batho ba mabifi / ba sa tsotelleng ba fihletseng litekanyetso tsa ho ba le mathata a botho bo sa hlonepheng kapa IED (Lappalainen et al., 1998). Ho fapana le seo, 5HT 1B receptor ha e so ka e ameha lithutong tsa liphatsa tsa lefutso tsa OCD, leha mefuta e meng e 'maloa e amanang le 5HT (mohlala, ba kenyang li-receptors tsa 5HT 1D le 5HT), ha lia ka tsa sebelisoa ho tse ling. lithuto tsa OCD (Hemmings le Stein, 2006).

3.4. Neurobiology: Mehlala ea Liphoofolo le Lithuto tsa Batho

Lits'ebetso tse ngata tsa methapo ea kutlo le libaka tsa boko li kenya letsoho mohaleng o sa susumetseng. Mefuta ea liphoofolo e kenyelitse mekhoa e mengata ea tlhaho le li-neurotransmitters ho kenyelletsa le tse kenyeletsang testosterone, gamma-amino butyric acid, nitric oxide, monoamine oxidase, glutamate, dopamine le serotonin (Olivier le Monyane, 2002; Korff le Harvey, 2006). Ka har'a litsamaiso tsena, likarolo tse ikhethileng li bonahala li le bohlasoa haholo. Mohlala, datha e matla e beha "5HT 1B receptor" ka mabifi a phehellang ho litoeba; litoeba tse kokotang tse se nang pokello ea li-receptor li tšoaea mabifi a 'mele (Saudou et al., 1994). Liphumano tsena li tsamaellana le lithuto tsa batho tse hohelang motho ea amohelang joala hampe (Lappalainen et al., 1998). Le ha lits'ebetso tse ling tse tšoanang (mohlala, 5HT, dopamine) li sebetsa ka bobeli ho IED le OCD, li bonahala li ameha ka mekhoa e fapaneng. Mohlala, ho sitisoa ha liphatsa tsa lefutso tse kenyelletsang 5HT 2C receptor le "dopamine transporter" li hlahisa boits'oaro bo tšoanang le OCD (Korff le Harvey, 2006), joalo ka ha ho bapisoa le 5HT 1B receptor mananeo a sebetsang haholoanyane ho IED. Phapang ea liphatsa tsa lefutso mefuteng e atamelaneng e amanang le 5HT e amanang le mohlala (mohlala, ea 5HT transporter) mekhoa ea 5HT e amanang le mabifi a susumetsang (Mannelli et al., 2006).

Ke liphuputso tse fokolang tse ileng tsa hlahloba neurobiology ea IED bathong, 'me tse fumanehang ha lia ka tsa supa phapang lipakeng tsa sehlopha sa batho. Mohlala, patlisiso ea maqhubu a bongoana a bonts'ang liphapang lithutong tsa boloi tsa bongoana le lithuto tsa taolo mehatong ea myoinositol ha lia ka tsa fumana phapang lipakeng tsa bacha le ntle le IED (Davanzo et al., 2003). Leha lithuto tse 'maloa li entsoe ho batho ba nang le IED, ba bangata ba fuputse ka batho ba mabifi ba sa tsotelleng. Lisebelisoa tse ngata tsa likokoana-hloko, ho kenyelletsa le tse amanang le li-opiate, vasopressin, testosterone, catecholamines (norepinephrine, dopamine), le 5HT, li fumanoe li kenya letsoho ho hlekefetsa batho (Coccaro le Siever, 2002). Har'a tse fumanoeng tse phetoang ka ho fetesisa ke ea maemo a tlase a mehato e bohareng ea 5HT (haholo-holo 5HT metabolite 5-hydroxy indole acetic acid) ho batho ba mabifi ba sa tsotelleng (Coccaro le Siever, 2002; Williams le Potenza, ka khatiso). Le ha lits'ebetso tsa 5HT li kentse letsoho ho OCD, mofuta oa ho kenya letsoho oa fapana, joalo ka ha u ahloloa ka litholoana tsa lithuto tsa phephetso ea pharmacological. Tsamaiso ea lithethefatsi tsa serotonergic meta-chlorophenylpiperazine (m-CPP, 5HT1 le 5HT2 receptor agonist (Potenza le Hollander, 2002)) le fenfluramine (sethethefatsi se khothalletsang 5HT ho lokolloa le ho ba le ketso ea post-synaptic 5HT (Curzon le Gibson, 1999)) e amana le ho eketsoa ha matšoao a OC le tokollo ea prolactin e ntlafalitsoeng lithutong le OCD (Hollander et al., 1991; Monteleone et al., 1997; Gross-Isseroff et al., 2004). Leha ho le joalo, lihlopha tsa bana le batho ba baholo ba tsebahalang ka ho ba mabifi ho sa bonahaleng ba bonts'a karabelo e sa nepahalang ea prolactin ho m-CPP le fenfluramine (Cocarro et al., 1997; Halperin et al., 2003; E ncha et al., 2004b; Patkar et al., 2006). Liphumano tsena li lumellana le tse tsoang ho li-primates, moo ho tlalehiloeng kamano e fapaneng pakeng tsa mabifi le ts'ebetso ea serotonergic (Tiefenbacher et al., 2003)

Lithuto tsa monahano oa Brain li hlahisitse leseli ho pathophysiology ea mabifi a sa sisinyeheng ho batho. E lumellana le karolo ea cortex ea ventromedial pre mapemaal cortex (vmPFC), tikoloho e kenyeletsang medial orbital frontal cortex (Bechara, 2003)) liqetong tsa ho etsa liqeto le liqeto tsa bophelo le boitšoaro (Damasio, 1994; Anderson et al., 1999; Bechara, 2003), batho ba nang le mabifi a kenelletseng ba bonts'a ts'ebetso e fokolang ea vmPFC. Mohlala, hara batho ba nang le khatello ea maikutlo, ba nang le tlhaselo ea khalefo ba bonts'a khokahano e fapaneng pakeng tsa phallo ea mali a khubung ea sethoathoa ho vmPFC e tlohileng le amygdala nakong ea ts'usumetso ea khalefo, athe lithuto tse se nang tlhaselo ea bohale li ne li sa (Dougherty et al., 2004). Melemo ea ts'ebetso ea vmPFC joalo ka ha e amana le khatello e matla e hlaha e hokahane le mosebetsi oa 5HT. Batho ba nang le mabifi a sa bonahaleng ha ba bapisoa le ba se nang likarabo tse hlakileng tsa hemodynamic ho lithethefatsi tsa serotonergic fenfluramine (Siever et al., 1999) le m-CPP (E ncha et al., 2002). Batho ba nang le mabifi ba sa qobelloang ba boetse ba bonts'a ho fokotseha ha 5HT ho fumaneha ha cortex ea anterior, ho kenyelletsoa kahare ea karolo e kenelletsoeng vmPFC (Frankle et al., 2005). Flugetine ea 5HT reuptake inhibitor (SRI) e eketsa metabolism ka har'a orbitof Pambal cortex (E ncha et al., 2004a). Leha ts'ebetso ea cortical ea orbitofrontal e bile le tšusumetso ho OCD, mofuta oa ho nka karolo ha o tšoane le o mabifi o sa susumetseng. Ka ho khetheha, ho fapana le ts'ebetso ea vmPF e fokotsehileng e amanang le mabifi a fetelletseng, ts'ebetso e eketsehang ea li-cortical-striato-thalamo-cortical circry, ho kenyelletsa libaka tsa orbitofrontal tse kenyelletsang vmPFC, e phetoa khafetsa ho OCD (Korff le Harvey, 2006; Mataix-Cols le van den Heuvel, 2006). Leha ho le joalo, lihlopha tse ikhethileng tsa batho ba nang le OCD li bontša ts'ebetso e fapaneng ea potoloho ena. Mohlala, nakong ea lipatlisiso tsa ts'ebetso ea matšoao a fMRI, batho ba hlatsoang OCD ba bonts'itse ts'ebetso e matla ea vmPFC le caudate, ba neng ba hlahloba OCD ba bonts'itse ts'ebetso e matla ea libaka tsa putamen / globus pallidus, thalamus, le dorsal cortical, le ba neng ba ts'oara ba bonts'a ts'ebetso e matla ea OCD ea gorus ea pele le orbitofrontal cortex (Mataix-Cols et al., 2004).

3.5. Litlhare le kalafo ea kalafo

Liteko tse 'maloa tsa tliliniki li' nile tsa etsa lipatlisiso ka ho sebetsa hoa lithethefatsi kalafong ea IED. Lithethefatsi tse thibelang tsamaiso ea serotonin (li-SRI ka bobeli tse khethang le tse sa khethang joaloka sertraline le venlafaxine, ka ho latellana) li tlalehiloe litlalehong tsa linyeoe hore li ka thusa ho batho ba nang le IED (McElroy et al., 1998; Feder, 1999). Leha ho fumaneha hona ho ka fana ka maikutlo a tšoanang le tšebeliso ea li-SRI ho alafa OCD, hangata litekanyetso li ne li sebelisoa li le tlase ho tse tloaelehileng tse sebelisoang ho OCD (Maqhubu, 2006). Mohlala, letotong le le leng le amanang le lithuto tsa IED, sertraline e ile ea hlahisoa ho 50-100 mg / day (Feder, 1999) ho fapana le moo litekanyetso li atamelang 200 mg / letsatsi hangata le sebelisoang bakeng sa OCD. Karolo ea li-SRI kalafong ea IED e tsamaisana le ho sebetsa hoa bona ho ho hlasela bohale bo sa susumetseng (Coccaro le Kavoussi, 1997; Hanela et al., 2003). Lithethefatsi tse nang le botsitso tse kang lithium le valproic acid li tlalehiloe li thusa lithutong tsa kalafo tsa kalafo tsa IED tse bulehileng lebitso (McElroy et al., 1998), e tsamaellanang le liphumano tse tsoang ho ba bang empa eseng lithuto tsohle tsa bana le tse ling tse sisimosang maikutlo (carbamazepine, phenytoin) mabapi le ho hlasela mabifi a susumetsang (Olvera, 2002; Dell'Osso et al., 2006; Grant le Potenza, 2006a). Leha ho le joalo, lithium e haelloa ke ho sebetsa e le moemeli oa matlafatsang kalafong ea OCD (McDougle et al., 1991), leha lithethefatsi tse ling tsa antipsychotic (mohlala, olanzapine, risperidone) tse nang le thepa ea ho tsitsa li bonts'itse ts'ebetso ea ho eketsa karabelo ea SRI ho kopanyeletsa OCD (Maqhubu, 2006). Lithethefatsi tse ling tsa antipsychotic le tsona li atlehile ho phekola moferefere lithutong tse laoloang (Ho fumana et al., 2001; Buitelaar et al., 2001). Bo-raliphetoho ba li-agonists tsa Al-adrenergic le bahanyetsi ba beta-adrenergic ba bontšitse tšepiso e 'ngoe le e' ngoe ea ho lebisa pefo e potlakileng (Olvera, 2002; Dell'Osso et al., 2006; Grant le Potenza, 2006a), athe ha ho karolo e entsoeng bakeng sa lithethefatsi tsena e bonts'itsoeng kalafong ea OCD (Maqhubu, 2006). Ho nkuoa hammoho, leha data ea IED e fokola, tlhaiso-leseling e teng e fana ka maikutlo a hore ho ts'oana ha kalafo ea kalafo ea IED le OCD ho makatsoa ke liphapang tse kholo.

Lintlha tse tsoang ho liteko tsa psychotherapy bakeng sa batho ba nang le IED li na le moeli, ka litlhahiso tsa hore psychotherapy e nang le temohisiso le kalafo ea boitšoaro e ka ba molemo ho batho ba itseng (Grant le Potenza, 2006a). Lithuto tse lekantsoeng tse kenyelletsang lipalo tse nyane tsa lithuto ha li fumane ntlafatso ea bohlokoa e amanang le sehlopha, balekane kapa kalafo ea malapa (McElroy et al., 1998). Mabapi le boits'oaro bo mabifi, lithuto tse laoloang tsa ts'ebetso ea boits'ireletso ho kenyeletsa CBT, kalafo ea sehlopha, kalafo ea lelapa le koetliso ea litsebo tsa sechaba li tlaleha katleho e itseng ho bakuli ba mabifiAlpert le Spilman, 1997). Litlhare tsena li fapana le mekhoa ea ho thibela le ho arabela e sebetsang kalafo ea OCD (Neziroglu et al., 2006). Kahoo, joalo ka data ea pharmacotherapy, lintlha tse fumanoeng tsa kalafo ea boitšoaro li fana ka phapang e kholo lipakeng tsa IED le OCD.

3.6. Mehopolo ea setso

Litloaelo tsa moetlo ho boits'oaro bo mabifi li lokela ho nahanisisoa ho IED, leha ho le joalo lipatlisiso tse fokolang tsa tsamaiso li entsoe mabapi le tšusumetso ea lintlha tsa setso. Mofuta o mong oa mabifi, li-episode tsa amok, o tšoauoa ka pefo e matla, e sa laoleheng, e amanang le amnesia, mme ka moetlo e bonoa feela linaheng tse ka boroa-bochabela ho Asia (Komiti ea Mokhatlo oa Amerika oa Psychiatric mabapi le Nomenclature le Statistics, 2000). Hore na IED e tšoana le li-episode kapa maikutlo a eona a lintlha joang, ho hlokahala hore e hlahlojoe. Leha OCD e etsahala hohle merabeng / merabeng le libakeng tsa lefatše (Karno et al., 1988; Mohammadi et al., 2004), ho fapana hoa litso ho bohlokoa ho ho nahanoa ka hore mekhoa ea setso e amanang le mekhoa e mengata ea moetlo e ka fapana (Komiti ea Mokhatlo oa Amerika oa Psychiatric mabapi le Nomenclature le Statistics, 2000). Leha likhopolo tsa setso li le teng bakeng sa IED le OCD ka bobeli, sebopeho sa litloaelano lipakeng tsa lintlha tse ikhethang tsa setso le liphapang tse peli li bonahala li fapana.

4.1. Phenomenology le Epidemiology

PG e filoe hypothesized ho emisa bobeli ba OC-spectrum disorder le tšebeliso ea lithethefatsi ntle le lithethefatsi, mme data e teng ho ts'ehetsa sehlotšoana ka seng (Hollander le Wong, 1995; Potenza et al., 2001). Le ha likarolo tsena li sa ikhethise ka bobeli, li na le bohlokoa ba khopolo le likhopolo (Tamminga le Nestler, 2006). Mehopolo e phetoang, e makatsang mabapi le papali ea chelete papaling ea PG e arolelana likarolo tsa OCD. Joalo ka OCD, PG e tšoauoa ka mekhoa e pheta-phetoang. Ho PG, boitšoaro bo amanang le papali ea chelete le papali ea chelete (mohlala, ho ts'oara matsoho, ho fumana chelete ea ho becha, jj) ho etsoa khafetsa (Potenza et al., 2001). Joalo ka OCD, boits'oaro hangata bo kena-kenana haholo le libaka tse kholo tsa ts'ebetso (Komiti ea Mokhatlo oa Amerika oa Psychiatric mabapi le Nomenclature le Statistics, 2000). Ha ho bapisoa le boits'oaro ba "ego-dystonic" bo amanang le OCD, papali ea chelete ho PG hangata e "ego-syntonic kapa hedonic" ka tlhaho, le ha nako e ntse e feta, thabo e tlisoang ke papali ea chelete e ka fokotseha. Mabapi le sena, papali ea chelete ho PG e ka tšoana le ts'ebeliso ea lithethefatsi ho ts'ebelisong ea lithethefatsi, mme sena le tse ling tse ts'oanang tsa bonohe li khothalelitse hore PG e ka emela "temallo ea boitšoaro" (Holden, 2001; Petry, 2006; Potenza, 2006). Ketsahalo ea telescoping e tlalehiloe bakeng sa PG le ts'ebelisong ea lithethefatsi le joala eo ho eona basali ka kakaretso ba kenang boits'oaro bo amanang le ho hloka taolo lilemong tse tlang empa ba hatela pele ka potlako ho feta "banna"Potenza et al., 2001; Tavares et al., 2001). Karolelano ea banna: basali ba nang le PG (hoo e ka bang 2: 1) le eona e tšoana le hore ho lithethefatsi le joala ho itšetleha haholo ka karolelano e bonoang ho OCD (ka 1: 1) (Potenza et al., 2001; Petry, 2006; Potenza, 2006). Lintlha tse teng lithutong tsa bongaka tsa PG le ts'ehetso ea thepa le tsona li fana ka maikutlo a tšoanang, ka litekanyetso tse sa tsotelleng bongoaneng, litheko tse phahameng ho bocha le ho ba motho e moholo lilemong le litheko tse tlase ho batho ba baholo ba baholo (Litsi le Potenza, 2003; Potenza, 2006). Mekhoa ena e fapana le e bonoang ho OCD. Mohlala, ho qala ha OCD nakong ea bongoana ho tloaelehile haholo (Komiti ea Mokhatlo oa Amerika oa Psychiatric mabapi le Nomenclature le Statistics, 2000). Mekhoa e mengata ea ts'ebetso ea ho hlahloba bakeng sa PG e bonts'a haholoanyane ho itšetleha ka lintho, ho kenyelletsa likarolo tsa mamello, ho tlohela, liteko tse sa atleheng hangata tsa ho fokotsa kapa ho tlohela, le ho kena-kenana le likarolo tse kholo tsa bophelo bo sebetsang. Mehato ea botho e fana ka maikutlo a hore batho ba nang le PG, joalo ka ba nang le ts'ebeliso ea lits'ila, ha ba qobellehe ebile ba batla maikutlo (Blaszczynski et al., 1997; Potenza et al., 2003b) athe ba nang le OCD ba qoba tse mpe haholo (Hollander le Wong, 1995; Anholt et al., 2004). Kahoo, leha ho na le ho ts'oana ho makatsang lipakeng tsa PG le OCD, ba lipakeng tsa PG le ts'ebeliso ea thepa ba bonahala ba matla le ho feta.

4.2. Mathata a Kopaneng

Boithuto ba lipampiri tsa kliniki bo bonts'a litheko tse phahameng tsa ho ba teng lipakeng tsa PG le mafu a mangata a kantle le a kantle ho naha, ho kenyeletsoa maemo a Axis I le Axis II (Crockford le el-Guebaly, 1998; Potenza, 2007). Lintlha tse tsoang mehlaleng ea sechaba le tsona li bonts'a litheko tse phahameng tsa mafu a hlahang. Mohlala, tlhaiso-leseling e tsoang thutong ea St. Louis Epidemiologic Catchment Area (ECA) e fumane litekanyetso tse phahameng pakeng tsa papali ea bothata / ea methapo ea maikutlo le khatello e kholo ea maikutlo, mathata a ho tšoenyeha (phobias, somatization), mathata a ts'ebeliso ea lithethefatsi (ts'ebeliso ea nicotine le ts'ebeliso e mpe ea lino tse tahang). mathata a kelello le mathata a ho hlaseloa ke botho (Cunningham-Williams et al., 1998). Karolelano ea menahano e sa nyoloheng ea 0.6 e ile ea bonoa pakeng tsa papali ea bothata / ea methapo ea methapo le OCD (Cunningham-Williams et al., 1998). Mehlala e meng e meholo ea sechaba (mohlala, mohlala oa mafahla a banna ka ngollano ea Vietnam Era Twin (VET)) e boetse e bonts'itse likamano tse phahameng pakeng tsa PG le maikutlo, ho tšoenyeha, tšebeliso ea lithethefatsi, le mathata a botho bo khahlano (Potenza et al., 2005). Haufinyane tjena, datha e tsoang NESARC e bontsitse likhaohano tse phahameng tsa PG ha e kopana le mathata a mangata a I le axis II ho kenyelletsa joala, nicotine le ho ts'epa lithethefatsi tse ling, mathata a maikutlo (ho kenyeletsa manic le khatello ea maikutlo), mathata a ho tšoenyeha (ho kenyeletsa ho tšoha, phobic le ho tšoenyeha ka kakaretso), le mathata a botho (ho kenyeletsa le a ka thibelang, a its'episitse, a qobella ho shebella, paranoid, schizoid, histrionic, and antisocial) (Petry et al., 2005). Ha ho NESARC kapa sampole ea VET tseo e seng tlhahlobo ea tlhahlobo ea OCD e fumanoeng. Kahoo, tlhaiso-leseling e teng ea sechaba e fana ka khokahano e matla lipakeng tsa PG le mafu a mangata a kelello ho feta a teng pakeng tsa PG le OCD.

4.3. Nalane ea Lelapa le Lipalo

Lithuto tsa Twin li bonts'a hore PG e na le tekanyo e phahameng ea heritability. Phuputso ea mafahla a banna a 3,359 e fihlile qeto ea hore lefutso le hlalositse ho tloha 35% ho 54% ea mokoloto oa PG (Eisen et al., 1998; Shah et al., 2005). Liphumano tsena li lumellana le thuto e nyane ea nalane ea malapa eo ho eona likhakanyo tsa PG ho beng ka li-probands le PG li neng li le 9%, tse phahameng haholo ho feta tekanyo ea 1% hangata e bonoang ho bongata ka kakaretso (Ntsu et al., 2003). E lumellana le ya data e teng mabapi le mathata a hlahang, lithuto tsa nalane ea malapa ha li bonts'e litheko tse phahameng tsa PG hara litho tsa lelapa tsa li-probands le OCD (Hollander et al., 1997; Bienvenu et al., 2000). Hape e lumellana le lipaterone tsa mafu a hlahang a kopaneng a bonoang lisampong tse thehiloeng ho baahi (Cunningham-Williams et al., 1998; Petry et al., 2005), datha e tsoang ho registry ea VET e bonts'a liphallelo tsa bohlokoa tsa liphatsa tsa lefutso le tikoloho ho PG le ho ba teng ha tsona ka ts'ebeliso ea joala (Slutske et al., 2000le boits'oaro bo khahlisang (Slutske et al., 2001). Ha ho bapisoa, phapang pakeng tsa PG le khatello ea maikutlo e kholo e hlahisoa ke mabaka a liphatsa tsa lefutso (Potenza et al., 2005). Lithuto tse tšoanang tse batlang kamano ea PG le OCD ha li tlalehiloe.

Boithuto ba mofuta oa motho ea khethiloeng ba bontšitse hore mefuta e mengata e hlahang e etsahalang hangata e kenya letsoho ho PG (Ibanez et al., 2003; Shah et al., 2004). Pholororism ea Taq-A1 ea gene e kenyellelitseng D2 dopamine receptor e se e amahantsoe le PG, tlhokomeliso e fokolang ea tšilafalo ea kelello, khatello ea kelello ea Tourette, joala le tšebeliso e mpe ea lithethefatsi / ho its'etleha, boits'oaro bo khahlanong le sechaba, le taolo e mpe ea taolo (Blum et al., 1996; Metsoako, 1998; Ponce et al., 2003; Rodriguez-Jimenez et al., 2006). Mefuta e meng ea litlatsetso e kenyelletsang tse ho tsa genod cepting D1 dopamine receptor, monoamine oxidase A enzyme, le 5HT transporter, hara tse ling, e bile le phello ho PG (Perez de Castro et al., 1997; Metsoako, 1998; Perez de Castro et al., 1999; Comings et al., 2001; Ibanez et al., 2003; Shah et al., 2004; Williams le Potenza, ka khatiso). Leha mefuta e meng e fapaneng ea mohlala (mohlala, mefuta ea 5HT transporter gene) e hlahisitsoe ho OCD le PG, mofuta oa mokhatlo o fapane, ka nako e telele ea khale e fumanoeng e kopane le OCD le allele e khutšoane e fumanoeng e kopane le PG (Ibanez et al., 2003; Hemmings le Stein, 2006). Ho feta moo, lintho tse fumanoeng ho OCD ha li lumellane, 'me ho na le lithuto tse' maloa tse amang allele le ba bang eseng (Hemmings le Stein, 2006). Ho na le meeli e mengata lipatlisisong tsa mofuta oa gene tse entsoeng ho fihlela joale ho PG. Mohlala, lithuto tse ling ha li kenyelelle liteko tsa tlhahlobo ea bongaka kapa ho nka phapang lipapaling tsa merabe / morabe lipakeng tsa lihlopha. Ka lebaka leo, lithuto tsena li lokela ho nkuoa e le tsa pele, ka ts'ebetso e eketsehileng ho hlokahala ho tseba liphallelo tse ikhethang tsa lefutso ho PG le hore na li bapisoa joang le ho bapisoa le tse tlasa OCD.

4.4. Neurobiology: Mehlala ea Liphoofolo le Lithuto tsa Batho

Leha mefuta ea liphoofolo ea PG ka bonngoe e sa qala ho etsoa, ​​li-frontostriatal circry li kentsoe kahare ho mefuta ka mesebetsi e kenyang khetho e potlakileng (Jentsch le Taylor, 1999; Schultz et al., 2000; Everitt le Robbins, 2005). Potoloho ena e bile le tšusumetso lithutong tsa batho tsa PG (Potenza, 2001; Potenza, 2006; Williams le Potenza, ka khatiso). Lithuto tsa ho nahana ka Brain tsa batho ba nang le PG li hlahisitse vmPFC nakong ea takatso ea papali ea chelete (Potenza et al., 2003b), taolo ea kelello (Potenza et al., 2003a), le papali ea chelete e etselitsoeng (Reuter et al., 2005). Lithutong tseo e seng tsa PG, sebaka sena sa boko se ameha lits'ebetsong tsa kelello tse amanang le papali ea chelete, ho kenyelletsa le ts'ebetso ea moputso (Knutson et al., 2001; McClure le al., 2004) le ho etsa liqeto tse bakang likotsiBechara et al., 1998; Bechara et al., 1999; Bechara, 2003). Boithuto ba ts'ebetso ho mesebetsi ea methapo e shebileng lits'ebetso tsena li senotse liphapang lipakeng tsa PG le lithuto tsa papiso ea taolo (Petry le Casarella, 1999; Petry, 2001; Cavedini et al., 2002a). Phapang lipakeng tsa PG le lihlooho tsa taolo mosebetsing oa ho etsa liqeto li fumanoe (Cavedini et al., 2002a) mme phapang ena e ts'oana le pakeng tsa OCD le lithuto tsa taolo (Cavedini et al., 2002b) le tse lipakeng tsa lithuto tse laolang lithethefatsi le taolo (Bechara, 2003). Leha ho le joalo, ts'ebetso ea ts'ebetso ea ts'ebetso ea mantlha e pakeng tsa sehlopha-leseling mabapi le mesebetsi ea ho etsa liqeto ha e so hlahlojoe ka kotloloho. Ka lebaka la hore ts'ebetso e eketsehileng ea potoloho ea li-frontostriatal e shebiloe khafetsa ho OCD (Mataix-Cols le van den Heuvel, 2006) le ts'ebetso e fokotsehileng e bonoang ho PG (Reuter et al., 2005; Potenza, 2006), lipatlisiso tse tšoanang tsa PG, OCD, lithuto tse itšetlehileng ka lithethefatsi le taolo lithutong tsa methapo ea kutlo tse amanang le lihlopha tsena tsa thuto lia hlokahala.

Boithuto ba phephetso ea pharmacological bo kentse ts'ebetso ea li-neurotransmitter tse ngata ho PG, ho kenyelletsa 5HT, dopamine, norepinephrine opioid le litsamaiso tse ling (Potenza, 2001; Potenza le Hollander, 2002; Litsi le Potenza, 2003). Boholo ba lits'ebetso tsena li na le tšusumetso ho mafu a mang a kelello ho kenyeletsa OCD, moo data e bonts'ang ho kenya letsoho ha 5HT le dopamine li sebetsa hantle (Pauls et al., 2002). Leha ho le joalo, datha e fana ka maikutlo a phapang mabapi le mofuta oa ho kenya letsoho ha litsamaiso tsena ho PG le OCD. Boithuto lithutong tsa OCD tsa li-pro-serotonergic agents tse kang m-CPP li bonts'a hore karolo e kholo (e ka bang 50%) e tlaleha ho mpefala ho hoholo ha matšoao ho latela phephetso ea lithethefatsi (Pauls et al., 2002). Ka lehlakoreng le leng, batho ba nang le PG ba kanna ba tlaleha karabelo kapa e "phahameng" ho li-pro-serotonergic agents (Potenza le Hollander, 2002). Liphumano tsena ha li tlatselle feela liphumano tsa ts'ebetso ea kelello moo paradigms e ts'oanang e bonts'ang phapang lipakeng tsa lihlopha tsa li-valefere tse fapaneng ho OCD le PG (Potenza et al., 2003b), empa hape e fana ka maikutlo a hore likarolo tse ikhethang tsa ho potlaka (mohlala, tse amanang le euphoria kamanong le disinhibition) li ka hokahanngoa le likarolo tse ikhethileng tsa Sistimi ea 5HT.

4.5. Litlhare le kalafo ea kalafo

Lilemong tse leshome tse fetileng kutloisiso ea rona ea kalafo e bolokehileng le e sebetsang bakeng sa PG e hatetse pele haholo (Grant le Potenza, 2004; Grant le Potenza, 2007; Brewer et al., Ka khatiso). Ho tšoana le ho se tšoane ho tšoanang ho bonahala mabapi le kalafo ea meriana ea PG le OCD. Pharmacotherapy ea mantlha ea OCD e kenyelletsa tšebeliso ea li-SRI, lithethefatsi tse bontšitsoeng litekong tse 'maloa tse laoloang ke placebo, tse sa sebetseng ka kotloloho bakeng sa ho sebetsa (Maqhubu, 2006). Karolo ea li-SRI kalafong ea PG ha e hlake. Ha li-RCT tse 'maloa li fumane li-SRI tse kang fluvoxamine le paroxetine li phahame ho feta placebo kalafo ea PG (Hollander et al., 2000; Kim et al., 2002), ba bang ha ba so fumane phello ea lipalo-palo (Blanco et al., 2002; Grant et al., 2003). Liphumano tsena li fana ka maikutlo a hore ho na le lintlha tsa bohlokoa tse amanang le sephetho sa kalafo lihlopheng tsa batho ba nang le PG. Ho nahana ka mathata a hlahang a kopaneng e ka ba mokhoa o le mong oa ho tataisa li-pharmacotherapies (Hollander et al., 2004; Potenza, 2007). Mohlala, phuputso ea morao-rao ea escitalopram kalafong ea PG le matšoenyeho a hlahang a fumanoe a fokotsehile ka mokhoa o ts'oanang oa matšoao a ho tšoenyeha le ho becha nakong ea kalafo e ngotsoeng e bulehileng (Grant le Potenza, 2006b). Lithutong tse amohelang lithethefatsi tse sebetsang nakong ea karohano ea mahlo a mabeli a sa boneng, karabelo ea bongaka e ile ea lula; ka lehlakoreng le leng, kalafo ea placebo e ne e tsamaisana le ho mpefala ha matšoao (Grant le Potenza, 2006b). Lintlha tse hlahang li fana ka maikutlo mabapi le likarolo tsa kalafo tsa glutamatergic kalafong ea bobeli ea OCD le PG (Maqhubu, 2006; Grant, 2006). Leha ho le joalo, litholoana tsa liteko tse ngata tsa meriana ea meriana le tse ling tsa PG li lokela ho nkuoa ka hloko ka meeli e kang mehlala e menyenyane ea sampole le nako e khutšoane ea kalafo. Tlhokomeliso e ikhethang e loketse mabapi le liphetho tse fumanehang tse buletsoeng litekanyetso tse phahameng tsa karabelo ea placebo tse bonoang lithutong tsa PG (Grant le Potenza, 2004).

Liphetho tsa liteko tse ling tsa pharmacotherapy li bontša phapang lipakeng tsa PG le OCD. Mohlala, bahanyetsi ba opioid ba kang naltrexone le nalmefene ba fumanoe ba phahame ho feta placebo kalafo ea PG (Kim et al., 2000; Grant et al., 2006b). Ka lehlakoreng le leng, opioid antagonist naloxone e amahantsoe le matšoao a ho eketsoa ha matšoao le OCD (Insel le Pickar, 1983; Keuler et al., 1996). Le ha ho le joalo li-utulivu tse kang lithium li ka thusa lihlopheng tsa lithuto le PG (Hollander et al., 2005), katleho ea bona ho OCD e bonahala e belaella (McDougle et al., 1991). Athe lithethefatsi tsa antipsychotic tse antagonize D2 dopamine receptors (mohlala, haloperidol, risperidone le olanzapine) li bonts'itse ts'ebetso e le baemeli ba matlafatsang ho OCD (Maqhubu, 2006), data e teng ha e tšehetse karolo ea lithethefatsi tsena kalafong ea PG (Grant le Potenza, 2004).

Boitsebiso bo fana ka maikutlo a hore mekhoa ea phekolo ea boits'oaro e na le likarolo tsa bohlokoa kalafong ea PG le OCD. Leha ho le joalo, mekhoa e khethehileng ea boits'oaro e fapana. Ho PG, lenaneo la bohato ba 12 Gamblers Anonymous (GA) ke phehisano e sebelisoang haholo ho feta 'me tlhaiso-leseling e teng e fana ka maikutlo a hore ba eang moketjaneng ba betere ho feta ba sa eeng (Petry, 2005; Brewer et al., Ka khatiso). Hore na sena se emela phello ea kalafo ea 'nete joang kapa ho bontša khethollo (ke hore, ba khothalletsoang hore ba lule GA le bona ba khothalletsoa hore ba se ke ba becha) lipatlisiso tse eketsehileng. GA, ts'ebetso le mojaro o fokolang oa moruo, e etsoa ka mor'a Alcoholics Anonymous. Ha ho lenaneo le hlophisitsoeng ka mokhoa o tšoanang oa 12 le thehiloe bakeng sa kapa leo ho lumeloang hore le ka thusa batho ba nang le OCD. Mekhoa ea boitšoaro ea boits'oaro e thusang batho ba nang le PG e kenyelletsa ntlafatso e khothatsang kapa ho hlahlobeloa lipotso le kalafo ea boitšoaro bo hlokolosi (Sylvain et al., 1997; Hodgins et al., 2001; Petry et al., 2006; Grant le Potenza, 2007; Brewer et al., Ka khatiso). Mekhoa ena e tloaetse ho fetoloa ka mor'a e bonts'ang katleho ea kalafo ea bokhoba ba lithethefatsi (Miller, 1995; Carroll et al., 1998) ho fapana le maano a thibelo ea ho hlahisa / ho arabela a sebetsang ho alafa OCD (Hohagen et al., 1998; Neziroglu et al., 2006).

4.6. Mehopolo ea setso

Ka bobeli PG le OCD li teng litsong tsohle. Phapang ea setso e amanang le ho amoheloa ke sechaba le ho fumaneha ha papali ea chelete e ngolisitsoeng ka molao li ka ama litekanyetso tsa PG (Shaffer et al., 1999). Joalo ka OCD, likhakanyo tse tšoanang tsa ho ata ha PG li bonoa lithutong ho pota lefatše (Cunningham-Williams le Cottler, 2001; Abbott et al., 2004). Leha ho le joalo, baahi ba bang (mohlala, bajaki ba boroa-bochabela ba Asia (Petry, 2003)) ba na le litheko tse phahameng haholo tsa papali ea chelete. Mabaka a hlakileng a liphumano tsena a hloka lipatlisiso tse eketsehileng. Linyehelo tsa tikoloho tse ka 'nang tsa fapana litsong tsohle le ho kenya letsoho ho PG li kanna tsa fapana le tse tlatsetsang ho OCD, empa ho hlokahala lipatlisiso tse ngata ho fuputsa maikutlo ana ka kotloloho.

E tšehelitsoe ke karolo ke: (1) National Institute on Drug Abuse (R01-DA019039); (2) Patlisiso ea Bophelo ba Basali ho Yale; le (3) Lefapha la Litaba tsa Veterans VISN1 MIRECC.and REAP.

Boitlhotlhollo ba Mohoeletsi: Ena ke faele ea PDF ea mongolo o ngotsoeng ka letsoho o sa amoheloang o amoheletsoeng bakeng sa ho hatisoa. Joaloka tšebeletso ho bareki ba rona re fana ka phetolelo ena ea pele ea mongolo o ngotsoeng ka letsoho. Mongolo o ngotsoeng ka letsoho o tla ba le ho kopitsa, ho kenya lihlopha le ho hlahloba bopaki bo hlahang pele o hatisoa ka mokhoa oa oona oa ho qetela. Ka kopo hlokomela hore nakong ea mekhoa ea tlhahiso ea lihlahisoa e ka fumanoa e ka amang litaba, le litsebiso tsohle tsa molao tse sebetsang koranteng e amanang le eona.

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