Boitšoaro bo qobelloang ba ho Kopanela Liphate le Bothata ba Tšebeliso ea Joala bo Phekotsoeng ka Naltrexone: Tlaleho ea Taba le Tlhahlobo ea Lingoliloeng (2022)



inahaneloang

Boitšoaro bo qobelloang ba thobalano (CSB) kapa bokhoba ba thobalano ke lentsoe leo ka kakaretso le supang boitšoaro bo feteletseng le bo sa laoleheng ba thobalano. Sena se ka lebisa khatellong ea maikutlo, mathata a sechaba le a mosebetsi, kapa litlamorao tsa molao le tsa lichelete. Hangata, boemo bona ha bo tlalehoe hantle ebile ha bo phekoloe. Ho fihlela joale ha ho na meriana e lumelletsoeng ke FDA bakeng sa bokhoba ba thobalano kapa boitšoaro bo qobelloang ba thobalano. Leha ho le joalo, melemo ea phekolo ea serotonin reuptake inhibitors (SSRIs) le naltrexone e tsejoa. Ena ke taba ea monna ea lilemo li 53 ea nang le nalane ea ho sebelisa joala haholo, ho ts'oaroa ha joala, le delirium tremens. Mokuli o ne a phekoloa ka naltrexone 50 mg / letsatsi bakeng sa bothata ba ho sebelisa joala. Mokuli o ile a tlaleha hore "tlamello ea ho kopanela liphate" ea hae e boetse e fokotsehile ka mor'a hore a sebelise meriana 'me ho bile le ntlafatso ho bobeli bokhoba ba tahi le boitšoaro bo hlephileng ba ho kopanela liphate. Tlaleho ena ea nyeoe e boetse e kenyelletsa tlhahlobo ea lingoliloeng tsa pharmacotherapy, haholo-holo naltrexone, bakeng sa phekolo ea bokhoba ba thobalano / boitšoaro bo qobelloang ba ho kopanela liphate. Tlhahlobo ea lingoliloeng e bontšitse hore matšoao a bakuli a ile a ntlafatsoa ka tekanyo e fapaneng ntle le litla-morao, 'me ho itšetlehile ka sena le phihlelo ea rona, ho ka boleloa hore naltrexone e sebetsa hantle ho fokotsa le ho fokotsa matšoao a CSB kapa ho lemalla thobalano.

Selelekela

Ho ipapisitsoe le bopaki ba bongaka le ba lefu la seoa, boits'oaro ba hypersexual le pherekano li hlalosoa e le takatso e feteletseng ea thobalano le ts'ebetso e nang le karolo ea ts'usumetso e tsamaeang le khatello ea maikutlo e kholo ea motho, le mathata a bophelo sechabeng le a bongaka. Sekhahla se hakantsoeng sa sekhahla sechabeng ka kakaretso ke 3-6%. Boitšoaro bo nang le mathata bo kenyelletsa ho pholla litho tsa botona kapa tsa botšehali ho tlōla, cybersex, litšoantšo tse manyala tse hlephisang boitšoaro, boitšoaro ba ho kopanela liphate le batho ba baholo ba lumeletsoeng, ho kopanela liphate ka thelefono, ho etela lihlopha tse hlobolang, le tse ling. [1,2]. Pejana, ka 1991, Coleman et al. e hlalositse boitšoaro bo qobelloang ba thobalano (CSB) e le bo amang mefuta e mengata ea matšoao a paraphilic le ao e seng a paraphilic. Paraphilic CSB e kenyelletsa boitšoaro bo sa tloaelehang ba thobalano moo ho nang le pherekano molemong oa ho ikhotsofatsa ka thobalano kapa polelo ea ho khotsofatsa takatso ea thobalano. Ka lehlakoreng le leng, CSB e seng paraphilic e kenyelletsa boitšoaro bo tloaelehileng ba thobalano bo fetohileng bo feteletseng kapa bo sa laoleheng [3]. Ka lebaka la liphello tse mpe haholo tsa boitšoaro bona bophelong ba botho, ba lelapa, le sechabeng; lisebelisoa tse nepahetseng tsa ho hlahloba, tlhahlobo le tlhahlobo hammoho le nts'etsopele ea mohlala o nepahetseng bakeng sa kalafo ea bokhoba ba thobalano kapa CSB e bohlokoa haholo.

The etiology ea ho lemalla thobalano ke lintho tse ngata 'me e ntse e sa tsejoe; Rosenberg et al. e khothalelitse ho eketsa maemo a dopamine e le sesosa se ka sehloohong sa boitšoaro bo qobelloang ba thobalano [4]. Mabaka a mang a ka bakang kapa a tlatsetsang a amanang le boitšoaro ba hypersexual a kenyelletsa liphetoho tsa epigenetic, dysregulated hypothalamo-pituitary-adrenal axis, tlhekefetso ea thobalano, kapa liphihlelo tse ling tse sithabetsang joalo ka tlhekefetso ea kelello. CSB e ka boela ea e-ba pontšo ea mathata a mang haholo-holo mafu a kelello le a kelello [5]. Lingaka lefapheng lena li khothaletsa mekhoa ea kalafo e nang le likarolo tse ngata ho kenyelletsa mefuta e fapaneng ea kalafo ea kelello le kalafo ea psychopharmacological. Mekhoa e mengata ea phekolo ea meriana (mohlala, naltrexone, selective serotonin reuptake inhibitors (SSRIs), citalopram, clomipramine, nefazodone, leuprolide acetate, valproic acid) e sebelisitsoe le ho tlalehoa litlalehong tse 'maloa. [6]. Naltrexone ke mohanyetsi oa opiate ea amohetsoeng qalong bakeng sa bothata ba tšebeliso ea opiate (ka 1960s) mme hamorao bakeng sa kalafo ea bothata ba tšebeliso ea joala (ka 1994) [7]. Haufinyane tjena, tšebeliso ea off-label ea naltrexone e bontšitsoe ho fokotsa matšoao a ho lemalla ho kopanela liphate, boitšoaro bo bobe ba thobalano, kapa CSB le bothata, joalokaha ho totobetse litlalehong tse 'maloa tsa linyeoe, letoto la linyeoe le liteko tse bulehileng. [8,9,10,11,12]. Tlaleho ena ea nyeoe e kenyelletsa tlhahlobo e qaqileng ea lingoliloeng e amanang le bokhoba ba thobalano kapa CSB le maano a kalafo. Bangoli ba boetse ba batlisisa karabelo ea kalafo kapa sephetho sa naltrexone mabapi le bokhoba ba thobalano kapa CSB ho latela bopaki bo fumanehang libukeng.

Tlhahiso ea pale

Re fana ka taba ea monna ea lilemo li 53 ea nang le nalane e ngata ea ho sebelisa joala, ho tsietsana, le delirium tremens, ea kileng a ba le khatello ea maikutlo ho kenyelletsa ho hlokahala ha ntate oa hae hoo e ka bang khoeling e fetileng, ho se sireletsehe mosebetsing le maemo a fokolang sechabeng. tšehetso, e hlahisoang ke khatello ea maikutlo le maikutlo a ho ipolaea maemong a botahoa. Mokuli o tlalehile ho noa "boima" letsatsi le leng le le leng ho kenyelletsa "ho bula mahlo" hoseng. Nakong ea tlhahlobo, mokuli o ne a ikakhela ka setotsoana ho noa joala ka tekanyo e phahameng ea Clinical Institute Withdrawal Assessment (CIWA) ea 16. Tekanyo ea hae ea joala ea mali e ne e le 330. Mokuli o ile a boela a tlaleha ho hlobaela, ho hloka takatso ea lijo, le ho tšoenyeha ho feteletseng empa a latola anhedonia ea hona joale, tahlehelo. matla, ho se tsepamise maikutlo hantle, le ho felloa ke tšepo. Mokuli o ile a hana maikutlo a hona joale a ho ipolaea/homicidal/intent/plan. Matšoao a psychosis le mania ha aa ka a tlalehoa kapa a bonoa. 

Mokuli o ne a e-na le histori ea ho kena sepetlele ka lebaka la ho tsuba ha joala le ketsahalo ea delirium tremons selemong se fetileng. Ho ne ho se na histori ea ho kena sepetlele pele ho mafu a kelello, teko ea meriana, le phekolo ea bakuli ba ka ntle. Mokuli o ile a tlaleha histori ea matšoao a tepeletseng a maikutlo a ho hlonama, matla a fokolang le ho tsepamisa mohopolo, le anhedonia. Mokuli o ile a boela a tlaleha histori ea matšoao a ho tšoenyeha a ho tšoenyeha ho feteletseng le mokhathala. O ile a hana tšebeliso ea lithethefatsi tse seng molaong.

Mokuli o ile a qalisoa ka antidepressant sertraline le naltrexone 50mg letsatsi le leng le le leng ho sebetsana le khatello ea maikutlo le bothata ba ho sebelisa joala. Ho makatsang ke hore mokuli o ile a tlaleha hore o bile le takatso e sa tloaelehang ea ho kopanela liphate ka lilemo tse ka bang peli tseo ho neng ho le thata ho li laola. CSB ea hae e ne e khetholloa ka tšebeliso e feteletseng ea litšoantšo tse manyala tse hlephisang boitšoaro le ho ipholla litho tsa botona kapa botšehali ka mokhoa o qobelloang ho fella ka ho senyeha ho itseng ha mosebetsi bophelong ba hae ba letsatsi le letsatsi le sechabeng. Ka mor'a khoeli ea ho qala naltrexone 50 mg letsatsi le leng le le leng, o ile a hlokomela hore o fokotsehile haholo ka ho sebelisa litšoantšo tsa bootsoa le ho ipholla litho tsa botona kapa botšehali ka ho qobella. Sena se ile sa boela sa ntlafatsa ts'ebetso ea hae ea letsatsi le letsatsi. Mokuli o ile a tsoela pele ho phekoloa 'me a tlaleha ntlafatso e tsitsitseng ea litakatso tsa thobalano kapa CSB.

Puisano

Mekhoa e hlophisitsoeng ea CSB e fumanoeng ha e e-s'o thehoe, haholo-holo ka lebaka la khaello ea lipatlisiso hammoho le pontšo e fapaneng ea boemo bona. Bakuli ba bang ba teng ba e-na le likarolo tsa kliniki tse tšoanang le lefu la ho lemalla, ba bang ba bontša likarolo tsa bothata ba ho laola maikutlo, 'me ba bang ba itšoara ka tsela e tšoanang le bothata ba ho qobella motho ho etsa lintho ka tsela e feteletseng. [7]. Ntle ho moo, CSB e hlahisa e le matšoao a mafu a mangata a kelello (mohlala, liketsahalo tsa manic, khatello ea maikutlo, bothata ba tšebeliso ea lithethefatsi, bothata ba botho ba moeli) le mathata a kelello (mohlala, lesion ea pele le ea nakoana, 'dementia'), 'me e amana le ho sebelisa meriana e itseng. (mohlala, L-dopa bakeng sa phekolo ea Parkinson) le lithethefatsi tse seng molaong tse kang methamphetamine. Hangata, CSB e amanang le maemo ana ha e phethe mekhoa ea ho qobella boitšoaro ba thobalano (CSBD) e hlalositsoeng ho ICD-11 bakeng sa lefu le ho kula (version 04/2019).

Litaelo tsa tlhahlobo ea ICD-11 bakeng sa CSBD [11,5].

"Bothata bo qobelloang ba boitšoaro ba ho kopanela liphate bo khetholloa ka mokhoa oa ho hlōleha ho laola takatso e matla, e pheta-phetoang ea ho kopanela liphate kapa litakatso tse bakang boitšoaro ba ho kopanela liphate bo pheta-phetoang. Matšoao a ka 'na a kenyelletsa ho pheta-pheta liketso tsa thobalano ho fetoha sepheo sa mantlha sa bophelo ba motho ho isa bohōleng ba ho hlokomoloha bophelo bo botle le tlhokomelo ea botho kapa lithahasello tse ling, mesebetsi le boikarabelo; boiteko bo bongata bo sa atleheng ba ho fokotsa haholo boitšoaro ba thobalano bo pheta-phetoang, le ho tsoela pele ho pheta-pheta boitšoaro ba thobalano ho sa tsotellehe liphello tse mpe kapa ho fumana khotsofalo e fokolang kapa ho se khotsofale ho eona. Mokhoa oa ho hloleha ho laola maikutlo a matla, a ho kopanela liphate kapa litakatso le ho pheta-pheta boitšoaro ba ho kopanela liphate ho bonahala ka nako e telele (mohlala, likhoeli tsa 6 kapa ho feta), 'me ho baka khatello e matla kapa ho senyeha ho hoholo ho motho ka mong, lelapa, sechaba, thuto, mosebetsi, kapa dibaka tse ding tsa bohlokwa tsa tshebetso. Matšoenyeho a amanang ka ho felletseng le likahlolo tsa boitšoaro le ho se amoheloe mabapi le litakatso tsa botona le botšehali, litakatso, kapa boitšoaro ha lia lekana ho finyella tlhokahalo ena”

Hape, haeba CSB e le letšoao la mathata a joalo, tlhahlobo ea CSBD ha ea lokela ho nkoa [5]. Ho feta moo, ho khetholla CSBD ke phephetso ka lebaka la tlhaho ea eona e hlokolosi le ea botho. Ntle le haeba mokuli a fana ka phekolo ea boemo bona, ba leqe ho bua ka bona [13]. Tabeng ena e hlahang, CSB e ne e amana le bothata ba ho sebelisa joala (AUD) mme ha ea ka ea phethahatsa litekanyetso tsa CSBD.

Ho bile le liphuputso tse ntseng li hola ka bopaki ba lintho tse tlatsetsang ho baeloji, kelello, le maemo a bophelo boemong bona. Neurobiology ea likarabelo tse monate tse tsoang mekhoeng e fapaneng ea boitšoaro, liphihlelo, kapa lintho tsa maiketsetso li hlalosoa ke litsebi tse ngata tse amang haholo ts'ebetso ea litsela tsa dopaminergic ka ho susumetsa li-opiate receptors. Khothatso ea tlhaho kapa ea maiketsetso ea li-opiate receptors e eketsa maemo a dopamine ka ho fokotsa ho thibela litsela tsa dopamine, tse bakang maikutlo a monyaka. [14]. Ts'ebetso e tsoelang pele ea litsela tsa dopamine e lebisa ho theoleheng ha mohopolo oa dopamine ho fella ka takatso e bonoang mathateng a bokhoba. [7]. Maemo a sa tloaelehang a dopamine a hlahisitsoe e le sesosa kapa sesosa se tlatsetsang boitšoarong bo feteletseng ba thobalano [4]. Dopamine e bapala karolo ea bohlokoa ho neurobiology, tse ling tsa mesebetsi ea dopamine e kenyelletsa ho sisinyeha, mohopolo, monyaka, boitšoaro, kelello, maikutlo, boroko, ho tsosoa ke thobalano le taolo ea prolactin. [7]. Hape, liphuputso tse ling li khothalelitse tšebelisano lipakeng tsa matlafatso e mpe (phokotso ea matšoenyeho) le matlafatso e ntle (ho khotsofala ka ho hlasimoloha le orgasm), e ka amanang le ho se leka-lekane ho li-neurotransmitters tse fapaneng tse kang dopaminergic le serotonergic system. [5].

Jokinen et al 2017 o bontšitse hore liphetoho tsa epigenetic sebakeng sa liphatsa tsa lefutso tsa corticotropin-releasing hormone li ne li amana le boitšoaro ba hypersexual. [15]. Boithuto bo fapaneng bo bonts'itse hore hypothalamo-pituitary-adrenal axis e ne e se na taolo ho banna ba nang le bothata ba hypersexual. Bothata bona bo ka tsamaisana le tlhekefetso ea thobalano kapa liphihlelo tse sithabetsang joalo ka tlhekefetso ea kelello [5]. Li-Psychological correlates ho CSB ke mathata a ho khomarela 'me li ka amahanngoa le liphihlelo tse sithabetsang [16]. Ho batho ba bang, thobalano e sebelisoa e le leano la ho iphekola le ho sebetsana ka katleho le maikutlo a nyahamisang joalo ka khatello ea maikutlo. [17]. Maikutlo a fosahetseng mabapi le thobalano le tšebeliso ea litšoantšo tsa bootsoa li amana le maemo a sechaba. Mecha ea phatlalatso ea dijithale le ho fumaneha ho amanang le litšoantšo tsa bootsoa, ​​hammoho le lintlha tse kang bolumeli le boitšoaro bo sa lumellaneng le tšebeliso ea litšoantšo tse manyala tse hlephisang boitšoaro le tsona li susumetsa ntshetsopele ea CSBD boemong ba sechaba. [5].

Lisebelisoa tsa ho hlahloba kapa litekanyo ho khetholla motho ea kotsing ea ho ba le CSB li ile tsa ntlafatsoa ke Patrick Carles ka 1991. Tlhahlobo ena ea Tlhahlobo ea ho Lemalla ho Kopanela Liphate ke lethathamo la lintlha tse 25, tse itlhalosang. Liteko tsa tlhahlobo li ka supa boitšoaro bo kotsing bo hlokang tlhahlobo e eketsehileng ea bongaka [18]. Hamorao, Kafka o ile a etsa tlhahiso ea tlhahlobo ea boitšoaro (ke hore Total Sexual Outlet) moo li-orgasm tse supileng tsa thobalano ka beke ho sa tsotellehe hore na li finyelloa joang, li ka ba kotsing ea ho ba le CSB 'me li hloka tlhahlobo e eketsehileng ea bongaka. [13]. Ho entsoe lintlafatso tse 'maloa mabapi le ho metha sesebelisoa sa CSB le CSBD. Litekanyo tse entsoeng ka ho fetesisa tsa boits'oaro ba mathata a hypersexual ke Hypersexual Screening Inventory, Hypersexual Behavior Inventory (HBI-19), Sekala sa Boitlamo ba ho Kopanela Liphate, Teko ea Tlhahlobo ea ho Lemalla ho Kopanela Liphate, Teko ea Tlhahlobo ea ho Lemalla ho Kopanela Liphate, le Boitšoaro bo Kopanetsoeng ba ho Kopanela Liphate. Inventory. E 'ngoe ea litekanyo tsa boithati e kopantsoe le tekanyo ea ka ntle ea litekanyetso tsa ICD-11 bakeng sa tlhahlobo e feletseng. [5,19,20,21]

Mokuli e mong le e mong ea nang le CSB o lokela ho ba le mokhoa oa motho ka mong le oa mekhoa e mengata ea phekolo e kenyelletsang psychotherapy e khethehileng hammoho le pharmacotherapy. [5]. Phekolo ea kelello ea motho ka mong ea fapana empa mekhoa e atileng haholo ke "cognitive behavioral therapy" (CBT) le psychodynamic psychotherapy. CBT ho li-CSB e tsepamisitse maikutlo ho khetholleng lintho tse susumetsang le ho hlophisa bocha ho sotha maikutlo a boitšoaro ba thobalano le ho totobatsa thibelo ea ho khutlela mokhoeng. Psychodynamic psychotherapy ho CSB e hlahloba likhohlano tsa mantlha tse tsamaisang boitšoaro bo sa sebetseng ba thobalano. Kalafo ea malapa le phekolo ea banyalani le tsona lia thusa [13]. Mekhoa ea phekolo bakeng sa CSBD e ka thehoa ho mefuta e fapaneng e kang Dual-Control Model, le Sexual Tipping Point Model. Mehlala ena e kopaneng ea CSBD e ikemiselitse ho tlisa tekano e feto-fetohang lipakeng tsa thibelo ea thobalano le thabo. Ho leka-lekana hona ho ka finyelloa ka ho ntlafatsa boitšoaro ba ho kopanela liphate. Psychotherapy bakeng sa CSBD e kenyelletsa CBT le kalafo ea kamohelo le boitlamo (ACT), mme pharmacotherapy e kenyelletsa SSRIs joalo ka escitalopram le paroxetine, naltrexone, le li-agent tse theolang testosterone. [5]

Ho itšetlehile ka lingoliloeng tse hatisitsoeng mabapi le tšebeliso ea naltrexone (off-label) bakeng sa phekolo ea CSB, CSBD, le ho lemalla ho kopanela liphate ho bakoang ke phekolo ea phetoho ea dopamine, taolo e feletseng ea litakatso tsa thobalano e finyelloa ka tekanyo ea tekanyo ea 100-150mg / letsatsi. Naltrexone e sebelisoa ka mor'a ho theha liteko tse tloaelehileng tsa sebete le liphio. Grant le ba bang. (2001) e hatisitse tlaleho ea nyeoe ea monna ea lilemo li 58 ea nang le kleptomania le CSB ea ileng a hlōleha ho arabela ho fluoxetine, phekolo ea boitšoaro, le psychotherapy, 'me a fumana tšoarelo ka tekanyo e phahameng ea naltrexone (150mg / letsatsi). Ho khaotsa le ho khutlisa ho tšehetsa sephetho sa bona [10]. Raymond et al. (2002) e tlalehile letoto la linyeoe tse peli, mosali ea lilemo li 42 ea nang le bothata bo boholo ba ho tepella maikutlo le CSB, matšoao a ho tšoenyeha, le ho tepella maikutlong li ile tsa ntlafatsoa ke fluoxetine 60mg / letsatsi empa ha lia ka tsa fokotsa matšoao a CSB. Naltrexone 50mg/letsatsi e ile ea fokotsa matšoao a CSB qalong mme o ile a phomotse takatsong ea thobalano mme a khothalletsoa ho sebelisa cocaine ka naltrexone 100mg/letsatsi. Tabeng ea bobeli, monna ea lilemo li 62 ea nang le histori ea lilemo tsa 20 ea CSB ea nakoana le liteko tse hlōlehileng tsa fluoxetine, citalopram, bupropion, le buspirone o ile a phekoloa ka katleho ka naltrexone 100mg / letsatsi. [8]. Rayback le ba bang. (2004) o ithutile katleho ea naltrexone ho batlōli ba thobalano ba bacha. Boholo ba barupeluoa ba tlalehile ho fokotseha ha ho tsoheloa, ho ipholla litho tsa botona kapa botšehali ho li khotsofatsa, mehopolo ea ho kopanela liphate, le taolo e eketsehileng ea litakatso tsa thobalano pakeng tsa litekanyetso tsa 100-200 mg / kg. [22]. Bostwick et al. (2008) o tlalehile nyeoe ea monna ea lilemo li 24 ea ileng a hlahisa temallo ea thobalano ea inthanete mme a ba le taolo e felletseng holim'a maikutlo a hae ha lethal dose la naltrexone le ne le lebisitsoe ho 150mg / letsatsi. Hamorao, mokuli o ile a theola tekanyo butle-butle 'me a tsitsitse ho naltrexone 50mg / letsatsi. O ne a le ho SSRI mme o ne a boetse a lekile psychotherapy ea sehlopha le motho ka mong, Makhoba a Thobalano a sa Tsejoeng, le tlhabollo ea boruti ntle le ntlafatso. [12]. Camacho et al. (2018) e tlalehile nyeoe ea monna ea lilemo li 27 ea nang le "tšusumetso ea thobalano" e ikemetseng e sa kang ea ntlafala ha a ntse a le fluoxetine 40mg / letsatsi le aripiprazole 10mg / letsatsi, ea tlalehileng ntlafatso e kholo ho naltrexone 50-100mg / letsatsi. [23]

Verholleman et al. (2020) e hlahisitse nyeoe tlhahlobisong e hlophisitsoeng ea kalafo ea naltrexone bakeng sa hypersexuality e bakiloeng ke dopamine replacement therapy. Monna ea lilemo li 65 oa Caucasia o ne a lemaletse ho kopanela liphate ha a ntse a le kalafo ea lefu la Perkinson. Sena se ile sa phekoloa ka katleho ka naltrexone 50mg / letsatsi [18]. Savard le ba bang. (2020) e phatlalalitse phuputso e lebelletsoeng ho ba sefofane ho bakuli ba banna ba 20 (lilemo tse bolelang = 38.8) ba nang le tlhahlobo ea CSBD e tšoaroang ka naltrexone 50mg / letsatsi bakeng sa libeke tse 'ne. Sephetho sa bona se fana ka maikutlo a hore naltrexone ea khoneha, ea mamelloa, 'me e ka fokotsa matšoao a CSBD. Boithuto bona bo fana ka leseli le lecha mabapi le ho kenella ha pharmacological ho CSBD [24].

Nahanisisa

Ho latela nyeoe e tlalehong ena, ho ka bonoa hore naltrexone e sebetsa hantle bakeng sa bokhoba ba thobalano le CSD ka litekanyetso tse fapaneng. Leha ho le joalo, ke habohlokoa ho theha katleho le mamello ka liteko tse laoloang ka mokhoa o sa reroang hobane boitšoaro bona ha bo tloaelehe ebile bo na le liphello tsa kelello le tsa bongaka. 


References

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