Ukuxhatshazwa kwezesondo ze-Intanethi Kuthathwa ngeNaltrexone (2008)

Amazwana: I-Naltrexone ngumchasi we-opioid receptor osetyenziswa ngokuyinhloko ekulawuleni ukuxhomekeka kotywala kunye nokuxhomekeka kwe-opioid. Eli nqaku lineengcaciso ezibalaseleyo zenkqubo yokukhobokisa kunye nokuziphatha.

nguMichael Bostwick, MD kunye noJeffrey A. Bucci, MD

i-doi: 10.4065 / 83.2.226

IMayo Clinic Proceedings, ngoFebruwari 2008 vol. 83 no. 2 226-230

Jonga kwi-intanethi

I-Article ecacileyo

  1. INGXELO YEtyala
  2. UKUQALA
  3. ISIPHELO

Ukungasebenzi kakuhle kweziko lembuyekezo yengqondo kuya kuqondwa ngakumbi njengesiseko sayo yonke indlela yokuziphatha ekhobokisayo. Idityaniswe yi-mesolimbic inkuthazo yesekethe yokujikeleza, iziko lomvuzo lilawula zonke iindlela zokuziphatha apho inkuthazo inendima ephambili, kubandakanya nokufumana ukutya, ukukhulisa ulutsha, kunye nokuba nesondo. Ukonakalisa ukusebenza okuqhelekileyo, imisebenzi esisiseko yokusinda inokubaluleka ngokubaluleka xa icelwa umngeni ngumtsalane wezinto ezikhobokisayo okanye indlela yokuziphatha. I-Dopamine yi-neurotransmitter eqhuba zombini ukuziphatha okuqhelekileyo kunye nokulutha. Ezinye ii-neurotransmitters zimodareyitha isixa se-dopamine ekhutshiweyo ekuphenduleni isivuseleli, kunye nokuqina okugqitywe bubunzulu be-dopamine pulse. Ii-opiates (nokuba zi-endogenous okanye zangaphandle) zibonisa ezo modyuli. Imiselwe ukunyanga utywala, i-naltrexone ivimba amandla e-opiates ukunyusa ukukhutshwa kwe-dopamine. Eli nqaku liphonononga indlela yokusebenza ye-naltrexone kwiziko lomvuzo kwaye ichaza ukusetyenziswa kwenoveli ye-naltrexone ekucinezeleni umlutha onyanzelekileyo kunye nowonakalisa umntu kwiphonografi ye-Intanethi.

GABA (γ-aminobutyric acid), ISC (i-incentive salience circuitry), MAB (indlela yokuziphatha ekhuthazayo), MRE (isiganeko esichaphazelekayo ngenkuthazo), NAc (nucleus accumbens), PFC (i-correx), VTA (indawo yezentlalo)

Abstract

Ude wonganyelwe likhoboka, iziko lomvuzo le-mesolimbic lisebenza ngokuguquguqukayo ukukhuthaza indlela yokuziphatha enceda abantu kunye neentlobo zabo. Ukusuka nzulu ngaphakathi kwi-brainstem, ilungelelanisa inkuthazo ephambili yokufuna iimfuno zokuphila ezinje ngokutya, ukondla ulutsha, kunye nokunxibelelana ngokwesondo.1 Njengoko umlutha ukhula, eminye imbuyekezo engenanzuzo ishicilelwa kwi-incentive salience circuitry (ISC) ukonakalisa ukuziphatha okubalulekileyo ekusindeni. Ngokwandayo, oogqirha badibana nezigulana ezinomdla wokuziphatha okukhobokisayo.

Njengoko i-neuroscience iqhubeka icacisa i-neural underpinnings yomlutha, kuya kucaca ngakumbi ukuba iziko lokuvuza elingasebenzi kakuhle liqhelekile kuzo zonke iindlela zokuziphatha ezinyanzelekileyo, nokuba ukusetyenziswa kakubi kweziyobisi, ukutya kakhulu, ukungcakaza, okanye ukwenza ngokwesondo ngokugqithisileyo.2, 3 Nangona ukuziphatha okunyanzelekileyo kwezesondo kuye kwafundwa kancinci,4 Iyavakala into yokuba ii-pharmacotherapies ezisebenza ngokuchasene nohlobo oluthile lokuziphatha okukhobokisayo ziyakulwa nezinye iintlobo. Ukuziphatha ngakunye kunezisusa ezithile kunye nokubonakaliswa, kodwa indlela yokugqibela eqhelekileyo kubo bonke ibandakanya ukumodareyithwa kwe-neurochemical yomsebenzi we-dopaminergic ngokusebenzisa i-receptors kwindawo ye-ventral tegmental (VTA).3, 5

I-VTA ke ngoko ibe yinto ekujoliswe kuyo kwi-pharmacotherapies entsha yokulutha, kunye ne-naltrexone, i-opiate receptor blocker ngoku evunyiweyo yi-Food and Drug Administration kuphela kunyango lotywala, ngumzekelo wechiza elinokuba luncedo ekulweni neendlela ezininzi zokuziphatha eziluthayo.6 Ngokuthintela umthamo we-opioids engapheliyo ukubangela ukukhutshwa kwe-dopamine ekuphenduleni umvuzo, i-naltrexone inceda ukucima loo mandla omlutha womvuzo. Sibonisa imeko ye-naltrexone emiselweyo ukunciphisa ukusetyenziswa okunyanzelekileyo kwe-Intanethi ukwanelisa ngokwesondo. Iiyure ezichithwe sisigulana silandela i-cyber-stimulation zehla, kwaye ukusebenza kwakhe ngokwasengqondweni kwaphucuka kakhulu ngokusetyenziswa kwe-naltrexone.

INGXELO YEtyala

IBhodi yokuHlola yeziko leKliniki yaseMayo ikuvumile ukuxelwa kweli tyala.

Isigulana esiyindoda saqala saboniswa kugqirha wengqondo (JMB) sineminyaka engama-24 ubudala, ngengcaciso, “Ndilapha ngenxa yokuba likhoboka lezesondo. Ibuchithe ubomi bam bonke.” Wayesoyika ukuphulukana nomtshato kunye nomsebenzi ukuba wayengenakukwazi ukuzibamba ngokuxakeka kwakhe kwi-Intanethi. Wayechitha iiyure ezininzi suku ngalunye encokola kwi-intanethi, ezibandakanya kwiiseshini ezandisiweyo zokuphulula amalungu esini, kwaye ngamanye amaxesha edibana nabantu abafowunelwa kwi-cyber eyedwa ngenxa yesondo elizenzekelayo, elingakhuselekanga.

Kwiminyaka eyi-7 elandelayo, isigulane sehla ngokuphindaphindiweyo ngaphakathi nangaphandle kwonyango. Wazama i-antidepressants, iqela kunye ne-psychotherapy yomntu, i-Sexual Addicts engaziwa, kunye nokucebisa ngomfundisi, kodwa kwada kwalulingo lwe-naltrexone wagcina impumelelo ekunqandeni ukusetyenziswa kwe-Intanethi ngokunyanzelekileyo. Xa wayeka i-naltrexone, iminqweno yakhe yabuya. Xa waphinda wathatha i-naltrexone, zancipha.

Ukususela kwiminyaka eyi-10, emva kokufumanisa i-cache katatomkhulu wakhe "amaphephancwadi angcolileyo," umguli wayenomdla omkhulu wokubukela iphonografi. Xa wayesele ekwishumi elivisayo, wabelana ngesondo ngefowuni esebenzisa amakhadi okuthenga ngetyala kunye nothotho lweemfonomfono ezingama-900. Ezichaza njengomntu ophololoza amalungu esini, wayekwaxhasa iinkolelo zamaKristu. Ekhathazwa yihambo yakhe yokuziphatha, wathi izenzo zakhe zesini zaphuma—ubuncinane ngokuyinxenye—“kwiimpembelelo ezimbi ezivela kumtyholi.” Emva kwesikolo samabanga aphakamileyo, wathatha umsebenzi wokuthengisa intengiso oquka ukuhamba ubusuku bonke. Kokubini emsebenzini nakwiihambo, akazange asebenzise ikhompyutha yakhe kwimisebenzi enxulumene nezoshishino kuphela kodwa nakwi-intanethi "i-cruising" (oko kukuthi, ukukhangela umsebenzi wokwanelisa ngokwesondo). Uhambo lweshishini luya kubandakanya iiyure zokuphulula amalungu esini kwi-intanethi kunye neminqweno eyothusayo yokutyelela iiklabhu zestrip. Ngokufikelela kwi-Intanethi iiyure ezingama-24 eofisini yakhe, wayehlala esebenza ubusuku bonke kwi-intanethi. Ngokukhawuleza wahlakulela ukunyamezela, ukuyeka iseshoni kuphela xa enyanzeliswa kukudinwa. Ngokuphathelele ukukhotyokiswa kwakhe ngokwesini, wathi, “Yayingumhadi wesihogo. Andizange ndaneliseke, kodwa ndaya apho.”

Ukuqiqa ukuba isigulane sinokuthi sihlupheke ngenxa ye-obsessive-compulsive disorder variant, ugqirha wakhe wengqondo wamisela i-sertraline kwi-dose yomlomo ye-100 mg / d. Ngelixa umoya wesigulana kunye nokuzithemba kuye kwaphucuka kunye nokucaphuka kwehlile, ukwehla kweminqweno yesini akuzange kuzinze. Wayeka ukuthatha i-sertraline kwaye wayeka ubudlelwane bakhe nogqirha wengqondo unyaka.

Xa isigulana ekugqibeleni sabuyela kunyango, wayechitha ukuya kwiiyure ze-8 ngosuku kwi-intanethi, ephulula amaphambili de ukucaphuka kwezicubu okanye ukudinwa kuphele iiseshoni. Wayenabo “unxibelelwano” oluliqela nonxibelelwano lwe-Intanethi oluquka ukwabelana ngesondo okungakhuselekanga kwaye wayengasathandani nenkosikazi yakhe kuba esoyika ukosulela kuye isifo se-venereal. Wayephulukene nemisebenzi emininzi ngenxa yokungabi namveliso ngenxa yexesha awayelichithe elandela izinyanzelo zakhe ngenxa yomsebenzi. Wachaza ulonwabo olugqithisileyo kwisondo ngokwalo kodwa ngokulinganayo ukuzisola ngokungakwazi kwakhe ukuzibamba. Xa unyango lwe-sertraline lwabuyiselwa, isimo sakhe sengqondo saphucuka, kodwa wayeziva "engenamandla okuxhathisa iminqweno" kwaye wayeka kwakhona unyango.

Xa isigulana siphinde savela emva kwesinye isithuba seminyaka emi-2, uxinzelelo olungakumbi lomtshato, kunye nomnye umsebenzi olahlekileyo, ugqirha wengqondo ucebise ukongeza i-naltrexone kunyango lwe-sertraline. (I-sertraline ngoku yayibonakala iyimfuneko kwingxaki eqhubekayo yokudakumba.) Kwiveki yonyango kunye ne-50 mg / d yomlomo we-naltrexone, isigulane sachaza "umahluko onokulinganiswa kwiminqweno yesini. Bendinga chukunyiswa ngalo lonke ixesha. Kwakufana neparadesi.” Uluvo lwakhe "lokonwaba kakhulu" ngexesha leeseshini ze-Intanethi zehla kakhulu, kwaye wafumanisa amandla okuxhathisa kunokuba azithobe kwiimpembelelo. Hayi de idosi ye-naltrexone yafikelela kwi-150 mg/d akazange achaze ulawulo olupheleleyo kwiimpembelelo zakhe. Xa ezama eyedwa ukucofa ichiza, waziva liphulukene nokusebenza kwalo ngo-25/d. Wangena kwi-intanethi ukuze azivavanye, wadibana nomntu onokudibana naye ngesondo, kwaye wafika emotweni yakhe ngaphambi kokuba acinge ngcono ngokudibana nomntu. Ngeli xesha, ukubuyela kwi-50 mg ye-naltrexone kwakwanele ukukhupha iminqweno yakhe yesini.

Kwiminyaka engaphezulu kwe-3 efumene i-sertraline kunye ne-naltrexone, sele esondele ekuxolweni ngokupheleleyo kwiimpawu ezicinezelayo kunye nokusetyenziswa okunyanzelekileyo kwe-Intanethi, njengoko yena ngokwakhe ephawulile: "Ngamanye amaxesha ndiyatyibilika, kodwa andiyithwali kude, kwaye Andifuni kudibana nabani na.” Njengenzuzo eyongezelelekileyo, uye wafumanisa ukuba ukuzinkcinkca ngotywala akusenamtsalane. Akanatywala kwiminyaka emi-3 kwaye uye wavuma ukuba “akanakusela engaselanga kakhulu.” Usatshatile, nangona engonwabanga ngolo hlobo. Ugcine umsebenzi ofanayo osekelwe kwi-teknoloji iminyaka engaphezu kwe-2 kwaye uyaziqhenya ngempumelelo yakhe yengqesho.

UKUQALA

Ngenjongo yale ngxoxo, umlutha uchazwa njengokuziphatha okunyanzelekileyo okuqhubeka ngaphandle kweziphumo ezibi kakhulu zomntu, intlalontle, okanye umsebenzi.7 Ezo zenzo ziquka ukusebenzisa kakubi iziyobisi, ukutya ngokugqithiseleyo, ukutya ngendlela engqongqo, ukuzenzakalisa nokungcakaza ngokugqithiseleyo.6 Zikwanokuba zizinyanzelo ngokwesondo ngokuthe ngqo, kubandakanya imisebenzi okanye iingcinga esizithathela ingqalelo le meko yokusetyenziswa ngokugqithisileyo kwe-Intanethi ukumela.8 Lo mbono wokulutha uyangqinelana nendlela yokuziphatha yokuphazamiseka kwengqondo, ecinga ukuba lonke uxilongo lokuxilonga "ziingxaki eziqhutywa kukunyanzelwa" kunye nokuziphatha okunyanzelekileyo kumbindi wabo.3, 6 Ukuqonda okongeziweyo kwesiseko se-neural sokukhobokisa siqinisekisa lo mbono. UHyman5 ibiza umlutha "kukuhluthwa kwe-pathological yeendlela zokufunda kunye nememori eziphantsi kweemeko eziqhelekileyo zisebenza ukubumba indlela yokusinda enxulumene nokusukela imbuyekezo kunye nezinto ezizixela kwangaphambili." Yile sekethe ye-neural ye-motitive adaptive behaviour (MAB)-injongo-ndlela yokuziphatha ejoliswe ekufezekiseni iinjongo eziyimfuneko yebhayoloji-ukuba umlutha uyathobisa.

Kwimizobo eyahluka-hlukeneyo ukusuka kwimifanekiso eshukumayo yemveli ukuya kwiividiyo kunye namagumbi okuncokola, i-Intanethi ngumthombo okhulayo wokuxhamla ngokwesondo kunye nokuvuselela abantu abaninzi ababizwa ngokuba ngabantu abaqhelekileyo, ukuqwalaselwa kokuziphatha-okanye inkcazo-yephonografi ngaphandle. Kunini apho ukusetyenziswa ngokuqhelekileyo kwento ethile okanye ukwenza okuthile ngenjongo yokwanelisa umntu iba sisinyanzelo? Ngokuzixakekisa kwakhe kunye nokusetyenziswa ngokugqithisileyo kunye neziphumo ezibi kakhulu phakathi kwabantu kunye neziphumo zomsebenzi azigcinayo, isigulane esichazwe kule ngxelo yengxelo ngumzekelo we-crossover kwindawo yokulutha.

I-MAB inamacandelo ama-2 alandelelanayo.9 Eyokuqala sisivuseleli esisebenzayo esikhuthazwa yimibutho efundiweyo kwi-trigger yangaphandle. Oko kukhuthazwa kuvelisa okwesibini: impendulo yokuziphatha ejoliswe kwinjongo-yintoni iStahl10 Ibiza "ukuphakama kwendalo." Ii-MAB ezisisiseko ziquka iinzame zethuku lokufumana ukutya, amanzi, ukudibana ngokwesondo, kunye nekhusi. Ii-MAB ezintsonkothileyo ezinokwaleka ngokwasengqondweni ziquka ukufuna ubuqabane bokukhulisa, iwonga lentlalontle, okanye impumelelo emsebenzini.

I-neural network mediating expression ye-MAB (iziko lokuvuza) ikwabizwa ngokuba yi-ISC, kuba ixabiso elabelwe isivuseleli (ukuqina kwayo) limisela inkuthazo (ubunzulu bempendulo yokuziphatha eyenziwa yi-stimulus).5, 11 Amacandelo e-incentive salience circuitry abandakanya i-VTA, i-nucleus accumbens (NAc), i-prefrontal cortex (PFC), kunye ne-amygdala, nganye inendima yayo ekubumbeni i-MAB (inani). Okuqhelekileyo kumsebenzi we-ISC kuzo zombini iindlela zokuziphatha zendalo kunye nokulutha kukukhutshwa kwe-dopamine kwi-NAc-ebizwa ngokuba yi-priming-ekuphenduleni iimpembelelo ezivela kwi-VTA.3, 5 Uqikelelo lwe-dopaminergic ukusuka kwi-VTA ukuya kwi-NAc zizinto eziphambili ze-ISC ezinxibelelana noqikelelo lwe-glutamatergic phakathi kwawo onke amacandelo e-ISC. I-amygdala kunye ne-PFC zibonelela ngegalelo lokumodareyitha.5 I-amygdala inika i-valence enobungozi okanye eyonwabileyo-ithoni echaphazelekayo-kwi-stimulus, kwaye i-PFC inquma ukuqina kunye nokulinganisela kokuphendula kokuziphatha.9, 12 Le sekethe yomvuzo wolonwabo zombini ilumkisa into ephilayo xa inoveli isivuseleli esinamandla sivela kwaye ikhumbula imibutho efundiweyo xa ingasekho inoveli kodwa iphinda iphinde ivuseleleke.5, 9, 12

Umzobo wokulutha

 

 

Kumfanekiso onqamlezayo wengqondo, i-incentive salience circuitry (ISC) iqulethe indawo ye-ventral tegmental (VTA) ejoliswe kwi-nucleus accumbens (NAc). I-NAc ifumana igalelo lokumodareyitha kwi-prefrontal cortex (PFC), i-amygdala (A), kunye ne-hippocampus (HC). Ibhokisi A ibonisa iphonografi ye-Intanethi ebangela ukukhutshwa kwe-opioids engapheliyo eyenza i-dopamine (DA) ikhululwe kwi-ISC ngokuthe ngqo nangokungathanga ngqo.2 I-opiates yonyusa isenzo se-DA ngokuthe ngqo nge-guanine nucleotide-i-protein-coupled opioid receptors kwi-NAc. Basebenza ngokungathanga ngqo kwi-interneurons ngokuzibophelela kwi-opioid receptors eziphazamisa ukukhululwa kwe-×-aminobutyric acid (GABA). Ayisacinezelwa yi-GABA, i-VTA ithumela i-NAc ukuthululwa kwe-DA. Iphonografi iyanda. Ibhokisi B ibonisa indlela i-naltrexone evimba ngayo zombini i-NAc kunye ne-interneuron opioid receptors. Inkuthazo ye-DA ayisaphuculwa, ngokuthe ngqo okanye ngokungathanga ngqo, okukhokelela ekwehleni koburhelem bamanyala. (Ithatyathwe ngemvume evela kwi-Macmillan Publishers Ltd: I-Nature Neuroscience, 2 copyright 2005.)

I-ISC ayisebenzi yodwa. Uphando olubanzi lwezilwanyana lubonisa i-pharmacopoeia ye-neurochemicals evela kwi-cortex kunye nemimandla engaphantsi kwe-subcortical eyenza i-activation ye-ISC, kuquka i-opiodergic engapheliyo, i-nicotinic, i-cannabinoid, kunye nezinye iikhompawundi.11, 13 Iindlela ze-Opiodergic ze-ISC ziquka i-receptors kwi-NAc ngokwayo ephazamisana ngokuthe ngqo nokukhululwa kwe-dopamine.2 kunye ne-μ-opiate receptors kwii-interneurons ezisasaza okanye ezikhupha i-γ-aminobutyric acid (GABA) kwaye ngokwesiko inqanda ukukhutshwa kwe-dopamine kwi-VTA dopaminergic neurons.1, 5, 7, 14 Xa i-opiates engapheliyo (endorphins) okanye i-opiates exogenous (i-morphine kunye ne-derivatives yayo) ibophelela kula ma-receptors, ukukhululwa kwe-GABA kuncipha. Ii-opiates zithintela i-interneuron ekwenzeni umsebenzi wazo wesiqhelo wokucinezela, kwaye amanqanaba e-dopamine ayanda kwi-VTA.3

 

Zonke izinto ezikhobokisayo ngokwasemzimbeni zibonakala zikhokelela kumsebenzi ongalunganga we-ISC. Ngokwesiqhelo kwinqanaba leselula, isiganeko esikhuthazayo (MRE), esifana nendlala okanye ukuvuswa ngokwesondo, kubangela ukukhutshwa kwe-opiate endogenous ebangela ukuba amanqanaba e-dopamine anyuke. I-ISC iphendula nge-MAB kunye neenguqu zeselula ekugqibeleni ezifakela imibutho efundiweyo yexesha elide kunye nesiganeko. Olu tshintsho lwe-neuroplastic lubangela impendulo ekhawulezayo yokuziphatha xa isiganeko siphinda siphinda, kwaye ngokuqhelekileyo, ukubonakaliswa okuphindaphindiweyo kwe-MRE kuyanciphisa kwaye ekugqibeleni kucime ukukhutshwa kwe-VTA dopamine. Ukukhutshwa kwe-Dopamine akusafuneki ukuba i-organism yenze ii-MAB ezifanelekileyo ukuze uphile.

Iziyobisi ezikhobokisayo okanye imisebenzi ichaphazela i-ISC ngokwahlukileyo kwii-MREs ekubeni ukubonakaliswa okuphindaphindiweyo akucimi ukukhutshwa kwe-dopamine.9 Ngapha koko, amachiza anokoyisa ukuvuselela kwendalo ngokubangela ukukhutshwa kwe-dopamine ngakumbi ixesha elide.5, 9 Iziphumo zomjikelo okhohlakeleyo wokulutha umlutha, kunye nokukhutshwa kwe-dopamine okuqhubekayo okuchaza ukubaluleka ngakumbi nangakumbi ekufuneni iziyobisi kunye nokubaluleka okuncinci kokuziphatha okusisiseko ekusebenzeni okuqhelekileyo kunye nokusinda.3, 5, 12, 15

Amandla okunika ixabiso elifanelekileyo kwichiza kunye nokukwazi ukuxhathisa umnxeba walo we-siren-yomibini imisebenzi ye-lobe yangaphambili-iphazamisekile kwikhoboka leziyobisi.12 UHyman ubhala athi: “Ukufuna iziyobisi kuba namandla kangangokuba kunokushukumisela abazali ukuba babatyeshele abantwana, abantu ababethobela umthetho ngaphambili ukuba benze izenzo zolwaphulo-mthetho, nabantu abanezigulo ezibuhlungu ezibangelwa butywala okanye icuba ukuba baqhubeke besela yaye betshaya.”5 Ezi ntsilelo ze-PFC zibangela ingqiqo ephosakeleyo kunye nesigwebo esikhapha ezi ndlela zokuziphatha ezinxulumene neziyobisi.7

Ezo pharmacotherapies ekujoliswe kuzo njenge-morphine-receptor antagonist naltrexone emiselwe isigulana sethu inokuphazamisa i-dopamine crescendo engathintelekiyo ebangela ukuchazwa kobuchule kunye nemisebenzi yokuthintela ukuphendula ukuba ingalingani. I-Naltrexone ivimba i-morphine receptors, ngaloo ndlela iququzelela ukonyuka kwethoni ye-GABA kunye nokuncipha kumanqanaba e-NAc dopamine ngeendlela zombini ezithe ngqo nezingathanga ngqo.2 Ekugqibeleni, ngokuphelelwa yimvakalelo ngokuthe ngcembe, indlela yokuziphatha ekhobokisayo kufuneka yehle.15, 16

Isishwankathelo, ulungelelwaniso lweselula kwi-PFC yekhoboka lukhokelela ekunyukeni kokuqina kwe-stimuli ehambelana neziyobisi, ukuncipha kobuchule bezinto ezingezizo iziyobisi, kunye nokuncipha komdla ekulandeleni imisebenzi ejolise kwinjongo esembindini wokusinda. Ukongeza kwimvume ye-naltrexone evela kuLawulo lokuTya kunye neDrugs yokunyanga utywala, iingxelo ezininzi ezipapashiweyo ziye zabonisa amandla ayo okunyanga ukugembula kwe-pathologic, ukuzenzakalisa, i-kleptomania, kunye nokuziphatha okunyanzelekileyo ngokwesondo.8, 14, 17, 18, 19, 20 Sikholelwa ukuba le yinkcazo yokuqala yokusetyenziswa kwayo ukulwa nokulutha ngokwesondo kwi-Intanethi. Ryback20 wafunda ngokuthe ngqo ukusebenza kwe-naltrexone ekunciphiseni ukuvuseleleka ngokwesondo kunye nokuziphatha ngokwesondo ngokugqithisileyo kulutsha olubanjelwe amatyala aquka ukudlwengula, ukulala nezilwanyana, kunye nokwabelana ngesondo nabantwana abancinci. Ngelixa ufumana iidosi phakathi kwe-100 kunye ne-200 mg / d, abaninzi abathathi-nxaxheba abachazwe banciphisa ukuvuswa, ukuhlaziya i-masturbation, kunye neengcamango zesini, kunye nokwanda kokulawula iminqweno yesini.20 Ecaphula ubungqina obuvela kwizifundo zeempuku, uRyback ugxininisa ukudibana kwePFC phakathi kwenkqubo ye-dopaminergic kunye ne-opioid, equkumbela ngelithi "inqanaba elithile le-opioid elingapheliyo libonakala libalulekile ekuvuseleleni nasekusebenzeni ngokwesondo."20

ISIPHELO

Isigulana sineengxaki ezivela kwixesha elichithwe kwi-cybersex enyanzelekileyo ye-masturbatory kunye nemiphumo enokubakho, njengokukhulelwa okungafunekiyo kunye nezifo ezithathelwana ngesondo, xa imisebenzi yakhe ebonakalayo yandiswe kunxibelelwano lwezesondo olungaphandle komtshato. Ukongeza i-naltrexone kwirejimeni yamayeza esele ibandakanya i-serotonin reuptake inhibitor ekhethiweyo ehambelana nokuhla okukhawulezileyo kunye nokusombulula ekugqibeleni kweempawu zakhe ezikhobokisayo, kunye nesiphumo sokuvuselelwa kwentlalo, umsebenzi, kunye nomsebenzi wakhe wobuqu. Nge-naltrexone ehlala i-morphine receptors kwi-GABAergic interneurons ethintela i-VTA dopaminergic neurons, siqikelela ukuba i-opiate peptides engapheliyo ayisawuqinisekisi umsebenzi wakhe wesondo onyanzelekileyo kwi-Intanethi. Nangona ekuqaleni waqhubeka ewunqwenela lo msebenzi, njengoko kungqinwa yindlela awayeziphethe ngayo, akazange aphinde awufumane unomvuzo ongenakuthintelwa. Ubume beempawu ezikhuthaza ukwenza ngokwesondo kwi-Intanethi kwehle ukuya kuthi ga kwinqanaba lokuphela kokuziphatha ebusweni besimo sakhe sengqondo sokuthatha-okanye-ukuyishiya. Ngokuzenzekelayo, kodwa akumangalisi, wafumanisa ukuba wayengasakunandiphi ukuzinkcinkca ngotywala. Uphando oluthe kratya luyafuneka ukuze kuqinisekiswe ukuba uqwalaselo lwethu lunokwenziwa ngokubanzi kwezinye izigulana kunye nokucacisa indlela i-naltrexone ecima ngayo indlela yokuziphatha ekhobokisayo.

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