IZIMVO: Le yinguqulelo kaGqr. Hilton Umlutha woTyhila: I-Neuroscience Perspective (2011), efumaneka kwakweli candelo linye. Uqinisekile, njengoko sinjalo, ukuba umvuzo wendalo unokuba ngumlutha kwaye ubangele utshintsho olufanayo lobuchopho njengeziyobisi. Iphepha lakhe lamva nje eliphononongwe ngoontanga li Umlutha wephonografi-isivuseleli esinamandla esithathelwa ingqalelo kumxholo we-neuroplasticity | Hilton | I-Socioaffective Neuroscience & Psychology (2013).
January 20, 2011
UDonald L. Hilton, Jr. MD, FACS
Njingalwazi Ojongene Nezonyango
ISebe leNeurosurgery
IYunivesithi yase-Texas yeSayensi yezeMpilo eSan Antonio
Ingqondo yomntu ilungiselelwe ukuba ikhuthaze indlela yokuziphatha enegalelo ekusindeni. Inkqubo ye-mesolimbic dopaminergic ivuza ukutya kunye nesondo kunye nenkuthazo enamandla yolonwabo. I-Cocaine, i-opioids, utywala, kunye nezinye iziyobisi zibhukuqa, okanye ukuqweqwedisa, ezi nkqubo zolonwabo, kwaye zibangela ingqondo icinge ukuba ichiza eliphezulu liyafuneka ukuze uphile. Ubungqina ngoku bunamandla ukuba imivuzo yendalo efana nokutya kunye nesondo ichaphazela iinkqubo zomvuzo ngendlela efanayo neziyobisi ezichaphazelayo, ngaloo ndlela umdla wangoku 'kwi-additional addiction.' Umlutha, nokuba kwi-cocaine, ukutya, okanye ngesondo kwenzeka xa le misebenzi iyeka ukufaka isandla kwimeko ye-homeostasis, kwaye endaweni yoko ibangele iziphumo ezibi. Ngokomzekelo, xa ukutya kubangela ukutyeba okugulayo abambalwa baya kuphikisa ukuba umzimba usempilweni. Ngokufanayo, iphonografi yenza umonakalo xa iphazamisa okanye itshabalalisa amandla omntu okwakha ubuhlobo ngokweemvakalelo.
Ubungqina beminyaka elishumi edlulileyo baqala ukukhomba ubume bomlutha wokusetyenziswa kakhulu kokuziphatha kwendalo okubangela ukuba umvuzo we-dopaminergic ube namava engqondweni. Umzekelo, uGqr. Howard Shaffer, uMlawuli woPhando lweAddiction kwiYunivesithi yaseHarvard, wathi ngo-2001, "Ndandinobunzima obukhulu kunye noogxa bam xa ndandicebisa ukuba umlutha kakhulu sisiphumo samava ... ukuphindaphinda, uvakalelo oluphezulu, -amava rhoqo. Kodwa kuye kwacaca ukuba i-neuroadaptation-oko kukuthi, utshintsho kwi-neural circuitry enceda ukuqhubela phambili ukuziphatha-kwenzeka naxa kungabikho ukusetyenziswa kweziyobisi”[1] Kwiminyaka elishumi ukusukela oko ethethe oku, uye wajolisa ngakumbi kuphando lwakhe nangakumbi kwiziphumo zengqondo yeziyobisi zendalo ezifana nokungcakaza. Qaphela oku kulandelayo kwalapha inzululwazi iphepha ukusuka ku-2001
Iingcali ziyakuthanda ukuthi umlutha uyenzeka xa umkhwa "uqweqwedisa" iisekethe zobuchopho eziye zavela ukuze zivuze indlela yokuphila ephuculweyo efana nokutya kunye nesondo. Isazi ngengqondo seYunivesithi yaseStanford uBrian Knutson uthi: “Kusengqiqweni ukuba unokuphambukisa ezi ziphaluka usebenzisa ikhemesti, unokuyenza loo nto ngomvuzo wendalo. Ngaloo ndlela, iziyobisi azisekho entliziyweni yalo mbandela. "Yintoni eza ngokukhawuleza njengowona mba uphambili ... kukuqhubeka nokuzibandakanya ekuziphatheni okutshabalalisayo ngaphandle kwemiphumo emibi," utsho uSteven Grant we-NIDA.[2]
Kwishumi leminyaka ukusukela ezi ngcinga zohlaziyo zachazwa okokuqala, ubungqina bombono wendalo wokulutha umvuzo womelele kuphela. Ngo-2005 uGqr. Eric Nestler, ngoku ongusihlalo weNeuroscience kwiMount Sinai Medical Centre eNew York wapapasha iphepha elibalulekileyo I-Nature Neuroscience enomxholo othi, “Ngaba Ikhona Indlela Eqhelekileyo Yokukhobokisa?” Uthe: "Ubungqina obukhulayo bubonisa ukuba indlela ye-VTA-NAc kunye neminye imimandla ye-limbic ekhankanywe ngasentla ilamla ngokufanayo, ubuncinci, imiphumo emihle yeemvakalelo zemivuzo yendalo, njengokutya, isondo kunye nokunxibelelana kwezentlalo. Le mimandla ikwaye yabandakanyeka kwinto ebizwa ngokuba 'yiziyobisi zendalo' (oko kukuthi, ukunyanzeliswa kokusetyenziswa kwembuyekezo yendalo) njengokutya ngokugqithisileyo, ungcakazo lwe-pathological kunye nokulutha ngokwesondo. Iziphumo zangaphambili zicebisa ukuba iindlela ekwabelwana ngazo zinokubandakanyeka: [umzekelo] ukwazisana okwenzeka phakathi kwemivuzo yendalo kunye neziyobisi zokuxhatshazwa. "[3]
Ngo-2002 kwapapashwa uphononongo malunga nokuba likhoboka le-cocaine olwabonisa ilahleko yevolumu enokulinganiswa kwiindawo ezininzi zobuchopho, kubandakanya ne-lobes engaphambili.[4] Ubuchwephesha yayikukusebenzisa iprotocol esekwe kwiMRI ebizwa ngokuba yi-voxel-based morphometry (VBM), apho iityhubhu zemilimitha enye yobuchopho zibalwa kwaye zithelekiswe. Olunye uphononongo lwe-VBM lwapapashwa ngo-2004 kwi-methamphetamine eneziphumo ezifanayo kakhulu.[5] Ngelixa inika umdla, ezi zinto zifunyanisiweyo azimangalisi kwisazinzulu okanye kumntu wonke, kuba la “ngamachiza okwenene.”
Ibali liya kuba nomdla ngakumbi xa sijonga umlutha wendalo njengokutya kakhulu okukhokelela ekutyebeni. Ngo-2006 uphononongo lwe-VBM lwapapashwa lujonge ngokukodwa ekutyebeni, kwaye iziphumo zazifana kakhulu nezifundo ze-cocaine kunye ne-methamphetamine.[6] Uphononongo lokutyeba kakhulu lubonise iindawo ezininzi zokulahleka kwevolumu, ngakumbi kwi-lobes yangaphambili, iindawo ezinxulumene nokugweba kunye nolawulo. Ngelixa olu phononongo lubalulekile ekuboniseni umonakalo obonakalayo kumlutha wendalo wendalo, ngokuchaseneyo nomlutha weziyobisi wangaphandle, kuselula ukwamkela ngokubonakalayo kuba singakwazi. ukubona iziphumo zokutya kakhulu emntwini otyebe kakhulu.
Ngoko kuthekani ngokukhotyokiswa ngokwesini? Ngo-2007 uphononongo lwe-VBM oluphuma eJamani lwajonga ngqo kwi-pedophilia, kwaye lwabonisa ukufunyaniswa okuphantse kufane kwi-cocaine, methamphetamine, kunye nezifundo zokutyeba.[7] Ukubaluleka kwesi sifundo ngokumalunga nale ngxoxo kubaluleke kakhulu kuba Ibonisa ukuba ukunyanzeliswa ngokwesondo kunokubangela ukuba umzimba, utshintsho lwe-anatomic kwingqondo, oko kukuthi, ingozi. Okubangela umdla kukuba, iphepha lamva nje lifumene unxulumano oluphezulu phakathi kwephonografi ye-pedophilic kunye nokuxhatshazwa kwabantwana ngokwesondo.[8] Oku kuphawulwe, eli phepha ke ngoko ligxile kwiqela elingaphantsi, phakathi kwezinye iingxaki, likhoboka lephonografi. Ngelixa sinokuzoba umahluko osesikweni kunye nomthetho phakathi kwephonografi yabantwana kunye neyabantu abadala, ingqondo ayinakukwazi ukuba nendawo ehambelana neminyaka malunga nokuthotywa kwe-dopaminergic kunye nokulahleka kwevolumu esekwe kumlutha. Ngaba ingqondo iyakhathala ukuba umntu uhlangabezana nesondo ngokwasemzimbeni, okanye uyenza ngendlela yesini, oko kukuthi, iphonografi. Iinkqubo zesibuko zengqondo zijika amava abonakalayo oonografi abe ngamava okwenene, ngokubhekiselele kwingqondo. Oku kuxhaswa luphononongo lwakutsha nje oluvela eFransi olubonisa ukusebenza kweendawo ezinxulumene nesibuko se-neurons ebuchosheni bomntu kumadoda ajonga iphonografi. Ababhali baqukumbela ngelithi, “sicebisa ukuba…[9] Uphononongo lokuqala luxhasa umonakalo ongaphambili ngokukodwa kwizigulana ezingakwaziyo ukulawula ukuziphatha kwazo ngokwesondo.[10] Olu phononongo lusebenzise i-MRI yokusasaza ukuvavanya umsebenzi wokuhanjiswa kwemithambo-luvo ngombandela omhlophe, apho ii-axon, okanye iingcingo ezidibanisa iiseli zemithambo-luvo zikhoyo. Ibonise ukungasebenzi kakuhle kwindawo engaphambili ephezulu, indawo ehambelana nokunyanzeliswa, uphawu lokuba likhoboka.
Izifundo ezininzi zibonisa utshintsho lwe-metabolically pathologic kwi-neurochemistry njengoko ingqondo "ifunda" ukuba likhoboka. Olu tshintsho lukhobokisayo kwinkqubo yomvuzo we-dopamine lunokuskenwa ngeskena sobuchopho njenge-MRI esebenzayo, i-PET, kunye ne-SPECT scans. Ngelixa sinokulindela uphononongo lokuskena kwengqondo ukubonisa ukungaqhelekanga kwi-dopamine metabolism kwikhoboka le-cocaine,[11] singamangaliswa kukufumanisa ukuba uphononongo lwamva nje lukwabonisa ukungasebenzi kwala maziko olonwabo afanayo nongcakazo lwe-pathologic.[12] Ukutya ngokugqithisileyo okukhokelela ekutyebeni, enye ikhoboka lendalo, ikwabonisa i-pathology efanayo.[13]
Kwakhona kufanelekile iphepha elivela kwiKliniki yaseMayo kunyango lwe-intanethi ye-pornography kunye ne-naltrexone, i-opioid receptor antagonist.[14] UGqr. UBostsick kunye noBucci kwiKliniki yaseMayo baphatha isigulana esingakwaziyo ukulawula ukusetyenziswa kwephonografi kwi-Intanethi.
Wabekwa kwi-naltrexone, ichiza elisebenza kwinkqubo ye-opioid ukunciphisa amandla e-dopamine ukuvuselela iiseli kwi-nucleus accumbens. Ngeli chiza wakwazi ukufumana ulawulo lobomi bakhe bokwabelana ngesondo.
Ababhali bathi:
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. Sikholelwa ukuba le yinkcazo yokuqala yokusetyenziswa kwayo ukulwa nokulutha ngokwesondo kwi-Intanethi.
IRoyal Society yaseLondon edumileyo yasekwa ngeminyaka yoo-1660, kwaye ipapasha eyona magazini inde yezenzululwazi ehlabathini. Kushicilelo lwakutsha nje lwe Iinkcukacha zezobuGcisa zeRoyal Society, imeko yangoku yokuqonda ukukhotyokiswa kwanikelwa ingxelo njengoko yaxutyushwa zezinye zezazinzulu ezikhokelayo zehlabathi zokukhotyokiswa ziziyobisi kwintlanganiso yoMbutho. Isihloko somcimbi wejenali enika ingxelo ngentlanganiso ibisithi "I-neurobiology yokulutha - iimbono ezintsha." Okubangel 'umdla kukuba, kumanqaku ali-17, amabini ayenenkxalabo ngokuthe ngqo kumlutha wendalo: ukungcakaza kwe-pathologic.[15] kunye nephepha likaGqr. Nora Volkow malunga nokufana kokungasebenzi kwengqondo kumlutha weziyobisi kunye nokutya kakhulu.[16]. Iphepha lesithathu elibhalwe nguGqr. Nestler lithetha ngeemodeli zezilwanyana zokukhotyokiswa kwendalo ngokunjalo ngokubhekiselele kwi-DFosB.[17]
I-DFosB yikhemikhali efundwe nguGqr. Nestler, kwaye ibonakala ifumaneka kwi-neurons yezifundo ezikhobokileyo. Kubonakala ngathi inendima ye-physiologic ilungile, kodwa ibandakanyeka kakhulu kumlutha Okubangela umdla kukuba, yafunyanwa okokuqala kwiiseli zengqondo yezilwanyana ezifundwe kumlutha weziyobisi, kodwa ngoku ifunyenwe kwiiseli zengqondo kwi-nucleus accumbens ehambelana nokusetyenziswa kakhulu. yemivuzo yendalo.[i] Iphepha lamva nje eliphanda i-DFosB kunye nendima yayo ekusebenziseni ngokugqithisileyo imivuzo emibini yendalo, ukutya kunye nokwabelana ngesondo, iqukumbela ngelithi:
Isishwankathelo, umsebenzi oboniswe apha ubonelela ngobungqina bokuba, ukongeza kwiziyobisi zokuxhatshazwa, imbuyekezo yendalo yenza amanqanaba e-DFosB kwi-Nac… Imiba yezinto ezibizwa ngokuba likhoboka lendalo elibandakanya ukusetyenziswa ngokunyanzelekileyo kwembuyekezo yendalo.[18]
UGqr. Nora Volkow yintloko yeZiko leSizwe lokuSetyenziswa gwenxa kweZiyobisi (NIDA), kwaye ungomnye wezazinzulu ezipapashiweyo nezihlonitshwayo zokukhobokisa ehlabathini. Uyiqaphele le nguquko ekuqondeni ukuba likhoboka lendalo kwaye wakhuthaza ukutshintsha igama le-NIDA kwiZiko leSizwe leZifo zokuSebenza. Ijenali inzululwazi Ingxelo ithi: “Umalathisi weNIDA uNora Volkow naye wavakalelwa kukuba igama leziko lakhe lifanele ukuqukaizilwanyana ezinjengezoconografi, ukungcakaza, nokutya, utsho njalo umcebisi weNIDA uGlen Hanson. 'Ingathanda ukuthumela umyalezo wokuba [sifanele] sijonge yonke intsimi.'”[19] (ugxininiso olongezelelweyo).
Ngamafutshane, kule minyaka ili-10 idlulileyo ubungqina buxhasa ngokuqinileyo ukukhobokisa kwembuyekezo yendalo. UGqr. UMalenka noKauer, kwiphepha labo elibalulekileyo kwindlela yotshintsho lweekhemikhali ezenzeka kwiiseli zengqondo zabantu abakhobokileyo, "umlutha umele indlela yokufunda kunye nenkumbulo enamandla."[20] Ngoku silubiza olu tshintsho kwiiseli zobuchopho "ukubakho kwexesha elide" kunye "noxinzelelo lwexesha elide," kwaye sithethe ngengqondo njengeplastiki, okanye inokuthi itshintshe kwaye ifakwe kwakhona. UGqr Norman Doidge, ugqirha wemithambo-luvo e-Columbia, kwincwadi yakhe Ubungqina Obuguqula ichaza indlela iphonografi ebangela ngayo kwakhona i-wiring ye-neural circuits. Uphawula uphononongo kumadoda abukela iphonografi ye-Intanethi apho ayejongeka “ngokungaqhelekanga” njengeempuku ezityhala i-lever ukuba ifumane i-cocaine kwiibhokisi zovavanyo ze-Skinner. Njengempuku ekhobokileyo, bafuna ngokungxamisekileyo ukulungiswa okulandelayo, becofa imawusi kanye njengokuba impuku ityhala i-lever. Ukuba likhoboka lephonografi likhulu ukufunda, kwaye mhlawumbi kungenxa yesi sizathu le nto abaninzi abaye banengxaki yeziyobisi ezininzi bexela ukuba yayiyeyona nto inzima kubo ukuba boyise. Iziyobisi, ngelixa zinamandla, zingenzi nto ngendlela "yokucinga", ngelixa ukubukela iphonografi, ngakumbi kwi-Intanethi, kuyinkqubo esebenzayo ngakumbi kwi-neurological. Ukukhangela rhoqo kunye nokuvavanya umfanekiso ngamnye okanye ikliphu yevidiyo eveliswe amandla kunye nesiphumo ngumsebenzi wokufunda nge-neuronal kunye nokuphinda kufakwe iintambo.
Uvuthondaba lwezesondo lomntu lusebenzisa iindlela zomvuzo ezifanayo nezo zihlanganiswe ngexesha lokuleqa iheroin.[21] Ukuba siyasilela ukuqonda iimpembelelo zokukwazi kwephonografi ukucwangcisa kwakhona ingqondo ngokwesakhiwo, i-neurochemically, kunye ne-metabolism, siya kuphumelela ukuba siqhubeke nokusilela ekunyangeni esi sifo soyikekayo. Nangona kunjalo, ukuba siyawunika lo mvuzo unamandla wendalo ugqaliselo olufanelekileyo kunye nogxininiso sinokunceda abaninzi ngoku ababanjelwe kumlutha kunye nokuphelelwa lithemba bafumane uxolo nethemba.
[1] UConstance Holden, "Iziyobisi Zokuziphatha: Ngaba Zikhona? inzululwazi, 294 (5544) 2 Novemba 2001, 980.
[2] Ibid.
[3] Eric J. Nestler, “Ngaba kukho indlela eqhelekileyo yeemolekyuli yokukhotyokiswa?” I-Nature Neuroscience 9(11):1445-9, Nov 2005
[4] UTeresa R. Franklin, uPaul D. Acton, uJoseph A Maldjian, uJason D. Grey, uJason R. Croft, uCharles A. Dackis, uCharles P. O'Brien, no-Anna Rose Childress, “Ukuncipha kokuNgxinaniswa kweGrey kwi-Insular, I-Orbitofrontal, iCingulate, kunye neTemporal Cortices yezigulane zeCocaine, " Psychiatry (51)2, Januwari 15, 2002, 134-142.
[5] UPaul M. Thompson, uKikralee M. Hayashi, uSara L. Simon, uJennifer A. Geaga, uMichael S. Hong, uYihong Sui, uJessica Y. Lee, uArthur W. Toga, uWalter Ling, kunye noEdythe D. London, “Izinto ezingaqhelekanga zesakhiwo kwiBrains of Human Subjects Abasebenzisa iMethamphetamine,” I-Journal ye-Neuroscience, 24(26) Juni 30 2004;6028-6036.
[6] UNicola Pannacciulli, Angelo Del Parigi, Kewei Chen, Dec Son NT Le, Eric M. Reiman kunye noPietro A. Tataranni, "Ukungahambi kakuhle kwengqondo ekutyebeni komntu: Isifundo se-voxel-based morphometry." Neuroimage 31(4) Julayi 15 2006, 1419-1425.
[7] U-Boris Schiffer, uThomas Peschel, uThomas Paul, u-Elke Gizewshi, uMichael Forshing, uNorbert Leygraf, uManfred Schedlowske, kunye noTillmann HC Krueger, "Ukungahambi kakuhle kwengqondo kwiNkqubo yeFrontostriatal kunye neCerebellum kwi-Pedophilia," Umbhalo woPhando lwezeMpilo (41)9, Novemba 2007, 754-762.
[8] M. Bourke, A. Hernandez, i-'Bunner Study' i-Redux: Ingxelo yezehlo zokuXhotyiswa koMntwana ngaBantwana bePhonografi. Ijenali yoBundlobongela boSapho 24(3) 2009, 183-191.
[9] H. Mouras, S. Stole4ru, V. Moulier, M Pelegrini-Issac, R. Rouxel, B Grandjean, D. Glutron, J Bittoun, Ukuqaliswa kwenkqubo yesipili-neuron ngeziqeshana zevidiyo ezivuselelayo ziqikelela iqondo lokumiswa okubangelwayo: isifundo se-fMRI . NeuroImage 42 (2008) 1142-1150.
[10] UMichael H. Miner, uNancy Raymond, uBryonA. Meuller, uMartin Lloyd, uKelvin Ol Lim, "Uphando lwangaphambili lweempawu ezingxamisekileyo kunye ne-neuroanatomical yokuziphatha okunyanzelekileyo ngokwesondo." Uphando lwePsychiatry Neuroimaging Umqulu 174, ushicilelo 2, Novemba 30 2009, amaphepha 146-151.
[11] UBruce E. Wexler, uChristopher H. Gottschalk, uRobert K. Fulbright, uIsak Prohovnik, uCheryl M. Lacadie, uBruce J. Rounsaville, noJohn C. Gore, “I-Functional Magnetic Resonance Imaging of Cocaine Craving,” I-American Journal ye-Psychiatry, 158, 2001, 86-95.
[12] UJan Reuter, uThomas Raedler, uMichael Rose, u-Iver Hand, uJan Glascher, kunye noChristian Buchel, "Ukungcakaza kwePathological kunxulunyaniswa nokunciphisa ukusebenza kwenkqubo yemivuzo ye-mesolimbic," I-Nature Neuroscience 8, Januwari 2005, 147-148.
[13] UGene-Jack Wang, uNora D. Volkow, uJean Logan, uNaomi R. Pappas, uChristopher T. Wong, u-Wei Zhu, uNoelwah Netusil, uJoanna S Fowler, "i-Brain dopamine kunye nokukhuluphala," Lancet 357(9253) February 3 2001, 354-357.
[14] J. Michael Bostwick kunye noJeffrey A. Bucci, "Ukukhotyokiswa ngokwesini kwi-Intanethi kunyangwa ngeNaltrexone." IMayo Clinic Proceedings, 2008, 83(2):226-230.
[15] Marc N. Potenza, "I-neurobiology ye-pathologic yokungcakaza kunye nokukhotyokiswa kweziyobisi: isishwankathelo kunye neziphumo ezintsha," Iinkcukacha zezobuGcisa zeRoyal Society, 363, 2008, 3181-3190..
[16] Nora D. Volkow, uGene-Jack Wang, uJoanna S. Fowler, uFrank Telang, "Iijikelezo ze-neuronal ezixubileyo kwi-addiction kunye nokukhuluphala: ubungqina beenkqubo ze-pathology," Iinkcukacha zezobuGcisa zeRoyal Society, 363, 2008, 3191-3200.
[16] U-Eric J. Nestler, "Iindlela zokubhaliweyo zokulutha: indima ye-DFosB," Iinkcukacha zezobuGcisa zeRoyal Society, 363, 2008, 3245-3256.
[18] U-DL Wallace, et al, Impembelelo ye-DFosB kwi-Nucleus Accumberns kwi-Natural Related Behaviour,I-Journal ye-Neuroscience, 28(4): Oktobha 8, 2008, 10272-10277,
[19] inzululwazi 6 Julayi 2007:?Vol. 317. no. 5834, iphe. 23
[20] UJulie A. Kauer, uRobert C. Malenka, "I-Synaptic Plasticity and Addiction," Uphononongo lweNdalo kwiNeuroscience, 8, 8440858 Novemba 2007, 844-858.
[21] UGert Holstege, uJanniko R. Georgiadis, u-Anne MJ Paans, uLinda C. Meiners, uFerdinand HCE van der Graaf, kunye no-AAT Simone Reinders, "Ukusebenza kwengqondo ngexesha lokuphuma kwendoda," I-Journal ye-Neuroscience 23 (27), 2003, 9185-9193