Ubudlelwane phakathi komgangatho wobomi kubaselula abaselula kunye nokunyanzelisa / ukunyanzelisa (2019)

Uphando loPhando

Volume 271, UJanuwari 2019, iphepha 253-258

UJon E.Grantb

Iimbalasane

• Olu phononongo luvavanye imilinganiselo eyayanyaniswa nomgangatho we ubomi kubantu abadala abancinci.
• Iziphazamiso zokulawula impembelelo zayanyaniswa ngamandla nomgangatho ophantsi wobomi.
• Uphawu ukunganyanzelekanga kwaye ukuqonda zazikwanxulunyaniswa nomgangatho wobomi ombi.

Abstract

Iimpawu ezityhutyhayo nezinyanzelekileyo zihlala zibonakala ngexesha lokukhula okuncinci, elixesha elibalulekileyo lophuhliso lobuchopho kunye nokusekwa kweenjongo zobomi. Injongo yolu phononongo yayikukuchonga imibutho ebalulekileyo kunye nomgangatho wobomi kubantu abadala abancinci, kuluhlu lweklinikhi, iphepha lemibuzo, kunye namanyathelo okuqonda, kugxininise ukunyanzeliswa kunye nokunyanzeliswa. Ubudlelwane obubalulekileyo phakathi kwezinto eziguquguqukayo zophononongo kunye nomgangatho wobomi zichongiwe kusetyenziswa izikwere eziNcinane eziNcinane (PLS). Kubathathi-nxaxheba be-479 (iminyaka eyi-22.3 [SD 3.6] iminyaka), umgangatho wobomi uchazwe kakuhle ngomzekelo omnye (p <0.001). Izinto eziguquguqukayo ezinxulunyaniswa kakhulu nomgangatho ophantsi wobomi zazi: iminyaka yobudala, ukusela utywala kakhulu, kunye nobukho bokuphazamiseka kokulawula impembelelo (kubandakanya ukungcakaza, ukuthenga ngenkani, ukuphazamiseka okuqhushumba okwethutyana, ukuziphatha okunyanzelekileyo ngokwesondo, ukutya kakhulu, kunye nokucofa ulusu), imo/ ukuphazamiseka kokuxhalaba, ukuphazamiseka koxinzelelo lwasemva koxinzelelo, kunye nengxaki yokusebenzisa iziyobisi. Umgangatho ombi wobomi nawo wachazwa ngokubalulekileyo kukungxama okuphezulu kwisikali se-Barratt, kunye nothintelo olunxulumeneyo ekusetweni okungaphezulu-kwemilinganiselo kunye nomgangatho wokwenza izigqibo. Ezi ziphumo zibonisa ukuba ukuphazamiseka kokucinga kufuneka kuhoywe ngakumbi kwimpilo yoluntu, ngakumbi ingxaki yokungcakaza. Intsebenzo ekuthathweni kwezigqibo kunye nemisebenzi yokutshintsha kwakhona ibonakala ibaluleke kakhulu ekuqondeni umgangatho wobomi kubantu abadala abancinci.

     

    Internet Ukungxama, Ukunyanzeliswa, Umlutha, Ukusebenza, Cognition

    1. intshayelelo

    Young umdala ibandakanya utshintsho olukhulu kwimo yokusingqongileyo yomntu – ibandakanya ixesha lenguquko apho abantu banokukhululeka ngakumbi kusapho (umzekelo, ukuya eyunivesithi), baqalise ingqesho ebambekayo okokuqala, baze baphile ubomi obude. ubudlelwane kwezentlalo (kubandakanywa intsebenziswano). Kwakunye neenguqu zangaphandle, ubudala obutsha bukwalixesha elibalulekileyo kubo ukukhula kwengqondo, kokubini ngokwesakhiwo kunye nomsebenzi (Casey et al., 2017, UColver noLongwell, ngo-2013, Sharda et al., 2015). Ukuziphatha imikhwa kwakhiwa ebutsheni kaninzi kuneempembelelo zexesha elide kwaye zingaqhubeka ngokuhamba kwexesha, ezifana Ukusetyenziswa kweziyobisi ukuphazamiseka (Degenhardt et al., 2016), nto leyo echaphazela ukukhula kwengqondo kunye ukuqonda (Cservenka kunye Brumback, 2017). Iikhonsepthi ezimbini eziphambili zokubaluleka okuthile kubuntu obudala obutsha kunye neendlela zokuqonda psychopathology are ukungafuneki kunye nokunyanzeliswa. Impulsivity ibhekisa ku ziphatha (okanye utyekelo lokuziphatha) olungxamisekileyo ngokungafanelekanga, oluyingozi, olukhokelela kububi iziphumo zexesha elide (Evenden, ngo-1999). Ukunyanzeliswa kubhekiselele kwiindlela zokuziphatha (okanye utyekelo lokuziphatha) olungqongqo, oluphindaphindayo, kunye nokungasebenzi kakuhle (Robbins et al., 2012). Kwiimeko eziqhelekileyo, abaselula kwaye abantu abadala abancinci banengxakeko kodwa ukungxamiseka kunokuncipha ngokuhamba kwexesha (UMitchell noPotenza, ngo-2014, Steinberg et al., 2009). Ukunyanzeliswa akufundwanga kakuhle ukusuka kwindawo yokujonga i-longitudinal, nangona kunjalo uphando loguqulo ibeka ukuba iindlela zokuziphatha ezithile (ngokukodwa ukusetyenziswa kweziyobisi) zinokusuka ekubeni sisinyanzeliso ukuya ekunyanzelweni kwexesha, njengoko izimilo ziphindaphindwa (Belin et al., 2008, UKoob noLe Moal, i-2008).

    Ngelixa impembelelo yokuphazamiseka kwengqondo okuqhelekileyo (isimo sengqondo, ixhala, kunye nokuphazamiseka kokusetyenziswa kweziyobisi) kumgangatho we ubomi kunye nokusebenza kwabaselula kuye kwafundwa ngokubanzi, ezinye iziphazamiso ngakumbi ukuphazamiseka kokulawula impembelelo ziye zingahoywa (Bell et al., 2013, Lipari kunye noHedden, ngo-2013, UPatel et al., ngo-2016, UPatel et al., ngo-2007).

    Ke ngoko, injongo yolu phononongo yayikukuphonononga iklinikhi, Ubuntu, kunye nemilinganiselo yokuqonda ehambelana nomgangatho wobomi kubantu abadala abancinci, ngokugxininisa ukunyanzeliswa kunye nokunyanzeliswa. Ukufezekisa le njongo, sisebenzise indlela entsha yamanani ngokuyinxenye izikwere ezincinci, eluncedo xa kukho inani elikhulu leenguqu xa kuthelekiswa nobungakanani besampulu; kwaye apho idatha inokuthi inxulumane kwaye ingasasazwa ngokuqhelekileyo. Sicinge ukuba umgangatho wobomi uya kunxulunyaniswa kakhulu noluhlu lweengxaki kubantu abadala abancinci, kodwa ngakumbi kukuphazamiseka kokulawula impembelelo, ukongeza ekusebenziseni iziyobisi, ixhala, kunye ngqondweni ukuphazamiseka. Saphinda saqikelela ukuba ukungxamiseka okumandla okubonakaliswa luluhlu lwemibuzo kunye namanyathelo asekwe kwingqiqo kuya kunxulunyaniswa nomgangatho wobomi ombi. Ngokwahlukileyo koko, saqikelela ukuba kunyanzelekile iimpawu inokuba buthathaka ngokwentelekiso idityaniswe nomgangatho wobomi kule meko.

    2. Iindlela

    2.1. Abathathi-nxaxheba

    Abantu abadala abancinci, abaneminyaka eyi-18 ukuya kwengama-29 ubudala, baqeshwa kusetyenziswa iintengiso zeendaba kwisixeko esikhulu sase-US. Izibhengezo zicele abantu ukuba bathathe inxaxheba kuphononongo lophando ukuziphatha ngokungxama kunye nokunyanzeliswa. Umlinganiselo wokubandakanywa wawu ukungcakaza kanye kanye kulo nyaka uphelileyo (ekubeni uphononongo lulonke beluphonononga ungcakazo kubantu abancinci). Izifundo bezikhutshelwa ngaphandle ukuba bebengakwazi ukunika imvume yokwazi, abakwazanga ukuqonda/ukwenza iinkqubo zophononongo, okanye bebefuna unyango lwalo naluphi na ukuphazamiseka kwengqondo. Ngaphambi kokuthatha inxaxheba, kwanikwa imvume ebhaliweyo enolwazi. Uphononongo luvunyiwe yiBhodi yokuHlola yeziko (iYunivesithi yaseChicago). Abathathi-nxaxheba bahlawulwa nge-50 yeedola isipho ikhadi levenkile yesebe lendawo yokuthatha inxaxheba.

    2.2. Uvavanyo

    Umthathi-nxaxheba ngamnye waya kwilabhoratri yophando ngesihlandlo esinye ukuzalisa imibuzo, a udliwano-ndlebe lwezonyango, yaye uvavanyo lwe-neuropsychological. Zonke iinkqubo zaqhutywa kwindawo ezolileyo. Le datha yedemografi ilandelayo iqokelelwe: ubudala, ngesini, inani lamaxesha alcohol idliwe ngeveki ngokomndilili, kunye nenqanaba lemfundo. Umgangatho we ubomi yavavanywa kusetyenziswa uMgangatho we-Life Inventory (QOL) (Frisch et al., 2005), elinganisa ngokubanzi ngokubanzi ulwaneliseko lobomi kunye nentlalo-ntle, intle kakhulu i-psychometric iipropati, kwaye unovelwano kwiziphumo zesifo kumgangatho wobomi; kunye neziphumo eziluncedo zonyango (Frisch et al., 2005).

    Udliwano-ndlebe olucwangcisiweyo lwezonyango lwenziwe kusetyenziswa i-Mini International Neuropsychiatric Inventory (MINI) eqinisekisiweyo ngaphambili (USheehan et al., ngo-1998) kunye neMinnesota Impulse Disorder Interview (MIDI) (Grant et al., 2005). I-MINI ichonga ukuphazamiseka kwengqondo okuqhelekileyo, kubandakanywa ngqondweni kunye neengxaki zokukhathazeka, ubume obungalunganga obuphambanisayo, yokudla, ukungahambi kakuhle kubuntu, yaye ukuphazamiseka kokusetyenziswa kweziyobisi. I-MIDI ichonga ukuphazamiseka kokulawula impembelelo: ukuthenga okunganyanzelekanga, kleptomania, trichotillomania, Ukuphazamiseka kwesiqhushumbisi, ipiromania, ukuphazamiseka kokungcakaza, ukuba likhoboka ukuziphatha ngokwesondo, Isifo sokutya okukutya kakhulu, kunye nokuphazamiseka kokukhetha ulusu (Grant, ngo-2008). Ubungakanani bokuphazamiseka kokungcakaza iimpawu zilinganiswe kusetyenziswa i-Structured Clinical Interview for Gambling Disorder (SCI-GD) (ilungiswe kwi-DSM-5) (Grant et al., 2004), ukungxamiseka kwalinganiswa kusetyenziswa iBarratt Ukunganyanzelekanga Isikali (BIS-11) (Barratt, ngo-1965, uPatton et al., ngo-1995, Stanford et al., 2016), kunye neempawu ezinyanzelekileyo kunye noluhlu lwePadua (Sanavio, ngo-1988).

    Uvavanyo lwe-Neuropsychological lugxile kwimida emithathu, kwaye lwenziwa kusetyenziswa iCambridge Uvavanyo lwe-Neuropsychological Ibhetri ezenzekelayo (CANTABeclipse, version 3, Cambridge Cognition Ltd, UK): umsebenzi weCambridge Gamble (URogers et al., 1999), Misa-Umqondiso umsebenzi (UAron et al., 2007), kunye ne-Intra-Dimensional/Extra-Dimensional set-shift task (UOwen et al., ngo-1991). Ezi nkalo zengqondo zikhethwe zinikwe ukuba zihlala zibandakanyeka kwi Pathophysiology yokungxama, isinyanzelo, kunye iingxaki zomlutha (Chamberlain et al., 2016, UGoudriaan et al., ngo-2005, UGoudriaan et al., ngo-2006, UGoudriaan et al., ngo-2014, Isibonelelo seGrant kunye neChamberlain, 2014, UGrant et al., 2011, Umkhuhlane, i-2007, Umkhuhlane, i-2008).

    Kumsebenzi weCambridge Gamble, kulingo ngalunye, iibhokisi ezilishumi zaboniswa, ezinye ziluhlaza okwesibhakabhaka kwaye ezinye zibomvu, kunye nophawu olufihlwe emva kwenye yezi. Umthathi-nxaxheba ukhethe umbala webhokisi abakholelwa ukuba umqondiso ufihlwe ngasemva, waza wagqiba ekubeni zingaphi iingongoma zokungcakaza ekubeni wenze isigqibo esichanekileyo. Imilinganiselo ephambili ye ukwenza isigqibo kulo msebenzi ibingumlinganiselo wamanqaku angcakasiweyo ngokubanzi, umyinge wezigqibo ezinengqiqo ezenziweyo (umlinganiselo wezilingo xa ivolontiya wakhetha umbala owawuninzi), kunye nobungakanani bomngcipheko uhlengahlengiso (ubungakanani apho abantu bamodareyitha imali abangcakaza ngayo ngokuxhomekeke kumathuba okwenza ukhetho oluchanekileyo).

    Kumsebenzi we-Stop-signal, abathathi-nxaxheba bajonge uluhlu lweempazamo ezibhekiselele ezibonakala ngexesha elinye-ngexesha kwisikrini, kwaye benza iimpendulo zemoto ezikhawulezayo - ukuba utolo lwasekhohlo lwenzekile, bacinezela iqhosha lasekhohlo, kwaye ngokuphambene noko kwiintolo ezijongene nelungelo. Xa i-auditory stop-signal ("beep") yenzeka, abathathi-nxaxheba bazama ukubamba impendulo yabo yemoto kulingo olunikiweyo. Umlinganiselo wesiphumo ongundoqo kumsebenzi luphawu lokumisa ixesha lokuphendula, oluluqikelelo lokuba kuthatha ixesha elingakanani umntu onikiweyo ukucinezela impendulo esele iqalisiwe.

    Kwi-Intra-Dimensional/Extra-Dimensional set-shift task, amavolontiya azame ukufunda umgaqo osisiseko malunga nokuba yeyiphi kwezi zimbini. ukuvuselela eboniswe kwiscreen sekhompyuter ichanekile. Emva kokwenza ukhetho ngalunye ngokuchukumisa isivuseleli, ingxelo yanikwa ('ilungile' okanye 'engalunganga' yavela kwiscreen). Ngokuzama kunye neempazamo, abathathi-nxaxheba bafunde umgaqo osisiseko. Ngethuba lomsebenzi, umgaqo watshintshwa yikhompyutheni ukuvavanya amacandelo ahlukeneyo okuphendula okuguquguqukayo. Inqanaba lomsebenzi obalulekileyo linqanaba leshifti ye-extra-dimensional, apho amavolontiya kufuneka atshintshe ingqwalaselo ayisuse kwidimension ye-stimulus echaphazelekayo iye kumlinganiselo we-stimulus owawungenamsebenzi ngaphambili (inguqu yengqalelo 'eyongezelelweyo'). Umlinganiselo wesiphumo ongundoqo kumsebenzi yayilinani leempazamo ezenziweyo kwesi sigaba.

    2.3. Uhlalutyo lwedatha

    Ukuchonga imilinganiselo yedemografi, yeklinikhi, kunye nengqiqo ehambelana nokwahluka kwamanani kumgangatho wobomi, sisebenzise ubuchule bamanani ngokuyinxenye izikwere ezincinci (PLS) (Abdi noWilliams, ngo-2013, UCox noGaudard, ngo-2013, Garthwaite, ngo-1994, UHöskuldsson, ngo-1988). Obu bubuchule bobalo bunamandla bakha enye okanye ezininzi eziguquguqukayo ezifihlakeleyo (ezaziwa ngokuba ziinxalenye ze-PLS) ezichaza ngokufanelekileyo ubudlelwane phakathi kweseti yee-X (iinguqu ezicacisayo) kunye nolunye uguquguquko lwe-Y (iziphumo eziguquguqukayo). Apha, ukuhluka kwe-Y kwakusemgangathweni wobomi, kwaye iinguqu ze-X zazi: ubudala, isini, inqanaba lemfundo, inani lamaxesha otywala obusetyenzisiweyo ngeveki, ubukho (okanye hayi) bengxaki nganye yengqondo echongwa yi-MINI kunye ne-MIDI, ingxaki yokungcakaza iyonke. iimpawu ezivunyiweyo (SCI-GD), i-Barratt impulsivity (motor, ingqalelo, kunye nokucwangcisa), iimpawu ezinyanzelekileyo (amanqaku ePadua ewonke), kunye nemilinganiselo yeziphumo zokuqonda uthintelo lokuphendula, ukwenza izigqibo, kunye ne-extra-dimensional set-shifting. I-PLS ifanelekile kwiimeko apho iinguqu zihambelana kunye; kwaye xa inani leenguqu likhulu xa kuthelekiswa nenani leemeko.

    Uhlalutyo lwenziwe kusetyenziswa i-JMP Pro software Version 13.0 (SAS Institute Inc., 2017). Nawaphi na amanqaku alahlekileyo edatha afakwe ngokuzenzekelayo yi-JMP esebenzisa iindlela zokufunda. Imodeli ye-PLS yafakwa kusetyenziswa ikhefu-enye-ngaphandle ukuqinisekiswa okunqamlezayo (i-non-linear iterative iterative partial ubuncinane izikwere, i-algorithm ye-NIPALS), kunye nelona nani lifanelekileyo lezinto ezifihlakeleyo zikhethwe ngokunciphisa i-predictive residual sum of the squares (PRESS). Iinguqu zokuqala ezichazayo ezingazange zidlule i-Various Importance Threshold (VIP) ye-0.8 ayizange igcinwe kumzekelo (2017). Ingcaciso eguquguqukayo enegalelo elikhulu kumzekelo (okt ukuchaza umahluko omkhulu kumgangatho wobomi) ichongiwe ngokwesiseko se-95% yamathuba okuzithemba I-bootstrap unikezelo lwemodeli esemgangathweni yomlinganiso engaweleli i-zero (N = 1000 i-bootstraps).

    3. Iziphumo

    Ubungakanani besampulu iyonke yayingabantu abangama-479, kunye nentsingiselo (ukutenxa okusemgangathweni, i-SD) ubudala 22.3 (3.6) iminyaka, 167 (33.8%) ababhinqileyo. Umndilili wenqanaba lemfundo wawuthetha u-3.2 (0.8), olingana nesikolo samabanga aphakamileyo okanye esingcono. Inani [ipesenti] yabantu kumgangatho onikiweyo we ubomi udidi olusekelwe kwimimiselo lwaluyi: i-56 ephezulu [11.7%], i-264 eqhelekileyo [55.1%], i-65 ephantsi [13.6%], kwaye iphantsi kakhulu i-94 [19.6%]. Ezinye iimpawu zesampulu ziboniswe kwi Itheyibhile 1.

    1 Table. Iimpawu zesampulu.

    UkulinganisaIthetha (SD) okanye N [%]Idatha yesiqhelo (apho ikhona)Ireferensi yedatha yesiqhelo
    Ukusetyenziswa kotywala, amaxesha ngeveki1.40 (1.40)Ukwahluka kakhulu kuzo zonke izifundo
    Ubukho bokuphazamiseka kwengqondo okuqhelekileyo (MINI)173 [35.1%]27.8%∼(Gustavson et al., 2018)
    Ubukho bokuphazamiseka kokulawulwa kwempembelelo (MIDI)55 [11.4%]10.4%(Odlaug kunye noGrant, ngo-2010)
    SCI-GD, iimpawu ezivunyiweyo1.1 (2.0)0.14 (0.8)Iqela labantu abadala abangapapashwanga (elizimeleyo).
    Barratt motor impulsivity23.8 (4.7)21.5 (4.0)(Reise et al., 2013)
    Barratt ingqalelo impulsivity16.9 (4.1)14.4 (3.5)(Reise et al., 2013)
    Barratt non-planning impulsivity23.7 (5.3)23.3 (4.6)(Reise et al., 2013)
    Padua OC iyonke amanqaku19.6 (44.2)46.8 (26.2)(Sanavio, ngo-1988)
    SST Stop-signal inhibition, msec181.5 (65.0)167.8 (48.6)(Chamberlain et al., 2006)
    CGT, amanqaku angcakaziwe (%)91.0 (1.3)65 (1.3)(UMannie et al., ngo-2015)
    CGT, ukwenza izigqibo ezinengqiqo (%)95.0 (0.1)99.0 (0.4)(UMannie et al., ngo-2015)
    CGT, uhlengahlengiso lomngcipheko1.53 (1.18)1.8 (0.1)(UMannie et al., ngo-2015)
    Iimpazamo ze-IED ED9.7 (10.2)10.3 (13.1) #(Chamberlain et al., 2006)

    Umbhalo osemazantsi weTheyibhile: Ushunqulelo: I-MINI = I-Inventory encinci ye-Neuropsychiatric Inventory; MIDI = Minnesota Impulse Disorders Inventory; I-SCI-GD = Yakhiwe Udliwano-ndlebe lwezonyango kuba ukungcakaza Ukuphazamiseka; OC = Obsessive-compulsive; SST = Misa-Umqondiso Umsebenzi; CGT = Umsebenzi weCambridge Gamble; IED = I-Intra-Dimensional / Extra-Dimensional Shift Task; ED = Iseti-shift eyongezelelweyo-dimensional. # Iimpazamo kwikhrayitheriya ebalwa ukusuka kulingo ukuya kwikhrayitheriya. ∼ Ukukhula uqikelelo kuyo nayiphi na ukuphazamiseka kwengqondo (ixhala, ngqondweni, okanye iiSUDs).

    Izikwere eziNcinane (PLS) ivelise imodeli yento enye (Umzobo 1), eyachaza i-17.8% yenguqu kwiinguqu ezichazayo, kunye ne-19.7% yokuhluka komgangatho wobomi. Ukuhlolwa kweeploti ezishiyekileyo kunye neequantiles zibonise ukuba zifanelekile kwaye azibalulekanga ngaphandle. Inkcazo yedemografi, iklinikhi, kunye nemilinganiselo yokuqonda eyayibalulekile kwimodeli ye-PLS ibonisiwe Umzobo 2.

    Umzobo 1.

    1. Khuphela umfanekiso ophakamileyo (241KB)
    2. Khuphela umfanekiso opheleleyo

    Ikhiwane. 1. Ekhohlo: Inxenye yentsalela yesambuku yesikwere (PRESS) yeploti, ebonisa ukuba elona nani leefektha ibenye. Ekunene: iploti yamanqaku engcaciso (X) ngokuchasene nomgangatho we ubomi Inqaku lenqaku (Y) ebonisa ukungena kakuhle.

    Umzobo 2.

    1. Khuphela umfanekiso ophakamileyo (278KB)
    2. Khuphela umfanekiso opheleleyo

    Ikhiwane. 2. Iziphumo zemodeli ye-PLS. I X i-axis idwelisa imilinganiselo yedemografi, yeklinikhi, kunye neyokuqonda eyayiqikelelwa kakhulu ngokwezibalo kumgangatho we ubomi. The y-i-axis ibonisa ukulayishwa kokuguquguquka ngakunye kwimodeli (+ ulayisho lubonisa umgangatho wobomi ombi; -ve ukulayisha umgangatho wobomi obungcono).

    IED: Umsebenzi we-Intra-Dimensional / Extra-Dimensional set-shift (iimpazamo ezongezelelweyo); CGT: Cambridge Gamble Task; I-SCIPG: i-maladaptive ukungcakaza amanqaku kwi Structured Udliwano-ndlebe lwezonyango kwiGambling Disorder; BISAI: Barratt ingqalelo ukunganyanzelekanga; BISMI: Barratt motor impulsiveness; I-BISNI: I-Barratt engacwangciswanga ngokungxama; MIDICB: Udliwano-ndlebe lwaseMinnesota Impulse Disorder Ukuphazamiseka kokuthenga okunyanzelekileyo; MDIDI: MIDI Ukuphazamiseka kwesiqhushumbisi; I-MIDIBED: MIDI Isifo sokutya okukutya kakhulu; etohdepabuse: alcohol sebenzisa ukuphazamiseka kwi-Mini International Neuropsychiatric Inventory; substdepabuse: Ukusetyenziswa kweziyobisi (ngaphandle kotywala) kwi-MINI; I-MINIAffectivecurr: Ukuphazamiseka kwemood; I-MINIAnxcurr: ingxaki yokuxhalaba; I-PTSD curr: ukuphazamiseka kwengxaki emva kokudandatheka.

    Kwimilinganiselo yedemografi, umgangatho ombi wobomi wanxulunyaniswa ne ubudala, nangaphezulu alcohol ukusetyenziswa ngeveki. Kwimilinganiselo yeklinikhi, umgangatho ombi wobomi wawunxulunyaniswa nobukho be ukuphazamiseka kokulawula impembelelo (ngokuthe ngqo ukungcakaza ukuphazamiseka, Ukuphazamiseka kokuthenga okunyanzelekileyo, Ukuphazamiseka kwesiqhushumbisi, isinyanzelo ukuziphatha ngokwesondo ukuphazamiseka kokutya, ukuphazamiseka kokutya kunye nokuphazamiseka kokutya), Ukusetyenziswa kweziyobisi (utywala okanye enye), nayiphi na Ukuphazamiseka kwemood, nayiphi na ingxaki yotywala, kunye ukuphazamiseka kwengxaki emva kokudandatheka. Ubudlelwane kunye nokuphazamiseka kokungcakaza kwakubalulekile kumlinganiso we-SCI-GD wokungcakaza ophazamisekileyo. uphawu. Ngemibuzo, amanqaku aphezulu kwiBarratt ukunganyanzelekanga isikali zayanyaniswa nomgangatho ophantsi wobomi. Kuba ukusebenza kwengqondo, i-extra-dimensional set-shifting impairment, kunye nokungabi nangqiqo ukwenza isigqibo (Uvavanyo lweCambridge Gamble), zombini zazinxulunyaniswa kakhulu nomgangatho ophantsi wobomi. Eminye imilinganiselo ye-X yomdla yayingengobaxhasi ababalulekileyo kwimodeli ye-PLS.

    4. Ingxoxo

    kusasa umdala lixesha elibalulekileyo, xa ulutsha lunokuthi lube sesichengeni okokuqala ukuya kwinqanaba ukuzimela kunye neendawo zokuthengisa ukuziphatha ngokungxama kunye nokunyanzeliswa (njengokufumaneka kwezinto eziphazamisa ingqondo okanye ukungcakaza amathuba). Olu phononongo luphonononge iindlela apho umgangatho we ubomi yayanyaniswa neendidi zamanyathelo anjalo kubantu abadala abancinci. Sasebenzisa ubuchule be ngokuyinxenye izikwere ezincinci, ehambelana neyona modeli ilungileyo echaza umahluko kumgangatho wobomi, ngokusekelwe kwiinguqu ezichazayo, ngokusebenzisekayo ukubalwa kobudlelwane phakathi kobudlelwane phakathi kwezinto eziguquguqukayo. Esona siphumo siphambili yayikukuba umgangatho wobomi ombi kakhulu wawusomelele kwaye unxulunyaniswa kakhulu nokungcakaza okungalungelelananga iimpawu, ngokungxama Ubuntu iimpawu kwiBarratt ukungafuneki isikali, silandelwe ngu ngqondweni, ixhala, yaye ukuphazamiseka kokusetyenziswa kweziyobisi. Kwakhona okunxulunyaniswa kakhulu nomgangatho wobomi ombi yayibubukho bokuqinisekileyo ukuphazamiseka kokulawula impembelelo (enyanzelekileyo ukuziphatha ngokwesondo ukuphazamiseka, Isifo sokutya okukutya kakhulu, ukuphazamiseka kokukhetha ulusu, Ukuphazamiseka kokuthenga okunyanzelekileyo, kunye nokuphazamiseka kokugqabhuka kwesiqhushumbisi) kunye notshintsho olubi ngakumbi olungaphaya kwemida, kunye ubudala.

    Loo mvakalelo, ixhala, kunye nokuphazamiseka kokusetyenziswa kweziyobisi kwakunxulunyaniswa kakhulu nomgangatho ombi wobomi kubantu abadala abancinci njengoko bekulindelekile. Uluntu impilo Impembelelo yezi ngxaki ibonwa ngokubanzi (Baxter et al., 2014, UPatel et al., ngo-2016). Iziphumo zethu zidlulela ngaphaya kwezi ziphazamiso ngokwesiko zamkelekileyo kwimpilo yengqondo ukuya kwindawo yokungxama kunye nokuziphatha iingxaki zomlutha, ezihlala zinganakwa zombini kwimbono yeklinikhi kodwa nakwimali yophando. Ingxaki yokungcakaza luluntu olukhulu inkxalabo yezempilo. Kwi uphononongo olucwangcisiweyo zoncwadi, ukuxhaphaka kwingxaki yokungcakaza kuqikelelwa ukuba yi-3.1% kwihlabathi jikelele (Ferguson et al., 2011). Uhlalutyo lwe-Meta lugxile kwizifundo eziqhutywe kwi abafundi beekholeji kufunyenwe amazinga aphezulu okuxhaphaka, ye-6% yokuphazamiseka kokungcakaza kunye ne-10% yokungcakaza okunengxaki (Ngo-2017). Apha, naliphi na inqanaba lokungcakaza okungahambi kakuhle (ngokusekwe kwinani lilonke leenqobo ze-DSM zokungcakaza kwengxaki evunyiweyo) yayanyaniswa nomgangatho wobomi obubi, njengoko kwakunjalo. ukuxilongwa yokuphazamiseka ukugembula ngokwayo. Oku kuphakamisa ukuba neendlela ezibuthathaka zokungcakaza okungacwangciswanga zinokuba neziphumo ezibi ezongezelelekileyo kumgangatho wobomi kubantu abadala abancinci - ngaphezulu kunezinye. ukuphazamiseka kwengqondo ezijongwa ngokubanzi kwiiklinikhi ezinje ngokuphazamiseka kweemvakalelo kunye noxinzelelo. Iimpawu zokungcakaza (inani leenqobo zokugweba ezivunyiweyo) libe nolona nxulumano lunamandla nomgangatho wobomi xa kuthelekiswa nezinye iinguqu ezivavanyiweyo, zibekwe ngendlela efanayo kakhulu njengeempawu zobuntu ezityhutyhayo ezilinganiswa kusetyenziswa isikali se-Barratt impulsivity.

    Ukuxilongwa kweDSM ye Ukuphazamiseka kwesiqhushumbisi, ukuphazamiseka kokutya kakhulu, kunye nengxaki yokuchola ulusu zonke ezo zinto zazinxulunyaniswa nomgangatho ombi wobomi. Idatha yangaphambili iyahambelana nesi siphumo. Ingxaki yokutya kakhulu eneneni yeyona ixhaphakileyo yokutya kwihlabathi jikelele (Kornstein, 2017). Uninzi lwabantu abanengxaki yokutya kakhulu banamava ukungasebenzi kakuhle ngakumbi kwindawo ye ukusebenza kwentlalo kodwa kwakhona, ukuya kwinqanaba elingaphantsi, ekhaya kunye izicwangciso zomsebenzi (Kornstein, 2017). Kanye neempembelelo zengqondo, ukuphazamiseka kokutya kakhulu kunokukhokelela ukunyanya, iswekile, yaye ukulala ukuphazamiseka, okunokondla kolu mgangatho wobudlelwane bobomi. Umgangatho wokukhubazeka wobomi ngaphambili wathelekiswa kwingxaki yokuchola ulusu, trichotillomania, kunye nolawulo olusempilweni. Omabini amaqela eklinikhi ayenomgangatho ophantsi wobomi kodwa kukho impembelelo yengqondo ngakumbi kwingxaki yokukhetha ulusu (Odlaug et al., 2010). Oku kunokubangela ukuba kutheni i-trichotillomania inganxulunyaniswanga kakhulu nomgangatho ophantsi wobomi kuhlalutyo lwethu; kodwa enye ingcaciso kukuba i-trichotillomania yayingaqhelekanga kwisampulu yethu. Kuphononongo lwakutsha nje, ababhali baqaphele ukuba kukho uphononongo oluncinci lwezenzululwazi malunga nokuphazamiseka kokugqabhuka kwangaphakathi, uninzi lwedatha epapashiweyo ivela kwindawo enye yophando. Kolunye uphononongo lokuqala lokuvavanya ukuphazamiseka koqhushumbo, uninzi lwabantu abachaphazelekayo luchaze lukhulu Ndezelo, ukuthotywa kwentlalontle, ukuphazamiseka emsebenzini, kunye neziphumo zomthetho (McElroy et al., 1998). Ngenxa yenkqubela phambili yamva nje yokuphuculwa kweendlela zokuxilonga kunye nophando lwe-neuroscientific (Coccaro, 2012), uhlolisiso lwangoku lubalaselisa imfuneko enkulu ngakumbi Ulwazi yale meko njengoko, kumava ethu, bambalwa oogqirha bezempilo yengqondo abakwaziyo malunga nesi sifo singasathethi ke ngokusijonga.

    Ezinye iziphazamiso ezininzi zolawulo lwempembelelo nazo zayanyaniswa apha nomgangatho ophantsi wobomi: ukuphazamiseka kokuziphatha ngokwesondo okunyanzelekileyo kunye nokuphazamiseka kokuthenga okunyanzelekileyo. Ezi meko azikaqatshelwa ngokucacileyo kwi-DSM, kodwa zifanele ukuqwalaselwa ngakumbi ukuba zifakwe kwiinkqubo zokuxilonga ezisekelwe kwiziphumo zangoku kunye neziphumo zangaphambili (Abamnyama, i-2001, I-Derbyshire kunye neGrant, 2015). Xa abantu abanengxaki yokuthenga ngesinyanzelo baye balandelwa kwiminyaka emihlanu, iimpawu zabo ziye zaphucuka kodwa azikancipha – okt kusenokwenzeka ukuba basenokungasebenzi kakuhle (Black et al., 2016). Okubangela umdla, kwisampulu enkulu yokufuna unyango yabantu abanengxaki yokuthenga ngokunyanzelekileyo, ngakumbi ephezulu comorbidity yabonwa ngokuziphatha okunyanzelekileyo ngokwesondo, kunye nokuphazamiseka kokuqhushumba okuphakathi (UNicoli de Mattos et al., 2016).

    Imilinganiselo Ukunyanzeliswa kungaqhutywa kungekuphela kwinqanaba leempawu zengqondo ezicacileyo kodwa nakwimbono yesiseko esiphakathi. phenotypes, njengemibuzo kunye novavanyo lwe-neurocognitive (Isibonelelo seGrant kunye neChamberlain, 2014, Stanford et al., 2016). Ngokuphonononga iinkqubo ezihambelana nengqondo yokusika kuzo zonke iziphazamiso zengqondo, kuye kwaxoxwa ukuba i-psychiatry iya kwenza indlela entsha yokuqonda ukuphazamiseka kwengqondo kunye nokunyanga (Insel et al., 2010). Kuwo onke amanyathelo avavanyiweyo, uBarratt ukunganyanzelekanga amanqaku esikali alayishwe phezulu kakhulu kwinto efihlakeleyo enoxanduva lokutshintsha komgangatho wobomi kwimodeli yesikwere esincinci esincinci; ngenene, impulsiveness non-ucwangciso kwesi sikali yaba yeyona inkulu determinant single umgangatho ophantsi wobomi kule sampuli. I-Barratt impulsiveness iluncedo njengomgqatswa ophakathi umakishi kwi-psychiatry ngenxa yokuba ibonakala inofuzo kakhulu (Niv et al., 2012) kwaye sele inxulunyaniswe nenani le zendalo (Grey et al., 2017, MacKillop et al., 2016).

    Amanye amanyathelo okuqonda aye anxulunyaniswa nomgangatho ophantsi wobomi, ukuya kwinqanaba elibalulekileyo kodwa elingaphantsi, ngakumbi umgangatho ombi kakhulu wobomi. ukwenza isigqibo kwiCambridge Gamble Task, kunye neempazamo zokutshintsha ezongezelelweyo kwi-Intra-Dimensional/Extra-Dimensional set shift shift. Le misebenzi ixhomekeke kwimfezeko ye-medial kunye iintambo zangaphambili zangaphambili ngokulandelelana (UClark et al., ngo-2004, IHampshire kunye no-Owen, 2006). Lilonke, iziphumo zihambelana nokuba abanye abantu bathambekele ekuthini ucingeleke, nto leyo enokubonisa ukungasebenzi kakuhle kwangaphambili. kwingingqi yengqondo, njengokuba ngenxa yotshintsho kwiindlela zophuhliso. Ngokuchaseneyo ne kulindela nangona kunjalo, asizange sifumane ubudlelwane obubalulekileyo phakathi komgangatho wobomi kunye uthintelo lokuphendula kulinganiswa ngovavanyo lwe-Stop-signal, olusetyenziswa ngokubanzi umlinganiselo we ukuthintela iimpendulo zeemoto ezinamandla kwangaphambili; okanye phakathi komgangatho wobomi kunye neempawu ezinyanzelekileyo njengoko zifakwe kwi-inventory yasePadua. Qaphela, uluhlu lwe-Padua lwenzelwe ukubamba iimpawu ezinyanzelekileyo endaweni yengcamango ebanzi yokunyanzeliswa. Kwixesha elizayo, izikali eziyilelwe ukubamba ngokupheleleyo ukunyanzeliswa kunceda ukuphononongwa ngokusondeleyo kweziphumo zotyekelo olusisinyanzelo olunjalo kumgangatho wobomi.

    Kufuneka kuqwalaselwe imida eliqela. Imodeli yeenkcukacha-manani yenza i-17.8% yokuhluka kwimilinganiselo yenkcazo, kunye ne-19.7% yokuhluka kumgangatho wobomi. Sivakalelwa kukuba oku kunokwenzeka ukuba kuhambelana neklinikhi, kodwa oku kuthetha ukuba uninzi lokwahlukana kwachazwa ngokwethiyori ngezinto ezingavavanywanga kolu phononongo. Oku akumangalisi, kuba umgangatho wobomi unokuthi unxulunyaniswa nentlalo, inkcubeko, uqoqosho, impilo yengqondo kunye nempilo yomzimba. Kumaphepha emibuzo kunye novavanyo lokuqonda, sigxininise kumanyathelo ahambelana nokunyanzeliswa, ukunyanzeliswa, kunye nokulutha; ngoko ke, umda weprojekthi wawuthintelwe. Olu yayingelovavanyo olupheleleyo lwayo yonke imiba yempilo yengqondo enokuthi ichaphazele umgangatho wobomi. Ubuchwephesha be-PLS buneenzuzo ngaphezu kweendlela zeenkcukacha-manani eziqhelekileyo (oko kukuthi ukuhlehla) kubuchule bayo bokuphatha ngokuqinileyo ulungelelwaniso kuzo zonke iinguqu ezichazayo nalapho kukho amanani amakhulu eenguqu ezicacisayo; nangona kunjalo, i-PLS inokuhoya ulungelelwaniso olufihlakeleyo (I-Cramer, ngo-1993). Uphononongo alukwazi ukujongana unobangela kuba ibinocando olunqamlezileyo kunelongitudinal ngokwendalo. Umsebenzi wexesha elizayo unako umgangatho wobomi bokufunda kunye nobudlelwane bayo neenguqu ezicacisayo ngokuhamba kwexesha, ukucacisa unobangela nesiphumo. Ubungakanani besampulu bunokunciphisa amandla. Njengoko kunokubonwa kwi Itheyibhile 1, isampulu yangoku ubukhulu becala ibinamanqaku aqhelekileyo/amazinga oncomelo xa kuthelekiswa nolawulo lwedatha kwenye indawo. Ngaphandle koku yayikukuba isampulu yayineempawu ze-OC ezisezantsi ngokwentelekiso kunye nokungcakaza okuphezulu kwamanqaku (iCambridge Gamble Task) kunye nokuqinisekiswa okuphezulu kweempawu zeDisorder yoNgcakazo kunokuba bekulindelwe ngokusekelwe kwezinye iinkcukacha eziqhelekileyo. Sikrokrela ukuba oku kungenxa yendlela yokugaya, ejolise kubantu abadala abaselula abangcakaza ubuncinane amaxesha ama-5 ngonyaka. Oku kunokunqanda ukufezekiswa kweziphumo kubemi ngokubanzi. Ekugqibeleni, asizange silinganise ubude bezifo ezahlukeneyo, kwaye ukunganyangeki iye yayanyaniswa neziphumo ezibi ezongezelekayo kumgangatho wobomi.

    Ngamafutshane, olu phononongo luqaqambisa ukuba iinkalo ezithile zokungangxami (ingakumbi utyekelo lobuntu olungxamisekileyo, kunye neempawu zokungcakaza okungacwangciswanga kunye nokuphazamiseka okuthile kokulawula impembelelo) zinobudlelwane obuluqilima nomgangatho ophantsi wobomi kubantu abadala abancinci. Obu budlelwane bubonakala buphawuleka ngakumbi nangaphezu kweemvakalelo, ixhala, kunye nokuphazamiseka kokusetyenziswa kweziyobisi. Ngenxa yokuba iingxaki ezingxamisekileyo zihlala zingahoywa kwimisebenzi yezonyango, idatha igxininisa ukubaluleka kokuhlolwa kweengxaki ezinjalo kunye nokungenelela ngenjongo yokwandisa umgangatho wobomi. Ulingo lwezonyango kufuneka kwakhona luthathele ingqalelo ukudibanisa imilinganiselo efana nesikali seBarratt kunye nezikali zokulinganisa ukunyanzeliswa xa sele ziphuhliswe kwixesha elizayo. Kuya kuba nomdla ukuqwalasela kumsebenzi wexesha elizayo ukuba ukungxamiseka kwenza umthwalo ongenakulinganiswa kumgangatho wobomi kumaqela ahlukeneyo obudala; kwaye eneneni ingaba ukungxamiseka kulutsha kunxulunyaniswa nomgangatho ombi wobomi ekukhuleni kwethuba, nokuba ukungxama kuyehla ngokuhamba kwexesha.

    Ukwamkela

    UGqr Grant ufumene izibonelelo zophando I-NIDA, IZiko leLizwe leMidlalo eliThembekileyo, American Foundation for ukuzibulala Uthintelo, kunye Ihlathi kunye neRoche Pharmaceuticals.UGqr Grant ufumana imbuyekezo ngonyaka Springer Publishingngokusebenza njengoMhleli oyiNtloko weJenali ye ukungcakaza Izifundo kwaye ifumene i-royalties kwi-Oxford University Press, i-American Psychiatric Publishing, Inc., Norton Press, Johns Hopkins University Press, kunye neMcGraw Hill. UGqr Chamberlain ucebisana neCambridge Cognition, Shire, Promentis, kunye ne-Ieso Digital Healthcare. Uphando lukaGqr. Chamberlain lwaxhaswa ngemali yiClinical Fellowship evela kwi Wellcome Trust (isalathiso I-110049 / Z / 15 / Z).

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    ✰Imiboniso yangaphambili: akukho.