Curr Behav Neurosci Rep. 2016; 3: 49-57 .
Ishicilelwe kwi-intanethi 2016 Feb 20. ikhonkco: 10.1007/s40473-016-0068-3
PMCID: PMC4769313
Abstract
Ulwakhiwo lokuqonda lubonelela ngesikhokelo sengqikelelo yeempawu ze-transpathological kunye nokuphuculwa kwephenotyping yamaqela engqondo ahlukeneyo. Le ndlela yokulinganisa ingasetyenziswa kuvavanyo lwabantu abaneziyobisi zokuziphatha, umzekelo, ekungcakazeni, imidlalo yevidiyo, i-intanethi, ukutya, kunye nesondo, evumela ukusebenza kokusilela okungundoqo. Sisebenzisa le ndlela ukuphonononga ulwakhiwo olunje ngokungxama, ukunyanzeliswa, kunye nommiselo woqwalaselo, olunokuthi lube yeyona nto ifanelekileyo, isebenzayo, kwaye iphumelele ekuqondeni kunye nonyango olulandelayo lweziyobisi.
intshayelelo
Ukuqondwa kweziyobisi ezinganxulumananga neziyobisi, umzekelo, malunga nokungcakaza, imidlalo yevidiyo, i-intanethi, ukutya, kunye nesondo, zikhula ngokukhawuleza ngenxa yokwanda kobungqina bokuphazamiseka okuqhelekileyo okunxulumene nokuphazamiseka kokusetyenziswa kweziyobisi (SUD).) [1, 2]. Uvavanyo lokuqonda kumlutha wokuziphatha luvumela ukubonakaliswa kwe-trans-pathological yentsilelo enqumla ukuxilongwa kunye ne-phenotypes, ibonelela ngenoveli kunye neendlela ezifikelelekayo zokwahlulahlula kunye nokunyanga amaqela ahlukeneyo.
Isidingo sokuchaza kunye nokwahlula ukuphazamiseka okunjalo kunye neempembelelo zengqondo yengqondo ngundoqo kwindlela esebenzayo yokuxilongwa kunye nonyango lweziyobisi zokuziphatha. Indlela enokubakho ethembisayo eya kuphawu olunjalo kungolwakhiwo lwengqiqo, izikhokelo zengqikelelo ezidlula iindidi zokuphazamiseka ngokubaluleka koxilongo [3]. Le ndlela, isebenzisa izakhiwo ezinjengokutsalwa, ukunyanzeliswa, kunye nommiselo wokuqwalasela, inokuba yeyona nto ifanelekileyo, isebenzayo, kwaye iphumelele kwiziyobisi [3-5]. Ugxininiso lwephepha langoku kukuphonononga olu lwakhiwo lwengqondo kumlutha wokuziphatha, ngokuthelekisa ne-SUD, ukuze kusekwe nakuphi na ukufana kunye nazo naziphi na iimpawu ezahlukileyo kuzo.
Siye saphanda ePubmed (http://www.ncbi.nlm.nih.gov/pmc/) ngala magama ophando alandelayo: ukungcakaza ngezifo okanye imidlalo ye-pathological okanye ingxaki yokudlala, kunye nokuqonda, inkumbulo yokusebenza, ukufunda, inkumbulo, ukucwangcisa. Ukuziphatha okunyanzelekileyo ngokwesondo kwakhangelwa ngokwahlukeneyo, kwaye ukuphazamiseka kokutya kakhulu kujongwa ngokufutshane.
uhlelo
I-Pathological gambling (PG) yaba likhoboka lokuqala lokuziphatha elibandakanyiweyo njengokuphazamiseka okuzimeleyo kwi-Diagnostic and Statistical Manual of Mental Disorders (DSM) ngo-1994.6], ukuphazamiseka okunyanzelekileyo (OC), okanye ukungalungi kweziyobisi [7], kodwa izifundo ezalandelayo zabonisa ukufana nokuphazamiseka kokusetyenziswa kweziyobisi (SUD) [8] phezu kokuphazamiseka kwe-OC spectrum [9]. Uhlalutyo lwe-meta lubonise unxulumano olomeleleyo phakathi kweempawu ze-PG kunye ne-OC kunokuphazamiseka kwe-OC (OCD) [10], eqinisekisa ukwahlulwa kwayo okucetyisiweyo njengekhoboka lokuziphatha [8]. Ewe, kutsha nje, i-DSM-5 ibandakanye ukuphazamiseka kokungcakaza phantsi kokuphazamiseka okunxulumene neziyobisi kunye nomlutha.
I-Intanethi- kunye nokuziphatha okunxulumene nomdlalo kuya kuqondwa ngakumbi kodwa akuzange kufakwe kwi-DSM-5 njengoko kufunwa umlinganiswa ongakumbi [11]. Nangona kunjalo, ngelixa umlutha onxulumene ne-intanethi kunye nomdlalo ungaqatshelwa kakuhle, impembelelo yabo yangoku iphezulu. Uphononongo lwe-epidemiological yokusetyenziswa kwe-intanethi e-USA lubonise ukuba phakathi kwe-3.7 kunye ne-13% yabaphenduli badibana neendlela zokusetyenziswa kwe-intanethi ingxaki. [12]. Ukusetyenziswa komdlalo wevidiyo we-Pathological kubonakala kuxhaphake kakhulu kubantu abancinci, phantse kathathu ukuxhaphaka kolutsha [13], ukufikelela kwi-8-9.3 % yabafikisayo/abancinci abadala e-USA naseJamani [14, 15]. Ngenxa yokugqithiselana phakathi kokulutha kwi-intanethi, ukuba likhoboka lemidlalo ye-intanethi, kunye nokulutha kwemidlalo yevidiyo, ezi ndlela zokuziphatha zixoxwe kunye kolu phononongo.
Ukuziphatha okunyanzelekileyo malunga nokutya kunye nokwabelana ngesondo kujikeleze umvuzo okhoyo ngokwendalo kokusingqongileyo. Ngenxa yoqwalaselo lokuba ukwabelana ngesondo kusebenze imimandla yobuchopho efanayo kunye neenkqubo ze-neurotransmitter njengeziyobisi zokuxhatshazwa, ukuba likhoboka lezesondo kwakucingelwa ukuba sisifo sokuxhomekeka kwangoko [16, 17[18]), ilungele imiqathango yokukhotyokiswa ngokufanelekileyo [19]. Igama elithi compulsive sex behaviour (CSB) layilwa ngo-1985 [20] kwaye kwafunyaniswa ukuba luphawu oluzinzileyo [21], ekwahlulwayo kwisenzo sesondo esisempilweni esinokuguqulwa ngempumelelo ngonyango lwengqondo [20]. Ngelixa kungekho kuvunyelwana ngengcaciso ye-CSB [22], ezinye iindlela zokuxilonga ziye zachazwa, kubandakanywa ukuqonda okuphindaphindiweyo ngokwesondo kunye nezibongozo ezikhokelela ekubandezelekeni okanye impilo, intlalo, okanye iindleko zoqoqosho.s [22-25]. Okokugqibela, ukuziphatha okunyanzelekileyo ukuya komnye umvuzo wendalo, ukutya, kuvela kukuphazamiseka kokutya (BED), okuphawulwa ngamaxesha okutya okukhawulezayo ngaphandle kokucocwa kwaye kuqhelekile kodwa kungasoloko kunxulunyaniswa nokutyeba. Iinkqubo zokuqonda kwi-BED zisandula ukuphononongwa [26] kodwa iziphumo eziphambili zibandakanyiwe apha.
Iimpawu zakudala zokulutha
Iimpawu zePhysiological zokulutha ezifana nokunyamezelana kunye nokurhoxa ziimpawu ezibalulekileyo ze-SUD, kwaye ukunikezelwa kweziganeko ezinjalo kumlutha wokuziphatha kuya kuchaphazela iinkqubo ekwabelwana ngazo nge-neuroadaptive okanye ye-psychopathological. Nangona kunjalo, kusekho ubungqina obuncinci obubonisa iimpawu ezinjalo kumlutha wokuziphatha. Obunye ubungqina obubambekayo buvela kwizifundo ze-PG, ngakumbi ukunyamezelana, ukurhoxa, ukunqwenela, ukunciphisa ulawulo, kunye nokuphazamiseka komsebenzi obalulekileyo (owobuqu, wosapho, kunye/okanye womsebenzi).s [7]. Abantu abane-PG bafumana iimpawu zokurhoxa (kubandakanya ukungazinzi, intloko ebuhlungu, kunye nokucaphuka) [27, 28], kumanqanaba athelekisekayo kubantu abanengxaki yokusebenzisa utywala (AUD) [27]. Kwakhona, i-91% yesampulu ye-222 PG ababecotha okanye beyeka imikhwa yokungcakaza bachaze "iminqweno" eyayingadibani notywala obunxilisayo okanye ukusetyenziswa kweziyobisi [28]. Ukunqwenela kwi-PG [29] inokunxulunyaniswa nokudakumba [30], enokuthi ibonise impembelelo yokuqinisa okungalunganga, inkqubo ehlala icetyiswa ukuba ibe phantsi kweziyobisi [31]. Ngokuphathelele ukunyamezelana, abantu abane-PG babonisa utshintsho kwiimpendulo zesantya sentliziyo kwimisebenzi yokungcakaza [32] kunye nengxelo ekhulayo yamanqanaba ongcakazo okanye ubungakanani bokubheja ngokuhamba kwexesha [27]. Esi siphumo samva sanxulunyaniswa nenjongo yokwandisa amathuba okuphumelela kunokunyusa okanye ukugcina amanqanaba olonwabo [27], icebisa ukuba ukuziqhelanisa nenkuthazo kweli qela kunokwahluka kwi-SUD.
Kukwakho nobungqina bokunyamezelana, ukurhoxa, kunye neengxaki zosapho kunye nezentlalo kulutsha oluhlangabezana nemigaqo yokulutha okunxulumene ne-intanethi xa kuthelekiswa noontanga abangenalo ikhoboka. [33]. SImilinganiselo ye-elf-exeliweyo yokunyamezela kunye nokurhoxiswa okuhambelana nokusetyenziswa kwe-intanethi kubantu abadala abaneminyaka ekholejini kubonakala kuphezulu kwabo babandakanyeka ekusebenzeni kwentlalo kwi-intanethi.e [34]. Nangona kunjalo, ubungqina obuninzi obunamandla ngokuqinisekileyo bunqongophele kweli qela [35]. Intsingiselo yonyamezelo kunye nokurhoxa kwi-BED ihlala i-anecdotal [36]; nangona kunjalo, Uphononongo lwakutsha nje lubonise ukuba malunga nesiqingatha sesampulu ye-81 yezigulane ezityebileyo ze-BED zadibana neendlela zokunyamezela kunye neempawu zokurhoxa kwisikali se-Yale sokulutha kokutya. [37], icebisa amaqela angaphantsi anokubakho anobuqatha obahlukeneyo.
Ukuziphatha kokuxhomekeka kwiziyobisi kunye nokungaxhomekeki kwiziyobisi kubonakala ngathi kubuthathaka okwabelwanayo [38], kunye ne-maladaptive, ukuziphatha okungaguqukiyo luphawu lwezo zombini [39, 40], ngokufuthi ukuphazamiseka okubalulekileyo kwimizamo yobuqu [41] kunye nelahleko yemali okanye yezentlalo [42]. Nokuba ndinobu bungqina bukhulayo bokufana phakathi kweziyobisi kunye neziyobisi ezinganxulumananga neziyobisi (ubuncinci kwi-PG), izifundo ezongezelelekileyo zobungqina kunye nokudibanisa zisafuneka, ezithi xa zidibene ziqaqambise amacandelwana aqatha kunye nezicwangciso zonyango ezinokuthi zibekho.
Cognition
Ukuphazamiseka ekusebenzeni kwengqondo kwimikhwa yokuziphatha ayisoloko ibonakala ihambelana. Abantu abane-PG babonakalise ukuphazamiseka ekuguquguqukeni kwengqondo kunye nocwangciso [43, 44] kodwa kukho neengxelo zokungabi nantlukwano xa kuthelekiswa ne-HV kwimilinganiselo efanayo [45]. Ngaphaya koko, uthelekiso oluthe ngqo lwe-PG kunye ne-SUD (ukuxhomekeka kotywala) lubonise ukonakala kwinkumbulo yokusebenza kwi-SUD kodwa hayi i-PG ecetyisiweyo ukuba inxulumene nokuvezwa kotywala [46].
Oku kuqaqambisa imfuneko yokuqhubela phambili umzobo ongaphantsi kokwenza iinkqubo zecandelo lengqiqo entsonkothileyo, mhlawumbi ngokwahlula iimpembelelo zamacandelo omsebenzi wolwakhiwo. Koku kulandelayo, sivavanya ngokwahlukeneyo iindima zokuthathela ingqalelo, ukungxama, kunye nokunyanzeliswa. Ezi zakhiwo zintathu ziboniswe kwiFig. 1, apho umlutha wokuziphatha ngamnye ubekwe ngokusekelwe kuthintelo olwaziwayo.
Ingqalelo yokuthathela ingqalelo
I-SUD ihlala iphawulwa ngokuthambekela kokuthathela ingqalelo kwiimpawu zeziyobisi, ukuphazamiseka okuququzelela ukunqwenela ngomjikelo, ngendlela yokuzisasaza. [47]. Ubudlelwane phakathi kokuthathela ingqalelo ingqalelo kunye nokunqwenela kuhlala kuhleli nangona imeko yonyango [48]. Ukuphazamiseka kommiselo wokuqwalaselwa kwakhona kubonakala kufanelekileyo kulo lonke uluhlu lweziyobisi zokuziphatha. Abantu abane-PG bobabini bayazixela [49] kwaye ubonise ukuthomalalisa kwiinkqubo zoqwalaselo oluphezulu [50, 51]. Ngokufana ne-SUD kunye nokusetyenziswa kwemidlalo ye-pathological, le ntsilelo inokubonisa utshintsho kwingqwalasela, njengoko abantu abane-PG bebonisa umkhethe kwaye bagcine ingqalelo ekungcakazeni [52]. Kukwakho nobungqina bokuthathela ingqalelo kwangethuba kwiindlela zokutya kwi-BED, kunye nobunzima bokungazibandakanyi kwizinto zokutya, nangona isiphumo sokugqibela sikwabonwa nakubantu abasempilweni [53]. Ukuthambekela ingqalelo kwimpembelelo enxulumene ne-intanethi kuye kwaxelwa kubantu abanomlutha womdlalo we-intanethi [54], kunye ne-CSB inxulunyaniswa nokuthathela ingqalelo kwangaphambili kwimifanekiso engcolileyo ngokwesondo [55]. Ke, into eqhelekileyo enempembelelo yokuthathela ingqalelo into ethile yokuphazamiseka ibonakala ibonakalisa kuzo zonke ezi ziphazamiso zokuziphatha.
Ngelixa ubudlelwane phakathi kokuthambekela kokuthathela ingqalelo kunye nokulangazelela kusaza kuphononongwa kuyo yonke iziyobisi zokuziphatha, ulwazi olusuka kwizifundo ze-SUD lucebisa ikhonkco eliqinileyo phakathi kwezi zinto zimbini, ebandakanya indlela eya kwindlela yokuziphatha kwe-pathological, ngakumbi eqhutywa yinkuthazo. Kunzima kolu phando, nangona kunjalo, ukufumanisa ukuba ngaba ukuthambekela kokuqwalaselwa kwangaphambili kukho ukuphazamiseka okanye kuququzelelwe ngabo, nangona ubungqina obuvela kuncwadi lwe-SUD bucebisa okokugqibela [47]. Ngokuhambelana noku, ukuguqulwa kweengqwalasela ezithintekayo ukuphambukisa izibonelelo zokuqwalasela kwi-stimuli yeziyobisi kuye kwaba nemiphumo ethembisayo kunye nekliniki efanelekileyo [56, 57], enempembelelo ethile ekunqweneleni iintshayi [58], nangona i-generalization yoqeqesho lwengqwalasela ingacacanga ngoku [59].
Impulsivity
Impulsivity, ukutyekela ekuziphatheni okukhawulezayo, okungacwangciswanga okuqhawule umtshato kuqikelelo olwaneleyo kwaye kwenzeke ngaphandle kweziphumo ezibi ezinokuthi zibekho, kubhalwe kakuhle kulo lonke uluhlu lwezifo zengqondo, kubandakanya i-SUD [60, 61]. Ukuziphatha okungxamisekileyo ngoku kukwaboniswa kwiziyobisi zokuziphatha, kubandakanywa amaqela ahlukeneyo abantu abane-PG [43, 45, 62], ingxaki yokungcakaza [63], kunye ne-BED [26]. Ukunyanzeliswa kokuzixela ngokwakho kusebenza njengomngcipheko womdlalo we-pathological kwizikolo zamabanga aphantsi nakwisekondari eSingapore [64] kwaye inxulunyaniswe nobungqongqo bokungcakaza kwi-PG ebanjwe yi-PG-YBOCS [65]. Ukuzixela ngokwakho ukunyanzeliswa kunokuba phezulu kwi-PG xa kuthelekiswa naleyo ye-SUD [66].
Ukutsaleleka kunokuboliswa ngakumbi kulwakhiwo oluninzi kodwa oluhlala ludibana, lugcinwe ziinkqubo ze-neural dissociable [61]. Ngokufutshane, ukunyanzeliswa kwemoto kuchaza amandla okuthintela impendulo okanye ukurhoxiswa kwesenzo; Ukunyanzeliswa kwesigqibo kuchaza ukhetho olungxamisekileyo, oluhlengahlengiswayo mhlawumbi ngenxa yempembelelo, okanye ukusilela, kobungqina bangaphambili (ukucinga okubonakalayo) okanye iimpawu zexeshana zesiphumo (ukulibazisa isaphulelo); kwaye okokugqibela, ukungxama kokulinda kuchaza ukuthambekela ekuphenduleni kwangethuba elibi. Oku kungafaniyo kucebisa ukuba kunokubakho iinkcazo ezahlukeneyo kuzo zonke iziphazamiso [61].
I-Motor impulsivity inokubanjwa kunye nomsebenzi we-Go / NoGo okanye umsebenzi wesignali yokuyeka (SST), apho iimpendulo zivinjelwe ngaphambi okanye emva kokuqaliswa kwempendulo, ukumakisha ukuthintela isenzo okanye ukucinywa kwesenzo, ngokulandelanayo. Abantu abane-SUD babonisa ukusebenza kakubi kuyo yomibini imisebenzi ye-SST kunye ne-Go/NoGo, egxininiswe luhlalutyo lwe-meta olubonisa iintsilelo ngokukodwa kwizivuseleli kunye ne-nicotine kodwa hayi i-opioid okanye ukusetyenziswa kakubi kwe-cannabis [67•,, 68]. Izifundo zokunyanzeliswa kweemoto kwi-PG zibonise iziphumo ezixubeneyo. Ukusebenza kakubi ngexesha lomsebenzi we-Go/NoGo kuye kwaxelwa [69] kananjalo akukho mahluko kulawulo olusempilweni kumsebenzi omnye [67••]. Ngokufanayo, izifundo ezininzi zichaze ukunqongophala kwawo nawuphi na umahluko ngexesha le-SST xa kuthelekiswa nolawulo olunempilo [70-72] nangona uhlalutyo lwamva nje lwemeta lufumene isiphumo esiphakathi-esikhulu sokungasebenzi kakuhle kwi-SST kubangcakazi [67••]. Ukusukela ukuba eli qela libonisa ubunzima ekubhaqweni okujoliswe kuko ngexesha lomsebenzi weGo/NoGo [69] kwaye Hamba ixesha lokuphendula ngexesha le-SST [67••], ezinye zezi ziphumo zinokunxulunyaniswa nokungakhathaleli [67••]. Abadlali bevidiyo be-Pathological kuxelwe ukuba abanangxaki kwi-SST [73]. Okubangel 'umdla kukuba, ngelixa abadlali beengxaki babonakala bencitshisile ulawulo lokuthintela kumsebenzi weGo/NoGo [63], abasebenzisi be-intanethi be-pathological baye baboniswa ukuba bachaneke ngakumbi kumsebenzi ofanayo xa kuthelekiswa ne-HV [74]. Ke ngoko, kufuneka kuthathwe ukhathalelo malunga nokufezekiswa ngokubanzi kwenkqubo yekhompyuter esetyenzisiweyo ngokugqithisileyo kwiimvavanyo zaselabhoratri, isiphumo esiqinisekisa uphando olongezelelweyo. Indima yokubaluleka kwenkuthazo ye-stop cue nayo ibaluleke kakhulu; abantu abane-BED babonisa ukusilela okungaguqukiyo kwi-Go/NoGo kunye ne-SST kodwa kuphela kumxholo wokutya, kungekhona nge-stimulus engathathi hlangothi [75, 76]. Ke, uthintelo ekuthinteleni ukuphendula akubonakali ngathi kujongwa ngokufanayo kuzo zonke iindlela zokuziphatha, kwaye ezinye iiyantlukwano ezibonisiweyo zinokunxulumana nezakhono ezongezelelweyo zeemoto.
Kwi-PG, i-BED kunye nemidlalo ye-pathological, ubungqina obuvelayo bucebisa ukuba intsilelo kwi-impulsivity ibalasele ngaphakathi kwemimandla yokwenza izigqibo. Abantu abanePG [49, 77-79], IBED [80, 81], kunye nomdlalo wezifo [73] isaphulelo semivuzo elibazisiweyo ukuya kumlinganiselo omkhulu kunolawulo olusempilweni, okuthetha ukuba imivuzo emincinci, ekhawulezileyo iyakhethwa kunemivuzo emikhulu, elibazisiweyo. Nangona isiphumo esifanayo sibonakalisiwe kubantu abaneengxaki zokulutha kwiziyobisi zokusetyenziswa kakubi [68, 82, 83], olu thintelo lusenokubonakala ngakumbi kubantu abane-PG. Umzekelo, abantu abane-PG babonisa isaphulelo esiphakamileyo sokulibaziseka xa kuthelekiswa nabantu abaxhomekeke kwi-cocaine [84], kunye nokungcakaza ubukhali sisibikezelo esinamandla somlinganiselo wesaphulelo kunembali yokusetyenziswa kweziyobisi okanye omnye umlinganiselo ozixelileyo wokungxama [85]. Ukulibaziseka kwesaphulelo kubonwa ngokufanayo kwizifundo ezityebileyo kunye nangaphandle kwe-BED, nangona kwizifundo ezityebileyo ezinesalathiso sobunzima bomzimba, abo bane-BED babonisa isaphulelo esikhulu kuyo yonke imali, umvuzo wokutya, kunye nexesha lokuthambisa [81], ebandakanya ukuthomalalisa kwisigqibo sesigqibo kuzo zonke iintlobo zomvuzo [86]. Kufuneka kuqatshelwe ukuba abantu abane-PG babonisa ubunzima ekuboneni ixesha ngokuchanekileyo [43], into enokuthi ngokuqinisekileyo ibe negalelo kwizigqibo eziphathelele kwiziphumo ezilibazisekayo kodwa zivavanywe ngokuthe ngqo.
Ubungqina obungakumbi bokuthomalalisa kwimpembelelo yesigqibo buvela ekusetyenzisweni komsebenzi wesampulu yolwazi (IST), elinganisa ukuthambekela kwisampulu okanye ukuqokelela ulwazi ngaphambi kokwenza isigqibo [46]. Abantu abane-PG kunye ne-AUD babonisa ukonakala kulo mlinganiso wokubonisa impembelelo [46], ukuqaqambisa iintsilelo ekwabelwana ngazo kuzo zonke izinto ezinxulumene neziyobisi kunye nokuziphatha. Abadlali be-pathological ngokufanayo babonisa ubungqina obuncinane bokuqokelelwa phambi kwesigqibo kwi-IST [73] kunye namaso amancinci azotywe phambi kwesigqibo kumsebenzi wamaso [87].
Kukho izifundo ezimbalwa ezivavanya ukungxama kokulinda ebantwini abanokuziphatha kakubi. Nangona kunjalo, ingxelo yamva nje esebenzisa inoveli yokuguqulela umsebenzi wokuvavanya iimpendulo zangaphambi kwexesha ayifumananga mahluko phakathi kwabantu abane-BED kunye nolawulo olutyebileyo ngelixa abantu abaxhomekeke, utywala kunye nabaxhomekeke kwi-nicotine bakhubazekile [88]. Abadlali bevidiyo be-Pathological benza iimpendulo zangaphambi kwexesha xa kuthelekiswa nolawulo olusempilweni kodwa kuphela kumxholo wokusetyenziswa kwe-nicotine ye-comorbid [73]. Ngelixa ukunyanzeliswa kokulinda kubonakaliswe ukuba kuphazamisekile kulo lonke uluhlu lwe-SUD, iziphumo zinokuthi zixhomekeke kurhulumente weziyobisi, njengoko abo bebesatshaya bebonisa amanqanaba aqhelekileyo eempendulo zangaphambi kwexesha [88]. Izifundo ezongezelelekileyo kwi-PG kunye ne-CSB ziyimfuneko phambi kokuba ubungakanani bobukhulu bokulinda ukungxamiseka kuzo zonke iziphazamiso zokukhobokisa buqondwe kakuhle.
Okwangoku kukho ubungqina obuncinci bobungqina bokusilela kwi-impulivity kubantu abane-CSB [22]. Ukusebenzisa udliwano-ndlebe lweklinikhi olucwangcisiweyo, iimpawu zokunyanzeliswa zifunyenwe zixhaphake kwisampulu yamadoda angama-23 kunye nabasetyhini be-2 abaye bahlangabezana neendlela ze-CSB [89], kunye nophononongo lwakutsha nje lubonise ukuba i-CSB iyazixela ngokwamanqanaba aphezulu okuchukumiseka [55].
Ukuguquguquka kwengqondo kunye nokunyanzeliswa
Imilinganiselo yokuguquguquka kwengqondo inokugqamisa ukuthembeka kwemisebenzi yesigqeba kunye negalelo elinokubakho lokukhetha okunyanzelekileyo kwindlela yokuziphatha ye-pathological. Ukuguquguquka kwengqondo kuye kwavavanywa kunye nomsebenzi wokuhlelwa kwekhadi leWisconsin (WCST) kunye ne-intra-dimensional extra-dimensional (IDED) yokumisela umsebenzi wokutshintsha. I-WCST isebenzisa imigaqo eguqukayo efuna ukutshintshwa okuguquguqukayo kokhetho ebusweni bempendulo echanekileyo okanye engalunganga, apho umlinganiselo ophambili uyimpazamo eqhubekayo (ukusetyenziswa okuqhubekayo komgaqo ofanayo nangona ingxelo embi, ebonisa ukunyanzeliswa) okanye ubunzima ekutshintsheni umsebenzi kunye nokulawula inhibitory. . Umsebenzi wokutshintsha we-IDED uhlola ukugcinwa kweseti yengqwalasela kunye neseti yeengcamango, ebonisa ukutshintsha kwengqondo okanye ukuguquguquka.
Ukusebenza kuzo zombini i-WCST kunye ne-IDED kwi-SUD ayihambelani. Abantu abaxhomekeke kwi-Cocaine bayazingisa kwi-WCST kodwa kuphela ngexesha lokuqala lokutshintsha [90]; nangona kunjalo, abaxhaphazi beziyobisi ezininzi babonakaliswe ukuba abahlukanga kulawulo olusempilweni [91]. Akukho monakalo ucacileyo kwi-WCST ekuxhomekeke etywaleni [92, 93] kodwa utywala obunxilisayo buyaziphucula iimpazamo zogcino kubantu abasempilweni [94]. I-Amphetamine kodwa abasebenzisi be-opioid babonisa ukuphazamiseka kwinqanaba elibalulekileyo lokutshintsha kwe-ED yomsebenzi we-IDED [95], nangona le mpembelelo ayizange iphindwe kuphononongo lwamva nje [96].
Kukho ukungangqinelani okufanayo kumaqela amakhoboka okuziphatha. Nangona kunqongophele, ubungqina buchaphazela uthintelo ekusetweni kwe-BED [97•], kunye neempazamo eziphezulu zokuzingisa kwi-WCST xa kuthelekiswa nabantu abangatyebe kakhulu kwi-BED [98] kunye neengxaki zokulondoloza iseti xa kuthelekiswa nolawulo olutyebileyo [98] kunye nabantu abane-anorexia nervosa [99]. Nangona kunjalo, i-WCST ivelise iziphumo ezingangqinelaniyo phakathi kwabantu abane-PG. Zombini iimpazamo eziphuculweyo zokunyamezela kubafazi bePG [100] kunye nokungabikho komehluko kulawulo olusempilweni [101, 102] zibonisiwe. Ukonyuka kweempazamo ezinganyamezelekiyo kuye kwaxelwa kwi-PG ngexesha le-WCST, icebisa ukuba uthintelo olujongweyo lusenokungachaneki ngokuthe ngqo kwi-seti-shift kodwa ngaphezulu kokungasebenzi kakuhle kwengqondo. Abantu abane-PG babonakala bephazamisekile kumsebenzi we-IDED [103], ephucula ngoncedo lwe-pharmacological (memantine) [104].
Ngelixa uncwadi lwentsebenzo kwimisebenzi yokuguquguquka kwengqondo kubantu abane-intanethi okanye ukukhotyokiswa kwemidlalo kunqabile, kukho ubungqina bokuphazamiseka kwi-set-shifting xa kufuneka kwenziwe utshintsho phakathi kokungathathi hlangothi kunye nomdlalo ohambelana nomdlalo [54] ecebisa isiphumo esithile senkuthazo endaweni yokusilela ngokubanzi kwisethi yokutshintsha. Ewe, uphando lwakutsha nje alufumananga mahluko phakathi kwabantu abanomlutha we-intanethi kunye nabantu abasempilweni ngexesha lomsebenzi we-IDED [105•].
Olunye uvavanyo lokuziphatha okuguquguqukayo okanye ukhetho olunyanzelekileyo ngumsebenzi wokufunda umva womva (PRR), apho uhlaziyo lokhetho luxhomekeke kutshintsho okanye ukuguqulwa kweemeko ezilindelekileyo zeziphumo zovuselelo ezifundiweyo. Abantu abaxhomekeke kwi-Cocaine abanakukwazi ukubuyisela umva ebusweni be-stimulus eyavuzwa ngaphambili, ubukhulu becala bazingisa ukufumana umvuzo [106]. Nangona kunjalo, i-amphetamine, i-opiate [106], kunye nicotine [107] ukuxhomekeka akuzange kudityaniswe nolu thintelo. Ukubuyisela umva uthomalaliso kubonisiwe kwi-PG kuwo omabini umvuzo [62, 102, 107] kunye nelahleko [107] iziphumo. Kuba iPG ibonisa ukusebenza okuqhelekileyo kwi-WCST [102], oku kusenokubangelwa nokuba ngumahluko ongaphakathi kwisethi yokutshintsha kuthelekiswa nokufunda umva (umzekelo, ukusebenzisa i-dorsolateral xa kuthelekiswa ne-orbitofrontal substrates ngokulandelelanayo) okanye umahluko kwiziphumo ezikhuthazayo phakathi kwale misebenzi mibini: iPRR isebenzisa iziphumo zemali kodwa iWCST ayenzi [102]. Ewe, uphononongo lwamva nje lwemeta lufumene unxibelelwano phakathi kwe-PG kunye nokunyamezela kwimisebenzi yemali ngaphandle kocwangciso olululo [108]. Oku kubonisa umahluko onomdla kufundo lwePG. Ngokungafaniyo nolunye umlutha, imisebenzi yokuqonda esetyenziswa rhoqo kuphando ihlala isebenzisa eyona nto yokulutha kwi-PG: imivuzo yemali. Ukuba iPRR isebenzise i-cocaine cues okanye imbuyekezo yokuxhomekeka kwe-cocaine okanye imbuyekezo yokutya kwi-BED, ukonakala ekubuyiseleni umva kunokuba kuxhaphake ngakumbi.
Ukunyamezela ngexesha le-PRR kwingxaki yokungcakaza inxulunyaniswa nokuncipha kovakalelo kumvuzo kunye nelahleko [107], kunye nokunyamezela ukufumana umvuzo ngokukodwa kuye kwaboniswa kunye nomsebenzi wokudlala wekhadi, apho ukhetho olwaluvuzwa ngaphambili kufuneka luthintelwe; I-PG iyaqhubeka nokudlala ixesha elide ngaphandle kokutshintsha ukusuka kwiziphumo ezinomvuzo ukuya kwilahleko [109]. Ke ngoko, umvuzo wemali ubonakala unefuthe kwi-PG, kwaye ukonakala kokuguquguquka kwengqondo kufuneka kuthathelwe ingqalelo ngokweemvakalelo zomvuzo ngakumbi kweli qela.
Ngelixa kukho izifundo ezimbalwa kakhulu ezivavanya ukunyanzeliswa kusetyenziswa le misebenzi kwi-CSB, ubungqina obuvela kudliwano-ndlebe olulungelelanisiweyo bukwacebisa iimpawu ezinyanzelekileyo kweli qela [89] kodwa izifundo ezongezelelweyo zisafuneka. Ukujonga ukungangqinelani kwi-SUD, kubonakala ngathi le milinganiselo ikhethekileyo yokunyanzeliswa okanye ukhetho olubhetyebhetye ayinakuthabatha ukonakaliswa okungaguqukiyo okanye olomeleleyo kumlutha wokuziphatha, nangona ukonakala kuguquko lwengqondo ngokubanzi kwi-BED kunye nomvuzo wokuzingisa kwi-PG.
I-Comorbidity kunye ne-Heterogeneity
Kubalulekile kuphuhliso lweempawu ezicacileyo zazo zonke iziyobisi, i-PG ngoku isebenza njengemodeli efanelekileyo, engenabutyhefu yokulutha [110]. Nangona kunjalo, kwi-PG [7, 111], kunye ne-CSB [25], ukuhambelana ne-SUD kuphezulu. I-SUD yabelana ngokudibana kwemfuza ephezulu kunye ne-PG [111], kunye nomngcipheko wokuxhomekeka kotywala obangela i-12-20 % yokwahluka kofuzo kumngcipheko we-PG, kugxininisa izinto eziqhelekileyo eziqhelekileyo [112, 113]. Ngaphaya koko, emngciphekweni okanye ingxaki yokungcakaza kwisampulu enkulu yolutsha yayihlala ixhaphakile kubasebenzisi bentsangu abazixelayo kwaye inxulumene nokungcakaza kakhulu [114].
Ngelixa ubungqina obuninzi buchaphazela ukungahambi kakuhle kwezigqibo kunye nokukhethwa kokhetho ebusweni bomvuzo wemali okhawulezileyo kwi-PG, ezi kunye nezinye iintsilelo ezibandakanyekayo kufuneka zivavanywe kujongwe ukungafani okwaziwayo koluntu. Okokuqala, isini sibonakala sidlala indima ekukhuthazeni ubungozi bokungcakaza kwingxaki yokungcakaza [115]. Esi sifo sibonakala sixhaphake kakhulu emadodeni, abakwachaza amazinga aphezulu okusetyenziswa kakubi kweziyobisi [115, 116], xa kuthelekiswa nabasetyhini ababonisa ukuxhaphaka okuphezulu kweemvakalelo, ixhala, kunye nokuphazamiseka kwengqondo [116, 117] kunye nexesha elizayo lokuphazamiseka [117]. Iimpembelelo ezinjalo zinokuchaphazela kungekuphela nje izizathu zokuphazamiseka kodwa iindlela ezahlukeneyo zonyango olusebenzayo kunye nolawulo lweempawu. Umzekelo, abantu ababhinqileyo kunokwenzeka ukuba bachaze ukukhululeka kwimeko embi okanye isimo sengqondo esingalunganga njengesizathu sokuziphatha okungcakazayo [117].
Olunye unxunguphalo kwi-PG olunjengokuphazamiseka koxinzelelo lwasemva kokwenzakala okanye ukutyeba kunokuba negalelo kwiingxaki zokwenza izigqibo eziyingozi [118] kunye nokuthabatheka [119••], ngokulandelelanayo. Kwingxaki yokungcakaza, amaxabiso aphezulu e-ADHD (21.4% ye-126) anxulunyaniswa nokungabinamdla okuxeliweyo okuphezulu kunye nokuthintela impendulo (SST) [120], kunye nokuxhaphaka kokutyeba kweli qela (10.6 % ye-207) inokuchaza ukungafani kwexesha lokuphendula okufaka isandla kwiiyantlukwano zokunyanzeliswa kwemoto [119••]. Ubudala bomntu kunye neminyaka yokuqalisa ukuphazamiseka kwakhona kunegalelo kumahluko ekuboniseni ukuphazamiseka. Ukuxhaphaka okuphezulu kwe-PG ngexesha lokufikisa kunokubonisa uphuhliso olucothayo lweendlela zolawulo lwengqondo, ngakumbi kulawulo lwempembelelo yomkhwa [121]. Abangcakazi abadala abafane bachaze ixhala, iingxaki zosapho, kunye nokuziphatha okungekho mthethweni [122]. Ngaphaya koko, uhlanga nemfundo ziqikelela ngokubalulekileyo ubungozi bokungcakaza [123[]124]. Ke ngoko, amacandelwana ahlukeneyo ngokwedemografi anokwenza kube kanye ukumiselwa kweempawu ngokucokisekileyo, kunikeze ithemba elingakumbi lomntu ngamnye kwizicwangciso zonyango.
Enye into ebalulekileyo ekuqondeni iipateni zokusilela kwengqondo, ngakumbi kwi-PG, luhlobo lomdlalo oluthi lwenzelwa indlela yokuziphatha kwe-pathological. Ukhetho lomdlalo kwi-PG (oomatshini be-slot ngokuchasene nekhasino) yahlula iintsilelo [125, 126[109]. Ukungcakaza koomatshini bokungcakaza luhlobo longcakazo olungacwangciswanga, olwahlukileyo kwisimbo songcakazo lweqhinga (umzekelo, imidlalo yamakhadi, imidlalo yedayisi, kunye nokubheja kwezemidlalo) [126]. Xa uthelekisa ngokuthe ngqo la maqela mabini, abasebenzisi bomatshini we-slot benza iimpazamo ezininzi zekhomishini kwi-Go/NoGo umsebenzi wokuthintela impendulo [109]. Kubonakala ngathi i-non-strategic sub-group yonakele ngakumbi kwiimvavanyo jikelele zomsebenzi wesigqeba [45] kwaye kusenokwenzeka ukuba uqhuba iintsilelo ekuxoxiwe ngazo.
isiphelo
Ukuphonononga ukuqonda okungahambi kakuhle kuyo yonke imilutha, sibonisa indlela ye-transpathological kunye ne-dimensional ekuqondweni kwamaqela abonakala ngathi ahlukene. Ubungqina obuxoxiweyo buqokelelwe kwiThebhile Table1,1, ebonisa oko kuphazamisiseka komkhethe kunye nokunyanzeliswa kwesigqibo sokulibaziseka kwemivuzo ekhoyo kuwo wonke umlutha wokuziphatha ophononongwayo ngoku. Impembelelo yokubaluleka kwenkuthazo icacile, kunye nokukhubazeka okuhlala kusenzeka malunga nokuphazamiseka-into ethile (okt, ukutya kwi-BED). Nokuba ngaba ubudlelwane phakathi kolwakhiwo lokuqonda, umzekelo, ukuthath'ingqalelo kunye nokunqwenela, ngunobangela okanye isiphumo sokuziphatha okukhobokisayo ngumbuzo osaza kucaciswa. Ngokudibeneyo, ulwakhiwo lokuqonda lubonelela ngesakhelo esiluncedo kwi-phenotypic characterization yamaqela asakhulayo engqondo.
Ukuthotyelwa kweMigangatho yokuHlola
Ukugqubana kwemidla
UGqr. Laurel Morris unika ingxelo yenkxaso-mali evela kwiSibonelelo soQeqesho lobuGqirha eMRC, ngaphandle komsebenzi ongenisiweyo.
UDkt. Valerie Voon uvakalisa ukuba akanalo ukungqubuzana komdla.
Amalungelo Abantu kunye Nezilwanyana kunye neMvume Yolwazi
Eli nqaku alinalo naluphi na uphononongo olwenziwa ngabantu okanye kwizifundo zezilwanyana ezenziwa nangubani na ababhali.
Ucaphulo
Iincwadi ezinomdla ngokukodwa, ezipapashwe kutshanje, ziye zaqaqanjiswa njenge: • Ukubaluleka •• Kubaluleke kakhulu