Isingeniso kwiZenzo zoLungiso (2010)

IIMBONO: Ushwankathelo olukhulu lweziyobisi. Umxholo kukuba iziyobisi kunye nokuziphatha kuzonwabisa ngendlela efanayo yendlela yengqondo, iindlela, kunye nokuziphatha.

NdinguJ J ukusebenzisa iziyobisi gwenxa. I-2010 ngoSeptemba; 36(5): 233-241.

ikhonkco: 10.3109/00952990.2010.491884

Abstract

imvelaphi

Ukuziphatha ngeendlela ezahlukeneyo, ngaphandle kokungenisa into yengqondo yengqondo, ukuvelisa umvuzo wexesha elifutshane onokuthi usebenze ngokuqhubekayo nangona ulwazi lweziphumo ezibi, okt, ukunciphisa ulawulo malunga nokuziphatha. Ezi ziphazamiso bezikhe zangqinwa ngeendlela ezininzi. Olunye uluvo lubeka ezi ngxaki njengokulala ecaleni kwembonakalo enganyanzelekanga, ezinye zichongwa ngokuba ziimpembelelo zolawulo lwempembelelo. Enye into, kodwa engakhethi cala, conceptualisation ithatha ukungahambelani njengento engeyiyo eyonto okanye "kukuziphatha".

iinjongo

Yazisa malunga nengxoxo malunga nobudlelwane phakathi kwento yengqondo kunye neziyobisi. Iindlela: Sijonga kwakhona idatha ebonisa ukufana kunye nolwahluko phakathi kokuphazamiseka kokulawulwa okanye ukuthintelwa kokuziphatha kunye neziyobisi. Esi sihloko sibaluleke ngokukodwa kukwahlelwa okufanelekileyo kwezi ziphazamiso kuhlelo lwesihlanu oluzayo lwe-American Psychiatric Association Diagnostic kunye ne-Statistical Manual yeNgqondo yeNgqondo.

iziphumo

Ubungqina obukhulayo bunika ukuba iziyobisi ziziphatha kakubi zifana neziyobisi kwimimandla emininzi, kubandakanya imbali yendalo, ubugqi, ukunyamezelana, ubugqwirha, igalelo lemfuzo, iinkqubo ze-neurobiological, kunye nempendulo kunyango, ukuxhasa iDSM yeVenkile yoMsebenzi ophakanyisiweyo kubandakanya zonke iingxaki zokusebenzisa iziyobisi kunye neziyobisi. Idatha yangoku icebisa ukuba eli nqanaba lidibeneyo lingakulungele ukungcakaza kwendalo kunye nezinye iindlela zokuziphatha ezifundwe ngcono, umzekelo, iziyobisi kwi-Intanethi. Okwangoku akukho lwazi lwaneleyo lokucacisa nakuphi na ukwahlulwa kolunye uhlobo lokuziphatha okucetyiweyo.

Iziphetho kunye neNzululwazi yeSayensi

Ukuhlelwa ngokuchanekileyo kweziganeko zokuziphatha okanye ukuphazamiseka kolawulo kunefuthe elinamandla ekuphuhlisweni kweendlela zokuthintela nokunyanga.

Internet: Ukuziphatha gwenxa, ukwahlula-hlula, ukufumanisa isifo, ukuphazamiseka kolawulo, ukusetyenziswa kweziyobisi, ukunyanzelwa, ukusebenzisa iziyobisi,

intshayelelo

Ukuziphatha ngeendlela ezahlukeneyo, ngaphandle kokungenisa into yengqondo yengqondo, ukuvelisa umvuzo wexesha elifutshane onokuthi usebenze ngokuqhubekayo nangona ulwazi lweziphumo ezibi, okt, ukunciphisa ulawulo malunga nokuziphatha. Ukulawulwa okonakalisiweyo sisiseko esichaza ingqondo yokuxhomekeka kwento yengqondo okanye umlutha. Oku kufana kukhuphe umba wokungabinanto yento okanye "kukuziphatha", okt., Syndromes analogous to drug drug, kodwa ngokugxila kwindlela yokuziphatha ngaphandle kokufaka into yengqondo. Uluvo lwezinto oziphethe kakuhle unazo ukubaluleka kwesayensi kunye neekliniki, kodwa uhlala eneempikiswano. Imicimbi ejikeleze ekuziphatheni okuchasene nokuziphatha ngoku kuxoxwa ngayo kwimeko yophuhliso lwe-DSM-V (1,2)

Iimpawu zokuziphatha ezininzi ziye zafakwa kwiimpawu zokuziphatha ezifanayo. Isikhokelo esikhoyo sokuNxibelelanisa kunye neNcwadi yeZibalo, i-4^th Ushicilelo (i-DSM-IV-TR) ichonge indlela yokuvavanywa ngokusesikweni kwezi ntlobo zininzi zeziphazamiso (umzekelo, ukungcakaza ngokwendalo, i-kleptomania), ibabeka njengeziphazamiso zolawulo olungenampembelelo, udidi olwahlukileyo kunengxaki yokusetyenziswa kweziyobisi. Eminye imilo yokuziphatha (okanye impembelelo yokuphazamiseka kolawulo) iye yaqwalaselwa ukuze ifakwe kwi-DSM ezayo-ukuthengwa okunyanzelekileyo, ukuthathwa kwesikhumba se-patologic, iziyobisi ngokwesini (ukungabandakanyi paraphilic hypersexourse), ukusoka kakhulu, umdlalo wekhompyuter / wevidiyo, kunye nomlutha we-intanethi. Yeyiphi indlela yokuziphatha yokuziphatha kubandakanya3). Ayizizo zonke iingxaki zokuphazamiseka, okanye ukuphazamiseka okuphawulwa kukungxamiseki, ekufuneka kuthathelwe ingqalelo njengeziyobisi. Nangona uninzi lwezinto ezinokubangela impembelelo yokungalawuleki (umzekelo, ukungcakaza ngokwendalo, i-kleptomania) zibonakala zabelana ngeempawu eziphambili kunye neziyobisi, abanye, njengokuphazamiseka kwesiqhushumbo, abanakukwenza oko. Ngethemba lokufaka igalelo kule ngxoxo-mpikiswano, eli phepha liphonononga ubungqina bokufana phakathi kokuziphatha gwenxa nokuchaphazeleka kokusetyenziswa kweziyobisi, umahluko wabo kwinto engalawulekiyo enyanzelisayo, kwaye ichonge iindawo zophando olungaqinisekanga lwexesha elizayo. Ikwasebenza njengokwazisa kumaphepha alandelayo kulo mbandela, ophononongwa kwezinye zeendlela zokuziphatha ezingekho mthethweni ngakumbi.

Iimpawu eziqhelekileyo zoKuziphatha ngokuziphatha: Unxibelelwano kubudlelwane bokuPhazamiseka kokuSetyenziswa

Into ebalulekileyo ekuziphatheni okuchasene nokuziphatha kukusilela ukumelana nokuphembelela, ukuqhuba, okanye isilingo sokwenza into eyenzakalisayo emntwini okanye kwabanye (4). Isimo ngasinye sokuzibonakalisa siphawuleka ngephethini eqhelekileyo yokuziphatha enenqaku elibalulekileyo ngaphakathi kwesizinda esithile. Ukuzibandakanya okuphindaphindiweyo kwezi zinto zokuziphatha ekugqibeleni kuphazamisa ukusebenza kweminye imimandla. Ngokuphathelele koku, iziyobisi ekuziphatheni zifana nokuphazamiseka kokusetyenziswa kweziyobisi. Abantu abaziyobisi iziyobisi baxela ubunzima ekuxhathiseni umnqweno wokusela okanye ukusebenzisa iziyobisi.

Ukuziphatha kunye neziyobisi kuninzi okufanayo kwimbali yendalo, phenomenology, kunye neziphumo ezibi. Zombini zinenqanaba lokufikisa kunye nokuba ngumntu osemdala kunye namaqondo aphezulu kula maqhezu kunakwabantu abadala.5). Zombini zinembali yendalo enokuthi ibonakalise iipateni ezingapheliyo, ezibuyela umva, kodwa kubantu abaninzi baziphilise ngokwabo ngaphandle konyango olusesikweni (oko kubizwa ngokuba “kukuzola”)6).

Iziyobisi ezidla ngokuziphatha zihlala zandulelwa ziimvakalelo “zokuxinana okanye ukuvusa umzimba ngaphambi kokuba wenze isenzo” kunye “nokonwaba, ukuzonwabisa okanye ukukhululeka ngexesha lokwenza isenzo” (4). Ubume be-ego-syntonic yezi ndlela yokuziphatha bufana ngokwamava okuziphatha kweziyobisi. Oku kwahlukileyo kubume be-ego-dystonic bendalo yokuphazamiseka okungafunekiyo. Nangona kunjalo, zombini okuziphatha kunye neziyobisi kunokubambezeleka ngokwenyani kwaye kungangqineki kangako ngokuhamba kwexesha, njengoko isimilo (kubandakanya ukuthatha into) ngokwaso kuya kusiba mnandi kwaye kungaphezulu komkhwa okanye kunyanzeliso (2,7,, okanye okhuliswa kancinci kukuqiniswa okuqinisekileyo kunye nangakumbi ngokuqiniswa okungalunganga (umzekelo, ukukhululeka kwedysphoria okanye ukurhoxa).

Ukuziphatha kunye neziyobisi kunokubakho ngokufana. Uninzi lwabantu abanokuziphatha okubi kakhulu banika ingxelo ngokubongoza okanye ngokulangazelela isimo ngaphambi kokuba baqalise indlela yokuziphatha, njengoko benzayo abantu abaneengxaki zokusebenzisa iziyobisi ngaphambi kokusetyenziswa kwento. Ukongeza, ezi ndlela zokuziphatha zihlala zinciphisa uxinzelelo kwaye zikhokelela kwimeko entle yemvakalelo okanye "ephezulu", efana nokunxila kweziyobisi. Uxinzelelo lweemvakalelo lunokuba negalelo kwiminqweno kuzo zombini iindlela zokuziphatha nokusetyenziswa kweziyobisi (8). Uninzi lwabantu abanengxaki yokungcakaza kwe-pathological, i-kleptomania, isenzo sokuziphatha ngokwesondo esisinyanzelo, kunye nokuthenga okunyanzelekileyo kunika ingxelo yokuhla kwezi mphumo zintle zokuziphatha okuphindaphindiweyo okanye isidingo sokonyusa ubunzulu bokuziphatha ukufezekisa isiphumo esifanayo semood, analogous to tolerance (9-11). Abantu abaninzi abanokuziphatha okuziphetheyo baxela imeko yedysphoric ngelixa bengaziphathi, bengakwazi ukurhoxa. Nangona kunjalo, ngokungafaniyo nokushenxiswa kwezinto, azikho iingxelo zokuxhamla ngokwezomzimba okanye ukurhoxa okunzulu kwezonyango kwimikhwa yokuziphatha.

Ukungcakaza okungapheliyo, okufundwe ngokucokisekileyo kukuziphatha okubonakalayo, kunika ulwazi oluthe kratya malunga nolwalamano lokuziphatha gwenxa kunye nokuphazamiseka kokusebenzisa iziyobisi (jonga iWareham kunye nePotenza, lo mbandela). Ukungcakaza okungokwasendalweni kuvame ukuqala ebuntwaneni okanye ebusheni, kunye nendoda elangazelela ukuqala kwiminyaka yobudala bokuqala (5,12), Ukujonga isiphatho sokuphazamiseka kokusetyenziswa kweziyobisi. Amanqanaba aphezulu okugembula okubonakalayo abonwa emadodeni, ngento ye-telescoping eqwalaselwe kwabasetyhini (oko kukuthi, abantu basetyhini babandakanyeka okokuqala kwisenzo sokulutha, kodwa bafanekisela ixesha ukusuka ekubandakanyekeni kokuqala ukuya kulutywala) (13). Into ye-telescoping ibhalwe ngokubanzi kwiimeko ezahlukeneyo zokuphazamiseka kokusetyenziswa kweziyobisi (14).

Njengakwimeko yokusetyenziswa gwenxa kweziyobisi, iingxaki zemali kunye nomtshato zixhaphakile kwiindlela zokuziphatha. Abantu abaphembelela ekuziphatheni okuchaseneyo nokuziphatha, ezinjengeziyobisi, baya kuthi rhoqo benze izinto ezingekho mthethweni, ezinjengobusela, ubusela, kunye nokubhala iitsheki ezimbi, ukuxhasa indlela abaziphethe ngayo okanye ukujongana neziphumo zokuziphatha.15).

isimo

Abantu abaphembelela ekuziphatheni kwaye abo banengxaki yokusebenzisa iziyobisi bobabini banamanqaku aphezulu kumanqaku enkqubo yokuzifaka kunye nokufuna imvakalelo kwaye ngokubanzi baphantsi kumanyathelo okuphepha ukonzakala (16-20). Nangona kunjalo, abantu abanokuziphatha okuthile, njengokulutha kwi-intanethi okanye ukugembula kwe-pathological, banokuxela amanqanaba aphezulu okuphepha ukulimala (i-21; bona kwane Weinstein noLejoyeux, lo mbandela). Olunye uphando licebisile ukuba iinkalo zengqondo, ukungqubana phakathi kwabantu, kunye nokuzilawula kungadlala indima kwi-intanethi (jonga u-Weinstein noLejoyeux, lo mbandela). Ngokwahlukileyo, abantu abanesifo sokunyanzeliswa okungapheliyo bafumana amanqaku aphezulu kuthintelo lokulimala kwaye baphantsi ekungxamisekeni (17,21). Abantu abaphembelela ekuziphatheni okuziphatha banamanqaku aphezulu kwimilinganiselo yokunyanzelwa, kodwa ezi zinokuphelela kulawulo olungalunganga kwimisebenzi yengqondo kunye nexhala malunga nokulahleka kolawulo kwiimpawu zokuziphatha (22). Uthintelo olungalunganga lweempendulo zemoto (ukuqhuba) lufunyenwe kubantu abanesiphazamiso sokunyanzeliswa okungafunekiyo kunye nokuchola ulusu (ulwalamano olukhoyo kunye nonxibelelwano olungendawo lwezinto ezinokubangela ukungqinelani), ngelixa ukungqondakaliyo (kucingelwa ukuba negalelo kunyanzeliso) ukunganyanzelekanga23,24).

Ukunyibilika

Nangona uninzi kwizifundo ezimele ilizwe lonke lungabandakanyi kuvavanyo lokuziphatha okubi, idatha ekhoyo yezifo ezikhoyo ixhasa ubudlelwane phakathi kokungcakaza kwe-pathological kunye nokuphazamiseka kokusebenzisa iziyobisi, ngamaxabiso aphezulu okwenzakala kwicala ngalinye.25,26). Isifundo se-St. Louis Epidemiologic Catchment Area (ECA) safumanisa amazinga aphezulu okuhlangana kweziphazamiso zokusetyenziswa kweziyobisi (kubandakanya ukuxhomekeka kwe-nicotine) kunye ne-pathological ukugembula, kunye nemilinganiselo ephezulu yokuphawulwa okubonwa ngokubanzi phakathi kokungcakaza, ukuphazamiseka kotywala, kunye nokuphazamiseka kobuntu.25). Uhlolisiso olwenzeka kwelaseCanada lubonisa ukuba umngcipheko wesifo sokusetyenziswa kotywala unyuke nge-3.8-fold xa ukungcakaza okungalunganga kwakukhona (27). Phakathi kwabantu abaxhomekeke kwiziyobisi, umngcipheko wokumodareyitha ukuya nokufumana ukungcakaza okuphezulu wawuphindaphindwe amaxesha e-2.9 (28). I-odds ratios ukusuka kwi-3.3 ukuya kwi-23.1 iye yaxelwa phakathi kokungcakaza kwe-pathological kunye nokuphazamiseka kokusetyenziswa kotywala kwizifundo ezisekelwe kubemi base-US (25; 29). Ukusetyenziswa gwenxa kwe-Intanethi kwakudityaniswa nokusetyenziswa gwenxa kotywala (umlinganiso we-1.84) kwisifundo sabafundi bekholeji i-2,453, emva kolawulo ngokwesini, ubudala kunye noxinzelelo (30).

Iisampulu zeeklinikhi zezinto ezizezinye ezinokuziphatha zicebisa ukuba ukwenzeka ngokudibeneyo nokuphazamiseka kokusebenzisa iziyobisi kuyinto eqhelekileyo (1 Table). Ezi ziphumo zibonisa ukuba ukubhekisa ngokuziphatha kunokukwabelana nge-pathophysiology eqhelekileyo kunye nokuphazamiseka kokusebenzisa iziyobisi.

Amaxesha oBomi bokuqikelela kokusetyenziswa kweziyobisi kwiNtsholongwane yeziyobisi

Nangona kunjalo, idatha malunga nokusetyenziswa kwesiyobisi i-comorbidity kufuneka itolikwe ngononophelo kuba nayiphi na imibutho enokubangela ibangele inqanaba lokuziphatha (umzekelo, ukusetyenziswa kotywala kunento yokwenza neendlela zokuziphatha ezingalunganga, kubandakanya nezo zichongiweyo njengezikhobokisayo) okanye kwinqanaba lolungelelwaniso (umzekelo, Imikhwa yokuziphatha okubi iqala emva konyango olunxilisayo, njengokuthatha indawo yokusela). Ingxaki yokungcungcuthekiswa rhoqo kukusetyenziswa kotywala ngokungqongqo kwaye kuneengxaki zengqondo nezengqondo ezivela ekungcakazeni kunalawo angabinayo imbali yokusebenzisa utywala.31), kwaye abakwishumi elivisayo abalingeneyo kubungakanani obuselayo basengozini yokungcakazwa rhoqo kunabo bangeziyo (32), Ukucebisa intsebenziswano yokuziphatha phakathi kotywala nokungcakaza. Ngokwahlukileyo koko, ukufumanisa okufanayo ngokubhekisele ekusebenziseni i-nicotine kucebisa ukusebenzisana, njengoko nento yokuba abantu abadala bengcakazo bengoyena mntu bangoku okanye ababhemayo ngaphambili babenomnqweno onamandla wokungcakaza (33). Abaneengxaki zokungcakaza abasebenzisa icuba imihla ngemihla banethuba lokuba neengxaki zokusebenzisa utywala neziyobisi (34).

Olunye uphazamiseko lwengqondo, njengokuphazamiseka kwengcinezelo, ukuphazamiseka kwengqondo, ukuphazamiseka kwengqondo, kunye nengxaki yokuchaphazeleka kwengqondo, zixelwa rhoqo xa kunxulunyaniswa nokuziphatha (i-35,36; bona kwane Weinstein noLejoyeux, lo mbandela). Nangona kunjalo, uninzi lwezi zifundo ze-comorbidity lwalusekwe kwiisampulu zeklinikhi. Ubungakanani bezi zinto zifunyanwayo ngokubanzi kwiisampulu zoluntu zihlala zimisiwe.

Ukunxibelelana

Ukuziphatha okubi kunye nokuphazamiseka kokusebenzisa iziyobisi kunokuba neempawu eziqhelekileyo zokuqonda. Zombini iindlela zokungcakaza kunye nabantu abanengxaki yokusebenzisa iziyobisi ngokuqhelekileyo bayaphulukana nembuyekezo ngokukhawuleza (37) kwaye enze ngokungathandabuzekiyo kwimisebenzi yokwenza izigqibo (38) njenge-Iowa Ginja Task, iparadigm evavanya ukwenziwa kwezigqibo ngomngcipheko wokuthatha izigqibo (39). Ngokuchasene noko, uphando lwabantu abanomlutha we-intanethi abukhombisi nakuphi na ukusilela ekwenzeni izigqibo kwi-Iowa Gask Task (40). Isifundo esisebenzisa ibhetri ebanzi ye-neurocognitive kwi-49 i-pathological gambler, i-48 engafunekiyo kwizifundo ezixhomekeke kwiziselo ezinxilisayo, kunye nokulawulwa kwe-49 kufumanise ukuba ukungcakaza kunye notywala bobabini kubonise ukunciphisa ukusebenza kwimvavanyo yokuzinqanda, ukuguquguquka kwengqondo, kunye nemisebenzi yokucwangcisa, kodwa kwakungekho mahluko kuvavanyo ukusebenza kolawulo (41).

Iinkqubo eziqhelekileyo ze-Neurobiological

Umzimba okhulayo woncwadi ubeka iinkqubo ezininzi ze-neurotransmitter (umzekelo, i-serotonergic, idopaminergic, i-noradrenergic, i-opioidergic) kwi-pathophysiology yokuziphatha kweziyobisi kunye nokuphazamiseka kokusebenzisa iziyobisi (42). Ngokukodwa, i-serotonin (5-HT), ebandakanyeka kuthintelo lokuziphatha,, kunye ne-dopamine, ebandakanyeka ekufundeni, ekukhuthazeni, nasekuthambekeni komoya, kubandakanya nemivuzo,, kunokuba negalelo elikhulu kuzo zombini iiseti zokuphazamiseka (42,43).

Ubungqina bokubandakanyeka kwe-serotonergic kwizikhuzo zokuziphatha kunye nokuphazamiseka kokusetyenziswa kweziyobisi kuza ngokwenxalenye evela kwizifundo zomsebenzi we-platelet monoamine oxidase B (MAO-B), ehambelana nenqanaba le-cerebrospinal fluid (CSF) ye-5-hydroxyindole acetic acid (5-HIAA, metabolite ye-5-HT) kwaye ithathwa njengophawu lomsebenzi we-5-HT. Amanqanaba asezantsi e-CSF 5-HIAA alungisa amanqanaba aphezulu okunyanzeliswa kunye nokukhangela kwimvakalelo kwaye afunyenwe ekungcakazeni kwe-pathological kunye nokuphazamiseka kokusebenzisa iziyobisi (44). Uphononongo lophicotho-mngeni kwizifundo ezilinganisa iimpendulo zehomoni emva kolawulo lwamachiza e-serotonergic zikwabonelela nangobungqina bokungasebenzi kakuhle kwe-serotonergic kuzo zombini iindlela zokuziphatha kunye nokuphazamiseka kokusebenzisa iziyobisi (45).

Ukuphindaphinda ukusetyenziswa kwezinto okanye ukubandakanyeka kwisimo sokuziphatha ngokulandela isibongozo kunokubonakalisa inkqubo yobumbano. Izifundo zaphambi kwexesha kunye nonyango zicebisa ukuba indlela engeyiyo ye-biological yento yokuphembelela yokuqhubela phambili inokubandakanya ukulungiswa kokungeniswa kwembuyekezo yecandelo le-ventral tegmental ndawo / i-nucleus accumbens / orbital frontal cortex yesekethe (46,47). Indawo ye-ventral tegmental iqulethe ii-neurons ezikhupha i-dopamine kwi-nucleus accumbens kunye ne-orbital frontal cortex. Utshintsho kwindlela dopaminergic iye yacetyiswa njengokuqhubeka komvuzo (ukugembula, iziyobisi) okubangela ukukhutshwa kweedopamine kwaye kuvelise imvakalelo yolonwabo (48).

Ubungqina obunqamlekileyo obuvela kwizifundo ze-neuroimaging exhasa i-neurocircuitry ekwabelwana ngayo malunga nokuziphatha kunye nokuphazamiseka kokusetyenziswa kweziyobisi (7). Umsebenzi otyholwayo we-cralex yangaphambili ye-ventral medial preortal cortex (vmPFC) inxulunyaniswa nokwenza izigqibo ngokungxamisekileyo kuhlolo lomngcipheko kunye nokuphendula okunciphisayo kwizenzo zokungcakaza kubaphengululi be-pathological (49). Ngokunjalo ukusebenza kwe-vmPFC engaqhelekanga kufunyenwe kubantu abanengxaki yokusebenzisa iziyobisi (50). Ukwenza umdlalo ohambelana nobuchopho obunxulumene nomdlalo kwi-Intanethi iziyobisi kwimidlalo ye-intanethi kwenzeka kwimimandla efanayo yobuchopho (i-orbitofrontal, i-dorsolateral prefrontal, i-anterior cingulate, i-nucleus accumbens) njengesiyobisi se-cue-enxulumene nokusebenza kwengqondo ekusebenzeni iziyobisi (i-51; jonga ne-Weinstein kunye neLejoyeux, lo mbandela ).

Uphando lokucingela ubuchopho lubonisa ukuba indlela ye-dopaminergic mesolimbic indlela esuka kwindawo yecutral yendlela yokuhamba yecutral ukuya kwi-nucleus accumbens inokubandakanyeka kokubini ukuphazamiseka kokusetyenziswa kweziyobisi kunye nokungcola kwe-pathological. Izihloko ezinengxaki yokungcakaza kwe-pathological zibonise umsebenzi omncinci we-ventral striatal neuronal kunye ne-fMRI ngelixa besenza ukungcakaza okwenziweyo kunokwalawula izihloko (52), okufanayo nokubonileyo kwizifundo ezixhomekeke kuotywala xa kusetyenzwa ngembuyekezo yemali (53). Uqhushululu olusebenzayo lwe-ventral olwenziweyo luye lwanyanzelwa kwiminqweno ehambelana neziyobisi kunye nokuziphatha41). Ukuthatha inxaxheba kumsetyenzana wokungcakaza kubonakala kukhuthaza ukukhululwa kwe-dopamine enkulu kwi-ventral striatum kubantu abanesifo sikaParkinson (PD) kunye nongcakazo lwe-pathological kunabantu abane-PD kuphela (54), impendulo efana naleyo yaphakanyiswa iziyobisi okanye iziyobisi ezinxulumene neziyobisi kwiziyobisi (55).

Ukubandakanyeka kwi-Dopamine kwizenzo zokuziphatha kukwacetyiswa ngezifundo zezigulana ezanyangiweyo ze-PD (56,57). Izifundo ezibini zezigulana ezine-PD zifumanise ukuba ngaphezulu kwe-6% yafumana into entsha yokuziphatha okanye ukulawulwa kokungalawuleki (umzekelo, ukugembula ngokwendalo, iziyobisi ngokwesondo), kunye namaxabiso aphakamileyo phakathi kwabo bathatha amayeza e-dopamine agonist (58,59). Ukufana kwe-levo-dopa ephezulu yokulingana kunxulunyaniswa namathuba amakhulu okuba neziyobisi59). Ngokuchasene noko kunokulindeleka ukubandakanyeka kwe-dopamine, abachasi kwi-dopamine D2 / D3 receptors baphucula inkuthazo enxulumene nokungcakaza kunye nokuziphatha kubantu abangalunganga be-PD ngokungcakaza kwe-pathological (60) kwaye ungabinakho ukusebenza gwenxa kunyango lokungcakaza (61,62). Uphando olongezelelekileyo lufanelekile ukucacisa indima eyiyo ye-dopamine kuhambo lokungcakaza lwendalo kunye nezinye iindlela zokuziphatha.

Imbali yosapho kunye ne-genetics

Zimbalwa kakhulu imbali yosapho / yezifundo zofuzo zohlobo lokuziphatha eziyilwe ngamaqela olawulo afanelekileyo (7). Izifundo ezincinci zosapho ze-probands ngongcakazo lwendalo (63), kleptomania (64), okanye ukuthenga okunganyanzelekanga (65) ngamnye ufumanise ukuba izalamane zokuqala zenqanaba lovavanyo zinezinto eziphezulu kakhulu kubomi zotywala kunye nokunye ukuphazamiseka ekusebenziseni iziyobisi, kunye noxinzelelo kunye nokunye ukuphazamiseka kwengqondo, kunokulawula izifundo. Ezi zifundo zentsapho ezilawulwayo zixhasa umbono wokuba iziyobisi ekuziphatheni zinokuba nobudlelwane bemfuza kuphazamiso lokusebenzisa iziyobisi.

Igalelo lohlobo lokuchasana nemeko yokusingqongileyo kwindlela ethile yokuziphatha kunye nokuphazamiseka kunokuqikelelwa ngokuthelekisa ikhonkrithi yabo ngokuchanekileyo (i-monozygotic) kunye namabini ama-dizygotic). Kuphononongo lwamawele angamadoda asebenzisa iVietnam ye-Era Twin Registry, i-12% ukuya kwi-20% yokwahluka kwemfuza emngciphekweni wokungcakaza kwe-pathological kunye ne-3% ukuya kwi-8% yantlukwano yokungalingani emngciphekweni kwaba semngciphekweni wokuba semngciphekweni wotywala. ukusetyenziswa kwengxaki66). Isibini kwisithathu (64%) sengozi eyenzeka phakathi kokungcakaza kwe-pathological kunye nokusetyenziswa kotywala kunxulunyaniswe nobume obuphembelela ukuphazamiseka, ukucebisa ukuxhaphaka kokungaphaya kwemfuza kwezi meko zombini. Ezi zinto zifunyanisiweyo ziyafana nezo ziphakamisa igalelo lemfuzo oluqhelekileyo kuluhlu lweengxaki zokusetyenziswa kweziyobisi (67).

Zimbalwa kakhulu izifundo zenzululwazi yemfuza malunga nokuziphatha. I-D2A1 i-allele ye-D2 dopamine receptor gene (i-DRD2) inyuka kumandla avela kubantu abanengxaki yokungcakaza ukuya ekungcakazeni kwe-pathological kunye nokwenzeka kwe-pathological kunye nokusetyenziswa kweziyobisi.68). Iimpawu ezahlukeneyo ze-DRD2 gene single nucleotide polymorphisms (SNPs) zidibene nemilinganiselo yobuntu yokunyanzeliswa kunye nokuvavanywa kwamanyathelo okuziphatha kokuthintela kwiivolontiya ezinempilo (69), kodwa ezi azivavanywa ebantwini abanokuziphatha okubi. Abasebenzisi be-intanethi abagqithisileyo babenamaxesha amaninzi aphezulu e-alle (i-SS) ye-serotonin transporter gene (5HTTLPR) kunolawulo olusempilweni, kwaye oku bekudityaniswa nokuthintelwa kokulimala kakhulu (70; bona kwane Weinstein noLejoyeux, lo mbandela).

Ukuphendula kunyango

Ukuziphatha okubi kunye nokuphazamiseka kokusetyenziswa kweziyobisi kuhlala kuphendula ngokuchanekileyo kunyango olufanayo, kokubini ngokwengqondo nangokwezonyango. I-12-inyathelo lokuzinceda ngokwayo, ukuphucula amandla, kunye neendlela zonyango zokuziphatha eziqhele ukusetyenziswa ukunyanga iingxaki zokusetyenziswa kweziyobisi zisetyenziswe ngempumelelo ekunyangeni ukugembula kwengqondo, ukunyanzeliswa kwesini, kleptomania, ukuthathwa kwesikhumba kunye nokunyanzelwa kokuthenga.71-74). Ungenelelo lwengqondo kunye nokuziphatha okuneziyobisi kunye nokuphazamiseka kokusetyenziswa kweziyobisi bahlala bexhomekeke kwimodeli yokuthintela ukuphinda bakhuthaze ukungakhathali ngokuchonga iipatheni zokuxhatshazwa, ukunqanda okanye ukujongana neemeko zomngcipheko omkhulu, kunye nokwenza utshintsho lwendlela eqinisa indlela yokuziphatha esempilweni. Ngokwahlukileyo, unyango oluyimpumelelo lwengqondo kunye nonyango lokungaboni kakuhle nokunyanzeliswa kokugxininisa ekuvezeni nasekuphenduleni ngeendlela zokuthintela impendulo (2).

Akukho mayeza amkelweyo njengangoku okunyangwa kukuziphatha gwenxa, kodwa amayeza athile abonise isithembiso ekunyangeni ukuphazamiseka kokusetyenziswa kweziyobisi ikwabonisa isithembiso kunyango lokuziphatha kakubi (75). I-Naltrexone, i-mu-opioid receptor antagonist evunywe yi-US Food and Drug Administration kunyango lotywala kunye nokuxhomekeka kwe-opioid, ibonakalise ukusebenza ngokulingeneyo kwizilingo zeklinikhi ezilawulwayo kunyango lokungcakaza kwe-pathological kunye ne-kleptomania (76-79), kunye nesithembiso kwizifundo ezingalawulwa zokuthenga okunyanzelekileyo ((80), yokuziphatha okunyanzelekileyo ngokwesini (81), isiyobisi se-intanethi (82), kunye nokukhetha ulusu lwesifo sengqondo (83). Ezi ziphumo zibonisa ukuba ii-receptors ze-mu-opioid zidlala indima efanayo kwizimo zokuziphatha njengoko zisenza kwinto yokusetyenziswa kweziyobisi, ngokunokwenzeka ekuguqukeni kwendlela ye-dopaminergic mesolimbic. Ngokuchasene noko, i-mu-opioid receptor antagonist ekwi-anxone ekhulayo ye-muxone iyandisa iimpawu kwisifo esinganyangekiyo (84).

Amayeza atshintsha utshintsho lwe-glutamatergic ikwasetyenziselwa ukunyanga ukubakho kweziyobisi kunye nokuxhomekeka kwento. I-Topiramate, i-anti-convulsant evimba i-AMPA subtype ye-glutamate receptor (phakathi kwezinye izinto), isibonisile isithembiso kwizifundo ezivulekileyo zelebula yokungcakaza,85), kunye nokusebenza ngempumelelo ekunciphiseni utywala (86), icuba (87), kunye necocaine (88) Sebenzisa. I-N-acetyl cysteine, i-amino acid ebuyisela uxinzelelo lwe-glutamate ye-extracellular kwi-nucleus accumbens, inciphise iminqweno yokungcakaza kunye nokuziphatha kwisifundo esinye sabantu abagembulayo be-pathological (89), kunye nokunciphisa umnqweno wecocaine (90kunye nokusetyenziswa kwecocaine (91) kwizidakamizwa zeecocaine. Olu phononongo lubonisa ukuba ukumodareyitha kwethoni yelungu lokudumba emzimbeni we-dopaminergic kwi-nucleus accumbens kunokuba yindlela eqhelekileyo kukuziphatha kakubi kunye nokusetyenziswa kweziyobisi (92).

Imicimbi yokuqonda

Mnye kuphela umlutha wokuziphatha, ukugembula kwe-pathological, sisifo esichongiweyo kwiDSM-IV kunye ne-ICD-10. Iindlela zokuchonga zihambelana ngokufana neziyobisi / ukuxhomekeka kwento, ukuxhomekeka ekuziphatheni, ukunciphisa amandla okulawula indlela yokuziphatha, ukunyamezelana, ukurhoxa, kunye neziphumo ezibi zengqondo. I-DSM-V Task Force yacebise ukungcakaza okukungokoqobo okuvela kuhlelo lwangoku njengophazamiso lolawulo lwempembelelo kulwahlulo oluntsha olubizwa ngokuba "yiAdiction kunye neeNgozi eziNxulumene noko," ezibandakanya ukuphazamiseka kokusebenzisa iziyobisi kunye "nokungena iziyobisi" (www.dsm5.org, ifikelele ngoFeb. 10, 2010). Olona tshintsho lubonakalayo kuphela kwiindlela zokuchonga kukuhla komgaqo ngokubhekisele kwizenzo ezingekho mthethweni ukuxhasa ngezimali ukugembula, okufunyaniswe ukuba kunobuthathaka obuphantsi kunye nefuthe elincinci kwisifo.

Iqela leendlela zokuziphatha ezithile ziphakamise indlela yokuqonda, kubandakanya ukuthenga okunyanzelekileyo (93), Isiyobisi se-Intanethi (94), ividiyo / ikhomputha yomdlalo wekhompyuter (95), iziyobisi ngokwesini (96), kunye nokushushu ngokugqithisileyo (jonga uKouroush et al., lo mbandela). Ezi zihlala zihlala kusekwe kumgaqo okhoyo we-DSM-IV wokusetyenziswa gwenxa kweziyobisi okanye ukuxhomekeka, umzekelo, ixesha elininzi elichithwa ekuziphatheni, ukuphinda-phinda imizamo engaphumeleliyo yokusika okanye ukuyekisa isimilo, ukunciphisa ulawulo malunga nokuziphatha, ukunyamezelana, ukurhoxa, kunye nokuphambana kwengqondo iziphumo. Iqela lokuphazamiseka kwento enxulumene neDSM-V lijongana neqela lezinto ezingabandakanyi iziyobisi ukuze zibandakanywe kwi-DSM-V, ikhankanya ngqo iziyobisi kwi-Intanethi (www.dsm5.org; ifikelele ngoFeb. 10, 2010). Nangona kunjalo, kuninzi lokuphazamiseka, akukho lwazi luncinci okanye akukho datha eqinisekisiweyo kwezi ndlela zokuqonda; Okwangoku ziluncedo njengezixhobo zokuphanda ukuqikelela ubukho bengxaki.

Umbuzo omnye wokuqonda ophakanyiswe kuncwadi apho kulapho imikhwa yokuziphatha (kunye neziyobisi) iwela khona kumda wokunyanzeliswa (97), okt, ngaba bafana nokuphazamiseka kokulawula okungafunekiyo okanye ukuphazamiseka okunyanzelekileyo? Abanye bathi le ndlela yobumbano yobumbano iyinto elula, kwaye ukunyanzeliswa nokunyanzelwa kumelele imilinganiselo ye-orthogonal.98). Ngokuhambelana nengxoxo yokugqibela ziziphumo ezinje ngokuhlukahluka okukhulu kumgangatho wokuxhonywa kwabantu abanokuziphatha okuchaseneyo, ukwahluka okunokuthi kunxulunyaniswe nokuphendula kunyango lwe-pharmacological (48, 99).

Kwi-DSM-IV, iziyobisi (iziyobisi ukusetyenziswa kweziyobisi) luluhlu oluzimeleyo, ngelixa ukugembula komzimba kuthathwa njengokuphazamisayo kolawulo, okufana, umzekelo, i-pyromania kunye ne-kleptomania. I-ICD-10 ichaza ukungcakaza okwenzekileyo njengesiqhelo "nokuziphatha okunyanzelekileyo", kodwa iyaqonda ukuba "indlela yokuziphatha ayinyanzelekanga kwimeko yezobuchwephesha," nangona ngamanye amaxesha ibizwa ngokuba "kukungcakaza okunyanzelekileyo."

Umcimbi onxulumene naloo nto ngumanyano, okanye ukudibana, ukuba ukhona, phakathi kweziyobisi ezahlukeneyo zokuziphatha. Uhlalutyo lwamaqela ngokuguquguquka kokuhlala ngokwabantu kunye nokuhluka kweklinikhi kwizigulana ze-210 kwizigulo ezinganyanzelekanga ezingxamisekileyo ezichongiweyo zibonisa amaqela amabini ahlukeneyo abaguli abanesimo sokuziphatha (100): Izigulana ezinengxaki yokungcakaza okanye iziyobisi ngokwesini ("hypersexuality") zazineminyaka engaphambi kokuba ziqale kwaye zazinokuba yindoda ngakumbi, xa kuthelekiswa nezigulana ezithenga ngokunganyanzelekanga. Uphando oluthe kratya luyafuneka ukuqinisekisa kunye nokwandisa okufunyenweyo. Enye indlela yophando enokuthi ibenegalelo elikhulu ebaleni iya kuba luvavanyo olupheleleyo lweqela elikhulu, elinokulinganiswa, elinabantu abaninzi abaneendlela ezahlukeneyo zokuziphatha kunye neziyobisi ngokwezinto ezinokubangela ukunganyanzeleki kunye nokunyanzelwa kokubini kwengqondo (engqondweni) nasekuziphatheni ( motor) imimandla, umz., ubuntununtunu bokubuyisa ukulibaziseka (ukuncitshiswa okwethutyana komvuzo), izigqibo zomngcipheko wokuthathwa kwezigqibo, ukuqina kwengqondo, ukuphendula okulindelekileyo kwangaphambili, ukuphendula ngonyamezelo, ukuthintela impendulo, kunye nokufunda umva.

Isishwankathelo nezigqibo

Ubungqina obukhulayo bubonisa ukuba iziyobisi eziphethe kakubi zifana neziyobisi kwimimandla emininzi, kubandakanya nembali yendalo (imeko engapheliyo, ephinda iphinde iphinde yenzeke kunye nokuxhaphaka kolutsha kunye nabantu abadala), ifilosofi (ukunqwenela ukuzenzisa, ukunxila [“ukuphakama”], kunye nokurhoxa), unyamezelo , i-comorbidity, igalelo lemfuzo ngaphezulu, iindlela ze-neurobiological (kunye neendima zokusebenza kwengqondo glutamatergic, opioidergic, serotonergic kunye ne-dopamine mesolimbic system, kunye nokuphendula kunyango. Nangona kunjalo, ulwazi olukhoyo lubanzi kakhulu ekungcakazeni kwe-pathological (jonga iWareham kunye nePotenza, lo mbandela), unedatha emiselweyo yokuthenga okunyanzelekileyo (bona i-Lejoyeaux kunye neWeinstein, lo mbandela), umlutha we-intanethi (bona u-Weinstein noLejoyeaux, lo mbandela), kunye ividiyo / ikhomputha yomdlalo wekhompyuter (jonga u-Weinstein, lo mbandela), kwaye phantse akukho datha yolunye uhlobo lweziyobisi ezinjengokuziphatha kakubi ngokwesondo (jonga uGarcia kunye noTibabaut, lo mbandela), ukuthanda iziyobisi (jonga u-Reynaud, lo mbandela), ukuthathwa kwesikhumba. I-Odlaug kunye nesibonelelo, lo mbandela), okanye ukujija kakhulu (jonga uKouroush et al., Lo mbandela). Kukho ubungqina obaneleyo bokugunyazisa ukungcakaza kwendalo njengento engeyiyo eyakho into okanye eyokuziphatha; I-DSM-V Task Force iphakamise ukutshintsha ukwahlula-hlula kwayo kwi-DSM-V ukusuka kuphazamiso lolawulo lwempembelelo ukuya kulutyekelo kunye nokuphazamiseka okunxulumene noko (icandelo elitsha elibandakanya zombini iziyobisi ezinxulumene neziyobisi nezingezizo izinto) .. Kwimeko yangoku yolwazi, ngakumbi ukungabikho kweendlela zokuvavanya ezichaziweyo kunye nezifundo ezinokubakho, izifundo esele zikho, kusengaphambi kwexesha ukuthathela ingqalelo ezinye iindlela zokuziphatha njengokuphazamiseka okuzimeleyo okugcweleyo, ubukhulu becala azifane zonke zifane neziyobisi, endaweni yokuba zibe kukuphazamiseka kolawulo. Uphando lwexesha elizayo olubalulekileyo, kubandakanya zombini izifundo zabantu kunye nezilwanyana (101), ifuneka ukuzisa ulwazi lwethu malunga nokuziphatha kwinqanaba lezinto zokulutha iziyobisi, ngakumbi kwimimandla ye-genetics, neurobiology (kubandakanya nengqondo yobuchopho), kunye nonyango.

Imibulelo

Ixhaswe yiNkqubo yokuPhanda i-Intramural, amaZiko eSizwe wezeMpilo, iZiko leSizwe kuZokusetyenziswa gwenxa kweziyobisi; I-NIH (NIDA) izibonelelo i-R01 DA019139 (MNP) kunye ne-RC1 DA028279 (JEG); kunye namaZiko eMinnesota kunye neYale aGqwesileyo kuPhando loNgcakazo, axhaswe liZiko leSizwe loThengiso oluThembekileyo kunye neZiko lakhe loPhando kwiNgcakazo yokuNgcakaza. UGqirha Weinstein uxhaswa yi-Israel National Institute for Psychobiology. Iziqulatho zombhalo wesandla ziluxanduva lwababhali kuphela kwaye akufuneki zimele izimvo ezisemthethweni zeZiko leSizwe leNtlalontle eliDala okanye iZiko loPhando kwiNgcakazo yokuNgcakaza okanye nayiphi na enye arhente yokuxhasa ngemali.

Imihlathi

Ukutyhilwa kwababhali: Bonke ababhali baxele ukuba akukho kungqubana komdla ngokubhekisele kokubhaliweyo kweli phepha. Ugqirha Grant ufumene izibonelelo zophando kwi-NIMH, NIDA, iZiko leLizwe leMidlalo elinoXanduva kunye neZiko eliDibeneyo loPhando ngeNgcakazo yokuNgcakaza, kunye nezaMithi zamaHlathi. UGqr Grant ufumana imbuyekezo yonyaka evela kuSpringer Shicilela ngokusebenza njengoMhleli-kwiNtloko yeJenali yeziFundo zoNgcakazo, wenza uhlolo lwesibonelelo se-NIH kunye noMbutho woNgcakazo i-Ontario, ufumene ubukhosi kwiOxford University Press, kwiAmerican Psychiatric Publishing, Inc. , I-Norton Press, kunye neMcGraw Hill, ifumene i-honaria kwi-Indiana University Medical School, kwiYunivesithi yaseSouth Florida, iMayo Medical School, kwiCalifornia Society of Addiction Medicine, i-State of Arizona, ilizwe laseMassachusetts, ilizwe lase-Oregon, Iphondo laseNova Scotia, kunye nePhondo laseAlberta. UGqr Grant ufumene imbuyekezo njengomcebisi weeofisi zomthetho kwimiba enxulumene nokuphazamiseka kolawulo. UGqr Potenza ufumene inkxaso yemali okanye imbuyekezo koku kulandelayo: umcebisi kunye nomcebisi ku-Boehringer Ingelheim; umdla wemali eSomaxon; Inkxaso yophando evela kuMaziko kaZwelonke ezeMpilo, iSebe lezeMicimbi yeVeterans, e-Mohegan Sun Casino, iZiko leLizwe lezeMidlalo eliThembekileyo kunye neZiko elisebenzisanayo loPhando ngeNgcinga yokuNgcakaza, kunye neeLabhoratri zehlathi; Uthathe inxaxheba kuphando, ukuthunyelwa ngeposi okanye ukubonisana ngefowuni okunxibelelene nokusetyenziswa kweziyobisi, ukuphazamiseka okulawulekayo okanye ezinye izihloko zezempilo; Ubonisane neeofisi zomthetho kwimiba enxulumene nokulutha okanye ukuphazamiseka kolawulo; unike ukhathalelo lweklinikhi kwiCandelo le-Connecticut lezeMpilo yeNgqondo kunye neeNkonzo zeeNkozo zoNgcakazo ngeNgozi; kwaye wavelisa iincwadi okanye izahluko zeencwadi zabapapashi bezicatshulwa zempilo yengqondo. Ugqirha Weinstein ufumene izibonelelo zophando kwi-Israeli anti-Drug Authority, i-Israel National Institute for Psychobiology, iNjingalwazi eyi-Ministry of Health yase-Israel, kunye ne Rashi Trust (Paris, France) kunye nemirhumo yokufunda malunga nokusetyenziswa kweziyobisi. Icandelo loMphathiswa Wezemfundo wase-Israeli. UGqr Gorelick unika ingxelo yokuba akukho nkxaso mali ingaphandle okanye ukungqubana kwenzala.

Ucaphulo

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