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UJulie Goulet-Kennedy, iZiko eliphakathi lenze iziqulatho ngokutsha kunye nokuhlaziywa kwezentlalo. Iziko lokufunda kwakhona l'Institut universitaire en santé mentale de Quebec; Ikhosi yezeMfundo, iYunivesithi yaseLaval, iQuebec, Canada;
USara Labbe, I-MSc
ISara Labbe, iZiko elinonxibelelwano ngamacandelo okufunda ngokutsha kunye nokuvuselelwa kwakhona kwezentlalo. Iziko lokufunda kwakhona l'Institut universitaire en santé mentale de Quebec; Ikhosi yezeMfundo, iYunivesithi yaseLaval, iQuebec, Canada;
UShirley Fecteau, PhD*
UShirley Fecteau, iZiko lokudibanisa izifundo phakathi kokuhlengahlengiswa kunye nenqanaba lentlalontle. Iziko lokufunda kwakhona l'Institut universitaire en santé mentale de Quebec; Ikhosi yezeMfundo, iYunivesithi yaseLaval, iQuebec, Canada;
Abstract
Ukuthatyathwa kwezigqibo kufundwe ngokubanzi kumxholo wezoqoqosho nakwimbono yeqela, kodwa okwangoku kuncinci okwaziwayo ekuthathweni kwezigqibo. Apha sixoxa ngeendlela ezahlukeneyo zokusebenza kwengqondo ezibandakanyekileyo ekwenzeni izigqibo kunye neendlela ezihambelana neural. Abaqhubi abaziphetheyo ekuthathweni kwezigqibo babonakala ngathi bangaphambili kunye ne-striatum. Izakhono zokuthatha izigqibo ezingalunganga kwiindawo ezahlukeneyo zeklinikhi zidibene nomsebenzi kwi-cortex yangaphambili kunye ne-striatum. Sigxininisa ukubaluleka kokuqiniswa komgangatho wokudityaniswa kokubini kunye nobuncinci bamacandelo ukuze siqhubele phambili ukuqonda kwethu kwezakhono zokwenza izigqibo. Ngokweparadigms yokuqonda, kukho isidingo sokuphucula ixabiso lendalo yemisebenzi yovavanyo oluvavanya ukwenziwa kwesigqibo kwimixholo eyahlukeneyo kunye nemivuzo; oku kunganceda ukuguqulela ukuvavanywa kwelabhoratri kwiinzuzo zobomi bokwenyani. Malunga ne-subural subctates, ukusetyenziswa kweendlela ze-neuroimaging kunceda ekuboniseni uthungelwano lwe-neural olunxulumene nokwenza izigqibo; kutsha nje, iindlela zokumodareyitha imisebenzi yobuchopho, njengakwicala eliphambili kunye neendawo ezixhunyiwe (umzekelo, striatum), kunye nokukhuthaza ubuchopho obungenakuphikiswa nako kukhanyise ngemibono yangaphantsi kunye nengqondo yokuthatha izigqibo. Ngokudibeneyo, ezi ndlela ziqondayo nezibonakalayo zinokuba luncedo kwizigulana ezinamakhono okwenza izigqibo angalunganga. Eyona nto iqhubayo kulo msebenzi kukuba amandla okwenza izigqibo enza izinto ezibalulekileyo ebomini, ezempilo, ezokhuseleko, nokhetho lwezezimali noluntu kubomi bethu bemihla ngemihla.
intshayelelo
Sihlala sijongana nezigqibo kubomi bethu bemihla ngemihla: "Sesiphi isidlo sakusasa?" "Ngaba kufuneka ndithambise umzimba? Ewe, kodwa ngowuphi umsebenzi? Ibhola ekhatywayo okanye iyoga? ”“ Ngaba kufuneka ndiye eholideyini? Mhlawumbi emva kwalo mhla wokugqibela wesibonelelo. "" Ngaba kufuneka ndisele enye iglasi yeWhiskey ukuzehlisa? Enye indebe yekofu yokundivusa? "Izigqibo ziqhutywa zangaphandle (umz. Ubungakanani kunye nokulibaziseka kwemivuzo / ilahleko ezinokubakho) kunye nezinto zangaphakathi (umz.1), kunye nefuthe lemfuzo (umzekelo: iinkqubo zangaphambili zedopamine2) okanye i-psychopathology.
Ukuthathwa kwezigqibo ngendlela engalunganga kubantu inokubangelwa kukungoneliseki ngokwaneleyo kokukhetha okanye indlela eyingozi kakhulu (okanye yokulumka kakhulu), kwaye inokuba neziphumo ezibi kwimpilo, ukhuseleko kunye nentlalontle. Ukuqonda okungcono kwezakhono zokwenza izigqibo, ezomeleleyo okanye ezingalunganga, kubalulekile. Oku kungabonakaliswa ngumzekelo wokutshaya icuba. Cinga ngempembelelo yokuqonda ukuba kutheni omnye umntu engazange atshaye icuba, ngelixa omnye eye watshaya omnye okanye ababini emva koko wayeka, okanye omnye uye watshaya kangangexesha elithile waphinda wayeka, ukanti omnye oqhubeka nokutshaya emva koko ahlupheke ziziphumo zobuchopho Utshintsho lweplastikhi oluthi emva koko luxhase into ekhulayo ibe yingozi yengqondo kunye nokuziphatha komzimba wokuphazamiseka kokusetyenziswa kweziyobisi. Lo ngumzekelo nje, kodwa ingcinga efanayo inokusetyenziswa kwikhoboka lokuziphatha (umzekelo, ukungcakaza okungapheliyo): kutheni umntu omnye eqhubeka nokuthatha umngcipheko ekungcakazeni de impilo yakhe ibe semngciphekweni. Omnye umzekelo kukuba kutheni umntu onexinzelelo okanye othe wabethwa sistroke ehambelana notshintsho lwendlela yokuphila kunye / okanye neengcebiso kwezonyango (umzekelo, ukuzilolonga, ukunciphisa utywala, ukutya ngendlela esempilweni, ukuthatha inxaxheba kwezoluntu), xa kuthelekiswa nomnye umntu ukuthobela nangona impilo nobomi bomntu busesichengeni. Kukho ke uluhlu olubanzi lwezifo apho kufuneka khona utshintsho lweendlela zokuziphatha kunye nendlela yokuphila yexesha elide, efuna izakhono zokwenza izigqibo.
Injongo yeli nqaku kukuxoxa ngezakhono zokwenza izigqibo kunye neendlela ezihambelana neural. Sigxininisa indima enempembelelo ye-cortex yangaphambili kunye ne-striatum kwezo zakhono. Sikwajongisisa kwakhona iinkqubo zokuqonda kunye nezizathu ezibandakanyekayo ekuthathweni kwezigqibo ezaziwa ukuba zinokungalunganga kwiindawo ezahlukeneyo zeklinikhi, ngakumbi ukuphazamiseka kokusetyenziswa kweziyobisi, ikhoboka lokuziphatha, kunye ne-schizophrenia. Sigxininisa isidingo sokuphawuleka kwezi nkqubo zokuqonda kunye nokusetyenzwa kwangaphantsi ukuze sikhuthaze ukuphuhliswa kwezicwangciso zonyango. Ewe, iindlela zinokujolisa kuzo zombini iingqondo kwaye Ukuziphatha ukuze kukhokelele abaguli kude ne-trajectory engalunganga, kunye nendlela yokuphila esempilweni.
Iinkqubo zokwenza izigqibo kunye nendima yestriatum
Ukuthathwa kwezigqibo kufundwe ikakhulu kwimeko yezoqoqosho nentengiso kunye nembono yeqela.3 Ukuvela nje kwe-neuroeconomics kunye ne-neuromarketing kuvule iindawo zophando malunga nendlela ingqondo yomntu eyenzayo, umzekelo, izigqibo zemali.4 Ewe, izigqibo esizenzayo zikwanefuthe elibonakalayo kwimpilo yethu yengqondo neyomzimba, kwaye banokufundwa ngemisebenzi yovavanyo kunye neendlela zokuvula umzimba.
Ukwenza izigqibo kubandakanya iinkqubo zengqondo eziqiqisayo nezishukumisayo, njengokujonga, ukufuna umvuzo, ukungxamiseki, kunye nokuthatha umngcipheko. Ezi nkqubo zinokujongwa njengenxalenye yeenkqubo ezimbini ezinxibelelana xa usenza isigqibo: kukho inkqubo "evakalayo" exabisa umvuzo okhawulezileyo kunye nenkqubo evakalayo nefanelekileyo nevuzayo. Ukwenza izigqibo kungachazwa njengenkqubo yokubonakalisa kwizinto ezininzi kunye nenkqubo yeemvakalelo ekhonzwa yintshukumo eguquguqukayo ye-multilevel efunyanwa kunye nokubonisa imiqondiso ye-amodal, kunye nokulawula ngokuqhubekayo kunye nokuphinda uzibone uqhubeka ngokwakho kunye nengxelo. Le setyhula idibanisa kwaye idityanise ulwazi ngaphakathi kothungelwano lwe-cortical and subcortical, kunye ne-cortex yangaphambili kunye ne-striatum njengabaqhubi be-putative (umzekelo, jonga ii-Refs. 4-5-6-7-8-9-10).
Ngaphakathi kwesi sikhokelo, ukuphawuleka kunye nokukhuthaza ukwenziwa kwezigqibo kunokuqinisa inqanaba lokudityaniswa kumanqanaba okuqonda nawokuhamba, kuthathelwa ingqalelo izinto zangaphandle (umz. Imeko yezentlalo). Umzekelo, amacebo akhuthaza ukwenziwa kwezigqibo ezifanelekileyo aquka iindlela zokuphinda axabise amaxabiso omvuzo wezinto ezingenampilo kunye nokukhetha okunempilo ngokuqinisa ulawulo lwangaphakathi nolawulo lwengqondo kwabo bantu banqwenela ukufikelela kwiinjongo zabo zokutshintsha kobomi (umz. Ukwenza umthambo; ukuyeka okanye ukunciphisa ukutshaya, ukungcakaza, okanye ukusela; ukutya ngokwasempilweni) kodwa oye wasilela okuphindaphindiweyo.11 Nangona kunjalo, umceli mngeni kukuchonga eyona ndlela ilungileyo yokukhokela indlela yokuziphatha eguqukayo kunye nokuqina kwengqondo ukuze kukhuthazwe imisebenzi ephantsi kokwenza izigqibo ngokobuqu enokukhokelela kwizibonelelo zobomi bokwenyani.
Ukukhokela ezi ndlela zokuziphatha eziguqukayo, uthungelwano lwe-neural kufuneka luchazwe kakuhle. Njengoko sele kukhankanyiwe apha ngasentla, izakhono zokwenza izigqibo zibandakanya iinkqubo ezithile ezibonakalayo nezishukumisayo, ezibandakanya uthungelwano oluntsonkothileyo lwe-neural. Nangona kunjalo, kukho abathile abadlali abaphambili, ngakumbi i-cortex yangaphambili kunye ne-striatum. TI-cortex yangaphambili kunye ne-striatum zidibene kakhulu12 kwaye rhoqo uququzelele ngexesha leenkqubo zokunyusa.13,14 Iindawo ezingafaniyo zombini zangaphakathi kunye ne-dorsal striatum zidityaniswe neenkqubo ezahlukeneyo zokwenza izigqibo kubantu abadala abasempilweni.14-16 Ngapha koko, imivuzo inempembelelo xa kusenziwa izigqibo kwaye zibonakala zisebenza ngakumbi.17 Okubangela umdla kukuba, ukukhetha kunokubonakala kunomvuzo ngokwemvelo.18 Izifundo zibonakalise ukuba ukwenza ukhetho kunye nokukhetha (umzekelo, umbono wolawulo) kunomvuzo kunye nomsebenzi wokukhuthaza kwi-striatum. Umzekelo, umsebenzi omkhulu kwi-striatum wafunyanwa kwizifundo ezafumana imbuyekezo ngokukhetha phakathi kweendlela ezahlukeneyo kunakwizifundo ezifumene imbuyekezo efanayo ngaphandle kokukhetha;19 lI-ikewise kwizifundo ezifumene iingeniso ezisisibonelelo ngokuthelekiswa nezo zafumana umvuzoy.20,21
Xa ubuchule bokwenza izigqibo buthathaka
Ukwenza izigqibo kunokuchaphazeleka kukuziphatha gwenxa kunye / okanye inethiwekhi engalunganga ye-neural. Ukuziphatha okunxulumene nokwenza izigqibo (umzekelo, ukwamkela icuba lokuqala [okanye "elinye lokugqibela"]) kunye nemisebenzi yengqondo (umzekelo, ukufuna umvuzo, ukubhukuqa, ukuzilawula, ukuthatha umngcipheko, ukuthathela ingqalelo) kunokunxulunyaniswa neempawu (umz. ) kwiimeko ezithile zonyango (umzekelo, ukuphazamiseka kwecuba). Ukuthathwa kwezigqibo ngendlela engachazwanga kuxeliwe kuxinzelelo olwahlukileyo, kubandakanya ukuphazamiseka kokusebenzisa iziyobisi, iziyobisi ekuziphatheni, kunye nengqondo (ITheyibhile I).
Ukuphazamiseka kokusetyenziswa kweziyobisi
Izifundo ziphindaphinde ingxelo yokuba izigulana ezinengxaki yokusebenzisa iziyobisi ziyahluka kwizifundo ezisempilweni kwizakhono zokwenza izigqibo, kwaye ezi zinto zihlukile kwindlela yokuziphatha ziye zadityaniswa neepatheni ezahlukeneyo zomsebenzi kwimimandla eyahlukeneyo yobuchopho, kodwa ngakumbi kwi-ventral striatum. Abasebenzisi be-Methamphetamine babonisa ukuthatha izigqibo ezinobungozi,22,23 edityaniswe necortex yangaphambili kunye ne-striatum.24 Umzekelo, Abasebenzisi be-methamphetamine bathathe umngcipheko ngakumbi kwi-Balloon Analog Risk Task kwaye babonisa umsebenzi omkhulu kwi-ventral striatum kunye nomsebenzi ongenamandla kwi-cortex yase-dorsolateral eyandulelayo kunolawulo olunempilo.23 Ulindelo lomvuzo wemali likwaphakanyisile imisebenzi kwi-ventral striatum kwizigulana ezinengxaki yokusebenzisa icocaine25 kunye nakubasebenzisi abanzima be-cannabis26 Izigulana ezinengxaki yokusetyenziswa kwecuba zikwabonisa ukungakhathali kunye nokwenza izigqibo ngobungozi.27,28 Njengoko sele kukhankanyiwe apha ngasentla, imivuzo ibonakala inefuthe kwimisebenzi yenzululwazi, kwaye oku kuye kwaqwalaselwa nakwizigulana ezinengxaki yokusebenzisa iziyobisi.29-35 Umzekelo, imisebenzi ye-striatal ekuphenduleni kumvuzo wemali iyancipha kubantu abatshayayo ngethemba lokutshaya.32 Kutshanje, uWilson kunye noogxa bakhe bafunda imbono yomntu ngamnye kunye nekhonkco lakhe kwistriatum kubantu abatshayayo abatshayayo.33 Baye bafumanisa ukuba abantu ababhemayo babonakalisa eyona nto ibuthathaka kwi-ventral striatum ngexesha lemivuzo yemali babengazimiselanga ukwala ukutshaya ukuze baqinise imali. Ngokunjalo, abaguli abanengxaki yokusebenzisa kakubi utywala babonisa izigqibo zobungozi,36 ebonakala ibandakanya imisebenzi yesondo. Umzekelo, abaguli abanengxaki yokusebenzisa kakubi utywala babexhalabile34 kwaye ibonakalise imisebenzi ebuthathaka kwi-ventral striatum ngexesha lokulindela umvuzo wemali.34,35 Iziphumo ezifanayo zaqatshelwa kwizifundo ezisempilweni xa kutyhilwa ngotywala. UGilman kunye noogxa bakhe bafumanisa ukuba i-infusion yotywala inomdla kwi-striatum xa abaphuhlisi besempilweni besenza ukhetho olunobungozi kunokuba bakhethe iindlela ezikhuselekileyo.37 Into ebangela umdla kukuba, ezi zifundo zine zibika ukuxinezeleka okukhulu kwizigulana ezinengxaki yokusebenzisa iziyobisi kunolawulo olusempilweni lubonise ukunciphisa kwezenzo kwi-ventral striatum, 29,31,34,35 lo gama ezi zifundo zibini zingawubonisi mahluko wokunyanzeliswa phakathi kwamaqela zibonise ukwanda kwentshukumo yangaphakathi25,26 (ITheyibhile I).
Umlutha wokuziphatha
Ukwenza izigqibo ngobungozi kuthathwa njengenkqubo yokuziphatha njengendawo yokungcakaza yomzimba, ebandakanya imisebenzi yeseriya. Ukuthathwa kwezigqibo ngendlela engaqhelekanga kunye nomsebenzi ohambelana nawo kwizigulana ezinokungcakaza kwe-pathological zibonakala zifana nezo zibonwa kwizigulana ezinengxaki yokusebenzisa iziyobisi.38 Umzekelo, isenzo kwistriatum yangaphakathi ngexesha lokuqikelelwa komvuzo kwakuhambelana kakhulu nenqanaba lokunyanzeliswa kwizigulana ezinengxaki yokusetyenziswa kotywala kunye nakwizigulana ezinomngcipheko we-pathological. 34,39,40 Oku akunakumangaliswa, njengoko bobabini bafumanisa ukuba babelana ngeempawu: ezi zigulana ziyaqhubeka nokuziphatha ezizisa imbuyekezo yokungalunganga, ngaphandle kwemiphumo emibi, ukunyamezelana, kunye nokurhoxa.41
kwengqondo
Ezinye idatha ziphakamisa ukuba izigulana ezine-schizophrenia zibonise ukusilela ekuthathweni kwezigqibo, njengoko kuvavanywa ngomsebenzi weIowa wokuNgcakaza.42 Zibonakala ngathi zinganyanzelekanga ngaphezu kolawulo olusempilweni kumsebenzi wokuCothisa ukuCothisa43 kunye nokwenza izigqibo ngokungxama kwi-Beads Task.44,45 Ngaphaya koko, kuye kwaxelwa ukuba izigqibo zokungxama kwizigulana ezinesifo sokudalwa kwengqondo zinxulunyaniswa nomsebenzi otshitshisiweyo kwindawo efanelekileyo yenzala ngexesha lokugqibela lokuthatha izigqibo.46 Izihlobo ezikwinqanaba lokuqala zibonisa nezigqibo ezingaqhelekanga,47 Ngelixa abantu abanesimo sengqondo esisesichengeni sokungakhathali babonakala ngathi abonakalisi zigqibo zingxamisekileyo, kodwa babonisa imisebenzi encitshisiweyo ekunene xa bethatha izigqibo zokugqibela xa kuthelekiswa nezifundo ezisempilweni.48
omnye
Abanye abantu bezonyango babonisa izigqibo ezinobungozi zokuthatha izigqibo, kubandakanya nezo zinobuntu bomda wokuchacha,49-51 ukunyanzelwa52 kunye nokufunyanwa kwesilonda kwindawo yokuqala.53-57 Ukubandakanyeka kwesistimenti enxulunyaniswa nokwenza izigqibo zobungozi kusafuneka kufundwe kolu lutsha. Izigulana ezinesifo sikaParkinson ezinesifo sokulawulwa kwempembelelo zikwabonisa izigqibo ezinobungozi.58 Umzekelo, ezi zigulana zithathe umngcipheko ngakumbi kwi-Balloon Analog Risk Task, kwaye oku kunxulunyaniswa nomsebenzi ongezantsi kwi-ventral striatum kunezigulana ezinesifo seParkinson ngaphandle kweziphazamiso zolawulo.59
Abanye abantu babonisa ukuthatha ulumlo ngokungaqhelekanga lokuthatha izigqibo, kubandakanya nabantu abanoxinzelelo olukhulu,60-62 Ukuphazamiseka63 kunye nabantu abaphilile abanenkxalabo ephezulu yokuxhalaba.64 Izigulana ezinobungozi bokulimala kwengqondo zibonakala zibonakalisa umngcipheko wokulumka ngendlela engaqhelekanga njengoko kubonisiwe, umzekelo, kwi-Balloon Analog Risk Task.65 Kwakhona, uphando oluthe kratya luyafuneka ukuchaza ngcono izakhono zokuthathwa kwezigqibo kunye nezigqibo ezihambelana noko.
Nokuba izakhono zokuthatha izigqibo ezingalunganga zingunobangela okanye sisiphumo seengxaki ezithile, iindlela zokukhuthaza kunye nokubuyisela kwimeko yesiqhelo izigqibo zomntu ngamnye ngokuhambelana nenjongo yakhe (umzekelo, ukuyeka ukutshaya) ziya kuba nempembelelo enkulu kwezonyango, kwezentlalo nakwezoqoqosho.
Iimbono zexesha elizayo: singabakhuthaza njani ubuchule bokwenza izigqibo?
Eyona njongo iphambili yomsebenzi wexesha elizayo kukuphawula, ukukhuthaza, kunye nokugcina kulungiswa imeko yokuthatha izigqibo umntu ngamnye ukwenzela ukuphucula impilo nentlalontle yezigulana. Umngeni omnye kukudibanisa iindlela ezahlukeneyo zokuziphatha, njengoko ukwenza izigqibo kukuphambana kwezonyango, inzululwazi yomntu, ii-neuroscience, ezoqoqosho kunye nentengiso. Kananjalo, ukwenzela ukukhuthaza isimilo esithile (umzekelo, ukwala ukunikezelwa kwecuba), sifuna iindlela zokuphucula ukusebenza kwengqondo (umzekelo, ukunciphisa umvuzo [wecuba] nokufuna) kunye / okanye ukumodareyitha ama-neural substrates (ngakumbi kwindawo yangaphambili kunye striatum). Olu tshintsho ekugqibeleni lunokuguqulelwa kwizibonelelo zekliniki (umzekelo, ukunciphisa okanye ukuyeka ukutshaya). Ke, kufuneka siphuhlise paradigms ezingcono zokuqonda kunye neendlela eziya kumodareyitha imisebenzi yangaphambili kunye nokuzinza kweminye imimandla kunye neenethiwekhi.
Iindlela zokukhuthaza imisebenzi yokuqonda ebandakanyekayo ekwenzeni izigqibo
Enye into ebalulekileyo kukulungelelanisa ulwazi olusekwe elabhoratri yokuthatha izigqibo kwiimeko zokoqobo zehlabathi. Ewe, iimvavanyo kufuneka zigqithe ngaphaya kolingo lwelabhoratri olulawulwayo kwiimeko zangempela ebomini ukuguqula iziphumo ezisisiseko kwizibonelelo zobomi bokwenyani. Into ebaluleke kakhulu, kodwa ehlala ihoywa, xa ulinganisa iimpendulo zengqondo yomntu kwiimvakalelo, amandla, kwiminqweno, njalo njalo (iinkqubo ezichaphazela ukwenziwa kwezigqibo) bubunyani bendalo. Ukwenza izigqibo, njengokwamkela okanye ukwala ukutshaya, kusenokwenzeka ukuba kusebenza ngokwahlukileyo kubomi benene kunokuba kusenziwa kwilabhoratri. Kukho paradigms ezimiswe kakuhle zokwenza izigqibo66,67 enokutshintshwa ukuze ibandakanye imivuzo yenyani yenyani yehlabathi. Umzekelo, Takahashi68 wafunda ukuzonwabisa ngesiqu somdlalo wokugqibela, enika umvuzo wemali kunye necuba kwizigulana ezinengxaki yokusebenzisa icuba kunye nabantu abaphilayo. Izigulana ezinengxaki yokusetyenziswa kwecuba ziye zagatya ukunikezelwa kwemali ngokungalunganga (njengoko benzayo abantu abaphilayo), kodwa ke bakwamkela okutshaya ngokungafanelekanga. Iparadigms kufuneka ibandakanye nefuthe elinokubakho kwindalo esingqongileyo kunye nenethiwekhi yezoluntu (umzekelo, ingcinezelo yoontanga yokutshaya). Indawo evelayo yenyani yokuntywila ngokuqinisekileyo inokuba negalelo ekubonakalisweni okungcono kokuziphatha kunye nemisebenzi yokuqonda kwizifo ezahlukeneyo zeklinikhi, kubandakanya nezo zinengxaki yokusebenzisa iziyobisi,69,70 iakhawunti71 kunye ne-schizophrenia.72 Sifuna iiparadigms ezinzima ezixelisa iimeko zokwenyani, kodwa sikwadinga iiparadigms eziya kuthi zihlukanise kwaye zihlukanise iinkqubo ezahlukeneyo ezichaphazelekayo xa sisenza isigqibo, ukusuka kwiinkqubo zononophelo ukuya kwinkuthazo, kuvavanyo, ekukhetheni nasekulangazeleleni. Ukuchazwa kwenkqubo yokuqonda xa usenza izigqibo ngumdla weklinikhi. Umzekelo, iziphumo zokutshaya zaxelwa kwangaphambili yimikhwa eshukumisayo73,74 Ukuphungulwa kwembuyekezo yokulibaziseka.75 Kunikwe ingxelo yokuba abaguli abanengxaki yokusebenzisa icuba ababonisa isaphulelo esikhulu semivuzo yemali babengaphantsi kokugcina imeko yokutshaya ngexesha le-28-veki yonyango lokuziphatha.76,77
Iindlela zokukhuthaza umsebenzi wobuchopho obandakanyekayo ekwenzeni izigqibo
Kukho iindlela zokumodareyitha ukusebenza kobuchopho, kubandakanya iindlela zokuziphatha (umzekelo, i-neurofeedback) kunye, kutshanje, iindlela zobuchule bokukhuthaza ubuchopho. Ukuvuselela ubuchopho obungavulelekanga, njengokuphindaphindeka kokunyusa amandla kazibuthe (i-rTMS) kunye nokukhuthaza okuthe ngqo kwangoku (tDCS), kunokuguqula imisebenzi yengqondo yabantu kwi-vivo.78 I-rTMS yindlela yokwenza iinguqu eziguqukayo ekusetyenzisweni kwengqondo ngokusebenzisa amandla kazibuthe, aphindaphindiweyo. I-TDCS yenza ukuba utshintsho lungxamiseko ngenxa yesithambiso se-neuronal membrane depolarization ebangelwa lutshintsho kwiiprotein ze-transmembrane protein kunye neenguqu ezinxulumene ne-elektroli kwi-hydrogen ion. Zombini i-rTMS kunye ne-TDCS zinokubangela i-neural inhibitory kunye / okanye utshintsho olunomdla olunokuthi luvele ixesha lokuvuselela, kuxhomekeke kwiiparamitha zonyuselo. Ngamafutshane, ezi ndlela zokukhuthaza ubuchopho zingasebenzi kwaye zinokuguqula umsebenzi womnatha wengqondo; ke, Iziphumo zokujikeleza kwengqondo zibangelwa ziziphumo zokuziphatha ezibonakalayo kamva. Ezi ndlela zokuhlakulela ubuchwephesha bokuguqula ingqondo ziguqule imisebenzi yokuqonda ebandakanyekayo ekwenzeni izigqibo,79 kubandakanya ukufuna umvuzo,80,81 ukuthatha umngcipheko,82,83 ukunganyanzelekanga,84,85 kunye nokuqwalaselwa ngocoselelo lweliso86 kunye nolwazi lweemvakalelo.87,88 Banokuba nakho ukuphucula izakhono zokwenza izigqibo kubemi bezonyango.89 Izifundo ezithile ezingubungqina besifundo esiguquliweyo seenkqubo zokuthatha izigqibo kwizigulana, ezinjengezo zinengxaki yokusebenzisa iziyobisi,90-92 ukugembula kwengqondo93 kunye nokuphazamiseka okungapheliyo.94 Umzekelo, hayashi kunye noogxa90 wafunda iziphumo ze-rTMS ezisetyenzisiweyo kwicala lasekhohlo dorsolateral preortal cortex kwizigulana ezinengxaki yokusebenzisa icuba. Bafumene ukucinezelwa komnqweno wecuba nokungabinamali kwimbuyekezo yemali njengoko kumiselwe ngumSebenzi wokuCothisa ukuCutha. Kwesinye isifundo, iziphumo ze-tDCS ngaphezulu kwe-dorsolateral preortal cortex ziye zavavanywa kwizigulana ezinengxaki yokusebenzisa icuba ezinqwenela ukuyeka ukutshaya.92 Inani lecuba elitshayiweyo kunye neenkqubo zokuthatha izigqibo bezifundiwe. Ukuthathwa kwezigqibo kwizakhono zokuthintela umdla wakho kunye nokuthatha umngcipheko ekusebenziseni umdlalo we-Ultimatum68 Umsebenzi oMngcipheko,22 ngokwahlukeneyo, ngemivuzo yemali kunye neecuba, zalinganiswa. Iziphumo eziphambili zibandakanya ukwehla kwenani lecuba elitshayiweyo kunye nokunyuka kwamanqanaba okunikwa kwecuba, kodwa hayi okunikezelwayo kwimali, kumdlalo wokugqibela, kucebisa ukuba iziphumo ze-TDCS zinokuba nomvuzo onobuzaza. Akukho lutshintsho lubalulekileyo lufunyenweyo kwi-Risk Task ngokubhekisele kunoma yimuphi umvuzo.
Uninzi lweeprothokholi ezisebenzisa i-rTMS kunye ne-tDCS ejolise kumgaqo wokuqala wesibeleko. Ngenxa yokuba i-anatomy yengqondo, i-striatum ayinakujoliswa ngqo kwiindlela ezingenzi nto. Nangona kunjalo, njengoko i-cortex yangaphambili kunye ne-striatum zidibene kakhulu, kuye kwafunyaniswa ukuba ukujolisa kumqolo wokuqala kunye nokuvuselelwa kwengqondo okungavuseleliyo kunokulinganisa umsebenzi we-striatal. Ewe, ukujolisa kwimbonakalo yangaphambili dorsolateral preortal cortex nge-rTMS ekhuphelwe ukuphuma kwe-dopamine kwi-caudate nucleus,95 ngokunjalo nakwindawo engaphandle kwangaphandle cortulate kunye ne-orbitof Pambal cortex.96 Kuphononongo lwakutshanje, sisebenzise ii-tDCS ngaphezulu kwe-dorsolateral preortal cortex yabantu abadala abasempilweni ngexesha lokubonwa kwemagnethi yomzimba. Sifumene ukuba ngokuthelekisa ukunyusa i-sham, ukukhuthaza okusebenzayo kwe-N-acetyl aspartate kwi-cortex yangaphambili, kunye ne-glutamate kunye ne-glutamine kwi-striatum.97 Kuya kuba ngumdla ukuvavanya ukuba ingaba ukuvuselela kwengqondo okungavuthanga kunganciphisa ukusilela kwizakhono zokwenza izigqibo ngokumodareyitha imisebenzi kwimbonakalo yangaphambili kunye ne-striatum kwizigulana ezithatha izigqibo ezingalunganga, njengoko kubonisiwe ukuba umsebenzi we-striatal uneempembelelo zekliniki. Umzekelo, isenzo kwiseti ye-ventral striatum eqikelele iziphumo zonyango kunye nokuthatha iziyobisi kwizigulana ezinengxaki yokusebenzisa i-cannabis,98 Ukuphazamiseka kokusebenzisa icocaine99 kunye ne-meth amphetamine yokusetyenziswa kokuphazamiseka.100 Kwakhona, isenzo se-ventral striatum ephakanyisiweyo ngexesha lokuqagela ikhadi lokungcakaza ngomvuzo wemali kunye nesohlwayo sinxulunyaniswa nobunzima bokungcakaza kwizigulana ezinomngcipheko we-pathological.39
izigqibo
Ngokudibeneyo, ezi zicwangciso kufuneka zincedise ekubonakaliseni ubunjani bobuciko kunye nobunjalo bezinto ezichaphazelekayo xa sisenza izigqibo. Kufuneka siphonononge iindlela zokonyusa ubunyani bendalo yokuthathwa kwezigqibo zethu zokuthathwa kwezigqibo ukuze kukhululeke utshintsho olusuka kwiseti yeelebhu lube kwiimeko zobomi bokwenyani. Kananjalo, njengayo nayiphi na imisebenzi yengqondo neyokubonelela, ukwenza izigqibo kuphuculo kwaye kutshintsha kubomi bonke, ekufuneka kuthathelwe ingqalelo kwakhona kwizifundo ezizayo. Umzekelo, izinto ezenzeka dorsal striatum zaphakanyiswa ngexesha lokukhawulezisa nokulibaziseka kwemivuzo kubantu abadala, kodwa hayi kubantu abancinci, abasempilweni.101 Oku kuya kunceda ngakumbi kuphuhliso lweendlela zothintelo kwaye kuya kujongana nemibuzo enamabhongo, anje Kutheni le nto abanye abantu ingekuko abanye besitya ngokusempilweni, ukusela ngendlela efanelekileyo, kunye nokuzivocavoca?
IZALATHISO