Iipatheni zokusebenza zoBongo ezihambelana nokukhwabanisa kunye nokulangazelela kwiingxaki zokungcakaza, ababhemayo abakhulu kunye nokulawula okunempilo: uphando lwe-FMRI (2010)

Umlutha weBiol. Okt 2010; 15(4): 491–503.

ikhonkco:  10.1111 / j.1369-1600.2010.00242.x

 
Eli nqaku liye khankanywe ngu amanye amanqaku kwi-PMC.

Abstract

I-reactivity engaqhelekanga ye-cue reactivity luphawu olusembindini wokulutha, olunxulunyaniswa nokwanda komsebenzi kwinkuthazo, ingqalelo kunye neesekethe zobuchopho ezinxulumene nenkumbulo. Kolu phononongo lwe-neuroimaging, i-cue reactivity kwingxaki yokungcakaza (PRG) yathelekiswa necue reactivity kubantu abatshaya kakhulu (HSM) kunye nolawulo olusempilweni (HC). I-active magnetic resonance imaging imaging event-related cue reactivity paradigm, equka ungcakazo, imifanekiso enxulumene nokutshaya kunye nemifanekiso engathathi hlangothi, yaqeshwa kwi-PRG ye-17 efuna unyango olungatshayiyo, i-HSM ye-18 engangcakazeli, kunye ne-17 engangcakazo kunye nokungatshayi. HC. Ukubukela imifanekiso yokungcakaza (ngokunxulumene nemifanekiso engathathi hlangothi) yayanyaniswa nokusebenza kwengqondo ephezulu kwiindawo ze-occipitotemporal, i-posterior cingulate cortex, i-parahippocampal gyrus kunye ne-amygdala kwi-PRG xa kuthelekiswa ne-HC kunye ne-HSM. Umnqweno wokuzithoba kwi-PRG ulungelelaniswe kakuhle kunye nokusebenza kwengqondo kwi-cortex yangaphambili ye-ventrolateral prefrontal kunye ne-insula yasekhohlo. Xa kuthelekiswa neqela le-HSM kunye namanye amaqela amabini, akukho mahluko abalulekileyo kwimisebenzi yengqondo ebangelwa yimiba yokutshaya ifunyenwe. Kucazululo olucwangcisiweyo, iqela le-HSM elinoVavanyo oluphezulu lweFagerström lwamanqaku okuxhomekeka kweNicotine (FTND M = 5.4) lubonise ukusebenza kwengqondo okuphezulu kwi-ventromedial prefrontal cortex, i-rostral yangaphambili ye-cingulate cortex, i-insula kunye ne-middle/high temporal gyrus ngelixa ubukele imifanekiso yokutshaya. ngokumalunga nemifanekiso engathathi hlangothi) kune-subgroup ye-HSM enamanqaku aphantsi e-FTND (FTND M = 2.9) kunye ne-HC engatshayiyo. Umnqweno weNicotine uhambelana nokusebenza kwi-prefrontal yasekhohlo kunye ne-amygdala ekhohlo xa ujonga imifanekiso enxulumene nokutshaya kwi-HSM. Ukusabela okwenyuka kwengingqi kwimifanekiso yongcakazo kwimimandla yobuchopho enxulunyaniswa nenkuthazo kunye nokusetyenzwa okubonakalayo ikhona kwi-PRG, efana neendlela ze-neural eziphantsi kwe-cue reactivity ekuxhomekeke kwiziyobisi. Ukonyuka kokusebenza kwengqondo kwiindawo ezinxulumene nobuchopho be-fronto-limbic yayikhona kwi-HSM enamanqaku aphezulu e-FTND xa kuthelekiswa ne-HSM enamanqaku asezantsi e-FTND.

Internet: Umlutha, i-cue reactivity, i-fMRI, ukuphazamiseka kokulawula impembelelo, ukuxhomekeka kwenikotini, ukungcakaza ngezifo

INTSHAYELELO

Ukungcakaza kwePathological (PG) luphazamiseko oluxhaphakileyo ngokuqikelelwa kwenqaku elimalunga ne-1% (Welte okqhubekayo. 2001). I-PG ihlala ikhokelela kwiingxaki ezinzima ngokwasengqondweni (Petry & Kiluk 2002; Potenza okqhubekayo. 2002). Okwangoku, i-PG ihlelwa njengengxaki yokulawula impembelelo, kodwa iindlela zokuxilonga zifana ngokusondeleyo nezo zokuxhomekeka kweziyobisi. Ukongeza, izifundo zamva nje zibonise ukufana kwe-neurobiological phakathi kwe-PG kunye nokuxhomekeka kweziyobisi (Petry & Kiluk 2002; Potenza okqhubekayo. 2002; Goudriaan okqhubekayo. 2004). Ngenxa yoko, abanye ababhali baye bacebisa ukuba i-PG iphinde ihlelwe njengomlutha wokuziphatha kwi-DSM-V (Petry 2006; Potenza 2006).

Ukonyuka kwe-cue reactivity edityaniswa nengqalelo ephezulu yeendlela ezinxulumene nomlutha kubonisa indlela ebalulekileyo ekuphuhliseni izimilo eziluthayo (IGoldstein kunye neVolkow 2002) kwaye inokukhuthaza ukubuyela ekuxhomekekeni kwiziyobisi (Cooney okqhubekayo. 1997; iindleko okqhubekayo. 2006; Marissen okqhubekayo. 2006). Izifundo zokucinga ezisebenzayo zisebenzisa i-cue-exposure paradigms kwi-nicotine, utywala kunye nokuxhomekeka kwe-cocaine kuye kwaxela ukonyuka kwe-ventral prefrontal, i-insular, i-amygdala, i-striatal, kunye nomsebenzi we-thalamic, imimandla yobuchopho ehambelana nokusetyenzwa kweemvakalelo kunye nokuziphatha okukhuthazayo. Ukongezelela, ukujikeleza kwe-ingqwalasela kunye nokulawulwa kwengqondo kuye kwabandakanyeka kwizifundo ze-neuroimaging cue reactivity, eziboniswe ngokunyuka kwe-dorsolateral prefrontal, i-anterior cingulate cortex kunye ne-activation parietal (Iikhithi okqhubekayo. 2001; Tapert okqhubekayo. 2004; david okqhubekayo. 2005; iindleko okqhubekayo. 2006; McBride okqhubekayo. 2006; Franklin okqhubekayo. 2007).

Malunga ne-50% yabangcakazi be-pathological abazama ukuyeka ukuphinda baphinde babe neziphumo ezibi kakhulu (Hodgins & el Guebaly 2004), kunye nolunye uphononongo lubonisa ukuphindaphinda rhoqo kwi-pathological gamblers efuna unyango (Ledgerwood & Petry 2006). Kuba i-cue reactivity yeyona ndlela iphambili kuphuhliso lokuphazamiseka kokulutha, kwaye ngenxa yokuba inyanyaniswe nomngcipheko ophezulu wokuphinda uxhomekeke kukuxhomekeka kweziyobisi (Cooney okqhubekayo. 1997; iindleko okqhubekayo. 2006; Marissen okqhubekayo. 2006), ukuphanda iindlela ze-neurobiological ze-cue reactivity kule ndawo ibaluleke kakhulu. Ukuza kuthi ga ngoku, zimbini kuphela izifundo ezisebenzayo zokucinga ngemagnethi (fMRI) malunga nokuvezwa kwizinto ezinxulumene nokungcakaza kubangcakazi bezifo eziye zapapashwa (Potenza okqhubekayo. 2003; eCrockford okqhubekayo. 2005). Zombini izifundo zisebenzise amaqhekeza evidiyo anxulumene nongcakazo kunye neendawo ezahlukeneyo zolawulo, kodwa zivelise iziphumo ezingangqinelaniyo. Kuphononongo lokuqala phakathi kwe-10 yokungcakaza kwe-pathological kunye nolawulo oluqhelekileyo lwe-11, izifundo ze-PG zityhilwe zinciphile, endaweni yokwandisa ukusebenza kwi-ventral anterior cingulate cortex, i-orbitofrontal cortex, i-basal ganglia kunye ne-thalamus ngexesha lokungcakaza-eyanyaniswa ngokuchasene nolawulo lwe-epochs. Ukonyuka kokusebenza ngexesha lokujonga izinto ezinxulumene nokungcakaza kufunyenwe kwi-occipital lobe kuphela (Potenza okqhubekayo. 2003). Kuphononongo lwesibini kwi-10 yokungcakaza kwe-pathological kunye ne-10 yolawulo olunempilo (HC) (eCrockford okqhubekayo. 2005), izifundo ze-PG zibonise ukusebenza kwengqondo ephezulu ekuphenduleni ukugembula kwe-occipital cortex yasekhohlo, i-gyrus ye-fusiform yasekhohlo, i-gyrus ye-parahippocampal yasekunene kunye neendawo zangaphambili zangaphambili, xa kuthelekiswa ne-HC.

Ke, ngelixa ezi zifundo ze-PG zibonisa ukwanda kokusebenza kwemimandla yobuchopho ebandakanyeka kuqwalaselo, inkumbulo kunye nokusetyenzwa okubonakalayo, akukho bungqina bokwenyuka ngokungaqhelekanga komsebenzi kwi-limbic izakhiwo ngexesha lokusetyenzwa kweempawu zongcakazo zafunyanwa (umz. ukwanda kokusebenza kwi-amygdala), ngokungafaniyo nezifundo ze-neuroimaging kwi-cue. ukusebenza kwakhona kukuxhomekeka kwento (Iikhithi okqhubekayo. 2004; Tapert okqhubekayo. 2004; iindleko okqhubekayo. 2006; McBride okqhubekayo. 2006; Franklin okqhubekayo. 2007). Izizathu ezinokwenzeka zoku mahluko kukusetyenziswa kweevidiyo endaweni yemifanekiso kunye nokungabikho kwamandla ngenxa yeesampulu ezincinci. Ngaphaya koko, zozibini izifundo babhalisa abangcakazi abaqeshwe ngeentengiso, kwaye akukho phando luphandwe ukuba ngaba abangcakazi abanengxaki yokufuna unyango (PRGs) banokwahluka kwi-cue reactivity ukuya kwizikhokelo zongcakazo ukusuka kulawulo oluqhelekileyo. Kuphononongo lwe-fMRI olugxile ekusetyenzweni kwemivuzo kubangcakazi be-pathological (Ngaphandle okqhubekayo. 2005), impendulo engacacanga yokuphumelela ngokuchasene nelahleko yafunyanwa kwiindawo zomvuzo we-limbic kwi-pathological gamblers ngokuchasene ne-HC. Xa ubonisa abantu abangcakazayo abaneevidiyo zokungcakaza, inkqubo yelimbic inokuthi ngaloo ndlela ingasebenzi kakuhle ngenxa yokuhla kwempendulo kwiimeko zokungcakaza apho kufunyanwa khona imali. Ngenxa yale mpendulo ibuthuntu kwiinzuzo zemali, uphando lokuvula i-limbic kungcakazo ngokuchasene neempawu ezingathathi hlangothi ezingabandakanyi inzuzo yemali inokubonelela ngengqiqo kwi-cue reactivity kwizikhokelo zongcakazo jikelele.

Kuphononongo lwangoku, besifuna ukujongana nale miba ngokuphanda iipatheni zokusebenzisa ubuchopho ekungcakazeni okanye ukutshaya kwii-PRG ezingapheliyo ezifuna unyango, abantu abatshaya kakhulu (HSM) kunye nolawulo olungangcakazi olusempilweni (HC). Sisebenzise umfanekiso onxulumene nomsitho (George okqhubekayo. 2001; Myrick okqhubekayo. 2004; Smolka okqhubekayo. 2006) ngenxa yokuba oku kubonelela ngokuguquguquka okugqwesileyo malunga nexesha lokuvuselela kwaye kunqanda iingxaki zemodeli ezinokuvela xa kuhlalutywa idatha yeparadigm ye-fMRI yevidiyo. Ukuze kuthelekiswe i-cue reactivity kwi-PRG ukucupha ukuphinda kusebenze kweqela elixhomekeke kwinto, iqela lokuthelekisa le-HSM libandakanyiwe ngokunjalo. Iqela lolawulo lwe-HSM lakhethwa ngenxa yokuba iziphumo ze-neurotoxic ze-nicotine zilinganiselwe xa zithelekiswa nezo zezinye iziyobisi zokusetyenziswa kakubi, ezifana notywala.Sullivan 2003; Mudo, Belluardo & Fuxe 2007). Ngokusekwe kwizifundo zangaphambili ze-cue-reactivity kukuxhomekeka kweziyobisi, sicinge ukuba iindlela zokungcakaza kwi-PRG kunye neendlela zokutshaya kwi-HSM ziyakwenza ukuba ingqondo isebenze ngakumbi xa kuthelekiswa nokuphinda kusebenze kwengqondo kulawulo olungatshayiyo olusempilweni kwimimandla yobuchopho ehambelana nokusetyenzwa kweemvakalelo kunye nokuziphatha okukhuthazayo okunje. i-amygdala, i-ventral striatum kunye ne-ventral prefrontal cortex, kunye nengqalelo kunye nemimandla yobuchopho enxulumene nokulawula kwengqondo efana ne-dorsal prefrontal cortex kunye ne-anterior cingulate cortex (ACC). Ukongeza, ubudlelwane phakathi komsebenzi wobuchopho obunxulumene ne-cue kunye nokukhanga okuzimeleyo kwi-PRG kunye ne-HSM kwafundwa. Siye sacinga ukuba ukulangazelela okuzimeleyo kuya kudibaniswa nokunyuswa kokusebenza kweemvakalelo kunye nemimandla yengqondo enxulumene nenkuthazo kwi-PRG kunye ne-HSM.

IMPAHLA NENKQUBO

I zifundo

Ishumi elinesithoba elifuna unyango lwe-PRG (ezine zasekhohlo), i-19 HSM (ezintathu ngasekhohlo) kunye ne-HC ye-19 engatshayiyo (enye inxele), bonke abesilisa, bathathe inxaxheba kolu phononongo. Kwii-PRG ezimbini, i-HSM enye kunye ne-HC ezimbini, idatha ye-magnetic resonance (MRI) ayinakufumaneka (ngokupheleleyo) ifunyenwe ngenxa yokungaphumeleli kweskena. Ke ngoko, i-17 PRG, 18 HSM kunye ne-17 HC zenze amaqela amathathu asetyenziselwa uhlalutyo lwamanani. I-PRG iye yagaywa kumaziko amabini amaDatshi onyango lwabakhotyokisiweyo. I-HSM kunye neqela leHC baye bafunwa ngeentengiso kumaphephandaba.

Eyona nqobo iphambili yokubandakanywa kwePRG yayilunyango lwangoku lweengxaki zongcakazo. I-PRG ibanjwe udliwano-ndlebe necandelo T leShedyuli yoHlolo loNxibelelwano (Robins okqhubekayo. 1998) ukuvavanya indlela yokuxilonga ye-DSM-IV-TR yokuxilongwa kwe-PG. Ukongeza, i-South Oaks Gambling Screen (SOGS; Lesieur & Blume 1987) yayilawulwa njengomlinganiselo wengxaki yobunzima bokungcakaza. I-PRG emibini ayiphumelelanga ukuhlangabezana nemilinganiselo ye-DSM-IV-TR PG yokuxilongwa. Nangona kunjalo, ngenxa yokuba baye bahlangabezana neenqobo ze-PG ezimbini ngoku, badibana nenqobo ye-PG kwixesha elidlulileyo kwaye amanqaku abo e-SOGS (i-7 kunye ne-8, ngokulandelanayo) ayefana ne-PRG eyazalisekisa inkqubo yokuxilongwa kwe-PG (bona. 1 Table; kuthetha ukuba amanqaku e-SOGS = 9.6 ± 2.6), ezi PRG zifakwe kuhlalutyo. Yonke i-PRG yayizikhwebule ekungcakazeni kangangeveki enye. I-HSM yayibandakanyiwe ukuba batshaya ubuncinane i-cigarettes ye-1 ngosuku, kwaye abazange bahlanganyele kwimisebenzi yokungcakaza ngaphezu kwesibini ngonyaka. I-HSM yayingabantu abatshayayo ngoku abaye bazama ukuyeka ukutshaya njengenxalenye yolu phononongo. Uvavanyo lweFagerström lokuxhomekeka kwiNicotine (FTND) lusebenze njengesalathisi sobunzima bokuxhomekeka kwinikotini (Heatherton okqhubekayo. 1991). Akukho manqaku amancinci kwi-FTND afunekayo kwi-HSM. I-HSM kwafuneka ukuba itshaye ubusuku bonke, igcwalise amaphepha emibuzo kusasa kwaye iskenwe emva kwemini (iiyure ze-16-18 zingasebenzi). Ukuziyeka kwaqinisekiswa ngomlinganiselo wokuphefumula wekhabhoni ye-carbon monoxide ekuseni, usebenzisa i-micro + Smokerlyzer (i-Bedfont Scientific, Ltd., Rochester, UK). U-HC akazange atshaye, akazange abe nembali yengxaki yokungcakaza kwaye akazange abandakanyeke kwimisebenzi yongcakazo ngaphezu kwezihlandlo ezibini kulo nyaka uphelileyo.

1 Table 

Iimpawu zamanani abantu abangcakazayo abanengxaki, abatshaya kakhulu kunye nolawulo olusempilweni

Iikhrayitheriya zokukhutshelwa ngaphandle kwawo onke amaqela ibizi: ubudala obungaphantsi kwe-18 leminyaka; kunzima ukufunda isiDatshi; ukusetyenziswa kwamachiza e-psychotropic; ukuxilongwa ubomi bonke be-schizophrenia okanye i-psychotic episodes; ukuxilongwa kweenyanga ze-12 ze-manic disorder, ezihlolwe ngamacandelo ahlukeneyo kwi-Composite International Diagnostic Interview (CIDI; Heatherton okqhubekayo. 1991; Umbutho wezeMpilo weHlabathi ngo-1997); unyango lwangoku lokuphazamiseka kwengqondo ngaphandle kwezo ziphantsi kophando; iimeko zomzimba ezaziwayo ukuba zinefuthe ekuqondeni nasekusebenzeni komzimba (umz. i-multiple sclerosis, isifo samathambo); isikrini esilungileyo somchamo wotywala, i-amphetamines, i-benzodiazepines, i-opioids okanye i-cocaine; ukusetyenziswa kweeyunithi ezingaphezu kwe-21 zotywala ngeveki. Amaqela ayengawodwa ngokumalunga nokuphazamiseka kwengqondo phantsi kofundo. Ngokomzekelo, i-PRG kunye ne-HC abazange batshaye (ngaphandle kwe-PRG enye eyayitshaya ngaphantsi kweesigarethi ezintlanu ngosuku). Iikhrayitheriya ezongezelelweyo zokukhutshwa kwe-HC kunye ne-HSM, kodwa kungekhona kwi-PRG, kwakukho iingxaki zokukhathazeka (i-CIDI-icandelo D), ukudakumba (i-CIDI-section E), i-obsessive-compulsive disorder (i-CIDI-icandelo K), ukuphazamiseka kwengqondo emva kokuphazamiseka (i-post-traumatic stress disorder). I-CIDI-icandelo K) kunye nokusilela kwengqwalasela / ukuphazamiseka kwengqondo (Conners ADHD Rating Scales; Conners & Sparrow 1999). I-PRG enezi ngxaki ze-comorbid ayizange ikhutshelwe ngaphandle, kuba ingxaki yokungcakaza ixhaphake kakhulu kwezi ngxaki. Ubunzima beempawu zokudakumba kwavavanywa kunye ne-Beck Depression Inventory (BDI-II; Beck okqhubekayo. 1996). Ukusetyenziswa kotywala okuyingxaki kuye kwajongwa ngovavanyo lokuchongwa kokusetyenziswa kotywala kotywala (Bush okqhubekayo. 1998).

Ukongeza kuMsebenzi weCue Reactivity, umsebenzi wokufunda obuyela umva onokwenzeka, umsebenzi wocwangciso kunye nomsebenzi wophawu lokumisa walawulwa. Iziphumo ezivela kumsebenzi wokufunda umva kunye nomsebenzi wocwangciso zichazwe kwenye indawo (nguRuiter okqhubekayo. 2009). Ibhodi yophononongo lweenqobo ezisesikweni yeZiko lezoNyango lwezeMfundo yaluvuma uphononongo kwaye kwafunyanwa imvume ebhaliweyo enolwazi. Abathathi-nxaxheba babuyiselwa nge-50 ye-euro edluliselwe kwi-akhawunti yabo yebhanki emva kokuthatha inxaxheba.

Iparadigm yeFMRI: Cue Reactivity Task

Umsebenzi wokuphendula wemifanekiso emibini okhethiweyo wasetyenziswa (umzekelo wemifanekiso, bona Ikhiwane. 1). Imifanekiso iye yadityaniswa nokuntsonkotha ngolu hlobo lulandelayo: inani elilinganayo lemifanekiso yesishwankathelo kunye neenkcukacha zemifanekiso yakhethwa kwimeko nganye (umz. abantu abaninzi abangcakazayo, abatshayayo okanye abathethayo, xa bethelekiswa nemifanekiso eneenkcukacha yesandla kumatshini wokungcakaza, isandla esinecuba, ngesandla nemagazini). Okwesibini, ukuthelekisa ukuntsokotha kwemifanekiso kunye nokuthelekiseka, yonke imifanekiso yathathwa ngokwesimo sendalo esifanayo (umzekelo, yonke imifanekiso enabantu abaninzi yathathwa ngezinto ezininzi ngasemva), ngamadoda kuphela afakiweyo kwimifanekiso, kwaye kwathathwa inkathalo ukuze itshatise. ukubonakaliswa kweemvakalelo phakathi kwemifanekiso eyahlukeneyo, ngokubandakanya kuphela iifoto ezinobuso obungathathi hlangothi. Imifanekiso engamashumi amathathu yokungcakaza, imifanekiso ye-30 enxulumene nokutshaya, imifanekiso ye-30 engathathi hlangothi kunye ne-30 yemifanekiso yesiseko ephantsi yaboniswa ngokungaqhelekanga, kunye nomda wokuba i-stimulus yecandelo elifanayo le-stimulus ayizange iboniswe ngaphezu kwamaxesha amathathu ngokulandelelana. Imifanekiso yesiseko esezantsi eneentolo ezikhomba ekhohlo okanye ekunene zanikezelwa, kwaye impendulo yasekhohlo okanye ekunene kwafuneka inikwe, ukuze ukwazi ukuthelekisa ukusetyenzwa kwemifanekiso entsonkothileyo xa kuthelekiswa nomgangatho wokubonwa ophantsi. Kumdlalo wokungcakaza, imifanekiso enxulumene nokutshaya kunye nokungathathi hlangothi, abathathi-nxaxheba kwafuneka bacinezele iqhosha lokuphendula ngomnwe wabo wesalathiso wasekhohlo xa ubuso bukhona emfanekisweni kwaye kwafuneka bacinezele iqhosha lokuphendula ngomnwe wabo wokunene xa kungekho buso. Amashumi amahlanu epesenti yemifanekiso yonke kwicandelo ngalinye inobuso. Umfanekiso ngamnye unikwe ixesha elimiselweyo lemizuzwana ye-5, kwaye abathathi-nxaxheba baceliwe ukuba baphendule ngeli xesha. Xa kungekho mpendulo yenziweyo emva kwemizuzwana emi-5, umsebenzi waqhubeka. Isikrini esingenanto semizuzwana eyi-2.5 saboniswa phakathi komfanekiso ngamnye. Akukho mpendulo yanikwayo malunga neempendulo ezilungileyo okanye ezingalunganga. Iseshoni yokuskena yathatha imizuzu eyi-15; nganye yongcakazo, imifanekiso enxulumene nokutshaya kunye nengathathi hlangothi yaboniswa kanye. Izifundo azizange zikhuthazwe ukuba ziphendule ngokukhawuleza kangangoko kunokwenzeka. Umsebenzi wacaciswa kwaye waziqhelanisa ngaphandle kweskena kusetyenziswa eminye imifanekiso. Iparamitha yokwenziwa komsebenzi ibithetha ixesha lokusabela kwimifanekiso ekudidi ngalunye lwezivuseleli.

Umzobo 1 

Imizekelo yezivuseleli zokungcakaza (ekhohlo), izivuseleli ezinxulumene nokutshaya (embindini) kunye nezivuseleli ezingathathi hlangothi (ekunene)

Cela amaphepha emibuzo

I-questionnaire ye-8-item yongcakazo, uluhlu lwe-1-7 (MN Potenza & SS O'Malley, idatha engapapashwanga) kunye ne-questionnaire ye-10-into yokutshaya ukutshaya, uluhlu 1-7 (Tiffany & Drobes 1991), zibandakanyiwe ukuvavanya amanqanaba okungcakaza kunye nokukhanga kwenikotini, ngokulandelelanayo. Abathathi-nxaxheba bazalise iikhweshine phambi nasemva kokuskena i-fMRI.

Ukufunyanwa kwemifanekiso kunye nokulungiswa kwangaphambili

Idatha yokucinga ifunyenwe ngokusebenzisa i-3.0 Tesla Philips Intera full-body fMRI scanner exhotywe nge-standard SENSE RF i-coil yekhanda (inkqubo ye-Quasar gradient, i-Philips Medical Systems BV, i-Eindhoven, e-Netherlands) efumaneka kwi-Academic Medical Centre, e-Amsterdam. Ngelixa abathathi-nxaxheba benza umsebenzi, i-T2 * -i-weighted echo planar images, i-ecocientity kwi-blood oxygenation level-dependent (BOLD) umehluko wafunyanwa (35 axial slices, ubukhulu be-voxel 3 × 3 × 3 mm, i-interslice gap 0.3 mm, ubukhulu be-matrix 64 × I-64 mm, i-bandwidth 90 kHz, TE 35 ms, ixesha lokuphindaphinda imizuzwana ye-2.28), egubungela yonke ingqondo ngaphandle kwemimandla ephantsi ye-cerebellum. I-sagittal ye-T1-eyenziwe i-scan yesakhiwo (ubukhulu be-voxel 1 × 1 × 1 mm, izilayi ze-170) yenziwe ukuze ibhalise ngokubambisana kunye nedatha ye-fMRI. Uhlalutyo lomfanekiso lwenziwe kusetyenziswa i-SPM2 (i-Statistical Parametric Mapping; iSebe le-Wellcome le-Cognitive Neurology, eLondon, e-UK). Imifanekiso yacwangciswa ngexesha, yahlengahlengiswa kwaye yalungelelaniswa kumqulu wokuqala. Okulandelayo, imiqulu ye-T1-coregistered yayiqhelekile kwi-SPM T1- template (usebenzisa i-12 parameters linear kunye neseti ye-non-linear cosine basis functions), kunye ne-spatial smoothing yenziwa kusetyenziswa i-8 mm FWHM Gaussian kernel.

Uhlalutyo lwesatisatisti

Umahluko weqela kwidatha yedemografi kunye nekliniki yahlaziywa kusetyenziswa uhlalutyo olungaguqukiyo lokungafani (ANOVA) kunye neTukey's iposi iimvavanyo. Umahluko weqela kwinqanaba lemfundo uhlalutywe kusetyenziswa uvavanyo lwe-chi-square lukaPearson. Ii-ANOVA zisetyenziselwe ukuhlalutya idatha yokusebenza (ixesha lokuphendula elichanekileyo) kunye neqela eliphakathi-kwesihloko (PRG, HSM kunye neHC), kunye nodidi lokuvuselela (ungcakazo ngokuchasene nokungathathi hlangothi, okunxulumene nokutshaya ngokuchasene nokungathathi hlangothi, okanye umgangatho ophantsi wesiseko ngokuchasene nokungathathi hlangothi) njengoko into ephakathi kwesihloko, kusetyenziswa ukuchasana kweqela. I-ANOVA isetyenziselwe ukuhlalutya imilinganiselo yokukhuthaza (intsingiselo yokungcakaza, intsingiselo yokutshaya), kunye nexesha (phambi nasemva kokugqitywa komsebenzi) njengento engaphakathi kwesifundo. Lonke uhlalutyo lwenziwe ngemisila emibini.

Umlinganiselo wenqaku le-FTND kwiqela le-HSM laliphantsi (M = 4.0; SD = 1.5) xa kuthelekiswa namanqaku e-FTND kubantu abatshayayo abaxelwe kwezinye izifundo ze-fMRI cue reactivity (Franklin okqhubekayo. 2007, FTND = 4.8; McClernon okqhubekayo. 2007, FTND = 6.4; McClernon, Kozink & Rose 2008, FTND = 6.5), kwaye akukho zixilongo zokuxhomekeka kwe-nicotine zazifumaneka kwi-HSM, njengezinye izifundo (Brody okqhubekayo. 2002). Ngoko ke, uhlalutyo lokuhlola lwenziwa, kuthelekiswa ne-HSM kunye namanqaku aphezulu e-FTND (n = 10, i-FTND-iqela eliphezulu M = 5.4, SD = 0.5) kwi-HSM enamanqaku aphantsi e-FTND (n = 8, iqela le-FTND-low: M = 2.9, SD = 1.0), emva kokuhlukana kwe-median kwenziwa. Kwiqela le-PRG, akukho qhekeko lwenziwayo phakathi kobunzima obuphezulu okanye obuphantsi be-PRG, ngenxa yokuba ubuzaza beengxaki zokungcakaza kwisampulu yethu, njengoko kuvavanywayo ne-SOGS, bathelekiseka nobukhali obuxelwe kwezinye izifundo kubangcakazi abafuna unyango.

Idatha ye-fMRI yahlaziywa kumxholo wemodeli yomgca jikelele, usebenzisa imisebenzi ye-delta ehlanganiswe nomsebenzi wempendulo ye-hemodynamic yokwenziwa kwimodeli yeempendulo kuhlobo ngalunye lwe-stimulus. Kuthelekiso ngalunye lomdla, imifanekiso echaseneyo yomxholo omnye yangeniswa kwinqanaba lesibini (iziphumo ezingalindelekanga) uhlalutyo. Ukuphanda ukusetyenzwa kweendlela ezahlukeneyo zokulutha umlutha phakathi kwamaqela, ii-ANOVA zendlela enye zenziwa kwaye iziphumo zokusebenzisana zabalwa kungcakazo ngokuchasene nemifanekiso engathathi hlangothi kwi-PRG ngokuchasene ne-HC okanye i-HSM, kunye nemifanekiso enxulumene nokutshaya ngokuchasene nokungathathi hlangothi kwi-HSM (i-HSM iyonke. iqela; Iqela le-FTND-phezulu; Iqela le-FTND-low) ngokuchasene nePRG okanye iHC. Iziphumo eziphambili kunye neziphumo zokusebenzisana zahlaziywa ngendlela enye ye-ANOVA ephunyezwe kwi-SPM2 kwaye zixelwe kunye nomlinganiselo weqela le-voxels ezili-10. P < 0.05 ilungiswe ukuthelekisa ezininzi ngokwendlela yempazamo yoSapho yoBulumko (Tiffany & Drobes 1991; Nichols & Hayasaka 2003). Ukusebenzisana kweqela kuxelwe kunye nesithintelo sobungakanani beqela le-5 voxels kwi P <0.001, igqunywe ngesiphumo esifanelekileyo esiphambili.

Ukungcakaza okanye imifanekiso enxulumene nokutshaya ngokuchasene nemifanekiso engathathi hlangothi yakhethwa kowona mahluko ophambili wonxibelelwano lweqela, kuba lo mahluko ugxile kakhulu kwisiphumo se-cue-reactivity: ukuphinda usebenze kwiziyobisi ezithile ngokuchasene neempawu ezinganxulumananga nokuba likhoboka. Ukuthelekiswa kwemifanekiso enxulumene nomlutha ngokuchasene nesiseko kuya kubandakanya iinkqubo ezahlukeneyo zokubonwayo ezingangcalwanga (ezifana nokusetyenzwa kwe-stimulus, ukuqondwa kwento) ezithi zisebenze xa ubukele isivuseleli esibonakalayo esintsonkothileyo xa kuthelekiswa nesivuseleli esibonakalayo esilula kakhulu (utolo olukhomba ekhohlo okanye ekunene) . Ukunxibelelana phakathi kwemifanekiso enxulumene nokulutha kunye nesiseko kuya kuba yinto engacacanga kangako, kuba ukusetyenzwa okubonwayo kuya kuthi emva koko kunxibelelane neziphumo zecue reactivity. Nangona kunjalo, kubantu abakhobokileyo, kubalulekile ukuseka ukuba ukutolika okubonakalayo okusisiseko kuyafana kubo bobabini abantu abakhobokileyo nakumaqela angengomakhoboka. Kwesinye isifundo esivela kwiqela lethu, kwafunyaniswa ukuba abantu abakhobokileyo babenempendulo enkulu yobuchopho kwimifanekiso engathathi hlangothi xa kuthelekiswa nesiseko (Zijlstra okqhubekayo. 2009). Ke ngoko, sikwabonisa umahluko phakathi kokungathathi hlangothi ngokuchasene nesiseko, ukubonisa ukuba imifanekiso engathathi hlangothi ivelise iipateni zokuvula ezifanayo kumaqela onke.

Ukongeza, impembelelo enokubakho yesandla sasekhohlo kwiipateni zokusebenza kwengqondo yaphandwa ngokwenza lonke uhlalutyo kunye nangaphandle kwabathathi-nxaxheba abasekhohlo. Iipateni zomsebenzi ezifunyenwe emva kokungabandakanyi abathathi-nxaxheba abasekhohlo zifana kakhulu nezo zifunyenwe xa kubandakanywa abathathi-nxaxheba abasekhohlo nabasekunene. Ngoko ke, kwicandelo leZiphumo, sinika kuphela idatha esekelwe kwisampuli yonke.

Uhlahlelo lokubuyela umva lwenziwa kwi-PRG kunye ne-HSM ngokwahlukeneyo, ukuphanda ukuba ubuchopho busebenza ekuphenduleni isivuseleli esinxulumene nokulutha (ukungcakaza kunye nokutshaya, ngokulandelanayo) Ukuqobisana Imifanekiso engathathi hlangothi ehambelana nomnqweno ozixelayo emva kokuskena. Uhlahlelo lokubuyela umva luye lwenziwa ukuphanda ukuba ngaba i-ADHD ye-co-morbid [i-Conners Adult ADHD Rating Scales (CAARS) amanqaku] kunye neempawu ezidakumbisayo (amanqaku e-BDI-II) ahambelana nokusebenza kwengqondo okunxulumene ne-cue-reactivity (imifanekiso enxulumene nokulutha ngokuchasene nemifanekiso engathathi hlangothi) . Ngenxa yokuba i-PRG ifumene amanqaku aphezulu kwi-CAARS, kwaye iphezulu kakhulu kwi-BDI-II kunamanye amaqela amabini (bona 1 Table), olu hlalutyo lwenziwa ngokwahlukeneyo kwiqela ngalinye. I-PRG emine yayineengxaki zengqondo ezidibeneyo (ixhala kunye / okanye ukudakumba). Ke ngoko, unxibelelwano lweqela olubandakanya iPRG lwahlalutywa zombini kunye nangaphandle kwaba bathathi-nxaxheba be-co-morbid.

IINKCUKACHA

Iziphumo zamanani abantu kunye nekliniki

1 Table ishwankathela iimpawu zabantu kunye nekliniki kumaqela amathathu. I-PRG yayinomndilili ophantse ube yi-€60 000 kumatyala anxulumene nokungcakaza. Amanqanaba e-carbon monoxide yokuphefumla ayephezulu kwi-HSM, xa kuthelekiswa ne-PRG kunye ne-HC. I-PRG ifumene amanqaku aphezulu kwi-CAARS kunye ne-BDI-II kune-HSM kunye ne-HC zombini.

Iziphumo zedatha yokusebenza kunye neereyithingi zokunqwenela

Amaxesha okusabela okuthetha ukuba kwimifanekiso yongcakazo (M: 1143 ms, SD: 340) ayemade kunamaxesha okusabela kwimifanekiso engathathi hlangothi (M: 1006 ms, SD: 311), F(1,49) = 50.1, P < 0.0001; Amaxesha athetha ukusabela kwimifanekiso yokutshaya (M: 929 ms, SD: 235) yayimfutshane kunamaxesha okusabela okunentsingiselo kwintshukumo engathathi hlangothi (F(1,49) = 12.9, P < 0.0001; kunye namaxesha okuphendula okuphakathi kwinqanaba elisezantsi lesiseko (M: 717 ms, SD: 169) yayimfutshane kune-stimuli engathathi hlangothi, F(1,49) = 80.3, P <0.0001, kodwa akukho hlobo lovuselelo ngonxibelelwano lweqela lwalukhona (lonke iqela ngokuchasana kwe-stimulus F amaxabiso <1, NS). Ukuchaneka kwakuphezulu; Intsingiselo yeempazamo ezidityanisiweyo kuzo zonke iimeko yayiyi-1.2, kwaye akukho mahluko kwinani leempazamo phakathi kwamaqela okanye iimeko ezifunyenweyo (F <1, NS). I-ANOVA ibonise ukuba ukulangazelela ukutshaya phambi kokuskena kwakuphezulu kwi-HSM xa kuthelekiswa ne-HC, F(1,34) = 87.4, P <0.0001, kwaye xa kuthelekiswa nePRG F(1,34) = 57.8, P < 0.0001. Umnqweno awuzange uhluke phakathi kweqela le-FTND eliphezulu kunye neqela eliphantsi le-FTND, F(1,17) <1, NS. Akukho mahluko phakathi kokunqwenela ukutshaya ngaphambi nangemva komsebenzi we-cue reactivity kwiqela elipheleleyo le-HSM F(1,17) = 1.42, P = 0.25, okanye kwiqela le-FTND-eliphezulu ngokuchasene neqela eliphantsi le-FTND, F(1,16) = .29, P = 0.60 yayikhona. Ukuthanda ukungcakaza kwakuphezulu kwi-PRG xa kuthelekiswa ne-HSM kunye ne-HC, F(2,51) = 6.92, P <0.002, kunye nomkhwa wokunyusa umnqweno wokungcakaza emva komsebenzi we-cue reactivity wabonwa kwi-PRG, F(1,16) = 3.18, P = 0.09, ngokuyinxenye η2 = 0.17 (ichazwa njengobungakanani besiphumo esikhulu, Stevens 1996).

fMRI cue reactivity

Iziphumo eziphambili (imifanekiso ngokuchasene nesiseko)

Iziphumo eziphambili zokujonga imifanekiso engathathi hlangothi xa kuthelekiswa nemifanekiso ekwinqanaba elisezantsi ziye zajongwa kuwo onke amaqela amathathu ubukhulu becala kumjelo obonakalayo we-ventral (i-occipital lobe: ephakathi, ephantsi kunye ne-langual gyrus), kunye nakwiindawo ezinxulumene nomvuzo / inkuthazo, kunye nengqalelo. kunye nolawulo lwengqondo; I-medial temporal lobe equka i-amygdala, i-bilateral dorsolateral prefrontal cortex (DLPFC), kunye ne-thalamus yangasemva yamacala amabini, bona Ikhiwane. 2, indawo yolawulo yasekhohlo. Ukungcakaza xa kuthelekiswa nemifanekiso yesiseko kunye nemifanekiso enxulumene nokutshaya ngokuchasene nesiseko, imimandla efanayo ichongiwe. Ukongeza, sifumene ukusebenza kwamazwe amabini kwi-ventrolateral prefrontal cortex (VLPFC) yokungcakaza kunye nemifanekiso enxulumene nokutshaya ngokuchasene nemifanekiso esisiseko, kunye ne-dorsomedial prefrontal cortex activation yemifanekiso yokungcakaza ngokuchasene nemifanekiso esisiseko (Ikhiwane. 2, iiphaneli eziphakathi nasekunene, ngokulandelanayo).

Umzobo 2 

Iipateni zokuvula kumaqela emifanekiso engathathi hlangothi xa kuthelekiswa nemifanekiso ekwinqanaba elisezantsi (iphaneli ephezulu ngasekhohlo), imifanekiso yokungcakaza ngokuchasene nemifanekiso ekwinqanaba elisezantsi (iphaneli ephakathi ephezulu), imifanekiso yokutshaya xa ithelekiswa nemifanekiso ekwinqanaba elisezantsi (iphaneli ephezulu ngasekunene), ...

Unxibelelwano lweqela

Kwimifanekiso engathathi hlangothi xa kuthelekiswa nemifanekiso ekwinqanaba elisezantsi, akukho ziphumo zibalulekileyo zokusebenzisana zabonwa. Kwimifanekiso yokungcakaza ngokuchasene nemifanekiso engathathi hlangothi, sifumene ukusebenza okukhulu kwi-cortex ye-occipital yasekhohlo, i-parahippocampal gyrus, i-amygdala yasekunene kunye ne-DLPFC yasekunene kwi-PRG xa kuthelekiswa ne-HC. Ngokunxulumene ne-HSM, i-PRG ibonise i-cortex ye-occipital ephezulu yamazwe amabini, i-parahippocampal gyrus yamazwe amabini, i-amygdala yamazwe amabini, i-DLPFC yamazwe amabini kunye nokusebenza kwe-VLPFC ekhohlo xa kujongwa imifanekiso yokungcakaza ngokuchasene nemifanekiso engathathi hlangothi (2 Table kwaye Ikhiwane. 3). Ukwahluka kweqela elifanayo kwabonwa xa i-PRG kunye ne-psychopathology ye-co-morbid yayingabandakanywa, nangona iyantlukwano ekusebenzeni kwe-DLPFC kwi-PRG xa kuthelekiswa ne-HC, kunye nokwahlukana kokusebenza kwi-amygdala yasekunene kunye ne-DLPFC ekhohlo kwi-PRG xa kuthelekiswa ne-HSM iye yayeka ukubaluleka ngokwezibalo.

2 Table 

I-Cue Reactivity Task: Ukuvuselelwa kwe-BOLD kwiziphumo eziphambili (ukungathathi hlangothi/ungcakazo/imifanekiso enxulumene nokutshaya ngokuchasene nemifanekiso ekwinqanaba elisezantsi); ukusebenzisana kweqela (imifanekiso yokungcakaza ngokuchasene nemifanekiso engathathi hlangothi, kunye nemifanekiso enxulumene nokutshaya ngokuchasene nemifanekiso engathathi hlangothi); ...
Umzobo 3 

Intsebenziswano yeqela: Iindawo ezikhankanyiweyo kusetyenziso oluphezulu kwingxaki yokungcakaza (PRG) ngokuchasene nesampulu edityanisiweyo yolawulo olusempilweni (HC) kunye nabatshaya kakhulu (HSM) kwii-coordinates -9, 0, -18. Ukukhutshwa kwe-PRG kunye nokuphazamiseka kwengqondo okuhambelanayo ...

Akukho qela libalulekileyo ngonxibelelwano lwemeko luye lwabonwa kwimifanekiso yokutshaya kwi-HSM xa kuthelekiswa nePRG okanye iHC. Ukusebenza okukhulu kwakukho kwi-ventromedial prefrontal cortex (VMPFC) ngokudibeneyo, kwi-rostral ACC ngokudibeneyo kunye ne-VLPFC yasekhohlo kwiqela le-FTND-high xa kuthelekiswa ne-HC kunye neqela le-FTND-high xa kuthelekiswa neqela eliphantsi le-FTND. Iziphumo ezifanayo zabonwa xa kuthelekiswa ne-FTND-iqela eliphezulu kunye ne-PRG (bona 3 Table kwaye Ikhiwane. 4). Ukongezelela, kwiqela le-FTND-high, ukusebenza kwi-precuneus ekhohlo, i-insula yasekunene kunye nesobunxele phakathi kunye ne-gyri ye-temporal ephezulu yayinkulu kuneqela le-FTND-low. Akukho qela libalulekileyo ngokweentsebenziswano zemeko ezibonwe kwiqela le-FTND-low xa kuthelekiswa nokuba yi-HC okanye i-PRG.

3 Table 

Umsebenzi we-Cue-reactivity: Ukuvuselelwa kweBOLD kunxibelelwano lweqela: imifanekiso enxulumene nokutshaya ngokuchasene nemifanekiso engathathi hlangothi.
Umzobo 4 

Intsebenziswano yeqela: Iindawo ezigxininiswe kusetyenziso oluphezulu kuVavanyo lwe-Fagerström lokuxhomekeka kweNicotine (FTND)-iqela eliphezulu ngokuchasene nesampulu edityanisiweyo yeqela eliphantsi le-FTND, ingxaki yokungcakaza (PRG) kunye nolawulo olusempilweni (HC) kulungelelwaniso lwe-3, -51, ...

Unxulumano phakathi kokusebenza kwe-BOLD, ukukhanga okuzimeleyo, i-BDI-II kunye ne-CAARS

Uhlahlelo lokubuyela umva lubonise ubudlelwane obuhle phakathi kokunqwenela ukungcakaza emva kokuskena kwi-PRG kunye nokusebenza kweBOLD kwi-VLPFC, i-insula yasekhohlo yangaphambili kunye nentloko ye-caudate ekhohlo xa ujonga imifanekiso yokungcakaza ngokuchasene nemifanekiso engathathi hlangothi (bona 2 Table). Ubudlelwane obuhle phakathi kokunqwenelwa kwe-nicotine emva kokuskena kwi-HSM kunye nokusebenza kweBOLD kwi-VLPFC kunye nommandla we-amygdala washiya ngexesha lokujonga imifanekiso enxulumene nokutshaya kunye nemifanekiso engathathi hlangothi yayikhona (4 Table).

4 Table 

Cue Reactivity Task: ulungelelwaniso phakathi kokuvula i-BOLD kunye nenqanaba lokuzixela lokunqwenela kwingxaki yokungcakaza kunye nabatshaya kakhulu

Akukho budlelwane bubalulekileyo phakathi kwamanqaku e-BDI-II okanye e-CAARS kunye notshintsho lokuhamba kwegazi kwi-cerebral ngexesha lokubukela ukugembula okanye imifanekiso enxulumene nokutshaya ngokuchasene nemifanekiso engathathi hlangothi yayikhona kwi-PRG, i-HSM okanye i-HC.

UKUQALA

Olu luphononongo lokuqala oluphanda i-cue reactivity kwisivuseleli sokungcakaza ekufuneni unyango lwe-PRG xa kuthelekiswa ne-HSM kunye ne-HC, kusetyenziswa i-paradigm yomfanekiso onxulumene nesiganeko se-fMRI. I-PRG ibonise ukusebenza kwengqondo okuphezulu xa kuthelekiswa ne-HC kunye ne-HSM xa kujongwa imifanekiso yokungcakaza (xa kuthelekiswa nemifanekiso engathathi hlangothi) kwiindawo zobuchopho ezinxulumene nokusetyenzwa kolwazi olubonakalayo kunye nenkumbulo (i-bilateral occipital cortex, i-parahippocampal gyrus), kunye nemvakalelo kunye nenkuthazo (ingingqi ye-amygdala, i-VLPFC). Ngokukodwa, ukulawulwa kweendawo ezibonwayo zokusetyenzwa kolwazi kuye kwanxulumana nokuhanjiswa kwe-dopaminergic etshintshileyo kwiinkqubo ze-neural ezibandakanyeka kukuxhomekeka kwento: (1) imvakalelo/ekhuthazayo kunye nememori/isekethe yokufunda, kubandakanya i-orbitofrontal, i-subcallosal cortex, i-amygdala kunye ne-hippocampus; kunye (2) isekethe yokuqwalasela / yokulawula, kubandakanywa i-dorsal prefrontal kunye ne-ACC (Breiter kunye noRosen ngo-1999; IGoldstein kunye neVolkow 2002; IKalivas kunye neVolkow 2005). Ukusebenza okuphezulu kwi-PG kwezi ndawo zokusetyenzwa kolwazi kunokunxulunyaniswa nomgangatho ophezulu wokukhuthaza ungcakazo, ngokusebenzisa i-innervations yeendlela ze-dopamine ukusuka kwi-nucleus accumbens, indawo ye-ventral tegmental kunye neendawo ze-limbic kule nkqubo yokubonwayo. Iindawo ezifanayo zobuchopho zifunyenwe zisebenza kwizifundo ze-fMRI cue reactivity yabantu abatshayayo kunye nabantu abaxhomekeke etywaleni (George okqhubekayo. 2001; ngenxa okqhubekayo. 2002; Myrick okqhubekayo. 2004). Ukusebenza okuphezulu kwingingqi ye-amygdala kunye ne-parahippocampal gyrus ibonisa ukuba imifanekiso yokungcakaza isebenze imvakalelo / inkuthazo kunye nokujikeleza okunxulumene nenkumbulo ngakumbi kwi-PRG kune-HSM kunye ne-HC. I-parahippocampal gyrus ibandakanyeka ekuqhubeni ulwazi olubonakalayo oluyinkimbinkimbi, ifumana igalelo kwi-nucleus accumbens kunye ne-amygdala, kwaye iyindlela ebalulekileyo ehambelanayo kwi-hippocampus. Izifundo zeCue reactivity zengxaki yokungcakaza, ukuxhomekeka etywaleni kunye nokuxhomekeka kwinikotini zikwachaze ukusebenza kwengqondo kwi-parahippocampal gyrus.eCrockford okqhubekayo. 2005; Smolka okqhubekayo. 2006; ipaka okqhubekayo. 2007). Olu phononongo lolokuqala ukubonisa ukubandakanyeka kommandla we-amygdala kuphononongo lwe-cue-reactivity kwi-PRG, kunye nokuqwalasela ukuba ukusebenza kwiindawo zobuchopho ezifana ne-insular cortex kunye ne-caudate nucleus inxulumene nomnqweno wokungcakaza ozixelayo. Ezi zinto zifunyanisiweyo zalatha ekuzingiseleni ngokweemvakalelo ukukhuthaza ungcakazo kwizigulana ezikunyango lweengxaki zongcakazo ngoku.

Zonke i-PRG zazinyangelwa i-PG xa zithatha inxaxheba kuphononongo, kwaye zichaze ixesha eliphakathi leengxaki zokungcakaza zeminyaka eyi-13 (idatha ayiboniswanga). Izifundo ezimbini ze-fMRI cue reactivity kwi-PG ezikhoyo kuncwadi (Potenza okqhubekayo. 2003; eCrockford okqhubekayo. 2005) igxininise kwi-PRG eqeshwe ngabahlali, kwaye ayizange ibike i-amygdala, i-cortex ye-insular okanye i-caudate nucleus activation. Iziphumo zolu phononongo zibonisa ukuba i-cue reactivity kwii-PRG ezingapheliyo ezifuna unyango zinokunxulunyaniswa ngamandla ngakumbi kwi-reactivity yobuchopho kwiisekethe zovakalelo kunye nenkuthazo kune-cue reactivity kwi-PRGs (engeyongozi) engekho kunyango.

Umahluko kwiipateni zokusebenzisa ubuchopho kwimifanekiso yokutshaya phakathi kwe-FTND-phezulu abatshayayo kunye ne-HC okanye i-PRG bezisoloko zikho kwi-VLPFC, VMPFC kunye ne-rostral ACC, ehambelana nezifundo zangaphambili ze-fMRI cue reactivity kubantu abatshayayo.david okqhubekayo. 2005; Lee okqhubekayo. 2005; McClernon okqhubekayo. 2005, 2008). Ukungabikho kwempembelelo ye-cue-reactivity kwiqela le-FTND-low HSM xa kuthelekiswa ne-PRG okanye iqela le-HC kusenokwenzeka ukuba linxulumene nenqanaba elisezantsi lokuxhomekeka kwe-nicotine kweli qela. Kuye kwaxelwa ukuba amanqaku e-FTND ahambelana ngokufanelekileyo kunye nokusebenza kwengqondo yengingqi kwiimpawu zokutshaya (Smolka okqhubekayo. 2006; McClernon okqhubekayo. 2008). Ngoko ke, kwizifundo ezizayo, ukukhethwa kweqela elilinganayo labantu abatshayayo, kunye namanqaku amancinci kwi-FTND okanye ukuxilongwa ngokusesikweni kwe-DSM-IV ND kuya kucetyiswa.

Ukongeza kwiziphumo zethu zokusebenzisa ubuchopho obuphezulu kwi-VMPFC kunye ne-rostral ACC kwi-FTND-intshayi ephezulu xa kuthelekiswa namanye amaqela, siye sabona ukuba umnqweno wokutshaya kwi-HSM unxibelelene kakuhle nomsebenzi kwiindawo zobuchopho ezinxulumene neemvakalelo kunye nomvuzo / ukusetyenzwa kokukhuthaza (i-amygdala). kunye neVLPFC), iindawo ebezikhe zachaphazeleka kumnqweno wokutshaya (david okqhubekayo. 2005; McClernon okqhubekayo. 2008).

Imida

Nangona siye sabona ukwanda kokusebenza kwengqondo ekuphenduleni kwimifanekiso yokungcakaza kwi-PRG kunye nokutshaya kwiqela le-FTND ephezulu ye-HSM, ukujonga le mifanekiso kubangele umkhwa wokuzibika okuphezulu kwi-PRG, ngelixa kwi-HSM kungekho ziphumo ze-cue reactivity. umsebenzi weminqweno yokutshaya wawukho. Utshintsho kwi-subjective craving ngaphambi nangemva komsebenzi lunokuthi lube luncinci kwisifundo sethu ngenxa yexesha lokulinganisa: iphepha kunye nephepha lemibuzo lokunqwenela ipensile lazaliswa emva kokushiya i-scanner, xa iziphumo ezikhawulezayo zomsebenzi ekunqweneleni zinokuthi ziphelile. Kuphando lwexesha elizayo, imilinganiselo yokunqwenela ikhompyutha elawulwa kwiskena, isiqingatha okanye ngokukhawuleza emva komsebenzi we-cue reactivity, ikhethwa ke ngoko.

Emva kokuqesha iqela le-HSM, kuye kwacaca ukuba amanqaku e-FTND ahluke kakhulu kweli qela. Ngoko ke, iposi uthelekiso lwenziwe phakathi kwamacandelwana amabini e-HSM: iqela le-FTND-high kunye neqela eliphantsi le-FTND. Iziphumo zokwahlula kumaqela e-FTND-phezulu kunye ne-FTND-asezantsi kuthetha ukuba kubalulekile ukubandakanya ubungakanani bokuxhomekeka kwe-nicotine kwizifundo ze-cue reactivity kubantu abatshayayo, ngaphezu kokukhetha abatshayayo ngokusekelwe kwinani lecuba abalitshayayo. Ubungakanani beqela lamaqela amancinci eFTND ayemancinci (n = 10 kunye n = 8, ngokulandelelanayo), kwaye ke ngoko iziphumo ezibhekiselele kula macandelwana kufuneka zitolikwe ngononophelo. Izifundo kumaqela amakhulu abantu abatshayayo ahlukeneyo kumanqaku e-FTND kufuneka zenziwe ukuphinda ezi ziphumo zokuqala.

isiphelo

Olu pho nonongo lubonisa ukuba ukujonga imifanekiso yokungcakaza (ngokuchaseneyo nemifanekiso engathathi hlangothi) inxulumene nokusebenza kwengqondo okukhulu ekusebenzeni okubonakalayo, ukukhuthaza imvakalelo kunye nokulawula ukujikeleza kwengqondo kwi-PRG efuna unyango, xa kuthelekiswa neHC kunye ne-HSM, kwaye oku kuvula ngokufanelekileyo ezinxulumene ukugembula iminqweno. Ezi ziphumo ziyahambelana nezo zibonwa kubantu abaxhomekeke kwiziyobisi (George okqhubekayo. 2001; Myrick okqhubekayo. 2004; Franklin okqhubekayo. 2007). Kuphononongo lwangoku, siye sabona ukonyuka kokusebenza kwengqondo ekutshayeni kubantu abanamanqaku e-FTND abonisa ukuxhomekeka okuphakathi kwenikotini xa kuthelekiswa ne-HC, kodwa abafumananga mahluko kubantu abanamanqaku e-FTND abonisa ukuxhomekeka okuphantsi kwenikotini. Umnqweno ophakamileyo wokutshaya kwi-HSM unxulunyaniswa nokunyuka komsebenzi kumvuzo kunye nemimandla yengqondo enxulumene neemvakalelo. Uphando lwexesha elizayo lufuna ukufumanisa ukuba ingaba iziphumo zexesha elide zongcakazo kwi-brain activation kwi-PRG kunyango zinxulumene nokubuyela kwingxaki yokungcakaza.

Imibulelo

Olu phononongo luxhaswe ngemali yenkxaso evela kuMbutho waseNetherlands woPhando lwezeMpilo kunye noPhuhliso (#31000056) ye-Netherlands Organisation for Scientific Research (NWO) ukuya kwi-AG, DV, JO kunye ne-WB, kunye nesibonelelo soMphengululi omtsha (AG, Veni igranti) evela kuMbutho weNzululwazi waseDatshi (NWO ZonMw, #91676084, 2007–10). Iindleko zokuskena zaxhaswa ngemali yi-Amsterdam Brain Imaging Platform. U-AG, MR, DV, JO kunye ne-WB babika ukuba akukho kungqubana kwemidla. Sibulela i-Jellinek Amsterdam ngoncedo lwabo ekufuneni abangcakazi abanengxaki.

Igalelo lababhali

U-AG, uMR, kunye no-DV bathatha uxanduva lokuthembeka kwedatha kunye nokuchaneka kohlalutyo lwedatha. Bonke ababhali baye bafikelela ngokupheleleyo kuzo zonke iinkcukacha kwisifundo. U-AG, MR, JO, WB, kunye noDV babenoxanduva lwengqikelelo yophononongo kunye noyilo. UMR wayenoxanduva lokufumana idatha. UMR, AG, kunye ne-DV babenoxanduva lokuhlalutya amanani kunye nokuchazwa kwedatha. U-AG uyile umbhalo-ngqangi. UMR, JO, WB kunye ne-DV banikezele ngohlaziyo olubalulekileyo lombhalo wesandla kumxholo obalulekileyo wobukrelekrele. Bonke ababhali baphonononge ngokunzulu umxholo kunye nenguqulelo yokugqibela evunyiweyo ukuba ipapashwe. Idatha yokuqala yolu phononongo yaboniswa kwiNtlanganiso yoBuchule boBuchule boMntu ngoJuni 15-19, 2008, eMelbourne, e-Australia.

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