IZIMVO: Kucacile kolu phononongo ukuba ungcakazo lwe-pathological lubonisa i-neurobiology yeziyobisi. Bafumene umvuzo oncitshisiweyo wesekethe kwi-wine kunye nelahleko, ngokungafaniyo nolawulo oluqhelekileyo. Enye into efunyanisiweyo kukuba izinto ezivuselelayo ezibalulekileyo zobuqu azizange zisebenze kumjikelezo womvuzo. Nako oku kufumaneka kwiziyobisi. I-DSM entsha iya kuhlela ungcakazo lwe-pathological njengomlutha.
Hum Brain Imephu. 2010 Nov;31(11):1802-12.
de Greck M, Enzi B, Prösch U, Gantman A, Tempelmann C, Northoff G.
Isebe le-Psychiatry kwiYunivesithi yase-Otto-von-Guericke yaseMagdeburg, eLeipziger Straße 44, 39120 Magdeburg, eJamani. [imeyile ikhuselwe]
KWI-ABSTRACT
Abangcakazi be-pathological bachukumiseka ngokuzixakekisa ngokunyukayo ngokungcakaza, nto leyo ekhokelela ekutyeshelweni kwezivuseleli, izinto esinomdla kuzo, kunye nokuziphatha ebezikade zibalulekile kumntu ngamnye. Ukungasebenzi kakuhle kwe-Neurobiologically kumjikelezo womvuzo kudlala ungcakazo lwe-pathological. Ukuphonononga umanyano lweziphumo zozibini ezifunyenweyo, siphande i-16 yokungcakaza kwe-pathological engaxilwanga kusetyenziswa i-fMRI paradigm ebandakanya imisebenzi emibini eyahlukeneyo: uvavanyo lokubaluleka komntu kunye nomsebenzi womvuzo osebenze njenge-localizer esebenzayo. Abangcakazi bePathological baveze ukuncipha kokungasebenzi ngexesha leziganeko zolahleko lwemali kweminye yemimandla yethu yemivuzo ephambili, i-nucleus accumbens yasekhohlo kunye ne-putamen yasekhohlo. Ngaphaya koko, ngelixa abangcakazi be-pathological bajonga izinto ezikhuthaza ukubaluleka kobuntu obuphezulu, sifumene ukuncipha komsebenzi we-neuronal kuyo yonke imimandla yethu yemivuzo ephambili, kubandakanya i-nucleus accumbens yamazwe amabini kunye ne-ventral putamen cortex yasekhohlo xa kuthelekiswa nolawulo olusempilweni. Sibonise okokuqala ukuguqula umsebenzi we-neuronal kumjikelezo womvuzo ngexesha lokubaluleka komntu ongcakazayo. Iziphumo zethu zinokubonelela ngemibono emitsha kwisiseko se-neurobiological sokuzixakekisa kwabangcakazayo ngokungcakaza.
INTSHAYELELO
''Usuke washiywa ziingqondo,'' watsho. ''Awuzange ulahle ubomi kuphela, izilangazelelo zakho kunye nezo zoluntu lwakho, umsebenzi wakho njengendoda kunye nommi, abahlobo bakho (kwaye unabo bonke ngokufanayo) - awuzange ulahle zonke iinjongo zakho. ubomi, ngaphandle kokuphumelela kwiroulette—ude wazincama neenkumbulo zakho.''
UDostoyevsky, uMngcakazi, ngo-1867
Umbhali waseRashiya uDostoyevsky uchaza iimpawu ezimbini ezingundoqo zokungcakaza kwezifo, ezinokuthi oogqirha banamhlanje bazibonakalise njengomnqweno wokungcakaza kunye nokwanda kokungahoywa kwezinto ebezifudula zibalulekile. Iincwadana zangoku zokuxilonga [i-DSM-IV, i-American Psychiatric Association, i-1994; I-ICD-10, iWorld Health Organization, yowe-1992] ihlela ukungcakaza ngezifo njengengxaki yokulawula umnqweno. Nangona kunjalo, ukufana nokuphazamiseka kokukhobokisa, njengokukhotyokiswa butywala kunye nokukhotyokiswa kwecocaine, kuvumela imbono entsha ukuba ithathwe. Ukungcakaza kwePathological kunokujongwa njengengxaki enxulumene neziyobisi [Reuter et al., 2005].
Ulwahlulo lokungcakaza kwe-pathological njengengxaki yokulutha enxulumene neziyobisi icebisa ukungaqhelekanga kumjikelezo womvuzo njengabo bakwiziyobisi. Oku kungaqhelekanga kufunyenwe kwi-nucleus accumbens (NACC)/ventral striatum (VS), iputamen, i-ventromedial prefrontal cortex (VMPFC), i-orbitofrontal cortex (OFC), indawo ye-ventral tegmental (VTA) [ukujonga ngokubanzi bona i-Knutson kunye ne-Gibbs, i-2007 ; McClure et al., 2004; O'Doherty, 2004; kumbutho wokuphazamiseka kokulutha kunye nomvuzo wokujikeleza jonga uMartin-Soelch et al., 2001; Volkow et al., 2004, 2007a]. Reuters kunye nabanye. [2005] iphande umsebenzi we-neuronal wabangcakazi be-pathological usebenzisa umsebenzi wokuqikelela ikhadi kunye ne-fMRI. Ngexesha lokufumana umvuzo wemali, bafumene umsebenzi otshintshileyo we-neuronal kumjikelezo womvuzo wabangcakazi be-pathological kubandakanya i-VS efanelekileyo kunye ne-VMPF xa kuthelekiswa nezifundo zolawulo olusempilweni. Ngaphezu koko, ababhali bafumene umahluko onciphileyo kumsebenzi we-neuronal phakathi kweenzuzo zemali kunye nelahleko kwezi zifundo.
Potenza et al. [2003], ophande abangcakazayo bezifo abenza umsebenzi weStroop, wafumana umsebenzi oncitshisiweyo weVMPFC. Nangona kunjalo kuphononongo olwahlukileyo, ummandla ofanayo ubonise ukwanda komsebenzi kubadlali bokungcakaza be-pathological ngexesha lomsebenzi we-jack emnyama kunye nomvuzo wemali xa kuthelekiswa nomsebenzi ofanayo ngaphandle kwawo [Hollander et al., 2005]. Ngexesha lokuboniswa kwemidlalo yokungcakaza, ukuncipha komsebenzi weminye imimandla efana ne-OFC, i-thalamus, kunye ne-basal ganglia, nayo yabonwa [Potenza et al., 2003]. Ezi ziphumo zinokongezwa ngokufunyenweyo kwizifo ezinxulumene neziyobisi ezifana nokusela utywala kunye nokuba likhoboka lecocaine. Ngokufana nabangcakazi be-pathological, izigulana ezinxilisayo zibonise ukuncipha komsebenzi we-neuronal kwi-VS ngexesha lokufumana imali [Wrase et al. Ngo-2007] kunye nokunciphisa umsebenzi we-striatal dopamine ngexesha lokuthatha i-methylphenidate njengoko kulinganiswe ne-PET. usebenzisa [11C] -raclopride [Volkow et al., 2007b]. Izigulana ezikhotyokiswe yiCocaine zibonise ukuncipha komsebenzi we-neuronal ngexesha lokuvuzwa kwemali kwi-OFC, i-lateral prefrontal cortex, kunye ne-mesencephalon phakathi kwabanye [Goldstein et al., 2007]. Ekugqibeleni, uTanabe et al. [2007] ubonise umsebenzi otshintshileyo we-neuronal ngexesha lokwenziwa kwezigqibo kwi-ventromedial prefrontal cortex kunye neminye imimandla, ebonisa ukufana kokungcakaza kwe-pathological kwezinye iziphazamiso ezikhobokisayo.
Zithathiwe kunye, ezi ziphumo zibonisa ukubaluleka kokujikeleza komvuzo kungcakazo ye-pathological kunye nokufana kwayo nezinye iziphazamiso ezikhobokisayo. Ngokutsho kukaReuters et al. [2005], oko kuncitshiswa kokuphendula kumvuzo kunokukhokelela ngokubonakalayo kwimvakalelo engapheliyo yokungoneliseki. Oku ke kunokonyusa umngcipheko wokufuna ukwaneliseka ngabaqinisekisi abomeleleyo njengokungcakaza, icocaine, okanye ezinye iziyobisi zokuxhatshazwa ukufumana inqanaba lokuvula elaneleyo kwimimandla yomvuzo.
Olunye uphawu olumangalisayo lokungcakaza ngezifo kukutshintsha okucacileyo kokubaluleka komntu. Izigulana zixakeke ngakumbi kukungcakaza kwaye ke ngoko ziqala ukutyeshela ezinye izinto ezazifudula zibalulekile kunye nokuziphatha. Ngokwengqondo, ukuvavanywa kokubaluleka komntu okanye ukuzibandakanya, njengoko izifundo zangaphambili ziyibiza ngokuba [de Greck et al., 2008, 2009; Kelley et al., 2002; INorthoff neBermpohl, ngo-2004; Northoff et al., 2006; U-Phan et al., 2004], uchaza indlela ekubaluleke ngayo kunye nokuba basondele kangakanani kuzo izifundo ezifumana izivuseleli ezithile. I-Neurobiologically, imisebenzi ebandakanya uluvo lokunxulumana kwakho, kwaye ngenxa yoko ukufaneleka komntu kuye kwachaphazela imimandla evela kumjikelezo womvuzo onjenge-NACC, i-VTA, kunye ne-VMPFC [de Greck et al., 2008; Northoff et al., 2006; Northoff et al., 2007; Phan et al., 2004].
Ukugaywa komvuzo wesekethe ngokuvuselela ukufaneleka okuphezulu komntu kuphakamisa umbuzo wobudlelwane obuchanekileyo phakathi kokusetyenzwa komvuzo kunye nokusetyenzwa kovuselelo lokubaluleka komntu. Kuphononongo lwangaphambili lweqela lethu, imisebenzi yobuntu obuphezulu obubangela ukuba kwenziwe umsebenzi we-neuronal ngokuthe ngqo kwimimandla echaphazelekayo kumsebenzi womvuzo kwizifundo eziphilileyo [de Greck et al., 2008]. Kutshanje, iqela lethu Kwakhona kwafumanisa ukuba izigulana ezinxilisayo zibonise ukwehla komsebenzi we-neuronal kumjikelezo womvuzo (okt, ekhohlo nasekunene i-NACC/VS, VTA, VMPFC) ngexesha lovavanyo lwe-stimuli enokubaluleka okuphezulu komntu xa kuthelekiswa nolawulo olusempilweni [de Greck et al., 2009] ebonisa ukuba utshintsho olubonakalayo ekuziphatheni lubangelwa kukunqongophala kokusebenza kumjikelezo womvuzo ngexesha lovavanyo lwe-stimuli yokubaluleka okuphezulu komntu.
Injongo ngokubanzi yophononongo lwethu yayikukuphonononga isiseko se-neural sokutshintsha okungaqhelekanga kokubonwa kokubaluleka kobuqu kumjikelezo womvuzo kubangcakazi be-pathological abangasetyenziswanga. Ngokukodwa, siqeshe iparadigm ukuphanda umsebenzi we-neuronal kumvuzo wokungcakaza kwabangcakazayo ngexesha lomibini umsebenzi womvuzo obandakanya ukuphumelela kwemali kunye nelahleko, kwaye ngexesha lomsebenzi ofuna uvavanyo lokunxulumana kwakho, apho izifundo zilinganise imifanekiso eyahlukeneyo equlathe iindawo zongcakazo. , ukutya okanye utywala, njengento ephezulu okanye ephantsi yokubaluleka komntu. I-hypothesis yethu ibintlu-mbini. Okokuqala, besilindele ukuphinda iziphumo zikaReuter et al. [2005] ngokubonisa ukuba abangcakazi be-pathological babonisa ukuncipha komsebenzi we-neuronal kwimimandla yomvuzo ngexesha lomsebenzi womvuzo. Ngaphezu koko, besilindele ukwandisa ezi ziphumo ngokwahlula phakathi kweenzuzo kunye nelahleko. Siqikelela ukusebenza okuncinci ngexesha leenzuzo zemali kunye nokuvalwa okuncinci ngexesha lelahleko yemali. Okwesibini, ngokusekwe kwiimpawu zeklinikhi kunye neziphumo zethu etywaleni [de Greck et al., 2009], siye saqikelela umsebenzi ophazamisekileyo kumjikelezo womvuzo ngexesha lovavanyo lokubaluleka okuphezulu kobuqu kubangcakazi be-pathological xa kuthelekiswa nolawulo olusempilweni.
UKUQALA
Siphande umjikelezo womvuzo ngexesha lokuvavanywa kokufaneleka komntu kubangcakazi be-pathological. Ukuphindaphinda iziphumo zika-Reuter et al. [2005], abangcakazi be-pathological babonise ukunciphisa umsebenzi we-neuronal kwi-NACC yamazwe amabini kunye nokushiya i-ventral putamen ngexesha lomsebenzi womvuzo. Ukwandisa ezi ziphumo, sibonise ukuba abangcakazi be-pathological babonise utshintsho oluncitshisiweyo lwesignali kwiindawo ezifanayo zomvuzo ngexesha lovavanyo lokubaluleka komntu xa kuthelekiswa nezifundo eziphilileyo. Sithathiwe kunye, okokuqala, sibonisa ukungahambi kakuhle kwe-neuronal kumjikelezo womvuzo wabangcakazi be-pathological ngexesha lovavanyo lokufaneleka komntu.
Ukuguqulwa koMvuzo weSekethe kwi-Pathological Gamblers Ngexesha lokuphumelela kweMali kunye nokulahlekelwa
Idatha yethu ihambelana neziphumo zikaReuter et al. [2005] ofumene ukuhla kwentlupheko kumsebenzi we-neuronal ngexesha lokuphumelela kwemali kunye nokulahlekelwa. Ukongeza koku sakwazi ukwandisa iziphumo zabo ngeendlela ezimbini. Okokuqala, sibonise ukuba umahluko oncitshisiweyo womsebenzi we-neuronal phakathi kokuphumelela kunye nelahleko uvela kukungasebenzi okubuthathaka kwi-NACC yasekhohlo kunye ne-ventral putamen yasekhohlo ngexesha lokulahleka-iziganeko endaweni yokuvula okuncinci ngexesha lokuphumelela.
Utshintsho kuMvuzo weSekethe yabangcakazi bePathological ngexesha loVavanyo lokuBamba koMntu
Iziphumo ezimangalisayo zophononongo lwethu zichaphazela ukuguqulwa komsebenzi wobuchopho ngexesha lovavanyo lokubaluleka komntu kubangcakazi be-pathological. Njengoko bekulindelekile sifumene ukunqongophala okubalulekileyo komsebenzi we-neuronal kwimimandla yethu emithathu yomvuzo (ekhohlo nasekunene i-NACC, i-putamen yasekhohlo) ngexesha lovavanyo lwe-stimuli enokubaluleka okuphezulu komntu. Ezi ziphumo zihambelana ne-hypothesis yethu kunye nokuchaphazeleka kokuncipha kwe-neuronal reactivity kumjikelezo womvuzo wabaguli abangcakazayo ngexesha lemisebenzi ebaluleke kakhulu. Iziphumo zethu zangoku zincedisana nangaphambili kwiqela lethu apho izigulana ezinxilisayo zibonise umsebenzi oncitshisiweyo we-neuronal kumjikelezo womvuzo ngelixa ujonge i-stimuli yokubaluleka okuphezulu kobuntu [de Greck et al., 2009]. Kwakhona njengakwizigulana ezinxilisayo, oku kuncitshisiwe komsebenzi we-neuronal ngexesha lokuzinxulumanisa kubangcakazi be-pathological kuhambelana kakuhle noqwalaselo lweklinikhi lotshintsho oluqatha lokubaluleka kobuqu ukusuka kwimikhwa ebalulekileyo yangaphambili ukuya ekungcakazeni njengokuphela komsebenzi ofanelekileyo wobuqu. Olu qikelelo luxhaswa kukufumanisa kwethu indlela yokuziphatha ukuba abangcakazi be-pathological bahlela izinto ezivuselela ungcakazo ngokufuthi ngakumbi njengezihlobene kakhulu neziqu xa kuthelekiswa nezifundo ezisempilweni.
Okona kubaluleke kakhulu, iziphumo zethu zibonisa okokuqala ukuba olu tshintsho lweklinikhi kunye nokuziphatha kwimbono yokubaluleka komntu kunokuhambelana nomsebenzi ophazamisekileyo we-neuronal kumjikelezo womvuzo kwinqanaba le-neurobiological. Ngaphaya koko, izivuseleli ezichazwe njengezifanelekileyo ngokobuqu ekugqibeleni ziyasilela ukukhuthaza umsebenzi we-neuronal kumjikelezo womvuzo. Ke ngoko, ngokuhambelana nemigqaliselo yangaphambili [Reuter et al., 2005], umntu unokuqikelela ukuba ngenxa yokungakwazi okubonakalayo ukuvuselela umvuzo wabo wesekethe ngokuvuselela okunxulumene kakhulu, ezi zigulana zinokunyanzelwa ukuba zifune iimeko ezibonelela ngokuqiniswa ngamandla. ezifana nokungcakaza okanye iziyobisi ukwenza umsebenzi osisiseko owaneleyo kumjikelezo womvuzo wabo.
Unyino lweNdlela
Okokugqibela, kufuneka siqwalasele imida yendlela yokwenza isifundo sethu. Okokuqala nokuphambili, ingqikelelo yokubaluleka kobuqu okanye ukuzalana kwakho kunokubonakala kuyingxaki engacacanga ngokwamandla kunye/okanye ngokwengqiqo. Sisebenzise ingqikelelo evela kwizifundo zangaphambili malunga nokufaneleka komntu kunye nokuzibandakanya [de Greck et al., 2008, 2009; INorthoff neBermpohl, ngo-2004; Northoff et al., 2006, 2007] eyavumela izifundo ukuba zibonise ngokucacileyo ukuba i-stimulus ebonisiweyo yayiphezulu okanye ephantsi yokufaneleka komntu. Nangona le ngcamango yokubaluleka komntu iyindlela ebanzi, nangona kunjalo sigqibe ekubeni siyiphumeze kwipharadigm yethu.
ISIPHELO
Kolu phononongo, sibonise indima ebalulekileyo esisiseko somvuzo wesekethe kungcakazo ye-pathological. Abangcakazi be-Pathological ababonisi nje ukunciphisa umsebenzi we-neuronal kumjikelezo womvuzo (ekhohlo nasekunene i-NACC, i-ventral putamen yasekhohlo) ngexesha lokuphumelela kwemali kunye nelahleko, kodwa kwakhona-kwaye ngakumbi-ngexesha lokuvavanywa kovuselelo olunokubaluleka okuphezulu komntu. Ngelixa izifundo ezisempilweni zibonisa umsebenzi ophakamileyo wokujikeleza komvuzo ngexesha lokuvavanywa kovuselelo olufanelekileyo lomntu, abangcakazi be-pathological abanakho oku kunyuka komsebenzi we-neuronal. Ezi ziphumo zinokuthi, ekuhambeni kwexesha, zifunyanwe zihambelana nokuqwalaselwa kweklinikhi kokunyuka kokungahoywa kweminye (eyayifudula ifanelekile) imisebenzi kunye nokuzixakekisa ngokupheleleyo ngokungcakaza.
;