Iziyobisi. 2011 May 7;71(7):827-40. doi: 10.2165/11591790-000000000-00000.
UFontenelle LF1, I-Oostermeijer S, Harrison BJ, UPantelis C, Yücel M.
Abstract
Iikhonsepthi ezisisiseko ezisisiseko sokunyanzelwa, ukungxamiseka kunye nokuziphatha okukhobokisayo ziyahambelana, ezinokuthi zincede ukuchaza ukuba kutheni abantu abaqhelekileyo besebenzisa la mabinzana ngokutshintshanayo. Nangona kuye kwakho umzamo omkhulu wophando wokubonakalisa ngcono kunye nokuphelisa ezi ziphathamandla, oogqirha kunye nososayensi abakakwazi ukuzohlula ngokucacileyo. Ngako oko, i-obsessive-compulsive disorder (OCD), ukuphazamiseka kokulawulwa kwempembelelo (ICD) kunye neengxaki ezinxulumene neziyobisi (SUD) zidibanisa kumanqanaba ahlukeneyo, kuquka i-phenomenology, i-co-morbidity, i-neurocircuitry, i-neurocognition, i-neurochemistry kunye nembali yentsapho. Kolu hlaziyo sishwankathela le miba ngokugxininisa ngokukodwa kwindima yenkqubo ye-opioid kwi-pathophysiology kunye nonyango lwe-OCD, i-ICD kunye ne-SUD. Sibeka ukuba ngokuqhubekeka kunye nokunganyangeki kwe-OCD, umyinge weendlela zokuziphatha ezinxulumene ne-OCD (umzekelo, ukujonga, ukuhlamba, ukuodola kunye nokugcinwa, phakathi kwezinye) eziqhutywa ziinkqubo ezingxamisekileyo 'zokurhashazwa' zonyuka njengoko ukubandakanyeka kweesekethe ze-ventral striatal ziba zibalaseleyo. . Ngokwahlukileyo, njengoko inkqubela ye-SUD kunye ne-ICD, umyinge weendlela zokuziphatha ezinxulumene ne-SUD- kunye ne-ICD eziqhutywa ziinkqubo ezinyanzelekileyo 'zesiqhelo' zonyuka njengoko ukubandakanyeka kweesekethe ze-dorsal striatal zivelela. Asiphikisi ukuba, ngokuhamba kwexesha, i-ICD iba yi-OCD okanye ngokuchaseneyo. Endaweni yoko, sicebisa ukuba ezi ngxaki zinokufumana iimpawu zomnye ngokuhamba kwexesha. Ngamanye amazwi, ngelixa izigulana ezine-ICD/SUD zinokuphuhlisa 'iimpembelelo ezinyanzelekileyo', izigulane ezine-OCD zinokubonisa 'ukunyanzeliswa kokunyanzeliswa'. Zininzi iimpembelelo ezinokwenzeka kwimodeli yethu. Ngokwethiyori, izigulana ze-OCD ezibonisa izinto ezingxamisekileyo okanye ezikhobokisayo zinokulawulwa ngamachiza ajongana nomgangatho wezinto eziqhubayo kunye nokubandakanyeka kweenkqubo ze-neural. Ngokomzekelo, ii-arhente zokunciphisa okanye ukuthintela ukuphinda umlutha (umz. ukusela kakhulu), okulungelelanisa inkqubo ye-cortico-mesolimbic dopamine ngokusebenzisa i-opioid (umzekelo, i-buprenorphine kunye ne-naltrexone), i-glutamate (umz. i-topiramate), i-serotonin (umz. i-ondansetron) okanye i-γ -i-aminobutyric acid (umzekelo, i-baclofen kunye ne-topiramate) iinkqubo, zinokubonisa ukubonisa inzuzo ethile kwiindlela ezithile ze-OCD. Ngokusekelwe kubungqina obukhoyo, sicebisa ukuba unyango lwezigulane ezinezi ngxaki kufuneka ziphendule ngokuguqulwa kwezinto ezisisiseko kunye ne-neurobiology yemeko. Sinikezela ngesikhokelo sokuqala kunyango oluthile olunokuthi luthathelwe ingqalelo kwizilingo zeklinikhi kwizigulane ezine-OCD. Ngokomzekelo, kunokuba bubulumko ukuvavanya i-naltrexone kwizigulane ezine-SUD kunye ne-ICD ye-co-morbid, i-topiramate kwizigulane ezine-ICD ye-co-morbid kunye nokuphazamiseka kokutya, kunye ne-baclofen kwizigulane ezine-co-morbid Tourette's syndrome. Olu lingo lusenokubandakanya izikali ezijolise ekuvavanyeni ukungxamiseka okusisiseko (umzekelo, iBarratt Impulsiveness Scale) ukujonga ukuba ingaba olu lwakhiwo lunokuqikelela impendulo kumachiza asebenza kwinkqubo yomvuzo.
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