Neurosci Biobehav Rev. I-2019 Jun 24. pii: S0149-7634 (19) 30370-7. doi: 10.1016 / j.neubiorev.2019.06.032.
Brand M1, Wegmann E2, Stark R3, Müller A4, I-Wölfling K5, Robbins TW6, Potenza MN7.
Iimbalasane
- Ukuziphatha okuluthayo kunxulunyaniswa nokusebenza kwakhona kunye nokunqwenela
- Ukuziphatha okuluthayo kunxulunyaniswa nolawulo lwe-inhibitory
- Ukuziphatha kwindlela yokuziphatha kuphuhliswa kwinkqubo yokuziphatha okuluthayo
- Ukungalingani phakathi kweesekethe ze-fronto-striatal kunegalelo kuhlobo lokuziphatha
Abstract
Sicebisa uhlobo oluhlaziyiweyo lwendlela yokuNxibelelana koMntu-eyaziwa njenge-Af-Cognition-Achiuction (I-PACE), esithi sivumelekile kwiindlela ezahlukeneyo zokuziphatha okufana nokungcakaza, ukugembula, ukuthenga-ukuthenga kunye nokuziphatha okungokwesondo okunyanzelekileyo ukuphazamiseka. Ngokusekwe kwiziphumo zakamuva zokufumana amandla kunye nokuqwalaselwa kwethiyori, sibonisa ukuba isimilo sokuziphatha okuphucukileyo siphuhla njengesiphumo sentsebenzo ephakathi kwezinto eziguquguqukayo, ezinokubakho kunye neempendulo ezibonakalayo kwisikhuselo esithile, kunye nemisebenzi yolawulo, efana nolawulo lwe-inhibitory kunye nokwenza izigqibo. Kwinkqubo yokuziphatha okukhohlakeleyo, ukunxibelelana phakathi kokuphinda-phinde umsebenzi / umnqweno kunye nokuncitshiswa kolawulo lwe-inhibitory kunegalelo kuphuhliso lweendlela zokuziphatha. Ukungalingani phakathi kwezakhiwo zemijikelezo ye-fronto-striatal, ngakumbi phakathi kwe-ventral striatum, i-amygdala, kunye neendawo eziphambili zangaphambili ze-dorsolateral, zinokubaluleka ngokukodwa kumanqanaba okuqala kunye ne-dorsal striatum kumanqanaba alandelayo eenkqubo zokulutha. Imodeli ye-I-PACE inokunika isiseko solwazelelelo kwizifundo ezizayo malunga nokuziphatha okuluthayo kunye nokuziqhelanisa nekliniki. Izifundo zexesha elizayo kufuneka ziphande ngeendlela eziqhelekileyo nezizodwa ezibandakanyeke kubuchwephesha bokunxibelelana, ukujonga-ukunyanzeliswa, ukuthintela-ukusetyenziswa, kunye nokuphazamiseka kokusebenzisa iziyobisi.
IINKCUKACHA: Iziyobisi ingxaki yokuthenga-ukuthenga; ukwenzeka kwakhona ingxaki yokungcakaza; ukuphazamiseka kwemidlalo; ulawulo lwe-inhibitory; ukusetyenziswa kwengxaki yamanyala
PMID: 31247240
1. intshayelelo
Ukudibana koMntu-okuChasene nokwazi ukuqaphela (i-I-PACE) yemodeli yokusetyenziswa gwenxa kwe-Intanethi kwapapashwa ngaphezulu kweminyaka emibini eyadlulayo (I-Brand et al., 2016b). Enye yeenjongo yayikukuchaza iinkqubo zengqondo kunye ne-neurobiological ezisisiseko sophuhliso kunye nokugcinwa kokusetyenziswa kweziyobisi kwi-Intanethi, njengaleyo isetyenziswa xa udlala, ukungcakaza, ukubukela iphonografi, ukuthenga nokuthenga kunye nenethiwekhi. Ukusukela ukupapashwa kwemodeli ye-I-PACE, ibicaciswa rhoqo ngabaphandi kwihlabathi jikelele kungekuphela nje kukuphazamiseka kwemidlalo (umz. Susa u-al., 2017; Dieter et al., 2017; Dong et al., 2019; Kaess et al., 2017; U-Lee et al., 2018a; U-Lee et al., 2018b; Li et al., 2018; UPaulus et al., 2018; USariyska et al., 2017), kodwa kunye nengxaki yokungcakaza (umz. Ioannidis et al., 2019b; I-Starcke et al., 2018), ukunganyanzelekanga ekuziphatheni okubi ngokwesini kubandakanya ukusetyenziswa kwengxaki yeephonografi (umz. IiCarnes kunye noThando, 2017; Strahler et al., 2018; UWryry et al., 2018), ingxaki yokuthenga-ukuthenga (umz. ILam kunye neLam, 2017; UVogel et al., 2018) Ukusetyenziswa kakhulu kwezicelo zonxibelelwano (umz. UDempsey et al., 2019; U-Elhai et al., 2018; IKircaburun kunye neGriffiths, 2018; IMontag et al., 2018; Rothen et al., 2018), ukungachazeki kokusetyenziswa kwe-Intanethi (umzekelo, UCarbonell et al., 2018; U-Emelin et al., 2017; Ioannidis et al., 2019a; I-Lachmann et al., 2018; Vargas et al., 2019; UZhou et al., 2018b), kunye nezinye iindlela zokuziphatha gwenxa kubandakanya iingxaki zokusebenzisa iziyobisi (UZhou et al., 2018a). Ushicilelo lweshumi elinanye loHlelo lweHlabathi lweZifo (i-ICD-11), njengoko kukhutshwe kutshanje (Umbutho wezeMpilo-kwiHlabathi, i-2019), igxile kugxalaba ngokwalo (umz. ukungcakaza) ngaphandle kokubhekisa kumbindi wesiphazamiso, umzekelo, umdlalo wokuphazamiseka kwemidlalo endaweni yokuphazamiseka kwemidlalo ye-Intanethi kuhlelo lwesihlanu lweDiagnostic and Statistical Manual (DSM-5) (APA, 2013). Kwi-ICD-11, imeko-bume yokuziphatha inokuchazwa kamva njengokungaxhunyiwe kwi-intanethi okanye ubukhulu becala kwi-intanethi yokungcakaza kunye nokuphazamiseka kwezemidlalo. Ngenxa yoko, umfuziselo ochaza iinkqubo ezingaphantsi kwendlela yokuziphatha eyingxaki kufuneka usebenze kuwo onke amaziko akwi-Intanethi nakwindawo engaxhunyiwe kuyo kunye nokudityaniswa kweendlela zokuziphatha zangaphandle kunye nezangaphandle. Siyaqhubeka sicebisa ukuba indlela yokuziphatha ngokwayo iyeyona nto iphambili ekufuneka uyiqwalasele kunye nokusingqongileyo (kwi-Intanethi ngokuchaseneyo ne-intanethi) kunokuba yinto yesibini kodwa kunganegalelo elibalulekileyo ekubonakalisweni kweendlela ezithile zokuziphatha ezilungelayo kunye nomahluko oqhelekileyo kuzo zonke ezi ndlela zokuziphatha (I-Baggio et al., 2018). Sicebisa uhlobo oluhlaziyiweyo lwemodeli ye-I-PACE, esisebenza ngayo iya kuba semthethweni kungekuphela kweziphazamiso zokusebenzisa i-Intanethi, kodwa kunye nezinye iintlobo zokuziphatha okubi. Le modeli ye-I-PACE ehlaziyiweyo igxila kwindlela yokusebenza kwengqondo kunye ne-neurobiological yeendlela zokuziphatha ezichasayo. Izinto ezichaziweyo kwimidiya kunye nezinye izinto ezinxulumene nokuziphatha ezinokuthi zikhawulezise okanye zinciphise ukukhula kohlobo lokuziphatha okunokuchazwa kwaye zichazwe kwiinguqulelo ezithile zemodeli. Ikhiwane. 1 ishwankathela umahluko ocetywayo phakathi kwemiba ephakathi / yendalo esingqongileyo, ukuphendula komntu ngamnye, kunye nokuziphatha kunye nezinto ze-neurobiological ezichaphazelekayo ekuziphatheni okuchaseneyo.
Ikhiwane. 1. Ukwahlula imiba yokusingqongileyo, ukujongana komntu kunye nemiphumo yokuziphatha okuphindaphindiweyo kokuhamba kwexesha. Imodeli ye-I-PACE ehlaziyiweyo igxila kwindlela umntu aphendula ngayo nakwimiphumela ebandakanyeka kuphuculo lokuziphatha okuluthayo.
Ukongeza, sijolise ekucaciseni ngokucacileyo ngakumbi umlinganiswa wenkqubo yemodeli ngokwahlulahlula imizekelo emibini, enye yeendlela ezichaphazelekayo kumanqanaba okuqala kunye neendlela ezichaphazelekayo kumanqanaba alandelayo enkqubo yokulutha. Asiphindi ingxoxo eneenkcukacha yazo zonke izinto ezifakiweyo kwimodeli ye-I-PACE (cf. I-Brand et al., 2016b). Endaweni yokuba, sigxile kakhulu kumanqaku asemva, ngakumbi ukuhlaziya imeta kunye nohlengahlengiso olucwangcisiweyo oluphefumlele uhlaziyo lwe-I-PACE.
2. Imodeli ye-I-PACE ehlaziyiweyo yokuziphatha kakuhle
Ukuhlaziywa kwemodeli ye-I-PACE kubandakanya amanyathelo amathathu aphambili. Kuqala, sigxile ekuguquleni kusengaphambili, ezinokuthi zithathwe njengezibandakanya iintlobo ezahlukileyo zokuziphatha (ukuphazamiseka kwongcakazo, ukuphazamiseka kwemidlalo, kunye nabanye) kwayehlulahlulahlula izinto eziguquguqukayo ezichazayo. Okwesibini, sichaza ngokuthe ngqo umjikelezo wangaphakathi wenkqubo yokulutha kwimodeli ye-I-PACE ngokubhekisele kwizinto ezifunyenwe kutshanje. Okwesithathu, sahlula phakathi kwamanqanaba okuqala kunye nasemva enkqubo ukucacisa ngokucacileyo iindima ezahlukeneyo zokumodareyitha kunye nokutshintsha eziguqukayo ngokuxhomekeke kwinqanaba lokulutha. Imodeli ye-I-PACE ehlaziyiweyo yokuziphatha okukhohlakeleyo kubonisiwe ngaphakathi Ikhiwane. 2. Ikhiwane. 2A bonisa unxibelelwano phakathi kwezinto ezijongwa njengokubaluleke kakhulu kumanqanaba okuqala okuziphatha. Ikhiwane. 2B bonisa unxibelelwano lwezinto eziguquguqukayo kwinqanaba elilandelayo leenkqubo zokulutha.
Ikhiwane. 2. Imodeli ye-I-PACE ehlaziyiweyo yokuziphatha okuluthayo. Umzobo A ubonakalisa amabakala okuqala okukhula kokuziphatha okuluthayo. Umzobo B ubonakalisa amanqanaba kamva enkqubo kunye nezinto ezinegalelo kulondolozo lweempawu zokuziphatha eziyingozi. Iintolo zeBolder zibonisa unxibelelwano olomelele / iindlela ezikhawulezayo.
2.1. Icandelo le-P yemodeli ye-I-PACE
Icandelo-P libonisa iimpawu eziphambili zomntu ezinokubandakanyeka kwinkqubo yokulutha njengokuguquguquka kusengaphambili (bona ingxoxo kwi I-Brand et al., 2016b). Izinto eziguquguqukayo ezixhaphakileyo (kwicala lasekhohlo kwibhokisi ephezulu yemodeli) zinokuba negalelo elibalulekileyo kuzo zonke iintlobo zokuziphatha okukhobokisayo (umzekelo: ukungcakaza, ukuphazamiseka kwemidlalo, ukuphazamiseka ekuthengweni, ukuphazamiseka okubukela imifanekiso engamanyala / ukuziphatha okubi ngokwesondo). Uluhlu lwezi zinto zinokubekwa phambili kusenokwenzeka ukuba azikho. Ishwankathela kuphela eziguquguqukayo ezinobungqina obuninzi obukhoyo, kubandakanya novavanyo-meta, nangona ubungqina bunokwahluka ngokwamandla kwiindidi ezahlukeneyo zokuziphatha okukhohlakeleyo. Idatha iphakamisa igalelo lemfuzo elibalulekileyo kukungcakaza (I-Lobo, i-2016; Umkhuhlane, i-2017, 2018; U-Xuan et al., 2017) kunye nengxaki yokusetyenziswa kwe-intanethi engachazwanga (Hahn et al., 2017). Ngaphaya koko, amava amabi abantwana abancinci abuxelwe njengezinto ezisengcupheni yokungcakaza (URoberts et al., 2017kunye nengxaki yemidlalo (Schneider et al., 2017), iziphumo ezihambelana nengqikelelo yethiyori yendima yokuncamathisela kwiindlela zokuziphatha (UAlvarez-Monjaras et al., 2018). I-Psychopathological correlates, ngakumbi uxinzelelo kunye noxinzelelo lwentlalo, kuye kwanikelwa ingxelo ephindaphindiweyo ngokungcakaza (Dowling et al., 2017), imidlaloMännikkö et al., 2017), ukusetyenziswa kwe-intanethi okungachazwanga (Ho et al., 2014), kunye nokuthenga-(Müller et al., 2019) iingxaki, kunye nezinye izinto ezinokuziphatha.I-Starcevic kunye neKhazaal, 2017). Iimpawu zobushushu, ezinje ngokuxhaphaza okuphezulu, nazo zinxulunyaniswa nongcakazo (Dowling et al., 2017), imidlaloUGervasi et al., 2017; UKuss et al., 2018; URyu et al., 2018), kunye nokusetyenziswa kwe-intanethi okungachazwanga (UKayiş et al., 2016) iingxaki, njengoko kunokungasebenzi kakuhle kwisitayile sokungaphatheki kakuhle (Schneider et al., 2018). Kwimodeli ye-I-PACE, sisebenzisa amagama aqhelekileyo (umzekelo, i-psychopathology, amanqaku omoya kubandakanya, umzekelo, ukungafuneki) okunokuthi kuchazwe ngakumbi ngokubhekisele kwindlela ethile yokuziphatha okulutha. Iimpawu ezihambelana nokuziphatha ezichaziweyo (icala lasekunene lebhokisi ephezulu kwimodeli, Ikhiwane. 2A no-B) bathathelwa ingqalelo kwiimpawu ezahlukileyo zokuziphatha. Umzekelo, abantu abafuna ubukrelekrele obuphezulu banokubakho ngakumbi ukukhula kwengxaki yokungcakaza (UDel Pino-Gutiérrez et al., 2017). Abantu abanobundlobongela obuphakamileyo kunye neempawu zobuntu ezixineneyo banokuba lula ukuba bahlakulele isifo somdlalo (UGervasi et al., 2017). Abantu abaneempawu ezivakalayo zesini eziphezulu banokuba semngciphekweni wokukhula kwi-hypersexual behaviour okanye iphazamiso lokusebenzisa iphonografi (Stark et al., 2017), kunye nabantu abanexabiso eliphezulu lezinto ezibonakalayo banokuba nomngcipheko wokukhulisa ingxaki yokuthenga (UClaes et al., 2016; Müller et al., 2014).
2.2. Isangqa sangaphakathi: Ichaphaza (A-), ukuqonda kwengqondo (C-), kunye nokwenza (E-) amacandelo emodeli ye-I-PACE
Olunye uluvo oluphambili lwesangqa esingaphakathi kwimodeli ye-I-PACE kukuba ukukhula kwengxaki yokuziphatha kunye nokulutha kwenzeka kuphela kwintsebenzo phakathi kwezinto eziguquguqukayo ezichazayo kunye nezinto ezithile eziziswa ziimeko ezithile. Unxibelelwano lukhokelela kumava okonwaba kunye nembuyekezo ezinxulumene nokuziphatha okuthile. Kwinqanaba lokuqala (Ikhiwane. 2A), abantu banokubona izinto zangaphandle (umzekelo, ukujongana nefuthe lokuziphatha elihambelana nokuziphatha) okanye izinto ezingaphakathi (umz. Iimeko ezimbi okanye ezakhayo) kwiimeko ezithile. Ukuqonda kunokukhokelela kwimpendulo ezichazayo kunye nengqondo, njengokunyusa ingqalelo kwezi zinto zibangela umdla kwaye zibongoza ukuba ziziphathe ngeendlela ezithile; Umz. ukudlala imidlalo ye-Intanethi okanye ukubukela iphonografi (I-Starcke et al., 2018).
Impendulo ezibonakalayo kunye nengqondo ekhokelela kwizigqibo zokuziphatha ngeendlela ezithile. Isigqibo sokubandakanyeka kwindlela yokuziphatha ethile sinokuthi sikhokelwe ziinkqubo ezimbini ezisebenzayo: inkqubo engxamisekileyo / esetyenziswayo, esekwe ikakhulu ekufundeni kokudibana (imeko yaseklasini kunye neyokusebenza), kunye nenkqubo yokubonakalisa / enomdla, enxulumana ikakhulu nokuqiqa kunye imisebenzi yolawulo (Kahneman, 2003; Schiebener kunye neBrand, 2015; Strack & Deutsch, 2004). Kubantu abanobukhoboka, indlela yokuziphatha ithathwa njengokuxhomekeka ikakhulu kwiinkqubo ze-neural ezisebenzayo, kubandakanya izakhiwo ze-limbic (UNoël et al., 2006). Ulawulo lwe-inhibitory olunxulumene nolwaphambi kwexesha kunye nolangazelelo lunokwehla ngexesha lenkqubo yokulutha (Bechara, 2005; IVolkow neMorales, 2015). Ukudibanisa le mibono yethiyori, sicebisa ukuba ubudlelwane phakathi kweempendulo ezichaphazelekayo nezingqondakaliyo zangaphandle okanye zangaphakathi kunye nezigqibo zokuzibandakanya kwiindlela ezithile zokuziphatha zimodareyithwe nenqanaba lolawulo ngokubanzi lwe-inhibitory (ngokuchasene nokucaciswa okukhethekileyo okanye ukuvuselela okuthile kulawulo lwe-inhibitory) kunye Ukuzilawula / ukuzilawulaHahn et al., 2017), ubuncinci kwizigaba zokuqala zokuziphatha okuluthayo. Uhlalutyo lwe-meta olwenziwa nguMeng, uDeng, uWang, uGu, kunye noLi (2015) lubonisa ukuba ukungasebenzi kakuhle kwangaphambili kunxulunyaniswa nengxaki yokudlala, kubonakalisa ukungqubana phakathi kokulindelwa komvuzo kunye neenkqubo zokuzibamba. (IVolkow kunye neBaler, 2015). Ngokuphathelele kulawulo ngokubanzi lwe-inhibitory, Yao et al. (2017) Xela uguquko olusebenzayo nolwakhiwo kwengqondo kubuchwephesha bokudlala obunxibelelene nokuncitshiswa kokusebenza kwesikhundla. Ukuziphatha okhethekileyo (umz. Ukudlala umdlalo we-intanethi, ukungcakaza ekhasino, ukuthenga izinto) kunokukhokelela kwiimvakalelo zokwaneliseka okanye ukukhululeka kwiimeko ezimbi (ILaier kunye neBrand, 2017). La mava kamva aguqula ukulindelwa komvuzo olindelekileyo onxulumene nokuziphatha okuthile. Banokutshintsha indlela yokuguqula umntu ngamnye. Umzekelo, ukuba abantu bafunda ukuba ukudlala imidlalo kwi-intanethi kusebenza ngokubonakalayo kwiimvakalelo ezintle okanye ukuthintela imeko engathandekiyo yeemvakalelo, banokuwubeka ngokubanzi umbono wokuba ukudlala imidlalo kwi-Intanethi kuluncedo ekujonganeni neemvakalelo kubomi bemihla ngemihla (UKuss et al., 2018; Laier et al., 2018). Utshintsho lwezinto ebezilindelwe kunye nokutshintsha kwendlela kunokunyusa amathuba okuphendula kunye neemvakalelo okanye iimvakalelo zomnqweno kwiimeko ezilandelayo xa ujongana nezikhuhli zangaphandle okanye zangaphakathi. Oku kudibana kwamava okulangazelela okulindelekileyo kuboniswe ngabantu abanobuphawu obuphakamileyo bokusetyenziswa kweenkonzo zonxibelelwano ze-Intanethi.Wegmann et al., 2018b). Ixesha elingaphezulu, ezi zinto zidibeneyo phakathi kweempendulo ezichaphazelekayo kunye nengqondo, izigqibo zokuziphatha ngeendlela ezithile, amava okufumana ulwaneliseko kunye nembuyekezo kunye nolindelo oluchaziweyo lokuziphatha lunokuba namandla. Ngenxa yoko, ukulawulwa kokuziphatha ngeendlela zokuzibamba ngokubanzi kunokuba nzima ngakumbi, kwaye izigqibo zokuziphatha ngeendlela ezithile zinokukhokhelwa ngakumbi kukuphendula okungafunekiyo / okusebenzayo kokucaphukisayo. Iindlela ezicetywayo ukuba zibandakanyeke kumanqanaba okugqibela okuziphatha okushwankathelweyo zishwankathelwe Ikhiwane. 2B.
Kumanqanaba amva enkqubo yokulutha, nangona inguquko inokuthi ngokuthe ngcembe, le mibutho ichaziweyo inokuqina, ikhokelele ekuziphatheni okunokuziva ngokuzenzekelayo kwiimeko ezithile. Ukusebenza kwakhona kunye nokulangazelela kunokuvela kwiimpendulo ezibonakalayo kunye nokuqonda ixesha elingaphezulu ngenxa yeenkqubo zokuvuma imeko (I-Starcke et al., 2018). Uphando lwangaphambili lubalaselisa indima ebalulekileyo yokuzivavanya malunga nokuvuselelwa okunxulumene nomlutha kunye nokusebenza kwiinkqubo zemivuzo ye-neural ebandakanya i-ventral kunye ne-drial striatum kunye nolunye ulwakhiwo lweemilo kwiimpawu zokuziphatha (UFauth-Bühler kunye noMann, 2017; UFauth-Bühler et al., 2017; Luijten et al., 2017; I-Palaus et al., 2017). Izinto ezilindelekileyo ezinokubakho zinokuvela zibe kukuchaphazela ngokubonakalayo kunye nokukhathalela okubonakalayo, okunokubandakanya ucalucalulo okanye uthathele ingqalelo ngokuzenzekelayo kukhuthazo oluhambelana nokuziphatha kunye nezibangela (UJeromin et al., 2016). Sicebisa ukuba imiphumo yokunyanzelwa ibe namandla ngakumbi kwiziphumo ezonwabisayo kumanqanaba enkqubo yokusetyenziswa gwenxa (cf. I-Brand et al., 2016b). Ukongeza kwiziphumo zokumodareyitha zolawulo ngokubanzi lwe-inhibitory kulwalamano phakathi kwenyani-ukwenza kwakhona / umnqweno kunye nokuziphatha okuqhelekileyo, sicebisa ukuba ulawulo olucacileyo lwe-inhibitory lusebenze njengomlamli kumanqanaba alandelayo eenkqubo zokulutha (I-Everitt kunye neRobbins, 2016). Iqela labaphandi bagxininise ukonakaliswa kolawulo lwe-inhibitory kunye nemisebenzi yesigqeba ekuphazamiseni ukungcakaza (Ioannidis et al., 2019b; van Timmeren et al., 2018), ingxaki yokudlala (Argyriou et al., 2017; UKuss et al., 2018; Yao et al., 2017), kunye nengxaki yokusetyenziswa kwe-intanethi engachazwanga (Ioannidis et al., 2019a). Siphakamisa, nangona kunjalo, ukuba ulawulo lwe-inhibitory ngokubanzi lunokwehla ngelixa lenkqubo yokulutha, uphuhliso lolawulo oluthile lokuthintela inhibitory olunxulumene nokuziphatha luzibandakanya ikakhulu kwindlela yokuziphatha yokuziphatha kumanqanaba okugqibela okuziphethe kakuhle. Sicebisa ukuba, ukuba iphinde yenzeke kwakhona kunye nokukhanuka sele kuphuhlisiwe njengeempendulo kwiimvumbatho zangaphandle okanye zangaphakathi, oku kungakhokelela ekunciphiseni kolawulo lomnqweno xa ujongene nefuthe elinamandla, elinokuthi ke landise ukubanakho kokuziphatha okungaqhelekanga (I-Piazza kunye neDeroche-Gamonet, ngo-2013).
3. Iindlela ze-Neurobiological
3.1. Iithiyori zeNeososciology zesidakamizwa esihlanganisiweyo kwisangqa esingaphakathi kwimodeli ye-I-PACE
Iithiyori ezahlukeneyo ze-neurosci science kunye nemodeli echaza isimilo esidibeneyo ziye zadityaniswa kwisikhokelo sethiyori sesangqa sangaphakathi semodeli ye-I-PACE (I-Brand et al., 2016b). Amakhonkco ngokuthe ngqo angabonakala kwi Ukuthintela ukuphendula okungalunganga kunye neGalelo leSalience (I-RISA) imodeli (IGoldstein kunye neVolkow, ngo-2011), Inkuthazo-uSensitization (URobinson kunye neBerridge, ngo-2008), Isifo sokuNqabiseka komvuzo (I-Blum et al., 1996) iimodeli kunye nethiyori, nakwiindlela zenkqubo-mbini zotywala (Bechara, 2005; I-Everitt kunye neRobbins, 2005, I-2016) kunye nemibono yokungalingani phakathi kweempawu ezijolise ekuziphatheni kunye nemikhwa (Robbins et al., 2019). Sikwabhekisa kumanqaku eemodeli ezizezinye ezichazayo ngakumbi zokudibanisa imigqaliselo ye-neurosciological yongxaki yokungcakaza (IBlaszczynski kunye neNower, 2002; UGoudriaan et al., 2004kunye nengxaki yemidlalo (I-Dong kunye nePotenza, ngo-2014; Wei et al., 2017). Ukudibanisa ezi mbono, sijonga ukuqhubela phambili kokungalingani phakathi kokukhulisa iminqweno ekhuthazwayo kunye neminqweno kwelinye icala kunye nokunciphisa imeko ethile yokuthintela ulawulo kule minqweno kunye neminqweno kwelinye icala njengoko ibalulekile kuphuhliso kunye nokugcinwa kokuziphatha okuluthayo. Ukonyusa isivuseleli senkxaso, njengesiphumo seenkqubo zokujonga imeko (IBerridge et al., 2009), banokunxibelelana nokukhathalela okubonayo kunye nokuphinda-phinda emva koko kwiinkqubo zamva. Abantu abaneziphene zomvuzo banokuthi bathambekele ekuphuhliseni uvakalelo lokukhuthaza (I-Blum et al., 2012). Ukunyanzelwa kukhuthazo kunokukhuthaza ukwenziwa kwakhona komnqweno, okunokuthi kube negalelo ekuzibandakanyeni kwiimpawu zokuziphatha.
Ukuncitshiswa kwemisebenzi yolawulo kuthathele ingqalelo njengezinto ezinobungozi kunye neziphumo zokuziphatha okugwenxa kubandakanya ukuphazamiseka kokusebenzisa iziyobisi (Volkow et al., 2012). Kwimikhwa yokuziphatha, efana nokungcakaza kunye nokuphazamiseka kwezokudlala, umntu unokuphikisa ukuba ukuncitshiswa okulawulayo kubeka izinto ezinobungozi kwaye ungaphuhli njengesiphumo sokuziphatha okuchaseneyo, ngenxa yokuba akukho miphumo ichaphazela ngokuthe ngqo kwizinto ezinxulumene nobuthathaka begazi. Ngokuhambelana nale mbono, sicebisa ukuba inqanaba elincitshisiweyo lolawulo ngokubanzi lwe-inhibitory yinto enobungozi ekuziphatheni okukhohlakeleyo kwaye isebenza njengokuguquguquka kobuhlobo phakathi kweempendulo ezichaphazelekayo kwisikhuthazo esithile esishukumisayo (umzekelo, uxinzelelo okanye imood). bazibandakanye kwiindlela ezithile zokuziphatha (jonga Ikhiwane. 2A). Ukongeza, nangona kunjalo, sibonisa ukuba ngaphaya kwale mpembelelo yokumodareyitha yemisebenzi yesigqeba njengenye yokuba sesichengeni sokulutha, ukulawulwa kokuthintela imeko ethile (xa ujongana nemeko yokuziphatha ehambelana nomlutha) inokuncipha ngokuhamba kwexesha njengesiphumo sokuziphatha okukhohlakeleyo, nangona - Ngokuchasene nengxaki yokusetyenziswa gwenxa kweziyobisi-akukho miphumo ethe ngqo ebuchosheni ebandakanyeka kwizenzo zokuziphatha. Ukuncitshiswa kolawulo olungashukumiyo lwe-inhibitory kunokukhula ngokusekelwe kulwalamano kwakhona kunye nokulangazelela kwaye kuhambisane notshintsho kwengqondo esebenzayo kwimijikelezo enxulumene nomlutha (U-Ersche et al., 2012; IKoob kunye neVolkow, ngo-2010; IVolkow neMorales, 2015; Volkow et al., 2012). Ke ngoko, kumanqanaba okugqibela eendlela zokuziphatha (Ikhiwane. 2B), iinkqubo ezingalawulekiyo zolawulo lwe-inhibitory zinokuphembelela kukunqwenela kunye neminqweno enxulumene nokudibana okunxulumene nomlutha, onokuthi emva koko wenze ukuba kwenzeke ukuba umntu aziphathe ngokwasekhaya okanye abonakale ngathi uzenzekelayo (I-Everitt kunye neRobbins, 2005, 2013, 2016).
3.2. Ukudityaniswa kwe-Neural yeenkqubo eziphambili ngaphakathi kwesangqa semodeli ye-I-PACE
Oku kuchazwe ngaphambili kokungalingani phakathi kwemijikelezo yengqondo / yomjikelo womsebenzi kunye nolawulo olungaphambili kwimikhwa yokuziphatha luye lwaphononongwa ngokubanzi kubuchwephesha bokungcakaza (UClark et al., 2013; UGoudriaan et al., 2014; Umkhuhlane, i-2013; van Holst et al., 2010kunye nengxaki yemidlalo (UKuss et al., 2018; Weinstein, 2017; Weinstein et al., 2017), kubandakanya novavanyo lwe meta (UMeng et al., 2015). Nangona lungaphantsi kakhulu, kukho izifundo ezinomdla zokuziphatha ngokwesondo okunyanzelekileyo, kubandakanya ukusetyenziswa kwengxaki yeephonografi (umz. I-Brand et al., 2016a; Gola et al., 2017; UKlucken et al., 2016; Schmidt et al., 2017; Voon et al., 2014), eziye zahlolwa kuvavanyo lwakutsha nje (Kraus et al., 2016; Stark et al., 2018). Izifundo zesayensi zokuhambelana kwe-neural yokuphazamiseka kokuthenga-kunqabile. Kukho, nangona kunjalo, ezinye izifundo zivela kwiimbono zengqondo zesayensi yabathengi (umz. URaab et al., 2011) kunye nezifundo ezisebenzisa amanyathelo e-electrophysiological ukuphanda ngeendlela zentsholongwane yokugula kokugulaI-Trotzke et al., 2014) ezihlolwe kutshanje (I-Kyrios et al., 2018; I-Trotzke et al., 2017). Nangona ingekamkelwa njengombandela weklinikhi, zikwashicilelwa kutshanje ngokufunyanwa kolwakhiwo kunye nokusebenza okusebenzayo kokusetyenziswa gwenxa kunye nengxaki yokusetyenziswa kweziza zonxibelelwano zenethiwekhi kunye nezinye iinkqubo zonxibelelwano ze-Intanethi (umz. Dieter et al., 2017; U-et al., 2017; I-Lemenager et al., 2016; IMontag et al., 2017; IMontag et al., 2018; ITurel kunye neQahri-Saremi, 2016), eziye zaqwalaselwa ngokutsha Wegmann et al. (2018a).
Kukho umahluko obonakalayo kuzo zonke izifundo ezinomdla wokuziphatha okuluqilima malunga neendlela zokuziphatha, ubuchule obusetyenzisiweyo (umzekelo, ulwakhiwo / ukusebenza kogwetyhululo lwamandla ombono [s / fMRI], positron emission tomogra [PET], ukubumba kwengqondo okanye iinkqubo zomdla. , imisebenzi yovavanyo esetyenziselwa ukulinganisa imisebenzi ethile, iisampulu ezibandakanyiweyo (iisampulu ezilula nabantu ababonisa iidigri ezahlukeneyo zeempawu xa kuthelekiswa nabantu abanyangiweyo okanye abaguli abafuna unyango), kunye neenkqubo zokuxilonga ezisetyenzisiweyo. Nangona kunjalo, xa uqukumbela izigqibo, uphononongo lwe-meta-kunye nokuphononongwa (jonga, umzekelo, iikowuteshini ezingasentla), kukho ubungqina bokuqala bokuzibandakanya kwe-limbic organisational, kubandakanya i-amygdala kunye ne-ventral striatum, kunye nezijikelezo zentshukumo yangaphambili yokuthatha inxaxheba. kulawulo lwengqondo malunga nokuziphatha. Kukho, nangona kunjalo, kukho imiqolomba ethile, umzekelo, ukuzibandakanya kwe-hypoactive yokujikeleza komvuzo ngexesha lesigaba sokulindela ukucubungula imali (IBalodis kunye nePotenza, 2015), kunye nabaphandi abathile becebisa umahluko onxulumene nokulungiswa kweendlela zokulutha (ukuphendula ngomvuzo oqinisekileyo) kunye neendlela zokufumana umvuzo ongekho mthethweni (kuphendulwa imbuyekezo yomvuzo onamandla) (I-Limbrick-Oldfield et al., 2013). I-insula inokuba ngumlamli phakathi kwezi nkqubo zimbini (limbic kunye ne-prerial-striatal), imele amazwe azimeleyo adibene nokunqwenela kunye nomnqweno wokuziphatha ngokungqalileyo (bona ingxoxo kwi Namkung et al., 2017; Wei et al., 2017). Ezona zakhiwo ziphambili zichongiweyo njengezinokuchaphazela ubuchopho ezinokubakho ngokuziphatha okushwankathelwe Ikhiwane. 3.
Ikhiwane. 3. Imijikelezo yobuchopho enokubakho ngokuziphatha okuchasene noko. Iintolo ze-orenji zibonisa i-circry ephambili ephakanyisiweyo ukuba ibandakanyeke kwinqanaba lokuqala leenkqubo zokulutha. Iintolo ezihlaza okwesibhakabhaka zibonisa ukubandakanyeka okongeziweyo kwecandelo le-dorsal striatum kunye nezinye izinto ezinxulumene noko kwinqanaba lesigaba seenkqubo zokuphamba, xa indlela yokuziphatha iba yinto eqhelekileyo. I-ACC = i-anterior cingate cortex, AM = amygdala, DLPFC = dorsolateral preortal cortex, DS = dorsal striatum, GP = globus pallidus, Hipp = hippocampus, Ins = insula, Motor = motor cortex kunye neendawo ezinxulumene nayo zokuziphatha, OFC = orbitofortal. I-Rap = i-serotonergic raphé nuclei, SN = substantia nigra, Thal = thalamus, VMPFC = i-cortex ye-ventromedial yangaphambili, i-VS = indawo ye-ventral striatum, i-VTA = indawo ye-dopaminergic ye -ralral yendawo.
Kuphando lwakutsha nje lwe-meta-cue-reactivity enxulumene nomsebenzi wengqondo kwi-fMRI-yezifundo ezinesampulu zezigulana ezinesifo sokuziphatha xa kuthelekiswa nezifundo zokulawula (I-Starcke et al., 2018), i-dorsal striatum (i-caudate nucleus) yayisebenza ngakumbi kubantu abanobukhoboka xa buthelekiswa nalawo angaphandle kunye nabantu abaziyobisi xa kuthelekiswa imeko ehambelana nomlutha nemeko yokungathath 'inxaxheba kwimisebenzi yokuphinda ibekho. Iziphumo ezifumanekayo zingabonakalisa uguquko ekubandakanyekeni kwe-ventral striatum kumanqanaba okuqala okokuziphatha xa ujongana nemeko enxulumene nomlutha ekubandakanyekeni kwesibambiso dorsal kwizigaba zamva zokuphazamiseka, xa isimilo iba yinto yesiqhelo.I-Everitt kunye neRobbins, 2013, 2016; Zhou et al., 2019). Izakhiwo zobuchopho kunye nemijikelezo enokwenzeka ekuziphatheni okukhohlakeleyo kokuziphatha kunye nokutshintsha ukusuka kwinqanaba ukuya kwelinye kwinqanaba leenkqubo zokulutha kubonakaliswa kutsha nje Ikhiwane. 3.
Unxibelelwano olubanzi phakathi kwamacandelo e-fronto-striatal luye lwaphononongwa kusetyenzwa ngophando lwe-fMRI lokuphumla kunye nezifundo ezinempilo kwaye kubonakalisiwe ukuba bayabandakanyeka ekuguquguqukeni kokuziphatha (UMorris et al., 2016). Ezi setyhula zikwabhebhetheka ngokubanzi kunxibelelwano olusebenzayo olubandakanyeka kulawulo lweemvakalelo (I-Öner, i-2018). Iinguqu zonxibelelwano phakathi kwezakhiwo ezithile ezichaphazelekayo kwimijikelezo ye-fronto-striatal (umzekelo, unxibelelwano phakathi kwe-amygdala kunye ne-medial PFC) zibonakala zibalulekile ekucaciseni ukudakumba kwemvakalelo kukuphazamiseka kokusebenzisa iziyobisi (I-Koob, i-2015; UWilcox et al., 2016). Unxibelelwano lothungelwano olubandakanyeka kulawulo lwengqondo (imijikelezo ye-fronto-parietal kunye neendawo zangaphambili zedatha) kunye nokulungiswa kwembuyekezo (kubandakanywa nolwakhiwo lwe-subcortical kunye ne-limbic) lubonakalisiwe ukuba luqikelele ukungahambi kakuhle ekusebenzeni kwe-cocaine emva konyango (Yip et al., 2019). Ukwahlulwa okomeleleyo kothungelwano olubini olubandakanyekayo kulawulo oluphezulu kunye nokuziva kwembuyekezo kucetyisiwe ukuba bhetyebhetye ngokuziphatha kunye nokuncitshiswa kokunyanzelwa, okunokucacisa iziphumo ezingcono zonyango (Yip et al., 2019).
Isishwankathelo, sicebisa ukuba ukungalingani kwimijikelezo ephantsi koguquguquko ekuziphatheni kunye neemvakalelo / ukubongoza umgaqo kunxulumene nezinto eziphambili zokuziphatha okuluthayo. Iindlela zibandakanya ulwazelelo lwe dopaminergic ukusuka kwindawo yentshukumo yecralral kunye nigra yeqela ukuya kwindawo ezingaphambi kwayo, i-ventral striatum, kunye ne-anterior cingulate gyrus kunye ne-serotonergic eqikelelweyo ukusuka kwi-raphé nuclei ukuya kwindawo zangaphambili (ubukhulu becala kwimimandla ejikelezayo) (I-Everitt kunye neRobbins, 2005; Volkow et al., 2012; Volkow et al., 2013). Unxibelelwano phakathi kwezakhi zestriatal, thalamus, kunye neendawo eziphambili zangaphambili zixhomekeka ikakhulu kwiglutamate nakwi-gamma-aminobutyric acid (GABA) (UNaaijen et al., 2015), kunye neesistim ze-neurochemical ezibandakanyekayo kwi-loonto ye-fronto-striatal loops isebenze ngokubonisana kunye nefashoni elawula iminqamlezoUGleich et al., 2015). I-Neurochemical ulungelelwaniso lweziyobisi zixoxwe ngokunzulu kwenye indawo, kwaye uninzi lwezifundo zigxininisa indima ebalulekileyo ye-dopamine kwimpazamo yokusebenzisa iziyobisi (UHerman noRoberto, 2015; IPascoli et al., 2018; Volkow et al., 2016). Iziphumo ezifunyanwa dopamine kulukhukuliso lokuziphatha, nangona kunjalo, azinamandla kwaphela (Umkhuhlane, i-2018).
Nangona inani elinentsingiselo lophononongo kwi-neural nllungelelaniso lweziyobisi zokuziphatha lushicilelwe kule minyaka idlulileyo, kusekho ukunqongophala ekufuneka kuchazwe. Okokuqala, uninzi lwezifundo zipapashiwe malunga nokungcakazwa kokungcakaza kunye nokuphazamiseka kwezemidlalo (jonga izimvo apha ngasentla). Ubungqina obuncinci bukhona kwezinye izinto zokuziphatha okubandakanya ukubandakanyeka ekuziphatheni okubi ngokwesondo kubandakanya ukusetyenziswa kwengxaki yokusebenzisa iphonografi, ukuphazamiseka kokuthenga, kunye nezinye izinto ezingekaziwa njengemeko zeklinikhi, njengokusebenzisa ingxaki kwiisayithi zenethiwekhi yoluntu. Ngokukodwa, izifundo eziphanda ngokucwangcisiweyo iinkqubo zokunxibelelana ze-neural zemisebenzi ethile yengqondo (umz: ukuthanda, ukulawula inhibitory) kuzo zonke iindlela zokuziphatha ezingekhoyo. Izifundo eziphanda ngamanqanaba eenkqubo zokulutha okanye ubungakanani beempawu njengababikezeli okanye ukumodareyitha kwezinto eziguquguqukayo zomsebenzi we-neural kunye nokuchaphazeleka kwengqondo ngendlela efanelekileyo kubalulekile ukuqonda ngcono iindlela eziphantsi kokuqhubekeka kweendlela zokuziphatha. Ngokuhambelana noku, izifundo ezinde zobugqithisela kulungelelaniso lobuchwephesha bokuziphatha okuvavanyayo akwekho. Ukuphanda ngotshintsho olunokwenzeka ukusuka emsebenzini we-ventral ukuya kwi-dorsal striatum njengempendulo kwimikhombandlela enxulumene nomlutha kwiintlobo zokuziphatha gwenxa kunye kuwo onke amanqanaba ahlukeneyo okuba likhoboka, usebenzisa macala omnqamlezo kunye noyilo olude, kunganceda ukuqonda ngcono imeko yokulutha. isimilo. Izifundo ezinjalo ziyimfuneko ukwahlula utshintsho olunokwenzeka ukusuka ekunqweneleni ukunyanzelwa kunye nokulindela ukwaneliseka kulindelo lokukhululeka kwimeko ezimbi xa udibana nesikhuthazo esinxulumene nomlutha kumanqanaba ohlukeneyo okuziphatha okuchaseneyo, okuya kuthi emva koko kuncede ekwenzeni unyango lube ngcono. Izifundo ngokuthelekisa iintlobo ezahlukeneyo zokuziphatha okuluthayo kunye namanqanaba ahlukeneyo enkqubo yokulutha kubandakanya nezifundo ezinokubakho kwixesha elide zinokuphanda ukubandakanyeka kwe-hypothesised ekunciphiseni ulawulo lwe-inhibitory njengento yokuthinteleka kunye / okanye njengesiphumo seendlela zokuziphatha ezichasayo, kunye nesinye esinokulamla ikhonkco phakathi koncedo iimpendulo kunye nokuziphatha okuqhelekileyo / okunyanzelekileyo (bona ingxoxo kwi I-Everitt kunye neRobbins, 2016).
4. Ukuqukumbela kunye nezikhokelo zekamva
Imodeli ye-I-PACE ehlaziyiweyo yindlela yethiyori yokuchaza inkqubo yokuziphatha okuluthayo ngokudibanisa iingcinga zengqondo neze-neurosciology zengxaki yokusebenzisa iziyobisi kunye nokuziphatha okukhoyo. Sithathela ingqalelo ukuphazamiseka ngenxa yokuziphatha okuluthakathaka njengesiphumo sokunxibelelana phakathi kweempawu eziphambili zomntu kunye nokumodareyitha okuninzi kunye nokuguquguquka okunokuguquguquka ngokuhamba kwexesha njengesiphumo sokuzibandakanya kwiindlela ezithile zokuziphatha. Sicebisa ukuba umfuziselo we-I-PACE weendlela zokuziphatha ezinokuba luncedo kuphando lwengqondo kunye nophando lwenzululwazi kuba luvumela ukwakheka kunye nokuvavanywa kweempawu ezilandelanayo ezicacileyo ngokubhekisele kwimpembelelo yokuhlangana kwezinto ezithile ezichaziweyo ekuchazeni umahluko kwiimpawu zobukrelekrele bokuziphatha. Imodeli inokuphinda ikhuthaze ukusebenza kwezonyango (cf. UKumkani et al., 2017; Umkhuhlane, i-2017) ngokuchaza nokuphanda izinto eziguquguqukayo ezinokubonakalisa iithagethi zonyango (umzekelo, izinto ezilindelweyo, iimpendulo ezichazayo nezishukumisayo. Imodeli ye-I-PACE ehlaziyiweyo ikwabonelela ngamathuba okufumana ii-hypotheses kumanqanaba enkqubo yokulutha (zombini ngexesha lokuqhubekeka kunye nokubuyisela kwimeko yesiqhelo), umzekelo ngokuxoxa ukuba ukuncitshiswa kolawulo oluthile lwe-inhibitory lukhawuleze kumanqanaba alandelayo ekuqhubekeni kweenkqubo zokulutha. Kubalulekile ukuba uqaphele, nangona kunjalo, ukuba sijonga imodeli yethiyori njengeyamandla. Ubunyani be-hypotheses ethile, edityaniswe kwisakhelo sobunyani, kufuneka kuvavanywe ngamandla, kwaye iimodeli zethiyori kufuneka zihlaziywe ngokujonga iziphumo zenzululwazi zamva nje ezahlukeneyo.
Yintoni ebalulekileyo ekufuneka uyikhumbule kukuba imodeli yethiyori ecetywayo isekwe kumanqanaba ohlukeneyo obungqina besayensi malunga nokuziphatha okuluthayo. Njengoko kukhankanyiwe kumacandelo angaphambili, ukubandakanyeka kweendlela ezithile zokusebenza kwengqondo kunye neenkqubo ze-neurobiological kufundwa kakuhle kwisifo sokungcakaza kunye nokuphazamiseka kwezokudlala kwaye kuphandwe ngokunzulu kwezinye iindlela zokuziphatha ezinokuthi zibe ngumlutha, umzekelo, ukusebenzisa imifanekiso engamanyala, ukuthenga-ukuthenga kunye nentlalontle. -kuSebenza. Ngapha koko, kweminye imiba kunye neendlela ezicetywayo kwimodeli ye-I-PACE ehlaziyiweyo, amanqanaba ahlukeneyo obungqina akhona. Ngemisebenzi yolawulo kunye nolawulo lwe-inhibitory, inani elikhulu kakhulu lezifundo lisebenzise iindlela zokuvavanya kwaye lihlole amanqaku athile ekusebenzeni kolawulo kwiintlobo ezahlukeneyo zokuziphatha okuluthayo. Kwelinye icala, ukwenza izinto ezibonakala ngokutsha kunye nokunqwenela iindlela ezithile zokuziphatha ezigwenxa, ezinye izifundo zasebenzisa uyilo oluhambelana, olwenza utoliko kunye nexesha lophuhliso lwenkcubeko kunye nokunqwenela inkqubo yokulutha kunzima ukuyichaza.UZilberman et al., 2019). Ukuthathela ingqalelo oku kusikelwa umda kubalulekile ukugxininisa ukuba imodeli ephakanyisiweyo iyimodeli yethiyori esishwankathela imeko yangoku yophando lokuziphatha okukhoyo kwaye ijolise ekukhuthazeni izifundo ezisekwe kwithiyori.
Omnye umba obalulekileyo ekufuneka uqwalaselwe kukuba ubuntu kunye neempawu zobushushu zibubumbi obucacileyo bokuziphatha okuchaziweyo, inikezwe ukuba ezi zinto zibandakanyekayo zibandakanyeka kwi-psychopathologies ezininzi kwaye zihlala zichaza kuphela ulwazelelelo lweempawu ezibonakalayo kwiimeko ezahlukeneyo zokuphazamiseka.UZilberman et al., 2018).
Sinqwenela ukuphawula kwingxoxo-mpikiswano yangoku malunga nokuhlelwa kokuphazamiseka kokuthenga kunye nokusebenzisa iphonografi njengokuphazamiseka kolawulo okanye njengeziyobisi. I-ICD-11 ibandakanya ukusetyenziswa kwengxaki yemifanekiso engamanyala njengenye yeenkalo zokuziphatha ngokwesondo okunyanzelekileyo ngaphakathi kwinqanaba lokuphazamiseka kokulawulwa kokuziphatha. Ukuthenga-ukuphazamiseka kokuthenga kudweliswe njengomzekelo wolunye uxinzelelo lolawulo lwempembelelo kwisixhobo se-ICD-11 codingUmbutho wezeMpilo-kwiHlabathi, i-2019). Uninzi lwabaphandi, nangona kunjalo, zibonisa ukuba zombini ezi ntlobo zokuphazamiseka zinokuhlelwa ngcono njengezikhobisi zokuziphatha (Potenza et al., 2018).
Umngeni omnye wophando lwexesha elizayo kunye nokwakhiwa kwethiyori kubandakanya ukwalatha kunye nokuchaphazela izinto ezinokubakhona kunye nantlukwano phakathi kokuphazamiseka ngenxa yokuziphatha okukhoyo kunye nokunye ukuphazamiseka kwengqondo, njengokujonga okungahambelaniyo nokunyanzeliswa kokuziphatha kunye nokuphazamiseka, okunokuthi kuhambelana nokuziphatha okuchasene nengqondo kunye ne-neurobiological. amanqanaba (I-Chamberlain et al., 2016; Fineberg et al., 2013; Fineberg et al., 2018; Robbins et al., 2019). Umzekelo, ulawulo lwe-inhibitory kunye nokulungiswa kwemivuzo kuye kwacetywa ukuba lubalulekile ekuphazamisekeni-okunyanzelekileyo okunxulumene nokuthinteleka kolawulo-lokuphatha, njengokuxoxwa ngakocholiseko lokukhetha ulusu kunye ne-trichotillomania, ekwanxulumene nokusebenza kwengqondo ye-fronto-striatal imijikelezo (I-Chamberlain et al., 2008). Ukungasebenzi kweelops ze-fronto-striatal, nangona kunjalo, kungabandakanyeka kwezinye iingxaki ezininzi zempilo yengqondo kunye (I-Mitelman, 2019). Nangona kunjalo, isibakala sokuba ii-loops ze-fronto-striatal zibandakanyeka ukuphazamiseka kwengqondo akuthethi ukuba iinkqubo zengqondo ezinxulumene ne-phenotypes yeklinikhi yokuphazamiseka iyafana. Okokuqala, ii-loonto ze-fronto-striatal zichazwa ngendlela eyahlukileyo kwaye ziyahlalutywa kwizifundo. Izifundo zexesha elizayo kufuneka zihlolisise igalelo elingqalileyo lolwakhiwo ngoku oluchazwa ngokubanzi ngaphakathi kwe-loonto-ye-striatal loops kwiinkqubo ezithile zengqondo ezilandela imeko ethile yokuziphatha. Okwesibini, ukubandakanyeka ngokubanzi kolawulo lwe-inhibitory kunye nokulungiswa kwembuyekezo akuthethi ukuba iinkqubo zengqondo ziyafana ngokuthelekiswa nokuphazamiseka, nangona kunokuba khona ukugqithisa kokunyanzeliswa / ukunyanzelwa kunye nokuziphatha okuluthayo (umzekelo, I-Chamberlain et al., 2018). Kubalulekile ukuchaza ngokuthe ngqo ezona zinto zibangela ukuqhubela phambili okwethutyana kwezizathu zezizathu zokuba abantu bazibandakanye kakhulu kwindlela yokuziphatha ethile. Umzekelo, kwiindlela zokuziphatha ezingekho mthethweni, inokuba zezona ntshukumisa ziphambili zokuzibandakanya kwimidlalo okanye ukungcakaza, ubuncinci kwinqanaba lokuqala, kubandakanya ukubonwa komvuzo. Kumanqanaba amva, ukuphepha ukuziva ungonwabanga kunokwenzeka ukuba ubandakanyeke. Kwingxaki ezinxulumene nokuphembelela okunganyanzelekanga, inokuba ukuqhubela phambili ngamandla kwinqanaba lokuqala kubandakanya ukungathintelwa kweemvakalelo ezingalunganga okanye ixhala. Mva, indlela yokuziphatha inokuthi ibe nakho ukuvuza ngokuba inokunceda ukudambisa uxinzelelo. Ngamanye amagama, ukubandakanyeka ngokubanzi kwemisebenzi ethile ye-neurocognitive akunakuyichaza ngokupheleleyo ingxaki. Olona luvo lusebenzayo kwiindlela ze-neural. Kungenzeka ukuba kwimeko yokuphazamiseka ngenxa yokuziphatha okuluthayo, i-ventral striatum inegalelo elibalulekileyo kumanqanaba okuqala kwesi sifo, ngokubhekisele kwimicimbi ephambili kunye nasekuthandeni. Kumanqanaba amva, i-dorsal striatum inokuthi ibandakanyeke ngakumbi kwaye inxulumene nezinto ezihlala zihleli kunye nezinyanzelekileyo zeziphazamiso. Ngokwahlukileyo, i-dorsal striatum inokwenzeka ukuba ibandakanyeke ekuphazamisekeni okunxulumene nokupheliswa kwempembelelo kunye nolawulo lwempembelelo, njenge-trichotillomania, ukusuka kwinqanaba lokuqala (Isobe et al., 2018; van den Heuvel et al., 2016).
Kwizifundo ezizayo, kubonakala kubalulekile ukuba kuphandwe iinkqubo kunye nokunxibelelana kwemisebenzi eyahlukeneyo ye-neurocognitive kwiindidi ezahlukeneyo zokuziphatha okuluthayo ukwenzela ukufezekisa ukuqonda okungcono kweempawu ezingaphantsi zento yokuziphatha. Imodeli ye-I-PACE inokusetyenziselwa ukucacisa kunye nokucacisa imiba ethile yophando ekwenzeni ezi zinto. Kubalulekile ukuvavanya iinkqubo ze-hypothesised kwiimpawu zokuziphatha kunye nokuzithelekisa nolunye uphazamiseko lwengqondo, njengokujonga okungahambelaniyo nokunyanzeliswa kolawulo lokuqonda ukuze uqonde ukuba ngaba iinkqubo ezikhoyo zibandakanyekile azifani okanye ziyafana. Kule nkqubo, idatha evelisiweyo kufuneka incede ukucacisa ubungakanani bamagama ahlukileyo anokuthi asetyenziselwe ukuchaza iindlela ezifanayo kwiziphazamiso. Ngale ndlela, inguqulelo ehlaziyiweyo yemodeli ye-I-PACE ibonelela ngesikhokelo sethiyori esiya kuthi sincede ekuphenduleni imibuzo ephambili enxulumene nokulutha, ukunyanzela ukunganyanzeleki, ukulawulwa okungafunekiyo kunye nokunye ukuphazamiseka, kubandakanya nezo zinxulumene nokusetyenziswa kwe-intanethi, ezinokuthi zihambelane ngakumbi. ekuhambeni kwexesha banikwa utshintsho kwimeko yetekhnoloji yedijithali.
Isibhengezo somdla
Ababhali bavakalise ukuba abanangxabano yemidla. UGqr Brand ufumene (kwiYunivesithi yaseDuisburg-Essen) izibonelelo ezivela Isiseko sophando saseJamani (i-DFG), i I-Federal Ministry yaseJamani yoPhando kunye neMfundo, i Inkonzo yaseJamani yezeMpilo, kwaye i udibano lwaseyurophu. UGqirha Brand wenze uphononongo lwesibonelelo kwiiarhente ezininzi; uhlele amacandelo ejenali kunye namanqaku; unike intetho yokufunda kwiindawo zonyango okanye kwezesayensi; kwaye wavelisa iincwadi okanye izahluko zeencwadi zabapapashi bezicatshulwa zempilo yengqondo. UGqr Potenza ufumana inkxaso NIH (I-R01 DA039136, I-R01 DA042911, I-R01 DA026437, I-R03 DA045289, I-R21 DA042911, yaye IP50 DA09241), i I-Connecticut iSebe lezeMpilo yeengqondo, i I-Connecticut Council kwiNgxaki yokuNgcakaza kwaye i IZiko leLizwe leMidlalo eliThembekileyo. Ugqirha Potenza uthintene neengcebiso kwi-Rivermend Health, Opiant / Lakelight Therapeutics kunye neJazz Pharmaceuticals; wafumana inkxaso yophando (ukuya kuYalele) evela kwiMidlalo yeMogan yaseLangeni kunye neZiko leSizwe leNtlalontle eliThembekileyo; kuboniswane okanye kucetyiswe amaziko asemthethweni kunye nongcakazo kwimicimbi enxulumene nolawulo lokuziphatha kunye nokuziphatha okuluthayo; inike ukhathalelo lweklinikhi olunxulumene nolawulo lwempembelelo kunye nokuziphatha okuluthayo; uphononongo lwesibonelelo; Iijenali ezihleliweyo / amacandelo ejenali; unike intetho yokufunda kwimijikelo emihle, imicimbi ye-CME nakwezinye iindawo zekliniki / zenzululwazi; kwaye kwaveliswa kweencwadi okanye izahluko ezenzelwe abapapashi bezicatshulwa zempilo yengqondo.
Imibulelo
Sibulela ngokungazenzisiyo kwigalelo lobuchule likaGqirha Kimberly S. Mncinci kule nguqulo yangaphambili ye-I-PACE, eyayikhuthaza imodeli ehlaziyiweyo. UGqr. Young uswelekile ngoFebruwari 2019. Ukukhumbula uGqirha Kimberly S. Mncinci, sinikezela eli nqaku kuye.
Ucaphulo
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