Psychiatry Res. Umbhalo obhaliweyo ifumaneka kwi-PMC 2017 Feb 28.
Ishicilelwe kwifomu yokugqibela ehleliweyo njenge:
Psychiatry Res. 2016 Dec 30; 246: 230–235.
Ipapashwe kwi-intanethi ye-2016 Sep 26. doi: 10.1016 / j.psychres.2016.09.044
PMCID: PMC5330407
I-EMSID: EMS71673
EW Leppink,(1) SR Chamberlain,(2) SA Redden,(1) kwaye JE Grant(1)*
Abstract
injongo
Inani eliqaphelekayo labantu abadala abasebatsha bayasokola ukulawula indlela yokuziphatha etyhutyhayo, nto leyo ekhokelela kukonakala kunye nonxunguphalo. Uvavanyo lwengxaki yokuziphatha ngokwesondo (PSB) iqaphele umahluko weklinikhi onxulumene nabanye abantu, kodwa iziphumo ze-neurocognitive ziye zahluka. Olu hlalutyo luvavanya inkcazo yeklinikhi kunye neprofayili ye-neurocognitive yezigulane ezine-PSB ezihambelana nabathathi-nxaxheba ababonisa iimpawu ze-PSB.
tindlela
Abathathi-nxaxheba be-492 (i-18-29) baqeshwe kuphononongo malunga nokunyanzeliswa kwabantu abadala abaselula. Abathathi-nxaxheba bagqibe ukuxilonga, ukuzixela, kunye nemilinganiselo ye-neurocognitive evavanye iindawo ezininzi zokuqonda. I-PSB yayichazwa njengokuxhasa iingcamango, izibongozo, okanye indlela yokuziphatha ngokwesondo eziva ingalawuleki okanye ibangela uxinzelelo.
iziphumo
Ama-54 (11%) abathathi-nxaxheba bachaze iPSB yangoku. Eli qela lalisele likhulile, lichazwe ngamava esondo angaphambili kunye nokusetyenziswa kotywala, kunye nomgangatho ophantsi wobomi kunye nokuzithemba. I-Comorbidity yayinkulu kwiqela le-PSB, ngakumbi kuxinzelelo kunye nokuxhomekeka kotywala. Iqela le-PSB likwabonise iyantlukwano ekunganyanzelekanga, ukwenza izigqibo, inkumbulo yokusebenza yendawo, ukusonjululwa kweengxaki, kunye nokuphazamiseka ngokweemvakalelo.
isiphelo
Iziphumo zibonisa ukuba i-PSB inxulunyaniswa nokungasebenzi kakuhle kwengqondo, ukuxinana okukhulu, kunye nokwahlukana kwe-neurocognitive. Olu nxulumano lucebisa impembelelo ebonakalayo ngakumbi kunendlela yokuziphatha eqhelekileyo ngokwesondo. Ngaphaya koko, olu phononongo lubonise iintsilelo ezininzi ze-neurocognitive kwiqela le-PSB elifumene inkxaso exutyiweyo ngakumbi ngaphambili.
1. Intshayelelo
Ukuziphatha ngokwesondo, kubandakanya ukuthatha umngcipheko ngokwesondo kunye nokulinga, kuxhaphakile phakathi kwabantu abadala abancinci (Kaestle et al., 2004; Kann et al., 2014; USatelli et al., ngo-1998). Abanye abantu, nangona kunjalo, baneengxaki zokulawula iminqweno yabo yesini kunye / okanye indlela yokuziphatha. Ubudala obutsha buhlala bunxulunyaniswa neendlela ezininzi zokuziphatha ngokungxama ngokubanzi, kubandakanya ukusetyenziswa kakubi kotywala kunye nokusetyenziswa kweziyobisi ezingekho mthethweni (Chen et al., 2005; Courney kunye nePolich, ngo-2009; Kann et al., 2014; Young et al., 2002). Kwezinye iimeko, ukuziphatha ngokwesondo kunye nezinye izinto ezibeka umngcipheko ziqala ukubonakalisa ipateni yokutsala nzima okukhokelela kumonakalo omkhulu kunye noxinzelelo. Nangona ukuziphatha ngokwesondo kunokuqheleka phakathi kwabantu abadala abancinci, akucaci ukuba bangaphi abantu abadala abanengxaki ngesondo. Ingxaki yokuziphatha ngokwesondo ijongelwa phantsi kubomi babo bonke, ngakumbi kubantu abadala abancinci.
Kuphononongo lwangoku, sivavanye isampuli enkulu yokunganyangeki efuna abantu abadala abancinci malunga nokuziphatha ngokwesondo. Nangona uphando lwangaphambili lubonisa ukuba ukuziphatha okunyanzelekileyo ngokwesondo kunye nezinye iindlela zokuziphatha eziluthayo zinokunxulunyaniswa, akukho sifundo sivavanye ngokucwangcisiweyo ubudlelwane bokuziphatha okunengxaki ngokwesondo kuluhlu lweendlela zokuziphatha kunye nokuqonda. (Imnyama et al., 1997; I-Derbyshire kunye neGrant, 2015; Kuzma noMnyama, i-2008). Ngenjongo yolu phononongo, sikhethe ukuvavanya indlela yokuziphatha ngokwesondo ebonisa inqanaba elingenampilo okanye eliyingxaki (eliphawulwa yindibaniselwano yokuphindaphinda iingcinga zesondo, izibongozo, okanye ukuziphatha okubonwa njengokungalawulekiyo okanye kubangela uxinzelelo olukhulu) ngaphandle kokugqithisa kakhulu ukuziphatha njengengxaki yengqondo (njengoko kunokuba njalo kwi-hypersexuality okanye ukuziphatha okunyanzelekileyo ngokwesondo). Indlela efanayo isetyenzisiwe kunye nezinye iindlela zokuziphatha eziyingxaki, njengokusela okuyingozi kunye nomngcipheko ophezulu wokungcakaza, ukuze kuvavanywe impembelelo yezi ziphatha kunikezelo lweklinikhi kunye nokusebenza (Agrawal et al., 2010; UCarneiro et al., 2014). Sicinge ukuba i-PSB iya kuxelwa rhoqo, iya kudibaniswa noluhlu lweendlela zokuziphatha ezingangxamiyo, kwaye ziya kunxulunyaniswa nokungasebenzi kakuhle kwengqondo okunxulumene nabantu abadala abancinci abangenambali ye-PSB.. Ukuphonononga inqanaba elinengxaki yokuziphatha ngokwesondo, elingafikeleli kwiikhrayitheriya zokuxilonga ukuphazamiseka ngokwesondo, kunokuba nefuthe elibalulekileyo kwimpilo yoluntu, ngakumbi kungenelelo lokuqala kunye nemfundo.
Ukunikezelwa kwedatha engaphelelanga malunga nokuziphatha okunengxaki ngokwesondo phakathi kwabantu abancinci, ngakumbi kwiisampulu zoluntu, iinjongo zolu phononongo yayikukuba: 1) kuphonononga ukuxhaphaka kunye nokunxibelelana kwezentlalo ngokwesondo okunengxaki kubantu abadala abancinci; I-2) iphande ngonxibelelwano lwempilo yengqondo kubantu abadala abancinci abaxela ukuziphatha okunengxaki ngokwesondo; kunye ne-3) bavavanye i-neurocognitive underpinnings kubantu abadala abancinci abaneengcinga zesini / ukuziphatha okubonisa le ngxaki.
2. Iindlela
Isampulu yabathathi-nxaxheba abangama-491 baqeshwa kuluntu olujikelezileyo kufutshane neeyunivesithi ezimbini ezinkulu zaseMidwestern kuphononongo malunga nokuziphatha ngokungxama kubantu abadala abancinci. I-PSB yavavanywa kusetyenziswa iMinnesota Impulsive Disorders Interview (MIDI) (Odlaug kunye noGrant, ngo-2010) kwaye yachazwa njengempendulo ethi "Ewe" kuyo nayiphi na imibuzo ephambili ye-4 yokuxilongwa kwimodyuli yesinyanzelo sokuziphatha ngokwesondo, edweliswe ngezantsi:
- Ngaba wena okanye abanye obaziyo bacinga ukuba unengxaki yokuzixakekisa ngokugqith’ emgceni ngesini sakho okanye ukuba neentlobano zesini ngokugqithiseleyo?
- Ngaba uphinda-phinda ukucinga ngesondo ovakalelwa kukuba akukho kulawulo lwakho okanye kukwenza ukhathazeke?
- Ngaba uneminqweno yesondo ephindaphindayo oziva ngathi ayikho kulawulo lwakho okanye ikwenza ukhathazeke?
- Ngaba uyaziphindaphinda indlela yokuziphatha ngokwesondo ovakalelwa kukuba ayikho kulawulo okanye unobangela okanye uxinzelelo?
Bonke abathathi-nxaxheba baye bagqiba udliwano-ndlebe oluqhelekileyo lokuxilonga, ulwazi olusisiseko lwabantu, i-self-report impulsivity inventories, kunye nebhetri yolwazi lwekhompyutha. I-Psychiatric comorbidity yavavanywa kusetyenziswa i-Mini International Neuropsychiatric Inventory (MINI) (UShehan et al., 1998) ngabahlawuli abaqeqeshiweyo. Zonke iinkqubo zokufunda zenziwa ngokuhambelana neSibhengezo saseHelsinki. IiBhodi zokuHlola iziko leYunivesithi yaseMinnesota kunye neYunivesithi yaseChicago zivume iinkqubo kunye neefom zemvume ezihamba nazo. Bonke abathathi-nxaxheba banikeze imvume ebhaliweyo enolwazi ngaphambi kokuthatha inxaxheba kwisifundo.
2.1. Amanyathelo onyango
Udliwano-ndlebe lwe-Minnesota Impulsive Disorders (MIDI) (Odlaug kunye noGrant, ngo-2010): I-MIDI yi-self-report inventory ehlola iziphazamiso ezininzi zokulawula impulse kuquka oku kulandelayo: CSB, kleptomania, intermittent explosive disorder, gambling disorder, compulsive buy, skin picking disorder, trichotillomania, pyromania, and binge food disorder. Apho ikhoyo, i-MIDI isebenzisa indlela ebekwe yi-DSM-5 ukuchonga ukuphazamiseka komntu ngamnye, kubandakanya ukuchola ulusu, i-trichotillomania, ukuphazamiseka kokungcakaza, kunye nengxaki yokutya kakhulu. I-MIDI isetyenziswe ngaphambili ukuvavanya ukuxhaphaka kokuphazamiseka kokulawulwa kwempembelelo kwiisampulu ezininzi ezinokuthembeka okulungileyo (Odlaug kunye noGrant, ngo-2010).
2.2. Amanyathelo okuzixela
Barratt Impulsiveness Scale, Version 11 (BIS) (Barrett, 1959; Patton et al., 1995): I-BIS ngumlinganiselo wokuzixela ngokwawo wokunyanzeliswa kuyo yonke imilinganiselo yokuqwalaselwa, imoto, kunye nokungacwangciswanga. Lo mlinganiso unemibuzo engama-30, ngamnye ulinganiswe kwisikali esi-1 (“Akufane/Azange”) ukuya ku-4 (“Phantse Ngamaxesha Onke”). Amanqaku omyalelo wesibini axelwe kwimilinganiselo yengqalelo, i-motor, kunye ne-non-planning impulsivity.
I-Rosenberg Self-Esteem Scale (RSE) (IRosenberg, 1965): I-RSE ngumbuzo we-10 we-self-report inventory evavanya amanqanaba okuzithemba. Izinto ezivavanyiweyo ziquka iimvakalelo zokwaneliseka ngesiqu sakho, ukuxabiseka, kunye nesimo sengqondo ngakuwe phakathi kwabanye. Iimpendulo zisuka ku-"Andivumi kakhulu" ukuya ku-"Ndivuma kakhulu", kwaye zinika amanqaku adibeneyo.
Ubunzima kwiSikali soLawulo lweeMvakalelo (DERS) (Gratz kunye noRoemer, ngo-2004): I-DERS ngumlinganiselo wokuzibika we-disregulation yeemvakalelo. Umlinganiselo uquka imibuzo engama-36 eneempendulo ezisusela ku-1 (“Phantse azange”) ukuya kwi-5 (“Phantse Ngamaxesha onke”). Inkalo ekujoliswe kuyo yokulinganisa kolu hlalutyo yayiyinqaku elihlanganisiweyo lomlinganiselo.
Umgangatho woBomi (QOL) (Frisch et al., ngo-1992): I-QOLI ngumbuzo we-32 wokuzibika umlinganiselo womgangatho obonwayo wobomi. Abathathi-nxaxheba bacelwa ukuba banike iimpendulo malunga nokuba kubaluleke kangakanani into enikiweyo kwisikali ukusuka kwi-0-2, kwaye ke impendulo yokuba banelisekile kangakanani naloo nto kwisikali se-3-3. La maxabiso aphinda-phinda-phinda ukunika inqaku elishiyekileyo lalo mba. Izinto ke zishwankathelwa ukunika amanqaku akrwada. Amanqaku aguqulwa abe ngamanqaku e-t kuhlalutyo lokugqibela kusetyenziswa iindlela ezichazwe nguFrisch kunye noogxa (Frisch et al., ngo-1992).
2.3. Amanyathelo okuqonda
Iinguqu ze-neurocognitive zavavanywa kusetyenziswa inkqubo ye-Cambridge Neuropsychological Test Automated Battery (CANTAB). Olu vavanyo lulandelayo lubandakanyiwe kolu hlalutyo:
I-Intra-/Extra-dimensional Seti Shift (IDED): I-IDED ivavanya ukuguquguquka kwengqondo, okuhambelana nokunyanzeliswa. Ngexesha lomsebenzi, abathathi-nxaxheba banikwa iibhokisi ezine, ezimbini zinemilo epinki. Abathathi-nxaxheba baxelelwa ukuba imilo enye ikhethwe "njengechanekileyo", kwaye intsalela "ingalunganga". Baye baxelelwe ukuba injongo yabo kukukhetha imilo echanekileyo kaninzi kangangoko kunokwenzeka. Emva kwenani elithile leenketho ezichanekileyo, impendulo echanekileyo (okt umgaqo olawula ukuba loluphi uvuselelo oluchanekileyo) itshintshwa yikhompyutha, ifune umntu ngamnye ukuba afunde kwi-feedback aze abhaqe umgaqo omtsha. Ukuguquguquka okujoliswe kuyo kolu hlalutyo kwakuyinani elipheleleyo leempazamo ezenziwe ngexesha lomsebenzi, ezilungelelaniswe kwinqanaba lobunzima isifundo esikwaziyo ukufikelela kuso.
Misa uMsebenzi woMqondiso (SST): I-SST ivavanya iinkalo zokuthintelwa kweemoto, nto leyo ebonisa ukunyanzeliswa kwemoto. Ngexesha lomsebenzi, ikhomputha ibonisa ulandelelwano lweentolo ezijonge ngasekhohlo okanye ngasekunene. Umxholo uyacelwa ukuba ucinezele elinye lamaqhosha amabini ahambelana notolo lwasekhohlo nasekunene oluboniswe kwiscreen. Emva kwesigaba soqeqesho, "beeps" ezivakalayo zingeniswa emva kweentolo ezithile, kwaye abathathi-nxaxheba bayalelwa ukuba bangacinezeli iqhosha kwiintolo emva koko kukho "beep" kude kube utolo olulandelayo luboniswe. Ubude bexesha phakathi kotolo kunye nesandi buyahluka ngexesha lovavanyo, kuxhomekeke kwimpumelelo yomthathi-nxaxheba ekuthinteleni impendulo yokuqala yemoto. Umlinganiselo ekujoliswe kuwo ngulo msebenzi liXesha le-Stop-Signal Reaction Time (SSRT); olu tshintsho luqikelelo lwexesha elithathwa yingqondo yomntu ukumisa impendulo ebiya kwenziwa ngokwesiqhelo. Ii-SSRTs ezinde zilingana nothintelo olubi lokuphendula.
Umsebenzi woNgcakazo waseCambridge (CGT): I-CGT ivavanya umngcipheko wokuthatha kunye nokwenza izigqibo kwimeko yomsebenzi wongcakazo. Ngexesha lomsebenzi, abathathi-nxaxheba baboniswa uluhlu lweebhokisi ezilishumi, ezinobungakanani obahlukeneyo bemibala ebomvu okanye eluhlaza okwesibhakabhaka. Isikwere esincinci esimthubi sifihlwa ngaphantsi kwenye yeebhokisi ezibonisiweyo, kwaye abathathi-nxaxheba bayalelwa ukuba banethuba elilinganayo lokuba phantsi kwayo nayiphi na ibhokisi ekwisikrini. Abathathi-nxaxheba bayacelwa ukuba bakhethe iibhokisi ezibomvu okanye iibhokisi ezibhlowu, ezihambelana nebhokisi yombala abakholelwa ukuba isikwere esimthubi singaphantsi. Emva kokukhetha, umthathi-nxaxheba ukhetha inqaku elipheleleyo lokubheja kwi-"point bank" yabo, ehambelana nokubheja kwabo abathe bachonga ngokuchanekileyo ukuba ngowuphi umbala oza kuvela ngaphantsi kwesikwere esityheli. Amanqaku akhethwe kwenye ibhokisi ekwisikrini ebonisa ngokuthe ngcembe amaxabiso amanqaku (tshintshela ekunciphiseni isiqingatha sendlela ngomsebenzi) ukusuka kwi-5% ukuya kwi-95% yamanqaku ewonke akhoyo. Ukuba ichanekile, amanqaku aphindwe kabini ukuze asetyenziswe kulingo oluzayo; ukuba ayichanekanga, umthathi-nxaxheba ulahlekelwa ngamanqaku abhejiweyo. Iinguqu ekujoliswe kuzo kumlinganiselo kukubheja komlinganiselo ngokubanzi, umgangatho wokwenziwa kwezigqibo, kunye nohlengahlengiso lomngcipheko. Ubhejo lulonke lubonisa umyinge wamanqaku akhoyo umthathi-nxaxheba adla ngokuwakhetha ngexesha lomsebenzi. Umgangatho wokwenziwa kwezigqibo ubonisa ubungakanani bamaxesha umthathi-nxaxheba akhethe ibhokisi yombala enelona nani likhulu elikhoyo kwisikrini, ehambelana nelona lungelo likhulu lokuqulatha isikwere esityheli. Uhlengahlengiso lomngcipheko lubonisa kunye notyekelo lomntu ngamnye lokuguqula iipateni zokubheja ngokusekwe kumathuba abawakhethayo ukuba achanekile (umz. ukubheja kancinane ku-1:1 odds, nangaphezulu kwi-4:1 odds).
IMemori yokuSebenza ngokuSithuba (SWM): I-SWM ivavanya inkumbulo yokusebenza yendawo enxulumene nokugcina kunye nokulawula ulwazi lwesithuba. Umsebenzi ubandakanya uluhlu lweepuzzle eziqulethe izikwere ezininzi. Abathathi-nxaxheba bayalelwa ukuba izikwere ezincinci ezihlaza okwesibhakabhaka zifihlwe phantsi kwezikwere eziboniswe enye ngexesha, kwaye kufuneka bafumane okwaneleyo ukuzalisa ibha eboniswe kumda wesikrini. Baye baxelelwe ukuba emva kokufumana ibhokisi ezuba phantsi kwebhokisi enkulu kube kanye, akunakwenzeka ukufumana enye kuloo ndawo kwintsalela yaloo puzzle. Iinguqu ekujoliswe kuzo kulo msebenzi linani lilonke leempazamo ezenziweyo ngexesha lomsebenzi, apho umthathi-nxaxheba ekhetha isikwere esikhulu esingenaso isikwere esiluhlaza ngaphantsi, kunye nomgangatho wesicwangciso esisetyenziswayo xa kusonjululwa iipuzzle (amanqaku eqhinga asezantsi alingana neqhinga elingcono). sebenzisa).
I-One Touch Stocking yaseCambridge (OTS): I-OTS ivavanya izakhono zokucwangcisa ezilawulayo, kwaye ilandela inkqubo efanayo kwi-classic Tower yaseLondon umsebenzi. Ngexesha le-paradigm, abathathi-nxaxheba bacelwa ukuba babonise iibhola ezihambayo phakathi kweesethi zeetyhubhu eziboniswe kwisikrini ukufanisa umzekelo oboniswe phezulu kwesikrini. Ekusombululeni iphazili ngengqondo, bayacelwa ukuba bachukumise inani elincinci leentshukumo abakholelwa ukuba iphazili iyakuyithatha kuluhlu lwamanani ukusuka ku-1-9 eboniswe ezantsi kwesikrini. Umlinganiselo ekujoliswe kuwo wolu hlalutyo yayilinani leephazili ezisonjululwe kukhetho lokuqala ngexesha lomsebenzi.
2.4. Uhlalutyo lwesatisatisti
Idemografi, iklinikhi, kunye neempawu zengqondo zezifundo ze-PSB zifaniswa nolawulo olusebenzisa i-t-mvavanyo ezimeleyo yezinto eziguquguqukayo eziqhubekayo (uvavanyo lwe-t-test, okanye uvavanyo lwe-Welsh t-uvavanyo lwemilinganiselo engalinganiyo phakathi kwamaqela), kunye ne-chi-square (okanye i-Fisher's). Uvavanyo oluchanekileyo lobungakanani beeseli ezincinci) kwiintlobo ezahlukeneyo zecategorical. Onke amaxabiso e-p achazwe anemisila emibini, engalungiswanga. Ukubaluleka kwachazwa njenge p≤.05. Akukho lungiso lwenziwayo ngenxa yophindaphindo ngenxa yobume bophononongo lophononongo. Ukulungiswa kwe-Bonferroni bekuya kuba kukugcinwa ngokugqithiseleyo kolu hlalutyo lokuhlola (jonga i-26). Ngomlinganiselo wesampulu efunyenwe kolu phononongo, uphando lune- ~ 80% yamandla okubona umahluko obonakalayo phakathi kwamaqela kwi-variable variable, kuthathwe ubungakanani besiphumo esiphakathi 0.4, kunye ne-alpha = 0.05 (okt ngaphandle kokulungiswa kwe-Bonferroni). Ukuba ukulungiswa kwe-Bonferroni kusetyenziswe, uphononongo lwaluza kuba namandla <40% okufumanisa ukuhlukana kweqela elinjalo kumlinganiselo onikeziweyo, okubangelwa umngcipheko ophezulu ongamkelekanga wephutha lohlobo lwe-II.
Ubungakanani besiphumo nabo babalwe. Ubungakanani beempembelelo zokulingana kweeseti zokwahlukana kwentsingiselo phakathi kwamaqela zichazwe ngokwemiqathango ye-Cohen effect size index ("d") okanye ngokusekelwe kwiimvavanyo zokulingana kwe-2 okanye ngaphezulu kokusasazwa kwisethi ye-2 yeendidi ezininzi (Χ2 iimvavanyo) (“w”). I-d ye-.2 ithathwa njengobungakanani besiphumo esincinci, .5 siphakathi, kwaye .8 inkulu; i-aw ye-.1 ithathwa njengencinci, .3 iphakathi, kwaye .5 inkulu (Cohen, 1988).
3. Iziphumo
Bebonke ngama-54 (11%) abathathi-nxaxheba abachaze iPSB yangoku. Uhlalutyo lubonise ukuba iqela le-PSB lalikhulile kakhulu (p = .005), lichaze iminyaka yangaphambili yokuqala yamava okwabelana ngesondo (p = .031) kunye nokusetyenziswa kotywala (p <.001), kwaye yayinesalathisi esiphezulu somzimba ( p=.001).
Kumanyathelo okuzixela, iqela le-PSB libike amanqaku aphezulu kakhulu kuyo yomithathu imilinganiselo engaphantsi ye-BIS (ingqwalasela: p = .008; motor: p = .002; non-planning: p = .002), ukuzithoba ngokubanzi -i-esteem (p <.001), i-dysregulation enkulu yeemvakalelo (p = 0.002), kunye nomgangatho ophantsi wobomi (p <.001). Ukuhambelana kwangaphakathi kwezikali kwakukuhle (i-alpha kaCronbach 0.79 okanye ngaphezulu).
Ngokweziphumo zokuqonda, iqela le-PSB ngokuchasene nolawulo libonise inkumbulo embi kakhulu yendawo yonke yokusebenza (p=.005), isicwangciso sememori yendawo yokusebenza (p=.028), inhibition yemoto (p=.048), kunye nocwangciso lwesigqeba (p= .028). Iqela le-PSB kwakhona babheje umlinganiselo omkhulu wamanqaku abo ewonke ngexesha le-CGT echasene nolawulo (p = .008).
I-alphas yeCronbach yemilinganiselo ephambili esetyenziswe kwisifundo yayimi ngolu hlobo lulandelayo: Barratt alpha = 0.80, DERS = 0.79,
Amazinga okugula nawo ahluke kakhulu phakathi kwala maqela mabini. Iqela le-PSB lichaze izinga eliphezulu lokuxhaphaka kwezifo zengqondo ezininzi eziqhelekileyo, kubandakanywa ingxaki enkulu yokudakumba (p <.001), ukuzibulala (p = .038), i-agoraphobia (p = .010), ukuphazamiseka kokusetyenziswa kotywala (p <.001), kunye nokuphazamiseka kobuntu obuchasene noluntu (p=.001). Iqela le-PSB likwachaze amazinga amakhulu okuphazamiseka kokungcakaza (p = .018), kunye nokuphazamiseka kokutya kakhulu (p = .034), ezithathwa njengeziphazamiso zokulawula impembelelo.
4. Ingxoxo
Kuhlalutyo lwangoku, abathathi-nxaxheba be-54 (11%) babike i-PSB yangoku. Oku kuxhaphaka, njengoko kulindelekile, kuphezulu kunamazinga okuxhaphaka okuxelwe ngokuziphatha okunyanzelekileyo ngokwesondo kubantu abadala abancinci (Imnyama et al., 1997; I-Derbyshire kunye neGrant, 2015). Olu hlahlelo lukwabonise ukuba i-PSB yayinxulunyaniswa nomgangatho ombi wobomi, ukuzithemba okuphantsi, kunye namazinga aphezulu e-comorbidities kuzo zonke iziphazamiso ezininzi. Ngaphaya koko, iqela le-PSB libonise iintsilelo kuzo zonke iindawo ezininzi ze-neurocognitive, kubandakanywa inhibition yemoto, inkumbulo yokusebenza yendawo, kunye nenkalo yokwenza izigqibo.
Esinye isiphumo esiphawulekayo kolu hlalutyo kukuba i-PSB ibonisa unxulumano olubalulekileyo kunye nenani lezinto ezinobungozi zeklinikhi, kubandakanya ukuzithemba okuphantsi, ukuhla komgangatho wobomi, i-BMI ephakamileyo, kunye namazinga aphezulu e-comorbidity kwiziphazamiso ezininzi. Ingcaciso enokubakho kulo mbutho kukuba i-PSB yeyona ngxaki iphambili apho ezi ezinye iingxaki zandisa khona. Uphando lwangaphambili kubantu abafanayo luqaphele ukuba iimpawu ezinje ngehlazo zixhaphakile phakathi kwabaguli abanengxaki yokuziphatha ngokwesondo (UDhuffar kunye noGriffiths, ngo-2014; Reid et al., 2014). Ezi ziphumo ziyangqinelana nedatha ekhoyo, njengoko kunokwenzeka ukuba abantu abaziva bebodwa kwaye bebekwe ibala banokuthi bavumele ukuzithemba okuphantsi kunye nomgangatho wobomi, njengoko ezi mpawu zinokuthungelana nobudlelwane phakathi kwabantu. Ke, kunokwenzeka ukuba i-PSB ibangele inkitha yeengxaki zesibini, ukusukela kukuxhomekeka etywaleni kunye nokudakumba ukuya ekuwohlokeni komgangatho wobomi kunye nokuzithemba.. Olu phawu luya kubonisa ukuba kunokwenzeka ukunciphisa iimpawu zesibini ezifana nokudakumba kunye nokusetyenziswa kotywala ngokujongana neengxaki ze-PSB ngokuthe ngqo ngexesha lonyango.
Ngakolunye uhlangothi, kunokwenzeka ukuba i-PSB ifanele ibonakaliswe njengendlela yokujongana neengxaki ezenzekayo ekuphenduleni inkitha yezinye iingxaki ezichongiweyo kolu hlalutyo, ezifana nokusetyenziswa kotywala okanye ukudakumba. Ngokwale mbono, endaweni yokubonakalisa i-PSB njengeyona nto iphambili ye-pathology eyenza iingxaki ezongezelelweyo, inokuthathwa njengendlela yokumelana neemvakalelo ezingathandekiyo eziqhubekayo kunye neemvakalelo, ezinjengezo zinokukhapha ukudakumba. Olu phawu luhambelana nemiba emininzi yeziphumo ezikhoyo, ngakumbi inqanaba elikhulu loxinzelelo lweemvakalelo oluchongiweyo kwiqela le-PSB.. Enye into enokwenzeka kukuba abantu abanolawulo olulambathayo ngokweemvakalelo banokufumana amaxesha okudakumba, apho bayasokola ukulawula iingxaki zabo. Njengempendulo kobu bunzima, banokulandela ezinye iindlela zokuqinisa umoya wabo, ezinokuthatha uhlobo lwe-PSB okanye ezinye iindlela zokuziphatha, ezinjengotywala, enye into eqhelekileyo phakathi kweqela le-PSB. Oku kuhambelana nezifundo zangaphambili malunga nokuziphatha okungahambi kakuhle ngokwesondo, ezibonise umdla omkhulu ngokwesondo kumazwe oxinzelelo okanye ukuxhalaba, kunye neninzi ebonisa impendulo ekhethekileyo phakathi kwabo babandakanyeka kwiindlela ezinyanzelekileyo zokuziphatha ngokwesondo. (IBancroft kunye neVukadinovic, i-2004; UGrov et al., 2010; ULykins et al., ngo-2006). Ukusuka kulo mbono, kunokuba uchonge nayiphi na ingxaki yeklinikhi njengendawo ekugxilwe kuyo kunyango, kunokuba ngcono ukunceda izigulana ukulawula iingxaki ngolawulo lweemvakalelo, ngokufanelekileyo ukubonelela ngeendlela zokuhlangabezana nezingathembeli kwimisebenzi kunye nokuziphatha okuye kwaba yingxaki kwixesha elidlulileyo. , njengePSB.
Ngelixa zombini ezi zinto zinokwenzeka zibonelela ngengcaciso enokubakho yeziphumo ezikhoyo kusetyenziswa izikhokelo ezahlukeneyo zesizathu, kuyenzeka ukuba iimpawu zekliniki ezichongiweyo kwiqela le-PSB ngokwenene zisisiphumo sokuguquguquka kwenqanaba eliphezulu okukhokelela kuzo zombini i-PSB kunye nezinye iimpawu zeklinikhi. . Enye into enokuthi izalise le ndima inokuba kukunqongophala kwe-neurocognitive okuchongiweyo kwiqela le-PSB, ngakumbi ezo zinxulumene nenkumbulo yokusebenza, ukungxamiseka/ulawulo lwempembelelo, kunye nokwenza izigqibo. Ukusuka kolu phawu, kunokwenzeka ukulandelela iingxaki ezibonakala kwi-PSB kunye neempawu ezongezelelweyo zeklinikhi, ezifana nokuphazamiseka ngokweemvakalelo, kwiintsilelo ezithile zengqondo.. Imiba enxulumene nokungxamiseka inokuphawuleka ngakumbi, njengoko zombini i-BIS kunye ne-SSRT zibonise ukuba iqela le-PSB lalingxamiseke ngakumbi kunabanye abathathi-nxaxheba. Le ngcaciso iphinda ifane nezinye iziphumo ezivela kuhlalutyo, ezifana nobudala bokuqala bokuziphatha ngokwesondo kunye nokusetyenziswa kotywala, ebonisa ukuba iingxaki zokungashukumi zingabonakala ukususela kwiminyaka yobudala kunokuqala kwe-PSB kunye nezinye iingxaki.
Ngokwahlula i-neurocognition njengophawu olusembindini wokuchonga abathathi-nxaxheba kwi-PSB, iziphumo zangoku zinokucebisa ukuba ukubonakaliswa kwale miba ye-neurocognitive kukhokelela kubunzima bokulawulwa ngokweemvakalelo okuxelwe ngaphambili, njengoko abantu abane-PSB banokuzabalaza neenkqubo eziyimfuneko ukuphuhlisa ukulungelelaniswa kunye iindlela ezisebenzayo zokuhlangabezana. Ngaphezu koko, le miba ngokungxama inokuthi ichaphazele amandla okulamla impembelelo yemoto ekuziphatheni ngokwesondo, ngokuhambelana nokusilela kuthintelo lwemoto olubonwa kwi-SSRT.. Ukuba iingxaki zengqondo ezichongiweyo kolu hlalutyo ziyinkalo ephambili ye-PSB, oku kunokuba neziphumo eziphawulekayo zeklinikhi. Endaweni yokusebenzela ukunyanga iingxaki ezinxulumene nokuba yi-PSB okanye iingxaki ze-comorbid, kunokusebenza ngakumbi ukulungisa iingxaki ezisisiseko kwi-neurocognition. Ukuze ulungelelanise unyango ngokuthe ngqo kwiimfuno zezigulane ezine-PSB, oogqirha banokukwazi ukuphuhlisa iindlela zonyango ezigxininisa izicwangciso zokulamla ukungahambi kakuhle, kunye nokuphuhlisa iindlela ezihambelanayo zokuhlangabezana nokulawula ukuxhatshazwa ngokweemvakalelo.
Kwakukho, nangona kunjalo, imida emininzi kuhlalutyo lwangoku. Omnye umba kukuba isampuli ibandakanya abantu abadala kuphela. Ngaloo ndlela, kunokwenzeka ukuba olu hlalutyo aluzange lubambe imiba yokuqonda kunye nemibutho yeklinikhi ebonakala kuphela emva kokugula okukhulu. Ukongezelela, uphononongo lwangoku aluzange lubandakanye umlinganiselo wobungqongqo (asazi ukuba akukho milinganiselo yobukhali kule nqanaba le-subsyndromal yokuziphatha ngokwesondo) (I-Reid, 2015), ngoko kwakungenakwenzeka ukuvavanya indima ye-neurocognition kubunzima be-PSB. Ngenxa yolu thintelo, uhlalutyo alukwazanga ukugqiba ukuba ezi zinto zibonise imibutho ebalulekileyo kunye nayo nayiphi na imiba ethile ye-PSB okanye ubunzima obupheleleyo beempawu ze-PSB. Asizange silungise uthelekiso oluninzi njengoko ubungakanani besampulu babunganelanga ukwenza oku ngaphandle kokulahlekelwa okungamkelekanga kwamandla ezibalo. Ke ngoko, kuya kubaluleka kwizifundo zexesha elizayo ukuzama ukuphinda-phinda ezi ziphumo kwisampulu enkulu. Ubungakanani beeseli zezinye iinkcukacha zecandelo bezincinci kwaye isilumkiso siyafuneka ekutolikweni. Umzekelo, ezinye iziphazamiso zolawulo lwempembelelo zazingaqhelekanga kumaqela omabini, kwaye ke ngoko amandla eenkcukacha-manani okufumanisa iyantlukwano yeqela ebenokusikelwa umda.
Nangona uhlalutyo lwangoku alukwazi ukusombulula isalathiso se-causality kwezi zinto, lugxininisa iingxaki ezichaphazela izigulane ezine-PSB. TIziphumo zophando zibonisa ukuba abantu abane-PSB bayasokola ngenani lemiba, kubandakanywa amazinga aphezulu okugula, ukungasebenzi kakuhle ngokweemvakalelo, kunye nokukhetha intsilelo ye-neurocognitive. Ngelixa uninzi lwabantu lukwazi ukujongana nokuziphatha ngokwesondo ngendlela enempilo, eyakhayo, ezi ngxaki zibonisa ukuba kwabo basokolayo ukulawula ezi ndlela zokuziphatha, iingxaki ezinxulumeneyo zinokuchaphazela umgangatho wobomi naziphi na ezinye iinkalo ezininzi zempilo. Ke ngoko, i-PSB inokuba yinto ebalulekileyo yoqwalaselo koogqirha abasebenza nabantu abancinci abancinci, begxininisa ngakumbi ukubaluleka kokuvavanywa kweengxaki zokuziphatha ngokwesondo kwiminyaka emininzi kunye namaqela esini. Uphando lwexesha elizayo oluvavanya ukubaluleka kwe-neurocognition kunyango lunokuba luncedo kakhulu, njengoko kunokwenzeka ukuba abezonyango baphumeze uvavanyo olungcono kunye neendlela zonyango ezisekelwe kwiprofayili eyodwa ye-neurocognitive ebonakala kwizigulane ezine-PSB.. Ngelixa idatha kwi-PSB ihlala ilinganiselwe, iziphumo zangoku zibalaselisa ukubaluleka kokwandisa kunye nokucacisa ukuqonda kwethu i-neurocognition kunye nenkcazo yekliniki kubantu abanengxaki ye-PSB.
Imibulelo
Olu phando luxhaswe yinkxaso-mali evela kwiZiko leSizwe lokuGala ngokuZiphendulela (amaZiko okuGqwesa kwiSibonelelo soPhando lokuNgcakaza).
Imihlathi
Iimbambano zomdla
UGqr Grant uye wafumana izibonelelo zophando kwiZiko leSizwe loKudlala ngoXanduva, i-American Foundation for Suicide Prevention, Brainsway, and Forest, Takeda, kunye nePsyadon Pharmaceuticals. Ufumana imbuyekezo yonyaka kwiSpringer Publishing ngokusebenza njengoMhleli oMkhulu weJenali yezifundo zoNgcakazo kwaye ufumene iiroyalties kwiOxford University Press, American Psychiatric Publishing, Inc., Norton Press, McGraw Hill, kunye neJohns Hopkins University Press. Ukuthatha inxaxheba kukaGqr Chamberlain kolu phando kwaxhaswa ngemali yiAcademy of Medical Sciences (UK). UGqr Chamberlain ucebisana neCambridge Cognition. UMnu. Leppink kunye noNksz Redden babika akukho budlelwane bezemali kunye nomdla wezorhwebo.
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