Ukubheja kocansi kwe-intanethi kuthathwa nge-Naltrexone (i-2008)

Amazwana: I-Naltrexone ngumphikisi we-opioid receptor osetshenziswa ngokuyinhloko ekuphathweni kokuncika kotshwala nokuncika kwe-opioid. Lo mbhalo unezincazelo ezinhle kakhulu zenqubo yokulutha nokulutha kokuziphatha.

nguMichael Bostwick, MD noJeffrey A. Bucci, MD

i-doi: 10.4065 / 83.2.226

Ukuqhubeka Komtholampilo wase-Mayo, ngoFebhuwari 2008 vol. I-83 cha. I-2 226-230

Bheka online

Uhlaka Lwezihloko

  1. UMBIKO WEKHAYA
  2. UKUKHULUMA
  3. ISIPHETHO

Ukungasebenzi kahle kwesikhungo semivuzo yobuchopho kuyaqondakala ngokuya phambili njengokuziphatha konke okuluthayo. Yenziwe ngamasenti we-mesolimbic incentive salience circry, isikhungo semivuzo silawula konke ukuziphatha lapho ukugqugquzela kunendima ebalulekile, kufaka phakathi ukuthola ukudla, ukukhulisa abancane nokwenza ucansi. Ukulimaza ukusebenza okujwayelekile, imisebenzi eyisisekelo yokusinda ingabonakala ibalulekile lapho iphonswa inselelo ukuheha kwezinto eziluthayo noma isimilo. I-Dopamine iyi-neurotransmitter eqhuba ngokuziphatha okujwayelekile nokuluthayo. Amanye ama-neurotransmitters alinganisa inani le-dopamine ekhishwe ngokuphendula umfutho, ngobunono obunqunywa ngamandla we-pulse ye-dopamine. Ama-opiates (kungaba endogenous noma exogenous) abonisa labo modulators. Inikezwe ukwelashwa utshwala, i-naltrexone ivimba amandla ama-opiates ukukhulisa ukukhishwa kwe-dopamine. Le ndatshana ibukeza indlela yokwenza kwe-naltrexone esikhungweni semivuzo futhi ichaza ukusetshenziswa kwenoveli kwe-naltrexone ekucindezeleni ukulutheka okucindezelayo nokulimazayo kwezithombe zobulili ezingcolile ze-Intanethi.

Gaba (γ-aminobutyric acid), I-ISC (isisusa sokujikeleza komzimba), MAB (indlela yokuziphatha eguqukayo), MRE (umcimbi ofanelekile), I-NAc (i-nucleus accumbens), PFC (i-prefrontal cortex), I-VTA (indawo ye-ventral tegmental)

abstract

UNjengoba sikhungathekiswa umlutha, isikhungo somvuzo se-mesolimbic sisebenza ngokuzinikela ukuze sikhuthaze izimilo ezizuzisa bobabili nezinhlobo zabo. Ukusuka ekujuleni kwenqubo yobuchopho, kuxhumanisa ukukhuthaza okuningana ukufuna izidingo zokusinda njengokuondla, ukunakekela abasha, kanye nokuxhumana ngocansi.1 Njengoba umlutha uthuthuka, eminye imivuzo engasizakali kangako ifakwa kumjikelezo wokukhuthazeka wokuqina (ISC) kulimaza izimilo ezibalulekile ekusindeni. Ngokuya ngokwengeziwe, odokotela bahlangana neziguli ezithandekayo ekuziphatheni okuluthayo.

Njengoba i-neuroscience iqhubeka nokucacisa izisekelo zokulutha komlutha, kuyacaca ngokusobala ukuthi isikhungo somvuzo esingasebenzi kahle sijwayelekile kuzo zonke izindlela zokuziphatha okuphoqelekile, noma ngabe ukusebenzisa kabi izidakamizwa, ukudla ngokweqile, ukugembula noma ukwenza ucansi ngokweqile.2, 3 Yize ukuziphatha kocansi okuphoqayo kungafundelwa kancane,4 kunengqondo ukuthi ama-pharmacotherapies asebenza ngokuphumelelayo kuhlobo lunye lokuziphatha okuluthayo angaphinde alwe nezinye izinhlobo. Ukuziphatha ngakunye kunezimbangela ezithile nokubonakaliswa, kepha indlela yokugcina evamile yabo bonke ifaka ukushintshaniswa kwe-neurochemical yomsebenzi we-dopaminergic ngama-receptors endaweni ye-ventral tegmental endaweni (VTA).3, 5

Ngakho-ke i-VTA isibe yinqophamithi yemithi emisha yokulutha, ne-naltrexone, i-opiate receptor blocker okwamanje evunyelwe yi-Food and Drug Administration kuphela ekwelashweni kotshwala, iyisibonelo somuthi onamandla wokulwa nezindlela zokuziphatha eziningi eziluthayo.6 Ngokuvimbela amandla ama-opioid endogen ukuze abangele ukukhishwa kwe-dopamine ekuphenduleni umklomelo, i-naltrexone isiza ukucisha amandla aluthayo alowo mvuzo. Sethula icala le-naltrexone enqunyiwe ukunciphisa ukusetshenziswa kwe-Intanethi okuphoqelela ukuzanelisa ngokocansi. Amahora isiguli esichithe ukuphishekela ukukhuthaza i-cyber kwehla, futhi ukusebenza kwaso ngokwengqondo nangokwengqondo kuthuthuke kakhulu ngokusetshenziswa kwe-naltrexone.

UMBIKO WEKHAYA

Isigungu Sokuhlolwa Kwezikhungo Zomtholampilo saseMayo sikuvumile ukubikwa kwaleli cala.

Isiguli sesilisa saqala ukwethula kudokotela wezifo zengqondo (i-JMB) eneminyaka engama-24, ngencazelo ethi, “Ngilapha ukulutha ucansi. Kungidlile impilo yami yonke. ” Wesaba ukulahlekelwa womabili umshado nomsebenzi uma ehluleka ukuzibamba ekhathazeka ngokweqile ngezithombe zobulili ezingcolile ze-Intanethi. Wayechitha amahora amaningi usuku ngalunye exoxa ku-inthanethi, ezibandakanya ngezikhathi ezandisiwe zokushaya indlwabu, futhi ngezikhathi ezithile ehlangana nabantu abaxhumana nabo nge-cyber ngokocansi okuzenzekelayo, okungavikelekile.

Eminyakeni elandelayo ye-7, isiguli sehle kaningi ngaphandle nangaphandle kokwelashwa. Wazama izithiyo zokulwa nabasebenzi, iqembu kanye nodokotela abelulekela ngokwengqondo, i-Anuric Adicts Anonymous, kanye nokwelulekwa okwenziwa ngabelusi, kepha kuze kube yilapho kuvivinywa i-naltrexone lapho waqinisa khona impumelelo ekugwemeni ukusetshenziswa kwe-inthanethi okuphoqayo. Lapho eyeka i-naltrexone, izifiso zakhe zabuya. Lapho ethatha i-naltrexone futhi, baphinda bancipha.

Kusukela eminyakeni yobudala eyi-10, ngemuva kokuthola inqwaba kamkhulu wakhe "omagazini abangcolile," isiguli besinesifiso esinamandla sokubuka izithombe zobulili ezingcolile. Lapho esanda kweva eminyakeni eyishumi nambili, wazibandakanya ocansini ngocingo esebenzisa amakhadi esikweletu noxhumano lwezingcingo ezingama-900 oluchungechunge. Ezichaza njengomuntu oshaya indlwabu ophoqayo, ubhalise nasezinkolelweni zobuKristu ezilandelanayo. Ekhathazekile ngokokuziphatha kwakhe, wathi izenzo zakhe zocansi zivela "okungenani ngokwengxenye" ​​"kumathonya amabi avela kudeveli." Ngemuva kwesikole samabanga aphezulu, wathatha umsebenzi wokuthengisa wokukhangisa owawubandakanya ukuhamba ubusuku bonke. Kokubili emsebenzini nasohambweni, wayengasebenzisi ikhompyutha yakhe hhayi kuphela kwimisebenzi ehlobene nebhizinisi kepha futhi "nokuhamba ngezinyawo" online (isb., Ukufuna umsebenzi ojabulisa ezocansi). Uhambo lwebhizinisi luzoba namahora amaningi okushaya indlwabu online kanye nokunxenxa okukhulu ukuvakashela amaklabhu ama-strip. Ngokuthola i-inthanethi kwamahora angama-24 ehhovisi lakhe, wayejwayele ukuhlanganyela ubusuku bonke ku-inthanethi. Wakhula ngokushesha ukubekezelelana, wayeka iseshini kuphela lapho ephoqelelwa ukukhathala. Mayelana nokulutha kwakhe ngokocansi, uthe, “Kwakungumgodi wesihogo. Angizange ngigculiseke, kodwa ngaya khona vele. ”

Ecabanga ukuthi isiguli singahle siphathwe yinkinga eguquguqukayo yokucindezela, udokotela wezifo zengqondo anqume i-sertraline ngomthamo womlomo we-100 mg / d. Ngenkathi isimo sesiguli nokuzethemba kuthuthukile futhi ukucasuka kwehla, ukwehla kokuqala kwezifiso zobulili akuzange kuqiniswe. Uyeke ukuthatha i-sertraline futhi wamisa ubudlelwano bakhe nodokotela wezifo zengqondo unyaka.

Lapho isiguli ekugcineni sibuyela ekwelashweni, sasichitha amahora angama-8 ngosuku ku-inthanethi, silishaya indlwabu kuze kube yilapho ukucasuka kwezicubu noma ukukhathala kuphele amaseshini. Wayene-“hook-up” eminingana exhumana nabantu be-Intanethi ababebandakanya ukuya ocansini okungavikelekile futhi wayengasasondelani nonkosikazi wakhe ngokwesaba ukumdlulisela isifo esibuhlungu. Ubelahlekelwe yimisebenzi eminingana ngenxa yokukhiqiza okungekuhle kusukela ngesikhathi asichitha ekuphokopheleni ukuphoqwa kwakhe ngenxa yezindleko zomsebenzi. Ubuye wachaza ubumnandi obukhulu obuvela ocansini uqobo kodwa wazisola ngokulingana ngokuhluleka kwakhe ukuzibamba. Lapho i-sertraline therapy ibuyiselwa, imizwa yakhe yathuthuka, kepha wayesazizwa 'engenamandla okumelana nezifiso' futhi wayeka ukwelashwa.

Lapho isiguli siphinde savela ngemuva kwenye i-hiatus yeminyaka emibili, ukucindezeleka komshado okwengeziwe, nomunye umsebenzi olahlekile, udokotela wezifo zengqondo uphakamise ukufaka i-naltrexone ekwelashweni kwe-sertraline. (I-sertraline manje yabonakala iyadingeka ekucindezelekeni okuqhubekayo.) Kungakapheli isonto yokwelashwa nge-2 mg / d ye-naltrexone yomlomo, isiguli sabika “umehluko olinganisekayo ezifisweni zobulili. Bengingacindezelwa ngaso sonke isikhathi. Kwakufana nepharadesi. ” Umuzwa wakhe "wobumnandi obukhulu" ngezikhathi ze-Intanethi ubunciphile kakhulu, futhi wathola ikhono lokumelana kunokuvumela izifiso. Kuze kube yilapho umthamo we-naltrexone ufinyelela ku-50 mg / d lapho abike khona ukulawula okuphelele kwezifiso zakhe. Lapho ezama yedwa ukuthoba umuthi, wezwa ukuthi ulahlekelwe ukusebenza kwawo ngo-150 / d. Uye ku-inthanethi ukuzihlola, wahlangana nongaba nobulili, futhi wafinyelela emotweni yakhe ngaphambi kokucabanga kangcono ngokuhlangana nabantu. Ngalesi sikhathi, ukubuyela ku-25 mg we-naltrexone kwakwanele ukunciphisa izifiso zakhe zocansi.

Eminyakeni engaphezu kwengu-3 ethole i-sertraline ne-naltrexone, ubeselulame cishe ngokuphelele kwizimpawu zokucindezeleka nasekusebenziseni i-Intanethi ngokweqile, njengoba yena ngokwakhe ephawulile: “Ngezinye izikhathi ngiyashelela, kodwa angikuthwali kuze kube manje, futhi Anginaso isifiso sokuhlangana nanoma ngubani. ” Njengenzuzo eyengeziwe, uthole ukuthi ukuzitika ngophuzo kulahlekile. Ubengaphuzi utshwala eminyakeni emithathu futhi ukwamukele ukuthi “akakwazi ukuphuza ngaphandle kokuphuza ngokweqile.” Uhlala eshadile, yize kungemnandi neze. Ugcine umsebenzi ofanayo wobuchwepheshe iminyaka engaphezu kwengu-3 futhi uyaziqhenya ngempumelelo yakhe yokuqashwa.

UKUKHULUMA

Ngenhloso yale ngxoxo, umlutha uchazwa njengokuziphatha okuphoqayo okuqhubeka naphezu kwemiphumela emibi emibi yokusebenza komuntu siqu, yenhlalo, noma yomsebenzi.7 Ukuziphatha okunjalo kufaka ukusetshenziswa kabi kwezidakamizwa, ukudla ngokweqile, ukudla okuvinjelwe, ukuzilulaza nokugembula ngokweqile.6 Zingaba futhi nokuphoqelelwa ngokocansi ngokuqondile, kufaka phakathi imisebenzi noma imicabango esicabanga ukuthi le ndaba yokusebenzisa i-Intanethi ngokweqile imele.8 Lo mbono wokulutha uhambisana nokwakheka kokuphazamiseka kwengqondo, okucabanga ukuthi konke ukuxilonga umlutha “kungukuphazamiseka okuqhutshwa yisisusa” nokuziphatha okucindezelayo emgogodleni wabo.3, 6 Ukwanda kokuqonda kwesisekelo se-neural sokulutha kuqinisa lo mbono. Hyman5 ubiza umlutha "ukuthathwa kwemininingwane yokufunda yezindlela zemvelo zokufunda nokukhumbula ukuthi ngaphansi kwezimo ezijwayelekile zisebenza ekwakheni izimo zokusinda ezihlobene nokuphishekela imivuzo nezindlela zokubikezela ezibikezayo." Lokhu ngukujikeleza kwe-neural yokuziphatha okushukumisayo okuguqukayo (MAB) - Ukuziphatha okuqondiswe emgomweni ukufezekisa izinhloso ezidingekayo zemvelo-lokho kumlutha.

Ngezifiso ezihlukile kusuka ezithombeni zesiko ezixakile nezizwisisayo kuya kumavidiyo nezingosi zengevu, i-Intanethi ingumthombo okhulayo wokungathandeki kocansi nokukhuthaza abantu abaningi okuthiwa ngabantu abajwayelekile, ukucatshangelwa kokuziphatha — noma kwencazelo — yezithombe zocansi eceleni. Ukusetshenziswa okuvamile kwento ethile noma umsebenzi wokwanelisa komuntu kuqala nini? Ngokugxila kwakhe nokusebenzisa ngokweqile kanye nemiphumela ebabazekayo yokusebenzelana nabanye abantu emsebenzini wakhe, isiguli esichazwe kulo mbiko siyisibonelo senkambo yokulutha.

I-MAB inezingxenye ezilandelanayo ze-2.9 Esokuqala yisikhuthazo esisebenzayo eshukunyiswa izinhlangano ezifundile zesisusa sangaphandle. Lokho kugqugquzela kufaka owesibili: indlela yokuziphatha eqondiswe emgomweni — yini uStahl10 kubiza “indawo ephakeme yemvelo.” Ama-MAB ayisisekelo afaka imizamo yemvelo yokuthola ukudla, amanzi, ukuxhumana ngocansi nendawo yokukhosela. Ama-MAB amaningi ayinkimbinkimbi ngokumbondelana kwengqondo afaka ukufuna ukhulisa ubungani, isimo senhlalo, noma impumelelo yomsebenzi.

I-neural network mediating expression ye-MAB (isikhungo somvuzo) ibizwa nangokuthi i-ISC, ngoba inani elinikezwe isikhuthazo (ubukhulu baso) linquma isisusa (ukuqina kwendlela yokuziphatha ephendukayo yokuvuselela).5, 11 Izakhi zomjikelezo we-Incenceveity saliry zifaka i-VTA, i-nucleus accumbens (NAc), i-preortal cortex (PFC), ne-amygdala, ngayinye inendima yayo ethile ekubumbeni i-MAB (Figure). Umsebenzi ojwayelekile we-ISC kuzo zombili izindlela zokuziphatha zemvelo nezomlutha kukhululwa kwe-dopamine ku-NAc-okubizwa ngokuthi yi-priming-ukuphendula ukuthambekela kwe-VTA.3, 5 Ukuqagelwa kwe-dopaminergic kusuka ku-VTA kuya ku-NAc yizici ezibalulekile ze-ISC ezisebenzisana nokuqagela kwe-glutamatergic phakathi kwazo zonke izingxenye ze-ISC. I-amygdala ne-PFC zinikeza okokufaka kokulinganisa.5 I-amygdala ibeka indlovukazi engathandeki noma ethokozisayo-ithoni esebenzayo-esivuselelweni, futhi iPFC inquma ubungako nokulinganisela kwempendulo yokuziphatha.9, 12 Lo mjikelezo ojabulisa izinzuzo zombili uxwayisa umzimba lapho kuvela isivuseleli senoveli futhi ukhumbula izinhlangano ezifundile lapho incwadi engasasebenzi inoveli kodwa iphinda ivuselele isisusa esifanelekile.5, 9, 12

Umdwebo wokulutha

 

 

Esithombeni esinqamulelayo sobuchopho, ama-incentive salience circry (ISC) aqukethe indawo ye-ventral tegmental area (VTA) ekhombisa i-nucleus accumbens (NAc). I-NAc ithola okokufaka okuguqukayo kusuka ku-prefrontal cortex (PFC), amygdala (A), ne-hippocampus (HC). Ibhokisi A libonisa izithombe zobulili ezingcolile ze-Intanethi ezibangela ukukhishwa kwama-opioid endogenous athuthukisa ukukhishwa kwe-dopamine (DA) ku-ISC zombili ngqo nangokungaqondile.2 I-Opiates yandisa isenzo se-DA ngqo ngokusebenzisa i-guanine nucleotide-binding protein-coupled opioid receptors ku-NAc. Zisebenza ngokungaqondile kuma-interneuron ngokubopha kuma-opioid receptors aphazamisa ukukhishwa kwe-x -aminobutyric acid (GABA). Ingasacindezelwe yi-GABA, i-VTA ithumela i-NAc ukuthululwa kwe-DA. Ubungqingili bezithombe zobulili ezingcolile buyanda. Ibhokisi B likhombisa ukuthi i-naltrexone ivimba kanjani ama-NAc ne-interneuron opioid receptors. Isikhuthazo seDA asisathuthukiswa, kungaba ngqo noma ngokungaqondile, okuholela ekunciphiseni ubuqili bezithombe zocansi. (Ishintshwe ngemvume yakwaMacmillan Publishers Ltd: Nature Neuroscience, 2 copyright 2005.)

I-ISC ayisebenzi ngokwahlukana. Ucwaningo olwengeziwe lwezilwane libonisa i-pharmacopoeia yama-neurochemicals evela kuyo yonke i-cortex kanye nezifunda ezingaphansi kwe-subcortical eziguqula ukusebenza kwe-ISC, kufaka phakathi i-opoodergic, i-nicotinic, i-cannabinoid, nezinye izinhlanganisela.11, 13 Izindlela ze-Opiodergic ze-ISC ziqukethe ama-receptors ku-NAc uqobo aphazamisa ngqo ukukhishwa kwe-dopamine2 kanye nama-receptors we-μ-opiate kuma-interneurons adlulisa noma afihlelela i-γ-aminobutyric acid (GABA) futhi lokho kuvamise ukukhishwa kwe-dopamine kusuka ku-VTA dopaminergic neurons.1, 5, 7, 14 Lapho noma opiates opoates (endorphins) noma ama-opiates angaphandle (i-morphine kanye nezinto eziphuma kuzo) ezibopha kulawa ma-receptors, ukukhishwa kwe-GABA kuyancipha. Ama-Opiates avimbela ama-interneurons ukuthi enze umsebenzi wawo ojwayelekile wokucindezela, futhi amazinga e-dopamine akhuphuka ku-VTA.3

 

Zonke izinto eziluthayo ngokomzimba zibonakala ziphumela emsebenzini we-ISC oyiphutha. Imvamisa ezingeni lamaselula, umcimbi ofanelekile oshukumisayo (i-MRE), njengokulamba noma ukuvuswa kocansi, obangela ukukhululwa kwe-opoate endo native obangela amazinga e-dopamine akhuphuke. I-ISC iphendula nge-MAB nezinguquko ekugcineni zamaselula ezingena ezinhlanganweni ezifundwe isikhathi eside nomcimbi. Lezi zinguquko ze-neuroplastic zidala ukuphendula okusheshayo kokuziphatha lapho umcimbi uphinda uvela, futhi, ngokuvamisile, ukuvezwa okuphindwe kabili kwe-MRE futhi ekugcineni kucime ukukhishwa kwe-VTA dopamine. Ukukhishwa kwe-Dopamine akusadingeki ukuze umzimba wenze i-MAB efanelekile ekusindeni.

Izidakamizwa eziluthayo noma imisebenzi zithinta i-ISC ngokuhlukile kuma-MREs lapho ukudalulwa okuphindaphindiwe kungacimi ukukhishwa kwe-dopamine.9 Ngaphezu kwalokho, izidakamizwa zingalingana nezisusa zemvelo ngokuvusa ukukhishwa kwe-dopamine isikhathi eside.5, 9 Imiphumela yokujikeleza okunonya komlutha, ngokukhishwa okuqhubekayo kwe-dopamine okunikeza okubaluleke kakhulu ekufuneni izidakamizwa kanye nokubaluleka okungaphansi kokuziphatha okuyisisekelo ekusebenzeni okuvamile nokusinda.3, 5, 12, 15

Umthamo wokunikeza inani elifanele lomuthi kanye nekhono lokuphikisa ucingo lwayo lwe-siren — yomibili imisebenzi ye-lobe yangaphambili — isungulwe umlutha wezidakamizwa.12 UHyman wabhala: “Ukufuna izidakamizwa kuthatha amandla anjalo, ukuthi kungagqugquzela abazali ukuthi banganaki izingane, abantu abathobela umthetho ngaphambili ukuba benze ubugebengu, kanye nabantu abanezifo ezihlobene notshwala noma obangelwa ugwayi ukuze baqhubeke nokuphuza nokubhema.”5 Le mikhuba ye-PFC isola i-akhawunti yokuqonda okungalungile nokwahlulela okuhambisana nale mikhuba ehlobene nezidakamizwa.7

Ama-pharmacotherapies anjalo abhekisiwe njenge-morphine-receptor antagonist naltrexone ebekelwe isiguli sethu ingaphazamisa i-crescendo ye-dopamine engavinjelwe ebangela imisebenzi ye-salience kanye nemisebenzi yokuvinjwa kokuphendula ukuthi ingalingani. I-Naltrexone ivimba ama-morphine receptors, ngaleyo ndlela kusiza ukwanda kwethoni ye-GABA kanye nokwehliswa kwamazinga we-dopamine we-NAc ngokusebenzisa zombili izindlela eziqondile nezingaqondile.2 Ekugcineni, ngokususa ukungabi namuntu kancane kancane, amandla okuziphatha okuluthayo kufanele anciphe.15, 16

Ngokufingqa, ukuguqulwa kwamaselula ku-PFC yomlutha kubangela ukukhuphuka kwesibindi sezinto ezihlobene nezidakamizwa, ukwehla kwesibindi sezinto ezingezona izidakamizwa, nokunciphisa inzalo ekuphishekeleni imisebenzi eqondiswe imigomo emaphakathi nokusinda. Ngaphezu kokuvunyelwa kwe-naltrexone okuvela ku-Food and Drug Administration ekwelapheni ukuphuza ngokweqile, imibiko eminingana yamacala eshicilelwe ikhombisile ukuthi inamandla okwelapha ukugembula kwe-pathologic, ukuzilimaza, i-kleptomania, nokuziphatha ngocansi okucindezelayo.8, 14, 17, 18, 19, 20 Sikholwa ukuthi le yincazelo yokuqala yokusetshenziswa kwayo ukulwa nomlutha wobulili we-Intanethi. Ryback20 wafunda ngokukhethekile ukusebenza kwe-naltrexone ekwehliseni ukuvusa inkanuko nokuziphatha kocansi ocansini kwabasencane ababoshelwe amacala ahlanganisa ukudlwengula, ukulala nesilwane, kanye nokwenza ucansi nezingane ezincane. Ngenkathi ethola imithamo phakathi kwe-100 kanye ne-200 mg / d, ababambiqhaza abaningi bachaza ukwehla kokuvuka, ukushaya indlwabu, nemicabango yezocansi, kanye nokulawulwa okwengeziwe kwezifiso zobulili.20 Echaza ubufakazi obuvela ezifundweni zamagundwane, uRyback ugcizelela ukuxhumana kwe-PFC phakathi kwezinhlelo ze-dopaminergic ne-opioid, ephetha ngokuthi "izinga elithile le-opioid livela libalulekile ekuvuseleleni nasekuvuseleleni ezocansi."20

ISIPHETHO

Isiguli sinezinkinga ezibangelwe kusukela ngesikhathi esichithwa ocansini oluyimpoqo lwe-inthanethi olusebenzisa indlwabu nasemiphumeleni engahle ibe khona, njengokukhulelwa okungafunwa kanye nezifo ezithathelwana ngocansi, lapho imisebenzi yakhe ebonakalayo yandiswa yabaxhumana nabantu abangaphandle kwezocansi. Ukungeza i-naltrexone ohlelweni lwemithi ebelivele ifaka i-serotonin reuptake inhibitor ekhethiwe ehambisana nokwehla okukhulu kanye nokuxazululwa kokugcina kwezimpawu zayo zokulutha, ngokuvuselelwa okuthe xaxa kokusebenza kwakhe kwezenhlalo, emsebenzini nasekusebenzeni kwakhe. Njengoba i-naltrexone ihlala kuma-morphine receptors kuma-GABAergic interneurons avimbela i-VTA dopaminergic neurons, sicabanga ukuthi ama-opiate peptide endogenous awasayiqinisi imisebenzi yakhe yocansi ye-Intanethi. Yize ekuqaleni eqhubeka nokulangazelela lo msebenzi, njengoba kufakazelwa wukuziphatha kwakhe kokuhlola, akasakutholi kuzuzisa ngokunganqandeki. Ubungqabavu bezinkomba ezenza ukuthi umsebenzi wezocansi we-Intanethi wehle kuze kube seqophelweni lokuqothulwa kokuziphatha lapho ubhekene nesimo sakhe sokuthatha noma sokushiya. Kwaziqondanela nje ukuthi kodwa akumangalisi, wathola ukuthi wayengasakujabuleli ukuphuza ngokweqile. Ucwaningo oluningi luyadingeka ukuqinisekisa ukuthi ukubonwa kwethu kungenziwa kwenziwe kwezinye iziguli futhi kucacise indlela i-naltrexone eqeda ngayo isimilo.

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