Front Endocrinol (Lausanne). I-2017 Jun 14; 8: 127. doi: 10.3389 / fendo.2017.00127. eCollection 2017.
UMichaud A1, UVainik U1,2, Garcia-Garcia I1, Dagher A1.
abstract
Ukuphoqelelwa kusho ukuthambekela kokwenza ngokushesha ngaphandle kokucabanga ngokuphelele ngemiphumela. Isici kucatshangelwa ukuthi sivela ekuxhumaneni phakathi kwezimpendulo eziphezulu zokuvuselela imivuzo engabakhona kanye nokuzithiba okungekuhle. Ucwaningo luye lwaphakamisa ukuthi ukufakwa kungukubeka engcupheni yokuba umlutha nokukhuluphala ngokweqile. Kodwa-ke, imiphumela kule ndawo ayikacaci, mhlawumbe ngenxa yenkimbinkimbi ephakeme yokulutha nokukhuluphala. Ukugxila ekugxilisekeni, inhloso yalokhu kubuyekezwa ukuphatha ukugqama okukhulu phakathi kokulutha nokukhuluphala kuzizinda ezine: (1) cwaningo lobuntu, (2) imisebenzi ye-neurocognitive, (3) ubuchopho bokucabanga, kanye (4) nobufakazi bemitholampilo. Siphakamisa ukuthi izizinda ezintathu ezihlobene nokushukuma zibalulekile ikakhulukazi ekuqondeni kwethu ukufana phakathi komlutha nokukhuluphala: ukuzithiba okuphansi (iDiscohibition ephezulu / Ukukhalipha okuphansi), ukuzwela komvuzo (ukuphakama okuphezulu / ukuqina okuhle), kanye nomthelela omubi (ukuphakama okuphezulu kwe-Neuroticism / Ukuxineka Okungalungile). Ucwaningo lwe-Neurocognitive luye lwabonisa ukuthi ukukhuluphala umlutha kanye nokulutha zombili kuhlobene nokwanda kokuthatha izinqumo nokunaka ukunakwa ekuphenduleni izidakamizwa noma izidlo zokudla, ngokulandelana. Ukuphenya lokhu, ukukhuluphala nezindlela ezihlukile zomlutha zibonakala zibonisa izinguquko ezifanayo ekusebenzeni kobuchopho be-MRI ngokuphendula ukucubungula komvuzo nangemisebenzi yokuzilawula. Sekukonke, isibuyekezo sethu sinikezela ngendlela eqondile yokuqonda lezo zingxenye zokukhuluphala eziveza ukufana kokuziphatha okuluthayo. Ngaphezu kwalokho, siphakamisa ukuthi ukungenelela kwezokwelapha okuqondisa ukulawulwa kokuvinjwa kungabonisa indlela ethembisayo yokuvimbela kanye / noma ukwelashwa kokukhuluphala.
KEYWORDS: umlutha; ubuchopho; ukungahambi kahle; ukukhuluphala; ubuntu nezimpawu ze-neurocognitive
I-PMID: 28659866
I-PMCID: I-PMC5469912
I-DOI: I-10.3389 / fendo.2017.00127
Isingeniso
Ukukhuluphala umlutha nezimo eziyinkimbinkimbi futhi eziyindida ekuxhumaneni kwe-biology nempilo yengqondo. Inqwaba yezincwadi zesayensi iveze ukubaluleka kwezici ze-neurobiological and neuropsychological ku-pathophysiology of obesity (Umdwebo 1) (1, 2). Okubaluleke kakhulu, ubufakazi obukhulayo bukhombisa ukuthi ukukhuluphala kuhlanganyela izindlela ezijwayelekile zokulutha ngokwezinhlelo ze-neurobiological ezithola umvuzo nezinqubo zokuzibamba (3-5). Inhloso yalokhu kubuyekezwa ukuthi kuhlolwe ngokunzulu ukugqama okukhona phakathi kokulutha nokukhuluphala kuzizinda ezine: (1) research botho, (2) neurocognitive task, (3) imaging ubuchopho, kanye (4) nobufakazi bemitholampilo.
Umfanekiso we-1. I-Bop endophenotype yokukhuluphala engozini. Ubuntu, ukuqonda nezimpawu zokusebenza kwengqondo ezisebenzayo ezikhulisa ubungozi bokukhuluphala. Ukudla okungalawulwa (i-UE) kuphumela ekuxhumaneni kokuzwelana okuhle komvuzo nokuzithiba okungekuhle. I-OFC, i-cortex ejikelezayo; I-PFC, i-cortex yokuqala; I-ACC, i-cortex ye-anterior; I-BED, inkinga yokudla kokudla; I-ADHD, ukusilela kokunaka / i-hyperactivity disorder; BMI, inkomba yesisindo somzimba.
Izindlela Zobuchopho Zokulawula Ukudla Nokulawulwa
Izinhlelo ezintathu zobuchopho ezixhumene zilawula ukungena kokudla kanye nokuziphatha kokudla: (1) the hypothalamus, ephendula amasignali wangaphakathi wamandla we-energy, (2) uhlelo lwe-limbic [amygdala / hippocampus, i-insula, i-orbitofrontal cortex (OFC), ne-striatum], ubandakanyeka ekufundeni nasenkumbulweni futhi ufaka inani noma isisusa sokudla, kanye (3) uhlelo lokulawula lokuqonda, (olwaziwa kuqala)6, 7). Umsebenzi ojwayelekile walezi zinhlelo ugcina amandla e-homeostasis, unika amandla ukufunda ngokuqukethwe kwezakhi zokudla, futhi ukhuthaza ugqozi lokufuna nokudla ukudla njengoba kufanele.
Kodwa-ke, umehluko ngamunye ezinhlotsheni ze-neurobiological ezithintekayo kulawulo lokukhetha ukudla nokudla kungenzeka uchaze ukuthi kungani abanye abantu bethambekele ekuzuzeni isisindo kunabanye (8). Ngempela, abantu abakhuluphele bangaba nezimpawu zokuxhumana ezithi zibangele ukuba badle kakhulu lapho bechayeka ezimweni ezivumayo zemvelo noma ezizimele. Enye yezinto ezinjengalesi senzo. Yize izincazelo eziningi zikhona (9-14), ukuphoqelelwa ngokuvamile kuthathwa njengokuthambekela kokwenza ngokushesha ngaphandle kokucabanga okugcwele kwemiphumela (15). USharma et al. (16) muva nje kwenziwe ucwaningo lwezinto eziyinhloko ze-meta-analytic futhi lwaphakamisa ukuthi impulsivity ukwakhiwa okubanzi okubandakanya izakhi ezahlukahlukene zezengqondo ezifana nokusabalalisa, ukubulala izinzwa, ukuthambekela ngokweqile, ukufuna umuzwa, ukunganakwa, ukwenza izinqumo okungafanele, ukulawula okwanele kokuvinjwa, kanye nokuntuleka ukuguquguquka kwengqondo (16-19).
I-Impulsivity iyingxenye esemqoka yezinkinga eziningana ze-neuropsychiatric ezinjengokunaka ukuntuleka / ukuqina kwethambo (ADHD), i-mania, nokuphazamiseka kobuntu (20, 21). Ucwaningo oluningi lubike ukuthi ukucindezelwa, isimo sobuntu esivame ukubonwa kubantu abanomlutha (22-26), futhi ingahle ihlotshaniswe nokukhethwa kokudla okuphezulu kwekhalori, ukudla okungalawulwa, nokukhula kokukhuluphala (27-31). Isibonelo, abantu ababonakala ngokuziphatha okungavinjelwe njalo kanye nokuphendula okuphakeme kwimivuzo engaba khona bangaba sengozini enkulu yokuthola isisindo sempilo esingenampilo uma bevezwa endaweni ebizwa ngokuthi yi-obesogenic8, 28, 32). Izinqubo ze-Neurobehaisheral eziholela ekuhoxeni okuthile zivela ekuxhumaneni kokuphendula okuvusa amadlingozi kwemivuzo engaba khona (okungukuthi, ukuzwela komvuzo) kanye nokuzithiba okungekuhle (ie, ukuziphoqelela okuzenzakalelayo) (14, 28). Uhlelo lokuvuza luvame ukucatshangwa ukuthi luhlanganisa amasayithi wokuqagela we-mesolimbic dopamine neurons, kuyilapho ukuzithiba kuncike kwi-preortal cortex (PFC), ikakhulukazi i-PFC eseceleni, kanye ne-dorsal anterior cingrate cortex (ACC). Ukwehluka okungafani nomuntu ngamunye kokufaka amandla kungakha i-dekhystemia ejwayelekile kuwo wonke umfutho nokukhuluphala kwezidakamizwa. Kulokhu, izifundo eziningana ziphakamise ukuba khona kokufana phakathi komlutha nokukhuluphala kokulungiswa kwemivuzo (4, 5, 33, 34). Eqinisweni, izidakamizwa eziluthayo kucatshangelwe ukuthi ziyimilutha ngenxa yezenzo zazo ezinhlelweni ze-neural ezilawula izimpendulo ezithandekayo emvuzweni wemvelo njengokudla (4, 34-36). Ukujikeleza kwe-Dopamine kudlala indima ebalulekile ekufakweni kwamanani wokuqinisa wezinto ezifakwayo (37, 38).
Uma kucatshangelwa ukuthi ezinye zezimpawu zokuziphatha ezibucayi bokuthi umuntu abe umlutha wazo zingabonisa nezinto ezingaba sengozini yokukhuluphala, lokhu kubuyekezwa kuhloswe ukubhekana nalo mbuzo olandelayo: ingabe ukuzimela kokuzibamba okungenampilo futhi okukhohlakele kukhonjwe ekuluthweni kwezidakamizwa nakho kuyikhona ngokukhuluphala? Lezi zingxenye ezilandelayo zibukeza ubufakazi ngokuya kobuntu, imisebenzi ye-neurocognitive, i-neuroimaging, nobufakazi bemitholampilo.
Izici zobuntu
Izici zobuntu zibonisa ukuthambekela kwezimpendulo eziqondayo, ezingokomzwelo nezokuziphatha ezenzakalweni nakwindawo ezikuyo. Izici ezithinta ukuthambekela okuxakile zihlotshaniswa nokuthola isisindo esinempilo nokulutha (39). Ukuhlaziywa kwesakhi esiyinhloko semeta-analytic samakhasi wemibuzo yobuntu kuveze izizinda ezintathu ezihlukile zokuxoshwa (16): ((1) Disinhibition dhidi yeContraint / Consciciousness, (2) Neuroticism / Negative Emotionality, kanye (3) Extraversion / Positive Emotionality. Lezi zibalo zibonisa kahle uhlaka lobuntu be- "Big tano" (40), i-UPPS (Uphuthumayo, Ukuphikelela, Ukulungiselela, Ukufuna Ukubuyiselwa) (19), nezinye izingqinamba eziningi zokuphoqelelwa (9, 11). Ngakho-ke, sisebenzisa lesi sinqumo sezici ezintathu zokuphoxeka (16) njengohlaka lwesisekelo lokuhlela ubufakazi bokuthi ukufakwa ngokulinganisa ubuntu kuhlotshaniswa nokulutha nokukhuluphala (Ithebula 1).
Ithebula 1. Isifinyezo sokuhlangana okuyinhloko phakathi komlutha noma ukukhuluphala nezilinganiso zokuphoqelela.
Ukuchazwa Okuphezulu kanye neContraint ephansi / Unembeza
I-Disinhibition dhidi yeConstraint / Consciciousness factor yakhiwa yizinto ezimbili ezihlotshaniswa ne-dyscontrol yokuziphatha: ukungahleleki, okuholela ekungakwazi ukwenqaba isenzo sokujaha, kanye nokuntula noma ukubekezelela, okuholela ekwehlulekeni kokulawula ukuzithiba ebusweni be ubunzima (16). Le nto iphathelene nezinyathelo ezilandelayo ezivela esikalini sobuntu esivame ukusetshenziswa: ukungabekezeleli kanye nokuntuleka kokulungiswa kwangaphambi kokuqala kusuka ku-UPPS, ukubekezela okuphansi okuvela kwi-NEO-Personality Inventory-Revised NEO-PI-R, kanye nokuxoshwa kwezimoto nokungahambi kahle kokuphuma Isikali se-Barratt Impulsiveness Scale (BIS) (16).
Izikolo eziphansi ngokunembeza zihlobene nokuziphatha okuhlukahlukene okuluthayo (41) kufaka phakathi ukusetshenziswa kabi kwezidakamizwa okungekho emthethweni (42-44), izinkinga zokugembula (45), ukubhema (46-48), kanye nokusetshenziswa kotshwala (49, 50). Ngaphezu kwalokho, unembeza ophansi ukwandisa ingozi yokuphinda ubuye emuva kokwelashwa (51). Ukuntuleka kokuhlela noma ukulungiswa kwangaphambili kuhlolwe kusetshenziswa isikali se-UPPS nakho kuyisibikezeli esizimele sokulutha (52). Ngakho-ke, isizinda esiphakeme se-Disinhibition kanye nesizinda esiphansi se-Consciciousness sokuhlangana njalo sihlotshaniswa nengozi ephezulu yokulutha, kusekela ukubaluleka kokuzithiba ekulweni nokusebenzisa kabi izidakamizwa.
Ngokufanayo, ukukhuluphala ngokweqile kuhlotshaniswe nezinga elehlisiwe Lonembeza (28, 53) njengoba kulinganiswe yi-NEO-PI, inhlangano eqinisekisiwe ekuhlaziyeni okukhulu kwe-meta okubandakanya abantu abasondelene ne-50,000 (54). Kwisampula enkulu enkulukazi esebenzisa i-BIS, Meule ne-Blechert (31) ithole ukuthi ukunakwa okuphezulu kokubhekisisa kanye ne-motor bekucatshangelwa yinkomba ephezulu yomzimba (BMI) ngemuva kokulungiswa kwezibalo ngobudala nobulili. Kodwa-ke, umphumela ube mncane, futhi ukungahambi kahle kokungaxhunyaniswa nakho akuhlangene kakhulu ne-BMI (31). Ekugcineni, ucwaningo olusebenzisa i-UPPS seluthole nobudlelwano phakathi kwe-BMI kanye nokuntuleka kokuphikelela, okuwukuhluleka kokuphikelela ngemisebenzi eyinselele (55, 56). Ngaphezu kwalokho, amazinga aphakeme we-disinhibition ejwayelekile, njengoba kulinganiswa yi-Three-Factor Eating Questionnaire, ahlanganiswe nokuthola isisindo somzimba ngokuhamba kwesikhathi (57). I-Disinhibition lapha isho ukuthambekela kokudla kakhulu lapho kuchayeka ekudleni okuthandekayo noma ezimweni ezicindezelayo, uphawu oluhlobene nokwazi nokuzithiba. Uma ucabanga ngalezi zifundo, ukukhuluphala kubonakala kuhlobene ne-Disinhibition ephezulu kanye neConccienceness ephansi. Lezi zici zingakhulisa ukuthambekela komuntu kokudla ngokweqile ezimweni ezithile futhi zingathokozise ukulondolozwa kokuziphatha okuhambisana nokwehliswa kwesisindo somzimba kubantu abakhuluphele (58).
I-Neuroticism / Ukuqina Okubi
Isici i-Neuroticism / Nexative Emotionality ikhombisa ukuthambekela kokukwenza ngokungxhamazela ngokuphendula imizwa engemihle nokuzwa izinkanuko lapho kukhulunywa ngezimo ezingezinhle (16). Kuboniswa ku-neuroticism ku-NEO-PI-R, ukuphuthuma okungekuhle ku-UPPS, kanye nokugxila okuxakile ku-BIS (16).
I-Neuroticism (NEO-PI-R) ihlobene nama-syndromes ahlukahlukene omlutha, kufaka phakathi ukusetshenziswa kwezidakamizwa (42-44), ukugembula okuyinkinga (45), ukubhema (46-48), kanye nokusetshenziswa kotshwala (49, 50), futhi nangengozi ekhulayo yokuphinda ubuye emuva kokwelashwa (51). Olunye ucwaningo futhi lubike ubudlelwano phakathi kokuphuthumayo okungalungile (i-UPPS) nokulutha kwezidakamizwa (59-62). Sekukonke, abantu abanokuziphatha okuluthayo bangabandakanyeka ekusebenziseni izidakamizwa njengendlela yokubhekana nengcindezi nemizwelo engemihle.
Ubudlelwano phakathi kokukhuluphala ne-neuroticism abubonakali kangako. Ngenkathi ukubuyekezwa kwangaphambilini kubike ukuxhumana phakathi kwalokhu (28, 53), ukuhlaziywa kwe-meta kwakamuva akutholanga ukuhlangana (54). Amathuba kulokhu kwehluleka kobudlelwano obalulekile ukuthi isisindo somzimba sixhumene kuphela nezici ezithile zomoya ongemuhle. Isibonelo, kukhonjiswe ngokungaguquki ukuthi kuphela i-impulsiveness subildor ("N5: Impulsiveness") yokuxhunywa kwe-NEO-PI-R ngokuhlonishwa (39, 63). Ukutholwa okuvela ku-UPPS kusekela lo mbono, njengokuphuthumayo okungalungile, ukuthambekela kokuzwa izifiso eziqinile ngesikhathi sokuthinteka okubi, kuxhunyaniswe ne-BMI enkulu (55, 56). Ezinye izinto ezingasusa ukuxhumeka phakathi kokukhuluphala kanye ne-Neuroticism / Negative Emotionality ifaka iqiniso lokuthi ukuhlangana kungenzeka kube kwabesifazane kuphela nokuthi i-neuroticism nayo inganquma ukuthi babe ngabaphansi, nge ukuxhumana nezifo zokudla (64). Lokhu kungasusa ubudlelwano obulayini phakathi kokukhuluphala ne-neuroticism ezifundweni zabantu. Ekugcineni, ukuxhumana phakathi kwe-neuroticism kanye nokukhuluphala kungaqhutshwa yimibuzo emibili kusilinganiso se-Neuroticism se-NEO PI-R esiqondise ngqo ekuziphatheni okungalawulwa (i-UE) yokuziphatha (65, 66).
Ngamafuphi, ubudlelwane phakathi kwesizinda se-Neuroticism / Negative Emotionality kanye nokukhuluphala ngandlela-thile akuhambelani kunalokho ngeSazela ne-Disinhibition. Noma kunjalo, le ndlela yobuntu ingahle inqume umuntu ukuthi adle kakhulu ezimweni zokuxineka ngokomzwelo (67), okungaholela ekuthandeni isikhathi eside.
I-Extraversion / Umuzwa Omuhle
I-Extraversion / Positive Emotionality factor isho ukufunwa kwemizwa nokuzwela ezintweni ezijabulisayo noma ezinomvuzo (16). Abantu abane-Extraversion ephezulu / i-Positive Emotionality bayazwela ukushukumisa okuhle kwemvelo futhi kungenzeka ukuthi bazibandakanye ekuziphatheni okuphoqayo noma okufuna umvuzo lapho bezwa imizwa emihle. Kuthiwa bafuna inoveli nokuhlangenwe nakho okuthokozisayo. I-Extraversion / Positive Emotionality ihlangana nesizinda se-Extraversion ku-Mod-Factor Model yobuntu nangokufuna kwe-UPPS (16). I-Sensitivity to Reward ingxenye ye-Sensitivity to punishment kanye ne-Sensitivity to Reward Questionnaire (SPSR) uhlu lwemibuzo oluzenzele lona futhi oluhlola lobu bukhulu (28, 68).
Ucwaningo oluningi lukhombisa ukuthi ukufikelwa ngumvuzo kuhambisana nento ebeka engcupheni yokuluthwa yizidakamizwa kanye nokudla ngokweqile ngokuthuthukisa isisusa sokuthola izidakamizwa noma ukudla okuthandekayo (69, 70). Izikolo eziphakeme kakhulu ku-Extraversion zihlobene nokuluthwa kwezidakamizwa (47). Isici esihambisanayo, ukuphuthuma okuqondile, ukuthambekela kokuthatha isinyathelo masisha ngokuphendula imizwa emihle, kwahlanganiswa futhi nokulutha kwezidakamizwa (59-62). Ngaphezu kwalokho, Ukufuna Ukubuyiselwa Kwembuyiselo kuvame ukuhlotshaniswa nokuphazamiseka kokusebenzisa izidakamizwa kanye nezinkinga zotshwala (62). Sekukonke, izincwadi ziyahambisana ekuhlobiseni isizinda se-Extraversion / Positive Emotionality sokuphoqelela kokuphazamiseka okuluthayo.
Olunye ucwaningo luye lwaphakamisa ukuthi iBMI ephezulu ihlotshaniswa namazinga akhuphukile we-Extraversion (28, 53). Izikolo eziphakeme kakhulu ku-Extraversion nazo zibonakala zibikezela inzuzo yokuthola isisindo (ngemuva kweminyaka engu-2) (71). Kodwa-ke, ukutholakala okuphikisanayo kukhona, ngokuhlaziywa kwe-meta (54) ukwehluleka ukukhombisa ubudlelwane obungaguquki phakathi kokukhuluphala kanye ne-Extraversion ezifundweni ezinde. Kodwa-ke, uDavis et al. (72) ithole ukuthi ukuzwela komvuzo, njengoba kuhlolwe yi-SPSR, kuhlotshaniswa nokuziphatha okungalungile kokudla njengokuthanda ukudla okuphezulu kwekhalori nokudla ngokweqile (72). Baphakamise ukuthi abanye abantu bangahle babuyisane kakhulu nezindlela zokudla nokuthi ukuphathwa kwesisindo, kulaba bantu, kungahle kumelele umzabalazo oqhubekayo esimweni sanamuhla sokukhuthaza ukukhuluphala. Isebenzisa i-SPSR, leli qembu liphinde lakhombisa ubudlelwane obuchazwe u-U phakathi kokuzwela ngomvuzo ne-BMI kusampula yezihloko ezimboza inani elikhulu lamagugu wokuphakanyiswa, okuphakamisa ukuthi izifundo ezinciphile futhi ezinamafutha amakhulu bezingazweli kangako ekuzuzeni kunasezifundeni ezikhuluphele nezinamafutha (73). Ngokusebenzisa i-Behahlangual activation Scale, amanye amaqembu futhi anikeze ubufakazi bobuhlobo be-quadratic phakathi kwe-BMI nokuzwela ngomvuzo (74, 75). Ukuchaza lobu budlelwano be-curvilinear, uDavis no Fox (73) iphakamise ukuthi kokubili i-hyper- kanye ne-hyposensitivity ukuvuza kungabeka phambili ukukhuluphala. Amathuba wobudlelwano obunjengobunjalo be-U-shape phakathi kwe-BMI ne-Extraversion aphakamisa ukuthi umehluko ebangeni le-BMI eliyisampula ezifundweni zonke ungabangela ukungafani kwezincwadi. Ngaphezu kwalokhu, ubulili bungalinganisa ukuvumelana phakathi kwe-Extraversion ne-BMI. Kwabesifazane, izikolo eziphansi ku-Extraversion zibonakala zihlobana nokuqondiswa okuphezulu (76, 77), kuyilapho kubikwa okuhlukile kubesilisa (76, 78).
Sekukonke, yize okutholakele kungqubuzana kukhona, ubufakazi obukhona manje bukhomba indlela amaphrofayli afanayo okuphoqelela ukukhuluphala nokukhubazeka okuluthayo. Ngokuqondile, lezi ziphazamiso ezimbili zibonakala zabelana ngokulawulwa okungqondo okuphansi (iDis Dishibhibition / low Consciciousness), kanye nokuthambekela kokwenza izinqumo eziphoqelela ukuphendula i-positive (high Extraversion / Positive Emotionality) kanye ne-negative (high Neuroticism / Negative Emotionality). Umdwebo 2 ikhombisa ukubuka okuphelele kokwehluka kobuntu ekukhuluphiseni kanye nomlutha njengoba kuthathwe ku-Ref. (39, 42, 79). Lokhu kukhombisa ukuthi ngenkathi, ebanzi, ukukhuluphala kubonakala kufana nokuziphatha okuluthayo, kukhona futhi umehluko ezingeni elikhanyayo lezikhwama zobuntu.
Umfanekiso we-2. Amaphrofayili wobuntu bokukhuluphala kanye nama-phenotypes anomlutha ngokuya ngokusungulwa kwe-NEO-ubuntu. Sethula umehluko kumayunithi we-T-amaphuzu phakathi kokukhulu okususile kweqembu lesisindo elijwayelekile neqembu lokulawula umlutha we-phenotype group. Ezingeni elibanzi lezinto, wonke ama-phenotypes abelana nge-Neuroticism ephezulu (i-Negative Emotionality ephezulu) kanye ne-Agreeableness ephansi ne-Consciciousness (Disinhibition ephezulu). Kodwa-ke, ngokwezinga elenziwe kahle, amaphrofayli abe mancane ngokufana. Isibonelo, ukukhuluphala kuhlukanisa ngaphandle kokunye umlutha okuvela kuphela esicini esisodwa se-Neuroticism, hhayi kuzo zonke izici zokuhlonipha. Ngakho-ke, ngenkathi kukhona ukufana okubanzi, ukukhuluphala kanye nama-phenotypes omlutha awafani ngokuphelele komunye nomunye. Izikolo ezishiwoyo zitholwe kulawa maphepha (39, 42, 79).
Imisebenzi ye-Neurocognitive
Imisebenzi ye-neurocognitive esekwe elebhu ingasetjenziselwa ukukala ukulawulwa kwe-inhibitory noma ukuzilawula. Izibonelo ezisetshenziswa kakhulu ngumsebenzi wokunciphisa ukubambezeleka, umsebenzi wokumisa isignali (SST), umsebenzi weGo / No-Go, umsebenzi weStroop, nomsebenzi wokuhlunga kwamakhadi weWisconsin (WCST) (80). Lezi zivivinyo ze-neurocognitive zihlola ubukhulu obuhlukahlukene bokungacindezeleki, kufaka phakathi ukukhetha okungathandeki, ukuphendula okungenangqondo, nokunganakwa (15, 81). USharma et al. (16) iphinde futhi yenza ukuhlaziya kwe-meta-analytic principal-element factor factor of the most behaal behaviour taskways of impulsivity futhi yakhomba izizinda ezine ezinkulu: (1) ukuthatha izinqumo ngokungafanele, (2) ukunganakwa, (3), kanye (4), ) ukuguquka. Izigaba ezilandelayo zichaza ukuthi le mikhakha emine yokuxoshwa ihlangana kanjani nokulutha nokukhuluphala (Ithebula 1).
Ukwenza Isinqumo Okuphoqayo
Ukwenza izinqumo (noma ukukhetha okuphoqayo) kusho ukuthambekela kokungalibazisi ukwaneliseka futhi ukhethe imivuzo etholakalayo ngokushesha (16). Ngokuvamile kuvivinywa ngomsebenzi wokunciphisa ukubambezeleka, lapho ababambiqhaza kufanele bakhethe phakathi kwesamba esincane, esincane semali nenani elikhudlwana, elibambezelekile (82). Isilinganiso sokunciphisa ukubambezeleka esijulile sihlotshaniswa nokukhetha okukhulu kwemivuzo esheshayo, ekhombisa ukuthatha izinqumo okungaphoqeleli.
UKirby noPetry (83) kukhombisile kusetshenziswa inguqulo yemibuzo yalo msebenzi ukuthi abantu abayimilutha yezidakamizwa banamanani aphezulu aphezulu wesephulelo emivuzo ebambezelekile kunolawulo. Ukuhlaziya okubili kwe-meta futhi kunikeze ubufakazi obuqinile bokuthi isilinganiso esinciphayo sokunciphisa isaphulelo sihambisana nobunzima nobunzima bokuziphatha okuluthayo (84, 85). Ubukhulu benhlangano bebufana phakathi kwezinhlobo ezahlukahlukene zezinkinga eziluthayo (utshwala, ukugembula, ugwayi, insangu, opiates, nezivuseleli) (85). Iqembu elifanayo futhi libike ubudlelwano obufanayo nokukhuluphala: yize imiphumela iyehluka, ukuhlaziya kwabo kwe-meta kuphethe ngokuthi ukukhuluphala kuhlotshaniswa nokubambezeleka okusheshayo kwezephulelo zemali esizayo kanye nemivuzo yokudla (86). Kuyathakazelisa ukuthi uWeygandt et al. (87) kamuva nje kutholwe ukuthi ukusebenza kancane kwe-MRI (fMRI) yokusebenza kwezindawo ezilawula ukunqandwa ngesikhathi somsebenzi wokunciphisa ukubambezeleka kuhlotshaniswa nokulondolozwa kwesisindo okuntengayo ngesikhathi eside. Ngokucacile, izifundo ezikhuluphele zibonakala zinokuncishiswa okukhulu kokubambezeleka kokudla kuqhathaniswa nolunye uhlobo lwemivuzo. Ngokufanayo, izifundo eziluthiswe izidakamizwa zinokuncishiswa okukhulu kokubambezeleka kwezidakamizwa kuqhathaniswa nolunye uhlobo lwemivuzo (28, 85, 86). Ukwenza izinqumo okuphoqelela ukulutha nokukhuluphala kungachaza ukuthi kungani abanye abantu bezibandakanya ekuziphatheni okungalungile okuvuza ngokushesha kodwa okulimazayo ngokuhamba kwesikhathi.
Omunye umbono ekwenzeni izinqumo okungaphoqeleli ukugoqa umqondo wokuzwela ubungozi. Ukuzwela ubungozi kubhekisele ebangeni elithile lokuhehayo noma lokuphikisayo kumiphumela engaqinisekile (88). Ukuziphatha okulinganiselayo okufuna ubungozi kungahle kube nemiphumela emihle ekutholakaleni kwendawo entsha nezinsizakusebenza futhi kungaholele ekuhlangabezaneni nezikhathi ezijabulisayo. Kodwa-ke, ukuheha ngokweqile ebungozini kungahle kuhlotshaniswe nemiphumela emibi futhi kungaba neqhaza ekuthuthukiseni umlutha wezidakamizwa. Eminyakeni yamuva nje, umqondo wokuzwela ubungozi usetshenzisiwe ukuchaza isimilo esiqhutshwa umlutha nokukhuluphala (89, 90). Kokubili umlutha nokukhuluphala kungahle kufinyelele ezingeni elithile ukuthambekela kwenjabulo yesikhashana esifushane yize kungaba yingozi yemiphumela emibi yesikhathi eside (89, 91). Ucwaningo oluningi luye lwaphakamisa ukuba khona kwezinguquko ezihlobene nomlutha ekukhethweni okuyingozi. Isibonelo, uma kuqhathaniswa nezilawuli ezinempilo, abahlanganyeli abaphuzayo babonise ukwanda kokufuna ingozi lapho belindela ukulahleka kwemali okungalindelekile (92). Ukwenza izinqumo ezinobungozi kanye nokunciphiswa okubambezeleka okuphezulu kuphinde kubonakale kuphazamisa ukugcinwa kokulashwa ngokulandela ukwelashwa (93).
Bambalwa abacwaningi abaye bahlola ngokuqondile ukuthathwa okufana nobungozi noma umehluko phakathi kokulutha nokukhuluphala kuze kube manje. Olunye ucwaningo luthole ukuthi abantu abakhuluphele abanenkinga yokudla ngokungadingeki (BED) benza izinqumo eziningi eziyingozi emsebenzini wezimali njengabayimilutha yezidakamizwa (94).
Ukuvinjwa
Isizinda sokuvinjezelwa sisho amandla wokucindezela izimpendulo zemoto yangaphambi kwesikhathi (16). Imisebenzi evimbela ukuvimbela kufaka i-Go / No-Go ne-SST (80, 82). Emsebenzini we-Go / No-Go, abantu bacelwa ukuba baphendule ngokushesha ngangokunokwenzeka lapho kuvela isivuseleli esibukwayo esiphindaphindekayo (isibonakaliso se-Go) kodwa ukuvimba ukuphendula kwabo lapho kuvela uphawu olungavamisile lokumisa (uphawu lwe-No-Go). Kumsebenzi we-SST, isinali yokumisa yethulwe ngemuva kwesiginali ye-Go ukukala amandla womuntu ukumisa impendulo esele iqalile (95).
Ubufakazi obukhulu buxhumanisa umlutha wezidakamizwa nokulawulwa kokuvimbela i-inhibitory (96-98). Ukuhlaziywa kwe-meta-kwezifundo ze-97 kusetshenziswa imisebenzi ye-SST noma i-Go / No-Go kubike ukuthi ukulawulwa kokuvinjwa kokuvinjwa kuvame ukubonwa ngezihloko ezinokuphazamiseka okuphezulu kokusebenzisa izidakamizwa kanye nokugembula kwe-pathological (99). Kodwa-ke, bekungenabo ubufakazi bokuthi kusilela kwe-inhibitory ezifundweni okutholakala ngazo i-cannabis, opioid, noma umlutha we-Intanethi (99).
Ngokufanayo, ukukhuluphala kuye kwaxhunyaniswa nokulawulwa okungalungile kokuvinjezelwa. Ukubuyekezwa kwezincwadi okuphelele kutholile ukuthi abantu abakhuluphele nabakhuluphele ngokweqile banokusebenza okuphansi kokuvinjwa kokuvinjwa kwezinguqulo eziqondene nokudla ze-SST (100). Ababhali bahlongoze ukuthi i-SST ingaba umaka omuhle ukukhomba abantu abasengozini enkulu yokuthola isisindo noma abasabeli kangako ekungeneleleni kwesisindo (100). Ukulawulwa kokuvimbela i-inhibitory kubuye kuhlotshaniswe nokukhula kwesisindo okuphezulu (101, 102) nokudla103). Ngaphezu kwalokho, ukuhlaziywa kwe-meta kwakamuva kuqinisekisile ukuthi abantu abakhuluphele ngokweqile babonisa ukusilela kokulawula ukunqotshwa kuqhathaniswa nezilawuli eziwumbala (104). Ukutholwa okufanayo kuye kwabikwa ezinganeni nakwentsha (104-108). Kodwa-ke, uLoeber et al. (109) awutholanga mehluko omkhulu phakathi kwabahlanganyeli abanesifiso sokukhuluphala kokusebenza ngesikhathi somsebenzi ohlobene nokudla weGo / No-Go. Ngaphezu kwalokho, abanye abatholanga umphumela we-BMI ngayinye se ekusebenzeni kwe-SST ekuphenduleni ekudleni, kepha kunalokho ukuxhumana okuyinkimbinkimbi phakathi kwe-BMI kanye nokuphoqelela (110).
Ngaphezu kwalokho, uVoon et al. (111) usebenzise umsebenzi wesikhathi sokuphendula oshintshiwe ovela kuhlolo lwama-rodent ukuhlola uhlobo oluhlukile lokufakwa kwezimoto: ukuphoqelela ukulinda noma ukuphendula ngaphambi kwesikhathi. Bathole ukuthi izimpendulo zangaphambi kwesikhathi zaziphezulu kakhulu kubantu abayimilutha (utshwala, ukubhema nezidakamizwa) kepha hhayi ezifundweni ezikhuluphele noma ze-BED. Ngakho-ke, izinhlobo ezithile zokuxinzelelwa kwezimoto okubonwa umlutha azikho ngokukhuluphala.
Inattention
Isizinda sesithathu sokuphoqelelwa okucatshangelwe lapha sisho emandleni okugxila emisebenzini ethile ngenkathi kucindezela impendulo ekuphazamiseni (16). Umsebenzi we-Stroop uvame ukusetshenziselwa ukukala isizinda sokunganakwa sokuxoshwa (16). Lo msebenzi udinga ukuthi ababambiqhaza bakhombe (ngokuvamile ngamazwi) umbala wegama lombala elibhaliwe, ngaphandle kokufunda igama uqobo. Lapho igama liphrinta ngombala ongahambisani negama (ngokwesibonelo, igama elithi blue liprintiwe luhlaza), kuba khona ukungqubuzana phakathi kokufunda amagama nokuqanjwa kombala. I-PFC ifakwe umfutho ekwenzeni umsebenzi weStroop (112).
Ukuvuselelwa kwalomsebenzi, "umlutha-we-Stroop," lapho isisusa sokuphambuka sibonisa into eyimilutha yenzalo, sisetshenziselwe futhi ukuhlola izinqubo zokunaka eziguquliwe ezihambisana nokuziphatha okuluthayo (113). Impela, bukhona ubufakazi obukhulu bokuthi abantu ababa umlutha banokucasukela okuphathelene nezinkambo ezihlobene nezidakamizwa, ezingabamba iqhaza elibalulekile ekufiseni izidakamizwa, ekusebenziseni nasekubuyeleni kabusha (114). Ngokufanayo, ezinye izifundo zibike ukuthi abantu abakhuluphele bangase babe nokubandlulula okubhekisisa ezinhlelweni ezihlobene nokudla, ezingakhulisa ukusetshenziswa kokudla kanye nokuthola isisindo ngokuhamba kwesikhathi (115). IHholo et al. (116) ithole ukuthi amazinga aphakeme wokunganakwa ayengababikezeli bokudla okungelona ikhalori ephezulu. Ngaphezu kwalokho, ucwaningo lwakamuva luveze ukuthi abantu abakhuluphele baboniswa amamaki aphansi emsebenzini wendabuko weStroop (117). Noma okunye ukubuyekezwa kubike ukuzihlanganisa okungahambelani phakathi kokukhathalela ukunaka kwezinto eziphathelene nokudla kanye nokukhuluphala (28, 115, 118, 119), esike saphetha ekubuyekezweni okuphelele ukuthi umsebenzi weStroop ungomunye wemisebenzi yokulawula ukuqonda engaguquki ekhombisa ukuzihlanganisa okuphindaphindayo nokuziphatha okuhlobene nokukhuluphala kanye nokuziphatha okuhlobene nesisindo (28).
Ukushintsha
Ukuguquguquka kokuziphatha, noma amandla okushintsha ukunaka noma umsebenzi osethelwe ukuphendula imithetho eshintshiwe, nakho kuxhumene nokuxoshwa (16). Ngokuvamile kuhlaziywa nge-WCST (16). Ngesikhathi salo msebenzi, ababambiqhaza bacelwa ukuba baqondanise ikhadi lokuphendula nelinye lamakhadi wesigaba ezine asuselwa emithethweni ethile (isib. Umbala, ukwakheka, noma inombolo) (120). Imithetho iyashintsha ngokuhamba kwesikhathi futhi izifundo zidinga ukuguqula impendulo yazo. Ukuthambekela ukwehluleka ukushintshwa kubizwa ngokuthi ukuphikelela, futhi kungakhombisa uhlobo lokuphoqelela. Ukuguquguquka kwengqondo okumpofu kuhlotshaniswa nokuziphatha okuphoqayo (121, 122).
Ukubuyekezwa kwakamuva kukaMorris noVoon (122) waveza ukuthi ukuxhumana phakathi kokuguquguquka kwengqondo okuhlolwe kusetshenziswa i-WCST kanye nomlutha akuhambelani. Impela, ezinye izifundo zibike ukuguquguquka kwengqondo kokuphazamiseka komlutha wezidakamizwa (123) kanye nabantu abangamlutha izidakamizwa (ukugembula, i-bulimia) (124). Kodwa-ke, abanye abatholanga ukuhlangana okubalulekile phakathi kokusebenza ku-WCST kanye nomlutha (125-127). Mayelana nokukhuluphala, ucwaningo lwakamuva lubike ukusebenza okulimazayo ku-WCST kubantu abakhuluphele uma kuqhathaniswa nabantu abanenkinga yokudla (128). Ngaphezu kwalokho, ukuhlaziywa kwe-meta (121) nokubukeza okuhlelekile (118) bobabili babike ukungasebenzi kahle kwe-WCST kubantu abakhuluphele ngokuqhathaniswa nezilawuli. Kodwa-ke, ukukhuluphala esikhundleni sabantu abakhuluphele bekungabonakali ngokulimala okuguquguqukayo (121).
Sekukonke, ubufakazi bamanje obuvela emisebenzini ye-neurocognitive ukuthi abantu abakhuluphele nabayimilutha bobabili ngokuvamile babonakala ngokuthatha izinqumo okuphezulu kanye nokukhathalela ukunaka ukuphendula izidakamizwa noma izidlo zokudla. Ngaphezu kwalokho, ukukhuluphala kuvame ukuhlotshaniswa nokuguquguquka kwengqondo okuguqulwayo (ukusetha ukuguquka) okuhlolwe ne-WCST kanye nokulawulwa kokuvinjwa okungekuhle okuhlolwe ne-SST.
Neuroimaging
I-Neuroimaging isetshenziselwe ukuphenya ukufakelwa kwemvelo okusebenzayo nokuthambekele kokungabi sengozini kokusebenzisa kabi izidakamizwa kanye nokudla ngokweqile. Ukuba sengozini yokulutha kungabhekwa njengokuvela kokuxhumana kokuphendula kokukhuthaza okuthe xaxa ezinkingeni zezidakamizwa, ubungako bokwakheka komkhuba, ukuzithiba okungekuhle, kanye nokuphakama kwemizwa engemihle (129, 130). Lezi zinqubo zihlobene nezinqubo zobuchopho ezihlukene kodwa ezixhumene: (1) uhlelo lwe-mesolimbic dopamine, olufakelwe umvuzo, ugqozi, nokwakheka komkhuba, okubandakanya indawo ye-ventral tegmental, i-ventral striatum, i-anterior insula, i-OFC, i-amygdala, ne-hippocampus kanye ( I-2) imijikelezo yokulawula ukuqonda, ifakwe ekuzimeni, kufaka phakathi i-PFC ephakathi nendawo futhi engaphansi, i-ACC, ne-insula (131). Ucwaningo lwangaphambilini lwe-neuroimaging luye lwakhanyisa iqhaza lesistimu ye-mesolimbic ku-pathophysiology yokulutha.132-139). Abahlanganyeli abanomlutha babonakala bakhombisa ukwanda kokusebenza kwe-fMRI ezikhungweni zangaphakathi, e-amygdala nasezifundeni ze-OFC ngenxa yezidakamizwa (133). Ngokuvamile, le miphumela ihambisana nokubonwa ukuthi abahlanganyeli abaphethwe yizidakamizwa bakhombisa ukugxila okuphezulu kokubhekisisa noma okugqugquzela ukubamba okuhlobene nezidakamizwa (130).
Mayelana nemijikelezo yokulawula kwengqondo, intsha ebamba ukusetshenziswa kwezidakamizwa ibonakala ikhombisa ukuncishiswa kwezinga le-oxygen oxygenxhomekeka (i-BOLD) ku-dorsolateral prefrontal cortex (DLPFC), putamen, kanye ne-portetal cortex ephansi ngesikhathi somsebenzi we-Go / No-Go, okuphakamisa ukuthi ukungasebenzi okuyisisekelo kulezi zindawo kungabikezela ukuqala kokusetshenziswa kwezidakamizwa (140, 141). Kulesi vein, umsebenzi we-theoretical ugcizelele indima ebalulekile yezindawo ze-PFC kuhlobo lwe-endophenotype yokuba sengozini yokulutha (112). Isibonelo, ababambiqhaza abanomlutha babonakala bebonisa ukungasebenzi kahle kwangaphambi kokuqala, okufaka umfutho ku-PFC (dACC kanye ne-DLPFC) ababamba iqhaza ekuzithibeni, i-ventromedial prefrontal cortex (VMPFC) ebandakanyeka kummiselo wobuzwelo nobuthakathaka besici, kanye ne-ventrolateral preortal preortal cortex kanye ye-lateral ye-OFC ebandakanyeke ekuphenduleni okungaphenduki noma okuzenzakalelayo (112). Kuphakanyisiwe ukuthi i-PFC ibandakanyeke ezindleleni zokuziphatha eziluthayo ngamandla ayo okulawula izifunda eziyingxenye yezinhlelo zemivuzo (112, 142). Isibonelo, amandla wokuxhumana phakathi kwe-dACC ne-striatum kuhlotshaniswe ngokungafanele nobunzima bokulutha kwe-nicotine (143). Ukungasebenzi kwe-PFC kungahle kube nomthelela kuhlobo lwe-endophenotype eqanjwe ukungavinjelwa kokuphendula okungathintekiyo kanye nesici sokuqina (112). Le endophenotype yomabili ikhulisa ukuzwela kwezimpawu zezidakamizwa futhi inciphisa amandla okuvimbela isimilo esingalunganga (144). Ngokuhambisana nalokhu okutholakele, ukufisa izidakamizwa kubonakala kufaka phakathi i-amygdala, ACC, OFC, ne-DLPFC (145), okuphakamisa ukubandakanyeka kokusebenza zombili ezihlobene nomvuzo nokulawulwa kokuvinjelwe.
Izifundo eziningi zokucabanga kobuchopho futhi zisekela umbono wokuthi ubungozi bokuthola isisindo kanye nokudla ngokweqile kungahle kuholele ekuxhumaneni phakathi kokuzwa komvuzo wokudla okuphezulu (isisusa sokucabanga kwekhono) nokulawulwa okungajwayelekile kokuvinjwa. Ekuphenduleni isikhuthazo sokudla okubonakalayo, ababambiqhaza abanombukiso wokukhuluphala bakhuphuke ukusebenza ku-doromedial PFC, i-ventral striatum, i-parahippocampal gyrus, i-precyral gyrus, i-front / inferior frontal gyrus (IFG), kanye nesihlobo se-ACC esihlangene nezifundo ezinciphile (119-121). Lezi zindawo zobuchopho kucatshangwa ukuthi zifaka izimpendulo zemivuzo, ukuhamba kwesikhuthazo, ukusebenzisana kwezimoto nememori. Imiklamo yokutadisha eyi-Longitudinal ikhombisile ukuthi ikhuphuka imisebenzi ye-BOLD ezindaweni ezihlobene nomvuzo (ie, i-ventral striatum ne-OFC) ibikezela ukuzuza kwesisindo, iphakamisa ukuxhumana phakathi kokuphendulwa komvuzo okuphezulu nokukhula kokukhuluphala (146, 147). Mayelana nokujikeleza okulawula ukungavikeleki, ababambiqhaza abanokukhuluphala babukeka bakhombisa imisebenzi engaguquki eqoqwe ku-DLPFC ne-insula ngokuphendula izintambo zokudla ezibonakalayo (148), okuphakamisa ukuhlanganyela okuncishisiwe kwezinsiza ze-neural ezihambisana nokuvinjezelwa, ukuphatha okuphezulu, nokuqwashisa okuqondayo. Okuqaphelekile, ukuthi izifundo ezenziwa nge-longitudinal ziye zabika ukuthi ukwenziwa kwe-activation ku-DLPFC ngenxa yezithombe zokudla ezinekhalori ephezulu kuhlotshaniswa nokuphumelela kwesisindo ngokuzithandela (149, 150). Kungenzeka ukuthi izinqubo zokuzithiba ku-DLPFC zingahlehlisa umsebenzi we-VMPFC ngaleyo ndlela, zilinganise izinketho zokudla (151). Ukusekela lo modeli, ukuhlangana okuqinile okusebenzayo phakathi kwe-DLPFC ne-VMPFC kuhlotshaniswe nokunciphisa isisindo sokudla (102) nezinqumo zokudla okunempilo (151). Ngaphezu kwalokho, ezinye izifundo ze-FMRI ziye zabika ukuthi ukulawulwa kokunxanela ukudla kuhlotshaniswa nomsebenzi owandayo eDLPFC, IFG, nase-dorsal ACC (152-154).
Izifundo ezimbalwa ze-neuroimaging in ngokweqile ziye zalungisa ngqo izinqubo zokulawula ukuqonda ngokusebenzisa ama-paradigms alawulwa yi-inhibitory-control. Lapha, izifundo ze-fMRI zithole ubudlelwane obubi phakathi kokusebenza kobuchopho ezifundeni ezilawula amandla aphezulu (i-PFC yamuva) ne-BMI (155-157). Izifundo ze-Longitudinal ziye zabika ukuthi umsebenzi ku-DLPFC ngesikhathi sokulawula imisebenzi yengqondo kubonakala sengathi ubikezela ukuphumelela ukunciphisa umzimba ngemuva kokwelashwa (87, 102). Ngakolunye uhlangothi, ukulimazeka kokulawulwa kwengqondo ezifundeni ezithokomele kungahle (i-1) kunciphise ukutholwa kokuziphatha okuholela ekulahlekelweni kwesisindo okuphumelelayo futhi (i-2) kuthuthukisa inkuthazo yokudla ukudla okuthandekayo, noma ngabe kungekho zidingo zamandla (6, 158).
Ngokubambisana, ucwaningo olushiwo ngenhla lubonisa ukuthi abahlanganyeli abanenkinga yokukhuluphala kanye neziguli ezinomlutha bethula izinguquko ezifanayo zomsebenzi ezifundeni ezingaphambili nasemjikelezweni we-mesocorticolimbic. Kodwa-ke, kuze kube manje izifundo ezimbalwa ze-neuroimaging ziqhathanise ngqo umthelela wokukhuluphala kanye nezinhlobo ezahlukahlukene zemilutha ku-activation yobuchopho. Leli phuzu lokugcina libaluleke kakhulu, ngoba izinkambo zokudla nezidakamizwa zibonakala zisebenza izifunda zobuchopho ezifanayo ezibandakanyeka kwinqubo yemivuzo, njenge-striatum, amygdala, OFC, ne-insula (135). Ukuhlaziywa kwangaphambili kwe-meta kwaphawula ukuthi abahlanganyeli abanenkinga yokukhuluphala nezifundo ezinezindlela ezihlukile zokuluthwa kwezidakamizwa babonisa umsebenzi ofanayo owenziwe BOLD e-amygdala nase-ventral striatum ukuphendula izinkomba ezifanele (ukudla ngokukhuluphala nezidakamizwa eziluthayo) (159).
Sekukonke, izifundo zamanje ze-fMRI zinikeza ubufakazi bokuba khona kwezinqubo ze-neural ezabiwe ezihambisana nokukhuluphala nezindlela ezihlukile zokulutha. Ukulawulwa kokuvinjwa okungekuhle ngokuhambisana nokukhula kokuzwela komvuzo nokunakwa kwezinkomba (ukudla noma izidakamizwa) kungahle kube nakho kokubili ukukhuluphala nokukhubazeka okuluthayo.
Ubufakazi bezokwelapha
Ukuphazamiseka Kwe-Binge-Eating
I-Binge-eating disorder (BED) yisifo sokudla esibonakala ngeziqephu ezijwayelekile zokusebenzisa kakhulu amanani amaningi okudla esikhathini esifushane (160). Lokhu kulunywa kuhlotshaniswa nomuzwa wokulahleka kokulawulwa kanye nosizi oluzayo nokungahle kwenzeke. Ucwaningo oluningi lubika ukuthi abantu abane-BED ukubonisa bakhuphula ukuzwela, batshintsha imizwa yokuthola umvuzo, futhi bashintsha ukunaka kokunaka nokwenkumbulo kukukhuthazo okuhlobene nokudla (161, 162). Isibonelo, abantu abane-BED banokulibaziseka okwehlisiwe kokubambezeleka kwemivuzo (163) nokwenza kusebenze kancane ezifundeni ze-PFC ngesikhathi semisebenzi yokulawula inhibitory (164, 165), kuphakamisa ukuthi ukuphoqelelwa kungahle kuhlobane ne-BED. I-BED iveza ukufana kwe-phenotypic ngokuphazamiseka kokusebenzisa izidakamizwa (166). Impela, ukuphazamiseka kokusetshenziswa kwezidakamizwa kanye ne-BED zombili kubonakaliswa ukulahleka kokulawula ukusetshenziswa, kanye nokusetshenziswa ngokweqile kokungasebenzi yize kungaba nemiphumela emibi (167).
Ukuqashelwa ukuthi i-BED ihlanganyela ekuziphatheni kokuziphatha kanye ne-neural nokuphazamiseka kokusebenzisa izidakamizwa kuholele ekusetshenzisweni kwenkulumo ethi "umlutha wokudla," ngokuqondene nabantu abahlangabezana nenqubo yokuxilongwa kwe-BED, kodwa futhi ikakhulukazi njengokuchaza kokukhuluphala. Imodeli igcizelela ukuthi ukudla okune-hyper-palatable kungaholela ekuphenduleni okuluthayo kubantu abasengozini nababhekene nengozi enkulu (168, 169). Ukuhlukahluka komuntu ngamunye “kumlutha wokudla” kungasebenza ngezikali ezinjengeYale Food Addiction Scale (YFAS) (166, 170, 171) noma i-YFAS 2.0 (inguqulo ebuyekeziwe eguqulwe nenqubo ye-DSM-5 yokuphazamiseka okuhlobene nezinto nezinto eziluthayo) (172). Kodwa-ke, imodeli "yokulutha kokudla" kubantu isaphikisana (173-177). Ukugxekwa okukhulu ukuthi imodeli isuselwa kakhulu ezifundweni zezilwane nokuthi uhlobo nobungako bokudla okubonakaliswa “umlutha wokudla” akusilo iqiniso (173, 174, 177). Ngaphezu kwalokho, izilwane ziyaqabukela zibonise indlela yokuziphatha efana noshukela; lezi zindlela zokuziphatha zenzeka kuphela lapho ukufinyelela ushukela kudlula, futhi hhayi ngenxa yomthelela othile we-nosochemical kashukela (177). Lokhu kwehluleka ukubonakalisa lokho okwakha i-ejenti umlutha ekudleni kuholele ekutheni abanye bezethembisi bavunyelwe ukuthi bakhulume ngokubhekisele kulokho okwenzeka ngokuthi “umlutha wokudla” esikhundleni (178). Siphakamise igama elithi "UE" (65). Ngaphezu kwalokho, noma izikolo "eziluthayo lokudla" zixhunyaniswe ngokuqondile nezinyathelo eziningana zokudumile (179), hhayi bonke abantu abanokukhuluphala ngokweqile noma i-BED ekhombisa "umlutha wokudla," futhi, ngakolunye uhlangothi, abanye abantu ababonisa "umlutha wokudla" abayona abakhuluphele (174, 180). UDavis (171) iphakamisa ukuthi "umlutha wokudla" uyisigaba sokugcina sesigcawu sokudla (65) futhi ingamelela i-subtype eyeqile ye-BED. Ngomthambo ofanayo, i-BED ihlotshaniswe kakhulu nokukhuluphala; kepha iBED kungenzeka futhi kubantu abanesisindo somzimba (181). Njengoba kuphakanyiswe izifundo ezedlule, abantu abakhuluphele abane-BED babonakala njengabantu abamele uhlobo oluthile lokukhuluphala oluthile (futhi olunqabile)166, 182). Noma kunjalo, ngenkathi imigqa phakathi kwe-BED, "umlutha wokudla," nokukhuluphala kungachazwa kahle, lezi zimo zibonakala zabelana ngezici ezijwayelekile kufaka phakathi ukungasebenzi kanye nokungasebenzi kahle.
Ukunaka Ukushoda / Hyperaciture Disorder
Ukunaka ukushiyeka / ukuphazamiseka kwethambo kungukuphazamiseka kwengqondo okubandakanya ukunganaki, ukuqina kwento, kanye nokuxoshwa (160). Izifundo ze-Neuroimaging ziphakamise ukuxhumana phakathi kwe-ADHD nokungasebenzi kahle kumasekethe angaphambili. Isibonelo, ucwaningo lwe-anatomical luqaphele ukuthi ababambiqhaza abane-ADHD babonisa ukuqina kwe-cortical ku-PFC, okuhambisana nokusilela kokulawula inhibitory (183, 184). I-comorbidity ejwayelekile ye-ADHD ukuphazamiseka kokusebenzisa izidakamizwa (185-187). Isibonelo, ucwaningo lwe-longitudinal luthole ukuthi izingane nentsha ene-ADHD isengozini ephezulu yokuphazamiseka kokusebenzisa izidakamizwa nokubhema ugwayi ngemuva kokulandela unyaka wokulandela we-10 (188).
Kukhona futhi ubufakazi obukhulayo besixhumanisi phakathi kwe-ADHD nokukhuluphala. Kodwa-ke, lobu budlelwano buhlala buyimpikiswano (189, 190). Umbiko wakamuva we-meta-analytic uthole ubudlelwane obuphakathi kokukhuluphala ne-ADHD ezinganeni nakubantu abadala ngemuva kokulawula ngezinto ezingadangalisa (isib, ubulili, ukwakheka kokufunda, izwe, nekhwalithi yokutadisha) (190). Ngakolunye uhlangothi, okunye ukuhlolwa kwe-meta kwakamuva kubike ukuthi amandla wobudlelwano phakathi kwe-ADHD nokukhuluphala kwakungekho buthaka. Noma kunjalo, usayizi womphumela uyakhula kanye nobudala obukhombisa ukuthi ukuhlangana kunamandla kubantu abadala kunezingane (189). Izifundo ezimbili ezenziwa nge-longitudinal zathola ukuthi abantu abane-ADHD basengozini ephezulu yokukhuluphala kunezilawuli (191, 192). Ukubuyekezwa okuhlelekile kwamuva kutholile ukuthi amandla wobudlelwano phakathi kwe-ADHD nokuziphatha kokudla okulinganiselwe bekuphakathi193). Ngaphezu kwalokho, ukutholakala kwezakhi zofuzo kutholakale phakathi kwe-ADHD, BMI, nokubhema (194). Ukuchaza ukuxhumeka phakathi kwe-ADHD kanye nokukhuluphala, abacwaningi bathole ukuthi lezi zinkinga ezimbili zibonisa izici ezijwayelekile ze-neurocognitive, njengokuxoshwa kanye nokunganakwa (195). UDavis et al. (196) siphinde saphakamisa ukuthi abantu abane-ADHD bangahle bangazinaki izibonakaliso zabo zangaphakathi zokulamba nokuqaqamba, okungaholela ekuzondleni okulandelayo. Kuyathakazelisa ukuthi ukwelashwa ngamakhemikhali kwe-ADHD nge-dopaminomimetics kungahle kube lula ukulawula isisindo ngokuguqula amasignali e-satiety kanye nokuziphatha kokudla (197). Sekukonke, i-ADHD ibonakala ihambisana nokulutha nokukhuluphala ngokweqile kanye ne-neural endophenotypes ebeka phambili kuzo zombili, okuwukuthi, ukuzithiba kokuzibamba nokuxakwa.
Ukucindezela noma Ukuxineka Kwemizwa
Ukucindezeleka kuyingozi eyingqayizivele kukho konke ukuphazamiseka kwengqondo, futhi kunemiphumela ebalulekile ekuqondeni kwethu kwamanje umlutha nokukhuluphala (198, 199). Ucwaningo lukhombise ubudlelwane phakathi kokuxakeka nokufisa ngezidakamizwa (200, 201). Ukuchayeka okungapheli kwezingcindezi zempilo nakho kubikezela ekuguqukeni kokusebenzisa kabi izidakamizwa kuya ekusetshenzisweni kabi kwezidakamizwa (202), futhi kubonakala sengathi kukhulisa ubungozi bokuphinda usebenzise phakathi kwabasebenzisi abahoxisiwe (202). Ukuxineka kungenye yezinto ezibalulekile zemodeli yokulutha okuhlongozwe uKoob noLe Moal (203). Ngokwalolu hlaka, umlutha ungaqalwa njengenqubo eqhubekayo yedysregulation ye-hedonic ne-homeostasis (204). I ukucindezela komoya Umjikelezo uchaza ukuthi ukuqhubeka kokusetshenziswa kwezidakamizwa kanye nokwehluleka ukuzithiba kungadala ukungasebenzi isikhathi eside kohlelo lomvuzo. Njengoba ukusetshenziswa kwezidakamizwa kukhuphuka, iziguli zifinyelela esimweni se-pathological esibonakaliswa ukwanda okungathandeki kokubi kanye nosizi, okukhulunywa ngalo ikakhulukazi ngemuva kokuhoxiswa kwezidakamizwa. Imodeli igcizelela ukuthi lesi simo esinemizwa esiphikisayo siyisisusa esinamandla sokufuna izidakamizwa, ngoba iziguli ezisezingeni elibi lomlutha wezidakamizwa zizosebenzisa izidakamizwa ukuthola impumuzo ekucindezelekeni (203).
Mayelana nokukhuluphala, ubufakazi obukhuphukayo bukhombisa ukuthi ukucindezela kungashintsha amaphethini wokudla (198, 205). Izimo zemood ezingezinhle noma ukucindezeleka okungapheli kukhulisa isifiso sokudla noma izinkanuko zokudla, ukunakwa okukhethiwe kokudla, kanye nezinto ozithandayo zokudla okulula amakhalori (isib, amaswidi noshokoledi) (206-209). Ukwanda kokufunwa kokudla kanye nokusetshenziswa kokudla phakathi kwezimo ezifuna imizwa kungahle kuhambisane neqiniso lokuthi ukudla okubizwa ngokuthi “ukudla okududuzayo” kukhuthaza ukuthuthuka emithethweni emibi (210, 211), ngokuhambisana nemodeli kaKoob noLe Moal. Ubudlelwano phakathi kokucindezelwa nokudla, kepha kuveza ukwehlukahluka okufana ngamehlo. Impela, ukucindezelwa kungahlotshaniswa nesifiso esandisiwe nesinciphile (205), cishe i-30% yesibalo sabantu esibhekene nokunyuka kokudla, i-48% isifiso sokuxakaniseka, kanti okunye alukho ushintsho (212). Ucwaningo luye lwaphakamisa ukuthi ukukhuluphala kwakha isibikezeli esibalulekile sokwanda kokudla ngesikhathi sokuxineka. Isibonelo, ngenkathi ukucindezelwa komsebenzi kuhlobene nokutholwa kwesisindo kubahlanganyeli besilisa abane-BMI ephakeme, ukucindezelwa okufanayo kwengqondo kuholela ekunciphiseni isisindo kubahlanganyeli abaqinile (213). Ekugcineni, abantu abanokukhuluphala ngokweqile babonakala bethola inani eliphakeme lemicimbi yokuphila engemihle nezingcindezi ezingapheli eziqhathaniswa nabantu abazonda (198).
Ukucindezela kusebenza ezindaweni zobuchopho ezibandakanyeka kuzo zombili izinhlangothi zokulawulwa kwesifiso sokudla: uhlelo lomvuzo / wokugqugquzela kanye nezindlela zokulawula inhibitory. Isibonelo, uTryon et al. (214) ithole ukuthi ngenxa yezithombe zokudla ezinamakhalori aphezulu, abesifazane abaphethwe ngukuphazamiseka kwengqondo okuphezulu okwandisiwe kukhuphukile kusebenze ezifundeni zobuchopho ezibandakanyeka emvuzweni nashukumisweni kanye nasekusebenzeni okuncishisiwe ezifundeni zokuqala. Labesifazane babebuye bakhombise ukusetshenziswa okukhulu kokudla okunama-khalori aphezulu ngemuva kweseshini yokuskena. Ngendlela efanayo, Maier et al. (215) ngiqhathanise izimpendulo ze-neural phakathi kwabahlanganyeli ababelwe ingcindezi yokuhlolwa kwelebhu nokuqhathanisa nalabo ababelwe esimweni sokungathathi hlangothi ngesikhathi somsebenzi wokukhetha ukudla. Izinto ezinikezwe ingcindezeli zibeka inani elikhudlwana ekunambithekeni kokudla okwethuliwe. Ngokuhambisana nalokhu, ama-amygdala we-biliveal kanye ne-nucleus engakwesokudla kubonise inani lokunambitheka okuhlobene nokukhethwa okuqine ngokuqinile lapho kuqhathaniswa nababambiqhaza abalawulayo. Ababhali bahumushe lokhu okutholakele njengokuphakamisa ukuthi ukucindezelwa kakhulu kungakhuphula izimfanelo ezijabulisayo zesisusa sokudla (215). Ngaphezu kwalokho, uJastreboff et al. (216) ibone ukuthi abantu abakhuluphele babonisa ukwanda kokusebenza ezifundeni ezi-striatal, insular, kanye ne-hypothalamic ekuphenduleni kwengcindezi nezindlela zokudla ezithandekayo eziqhathaniswa nabantu abancikayo. Lokhu kusebenze okwandisiwe kwe-corticolimbic-striatal ekuphenduleni izinkomba zokudla kanye nengcindezi kuhlangene kahle nokulinganiselwa kokudla, kuphakamisa ukuthi abanye abantu bangaba sengozini enkulu yokudla ukudla okuphezulu kwekhalori ngezikhathi ezicindezelayo (216). Ngesisekelo semodeli yemibono ehlongozwe uSinha noJastreboff (198), izintambo zokudla ezithandeka kakhulu ezihambisana nokuchayeka okungapheli kwengcindezi zingalinganisa imizwa, izimpendulo ze-metabolic (isib. Ama-glucose nama-hormone wokulinganisa amandla), nama-hormone aphendula ukucindezela (isib. i-adrenocorticotrophin cortisol) athonya izifunda zobuchopho ezibandakanyeka emvuzweni, ugqozi, ukuzithiba, nokwenza izinqumo. Ngakho-ke, ukuzwela ukucindezelwa kungenzeka kuxhumane nezinhlelo zemivuzo ukukhuthaza ukusetshenziswa kwezidakamizwa noma ukuzidla ngokweqile (noma bobabili) kubantu ababuthakathaka (217).
Isiphetho
Ubufakazi bokungashayisani
Ngaphandle kokufana okuvezwe lapha kunobufakazi bokuthi ukukhuluphala nezinye izimilo zokuziphatha ezihlukile futhi kungahle kube ngokweqile kuphela (218). Ngenkathi ezinye izifundo zibonile amanani aphakeme wokuphazamiseka okuluthayo kumiphilo yokukhuluphala (219, 220), abanye baye babika ukuntuleka kobudlelwano obukhulu phakathi kokulutha nokukhuluphala (221-224). Izici ze-Way (224) kanye nobunzima obumangalisa bokuqonda kanye ne-heterogeneity ehambisana nokukhuluphala kanye nomlutha (225) kungasiza ukuchaza ukungafani okubonwe phakathi kwezifundo. Izici eziningi (isib. Impulsivity kanye nezimpawu ezicindezelayo) zingaxhumana nokukhuluphala / indlela yokudla ngezindlela eziyinkimbinkimbi okunzima ukuzilandela ezifundweni ezinosayizi omncane wesampula. Lezi zinto zingachaza izifundo eziphikisanayo ezincwadini. Ngaphezu kwalokho, kungenzeka okuthokozisayo ukuthi amanye ama-subtypes wokukhuluphala angaba sengozini ephezulu yokuhlakulela isimilo somlutha (33). Isibonelo, ezinye iziguli ezihlinzwa ngemuva kwe-bariatric zibonakala zibonisa amanani akhulayo ezinkinga eziluthayo (226-228). Le nto ijwayele ukubizwa ngokuthi "umlutha wokuphambuka" noma "ukudlulisa umlutha."
Imikhawulo yokubuyekezwa yamanje kufanele yamukelwe. Ukukhuluphala komzimba kubangelwa ukungalingani okuhlala njalo okuhle phakathi kokudla kwamandla nokusetshenziswa kwamandla. Cishe zonke izifundo zokukhuluphala kanye nokuxineka okuvezwe lapha kuchaza ababambiqhaza abakhuluphele ngokwe-BMI (kg / m2). Ngenkathi iBMI iyisinkomba sokudonswa ngokuphelele, umehluko obalulekile ukuthi kungenzeka ungahlotshaniswa namaphethini wokudla anjengomlutha. Kulesi vein, ngakho-ke kubalulekile ukufaka incazelo yababambiqhaza ngokuya ngokuziphatha kwabo noma amaphethini abo e-UE. Ngaphezulu kwalokho, izimo zemitholampilo ezivame ukubakhona ekukhululekeni ngokweqile, njenge-BED noma i-ADHD azihlaziywa ngokuhlelekile futhi azifakwa kuzo zonke izifundo ezifakiwe ekubuyekezweni kwamanje. Leli phuzu lakha umkhawulo obalulekile ongasusa noma uthambise ukugqama phakathi kokulutha nokukhuluphala.
Ukuphetha Imisho
Umlutha nokukhuluphala kuyinkinga yezempilo enobunzima obukhulu be-phenotypic. Ubufakazi obukhulayo obuvela ebuntwini, ebuchosheni bokuqonda, kanye nezifundo zokucabanga kobuchopho bukhombisa ukuthi ukuhlanganiswa kokuncishiswa kokulawulwa kwengqondo futhi, ngezinga elincane, ukuzwela komvuzo okwandisiwe kuyisici esiyingozi sokuthuthuka nokulondolozwa kwama-syndromes womabili. Lokhu kuyiqiniso ikakhulukazi esizindeni sokulawula ukuqonda (Umdwebo 2) njengoba kulinganiswa yi-Consciciousness dhidi we-Disinhibition factor kumibuzo yemibuzo yobuntu, ngemisebenzi ebonakalayo yokusebenza kwesigungu esiphezulu, noma ukunciphisa ukuncipha kwezindawo ezihambisana nokulawulwa kwengqondo, njenge-PFC yamuva, ezifundweni ze-fMRI. Abantu ababonakala ngokushayela kokudla okuphezulu nokulawula okuphezulu kwengqondo bangase balawule kangcono isisindo somzimba wabo endaweni egcwele ukudla okuthandekayo.
Ukubuyekezwa kwamanje kunikeza umbono ophelele wokushintshwa okuhlobene nokuphoxeka ekukhuluphondeni nasekulutheni, ukumboza imiphumela kusuka ebuntwini, ku-neurocognitive, neuroimaging nasemkhakheni wezempilo. Iziphetho zokubukeza zinamandla okwazisa izindlela zokwelapha okuhloswe ngazo ukuvimbela noma ekwelapheni ukukhuluphala. Ukuzithiba okuqediwe kuyisibikezeli semiphumela yokwelashwa okumpofu kokuphazamiseka kwezidakamizwa (51) futhi futhi singaba munye ekwelapheni ukukhuluphala. Ukutholwa kokubuyekezwa kwamanje kungenzeka, kube nentshisekelo kwabelaphi bezokuziphatha abahlose ukukhuthaza amasu wokulawula ukufaka umfutho kubahlanganyeli abanokukhuluphala. Ukungenelela okuqondile kokuvimbela inhibitory nakho kungamelela indlela ethembisayo yokuvimbela ukukhuluphala kubantu abanokuzithiba okungekuhle nokuzwela okukhulu.
Iminikelo Yomlobi
I-AM: ukuklanywa nokuqanjwa kombhalo wesandla; wabhala umbhalo wesandla; futhi wanikeza imvume yokugcina. I-UV ne-IG: yabhala futhi yahlaziya kabusha umbhalo wesandla; wanikeza imvume yokugcina. I-AD: ukuklanywa nokuqanjwa kombhalo wesandla; wabhala futhi wawubukeza ngokukhulu ukucophelela umbhalo wesandla; ukuphatha ukutadisha futhi obhekene nokuthola imali; futhi wanikeza imvume yokugcina.
Ukungqubuzana kwesitatimende senzalo
Abalobi bamemezela ukuthi ucwaningo lwaluqhutshwa ngokungabikho kobudlelwane bezohwebo noma zezimali ezingase zithathwe njengokungqubuzana okungase kube khona.
Izimali
Lo msebenzi wesekwa yizimali ezisebenzayo ezivela eCanadaan Institutes of Health Research to AD. I-AM ingumamukeli wobudlelwano be-postdoctoral from Canadian Institutes of Health Research.
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Amagama agqamile: ukukhuluphala, umlutha, ukufakwa kwesibindi, ubuchopho, ubuntu kanye nezimpawu zokusebenzisa ubuciko bezinzwa
Ukucaphunwa: I-Michaud A, Vainik U, Garcia-Garcia I ne-Dagher A (2017) Eqa i-Neural Endophenotypes ku-Adiction and obesense. Phambili. I-Endocrinol. I-8: 127. doi: 10.3389 / fendo.2017.00127
Kwamukelwe: 06 Mashi 2017; Kwamukelwe: 26 Meyi 2017;
Ishicilelwe: 14 Juni 2017
Kuhlelwe ngu:
UHubert Vaudry, University of Rouen, France
Review yenziwe ngu:
IGuang Sun, ISikhumbuzo University of Newfoundland, Canada
USusanne E. la Fleur, I-University of Amsterdam, Netherlands
Ilungelo lobunikazi: © 2017 Michaud, Vainik, Garcia-Garcia and Dagher. Le i-athikili yokungena evulekile esatshalaliswa ngaphansi kwemibandela ye Ilayisense ye-Creative Commons Attribution (CC BY). Ukusetshenziswa, ukusatshalaliswa noma ukukhiqizwa kwamanye amaforamu kuvumelekile, uma ngabe abalobi bokuqala noma abanikezeli belayisensi bebanjwa nokuthi ukushicilelwa kokuqala kulo magazini kubhalwe, ngokuhambisana nomkhuba wokufunda owamkelwe. Akukho ukusetshenziswa, ukusatshalaliswa noma ukukhiqizwa okuvunyelwe okungavumelani nale migomo.
* Ukuxhumana: I-Elena Dagher, [i-imeyili ivikelwe]
;