Ukubuyekezwa kokulawulwa kokusebenza komsebenzi kanye nokuphathwa kwemithi kubantwana kanye nentsha. (I-2012)

J Can Acad Ingane Adolesc Psychiatry. 2012 Aug;21(3):223-9.
 
I-Hosenbocus S, Chahal R.

UMnyango Wezengqondo, Isibhedlela SaseRoyal Inland, Kamloops, eBritish Columbia.

abstract

INJONGO:

Ukubukeza yonke imisebenzi nokusebenza kohlelo lwesikhulu (i-ES) kugxile kubukhulu bokusebenza kokuphatha (i-EF) ekuphazamisekeni kwezifo zengqondo ezinganeni nasebusheni kanye nokungenzeka kokushoda okunjalo kusebenza njengophawu lokuphathwa kwemithi.

INDLELA:

Ukubuyekezwa KOKUFUNDA KWENZIWE UKUSETSHENZISWA IMITHI YOKUFUNDA, I-PSYCHINFO, I-CINAHL, I-PSYCHARTICLES KANYE YAMUKELWA NGOKUFUNDA IZIMPAWU: umsebenzi wokuphatha noma ukungasebenzi, izingane noma izingane noma intsha, i-psychopharmacology, umuthi wezengqondo disorder (ADHD), ukudangala, ukungaboni ngaso linye okuphoqayo, izinkinga zokukhathazeka, ukuphefumula disorder, i-schizophrenia, i-autism spectrum ukuphazamiseka (i-ASD), ukuphazamiseka kwe-fetus alcohol spectrum (FASD). Ngenxa yenani elilinganiselwe lemininingwane ethize etholakele ngenxa yokuphazamiseka okuthile kwengane, ukusesha bekubanzi ukuze kufakwe nezincwadi ezindala zabantu abadala lapho ulwazi luphinde lwadalulwa khona.

IZIPHUMA:

Izincwadi eziningi zatholakala ngesimo se-ES kanye ne-dysfunctions ephezulu ekuphazamisekeni kakhulu kwezengqondo ezinganeni nakubantu abasebasha, kepha hhayi kangako ekusetshenzisweni kwemithi. Ukushoda kwe-EF kutholakale ukuthi kuhambelana kakhulu ekuphazamisekeni okufana ne-ADHD, ASD ne-FASD kunakwezinye izinkinga kodwa bekungacaciswanga ngokwanele ukuthi kusetshenziswe njengophawu lwasemitholampilo kulolo kuphazamiseka. Ezinganeni ezine-ADHD ne-ASD bekunemininingwane eyanele yokusetshenziswa kwemithi ye-psychotropic kanye nomthelela kwezinye izizinda ze-EF kodwa imininingwane ngomthelela wezokwelapha e-EF kolunye ukuphazamiseka ezinganeni nasebusheni obuncane ibilinganiselwe. MUkuhlelwa okwenziwa ohlelweni lwe-dopaminergic nakho kukhombisile imiphumela emihle ekushoneni kwe-EF futhi kuvame ukusetshenziswa ekwelapheni ukuphazamiseka kwe-EF njenge-ADHD, ASD ne-FASD.

ISIPHUMELELO:

Izincwadi ezikhona zikhomba ukuthi ukushoda kwe-EF kubhekene nokuphazamiseka kakhulu kwengqondo ezinganeni nasebusheni. Kodwa-ke, kunemisebenzi eminingi yokuphatha exhumene nemisebenzi eminingi nemijikelezo ebuchosheni kangangokuba kunzima ukuyilinganisa ngandlela thile disorder ukusetshenziswa njengamamaki athile walokho disorder. I-ES isebenzisa i-dopamine njenge-neurotransmitter yayo eyinhloko futhi lokhu kunethonya ekuphathweni kwemitholampilo. I-Dopamine ama-agonists (isb. ama-stimulants) nama-antagonists (isib. ama-neuroleptics) yimithi enomthelela oqondile ku-ES futhi ijwayele ukusetshenziswa ekwelapheni ukuphazamiseka kwe-EF ezinganeni nasentsheni ngenkathi imithi ye-serotonergic isib. ukukhetha i-serotonin reuptake inhibitors (SSRIs) akuphumelelanga kakhulu ekwelapheni ukuphazamiseka okunjalo. Ukubona kuqala ukusilela kwe-EF kungaba usizo ekuqondiseni ukuphatha kufaka phakathi ukusetshenziswa kwemithi kulezo zinkinga.

Isingeniso

Izingane ezingenakukhubazeka okubonakalayo kulindeleke ukuba zisebenze ngokohlu lwemithetho nemithetho emphakathini wanamuhla. Muva nje, kube nezinkinga ezikhulayo ezivela kubazali, othisha nakwabanye ochwepheshe ukuthi izingane eziningi aziphenduli kulindelwe okufanele noma zisebenze ngokwanele ekhaya, esikoleni nasemphakathini. Babizwa ngamavila, abangaxhamazeli noma abakhohlwa futhi indlela abaziphatha ngayo kwesinye isikhathi ibhekwa njengey ngamabomu. Ukwehluleka kwabo ukuqala noma ukuqedela umsebenzi, ukuziphatha okuphikisayo okuphikisayo, ukukhathazeka ngokweqile, ukudonsa kwemizwa, ukuncibilika komoya, ukuziphatha okunolaka, izinsongo zokuzibulala / imizamo kanye nezinye izindlela eziphazamisayo kuholela ekutheni bahlolwe futhi baphathwe ngenqwaba yabasebenzi bezempilo yengqondo. Lapho izimpawu zabo zivumelana ne-Diagnostic and Statistical Manual of Mental Disriers (DSM), bayatholakala futhi balawulwe ngokuya kwemihlahlandlela yokusebenza efanele. Inkinga enkulu ebangela eziningi zalezi zimo imvamisa uhlelo oluphathekayo olungenaphutha (ES) (UParker, 2001). I-DSM ayinasigaba sokuxilonga esaziwa ngokuthi “Ukusebenza Okuphezulu Kwezinkinga”. Ngenxa yalokhu, lokhu kusilela kwezingane kwe-EF akuhlolwa kahle futhi kuvame ukusuka kubungcweti kuya kongcweti isikhathi esithile seminyaka ngaphandle kokuzivumelanisa okufanele nokuphathwa kwalokhu kusilela. Lokhu kubuyekezwa kugxile ekushiyekeni kwe-EF okuchazwe ekuphazamisekeni kwengqondo okuvamile kwezingane nentsha nokusetshenziswa kwazo okungenzeka njengesiqondisi ekuphathweni kufaka phakathi ukungenelela ngemithi ye-psychotropic.

Uhlelo Olusaphethe

Ukulawula nokuqondisa indlela yokuziphatha endaweni eshintsha njalo, ubuchopho budinga uhlelo lokuxhumanisa oluphakathi. Tyena u-ES ubhekene nokusebenza kanyekanye kwezinqubo eziningi zokuqonda eziqondisa izinhloso eziqondiswe emgomweni, ekuphatheni umsebenzi, ukuzibamba nokuzithiba kokuziphatha kanye nokuhlela, inkumbulo yokusebenza, ukuguquguquka kwengqondo, ukuvinjwa kokuphendula, ukuphoqelelwa kokulawula nokuqapha ye-action (URobinson, uGoddard, uDritschel, uWisley, noHowlin, ngo-2009). I-EF ibhekisa kumakhono amaningi adingekayo ukulungiselela nokwenza izinto eziyinkimbinkimbi yokuziphatha (U-Ozonoff et al., 2004). Noma ikuphi ukungasebenzi kwe-ES kuthinta i-EF yengane ekwenzeni amandla ayo okuhlaziya, ukuhlela, ukubeka izinto phambili, ukuhlela, ukuqalisa kanye nokuqedela umsebenzi ngendlela efike ngesikhathi. Ukuphatha isikhathi nesikhathi sokuhlangana bese kuba yinkinga enkulu. Lezi zingane zidinga izikhumbuzo njalo ngenxa yezinkinga ngememori yokusebenza. Abakwazi ukushintsha indlela yokuziphatha noma amacebo ngokuya ngokufunwa kwemvelo futhi banobunzima bokuphinda benze enye uhlelo lapho bethulwa yizimo ezintsha noma imisebenzi. Bahlala ikakhulukazi lapha nalokhu, abasebenzelani nokuphikisana kahle futhi abakwazi ukuzivumelanisa nezinguquko noma ukuguqula izimo ngokushesha. Aziguquki kalula, zingabambelela enkambisweni eyodwa, ukugxila emsetshenzisweni owodwa futhi ziqinile ekucabangeni kwazo. Ekusebenzisaneni kwabo nomphakathi balindele ukuthi ontanga yabo kanye nabazali baziphathe ngezindlela ezinokubikezelwa futhi lapho lokhu kungenzeki bazama ukulawula isimo, basabele ngokweqile noma baye esimeni esivaliwe.

I-Neurobiology

I-ES ihlukaniswe ngamanethiwekhi ahlukene endaweni yangaphambili, parietal kanye ne-occipital cortices, i-thalamus kanye ne-cerebellum (UJurado noRoselli, 2007). Ixhunyaniswa ngochungechunge lweziyingi ezixhumanisa zonke izifunda zesistimu yezinzwa ephakathi. Thamasekethe avela ku-dorsolateral prefrontal cortex (PFC) / orbitofrontal cortex (OFC), iphrojekthi nge-striatum, i-synapse esezingeni le-globus pallidus, i-substrantia nigra kanye ne-thalamus kanye ne-thimalus kanye nokubuyela kwe-PFC okwenze ukuthi kube khona okuvulekiles (UNarushima, Paradiso, Moser, Jorge, noRobinson, 2007). Each wesifunda ulawula imisebenzi ethile. Umjikelezo obhekele kakhulu ukuxhumanisa i-EF utholakala ngokuyinhloko kwi-lobe yangaphambili. Izifundo zokucabanga okusebenzayo zenze i-PFC yaba indawo yokuqala yokusebenza kwe-cortical ngesikhathi semisebenzi efaka i-EF (Elliott, 2003).

I-Neurochemistry

Tyena i-PFC ilawula ukunakwa nokuziphatha ngokusebenzisa amanethiwekhi amaseli we-pyramidal axhumene kakhulu ancike kakhulu esimweni sawo se-neurochemical. Izinguquko ezincane kuma-catecholamines, i-norepinephrine noma i-dopamine, zingaba nemiphumela emibi emsebenzini we-PFC (ukungalingani kwamakhemikhali). INorepinephrine ne-dopamine bakhululwa ku-PFC ngokusho kwesimo sengane yomntwana; okuncane kakhulu (ngesikhathi sokukhathala noma isithukuthezi) noma kakhulu (ngesikhathi sokuxineka) kuzokhubaza ukusebenza kwe-PFC. Kukhululwa amanani aphezulu lapho ingane iqaphile futhi inentshisekelo (I-Arnsten, 2009). DI-opamine, i-neurotransmitter eyinhloko ye-ES, idlala indima ebalulekile ku-cortex yangaphambili ekulamuleni i-EF. Ama-dopamine neurons abamba iqhaza ekuguqulweni kokulindelekile, umvuzo, inkumbulo, umsebenzi, ukunakwa, ukushayela kanye nemizwa. Ukuphazamiseka ohlelweni lwe-dopaminergic kudala isisekelo sezifo eziningi zengqondo (UCohen noCarlezon, 2007).

Dysfunction Executive kanye Psychopathology

Ukulimazeka noma ukungasebenzi kahle kwe-lobe yangaphambili nokuphazamiseka ezindleleni ze-fronto-subcortical kusuka ukungalingani kwamakhemikhali kuhlotshaniswe ngokuqinile nokungasebenzi kwe-ES njengoba kuboniswe ngezifundo ze-neuroimaging besebenzisa ukuskena kwe-PET ne-fMRI (Elliott, 2003). Ukusebenza ngokungafanele kukhombisa ukungasebenzi kahle kumasekethe axhumanisa izindawo ezingaphansi kwe-cortical nama-lobes angaphambili (URosenblatt noHopkins, ngo-2006). Zombili izici zofuzo nezemvelo zingaphazamisa ukusebenza kwe-ES.

Ukulimazeka kwe-EF ngaphansi kwe-psychopathology ebonwe ezimweni eziningi zengqondo futhi kuhlotshaniswa ngokuqinile nemiphumela yokusebenza, ukukhubazeka kanye nokuziphatha okuyinkinga okuthile (URoyall et al., 2002). Ukungasebenzi kahle (Executive dysfunction) ngakho-ke kunomthelela ezimpawu eziningi izingane ezingase zilethe nazo (Amarobert, 2006) futhi ixhumene nenqwaba yokuphazamiseka (URobinson et al., 2009).

Ukukhathazeka Kokukhubazeka Kwengqondo (ADHD)

Izingane ezine-ADHD zinobunzima obukhulu ne-EF ezindaweni eziningi kakhulu kangangokuba abanye odokotela bengqondo nodokotela bengqondo bahlongoze ukuthi lo msebenzi ungaphinde uyiqede njenge-EF disorder (UParker, 2011) noma i-EF deficit disorder (IBarkley, 2012). Izinto eziningi ezingasebenzi kahle ezichazwe ekuqaleni zitholakala ezinganeni ezine-ADHD kufaka phakathi ubunzima ngokubheka phambili nokuphatha isikhathi, ukuhlela nenhlangano, ukuqala nokuqedela imisebenzi ngendlela yesikhathi, ubunzima bokususa isethi yokuqonda, izinga eliphakeme lokuhlehlisa, ukukhohlwa nememori engemihle yokusebenza .

Ngokuya mayelana ne-chemacotherapy iningi lezifundo zihambisane nemithi evuselelayo, zombili i-methylphenidate (MPH) ne-dextroamphetamine (D-AMP), ngokusebenza okuthuthukile kwe-EF, ukunciphisa futhi kuvame ukukulungisa imbandezelo yokuqonda neyokuziphatha ezinganeni ezine-ADHD (USnyder, Maruff, Pietrzak, Cromer, noSnyder, ngo-2008). I-EF ihlolwe ezinganeni ze-30 ezine-ADHD; Ama-15 ayengama-navive asetshenziswa ngemithi futhi i-15 ayelashwa ngemithi evuselelayo. Lawa maqembu amabili aqhathaniswa nezilawuli ze-15 ezihambisana nobudala, ubulili kanye ne-intelligence (IQ). Izingane ezingenazo iziqu ezine-ADHD zikhombisa ukungahambi kahle kwengqondo kwimisebenzi eminingana ye-EF ngenkathi izingane eziqondisiwe ezine-ADHD azikhombisanga ukuphazamiseka kunoma imiphi imisebenzi ye-EF ngaphandle kokusilela kwimemori yokuqashelwa kwendawo (UKempton et al., 1999). Umthamo owodwa we-MPH uhlotshaniswa nokwenziwa ngcono kokusebenza kwengqondo kwangaphambi kokubandakanya, kufaka phakathi impumelelo yomsebenzi we-Hearts and Flowers EF nomsebenzi wokubuka okuqhubekayo wokuqhathanisa uma uqhathaniswa ne-placebo (I-Green et al., I-2011). Ukuthuthuka okunjalo ku-EF kungasetshenziswa njengophawu lomphumela womuthi we-psychostimulant ezinganeni ezine-ADHD, uhlobo oluhlanganisiwe (U-Efron et al., 2003).

Umphumela wokwelashwa kwezivuseleli ku-ADHD uhlotshaniswa nemiphumela yabo ohlelweni lwe-catecholamine. Ukungasebenzi kahle kwe-neurotransication ebangela ukungasebenzi kahle kwesikhundla kwenzeka ngenxa yokungajwayelekile kwe-dopamine transporter (USnyder et al., 2008). Wonke ama-pharmacotherapies avunyiwe njengamanje e-ADHD, womabili amandla okuvuselela kanye nezingesiqinisi, asebenza ngokufaka i-neurotransuction ku-PFC (I-Arnsten, 2009). Ezifundweni ze-ADHD, imithamo eyodwa ye-atomoxetine engavuseleli ikhiqize imiphumela ekhethiwe yokuvinjwa kokuphendula ngokungatholakali kwemiphumela yokunaka nememori (UMarsh, uBiglan, uGertenhaber, noWilliams, ngo-2009). Yize i-norepinephrine reuptake inhibitor, i-atomoxetine isebenza ngokuyinhloko nge-preynaptic norepinephrine transporter blockade futhi iphakamise i-dopamine ezindaweni ezikhethiwe zekhokhonathi.

Izinkinga Zokuphazamiseka Kwe-Autism Spectrum (ASD)

Enye yezinto ezibucayi bokuphindaphindeka okuphindaphindeke kakhulu kwengqondo kubantu abatholwa ne-autism ukusebenza okuphezulu. Umsebenzi wakamuva wokuqagela nokusebenza kahle wokuqagela izifundo kanye ne-neuropathology kanye ne-neuropsychology unikeza ukwesekwa okuqinile kokuqina kokubandakanyeka kwe-cortex yangaphambili ku-autism (U-Ozonoff et al., 2004). Ucwaningo oluningi lokuqhathanisa izingane ezine-ASD (i-autism ne-Asperger syndrome) kanye namaqembu wokulawula afanayo we-IQ zikhombisile ukusilela kwe-EF (IHappe, iBooth, uCharlton, neHughes, 2006). Ukufana kokuziphatha phakathi kweziguli ezinezilonda zangaphambili ze-lobe nabantu abane-ASD kuholele emcabangweni wokuthi ezinye zezinto zokuziphatha ezenziwa nsuku zonke nezokuziphatha ezingezona ezenhlalo zibonakala kubantu abane-ASD zingakhombisa ukungasebenzi kahle kwesigungu (URobinson et al., 2009). Ukubuyekezwa kwezifundo ebezihlole ngokucacile amakhono we-EF anjengekhono lokuhlela, ukuguquguquka kwengqondo, inhibition, amandla wokuzihlola kanye nokuzibheka kubantu abane-ASD, kuqhathaniswa neqembu elilawulwa kahle noma idatha yokuhlola ejwayelekile, kubikwe ukusilela kuleso nalezi zizinda (I-Hill, i-2004).

Kunobufakazi obunamandla bokuthi izinto ezingahambi kahle ohlelweni lwe-dopaminergic zihambisana nokushoda kwe-ASD (UDenys, uZohar, noWestenberg, 2004; McCracken et al., 2002). I-Dopamine modulates motor motor, amakhono ukunakwa, ukuziphatha komphakathi kanye nombono wezwe elingaphandle, konke okungajwayelekile ku-autism (U-Ernst, Zametkin, Matochik, Pascualvaca, & Cohen, 1997). Imithi ye-antipsychotic, esebenza kakhulu njengabaphikisi be-dopamine, kufaka phakathi i-haloperidol ne-risperidone kube yizo izidakamizwa ezifundwe kakhulu zokunciphisa izimpawu ze-autism (IMalone, Gratz, Delaney, neHyman, 2005). I-atypical antipsychotic risperidone kwakuyisidakamizwa sokuqala esivunyiwe i-US Food and Drug Administration (FDA) e-2006 ukwelashwa okungaxhunyanisiwe okuhambisana ne-autistic disorder, kufaka phakathi nezimpawu zokucasuka, ukuzilimaza ngamabomu, ukuthukuthela kwemizwa, kanye nokushintsha kwemizwa ngokushesha, izingane nentsha eneminyaka eyi-5 kuya eminyakeni eyi-16. Izingane eziphathwe nge-risperidone zikhombisa ukuncipha ku-stereotypy, hyperactivity kanye nezimpawu ezinolaka ngokuqhathaniswa ne-placebo (UParikh, uKolevzon, noHollander, ngo-2008). Ku-2009, i-aripiprazole yanikezwa imvume yi-FDA ngalesi sibonakaliso. I-Aripiprazole ne-risperidone ngayinye inosayizi omkhulu womphumela wokulashwa kokungahambi kahle, iveza ngokungaqondile ukusebenza okufana phakathi kwezihlanganisi ezimbili (IDouglas-Hall, iCurran, neNyoni, ngo-2011). Ukulawulwa kweSerotonin kufakwe umfutho ekubonakalisweni kokuphindaphindeka kokuziphatha (IKolevzon, Mathewson, & Hollander, 2006). Izilingo eziningana ezilawulwa ngokungahleliwe ezihlolisisa ukusebenza kwe-SSRIs ekwelashweni kokuphindaphindeka kokuziphatha ezinganeni ezine-ASD ziye zabika imiphumela engaqinisekile kodwa ukuhlolisiswa kwe-meta kwezincwadi ezishicilelwe kuphakamise umphumela omncane kodwa obalulekile (ICarrasco, iVolkmar, neBloch, 2012). Futhi, yize kungathathwa njengommeleli wabantu bonke, ucwaningo lwezingane zase-60,641 zase-US ezithola iMedicaid lubike ukuthi i-56% okungenani ibinomuthi owodwa we-psychotropic kanye ne-20% inikezwe umuthi emithathu noma ngaphezulu ngasikhathi sinye. Izidakamizwa ze-Neuroleptic zaziyizo ezisetshenziswa kakhulu (i-31%), zilandelwa ngama-antidepressants (25%) kanye nezivuseleli (22%) (UMendell et al., 2008).

I-fetal Alcohol Spectrum Disorder (FASD)

I-EF ibilokhu ifakwa amandla njengekhadi elishodayo ku-FASD, ukuvezwa kotshwala ebudaleni kungumthelela omubi ekwakhiweni kwecortal yangaphambili (URasmussen noBisanz, 2009). Ocwaningweni lwezingane ze-18 (iminyaka engu-8 iminyaka eyi-15) izingane ezivezwe utshwala bezinezinkinga eziningi ezilinganisweni ze-EF zamakhono wokuhlela, inhibition yokukhetha, ukwakheka komqondo kanye nokubonisana (UMattson, uGoodman, uCaine, uDelis, noRiley, ngo-1999). Izingane ezine-FASD nazo zihlangabezana nobunzima obukhulu ngokuziphatha okuyinkimbinkimbi okubandakanya ukuhlanganiswa kwezizinda eziningi kufaka phakathi ukushintshwa kokuhlela, ukuhlela nokusetshenziswa kwamasu, ukunakwa kanye nememori yokusebenza yendawo, ukusabela okude nesikhathi sesinqumo okuncike ekusebenzeni okufanele kwezingxenye ezahlukahlukene ubuchopho, ikakhulukazi ama-lobes angaphambili (I-Green et al., I-2009).

Awukho umuthi we-psychotropic othize olungiselelwe ukwelashwa kwe-FASD. Ukuvezwa kotshwala ebuntwaneni kuhlotshaniswa nokushoda kwe-EF ezindaweni ezihlala ngaphambili. Unikezwe isixhumanisi sokuphazamiseka kwe-dopamine ne-norepinephrine neurotransmitter kuma-lobes angaphambili (UFrankel, uPaley, uMarquardt, no-O'Connor, ngo-2006) izindlela zokuziphatha ezingezinhle kungenzeka ukuthi ziphendule ezidakamizweni ezithinta uhlelo lwe-dopaminergic kufaka phakathi okuvusayo kanye ne-neuroleptics. Iningi lalaba bantwana livame ukubekelwa inhlanganisela ye-stimulant kanye nesizukulwane sesibili se-neuroleptic (atypical antipsychotic).

Ukucindezeleka

Ukudangala okukhulu (MDD) kuhlotshaniswe nokungasebenzi kahle (Fava, 2003) kanye nekhono elingajwayelekile lokuphambi kwekhambi (van Tol et al., 2011). Nizifundo ze-euroimaging kubantu zisekela i-hypothesis yokuthi i-MDD ihlotshaniswa nesimo sokudluliselwa kwe-dopamine (UDunlop noNemeroff, ngo-2007). Ukucabanga kokuzibulala kuye kwabonwa njenge- "isinqumo esikhulu" esiyingozi esenziwa ngumuntu okhombisa ukungacabangi kokucabanga nokucabanga okungaqondakali, okuwukuthi, umuntu ohluleka ukubona izixazululo zezinkinga ngaphandle kokuzibulala. Njengesikhungo "sokwenza izinqumo zesigungu esiphezulu" sobuchopho, i-lobe yangaphambili ingahle isebenze kahle ezigulini ezifuna ukuzibulala (IHartwell, 2001). Akukho ukwelashwa okukodwa okutholakale kusebenza ngokufana ku-MDD njengoba yi-40% kuphela yeziguli ezithola ukuxolelwa ngesivivinyo sokuqala sokulwa nokucindezela. Yize izifundo eziningana zikhombe uhla lokushoda kwengqondo okungasetshenziswa njengamamaki kwimpendulo ye-SSRI, lokhu akubanga nalusizo emtholampilo kuze kube manje njengoba iphrofayili ye-neuropsychological ebalulekile ephathelene ne-SSRI yokungaphenduli ihlala ingaziwa. Kodwa-ke, iziguli ezinokulimazeka okuthe xaxa kwe-EF zisengozini yokuthola umphumela wokwelashwa ompofu (UGorlyn et al., 2008).

I-Bipolar Disorder

Mayelana neBipolar Disorder (BD), ukuqonda okuphathelene nokuqonda okubandakanya i-EF kuchazwe kuzo zonke izigaba zalo mkhuba. Ukulimazeka kuzizinda ezithile ezibonakalayo ezinjengememori ebonakalayo, inkumbulo yokusebenza nokuziphatha okuthatha ingozi, kubonakale njengokuxosha ngezikhathi zokuphathelene nokukhubazeka kepha ukuphazamiseka kwezinye izindawo ezinjengokunaka okukhethiwe, ukushintshwa kokunaka, ukuhlela ngamazwi, inkumbulo yomlomo, ukuphikelela, isivinini sokucubungula kanye ezinye izinto ze-EF njengokulawula kokuvinjezelwa, ukunqandwa kokuphendula nokucabanga amasu, kungenzeka ukuthi ziqhubeke ngokungakhathaleli isimo samanje semoya (IGoldberg neChengappa, ngo-2009). Okunye futhi ukonakala ezilinganisweni zokungasebenzi kahle (Executive dysfunction) kuye kwabikwa eminyakeni yeshumi nambili ngaphambi kokubonakaliswa kwale nkinga (Meyer et al., 2004). Ukushoda kokuqonda kwengqondo kwe-BD kuhlotshaniswa nezinkinga zokucubungula ukunaka, i-EF nememori ekhuluma ngamazwi ngokugcinwa okuhlobene kweminye imisebenzi enjenge-visuo-spatial memory, fluency verbal kanye nesilulumagama. Ucwaningo lwe-44 euthymic bipolar Outpatients eqhathaniswa ne-46 ifaniswe nezilawuliwe luveze ukuthi ukuphazamiseka kwe-EF kanye nokulahleka kokuvinjwa kungenzeka kube yinto ebalulekile ye-BD noma ngabe ukugula kwesihluku noma imiphumela yemithi (UMur, Portella, uMartinez-Aran, uPfifarre, noVieta, 2007).

Ucwaningo lokubhala ngomthelela wemithi ethile kwi-EF yezingane nentsha kunoma yisiphi isigaba esisodwa se-BD azikhonjwanga kulokhu kubuyekezwa. Kukhona ukungaboni ngaso linye phakathi kodokotela ngenkambo efanelekile yokusebenza noma kwemithi ku-BD ezinganeni. Izinketho zokwelapha zibandakanya ukuqina kwemizwelo (isb. I-lithiamu ne-valproic acid) kanye nama-antiypychotic atypical (risperidone, quetiapine ne-aripiprazole njengoba kuvunyelwe yi-FDA). I-Aripiprazole isanda kuvunywa yi-Health Canada ukuthi isetshenziswe eminyakeni yobudala ye-13-17 iminyaka engu-BD (Mashi 2012).

schizophrenia

Kwi-schizophrenia, ukusebenza kwengqondo kuthikamezeka kakhulu kwiziguli eziningi. Ukushoda kufaka ukungonakaliseki ukunakwa, imemori yokusebenza ne-EF (IGoetghebeur & Dias, 2009). Imicabango engenangqondo, ukukhohlisa kanye nama-hallucinations (izimpawu ezinhle) zihlobene nokuqalwa kokudumba kanye ne-dopamine ngokweqile ebuchosheni. Ukuthuthuka kwezinye kodwa akuzona zonke izizinda zokuqonda ngesikhathi sokulashwa nge-atypical antipsychotic drug clozapine, quetiapine, olanzapine kanye ne-risperidone kuye kwabikwa kwezinye kodwa hhayi zonke izifundo (IHarvey, iNapolitano, iMao, neGharabawi, 2003; ICuesta, iPeralta, neZarzuela, 2001). Ukuqhathaniswa okungahleliwe, okulawulwayo, okungaboni kabili, okuqhathanisa izikhungo eziningi zemiphumela yokuqonda kwe-ziprasidone kanye ne-olanzapine ezigulini ezigula kakhulu ezine-schizophrenia noma i-schizoaffective disorder kukhombisile ukuthi ukwelashwa kungaba nokuhambisana nentuthuko ebalulekile yezibalo kusuka kusisekelo kunaka, inkumbulo, inkumbulo yokusebenza , isivinini sezimoto ne-EF (UHarvey, uSiu, noRomano, 2004). Akukho mehluko obalulekile wezibalo phakathi kwale mishanguzo owatholakala ngobukhulu bokuthuthuka kusuka kusisekelo ngezinga lokuthuthuka kwengqondo (UHarvey et al., 2004). Iziguli ezingamashumi amathathu ezine ezine-schizophrenia ezazingaphenduli ngokwengxenye kuma-antipsychotic ajwayelekile zihlolwe ngebhethri le-neurocognitive eliphelele kufaka nezinyathelo ze-EF: ukufunda ngomlomo nokubonwayo nememori, inkumbulo yokusebenza, ukunakwa okukhethekile, ukunakekelwa okuqhubekayo, ukucubungula / ukubona ngemoto kanye namakhono emoto, ngaphambili Ukwelashwa nokulandela ukwelashwa nge-olanzapine ye-atypical amasonto ayisithupha nezinyanga eziyisithupha kamuva. I-Olanzapine yathuthukisa okunye kepha hhayi konke ukusilela kokuqonda ku-schizophrenia kufaka imemori yomlomo (UMcGurk, uLee, uJayathilake, noMeltzer, ngo-2004). Izimpendulo azange zibonakale zingashintshi noma zisho ngokwanele ukuba lusizo njengophawu lwanoma imuphi umuthi.

Ukuphazamiseka Okucindezelayo Okucasulayo (i-OCD)

I-OCD ihlotshaniswe nokungasebenzi kahle okuxhumene ne-neuropathology yezindlela ze-fronto-striatalways (UChang, McCracken, noPiancentini, 2007) kepha ukukhonjwa kwezinkinga ezejwayelekile bekungahambelani nemibiko ehlukahlukene. Ukushoda okuvamile kubonakala sengathi kunobunzima ekuvinjelweni kanye nekhono lokuguquguquka kokushona yize amandla okuhlela abonakala engathinteki. Zimbalwa izifundo eziye zathola ukungahambi kahle okunjalo ezinganeni ezine-OCD futhi kulolo cwaningo olushicilelwe imiphumela ixubekile (Ornstein, Arnold, Manassis, Mendlowitz, & Schachar, 2010). Isibonelo, okutholakele kwimemori esebenzayo kanye nokushelelayo komlomo bekungahambelani. Kokunye ukuhlola, okuhlobene nokulawula, intsha ene-OCD ibonise ukusilela kwendawo okubonakalayo kufana neziguli ezinezilonda zangaphambili ze-lobe. Ucwaningo lwesibili aluzange lubike ukuthi luphazamisekile ebhethri elibanzi le-neurocognitive elifaka izindlela eziningana ze-EF (Chang et al., 2007). Olunye ucwaningo alutholanga mehluko phakathi kwezingane ezine-OCD nezilawuli (U-Andres et al., 2007). Ucwaningo lwakamuva (U-Ornstein et al., 2010) zezingane ze-14 ezine-OCD nezilawuli ezinempilo zikhombise ukuthi izingane ezine-OCD zikhombise amandla afanayo kwizizinda ezahlukahlukene zokulawula nokusebenza kwememori okuyiqiniso.

Kuze kube manje, ama-SSRIs ahlala eyindlela ephumelela kunazo zonke yokwelapha izimpawu ze-OCD yize umthelela wazo ekushayweni kwe-EF ungacaci. Olunye ucwaningo luye lwaphakamisa ukuthi i-serotonin idlala indima enkulu ekusebenzeni kwama-lobes angaphambili ngokwenza lula ukuxhumana kwemininingwane kusuka kolunye i-neuron kuye kolandelayo (UHuey, Putman, noGrafman, 2006) nangokuxhumana kwayo ne-dopamine (UDunlop noNemeroff, ngo-2007).

Izinkinga Zokukhathazeka

Ngokuqondene neziguli ezinenkinga yokuxhalaba, akukho ukuthikamezeka okukhulu kokutholwa okutholakele uma kuqhathaniswa nontanga abanempilo, futhi umlando wokuphila kokuphazamiseka kokukhathazeka ungahlotshaniswa nokukhubazeka kwengqondo (UCastaneda et al., 2011). Isimo se-EF ekuphazamisekeni kokukhathazeka nasekucindezelekeni okubambekayo nokukhathazeka asikacaci (van Tol et al., 2011).

Ingxoxo

Lokhu kubuyekezwa kukhombe ukusilela ku-EF ezimeni eziningi zengqondo ezinganeni nasebusheni futhi kubathole ukuthi kwenzeke kaningi futhi ngokungaguquki ezimweni ezifana ne-ADHD, ASD ne-FASD. Le "trio" ibonakala ihlanganyela ukungasebenzi okujwayelekile nokuziphatha, futhi ngalesi sikhathi ngokuhamba kwesikhathi kungabhekwa njenge- "Executive Function Disways". Ukushoda kulezi zinkinga kuqubuka ekuphazanyisweni kwe-frontal-subcortical kubandakanya ikakhulu i-neurotransmitter dopamine. Lokhu kunomthelela ekuphathweni kwemitholampilo ikakhulukazi ekuqondiseni ukukhetha kwemithi. Ukwelashwa komugqa wokuqala we-ADHD kuseyimithi evuselelayo (IHosenbocus & Chahal, 2009), ngenkathi kuphazamiseka ukuphazamiseka kwemizwa okwenziwa ngemithi yemithi emibili evumele ukusetshenziswa kwe-FDA ku-ASD yi-risperidone ne-aripiprazole, futhi bobabili basebenza ukuqinisa uhlelo lwe-dopaminergic. Ama-stimulants angama-dopamine agonists, i-risperidone ingumphikisi we-dopamine, futhi i-aripiprazole iyi-dopamine ingxenye yokulinganisa i-agonist / antagonist. Womabili la makilasi emithi avame ukusetshenziswa ngokubambisana ekuphathweni kwe-ADHD, ASD ne-FASD. Kuyaqabukela ukuthola ingane enenkinga ye-EF ithatha zombili iziqandisi kanye ne-risperidone ngasikhathi sinye. Ngokuzayo, ngokubheka izizinda ezihlukile ngaphakathi kwe-EF, kungenzeka ukucacisa uhlobo lokushoda kulezi zinkinga futhi ukhiphe amaphrofayili we-EF ahlukile ()U-Happye et al., 2006) ezingaba wusizo ngokomtholampilo. Lokhu kungashintsha indlela izingane ezilawulwa ngayo ezine-EF ezilawulwa ngayo. Kwezinye izinkinga ezifana ne-OCD, MDD ne-BD ukushiyeka akuhambelani futhi kuhlanganiswa nezinkinga zangaphambi kokuziphatha noma i-co-morbid. Imodeli yokudangala-Executive dysfunction (DED) ebikezela ukuthi ukuba khona kokungasebenzi kahle kuhlotshaniswa nokuphendula okumpofu ekwelashweni kwezokwelapha akubanga ubufakazi obutholakalayo (UMcLennan noMathias, 2010). Lokhu ngeshwa njengoba ubukhona bokushoda okuthile kwe-EF kungenzeka kube yinkomba ekusetshenzisweni kwemithi ekucindezelekeni. Kodwa-ke, ama-SSRIs okuwukuphela kwemithi elwa namagciwane asetshenziswa kulolu cwaningo futhi kuze kube manje iningi lama-SSRIs liye langenza kabi ekwelapheni i-MDD ebuntwaneni, mhlawumbe ngoba ukudangala kungahle kuhlotshaniswe nokushoda okuqinile kwi-dopaminergic ES okungukuthi ama-SSRIs angabhekeli kuyo ikakhulukazi.

Awukho umuthi owodwa oye wakhonjwa njengowenzelwe ukulungisa noma ukuthuthukisa zonke izici ze-ES kunoma yisiphi isimo esisodwa. Ama-stimulants angasiza ngokunaka futhi alawuleke ngethonya, ama-antiypychotic ama-atypical noma ama-anticonvulsants ngokuqina kwemizwelo, ukucasuka, ukuphinda enze okuthile noma ulaka nama-SSRIs nokukhathazeka ngokweqile nokuziphatha okuphindaphindayo kepha umuthi owodwa awukwazi ukukwenza konke. Akuyona into edabukisayo ukuthola zonke lezi zimpawu zibakhona enganeni eyodwa futhi nemithi ihlanganiswa ukulawula izimpawu eziningi ngangokunokwenzeka okuholela “ekhemisi.” Ukusetshenziswa kwemithi ye-Psychotropic ezinganeni nasebusheni kuyaqhubeka kuyindawo yezingxabano futhi sesha okumaka okungokwethenjelwa okumaka, kufaka phakathi ukuthi ngabe ukushiyeka kwe-EF okuthile kungadlala le ndima, ukuzithethelela ukusetshenziswa kwayo kuyaqhubeka.

Iya ku:

Izincomo

Ukushoda kwe-EF kungaphansi kokuphazamiseka kakhulu kwengqondo futhi kufanele kukhonjwe ekuqaleni kwenqubo yokuhlola ngaphambi kokuhlela uhlelo lokuphatha. Ukwazi ukuthi yikuphi ukusweleka okungaphenduli kumuthi othile noma isilinganiso sendawo ezungezile kuzokwenza ukusetshenziswa kwezinye izinsiza noma amasu abalulekile ukuphatha ukusilela okunjalo futhi, ngethemba, kuholele kumphumela ongcono. Ngaphandle kwalokho, ukuthembela ekusetshenzisweni kwemithi yodwa ukwenza umehluko kubeka ukulindelwa okungadingekile kulo muthi futhi kungaholela ekudumazekeni lapho impendulo inganelisi noma i-"poly-pharmacy" emzamweni wokuhlanganisa zonke izimpawu eziyinkinga. Kubalulekile njalo ukuhlanganisa umuthi namanye amasu wokuphatha futhi uqinisekise ukuthi umuthi noma noma iyiphi inhlanganisela yemithi ayithinti ukusebenza kwengqondo okudala ukuphazamiseka okuthe xaxa.

Ukuhlola okuhlelekile kwe-EF kuvame ukwenziwa ngudokotela wezengqondo noma nge-neuropsychologist esebenzisa ukuhlolwa okuhleliwe okufana ne-Behavior Rating Inventory of Executive Function (BRIEF), Developmental Neuropsychological Battery (NEPSY II) noma amanye amabhethri wokuhlola we-neuropsychological. Ngeshwa izisebenzi ezinjengalezi kungenzeka zingatholakali kalula ezikhungweni eziningi futhi izingane zihlala ezinhlwini ezinde zokulinda ukuze zihlolwe. Kodwa-ke, uhlelo lokuphatha kudingeka lusethelwe ngokushesha nje lapho ingane ibonakala. Ngokungahleliwe, imininingwane ewusizo ku-EF yengane ingaqoqwa emithonjeni ehlukene kufaka phakathi eyodwa ku-interview eyodwa lapho izici ezahlukahlukene zomsebenzi wengane ezinjengamakhono enhlangano, ukulawulwa kokuthinta, ukucubungula imininingwane, amandla okuhlela, izinga lokuguquguquka, amandla okusuka umsebenzi ukwenza umsebenzi, ukuqala umsebenzi / ukuqeda, ukuphatha isikhathi kanye nekhono lokuxazulula izinkinga kwengane kuyabonakala futhi kubhalwe phansi. Amandla akhe okwenza imisebenzi eyinkimbinkimbi yokuphila kwansuku zonke nawo angahlolwa ngokwethukela. Izimpawu ezithambile zemithambo yemithi zingaphakanyiswa futhi namasampula omsebenzi abukezwe. Amaphepha emibuzo ahleliwe, izinhlu zokuhlola noma izikali zokulinganisa ezifana ne-Barkley Deficits in Executive Functioning Scale — Izingane Nabafana (BDEFS-CA) nazo zingasetshenziswa noma nini lapho kungenzeka. Ngokuhlela imininingwane eqoqwe, iphrofayili yengane ye-EF ingahlanganiswa ndawonye futhi isetshenziswe ekumiseni uhlelo lokuphatha ngenkathi kulindwe ukuhlolwa okusemthethweni.

Ukushoda kwe-EF, uma sekutholakele, kufanele kuxoxwe ngayo nengane (noma nini lapho kusebenza), abazali nabanye ababanakekelayo kubandakanya nothisha. Ekuphazamisekeni kwe-EF, ukuqonda okulungile kokushoda kungaholela ekwamukelweni okungcono kanye nokuhambisana nokuhambisana nezimo noma indawo yokuhlala edingekayo ekhaya, esikoleni nasemphakathini ukuze kugwemeke ubunzima noma izimo ezinzima. Ukusetshenziswa kanye nomthelela wezokwelapha kokushoda okuthile noma izindawo eziqondiwe, lapho kukhonjisiwe, kufanele kucaciswe kanye nokulinganiselwa kwabo kanye nesidingo sokwelashwa okufanayo. Kwezinye izinkinga, kubalulekile ukusetha uhlelo lokuqeqeshwa kwabazali ukuze kufundiswe amasu wokuphatha njengezindlela ezingaguquki zephula imisebenzi yezinyathelo eziningi ukunciphisa ukukhungatheka futhi kusetshenziswe indlela yokubambisana yokuxazulula inkinga phakathi kwengane nomnakekeli ukuze kugwenywe ukulwa kwamandla nokuqhuma izimilo (Greene, 2005). Amasu ajwayelekile wokuba ngumzali nokulawulwa kokuziphatha okusebenzela izingane ezijwayelekile, kufaka phakathi imivuzo noma imiphumela, awuzange ube nempumelelo enkulu nezingane ezinenkinga yokuphazamiseka kwe-EF. Futhi ukwelulekwa kanye ngeviki ngaphandle kwemizamo yokufaka indawo yokuhlala “kumaphoyinti wokusebenza” esemqoka kuzilungiselelo zemvelo akunakwenzeka ukuthi kuphumelele isiguli esingenayo i-EF (IBarkley, 2012). Ukuphatha okusebenzayo kudinga ukuthi kube nemodi ejwayelekile lapho kusondelene nezinhlangano eziningi nabasebenzi abaqeqeshiwe ukudonsa izinsiza zabo ndawonye futhi baxhumane ngokubambisana ngaphandle kokudiliza noma ukunikela imiyalezo exubile enganeni nakubazali. Alikho ikhambi lokungasebenzi kahle futhi ukwelashwa kumele kuqhubeke impilo yonke (UJones, 2000). Izingane ezinenkinga ye-EF zingafinyelela umuzwa wempumelelo futhi zigweme ukungena ebunzimeni inqobo nje uma zisekelwa ngomunye umuntu, umzali, uthisha, umeluleki noma umngani ukuze zisebenze njenge “surrogate frontal lobe” ukuze ziqondise futhi ziqhubeke zilandelana. . Ukucwaninga okugxile ekutheni izimpawu ezibonakalayo zihlangana kanjani nokushoda kwe-EF ethile kunomthelela obalulekile ekungeneleleni kokusebenza kwengqondo okuzayo kule ndawo ngokugcizelela imigqa engaphansi ye-neural kanye nemizila esekela i-Symbomatology (U-O'Grada noDinan, ngo-2007).

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