Neurosci Biobehav Rev. I-2019 Jun 24. pii: S0149-7634 (19) 30370-7. doi: 10.1016 / j.neubiorev.2019.06.032.
I-Brand M1, Wegmann E2, Stark R3, UMüller A4, I-Wölfling K5, Robbins TW6, Potenza MN7.
Amaphuzu avelele
- Ukuziphatha okuluthayo kuxhunyiwe ekusetshenzisweni kokunye nokufisa
- Ukuziphatha okuluthayo kuhlangene nokulawulwa kokunciphisa kokuvinjelwa
- Ukuziphatha okujwayezwayo kuthuthukiswa phakathi kwezindlela zokuziphatha umlutha
- Ukungalingani phakathi kwezigcawu ze-fronto-striatal kunomthelela ekuziphatheni okuluthayo
abstract
Siphakamisa ukuthi kubuyekezwe imodeli evumelekile ye-Interaction of Person-Afitive-Cognition-Execution (I-PACE), ethi siyasebenza izinhlobo ezithile zokuziphatha umlutha, njengokugembula, ukugembula, ukuthenga, kanye nokuziphatha okuya ocansini okuphoqayo ukuphazamiseka. Ngokusekelwe ekutholakaleni kwakamuva kokucatshangelwa kokucabanga kanye nokucatshangelwa kwethiyori, siphikisana ngokuthi izindlela zokulutha ziyakhula njengomphumela wokusebenzisana phakathi kokuguquguquka okusobala, izimpendulo ezivumayo nezokuqonda zokucabanga okuthile, nemisebenzi ephezulu, njengokulawulwa kokuvinjezelwa kanye nokwenza izinqumo. Ehlelweni lokuziphatha okuluthayo, izinhlangano eziphakathi kokulungiswa kabusha / ukunxanela kanye nokuncipha kokulawulwa kokuvinjwa kufaka isandla ekuthuthukiseni isimilo. Ukungalingani phakathi kwezakhiwo zemibuthano ye-fronto-striatal, ikakhulukazi phakathi kwe-ventral striatum, i-amygdala, nezindawo eziphambi kwekhaya, kungahle kuthintane ikakhulukazi nezigaba zokuqala kanye ne-dorsal striatum kuzigaba zakamuva zezinqubo eziluthayo. Imodeli ye-I-PACE inganikeza isisekelo somqondo wokucwaninga kwesifundo esizayo ekuziphatheni okuluthayo nasekuziphatheni komtholampilo. Izifundo zesikhathi esizayo kufanele ziphenye izindlela ezijwayelekile nezingafani ezibandakanyekile ekuluthweni okuphathelene nomlutha, okuhlobene nokuphoqelela, ukulawulwa kokuthatheka, kanye nokuphazamiseka kokusebenzisa izidakamizwa.
KEYWORDS: Imilutha yokuziphatha; ukuphazamiseka kokuthenga; ukwenziwa kabusha kwecue; ukuphazamiseka kokugembula; ukuphazamiseka kwemidlalo; control inhibitory; ukusetshenziswa kwezinkinga zobulili ezingcolile
I-PMID: 31247240
1. Isingeniso
Imodeli yokuxhumana kwe-Umuntu-Afitive-Cognition-Rulection (I-PACE) yokuphazamiseka kokusebenzisa i-Intanethi yashicilelwa eminyakeni engaphezu kwemibili edlule (I-Brand et al., 2016b). Inhloso eyodwa kwakuwukuchaza izinqubo ezingokwengqondo nezobuchwepheshe ezenzelwe ukuthuthukiswa nokulondolozwa kokusetshenziswa okulimazayo kwezicelo ezithile ze-Intanethi, njengalezo ezisetshenziswa lapho kudlalwa umdlalo wokugembula, ukugembula, ukubuka izithombe zobulili ezingcolile, ukuthenga nokuthenga kanye nezinkundla zokuxhumana. Kusukela kushicilelwa imodeli ye-I-PACE, ibilokhu icashunwa kaningi ngabacwaningi emhlabeni jikelele hhayi kuphela ngokuphazamiseka kwemidlalo (isib. U-Deleuze et al., 2017; UDieter et al., 2017; Dong et al., 2019; Kaess et al., 2017; U-Lee et al., 2018a; U-Lee et al., 2018b; Li et al., 2018; UPaulus et al., 2018; USariyska et al., 2017), kepha futhi nokuphazamiseka kokugembula (isib. Ioannidis et al., 2019b; Starcke et al., 2018), ukuphazamiseka kokuziphatha kobulili okuphoqelekile kufaka phakathi ukusetshenziswa okuyinselele kocansi (isib. Izinkomo nothando, 2017; Strahler et al., 2018; UWryry et al., 2018), ukuphazamiseka kokuthenga (isib, ILam & Lam, 2017; UVogel et al., 2018), ukusetshenziswa ngokweqile kwezicelo zokuxhumana (isib. Dempsey et al., 2019; U-Elhai et al., 2018; IKircaburun & Griffiths, 2018; I-Montag et al., 2018; URothen et al., 2018), isiphithiphithi sokusetshenziswa kwe-inthanethi okungacacisiwe (isib, UCarbonell et al., 2018; U-Emelin et al., 2017; Ioannidis et al., 2019a; Lachmann et al., 2018; Vargas et al., 2019; UZhou et al., 2018b), nezinye izindlela zokulutha kufaka phakathi ukuphazamiseka kokusebenzisa izidakamizwa (UZhou et al., 2018a). Uhlelo lweshumi nanye lwe-International Classization of Diseases (ICD-11), njengoba sekukhishwe maduze (I-World-Health-Organisation, i-2019), igxile kokuphazamiseka ngokwayo (isib. ukugembula ukuphazamiseka) ngaphandle kokubhekisa esikhathini sokuphazamiseka, ngokwesibonelo, ukuphazamiseka kwemidlalo esikhundleni sokuphazamiseka kwemidlalo ye-Intanethi kuhlelo lwesihlanu lwe-Diagnostic and Statistical Manual (DSM-5) (I-APA, i-2013). Ku-ICD-11, imvelo yokuziphatha ingahle ichazwe njengokungaxhunyiwe ku-inthanethi kakhulu noma ekuxhumekeni kwe-inthanethi kakhulu ekuphazamiseni ukugembula nokudlala. Ngenxa yalokho, imodeli echaza izinqubo ezingezansi zokuziphatha okuyinkinga kufanele isebenze kuyo yonke indawo eku-inthanethi nokungaxhunyiwe ku-inthanethi kanye nokuhlanganiswa kokuziphatha okungaxhunyiwe ku-inthanethi nakwe-inthanethi. Siyaqhubeka nokuphakamisa ukuthi indlela yokuziphatha uqobo eyiyona nto eyisisekelo okufanele icatshangwe nemvelo (eku-inthanethi nokungaxhunyiwe ku-inthanethi) kungahle kube okuphezulu kepha kungaba nomthelela obalulekile ekubonakalisweni kokuziphatha okuthile okuluthayo nokwehluka okuvamile kuyo yonke le mikhuba (UBaggio et al., 2018). Siphakamisa ukuthi kubuyekezwe imodeli ye-I-PACE, esisebenza ngayo ukuthi izovunyelwa hhayi kuphela ekuphazamiseni ukusetshenziswa kwe-Intanethi, kepha nezinye izinhlobo zokuziphatha umlutha. Le modeli ye-I-PACE ebuyekeziwe igxile kwezindlela zokuziphatha nezengqondo zomuntu ngamunye. Izici eziphathelene nemidiya kanye nezinye izici zemvelo ezihlobene nokuziphatha okungenza kusheshise noma kunciphise ukuthuthuka kokuziphatha umlutha kungachazwa futhi kuchazwe izinhlobo ezithile zemodeli. I-Fig. 1 lifingqa umehluko ohlongozwayo phakathi kwezici eziphakathi nendawo / zemvelo, ukusabela komuntu ngamunye, nezici zokuziphatha nezomqondo ezibandakanyeka ekuziphatheni okuluthayo.
I-Fig. 1. Ukwehlukanisa izici zemvelo, ukusabela komuntu nomuntu, kanye nemiphumela yokuziphatha okuphindaphindiwe okuqondile ngokuhamba kwesikhathi. Imodeli ebuyekeziwe ye-I-PACE igxila ekusizeni komuntu nasemiphumeleni ethintekayo ekwenziweni kokuziphatha okuluthayo.
Ngaphezu kwalokho, sihlose ukucacisa ngokusobala umlingiswa wenqubo yemodeli ngokuhlukanisa imodeli engezansi ezimbili, enye yezinqubo ezithintekayo ezigabeni zokuqala kanye nenye yezinqubo ezibandakanyekayo ezigabeni zakamuva zenqubo yokulutha. Asiphindi ingxoxo eningilizayo yazo zonke izakhi ezifakiwe kumodeli ye-I-PACE (cf. I-Brand et al., 2016b). Esikhundleni salokho, sigxila kakhulu ezindabeni zakamuva kakhulu, ikakhulu ukuhlaziya kwe-meta nokubuyekezwa okuhlelekile okuphefumule ukuvuselela kwe-I-PACE.
I-2. Imodeli ebuyekeziwe ye-I-PACE yokuziphatha okuluthayo
Ukuvuselelwa kabusha kwemodeli ye-I-PACE kufaka phakathi izinyathelo ezintathu eziphambili. Okokuqala, sigxila kokuguquguqukayo okungenakuqhathaniswa nakho, okuye kubhekwe njengokubandakanyeka ezinhlotsheni ezihlukile zokuziphatha okuluthayo (ukuphazamiseka kokugembula, ukuphazamiseka kwemidlalo, nabanye) futhi ukuhlukanisa phakathi kokuhlukahluka okuphathelene nokuziphatha okukhethekile. Okwesibili, sichaza ngokunemba umbuthano wangaphakathi wenqubo yokulutha kumodeli ye-I-PACE maqondana nokutholakele kwakamuva. Okwesithathu, sahlukanisa phakathi kwezigaba zokuqala zenqubo ukuze sifanekise kahle izindima ezingafani zokushintsha nokuguqula okuguqukayo ngokuya esigabeni sokulutha. Imodeli ebuyekeziwe ye-I-PACE yokuziphatha okuluthayo iyakhonjiswa ku I-Fig. 2. I-Fig. 2I-A ikhombisa ukusebenzisana phakathi kokuguquguqukayo okubhekwa njengokubaluleke kakhulu ezigabeni zokuqala zokuziphatha okuluthayo. I-Fig. 2B bonisa ukusebenzisana kwezinto eziguquguqukayo ezigabeni zakamuva zezinqubo eziluthayo.
I-Fig. 2. Imodeli ebuyekeziwe ye-I-PACE yokuziphatha okuluthayo. Umdwebo A ukhombisa izigaba zokuqala zokukhula kwezimilo zokuziphatha. Umdwebo B ukhombisa izigaba ezilandelanayo zenqubo nezinto ezifaka isandla ekugcinweni kokuziphatha okuluthayo. Imicibisholo yeBolder ibonisa ukuxhumana okuqinile / izindlela ezisheshayo.
I-2.1. Ingxenye ye-P yemodeli ye-I-PACE
Isakhi se-P simele izakhi zomuntu ezingaphakathi ezibandakanya ukubandakanyeka enqubweni yokulutha njengokuguquguquka okusobala (bona ingxoxo ku I-Brand et al., 2016b). Ukuguquguquka okujwayelekile okusobala (uhlangothi lwesobunxele ebhokisini elingenhla lemodeli) kungaba nomthelela obalulekile kuzo zonke izinhlobo zokuziphatha okuluthayo (isib. Ukugembula, ukungalawuleki kwezemidlalo, ukuphazamiseka kokuthenga, ukuphazamiseka okubuka izithombe zobulili ezingcolile / i-hypersexual). Uhlu lwalezi zinto eziguquguqukayo ezingase zivele alupheli. Sifingqa kuphela okuguquguqukayo okukhona ukuthi bukhona ubufakazi obubanzi, kufaka phakathi okucubungula i-meta, noma ngabe ubufakazi bungahluka ngokwamandla ezinhlobonhlobo zokuziphatha okuluthayo. Imininingwane iphakamisa umnikelo obalulekile wofuzo ekubandakanyekeni kokugembula (Lobo, 2016; Potenza, i-2017, 2018; UXuan et al., 2017) kanye ne-inthanethi engacacisiwe yokusebenzisa i-inthanethiHahn et al., 2017). Ngaphezu kwalokho, okuhlangenwe nakho okungekuhle kwesencane kubikwe njengezinto ezisengcupheni yokuphazamiseka kokugembula (URoberts et al., I-2017) kanye nokuphazamiseka kwemidlalo (Schneider et al., 2017), okutholakele kuhambisana nokucatshangelwa kwamuva kwe-theory kwendima yokunamathiselwa kukuziphatha okuluthayo (I-Alvarez-Monjaras et al., 2018). Izixhumanisi zokuxineka kwengqondo, ikakhulukazi ukucindezelwa kanye nokukhathazeka komphakathi, kuye kwabikwa kaningi ngokugembula (I-Dowling et al., 2017), amageyimu (Männikkö et al., 2017), ukusetshenziswa kwe-inthanethi okungacacisiwe (Ho et al., 2014), kanye nokuthenga-ukuthenga (UMüller et al., 2019) ukuphazamiseka, nokunye ukuluthwa kokuziphatha (I-Starcevic neKhazaal, 2017). Izici zokushisa, ezinjengokuxwila okuphezulu, nazo zihlotshaniswa nokugembula (I-Dowling et al., 2017), amageyimu (UGervasi et al., 2017; UKuss et al., 2018; URyu et al., 2018), nokusetshenziswa kwe-inthanethi okungacacisiwe (UKayiş et al., 2016) ukuphazamiseka, njengoba kunezitayela ezingalungile zokwenza umsebenzi wokuphamba onesifo semidlalo (Schneider et al., 2018). Kumodeli ye-I-PACE, sisebenzisa amagama ajwayelekile (isib. I-psychopathology, izici zokufudumeza kufaka, isibonelo, impulsivity) okungacaciswa ngokuqhubekayo ngokuqondene nokuziphatha okuthile okuluthayo. Ukuhlukahluka okucacile kokuziphatha (uhlangothi olungakwesokudla lwebhokisi eliphezulu kwimodeli, I-Fig. 2A no-B) kubhekwa njengophawu lokuziphatha okuhlukile okuluthayo. Isibonelo, abantu abafuna amanoveli aphezulu bangahle bahlakulele ukuphazamiseka kokugembula (UDel Pino-Gutiérrez et al., 2017). Abantu abanobudlova obuphakeme kanye nezimpawu zobuntu obuhle bangathambekela kakhudlwana ekuthuthukiseni ukuphazamiseka kwemidlalo (UGervasi et al., 2017). Abantu abanesisusa esiphakeme sokukhuthala kwezocansi kungenzeka bathola ukuthuthuka kokuziphatha noma ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile (I-Stark et al., I-2017), kanye nabantu abanamanani aphezulu wokuthanda izinto ezibonakalayo kungenzeka bathambekele ekuthuthukiseni ukuphazamiseka kokuthenga (UClaes et al., 2016; UMüller et al., 2014).
I-2.2. Umbuthano ongaphakathi: Izakhi ezithinta imodeli (A-), ukuqonda (C-), nokubulawa (i-E) imodeli ye-I-PACE
Umqondo owodwa oyisiyingi sangaphakathi semodeli ye-I-PACE ukuthi ukuthuthuka kokuziphatha okunenkinga futhi okuluthayo kwenzeka kuphela ekuxhumaneni phakathi kokuguquguquka okusobala kwabantu nezici ezithile ezilethwa yizimo ezithile. Ukuxhumana kuholela ekuhlangenwe nakho kokugculiswa nokunxeshezelwa okuhambisana nokuziphatha okuthile. Ezigabeni zokuqala (I-Fig. 2A), abantu bangabona okungaphandle (isb, ukuxabana nokuvusa okuhlobene nokuziphatha) noma izingqinamba zangaphakathi (isib. Izimo ezingezinhle noma ezinhle kakhulu) ezimeni ezithile. Imibono ingahle ibangele izimpendulo ezivumayo nezokuqonda, njengokuthi kunakwa ukunakwa kulezi zivuseleli futhi kunxusa ukuthi ziziphathe ngezindlela ezithile; isib unxusa ukudlala imidlalo eku-inthanethi noma ukubuka izithombe zocansi (Starcke et al., 2018).
Izimpendulo ezisebenzayo neziqondayo ziholela ezinqumweni zokuziphatha ngezindlela ezithile. Isinqumo sokubandakanyeka ekuziphatheni okuthile singaholwa yizinqubo ezimbili ezisebenzisanayo: uhlelo olungamukeleki / olusebenzayo, olususelwa kakhulu ekufundeni okuhlanganayo (isimo sokwedlule nesokusebenza), kanye nohlelo olukhombisa / olubumbene, oluxhumene kakhulu nokucabanga kanye imisebenzi ephezulu (I-Kahneman, 2003; I-Schiebener & Brand, 2015; I-Strack & Deutsch, 2004). Emuntwini onomlutha, indlela yokuziphatha ibhekwa njengeya ngokuya ngezinhlelo eziphoqelelayo / ezisebenzayo ze-neural, kubandakanya izakhiwo ze-limbic (UNoël et al., 2006). Ukulawulwa kokuhlobene kokuvimbela okuhlobene ne-preparal-cortex okuphathelene nezifiso nezifiso kungancipha ngesikhathi senqubo yokulutha (U-Bechara, i-2005; IVolkow neMorales, 2015). Ukuhlanganisa le mibono yemibono, siphakamisa ukuthi ubudlelwano phakathi kwezimpendulo ezibambekayo nezingqondisi kweziwumbono zangaphandle noma zangaphakathi kanye nezinqumo zokuziphatha okuthile kuhlolwe ngezinga lokulawulwa kokuvinjelwa okujwayelekile (ngokuhlukile kokulawulwa kokuthintela okuthile okuqondile) Ukuzithiba / ukuziqondisaHahn et al., 2017), okungenani ezigabeni zokuqala zokuziphatha okuluthayo. Ukuhlaziywa kwe-meta okwenziwe nguMeng, Deng, Wang, Guo, kanye noLi (2015) kukhombisa ukuthi ukungasebenzi kahle kwangaphambi kwesikhathi kuhlotshaniswa nokuphazamiseka kwemidlalo, okubonisa ukungqubuzana okukhona phakathi kokulindela umvuzo nezinhlelo zokuzithiba, kubandakanya izingxabano ezibandakanyeka ekubambezelweni kokuzanelisa (IVolkow neBaler, 2015). Mayelana nokulawulwa jikelele kwe-inhibitory, Yao et al. (I-2017) bika ukuguqulwa kwengqondo okusebenzayo nokuhlelekile ekuphazamisekeni kwemidlalo okuxhumene nokunciphiswa kokusebenza okuphezulu. Ukuziphatha okuqondile (isib. Ukudlala umdlalo online, ukugembula ekhasino, izinto zokuthenga) kungaholela emizweni yokwaneliseka noma ukukhululeka ezimeni ezingemihle (ILaier & Brand, 2017). Lokhu okuhlangenwe nakho okushintsha kamuva okulindelwe komvuzo okulindelwe okuhambisana nokuziphatha okuthile. Zingahle futhi ziguqule isitayela sokukopela komuntu ngamunye. Isibonelo, uma abantu befunda ukuthi ukudlala imidlalo eku-inthanethi kuyasebenza ukukhiqiza imizwa enhle noma ukugwema isimo esingesihle sokomoya, bangahle benze isilinganiso esilinganiselwe sokuthi ukudlala imidlalo online kuyasiza ekubhekaneni nemizwelo empilweni yansuku zonke (UKuss et al., 2018; Laier et al., 2018). Ushintsho lwezinto ezilindelwe nezitayela zokubhekana nazo zingakhulisa amathuba okuphendula ngemizwa noma imizwa yesifiso ezimweni ezilandelayo lapho kubhekwana nezimbangi zangaphandle noma zangaphakathi. Lokhu kuhlangana kokulangazelela okuhlangenwe nakho okulindelwe kuboniswe ngabantu abanophawu oluphakeme lokusetshenziswa okuluthayo kwemisebenzi yokuxhumana nge-inthanethi (Wegmann et al., 2018b). Ngokuhamba kwesikhathi, lezi zinhlangano phakathi kwezimpendulo ezivumayo nezengqondo, izinqumo zokuziphatha ngezindlela ezithile, okuhlangenwe nakho kokugculiswa nokunxeshezelwa kanye nokulindelwe okuqondene nokuziphatha kungaqina. Ngenxa yalokho, ukulawula izindlela zokuziphatha ngamasu wokuvimbela ajwayelekile kungaba nzima kakhulu, futhi izinqumo zokuziphatha ngezindlela ezithile zingaqondiswa kakhulu izimpendulo ezingaphoqi / ezisebenzayo zokuthi zibangele. Izindlela ezihlongozwayo ukuthi zibambe iqhaza ezigabeni zakamuva zokuziphatha okuluthayo zifingqiwe ku I-Fig. 2B.
Ezigabeni zakamuva zenqubo yokulutha, noma kungenzeka ukuthi ukuguquka kube kancane, izinhlangano ezisanda kuchazwa zingaqina kakhulu, okuholele ekuziphatheni okungazenzakaleli okungazizwa kuzenzakalela ezimweni ezithile. Ukwenza kabusha okuthile nokulangazelela kungavela kusuka kuzimpendulo ezisebenzayo nezokuqonda ngokuhamba kwesikhathi ngenxa yemiphumela yokuma kwezimo (Starcke et al., 2018). Ucwaningo lwangaphambilini luqokomisa iqhaza elibalulekile lokuzwela ebhekise kulokho okuhlobene nomlutha nokusebenza ezinhlelweni zemivuzo ye-neural efaka i-ventral kanye ne-dorsal striatum nezinye izakhiwo ze-limbic kukuziphatha okuluthayo (UFauth-Bühler noMann, 2017; UFauth-Bühler et al., 2017; Luijten et al., 2017; UPalaus et al., 2017). Ukulindela izinto okungenzeka kungaguqukela ekubandakanyekeni okuhlobene nokubonakalayo, okungahlanganisa ukunakwa okukhethiweyo noma okubonakala sengathi kuzenzakalelayo kokuthintekayo nezihlose okuhlobene nokuziphatha (UJeromin et al., 2016). Siphakamisa ukuthi imiphumela yokuncenga ibe namandla ngaphezu kwemiphumela egculisayo ezigabeni zakamuva zenqubo yokulutha (cf. I-Brand et al., 2016b). Ngokungeziwe emiphumeleni yokulinganisa yokulawulwa kokuvinjwa okujwayelekile ebudlelwaneni obuphakathi kokukhumbula kabusha / ukufisa nokuziphatha okujwayelekile, siphakamisa ukuthi ukulawulwa kokuvimbela ukubekelwa inhibitory kungasebenza njengomlamuli ezigabeni zakamuva zenqubo yokulutha (I-Everitt neRobbins, 2016). Abaphenyi abaningana bagcizelele ukungahambi kahle kokulawulwa kokuvinjwa kwemisebenzi nemisebenzi eyongamele ekulweni nokugembula (Ioannidis et al., 2019b; van Timmeren et al., 2018), ukuphazamiseka kwemidlalo (U-Argyriou et al., 2017; UKuss et al., 2018; Yao et al., 2017), kanye nokuphazamiseka kokusetshenziswa kwe-inthanethi okungacacisiwe (Ioannidis et al., 2019a). Siphakamisa, noma kunjalo, ukuthi yize ukulawula okujwayelekile kokuvinjwa kungancipha futhi ngenkathi kwenziwa izinqubo zokulutha, ukuthuthukiswa kokunciphisa okuhlobene nokuvuselela okuhlobene nokuvuselela kuhileleke kakhulu ekuziphatheni okuvamile ezigabeni zakamuva zokuziphatha umlutha. Siphakamisa ukuthi uma ukwenziwa kwe-cue-reacaction kanye nokulangazelela kwenziwe njengezimpendulo kuma-trigger angaphandle noma angaphakathi, lokhu kungaholela ekunciphiseni kokulawula isifiso lapho kubhekwana nesisusa somlutha, esingakhuphula amathuba wokuziphatha okuvamile (I-Piazza neDeroche-Gamonet, 2013).
I-3. Amasu we-Neurobiological
I-3.1. Ithiyorios yesayensi yokulutha ihlanganiswe embuthanweni ongaphakathi wohlobo lwe-I-PACE
Imibono eminingana ye-neurosci science kanye nemodeli echaza izindlela zokulutha umlutha ihlanganiswe ohlakeni lwethiyori lwesiyingi sangaphakathi semodeli ye-I-PACE (I-Brand et al., 2016b). Izixhumanisi eziqondile zingabonakala ku Ukuvinjwa Ukuphendula Ngokuvinjelwe kanye Salience Attribution (I-RISA) imodeli (IGoldstein neVolkow, ngo-2011), Khuthaza Ukuzwela (URobinson neBerridge, ngo-2008), Umvuzo Ukuntuleka kwesifo (I-Blum et al., 1996) amamodeli nemibono, nangezinqubo ezi-nqubo ezimbili zokulutha (U-Bechara, i-2005; I-Everitt neRobbins, 2005, 2016) nemibono yokungalingani phakathi kokuziphatha nemikhuba eqondiswe kugoli (URobbins et al., 2019). Siphinde futhi sibheke ezicini zamamodeli athile acwazimisayo ahlanganisa ukucatshangelwa kwe-neurosci science yongcakazo lokugembula (IBraszczynski & Nower, 2002; I-Goudriaan et al., I-2004) kanye nokuphazamiseka kwemidlalo (UDong & Potenza, 2014; Wei et al., 2017). Kuhlanganisa lemibono, sibheka kuchubeka kwekungalingani emkhatsini wekukhulisa tifiso letisuselwa ekucondzisweni kanye netifiso ngakolunye uhlangothi kanye nokwehla kwesimo sekuvimbela lokutsite lesicondzile kuletinkhanuko kanye netifiso ngakolunye uhlangothi njengokubaluleke kakhulu ekuthuthukiseni nasekugcinweni kwezimilo zokuziphatha. Khulisa ukuzizwa kokukhuthaza, ngenxa yezinqubo zokuma (I-Berridge et al., I-2009), ingahlangana nokubandlulula okubhekisisa nokubuye kwenziwe kabusha kwezigaba ezilandela izinqubo zokulutha. Abantu abanokushoda kwemivuzo kungenzeka bathambekele ekuthuthukiseni ukuzwela kokukhuthaza (I-Blum et al., 2012). Ukuqina kwesisusa kungakhuthaza ukusebenziseka kabusha nokulangazelela, okungaba nomthelela ekuzibandakanyeni ekuziphatheni okuluthayo.
Ukuncishiswa kwemisebenzi ephezulu kuthathe zombili njengezinto ezingabeka engcupheni nemiphumela yokuziphatha okuluthayo kubandakanya ukuphazamiseka kokusebenzisa izidakamizwa (I-Volkow et al., I-2012). Ezimisweni zokuziphatha, ezinjengokugembula kanye nokuphazamiseka kwemidlalo, umuntu angaphikisa ukuthi ukuncishiswa okuphezulu kwakha izici zokuzibeka engcupheni futhi kungathuthukisi njengomphumela wokuziphatha okuluthayo, ngoba akukho mthelela oqondile ohlobene nezinto ezihlobene nobuchopho ebuchosheni obandakanyekayo. Ngokuhambisana nalomqondo, siphakamisa ukuthi izinga elehlisiwe lokulawulwa kokuvinjwa okujwayelekile liyinto ebekeka engcupheni yokuziphatha okuluthayo futhi lisebenza njengokuhlukahluka kobuhlobo phakathi kwezimpendulo zokubambisanayo ekuvuseleleni okuthile okudala (isib, ingcindezi noma imizwa engemihle) nezinqumo eziya baziphathe ngendlela ethile (bheka I-Fig. 2A). Ngaphezu kwalokho, noma kunjalo, siphikisana ukuthi ngaphandle kwalomphumela olinganiselayo wemisebenzi yesikhundla njengento engabekeka engcupheni yokuluthwa, ukulawulwa kokuvinjelwa okuqondene nesimo (lapho kubhekwana nezinkinga ezihlobene nomlutha) kungancipha ngokuhamba kwesikhathi njengomphumela wokuziphatha okuluthayo. ngokungafani nokuphazamiseka kokusebenzisa izidakamizwa - akukho miphumela eqondile ebuchosheni ebandakanyeka ekuluthweni kokuziphatha. Ukwehliswa kokulawulwa kokuvinjezelwa okuqondile kungakhula ngokusekelwe ekusetshenzisweni kokunye nokulangazelela futhi kuhambisane nokushintsha kobuchopho okusebenzayo kumasekethe ahlobene nomlutha (Ersche et al., 2012; IKoob neVolkow, ngo-2010; IVolkow neMorales, 2015; I-Volkow et al., I-2012). Ngakho-ke, ezigabeni zakamuva zokuziphatha okuluthayo (I-Fig. 2B), izinqubo zokulawula izinhibitory eziqondile ezingathonywa ngokulangazelela nezinxephezelo ezihlobene nokuhlangabezana nogqozi oluhlobene nomlutha, okungenza ukuthi kube lula ukuthi umuntu aziphathe ngendlela evamile noma ebonakalayo ngokuzenzakalelayo (I-Everitt neRobbins, 2005, 2013, 2016).
I-3.2. Izixhumanisi ze-Neural zezinqubo eziphambili ngaphakathi kwendilinga yangaphakathi yemodeli ye-I-PACE
Lokhu kushiwo ngenhla kokungalingani phakathi kwezigcawu zobuchopho ezigxile ekuzuzeni umvuzo kanye nokulawulwa kwangaphambi kokuluthwa kokuziphatha kubukezwe kakhulu ngobunzima bokugembula (UClark et al., 2013; I-Goudriaan et al., I-2014; Potenza, i-2013; van Holst et al., 2010) kanye nokuphazamiseka kwemidlalo (UKuss et al., 2018; Weinstein, 2017; Weinstein et al., 2017), kufaka phakathi ukuhlaziya kwe-meta (I-Meng et al., I-2015). Yize kuncane kakhulu, kukhona futhi izifundo ezinesimilo zokuziphatha kocansi okuphoqayo, kufaka phakathi ukusetshenziswa kwezinkinga zocansi okuyinkinga (isib. I-Brand et al., 2016a; I-Gola et al., 2017; Klucken et al., 2016; Schmidt et al., 2017; I-Voon et al., I-2014), ezihlolwe kuzibuyekezo zakamuva (I-Kraus et al., I-2016; I-Stark et al., I-2018). Izifundo zesayensi zokuhlobana kwe-neural kokugula kokuthenga-okuncane ziyindlala. Kukhona, kepha, ezinye izifundo ezivela ekubonweni kwengqondo yabathengi (isib., URaab et al., 2011) kanye nezifundo ezisebenzisa izindlela ze-electrophysiological ukuphenya izindlela ze-neurobiological ze-buy-Shopping disorder (I-Trotzke et al., 2014) ezibuyekezwe kamuva nje (UKyrios et al., 2018; I-Trotzke et al., 2017). Yize ingakaziwa njengesimo sezempilo, kukhona futhi okushicilelwe kwakamuva kokutholakala kokuhlelekile nokusebenzayo kokusetshenziswa okungalawulwa kahle nenkinga yezingosi zokuxhumana nomphakathi nezinye izinhlelo zokusebenza zokuxhumana nge-inthanethi (isib. UDieter et al., 2017; U-et al., 2017; Lemenager et al., 2016; I-Montag et al., 2017; I-Montag et al., 2018; UTurel noQahri-Saremi, 2016), ezibuyekezwe yi Wegmann et al. (2018a).
Kunokuhlukahluka okukhulu ocwaningweni lwe-neuroimaging lokuziphatha okuluthayo mayelana nezinhlobo zokuziphatha okuluthayo, amasu asetshenzisiwe (isib., I-imagical imagon imaging imaging [s / fMRI], i-positron emission tomography [PET]), okuqanjwa ngokwengqondo noma izinqubo zentshisekelo. , imisebenzi yokuhlola esetshenziselwa ukukala imisebenzi ethile, amasampula afakiwe (amasampula alula nabantu abonisa amabanga ahlukahlukene ezimpawu ngokuqhathaniswa nabantu abatholwa noma abaguli abafuna ukwelashwa), nezinqubo zokuxilonga ezisetshenzisiwe. Noma kunjalo, lapho kufinyelelwa eziphethweni ezivela ezifundweni, ukuhlaziya ama-meta nokubuyekezwa (bheka, ngokwesibonelo, izingcaphuno ezingenhla), kunobufakazi bokuqala bokubandakanyeka kwe-hyperactive kwezakhi ze-limbic, kufaka phakathi i-amygdala kanye ne-ventral striatum, kanye nokujikeleza okusebenzayo kwe-prerialal precyalal. ngokulawulwa kwengqondo kokuziphatha. Kukhona, noma kunjalo, kukhona emigedeni ethile, ngokwesibonelo ukuzibandakanya okuphathelene nokujikeleza kwemivuzo ngesikhathi sesigaba sokulindela ukucubungulwa kwemali (IBalodis nePotenza, 2015), abanye abacwaningi bephakamisa ukungezwani okuhlobene nokucutshungulwa kwezindlela zokwenziwa umlutha (ukuphendula ngomvuzo ophikisayo) kanye nezinkokhelo ezinemivuzo ezingaphenduki umlutha (ukuphendula okuvuzayo komvuzo) (Limbrick-Oldfield et al., 2013). I-insula ingaba ngumlamuli phakathi kwalezi zinhlelo ezimbili (i-limbic ne-prerial-striatal), emele amazwe athile axhunyaniswe nokufisa kanye nesifiso sokuziphatha ngqo (bona ingxoxo ku Namkung et al., 2017; Wei et al., 2017). Izakhiwo eziphambili eziye zakhonjwa njengezingaxhunyaniswa ngobuchopho obuthile bokuziphatha okuluthayo zifingqiwe ku I-Fig. 3.
I-Fig. 3. Imijikelezo yobuchopho okungenzeka icashunwe ngokuziphatha. Imicibisholo ye-Orange imele imigwaqo ephambili ehlongozwayo ukuthi ibambe iqhaza ezigabeni zokuqala zenqubo yokulutha. Imicibisholo eluhlaza okwesibhakabhaka ikhombisa ukubandakanyeka okwengeziwe kwe-dorsal striatum kanye nezinhlaka ezihlobene ezigabeni zakamuva zenqubo yokulutha, lapho izimilo zijwayela. I-ACC = i-cterex ye-anterior cortex, i-AM = amygdala, i-DLPFC = i-dorsolateral prewardal cortex, DS = dorsal striatum, GP = globus pallidus, Hipp = hippocampus, Ins = insula, Motor = motor cortex kanye nezifunda ezihambisanayo zokuziphatha. I-Rap = i-serotonergic raphé nuclei, SN = substantia nigra, Thal = thalamus, VMPFC = i-cortex ye-ventromedial precental preortal, VS = indawo ye-ventral striatum, i-VTA = indawo ye-dopaminergic ventral.
Ekuhlaziyweni kwakamuva kwe-meta kokusebenza kwengqondo okuhlobene nokusebenza kwengqondo ku-fMRI-izifundo ezinamasampula eziguli ezinemilutha yokuziphatha ngokuqhathaniswa nezihloko zokulawula (Starcke et al., 2018), i-dorsal striatum (i-caudate nucleus) ibisebenza kakhulu kubantu abanomlutha ngokuqhathaniswa nalawo ngaphandle nangaphakathi kwabantu abanemilutha lapho beqhathanisa isimo esihlobene nomlutha nesimo sokungathathi hlangothi emisebenzini yokuphinda yenziwe. Okutholakele kungabonisa ukushintshwa kusuka ekubambeni iqhaza kwe-ventral striatum kuzinqubo zokuqala zokuluthwa kokuziphatha lapho kubhekwana nesisusa esihlobene nokulutha ekubandakanyekeni kwe-dorsal striatum ezigabeni zakamuva zokuphazamiseka, lapho isimilo senzeka kakhuluI-Everitt neRobbins, 2013, I-2016; U-Zhou et al., 2019). Izakhi zobuchopho nemijikelezo engase ibe nokuziphatha okuluthayo futhi kususwe kusuka ezigabeni zokuqala kuya kwamuva zenqubo yokulutha kuboniswa ngamabomu I-Fig. 3.
Ukuxhumana okugcwele phakathi kwezakhiwo ze-fronto-striatal kuhlolwe kusetshenziswa ukuphenya kwesimo se-fMRI sokuphumula ngezihloko ezinempilo futhi kukhonjisiwe ukuthi kubandakanyeka ekuguqukeni kokuziphatha (UMorris et al., 2016). Lemibuthano ibuye ihambisane ngokubanzi namanethiwekhi okusebenza abandakanyeka kummiselo wesimo (Öner, 2018). Izinguquko zokuxhuma phakathi kwezakhiwo ezithile ezibandakanyeka kumjikelezo we-fronto-striatal (isib. Ukuxhumana phakathi kwe-amygdala ne-medial PFC) zibukeka zibalulekile ekuchazeni ukungahambisani kwemizwa kokuphazamiseka kokusebenzisa izidakamizwa (I-Koob, i-2015; UWilcox et al., 2016). Ukuxhumeka kwamanethiwekhi abandakanyeka kulawulo lokuqonda (amasekethe we-fronto-parietal nezindawo zangokwendabuko) nasekwenzeni imbuyekezo (kufaka nezinhlaka ezingekho ngaphansi kanye ne-limbic) kukhonjisiwe futhi ukubikezela ukungaziphathi kahle kokuphazamiseka kokusebenzisa i-cocaine ngemuva kokwelashwa (U-Yip et al., 2019). Ukwahlukaniswa okunamandla kwamanethiwekhi womabili ahilelekile kulawulo oluphezulu nokuzwela komvuzo kuhlongoziwe ukuthi kuguqulwe ngokuziphatha futhi kunciphe ukubekezelela, okungachaza imiphumela engcono yokwelashwa (U-Yip et al., 2019).
Ngokufingqa, siphakamisa ukuthi ukungalingani kumasekethe okwenziwa kube nokuguquguquka kokuziphatha kanye nemizwelo / isimemo somthetho kuhlobene nezinto eziphambili zokuziphatha okuluthayo. Izindlela zihlanganisa ukuqagelwa kwe-dopaminergic kusuka endaweni yangaphakathi ye-ventral tegmental kanye ne -antiantia nigra kuya ezindaweni zangaphambili, i-ventral striatum, kanye ne-anterior cingulate gyrus kanye ne-serotonergic proion kusuka kwi-raphé nuclei ukuya ezindaweni ezingaphambili (ikakhulukazi izindawo ezi-orbitofrontal) (I-Everitt neRobbins, 2005; I-Volkow et al., I-2012; I-Volkow et al., I-2013). Ukuxhumana phakathi kwezakhiwo zestriatal, i-thalamus, nezindawo zangaphambili kuxhomeke kakhulu ku-glutamate ne-gamma-aminobutyric acid (GABA) (Naaijen et al., 2015), nezinhlelo ze-neurochemical ezibandakanyeka kuziphatho ze-fronto-striatal loops zisebenza ngemfashini ekhonjiwe kanye nemikhawulo (UGleich et al., 2015). Izixhumanisi ze-Neurochemical of addictions ziye zaxoxwa kakhulu kwenye indawo, futhi izifundo eziningi zigcizelela indima ebalulekile ye-dopamine ekuphazamiseni ukusetshenziswa kwezidakamizwa (UHerman noRoberto, 2015; Pascoli et al., 2018; I-Volkow et al., I-2016). Okutholakele maqondana ne-dopamine ekuluthweni kokuziphatha, nokho, kungamandla amancane (Potenza, i-2018).
Yize kushicilelwe inani eliyisisekelo lezifundo zokuhlobana kwe-neural zokuziphatha okulimazayo eminyakeni yamuva nje, kusasele ukulinganiselwa okufanele kushiwo. Okokuqala, ucwaningo oluningi luye lwashicilelwa ekulweni nokugembula kanye nokuphazamiseka kwemidlalo (bheka amazwana ngenhla). Ubufakazi obuncane bukhona obunye bokuluthwa kokuziphatha kufaka phakathi izindlela zokuziphatha zocansi eziphoqayo kufaka phakathi ukusetshenziswa kwezinkinga zobulili ezingcolile, ukuphazamiseka kokuthenga, nezinye izinto ezingakahlonishwa njengezimo zekliniki, njengokusebenzisa okuyizingqinamba izingosi zokuxhumana nabantu. Ikakhulu, izifundo eziphenya ngokuhlelekile izixhumanisi ze-neural zemisebenzi ethile yengqondo (isib. Ukuthanda, ukulawula inhibitory) kuzo zonke izinhlobo ezithile zokuluthwa kokuziphatha azikho. Ucwaningo oluphenya izigaba zezinqubo zokulutha noma ukwedlula uphawu njengababikezeli noma ukumodareyitha okuguquguqukayo kwemisebenzi ye-neural kanye nokulimazeka kwengqondo okungakhekile kubalulekile ukuqonda kangcono izindlela ezilandela ukuqhubekeka kokuziphatha okuluthayo. Ngokuhambisana nalokhu, izifundo ezinde zobuchopho ekuxhumeni kobuchopho kokuziphatha okuluthayo okuhlola imiqondo ethize azikho. Ukuphenya ngokushintshwa okungenzeka kusuka emsebenzini we-ventral kuya kwasesithombeni esiyisidakamizwa njengempendulo kuzintambo ezihlobene nomlutha kuzo zonke izinhlobo zokuluthwa kokuziphatha nakuzo zonke izigaba ezahlukahlukene zokuluthwa, kusetshenziselwa ukwakheka kobubanzi besigaba nobude obude, kungasiza ukuqonda kangcono uhlobo lomlutha izimilo. Ucwaningo olunjalo luyadingeka ukwehlukanisa ukuguquguquka okungaba khona kusuka ekufiseni kuya ekucindezelweni nasekutheni ulangazelele ukwaneliseka kulindele ukukhululeka ezizweni ezingezinhle lapho uhlangabezana nesisusa esihlobene nomlutha ezigabeni ezahlukahlukene zokuluthwa umkhuba wokuziphatha, okufanele nawo kusize ekwenzeni ukwelashwa kube ngcono. Ucwaningo oluqhathanisa izinhlobo ezahlukahlukene zokuziphatha umlutha kanye nezigaba ezahlukahlukene zenqubo yokulutha kufaka phakathi izifundo ezingahle zivele futhi zingaphenya ukubandakanyeka okuthe xaxa kokuncishiswa kokulawulwa kokuvinjwa njengento engabekeki engozini futhi / noma njengomphumela wokuziphatha okuluthayo, kanye nalokho okungase kube phakathi kokuxhumeka phakathi kwesibambiso izimpendulo kanye nokuziphatha okujwayelekile / okuphoqayo (bheka izingxoxo ku I-Everitt neRobbins, 2016).
I-4. Isiphetho nezinkomba ezizayo
Imodeli ye-I-PACE ebuyekeziwe iyindlela yokuqhathanisa yokuchaza inqubo yokuziphatha okuluthayo ngokuhlanganisa imibono yezengqondo neyezinzwa yokuphazamiseka kokusebenzisa izidakamizwa kanye nokuluthwa kokuziphatha. Sibheka ukuphazamiseka ngenxa yokuziphatha okuluthayo kube wumphumela wokusebenzisana phakathi kwezimpawu zomuntu kanye nokuguquguquka okuningana nokulamula, okungahle kube namandla futhi kuthuthuke ngokuhamba kwesikhathi njengomphumela wokuzibandakanya ekuziphatheni okuthile. Siphakamisa ukuthi imodeli ye-I-PACE yokuziphatha okuluthayo ingasebenziseka ocwaningweni lwengqondo nolwezinzwa ngoba ivumela ukwakheka nokuhlolwa kwezimpawu ezicacile maqondana nemiphumela yokuhlangana kokuguquguquka okuthile ekuchazeni umehluko ekubonakaleni kokulimala kokuziphatha. Imodeli futhi ingakhuthaza ukuzijwayeza emitholampilo (cf. King et al., 2017; Potenza, i-2017) ngokuchaza nangokuphenya okuguquguqukayo okungahle kwenzeke okungamelela imigomo ebalulekile yokwelashwa (isb. okulindelekile, izimpendulo ezihambelana nalokhu nezimbangela). Imodeli ye-I-PACE ebuyekeziwe futhi inikezela ngamathuba okuthola izizatho ezisekelweni zenqubo yokulutha (zombili ngesikhathi sokuqhubekekela phambili nokululama), ngokwesibonelo ngokuthi ukuncipha kwenqubo ethile yokulawula ukubekelwa amandla kushesha ezigabeni zakamuva ekuqhubekeni kwezinqubo zokulutha. Kubalulekile ukuqaphela, noma kunjalo, ukuthi sibheka amamodeli wethiyori njengoshukumisayo. Ukuba semthethweni kwama-hypotheses athile, ahlanganiswe ohlakeni lwe-theoretical, kufanele kuhlolwe ngokubonakalayo, futhi amamodeli we-theoretical kumele avuselelwe ngokubheka okutholakele kwakamuva kwesayensi kusukela ekuboneni okuhlukile.
Okubalulekile ukukhumbula ukuthi imodeli yethiyori ehlongozwayo isuselwa kumazinga ahlukahlukene obufakazi besayensi maqondana nokuziphatha okuluthayo. Njengoba kushiwo ezingxenyeni ezedlule, ukubandakanyeka kwezinqubo ezithile ezingokwengqondo nezinqubo ze-neurobiological kufundwa kahle kugembula nokuphazamiseka kwemidlalo futhi kuphenywa kakhulu kwezinye izinhlobo zokuziphatha ezingaba umlutha, ngokwesibonelo ukusetshenziswa kwezithombe zobulili ezingcolile, ukuthenga nokuthenga nomphakathi -Kusebenza. Ngaphezu kwalokho, kwezinye izici nezinqubo eziphakanyisiwe kumodeli ye-I-PACE ebuyekeziwe, amazinga ahlukahlukene obufakazi akhona. Ngemisebenzi ephezulu yokulawula nokulawula inhibitory, inani elikhulu kakhulu lezifundo lisebenzise ama-paradigms wokuhlola futhi lihlole izici ezithile zomsebenzi wokusebenza eziphezulu ezinhlobonhlobo zokuziphatha okuluthayo. Ngakolunye uhlangothi, ngokubuyiselwa kwezinto ezibucayi nokufisa ekuziphatheni okuthile okuluthayo, ezinye izifundo zisebenzise ukwakheka kokuhlobanisa, okwenza ukutolika kokudala nesikhathi sokuthuthuka kokuphinda kwenzeke futhi okufisa inqubo umlutha kube nzima ukuchaza (UZilberman et al., 2019). Uma ucubungula lokhu kukhawulelwa kubalulekile ukugcizelela ukuthi imodeli ehlongozwayo iyimodeli yase-theoretical efingqa isimo samanje sokwecwaninga kokuziphatha kokuziphatha futhi ihlose ukuvuselela izifundo ezisekela theory ezisuselwa esikhathini esizayo.
Olunye udaba olubalulekile okufanele lucatshangwe ukuthi ubuntu nezici zesimo somqondo kungukuqagela okungacacile kokuziphatha okuthile okuluthayo, uma unikezwe ukuthi lezi zinto eziguquguqukayo zibandakanyeka kuma-psychopathologies amaningi futhi zivame ukuchaza ingxenye yezimpawu ezilinganiselayo ezilinganiseleni zokuphazamiseka okuhlukile (UZilberman et al., 2018).
Sithanda ukuphawula futhi kule mpikiswano ekhona maqondana nokuhlukanisa inkinga yokuthenga nokuthenga ngocansi njengokuphazamiseka kokulawula noma njengezimilo zokuziphatha. I-ICD-11 ifaka ukusetshenziswa okuyinkinga kwenkinga yezithombe zocansi njengengxenye eyodwa yokuphazamiseka kokuziphatha kocansi okuphoqelekile ngaphakathi kwesigaba sokuphazamiseka kokulawulwa kokuziphatha. Ukugula kokuthenga kubalwa njengesibonelo kwezinye iziphazamiso ezichaziwe zokulawula umfutho kuthuluzi lokufaka ikhodi le-ICD-11 (I-World-Health-Organisation, i-2019). Abaphenyi abaningi, noma kunjalo, baphawula ukuthi zombili lezi zinhlobo zokuphazamiseka zingahlukaniswa kangcono njengezenzo zokulutha (Potenza et al., 2018).
Inselelo eyodwa yocwaningo lwakamuva nokwakhiwa kwethiyori kubandakanya ukukhomba nokukhipha ukungafani okungahle kwenzeke kanye nomehluko phakathi kokuphazamiseka ngenxa yokuziphatha okuluthayo nokunye ukuphazamiseka kwengqondo, njengokuphazamiseka okuhlobene nokuphoqelela okuhlobene nokuphoqelela, okungahlobene nokuluthwa kokuziphatha kokuphazamiseka kwengqondo kanye ne-neurobiological amazinga (IChamberlain et al., 2016; UFineberg et al., 2013; UFineberg et al., 2018; URobbins et al., 2019). Isibonelo, ukulawulwa kokuvinjezelwa kwemithi kanye nokuhanjiswa kwemivuzo kuye kwahlongozwa ukuthi kubaluleke kakhulu ekuphazamisekeni okuhlobene nokuphoqelela okuphathelene nokuphoqelela, njengokuxoxwa ngakho lapho kuthathwa isikhumba ne-trichotillomania, okubuye kuhlobane nokusebenza kwengqondo ye-fronto-striatal amasekethe (IChamberlain et al., 2008). Ukungasebenzi kwe-loonto ye-fronto-striatal, noma kunjalo, kungabandakanyeka kwezinye izifo eziningi zempilo yengqondo kanye (I-Mitelman, 2019). Noma kunjalo, iqiniso lokuthi izihibe ze-fronto-striatal zithinteka ekuphazamisekeni kwengqondo okuhlukile akusho ukuthi izinqubo zengqondo ezihlobene ne-phenotypes yomtholampilo yokuphazamiseka ziyefana. Okokuqala, izihibe ze-fronto-striatal zichazwa ngokuhlukile futhi zihlaziywa kuzo zonke izifundo. Izifundo zesikhathi esizayo kufanele zihlolisise iminikelo ethile yezakhiwo ezachazwa kabanzi kabanzi ngaphakathi kwama-loonto ase-fronto kuya ezinqubweni ezithile zengqondo ezilandelwayo ekuziphatheni okuthile okuyinkinga. Okwesibili, ukubandakanyeka okujwayelekile kokulawulwa kokuvinjezelwa kanye nokulungiswa kwemivuzo akusho ukuthi izinqubo zokusebenza kwengqondo ziyaqhathaniswa kuzo zonke iziphazamiso, noma kungahle kube nokugqagqana kokuziphatha okuphoqayo / okuphoqayo kanye nokuziphatha okuluthayo (isib. IChamberlain et al., 2018). Kubalulekile ukuchaza ngokunemba izimbangela ezingaphansi kokuqhubekela phambili kwesikhashana kwezisusa kubantu zokubandakanya ngokweqile ekuziphatheni okuthile. Isibonelo, ekuziphatheni okuluthayo, kungenzeka kube ukuthi izisusa eziyinhloko zokuzibandakanya emidlalweni yokugembula noma yokugembula, okungenani ezigabeni zokuqala, zibandakanya ukulindelwa komvuzo. Ezigabeni zakamuva, ukugwema imizwa engemihle kungenzeka kuhileleke ngokwengeziwe. Ekuphazamisekeni okuhlobene nokuphoqelela okuhlobene, kungenzeka ukuthi i-drive drive esezigabeni zokuqala kufaka ukugwema imizwa engemihle noma ukukhathazeka. Kamuva, indlela yokuziphatha uqobo lwayo ingahle ibe nakho njengekuzuzisayo ngoba kungasiza ukudambisa ukucindezeleka. Ngamanye amagama, ukubandakanyeka okuvamile kwemisebenzi ethile ye-neurocognitive kungenzeka kungachazi ngokuphelele ukuphazamiseka. Umqondo ofanayo unamandla okusebenza kuzindlela ze-neural. Kungenzeka kube ukuthi ezimweni ezithintekayo ngenxa yokuziphatha okuluthayo, i-ventral striatum inegalelo elibalulekile emazingeni okuqala alo mkhuba, maqondana nokubuyela emuva nokufisa. Emazingeni akamuva, i-dorsal striatum ingahle ibandakanyeke kakhulu futhi iqondane nezinto ezithambekele futhi eziphoqelelayo zokuphazamiseka kwengqondo okuluthayo. Ngokuphambene nalokho, i-dorsal striatum kungenzeka ibandakanyeke ekuphazamisekeni okuhlobene nokuphoqelela okuhlobene nokuthinteka kokulawula, okufana ne-trichotillomania, kusuka ezigabeni zokuqala (Isobe et al., 2018; van den Heuvel et al., 2016).
Ezifundweni zesikhathi esizayo, kubonakala kubalulekile ukuphenya izinqubo kanye nokuxhumana kwemisebenzi ehlukahlukene yezinzwa ngezinhlobo ezihlukile zokuziphatha umlutha ukuze kufinyelelwe ukuqonda okungcono kwezimo ezisetshenziswayo zokuziphatha. Imodeli ye-I-PACE ingahle isetshenziselwe ukuchaza nokucacisa imiqondo ethile ekucwaningeni ngalezi zinto. Kubalulekile ukuhlola izinqubo ze-hypothesised ezindleleni zokuziphatha umlutha futhi uziqhathanise nezinye iziphazamiso zomqondo, njengokuphazamiseka okuhlobene nokuphoqelela okuhlobene nokuphoqelela ukuqonda ukuthi izinqubo eziyisisekelo ezibandakanyekile azifani yini noma ziyafana. Kule nqubo, idatha ekhiqizwayo kufanele isize ekucaciseni ukuthi mangaki amagama angaqashwa njengamanje ukuchaza izindlela ezifanayo zokuphazamiseka. Ngale ndlela, inguqulo ebuyekeziwe yemodeli ye-I-PACE inikeza uhlaka lwethiyori okufanele isize ekubhekaneni nemibuzo enkulu ephathelene nokulutha, ukubekezelela, ukuphoqa ukuthinteka nezinye izinkinga, kufaka phakathi lezo ezihlobene nokusetshenziswa kwe-inthanethi, ezingaba ngokuya zifanelekile ngokuhamba kwesikhathi ezinikezwe izinguquko kumvelo wobuchwepheshe bedijithali.
Isimemezelo sentshisekelo
Ababhali bamemezela ukuthi abanakho ukungqubuzana kwezintshisekelo. UDkt Brand uthole (e-University of Duisburg-Essen) izibonelelo ezivela I-German Research Foundation (i-DFG), lo Ministry waseJalimane Wocwaningo Nezemfundo, lo Ministry Wezempilo waseJalimane Wezempilo, Kanye iyuniyani yase-Europe. UDkt Brand wenze ukubuyekezwa kwesibonelelo kuma-ejensi ambalwa; uhlele izingxenye zamaphephabhuku nezindatshana; unikeze izinkulumo zezifundo ezindaweni zemitholampilo noma zesayensi; futhi ukhiqize izincwadi noma izahluko zencwadi zabashicileli bemibhalo yezempilo yengqondo. UDkt Potenza uthola ukwesekwa ngu I-NIH (I-R01 DA039136, I-R01 DA042911, I-R01 DA026437, I-R03 DA045289, I-R21 DA042911, Futhi I-P50 DA09241), the I-Connecticut uMnyango Wezempilo Yengqondo Nezinsizakalo Zokulutha, lo I-Connecticut Council on Inkinga Yokugembula futhi Isikhungo Sikazwelonke Sokudlala Amageyimu. UDkt Potenza uthintane nezokwelapha i-Rivermend Health, Opiant / Lakelight Therapeutics kanye neJazz Pharmaceuticals; uthole ukwesekwa kocwaningo (ku-Yale) kwi-Mohegan Sun Casino nakwiSikhungo Sikazwelonke Sokudlala Ngokubambisana; kuboniswane noma kwalulekwe izinhlangano ezingokomthetho nezokugembula ezindabeni ezihlobene nokulawulwa okungathandeki kanye nokuziphatha okuluthayo; uhlinzeke ukunakekelwa kwemitholampilo okuhlobene nokulawulwa okungathandeki kanye nokuziphatha okuluthayo; kwenziwe ukubuyekezwa kwesibonelelo; amaphephabhuku ahleliwe / izingxenye zamaphephabhuku; unikezwe izinkulumo zezifundo emjikelezweni omuhle, imicimbi ye-CME nakwezinye izindawo zokwelapha / zesayensi; futhi kukhiqizwe izincwadi noma izahluko zabashicileli bemibhalo yezempilo yengqondo.
Ukubonga
Silibonga kakhulu igalelo lobuhlakani likaDkt Kimberly S. Young ohlotsheni lwangaphambili lwe-I-PACE modeli, ebeligqugquzela imodeli ebuyekeziwe. UDkt Young udlule emhlabeni ngoFebhuwari 2019. Ukukhumbula uDkt Kimberly S. Young, sinikezela le ndatshana kuye.
Okubhekwayo
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