Ukusebenza kwengqondo okukhona manje, NgoFebhuwari 2018 nguJon E. Grant, JD, MD, MPH, uSolwazi - uMnyango Wezengqondo Nezengqondo Zokuziphatha Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
Ukuziphatha kocansi okuphoqelekile (CSB), okubizwa nangokuthi umlutha wezocansi noma i-hypersexourse, kubonakaliswa ukuphindaphinda nokucabanga okukhulu ngemicabango yocansi, ukunxenxa, nokuziphatha okuthikameza umuntu lowo kanye / noma umphumela wokukhubazeka kwengqondo. Abantu abane-CSB bavame ukubona ukuthi ukuziphatha kwabo kocansi kuyokweqisa kepha abakwazi ukukulawula. I-CSB ingahle ifake imibono emnandi kanye nokunxenxa ngaphezu noma endaweni yokuziphatha kepha kumele ibangele ukucindezeleka okukhulu nokuphazamiseka kwempilo yansuku zonke ukuze ifaneleke njengengxabano.
Ngenxa yokuntuleka kwezinga elikhulu, izifundo ezibhekiswe kubantu ezibangelwa yizifo eziwumshini wokuhlola i-CSB, ukwanda kwaso phakathi kwabantu abadala akwaziwa. Ucwaningo lwe-204 yezifo zezengqondo luthole ukwanda kwe-4.4% manje,1 ngenkathi ucwaningo olususelwa eyunivesithi lubala ubukhona be-CSB cishe nge-2%.2 Abanye balinganise ukuthi ukwanda phakathi kwe-3% kuya ku-6% yabantu abadala e-United States,3,4 abesilisa abandakanya iningi (≥80%) labantu abathintekile.5
I-CSB imvamisa ukukhula ngesikhathi sokukhula kobudala / ukuguga, futhi iningi elethula ukwelashwa ngabesilisa.5 I-Mood ithi, kufaka phakathi ukudangala, injabulo, kanye nesizungu, kungahle kubangele i-CSB.6 Abantu abaningi babika imizwa yokuzihlukanisa ngenkathi beziphatha ngokuhlobene ne-CSB, kanti abanye babika bezizwa bebalulekile, benamandla, bejabule noma benelisekile.
Kungani CSB kunzima ukuyithola
Yize i-CSB ingahle ivame, ivame ukungaziwa. Lokhu kuziphatha okunamandla okuyinkinga kuvame ukungatholakali ngenxa yokuthi:
- Amahloni nokufihlwa. Ukuhlazeka nehlazo, okuyisisekelo ku-CSB, kubonakala sengathi kuchaza, ngokwengxenye, ukuthi kungani ezimbalwa iziguli zivolontiya imininingwane ephathelene nalokhu kuziphatha ngaphandle kokuthi icelwe ngokuqondile.1
- Ukuswela ukubekezelela ulwazi. Iziguli zivame ukungazi ukuthi ukusebenza kwazo kungalashwa ngokuphumelelayo.
- Ukuswelakala kwemitholampilo. Bambalwa ochwepheshe bezokunakekelwa kwezempilo abanemfundo noma uqeqesho ku-CSB. Ukuntuleka kokuqashelwa kwe-CSB nakho kungahle kube ngenxa yokuqonda kwethu okulinganiselwe maqondana nemikhawulo yokulingana ngokocansi. Ngaphezu kwalokho, ukuhlukaniswa kwe-CSB akucaci futhi akuvunyelwana ngakho (Ibhokisi7-9), futhi izahlulelo zokuziphatha zivame ukubandakanyeka ekuqondeni ukuziphatha kobulili.10
Ukuhlukanisa ukuziphatha kocansi okuphoqayo
[Ibhokisi] Kuhlongozwe iziphakamiso ezahlukahlukene zokuhlukaniswa kokuziphatha kocansi okuphoqayo (CSB). Kungahle kuhlobane ne-obsessive-activive disorder (OCD), yakha i-“spectrum-activive spectrum;” kwiziphazamiso zemizwa (“i-affidence spectrum disorder”)7,8; noma njengophawu lwezinkinga zobudlelwano, ukusondelana nokuzithemba. Ukuqokwa kwe-CSB ngaphakathi noma kokubonakalayo okuphoqayo noma okubonakalayo kususelwa kufana nesimpawu, amahlaya, umlando womndeni, nezimpendulo zokwelashwa. Kuyafana nakubantu abane-OCD, iziguli ze-CSB zibika imicabango ephindaphindayo nokuziphatha. Ngokungafani ne-OCD, noma kunjalo, indlela yokuziphatha kwezocansi ye-CSB iyajabulisa futhi imvamisa iqhutshwa izifiso noma ukunxenxa. Ngokunikezwa kwalezi zincazelo, i-CSB nayo ingahle ibelane ngezici zokuphazamiseka kokusetshenziswa kwezidakamizwa, futhi ikhiqize umbono wokuziphatha kobulili umlutha. Kusenempikiswano enkulu yokuthi ungakuqonda kanjani kangcono lokhu kuhlanganiswa kwezimpawu nokuziphatha-njengengxabano eseceleni noma njengophawu lwenkinga ethile. I-DSM-5 ayitholanga sizathu esanele sokuqoka umlutha wobulili njengengqondo yokuphazamiseka kwengqondo.9
Akukho ukuvumelana ngezinqubo zokuxilonga
Ukuxilonga ngokunembile i-CSB kunzima ngenxa yokuntuleka kokuvumelana mayelana nenqubo yokuxilongwa kwalesi sifo. UChristenson et al11 ithuthukise isethi yokuqala yezindlela ze-CSB njengengxenye yocwaningo olunkudlwana lokuphazamiseka kokulawula okuthonyayo. Basebenzise le mibandela elandelayo ye-2 ukuthola i-CSB: (1) izindlela zokuziphatha zocansi ngokweqile noma ezingalawulwa noma imicabango yezocansi / ukunxenxa ukuzibandakanya ekuziphatheni, futhi (2) lezi zindlela zokuziphatha noma imicabango / ukunxenxa kuholela ekucindezelekeni okukhulu, ukulimala komphakathi noma komsebenzi , noma imiphumela yezomthetho neyezezimali.11,12
Ngesikhathi senqubo yokuhlaziywa kabusha kwe-DSM-5, kwahlongozwa indlela yesibili yokuthola izindlela zokuxilongwa kwe-hypersexuality disorder. Ngaphansi kwemigomo ehlongozwayo ye-hypersexeness, umuntu angahlangabezana nokuxilongwa uma i-≥3 yokulandelayo elandelayo yaqinisekiswa esikhathini esiyinyanga eyi-6: (a) isikhathi esichithwa yimicabango yokuya ocansini, ukunxusa, noma isimilo esiphindaphindayo ukuphazamisa okunye okubalulekile (okungekhona kocansi) ) izinhloso, imisebenzi, kanye nezibopho; (b) ukuzibandakanya ephindelela emcabangweni wezocansi, ukunxenxa, noma isimilo ekuphenduleni kwizimo zemizwa ezinesizungu; (c) ukuzibandakanya nokuphindelela emcabangweni wezocansi, ukunxenxa, noma isimilo ekuphenduleni izehlakalo zempilo ezicindezelayo; (d) imizamo ephindaphindwayo kepha engaphumeleli yokulawula noma yokunciphisa kakhulu le micabango yezocansi, izifiso, noma isimilo; futhi (e) ziphindaphinde ukuzibandakanya ekuziphatheni kobulili ngenkathi zinganaki ubungozi bokuzilimaza ngokwasemzimbeni noma nangokomzwelo ngokwakhe noma kwabanye.9
Lezi zindlela eziphakanyisiwe ze-2 zokuxilongwa kwezifo ziyefana. Zombili ziphakamisa ukuthi izingqinamba eziyisisekelo ezibandakanya izifiso zobulili noma zokuziphatha okunzima ukuzilawula futhi okuholela ekungasebenzi kahle kwengqondo. Ukwahluka ezindinganisweni, noma kunjalo, kungaholela emazingeni ahlukahlukene wokuxilongwa kwe-CSB; Ngakho-ke, olunye ucwaningo luzodinga ukunquma ukuthi iyiphi indlela yokuxilonga ekhombisa i-neurobiology engaphansi kwe-CSB.
Gwema ukungaziphathi kahle
Ngaphambi kokuthola ukuxilongwa kwe-CSB, kubalulekile ukuthi odokotela babheke ukuthi ngabe bayabandlulula yini “imiphumela emibi,” usizi, noma ukuthikamezeka komphakathi okususelwa ekuvumeleni okuthile kokuziphatha okuthile kocansi. Ngaphezu kwalokho, kudingeka siqinisekise ukuthi asibambeleli ubulili ezindinganisweni ezihlukile kunezinye izindlela zokuziphatha (ngokwesibonelo, kunezinto eziningi empilweni esizenzayo eziholela emiphumeleni emibi kepha nokho azihlukanisi njengokuphazamiseka kwengqondo, njengokuzibandakanya ukukhetha ukudla okunempilo okuncane). Ngaphezu kwalokho, izimilo zocansi ngokweqile zingahle zihambisane nenqubo ejwayelekile yokuphuma yabantu be-LGBTQ, izinkinga zobudlelwano bomlingani, noma ubunikazi bocansi / ubulili. Ngakho-ke, le ndlela yokuziphatha idinga ukuhlolwa kumongo walezi zici zemvelo nezengqondo.
Ukuxilongwa okuhlukile
Ukuphazamiseka okuhlukahlukene kwengqondo nakho kungahlanganisa nokuziphatha ngokweqile kobulili njengengxenye yokwethulwa kwabo ngokomtholampilo, futhi kubalulekile ukuhlukanisa leyo ndlela kusuka ku-CSB.
Ukuphazamiseka kweBipolar. Ukuziphatha ngokweqile kwezocansi kungenzeka njengengxenye yesiqephu se-menic ku-bipolar disorder. Uma inkinga yokuziphatha kobuchopho ivela futhi lapho isimo somuntu sizinza, lowo muntu angaba ne-CSB kanye ne-bipolar disorder. Lokhu umehluko kubalulekile ngoba ukwelashwa kokuphazamiseka kwengqondo okuguquguqukayo kuvame ukwehluka kwi-CSB, ngoba ama-anticonvulsants anemibiko yamacala kuphela efakazela ukusetshenziswa kwawo ku-CSB.
Ukuxhashazwa kwezidakamizwa. Ukuziphatha ngokweqile kwezocansi kungenzeka lapho umuntu esebenzisa kabi izidakamizwa, ikakhulukazi izinto ezikhuthaza njenge-cocaine nama-amphetamines.13 Uma isenzo sokuziphatha kocansi singenzeki lapho umuntu engazisebenzisi izidakamizwa, khona-ke ukuxilongwa okufanelekile kungenzeka kube yi-CSB.
Ukuphazamiseka kwengqondo okuphoqayo (OCD). Abantu abane-OCD bavame ukuba matasa nezindikimba zocansi futhi banomuzwa wokuthi bacabanga ngokweqile ngokobulili.14 Yize iziguli ezine-OCD zingase zibe matasa ngemicabango yezocansi, umehluko osemqoka ukuthi abantu ababika nge-CSB bazizwa bejabule ngale micabango futhi bathokoze ngokuziphatha, kanti imicabango yocansi ye-OCD ibonwa njengemnandi.
Okunye ukuphazamiseka engase iholele ekuziphatheni kwe-hypersexual ifaka ukuphazamiseka kwe-neurocognitive, ukunakwa kokushoda / ukuqina kokuphazamiseka kwengqondo, ukuphazamiseka kwe-Autism spectrum, kanye nokuphazamiseka kwengqondo okucindezelayo.
Imiphumela emibi yemithi. Kubalulekile ukubuza isiguli ukuthi ingabe yona (yona) yathuthuka yini i-CSB ngemuva kokuqala umuthi. Imithi ethile (isb., Imishanguzo yesifo sikaParkinson noma i-restless leg maoto, noma i-aripiprazole yokwelapha ukudana noma i-psychosis) ingadala ukuthi iziguli ziziphathe kabi ngokobulili.15,16 Uma ukuziphatha kocansi kuncipha noma kuyeka lapho umthamo wemithi uncishisiwe noma umuthi umisiwe, ukuxilongwa kwe-CSB bekungeke kufanele.
I-Comorbidity ivamile
Ucwaningo lukhombisa ukuthi cishe ingxenye eyodwa yabantu abadala ene-CSB ihlangabezana nemibandela okungenani yokuphazamiseka kwengqondo kwe-1, okunjengesimo sokuxakeka, ukukhathazeka, ukusetshenziswa kwezidakamizwa, ukulawulwa okungafuneki, noma ukuphazamiseka kobuntu. Ucwaningo lwamadoda ane-CSB (N = 103) luthole ukuthi i-71% ihlangabezane nenqubo yokuphazamiseka kwemizwa, i-40% yokuphazamiseka kokukhathazeka, i-41% yokuphazamiseka kokusebenzisa izidakamizwa, kanye ne-24% yokuphazamiseka kokulawula okungathinti njengokuphazamiseka kokugembula.17 Ngakho-ke, ukwelapha ngempumelelo i-CSB, odokotela nabo bangadinga ukugxila ekutheni lezi zinkinga ezenzeka ndawonye ziqhuba kanjani ezocansi.
Izimo zezokwelapha ezenzeka ngokubambisana nazo zivamile phakathi kwabantu abane-CSB. Izingqinamba zokwelashwa zingafaka ukukhulelwa okungafuneki, izifo ezithathelwana ngocansi, kanye ne-HIV / AIDS. Ngakho-ke, ukwelapha ama-comorbidities wezengqondo nokuhlinzeka ngemfundo mayelana nempilo yezocansi, ngokudluliselwa kochwepheshe bezokunakekelwa okuyisisekelo, imvamisa kuyingxenye yokwelashwa kwe-CSB.
I-Neuroimaging and cognition
Ucwaningo oluthile lokucabanga oluqhathanisa ababambiqhaza ne-CSB engenayo i-CSB ithole ukuthi ababambiqhaza abane-CSB babenomsebenzi ophakeme endaweni ye-ventral striatum, i-anterior cingrate cortex, kanye ne-amygdala ehambelana nezilawuli ngesikhathi somsebenzi we-Mue cac kabusha.18 Lokhu okutholakele kukhombisa ukufana okuphawulekayo namaphethini wokusebenza okubonakalayo ezigulini eziluthiswe ezidakamizweni lapho kuhlolwa kusetshenziswa ubuciko bokufisa izidakamizwa. Ucwaningo olwengeziwe lwe-neuroimaging lokuhlola iziguli nge-hypersexuality usebenzisa i-infusion tensor imaging luphawulile ukuthi ukwehluka kwipheshana lezinto ezimhlophe zangaphambi kwesifunda esifundeni esiphambili sangaphambili kwakukhulu kwiziguli ezine-CSB.18Lolu cwaningo luphinde futhi lwabonisa ukuthi kunokuhlangana okungalungile phakathi kokuphazamiseka okubonwe endaweni ebonisiwe kanye nenqaku lokuqina lobunzima bezimpawu ze-CSB ezinjengemvamisa yezikhalazo noma isimilo.
Ngokomqondo wokuqashelwa, ukuhlolwa kokuqala kwabantu abadala abasebasha nge-CSB kuqhathaniswa nezilawuli ezinempilo akubatholanga mehluko phakathi kwamaqembu emisebenzini eminingana, yize ucwaningo lokucabanga kokuphambanisa olushiwo ngaphambili lubike ngokuxineka okuphezulu ku-CSB.18
Izindlela zokwelashwa
Abantu abaningi abane-CSB bayanqikaza ukuyisho kubahlinzeki babo bezokunakekelwa kwempilo, futhi iningi lodokotela ngokuvamile alikhululekile ukukhuluma ngocansi neziguli zabo, ngokwengxenye, ngenxa yokuntuleka kokuqeqeshwa.19 Iziguli zivame ukuletha isihloko lapho zithola ukwelashwa kokukhathazeka, ukudangala, noma ukuhlukunyezwa kwezidakamizwa. Ngakho-ke, odokotela kumele babheke ukuthi indlela yokuziphatha kobulili ingahle ihlotshaniswe nendlela yokubhekana nakho, umphumela odabukisayo, noma isimo se-comorbid kulezi ziguli.
Ukwelashwa ngamakhemikhali
Ubufakazi bokuphathwa kwe-chemacologic kwe-CSB buqukethe ikakhulu izifundo ezincane, ezivulekile, ilebula lamacala, noma ukuhlaziya okwenziwe emuva, ngaphandle kwe-1 eyimpumputhe ephindwe kabili, isifundo esilawulwa yi-placebo. Ngokusekelwa kulobu bufakazi, kungahle kube nezindlela zokwelapha eziningi ze-pharmacologic ezigulini ezine-CSB; kodwa-ke, akukho mithi evunyelwe i-FDA ye-CSB.
Izidambisi. Esinye sezigaba ezibhalwe ngokuphelele zokwelashwa kwe-pharmacologic ye-CSB ukukhetha i-serotonin reuptake inhibitors (SSRIs) ekhethiwe. Ukuhlaziywa okuningana kokubuyela emuva kanye nochungechunge lwamacala kubike ngokusebenza okujwayelekile kwama-SSRI ekwehliseni izimpawu ze-CSB.20-23 I-Citalopram, okuwukuphela kokwelashwa kwe-CSB okuye kwahlolwa kusetshenziswa indlela elawulwa izimpumputhe ephindwe kabili, okuhambisana nokuncipha okukhulu kwezimpawu ze-CSB, kufaka phakathi isifiso / ukuhanjiswa kocansi, imvamisa yokushaya indlwabu nokusebenzisa izithombe zocansi.24
Ngokungeziwe kuma-SSRIs, imibiko eyengeziwe eyengeziwe yamacala iphakamise ukuthi amanye amakilasi we-antidepressants, anjenge-serotonin-norepinephrine reuptake inhibitors kanye nama-anticepressants ama-triceclic, noma ama -qabunga angasiza lapho welapha i-CSB.25 Imibiko eminingana yamacala ikhombise ukuphuculwa okukhulu kwezimpawu ze-CSB zisebenzisa i-clomipramine.22 Ucwaningo lokuthola kabusha i-nefazodone nalo luye lwaphakamisa ukuthi kungaba yindlela yokwelapha i-CSB. Iziguli zibike ukuncipha okuphawuleka imvamisa yokufuna / ocansini lapho zithatha i-nefazodone futhi zabika imiphumela emibi kwezocansi.26 Uhlobo oluthile lomkhiqizo lwe-nefazodone, iSerzone, luhlotshaniswa nezinkinga zesibindi ezinqabile kodwa ezinzima futhi lwahoxiswa emakethe yase-US e-2004.
Noma bukhona ubufakazi bokuqala mayelana nokusetshenziswa kwe-antidepressant, ikakhulukazi ama-SSRI, ukwelapha i-CSB kuphakamise ukuthi le mishanguzo ingaba usizo olungabakhona, okutholakele kukude nokuqhathaniswa, ngesivivinyo kuphela eselawulwa i-1 kanye nemibiko yecala elilodwa lesifundo esisodwa semithi eminingi efundwayo.
INaltrexone, umphikisi we-opioid, uthole ukwesekwa kumacala atholakalayo, izifundo ezilebuli evulekile, kanye nokuhlaziywa kokubuyiselwa emuva.17,27 Yize ubufakazi bokuthi kusetshenziswe i-naltrexone ku-CSB bunqunyelwe emibikweni yamacala nokuhlaziywa okubuyiselwe emuva, imiphumela ibe mihle. I-Naltrexone ikhombise ukwehla okuphawuleka kokwehluka kwezimpawu ze-CSB lapho isetshenziswa njenge-monotherapy nalapho isetshenziswa ngokuhlanganiswa nezinye izindlela zokwelapha.
Ama-anticonvulsants. Imibiko eminingana yamacala iphakamise ukuthi ama-anticonvulsants athile angasiza ekwelapheni i-CSB. I-Topiramate ingaba yindlela ewusizo kakhulu.28 Amanye ama-anticonvulsants akhombisa ukuzuzisa i-CSB uma kwenzeka imibiko ifaka i-valproic acid, i-lamotrigine, ne-levetiracetam.18
Ezengqondo
Ubufakazi obuxhasa izinhlobo ezithile ze-psychotherapy ye-CSB bunqunyelwe futhi ikakhulukazi butholakala ocwaningweni olungalawulwa nemibiko yamacala.
Ukwelashwa kwengqondo-yokuziphatha (i-CBT) kungenye yezindlela ezivame kakhulu ze-psychotherapeutic ezisetshenziselwa i-CSB. Ucwaningo oluningi olungalawulwa nemibiko yamacala ithole ukuthi i-CBT ilusizo ku-CSB, yize izindlela ziye zahlukahluka.
Amacala amaningana athola ukuthi ukuhlanganisa i-CBT nokuxoxisana okwenziwe ngenhloso kuhlobene nokuncipha okukhulu ekuziphatheni kwezocansi, okufana nemvamisa yabalingani bezocansi nenani lesikhathi esichithwa ku-inthanethi ngezikhathi zomsebenzi.29,30 I-CBT yeqembu nayo ikhonjisiwe ukuthi isebenza nge-CSB.31
Ukwelashwa nokwamukela ukuzibophezela (i-ACT) kuthole ukwesekwa kokuqala, ngocwaningo olungu-1 olungalawulwa kanye nocwaningo olulawulwa olungu-1.32,33 Ucwaningo olulawulwayo lusebenzise amaseshini we-12 we-ACT ngamunye kuqhathaniswa nesimo sokulinda.32Ukuthuthuka kwezimpawu ze-CSB kwagcinwa izinyanga ze-3. Ukuncishiswa okuphelele kwezinkinga zokusebenzisa izithombe zobulili ezingcolile kwe-inthanethi kwabikwa njenge-92% ngokushesha nje ngemuva kokuphela kocwaningo, kanye ne-86% ngemuva kwezinyanga ze-3.
Ukwelashwa komshado / kobudlelwano kusetshenziswe ngempumelelo ochungechungeni lwamacala amaningi nemibiko yamacala, yize kungekho zifundo ezihlolisise ukusebenza kwazo ekwelapheni i-CSB kusetshenziswa umthetho olandelwayo ongahleliwe. Embikweni we-1, umcwaningi uthole ukuthi ukubamba iqhaza ekwelashweni kocansi emshadweni kuphakamise ukuthuthuka okuphawulekayo phakathi nonyaka owodwa nezikhathi ezingama-1.34
Umugqa Ongezansi
Ukucwaninga okulinganiselwe kanye nokuntuleka kwezinqubo ezijwayelekile kungenza isimilo sokuziphatha ngokocansi okuphoqelekile (CSB) kube inselele yokuthola nokwelapha kahle. Ubufakazi bokuqala buveza ukuthi ama-antidepressant athile kanye nokwelashwa kwengqondo kunganciphisa izimpawu ze-CSB.
Izinsiza Ezihlobene
Carnes PJ. Ngaphandle kwemithunzi: ukuqonda umlutha wobulili. I-3rd ed. Center City, MN: IHazelden Publishing; I-2001.
Amagama Omkhiqizo Wezidakamizwa
I-Aripiprazole • Yenza ngcono
ICitalopram • UCelexa
Clomipramine • Anafranil
I-Lamotrigine • I-Lamictal
I-Levetiracetam • IKeppra
I-Naltrexone • I-Revia
I-Topiramate • I-Topamax
I-Valproic acid • I-Valproic
;