Ukungenelela kwengqondo kwezokwelapha ngokobulili - Ukubuyekezwa. (I-2018)

UGeorge, Manju, Shreemit Maheshwari, Suhas Chandran, Suman S. Rao, J. Shivanand Manohar, noSt Sathyanarayana Rao.

I-Indian Journal of Psychiatry 60, akukho. 8 (2018): 510.

abstract

Isiyaluyalu yigama elisetshenziselwa ukusetshenziselwa ngokweqile izinto kuphela, kodwa futhi nezinkinga zokuziphatha ezinjengezokuphazamiseka kokudla, ukugembula okufuywayo, ukubheja komshini kanye nokukhathazeka ngokwemvelo nemidlalo yevidiyo nezenzo zocansi. Ayikho imingcele ecacile yokuxilonga esungulwe ngokuqiniswa kwezidakamizwa zokuziphatha. Ukulutha ngokweqile ngokobulili, okubandakanya ukulutha kwezidakamizwa ezingcolile akuhlanganisiwe njengenhlangano ehlukile ngenxa yokungabi nobufakazi obunamandla obukhona kule ndawo. Izilinganiso ezahlukene zingasetshenziswa ekuhloleni ukulutha ngokocansi. Njengoba kukhona ukungabi khona kwemigomo yokuhlonza okuqinisekisiwe, ukubaluleka kokusebenza kwalesi sikali akungabazeki. Imibuzo eminingana kulezi zingqinamba ayinikezi ulwazi mayelana nokuthi ngabe i-diagnostic criteria ihlangabezane noma cha. I-Pharmacotherapy, kanye ne-psychotherapy ifakazela ukuthi ibe nomphumela ongcono kulawo maguli njengoba kusiza ukukwenziwa indima yendiza yokuthuthukiswa, ukunciphisa ukukhathazeka kwamanje, ukucindezeleka, ukuzithoba futhi ukuthuthukisa ukulungiswa komphakathi.

Amagama angukhiye: Ukulutha kokuziphatha, ukulutha ngokobulili, ukulutha kwe-inthanethi, ukungenelela kwengqondo

Isingeniso

Isiyaluyalu sichazwa njengesimo esiyisisekelo nesiguli sobuchopho obukhuthaza umvuzo, ukugqugquzela kanye nezindawo eziphathelene nokukhumbula imemori. I-American Society of Addiction Medicine yanikeza le ncazelo ku-2011 ukufaka kokubili izinto nezinto zokuziphatha.^[1] Igama elithi "ukulutha umlutha" lisetshenziswa ngokujwayelekile ekudleni okungalawulwa kwemithi efana nezidakamizwa noma utshwala, izidakamizwa zobulili, ukuziphatha kwezinkinga ezifana nokukhathazeka kokudla, ukugembula okuphathelene nokudlalwa, ukulutha komshini nokukhathazeka ngokwemvelo ngemidlalo yevidiyo. Ngaphandle kwalokhu, omunye umlutha ophuthumayo oye wakhathalela kakhulu ukulutha kwezithombe zobulili ezingcolile, okuhlobene nokukhubazeka okubalulekile komphakathi nokusebenza kwengqondo.^[2] Umuntu olandela umvuzo kanye / noma ukusiza ngokusetshenziswa kwezidakamizwa noma ezinye izinto eziziphathayo kubonisa ukungasebenzi emjikelezweni womvuzo wengqondo. Izinzuzo ezingathinta umjikelezo ojikelezayo ebuchosheni bomuntu ziholela ekulahlekelweni kokulawulwa kanye nezinye izimpawu zokulutha, okungenani abanye abantu. Ucwaningo luye lwabonisa ukuthi ekuziphatheni komkhuba wokuziphatha, izinqubo ze-neural ezisemqoka zifana nokulutha ngokweqile.^[3] Ukunikeza izincwadi kanye nocwaningo kugcizelela ukuthi ukuze kutholakale ukuxilongwa kokuziphatha ngokweqile, ukulimala okuphawulekayo kufanele kube khona emsebenzini, ebuhlotsheni bezenhlalakahle noma kwezinye izimo zomphakathi. Ochwepheshe abaningi bakholelwa ukuthi izidakamizwa zokuziphatha zingahle zibekwe eceleni (isib. Ithelevishini) noma zisebenzayo (isib. Imidlalo yekhompyutha), futhi ngokuvamile ziqukethe ukunciphisa nokuqinisa izinto ezingabangela ukukhuthazwa kokuthambekela kokulutha.^[4]

Ukutholakala kwezidakamizwa ze-intanethi kwakusungulwa okokuqala ngu-Ivan Goldberg, iNew York Psychiatrist ku-1995 futhi leli gama lihlelwe nguKimberly Young we-University of Pittsburgh. Ukuxhomeka kwe-Inthanethi kuye kwavame ukucatshangelwa njengokweqile ukuziphatha, okusebenza esimisweni sokuguqulwa kwamakhompiyutha wokulutha.^[5] Amalebula athi 'Internet Addiction', 'Internet Addiction Disorder', 'Pathological Internet Use' kanye 'Compulsive Internet Use' wonke asetshenziselwe ukuchaza umqondo ofanayo. Kwakhiwe amakamu amabili endaweni yocwaningo lwe-Intanethi - 1. Ukulutha kwe-Intanethi kufanele, noma kufanele, kusungulwe njengokuphazamiseka kwengqondo ngokwakho. 2. Abahlukunyezwa yi-Inthanethi ngokweqile bancike esicini esithile esivuzayo noma ekusebenzeni kokuziphatha okuhlobene nokusetshenziswa kwe-Intanethi okungaba khona emhlabeni 'wangempela', njengamaphethini wokuziphatha othembekile noma wokulutha ahlobene nemali noma ucansi. Bambalwa abacwaningi abaye bakungabaza ukuba khona kokulutha kwe-Intanethi njengenhlangano ehlukile njengoba kungakacaci noma ngabe kuyazivelela yini, noma kubangelwa yisifo sengqondo esibangela ubuthakathaka.^[6]

Izithombe zobulili ezingcolile zibhekwa njengenye indlela yokulutha ukuziphatha. Kuthiwa ukuthi abafana baqala ukwazi ngocansi futhi bazuze ukuqonda izifiso zabo kanye nezifiso zabo. Ucwaningo lwenziwe ku-2004 ngu-MSNBC.com nomagazini we-Elle bafunda amadoda nabesifazane be-15,246. Bathole ukuthi abantu abathathu kwabayisishiyagalombili bathi balayishe amafilimu namavidiyo asuka e-intanethi futhi i-41% yabesifazane besenza kanjalo. Izithombe zobulili ezingcolile zibhekwa njengeziqondile futhi zilula. Ihlinzeka isiphephelo esinqumweni sokuhlukunyezwa ngokocansi ukuthi intsha ibhekene nezwe langempela. Ngabesifazane futhi abaphendukela ezingcolile zobulili ezingcolile, indlela yokwakha ukucabanga kwabo empilweni yabo yangempela ngokobulili ishintsha ngokuyisisekelo.^[7] Ucwaningo oluningi luye lwaqhutshwa emhlabeni jikelele ngokuphathelene nabasha kanye nokulutha kocansi.

Imigomo Yokuchaza Ukubheja Ngokwecansi

Igama lomlutha alitholakali kwi-Manual Diagnostic and Statistical of Mental Disorders (DSM) Ukushicilelwa Kwesine, Ukubuyekezwa Kwombhalo noma Ukuhlukaniswa Kwezizwe Ngezifo 10 (ICD10): Igama elibanzi lo "ukulutha ngokocansi" lichazwe, kepha kukhona ukungahambisani criteria ehlinzekwa abacwaningi abahlukahlukene.^[1] Esinye sezizathu eziyinhloko i-DSM-5 engakafaki ukugqilaza ngokocansi ukuthi ukucwaninga okusemthethweni akunamandla kule ndawo. Kubekho ukuhlola okumele kubonakale ezweni lonke besebenzisa izinqubo eziqinisekisiwe. Ngokufana ne-Internet Gaming Disorder manje ehlanganisiwe kwisithasiselo se-DSM-5, ukulutha kocansi akukwazi ukufakwa kuze kutholakale idatha ephawulekayo mayelana nezici ezicacile, ukwethembeka nokuqinisekiswa kwezinga kanye nokukhula kwamazinga emhlabeni jikelele. Abacwaningi bakholelwa ukuthi ngisho noma umlutha wezocansi ekugcineni ungenza izinhlelo ezizayo ze-DSM, kuyoba enye yezigaba ezincane ze-Internet Addiction Disorders kunokuba ibe yinto ehlukile.^[8]

Isimiso sokuxilonga ngokobulili ekunqumeni^[9]

A. Okungenani kwezinguquko ezintathu ezihlangene phakathi nenyanga ye-12:

1. Ukwehluleka okujwayelekile ukulwa nomqondo wokuzibandakanya ekuziphatheni okwezocansi ezithile.
2. Ukuzibandakanya njalo kulezi zici ngendlela enkulu noma isikhathi eside kunalokho okuhlosiwe.
3. Isifiso esiqhubekayo noma imizamo engaphumeleli yokuyeka, ukunciphisa, noma ukulawula ukuziphatha.
4. Isikhathi esiningi esingasetshenziselwa ukuthola ucansi, ukulala ngokobulili, noma ukubuyisela ekuhlangenwe nakho kobulili.
5. Ukukhathazeka ngokuziphatha noma imisebenzi yokulungiselela.
6. Ukuzibandakanya njalo ekuziphatheni lapho kulindeleke ukuthi ufeze izibopho zomsebenzi, zezemfundo, zekhaya, noma ezenhlalakahle.
7. Ukuqhubeka kokuziphatha naphezu kolwazi lokuba nenkinga yomphakathi, yezezimali, yengqondo, noma engokwenyama eqhubekayo noma ephindaphindiwe ebangelwa noma ekwenzeni ukuziphatha.
8. Kudingeka ukwandise amandla, imvamisa, inombolo, noma ingozi yokuziphatha ukufeza umphumela oyifunayo noma umphumela wokunciphisa ukuziphatha okuqhubekayo ezingeni elifanayo lokuqina, imvamisa, inombolo noma ingozi.
9. Ukunikela noma ukunciphisa imisebenzi yomphakathi, imisebenzi, noma yokuzilibazisa.
10. Ukucindezeleka, ukukhathazeka, ukuphumula, noma ukucasuka uma kungenakukwazi ukuzibandakanya ekuziphatheni.

B. Kunemiphumela ephawulekayo yomuntu siqu kanye nomphakathi (njengokulahlekelwa komlingani, umsebenzi, noma impikiswano yomthetho).

Indlela yokuhlola yokulutha kokuziphatha njengokuphakanyiswa nguGoodman 1990 ngendlela efana ne-DSM III R:^[10]

1. Ukuhluleka okwesikhashana ukumelana nezifiso ukuze uhlanganyele ekuziphatheni okucacisiwe.
2. Ukwanda kwemibango ngokushesha ngaphambi kokuqala ukuziphatha.
3. Ukujabulisa noma ukuphumula ngesikhathi sokuzibandakanya ekuziphatheni.
4. Umzwelo wokuntuleka kokulawula ngenkathi uhlanganyela ekuziphatheni.
5. Okungenani okuyisihlanu kokulandelayo: (1) ukukhathazeka okuvamile ngokuziphatha noma ngomsebenzi olungiselela ukuziphatha (2) ukuhlanganyela njalo ekuziphatheni ngendlela enkulu noma esikhathini eside kunalokho okuhlosiwe (3) imizamo ephindaphindiwe yokunciphisa , ukulawula noma ukumisa ukuziphatha (4) isikhathi esiningi esichithwa emisebenzini edingekayo ekuziphatheni, ekuziphatheni noma ekubuyiseleni emiphumeleni yayo (5) ukuhlanganyela njalo ekuziphatheni lapho kulindeleke ukuthi kufezeke umsebenzi, wezemfundo, wekhaya noma wezenhlalakahle izibopho (6) ezibalulekile zomphakathi, imisebenzi yomsebenzi noma yokuzilibazisa okwenziwe noma eyancishiswe ngenxa yokuziphatha (7) ukuqhubeka kokuziphatha naphezu kolwazi lokuba nenkinga yomphakathi, yezimali, yengqondo noma engokwenyama eqhubekayo noma ebhekene nokuziphatha (8) ukubekezelelana: isidingo sokwandisa ubukhulu noma imvamisa yokuziphatha ukuze kufezwe umphumela oyifunayo noma ukunciphisa ukusebenza i-ect ngokuziphatha okuqhubekayo kokungabi namandla okufanayo (9) noma ukucasula uma kungenakukwazi ukuzibandakanya ekuziphatheni.
6. (F) Ezinye izimpawu zokuphazamiseka ziye zaqhubeka okungenani inyanga ye-1, noma zenzeke ngokuphindaphindiwe isikhathi eside.

Izimpawu ezibonakalayo zokulutha izidakamizwa azikho emlonyeni wokuziphatha. Omunye wezinto eziphambili zokulutha komzimba ukutholakala kwengqondo ye-psychopathologies njengokucindezeleka, ukuthembela ngokwezinto ezibonakalayo noma ukuhoxiswa, nokukhathazeka komphakathi kanye nokuntuleka kokusekelwa komphakathi.^[11]

Ubukhulu beNkinga

Ku-2007, i-China yaqala ukuvimbela ukusetshenziswa komdlalo wekhompiyutha: imithetho yamanje idonsa ngaphezu kwamahora angu-3 wokusetshenziswa komdlalo nsuku zonke. Ukusebenzisa idatha kusuka ku-2006, uhulumeni waseNingizimu Korea ulinganisela ukuthi izingane ze-210,000 ezineminyaka yobudala ye-6-19 iminyaka ziyathinteka futhi zidinga ukwelashwa. U-80% walabo abadinga ukwelashwa bangadinga imithi ye-psychotropic, mhlawumbe i-20-24% idinga ukunakekelwa esibhedlela. Njengoba isilinganiso somfundi esikoleni esiphakeme saseNingizimu Korea sisebenzisa amahora angu-23 ngesonto ngalinye, ezinye izigidi ezingu-1.2 zikholakala ukuthi zisengozini yokulutha futhi zifuna ukwelulekwa okuyisisekelo.^[12] Abahlengikazi bakhathazeka ngenani elikhulayo labantu abaphuma esikoleni, basebenze ukuchitha isikhathi kuma-computer noma bangene ezinkingeni zomthetho. Kusukela ngoJune 2007, iNingizimu Korea iqeqeshe abacebisi be-1,043 ekwelapheni umlutha we-inthanethi futhi yabhala izibhedlela ze-190 nezikhungo zokwelapha. Abaningi balaba bantu abahlukumezayo bangena ebuhlotsheni bama-cyber kanye nocansi lwe-inthanethi.^[13] Ngokwezibalo ezenziwa phakathi kwabantu base-United States, kutholakale ukuthi ukubheja kocansi kwakukhona ku-3%, ukuvivinya umzimba ngokwe-3%, nokuthengwa ngokweqile ku-6% phakathi kwenani labantu. E-India, ucwaningo lwe-ICMR oluxhaswe ngemali lukhomba ukulutha kokudla (1.6%; 2% wesilisa no-1.2% wesifazane), ukuthengwa kokuthengwa (4%; owesilisa-3.2% nowesifazane-4.8%), ukulutha kocansi (2%; 0.3% wesilisa I-0.1% yowesifazane) nokuzivivinya umzimba (5.6%; 7.5% abesilisa nabangu-3.8% abesifazane).^[14]

Isampula yokufunda enezingxenye ezinabafundi abangama-987 bezindlela ezahlukahlukene kulo lonke idolobha laseMumbai yenziwa futhi abafundi bahlolwa nge-proforma eyakhiwe ngokukhethekile eyakhiwe kanye ne-Internet Addiction Test (IAT; Young, 1998). Ezinganeni ezingama-987 ezibambe iqhaza ocwaningweni, ezingama-681 (68.9%) kwakungabesifazane kwathi ezingama-306 (31.1%) zabesilisa. Isamba, cishe ama-74.5% babengabasebenzisi abasesimweni esifanele (isilinganiso). Kusetshenziswa izindlela zokuqala zikaYoung, kutholakale ukuthi u-0.7% uyimilutha. Labo abane-intanethi yokusebenzisa ngokweqile babenezibalo eziphakeme ekukhathazekeni, ekucindezelekeni nasekukhathazekeni kokukhathazeka^[15]

Izinsimbi zokuhlola

Izilinganiso ezihlukene ezingasetshenziselwa ukuhlolwa kokulutha ngokobulili zihlanganisa:

θ Isivivinyo sokuhlola izidakamizwa zocansi

θ Isilinganiso sokuphoqelela ngokocansi

θ Isamba sokuxhaswa ngokocansi - sibuyekezwe

θ Ukuhlukunyezwa ngokocansi kuyinhloko yemibuzo engaziwa

θ Inqubo yokuzibandakanya ngokobulili ngokweqile

Njengoba kukhona ukungabi khona kwemigomo yokuhlonza okuqinisekisiwe, ukubaluleka kokusebenza kwalesi sikali akungabazeki. Imibuzo eminingana kulezi zingqinamba ayinikezi ulwazi mayelana nokuthi ngabe i-diagnostic criteria ihlangabezane noma cha.

Isilinganiso sokuphoqeleka ngokobulili sivame ukusetshenziselwa ukulinganisa ukutholakala komlutha wezocansi. Ihlanganisa kokubili izici eziyinhloko zokulutha (ukulawulwa okungekho kahle nemiphumela eyingozi). Kuyinto esikalini sento ye-10 esukela ku-1-4. Inani elinqunywe yi-24.^[16]

Ukuphathwa

Ukwelashwa ngokwemithi kunenzuzo enesizotha nesikhashana. Umcwaningi wamanje wamanje wukuthi inhlanganisela ye-pharmacotherapy ne-psychotherapy yicebo elihle lokuphatha nganoma yiluphi uhlobo lokulutha kokuziphatha.

θ I-Pharmacotherapy ifaka phakathi 1. Ama-endocrinological agents: I-anti androgenslike Medroxy progesterone acetate esebenza ngokuvimbela i-testosterone reductase. Lokhu kuyasetshenziswa naseParaphilias. Ngaphezu kwalokho le mithi inciphisa ubulili nokuziphatha ngokocansi okunolaka. Amanye ama-pharmacological agents afaka phakathi iCyproterone acetate, ama-Analogues we-GNRH (leuprolide acetate) kanye nama-affectregulation agents afana ne-SSRI's, TCA's, lithium, carbamazepine, buspirone. Lawa ma-ejenti anesilinganiso sokuphendula esihle esingu-50-90%. Banciphisa idrayivu yokuziphatha ngokweqile ngokocansi ngaphandle kokunciphisa idrayivu yokuziphatha kahle. Futhi kubangela ukwehla kwemvamisa yezifiso zocansi oluyisibonakaliso somuntu ongumlutha, ukushaya indlwabu, kanye nokusetshenziswa kwezithombe zocansi, ngenkathi kungenamthelela omkhulu ekuziphatheni kocansi okuhlukanisiwe.^[17]

Ayikho Imithi:

I-psychotherapy ye-Psychodynamic isiza ukuhlanganiswa indima yezingqinamba zentuthuko, ukunciphisa ukukhathazeka kwamanje, ukucindezeleka, inecala nokuthuthukisa ukulungiswa komphakathi. Akukho bufakazi balokhu njengokwelashwa kwedwa. Ukubhekisela eqenjini lokuzimela kungenye yezokwelapha ezithandwa kakhulu ezihambisana nomphumela ophumelelayo. Ichazwe ku-12-Izinyathelo futhi inethonya elijulile endleleni yokuthola kabusha.^[18] Imodeli yokuvimbela ukuphindaphindiwe nokuhambisana namasu okufunda nokuziphatha komphakathi okujwayele ukuziphatha ngokuvamile kuvame ukusetshenziselwa izinhlelo ezikhethekile zokwelashwa ngokobulili e-United States naseCanada. Ayikho idatha eshicilelwe ngale ndlela ephelele yokwelashwa kokulutha ngokocansi.

Intsha ichaza izindlela eziyisikhombisa ezikhona zokubhekana nokulutha kwe-intanethi, okuyizintathu zokuqala eziyisisekelo zokuphatha isikhathi. Lezi zindlela zihanjiswe ngokuningiliziwe kulesi sihloko mayelana nokulutha kobuchwepheshe.^[19]

I-Orzack ne-Orzack baye basikisela amasu amabili okwelashwa. I-1) Ukwelashwa kokuziphatha okunengqondo okubandakanya ukulungiswa kwengqondo mayelana nezinhlelo zokusebenza ze-intanethi umuntu osebenzisa kakhulu kakhulu, ukuziphatha kokuziphatha nokuzikhandla lapho umuntu ehlala ungaxhunyiwe ku-intanethi ngokukhulisa isikhathi eside. I-2) Ukwelashwa Okukhuthazayo Okugqugquzelayo: Ivumela izilonda kanye nabahlengikazi bazo ukuba babambisane ngezinhlelo zokwelashwa futhi bahlele imigomo efinyelelekayo. Kudinga indlela engafani ukuphikisana nayo futhi kubhekwe njengento entsha.^[20]

Kuningi ukungenelela kwengqondo njengohlelo lwe-Multi-Level Counseling Program (MLC), ukuqeqeshwa kobuchwepheshe bezenhlalakahle (SoCo), ukuHlelwa kweSisombululo (SFBT), i-Cognitive Therapy (CT) ne-Reality Therapy (RT) esetshenziselwe ukwelashwa kokuziphatha izidakamizwa.^[21]

Isiphetho

Ukwandiswa kokufinyelela kwi-intanethi yizingane ezisencane kuye kwadala amathuba angakaze atholakale ekufundiseni ngokocansi, ekufundeni nasekukhuleni. Ngakolunye uhlangothi, kuye kwaholela ekukhuleni kwezimo ezihlukahlukene eziqinisa ngokuphindaphindiwe umvuzo; ukugqugquzela nokukhumbula inkumbulo konke okuyingxenye yesifo sokulutha. Enye yokulutha ukuziphatha okubandakanya ukubandakanya izithombe zobulili ezingcolile Ucwaningo lubonisa ukuthi intsha esebenzisa izithombe zobulili ezingcolile, ikakhulukazi ezitholakala kuyi-intanethi, inezilinganiso eziphansi zokuhlanganiswa komphakathi, ukwanda kwezinkinga zokuziphatha, amazinga aphezulu wokuziphatha okubi, izimo eziphakeme zezimpawu zokucindezeleka, nokunciphisa ukubopha ngokomzwelo nabanakekeli. Ukwelashwa kokubheja ocansini kunezinselelo eziyingqayizivele ukuthi iningi lababhebheli bezokwelapha kanye nabachwepheshe bezempilo yengqondo bangase bangaboni uma bengenalo izandla eziningi-okuhlangenwe nakho okwelapha lesi sifo. Nakuba kunesibalo sezifundo mayelana nemiphumela yokwelapha, kubonakala ukuthi inhlanganisela ye-pharmacotherapy kanye ne-psychotherapy inomphumela ongcono wokuvimbela ukuphindwa kweziguli.

Ukwesekwa kwezezimali nokuxhaswa

Nil.

Izingxabano zesithakazelo

Azikho izingxabano zentshisekelo.

Okubhekwayo

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