I-neurobiology yezokugembula kokugula kanye nokulutha kwezidakamizwa ukubuka konke kanye nokuthola okusha (2008)

abstract

I-1. Ukuzijabulisa, inkinga kanye nokugembula kwe-pathological

Ukugembula kungachazwa njengokubeka okuthile kwenani engcupheni ethembeni lokuthola okuthile kwenani elikhulu kakhulu (Potenza 2006). Iningi labantu abadala liyabheja, futhi iningi lenza kanjalo ngaphandle kokuhlangabezana nezinkinga ezinkulu. Noma kunjalo, izinkinga zokugembula phakathi kwabantu abadala ziye zalinganiselwa ukuthi ziphezulu njenge-5%, namaqembu athile (abantu abadala abancane, abantu abanenkinga yempilo yengqondo nabantu ababoshiwe) abanokulinganisa okuphindwe kabili okuphezulu (Shaffer et al. 1999). Ukugembula kwe-Pathological (PG), okufanekisela uhlobo olubi kakhulu lokugembula okuyinkinga (bheka ngezansi), kulinganiselwa kokuqagela cishe kwe-0.5-1% (UPretty et al. 2005). Njengoba kunikezwe ukutholakala okwengeziwe kokugembula okusemthethweni nokuthandwa kwaso emashumini amaningi eminyaka adlule, ukunakwa okuthe xaxa emiphumeleni yezempilo yamazinga athile wokuziphatha kokugembula kufanelekile (UShaffer noKorn 2002).

Kwakungenxa kuze 1980 ukuthi Diagnostic futhi ibhukwana incwajana (DSM) ichaza indlela yokuphazamiseka kokugembula (I-American Psychiatric Association 1980). Igama elithi 'PG' lakhethwa ukuze lisebenzise amanye amagama (isib. Ukugembula okuphoqayo) okwakusetshenziswa kabanzi ngaleso sikhathi, mhlawumbe emzameni wokuhlukanisa lo mqedazwe kokungaboni ngasolinye. Kanye ne-pyromania, i-kleptomania, i-trichotillomania kanye nezifo eziqhumayo eziqhubekayo, i-PG njengamanje ihlukaniswa ngokuthi 'i-impulse control disorder (ICD) hhayi kwenye indawo' kwi-DSM. Ngokufanayo, ku-International Classization of Disways, lesi sifo sihlukaniswa ngaphansi kwe- 'Habit and impulse disrupt' kanye ne-pyromania, kleptomania kanye ne-trichotillomania. Izindlela eziningi zokuxilonga yamanje zezici zokwabelana ze-PG nalezo zokuncika kwezidakamizwa (DD). Isibonelo, izindlela eziqondise ukubekezelela, ukuhoxa, imizamo ephindaphindayo engaphumelelanga yokunciphisa noma ukuyeka, kanye nokuphazamiseka ezindaweni ezinkulu zokusebenza kwempilo kuqukethe imibandela ye-PG ne-DD. Ukufana kunwebeka kwizizinda ezingama-phenomenological, epidemiological, clinical, genetic kanye nezinye izizinda zezinto eziphilayo (Goudriaan et al. 2004; Potenza 2006; IBrewer & Potenza 2008), kuphakamisa imibuzo yokuthi ingabe i-PG ingahle ibonwe njengomlutha 'wokuziphatha'.

I-2. I-PG njengomlutha

Uma i-PG imele umlutha, kufanele yabelane ngezici eziyinhloko ze-DD. Izingxenye eziyinhloko zokulutha ziye zahlongozwa kufaka (i) ukuqhubeka kokuzibandakanya ekuziphatheni yize kunemiphumela emibi, (ii) kwehlise ukuzithiba ngokuzibandakanya ekuziphatheni, (iii) ukuzibandakanya okuphoqelekile ekuziphatheni, kanye (iv) nokunxenxa okujabulisayo noma Ukufuna izwe ngaphambi kokuzibandakanya ekuziphatheni (Potenza 2006). Eziningi zalezi zici, kanye nezinye, njengokubekezelela nokuhoxisa, zibonakala zilungele i-PG ne-DD (Potenza 2006). Izifundo ezifanayo ze-PG ne-DD kufanele zisize ukuchaza izici ezihlobene nezidakamizwa. Okusho ukuthi, izidakamizwa zingathonya ukwakheka kobuchopho futhi zisebenze ngezindlela eziphakathi nendawo noma ezingahambisani nenqubo yokulutha. Ngaleyo ndlela i-PG ingacatshangwa njengomlutha ngaphandle komuthi, ukuqhathanisa okuqondile kwalezi zinkinga kunganikeza ukuqonda kwezici ezingumgogodla zomlutha wokulutha futhi kuqondise ukuthuthukiswa nokuhlolwa kokwelashwa okusebenzayo.

I-3. Izinhlelo ze-Neurotransmitter ne-PG

Ama-neurotransmitters acacisiwe ahanjisiwe ukuthi ahlobane nezici ezihlukile ze-PG. Ngokusekelwe ocwaningweni lwe-PG kanye / noma okunye ukuphazamiseka, i-noradrenaline ifakwe ama-ICD ukuthi ibhekane ngqo nezici zokuvuselela injabulo, i-serotonin ekuqalisweni kokuziphatha kanye nokuyeka, i-dopamine ukuvuza nokuqinisa, kanye ne-opioids yokujabulisa noma ukunxusa. Lezi nezinye izinhlelo zibhekwa ngezansi.

I-4. Izinhlelo ze-Neural

Abaphenyi abambalwa bahlolisisa ukuthi imisebenzi yobuchopho ihluke kanjani kubantu abane-PG noma amanye ama-ICD ngokuqhathaniswa nalawo angenayo. Ucwaningo olulodwa olusebenzayo lokuqala lwe-magnetic resonance imaging (fMRI) luphenye ukunxenxa noma ukuthanda izifundazwe emadodeni ane-PG (amandla et al. 2003b). Lapho ubheka amateyipu wokugembula nangaphambi kokuqala kokuphendula okuphathelene nokushukumisela noma ngokomzwelo, abagembuli be-pathological (PGers) njengoba kuqhathaniswa nabokuzithokozisa bakhombisa ushintsho oluncane lwe-oxygen oxygen-based (BOLD) changes in frontal cortical, basal ganglionic and thalamic brain region . Lokhu umehluko phakathi kweqembu akubonwanga ngesikhathi sevidiyo ejabulile noma edabukisayo ngesikhathi sokuqhathanisa sokubuka, futhi okutholakele kuhlukile ezifundweni zabantu abanokuphazamiseka kwengqondo okubonakalayo, okuvame ukukhombisa ukwenziwa okuthe xaxa kwalezi zifunda phakathi kwezifundo zokuvusa izimpawu. (UBreiter noRauch 1996). Ngesikhathi sokugcina sokubuka i-tepi, isikhathi lapho kwethulwa khona okokukhuthaza ukugembula okunamandla kunabo bonke, amadoda ane-PG ngokuqhathaniswa nalawo ngaphandle ayephawuleka kakhulu ngokukhombisa ushintsho lwesiginali BOLD olwehlisiwe ku-vmPFC. Lokhu okutholakele kubonakala kuhambisana nalokho okuvela kwizifundo zokulawulwa kokuthinteka kokuphazamiseka kwezinye izizinda zokuziphatha, ubuhlakani obukhulu (Umthungi et al. 1999; New et al. 2002) nokwenza izinqumo (Bechara 2003).

Yize ezinye izifundo zokucabanga zinethonya lesifunda sangaphambili kwi-PG (ICrockford et al. 2005), uphenyo oluningi lubonile umehluko ekusebenzeni kwe-vmPFC ku-PG. Ucwaningo lokulawula kwengqondo kusetshenziswa uhlobo oluhlobene nomcimbi wokuphazanyiswa kombala we-Stroop bathola ukuthi amadoda ane-PG ngokuqhathaniswa nalawo ngaphandle ahlukaniswe kakhulu ngokushintshwa kwesiginali BOLD okunciphisiwe ku-vmPFC kwesokunxele kulandela ukwethulwa kwesimangalo esingalungileamandla et al. 2003a). Lapho benza okufanayo kwe-fMRI Stroop paradigm, abantu abanenkinga yokuphefumula babehlukaniswa kakhulu kwizifundo zokulawula esifundeni esifanayo se-vmPFC (Blumberg et al. 2003), kuphakamisa ukuthi ezinye izinto ezivamile kokuphazamiseka (isib. ukulawulwa kokungafaneleki kokuphathwa, ukulawulwa okungokomzwelo okungalungile) zabelana ngezakhi zomhlaba ezingaphansi kwemingcele yokuxilonga. Nge-analog, abantu abathembele kwinto noma ngaphandle kwe-PG bakhombise ukwenziwa okuncane kwe-vmPFC kunokulawula izihloko ekuhlolweni kokuthatha izinqumo 'zokugembula' (UTanabe et al. 2007).

Kokunye ukuhlola kwe-fMRI, abantu abane-PG njengoba kuqhathaniswa nalabo ngaphandle kokukhombisa ukusebenza kancane kwe-vmPFC ngesikhathi sokugembula okulinganiselwe kuqhathaniswa nokuwina nokulahlekelwa kwezimo, futhi ukuguqulwa kwesiginali BOLD ku-vmPFC kuhlobene nobunzima bokugembula phakathi kwe-PGers (Ukubuyela emuva et al. 2005). Esifundweni esifanayo nokusebenzisa umehluko ofanayo, iphethini efanayo yokuncishiswa kwehle yabonwa kwabakwa-PG endaweni ye-ventral striatum, indawo yobuchopho ene-dopaminergic innervation futhi okunomthelela omkhulu ekuluthweni kwezidakamizwa nasekusebenziseni umvuzo (I-Everitt neRobbins 2005). Kususelwa emsebenzini ezinsukwini zokuqala (Schultz et al. 2000), izifundo zokulungiswa kwemivuzo kubantu zihlobanise ukusebenza kwe-ventral striatum ngokulindela ukusebenza komvuzo wemali nokwenza kusebenze i-vmPFC ngokuthola imivuzo yemali (Knutson et al. 2003). Lo mjikelezo ubonakala usebenza kakhulu ekucutshungweni kwemivuzo masisha njengoba ukukhethwa komvuzo obambezelayo obukhulu kubandakanya amanethiwekhi e-dortal cortical network (McClure et al. 2004). Ukugembula kweBlackjack njengoba kuqhathaniswa nokudlala i-blackjack yamaphoyinti kuhlotshaniswa nokwenza okwengeziwe kwe-corticostriatal ku-PGers (Hollander et al. 2005). Kodwa-ke, lolu cwaningo aluzange lufake izifundo ezingenayo i-PG ngakho-ke aluzange luphenye ukuthi izifundo ze-PG ziyehluka kanjani kulabo abangenawo lo mkhuba. Ukutholwa kokusebenza okuncishisiwe kwe-cyral striatum ku-PGers ku-paradigm yokugembula eyenziweUkubuyela emuva et al. 2005) iyahambisana nokutholakele kusuka ocwaningweni lokulindelwa komvuzo kubantu abanokulutha noma okubonakala sengathi kusengozini yalokhu kuphazamiseka. Isibonelo, ukwenziwa okunciphise kokusebenza kwe-ventral striatum ngesikhathi sokulindelwa kwemivuzo yemali kuye kwabikwa kubantu abethembele otshwaleni (IHommer 2004; Sula et al. 2007) noma ukuxhomekeka kwe-cocaine (CD; Pearlson et al. 2007) kanye nasebusheni ngokuqhathaniswa nabantu abadala (I-Bjork et al. 2004) nalabo abanomlando womndeni wotshwala ngokuqhathaniswa nalezo ezingenawo (Indoda et al. 2004). Ngokubambisana, lokhu okutholakele kusikisela ukuthi ukwenziwa okuncishisiwe kokusebenza kwe-ventral striatum ngesikhathi sokulindela kokulungiswa kwemivuzo kungahle kumelele phenotype ebalulekile yomlutha wezidakamizwa nama-ICD.

I-5. Isifiso sokuncenga esijwayelekile ku-PG naku-CD

Isifiso esivumayo noma izifiso ezifisayo ngokuvamile zandulela ukubandakanyeka ekuziphatheni okuyinkinga njengokugembula kwabakwa-PGers noma ukusetshenziswa kwezidakamizwa ekuluthweni kwezidakamizwa. Kanjalo, ukuqonda kokuhlangana kwe-neural yalezi zifundazwe kunomthelela obalulekile emtholampilo (izindleko et al. 2006). Ngokombono wesayensi, ucwaningo lwezinqubo ezifanayo, njengokuthi izifiso ezinxanelekayo kubantu abane-PG noma labo abane-DD, zingacacisa izici eziwumgogodla wenqubekelaphambili yezinqubo ezishukumisayo kuzo zonke iziphazamiso, ngaphandle kwemiphumela yokuvezwa kwezidakamizwa okubi kakhulu noma okungamahlalakhona.

Ukuphenya, sisebenzise idatha kwizifundo zethu ezishicilelwe zezinhlelo zokugembula ku-PG (amandla et al. 2003b) nokunxanela izidakamizwa kwi-CD (Wexler et al. 2001). Njengoba ucwaningo lwethu lokugembula luhilela izifundo zabesilisa kuphela, sinqande ukucubungula emadodeni, siveza isampula kufaka phakathi izifundo ze-10 PG kanye nokugembula kwe-11 (C_PG izikhonzi) ababuke amageyipu wokugembula, odabukisayo futhi ajabule ngesikhathi se-fMRI, nezifundo ze-9 CD kanye nabalingisi be-non-cocaine abasebenzisa iCocaine (C_CD izikhonzi) ababuke i-cocaine, izimo ezidabukisayo nezinenjabulo, njengoba kuchaziwe ngaphambili. Siphenye ngale ndlela elandelanayo ukuthi ubungakanani bokusebenza kobuchopho ekusebenzeni okushukumisayo noma ngokomzwelo buyefana noma buhluke kumlutha wokuziphatha onjenge-PG uma uqhathanisa ne-CD yokulutha kwezidakamizwa. Siphinde sazi ukuthi izifunda zobuchopho obumsebenzi wazo obuthonywe yi-cocaine exposition, ezifana ne-cortex yangaphambili ne-anterior cortex, buzohileleka ngokwahlukahlukana kwezifiso ze-cocaine ezise-CD nasezincekelweni zokugembula ku-PG.

Sisebenzise inqubo esekwe nge-voxel ukwazisa ukubaluleka kwezibalo esizukulwaneni se pAmamephu akhomba umehluko ngendlela ukusebenza kobuchopho bezihloko ezithintekile okwehlukile ngayo kwezilawuli kuwo wonke amaqembu okugembula necocaine ngesikhathi sokubukwa komlutha, amateyipu evidiyo ajabule futhi adabukisayo (Wexler et al. 2001; amandla et al. 2003b). Eqenjini ngalinye lezihloko ezibuka uhlobo ngalunye lwetheyiphu, sikhiqize a t-map ngokuqhathanisa isikhathi sokubuka kwesimo njengoba kuqhathaniswa nemigwaqo eyisisekelo yesibuko se-pre-and post-tape grey screen. Okulandelayo, zohlobo ngalunye lwetheyiphu, esikhiqizayo t-Imisho lokwehlukanisa umehluko lapho tifundvo letitsintekile (sibonelo i-PG) leyehluka kulawulo lwato lolutsite (sib. C_PG), yakha i-PG-C_PG umehluko. Okulandelayo, siqhathanisa indlela amaqembu athintekayo ahluke ngayo kulawulo kuyo yonke imilutha ((PG-C.)_PG) - (CD-C_CD); ithebula le-1a, bona isibalo 1A kokuqukethwe kokungezelelwa ngogesi). At p<0.005 nokusebenzisa iqoqo lama-25 ukukhulisa i-stringency (UFriston et al. 1994), umehluko ohlobene nokuphazamiseka kokungafani phakathi kwamaqembu athintekayo nawathintekile athintekayo abonwa ngesikhathi kubhekwa ompompi bokulutha (ithebula le-1a; bona i-figure 1A kokuqukethwe kokungezelwa kwe-elekthronikhi) kepha hhayi izimo ezidabukisayo noma ezijabulisayo (ezingakhonjiswanga). Izifunda ze-ventral kanye ne-dorsal anterior cingulate kanye ne-parietal lobule ephansi efanelekile zikhonjwe ngenkathi kubukwa lezi zimo zokulutha, ngomsebenzi omncane oye wehla ku- (PG-C_PG) qhathanisa ngokuqhathaniswa ne- (CD-C_CD) ukuqhathanisa. Iminikelo yeqembu engaphansi kwesifundo kulokhu umehluko iyabhalwa (ithebula le-1a). I-cortex ye-anterior, isifunda sobuchopho esifakwe ekucutshungulweni ngokomzwelo nokulawula kokuqonda kokuphilile (Bush et al. 2000) nezihloko ze-CD (IGoldstein et al. 2007), kukhonjiswe ukuthi kusebenze ngenkathi kunxenxa i-cocaine (Izingane et al. 1999). Ukuphathwa kwe-Cocaine kusebenze i-cingulate engaphandle (Febo et al. 2005), nesikhathi kanye nephethini yokuphatha i-cocaine kunomthelela emsebenzini we-cingate we-anterior (IHarvey 2004). Umehluko ekusebenzeni okungaphansi kwe-parietal lobule kumaqembu ezifundo kukhombisa umehluko omkhulu ezimpendulweni ze-neural zamaqembu olawulo emidlalweni yokugembula neyama-cocaine. I-parietal lobule engaphansi iye yafakwa umthelela ekuphenduleni kwezakhi zokuvimbela zomthethonqubo wethonya (I-Menon et al. 2001; Igalari et al. 2006). Ngakho-ke, okutholakele kukhombisa ukuthi amateyipu wokubuka wokuqukethwe okuhlukile (isb. Izincazelo zokuziphatha okungahlangene nomphakathi (ukugembula) ngokuqhathaniswa nomsebenzi ongekho emthethweni (ukusetshenziswa kwe-cocaine)) kuhlotshaniswa nokwenza kusebenze okuhlukile kulawulo lwezifundo zesifunda sobuchopho ezibandakanyekayo ekuphenduleni kokulamula ukuvimbela.

Ithebula 1

Ukusebenza kobuchopho ku-PG ne-CD kuqhathaniswa nezifundo zokulawula.

Sibe sesiphenya izifunda zobuchopho ezivame ukufiswa yizifiso ze-cocaine nezifiso zokugembula, sibonisa ukuthi sizokhomba izindawo zobuchopho ezibe nomthelela ofanayo kwi-CD naku-PG, njengokuncipha kokusebenza kwe-ventral striatum ekusebenzeni kwemivuzo ethintekayo kuqhathaniswa nezihloko zokulawula (Ukubuyela emuva et al. 2005; Pearlson et al. 2007). Eqenjini ngalinye lezihloko ezibuka uhlobo ngalunye lwetheyiphu, sikhiqize a t-map ngokuqhathanisa isikhathi sokubuka kwesimo kokuqala kanye naphansi kwetheyiphu yangaphansi. Okulandelayo, zohlobo ngalunye lwetheyiphu, sidale t-Imephu ekhombisa ukungasebenzi kahle emaqenjini eziguli ngokuqhathanisa iqembu ngalinye lesiguli ngokulawula kwalo, kukhiqiza i-PG-C_PG kanye ne-CD-C_CD umehluko. Ukuqhathanisa okwenziwe ngamakhompiyutha emikhondweni yokubaluleka elandelanayo (p<0.005, p<0.01, p<0.02 futhi p<0.05) zenzelwe ukukhomba izifunda lapho i-PG – C_PG kanye ne-CD-C_CD Ukuqhathanisa kubonise ukutholwa okufanayo. Iqembu ngalinye p-Maps kwasetshenziswa ukubona izifunda zobuchopho ezineqhaza kulokhu okutholakele. Azikho izifunda zobuchopho ezihlonziwe zisebenzisa le nqubo yokulutha, amakhomputha ajabule futhi adabukisayo. Njengoba izifundo zethu zangaphambili zikhombisile ukuthi isikhathi sokuqala sokubuka i-tepi, ngaphambi kokuqala kokuphendula okushukumisayo / kwemizwa, kuhlotshaniswa nokwehlukana okukhulu phakathi kweqembu izimpendulo kuma-videotapes omlutha (Wexler et al. 2001; amandla et al. 2003b), senze ucwaningo olufanayo sigxile esikhathini sokuqala sokubuka kwetheyiphu kuqhathaniswa nesisekelo sangaphambi kwetheyiphu. Le nqubo ikhombe izifunda zobuchopho eziningi (ithebula le-1b; bona i-figure 1B kokuqukethwe kokungezelwa kwe-elekthronikhi) okubonisa izinguquko zomsebenzi ofanayo ekuqhathaniseni phakathi kwezihloko eziluthayo nezokulawula ngesikhathi sokubuka kwamateyipu umlutha ofanele, futhi akukho zifunda ezikhonjwe ngokuqhathaniswa ezibandakanya ompompi abadabukisayo noma abajabulayo (abangakhonjiswanga).

Izifunda zobuchopho ezikhonjwe njengokukhombisa amaphethini okusebenza okuvamile ezinqabeni zezihloko ezingamakhoboka omlutha zifaka izifunda ezinegalelo ekusetshenzisweni ngokomzwelo nokushukumisayo, ukuhlolwa komvuzo nokwenza izinqumo, ukuvimbela impendulo, kanye nomphumela ekwelapheni umlutha. Ezimweni eziningi, lezi zifunda zazenziwa ngezifundo zokulawula kepha hhayi eziluthayo. Ukusebenza okuncishisiwe okuncishiswe kakhulu kwe-ventral striatum kwaqapheleka ezifundweni ezingumlutha ngokuqhathaniswa nezifundo zokulawula, kuyahambisana nokutholakele kwimisebenzi ebandakanya ukucubungula imivuzo kumaqembu ezihloko ze-PG ne-CD (Ukubuyela emuva et al. 2005; Pearlson et al. 2007). Izakhi ze-ventral ze-cortex zangaphambili, ikakhulukazi i-cortex ye-orbitofrontal, zifakwe umthelela ekucutshungulweni kwemivuzo (Schultz et al. 2000; Knutson et al. 2003; McClure et al. 2004), futhi isifunda esilandelanayo sicatshangelwa ukuthi sizosebenza lapho kudingeka imininingwane eyengeziwe ukuqondisa izindlela zokuziphatha noma lapho ukwenza izinqumo kufaka ukucindezela kwezimpendulo ezivuzwe ngaphambilini (Elliott et al. 2000). Izifunda ezizayo ze-cortex ye-ventral prefrontal preortal, efana ne-gyrus ephansi yangaphambilini, nazo zibhekwa njengezibaluleke kakhulu ekuvinjelweni kokuphendula nokulawula okungafuneki (IChamberlain neSahakian 2007). Ezinye izifunda zobuchopho ezinamaphethini wokusebenzisa amandla ahlukanisa izihloko ezingamlutha nezingamlutha ocwaningweni lwamanje nazo zibe nomthelela ekulameni ukulawulwa kwethonya. Isibonelo, ku-Go / NoGo paradigm ebandakanya izifundo ezinempilo, i-insula, i-precuneus ne-posterior cingulate zavuselelwa ngenkathi kusetshenzwa ngephutha kanye ne-orbitofadal cortex ne-girus yolimi ngesikhathi sokuvinjelwa kokuphendula (I-Menon et al. 2001). Ukwenza kusebenze ngaphakathi kufaka isandla ezifisweni futhi kungathonya izinqubo zokwenza izinqumo ekuluthweni (UCraig 2002; Naqvi et al. 2007). Ukwehluleka kwezifundo eziluthayo ukwenza kusebenze lezi zifunda kusigaba sokuqala sokuphendula ezinkambeni ezisebenza njengezimbangi kungaba nomthelela ekuzibambeni kabi nasekusebenziseni izidakamizwa okulandelayo. Lokhu okutholakele kunemiphumela yomphumela wokwelashwa wabo bobabili i-PG kanye nokulutha kwezidakamizwa. Isibonelo, ukulimala kwe-insula kuhlotshaniswe nokuziphatha okungafaneleki kokubheja njengoba kufakazelwa ukwehluleka ukulungisa ukubheja maqondana nemikhawulo yokuwina, futhi-ke ukusebenza okungekuhle kungathinta ikakhulukazi i-PG (Clark et al. 2008). I-activation cingrate activation ngesikhathi sokubuka amakhasethi e-cocaine yayihlotshaniswa nemiphumela yokwelashwa ezifundweni ze-CD, nalabo abakwazi ukwenqatshelwa kokubonisa ukusebenza okwengeziwe kwale ndawo yobuchopho (izindleko et al. 2006). Ngakho-ke, yize le miphumela kufanele ibhekwe njengokunikezwa kuqala amasampula amancane eqembu ngalinye lezifundo, okutholakele kuhambelana nezincwadi ezinkulu ku-PG, umlutha wezidakamizwa, ukulawulwa kokuthinteka kanye nokuhlobana kwe-neural komphumela wokwelashwa wokulutha kwezidakamizwa. Uphenyo olwengeziwe olubandakanya amasampula amakhulu nangaphezulu ayadingeka ukuze uqinise futhi wandise lokhu okutholakele.

I-6. Iziphetho nezinkomba zesikhathi esizayo

Yize kunentuthuko enkulu eyenziwe ekuqondeni kwethu i-PG kule minyaka eyishumi edlule, izikhala ezinkulu zisala ekuqondeni kwethu ngale nkinga. Izifundo eziningi zebhayoloji kuze kube manje ziye zabandakanya amasampula amancane abesilisa noma abesilisa kuphela, okuphakamisa ukukhathazeka maqondana nokutholakele kokutholakele, ikakhulukazi kubantu besifazane. Ukwehluka kobulili ekuziphatheni kokugembula kuye kwabikwa zombili maqondana nezinhlobo zezinkinga zokugembula kwabesifazane uma kuqhathaniswa nabesilisa kanye namaphethini wokuthuthuka kwezinkinga zokugembula (amandla et al. 2001). Isibonelo, into ye- 'telescoping', inqubo ebhekisele kusikhathi esinqunyelwe ngaphambili phakathi kokuqalisa namazinga ayinkinga wokuzibandakanya kokuziphatha, sichazwe okokuqala ngotshwala, muva nje nge-DD, futhi muva nje ngenkinga ne-PG (amandla et al. 2001). Uma kunikezwe umehluko ofanele emtholampilo, izivivinyo ku-biology eyisisekelo ye-PG kufanele zicabangele ukuthonya okungaba khona ocansini. Ngokufanayo, izigaba ezahlukahlukene zokugembula kwezokugembula kufanele zibhekwe ophenyweni lwebhayoloji, uma kunikezwe imininingwane eveza ukubandakanyeka okuhlukile kwe-neurocircuitry (isb. I -ralral volus dorsal striatum) njengoba izimilo zithuthuka zisuka kunoveli noma ngokuphoqelela kokuya ejwayelekile noma okuphoqayo (I-Everitt neRobbins 2005; Chambers et al. 2007; IBelin ne-Everitt 2008; IBrewer & Potenza 2008). Ukucatshangelwa okungeziwe kufaka uhlobo lokuphoqelela nobudlelwano bayo nama-ICD kanye nokuluthwa kwezidakamizwa. Okusho ukuthi, kungenzeka ukuthi ukusetshenziswa kwezidakamizwa kungaholela ekugembeni okuningi, ukugembula okwengeziwe kungaholela ekusetshenzisweni kwezidakamizwa, noma ukuthi izici ezivamile njengokuphoqelela zingaholela ekuzibandakanyeni ngokweqile kwesizinda ngasinye. Ukucacisa la mathuba kuzilungiselelo zezilwane nezezifiso zangempela kumelela umgomo ofanele ngokomtholampilo nangokwesayensi (Dalley et al. 2007). Ngokunikezwe ukuthi ukufakwa kungumakhi oyinkimbinkimbi owakhiwe (Moeller et al. 2001), ukuqonda ukuthi izici ezithile zihlobana kanjani nama-pathophysiologies kanye nokwelashwa kwe-PG nokulutha kwezidakamizwa kubalulekile. Okokugcina, i-PG ngokungenakuphikwa ifundwe kahle kunazo zonke zeqembu lama-ICD okwamanje ahlukaniswe ndawonye ezincwadini zokuhlonza. Ucwaningo olwengeziwe luyadingeka kwamanye ama-ICD kanye ne-neurobiology yawo, ukuvikela kanye nokwelashwa, ikakhulukazi njengoba lokhu kuphazamiseka kuhlotshaniswa nokumaka kakhulu i-psychopathology enkulu futhi kubonakale okwamanje ukuthi akuvunyelwa kuzilungiselelo zokwelashwa (Grant et al. 2005).

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