Dürtüselliğin Nöroanatomik ve Nörokimyasal Temelleri

Dürtüsellik ortama uygun olmayan veya aşırı riskli, olgunlaşmamış, iyi planlanmamış ve çoğunlukla istenmeyen sonuçlara yol açan çeşitli davranışları kapsar. Dürtüsellik sabırsızlık, dikkatsizlik, risk alma, heyecan arama, zevk arama, zarar görme ihtimalini düşük hesaplama ve dışadönüklük gibi özellikler ile kendini gösterir. Dürtüsellik çok sayıda psikiyatrik bozukluğun çekirdek belirtilerinden biridir. Dürtüsel davranışların farklı yönlerine odaklanarak, hem insanda hem de hayvanlarda dürtüselliği ölçmek için birtakım davranışsal modeller geliştirmek mümkün olmuştur. Bunlar dürtüsel eylemi (motor dürtüsellik) ölçenler ve dürtüsel seçim ya da dürtüsel karar vermeyi (bilişsel dürtüsellik) ölçenler şeklinde iki ana kategoriye ayrılabilirler. Dürtüsel eylem bir yanıt vermeye engel olamamak olarak tanımlanabilir. Davranış bilimleri açısından, dürtü kontrolü yiyecek, cinsellik ya da yüksek derecede arzulanan diğer kazançlar için içsel veya dışsal olarak harekete geçirilen güçlü bir isteği modüle eden aktif bir inhibitör mekanizma şeklinde tarif edilir. Bu inhibitör kontrol mekanizması sayesinde hızlı koşullanmış yanıtlar ve refleksler geçici olarak baskılanır ve böylelikle daha yavaş bilişsel mekanizmalar davranışı yönlendirebilir. Bu sürece yanıt engellenmesi adı verilir. İnhibitör süreçleri incelemekte en yaygın kullanılan iki test go/no-go (yap/yapma) ve stop-signal reaction time (SSRT, dur işareti tepki süresi) testleridir. Dürtüsellik, dürtüsel eylemlerin yanısıra, dürtüsel kararlar veya seçimlerde de kendini belli eder. Burada ortaya çıkan ve inhibe edilen motor bir yanıt değil, bir karar verme süreci sözkonusudur. Dürtüsel karar verme ya da dürtüsel seçim yapma eylemlerin diğer muhtemel seçenekleri veya sonuçları yeterince düşünmeden başlatılması olarak tanımlanır. Dürtüsel seçim yapmanın ölçülmesinde kullanılan testlerden biri "gecikme indirimi"dir (delay-discounting). Burada bir ödülün verilmesi geciktiğinde subjektif olarak değerini kaybetmesi sözkonusudur. Bu tür testlerde hemen verilen daha küçük bir ödülün mü yoksa daha sonra verilen daha büyük bir ödülün mü tercih edileceği belirlenmeye çalışılır. Dürtüsel seçim hemen verilen küçük ödülün seçimi olarak tanımlanır. Dürtüsellik farklı bileşenleri olan bir davranıştır. Nöroanatomik ve nörokimyasal olarak birbirinden farklı süreçlere bölünerek incelenebilir. Nöroanatomik veriler yanıt engellenmesi (dürtüsel eylem/motor dürtüsellik) ve ödül gecikmesinin tolere edilememesi (dürtüsel seçim/karar verme) süreçlerinin farklı frontostriatal döngüler tarafından düzenlendiği düşüncesini desteklemektedir. Dorsal prefrontal korteks ve anterior singulat korteks dürtüsel seçim yapma ile ilgili görünmemekte, ancak inhibitör süreçlerin düzenlenmesinde bir şekilde rol oynamaktadır. Buna karşılık, orbitofrontal korteks ve bazolateral amigdala dürtüsel karar verme süreçlerinde önemli rol oynamaktadır. Nukleus akumbens ve subtalamik çekirdek gibi diğer yapılar ise her iki sinir devresinde ortak yapılar olabili

Anahtar Kelimeler:

Dürtüsellik, Nöroanatomi, Nörobiyoloji, Nörokimya

Neuroanatomical and Neurochemical Basis of Impulsivity

The term 'impulsivity' encompasses a multitude of behaviours that are poorly conceived, premature, inappropriate, and that frequently result in unwanted or deleterious outcomes. Impulsivity manifests as impatience carelessness, risk-taking, sensation-seeking and pleasure-seeking, an underestimated sense of harm, and extroversion. Impulsivity is a core symptom of a broad spectrum of psychiatric disorders. Through focusing on different aspects of impulsive behavior, it has proved possible to devise a variety of behavioral paradigms to measure impulsivity in both human and non-human subjects. These can be broadly divided into two categories: those measuring impulsive action or motoric impulsivity, and those measuring impulsive choice or impulsive decision-making. Impulsive action can be broadly defined as the inability to withhold from making a response. Within the framework of behavioral neuroscience and cognitive psychology, impulse control has been described as an active inhibitory mechanism which modulates the internally or externally driven pre-potent desire for primary reinforcers such as food, sex or other highly desirable rewards. This inhibitory control mechanism may provide the substrate by which rapid conditioned responses and reflexes are transiently suppressed, so that slower cognitive mechanisms can guide behavior. This process is referred to as response inhibition. Two of the most common tests used to study inhibitory processes are the go/no-go and stop-signal reaction time tasks. Impulsivity is also evident in the making of impulsive decisions or choices as well as in impulsive actions. Here, there is no "pre-potent" response that is primed and then forcibly inhibited, but a decision-making processes. Impulsive decision making or impulsive choice is defined as initiating actions without adequately considering other possible choices or consequences. Impulsive choice is typically measured in the delay discounting paradigm. In tis paradigm, the tendency to prefer small immediate rewards over larger, more delayed reinforcers is measured. İmpulsive choice is defined by a greater tendency to value or choose smaller, more immediate reinforcers. Impulsivity is a multi-faceted behaviour. This behaviour may be studied by subdividing it into different processes neuroanatomically and neurochemically. Neuroanatomical data support the suggestion that behavioral disinhibition (impulsive action / motoric impulsivity) and delay-discounting (impulsive choice / decision making) differ in the degree to which various components of frontostriatal loops are implicated in their regulation. The dorsal prefrontal cortex does not appear to be involved in mediating impulsive choice, yet does have some role in regulating inhibitory processes. In contrast, there appears to be a pronounced role for the orbitofrontal cortex and basolateral amygdala in controlling impulsive choice. Other structures, however, such as the nucleus accumbens and subthalamic nucleus may

Keywords:

Impulsivity, Neuroanatomy, Neurobiology, Neurochemistry,

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