Deconstructing and reconstructing behaviour relevant to mental health disorders: The benefits of a psychological approach, with a focus on addiction

Opening new vistas on obsessive-compulsive disorder with the observing response task

Obsessive-compulsive disorder (OCD), a highly prevalent and debilitating disorder, is incompletely understood in terms of underpinning behavioural, psychological, and neural mechanisms. This is attributable to high symptomatic heterogeneity; cardinal features comprise obsessions and compulsions, including clinical subcategories. While obsessive and intrusive thoughts are arguably unique to humans, dysfunctional behaviours analogous to those seen in clinical OCD have been examined in nonhuman animals. Genetic, ethological, pharmacological, and neurobehavioural approaches all contribute to understanding the emergence and persistence of compulsive behaviour. One behaviour of particular interest is maladaptive checking, whereby human patients excessively perform checking rituals despite these serving no purpose. Dysfunctional and excessive checking is the most common symptom associated with OCD and can be readily operationalised in rodents. This review considers animal models of OCD, the neural circuitries associated with impairments in habit-based and goal-directed behaviour, and how these may link to the compulsions observed in OCD. We further review the Observing Response Task (ORT), an appetitive instrumental learning procedure that distinguishes between functional and dysfunctional checking, with translational application in humans and rodents. By shedding light on the psychological and neural bases of compulsive-like checking, the ORT has potential to offer translational insights into the underlying mechanisms of OCD, in addition to being a platform for testing psychological and neurochemical treatment approaches.

Drug memory reconsolidation: from molecular mechanisms to the clinical context

Since its rediscovery at the beginning of the 21st Century, memory reconsolidation has been proposed to be a therapeutic target for reducing the impact of emotional memories that can go awry in mental health disorders such as drug addiction (substance use disorder, SUD). Addiction can be conceptualised as a disorder of learning and memory, in which both pavlovian and instrumental learning systems become hijacked into supporting drug-seeking and drug-taking behaviours. The past two decades of research have characterised the details of the molecular pathways supporting the reconsolidation of pavlovian cue-drug memories, with more recent work indicating that the reconsolidation of instrumental drug-seeking memories also relies upon similar mechanisms. This narrative review considers what is known about the mechanisms underlying the reconsolidation of pavlovian and instrumental memories associated with drug use, how these approaches have translated to experimental medicine studies, and the challenges and opportunities for the clinical use of reconsolidation-based therapies.

Measurement properties of patient-reported outcome measures of mental help-seeking attitude: a systematic review of psychometric properties

Background

At present, the phenomenon of patients with mental disorders not seeking mental help is very serious, and the mental help-seeking attitude is the central structure of the help process. However, there is no consensus on which patient-reported outcome measure (PROM) should be used to assess mental help-seeking attitudes.

Objective

The systematic review aims to critically appraise, compare, and summarize the measurement quality of the all-available PROMs about mental help-seeking attitudes to provide evidence-based guidance and reference for clinical researchers.

Methods

A systematic search was conducted in 9 databases (PubMed, Embase, Web of Science, Medline, APA, CINAHL, Sinomed, CNKI, and WanFang) since the establishment of the database until November 30, 2022 to identify articles on the PROMs of mental help-seeking attitudes. We used the COSMIN guidelines to evaluate the methodological quality and measurement properties of all-available PROMs, and a modified Grading, Recommendation, Assessment, Development, and Evaluation (GRADE) system to evaluate the level of evidence supporting each rating. Finally, the recommendation level is given according to the overall quality of each PROM.

Results

We identified 29 studies representing 13 PROMs out of 2,828 screening studies. The overall quality of the included PROMs varied, with 6 rated as class B, 6 as class C, and only the Mental Help Seeking Attitudes Scale (MHSAS) as class A.

Conclusion

The measurement characteristics of MHSAS have been the most comprehensive evaluation, and it has good reliability and validity, and high feasibility for clinical application, so it can be temporarily recommended for use, but the above conclusions still need to be supported by more high-quality evidence.

Making Leaps and Hitting Boundaries in Reconsolidation: Overcoming Boundary Conditions to Increase Clinical Translatability of Reconsolidation-based Therapies

Reconsolidation results in the restabilisation, and thus persistence, of a memory made labile by retrieval, and interfering with this process is thought to enable modification or weakening of the original trace. As such, reconsolidation-blockade has been a focus of research aiming to target the maladaptive memories underlying mental health disorders, including post-traumatic stress disorder and drug addiction. Current first-line therapies are not effective for all patients, and a substantial proportion of those for whom therapies are effective later relapse. A reconsolidation-based intervention would be invaluable as an alternative treatment for these conditions. However, the translation of reconsolidation-based therapies to the clinic presents a number of challenges, with arguably the greatest being the overcoming of the boundary conditions governing the opening of the reconsolidation window. These include factors such as the age and strength of memory, and can broadly be divided into two categories: intrinsic features of the targeted memory itself, and parameters of the reactivation procedure used. With maladaptive memory characteristics inevitably varying amongst individuals, manipulation of the other limitations imposed by procedural variables have been explored to circumvent the boundary conditions on reconsolidation. Although several apparently discrepant results remain to be reconciled and these limitations yet to be truly defined, many studies have produced successful results which encouragingly demonstrate that boundary conditions may be overcome using various proposed strategies to enable translation of a reconsolidation-based intervention to clinical use.

Editorial introduction: animal models relevant to mental health disorders

Mental health disorders affect a substantial proportion of the worldwide population, and currently available treatments do not work for all affected individuals. Understanding the psychological and biological mechanisms that underlie mental health disorders will facilitate treatment development, and the use of translational animal models is potentially transformative for this. Structured around the US National Institute of Mental Health's 'Research Domain Criteria' (RDoC) approach, this special issue showcases reviews that consider how animal models can best be used to understand and treat the processes that go awry in mental health disorders.