European archives of psychiatry and clinical neuroscience
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Eur Arch Psychiatry Clin Neurosci · Nov 2009
ReviewLearning and memory in the aetiopathogenesis of addiction: future implications for therapy?
Addiction is a chronic relapsing disorder. Even after long periods of abstinence from drugs, the risk of relapse, often precipitated by drug-associated cues, remains high. Especially learning processes have been shown to play a major role in the maintenance of addictive behaviour. ⋯ These observations have converged on the hypothesis that addiction represents the pathological usurpation of neural processes that normally serve reward-related learning. In this context, a substantial body of evidence suggests that several types of neuroadaptation occur, including synapse-specific adaptations of the type thought to underlie specific long-term associative memory. Consequently, understanding learning and memory processes in the brain in addiction is an important key for understanding the persistence of addiction, and it is reasonable to hypothesize that the disruption of drug-related memories may help to prevent relapses.
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Despite the huge personal and social impact of mental illnesses, mental health globally is widely neglected and marginalised. A conceptual change in thinking, from the biomedical to a public health model, is essential for integrating mental health services into health systems across the globe. This article discusses the burden of mental health globally, resources available to tackle the massive burden, WHO's mental health Gap Action Programme (mhGAP) on scaling up services with a special focus on low- and middle-income countries, and the paradigm shift required in psychiatry as the way forward.