Scielo RSS <![CDATA[Salud mental]]> vol. 28 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[Fenomenología del amor y psicopatología]]> resumen está disponible en el texto completo<hr/>Abstract: The question posed by this author is how the universal human phenomenon of love is disturbed in the leading psychopathological syndromes. With a view to answering this question, he proceeds first to make a phenomenology of love, for which he will analyze its spatiality and its temporality. The following step will be to show the way that these anthropological dimensions appear deformed both in schizophrenia and in melancholia. Spatiality of human love In daily life the space of dimensions remains rather hidden, and thus the "above" means "on the roof" and the "below" is understood as "on the floor". Every "where" is discovered through the relationship with things and is not determined by spatial measurements. The geometrical space, the artistic or the religious, etc. are possible because the human being is already spatial from his/her structure itself as "being-in-the-world". Now, the human spatiality has, according to Heidegger, two fundamental characteristics: das Ent-fernen, which could be translated as "removing", that is to say, the human being tendency to make disappear the distances, and das Einraumen, which has, in its turn, two meanings: clearing or cleaning, and conceding or giving. The first corresponds to the "principle of vital space", origin of aggressiveness and competence, about which K. Jaspers affirms: "Every position I conquer excludes some other by claiming for me part of the limited available space". Love represents the ex treme case of the second meaning: to concede or to give space. "Only where you are, a place for me is born", tells us the poet R. M. Rilke. In love not only there is no displacement of the other, but also there is creation of a new space, "our" space, whose most perfect realization is the embracement. It does not enclose the danger of fusion and loss of freedom because, as Rilke goes on to say, "no one can damage the other by limiting him/her; on the contrary, lovers constantly give each other space, breadth and freedom". The spatiality of love in schizophrenia and melancholia The schizophrenic lives in relation to the other with a great fear of closeness. The other is maintained at a distance through delusion, inadequate behaviors, eccentric plans or autism. In loving relationships the closeness of the other becomes unbearable for them and they frequently react in a paranoid way, which is exacerbated by their difficulty to correctly interpret messages from the other. The limitation of the loving capacity resulting from the failure to create the common space, is also revealed to us in typical triggering situations: love declaration, engagement (the Verlobunskatatonie from the classic German authors), homosexual seduction, entry into group organizations, etc., all situations having in common the fact that the other passes the limits they need to impose in order to maintain their fragile structure. Finally, it would be necessary to add that the loss of the ability to meet with the other in love also means that the world goes from being a home, a dwelling place, to an abstract geography, a place threatened by anonymous voices and enemies, where there are no walls keeping out the alien. Here the very basis of interhuman encounter itself -the fact of being unique, free and personal- has been lost. In melancholia space acquires characteristics to a certain extent polarly opposite to schizophrenia. It is warm and ordered; it is a space, where the kept objects retain the past and avoid change. The limits between the proper and the foreign are here very precise, as are too as the ranks governing human relationships. During the depressive phase this space loses color and perspective and, although the boundary between the familiar and the strange does not disappear, the space is reduced, because of a sort of "inflation" affecting the body, which begins to invade the patient through anxiety, discouragement and painful sensations. The depressed patient cannot tolerate the distance of the other, so much so that the most frequent triggering situations are constituted by separations and losses. Their exaggerated tendency to organize and to stick to persons and things indicates to us, for its part, the existence of a disturbance of that form of spatiality already mentioned: "das Einraumen", that is to say, giving, conceding space to the other. The depressive space is the contrary of that taught to us by Rilke in the "Requiem for a friend" (1908) as most properly pertaining to love: "Since that is guilt, if indeed something can be guilt: not to increase the liberty of the beloved...". The temporality of human love With time it occurs as with space; it is only a derivative, an abstraction of the existential time. And thus, the human being is always temporal by virtue of his very structure as being-in-the-world, as expressed by Heidegger. And the reason is that the motor of this structure is the care, cure or concern (die Sorge), where the past, present and future are articulated. In every action we are anticipating and interpreting the future from a determined "feeling ourselves" (the past) and we are carrying out the act of encountering ourselves with something or with somebody (in the present). Now, this time is constituted from finiteness, that is to say, from death, and its central feature is the passing. The time of love, by contrast, is the opposite of chronos, of that all-consuming passing time. The English poet Elizabeth Barrett-Browning com pares the life that passes and the love that remains ("love that endures, life that disappears"), while Schiller says to his beloved: "Only thinking that previously we cared less for each other upsets me, because love must see eternity backwards and forwards". This temporality of duration that we find in human love, and which opposes the temporary nature of life, is also observed in the realm of the religious and it is expressed in a very particular way in the rites. Finally, it would be necessary to add that the poets teach us how love is not only able to access the time of the eternal, but also to vanquish death. And thus Wagner's poetic version of the old legend of Tristram and Isolde sings: "The old song has repeated it: / to love and to die, / but no, no, it is not so! / To love! To love! / To love even in death / and not to die of love." The temporality of love in schizophrenia and melancholia The most characteristic feature of schizophrenic time is a certain degree of "atemporality". The past is never really overcome, because they remain in the symbiotic relationship with the mother seen in the first year of a baby's life. Moreover, their delusions persevere both in the content and in the form, which makes them in a certain way immune to the passing of time. As for the future, we observe a lack of purpose and almost an absence of the phenomenon of "anticipation", the very "motor" of human life. Finally, the schizophrenic patients show great difficulty to carry out (in the present) the tasks corresponding to their intellectual and socio-cultural level; hence, the frequent failures of gifted youth in their studies and of adults in work. The symptom of apathy is merely another form of disturbance of the relationship with the present. This "atemporality" has nothing to do with the "intemporality" of love. The schizophrenic is outside of time, while lovers have overcome it. The schizophrenic becomes detached from that time that passes, which is what allows action. The lovers, instead, go on acting and creating, but they are indeed able to overcome, through love, the sad and painful nature of time: the fact that so many things that one would like to retain are destroyed and inexorably pass. This eternity of love is what brings the lovers to live often in a state of ecstasy. Nothing of that shows the "atemporality" of the schizophrenics, who rather tend to live in a constant disappointment, pursued by a sort of primary anxiety. In depression time passes slower, and in extreme cases such as stupor, stops. The patient has difficulties in thinking, concentrating and making decisions; his/her movements are slow, he/she takes long answering and his/her words are heard without force. Now it is not, obviously, chronological time that stops, but the immanent time associated with life, time as maturation and growing. But as occurred with spatiality, in the previous personality of depressive patients the alteration of temporality is already noticed in that rigid way of carrying out acts, in the constant attempt to plan the future and prevent fate and in the inability to tolerate separations. And thus, the depressed patient cannot, when loving, transcend together with the beloved the space of dimensions and the time of hours. And this explains why each loss pushes him/her deeper into the abyss and that later less important situations can be enough to trigger the depressive process. Compared to the temporality of the depressed patient, the time of love appears to us in all its luminosity: eternity lightning past, present and future, fertility in all that richness that can emerge in the encounter, maturation and personal growth as envisioned by Plato. <![CDATA[Treatment preference and attitude toward pharmacotherapy and psychotherapy in Latin America. ULAD Task Force]]> Abstract: The development of psychopharmacolgy has reached a considerable progress in the treatment of mental illnesses, although patients have an ambivalent opinion regarding its use. It is generally believed that psychoactive drugs produce secondary effects, such as the potential capacity to create addiction. Little is known about the health professionals' attitude towards the risks or benefits of psychopharmacology in the treatment of mental illnesses. Objective To determine the preferences towards the type of treatment (psychopharmacology vs. psychotherapy) and the attitudes in regard to the specific use of psychodrugs that prevail among health professionals in 13 countries of Latin America. Method A total of l868 surveys was applied to psychiatrists, non-psychiatric doctors, and psychologists in l3 countries of Latin America. The survey covered the following items: a) questionnaire on the preferences regarding the treatment of mental illnesses, including personality disorders; b) attitude scale on the use of psychodrugs, and c) patient's attitude perceived by doctors while prescribing psychotherapeutical drugs. Results Pharmacotherapy was preferred by non-psychiatric doctors; psychologists had a negative attitude towards its use pointing out its secondary effects and the risk of addiction; psychiatrists and non-psychiatric doctors held a more favorable opinion. Doctors' opinion as to the patients' attitude towards psychotherapeutical drugs indicates that the latter accept taking them when they are properly informed regarding its use. Conclusión There is no doubt that psychiatrists and non-psychiatric doctors have a better knowledge about the benefits offered by psychoactive drugs and their potential secondary effects. Psychologists postulate psychotherapy as basic treatment because their knowledge about the benefits of pharmacological treatment is limited. Nonpsychiatric doctors have a medical education that permits them to know more deeply the therapeutical action of psychotherapeutical drugs despite knowing less about the psychotherapeutical process.<hr/>Resumen: Aunque el desarrollo de la psicofarmacología ha presentado considerables avances en el tratamiento de las enfermedades mentales, los pacientes tienen una opinión ambivalente acerca de su uso. En general, se piensa que los fármacos psicoactivos presentan efectos secundarios como su potencial capacidad para generar adicción. Se conoce poco acerca de la actitud que tienen los profesionales de la salud sobre el riesgo-beneficio del uso de la psicofarmacología en el tratamiento de las enfermedades mentales. Objetivo Determinar las preferencias hacia el tratamiento (psicofarmacología vs. psicoterapia) y la actitud hacia el uso específico de los psicofármacos en profesionistas de la salud de 13 países latinoamericanos. Método Se aplicaron 1868 encuestas a psiquiatras, médicos no psiquiatras y psicólogos de 13 países latinoamericanos. La encuesta desarrollada contó con los siguientes apartados: a) Cuestionario sobre las preferencias de tratamiento en 11 enfermedades mentales, incluidos trastornos de la personalidad; b) escala de actitud sobre el uso de psicofármacos, c) actitud del paciente percibida por los médicos cuando prescriben psicofármacos. Resultados En la preferencia por el tratamiento, entre los médicos no psiquiatras predominó la farmacoterapia. Los psicólogos manifiestan una actitud negativa, indicando sus efectos secundarios y el riesgo de adicción. Los médicos psiquiatras y no psiquiatras opinaron más favorablemente. La actitud del paciente hacia los psicofármacos, en opinión de los médicos, indica que aceptan su uso cuando son informados adecuadamente. Conclusiones Es indudable que los médicos psiquiatras y no psiquiatras tienen un mayor conocimiento sobre los beneficios que proporcionaron los fármacos psicoactivos; también poseen un mejor conocimiento de los efectos secundarios potenciales. Los psicólogos postulan como tratamiento primordial la psicoterapia por su limitado conocimiento de los beneficios del tratamiento psicofármacológico. Los psiquiatras tienen una formación médica que les permite conocer con mayor profundidad las acciones terapéuticas de los psicofármacos y tienen menos conocimiento del proceso psicoterapéutico. <![CDATA[Mapeo cortical que muestra el efecto de las encefalinas en un foco epiléptico]]> resumen está disponible en el texto completo<hr/>Abstract: Introduction. Epileptic activity modifies the endogenous opioid system by increasing its levels at the end of the ictal phase, and in post-ictal and interictal phases. This increase originates a cortical excitatory effect which suppresses both slow wave sleep and REM. The epileptic activity is initiated with the presence of interictal epileptiform activity, which may be induced through penicillin administration into amygdaline nuclei. Interictal epileptiform activity is a widely employed tool used to determine the localization of epileptic foci characterized by the sudden presence of spikes or acute waves in an electroencephalogram (EEG). In the present work, this tool was used to study the participation of the opioid system in the installation and propagation of epileptic activity induced in temporal lobe amygdala. In the epiloptogenetic study, amygdaline interictal epileptiform activity was used to assess changes induced by opioids and an antagonist in the occurrence of interictal activity using an event histogram. Propagation was studied with the cortical topographic mapping technique, which shows EEG frequency components in a power spectrum, as well as the rhythmic EEG patterns. The aim of the present study was to analyze the effect of enkephalins on epileptiform activity induced with penicillin in tem poral lobe amygdala and its propagation to the cerebral cortex. Method. Fifteen male Wistar rats were submitted to an acute preparation; they were anesthetized with urethane (1.2 g/kg, i.p.). A stainless steel bipolar electrode provided with a cannula was directed toward the left amygdaline basolateral nucleus and a second concentric bipolar electrode to the right amygdaline basolateral nucleus. Two types of cortical recordings were carried out: global mapping and restricted areas. The first consisted of the placement of a 16 stainless steel electrode matrix (in which the electrodes from the vertex were removed) on the scalp, taking care that the tips of the electrodes were in contact with the cortex; this arrangement covered the whole cerebral cortex. The second involved a 4x4mm square matrix consisting of 16 equidistant electrodes placed on the cerebral cortex. The cortical recording was a result of placing this matrix in four different positions so that the whole cerebral cortex was monitored. To monitor cortical recordings, experimental groups were injected penicillin into the amygdaline nuclei. To perform global mapping, enkephalins, [D-ala]-methionine and [D-ala]-leucine, were topically applied into the amygdaline nuclei and naloxone was administered systemically. Analogical signals were recorded in a video-tape and were digitized in parallel with an HP workstation. Off-line analysis was carried as follows: a) information recorded in video-tapes was acquired in a computer designed for this purpose, using amygdaline interictal epileptiform activity to plot event histograms; b) EEG digitized signal, obtained from global mapping, was used to obtain a spectral analysis, consisting of color images maps in time and frequency domains, using RBEAM software. The recording of electrical activity obtained with the square matrix was visually analyzed only. At the end of each experiment, animals were perfused and each brain was fixed intracardially with 10% formaldehyde. To verify the recording and sub-cortical injection sites, the rapid procedure was used. Results. During control stages, cortical records showed slow activity in the form of spindles in all the recording channels; this was due to urethane. Penicillin administration in amygdaline nuclei induced epileptiform activity with a specific pattern: immediate appearance after penicillin application with a gradual increase in amplitude until stabilization was reached within 5-10 minutes of administration. Analyses of global mapping in the frequency domain showed a specific mode of amygdaline interictal epileptiform activity propagation, starting in ipsilateral temporal, prefrontal and fron tal cortices, appearing subsequently in contralateral prefrontal and frontal cortices, and finally in temporal cortex. In the time domain spectrum, an electric dipole generating an interictal spike was found in cerebral cortex. Restricted areas mapping approach showed interictal epileptiform activity and its propagation along the ipsilateral fronto-temporal region. Data revealed an antero-posterior medial cortical activation spreading with decreasing intensity toward occipital regions. Application of enkephalins-[D-ala]-methionine and [D-ala]-leucine produced no epileptic activity, but an increase in basal EEG of cortical epileptiform activity was detected, as well as a decrease in amplitude and frequency of amygdaline epileptiform activity. Naloxone originated a facilitatory effect, since its administration induced focal and generalized electrocorticographic seizures. Conclusions. Focal penicillin is a reliable model of interictal spikes, paroxysms and generalized seizures. The study in rats showed a propagation of epileptic activity to prefrontal cortices prior to contralateral amygdala. Our results showed that enkephalins produced a double effect. First, they originated an increase in basal EEG in temporal cortical areas, as well as a putative participation in propagation mechanisms. Second, they exerted an inhibitory effect on epilepsy installation mechanisms. The inhibitory effect originated by enkephalins was reverted by naloxone. <![CDATA[<strong>Tratamiento psicofisiológico y conductual del trastorno de ansiedad</strong>]]> resumen está disponible en el texto completo<hr/>Abstract: Panic disorder is a complex phenomenon according to its biochemical and psychosocial etiology. Therapeutic interventions of panic disorder are aimed to promote effectiveness through the combined use of medication and behavioral cognitive therapy. Anxiety is a normal human response. Moderate levels of anxiety are well accepted because they act as an aid to improve performance, and high levels of anxiety are experienced as normal if they are consistent with the demands of the situation. Persons with anxiety disorders complain of experiencing anxiety too often but they seek help also to overcome fears they recognize as irrational and intrusive. From a psychological point of view, behavioral cognitive techniques -such as hyperventilation control, exposure, and cognitive therapy- and structured problem solving have been successful in the treatment of the symptoms associated to anxiety. It is worth to emphasize that graded exposure is perhaps the most powerful technique assisting patients to overcome fearful situations. Cognitions are also important because it has been found that panic attacks occur when people process information in the external environment, as well as internal somatic stimuli, as though they were threatening experiences. In other words, they feel they have no control over their sensations. Panic attacks prevalence in Mexico City is 1.1% in men and 2.5% in women. It is more frequent among 25-to 34- year old single men and married women, with an average scholarity between 7 and 9 years. From a biological point of view, it is suggested that the etiology of panic attacks involves the participation of the serotonergic and adrenergic neurotransmitter systems, as well as the GABA/ benzodiacepine. Studies based on the noradrenergic theory had lead to conclude that panicking patients have more sensitive brainstem carbon dioxide receptors than normal control subjects. At the same time, other lines of work indicate that serotonergic transmission may also play an important role in the genesis of panic attacks. It has been found that patients with panic disorder may have a lower tolerance threshold to methoclorophenylpiperazine response than control subjects because of hypertensive serotonergic receptors. The accumulated laboratory evidence seems to support the idea that panic attacks begin with the stimulation of irritable foci in one of three brainstem areas: the medullary chemoreceptors, the noradrenergic pontine locus coeruleus, or the serotonergic midbrain dorsal raphe. On the other hand, biofeedback is a psychophysiological intervention that allows in the first place for the external control of some of the physical symptoms involved in this disorder, which is later transferred to internal control of psychophysiological cognitions and behaviors that enable the patient to prevent symptom's occurrence. Based on the principles of the General Systems Theory, biofeedback utilizes the concepts of self regulation and disregulation to describe the conditions under wich normally integrated self-regulatory systems may become imbalanced with regard to their positive and negative feedback loops. Technically, all that a person needs to do is to attend to the signals feedback and not to "try" to control them; the effects of a positive feedback loop should occur automatically, without conscious awareness, as long as the person processes the stimuli. Biofeedback has been effectively used in the treatment of essential hypertension, migraine headaches, Raynaud's disease, tension headaches, temporomandibular joint syndrome, asthma, primary dysmenorrhea, peptic ulcers, fecal incontinence, and conditioning of electroencephalographic rhythms, among other problems. The present study reports data from 32 panic disorder outpatients from the National Psychiatry Institute, Mexico City. They were randomly assigned to: Control Group (N = 14): daily doses of 75 milligrams of imipramine. The participants of this group were required to assist to the psychology department in order to obtain a baseline (pre-test and post-test) with the biofeedback equipment. In addition, every two weeks they visited a psychiatrist who verified that there were no collateral effects from the medicament. Experimental Group (N = 18): besides daily doses of imipramine, and visits to the psychiatrist, these patients went through eight multimodal biofeedback and behavioral cognitive techniques which were assisted with relaxation training sessions. All biofeedback sessions lasted 30 minutes divided in six five-minute trails. The first and final trials served to stabilize the biological responses, and the four middle trials were used to give biofeedback and reinforcement to the response being trained in addition to the verbal explanation of the changes occurring on the screen of the computer. All patients were assessed with the Anxiety Sensitivity Index, and with Beck's Anxiety and Depression Inventories. Results showed that patients in the experimental group reported significant lower scores in the anxiety sensitivity index than the control group. Post-test differences showed that the electromiographic and electrodermic activity from the experimental group was lower than the one from the control group. Diaphragmatic respiration training and progressive muscular relaxation and imagery proved to be effective in reducing the symptoms associated to panic attacks. The overall final result is that all patients improved clinically. They verbally reported that the intensity, frequency and evitative behaviors derived from panic attacks had almost disappeared. However, the cognitive factor of anxiety sensitivity changed significanty only in the experimental group. These findings support the hypothesis that clinical improvement results from a symptom "reattribution" which gives them cognitive skills to cope with stressing stimuli. Further studies should reassess the effectiveness of the combined treatment (imipramine and behavioral cognitive techniques). It is also recommended to expand the study to generalized anxiety disorder and to adjust the experimental design in order to incorporate a second phase with neurofeedback as independent variable. Equally important is to investigate the mechanisms of the hypnotic ability and its impact on the clinical improvement of anxiety disorders. <![CDATA[La Encuesta de Estudiantes de Nivel Medio y Medio Superior de la Ciudad de México: noviembre 2003. Prevalencias y evolución del consumo de drogas]]> resumen está disponible en el texto completo<hr/>Abstract: Introduction: Research focused on drug consumption in schools has been developed in México since 1976 and has allowed for a constant monitoring of this behavior in the population. The National Institute of Psychiatry Ramón de la Fuente (INP) and the Public Education Administration (SEP) have been the pionering institutions in these efforts, where other interested institutions and states add their contributions to the assessment of the problem in this social sector. Due to the need of developing local preventive programs to reduce drug consumption, several regions of the country have carried out, in a first stage, situational diagnoses of drug consumption. These data, in addition to other community information sources, have helped to enhance efforts in terms of prevention. To date, the main investigations related to students are the Fourth National Survey on Addictions, the National Survey from the National System for the Integral Family Development, regional surveys with young students from 7th to 91 grades (Queretaro; Ríoverde, San Luis Potosí; Sinaloa; Tamaulipas and Ciudad Guzmán, Jalisco.), from 101 to 12th grade (same states, except for Ciudad Guzman and the study done in Guanajuato whose results have not been published yet) and college (Ríoverde). The main findings for adolescents and youths obtained from these studies show an increase in drug consumption, specially for alcohol, cannabis and metamphetamines, although the general index of consumption remains steady since 2001, specially in the case of cocaine. There have also been changes in men and female contributions to the consumption index, giving similar prevalences for alcohol and tobacco in both. Regional variations have been observed, where drug consumption is higher in more urbanized cities. However, new generations are more affected by this phenomenon regardless of the level of urbanization of the place where they live. Also, as it has been previously established, being in a scholastic environment is a protective factor against drug consumption, beacause consumption is higher among adolescents who do not study, and it is a differential factor that protects men more than women. As a consequence, these sources and different students' surveys point out that the probability of drug consumption increases when a minor is working. Additionally, studies report that an early consumption onset for tobacco and alcohol, mainly before 13 years old, increases the possibility of consuming other drugs. This fact is important because several reports on the literature show that age of onset for consuming these drugs is becoming earlier. It is relevant to consider that drug consumption is not an isolated factor. It is known that some precursors for drug consumption are the same for other behaviors, such as sexual intercourses without protection, antisocial, delinquent behaviors or suicide attempt. In behalf of this, prevention programs must be designed in an integral way considering the global environment of adolescents, and not just focused on drug consumption. From this point of view, results from the survey on drug use carried out among students in Mexico City in autumn, 2003, are presented. This survey is the most recent diagnosis about this problem in Mexican adolescents, and keeps the methodological standards of previous surveys. Objective: The aim of the present work is to give a recent and complete view about this problem and prevention opportunities for adolescents of Mexico City and the whole country. Materials and method: The study comprised a randomized sample of 10,659 students from Mexico City, with a two-stage design (school-group), and stratified (from 71 to 9 grades, and from 10 to 123 grades, technical and normal), where the last selection unit was the scholar group. Data is representative for delegation and educational level, and the design is similar to those previously applied in schools by the INP and SEP. The reviewed sample frame was obtained from the registrations to the 2001-2002 school period of SEP A randomized sample was obtained for each county and educational level. Regarding estimations precision, calculated non-response index was 15%, with an absolute error average of 0.004, and a design effect equaling 2. The confidence intervals obtained were generated by the STATA program, version 7.0. The mean-age of the subjects was 14.6 years (12-22 years), 50.5% of the sample were men and 49.5% were women. The indicators of drug consumption included in the questionnaire are the same used in similar studies and are the same used by the WHO. In addition to drug consumption and related problems, several behaviors were assessed among adolescents, such as suicide attempt, level of depression, eating risk behaviors and some features of their sexual behavior. Interviewers were trained to obtain the most reliable information from the adolescents and to keep confidentiality. A total of 23 interviewers and five supervisors participated in the study. Results: First of all, a slightly increase in drug consumption was found in the last three years, from 14.7% to 15.2%, which is not significative. Nevertheless, there are significant changes in the consumption of specific drugs. There is a significant increase in cannabis consumption, while inhalants and tranquilizers remain steady and cocaine use showed a slightly decrease. By sex, it was observed that drug consumption in women has increased, while in men it remains steady or has even decreased a little. In this context, drug preferences remain very similar to those reported three years ago, where cannabis occupied the first place, followed by inhalants, tranquilizers and cocaine (with similar levels of consumption between the last three ones). The drugs of preference among women are tranquilizers. With respect to legal drugs, alcohol consumption has increased, while tobacco consumption remains similar to the reported in the survey of 2000. A significant change in these drugs, as mentioned above, is that their consumption is almost the same among men and women. Talking about alcohol abuse, a 2% increase was observed, which indicates 23.8% of the adolescents had consumed at least five drinks per occasion during the month previous to the study. In regional terms, there were also changes. The most affected delegations are Azcapotzalco, Venustiano Carranza, Miguel Hidalgo and Cuauhtemoc. In the last survey, the most affected delegations were Gustavo A. Madero and Coyoacan. This is very important information, because the SEP implemented several prevention strategies in these two delegations in order to reduce drug consumption. Considering the results of the present study, it can be concluded these efforts were successful. Even though results will be presented in a specific publication, according to the adolescents' evaluation of the brochure given to each student at the end of the application, we can say they were very positive, as 15% of the adolescents indicated they had quitted smoking and a similar percentage reported a decrease in their tobacco consumption. Another 15% mentioned they had used help telephone lines, and more than 60% shared the content of the brochure with their families. Most of them have kept the brochure for future occasions and have also lent it to friends. Discussion: The data about drug consumption is similar to the data of other national studies reporting that consumption of medical and illegal drugs and tobacco, is steadier on the whole, although there are changes in specific drugs consumption and by sex. Meanwhile, the prevalence of alcohol consumption has been increasing, even when its abuse remains stable. For prevention, it is important to consider the new location of the problem (most affected delegations), and to use crime indicators and other delinquent behaviors, to share prevention efforts in the most affected areas of the city. Another interesting result is the low level of risk perception for tobacco and alcohol consumption, which are important precursors for the consumption of other drugs, especially if there is an early consumption onset for these substances. In the context of drug consumption associated with other adolescents' problems, suicide attempt is the most frequent situation reported by the participants (16%) and it is even more frequent than drug consumption. Although this situation seems to be quite problematic, adolescent population in scholastic environments is the least affected in comparison to those that quit or stop studying. On the other hand, the information obtained about the brochure "What's up with your life?" is encouraging for prevention practices, and the presence and growth of these problems makes it important to consider that the process of obtaining information as an integral part of the diagnosis may also be used as an opportunity to reach adolescents with information or materials created for them. Finally, it is important to point out that prevention must be applied during childhood and not only during adolescence. To reach this goal, it is important to include all possible human resources. The point is simple: the possibilities to obtain better results under this conception are greater, because the interaction with children and their complete integration at home facilitate this prevention task. During childhood, the human being is more receptive to this kind of interventions and it is simpler to work with the families. So, when children grow up, it will be easier to communicate with them as adolescents and to give them all the support they require in their identity formation. Even when the work is focused on the longer term, the results will be better and we will be able to offer better options to the new generations from the construction of an adequate prevention culture. <![CDATA[Apego al tratamiento psicoterapéutico grupal en pacientes con Trastorno Límite de la Personalidad. Estudio piloto en pacientes de 18 a 24 años]]> resumen está disponible en el texto completo<hr/>Abstract: The treatment of election for patients with Borderline Personality Disorder (BPD), consists on the combination of psychotherapy and pharmacotherapy. Concerning a psychoanalitic and individual focuse, there has been found, that in spite of the differences in orientations and the therapists experience, the manifestations of the disorder tend to decrease. First of all, a decrease in the impulsivity and an increase in the affective stability is seen, whether the identity alterations modify poorly with treatments of a duration of up to two years. Traditionally, patients with BPD have not been considered apt for group therapy, because their disruptive behavior interferes with the development of the groupal cohesion; however, this characteristics are the ones that can be rapidly treated in the group, when putting a slight pressure on the patient so he can modify this maladaptive behavior. The objectives of group therapy, are consistent with the ones in individual therapy. They include stability for patients, management of impulsivity and other symptoms, and management of the reactions in the transference and countertransference. The presence of other patients helps to establish limits between the participants and it also generates an altruistic interaction, in which they can consolídate their changes in the process of helping others. Group therapists suggest that individual therapy can be accelerated if the patient participates in the group in which the primitive fantasies are stimulated and where the group structure provides a support that helps personal growth. One of the most difficult tasks in any therapy is the desertion of the patients. Specially, the group is vulnerable to desertion, in its initial stage, since it has been recorded that there is a 13 to 63% of desertions. The purpose of the present study was to determine the psychological and psychopathological variables in patients with BPD, that influence the compliance in a group therapy. All the candidates in this investigation were patients with a probable diagnose of BPD, that had been sent to the Psychotherapy Department of National Institute of Psychiatry, aged between 18 to 24 years. This diagnose was corroborated with the SCID II. A descriptive study was made with the characteristics of the patients in some different areas: character and temperament, self esteem, quality of life, psychosocial functioning, interpersonal problems, ego strength, and psychiatric symptoms. A total of 24 weekly sessions with a duration of an hour and a half, were conducted under the direction of two psychotherapists and a non active observer. A Spearman correlation was used to correlate the psychological variables with the number of assisted sessions. We included 16 female patients, with an age mean of 20.43 years; the mean of assistance to the group was of 4.5 sessions. None of the subjects assisted to all the 24 sessions and 56% of the patients deserted the group as well as the pharmacological treatment. The findings of the correlations between the number of assisted sessions and the psychological variables, suggested first of all, a positive relation between the persistence scale of the ITC and a negative association with the subscales 1 (preoccupation vs optimism) and 4 (fatigability vs energy). Other findings suggested negative correlations between the psychosis scale of the SCL 90 and the evitative scale. The rest of the scales did not have a significative correlation with the number of assisted sessions. The items mentioned during the sessions by the patients consisted in the extreme dependency to the external criticism, that came from significative figures. The patients also talked about some of the common symptoms of BPD, like frustration, intolerance, suicide, lack of affective stability, self mutilations, rage, ambivalence, poor self concept, feelings of inferiority, and low self esteem. The percentage of desertion in this study was a lot higher than expected, assuming that in a regular group basis, there is 30% to 40% of desertion. It also came to our attention, that groupal phenomena, were not observed. Specially identifications and groupal cohesion, were not developed in this case. The patients collaborated exclusively with the therapists; they did not give any devolutions to other patients. They all waited for their turn, changing the theme, in a way that satisfied their own conflicts. The universality of the experience phenomenon was no seen, since the patients, did not feel that the others had the same problems, conflicts emotions or ideas, feeling supported or relieved by it. In conclusion, the patients with BPD, in our institution have a bad compliance in a group therapy, in which only personality disorders are admitted. These patients did not blend within the environment, because the groupal phenomena that produce the changes were not seen at all. This is probably associated with the intrinsic characteristics of the disorder, and this is why the probable changes in the patients should be evaluated and this technique questioned, as a reliable treatment method for personality disorders. A comparison of this technique with others, such as individual therapy and the combination of both, should be also considered. The Psychobiologic model of Cloninger, used in other investigations to predict the efficacy of pharmacotherapy, can be used to make a prediction of the compliance of BPD with groupal therapy. This data should be considered in the previous evaluation of the patients, with the goal of establishing different strategies, and an adequate treatment, for subjects with these characteristics. <![CDATA[Adaptación de un modelo de intervención cognoscitivo-conductual para usuarios dependientes de alcohol y otras drogas a población mexicana: Un estudio piloto]]> resumen está disponible en el texto completo<hr/>Abstract: The chronical abuse of addictive substances is a major public health problem, due to the seriousness of the consequences: fatal automobile accidents or others involving traumatic injury and emergency medical care, chronic physical diseases such as cirrhosis of the liver, cardiovascular complaints, cerebrovascular problems and pancreatitis, as well as disability and disruption in different functional areas of daily life, whether social, psychological, legal, personal, family, economic or professional. These factors include: depression, anxiety, loss of sleep, loss of support networks, suicide, violence, injury in fights, homicide, financial debt, divorce, loss of employment, hospitalization, crime and imprisonment, among others. It is therefore required to establish multidisciplinary intervention models that respond to the seriousness of the problem. In Mexico, reports show that there is a need for the development of more intervention models for chronic users of addictive substances, which include systematic implementation and evaluation as well as medium- and long-term measurements to assess effectiveness. Intervention services often do not go beyond support for the initial detoxification. Additionally, the high cost of most treatment schemes makes them inaccessible to the majority of the people affected by these problems. Intervention models must be designed and developed to include elements from other models that have proven to be reliable and effective on the basis of empirical evidence. The Community Reinforcement Approach or "CRA" intervention model has gained recognition in scientific literature and from international institutions (the National Institute of Drug Addiction, NIDA, and the National Institute of Alcoholism and Alcohol Abuse, NIAAA) as one of the most effective means in reducing consumption by chronic users of addictive substances. Consequently, the objective of this research was to use a pilot project to adapt, systemize, implement and assess the impact of the Community Reinforcement Approach intervention model in reducing consumption patterns among chronic dependent users of alcohol and other drugs within the Mexican population. A cognitive-behavioral intervention model was applied to 9 chronic users who had requested psychological help at the Psychological Service Centers of the Faculty of Psychology. The average age of the users was 35. Seven of them were male and two female. The most commonly consumed addictive substance was alcohol by six users, with other drugs accounting for three (benzodiazepine, marihuana, cocaine, solvents and amphetamines). On average, the subjects had spent 14 years in schooling. Five of them were single, one was married, one cohabiting and two divorced. With regard to the occupations of the sample, one was a student, two had abandoned a course of study, four were employed before treatment and two were unemployed. The criteria that the users had to meet for inclusion in the study were: to be aged 18 or over; to be able to read and write; to have a medium-to-severe level of alcohol dependence corresponding to a range between 22 and 47 points on the Alcohol Dependence Scale (ADS) and/or a substantial-to-severe level of dependence on other drugs of between 11 and 20 points according to the Drug Abuse Questionnaire (DAQ); to consume a quantity of 14 or more measures of alcohol per occasion and/ or 20 or more measures per week for men, and 10 or more per occasion or 15 or more per week for women; to have been treated or interned on at least one previous occasion; to suffer consumption-related difficulties in different areas of daily life. The duration of the treatment period was from 15 to 24 sessions, depending on the specific training needs of each user. Sessions lasted 1% hours, and were given twice a week. The methodology used was single case with repetitions and follow-up. The cognitive-behavioral model included the following intervention components: Functional Analysis, Demonstration of Non-Consumption, Daily Life Goals, Communication, Problem Solving, Consumption Refusal, Marriage Guidance, Employment Searches, Recreational and Social Skills and Prevention of Relapses. The didactic techniques used in the training for each of the aforementioned components were: verbal instruction, modeling, behavioral trials and feedback. The original model (CRA) was adapted to include the following changes: 1) More communication skills were integrated, including listening, starting conversations, giving and receiving criticism, giving and receiving recognition, and sharing positive and negative feelings; 2) Relapse prediction variables were assessed: self-effectiveness and triggers; 3) New skills for refusing consumption were added: interrupting interaction, justification for non-consumption. Occurrence records were kept for the application in natural settings of the skills taught. In addition, teaching materials were prepared, along with information brochures on different addictive substances and the different training components, lists of community resources and therapist checklists to guarantee the systematic implementation of the model. The pre-post-test evaluation methods were: Retrospective Baseline (RETBAS), Self-Recording, Situational Confidence Scale and/or Drug Consumption Self-Confidence Scale, Daily Life General Satisfaction Scale, Inventories of Drug Consumption Situations and/or Inventories of Alcohol Consumption Situations. The significant changes identified in this preliminary research were: decreases in consumption patterns during and after treatment, since in the pre-post-test statistical analysis for paired samples the results t= 4.75 p = .001 were obtained in the comparison of baseline and treatment, and t= 4.28 p=.002 in the comparison of the baseline and follow-up; increases in the levels of general satisfaction in daily life following treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t=-3.94 and p=.004 were obtained, and t=-4.03 and p=.004 in the pre-follow-up comparison; increases in levels of self-effectiveness after treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t= -5.08 and p=.001 were obtained, and t= 4.37 and p=.002 in the pre-follow-up comparison; decrease in the number of consumption triggers after treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t= 5.80 and p=.000 were obtained, and t= 5.3 and p=.001 in the pre-follow-up comparison. As a result of the foregoing, the researchers were able to verify the effectiveness of this intervention model in significantly reducing consumption patterns in nine chronic dependent users of addictive substances. Similarly, the model had a significant impact on consumption prediction variables, as well as increasing self-effectiveness levels and eliminating triggers to avoid relapses. Users learnt how to create a more satisfying day-to-day lifestyle, by including activities incompatible with consumption. Finally, in repetitions of the implementation of this intervention model, it is recommended that a training component be introduced for emotion management (depression, anxiety and anger), as well as an assessment of cognitive functioning as a relapse prediction variable, and the participation of users that have been part of a social-recreational activity group to reinforce sustained abstinence in the long term. <![CDATA[Datos sobre la validez y confiabilidad de la Symptom Check List 90 (SCL 90) en una muestra de sujetos mexicanos]]> resumen está disponible en el texto completo<hr/>Abstract: A genetic epidemiology paradigm employed in the identification of genes associated with a disease depends on the comparison of the frequency of common genetic variants between groups of individuals who possess a relevant trait versus those who do not show the trait (i.e., cases vs. controls genetic association study). The adequate classification of groups of contrast is therefore of seminal importance for the identification of relevant genes. For psychiatric disorders, the careful clinical evaluation of particular symptoms is the basis for the classification of the "affected or disease group". However, in many psychiatric genetics studies the constitution of the "control" or "normal" group has been based only on the absence of an overt expression of symptoms, where no particular emphasis is given to the symptom evaluation to exclude the phenotype. The use of psychometric instruments can help to assess some behavioral traits of clinical relevance. In turn, these assessments could help in the diagnosis, prognosis and treatment of disorders. Moreover, quantitative assessments let determine if these traits belong to the normal range of variation in a population or could be a deviation of the trend. The Symptom Checklist 90 (SCL90) is a 90-item self-report inventory that assesses the level of distress recently experienced by the subject. It is comprised of nine dimensions: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism and a General Severity Index (GSI). Although the SCL 90 is a well-accepted and widely used instrument in research and clinical practice in many countries, we found a scarcity of relevant studies for Latin America and a lack of normative data for Mexican populations. The aim of the present report was to evaluate the reliability and construct validity of the SCL 90. Method Subjects A Spanish translation of the original SCL90 English version was administered to a group of 228 subjects, comprised by relatives of patients, members of a family parents association, medical and paramedical staff, and college students. The SCL90 was included within a battery of clinical and psychometric assessments of individuals participating at ongoing research protocols on the genetics of personality and creativity. An additional group of 30 ambulatory psychiatric patients from the Instituto Nacional de Psiquiatría Ramón de la Fuente (INPRF) was also analyzed. The instrument was applied by experienced qualified personal. Statistical analyses Statistical analyses were performed using SYSTAT 8.0. Reliability was evaluated by assessing the response consistency obtained from those items with similar questions. The Cronbach's alpha coefficient was used as the measure of the internal consistency for all nine subscales for this purpose. Construct validity was assessed using two complementary criteria: a) evaluating pre-conceptual hypotheses and b) analysing psychometric data. In the first case, and based on previous reports showing that the level of distress is a function of social-demographic, gender and clinical status, it was hypothesized that the mean scores should be higher in women, younger people and individuals affected with a psychiatric condition. ANOVA and F statistics were computed using the mean scores and standard deviations for the nine dimensions and GSI. In addition, the extent of correlation between individual items and its own subscale dimension should be higher than the other subscales, and the level of correlation between each item and the GSI should be positive. In this case, a Spearman rank correlation matrix was constructed for the SCL90 items and the nine subscales, as well as the GSI. Results Internal consistency All but two of the nine SCL90 dimensions showed good internal consistency values (Cronmbach's alphas &gt;0.7-0.85); with only hostility and paranoid ideation subscales reaching an acceptable value (&gt;0.6-&lt;0.7). The overall Cronbach's alpha score obtained for the GSI was 0.96. Construct validity Fifty-six of the SCL90 items showed a Spearman rank correlation coefficient value (r &gt; 0.5), 23 items showed a moderate value (r &gt;0.25 and &lt;0.5), and only one item showed a weak correlation with its own scale (r =0.2). Only in one case (item 80) the highest correlation value did not correspond with its particular dimension. Mean scores for all of the nine dimensions of the SCL90, as well as the GSI, were higher in women compared to men, and in subjects &lt; 25 years old. The ANOVA showed statistically significant differences (p&lt; 0.01) for somatization, depression, obsessive-compulsive, interpersonal sensitivity, anxiety, hostility dimensions as well as for the GSI. Likewise, an ANCOVA, using age as a covariable, showed an age effect for the last five dimensions (p &lt; 0.005), and in lesser degree for paranoid ideation (p =0.014). Likewise, both men and women patients populations showed higher scores for each dimension compared to general population. Comparison between Mexican and Argentine populations Independent sample t test showed meaningful differences for three scales (obsessive compulsive, interpersonal sensitivity, anxiety, as well as for the GSI) in men and women. Somatization was statistically different only for women from Argentina. Percentiles calculated for each one of all dimensions and the GSI showed a general tendency to be higher for the Mexican population compared with data from Argentina. Discussion The SCL90 is a self-report inventory where the subject reflects his/her perception about the degree of distress that he/she is experiencing. It is used by clinicians and researchers to gather information about the mental health of subjects. In the mental health field, the SCL90 has been employed world-wide to monitor the quality of the medical-psychological interventions, as well as a screening tool to identify psychopathology symptoms. We examined certain psychometric properties of the Spanish version of the SCL90, as there is a lack of normative data for Mexico. The internal consistency reliability for the scale as a whole and for individuals subscales was in general terms adequate for the group of individuals examined. Validity was assured throughout the confirmation of expected differences of groups of comparison and by the good correlation agreement among specific items and their particular dimensions. Compared to the only Latin American study, the mean scores for Mexican population were higher than in Argentina and even higher compared with the USA normative sample. Among others putative factors, translation issues (e.g. use of double negative sentences) and /or cross-cultural differences (e.g. demographic characteristics, socioeconomic differences) should be taken into account to explain these differences; therefore caution should be applied when comparing data of different populations. Among the limitations of this study we must include the analysis of a non-population sample of modest size. Nonetheless, we can conclude that the SCL90 inventory shows good psychometric attributes that may be useful for research and/or clinical purposes. Percentiles rank data can be used as a starting reference for others researchers interested in evaluating in a fast and simple way the psychological distress status of a particular individual, underlying the necessity of developing on a short-term basis normative data for the Mexican population. <![CDATA[Factores de riesgo organizacionales asociados al síndrome de <em>Burnout</em> en médicos anestesiólogos]]> resumen está disponible en el texto completo<hr/>Abstract: Introduction Burnout Syndrome is considered by the WHO as a worker's risk, that causes mental and physical deterioration (headaches, gastrointestinal illness, high blood pressure, muscular tension and chronic fatigue). This is a result of chronic stress and of the workplace environment, which today is cold, hostile, demanding, both economically and psychologically. People are becoming cynical, with negative feelings toward their patients and their professional roll; they feel emotional exhaustion. This occurs frequently in health workers who deal with people who are dependent. What is the cause of this syndrome that is damaging the community of the workers? It is due to many facts, such as organizations where there is work overload (workload is a dimension of organizational life, this means productivity. In their scramble for increased productivity, organizations push people beyond what they can sustain, making work more intense, demanding more time and becoming more complex; this is the major risk factor, in which is shown an uncorrelation between the people and their work); lack of control (of the capacity to set priorities in their own work, to select and to make decisions regarding resources that are central in the professional roll; politics of the organization that interfere with this capacity, reduce individual autonomy an involvement with work); lack of reward (lack of community harmony, lack of fairness and also value conflict); breakdown of community (the loss of harmony in the community is made evident by greater conflicts among people, less mutual support and respect, and a growing sense of isolation); absence of fairness (trust, openness and respect, are all three, elements of fairness essential to maintain a person's engagement with work. Their absence contributes directly to burnout); conflicting valúes (this occurs when there is no correlation between the sources of workplace and the personal values, in some cases work overload makes people work with no ethics, causing them conflict with their own values). This syndrome has three dimensions: Exhaustion. When people experience exhaustion, they feel overextresed, both emotionally and physically; they feel drained, unable to recover, they don't sleep enough, and lack of energy needed to face new projects. Exhaustion is the first reaction to the stress of job demands or major change. Cynicism. They take a distant attitude toward work and the people on the job. They minimise their involvement at work and even give up their ideals. In some way, this is a form of protecting themselves from exhaustion and disappointment, persons feel it's safer to be indifferent, especially when the future is uncertain. Such a negative attitude can seriously damage a person's well-being and capacity to work. Ineffectiveness. Persons feel a growing sense of inadequacy, every project seems overwhelming, they think everybody conspires against them, and whatever they do, seems to be trivial. They lose confidence in themselves, and at the same time, others lose confidence in them. They become vulnerable to family strangements, and to abandon social activities, they tend to remain alone. By this time they can incur in drug abuse, become mentaly insane, and in extreme cases, comit suicide. The measurement instrument for the diagnosis of Burnout Syndrome is Maslach Burnout Inventory, which allows to sample large populations under this condition; it was developed by Maslach in 1976, and a large number of studies have been developed by this time. Chronic stress could have important effects on the quality of family relationships and have a negative influence in anesthesiology performance as well. Because of this important problem that affects physical condition of illness, mental health and performance and quality of medical services, and also because there are no studies in the anesthesiologist environment, we performed this study to asses burnout among anesthesiologist in the city of Mexicali, Baja California. The object of this study was to determine and evaluate the organizational factors associated to burnout, because anesthesiologist performs at surgery rooms, where they have to manage chronic and sustained stress; moreover they get involved with patients, and are exposed to organizational factors. Burnout may affect mental health, and thus, the performance of the anesthesiologist practice, fact that even may put in serious risk the life of patients. Material and methods Control and cases study was performed, universe included all anesthesiologist in Mexicali City (n=92), excluding thoses that are not active in anesthesiologist practice, and who refused to respond the surveys. Cases group was constituted by anesthesiologists with burnout syndrome and control group was constitute by anesthesiologists without burnout. Sampling was obtained by Cochran's formula obtaining n=28 for each group. Independent variables were vicious organizational factors (work overload, lack of control, lack of reward, breakdown of community, absence of fairness, conflicting values). Dependent variable was Burnout Syndrome. Valídate instruments use were Maslach's Inventory for diagnosis of Burnout and a general sociodemographic inventory, for risk factors. Statistic analysis performed were descriptive analysis, proportion tests for two populations, Odds ratios, and Chi2, at the same time Logistic regression was performed, the statistic program use was BMDP and Epi Info 6. Results First of all, we estimated the prevalence of burnout, excluding three anesthesiologists that refused to answer the inventory test, of 89 persons analyzed we obtained 37 cases, that gives us a prevalance of 44%. The group case was constituted by 23 males and five females, control group by 19 males and 9 females (p&gt;0.05). Mean age of case group was 43.7 years; control group 45.8 years. Civil state for cases group was 85.7% married, 7.1% divorced, 3.5% single, 3.5% not married couple, for control group 71.4% married, 14.3% single, 7.1% widows and 7.1% not married couple; working time for case group range from 24 years to two years, mean age 13.5 years, control group range from 28 years to two years, mean age 16.4 years. For no organizational factors, being married or divorced was a risk for burnout with OR 5.20, having children's was a risk for burnout with OR 33.2, and having more years at work was also significant for developing burnout with OR 1.17. For organizational factors, the two variables for risk for burnout were work overload with p = 0.003, and conflicting values with p = 0.034, the other factors were no significant. Discussion The most important findings of the present study, were that work overload is a factor risk for burnout, this agrees with literature reports, where it is said that work overload is the factor that most affects health workers. In relation to conflicting values it also agrees with Maslach's studies, where the author says that this occurs where there is no correlation between work demand and moral values. In most cases, work overload can lead people to act with no ethics in their work, this creating conflicts with their moral values. In this study conflicting values result in being an protecting factor, considering Maslach's publishing, this is a form that health workers assume to try to protect themselves against exhaustion and deception, thus adopting the form of cynicism. The sieges we can find in this study is the honesty in the answers of the persons, besides this is assume by the inventory, this exist. Another siege is the sample size, but this was affront by an statistic manner. It is so important to continue with new investigation lines, because as long as a medical doctor has good mental and physical health, he will be apt to give qualified attention to patients. At the same time is important that organizations recognize this health problem, so they can provide psychiatric intervention for those medical doctors who are affected by this syndrome, and try also to reestructure their organization in order to avoid this problems.