Scielo RSS <![CDATA[Salud mental]]> vol. 28 num. 2 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<strong>Desarrollo de la genética y la medicina genómica</strong>]]> <![CDATA[La identidad del dolor; ¿lesión, congoja, lamento o neuromatríz?]]> resumen está disponible en el texto completo<hr/>Abstract: This article formulates a perceptual and representational theory of pain that requires a second-person epistemology that is optimally compatible with a dual aspect theory of consciousness calling for progressive psychophysical correlations. The identity of pain, taken as a peculiar state of consciousness, is explored in physiological, phenomenological, epistemological, and ontological terms. At the same time, and following the leads of philosophers of mind, pain is used to stipulate and examine the main current mind-body theories. The current definitions are unsatisfactory because it is not possible to identify the nature of pain with words beyond asserting that it is an unpleasant sensation resulting from a body injury. The usual definitions of pain accept that it is a conscious phenomenon that has well-established physiological foundations, except for its precise brain representation. Indeed, the phenomenological physiology of pain is known from the nociceptive receptors, the peripheral pathways and their central relays up to the thalamus and cerebral cortex. The somatosensory cortex, parieto-limbic, and anterior cingular sections of the cortex are involved in the central neuromatrix of pain, a concept that entails a functional binding among different sensory, cognitive, affective and volitional areas necessarily involved in the central representation of pain. A purely sensorial conception of pain is incomplete because it usually constitutes a legitimate perception in the sense that pain is the conscious representation of a bodily lesion subjected to different degrees of appraisal, knowledge, and understanding. Furthermore, as it occurs with every perception, in the case of pain there are illusions (referred pain), hallucinations (phantom limb pain), cognitive influences (the analgesia of the athlete and soldier), semantic components and pathologies where stimulus and representation can be dissociated. Phantom limb pain suggests that receptors and peripheral signals do not only activate the neuromatrix, but that it activates itself generating a pain experience without external stimuli. Upon these physiological and cognitive bases it is proposed that pain is the subjective representation of a bodily injury. The representation is composed of six different aspects: the sensitive (quale of pain sensation), affective (aversive and disturbing emotion), cognitive (recognition of the lesion), volitional(intending the actions), behavioral (movement, gesture, exclamation), and cultural (modulation according to beliefs and social learning of rules). The different components are linked in different ways to construct a complex representation where each one appears as physical and mental, neurophysiological and conscious. Different combinations of the various elements are the bases to build a medical taxonomy in classes such as "angina," "migraine," "colic," "trigeminal neuralgia," "lumbago," or "radicular pain." The spatial location of pain is baffling because even though it is referred to the site of the lesion, the neuroscience concept is that it is not there, but in the brain, creating an incongruity between phenomenological experience and scientific evidence. The perceptual and representational theory of pain solves this discrepancy but also opens the possibility that consciousness may cover more bodily territory than a restricted neuromatrix. The phenomenology of pain is difficult to establish because painful qualia are ineffable. In order to explore the phenomenology of pain, the Diario del dolor (Journal of Pain) by Mexican writer María Luisa Puga is used in the present article. In this journal pain appears as a foreign and invasive factor producing fear and forcing consciousness to focus on the discomfort, incapable of habituation to the affliction. Multiple strategies to deal with pain are set in operation. Pain acquires a face, a body, and a personality. Accepting pain implies to conceptualize it as an enemy that can be understood and with whom is possible to confer. Self-consciousness deteriorates and the narrator dos not recognize herself in the mirror, she has lost past and future, there is only a present with pain. The existence has become insipid and it is necessary to deal with dejection, depression, and defeat. Finally pain is recognized as intrinsically human and Puga's Journal underlies that the private and lonely experience of pain that a person experiences using multiple coping strategies may result in considerable understanding and dignity. From such a first person perspective, pain is confirmed to be a very complex experience where consciousness kindles unusual faculties, demands extraordinary resources, and stages costly battles. The epistemology of pain can be tackled from first, second, and third person perspectives. Since the subjective nature of pain is insuperable, the essential core of pain is the private experience reclaimed and expressed as a symptom by a subject. Nevertheless, from such first person perspective it is possible to describe, analyze, and evaluate the experience with phenomenological tools. Third person perspective means to be objective about the subjective symptom and it takes recourse in semiology and pathological correlations in order to reach a diagnosis. Usually first and third person perspectives are taken to be unfitting. From a methodological point of view there is no contradiction between these two falsely separated perspectives since what normally occurs is a face to face interaction calling for a second person perspective. From this methodological position pain consciousness overflows towards another person and ceases to be a private phenomenon acquiring an expressive and communicative aspect between the patient and the analyst gathering information through dialog and anamnesis. The second person perspective is based on the solicitation of help, and relief in the part of the patient, and the provision of attention, care, compassion, and therapy in the part of the supporter. A second person perspective acquires meaning in the interview, consultation and face-to-face dialog so that an adequate understanding aims at the subjective well being even before the cure of the injury. The ontological identity of pain is analyzed in neurobiological terms and philosophical theories. Identity theory poses that pain is a specific physiological state, such as the activation of pain fibers, brain centers, or a neuromatrix that may be species-specific. Nevertheless the identity theory appears deficient since pain is general to many species with different nervous systems, and because there is an explanatory gap between phenomenological qualia and neurophysiological mechanism that remains obscure. The theory of emergence is also formulated and it becomes apparent that it is necessary to identify the nature of the emergent property in order to become testable. Finally dual-aspect theory is proposed as the most satisfactory to understand the nature of pain. This theory implies the emergence of a high level of nervous integration that, because of its inherent complexity acquires a subjective qualitative aspect. Even though the precise nature of the aspectual shape of pain also remains blurred, the theory heuristically calls for correlations and not a reduction between phenomenological and neurophysiological aspects of pain. Such correlations are open to continuous scientific exploration and they may constitute psychophysical laws. This formulation is compatible with the perceptual and representational theory of pain and it requires the methodological approach of the second person perspective. <![CDATA[Disfunción estructural del lóbulo temporal en pacientes con un primer episodio psicótico de esquizofrenia]]> resumen está disponible en el texto completo<hr/>Abstract: Magnetic resonance imaging (MRI) has been useful in revealing subtle structural differences in the brains of schizophrenic patients compared with healthy controls. MR structural analyses have revealed a number of brain abnormalities including ventricular enlargement, total brain volume reduction, and regional reductions in brain volume in frontal, parietal and temporal regions. However, it is still unknown whether the brain abnormalities observed with MRI in schizophrenia are confounded by chronicity or whether there is a continual degenerative process. Evaluation of the brain structure during the first episode of psychosis (FEP) is a powerful strategy for investigating these fundamental questions. The first-episode design avoids the confusion of chronicity of illness, longstanding substance abuse, and the effects of treatment. Structural MRI studies of patients experiencing a first-episode psychosis have revealed a similar pattern of brain abnormalities as in samples of chronic patients, although deficits may be less extensive. The temporal lobe, a brain structure traditionally implicated in the pathophyisiology of schizophrenia, has been examined often in first-episode studies. Many studies have reported significant abnormalitites in the medial areas and superior temporal gyri. However, most studies examining the whole temporal lobe have been unable to show such significant abnormalities. In the light of the increasing amount of ambiguous findings regarding structural temporal lobe abnormalities in patients with schizophrenia experiencing their first-episode of psychosis, a quantitative review of the existing literature was needed to better characterize the temporal lobe deficits observed with MRI in those patients. Thus we conducted a systematic review of structural MRI studies of patients with first-episode schizophrenia in which volume measurements of temporal lobe structures were reported. Using meta-analytical methods, we carried out an analysis of the temporal lobe volumes in these FEP patients and the comparison subjects. In addition to solving the problems of traditional narrative reviews, a meta-analysis provides tools for integrating quantitative data from multiple studies, improving the overall effect size of variables of interest, and increasing statistical power. Eighteen studies were identified as suitable for the present analysis. These studies included 575 FEP patients and 738 control subjects. The average number of patients across studies was 32. The majority of patients in the studies were male (62%) and the average age of patients was 27 years old. In terms of structural brain findings, and assuming a volume of 100% in the comparison group, we found that the mean temporal volume of subjects with FEP was smaller (95%), as well as the analysis of regional structures such as left amygdala (95%), hippocampus-amygdala (left 92%, right 94%), hippocampus (left 85%, right 96%), and left temporal lobe (97%). Right temporal lobe volume was slightly greater (104%) and there was no difference in the volume of the right amygdala. Although this review was focused on evaluating the findings on temporal lobe deficits in patients with a first episode of psychosis, other brain region volumes were analyzed. The whole brain volume (95%) and frontal lobe volume (right 98%, left 99%) were lower in patients than in the comparison subjects. It is important to consider several potential limitations of this study. The first one has to do with the methodology employed to analyze structural MRI data. The method of choice in investigating the distribution of subtle cerebral pathology in schizophrenia has been an examination of anatomically defined regions of interest (ROI) within the brain. This method has some limitations, including the manual tracing of ROI on successive brain slices, a time consuming process that does not easily allow for the comparison of many brain regions or for the examination of volume differences in large samples of subjects. Furthermore, the question of validity is relevant as the ROI is investigator-determined and depends on the complex interindividual variability of the brain. The other method used in two studies included in this review is the voxel-based morphometry (VBM). This is an automated statistical method for examining structural MR images of the brain. VBM methodology makes voxel-wise comparisons of the local concentrations of grey matter between two groups of subjects and offers a more rapid and extensive survey of grey matter abnormalities in patients than ROI analysis. An important limitation of this methodology is that it has less regional sensitivity compared to the ROI technique and that these differences have to be considered in the interpretation of the results. Secondly, although our review only considered studies with patients experiencing a first episode of psychosis in schizophrenia (and not affective psychotic disorders), the fact that different investigators used somewhat different criteria when making their diagnoses could have introduced a potential bias in our inclusion process. Thus, it is possible that our results can not be generalized to the full population of first-episode patients. For instance, although most of the studies included used either DSM-IV diagnostic criteria (16 studies) or the Research Diagnostic Criteria (2 studies), variability may arise because many authors did not consider previous psychotic episodes in which patients were treated with antipsychotic medications for less than 30 days. In conclusion, this meta-analysis suggests that schizophrenic patients present temporal lobe differences, mainly diminished volume values in mesial temporal lobe structures during the initial presentation of a first episode of their illness. However, our results indicated that there was also evidence of global volume changes and regional volume decreases in the frontal lobes of these patients. This data, derived from patients in the early courses of their illness, is compatible with developmental hypotheses of schizophrenic abnormalities and with the view of schizophrenia as a neuropsychiatric disorder with marked deficits in the temporal lobes. However, the central questions in schizophrenia research regarding which brain abnormalities are independent of psychosis and which evolve before and after psychosis begins still remain unanswered. We think that these questions can be addressed by longitudinal neuroimaging studies beginning in the prodromal phase of the illness or by evaluating high-risk subjects during the critical period of transition to first-episode psychosis. <![CDATA[Suicidal behavior in the Mexican National Comorbidity Survey (M-NCS): Lifetime and 12- month prevalence, psychiatric factors and service utilization]]> Abstract: Background: Nationally representative data from México are presented on the lifetime and 12-month prevalence of the onset of suicide ideation, suicide plans and suicide attempt, as well as associated DSM-IV psychiatric disorders and service utilization. Methods: Data are from the Mexican National Comorbidity Survey (M-NCS). This population survey was carried out in 2001-2003 in a sample of 5,782 respondents of 18 years and older. Onset of ideation, a plan, and suicide attempt, as well as psychiatric and service use correlates were estimated using survival analysis. Results: Of the respondents, 8.3% reported lifetime ideation, 3.2% reported a lifetime plan and 2.8% reported lifetime suicide attempt(s). The prevalence for 12-month suicidal behaviors was 2.3%, 1.0% and 0.6%, respectively. Suicidal behaviors were more prevalent in early adolescence and early adulthood and became less common after the mid-thirties, with the exception of suicidal ideation that continues into older ages. Having met criteria for one or more of the DSM-IV disorders assessed in the survey was common among suicide ideators (60.9%), planners (75.6%) and attempters (74.6%), and was a strong risk factor for suicidal behaviors, with odds ratios of 4.8 for ideation, 10.2 for plan and 9.6 for attempt. Approximately one of every four lifetime attempters reported to have ever seen a psychiatrist. Conclusions: As in many other countries, mental disorders have an important impact on suicidal behaviors in Mexico. Intervention efforts aimed at identifying and treating persons at or before the onset of suicidal ideation is strongly recommended.<hr/>Resumen: Antecedentes: Se documentan datos representativos a nivel nacional en México sobre las prevalencias para inicio de ideación, plan e intento suicidas, así como trastornos psiquiátricos (de acuerdo con el DSM-IV) y uso de servicios asociados a estos comportamientos suicidas. Métodos: Los datos fueron tomados de la Encuesta Nacional de Epidemiología Psiquiátrica de México (ENEP). La población fue tomada de una muestra de 5,782 entrevistados de 18 o más años de edad, durante el periodo 2001-2003. Se estimaron inicios para ideación, plan e intento suicida, así como factores psiquiátricos y de uso de servicios mediante el análisis de supervivencia. Resultados: De los entrevistados, el comportamiento suicida alguna vez en la vida fue como sigue: el 8.3% reportó haber tenido ideación, el 3.2% reportó haber tenido un plan y el 2.8% reportó haber tenido intento(s) suicida(s). La prevalencia para los comportamientos suicidas los 12 meses previos a la entrevista fue de 2.3%, 1.0% y 0.6%, respectivamente. Dichos comportamientos prevalecieron en la adolescencia y adultez temprana y fueron menos comunes después de los 35 años de edad, con excepción de la ideación suicida que se mantuvo presente en edades más avanzadas. El presentar uno o más trastornos, evaluados en la encuesta de acuerdo con el DSM-IV, fue común entre las personas con ideación (60.9%), plan (75.6%) e intento (74.6%) suicidas y se encontró que este hecho es un factor de riesgo fuerte para el comportamiento suicida, incrementando en 4.8 veces el riesgo para ideación, 10.2 para plan y 9.6 para intento. Aproximadamente una de cada cuatro personas con intento suicida reportó haber consultado alguna vez un psiquiatra. Conclusiones: Como en muchos otros países, en México los trastornos mentales tienen un impacto importante en los comportamientos suicidas. Se recomiendan ampliamente los esfuerzos de intervención enfocados a la identificación y al tratamiento de personas antes o durante el inicio de la ideación suicida. <![CDATA[Mecanismos celulares y moleculares de la neurotoxicidad por plomo]]> resumen está disponible en el texto completo<hr/>Abstract: Lead, a heavy metal, has been used by humans for many technological aims, a fact that has determined its actual widespread distribution. Although various actions have been taken to diminish the use and distribution of lead in the environment, it remains a significant health problem. The evolution of technological processes applied in the industry has followed economic interest. Its only in recent times that criteria related to health and ecology have been considered while designing new industries. Particularly susceptible groups are children and workers involved in mining, metallurgy, paint manufacturing and battery recycling. The communities living in areas where those industries are settled have also a higher lead exposure risk. Its high biological toxicity has determined lead to become one of the most significant environmental contaminants with pathogenic potential for humans. The toxic mechanism of lead is essentially due to its capability to substitute other polyvalent cations (particularly divalent cations such as calcium and zinc) into the molecular machinery of living organisms. Thanks to its ionic structure, lead establishes very favorable interactions, usually with higher affinity, with chemical groups that normally coordinate divalent cations in proteins. The coordination of cations in proteins is usually achieved by negatively charged acidic residues. These residues establish ionic interactions with the positively charged ion, resulting in a change in the structure and electric charge of the protein. These interactions determine that lead may affect different biologically significant processes, including metal transporting proteins, ionic channels, cell adhesion molecules, diverse enzymes which have metallic cofactors, signaling molecules such as calmodulin and protein kinase C and DNA binding proteins, among other molecular targets. Lead interactions with the coordinating amino acid residues in proteins may induce an abnormal conformational configuration of proteins, as compared to the conformational structure acquired when interacting with commonly active cations, thus significantly altering its functional properties in the very complex molecular machinery. Among the biologically active sites usually occupied by lead, those related to calcium seem to have the most significant pathological importance for lead toxicity due to their widespread distribution and highly significant functional relevance for the normal cell function. Two of the principal calcium binding motifs in proteins, the EF-hand motif and the C2 motif, have an intrinsic high affinity for lead. In the case of EF-hand motifs, calmodulin is one of the most remarkable targets for lead due its importance in regulating cellular processes, being activated by lead at lower concentrations than required for calcium and displaying an abnormal activity. The C2 motif is expressed mainly in calcium dependent membrane associated proteins such as protein kinase C (PKC) or synaptotagmin. The principal characteristic in these motifs is an electrical change in the protein after the calcium binding, allowing its interaction with biological membranes. In synaptotagmin, according with the electrical characteristics of lead, the interaction of the complex lead-synaptotagmin with biological membranes is similar to the interaction calcium-synaptotagmin with membranes, which is eminently electrical. Hence, the conformation of this complex is probably different to the conformation with calcium, fact evidenced by the failure of lead-synaptotagmin to interact with other proteins of the exocitic machinery. In relation to lead neurotoxicity, membrane ionic channels seem to be among the most relevant molecular targets of lead. In particular, calcium and potassium channel function may be significantly impaired by lead, affecting the activation of calcium activated potassium channels, the inactivation process of calcium channels, and the ionic conductance of calcium channels. As occurs with other heavy metals, lead is capable of blocking the calcium channel, probably at the selectivity filter. The high affinity lead binding to the acidic residues of the filter provokes a slow flux of the metal trough the channel pore, blocking the calcium conductance. The regulation of ionic channels will be significantly altered also. Calmodulin is a common calcium sensing protein for many ionic channels and its alteration by lead could affect the channel operation. Abnormal functioning of regulatory and signaling proteins such as calmodulin, protein kinase C and synaptotagmins, which normally require calcium for its activity, may also display an abnormal functioning, thus determining a widespread metabolic influence of lead poisoning. Lead distributes evenly into the cell thus reaching intracellular organelles, including the endoplasmic reticulum, mitochondria and the cell nucleus. This results in significant alterations of intracellular calcium metabolism and regulation due in part to the malfunctioning of calcium channels and ionic pumps in plasma membrane, endoplasmic reticulum and mitochondria. Inadequate energy generation due to mitochondrial damage and malfunctioning in cation dependent enzymes, alterations in protein folding due to the direct binding of lead to calcium activated reticular chaperones, or indirectly, altering the intrareticular calcium levels, and the disruption of the structure of DNA binding motifs such as zinc fingers, among others, promotes alterations in gene expression and DNA reparation. Lead poisoning is one of the most important chronic environmental illnesses affecting children in modern life. Developing central nervous system is particularly susceptible to lead toxicity. At critical times in development, lead may have a disorganizing influence with long-lasting effects which may continue into teenage and beyond. Mechanisms originating this disorganizing influence in the central nervous system are a consequence of the interaction of lead with various targets as previously described; alterations of cell molecular machinery, at the systems level induce excitotoxic phenomena, interferes with neurotransmission at neurotransmitter synthesis, release and receptor activation levels, alters intracellular signaling and produce cell membrane peroxidative damage. Compared to adult lead poisoning, pediatric lead is most common and its effects may occur at reduced blood levels with subclinical symptoms; thus a high index of suspicion is necessary for physicians when dealing with pediatric patients. Long-term effects of lead may produce cognitive and motor impairment, with behavioral alterations. The particular vulnerability of the immature nervous system to the lead poisoning is probably due to the fact that in this stage of development the establishment of appropriate neural networks is highly dependent on the synaptic activity, which in turn could be altered by lead. Lead poisoning has been considered as a potential co-factor in complex neuropsychological alterations such as schizophrenia. In this sense it is worth to note the possibility that the physical and psychic symptoms of Vincent Van Gogh may have been due to chronic lead poisoning. The following are among the clinical symptoms described by Van Gogh in his autographed letters: initial debilitation, stomatitis with loss of teeth, recurring abdominal pains, anemia (with a "plumbic" skin tone), neuropathy of the radial and saturnine encephalopathy, including epileptic crises, progressive character changes and periods of delirium, all of which meet present criteria for diagnosis of Organic Mental Disorder due to cerebral lesion or somatic illness, and Organic Character Disorder (DSM-IV-R). Apha-thujone, found in absinthe and in many popular herbal medicines, may also have contributed to Van Gogh symptoms since he was a well-known absynthe drinker. Many countries, including Mexico, have implemented politics aimed to eliminate lead from the majority of their industrial processes. This has been carried out with considerable effort, and in some cases, with open confrontations between the scientific community and industrial sector. Although there have been actually significant advances to eliminate lead from many products (gasoline, painting manufacturing, etc.), lead is not degradable, thence once it is released in the environment it remains there for long periods of time. This implies that we should have to deal with lead poisoning in the years to come and to be aware of this diagnostic possibility in any suspicious case. This review is centered in the description of the molecular mechanisms of lead toxicity and its repercussion in the cellular excitability and central nervous system function. <![CDATA[Crianza y esquizofrenia]]> resumen está disponible en el texto completo<hr/>Abstract: Introduction. Schizophrenia is a chronic psychotic disorder whose prevalence in adults is from 0.5 to 1.5%, and its annual incidence ranks from 0.5 to 5 by each 10,000 inhabitants. Antipsychotic medications have shown to be effective in the treatment of acute psychosis and the prevention of relapse for persons suffering form schizophrenia. However, most of them have not shown to be able to correct fully the alterations in social and labor adjustment. Several studies -refering to the most important advances of the last years regarding this pathology, emphasize the necessity to know which are the psycho-social factors that participate in schizophrenia in order to prevent psychotic relapses and re-hospitalization. Approaches tending to find out the influence of the familiar surroundings have been limited by methodological matters. Although it is certain that attachment has been studied to understand the influence of the raising, in the evolutionary process of the personality and of some mental disorders, little is known about the early parental relations of the schizophrenic. Objectives. 1. To compare the description of the raising made by the schizophrenic patients in remission, with that made by healthy subjects with similar sociodemographic characteristics; 2. To compare the pattern of raising described by the hospitalized schizophrenic patient while presenting acute manifestations of psychosis, with that described once that such manifestations have been controlled; 3. To determine the relation and participation of the dimensions of the raising in regard to schizophrenia and its evolution. Methodology. An explanatory nonexperimental transeccional correlacional causal study was made. The sample was formed by the 23 schizophrenic patients hospitalized in the Instituto Nacional de Psiquiatría during the second semester of 2003, and by a control group formed by 50 healthy subjects with similar socio-demographic characteristics. The schizophrenic patients were evaluated through a clinical history and the application of The Positive and Negative Syndrome Scale (PANSS) and The Parental Bonding Instrument (PBI)(formed by two dimensions: 1. warmth; 2. distance and emotional coldness). These instruments were applied within the first five later days to their hospitalization and within the five previous days to their discharge by improvement. The control group was evaluated only on one occasion. A brief interview was made to collect some sociodemographic data and The Parental Bonding Instrument (PBI) was applied. Results. In order to determine the existing differences in the perception of the paternal and maternal raising between the group of schizophrenic patients in remission and the control group, a t test for independent samples was made. As established in the first hypothesis, significant differences in both groups were found, but only in the dimension paternal of distance and emotional coldness (p = .03) and maternal distance and emotional coldness (p = .000). With the purpose of determining the differences in the perception of the raising by the schizophrenic patients while suffering from acute psychosis and once they were in remission, the punctuation of the paternal and maternal PBI of admission and discharge were compared. In the maternal raising it was observed, in spite that both dimensions scored higher at the discharge, that distance and emotional coldness did not show significant changes. Warmth scored significantly higher at discharge (p = .003). In the case of perception of the parental raising, warmth (p = .001) as will as distance and emotional coldness (p = .02) scored significantly higher at the time of discharge. When analyzing with more detail the items of PBI that showed a significant change with the improvement of acute psychosis, it was observed that in the paternal warmth those were items 5 (p = .008), 7 (p = .021), 11 (p = .015), 12 (p = .049) and 17 (p = .047). As to distance and emotional coldness the items that changed were 16 (p = .002), 18 (p = .004) and 23 (p = .012). In the case of maternal warmth, the items that showed a significant change with the improvement of acute psychosis were 3 (p = .03) and 13 (p = .004). In distance and emotional coldness, only number 14 (p = .015) changed. Of the items of paternal being up that showed a significant change at the time of discharge, it was observed that item 5 had direct relation with the positive symptoms of discharge (p = .03); 7 with the positive symptoms of discharge (p = .01), the general psychopathology of discharge (p = .029) and the total qualification of the PANSS of discharge (p = .012); 11 with the positive symptoms of discharge (p = .04), the general psychopathology of discharge (p = .045) and the total qualification of the PANSS of discharge (p = .037); 12 with the positive symptoms of discharge (p = .003), the general psychopathology of discharge (p = .006) and the total qualification of the PANSS of discharge (p = .009); 18 with the general psychopathology of discharge (p = .041). With respect to the maternal raising it was observed that only number 13 correlated with the positive symptoms of admission (p = .014). In order to determine the relation between these dimensions with the variables and evolution of schizophrenia, a correlation of Pearson was made. In the paternal raising, Warmth (admission) correlated positively with the positive symptoms (admission) (p = .032). Warmth (discharge) was negatively correlated with the positive symptoms (admission) (p = .032) and the number of hospitalizations (p = .034). The paternal Distance and Emotional Coldness (admission) correlated negatively with the age of beginning of the schizophrenia (p = .04), and positively with time of evolution of the disease (p = .048). Distance and emotional coldness (discharge) did not have correlation. With respect to the maternal raising, warmth (admission) was positively correlated with the punctuation of general psychopathology (admission) (p = .032) and the years of study of the patient (p = .026). Distance and Emotional Coldness (admission) did not correlate significantly, nevertheless at the time of discharge did it positively with years of study (p = .03). In order to deter mine if the dimensions of the raising could predict the symptoms of the schizophrenic patient at the time of discharge, a multiple regression analysis was made. It was found that the positive symptoms could be predicted in 41.5% (R2 = .415) through the punctuation of the paternal Distance and Emotional Coldness (admission) (P = .510) and paternal Warmth (discharge) (P = -.622). Negative symptoms were not influenced neither by the paternal raising, nor by the maternal one. The punctuation of the scale of general psychopathology of the PANSS could be predicted in 26.3% (R2 = .263) through maternal warmth (P = -1.01) (discharge) and maternal distance and emotional coldness (P = .805) (discharge). The total qualification of the PANSS at the time of discharge could be predicted in 29.8% (R2 = .298) by maternal warmth (P = .516) (admission) and paternal Warmth (P = -.620) (discharge). The age in with the patient got sick could be predicted though the punctuation of the paternal distance and emotional coldness (P = -.625) (admission) and maternal warmth (P = .5) (discharge) in 44.8% (R2 = .448). The time of evolution could be predicted in 18.2% (R2 = .182) through paternal Distance and Emotional Coldness (P = .427) (admission). The number of hospitalizations was predicted in 37.5% (R2 = .375) by paternal Distance and Emotional Coldness (P = .543) (admission), maternal Warmth (P = -.916) (discharge) and maternal distance and emotional coldness (P = .811) (discharge). The number of days that was committed the patient at the moment of the evaluation could be predicted in 19.6% (R2 = .196) by paternal distance and emotional coldness (P = .484) (admission). Other variables, as the years of study were predicted in 18.6% (R2 = .186) by maternal warmth (P = .474) (admission). Conclusions. The schizophrenic patient in remission had a different perception of their parents than the control group. Schizophrenic patients perceived both parents colder and distant than the control group. In the particular case of first, it was observed that when improving the psychosis, also improved the perception of the raising. This one was related to the psychotic symptoms and other variables of the schizophrenia. These findings indicate the importance of the raising in the evolution of the schizophrenic patient. <![CDATA[Rechazo parental y ajuste psicológico y social de los hijos]]> resumen está disponible en el texto completo<hr/>Abstract: Intercultural research indicates that two dimensions of parental behavior can be identified in human societies: acceptance and rejection. According to Rohner, parental behavior can be defined as a continuum. In one end of the continuum we could find parents that manifest love and affection towards their children, both verbally and physically. In the other, we could find parents with aversive feelings towards their children, who use severe and abusive practices. Parental rejection is, according to Rhoner, the absence or the significant withdrawal of warmth, affection or love from parents toward their children. Rohner's framework proposes three dimensions of parental rejection: a) hostility and aggression; b) indifference and negligence and, c) indifferenciated rejection. A long research tradition has demonstrated that parental styles characterized by anger, aggressiveness, and rejection, are related with children's mental health problems. Normally, this field of research has analyzed the relationship between parents and children without differentiating the father from the mother. However, recent research suggests that fathers and mothers, behaviors can have differential effects on the psychological adjustment of their children. Also, research on parents-children relationships, has traditionally used perceptions or observations of either parents or children. The definition of a parent as hostile or as rejecting or affectionate and warm can not be made only by observing parents' behavior, since acceptance and rejection are not fixed qualities of behavior. From this point of view the effects of parental behavior on their children depends not only from objective elements but also from children's perceptual and inferential processes. Parents and children do not necessarily perceive in the same fashion parental acceptance, demands or punishments. These caveats underlie the importance of analyzing parental behavior both from parents' and children's perspectives. On behalf of these ideas, the aim of this paper is to analyze the relationships between parental and maternal rejection and the psychological and social adjustment of their children. In order to do so, this study will use both children and parents perceptions. That is, this study will observe the children's perceptions of their mothers and fathers behaviors towards them, as well as the perception of their own psychological adjustment. Also, this study will examine parents perceptions of their parental practices as well as parents perceptions of their childrens' psychological and social adjustment. Participants in this study are a total of 444 families distributed into two groups (risk and comparison groups). The first group (risk group) consists of 100 families in which parent-child relationships were considered as disfunctional or not adecuate. The second group of families (comparison group) consists of 344 families in which parent-child realtionships were considered as adecuate. The group of families considered at risk were identified by school teachers in public schools (Valencian Community, Spain). Children ranged in age from 7 to 13 years. Of the children 54% were male and 46% female. All the children were atttending school at the time of the research. Teachers had also to contact parents to obtain their agreement to collaborate in the study. Of the parents' questionnaires, 77% were completed by mothers and 23% by fathers. Measures were the following: Parental Acceptance-Rejection Questionnaire (PARQ). This self-report questionnaire (Rohner et al.) measures perceptions of parental treatment of the child in terms of four dimensions, a) parental warmth and affection, b) parental hostility and aggression, c) parental indiference and neglect, and c) parental undifferentiated rejection. The two forms used in this study allowed us to obtain three measures of parental acceptance-rejection: parents perceptions of their treatment of their children, and children's perceptions of the way they are treated by both their mothers and fathers. Personality Assesment Questionnaire (PAQ). This self-report questionnaire (Rohner et al.) asseses the way in which children perceive their own personality and behavioral dispositions. The following scales constitute the child PAQ: a) hostility/aggression, b) dependence, c) negative self-esteem, d) negative self-adequacy, e) emotional irresponsiveness, f) emotional uncertainty, and g) negative world view. Child Behavior Checklist (CBCL). This cheklist (Achenbach &amp; Edelbrock) evaluates the behavior problems and social competencies of children as reported by their parents. The behavior problems measure used in this study is composed of two broad dimensions: internalizing and externalizing. Internalizing includes anxious, obsessive, somatic complaints, schizoid behavior, depressed withdrawal, being immature, and being uncommuni-cative. Externalizing includes being delinquent, aggressive, cruel, or hyperactive. Results show that rejected children are psychologically and socially different from those children who have adequate relationships with their parents (characterized by parental acceptance). Rejected children, when compared to children in the comparison group, manifested significantly more problems. The personality of these children was characterized by dependency, low self-esteem and self-adjustment, emotional instability, and a negative world view. Because an alternative explanation is that those children with psychological and social problems could bias their perception of their parents behavior as rejecting, this study included also an analysis of parents perceptions of their treatment of their children, as well as their perceptions of their children behavior. By including both perceptions (parents and children) in the study design, the parent-child interaction can be better defined (in terms of acceptance and rejection), and possible biases in the definition of parental behavior can be avoided. These analyses showed that parents from the risk group, when compared to the comparison group, perceive their children as having more behavior problems expressed both in an externalizing fashion (i.e., being aggressive, hyperactive, disobedient, overactive, and destructive), and in an internalizing fashion (i.e., being anxious, uncommunicative, immature, submissive, and withdrawn). The results obtained in this study show clearly that rejected children are "different", in both psychological and social dimensions, from other childrens whose parent-child relationships are characterized by parental acceptance. These findings would be consistent with Rohner's parental acceptance-rejection theory according to which these characteristics are manifested by children who experience rejection. Children in the risk group perceive less warmth and affection (expressed psysically or verbally), and more rejection (manifested by hostility and agression, indifference and neglect, and undiferentiated rejection) in the way they were treated by their parents. Also it is interesting to note that these results hold, independently from who is reportimg parental behavior (parents or children). This study has shown that childrens perceived rejection, either from the mother or the father has a negative outcome for their psychological and social adjustment. <![CDATA[<strong>Expectativas relacionadas con el alcohol en la predicción del abuso en el consumo en jóvenes</strong>]]> resumen está disponible en el texto completo<hr/>Abstract: In México, addictions among the middle- and high-school student population have been widely studied, which has shed light on certain risks associated with alcohol abuse, including a higher probability of expriencing with other drugs -particularly in the case of males-, engaging in risky sexual practices and attempting suicide, a situation that is twice as common among those who drink and drive. Nevertheless, research on alcohol abuse among the university population has been less explored, particularly as regards the identification of the variables that predict excessive alcohol consumption. A review of the international literature on factors associated with alcohol abuse in this type of population indicates that it is among university students that high or explosive consumption tends to be largest, even among young people who do not attend school, and that the period of higher consumption is between 17 and 21 years of age. Other factors that have been identified include exposure to negative life events, inappropriate coping styles, personality variables, resorting to alcohol to reduce tension, and environmental and socio-cognitive variables, foremost among which are expectations of the positive effects of alcohol. These expectations not only predict alcohol consumption but also differentiate between problem and non-problem drinking. For example, while social drinkers tend to harbor more social expectations when drinking alcohol, excessive drinkers expect alcohol to increase their aggressive and social behavior, while reducing stress or tension. This paper seeks to evaluate the impact of expectations regarding alcohol, in predicting alcohol abuse among students at public and private universities in Mexico City. Indicators of alcohol abuse include consumption of five or more drinks on each occasion, drunkenness during the past month and year as well as associated problems. The study also seeks to determine the way in which sub-scales of expectations interact with each other. An ex post facto transversal study was carried out on a sample of 678 university male and female students aged 17 to 25, with an average age of 20 (s.d. = 1.80). Participants were asked to complete a self-report which included the following areas: a) Sociodemographic data, b) Questionnaire on Expectations regarding Alcohol (AEQ), in a version adapted to this population and c) Alcohol consumption habits over the past month and year. As regards drinking habits, a comparative analysis was carried out by sex and age. Consumption of 5 or more drinks per occasions tends to be more common among men, while the consumption of 5 drinks or less is more frequent in women. At the same time, a higher proportion of heavy drinkers was concentrated in the 20 to 22 age range. Consumers of over 5 glasses of alcohol began drinking at an average age of 14 (s.d. = 2.55) whereas consumers of fewer than 5 drinks began drinking at the age of 15 (t= 4.79 , p &lt; .001). In both cases, the means obtained from the indicators of abuse were highest among consumers of five or more drinks. Males take more drinks than women when they get drunk, consuming an average of 9 glasses (s.d. = 4.7) whereas women get drunk after an average of 5 glasses (s.d. = 3.2) (t= -10.80, p &lt; .001). Out of a total of 26% of young people who mentioned having problems associated with their drinking, most were men (17.9%) as opposed to women (8.2%). The multiple regression analysis carried out to determine the impact of the sub-scales of AEQ expectations on alcohol abuse found that expectations regarding alcohol as a "facilitator of group interaction" and the sub-scale of "reduction of psychological tension" were the main predictors of abuse. This model explained 20% of the variance (F=19.35, p &lt; .001). A logistic regression analysis found that the sub-scale of expectations regarding "increase of power and aggression" as well as alcohol abuse predicted problems associated with drinking. A model was subsequently designed to integrate the expectations that predicted alcohol abu se and associated problems. A structural equations model was used which found that expectations regarding "reduction of psychological tension" and alcohol as a jacilitator of group interaction predicted 30% and 24% of abuse, respectively (X2sb = 33.52, p &gt;0.00, CFI = 0.99 and RMSEA = 0.01). The rest of the sub-scales concerning expectations were regarded as mediating varia bles to see how they interacted with each other. As one can see, although the sub-scales of expectations are inter-related, group expectations were specifically associated with the sub-scales of "increase in sexuality," "physical tension" and "increase in power and aggression." At the same time, expectations regarding "reduction of psychological tension" are closely linked to the social sphere, specifically the expectations regarding "verbal expressiveness" and "lack of inhibition." Along these same lines, alcohol abuse and the expectations regarding alcohol as an agent that increases feelings of power and aggression predicted 26% and 28% of alcohol-related problems. One of the contributions of this research is that it considered the inter-relationship of sub-scales of expectations to explain alcohol abuse. Psychological tension, for example, appears to be linked to social aspects, specifically to verbal expressiveness and lack of inhibition, while group expectations refer to sexuality, the reduction of psychological tension and the increase of aggressiveness and feelings of power. Likewise, it is interesting to note that in addition to alcohol abuse, expectations regarding an increase in power and feelings of aggression are the best predictors of problems associated with alcohol use. The results have implications at the intervention level for developing programs specifically aimed at this population. The fact that expectations regarding alcohol as a "facilitator of social interaction" is one of the main predictors of abuse indicates the importance of considering environmental factors in the development of prevention programs. This involves including not only young people but also parents, schools, and other adults in order to question the cultural norms that promote beliefs regarding alcohol consumption, as a way of enjoying social interaction with positive, pleasurable states, and as a socially appropriate response for coping with negative events that arise in everyday life, such as drinking to relieve tension, handle crises and as an escape from chronic stress, by providing information on the negative consequences of use and promoting healthier lifestyles. At the intervention level, it is essential to target university students through programs specially designed for young people who engage in high-risk drinking. As regards expectations, actions must be carried out to resignify the positive beliefs surrounding alcohol, by providing information on the high health costs of heavy drinking and offering alternative resources oriented towards other means of responding to stress that do not involve excessive alcohol consumption. <![CDATA[Tendencias y uso de cocaína en adolescentes y jóvenes de la ciudad de México. Sistema de reporte de información en drogas]]> resumen está disponible en el texto completo<hr/>Abstract: Introduction and antecedents The Information Reporting System on Drugs (IRSD) provides since 1986 an updated overview of the main trends and characteristics of drug use in Mexico City. It identifies the changes in patterns of use and provides information useful to estimate its future path. It is supported by the main health and justice agencies. Up to this date, it has carried out 34 evaluations and its data base includes 16377 cases. Research on illicit drug use among adolescents and young adults started in our country during the 1970's; in those days, the level of cocaine use was low. Nevertheless, its use has been increasing gradually. Up to this date, different research reports indicate that cocaine, marihuana and solvent-inhalants are the most used illicit substances, especially among adolescents and young adults. Based on a 2003 high school survey carried out in the Distrito Federal, the latest research results indicate that marihuana is the most used substance (7.2%), followed by solvent-inhalants (4.6%), tranquilizers (4.5%) and cocaine (4.0%). Results of the most recent household survey carried out in 2002 indicate that 215,634 adolescents, between 12 and 17 years old, have ever used drugs. Excluding alcohol and tobacco, the first ever used drug in this group is marihuana, followed by solvent-inhalants and cocaine. As it can be observed, these results highlight that cocaine use is an issue and a matter of concern due to its pharmacological characteristics, psychological and social implications, and also because it affects adolescents and young adults who conform the main population group of the country. Objective This paper presents results of the Information Reporting System on Drugs, which describe the trends of cocaine use for 1987 2003 among users between 15 and 24 years old in Mexico City. It also describes the results of the evaluation carried out by the IRSD in June 2003 which include the sociodemographic characteristics of users, pattern of use, associated problems and slang words used to refer to this substance, according to the reports of the evaluated cases. Material and method Instrument. The data collection instrument was the questionnaire "Informe Individual sobre Consumo de Drogas" (Individual Report on Drug Use). It gathers information about the sociodemo-graphic characteristics of users, the most used substances, their patterns of use, the new substances being used or the substances not being used anymore, the perception of the user about the problems associated to the drug use before and after the drug use life has started, among other variables. This instrument is applied through an interview to individuals attending the participating agencies during the admission procedure. Evaluations are carried out twice a year, during June and November. The cases are obtained from all the individuals attending the participating agencies during the evaluation periods, and who identify themselves as ever having used any substance without a prescription, and with the purpose of getting intoxicated; this is the case definition. Since the beginning of the IRSD, the instrument, case definition, data processing and analysis procedures have remain similar in order to make comparisons. Until June 2003, the IRSD carried out 34 evaluations and the data base includes 16377 cases. Results Cocaine use trends: From 1987 to 2003, 9,120 cocaine cases were identified in the level "ever used". They are between 15 and 24 years old and represent 55.6% of the total population of drug users identified during such period. The use of cocaine has been increasing in this group: in 1987 there were 3.1 cocaine users out of every 100 drug users in general; in 1992, this proportion increased to 9.0%. From this date, the level of use gradually increases, reaching 74.3% in November 1998; this is the highest level recorded. From this date up to 2003, cocaine use has maintained the highest level of use of all drugs, and its level of use has remained stable. Evaluation number 34, carried out in June 2003, studied 770 cases of drug users; 533 of them reported having ever used cocaine. From this group, 293 cases (55%) are between 15 and 24 years old. Sociodemographic characteristics: 89.7% of the cocaine users were male, 58.7% were between 15 and 19 years old and 41.3% were between 20 and 24; 81.7% were single, 61.9% belonged to the middle socioeconomic level; 45.3% completed high school. Occupational status includes both employed, 31.4%, and unemployed cases, 29.5%. Pattern of use: 64% of the cocaine users started this behavior between 15 and 19 years old. 39.4% of the cocaine users are "light" users. The most frequent type of user follows a pattern of use between 1 to 5 times a month. 20.8% are "heavy" users: they use cocaine more than 20 times a month. Most used drugs, besides alcohol and tobacco, were marihuana: 60.1%; solvent-inhalants: 39.9%; and sedative-tranquilizers: 15%. Gender differences: Men and women have similar preferences regarding substance use. Nevertheless, women have higher levels of use for almost all the substances studied. Associatedproblems: The users perceive problems associated to the onset of their drug use life, and also they perceive problems once this has started. Family problems are the most frequently reported ones, increasing in frequency after drug use behavior has settled. Excluding social problems, all the other problems also increase after the onset of the drug use life. Slang words: Names used in the subculture of cocaine use to designate this substance, reported in this evaluation were: "cocaine", "crack", "piedra", "cocaína piedra", "cocaína polvo", "blanca", "bote", "coca", and "inhalada". Conclusions As it has been indicated, IRSD provides twice a year an updated diagnosis of drug use in Mexico City. Results indicate that during the period 1987-2003 cocaine use has three moments. The first one goes until 1992 and is characterized by a low level of use, below marihuana and solvent-inhalants; from there till 1998, its level reached the highest peak: 74 cocaine users out of every 100 drug users in general, with marihuana and cocaine occupying the second and third places. From this date to 2003, cocaine has remained stable in the first place. The highest risk groups are adolescents and young adults, and this is true for the onset of use as well as for the chronic use. This substance is a matter of concern due to its emotional and physical effects, but also because there are no indicators suggesting that the level of use will decrease. The problem of cocaine use indicates the need of prevention programs starting during childhood and with a long-term vision. The goal should be to promote the development of social support networks to counteract the influence of drug use in general, as well as to promote healthy lifestyles non compatible with drugs.