Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520060005&lang=pt vol. 29 num. 5 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[Depression among health workers: The role of social characteristics, work stress, and chronic diseases]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500001&lng=pt&nrm=iso&tlng=pt Abstract: Antecedents A substantial number of Mexican adults (9-13%) experience psychological distress and a significant minority suffers from severe mental impairment. Most people suffering from depression do not seek treatment, even though they can be helped and treated. In some families, depression may occur across generations, but it may also affect those without any family history. Low self-esteem, stressful life changes and chronic stress may provoke a depressive episode. In recent years, it has been demonstrated that medical conditions, such as cardiovascular diseases, cancer, Parkinson's disease and hormonal disorders, may lead to depression, making a sick individual apathetic, incapable of taking care of his/her physical needs. In turn, such apathy increases the recovery period. Most probably, a combination of genetic, psychological, and social factors work together in the development of a depressive disorder. However, very little is known about the principal causes of depression in Mexico. It is possible that, due to cultural and social differences, these factors and their impact are distributed differently on the Mexican population as compared to those from the US population. Objectives The first objective from this study is to estímate the frequency and distribution of depression by social characteristics on a population of health workers in Mexico. The second objective is to study the effect of stress and chronic diseases on depression. Methods To study the effects of stress and chronic diseases on depression we used a cross-sectional data obtained from a total of 4048 workers. These workers participated in the "IMSS Health Worker Cohort Study in Morelos" through the years 1998 to 2000. Their age varied from 18 to 89 years. A self-reported questionnaire was administered to obtain information on life-style factors, social characteristics, work stress, and chronic diseases. Data were analyzed using politomic regressions to study the effects of social characteristics on moderate and high levels of depressive symptomatology and on risk factors, such as work stress and chronic diseases. The analysis is stratified by gender as it is expected that effects of such characteristics vary by gender. Results Our results show that the workers' socioeconomic characteristics are significantly associated with their depression level. Being female, being separated from the spouse, having lower education, and working in non-professional jobs with lower income is significantly and positively associated with depression. Similarly, having a less satisfying job and having more than one chronic disease is significantly and positively associated with depression. Workers from a lower socioeconomic status report higher levels of stress and suffer more chronic diseases compared to those from higher socioeconomic levels. Hence, some of the effects of social characteristics seem to be mediated by stress and chronic diseases. Conclusion Our results are consistent with previous research demonstrating systematic variations among groups of people who are at a higher risk for depression. In our study, we find that depression is higher among selected groups, such as women, young and old workers, those without a partner, and those with lower economic resources. We also find that stress and chronic diseases are among the reasons for which groups, which are socially and economically vulnerable, tend to become depressed. To be effective in the long run, any intervention directed to these groups of people must take into account associations highlighted in this paper.<hr/>resumen está disponible en el texto completo <![CDATA[Abordaje epidemiológico de un brote de trastorno conversivo epidémico en adolescentes]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500009&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Introduction Several outbreaks of Epidemic Conversión Disorder are occurring in different groups of people in the world. Rather than being viewed as a number of people suffering from individual conversion disorder, epidemic hysteria is considered as a social phenomenon involving otherwise healthy people. We received a report letter from Dirección General de Epidemiología, about the existence of a large number of possible food poisoning cases among students, attending morning sessions at a technical high school, located in the downtown area of Mexico City. Twelve students were driven to the Mexican Red Cross Hospital due to fainting. The aims of this study were to determine the cause of such outbreak in a group of adolescents; to get an adequate explanation about the origin of the event; to identify the event dissemination ways and associates risk factors. Methods Study design: A matched case-control study was carried out to identify factors associated with the illness. Two control cases were randomly selected from the list of nonill students for each case. Fifty two cases and 104 controls were included. Hypotheses: Following the good health status determined by the physician at the hospital, we started the initial interview with the students. We reached the following possible hypotheses regarding the origin of this outbreak: first, the event was due to food poisoning; second, to the inhalation of a toxic gas such as carbon monoxide and thirdly, by exposure to high levels of contaminants. Finnaly, it might be a mass event of conversion disorder. Variables: Among the variables included in the study were: sex, age, class group, location of the student at the time of the out-break, and foods eaten during recess and immediately before the outbreak. All the students present at the time of the outbreak were interviewed using a standard questionnaire. Laboratory Simultaneously, samples of the food-products sold in and around the school that day were collected for bacteriologic and chemical analyses, the existence of a gas leak, carbon monoxide source, or any other airborne pollutant was investigated by the research team. Analyses: The demographic characteristics were analyzed by descriptive statistic; association between risk factors as possible causes of the event was determined by multivariate analysis at 95% confidence interval. Results: The outbreak occurred in the building of a downtown public school in Mexico City. The school has three floors, surrounding a central yard. There are 11 classrooms, two laboratories, an art workshop and a school medical clinic. The total duration of outbreak was 15 minutes. There were 455 students enrolled in the morning program, all of them were interviewed. A total of 52 cases was identified, among the 455 students, for an attack rate of 11.4%. There were three groups in which no cases were found. The attack rate in girls was 3.9 times higher than in boys. Sixty five percent of the cases occurred in two of the nine classrooms (1° B and 2° A). All the students of one group had been waiting at the patio for over an hour during an interclass break. Case cero was a girl from this group with a previous history of fainting. The outbreak occurred outside class-room in the central yard. Five female classmates of case cero fainted while they were with her in the yard. Cases then spread rapidly to the first floor with an attack rate of 13.2 percent, the second floor had 7.7 percent, and finally the third floor had 2.1 percent. All cases had fainted as per case definition. Additionally, headache was a prominent symptom occurring in 88 percent, paresthesias in 56 percent, and perceived difficulty in moving arms or legs in 35 percent. Also almost a quarter of the cases complained of irritation of the eyes and nose. Within one hour, all had completely recovered. Five days after the problem, three girls fainted; no outbreak occurred. Being a girl or belonging to class groups 1°B or 2°A, were the most significant risk factors, with (p 0.001). Also being less than 15 years of age was a significant risk factor for illness. The analysis of food preference data in the cases and controls showed that drinking a fruit beverage "X" was not related to the illness. Foods such as sandwiches, brought from home and cookies, candies and popcorn bought from street venders, had a borderline significant association with the illness. However, the number of cases attributable to these foods was very low. Also, it was difficult to figure out how sandwiches were prepared by mothers of individual students and how this factor could be implicated. No pathogen toxin or toxic chemical were identified in the food samples. Some foods studied in the crude analysis were ruled out in the multivariate analysis. A thorough environmental was negative, there being no evidence of a continuing gas leak or other causes. The pollution levels during that week were reported as being within the normal range, by the Metropolitan Index of Air Quality (IMECA). In order to evaluate psychological factors, individual interviews were carried out. The psychologist found that the cases tended to have one or both parents absent from home due to divorce or death, and their family have been damaged by eco-nomic problems. In addition, psychological testing showed that these cases had higher anxiety levels than controls. Discussion According to our findings, this outbreak appears as a Epidemic Conversion Disorder. First, no biologic cause was found for the cases. In addition, there was not any evidence to implicate food poisoning, no source of toxic gas could be identified at the school, and the levels of air pollution were not above normal levels. The clinical presentation was not different from the fainting and paresthesia reported in others studies, nor was sex distribution. One possible explanation for the initial case was the time of sun exposure in the schoolyard. Subsequent spread of the outbreak was due to psychological and extra-medical factors, including publicity by the mass media. Interestingly the spread was stopped immediately after closure of the school for one day. All the findings of the psychological reports, applied by another researcher group add further weight to this conclusion. In support to our results, many studies has been reported in which the clinical manifestations are the same that we found. In these reports, the outbreak occurred frequently among women, teenagers, students of elementary and secondary schools and chorus, in whom no organic etiology or precipitant causes can be identified. Some authors have reported that the phenomena is more evident in groups with hormonal changes, rigid discipline used in music bands, and during periods of exams or situations under stress. Such circumstances are more related to the outbreak. Some studies have demonstrated that dysfunctional families, divorced or dead parents, play a mayor role in comparison with other factors such as socioeconomic level, religion or ethnicity. The mechanisms of these events have not been clearly identified. The typical course of a psychogenic epidemic at a workplace progresses from sudden onset, often with dramatic symptoms, to a rapidly attained peak that draws much publicity and is followed by quick disappearance of the symptoms. Over 90% of the affected people are women, and the signs range from dizziness, vomiting, nausea, and fainting to epileptic type seizures, and hyperventilation. Predisposing factors include boredom, physical stressors, poor labor-management relations, impaired interpersonal communications and lack of social support. The rapid spread in the conversion disorder, is by visual contact; the treatment should be directed towards the underlying stressors but the out-break may be prolonged. In Epidemic Conversion Disorder the abnormality is confined to group interactions. This outbreak shows the importance of psychological support in populations with risk factors of presenting the illness. The social problems among large populations produce an unforgettable painful experience, mainly among teenagers who dealt with the psychological damage with-out any support. <![CDATA[Tratamiento farmacológico del transtorno límite de personalidad]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500016&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Temperament and character are terms utilized to delinéate the participation of biologic and psychosocial factors in the development of normal and disordered personality. At times, biological factors, and in others rearing, education, psychological and social events at an early age are the main determinants. The American Psychiatric Association describes Borderline Personality Disorder (BPD) as characterized by a pattern of interpersonal, selfimage and affective instability, as well as notable impulsivity. In this disorder, temperament as an inherited factor plays an important role, as demonstrated by familial studies in which the disorder is more frequently present in the families of probands than non-probands. Other disorders where impulsivity is an outstanding feature, such as antisocial personality disorder and substance abuse, are also frequent in first degree relatives of patients with BPD. Psychological factors, such as sexual abuse during childhood, are particularly high in this disorder. This is believed to generate features such as emotional instability, distrust, and dissociative states. From this point of view, it is possible that BPD is a form of "adaptation" not only psychological and behavioral, but also biological. Changes in the volume of the amygdala and hippocampus have been described in the brain of women abused during childhood, and those with BPD. BPD is frequently present in clinical practice, either or not associated to other psychiatric disorders; it can be found anywhere from 11 to 40.4% according to the setting studied. This incidence is even higher in patients with multiple suicide attempts. The term "borderline" was established when this pathological condition was conceptualized to origínate between neurosis and psychosis. However, current understanding of personality is better explained with a psychobiological model based on various dimensions. There is one related to schizophrenia (cognitive-perceptual organization dimension) and others related to mood disorders (mood regulation dimension), impulse control (impulsivity-aggression dimension), and anxiety disorders (anxiety-inhibition dimension). Patients with BPD show persistent disturbance on the four dimensions. The combination of these disturbances, along with specific defense mechanisms and coping strategies, originate the characteristic behaviors of individuals with BPD. Regarding the first dimension (cognitive-perceptual organization), BPD patients manifest paranoid ideation and dissociative symptoms usually under severe stress. It is possible that frontal lobe functioning is compromised due to a reactive dopamine and norepinephrine surge in the prefrontal lobe. The disturbance in the second dimension (mood regulation) is manifested in BPD by rapid mood shifts due to excessive sensitivity to separation, frustration and criticism. Although present in all cluster B personality disorders, mood instability in BPD is responsible for stormy relationships, self-image and self-esteem fluctuations, constant rage and bad temper, physical fights, and feelings of emptiness. This mood instability seems to be related to a serotonin effect on the dopaminergic and noradrenergic systems. Disturbances in the third dimension (impulsivity-aggression) originate a lack of control in the use of alcohol and/or drugs, as well as binge eating, reckless driving, shopping sprees, suicide gesture/attempts, self mutilation, and uncontrollable/inappropriate anger. Most studies note the inverse relationship between serotonin levels, and impulsivity, aggression, and selfharm behavior. Finally, abnormalities in the fourth dimension (anxiety-inhibition) manifest as themselves frantic attempts to prevent real or imaginary abandonment. No neurobiological substrate has been proposed in this dimension. The growing evidence of neurobiological basis favors the utilization of pharmacological agents in the treatment of BPD. This paper reviews available publications on controlled clinical trials, hoping to provide a guide in the prescription of psychopharma-cological agents to the patient with BPD. These patients can benefit from pharmacological treatment for impulsivity, psychotic states, affective instability and depression. After establishing a diagnosis, and ruling out associated conditions -such as major psychiatric disorders, substance use disorders, and/or general medical conditions-, a treatment plan including medications can be implemented. Studies on selective serotonin reuptake inhibitors (SSRI's) show the efficacy of fluoxetine in diminishing irritability and aggression and, to a lesser degree, depressed mood. A study adding fluoxetine to behavioral dialectic therapy did not seem to improve the outcome. Fluvoxamine, an antidepressant from the same class, improved emotional lability. Antipsychotics have shown to be useful. Olanzapine is the most studied of the atypical antipsychotics. Case reports using quetiapine and clozapine have also been published. Haloperidol improved depression, anxiety and anger. Anticonvulsants such as carbamazepine, valprote and, more recently topiramate, were reported to improve depressed mood, aggression and self-mutilation. TCA's and MAOI's seemed to help in symptoms such as anxiety, anger, suicidal ideation and rejection sensitivity. In turn, benzo-diacepines were associated with decreased impulse control, in-creased aggression and risk for overdose. Based on this literature review, the following considerations can be made: Patients with BPD, where aggressive behavior, self-multilation, or chronic disphoria are the outstanding features, should be started on an antipsychotic and as second option an anticonvulsant. In resistant cases, clozapine or lithium should be considered. In patients where depressed mood, anxiety, or impulsivity predominate, it is recommended to start an SSRI; as a second option, and only in cases where the patient is reliable, consider a tricyclic antidepressant (TCA), and as a last option, a monoaminoxidaseinhibitor (MAOI). In the more unstable cases, a combination of two or more medications may be needed. Fortunately, there is one study evaluating the combination of fluoxetine and olanzapine. In the pratice, drug combinations are frequent, and they seem to be matter of craft rather than science, as the clinician commonly uses his/ her experience rather than the limited published evidence. Treatment with medication should be started at a low dose, slowly increased for at least four weeks, as most controlled studies available do not show improvement earlier. Therefore, it is not recommended to change or add medications before waiting for a reasonable period, in spite of a patient's demand expecting a faster relief to his/her suffering. <![CDATA[<strong>Empowering women abused by their problem drinker spouses: effects of a cognitive-behavioral intervention</strong>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500025&lng=pt&nrm=iso&tlng=pt Abstract: According to the National Survey of Addictions, in México nearly one in ten males (9.6%) inhabiting urban areas complies with the alcohol dependence criterion established in the DSM-IV Problem drinking men frequently drive their spouses to develop severe personality disorders and tolerate extremely degrading situations. Diverse interventions have been used to treat these problems. These include group counseling, and improving self-esteem. Family therapy has also been used to assess the extent to which these women actually influence their problem-drinking partner. Family education may promote self-sufficiency and assertiveness. Other results suggest that group training reduces the abused spouse's psychiatric symptoms. Rational-Emotive Behavioral Therapy (REBT) operates on cognitive biases related to personal interaction and assertiveness. This includes effectively expressing desires, beliefs, needs, and opinions. Thus, the purpose of the present study was to examine the effects of an intervention designed to promote self-esteem, coping strategies and assertiveness in abused spouses of problem drinkers. Method A non-probabilistic random sampling procedure was used to select 35 women from two community centers. One produced 18 participants, and the other 17. All were spouses of problem drinkers, between 25 and 50 years of age and their schooling fluctuated from complete elementary school to college education and their socioeconomic level fluctuated from low to middle. A scheme similar to a multiple baseline design across two groups as well as an accidental control group, was used to evaluate the pertinent comparisons. Instruments used to collect data included the Assertion Inventory validated for Mexico by Guerra, the Coopersmith's Self-esteem Inventory, validated by Lara-Cantú, Verduzco, Acevedo and Cortés, The Coping Inventory and the Mini International Neuropsychiatric Interview (MINI). The Wilcoxon statistical test was run on the data in order to establish the probability associated to the differences between pretest and post-test, follow-up 1, follow-up 2 and follow-up 3. Results revealed significant improving differences on assertiveness, coping responses and self-esteem.<hr/>Resumen: Según la Encuesta Nacional de Adicciones, uno de cada diez varones (9.6%) que habitan en zonas urbanas cumplen el criterio de dependencia al alcohol del DSM-IV. Este consumo crea intensos problemas familiares, incluidos trastornos de la personalidad en las esposas, las lleva a tolerar situaciones extremas y abate su desarrollo personal. El presente estudio usó algunas técnicas como las de Loughead, Kelly y Bartlett en consejo psicológico (counseling) en grupo. También se ha señalado que al inicio de este tipo de tratamientos se requiere fortalecer la autoestima, antes de tratar los problemas familiares. La terapia familiar ha evaluado si estas mujeres influyen sobre sus parejas. Otras terapias buscan generar autosuficiencia y asertividad. Asimismo, hay hallazgos que señalan que el entrenamiento en grupo disminuye los síntomas psiquiátricos en parejas de bebedores problema. Así, es necesario generar en la pareja del bebedor cambios cognitivos y conductuales, entre otros. El presente estudio evaluó una intervención cognitivo-conductual sobre asertividad, autoestima y afrontamiento para habilitar a la pareja del bebedor. Algunos abordajes se basan en la reducción de cogniciones irracionales y su efecto en emociones negativas y sus conductas desadaptativas. La asertividad incluye la habilidad de expresar deseos, creencias, necesidades y opiniones Así, el propósito del presente estudio fue examinar los efectos de una intervención cognitivo-conductual en la autoestima, afrontamiento y asertividad en cónyu ges de bebedores problema. Método Se emplearon un diseño similar al de línea base múltiple y una condición control accidental. Se comparó la preevaluación con la postevaluación y seguimientos a tres, seis y 18 meses. Se usaron los siguientes instrumentos: Inventario de Asertividad de Gambrill y Richey, en versión validada por Guerra, el Inventario de Autoestima de Coopersmith, validado por Lara-Cantú, Verduzco, Acevedo y Cortés; el Inventario de Afrontamiento, descrito por Orford, Natera, Davis, Nava, Mora, Rigby, Bradbury, Bowie, Copello y Velleman, y la entrevista Mini International Neuropsychiatric Interview (MINI) 5.00, descrita por Ferrando, Bobes-García, Gilbert-Rahola y Lecrubier. Se captaron 35 parejas de bebedores problema de dos centros, uno comunitario del sur de la Ciudad de México, y otro del Centro de Ayuda al Alcohólico y sus Familiares: 18 en uno y 17 en el otro. Sus edades oscilaron entre los 25 y 50 años, y su escolaridad de primaria terminada a profesional, con un nivel socioeconómico de bajo a medio. Tres sufrían depresión mayor y tres abusaban del alcohol (canalizadas a otros programas); tres dejaron el estudio por razones laborales y ocho se dieron de baja voluntaria, con lo que permanecieron 18 participantes. A los datos se les aplicó la prueba de Wilcoxon en las diferencias entre preevaluación, postevaluación y los seguimientos 1, 2 y 3. Los resultados revelaron mejorías clínica y estadísticamente significativas en asertividad, afrontamiento y autoestima. <![CDATA[Uso de sustancias entre hombres y mujeres, semejanzas y diferencias. Resultados del sistema de reporte de información en drogas]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500032&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: Introduction and background Substance abuse in the world is reported higher among men than in women; nevertheless in different countries including mexico, use has increased among women during recent years. The distribution among male and female population is different according to each substance. Prevalence among both populations shows a preference for illegal drugs: mariguana, cocaine, solvent-inhalants and in a lesser degree, heroine. Meanwhile among women the mainly used substances are medical, such as sedatives and stimulants. Nevertheless in recent years there has been a higher involvement of female population in the use of illegal substances. In different countries it has been observed a high level of use among women and a trend of age of first use at earlier ages. In different countries research findings indicate a high level of use among young women that resembles the patterns of men; nevertheless among women who are older the levels of use are relatively low. At the same time there is more participation of women in delictive activities. The information reporting system on drugs (srid) of the national institute of psychiatry has evaluated the problem of drug use among men and women in the mexico city area from 1987 up to this date through a transversal study and carried out every 6 months. Results obtained, identify the most important trends of this problem and also describe its nature and evolution. Other different methodological approaches have been used to get a deeper understanding of the nature and extent of this problem. School population survey (ene) oriented to evaluate the prevalence during the autumn of 2003, among high school students, reveals that 9.6% of male students and 4.8% of females have ever used mariguana some time, 5.3% of males and 2.7% of females have ever used cocaine sometime. Women using tranquillisers constitute 5.3%, and solvent-inhalants 3.8%. The national survey on addictions (ena) carried out in 2002 among general population, reveals that substance abuse includes one woman out of every 4 men. According to this methodology 8.59% of men in general population and 2.11 of women have ever used some other drug, besides alcohol and tobacco. Mariguana (3.48%) and cocaine (1.23%) are the main used substances in the category ever used. Results of the system for epidemiological surveillance of addictions (sisvea) indicates that for year 2004 at national level 95.0% of males were in treatment due to mariguana and heroine use, followed by 93.0% of patients treated for cocaine. Female population used tranquillisers 13.8%, solvents - inhalants 7.6% and 7.0% cocaine. As it can be observed the above results support the existence of different patterns of substance use between men and women. Objective The objective of this communication is to analyze the results of the information reporting system on drugs considering similarities and differences between men and women regarding different variables associated to substance use such as sociodemographic profile, patterns of use, associated problems and trends of use. This information is a result for the second semester of 2004. Material and method Srid is a transversal study with two cross cut evaluations carried out twice a year. Information is gathered by means of a survey applied during an interview. Each evaluation gives a cross view of the problem in such moment of its history, and at present, information is available from 1987 to this date. The survey evaluates variables suggested by mexican research, experiences from other countries with information on systems for drugs already functioning, variables suggested by world health organization, and finally proposals obtained by discussion and agreement with experts of the participant health and justice agencies. The survey is applied during june and november each year and after the evaluation period, the information is compiled processed, analyzed and compiled in a report made by the national institute of psychiatry. This information is available for partici-pant agencies, state officers, and general public. Results The results from srid for november 2004 indicate that from 694 cases studied, 89% were males, 60% single and 64% of low socioeconomic level. Of the women surveyed 73.6% are single and 62.7% from low socio-economic level. The main age group for men is in the range of 30 and more years, for women it is between 15 to 19. Occupational status for men is employee and business (34.6%) and for women, student (34.7%). School level for men is high school completed (24.4%), for women it is 19.4% unfinished high school. Ever some time use of substances indicate that mariguana is employed by 70.7% males and 65.8% females. Cocaine among women and men is respectively 65% y 56.6%; solvent inhalants is 37.4% for men and 30.3% for women. Amphetamines and other stimulants report 6.6% for women and 5.5% for men; sedatives and tranquillisers reach 14.5% for women and 13.4% for men. Age of first use for men is 15 to 19 years and for women 12 to 14. Substance of first use for men is mariguana (45.3%), for women is solvent inhalants (45.0%), followed by cocaine: 19.0% for men and 10.0% for women. Problems preceding drug use regarding family are 15.9% for men, and 11.8% for women; nervous problems: 7.4% for men and 2.6% for women. Problems derived of drug use among women are those refer-ring to family interaction 57.9% and 49.4% for men; nervous problems: 30.3% and 26.5%; finally, psychological problems among women 39.5% and 23.5% each. Possible explanations for such results are the following: - Social devaluation towards women: women are subject to social pressures regarding child rising, household work, etc. This kind of work is seldom recognized and appreciated, and such situation could be a risk factor for substance use. The same is true for the pregnancy periods, because women are emotionally more vulnerable and as a result some substances are used as a tool to soothe personal, family and couple problems. - Social attitudes towards substance use are different for men and women. Substance use in the case of male population is regarded as an open, allowed and prestigious behaviour; never-theless for women it is hidden, prohibited and devaluatory. Thus for women substance use becomes a private behaviour, out of sight, denied; a sort of relief valve in face of the need to relax, feel pleasure and socialize. Substance use then becomes a "necessary" instrument to cope with tensions but at the same time excludes women of the social scene. - Among men and women the fantasy of solving everyday problems through the use of substances is frequent. This is a paradox since at the same time users perceive that problems become worse as a result of substance use. The clarification of such motivations is a matter for further research. Conclusions Further research is needed to explain the differences between patterns of substance use of men and women; this is so for motivation of onset and maintenance of substance use. Finally the information gathered by the srid has been a valuable tool as an early warning system on substance use, it is a diagnostic resource for decision and policy making as well as for intervention and treatment planning in mexico city. <![CDATA[Papel de los receptores de glutamato durante la diferenciación neuronal]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500038&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: L-glutamate (Glu) is the main excitatory neurotransmitter in the Central Nervous System (CNS). The glutamate receptors (GluRs) are distributed in all CNS regions and they llave been classified in two big families. The first big family is formed by the ionotropic glutamate receptors (iGluRs) or ligandgated ion channels, which allow selective crossing of ions through selective ion channels permeable to Ca2+, Na+ and K+. Depending of the electrophysio-logical and pharmacological properties of diese receptors, they are classified in three families: the a-amino-3-hydroxi-5-methyl-4-isoxazol-propionic acid (AMPA) receptors, the kainate receptors (KA) and the N-methyl-D-aspartate (NMDA) receptors. The general structure of iGluRs, consists of an extracellular amino terminal domain (NTD), two ligandbinding domains (S1 and S2), three transmembrane segments (TM1, TM2 and TM3), a reentrant pore loop and an intracellular carboxyl terminal domain (CTD). They are generally assembled into a tetrameric structure, formed by hetero-oligomeric integral protein subunits, which are encoded by different genes. The AMPA receptors family includes GluR-1, GluR-2, GluR-3 and GluR-4; the kainate receptors family comprises GluR-5, GluR-6, GluR-7, K1 and K2; and the NMDA receptors family is conformed by NR1, NR2 (NR2A-D) and NR3 (NR3A and 3B). In addition, alternative splicing of the primary transcripts increases the diversity of ionotropic receptor variants. The second great family is composed by the metabotropic glutamate receptors (mGluRs), which are associated to G-proteins that work through intracellular signaling generated by second messengers (inositol 3-phosphate, diacylglycerol and cAMP). As a general characteristic of their structure, the mGluRs have a large extracellular NTD, seven transmembrane passages connected by intracellular and extracellular loops, and an intracellular CTD. The mGluRs are divided in three groups: class I receptors include mGluR1 and mGluR5; class II receptors include mGluR2 and mGluR3; and class III receptors include mGluR4, mGluR6, mGluR7 and mGluR8. Generally, class I receptors are coupled to a Gq associated to phosphoinositides hydrolysis and function as postsynaptic receptors with an increased neuronal excitability. Class II and III receptors are coupled to Gi/Go, and are associated with adenylyl cyclase inhibition and function as pre-synaptic receptors diminishing neurotransmitter release. As in the case of iGluRs, there are many isoforms for mGluRs generated by alternative splicing of the pre-mRNA. The physiological relevance for studying GluRs is due to the key role they play in various neurodegenerative diseases, such as Huntington's disease, Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, stroke, epilepsy, HIV dementia, Creutzfeld-Jacob's disease and hypoglycemia. They are also involved in psychiatric disorders like schizophrenia, depression, anxiety disorder and post-traumatic stress disease. Moreover, the GluRs are involved in all the related steps of CNS development and neuronal differentiation. The great variability of responses to Glu is due in part to extracellular Glu concentration, as well as to the diversity of GluRs. It has been observed that differential expression of GluRs subunits is related to the stage of development and to the region of CNS. Thus, the pattern of differential expression of GluRs in a temporal and spatial manner is fundamental to understand the role of Glu in the CNS development. During neurogenesis, the early developing brain contains high levels of extracellular Glu. The activation of different GluRs, activates in turn intracellular second messenger signaling pathways, modifying the intracellular calcium concentration [Ca2+]i, which triggers transcriptional activation of cell cycle regulatory genes that promote cellular growth, regeneration, differentiation and neuronal survival. Furthermore, GluRs can stimulate growth of the pre-synaptic dendritic tree and harboring of post-synaptic dendrites, as well as to promote synaptic consolidation and maintenance. Other important mechanisms to generate mature neural networks are synaptic elimination, which diminishes the established neuronal contacts during synaptic refinement, and silencing of GluRs activity, which favors synaptic elimination during neuronal network formation. In addition, GluRs play an important role in the formation of inhibitory synapses during CNS development. GluR activation promotes dendritic growth through the generation of intracellular second messengers. However, biphasic changes of [Ca2+]i, in response to GluR activation, are related to the inhibitory and stimulatory dendritic growth phases. Therefore, a transitory increase of [Ca2+]i is related to a calmodulin-dependent dendritic growth, while a sustain rise of intracellular calcium is related to a calpain-dependent dendritic retraction resulting in dendritic microtubule polymer reduction. Another mechanism for dendritic growth is mediated through extracellular calcium influx, which triggers a cascade of intracelullar signaling path-ways, such as phosphorylation of Tiam1, Ras/Rac activation and recruiting protein kinases, phosphoinositide-dependent kinase and Akt, which are involved in the protein synthesis necessary for dendritic development and neuronal plasticity. It has been shown that excessive GluR activation can alter neuronal migration. Superficial cortical neurons release Glu producing a concentration gradient, which in turn promotes neuronal migration to the cortical plate, changing the cytoskeleton dynamics. The neuronal migration rate depends on increased intra-cellular calcium through GluRs. The GluRs can inhibit migration due to cytoskeleton depolymerization, or due to mechanisms influencing the direction of the migration of phillopodias. Although the NMDA receptors are the most studied in the development of CNS and during neuronal differentiation, in this review we also analyze the importance of the great variety of iGluRs and mGluRs during the development of the brain. We review the establishment and maintenance of synapses, cellular growth and differentiation through symmetric and asymmetric division, as well as neuronal survival, dendritic growth, synapsis elimination, receptor activity silencing and neuronal migration. All of the above processes play key steps in the establishment and development of mature neuronal networks, which are fundamental to consolidate the formation of all regions of the CNS from embryogenesis to adult life. <![CDATA[Dependencia de los sistemas de memoria al ciclo luz-oscuridad en la expresión de estrategias adaptativas. Segunda parte]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500049&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: In the first part of this work we reviewed the hippocampus and striatum anatomy and function in the context of the memory systems. In this second part we describe the anatomic and physiologic basis of the memory systems represented by the amygdala and prefrontal cortex (PFC) and their participation in the expression of strategies for the solution of specific problems. Amygdaloid formation is divided in three principal regions, the baso-lateral nucleus, the superficial nucleus, and the centromedial nucleus. Amygdala is highly connected with several regions of the brain including hippocampus, striatum and PFC. Amygdala has been implicated in the processing, storing and retrieval of emotional information. Another function proposed for the amygdala is to modulate the activity of structures such as the hippocampus, the striatum and the cerebral cortex. The participation of the amygdala has been shown in different tasks such as the Morris water maze, the radial maze, the passive avoidance task, and the freezing behavior among others. In some of these studies it has been shown that the activation of the amygdala enhances the acquisition of the task. When the amygdala is activated pharmacologically it is able to enhance the acquisition of hippocampus or striatum related tasks. In these context, the efficiency of the amygdala activation depends on the synchrony, the precise time, at which it occurs in relation to the event the subject is learning. This is, either immediately before, during or immediately after learning. In support of this enhancing role of the amygdala, some electrophysiological studies have shown that the activation of the amygdala facilitates the development of LTP in the hippocampus while its lesion decreases it. On the other hand, it has also been shown that the amygdala activation increases c-Fos expression in both, the hippocampus and the striatum. In summary, the amygdaloid formation has been proposed as an enhancer of learning, representing the emotional component of the response to the environment. PFC is the other structure involved in the generation of strategies. It has been related with the correct functioning of higher functions such as memory, attention, emotion, anticipation and planning. It has been called the central executor for its fundamental role as a coordinator of past, present information and future performance. It is been proposed as responsible for the so called working memory, that allows to put together different kinds of information at the same time, giving the chance of comparing, selecting and generating a goaloriented behavior. Working memory has been studied with many different techniques, however electrophysiological experiments have shown interesting aspects of its functioning. Recording cells from the PFC of monkeys, Goldman-Rakic showed that these cells remain firing in a short period of time when visual information should be retained to be used in ulterior comparison task. This cell activity suggests that these neurons would be responsible for the maintenance of information in our "mind" a short period of time. These results have been replicated in humans by using real time imaging techniques as fMRI and PET. Again, during the periods of retention of the information, the activity on prefrontal areas increase until such information is used. Besides working memory, anticipation is another important function regulated by the PFC. Several studies have shown that the activity of prefrontal cortex increases before the performance, it seems like the prefrontal cortex predicts the actions in the environment and readily generates a strategy to efficiently act in response. PFC is connected reciprocally with the hippocampus, the striatum and the amygdala, the relation between these structures is under heavy investigation. Regarding the hippocampus, some interaction has been observed, and it has been proposed an interaction between these structures for the long term consolidation of memory. As for the striatum, the relationship with PFC has been studied preferentially with the ventral striatum or nucleus accumbens with respect to reinforcement of behavior. We understand poorly the relationship with the dorsal striatum. The relation between amygdala and PFC, on the other hand, has been studied in relation to the expectancy of the reinforcement. This is defined as the representation in the mind of the reinforcement and the association of that representation with the conditions under which it was delivered. In simple words, this is a way to explain how is that a subject prefers a specific reinforcer over another. It has been shown that lesions of the basolateral amygdala as well as PFC interfere with the expectancy of reinforcement. The function of the amygdala in this case is to provide the emotional component related to the presence of the reinforcement. An extensive literature has addressed the question of circadian variations in the release of neurotransmitters. For example, the diurnal variations in the release of acetylcholine in the hippocampus and PFC. The binding for acetylcholine, serotonin and norepinephrine to glutamatergic hippocampal cells is different depending on the light-dark cycle, suggesting that the modulation of the hippocampus by these neurotransmitters is different depending on the presence or absence of light. In this review, we have devoted special interest to the influence of the light dark cycle on these mnemonic systems and on goaloriented behaviors. We analyze selected papers from the available literature on circadian rhythms and memory, emphasizing the hippocampus role. We believe that the study of this relationship (brain/light-dark cycle) could be a useful tool to understand how the environment influences behavior. On this topic, there's evidence that the learning of a task may be different depending on the part of the day when it was learned. For example, it has been shown in humans that when subjects are submitted to explicit or implicit task the performance is different depending on the hour of the day, being better during the light for the explicit memory and better during the dark for the implicit memory. Studies in rats trained in fear conditioning tasks, showed that subjects learn the task easily when they are trained during the light phase of the cycle and the learned behavior showed a higher resistance to extinction. Conclusión. When a subject is confronted with a specific problem, he/she can find the solution by using different strategies. The expression of one of those strategies depends on the interaction of the different memory systems, these systems process and storage different kinds of information, and this information is useful to generate and exhibit a given strategy. The memory systems are constantly under the influence of the environment, one critical component of this environment is the lightdark cycle, which apparently is modulating the activity of these structures. As a result of the influence of the light-dark cycle on these structures, the behavior of the subject would be modulated as well. All these interaction just for the sake of adaptation, survival, and reproduction in this rotating and translating world. <![CDATA[Tipos de ansiedad frente a la donación hipotética de embriones para investigación. Una aproximación desde la perspectiva de género]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500059&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: An article published recently explored the kinds of anxiety displayed by couples that have been treated with assisted fertilization techniques, IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) towards the hypothetical embryo donation for research. The study shows that the more frequent kinds of anxiety, in agreement with the methodology of Gottschalk et al, are guilt anxiety and separation anxiety. This work intends to give a reflection as an essay on the probable relationship present between gender and these kinds of anxiety. Reproductive medicine. Basic definitions The different clinical presentations of infertility and sterility have given origin to their study in a novel area called reproductive medicine. Reproductive medicine is in charge of the prevention, diagnosis and opportune treatment of the problems of human fertility. A reproductive problem is that one present in the couple who does not obtain a spontaneous pregnancy. Sterility is the inability of the man or the woman to conceive. Primary sterility is acknowledged when the couple, after a year of sexual relations without use of contraceptive method and with deliberate search of descendants, has not become pregnant. Secondary sterility occurs when the couple, after conceiving, does not obtain a new gestation after trying for two or more years. On the other hand, infertility is the inability to produce a living child. Therefore, primary infertility is suffered by the couple who has a gestation without a suitable ending (abortion, repeated loss of gestation, etc.), and the secondary infertility occurs when after a childbirth with at least one child being born alive, they cannot attain a new gestation upon maturity. After a complete medical evaluation, the treatment plan could include simple techniques of assisted fertilization (like the intrauterine insemination) or complex techniques of assisted fertilization (like IVF and ICSI). IVF technique begins with the ovarian hyperstimulation with exogenous hormones, in a controlled way, and the transvaginal ovular capture guided by ultrasound; then, every ovum with a high quality is incubated with sperm treated previously in the gamete laboratory by an embryologist. After the gamete meeting, a culture of the zygote is done to be able to visualize the cellular division and thus to demonstrate its fertilization. Later the transference to the uterus is made. The pregnancy probability increases with the number of transferred embryos: 9% with one, 18% with two, 29% with three and 32% with four. The rest of produced embryos is cryopreserved. The success of the technique, understood like «baby in house», cannot exceed 40%, basically because the knowledge of the molecular mechanisms that regulate the implantation of the human embryo is still very limited. ICSI technique consists in the same steps that the IVF, but differs in the way of fertilization, which is done here by a direct injection of a sperm into the cytoplasm of an ovum. The use of these new techniques as tools to the service of human reproduction have undertaken the analysis and the debate in this kind of treatments, with special emphasis on the psycho-logical, social and ethical aspects. This is so because now appears the possibility (unthinkable before), of 5 relatives as parents: the genetic mother (the ovum producer), the biological mother (who held the pregnagcy), the social mother (who will take care of the product in postpartum), the genetic father (sperm producer), and the social father (who will take care of the product in postpartum). Anxiety in reproductive medicine The emotional and psychological aspects have been, in general, little studied and understood in the population of the couples that have fertility problems. Usually it is accepted that the reproductive problems have repercussions in the psychological sphere, but still it is discussed that the psychological factor is a cause of fertility problems. At the beginning of this type of studies, it could have suggested that women with a traditional feminine roll are more anxious than men, but they would not show levels of depression nor of sexual or marital dissatisfaction. Nevertheless, the taller will depend largely on the conceptions that settle down around the relation between masculinity and paternity, femininity and maternity. Gender perspective Gender perspective makes reference to the academic, illustrated and scientific conception that synthesizes the theory, the liberating philosophy and the policy, created by the women in the femnist culture. Gender perspective allows to analyze and to understand the characteristics that define women and men in a specific way, as well as their similarities and differences. This gender perspective analyzes the vital possibilities of women and of men: the sense of their lives, their expectations and opportunities, the complex and diverse social relations, that occur between both genders, as well as the institutional and daily conflicts that they must face and the ways in which they do it. The feminist gender analysis is detractive of the patriarchal order, it contains specific criticism of the injurious, destructive, oppressive and alienated aspects that are present due to the generic organization based on the inequality, injustice, and political hierarchy sustained by people based on gender. The category of captivity for the feminine gender and of dominion for the masculine gender cannot escape to the scope of the reproductive medicine and to the theoretical possibility which is becoming more and more real, of using human embryos for research. Guilt anxiety Guilt anxiety can be associated independently with the disapproving vision of Christianity in the West, in respect to the reproductive medicine in general and to the donation of embryos in particular, wether its aim is reproductive or not. It would be possible to locate a first instance of patriarchal dominion through the Church and the exerted control over sexuality and reproductivity in the Family, and a second one of patriarchal dominion when the previous one not being enough, it uses reproductive medicine like a dominion agent on the feminine captivity, that is, the "motherspouse" captivity. Separation anxiety It is possible to consider what the series of procedures involved arouses in a so technified reproductive medicine: the solitude sensation that can experience a human body when self perceived by itself like a biological body; like another object more of the technological and science to the service of the human reproduction. Solitude, isolation, loss of what has been gained or isolation from what it is about to be gained through the technique (the non had son until the moment to go to receive diagnosis). If one considers the embryo like a being of equal ontological value that an adult, these will be a greater anxiety of separation when donating embryos. Final considerations Reproductive medicine has too many matters not sufficiently explored. Other sciences should make new theoretical constructions, besides psychology (which should study empirically and theoretically if the anxiety is the same when people is thinking about embryo donation, and when they are donating the embryos). For example, anthropology must review and (eventually) redefine some concepts as family, incest and others. Law must create new norms about gamete and embryo donation, and contribute with the legal definitions of "father", "mother", "son"; maybe even make laws regarding the legal disposition of cryopre-served embryos, etc. Finally, real world is too complicated as are our mental maps and schemes. <![CDATA[El suicidio, conceptos actuales]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500066&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: One current problem in Public Health relates to suicide and the identification of the risk factors needs to be clarified accurately. The bases of suicide involve complex multiple factors. In a high proportion of nations, mainly in industry-developing countries, suicide is placed among the first three causes of death in groups aged from 15 to 34 years. In Mexico, suicide represents the ninth cause of mortality, within a wide scale of age ranging from 15 to 64 years. Some risk factors have been identified. Epidemiological studies show that males commit suicide more frequently than females, in a proportion of 5:1. Consummate suicide occurs in men about 50 years old, mainly by hanging or fire arms. Females between 20 and 29 years old, on the contrary, carry out more frequent unsuccessful attempts in the same proportion, by using pesticides and medical drugs. However, in recent years an increase in the number of suicides among young people from 15 to 24 years old has been observed, commonly in lowincome sectors, in subjects with a previous history of psychiatric disorders, mainly personality disorders, abuse of substances and prior suicidal attempts. The risk of suicide generally increases after 45, and becomes especially serious in older people. The phenomenon of suicide in the elderly deserves special attention, due to the fact that the population over 65 years old is continuously increasing. This group displays fewer attempts than youths, but they achieve their aim more often through a silent suicide, by refusing to eat or to accept and follow medical prescriptions. Some psychiatric disturbances are intimately related to suicide. It is considered that 50% or more of the consummate suicides are performed by people suffering from an affective disorder, mainly depression. In this sense, it is noteworthy that most of these patients had been misdiagnosed and in many cases had not received any proper treatment. In addition, the abuse of or dependence on alcohol is present in about 20% of consummate suicides, and high rates of suicide are also observed in schizophrenia. Another common disturbance associated with suicide is anxiety. The simultaneous presence of anxiety and depression must be considered as a great risk factor, since the depressed patient has a high risk of committing suicide under phases of increased anxiety. All of these observations imply an alert signal for medical care units concerning the importance of detecting signs of the presence of risk factors and suicidal ideation, and of implementing adequate therapeutic management, namely, a supervised pharmacological treatment of depression and anxiety, including hospitalization, if it were the case. The risk factors in potential suicide include isolation, poor health, depression, alcoholism, lowered selfesteem, despair and feelings of social and family refusal. Frequently, the potential suicide directly or indirectly gives behavioral and verbal cues of his or her suicidal intention. Roughly, 60% of the victims of suicide had attended some medical care unit in the month previous to the suicide and had commented something about their desires and feelings about death at some moment, and 30% had clearly revealed their suicidal ideation. For such reason, the evaluation of risk of the potentially suicidal patient should be a common practice in medical care units. Therefore, the early detection of the presence of risk factors of suicide, including the report of self-harm and of a detectable incapacity for solving problems, mainly of social type may provide an invaluable time to permit its prevention. Another current aspect awaiting conclusive evidence is associated with some controversial data regarding the impact that the use of antidepressants could have upon suicide. The Food and Drug Administration office (USA) pointed out that deficiencies in information do not allow to confirm any existing relation between the use of serotonin selective reuptake inhibitors (SS-RIs) and suicide in youths. The suicidal risk after initiating the treatment is similar in the patient receiving tricyclics, or seroton-in selective reuptake inhibitors. The risk of suicide can increase significantly in the first month of antidepressant treatment, especially during the first nine days. Consequently, the observation that patients receiving antidepressants attempt suicide, is due, at least partly, to the fact that for still unknown reasons, antidepres-sants require from three to four weeks of impregnation to attain clear therapeutic effects. Therefore, it is indispensable to carry out further clinical and experimental studies to determine the variables that could be implied in this time lag in the action of antidepressants. However, fluoxetine represents a useful alternative in the management of depressive disorders; albeit as in the case of other antidepressants, it requires a strict follow-up of the patient receiving such treatments to avoid the risk of a fatal complication. In conclusion, the suicide risk, being a serious problem of public health, requires special attention. Recent research indicates that the prevention of suicide includes a series of activities, such as educational programs for children and youths, teachers and educators, and also primary health care units for the early detection of suicide risk factors. And, of course, medical training for the management of the potential suicide. For all of them, some relevant facts must be taken into account: Depression can be present in children and adolescents. Access to means of committing suicide, such as weapons, must be avoided. People from medical care units should be on the alert when any one shows signs and symptoms of despair and impulsiveness. Suicide, anxiety and depression have a biological basis; there-fore it is not a matter of cowardice or an act of defiance. An inadequate and inopportune diagnosis may increase the suicidal risk. Parents and teachers should be instructed to detect any sign of suicidal ideation and despair. Therefore, this revision intends to bring some recent data to bear upon the factors of the risk of suicide that provide the reader with information for a more effective prevention. <![CDATA[Día Mundial sin Tabaco 2006]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252006000500075&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract: One current problem in Public Health relates to suicide and the identification of the risk factors needs to be clarified accurately. The bases of suicide involve complex multiple factors. In a high proportion of nations, mainly in industry-developing countries, suicide is placed among the first three causes of death in groups aged from 15 to 34 years. In Mexico, suicide represents the ninth cause of mortality, within a wide scale of age ranging from 15 to 64 years. Some risk factors have been identified. Epidemiological studies show that males commit suicide more frequently than females, in a proportion of 5:1. Consummate suicide occurs in men about 50 years old, mainly by hanging or fire arms. Females between 20 and 29 years old, on the contrary, carry out more frequent unsuccessful attempts in the same proportion, by using pesticides and medical drugs. However, in recent years an increase in the number of suicides among young people from 15 to 24 years old has been observed, commonly in lowincome sectors, in subjects with a previous history of psychiatric disorders, mainly personality disorders, abuse of substances and prior suicidal attempts. The risk of suicide generally increases after 45, and becomes especially serious in older people. The phenomenon of suicide in the elderly deserves special attention, due to the fact that the population over 65 years old is continuously increasing. This group displays fewer attempts than youths, but they achieve their aim more often through a silent suicide, by refusing to eat or to accept and follow medical prescriptions. Some psychiatric disturbances are intimately related to suicide. It is considered that 50% or more of the consummate suicides are performed by people suffering from an affective disorder, mainly depression. In this sense, it is noteworthy that most of these patients had been misdiagnosed and in many cases had not received any proper treatment. In addition, the abuse of or dependence on alcohol is present in about 20% of consummate suicides, and high rates of suicide are also observed in schizophrenia. Another common disturbance associated with suicide is anxiety. The simultaneous presence of anxiety and depression must be considered as a great risk factor, since the depressed patient has a high risk of committing suicide under phases of increased anxiety. All of these observations imply an alert signal for medical care units concerning the importance of detecting signs of the presence of risk factors and suicidal ideation, and of implementing adequate therapeutic management, namely, a supervised pharmacological treatment of depression and anxiety, including hospitalization, if it were the case. The risk factors in potential suicide include isolation, poor health, depression, alcoholism, lowered selfesteem, despair and feelings of social and family refusal. Frequently, the potential suicide directly or indirectly gives behavioral and verbal cues of his or her suicidal intention. Roughly, 60% of the victims of suicide had attended some medical care unit in the month previous to the suicide and had commented something about their desires and feelings about death at some moment, and 30% had clearly revealed their suicidal ideation. For such reason, the evaluation of risk of the potentially suicidal patient should be a common practice in medical care units. Therefore, the early detection of the presence of risk factors of suicide, including the report of self-harm and of a detectable incapacity for solving problems, mainly of social type may provide an invaluable time to permit its prevention. Another current aspect awaiting conclusive evidence is associated with some controversial data regarding the impact that the use of antidepressants could have upon suicide. The Food and Drug Administration office (USA) pointed out that deficiencies in information do not allow to confirm any existing relation between the use of serotonin selective reuptake inhibitors (SS-RIs) and suicide in youths. The suicidal risk after initiating the treatment is similar in the patient receiving tricyclics, or seroton-in selective reuptake inhibitors. The risk of suicide can increase significantly in the first month of antidepressant treatment, especially during the first nine days. Consequently, the observation that patients receiving antidepressants attempt suicide, is due, at least partly, to the fact that for still unknown reasons, antidepres-sants require from three to four weeks of impregnation to attain clear therapeutic effects. Therefore, it is indispensable to carry out further clinical and experimental studies to determine the variables that could be implied in this time lag in the action of antidepressants. However, fluoxetine represents a useful alternative in the management of depressive disorders; albeit as in the case of other antidepressants, it requires a strict follow-up of the patient receiving such treatments to avoid the risk of a fatal complication. In conclusion, the suicide risk, being a serious problem of public health, requires special attention. Recent research indicates that the prevention of suicide includes a series of activities, such as educational programs for children and youths, teachers and educators, and also primary health care units for the early detection of suicide risk factors. And, of course, medical training for the management of the potential suicide. For all of them, some relevant facts must be taken into account: Depression can be present in children and adolescents. Access to means of committing suicide, such as weapons, must be avoided. People from medical care units should be on the alert when any one shows signs and symptoms of despair and impulsiveness. Suicide, anxiety and depression have a biological basis; there-fore it is not a matter of cowardice or an act of defiance. An inadequate and inopportune diagnosis may increase the suicidal risk. Parents and teachers should be instructed to detect any sign of suicidal ideation and despair. Therefore, this revision intends to bring some recent data to bear upon the factors of the risk of suicide that provide the reader with information for a more effective prevention.