Scielo RSS <![CDATA[Salud mental]]> vol. 29 num. 6 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<strong>El Maestro de la Fuente: El Universitario y Promotor de la Psiquiatría en México</strong>]]> <![CDATA[Toma de perspectiva y teoría de la mente: aspectos conceptuales y empíricos. Una propuesta complementaria y pragmática]]> resumen está disponible en el texto completo<hr/>Abstract: The present work completes an exhaustive revisión of the delimitation of the ability of perspective taking from different points of view. First, perspective taking is defined as the ability of an individual to interpret his/hers emotional and mental states and those of others. Additionally, the term has also been used in medical settings to refer to a tactic intended to stop certain limiting feeling and/or thoughts and instead move feelings and thoughts towards a different direction. At the same time, perspective taking is considered to be at the heart of psychological phenomena such as empathy, that is, the capacity to distinguish what individuals know about themselves in a certain situation (how someone thinks, feels and behaves), self-awareness, interpersonal relations, and various social skills deficits. Second, this ability is conceptualized as a metacognition and it is assumed that the object of study is the theory of the mind. Third, from a developmental perspective, data have shown that children four to five years old, without any psychological disabilities, have the ability to take somebody else's perspective. We reviewed different studies regarding the development of the abilities to express and interpret emotions as precursors to perspective taking. Subsequently, we revised and analyzed the tests or strategies most commonly used to evaluate the ability of perspective taking. Typically, the capacity of an individual to have "a theory of the mind" is determined through tests of false beliefs (such as the classic test of Sally-Anne, the "Smarties" test, "M&amp;M's", and the "Maxi's" Test). Múltiple variations of the tests of false beliefs have been conducted with flashcards or photographs, with characters in oral stories, and through the use of games. Additionally, over the last few years the focus of this body of research has evolved towards the elaboration and validation instruments to measure empathy. Among them are the tests of Empathy Quotient (EQ), the Friendship Questionnaire (FQ), and reading the "mind" in the eyes. It is important to note that these efforts have been focused mostly on individuals with Asperger" s Syndrome or those with higher verbal capabilities. From this latter perspective, we propose empirical evidence that points out to differences in the ability of perspective taking between children with or without autism. This is also shown in the results of previous studies, in which different levels of perspective taking skills were seen between children diagnosed with autism, and those diagnosed with Down Syndrome. It is important to note that this was not true when their verbal skills were not considered as a variable. Likewise, other studies showed that children with autism were not the only ones that failed the theory of the mind tests, but that these tests were also failed by those children with deficits in language and cognitive skills. In this article, we present the results of a study that replicates previous findings which show that typical developing children per-form better in perspective taking tests, followed by children diag-nosed with Down Syndrome, and subsequently by children with autism. It was also noted that the typical developing children showed the highest level of verbal discrimination, followed by the children diagnosed with Down Syndrome, and finally the children diagnosed with autism. One important finding in this study is that all children benefited from the use of contextual prompts, which improved the number of correct responses across all the theory of the mind tests. Additionally, the data varied depending on the type of tests utilized to measure perspective taking skills. In this article, we have also reviewed the different explanations for the origins and development of perspective taking, among which the theory of the mind prevails. The ability to take some-one else's perspective is explained by the development or matura-tion of an innate and specialized module of representations and knowledge, and the formation of conceptual structures of a higher order or meta-representations. Additionally, the ability to ignore perceptual information, salient or not, and to combine simultaneously various contexts are considered prerequisites. In other words, perspective taking speaks to the relationship between psychological constructs such as perception and knowledge. Additionally, it has been hypothesized that shared, joint, or independent attention can be a prerequisite for conversation, and may be the basis of a theory of the mind. In any case, the origins of the development of such a theory have been especially ubiquitous in terms of the executive function and possible relations with cerebral lesions or alterations. However, some authors consider that the process of central coherence may be relatively independent of a theory of the mind. The research of Baron-Cohen et al. has concentrated on identifying existing neurological deficits or organic changes such as bilateral lesions or the role of testosterone on the quality of social interactions and the restrictive social interests of individuals with autism. A similar interest exists in researching the difference in perspective taking and empathy abilities exhibited by members of the opposite sex. Continuing with the neurological foundations of the empathy is of full present time the discoveries regarding «mirror neurons» and this recent study with monkeys proposes a specific cerebral area for the formation of the meta-representation. These neurons discharge both when the individual performs an action and when the individual observes another person performing the same action. Finally, even in the light of all the above, other sources point toward the social root of perspective taking skills. Additionally, as indicated by the research of Howlin, Baron-Cohen &amp; Hadwin, it is considered perspective taking includes five different levels: a) simple visual perspective taking, b) the knowl-edge that different individuals can have separately the same thoughts, and c) understanding that "seeing leads to learning," followed by d) the ability to predict actions based on valid beliefs, and finally e) the ability to predict false beliefs. In the light of all of the above, once the radical conclusions of these investigations are viewed critically, the theory of the mind is viewed as a disputable theory of the delimitation of the cause and development of such skills. In addition, to the perspective taking tests themselves, the pre-requisite skills of perspective taking need to be extensively ana-lyzed. In fact, it has been shown that, in order to have an adequate performance on these tests of false beliefs, individuals should be able: 1. to remember and adequately retell their own past desires, thoughts, and past actions; 2. to retain an object in their mind, perceive a second object, and form a relationship between the two, as in a "symbolic function"; 3. to demonstrate the ability to pretend; and 4. to identify the role of age and verbal abilities in children as pre-requisites for an accurate performance on tests of false beliefs, and interpretations of the world. Lastly, we propose a pragmatic and complementary analysis the Theory of Mind based in the functional-contextual analysis of behavior. First, it is considered that perspective taking requires or is closely related to other social behaviors (such as taking turns when talking, initiating verbal responses in interpersonal relations, and the capacity for empathy). In the same manner, theory of mind requires an adequate level of simple and complex conditional discriminations, and these should be analyzed in terms of stimulus control and equivalence relations. In other words, this ability to infer thoughts, feeling, and emotions of others exists if the following prerequisites are present: 1. the processes of the classical conditioning of the emotions, 2. a generalized imitation, and 3. the development of functional classes. Without these experiences or the capability to be affected by them, children (i.e. children with generalized autism) do not develop language adequately. Second, perspective taking implies that an observer's previous experiences and observations with certain events determine his/ her reaction to responses emitted by others in similar circumstances. Finally, from a contextual perspective, it is considered that a speaker's relational frames play a role in this process (for the discriminations I/you, here/there, now/later). These relational properties are abstracted through multiple exemplars or multiple learning opportunities to speak from one's own perspective in relation to others. <![CDATA[<strong>An empirical study of defense mechanisms in panic disorder</strong>]]> Abstract: Panic disorder is present in 2.9% of females and 1.3% of males in the Mexican urban population; about two thirds of these patients have an associated depressive disorder. Genetics and psy-chosocial factors are intertwined in the etiology of this disorder. There are several studies related to the role of defense mechanisms in the pathogenesis of psychiatric disorders. Few studies of anxiety disorders have been conducted in Mexico, and there is little evidence about the importance of the defense mechanisms that are present in these disorders. In the DSM-IV-TR, defense mechanisms or coping styles are defined as "automatic psychological processes that protect the individual against anxiety and from the awareness of internal or external dangers or stressors. Individuals are often unaware of the processes as they operate". The purpose of the present research was to identify the differential use of the defense mechanisms in normal controls and in patients with panic disorder alone or complicated mainly with mood disorders, and the patients who responded or did not respond to psychopharmacological treatment. Method. The sample of this study comprised 48 consecutive outpatients with panic disorder from the Instituto Nacional de Psiquiatría, Ramón de la Fuente Muñiz. All of them were evaluated three times: first by a third grade psychiatry resident, in second place by a specialist in psychiatry and finally by one of the authors. After the patients agreed to participate, they completed a demographic questionnaire, the Hopkins Symptom Check List (SCL-90), and the Defense Style Questionnaire (DSQ, Spanish Version). To evaluate the intensity of anxiety and depression, the Anxiety Hamilton Scale and the Hamilton Scale for Depression were used in their first appointment. Patients were treated as usual with a tricyclic antidepressant, a benzodiazepine, or both, during an eight week period. Then they were evaluated again with the same instruments and scales. The Defense Style Questionnaire (DSQ) is a self-report instrument of common defense styles, which are empirically validated clusters of perceived defense mechanisms. Subjects rate their degree of agreement with 88 statements designed to tap defense or coping mechanisms on a ninepoint scale. The DSQ is a widely used measure of empirically derived groupings of defense mechanisms ranking an adaptive hierarchy. A review of published studies, indicates strong evidence that adaptiveness of defense style correlates with mental health, and that some diagnoses are correlated with specific defense patterns (borderline personality disorder correlates with greater use of both, maladaptive and image-distorting defenses, and less use of adaptive defenses). For other diagnoses, the pattern of defenses is less clear. The validity and the reliability of the DSQ Spanish Version were established before its application, in a sample of 261 psychiatric patients and controls. Two factors were obtained in the factor analysis. The first was denominated Mature Style. This category included: suppression, working orientation, sublimation, anticipation, affiliation, reactive formation, altruism, and humor. The Immature Style was the second factor; it included projection, acting out, repression, somatization, autistic fantasy, affective isolation and social withdrawal, inhibition, help rejection, splitting, undoing, consume, idealization, denial, projective identification, passive-aggression, and omnipotence. Higher mean scores indicated greater use of the individual defense mechanism and style. The mean scores for individual DSQ defense mechanisms and styles were calculated by adding and averaging the scores. The reliability calculated was .89 (Cronbach alpha) for the items cor-responding to the 25 defense mechanisms. Axis I was ascertained reliably with face-to-face interview and a list of the DSM-III-R criteria. This group had 32 patients with panic disorder and 16 patients with panic disorder associated to mood comorbidity or alcohol dependence, in persistent remission for at least one year; 32 subjects were included in the normal control group. Results. The comparison of patients with panic disorder, pa-tients with panic disorder associated to mood disorders and controls, showed that both groups of patients used more projection, regression, inhibition, acting out, fantasy, splitting, help rejection, undoing, and reactive formation (p&lt;.01), than the control group. The patients with panic disorder alone, used more somatization and denial (p&lt;.01) than controls, but not more than the group of patients with panic and mood disorders. They also used less humor and sublimation as defenses than the control group (p=.03). The defense mechanisms of the patients who responded to pharmacological treatment were similar to the defenses of patients who did not improve or deserted. The only defense used more by the patients who responded to treatment was undoing. Conclusions. Overall, the results of this study on panic disorder draw us to the conclusion that patients with this disorder make more use of immature and neurotic defenses than nonpatients. It is clear that maladaptive defenses, measured with this version of the DSQ, are related to mental illness and greater symptomatology, and adapative defenses are related to a better health. There was a clear difference in the use of defense mechanisms between the groups with illnesses and the control group. The clinical value of these observations depends on the relationship of the defenses with the symptoms. In this survey it is not possible to propose that defense mechanisms are the cause of the panic disorder, the reaction to the disease, or just a manifestation of the illness. The theory which establishes that the predominant use of certain defenses predisposes an individual to the development of specific illnesses, is attractive, but there is no evidence to support this hypothesis at present. In order to determine whether specific defenses or defense styles create vulnerability for the development of specific illnesses, the ideal study would be a prospective and longitudinal one; it would measure defenses in childhood, in adolescence, and at several points in adulthood, and would note whether there were significant correlations between preexisting defenses and specific illnesses. Such a study has yet to be under-taken. It is intriguing to speculate if an assessment of defenses could guide to treatment choices. Therapists do tend to consider diagnosis, ego strength, symptoms, behavior, and defenses when planning treatment, but a systematic assessment of defenses is not used as a basis for planning specific interventions. Although several studies have examined the relationship among defenses, alliance, therapist interventions, and outcome, more studies looking at a wider range of specific diagnoses are necessary.<hr/>resumen está disponible en el texto completo <![CDATA[La prueba de Rorschach y la personalidad antisocial]]> resumen está disponible en el texto completo<hr/>Abstract: This paper is concerned with the análisis of the personality of eight subjects evaluated by the authors, using the Rorschach Test. Our purpose is to use this test to reflect on the psychic functioning of subjects for whom there is no agreement between clinical and legal and/or social criteria, in comparison to cases where there is a correlation between them. That is, to contrast the diagnostic criteria of the test with those criteria which actually lead to labella subject as "antisocial". Method: A descriptive study was used, whose sample was taken from an experiment involving cases examined over a period of ten years. The first group of subjects selected who confirm the sample meet the diagnostic criteria of the Rorschach Test for antisocial personality and also are in line with what society considers this to be. The second group includes those subjects who according to the test criteria evidence signs of being antisocial but are nonetheless not considered so by society. Finally, the third group is formed by those who do not fulfill any of the Rorschach Test criteria for antisocial personality, but socially and legally are considered to have it. Results: Significant differences were found between the three groups being studied. The first group shows signs or indications that are clearly associated with the antisocial personality. The case analysis revealed signs that had not previously been described as peculiar to the antisocial personality in the test but which nonetheless we consider essential to enable us to draw a diagnostic conclusion. In the other two groups, it was more difficult to reach a diagnostic agreement between the clinical and legal criteria. This illustrates the difficulty of making a categorical diagnosis of personality disorders, as other authors have already pointed out (Jaspers, Kernberg y Dórr). The other phenomena are not found in the literature relating to the Rorschach Test, and agree with the character traits described in classical psychopathological literature, such as the description by Schneider of the ruthless psychopath and the assertions made by Jaspers regarding the existence of an ideal type and numerous personalities between these two extremes. Moreover, Kernberg draws a distinction between "antisocial behavior" and "antisocial psychic functioning". Antisocial behavior may appear in different personality profiles, especially in Narcissistic personalities, while the psychic functioning of an antisocial personality is closer to that of Schneider"s ruthless psychopath. Other phenomena not described, but which we observed and consider important to point out in severe cases of psychopathic behavior were Presence of an aggressive tendency to lie and make up stories: This reveals a marked tendency to fantasize and even to lie, to embellish their surroundings and seek gratification more in fantasy than in reality. Such cases are disturbing because of the violent and excessive nature of the fantasies. Stimulus can cause them to lose control when evoking violent fantasies. Frequent defect responses: This is a disassociation index. The phrasings of "incompleteness" (broken, split, fragmented) could be linked to the existence of badly configured or conserved internal objects, in the sense that they are damaged, looked at in a warped or incomplete way. Suffered action responses: These are associated with the existence of sadomasochistic elements, with signs of aggressor to victim and victim to aggressor relationships in a context of very lurid and destructive persecution fantasies. Presence of thoughts that reveal persecution anxiety: It is possible to appreciate indicators of a paranoid type of anxiety, associated with borderline constructs. It also shows up in the attitude to-ward the exam, marked by a very defensive bearing, distant, cold, controlling and overly critical. Hiding responses: Many times the subjects perceive "covered" figures, "hidden", avoiding direct and frank contact. Reaction to plate IV (authority or paternal): Indicators abound in rejection of the authority figure, lack of appreciation of the other's power; avoid to recognize the superiority of the other, attempt to put them down and downplay their power or the threat they pose. Presence of antagonistic elements: It is worth noting the presence of very contradictory elements, revealing very violent images appearing alongside their opposites, in the sense of benevolent, peaceful, unthreatening images. Shock or failure inplate X: Another phenomenon not described and that surprise us, was the inability to give responses in Plate X. This fact strikes us as curious given that this plate is called the "forecaster". This plate requires a greater integration of the perceptive process. Discussion: As it is difficult to come up with a diagnosis for antisocial personality, let alone the contradictions and confusion that can arise in this field, we believe it is important to point out the benefits of psychodiagnosis through the Rorschach Test. This enables us to discriminate more accurately between some type of antisocial behavior and an antisocial personality per se. The possibility of narrowing down the criteria of the Rorschach Test associated with this disorder becomes a significant contribution to forensic psychiatry. The analysis of the above cases reveals to us the difficulty of carrying out a diagnosis by categories of Personality Disorders. This conclusion takes us to what Jaspers already proposed with his "Ideal Type", Kernberg with his classi-fication on gradients of the different types of borderline Personality, and O. Dórr, with his phenomenological perspective of the concepts of normality and abnormality. That is, whether a given number of symptoms or traits confirms the existence or nonex-istence of a disorder, without taking into account the transition to other clinical pathologies or the particular case in the context of the subjecfs family and social life. Although there are cases that do not involve major difficulties in reaching a diagnosis where the clinical impression agrees with the tests and the behavior, it also happens that in many others, the different indicators do not agree. This fact leads us to the following reflections: I) It is not only necessary to consider the difficulty of forming a diagnostic hypothesis in cases that are ethically so sensitive, but also the responsibility that this brings and the need to remain at the verge of the influence that social phenomena exercise, namely the pressure exerted by public opinion on what is "politically correct". With this we referred to certain cases in our sample, that were quite widely publicized (priest, doctor and agronomist), charged with pedophilia and murder, and for whom our diagnostic hypothesis didn't agree with either the way the media depicted them or the assessment of the judges. We think that in these situations the subjects were already condemned by society before their trials, to the point that not even the justice system remained immune from this influence. II) What is there to be done, given what is being decided with an assessment of this type is the future life of the subjects? On the one hand, from the point of view of the professionals in psycho-diagnosis, it is necessary to count on the evidence and have tests systematically checked independently by one or more specialists in the area. III) Another important aspect to consider is related to the diagnosis itself. It is here, as we already stated, where we found the biggest problem. The fact that our conclusions did not always agree with the judgment of other social organizations (judicial power, society and family) leads us to be very careful when stating a definitive conclusion. We already mentioned the problem with categorical diagnoses, such as DSM-IV, since they do not consider transitions and are based only on the presence or absence of symptoms to determine the type of disorder. We think that when dealing with personality disorders it is necessary to make use of dimensional diagnoses. It is also suggested to propose a Tentative Diagnostic Hypothesis, and not state cat-egorically that the subject pertains to such or other type. Finally, we wish to address the aspect related to the presentation of the report itself to professionals outside of the area of psycho-metrics although in charge of the case, that is, psychiatrists and legal professionals. Lately the Rorschach test has been questioned a lot particularly in the formulation of legal expert opinions. This criticism may be due mainly to three factors: 1) Use of very specialized and esoteric terminology that makes it incomprehensible to those who are not specialized in the Test. 2) Insufficient experience in the Test as it requires a lot of study and experience. 3) Individual marking of the test, that is, without contrasting the results with another specialist, a fact that does not help to reduce the subjective factor, which is impossible to avoid. <![CDATA[Análisis del llanto en niños hipoacúsicos y normoyentes de 0 a 2 años de edad]]> resumen está disponible en el texto completo<hr/>Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation. <![CDATA[<strong>Enmascaramiento. Un tipo de sincronización. Primera parte</strong>]]> resumen está disponible en el texto completo<hr/>Abstract: Organisms adapt their temporary niche with two complementary mechanisms. The first mechanism is referred to as entrainment of the endogenous biological clock, which circumscribes temporarily the activity of the subject into day or night. The second mechanism is defined as masking, and this refers to an alternative route which does not involve the activity of the pacemaker. It involves, instead, a sharp response of the animal during light-time, inhibiting or enhancing the expression of locomotor activities in nocturnal or diurnal species, respectively. Masking describes the direct and immediate effects on the expression of any biological rhythm induced by the season-dependent signals present in the environment. Moreover, this masking mechanism appears to complement the biological clock entrainment, which is used by organismsto adapt to their specific nocturnal or diurnal niche. Several constraints arise when trying to study the biological clock entrainment or the light-associated oscillators system. Theseare due to the fact that the zeitgeber influences the biological clock and affects the output response of the circadian clock. According to the aforementioned description, it appears the masking effects occur as a natural event and result from an inevitable consequence to the season-dependent life of living organisms. Circadian rhythms do not only reflect the physiological output responses of the biological clocks as their activities also result from a mixture of responses arising either from the masking effects and/or from the entrainment mechanisms driving the timing of the biological clock within the animal. Although conspicuous differences do exist between maskingand entrained- rhythms, both rhythms follow a similar timecourse. Nevertheless, the transition between light and darkness (environmental change) under the masking rhythm results in abrupt changes in the animal behavior activity (i.e, from a resting to an ambulatory activity or viceversa). In contrast, when the environment acts as a zeitgeber under the biological clock entrainment, the behavioural transition of the animal appears to be less abrupt and, therefore, the environment factors affecting the biological rhythms never match. Based on different chronobiological studies in animals, several authors have described different forms of masking mechanisms used by the brain, and classified according to the light-induced decrease or increase locomotor activity responses: a) Positive Masking refers to the increase or decrease of locomotor activity response in a diurnal or nocturnal animal, respectively, as a result of the increase in lighting; b) Negative Masking refers to the decrease of locomotor activity responses as a result of decrease in lighting in a diurnal animal, or an increase in lighting in a nocturnal animal; c) Paradoxical Positive Masking refers either to the increase locomotor activity responses of a nocturnal animal exposed to increase lighting or an increase in locomotor activity responses in a diurnal animal after lighting decreases; d) Paradoxical Negative Masking refers to the decrease of locomotor activity responses in a nocturnal animal when lighting is decreased, or to the decrease of locomotor activity responses in a diurnal animal when lighting is increased. In addition to the aforementioned classification of different masking mechanisms on the behavioral locomotor activity responses in both diurnal and nocturnal animals, other authors classify different forms of masking, based on the neural mechanisms that generate the masking effects. Authors defined the occurence of different forms of masking effects when enviromental factors (i.e, light, darkness) produce direct or indirect effects on the cyrcadian rhythm in an animal. Thus, a) Type I masking occurs when the environment produces a direct effect on the circadian rhythm output; b) Type II masking occurs when behavioral changes in the animal affect other physiological brainrhythms, for instance, an increase or decrease of behavioral locomotor activity may affect the temperature rhythm of an organism, enhancing the expression of an altered activity on the biological clock; c) Type III masking occurs when physiological or biochemical changes alter the neural output of the biological clock that conveys the time-related information of the biological rhythm; for instance, physiological or pathological conditions have been shown to affect the functional activity of specific neural pathways and their membrane receptors involved in the regulation of the body temperature. Such situations appear to modify the phase of the body temperature rhythm with the phase of the biological clock, which both rhythms appear to match under basal conditions. The sensibility limits necessary to generate the inhibition of the synthesis and release of melatonine, in rats and hamster, suggest the involvement of the rods, the predominant photoreceptor in the rodent retina. Nevertheless, studies the mutant mice rd/rd (the mutation rd generates the total loss of photoreceptors type rods and a considerable loss of photoreceptors type cones) presented an inhibition in the synthesis and release of the melatonine and locomotor activity induced by the light. This suggests that the photoreceptors type cones and rods are not necessary to mediate the effects of the light on the locomotor activity and that the light masking depends on another type of contained photoreceptor in the retina. Some studies report the loss of the rhythmycity in drinking, locomotion or sleep-wakefulness, not only when the animals are kept in light constant, also when the animals are kept under lightdarkness cycles (L:D). Other studies that involve to mutant mice of the two genescryptocromos, which they are arrhythmic in constant conditions; they show a SCN functional diminished, light pulses applied in the subjective night do not generate alterations in the inhibition of the locomotor activity induced by the light. This suggests the loss of the masking responses induced by light. Certainly, these results point to a loss or attenuation of the masking by the SCN lesion. On the other hand, other works showing a persistence of the masking pd drinking and locomotor activity in L:D conditions after the SCN lesions. The lesions of other structures of the rodent visual system alter the light masking. It is more a significant increase of the masking in subjects with IGL lesion is observed. Subsequently, it was reported that the masking induced by the light was more significant in mice that were submitted to an NGLd lesions, which suggests that the increase in the masking to the light observed after the IGL lesions are probably due to an incidental damage of the NGLd. It also has been reported that the light masking increase after the visual cortex lesions in hamster and mice. The mutant mice clock shows brilliant light pulses: between 100 to 1600 lux they induce a complete suppression of the locomotor activity (negative masking). On the other hand, dim light pulses induce an increment of the basal levels of the locomotor activity (positive masking) in a similar way to that of the normal subjects. The participation of other genes clock in the regulation of the light-masking has not been specific. The masking is not a limited phenomenon to conditions of laboratory. There are few examples of the direct effects of light on the temporary organization of the behavior in wildlife. An impressive case is the owl primate (Aotus lemurinus griseimembra), which shows a pattern of locomotor activity that depends on the lunar cycle. This primate is nocturnal, but its activity increases (positive masking) when the luminescence is found between 0.1 and 0.5 lux, the luminescence generated precisely by the brightness of the moon. Intensities of light lower to this diminish the locomotor activity (negative masking) of the subject. The masking mechanism is an important process in the adaptation of an organism to its environment as it confers this the capacity to respond quickly to a sudden change in environmental conditions. Since the functional point of view the masking contributes to an increment in the amplitude of a entrainment rhythm, promotes direct responses to geophysical variables that the organism selects that they optimize its evolution and its adaptation to its temporary niche, all this contributes to an increase in the probability of survival of the subject to its environment. <![CDATA[<strong>Psicopatología y uso de tabaco en estudiantes de secundaria</strong>]]> resumen está disponible en el texto completo<hr/>Abstract: When we talk about drugs, we usually think about illicit substances. However some substances apparently innocuous such as caffeine and other legal ones like tobacco and alcohol, are considered as abuse substances. Nicotine has not been studied as extensively as other drugs. It is known that the pharmacological and behavioural processes that determine the addiction to nicotine are similar to those that determine the addiction to other drugs such as cocaine or heroine. The main adverse effect of nicotine is death. According to the Global Burden of Disease study of the World Health Organization, the World Bank, and Harvard University, in 2020, tobacco will be the first individual cause of death in the world even over AIDS. Nicotine dependence can appear at any age, though it generally begins during adolescence, and it acts on the brain mechanisms of reward, indirectly by endogenous opioid activity and directly by dopaminergic pathways. In the researches on drugs consumption among adolescents conducted in Mexico City during 1989, 1991 and 1993, it was observed that tobacco consumption has increased lightly but systematically, from 4.8% to 4.2%. The percentage of current users (in the last month) is 21.9%. At junior high school level it is 13.7%, and at high school level 34.4%. Attention Déficit Disorder With Hyperactivity (ADDH). Altough the relationship between ADDH and drugs consumption has been recognized none of the studies conducted in our country has included this variable. ADDH is a disorder with a frequency of 1.7% to 18.9%. The difference between the reported percentages is attributed to the fact that definitions and methods used in the studies are not the same. When the disorder is not treated, there is usually a gradual accumulation of adverse processes that increase the risk of pathology. The relationship between ADDH and drug consumption is complex. In a study of adolescents who received treatment for drug abuse, it was observed that 50% of them met the criteria for ADDH. As well, this disorder was a bad prognosis factor, either to the addiction evolution and its treatment. Another complex relationship is the one between ADDH and cigarette smoking. In a study conducted among adult smokers, the subjects with ADDH had an earlier onset of the tobacco addiction, compared to those who did not had ADDH. This finding was confirmed by Milberger, who in a four years follow up study, discovered that ADDH is a significant predictor on the early tobacco consumption. ADDH can be considered as a risk factor in developing other addictions. Although the relationship between ADDH and drug consumption has been studied, the reviewed researches show up some limitations : Only clinical samples have been studied. Most of the follow up studies have included just male individuals with ADDH. In our country the effect of the clinical variables on drugs use have not been studied. In ADDH as well as in drug consumption, it has been observed a remarkable influence of cultural variables, this emphasize the need of evaluating both problems in our country. The following study was conducted under the hypothesis that ADDH and general pathology symptoms are higher among adolescents that have consumed tobacco than those who have not. Material and methods A comparative, cross-sectional survey of adolescent with and without tobacco usage was performed. Fifteen junior high schools in Puebla City were randomly selected. First year junior high school students who agreed to answer the questionnaires were included. The studied variables were: symptoms of ADDH and general psychopathology symptoms. ADDH symptoms were dimensionally evaluated with the Conners-Wells Self Report Scale (long version). General psychopathology was rated with the SCL-90 which evaluates the intensity of symptoms in 9 subscales. Tobacco consumption was determined by the Junior High school Students Questionnaire, developed at the National Institute of Psychiatry, which was used in the Drug, Alcohol and Tobacco consumption surveys in Mexico City. Tobacco consumption was considered positive when the questions about lifetime, and last month consumption were affirmative. From the 15 junior high schools selected, a first year group was chosen at the beginning of the school term. A written authorization from the parents was requested, so the students could answer to the questionnaires. It was inferred that all of them accepted because none of the parents refused explicitely. The questionnaire about drug consumption was applied the first day. Before the application, it was explained to the adolescents, that the information would be confidentially handled; the questionnaire answers would be only known by the researchers and that the information would not be given to their parents or their teachers. The second day of evaluation, the Conners questionnaire was applied. The third day the students answered to the SCL-90. All the questionnaires were applied at the beginning of the daily activities. The 19 psychopathology subscales were compared between male and women and between the students with and without tobacco consumption in the last month and during lifetime. Although the statistical significance was determined with non parametric tests (Wilcoxon test), on the tables, means and standard deviations are shown. The analysis were done with the SAS 6.12. program. The significance level was determined at 0.05. Results From 590 students registered on the selected groups, 544 (92%) were evaluated, the rest of them did not show up during the week in which the evaluations were performed. The mean age was 12 years with a standard deviation of 1, 57.3% (n=295) were males. Twenty children (3.9%) have used tobacco during the last month. On the Conners-Wells Questionnaire, they had higher scores on all ten subscales. These differencies were statistically significant in seven subscales: Familial problems, Conduct problems, Cognitive problems, anger management problems, hyperactivity, Global index, and distractibility DSM IV. General psychopathology symptoms also were higher in those individuals who used tobacco during the last month, compared to those who did not, in seven of the nine subscales the differences were statistically significant. Regarding the experimental usage of tobacco (ever in lifetime), 84 children (15%) answered affirmatively. The scores of these children were higher than the scores of children who denied ever smoked in all subscales of the Conners-Wells Questionnaire. The differences were statistically significant in nine of the ten subscales. In the SCL-90 the scores of the children who have used tobacco during lifetime, were higher in all subscales, except in phobic anxiety. Discussion Our results confirm the proposed hypothesis that the students who consume tobacco present higher levels of psychopathology, compared to those students who have never used this substance. It is necessary to underline the fact that this is the first study in our country that correlates the tobacco consumption with psychopathology symptoms, evaluated in a structured way with valid and reliable instruments. <![CDATA[¿Cuándo utilizan servicios de salud las mujeres que viven en condiciones de violencia de pareja?]]> resumen está disponible en el texto completo<hr/>Abstract: Introduction Violence is recognized as a Public Health problem around the world. In the specific case of Intímate Partner Abuse, which occurs at home, women are particularly vulnerable to be abused by their partners. In Mexico, as in other countries in Latin America, the systematic study of violence towards women is incipient. However, it is a highly predominant problem, which has a big impact on women's health, and represents a significant challenge to the Health System demanding health care due to intentional injuries. This paper analyzed information generated by the first National Survey of violence against women in 2003 (ENVIM, by his name in Spanish). Objective The main objective is to identify the factors associated with the health services utilization by women, because of partner abuse. Methodology A cross-sectional design was used, including women users of health care services on public institutions all over the country in 2003. Intimate partner abuse was defined as "the repetitive event of abuse from the male partner side towards the woman, that is characterized by coercive conducts that could include physical, emotional or sexual violence". It was measure in a scale of 27 items, using the Index of Spouse Abuse (ISA) and the Severity of Violence against Women Scale (SVAWS). Both indexes were vali-dated previously in Mexican population. A factorial analysis was used and the factors that explain the variability were obtained. The selection of women to be interviewed was done using a probabilistic stratify biethapic sample. For the first one, medical unites were selected, and for the second, women over 14 years old who went to those medical unities to demand any kind of health care services. The ethic considerations were resolved using the next procedures: participants received information about the research objectives and signed an informant consent letter endorsed by the ethical committee of the Institution. They also received a brochure with information about the local institutions where they can go in case of abuse. Interviewers trained in technical areas as well as abuse management using a questionnaire on private spaces did the data collection. The answer rate was of 98%. The analyzed variables were Socio demographic, search of support on the health staff or reasons for not doing this. An index of socio-economic level categorized as very low, medium and high. Type of institution and services used. The dependent variable was utilization of the health services to attend the injuries due to a partner abuse event, during the last 12 months. The analysis used was simple and bivariate using chi square, and binary logistic regression model. The final model included the variables that in the binary showed a value of p&lt;0.25. We ad-justed the model using the Goodness of Fit Test of Pearson. Results From 24,958 women that utilized public health services 21% reported to have had a partner abuse event in the last year. From these, only 7.3% utilized health services. The more important variables were: age between 25 to 34 years old, elementary schooling and women having a job. Of the sample 94% belong to the very low and medium socio-economic levels; almost half of them (47%) do not have health insurance. More than 80% have a partner at present; 7.6% reported severe violence. From those who had injuries, 72% declared to have had just one minor injury (bruises, body aches), 25.5% reported more than one type of injuries, from which 10.8% were severe and required surgery or hospitalization. The type of injuries that demand more utilization of health services were those subsequent to sexual abuse as genital infection and genital bleeding. Only 45% of the women users' report to have medical insurance. Less than 6% of abused women talked with the health staff about their abuse situation and the main reason was the lack of trust. The factors associated to the utilization of health services were ages over 24 years(ORA 1.57, CI 95% 1.9 - 2.06) alcohol intake by the women (ORA =1.66 CI 95% 1.57-1.75) High Socio economic status (ORA =1.29 CI95% 1.07-1.54). The model was adjusted by severity index and to having medical insurance. There were not significative interactions (p&gt;0.15) and the global adjusted model was p= 0.23. Discussion and conclusions There is a low percentage of abused women injured that utilize formal medical care. This is a very important result for the identification of prevention and control strategies of the partner abuse problem in the health services. The study shows the existence of different types of injuries or medical problems such as genital infections and bleedings, fainting spells, body aches that provoked on one hand that women did not seek medical attention immediately and on the other that the health staff could not identify this kind of health problems with intimate partner abuse. There is a group of more vulnerable women who do not use health services to take care of the consequences of abuse, because they are uninsured. This inequality reveals that it is urgent to provide support services to poor women in the country. The finding about the difficulty for battered women to report their injuries to the health staff because of their lack of trust, agrees with different studies that report the different obstacles found by abused women in facing the health services. The last situation reveals the obstacles to be solved for the NOM implementation too. It is important to mention the study limitations related with the design utilized, and the selection bias due to the inclusion only of users of services. This situation leaves at one side women with less resources, who confront big obstacles for the utilization of health services, and at the other, women from high socio-economic levels, who utilize private health services; therefore there is no accuracy the point out differences. The way in which the question about the utilization of health services was made, makes it difficult to know the number of times these were used. This variable must be explored in future studies. The information generated by the ENVIM allows the Health Sector to define identification-attention strategies of battered women and provides information about the importance of training the health staff to generate trust among in partner-abused women. <![CDATA[Cuestionario breve de tamizaje y diagnóstico de problemas de salud mental en niños y adolescentes: confiabilidad, estandarización y validez de construcción. Primera parte]]> resumen está disponible en el texto completo<hr/>Abstract: Background Studies on developmental psychopathology have shown that several problems and disorders that started during childhood persist into adulthood. During adolescence, some disorders become risk factors for substance abuse, suicidal conducts, unwanted pregnancies, and violence. Also, results from the International Consortium in Psychiatric Epidemiology (ICPE), including data from Mexico City, have found that an early onset of anxiety disorders preceded substance abuse and dependence, emphasizing the need to early identify and treat mental problems that may eventually lead to other psychopathologies, thus requiring systematic and programmed preventive interventions. Children account for one third of all psychiatric consultations, usually arriving with chronic disorders and several complications. With this in view, the need to develop a useful instrument to early identify clinical risk conditions in children by health professionals was considered. In Mexico, our epidemiological work on children’s mental health started at the end of the 1980’s using the Report Questionnaire for Children (RQC), which is a 10-item screening instrument developed at the end of the 1970’s for a WHO collaborative research with the aim of extending psychiatric services to primary care settings. In our population, the instrument showedgood efficiency with a positive predictive value (PPV) of 76% and a negative predictive value (NPV) of 99%. Different studies have shown the magnitude of mental health problems in children, as well as the association of these problems with parents’ depression and alcohol abuse. However, the need to identify what kind of disorders are they and estimating their prevalence remains. The Brief Screening Diagnostic Questionnaire (CBTD) was built based on the previous experience using the RQC. Seventeen items exploring symptoms frequently reported as motives for seeking attention at the out-patient mental health services were added to the original 10 questions of the RQC. Most of them are items included in the CBCL-P, exploring hyperactivity, impulsivity, attention deficit, sadness, inhibition, oppositional and antisocial antisocial behaviors, as well as eating behaviors associated with low or high weight. The aim was to include cardinal symptoms which may lead to identify probable specific syndromes and disorders, based on the parent’s report. The present study shows how the CBTD was tested and further developed using the information gathered from a general population sample. The hypotheses were the following: More than 50% of the children and adolescents would be reported asymptomatic or with only one or two symptoms. It is expected that for those children and adolescents showing more symptoms these would form groups suggesting the presence of probable psychiatric syndromes as defined by the DSMIV and ICD-10 classifications. Method The CBTD was included as part of the instruments used in an Epide miological study on psychiatric morbidity in Mexico City. The study was designed as a household survey on a representative sample of the adult population aged 18-65 years in Mexico City. In addition, information was obtained about all the respondents’ children aged 4-16 years living at the same household. The total sample included 1685 children and adolescents with the following distribution by age groups: 4-5 years old: 16.3%; 6-8 years old: 25.5%; 9-12 years old: 30.9%, and 13-16 years old: 27.4%. Analysis was carried out as follows: First, the internal consistency of the new instrument was measured using the Kuder-Richardson coefficient. Using the CBTD as a scale, the score distribution on the total population, as well as for sex and age groups, was statistically studied, thus obtaining the median and percentiles with 95% confidence intervals, in order to establish the norm and define caseness. Next, as the answers to the CBTD questions are dichotomic, cluster analysis was used to identify group symptoms and test the construct validity of the instrument. Additionally, factor analysis using the principal component extraction and maxim likelihood methods, as well as different rotations of the factors, were obtained and compared with results from the cluster analysis. Results Internal consistency was 0.81 with a 0.75-0.85 range by age groups, indicating that the instrument can be used reliably as a scale. Asymptomatic children represented 48.6% and another 17% were reported with only one symptom, thus sustaining the first hypothesis of this study. The cut-off point for defining caseness was the report of five symptoms or more, which was the upper 95% confidence interval for the 90th percentile. Cluster analysis identified eight groups of symptoms named as follows: Inhibition, anxiety, enuresis, dissocial, delayed or backwards, attention, mood, and conduct. Similar results emerged from the factor analyses, indicating that the instrument indeed pictures different behavior constellations that correlate with the most frequent syndromes seen in children and adolescents. Discussion and conclusión It is important to highlight that the CBTD is based on symptoms which are frequently reported as motives for consultation. So, the instrument does not merely translate diagnostic criteria into questions but rather uses the way in which the population perceive and express concern about their children’s behavior in order, first, to define caseness and, second, to identify probable disorders. Results show that the CBTD has good internal consistency and construct validity for identifying groups of symptoms that suggest the presence of the most frequent psychiatric syndromes in children and adolescents. In this way, the CBTD accomplishes the objective of developing a brief screening instrument that may be useful for epidemiological studies, for screening at general and pediatric practices and, most important of all, for the surveillance of the mental health in childhood and adolescence. <![CDATA[Transcultural comparison of Symptom Rating Test (SRT) in women coping with an addiction problem in the family]]> Abstract: The purpose of this study was to test the factorial validity of the Symptom Rating Test (SRT) on women (mothers and wives of alcohol and drug users) coping with alcohol and drug use in a close relative (n=155). The purpose was to develop a common model of symptoms that would serve as the basis for establishing comparative analyses based on variables such as type of relationship with the drug user and country. This article is part of a broader transcultural study on family and addictions, carried out simultaneously in Mexico City and Southeast England. The overall sample in the two countries con-sisted of 200 families from both countries. The original methodology has been broadly described in previous studies. Half the sample came from specialized drug treatment centers, while the other half was drawn from the community population. The criteria for inclusion were as follows: a) Alcohol and/or drug use of a son, daughter or spouse during the six months prior to the interviews; b) Display of concern over active alcohol and/ or drug consumption of close relative (of either sex). Evidence was found of the validity and consistence of the symptom rating test, which included thirteen items (alpha = .93) and consists of two subscales of physical and psychological symptoms (X2 = 64.6 64 gl, p= 0.053). Variance analysis showed one main effect for the subscale of physical symptoms: Mexican women were more likely to somatize an addiction problem than English women (F=4.930. gl1/155, p &lt;.05) and the interaction between the type of relationship and the country was also signifi-cant (F=6.327, gl1/155, p &lt;.05). On the basis of the above, the implications of this study for future research are to increase the evidence of the factorial structure on the 13-item symptom scale in which different socio-cultural groups are considered, for instance, to explore how the male relatives of drug users express their symptoms. On the other hand, it is very important to consider the differences about type of drug and trajectory of use, between the rural and urban popu-lation, in order to identify the communalities and differences regarding symptoms and their meanings. This can be achieved by using complementary qualitative methodologies, in order to have more sensitive measurements and to establish standards of transcultural comparison that will enable to promote comparative studies.<hr/>Resumen: El objetivo de este trabajo fue comprobar la validez factorial de la Escala de Síntomas (Symptom Rating Test, SRT), en mujeres (madres y esposas de usuarios de alcohol y drogas) que hacen frente al consumo de alcohol y de drogas en un familiar cercano (n=155). El propósito fue desarrollar un modelo común de síntomas que sirviera como base para establecer análisis comparativos a partir de ciertas variables tales como tipo de relación con el usuario de drogas y país. Este trabajo forma parte de un estudio trascultural más amplio sobre familia y adicciones, que se llevó a cabo simultáneamente en la Ciudad de México y en el Suroeste de Inglaterra. La muestra global en ambos países fue de 200 familias. La metodología original se ha descrito en trabajos previos. De la muestra, 50% provenía de centros especializados de atención en drogas y el restante 50% de población comunitaria. Los criterios de inclusión fueron los siguientes: a) Consumo de alcohol y/o drogas en un hijo(a) o cónyuge durante los seis meses previos a la realización de la entrevista; b) Mostrar preocupación por el consumo activo de alcohol y/o drogas de un familiar cercano (de uno u otro sexo). Je encontraron pruebas de la validez y consistencia de la escala de síntomas que incluye trece reactivos (alpha=.93) y que consta de dos subescalas de síntomas físicos y psicológicos (X2=64.6 64gl, p=0.053). El análisis de varianza mostró un efecto principal para la subescala de síntomas físicos. Las mujeres mexicanas tendían más a somatizar un problema de adicciones que las inglesas (F=4.930. gl1/155, p &lt;.05) y la interacción entre el tipo de relación y el país también fue significativa (F=6.327, gl1/155, p &lt;.05). Las implicaciones de este trabajo en investigaciones futuras son poder comprobar más ampliamente la validez de la estructura factorial de la escala de síntomas con trece reactivos en la que se consideren diferentes grupos socioculturales, por ejemplo, cómo se expresan los síntomas en el caso de los familiares varones de usuarios de drogas. Por otra parte, es importante contrastar a la población rural y urbana, por tipo de droga y por trayectorias de consumo, a fin de poder identificar las comunalidades y diferencias respecto a los síntomas y sus significados. Lo anterior puede lograrse utilizando estrategias metodológicas complementarias de carácter cualitativo, para poder establecer estándares de comparación transcultural y contar con mediciones más sensibles que permitan impulsar los estudios comparativos.