Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520070001&lang=pt vol. 30 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[Neuropsychological characterization in clinical subtypes of an Obsessive-Compulsive Disorder (OCD) sample of patients]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100001&lng=pt&nrm=iso&tlng=pt SUMMARY: Since the decade of the seventies, several neuropsychological abnormalities in very different cognitive domains have been described among patients with Obsessive-compulsive disorder (OCD). Due to the nature of these abnormalities, it was concluded that possibly the main dysfunction for this disorder was located in the right hemisphere, especially in the frontal cortex; nevertheless this particular brain region was found to be involved in other psychiatric disorders, so neuropsychological results were considered to be of limited precision and it was thought that the diversity in results was not due to the malfunction of one particular brain region. So it became evident that a new research methodology based in the information processing model with highly specific neuropsychological paradigms of frontal functioning was needed; as well as considering a subtypology based in the cognitive characteristics in patients with the same disorder and similar phenomenology. Regarding OCD it is well known that the dorsolateral prefrontal cortex is in charge of the regulation of complex actions, executive functions and the elaboration of logical strategies in a problem solving task; so its dysfunction causes a failure in the creation of response patterns and perseverations due to the inability to change a pattern when an alternative response is needed. On the other hand, obsessions are associated mainly with the anterior cingulated cortex and the basal region of the corpus striatum and its connections with the limbic system, giving place to incapacity to select the relevant information from the environment, which makes the individual perceive irrelevant stimuli as threatening for physical integrity. By the way, some clinical subtypes have also been identified: contamination/washing, aggressiveness/checking, hoarding, symmetry/ order. There is also some evidence of different patterns of brain activation to several visual stimuli related to the obsessive or compulsive object in the clinical subtypes, as shown by functional magnetic resonance image in some regions of the frontal lobe, either dorsolateral, medial or basal and its connections with the basal ganglia, and in some cases thalamus or limbic system. In the face of all this evidence, the goal of the present study was to find if within this disorder it was possible, through several neuropsychological paradigms of frontal functioning, to find different patterns of execution, considering the clinical subtype and the severity of obsessions and compulsions. Fifty-eight patients with a diagnosis of OCD were studied; all patients were under treatment at the OCD clinic of the National Institute of Psychiatry Ramón de la Fuente in Mexico City. Two neuropsychological tests were administered: 1) Trail Making Test (TMT) and 2) Wisconsin Card Sorting Test (WCST). From the Target Symptom List, the clinical subtype was obtained. After the statistical analysis, we found no differences between the severity of obsessions and the severity of compulsions as measured by the Yale-Brown Scale. Also, we observed three factors concerning the neuropsychological tests, and patients were grouped in four different groups, each one with a distinct cognitive performance. Through the interpretation of results it was concluded that in a sample of 58 patients with OCD, different groups of neuropsychological functioning where distinguished. In their own, these groups where associated with different clinical subtypes. These results are in accordance with the neurobiological modular organization model of OCD, which sustains the existence of independent systems of cognitive dysfunction that regulate different symptomatic expressions.<hr/>RESUMEN: La metodología de investigación, a partir del modelo del procesamiento de información con paradigmas neuropsicológicos de funcionamiento del lóbulo frontal, permite un estudio más específico de los trastornos psiquiátricos con fenomenología parecida, lo que a su vez permite crear modelos basados en una subtipología de índole cognoscitiva y, por ende, lleva al conocimiento de los circuitos neurales involucrados en la manifestación clínica de estos padecimientos. En el caso del trastorno obsesivo-compulsivo (TOC), la corteza prefrontal dorsolateral se encarga de regular las acciones complejas, las funciones ejecutivas y la elaboración de estrategias lógicas en la resolución de problemas, de tal manera que su mal funcionamiento ocasiona fallas en la creación de patrones de respuesta y perseveraciones por incapacidad de cambiar de patrón cuando se requiere otra alternativa de respuesta. Por otra parte, las obsesiones se relacionan predominantemente con el cíngulo anterior y la parte basal del cuerpo estriado y de sus conexiones con el sistema límbico, dando lugar a la incapacidad para seleccionar la información relevante del entorno. Esto genera que el individuo perciba los estímulos inocuos como “amenazantes” para la integridad física. También se han identificado subtipos clínicos de obsesiones y compulsiones, tales como contaminación, lavado, agresividad, comprobación, atesoramiento, simetría y de orden, entre otros, que se han relacionado con distintos patrones de transmisión genética, comorbilidad y respuesta a tratamiento. Además, se han documentado distintos patrones de aumento o disminución, ya sea de metabolismo cerebral o de flujo sanguíneo, en los circuitos fronto- estriados. Con la resonancia magnética funcional también se han encontrado distintos patrones de activación en los circuitos neuronales entre distintos subtipos clínicos, mediante la exposición de imágenes que se relacionan con el contenido de la obsesión o bien con la acción de la compulsión. Ante esta evidencia, se decidió averiguar si en pacientes con este trastorno era posible encontrar, mediante distintos paradigmas neuropsicológicos de funcionamiento frontal, dichos patrones diferenciales, considerando tanto el subtipo clínico como la gravedad de las obsesiones y compulsiones. En este estudio participaron 58 pacientes con este diagnóstico pertenecientes a la Clínica de TOC del Instituto Nacional de Psiquiatría Ramón de la Fuente, de los que 24 eran mujeres y 34, hombres. Una vez que los psiquiatras adscritos a dicha clínica confirmaban el diagnóstico obtenido en la cita de primera vez, referían a los pacientes al programa para computadora de Diagnóstico Neuropsicológico Automatizado (DIANA). Se aplicaron en una sola sesión las siguientes pruebas: 1) Trazado con Hitos (TH) y 2) Test de Categorización de Tarjetas de Wisconsin (TCTW). Con posterioridad a la aplicación de las pruebas a todos los pacientes, se revisó cada uno de los expedientes de la clínica de TOC para obtener el subtipo clínico. En el análisis estadístico de los datos se realizó primero un análisis factorial para disminuir el número de variables y luego un análisis de conglomerados para ver si se formaban grupos conforme a la ejecución de los sujetos en las pruebas aplicadas. De acuerdo con la ejecución de los pacientes se observó que los sujetos se agruparon en cuatro grupos distintos de desempeño cognoscitivo: el primero tuvo una ejecución muy deficiente en ambas pruebas. El segundo exhibió un desempeño regular en las dos pruebas pero fue mas rápido para terminar el TH. El tercero sólo estuvo constituido por dos pacientes que tuvieron un desempeño muy diferente al del resto, al presentar una ejecución sobresaliente en WCST pero con gran cantidad de errores en el TH. En tanto, en el cuarto de estos grupos, donde se concentraba la mayoría de la muestra, se consideró que su ejecución fue la más característica y su desempeño en ambas pruebas regular, pero más lento en TH. Cada uno de estos grupos de funcionamiento neuropsicológico se relacionó con los distintos subtipos de obsesiones y compulsiones, mas no con su gravedad. Encontrar subtipos neuropsicológicos de TOC asociados a sintomatología clínica distinta presta apoyo al modelo de organización modular de los diferentes circuitos neurales que intervienen en la manifestación sintomática de este padecimiento. <![CDATA[Assessment of daytime symptoms in snoring subjects and obstructive sleep apnea patients]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100009&lng=pt&nrm=iso&tlng=pt Summary: The obstructive sleep apnea syndrome (OSAS) is a type of sleep disorder that has called the attention of many researchers because of its widespread distribution among middle-aged subjects. The OSAS is a respiratory problem characterized by the existence of apneas, defined as 10 second minimum intervals during which no aerial flux exchange takes place through the upper airways and the hypopneas not characterized by an arrest, but by a reduction of aerial flux through the upper airways. The most widespread index used in the diagnosis of the OSAS severity has been the apnea/hypopnea index (AHI). There is little consensus based on the apnea/hypopnea index regarding the clinical definition of the sleep apnea syndrome, as there is not a single criterion for the categorization of sleep apnea patients into severity levels. Nowadays, it is estimated that about 70% of the patients referred to sleep laboratories suffer from snoring, and it is suspected that they might also suffer from sleep apnea. Obstructive sleep apnea patients may suffer from memory and cognitive problems, excessive daytime sleepiness, as well as mood disturbance, among other symptoms. Additionally, this disorder has severe medical and social consequences. One of the most characteristic symptoms in sleep apnea is snoring. Although snoring is one of the symptoms of sleep apnea, it should be remembered it is a typical phenomenon among population in general. There is a primary kind of snoring, the most frequent type in less severe cases, which even occurs among the normal population. In this case, the noise accompanying inspiration is made with almost every breath. Secondly, there is another kind of snoring that is either intermittent or cyclic, and snoring does not come with every breath but silent periods are also frequent. The latter indicates apnea. A considerable number of epidemiological studies regarding snoring have been produced of late. Several of them have concluded that snoring may have severe clinical consequences. Most patients suffering from obstructive sleep apnea start having simple snores. In the last decade there has been a marked increase of patients who manifest respiratory disorders related to sleep who do not fall into the category of apnea patients. Nevertheless, the morbidity of these clinical disorders is not yet known, a circumstance that makes treatment more difficult. Only a reduced number of studies have tried to find out whether snorers show any kind of symptoms that could be used as a preventive measure against the development of sleep apnea. For all the previous reasons, the aim of this study is to assess whether there are any differences in daytime sleepiness, reaction time, short-term memory, depression, trait anxiety, state anxiety and neuroticism between a group of patients with obstructive sleep apnea and a group of snoring individuals who had not been diagnosed as suffering from OSAS. Material and method: The sample was made up of 11 snorers (two women and nine men), in an age range between 29 and 58 (X= 43.82 and SD= 8.67), and 14 patients with OSAS (two women and 12 men), in the age range between 30 and 65 (X= 49.64 and SD= 10.67), who were selected from a clinical population. The AHI used for establishing an OSAS diagnostic was of 10 apneas/hypopneas per sleeping hour. The patients were diagnosed to be snorers if they showed an apnea/hypopnea index &lt;10. The following instruments were used in the evaluation of snoring subjects and obstructive sleep apnea patients: 1. Cardio-respiratory polygraph of every hour of sleep for each one of the patients. The procedure consists in night-time monitoring of the following parameters: a) electrocardiogram; b) respiratory movements (expansion and relaxation of the thorax and abdomen), which evaluate the respiratory force; c) oronasal flow and d) oxygen saturation. The snoring was measured through a tracheal microphone. 2. To measure the subjective daytime sleepiness, the Epworth Sleepiness Scale was used. 3. A BASIC software program was used to measure the simple perceptual reaction times in milliseconds. 4. The digits test of WAIS was used in straight and inverse order to evaluate the capacity of short term memory. 5. To evaluate the depressive symptoms, the Beck’s Depression Inventory was employed. 6. The State/Trait Anxiety Inventory was used as a measurement of the state and trait anxiety levels. 7. As an index of neuroticism levels, the Eysenck Personality Inventory was used. Subjects under clinical risk of an OSAS diagnosis were referred to a sleep unit by primary care physicians. Respiratory pathologies other than OSAS were ruled out before the subjects’ inclusion. Among these were, in particular, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease. All the patients underwent a medical examination and a medical interview in which a detailed clinical history of each patient was compiled. Once the medical examination was over, each patient was given an appointment to sleep one night in hospital. Subsequently, cardio-respiratory poligraphy, registering height hours of sleep, was administered to each patient with the objective to establish a diagnosis. The morning after, a manual analysis was made of the following parameters which indicate the presence or absence of the disturbance and its severity: total number of nocturnal obstructive apneas, total number of hypopneas, value of saturation during the night, mean and minimum levels of SaO2% and apnea/hypopnea index. Afterwards, the sleep apnea diagnosis was established for those patients who showed an apnea/hypopnea index higher than 10. Snoring subjects with a lesser apnea/hypopnea index than 10 did not fit into the pathology of sleep apnea. Obstructive apneas were defined as the arrest of air flux during sleep along with the occurrence of respiratory movements lasting more than 10 seconds. Hypopnea was defined as an episode during which the partial obstruction of the upper airways produced a significant reduction of the air flux. The following morning, the psychological variables were evaluated (daytime sleepiness, short-term memory, reaction time, depression, neuroticism, state and trait anxiety). This process was carried out in the same place and under the same conditions for every subject. The tests were completed between 8:30 and 11:30 in the morning. Additionally, an exclusion criterion was established as the suffering from any psychiatric illness past or present in any way that could influence the psychological functioning of the patient. As a method of analysis of the results, a non-parametric analysis technique was used: the U Mann-Whitney test. All statistical analyses were made with the statistics package SPSS, 8.0, Spanish version. Results: Results from this study show that there are statistically significant differences between daytime sleepiness (p&lt;0.05) and depressive symptoms (p&lt;0.01) between both groups of subjects, whereas no statistically significant differences were found in terms of short term memory, reaction time, state anxiety levels, trait anxiety and neuroticism. Conclusions: The analysis of the results obtained reveals that the levels of daytime sleepiness are much higher in patients with OSAS than those in the snoring group. Some studies note that the fragmentation of sleep is responsible for excessive sleepiness during the day. Nevertheless, in this study we observed greater levels of obesity in patients with OSAS than in snoring patients, which could also explain the greater levels of sleepiness. In relation to the depression variable, the average scores show that depression levels are higher in apnea patients than in the snoring group. One of the possible explanations of this result is that the majority of apnea patients, due to the severity of the pathology, consequently present higher deficits in their daily social functioning, etc. Probably, the conditions previously described tend to influence an increase of depression levels.<hr/>resumen está disponible en el texto completo <![CDATA[Factores genéticos involucrados en la susceptibilidad para desarrollar enfermedad de Parkinson]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100016&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>SUMMARY: Parkinson’s disease (PD) is the main cause of parkinsonism (rigidity, resting tremor, bradykinesia and loss of postural reflexes). There is evidence highlighting the importance of the interaction between environmental factors and genetics on the pathogenesis of PD. The research about the role of genetics in Parkinson’s disease began with familial aggregation studies, which have shown that approximately 10-15% of patients with PD have a positive firstdegree family history of PD; this proportion is higher than a 1% found in controls. Twins studies have found a larger concordance rate in monozygotic twins with early-onset PD (symptoms onset before 40 years of age). Nevertheless, dopaminergic functional studies in twins using PET (Positron Emission Tomography) with [18F]dopa have also shown a substantial role for inheritance in late-onset, sporadic PD. In one of these studies with clinically discordant twins (monozygotic and dizygotic), the concordance rate at baseline for subclinical striatal dopaminergic dysfunction was higher in monozygotic than dizygotic twin pairs (55% vs 18%, respectively) using functional neuroimaging criteria. Nine loci have been so far identified and six genes inherited as a Mendelian fashion have been cloned. Also, α-synuclein (PARK1) gene mutations were found to be pathogenic and responsible for a rare PD with an autosomal dominant inheritance in a large Greek-Italian family (the Contursi kindred). These findings have not been reproduced in patients with late-onset, sporadic PD. Mutations in the gene encoding for parkin (PARK2) are responsible for PD with an autosomal recessive trait and are relatively common in patients with early-onset PD. Mutations in α-synuclein and parkin genes suggest that the dysfunction of the ubiquitine-proteasome system, that mediates degradation of proteins, plays an important role in the pathogenesis of PD. Ubiquitine is a key component of this system and is attached to the proteins by ubiquitine-ligases in order to mark them to be cleaved by the proteasome. The production of freeubiquitine involves a type of proteins called ubiquitine-hydrolases. Mutations in a gene that encodes for one of these proteins, UCHL1, have been also involved in familial PD. Cellular death models in PD have been centered in oxidative stress and excitoxicity mechanisms. Even though these mechanisms are still considered important, the models that highlight the abnormal aggregation of proteins and the failure of the ubiquitine proteolytic system are more consistent with available experimental data. The product of DJ-1 (PARK7) was recently involved in familial PD. This could protect dopaminergic neurons from damage due to oxidative stress as suggested by its structure similarity with the stress-induced bacterial chaperone (Hsp-31); it also could help in the appropriate folding of proteins. Other studies suggest DJ-1 mutations could contribute to the elevated levels of oxidative stress seen in PD. Theories about the pathogenesis of PD have been developed independently of the findings in the genetics field. One particularly prominent model suggests that various mitochondrial alterations that produce failure in the production of cellular energy or elevated free radicals levels or both have an important role in PD pathogenesis, and some recent genetic findings support this theory. Mutations in the gene encoding for PINK1 (PARK6), a mitochondrial protein-kinase, have been found in some patients with familial PD. Recently, a gene localized in PARK8 (LRRK2/dardarine) has been cloned. It is responsible for familial PD with autosomal dominant inheritance, typical age of onset and clinical findings similar to the ones found in idiopathic PD. Association studies with candidate genes have discovered the influence of some polymorphisms on certain PD clinical features, at least in the populations studied. The relative risk and age of onset of PD, as well as the levodopa induced dyskinesia, are among these characteristics. Candidate genes were chosen because of their alleged role on the pathogenesis of PD. The major candidate genes studied so far are related to dopamine synthesis, transport and metabolism, xenobiotics and other neuronal toxins detoxification, mitochondrial metabolism, and also transcription factors and neurotrophic genes involved in the mesencephalic dopaminergic system development. Of the susceptibility genes so far studied, only the MAO-B &gt;188 bp allele has shown a significant association in a meta-analysis. Additionally, only six genes (DRD2, ND3, BNDF, α-synuclein, UCHL1 and Nurr-1) have shown important associations with PD in several studies and have fulfilled the criteria for their replication and meta-analysis. These mixed results could be related to differences in sample size, ethnical background and methodology as to make it almost impossible to summarize independent studies. Other possible contributions are populations stratification, biologic credibility of the association between the gene and the phenotype and gene to gene interactions. However, these mutations are not found in the great majority of patients with sporadic PD. In these patients, normal gene polymorphisms must confer susceptibility to PD, and certain, not-yetidentified, environmental factors must interact with them in order to produce clinically PD. Normally, each subject receives one maternal and one paternal allele for each gene. During meiosis, the chromosomal recombination is undertaken in such a way the probability of two loci being transmitted together to the next generation is indirectly proportional to the distance in the chromosome between them. The group of alleles inherited as a cluster are known as haplotype and the study and knowledge of haplotypes present in the populations could be associated with clinical phenotypes. If loci are inherited as stable fragments, association studies can be developed for each haplotype and not for each locus, which saves time, money, human and material resources. The HapMap will contribute to a better design of genetic association studies with clinical phenotypes. A better understanding of the genetics involved in the relative risk of PD will be an important step to improve its prevention, diagnosis and treatment. Genetic testing for PD may be premature and is not currently recommended unless the patient has a strong family history, a family member is known to be carrier of a causal mutation, there is parental consanguinity, or the patient exhibits symptoms at an unusually early age (before 40 years of age). Presymptomatic testing for such an incurable neurodegenerative disease must always be accompanied by proper education and counseling and must be carried out at a center with expertise in this area. Currently there are no well-standardized presymptomatic protocols for PD genetic testing; therefore, it is recommended to follow the Huntington’s disease protocol. This review summarizes relative risk of genetics in PD. <![CDATA[Association between violent behavior and psychotic relapse in schizophrenia: once more through the revolving door?]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100025&lng=pt&nrm=iso&tlng=pt Summary: The potential for violence in a number of persons with mental illnesses stimulates public fear and prevents general acceptance of persons with psychiatric disabilities. Schizophrenia has been the diagnosis most often associated with violence as it has been taken as a paradigm of insanity, incompetence and dangerousness. Clinicians’ efforts to prevent violence through conventional external patient treatment are impede by several situational variables and patients become trapped in a costly cycle of repeated institutional admissions (revolving door phenomenon) in the most restrictive settings, going through involuntary in-patient treatment. The major hypothesis proposed in this review is that violence in schizophrenia can become a part of a self-perpetuating cycle, in which the combination of non-adherence to treatment and an inadequate management of illness from families and caregivers leads to violent behavior and deteriorated social relationships, finally resulting in institutional recidivism. As some of the initial symptoms of the illness, such as irritability and agitation may not be detected by the patient and his/her family, these symptoms eventually can easily escalate into open hostility, and the accompanying behavior is frequently violent. Disturbed moods secondary to psychotic symptoms, such as fear and anger apparently can also activate violent psychotic action. Accordingly, the path from the characteristics of the illness to violence leads to them through psychotic symptoms and lack of insight, and results in symptom-consistent violence. When psychotic symptoms and violent behavior cannot be managed by caregivers, patients are brought to the attention of psychiatric services and frequently admitted to patient service. During admission for a psychotic episode, there are more violent incidents than later on in the disease. As patients respond to medication and hospital environment, violent incidents and psychotic symptoms decrease in frequency and severity. After hospital discharge, patients may assume greater autonomy and control over several aspects of their daily lives. Nevertheless, this process may be hampered by familial reactions to the burden of living with a family member with schizophrenia. This burden can also be exacerbated because many patients have a history of violent behavior and families may experience negative attitudes towards them. In line with this, there is evidence of significant differences between the professionals’ perception about symptoms and illness, and that of the patient and his/her family. Sometimes, these different conceptions may reflect a lack of awareness regarding illness and treatment that may lead to discontinue medication. Medication suspension can lead to an eventual relapse which most obvious sign is the emergence of positive psychotic symptoms. Nevertheless if a patient has a past history of violent behavior, it is very likely that these behaviors will appear during relapse and it may be necessary to consider hospitalization. Although treatment with antipsychotics may be useful when violence is secondary to psychotic symptoms, violence might be indirectly reduced through clinical programs aimed at increasing insight into illness and treatment. A psychoeducational strategy may improve antipsychotic treatment compliance by helping the patients to work through their ambivalence regarding antipsychotic medication. For families, a psychoeducation strategy can lead to a change in attitudes toward the disorder, as well as to promote problem-solving skills for violence. The model presented here suggests that violence in schizophrenia is conditioned by several factors such as psychotic symptoms, medication non-compliance and lack of social support. The prevention of violent behavior in schizophrenia should include attention to other areas, such as the quality of the social environment surrounding the patient. For the “revolving door” patients, violence may be a key factor that complicates treatment. Health professionals have the responsibility to work in partnership with patients and their families for the prevention of violence.<hr/>Resumen: La esquizofrenia ha sido el principal diagnóstico psiquiátrico asociado con la violencia. La prevención de la violencia a través del tratamiento ambulatorio se ha visto obstaculizada por diversas variables situacionales y muchos pacientes llegan a verse inmersos en un ciclo de continuas admisiones hospitalarias (fenómeno de la puerta revolvente). La hipótesis central de la presente revisión es que la violencia en la esquizofrenia puede formar parte de un ciclo recurrente de hospitalizaciones psiquiátricas, en el que, combinados la falta de adhesión al tratamiento y el manejo inadecuado de la enfermedad por parte de los familiares, dan por resultado la manifestación del comportamiento violento. Diversas investigaciones han mostrado que tanto los síntomas psicóticos, como las alteraciones del ánimo secundarias a su presencia y la falta de una conciencia de enfermedad, son las principales características de la esquizofrenia, asociadas con la manifestación de la violencia en dicho padecimiento. Cuando los familiares no pueden manejar los síntomas psicóticos y el comportamiento violento del paciente, se busca la atención en un servicio especializado de psiquiatría, y con frecuencia, el paciente tiene que ser hospitalizado. La manifestación de conductas violentas ha sido considerada como una de las principales causas de hospitalización psiquiátrica. Diversas investigaciones han documentado que los actos violentos se presentan con mayor frecuencia durante la admisión hospitalaria por un episodio psicótico que en otros momentos durante el curso del padecimiento. Asimismo, la hospitalización psiquiátrica pos sí misma reduce la frecuencia e intensidad de la violencia, debido probablemente al tratamiento con antipsicóticos y al entorno restrictivo de las instalaciones. Tras la alta hospitalaria, los pacientes viven un proceso de transición mediante el cual van asumiendo mayor autonomía y control sobre diversos aspectos de su vida cotidiana. Sin embargo, este proceso se puede ver obstaculizado por las reacciones familiares secundarias al desgaste físico y emocional de vivir con un familiar con esquizofrenia. Asimismo, este desgaste puede verse exacerbado debido al antecedente de violencia en muchos de estos pacientes. Se ha descrito que la percepción que tienen los pacientes y sus familiares con respecto a los síntomas de la enfermedad difiere significativamente de la de los especialistas de la salud mental. A veces, estas diferencias se asocian con falta de discernimiento y conciencia sobre la enfermedad y con la necesidad de tratamiento médico, lo que a su vez puede llevar a la suspensión del mismo. La suspensión del tratamiento farmacológico induce a una eventual recaída cuyos signos más evidentes son los síntomas psicóticos. No obstante, si un paciente tiene antecedentes de comportamiento violento, es muy probable que este comportamiento surja durante la recaída y que sea necesario considerar nuevamente la hospitalización. En estos pacientes, en quienes la violencia tiene un importante papel en las hospitalizaciones recurrentes, es necesario considerar el establecimiento de programas clínicos, que incluyan la psicoeducación, dirigidos a incrementar la conciencia del paciente y de los familiares, sobre la enfermedad y la necesidad del tratamiento farmacológico. El modelo presentado en esta revisión sugiere que la violencia en la esquizofrenia es una condición generada por diversos factores tales como los síntomas psicóticos, la falta de adherencia al tratamiento y el inadecuado apoyo social. La prevención de la conducta violenta en la esquizofrenia no sólo debe fundamentarse en el uso de antipsicóticos, ya que existen otras áreas en las que intervienen las características propias del individuo y su entorno social. Los profesionales de la salud mental tienen la responsabilidad de trabajar en conjunto con los pacientes y sus familiares para prevenir la manifestación de conductas violentas. Es necesario realizar futuros estudios dirigidos a evaluar la forma en la que los servicios de salud mental pueden ser más efectivos en la reducción y prevención de la violencia en la esquizofrenia. <![CDATA[Riesgos asociados al consumo de alcohol durante el embarazo en mujeres alcohólicas de la Ciudad de México]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100031&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Alcoholism is among the main worldwide public health problems and it affects men and women differentially. Several studies show that, when compared to men, women develop more severe dependence, more family and social consequences and experience more difficulties to stop drinking. Differences on the impact that substance abuse has on women’s life and health are related to the roles, functions and social expectancies placed on them concerning the continuity and care for the rest of the family. For this reason, alcohol intake constitutes a special problem since it affects the health of both the mother and her offspring. Alcoholic women have a higher risk of suffering obstetric complications during pregnancy, such as placenta insufficiency, intrauterine development retardation, early placenta detachment, spontaneous abortion, stillbirth and pre-term delivery. Alcohol abuse during pregnancy is also associated with low weight offspring, congenital abnormalities and further behavioral and learning difficulties. In some countries, drinking during pregnancy is considered an offense which requires legal action. In some cases, women may be put in jail until delivery and lactation. In other regions, children welfare authorities view drinking during pregnancy as a form of aggression or neglect. Such measures prevent women from searching prenatal attention which in its case might lead to severe health consequences for the mother, the embryo and the society. Estimates of alcohol consumption during pregnancy around the world vary considerably and figures range from 4.1% to 83%. However, the variation might be related to the amount of alcohol units and the period of time considered in each measurement. A case-control study in Naucalpan, Mexico, found that 11% of the women interviewees admitted having drank during pregnancy, 5% of the mothers in the control group and 2% of the case group stopped drinking during lactation. Still, any of the considered variables was found to predict postnatal mortality through logistic regression analyses. Another study performed with data from the 1988 National Survey on Addictions documents that alcohol intake during pregnancy is a risk factor for congenital abnormalities (OR=3.4). The available data about the risks associated with drinking during pregnancy in Mexico comes from research in general population, while little is known about clinical population. For this reason, the objectives of this article are: 1. to analyze the characteristics of alcohol consumption in a group of women who sought help to stop drinking, 2. to identify family history of alcohol abuse in this group and 3. to explore the consequences of drinking on their offspring. In this case study, interviews were held with 200 women who attended two treatment agencies in Mexico City due to alcohol consumption problems. The questionnaire used includes the Spanish version of the CIDI-SAM and other sections to explore drinking during pregnancy and lactation, as well as family history of alcoholism. Selection criteria were: 1. aged 18 or older, 2. seeking help for the first time, 3. physical and mental conditions that would allow to answer the questionnaire, 4. having drank during the previous year. Women agreed to participate voluntarily once the objectives of the study were explained and confidentiality assured. Personnel of both treatment agencies administered the questionnaire and interviews lasted 60 minutes average. The diagnostics of alcohol dependence were obtained according to DSM-IV criteria. Data were analyzed with the statistical program SPSS v. 10, for Windows. A total of 134 women reported having been pregnant at least once, and 57.5% of them admitted having drank alcoholic beverages during pregnancy. Age ranged from 18 to 61 years (mean=40), 50% were married or living with a partner, 18% were divorced or separated and 13% had never married. The number of children ranged from 1 to 12 with a mean of 3. High percentages of family history of alcohol abuse were found among this group (93.5%): mostly the father (72.7%), siblings (63.6%) and the partner (48.1%). Significant differences in family history of alcohol use were found between women who drank during pregnancy and those who did not drink. Around 66% reduced alcohol intake after the confirmation of pregnancy; however, 26% continued drinking as usual and 6.5% started drinking at this period. The mean number of drinks consumed per drinking occasion during pregnancy was 3.5, being the traditional beverage pulque (48.8%) and beer (34.9%) the preferred beverages. In addition, 9.2% also took medical drugs. At least three out of the seven criteria proposed in DSM-IV for alcohol dependency were met by 70.3% of the women who drank during pregnancy. More severe dependence was found among the women who drank during pregnancy than among the group of women who abstained. As to the consequences of drinking, 12% of the women reported spontaneous abortion, 13.7% pre-term deliveries, 5.5% stillbirth, 6.8% congenital abnormalities and 13.7% low birth weight. When comparing women who drank and those who did not during pregnancy, significant differences were found in the percentage of pre-term deliveries (X2=5.63; p=0.01) and congenital abnormalities (X2=4.22; p=0.05). A number of logistic regression models was assessed using three independent variables: drinking during pregnancy, frequency of alcohol consumption and severity of dependence. Dependent variables, on the other hand, were spontaneous abortion, pre-term delivery, stillbirth, congenital abnormalities, low birth weight, alcohol use by the offspring and drinking problems in the offspring. The analysis shows that alcohol consumption during pregnancy is related to pre-term deliveries (OR=7.9), and alcohol use by the offspring (OR=2.1). Severity of dependence is related as well to low birth weight (OR=3.7) and further drinking problems in the offspring (OR=2.7). Likewise, drinking every day or almost every day is also related to later drinking problems in their children (OR=2.9). Finally, having siblings who drink (OR=2.11) and meeting alcohol dependency (OR=2.21) criteria are factors that predict alcohol consumption during pregnancy. These results are consistent with other studies that report positive family history of alcohol abuse among alcoholic women. The proportion of women who stopped drinking during pregnancy (42.5%) is higher than the one reported by other authors. Prevalence of spontaneous abortion, stillbirth and congenital abnormalities are higher than the prevalence reported among general population. These findings suggest that women with severe dependence face more difficulties to stop drinking during pregnancy in spite of the social stigma imposed to future mothers who drink. The results provide some elements that support an association of alcohol abuse during pregnancy with adverse pregnancy outcomes. Nevertheless, the impact of fetal alcohol exposure responds to a complex model where a number of interacting factors, longitudinal reaserch is needed to determine the weight of each participating variable and the underlying relationship between them. <![CDATA[Medidas de afrontamiento religioso y espiritualidad en adultos mayores mexicanos]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100039&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary: Spiritual life seems to play an important role in coping with stress in older adults. Spiritual life has been documented to have a positive effect on the sense of personal wellbeing in seniors and it has been inversely related to depression, to low levels of loneliness and psychopathology measured by MMPI-2. It has been documented that, when spirituality forms part of the subject’s personality it tends to be expressed in his/her religious coping strategies and to have a positive impact on his/her health when these strategies are effectively used against stress during hospitalization and illness and against losses common in older age that are associated with depression. Two general approaches to the study of religious coping have been emphasized: a) the specific ways of coping, in which religious coping is a multidimensional phenomenon, which may include forgiveness, purification and confession, spiritual support, etc.; b) the study of coping patterns. The second approach includes religious coping methods and the patterns of interrelation they involve. Pargament et al. have distinguished between positive religious coping and negative religious coping; the former leads the individual towards productive and efficient spiritual coping associated with better health indicators than the negative coping strategy. According to the authors above mentioned, positive religious coping includes methods such as benevolent religious appraisal, collaborative religious coping and seeking spiritual support, seeking the support of clergy and church members, religious help and religious forgiveness. Negative religious coping includes methods such as punishing religious reappraisal, demonic religious appraisal, the reappraisal of the power of God, spiritual discontent, self directed religious coping, and interpersonal religious discontent. Pargament et al. have included these coping patterns in the Scale of Positive and Negative Patterns of Religious Coping Methods (Brief-RCOPE). Our research was aimed at identifying the validity and reliability of the religious coping scale (Brief-RCOPE) proposed by Pargament et al. in two samples of older adults living in Mexico City and selected according to availability in two health clinics. Additionally, with the objective of gaining greater knowledge of the characteristics of religious coping and the spiritual life of older Mexican adults, our research explored the possible existence of significant differences in the above mentioned variables regarding sex, age, education and religious denomination, marital and employment status. The subjects answered a questionnaire containing 37 questions with dichotomic multiple choice answers (likert type) which included: 1) demographic information; 2) the Positive and Negative Methods of Religious Coping Scale, Brief- RCOPE, with two subscales (positive religious coping and negative religious coping); 3) the subscale of Religious Coping when Confronting Loneliness, ARS, from the Loneliness Multiphase Inventory, IMSOL; and 4) the subscale of the Relationship with God from the Spiritual Wellbeing Scale, EBE. The results obtained allowed us to conclude that the tools that were used have adequate internal consistency which we obtained by calculating Cronbach’s alpha coefficient; however, the negative religious coping subscale gave conservative results that may indicate the need for further investigation. A significant association between the positive Brief-RCOPE, Religious Coping when confronted with loneliness and the subscale of Relationship with God was found, which supports the convergent validity of the first subscale. On the contrary, and in a way consistent with the results of the authors negative Brief-RCOPE was not significantly associated with the other scales, but had a conservative association with regard to a measurement consisting of two items in the Relationship with God subscale. These items seem to specifically evaluate the dissatisfaction of the individual in his/her relationship with God. We calculated the factorial structure of the tools through the analysis of major components with varimax rotation of eigenvalues greater than 1: For Brief-RCOPE it was only possible to confirm a well defined structure representing 49.5% of the variance explained with an internal consistency of α=.82 and which corresponded to positive religious coping. The Scale of Religious Coping when confronted with loneliness maintained a solid structure based on only one component which explained the 70.2% variance, according to the expectations of the author, with an internal consistency of α=.91. The EBE subscale of the Relationship with God presented two clearly defined components, which explained the 59.3% variance. The first component seems to evaluate a satisfactory relationship with God, whereas the second one seems to indicate an unsatisfactory one. In analyzing the socio-demographic variables, we found that the tendency to cope with feelings of loneliness through greater closeness with God was more frequent among women ( X=18.46) than among men ( X=16.47; t=2.04, p=.04). On the other hand, Religious Coping, when confronted with loneliness, seems so show a relationship that changes with the number of years of schooling: the higher the educational level, the less this coping strategy was used (elementary school, =18.66; middle school, X=17.71; high school, X=17.55; college, X=14.61; F=3.252, p=.024). Meanwhile, those subjects who were in a relationship (either married or living with their partner) tended to resort to religious coping to a lesser extent (Positive Brief-RCOPE, =19.29, ARS, X=16.72), than single people (single, widowed, separated or divorced) did (Positive Brief-RCOPE, =21.44, t=2.203, p=.030; ARS, =18.85, t=2.249, p=.026.) Finally, we compared the largest religious groups -Catholics and Christians- and we found that the latter turn more frequently to religious coping when confronted with loneliness ( X=20.45) than Catholics do ( X=17.30; t=2.667, p=.017). On the other hand, traditional christian denominations relate to God more frequently ( X=40.27) than Catholics do ( X=37.35; t=2.345, p=.032). Results reported here significantly attest to the psychometric qualities of the tools utilized. However, the negative coping subscale appears to call for further research. The IMSOL Religious Coping subscale proved to have the best psychometric properties, as regards internal consistency, validity and factorial structure for its use in research protocols dealing with older Mexican adults. Although EBE’s Relationship with God subscale resulted in two clearly defined components instead of one, it was also shown to have psychometric qualities that make it useful for research. The analysis of the significant differences that exist in sociodemographic variables shows findings that are consistent with other research carried out in the Mexican context. The results obtained give empirical evidence on the way older Mexican adults live their spiritual life. Although the results described herein cannot be generalized, since they are not based on a random sample they contribute data that is consistent with other research. <![CDATA[Cuestionario breve de tamizaje y diagnóstico de problemas de salud mental en niños y adolescentes: algoritmos para síndromes y su prevalencia en la Ciudad de México. Segunda parte]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100048&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract Introduction: Studies on developmental psychopathology have shown that several problems and disorders that started during childhood persist into adulthood. Recent epidemiological studies have emphasized the need for the early identification of problems and disorders in childhood and adolescence that may eventually lead to other psychopathologies in adulthood. A previous paper presented the rationale and development of a brief instrument which could be used to early identify clinical risk conditions in children by health professionals: the Brief Screening and Diagnostic Questionnaire, CBTD. The CBTD is a 27-item questionnaire which is answered by the parents of the child exploring symptoms frequently reported as motives for seeking attention at the out-patient mental health services. The instrument showed good reliability, KR-20= 0.81, and construct validity for identifying groups of symptoms that suggest the presence of the most frequent psychiatric syndromes in children and adolescents. As our goal was to identify probable psychiatric disorders, and diagnostic criteria are not equal to clusters of symptoms identified by factor analyses, the next task was to explore the data using a different statistical technique and to develop observational units, syndromes, for further clinical evaluation. The objectives of this paper are: 1. to present the resulting algorithms and 2. their prevalence in children and adolescent population in Mexico City. Method: The CBTD was included as part of the instruments used in an epidemiological 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: 16.3% were 4-5 years old; 25.5%, 6-8 years old; 30.9%, 9-12 years old, and 27.4%, 13-16 years old. Once the independence of the observations was assured, logistic regression analyses were performed between cardinal symptoms for different diagnoses and the rest of the items from the questionnaire. Statistically significant associations were evaluated clinically and compared to psychiatric syndromes as defined by the DSM-IV and ICD-10 classifications. Based on these results, algorithms for probable psychiatric syndromes were created. Results: Using the results from logistic regression analyses, algorithms were created considering different levels of severity for probable disorders: attention-deficit and hyperactivity distinguishing three subtypes, depressive with two definitions and two severity degrees, anxiety with two subtypes, oppositional behavior, conduct disorder, specific language disorder, epilepsy, and other clinical conditions such as problems related with eating attitudes, enuresis and impulsivity. Depressive and hyperactive attention-deficit syndromes were the most frequent in the population. Among these groups of syndromes, depression, as defined in terms of the presence of irritability or sadness and three or more associated symptoms, and the combined subtype of hyperactive attention-deficit, were the most prevalent. Oppositional behavior and anxiety syndromes were also frequent, and all of the afore mentioned syndromes appeared predominantly associated at least with another one. Mixed externalizing and internalizing syndromes were found in 5% of the population, while only internalizing syndromes were reported in 4.5% and only externalizing syndromes in 2.4%. Although as a whole no significant differences by sex were found on the number of syndromes presented, in males the frequency increased with age, while in girls more syndromes were reported on the youngest and elder age-groups. Discussion: This paper has presented operational definitions for screening syndromes based on the associations among symptoms explored by the CBTD in children and adolescents of the general population in Mexico City. 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 use 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. Recently, Goodman designed an interesting brief instrument, the Strengths and Difficulties Questionnaire (SDQ), that generates scores for conduct problems, inattention-hyperactivity, emotional symptoms, peer problems, and prosocial behavior. One difference between the CBTD and the SDQ is that the former in- cludes items exploring language problems, enuresis, and seizures, which are clinically relevant and frequently associated with conduct and emotional problems. Furthermore, 4% of our study population presented these kind of problems associated with externalizing or internalizing syndromes. Results indicating that attention-deficit and depressive syndromes are the most common in the population are consistent with the most frequent disorders attended at the Pediatric Psychiatric Hospital in Mexico City. Also interesting is the fact that in a National Psychiatric Epidemiological Survey, 2% of the adult population with depressive disorders reported having their first depressive episode during childhood or adolescence with a mean duration of 31 months. Likewise, results from the present study found that 2.6% of the children and adolescents have the most severe depressive syndrome, IDEP-2S, which also has the highest diagnostic specificity in clinical settings. These results suggest that the CBTD accomplishes the goal of being a useful tool for epidemiological studies and for the surveillance of mental health in childhood and adolescence. The presence of a syndrome does not lead automatically to a psychiatric diagnosis. The intention is that, in those cases, corroboration should be sought by evaluating interference caused by the reported symptoms in familial, school, social and personal functioning. <![CDATA[Las bases neurales del proceso de enmascaramiento. Segunda parte]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100056&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Abstract Introduction: Studies on developmental psychopathology have shown that several problems and disorders that started during childhood persist into adulthood. Recent epidemiological studies have emphasized the need for the early identification of problems and disorders in childhood and adolescence that may eventually lead to other psychopathologies in adulthood. A previous paper presented the rationale and development of a brief instrument which could be used to early identify clinical risk conditions in children by health professionals: the Brief Screening and Diagnostic Questionnaire, CBTD. The CBTD is a 27-item questionnaire which is answered by the parents of the child exploring symptoms frequently reported as motives for seeking attention at the out-patient mental health services. The instrument showed good reliability, KR-20= 0.81, and construct validity for identifying groups of symptoms that suggest the presence of the most frequent psychiatric syndromes in children and adolescents. As our goal was to identify probable psychiatric disorders, and diagnostic criteria are not equal to clusters of symptoms identified by factor analyses, the next task was to explore the data using a different statistical technique and to develop observational units, syndromes, for further clinical evaluation. The objectives of this paper are: 1. to present the resulting algorithms and 2. their prevalence in children and adolescent population in Mexico City. Method: The CBTD was included as part of the instruments used in an epidemiological 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: 16.3% were 4-5 years old; 25.5%, 6-8 years old; 30.9%, 9-12 years old, and 27.4%, 13-16 years old. Once the independence of the observations was assured, logistic regression analyses were performed between cardinal symptoms for different diagnoses and the rest of the items from the questionnaire. Statistically significant associations were evaluated clinically and compared to psychiatric syndromes as defined by the DSM-IV and ICD-10 classifications. Based on these results, algorithms for probable psychiatric syndromes were created. Results: Using the results from logistic regression analyses, algorithms were created considering different levels of severity for probable disorders: attention-deficit and hyperactivity distinguishing three subtypes, depressive with two definitions and two severity degrees, anxiety with two subtypes, oppositional behavior, conduct disorder, specific language disorder, epilepsy, and other clinical conditions such as problems related with eating attitudes, enuresis and impulsivity. Depressive and hyperactive attention-deficit syndromes were the most frequent in the population. Among these groups of syndromes, depression, as defined in terms of the presence of irritability or sadness and three or more associated symptoms, and the combined subtype of hyperactive attention-deficit, were the most prevalent. Oppositional behavior and anxiety syndromes were also frequent, and all of the afore mentioned syndromes appeared predominantly associated at least with another one. Mixed externalizing and internalizing syndromes were found in 5% of the population, while only internalizing syndromes were reported in 4.5% and only externalizing syndromes in 2.4%. Although as a whole no significant differences by sex were found on the number of syndromes presented, in males the frequency increased with age, while in girls more syndromes were reported on the youngest and elder age-groups. Discussion: This paper has presented operational definitions for screening syndromes based on the associations among symptoms explored by the CBTD in children and adolescents of the general population in Mexico City. 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 use 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. Recently, Goodman designed an interesting brief instrument, the Strengths and Difficulties Questionnaire (SDQ), that generates scores for conduct problems, inattention-hyperactivity, emotional symptoms, peer problems, and prosocial behavior. One difference between the CBTD and the SDQ is that the former in- cludes items exploring language problems, enuresis, and seizures, which are clinically relevant and frequently associated with conduct and emotional problems. Furthermore, 4% of our study population presented these kind of problems associated with externalizing or internalizing syndromes. Results indicating that attention-deficit and depressive syndromes are the most common in the population are consistent with the most frequent disorders attended at the Pediatric Psychiatric Hospital in Mexico City. Also interesting is the fact that in a National Psychiatric Epidemiological Survey, 2% of the adult population with depressive disorders reported having their first depressive episode during childhood or adolescence with a mean duration of 31 months. Likewise, results from the present study found that 2.6% of the children and adolescents have the most severe depressive syndrome, IDEP-2S, which also has the highest diagnostic specificity in clinical settings. These results suggest that the CBTD accomplishes the goal of being a useful tool for epidemiological studies and for the surveillance of mental health in childhood and adolescence. The presence of a syndrome does not lead automatically to a psychiatric diagnosis. The intention is that, in those cases, corroboration should be sought by evaluating interference caused by the reported symptoms in familial, school, social and personal functioning. <![CDATA[Capacidad predictiva de la Teoría de la Conducta Planificada en la intención y uso de drogas ilícitas entre estudiantes mexicanos]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100068&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary The need of cost-effective drug abuse prevention programs has derived in a growing interest to develop scientific based alternatives. On this context, this study forms part of a project for the design and evaluation of a theoretical and empirically sustained intervention for illicit drug abuse prevention among Mexican junior high school students. Starting with the revision and assessment of different theoretical models that could be adapted to the conditions of the institutional context wherein the intervention will be developed, the Azjen and Fishbein’s Theory of Planned Behavior was chosen. This theory includes proximal cognitive and attitude factors directly related to the initiation of drug use. In accordance with it, the experimental use of substances is a result of the intention of consuming them, which, in turn, depends on three elements: a) the attitude toward the drug use, b) the normative beliefs on this matter (subjective norm) and c) the perceived behavioral control regarding drug use or, in turn, confronting social pressure. In a first instance, several items were developed adapting the constructs of the Theory of Planned Behavior to the target population’s characteristics. On this base, the reliability and validity of a self-applied questionnaire for the measurement of the variables of the model was proved. In this work are reported the findings of the evaluation of Theory of Planned Behavior’s potential to predict both behavioral intention of using illicit drugs and consumption of substances among Mexican high school students, in order to set a precedent to apply the model later on in the design and evaluation of a preventive intervention directed to such population. Method: The study was carried on with an ex post facto, correlational design, and with a non-probabilistic sample of 1,019 subjects. Sample. The sample size was estimated considering the possibility of selecting a subsample of drug users and comparison subjects for a post-stratified analysis, assuring a statistical power of 80% and adequate sensibility and stability. Therefore, this work includes the performed analyses with a sample of 75 drug users and 75 non users, paired by gender, age, school grade and occupation. Instrument. The instrument was a self-applied questionnaire specially developed for the study, according to information obtained in previous focal groups interviews with high school students. The questionnaire showed a global realiability of 0.9154 and between 0.62 and 0.94 in each one of its scales, which included: behavioral beliefs (0.9121), attributed value to behavioral beliefs (0.7964), normative beliefs (0.6480), subject’s disposition to adjust to normative expectations (0.8564), descriptive norm (0.6254), drug use opportunities (0.8129) and perceived behavioral control coping with such opportunity situations (0.9442). A factorial analysis of principal components yielded 16 factors of at least three items each, with factorial weights higher than 0.4, and closely attached to Theory of Planned Behavior’s variables, with an explained variance of 59%. Analysis. Previous to data analysis, normality tests (Kolmogorov- Smirnov) were performed, indicating the necessity to apply nonparametric tests of differences and to transform the data to be adapted to the requirements of later parametric analyses. A correlation analysis was carried out to prove the association between behavioral intention and drug use, as well as between the different components of the Theory of Planned Behavior. Finally, linear and logistic regression analyses were conducted to determine the explicative potential of the model and the predictive weight of each variable on the model with regard to the behavioral intention and the consumption of drugs. Findings: According to the Mann-Whitney test, compared with students who had not used drugs, subjects that used them at least once in their life showed more favorable attitudes toward consumption (median= 6.9 vs. 3.9, z=-5.22, p=0.000), perceived more social tolerance (median=3.8 vs. 3.5, z=-2.27, p=0.023), were more willing to give in to social pressure for using substances (median=2.0 vs. 1.0, z=-5.598, p=0.000), perceived a higher number of users among their significant others, and less negative consequences Salud Mental, Vol. 30, No. 1, enero-febrero 2007 69 of drug use in themselves (median=16.3 vs. 7.1, z=-4.246, p=0.000), and felt less capable of behavioral control when coping with opportunities for consumption, which, in turn, are more frequent in their case (median=5.7 vs 1.8, z=-6.76, p=0.000). The correlation between the intention and the behavior of drug use (r=0.41, p&lt;0.000) was allocated inside the range reported in other populations. Drug use intention correlated with attitude toward drug use at r=0.45 (p=0.000), with subjective norm, including additional components at r=0.48 (p=0.000), and with perceived behavioral control at r=0.59 (p=0.000). Drug use correlated with attitude at r=0.51 (p=0.000), with subjective norm at r=0.28 (p=0.001), and with perceived behavioral control at r=0.37 (p=0.000). Linear regression analysis yielded that the model explained 34% of the variance of drug use intention, which increased to 38% when adding personal and descriptive norm elements to the subjective norm construct. Behavioral control (measured on the basis of the product of exposition to drug use facilitating situations punctuations by perceived behavioral control to cope with these situations punctuations) was identified as the best predictor of drug use intention (B=0.32, p=0.001), followed by attitude toward drug use (B=0.24, p=0.004) and subjective norm, which originally showed a non-significant effect but increased its predictive weight when additional elements were added (B=0.24, p=0.004). According to the logistic regression analysis, behavioral control is also the best predictor of illicit drug use on the model (odds ratio= 1.42, p&lt;0.000). On the contrary, subjective norm (including personal and descriptive norm) and attitude (odds ratio=1.144, p=0.06) were not significant predictors of drug use. Discussion: In general, this findings indicate that the Theory of Planned Behavior showed an acceptable predictive capacity (similar to that found in other populations), and can be taken as a valid theoretical ground to develop a preventive intervention directed to Mexican students of high school education. As is the case with other populations, the variable in the Planned Behavior Theory with more predictive weight was perceived behavioral control, followed by attitude to drug use and, in third place, by subjective norm. Despite it could be supposed that subjective norm would have a higher predictive weight in Mexican teenagers, findings probably reflected idiocentric and individualistic tendencies reported in other studies. Results also point out to the convenience of including it in the program of intervention informative components to produce an awareness effect and an impact in the intention of using drugs. Still, they indicate above all, the need to integrate components directed to the development and reinforcement of behavioral control abilities that have an effect in the use of drugs itself. Specifically, it is considered the convenience of including components for the development of group pressure resistance abilities and assertive communication, appropriate to the contexts in which young people face drug abuse risk situations. <![CDATA[La eliminación de la violencia contra la mujer. ¿Una utopía?]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000100082&lng=pt&nrm=iso&tlng=pt Resumen: En diciembre de 1999, la Asamblea General de las Naciones Unidas declaró el 25 de noviembre como Día Internacional de la Eliminación de la Violencia contra la Mujer. Para ello invitó a los gobiernos y a distintas organizaciones a desarrollar en ese día actividades dirigidas a sensibilizar a la opinión pública respecto al problema de este tipo de violencia. Este breve artículo busca hacer solamente algunas reflexiones sobre el tema, considerando su importancia política, social, cultural y legal, pero también sus implicaciones en términos de los derechos humanos de las mujeres, así como de su salud física y mental. Por esto, las y los investigadores y profesionales de la salud mental necesitan cobrar conciencia de la magnitud de esta violencia, que se expresa de múltiples formas, incluidos el abuso sexual, el incesto, la prostitución forzada y el hostigamiento sexual en calles, instituciones y espacios domésticos, sin olvidar la violencia en las relaciones íntimas, la violación y los feminicidios. Los hombres son los principales perpetradores de estos actos ejercidos contra mujeres y niñas, por lo que es fundamental comprender que el problema requiere mirarse desde una perspectiva de género, que incluya, por lo tanto, un análisis del poder. En este artículo se discuten las posibilidades de investigadores y profesionales de la salud mental para contribuir a eliminar la violencia contra las mujeres, incluidos la necesidad de revisar los obstáculos que dificultan el cambio de creencias, valores, instituciones y prácticas que generan y reproducen la violencia en hombres y mujeres.<hr/>Summary: On December 1999, the UN General Assembly designated November 25 as the International Day for the Elimination of Violence against Women. Thus, governments, international and non-governmental organizations were invited to develop activities to raise public awareness about the problem on that day. Since 1981 activist women marked November 25 as the day against violence. This paper pretends to make some reflections about violence against women, considering that this is a political, social, cultural, legal and human rights-related issue, but also a severe public health problem. Mental health researchers and professionals should be aware of the relevance of this phenomenon and its multiple manifestations, including sexual abuse, incest, forced prostitution, and sexual harassment in streets, institutions and domestic contexts as well as violence in intimate relations, rape and femicides. Men are the main perpetrators of these acts against women and girls. For this reason, the problem should be understood from a gender perspective that includes the analysis of power issues. The possibilities of mental health researchers and professionals to contribute to eliminate violence against women are discussed, including the need to review any obstacles which difficult changing beliefs, values, institutions and practices that engender and reproduce violence in women and men.