Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520070002&lang=pt vol. 30 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[El neurocitoesqueleto: un nuevo blanco terapéutico para el tratamiento de la depresión]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200001&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary Postmortem and neuroimaging studies of Major Depressive Disorder patients have revealed changes in brain structure. In particular the reduction in prefrontal cortex and in hippocampus volume has been described. In addition, a variety of cytoarchitectural abnormalities have been described in limbic regions of major depressive patients. Decrease in neuronal density has been reported in the hippocampus, a structure involved in declarative, spatial and contextual memory. This structure undergoes atrophy in depressive illness along with impairment in cognitive function. Several studies suggest that reduction of hyppocampus volume is due to the decreased cell density and diminished axons and dendrites. These changes suggested a disturbance of normal neuronal polarity, established and maintained by elements of the neuronal cytoskeleton. In this review we describe evidence supporting that neuronal cytoskeleton is altered in depression. In addition, we present data indicating that the cytoskeleton can be a potential target in depression treatment. Neurons are structural polarized cells with a highly asymmetric shape. The cytoskeleton plays a key role in maintain the structural polarization in neurons which are differentiated in two structural domains: The somato-dendritic domain and the axonal domain. This differentiated asymmetric shape, depends of the cytoskeletal organization which support, transport and sorts various molecules and organelles in different compartments within the cell. Microtubules determine the asymmetrical shape and axonal structure of neurons and form the tracks for intracellular transport, of crucial importance in axonal flux. Actin microfilaments are involved in force generation during organization of neuronal shape in cellular internal and external movements and participate in growth cone formation. This important cytoskeletal organization preceed the formation of neurites that eventually will differentiated into axons or dendrites, a process that also comprises a dynamic assembly of the three cytoskeletal components. Intermediate filaments are known in neurons as neurofilaments spatially intercalated with microtubules in the axons and facilitate the radial axonal growth and the transport. Neurofilaments also act supporting other components of the cytoskeleton. All changes and movements of the cytoskeletal organization are coordinated by cytoskeletal associated proteins such as the protein tau and the microtubule associated proteins (MAPs). Also, specific interactions of microfilaments, microtubules and filaments which are regulated by extracellular signals take place in modulation of the cytoskeletal rearrangements. The polarized structure and the highly asymmetric shape of neurons are essentials for neuronal physiology and it appears to be lost in patients with a Major Depressive Disorder. Histopathological studies have shown that the hippocampus and frontal cortex of patients with major depressive disorder have diminished soma size, as well as, have decreased dendrites and cellular volume. Dendrite formation depends mainly in microfilaments organization as well as in polarization of the microtubule binding protein MAP2. In addition, there is a decreased synaptic connectivity and an increased oxidative stress, which originates abnormalities in the cytoskeletal structure. These neuronal changes originate alterations in the brain functionality such as decreased cognitive abilities and affective dis-regulations, usually encountered in patients with depression. Therefore, pathologic lesions implicating an altered cytoskeletal organization, may have an important role in decreased cognitive functions, observed in depression, as well as in changes in the brain volume, explained by a lost of neuronal processes such as axons, dendrite processes or dendritic spines, rather than by loss of neuronal or glial cell bodies. This explanation is supported by light immunomicroscopy of brain slices postmortem stained with specific antibodies. Psychological stress which causes oxidative stress has also been suggested to cause a decrease of neuronal volume in the prefrontal cortex, altering the synaptic connections established with the hippocampus. This conclusion was drawn from studies in animal models of psychological stress associated with molecular measurements where defects in the expression of MAP1 and sinaptophysin were found, suggesting that defects in cytoskeletal associated proteins could underlie some cytoarchitectural abnormalities described in depression. Together all the evidence accumulated indicates that major depression illness and bipolar depression are mental disorders that involve loss of axons and dendrites in neurons of the Central Nervous System, that in consequence cause disruption of synaptic connectivity. Thus is possible that depression can be considered as a cytoskeletal disorder, therefore this cellular structure could be a drug target for therapeutic approaches by restoring normal cytoskeleton structure and precluding damage caused by oxygen-reactive species. In this regard, melatonin, the hormone secreted by pineal gland during dark phase of the photoperiod, has two important properties that can be useful in treatment of mental disorders. First, the melatonin is a potent free-radical scavenger and second this hormone governs the assembly of the three main cytoskeletal components modulating the cytoskeletal organization. This notion is supported by direct action of melatonin effects on cytoskeletal organization in neuronal cells. In N1E-115 neuroblastoma cells, melatonin induced a two-fold increase in number of cells with neurites 1 day after plating; the effect lasting up to 4 days. Induction of neurite outgrowths is optimal at 1 nM melatonin and in presence of hormone the cells grew as clusters with long neurites forming a fine network to make contact with adjacent cells. Immunofluorescence of N1E-115 cells cultured under these conditions showed tubulin staining in long neurite processes connecting cells to each other. Neurite formation is a complex process that is critical to establish synaptic connectivity. Neuritogenesis takes place by a dynamic cytoskeletal organization that involves microtubule enlargement, microfilament arrangement, and intermediate- filament reorganization. In particular, it is known that vimentin intermediate filaments are reorganized during initial stages of neurite outgrowth in neuroblastoma cells and cultured hippocampal neurons. Evidence has been published indicating that increase in microtubule assembly participates in neurite formation elicited by melatonin antagonism to calmodulin. Moreover, recently it was reported that melatonin precludes cytoskeletal damage produced by high levels of free radicals produced by hydrogen peroxide, as well as, damage caused by higher doses of the antypsychotics haloperidol and clozapine. N1E-115 cells incubated with either 100 uM hydrogen peroxide, 100 uM haloperidol, or 100 uM clozapine undergo a complete cytoskeletal retraction around the nucleus. By contrast, NIE-115 cells incubated with hydrogen peroxide, clozapine, or haloperidol followed by the nocturnal cerebrospinal fluid concentration of melatonin (100 nM) showed a well preserved cytoskeleton and neuritogenesis. Thus melatonin is a neuroprotective compound, since protects the neurocytoskeletal organization against damage caused by high concentrations of antipsychotics and oxidative stress. As mentioned previously, polarity is intrinsic to neuronal function. In neurons, somatodendritic domain receives and decodes incoming information and axonal domain delivers information to target cells. Progressive loss of neuronal polarity is one of the histopathologic events in depression. Cytoskeletal collapse underlie the lost of structural polarity and it is known that precede neuronal death and disappearance of synaptic connectivity. Drugs that prevent the loss of polarity and cytoskeleton retraction intrinsic to these diseases, as well as damage in cytoskeletal structure produced by oxidative stress can be extremely useful in depression treatment. Melatonin is a potent free-radical scavenger that also acts as a cytoskeleton regulator; thus, we speculate that this hormone could be useful in prevention and alleviation of psychiatry diseases with synaptic connectivity disruption. Clinical trials show that melatonin administration is followed by alleviation of circadian disturbances and cognitive function in various neuropsychiatry diseases. Moreover, in depression, melatonin improves sleep. Thus, as suggestive as this information appears, controlled clinical trials will be necessary to investigate the beneficial effects of melatonin and other drugs in the depression treatment. <![CDATA[Las bases celulares de las oscilaciones neuronales]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200011&lng=pt&nrm=iso&tlng=pt Resumen Una de las características de los circuitos neuronales es que sus componentes, las neuronas, pueden presentar actividad eléctrica sincrónica y, gracias a ésta, generar actividad oscilatoria. Esta actividad se ha asociado a diversas funciones fisiológicas como el procesamiento de información sensorial, la memoria, el ciclo vigiliasueño y la conciencia. La actividad oscilatoria de un circuito neuronal está mediada por i) las propiedades intrínsecas de sus células, ii) la arquitectura de sus conexiones y iii) la dinámica de sus interacciones sinápticas. A nivel celular, las señales sinápticas pueden generar oscilaciones subumbrales del potencial de membrana y regular la frecuencia de disparo. Estas oscilaciones modulan la respuesta celular a las entradas sinápticas que ocurren en frecuencias funcionalmente relevantes y que, finalmente, producen los diferentes ritmos cerebrales. A nivel estructural, el conjunto de proyecciones axonales de corto, mediano y largo alcance, permiten que módulos discretos, pero interconectados, oscilen en sincronía a lo largo de amplias regiones cerebrales. En esta revisión, resaltamos la importancia que tienen las interacciones sinápticas, excitadora e inhibidora, en la regulación y mantenimiento de la sincronía del disparo en grupos neuronales. Abordamos también el impacto de la plasticidad de corto y largo plazo de la transmisión GABAérgica en la modulación de las propiedades sinápticas, las oscilaciones neuronales y su participación en la generación de ritmos hiper-sincrónicos, asociados con las descargas epilépticas y las alteraciones que éstas últimas producen en los mecanismos de inhibición sináptica. Por ejemplo, después de una crisis convulsiva generalizada o de inducir un estado de hiperexcitación, las células granulares glutamatérgicas del giro dentado del hipocampo, presentan modificaciones que les permiten sintetizar y liberar GABA, que actúa sobre receptores pre- y postsinápticos. En este escenario, el GABA liberado espontáneamente de las células granulares, inhibe las oscilaciones de ~20 Hz en la zona CA3 del hipocampo. Se ha propuesto que este mecanismo, activado por crisis convulsivas, podría servir para limitar la actividad de la red neuronal en respuesta a incrementos de excitabilidad. De igual forma, su presencia se ha asociado con los efectos deletéreos que tienen las crisis convulsivas sobre el aprendizaje y la consolidación de memoria, particularmente durante la fase post-ictal. Finalmente discutimos el posible papel computacional que las oscilaciones neuronales tienen en la representación de información sensorial.<hr/>Summary Neuronal oscillations emerge as a consequence of the interaction of large groups of neurons, which can synchronize their activity to generate a rhythmic field behavior. They occur in different brain areas and have been associated to relevant physiological and pathological processes such as sensory processing, memory, epilepsy and consciousness. Neuronal oscillations are mediated and shaped by i) the intrinsic properties of the cell membrane, ii) the architecture of synaptic connections between the neurons confined in a network, and iii) the dynamics of the synaptic currents. The firing properties of the neurons depend on the ionic channels that they possess but nonlinear interactions between different families of ionic currents, may produce small subthreshold membrane oscillations (SMOs). Because the probability to generate an action potential rises during the depolarizing phase of the SMOs, this activity can regulate the neuron’s firing frequency. Consequently, SMOs influence the responsiveness of the neuron to synaptic inputs that occur at particular frequencies and which, finally, produce a broad range of brain rhythms. In addition to the intrinsic properties of the neuronal membrane, the firing frequency of single neurons depends on the synaptic inputs from other neurons within the network. Indeed, neurons can produce responses in their neighbors by means of electrical and chemical synapses. In this sense, two or more neurons are in synchrony if each fires action potentials, within a small time window before or after the other. This could be explained if both neurons share the same synaptic input or if they interact with each other. Hence, network synchrony is reflected by the current flow between the extracellular and intracellular compartments which can be recorded as a field potential in the extracellular space. Thus, this field potential reflects both synchronic subthreshold events and action potentials generated by the cells contained in the recorded field. Therefore, the electric potential produced by the synchronized activity of cortical neurons can be recorded over the scalp (the electroencephalogram or EEG). This activity is characterized by its morphology, its frequency and the experimental context in which it is recorded. The cortical brain rhythms are classified in frequency bands, and they are associated with different brain states. They compete and interact with each other and can coexist in the same or in different structures. Because field oscillations can be spontaneously generated in vitro, their generating and sustaining mechanisms can be thoroughly studied. For instance, blockade of presynaptic or postsynaptic receptors is a common tool used to isolate the specific contributions of different synaptic components that generate the field oscillations. We also discuss the role of short and long-term GABAergic plasticity and its involvement in neuronal oscillations and in the generation of hyper-synchronic rhythms that underlie epileptic discharges. Indeed, excitatory and inhibitory synaptic interactions regulate and sustain the firing synchrony in neural networks. For instance, diverse sets of GABAergic interneurons contribute with different firing frequencies that finally inhibit their postsynaptic targets: excitatory principal cells and other interneurons. In other words, inhibitory synapses, as a whole, generate different synchronic neuronal events and restrain the network excitability. Hence, it is relevant to study which parameters do modify the GABAergic transmission. For instance, a feature of GABAergic synapses is that prolonged GABAA-R activation may lead to a switch from a hyperpolarizing to a depolarizing postsynaptic response. This is partly due to a positive shift on the GABAA-R reversal potential (EGABA) because of a GABA-induced-chloride (Cl-) accumulation in the postsynaptic neurons. Recent studies suggest that the activity-dependent EGABA shift may have important implications in the mechanisms involved in the generation of γ (~40 Hz) oscillations and seizure-like discharges. The study of how intracellular Cl- dynamics shape network oscillations may bring insights into the mechanisms of physiological and pathological brain rhythms. Moreover, Cl- dynamics have also prominent functional implications during development. Another relevant example of GABAergic plasticity is observed in the glutamatergic hippocampal granule cells (GCs). In response to an increment in network excitability, GCs are able to synthesize and release GABA for fast neurotransmission. Several experimental results have compellingly shown that GABAergic signaling from these cells activates presynaptic and postsynaptic GABAergic receptors. Therefore, it is plausible that after seizures, the GCs could spontaneously release GABA that would, in turn, change the spontaneous field activity that naturally emerges from the postsynaptic targets that comprise the CA3 intrinsic network oscillator. And this is indeed the case. GABA released from CGs inhibits β/γ oscillations (~20 Hz) in the CA3 area, where principal cells and interneurons are impinged by CGs. Thus, this mechanism could be used to limit network excitability after seizures. The emergence of the GABAergic phenotype in CGs could also be involved in the deleterious effects on learning and memory consolidation that have been observed after seizures. Finally, we briefly discuss the computational role that network oscillations may have to represent sensory information. <![CDATA[Personality disorders and emotional variables in patients with lupus]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200019&lng=pt&nrm=iso&tlng=pt Summary Introduction: Systemic lupus erythematosus (SLE), a prototype of the autoimmune diseases, is a multi-systemic disease characterized by an alteration in the immunological response, where the production of antibodies is directed against nuclear antigens, thus affecting many organs and systems. The course of this disease includes a wide range of clinical manifestations, different anatomo-pathological findings, and a series of immunological abnormalities. It is characterized by outbreaks and remissions. SLE can be manifested by general malaise, fever, fatigue, weight loss, skin rashes or joint inflammation, anemia, inflammation of the lymphatic glands, lowering of the defenses against infection, and cardiac, kidney, pulmonary and neurological alterations. In chronic dermatological lupus, only the skin is affected; this condition can present rash erythemas, etc. The recent introduction of new immunological diagnostic methods (antinuclear antibodies, anti-DNA antibodies, complementary fraction, etc.) has made it possible to recognize less severe forms of the disease, as well as its outbreaks and therapeutic guidelines. Different psychological variables have been associated with the exacerbation of the disease; one of the most notable is stress, and many patients with lupus also suffer diverse psychiatric and personality disorders associated with the disease, with a prevalence oscillating between 20% and 60%. Furthermore, these alterations have been associated with a lower quality of life, poorer evolution and psychiatric antecedents. In the specific case of personality alterations, previous research has found the existence of a “triad of personality” characteristics in patients with lupus. Depression, hysteria and hypochondria are the factors making up this triad. However, it has not been shown whether these personality disorders are just another symptom of the disease or a consequence of the emotional disorders produced by it. The purpose of this study was to test the possible existence of personality disorders and their relationship with other affective disorders in SLE. Methods: In order to do this, we studied 30 patients with lupus and evaluated their possible personality disorders with the MMPI and their levels of depression and anxiety with the BDI and STAI, respectively. Then, after analyzing the results obtained on the tests administered, three groups were established: patients with lupus who had no emotional disorders, patients with lupus who presented clinical anxiety, and patients with lupus who presented clinical depression. These categories were represented graphically. In order to test the effects of anxiety and depression in the psychopathological personality profile, 10 between-group univariate variance analyses (ANOVA) were carried out, one for each subscale of the MMPI. The variable “presence or non-presence of emotional disorders” was the two-level factor. Results: In the graphic representation of the personality patterns of the three groups, it can be seen that patients with lupus who did not present emotional disorders (neither depression or anxiety) did not show any alterations in their personality patterns. However, this pattern was altered in those who presented depression or anxiety. Later, the results found show statistically significant differences on the subscales of Hypochondria [F=9.795, df=1, 29, ±0.004)], Psychasthenia [F=15.266, df=1, 29, p±0.001], and Schizophrenia [F=4.97, df=1, 29, p±0.001)] among those patients who presented emotional disorders and those who did not present any emotional disorder, with the latter receiving higher scores. Conclusion: We can state that the development of personality disorders in patients with lupus is associated with emotional alterations, which probably relate more to processes of adaptation to the disease than to the disease itself.<hr/>resumen está disponible en el texto completo <![CDATA[Trastorno depresivo mayor en México: la relación entre la intensidad de la depresión, los síntomas físicos dolorosos y la calidad de vida]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200025&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>SUMMARY Background: Major Depressive Disorder (MDD) is a disease associated to emotional, vegetative and physical symptoms, including for the latter those pain-related symptoms. MDD has a high prevalence rate with a substantial burden of illness, and it expected that by 2020 it will become the second cause of world disability. The diagnosis of MDD is difficult due to the high prevalence of painful physical symptoms, and also due to the fact these symptoms are more evident that the embedded emotional ones. Over 76% of patients with MDD, report painful physical symptoms observed, like headache, abdominal pain, back pain and unspecific-located pain; observing these symptoms can even predict depression severity. In addition, the likelihood of psychiatric disease increases, importantly, with the number of physical symptoms observed; moreover, the remission of physical symptoms predicts the complete remission in MDD. We present an observational, prospective study to examine the clinical profile of Mexican outpatients suffering MDD and determine the relationship between depression severity, painful physical symptoms in quality of life and depression. Methods: Adult patients with current episodes of MDD, treated with antidepressants were included. MDD was defined according to the criteria of the Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) or in the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Patients should have been free of depression symptoms prior to the current episode for at least 2 months. Duration of current episode should not exceed two years. Treatment-resistant patients and those with other psychiatric diagnosis were excluded. Treatment-resistance was defined as: a) a failure to respond to treatment when two different antidepressants were employed at therapeutic doses for at least four weeks each, b) when the subject was previously treated with IMAO inhibitors, c) when electro-convulsive therapy (ECT) was previously employed. Other exclusion criteria comprise previous or current diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, bipolar disorder, dementia or mental impairment. Patients were selected in 34 centers in Mexico. Patients were classified according to the presence (SFD+) or absence (SFD-) of painful physical symptoms using the Somatic Symptom Inventory (SSI); SFD+ was defined as scores ≥ 2 for the pain-related items in the SSI (items 2, 3, 9, 14, 19, 27 and 28). Visual Analogue Scale (VAS) quantified pain severity (cervical pain, headache, back pain, shoulder pain, interference of pain in daily activities and vigil-time with pain). HAMD17 and CGI-S determined depression severity, while the Quality of Life in Depression Scale (QLDS) quantified subjective well-being. Linear regression models were employed to compare groups for VAS, HAMD17, CGI-S, and QLDS, to fit the confusions or clinical predictors when needed. Proportions between groups were established with Fisher exact test or logistic regression. Significance levels were established at 0.005 due to the observational nature of the study. In the result tables, standard deviation (SD) is reported as a variation around the mean value as Mean ± SD, and 95% confidence intervals are denoted 95% IC. Results: A total of 313 patients were enrolled in the study. All of the enrolled patients were Mexican, almost them were women and had at least a previous MDD episode. Painful physical symptoms were reported by 73.7% of patients, these patients were classified into the SFD+ group. Neither statistical nor clinical significant differences between the SFD+ and SFD- groups were found when analyzing socio-demographic variables (age, gender, ethnical origin) and disease history variables (number of previous episodes of MDD, in the last 24 months, duration of current episode). At baseline, patients had a CGI-S mean score of 4.6 and HAMD17 of 26.3. HAMD17 mean score (27.1) in SFD+ patients was significantly higher (p&lt;0.0001) than the SFD- patients (23.8), but nonsignificant differences between groups were found for the subscales central, Maier &amp; retard. CGI-S scores were similar between SFD+ and SFD-; 4.6 and 4.5 respectively (p&gt;0.05). Prevalent painful physical symptoms were also the most painful, when a five-point scale was employed to measure severity, and comprised muscular pain (84.9%), cervical pain (84.2%) and headache (83.5%). SFD+ patients had higher pain severity in all VAS scales (p&lt;0.0001), with perceived severity scores twice as large when compared to SFDgroup. In particular, the global pain VAS reported average values of 49.0 and 19.7 for the SFD+ and SFD- groups respectively. Patients came to the first psychiatric consultation treated with psychotherapy (27.9%), antidepressants (37.3%), anxiolytics (28.6%) and analgesics (9.7%); more than 50% of all patients were not taking any drugs or receiving psychotherapy for treatment of MDD at baseline. Analgesics were used only by 9.7% of patients for the treatment of painful physical symptoms in their current MDD episode. No significant differences between groups were found when comparing the use of psychotherapy, antidepressants, anxiolytics, antipsychotics, mood stabilizers or analgesics. Quality of life was poor for all patients, but significantly worse in the SFD+ group than in the SFD- group (QLDS scores of 23.2 and 20.0 respectively, p&lt;0.001). Discussion: The diagnosis and symptoms manifestation can be influenced by local socio-cultural factors, in particular cultural differences are associated with the prevalence of painful physical symptoms, but this finding is not consistent. The results of this study can be extrapolated to the MDD Mexican population, as selection criteria comprised only operative diagnosis criteria, and not enrollment into the study took place due to the presence of painful physical symptoms. Patients included into the study presented a moderate to severe disease as measured with the HAMD17 scores. The high prevalence of painful physical symptoms in patients with depression was confirmed in this study; it has been reported the patients report pain-related symptoms as the main (even the only) symptom when consulting general practitioners. Painful physical symptoms in MDD include headache, cervical pain, back pain or neck pain; the presence of painful physical symptoms in depression is associated to higher intakes medication, but in this study more than 50% of subjects were not receiving any treatment, including psychotherapy. The treatment of MDD is by no means optimal, as only 30%- 40% of these patients reach complete remission of symptoms with their first antidepressant. Psychological symptoms respond to antidepressant treatment, but in general, this is not the case for the physical symptoms. The lack of efficacy can be explained as a failure in the treatment of these painful physical symptoms. Resolving these symptoms is even a predictor for the complete remission of MDD; the evidence might suggest that treatment of emotional and physical manifestations of depression could improve successful-treatment rates. Conclusion: As found in other reports, a high prevalence of painful physical symptoms was found in MDD patients. Increase in pain severity is associated with higher HAMD17 scores but not CGI-S scores; this discrepancy in the final rates obtained with both scales suggests that both emotional and physical dimensions of MDD should be considered when the clinical assessment is performed. We concluded that clinical judgment of Mexican psychiatrists differs between their global impression and a semi-structured interview in the same patient and therefore is fundamental that the clinical evaluation consists of both emotional and physical manifestations as important components of MDD. <![CDATA[Ansiedad y depresión: el problema de la diferenciación a través de los síntomas]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200033&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>SUMMARY The differentiation between the symptoms of anxiety and depression is one of the most important problems in psychology as the dilemma profoundly affects the diagnosis and clinical intervention. According to the epidemiological data there is a strong comorbility between the two types of disorder. Nevertheless, it is not known which one of them precedes or predisposes to the other. The comorbility could be also caused by the confusion between the two. There are many common symptoms and some of them traditionally attributed to the anxiety are also present in depression and vice versa. Additionally, in some cases the symptoms themselves could constitute complete clinical charts. Taking into account the above description, one of the most important current preoccupations in psychology and psychopathology is the identification of the symptoms which would be characteristic for each disorder. Although there is clinical evidence on an overlap between the symptoms, the current manuals describe two disorders and the clinical differences are crucial. One of the possible explanations of the overlap between the symptoms of anxiety and depression has been classically attributed to comorbility which means the presence of both charts in many clinical cases. Different sources indicate that the presence of anxiety in early ages can generate certain vulnerability to develop later-age major depression. On the other hand, other studies indicate that the cases in which both, depression and anxiety are present, tend to chronify and are more resistant to treatment. In this case both disorders are present but there is no sufficient evidence to determinate which one of them would be the principal diagnosis and which one would be secondary. For this reason, the explanations are confused and neither the researchers nor clinicians are satisfied. On the other hand, the concurrence of symptoms has been attributed to the instruments utilized for the evaluation. The disorders also depend on the tools for their measure which follow a theoretical model to explain the aetiology, course, prognosis and associated symptomatology. This way, the implicit bias of the instruments is to privilege a specific aspect which depends on the definition of disorders without taking into account the other aspects. According the description above, the evaluation, especially in case of depression, is characterized by multiplicity of instruments and diversity of contents which are evaluated. Thus, it is difficult to establish the characteristic symptoms as in many cases only some of them coincide when utilizing different tools. Moreover, many symptoms which are detected by scales of depression are also present in anxiety disorders. This difficulty is one of the most important problems in clinics as it affects the validity and reliability of the tools which assess the disorders. The importance of the instructions given to the subjects should also be emphasized. In many cases they lead to the confusion of the measures of frequency and severity which is related to the classical discussion about the dimensional or categorical character of depression. Some authors state that the consideration of depression as a dimensional disorder makes possible to understand that some charts, as for example the anxiety disorders, can appear as a consequence of certain vulnerability generated by the depression. One of the alternatives to explain the presence of symptoms shared by the anxiety and depression is to consider the existence of a factor of negative affect which would be present in both types of disorder. This point of view is derived from the correspondence between some common symptoms in depression and anxiety observed in clinics. Additionally, some items included in the self-report questionnaires and scales are the same for the two disorders. The group of symptoms includes sadness, crying, psychomotor restlessness and irritability among others. The factor which includes these symptoms is called negative affect and would be common for the anxiety and depression. Although the negative affect factor is the same for anxiety and depression, some elements are characteristic for one disorder but not for the other. In case of anxiety, according to the tripartite model the characteristic factor refers to high physiological activation related to the vegetative symptoms. On the other hand, in depression, the negative affect is also accompanied by low positive affect which can be seen in the lost of interest in things which were enjoyed before (anhedony). Thus, the anxiety would be defined as high negative affect together with high physiological arousal whereas depression is characterized by high negative affect and low positive affect. For all the reasons described above, the importance of applying adequate and reliable instruments to evaluate the disorders should be emphasized. These instruments would help to clarify the features of each disorder and would support more effective interventions to decrease the rate and incidence of mental disorders in the population. In relation to this, Spielberger et al. offer an instrument which differentiates the aspects characteristic for depression utilizing two different scales: depression as a trait and as a state. The instrument allows the differentiation between the trait and the state which provides the information about the aspects which are more stable and lasting in time related to the mood which probably refer to the personality traits (the trait scale). The aspects which depend more on the punctual moments are measured by the state scale. This is possible thanks to the instructions which evaluate in a different manner the frequency and the severity which are usually confused in most of the scales. The component of negative affect (Dysthymia) which is common for the anxiety and depression is evaluated together with positive affect (Euthymia) and offers the valuation of low affectation levels which are not considered in most of the self-report questionnaires, although they are crucial for the clinical practice and investigation. <![CDATA[Validez del Cuestionario Breve de Tamizaje y Diagnóstico (CBTD) para niños y adolescentes en escenarios clínicos]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200042&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>SUMMARY Background: Psychopathology in children can be conceptualized as a normal development that has gone awry. That is, some conducts which are expectable at a certain age could turn to be inappropriate and pathological if they persist. When some traits, conducts or signs are very conspicuous and they are frequently present together, they are conventionally called syndromes. Studies registering children’s observed conducts by the parents have been very useful to identify groups of symptoms, and several scales have been designed to elicit psychopathology such as the Children’s Behavior Questionnaire (CBQ), Conner’s scales, and the Child Behavior Checklist, CBCL-P. With the exception of the CBQ, the other two instruments, although frequently used as screening instruments in several studies, are too long or too specific to be systematically employed at the general practice services and in the community. More recently, Goodman designed the Strengths and Difficulties Questionnaire (SDQ), which is a 25-item instrument showing an acceptable predictive validity for three groups of disorders: conduct, emotional, hyperactivity and inattentive. In Mexico, our epidemiological work on children’s mental health started at the end of the eighties using the Report Questionnaire for Children (RQC) which is a 10-item screening instrument developed at the end of the seventies for a WHO collaborative research with the aim of extending psychiatric services to primary care settings. In our population, the instrument showed good efficiency with a positive predictive value (PPV) of 76% and a negative predictive value (NPV) of 99%, and it has been useful in detecting mental health problems both in the general population, as well as in primary care services. However, the need to identify what kind of disorders are they and estimating their prevalence remains. The Brief Screening and Diagnostic Questionnaire (CBTD) was built based on previous experience using the RQC. Seventeen items which explored 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, which explore hyperactivity, impulsivity, attention deficit, sadness, inhibition, oppositional and antisocial behaviors, and eating behaviors associated with low or high weight. The aim was to include cardinal symptoms that could lead to identify probable specific syndromes and disorders, based on the parent’s report. The reliability of the instrument was measured using the Kuder- Richarson coefficient (KR-20), obtaining a 0.81 value. Based on responses obtained in a general population sample of 1686 children aged 4 to 16 years in Mexico City, the score at the 90th percentile, five symptoms, was established to define probable caseness. Also, using logistic regression analysis, the association between the cardinal symptoms for different disorders -as defined in the DSMIV and ICD-10 diagnostic criteria- and the rest of the items from the questionnaire was studied in order to obtain symptom profiles or syndromes signaling probable psychiatric disorders. The main objective of the present study was to evaluate the concurrent validity and the efficiency of the diagnostic algorithms of the CBTD, as compared with the psychiatric diagnoses of children attended at two out-patient mental health services in Mexico City. Method: A random sample of consecutive new out-patients aged 4 to 16 years was obtained. The CBTD was administered to the accompanying parent before the consultation. Clinical evaluation was done independently and blind to these results; the psychiatrists emitted diagnoses following the ICD-10 criteria. Diagnostic reliability between this initial evaluation and further diagnosis of hyperactivity and attention deficit disorder, depressive disorder, oppositional and conduct disorder and anxiety disorders, established at the different clinics of the children’s psychiatric hospital showed good agreement with Kappa values ranging from 0.60 to 0.83. Concurrent validity between the diagnostic algorithms of the CBTD and the psychiatric diagnoses was measured using Kappa and Yule statistics. Efficiency measures: sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were also obtained. Results: A total of 530 children were included in the study; 73% were male and 27% female; mean-age was 9.35 (s.d. 3.12) year old. Only eight patients reported less than five symptoms in the CBTD. The 4/5 cut-off point showed a sensitivity of 98.7% and PPV of 99.8%. However, as very few children were below the cut-off point, specificity resulted in 50% and NPV was 12.5%. Also, as the children attended the psychiatric services, they showed a highly symptomatic profile (median= 11 symptoms), concurrent validity analyses were first carried out in a sub-sample including only those patients with three CBTD syndromes at the most (n= 102). Diagnostic algorithms for attention deficit and hyperactivity, depression, and conduct disorders showed fair agreement with the corresponding psychiatric diagnoses: Yule statistic range from 0.43 to 0.55. As it could be expected, sensitivity (range: 71% to 84%) and NPV (range: 85% to 97%) were higher for the most general algorithms, while specificity and PPV were higher for the most stringent definitions. Analyses including the whole sample showed a sensitivity ranging from 54% to 95%, and NPV from 70% to 98% for the different diagnostic algorithms, and thus indicating a high efficiency of this brief instrument. Conclusion: The CBTD seems to be a good and efficient screening instrument, useful for the detection of the most frequent psychiatric disorders in childhood and early adolescence. Results suggest that it should be tested and incorporated as a tool at primary health services for the systematic surveillance of mental health during childhood and adolescence. <![CDATA[La detección de casos de trastorno bipolar por medio de un instrumento de tamizaje: el Cuestionario de Trastornos del Animo versión en español]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200050&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary Bipolar spectrum disorder which includes bipolar I, bipolar II, ciclothymia and bipolar disorder, not otherwise specified often goes unidentyfied, underdiagnosed, or confounded with major depressive disorder. There are several considerations that try to explain this frequent omission. One crucial aspect is that, the first mood episode at onset is often a depressive one, and some bipolar patients present multiple depressive episodes prior to their first episode of mania. Additionally, long-term evaluation of patients with bipolar I or II disorders, reveal that depressive symptoms occur more common than manic or hypomanic symptoms. Another plausible explanation is that bipolar patients frequently underreport symptoms of mania. Thus it is not surprising to find that in many patients, may elapse about 10 years from the first time for they seek treatment until a clinician finally makes the correct diagnosis. As a consequence, such patients may suffer poorer outcomes, subsyndromal symptoms and a course of illness marked by more sever symptoms, chronic mood episodes, increased recurrence and more impaired psychosocial functioning. The correct diagnosis of bipolar disorder becomes an important and crucial issue, if it is considered that there is a current trend to understand better this affective illness as a spectral disorder. This concept helps to identify different subtle subtypes of bipolarity which often are unrecognized, by means of the actual diagnostic criteria. This diagnostic reformulation is based on the phenomenological manifestations of the entities, as well as in other specific clinical aspects, such as comorbidity, predominant episodes, genetic information and treatment response to among others. Thus, correct recognition of bipolar disorder will bring an important benefit to patients and may reduce erratic treatments and improve outcome. Several epidemiological studies report that the global prevalence of bipolar I disorder is around 1%, in the general population, but when considering all subtypes included in the bipolar spectrum, this lifetime prevalence increases up to 5%. As a consequence of an incorrect diagnosis, patients are often undertreated or receive an erroneous pharmacological treatment, mainly with antidepressants, which complicate outcome by promoting manic or hypomanic reactions and may have devastating consequences in the further clinical intents to stabilize the disorder. In order to increase the recognition of an illness, the correct utilization of a clinical screening procedure is mandatory. Several screening instruments exist for a variety of psychiatric disorders. However, only until recently, some of them have been developed specifically to identify bipolar disorders. The Mood Disorder Questionnaire, was the first screening instrument specifically developed to detect bipolar cases in clinical settings. It is a self-report, single-page, paper and pencil inventory than can be quickly and easily scored by a physician, a nurse or by trained medical staff assistance. It is composed of 13 questions which are answered with a positive or negative fashion, elaborated from the bipolar diagnostic criteria and clinical experience and inquires about possible manic symptoms. In the original report of its development and validation, it was concluded that it is a useful screening instrument for bipolar spectrum disorders, with a good sensitivity (0.73) and a very good specificity (0.90). Method: The questionnaire has been translated to other languages and has been used in non-clinical settings, with very good standards of performance. Since there is not a Spanish version of it, we decided to translate this instrument and to design a trial for the following purposes: 1) to obtain a validated and understandable Spanish version of the questionnaire. 2) To determine its sensibility and specificity in a sample of patients with affective disorders. 3) To identify its optimal cutoff score for screening purposes. The first step in our study consisted in the development of a translated version of the instrument. For that purpose a translation- retranslation procedure was utilized, in which four clinical psychiatrists with experience in treating bipolar patients made each one a separate translation. Then, all the versions were discussed until a consensus was reached in a final version. This version was retranslated to English and, after making some adjustments, the final version in Spanish was concluded. The study aimed to determine the clinimetric parameters of the Mood Disorder Questionnaire in its Spanish version, was conducted at the outpatient affective disorders clinic in the National Institute of Psychiatry Ramón de la Fuente, in México City. Patients with an age of 18 years and over who looked for psychiatric consultation, due to the presence of affective disorder were invited to participate. After explaining the procedure and the purposes of the study, all those who accepted to participate, signed 51 an informed consent document. This study was approved by the Ethical Committee of our institution. All patients completed the Mood Disorder Questionnaire. Two experienced clinical psychiatrists, blind to the questionnaire results, applied the Structural Clinical Interview for DSM-IV (SCID) to obtain the specific affective diagnosis in all the patients. Clinical and demographic data, as well as results from the clinical interview and questionnaire’s scores, were obtained and then analyzed. Sensitivity and specificity for each Mood Disorder Questionnaire score, were plotted by using results from the SCID interview as a standard. Sensitivity (percent of criterion standard diagnosis correctly diagnosed by the questionnaire) and specificity (percent of criterion standard noncases correctly identified as noncases by the questionnaire) were obtained by using different symptoms, threshold that ranged from 5 to 10 points in order to determine the optimal screen threshold. Results: A total of 100 patients were included in the study. Mean age for the complete group was 35.3 years and 64% were female. According to the SCID results, 49 patients had a diagnosis within the bipolar spectrum disorder and 51 had a unipolar affective diagnosis. Each group included patients with both first and recurrent episodes, and with and without comorbidities. The questionnaire was completed by the total sample of patients covering the total range of answer’s possibilities, from non-positive responses (1% of the sample) to 13 positive responses (15% of the sample). Mean score (± SD) was 8.06 (3.5) with a significant difference between patients in the bipolar group (10.3 ± 2.7) and patients in the unipolar group (5.8 ± 2.7); t = -8.2, 98 gl, p&lt;0.001. Using different cutoff scores sensitivity and specificity were calculated, observing that with a 10 point cutoff score, equilibrated sensitivity (0.71) and specificity (0.92) levels were obtained. Conclusions: The study was aimed to obtain an adequate translated version into Spanish of the Mood Disorder Questionnaire, and to determine its sensitivity and specificity, according to an optimal cutoff score, for correctly detecting bipolarity from a sample of affective disorder patients. With a reliable procedure of translation process, we obtained a satisfactory, understandable and easy to use version for patients. Similar to other reports, a structured clinical interview was utilized to obtain the patients diagnoses. After evaluating with different cutoff scores, we found that a score of 10, gives an adequate distribution for levels of sensitivity and specificity. However, lower scores (between 7 and 9), also give adequate levels of sensitivity and specificity. It is important to consider, that our study was done in a very specific sample of patients who had only affective disorders. With these type patients it is necessary to raise the bar sufficiently to obtain adequate results. In other studies that included non-affective patients the questionnaire worked well with lower cutoff points. The operating characteristics of the Mood Disorder Questionnaire in its Spanish version are sufficiently good to consider its application as a reliable screening instrument for detecting bipolar spectrum disorders at least, in an affective disorders clinical setting. Further studies are needed to evaluate whether the instrument would be useful in other psychiatric settings as well as in community or primary care samples, and also to determine the best cutoff point depending in the characteristics of the population in which it is being used. <![CDATA[Datos psicométricos del EMBU-I “Mis memorias de crianza” como indicador de la percepción de crianza en una muestra de adolescentes de la Ciudad de México]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200058&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>SUMMARY Introduction: Childrearing or parenting is the assumption of responsibility for the emotional, social and physical growth and development of a child. Research literature has identified three related components commonly associated to rearing or parenting: a) spontaneous emotions and attitudes that are non-goal directed parental behaviors such as gestures, changes in the tone of voice, temperamental bursts, body language; b) specific goal-directed parental practices, which are better understood in the context of a socialization domain (academic achievement, peer cooperation), and c) the value system and beliefs of parents related to socialization goals of their children. Based on sound empirical data, there is no doubt about the impact of child-rearing environments on a wide variety of outcomes, ranging from normal variations of adaptive functioning and school success to an array of psychopathological results such as drug abuse, aggressive behavior, and anxiety in children and adolescents. During adolescence, parenting implies the transformation of the relationships between parents and children. This is a critical transition period in which the emerging social demands turn it into a particularly vulnerable period of life. Psychological distress that arises in adolescents may threaten their mental health on a medium and long term-basis. Based on an exhaustive literature study related to the parentchild relationship and the shared family environment, Repetti et al. suggest that conflict, lack of cohesion and organization, as well as unsupportive, cold and neglectful environments, were characteristic of families in risk of developing physical and mental problems. Adolescent studies provided evidence related to alcohol and drugs abuse, involvement in pregnancy, aggressive behaviour and delinquency as outcomes for children from families lacking cohesion and orderliness, as well as emotional warmth, support and involvement in parenting. Thus, it is important to rely on instruments that measure parenting and whose dimensions have proven to be relevant to the outcomes evaluated. One empirically evaluated instrument, in terms of internal consistency, construct validity, and convergent and divergent validity in transcultural context, is the Egna Minnen Betraffande Uppfostran-My memories of upbringing (EMBU). It has been extensively used and adapted in more than 25 countries, including Spanish-speaking populations from Guatemala, Venezuela and Spain. Factor analyses have revealed four factors (emotional warmth, rejection, control/overprotection and favouring subject), and multiple studies have documented the validity, reliability and cross-national transferability of the EMBU. Criticism regarding the retrospective nature of the EMBU has been overcome by designs with younger samples confirming its cross-stability for all scales except favouritism scale. There is a lack of instruments measuring parenting in Spanishspeaking countries. It is imperative to evaluate parental perceptions with adolescents as the source of information. There is, therefore, a need to empirically evaluate a reliable and valid parenting measurement, whose relational nature dimensions (warmth/rejection, control) can also be compared with those found in other countries. The purpose of the present study was to explore the psychometric properties of the EMBU-I in a sample of Mexican adolescents. In particular, its aim was to test the reliability (internal consistency), the congruency of the dimensions for fathers and mothers and within the scales comprising the EMBU, and its convergent and divergent validity. Method: Seven hundred seventy five adolescents, with a mean age of 13.81 years, from two secondary schools, one public and one private, participated in the study. Instruments: EMBU-C, parental involvement in studies scale, and the cohesion, conflict and organization scales from the FES. All of them showed reliability values above .50. Results: Emotional warmth, rejection, and control showed evidence of good internal consistency (Cronbach’s alphas above or equal .65), except favoritism, in agreement with previous studies. Correlation between both scales, for father and mother (emotional warmth, rejection and control) was positive and high. Negative correlations were found between emotional warmth and rejection, as expect. Interestingly, perception of father control positively correlated with warmth, whereas perception of mother control was higher loaded on rejection than in warmth. The multiple correlation analysis of each scale of the EMBU and the other instruments were as follows: warmth in both parents correlated positively with organization and cohesion in family and rejection, again in both parents, also correlated with conflict. Warmth and control for father, as well as for mother, correlated with parental involvement in studies, but stronger correlations were documented in the case of perception of father’s involvement. For mothers, cohesion and organization showed a tendency to correlate higher with involvement in studies. Results support the convergent validity of the scales. Evidence for the divergent validation was provided through the negative correlations found between warmth and conflict. This was also true for cohesion and organization, with regard to rejection. As expected, rejection also showed a negative correlation with parental involvement in studies. In agreement with other studies, the present study corroborates internal consistency in Mexican adolescents, as well as convergent and divergent validity of the EMBU-C scales of emotional warmth, rejection and control. A finding of this study was the different correlation tendency found between the dimension of control for fathers and mothers, suggesting that control in fathers is perceived more as warmth than rejection, in contrast to other studies. Also warmth and control, again in the fathers’ case, correlated higher with involvement in studies. This finding is in agreement with Youniss and Smollar, whose findings suggest a differential perception of fathers and mothers, especially in early adolescence. Mexican boys and girls tend to perceive fathers with more deference and as advisors or instructors. Although the risky families’ construct has a wider perspective, it is also important to evaluate separately the family unit with regard to the adolescent-parent relationship because intervention strategies are different. According to adolescent perception, parenting dimensions related to emotional climate are notably related to other parental components, such as parental involvement in school or family cohesion and organization. Psychometric properties of EMBU-C were acceptable in terms of reliability and validity. It proved to be a useful tool for future studies, purported to evaluate adolescent perception of parental childrearing. Future studies should provide further data on test-retest reliability, confirmatory factor analyses testing the three factor resolution found in previous studies and on its convergent validity. Limitations of the present study arise from the sample of students and its socioeconomic or demographic restrictions. Future studies could overcome the fact that data come only from one source, i.e., children. Concurrent validity comparing EMBU-C with other parenting indicators is also needed. <![CDATA[Consistencia interna a lo largo de un año del Inventario HOME-infantes en un grupo de niños de la Ciudad de México y zona metropolitana]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200067&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary As the environment is a crucial source in an infant’s development, it is important to assess the proximal environment where a variety of social relationships take place. Experiences derived from the home environment allow the specific activities that a child builds actively. These opportunities have an outstanding impact on an infant’s development. The home concept and its influence on development led to the discovery and interrelations of several dimensions and today’s emphasis relies on identifying the mechanisms of the variability of environment that exert an influence on the variability of development. Under this perspective, at the end of the 1960’s the Infant/Toddler HOME Inventory was developed by Caldwell and Bradley. Very soon, Cravioto adapted it for its use in a Mexican population according to the characteristics of typical families and cultural aspects. The purpose of this investigation was to establish the internal consistency of the Infant/Toddler HOME Inventory in the version adapted by Cravioto through the assessment of the precision of its scoring in terms of internal consistency. Cohort: 62 infants and their mothers were contacted in the first 72 hours after delivery through a Research Program from the Child Psychiatry Hospital Dr. Juan N. Navarro (Environmental Modulation of Infancy Development). They were born in two Mexico City hospitals: a state public hospital, Hospital de la Mujer (Women’s Hospital) and in the Mother-infant Research Center from the Birth Study Group (CIMIGEN). All of them were low-risk infants who met the criteria for a one year follow up and whose parents gave their informed consent and accepted to be visited at their homes. The distribution of the infants group by sex was: 30 infants (48%) were female and 32 (52%) were male. Families were classified as follows: 72.5% were nuclear and 27.5% were extended. According to their socioeconomic profile, a high relationship was found between income and housing: seven (11.3%) of the highest income families lived in houses or apartments of their own or rented, where there were more rooms than inhabitants, whereas all others were living as follows: crowded houses or apartments (23 families, 37.1%), houses with of only one room (4 families, 6.5%) and the poorest houses with collective bathroom (28 families, 45.2%). All households had electrical lighting and most of them had also drinkable water inside their homes (98.4%); one shared water from a deep pond with their community. Bathrooms were: 35.5% with running water, 59.7% used a bucket for carrying water and 4.8% had latrine. Instrument: The Infant/Toddler HOME Inventory, version adapted by Cravioto, with 62 items in a binary format response was used. Subscale VII, Play Materials, asked about color, size, consistency or texture and type of toys. The instrument is administered by having a person calling the home at a time when the infant is awake and can be observed interacting with the mother or principal caregiver. The internal consistency of the Infant/Toddler HOME Inventory was monthly assessed for each of its subscales and the total scale, until the child’s first year of life (12 months), applying Cronbach’s alpha. Results showed that alpha coefficient’s values higher than 0.60 throughout the 12 months were observed in the VII Play Materials shoed a range of 0.64 and 0.84, and 0.60 and 0.83 for the Total Scale. On the other hand, subscale VI, Physical Environment, showed a less than 0.60 value with an internal consistency coefficient of 0.56 in the first month of life; nevertheless the remaining months had values between 0.60 and 0.70. This was also observed with subscale II, Mental Development and Vocal Stimulation, with a 0.58 value for the first month of life and alpha values between 0.63 and 0.74 for the remaining eleven assessments. Subscale III, Emotional Climate, exhibited seven evaluations in a range between 0.61 and 0.76; this is the second with a 0.61, fourth with 0.69, sixth with 0.76, seventh with 0.67, ninth with 0.63, tenth with 0.69 and eleventh 0.63. Non-acceptable internal consistency, it is less than 0.60 in most of their scorings were observed for the following scales: I. Adult Contact, V. Breadth of Experience. Only in the sixth month’s a value of 0.64 was observed, and the rest of scales exhibited a range within a 0.38 as inferior limit and 0.56 superior limit in the former and a 0.65 value in the tenth month and 0.60 in the eleventh. Subscale IV, Avoidance of Restriction, showed the lowest coefficient with values between 0.24 and 0.49. These results suggest that most of the subscales had adequate reliabilities, except for subscales I, Adult Contact; IV, Avoidance of Restriction; and V, Breadth of Experience. The purpose of this study was to evaluate the internal consistency of an instrument which measures the home environment quality in infants during their first year of life. Results showed the Infant/Toddler HOME Inventory had high internal consistency values in the Total Scale. These results are similar to those obtained by Banard, Bee &amp; Hammond with a group of 179 children in Seattle, where they found 0.77 values at fourth months, 0.81 at eight and 0.86 at twelve. Our findings were within a rank of 0.68 and 0.83. Cronbach’s alpha value obtained for the different subscales showed intersubscale differences. Subscales II, III, VI and VII showed internal consistency values equal or higher than 0.60 in most of the assessments during the 12 months of life. This implies measurements are precise and reliable when using them in low risk Mexican infants. Lower values found in subscales I, Adult Contact, IV, Avoidance of Restriction and V, Breadth of the Experience, may be due to the low number of items. According to Nunnally and Bernstein, it is recommended that measurements with a low internal consistency should be used with initial, non-crucial decisions, and with temporary and reversible effects susceptible to replication and rectification. It is very important to stress the fact that this Infant/Toddler HOME Inventory version is not comparable with other in the literature because the structure was notably modified. Limitations in this study are not only this modification, but the size sample, and future research efforts should overcome this fact by trying to sample infants from different Mexican regions. This study points out the need to adapt, develop and evaluate psychometrically instruments that measure specific aspects of the environment of infant’s homes. Our results may be an initial step for those interested in measurements of Mexican families homes, or in those interested in the Infant/Toddler HOME Inventory as an indicator of the environmental aspects in early infancy. <![CDATA[In memoriam: Doctor José María Calvo y Otálora]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200074&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary As the environment is a crucial source in an infant’s development, it is important to assess the proximal environment where a variety of social relationships take place. Experiences derived from the home environment allow the specific activities that a child builds actively. These opportunities have an outstanding impact on an infant’s development. The home concept and its influence on development led to the discovery and interrelations of several dimensions and today’s emphasis relies on identifying the mechanisms of the variability of environment that exert an influence on the variability of development. Under this perspective, at the end of the 1960’s the Infant/Toddler HOME Inventory was developed by Caldwell and Bradley. Very soon, Cravioto adapted it for its use in a Mexican population according to the characteristics of typical families and cultural aspects. The purpose of this investigation was to establish the internal consistency of the Infant/Toddler HOME Inventory in the version adapted by Cravioto through the assessment of the precision of its scoring in terms of internal consistency. Cohort: 62 infants and their mothers were contacted in the first 72 hours after delivery through a Research Program from the Child Psychiatry Hospital Dr. Juan N. Navarro (Environmental Modulation of Infancy Development). They were born in two Mexico City hospitals: a state public hospital, Hospital de la Mujer (Women’s Hospital) and in the Mother-infant Research Center from the Birth Study Group (CIMIGEN). All of them were low-risk infants who met the criteria for a one year follow up and whose parents gave their informed consent and accepted to be visited at their homes. The distribution of the infants group by sex was: 30 infants (48%) were female and 32 (52%) were male. Families were classified as follows: 72.5% were nuclear and 27.5% were extended. According to their socioeconomic profile, a high relationship was found between income and housing: seven (11.3%) of the highest income families lived in houses or apartments of their own or rented, where there were more rooms than inhabitants, whereas all others were living as follows: crowded houses or apartments (23 families, 37.1%), houses with of only one room (4 families, 6.5%) and the poorest houses with collective bathroom (28 families, 45.2%). All households had electrical lighting and most of them had also drinkable water inside their homes (98.4%); one shared water from a deep pond with their community. Bathrooms were: 35.5% with running water, 59.7% used a bucket for carrying water and 4.8% had latrine. Instrument: The Infant/Toddler HOME Inventory, version adapted by Cravioto, with 62 items in a binary format response was used. Subscale VII, Play Materials, asked about color, size, consistency or texture and type of toys. The instrument is administered by having a person calling the home at a time when the infant is awake and can be observed interacting with the mother or principal caregiver. The internal consistency of the Infant/Toddler HOME Inventory was monthly assessed for each of its subscales and the total scale, until the child’s first year of life (12 months), applying Cronbach’s alpha. Results showed that alpha coefficient’s values higher than 0.60 throughout the 12 months were observed in the VII Play Materials shoed a range of 0.64 and 0.84, and 0.60 and 0.83 for the Total Scale. On the other hand, subscale VI, Physical Environment, showed a less than 0.60 value with an internal consistency coefficient of 0.56 in the first month of life; nevertheless the remaining months had values between 0.60 and 0.70. This was also observed with subscale II, Mental Development and Vocal Stimulation, with a 0.58 value for the first month of life and alpha values between 0.63 and 0.74 for the remaining eleven assessments. Subscale III, Emotional Climate, exhibited seven evaluations in a range between 0.61 and 0.76; this is the second with a 0.61, fourth with 0.69, sixth with 0.76, seventh with 0.67, ninth with 0.63, tenth with 0.69 and eleventh 0.63. Non-acceptable internal consistency, it is less than 0.60 in most of their scorings were observed for the following scales: I. Adult Contact, V. Breadth of Experience. Only in the sixth month’s a value of 0.64 was observed, and the rest of scales exhibited a range within a 0.38 as inferior limit and 0.56 superior limit in the former and a 0.65 value in the tenth month and 0.60 in the eleventh. Subscale IV, Avoidance of Restriction, showed the lowest coefficient with values between 0.24 and 0.49. These results suggest that most of the subscales had adequate reliabilities, except for subscales I, Adult Contact; IV, Avoidance of Restriction; and V, Breadth of Experience. The purpose of this study was to evaluate the internal consistency of an instrument which measures the home environment quality in infants during their first year of life. Results showed the Infant/Toddler HOME Inventory had high internal consistency values in the Total Scale. These results are similar to those obtained by Banard, Bee &amp; Hammond with a group of 179 children in Seattle, where they found 0.77 values at fourth months, 0.81 at eight and 0.86 at twelve. Our findings were within a rank of 0.68 and 0.83. Cronbach’s alpha value obtained for the different subscales showed intersubscale differences. Subscales II, III, VI and VII showed internal consistency values equal or higher than 0.60 in most of the assessments during the 12 months of life. This implies measurements are precise and reliable when using them in low risk Mexican infants. Lower values found in subscales I, Adult Contact, IV, Avoidance of Restriction and V, Breadth of the Experience, may be due to the low number of items. According to Nunnally and Bernstein, it is recommended that measurements with a low internal consistency should be used with initial, non-crucial decisions, and with temporary and reversible effects susceptible to replication and rectification. It is very important to stress the fact that this Infant/Toddler HOME Inventory version is not comparable with other in the literature because the structure was notably modified. Limitations in this study are not only this modification, but the size sample, and future research efforts should overcome this fact by trying to sample infants from different Mexican regions. This study points out the need to adapt, develop and evaluate psychometrically instruments that measure specific aspects of the environment of infant’s homes. Our results may be an initial step for those interested in measurements of Mexican families homes, or in those interested in the Infant/Toddler HOME Inventory as an indicator of the environmental aspects in early infancy. <![CDATA[Trastornos mentales y problemas de salud mental. Día Mundial de la Salud Mental 2007]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252007000200075&lng=pt&nrm=iso&tlng=pt resumen está disponible en el texto completo<hr/>Summary As the environment is a crucial source in an infant’s development, it is important to assess the proximal environment where a variety of social relationships take place. Experiences derived from the home environment allow the specific activities that a child builds actively. These opportunities have an outstanding impact on an infant’s development. The home concept and its influence on development led to the discovery and interrelations of several dimensions and today’s emphasis relies on identifying the mechanisms of the variability of environment that exert an influence on the variability of development. Under this perspective, at the end of the 1960’s the Infant/Toddler HOME Inventory was developed by Caldwell and Bradley. Very soon, Cravioto adapted it for its use in a Mexican population according to the characteristics of typical families and cultural aspects. The purpose of this investigation was to establish the internal consistency of the Infant/Toddler HOME Inventory in the version adapted by Cravioto through the assessment of the precision of its scoring in terms of internal consistency. Cohort: 62 infants and their mothers were contacted in the first 72 hours after delivery through a Research Program from the Child Psychiatry Hospital Dr. Juan N. Navarro (Environmental Modulation of Infancy Development). They were born in two Mexico City hospitals: a state public hospital, Hospital de la Mujer (Women’s Hospital) and in the Mother-infant Research Center from the Birth Study Group (CIMIGEN). All of them were low-risk infants who met the criteria for a one year follow up and whose parents gave their informed consent and accepted to be visited at their homes. The distribution of the infants group by sex was: 30 infants (48%) were female and 32 (52%) were male. Families were classified as follows: 72.5% were nuclear and 27.5% were extended. According to their socioeconomic profile, a high relationship was found between income and housing: seven (11.3%) of the highest income families lived in houses or apartments of their own or rented, where there were more rooms than inhabitants, whereas all others were living as follows: crowded houses or apartments (23 families, 37.1%), houses with of only one room (4 families, 6.5%) and the poorest houses with collective bathroom (28 families, 45.2%). All households had electrical lighting and most of them had also drinkable water inside their homes (98.4%); one shared water from a deep pond with their community. Bathrooms were: 35.5% with running water, 59.7% used a bucket for carrying water and 4.8% had latrine. Instrument: The Infant/Toddler HOME Inventory, version adapted by Cravioto, with 62 items in a binary format response was used. Subscale VII, Play Materials, asked about color, size, consistency or texture and type of toys. The instrument is administered by having a person calling the home at a time when the infant is awake and can be observed interacting with the mother or principal caregiver. The internal consistency of the Infant/Toddler HOME Inventory was monthly assessed for each of its subscales and the total scale, until the child’s first year of life (12 months), applying Cronbach’s alpha. Results showed that alpha coefficient’s values higher than 0.60 throughout the 12 months were observed in the VII Play Materials shoed a range of 0.64 and 0.84, and 0.60 and 0.83 for the Total Scale. On the other hand, subscale VI, Physical Environment, showed a less than 0.60 value with an internal consistency coefficient of 0.56 in the first month of life; nevertheless the remaining months had values between 0.60 and 0.70. This was also observed with subscale II, Mental Development and Vocal Stimulation, with a 0.58 value for the first month of life and alpha values between 0.63 and 0.74 for the remaining eleven assessments. Subscale III, Emotional Climate, exhibited seven evaluations in a range between 0.61 and 0.76; this is the second with a 0.61, fourth with 0.69, sixth with 0.76, seventh with 0.67, ninth with 0.63, tenth with 0.69 and eleventh 0.63. Non-acceptable internal consistency, it is less than 0.60 in most of their scorings were observed for the following scales: I. Adult Contact, V. Breadth of Experience. Only in the sixth month’s a value of 0.64 was observed, and the rest of scales exhibited a range within a 0.38 as inferior limit and 0.56 superior limit in the former and a 0.65 value in the tenth month and 0.60 in the eleventh. Subscale IV, Avoidance of Restriction, showed the lowest coefficient with values between 0.24 and 0.49. These results suggest that most of the subscales had adequate reliabilities, except for subscales I, Adult Contact; IV, Avoidance of Restriction; and V, Breadth of Experience. The purpose of this study was to evaluate the internal consistency of an instrument which measures the home environment quality in infants during their first year of life. Results showed the Infant/Toddler HOME Inventory had high internal consistency values in the Total Scale. These results are similar to those obtained by Banard, Bee &amp; Hammond with a group of 179 children in Seattle, where they found 0.77 values at fourth months, 0.81 at eight and 0.86 at twelve. Our findings were within a rank of 0.68 and 0.83. Cronbach’s alpha value obtained for the different subscales showed intersubscale differences. Subscales II, III, VI and VII showed internal consistency values equal or higher than 0.60 in most of the assessments during the 12 months of life. This implies measurements are precise and reliable when using them in low risk Mexican infants. Lower values found in subscales I, Adult Contact, IV, Avoidance of Restriction and V, Breadth of the Experience, may be due to the low number of items. According to Nunnally and Bernstein, it is recommended that measurements with a low internal consistency should be used with initial, non-crucial decisions, and with temporary and reversible effects susceptible to replication and rectification. It is very important to stress the fact that this Infant/Toddler HOME Inventory version is not comparable with other in the literature because the structure was notably modified. Limitations in this study are not only this modification, but the size sample, and future research efforts should overcome this fact by trying to sample infants from different Mexican regions. This study points out the need to adapt, develop and evaluate psychometrically instruments that measure specific aspects of the environment of infant’s homes. Our results may be an initial step for those interested in measurements of Mexican families homes, or in those interested in the Infant/Toddler HOME Inventory as an indicator of the environmental aspects in early infancy.