Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520080005&lang=es vol. 31 num. 5 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>La psiquiatría como saber-hacer, saber-estar y hacer-saber</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Síntomas psiquiátricos y rasgos de personalidad en dos grupos opuestos de la Facultad de Medicina de la UNAM</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500002&lng=es&nrm=iso&tlng=es Introduction Recent studies have shown an increase in psychiatric symptomatology in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety, depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger. It has also been documented that there is a significant link between certain personality traits and the presence or absence of mental symptoms, regardless of the situations to which people are exposed. The feature with the highest association with the presence of symptomatology is neuroticism, while the personality traits that are most conducive to the achievement of academic success and better adaptation and, therefore, a lower number of symptoms are empathy and kindness. The purpose of this study was to establish a diagnosis of the mental health and personality traits of medical students in the high performance groups and compare them with those of the groups of students that performed poorly during the first two years of the degree course. This transversal, exploratory study involved the participation of 370 students from the UNAM Medical School: 220 belonged to the high performance groups, called educational quality nuclei (NUCE), while 1 50 were repeat students. The variables considered were: age, sex, type of group (NUCE or repeat), academic year (first or second year of the degree), place of origin and type of high school from which they had graduated (public or private). Two instruments were used to measure personality traits and psychiatric symptomatology: the Big Five Personality Traits and the Symptom Check List-90. The results of the study show that in both groups (repeat students and NUCE) over 85% were from the Federal District. Repeat students were mainly women (85.3%) and students from public schools (93.6%). As for the high performance group (NUCE), 83.1 % were from private schools and just 1 6.9% from public schools. Repeat students showed personality traits that included neuroticism and very little openness compared with the high performance groups, which displayed traits of greater openness and less neuroticism, with p<0.01. In general, students from NUCE groups showed traits of greater extraversion, empathy and diligence compared with repeaters. Psychiatric symptomatology was more severe among the repeat group than the NUCE group (p<0.05). The psychiatric symptomatology displayed by both groups included: obsession-compulsion, depression and anxiety. In the comparisons, the two groups showed significant differences in total symptomatology. There were also differences in the following symptomatology, by order of importance: phobia, interpersonal sensitivity, somatization, anxiety, obsessive-compulsive disorder and psychoticism (p<0.05). Differences were found between academic years, with second-year students showing greater symptomatology; women displayed the greatest symptomatology. No differences were found for the interaction between sex and academic year. The analysis of structural models was used to determine the relationship between the variables being studied, with significant correlation coefficients with p<.05 being found between personality and sex, personality and type of high school, as well as type of group and suicidal ideation, academic year and psychiatric symptomatology, personality and suicidal ideation and personality and psychiatric symptomatology. The results of the study coincided with those in the literature, although there were some differences between the two groups of students. Repeat students displayed greater levels of psychiatric symptomatology compared with students in the high performance groups. This suggests that students who perform less well in their degree courses also report higher mean responses in psychiatric symptomatology, mainly on scales of somatization, anxiety, phobia and interpersonal sensitivity. As for type of personality, students in the high performance group reported higher average scores on the scales of extraversion, empathy and openness, with the exception of the neuroticism scale. This suggests that personality features may be predictors of better academic performance as well as greater intellectual skill. This finding is reinforced by the repeater group's results, since they report higher scores in the personality trait of neuroticism. The diligence scale was the same for both groups. The study corroborated the fact that second-year students display the greatest symptomatology, with women reporting higher averages in psychiatric symptomatology scores (mean = 7.3). Sex is associated with greater empathy and solidarity, with women achieving higher scores in both personality traits. Although the neuroticism trait is also associated with the female sex and suicidal ideation, scores for this trait were higher for men. This trait can be considered a predictor for both suicidal ideation and the presence of a higher number of psychiatric symptoms. Lastly, the symptomatology in which these students obtained the highest scores is related to the obsessive-compulsive disorder, a situation which we consider may be due to the type of screening test used. It is a fact that studying medicine involves continuously stressful conditions. For these students, however, seeking help to cope with the presence of psychiatric symptomatology is extremely complicated since they regard it as a form of weakness. This raises the need to develop large-scale programs to orient students in order to enable them to identify symptoms at an early stage, which in turn will permit timely treatment.<hr/>En estudios recientes se ha demostrado un incremento en la sintomatología psiquiátrica que presentan los estudiantes de medicina, así como los médicos durante su ejercicio profesional. En algunos estudios se señala que estos profesionistas tienen una prevalencia de síntomas psiquiátricos por arriba de los de la población general. Este fenómeno es una consecuencia de las condiciones propias de la actividad profesional y, en el caso de los alumnos, por situaciones que demandan una mayor exigencia académica, que conlleva a su vez situaciones estresantes que interfieren en su desempeño académico, así como en el desarrollo de habilidades clínicas que pueden repercutir en su relación con los pacientes. Los síntomas que predominan son la ansiedad, la depresión y el estrés, así como el consumo de sustancias; también se ha incrementado el número de estudiantes con intentos de suicidio. Se observa que la mayoría de estos problemas tipo se presentan en los dos primeros años de la carrera, así como en el año de internado. La depresión se encuentra enmascarada por enojo, en virtud de que ésta representa un enojo internalizado. Asimismo se ha documentado que existe una relación importante entre la presencia de ciertos rasgos de personalidad y la presencia o ausencia de síntomas mentales, independientemente de las situaciones a las que se expongan las personas. El rasgo que presenta una mayor asociación con la presencia de sintomatología es el neuroticismo, así como también los rasgos de personalidad que influyen con un mejor cumplimiento de logros académicos y una mejor adaptación. El objetivo de este trabajo fue establecer un diagnóstico de la salud mental y los rasgos de personalidad de los estudiantes de medicina que se encuentran en los grupos de alto rendimiento y compararlo con los grupos de alumnos que presentan bajo rendimiento académico durante los dos primeros años de la carrera. En este estudio exploratorio, de tipo transversal, participaron 370 estudiantes de la Facultad de Medicina de la UNAM: 220 correspondían a los grupos de alto rendimiento, llamados núcleos de calidad educativa (NUCE), y 150 eran alumnos repetidores. De entre los resultados que arrojó el estudio, se encontró que para ambos grupos (repetidores y NUCE) más de 85% provenía del Distrito Federal. En el grupo de repetidores predominaron las mujeres (85.3%) y los alumnos procedentes de escuelas públicas (93.6%). En relación con el grupo de alto rendimiento (NUCE), 83.1% procedía de escuelas privadas y sólo 16.9% de escuelas públicas. Los alumnos repetidores mostraron rasgos de personalidad de neuroticismo y de poca apertura en comparación con los grupos de alto rendimiento, quienes mostraron rasgos de mayor apertura y menor neuroticismo, con una p<0.01. En general, los alumnos de los grupos NUCE mostraron rasgos de mayor extroversión, mayor empatía y diligencia en comparación con los repetidores. La sintomatología psiquiátrica mostró mayor gravedad en el grupo repetidor con respecto al grupo NUCE (p<0.05). La sintomatología psiquiátrica que presentaron ambos grupos fue: obsesión-compulsión, depresión y ansiedad. Entre las comparaciones resultaron diferencias significativas en ambos grupos en el total de sintomatologías. También hubo diferencias en las siguientes sintomatologías por orden de importancia: fobia, sensibilidad interpersonal, somatización, ansiedad, trastorno obsesivo-compulsivo y psicoticismo (p<0.05). Los resultados del estudio presentan coincidencias con lo publicado por la bibliografía; sin embargo, hay diferencias entre ambos grupos de estudiantes. En los alumnos repetidores se observó mayor sintomatología psiquiátrica en comparación con los alumnos de los grupos de alto rendimiento. Por lo anterior, se concluye que los alumnos que presentan menores niveles de logro en la carrera también presentan medias de respuestas mayores en sintomatología psiquiátrica, principalmente en las escalas de somatización, ansiedad, fobia y sensibilidad interpersonal. <![CDATA[<b>Consumo de drogas en mujeres asistentes a centros de tratamiento especializado en la Ciudad de México</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500003&lng=es&nrm=iso&tlng=es Introduction There is plenty information about drug consumption in Mexico which examines from an epidemiological perspective several social groups such as: general population, student population, treatment centers, non-governmental organisms, homeless children, social re-adaption centers and even rural areas. However, these studies report drug consumption by gender and do not allow a precise analysis about specific characteristics in women, as the proportions of drug use are divergent and in some cases extremely different from those shown by men. This study analyses, specifically, women that received treatment according to age when admitted to a specialized institution, since it has been shown that age can influence drug use as well as treatment required. Also, it allows the introduction of prevention and treatment programs specifically for women. Methodology The objective of this study is to determine if there are significant differences in certain socio-demographic characteristics as weel as in factors related to the demand of drug treatment and consumption, according to female drug users age when admitted to treatment in CIJ. The study was based on information from the System of Epidemiological Information on Drug Consumption of CIJ. The design was exploratory, transversal and with a bi-varied analysis. The sample was non probabilistic and intentional, consisting of 754 drug users that arrived for the first time to CIJ between July and December 2004 in Mexico City. Furthermore, the sample was divided into three groups, according to admission age, as follows: Group 1. Women between 12 and 20 years old (n = 242); group 2. Women between 21 and 39 years old (n = 277), and group 3. Women 40 years old and older (n = 231). Results The sample showed a 31 years old average (DE=14.8) upon being admitted to CIJ: 51.2% were single, 32.6% were married or lived in cohabitation, 30.1% have studied high school; 32.8% stated that they had remunerated employment, 25.4% were homemakers and 23.8% were students. On average tobacco consumption starting age was 16.5 years old (DE = 5.3), alcoholic drinks 17 years old (DE = 5.9) and illegal drugs 18.5 years old (DE = 9.2). Tobacco (71.6%) was the main substance with which these women started drug use, followed by alcoholic drinks (19.9%). The most frecuently used illegal drugs as <<first>> substances were: marijuana (43.5%), solvents/removers (14.8%) and cocaine hydrochloride (11.8%). The most frecuently consumed drugs once in a lifetime were: tobacco (89.3%), alcoholic drinks (77.3%), marijuana (30.4%), crack (18.4%), cocaine hydrochloride (17.0%) and solvents and removers (15.4%). During the last year of use they were: tobacco (82.9%), alcoholic drinks (65.6%), marijuana (19.4%), crack (15.3%), cocaine hydrochloride (10.9%) and solvents and removers (10.1%). During the last month of use they were: tobacco (77.2%), alcoholic drinks (47.3%), marijuana (10.7%), crack (9.5%). In these three stages they consumed on average, including tobacco and alcoholic drinks, 2.9, 2.3 and 1.7 drugs respectively. Additionally, the sample shows that drugs prefered by women as well as those drugs that were harmful and damaging to their family, work or social life in the last year of use were: tobacco (48.9% vs 46.0%), alcohol drinks (20.0%) and crack (10.1% vs 10.7%). Furthermore, when comparing age groups it was observed that there were differences (p≤0.05) regarding marital status, education and occupation; finding, as could be expected according to the cycle of life, a larger proportion of women without partners in group 1 and 2; while the larger proportion of women that have at least 10 years of education (high school or more) were found in groups 2 and 3. The larger number of employed and unemployed women were found in group 1 while the largest percentage of homemakers were found in group 3. Likewise relevant differences were found (p≤0.05)regarding the following events: seeking treatment for tobacco use, alcohol and/or illegal drugs; seeking treatment by own initiative or conditioned by their family or due to medical guidance; interrupting consumption voluntarily without support and participating in self help groups; and current health, family, work, as well as psychological problems caused by drug consumption. The larger cases that were admitted because of illegal drugs or alcohol consumption were found in group 1, followed by group 2; while those admitted due to tobacco consumption were found in group 3. In the group 3, there was largest percentage of women seeking profesional help by their own will or following medical guidance, while those attending conditioned by their family were found in group 1. Additionally the largest proportion of women who attended support groups or that interrupted drug consumption at one time or another without support were found in group 2. The highest percentage of family problems associated to drug consumption was found in group 1; while health problems were found in group 3 and psychological or labor problems in group 2. Regarding drug consumption there were some relevant differences (p≤0.05) in the categories of <<first used>> drugs, such as: drugs consumed once in a lifetime, consumption in the last year, consumption in the last month, drug of preference during the last year, drug of greatest impact during the last year of consumption and consumption of two or more substances in the same day during the last year. According to once in a lifetime consumption, there were relevant differences (p≤0.05) between groups mainly in the use of: tobacco, alcoholic drinks, marijuana, cocaine, depressors and stimulants. However, between group 1 and 2 there were also differences (p≤0.05) in the consumption of inhalants. In the last year and in the last month at consumption, all groups differ from each other (p≤0.05) in tobacco and alcohol use. Also, in the last year of consumption differences were observed in the use of depressors. Also, when comparing groups 1 and 2 (p≤0.05) there were also found relevant differences in tobacco, marijuana, cocaine and inhalants consumption during the last year and the last months of consumption. Regarding consumption of alcoholic drinks, marijuana and inhalants once in a lifetime-in the last year and in the last month of consumption-, the highest proportion was found in group 1, as that found in cocaine in group 2 and that of tobacco in group 3. Even though tobacco, alcoholic drinks and illegal drugs were drugs of preference and of greatest impact during the last year of consumption, they showed different proportions between groups as follows (p≤0.5): group one reported the highest percentage of illegal drugs and alcohol while in group three the higher percentage was found in tobacco; and in group 2 tobacco and illegal drugs also yielded high percentages. Lastly, most cases where two or more drugs were consumed in the same day during the last year of consumption were found in group one, differing (p≤0.05) to those of group 2. Discussion Consequently it is very important to study drug users taking into account characteristics that allow us to provide information about their specific needs. This study offers evidence of relevant differences between women who seeked treatment at CIJ as well as differences related to age when admitted for treatment and that contributes useful elements to make progress in the development of differentiated preventative care and treatment for women in specialized institutes. Despite their limits, the results obtained offer a useful parameter for developing health care alternatives that will take into account factors such as drug users age, family, as well as social and health problems, substances that they have used in the past and those that they are consuming.<hr/>Introducción En los estudios del consumo de drogas en México existe información principalmente de tipo epidemiológico, la cual ha tomado en cuenta diversos sectores de la población abierta, por ejemplo la estudiantil, los centros de tratamiento, los organismos no gubernamentales, los niños en condición de calle, los centros de readaptación social e incluso la población rural. Dichos estudios dan cuenta del consumo de drogas por género y no permiten observar las características específicas de éste únicamente en mujeres, ya que las proporciones del uso de drogas son divergentes y en algunos casos extremas a las presentadas por hombres. Metodología El objetivo de este estudio es determinar la existencia de diferencias significativas en las características sociodemográficas, así como en los factores asociados con la demanda de tratamiento y con el consumo de drogas de acuerdo con la edad de ingreso al tratamiento. El estudio se realizó mediante un análisis bivariado y se basó en mujeres usuarias de drogas que solicitaron atención en Centros de Integración Juvenil (CIJ). Igualmente, se utilizó información del consumo de drogas de CIJ. Además, se extrajo una muestra no probabilística intencional de 754 mujeres que acudieron entre julio y diciembre de 2004 a las unidades de la Ciudad de México y se dividió en tres grupos de edad: 1) de 12 a 20 años; 2) de 21 a 39 años y 3) de 40 años y más. Resultados En promedio, al momento de ingresar a los CIJ las mujeres contaban con 31 años. La edad de inicio del consumo de tabaco fue a los 16.4 años, la de bebidas alcohólicas a los 17 años y la de drogas ilícitas a los 18.5 años. El tabaco (71.6%) fue la principal sustancia con la que iniciaron el consumo de drogas. Sin embargo, la droga ilícita de inicio más utilizada fue la mariguana (43.5%). Las drogas más consumidas alguna vez en la vida -durante el último año y el último mes-, así como las de preferencia y de mayor impacto fueron: tabaco, bebidas alcohólicas y mariguana. Al comparar los tres grupos de edad se observó que en el grupo 1 la mayoría no cuentan con pareja, se dedican a estudiar o trabajar y acuden condicionadas por la familia o por la escuela debido, principalmente, al consumo de drogas ilícitas y de bebidas alcohólicas. En este grupo los problemas asociados con su consumo son de tipo familiar y escolar, y las drogas más usadas fueron: tabaco, alcohol, mariguana, inhalables y cocaína. El segundo grupo se caracteriza porque en su mayoría son solteras, se dedican a estudiar o trabajar, acuden principalmente por iniciativa propia debido al consumo de tabaco y drogas ilícitas. Las acciones realizadas contra el consumo han sido principalmente la interrupción voluntaria sin apoyo y el acudir a grupos de autoayuda. En este grupo, los principales problemas asociados con el consumo fueron los familiares, de salud y psicológicos, y las principales drogas consumidas fueron: tabaco, alcohol, cocaína, mariguana, depresores e inhalables. Por último, el tercer grupo se caracteriza porque tienen pareja, se dedican a trabajar o al hogar; acuden principalmente por iniciativa propia en busca de un tratamiento para el consumo de tabaco. La acción predominante de este grupo contra el consumo de drogas ha sido la interrupción voluntaria sin apoyo y los problemas asociados a su consumo son de salud y familiares. Las sustancias que predominan en este rango de edad fueron el tabaco y el alcohol. Discusión Los resultados obtenidos ofrecen un parámetro útil para desarrollar alternativas de atención que tomen en cuenta distintos factores. Por ejemplo: la edad de las usuarias, así como los problemas familiares, sociales y de salud que enfrentan, las sustancias que han utilizado y las que están consumiendo en ese momento. Esto permitirá dar un mejor trato a toda usuaria que decida acudir a algún centro de tratamiento especializado, y así propiciar una mejor utilización de recursos económicos y humanos, pues se proporcionaría una atención específica de acuerdo a sus necesidades. Por ejemplo, en el tercer grupo los programas de atención podrían estar enfocados al uso de tabaco, mientras que en el segundo grupo podrían considerar tratamientos donde también se tome en cuenta el consumo de tabaco y de drogas ilícitas. <![CDATA[<b>Comparación del ambiente familiar y el tipo de consumo de tabaco en adolescentes mexicanos de nivel medio superior</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500004&lng=es&nrm=iso&tlng=es Introduction Tobacco use is an addiction of which prevalence, incidence, morbimortality, and medical and social impact have turned it into a global public health problem. It has been related with eleven causes of death and every year 4.9 million tobacco-related deaths occur at 30 years of age. By 2030, an estimated 10 million annual deaths will be tobacco-related. In the United States health care expenses for tobacco-related problems have been estimated from US8.2 to 77 million annually, meaning between 0.46 and 1.15% of GNP. Because of tobacco use is not an exclusive activity of adolescents and young adults it has been defined as a pediatric disease because it frequently begins before fifteen years of age. Even more alarming is that The Global Youth Tobacco Survey reported an increase in the tobacco consumption, particularly among women in developing countries like Mexico. This is so common that the previously reported gap between male and female adolescent tobacco users in these countries has all but disappeared. There is a need to develop more studies in order to identify the different influences of tobacco use that in the long run can be modified. Family is one of the most significant influences on people as it models many health-related behaviors, such as diet, exercise, tobacco and alcohol use. It is also the source of its members' psycho-social development, meaning it can both provide support and create stress. Preliminary studies suggest that some family environment factors may influence adolescent tobacco use risk, such as: a background of tobacco use among family members; low levels of family cohesion; defective interaction examples and lack of support bonds; family tolerance to use; low income and low education level; type of family; minimal parental monitoring of adolescent activities; and poor control of the influence of an adolescent's social context, focused on school choice and extra-curricular activity spaces. However, no study to date has evaluated if there is a relationship between family environment and type of tobacco use in Mexican adolescents. As a response to this lack of information, a comparative survey was done to compare family environment and type of adolescent tobacco use in high school students in the city of Guadalajara, Jalisco, Mexico. Materials and methods A cross-sectional, prolective, comparative study was done in a population of 6987 students enrolled in high schools No. 5 and No. 9 of the University of Guadalajara during the September to December 2005 semester. These schools were chosen as being the most representative of the city of Guadalajara based on their enrollment and graduation academic indicators. Sample size was calculated with the miscellaneous statistics module of the True Epistat Program using a 95% confidence level. Previous studies showed a tobacco use prevalence of 27% in the University of Guadalajara high schools, meaning minimum sample size, including an additional 10% for unrelocated students, was 205 for high school No. 5 (3056 enrolled students) and 400 for high school No. 9 (3931 enrolled students). Selection of eligible subjects was randomly done. All students enrolled in each school were numbered consecutively and a random selection table was generated using True Epistat. Later on the students corresponding to these numbers were located by the school prefects by group and shift. They were then called to answer the electronic self-administered survey in the school's computer room. Location rate was 96% because some students had dropped out and/ or changed schools. Data collection was done by using two standardized self-application scales for Mexican population: 1. Tobacco use categorized as light (one to five cigarettes by day) and moderate (six to fifteen cigarettes by day); and 2. Family environment, evaluated by five items: hostility and rejection, communication with children, mutual support from parents and children, and communication between parents. For each type of tobacco use, the mean grades ± 95% confidence interval of the items of the family environment scale were obtained and then, they were compared graphically. The project was approved by the Ethics and Research Committee of the Mexican Institute of Social Security. The survey included an informed consent form with electronic signature. If any participation was not accepted, the survey application did not open. Student participation was anonymous and an electronic mail address was provided for orientation. No users were recorded as requesting orientation. Results A total of 11 58 students (average age = 16.1 ± 1.1 years, range 14 to 20 years) took the survey, from which 659 (56.9%) were women and 499 (43.1%) were men. Of this total, 615 (53.1%) were non-smokers, 419 (36.1%) were light smokers and 124 (10.8%) were moderate smokers. Non-smoker status was consistently associated with better conditions in all the family environment scale dominions. In comparison with light smokers, non-smokers had higher grades of communication with their parents, there was support from parents to children, as well as communication between parents, and support from the son to the parents dominions; and lower grades in the hostility and rejection dominion. In comparison with moderate smokers, non-smokers had better grades in the communication with the son/ daughter dominion and lower grades in the hostility and rejection dominion. No significant differences were observed in the family environment scale between light and moderate smokers. Discussion Family environment was consistently shown to be more favorable for adolescent non-smokers compared to smokers; the main differences were between non-smokers and light smokers with fewer differences between non-smokers and moderate smokers. No differences in the family environment items were observed between light and moderate smokers. This finding of favorable family conditions for non-smokers coincides with previous reports. The fact that family environment does not deteriorate once an adolescent begins tobacco use may mean that certain family structures exists previously that favor tobacco use. Given the cross-sectional design used here, it could not be determined if the evaluated items generate any vulnerability or acted as preventing factors for tobacco use. This would require a more detailed study about these variables. Based on these results and those of previous studies, the starting point of adolescent tobacco use is probably favored by a coincidence among certain family structures such as: family type, family resources, family interactions, type of parent involvement with children, stress management strategies, family modeling, adolescent's psychology, as well as communication and support among family members. Given the above, adolescent tobacco use is likely a social phenomenon involving different social actors like the adolescent, his/her family and the influence of other agents. Educational actions and treatment of adolescents is therefore not enough to address the problem. Parent participation is needed that is specifically focused on understanding typical adolescent behavior; promoting harmonious parent/child relationships; training parents in parental functions such as negotiation and effective communication; and supervision of adolescent activities. The present study is an initial effort in evaluating the relationship between family environment and adolescent tobacco use. Although it is limited by its cross-sectional design and there is a lack of control of possible confusing variables, it does suggest that adolescent non-smokers have more favorable family environments than adolescent smokers. Future research on this matter will require studies using designs that allow a more thorough understanding of the influence of family environment at the onset of adolescent tobacco use.<hr/>Introducción Aunque el tabaquismo no es exclusivo de adolescentes y jóvenes, la enfermedad ha sido definida como pediátrica por su inicio antes de los quince años de edad, por lo es necesario el desarrollo de estudios que identifiquen las diferentes influencias del consumo de tabaco factibles de ser modificadas. La familia es una de las influencias más importantes para las personas, pues modela comportamientos relacionados con la salud y es donde ocurre el desarrollo psico-emocional de sus miembros. Estudios preliminares han sugerido que algunos factores del ambiente familiar podrían influir en el consumo de tabaco en adolescentes como, por ejemplo, el de consumo de tabaco de familiares, bajos niveles de cohesión familiar, pautas de interacción defectuosas, falta de vínculos de apoyo, tolerancia familiar al consumo, bajos ingresos y bajo nivel educativo, bajo monitoreo paterno en las actividades adolescentes y el pobre control de la influencia del contexto social. Dado que no se han localizado antecedentes de la asociación entre el ambiente familiar y el tipo de consumo de tabaco en adolescentes mexicanos, el objetivo de este estudio fue comparar el ambiente familiar entre los tipos de consumo de tabaco en adolescentes escolares de nivel medio superior en Guadalajara, México. Material y métodos Se incluyeron a 1158 estudiantes seleccionados aleatoriamente de dos preparatorias de la Universidad de Guadalajara en el segundo semestre de 2005. La recolección de los datos se realizó por medio de dos escalas de autoaplicación estandarizadas para población mexicana: 1. Consumo de tabaco en el que el patrón de consumo fue categorizado: leve y moderado; 2. Ambiente familiar evaluado por medio de cinco dominios: hostilidad y rechazo, comunicación con el hijo, apoyo de padres a hijos, comunicación entre padres y apoyo del hijo a los padres. Resultados Seiscientos quince (53.1%) adolescentes fueron no fumadores, 419 (36.1%) calificaron como fumadores leves y 124 (10.8%) como fumadores moderados. Ser no fumador se asoció consistentemente con un mejor estado en todos los dominios de la escala de ambiente familiar. Los no fumadores tuvieron mayores calificaciones en los dominios de comunicación padre-hijo, apoyo de los padres, comunicación entre los padres y apoyo significativo del hijo, así como menores calificaciones en hostilidad y rechazo en comparación con los fumadores leves. Los no fumadores tuvieron mayores calificaciones en el dominio de comunicación con el hijo y menores calificaciones en el dominio de hostilidad y rechazo en comparación con los fumadores moderados. No se apreció ninguna diferencia entre fumadores leves y moderados. Discusión El estudio reveló consistentemente que existe un ambiente familiar más favorable para los adolescentes no fumadores comparados con los fumadores. Las principales diferencias en el ambiente familiar radicaron entre los no fumadores y los fumadores leves, y en menor grado, entre los no fumadores y los fumadores moderados. No apreciamos ninguna diferencia en el ambiente familiar entre los fumadores leves al compararlos con los moderados. A partir de que el ambiente familiar no parece deteriorarse una vez que el adolescente ya inició el consumo de tabaco, sugerimos que existen ciertas estructuras familiares que favorecen su consumo. Partiendo de estas consideraciones, pensamos que el consumo de tabaco en adolescentes es un fenómeno social en el que intervienen diferentes actores sociales, por lo que no es suficiente desarrollar sólo acciones educativas y de tratamiento para los adolescentes, sino que además deben involucrarse los padres. <![CDATA[<b>Detección de los riesgos maternos perinatales en los trastornos generalizados del desarrollo</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500005&lng=es&nrm=iso&tlng=es Pervasive Developmental Disorders (PDD) refer to a group of severe neuropsychologic alterations. Symptoms affect three development components: social-interaction skills, language and communication skills and a set of behaviours and activities that become restricted and stereotyped. PDDs include the following disorders: Autistic, Rett's, Infantile Disintegrative, Asperger's and Generalized Non-specific Development Disorder. Regarding to its unknown causes, several explanations have been gathered as a challenging task. They highlight the idea of generalised alterations in the Central Nervous System (CNS). However, the strongest thesis defines a multicausal etiology, with different factors associated to PDDs. Never the less, over the past few years, the review of problems associated with pregnancy and labour have been stressed. This perspective is complemented by other elements that point towards genetic alterations and CNS deficits as causes behind PDD. It has been suggested that pregnancy, labour and even neonatal complications can act on different fronts: increasing the risk of autism or any other PDD, or interacting along with genetic determinants to increase the potential risk at a critical moment in the perinatal development process. The goal of this paper is to study the presence of perinatal risk in mothers of children with and without PDD. A total of 259 mothers took part in the study; 95 were used as an experimental group: they all had a PDD-diagnosed child, according to DSM-IV-TR criteria (68 had autistic disorder, six had Asperger's disorder, one had Rett's disorder and 19 had non-specific PDD). The remaining 165 women had children with a normal evolutive development and were selected as a control group. In order to collect information about perinatal risk, a Maternal Perinatal Risk Questionnaire (MPRQ) was used. This is a structured and specifically-designed autoreport that evaluates the presence or absence of 40 pregestational and perigestational risk factors annalysed from six perspectives: pregestational, perigestational, intrapartum, neonatal, psychosocial and sociodemographic. For every factor evaluated in the MPRQ, an analysis of the average scores and typical deviations was made, along with a frequency and percentage study. Furthermore, a comparative of the frequencies in the control and experimental groups was carried out for every MPRQ item. By means of descriptive analysis, both groups were classified according to the children's age and birth order, the mother's age during pregnancy, current parent's age and their educational and professional levels. When comparing the experimental group's frequencies to those of the control group in the pregestational stage, two significative items were found in Chi-square: the number of previous spontaneous abortions and the use of contraceptive methods. As a result, the control group had fewer spontaneous abortions than the experimental group (10.9% and 22.4% respectively). The use of contraceptive methods previous to pregnancy described the control group's superiority both for hormonal methods and intrauterine devices (IUD). The experimental group was defined by the absence of IUD and the scarce use of hormonal contraceptives (4.3%). In the perigestational dimension, the three significative items in Chi-square were: pharmacological consumption and presence of edema during pregnancy, and premature rupture of amniotic sac. Pharmacological consumption during pregnancy stresses the consumption of medicine or vitamines and iron in control group (81.2%), compared to the group of mothers of children with PDD (60.6%). The presence of gestational edema has been conclusively linked to the control group. As for the premature rupture of waters, a significantly higher presence of amniotic rupture was found in the experimental group compared to the control group. In the intrapartum dimension, the experimental group confirmed higher frequencies in situations that imply a higher perinatal risk such as: a very quick labour or one lasting over 12 hours. In the neonatal dimension, the control group showed with higher percentages (87.9%), the absence of blue coloration -which would be indicative of cyanosis-, when compared to the experimental group (79.8%). The psycho-social dimension included two significant items: the desired gender for the newborn and the desired pregnancy. The desired gender item confirmed that situations of happiness about finding out the baby's gender were higher in the control group (68.4%) than in the experimental group. The desired pregnancy item proved that situations of desired pregnancy were higher in the control group (91.5%) compared to the experimental group (84.0%). Finally, in the socio-demographic dimension, two siginificative items were identified when comparing both groups: the mother's profession and the baby's gender. In one hand, regarding the mother's profession, it was observed that mothers of PDD children were mainly found within home enviroment (37.2%) or unqualfied worker categories (18.1%). On the other hand, in the control group, the mothers who adscribed to the qualified professional category was notably higher (33.3%). Regarding the child's gender, a higher risk is detected in males, at a proportion of 1 to 3. The results of this study showed that there are significative differences between PDD children who developed perinatal risks, compared to children who have a regular evolutive development. Children with PDD will thus show significant differences compared to non-PDD children: they have an unequal perinatal development and developed perinatal risks. Therefore, many risks are present in a higher measure in PDD children when compared to the control group. An innovative contribution is also made, by strongly suggesting that physical risks define the presence of perinatal risks in PDD. However, the psychosocial and sociodemographic dimensions must also be taken into account.<hr/>Los trastornos generalizados del desarrollo (TGD), hacen referencia a un conjunto de alteraciones neuropsicológicas graves. Sus síntomas afectan a tres componentes del desarrollo: interacción social, lenguaje y comunicación e intereses, comportamientos y actividades restringidas y estereotipadas. Los TGD incluyen los siguientes trastornos: autismo, Rett, desintegrativo infantil, Asperger y el Trastorno generalizado del desarrollo no especificado. Su etiología resulta poco conocida y es un reto para la investigación actual. En los últimos años se ha acentuado la revisión de los problemas asociados con el embarazo y el parto. Diversas hipótesis sugieren que el embarazo, el parto e incluso las complicaciones neonatales, pueden actuar desde diversos frentes e incrementar el riesgo de autismo y de los demás TGD. El objetivo de esta investigación es estudiar la presencia de riesgos perinatales entre madres de hijos con TGD y madres de hijos sin TGD. En la investigación participaron un total de 259 madres. De ellas, 94 participaron como grupo experimental: todas tenían un hijo con un diagnóstico de TGD, según criterios del DSM-IV-TR (68 con trastorno autista, seis con trastorno de Asperger, uno con trastorno de Rett y 19 con TGD no especificado). Las mujeres restantes (165) fueron seleccionadas como grupo control y eran madres de infantes/niños con un desarrollo evolutivo normal. Para recoger la información sobre la presencia de riesgos perinatales, se utilizó el Cuestionario Materno de Riesgo Perinatal (CMRP). Este cuestionario es un autoinforme estructurado diseñado ad hoc que contempla, desde seis dimensiones -pregestacional, perigestacional, intraparto, neonatal, psicosocial y sociodemo-gráfica-la presencia o ausencia de 40 factores de riesgo pregestacionales y perigestacionales. Para cada factor valorado con el CMRP, se realizó un análisis de las puntuaciones medias y las desviaciones típicas, junto con un estudio de las frecuencias y los porcentajes resultantes. Asimismo, se efectuó una comparativa de las frecuencias y se utilizó el estadístico Chi-cuadrado de Pearson (χ²), de los grupos experimental y control en cada uno de los reactivos del CMRP. En la dimensión pregestacional, se encontraron dos reactivos significativos en Chi-cuadrado: el número de abortos espontáneos anteriores y el uso de métodos anticonceptivos. En la dimensión perigestacional tres reactivos resultaron significativos: el consumo de fármacos y la presencia de edema durante el embarazo, así como también la ruptura prematura de la fuente. En la dimensión intraparto el grupo experimental mostró frecuencias más altas en aquellas situaciones que implican un mayor riesgo perinatal; un parto muy rápido o la tardanza de más de 12 horas en el mismo. En la dimensión neonatal la coloración azulada del neonato, indicativa de cianosis, fue superior en el grupo experimental. Por otra parte, la dimensión psicosocial ofreció dos reactivos significativos: el sexo deseado del bebé y el embarazo deseado. Por último, en la dimensión sociodemográfica, se identificaron dos reactivos importantes al comparar el grupo experimental con el grupo control, que fueron: la profesión de la madre y el sexo del bebé. Los resultados de esta investigación indican que existen diferencias significativas en niños con TGD que presentaron riesgos perinatales frente a otros con desarrollo evolutivo sin dificultades. Los niños con TGD muestran diferencias significativas comparados con otros niños sin TGD: tienen un desarrollo perinatal desigual, con una presencia significativamente distinta de riesgos perinatales. De esta forma, los riesgos físicos definen la presencia de riesgos perinatales en los TGD. Ahora bien, las dimensiones psicosocial y sociodemográfica deben también ser tomadas en cuenta. <![CDATA[<b>Los malestares masculinos</b>: <b>Narraciones de un grupo de varones adultos de la Ciudad de México</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500006&lng=es&nrm=iso&tlng=es Introduction Distresses related to depressive conditions in men have not been sufficiently acknowledged, and yet less studied. The difference between distress and its attention is originated in factors such as a rigid and dual classification of the problem, a false conception that it is a <<women's problem>>, and the social stigma that leads men to accept and face negative emotional states that affect their life quality. This article shows the results of a qualitative study which sought to uncover the social construction of distress from a gender approach and to deepen the understanding about the way men live it and exteriorize it. The concept of loss was taken as a methodological strategy throughout the study to access the male distress experiences, considering that, before an emotionally meaningful loss or an unfavorable event, individuals may react using those experiences. Method Four adult men participated in the study; they were selected using an intensive intentional sampling strategy. We carefully selected only a few cases, seeking to characterize the object of study and to obtain profound information based on reality; they were males who had suffered an important loss. They received a detailed explanation of the study and its objectives, voluntarily accepted to participate and allowed the recording of the interviews. Confidentiality and anonymity were guaranteed. The information was gathered by means of in depth interviews and a thematic guide. We developed categories of analysis from the guide and the study objectives to classify data. Categories were grouped according to their meanings and they generated subcategories that allowed a deeper and more precise analysis. Results The analysis focused on the experiences of four men: Manuel (30 years old), Oscar (36), José (40), and Rodrigo (40). They lived in Mexico City. Manuel and Rodrigo completed high school education, while Oscar and José obtained a college degree. They had different marital status: Oscar is single, Rodrigo is a widower, José is separated from his wife, and Manuel lived together with his girlfriend. Their most important and emotionally meaningful losses, which had caused distress, are described as well as the relationship these had with other aspects of their masculine subjectivity, such as sexuality, the body, violence, sports and work. Loss of couple. Losing the couple was one of the most important experiences the four men lived. This had common causes: psychological and physical violence, cheating, and sexual dissatisfaction. Manuel and Rodrigo spoke about extremely violent episodes where they were beaten-up by their fathers and schoolmates during childhood, followed by brawls during youth as a way of gaining respect. They also said they later reproduced this violence in their relationships with women. Both were jealous and controlling men, but they used different ways to intimidate their couples. Manuel did not use physical, but psychological violence. Instead of psychologically controlling his couple, Rodrigo used to act violently against her. Different elements can be identified from the experience of these men, which entwine in the distress-gender-violence relationship: <<uncontrollable>> jealousy that triggers violence and using physical or psychological violence as a means for controlling and subordinating the couple. Once they committed and act of violence, they experienced guilt and fear of neglecting that lead them to the rarely kept promise of never doing it again. These events are usually minimized, naturalized, and hardly acknowledged. In the case of cheating, it is important to consider the context where breaking-up takes place, since it is necessary to incorporate other relevant elements of masculine subjectivity: the relationship with the body, the practice of sexuality, the forced heterosexuality, and the continuous evaluation of manhood through social pressure from other men (father, brothers, uncles, and friends). Manuel's experience represents an example of this, because his link with sports and the fitness world allowed him to model his body in order to keep an appealing figure for women and a vehicle for socializing with other men that had similar interests. Being a part of this fellowship allowed Manuel to become a personal trainer and to have several affairs while he was living together with his couple. He said his interest in women and the constant cheating had four basic reasons: the context where fitness takes place, living together for a long time with the same person, feeling sexually unsatisfied, and the realization that her partner showed little interest at home and in doing housework. Thus, in the relationship distress-gender-cheating, when she finds out about him cheating and decides to break-up with him and she leaves him, become the causes on Manuel's distress. José told that problems in his sexual life caused the end of his relationship. He lost his interest in sex and ceased contact with his wife for five or six years because on a genital infection. He also had diabetes since his youth, which also contributed to his lack of interest in sex. José was reluctant to seek medical or psychological help, so his wife decided not to stay with him anymore. Then he reacted with sorrow, impotence, and anger, feelings he considered as a depressive phase. Loss of health. The loss of health could be the result of a chronic illness or a severe injury. It was a distress generating experience for two of them, which had an important impact on their masculine identity in two basic axes: the body and the sexual life. The experiences of José and Manuel allow recognizing the difficulty that men face when they try to accept and admit their own illness and vulnerability, as well as their reticence for taking care of their bodies and health. José said his first painful event was when he was diagnosed with the diabetes at age 25; it was a total self-image change. <<I was not normal anymore, I became a sick man>> who had to take medication for life. The most traumatic situation Manual had lived was when one of his girlfriends stabbed him in his heart during a fight. This changed the meaning of his life and body; he was downhearted for seven years, affecting his work and his social and sexual life. The origin of distress is beyond losing a couple or health in these cases, because, deep down this distress-health-gender relationship, the problem is in losing the ability to fight or in stopping being sexually active, and therefore in not being able to sustain the gender based commands. Loss of job. Oscar talked about one of this distress generating experiences. Even though he considered himself a competent architect, he had not reached a position where he could get enough social success and economic balance. His story offers the possibility of understanding the meaning of a well-paid job in the life of men: the notion of value as a self-reference, the illusion of self-nomination as someone different and unique, the possibility of recognition and appreciation from others, and the money and power. These elements interact to structure what seams to be one of the most important axes for masculine identity. Because when men cannot enter into the working world, they face crisis and distress periods, which in turn have negative repercussions on their gender identity. Male expressions before losses. There were some fundamental physical expressions of distress: muscular pain, difficult in sleeping, laziness, and untidy appearance. The most frequent emotional expressions included sadness, anger, rage, and vindictive impulses. Other manifestations were more related to the way they have learned to <<master their emotions>> by repressing their feelings: not to cry, not to be vulnerable before others, not to show any feelings, and to endure pain.<hr/>Introducción Los malestares asociados con estados depresivos en los hombres han sido poco reconocidos y aún menos abordados. Esta diferencia entre el malestar y su atención se origina en factores como una clasificación rígida y dual del padecimiento, la falsa concepción de que es un problema sólo de mujeres y el estigma social que dificulta que el hombre acepte y enfrente estados de ánimo negativos que afectan su calidad de vida. En este artículo presentamos un estudio de corte cualitativo que desde la perspectiva comprensiva-interpretativa y el enfoque de género pretendió desentrañar la construcción social del malestar, con el fin de profundizar en el entendimiento de la forma en que los hombres manifiestan y viven este malestar. Método El estudio se llevó a cabo con cuatro varones adultos y para seleccionarlos se utilizó la estrategia de muestreo intencional intensivo. Se buscó seleccionar cuidadosamente pocos casos que pudieran caracterizar al objeto de estudio. Se seleccionaron varones que hubieran vivido una pérdida importante, a los cuales se les dio una explicación detallada del estudio y de sus objetivos. Se llevaron a cabo entrevistas en profundidad y se recopiló la información por medio de una guía temática. Se elaboraron categorías de análisis para clasificar la información a partir de esta guía y los objetivos del estudio. Estas categorías se agruparon de acuerdo con sus significados y generaron otras subcategorías de análisis, las cuales permitieron, a su vez, realizar un análisis más preciso de la información. Resultados El análisis se centró en las vivencias de cuatro varones: Manuel, de 30 años; Oscar, de 36; José, de 40 y Rodrigo, de 48, todos residentes de la Ciudad de México. Dos de ellos terminaron la preparatoria (Manuel y Rodrigo) y los otros dos estudiaron una licenciatura (Óscar y José). Su estado civil era heterogéneo: Óscar era soltero, Rodrigo era viudo, José era casado, pero estaba separado y Manuel vivía en unión libre. De todos ellos se describen las pérdidas más importantes que han originado su malestar y la relación que guardan con otros aspectos de la subjetividad masculina, como la sexualidad, el cuerpo, la violencia, el deporte y el trabajo. La pérdida de la pareja. Es una de las principales experiencias vividas por los cuatro varones entrevistados, en función de la cual se encontraron causas comunes de ruptura: la violencia física y psicológica de ellos hacia sus parejas, su infidelidad y la insatisfacción de la mujer en su vida sexual con su pareja. La pérdida de la salud. Ocasionada por alguna enfermedad crónica o alguna lesión grave. Como ya se preveía, ésta fue una experiencia que produjo malestar en dos de ellos (José y Manuel) y que tuvo un fuerte impacto en su identidad masculina, sobre todo en dos ejes importantes de la subjetividad: el cuerpo y la sexualidad. La pérdida del trabajo. El testimonio de Óscar permite comprender lo que significa el mundo laboral en la vida de los hombres. Sin embargo, cuando no pueden acceder al mundo del trabajo, los hombres enfrentan estados de crisis y malestar, con fuertes repercusiones en su identidad de género. Manifestaciones del malestar masculino ante las pérdidas. Aparecieron expresiones físicas como dolores musculares, problemas para conciliar el sueño, flojera y descuido en el arreglo personal. Las expresiones emocionales más frecuentes fueron los sentimientos de tristeza, enojo, ira y deseos de venganza. Otras manifestaciones estuvieron muy vinculadas con la forma en que aprendieron a <<dominar su vida emocional>>, como no llorar, no mostrarse vulnerables ante los demás, no exteriorizar los sentimientos y aguantar el dolor en general. <![CDATA[<b>Aproximación de las redes sociales</b>: <b>una vía alterna para el estudio de la conducta de uso de drogas y su tratamiento</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500007&lng=es&nrm=iso&tlng=es Introduction The purpose of this article is to show the principal contributions of the social network perspective to the understanding of drug use behavior and its treatment, based on a review of studies undertaken using this approach. The study of social networks has become a new means of explaining the causality of numerous social phenomena. It has proved to be a valuable contribution to the understanding of various problems related to individuals' physical and mental health, including drug use behavior. The literature has shown that the study of social networks contains the key to understanding drug use initiation and progression over time, since it has been proved that persons that use and abuse drugs are often surrounded by friends, relatives and acquaintances that abuse these substances or approve of this behavior. Paradigm of social networks and drug consumption This approach comprises a set of theories, methods and techniques used to understand social relations and the way these relations can influence individual and group behavior. This perspective assumes that the social network influences its members' behavior to a certain extent and that the degree of influence will depend on the way this network is shaped, the person's level of integration within the latter, the position the individual occupies, how he is linked to other members of the network and how important these links are in his life. Social network studies analyze the relationships established by individuals by examining their social network, defined as the set of significant individuals, family, friends and relationships established at school, university or work. They also analyze various components of social networks, such as their structure, type and the quality of the links and their function. Within the field of the study of addictive behavior, the social network perspective has proved useful in examining the pattern of individuals' relationships within their groups, analyzing the impact of this pattern on the level of similarity in substance use in these groups, and evaluating the influence of the peer group on behavior. Influence of social network on drug use behavior Various studies have repeatedly pointed out the influence of social networks on the various stages of addiction (starting, habituation and stopping). They have also shown that drug users' networks undergo significant changes during each of these stages. Several social factors have been linked to the starting, use and abuse of licit and illicit substances. The family, the prevailing norms in social networks and peer influence are the social aspects that have been most positively associated with this behavior. As with starting and becoming accustomed to drug use, the family and the prevailing norms among members of the social network are regarded in the literature as prominent factors in stopping substance abuse. Characteristics of drug users' social networks Several studies have been conducted to determine the nature of drug users' networks. These studies are based on comparative analyses of the characteristics of drug users' and non-users' networks. They also analyze whether the characteristics of these networks vary according to certain variables such as sex, age, race, type of drug, etc. Drug users' networks are known to be generally smaller. It has also been reported that their networks are clearly distinct from those of the normal population, containing a larger number of abusers (including friends and family members) and persons with psychiatric dysfunctions. Differences have also been found by type of drug; for example, opiate users' networks comprise members involved in illegal behaviors, as opposed to other drug users' networks. Other studies have also reported differences in networks as regards gender, the most common one being that female drug users receive less social support from their networks than their male counterparts. Influence of social networks on treatment Most studies to determine the role of social links in the treatment and recovery of persons with drug use problems have highlighted the importance of the support of both relatives and friends in seeking treatment in a timely fashion and obtaining positive results both during and after treatment. It has been shown that specific structures in drug users' networks are closely linked to certain treatment-resistant behaviors and that seeking timely treatment, being able to stop taking drugs and successful treatment are possible thanks to the help of a network of relatives and friends with a high level of support. Conclusions Studies on social networks can provide a complementary approach to documenting and determining, through the analysis of individuals' interpersonal relations, the influence of the social context on behaviors related to substance use. The use of the social network approach has produced a considerable amount of literature throughout the world, which has permitted the development of new knowledge for the theoretical advancement of this phenomenon, as well as a set of instruments and techniques for supporting the work of researchers dedicated to explaining this problem in specific contexts.<hr/>Introducción En la bibliografía se ha señalado que el estudio de las redes sociales contiene claves importantes para comprender el inicio y la progresión del uso de drogas a lo largo del tiempo, pues se ha identificado que las personas que usan y abusan de las drogas están rodeadas a menudo de amigos, familiares y/o conocidos que abusan de estas sustancias o personas que aprueban esta conducta. El propósito de este artículo es mostrar las principales aportaciones de la perspectiva de redes sociales para comprender la conducta de uso de drogas y su tratamiento, partiendo de la revisión de estudios desarrollados según esta aproximación. Paradigma de las redes sociales y consumo de drogas Esta aproximación abarca un conjunto de teorías, métodos y técnicas usadas para comprender las relaciones sociales y el modo en que afectan el comportamiento individual y grupal. En el campo de estudio del comportamiento adictivo, la perspectiva de la red social ha servido para examinar las relaciones que establecen los individuos con la familia, con los amigos, en la escuela y/o en el trabajo, y para evaluar la influencia de esas relaciones en la aparición y el desarrollo de la conducta de uso de drogas. Influencia de red social en la conducta de uso de drogas En varios estudios se ha señalado reiteradamente la influencia de la red social en las distintas etapas de la carrera adictiva (inicio, habituación y cese). Asimismo, se ha descrito que las redes de los usuarios de drogas presentan modificaciones importantes en cada una de estas etapas. Características de las redes sociales de los usuarios de drogas Se han realizado varios estudios para conocer cómo son las redes de los usuarios de drogas. Estos trabajos se basan en análisis comparativos de las características de las redes de personas que utilizan drogas, respecto de aquellas que no las usan. En general, se ha identificado que las redes de consumidores son diferentes a las de la población normal, pues son más pequeñas e incluyen un número mayor de miembros que usan drogas. Asimismo, se ha observado que su estructura y composición varía por tipo de droga y que es mayor el apoyo que reciben los hombres de sus redes sociales que las mujeres. Influencia de las redes sociales en el tratamiento Existen abundantes pruebas de que una red social estable, activa, sensible y con un alto nivel de apoyo ejerce un impacto positivo en la salud de sus miembros, ya que incrementa las posibilidades de recuperación de cualquier enfermedad, promueve la utilización oportuna de los servicios de salud y aumenta la sobrevida. La mayoría de los estudios sobre tratamiento han destacado la importancia del apoyo familiar y de los amigos tanto para una búsqueda oportuna de atención como para obtener resultados positivos durante y después del tratamiento. Conclusiones La investigación de las redes sociales ha producido en todo el mundo una cantidad considerable de bibliografía, que ha permitido ampliar nuestra comprensión sobre la importancia del contexto social en la génesis y el desarrollo de la conducta adictiva. Ha posibilitado, asimismo, el desarrollo de nuevos conocimientos para el avance teórico de este fenómeno al aportar un conjunto de instrumentos y técnicas de gran apoyo para los investigadores que se dedican a explicar esta problemática en contextos específicos. <![CDATA[<b>Problemas y dilemas éticos en la investigación de la explotación sexual comercial de niñas y niños</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500008&lng=es&nrm=iso&tlng=es The article begins by defining commercial sexual explotation of children (CSEC) as an exercise of power that commercializes the sexual abuse of children and adolescents so that the exploiters, nearly always adult men, will obtain financial profit or some type of social, psychological or other satisfaction. Victims of CSEC are girls and, to a lesser extent, boys. In any case, they are persons under the age of 18, who have been stripped of their right to be respected and protected from slavery and sexual abuse, discrimination, sickness and crime. This usurpation of rights occurs in certain businesses in the sexual industry (such as prostitution in bars, saloon bars, eateries, brothels, hotels and in the journals, videos and websites on the Internet run by pornographers and child molesters) and the street sex market (including prostitution in streets, squares, beaches, and parks). The main thrust of this article is to analyze some of the problems derived from the failure to comply with the principles of research ethics when studying commercial sexual exploitation (CSEC) in the sex industry and street sex market in Mexico. Research about CSEC started during the 90's focusing on the sex industry and street market in Mexico City and Guadalajara, Jalisco. By the end of that decade the National System for the Integral Development of Families (NSIDF) created a program against CSEC, with social research being one of its core objectives. A brief analysis is conducted of the problems derived from the failure to comply with ethical standards in the early covert research on CSEC in Mexico. It reports that this type of research encourages protection of the researcher without obtaining informed consent, respecting the dignity, confidentiality or anonymity of victims or providing any type of protection for the victims from any type of damage caused by their participation in the research. Most of the research projects focus on detecting victims in the sex industry and the stress sex market in various cities throughout the country. To this end, various methods and techniques have been used that require compliance with basic ethical standards in the relationship between researchers and key informants and in the reports by responsible researchers. Although it might be said that projects review and approval by an ethics committees implicitly assume compliance, there is still a considerable amount of studies without manifest ethic support. This article also discusses the fact that the de-contextualized application of the principles of research ethics to CSEC studies does not suffice to solve the previous problems, and may create ethical dilemmas in CSEC research. It also specifically describes one of the dilemmas faced in the authors' own research. Although a certain percentage of the research related to the issue is obviously reviewed and approved by an ethics committee that implicitly acknowledges this compliance, there continues to be a considerable number of studies with no manifest ethical support. Researchers responsible for the detection of and interviews with victims of CSEC also seek to defend themselves without protecting any of the latter. For example, many researchers act as clients in order to go unnoticed by exploiters and record the presence of teenagers in bars, saloon bars and diners without offering them any form of protection. These researchers never report that the victims interviewed have been informed of their right to refuse to answer or to leave whenever they wish. Ten years ago one researcher decided to penetrate a network that exploited adolescents. He managed to know the procedures followed to contact, enroll and coerce victims, as well as the commercial sex activities. Some authors consider that the violation of informant's rights in social research can be avoided by applying the universal principles of ethics in scientific research. However, the application of such principles seems to be insufficient to solve the wide range of ethical problems that raise in frequent and deep social relationships to informants. Applying the universal principles out of context would also obstruct the development of ethical validated social sciences such as participant observation, and generate other problems. For instance, the application of the principle of anonymity to protect the informant's identity when the participants wish to have their real names used on research reports, can make participants feel disappointed and stolen when reading their own experiences being reported under somebody else's name. This might persuade them to participate in other research projects. The article ends by describing the lessons learned during this work. Recommendations include protecting the physical, social and psychological welfare of the persons studied and those with whom one works, finding out about the social context where one's fieldwork is conducted; adopting a rights and gender approach; avoiding research solely designed to detect victims without offering them protection; detecting victims within the context of inter-institutional coordination (State Prosecutor's offices, Municipal and State DIF Systems and welfare organizations run by civilians), and rescue and protection programs that will guarantee the restoration of their rights and ensure the research team's welfare. At the very least, they should be quite clear that their own safety should always take precedence over their research.<hr/>En este artículo se define primero la explotación sexual comercial infantil (ESCI) como un ejercicio de poder que mercantiliza el abuso sexual de niñas, niños y adolescentes, con el fin de que los explotadores, casi siempre hombres adultos, obtengan alguna ganancia financiera o alguna satisfacción social, psicológica o de cualquiera otra especie. Las víctimas de la ESCI son niñas y, en menor medida, niños. En cualquier caso se trata de personas menores de 18 años de edad, usurpadas de su derecho a ser respetadas y protegidas contra la esclavitud y el abuso sexual, la discriminación, las enfermedades, la delincuencia, entre otros. Esta usurpación de derechos ocurre en algunos negocios de la industria sexual (la prostitución en bares, cantinas, fondas, casas de cita, hoteles y en las revistas/videos/sitios de la WEB de pornografía, pederastas, etc.) y del mercado callejero del sexo (la prostitución en las calles, plazas, playas, jardines, etc.). El propósito del artículo es analizar algunos problemas derivados del incumplimiento de los principios de la ética de la investigación al estudiar la explotación sexual comercial infantil (ESCI) en la industria sexual y el mercado callejero del sexo en México. De esta manera se hace un rápido análisis de los problemas derivados del incumplimiento de los estándares éticos en las primeras investigaciones encubiertas sobre la ESCI en México. Se reporta que este tipo de investigaciones privilegia la protección del investigador sin obtener el consentimiento informado, sin respetar la dignidad, la confidencialidad ni el anonimato de las víctimas y sin brindarles algún tipo de protección contra cualquier tipo de daño producido por su participación en la investigación. La mayoría de las investigaciones se centra en la detección de víctimas en la industria sexual y en el mercado callejero del sexo de diferentes ciudades del país. Para tal efecto se han ocupado métodos y técnicas que exigen el cumplimiento de estándares éticos básicos en la relación de los investigadores con los informantes clave y en el reporte de los investigadores responsables. Asimismo se discute que la aplicación descontextualizada de los principios de la ética de la investigación a los estudios de la ESCI no es suficiente para resolver los problemas anteriores y que puede generar dilemas éticos en la investigación de la ESCI. De manera específica se expone uno de los dilemas enfrentados en el propio trabajo de investigación de los autores. Es innegable que se podría asumir que cierto porcentaje de investigaciones relacionadas con el tema pasa por la revisión y aprobación de un comité de ética que da cuenta implícitamente de ese cumplimiento. Sin embargo, aun así persiste un número considerable de estudios que no tiene ningún respaldo ético manifiesto. Los investigadores responsables de la detección y las entrevistas a las víctimas de la ESCI también buscan salvaguardarse sin proteger a ninguna de ellas. Por ejemplo, muchos investigadores actúan como clientes para pasar desapercibidos ante los explotadores y registrar la presencia de adolescentes en bares, cantinas y figones sin ofrecer a ellas algún tipo de protección. Los investigadores nunca reportan que las víctimas entrevistadas hayan sido enteradas de que tenían derecho a negarse a contestar o a retirarse cuando lo decidieran. Finalmente se exponen las lecciones aprendidas en dicho trabajo, las cuales recomiendan proteger el bienestar físico, social y psicológico de las personas a las que se estudia y con las que se trabaja; conocer el contexto social donde uno hace su trabajo de campo; adoptar un enfoque de derechos y de género; evitar las investigaciones que persigan como único fin detectar a víctimas sin ofrecerles protección; realizar la detección de victimas en el contexto de programas de coordinación interinstitucional (ministerios públicos, sistemas estatales y municipales DIF; organismos asistenciales de la sociedad civil), de rescate y de protección que garanticen la restitución de sus derechos, y proteger el bienestar del equipo de investigación. Por lo menos debe quedar claro al investigador que su propia seguridad debe estar en todo momento por encima de la realización de las tareas de investigación. <![CDATA[<b>Tabaquismo y depresión</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500009&lng=es&nrm=iso&tlng=es The objective of the present work is to review updated information about smoking and depression, based on a revision of PubMed Data Base to find articles with the words <<treatment>>, <<smoking>> and <<depression>> in the title, the summary, or the key words. The date of the most recent article reviewed was April of the 2008. An analysis of these articles was performed aiming to select the pertinent ones for the subject to treat in this summary. Additional articles were selected from references found in articles identified in the original revision. In addition, we offer a proposition about new research directions for depression and smoking, specially treatments for those patients who have simultaneously these disorders, since it's important to design and evaluate new treatments against tobacco smoking habits. Treatments must have an integral approach, contemplating the psychological as well as the pharmacological intervention in order to achieve for a complete treatment. Smoking and depression constitute two important worldwide and national public health problems. Tobacco addiction is worldwide one of the main causes of deterioration of the quality of life and increased morbi-mortality. It causes 5000000 deaths per year (one out of ten deaths of adults).The World Health Organization (WHO) estimated that according to present tendencies, in the year 2020, smoking habits will be responsible for ten million deaths, of which, seven out of ten will take place in developing countries. For the year 2030 tobacco smoking will be the main cause of death around the world. In Mexico, according to the latest National Survey of Addictions, there were 14 million smokers, 9.6 million were former smokers and around 60000 people die every year due to illnesses directly related to smoking habits. In adittion, in the year 2002 the WHO informed that depression was the prevailing disorders in general population with 154012 cases, affecting primarily women (62%) (95023 cases). This disorder is already the main cause of disability in the world, with 121 million people living with the disease. The estimation for the year 2020 is that it will be the second cause of labor loss in developed countries. In Mexico, depression is one of the main causes of mortality and burden of disease nation wide. A study focused on early depression in Mexican population, reported that 2.0% has suffered depression at some point during childhood or adolescence, and will present an average of seven depression episodes throughout their life. During the last years, studies have shown a strong relation between smoking and depression. Therefore, people with history of depression have a tendency to develop tobacco addiction. Also, this kind of patients reveal an important reduction in the severity of the depressive symptoms when consuming nicotine. In spite of the evidence of the high comorbidity between these two diseases, their treatment is generally provided from an independent perspective, making it urgent to recognize the importance of their integrate attention. In a study performed in order to determine the probability of occurrence of substance dependency disorder when affection disorders coexist, it was reported that dependency disorders occur before the abuse or dependency of substances in 47% of men and in 26% of women. In relation specifically to tobacco smoking habits, it has been reported that smokers who consume more than one pack per day have three times more probability of presenting symptoms of depression compared to nonsmokers. It has been shown that patients with depressive symptomatolgy smoke as a way of self medication against this disabiling disease. Until now there is not enough information to predict if former smokers with depression can attain long term tobacco abstinence, as well as which would be are the effects produced by abstinence over depressive symptomatology. Because smokers with history of depression have a great probability of experiencing symptoms of the disease during abstinence, more research regarding treatment with antidepressants after abstincence period has been proved necessary. Reviews are discussed in terms of their theoretical and clinical implications for smoking cessation research. Treatment of patients with both disorders must contemplate psychological and pharmacological attention. The appropriate medical attention of comorbid diseases will surely increase the rehabilitation's rate of success.<hr/>La intención del presente trabajo es la de reseñar información actualizada sobre el tabaquismo y la depresión, a partir de una revisión de la base de datos PubMed. La fecha del artículo revisado más reciente fue abril del 2008. Se seleccionaron sólo los trabajos pertinentes al tema a tratar en este resumen. Artículos adicionales fueron seleccionados a partir de las referencias de los artículos de la revisión original. Asimismo, se plantea una propuesta sobre hacia dónde se debería dirigir la investigación para el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, contemplando tanto el aspecto psicológico como el farmacológico. La adicción al tabaco es una de las principales causas de morbimortalidad y deterioro de la calidad de vida, y ocasiona cinco millones de muertes al año (una de cada diez defunciones de adultos en el mundo). La Organización Mundial de la Salud (OMS) estima que de mantenerse las tendencias actuales, para el año 2020 el tabaquismo será responsable de diez millones de defunciones, de las cuales siete de cada diez ocurrirán en los países en desarrollo. En México, de acuerdo con la última Encuesta Nacional de Adicciones, existen 14 millones de fumadores y 9.6 millones de exfumadores (ENA, 2002). Alrededor de 60000 personas mueren al año por padecimientos vinculados con el tabaquismo. Por otro lado, la depresión es ya la principal causa de invalidez en el mundo, siendo 121 millones de personas las que la padecen, y se estima que para el año 2020 será la segunda causa de baja laboral en los países desarrollados. En nuestro país la prevalencia de la depresión con inicio temprano es del 2.0%, con un promedio de siete episodios a lo largo de la vida y se clasifica entre las principales causas de mortalidad y morbilidad a nivel nacional. En los últimos años se ha reportado una fuerte asociación entre el tabaquismo y la depresión. Se sabe que las personas con historia de depresión son más susceptibles a fumar, y que los síntomas depresivos que se manifiestan durante la abstinencia son reversibles con la reintroducción del cigarro. Con el objetivo de determinar la probabilidad de ocurrencia de un trastorno de dependencia de sustancias cuando coexisten trastornos del afecto, se encontró que dichos trastornos ocurren antes del abuso o dependencia de sustancias en 47% para los hombres y en 26% para las mujeres. En concordancia con lo anterior, se ha reportado que los fumadores actuales que consumen más de una cajetilla por día, tienen tres veces más probabilidad de presentar depresión que los no fumadores. Como resultado de varios estudios, se ha propuesto la teoría de que las personas con depresión fuman a manera de automedicación contra sus síntomas, pero se desconoce si los pacientes con depresión pueden mantenerse en abstinencia a largo plazo, e igualmente se desconoce cuáles son los efectos de la abstinencia sobre la sintomatología depresiva. Además se ha planteado la necesidad de evaluar si el tratamiento postabstinencia con antidepresivos previene dicha sintomatología. A partir de la información reseñada es posible concluir que el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, debería contemplar tanto el aspecto psicológico como el farmacológico y que la atención simultánea de los trastornos comórbidos elevará la tasa de éxito de los tratamientos. <![CDATA[<b>El suicidio y algunos de sus correlatos neurobiológicos. </b><b>Segunda parte</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500010&lng=es&nrm=iso&tlng=es The objective of the present work is to review updated information about smoking and depression, based on a revision of PubMed Data Base to find articles with the words <<treatment>>, <<smoking>> and <<depression>> in the title, the summary, or the key words. The date of the most recent article reviewed was April of the 2008. An analysis of these articles was performed aiming to select the pertinent ones for the subject to treat in this summary. Additional articles were selected from references found in articles identified in the original revision. In addition, we offer a proposition about new research directions for depression and smoking, specially treatments for those patients who have simultaneously these disorders, since it's important to design and evaluate new treatments against tobacco smoking habits. Treatments must have an integral approach, contemplating the psychological as well as the pharmacological intervention in order to achieve for a complete treatment. Smoking and depression constitute two important worldwide and national public health problems. Tobacco addiction is worldwide one of the main causes of deterioration of the quality of life and increased morbi-mortality. It causes 5000000 deaths per year (one out of ten deaths of adults).The World Health Organization (WHO) estimated that according to present tendencies, in the year 2020, smoking habits will be responsible for ten million deaths, of which, seven out of ten will take place in developing countries. For the year 2030 tobacco smoking will be the main cause of death around the world. In Mexico, according to the latest National Survey of Addictions, there were 14 million smokers, 9.6 million were former smokers and around 60000 people die every year due to illnesses directly related to smoking habits. In adittion, in the year 2002 the WHO informed that depression was the prevailing disorders in general population with 154012 cases, affecting primarily women (62%) (95023 cases). This disorder is already the main cause of disability in the world, with 121 million people living with the disease. The estimation for the year 2020 is that it will be the second cause of labor loss in developed countries. In Mexico, depression is one of the main causes of mortality and burden of disease nation wide. A study focused on early depression in Mexican population, reported that 2.0% has suffered depression at some point during childhood or adolescence, and will present an average of seven depression episodes throughout their life. During the last years, studies have shown a strong relation between smoking and depression. Therefore, people with history of depression have a tendency to develop tobacco addiction. Also, this kind of patients reveal an important reduction in the severity of the depressive symptoms when consuming nicotine. In spite of the evidence of the high comorbidity between these two diseases, their treatment is generally provided from an independent perspective, making it urgent to recognize the importance of their integrate attention. In a study performed in order to determine the probability of occurrence of substance dependency disorder when affection disorders coexist, it was reported that dependency disorders occur before the abuse or dependency of substances in 47% of men and in 26% of women. In relation specifically to tobacco smoking habits, it has been reported that smokers who consume more than one pack per day have three times more probability of presenting symptoms of depression compared to nonsmokers. It has been shown that patients with depressive symptomatolgy smoke as a way of self medication against this disabiling disease. Until now there is not enough information to predict if former smokers with depression can attain long term tobacco abstinence, as well as which would be are the effects produced by abstinence over depressive symptomatology. Because smokers with history of depression have a great probability of experiencing symptoms of the disease during abstinence, more research regarding treatment with antidepressants after abstincence period has been proved necessary. Reviews are discussed in terms of their theoretical and clinical implications for smoking cessation research. Treatment of patients with both disorders must contemplate psychological and pharmacological attention. The appropriate medical attention of comorbid diseases will surely increase the rehabilitation's rate of success.<hr/>La intención del presente trabajo es la de reseñar información actualizada sobre el tabaquismo y la depresión, a partir de una revisión de la base de datos PubMed. La fecha del artículo revisado más reciente fue abril del 2008. Se seleccionaron sólo los trabajos pertinentes al tema a tratar en este resumen. Artículos adicionales fueron seleccionados a partir de las referencias de los artículos de la revisión original. Asimismo, se plantea una propuesta sobre hacia dónde se debería dirigir la investigación para el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, contemplando tanto el aspecto psicológico como el farmacológico. La adicción al tabaco es una de las principales causas de morbimortalidad y deterioro de la calidad de vida, y ocasiona cinco millones de muertes al año (una de cada diez defunciones de adultos en el mundo). La Organización Mundial de la Salud (OMS) estima que de mantenerse las tendencias actuales, para el año 2020 el tabaquismo será responsable de diez millones de defunciones, de las cuales siete de cada diez ocurrirán en los países en desarrollo. En México, de acuerdo con la última Encuesta Nacional de Adicciones, existen 14 millones de fumadores y 9.6 millones de exfumadores (ENA, 2002). Alrededor de 60000 personas mueren al año por padecimientos vinculados con el tabaquismo. Por otro lado, la depresión es ya la principal causa de invalidez en el mundo, siendo 121 millones de personas las que la padecen, y se estima que para el año 2020 será la segunda causa de baja laboral en los países desarrollados. En nuestro país la prevalencia de la depresión con inicio temprano es del 2.0%, con un promedio de siete episodios a lo largo de la vida y se clasifica entre las principales causas de mortalidad y morbilidad a nivel nacional. En los últimos años se ha reportado una fuerte asociación entre el tabaquismo y la depresión. Se sabe que las personas con historia de depresión son más susceptibles a fumar, y que los síntomas depresivos que se manifiestan durante la abstinencia son reversibles con la reintroducción del cigarro. Con el objetivo de determinar la probabilidad de ocurrencia de un trastorno de dependencia de sustancias cuando coexisten trastornos del afecto, se encontró que dichos trastornos ocurren antes del abuso o dependencia de sustancias en 47% para los hombres y en 26% para las mujeres. En concordancia con lo anterior, se ha reportado que los fumadores actuales que consumen más de una cajetilla por día, tienen tres veces más probabilidad de presentar depresión que los no fumadores. Como resultado de varios estudios, se ha propuesto la teoría de que las personas con depresión fuman a manera de automedicación contra sus síntomas, pero se desconoce si los pacientes con depresión pueden mantenerse en abstinencia a largo plazo, e igualmente se desconoce cuáles son los efectos de la abstinencia sobre la sintomatología depresiva. Además se ha planteado la necesidad de evaluar si el tratamiento postabstinencia con antidepresivos previene dicha sintomatología. A partir de la información reseñada es posible concluir que el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, debería contemplar tanto el aspecto psicológico como el farmacológico y que la atención simultánea de los trastornos comórbidos elevará la tasa de éxito de los tratamientos. <![CDATA[<b>Autoevaluación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252008000500011&lng=es&nrm=iso&tlng=es The objective of the present work is to review updated information about smoking and depression, based on a revision of PubMed Data Base to find articles with the words <<treatment>>, <<smoking>> and <<depression>> in the title, the summary, or the key words. The date of the most recent article reviewed was April of the 2008. An analysis of these articles was performed aiming to select the pertinent ones for the subject to treat in this summary. Additional articles were selected from references found in articles identified in the original revision. In addition, we offer a proposition about new research directions for depression and smoking, specially treatments for those patients who have simultaneously these disorders, since it's important to design and evaluate new treatments against tobacco smoking habits. Treatments must have an integral approach, contemplating the psychological as well as the pharmacological intervention in order to achieve for a complete treatment. Smoking and depression constitute two important worldwide and national public health problems. Tobacco addiction is worldwide one of the main causes of deterioration of the quality of life and increased morbi-mortality. It causes 5000000 deaths per year (one out of ten deaths of adults).The World Health Organization (WHO) estimated that according to present tendencies, in the year 2020, smoking habits will be responsible for ten million deaths, of which, seven out of ten will take place in developing countries. For the year 2030 tobacco smoking will be the main cause of death around the world. In Mexico, according to the latest National Survey of Addictions, there were 14 million smokers, 9.6 million were former smokers and around 60000 people die every year due to illnesses directly related to smoking habits. In adittion, in the year 2002 the WHO informed that depression was the prevailing disorders in general population with 154012 cases, affecting primarily women (62%) (95023 cases). This disorder is already the main cause of disability in the world, with 121 million people living with the disease. The estimation for the year 2020 is that it will be the second cause of labor loss in developed countries. In Mexico, depression is one of the main causes of mortality and burden of disease nation wide. A study focused on early depression in Mexican population, reported that 2.0% has suffered depression at some point during childhood or adolescence, and will present an average of seven depression episodes throughout their life. During the last years, studies have shown a strong relation between smoking and depression. Therefore, people with history of depression have a tendency to develop tobacco addiction. Also, this kind of patients reveal an important reduction in the severity of the depressive symptoms when consuming nicotine. In spite of the evidence of the high comorbidity between these two diseases, their treatment is generally provided from an independent perspective, making it urgent to recognize the importance of their integrate attention. In a study performed in order to determine the probability of occurrence of substance dependency disorder when affection disorders coexist, it was reported that dependency disorders occur before the abuse or dependency of substances in 47% of men and in 26% of women. In relation specifically to tobacco smoking habits, it has been reported that smokers who consume more than one pack per day have three times more probability of presenting symptoms of depression compared to nonsmokers. It has been shown that patients with depressive symptomatolgy smoke as a way of self medication against this disabiling disease. Until now there is not enough information to predict if former smokers with depression can attain long term tobacco abstinence, as well as which would be are the effects produced by abstinence over depressive symptomatology. Because smokers with history of depression have a great probability of experiencing symptoms of the disease during abstinence, more research regarding treatment with antidepressants after abstincence period has been proved necessary. Reviews are discussed in terms of their theoretical and clinical implications for smoking cessation research. Treatment of patients with both disorders must contemplate psychological and pharmacological attention. The appropriate medical attention of comorbid diseases will surely increase the rehabilitation's rate of success.<hr/>La intención del presente trabajo es la de reseñar información actualizada sobre el tabaquismo y la depresión, a partir de una revisión de la base de datos PubMed. La fecha del artículo revisado más reciente fue abril del 2008. Se seleccionaron sólo los trabajos pertinentes al tema a tratar en este resumen. Artículos adicionales fueron seleccionados a partir de las referencias de los artículos de la revisión original. Asimismo, se plantea una propuesta sobre hacia dónde se debería dirigir la investigación para el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, contemplando tanto el aspecto psicológico como el farmacológico. La adicción al tabaco es una de las principales causas de morbimortalidad y deterioro de la calidad de vida, y ocasiona cinco millones de muertes al año (una de cada diez defunciones de adultos en el mundo). La Organización Mundial de la Salud (OMS) estima que de mantenerse las tendencias actuales, para el año 2020 el tabaquismo será responsable de diez millones de defunciones, de las cuales siete de cada diez ocurrirán en los países en desarrollo. En México, de acuerdo con la última Encuesta Nacional de Adicciones, existen 14 millones de fumadores y 9.6 millones de exfumadores (ENA, 2002). Alrededor de 60000 personas mueren al año por padecimientos vinculados con el tabaquismo. Por otro lado, la depresión es ya la principal causa de invalidez en el mundo, siendo 121 millones de personas las que la padecen, y se estima que para el año 2020 será la segunda causa de baja laboral en los países desarrollados. En nuestro país la prevalencia de la depresión con inicio temprano es del 2.0%, con un promedio de siete episodios a lo largo de la vida y se clasifica entre las principales causas de mortalidad y morbilidad a nivel nacional. En los últimos años se ha reportado una fuerte asociación entre el tabaquismo y la depresión. Se sabe que las personas con historia de depresión son más susceptibles a fumar, y que los síntomas depresivos que se manifiestan durante la abstinencia son reversibles con la reintroducción del cigarro. Con el objetivo de determinar la probabilidad de ocurrencia de un trastorno de dependencia de sustancias cuando coexisten trastornos del afecto, se encontró que dichos trastornos ocurren antes del abuso o dependencia de sustancias en 47% para los hombres y en 26% para las mujeres. En concordancia con lo anterior, se ha reportado que los fumadores actuales que consumen más de una cajetilla por día, tienen tres veces más probabilidad de presentar depresión que los no fumadores. Como resultado de varios estudios, se ha propuesto la teoría de que las personas con depresión fuman a manera de automedicación contra sus síntomas, pero se desconoce si los pacientes con depresión pueden mantenerse en abstinencia a largo plazo, e igualmente se desconoce cuáles son los efectos de la abstinencia sobre la sintomatología depresiva. Además se ha planteado la necesidad de evaluar si el tratamiento postabstinencia con antidepresivos previene dicha sintomatología. A partir de la información reseñada es posible concluir que el tratamiento de aquellos pacientes que presentan de manera simultánea estos dos trastornos, debería contemplar tanto el aspecto psicológico como el farmacológico y que la atención simultánea de los trastornos comórbidos elevará la tasa de éxito de los tratamientos.