Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520090004&lang=pt vol. 32 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>The psychiatric reform in Brazil</b>: <b>perspectives and problems</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Teenage consumers of marijuana</b>: <b>implications for the familiy and the school</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400002&lng=pt&nrm=iso&tlng=pt Human groups make up for themselves, for the others and for the events they live explanations that, although not scientific, determine the practices that regulate their behavior. In the case of marijuana consumption, the representations of young people in particular and society in general influence the decision about whether or not to continue consuming. The perception of risk associated with consumption by high school students dropped from 60% in 1994 to 36.9% in 2004, which backs up the relationship between high consumption and low risk perception. Cannabis is the illegal drug with the highest indexes of consumption in the world with an increasing growth rate, to which we may add the alarming reduction in the age when people begin consuming it. This research paper is concerned with the effects of consumption on cognitive processes in school and social performance: a drop in performance, more problems getting along with others, absenteeism and drop out. The study aims to know how low marihuana doses affect cognitive ability in post-primary students. There are no studies concerned with the effect of marihuana in non-patient students (i.e. not diagnosed with addictive behavior and not considered socially as drug addicts). Material and methods Sample: The sample comes from high school students in public schools, private subsidized schools and private paying schools. The sample was stratified by non-proportional affixation, considering the sex, course and social economic level variables, and was made up of 304 students in high schools of the Metropolitan Area (Santiago), belonging to low, medium, and high socioeconomic groups (determined by dependence and the city in which the school is located). The research is descriptive, not experimental, ex post facto. Instruments: Group application to the entire sample (n = 304) a) Psychosocial evaluation and consumption questionnaire, abbreviated and adapted, aimed at the collection of demographic data, consumption behaviors and other required information. The young people are identified with a number in order to ensure their anonymity and thus promote the truth of the responses. b) Domino Test (D-48): Evaluates non-verbal intelligence. It controls differences caused by social and educative factors. It is applied on a group basis in order to discard subjects whose IQ is lower than average, regardless of consumption. Individual application to the consumer group and the non-consumer group. a) Rey Complex Figure Test: Widely used in recent studies on the effects of drugs on teenagers. Evaluates neuropsychological functioning. b) Benton Test: Evaluates current intellectual efficiency from the attention span, concentration and immediate retention. c) Verbal memory (Rey): Evaluates immediate verbal memory. Results General: The total results for the three schools polled and evaluated show that 14.5% of the students declared that they consumed marijuana at least four times during the last month. The proportion in the three establishments is not distributed in a homogenous fashion, but is concentrated in the low social economic level school (27.8%), with the lowest percentage in the high social economic level school. With regard to sex, 11% are girls and 15.7% are boys. Although a higher proportion of the boys consumed, the consumption in girls shows a sustained increase in recent years. A significant group is beginning to consume marijuana at age 15 or even earlier. The perception of risk associated with frequent consumption and the possibility of quitting smoking on a voluntary basis show significant differences: among consumers (C), 51% consider that there is no risk or negative effect in consumption, while only 10% of non-consumers (NC) share this perception. Protective factors or those associated with risk The family. In this study, the objective characteristics of families are not researched, but only the perception teenagers have of them. In any case, only 24% of the C state that their families have any influence on what they think, and another 54.8% agrees that they would not do anything, or simply do not know how their parents would react if they found out they consumed. School. The results on the perception of consumers and non-consumers in the school context shows that in general consumers perceive the school as less demanding than non-consumers as far as the existence of disciplinary standards is concerned. Regarding the reactions of teachers who found out that the students consumed, the proportion of NC who perceive the teacher in a more active role is higher: they would scold him (24.1%), they would talk to the student (27.6%). While only 10% believe that they would do nothing, 32.6% of the C share this perception. Around 35% of the total group does not know what the teacher would do. Peer groups. In the case of C, more than half of them (54.2%) state that it is their friends who have more influence on the way they think, compared to 29.5% of the NC who believe the same thing. The friends and classmates of the C are perceived by them (67.4%) as not caring about whether they consume or not. This perception is reversed in the case of the NC, in which the majority (63.7%) consider that the group would try to dissuade their consumption. They add that in 74% of the cases the student states that marijuana is provided by persons close at hand: friends (74%) and acquaintances (12%). Conclusions Regarding group behavior in general: In demographic terms, the results show that the number of consumers in schools belonging to the marginal and economically deprived sectors is higher than that detected in medium and high socio-economic level schools. In all sectors we see people starting to consume marijuana at ever younger ages: 15 years and even less, in a significant percentage of the sample. The results coincide with the majority of studies performed recently, which point to a sustained reduction in the age when people start consuming, which considerably increases the risks of damage. Effects of consumption on cognitive functions: On workstyle. By comparing the results of the two groups (consumers and non-consumers) we can conclude that consumers obtain much lower scores than the control group in tests that evaluate accuracy and workstyle, showing strategies and approaches to the task which could be expected from subjects with possible neurological damage. Visual and verbal memory. As far as visual memory is concerned, the results of consumers indicate scores far lower than those achieved by control groups in tasks that require this kind of memory to be carried out successfully. Despite consumers having obtained somewhat lower scores, verbal memory does not appear to be so damaged. Attention, concentration. According to their performance on tests that evaluate current intellectual efficiency from the ability to focus/concentrate and retain information for a short time, the results are significantly lower in the consumer group. The results suggest a possible alteration in the integration and structuring of spatial stimuli, if we consider the large number of errors made by consumers and that they may indicate organic and cerebral damages. Even though from the results of this work it is not possible to determine with accuracy the magnitude of the damage caused or even if this damage is the direct and exclusive effect of the consumption of marijuana, we can establish: a) a clear association between consumption and a significant drop in scores in the cognitive functions evaluated compared to what was expected, b) scores significantly lower than those obtained by the control groups consisting of non-consumers, and c) deficiencies in the styles and strategies of execution employed in the task and in the organization of the material.<hr/>La cannabis es la droga ilegal con más altos índices de consumo en el mundo. Su consumo mantiene un ritmo de crecimiento sostenido y a él se suma una disminución alarmante en la edad de inicio. En los 10 últimos años, la percepción de riesgo asociada al consumo entre estudiantes secundarios descendió de 60% en 1994 a 36.9% en 2004, lo que sustenta una relación entre alto consumo y baja percepción de riesgo. El efecto de la marihuana en pocas dosis y en escolares no consultantes y no rotulados socialmente como drogadictos, no se conoce, es por ello que nuestro estudio pretende averiguar cómo este consumo afecta en las habilidades cognitivas necesarias para el aprendizaje. Material y métodos Muestra: Se conformó con alumnos de educación media de liceos municipalizados, particulares subvencionados y particulares pagados. La muestra se estratificó por afijación no proporcional, considerando las variables sexo, curso y nivel socioeconómico, y estuvo conformada por 304 alumnos de liceos del Área Metropolitana (Santiago), pertenecientes a los niveles socioeconómicos bajo, medio y alto (determinados por dependencia y comuna en que se ubica el establecimiento). La investigación es descriptiva, no experimental, ex post facto. Instrumentos aplicados: a)Cuestionario de Evaluación Psicosocial y Consumo, b)Test de Dominó (D-48),c) Test de la Figura Compleja de Rey, d) Test de Benton, e)Memoria de palabras (Rey). Resultados Los resultados totales para los tres colegios encuestados y evaluados muestran que 14.5% de los alumnos afirman haber consumido marihuana al menos en cuatro ocasiones durante el último mes. La proporción que corresponde a los tres establecimientos no se distribuye homogéneamente, sino que se concentra en el liceo de nivel socioeconómico más bajo (27.8%), con el menor porcentaje en el nivel socioeconómico más alto. En relación con el género, 11% son mujeres y 15.7%, varones. Si bien los varones consumen más, el consumo en mujeres muestra un aumento sostenido en los últimos años. Respecto de la edad de inicio, un grupo importante por el riesgo que representa la precocidad en el inicio comienza a consumir a los 15 años e incluso antes. Del total de consumidores, 51% consideran que no existe ningún riesgo ni efecto negativo en el consumo, mientras sólo 10% de los no consumidores (NC) comparten esa percepción. Factores protectores o asociados a riesgo La familia. En este estudio, no se investigan las características objetivas de las familias, sino solamente la percepción que tienen de ellas los adolescentes. Como quiera que sea, sólo 24% de los consumidores afirman que su familia tiene influencia en lo que piensan, sumado a que 54.8% coinciden en que no harían nada o simplemente no saben cómo reaccionarían sus padres si los descubrieran consumiendo. Colegio. Los resultados sobre la percepción de los consumidores y no consumidores en relación con el colegio muestran que en general los primeros perciben el colegio como menos exigente que los segundos en cuanto a la existencia de normas disciplinarias. Conclusiones En todos los sectores se aprecia un inicio cada vez más precoz del consumo, 15 años e incluso antes, en un importante porcentaje de la muestra, hecho que aumenta considerablemente los riesgos de daño. Efectos del consumo en las funciones cognitivas relacionadas con el rendimiento escolar: a) En estilo de trabajo: podemos concluir que los consumidores obtienen rendimientos significativamente inferiores a los grupos control en las pruebas que evalúan la precisión y el estilo de trabajo; muestran asimismo estrategias y formas de abordaje de la tarea esperables en sujetos menores o con posibles daños neurológicos; b) Memoria visual y verbal: en cuanto a la primera, los resultados de los consumidores indican puntajes muy inferiores a los logrados por los grupos controles, mientras que la memoria verbal no parece estar tan comprometida; c) Atención, concentración y retención inmediata: los resultados son significativamente inferiores en el grupo consumidor. Los resultados sugieren una posible alteración en la integración y estructuración de los estímulos espaciales si se considera el alto número de errores cometidos por los consumidores, los cuales pueden ser indicativos de daños orgánicos cerebrales. <![CDATA[<b>Neuropsychological functioning of adolescents with bipolar disorder</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400003&lng=pt&nrm=iso&tlng=pt Persistent neuropsychological deficits have been reported in adult bipolar affective disorder, and impairments in executive functions, attention, verbal learning and memory, are postulated as neurocognitive endophenotypes. However, there is a lack of information about the neuropsychological functioning in Pediatric Bipolar Disorder (PBD). Hence, it is important to study this pediatric disorder because it could help, in first place, to clarify if children and adolescents with this disorder have neurocognitive impairments and secondly to analyze if the neuropsychological impairments in PBD are alike to those reported in adults. Neuropsychological characterization of PBD has been complicated because it has a 60%-90% comorbidity with Attention Deficit Hyperactivity Disorder (ADHD). Several studies have reported ADHD neuropsychological impairment in executive functions, sustained attention and working memory. Meanwhile, few studies in PBD have reported impairments in vigilance, working memory, interference control, speed processing, abstract problem solving and verbal learning. Yet, it is unknown if these deficiencies are distinct to the ones reported in ADHD or if they are a more severe manifestation of the same deficits. The objective of the present study was to assess the neuropsychological functioning of PBD by means of a battery of tests to analyze the capacities of complex problem solving, abstract reasoning and planning. We seeked if PBD presents other neuropsychological impairments beyond executive functions, verbal learning and memory, and attention that have been reported in adults with this disorder. Two groups were assessed, the first one included fourteen adolescent patients with PBD in euthimic phase, the other group consisted of eleven asyntomatic adolescents selected by means of absence of bipolar, affective, psychotic or neurodevelopmental disorders. Each participant was evaluated by certified neuropsychologists during three sessions of one hour each. As study variables we considered the general capacity for complex problem solving measured by subtest of the Intelligence Scales of Wechsler (WAIS or WISC-R) that were administered and qualified according to Lezak's proposals. We also assessed abstract reasoning, cognitive flexibility and planning measured by the Wisconsin Card Sorting Test (WCST) and Tower of London Drexel University (TOL DX). Results were analized with SPSS 11 program using U Mann-Whitney test with statistic significance at p <0.05 and <0.01. The results obtained, showed that adolescents with PBD had impairments in neuropsychological functioning. Some of the deficits are alike the impairments reported in adults with bipolar disorder, specially in tasks that involve executive funcioning like working memory and planning. Besides, we detected impairments in other neuropsychological measures that are associated with complex problem solving capacities that no other studies have reported, suggesting that PBD show neuropsychological impairments that go beyond those reported in adult patients. Capacities for complex problem solving were related to diminished scores for Wechsler's subtests of information, vocabulary, similarities, comprehension, picture completion, block designs and digit symbol. These subtests are associated with language abilities, concept formation, verbal reasoning, visual reasoning and speed of information processing. Although in our study adolecents with PBD scored within the normal range on Intellectual Quotient (IQ) full, verbal and executive scales, analysis showed statistical differences when compared to control group, suggesting a potentially more insidious impact of the early onset of the disorder on overall cognitive functioning. This impact can directly affect through disease evolves, or indirectly disrupting academic functioning. PBD group also differed from control group on variables that measured executive functions like planning and working memory as could be seen in Digit Span Wechsler's subtests and TOL 's total move, total rule violation and total execution time variables. Explanation of deficits could involve problems with speed processing, given the lower scores obtained on Wechsler's digit-symbol substitution subtest; or with executive deficits, such as organization and problem solving ruled out by working memory and language reasoning. Whatever the explanation could be, our data contributes to the possibility of a continuity of domains of neuropsychological impairment in people with early and later onset of bipolar disorder, although direct comparison of such groups is necessary in future studies. As such, these neuropsychological findings also could provide support for the validity of the differential diagnosis in children and adolescents with bipolar disorder. The neuropsychological impairments found in our research are consistent with the behavioral dyscontrol, poor frustration tolerance and impulsive aggression that are characteristic of PBD. It is proposed that the ability to regulate attention has implications for emotional regulation, meanwhile verbal reasoning deficits may reflect difficulties with effortful semantic processing, and impairments in executive functions such as working memory and planning, contribute to self-control and completion of goal-directed behavior. Together, deficits in these domains may impair the ability of PBD to attend to cues in the environment that assist the regulation of emotion and arousal, and to limit the ability for identifying and implementing novel and prosocial options for behavior by processing efficiently cues that are presented and ignore emotionally salient or distracting stimuly. It is important to point out that not all capacities for complex problem solving were impaired in PBD. There were no differences in Wechsler's subtests of object assembly, picture arrangement or arithmetic, neither differences were observed in TOL's variables of total correct, total time violation, total problem-solving or none of WCST variables. These findings can be associated with preserved capacities for set shifting, abstract reasoning, interference control, arithmetic reasoning, sequencing thinking, interpretation of socio-emotional clues and visuo-spatial planning. However, more work is needed to elucidate the meaning of this preserved capacities and how they interact with the impairments already discussed. In this sense, it is possible to speculate that although the impairments already described can influence on academic functioning, the preserved capacities might exert an important role in the regulation of adaptive behavior. As a conclusion, our data indicate neuropsychological deficits in youth with PBD in domains of executive functioning and capacities for general problem solving. These findings add to a growing body of work documenting the presence of neurocognitive underpinnings of bipolar disorder in adolescents. Data suggests that measures of verbal reasoning, visual reasoning, speed processing, working memory and planning might be explored further in future functional neuroimaging studies of PBD.<hr/>Los estudios neuropsicológicos del trastorno bipolar en adultos han señalado alteraciones en las funciones ejecutivas, mnésicas y atencionales como endofenotipos neurocognitivos del trastorno. Sin embargo, se conoce poco sobre la caracterización neuropsicológica del Trastorno Bipolar Pediátrico (TBPP), misma que ha sido complicada dado que existe una comorbilidad del 60%-90% con el Trastorno por Déficit de Atención con Hiperactividad (TDAH). Así, desde la perspectiva neuropsicológica, el TBPP ha sido poco estudiado. Existen algunas investigaciones que no reportan alteraciones neurocognitivas, y otras reportan deficiencias en tareas de vigilancia, memoria de trabajo, control de interferencia, velocidad de procesamiento, solución de problemas abstractos y aprendizaje verbal. Sin embargo, aún se desconoce si estas deficiencias son distintas a las observadas en el TDAH, o si son formas más severas de las mismas alteraciones del TDAH. Por lo tanto, el objetivo del presente estudio fue evaluar el funcionamiento neuropsicológico del TBPP por medio de una batería de pruebas integrada para analizar las capacidades en la solución de problemas complejos, razonamiento abstracto y habilidades de planeación. Esto con la finalidad de valorar si el TBPP cursa con otras alteraciones neuropsicológicas, más allá de la esfera de la atención, memoria y del funcionamiento ejecutivo, como se han descrito hasta el momento en adultos con trastorno bipolar. Así, se comparó el funcionamiento neurocognitivo en un grupo de 14 pacientes adolescentes con diagnóstico de TBPP en fase de eutímia y un grupo control de 11 adolescentes asintomáticos. Además, se consideraron como variables del estudio la capacidad general para solucionar problemas, medida por medio de las subpruebas de las Escalas de Inteligencia de Wechsler, así como las habilidades de razonamiento abstracto, flexibilidad cognoscitiva y planeación, medidos con el Test de Clasificación de Tarjetas de Wisconsin y la Torre de Londres Drexel University. Los resultados señalaron que los adolescentes con TBPP presentan alteraciones en el funcionamiento neuropsicológico. Algunas de las deficiencias encontradas son parecidas a las alteraciones reportadas en adultos, especialmente ante tareas que involucran funciones ejecutivas como la memoria de trabajo y la planeación. Además de esto, se detectaron alteraciones en otras mediciones neuropsicológicas que implican la capacidad para solucionar problemas complejos y que no han sido reportadas en estudios previos. Al evaluar la capacidad general para solucionar problemas, se encontraron alteraciones en las habilidades de lenguaje, formación de conceptos, razonamiento verbal, razonamiento visual práctico/ conceptual, análisis-síntesis visual y velocidad de procesamiento. También se observaron deficiencias en las funciones ejecutivas que involucran la planeación y la memoria de trabajo. De tal manera, que nuestros datos ofrecen la posibilidad de plantear una continuidad en la alteración de las funciones ejecutivas en el trastorno bipolar tanto de inicio temprano como en el tardío. Estos hallazgos también pueden considerarse un apoyo para la validez del diagnóstico diferencial del trastorno bipolar en adolescentes. Como conclusión, podemos señalar que nuestros resultados son consistentes con la bibliografía en general al indicar que existen deficiencias neuropsicológicas en adolescentes con TBPP, al tiempo que se mencionan otras alteraciones no descritas con anterioridad. Estas deficiencias involucran el funcionamiento ejecutivo y otros dominios cognitivos que influyen sobre la capacidad general para solucionar problemas. Además, se sugiere que las mediciones que involucran el razonamiento verbal, razonamiento visual, velocidad de procesamiento, memoria de trabajo y planeación podrían examinarse con mayor detenimiento en futuros estudios de neuroimagen funcional en el TBPP. <![CDATA[<b>Student survey of Mexico City 2006</b>: <b>Prevalence and trends of drug use</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400004&lng=pt&nrm=iso&tlng=pt Introduction Since three years from now, in Mexico there has been several surveys and specific research regarding drug use. Over these years the national surveillance systems databases (SISVEA, CIJ) have shown that cocaine use has stabilized and marijuana use is still increasing, although there are some regional differences. Also, the results of the 2003 Mexico City Students' Survey revealed a similar inclination: an increase on marijuana use, a slight diminish on cocaine use and as a new stage: a rebound on inhalant use. However, these changes and trends on drug use are not the same all over the country. The results found in these databases suggest that the northern border behaves differently from the rest of the country, even all along the northern border itself. While drug use in Matamoros is lower than in other border cities, Nuevo Laredo, Reynosa and Ciudad Juarez registered high cocaine and heroin use. On the other hand, even though the border cities of Sonora and Baja California have these same drug use problems, they also show high rates of methamphetamine use. Another important issue on border cities is that Ciudad Juarez has reached Tijuana's use levels, mainly among teens between 12 and 1 7 years old. These two cities have the highest substance use levels in the country, even above Mexico City. On the central region of the country, the drug use rates are halfway between. Even though Mexico City's drug use levels are among the central region and the two border cities mentioned before, in all the states that have been studied, there's been a general significant increase in drug use. In southern states, especially Yucatan (where there's a household and a students' survey), the drug rates are the lowest in the country. However, the women's drug use rates keeps increasing. Specifically the 2003 students' survey showed that in some Mexico City's counties women have higher alcohol and tobacco prevalence, and their illegal drug use trends begin to be alike to men's illegal drug use trends. Objective To present drug use prevalence results from the 2006 Mexico City Students Survey. Material and methods This survey used a 10523 Mexico City students random sample. The sample design was stratified (by county), with two stages (by school) and clustered (by groups). This data is representative by State County and by educational level. The design is comparable with previous student's surveys made by the National Psychiatric Institute (INP) and the Mexican Board of Education (SEP). The marijuana, cocaine and inhalants variation coefficients (VC) were determined according to the 2003 survey. The variable with the highest VC, a non-response rate and a design effect of two were considered as in previous surveys. With all these parameters, it was considered a 15% non-response rate, the same found in previous studies. The sample's accuracy level was 95%, with an absolute error average of 0.004. The questionnaire was made with drug use indicators that the World Health Organization used in their own surveys. Besides, some youth behaviors were explored: suicide attempt, depression, eating risk behaviors, sexual behavior, etc. Results From this sample 49.9% were women and 50.5% male. As for Tobacco <<Ever use>>, it affected the same both men and women, and remained similar in comparison to 2003. Also, 68.8% of the adolescents have consumed alcohol at least once in their life and 41.3% has drunk it in the previous month, being women and men equally behaved. The total drug use prevalence was 1 7.8%, statistically higher than in the 2003 survey, with a 2.6% difference. Men use more drugs compared to women. Of the total sample, 12.9% is an experimental user and 4.9% is a regular user (have used drugs five or more times). As for medical drugs (tranquillizers and amphetamines), their use is higher in women, while illegal drugs use (marijuana, cocaine, hallucinogens, inhalants, methamphetamine and heroin) is higher in men. In general terms, illegal drug use is higher than medical drugs use. Substance use percentage was nearly twice for tenth to twelfth grade students, compared to seventh to ninth grade students. Women have experimented less with illegal drugs in the 'previous year of use' than men, yet women have shown an important increase on inhalant and marijuana use over the past three years, and cocaine use has remained similar. Marijuana is the first choice drug among adolescents, followed by inhalants, tranquillizers in third place and cocaine in fourth place of choice. Also, the results show that drug use is highly related with other problematic behaviors like suicidal attempt, depressive sintomatology, antisocial behavior, and sexual risk behaviors. Conclusions The study points out an important increase in drug use over the past three years, going from 15.2% to 17.8%. Different trends can be seen on each substance. On the one hand, marijuana and inhalants use has increased widely, on the other hand tranquillizers use remains stable and cocaine use has decreased. These results showed that the illegal drugs use among both men and women has increased (marijuana and inhalants mostly), women's cocaine use has remained steady, but men's has been reduced. Legal drugs use behavior hasn't changed: the use of alcohol has enhanced, while tobacco use is similar to the 2003 survey. It has also been reported that the use rate of both substances is practically the same among men and women. Also, the situation of México City has changed slightly. The counties that are more damaged by drug use are: Azcapotzalco, Cuauhtémoc, Benito Juárez, Coyoacán and Tlalpan. In order to improve drug use prevention programs to consider the relationship between several problematic behaviors like suicidal attempt or antisocial behavior, because users showed prevalence at least twice more than non users. Likewise, there still exist a low risk perception and a high tolerance towards tobacco and alcohol use, which are important risk factors for using other drugs. Additionally, if we also take into account that the first use takes place a younger age, the probabilities of using medical and illegal drugs increase significantly.<hr/>Introducción Desde hace tres años se han hecho varias encuestas sobre consumo de drogas en nuestro país, además de investigaciones específicas sobre el tema. En estos últimos tres años diversos sistemas de información del país (SISVEA, CIJ) han mostrado que el consumo de cocaína se ha estabilizado y que el consumo de mariguana sigue en aumento, aunque estos aspectos presentan variaciones a nivel regional. Asimismo, en los datos de la encuesta de estudiantes de la Ciudad de México del 2003, se encontró una situación similar, hubo un incremento en el consumo de mariguana, un ligero decremento en el consumo de cocaína y, como nueva situación, un repunte en el consumo de inhalables. Por supuesto que los cambios y comportamientos no son iguales en todo el país. Por otra parte, se ha observado que las mujeres han incrementado su consumo de drogas de manera específica. Por ejemplo, el reporte de la encuesta del 2003 muestra que en los casos del alcohol y del tabaco, en algunas delegaciones de la Ciudad de México hay una mayor prevalencia de mujeres que consumen estas sustancias y hay indicios de que en el consumo de algunas drogas ilegales las prevalencias del consumo son similares a las de los hombres. Objetivo El objetivo de este estudio fue el de presentar los resultados de la Encuesta del 2006 sobre las prevalencias del uso de drogas entre la comunidad escolar en la Ciudad de México. Material y métodos El estudio se realizó con una muestra aleatoria de 10 523 estudiantes de todo el Distrito Federal. Los datos de este estudio son representativos por delegación y por nivel educativo, y el diseño es comparable al de estudios anteriores realizados en escuelas por el Instituto Nacional de Psiquiatría Ramón de la Fuentes Muñiz y la Secretaría de Educación Pública. El cuestionario se conformó con los indicadores de consumo de drogas que se han utilizado en este tipo de estudios que corresponden a los empleados por la OMS. Además, se exploraron diversas conductas de los adolescentes, como el intento suicida, su nivel de depresión y sus conductas alimentarias de riesgo, así como diversos aspectos de su conducta sexual. Resultados Del total de la muestra el 49.5% fueron mujeres y el 50.5% fueron hombres. En los resultados se encontró que el consumo de tabaco alguna vez en la vida ha afectado de modo similar tanto a hombres como a mujeres y fue similar a lo encontrado en el 2003. Por otro lado, se encontró que el 68.8% de los/as adolescentes ha usado alcohol alguna vez en su vida y un 41.3% lo ha consumido en el último mes; resultando igualmente afectados tanto los hombres como las mujeres. La prevalencia total de consumo de drogas fue del 1 7.8%, porcentaje estadísticamente mayor al del 2003 en un 2.6%. Los hombres estuvieron dentro del subgrupo más afectado por el consumo actual en comparación con las mujeres. De acuerdo al nivel educativo de los participantes, el consumo de sustancias fue casi del doble para los/as adolescentes de escuelas de bachillerato, como para los de bachillerato técnico, en comparación con los/as de secundaria. En cuanto a las drogas ilegales, en el consumo durante el último año, una proporción menor de mujeres ha experimentado con drogas -en ellas se ha observado, en los últimos tres años, un incremento importante en el consumo de inhalables y mariguana- en tanto que el consumo de cocaína se ha mantenido estable. Por lo que respecta a cada sustancia, la mariguana ocupa el primer lugar de preferencia entre los/as adolescentes, le sigue el consumo de inhalables, los tranquilizantes en tercer lugar y la cocaína en cuarto. Conclusiones El estudio mostró un incremento importante en el consumo de drogas en los últimos tres años: del 15.2% ha pasado a 17.8%. Además, dentro del uso de cada sustancia se observan situaciones distintas. Por un lado, el incremento del uso de la mariguana y de los inhalables es grande, mientras que en los tranquilizantes el consumo se mantiene estable y el de la cocaína ha disminuido. Al analizar estos resultados según el sexo, se encontró que los niveles de consumo de drogas ilegales (mariguana e inhalables principalmente), en las mujeres, han aumentado y la cocaína se ha mantenido estable: en tanto que en los hombres también se han incrementado las dos primeras sustancias, pero el consumo de cocaína ha disminuido. Por lo que respecta a las drogas legales, la dinámica se mantiene similar. Por un lado, el consumo de alcohol se ha incrementado en tanto que el consumo de tabaco se mantiene similar al del 2003. Las delegaciones más afectadas por el consumo de drogas son Azcapotzalco, Cuauhtémoc, Benito Juárez, Coyoacán y Tlalpan, las cuales han desplazado a Gustavo A. Madero, Venustiano Carranza, Iztacalco y Miguel Hidalgo. En el caso del abuso del alcohol, también han cambiado las delegaciones más afectadas, actualmente son Miguel Hidalgo, Cuauhtémoc, Benito Juárez, Cuajimalpa y Tlalpan. Al analizar la relación del consumo de drogas con otras conductas problemáticas se observa que los y las usuarias de drogas, han presentado de dos a tres veces más sintomatología depresiva, intento suicida, conductas antisociales, así como un posible trastorno por déficit de atención. <![CDATA[<b>Psychometric characteristics of the Center for Epidemiological Studies-depression Scale (CES-D), 20-and 10-item versions, in women from a Mexican rural area</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400005&lng=pt&nrm=iso&tlng=pt Depressive symptoms constitute a common mental health problem, with a relevant social and personal impact. These symptoms are present not only among the urban population in more economically developed countries, but also in rural areas in poor and middle development countries. In order to obtain reliable information on the frequency of depressive symptoms, their risk factors or the impact of preventive and clinical measures, valid measurement instruments are needed. Radloff's Center for Epidemiological Studies - Depression scale (CES-D) was originally developed for the study of depressive symptoms in an open population. While the CES-D is not useful for the evaluation of depressive disorders according to psychiatric criteria, it can still yield useful information about the presence of depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, and somatic complaints, which constitute dimensions of depression. The instrument has been shown to be valid in culturally diverse groups. It has also been shown to correlate with the clinical diagnosis of depression, with sensibility as high as 100%, while its specificity has been reported as 57-88%. Shorter versions of the CES-D have been developed. Their advantages include a more easy inclusion in ample questionnaires, and their being less tiresome for respondents. The main objective of this study was to evaluate the psychometric properties of CES-D, both the original, 20- item version, and the 10-item version by Andresen et al., in women living in the Mixteca, a poor rural area which includes part of the states of Guerrero, Oaxaca and Puebla, in southern Mexico. The instrument was applied as part of a comprehensive survey on health and migration in three rural municipalities in the Mixteca. The sampling design included cluster, proportional to size sampling of localities, and systematic selection of households. At each household, one woman of between 15 and 49 years of age responded a questionnaire which included the CES-D. A total of 468 women were included in the sample (median 35 years, interquartile range 28, 42). Of these, 89% were married or had a stable partner, 5% were single, 13% separated, and 12% widowed. The majority (65%) had only six years of schooling, while 1 6% had no formal education. The statistical analysis was conducted on the 343 questionnaires with complete answers to the CES-D (73% of the sample). The mean score in CES-D-20 was 11.3 (standard deviation 8.8). The mean score in CES-D-10 was 6.3 (standard deviation 5.0). According to the respective cut-off points, prevalence of depressive symptoms was 24.5% for the CES-D-20 and 22.3% for CES-D-1 0. A descriptive statistical analysis of the scores in each item and in the complete scales was conducted. In order to evaluate the internal consistency of CES-D, both 1 0- and 20- item versions, inter-item and item-total correlations were calculated. Cronbach's alpha coefficient was also obtained. Factor analysis was employed to determine if the actual aggregation of the items was coherent with the theoretical dimensions they were intended to measure. Another way to prove validity was through the analysis of the association between the score in the CES-D and the answers to questions about <<nervios>>, an ethnical syndrome well recognized in the region and sharing characteristics with depression. Also, the association of scores with other variables known to be related to depressive symptoms, such as being chronically ill or the educational level, was investigated. In order to evaluate CES-D-10 capacity to identify depressive symptoms, taking the CES-D-20 as reference, Spearman's correlation coefficient between the scores in both scales was calculated. The kappa statistic was employed to evaluate the concordance between scales in the classification of individuals according to their respective cut-off points. For CES-D-20, Cronbach's alpha value was 0.84 and for CES-D-10 it was 0.74. For CES-D-20, four factors with eigen values over 1 were extracted, accounting for 50.6% of variance. The first one included items which, according to Radloff's original solution, are part of the dimensions depressed affect, retarded activity, and positive affect. The second one included items from the depressed affect, retarded activity, and interpersonal dimensions. The fourth factor included only two items, both from the positive affect dimension. A scree plot showed that a two factor solution could also be adequate. For CES-D-10, two factors were extracted, accounting for 46.5% of variance. As for convergent validity, women who reported having <<nervios>> had a median CES-D-20 score of 13.5 (IQR 8.8, 22), while those who did not report the illness had a median score of 9 (IQR 4, 14). Women without a formal education had a median CES-D-20 score of 1 2 (IQR 8, 20), those who had completed elementary school had a median score of 10 (IQR 5, 15), and those with junior high or over had a median of 8 (IQR 3, 15). Those who reported having a chronic illness had a median score of 12 (IQR 8, 18), while those without a chronic illness had a median of 8 (IQR 4, 13). Similar results were observed for the CES-D-10. Spearman's correlation coefficient between CES-D-20 and CES-D-10 was 0.94 (p<.0001). Kappa value for concordance between both versions of the scale was of 0.80. In comparison to the longer version, CES-D-10 had a sensibility of 79.8% and a specificity of 97.3% for the detection of those over cut-off point. The results show that both scales had good reliability and validity in relation to measures of other variables related to depressive symptoms. The factorial grouping of the items was different from the original, as has been observed by other authors. A similar, unimodal distribution centered in 0 and with a positive skew was observed for the answers to all items, except for two items with a bimodal distribution. Those two items were also different to the rest in their presence (having the symptom at least on day during the past week) and persistence (having the symptom everyday during the past week). These differences suggest that items 4 and 8 of the CES-D could have validity problems in this population. In conclusion, both versions of the CES-D were found to have good psychometric properties in this sample, with the shorter one having the advantage of being easier to include in questionnaires for more comprehensive studies. However, further studies with the use of qualitative methods should clarify the true cross-cultural validity of the CES-D in rural areas in Mexico.<hr/>Los síntomas depresivos son un problema de salud mental frecuente e importante en cuanto a sus consecuencias personales y sociales, que afecta no solamente a la población urbana de los países más desarrollados, sino también a los habitantes de zonas rurales en los países pobres. Para obtener información confiable acerca de la frecuencia de síntomas depresivos, así como de sus factores de riesgo o el éxito de las medidas preventivas y de atención, es necesario contar con instrumentos de medición confiables y válidos. El instrumento Center for Epidemiological Studies - Depression (CES- D), de Radloff, fue desarrollado originalmente para el estudio de síntomas depresivos en población abierta. Si bien no es útil para evaluar la presencia de trastornos depresivos del estado de ánimo tal como son definidos en la nosología psiquiátrica, este instrumento permite estudiar la de un rango de manifestaciones basadas en dimensiones de la depresión consideradas en la bibliografía clínica. El objetivo principal de este estudio fue evaluar las propiedades psicométricas del CESD en mujeres de una zona rural de alta marginación, tanto en su versión original como en la versión de 1 0 reactivos de Andresen et al. La información para este estudio se recabó en la zona mixteca, en tres municipios rurales en los cuales se llevó a cabo un muestreo por conglomerados de localidades y sistemático de hogares. Se aplicó el CES-D a 468 mujeres de entre 1 5 y 49 años en los hogares seleccionados. Se hizo un análisis descriptivo de los resultados de puntuación en cada reactivo, así como de los de la escala completa. Para evaluar la consistencia interna del CES-D en sus versiones de 10 y 20 preguntas, se calcularon las correlaciones entre reactivos, y de cada reactivo con la puntuación en la escala completa, así como el coeficiente de alfa de Cronbach. Se llevó a cabo un análisis factorial con el fin de determinar si la agrupación de los reactivos correspondía a sus dimensiones teóricas. Otra medida de la validez de constructo consistió en analizar la relación entre la puntuación en el CES-D y los resultados en preguntas acerca de los <<nervios>>, un padecimiento reconocido en la tradición étnica de la región. Se observó también la asociación con la presencia de enfermedades crónicas y con el nivel educativo, dos variables que han mostrado estar asociadas a los síntomas depresivos. Para evaluar la capacidad del CES-D-10 de medir los síntomas depresivos, en comparación con la versión de 20 reactivos, se calculó el coeficiente de correlación de Spearman entre las puntuaciones en ambas escalas. Se calculó también el estadístico kappa para evaluar la concordancia entre las versiones larga y corta en la clasificación de individuos por encima del punto de corte. El valor de alfa de Cronbach del CES-D-20 fue de 0.84 y el del CES-D-1 0 de 0.74. Para el CES-D-20, se extrajeron cuatro factores con valores propios mayores a 1, que explicaron en conjunto 50.6% de la varianza. El gráfico de sedimentación mostró que una solución en dos factores también hubiera sido adecuada. Para el CES-D-1 0, se extrajeron dos factores que explicaron en conjunto 46.5% de la varianza. La correlación de Spearman entre el CES-D-20 y el CES-D-10 fue de 0.94 (p<.0001). El valor del estadístico kappa para la concordancia entre ambas formas de la escala fue de 0.80. Se observó un comportamiento similar en la distribución de las respuestas a todos los reactivos, a excepción de dos, los cuales difirieron también en su presencia y persistencia en comparación con el resto, por lo que se sugiere que estos dos reactivos podrían estar presentando problemas de validez. <![CDATA[<b>Temperament and character dimensions in first-episode depressed patients</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400006&lng=pt&nrm=iso&tlng=pt Unipolar depression is considered as one of the main psychiatric diagnosis related to psychosocial functioning impairment. It has been documented that personality features exert a direct influence on how people with depression cope and adapt to the disorder. The relationship between personality traits and depression has been studied in several models. As depressed patients usually exhibit several personality features of more than one personality disorder, a multidimensional theoretical perspective may increase the clinical description of prototypical diagnosis provided by current categorical criteria. The psychobiological model of personality proposed by Cloninger takes into account the respective contribution of neurobiologically-based mechanisms related to adaptative behaviors in response to danger, avoidance and reward, formulating four main temperamental dimensions and three characterological dimensions centered in conscious learning about self-concepts. The four temperament dimensions are: Novelty Seeking (NS) is thought to be related to the behavioral activation system; Harm Avoidance (HA) to the behavioral inhibition system; Reward Dependence (RD) is defined as a bias toward the maintenance of ongoing behaviors; and Persistence (PE) is defined as a tendency to perseverance despite frustration and fatigue. The character dimensions are: Self-directedness (SD) refers to the ability of an individual to control, regulate and adapt behavior to fit the situation in accordance with personal goals and values; Cooperativeness (CO), account for individual differences in identification with and acceptance of other people; and Self-transcendence (ST) refers to spiritual maturity, transpersonal identification and creativity. Several studies that used the psychobiological model or personality reported that personality differences are detectable among persons with a current major depressive disorder when compared to non-depressed. The most frequent finding reported is the association between higher scores in harm avoidance (HA) and depression. Nevertheless, other studies have found that depression is also related with high scores in the temperamental dimension: reward dependence (RD). In terms of character dimensions, it has been reported that depressed patients exhibit low self-directedness (SD) and low cooperativeness (CO). Objetive The aims of the present study were to determine the reliability of the Temperament and Character Inventory (TCI) in a sample of Mexican depressed patients and healthy controls and to compare TCI dimensions between both groups. Method A total of 40 first-episode depressed patients and 40 healthy controls matched by gender, age and length of education were recruited. All patients were recruited from the outpatient service at the Instituto Nacional de Psiquiatría Ramón de la Fuente. Patients were excluded if they had received any psychotropic medication for the treatment of depression, if they had concomitant medical or neurological illness, current substance abuse or a history of substance dependence, history of bipolar disorder; high risk for suicide or were agitated. Healthy controls were recruited from a public university and were not enrolled if they presented any psychiatric disorder or scored ≥ 2 points in any SCL-90 subscale, or verbally reported any aggressive behavior in the week prior to the assessment. Diagnosis of depression was done according to DSM-IV criteria and confirmed by clinical consensus. The Montgomery & Asberg Depression Rating Scale (MADRS) was used to measure depressive symptom severity. Personality dimensions were assessed using the Temperament and Character Inventory (TCI). Results Personality dimensions of the TCI showed moderate to high reliability. Internal consistency was higher for the character dimensions than for the temperament dimensions in both groups. Patients with major depression showed higher scores in the temperament dimension harm avoidance when compared to healthy controls. No significant differences emerged between groups in the dimensions: novelty seeking, reward dependence and persistence. Significant differences emerged between groups in terms of character dimensions. Depressed patients exhibit: lower self-directedness, lower cooperativeness and lower self-transcendence when compared to healthy controls. Discussion Personality assessment in patients with their first depressive episode offers the advantage of reducing biases secondary to the falsification of retrospective report, the effects of illness chronicity and pharmacological treatment on personality. Our results support the idea that the temperament dimension harm avoidance can be consider as an intermediate phenotype for major depression, as it can be a risk factor or may have a direct influence in the way depression is manifest. In terms of character dimensions, lower scores of self-direct edness may be reflected in patients lack of control responses in situations where mature and effectives responses are required. In this way, patients with low self-direct edness may exhibit irresponsible behaviors and a poor impulse control. Low cooperativeness in patients with depression may represent a state characterized by a limited empathy and can be reflected as social intolerance or social isolation. These behavioural changes are frequent depressive symptoms that can be observed by persons that share the environment with the patient. The result of a low self-transcendence in patients with depression raises the possibility that certain beliefs can modify patients' behavior when they cannot conceive their existence as a part of a unified whole. This, in conjunction with lack of transpersonal identification may explain the presence of self-destructive thoughts and behaviors, such as suicide ideation, frequent symptoms observed in patients with depression. In conclusion, our results show that the temperament dimension HA can be associated with vulnerability to depression, while severity of depression may lay in the interaction between constitutional factors and the subjectivity of illness experience conferred by character.<hr/>La depresión unipolar se ha considerado como uno de los trastornos mentales que tiene un mayor impacto en el funcionamiento psicosocial de los individuos. Se ha documentado que los rasgos de la personalidad influyen directamente sobre la forma en como las personas con depresión mayor se adaptan y enfrentan este padecimiento. Diversos estudios que han empleado el abordaje multidimensional de la personalidad mediante el modelo psicobiológico de la personalidad de Cloninger, han considerado que la personalidad es un constructo que diferencia a los sujetos que cursan con un trastorno depresivo mayor de los sujetos sin esta patología. El hallazgo más reportado en la bibliografía ha mostrado que una elevada Evitación al Daño (HA) se asocia con la depresión. Sin embargo, otras investigaciones han encontrado que la depresión mayor también se asocia con una mayor Dependencia a la Recompensa (RD). En cuanto a las dimensiones de carácter, se ha encontrado que los pacientes con depresión muestran una Baja Autodirección (SD) y una Baja Cooperatividad (CO). Objetivo Los objetivos del presente estudio fueron determinar la confiabilidad del Inventario de Temperamento y Carácter (ITC) en una muestra mexicana de pacientes con trastorno depresivo mayor y sujetos control, y comparar las dimensiones del ITC entre ambos grupos. Método Se incluyeron 40 pacientes que estuvieran cursando con su primer episodio de depresión mayor y 40 sujetos controles comparados por el método de pares por género, edad y nivel de escolaridad. Los pacientes fueron reclutados del servicio de consulta externa del Instituto Nacional de Psiquiatría Ramón de la Fuente. Los sujetos control fueron reclutados de una universidad pública de la Ciudad de México. El diagnóstico de los pacientes se realizó a partir de los criterios del DSM-IV y fue confirmado mediante consenso clínico. La severidad de los síntomas de depresión fue evaluada mediante la Escala de Depresión de Montgomery & Asberg (MADRS). Las dimensiones de la personalidad en pacientes y controles fue evaluada mediante el Inventario de Temperamento y Carácter (ITC). Resultados Las dimensiones del ITC mostraron una confiabilidad de moderada a alta. Se observaron diferencias significativas entre grupos en la dimensión de temperamento: Evitación al Daño (HA) y en las dimensiones de carácter Autotrascendencia (ST), Cooperatividad (CO) y Autodirección (SD). Discusión La evaluación de la personalidad en pacientes con un primer episodio de depresión permite excluir la falsificación del reporte retrospectivo así como los efectos que la cronicidad del padecimiento o el tratamiento farmacológico tienen sobre la personalidad. La dimensión de temperamento HA puede ser considerada un factor de vulnerabilidad en el desarrollo de la depresión, mientras que la severidad de la depresión podría estar relacionada con la interacción de los factores constitucionales del sujeto y la subjetividad de la experiencia del padecimiento a partir de la conformación del carácter. <![CDATA[<b>Suicidal risk and lethality in patients with borderline personality disorder (BPD), at a psychiatry hospital</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400007&lng=pt&nrm=iso&tlng=pt Suicide attempt in patients diagnosed with Borderline Personality Disorder (BPD) is the most frequent cause of hospitalization in this clinical category and suicidal risks are usually the first manifestation of such disorder. Patients frequently relapse, thus generating high personal and family costs, including: treatments, hospitalization, medication, work disability in economically active people and even death. The American Psychiatric Association, through the DSM-IV, defines the Borderline Personality Disorder as <<A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts>>. More specifically, criterion five of the disorder mentions self-mutilating behavior, threats, and recurrent suicidal behavior. DSM-IV reports that 8-10% of borderline patients commit suicide. In our country, however, there are no specific data about people diagnosed with BPD who actually have commited suicide. Prevalence of BPD among the general population ranks from 1 to 2%, from 11 to 20% of the psychiatric population; representing 20% of hospitalized patients. The gender distribution is 3:1, being more frequent among women than men. The objective of this study is the assessment of suicidal risk and lethality of 15 patients diagnosed with Borderline Personality Disorder. This research was conducted at the doctors' offices of the host institution, where 1.39% of a total of 1151 hospitalized patients in 2007 were diagnosed with BPD. The comorbidity of DSM-IV Axis I and BPD is frequent and can be found together with mood disorders (depression, dysthymia), substance-related disorders, eating disorders (bulimia nervosa), post-traumatic stress disorder, anxiety disorder and/or attention-deficit hyperactivity disorder. A research conducted in the USA with 504 patients diagnosed with BPD showed that 93% (n = 379) of the patients showed comorbidity of DSM-IV Axis I and mood disorders. Similar results were reported by other researchers. This study was designed to be a descriptive and transversal study. We went through the records of all the adult patients who had been hospitalized due to suicide ideation or attempt, diagnosed by psychiatrists as Borderline Personality Disorder, and confirmed by the SCID-II, and medicated by a psychiatrist. Selection criteria: 18 year-old patients or older, hospitalized due to suicide attempt or ideation, and diagnosed with BPD. The research was conducted in compliance with the regulations governing human research ethics set forth in the Declaration of Helsinki (1975). The instruments used were: the medical history of the patients, the ID file for clinical and epidemiological studies, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID -II), the Hopelessness Scale, the Depressive Syndrome Questionnaire, the Suicidal Ideation Scale, the Risk-Rescue Scale and some risk factors such as: sexual abuse, separation from partner, parental divorce, the suicide of a close relative, and alcohol and substance abuse. The results on the lethality of suicide attempts are similar to the results of other studies: women show a higher number of less lethal suicide attempts, and the methods used are also similar (medication intoxication and mutilation). The comorbidity with depressive disorders was of 86.6%, thus our results concur with those of other studies. Regarding risk factors, 86.6% (n = 13) mentioned they have experienced some type of sexual abuse, 46.6% (n = 7) separated from their partner, 40% (n = 6) had divorced parents, and 6.6% (n = 1) had a close relative who had committed suicide. During their last suicide attempt, one of the subjects had consumed alcohol and none of them had taken drugs; however, these behaviors did not appear to potentiate the suicidal risk. According to the scales applied, 46% of the subjects (n = 7) showed severe hopelessness, while 54% (n = 8) ranged between mild or moderate hopelessness; 13% (n = 2) had severe depression according to Calderon's scale. According to the Suicidal Ideation Scale, 93.3% (n=14) had a >10 score, which means patients show risk of attempting suicide again. The Risk-Rescue Scale suggests that most patients (n = 13) exhibited deliberate self-harming behavior (e.g. cutting superficially the skin around the wrist, taking prescription drugs or intoxicating near key people who could rescue them or provide help and rescue), which are not considered true parasuicidal behavior. The literature shows that BPD is the most prevalent of all personality disorders, both in the general and clinical population, the one with the highest number of suicide attempts in the DSM-IV Axis II, and the one with the highest comorbidity with Axis I mood disorders and Axis II personality disorders. The 15 patients in this sample carried out a total of 128 suicide attempts throughout their lives, which coincides with other research results, which describe that a history of multiple suicide attempts is a predictor of future suicidal behavior and increase the suicidal risk. As shown above, there were no cases obtaining high scores in all the scales applied (hopelessness, depression, suicidal ideation, high risk and low rescue), even in the result integration per subject, thus showing very few, high-lethality suicidal cases. It would be a mistake, however, to think that suicide attempts will always be less lethal, since there is always the risk of someone attempting a more lethal suicide that translates into the death of the patient. Suicide attempt assessment in dealing with Borderline Personality Disorder becomes a necessary condition to design better therapeutic strategies, since it allows health professionals to know the degree of lethality and timely treatment. The assessment of suicide attempts enables a more realistic prognosis, which backs up and guides clinical decisions.<hr/>El intento de suicidio en los pacientes diagnosticados con Trastorno Límite de la Personalidad (TLP) es la causa más frecuente de hospitalización en esta categoría clínica, los riesgos suicidas constituyen con frecuencia la presentación del padecimiento. Los pacientes recaen continuamente generando altos costos personales-familiares, de hospitalización en tratamientos, medicación e incapacidades laborales en personas económicamente activas, siendo el costo más alto, la pérdida de la vida humana. La Asociación Psiquiátrica Americana, en el Manual del DSM-IV, define el trastorno límite de la personalidad como: <<un patrón general de inestabilidad en las relaciones interpersonales, la autoimagen y la afectividad, y una notable impulsividad, que comienzan al principio de la edad adulta y se da en diversos contextos>>. El DSM-IV reporta que del 8 al 10% de los pacientes fronterizos llegan a consumar el acto suicida. La prevalencia del TLP en población general va de 1 al 2%, de 11 al 20% en población clínica psiquiátrica, representa 20% de los hospitalizados y desde el punto de vista de la distribución por sexos, es más frecuente entre las mujeres de 3:1 con respecto a los varones. El objetivo de esta investigación consistió en la evaluación del riesgo y la letalidad suicida, en pacientes diagnosticados con trastorno límite de la personalidad, en un hospital de psiquiatría del Valle de México, por medio de: la historia clínica, la ficha de identificación para estudios clínicos y epidemiológicos, la Entrevista Clínica Estructurada para los Trastornos de la Personalidad SCID-II, la Escala de Desesperanza, el Cuestionario del Síndrome Depresivo, la Escala de Ideación Suicida, la Escala de Riesgo-Rescate y algunos factores de riesgo, tales como el abuso sexual, la separación de la pareja, el divorcio de los padres, el suicidio de algún familiar cercano, el abuso de sustancias y alcohol. El diseño de este estudio fue descriptivo y transversal. Los resultados mostraron que la comorbilidad con los trastornos depresivos fue del 86.6%, esto concuerda con otras investigaciones. La letalidad del intento suicida coincide con los resultados de otras investigaciones en cuanto a que las mujeres presentan mayor número de tentativas suicidas de menor letalidad. La escala de Riesgo-Rescate sugiere que la mayoría de los casos (n = 13) realizó conductas de automutilación, ej., cortarse la piel superficialmente a la altura de la muñeca, ingerir medicamentos o intoxicarse en presencia de personas-clave que estaban en posibilidad de rescatarlas o solicitar el rescate. Con relación a los factores de riesgo, el 86.6% (n = 13) respondió haber vivido algún tipo de abuso sexual, 46.6% (n = 7) separación de la pareja, 40% (n = 6) padres divorciados, y 6.6% (n = 1) suicidio de algún familiar cercano. El consumo de alcohol y drogas no potencializaron el riesgo suicida. Conclusiones Los métodos más utilizados en pacientes con TLP fueron el uso de fármacos y la mutilación de la piel de manera superficial en las muñecas. La letalidad de los intentos de suicidio en general fue baja. Las conductas de riesgo suicida en TLP como el consumo del alcohol y drogas, el abuso sexual, la separación de la pareja, los padres divorciados, el suicidio de algún familiar cercano, no incrementaron la gravedad suicida en la mayoría de los casos, por lo que se puede hablar de intentos de suicidio, y no de suicidios frustrados o verdaderos comportamientos que comprometan la vida. La evaluación del intento de suicido en el trastorno límite de la personalidad, es una condición necesaria para diseñar mejores estrategias terapéuticas y con ello reducir el riesgo suicida. <![CDATA[<b>Unmet needs for treatment of alcohol and drug use in four cities in Mexico</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400008&lng=pt&nrm=iso&tlng=pt Introduction Even though heavy alcohol consumption is frequent, alcohol-related consequences are common, and drug use has become more common in this country, we know very little about public health response and the types of treatments available for persons with substance use disorders in Mexico. Current national estimates show that about one in every five persons with alcohol and substance use disorders received treatment in the last 12 months, but to date the rates of treatment for local communities are unknown; these data are needed for policy planning at community level. This study presents data on the treatment for substance use and substance use disorders in three urban areas of Northern Mexico and one state capital in Central Mexico. The Northern region is of particular interest in Mexico because of its proximity to the United States and previous evidence that alcohol and drug use is about twice as common in this region compared with other regions. The city of Queretaro provides a more appropriate comparison for the cities in Northern Mexico than a place as Mexico City, or the national means, due to its level of development, population size, and basic epidemiologic data on drug use. Material and methods The Local Surveys on Addictions 2005 (Encuestas Locales de Adicciones 2005) are part of the Mexican National Survey on Addictions (ENA) series, supported by the Ministry of Health (CONADIC- National Council Against the Addictions), state and local governments, and the National Institute of Psychiatry (INP), and included the cities of Tijuana (Baja California), Ciudad Juarez (Chihuahua), Monterrey (Nuevo Leon) and Queretaro (Queretaro), as part of a continuous effort to monitor use of illicit substances in Mexico. The 12-month prevalence of health and non-health care service use for treatment of substance use was estimated. Correlates of service use, including interference with role impairment, were identified in logistic regression analyses that took into account the complex sample design and weighing process. Results A total of 2,148 completed interviews were obtained for a response rate of 70.5%. About 2.2% of those who used any substance saw any provider in the last 12 months, with the largest prevalence among the health care sector (1.37%), followed closely by the non-health care sector (0.91%). Among the health care sectors, the general medical sector provided more services than mental health specialists. About 11 % of those with any disorder consulted for services, with the health care sector providing many more services than the non-health care sector. The prevalence of use for mental health specialists and the general medical sector is very similar for those with a disorder. The largest prevalence of any service was found in Monterrey (about 15%), while Ciudad Juarez had the lowest (6.6%). Less than 50% of those with an active disorder reported any role impairment, but respondents with high levels of role impairment were more likely to use services. Conclusion We found large unmet needs for substance use services among urban residents of Queretaro and in three major northern cities in Mexico. The two cities that have shown higher rates of substance use in addiction surveys in Mexico (Tijuana and Ciudad Juarez) had the lowest levels of any treatment. We found few predictors of service use among those who used any substance and among those with an active disorder. Among those, respondents with high levels of role impairment were more likely to use services. Treatment for substance use can be effective and is urgently needed if Mexico wants to face the prominent place of alcohol in the burden of disease in the country. The effort to change the current situation of alcohol and drug service utilization, including the low rates of mental health specialists in these cities, is likely to require coordination of research, larger numbers of services, treatment alternatives, and service development.<hr/>Introducción Aunque el consumo excesivo de alcohol sea frecuente, las consecuencias de este consumo sean comunes y haya aumentado la disponibilidad de drogas, se sabe poco de las acciones de salud pública y los tipos de tratamiento disponibles para personas con trastornos por el uso de sustancias en México. Estimaciones actuales nacionales muestran que alrededor de una de cada cinco personas con trastornos por el uso de alcohol y drogas recibió tratamiento en los últimos 12 meses. Pese a ello, hasta la fecha no disponemos de estimaciones de las tasas de tratamiento a nivel local, lo que es necesario para la planeación de políticas públicas a nivel comunitario. Este trabajo presenta datos sobre el tratamiento para el uso de sustancias y para los trastornos por el uso de sustancias en tres áreas urbanas del norte de México y una ciudad capital localizada en el centro del país. La región norte es de particular interés por su proximidad con los Estados Unidos y por la evidencia previa de que el alcohol y las drogas es dos veces más común en esta región comparada con otras de la República. Por su nivel de desarrollo, su tamaño poblacional y los datos epidemiológicos básicos que aporta sobre el uso de drogas, la ciudad de Querétaro provee un punto de comparación para las ciudades del norte más apropiado que un lugar como la Ciudad de México o el promedio nacional. Material y métodos Las Encuestas Locales de Adicciones 2005 son parte de la serie de Encuestas Nacionales de Adicciones (ENA), apoyadas por la Secretaría de Salud, el Consejo Nacional Contra las Adicciones (CONADIC), los gobiernos locales y estatales, y el Instituto Nacional de Psiquiatría, e incluyen las ciudades de Tijuana (Baja California), Ciudad Juárez (Chihuahua), Monterrey (Nuevo León) y Querétaro (Querétaro) como parte de un esfuerzo continuo por monitorear el uso de sustancias ilícitas en México. Se estimó la prevalencia en los últimos 12 meses de servicios médicos y no médicos para el tratamiento del uso de sustancias. Los correlatos del uso de servicios, incluida la discapacidad asociada con la interferencia en los roles, se identificaron por medio de regresiones logísticas, mismas que tomaron en consideración el diseño de la muestra y los ponderadores de la encuesta. Resultados Un total de 2148 residentes tuvieron entrevistas completas, para una tasa de respuesta de 70.5%. Solamente 2% de las personas que usaron alcohol o drogas en los últimos 12 meses hicieron uso de algún servicio de tratamiento. La prevalencia más elevada se dio en los servicios de salud (1.37%), seguida de cerca por el sector no médico (0.91%). Entre el sector salud fueron más frecuentes los servicios ofrecidos por el médico general que por los especialistas en salud mental. Alrededor de 11% de aquéllos con algún trastorno por sustancias consultó con los servicios; el sector médico ofreció mucho más servicios que el sector no médico. La prevalencia de uso de servicios de salud mental especializados y la del médico general fueron muy similares para aquellos con un trastorno por sustancias. La prevalencia más elevada de cualquier uso de servicios se dio en la ciudad de Monterrey (alrededor de 15%), mientras que Ciudad Juaréz tuvo la prevalencia más baja (6.6%). Menos de 50% de aquéllos con un trastorno activo mostró algún nivel de discapacidad en el desempeño de roles, pero las personas con mayores niveles de discapacidad tuvieron mayores probabilidades de usar servicios. Conclusiones Encontramos una gran cantidad de necesidades no satisfechas para el tratamiento del uso de sustancias entre residentes de áreas urbanas de cuatro grandes ciudades de México. Las dos ciudades que mostraron las tasas más elevadas de uso de sustancias en otras encuestas de adicciones en México (Tijuana y Ciudad Juárez) mostraron los niveles más bajos de cualquier tratamiento. Encontramos pocos correlatos para el uso de servicios entre aquellos que usaron cualquier sustancia y entre aquellos con un trastorno activo. Entre éstos, los entrevistados con mayores niveles de discapacidad tuvieron mayores probabilidades de usar cualquier servicio. El tratamiento para el uso de sustancias puede ser efectivo y es urgentemente necesario si México quiere enfrentar el lugar prominente que tiene el consumo de alcohol en la carga de la enfermedad en el país. El esfuerzo necesario para cambiar la presente situación del bajo uso de servicios para el tratamiento del consumo de alcohol y drogas, incluidas las bajas tasas de uso de servicios especializados en salud mental, probablemente requiera la coordinación de investigación, mayor número y disponibilidad de servicios, más alternativas de tratamiento y desarrollo de servicios. Son urgentemente necesarias mejorías en la disponibilidad y en los tipos de tratamientos disponibles para los trastornos por uso de sustancias. <![CDATA[<b>The polychlorinated biphenyls (PCBS) environmental pollutants and their effects on the Nervous System and health</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400009&lng=pt&nrm=iso&tlng=pt Environmental pollution is a world-wide issue which is a matter for concern among the international community. Great industrialized cities are the most polluted and Mexico City is among them. However, pollution affects places which are far away from contaminated urban areas, thus damaging eco-systems. Environmental pollution is responsible for an alarming and increasing list of illnesses in humans, animals and plants. This has generated an international interest in this problem. From the 187 chemical agents considered toxic for living organisms, the Inter-Government Committee for the Negotiation of Persistent Organic Pollutants (Pops) has catalogued 12 as the most hazardous for life. Among them are the so-called polychlorinated biphenyls (PCBs). PCBs are a family of 209 structurally chlorinated compounds made up of chlorine, carbon and hydrogen. These compounds are chemically and thermally stable, insoluble in water, non-flammable, electrically resistant, with low volatility at normal temperatures, and bio-degradable only at high temperatures (1200°C). One of their main disadvantages is that they are subject to a process of bioaccumulation where their concentration increases along the food chain. Their physical properties make them widely used in industry, mainly in the electrical and building areas. Not long after PCBs were manufactured, it was determined that food for human intake such as milk, fish and eggs, to mention just a few, presented higher PCBs concentrations than those allowed by the Organism for US Environmental Protection (0.0005mg/l). It has been demonstrated that PCBs can cause damage to the endocrine, immunologic and Nervous Systems, among others. The underlying mechanism of action of these compounds is through the activation of the aril hydrocarbon receptor (AhR), a ligand-dependent cytosolic transcription factor. PCBs act like ligands and, given their lipophilic properties, enter cells by passive diffusion. Two co-chaperone proteins are bound to AhR to form an oligomer which dissociates when binding to a PCB. After ligand binding, a heterodimer is formed which translocates into the nucleus and links to specific DNA regions; this in turn regulates the transcription velocity of specific genes and produces genetic alterations that modify processes and functions in the cell. PCBs belong in the group of chemicals considered endocrine disruptors. Damage caused by these compounds can be irreversible. In the endocrine system they interfere with the production and regulation of steroid and thyroid hormones, acting as agonists or antagonists of hormone receptors. They impair endocrine metabolic pathways, such as those of thyroid hormones (T3 and T4), and inhibit carrier proteins such as transthyretin. Contaminants that harm the endocrine system also affect the reproductive function and disrupt various aspects of sexuality. In males, PCBs inhibit the synthesis of testosterone, alter masculinity, reduce sperm motility and the capacity of binding and penetrating the ovule, induce changes in the shape of the penis as well as its size, retard or inhibit testicle descent, and can generate testicular cancer. In females, they can cause early menarche (first menstruation), enhanced duration of menstrual bleeding, urogenital malformations, endometriosis, spontaneous abortion, fetal death, premature delivery and low-weight in offspring. Our group, as well as other research groups, has encountered that PCB administration to gestating rats causes an increment in offspring mortality, fetal miscarriages, low bodily weight of the offspring and a reduction in the number of males per litter. The immunological system is sensitive to chemicals such as PCBs which originate an immunological response; they act as immunotoxins that cause thymus atrophy, affect innate immunity, compromise host resistance and immunity mediated by B and T cells, as well as humoral immunity. PCBs and their metabolites are carcinogenic and act as general cancer promoters by enhancing the effects of other substances through the generation of oxygen reactive compounds that can induce DNA oxidative damage. Chronic PCB exposure can cause chromosomal aberrations; these compounds have been related to all types of cancer: mammary gland, liver, biliary tract, gastrointestinal, skin (especially malignant melanomas), lung, pancreas and brain. There is evidence that organisms are more vulnerable to PCB exposure during the early embryonic stages. These compounds can cross the placenta and affect the fetus; when they are present in human milk they keep the offspring under high PCB levels thus altering development. In addition, they can contribute to the interruption of growth and development of brain, organs and tissues. As a result, malfunctions or miscarriage occur. PCBs are involved in the neurodegeneration process since they affect dopaminergic neurons in caudate nucleus, ventral tegmental area and substantia nigra. These compounds disrupt neuronal mechanisms such as vesicular transport and dopamine release which lead to cellular death similar to that described for diseases such as Parkinson's. Perinatal exposure to PCBs is associated with neurodevelopmental deficiencies of infants which consist of dysfunctions at the neuropsychological level such as in verbal learning (syllables, words and concepts), performance functions, changes in attention and psychomotor development. Acute or chronic exposure to PCBs is associated with cephalea, insomnia, nervousness, irritability, depression and anxiety; these symptoms in turn modify behavior. At the neurophysiological level, these contaminants impair excitatory and inhibitory synaptic transmission in the hippocampus, inhibit long-term potentiation and synaptic plasticity, alter some mechanisms of cell signaling (GABAergic pathway), and deteriorate learning and memory. Recently, these compounds have been related to cognitive alterations. Our group demonstrated that the administration of PCB-77 and Aroclor 1254 during gestation inhibits the enzymatic activity of nitric oxide synthase (NOS) in 10-day postnatal pups. These rats presented degenerative morphological neuronal changes such as shrinking, picnosis, loss of neurites, neuronal death and decrease in the number of nitrergic neurons in the paraventricular and supraoptic hypothalamic nuclei. We also reported that in these nuclei a decrease in immunoreactivity to vasopressin and neuronal NOS is observed. The evidence in PCB studies is conclusive. The exposure to these environmental toxins interferes with the functioning of various organs and systems such as the endocrine and Nervous Systems, not only in humans but also in animals. These contaminants pose a risk factor for a wide number of neurodegenerative alterations.<hr/>La contaminación ambiental es un grave problema mundial que actualmente preocupa a la comunidad internacional. Las grandes ciudades industrializadas, como la de México, son las más contaminadas. Sin embargo, la contaminación llega hasta zonas alejadas de donde se produce y afecta los ecosistemas. La contaminación es responsable de una alarmante y creciente lista de enfermedades en el hombre, los animales y las plantas. Los bifenilos policlorados (PCB) se catalogaron dentro de los 12 contaminantes orgánicos más tóxicos para los organismos vivos. Sus propiedades físicas hicieron que se usaran ampliamente en la industria. No son biodegradables y se acumulan en el ambiente, se transfieren dentro de la cadena alimenticia y tienden a concentrarse más al final de ésta, por lo que en los alimentos se determinaron concentraciones que sobrepasaban los límites establecidos por el Organismo de Protección del Ambiente de los Estados Unidos. Se demostró que los PCB afectan la función de los sistemas endocrino, inmunológico y nervioso, entre otros. El mecanismo de acción descrito para los PCB, es por medio de la activación del receptor aril hidrocarburo, un factor de transcripción citosólico dependiente de ligando. Los PCB actúan como ligandos y son lipofílicos, por lo que entran a la célula y llegan al núcleo para unirse al ADN, lo cual altera la trascripción de genes específicos y provoca alteraciones genéticas que conducen a cambios en los procesos y funciones celulares. Los PCB interfieren con la producción y regulación de las hormonas esteroides y tiroideas al actuar como antagonistas o agonistas de los receptores hormonales. Afectan la función reproductora y alteran diferentes aspectos de la sexualidad. Como otros grupos de investigación, el nuestro ha observado que la administración de PCB a ratas gestantes causa un incremento de la mortalidad de las crías, pérdida fetal, peso corporal bajo y una reducción en el número de machos por camada. Los PCB actúan como inmunotoxinas que causan la atrofia del timo y afectan la respuesta inmune. Los PCB y sus metabolitos son carcinogénicos debido a la generación de especies reactivas de oxígeno que pueden producir daño oxidativo al ADN, provocar aberraciones cromosómicas y generar cáncer de mama, hígado, tracto biliar, gastrointestinal, cerebral, etc. Los organismos son más vulnerables a la exposición de los PCB durante las etapas tempranas del desarrollo embrionario. Los PCB atraviesan la placenta y llegan al feto, permanecen en la leche materna y mantienen niveles altos en las crías. Los PCB afectan así el desarrollo del Sistema Nervioso, los órganos y los tejidos, y pueden llevar a la pérdida fetal. También se asocian a deficiencias en el neurodesarrollo del niño y a alteraciones neuropsicológicas en la atención, el aprendizaje y el desarrollo psicomotor. La exposición aguda o crónica a los PCB se asocia con cefalea, insomnio, nerviosismo, irritabilidad, depresión y ansiedad. Los PCB participan en el proceso de neurodegeneración al afectar el sistema dopaminérgico. En el nivel neurofisiológico, afectan la transmisión sináptica excitatoria e inhibitoria hipocampal; inhiben la potenciación a largo plazo y la plasticidad sináptica; alteran mecanismos de señalización celular como el GABAérgico, en el aprendizaje y la memoria, y producen alteraciones cognoscitivas. Nuestro grupo demostró que la administración de los PCB durante la gestación inhibe la actividad de la enzima sintasa del óxido nítrico y provoca cambios neuronales morfológicos degenerativos en los núcleos paraventricular y supraóptico hipotalámicos. Las evidencias de los estudios realizados con los PCB son concluyentes en cuanto a que la exposición a estos tóxicos ambientales interfiere con el funcionamiento de diferentes órganos y sistemas y a que son un factor de riesgo para un amplio número de alteraciones neurodegenerativas. Actualmente, las poblaciones están expuestas a concentraciones que exceden los niveles límite tolerables recomendados por la Organización Mundial de la Salud. Nuestro grupo está analizando las alteraciones de estos contaminantes en el nivel neuroendocrino y en algunos aspectos del aprendizaje y la memoria. Dada la relevancia de los efectos de los PCB en la salud y de la falta en México de una valoración de los niveles de los PCB existentes en personas y alimentos, es importante que las instituciones de salud fomenten y apoyen las investigaciones en esta área. <![CDATA[<b>Cervantes, Alonso-Fernández and the autometamorphosic delusions</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400010&lng=pt&nrm=iso&tlng=pt Environmental pollution is a world-wide issue which is a matter for concern among the international community. Great industrialized cities are the most polluted and Mexico City is among them. However, pollution affects places which are far away from contaminated urban areas, thus damaging eco-systems. Environmental pollution is responsible for an alarming and increasing list of illnesses in humans, animals and plants. This has generated an international interest in this problem. From the 187 chemical agents considered toxic for living organisms, the Inter-Government Committee for the Negotiation of Persistent Organic Pollutants (Pops) has catalogued 12 as the most hazardous for life. Among them are the so-called polychlorinated biphenyls (PCBs). PCBs are a family of 209 structurally chlorinated compounds made up of chlorine, carbon and hydrogen. These compounds are chemically and thermally stable, insoluble in water, non-flammable, electrically resistant, with low volatility at normal temperatures, and bio-degradable only at high temperatures (1200°C). One of their main disadvantages is that they are subject to a process of bioaccumulation where their concentration increases along the food chain. Their physical properties make them widely used in industry, mainly in the electrical and building areas. Not long after PCBs were manufactured, it was determined that food for human intake such as milk, fish and eggs, to mention just a few, presented higher PCBs concentrations than those allowed by the Organism for US Environmental Protection (0.0005mg/l). It has been demonstrated that PCBs can cause damage to the endocrine, immunologic and Nervous Systems, among others. The underlying mechanism of action of these compounds is through the activation of the aril hydrocarbon receptor (AhR), a ligand-dependent cytosolic transcription factor. PCBs act like ligands and, given their lipophilic properties, enter cells by passive diffusion. Two co-chaperone proteins are bound to AhR to form an oligomer which dissociates when binding to a PCB. After ligand binding, a heterodimer is formed which translocates into the nucleus and links to specific DNA regions; this in turn regulates the transcription velocity of specific genes and produces genetic alterations that modify processes and functions in the cell. PCBs belong in the group of chemicals considered endocrine disruptors. Damage caused by these compounds can be irreversible. In the endocrine system they interfere with the production and regulation of steroid and thyroid hormones, acting as agonists or antagonists of hormone receptors. They impair endocrine metabolic pathways, such as those of thyroid hormones (T3 and T4), and inhibit carrier proteins such as transthyretin. Contaminants that harm the endocrine system also affect the reproductive function and disrupt various aspects of sexuality. In males, PCBs inhibit the synthesis of testosterone, alter masculinity, reduce sperm motility and the capacity of binding and penetrating the ovule, induce changes in the shape of the penis as well as its size, retard or inhibit testicle descent, and can generate testicular cancer. In females, they can cause early menarche (first menstruation), enhanced duration of menstrual bleeding, urogenital malformations, endometriosis, spontaneous abortion, fetal death, premature delivery and low-weight in offspring. Our group, as well as other research groups, has encountered that PCB administration to gestating rats causes an increment in offspring mortality, fetal miscarriages, low bodily weight of the offspring and a reduction in the number of males per litter. The immunological system is sensitive to chemicals such as PCBs which originate an immunological response; they act as immunotoxins that cause thymus atrophy, affect innate immunity, compromise host resistance and immunity mediated by B and T cells, as well as humoral immunity. PCBs and their metabolites are carcinogenic and act as general cancer promoters by enhancing the effects of other substances through the generation of oxygen reactive compounds that can induce DNA oxidative damage. Chronic PCB exposure can cause chromosomal aberrations; these compounds have been related to all types of cancer: mammary gland, liver, biliary tract, gastrointestinal, skin (especially malignant melanomas), lung, pancreas and brain. There is evidence that organisms are more vulnerable to PCB exposure during the early embryonic stages. These compounds can cross the placenta and affect the fetus; when they are present in human milk they keep the offspring under high PCB levels thus altering development. In addition, they can contribute to the interruption of growth and development of brain, organs and tissues. As a result, malfunctions or miscarriage occur. PCBs are involved in the neurodegeneration process since they affect dopaminergic neurons in caudate nucleus, ventral tegmental area and substantia nigra. These compounds disrupt neuronal mechanisms such as vesicular transport and dopamine release which lead to cellular death similar to that described for diseases such as Parkinson's. Perinatal exposure to PCBs is associated with neurodevelopmental deficiencies of infants which consist of dysfunctions at the neuropsychological level such as in verbal learning (syllables, words and concepts), performance functions, changes in attention and psychomotor development. Acute or chronic exposure to PCBs is associated with cephalea, insomnia, nervousness, irritability, depression and anxiety; these symptoms in turn modify behavior. At the neurophysiological level, these contaminants impair excitatory and inhibitory synaptic transmission in the hippocampus, inhibit long-term potentiation and synaptic plasticity, alter some mechanisms of cell signaling (GABAergic pathway), and deteriorate learning and memory. Recently, these compounds have been related to cognitive alterations. Our group demonstrated that the administration of PCB-77 and Aroclor 1254 during gestation inhibits the enzymatic activity of nitric oxide synthase (NOS) in 10-day postnatal pups. These rats presented degenerative morphological neuronal changes such as shrinking, picnosis, loss of neurites, neuronal death and decrease in the number of nitrergic neurons in the paraventricular and supraoptic hypothalamic nuclei. We also reported that in these nuclei a decrease in immunoreactivity to vasopressin and neuronal NOS is observed. The evidence in PCB studies is conclusive. The exposure to these environmental toxins interferes with the functioning of various organs and systems such as the endocrine and Nervous Systems, not only in humans but also in animals. These contaminants pose a risk factor for a wide number of neurodegenerative alterations.<hr/>La contaminación ambiental es un grave problema mundial que actualmente preocupa a la comunidad internacional. Las grandes ciudades industrializadas, como la de México, son las más contaminadas. Sin embargo, la contaminación llega hasta zonas alejadas de donde se produce y afecta los ecosistemas. La contaminación es responsable de una alarmante y creciente lista de enfermedades en el hombre, los animales y las plantas. Los bifenilos policlorados (PCB) se catalogaron dentro de los 12 contaminantes orgánicos más tóxicos para los organismos vivos. Sus propiedades físicas hicieron que se usaran ampliamente en la industria. No son biodegradables y se acumulan en el ambiente, se transfieren dentro de la cadena alimenticia y tienden a concentrarse más al final de ésta, por lo que en los alimentos se determinaron concentraciones que sobrepasaban los límites establecidos por el Organismo de Protección del Ambiente de los Estados Unidos. Se demostró que los PCB afectan la función de los sistemas endocrino, inmunológico y nervioso, entre otros. El mecanismo de acción descrito para los PCB, es por medio de la activación del receptor aril hidrocarburo, un factor de transcripción citosólico dependiente de ligando. Los PCB actúan como ligandos y son lipofílicos, por lo que entran a la célula y llegan al núcleo para unirse al ADN, lo cual altera la trascripción de genes específicos y provoca alteraciones genéticas que conducen a cambios en los procesos y funciones celulares. Los PCB interfieren con la producción y regulación de las hormonas esteroides y tiroideas al actuar como antagonistas o agonistas de los receptores hormonales. Afectan la función reproductora y alteran diferentes aspectos de la sexualidad. Como otros grupos de investigación, el nuestro ha observado que la administración de PCB a ratas gestantes causa un incremento de la mortalidad de las crías, pérdida fetal, peso corporal bajo y una reducción en el número de machos por camada. Los PCB actúan como inmunotoxinas que causan la atrofia del timo y afectan la respuesta inmune. Los PCB y sus metabolitos son carcinogénicos debido a la generación de especies reactivas de oxígeno que pueden producir daño oxidativo al ADN, provocar aberraciones cromosómicas y generar cáncer de mama, hígado, tracto biliar, gastrointestinal, cerebral, etc. Los organismos son más vulnerables a la exposición de los PCB durante las etapas tempranas del desarrollo embrionario. Los PCB atraviesan la placenta y llegan al feto, permanecen en la leche materna y mantienen niveles altos en las crías. Los PCB afectan así el desarrollo del Sistema Nervioso, los órganos y los tejidos, y pueden llevar a la pérdida fetal. También se asocian a deficiencias en el neurodesarrollo del niño y a alteraciones neuropsicológicas en la atención, el aprendizaje y el desarrollo psicomotor. La exposición aguda o crónica a los PCB se asocia con cefalea, insomnio, nerviosismo, irritabilidad, depresión y ansiedad. Los PCB participan en el proceso de neurodegeneración al afectar el sistema dopaminérgico. En el nivel neurofisiológico, afectan la transmisión sináptica excitatoria e inhibitoria hipocampal; inhiben la potenciación a largo plazo y la plasticidad sináptica; alteran mecanismos de señalización celular como el GABAérgico, en el aprendizaje y la memoria, y producen alteraciones cognoscitivas. Nuestro grupo demostró que la administración de los PCB durante la gestación inhibe la actividad de la enzima sintasa del óxido nítrico y provoca cambios neuronales morfológicos degenerativos en los núcleos paraventricular y supraóptico hipotalámicos. Las evidencias de los estudios realizados con los PCB son concluyentes en cuanto a que la exposición a estos tóxicos ambientales interfiere con el funcionamiento de diferentes órganos y sistemas y a que son un factor de riesgo para un amplio número de alteraciones neurodegenerativas. Actualmente, las poblaciones están expuestas a concentraciones que exceden los niveles límite tolerables recomendados por la Organización Mundial de la Salud. Nuestro grupo está analizando las alteraciones de estos contaminantes en el nivel neuroendocrino y en algunos aspectos del aprendizaje y la memoria. Dada la relevancia de los efectos de los PCB en la salud y de la falta en México de una valoración de los niveles de los PCB existentes en personas y alimentos, es importante que las instituciones de salud fomenten y apoyen las investigaciones en esta área. <![CDATA[<b>Autoevaluación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000400011&lng=pt&nrm=iso&tlng=pt Environmental pollution is a world-wide issue which is a matter for concern among the international community. Great industrialized cities are the most polluted and Mexico City is among them. However, pollution affects places which are far away from contaminated urban areas, thus damaging eco-systems. Environmental pollution is responsible for an alarming and increasing list of illnesses in humans, animals and plants. This has generated an international interest in this problem. From the 187 chemical agents considered toxic for living organisms, the Inter-Government Committee for the Negotiation of Persistent Organic Pollutants (Pops) has catalogued 12 as the most hazardous for life. Among them are the so-called polychlorinated biphenyls (PCBs). PCBs are a family of 209 structurally chlorinated compounds made up of chlorine, carbon and hydrogen. These compounds are chemically and thermally stable, insoluble in water, non-flammable, electrically resistant, with low volatility at normal temperatures, and bio-degradable only at high temperatures (1200°C). One of their main disadvantages is that they are subject to a process of bioaccumulation where their concentration increases along the food chain. Their physical properties make them widely used in industry, mainly in the electrical and building areas. Not long after PCBs were manufactured, it was determined that food for human intake such as milk, fish and eggs, to mention just a few, presented higher PCBs concentrations than those allowed by the Organism for US Environmental Protection (0.0005mg/l). It has been demonstrated that PCBs can cause damage to the endocrine, immunologic and Nervous Systems, among others. The underlying mechanism of action of these compounds is through the activation of the aril hydrocarbon receptor (AhR), a ligand-dependent cytosolic transcription factor. PCBs act like ligands and, given their lipophilic properties, enter cells by passive diffusion. Two co-chaperone proteins are bound to AhR to form an oligomer which dissociates when binding to a PCB. After ligand binding, a heterodimer is formed which translocates into the nucleus and links to specific DNA regions; this in turn regulates the transcription velocity of specific genes and produces genetic alterations that modify processes and functions in the cell. PCBs belong in the group of chemicals considered endocrine disruptors. Damage caused by these compounds can be irreversible. In the endocrine system they interfere with the production and regulation of steroid and thyroid hormones, acting as agonists or antagonists of hormone receptors. They impair endocrine metabolic pathways, such as those of thyroid hormones (T3 and T4), and inhibit carrier proteins such as transthyretin. Contaminants that harm the endocrine system also affect the reproductive function and disrupt various aspects of sexuality. In males, PCBs inhibit the synthesis of testosterone, alter masculinity, reduce sperm motility and the capacity of binding and penetrating the ovule, induce changes in the shape of the penis as well as its size, retard or inhibit testicle descent, and can generate testicular cancer. In females, they can cause early menarche (first menstruation), enhanced duration of menstrual bleeding, urogenital malformations, endometriosis, spontaneous abortion, fetal death, premature delivery and low-weight in offspring. Our group, as well as other research groups, has encountered that PCB administration to gestating rats causes an increment in offspring mortality, fetal miscarriages, low bodily weight of the offspring and a reduction in the number of males per litter. The immunological system is sensitive to chemicals such as PCBs which originate an immunological response; they act as immunotoxins that cause thymus atrophy, affect innate immunity, compromise host resistance and immunity mediated by B and T cells, as well as humoral immunity. PCBs and their metabolites are carcinogenic and act as general cancer promoters by enhancing the effects of other substances through the generation of oxygen reactive compounds that can induce DNA oxidative damage. Chronic PCB exposure can cause chromosomal aberrations; these compounds have been related to all types of cancer: mammary gland, liver, biliary tract, gastrointestinal, skin (especially malignant melanomas), lung, pancreas and brain. There is evidence that organisms are more vulnerable to PCB exposure during the early embryonic stages. These compounds can cross the placenta and affect the fetus; when they are present in human milk they keep the offspring under high PCB levels thus altering development. In addition, they can contribute to the interruption of growth and development of brain, organs and tissues. As a result, malfunctions or miscarriage occur. PCBs are involved in the neurodegeneration process since they affect dopaminergic neurons in caudate nucleus, ventral tegmental area and substantia nigra. These compounds disrupt neuronal mechanisms such as vesicular transport and dopamine release which lead to cellular death similar to that described for diseases such as Parkinson's. Perinatal exposure to PCBs is associated with neurodevelopmental deficiencies of infants which consist of dysfunctions at the neuropsychological level such as in verbal learning (syllables, words and concepts), performance functions, changes in attention and psychomotor development. Acute or chronic exposure to PCBs is associated with cephalea, insomnia, nervousness, irritability, depression and anxiety; these symptoms in turn modify behavior. At the neurophysiological level, these contaminants impair excitatory and inhibitory synaptic transmission in the hippocampus, inhibit long-term potentiation and synaptic plasticity, alter some mechanisms of cell signaling (GABAergic pathway), and deteriorate learning and memory. Recently, these compounds have been related to cognitive alterations. Our group demonstrated that the administration of PCB-77 and Aroclor 1254 during gestation inhibits the enzymatic activity of nitric oxide synthase (NOS) in 10-day postnatal pups. These rats presented degenerative morphological neuronal changes such as shrinking, picnosis, loss of neurites, neuronal death and decrease in the number of nitrergic neurons in the paraventricular and supraoptic hypothalamic nuclei. We also reported that in these nuclei a decrease in immunoreactivity to vasopressin and neuronal NOS is observed. The evidence in PCB studies is conclusive. The exposure to these environmental toxins interferes with the functioning of various organs and systems such as the endocrine and Nervous Systems, not only in humans but also in animals. These contaminants pose a risk factor for a wide number of neurodegenerative alterations.<hr/>La contaminación ambiental es un grave problema mundial que actualmente preocupa a la comunidad internacional. Las grandes ciudades industrializadas, como la de México, son las más contaminadas. Sin embargo, la contaminación llega hasta zonas alejadas de donde se produce y afecta los ecosistemas. La contaminación es responsable de una alarmante y creciente lista de enfermedades en el hombre, los animales y las plantas. Los bifenilos policlorados (PCB) se catalogaron dentro de los 12 contaminantes orgánicos más tóxicos para los organismos vivos. Sus propiedades físicas hicieron que se usaran ampliamente en la industria. No son biodegradables y se acumulan en el ambiente, se transfieren dentro de la cadena alimenticia y tienden a concentrarse más al final de ésta, por lo que en los alimentos se determinaron concentraciones que sobrepasaban los límites establecidos por el Organismo de Protección del Ambiente de los Estados Unidos. Se demostró que los PCB afectan la función de los sistemas endocrino, inmunológico y nervioso, entre otros. El mecanismo de acción descrito para los PCB, es por medio de la activación del receptor aril hidrocarburo, un factor de transcripción citosólico dependiente de ligando. Los PCB actúan como ligandos y son lipofílicos, por lo que entran a la célula y llegan al núcleo para unirse al ADN, lo cual altera la trascripción de genes específicos y provoca alteraciones genéticas que conducen a cambios en los procesos y funciones celulares. Los PCB interfieren con la producción y regulación de las hormonas esteroides y tiroideas al actuar como antagonistas o agonistas de los receptores hormonales. Afectan la función reproductora y alteran diferentes aspectos de la sexualidad. Como otros grupos de investigación, el nuestro ha observado que la administración de PCB a ratas gestantes causa un incremento de la mortalidad de las crías, pérdida fetal, peso corporal bajo y una reducción en el número de machos por camada. Los PCB actúan como inmunotoxinas que causan la atrofia del timo y afectan la respuesta inmune. Los PCB y sus metabolitos son carcinogénicos debido a la generación de especies reactivas de oxígeno que pueden producir daño oxidativo al ADN, provocar aberraciones cromosómicas y generar cáncer de mama, hígado, tracto biliar, gastrointestinal, cerebral, etc. Los organismos son más vulnerables a la exposición de los PCB durante las etapas tempranas del desarrollo embrionario. Los PCB atraviesan la placenta y llegan al feto, permanecen en la leche materna y mantienen niveles altos en las crías. Los PCB afectan así el desarrollo del Sistema Nervioso, los órganos y los tejidos, y pueden llevar a la pérdida fetal. También se asocian a deficiencias en el neurodesarrollo del niño y a alteraciones neuropsicológicas en la atención, el aprendizaje y el desarrollo psicomotor. La exposición aguda o crónica a los PCB se asocia con cefalea, insomnio, nerviosismo, irritabilidad, depresión y ansiedad. Los PCB participan en el proceso de neurodegeneración al afectar el sistema dopaminérgico. En el nivel neurofisiológico, afectan la transmisión sináptica excitatoria e inhibitoria hipocampal; inhiben la potenciación a largo plazo y la plasticidad sináptica; alteran mecanismos de señalización celular como el GABAérgico, en el aprendizaje y la memoria, y producen alteraciones cognoscitivas. Nuestro grupo demostró que la administración de los PCB durante la gestación inhibe la actividad de la enzima sintasa del óxido nítrico y provoca cambios neuronales morfológicos degenerativos en los núcleos paraventricular y supraóptico hipotalámicos. Las evidencias de los estudios realizados con los PCB son concluyentes en cuanto a que la exposición a estos tóxicos ambientales interfiere con el funcionamiento de diferentes órganos y sistemas y a que son un factor de riesgo para un amplio número de alteraciones neurodegenerativas. Actualmente, las poblaciones están expuestas a concentraciones que exceden los niveles límite tolerables recomendados por la Organización Mundial de la Salud. Nuestro grupo está analizando las alteraciones de estos contaminantes en el nivel neuroendocrino y en algunos aspectos del aprendizaje y la memoria. Dada la relevancia de los efectos de los PCB en la salud y de la falta en México de una valoración de los niveles de los PCB existentes en personas y alimentos, es importante que las instituciones de salud fomenten y apoyen las investigaciones en esta área.