Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520090006&lang=pt vol. 32 num. 6 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>The four dimensions of the depressed patients</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Hazardous and harmful drinking among Mexican adolescents: prevalence and predictive factors</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600002&lng=pt&nrm=iso&tlng=pt Alcohol is commonly used among adolescents in Mexico. In a representative survey of Mexico's general population, 30% of the teenagers reported current drinking, whereas 8% incurred in binge drinking (5 or more drinks per occasion) at least once during the last year. In addition, 3% reported three or more alcohol dependence symptoms over the last 12 months. In this Mexican age group, alcohol consumption importantly contributes to the most frequent causes of morbidity and mortality (e.g. accidents, violence, homicides, suicide and risky behaviors). Data from a representative survey of adolescents attending middle and high school in Mexico City suggests that adolescents attending Mexico's schools run a high risk for alcohol problems. In this study, prevalence of lifetime and current drinking, and of current binge drinking (5 or more drinks per occasion) were, respectively, 65.8%, 35.2%, and 23.8%. These rates are substantially higher than those described in teenagers from Mexico's general population. Furthermore, although among Mexico's general population the prevalence of drinking has traditionally been higher among male than female adolescents, no gender differences in prevalence of alcohol consumption have been reported among Mexican middle and high school students. This suggests that female adolescents in Mexico's schools have become equally exposed to drinking as their male counterparts. Despite these trends, there is a paucity of studies examining drinking patterns and their respective correlates among Mexican adolescents attending post-elementary education. To our knowledge, in this population, there are no published prevalence estimates of Hazardous and Harmful Drinking (HHD). HHD is defined as a pattern of alcohol consumption conferring to the individual a greater risk for health problems, or frankly conducive to medical or psychological complications (e.g. accidents, victimization, violence, alcohol dependence, liver cirrhosis and/or other medical complications). The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization, is currently the only instrument specifically designed to identify HHD. Although the AUDIT was initially validated only among adult patients in primary care settings, this instrument has consistently shown to be valid and reliable in detecting alcohol problems in different populations, such as the adolescent population in many countries around the world. Given the public health implications of estimating the frequency of HHD among adolescents attending high school in Mexico, and given the importance of elucidating the variables influencing this problem, we decided to conduct the analysis presented here. To our knowledge, this is the first report published in the international literature on the prevalence of HHD among adolescents attending high school in a Latin American country. Objective In the study described here, derived from a Universidad Nacional Autónoma de México (UNAM) project entitled <<Early Identification and Treatment of Problem Drinkers>>, we aimed at examining the frequency and risk factors for HHD among Mexican high school students. More specifically, our objectives were: 1. to determine the past-year prevalence of HHD among high school freshmen; and 2. to examine, in this population, the effects of demographic and family variables in the likelihood of HHD. Subjects and methods This study was a cross-sectional survey conducted at the beginning of the school year during the registration period between September 1st and September 30th, 2005. In 2005, a total of 34000 students were accepted to initiate college at the nine UNAM college campuses located in the Mexico City metropolitan area. Of these, 28784 students (87.4 %) (age=14.8 [±2.5] years; 51.0% women) consented in answering the survey and provided complete data. Consequently, 521 6 students (12.6%) were excluded from the analysis due to a lack of consent, incomplete data or their absence at the time of registration. We used the AUDIT to examine past-year prevalence of HHD. This self-report instrument includes 10 items that examine frequency and intensity of drinking (items 1-3), presence of alcohol dependence symptoms (items 4-6), and negative consequences of drinking (items 7-10), yielding a maximum possible score of 40 points. Among adult patients in primary care settings, it has been accepted that an AUDIT score of 0-7 points reflects safe levels of alcohol consumption, whereas a score of 8 points or higher indicates the presence of Hazardous and/or Harmful Drinking. It has been described however, that among adolescents, an AUDIT score of 3 points or higher reliably identifies those students experiencing this problem. In the analysis presented here, we separately examined and reported prevalence estimates and correlates for HHD using both AUDIT's cut-off scores (≥3 and ≥8). The AUDIT was administered at the same time that a wellness screening survey that the UNAM Medical Services routinely administer to all registering high school freshmen at the beginning of the school year. Questions in the wellness survey pertained students' medical and dental health, family medical history, immunizations, and use of tobacco and other drugs. In addition, demographic and socioeconomic information was obtained from a questionnaire also routinely administered by the UNAM registrar's office. This questionnaire included 37 items inquiring about gender, age, employment and marital status, monthly family income, parental education, place and type of residency, persons with whom the student resided, and questions on previous academic performance. We estimated the prevalence of HHD and their respective 95% confidence intervals (95% CI) in the total of the sample, and separately by age group, gender, working status, monthly family income, parental education, and by variables reflecting whether the students lived with their family, peers, or alone. These variables were modeled using simulated binary terms (0, 1). Subsequently, a multinomial logistic regression was used to examine the relationship between HHD and the demographic and socioeconomic variables listed above. Variables were entered simultaneously into the logistic regression equation. To summarize the level of risk of HHD conferred by significant variables in the logistic regression model, odds ratios (OR) and their respective 95% CI's were estimated. All the significant effects reported here were adjusted considering the effects of the remaining demographic and socioeconomic variables. Results Among the high school students examined here, the prevalence of HHD was 4.0% when an AUDIT cut-off score of ≥ 8 was used. When an AUDIT score of ≥3 was considered, a frequency of 1 7.2% was observed. Men (AUDIT ≥8: 5.4%; AUDIT ≥3: 21.4%) experienced this problem more frequently than women (AUDIT≥8: 2.6%; AUDIT≥3: 13.1%). The highest prevalence of HHD among men was observed in all age groups and regardless of working status, family income, parents' education, or regardless of the persons with whom the student reported to live with. Controlling for demographic and socioeconomic differences between men and women, we found that the risk of experiencing HHD among men was approximately two times higher than among women (OR's and 95% CI's for AUDIT's cut-off score ≥8 or ≥3, respectively 2.0[1.6-2.4] and 1.6[1.5-1.8]).<hr/>De acuerdo a la Encuesta Nacional de Adicciones (ENA) (Medina-Mora et al., 2003), de 1990 al 2002, la prevalencia en el consumo de alcohol durante los últimos 12 meses entre los jóvenes mexicanos de 12 a 17 años de edad, se elevó del 27.6% al 30%. De manera más reciente, la Encuesta de Estudiantes de Nivel Medio y Medio Superior de la Ciudad de México (EENMMS) (Villatoro et al., 2003), describió que el consumo alguna vez en la vida y el consumo durante el último mes de bebidas etílicas afectó respectivamente al 65.8% y al 35.2% de los estudiantes. Llama la atención que la frecuencia del consumo alguna vez en la vida reportada por la EENMMS es considerablemente mayor que la descrita en los adolescentes de la población general urbana (39.8%) por la ENA. Además, las diferencias de género reportadas por la ENA, en las que los hombres tradicionalmente beben con más frecuencia que las mujeres, no fueron encontradas por la EENMMS en la población estudiantil del nivel medio y medio superior. Hasta lo que nosotros sabemos, se desconoce cuál es la prevalencia en esta población de patrones de consumo problemático de alcohol como serían el consumo riesgoso y dañino (CRDA) o el consumo dependiente. Por lo que se desconoce si existen diferencias entre la población estudiantil y los adolescentes de la población general, en la prevalencia de estos problemas. El CRDA se define como un patrón de consumo de bebidas embriagantes, que se sitúa en un continuum de severidad, que coloca al sujeto en riesgo de desarrollar problemas de salud y/o que puede desembocar en francas complicaciones físicas y/o psicológicas (accidentes, victimización, violencia, dependencia al alcohol, etc.). Objetivo En el estudio que se presenta aquí, nos propusimos: 1) estimar la prevalencia durante el último año del CRDA en los estudiantes de primer ingreso al nivel bachillerato de la UNAM, y 2) evaluar la influencia de las variables sociodemográficas y familiares en el riesgo para el CRDA. Material y métodos El diseño del estudio fue el de una encuesta transversal en los estudiantes del primer año del bachillerato en el sistema escolarizado de la UNAM. Se estudiaron a 28 784 estudiantes (87.4 % de la población total). Se utilizó el Alcohol Use Disorders Identification Test (AUDIT) -versión en español para detectar el CRDA en la población adolescente. En este análisis empleamos tanto los puntos de corte recomendados para evaluar el CRDA en adultos (AUDIT≥8) como el puntaje recomendado para la población adolescente (AUDIT≥3). Se utilizaron porcentajes, promedios y desviaciones estándar para el análisis de las variables demográficas, y pruebas de contraste de medias (análisis de varianza) y de proporciones ( χ²) de acuerdo a la variable. Se utilizó la regresión logística multinomial para examinar la asociación de las variables demográficas y familiares con el CRDA. Se calcularon los odds ratios (OR) con intervalo de confianza al 95% para resumir el nivel de riesgo de ser afectado por el CRDA. Resultados Cuando se usó la definición del CRDA para la población adulta, se encontró que 4.0% de los estudiantes lo presentaron, frente a 1 7.2% cuando se utilizó el puntaje del AUDIT recomendado para los adolescentes. El riesgo de experimentar el CRDA fue casi dos veces mayor en los hombres que en las mujeres. <![CDATA[<b>EEG changes induced by habituation and conditioning in 3- to 15-year-old children attending the Instituto Nacional de Rehabilitación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600003&lng=pt&nrm=iso&tlng=pt During waking, stimuli activate the sensory pathways giving rise to sensation and the response to such stimulation. The electrobiochemical changes and modifications in EEG rhythms event-related synchronization or event-related desynchronization, ERD or ERS) propagated in the specific and unspecific cortex are added to the changes elicited by the responses and to the new signals originated by those same responses, bringing about perception. Diverse factors can alter these glialneuronal circuits, producing alterations in attention processes (ADD) and in the integration with their meaning. The inability to identify signals and integrate correct coordinated responses leads to deficiencies in responding to the environment and to associated morbidities that are added to ADD. ADD and its associated morbidities cause high social and economic impacts and, even more so, because of their persistence into adolescence and adulthood. Therefore, highly accurate diagnostic procedures are needed for these diseases. According to the CIE-10, in the clinical setting symptoms are analyzed without studying the neuro-developmental and neuro-degenerative signs that identify alterations in neuronal circuits. As is known, behavior (including motivation, memory, thoughts) results from the Central Nervous System (CNS) activity, and the EEG records the electrical activity of neurons and synapses of the cerebral cortex, where cognitive processes are most likely to take place. To establish more accurate diagnostic procedures for ADD, we are integrating an electronic database, considering the intensity and cerebral distribution of theta (θ), alpha (α), and beta (β) rhythms. We propose that the ERD of α and β reflects a cortical activation that gives rise to sensory-motor coordination processes. The first stimulations induce ERD, and their repetitions produce its decrement (ERS): ERD habituation. In addition, this ERD to ERS change might be reversed when giving meaning to the stimulation. We present herein the changes in θ, α, and β rhythms induced by repeated photostimulation (RPS), with the same characteristics, that, when presented, requires the subject to press a knob. Hundred-twenty-four children were studied at the Instituto Nacional de Rehabilitación (INR, for its initials in Spanish) in Mexico City. Children were of either gender and aged from 3 to 15 years, separated in four groups of 3-year intervals. During clinical exploration, we searched for possible delays in physical-emotional-intellectual development, epilepsy, and medical or psychological treatments during the last six months, which were considered exclusion factors. Parents were briefed on the study, explaining them that the procedure had a low-risk nature and allowed for the analyzis of the electrical activity of the brain. Once having understood and accepted the procedure, they signed the informed consent form prepared by the institution. Children were explained <<how the batteries of the brain>> work and that the procedure caused no pain at all. They were asked to close their eyelids during the recordings, and to remain as motionless as possible. The exclusion factors left a sample of 94 children for the habituation analysis and of 47 for the simple conditioning procedures. The EEG was recorded in dorsal decubitus position, with a digital 24-channel electroencephalograph, according to the 10/20 international system. In addition, we recorded eye movements and the EKG. After 5-min recordings with closed eyelids, photo-stimulation was started at 5 flashes per second during 2s, repeated 20 times (RPS), at 21 to 25 sec. intervals. After finishing the series, 5 min rest were provided, and then a round device with a knob was placed in the children's hands, telling them to press the knob at the start of the RPS and to release it at the end. Analyses were performed with 1.6 to 40 Hz bandwidth filters. From the bipolar leads, samples recorded 2 sec. before, during, and after the 1st, 5th, 10th, 20th associations (PS-knob pressing) were manually chosen. For conditioning analyses, we also measured the response latency. The Fourier's FT was applied to the samples and the absolute potency (AP) was calculated for θ (4.0 to 7.5 Hz), α (8.0 to 12.5 Hz), and β (13 to 20 Hz). The average of these frequencies was obtained for each hemisphere (Right, RH; Left, LH) and for both (BH). Wilcoxon's test for related samples was used with (α > 0.05 as significant. Analyses of the AP of the three frequencies in all children revealed a background activity below 10 µV². The first RPS produced a decrease in the AP of θ and α, with an increase in β in BH. At the 5th RPS, θ and α continued to decrease along with an increase in β. At the 10th RPS, θ and α decreased less but the increase in β persisted. At the 15th RPS, θ continued to decrease but α increased in the LH and decreased somewhat in the RH, whereas β continued its increase in BH. At the 20th RPS, the AP of θ and a decreased in BH, but the difference was smaller than that recorded during the previous RPS. The AP of β continued to increase in BH. The most relevant aspects are: a) in G-1 (children aged 3 to 6 years), the AP of the three frequencies is higher, predominating θ, which is twice the magnitude of that of the whole group; b) the 1st PS produced an increase in the AP of all three frequencies, which was not recorded in the other groups (children aged 6.5 to 15 years); c) in G-4 (children 12.5 to 15 years of age), the 1st and 5th PS produced a clear diminution in the AP of θ and a (ERD), which was smaller at the 10th RPS and reversed at the 15th and 20th RPS (ERS). After indicating to the children that with each RPS they would have to press a knob, the background activity increased to 12 µV². During the 1st association (assoc), the AP of θ and α decreased with a slight decrease in β; the response latency was 930 ms. At the 5th assoc, θ decreased together with a small increase in a and β, and the response latency decreased to 750 ms. On the 10th and 15th assoc, the three frequencies increased and the latency decreased to 650 and 640 ms, respectively. On the 20th assoc, the AP increase of each rhythm was smaller, and the latency increased to 750 ms. The EEG analysis per group revealed a higher AP for 0 in the smaller children that decreased along increasing age together with a relative increase in a, which reached its maximal value in G-4. In the four groups, the RPS induced an undulating tendency towards a decrease in the EEG desynchronization that represents habituation, being more noticeable in G-4. Although the reached synchronization level did not reflect a better inhibition, as described in adults, it suggested that, in these children, the inhibitory activity on sensory control has not yet developed completely. Another important finding is that in G-1, the 1st RPS induced and increase in θ and α that was not observed in the other groups.<hr/>Algunos cambios del ambiente activan las vías sensoriales generando la sensación y la respuesta a dicha estimulación. Los cambios electrobioquímicos modifican el EEG que al propagarse en la corteza cerebral se suman a los potenciales que generan las respuestas y éstas producen nuevas señales que dan lugar a la percepción. Diversos factores pueden alterar la organización de esos circuitos glioneuronales produciendo trastornos de la atención (TDA), de su integración con su significado, lo que regula el tipo e intensidad de respuestas adecuadas al contexto social. La discapacidad de estas funciones genera comorbilidades que se suman al TDA. Estas enfermedades son de alto impacto socio-económico y cultural y lo son más cuando persisten en la adolescencia y la adultez. Por esto es necesario desarrollar metodologías diagnósticas de alta precisión. Actualmente se acepta que la conducta integral resulta de la actividad del Sistema Nervioso (SN). El EEG registra la actividad eléctrica de las neuronas de la corteza cerebral donde se realizan procesos cognitivos. Para caracterizar el EEG estamos integrando, en una base de datos electrónica, la intensidad y distribución cerebral de los ritmos delta (Δ), theta (θ), alfa (α) y beta (β). Proponemos que la desincronización (DRE) refleja la activación cortical, base de los procesos de coordinación sensoriomotora. Las primeras estimulaciones producen DRE que, al repetirse, disminuyen la habituación de la DRE. Además, es posible que se invierta este cambio DRE a sincronización (SRE) al darle significado a la misma estimulación. En este trabajo se presentan los cambios de θ, α y β ante la fotoestimulación repetida y cuando el sujeto tiene que presionar un botón al inicio de dicha estimulación. Sujetos y método Se atendieron 124 niños, de tres a 15 años, separados en cuatro grupos con intervalos de tres años. En el interrogatorio clínico se indagó el posible retraso del desarrollo físico-emocional-intelectual, de epilepsia o tratamientos médicos o psicológicos convirtiéndose en factores de exclusión. A los niños, delante de los padres, se les explicó cómo funciona su cerebro, que el estudio no produce dolor, que estarán acostados con los párpados cerrados (OC), permaneciendo lo más inmóviles posible, los padres al comprenderlo y aceptar firmaron la autorización. Los factores de exclusión dejaron 94 niños para análisis de habituación y 47 para condicionamiento. El EEG se registró utilizando los montajes bipolares A-P parasagitales del sistema internacional 10/20, además se registraron los movimientos oculares y el EKG. El sujeto con OC se fotoestimulaba 20 veces (FR a 5/s X 2s). Después de 5 min de terminada la serie se les ponía en la mano dominante un aditamento con un botón, indicándoles que lo apretaran al inicio de cada FR y lo liberaran al terminarse (asociaciones). El análisis se efectuó con filtro de 1.6 y 40 Hz. Seleccionando manualmente, de la 1era, 5ª, 10ª 15ª y 20ª FR muestras de registros bipolares de 2s antes, durante y después. Para el condicionamiento se agregó la medición de la latencia de la respuesta. Se aplicó la TRF y se calculó la Potencia Absoluta (PA) de θ (4.0-7.5 Hz), α (8.0-1 2.5 Hz) y β (1 3-20 Hz), se obtuvo el promedio en cada hemisferio (HI, HD) y de ambos (AH). Se utilizó la prueba de Wilcoxon con α >0.05. Resultados El promedio de la PA de la actividad de fondo, de todos los niños, está por debajo de 10 µV². La 1era FR disminuye la PA de θ y de α con incremento de β en AH. En la 5ª FR disminuye θ y α con incremento de β. En la 10° disminuye menos θ y α, persistiendo el incremento de β. En la 15ª continúa la disminución de θ, pero aumenta α en el HI y disminuye en el HD. En AH se incrementa β. En la 20° se vuelve a disminuir θ y α en AH; sin embargo, el rango de la diferencia es menor que el registrado en anteriores FR. La PA de β sigue aumentando en AH. El análisis por grupo muestra que en el G-1, la PA de los tres ritmos es mayor, con predominio de θ, siendo del doble del grupo total. En la 1era FR incrementa la PA de los 3 ritmos, lo cual no se registró en los otros grupos. En el G-4, la 1era y 5ª FR disminuyen la PA de θ y de α (DRE), siendo menor la disminución en la 10ª y se invierte en la 1 5ª y 20ª (SER). Consecutivamente a la explicación de que con la FR deben presionar el botón, se incrementa el promedio de la PA a 12 µV² en promedio de la muestra. En la 1era Aso disminuye la PA de 6 y de θ incluyendo una discreta disminución de β, la latencia es de 930 ms. En la 5ª Aso disminuye θ con pequeño incremento de θ y α y la latencia es de 750 ms. En la 10ª y 15ª continúa el incremento de los tres ritmos y la latencia disminuye a 650 y 640 ms, respectivamente. Mientras que en la 20ª el incremento de la PA de cada ritmo es menor y la latencia se incrementa a 750 ms. <![CDATA[<b>Evaluation of an induction component in the treatment of alcohol use among </b><b>Mexico City</b><b> adolescents</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600004&lng=pt&nrm=iso&tlng=pt There are two main problems reported in the intervention programs addressing teenage substance users: 1) limited admission to treatment, 2) high drop out rates. Institutions in other countries working with teenage substance users report a dropout rate between 50 and 70% after the first session at early treatment stages. In Mexico, a study on dropout rates in a brief intervention program found rates of 53%, with teenagers dropping out between the first and second session. In the addictive behavior field, there is a factor involved in the lack of acceptance for treatment and the dropout rate during treatment. This factor is the perception of addiction treatment programs and teenagers' readiness for change their consumption. Particularly, it was proposed that the lack of agreement over the actions that the therapist and the user develop, jointly and individually, affects the admission to and permanence of users in treatment programs. In addition, Yahne & Miller consider that most of the people can be admitted to the program without any willingness or with a limited willingness to change their consumption. This suggests the need for strategies that increase teenagers' interest in modifying their substance consumption. That is why this study reports the results of an evaluation of an induction to treatment session as a part of the <<Brief Intervention Program for Adolescents that Begin Alcohol and Drug Use>> [BIPA]. This induction to treatment session uses some of the strategies from motivational interviewing that also includes the change stages of Prochaska and DiClemente. These strategies are based on four steps: a) give teenagers feedback on the impact of alcohol use on their lives according to the results of a previous evaluation, b) give direct counseling about the importance of change, c) suggest alternatives to achieve this change, d) describe the BIPA characteristics and clarify the therapist's and teenagers' role in the treatment. If they follow these steps, teenagers increase their readiness to change. In addition, this induction to treatment session may help to clarify the perception about the activities that both therapist and the teenager must develop during the intervention program. The objectives of the current study are: 1) Evaluate the impact of the induction to treatment session on the therapist and teenagers' perception, 2) Evaluate the impact of the induction to treatment session on the stage of teenagers' readiness willingness to change, and 3) Determine the effects of the induction to treatment session on teenage alcohol users' acceptance and permanence. In this study, a pre-post test design without a control group was used in a sample of 28 volunteer teenage students from Mexico City. The sample was non probabilistic and included volunteer participants meeting the following criteria: a) teenage alcohol users drinking more than 4 drinks on more than 5 occasions in the last 6 months; b) reports on alcohol-related problems without physical symptoms of alcohol dependence according to DSM-IV-TR; c) being aged between 14 to 18 years old; d) being a student. This study took place at the <<Guillermo Dávila>> Center of Psychological Services and the Acasulco Center of the UNAM Psychology Faculty, as well as at a secondary and high school in Mexico City. The instruments used were: Initial Interview, Readiness to Change Scale, and the Perception of Therapist's and Teenager's Role Questionnaire. The principal characteristics related to teenage consumption were: the overall sample reported alcohol consumption as a preeminent substance; the majority reported moderate alcohol consumption (1-2 occasions per month) over the past 90 days, although 80% reported large amounts of alcohol (more than 5 drinks per occasion). On the other hand, the three main problems reported by teenagers were related to attending parties where alcohol was necessarily consumed, family or friend's arguments and consequences related to affective situations. Data analysis showed statistical differences before and after the induction according to perceptions about the therapist's role t(27) = -2.803, p <.05, but not about the teenagers' role t(27) = -1.793, p >.05, although the average group analysis before the induction session showed that the participants had a clear perception of the activities they perform during the program. On the other hand, the data analysis did not show significant statistical differences in the recognition t(27) = .000, p >.05 and action t(27) = -1.839, p >.05 subscales, both from the readiness for change scale. As for the acceptance and permanence percentage in the treatment, 100% of the teenagers agreed to join the treatment program after the induction session, 93% only attended the first session of treatment, and 62% finished their participation in the treatment program. Based on these results, the induction to treatment session represents a component that clarifies teenagers' perception about the therapist's actions during the treatment. Although there were no significant differences in the readiness to change scale, the induction session is thought to have helped in the teenagers' admission to treatment in addition to promoting progress to action. The induction session can also be one of the variables that contributed to acceptance of and permanence in treatment among teenagers. However, it is important to evaluate the effect that the induction to treatment session had by comparing it with a control group. It is also essential to consider the evaluation of the induction to treatment session with teenage drug users, as well as teenagers that do not go to school. Despite the limited sample, the results observed suggest the relevance of this kind of components in treatment for teenage substance users.<hr/>Entre los programas de intervención dirigidos a los adolescentes que abusan del alcohol y otras drogas se han reportado dos grandes problemas: 1. la escasa aceptación para ingresar a tratamiento y 2. las altas tasas de abandono. Instituciones de otros países que trabajan con adolescentes usuarios de sustancias, reportan una tasa de deserción después de un primer contacto de entre el 50% y el 70% en fases tempranas del tratamiento. En México, un estudio sobre la deserción de los adolescentes participantes en un programa de intervención breve determinó que el porcentaje de deserción fue del 53% y la deserción se presentó entre la primera y la segunda visita al terapeuta. Algunos de los factores implicados en la falta de aceptación del tratamiento y la deserción durante el tratamiento en el campo de las adicciones, son la etapa de disposición a cambiar su consumo en la que se encuentran los sujetos y su percepción acerca de los tratamientos de las adicciones. En este sentido, en este trabajo se reporta la evaluación de una sesión de inducción al tratamiento como parte del <<Programa de Intervención Breve para Adolescentes que Inician el Consumo de Alcohol y Otras Drogas>> [PIBA]. La sesión de inducción al tratamiento desarrollada como parte del PIBA, utiliza algunas de las estrategias propuestas por la entrevista motivacional, las que se integran en cuatro pasos: a) retroalimentar al adolescente sobre el impacto del uso de alcohol en su vida de acuerdo a los resultados de una evaluación previa, b) dar consejo directo sobre la necesidad de cambio, c) sugerir alternativas para el cambio y d) describir las características del PIBA y aclarar las acciones que el terapeuta y el adolescente realizan en el tratamiento. Con estos pasos se busca que el adolescente avance en su etapa de disposición al cambio y aclare su percepción acerca de las actividades que él y el terapeuta realizan durante el tratamiento. De manera adicional, se planteó que la sesión de inducción al tratamiento puede resultar efectiva para promover la aceptación y permanencia en el tratamiento entre los adolescentes. Para tal efecto se utilizó un diseño de grupo pretest-postest sin grupo control, con una muestra de 28 adolescentes estudiantes voluntarios del Distrito Federal, quienes reportaron consumir alcohol y tener problemas relacionados. El análisis de los datos mostró diferencias estadísticas significativas antes y después de la sesión de inducción para la percepción del rol del terapeuta, pero no para la percepción del rol del adolescente, aunque el análisis del promedio grupal acerca de la percepción del adolescente sobre su rol en el tratamiento, antes de la sesión de inducción, arrojó que los participantes tenían una percepción clara acerca de las actividades que ellos realizan durante el tratamiento. Por otra parte, el análisis no mostró diferencias estadísticas significativas para la etapa de disposición al cambio de los adolescentes antes y después de la sesión de inducción al tratamiento, sin embargo, el análisis de las medias grupales para las dos subescalas del instrumento que midió esta variable mostró que en un inicio los adolescentes se encontraban preparados para el cambio. Finalmente, se reportó que el 100% de los jóvenes aceptaron ingresar a tratamiento, el 92% acudió por lo menos a la primera sesión del programa y el 62% lo concluyó. Se propone que la sesión de inducción al tratamiento representa una estrategia mediante la cual se puede clarificar la percepción de los adolescentes sobre las actividades que realizan los terapeutas en el tratamiento, además de que puede favorecer el avance de los adolescentes de la etapa de preparación al cambio a la etapa de acción. Finalmente se considera que puede ser una de las variables que favorezcan la aceptación y permanencia en tratamiento entre los adolescentes atendidos en el estudio. <![CDATA[<b>Influence of sleep quantity and aggressiveness on anxiety during academics evaluation tests</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600005&lng=pt&nrm=iso&tlng=pt The situation of academic evaluation has often been studied in relation to emotional alterations such as anxiety, stress or even fear. Possibly, aggressiveness may be another variable present in these situations. Aggressiveness seems to be present in different teaching activities as well as in all levels of the educational context, showing even more clearly in students with academic difficulties and especially when exposed to stressful situations. Various classical investigations have indicated for some time now that physical and verbal aggressiveness is more frequent in men than in women, and also more intense. The execution of academic tests is perceived as an aversive situation and often even as a threat, which may explain why they would be the cause of anxiety or stress. In fact, an intense emotional alteration could be present in nearly 25% of the students during the examination procedure; furthermore, exams are the most frequent evaluation method used in all educational levels. According to some studies, women seem to show higher levels of resources for coping with stressful situations, which would also be applied to circumstances of academic evaluation. Nevertheless, again in relation to gender differences, higher levels of anxiety have been found in women in comparison to men among university students before exams are carried out. In this situation the presence of aggressiveness does not seem to be clear. Although in the psychological environment there is no doubt of the negative effect which sleep deprivation has on different types of performance, we have observed with some frequency that university students tend to reduce sleep time days before an exam. The studies centred in the population of university students' quality of sleep have found that it quite often drops during this period. Thus, for example, in normal circumstances (not during exam periods), poor sleep quality can be found in approximately 30% of the university students. With this, we may suppose that the quality and the quantity could be even worse in exam periods. The quality of sleep has been studied frequently and also in relation to difficulties and psychological alterations. In the case of test anxiety, the correlation with the reduction of the quantity of sleep the previous night seems to be positive. Although multiple investigations have centred on the disrupting role that anxiety plays on the performance of exams, not many have focused on the relation between test-anxiety and aggressiveness in that situation, and even less so in circumstances of reduction of sleep hours. In the present work, we intend to determine first the possible presence of aggressiveness during the execution of exams in a sample of university students. At the same time, it was of our interest to establish a possible relation between sleep hours and the level of aggressiveness in that situation, keeping in mind that many students reduce sleep hours during this time, and specially the night before an exam. A second objective is to determine if different levels of aggressiveness may be related to different levels of test-anxiety. Thirdly, we try to seek differences between men and women's levels of aggressiveness while test circumstances, differences in aggressiveness in function of different age levels, as well as in function of different amount of time dedicated to sleep. In this study, 143 students aged 19-48 participated. The average age was 21.67, with a 3.79 standard deviation. Forty-two of the participants were men, 98 women and three of them did not consign their gender. All of them participated in the study just before beginning the execution of a final test in diverse subjects when they were already seated in the classroom. Aggressiveness was assessed with the reduced Spanish version of the Aggression Questionnaire (AQ). For the anxiety assessment, the Spanish version of the Spiel berger State-Trait Anxiety Inventory (STAI) was used, applying only the state scale. Additionally, participants were asked to note the hours of sleep they had had the previous night. The collection of data was carried out during a final exam, which assigned the final qualification in that subject. Several studies have shown the poor sleep quality in university students, being this significant characteristic a variable with possible and important implications in their quality of life, health, or even in their performance. Our data show that the average number of hours of sleep on the previous night to an exam was 6.43 (S.D. = 1.55), which indicates that the tendency to reduce the hours of sleep in this situation is a frequent habit among the university students being analyzed. Our descriptive results indicated that the levels of aggressiveness are not too high, although a certain degree does exist before the evaluation tests. The correlation analysis carried out indicates that having less hours of sleep the previous night is not associated with a higher level of aggressiveness [r = -.066 (p = .437)]. Nevertheless, when the sample was divided into two groups in function of the aggressiveness level, we found significative differences in the hours of sleep the previous night. The amount of sleep was higher in subjects with less aggressiveness. This result agreed with other studies that have found a relation between sleep deprivation and emotional alterations, specifically anxiety, or other psychological alterations. According to our data, the quantity of sleep had the previous night is related to the latter aggressiveness, and possibly with other aspects of this situation, like sensation of threat or anger. On the other hand, our data has shown significant differences in test-anxiety when we compared subjects with low and high levels of aggressiveness. The result indicates that subjects with high levels of aggressiveness showed higher levels of test-anxiety. This result agrees with those studies that have found an association between some varieties of emotional alterations, for example, social anxiety and aggressiveness and even one acceptable mediator role of social anxiety on social aggression. It has surprised us not to find significant differences between men and women's levels of aggressiveness, keeping in mind that this result goes against most studies that have verified these types of differences. Perhaps this result shows that in a specific threatening and aversive situation, such as an exam, women are able to show levels of latent aggressiveness as high those of as men. Furthermore, in the same way, this situation could create higher levels of aggressiveness in women students than many other daily situations could. Nevertheless, this conclusion is no more than a preliminary one and needs to be further investigated in the future. No significant differences were found between younger and older students' levels of aggressiveness. Although this result matches those obtained by other authors, in our case the reason for this might be the reduced number of age groups within the subjects. We interpret our results in the sense that sleeping less hours before an exam would perhaps be able to imply a worse performance in the test, even the possible presence of emotional alterations such as stress or anxiety, but would not imply significant differences in aggressiveness. The situation of examination in a university context, in function of our results, seems to be a quite specific context. Our study shows different results in contrast with the data on the effects sleep deprivation has on the psychological operation, as well as the patterns of latent aggressiveness found in other populations. The results of this line of investigation have practical implications on the teaching-learning processes, specifically in relation to evaluation as a fundamental element of them, as well as of the role that some psychological variables would perform in these procedures.<hr/>La agresividad parece estar presente en diversas actividades docentes así como en todos los grados y niveles del contexto educativo. Igualmente, diversas investigaciones clásicas han señalado desde hace tiempo la agresividad física y verbal como más intensa y frecuente en hombres que en mujeres. Por otra parte, con cierta frecuencia observamos que los estudiantes universitarios suelen reducir el tiempo que dedican al sueño en fechas previas a un examen. Los estudios centrados en el sueño de la población de estudiantes universitarios han encontrado con cierta frecuencia una relativa baja calidad del mismo. La realización de pruebas académicas suele ser percibida como una situación aversiva y frecuentemente incluso como amenazante, por lo que podría ser generadora de alteraciones emocionales como por ejemplo ansiedad o estrés. En el caso de la ansiedad a los exámenes, la correlación con la reducción en la cantidad de sueño la noche anterior parece ser positiva. En el presente trabajo se pretende determinar, en primer lugar, la posible presencia de agresividad durante la realización de exámenes en una muestra de estudiantes universitarios. Paralelamente es de interés establecer una posible relación entre horas de sueño la noche anterior y agresividad. Un segundo objetivo se centra en determinar si diferentes niveles de agresividad pueden relacionarse con ansiedad a los exámenes. En tercer lugar intentamos determinar si variables como el género, la edad, la ansiedad y la duración del sueño, pueden predecir diferencias en agresividad en nuestra muestra. Participaron 143 estudiantes con edades comprendidas entre 19-48 años. La media de edad fue de 21.67 años con una desviación estandar de 3.79. Cuarenta y dos de los participantes eran hombres, 98 mujeres, y tres de ellos no indicaron su género. La agresividad se evaluó con la versión española reducida del Aggression Questionnaire (AQ). Para la valoración de la ansiedad se utilizó la versión española del cuestionario de Ansiedad Estado-Rasgo de Spielberger (STAI), aplicándose únicamente la escala de evaluación de la ansiedad-estado. Adicionalmente se les pidió a los participantes que anotaran las horas de sueño que habían dormido la noche anterior al examen. Los datos se obtuvieron durante un examen final, donde estaba en juego la calificación definitiva de esa asignatura. Los datos muestran la tendencia a reducir las horas de sueño en los estudiantes universitarios estudiados, encontrándose un cierto grado de agresividad latente ante la realización de pruebas de evaluación. El análisis de correlación llevado a cabo indica que a mayores niveles de agresividad parece asociarse menor cantidad de sueño la noche anterior al examen, aunque esta relación no resultó significativa. Sin embargo, cuando dividimos a la muestra en grupos según el nivel de agresividad, sí se observan diferencias significativas en la cantidad de sueño la noche anterior al examen, siendo ésta menor en los sujetos más agresivos. Este resultado concuerda con aquellos otros estudios que sí han encontrado una relación entre pocas horas de sueño y alteraciones emocionales, específicamente ansiedad u otras alteraciones psicológicas. Se han encontrado diferencias significativas en ansiedad a los exámenes cuando comparábamos a sujetos con niveles bajos y altos de agresividad. La prueba de diferencia de medias confirma que los estudiantes más agresivos manifiestan mayores niveles de ansiedad a los exámenes en comparación con los estudiantes menos agresivos. Ha resultado sorprendente no encontrar diferencias significativas entre hombres y mujeres en los niveles de agresividad, teniendo en cuenta que este resultado va en contra de la mayor parte de estudios revisados. Quizá este resultado pueda deberse a que en una situación de amenaza tan específica como es un examen, las mujeres podrían mostrar niveles de agresividad latente tan elevados como los hombres. Este punto merece mayor investigación y atención futura. La asociación entre agresividad y baja duración del sueño se corresponde con un escenario bastante específico que se acerca en cierto sentido a los datos encontrados en otras poblaciones en cuanto a las repercusiones de la duración del sueño sobre el funcionamiento psicológico, así como en cuanto a los patrones de agresividad latente. <![CDATA[<b>Recognition and use of sexual coercion tactics in men and women in the context of heterosexual relations a study of university students</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600006&lng=pt&nrm=iso&tlng=pt Violence is a problem gone through by people in one way or another because of the great amount of manifestations in which it is presented. Sexual violence constitutes one of those ways. At the present time, sexual violence is considered a high-priority problem of public health and of human rights; this type of violence is presented in a continuum that goes from groping to forced sexual relationships. Most of the people associate sexual violence with its extreme form which is rape, but, what does it happen with that type of violence where subtlety or persuasions are involved in order to obtain a sexual relationship? This kind of violence is denominated sexual coercion, and it is defined as the use of any type of physical or emotional pressure used by a person to impose on another one acts of sexual order in the context of a heterosexual encounter of mutual agreement to go out together, to get to know themselves, or to have a romantic or erotic relationship, or a more formal relationship such as the courtship. Sexual coercion is a phenomenon mainly studied in heterosexual and student populations and by means of the theory of sexual scripts is one of the forms adopted by it that have been theoretically tackled with. Sexual scripts are all those structural blocks of knowledge information processing where concepts, categories and relationships based on social experience are gathered and which indicate how heterosexual sexual relationships are to be. The vast majority of the studies on sexual coercion have provided enough evidence on the fact that men are the main perpetrators and women are mostly the injured victims. In developing countries, such as Mexico, several studies show that young men frequently feel with the right, precisely for the fact of being men, to have sexual relationships with young women. For this reason, it is understandable that young women's sexual activity is mostly stigmatized, what can contribute to the acceptance of sexual coercion within the intimate couple relationships as a more <<masculine>> behavior and socially accepted. For this reason, although men can in some moment be sexually constrained and women can exert coercion, the meaning of the fact can be different and, besides, behaviors that are carried out to obtain the wanted sexual behavior themselves also differ between men and women. Tactics constitutes a clear example on the difference between men and women in the act of coercion. Some international studies have identified, in general terms, two types of sexual coercion tactics: indirect and the direct ones. The indirect tactics are strategies in which the person hides his/her sexual purpose. The direct tactics are strategies where the person openly uses physical or psychological force to compel the other one to get involved in certain sexual activity. In Mexico there are not studies about sexual coercion in non formal relationships of heterosexual couples. Because of the above-mentioned, the present work objectives were to know the frequency and type of sexual coercion tactics in men and women university students. Methods and material Three hundred and twenty students were interviewed, 49.7% of them were men and 50.3% women, and the average individual age was of 21 years. The sample was a non random one and the study was of exploratory type. A questionnaire ad hoc of open questions was elaborated, which made inquiries on the tactics used by men and women to press people of another sex to have a sexual relationship. Personal experiences of sexual coercion were also investigated. The application of the instrument was carried out in a group way and its length was around 45 minutes. Open questions were analyzed through the search of thematic units and categories. The contents analysis was used and later transformed into cases count in order to make the corresponding statistical analysis. Result About the experience of sexual coercion, 33.4% of the total sample mentioned that he/she had been victim of sexual coercion. Women (56.1 %) reported being mainly victims of sexual coercion contrary to the men (43.9%), when carrying out an X² statistics there were not significant differences, in statistical terms, between men and women. Nine point four percent of the total sample mentioned that he/she had exerted sexual coercion toward his/her couple. Men (83.3%) reported to have mainly exerted sexual coercion toward their couple contrary to women (16.7%). When carrying out an X² statistics a significant difference, in statistical terms, between men and women was found [X²=16.21, (gl =320/1) p = .000]. Regarding the frequency of the different tactics used by men, men and women reported that the indirect tactics are the most used by men to press women to have sexual relationships. Among the indirect tactics there were found the blackmail, the <<test of love>>, the verbal deceits, etc. On the other hand, the direct tactics such as threats of physical violence, use of physical violence, insistent petting, etc., were less used by men. Regarding sexual coercion tactics used by women, men and women who participated in the sample, mentioned that direct tactics are more used by women to press a man to have sexual relationships. Within this kind of tactics there were found sexual advances using the body, use of physical violence, use of verbal violence, etc. With respect to the indirect tactics, there were verbal deceits, blackmail, psychological threats, among others. Discussion This research is barely an exploratory study, non representative, but we consider that it makes a contribution of descriptive type to the understanding of sexual coercion in heterosexual relationships when considering both men as women. As it is observed in the results about the experience of sexual coercion, in general terms, such as it is shown in other studies, women were the main victims of sexual coercion, although some men reported being victims, there were no significant difference. Besides, as in other studies, men were those who mostly reported to exert sexual coercion contrary to women, being differences significant in statistical terms. Regarding the tactics used by men in order to coerce their couple, men and women who participated in the sample recognized the indirect tactics as the most used ones, which is in agreement with the outcomes found in other studies. What makes these results interesting is the fact that women recognize in a more open and significant way, that the way a man exerts coercion to a woman is by means of an indirect tactics. These results are much related with the sexual scripts where the man has to gain a sexual access to the woman. With regard to sexual coercion tactics used by women, the direct ones are outstanding, that is to say, those in which woman openly uses the physical, psychological or economic force to press a man to have sexual relationships. The studies about domestic violence state, on the whole, that violence is more exerted by men toward women than the opposite case. Nevertheless, there are also studies about domestic violence which state that women are as aggressive as men. These studies have been questioned and at the moment the debate persists about the findings, because although women use physical violence, it is important to wonder about the intensity of the blow or if the physical violence is rather a defensive answer. The results of this study show the relevance of knowing more about this phenomenon, since many of the subjects in this study are not able to identify any event of sexual coercion in their relationship, reason for which it will be necessary to search what is happening in Mexico on this matter and to even go into the topic of youth's relationships, in particular, the heterosexual ones and the scripts that regulate this relationship, in order to be able of creating better prevention programs guided to eliminate domestic violence to obtain a better mental, sexual and reproductive health.<hr/>La violencia es un problema que nos afecta a todas las personas de una u otra manera por la gran cantidad de manifestaciones en las que se presenta. Una de esas formas es la violencia sexual. En la actualidad ésta es considerada un problema prioritario de salud pública y de derechos humanos y se presenta en un continuo que va desde el manoseo hasta las relaciones sexuales forzadas. Una de las formas de este tipo de violencia es la coerción sexual que se define como el uso de cualquier tipo de presión física o emocional que es utilizada por una persona para imponer actos de orden sexual sobre otra en el contexto de un encuentro heterosexual de mutuo acuerdo para salir juntas, para conocerse o sostener una relación romántica o erótica, o en una relación más formal como el noviazgo. La coerción sexual ha sido abordada teóricamente a través de la teoría de los guiones sexuales o scripts. Aunque hombres y mujeres pueden sufrir este tipo de violencia, la gran mayoría de los estudios sobre coerción sexual han evidenciado que los hombres son los principales perpetradores y las mujeres, las víctimas. Un claro ejemplo sobre la diferencia entre hombres y mujeres en la forma de coercionar son las tácticas. Por lo anterior, el presente trabajo tiene como objetivos conocer la frecuencia y tipo de tácticas de coerción sexual en hombres y mujeres universitarios. Material y métodos Se entrevistaron a 320 estudiantes, un 49.7% de los sujetos fueron hombres y 50.3% mujeres, la media de edad fue de 21 años. La muestra fue no probabilística y el estudio fue de tipo exploratorio. Se elaboró un cuestionario ad hoc de preguntas abiertas, las cuales indagan sobre las tácticas utilizadas por hombres y mujeres para presionar a personas de otro sexo a tener una relación sexual; también se indagó sobre las experiencias personales de coerción sexual. La aplicación del instrumento se realizó de manera grupal con una duración aproximada de 45 minutos. Las preguntas abiertas fueron analizadas a través de la búsqueda de unidades temáticas y categorías. Se utilizó el análisis de contenido y después se transformó en conteo de casos para hacer el análisis estadístico correspondiente. Resultados Sobre la experiencia de coerción sexual, un 33.4% de la muestra total menciona que ha sido víctima de ella. Un 9.4% de la muestra total menciona que ha ejercido coerción sexual hacia su pareja; al realizar una X² se encontró una diferencia estadísticamente significativa entre hombres y mujeres [X² =16.21, (gl = 320/1) p = .000]. En cuanto a la frecuencia de las diferentes tácticas utilizadas por los hombres, los y las participantes reportan que las tácticas indirectas son más utilizadas por éstos, mientras que las mujeres utilizan más las tácticas directas. Discusión: Como se observa en los resultados, en general, al igual que en otros estudios, las mujeres son las principales víctimas de coerción sexual y los hombres quienes la ejercen. Los resultados de este estudio evidencian la importancia de conocer más sobre este fenómeno ya que muchos de los sujetos en este estudio no fueron capaces de identificar algún evento de coerción sexual en su relación, por lo que habrá que profundizar mucho más en el tema de las relaciones de pareja de los jóvenes, en particular en la heterosexualidad, y los guiones que la norman, para poder crear cada vez mejores programas de prevención encaminados a eliminar la violencia en las relaciones de pareja y para obtener una mejor salud mental, sexual y reproductiva. <![CDATA[<b>Suicidal ideation among school children population</b>: <b>psycological factors associated</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600007&lng=pt&nrm=iso&tlng=pt Nowadays, suicide is a public health problem and a social phenomenon that affects human development. From 1995 to 2002, the state of Sonora showed a 3.8% annual average increase in the occurrence of suicide in productive age population, occupying the national third place with regard to this problem's growth. During the 1970's suicide in groups of infants and school children between 5 and 14 years old started to be noticed in the country. At present time, self-inflicted injuries are eighth cause of death for this age group. Suicidal behavior is a process comprised by several stages: passive suicidal ideation, active contemplation of suicide itself, planning and preparation, suicide attempt execution, and completed suicide. Since these stages may or not be sequential, it is important to study the steps preceding suicides, such as the ideation and the attempt, in order to know and treat this problem. The suicidal ideation is a very important stage as predictive factor to approach the completed suicide and refers to the thoughts regarding one's own death, which may or not be verbalized. There is little research about this subject matter particularly in regards to population under 14; hence, in this study, psychological factors of a sample comprised by boys and girls between 10 and 12 from public and private schools from the State of Sonora will be analyzed and compared to identify those children associated with suicidal ideation and advance in the understanding of this complex phenomenon. Material and methods The study was descriptive-comparative, observational, and transversal in nature. Sample: 631 elementary school fifth and sixth grader students, both genders, aged between 10 to 13 years, from 16 public schools and four private schools in Hermosillo, Sonora. A 631 student sample was considered through clusters connecting the entire schools within the city and the number of students enrolled in the school term. Instruments: A self applied form questionnaire, which evaluates socio-demographic data, was used with the following scales: Children's Depression Inventory CDI; Children's Manifest Anxiety Scale CMAS-R (revised); Self Esteem Inventory. Procedure: In order to carry out this research, authorization was requested to the Ministry of Education of Sonora. In a first phase during an academic hour, a self-applied form questionnaire with socio-demographic information and the depression scale was given. Subsequently, the second part of the questionnaire was given to a sub-sample of two equal groups, one of them identified with suicidal ideation and the other one without ideation. Data analysis: The statistical analyses were performed using the program SPSS version 15.0. Non-parametric test χ² (Chi Square) and prevalence ratio (odds ratio) were used. Results A total of 631 boys and girls were evaluated with the depression questionnaire during the first phase. The mean age was 1 0.9 years (range: 10-13 years), the gender variable was distributed 50.8% girls and 49.2% boys, as a result of the registration rate for fifth and sixth grades of elementary education; 72.1% of the children were in public schools and 27.9% in private schools. In accordance to answers of CDI item 9, children who marked these two possible answers: <<You think in killing yourself but you believe you won't do it>> (18.1%) and <<You have sometimes seriously thought about killing yourself>> (11.1%) were considered with suicidal ideation. This scale evaluated how the children felt during the two weeks previous to taking the questionnaire and 29.2% of the children somehow showed suicidal ideas. The sub-sample defined from the total population was distributed into two groups: one control group with 184 children without suicidal ideation and another group with 184 children with suicidal ideation. Depression: In regard to depression, results showed that group with suicidal ideation presented greater depressive states compared to the group without suicidal ideation (p<0.03, χ²= 65.66, gl = 2), the highest percentage is located in moderate depression (40.7% and 22.8% respectively). Gender differences were shown only in the group of children without ideation becoming more frequent in boys (p<0.03, χ² = 6.92, gl = 2). While analyzing with the prevalence rate, it was found that children who show severe depression have an 8.8 higher risk of having suicidal ideation when compared with the group of children presenting this level of depression, but not expressing suicidal ideation (CI: 3.85-20.15). Self-esteem: The group with suicidal ideation showed 52.9% low self-esteem cases a statistically significant difference (p<0.00, χ² = 32.31, gl=2) compared to the group of children with no ideation that presented a 3.1% of it. Gender differences were not found in these groups. Boys and girls who show low self-esteem level have 3.7 more risk to present suicidal ideation compared with the group of children who have better self-esteem (CI: 2.3-5.9). Anxiety: Of the children with suicidal ideation, 37.7% showed a high anxiety level compared to the 18.4% presented by the children without ideation. There were no differences between boys and girls. Showing anxiety indicates a 2.6 times higher risk to present suicide ideas (CI: 1.60-4.32). Discussion Although suicidal ideation was present in school children population in a very significant way, it is considered low risk for this type of behavior. Depression appeared like the risk factor mostly associated with suicidal ideation. Boys showed more depression compared to girls; on the other hand, most studies conducted with adolescents reported that before 12 years old it is likely not to find significant differences between genders perhaps by the gender issues, the biological, hormonal and society characteristics. It is important to point out that some cases of children without depression presenting suicidal ideation were found, this information was supported by other studies. Although depression is an important risk factor, its presence is not essential for the suicidal ideation to be evident. Low self-esteem is more evident as a higher risk factor than anxiety for the presence of suicidal ideation. No significant differences by gender were found. Entering into the subject matter with population under fourteen is difficult not only because the parents' limitations to talk about it, but because of the care it must be taken while working with minors. The access to carry out this kind of research within the private school population is difficult; hence the existing little information about it. As a result of the lack of information, it becomes necessary to put it into execution under a strict methodology and according to the professional ethics in such a way that differences between children with and without suicidal ideation could be identified. Suicide is a multi-factorial character dynamic process and not only a single and changeless event; therefore, it is necessary to study how suicidal ideas are conceived and what context surrounds them from the earliest age. It is recommended to detect at a younger age the process leading to suicidal behavior and factors related to it.<hr/>El suicidio es un problema de salud pública y un fenómeno social que incide sobre el desarrollo humano. A partir de la década de 1970 se observan en nuestro país suicidios en el grupo de infantes y escolares en el rango de edad de cinco a 14 años. Las lesiones autoinfligidas se ubican en el octavo lugar de las causas de defunciones para este grupo etáreo. El comportamiento suicida es un proceso de varias etapas. La primera es la ideación suicida que se refiere a los pensamientos en torno a la propia muerte y es de vital importancia como factor predictor para llegar al suicidio consumado. Aunque existe alguna investigación sobre el tema, ésta es escasa en población menor de 14 años. De ahí que en el presente estudio el objetivo es analizar los factores psicológicos en niños y niñas de 10 a 13 años, a fin de identificar aquellos asociados con la ideación suicida. Material y métodos El estudio fue descriptivo de tipo comparativo, observacional, transversal. Participantes: 631 estudiantes de quinto y sexto de primaria, varones y mujeres con edades de 10 a 13 años, de la ciudad de Hermosillo, Sonora. Instrumentos: Cuestionario en formato autoaplicado con las siguientes escalas: Children's Depresion Inventory CDI, escala de ansiedad manifiesta en niños CMAS-R y el inventario de autoestima de Coopersmith. Procedimiento: Se aplicó la primera parte del cuestionario a 631 niños, posteriormente se trabajó con una submuestra de dos grupos iguales: Uno identificado con ideación suicida (174) y el otro sin ideación (174), a los que se les aplicó la segunda parte del cuestionario. Análisis de datos: Se utilizó la prueba no paramétrica χ² y razón de prevalencias del paquete estadístico SPSS. Resultados La media de edad fue de 10.9 años, la variable sexo quedó a su vez distribuida en 50.8% niñas y 49.2% niños, el 72.1% de ellos en escuelas públicas y 27.9% en escuelas privadas, semejante a la proporción de la matrícula de educación primaria para los grupos de quinto y sexto grados. El 29.2% de los niños y niñas manifestó ideas suicidas. Depresión: El grupo de niños con ideación suicida presentó mayores estados depresivos en comparación con el grupo sin ideación (p<0.00, χ² = 65.66, gl=2). El porcentaje más alto fue localizado en la depresión moderada. Se muestran diferencias por sexo sólo en el grupo sin ideación, siendo más frecuente en los niños (p<0.03, χ² = 6.92, gl = 2). Los niños que presentan depresión grave tienen un riesgo 8.8 veces mayor de tener ideación suicida (IC: 3.85-20.15). Autoestima: El grupo con ideación presenta más casos de autoestima baja en comparación con el grupo sin ideación (52.9% y 23.1 % respectivamente), diferencia que es estadísticamente significativa (p<0.00, χ² = 32.31, gl=2). No se encontraron diferencias por sexo. Los niños y niñas que presentan un nivel de autoestima bajo tienen 3.7 veces mayor riesgo de presentar ideación suicida (IC: 2.3-5.9). Ansiedad: Treinta y siete punto siete por ciento de niños con ideación presentan un nivel de ansiedad alto en contraste con 18.4% de niños sin ideación. Tampoco aquí se presentaron diferencias por sexo. Manifestar ansiedad indica un riesgo 2.6 veces mayor para presentar ideas suicidas (IC: 1.60-4.32). Discusión La ideación suicida está presente en la población infantil escolarizada de Hermosillo, Sonora. La depresión aparece como un factor de riesgo asociado con las ideas suicidas aunque se encontraron casos de niños sin depresión pero con ideación suicida, lo que se observa también en otros estudios. La autoestima baja tiene más probabilidades de ser un factor de riesgo para la ideación suicida que la ansiedad, sin diferencias significativas por sexo. El abordaje del tema en la población menor de catorce años se dificulta no sólo por las limitaciones de los padres/madres para hablar del mismo, sino también por los cuidados que deben tenerse cuando se trabaja con menores. El suicidio es un proceso dinámico de carácter multifactorial y no sólo un hecho estático e individual. Por lo mismo es necesario estudiar cómo se gestan las ideas suicidas desde la más temprana edad. Se recomienda detectar en la edad escolar el proceso que lleva a las conductas suicidas y los factores que se le relacionan. De esta manera se pueden crear programas de prevención orientadas a los niños y prevenir que en la adolescencia se conviertan en parte de la cifra de suicidios. <![CDATA[<b>Structural brain alterations in attention-deficit/hyperactivity disorder</b>: <b>an update. First part</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600008&lng=pt&nrm=iso&tlng=pt The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, text Revision) defines attention-deficit/hyperactivity disorder (ADHD) as a disorder usually first diagnosed during infancy. Its essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than typically observed in individuals at a comparable level of development. It produces a significant impairment in social, academic, or occupational functioning. The prevalence of ADHD among the general population is between 5-10% in children and adolescents, and 1.2% to 7.3% in adults. In clinical samples, the prevalence in adults is higher: 1 6.80%. Less than 10% of the children diagnosed with ADHD reached a total functional remission when they became adults. Subjects with ADHD have a higher risk of suffering personality disorders and substance abuse. This disorder has a genetic basis. About 80% of the variance is explained by genetics. Some of the genes implied in this disorder are the dopamine transporter, the dopamine receptor 4, the beta-hydroxilase enzyme, the adrenergic receptor α2, the serotonin transporter and the serotonin receptor 1B. Environmental factors such as parental nicotine consumption during pregnancy, low birth weight, perinatal problems, parental psychiatric disorders, social adversity, and low parental education are related to a higher risk for ADHD. Several studies have shown that there are morphological brain abnormalities in subjects with ADHD. Structures like frontal lobe, cerebellar hemispheres and vermis, callosum splenium, cingulate anterior cortex and right caudate, are smaller in subjects with ADHD compared with healthy subjects. On the other hand, regarding the response to stimulants, studies with positron emission tomography (PET), among other techniques, suggest that the dopamine and noradrenergic systems play a role in the pathophysiology of ADHD. From 1990 to date, there are 41 morphological studies in ADHD, published in English, reporting volumetric abnormalities. However, the results are contradictory, so definitive conclusions about the brain structures being involved in ADHD remain unclear. Objective This article reviews the general neurobiology of ADHD providing an updated and comprehensive overview of the brain structural findings. The methodologies of morphological studies using magnetic resonance imaging (MRI) are reviewed in detail so as to find the source of the contradictory findings reported in the published studies. Method A literature search and review of the relevant published articles in MEDLINE and PsycINFO sites was made using the following key words: attention deficit hyperactivity disorder, neurobiology, morphological alteration, and MRI. In general, the literature supports the genetic basis of the disorder as well as the involvement of dopaminergic and noradrenergic systems in the pathophysiology. Nevertheless, regarding the structural abnormalities reported in ADHD, there is an enormously heterogeneous methodology in MRI scan acquisition and processing. Almost every study used a different image analysis to measure brain structures. Some works chose a hand user definition of the region of interest (ROI), which is prone to a user's bias. Other papers used a semi-automated analysis combining a user-defined ROI and segmentation techniques based only in intensity. These methodologies are prone to bias and to a deficient separation of grey and white matter. Finally, the automated methods where there is no user intervention are preferred because they are not a biased in the selection of ROI and use tissue probability maps to improve the segmentation. Unfortunately, none of these methods has been validated against histological and anatomopatological data. So, there is not a measure of validity and reliability of these methods. On the other hand, female subjects are extremely underrepresented in these studies: only around 20% of the individuals studied were females and only 50% of the ADHD samples included female subjects, whereas 95% included males. The number of reports done in ADHD adults is very scarce. Discussion Despite the multiple inconsistencies found in each MRI study as a consequence of limitations such as small samples size, and methodological differences across the studies such as lack of consistency in the acquisition and the image analysis, the structures more frequently and consistently reported to be smaller in ADHD subjects, compared to healthy subjects, are regions of the frontal lobe, the callosum splenium, the anterior cingulate gyrus, the vermis, the cerebral hemispheres and the right caudate. However, these findings are applicable to the most frequently studied samples: male children. Considering the prevalence and lack of complete remission of ADHD symptoms during adulthood, there is a need for structural studies in adults as well as in women. Conclusion The findings and results of MRI studies represent clear but insufficient advances in the knowledge of the anatomical structures involved in ADHD. There is a lack of research on the age-related changes imposed by neurodevelopment. The brain abnormalities and their gender differences in ADHD individual are subjects of future research.<hr/>El trastorno por déficit de atención e hiperactividad (TDAH) se caracteriza por un patrón persistente de inatención y/o hiperactividad e impulsividad y produce un deterioro en diversas áreas del funcionamiento del individuo. La prevalencia del TDAH en niños y adolescentes en la población general es de 5-10% y en adultos es de 1.2 a 7.3%. Menos del 10% de los niños que fueron diagnosticados con TDAH alcanzan una remisión funcional total en la edad adulta. Estos sujetos presentan más riesgo de sufrir un trastorno grave de la personalidad así como de dependencia a substancias. Cerca del 80% de la varianza del TDAH se explica por factores genéticos. Los genes que han sido asociados al TDAH con más frecuencia son aquellos que codifican al transportador de dopamina, al receptor de dopamina D4, a la enzima beta-hidroxilasa, al receptor adrenérgico a2, al transportador de serotonina y al receptor de serotonina 1B. Existen variables medioambientales asociadas al TDAH; como el consumo materno de tabaco durante el embarazo, las complicaciones perinatales, la psicopatología de los padres, y la adversidad psicosocial. Por otra parte, la respuesta a los estimulantes así como los estudios hechos con tomografía por emisión de positrones, sugieren que la dopamina y los sistemas noradrenérgicos tienen un papel en la fisiopatología del TDAH. Desde 1990 a la fecha, se han realizado 41 estudios morfológicos del TDAH que han reportado anormalidades volumétricas. Sin embargo, los resultados son contradictorios, lo que no permite obtener conclusiones definitivas acerca de las estructuras involucradas en el trastorno. Objetivo El presente artículo presenta una revisión general de la neurobiología del TDAH y una actualización de las anomalías estructurales encefálicas en los sujetos con TDAH por medio del uso de imágenes por resonancia magnética (IRM). Se han revisado en detalle las metodologías usadas en los estudios estructurales con el fin de conocer el origen de los hallazgos contradictorios en los estudios publicados hasta la fecha. Métodos Se realizó una búsqueda en la bibliografía médica de los artículos publicados en las bases MEDLINE y PsycINFO, con las siguientes palabras clave: TDAH, neurobiología, alteraciones morfológicas e imágenes por resonancia magnética. Resultados Los estudios sobre las anormalidades estructurales en el TDAH muestran una enorme heterogeneidad en la metodología de la adquisición y del procesamiento de las IRM. Por otro lado, la mayoría de los estudios se han realizado en niños del sexo masculino. Existen pocos artículos realizados en sujetos del sexo femenino y en adultos. Discusión A pesar de las inconsistencias encontradas en cada estudio de IRM, las estructuras encefálicas que se reportan reducidas en los sujetos TDAH son: el lóbulo frontal, el esplenio calloso, el cíngulo anterior, el vermis cerebeloso, los hemisferios del cerebelo y el núcleo caudado derecho. Dada la alta prevalencia del TDAH y la falta de remisión de síntomas en la población adulta, es necesario realizar más estudios estructurales en sujetos adultos y femeninos. Conclusión Los resultados obtenidos en los estudios de IRM constituyen avances claros pero insuficientes en el conocimiento de las estructuras anatómicas involucradas en el TDAH. Las anormalidades encefálicas entre los sujetos TDAH y las diferencias de edad y género entre estos sujetos deben ser los objetivos de futuras investigaciones. <![CDATA[<b>Person, mind and memory</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600009&lng=pt&nrm=iso&tlng=pt The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, text Revision) defines attention-deficit/hyperactivity disorder (ADHD) as a disorder usually first diagnosed during infancy. Its essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than typically observed in individuals at a comparable level of development. It produces a significant impairment in social, academic, or occupational functioning. The prevalence of ADHD among the general population is between 5-10% in children and adolescents, and 1.2% to 7.3% in adults. In clinical samples, the prevalence in adults is higher: 1 6.80%. Less than 10% of the children diagnosed with ADHD reached a total functional remission when they became adults. Subjects with ADHD have a higher risk of suffering personality disorders and substance abuse. This disorder has a genetic basis. About 80% of the variance is explained by genetics. Some of the genes implied in this disorder are the dopamine transporter, the dopamine receptor 4, the beta-hydroxilase enzyme, the adrenergic receptor α2, the serotonin transporter and the serotonin receptor 1B. Environmental factors such as parental nicotine consumption during pregnancy, low birth weight, perinatal problems, parental psychiatric disorders, social adversity, and low parental education are related to a higher risk for ADHD. Several studies have shown that there are morphological brain abnormalities in subjects with ADHD. Structures like frontal lobe, cerebellar hemispheres and vermis, callosum splenium, cingulate anterior cortex and right caudate, are smaller in subjects with ADHD compared with healthy subjects. On the other hand, regarding the response to stimulants, studies with positron emission tomography (PET), among other techniques, suggest that the dopamine and noradrenergic systems play a role in the pathophysiology of ADHD. From 1990 to date, there are 41 morphological studies in ADHD, published in English, reporting volumetric abnormalities. However, the results are contradictory, so definitive conclusions about the brain structures being involved in ADHD remain unclear. Objective This article reviews the general neurobiology of ADHD providing an updated and comprehensive overview of the brain structural findings. The methodologies of morphological studies using magnetic resonance imaging (MRI) are reviewed in detail so as to find the source of the contradictory findings reported in the published studies. Method A literature search and review of the relevant published articles in MEDLINE and PsycINFO sites was made using the following key words: attention deficit hyperactivity disorder, neurobiology, morphological alteration, and MRI. In general, the literature supports the genetic basis of the disorder as well as the involvement of dopaminergic and noradrenergic systems in the pathophysiology. Nevertheless, regarding the structural abnormalities reported in ADHD, there is an enormously heterogeneous methodology in MRI scan acquisition and processing. Almost every study used a different image analysis to measure brain structures. Some works chose a hand user definition of the region of interest (ROI), which is prone to a user's bias. Other papers used a semi-automated analysis combining a user-defined ROI and segmentation techniques based only in intensity. These methodologies are prone to bias and to a deficient separation of grey and white matter. Finally, the automated methods where there is no user intervention are preferred because they are not a biased in the selection of ROI and use tissue probability maps to improve the segmentation. Unfortunately, none of these methods has been validated against histological and anatomopatological data. So, there is not a measure of validity and reliability of these methods. On the other hand, female subjects are extremely underrepresented in these studies: only around 20% of the individuals studied were females and only 50% of the ADHD samples included female subjects, whereas 95% included males. The number of reports done in ADHD adults is very scarce. Discussion Despite the multiple inconsistencies found in each MRI study as a consequence of limitations such as small samples size, and methodological differences across the studies such as lack of consistency in the acquisition and the image analysis, the structures more frequently and consistently reported to be smaller in ADHD subjects, compared to healthy subjects, are regions of the frontal lobe, the callosum splenium, the anterior cingulate gyrus, the vermis, the cerebral hemispheres and the right caudate. However, these findings are applicable to the most frequently studied samples: male children. Considering the prevalence and lack of complete remission of ADHD symptoms during adulthood, there is a need for structural studies in adults as well as in women. Conclusion The findings and results of MRI studies represent clear but insufficient advances in the knowledge of the anatomical structures involved in ADHD. There is a lack of research on the age-related changes imposed by neurodevelopment. The brain abnormalities and their gender differences in ADHD individual are subjects of future research.<hr/>El trastorno por déficit de atención e hiperactividad (TDAH) se caracteriza por un patrón persistente de inatención y/o hiperactividad e impulsividad y produce un deterioro en diversas áreas del funcionamiento del individuo. La prevalencia del TDAH en niños y adolescentes en la población general es de 5-10% y en adultos es de 1.2 a 7.3%. Menos del 10% de los niños que fueron diagnosticados con TDAH alcanzan una remisión funcional total en la edad adulta. Estos sujetos presentan más riesgo de sufrir un trastorno grave de la personalidad así como de dependencia a substancias. Cerca del 80% de la varianza del TDAH se explica por factores genéticos. Los genes que han sido asociados al TDAH con más frecuencia son aquellos que codifican al transportador de dopamina, al receptor de dopamina D4, a la enzima beta-hidroxilasa, al receptor adrenérgico a2, al transportador de serotonina y al receptor de serotonina 1B. Existen variables medioambientales asociadas al TDAH; como el consumo materno de tabaco durante el embarazo, las complicaciones perinatales, la psicopatología de los padres, y la adversidad psicosocial. Por otra parte, la respuesta a los estimulantes así como los estudios hechos con tomografía por emisión de positrones, sugieren que la dopamina y los sistemas noradrenérgicos tienen un papel en la fisiopatología del TDAH. Desde 1990 a la fecha, se han realizado 41 estudios morfológicos del TDAH que han reportado anormalidades volumétricas. Sin embargo, los resultados son contradictorios, lo que no permite obtener conclusiones definitivas acerca de las estructuras involucradas en el trastorno. Objetivo El presente artículo presenta una revisión general de la neurobiología del TDAH y una actualización de las anomalías estructurales encefálicas en los sujetos con TDAH por medio del uso de imágenes por resonancia magnética (IRM). Se han revisado en detalle las metodologías usadas en los estudios estructurales con el fin de conocer el origen de los hallazgos contradictorios en los estudios publicados hasta la fecha. Métodos Se realizó una búsqueda en la bibliografía médica de los artículos publicados en las bases MEDLINE y PsycINFO, con las siguientes palabras clave: TDAH, neurobiología, alteraciones morfológicas e imágenes por resonancia magnética. Resultados Los estudios sobre las anormalidades estructurales en el TDAH muestran una enorme heterogeneidad en la metodología de la adquisición y del procesamiento de las IRM. Por otro lado, la mayoría de los estudios se han realizado en niños del sexo masculino. Existen pocos artículos realizados en sujetos del sexo femenino y en adultos. Discusión A pesar de las inconsistencias encontradas en cada estudio de IRM, las estructuras encefálicas que se reportan reducidas en los sujetos TDAH son: el lóbulo frontal, el esplenio calloso, el cíngulo anterior, el vermis cerebeloso, los hemisferios del cerebelo y el núcleo caudado derecho. Dada la alta prevalencia del TDAH y la falta de remisión de síntomas en la población adulta, es necesario realizar más estudios estructurales en sujetos adultos y femeninos. Conclusión Los resultados obtenidos en los estudios de IRM constituyen avances claros pero insuficientes en el conocimiento de las estructuras anatómicas involucradas en el TDAH. Las anormalidades encefálicas entre los sujetos TDAH y las diferencias de edad y género entre estos sujetos deben ser los objetivos de futuras investigaciones. <![CDATA[<b>Five years after Augusto Fernández-Guardiola's death: scientist, frind, and teacher</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600010&lng=pt&nrm=iso&tlng=pt The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, text Revision) defines attention-deficit/hyperactivity disorder (ADHD) as a disorder usually first diagnosed during infancy. Its essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than typically observed in individuals at a comparable level of development. It produces a significant impairment in social, academic, or occupational functioning. The prevalence of ADHD among the general population is between 5-10% in children and adolescents, and 1.2% to 7.3% in adults. In clinical samples, the prevalence in adults is higher: 1 6.80%. Less than 10% of the children diagnosed with ADHD reached a total functional remission when they became adults. Subjects with ADHD have a higher risk of suffering personality disorders and substance abuse. This disorder has a genetic basis. About 80% of the variance is explained by genetics. Some of the genes implied in this disorder are the dopamine transporter, the dopamine receptor 4, the beta-hydroxilase enzyme, the adrenergic receptor α2, the serotonin transporter and the serotonin receptor 1B. Environmental factors such as parental nicotine consumption during pregnancy, low birth weight, perinatal problems, parental psychiatric disorders, social adversity, and low parental education are related to a higher risk for ADHD. Several studies have shown that there are morphological brain abnormalities in subjects with ADHD. Structures like frontal lobe, cerebellar hemispheres and vermis, callosum splenium, cingulate anterior cortex and right caudate, are smaller in subjects with ADHD compared with healthy subjects. On the other hand, regarding the response to stimulants, studies with positron emission tomography (PET), among other techniques, suggest that the dopamine and noradrenergic systems play a role in the pathophysiology of ADHD. From 1990 to date, there are 41 morphological studies in ADHD, published in English, reporting volumetric abnormalities. However, the results are contradictory, so definitive conclusions about the brain structures being involved in ADHD remain unclear. Objective This article reviews the general neurobiology of ADHD providing an updated and comprehensive overview of the brain structural findings. The methodologies of morphological studies using magnetic resonance imaging (MRI) are reviewed in detail so as to find the source of the contradictory findings reported in the published studies. Method A literature search and review of the relevant published articles in MEDLINE and PsycINFO sites was made using the following key words: attention deficit hyperactivity disorder, neurobiology, morphological alteration, and MRI. In general, the literature supports the genetic basis of the disorder as well as the involvement of dopaminergic and noradrenergic systems in the pathophysiology. Nevertheless, regarding the structural abnormalities reported in ADHD, there is an enormously heterogeneous methodology in MRI scan acquisition and processing. Almost every study used a different image analysis to measure brain structures. Some works chose a hand user definition of the region of interest (ROI), which is prone to a user's bias. Other papers used a semi-automated analysis combining a user-defined ROI and segmentation techniques based only in intensity. These methodologies are prone to bias and to a deficient separation of grey and white matter. Finally, the automated methods where there is no user intervention are preferred because they are not a biased in the selection of ROI and use tissue probability maps to improve the segmentation. Unfortunately, none of these methods has been validated against histological and anatomopatological data. So, there is not a measure of validity and reliability of these methods. On the other hand, female subjects are extremely underrepresented in these studies: only around 20% of the individuals studied were females and only 50% of the ADHD samples included female subjects, whereas 95% included males. The number of reports done in ADHD adults is very scarce. Discussion Despite the multiple inconsistencies found in each MRI study as a consequence of limitations such as small samples size, and methodological differences across the studies such as lack of consistency in the acquisition and the image analysis, the structures more frequently and consistently reported to be smaller in ADHD subjects, compared to healthy subjects, are regions of the frontal lobe, the callosum splenium, the anterior cingulate gyrus, the vermis, the cerebral hemispheres and the right caudate. However, these findings are applicable to the most frequently studied samples: male children. Considering the prevalence and lack of complete remission of ADHD symptoms during adulthood, there is a need for structural studies in adults as well as in women. Conclusion The findings and results of MRI studies represent clear but insufficient advances in the knowledge of the anatomical structures involved in ADHD. There is a lack of research on the age-related changes imposed by neurodevelopment. The brain abnormalities and their gender differences in ADHD individual are subjects of future research.<hr/>El trastorno por déficit de atención e hiperactividad (TDAH) se caracteriza por un patrón persistente de inatención y/o hiperactividad e impulsividad y produce un deterioro en diversas áreas del funcionamiento del individuo. La prevalencia del TDAH en niños y adolescentes en la población general es de 5-10% y en adultos es de 1.2 a 7.3%. Menos del 10% de los niños que fueron diagnosticados con TDAH alcanzan una remisión funcional total en la edad adulta. Estos sujetos presentan más riesgo de sufrir un trastorno grave de la personalidad así como de dependencia a substancias. Cerca del 80% de la varianza del TDAH se explica por factores genéticos. Los genes que han sido asociados al TDAH con más frecuencia son aquellos que codifican al transportador de dopamina, al receptor de dopamina D4, a la enzima beta-hidroxilasa, al receptor adrenérgico a2, al transportador de serotonina y al receptor de serotonina 1B. Existen variables medioambientales asociadas al TDAH; como el consumo materno de tabaco durante el embarazo, las complicaciones perinatales, la psicopatología de los padres, y la adversidad psicosocial. Por otra parte, la respuesta a los estimulantes así como los estudios hechos con tomografía por emisión de positrones, sugieren que la dopamina y los sistemas noradrenérgicos tienen un papel en la fisiopatología del TDAH. Desde 1990 a la fecha, se han realizado 41 estudios morfológicos del TDAH que han reportado anormalidades volumétricas. Sin embargo, los resultados son contradictorios, lo que no permite obtener conclusiones definitivas acerca de las estructuras involucradas en el trastorno. Objetivo El presente artículo presenta una revisión general de la neurobiología del TDAH y una actualización de las anomalías estructurales encefálicas en los sujetos con TDAH por medio del uso de imágenes por resonancia magnética (IRM). Se han revisado en detalle las metodologías usadas en los estudios estructurales con el fin de conocer el origen de los hallazgos contradictorios en los estudios publicados hasta la fecha. Métodos Se realizó una búsqueda en la bibliografía médica de los artículos publicados en las bases MEDLINE y PsycINFO, con las siguientes palabras clave: TDAH, neurobiología, alteraciones morfológicas e imágenes por resonancia magnética. Resultados Los estudios sobre las anormalidades estructurales en el TDAH muestran una enorme heterogeneidad en la metodología de la adquisición y del procesamiento de las IRM. Por otro lado, la mayoría de los estudios se han realizado en niños del sexo masculino. Existen pocos artículos realizados en sujetos del sexo femenino y en adultos. Discusión A pesar de las inconsistencias encontradas en cada estudio de IRM, las estructuras encefálicas que se reportan reducidas en los sujetos TDAH son: el lóbulo frontal, el esplenio calloso, el cíngulo anterior, el vermis cerebeloso, los hemisferios del cerebelo y el núcleo caudado derecho. Dada la alta prevalencia del TDAH y la falta de remisión de síntomas en la población adulta, es necesario realizar más estudios estructurales en sujetos adultos y femeninos. Conclusión Los resultados obtenidos en los estudios de IRM constituyen avances claros pero insuficientes en el conocimiento de las estructuras anatómicas involucradas en el TDAH. Las anormalidades encefálicas entre los sujetos TDAH y las diferencias de edad y género entre estos sujetos deben ser los objetivos de futuras investigaciones. <![CDATA[<b>Autoevaluación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000600011&lng=pt&nrm=iso&tlng=pt The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, text Revision) defines attention-deficit/hyperactivity disorder (ADHD) as a disorder usually first diagnosed during infancy. Its essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than typically observed in individuals at a comparable level of development. It produces a significant impairment in social, academic, or occupational functioning. The prevalence of ADHD among the general population is between 5-10% in children and adolescents, and 1.2% to 7.3% in adults. In clinical samples, the prevalence in adults is higher: 1 6.80%. Less than 10% of the children diagnosed with ADHD reached a total functional remission when they became adults. Subjects with ADHD have a higher risk of suffering personality disorders and substance abuse. This disorder has a genetic basis. About 80% of the variance is explained by genetics. Some of the genes implied in this disorder are the dopamine transporter, the dopamine receptor 4, the beta-hydroxilase enzyme, the adrenergic receptor α2, the serotonin transporter and the serotonin receptor 1B. Environmental factors such as parental nicotine consumption during pregnancy, low birth weight, perinatal problems, parental psychiatric disorders, social adversity, and low parental education are related to a higher risk for ADHD. Several studies have shown that there are morphological brain abnormalities in subjects with ADHD. Structures like frontal lobe, cerebellar hemispheres and vermis, callosum splenium, cingulate anterior cortex and right caudate, are smaller in subjects with ADHD compared with healthy subjects. On the other hand, regarding the response to stimulants, studies with positron emission tomography (PET), among other techniques, suggest that the dopamine and noradrenergic systems play a role in the pathophysiology of ADHD. From 1990 to date, there are 41 morphological studies in ADHD, published in English, reporting volumetric abnormalities. However, the results are contradictory, so definitive conclusions about the brain structures being involved in ADHD remain unclear. Objective This article reviews the general neurobiology of ADHD providing an updated and comprehensive overview of the brain structural findings. The methodologies of morphological studies using magnetic resonance imaging (MRI) are reviewed in detail so as to find the source of the contradictory findings reported in the published studies. Method A literature search and review of the relevant published articles in MEDLINE and PsycINFO sites was made using the following key words: attention deficit hyperactivity disorder, neurobiology, morphological alteration, and MRI. In general, the literature supports the genetic basis of the disorder as well as the involvement of dopaminergic and noradrenergic systems in the pathophysiology. Nevertheless, regarding the structural abnormalities reported in ADHD, there is an enormously heterogeneous methodology in MRI scan acquisition and processing. Almost every study used a different image analysis to measure brain structures. Some works chose a hand user definition of the region of interest (ROI), which is prone to a user's bias. Other papers used a semi-automated analysis combining a user-defined ROI and segmentation techniques based only in intensity. These methodologies are prone to bias and to a deficient separation of grey and white matter. Finally, the automated methods where there is no user intervention are preferred because they are not a biased in the selection of ROI and use tissue probability maps to improve the segmentation. Unfortunately, none of these methods has been validated against histological and anatomopatological data. So, there is not a measure of validity and reliability of these methods. On the other hand, female subjects are extremely underrepresented in these studies: only around 20% of the individuals studied were females and only 50% of the ADHD samples included female subjects, whereas 95% included males. The number of reports done in ADHD adults is very scarce. Discussion Despite the multiple inconsistencies found in each MRI study as a consequence of limitations such as small samples size, and methodological differences across the studies such as lack of consistency in the acquisition and the image analysis, the structures more frequently and consistently reported to be smaller in ADHD subjects, compared to healthy subjects, are regions of the frontal lobe, the callosum splenium, the anterior cingulate gyrus, the vermis, the cerebral hemispheres and the right caudate. However, these findings are applicable to the most frequently studied samples: male children. Considering the prevalence and lack of complete remission of ADHD symptoms during adulthood, there is a need for structural studies in adults as well as in women. Conclusion The findings and results of MRI studies represent clear but insufficient advances in the knowledge of the anatomical structures involved in ADHD. There is a lack of research on the age-related changes imposed by neurodevelopment. The brain abnormalities and their gender differences in ADHD individual are subjects of future research.<hr/>El trastorno por déficit de atención e hiperactividad (TDAH) se caracteriza por un patrón persistente de inatención y/o hiperactividad e impulsividad y produce un deterioro en diversas áreas del funcionamiento del individuo. La prevalencia del TDAH en niños y adolescentes en la población general es de 5-10% y en adultos es de 1.2 a 7.3%. Menos del 10% de los niños que fueron diagnosticados con TDAH alcanzan una remisión funcional total en la edad adulta. Estos sujetos presentan más riesgo de sufrir un trastorno grave de la personalidad así como de dependencia a substancias. Cerca del 80% de la varianza del TDAH se explica por factores genéticos. Los genes que han sido asociados al TDAH con más frecuencia son aquellos que codifican al transportador de dopamina, al receptor de dopamina D4, a la enzima beta-hidroxilasa, al receptor adrenérgico a2, al transportador de serotonina y al receptor de serotonina 1B. Existen variables medioambientales asociadas al TDAH; como el consumo materno de tabaco durante el embarazo, las complicaciones perinatales, la psicopatología de los padres, y la adversidad psicosocial. Por otra parte, la respuesta a los estimulantes así como los estudios hechos con tomografía por emisión de positrones, sugieren que la dopamina y los sistemas noradrenérgicos tienen un papel en la fisiopatología del TDAH. Desde 1990 a la fecha, se han realizado 41 estudios morfológicos del TDAH que han reportado anormalidades volumétricas. Sin embargo, los resultados son contradictorios, lo que no permite obtener conclusiones definitivas acerca de las estructuras involucradas en el trastorno. Objetivo El presente artículo presenta una revisión general de la neurobiología del TDAH y una actualización de las anomalías estructurales encefálicas en los sujetos con TDAH por medio del uso de imágenes por resonancia magnética (IRM). Se han revisado en detalle las metodologías usadas en los estudios estructurales con el fin de conocer el origen de los hallazgos contradictorios en los estudios publicados hasta la fecha. Métodos Se realizó una búsqueda en la bibliografía médica de los artículos publicados en las bases MEDLINE y PsycINFO, con las siguientes palabras clave: TDAH, neurobiología, alteraciones morfológicas e imágenes por resonancia magnética. Resultados Los estudios sobre las anormalidades estructurales en el TDAH muestran una enorme heterogeneidad en la metodología de la adquisición y del procesamiento de las IRM. Por otro lado, la mayoría de los estudios se han realizado en niños del sexo masculino. Existen pocos artículos realizados en sujetos del sexo femenino y en adultos. Discusión A pesar de las inconsistencias encontradas en cada estudio de IRM, las estructuras encefálicas que se reportan reducidas en los sujetos TDAH son: el lóbulo frontal, el esplenio calloso, el cíngulo anterior, el vermis cerebeloso, los hemisferios del cerebelo y el núcleo caudado derecho. Dada la alta prevalencia del TDAH y la falta de remisión de síntomas en la población adulta, es necesario realizar más estudios estructurales en sujetos adultos y femeninos. Conclusión Los resultados obtenidos en los estudios de IRM constituyen avances claros pero insuficientes en el conocimiento de las estructuras anatómicas involucradas en el TDAH. Las anormalidades encefálicas entre los sujetos TDAH y las diferencias de edad y género entre estos sujetos deben ser los objetivos de futuras investigaciones.