Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520100001&lang=en vol. 33 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>In defense of children and women</b>: <b>a life approach to a psychiatrist Mathilde Rodriguez Cabo</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100001&lng=en&nrm=iso&tlng=en Mathilde Rodríguez Cabo was the first female psychiatrist in Mexico. She was a prominent feminist leader who participated in the movement for childhood protection. She was also part of the struggle for political, social, and human rights of women. However, her outstanding career has remained forgotten and unknown to the public for a long time. This article seeks to bring to light her biography by rebuilding two important aspects of her life: her performance in the field of child psychiatry in post-revolutionary Mexico, and her fierce struggle as an activist defending Mexican women's rights. Mathilde Rodríguez was born in Las Palmas, San Luis Potosí, in 1902. While the country was convulsed by the revolutionary war, she joined the Colegio Alemán in Mexico City at the age of fourteen. An outstanding student, she finished her high school studies and learned German, which became useful for traveling and studying in Germany. Later she also translated in to Spanish important works from German psychiatry, such as Carl Gustav Jung's Symbolik des Geiste, and the Correspondence, between Sigmund Freud and Oskar Pfister. In 1922, Rodríguez began studing medicine at the Universidad Nacional de México. In 1929, she received a scholarship from the Alexander von Humboldt Society, given to young doctors to study a specialty in psychiatry and neurology at Cursos Internacionales de Perfeccionamiento Médico, offered annually by the University of Berlin. Thus, doctor Rodríguez became part of the small and selected group of Mexicans who got a university degree and a specialty. While still in Germany after finishing her curses, the Mexican government commissioned Rodríguez to travel to the Soviet Union to do research and learn the methods to protect children in that country. The permanence of Mathilde in Stalinist SSRU allowed her to observe directly the Russian social organization, and to get involved in socialist and progressive ideas. In 1932, the Children's Pavilion was created at the General Mental Hospital of La Castañeda, which responded to the general concern on childhood that characterized the Mexican twentieth century. Also, this was considered as a way to revalue and reconstruct the credibility of the institution. In October of the same year, the director of the Mental Hospital named Rodríguez Cabo director of the Children Psychiatric Pavilion. The early work of doctor Mathilde was to plan the organization of the place in order to enhance services and to obtain economical funds for its management. She removed unnecessary personnel and regulated the operation of the annexed school by including life conditions of students and general rules that should be followed in the institution. In addition, she developed a curriculum to include courses on special teaching and general culture, she proposed a class schedule with teaching procedures and evaluation systems, and elaborated a spending budget, which included food and attention of children, as well as the implementation of workshops. During her term as director of the Children's Pavilion, Mathilde Rodríguez intensified the work with mentally ill patients at the mental hospital, seeking a social rehabilitation and considering specific clinical circumstances in each particular case. Also, young patients had to be trained for social life as responsible individuals showing respect, submission, and capability to work. Psychiatrist Rodríguez Cabo not only was outstanding in the field of child psychiatry. Her activities for the struggle for women's rights made her one of the most politically committed Mexican doctors, with a high level of social activism. The government of General Lázaro Cárdenas had given a powerful impulse to the mobilization, organization, and consolidation of feminist struggles. In 1935, women who fought in the ruling Partido Nacional Revolucionario (the current PRI) and the Partido Comunista Mexicano were in charge of organizing a congress, established a united front for the rights of women. Mathilde Rodríguez Cabo participated in this congress, as in many others. In relation to women's civil rights, her criticism focused on the law, which did not sufficiently protect single mothers or natural children. She claimed it was necessary to regulate and structure and regulate the investigation over paternity to compel parents to cooperate with the mothers in raising their children, especially among the proletarian class, in which marriage or permanent unions were exceptional and children were very often the result of casual sex. Another issue Mathilde was concerned with was abortion. Between 1920 and 1940 several doctors discussed the pros and cons of the legalizing abortion in the context of eugenic ideas. Until then, criminal justice described abortion as infanticide. Mathilde Rodríguez Cabo shared the eugenic thought in Mexico, which gave women a role as the reproductive, and protector agent of the genetic heritage, and which recommended abortion and birth control for mentally weak, insane or epileptic women. Abortion was proposed as a measure to assist in the improvement of race. Rodríguez Cabo strongly defended that abortion had to be removed from the catalog of crimes, and thus she established the antecedents of the struggle for the legalization of abortion in Mexico. Furthermore, being the first female psychiatrist in Mexico, doctor Mathilde Rodríguez Cabo had a deep awareness of the importance of women in professional, social, and political life of the country. She was related to great figures in medicine, law, politics, and literature of her time. Mathilde was aware of maternity and health problems of both Mexican mothers and children, as well as of social problems related to social rehabilitation centers. She was also a figure who supported child psychiatry as a profession and she helped to develop it in our country. She argued that it was possible to rehabilitate abnormal or mentally ill children by making them useful to society, helping them to reintegrate into social life as early as possible. Feeding, working, music, and gymnastics became the most important therapeutic activities for Rodríguez Cabo. However, she was convinced that a substantial part of children's rehabilitation depended on a close and loving treatment, as well as psycho-physiological studies to determine appropriate diagnosis of illness and its treatment. Although she acknowledged that the causes of children's mental and school retardation could result from genetics or inheritance, she argued that the economic situation of their families contributed to these problems as well. Such thought was contrary to the biological and hereditary deterministic ideas, which were predominant during the post-revolution. Mathilde spread the word of Mexico at each of the international conferences she attended, especially in relation to women and children, the two major groups to whom she devoted her life. From the public institutions where she worked, she became actively involved in the development of law projects, and she fought permanently for a more just and equal society to face inequality and social injustice. Finally, she sought to provide men and women with the same rights, in spite of the fact that the Mexican Revolution had not yet reached society.<hr/>Mathilde Rodríguez Cabo fue la primera especialista en psiquiatría en México, además de una destacada líder feminista que participó en el movimiento por la protección a la infancia y en la lucha por los derechos políticos, sociales y humanos de las mujeres. Nació en Las Palmas, San Luis Potosí, en 1902. En su adolescencia logró un dominio completo del idioma alemán lo que más tarde utilizó para traducir al castellano algunas obras de psiquiatría alemana como la Simbología del espíritu de Carl Gustav Jung o la Correspondencia entre Sigmund Freud y Oskar Pfister. En 1922, Rodríguez Cabo buscó ingresar a la carrera de médico cirujano en la Universidad Nacional de México, y fue en 1929 cuando la Sociedad Alexander von Humboldt becó a la joven médica Mathilde para estudiar una especialidad en psiquiatría y neurología en los Cursos Internacionales de Perfeccionamiento Médico que se impartían anualmente en la Universidad de Berlín. De tal modo, la doctora Rodríguez Cabo entró en el minúsculo y selecto grupo de mexicanas que contaban con una carrera universitaria y estudiaban una especialidad. Al concluir sus cursos de psiquiatría y encontrándose todavía en Alemania, el gobierno mexicano la comisionó para viajar a la Unión Soviética para investigar y conocer los métodos de protección a la infancia que se realizaban en aquél país. La permanencia de Mathilde en la URSS estalinista le permitió observar de cerca la organización social soviética y además imbuirse en ideas socialistas y de progreso social. En 1932 se creó el Pabellón Infantil en el Manicomio General de La Castañeda, suceso que respondió al contexto de preocupación generalizada por la infancia que inundó al siglo XX mexicano. En octubre de 1932, el director del Manicomio General notificó a Rodríguez Cabo su designación como directora del Pabellón de Psiquiatría Infantil. Las primeras labores de la doctora Mathilde fueron elaborar un proyecto de organización del pabellón que diera eficiencia tanto en los servicios como en los fondos del manicomio. En su gestión al frente del Pabellón Infantil intensificó el trabajo de los enfermos mentales internados en el Manicomio, intentando una readaptación social que, sin olvidar las circunstancias clínicas específicas a cada caso individual, capacitara al enfermo para la vida social, lo hiciera un individuo responsable, con respeto, sumisión y capacidad de trabajo. La psiquiatra Rodríguez Cabo no sólo sobresalió en el campo de la psiquiatría infantil. Sus actividades en torno a la lucha por los derechos de la mujer la convirtieron en una de las médicas mexicanas más comprometidas políticamente y con un mayor ámbito de acción social. En relación a los derechos civiles de la mujer, la crítica de la psiquiatra se enfocó en que la ley no protegía suficientemente ni a la madre soltera ni a los hijos naturales y en que sería necesario sistematizar y reglamentar la investigación de la paternidad para obligar a los padres a colaborar con la madre en el sostenimiento de los hijos, sobre todo en las clases proletarias en las que el matrimonio o las uniones permanentes eran excepcionales y los hijos eran muy frecuentemente resultado de relaciones sexuales accidentales. Otro de los temas que le preocupó fue el del aborto. Entre 1920 y 1940 varios médicos discutieron los pros y contras de su legalización en el marco de las ideas eugenistas. Hasta ese momento el código penal lo calificaba como infanticidio. Rodríguez Cabo se manifestó con una férrea defensa de que el aborto fuera eliminado del <<catálogo de delitos>>, y marcó así los antecedentes de la lucha por su legalización en México. Rodríguez Cabo fue la primera psiquiatra en México, la caracterizó su profunda conciencia de la importancia de la mujer en la vida profesional, social y política del país. Estuvo relacionada con grandes figuras de la medicina, del derecho, de la política y de la literatura de su época. Fue una figura que marcó la profesionalización y el desarrollo de la psiquiatría infantil en nuestro país. <![CDATA[<b>Disordered eating, internalization of the body thin-ideal and body mass index in high school and college students from a private institution in Hidalgo, Mexico</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100002&lng=en&nrm=iso&tlng=en The term <<eating behavior>> is immediately related to food consumption. However, eating is a complex behavior mediated by external factors. Eating is not exclusively related to satisfying individual's needs or nutritional requirements. Eating behavior alteration has originated disordered eating (DE) and eating disorders (ED), such as anorexia nervosa, bulimia nervosa and binge eating syndrome, where patterns of food ingestion are altered and people forget the importance of maintaining a balance between caloric ingestion and caloric expenditure, with repercussions in the nutritional status and in the individual's health. Recent studies carried out in Mexican population have confirmed the presence of DE, particularly among adolescents and young adults, and predominantly in females. Data from a representative sample of students with a mean age of 14.5 years reported an increase in the proportion of DE between the 1997 and the 2003 assessments (1.3% in males and 3.4% in females) compared to the 3.8% in males and 9.6% in females registered in 2003. More recent data from the National Nutrition and Health Survey 2006, in a representative sample of adolescents 10 to 19 years of age, indicated a prevalence of 0.8% (1% in females and 0.4% in males), with higher scores in the north and center-west areas of the country, followed by the central and south-south-east areas, with almost two-fold percentages in the urban settings compared to the rural ones. The multifactorial origin of ED is well known and among the most studied risk factors are: eating behaviors, high body mass index (BMI) and body thin-ideal internalization. Research findings indicate that overweight and obese adolescents are at more risk for body dissatisfaction, as their physical appearance is farther away from being as the one promoted by society and the media. The sociocultural pressure to be thin has promoted the internalization of the idea that being thin is synonymous to success, greater social acceptance, femininity (among females), self-control, and self-esteem. Based on the above, the main purpose of this paper was to evaluate the prevalence of DE and its relationship to body thin-ideal internalization and BMI in high school and college male and female students from an urban setting. An additional objective was to provide data on reliability and validity of the scales used in a sample of males, as well as additional validity data in females. Data analyzed in this research come from a larger study on risky factors associated to ED carried out in high-school and college students in the city of Pachuca, Hidalgo, during the 2007-2008 school years. After censing the school, a sample of 845 students was selected (381 males, 464 females), 45.1% was from high school, with a range of 15 to 17 years(× =15.82; D.E.=0.78), and 54.9% from college with a range of 18 to 23 years(× =19.81; D.E.=1.41) and that completed the questionnaires adequately. Two previously validated questionnaires in Mexican samples were used to assess DE and body thin-ideal internalization: the Brief Questionnaire for Risky Eating Behaviors and the Attitudes toward Body Figure Questionnaire. Cutoff points for these questionnaires were used to determine the prevalence rates. BMI was obtained by measuring each subject's weight and height by standardized experts and divided in categories according to NCHS those under 18 years old, and to the World Health Organization Experts Committee for those above 18. Self-reported questionnaires were applied to students after verbal consent was received from the school authorities and students, who were previously informed about the voluntary, anonymous, and confidential nature in the study. The protocol was revised by the Ethics Committee of the institution were the field work was carried out. Descriptive analyses were held, as well as Student t tests for comparisons between groups, and a logistic regression analysis to estimate the risk for DE. Results showed that 70% of the women had a normal weight, and there were fewer students in the very underweight and underweight categories (high-school 2.9% and 8.7% college) than those in the overweight and obese categories (high-school 15.2% and 8.3% vs. 18.6% and 6.6% in college). Among the males, a similar distribution was found, 71.3% of the high-school and 58.2% of college students have normal weight, 2.7% and 4.8% low weight, 19.1% and 26.1% were overweight, and 6.9% and 10.9% were obese, respectively. The prevalence of DE was 8.4% in females (9.0% in high school and 7.9% in college), and 2.9% in males (1.6% in high school and 4.2% in college). DE was more prevalent among females, with the exception of binge eating and lack of control while eating. The analysis by BMI showed that neither females nor males with very low or low weight scored high on DE. The higher percentages were obtained for the overweight students of both sexes, and obese males obtained the higher percentages of all. From the total of females with DE, the 84.2% of high-school and 80% of college students also scored high on body thin-ideal internalization, while in males the results were 33.3% and 62.5%, respectively. The regression analysis indicated that the two variables associated with DE were body thin-ideal internalization (OR=27.27) and sex <<being female>> (OR=2.33). The model correctly classified 94.5% of the cases and explained 35% of the DE occurrence. The DE scale yielded a reliability score of 0.72 in females and of 0.63 in males. For both males and females, the scale yielded 3 factors with a congruent conceptual structure. The Attitudes toward Body Figure Questionnaire had a reliability of 0.94 in females and of 0.89 in males. In the case of females, the structure obtained nearly replicated the one obtained in Mexico City's students, but in the case of the male's questionnaire, three questions were eliminated leaving a two-factor structure. From the present data, it can be concluded that DE is present in the sample studied, mainly in females. It was also found that the preoccupation with gaining weight, dieting, and excessive exercising with the purpose of losing weight are also present in a high percentages in Mexican youths not only from the largest metropolis, but also in other urban settings such as Pachuca, Hidalgo. The prevalence found was similar to the one from the Student Survey from Mexico City in adolescents. A positive relationship between DE, educational status, and age was also found; overweight women and obese men were the ones that obtained the higher percentages of DE. The fact that obese men displayed the higher percentages is an important finding regarding the development of future preventive interventions, as it has been so far a neglected population in relation to this topic. The psychometric properties of the validated questionnaires in females were adequate and factorial structures were conceptually congruent. Nevertheless, in the case of males, it is important to continue working in the development of screening questionnaires sensible to their conceptions, beliefs, and attitudes regarding eating, weight control, and beauty ideal, in a way to count with reliable and valid instruments for the detection of DE and body thin-ideal internalization, so we recommend to use caution in interpreting the use of these scales in male populations.<hr/>El término <<conducta alimentaria>> se asocia de manera inmediata con el hecho de ingerir alimentos; sin embargo, es una conducta compleja mediada por factores externos a la persona y no exclusivamente porque los individuos quieran satisfacer sus necesidades alimentarias y sus requerimientos nutricios. La alteración de esta conducta ha dado origen a lo que se conoce como trastornos de la conducta alimentaria (TCA) tales como la anorexia nervosa, la bulimia nervosa y <<el trastorno por atracón>>, en los cuales se ven distorsionados los patrones de la ingestión de alimentos, olvidándose la importancia de mantener un balance entre ingestión y gasto de energía, lo que repercute de manera importante en el estado nutricio y por ende en la salud del individuo. Es bien sabido el origen multifactorial de los TCA, y dentro de los factores de riesgo más estudiados están: las conductas alimentarias, el Índice de Masa Corporal (IMC) y las actitudes hacia el cuerpo provenientes de la interiorización de una figura corporal delgada. El objetivo principal de este estudio fue conocer la prevalencia de las conductas alimentarias de riesgo (CAR) y su relación con la interiorización del ideal estético de delgadez y con el IMC, en estudiantes de ambos sexos de nivel preparatoria y licenciatura en una escuela privada de la ciudad de Pachuca, Hidalgo. Un objetivo adicional fue el de proporcionar datos de confiabilidad y validez de las escalas utilizadas en una muestra de hombres, así como datos adicionales de validez en las mujeres. Se trabajó con una muestra de 845 sujetos (381 hombres y 464 mujeres) de los cuales 45.1% eran de nivel preparatoria con un rango de edad de 15 a 17 años (× =15.82; D.E.=.78) y 54.9% de nivel licenciatura en un rango de edad de 18 a 23 años (× =19.81; D.E.=1.41). Se aplicaron el Cuestionario Breve de Conductas Alimentarias (CBCAR) y el Cuestionario de Actitudes hacia la Figura Corpora l. El IMC se obtuvo partir de la medición del peso y la estatura de cada sujeto. La distribución por categorías del IMC por nivel escolar mostró que el 70% de las mujeres tiene peso normal, y que el porcentaje de las que se encuentran en las categorías de peso muy bajo y bajo (preparatoria 2.9% y licenciatura 8.7%) es mucho menor que las que se hallan en sobrepeso y obesidad (preparatoria 15.2% y 8.3% vs. licenciatura 18.6% y 6.6%). En los hombres se encontró una distribución similar: 71.3% de los de preparatoria y 58.2% de los de licenciatura tienen peso normal, 2.7% y 4.8% bajo peso, 19.1% y 26.1% sobrepeso, y 6.9% y 10.9% obesidad, respectivamente. La prevalencia de CAR en mujeres fue de 8.4% (9.0% en preparatoria; 7.9% en licenciatura) y de 2.9% en hombres (1.6% en preparatoria; 4.2% en licenciatura). <<Los porcentajes de preocupación por engordar, sensación de falta de control al comer, vómito auto-inducido, ayunos, dietas, pastillas, diuréticos y laxantes fueron mayores en las mujeres>>. Del total de mujeres con CAR elevadas, el 84.2% de preparatoria y el 80% de licenciatura también obtuvo puntuaciones altas en el cuestionario sobre interiorización del ideal estético de delgadez, en tanto que en los hombres fue el 33.3% y el 62.5%, respectivamente. La escala CBCAR en mujeres arrojó un alfa de Cronbach de 0.72 y de 0.63 en hombres. El instrumento de actitudes alcanzó valores de confiabilidad de 0.94 para mujeres y de 0.89 para hombres. Se puede concluir que en la población estudiada están presentes las CAR características de los TCA, y que a mayor interiorización de una figura delgada mayor aparición de dichas conductas, principalmente entre las mujeres. Igualmente se comprobó que la práctica de dietas y de ejercicio para bajar de peso, aunadas a la preocupación por engordar, se presentan en porcentajes importantes en estudiantes del Estado de Hidalgo, lo que confirma que esta problemática no es exclusiva de las grandes urbes. <![CDATA[<b>Body dissatisfaction and perceived sociocultural pressures</b>: <b>gender and age differences</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100003&lng=en&nrm=iso&tlng=en One important area of research that has emerged in recent years is the assessment of factors that contribute to the development of body image problems and, more concretely, to the development of body dissatisfaction. The female sociocultural beauty ideal, a constant object of research for over three decades now, is so ultra-thin that it is both unattainable and unhealthy. Likewise, the male beauty ideal of a lean yet muscular body is becoming an important issue for men, with poor body image sometimes leading to the adoption of numerous health-threatening behaviors, such as the use of steroids, ephedrine and deleterious dieting strategies. Body image has been related with self-esteem, depressed mood, social anxiety and disordered eating. In recent years, physical self-perceptions are also studied from the parallel perspective of physical self-concept. In general, women report much higher body dissatisfaction than men at all moments of life, from pre-adolescence to third age, although gender differences in adulthood and in the old age are less important than in adolescence. In the other hand, although women's dissatisfaction with their bodies remains fairly stable across the whole life span, the importance attached to physical appearance, specifically body size and weight, decreases with age. The sociocultural framework has become the most empirically validated of all body image theories and this theory conceptualizes perceived sociocultural pressures as the principal cause of body dissatisfaction. Mass media, peer groups, and family are the three factors which have evolved as the most frequently assessed sociocultural perceived pressures of body dissatisfaction. Previous research has paid considerable attention to gender and age differences in body dissatisfaction, but certain gaps still remain: a) more precise knowledge is required regarding men's body dissatisfaction; b) a comparative perspective of gender differences, in both body dissatisfaction and perceived pressure throughout the different stages of the lifecycle, is lacking; c) more information is required on the interpersonal variations involved in the relationship between body dissatisfaction and perceived sociocultural pressure; and d) a better understanding of the nature of sociocultural influences needs to be gained. This research examines gender and age differences on body image -responses to the Garner's Eating Disorders Inventory-2 (EDI-2)- and perceived sociocultural pressures regarding body ideals -responses to the Questionnaire of Sociocultural Influences on the Aesthetic Body Shape Model (CIMEC-26), by Toro, Salamero, and Martínez-Mallén. The sample group comprised 1259 participants: 627 adolescents, 271 young adults, 248 midlife adults, and 112 over 55's. Results indicate that: a) body dissatisfaction is closely related to perceived sociocultural pressure; b) female participants show higher body dissatisfaction and perceive themselves more affected by sociocultural factors than their male counterparts; c) gender differences (in body dissatisfaction as in perceived sociocultural pressures) are greater for younger age groups than older; d) gender is a better predictor of body dissatisfaction and sociocultural perceived influences than age. The results obtained provide a more comprehensive view of the relationship between body dissatisfaction and perceived sociocultural pressure during the different stages of the lifecycle, highlighting a number of close parallels between both variables. The new data also enables us to identify the young female population as the most susceptible to body dissatisfaction problems and the most vulnerable to sociocultural pressure, with the group of older women emerging as the one best able to cope with these problems. The study also identifies a number of themes which deserve further, more in-depth attention in the future. Tw o especially are worth noting: 1) this study analyses age differences (which may represent generational differences affected by cohort effects), rather than changes associated with age, since the inter-group differences observed correspond to people of different ages, but each separate group also represents a specific age at a specific moment in history; 2) it is important to continue exploring the different pressures exerted by different sociocultural factors (both perceived pressure and objective data on the influence of these factors), as well as the psychological mechanisms that enable some people to cope with these pressures better than others.<hr/>Despierta gran interés teórico y social en nuestros días la identificación y medida de los factores que contribuyen al desarrollo de alteraciones de la imagen corporal y más concretamente al desarrollo de la insatisfacción corporal. El prototipo femenino de belleza dominante desde hace tres décadas en nuestra cultura propone una delgadez tan extrema que resulta no sólo inalcanzable, sino además muy poco saludable. El ideal masculino de belleza, por otro lado, demanda un cuerpo delgado, pero musculado, y éste ha adquirido gran importancia, por lo que con frecuencia se adoptan, a fin de mejorar la propia imagen, numerosas conductas peligrosas para la salud, como el consumo de esteroides, efedrina y dietas alimentarias dañinas. La imagen corporal, conformada por las autopercepciones físicas de cada persona, ha sido objeto de numerosas investigaciones durante las últimas décadas en relación con rasgos psicológicos tan importantes como la autoestima, la depresión, la ansiedad o los trastornos alimentarios y, muy en especial, con la insatisfacción corporal. Está comprobado que, en general, las mujeres manifiestan mayor insatisfacción corporal que los hombres en todas las épocas de su vida, desde la preadolescencia hasta la tercera edad, si bien las diferencias de sexo en la edad adulta y en la tercera edad son menores que en la adolescencia. Por otro lado, aun cuando la insatisfacción de las mujeres con su cuerpo tiende a mantenerse estable a lo largo de todo el ciclo vital, es digno de señalar que la importancia conferida a la apariencia física y, más en concreto, al tamaño y peso corporal, decrece con la edad. La presión sociocultural percibida aparece como principal causa de la insatisfacción corporal. Desde el enfoque sociocultural se señala, en concreto, a los medios masivos de comunicación, al entorno social próximo y a la familia como los tres elementos clave de dicha presión: cuanto más altos son los niveles de presión percibida con respecto a una imagen corporal idealizada, más se incrementa la preocupación por la imagen y por las estrategias de cambio corporal. La investigación previa ha prestado considerable atención a las diferencias de sexo y de edad en cuanto a la insatisfacción corporal, pero se echan en falta: a) conocimientos más precisos sobre la insatisfacción corporal de los hombres; b) una perspectiva comparativa de las diferencias de sexo tanto en insatisfacción corporal como en presión percibida a lo largo de las distintas etapas del ciclo vital; c) mayor información sobre las variaciones interpersonales en la relación entre la insatisfacción corporal y la presión sociocultural percibida, y d) una mejor comprensión de la naturaleza de las influencias socioculturales. Esta investigación trata de contribuir a la superación de estas carencias planteándose las siguientes hipótesis: 1) La insatisfacción corporal guarda estrecha relación con la presión sociocultural percibida; 2) las mujeres participantes, en todos los grupos de edad, muestran más insatisfacción corporal e indican sentirse más influidas por factores socioculturales que los hombres; 3) las diferencias de sexo (tanto en insatisfacción corporal como en presión sociocultural percibida) son mayores en los grupos de menor edad que en los de más edad; 4) el sexo resulta ser un mejor predictor de la insatisfacción corporal y de los influjos socioculturales percibidos que la edad. Participaron en el estudio 1259 personas: 627 adolescentes, 271 adultos jóvenes, 248 adultos y 112 sujetos mayores de 55 años, quienes respondieron el Eating Disorders Inventory-2 (EDI-2), de Garner, que permite identificar la insatisfacción corporal, así como el Cuestionario de Influencias sobre el Modelo Estético Corporal (CIMEC), de Toro, Salamero y Martínez-Mallén. Los resultados obtenidos proporcionan una visión más completa que la hasta ahora disponible acerca de las relaciones entre la insatisfacción corporal y la presión sociocultural percibida en las distintas etapas del ciclo vital: ambas variables guardan estrechos paralelismos; permiten, asimismo, identificar la población femenina joven como la más sensible a los problemas de insatisfacción corporal y de vulnerabilidad a la presión sociocultural, en tanto que el grupo de mujeres de más edad aparece como el que mejor sabe reaccionar ante los mismos. Por otro lado, han permitido identificar temáticas, especialmente dos, que merecen seguir investigándose: 1) aquí se han analizado diferencias de edad (que bien pueden representar diferencias generacionales afectadas por efectos de cohorte) y no cambios asociados con la edad, ya que las diferencias intergrupales observadas corresponden a personas de diferentes edades, pero cada uno de dichos grupos tiene además la misma edad en un mismo momento histórico; 2) es preciso seguir indagando sobre la presión diferencial que ejercen unos y otros factores socioculturales (tanto la presión percibida como datos objetivos de influencia a unos u otros factores), así como sobre los mecanismos psicológicos que permiten a unas personas afrontar mejor que otras estas presiones. <![CDATA[<b>Oedipus and his psychiatrists</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100004&lng=en&nrm=iso&tlng=en Introduction Over a hundred years have elapsed since Sigmund Freud's The Interpretation of Dreams was first published. Publication of this work obviously marked a new stage in the history of psychiatry and psychology. Since then, the Oedipus complex has been one of the pillars supporting the psychoanalytical view of the mind and a model for understanding the normal development of individuals as well as psychopathology. Many historians and psychoanalytic scholars believed that Freud was the first to suggest a pathway to understanding psychopathology by using characters from the theater as models for mental illness. However, in the second half of the nineteenth century, psychiatry had already considered the interface linking the sciences of the mind to the works of the great dramatists as a topic for study. Sigmund Freud and his desert island: The ignorance of the contributions of XIXth psychiatry How did Freud manage to chart a new course in an area that had already been explored and described by the psychiatrists that preceded him? The answer may lie in Freud's medical and intellectual isolation. A propos of this, there is an interesting analogy he draws between himself and a famous character: <<For psycho-analysis is my creation; for ten years I was the only person who concerned himself whit it […] Meanwhile, like Robinson Crusoe, I settled down as comfortably as possible on my desert island.>> It is important to note that in Daniel Defoe's novel, Robinson Crusoe managed to live with at least some of the comforts available to the people of his time. Thanks to his ingenuity, he was able to obtain a series of artifacts. Likewise, Freud devised psychological theories and explanations that already existed in his time and even beforehand. The difference was that Freud thought he owned the patent. Joseph Raymond Gasquet (1837-1902) and a model to understand psychopathology: Oedipus Rex Born on 24 August 1837, Joseph Raymond Gasquet was the oldest son of Raymond Gasquet, a surgeon who spent most of his working life in London. Gasquet was a brilliant student, studying medicine at University College Hospital in London and graduating with distinction in 1859. After the opening of St. George's Retreat, Gasquet accepted the post of assistant physician and played an active role in the growth and development of this asylum. He was a great admirer of the work of Charcot, whom he regarded as <<one of the greatest of modern physicians.>> As a result, Gasquet, like Freud, had a special interest in the phenomena of hypnosis and hysteria. He contributed to the dissemination of the knowledge of British psychiatry, writing for various publications. He spent his free time studying philosophy, theology, and universal literature, while his extensive knowledge of classical works enabled him to become familiar with ancient and modern schools of thought. In April 1872, Gasquet published an article on The Madmen of the Greek Theatre in the Journal of Mental Science and a few months later, in 1873, published a continuation of this work subtitled The Ajax and Oedipus of Sophocles. Both articles, published in a well-known specialist journal, were several years ahead of the psychoanalysts interested in looking to Greek theater for models for psychopathology. Gasquet published his observations on Oedipus 26 years before Freud, also contributing studies on Orestes, Hercules and Cassandra to the same journal. Gasquet vs. Freud: contrasts and similarities with psychoanalytic thought Due to Gasquet's significant contributions to the Dublin Review, two years after his death, a compilation of several of his works was published in a book called Studies Contributed to the <<Dublin Review.>> This work included an article called Hypnotism written in April 1891, in which Gasquet attributes the start of the scientific study of hypnotism to Charcot. The most interesting fact about the article on Hypnotism is that Gasquet dealt with the issue of the unconscious nearly a decade before Freud published his descriptions. His deductions about the unconscious were so accurate and profound that, through Gasquet, we seem to be listening to the father of psychoanalysis. Another aspect worth mentioning is the seriousness with which Gasquet felt hypnosis should be used. Here we find an enormous contrast with Freud who, four years after Gasquet wrote this, would confess to his abuse of this form of therapy in Studies on Hysteria. Like Freud, Gasquet was a psychiatrist profoundly interested in the subject of religion. Gasquet analyzed the issue of religion in works such as The Physiological Psychology of St. Thomas, The Present Position of Arguments for the Existence of God, Lightfoot's St. Ignatius and the Roman Primacy, The Canon of the New Testament and The Cures at Lourdes. In this last work, Gasquet described his experience of examining several cases of miraculous cures of pilgrims that visited the city of Lourdes. It is also important to mention that Gasquet described slips of the tongue (lapsus linguae), attributing them to an unconscious origin, over a decade before Freud. In a footnote to his article Lightfoot's St. Ignatius and the Roman Primacy, written in 1887, Gasquet highlighted William Cureton's mistake in quoting a Greek text from a letter from St. Ignatius: <<Cureton unconsciously paraphrases <img border=0 src="../../../../../img/revistas/sm/v33n1/a4s1.jpg">by <img border=0 src="../../../../../img/revistas/sm/v33n1/a4s2.jpg">>> Lastly, we should mention that Gasquet's interpretation of the myth of Oedipus significantly contrasted with Freud's a few years later. Gasquet did not highlight parricide and incest as Freud did but rather Oedipus's self-mutilation in the presence of a high degree of mental anguish. From Gasquet's perspective, this self-mutilating behavior, which some have called the <<Van Gogh Syndrome>>, could well be an <<Oedipus complex>> applicable to seriously disturbed patients and all the mentally ill that resort to self-injuries to certain extent.<hr/>Introducción Han transcurrido más de cien años desde que La Interpretación de los Sueños, de Sigmund Freud, apareció por primera vez. Podemos afirmar, sin temor a equivocarnos, que la publicación de esta obra marcó una nueva época en la historia de la psiquiatría y la psicología. Desde entonces, el complejo de Edipo ha sido uno de los pilares que sustentan la visión psicoanalítica de la mente y un modelo para entender tanto el desarrollo normal de los individuos como la psicopatología. Muchos historiadores y estudiosos del psicoanálisis creyeron que Freud marcó por primera vez un camino para comprender la psicopatología, al tomar a los personajes del teatro como modelos de la enfermedad mental. Sigmund Freud y su isla desierta: La ignorancia de las aportaciones de la psiquiatría decimonónica Freud ignoraba las aportaciones al estudio de la interfase de la psiquiatría y la creación literaria realizadas por algunos psiquiatras que lo antecedieron. ¿Cómo es que Freud creyó trazar un nuevo camino en un área ya explorada y descrita por los psiquiatras del siglo diecinueve? Quizá la respuesta esté en el propio aislamiento médico e intelectual de Freud. Respecto a esto, resulta interesante la analogía que él hace de sí mismo con un célebre personaje: <<El psicoanálisis es, en efecto, obra mía. Durante diez años fui el único en ocuparme de él […] Entretanto, Robinsón en mi isla desierta, me las arreglé lo más cómodamente posible.>> Joseph Raymond Gasquet (1837-1902) y un modelo para entender la psicopatología: Edipo Rey En abril de 1872, Gasquet publicó en el Journal of Mental Science un artículo titulado Los locos del teatro griego, y unos meses más tarde, en enero de 1873, una continuación de dicho trabajo subtitulado Ayax y Edipo de Sófocles. Ambas publicaciones, aparecidas en una revista especializada y reconocida, se adelantaron por muchos años a la intención psicoanalítica de mirar hacia al teatro griego en busca de modelos de psicopatología. Gasquet publicó sus observaciones sobre Edipo veintisiete años antes que Freud, también publicó en la misma revista estudios sobre los personajes de Orestes, Hércules y Casandra. Hoy sabemos que el estudio de los personajes del teatro griego nace de la psiquiatría británica por influencia de Gasquet y no del psicoanálisis. Gasquet vs. Freud: contrastes y similitudes con el pensamiento psicoanalítico Al analizar el personaje de Edipo, Gasquet hizo un paralelismo con El Rey Lear de Shakespeare, en el sentido de que ambos dramas se inician con un rey que goza de poder y buena fortuna, sin que ambos sean capaces de vaticinar su infortunio. Gasquet resaltó, no el parricidio y el incesto como lo hizo Freud, sino la automutilación que ejecutó Edipo ante la presencia de un grado elevado de angustia mental. Este comportamiento automutilador, el cual ha sido llamado por algunos <<síndrome de Van Gogh>> bien podría ser, desde la perspectiva de Gasquet, un <<complejo de Edipo>>, aplicable a pacientes gravemente perturbados y a todos aquellos enfermos mentales que en cierta medida incurren en autolesiones. Sin embargo, la principal interpretación que hizo Gasquet del mito de Edipo se centró en un aspecto positivo de la tragedia, un detalle no observado por Freud y que tiene gran relación con el concepto de resiliencia introducido por Rutter cien años más tarde. Gasquet asumió que Sófocles: <<deseaba sobre todo demostrar cómo la más pesada de las maldiciones representaba bendiciones disfrazadas, si conducían a la autodisciplina y a la mejora moral.>> Conclusión Contrariamente a lo que han creído los seguidores del psicoanálisis, no fue Freud el primer psiquiatra en estudiar la psicopatología de Edipo, ni en crear un puente entre la ciencia de la psiquiatría y las humanidades. Joseph Raymond Gasquet, prescindiendo de las teorías psicoanalíticas, supo explorar los terrenos que Freud más tarde creyó descubrir. <![CDATA[<b>The role of optimism and social support on subjective well-being</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100005&lng=en&nrm=iso&tlng=en Introduction In recent years, a great deal of research has been carried out to identify the aspects that affect subjective well-being. In these studies, different indicators of well-being have been used. While some studies have used satisfaction with life as an indicator, others have focussed on psychological adjustment, while still in some other cases the focus has been on positive emotions and even physical health, understood as the lack of illness, as contributing to well-being. Nevertheless, these indicators have not been directly comparable. The objective of this study is to analyze whether optimism and social support equally affect or not subjective well-being. Subjective well-being has been defined as the global tendency to experience life in a pleasant way. The evaluation that people carry out has two components: a cognitive component, evaluated through life satisfaction, and an affective one, measured through positive and negative affect. Previous research has been centred on analysing the factors which could influence either on positive or negative ways, such as personality, optimism, coping styles, and social support. It has been demonstrated that well-being is determined, in some way, by optimism and social support. However, there has been very little research analysing the relative impact of these variables on the different measures of well-being. Thus, the purpose of this study was to examine the influence of optimism and social support on the different components of subjective well-being. We have analysed: firstly, the relationships of optimism and social support with well-being; second, whether or not optimists feel more subjective well-being; third, social support together with optimism have an enhancer effect on well-being; and four, optimism and social support can differentially predict the several components of subjective well-being. Method This is a cross-sectional study where subjective well-being has been assessed in 477 people from general population between 18 and 66 years old (M=25.66; SD=8.81). The following measures were used: satisfaction with specific life domains (partner, job/studies, health and leisure), life satisfaction, positive emotions, negative emotions, and mental health. Optimism was evaluated through the Life Orientation Test-Revised (LOT-R) and Social Support through the Social Support Questionnaire (SSQ-6). Moreover, certain demographic and physical health characteristics were assessed through a semi-structured interview. In order to analyse the relationships among the variables included in the study, we administered partial correlations, controlling for gender. Also, one-way analyses were conducted to discover any differences in well-being between high, medium, and low optimists. Afterwards, U Mann-Whitney was applied in order to analyze whether optimist people with high social support show more well-being than optimist people without social support. Finally, in order to study the capacity of optimism and social support in predicting the different components of well-being, several multiple regression analyses were applied. Results Results showed that socio-demographic and physical health variables do not influence optimism. There is a close relationship between optimism and all the measures of subjective well-being, with optimists showing more life satisfaction, fewer psychological symptoms, more positive emotions, less negative emotions, and being more satisfied in several specific life domains, such as partner and health. Perceived social support is associated with different signs of well-being, although the extent of the correlation is lower. Participants with more perceived social support show better adjustment, more life satisfaction and partner satisfaction, they have more positive emotions and less negative emotions. There are not significant associations of perceived social support with health satisfaction and with job satisfaction. The amount of social support resources shows low correlations with subjective well-being, particularly with some of the psychological adjustment measures and with life satisfaction. When differences between high and low optimists are analysed, similar results are observed. High optimists have less anxiety, depression, interpersonal sensitivity symptoms, and score lower in the strength disorder index than low optimists. Moreover, high optimists experience more positive emotions and less negative ones, report more satisfaction with their partner, with health and with life in general, and have more perceived social support. So, optimism seems to have an influence on most of the well-being components. On the other hand, when optimism and social support effect on well-being are analyzed altogether, it can be observed that high optimist people with high social support show more positive emotions, more satisfaction with leisure, more life satisfaction; and less negative emotions, depression and interpersonal sensitivity than high optimists with poor social support.<hr/>Introducción Identificar los factores que inciden en el bienestar de los individuos ha sido uno de los aspectos psicológicos más estudiados en los últimos años. El bienestar subjetivo se ha definido como la tendencia global a experimentar la vida de modo placentero. Esta valoración que hace el individuo tiene dos componentes: el cognitivo, evaluado por medio de la satisfacción vital, y el afectivo, que se basa en la presencia de emociones positivas y emociones negativas. La investigación previa se ha centrado en analizar los factores que inciden en el bienestar subjetivo, pero se han empleado diversas medidas de bienestar que no han sido directamente comparables. En este estudio se analizan conjuntamente los diversos indicadores de bienestar, con el objetivo de estudiar si el optimismo y el apoyo social inciden de manera similar o diferencial en cada uno de ellos. Método Es un estudio transversal con una muestra de conveniencia compuesta por 477 personas entre 18 y 66 años (M=25.66; DT=8.81). Se evalúan distintos componentes del bienestar: satisfacción en áreas específicas como pareja, trabajo/estudios, salud y ocio; satisfacción vital; emociones positivas; emociones negativas y ajuste psicológico. El optimismo disposicional se mide mediante el Test de Orientación Vital Revisado (LOT-R) y el apoyo social por medio del Social Support Questionnaire (SSQ-6). Resultados Los resultados indican que las variables sociodemográficas y las relacionadas con la salud no inciden en el nivel de optimismo. El optimismo guarda relación con la mayor parte de los indicadores de bienestar subjetivo. Las personas optimistas están mejor ajustadas psicológicamente, muestran mayor satisfacción con la vida, experimentan más emociones positivas y menos negativas, y además, informan de mayor satisfacción en algunas áreas de su vida, como la pareja y la salud. Por su parte, las personas con mayor percepción de apoyo se sienten más satisfechas con su vida, muestran más satisfacción con la pareja, están más ajustadas psicológicamente y tienen más emociones positivas y menos negativas. Sin embargo, la cantidad de fuentes de apoyo resulta menos relevante para el bienestar. El análisis de las diferencias entre personas optimistas frente a las poco optimistas confirma el patrón descrito, las optimistas tienen mejor ajuste psicológico, mayor satisfacción en áreas vitales (salvo laboral y de ocio), mayor satisfacción con la vida, experimentan más emociones positivas y menos negativas y tienen más apoyo social percibido. Por otra parte, si se analiza el efecto conjunto del optimismo y del apoyo social en el bienestar se observa que las personas con alto optimismo y alto apoyo muestran más emociones positivas, mayor satisfacción con el ocio y con la vida, menos emociones negativas, menor depresión y menor sensibilidad interpersonal que las personas optimistas con escaso apoyo social. Al analizar la capacidad del optimismo y del apoyo social para predecir el bienestar subjetivo se encuentra que estos factores apenas predicen la satisfacción en áreas específicas pero sí predicen cerca de un 30% de la varianza de la satisfacción vital, un 20.2% del ajuste psicológico y alrededor de un 14% de la varianza de las emociones positivas y emociones negativas. Discusión y conclusiones En general, los resultados avalan la importancia del optimismo y del apoyo social en los distintos indicadores de bienestar subjetivo. Sin embargo, el peso de estos factores no parece ser el mismo en cada uno de los componentes del bienestar. El optimismo guarda relaciones más estrechas con los indicadores de bienestar que el apoyo social, estando más vinculado a la satisfacción vital, a la depresión y al ajuste psicológico que a la satisfacción en dominios específicos. El optimismo, al ser una expectativa global, probablemente incida más en indicadores generales de bienestar que en índices de satisfacción concretos. Por otro lado, el apoyo social percibido tiene más peso a la hora de predecir la satisfacción en áreas específicas. Tal vez, porque en el momento de valorar situaciones de la vida cotidiana resultan más prominentes los otros, y esto incide directamente en el juicio del individuo acerca de su satisfacción en áreas en las que están implicadas las relaciones interpersonales. En investigaciones futuras se precisa profundizar sobre el significado de los distintos componentes del bienestar y qué otros factores, además del optimismo y el apoyo social, pueden estar incidiendo en el mismo. <![CDATA[<b>Maintenance of training on refusal skills in cronic users of alcohol and drugs</b>: <b>a case study</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100006&lng=en&nrm=iso&tlng=en In Mexico, alcohol and drug consumption has been a social problem for many years. Epidemiological studies show that moderate-to-high alcohol consumption has persisted in recent years, whereas in the case of illegal drugs consumption has become more widespread in both men and women. In fact, there is a tendency for consumption rates to level out between men and women, especially regarding legal drugs. Although most users are moderate consumers, between 5-10% are chronic consumers. It is necessary for these people to have access to a range of treatments that incorporate a system of examination and systematization. Consequently, in Mexico it is necessary to create new programs with a methodological structure that makes it possible to assess whether they assist in curtailing this social problem. One program that has proven to be effective is the Daily Satisfaction Program (DSP), which is based on the Community Reinforcement Approach (CRA). CRA is notable as one of the most successful programs in helping chronic users of legal or illegal drugs in the United States to give up substance abuse. In Mexico, it was necessary to modify some of the elements of DSP in order to adapt it to our culture, but it has encouraged a significant reduction in consumption patterns among participating users. This is an intensive program that includes several components, due to the serious nature of the problem to be tackled. However, it is necessary to carry out a systematized assessment of each of these components that foster in the user not only a reduction in consumption but also an increase in the satisfaction found in day-to-day activities. In Mexican culture, there are strong social pressures that affect consumption. Consequently the refuse-to-consume component is one of the most important, as it provides the user with the necessary strategies to be able to decline in a situation with peer pressure and in those moments when impulsive thoughts occur that might trigger the consumption response in the subject. The refuse-to-consume skills that were assessed in users were: body language, assertive refusal, suggesting alternatives, changing the subject of conversation, offering an explanation, suspending interaction, confronting the offerer, and changing impulsive thoughts by using cognitivist restructuring. Some investigators have detected a correlation between high consumption levels and a low degree of self-efficacy in refusing consumption. According to this theory, low self-efficacy in refusing consumption is the most accurate indicator of consumption behavior and makes it possible to discriminate between different types of user. High self-efficacy in refusing consumption is associated with less frequent episodes of consumption. With regard to motivation, these authors suggest that better self-efficacy in refusing consumption when offered the substance or in response to impulsive thoughts has an influence on the decision to consume or not to consume. In order to achieve a higher degree of self-efficacy in refuse-to-consume skills, it is necessary to control certain body responses that denote the desire or wish to consume. Some of these responses are: avoidance of eye contact, trembling, stuttering, blushing, sweating, palpitations, etc. The physiological responses associated with consumption are still displayed after the user has been through a period of non-consumption. They may be triggered by words associated with consumption or by watching videos of people who are consuming. Responses of this kind may be explained from a classical conditioning viewpoint, whereby a given stimulus provokes a given type of response. To explain what elicits, maintains, and increases the consumption of alcoholic drinks, three models of conditioning have been posited: the conditioned withdrawal model, the compensatory response model, and the conditioned motivational model. These models are based on an analysis of alcohol consumption situations with the aim of identifying the related variables. The model that most clearly explains alcohol consumption as a conditioned response is conditioned withdrawal. According to this model, in the case of people who have a history of alcohol dependence the stimuli associated with alcohol consumption (visual, olfactory, and auditory) provoke physiological responses such as salivation, trembling hands, or sweating. Alcohol consumption reduces these responses, which the subject is averse to. Users learn that, when they are offered a drink or drugs (the stimulus), they should accept it (the response). The aim of refuse-to-consume skills is to teach them to change their response to the stimulus, in other words, to teach users the necessary skills so that they learn to say no. When people are in the process of changing their consumption patterns by learning refusal skills and they experience high-risk situations, it is very probable that on the first few occasions they will exhibit a behavior that shows they are feeling insecure or anxious, such as avoiding eye contact with the person offering them the substance, stuttering, mumbling, not speaking with a decisive tone of voice, sweating, or having shaky hands. These responses make the offerer doubt whether the individual wishes to give up consuming, so he or she is more likely to insist and encourage a relapse in the user. Consequently, it is necessary to teach users how to react to these offers by relaxing and behaving assertively. This can be achieved by applying refuse-to-consume skills. Relaxation produces emotional effects that are the exact opposite of anxiety and which may be used therapeutically in everyday situations. Thus, it is less likely that the person offering the substance will follow up a refusal by repeating the offer, and the user may then take control of the situation and feel more secure. Peer pressure constitutes a high-risk factor that causes many users to relapse. It consists of direct or indirect pressure from other individuals or social groups who exert an influence on the user. In the case of direct pressure, the contact is personal, the offer involves verbal interaction, and the offerer is insistent that the user should consume the substance. In the case of indirect peer pressure, the user responds by watching other people use the substance in question. Often peers do not understand that the user has made a decision to quit and are insistent that he or she should continue to consume; the user also frequently feels that justification should be provided when refusing an offer. In reality, such an explanation is not necessary in most cases. It is frequently the case that when the user is with family members or close friends, they may question the refusal. For this reason, it is important for the user to preempt this reaction by asking friends and family members for support as a first step in the recovery process. The user must also interpret events, impulses, and emotions rationally, bearing in mind the negative consequences of consuming and the benefits of being sober or drug-free. Consequently, the user needs to learn to say no to him- or herself whenever temptation arises in the form of thoughts or desires. The user must confront them and change them into positive thoughts that favor his or her wellbeing and are unrelated to consumption. The objective of this study was to assess the degree of aptitude attained in refuse-to-consume skills by four chronic drug users in the Daily Satisfaction Program (DSP). Each user performed an evaluation of the high-risk situations in which consumption might occur as a result of peer pressure, and carried out a behavioral test in which the skills learnt were put to use. Subsequently, the users identified their impulsive thoughts and carried out an exercise in which the therapist repeated out loud the impulsive thoughts and the user replaced them with positive thoughts oriented toward reversing the decision to consume. These exercises were recorded and evaluated by two DSP therapists. Results indicate a high level of skill in refusing consumption in the face of external and internal pressure. Users also put these skills into practice in real-life situations, thereby reducing their episodes of consumption or maintaining abstinence.<hr/>En México, el consumo de alcohol y drogas ha sido un problema social. Los estudios epidemiológicos indican que el consumo moderado alto de alcohol ha prevalecido en los últimos años, se ha igualado la cantidad de ingesta en ambos sexos y alcanzado el consumo crónico hasta entre un cinco a 10% de la población. En lo referente al consumo de drogas ilegales, éste se ha incrementado tanto en hombres como en mujeres. Es indispensable que esta población tenga acceso a diversos tratamientos y se evalúe su impacto en la reducción de éste problema. El Community Reinforcement Approach (CRA) ha demostrado ser uno de los mejores programas de intervención para lograr la abstinencia en usuarios con consumo crónico de drogas legales o ilegales en los Estados Unidos. En México, la adaptación del CRA requirió modificar algunos de sus componentes y añadirle el de autocontrol emocional. A partir de estos cambios se estructuró el Programa de Satisfactorios Cotidianos (PSC) que favoreció la reducción significativa en el patrón de consumo en los usuarios participantes y el incremento en la satisfacción con su funcionamiento cotidiano. Este es un Programa intensivo, que integra diversos componentes en función de la gravedad de la problemática por modificar. Sin embargo, requiere la evaluación sistematizada de cada uno ellos. En un estudio con una población mexicana de consumidores crónicos, la habilidad para rechazar la presión social al consumo y los pensamientos de apetencia o necesidad por consumir funcionaron como precipitadores predictores de la abstinencia. El componente de Rehusarse al Consumo es uno de los más importantes ya que provee al usuario de las estrategias necesarias para negarse ante situaciones de ofrecimiento e insistencia en las invitaciones y en momentos en los que sus pensamientos precipitadores le activan la conducta de consumo. Las habilidades para rehusarse al consumo evaluadas en estos usuarios fueron: negarse asertivamente, sugerir alternativas, cambiar el tema de la plática, ofrecer justificación, interrumpir la interacción, confrontar al otro y su lenguaje corporal, así como el cambio de pensamientos precipitadores mediante el uso de la reestructuración cognoscitiva. El objetivo de este estudio fue evaluar el nivel de dominio alcanzado en las habilidades de rehusarse al consumo por cuatro usuarios crónicos de drogas del Programa de Satisfactores Cotidianos (PSC). Cada usuario realizó un análisis de sus situaciones de riesgo para el consumo ante la presión social y efectuó un ensayo conductual en el que ponía en práctica las habilidades. Posteriormente identificó sus pensamientos precipitadores y llevó a cabo un ejercicio en el que el terapeuta repetía en voz alta los pensamientos precipitadores del usuario y éste los cambiaba por pensamientos positivos orientados a modificar la decisión de consumir. Estos ejercicios fueron grabados y evaluados por dos terapeutas del PSC. Los resultados indican un nivel de dominio alto de las habilidades de rehusar el consumo ante presión externa e interna; adicionalmente, los usuarios aplicaron las habilidades de rehusarse a consumir en escenarios naturales. Redujeron sus episodios de ingesta, lograron mantener la abstinencia, disminuyeron las situaciones de ofrecimiento en las que tuvieron consumo e incrementaron su seguridad para no consumir al exponerse a ofrecimientos. <![CDATA[<b>Application experience and criteria for the interpretation of two versions of Infant-Toddler HOME</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100007&lng=en&nrm=iso&tlng=en The Home Observation for the Measurement of the Environment (HOME) Inventory is the most widely used tool in evaluating the environmental stimulation and family potential to provide necessary cognitive, social, and emotional support available to the child development. The HOME uses an observation/interview format to measure specific interactions between the caregiver and the child, various issues and events that might stimulate the child, and a variety of experiences provided at home or by family members that offer opportunity for growth and development. There are several versions to use from birth to age 3 (Infant-Toddler HOME), the most famous data come the late 60's (1968), it is composed by 45 items (HOME-45) clustered into six subscales. It has a back up of 40 years of publications, over 650 papers, associating with the children's language development, intellectual performance, and academic achievement or psychosocial and socioeconomic characteristics of the family. In Mexico, there are only two published version reports of the use of HOME-45. Most reports refer to the version of Cravioto from the late 60's, with 7 subscales and 62 items (HOME-62) from which there's poor information in the literature about the criteria for to interpreter the outcome results. The aim is to show the results of the implementation of both versions of HOME inventory, and provide criteria for interpretation in a sector of the Mexican population of low socioeconomic status. Material and methods We studied 1031 children and their homes from three communities of low socioeconomic status of central Mexico. Explaining the procedures and obtained informed consent, they were visited at home to implement the HOME Inventory and the socio-economic survey, with a 95% interobserver reliability. The procedures performed were approved by the Ethics and Research Committees from National Pediatric Institute. We applied the HOME-45 and HOME-62 in a integrated format to obtain the total score and each subscale from each version. It was also felt cut-off formed three groups with low stimulation (lowest fourth), middle stimulation (middle half) and high stimulation (upper fourth). The HOME-45 applies all the items to children 0 to 3 years; in the HOME-62 before 3 months old are evaluated only 50 items and after 3; 9; 12; 15 and 18 months old apply 54; 55; 57; 59 and 62 items respectively. Depending on the age, 26 to 36 items are common, representing from 58 to 80% of HOME-45 and 52 to 58% of HOME-62. There is no correspondence between the subscales of both versions, they have a different name and composition of items; so, we consider both versions as different. Social survey A modified version of the socio-economic interview of the National Pediatric Institute was applied, therefore three levels were established: medium low, low and very low social-economic status. Statistical analysis Four groups were formed by age range of children, to analyze the version HOME-45 and 6 groups for HOME-62 version, depending on the number of applicable items indicated in the format. The analysis related to HOME-62 considered only those items that the format indicates to apply for specific ages. Analyze was performed using JMP statistical software (version 5.01; SAS). We used ANOVA, Student's t test or Tukey Kramer's test to examine differences between means and chi square test to assess differences between proportions; p< 0.05 was considered statistical significance. Results 52.7% of the children were female, aged 1 to 35 months (<img border=0 src="../../../../../img/revistas/sm/v33n1/a7s1.jpg"> = 16.2 ± 9.3 months) mother was the primary caregiver of the child at 87.8%. The mean mother's age was 26.5 ± 5.7 years with a range of 14 to 43 years, the father's age was 29.8 ± 7.34 years. Mother's education mean was 9 years, 24% elementary school or less. HOME-45 Inventory achieved mean score in the population of 31.02 ± 5.68 points, equivalent to a hits proportion of 0.69 ± 0.13, with limits between 0.51 (variety) to 0.81 (responsibity). We found statistical significance differences in the total score of HOME-45 Inventory according to socioeconomic and marital status, birth order of children, education and age of parents. There were also found differences between all subscales of HOME-45 with the socioeconomic status and parent's education. With scores of HOME-45 Total difference was found between children younger than 6 months respect to older. There were also differences in the same sense in the subscales except for Acceptance and Organization subscales. It was considered the cutoff point for low, medium and high stimulation in the total population (0-35 months), to total scale and each subscale, the most important differences observed occurred in children under 6 months of age. HOME-62 Inventory (Cravioto) The total score and the subscales of HOME-62 also showed associations with sociodemographic variables such as education, age and marital status from parents, socioeconomic family status and birth order of children. Scores reached at the HOME-62 were equivalent to the hits proportion of 0.74 ± 0.1 , all subscales showed mean higher than 0.5 and three above 0.8. There were major differences in the total score of HOME-62 considering the age group proposed, similar differences were observed in most of the subscales. The cut-off points for types of stimulation of total HOME-62 tend to increase with the age of the child. The same happened with the subscales except Frequency and Stability of adult contact and Emotional climate, were descended. It was compared the relationship between the two versions of HOME once the criteria proposed was applied: 719 family environments were similarly characterized by both versions (69.7%) and 235 environments (22.8%) were defined by the HOME-45 with great stimulation while 80 environments (7.8%) were defined by the HOME-62 with great stimulation too. Discussion There are no benchmarks in the Mexican population for any of the two versions of HOME used. And the international benchmarks HOME-45 were obtained from American families for over 30 years, being important to have results related to its application and interpretation of HOME-45 in a sector of the Mexican population, allowing contrasting findings regarding those obtained in other latitudes. HOME-62 version is the most widely used in Mexico, but little has been reported about the achieved scores, because there are no criteria for interpretation. The values proposed in this paper can be used in future comparisons with the results of other studies. Differences in scores of each version of HOME according to the age of the children, make it necessary to show the results adjusted by age ranges, common procedure in several instruments. The results of HOME-45 in the population were similar to those obtained in other data, there were no statistical differences with the Little Rock values in the total score, and it existed with the subscales of Acceptance and Organization. Like in that population, the tendency to increase the total score of HOME-45 with age was due mainly to Learning materials and Variety subscales. The results of HOME-62 provide benchmarks for its interpretation in 6 age group and all subscales. If they are applied to the results of the Cravioto's investigation, they are able to differentiate families with a history of malnourished children in the early years of life. Both versions showed ability to discriminate socio-economic characteristics of family. It is necessary to report results of the implementation of HOME in different contexts in qualitative and quantitative terms for a proper comparison and interpretation of the differences between groups as well as analyzing the relationship between the specific results in the subscales of both versions with the development, behavior and welfare of children.<hr/>El instrumento más utilizado en la evaluación del potencial del ambiente familiar para brindar estimulación y apoyo necesario al desarrollo del niño, es el Inventario HOME (Home Observation for the Measurement of the Environment). La versión más conocida internacionalmente, para niños de cero a tres años, contiene 45 reactivos (HOME-45). En México la mayoría de reportes se refiere a una versión modificada por Cravioto con 62 reactivos (HOME-62), con poca información sobre los criterios para su interpretación. No existe correspondencia en el nombre de las subescalas de ambas versiones ni en los reactivos que las conforman, por lo que se consideran ambas versiones como distintas. No existen valores de referencia para la población mexicana de ninguna de las dos versiones utilizadas del HOME. Objetivo Mostrar los resultados de la aplicación de ambas versiones del inventario HOME y ofrecer criterios para su interpretación en un sector de la población mexicana de condición socioeconómica baja. Material y métodos Se estudiaron 1031 niños y sus hogares mediante visitas domiciliarias en tres comunidades del estrato socioeconómico bajo del centro de México. Los procedimientos tuvieron una confiabilidad interobservador del 95% y fueron aprobados por los Comités de Investigación y Ética del Instituto Nacional de Pediatría. Se obtuvo la puntuación para cada una de las versiones y se estimaron puntos de corte formándose tres grupos de estimulación, según la distribución cuartilar. Resultados El cincuenta y dos punto siete por ciento de los niños fue del sexo femenino, <img border=0 src="../../../../../img/revistas/sm/v33n1/a7s1.jpg" > o = 16.2 ± 9.3 meses de edad, el cuidador principal del niño fue la madre en el 87.8%. La puntuación alcanzada por la población en el Inventario HOME-45 fue de 31.02 ± 5.68 puntos. Se encontraron diferencias significativas en la puntuación del HOME-45 y las subescalas según el orden de nacimiento del niño, la condición socioeconómica, el estado conyugal, la edad y escolaridad de los padres. Se estimó el punto de corte para la baja, media y alta estimulación observándose las diferencias más importantes en los menores de seis meses de edad. Inventario HOME-62 La puntuación total y la de las subescalas del HOME-62 también mostraron asociación con las variables sociodemográficas; la puntuación total del HOME-62 fue equivalente a una proporción de aciertos de 0.74±0.1. Se observaron diferencias en la puntuación total y en la mayoría de las subescalas del HOME-62 según los intervalos de edad propuestos. Los puntos de corte para los tipos de estimulación del HOME-62 tienden a incrementarse con la edad del niño e igual sucede con la mayoría de las subescalas. La relación entre ambas versiones del HOME, una vez aplicados los criterios propuesto, mostró 69.7% de ambientes familiares tipificados de igual manera por ambas versiones, 22.8% tipificados con mayor estimulación por el HOME-45 y 7.8% de ambientes tipificados con mayor estimulación por el HOME-62. Conclusiones Es importante contar con referentes para la interpretación del HOME-45 en habitantes de México, que permita contrastar los hallazgos respecto a los obtenidos en otras latitudes. El HOME-62 es la versión más utilizada en México, pero se han reportado poco las puntuaciones alcanzadas, en parte porque no hay criterios para su interpretación. Se presentaron los resultados ajustados a intervalos de edad, procedimiento común en diversos instrumentos. Los valores propuestos en el presente trabajo pueden usarse en futuras comparaciones con los resultados de otros estudios. Los resultados del HOME-62 aportan referentes para su interpretación en seis intervalos de edad en cada subescala. Ambas versiones muestran capacidad para discriminar características socioeconómicas de las familias. Es necesario reportar resultados de la aplicación del HOME en diversos contextos en términos cualitativos y cuantitativos para una adecuada comparación e interpretación de las diferencias entre grupos, así como analizar las relaciones entre los resultados específicos en las subescalas de ambas versiones con el desarrollo, comportamiento y bienestar del niño. <![CDATA[<b>Evaluation of functioning, disability, and health status for psychosocial rehabilitation among institutionalized patients with severe mental disorders</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100008&lng=en&nrm=iso&tlng=en Introduction The World Health Organization (WHO) made a major shift on the outcomes of illness, diseases, and interventions from clinical indicators to those related with levels of functioning and disability, as well as the possibility to determine areas of improvement on a case-by-case basis. Along with this theoretical approach, a new instrument was proposed to WHO members: the International Classification of Functioning, Disability and Health (ICF). The instrument is flexible, easy to apply in different clinical scenarios (it is not attached to a cluster of diseases), culturally adapted in several languages, and complementary to clinical and para-clinical information. In psychiatry, the use of the ICF may be highly valuable to establish the preserved areas of functioning as well as the most salient disabilities to formulate a proper case management, and then, to plan adequate public policies. This report includes the results of an evaluation of functioning, disability and heath dimensions, along with the psychometric properties of the ICF checklist, among people with severe and persistent mental disorders that have been institutionalized in a psychiatric hospital in the State of Jalisco, Mexico. Method Subjects: Inmates of a 50 year old psychiatric facility, dependent from the Mental Health Institute of Jalisco (SALME), within the frame of the Ministry of Health of the State of Jalisco in Mexico. This facility is divided in acute wards, were patients are hospitalized in acute phases of severe and persistent mental disorders, and <<permanent>> wards which have existed since the origins of the hospital and became a place where people were abandoned and finally stayed institutionalized under the State's support and supervision. The later population was included in this evaluation. Measures: A psychiatrist (AM), previously trained on the administration of the ICF, supervised the evaluation of: 1) the <<Activities and Participation>> domains of the Short list of ICF proposed by WHO (AP-ICF); 2) The American Psychiatric Association's Global Assessment of Functionality Scale (GAF); and 3) The Life Skills Profile(LKP). Results A total sample of 205 subjects was included; they were 64.9% males, with a mean age of 40.28±14.39 years old. The mean hospitalization time was 18.04±10.29 years. Psychiatric diagnosis distribution was: severe mental retardation (MR) (29.8%); moderate MR (15.6%), residual or undifferentiated schizophrenia (8.3%), and paranoid schizophrenia (7.8%). A concurrent physical illness was identified in 48.8% (n=112) of the subjects. Salient health problems were: epilepsy (n=47, 22.9%), chronic obstructive pulmonary disease (n=6, 2.9%), diabetes (n=5, 2.4%), and systemic arterial hypertension (n= 4, 2%). AP-ICF validity and reliability: Correlations between AP-ICF domains and GAF were all moderate (between -.51 to -.71), negative and statistically significant. Cronbach's alphas were as follows: a) Learning and applying knowledge: .85 for the first qualifier, and .89 for the second; b) General tasks and demands: .90 and .92; c) Communication: .93 for both qualifiers; d) Movement: .78 for the first qualifier, and .89 for second qualifier; e) Self Care: .94 and .96; f) Domestic Life Areas: .91 and .95; g) Interpersonal Interactions: .79 and .91; h) Major Life Areas: .59 and .70; i) Community, Social and Civic Life: .75 and .72. Functionality and disability among institutionalized patients: In the Global Assessment of Functioning measure, subjects distribution belonging to punctuations ranges were: 31-40 points(n=54, 26.3%); 11-20 points (22.9%,n=47); 21-30 points (21%,n=43); 41-50 points (14.6%,n=30); 51-60 points (11.2%, n=23); 61-70 points (2.9%, n=6), and 1% felled in the <<more than 71 points>> range. On the Life Skills Profile (LSP), means and standard deviations were as follows: a) Self Care: row score= 19.85 ± 3.42, percentage transformation= 49.64% ± 8.56; b) Social Communication: row score= 16.70±3.42, percentage transformation= 41.76% ± 9.39; c) Communication with contact: row score= 14.00 ± 2.60, percentage transformation= 58.35% ± 10.85; d) Communication without contact: row score= 9.39 ± 2.47, percentage transformation= 39.12% ± 10.30; e) Autonomy Life: row score= 11.87 ±1.89, percentage transformation= 42.40% ± 6.76. Major <<activities and participation>> (ICF) dysfunction domains were as follows: Community, social and civic life, Domestic life areas, Interpersonal interactions, and Major life areas. For the first qualifier, mean row scores and percentage transformations for all activities and participation domains were: a) Learning & applying knowledge: 14.66 ± 5.40, 61.09% ± 22.5; b) General Tasks and demands: 4.78 ± 2.6, 59.75% ± 33.22; c) Communication: 8.88 ± 6.4, 44.43% ± 32.35; d) Movement: 2.63 ± 3.8, 10.99% ± 15.89; e) Self Care: 9.21 ± 8.5, 28.79% ± 26.73; f) Interpersonal Life Interactions: 20.06 ± 5.7, 71.67% ± 20.41; g) Major Life Areas: 15.15 ± 6.5, 63.15% ± 27.08; h) Community, Social & Civic Life: 17.42 ± 2.7, 87.10% ± 13.86. For the second qualifier, mean row scores and percentage transformations for all activities and participation domains were: a) Learning & applying knowledge:12.34 ± 5.8, 51.44% ± 24.33; b) General Tasks and demands: 3.91 ± 2.63, 48.90% ± 32.96; c) Communication: 7.36 ± 6.21, 36.82% ± 31.07; d) Movement: 2.24 ± 3.58, 9.34% ± 14.93; e) Self Care: 5.80 ± 7.15, 18.12% ± 22.37; f) Interpersonal Life Interactions: 16.88 ± 7.49, 52.77% ± 23.40; g) Major Life Areas: 13.5 ± 7.18, 56.25% ± 29.92; h) Community, Social & Civic Life: 14.29 ± 5.11, 71.48% ± 25.58. Conclusions In this study we identified three mayor groups of institutionalized patients, with different needs of attention. First, a group of people with severe disability, that do not require a permanent psychiatric hospitalization supervision and could benefit from treatment and increase quality of life in other kind community care facilities. A major second group (around 70% of patients) that are theoretically candidates for community rehabilitation and social reinsertion, in whom there is no scientific argument to justify their institutionalization in a psychiatric hospital. Reasons for this reality are to be explored in further social and service history implementation. A third subgroup of patients had been hospitalized many years, and for them, given the need of constant supervision is necessary and an alternative permanent assistance may be granted, but the psychiatric hospital is not the facility designated for them. Functioning and disability evaluation of persons with severe and persistent mental disorders that are institutionalized in the Mental Health Institute of Jalisco, Mexico, was useful to motivate and develop local communitarian psychiatric rehabilitation facilities and programs. Finally, we suggest that <<Activity and participation>> domains of ICF checklist are a valid and reliable tool to evaluate Mexican psychiatric patients.<hr/>Introducción En este reporte se presentan los resultados de la evaluación de funcionalidad, discapacidad y estado de salud de las personas con trastornos mentales graves y persistentes que se encuentran asiladas en el Centro de Atención Integral en Salud Mental de Estancia Prolongada (CAISAME-EP) del Instituto Jalisciense de Salud Mental (SALME), la instancia de la Secretaría de Salud del Estado de Jalisco que se encarga de la atención psiquiátrica de la entidad. El estudio se llevó a cabo para impulsar el desarrollo de políticas y programas de atención en salud mental locales que puedan elevar el estatus funcional y el bienestar vital de estos individuos. Adicionalmente se proporcionan los primeros datos de validez y confiabilidad, en población mexicana con trastornos mentales graves y persistentes, de la versión en español del apartado de <<actividades y participación>> de la lista corta de cotejo de la CIF. Método Los pacientes hospitalizados en los pabellones de la institución denominados <<de estancia permanente>> fueron evaluados con base en: 1. el apartado de <<Actividades y Participación>> de la lista corta de cotejo de la CIF (AP-LC-CIF); 2. la Escala de Evaluación de la Actividad Global (EEAG) y 3. el Perfil de Habilidades de la Vida Cotidiana (PHVC). Resultados De un total de 205 usuarios, el 64.9% eran de sexo masculino. Tenían una edad promedio de 40.28±14.39 años y se encontraban hospitalizados hacía 18.04±10.29 años. El diagnóstico más frecuente fue el retraso mental severo (29.8%), le siguió el moderado (15.6%), la esquizofrenia residual e indiferenciada (8.3%), y la esquizofrenia paranoide (7.8%). El 48.8% de la muestra presentó alguna otra enfermedad física (n=102). La mayoría de los usuarios tuvieron entre 31 y 40 de puntuación en la EEAG (n=54, 26.3%); el área de mayor deterioro en actividades de la vida cotidiana (PHVC) fue la relativa al contacto social interpersonal, seguida de la de autocuidado; y los dominios del AP-LC-CIF con mayor disfunción fueron: vida comunitaria, social y cívica; vida doméstica; interacciones y relaciones interpersonales, y áreas principales de la vida. Conclusiones Se identificaron tres grandes grupos de pacientes con enfermedades mentales graves y persistentes asilados en el Estado de Jalisco, México; con necesidades de atención diferentes entre sí. Por una parte, existe un alto porcentaje de usuarios con retraso mental pronunciado que no requiere de atención psiquiátrica continua bajo una norma hospitalaria costosa, sino cuidados en un ambiente protegido que no sea un hospital psiquiátrico. Por otro lado, prácticamente un 70% de los pacientes asilados en la institución es teóricamente susceptible de rehabilitación comunitaria y no hay razón que justifique que vivan en un hospital psiquiátrico. Sin embargo, un tercer grupo de pacientes, que constituye además un altísimo porcentaje, ha estado asilado ahí durante muchos años lo que implica sumar a las tareas para implementar un sistema de rehabilitación comunitaria, un proceso de desinstitucionalización psiquiátrica. La presente evaluación de la discapacidad y la funcionalidad de la población asilada en la institución fue de utilidad para al menos dos asuntos. En primer lugar, para demostrar la adecuación del apartado de actividades y participación la CIF para evaluar a la población psiquiátrica con trastornos mentales graves. Y en segundo lugar, para impulsar la planeación y desarrollo de instancias y programas de rehabilitación psiquiátrica comunitaria en la entidad. Idealmente, éstos deberán implementarse resolviendo las necesidades de capacitación específica del personal, así como el estigma y discriminación que asecha a estos pacientes y sus familias. <![CDATA[<b>Structural brain alterations in attention-deficit/hyperactivity disorder</b>: <b>an update. Part two</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100009&lng=en&nrm=iso&tlng=en Introduction The World Health Organization (WHO) made a major shift on the outcomes of illness, diseases, and interventions from clinical indicators to those related with levels of functioning and disability, as well as the possibility to determine areas of improvement on a case-by-case basis. Along with this theoretical approach, a new instrument was proposed to WHO members: the International Classification of Functioning, Disability and Health (ICF). The instrument is flexible, easy to apply in different clinical scenarios (it is not attached to a cluster of diseases), culturally adapted in several languages, and complementary to clinical and para-clinical information. In psychiatry, the use of the ICF may be highly valuable to establish the preserved areas of functioning as well as the most salient disabilities to formulate a proper case management, and then, to plan adequate public policies. This report includes the results of an evaluation of functioning, disability and heath dimensions, along with the psychometric properties of the ICF checklist, among people with severe and persistent mental disorders that have been institutionalized in a psychiatric hospital in the State of Jalisco, Mexico. Method Subjects: Inmates of a 50 year old psychiatric facility, dependent from the Mental Health Institute of Jalisco (SALME), within the frame of the Ministry of Health of the State of Jalisco in Mexico. This facility is divided in acute wards, were patients are hospitalized in acute phases of severe and persistent mental disorders, and <<permanent>> wards which have existed since the origins of the hospital and became a place where people were abandoned and finally stayed institutionalized under the State's support and supervision. The later population was included in this evaluation. Measures: A psychiatrist (AM), previously trained on the administration of the ICF, supervised the evaluation of: 1) the <<Activities and Participation>> domains of the Short list of ICF proposed by WHO (AP-ICF); 2) The American Psychiatric Association's Global Assessment of Functionality Scale (GAF); and 3) The Life Skills Profile(LKP). Results A total sample of 205 subjects was included; they were 64.9% males, with a mean age of 40.28±14.39 years old. The mean hospitalization time was 18.04±10.29 years. Psychiatric diagnosis distribution was: severe mental retardation (MR) (29.8%); moderate MR (15.6%), residual or undifferentiated schizophrenia (8.3%), and paranoid schizophrenia (7.8%). A concurrent physical illness was identified in 48.8% (n=112) of the subjects. Salient health problems were: epilepsy (n=47, 22.9%), chronic obstructive pulmonary disease (n=6, 2.9%), diabetes (n=5, 2.4%), and systemic arterial hypertension (n= 4, 2%). AP-ICF validity and reliability: Correlations between AP-ICF domains and GAF were all moderate (between -.51 to -.71), negative and statistically significant. Cronbach's alphas were as follows: a) Learning and applying knowledge: .85 for the first qualifier, and .89 for the second; b) General tasks and demands: .90 and .92; c) Communication: .93 for both qualifiers; d) Movement: .78 for the first qualifier, and .89 for second qualifier; e) Self Care: .94 and .96; f) Domestic Life Areas: .91 and .95; g) Interpersonal Interactions: .79 and .91; h) Major Life Areas: .59 and .70; i) Community, Social and Civic Life: .75 and .72. Functionality and disability among institutionalized patients: In the Global Assessment of Functioning measure, subjects distribution belonging to punctuations ranges were: 31-40 points(n=54, 26.3%); 11-20 points (22.9%,n=47); 21-30 points (21%,n=43); 41-50 points (14.6%,n=30); 51-60 points (11.2%, n=23); 61-70 points (2.9%, n=6), and 1% felled in the <<more than 71 points>> range. On the Life Skills Profile (LSP), means and standard deviations were as follows: a) Self Care: row score= 19.85 ± 3.42, percentage transformation= 49.64% ± 8.56; b) Social Communication: row score= 16.70±3.42, percentage transformation= 41.76% ± 9.39; c) Communication with contact: row score= 14.00 ± 2.60, percentage transformation= 58.35% ± 10.85; d) Communication without contact: row score= 9.39 ± 2.47, percentage transformation= 39.12% ± 10.30; e) Autonomy Life: row score= 11.87 ±1.89, percentage transformation= 42.40% ± 6.76. Major <<activities and participation>> (ICF) dysfunction domains were as follows: Community, social and civic life, Domestic life areas, Interpersonal interactions, and Major life areas. For the first qualifier, mean row scores and percentage transformations for all activities and participation domains were: a) Learning & applying knowledge: 14.66 ± 5.40, 61.09% ± 22.5; b) General Tasks and demands: 4.78 ± 2.6, 59.75% ± 33.22; c) Communication: 8.88 ± 6.4, 44.43% ± 32.35; d) Movement: 2.63 ± 3.8, 10.99% ± 15.89; e) Self Care: 9.21 ± 8.5, 28.79% ± 26.73; f) Interpersonal Life Interactions: 20.06 ± 5.7, 71.67% ± 20.41; g) Major Life Areas: 15.15 ± 6.5, 63.15% ± 27.08; h) Community, Social & Civic Life: 17.42 ± 2.7, 87.10% ± 13.86. For the second qualifier, mean row scores and percentage transformations for all activities and participation domains were: a) Learning & applying knowledge:12.34 ± 5.8, 51.44% ± 24.33; b) General Tasks and demands: 3.91 ± 2.63, 48.90% ± 32.96; c) Communication: 7.36 ± 6.21, 36.82% ± 31.07; d) Movement: 2.24 ± 3.58, 9.34% ± 14.93; e) Self Care: 5.80 ± 7.15, 18.12% ± 22.37; f) Interpersonal Life Interactions: 16.88 ± 7.49, 52.77% ± 23.40; g) Major Life Areas: 13.5 ± 7.18, 56.25% ± 29.92; h) Community, Social & Civic Life: 14.29 ± 5.11, 71.48% ± 25.58. Conclusions In this study we identified three mayor groups of institutionalized patients, with different needs of attention. First, a group of people with severe disability, that do not require a permanent psychiatric hospitalization supervision and could benefit from treatment and increase quality of life in other kind community care facilities. A major second group (around 70% of patients) that are theoretically candidates for community rehabilitation and social reinsertion, in whom there is no scientific argument to justify their institutionalization in a psychiatric hospital. Reasons for this reality are to be explored in further social and service history implementation. A third subgroup of patients had been hospitalized many years, and for them, given the need of constant supervision is necessary and an alternative permanent assistance may be granted, but the psychiatric hospital is not the facility designated for them. Functioning and disability evaluation of persons with severe and persistent mental disorders that are institutionalized in the Mental Health Institute of Jalisco, Mexico, was useful to motivate and develop local communitarian psychiatric rehabilitation facilities and programs. Finally, we suggest that <<Activity and participation>> domains of ICF checklist are a valid and reliable tool to evaluate Mexican psychiatric patients.<hr/>Introducción En este reporte se presentan los resultados de la evaluación de funcionalidad, discapacidad y estado de salud de las personas con trastornos mentales graves y persistentes que se encuentran asiladas en el Centro de Atención Integral en Salud Mental de Estancia Prolongada (CAISAME-EP) del Instituto Jalisciense de Salud Mental (SALME), la instancia de la Secretaría de Salud del Estado de Jalisco que se encarga de la atención psiquiátrica de la entidad. El estudio se llevó a cabo para impulsar el desarrollo de políticas y programas de atención en salud mental locales que puedan elevar el estatus funcional y el bienestar vital de estos individuos. Adicionalmente se proporcionan los primeros datos de validez y confiabilidad, en población mexicana con trastornos mentales graves y persistentes, de la versión en español del apartado de <<actividades y participación>> de la lista corta de cotejo de la CIF. Método Los pacientes hospitalizados en los pabellones de la institución denominados <<de estancia permanente>> fueron evaluados con base en: 1. el apartado de <<Actividades y Participación>> de la lista corta de cotejo de la CIF (AP-LC-CIF); 2. la Escala de Evaluación de la Actividad Global (EEAG) y 3. el Perfil de Habilidades de la Vida Cotidiana (PHVC). Resultados De un total de 205 usuarios, el 64.9% eran de sexo masculino. Tenían una edad promedio de 40.28±14.39 años y se encontraban hospitalizados hacía 18.04±10.29 años. El diagnóstico más frecuente fue el retraso mental severo (29.8%), le siguió el moderado (15.6%), la esquizofrenia residual e indiferenciada (8.3%), y la esquizofrenia paranoide (7.8%). El 48.8% de la muestra presentó alguna otra enfermedad física (n=102). La mayoría de los usuarios tuvieron entre 31 y 40 de puntuación en la EEAG (n=54, 26.3%); el área de mayor deterioro en actividades de la vida cotidiana (PHVC) fue la relativa al contacto social interpersonal, seguida de la de autocuidado; y los dominios del AP-LC-CIF con mayor disfunción fueron: vida comunitaria, social y cívica; vida doméstica; interacciones y relaciones interpersonales, y áreas principales de la vida. Conclusiones Se identificaron tres grandes grupos de pacientes con enfermedades mentales graves y persistentes asilados en el Estado de Jalisco, México; con necesidades de atención diferentes entre sí. Por una parte, existe un alto porcentaje de usuarios con retraso mental pronunciado que no requiere de atención psiquiátrica continua bajo una norma hospitalaria costosa, sino cuidados en un ambiente protegido que no sea un hospital psiquiátrico. Por otro lado, prácticamente un 70% de los pacientes asilados en la institución es teóricamente susceptible de rehabilitación comunitaria y no hay razón que justifique que vivan en un hospital psiquiátrico. Sin embargo, un tercer grupo de pacientes, que constituye además un altísimo porcentaje, ha estado asilado ahí durante muchos años lo que implica sumar a las tareas para implementar un sistema de rehabilitación comunitaria, un proceso de desinstitucionalización psiquiátrica. La presente evaluación de la discapacidad y la funcionalidad de la población asilada en la institución fue de utilidad para al menos dos asuntos. En primer lugar, para demostrar la adecuación del apartado de actividades y participación la CIF para evaluar a la población psiquiátrica con trastornos mentales graves. Y en segundo lugar, para impulsar la planeación y desarrollo de instancias y programas de rehabilitación psiquiátrica comunitaria en la entidad. Idealmente, éstos deberán implementarse resolviendo las necesidades de capacitación específica del personal, así como el estigma y discriminación que asecha a estos pacientes y sus familias. <![CDATA[<b>Memory systems: historical background, classification, and current concepts. Part one: History, taxonomy of memory, long-term memory systems: Semantic memory</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100010&lng=en&nrm=iso&tlng=en Memory is a fascinating brain function by means of which the nervous system can codify, store, organize, and recover a variety of information relevant to the subject. The formal study of memory started more than a century ago, providing in this time a considerable amount of scientific information on memory functioning. The actual knowledge of memory allow us to consider it far from being unique, isolated or static function, but more as a complex net of memory systems working in parallel for a common goal. Historic evolution of memory concepts and their classifications have progressed simultaneously to our knowledge on these systems. The first empiric approaches to memory description were found in ancient Greece by authors like Plato and Aristoteles, and were based on philosophy, thinking, and introspection and logic methods. However, the first real scientific approaches appeared in the XIX century, by authors such as Ebbinghaus and Lashley, who initiated the experimental study of memory in humans and animals, respectively. The contribution of the intellectual group known as <<behaviorist>> in the beginning of XX century, was also relevant during this period, and was represented by scientists like Pavlov, Watson, Skinner, and Thorndike, who detailed a variant of learning recognized in our days as associative learning. In turn, this variant can be divided into classic conditioning (associates a stimulus with a response) and instrumental or operant conditioning (associates a stimulus with a specific behavior). Behaviorists claimed that only on observational basis of behavior is possible to know processes linked to learning. However, these authors clearly made a mistake when they stated that knowledge on processes occurring in the brain will always be far of the understanding of the investigator. Later on, one of the hardest evidences for the study of memory processes came from clinic studies of patients with focal cerebral lesions. Penfield, Scoville, and Milner, during the 60's, documented the effects of surgical lesions of temporal lobe on declarative memory, finding selective alterations, such as severe anterograde amnesia and retrograde amnesia with temporal gradient. These findings were accompanied also by a description of memory subsystems remaining intact, despite of those temporal lobe lesions (procedural memory, long-term memory, etc.). Based on these findings, medial temporal lobe was described as a key structure for the acquisition of declarative information. In parallel to clinic studies, a first attempt to coordinate psycho-psychiatric research with the knowledge and scientific protocol of biology occurred in the 60's, thus allowing the emergence of disciplines known as cognitive neuroscience and cognitive psychology or psychophysiology, both created in an effort to explore the cellular and molecular mechanisms responsible for the storage of memory information. The list of significant findings provided by these two scientific disciplines is extensive, but among the most important are probably those derived from the study of the most elementary memory processes (i.e. habituation and sensitization) in invertebrate animal models, such as Aplysia spp. These researches established the basis for the basic cellular requirements for elementary learning, as well as the molecular basis for short-and long-term memory. The conjugation of these clinical descriptions together with experimental evidence led to the postulation of the first classifications of memory systems during the 80's. One of these classifications divided memory processes in two categories: declarative memory - the one containing information consciously acquired and easy to verbalize or transmit to other persons (this type of memory is also divided in semantic and episodic memories)-, and non-declarative -including that information not easy to verbalize or which acquisition is unconscious (this type of memory implies heterogeneous information in which the role of consciousness is complex and remains in discussion, and includes procedural memory, priming, classic, and operant conditioning, as well as the most elementary forms of learning, such as habituation and sensitization). To conceptualize these memory systems in an isolated form is a mistake since is results clear enough that all of them work together most of the time, and they work independently only very seldom, some other times cooperating, or even functioning in a competitive manner. Experimental studies have shown that the role of memory systems is different each time, even when two subjects perform exactly the same learning task, thus suggesting that codification, motivation and initial handling of information may determine whether this is processed as procedural, spatial or semantic information. The recent description of competitive relationships among the different memory systems (declarative vs. procedural) resulted to be an outstanding finding, although at the present there is hard clinical and experimental evidence indicating that a decrease of functions in procedural, spatial or declarative systems may induce the activation of another memory system. Initial studies in this field suggest that transient inactivation of striatal dorsal structures (implicated in performance of motor skills) or those from the hippocampus (implicated in the performance of spatial skills) facilitate learning in that system remaining active after pharmacological challenge. The real meaning of this competition among systems still remains unclear, although it has been proposed that both systems have evolved separately in response to distinct needs, which in turn might explain why eventually these systems can compete for the handling of information. Unfortunately, several studies have demonstrated that relationships among memory systems are complicated and poorly understood until now. Semantic memory Semantic memory mainly refers to information stored on characteristics defining concepts (facts lacking a well-defined spatial/ temporal frame), as well as processes allowing its efficient recovery for further utilization in language and thought. Knowledge about the anatomic location of semantic representations has gained attention with the use of new functional neuroimaging techniques. These studies have shown that the information about the features of specific objects needed to create concepts is stored in the same neuronal systems that remain active during the perception of different stimuli. The way in which this conceptual information is organized remains unclear so far, but there is evidence suggesting that its organization proceeds on the basis of grouped categories of concepts. Pathological studies in patients suffering semantic dementia have also demonstrated that some areas, such as temporal pole and perirhinal cortex, are relevant for semantic processing.<hr/>La memoria es una función cerebral fascinante, mediante ella el Sistema Nervioso codifica, almacena, organiza y recupera una gran variedad de tipos de información que resultan de vital importancia para el individuo en particular. Los conocimientos actuales nos permiten conceptualizar a la memoria como conformada por una red compleja de subsistemas de memoria que pueden trabajar en paralelo, cooperando e incluso en ocasiones funcionar de forma competitiva entre sí. La evolución de la clasificación de los sistemas de memoria se ha desarrollado en paralelo al conocimiento acerca del funcionamiento del los procesos mnésicos. Las primeras aproximaciones al estudio de la memoria estaban conformadas por métodos filosóficos que comprendían la observación, reflexión, lógica, etc. En el siglo XIX surgieron los primeros estudios científicos para el estudio experimental de la memoria. Autores como Ebbinghaus o Lashley estudiaron por primera vez la memoria humana y animal respectivamente. Los conductistas como Pavlov, Skinner, Thorndike y Watson sentaron las bases del aprendizaje asociativo que conocemos como condicionamiento clásico y condicionamiento operante. Más tarde los estudios neuropsicológicos de pacientes con lesiones quirúrgicas focales temporales arrojaron resultados contundentes acerca del sustrato anatómico de la memoria declarativa en el lóbulo temporal, lo que inició una avalancha de estudios y descripciones neuropsicológicas cada vez más finas sobre las consecuencias de las lesiones y patologías cerebrales en los distintos procesos de memoria. Más recientemente, los estudios de los procesos celulares y moleculares de las formas de aprendizaje más elementales (habituación y sensibilización) en modelos de animales invertebrados han demostrado los requerimientos celulares mínimos para el establecimiento del aprendizaje así como los mecanismos moleculares diferenciales involucrados en la memoria de corto y largo plazo. A últimas fechas, la introducción de los estudios de neuroimagen funcional en pacientes enfermos y sanos ha permitido la expansión de los conocimientos sobre el funcionamiento dinámico y en tiempo real de los diversos procesos de memoria. En la actualidad la clasificación más aceptada de los sistemas de memoria de largo plazo considera dos grandes esferas principales: la memoria declarativa y la no declarativa. La memoria declarativa se refiere a la que contiene información de la cual se tiene un registro consciente y que se puede verbalizar o transmitir fácilmente a través de algún medio a otro individuo. La memoria no declarativa comprende información que no se puede verbalizar fácilmente o cuyo aprendizaje puede ser inconsciente e incluso involuntario. La memoria declarativa se subdivide en memoria semántica y episódica. El ámbito de la memoria semántica es la información almacenada acerca de las características y atributos que definen los conceptos (hechos que carecen de un marco espacio temporal definido), así como los procesos que permiten su recuperación de forma eficiente para su utilización en el pensamiento y el lenguaje actual. Los estudios de imagen funcional han demostrado que la información sobre las características de objetos específicos que es necesaria para la generación de conceptos es almacenada dentro de los mismos sistemas neuronales que están activos durante la percepción de esos mismos estímulos. El rol del lóbulo temporal en esta variedad de memoria está comprobado por estudios experimentales y clínicos, pero los estudios de imagen funcional han demostrado otras áreas asociadas a la codificación y recuperación semántica cuyo papel aún no ha sido comprendido por completo. <![CDATA[<b>Premio Nacional de Investigación de la Fundación GlaxoSmithKline</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100011&lng=en&nrm=iso&tlng=en Memory is a fascinating brain function by means of which the nervous system can codify, store, organize, and recover a variety of information relevant to the subject. The formal study of memory started more than a century ago, providing in this time a considerable amount of scientific information on memory functioning. The actual knowledge of memory allow us to consider it far from being unique, isolated or static function, but more as a complex net of memory systems working in parallel for a common goal. Historic evolution of memory concepts and their classifications have progressed simultaneously to our knowledge on these systems. The first empiric approaches to memory description were found in ancient Greece by authors like Plato and Aristoteles, and were based on philosophy, thinking, and introspection and logic methods. However, the first real scientific approaches appeared in the XIX century, by authors such as Ebbinghaus and Lashley, who initiated the experimental study of memory in humans and animals, respectively. The contribution of the intellectual group known as <<behaviorist>> in the beginning of XX century, was also relevant during this period, and was represented by scientists like Pavlov, Watson, Skinner, and Thorndike, who detailed a variant of learning recognized in our days as associative learning. In turn, this variant can be divided into classic conditioning (associates a stimulus with a response) and instrumental or operant conditioning (associates a stimulus with a specific behavior). Behaviorists claimed that only on observational basis of behavior is possible to know processes linked to learning. However, these authors clearly made a mistake when they stated that knowledge on processes occurring in the brain will always be far of the understanding of the investigator. Later on, one of the hardest evidences for the study of memory processes came from clinic studies of patients with focal cerebral lesions. Penfield, Scoville, and Milner, during the 60's, documented the effects of surgical lesions of temporal lobe on declarative memory, finding selective alterations, such as severe anterograde amnesia and retrograde amnesia with temporal gradient. These findings were accompanied also by a description of memory subsystems remaining intact, despite of those temporal lobe lesions (procedural memory, long-term memory, etc.). Based on these findings, medial temporal lobe was described as a key structure for the acquisition of declarative information. In parallel to clinic studies, a first attempt to coordinate psycho-psychiatric research with the knowledge and scientific protocol of biology occurred in the 60's, thus allowing the emergence of disciplines known as cognitive neuroscience and cognitive psychology or psychophysiology, both created in an effort to explore the cellular and molecular mechanisms responsible for the storage of memory information. The list of significant findings provided by these two scientific disciplines is extensive, but among the most important are probably those derived from the study of the most elementary memory processes (i.e. habituation and sensitization) in invertebrate animal models, such as Aplysia spp. These researches established the basis for the basic cellular requirements for elementary learning, as well as the molecular basis for short-and long-term memory. The conjugation of these clinical descriptions together with experimental evidence led to the postulation of the first classifications of memory systems during the 80's. One of these classifications divided memory processes in two categories: declarative memory - the one containing information consciously acquired and easy to verbalize or transmit to other persons (this type of memory is also divided in semantic and episodic memories)-, and non-declarative -including that information not easy to verbalize or which acquisition is unconscious (this type of memory implies heterogeneous information in which the role of consciousness is complex and remains in discussion, and includes procedural memory, priming, classic, and operant conditioning, as well as the most elementary forms of learning, such as habituation and sensitization). To conceptualize these memory systems in an isolated form is a mistake since is results clear enough that all of them work together most of the time, and they work independently only very seldom, some other times cooperating, or even functioning in a competitive manner. Experimental studies have shown that the role of memory systems is different each time, even when two subjects perform exactly the same learning task, thus suggesting that codification, motivation and initial handling of information may determine whether this is processed as procedural, spatial or semantic information. The recent description of competitive relationships among the different memory systems (declarative vs. procedural) resulted to be an outstanding finding, although at the present there is hard clinical and experimental evidence indicating that a decrease of functions in procedural, spatial or declarative systems may induce the activation of another memory system. Initial studies in this field suggest that transient inactivation of striatal dorsal structures (implicated in performance of motor skills) or those from the hippocampus (implicated in the performance of spatial skills) facilitate learning in that system remaining active after pharmacological challenge. The real meaning of this competition among systems still remains unclear, although it has been proposed that both systems have evolved separately in response to distinct needs, which in turn might explain why eventually these systems can compete for the handling of information. Unfortunately, several studies have demonstrated that relationships among memory systems are complicated and poorly understood until now. Semantic memory Semantic memory mainly refers to information stored on characteristics defining concepts (facts lacking a well-defined spatial/ temporal frame), as well as processes allowing its efficient recovery for further utilization in language and thought. Knowledge about the anatomic location of semantic representations has gained attention with the use of new functional neuroimaging techniques. These studies have shown that the information about the features of specific objects needed to create concepts is stored in the same neuronal systems that remain active during the perception of different stimuli. The way in which this conceptual information is organized remains unclear so far, but there is evidence suggesting that its organization proceeds on the basis of grouped categories of concepts. Pathological studies in patients suffering semantic dementia have also demonstrated that some areas, such as temporal pole and perirhinal cortex, are relevant for semantic processing.<hr/>La memoria es una función cerebral fascinante, mediante ella el Sistema Nervioso codifica, almacena, organiza y recupera una gran variedad de tipos de información que resultan de vital importancia para el individuo en particular. Los conocimientos actuales nos permiten conceptualizar a la memoria como conformada por una red compleja de subsistemas de memoria que pueden trabajar en paralelo, cooperando e incluso en ocasiones funcionar de forma competitiva entre sí. La evolución de la clasificación de los sistemas de memoria se ha desarrollado en paralelo al conocimiento acerca del funcionamiento del los procesos mnésicos. Las primeras aproximaciones al estudio de la memoria estaban conformadas por métodos filosóficos que comprendían la observación, reflexión, lógica, etc. En el siglo XIX surgieron los primeros estudios científicos para el estudio experimental de la memoria. Autores como Ebbinghaus o Lashley estudiaron por primera vez la memoria humana y animal respectivamente. Los conductistas como Pavlov, Skinner, Thorndike y Watson sentaron las bases del aprendizaje asociativo que conocemos como condicionamiento clásico y condicionamiento operante. Más tarde los estudios neuropsicológicos de pacientes con lesiones quirúrgicas focales temporales arrojaron resultados contundentes acerca del sustrato anatómico de la memoria declarativa en el lóbulo temporal, lo que inició una avalancha de estudios y descripciones neuropsicológicas cada vez más finas sobre las consecuencias de las lesiones y patologías cerebrales en los distintos procesos de memoria. Más recientemente, los estudios de los procesos celulares y moleculares de las formas de aprendizaje más elementales (habituación y sensibilización) en modelos de animales invertebrados han demostrado los requerimientos celulares mínimos para el establecimiento del aprendizaje así como los mecanismos moleculares diferenciales involucrados en la memoria de corto y largo plazo. A últimas fechas, la introducción de los estudios de neuroimagen funcional en pacientes enfermos y sanos ha permitido la expansión de los conocimientos sobre el funcionamiento dinámico y en tiempo real de los diversos procesos de memoria. En la actualidad la clasificación más aceptada de los sistemas de memoria de largo plazo considera dos grandes esferas principales: la memoria declarativa y la no declarativa. La memoria declarativa se refiere a la que contiene información de la cual se tiene un registro consciente y que se puede verbalizar o transmitir fácilmente a través de algún medio a otro individuo. La memoria no declarativa comprende información que no se puede verbalizar fácilmente o cuyo aprendizaje puede ser inconsciente e incluso involuntario. La memoria declarativa se subdivide en memoria semántica y episódica. El ámbito de la memoria semántica es la información almacenada acerca de las características y atributos que definen los conceptos (hechos que carecen de un marco espacio temporal definido), así como los procesos que permiten su recuperación de forma eficiente para su utilización en el pensamiento y el lenguaje actual. Los estudios de imagen funcional han demostrado que la información sobre las características de objetos específicos que es necesaria para la generación de conceptos es almacenada dentro de los mismos sistemas neuronales que están activos durante la percepción de esos mismos estímulos. El rol del lóbulo temporal en esta variedad de memoria está comprobado por estudios experimentales y clínicos, pero los estudios de imagen funcional han demostrado otras áreas asociadas a la codificación y recuperación semántica cuyo papel aún no ha sido comprendido por completo. <![CDATA[<b>El espíritu. Ensayo sobre la unidad paradójica de los flujos energéticos de la dinámica psíquica</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100012&lng=en&nrm=iso&tlng=en Memory is a fascinating brain function by means of which the nervous system can codify, store, organize, and recover a variety of information relevant to the subject. The formal study of memory started more than a century ago, providing in this time a considerable amount of scientific information on memory functioning. The actual knowledge of memory allow us to consider it far from being unique, isolated or static function, but more as a complex net of memory systems working in parallel for a common goal. Historic evolution of memory concepts and their classifications have progressed simultaneously to our knowledge on these systems. The first empiric approaches to memory description were found in ancient Greece by authors like Plato and Aristoteles, and were based on philosophy, thinking, and introspection and logic methods. However, the first real scientific approaches appeared in the XIX century, by authors such as Ebbinghaus and Lashley, who initiated the experimental study of memory in humans and animals, respectively. The contribution of the intellectual group known as <<behaviorist>> in the beginning of XX century, was also relevant during this period, and was represented by scientists like Pavlov, Watson, Skinner, and Thorndike, who detailed a variant of learning recognized in our days as associative learning. In turn, this variant can be divided into classic conditioning (associates a stimulus with a response) and instrumental or operant conditioning (associates a stimulus with a specific behavior). Behaviorists claimed that only on observational basis of behavior is possible to know processes linked to learning. However, these authors clearly made a mistake when they stated that knowledge on processes occurring in the brain will always be far of the understanding of the investigator. Later on, one of the hardest evidences for the study of memory processes came from clinic studies of patients with focal cerebral lesions. Penfield, Scoville, and Milner, during the 60's, documented the effects of surgical lesions of temporal lobe on declarative memory, finding selective alterations, such as severe anterograde amnesia and retrograde amnesia with temporal gradient. These findings were accompanied also by a description of memory subsystems remaining intact, despite of those temporal lobe lesions (procedural memory, long-term memory, etc.). Based on these findings, medial temporal lobe was described as a key structure for the acquisition of declarative information. In parallel to clinic studies, a first attempt to coordinate psycho-psychiatric research with the knowledge and scientific protocol of biology occurred in the 60's, thus allowing the emergence of disciplines known as cognitive neuroscience and cognitive psychology or psychophysiology, both created in an effort to explore the cellular and molecular mechanisms responsible for the storage of memory information. The list of significant findings provided by these two scientific disciplines is extensive, but among the most important are probably those derived from the study of the most elementary memory processes (i.e. habituation and sensitization) in invertebrate animal models, such as Aplysia spp. These researches established the basis for the basic cellular requirements for elementary learning, as well as the molecular basis for short-and long-term memory. The conjugation of these clinical descriptions together with experimental evidence led to the postulation of the first classifications of memory systems during the 80's. One of these classifications divided memory processes in two categories: declarative memory - the one containing information consciously acquired and easy to verbalize or transmit to other persons (this type of memory is also divided in semantic and episodic memories)-, and non-declarative -including that information not easy to verbalize or which acquisition is unconscious (this type of memory implies heterogeneous information in which the role of consciousness is complex and remains in discussion, and includes procedural memory, priming, classic, and operant conditioning, as well as the most elementary forms of learning, such as habituation and sensitization). To conceptualize these memory systems in an isolated form is a mistake since is results clear enough that all of them work together most of the time, and they work independently only very seldom, some other times cooperating, or even functioning in a competitive manner. Experimental studies have shown that the role of memory systems is different each time, even when two subjects perform exactly the same learning task, thus suggesting that codification, motivation and initial handling of information may determine whether this is processed as procedural, spatial or semantic information. The recent description of competitive relationships among the different memory systems (declarative vs. procedural) resulted to be an outstanding finding, although at the present there is hard clinical and experimental evidence indicating that a decrease of functions in procedural, spatial or declarative systems may induce the activation of another memory system. Initial studies in this field suggest that transient inactivation of striatal dorsal structures (implicated in performance of motor skills) or those from the hippocampus (implicated in the performance of spatial skills) facilitate learning in that system remaining active after pharmacological challenge. The real meaning of this competition among systems still remains unclear, although it has been proposed that both systems have evolved separately in response to distinct needs, which in turn might explain why eventually these systems can compete for the handling of information. Unfortunately, several studies have demonstrated that relationships among memory systems are complicated and poorly understood until now. Semantic memory Semantic memory mainly refers to information stored on characteristics defining concepts (facts lacking a well-defined spatial/ temporal frame), as well as processes allowing its efficient recovery for further utilization in language and thought. Knowledge about the anatomic location of semantic representations has gained attention with the use of new functional neuroimaging techniques. These studies have shown that the information about the features of specific objects needed to create concepts is stored in the same neuronal systems that remain active during the perception of different stimuli. The way in which this conceptual information is organized remains unclear so far, but there is evidence suggesting that its organization proceeds on the basis of grouped categories of concepts. Pathological studies in patients suffering semantic dementia have also demonstrated that some areas, such as temporal pole and perirhinal cortex, are relevant for semantic processing.<hr/>La memoria es una función cerebral fascinante, mediante ella el Sistema Nervioso codifica, almacena, organiza y recupera una gran variedad de tipos de información que resultan de vital importancia para el individuo en particular. Los conocimientos actuales nos permiten conceptualizar a la memoria como conformada por una red compleja de subsistemas de memoria que pueden trabajar en paralelo, cooperando e incluso en ocasiones funcionar de forma competitiva entre sí. La evolución de la clasificación de los sistemas de memoria se ha desarrollado en paralelo al conocimiento acerca del funcionamiento del los procesos mnésicos. Las primeras aproximaciones al estudio de la memoria estaban conformadas por métodos filosóficos que comprendían la observación, reflexión, lógica, etc. En el siglo XIX surgieron los primeros estudios científicos para el estudio experimental de la memoria. Autores como Ebbinghaus o Lashley estudiaron por primera vez la memoria humana y animal respectivamente. Los conductistas como Pavlov, Skinner, Thorndike y Watson sentaron las bases del aprendizaje asociativo que conocemos como condicionamiento clásico y condicionamiento operante. Más tarde los estudios neuropsicológicos de pacientes con lesiones quirúrgicas focales temporales arrojaron resultados contundentes acerca del sustrato anatómico de la memoria declarativa en el lóbulo temporal, lo que inició una avalancha de estudios y descripciones neuropsicológicas cada vez más finas sobre las consecuencias de las lesiones y patologías cerebrales en los distintos procesos de memoria. Más recientemente, los estudios de los procesos celulares y moleculares de las formas de aprendizaje más elementales (habituación y sensibilización) en modelos de animales invertebrados han demostrado los requerimientos celulares mínimos para el establecimiento del aprendizaje así como los mecanismos moleculares diferenciales involucrados en la memoria de corto y largo plazo. A últimas fechas, la introducción de los estudios de neuroimagen funcional en pacientes enfermos y sanos ha permitido la expansión de los conocimientos sobre el funcionamiento dinámico y en tiempo real de los diversos procesos de memoria. En la actualidad la clasificación más aceptada de los sistemas de memoria de largo plazo considera dos grandes esferas principales: la memoria declarativa y la no declarativa. La memoria declarativa se refiere a la que contiene información de la cual se tiene un registro consciente y que se puede verbalizar o transmitir fácilmente a través de algún medio a otro individuo. La memoria no declarativa comprende información que no se puede verbalizar fácilmente o cuyo aprendizaje puede ser inconsciente e incluso involuntario. La memoria declarativa se subdivide en memoria semántica y episódica. El ámbito de la memoria semántica es la información almacenada acerca de las características y atributos que definen los conceptos (hechos que carecen de un marco espacio temporal definido), así como los procesos que permiten su recuperación de forma eficiente para su utilización en el pensamiento y el lenguaje actual. Los estudios de imagen funcional han demostrado que la información sobre las características de objetos específicos que es necesaria para la generación de conceptos es almacenada dentro de los mismos sistemas neuronales que están activos durante la percepción de esos mismos estímulos. El rol del lóbulo temporal en esta variedad de memoria está comprobado por estudios experimentales y clínicos, pero los estudios de imagen funcional han demostrado otras áreas asociadas a la codificación y recuperación semántica cuyo papel aún no ha sido comprendido por completo. <![CDATA[<b>La vulnerabilidad de los grupos migrantes en México</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100013&lng=en&nrm=iso&tlng=en Memory is a fascinating brain function by means of which the nervous system can codify, store, organize, and recover a variety of information relevant to the subject. The formal study of memory started more than a century ago, providing in this time a considerable amount of scientific information on memory functioning. The actual knowledge of memory allow us to consider it far from being unique, isolated or static function, but more as a complex net of memory systems working in parallel for a common goal. Historic evolution of memory concepts and their classifications have progressed simultaneously to our knowledge on these systems. The first empiric approaches to memory description were found in ancient Greece by authors like Plato and Aristoteles, and were based on philosophy, thinking, and introspection and logic methods. However, the first real scientific approaches appeared in the XIX century, by authors such as Ebbinghaus and Lashley, who initiated the experimental study of memory in humans and animals, respectively. The contribution of the intellectual group known as <<behaviorist>> in the beginning of XX century, was also relevant during this period, and was represented by scientists like Pavlov, Watson, Skinner, and Thorndike, who detailed a variant of learning recognized in our days as associative learning. In turn, this variant can be divided into classic conditioning (associates a stimulus with a response) and instrumental or operant conditioning (associates a stimulus with a specific behavior). Behaviorists claimed that only on observational basis of behavior is possible to know processes linked to learning. However, these authors clearly made a mistake when they stated that knowledge on processes occurring in the brain will always be far of the understanding of the investigator. Later on, one of the hardest evidences for the study of memory processes came from clinic studies of patients with focal cerebral lesions. Penfield, Scoville, and Milner, during the 60's, documented the effects of surgical lesions of temporal lobe on declarative memory, finding selective alterations, such as severe anterograde amnesia and retrograde amnesia with temporal gradient. These findings were accompanied also by a description of memory subsystems remaining intact, despite of those temporal lobe lesions (procedural memory, long-term memory, etc.). Based on these findings, medial temporal lobe was described as a key structure for the acquisition of declarative information. In parallel to clinic studies, a first attempt to coordinate psycho-psychiatric research with the knowledge and scientific protocol of biology occurred in the 60's, thus allowing the emergence of disciplines known as cognitive neuroscience and cognitive psychology or psychophysiology, both created in an effort to explore the cellular and molecular mechanisms responsible for the storage of memory information. The list of significant findings provided by these two scientific disciplines is extensive, but among the most important are probably those derived from the study of the most elementary memory processes (i.e. habituation and sensitization) in invertebrate animal models, such as Aplysia spp. These researches established the basis for the basic cellular requirements for elementary learning, as well as the molecular basis for short-and long-term memory. The conjugation of these clinical descriptions together with experimental evidence led to the postulation of the first classifications of memory systems during the 80's. One of these classifications divided memory processes in two categories: declarative memory - the one containing information consciously acquired and easy to verbalize or transmit to other persons (this type of memory is also divided in semantic and episodic memories)-, and non-declarative -including that information not easy to verbalize or which acquisition is unconscious (this type of memory implies heterogeneous information in which the role of consciousness is complex and remains in discussion, and includes procedural memory, priming, classic, and operant conditioning, as well as the most elementary forms of learning, such as habituation and sensitization). To conceptualize these memory systems in an isolated form is a mistake since is results clear enough that all of them work together most of the time, and they work independently only very seldom, some other times cooperating, or even functioning in a competitive manner. Experimental studies have shown that the role of memory systems is different each time, even when two subjects perform exactly the same learning task, thus suggesting that codification, motivation and initial handling of information may determine whether this is processed as procedural, spatial or semantic information. The recent description of competitive relationships among the different memory systems (declarative vs. procedural) resulted to be an outstanding finding, although at the present there is hard clinical and experimental evidence indicating that a decrease of functions in procedural, spatial or declarative systems may induce the activation of another memory system. Initial studies in this field suggest that transient inactivation of striatal dorsal structures (implicated in performance of motor skills) or those from the hippocampus (implicated in the performance of spatial skills) facilitate learning in that system remaining active after pharmacological challenge. The real meaning of this competition among systems still remains unclear, although it has been proposed that both systems have evolved separately in response to distinct needs, which in turn might explain why eventually these systems can compete for the handling of information. Unfortunately, several studies have demonstrated that relationships among memory systems are complicated and poorly understood until now. Semantic memory Semantic memory mainly refers to information stored on characteristics defining concepts (facts lacking a well-defined spatial/ temporal frame), as well as processes allowing its efficient recovery for further utilization in language and thought. Knowledge about the anatomic location of semantic representations has gained attention with the use of new functional neuroimaging techniques. These studies have shown that the information about the features of specific objects needed to create concepts is stored in the same neuronal systems that remain active during the perception of different stimuli. The way in which this conceptual information is organized remains unclear so far, but there is evidence suggesting that its organization proceeds on the basis of grouped categories of concepts. Pathological studies in patients suffering semantic dementia have also demonstrated that some areas, such as temporal pole and perirhinal cortex, are relevant for semantic processing.<hr/>La memoria es una función cerebral fascinante, mediante ella el Sistema Nervioso codifica, almacena, organiza y recupera una gran variedad de tipos de información que resultan de vital importancia para el individuo en particular. Los conocimientos actuales nos permiten conceptualizar a la memoria como conformada por una red compleja de subsistemas de memoria que pueden trabajar en paralelo, cooperando e incluso en ocasiones funcionar de forma competitiva entre sí. La evolución de la clasificación de los sistemas de memoria se ha desarrollado en paralelo al conocimiento acerca del funcionamiento del los procesos mnésicos. Las primeras aproximaciones al estudio de la memoria estaban conformadas por métodos filosóficos que comprendían la observación, reflexión, lógica, etc. En el siglo XIX surgieron los primeros estudios científicos para el estudio experimental de la memoria. Autores como Ebbinghaus o Lashley estudiaron por primera vez la memoria humana y animal respectivamente. Los conductistas como Pavlov, Skinner, Thorndike y Watson sentaron las bases del aprendizaje asociativo que conocemos como condicionamiento clásico y condicionamiento operante. Más tarde los estudios neuropsicológicos de pacientes con lesiones quirúrgicas focales temporales arrojaron resultados contundentes acerca del sustrato anatómico de la memoria declarativa en el lóbulo temporal, lo que inició una avalancha de estudios y descripciones neuropsicológicas cada vez más finas sobre las consecuencias de las lesiones y patologías cerebrales en los distintos procesos de memoria. Más recientemente, los estudios de los procesos celulares y moleculares de las formas de aprendizaje más elementales (habituación y sensibilización) en modelos de animales invertebrados han demostrado los requerimientos celulares mínimos para el establecimiento del aprendizaje así como los mecanismos moleculares diferenciales involucrados en la memoria de corto y largo plazo. A últimas fechas, la introducción de los estudios de neuroimagen funcional en pacientes enfermos y sanos ha permitido la expansión de los conocimientos sobre el funcionamiento dinámico y en tiempo real de los diversos procesos de memoria. En la actualidad la clasificación más aceptada de los sistemas de memoria de largo plazo considera dos grandes esferas principales: la memoria declarativa y la no declarativa. La memoria declarativa se refiere a la que contiene información de la cual se tiene un registro consciente y que se puede verbalizar o transmitir fácilmente a través de algún medio a otro individuo. La memoria no declarativa comprende información que no se puede verbalizar fácilmente o cuyo aprendizaje puede ser inconsciente e incluso involuntario. La memoria declarativa se subdivide en memoria semántica y episódica. El ámbito de la memoria semántica es la información almacenada acerca de las características y atributos que definen los conceptos (hechos que carecen de un marco espacio temporal definido), así como los procesos que permiten su recuperación de forma eficiente para su utilización en el pensamiento y el lenguaje actual. Los estudios de imagen funcional han demostrado que la información sobre las características de objetos específicos que es necesaria para la generación de conceptos es almacenada dentro de los mismos sistemas neuronales que están activos durante la percepción de esos mismos estímulos. El rol del lóbulo temporal en esta variedad de memoria está comprobado por estudios experimentales y clínicos, pero los estudios de imagen funcional han demostrado otras áreas asociadas a la codificación y recuperación semántica cuyo papel aún no ha sido comprendido por completo. <![CDATA[<b>Autoevaluación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000100014&lng=en&nrm=iso&tlng=en Memory is a fascinating brain function by means of which the nervous system can codify, store, organize, and recover a variety of information relevant to the subject. The formal study of memory started more than a century ago, providing in this time a considerable amount of scientific information on memory functioning. The actual knowledge of memory allow us to consider it far from being unique, isolated or static function, but more as a complex net of memory systems working in parallel for a common goal. Historic evolution of memory concepts and their classifications have progressed simultaneously to our knowledge on these systems. The first empiric approaches to memory description were found in ancient Greece by authors like Plato and Aristoteles, and were based on philosophy, thinking, and introspection and logic methods. However, the first real scientific approaches appeared in the XIX century, by authors such as Ebbinghaus and Lashley, who initiated the experimental study of memory in humans and animals, respectively. The contribution of the intellectual group known as <<behaviorist>> in the beginning of XX century, was also relevant during this period, and was represented by scientists like Pavlov, Watson, Skinner, and Thorndike, who detailed a variant of learning recognized in our days as associative learning. In turn, this variant can be divided into classic conditioning (associates a stimulus with a response) and instrumental or operant conditioning (associates a stimulus with a specific behavior). Behaviorists claimed that only on observational basis of behavior is possible to know processes linked to learning. However, these authors clearly made a mistake when they stated that knowledge on processes occurring in the brain will always be far of the understanding of the investigator. Later on, one of the hardest evidences for the study of memory processes came from clinic studies of patients with focal cerebral lesions. Penfield, Scoville, and Milner, during the 60's, documented the effects of surgical lesions of temporal lobe on declarative memory, finding selective alterations, such as severe anterograde amnesia and retrograde amnesia with temporal gradient. These findings were accompanied also by a description of memory subsystems remaining intact, despite of those temporal lobe lesions (procedural memory, long-term memory, etc.). Based on these findings, medial temporal lobe was described as a key structure for the acquisition of declarative information. In parallel to clinic studies, a first attempt to coordinate psycho-psychiatric research with the knowledge and scientific protocol of biology occurred in the 60's, thus allowing the emergence of disciplines known as cognitive neuroscience and cognitive psychology or psychophysiology, both created in an effort to explore the cellular and molecular mechanisms responsible for the storage of memory information. The list of significant findings provided by these two scientific disciplines is extensive, but among the most important are probably those derived from the study of the most elementary memory processes (i.e. habituation and sensitization) in invertebrate animal models, such as Aplysia spp. These researches established the basis for the basic cellular requirements for elementary learning, as well as the molecular basis for short-and long-term memory. The conjugation of these clinical descriptions together with experimental evidence led to the postulation of the first classifications of memory systems during the 80's. One of these classifications divided memory processes in two categories: declarative memory - the one containing information consciously acquired and easy to verbalize or transmit to other persons (this type of memory is also divided in semantic and episodic memories)-, and non-declarative -including that information not easy to verbalize or which acquisition is unconscious (this type of memory implies heterogeneous information in which the role of consciousness is complex and remains in discussion, and includes procedural memory, priming, classic, and operant conditioning, as well as the most elementary forms of learning, such as habituation and sensitization). To conceptualize these memory systems in an isolated form is a mistake since is results clear enough that all of them work together most of the time, and they work independently only very seldom, some other times cooperating, or even functioning in a competitive manner. Experimental studies have shown that the role of memory systems is different each time, even when two subjects perform exactly the same learning task, thus suggesting that codification, motivation and initial handling of information may determine whether this is processed as procedural, spatial or semantic information. The recent description of competitive relationships among the different memory systems (declarative vs. procedural) resulted to be an outstanding finding, although at the present there is hard clinical and experimental evidence indicating that a decrease of functions in procedural, spatial or declarative systems may induce the activation of another memory system. Initial studies in this field suggest that transient inactivation of striatal dorsal structures (implicated in performance of motor skills) or those from the hippocampus (implicated in the performance of spatial skills) facilitate learning in that system remaining active after pharmacological challenge. The real meaning of this competition among systems still remains unclear, although it has been proposed that both systems have evolved separately in response to distinct needs, which in turn might explain why eventually these systems can compete for the handling of information. Unfortunately, several studies have demonstrated that relationships among memory systems are complicated and poorly understood until now. Semantic memory Semantic memory mainly refers to information stored on characteristics defining concepts (facts lacking a well-defined spatial/ temporal frame), as well as processes allowing its efficient recovery for further utilization in language and thought. Knowledge about the anatomic location of semantic representations has gained attention with the use of new functional neuroimaging techniques. These studies have shown that the information about the features of specific objects needed to create concepts is stored in the same neuronal systems that remain active during the perception of different stimuli. The way in which this conceptual information is organized remains unclear so far, but there is evidence suggesting that its organization proceeds on the basis of grouped categories of concepts. Pathological studies in patients suffering semantic dementia have also demonstrated that some areas, such as temporal pole and perirhinal cortex, are relevant for semantic processing.<hr/>La memoria es una función cerebral fascinante, mediante ella el Sistema Nervioso codifica, almacena, organiza y recupera una gran variedad de tipos de información que resultan de vital importancia para el individuo en particular. Los conocimientos actuales nos permiten conceptualizar a la memoria como conformada por una red compleja de subsistemas de memoria que pueden trabajar en paralelo, cooperando e incluso en ocasiones funcionar de forma competitiva entre sí. La evolución de la clasificación de los sistemas de memoria se ha desarrollado en paralelo al conocimiento acerca del funcionamiento del los procesos mnésicos. Las primeras aproximaciones al estudio de la memoria estaban conformadas por métodos filosóficos que comprendían la observación, reflexión, lógica, etc. En el siglo XIX surgieron los primeros estudios científicos para el estudio experimental de la memoria. Autores como Ebbinghaus o Lashley estudiaron por primera vez la memoria humana y animal respectivamente. Los conductistas como Pavlov, Skinner, Thorndike y Watson sentaron las bases del aprendizaje asociativo que conocemos como condicionamiento clásico y condicionamiento operante. Más tarde los estudios neuropsicológicos de pacientes con lesiones quirúrgicas focales temporales arrojaron resultados contundentes acerca del sustrato anatómico de la memoria declarativa en el lóbulo temporal, lo que inició una avalancha de estudios y descripciones neuropsicológicas cada vez más finas sobre las consecuencias de las lesiones y patologías cerebrales en los distintos procesos de memoria. Más recientemente, los estudios de los procesos celulares y moleculares de las formas de aprendizaje más elementales (habituación y sensibilización) en modelos de animales invertebrados han demostrado los requerimientos celulares mínimos para el establecimiento del aprendizaje así como los mecanismos moleculares diferenciales involucrados en la memoria de corto y largo plazo. A últimas fechas, la introducción de los estudios de neuroimagen funcional en pacientes enfermos y sanos ha permitido la expansión de los conocimientos sobre el funcionamiento dinámico y en tiempo real de los diversos procesos de memoria. En la actualidad la clasificación más aceptada de los sistemas de memoria de largo plazo considera dos grandes esferas principales: la memoria declarativa y la no declarativa. La memoria declarativa se refiere a la que contiene información de la cual se tiene un registro consciente y que se puede verbalizar o transmitir fácilmente a través de algún medio a otro individuo. La memoria no declarativa comprende información que no se puede verbalizar fácilmente o cuyo aprendizaje puede ser inconsciente e incluso involuntario. La memoria declarativa se subdivide en memoria semántica y episódica. El ámbito de la memoria semántica es la información almacenada acerca de las características y atributos que definen los conceptos (hechos que carecen de un marco espacio temporal definido), así como los procesos que permiten su recuperación de forma eficiente para su utilización en el pensamiento y el lenguaje actual. Los estudios de imagen funcional han demostrado que la información sobre las características de objetos específicos que es necesaria para la generación de conceptos es almacenada dentro de los mismos sistemas neuronales que están activos durante la percepción de esos mismos estímulos. El rol del lóbulo temporal en esta variedad de memoria está comprobado por estudios experimentales y clínicos, pero los estudios de imagen funcional han demostrado otras áreas asociadas a la codificación y recuperación semántica cuyo papel aún no ha sido comprendido por completo.