Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520100002&lang=pt vol. 33 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>Unique psychosis nowadays</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>María Cristina García-Sancho y Álvarez-Tostado</b>: <b>first female neurosurgeon in Latin America</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200002&lng=pt&nrm=iso&tlng=pt Neurosurgery is one of the most complex branches of medicine. In most countries, a trained physician requires a minimum of five years of additional preparation to become a neurosurgeon. Though in modern times women have entered almost every area of medicine, the field of neurosurgery continues to be clearly male-dominated. In 2009, for example, the National Institute of Neurology and Neurosurgery, the most important institution in Mexico for the training of neurologists and neurosurgeons, had only one female physician registered to become a neurosurgeon, while in previous years the presence of women was almost null. Given this background, a study of the first woman neurosurgeon in Mexico and, in fact, all of Latin America, constitutes an attractive topic. This woman is María Cristina García-Sancho y Álvarez-Tostado, who began her brilliant career in the 1940's. García-Sancho y Álvarez-Tostado has a most dignified and pleasant demeanor, with expressive blue eyes and an appearance that belies her real age. Tall and thin, she possesses a natural beauty. Photographs show a very attractive woman. María Cristina García-Sancho y Álvarez-Tostado de Penichet (her married name) was born on May 22nd 1919 in Guadalajara, Jalisco. Her parents were Luis García-Sancho and Ana Álvarez-Tostado Robledo. While still a young girl, her family had to move to Mexico City in search of a better future because of the difficult economic situation that reined in Guadalajara after the Mexican Revolution. The young María Cristina studied high school at the Colegio Motolinía and was then admitted to the School of Medicine at the UNAM (National Autonomous University of Mexico), where she belonged to the 1941-1947 generation of students, one made up of 85 women and 850 men. A brilliant student, her interest in neurology began almost from her first day at medical school. It was there that she began to really appreciate the wondrous nature of the human body in general and, above all, of the brain, and came to see the understanding of that organ as a true challenge. She graduated in 1947 with a thesis entitled The Effects of Cephalic-Cranial Trauma (La secuela del traumatismo encéfalo cráneano). Her thesis adviser was Mariano Vázquez, and her brilliant defense won a honorable mention. She went on to study her Master's and Ph.D. degrees in neurosurgery from 1949 to 1951, under the direction of Alfonso Asenjo Gómez, a prestigious, internationally known neurosurgeon at the Institute of Neurosurgery and Cerebral Research in Santiago de Chile (Instituto de Neurocirugía e Investigaciones Cerebrales). At that time, this institute was an obligatory reference in everything related to neuroscience, especially clinical medicine and surgery. This Chilean physician was a magnificent teacher and their academic relationship developed later into a solid friendship that lasted until his death. During her training, García-Sancho took courses on neurology, neuropathology, neuro-otology, neuro-ofthalmology, and neuroradiology. At the conclusion of her studies, she had acquired the knowledge and experience needed to perform neurosurgery. Once again, the Chilean government offered a fellowship for her to continue her studies, this time in Europe. So, she spent three months in Germany with Wilhelm Tönnis and Joachim Zülch, and visited several neurosurgery clinics, including the Hôtel-Dieu in Paris with Jacques Le Beau and Jean Tavernier, and Madrid's Institute of Neurosurgery with Sixto Obrador Alcalde. In Portugal, she visited the clinic of Egas Moniz, the inventor of angiography, at the Department of Neurology from the Coimbra University. In all, she was in Europe for over a year. After that period overseas, she returned to Mexico, where she first joined the staff of the La Raza Hospital for a few months. However, she was soon named to the position of Head of Neurosurgery Services at the National Institute of Oncology, where she attended from 1952 more than 63 000 patients and performed operations for pain control such as peripheral blocks, rhizotomies, cordotomies, topectomies and medial, radiotherapeutic and physical treatments. The maturing and consolidation of the Neurosurgery Service under her guidance soon led to publications, congresses, teaching, and the supervision of aspiring neurosurgeons, including such important figures as Mario Echegaray Naveda, Manuel Mandujano, Estela Mandujano, José Carlos Palacios Márquez, María Teresa Ramírez Ugalde, Ramón Cerón Uribe, C. Freigó, Manuel Montoya, Miguel Ángel Hernández Absalón, José Gutiérrez Cabrera, Amelia Cabrera, and Alfonso Peña Torres, the latter four at the Institute of Neurosurgery in Santiago. The experience she acquired in several surgical techniques designed to relieve pain and, more fundamentally, her interest in this topic, led García-Sancho to improve the cordotomy procedure while working in the United States with Irving Cooper, a distinguished neurosurgeon whose main interest was functional neurosurgery. Cordotomy is a procedure used in cases of intolerable pain that resist all other kinds of treatment. It involves sectioning the anterolateral cord of the medulla. Perfecting this technique was just one of García-Sancho's achievements and contributions to Mexican neurosurgery. In fact, the technique is known as «the García-Sancho One-step Bilateral Cordotomy», and she used it in more than 1600 cases at the National Institute of Oncology and at the Women's Hospital in cases of cancer. Earlier, the cordotomy was a two-step procedure, but the variant that García-Sancho introduced consisted in cutting the sensitive roots of the medulla in just one intervention: after identifying the anterior roots, a cut is made on the posterior part in the posteroanterior direction in the space between the exit of the posterior root and the emergence of the anterior root in the medulla. García-Sancho's studies of pain and her extensive experience in that field led her to write the book Pain: Diagnosis and Treatment (Dolor, diagnóstico y tratamiento; 1974), which she dedicated to her husband and daughter, and in which she explains such topics as the anatomical channels of pain, its origin, and pain in oncologic processes. In addition to this book, she has published articles in national and international journals, some of them in Neurocirugía, a journal founded by Asenjo. Though García-Sancho is known mainly for her contributions to the understanding and surgical treatment of pain, she is also well-versed and skilled in the use of arteriography, a technique she learned in Portugal at the service of its discoverer, Moniz. García-Sancho also successfully combined her professional career with family life. In April 1954, she married Manuel Penichet, an industrialist, and they had a daughter, María Cristina Penichet García-Sancho, now a practicing psychotherapist. Today, García-Sancho, a widow since 1999, also enjoys the love and achievements of her granddaughter, a lawyer, and grandson, a business administrator. Also worth mentioning is that she studied a second career: Law at the Women's University of Mexico, where she graduated in 1989 with a thesis entitled Current Laws on the Problem of Insemination and in Vitro Fertilization (Las leyes actuales frente al problema de la inseminación y fertilización in vitro). She is also a member -in some cases a founder- of several national and international scientific societies. García-Sancho was not only Mexico's first female neurosurgeon, but also the first in Latin America. She stood out in an especially complex branch of medicine, one dominated by men. Moreover, she perfected a technique that renowned neurologists like Martín, Spiller, Froeser, Asenjo and Le Beau had been performing since 1912. Though her gender made it difficult for her to aspire to certain positions, her other professional activities gave her the intellectual satisfaction and maturity that are so evident in her demeanor.<hr/>La neurocirugía es una de las subdisciplinas más complejas de la medicina y pocas mujeres han incursionado en ella. Así pues, resulta muy atrayente estudiar a la primera neurocirujana mexicana y también de Latinoamérica, cuya labor brilló a partir de los años cuarenta del siglo XX. María Cristina García-Sancho y Álvarez-Tostado de Penichet, nació el 22 de mayo de 1919 en Guadalajara, Jalisco. Sus padres fueron los señores Luis García-Sancho y Ana Álvarez-Tostado Robledo. Por motivos económicos su familia emigró a la Ciudad de México en busca de un futuro mejor. María Cristina realizó los estudios preparatorios en el Colegio Motolinía y posteriormente ingresó a la Facultad de Medicina de la UNAM. Pertenece a la generación 1941-1947, que estaba formada por 85 mujeres y 850 hombres. Brillante estudiante, su interés por la neurología se inició desde su ingreso a la Escuela de Medicina. Entonces percibió lo maravilloso que es el cuerpo humano, pero sobre todo el cerebro, cuyo conocimiento consideraba un reto. En 1947 obtuvo el título con la tesis «La secuela del traumatismo encéfalo cráneano», dirigida por el doctor Mariano Vázquez y por cuya destacada defensa ganó mención honorífica. La doctora García-Sancho realizó la maestría y el doctorado en neurocirugía de 1949 a 1951, bajo la dirección del doctor Alfonso Asenjo Gómez, prestigioso neurocirujano de fama internacional, en el Instituto de Neurocirugía e Investigaciones Cerebrales en Santiago de Chile. En esa época, el Instituto era referencia obligada en lo relativo a las neurociencias, sobre todo en la clínica y la cirugía. El Gobierno de Chile la volvió a becar para continuar su preparación en Europa. En Alemania permanece durante tres meses con los doctores Wilhelm Tönnis y Joachim Zülch. En el Hôtel-Dieu de París estudió con Jacques le Beau y Jean Tavernier; en España con Sixto Obrador Alcalde, en el Instituto de Neurocirugía en Madrid, y en Portugal, en el servicio de Egas Moniz, donde aprendió la técnica de la arteriografía. En total permaneció un año más en Europa. A su regreso a México se incorporó por unos meses al Hospital «La Raza», del Instituto Mexicano del Seguro Social, y posteriormente ingresó como jefa del Servicio de Neurocirugía, en el Instituto Nacional de Cancerología, donde desde 1952 atendió más de 63 000 consultas y realizó múltiples y variadas operaciones para controlar el dolor. Su interés en el tema la llevó a mejorar la cordotomía en Estados Unidos, con Irving Cooper, distinguido neurocirujano. La cordotomía es la sección o corte del cordón anterolateral de la médula en casos de dolor intolerable y resistente a cualquier tratamiento. Su aportación a la neurocirugía mexicana es el perfeccionamiento que hizo a esta maniobra, la que se conoce como «Cordotomía bilateral en un solo tiempo, técnica García-Sancho». La autora empleó esta técnica en más de 1600 casos de cáncer en el Instituto Nacional de Cancerología y en el Hospital de la Mujer. El estudio y el dominio que tiene sobre el dolor dieron pie a que escribiera: «Dolor, diagnóstico y tratamiento» (1974). En abril de 1954 se casó con el industrial Manuel Penichet y tuvieron una hija, María Cristina Penichet García-Sancho, quien ejerce como psicoterapeuta. Es digno de enfatizar que estudió una segunda carrera, la de Derecho, en la Universidad Femenina de México, titulándose en 1989 con la tesis: «Las leyes actuales frente al problema de la inseminación y fertilización in vitro». La doctora María Cristina García-Sancho no sólo fue la primera neurocirujana en México, sino también en Latinoamérica. Sobresalió en una rama de la medicina particularmente compleja, de predominio masculino, y además perfeccionó una técnica que brillantes neurocirujanos practicaban desde 1912. La doctora es de trato muy fino y agradable, de expresivos ojos azules, representa una edad menor de la que realmente tiene. Alta y delgada, guarda una belleza natural. Las fotografías muestran una mujer sumamente atractiva. Su condición de género le dificultó acceder a ciertas posiciones, pero en otras actividades de su ejercicio profesional encontró la satisfacción intelectual y la madurez que son evidentes en su trato. <![CDATA[<b>Melatonin induces enkephalins synthesis and release in the rat brain</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200003&lng=pt&nrm=iso&tlng=pt Since enkephalins discovery in 1975, several opioid peptides have been included in neuroscience research. Enkephalins have been involved in the homeostasis maintenance of the organism, mostly with cellular and molecular mechanisms implicated in antinociception and narcotic responses. Moreover, enkephalins have been shown to be involved in the control of stress, regulation of cardiovascular functions, modulating primary immune responses, in addition to cellular differentiation processes. As opioid peptides appear to modulate several bioactivities and physiological responses in organisms, this posits that several modifications should occur during their synthesis, cell release, and receptor binding in target cells. At present, it has been demonstrated that the endogenous opioid system (EOS), displays a circadian rhythm, in which its tissue content, presynaptic release, and receptor's number reaches its maximal concentration during the dark phase (24:00h) and the minimal during the early morning (05:00 h). Recently, our group reported that functional pinealectomy disrupts the enkephalin circadian rhythm and significantly reduces the tissue content of opioid peptides in the rat brain. However, the effect was shown to be specific to the hour along the 24h daytime. There were no significant changes during the light period, only during the dark period (01:00h), when the enkephalin tissue content decreased in the experimental group. The effect was reverted when pinealectomized rats were injected with single doses of melatonin (MEL) (150µg/kg i.p.). If the lack of melatonin in the rat brain significantly reduced the enkephalin tissue content, and its exogenous administration re-established the enkephalin tissue levels, it is possible that the hormone is involved in the enkephalin synthesis. In this paper we provide further evidence that supports the relation between melatonin and opioid peptides synthesis and release. In addition, we studied the effect of darkness and melatonin administration in enkephalin tissue levels. Finally, we analyzed the luzindole effect as a melatonin receptor antagonist in the pinealectomized rat brain. Material and methods Subjects: Male Wistar rats were housed in a light and temperature controlled room. Water and pellet food were available ad libitum. This group was subdivided in: 1. Functional pinealectomy group (FP). Rats were housed individually during 15 days in a room with continuous light (<50lux). 2. FP rats were housed in a dark room during four or six hours. 3. FP rats were injected with melatonin (150, 300, 600µg/kg s.c.). 4. FP rats were injected with Luzindole (187.5, 375, 750µg/kg i.p.). After 30 min, the animals were injected with melatonin (150µg/kg). 5. FP rats were injected with melatonin (800µg/ kg) and subjected to the in vitro release processes. The rats were sacrificed by decapitation and the blood collected for melatonin serum determination. The brains were removed and processed for an analytical preparative procedure for the enkephalin determination by radioimmunoassay technique. The in vitro release methodology was performed as follows: tissue samples were homogenized by applying 8 strokes with a Thomas grinder system. The homogenates were centrifuged at 4,000rpm, 4°C during 10 min. Supernatants were recovered and centrifuged at 12,000rpm at 4°C for 20 min. Supernatants were discarded and pellets were resuspended in the homogeneization buffer (1:9 w/v). Samples were placed on top of a Percoll gradient density (23%, 15%, and 10%) and centrifuged at 20,000 rpm at 4°C for 25min. The synaptosomal enriched fraction (15-23%) was obtained and diluted in 1mL of Krebs buffer (mM: NaCl 119, KCl 4.6, CaCl2·2H2O 1.25, KH2PO4 0.85 MgSO4 0.84, NaHCO3 24.8, sucrose 10). Buffer was gasified with a mixture of C0(2) 95% and O2 5%, pH 7.4. 800µL aliquots were placed into plastic chambers. After 20 min of stabilization with Krebs buffer, three different superfusates were collected: 1. basal, 2. potassium [50mM], and 3. post-stimulus (Krebs buffer without potassium). Samples were collected into HCl 0.1N, boiled and subsequently loaded into Amberlite XAD-2 columns (8 × 0.7cm) for solid-phase peptide extraction. The flow rate was held constant at 0.5 mL min-1 and elution of the whole peptide fraction was carried out using a continuous gradient with absolute methanol. Eluted samples were lyophilized and resuspended in 2mL of distilled water and finally stored at -20°C for further quantification of IR-Enkephalin using standard radioimmunoassay procedures. The results showed that functional pinealectomy reduced the opioid tissue content in the different brain structures assayed. The lack of melatonin significantly decreased the enkephalin tissue content when compared to the control group. However, tissue levels of enkephalin material were completely restored after four and six hours of administration of different doses of exogenous melatonin administration to the rats. As continuous light decreases the melatonin content in the brain, darkness should be able to counteract the aforementioned effect. Our results showed that tissue levels of enkephalin material were increased over 200% and 300%, after exposing animals to a four or six-hour period of darkness, when compared to animals exposed to continuous light. Luzindole was used to abolish any melatonin activity via activation of its membrane brain receptors. Our experiments showed that different doses of the antagonist were not able to obliterate the increased content of opioid peptides induced with melatonin administration in the tested brain tissues.<hr/>En la actualidad se reconoce que el Sistema Endógeno Opioide (SEO) participa en la regulación y control de la homeostasis; por lo tanto se requiere que los procesos bioquímicos que dan lugar a su síntesis, liberación y unión a receptores se encuentren reguladas de manera endocrina. Diversas líneas de investigación han demostrado que la concentración y liberación presináptica de las encefalinas no permanece constante durante un ciclo de 24 horas. Por el contrario, su síntesis y liberación alcanzan su máxima concentración durante la fase de oscuridad y la mínima durante las primeras horas de la mañana. Recientemente, nuestro grupo de trabajo ha demostrado que la ausencia de melatonina (MEL), por efecto de la pinealectomía funcional, rompe el ritmo circádico y reduce significativamente la concentración de las encefalinas durante la fase de oscuridad. Si la ausencia de la hormona abate la concentración de opioides, es factible que la MEL se encuentre involucrada en la síntesis de las encefalinas. En el presente trabajo se muestran los resultados del efecto de la pinealectomía funcional sobre la concentración tisular y la liberación de los opioides, así como el efecto de la administración exógena de MEL y de su antagonista el luzindol (LZ). Diseño experimental Control Naive. Se utilizaron ratas macho de la cepa Wistar (200-250g), que permanecieron en un cuarto con un ciclo de luz y oscuridad controlada. La fase de luz duró 12 horas y comenzó a las 06:00h. A su vez, este grupo fue subdividido en: 1. Luz Continua (LC): Para abatir la concentración sérica de la hormona, se usó el modelo experimental conocido como pinealectomía funcional. 2. Luz Continua + Oscuridad: La luz abate la concentración de MEL y la exposición a la oscuridad revierte dicho efecto. Un grupo de ratas sometido a la luz continua se colocó en un cuarto con oscuridad durante cuatro y seis horas. 3. Luz continua+melatonina: Para analizar el efecto de la MEL sobre el contenido tisular de opioides, se administró una dosis de MEL (150, 300 y 600µg/Kg s.c.). 4. Luz continua+luzindol (LZ)+MEL: Si la melatonina ejerce su mecanismo de acción al unirse a sus receptores presentes en la membrana plasmática, entonces su efecto podría ser revertido por la presencia del LZ. Por lo tanto, a tres grupos de ratas sometidas a la pinealectomía funcional se les inyectó con LZ a una dosis de 187.5, 375, 750 µg/kg. s.c. Después de transcurridos 30min., los animales fueron inyectados con MEL (150µg/kg. s.c.). 5. Liberación: Se utilizaron tres grupos de ratas: a) control, b) luz continua y c) luz continua+MEL (800µg/kg. s.c.). Post mortem la amígdala fue sometida al proceso preparativo para la obtención de los sinaptosomas. Resultados Los resultados obtenidos en el presente trabajo nos muestran que la pinealectomía funcional reduce significativamente la concentración de encefalinas en todas las estructuras cerebrales analizadas. Sin embargo, el efecto es revertido tanto por la administración exógena de MEL, como por la exposición a la oscuridad. Las diferentes dosis administradas del LZ bloquearon parcialmente el efecto estimulante de la MEL sobre la síntesis de los opioides. Por último, la pinealectomía funcional redujo significativamente la liberación presináptica de encefalinas, misma que se pudo reestablecer con la administración exógena de la hormona. Discusión Las evidencias experimentales del presente trabajo sugieren que la MEL se encuentra relacionada con la síntesis y la liberación de las encefalinas. Por un lado, la pinealectomía funcional redujo significativamente el contenido tisular de encefalinas, pero el efecto fue revertido tanto con la administración exógena de la hormona como con la exposición a la oscuridad. La administración del LZ sólo fue capaz de bloquear parcialmente el efecto estimulante de la MEL sobre la síntesis de encefalinas. El efecto de la MEL sobre la liberación de opioides pone de manifiesto la relación funcional entre ambos sistemas. A menor cantidad de opioides por efecto de la pinealectomía, menor liberación presináptica y por el contrario, una vez administrada la hormona los valores de la síntesis-liberación se restablecen. Conclusión La MEL puede estar involucrada en la síntesis y la liberación de los péptidos opioides. <![CDATA[<b>Analysis of the Iberoamerican publications on drug dependency in the clinical psychology and psychiatry journals idexed in the <i>Journal Citation Reports</i></b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200004&lng=pt&nrm=iso&tlng=pt Introduction Drug consumption has become a social problem requiring political, social, and educational intervention in its prevention and treatment. In Latin America, the drug problem is highly related to the violence and the social exclusion of the metropolis. Forty percent of the 15-year-olds already smoke. On average, each person in the general population consumes approximately 6 kg of alcohol per year: the highest value in the less developed world. Meanwhile, in Spain, over a million people experience significant difficulties related to drug consumption (not including the effects of tobacco) in relation to health, family, labor, and social issues. In 2006, one out of 10 young people between the ages 14 and 18 consumed alcohol in an abusive manner more than four or five days per month. Drug consumption is a very complex, multi-factor issue with multiple economic, social, cultural, and personal implications. The most visible negative effects are observed in health issues and personal relationships. In the public scope, the most negative effects are related to important direct and indirect economic expenses, including the treatment and prevention of drug dependency, the reduction in labor productivity, the increase in charity, the fight against the delinquency, and the trafficking of drugs. The present study examines whether or not there is a correspondence between the social, public health, and political importance of drug dependency and the basic and applied research in Spanish and Latin American scientific literature. There are two objectives for this investigation: first, to quantify the scientific investigation of drug dependency in the last four years in Latin American clinical psychology and psychiatry journals, included in the Journal Citation Reports (JCR). The second objective is to state the differences between the journals in relation to the applied methodology, the type of sample used, and the principal topic of discourse. Method The units of analysis were articles published by journals selected between the years 2005 and 2008. The following journals were included: Revista Internacional de Psicología Clínica y de la Salud / International Journal of Clinical and Health Psychology, Salud Mental, Revista Argentina de Clínica Psicológica, Revista Latinoamericana de Psicopatología Fundamental, Actas Españolas de Psiquiatría, Arquivos de Neuro-Psiquiatria, Revista Brasileira de Psiquiatria, and Revista de Psiquiatria Clinica. All articles of theoretical or empirical character whose title indicated the topic of drug dependency were included in this descriptive study of document analysis. The articles were analyzed and compared on the basis of five variables: the number and proportion of articles on drug dependency and substance abuse in relation to the total number of articles published by each journal during the given time period; the type of methodology; the type of sample; the type of drug studied; and the central findings. Results Out of 2246 articles published between the years 2005 and 2008 by the eight journals analyzed, 152 were about drug dependency. This value represents 6.77% of the total of the documents published. Of these 152 articles, 133 came from psychiatry journals and 19 came from clinical psychology journals. These findings imply that, out of the total of the articles published, 5.92% correspond to articles on drug dependency in the psychiatry journals and 0.85% in the clinical psychology journals. Among the clinical psychology journals, it is observed that the International Journal of Clinical and Health Psychology has published the most articles on drug dependency, with 8%. With regards to the psychiatry journals, the most articles related to drug dependency were found in the Revista de Psiquiatría Clínica, with 21.65%. The methodology most used in the total 152 articles was ex post facto (34.21%), followed by theoretical studies (30.26%), and surveys with probabilistic samples (12.50%). In turn, in the field of psychiatry and in clinical psychology, the methodology used most was ex post facto studies. The type of sample used most in all of the articles was formed by people who consumed some kind of drug (including alcohol and tobacco) (32.24%), followed by studies without samples (such as theoretical revisions) (26.32%). Generally, alcohol was the drug most studied (33.08%), followed by tobacco (15.04%), and cocaine (9.02%). It is necessary to emphasize that 38.16% of these studies did not concentrate on a single type of substance/drug; on the contrary, they analyzed general drug dependency. The central topics of these articles related drug dependency to treatment, comorbid psychopathology, epidemiology, associated beliefs and attitudes, neurological risks of drug consumption, delinquency, gender differences, and psychological variables of personality.<hr/>Introducción El consumo y la dependencia de drogas se ha convertido en un problema social que requiere la intervención de agentes políticos, sociales y educativos en su prevención y tratamiento. En el presente estudio se pretende conocer si existe correspondencia entre la importancia social, sanitaria y política de las drogodependencias y la investigación básica y aplicada en los ámbitos español y latinoamericano. Los objetivos específicos de esta investigación son dos: examinar la producción científica sobre drogodependencias de los últimos cuatro años en revistas de psicología clínica y psiquiatría iberoamericanas, incluidas en el Journal Citation Reports (JCR) y, una vez examinada la producción científica, constatar las diferencias entre las diferentes revistas en relación con el tipo de metodología utilizada, el tipo de muestra y las principales temáticas desarrolladas. Método Las unidades de análisis fueron los artículos publicados por las revistas seleccionadas durante el periodo de 2005 a 2008. Se incluyeron en el análisis las siguientes revistas: Revista Internacional de Psicología Clínica y de la Salud/International Journal of Clinical and Health Psychology, Salud Mental, Revista Argentina de Clínica Psicológica, Revista Latinoamericana de Psicopatología Fundamental, Actas Españolas de Psiquiatría, Arquivos de Neuro-Psiquiatria, Revista Brasileira de Psiquiatria y Revista de Psiquiatria Clinica. En este estudio descriptivo mediante análisis de documentos se procedió a buscar y extraer todos aquellos artículos de carácter teórico o empírico cuyo título indicara el abordaje de las drogodependencias y cuyo resumen confirmara dicho contenido. Se analizaron y compararon los artículos seleccionados con base en cinco variables: número y proporción de artículos sobre drogodependencias y abuso de sustancias en relación con el total de artículos publicados por cada revista durante el periodo 2005-2008; el tipo de metodología empleada en el estudio; el tipo de muestra utilizada en cada estudio; tipo de droga estudiada y, por último, los aspectos centrales encontrados. Resultados De los 2246 artículos publicados entre los años 2005-2008 por las ocho revistas analizadas, 152 son sobre drogodependencias. Esto representa 6.77% del total de los documentos publicados. De estos 152 artículos, 133 proceden de las cuatro revistas de psiquiatría y 19, de las cuatro revistas de psicología clínica. Del total de artículos publicados, 0.85% corresponden a artículos sobre drogodependencias en el área de psicología clínica y 5.92%, en psiquiatría. Entre las revistas de psicología clínica se observa que International Journal of Clinical and Health Psychology es la que más ha publicado, con 8% de artículos sobre drogodependencias, mientras que entre las revistas de psiquiatría destaca en primer lugar la Revista de Psiquiatria Clinica, con 21.65%. El tipo de metodología más empleada en los 151 artículos analizados es la ex post facto (34.21%), aunque haya también muchos estudios teóricos (30.26%), sobre todo en psiquiatría (31.58%). La muestra más estudiada está formada por personas consumidoras de algún tipo de droga (incluidas el alcohol y el tabaco) (32.24%), seguida de estudios sin muestra (al tratarse de revisiones teóricas) (26.32%) y trabajos relacionados con adolescentes (13.82%). Por otro lado, el tipo de droga más estudiada es el alcohol (33.55%), seguida del tabaco (14.47%) y la cocaína (7.89%) y los principales temas analizados en estos artículos relacionan las drogodependencias con el tratamiento (18.42%), la psicopatología comórbida (11.84%) y la epidemiología (9.87%). Discusión A partir de los resultados obtenidos, se puede comprobar la existencia de una desconexión entre la investigación científica iberoamericana en psiquiatría y psicología clínica y la relevancia de las drogadicciones en el contexto socio-sanitario actual, debido al bajo número de artículos publicados sobre drogodependencias en estas revistas. Así, la investigación básica y aplicada en psiquiatría y psicología clínica no estaría respondiendo a las necesidades sociales, sanitarias y educativas de la población con respecto a las drogodependencias. En conclusión, en el presente estudio bibliométrico puede observarse que la producción científica relativa a drogodependencias en las revistas españolas y latinoamericanas de psiquiatría y psicología clínica es relativamente escasa si se tienen en cuenta sus repercusiones sociales, sanitarias y políticas. <![CDATA[<b><<It just never ends>>. Explanatory models of depression and emotional distress among adolescents in </b><b>Barcelona</b><b> (</b><b>Spain</b><b>). Part one</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200005&lng=pt&nrm=iso&tlng=pt Introduction In recent years, adolescent mental health has become a health policy priority in the majority of OCDE and European countries. According to the World Health Organization, in Europe some two million children and adolescents suffer from some type of mental disorder, especially depression, which affects 4% of the adolescents between the ages of 12 and 17, and 9% of 18-year-olds. As is also the case for behavioural and anxiety disorders, rates of adolescent depression are on the rise. Several studies associate depression in adolescence with either current or future consumption of psychoactive substances, a diagnosis of severe mental disorder in adulthood, and suicide. Some studies highlight the importance of social factors and lifestyles in the etiology and prognosis of these types of disorders; for example, various forms of social discrimination, abusive parents, and bullying. The incidence and prevalence of depression appear to be increasing among adolescents, as well as self-reported distress among young people and so-called «negative mood states». Despite the importance of depression, sadness, and so-called «negative mood states» among adolescents, there is a clear lack of qualitative studies analyzing these phenomena, and especially of studies that provide knowledge about the perceptions and cultural models of this age group with respect to their own sense of distress and lay strategies for coping with adversity, and the role of social capital as a buffer against it. Objective and methods The objective of this article is to describe the adolescents' explanatory models (EMs) or lay perceptions on depression, sadness, and related factors. With this purpose we performed an ethnographic study in a sample of 49 students (age 15-16) in three public secondary-schools of Barcelona and its metropolitan area using semi-structured interviews, cultural-domains interviews, and focus groups. We employed content analysis and semantic network analysis for qualitative data, and frequency analysis, cultural-consensus analysis, and multidimensional scaling for quantitative data. Results The results outline that adolescents use their own nosologies to define depressive mood states such as «rallado», «burchado», «chof», or «deprimido». These categories are dichotomically organized between passive items (i.e. to feel sadness or loneliness) and active items (i.e. <<to be angry>>). The state of deprimido (being depressed) is related to feelings of physical weariness and apathy. It can be defined as «a culmination of situations that make you feel bad», including the sense of feeling misunderstood by peers and adults, feeling insecure when having to take decisions or with his/her physical appearance, alone or isolated or in a bad mood. A person that is depressed is someone who «isn't in the mood to even speak about anything», that finds him/herself bad because «things haven't turned out as they expected». This leads him/ her «to blame him/herself for things», to have «very low self-esteem», to not «leave the house», to «become closed within himself», to «build a wall» or a «bubble», to think that «nothing is worth anything» and that «the whole world is against him/her». One can cope with that state for being a «bad time in a person's life», but it can also become «a burden that is much more» or «an eternity that never ends». When we asked our adolescents, «how can you tell that a person is sad or worried?», their answers were varied. One of the most common is to show an oscilation between the passive characteristics of discomfort and its active correlate, between isolation and an uneasy response, despite this behavior not being premeditated. A person that is rallada, deprimida or burchada can appear «isolated from society» and feel unaccepted, alone, insecure, apathetic; he/she might «stop talking or interacting with others», find him/herself feeling «tired of everything», downcast, depressive, as if he/she had experienced un bajón (suddenly feeling down); distracted, serious and without smiling, or anxious and nervous, and because of that hurting others although unintentionally. He/she can also sigh and weep, have difficulties to «express him/herself», appear to have «changed» for not behaving as he/she normally does, or have a lost gaze. The perception that adolescents have of a person exhibiting characteristics such as rallada, triste, burchada, or deprimida is not isomorphic with the vision they hold of themselves when they suffered adversity or experienced discomfort in the past. For example, the category rallada is not used very much in these cases, perhaps in order to save a semantic stigmatizing load. They normally define expressions of discomfort in terms such as «a desire to forget about school, of people and of everything», «scream where no one can hear you», «break things or hit someone», self-inflict physical pain «to balance the pain from within with exterior pain», «make someone feel the same as I feel», «flee or run very far», or of locking oneself up in one's bedroom to «cry while listening to music». They also feel powerless before «the things that they can not confront», «inferior to others», worthless, guilty, with difficulties to concentrate and insomnia. The adolescents situate the causes of their afflictions in the universe of their interactions with family members, adults in general, and peers, within situations of pressure and overexertion in daily life. When we segmented dates by gender we observed that male adolescents prioritized the «school loads» before «relations with friends», while female adolescents a higher relevance to these followed by «affective relations». When we asked our informants, «In your opinion, what can be done to help a person your age that is in this state of sadness or discomfort?», the answers were very diverse, but coincided as a whole to empower sociability between peers. It is striking although congruent with available literature that they discard the possibility of accompanying or referring the affected person to a specific professional for help or even suggest him/her to speak to his/her parents, tutors or professors. As a matter of fact, adolescents constitute an age group characterized by their vague consideration of professional resources in their help-seeking processes. Discussion A fundamental reason for the avoidance of professional services by adolescents is the existence of an explanatory model that, contrary to expert discourses from the «psy» field, understands afflictions as products of the social world. If the causes of discomfort are a result of social interactions (conflicts between equals, states of solitude and isolation, lack of recognition or prestige, dissonances with the models of the body and person, problems in the development of their autonomy against the tutelage of adults, etc.), the restitution of wellbeing must structure itself on those same relations and on that same independence in regards to the adult world. Our data points to a need to establish dialogical strategies of intervention. Insofar as adolescents show explanatory models different to the expert and adult systems in general, it is easy for them to feel indifferent to the interventions that do not involve them as active agents. They want to be protagonists of their own stories. For this reason, the promotion of participation and the dialogue of information (expert and lay) are guidelines that, in our opinion, must be present in any intervention in this field. In these strategies we find the possibility of reconverting lay explanatory models and social capital in a fundamental axis of mental health programs for adolescents.<hr/>Introducción En los últimos años, la salud mental de los adolescentes se ha convertido en una prioridad de las políticas sanitarias en la mayoría de los países de la OCDE y, especialmente, en Europa. La razón está justificada. Según la OMS, se calcula que dos millones de menores y jóvenes europeos sufren algún tipo de trastorno mental, entre los que destaca la depresión que afecta 4% de los adolescentes de entre 12 y 17 años y 9% de los jóvenes de 18 años. Junto con los trastornos de ansiedad y de conducta, ello dibuja una tendencia a la alza. A pesar de la relevancia de la depresión, la tristeza y los denominados «estados de ánimo negativos» entre los y las adolescentes, existe un claro déficit de investigaciones cualitativas que analicen estos fenómenos, principalmente si hablamos de investigaciones que permitan conocer las percepciones y modelos culturales de este grupo de edad con respecto a su propio malestar, así como sobre sus estrategias profanas para afrontar la adversidad y el papel de su capital social. Esta ausencia de investigaciones entra en contradicción con la importancia que estas variables adquieren en la salud mental y la salud pública contemporáneas. Objetivo y métodos El objetivo de este artículo es analizar los modelos explicativos o percepciones profanas de los adolescentes sobre la depresión, la tristeza y sus factores asociados. Con este propósito se realizó un estudio etnográfico en una muestra de 49 estudiantes (de edad entre 15 y 16 años) en tres centros públicos de enseñanza secundaria de Barcelona y su área metropolitana mediante entrevistas semiestructuradas, entrevistas de dominios culturales y grupos focales. Se empleó el análisis de contenido y de redes semánticas para los datos cualitativos obtenidos y el análisis de frecuencia, de consenso cultural y el escalado multidimensional para los datos cuantitativos. Resultados Los adolescentes utilizan sus propias nosologías para definir sus estados de ánimo como «rallado», «burchado», «chof» o «deprimido». Estas categorías se organizan entre un polo pasivo (sentirse triste o solo, por ejemplo) y otro activo (i.e., «estar enfadado»). Las expresiones del malestar depresivo son detectadas entre los iguales por la gestualidad (i.e., «el rostro», «la mirada») y el comportamiento (i.e., aislamiento social), pero sólo de forma marginal por el bajo rendimiento académico. Las causas de la depresión se vinculan con los conflictos en las relaciones interpersonales con iguales y adultos. No obstante, el proceso de búsqueda de salud o ayuda más común implica a los iguales, ya que los adultos son percibidos únicamente como un recurso para situaciones de gravedad inusual. De hecho, los adolescentes constituyen un grupo de edad caracterizado por considerar vagamente los recursos profesionalizados en sus procesos de búsqueda de ayuda. Discusión Una razón fundamental de la evitación de los servicios profesionales de atención por parte de los adolescentes barceloneses es la existencia de un modelo explicativo que, a diferencia de los discursos expertos en el campo «psi», entiende las aflicciones como productos del mundo social. Si las causas del malestar derivan de las interacciones sociales, la restitución del bienestar debe conformarse a partir de estas mismas relaciones y también de esta misma independencia con respecto al mundo adulto. Si bien los resultados de nuestra investigación no son extrapolables a la población adolescente catalana en general, éstos indican la necesidad de establecer estrategias dialógicas de intervención que permitan reconvertir los modelos explicativos legos y el capital social de los adolescentes en un eje fundamental de los programas en salud mental. <![CDATA[<b><<I want to I can…prevent violence>></b>: <b>Raising awareness of dating violence through a brief intervention</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200006&lng=pt&nrm=iso&tlng=pt Introduction Dating violence, a recent topic in scientific investigation, has an incidence ranging from 22% to 33% among young people. These findings are supported by a previous study that showed that about one third of high school and college students have experienced physical violence from a dating partner. Similarly, National and international studies (e.g. National Survey on Family Relations Dynamics and the International Dating Violence Study) found an incidence of violence between dating partners ranging from 10% to 45% among college students worldwide. Although there is evidence that men also experience violence perpetrated by women and that violence occurs in same sex relationships, the research continues to show that violence is usually perpetrated by men against women. However, past studies have focused on the occurrence of physical violence which signals the possibility that other types of violence, such as emotional or social, have a higher incidence. Their incidence varies and the harmful physical, emotional, and social consequences that they imply point to the need of creating prevention programs targeted at youth populations. It is important to prevent violence in a first stage by raising youth's awareness of this problem and, ideally, also by achieving a change in their behaviors and attitudes as well as in the social norms that promote its occurrence. In order to address all of these components of prevention, programs have been developed that do not only inform youth about violence, but also facilitate the formation of social skills through active participation and role playing which allows individuals to practice new models of interaction that are violence free. In addition, programs have to consider that many schools lack the disposition or the resources to impart long prevention workshops. For this reason, the development of brief prevention strategies has become imperative. The program «I want to, I can… prevent violence: Raising awareness of dating violence through a brief intervention» was developed, implemented, and evaluated with the objective of raising youth's awareness and increasing their knowledge about dating violence, its precursors related to gender and cultural norms and its physical, emotional, and social consequences. Materials and method The program consisted of eight interactive conferences imparted at different public high schools in Mexico. The conferences reached a total of 2250 participants in four different urban areas in the country. The conferences consisted of a presentation and different interaction exercises with a total duration of two hours and thirty minutes. The topics covered in each conference were: life skills (assertive communication, negotiation, decision-making), differentiation of the concepts of sex, sexuality and gender and how these are related to violence, what is and how to recognize violence, types of violence, gender roles and stereotypes, how to recognize violence in a dating relationship, and how to express love in a healthy way. A questionnaire, which included the following sections, was developed to assess participants' attitudes toward violence: a) Ability to recognize violence in everyday interactions: Identifying signs of violence in the behaviors and attitudes of characters presented in eight different cases of interactions between dating partners. b) Attitudes toward violence: Rating levels of agreement with statements that promote or discourage violence. c) Causes of violence: Ten causes of violence related to social norms that encourage men's aggression and promote gender inequality are presented; participants must identify the five that are false and the five that are true. d) Healthy ways of expressing love: Recognition of behaviors and signs in a dating relationship that imply the presence or the lack of love. The impact of the conference was evaluated by applying this brief questionnaire to a random sample of participants before and after the conferences. Across all high schools, a total number of 311 questionnaires were completed by participants before the conferences and 184 were completed after the conferences. Ideally, there should have been a longer term follow-up for which no funds were available. An explanatory model within the framework of the Item Response Theory (IRT) was used to analyze collected data. Results The results showed that the conference improved the participants' ability to identify violence and its causes as well as their understanding of healthy ways of expressing love. Responses also indicated favorable attitudes toward nonviolence both before and after the conference. The findings also suggest that participants might require more time to learn how to fully recognize assertive and violent communication as well as false causes of violence and that, ideally, programs should be undertaken to change behaviors not only create awareness and thus be carried out in smaller groups. An analysis of gender differences in responses to the questionnaire shows that women where better able to recognize violence, its causes, and healthy ways of expressing love. Women also had more favorable attitudes toward nonviolence. Discussion The findings show that raising awareness about dating violence through an interactive conference is an efficient brief first stage prevention strategy because it can promote important changes in participants' attitudes through a brief intervention. Participating adolescents showed an increase in their knowledge and awareness about the subject which allowed them to improve their recognition of violence in everyday life. The increase in their ability to recognize healthy ways of expressing love also points to an understanding of romantic relationships that does not exclude autonomy, assertiveness, and honesty. These changes could facilitate the participants' ability to identify myths and misinformation related to the causes of violence. In addition, awareness-raising can initiate a process of questioning and changing social norms that promote gender inequality, jealousy, and control as acceptable forms of violence within dating relationships. Gender differences in the findings suggest that men might need more time than women to fully understand the problem of dating violence which can be attributed to traditional gender role expectations related to violence and gender relationships. This signals the need to increase prevention programs' focus on masculinity, male roles in dating relationships, and how they can express feelings without violence and without limits related to gender stereotypes. The program's achievements indicate the importance of finding strategies that allow large audiences to learn about dating violence, recognize violence in everyday social interactions and understand how to ask for help. The interactive nature of the program goes beyond giving information to a large number of people as it allows participants to practice relationship skills and promotes reflection on the subject of violence. Throughout the program's implementation, schools demonstrated a great interest in raising awareness about dating violence. It would be convenient to utilize their interest in order to further implement prevention programs. The interactive and brief nature of our program allows schools to resolve the problem of lack of time and resources that might deter their participation. Preventing intimate partner violence must begin during adolescence in order to impede the development of unhealthy patterns of interaction that may become harder to change in adulthood.<hr/>Introducción La violencia en el noviazgo es un tema reciente en la investigación científica, cuya incidencia en personas jóvenes va de 22 a 33%. Aun cuando hay evidencias de mujeres que agreden a sus parejas masculinas y también existe violencia entre parejas del mismo sexo, la violencia de pareja sigue siendo predominantemente de control del hombre hacia la mujer. La incidencia de este tipo de violencia y sus consecuencias físicas, emocionales y sociales señalan la necesidad de crear programas de prevención en poblaciones jóvenes. Sin embargo, también debe tomarse en cuenta que en muchas escuelas no existe aún la disposición o los recursos para ofrecer talleres de prevención de larga duración enfocados a esta problemática. Por ello, resulta imperioso contar con estrategias breves que lleven a largo plazo a cambios de conductas en los jóvenes. El primer paso para lograr la prevención es la sensibilización en torno a esta problemática, lo cual permite empezar un proceso de cambio de normas sociales sobre el tema. El programa «Yo quiero, yo puedo… prevenir la violencia: Programa breve de sensibilización sobre violencia en el noviazgo» se desarrolló, instrumentó y evaluó con el objetivo de sensibilizar e incrementar la información que tienen las y los jóvenes sobre los antecedentes culturales y de género relacionados con la violencia en el noviazgo y sus consecuencias a nivel físico, emocional y social. Material y métodos Se impartieron ocho conferencias en preparatorias públicas en México; el total de participantes fue de 2250. Se elaboraron una presentación y un guión para impartir conferencias interactivas con duración de dos horas y treinta minutos dirigidas a jóvenes de nivel medio superior. Algunos de los temas incluidos en las conferencias fueron: habilidades para la vida, qué es y cómo reconocer la violencia, tipos de violencia, su relación con estereotipos de género y formas saludables de expresar el amor. Asimismo, se desarrolló un instrumento para evaluar conocimientos sobre y actitudes hacia la violencia, dividido en cuatro secciones. El impacto de la conferencia interactiva se evaluó mediante la aplicación de este instrumento antes y después de la conferencia impartida a una muestra al azar de la población beneficiada. Aunque idealmente se recomienda hacer un seguimiento del impacto del programa a largo plazo, la falta de recursos no lo permitió en este caso. Para el análisis de datos optamos por la aplicación de un modelo explicativo dentro del marco de la Teoría de Respuesta al Ítem (TRI). Resultados Se logró que los participantes tuvieran un mayor reconocimiento de la violencia y de sus causas. También se logró que los participantes identificaran formas saludables de expresar el amor. Asimismo, los resultados demuestran que los alumnos entendieron que en las relaciones de noviazgo se pueden dar situaciones violentas. Discusión Los hallazgos muestran que la estrategia de sensibilización sobre el tema de la violencia, por medio de una conferencia interactiva, es eficiente ya que logra el objetivo planteado. Una conferencia de corta duración puede promover cambios importantes respecto a un mayor conocimiento y sensibilización frente a la problemática de la violencia. Ello facilita la identificación de situaciones de violencia en la vida cotidiana y el abandono de mitos y creencias falsas relacionadas con las causas de la violencia. Este tipo de programas interactivos y breves, que promueven la reflexión y la aplicación de habilidades relacionales, permite resolver problemas de falta de tiempo para la sensibilización en torno a la violencia en el noviazgo. Asimismo, hacerlo con grandes números de alumnos aumenta el beneficio a un menor costo. Las conferencias interactivas como la aplicada en este estudio abren canales de comunicación sobre el tema en los ambientes escolares y propician la formación de redes de ayuda al respecto. <![CDATA[<b>Searching moderation in alcohol consumption adjusting knowledge to practice</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200007&lng=pt&nrm=iso&tlng=pt Alcohol abuse in Mexico has an enormous impact on people's health. This problem has led authorities to undertake actions to combat and reduce both consumption levels and their consequences. The interventions, focusing on handling problem drinkers -people who already show symptoms of dependence and consume more than one drug, including alcohol-, have proved their effectiveness in various scenarios. In the work setting, this problem is no exception and has also been a focus of concern and the implementation of actions to prevent excess alcohol consumption and provide care for persons beginning to display problems. However, implementing programs in the workplace has proved complicated. Other countries have found that many programs are not correctly evaluated or simply not evaluated, making it impossible to determine their effectiveness in solving the problems for which they were designed. Moreover, the personnel that implement them are not properly trained, programs are expensive to implement, and conflicts of interest tend to arise. In Mexico, low-cost, effective actions have been implemented for this population. However, the time available for undertaking preventive activities is limited, while the length of workers' shifts means that they do not have enough time for these activities. One current challenge is the Translation of Research as a tool for the development of efficient, simpler, more practical, and safer interventions, without ignoring the discovery of new information regarding health and disease prevention, as well as creating more efficient treatments and improving existing ones. Within this perspective, researchers worked to produce a brief intervention to reduce harmful alcohol consumption among the working population. It is based on the principles of cognitive social theory put forward by Bandura, in which alcohol consumption is regarded as learned behavior, that causes problems and may be replaced by healthy behaviors, provided dependence has not developed. Another of the components included is motivational theory, according to which the effectiveness of a particular form of treatment is related to individuals' motivation to continue it. The aim of this article is to describe the process of translation of research, derived from the implementation of cognitive social and motivational theories to adapt an intervention program designed in a comic book format that is easy to read and understand to teach workers with excess alcohol consumption to moderate their consumption. Method The work was carried out in two stages: Phase 1. Adaptation of a brief intervention to a comic book format. A comic was produced using the elements of a brief intervention. In order to ensure that the concepts put forward in the base theory were accessible to the target population, they were subjected to a process of cognitive laboratories following the methodology proposed by Beatty. The comic was produced to make the material easier to read and understand. The process began with a scriptwriter who translated the theoretical contents, together with the terms obtained in the cognitive laboratories into a story that would reflect the target population. This version was subjected to an evaluation described in stage 2. Phase 2. Evaluation of language, characters, contents, and format of comic. Participants: Researchers worked with 49 subjects from various firms and states in Mexico, 59.2% of whom were men, mostly between the ages of 24 and 42, and over half of whom were married (61.2%). Half had only completed high school or less. Instrument: The questionnaire contained demographic questions and indicators to evaluate the comic for: format, understanding of contents, characters, language, and perceived usefulness for reducing problem drinking, among other things. Procedure: Participants attended a training course during which they were asked to evaluate the comic. Each one was given a printed copy and a questionnaire. The subjects volunteered to participate and were guaranteed the confidentiality of the information they provided. Results Over 85% said that they were used to reading on a daily to weekly basis. Most of them thought that the illustrations were attractive and felt that the characters reflected the role they played in the story. They did not like the length of the comic or the fact that the drawings were extremely detailed, with too much text. They also disliked the font and the type of language used. Nearly 80% thought that the reading material was neither tedious nor dull. Most rated the story good or very good and thought that the title encouraged people to read it and that they would use it if they had drinking problems. They also identified themselves with the characters and the situations described in the comic. What they liked best was the way the topic was dealt with in a comic, the way the problem was highlighted, the type of language used (colloquial), the message given, the goal setting, the way they became involved in the reading, and the link between users and the family environment. Finally, the evaluations of the comic showed that some drawings were regarded as aggressive, the children's language did not match their parents', and the order of the dialogues was confusing. This moment in the translation of the intervention made it possible to make changes in several aspects included in the final version. The comic was given to a proofreader to correct spelling mistakes while maintaining the colloquial tone. Discussion This activity resulted in a comic in which the characters guide the workers through a series of strategies to reduce consumption. This complies with the principles of translating research by adapting the concepts derived from social and motivational cognitive theory, which have proved their effectiveness in dealing with addictive behaviors. The inclusion of experts from various areas made it possible to adapt knowledge, by incorporating strategies from the latter into a script that included the dialogues and sketched the characters that would form part of the story. The experts continued to participate during the evaluation process until the final version, with the definitive images, and final dialogues and exercises. Having the workers targeted by the intervention try out various aspects of the material made it possible to adjust the language, contents and the story told, the characters' performance and appearance and the way the exercises and dialogues were carried out. This also made it possible to see how useful the workers found it in reducing their own consumption or helping the people around them -family, co-workers and friends- to do so. In order to produce this sort of material, it is essential to use colloquial language that will be understood by the target population, which is the most delicate stage of the process since it involves the correct use of technical assumptions, since otherwise, one would work from a totally different perspective. This material can reach men of productive age, who are those that make less use of health services, meaning that it is a tool that covers this inaccessible sector of the population. However, the workers were also given the possibility of seeking help from specialists if they failed to achieve their objectives, in which case the comic achieves the objective of raising awareness. Lastly, one of the limitations of the material concerns the fact that the subject himself has to follow up his own progress, meaning that the adaptation must be carried out as rigorously as possible. It also implies that the material must be evaluated through an analysis of the changes that take place in workers as a result of using it. The next stage will therefore be to test the intervention through the comic in a controlled test and to evaluate its efficiency in reducing alcohol abuse problems, as well as the subject's possible progression to severe dependence.<hr/>El abuso en el consumo de alcohol en México es un problema de salud pública por lo que se han realizado diferentes acciones para reducir los niveles de consumo y las consecuencias derivadas de éste. Entre estas acciones hay intervenciones que han probado su eficacia en diferentes escenarios. En el ambiente laboral, sin embargo, ha sido complicado instrumentarlas, por el rechazo, el poco apoyo y el desinterés de funcionarios e instituciones, porque los empleados no disponen de tiempo en sus jornadas y por la falta de espacios para realizar actividades de prevención. Por esta razón es importante adaptar el conocimiento científico para el desarrollo de intervenciones eficientes, más simples, más prácticas y más seguras. Actualmente el proceso de traducción de la investigación es una vía para lograrlo. El objetivo de este artículo es describir este proceso mediante la adaptación de una intervención basada en las teorías cognitiva social y motivacional, cuyos conceptos se presentan en forma de estrategias guiadas por personajes en una historieta -de fácil lectura y comprensión- con la finalidad de que trabajadores que presentan consumo nocivo de alcohol aprendan a moderarlo. Método El trabajo se realizó en dos fases: Fase 1. Se creó la historieta para lograr que los conceptos planteados en la teoría base fueran accesibles a la población objetivo en un formato fácil de leer y entender. Fase 2. Evaluación de lenguaje, personajes, contenidos y formato de la historieta. Participantes: Cuarenta y nueve sujetos voluntarios de diferentes empresas y Estados de la República Mexicana, 59.2% hombres, la mayoría de entre 24 y 43 años, más de la mitad casados y con escolaridad de preparatoria o menos. Instrumento: Un cuestionario que contenía preguntas demográficas e indicadores para evaluar la historieta. Procedimiento: Los participantes se encontraban en un curso de capacitación, ahí se les dio una historieta y un cuestionario invitándolos a que ayudaran para evaluarla. La participación fue voluntaria y se garantizó la confidencialidad de la información proporcionada. Resultados En su mayoría las ilustraciones les resultaron agradables, consideraron a los personajes acordes con el papel que desempeñan en la historia, que la lectura del material no era tediosa o cansada, mencionaron que la historia era buena o muy buena y que el título motivaba a la lectura, que usarían la guía si tuvieran problemas con su consumo de alcohol, además de sentirse identificados con los personajes y las situaciones descritas. Lo que más les agradó es el modo en que se trató el tema en una historieta, el lenguaje utilizado, el mensaje que se les da, el planteamiento de metas, la forma de involucrarlos en la lectura, la relación del consumidor y la familia, cómo los van motivando, lo que sucede en la recaída y cómo se recupera el usuario. La información recabada fue utilizada para realizar la versión final de la historieta. Discusión El resultado fue un material de fácil lectura que permite su utilización individual, en momentos y lugares que cada persona deseé utilizar. Cumple con los principios de la traducción de la investigación al adaptar conceptos derivados de la teoría. Para lograrlo fue importante el uso de lenguaje coloquial que facilitó su lectura y la apropiación de los conocimientos por la población objetivo, esto implicó incluir cuidadosamente los supuestos teóricos para no distorsionar la perspectiva planteada originalmente. Esta intervención permite además llegar a grupos de difícil acceso como los hombres en edad productiva, que acuden poco a servicios de salud. Es necesario probar la intervención mediante la historieta, por ello la siguiente etapa será hacerlo mediante un ensayo controlado para evaluar su eficiencia para reducir los problemas de abuso de alcohol, así como la eventual progresión a la dependencia grave. <![CDATA[<b>The transcraneal magnetic stimulation for the negative symptoms in schizofrenia</b>: <b>a review</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200008&lng=pt&nrm=iso&tlng=pt Schizophrenia is one of the most studied diseases in psychiatry and different dysfunctions of thinking, emotions, perception, movement, and behavior converge in it. These dysfunctions affect the quality of life of the patients in different ways. It is a disease that has been observed in the whole world, with a 0.5 to 1.5% prevalence among adults. Although the biological basis of schizophrenia is not clear enough, the dopaminergic hypothesis is preponderant in our understanding of the symptoms of the disease. A mesolimbic pathway hyperactivity is related to a positive symptomathology, while a prefrontal dopaminergic hypofunction relates to negative symptoms. It has been observed that using serotoninergic antagonists, which promote dopaminergic activity in the prefrontal cortex, translates in to a reduction of the intensity of negative symptoms. This negative syndrome includes a difficulty to initiate new activities (apathy), speech and creativity impoverishment (alogia), alterations in emotional expression, and a lack of capacity to experiment joy. Patients with negative symptoms present gray and white matter loss in left-sided cerebral structures, including temporal lobe, anterior cingulated, and medial frontal cortex. Such a loss seems to be more evident in prefrontal regions, such as the dorsolateral prefrontal region, which connects with anterior temporal structures. Persistent negative symptomathology is a concept proposed by Buchanan, which must fulfill the following criteria: symptoms are primary to the disease or secondary but have not responded to current treatment; interfere with the patient's capacity to accomplish normal functioning; persist during periods of clinical stability, and represent an unresolved therapeutic need. They must be measurable by clinical scales and persist, at least, six months. The Food and Drug Administration has recently considered negative symptoms as an investigation target or new treatments due to their prevalence and high negative impact in the life of the schizophrenic population. Nowadays, the current treatments available for such an entity are second generation antipshycotics and glutamatergic agents -such as d-cycloserine and glicine-, amisulpiride and seleginine, even though their efficacy is limited. Dysfunction of the human prefrontal cortex is considered to be implicated in the pathophisiology of negative symptoms. This cerebral region is essential in the regulation of emotions and cognition. Multiple neural networks begin in the prefrontal cortex and go towards other cortical association areas, to insular region, thalamic structures, basal ganglia and limbic system. It regulates dopaminergic mesencephalic activity through activating and inhibitory pathways, allowing a precise regulation of dopaminergic activity. This double modulation model of dopaminergic pathways has been recently sustained by studies which prove that extracellular dopaminergic concentration in nucleus accumbens increases or reduces after a high or low frequency stimulation of the prefrontal cortex, respectively. A prefrontal cortex lesion causes a syndrome similar to the negative symptomathology in schizophrenia. Transcraneal magnetic stimulation (TMS) could be effective in the treatment of negative symptoms by activating the prefrontal cortex, maybe by stimulating the liberation of dopamine in the mesolimbic and mesoestriatal pathways which have a crucial role in the pathogenesis of negative symptoms such as apathy and anhedonia. TMS was introduced in 1985 and since the early 90's its potential as a treatment has been tested in numerous neurological and psychiatric conditions. It is a noninvasive means of stimulating nervous cells in superficial areas of the brain. During a TMS procedure, an electrical current passes through a wire coil placed over the scalp. This induces a magnetic field that can produce a substantive electrical field in the brain. This electrical field produces in turn a depolarization of nervous cells resulting in the stimulation or disruption of brain activity. TMS may be applied as a single stimulus or repeated many times per second (repetitive TMS), with variations in the intensity, site, and orientation of the magnetic field. Most research and interest has focused on the potential application of repetitive TMS (rTMS) in the treatment of depression. In addition, in recent years an increasing number of open and double-blinded studies of rTMS were conducted in patients with schizophrenia. Most investigators have chosen to focus on the treatment of specific refractory symptoms or syndromes within the disorder such as refractory auditory hallucinations or persistent negative symptoms. TMS has become widely used in research, especially as a method to probe normal and abnormal brain function, motor cortical physiology, and cognition. Regarding negative symptoms in schizophrenia, eleven studies using TMS were carried out until 2006, with a total of 172 patients studied. These studies are difficult to compare because they used different stimulation parameters and the symptoms described were heterogenic. Six studies were blind and five were open, using high frequency TMS in all of them (frequencies above 1 Hz), which is the type of stimulation most commonly used in treatment studies. Six of these studies found a reduction in the severity of the symptoms, but the reduction was not significant in two of them. Ten were the maximum number of sessions included in every study, except for one, in which 20 sessions of TMS were given. In this study, the score of negative subscale of the PANSS was reduced in 33%, which is considered a significant response, and this result was sustained within the next month. In one of these studies, researchers compared 3- and 20-Hz stimulation with sham stimulation and stimulation provided at the patient's individual alpha frequency. Alpha-frequency stimulation was calculated as the patient's peak alpha frequency from five frontal EEG leads. Stimulation of alpha frequency resulted in a significantly greater reduction in negative symptoms than the other conditions. This finding could suggest that negative symptoms may specifically relate to alpha EEG oscillations, which is interesting and requires further exploration and confirmation. Another two studies were conducted in 2007; in the first one, no improvement in negative, positive of affective symptoms was found. The second one, which was a double-blinded clinical trial, found a significant reduction in the intensity of negative, positive, and general symptoms with the active TMS. We should remark that TMS produces changes in the cortical activity in ventral and dorsoestratial regions, but other cerebral regions could be stimulated too, since some activation abnormalities in the left globus palidus, bilateral caudate nucleus, prefrontal, and temporal right cortex have been found and are associated with the etiology of the negative syndrome. In addition, it will be interesting to see whether changes in subcortical dopamine release, which were shown with rTMS in normal volunteers, can be demonstrated in clinical populations, such as patients with schizophrenia, and how this may relate to response to treatment. There is still a need for a larger number of controlled studies, with larger samples, longer periods of evaluation, and constant stimulation parameters, so they can be compared between them and the exact efficacy of TMS as a treatment for negative symptoms can be established.<hr/>La estimulación magnética transcraneal (EMT) es un método no invasivo que utiliza campos magnéticos alternantes para inducir corrientes eléctricas en el tejido cortical en diferentes áreas cerebrales. Se considera una forma de tratamiento para diferentes trastornos psiquiátricos, especialmente en la depresión, adicciones y esquizofrenia. Está técnica terapéutica ofrece una vía innovadora para estudiar la excitabilidad de la corteza, la conectividad regional cortical, la plasticidad de las respuestas cerebrales y las funciones cognitivas en el estado del enfermo. Aunque se han documentado resultados positivos en la estimulación de la CPF izquierda y en la CPF derecha, se sugiere que puede ejercer su acción beneficiosa a través de diversos mecanismos de acción aún no comprendidos en su totalidad. La corteza prefrontal humana es esencial en el control e integración de las emociones, la cognición y la regulación del Sistema Nervioso Autónomo. Numerosas conexiones neuronales bidireccionales se originan en la CPF y se extienden al resto de las áreas de asociación cortical, región insular, sistema límbico y los ganglios basales. La CPF modula la actividad dopaminérgica mesencefálica mediante una vía activadora y otra inhibidora, lo que permite una regulación sumamente fina de la actividad dopaminérgica. La vía activadora funciona por medio de proyecciones glutamatérgicas directas e indirectas a las células dopaminérgicas. La vía inhibitoria hace lo propio mediante eferencias glutamatérgicas prefrontales a las interneuronas GABAérgicas mesencefálicas y a las neuronas GABAérgicas estriatomesencefálicas. El modelo de la doble modulación del sistema dopaminérgico mesolímbico demuestra que la concentración dopaminérgica extracelular en el núcleo accumbens disminuye o aumenta después de la estimulación de la corteza prefrontal a baja o alta frecuencia, respectivamente. Dentro de los estudios que utilizan la EMT en la esquizofrenia, se ha encontrado que, tras una EMT de alta frecuencia (>1Hz) o repetititiva (EMTr), hay un aumento de la excitabilidad en varias áreas cerebrales, mientras que la excitabilidad cortical disminuye tras una EMT de baja frecuencia (<1Hz). La excitabilidad cortical también depende de la intensidad y duración de la estimulación, lo que quiere decir que a intensidades más altas habrá mayor actividad cortical y a trenes prolongados habrá cambios duraderos en la excitabilidad cortical. Una gama de síntomas de difícil tratamiento en la esquizofrenia son los síntomas negativos persistentes, donde se ha demostrado una disminución de la actividad en la CPF, por lo que la EMT se ha utilizado para revertir dicha hipoactividad y disminuir los síntomas. De forma contraria, los síntomas positivos, como las alucinaciones, se asocian con una hiperactividad de las áreas témporo-parietales y por tanto debería resultar beneficiosa la aplicación de EMT de baja frecuencia en dichas áreas. La EMT de alta frecuencia también se ha utilizado para tratar a sujetos con síntomas catatónicos prominentes y se ha logrado una mejoría con el tratamiento. El objetivo de esta revisión es que se comprendan mejor la EMT y el uso que se le puede dar para tratar diversos síntomas en la esquizofrenia. <![CDATA[<b>Endomorphin peptides</b>: <b>pharmacological and functional implications of these opioid peptides in the brain of mammals. </b><b>Part one</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200009&lng=pt&nrm=iso&tlng=pt The present paper describes several aspects of the biological activities, physiological and behavioral responses displayed by the most recent discovered opioid peptides: endomorphins. Endormorphins comprise two endogenous C-terminal amide tetrapeptides, named as endomorphin-1 (EM1; Tyr-Pro-Trp-Phe-NH2) and endomorphin-2 (EM2; Tyr-Pro-Phe-Phe-NH2), which were discovered a decade ago (1997) by Zadina's group. Initially, they reported the identification of two endogenous opioid peptides that displayed high binding affinities and selectivities for the µ-opioid receptor among other identified and cloned opioid receptors. These led authors to support the hypothesis that endomorphin peptides represent the endogenous ligand agonists for the µ-opioid receptor. Both peptides were identified and isolated from bovine and human brains. They consist of four amino acids that share a 75% structural homology among amino acids, and which display the structural α-amidated form of C-terminal -Phe- residue, as demonstrated for many other bioactive neuropeptides. These peptides are structurally distinct from other endogenous opioid substances identified in the brain of mammals, although they share some similarities with other amide terapeptides such as Tyr-W-MIF-1, found also in the mammalian brain. Here, we review the structure-relationship activity of both endomorphin molecules comparing their binding properties to different opioid receptors. Both EM1/EM2 peptides appear to be vulnerable to enzymatic degradation when exposed to the activities of different proteolytic enzymes, as occurs with many other neuroactive peptides found in the SNC of mammals. Immunohistochemical studies showed the wide and asymmetric distribution of both EM1-2 peptides in the brain, leading to the extensive pharmacological, cellular, and physiological studies that demonstrated the wide and varied bioactivities displayed by these peptides at both central and peripheral tissues. These studies led several authors to suggest the potential endogenous role of these peptides in major physiological processes (e.g. analgesia or antinociception). Based on the generation of specific (rabbit) polyclonal antibodies and the use of combined radioimmunoassay (RIA) techniques and immunohistochemical procedures, it was shown the wide distribution of EM1-2-LI (endomorphin1-2-like immunoreactivities) throughout the brain of different species (e.g. rat, primate, human), particularly co-localized in specific areas where µ-opioid receptor has been shown to be expressed. IHC mapping of endomorphin material in the CNS showed a parallelism with the neuroanatomical distribution of other endogenous opioid peptides (e.g. Met/Leu-enk, Dynorphin A, β-endorphin) previously reported. These studies showed for instance that, whereas EM1-LI was shown to be widely and densely distributed throughout the brain, particularly in forebrain structures (e.g. nucleus accumbens [NAc]; cortex [Cx]; amygdale [AMG]; thalamus [Th], the hypothalamus [Hyp], the striatum [CPu]), including the upper brainstem (BS); and dorsal root ganglia (DRG); EM2-LI is highly expressed in spinal cord and lower brainstem. Interesting enough is the demonstration of the expression of EM1-2-LI outside the CNS (e.g. spleen, thymus and blood), and detected in immune cells (e.g. macrophages/monocytes, lymphocytes, and polymophonuclear leucocytes) surrounding inflammatory foci. Pharmacological studies showed that these peptides displace with high potency several µ-opioid receptor ligands agonists in a concentration-dependent manner. Moreover, EM1-2 peptides have been shown to modulate the release of several conventional transmitters from neurons (e.g. DA, NA, 5-HT, ACh) besides on active neurohormones. Additionally, in vitro and in vivo studies showed that both EM-1/EM-2 peptides produce their pharmacological and biological effects by stimulating either µ1 or µ2-opioid receptors, which mediate the distinct pharmacological activities detected for each peptide. Cellular studies showed that both EM-1/EM-2 peptides induce a potent granule/vesicle endocytosis and trafficking of µ-opioid receptor in cells transfected with the µ-opioid receptor cDNA; following some endocytosis responses and µ-opioid receptor trafficking mechanisms shown in enteric neurons; cells previously reported to express naturally µ-opioid binding sites on cells. Endomorphins have been shown to induce potent antinociceptive responses after ICV or IT administration into mice; to modulate nociceptive transmission and pain sensation into the brain after stimulating peripheral nociceptors on primary neuronal afferents; and to generate cross-tolerance between endomorphin peptides and between EM1 and opiate compounds, such as morphine.<hr/>Este artículo resume varios aspectos de las múltiples actividades biológicas, celulares, efectos farmacológicos, respuestas fisiológicas y conductuales de dos nuevas sustancias peptídicas de naturaleza opioide, descubiertas recientemente y denominadas endomorfinas. Las endomorfinas son dos péptidos opioides, clasificados como endomorfina-1 (EM1, Tyr-Pro-Trp-Phe-NH2) y endomorfina-2 (EM2, Tyr-Pro-Phe-Phe-NH2), cuyas secuencias peptídicas fueron identificadas y aisladas del cerebro de bovino y humano por el grupo de Zadina en 1997. Estudios de unión radioligando-receptor demostraron que estos péptidos se unen con alta afinidad de unión al receptor opioide µ en relación con su capacidad de unión a otros subtipos de receptores opioides (kappa [κ], delta [δ] ), previamente identificados en el SNC de mamíferos. Ambos péptidos están compuestos por cuatro aminoácidos y son estructuralmente distintos de las demás sustancias opioides endógenas conocidas. Esta revisión detalla con precisión diversos aspectos de la farmacología y actividades celulares de estos opioides y sus implicaciones en la modulación de distintas circuitos o vías neurales y funcionamiento del SNC de los mamíferos, respectivamente. Los estudios relacionados con la función estructura-actividad de estos péptidos han mostrado que, al igual que la mayoría de los péptidos bioactivos endógenos de naturaleza opioide y no opioide, son vulnerables a la escisión peptídica por cortes enzimáticos mediante la exposición a distintas enzimas proteolíticas que pudiesen participar en la degradación endógena de las endomorfinas, y la obtención de diversos productos de degradación. Asimismo, este artículo menciona la amplia distribución neuroanatómica que poseen las endomorfinas en distintas regiones del cerebro, particularmente en aquellas que regulan el procesamiento y la transmisión de la información nociceptiva y que, por tanto, reflejan el papel potencial de estos péptidos en procesos fisiológicos de analgesia, entre muchos otros (memoria y otro aprendizaje). En este contexto, diferentes estudios basados en el empleo de ensayos inmunológicos (radioinmunoensayos [RIA] y técnicas de inmunohistoquímica [IHC]) que requieren el uso de anticuerpos específicos generados contra las secuencias consenso de las endomorfinas mostraron una amplia distribución de material inmunoreactivo a endomorfina (vg., EM1-LI, EM2-LI) en tejidos neurales de humano, bovino y roedores. Por ejemplo, la EM1-LI mostró una distribución relativamente abundante en una gran mayoría de las regiones del SNC de mamíferos estudiados, particularmente en la región rostral y superior del tallo cerebral, así como en el núcleo accumbens (NAc), la corteza prefrontal y frontal (PFCx), la amígdala (AMG), el tálamo (TH), el hipotálamo (HPT), el estriado (CPu) y fibras nerviosas de la raíz del ganglio dorsal (DRG). En contraste, la expresión de EMZ mostró ser muy abundante en la región de la médula espinal y en la región caudal del tallo cerebral. La distribución de material inmunoreactivo a EM1-2 en el SNC de mamíferos mostró similitudes en cuanto a la distribución neuroanatómica reportada para otros péptidos opioides endógenos, previamente identificados (vg., encefalinas, dinorfinas, endorfinas). Así mismo, estudios paralelos lograron identificar la presencia de EM1-2-LI en órganos periféricos (vg., bazo, timo, células inflamatorias del tipo de macrófagos-monocitos, linfocitos y leucocitos PMN) y en plasma. Más aún, diversos estudios farmacológicos han mostrado que las actividades biológicas y respuestas fisiológicas de las EM1-2 están mediadas a través de la estimulación de los subtipos de receptores opioides µ1 y µ2. Estudios de inmunohistoquímica (IHC) demostraron la colocalización del receptor opioide µ y las EM1-2 en diversas regiones del SNC de mamiferos. Esto ha permitido proponer que las EM1-2 representan una nueva familia de péptidos opioides con funciones neuromoduladoras relevantes en el SNC, las cuales intervienen en la regulación de los procesos biológicos de percepción del dolor; respuestas de estrés; funciones límbicas de placer y recompensa inducidas por incentivos naturales y/o sustancias psicotrópicas; funciones de estado de alerta y vigilia, funciones cognitivas (de aprendizaje y memoria) y actividades de regulación neuroendócrina. Además, diversos estudios celulares han mostrado que ambos péptidos opioides son capaces de inducir la internalización aguda o endocitosis del receptor opioide µ en células somáticas transfectadas con el ADN (ADNc) que codifica este mismo receptor opioide. Al igual que otros péptidos opioides (v.g., encefalinas), diversos estudios mostraron el catabolismo enzimático de estos péptidos amidados mediante la actividad de enzimas proteolíticas (v.g., carboxipeptidasa Y, aminopeptidasa M), lo que ha permitido sugerir que estos péptidos opioides son degradados por rutas de degradación enzimática similares que rigen para múltiples péptidos bioactivos moduladores en el SNC de los mamíferos. Al igual que otros péptidos endógenos, ambas endomorfinas mostraron la capacidad de modular la liberación neuronal de neurotransmisores (DA, NA, 5-HT, ACh) y hormonas peptídicas en áreas específicas del cerebro de los mamíferos. Asimismo, ambos péptidos mostraron una capacidad de generar efectos antinociceptivos potentes en forma dosis-dependiente posterior a su administración ICV o IT en animales experimentales, además de generar respuestas de tolerancia cruzada entre ambas endomorfinas y/o entre la EM1 y alcaloides opiáceos del tipo de la morfina. <![CDATA[<b>Memory systems: Historical background, classification and current concepts. Part two</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200010&lng=pt&nrm=iso&tlng=pt According to recent evidence, memory can be conceptualized as a series of subsystems working together to reach the same final goal. In the present time, most authors coincide in proposing a main division or long-term memory systems in mammals. This division separates memory in two categories: declarative and not declarative, often conceptualized also as explicit and implicit memories, respectively, although the latter terms are more appropriate to describe the role of consciousness during the development of codification and recovery tasks in regard to the information of each system. Declarative memory, as indicated by its name, includes a variety of memories implicating information that can be verbalized and effectively transmitted from person to person. This type of memory is conceptualized as conformed by two distinct memory sub-categories sometimes collaborating and coinciding in the use of memory. The first of these sub-categories is semantic memory, the one including the information about concepts and precise facts, and it is frequently defined as «general knowledge». It also makes reference to conceptual information lacking from the temporal-spatial frame (this issue is detailed in the first part of this paper). The second sub-category is episodic memory, which refers to the memory for personal experienced events, or the memory used for «what?, where?, and when?», in regard to the occurrence of a given personal event. Altogether, autonoesis (the conscious concept of a personally experienced event), subjective temporal consciousness (or subjective temporal frame about when a given event occurred), and self-consciousness are considered indispensable for the definition of episodic memory. In spite of these characteristics, there is yet controversy on whether this type of memory could be observed in animals. In this regard, some researchers have demonstrated that the processes needed to define episodic memory are effectively employed by non-human primates and rodents. In regard to the functional anatomy of episodic memory, an active role of the temporal lobe in the codification of some components of this memory is known from long time ago. Experimental studies employing hippocampal electro-physiological recordings have demonstrated that this region participates in two main components of episodic memory: i) the strong links of the subject with the environment or the spatial context, and ii) the temporal organization of the stored information. Some studies have clearly demonstrated the important participation of specific hippocampal cell areas (CA1 and CA3) for the resolution of behavioral tasks requiring episodic memory. However, clinical studies employing functional imaging have shown a considerable diversity of cortical areas as involved in the several processes of codification or recovery of episodic information, going from prefrontal medial and left ventrolateral regions to medial and lateral temporal regions, retrosplenial cortex, posterior cingulus posterior, and even the cerebellum. Non-declarative memory systems Non-declarative memory contains different categories: procedural memory, priming, associative learning (classic and operant conditioning) and non-associative learning (habituation and sensitization): a) Procedural memory refers to the storage and recovery of information on motor skills, or «know how to do» distinct tasks. Although this type of memory is considered as part of those memory systems often leading to unconscious learning, the relationship between procedural memory and consciousness is more complex. This is due in part to the fact that there is no evidence of a real association between the voluntary (conscious) desire of movement and the activation of motor brain areas. In addition, it has been demonstrated that movements consciously activated to start a given task may difficult the performance of the same task. Moreover, learning of motor skills exhibits a particular characteristic known as consolidation or off-line stabilization. This term refers to those motor skills exhibiting an improvement in performance during the interval of two practice sessions, meaning that the performance is improved if behavior is re-analyzed after an interval of rest typically occurring along the day or during sleep periods. This supports the theory that during sleep periods there is a recapitulation of events taking place during the day, thus favoring the strengthening of neuroplastic mechanisms involved in motor learning. b) Priming is a type of implicit memory not requiring any conscious recollection of previous experiences, and it shares some features with procedural and semantic memories. Similar to procedural memory, priming implies an increase of skills, but in this case, perceptual skills. It is also similar to semantic memory in terms of the involvement of cognitive representations of outdoor environment, and its representation is more cognitive than behavioral. The general characteristics of priming are: i) it is related with the perceptual identification of objects in general terms, including words or concepts; ii) its neuronal substrate is not depending on those brain regions needed for episodic or semantic memories; iii) it is developed early in life and its capacity remains stable all the time; iv) its activity is not related with consciousness and its function is not sufficient to recall a previous experience; v) it is relatively immune to the effects of drugs affecting the other memory systems; vi) its information is distributed in multiple representations of specific words and objects; and vii) the access to this representations is highly specific to each category of objects. Finally, among short-term memory systems, the concept of working memory proposed by Baddeley and Hitch is still accepted in our days, and is characterized by the transitory storage and administration of all kind of information useful for the achievement of a specific task. This system is based on three main components: i) a control system with limited attention capacity, also known as Executive Central Component; ii) the Phonologic Circuit, based on sound and language; and iii) the Visual-Spatial Scheme. The phonologic circuit is responsible for the transitory storage of language information based on sound and it is proponed to play an active role for learning of language. The Visual-Spatial Scheme is important for the visual-spatial representation of objects and their features, which in turn is relevant for the integration of concepts. The Executive Central Component is in charge of controlling the attention and the access to the other two subsidiary components. The knowledge on how the memory systems are functioning is and will remain in constant expansion, given the obvious contribution of recent studies on molecular biology and functional neuroimaging.<hr/>La memoria episódica (ME) forma parte de los sistemas de memoria declarativa y es considerada como aquella de los sucesos experimentados de forma personal, o sea la memoria del «¿qué?», «¿dónde?» y «¿cuándo?» ocurrió cierto suceso de la experiencia personal. La triada de autonoesis (es decir, la conciencia de que un suceso le ocurrió personalmente), conciencia temporal subjetiva (o el marco temporal subjetivo de cuando ocurrió un suceso y en qué orden) y la conciencia de sí mismo, son consideradas como requisito indispensable para la definición de la memoria episódica. Hasta hace algunos años la memoria episódica era típicamente considerada como una habilidad exclusiva del ser humano, debido a los procesos cognitivos con los que se asocia, sin embargo, recientemente se ha comprobado que otras especies animales tienen y utilizan eficazmente un sistema análogo al de la ME para resolver diversas tareas de memoria en el laboratorio. Estos modelos experimentales de ME han impulsado la generación de conocimientos acerca de este sistema. La participación del lóbulo temporal, y en especial del hipocampo, en la ME es conocida desde hace tiempo, sin embargo se han identificado diversas áreas cerebrales implicadas en la recuperación y codificación de la información episódica. Una de las más estudiadas actualmente es la corteza parietal posterior, pero existen otras cuyo rol preciso en este tipo de memoria aún no se ha esclarecido. Por otro lado, la otra gran categoría central de la memoria: la no declarativa, contiene diversas subcategorías heterogéneas en su contenido y función, como son: la memoria procedimental, el priming, el aprendizaje asociativo (condicionamiento clásico y operante) y el aprendizaje no asociativo (habituación, deshabituación y sensibilización) mediado por vías reflejas. La memoria procedimental se refiere al almacenamiento y recuperación de información sobre habilidades motoras, es decir, el aprendizaje de «saber cómo hacer» distintas tareas. La memoria procedimental tiene relaciones complejas con la «conciencia», se ha demostrado que presenta un proceso de consolidación off-line, es decir que la información se consolida mejor cuando existe un periodo de reposo entre las sesiones de entrenamiento motor, sobre todo si durante este descanso ocurre el sueño. Existe una serie de estructuras tanto corticales como subcorticales que participan en diversas funciones de la memoria procedimental y cuya lesión selectiva produce distintos trastornos de las funciones motoras, como la parálisis, la apraxia, el temblor, los movimientos coreicos, las distonías, las dismetrías o la ataxia. El priming es un tipo de memoria implícita que no requiere de ninguna recolección consciente de experiencias previas, y que comparte algunas características con la memoria procedimental pero también con la semántica. Se trata de una variedad de memoria en la cual se propone que participan áreas neocorticales de asociación visual. Finalmente, dentro de los sistemas de memoria de corto plazo se encuentra el concepto de memoria de trabajo, propuesto por Baddeley y Hitch, que sigue teniendo aceptación en la actualidad y que es considerado como un sistema encargado de almacenar y administrar transitoriamente toda la información (de distintas modalidades) que se encuentra actualmente en uso para la realización de una tarea específica. Esta memoria de trabajo se conceptualiza como conformada por un componente ejecutivo central y dos sistemas subsidiarios: el circuito fonológico (encargado entre otras cosas del reforzamiento verbal implicado en el aprendizaje del lenguaje) y el esquema visuo-espacial que estaría encargado del almacenamiento transitorio de la información espacial del ambiente externo. El conocimiento científico de la memoria continúa en expansión cotidiana, pero aún estamos lejos de conocer todos los detalles acerca de su funcionamiento desde el nivel molecular hasta el anatómico macroscópico. Sin duda los estudios moleculares y de imagen funcional ofrecerán en el futuro una panorámica más amplia al respecto. <![CDATA[<b>Pronunciamiento de la Academia Nacional de Medicina de México ante la salud reproductiva y los derechos de la mujer</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200011&lng=pt&nrm=iso&tlng=pt According to recent evidence, memory can be conceptualized as a series of subsystems working together to reach the same final goal. In the present time, most authors coincide in proposing a main division or long-term memory systems in mammals. This division separates memory in two categories: declarative and not declarative, often conceptualized also as explicit and implicit memories, respectively, although the latter terms are more appropriate to describe the role of consciousness during the development of codification and recovery tasks in regard to the information of each system. Declarative memory, as indicated by its name, includes a variety of memories implicating information that can be verbalized and effectively transmitted from person to person. This type of memory is conceptualized as conformed by two distinct memory sub-categories sometimes collaborating and coinciding in the use of memory. The first of these sub-categories is semantic memory, the one including the information about concepts and precise facts, and it is frequently defined as «general knowledge». It also makes reference to conceptual information lacking from the temporal-spatial frame (this issue is detailed in the first part of this paper). The second sub-category is episodic memory, which refers to the memory for personal experienced events, or the memory used for «what?, where?, and when?», in regard to the occurrence of a given personal event. Altogether, autonoesis (the conscious concept of a personally experienced event), subjective temporal consciousness (or subjective temporal frame about when a given event occurred), and self-consciousness are considered indispensable for the definition of episodic memory. In spite of these characteristics, there is yet controversy on whether this type of memory could be observed in animals. In this regard, some researchers have demonstrated that the processes needed to define episodic memory are effectively employed by non-human primates and rodents. In regard to the functional anatomy of episodic memory, an active role of the temporal lobe in the codification of some components of this memory is known from long time ago. Experimental studies employing hippocampal electro-physiological recordings have demonstrated that this region participates in two main components of episodic memory: i) the strong links of the subject with the environment or the spatial context, and ii) the temporal organization of the stored information. Some studies have clearly demonstrated the important participation of specific hippocampal cell areas (CA1 and CA3) for the resolution of behavioral tasks requiring episodic memory. However, clinical studies employing functional imaging have shown a considerable diversity of cortical areas as involved in the several processes of codification or recovery of episodic information, going from prefrontal medial and left ventrolateral regions to medial and lateral temporal regions, retrosplenial cortex, posterior cingulus posterior, and even the cerebellum. Non-declarative memory systems Non-declarative memory contains different categories: procedural memory, priming, associative learning (classic and operant conditioning) and non-associative learning (habituation and sensitization): a) Procedural memory refers to the storage and recovery of information on motor skills, or «know how to do» distinct tasks. Although this type of memory is considered as part of those memory systems often leading to unconscious learning, the relationship between procedural memory and consciousness is more complex. This is due in part to the fact that there is no evidence of a real association between the voluntary (conscious) desire of movement and the activation of motor brain areas. In addition, it has been demonstrated that movements consciously activated to start a given task may difficult the performance of the same task. Moreover, learning of motor skills exhibits a particular characteristic known as consolidation or off-line stabilization. This term refers to those motor skills exhibiting an improvement in performance during the interval of two practice sessions, meaning that the performance is improved if behavior is re-analyzed after an interval of rest typically occurring along the day or during sleep periods. This supports the theory that during sleep periods there is a recapitulation of events taking place during the day, thus favoring the strengthening of neuroplastic mechanisms involved in motor learning. b) Priming is a type of implicit memory not requiring any conscious recollection of previous experiences, and it shares some features with procedural and semantic memories. Similar to procedural memory, priming implies an increase of skills, but in this case, perceptual skills. It is also similar to semantic memory in terms of the involvement of cognitive representations of outdoor environment, and its representation is more cognitive than behavioral. The general characteristics of priming are: i) it is related with the perceptual identification of objects in general terms, including words or concepts; ii) its neuronal substrate is not depending on those brain regions needed for episodic or semantic memories; iii) it is developed early in life and its capacity remains stable all the time; iv) its activity is not related with consciousness and its function is not sufficient to recall a previous experience; v) it is relatively immune to the effects of drugs affecting the other memory systems; vi) its information is distributed in multiple representations of specific words and objects; and vii) the access to this representations is highly specific to each category of objects. Finally, among short-term memory systems, the concept of working memory proposed by Baddeley and Hitch is still accepted in our days, and is characterized by the transitory storage and administration of all kind of information useful for the achievement of a specific task. This system is based on three main components: i) a control system with limited attention capacity, also known as Executive Central Component; ii) the Phonologic Circuit, based on sound and language; and iii) the Visual-Spatial Scheme. The phonologic circuit is responsible for the transitory storage of language information based on sound and it is proponed to play an active role for learning of language. The Visual-Spatial Scheme is important for the visual-spatial representation of objects and their features, which in turn is relevant for the integration of concepts. The Executive Central Component is in charge of controlling the attention and the access to the other two subsidiary components. The knowledge on how the memory systems are functioning is and will remain in constant expansion, given the obvious contribution of recent studies on molecular biology and functional neuroimaging.<hr/>La memoria episódica (ME) forma parte de los sistemas de memoria declarativa y es considerada como aquella de los sucesos experimentados de forma personal, o sea la memoria del «¿qué?», «¿dónde?» y «¿cuándo?» ocurrió cierto suceso de la experiencia personal. La triada de autonoesis (es decir, la conciencia de que un suceso le ocurrió personalmente), conciencia temporal subjetiva (o el marco temporal subjetivo de cuando ocurrió un suceso y en qué orden) y la conciencia de sí mismo, son consideradas como requisito indispensable para la definición de la memoria episódica. Hasta hace algunos años la memoria episódica era típicamente considerada como una habilidad exclusiva del ser humano, debido a los procesos cognitivos con los que se asocia, sin embargo, recientemente se ha comprobado que otras especies animales tienen y utilizan eficazmente un sistema análogo al de la ME para resolver diversas tareas de memoria en el laboratorio. Estos modelos experimentales de ME han impulsado la generación de conocimientos acerca de este sistema. La participación del lóbulo temporal, y en especial del hipocampo, en la ME es conocida desde hace tiempo, sin embargo se han identificado diversas áreas cerebrales implicadas en la recuperación y codificación de la información episódica. Una de las más estudiadas actualmente es la corteza parietal posterior, pero existen otras cuyo rol preciso en este tipo de memoria aún no se ha esclarecido. Por otro lado, la otra gran categoría central de la memoria: la no declarativa, contiene diversas subcategorías heterogéneas en su contenido y función, como son: la memoria procedimental, el priming, el aprendizaje asociativo (condicionamiento clásico y operante) y el aprendizaje no asociativo (habituación, deshabituación y sensibilización) mediado por vías reflejas. La memoria procedimental se refiere al almacenamiento y recuperación de información sobre habilidades motoras, es decir, el aprendizaje de «saber cómo hacer» distintas tareas. La memoria procedimental tiene relaciones complejas con la «conciencia», se ha demostrado que presenta un proceso de consolidación off-line, es decir que la información se consolida mejor cuando existe un periodo de reposo entre las sesiones de entrenamiento motor, sobre todo si durante este descanso ocurre el sueño. Existe una serie de estructuras tanto corticales como subcorticales que participan en diversas funciones de la memoria procedimental y cuya lesión selectiva produce distintos trastornos de las funciones motoras, como la parálisis, la apraxia, el temblor, los movimientos coreicos, las distonías, las dismetrías o la ataxia. El priming es un tipo de memoria implícita que no requiere de ninguna recolección consciente de experiencias previas, y que comparte algunas características con la memoria procedimental pero también con la semántica. Se trata de una variedad de memoria en la cual se propone que participan áreas neocorticales de asociación visual. Finalmente, dentro de los sistemas de memoria de corto plazo se encuentra el concepto de memoria de trabajo, propuesto por Baddeley y Hitch, que sigue teniendo aceptación en la actualidad y que es considerado como un sistema encargado de almacenar y administrar transitoriamente toda la información (de distintas modalidades) que se encuentra actualmente en uso para la realización de una tarea específica. Esta memoria de trabajo se conceptualiza como conformada por un componente ejecutivo central y dos sistemas subsidiarios: el circuito fonológico (encargado entre otras cosas del reforzamiento verbal implicado en el aprendizaje del lenguaje) y el esquema visuo-espacial que estaría encargado del almacenamiento transitorio de la información espacial del ambiente externo. El conocimiento científico de la memoria continúa en expansión cotidiana, pero aún estamos lejos de conocer todos los detalles acerca de su funcionamiento desde el nivel molecular hasta el anatómico macroscópico. Sin duda los estudios moleculares y de imagen funcional ofrecerán en el futuro una panorámica más amplia al respecto. <![CDATA[<b>Autoevaluación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252010000200012&lng=pt&nrm=iso&tlng=pt According to recent evidence, memory can be conceptualized as a series of subsystems working together to reach the same final goal. In the present time, most authors coincide in proposing a main division or long-term memory systems in mammals. This division separates memory in two categories: declarative and not declarative, often conceptualized also as explicit and implicit memories, respectively, although the latter terms are more appropriate to describe the role of consciousness during the development of codification and recovery tasks in regard to the information of each system. Declarative memory, as indicated by its name, includes a variety of memories implicating information that can be verbalized and effectively transmitted from person to person. This type of memory is conceptualized as conformed by two distinct memory sub-categories sometimes collaborating and coinciding in the use of memory. The first of these sub-categories is semantic memory, the one including the information about concepts and precise facts, and it is frequently defined as «general knowledge». It also makes reference to conceptual information lacking from the temporal-spatial frame (this issue is detailed in the first part of this paper). The second sub-category is episodic memory, which refers to the memory for personal experienced events, or the memory used for «what?, where?, and when?», in regard to the occurrence of a given personal event. Altogether, autonoesis (the conscious concept of a personally experienced event), subjective temporal consciousness (or subjective temporal frame about when a given event occurred), and self-consciousness are considered indispensable for the definition of episodic memory. In spite of these characteristics, there is yet controversy on whether this type of memory could be observed in animals. In this regard, some researchers have demonstrated that the processes needed to define episodic memory are effectively employed by non-human primates and rodents. In regard to the functional anatomy of episodic memory, an active role of the temporal lobe in the codification of some components of this memory is known from long time ago. Experimental studies employing hippocampal electro-physiological recordings have demonstrated that this region participates in two main components of episodic memory: i) the strong links of the subject with the environment or the spatial context, and ii) the temporal organization of the stored information. Some studies have clearly demonstrated the important participation of specific hippocampal cell areas (CA1 and CA3) for the resolution of behavioral tasks requiring episodic memory. However, clinical studies employing functional imaging have shown a considerable diversity of cortical areas as involved in the several processes of codification or recovery of episodic information, going from prefrontal medial and left ventrolateral regions to medial and lateral temporal regions, retrosplenial cortex, posterior cingulus posterior, and even the cerebellum. Non-declarative memory systems Non-declarative memory contains different categories: procedural memory, priming, associative learning (classic and operant conditioning) and non-associative learning (habituation and sensitization): a) Procedural memory refers to the storage and recovery of information on motor skills, or «know how to do» distinct tasks. Although this type of memory is considered as part of those memory systems often leading to unconscious learning, the relationship between procedural memory and consciousness is more complex. This is due in part to the fact that there is no evidence of a real association between the voluntary (conscious) desire of movement and the activation of motor brain areas. In addition, it has been demonstrated that movements consciously activated to start a given task may difficult the performance of the same task. Moreover, learning of motor skills exhibits a particular characteristic known as consolidation or off-line stabilization. This term refers to those motor skills exhibiting an improvement in performance during the interval of two practice sessions, meaning that the performance is improved if behavior is re-analyzed after an interval of rest typically occurring along the day or during sleep periods. This supports the theory that during sleep periods there is a recapitulation of events taking place during the day, thus favoring the strengthening of neuroplastic mechanisms involved in motor learning. b) Priming is a type of implicit memory not requiring any conscious recollection of previous experiences, and it shares some features with procedural and semantic memories. Similar to procedural memory, priming implies an increase of skills, but in this case, perceptual skills. It is also similar to semantic memory in terms of the involvement of cognitive representations of outdoor environment, and its representation is more cognitive than behavioral. The general characteristics of priming are: i) it is related with the perceptual identification of objects in general terms, including words or concepts; ii) its neuronal substrate is not depending on those brain regions needed for episodic or semantic memories; iii) it is developed early in life and its capacity remains stable all the time; iv) its activity is not related with consciousness and its function is not sufficient to recall a previous experience; v) it is relatively immune to the effects of drugs affecting the other memory systems; vi) its information is distributed in multiple representations of specific words and objects; and vii) the access to this representations is highly specific to each category of objects. Finally, among short-term memory systems, the concept of working memory proposed by Baddeley and Hitch is still accepted in our days, and is characterized by the transitory storage and administration of all kind of information useful for the achievement of a specific task. This system is based on three main components: i) a control system with limited attention capacity, also known as Executive Central Component; ii) the Phonologic Circuit, based on sound and language; and iii) the Visual-Spatial Scheme. The phonologic circuit is responsible for the transitory storage of language information based on sound and it is proponed to play an active role for learning of language. The Visual-Spatial Scheme is important for the visual-spatial representation of objects and their features, which in turn is relevant for the integration of concepts. The Executive Central Component is in charge of controlling the attention and the access to the other two subsidiary components. The knowledge on how the memory systems are functioning is and will remain in constant expansion, given the obvious contribution of recent studies on molecular biology and functional neuroimaging.<hr/>La memoria episódica (ME) forma parte de los sistemas de memoria declarativa y es considerada como aquella de los sucesos experimentados de forma personal, o sea la memoria del «¿qué?», «¿dónde?» y «¿cuándo?» ocurrió cierto suceso de la experiencia personal. La triada de autonoesis (es decir, la conciencia de que un suceso le ocurrió personalmente), conciencia temporal subjetiva (o el marco temporal subjetivo de cuando ocurrió un suceso y en qué orden) y la conciencia de sí mismo, son consideradas como requisito indispensable para la definición de la memoria episódica. Hasta hace algunos años la memoria episódica era típicamente considerada como una habilidad exclusiva del ser humano, debido a los procesos cognitivos con los que se asocia, sin embargo, recientemente se ha comprobado que otras especies animales tienen y utilizan eficazmente un sistema análogo al de la ME para resolver diversas tareas de memoria en el laboratorio. Estos modelos experimentales de ME han impulsado la generación de conocimientos acerca de este sistema. La participación del lóbulo temporal, y en especial del hipocampo, en la ME es conocida desde hace tiempo, sin embargo se han identificado diversas áreas cerebrales implicadas en la recuperación y codificación de la información episódica. Una de las más estudiadas actualmente es la corteza parietal posterior, pero existen otras cuyo rol preciso en este tipo de memoria aún no se ha esclarecido. Por otro lado, la otra gran categoría central de la memoria: la no declarativa, contiene diversas subcategorías heterogéneas en su contenido y función, como son: la memoria procedimental, el priming, el aprendizaje asociativo (condicionamiento clásico y operante) y el aprendizaje no asociativo (habituación, deshabituación y sensibilización) mediado por vías reflejas. La memoria procedimental se refiere al almacenamiento y recuperación de información sobre habilidades motoras, es decir, el aprendizaje de «saber cómo hacer» distintas tareas. La memoria procedimental tiene relaciones complejas con la «conciencia», se ha demostrado que presenta un proceso de consolidación off-line, es decir que la información se consolida mejor cuando existe un periodo de reposo entre las sesiones de entrenamiento motor, sobre todo si durante este descanso ocurre el sueño. Existe una serie de estructuras tanto corticales como subcorticales que participan en diversas funciones de la memoria procedimental y cuya lesión selectiva produce distintos trastornos de las funciones motoras, como la parálisis, la apraxia, el temblor, los movimientos coreicos, las distonías, las dismetrías o la ataxia. El priming es un tipo de memoria implícita que no requiere de ninguna recolección consciente de experiencias previas, y que comparte algunas características con la memoria procedimental pero también con la semántica. Se trata de una variedad de memoria en la cual se propone que participan áreas neocorticales de asociación visual. Finalmente, dentro de los sistemas de memoria de corto plazo se encuentra el concepto de memoria de trabajo, propuesto por Baddeley y Hitch, que sigue teniendo aceptación en la actualidad y que es considerado como un sistema encargado de almacenar y administrar transitoriamente toda la información (de distintas modalidades) que se encuentra actualmente en uso para la realización de una tarea específica. Esta memoria de trabajo se conceptualiza como conformada por un componente ejecutivo central y dos sistemas subsidiarios: el circuito fonológico (encargado entre otras cosas del reforzamiento verbal implicado en el aprendizaje del lenguaje) y el esquema visuo-espacial que estaría encargado del almacenamiento transitorio de la información espacial del ambiente externo. El conocimiento científico de la memoria continúa en expansión cotidiana, pero aún estamos lejos de conocer todos los detalles acerca de su funcionamiento desde el nivel molecular hasta el anatómico macroscópico. Sin duda los estudios moleculares y de imagen funcional ofrecerán en el futuro una panorámica más amplia al respecto.