Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

OBJECTIVE: Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico. METHOD: 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions. RESULTS: Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results. CONCLUSIONS: Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Amapola, lindísima amapola: de los opiáceos y los opioides, utilidad y riesgos / Poppy, beautiful poppy: opiates and opioids, utility and risks

Resumen El opio y sus derivados, y recientemente los opioides, han acompañado a la humanidad desde las civilizaciones más antiguas hasta la actualidad. Sus efectos analgésicos, hipnóticos y placenteros no pasaron desapercibidos para los antiguos, los consideraron de utilidad médica y beneficiosa para el estado de ánimo. Hoy en día no existe otro tipo de medicamentos que puedan tratar el dolor más intenso tan eficientemente como estos potentes analgésicos. Sin embargo, el uso médico y recreativo de los opiáceos y los opioides conlleva riesgos para la salud, como la tolerancia, la hiperalgesia y la adicción. Actualmente, además de ser indiscutiblemente el tratamiento médico más poderoso para mitigar el sufrimiento ocasionado por el dolor, se ha convertido también en un problema de salud pública debido a la alta cantidad de personas con trastorno por uso de opioides y por las muertes ocasionadas por sobredosis. En esta revisión se hará mención de las bondades de los opiáceos y opioides, y también de los efectos no deseados que estos producen.

Abstract Opium and its derivatives, and recently the opioids have accompanied the humankind since the ancient civilizations to the present day. Its analgesic, hypnotic and pleasant effects did not go unnoticed by ancient people, which considered most of these effects of medical utility and noticed that they had remarkable mood benefits. Currently, there are no other kind of drugs that can palliate intense pain as efficiently as these powerful analgesics. However, the medical and recreational use of opiates and opioids may carry health risks such as tolerance, hyperalgesia, and addiction. Nowadays, in addition to being indisputably the most powerful medical treatment to alleviate the suffering caused by pain, it has also become a public health problem due to the high number of people with opioid use disorder that have facilitated deaths caused by opioids overdose. In this review we will discuss the medical benefits of opiates and opioids, as much as the unwanted effects they produce.

Cannabinoids and Sleep/Wake Control.

The sleep-wake cycle is a complex process that includes wake (W), non-rapid-eye-movement (NREM) and rapid-eye-movement (REM) sleep. Each phase is regulated by specialized brain structures that, by means of different neurotransmitters, maintain the constant expression of the sleep-wake cycle. Molecules like orexin, serotonin, noradrenaline, histamine, for waking; GABA, adenosine, prostaglandins, for NREM sleep and acetylcholine and glutamate for REM sleep, among other molecules are responsible for the expression and maintenance of each phase. When the endocannabinoid system was being described for the first time, almost three decades ago, oleamide's sleep promoting properties were highlighted. Nowadays, enough evidence has been cumulated to support the endocannabinoid system role in the sleep-wake cycle regulation. The endocannabinoids oleamide anandamide, and 2-arachidonylglycerol promote NREM and/or REM sleep via the CB1R, thereby making this system a target to treat sleep disorders, such as insomnia.

Marihuana: legalización y atención médica / Marihuana: Legalization and Medical Care

Resumen A pesar de que el uso de marihuana se considera ilegal en la mayoría de los países del mundo, es una de las drogas más utilizadas. El 8,6% de la población mexicana, entre 12 y 65 años, ha probado la marihuana alguna vez (2017). Este porcentaje ha aumentado significativamente en los últimos años. Casos fatales asociados con el consumo de cannabis no se documentaron durante mucho tiempo; sin embargo, recientemente se ha informado de muertes causada por un síndrome de hiperémesis de cannabis (CHS) y muerte por automutilación. Si bien se ha documentado que la marihuana sintetiza sustancias activas con potenciales propiedades terapéuticas, en la actualidad, el mayor uso de la marihuana en nuestro país y en el mundo es recreativo. Esta revisión analiza las consecuencias del uso recreativo de marihuana, el contexto social y de salud con respecto a la legalización y los posibles usos terapéuticos de compuestos extraídos de la planta, de acuerdo a estudios reportados en la literatura científica. La contribución que hacemos es alertar sobre el impacto negativo en la salud del uso recreativo de marihuana y la urgencia de favorecer la investigación sobre sus efectos en el cerebro. Asimismo, identificar los principios activos que tengan potencial para el uso terapéutico.

Abstract Despite the fact that the use of marihuana is illegal in most countries of the world, it still is one of the most commonly used drugs worldwide. 8.6% of the Mexican population, between 12-65 years old, has smoked marihuana at least once in their lifetime (2017). There has been a significant increase in the number of consumers in the last few years. Fatal cases associated with cannabis use had not been recognized for a long time, however, lately, deaths due to a cannabis hyperemesis syndrome (CHS) and deaths from self-mutilation have been reported. Although marihuana synthesizes several active substances with potential therapeutic properties, nowadays, the greatest use of marihuana in our country and in the world is recreational. This review discusses the consequences of using marihuana for recreational use, the social and health contexts regarding legalization and potential therapeutic uses of compounds isolated from the plant based on the scientific literature. Our contribution is to warn people about the potential negative impact on the health of recreational use marihuana and the urgency of supporting the research of its effects on the brain. Similarly, we aim to identify the active principles with potential therapeutic use.

Neurobiología de las adicciones / Neurobiology of addictions

Resumen La proporción de usuarios de una droga de abuso que desarrolla dependencia sólo representa una parte de ellos. Es decir, hay una proporción de usuarios que no presentan un trastorno por consumo de sustancias (TCS). Por ejemplo, en Mexico sólo el 15% de quienes consumen alcohol desarrollan un trastorno por consumo de alcohol (ТСА). Este 15% sugiere una vulnerabilidad en esta población, por lo que determinar los mecanismos que predisponen a estos sujetos a la adicción es indispensable para la prevención о para la rehabilitación del TCS. Se ha sugerido la participación de factores genéticos y medioambientales en el desarrollo de dicha vulnerabilidad al TCS. Por ejemplo, se ha demostrado que los sujetos que son psicópatas o sociópatas у que son agresivos, que presentan falta de atención y son impulsivos, entre otras características clínicas, presentan comorbilidad con el abuso y dependencia a sustancias. Por otro lado, se ha observado que existe una relación entre las experiencias adversas en los primeros años de vida y el consumo de sustancias de abuso. En estudios preclínicos, hemos demostrado que las ratas privadas de cuidado materno en los días posnatales 2 al 16 (DPN2-DPN16), al llegar a la edad adulta (DPN90) consumen más alcohol que las que han recibido cuidado materno todo el tiempo. Además, presentan una desregulación en la expresión de los receptores para canabinoides del tipo ו (CB1R) en algunas zonas del cerebro, por ejemplo, el núcleo accumbens y la corteza prefrontal. En breve, podríamos suponer que un sujeto es vulnerable a tener una adicción si nace psicópata o desarrolla una personalidad antisocial, o bien, si durante la infancia ha contendido con situaciones adversas, como son un pobre cuidado parental o el abuso verbal, fisco o sexual. Cabe señalar que estos no son los únicos factores que han sido asociados a este trastorno, pero para los fines de esta revisión, sólo discutiremos esta vulnerabilidad con base en los mecanismos epigenéticos que afectan al sistema endocanabinérgico (seCB) e interfieren con la función del sistema de inhibición de la conducta.

Abstract The proportion of drug abuse users that develop dependence does not represent the totality of users. Therefore, there is a substantial proportion of users that does not develop a substance use disorder (SUD). For example, in Mexico, only 15% of all alcohol consumers develop alcohol use disorder (AUD). Determining the mechanisms that predispose individuals to AUD or SUD is crucial for its prevention or rehabilitation. The involvement of genetic and environmental factors to the development of SUD has been suggested. For example, psychopaths or sociopaths that have a strong genetic predisposition have comorbidity with SUD. On the other hand, a relationship between adverse experiences in the early years of and substance abuse has been documented. In pre-clinical studies, we have shown that rats deprived of maternal care from postnatal day (PND)2 to PND16, and tested once they reach adulthood (PND90) consume more alcohol than those that were under materna care at all times. In addition, we observed a dysregulation in the expression of cannabinoid receptors type 1 (CBIR)in some areas of the brain, i.e. nucleus acumens and prefrontal cortex. In short, we presume that a subject who is vulnerable to addiction has either been born with a psychopathic disorder, developed an antisocial personality, experienced adverse situations such as neglected parental care, or verbal, physical or sexual abuse. These are not the only factors that have been associated with SUD, but for the purposes of this review we will discuss vulnerability based only on epigenetic mechanisms affecting the endocannabinergic system and interfering with the functioning of the behavior inhibition system.

Representación semántica del término ‘psicología médica’ en estudiantes de medicina: un estudio longitudinal / Semantic representation of the term ‘medical psychology’ in medical students: a longitudinal study

Introducción: La psicología médica constituye una parte esencial en la formación integral del alumno de medicina. Poco se ha estudiado sobre la manera en que éste la concibe. Objetivo: Analizar el proceso de estructuración y reestructuración que el estudiante de medicina realiza en torno al concepto de 'psicología médica'. Sujetos y métodos: La muestra de estudio estuvo integrada por un grupo de alumnos de la licenciatura de médico cirujano de la Facultad de Medicina de la Universidad Nacional Autónoma de México, perteneciente al Programa de Alta Exigencia Académica, y al que se dio seguimiento durante los cinco años de sus estudios. Se llevó a cabo un estudio observacional, longitudinal y prospectivo con cortes transversales anuales, con un análisis cuantitativo y cualitativo de la información obtenida, utilizando el método de redes semánticas naturales. Resultados. A partir de las ocho palabras que los alumnos asociaron con el término estudiado y que prevalecieron a lo largo de los cinco años de la investigación, se obtuvo la siguiente definición: ‘La psicología médica considera a la mente del paciente dentro de la relación de ayuda por parte del médico, que comprende su personalidad en pro de la salud’. Conclusiones. El estudio sistemático de la asignatura ‘Psicología Médica’ parece brindar al alumno recursos que favorecen la consolidación de términos que permanecen a lo largo de sus estudios y que se reflejarán en una futura práctica profesional más humanista

Introduction: Medical psychology constitutes an important part of the formation of a medical student and little has been studied on the way these students conceive it. Aim: To analyze the structural and restructuring process in medical students of the term 'medical psychology'. Subjects and methods: The sample was formed by a group of students from the Faculty of Medicine of the National Autonomous University of Mexico, who belonged to a Higher Academic Demands Course and was followed during their five years of studies. It was a prospective, observational, and longitudinal with annual cross-sections study, with quantitative and qualitative analysis of the information obtained through the implementation of the natural semantic network method. Results: From the eight words that were constant throughout the years, the next definition emerged: ‘medical psychology considers that the mind of the patient in relation to the help the doctor gives helps to understand his personality in favour of his health'. Conclusions: The systematic study the subject of 'Medical Psychology' seems to give the students resources to help consolidate terms that will be with him all along his studies and hopefully will permit him to develop a humanistic attitude that will remain with him during his professional life

[Factors that predict depression in medical students]. / Factores que predicen depresión en estudiantes de medicina.

INTRODUCTION: High prevalence of depression and anxiety symptoms has been observed in medical students. OBJECTIVE: To identify predictors of depressive symptoms according to CES-D in students during their first year of medical education. METHODS: We evaluated 517 students in their first year of medical education with the following instruments: Centers for Epidemiology Studies for Depression Scale, State-Trait anxiety inventory, and stressors list. A linear regression analysis was carried out to evaluate variables predicting high CES-D scores. RESULTS: We observed that anxiety and depressive symptoms were more frequent in women, as well as stressors. Predictors of depression were state of anxiety, stressors, and low socioeconomic level. CONCLUSIONS: It is important to implement support measures for students who live with stress factors, suffering anxiety, or with a low socioeconomic level.