Consumo de marihuana: análisis autobiográfico de caso paradigmático entre un adolescente consumidor y un no consumidor / Marijuana consumption: autobiographical analysis of a paradigmatic case between a consumer adolescent and a non-consumer

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The experience of time in habitual teenage marijuana smokers.

The research is qualitative; it studies the experience of time in young people who smoke marijuana in excess, given the high rate of smoking in the teenage years, a delicate stage regarding the planning of the future. Our objective is to see how the relationship between past and future plans is manifested in their biography, through goals and actions, in light of their ability to anticipate themselves. Our guiding principle is the ability to "anticipate oneself", proposed by Sutter, a phenomenological psychiatrist. The information was obtained from the analysis of autobiographies of young persons through the hermeneutical phenomenological method developed by Lindseth, based on Ricoeur. The results reveal that in the biographies the past temporal dimension is characterized by poor descriptions, the present is where they extend themselves most, describing tastes, how they visualize themselves, but showing a lack of clarity in their interests. In the future we see the absence of reference, giving the impression of no progression from the past, and without awareness of the fact that the future possibilities or lack thereof are heavily dependent on present actions.

Vivencia de la temporalidad en adolescentes consumidores habituales de marihuana / The experience of time in habitual teenage marijuana smokers

La investigación es cualitativa, estudia la vivencia del tiempo en los jóvenes consumidores abusivos de marihuana, dado el alto consumo en la adolescencia, etapa delicada en relación con la planificación del proyecto futuro. Nuestro objetivo es ver cómo se evidencia en su biografía la relación entre el pasado y proyectos futuros, a través de metas y acciones, en relación a su capacidad de anticiparse. Nuestro concepto rector es la capacidad de "anticipación" desarrollado por Sutter, psiquiatra fenomenológico. La información se obtuvo del análisis de autobiografías de jóvenes a través del método fenomenológico hermenéutico desarrollado por Linseth, basado en Ricoeur. Los resultados revelan que en las biografías la dimensión temporal pasada se caracteriza por descripciones pobres, el presente es donde más se explayan, describiendo gustos, cómo se visualizan, pero mostrando falta de claridad en intereses. En el futuro vemos ausencia de referencia, dando la impresión que éste no estuviese ligado al pretérito, y sin conciencia sobre el hecho que las posibilidades que se abren o cierran del futuro son dependientes delo que se hace en el presente

The research is qualitative; it studies the experience of time in young people who smoke marijuana in excess, given the high rate of smoking in the teenage years, a delicate stage regarding the planning of the future. Our objective is to see how the relationship between past and future plans is manifested in their biography, through goals and actions, in light of their ability to anticipate themselves. Our guiding principle is the ability to "anticipate oneself", proposed by Sutter, a phenomenological psychiatrist. The information was obtained from the analysis of autobiographies of young persons through the hermeneutical phenomenological method developed by Lindseth, based on Ricoeur. The results reveal that in the biographies the past temporal dimension is characterized by poor descriptions, the present is where they extend themselves most, describing tastes, how they visualize themselves, but showing a lack of clarity in their interests. In the future we see the absence of reference, giving the impression of no progression from the past, and without awareness of the fact that the future possibilities or lack thereof are heavily dependent on present actions

Efectos del consumo de marihuana en escolares sobre funciones cerebrales demostrados mediante pruebas neuropsicológicas e imágenes de neuro-SPECT / Effects of marihuana consumption in school children on brain functions demonstrated by means of neuropsychological tests and neuro-SPECT imaging

Comparative study based on 565 adolescent school children coming from four schools in the metropolitan area of Santiago, Chile. All were interviewed in order to select a sample that was stratified for sex, class and condition of consumer or non-consumer. The variables of intellectual coefficient and socioeconomical level were maintained constant. With this selection we conformed two groups: 40 consumers exclusively of marihuana and 40 non-consumers. We compared the results obtained in both groups in the neuropsychological tests while the neuroSPECT studies of consumers were compared against a normal database for the same age group. The adolescent consumers of marihuana demonstrate less cognitive capacity related to the process of learning such as attention, concentration, ranking, viso-spatial integration, immediate retention and visual memory. The differences between both groups are statistically significant. The findings of neuroSPECT demonstrate subgenual hypoperfusion bilaterally, more marked on the left side, in area 25 of Brodmann. This area controls mood. There is also frontal bilateral hypoperfusion (area 10 and area 32 of Brodmann). Area 32 is pre-anterior cingulate gyrus. Also hypoperfusion of the anterior cingulate gyrus (area 24 of Brodmann) and hypoperfusion of area 36 of Brodmann that projects over the hippocampus. Students that were consumers exclusively of marihuana demonstrate coincident abnormal findings of neuroimages and neuropsychological tests in areas of the brain related with learning and also significant differences between consumers with non-consumers in the neuropsychological tests.

Estudio comparativo basado en 565 escolares adolescentes pertenecientes a cuatro colegios de Santiago, Chile. Fueron encuestados todos para seleccionar una muestra estratificada por sexo, curso y condición de consumidores o no consumidores, manteniendo constante las variables coeficiente intelectual y nivel socioeconómico. Se conforman dos grupos: 40 consumidores exclusivos de marihuana y 40 no consumidores. Se comparan los resultados obtenidos en ambos grupos en los Test Neuropsicológios y del NeuroSPECT de consumidores con una base de datos considerados normales para el mismo grupo etario. Los adolescentes consumidores de marihuana evidencian menores habilidades cognitivas asociadas al proceso de aprendizaje, tales como atención, concentración, jerarquización, integración visoespacial, retención inmediata y memoria visual. Las diferencias entre ambos grupos son estadísticamente significativas. Los hallazgos del NeuroSPECT muestran hipoperfusión subgenual bilateral, más marcada en el hemisferio izquierdo (área 25 de Brodmann), hipoperfusión frontal bilateral (areas 10 y 32 de Brodmann), hipoperfusión del gyrus cingulado anterior (área 24 de Brodmann) e hipoperfusión del área 36 de Brodmann que proyecta sobre el hipocampo. Los estudiantes consumidores exclusivamente de marihuana muestran compromiso coincidente en neuroimágenes y test neuropsicológicos en áreas del cerebro relacionadas con el aprendizaje y se diferencian significativamente de los no-consumidores en las pruebas neuropsicológicas.

Adolescentes consumidores de marihuana: implicaciones para la familia y la escuela / Teenage consumers of marijuana: implications for the familiy and the school

Human groups make up for themselves, for the others and for the events they live explanations that, although not scientific, determine the practices that regulate their behavior. In the case of marijuana consumption, the representations of young people in particular and society in general influence the decision about whether or not to continue consuming. The perception of risk associated with consumption by high school students dropped from 60% in 1994 to 36.9% in 2004, which backs up the relationship between high consumption and low risk perception. Cannabis is the illegal drug with the highest indexes of consumption in the world with an increasing growth rate, to which we may add the alarming reduction in the age when people begin consuming it. This research paper is concerned with the effects of consumption on cognitive processes in school and social performance: a drop in performance, more problems getting along with others, absenteeism and drop out. The study aims to know how low marihuana doses affect cognitive ability in post-primary students. There are no studies concerned with the effect of marihuana in non-patient students (i.e. not diagnosed with addictive behavior and not considered socially as drug addicts). Material and methods Sample: The sample comes from high school students in public schools, private subsidized schools and private paying schools. The sample was stratified by non-proportional affixation, considering the sex, course and social economic level variables, and was made up of 304 students in high schools of the Metropolitan Area (Santiago), belonging to low, medium, and high socioeconomic groups (determined by dependence and the city in which the school is located). The research is descriptive, not experimental, ex post facto. Instruments: Group application to the entire sample (n = 304) a) Psychosocial evaluation and consumption questionnaire, abbreviated and adapted, aimed at the collection of demographic data, consumption behaviors and other required information. The young people are identified with a number in order to ensure their anonymity and thus promote the truth of the responses. b) Domino Test (D-48): Evaluates non-verbal intelligence. It controls differences caused by social and educative factors. It is applied on a group basis in order to discard subjects whose IQ is lower than average, regardless of consumption. Individual application to the consumer group and the non-consumer group. a) Rey Complex Figure Test: Widely used in recent studies on the effects of drugs on teenagers. Evaluates neuropsychological functioning. b) Benton Test: Evaluates current intellectual efficiency from the attention span, concentration and immediate retention. c) Verbal memory (Rey): Evaluates immediate verbal memory. Results General: The total results for the three schools polled and evaluated show that 14.5% of the students declared that they consumed marijuana at least four times during the last month. The proportion in the three establishments is not distributed in a homogenous fashion, but is concentrated in the low social economic level school (27.8%), with the lowest percentage in the high social economic level school. With regard to sex, 11% are girls and 15.7% are boys. Although a higher proportion of the boys consumed, the consumption in girls shows a sustained increase in recent years. A significant group is beginning to consume marijuana at age 15 or even earlier. The perception of risk associated with frequent consumption and the possibility of quitting smoking on a voluntary basis show significant differences: among consumers (C), 51% consider that there is no risk or negative effect in consumption, while only 10% of non-consumers (NC) share this perception. Protective factors or those associated with risk The family. In this study, the objective characteristics of families are not researched, but only the perception teenagers have of them. In any case, only 24% of the C state that their families have any influence on what they think, and another 54.8% agrees that they would not do anything, or simply do not know how their parents would react if they found out they consumed. School. The results on the perception of consumers and non-consumers in the school context shows that in general consumers perceive the school as less demanding than non-consumers as far as the existence of disciplinary standards is concerned. Regarding the reactions of teachers who found out that the students consumed, the proportion of NC who perceive the teacher in a more active role is higher: they would scold him (24.1%), they would talk to the student (27.6%). While only 10% believe that they would do nothing, 32.6% of the C share this perception. Around 35% of the total group does not know what the teacher would do. Peer groups. In the case of C, more than half of them (54.2%) state that it is their friends who have more influence on the way they think, compared to 29.5% of the NC who believe the same thing. The friends and classmates of the C are perceived by them (67.4%) as not caring about whether they consume or not. This perception is reversed in the case of the NC, in which the majority (63.7%) consider that the group would try to dissuade their consumption. They add that in 74% of the cases the student states that marijuana is provided by persons close at hand: friends (74%) and acquaintances (12%). Conclusions Regarding group behavior in general: In demographic terms, the results show that the number of consumers in schools belonging to the marginal and economically deprived sectors is higher than that detected in medium and high socio-economic level schools. In all sectors we see people starting to consume marijuana at ever younger ages: 15 years and even less, in a significant percentage of the sample. The results coincide with the majority of studies performed recently, which point to a sustained reduction in the age when people start consuming, which considerably increases the risks of damage. Effects of consumption on cognitive functions: On workstyle. By comparing the results of the two groups (consumers and non-consumers) we can conclude that consumers obtain much lower scores than the control group in tests that evaluate accuracy and workstyle, showing strategies and approaches to the task which could be expected from subjects with possible neurological damage. Visual and verbal memory. As far as visual memory is concerned, the results of consumers indicate scores far lower than those achieved by control groups in tasks that require this kind of memory to be carried out successfully. Despite consumers having obtained somewhat lower scores, verbal memory does not appear to be so damaged. Attention, concentration. According to their performance on tests that evaluate current intellectual efficiency from the ability to focus/concentrate and retain information for a short time, the results are significantly lower in the consumer group. The results suggest a possible alteration in the integration and structuring of spatial stimuli, if we consider the large number of errors made by consumers and that they may indicate organic and cerebral damages. Even though from the results of this work it is not possible to determine with accuracy the magnitude of the damage caused or even if this damage is the direct and exclusive effect of the consumption of marijuana, we can establish: a) a clear association between consumption and a significant drop in scores in the cognitive functions evaluated compared to what was expected, b) scores significantly lower than those obtained by the control groups consisting of non-consumers, and c) deficiencies in the styles and strategies of execution employed in the task and in the organization of the material.

La cannabis es la droga ilegal con más altos índices de consumo en el mundo. Su consumo mantiene un ritmo de crecimiento sostenido y a él se suma una disminución alarmante en la edad de inicio. En los 10 últimos años, la percepción de riesgo asociada al consumo entre estudiantes secundarios descendió de 60% en 1994 a 36.9% en 2004, lo que sustenta una relación entre alto consumo y baja percepción de riesgo. El efecto de la marihuana en pocas dosis y en escolares no consultantes y no rotulados socialmente como drogadictos, no se conoce, es por ello que nuestro estudio pretende averiguar cómo este consumo afecta en las habilidades cognitivas necesarias para el aprendizaje. Material y métodos Muestra: Se conformó con alumnos de educación media de liceos municipalizados, particulares subvencionados y particulares pagados. La muestra se estratificó por afijación no proporcional, considerando las variables sexo, curso y nivel socioeconómico, y estuvo conformada por 304 alumnos de liceos del Área Metropolitana (Santiago), pertenecientes a los niveles socioeconómicos bajo, medio y alto (determinados por dependencia y comuna en que se ubica el establecimiento). La investigación es descriptiva, no experimental, ex post facto. Instrumentos aplicados: a)Cuestionario de Evaluación Psicosocial y Consumo, b)Test de Dominó (D-48),c) Test de la Figura Compleja de Rey, d) Test de Benton, e)Memoria de palabras (Rey). Resultados Los resultados totales para los tres colegios encuestados y evaluados muestran que 14.5% de los alumnos afirman haber consumido marihuana al menos en cuatro ocasiones durante el último mes. La proporción que corresponde a los tres establecimientos no se distribuye homogéneamente, sino que se concentra en el liceo de nivel socioeconómico más bajo (27.8%), con el menor porcentaje en el nivel socioeconómico más alto. En relación con el género, 11% son mujeres y 15.7%, varones. Si bien los varones consumen más, el consumo en mujeres muestra un aumento sostenido en los últimos años. Respecto de la edad de inicio, un grupo importante por el riesgo que representa la precocidad en el inicio comienza a consumir a los 15 años e incluso antes. Del total de consumidores, 51% consideran que no existe ningún riesgo ni efecto negativo en el consumo, mientras sólo 10% de los no consumidores (NC) comparten esa percepción. Factores protectores o asociados a riesgo La familia. En este estudio, no se investigan las características objetivas de las familias, sino solamente la percepción que tienen de ellas los adolescentes. Como quiera que sea, sólo 24% de los consumidores afirman que su familia tiene influencia en lo que piensan, sumado a que 54.8% coinciden en que no harían nada o simplemente no saben cómo reaccionarían sus padres si los descubrieran consumiendo. Colegio. Los resultados sobre la percepción de los consumidores y no consumidores en relación con el colegio muestran que en general los primeros perciben el colegio como menos exigente que los segundos en cuanto a la existencia de normas disciplinarias. Conclusiones En todos los sectores se aprecia un inicio cada vez más precoz del consumo, 15 años e incluso antes, en un importante porcentaje de la muestra, hecho que aumenta considerablemente los riesgos de daño. Efectos del consumo en las funciones cognitivas relacionadas con el rendimiento escolar: a) En estilo de trabajo: podemos concluir que los consumidores obtienen rendimientos significativamente inferiores a los grupos control en las pruebas que evalúan la precisión y el estilo de trabajo; muestran asimismo estrategias y formas de abordaje de la tarea esperables en sujetos menores o con posibles daños neurológicos; b) Memoria visual y verbal: en cuanto a la primera, los resultados de los consumidores indican puntajes muy inferiores a los logrados por los grupos controles, mientras que la memoria verbal no parece estar tan comprometida; c) Atención, concentración y retención inmediata: los resultados son significativamente inferiores en el grupo consumidor. Los resultados sugieren una posible alteración en la integración y estructuración de los estímulos espaciales si se considera el alto número de errores cometidos por los consumidores, los cuales pueden ser indicativos de daños orgánicos cerebrales.

Proceso de duelo y muerte / Death and grief process

S. Freud definió duelo como un afecto normal que se presenta en los seres humanos como reacción frente a la pérdida de una persona amada o de una abstracción que haga sus veces, como la patria, la libertad, un ideal, etc. En este sentido el duelo no sólo se presentaría frente a la muerte de un ser querido, sino también con relación a situaciones que impliquen la evidencia para el sujeto de una falta, o de algo que ha de dejar atrás y que no volverá a recuperar, pero que deja siempre un recuerdo.

[On doctor-patient communication from an anthropological and social point of view]. / Acerca de la comunicación médico-paciente desde una perspectiva histórica y antropológica.

This paper attempts to perform a historical anthropological analysis of the factors that currently either favor or obstruct the doctor-patient relationship. For this purpose, the main works of reference are the sociologist Gilles Lipovetsky and the Spanish author Pedro Laín Entralgo. The former, identified with the concept of Postmodernity and individual Hedonism, is crucial in understanding what are the main determinants in the most recent developments affecting the doctor-patient relationship. Since the technological revolution, advances in science have surpassed all imagination, information technology has worked its way into all types of relationship, and thus medical practice has been particularly affected. On the other hand, the work of Laín Entralgo enables us to perform a review of the history of the doctor-patient relationship in the Western world, which affords a more accurate view of the origins and evolution of the current situation.

Adolescentes con problemas de orientación sexual: implicaciones para la terapia / Identity formation in adolescents with sexual orientation problems: implications for therapy

A los desafíos propios del período, un número no despreciable de adolescentes deben afrontar la difícil tarea de formación de la propia identidad, teniendo que integrar aspectos del sí mismo descalificados desde la sociedad, la cultura, la moral, los valores imperantes, etc. Son los adolescentes con dificultades de orientación sexual: gays, lesbianas y bisexuales. El tema central de esta monografía es la formación de la identidad en este grupo de adolescentes, las problemáticas que le son propias y algunas implicaciones para la terapia, en la línea de la Terapia Familiar Sistémica.

Enseñanza de entrevista médica en escuelas de medicina / Teaching of medical interviewing at medicine school

La enseñanza de entrevista médica, considerada cada vez más importante en las escuelas de medicina, ha progresado en la última década. Después de revisar los déficits de la situación previa, se muestra como una comunicación efectiva es parte integral del diagnóstico, logra mejorar la adherencia a los tratamientos indicados, asegura la seguridad del acto médico y de los usuarios, y hace un mejor uso de los recursos destinados a salud. Se revisan dos modelos actuales para la enseñanza de la entrevista: el funcional de Bird y Cole, y el estructural de Lipkin. El primero describe las tres funciones centrales de la entrevista: recopilar información para formular un diagnóstico, fortalecer la relación médico-paciente, y educar y motivar al paciente en su tratamiento. El segundo estudia la secuencia y las destrezas utilizadas en la entrevista, en una sucesión de apertura, exploración y cierre. Se revisan las principales técnicas de enseñanza utilizadas, tales como modelaje, juegos de rol y retroalimentación. Se concluye subrayando la necesidad de la capacitación en destrezas comunicacionales en un formato vivencial y discutiendo la ubicación curricular y la necesidad de evaluar la efectividad de la adquisición de estas destrezas a lo largo de la formación médica