Disregulación emocional en el trastorno por déficit de atención e hiperactividad infantil / Emotional dysregulation in childhood attention deficit and hyperactivity disorder

INTRODUCCIÓN: El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo. Se ha documentado que existe comorbilidad importante con alteraciones en la regulación emocional, pudiendo confundirse con trastornos del estado de ánimo; el objetivo de este trabajo es actualizar la información sobre la expresión alterada de la infancia (disregulación emocional) en el TDAH. MÉTODOS: Se aplicó la estrategia PICO, se utilizaron descriptores de acuerdo al Medical Subject Headings, y se usaron bases de datos ampliamente conocidas. RESULTADOS: Fue relevante documentar que diversos autores encuentran que la asociación entre la expresión emocional anormal y el TDAH está presente, mientras que otros establecen una base neuroanatómica y neuropsicológica en esta asociación, considerando precisamente las bases en la regulación normal inherente al ser humano. CONCLUSIÓN: La disregulación emocional y el TDAH son dos trastornos que están relacionados, la evidencia es clara y sin lugar a dudas el mayor conocimiento de sus bases biológicas y psicológicas, permitirá en el futuro mejorar el pronóstico médico y la calidad de vida de los infantes. Es importante destacar que de acuerdo a la evidencia no toda problemática emocional en menores con TDAH es sinónimo de disregulación emocional.

INTRODUCTION: ADHD is a neurodevelopmental disorder. It has been documented that there is significant comorbidity with an alteration in emotional regulation, witch can be confused with mood disorders. The purpose of this work is to update the information on the altered expression of emotions in childhood (emotional dysregulation) in attention deficit and hyperactivity disorder (ADHD). METHODS: The PICO strategy was applied, descriptors were used according to the Medical Subject Headings, and well-known databases were used. Results: It was relevant to document that several authors describe an association between abnormal emotionalal expression and ADHD, while others also have a neuroanatomical and neuropsychological basis for this association. CONCLUSION: There is strong evidence for a relationship between emotional dysregulation and ADHD, understanding its biological and psychological foundations will allow for a better prognosis and quality of life. It is important to emphasize that, according to the evidence, not all emotional problems in children with ADHD are synonymous with emotional dysregulation.

Alteraciones endocrinas vinculadas a la prescripción médica de carbonato de litio. Una revisión narrativa / Endocrinological Disorders Related to the Medical Use of Lithium. A Narrative Review

RESUMEN La prescripción de carbonato de litio es común en la actividad psiquiátrica cotidiana. El objetivo es identificar las alteraciones endocrinas secundarias y sus bases fisiopatológicas. La revisión de la literatura se realizó en Psycinfo, EMBASE, PubMed y Scopus. Se efectuó una búsqueda computarizada de información utilizando la estrategia PICO. Las alteraciones más comunes están en riñones, tiroides, paratiroides, páncreas y vías neuroendocrinas. Los mecanismos fisiopatológicos subyacentes son diversos, y destacan la inhibición de la adenilato ciclasa tiroidea sensible a tirotropina como causa de hipotiroidismo, la expresión reducida de acuaporina 2 como causa de diabetes insípida nefrogénica, la pérdida del equilibrio iónico del calcio y la presencia de hiperparatiroidismo e hipercalcemia. En el eje hipotálamo-hipófiso-adrenal, se documenta una disminución en la producción de catecolaminas. Finalmente, se documenta la desregulación en el control de la glucemia al aumentar la resistencia a la insulina. Es necesario conocer estas eventualidades e identificarlas tempranamente a través de evaluaciones periódicas. Se propone un esquema de evaluación integral, sin que implique un algoritmo de tratamiento.

ABSTRACT The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.

Endocrinological Disorders Related to the Medical Use of Lithium. A Narrative Review. / Alteraciones endocrinas vinculadas a la prescripción médica de carbonato de litio. Una revisión narrativa.

The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.

[Psychiatric manifestations by prions. A narrative review]. / Manifestaciones psiquiátricas por priones. Una revisión narrativa.

Prion diseases are a group of rare and rapidly progressive neurodegenerative conditions that may cause neuropsychiatric symptoms. This group of diseases has been described since the 18(th) century, but they were recognized decades later, when it became clear that the humans were affected by infected animals. There was controversy when the problem was attributed to a single protein with infective capacity. The common pathological process is characterized by the conversion of the normal cellular prion protein into an abnormal form. In humans, the illness has been classified as idiopathic, inherited and acquired through exposure to exogenous material containing abnormal prions. The most prominent neurological manifestation of prion diseases is the emergence of a rapidly progressive dementia, mioclonus associated with cerebellar ataxia and also extra pyramidal symptoms. Psychiatric symptoms occur in early stages of the illness and can contribute to timely diagnosis of this syndrome. Psychiatric symptoms have traditionally been grouped in three categories: affective symptoms, impaired motor function and psychotic symptoms. Such events usually occur during the prodromal period prior to the neurological manifestations and consists in the presence of social isolation, onset of delusions, irritability/aggression, visual hallucinations, anxiety and depression, and less frequent first-rank symptoms among others. Definite diagnosis requires post mortem examination. The possibility that a large number of cases may occur in the next years or that many cases have not been considered with this diagnosis is a fact. In our opinion, psychiatrists should be aware of symptoms of this disease. The main objective of this research consisted of assessing the correlation between this disturbance and neuro-psychiatric symptoms and particularly if this psychiatric manifestations integrate a clinical picture suggestive for the diagnosis of these diseases, but firstly reviewed taxonomic, pathogenic and pathological aspects. The authors of this project also added an element in relation to some diagnostic considerations based on scientific evidence. For the search controlled descriptors applied to the research for indexing scientific articles in databases were used. The electronic data bases used were PubMed, EMBASE and also PsycInfo. The descriptors were prion diseases, psychotic disorders, depression, mood disorders, pathology, classification, prion protein, history, neurological manifestations, and psychiatric manifestations. The selection criteria for the material were qualitative. To conclude, and based on the extensive literature review, the authors propose that the period where the evidence is more robust for mental impaired is named "psychiatric symptoms phase, which can be extended for a few months, being the psychiatric affective symptoms the most characteristic of this phase. In conclusion, we considered that the identification of these symptoms in a patient with risk factors for developing the disease will contribute to the early identification, and would regulate the guidelines in suspected diagnosis of this group of disorders. The intention is provide a better quality of life to the sick people.

Manifestaciones psiquiátricas por priones. Una revisión narrativa / Psychiatric manifestations by prions. A narrative review

Las enfermedades priónicas son un grupo de enfermedades neurodegenerativas raras y rápidamente progresivas que causan síntomas neuropsiquiátricos diversos. Estas enfermedades se describieron hace más de 200 arios, y con el tiempo se reconoció que los animales eran portadores de esta alteración; sin embargo, hasta finales de los noventa este problema conmocionó Europa, ya que para entonces la enfermedad había cruzado la barrera de especie y podía afectar al hombre. La polémica fue mayor al atribuirse la alteración a una proteína con capacidad infecciosa. El proceso patológico común se caracteriza por la conversión de la proteína priónica celular normal (PsPc) a una forma anómala y patológica (PrPSc). En el ser humano se han clasificado como padecimientos idiopáticos, hereditarios o adquiridos por la exposición a material exógeno con contenido priónico. La manifestación neurológica más sobresaliente de las prionopatías consiste en la aparición de una demencia rápidamente progresiva asociada a mioclonías y ataxia cerebelosa, además de síntomas extrapiramidales. Los síntomas psiquiátricos ocurren en etapas tempranas de la enfermedad y su presencia, además de la valoración de factores de riesgo, puede contribuir al diagnóstico oportuno de este síndrome. Clásicamente los síntomas psiquiátricos se han agrupado en tres categorías: síntomas afectivos, alteraciones de la motricidad y síntomas psicóticos. Este tipo de manifestaciones suele aparecer durante un periodo prodrómico previo a los signos neurológicos y consiste en la aparición de aislamiento social, ideas delirantes, irritabilidad/agresión, alucinaciones predominantemente visuales, ansiedad y depresión, así como otros menos frecuentes. El diagnóstico definitivo requiere de un estudio post mortem. La posibilidad de que un número mayor de casos pueda ocurrir en los próximos años o que en muchos pacientes no se haya considerado el diagnóstico es una realidad. En opinión de los autores de este trabajo, los psiquiatras debemos tener conocimiento de los síntomas de esta enfermedad. El objetivo de esta investigación es evaluar las alteraciones neuropsiquiátricas presentes en las prionopatías y, en particular, determinar si las manifestaciones psiquiátricas en conjunto integran un cuadro clínico que apunte al diagnóstico de estas enfermedades, aunque en primer término se revisan aspectos taxonómicos, patogénicos y patológicos. Como elemento agregado en este trabajo, los autores hacen algunas consideraciones diagnósticas basadas en la evidencia científica disponible hasta el momento. Los descriptores controlados aplicados a la búsqueda bibliográfica son los utilizados para indexación de artículos científicos en las bases de datos. Las bases de datos y EMBASE, aunque también se empleó PsycInfo. Los descriptores empleados son: enfermedades priónicas, trastornos psicóticos, depresión, trastornos afectivos, patología, clasificación, proteína priónica, historia, manifestaciones neurológicas y manifestaciones psiquiátricas. Los criterios de selección de material fueron cualitativos. Como conclusión y con base en la extensa bibliografía revisada, los autores plantean que el periodo en que hay más evidencia de alteraciones en la esfera mental se denomine «fase de síntomas psiquiátricos¼, la cual puede extenderse por algunos meses (hasta 4). Los síntomas afectivos son los más característicos de dicha fase. Como conclusiones, se considera que la identificación de estos síntomas en un paciente con factores de riesgo de sufrir esta enfermedad contribuiría a la identificación temprana del padecimiento y normaría qué pautas seguir ante la sospecha del diagnóstico de este grupo de trastornos, sobre todo con la idea de mejorar la calidad de vida de estos pacientes.

Prion diseases are a group of rare and rapidly progressive neurodegenerative conditions that may cause neuropsychiatric symptoms. This group of diseases has been described since the 18th century, but they were recognized decades later, when it became clear that the humans were affected by infected animals. There was controversy when the problem was attributed to a single protein with infective capacity. The common pathological process is characterized by the conversion of the normal cellular prion protein into an abnormal form. In humans, the illness has been classified as idiopathic, inherited and acquired through exposure to exogenous material containing abnormal prions. The most prominent neurological manifestation of prion diseases is the emergence of a rapidly progressive dementia, mioclonus associated with cerebellar ataxia and also extra pyramidal symptoms. Psychiatric symptoms occur in early stages of the illness and can contribute to timely diagnosis of this syndrome. Psychiatric symptoms have traditionally been grouped in three categories: affective symptoms, impaired motor function and psychotic symptoms. Such events usually occur during the prodromal period prior to the neurological manifestations and consists in the presence of social isolation, onset of delusions, irritability/aggression, visual hallucinations, anxiety and depression, and less frequent first-rank symptoms among others. Definite diagnosis requires post mortem examination. The possibility that a large number of cases may occur in the next years or that many cases have not been considered with this diagnosis is a fact. In our opinion, psychiatrists should be aware of symptoms of this disease. The main objective of this research consisted of assessing the correlation between this disturbance and neuro-psychiatric symptoms and particularly if this psychiatric manifestations integrate a clinical picture suggestive for the diagnosis of these diseases, but firstly reviewed taxonomic, pathogenic and pathological aspects. The authors of this project also added an element in relation to some diagnostic considerations based on scientific evidence. For the search controlled descriptors applied to the research for indexing scientific articles in databases were used. The electronic data bases used were PubMed, EMBASE and also PsycInfo. The descriptors were prion diseases, psychotic disorders, depression, mood disorders, pathology, classification, prion protein, history, neurological manifestations, and psychiatric manifestations. The selection criteria for the material were qualitative. To conclude, and based on the extensive literature review, the authors propose that the period where the evidence is more robust for mental impaired is named "psychiatric symptoms phase, which can be extended for a few months, being the psychiatric affective symptoms the most characteristic of this phase. In conclusion, we considered that the identification of these symptoms in a patient with risk factors for developing the disease will contribute to the early identification, and would regulate the guidelines in suspected diagnosis of this group of disorders. The intention is provide a better quality of life to the sick people.

Factores de riesgo y consecuencias del cyberbullying en un grupo de adolescentes: Asociación con bullying tradicional / Risk factors and consequences of cyberbullying in teenagers: association with bullying

Introducción. En el cyberbullying se utilizan medios electrónicos para intimidar. El objetivo del presente trabajo fue determinar la prevalencia de cyberbullying, identificar algunas características, explorar asociación con el bullying y analizar factores de riesgo y consecuencias. Métodos. El estudio incluyó alumnos de secundaria. El cyberbullying se utilizó como variable de exposición y de resultado. Se aplicó estadística no paramétrica y regresión logística. Resultados. Se encuestaron 603 alumnos, con media de edad de 13.4 años (DE 0.98 años). Fueron más prevalentes las cibervíctimas. El teléfono celular fue la herramienta más utilizada para intimidar. El factor de riesgo más importante para cibervíctimas fue "sentirse inseguro en la escuela" (X²=6.485 p=0.011 OR=4.1 IC95% 1.30-11.2). Para ciberagresores, "usar la computadora a escondidas de los padres y a altas horas de la noche" (X²=14.584 p<0.05 OR=4.2 IC95% 2.10-16.30); para cibervíctimas-ciberagresores, "ser mujer" (X²=2.891 p>0.05 OR=3.50 IC95% 1.70-16.80). La mayor asociación con bullying fue para varones y entre los roles víctima-agresor tradicional y ciberagresor (X²=28.821 p<0.05 OR=7.37 IC95% 3.78-14.3). Al considerar al ciberbullying como variable de exposición, la principal consecuencia fue la cefalea para el rol de ciberagresor (X²=15.125 p<0.05 OR=7.91 IC95% 2.28-29.6). Conclusiones. La prevalencia de cyberbullying fue menor a otras investigaciones, pero los factores de riesgo y las consecuencias son relevantes.

Background. Cyberbullying uses electronic tools to intimidate. We undertook this study to determine the prevalence of cyberbullying and to identify its characteristics. We explored the association with bullying and analyzed consequences and risk factors. Methods. Junior-high-school students were included. Cyberbullying was used as exposure and outcome variable. Nonparametric statistic and logistic regression were applied. Results. Six hundred three students with a mean age of 13.4 years (SD 0.98 years) were included. Cybervictims were more prevalent. The cell phone was the most common tool used to intimidate. The most important risk factor for cybervictims was "feeling unsafe at school" (c² = 6.485 p = 0.011 OR = 4.1 95% CI 1.30-11.2); for cyberaggressors it was "to use the computer hidden from parents and late at night" (c² = 14.584 p <0.05 OR = 4.2 95% CI 2.10-16.30); for cybervictims-cyberaggressors it was "to be female" (c² = 2.891 p >0.05 OR = 3.50 95% CI 1.70-16.80). The strongest association with bullying was shown for males and between traditional victim-aggressor and cyberaggressor roles (c² = 28.821 p <0.05 OR = 7.37 95% CI 3.78-14.3). When cyberbullying was considered as the exposure variable, the most relevant outcome measure was "to have headaches" for cyberaggressors (c² = 15.125 p <0.05 OR=7.91 95% CI 2.28-29.6). Conclusions. The prevalence of cyberbullying was less than demonstrated in other studies, but the risk factors and consequences are relevant.

El DSM-V. Luces y sombras de un manual no publicado. Retos y expectativas para el futuro / DSM-V. Lights and shadows of an unpublished manual. Challenges and expectations for the future

Throughout its history, one of the most fascinating topics of psychiatry has been that of the causes and consequences of mental disorders. The desire to strengthen the reliability of diagnosis in this area has led to significant advances in two important fields: psychopathological description and the formulation of an integral diagnosis. Classifications allow the definition of categories and in the case of the two most read taxonomies in the field of mental health, Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), these provide the most commonly used criteria for diagnosis. The revised fourth edition of the DSM is now insufficient to cover the ever greater clinical challenges and research. For over ten years, work has been carried out on the structure of DSM-V (the fifth edition), but despite the planning, organization, prediction, and the contributions of guest experts, it is feared that all the requirements of modern psychiatry will not be met. The first edition of DSM was published in the 1950s. It was based on the terminology developed by William Meninger. This version of the manual and the following, published several years later, reflected the psychodynamic psychiatry which prevailed at the time. The third edition was published in 1980 and its revised edition seven years later. The emphasis here was on descriptive and syndromatic considerations. The fourth edition appeared several years later. The most striking change in this edition was the inclusion of variables resulting from empirical studies. A later edition was published in the year 2000. The first attempts to put together DSM-V started in 1999. From 1999 until 2007 work was done on the planning of the investigation and technical documentation of DSM-V and the inclusion of the so called investigation schedules. The second phase of the project, known as «the refinement of the research program for DSM-V¼, was carried out between 2004 and 2007. A pilot test was undertaken between January and May 2010, among different segments of the population and different settings, to evaluate the revisions proposed by the working teams. Between March and April 2011, as a result of the field tests, the proposed criteria for diagnosis were reviewed. The dimensional measurements and the criteria for diagnosis will be reviewed again during the rest of 2011. The year 2012 will see the preparation of the final version of the text, and finally, in May 2013, DSM-V will be presented at the annual meeting of the American Psychiatric Association in San Francisco, California. Several external and independent authors have offered numerous proposals on topics related to psychopathology in general to the working groups formed for the preparation of DSM-V. Only some of these are mentioned below. One of the first factors to be taken into consideration in the revision of the manual is the need to distinguish between empirical questions or approaches and those of a more conceptual or philosophical nature, which should, by no means, be excluded. Another point to be evaluated is the advisability of defining phases according to the development of the condition, which would ideally create a schema focused on prevention. One of the expectations of psychiatry is that eventually laboratory criteria of diagnosis could be established, which could be measurable and would lead to clear statistics of psychiatric pathologies. As far as somatomorphic disorders are concerned, many practitioners agree that the current terminology and the systems of classification are inaccurate. One proposal is that this category should be eliminated altogether and that diagnoses should be made using an additional multidimensional description. One of the most interesting features of DSM is that it has had to accommodate changes brought about by new technologies. These advances go hand in hand with a new series of pathologies which need to be classified, as is the addiction to Internet. Undoubtedly, one of the greatest dilemmas facing DSM is how to classify eating disorders, as many people feel that the rather simplistic distinction between nervous anorexia and bulimia is not altogether convincing. There are two interesting proposals to consider in DSM-V: one is known as night eater syndrome and obesity, as in this case there is a compulsive consumption of food and an inability to limit this intake, in spite of a desire to do so. With regard to the compulsive, obsessive disorder, most experts believe that it is necessary to see the disorder as a spectrum, but defining criteria. Undeniably, a grave current problem which makes no distinctions is suicide. Different researchers recommend that suicidal behavior be considered and documented as a separate diagnosis in a sixth axis of the multiaxis schema. Another important aspect concerns the giving of quality attention to patients. This has led to the proposal to expand DSM-V to include indicators for situations which could eventually be a cause for treatment. The proposal is to structure something different from what can be found in axis I V. In the case of paraphilias, it is deemed necessary that DSM-V should deal not only with the strictly descriptive aspect, but also with the semantic and linguistic. The importance of post-traumatic stress has been described, but there exists the doubt whether it is necessary to experience an adverse incident for this to be triggered. There has been a suggestion that the term «pre-traumatic¼ stress disorder be included in DSM-V to diagnose this condition. In the case of anxiety disorders, some authors advise the creation of a category known as «disorders caused by stress and fear¼, which would allow linking the diagnostic classification with etiology and thus define a «true¼ anxiety nosology. It would be advisable that the DSM-V included a category for «seasonal affective disorder¼ as such, and not simply as a variant in the «specification of the seasonal pattern¼ of depression. In the field of substance consumption, it has been argued that it is necessary to establish a classification which is not only categoric but also dimensional so as to improve its taxonomic usefulness. The organization of mental disorders in DSM-IV-TR and ICD-10 (tenth edition) is complex and this has led to exploring the feasibility of developing a meta-structural system of classification based on risk and clinical factors. For disorders originated in infancy, childhood and adolescence, it has been suggested that the disorder known as «temperament disorder by disphoria¼ be included in the forthcoming taxonomy, as well as the use of the terms insensitive/emotionless for behavioral disorders, among others. In the case of attention deficit hyperactivity disorder (ADHD), the current criteria are considered insufficient and it has been suggested that the starting age for this disorder be increased from 7 to 12 years of age. It is suggested that autism be considered autistic spectrum, thus eliminating the other disorders covered in this section, including Asperger syndrome. The question as to whether this taxonomic-diagnostic system, to be implemented world-wide, will be both valid and reliable enough to cover all variations and particular characteristics of different cultures, ethnic groups, social groups and geographical regions in Mexico is another matter of concern, due to the lack of tools available for daily clinical work, except for the International Classification of Diseases of the World Health Organization. There are, at present, a number of doubts and queries which will need to be laid open and evaluated in all seriousness in order to obtain concrete and integral answers, given that the manual will continue to be used for clinical purposes in different parts of the world. The challenge will be to find the best way to apply diagnostic criteria, avoiding omissions and oversimplifications and taking into account the cultural and social context worked in.

Un tema de gran interés a lo largo de la historia de la psiquiatría, ha sido el relacionado a los sistemas diagnósticos. El Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM por sus siglas en inglés) y la Clasificación Internacional de Enfermedades (CIE), integran los criterios diagnósticos comúnmente utilizados en la práctica psiquiátrica. El DSM en su cuarta edición revisada, es ya insuficiente para el trabajo clínico actual, por lo que se ha estado trabajando en la configuración de lo que será el DSM-V (quinta edición); no obstante, aún y con toda la planeación, se teme que no se logren cubrir todas las necesidades de la psiquiatría moderna. La primera edición del DSM fue publicada en la década de 1950; esta versión del manual, y la subsiguiente, reflejaban la psiquiatría psicodinámica de esa época. En la década de 1980 se publicó la tercera edición y su versión revisada, en las que predominaban las consideraciones descriptivas y sindromáticas. Años después fue publicada la cuarta versión y una revisión posterior de este manual en el año 2000. Los primeros esfuerzos para iniciar el proceso de integración del DSM-V se iniciaron desde 1999. Desde ese año, hasta el 2007, se planificó la investigación y la documentación técnica por medio de un programa de investigación. Del año 2004 al 2007 se llevó a cabo la segunda fase del proyecto denominada «perfeccionamiento del programa de investigación para el DSM-V¼. De enero a mayo del 2010 se efectuó una prueba piloto con diferentes poblaciones y las revisiones propuestas por los grupos de trabajo. En el 2011 se revisarán los criterios diagnósticos propuestos y las medidas dimensionales. En el año 2012 se preparará el proyecto de texto final, y en mayo del 2013 se planea presentar el DSM-V en la Reunión Anual de la Asociación Psiquiátrica Americana, en San Francisco, California. Han sido numerosas las propuestas de autores externos e independientes para el desarrollo del DSM-V, como es el caso de la conveniencia de definir estadios de acuerdo a la progresión de la enfermedad o bien establecer criterios diagnósticos de laboratorio, e incluso favorecer una estadificación clara de las patologías psiquiátricas. En cuanto a los trastornos somatomorfos, muchos clínicos están de acuerdo en eliminar esta entidad y elaborar los diagnósticos con una descripción multidimensional adicional. Algunos expertos proponen integrar un diagnóstico denominado «adicción al Internet¼. Diferentes investigadores recomiendan que el comportamiento suicida sea considerado como un diagnóstico separado y documentado en un sexto eje del esquema multiaxial. Hay dos propuestas interesantes para el DSM-V, una es el síndrome del comedor nocturno y la otra la obesidad, al existir en estos casos un consumo compulsivo de alimentos y una dificultad para restringirlos, lo que podría tener implicaciones adictivas. En el caso de las parafilias se plantea la necesidad de que se trabaje en el aspecto descriptivo, semántico y lingüístico. Se ha descrito la importancia del estrés postraumático, pero se sugiere también un trastorno de estrés «pre-traumático¼ como diagnóstico en el DSM-V. En los trastornos de inicio en la infancia, niñez y adolescencia, se ha planteado incluir en la próxima taxonomía el denominado «trastorno por disregulación del temperamento con disforia¼. En lo referente al trastorno por déficit de atención e hiperactividad (TDAH) se considera que los criterios actuales son insuficientes, y se propone incrementar la edad de inicio del trastorno. Para el autismo se sugiere considerarlo como espectro autista, eliminando el trastorno de Asperger. Finalmente en opinión de los autores de este trabajo, existe por el momento una diversidad de cuestionamientos que deberá valorarse con seriedad, toda vez que el manual evidentemente seguirá siendo de uso clínico continuo en diferentes latitudes. El desafío será establecer la mejor forma de aplicar los criterios diagnósticos tomando en cuenta el contexto cultural y social en el que se trabaja, lo que, por lo revisado, sigue siendo un punto pendiente para los encargados de revisar la próxima versión del manual.

Bullying en alumnos de secundaria. Características generales y factores asociados al riesgo / Bullying in junior high school students. General characteristics and associated risk factors

Introducción. El bullying es una conducta de hostigamiento físico y/o psicológico entre los alumnos en un plantel escolar. En México 25% de los alumnos ha sufrido violencia en sus escuelas. El objetivo de este trabajo fue determinar prevalencia del bullying y explorar las variables asociadas con el riesgo de esta conducta. Métodos. Mediante la resolución de un cuestionario autoaplicable se seleccionaron alumnos de entre la población de una misma secundaria pública, hombres y mujeres, con base en la presencia o la ausencia del rol de víctima, agresor o víctima-agresor. Para el análisis estadístico se aplicaron las pruebas X² y regresión logística. Resultados. De un grupo de 688 alumnos con una media de edad de 13.62 ± 0.96 años se identificaron 20.5% víctimas, 13.1% agresores y 27.4% víctimas-agresores. Los factores de riesgo relevantes para las víctimas fueron: tener algún defecto físico (X² = 21.59, p = 0.000, OR 2.86, IC 95% 1.82-4.50), los padres consideran normal el problema (X² = 30.23, p = 0.000, OR 5.79, IC 95% 2.92-11.47); para los agresores: preferir programas televisivos violentos (X² = 10.38, p = 0.001, OR 2.22, IC 95% 1.36-3.62), tener amigos que pertenezcan a pandillas (X² = 31.78, p = 0.000, OR 4.05, IC 95% 2.45-6.71); para las víctimas-agresores destaca la combinación de factores inherentes a ambos grupos por separado. Conclusiones. El bullying en la escuela es una conducta prevalente y los factores asociados al riesgo son diversos.

Background. Bullying is physical harassment and/or psychological abuse among students at school. In Mexico, up to 25% of the students have experienced violence at school. The objective of this study was to determine the prevalence of bullying and to explore associated risk factors. Methods. Students of both genders from a junior high school were included and selected from the same population, based on the presence of being a victim, aggressor or victim-aggressor role according to self-reported questionnaire responses; X² and logistical regression statistics were applied. Results. Six hundred eighty eight students with a mean age of 13.62 ± 0.96 years were included; 20.5% victims, 13.1% aggressors and 27.4% victims-aggressors were identified. Major risk factors for victims were "have a physical defect" (X² = 21.59, p = 0.000, OR 2.86, 95% CI 1.82-4.50) and "parents considering bullying a normal problem" (X² = 30.23, p = 0.000, OR 5.79, 95% CI 2.92-11.47); for aggressors: "preference for violent television programs" (X² = 10.38, p = 0.001, OR 2.22, 95% CI 1.36-3.62) and "friends who belongs to gangs" (X² = 31.78, p = 0.000, OR 4.05, 95% CI 2.45-6.71); victims-aggressors present a highlighted combination of risks factors from both roles. Conclusions. There is a high prevalence of bullying at school with a variety of associated risk factors.

Ciberbullying: forma virtual de intimidación escolar / Cyberbullying: a virtual way of bullying

Introducción: Con el desarrollo de nuevas tecnologías, la interacción entre las personas es cada vez más rápida y efectiva. Infortunadamente, estas herramientas han favorecido que el bullying (acoso) tradicional haya sobrepasado los límites del plantel escolar de forma virtual y que hayan dado lugar al ciberbullying. Objetivo: Describir y precisar sus diversas características, señalar algunos aspectos inherentes al bullying tradicional y revisar las diferencias entre ambos fenómenos. Métodos: Búsqueda computarizada de información utilizando bases de datos electrónicas. Resultados: Cerca del 40% de los alumnos han tenido algún tipo de contacto con el ciberbullying y se estima que uno de cada cuatro estudiantes está involucrado en este problema. El riesgo de ser cibervictimizado se duplica al tener un perfil en una red social electrónica. El 50% de las víctimas no comunica a nadie sobre la problemática o rara vez lo hacen, lo que implica un riesgo mayor de volver a ser ciberintimidado. Las consecuencias más graves generadas por el ciberbullying son depresión, ideación suicida y, en el peor de los casos, intentos suicidas u homicidas. Conclusiones: La práctica del ciberbullying representa en los hogares y las escuelas una problemática de actualidad y de suma importancia que debe tratarse integralmente. Se debe dar prioridad a la prevención e identificación oportuna...

Introduction: With the development of new technologies interactions between people are becoming faster and more effective. Unfortunately, this means that traditional bullying has moved from the schoolyard to a virtual form giving rise to cyberbullying. Objective: To describe and define the characteristics of cyberbullying, to show some aspects inherent in traditional bullying, and to review the differences between the two phenomena. Methods: Computerized search of information using electronic databases. Results: About 40% of students have had some contact with cyberbullying and it is estimated that one in four students is involved in this problem. The risk of being cyberbullied is doubled if they have a profile on a social network. 50% of victims do not tell anybody about the problem, which means a higher risk of being cyberbullied again. The most severe consequences produced by cyberbullying are depression, suicidal ideation, and suicidal or homicidal attempts. Conclusions: The practice of cyberbullying is currently an important problem in homes and schools that must be treated in an integral manner, giving priority to prevention and early identification...

Revisión sistemática de la asociación entre sobrepeso, obesidad y enfermedad mental, con énfasis en el trastorno esquizofrénico / Systematic review of the association between overweight, obesity and mental illness with emphasis on the schizophrenic disorder

Introducción: La Organización Mundial de la Salud ha definido la obesidad y el sobrepeso como el “exceso acumulado de grasa corporal, que se presenta por un desequilibrio permanente entre la ingesta alimenticia y el gasto energético” y la Asociación Psiquiátrica de Estados Unidos señala que puede afectar al aparato psíquico. Objetivo: Describir algunas generalidades relacionadas con la obesidad y el sobrepeso y revisar la asociación que puede darse entre estas circunstancias y la enfermedad mental, en general, y la esquizofrenia, en particular, y su influencia en la administración de antipsicóticos atípicos en el peso corporal de estos pacientes. Método: Se efectuó una búsqueda en las bases de datos electrónicas (Pubmed, EBSCOhost y OvidSP), con prioridad en trabajos publicados en la última década y con una estricta metodología científica. Resultado: La incidencia del sobrepeso y la obesidad es mayor en personas con enfermedad mental, en general, y esquizofrenia, en particular, en comparación con la población general. Se señalan como factores de riesgo los polimorfismos genéticos, consumo de antipsicóticos atípicos y una mala y pobre dieta alimenticia. Conclusión: La obesidad, sin lugar a dudas, es un problema de salud pública en varios países, incluido México. Pacientes con trastornos psiquiátricos tienen una tendencia a desarrollar sobrepeso u obesidad...

Introduction: The World Health Organization has defined obesity and overweight as “cumulative excess body fat, which is presented by an imbalance between food intake and energy expenditure”, and the American Psychiatric Association declares that it may also affect the psychic apparatus. Objective: To describe some generalities related to obesity and overweight and to review the partnership that exists between these circumstances and mental illness in general and schizophrenia in particular, as well as the influence of the administration of atypical antipsychotics on the body weight of these patients. Method: A search of electronic databases (Pubmed, EBSCOhost, and OvidSP) was conducted, focusing on papers published in the last decade with strict scientific methodology. Results: Incidence of overweight and obesity is higher in people with mental illness in general and schizophrenia in particular compared to the general population, and risk factors such as genetic polymorphisms, use of atypical antipsychotics, and a poor diet are identified. Conclusion: Obesity is a major public health problem in several countries, including Mexico. Patients with psychiatric disorders have a tendency to develop overweight or obesity...

[Tobacco consumption among high school students. Preliminary results from a survey in Tampico, Tamaulipas, Mexico]. / Consumo de tabaco en alumnos de secundaria. Resultados preliminares de la aplicación de una encuesta estructurada.

BACKGROUND: Tobacco consumption constitutes a public health problem among adolescents. National addiction surveys in Mexico have documented a growing trend in this habit over the years. OBJECTIVE: Describe the prevalence of tobacco consumption among a sample of high school students sample in Tampico, Tamaulipas and identify socio-demographic variables. METHODS: Students enrolled in the 2006-2007 school year attending 31 schools located in this county were surveyed. The sample was probabilistic, stratified and random. Students were the sampling units. We used a standardized questionnaire. RESULTS: 5,060 students were surveyed, 50.99% were female, mean age was 13.5 +/- 1 range 11-17. 66.7% started tobacco consumption between the ages of 13- 14, 28.5% (CI 27.2-29.8) had smoked once in their lives, 17% (CI 15.9-18.5) in the last twelve months and 9% (CI 18.2-9.8) in the last thirty days. A small percentage (7.2%) believed smoking was not dangerous and 1.6% of smokers meet the criteria for nicotine dependence. CONCLUSIONS: We recommend to increase prevention programs targeted at high-risk groups such as adolescents.

Consumo de tabaco en alumnos de secundaria. Resultados preliminares de la aplicación de una encuesta estructurada / Tobacco consumption among high school students. Preliminary results from a survey in Tampico, Tamaulipas, Mexico

Antecedentes: El consumo de tabaco representa un problema de salud entre adolescentes. Las encuestas nacionales de adicciones en México han documentado una tendencia creciente en este hábito a través de los años. Los objetivos de esta investigación fueron describir las prevalencias del consumo de tabaco en una muestra de estudiantes de secundaria en Tampico, Tamaulipas, y determinar algunas variables sociodemográficas. Métodos: Alumnos del ciclo escolar 2006-2007 de las 31 escuelas localizadas en el municipio de Tampico. La muestra fue seleccionada con un método probabilístico, estratificado y aleatorio simple; las unidades muestrales fueron los alumnos. Se utilizó un cuestionario autoaplicable estandarizado. Resultados: De 5060 alumnos encuestados, 50.99% correspondió al sexo femenino, media de edad 13.5±1 años, rango de 11-17, 66.7% inició el consumo entre los 13 y 14 años, 28.5% (IC=27.2- 29.8) había fumado alguna vez en su vida, 17% (IC=15.9-18.5) en los últimos 12 meses y 9% (IC=8.2-9.8) en los últimos 30 días, 7.2% de la muestra consideró que no es peligroso fumar y 1.6% de los fumadores ya reúne criterios de dependencia a la nicotina. Conclusiones: Es recomendable incrementar los procesos de prevención dirigidos a grupos de alto riesgo como los adolescentes.

BACKGROUND: Tobacco consumption constitutes a public health problem among adolescents. National addiction surveys in Mexico have documented a growing trend in this habit over the years. OBJECTIVE: Describe the prevalence of tobacco consumption among a sample of high school students sample in Tampico, Tamaulipas and identify socio-demographic variables. METHODS: Students enrolled in the 2006-2007 school year attending 31 schools located in this county were surveyed. The sample was probabilistic, stratified and random. Students were the sampling units. We used a standardized questionnaire. RESULTS: 5,060 students were surveyed, 50.99% were female, mean age was 13.5 +/- 1 range 11-17. 66.7% started tobacco consumption between the ages of 13- 14, 28.5% (CI 27.2-29.8) had smoked once in their lives, 17% (CI 15.9-18.5) in the last twelve months and 9% (CI 18.2-9.8) in the last thirty days. A small percentage (7.2%) believed smoking was not dangerous and 1.6% of smokers meet the criteria for nicotine dependence. CONCLUSIONS: We recommend to increase prevention programs targeted at high-risk groups such as adolescents.

Principios generales sobre la psicofarmacoterapia en niños y adolescentes. Una revisión

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Abstract: The work of Charles Bradley done in 1937, which reports the effects of Benzedrine in 30 pediatric patients that had behaviour problems, is a classic document considered by many as the beginning of child psychopharmacotherapy. In spite of a coordinated effort made by the National Institute of Mental Health in the United States carried out by a panel, called "Conferences on Infantile Research in Psychopharmacology", for many years this practice kept being inarticulate. Psychopharmacotherapy in adults with psychiatric diseases has had a different development. During the decade of 1950 substances such as chlorpromazine and tricycle antidepressives started to be used in clinical practice and between 1980 and 1990 new products were developed for treating schizophrenia, depression and mania. Even if there is no such as the "ideal drug", the new psychopharmacological developments have allowed patients to have a better quality of life. In pediatric population the difficulty to conduct controlled clinical tests has been a constant; for this reason the practice of child psychopharmacotherapy keeps facing challenges; also, in the United States several very strict norms have been dictated in order to endorse the security and efficacy of a product for infantile use. Other problems faced today in clinical practice are the excesive use of medications for minors prescribed by people without enough practice and academic information, and also the deficient therapeutic results provoked by wrong prescriptions. But the worst of all are the false promises made to relatives and patients, on the usage of products or substances that have not been tested by a rigorous scientific scrutiny, specially concerning diffused clinical problems such as the Attention Deficit Hyperac-tivity Disorder (ADHD) or Autism. These facts, most of all, determine the rejection and fear for medications and become an adverse variable that we must face continuously. The main objective of this work is to make a review about the general principles that are suggested for a good psychopharmaco-therapy on children and teen-agers, a practice that must always be part of a planned multimode treatment that follows an adequate paidopsychiatric evaluation. A right diagnose will always be important for the appropriate selection of the medication. The development of taxonomies such as those described in the Mental Disorders Statistics and Diagnostic Manual of the American Psychiatric Association or by the International Classification of Diseases of the World Health Organization, have allowed the existence of an order in the ela-boration of paidopsychiatric diagnosis, that even if being mainly descriptive, allow to make a more structured clinical work. The parameters for the psychiatric evaluation of children and teen-agers recommended by the American Academy of Child and Adolescent Psychiatry (AACAP) in 1997 is an example of the importance that proves the attention on minors, its objective is to give a guide without pretending to make it a golden standard. The selection of a medication must be based on two premises: a diagnose of the disorder itself, and on the other hand, the recognition of target symptoms. Considering this interrelation will allow a more acceptable evaluation on the risks and benefits of a phar-macological prescription for children and teenagers. Thus pediatric psychopharmacotherapy must be based on the correlation between the actions and effects of drugs and the biochemical and evolving aspects of the disorder, but it will also be necessary that the professional be aware of the changes that inevitably will take place in the dynamic of absorption, distribution and elimination of the medications according to the stage of the biological child's development. When someone deals with very small children, it is almost impossible for the child psychiatrist to get direct information as it is for children to understand the information that the expert would pretend to give them. This constrains to consider the cognitive and verbal realities proper of each stage of the development, so the direct evaluation of the small patient must be complemented with reports of a multi-informers system. It will be fundamental to consider also that small children have little differentiated emotions and that it must not be ignored that for them concepts such as time and space are difficult to understand. Clinical exploration through recreational activities will be a primordial tool in the daily work with children. It will also be recommendable that the plan of the treatment be organized jointly with the parents of the minor in order to inform them completely about the goals and objectives of the prescription of a drug; the participation of the small patient must be included too. It must not be forgotten that the pharmacological treatment is part of a more integral attention program in which other experts must participate, such as pedagogues, clinical psychologists or language therapists, a fact that will be more common than irregular. The therapeutic adherence is a variable that must be constantly checked. If it is carried out irregularly or the wrong dose of the recommended drug is taken, the presence of symptoms as a result of the abrupt interruption of the medication could be confused with the adverse collateral effects, which would make worse the clinical condition. Pediatric patients must have a complete medical history complemented by a physical and neurological evaluation, which must be included in the registry of vital constants as well as size and weight of the minor; other registers could be more convenient if they are considered to be needed. The support on laboratory surveys plays an important roll and at the present time the recommendation for making an electro-cardiography evaluation previous to the administration of some drugs is more accepted; in this sense it is undoubtedly important to consider the recommendations proposed by the American Association of Cardiology for monitoring the cardiovascular function of children and teen-agers who receive medications after prolonged periods of time. Polypharmacy is a common practice; due to this fact, the interaction between drug/ drug must be carefully valued. The child psychiatric evaluation must be made with the support of structured or semistructured interviews for the clinical diagnosis and with evaluation scales for measuring the severity of the specific symptoms or global clinical conditions. The strategy for choosing a plan of pharmacological treatment for the pediatric patient must be made individually; in this sense, the development of algorithms for the administration of medications on children and teenagers has been the result of many efforts in order to make prescriptions more rational and neat. The revision of controlled clinical tests on the efficacy and security of these agents in the pediatric population is fundamental for the election of a prescription. The responsibility of the professional that prescribes a medication devolves on structuring a plan of formal treatment and an individualized monitoring according to the stages of the treatment (beginning, maintenance and interruption ). As it is expected, the expert must reach the maximum therapeutic benefit in a child or an adolescent with the minimum of collateral effects, evaluating always the risk and the benefits. Some authors recommend the prescription of drugs on children and teen-agers only for short periods of time as the nondesirable effects in long terms are not quite well known. There are no specific times for stopping the administration of a drug. However, it is recommended that during the stages of the treatment, clinical changes in minors be watched and registered rigorously, in order to be able to reduce or stop the dose in the appropriate moment, even in cases of clinical conditions such as schizophrenia, depression or development generalized disorders. The main objective of this clinical work will be that the quality of life of the minor becomes optimum.