Psychometric Correlation of Personality Disorders Along With Defense Mechanisms in Mexican Individuals With Depressive and Anxious Disorders: A Cross-Sectional Study.

Background Personality disorders are a multi-theoretical construct that encompasses predictable and quantifiable behavioral, cognitive, and affective characteristics in individuals. Previous studies underscore the existence of a relationship between personality disorders and defense mechanisms, these being coping styles that arise unconsciously in the face of adversity and that have adaptive purposes. There is evidence that alludes to a connection between pathological personality, defense mechanisms, and their relationship with negative mental health outcomes, such as depressive and anxious symptoms. The objective of this study was to study, psychometrically measure, and associate personality disorders, defense mechanisms, and depressive and anxious symptoms. Methodology A cross-sectional study was conducted on 81 participants with major depressive disorder, generalized anxiety disorder, and panic disorder who received treatment at a tertiary care institution between July 2021 and February 2022. Psychometric instruments were employed to evaluate the study variables, such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Personality Diagnostic Questionnaire - Version 4 (PDQ-4) Plus, and the 40-item Defensive Styles Questionnaire (DSQ-40). Results Depressive and anxious symptoms were related to the scores obtained in the Defensive Styles Questionnaire and the Personality Disorders Questionnaire. Some defense mechanisms were positive predictors of the score between these scales. Conclusions There is a relationship between personality traits and defense mechanisms that could influence the development and severity of depressive and anxious psychopathology in this population.

XLV Anniversary of the Mexican Council of Psychiatry / XLV Aniversario del Consejo Mexicano de Psiquiatría

Abstract The Mexican Council of Psychiatry is celebrating this year its 45th anniversary. It is one of the first specialized medical councils in the country, and to date has certified 2 532 psychiatric specialists. This article recounts how the Council was founded, the contributions that more than 40 Mexican psychiatrists have made to its consolidation over the years, and the outlook of its work for the future.

Resumen El Consejo Mexicano de Psiquiatría celebra este año su aniversario 45. Se trata de uno de los primeros consejos médicos de especialidad en el país, y a la fecha ha emitido constancia de certificación a 2 532 especialistas en psiquiatría. En este artículo se relata su historia fundacional, la contribución de más de 40 psiquiatras mexicanos a su consolidación a lo largo de los años y la perspectiva de sus trabajos hacia el futuro.

Diferencias en el gasto alimentario según características socioeconómicas y de seguridad alimentaria y nutricional en hogares de Medellín / Differences in Food Expenditure According to Socioeconomic Characteristics and Households Food Security in Medellin

Resumen Antecedentes: la proporción de gasto alimentario en el hogar con respecto al gasto total es un indicador inverso del bienestar. Objetivo: analizar las diferencias en la proporción de gasto alimentario en los hogares de Medellín según características socioeconómicas y clasificación de seguridad alimentaria y nutricional. Materiales y métodos: estudio transversal, en 3008 hogares de Medellín participantes en el Perfil de Seguridad Alimentaria y Nutricional de Medellín-2015. Se analizó el gasto alimentario según seguridad alimentaria, características del jefe del hogar, ubicación de la vivienda, estrato socioeconómico y lugar de compra. Se aplicaron las pruebas estadísticas ji al cuadrado, Spearman y regresión logística ordinal. Resultados: los hogares clasificados con inseguridad alimentaria presentaron alta proporción de gasto alimentario (p=0,000). Se encontró una relación inversa entre la proporción de gasto alimentario e ingreso y nivel educativo del jefe del hogar (p=0,00). También, mayor probabilidad de alta proporción de gasto alimentario en los hogares de estrato socioeconómico bajo (p=0,00) y localizados en el área rural (p=0,00). Hogares con mayor proporción de gasto alimentario hacen mayor uso de tiendas locales para com- prar alimentos (p=0,00). Conclusión: hay mayor proporción de gasto alimentario en los hogares de Medellín con estrato socioeconómico bajo, ubicados en zona rural, con bajo nivel educativo del jefe del hogar y que compran en tiendas locales.

Abstract Background: The proportion of food expenditure in the home with respect to total household expenditure is an inverse indicator to wellbeing. Objective: To analyze the differences in the proportion of food expenditure in Medellin households according to socioeconomic characteristics and food security classifications. Materials and Methods: A cross-sectional study in 3008 households in Medellin that participated in the 2015 Food and Nutrition Security Profile in Medellin. Food expenditure was analyzed according to food security, characteristics of the head of household, location of living space, socioeconomic strata, and places where purchases are made. The statistical tests chi-square, Spearman and ordinal logistic regression were applied. Results: Households classified as food-insecure presented with a higher proportion of food expenditure (p=0.000). An inverse relationship was found between the proportion of household expenditure and income and education level of the head of household (p=0.00). Also, a higher probability was found between high proportion of food expenditure and households of low socioeconomic status (p=0.00), and households located in rural areas. Households with a higher proportion of food expenditure are more likely to purchase foods at local stores and shops (p=0.00). Conclusion: There is a greater proportion of food expenditure in Medellin households of low socioeconomic status, located in rural areas, with low educational level of the head of household, and who make purchases in local stores.

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department.

BACKGROUND: Classification of Psychiatric Emergency Presentations (PEP) is not sufficiently clear due to their inherent high inter-subjectivity and lack of validated triage instruments. In order to improve current classification of psychiatric emergency presentations (PEP) at Emergency Departments, we implemented and validated the Color-Risk Psychiatric Triage (CRPT), an instrument for classifying PEP risk by sorting one to five color/risk levels and one to thirty-two possible conditions arranged by risk. METHODS: Users who visited the Emergency Department (ED) of a Mexican psychiatric hospital from Dec 1st, 2008 to Dec 1st, 2009 were included. One CRPT was assessed by an ED psychiatrist to each patient upon their arrival to ED. Some patients were randomly assessed simultaneously with an additional CRPT and a Crisis and Triage Rating Scale (CTRS) to test validity and reliability of the CRPT. RESULTS: A total of 7,631 CRPT assessments were included. The majority of PEP were non-urgent (74.28 %). For the validation phase n = 158 patients were included. CRPT score showed higher concurrent validity than CRPT color/risk. CRPT level/risk and score showed highest concurrent validity within dangerousness domain of CTRS (r = 0.703, p < 0.0001). CRPT and CTRS scores showed similar predictive validity (p < 0.0001). High intraclass correlation coefficient (0.982) and Cohen's Kappa (0.89) were observed for CRPT score (r = 0.982, p < 0.0001). CONCLUSIONS: CRPT appeared to be a useful instrument for PEP classification due to its concurrent validity, predictive validity and reliability. CRPT score showed higher correlations than the CRPT color/risk. The five levels of risk provided by the CRPT appear to represent a simple and specific method for classifying PEP. This approach considers actual or potential risk, rather than severity, as the main factor for sorting PEP, which improves upon the current approach to emergency classification that is mainly based on the criterion of severity. Regardless of the triage procedure, emergency assessments should no longer classify PEP as "not real emergencies."

La terapia cognitivo conductual en el tratamiento de la depresión del trastorno bipolar tipo I / Cognitive behavioral therapy for the acute major depressive episodes in bipolar I disorder

A pesar de la farmacoterapia, tratamiento esencial del trastorno bipolar I, un porcentaje importante de pacientes experimenta nuevos episodios afectivos. La terapia cognitivo conductual (TCC), la psicoterapia interpersonal y ritmo social y la terapia familiar focalizada, lo mismo que la psicoeducación, enfoques psicosociales útiles en el tratamiento del trastorno bipolar, comparten el énfasis en el empoderamiento del paciente para convertirlo en participante activo de su tratamiento. La adición de la TCC al tratamiento tiene como objetivos aliviar los síntomas depresivos, restablecer el funcionamiento psicosocial y prevenir la aparición de nuevos episodios afectivos. Aunque la investigación es limitada, en este trabajo se describen las bases teóricas y los estudios empíricos que avalan el uso de la TCC como una intervención psicosocial indispensable. Objetivos El presente trabajo tuvo como objetivo demostrar la utilidad de la TCC como tratamiento coadyuvante en la depresión del trastorno bipolar I para los síntomas residuales, la adherencia y el cumplimiento del tratamiento, la conciencia y la comprensión del trastorno bipolar, la identificación temprana de los síntomas de los episodios afectivos y el desarrollo de habilidades de afrontamiento. Método Se revisaron los ensayos clínicos controlados acerca de la utilidad de la TCC como tratamiento del paciente con depresión del trastorno bipolar I. Resultados La TCC aumenta la adherencia al tratamiento farmacológico, disminuye la frecuencia de recaídas en el primer año, los síntomas depresivos residuales, las hospitalizaciones y la duración de los episodios y mejora la adherencia terapéutica y el funcionamiento psicosocial; su utilidad es similar a la terapia familiar focalizada y la psicoterapia interpersonal y ritmo social. Los efectos terapéuticos disminuyen a lo largo del tiempo y sus resultados son menores en pacientes con mayor número de episodios afectivos (>12) y mayor comorbilidad. Conclusiones La TCC es una intervención que mejora la evolución del trastorno bipolar tipo I.

Although pharmacotherapy is the essential treatment for bipolar I disorder depression, a significant percentage of patients continue experiencing emotional episodes. Cognitive behavioral therapy (CBT), interpersonal psychotherapy and social rhythm and focused family therapy, as well as psychoeducation, share the emphasis on the empowerment of the patient so she/he becomes an active participant in treatment, becomes aware of the nature of the disorder who suffers, and learns to recognize early symptoms of depressive episodes in order to prevent its recurrence. The addition of the CBT aims to alleviate depressive symptoms, restore the psychosocial functioning and prevent the appearance of new affective episodes. Objectives This paper aimed to demonstrate the importance and usefulness of the CBT as an adjuvant of the pharmacological management of depression in bipolar disorder type I in those areas which cannot be resolved by pharmacological treatment (residual symptoms, adherence and compliance with treatment, awareness and understanding of bipolar disorder, identification of prodromal symptoms and developing coping skills). Method Controlled clinical trials about the usefulness of CBT as an adjunctive treatment of patient with depression due to bipolar disorder type I are reviewed. Results CBT increases adherence to drug therapy, decreases the frequency of relapses, diminishes residual symptoms, the need for hospitaliza-tion, and the duration time of depressive episodes; it also improves psychosocial functioning. However, these effects diminish over time and its results are lower in patients with more affective episodes and greater comorbidity. Conclusions There is evidence of the utility of the CBT as a useful tool to improve the evolution of the condition in depressed patients due to bipolar I disorder and of the need to extend the time of this and other psychosocial interventions, since this disorder is a condition that lasts a lifetime and causes significant impact on psychosocial functioning of the person.

Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trial.

OBJECTIVE: Second-generation antipsychotics (SGAs) are among the first-line treatments for bipolar disorder and schizophrenia, but have a tendency to generate metabolic disturbances. These features resemble a metabolic syndrome for which a central autonomic imbalance has been proposed that may originate from the hypothalamic suprachiasmatic nuclei. In a clinical trial, we hypothesized that melatonin, a hormone that regulates the suprachiasmatic nucleus, could attenuate SGA-induced adverse metabolic effects. METHODS: In an eight-week, double-blind, randomized, placebo-controlled, parallel-group clinical trial, we evaluated the metabolic effect of melatonin in SGA-treated patients in terms of weight, blood pressure, lipid, glucose, body composition, and anthropometric measures. A total of 44 patients treated with SGAs, 20 with bipolar disorder and 24 with schizophrenia, randomly received placebo (n = 24) or melatonin 5 mg (n = 20). RESULTS: The melatonin group showed a decrease in diastolic blood pressure (5.1 versus 1.1 mmHg for placebo, p = 0.003) and attenuated weight gain (1.5 versus 2.2 kg for placebo, F = 4.512, p = 0.040) compared to the placebo group. The strong beneficial metabolic effects of melatonin in comparison to placebo on fat mass (0.2 versus 2.7 kg, respectively, p = 0.032) and diastolic blood pressure (5.7 versus 5.5 mmHg, respectively, p = 0.001) were observed in the bipolar disorder and not in the schizophrenia group. No adverse events were reported. CONCLUSIONS: Our results show that melatonin is effective in attenuating SGAs' adverse metabolic effects, particularly in bipolar disorder. The clinical findings allow us to propose that SGAs may disturb a centrally mediated metabolic balance that causes adverse metabolic effects and that nightly administration of melatonin helps to restore. Melatonin could become a safe and cost-effective therapeutic option to attenuate or prevent SGA metabolic effects.

La enfermedad de Parkinson: neurología para psiquiatras / Parkinson's disease: neurological bases for psychiatrists

Parkinson's disease is a progressive and degenerative disease due to the loss of the substantia nigra dopaminergic neurons in the mesencephalon. Its manifestations are: tremor at rest, rigidity and slowing of movements, and alterations in posture and gait. The early onset of dementia or the presence of hallucinations, not related to the dopaminergic treatment, are associated with the presence of dementia with Lewy bodies (DLB) or Alzheimer's disease. The scales used to assess the stage and severity of Parkinson's disease are: the scale of Stages of Hoehn and Yahr, and the Unified Parkinson's Disease Rating Scale. Although there is not a drug that stops the progression of Parkinson's disease, the current treatment for this illness consist in: a) dopamine replacement through the use of its precursor, levodopa, b) administering substances, like ropinirole, pramipexole, and bromocriptine, that increase dopamine activity to stimulate their receptors, and c) inhibiting the enzymes that destroy dopamine as the catechol- O-methyltrans-ferase with entacapone, and monoamine oxidase type B (MAO B) with selegiline and rasagiline. Surgical treatment of Parkinson's disease consists of ablative procedures and deep brain stimulation. This review describes their indications, administration and side effects.

La enfermedad de Parkinson es una enfermedad degenerativa y progresiva debida a la pérdida de las neuronas dopaminérgicas de la sustancia nigra del mesencéfalo. Sus manifestaciones son: temblor en reposo, rigidez y enlentecimiento de los movimientos, alteraciones en la postura y en la marcha. La aparición temprana de problemas en la memoria o alucinaciones, no debidas al tratamiento, indica la presencia de demencia con cuerpos de Lewy. Las escalas utilizadas para evaluar el estado y la gravedad de la enfermedad de Parkinson son: la Escala de los Estadios de Hoehn y Yahr y la Escala Unificada de Calificación de la Enfermedad de Parkinson (UPDRS). Aunque todavía no existe un medicamento que detenga la evolución de la enfermedad de Parkinson, el tratamiento actual consiste en mejorar los síntomas mediante: a) la reposición de la dopamina por medio del uso de su precursor (levodopa, L-Dopa), b) la administración de sustancias que aumentan la actividad dopaminérgica al estimular a sus receptores (ropinirol, pramipexol, bromocriptina) y c) la inhibición de las enzimas que destruyen la dopamina como la catecol- O- metiltransferasa (COMT) con la entacapona, y a la monoamino oxidasa tipo B (MAO B) con la selegilina y la rasagilina. Existe además el tratamiento quirúrgico de la enfermedad de Parkinson que consiste en procedimientos ablativos y la estimulación cerebral profunda. En esta revisión se describen los elementos básicos de la enfermedad, su cuadro clínico y sus complicaciones. En una segunda parte se aborda el tratamiento médico con sus indicaciones, administración y efectos secundarios, y para terminar se describirá el tratamiento quirúrgico.

Coeficiente intelectual y factores asociados en niños escolarizados en la ciudad de Medellín, Colombia / Intelligence quotient and associated facts in children attending school in Medellin, Colombia

Objetivo: Analizar el coeficiente intelectual y los factores asociados en niños escolarizados de 6 a 8 años en las comunas Nororiental y Norocidental de la ciudad de Medellín-Colombia. Materiales y Métodos: Se realizó un muestreo aleatorio simple, polietápico y estratificado según grado escolar y comuna, la muestra estuvo constituida por 423 niños de ambos sexos. El coeficiente intelectual se evaluó con la Escala de Inteligencia Wechsler para Niños WISCIV y la estimulación psicosocial con Observation for Measurement of the Environment (HOME). Para la valoración del estado nutricional se utilizó las normas de referencia y puntos de corte de la OMS. Resultados: Los factores de riesgo que explican las puntuaciones en el Coeficiente Intelectual Total y sus índices fueron: Historia de problemas académicos de la madre y padre e historia de problemas de comportamiento de los hermanos, alcoholismo de la madre durante el embarazo y conductas agresivas en el hogar. Conclusión: En los niños que cursan los primeros años de escolaridad en las dos comunas más pobres de Medellín, el coeficiente intelectual y sus índices se encuentra correlacionado con factores de antecedencia psicosocial y conductas agresivas en el hogar.

Objective: Analyzing the IQ and associated factors in school children aged 6 to 8 years old from the northeastern and northwestern districts of Medellin, Colombia. Materials and Methods: Simple, random, stratified sampling was carried out according to grade, level and commune; the sample consisted of 423 male and female children. The Wechsler intelligence scale (WISCIV) was used for evaluating the children’s IQ and the Home Observation for Measurement of the Environment (HOME) for evaluating the children’s psychosocial stimulation/quality of their home environment. WHO cutoff points were used as reference standards for assessing their nutritional status. Results: The following risk factors explained IQ scores and rates: the parents’ academic problems, the siblings’ behavioral problems, the mothers’ alcoholism during pregnancy and aggressive behavior at home. Conclusion: The IQ scores and associated rates for children who attended early school years in the two poorest districts of Medellin were correlated with psychosocial background factors and aggressive behavior at home.

Perfil de la pobreza en hogares que participan en un programa de complementación alimentaria / Poverty profile regarding households participating in a food assistance program

Objetivo: El estudio tiene como objetivo establecer subgrupos con características socioeconómicas específicas mediante la utilización del análisis de clases latentes como método de segmentación de la población beneficiaria del programa de complementación alimentaria alianza MANA-ICBF. Antioquia Colombia y que permita determinar sus diferencias en sus condiciones de pobreza y salud para una mejor focalización de los recursos, programas y políticas públicas. Métodos: Población constituida por 200 000 niños y sus hogares beneficiarios del programa MANA. Se utilizó una muestra representativa por región. Se utilizó el análisis de clases latentes utilizando el algoritmo de Expectatio/Maximization y de Newton Raphson para identificar el número apropiado de clases. Resultados: El modelo final clasificó a los hogares en cuatro conglomerados que difieren entre sí de acuerdo a condiciones socio demográficas bien definidas que afectan la salud de los niños beneficiarios del programa. Conclusiones: Hay hogares en donde hay mayor profundización de la pobreza, por consiguiente condiciones de calidad de vida inferiores que afecta la salud de los niños de este grupo poblacional.

Objective: This study was aimed at establishing subgroups having specific socioeconomic characteristics by using latent class analysis as a method for segmenting target population members of the MANA-ICBF supplementary food program in the Antioquia department of Colombia and determine their differences regarding poverty and health conditions in efficiently addressing pertinent resources, programs and policies. Methods: The target population consisted of 200,000 children and their households involved in the MANA food assistance program; a representative sample by region was used. Latent class analysis was used, as were the expectation-maximization and Newton Raphson algorithms for identifying the appropriate number of classes. Results: The final model classified the households into four clusters or classes, differing according to well-defined socio-demographic conditions affecting children's health. Conclusions: Some homes had a greater depth of poverty, therefore lowering the families' quality of life and affecting the health of the children in this age group.

[Poverty profile regarding households participating in a food assistance program]. / Perfil de la pobreza en hogares que participan en un programa de complementación alimentaria.

OBJECTIVE: This study was aimed at establishing subgroups having specific socioeconomic characteristics by using latent class analysis as a method for segmenting target population members of the MANA-ICBF supplementary food program in the Antioquia department of Colombia and determine their differences regarding poverty and health conditions in efficiently addressing pertinent resources, programs and policies. METHODS: The target population consisted of 200,000 children and their households involved in the MANA food assistance program; a representative sample by region was used. Latent class analysis was used, as were the expectation-maximization and Newton Raphson algorithms for identifying the appropriate number of classes. RESULTS: The final model classified the households into four clusters or classes, differing according to well-defined socio-demographic conditions affecting children's health. CONCLUSIONS: Some homes had a greater depth of poverty, therefore lowering the families' quality of life and affecting the health of the children in this age group.

[Intelligence quotient and associated facts in children attending school in Medellin, Colombia]. / Coeficiente intelectual y factores asociados en niños escolarizados en la ciudad de Medellín, Colombia.

OBJECTIVE: Analyzing the IQ and associated factors in school children aged 6 to 8 years old from the northeastern and northwestern districts of Medellin, Colombia. MATERIALS AND METHODS: Simple, random, stratified sampling was carried out according to grade, level and commune; the sample consisted of 423 male and female children. The Wechsler intelligence scale (WISCIV) was used for evaluating the children's IQ and the Home Observation for Measurement of the Environment (HOME) for evaluating the children's psychosocial stimulation/quality of their home environment. WHO cutoff points were used as reference standards for assessing their nutritional status. RESULTS: The following risk factors explained IQ scores and rates: the parents' academic problems, the siblings' behavioral problems, the mothers' alcoholism during pregnancy and aggressive behavior at home. CONCLUSION: The IQ scores and associated rates for children who attended early school years in the two poorest districts of Medellin were correlated with psychosocial background factors and aggressive behavior at home.

Caracterización de los hogares colombianos en inseguridad alimentaria según calidad de vida / Characterising Colombian households regarding quality of life-based food insecurity

Objetivo Caracterizar los hogares colombianos en inseguridad alimentaria según calidad de vida. Materiales y métodos Para determinar la calidad de vida de los hogares colombianos se empleó la base de datos de la Encuesta de Calidad de Vida realizada en el año 2008 por el Departamento Nacional de Estadísticas de Colombia. Para establecer las prevalencias de inseguridad alimentaria en el hogar (INSAH) se utilizó la Escala Latinoamericana y Caribeña para la medición de la Seguridad Alimentaria en el Hogar, adaptada y validada para Colombia. Los datos se analizaron con la prueba Chi cuadrado y mediante un análisis de regresión logística. Resultados En los hogares donde se halló mayor probabilidad de inseguridad alimentaria, fue en aquellos con casa propia pero que la estaban pagando o los que tenían posesión de la vivienda pero sin título, los que manifestaron que los ingresos solo alcanzaban para cubrir los gastos mínimos y en los que no alcanzan para cubrir los gastos mínimos, en los que manifestaron sentirse pobres y en los que vivían hacinados. Perder el empleo por parte del jefe del hogar, atrasarse en el pago de los servicios públicos 4 meses ó más, disminuir el gasto en alimentación y haberse gastado los ahorros, también incremento esta probabilidad. Conclusión La INSAH se asoció de forma significativa con condiciones socioeconómicas del hogar y del jefe del hogar.

Objective Characterizing Colombian households regarding quality of life-based food insecurity. Materials and Methods Colombian households' quality of life was determined using data from the quality of life survey carried out by the Colombian Statistics' Department in 2008. The Latin-American and Caribbean Household Food Insecurity Scale was used for measuring the prevalence of household food insecurity(after having been adapted and validated for Colombia). Data was analyzed using the Chi square test and logistic regression analysis. Results The households having a higher probability of food insecurity were those owning their dwelling but still paying the mortgage or those who were in possession of a dwelling without ownership documents, households where income was deemed insufficient for covering minimum expenses or did not cover minimum expenses, those who stated that they felt poor and those living in overcrowded conditions. The probability of food insecurity was also increased in households where the head of the family had lost her/his job, where late payments of 4 months or more were due for public utilities, had decreased food expenses or had spent their savings. Conclusion Household food Insecurity was significantly associated with a household's socioeconomic conditions and those of a head of household.

The levels of psychological functioning of personality and the mechanisms of defense / Los niveles de funcionamiento psicológico y los mecanismos de defensa

Otto Kernberg states three types of personality organizations, also named psychological functional levels. They reflect the patient's predominant psychological characteristics: identity integration grade, defense mechanisms, and reality test. In mental disorders, the predominant defensive influences significantly in the severity and evolution of the suffering. Objectives The objective of the actual study was to determine the usage of defense mechanisms by patients with some mental disorder, grouping them according to personality organization levels or psychological functioning and the DSM-IV-TR Axis II diagnostic. Sample The sample included two groups: a) 1 02 hospitalized patients in the Instituto Nacional de Psiquiatría, 20 males and 82 females. b) A control group formed by 125 individuals, 48 males and 77 females; in all cases, they lived in Distrito Federal or Estado de México. Method The sample of this study was evaluated with the Defensive Questionnaire (DSQ-40) and the Personality Diagnostic Questionnaire (PDQ-4 + ); both instruments were applied as soon as patients were admitted to the hospital. The concepts of borderline psychological functioning and borderline personality disorder make reference to: The levels of personality organization or borderline psychological functioning characterized by an identity integration failure named identity diffusion, habitually reality judgment conserving and low level defenses supported on the splitting. b) The patients that were diagnosed with borderline personality disorder in agreement with the DSM-IV-TR. According to the personality organization, the psychotic disorders were grouped in the psychotic functioning level; the rest of the patients that suffered some anxiety or mood disorders were included in the borderline functioning level when they had also a diagnosis of borderline, narcissistic, antisocial, paranoid, schizoid, schizotypal, avoidant, dependent or histrionic personality disorder; in the neurotic functioning level those patients without personality disorder. The members of the control group were included in different academic level, labor and social scopes during the same period. Results The patients with a low level of personality organization (psychotic or borderline personality organization) used predominantly the immature or primitive defense mechanisms; patients with a high level of personality organization (neurotic level of psychological functioning) and members of the control group used predominantly mature or advanced defense mechanisms. Derived from the factorial analysis, three levels of defensive were determined: mature/advanced, neurotic and immature/primitive. In the mature/advanced defensive, the members of the control group were those that scored higher, followed by the psychotic patients and borderline. The scores of the neurotic defensive were higher in the borderline and psychotic groups than the control group. In the immature/primitive defensive, the borderline patients had higher scores than the psychotic and control group. The patients that were diagnosed through the PDQ-4+ with borderline personality disorder in agreement with the DSM-IV-TR had lower scores in the mature/advance defensive and higher than the control group in neurotic and immature/primitive defensive . The characteristics of personality of clusters A and B correlated positively with the following defensive s: immature/ primitive and neurotic and negatively with the mature/advanced defensive . The relation between the defensive s and the characteristics of personality of cluster C was negative in the defensive mature/advanced and positive in the neurotic and immature/ primitive. Conclusions: Through these findings a hierarchy between the levels of psychological functioning can be established, so that the lower the level of psychological functioning (borderline or psychotic), the higher is the use of immature mechanisms of defense and vice versa. The level of high psychological functioning (neurotic) used mature mechanisms of defense mainly; the borderline and psychotic levels of psychological functioning had major use of immature defenses, such as projection and autistic fantasy.

Los mecanismos de defensa son los elementos fundamentales de la organización de la personalidad, junto con la constancia objetal y el juicio de realidad. En los trastornos mentales, el estilo defensivo predominante influye significativamente en la gravedad y evolución del padecimiento. Objetivos El objetivo de este estudio fue determinar la relación existente entre los mecanismos de defensa, los trastornos de la personalidad y los niveles de funcionamiento psicológico (organización de la personalidad tipo neurótica, límite o psicótica) propuestos por Kernberg. Muestra La muestra del estudio estuvo constituida por dos grupos: a) Un grupo de 102 pacientes psiquiátricos hospitalizados, 20 del sexo masculino y 82 del femenino, provenientes del Instituto Nacional de Psiquiatría Ramón de la Fuente. b) Un grupo control, constituido por 1 25 sujetos, 48 hombres y 77 mujeres, en su mayoría residentes del Distrito Federal o del Estado de México. Método La población de este estudio fue evaluada con el Cuestionario de Estilos Defensivos (DSQ-40) y el Cuestionario Diagnóstico de la Personalidad (PDQ-4 + ) para determinar el uso de los mecanismos de defensa y detectar los trastornos de la personalidad, respectivamente. A los pacientes se les aplicaron ambos instrumentos al momento de su ingreso y se les agrupó en alguno de los tres niveles de funcionamiento psicológico de Kernberg. Los conceptos nivel de funcionamiento psicológico límite y trastorno límite de la personalidad hacen referencia a: a) La organización de la personalidad o nivel de funcionamiento límite caracterizada por la difusión de identidad, habitualmente conservación de la prueba de realidad y mecanismos de defensa basados en la escisión. b) El trastorno límite de la personalidad descrito por la Asociación Psiquiátrica Americana en el DSM-IV-TR. De acuerdo con la organización de la personalidad, los pacientes esquizofrénicos y con otras psicosis quedaron en el nivel de funcionamiento psicótico. Los pacientes que sufrían algún trastorno de ansiedad o del estado de ánimo se incluyeron en el nivel de funcionamiento límite o borderline cuando también tenían diagnóstico de trastornos de personalidad límite, narcisista, antisocial, paranoide, esquizoide, esquizotípico, evitativo, dependiente e histriónico; en el nivel de funcionamiento neurótico se incluyeron los pacientes con los trastornos mencionados, que no tenían trastorno de personalidad o bien cuyo diagnóstico fue de trastorno obsesivo-compulsivo de la personalidad. Los sujetos que sirvieron como controles fueron captados en distintos ámbitos escolares, laborales y sociales durante el mismo periodo. Resultados Los pacientes pertenecientes a los niveles de funcionamiento psicológico menores (psicótico o límite) usaron más los mecanismos de defensa inmaduros en comparación con los pertenecientes al nivel de funcionamiento psicológico de mayor nivel (neurótico) y que los sujetos controles. Se determinaron tres estilos defensivos: maduro/ avanzado, neurótico e inmaduro/primitivo. En el estilo maduro/ avanzado los sujetos del grupo control fueron los que puntuaron más alto, seguidos de los pacientes con nivel de funcionamiento psicológico psicótico y límite. Las puntuaciones del estilo defensivo neurótico fueron mayores en los grupos límite y psicótico que en el grupo control. En el estilo defensivo inmaduro/primitivo, los pacientes límites tuvieron puntuaciones mayores que los grupos psicótico y control. El grupo control puntuó más alto que el límite en sublimación, humor, anticipación y supresión, y que el psicótico en humor y supresión. El grupo de funcionamiento límite tuvo puntuaciones mayores que el grupo control en anulación, aislamiento, racionalización, proyección, agresión pasiva, exoactuación, fantasía autista, escisión y somatización. En cambio, puntuaron más alto que el grupo psicótico en supresión, agresión pasiva y somatización. El grupo psicótico tuvo puntuaciones mayores que el grupo límite en sublimación, anticipación y formación reactiva, y que el grupo control en anulación, desplazamiento, proyección y fantasía autista. Los pacientes diagnosticados a través del PDQ-4+ con trastorno límite de personalidad de acuerdo con el DSM-IV-TR tuvieron puntuaciones menores en el estilo defensivo maduro/avanzado que el grupo control pero mayores en los estilos defensivos neurótico e inmaduro/ primitivo. En el análisis individual de cada mecanismo de defensa se encontró que el grupo control tuvo mayores puntuaciones en sublimación, humor, anticipación, supresión y disociación que el grupo de pacientes con trastorno límite de la personalidad. Éstos puntuaron más alto en desplazamiento, racionalización, aislamiento, proyección, escisión, exoactuación, agresión pasiva, devaluación, fantasía autista, negación y somatización. Cuando se determinó el uso de las defensas de acuerdo con el diagnóstico de trastornos de la personalidad pertenecientes a los clusters A y B, se observó un mayor uso de los mecanismos de defensa basados en la escisión; de éstos, la fantasía autista fue la que tuvo mayor valor predictivo. Por el contrario, los trastornos de la personalidad del cluster C estuvieron asociados a los mecanismos de defensa de la esfera de la represión. Conclusiones Los resultados dan sustento empírico a la organización de la personalidad propuesta por Kernberg sobre los tres niveles de funcionamiento psicológico y a la vez demuestran la relación entre los trastornos de la personalidad y los mecanismos de defensa. El mecanismo de defensa denominado fantasía autista resultó ser un factor explicativo y predictivo de las características de la personalidad de los clusters A y B y del trastorno límite de la personalidad, en específico.

Factors associated with household food security of participants of the MANA food supplement program in Colombia.

The objective of this study was to explore demographic and economic characteristics associated with household food security of 2,784 low-income households with pre-school aged children receiving food supplements from the Colombian Plan for Improving Food and Nutrition in Antioquia - MANA (Mejoramiento Alimentario y Nutricional de Antioquia) in the Department of Antioquia, Colombia. Included in the study was a 12-item household food security survey was collected from a cross-sectional, stratified random sample of MANA participants in which households were characterized as food secure, mildly food insecure, moderately food insecure, and severely food insecure. It was hypothesized that household food security status would be strongly associated with demographic characteristics, food expenditure variables, and food supplement consumption by children in MANA. Food insecure households were characterized by more members, older parents, and lower income (p < 0.0001). Rural residence and female head of households had higher rates of food insecurity (p < 0.01). Food insecure households had the lowest monthly expenditures food (p < 0.0001). Severely food insecure households saved the highest percentage of per capita food expenditure from consuming MANA supplements (p < 0.0001), similarly, MANA food supplement intakes were greatest in households reporting the most food insecurity (p < 0.001). The results of this study are important to describe characteristics of the population benefiting from the MANA nutrition intervention by their unique level of household food security status.

Factors associated with household food security of participants of the MANA food supplement program in Colombia / Factores asociados con inseguridad alimentaría del hogar en participantes del programa alimentario MANA en Colombia

The objective of this study was to explore demographic and economic characteristics associated with household food security of 2,784 low-income households with pre-school aged children receiving food supplements from the Colombian Plan for Improving Food and Nutrition in Antioquia -MANA (Mejoramiento Alimentario y Nutricional de Antioquia) in the Department of Antioquia, Colombia. Included in the study was a 12-item household food security survey was collected from a cross-sectional, stratified random sample of MANA participants in which households were characterized as food secure, mildly food insecure, moderately food insecure, and severely food insecure. It was hypothesized that household food security status would be strongly associated with demographic characteristics, food expenditure variables, and food supplement consumption by children in MANA. Food insecure households were characterized by more members, older parents, and lower income (p<0.0001). Rural residence and female head of households had higher rates of food insecurity (p<0.01). Food insecure households had the lowest monthly expenditures food (p<0.0001). Severely food insecure households saved the highest percentage of per capita food expenditure from consuming MANA supplements (p<0.0001), similarly, MANA food supplement intakes were greatest in households reporting the most food insecurity (p<0.001). The results of this study are important to describe characteristics of the population benefiting from the MANA nutrition intervention by their unique level of household food security status.

El objeto de este estudio fue explorar la asociación de la inseguridad alimentaria en el hogar con las características demográficas, el gasto alimentario del hogar y el consumo del complemento alimentario de 2,784 hogares de bajos ingresos con niños preescolares que recibían el complemento alimentario de MANA (Programa de Mejoramiento Alimentario y Nutricional de Antioquia) en el Departamento de Antioquia, Colombia. En los hogares seleccionados mediante un muestreo probabilístico, se aplicó una escala de seguridad alimentaria compuesta por 12 ítems. Los hogares fueron clasificados como seguros, y con inseguridad alimentaria leve, moderada o severa. Se hipotecaron que el estado de seguridad alimentaria seria asociado de una manera fuerte con las características demográficas, el gastos alimentarias, y el consumo del complemento por los niños participantes en MANA. Los hogares con inseguridad alimentaria estaban compuestos por un mayor número de personas, los padres eran de mayor edad, y tenían menores ingresos y menor gasto alimentario (p<0.0001), de la misma manera, el consumo del complemento de MANA fue más alto en los hogares que reportaron inseguridad severa (p<0.001). Los resultados son importantes para describir las características de la población que se beneficie de la intervención nutricional de MANA por su nivel de seguridad alimentaria en el hogar.

[Characterising Colombian households regarding quality of life-based food insecurity]. / Caracterización de los hogares colombianos en inseguridad alimentaria según calidad de vida.

OBJECTIVE: Characterizing Colombian households regarding quality of life-based food insecurity. MATERIALS AND METHODS: Colombian households' quality of life was determined using data from the quality of life survey carried out by the Colombian Statistics' Department in 2008. The Latin-American and Caribbean Household Food Insecurity Scale was used for measuring the prevalence of household food insecurity(after having been adapted and validated for Colombia). Data was analyzed using the Chi square test and logistic regression analysis. RESULTS: The households having a higher probability of food insecurity were those owning their dwelling but still paying the mortgage or those who were in possession of a dwelling without ownership documents, households where income was deemed insufficient for covering minimum expenses or did not cover minimum expenses, those who stated that they felt poor and those living in overcrowded conditions. The probability of food insecurity was also increased in households where the head of the family had lost her/his job, where late payments of 4 months or more were due for public utilities, had decreased food expenses or had spent their savings. CONCLUSION: Household food Insecurity was significantly associated with a household's socioeconomic conditions and those of a head of household.

Enfermedades dermatológicas en un servicio académico asistencial universitario de Lima-Perú, 2004-2007 / Skin diseases in a dermatology academic teaching division of Lima-Peru, 2004-2007

OBJETIVOS: Evaluar la frecuencia de enfermedades dermatológicas en un Servicio de Dermatología Universitario de la ciudad de Lima. PACIENTES Y METODOS: Estudio descriptivo, observacional y retrospectivo, realizado en el Servicio Académico Asistencial de Dermatología de la UNMSM, durante enero del 2004 a diciembre 2007. Los diagnósticos fueron clasificados de acuerdo al CIE-10. RESULTADOS: Se incluyeron un total de 3294 pacientes nuevos, el promedio de edad fue de 35.4 ± 20.7 años, el 53.35% de pacientes fueron mujeres. Por grupo de enfermedad, las dermatosis infecciosas fueron las más comunes (29.3%), seguidas por las dermatitis (17.7%), neoplasias benignas (9.9%) y enfermedades de los anexos de la piel (9.8%). Las principales dermatosis encontradas fueron las verrugas víricas (14.3%), vitíligo (6%), otros tumores benignos de la piel (5.3%) y acné (4.8%). CONCLUSIONES: Las enfermedades infecciosas y las dermatitis fueron los diagnósticos más comunes. Las universidades como centro de formación integral del médico deberían ofrecer servicios académicos asistenciales que le permitan realizar docencia y proyeccióna la comunidad.

OBJECTIVES: To evaluate the frequency ofdermatological diseases at University Department of Dermatology of Lima. PATIENTSAND METHODS: Descriptive, observational and retrospective, performed at the Dermatology Academic Teaching Division of Universidad Nacional Mayor de San Marcos, during January 2004 to December 2007. Diagnoses were classified according to ICD-10. RESULTS: A total of 3294 new patients, the mean age was 35.4 ± 20.7 years, 53.35% of patients were female. For group of disease, infectious dermatoses were more common (29.3%), following by dermatitis(17.7%), benign neoplasms (9.9%) and diseasesof skin appendages (9.8%). The main dermatoses found were viral warts (14.3%), vitiligo (6%), other benign skin tumors (5.3%) and acne(4.8%). CONCLUSIONS: Infectious diseases and dermatitis were the most common diagnoses. The universities as centre of integral formation of physicians must provide academic assistance services that can deliver teaching and outreach to the community.

Eficacia y seguridad de la terapia tópica antioxidante versus placebo en el tratamiento del vitiligo generalizado de reciente inicio / Efficacia and security of topical antioxidant therapy versus placebo in the treatment of vitiligo of recent onset

Objetivo: Determinar la eficacia de la terapia tópica antioxidante en el tratamiento del vitíligo generalizado de inicio reciente. Material y métodos: Ensayo clínico aleatorizado, doble ciego, controlado con placebo. Los pacientes con vitíligo generalizado de inicio reciente fueron distribuidos aleatoriamente en dos grupos. Grupo de estudio: recibió terapia tópica reciente fueron distribuidos aleatoriamente en dos grupos. Grupo de estudio: recibió terapia tópica antioxidante aplicada en las lesiones cada 12 horas por 30 días. Grupo placebo: recibió terapia tópica con una sustancia carente de actividad farmacológica. La terapia tópica antioxidante estuvo compuesta fundamentalmente por pseudocatalasa activada por luz solar, luego de la aplicación se indicó a los pacientes exposición solar diaria por un período de 30 minutos. Al cabo de 10 semanas de tratamiento se evaluó si hubo re pigmentación, y se comparó los niveles pre y pos tratamiento de malonildialdehido (indicador de per oxidación lipídica) en lesiones cutáneas. Resultados: Al término del tratamiento los valores de MDA en lesiones del grupo que recibió terapia tópica antioxidante mostraron un incremento significativo del 24.5 por ciento con respecto a los valores basales (p=0.035); los valores del grupo placebo también mostraron un incremento significativo del 21.6 por ciento en los valores de MDA con respecto a la medición basal (p menor que 0.001). La evolución clínica mostró re pigmentación parcial de la lesiones en 16.6 por ciento de pacientes que recibieron terapia tópica antioxidante y en 6.6 por ciento de pacientes que recibieron placebo para lo cual no existió diferencia significativa (p = 0.206). En ningún paciente de ambos grupos se observó re pigmentación total de las lesiones. Conclusiones: Nuestros hallazgos en la muestra estudiada demuestran que la terapia tópica antioxidante no es eficaz en el tratamiento del vitíligo generalizado de inicio reciente y no reduce el estrés oxidativo.

Objective: To determine the efficacy of topical antioxidant therapy in the treatment of generalized vitiligo of recent onset. Material and methods: Randomized trial, double-blind, controlled with placebo. Patients with generalized vitiligo of recent onset were randomly distributed in two groups. Study group: They received topical antioxidant therapy applied in lesions each 12 hours for 30 days. Placebo group: They received topical therapy with a substance devoid of pharmacological activity. The topical antioxidant therapy was consisted primarily by pseudocatalasa activated by solar light, after the application, daily solar exposure was indicated to patients by a period of 30 minutes. After 10 weeks of treatment, repigmentation was evaluated whether there and pre and and post treatments of malonyldialdheyde (MDA) levels were compared in cutaneous lesion. Results: At the end of the treatment, values of MDA in lesions of group that receives topical antioxidant therapy showed a significant increase of 24.5 per cent with respect of basal values (p = 0.035); values of placebo group also showed a significant increase of 21.6 per cent in values of MDA with respect to basal measure (p minor that 0.001). Clinical evolution showed partial repigmentation of lesion in 16.6 per cent of patients that received topical antioxidant therapy and in 6.6 per cent of patients that received placebo for which there was no significant difference (p = 0.206). In no one patient of both groups we saw total repigmentation of lesion. Conclusions: Our findings in the sample studied showed that topical antioxidant therapy is not efficacy in the treatment of generalized vitiligo of recent onset and do not reduce the oxidative stress in cutaneous lesions.