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Barroca NCB, Della Santa G, Suchecki D, García-Cairasco N, Umeoka EHDL. Challenges in the use of animal models and perspectives for a translational view of stress and psychopathologies. Neurosci Biobehav Rev 2022; 140:104771. [PMID: 35817171 DOI: 10.1016/j.neubiorev.2022.104771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 12/25/2022]
Abstract
The neurobiology and development of treatments for stress-related neuropsychiatric disorders rely heavily on animal models. However, the complexity of these disorders makes it difficult to model them entirely, so only specific features of human psychopathology are emulated and these models should be used with great caution. Importantly, the effects of stress depend on multiple factors, like duration, context of exposure, and individual variability. Here we present a review on pre-clinical studies of stress-related disorders, especially those developed to model posttraumatic stress disorder, major depression, and anxiety. Animal models provide relevant evidence of the underpinnings of these disorders, as long as face, construct, and predictive validities are fulfilled. The translational challenges faced by scholars include reductionism and anthropomorphic/anthropocentric interpretation of the results instead of a more naturalistic and evolutionary understanding of animal behavior that must be overcome to offer a meaningful model. Other limitations are low statistical power of analysis, poor evaluation of individual variability, sex differences, and possible conflicting effects of stressors depending on specific windows in the lifespan.
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Affiliation(s)
- Nayara Cobra Barreiro Barroca
- Department of Neuroscience and Behavioral Science, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Giovanna Della Santa
- Department of Neuroscience and Behavioral Science, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Deborah Suchecki
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Norberto García-Cairasco
- Department of Neuroscience and Behavioral Science, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil; Department of Physiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Eduardo Henrique de Lima Umeoka
- Department of Neuroscience and Behavioral Science, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil; School of Medicine, University Center UniCerrado, Goiatuba, GO, Brazil
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Tamargo R, Moschenross D, Clark T, Novoa K, Gopalan P. C-L Case Conference: Psychiatric Evaluation and Management Following Gunshot Injury. J Acad Consult Liaison Psychiatry 2022; 63:426-433. [PMID: 35301160 DOI: 10.1016/j.jaclp.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
We present the case of a 23-year-old female presenting to CL Psychiatry after admission for multiple gunshot wounds. Top experts in the CL field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include risk factors for gun violence victimization, assessment of psychiatric diagnoses associated with gunshot injury, and management challenges including access to psychiatric care. Specifically, we highlight the high prevalence of trauma-related disorders, substance use disorders, and functional impairment after gunshot injury. We also provide practical guidance on issues of lethality assessment, trauma-informed care, psychiatric management, and community resources that support recovery.
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Affiliation(s)
- Rafael Tamargo
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Darcy Moschenross
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tiffany Clark
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Priya Gopalan
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
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3
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Robles R, Morales-Chainé S, Bosch A, Astudillo-García C, Feria M, Infante S, Alcocer-Castillejos N, Ascencio L, Real-Ramírez J, Díaz D, Gómez-Estrada HF, Becerra C, Escamilla R, López-Montoya A, Beristain-Aguirre A, Vega H, Álvarez-Icaza D, Rodríguez E, Durand S, Fresán A, Medina-Mora ME, Fernández-Cáceres C, Madrigal de León EÁ. Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010421. [PMID: 35010679 PMCID: PMC8744587 DOI: 10.3390/ijerph19010421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/23/2023]
Abstract
COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW’s COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW’s MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.
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Affiliation(s)
- Rebeca Robles
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
- Correspondence:
| | - Silvia Morales-Chainé
- Faculty of Psychology and General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico, Ciudad de México 04510, Mexico; (S.M.-C.); (A.B.); (A.L.-M.); (A.B.-A.); (D.Á.-I.)
| | - Alejandro Bosch
- Faculty of Psychology and General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico, Ciudad de México 04510, Mexico; (S.M.-C.); (A.B.); (A.L.-M.); (A.B.-A.); (D.Á.-I.)
| | | | - Miriam Feria
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | - Sara Infante
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | | | - Leticia Ascencio
- Palliative Care Service, National Cancer Institute, Ciudad de México 14080, Mexico;
| | - Janet Real-Ramírez
- Population Health Research Center, National Institute of Public Health, Ciudad de México 14080, Mexico;
| | - Dulce Díaz
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | | | - Claudia Becerra
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | - Raúl Escamilla
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | - Alejandra López-Montoya
- Faculty of Psychology and General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico, Ciudad de México 04510, Mexico; (S.M.-C.); (A.B.); (A.L.-M.); (A.B.-A.); (D.Á.-I.)
| | - Ana Beristain-Aguirre
- Faculty of Psychology and General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico, Ciudad de México 04510, Mexico; (S.M.-C.); (A.B.); (A.L.-M.); (A.B.-A.); (D.Á.-I.)
| | - Hamid Vega
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | - Dení Álvarez-Icaza
- Faculty of Psychology and General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico, Ciudad de México 04510, Mexico; (S.M.-C.); (A.B.); (A.L.-M.); (A.B.-A.); (D.Á.-I.)
| | - Evelyn Rodríguez
- Infectious Disease Research Center, National Institute of Respiratory Diseases, Ciudad de México 14080, Mexico;
| | - Sol Durand
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | - Ana Fresán
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
| | - María-Elena Medina-Mora
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
- Faculty of Psychology and General Directorate of Academic Personnel Affairs, National Autonomous University of Mexico, Ciudad de México 04510, Mexico; (S.M.-C.); (A.B.); (A.L.-M.); (A.B.-A.); (D.Á.-I.)
| | | | - Eduardo Ángel Madrigal de León
- Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 14370, Mexico; (M.F.); (S.I.); (D.D.); (C.B.); (R.E.); (H.V.); (S.D.); (A.F.); (M.-E.M.-M.); (E.Á.M.d.L.)
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Calderón-Garcidueñas L, Rajkumar RP, Stommel EW, Kulesza R, Mansour Y, Rico-Villanueva A, Flores-Vázquez JO, Brito-Aguilar R, Ramírez-Sánchez S, García-Alonso G, Chávez-Franco DA, Luévano-Castro SC, García-Rojas E, Revueltas-Ficachi P, Villarreal-Ríos R, Mukherjee PS. Brainstem Quadruple Aberrant Hyperphosphorylated Tau, Beta-Amyloid, Alpha-Synuclein and TDP-43 Pathology, Stress and Sleep Behavior Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6689. [PMID: 34206224 PMCID: PMC8297352 DOI: 10.3390/ijerph18136689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/27/2022]
Abstract
Quadruple aberrant hyperphosphorylated tau (p-τ), amyloid-β peptide, alpha-synuclein and TDP-43 brainstem and supratentorial pathology are documented in forensic ≤40y autopsies in Metropolitan Mexico City (MMC), and p-τ is the major aberrant protein. Post-traumatic stress disorder (PTSD) is associated with an elevated risk of subsequent dementia, and rapid eye movement sleep behavior disorder (RBD) is documented in PD, AD, Lewy body dementia and ALS. This study aimed to identify an association between PTSD and potential pRBD in Mexico. An anonymous online survey of 4502 urban college-educated adults, 29.3 ± 10.3 years; MMC, n = 1865; non-MMC, n = 2637, measured PTSD symptoms using the Impact of Event Scale-Revised (IES-R) and pRBD symptoms using the RBD Single-Question. Over 50% of the participants had IES-R scores ≥33 indicating probable PTSD. pRBD was identified in 22.6% of the participants across Mexico and 32.7% in MMC residents with PTSD. MMC subjects with PTSD had an OR 2.6218 [2.5348, 2.7117] of answering yes to the pRBD. PTSD and pRBD were more common in women. This study showed an association between PTSD and pRBD, strengthening the possibility of a connection with misfolded proteinopathies in young urbanites. We need to confirm the RBD diagnosis using an overnight polysomnogram. Mexican women are at high risk for stress and sleep disorders.
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Affiliation(s)
- Lilian Calderón-Garcidueñas
- Department of Biomedical & Pharmaceutical Sciences, College of Health, The University of Montana, Missoula, MT 59812, USA
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India;
| | - Elijah W. Stommel
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA;
| | - Randy Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA;
| | - Yusra Mansour
- Henry Ford Macomb, Department of Otolaryngology—Facial Plastic Surgery, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA;
| | - Adriana Rico-Villanueva
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Jorge Orlando Flores-Vázquez
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Rafael Brito-Aguilar
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Silvia Ramírez-Sánchez
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Griselda García-Alonso
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Diana A. Chávez-Franco
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Samuel C. Luévano-Castro
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Edgar García-Rojas
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | - Paula Revueltas-Ficachi
- Universidad del Valle de México, Mexico City 14370, Mexico; (A.R.-V.); (J.O.F.-V.); (R.B.-A.); (S.R.-S.); (G.G.-A.); (D.A.C.-F.); (S.C.L.-C.); (E.G.-R.); (P.R.-F.)
| | | | - Partha S. Mukherjee
- Interdisciplinary Statistical Research Unit, Indian Statistical Institute, Kolkata 700108, India;
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Robles R, Rodríguez E, Vega-Ramírez H, Álvarez-Icaza D, Madrigal E, Durand S, Morales-Chainé S, Astudillo C, Real-Ramírez J, Medina-Mora ME, Becerra C, Escamilla R, Alcocer-Castillejos N, Ascencio L, Díaz D, González H, Barrón-Velázquez E, Fresán A, Rodríguez-Bores L, Quijada-Gaytán JM, Zabicky G, Tejadilla-Orozco D, González-Olvera JJ, Reyes-Terán G. Mental health problems among healthcare workers involved with the COVID-19 outbreak. ACTA ACUST UNITED AC 2020; 43:494-503. [PMID: 33331498 PMCID: PMC8555639 DOI: 10.1590/1516-4446-2020-1346] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/16/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. METHODS A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. RESULTS The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). CONCLUSION The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.
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Affiliation(s)
- Rebeca Robles
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Evelyn Rodríguez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Hamid Vega-Ramírez
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Dení Álvarez-Icaza
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Eduardo Madrigal
- Dirección General, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Sol Durand
- Dirección General, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Silvia Morales-Chainé
- Facultad de Psicología Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Claudia Astudillo
- Servicios de Atención Psiquiátrica, Secretaría de Salud, Ciudad de México, Mexico
| | - Janet Real-Ramírez
- Cetro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, México
| | - María-Elena Medina-Mora
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico.,Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Claudia Becerra
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Raúl Escamilla
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Natasha Alcocer-Castillejos
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Leticia Ascencio
- Unidad de Cuidados Paliativos, Instituto Nacional de Cancerología, Ciudad de México, Mexico
| | - Dulce Díaz
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Hugo González
- Clínica de Trastornos Adictivos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | - Ana Fresán
- Subdirección de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | - Gady Zabicky
- Dirección General, Comisión Nacional contra las Adicciones, Ciudad de México, Mexico
| | | | | | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacional de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Ciudad de México, Mexico
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