Resumen de Psicopatología y uso de tabaco en estudiantes de secundaria

Maria del Carmen Lara Muñoz, Teresita Romero Ogawa, Héctor Foncerrada, Julián Aguilar Cortesano, Clementina Rebollo

• español

  Cuando se habla de drogas, generalmente se piensa en sustancias ilícitas. Sin embargo, sustancias aparentemente inocuas como la cafeína y otras legales como el tabaco y el alcohol son también sustancias de abuso. El principal efecto adverso del tabaco es la muerte. De acuerdo al estudio de la Carga Global de la Enfermedad, para el año 2020, el tabaco será la causa individual de más muertes en el mundo, y sobrepasará incluso al SIDA. La dependencia a la nicotina se puede presentar a cualquier edad, aunque generalmente empieza en la adolescencia. En las investigaciones sobre el consumo de drogas entre adolescentes realizadas en el Distrito Federal, en 1989, 1991 y 1993, se observó que el consumo de tabaco se ha incrementado ligera aunque sistemáticamente, de manera que ha pasado de 44.8% a 48.2%. En el consumo actual (en el último mes) el porcentaje de usuarios es de 21.9%. A nivel secundaria es de 13.7% y a nivel bachillerato de 34.4%. Aunque en la bibliografía internacional se reconoce la relación del Trastorno por déficit de la Atención con el consumo de drogas, ninguno de los trabajos realizados en nuestro país ha incluido esta variable.

  La relación del trastorno de la atención y el tabaquismo es compleja. En un estudio con adultos fumadores, los sujetos con TDA manifestaron haber iniciado más temprano la adicción a tabaco que los que no presentaban TDA. Este hallazgo ha sido confirmado en estudios de seguimiento. El presente trabajo se realizó con base en la hipótesis de que los síntomas del TDA y de la psicopatología general son más elevados entre los adolescentes que han consumido tabaco que entre los no consumidores.

  Material y métodos: Se realizó un escrutinio comparativo, transversal de adolescentes con y sin consumo de tabaco. Se seleccionaron aleatoriamente 15 escuelas secundarias de la Ciudad de Puebla. Se evaluó a los alumnos que ingresaron a 1o. de secundaria y que aceptaron responder a los cuestionarios. Los síntomas del trastorno por déficit de la atención se valoraron con la Escala del Reporte Personal para adolescentes de Conners-Wells (versión larga). La psicopatología general se evaluó con la Lista de 90 Síntomas (SCL-90). El consumo de tabaco se determinó mediante el Cuestionario de Estudiantes de Secundaria, desarrollado en el Instituto Nacional de Psiquiatría, empleado en las encuestas de Consumo de Drogas, Alcohol y Tabaco del D.F. Se consideró positivo el consumo de Tabaco cuando se respondió afirmativamente a las preguntas sobre consumo alguna vez en la vida, en el último año y en el último mes. Antes de la aplicación, se les explicó a los alumnos que la información se manejaría confidencialmente. Se compararon las 19 subescalas de psicopatología entre los estudiantes con y sin consumo de tabaco.

  Resultados: De 590 estudiantes inscritos en los grupos seleccionados, se evaluó a 544 (92%). El promedio de edad fue de 12.3 años; 57% (n = 312) eran varones. Veinte niños (3.6%) habían consumido tabaco en el último mes. En el Cuestionario Conners-Wells, éstos alcanzaron en todas las subescalas, puntuaciones más elevadas que los alumnos sin consumo. Fueron estadísticamente significativas las de Problemas familiares, de conducta, cognitivos, de control de enojo, hiperactividad, índice global de TDAH y distractibilidad DSM IV. Los síntomas de psicopatología general también fueron mayores en las nueve subescalas del SCL-90 en los que habían usado tabaco en el último mes, en relación con los que no lo habían usado: en siete de ellas, la diferencia fue estadísticamente significativa. En relación con el uso experimental de tabaco (alguna vez en la vida), 84 niños (15%) respondieron afirmativamente. Las puntuaciones de estos niños fueron significativamente mayores que las de los que respondieron negativamente en todas las subescalas del Cuestionario de Conners-Wells, excepto en la de problemas emocionales. En la Lista de 90 Síntomas las puntuaciones de los niños que han usado tabaco alguna vez en la vida fueron significativamente más elevadas en las subescalas de síntomas somáticos, obsesivo-compulsivos, sensibilidad interpersonal, enojo-hostilidad, ideación paranoide y síntomas psicóticos.

  Discusión: Los resultados obtenidos en este estudio confirman la hipótesis propuesta de que los estudiantes con consumo de tabaco presentan niveles de psicopatología superiores a los de aquéllos que nunca han consumido estas sustancias. Es necesario subrayar que éste es el primer estudio en nuestro país en el que se correlaciona el consumo de tabaco con síntomas de psicopatología evaluados de manera estructurada con instrumentos válidos y confiables.

• English

  When we talk about drugs, we usually think about illicit substances. However some substances apparently innocuous such as caffeine and other legal ones like tobacco and alcohol, are considered as abuse substances.

  Nicotine has not been studied as extensively as other drugs. It is known that the pharmacological and behavioural processes that determine the addiction to nicotine are similar to those that determine the addiction to other drugs such as cocaine or heroine.

  The main adverse effect of nicotine is death. According to the Global Burden of Disease study of the World Health Organization, the World Bank, and Harvard University, in 2020, tobacco will be the first individual cause of death in the world even over AIDS. Nicotine dependence can appear at any age, though it generally begins during adolescence, and it acts on the brain mechanisms of reward, indirectly by endogenous opioid activity and directly by dopaminergic pathways.

  In the researches on drugs consumption among adolescents conducted in Mexico City during 1989, 1991 and 1993, it was observed that tobacco consumption has increased lightly but systematically, from 4.8% to 4.2%. The percentage of current users (in the last month) is 21.9%. At junior high school level it is 13.7%, and at high school level 34.4%.

  Attention Déficit Disorder With Hyperactivity (ADDH).

  Altough the relationship between ADDH and drugs consumption has been recognized none of the studies conducted in our country has included this variable.

  ADDH is a disorder with a frequency of 1.7% to 18.9%. The difference between the reported percentages is attributed to the fact that definitions and methods used in the studies are not the same.

  When the disorder is not treated, there is usually a gradual accumulation of adverse processes that increase the risk of pathology.

  The relationship between ADDH and drug consumption is complex. In a study of adolescents who received treatment for drug abuse, it was observed that 50% of them met the criteria for ADDH. As well, this disorder was a bad prognosis factor, either to the addiction evolution and its treatment.

  Another complex relationship is the one between ADDH and cigarette smoking. In a study conducted among adult smokers, the subjects with ADDH had an earlier onset of the tobacco addiction, compared to those who did not had ADDH. This finding was confirmed by Milberger, who in a four years follow up study, discovered that ADDH is a significant predictor on the early tobacco consumption.

  ADDH can be considered as a risk factor in developing other addictions.

  Although the relationship between ADDH and drug consumption has been studied, the reviewed researches show up some limitations :

  Only clinical samples have been studied.

  Most of the follow up studies have included just male individuals with ADDH.

  In our country the effect of the clinical variables on drugs use have not been studied.

  In ADDH as well as in drug consumption, it has been observed a remarkable influence of cultural variables, this emphasize the need of evaluating both problems in our country.

  The following study was conducted under the hypothesis that ADDH and general pathology symptoms are higher among adolescents that have consumed tobacco than those who have not.

  Material and methods A comparative, cross-sectional survey of adolescent with and without tobacco usage was performed. Fifteen junior high schools in Puebla City were randomly selected. First year junior high school students who agreed to answer the questionnaires were included.

  The studied variables were: symptoms of ADDH and general psychopathology symptoms.

  ADDH symptoms were dimensionally evaluated with the Conners-Wells Self Report Scale (long version).

  General psychopathology was rated with the SCL-90 which evaluates the intensity of symptoms in 9 subscales.

  Tobacco consumption was determined by the Junior High school Students Questionnaire, developed at the National Institute of Psychiatry, which was used in the Drug, Alcohol and Tobacco consumption surveys in Mexico City. Tobacco consumption was considered positive when the questions about lifetime, and last month consumption were affirmative.

  From the 15 junior high schools selected, a first year group was chosen at the beginning of the school term.

  A written authorization from the parents was requested, so the students could answer to the questionnaires. It was inferred that all of them accepted because none of the parents refused explicitely.

  The questionnaire about drug consumption was applied the first day. Before the application, it was explained to the adolescents, that the information would be confidentially handled; the questionnaire answers would be only known by the researchers and that the information would not be given to their parents or their teachers. The second day of evaluation, the Conners questionnaire was applied. The third day the students answered to the SCL-90.

  All the questionnaires were applied at the beginning of the daily activities.

  The 19 psychopathology subscales were compared between male and women and between the students with and without tobacco consumption in the last month and during lifetime. Although the statistical significance was determined with non parametric tests (Wilcoxon test), on the tables, means and standard deviations are shown. The analysis were done with the SAS 6.12. program. The significance level was determined at 0.05.

  Results From 590 students registered on the selected groups, 544 (92%) were evaluated, the rest of them did not show up during the week in which the evaluations were performed. The mean age was 12 years with a standard deviation of 1, 57.3% (n=295) were males.

  Twenty children (3.9%) have used tobacco during the last month. On the Conners-Wells Questionnaire, they had higher scores on all ten subscales. These differencies were statistically significant in seven subscales: Familial problems, Conduct problems, Cognitive problems, anger management problems, hyperactivity, Global index, and distractibility DSM IV.

  General psychopathology symptoms also were higher in those individuals who used tobacco during the last month, compared to those who did not, in seven of the nine subscales the differences were statistically significant. Regarding the experimental usage of tobacco (ever in lifetime), 84 children (15%) answered affirmatively. The scores of these children were higher than the scores of children who denied ever smoked in all subscales of the Conners-Wells Questionnaire. The differences were statistically significant in nine of the ten subscales. In the SCL-90 the scores of the children who have used tobacco during lifetime, were higher in all subscales, except in phobic anxiety.

  Discussion Our results confirm the proposed hypothesis that the students who consume tobacco present higher levels of psychopathology, compared to those students who have never used this substance. It is necessary to underline the fact that this is the first study in our country that correlates the tobacco consumption with psychopathology symptoms, evaluated in a structured way with valid and reliable instruments.