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Yang R, Li Z, Zhu Y, Wu Y, Lu X, Zhao X, Liu J, Du X, Zhang X. Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China. BMC Psychiatry 2024; 24:413. [PMID: 38834989 DOI: 10.1186/s12888-024-05860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD. METHODS A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt. RESULTS Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32). CONCLUSION Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.
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Affiliation(s)
- Ruchang Yang
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yingzhao Zhu
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yuxuan Wu
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Junjun Liu
- Nanjing Meishan Hospital, Nanjing, China
| | - Xiangdong Du
- Suzhou Medical College of Soochow University, Suzhou, China.
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Wu Y, Zhao X, Li Z, Yang R, Peng R, Zhou Y, Xia X, Deng H, Zhang X, Du X, Zhang X. Prevalence and risk factors for psychotic symptoms in young, first-episode and drug-naïve patients with major depressive disorder. BMC Psychiatry 2024; 24:66. [PMID: 38262974 PMCID: PMC10807072 DOI: 10.1186/s12888-024-05517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a common psychiatric disorder worldwide. Psychotic depression has been reported to be frequently under-diagnosed due to poor recognition of psychotic features. Therefore, the purpose of this study was to reveal the rate and risk factors of psychotic symptoms in young, drug-naïve patients with major depressive disorder at the time of their first episode. METHODS A total of 917 patients were recruited and divided into psychotic and non-psychotic subgroups based on the Positive and Negative Syndrome Scale (PANSS) positive subscale score. Anxiety symptoms and depressive symptoms were measured by the Hamilton Anxiety Rating Scale (HAMA) and the 17-item Hamilton Depression Rating Scale (HAMD-17), respectively. Several biochemical indicators such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were also measured. RESULTS The rate of psychotic symptoms among young adult MDD patients was 9.1%. There were significant differences in TSH (p<0.001), FBG (p<0.001), TC (p<0.0001), TG (p = 0.001), HDL-C (p = 0.049), LDL-C (p = 0.010), diastolic blood pressure (DP) (p<0.001), systolic blood pressure (SP) (p<0.001), and HAMD total score (p<0.001) between young MDD patients with and without psychotic depression. HAMD, TSH, TC, and severe anxiety were independently associated with psychotic symptoms in young adult MDD patients. In addition, among young MDD patients, the rate of suicide attempts in the psychotic subgroup was much higher than in the non-psychotic subgroup (45.8% vs. 16.9%). CONCLUSIONS Our findings suggest that psychotic symptoms are common in young MDD patients. Several clinical variables and biochemical indicators are associated with the occurrence of psychotic symptoms in young MDD patients.
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Affiliation(s)
- Yuxuan Wu
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruchang Yang
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruijie Peng
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yue Zhou
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Xuzhou Medical University, Xuzhou, China
| | - Xingzhi Xia
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Xuzhou Medical University, Xuzhou, China
| | - Hanxu Deng
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Xuzhou Medical University, Xuzhou, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Medical College of Soochow University, Suzhou, China.
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoying District, Beijing, 100101, China.
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Jiang X, Zheng H, Yang R, Wang S, Zhong H. Retrospective analysis of clinical characteristics and treatment of children and adolescents with depression. Front Psychiatry 2023; 14:1036314. [PMID: 37575578 PMCID: PMC10412874 DOI: 10.3389/fpsyt.2023.1036314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/29/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To analyze the demographic and clinical characteristics and treatment among children and adolescents with depression in different age groups of onset. Methods 635 children and adolescents with depression in a hospital from January 2014 to December 2021 were collected by e-case, and grouped according to age of onset, including 115 cases in childhood 8-12, 359 cases in early adolescence 13-1 and 161 cases in late adolescence 16-18, and the general conditions, clinical characteristics, and treatment were compared between the three groups. Results Females had more onset and were more likely to have psychotic symptoms in childhood, short duration and hospitalization in early adolescence increased year by year, and males had more onset and less hospitalization in late adolescence. There were no statistical differences in medication regimen, suicide, length of hospitalization, or family history between the three groups. Conclusion Children and adolescents with depression have their unique clinical characteristics at different age of onset and need to enhance prevention and individualized treatment.
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Affiliation(s)
- Xiaolu Jiang
- Department of Child and Adolescents, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China
| | | | - Rong Yang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Shuo Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Hui Zhong
- Department of Child and Adolescents, Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Child and Adolescents, Fourth People’s Hospital, Hefei, Anhui, China
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Yang R, Zhu F, Yue Y, Lu X, Zhu P, Li Z, Zhao X, Yang X, Zhou Y, Du X. Association between thyroid function and psychotic symptoms in adolescents with major depressive disorder: A large sample sized cross-sectional study in China. Heliyon 2023; 9:e16770. [PMID: 37303557 PMCID: PMC10248252 DOI: 10.1016/j.heliyon.2023.e16770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Backgrounds Thyroid function was associated with depression and psychotic symptoms; however, little research has focused on its role in coexisting psychotic symptoms in adolescents with depressive disorder. This study aimed to explore the association between thyroid function and psychotic symptoms among depression adolescents. Methods A total of 679 adolescent patients (aged 12-18) diagnosed as depressive disorder were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The severity of psychotic symptoms was measured according to the assessment measure in DSM-5. Based on the severity of psychotic symptoms, patients were distributed into psychotic depression (PD) and non-psychotic depression (NPD) subgroups, respectively. Results The prevalence rate of PD was 52.7% among adolescents with depressive disorder in this study. PD patients were younger (p < 0.01), with more female (p < 0.001) and non-Han nationality (p < 0.01), and presented serum FT4 level decrease (p < 0.01). PD patients displayed a higher rate of abnormal thyroid relevant parameters (p < 0.05). 35.2% of PD patients presented at least one abnormal parameter among all five parameters tested (TSH, TT3, FT3, TT4, and FT4), compared to 27.4% among NPD patients. Further logistic regression analysis indicated that increased serum FT4 level was a protective effect of PD with an adjusted odds ratio (OR) of 0.615. We did not find a statistically significant difference in the family history of mental disorders, serum TSH, TT3, FT3, and TT4 levels. Conclusions Our results suggested a high prevalence of PD among depression adolescents, associated with younger age, female, non-Han nationality, and decreased serum FT4 level. We recommend that adolescents with depressive disorder regularly screen their serum FT4 levels for better clinical outcomes.
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Affiliation(s)
- Ruchang Yang
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Feng Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan Yue
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ping Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xuna Yang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
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Zhou Y, Li Z, Wang Y, Huang H, Chen W, Dong L, Wu J, Chen J, Miao Y, Qi L, Zhang S, Lang X, Zhang X. Prevalence and clinical correlates of psychotic depression in first-episode and drug-naïve outpatients with major depressive disorder in a Chinese Han population. J Affect Disord 2020; 263:500-506. [PMID: 31759662 DOI: 10.1016/j.jad.2019.10.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few systemic studies of psychotic depression (PD) have been conducted in first-episode and drug-naïve (FEDN) patients. This study was to examine the prevalence of PD and its clinical correlates in a large sample of FEDN outpatients with major depressive disorder (MDD) in a Chinese Han population, which to our best knowledge has not been studied. METHODS In this cross-sectional study, a total of 1718 FEDN MDD outpatients were recruited. All patients were rated on the positive symptom subscale of the Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms, the 17-item Hamilton Depression Rating Scale (HAMD-17) for depression and Hamilton Anxiety Rating Scale (HAMA) for anxiety. RESULTS The prevalence of PD was 10.0% (171/1718) in MDD patients. Compared to the non-PD patients, PD patients had significantly older age, lower educational levels, higher anxiety symptom score and were more likely to attempt suicide. Further logistic regression analysis indicated that PD was associated with older age, suicide attempt and comorbid anxiety (all p < 0.05). Multiple regression analyses showed that both HAMD and HAMA total scores were significantly associated with PANSS positive symptom subscale score. LIMITATIONS Our cross-sectional study design does not show a direct causal relationship between psychiatric symptoms and related factors in patients with MDD. CONCLUSIONS Our results suggest a high prevalence of PD in MDD patients in the acute early stage in a Chinese Han population, which is associated with demographic variables and clinical symptoms.
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Affiliation(s)
- Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Zezhi Li
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Yijun Wang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Huiteng Huang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Wencai Chen
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ling Dong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jiang Wu
- Wuhan Youfu Hospital, Wuhan, China
| | - Jing Chen
- Wuhan Youfu Hospital, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ying Miao
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ling Qi
- Wuhan Youfu Hospital, Wuhan, China; School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, 430023, China
| | - Shufang Zhang
- Wuhan Youfu Hospital, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Xiaoe Lang
- Department of Psychiatry, The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Jääskeläinen E, Juola T, Korpela H, Lehtiniemi H, Nietola M, Korkeila J, Miettunen J. Epidemiology of psychotic depression - systematic review and meta-analysis. Psychol Med 2018; 48:905-918. [PMID: 28893329 DOI: 10.1017/s0033291717002501] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. We performed a systematic review and meta-analyses on epidemiology, especially incidence and prevalence, risk factors, and outcomes of PD. A systematic search to identify potentially relevant studies was conducted using four electronic databases and a manual search. The search identified 1764 unique potentially relevant articles, the final study included 99 articles. We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. Onset age of PD was earlier than that of NPD in younger samples, but later in older samples. There were no differences in gender distribution in PD v. NPD, but higher proportion of females was found in PD than in SZ or in psychotic bipolar disorder (PBD). Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. Outcomes of PD were mostly worse when compared with NPD, but better compared with SZ and schizoaffective disorder. The outcome compared with PBD was relatively similar, and somewhat varied depending on the measure of the outcome. Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.
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Affiliation(s)
- E Jääskeläinen
- Center for Life Course Health Research,University of Oulu,Finland
| | - T Juola
- Center for Life Course Health Research,University of Oulu,Finland
| | - H Korpela
- Center for Life Course Health Research,University of Oulu,Finland
| | - H Lehtiniemi
- Center for Life Course Health Research,University of Oulu,Finland
| | - M Nietola
- Psychiatric Department,University of Turku and Turku University Hospital,Finland
| | - J Korkeila
- Psychiatric Department,University of Turku and Satakunta Hospital District,Finland
| | - J Miettunen
- Center for Life Course Health Research,University of Oulu,Finland
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Gournellis R, Tournikioti K, Touloumi G, Thomadakis C, Michalopoulou PG, Christodoulou C, Papadopoulou A, Douzenis A. Psychotic (delusional) depression and suicidal attempts: a systematic review and meta-analysis. Acta Psychiatr Scand 2018; 137:18-29. [PMID: 29178463 DOI: 10.1111/acps.12826] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It still remains unclear whether psychotic features increase the risk of suicidal attempts in major depressive disorder. Thus, we attempted, through a systematic review coupled with a meta-analysis, to elucidate further whether unipolar psychotic depression (PMD) compared to non-PMD presents higher levels of suicidal attempts. METHOD A systematic search was conducted in PubMed, EMBASE, PsycINFO as well as in various databases of the so-called gray literature for all studies providing data on suicidal attempts in PMD compared to non-PMD, and the results were then subjected to meta-analysis. RESULTS Twenty studies met our inclusion criteria, including in total 1,275 PMD patients and 5,761 non-PMD patients. An elevated risk for suicide attempt for PMD compared to non-PMD patients was found: The total (lifetime) fixed-effects pooled OR was 2.11 (95% CI: 1.81-2.47), and the fixed-effects pooled OR of the five studies of the acute phase of the disorder was 1.93 (95% CI: 1.33-2.80). This elevated risk of suicidal attempt for PMD patients remained stable across all age groups of adult patients. CONCLUSION Despite data inconsistency and clinical heterogeneity, this systematic review and meta-analysis showed that patients with PMD are at a two-fold higher risk, both during lifetime and in acute phase, of committing a suicidal attempt than patients with non-PMD.
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Affiliation(s)
- R Gournellis
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - K Tournikioti
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - G Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - P G Michalopoulou
- Cognition, Schizophrenia, Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Christodoulou
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - A Papadopoulou
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - A Douzenis
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
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Gournellis R, Tournikioti K, Touloumi G, Thomadakis C, Michalopoulou PG, Michopoulos I, Christodoulou C, Papadopoulou A, Douzenis A. Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis. Ann Gen Psychiatry 2018; 17:39. [PMID: 30258483 PMCID: PMC6150953 DOI: 10.1186/s12991-018-0207-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides. METHODS A systematic search was conducted in Scopus, PubMed, and "gray literature" for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields. RESULTS Nine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04-1.40). In a sub-analysis excluding a very large study (weight = 86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16-2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD's suicide risk. The lack of accurate diagnosis at the time of suicide, PMD's diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations. CONCLUSIONS The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients' suicidality constitutes a supreme priority.
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Affiliation(s)
- Rossetos Gournellis
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Kalliopi Tournikioti
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Giota Touloumi
- 2Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Thomadakis
- 2Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiota G Michalopoulou
- 3Cognition, Schizophrenia, Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Ioannis Michopoulos
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Christos Christodoulou
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Athanasia Papadopoulou
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
| | - Athanasios Douzenis
- 1Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 1 Rimini Str TK 12462, Athens, Greece
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Holshausen K, Bowie CR, Harkness KL. The Relation of Childhood Maltreatment to Psychotic Symptoms in Adolescents and Young Adults With Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 45:241-7. [PMID: 25411823 DOI: 10.1080/15374416.2014.952010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined the relation between a history of maltreatment and the presence of psychotic symptoms in a community sample of adolescents and young adults with major depressive disorder. One hundred and twenty-nine depressed adolescents and young adults (M = 16.02 years, 77% female, 92% White) were recruited through community advertisement and clinician referral. Clinical diagnoses and psychotic symptoms (i.e., hallucinations and delusions) were assessed using a structured diagnostic interview. Childhood maltreatment was assessed using a contextual interview and standardized rating system. Logistic regression analyses examined the relation between childhood maltreatment and psychotic symptoms. As hypothesized, individuals with psychotic symptoms were significantly more likely to report a history of severe sexual maltreatment than those without psychotic symptoms (Wald = 5.44, odds ratio = 3.86, p = .020), 95% confidence interval [1.24, 12.01]. Further, those with psychotic symptoms were more likely to report being the victims of more than one type of maltreatment than those without, χ2(2) = 6.66, p = .036 (ϕ = .23; 40% vs. 16%). Results held upon adjusting for overall level of depression symptoms. A history of severe sexual maltreatment is related to a severe presentation of major depressive disorder even in the initial onset of the syndrome in adolescence and young adulthood. These findings underscore the importance of early assessment of both depression and maltreatment history to implement interventions that have the potential to prevent the emergence of psychotic psychopathology in young people at risk.
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Affiliation(s)
| | - Christopher R Bowie
- b Departments of Psychology & Psychiatry , Queen's University , Kingston , Ontario , Canada
| | - Kate L Harkness
- b Departments of Psychology & Psychiatry , Queen's University , Kingston , Ontario , Canada
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Khasakhala LI, Ndetei DM, Mathai M. Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya. Ann Gen Psychiatry 2013; 12:13. [PMID: 23622559 PMCID: PMC3644274 DOI: 10.1186/1744-859x-12-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/16/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Suicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents. METHOD The study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively. RESULTS This study found a significant statistical association between depressive (p < 0.001), alcohol abuse (p <0.001) and substance abuse (p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder (p < 0.001) and perceived maternal rejecting parenting behaviour (p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16-18 years had suicidal behaviour than youths below 16 years or above 18 years of age (p = 0.004). CONCLUSION These findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.
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Affiliation(s)
- Lincoln I Khasakhala
- Department of Psychiatry, University of Nairobi, P.O. Box 30197, Nairobi, Kenya
- Africa Mental Health Foundation (AMHF), P.O. Box 59176 00200, Nairobi, Kenya
| | - David M Ndetei
- Department of Psychiatry, University of Nairobi, P.O. Box 30197, Nairobi, Kenya
- Africa Mental Health Foundation (AMHF), P.O. Box 59176 00200, Nairobi, Kenya
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, P.O. Box 30197, Nairobi, Kenya
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11
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Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Acta Psychiatr Scand 2010; 121:462-70. [PMID: 19764926 PMCID: PMC3671385 DOI: 10.1111/j.1600-0447.2009.01477.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Increasing evidence exists linking childhood trauma and primary psychotic disorders, but there is little research on patients with primary affective disorders with psychotic features. METHOD The sample consisted of adult out-patients diagnosed with major depressive disorder (MDD) at clinic intake using a structured clinical interview. Patients with MDD with (n = 32) vs. without psychotic features (n = 591) were compared as to their rates of different types of childhood trauma. RESULTS Psychotic MDD patients were significantly more likely to report histories of physical (OR = 2.81) or sexual abuse (OR = 2.75) compared with non-psychotic MDD patients. These relationships remained after controlling for baseline differences. Within the subsample with comorbid post-traumatic stress disorder, patients with psychotic MDD were significantly more likely to report childhood physical abuse (OR = 3.20). CONCLUSION Results support and extend previous research by demonstrating that the relationship between childhood trauma and psychosis is found across diagnostic groups.
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Affiliation(s)
- Brandon A. Gaudiano
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University,Psychosocial Research Program, Butler Hospital
| | - Mark Zimmerman
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University,Department of Psychiatry, Rhode Island Hospital
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12
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Simon AE, Cattapan-Ludewig K, Gruber K, Ouertani J, Zimmer A, Roth B, Isler E, Umbricht D. Subclinical hallucinations in adolescent outpatients: an outcome study. Schizophr Res 2009; 108:265-71. [PMID: 19167194 DOI: 10.1016/j.schres.2008.12.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/04/2008] [Accepted: 12/20/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We assessed the continued prevalence at one year and association with clinical variables of subclinical hallucinations ascertained at baseline in a cohort of adolescent outpatients referred to a specialized early psychosis service. We further assessed the prevalence of psychiatric disorders in adolescents presenting subclinical hallucinations. METHOD 84 adolescent patients were sampled from a longitudinal, prospective study that assesses the course of clinical and neuropsychological measures in patients identified as at high clinical risk for psychosis. Subclinical hallucinations were measured using the Scale of Prodromal Symptoms (SOPS) with its companion interview manual (Structured Interview for Prodromal Symptoms, SIPS) [Miller, T.J., McGlashan, T.H., Woods, S.W., Stein, K., Driesen, N., Corcoran, C.M., Hoffman, R., Davidson, L., 1999. Symptom assessment in schizophrenic prodromal states. Psychiatr. Q. 70, 273-287; McGlashan, T.H., Miller, T.J., Woods, S.W., Rosen, J.L., Hoffman, R.E., Davidson, L., 2001. Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). PRIME Research Clinic, Yale School of Medicine New Haven, Connecticut. ], and the Schizophrenia Proneness Instrument -Adult Version (SPI-A) [Schultze-Lutter, F., Addington, J., Ruhrmann, S., Klosterkötter, J., 2007. Schizophrenia Proneness Instrument (SPI-A). Giovanni Fioriti, Rome, Italy]. At one-year follow-up, only patients reporting subclinical hallucinations at initial assessment were studied. RESULTS Full remission of subclinical hallucinations occurred in over half and at least partial remission in two thirds of these patients at one-year follow-up. Mood disorders were present in 62.5% of adolescents with subclinical hallucinations at initial assessment. SOPS measures for depression, deficient attention and for unusual/delusional thought were significantly associated with subclinical hallucinations at baseline. However, sustained experience of subclinical hallucinations at one-year follow-up was only predicted by the global level of functioning at baseline, while cannabis abuse, psychiatric and psychopharmacological treatment were not predictors. CONCLUSIONS Subclinical hallucinations occur across a wide range of mental states in adolescents and show high rates of remission. Our results warrant that the clinical meaning of such phenomena needs to be carefully weighed against the specific developmental phenomena in this particular age range.
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Affiliation(s)
- Andor E Simon
- Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, 4101 Bruderholz, Switzerland.
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13
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Bendall S, Jackson HJ, Hulbert CA, McGorry PD. Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophr Bull 2008; 34:568-79. [PMID: 18003630 PMCID: PMC2632421 DOI: 10.1093/schbul/sbm121] [Citation(s) in RCA: 235] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is controversy over whether childhood trauma (CT) is a causal factor in the development of psychosis. This review aims to identify and critically analyze the association between CT and psychotic disorders. Studies investigating CT and psychotic disorder were identified by searches of electronic databases and manual searches of references lists, and 46 studies were identified. Forty studies had no control group, only psychiatric control groups, or unmatched, nonpopulation control groups and thus had methodologies that were inadequate to determine the relationship between CT and psychosis. Six studies used appropriate control groups. Three studies found an association between CT and psychosis, 2 found potentially real associations that failed to reach statistical significance, and 1 found no association, tentatively suggesting a relationship between CT and psychotic disorders. Several methodological problems were found in the studies in the review, including the highest quality studies, which limit the strength of the conclusions that can be drawn from them. These were lack of statistical power, lack of attention to moderating or mediating variables, the way in which CT was measured, and the use of cross-sectional research designs. These problems, some of which may be unavoidable in CT research, suggest the need for new and innovative methodologies in the investigation of CT and psychosis. Directions for further research are explored.
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Affiliation(s)
- Sarah Bendall
- ORYGEN Research Centre, 35 Poplar Road, Parkville, Victoria 3056, Australia.
| | - Henry J. Jackson
- ORYGEN Research Centre, 35 Poplar Road, Parkville, Victoria 3056, Australia,Department of Psychology, The University of Melbourne, Parkville 3056, Australia
| | - Carol A. Hulbert
- Department of Psychology, The University of Melbourne, Parkville 3056, Australia
| | - Patrick D. McGorry
- ORYGEN Research Centre, 35 Poplar Road, Parkville, Victoria 3056, Australia
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Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 2007; 46:1503-26. [PMID: 18049300 DOI: 10.1097/chi.0b013e318145ae1c] [Citation(s) in RCA: 560] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.
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15
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Daigneault I, Cyr M, Tourigny M. Profil psychologique d’adolescentes agressées sexuellement et prises en charge par les services de la protection de la jeunesse. SANTE MENTALE AU QUEBEC 2004. [DOI: 10.7202/008625ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RésuméCette étude s’intéresse aux symptômes de 30 adolescentes prises en charge par les services de protection de la jeunesse à la suite d’agressions sexuelles. En plus de tracer un profil psychologique de ces adolescentes, l’étude décrit les agressions sexuelles vécues, les services reçus et identifie les facteurs susceptibles d’être liés aux symptômes. Les résultats montrent que les adolescentes présentent plusieurs problèmes psychologiques et que la majorité d’entre elles vivent une détresse nécessitant une intervention clinique. Les agressions sexuelles se situent à l’extrémité la plus sévère du large éventail rapporté dans la littérature et les services sont peu fréquents et irréguliers. Les symptômes sont associés au temps écoulé depuis la fin des agressions et aux services reçus. La discussion souligne l’importance de l’adéquation entre les services et le profil psychologique de chaque adolescente en proposant un modèle de guérison.
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Affiliation(s)
- Isabelle Daigneault
- Ph.D., Département de psychologie de l’Université de Montréal et membre du Centre de recherches interdisciplinaires sur les problèmes conjugaux et les agressions sexuelles (CRIPCAS)
| | - Mireille Cyr
- Ph.D., Professeur titulaire au département de psychologie de l’Université de Montréal et directrice du CRIPCAS
| | - Marc Tourigny
- Ph.D., Professeur agrégé au département d’éducation spécialisée de l’Université de Sherbrooke, membre du CRIPCAS et du GRISE (Groupe de recherche sur les inadaptations sociales de l’enfance)
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Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP. J Am Acad Child Adolesc Psychiatry 1998; 37:63S-83S. [PMID: 9785729 DOI: 10.1097/00004583-199810001-00005] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Child and adolescent major depressive disorder and dysthymic disorder are common, chronic, familial, and recurrent conditions that usually persist into adulthood. These disorders appear to be manifesting at an earlier age in successive cohorts and are usually accompanied by comorbid psychiatric disorders, increased risk for suicide, substance abuse, and behavior problems. In addition, depressed youth frequently have poor psychosocial, academic, and family functioning, which highlights the importance of early identification and prompt treatment. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of youth with depressive disorders. Opinions vary regarding which of these treatments should be offered first and whether they should be offered in combination. In general, the choice of initial therapy depends on clinical and psychosocial factors and therapist's expertise. Based on the current literature and clinical experience, psychotherapy may be the first treatment for most depressed youth. However, antidepressants must be considered for those patients with psychosis, bipolar depression, severe depressions, and those who do not respond to an adequate trial of psychotherapy. All patients need continuation therapy and some patients may require maintenance treatment. Further research is needed on the etiology of depression; the efficacy of different types of psychotherapy; the differential effects of psychotherapy, pharmacotherapy, and integrated therapies; the continuation and maintenance treatment phases; treatment for dysthymia, treatment-resistant depression, and other subtypes of major depressive disorder; and preventive strategies for high-risk children and adolescents.
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Abstract
A number of studies have suggested that clinical populations of adolescents may report hallucinations and/or delusions without meeting criteria for a psychotic disorder. The purpose of this study was to provide information about the prevalence and symptom correlates of these subclinical hallucinations and delusions that occur in a nonpsychotic population of adolescents. Thirty-eight adolescents from a residential program and day treatment center were assessed with respect to hallucinatory experiences, ideas of reference, paranoid ideation, dissociative experiences, depressive symptomatology, and schizotypal cognitions. Results of this study indicated that 33% of the participants reported having experienced auditory hallucinations, and 24% reported having had delusional ideas. In addition, the results suggest that subclinical auditory hallucinations may have an especially strong relation with dissociative processes, whereas subclinical delusions appeared to be most strongly correlated with schizotypal thought processes. The results of this study begin to clarify the phenomenon of hallucinatory and delusional experiences in a nonpsychotic population.
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Affiliation(s)
- H Altman
- Department of Psychology, University of Miami, Coral Gables, FL 33124-2070, USA
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