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Tully PJ, Cosh SM. Post-traumatic Stress Disorder in Heart Failure Patients: A Test of the Cardiac Disease-induced PTSD Hypothesis. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666191113121558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:Post-traumatic stress disorder (PTSD) is prevalent in approximately 12% of patients with cardiovascular disease (CVD) and such patients are at risk of further CVD morbidity and mortality. It is unknown whether CVD patients with cardiac and non-cardiac traumatic events leading to PTSD differ in medical comorbidities and psychiatric vulnerabilities. Our objective was to compare heart failure (HF) patients with cardiac and non-cardiac PTSD.Method:A population of HF patients from 3 hospitals underwent a two-step depression and anxiety screening process to identify potential mental health treatment needs. The post-traumatic stress disorder module of the Structured Clinical Interview for DSM-IV Axis-I disorders was used to classify trauma(s) exposure, and other disorders. The patients with PTSD were sub-divided by cardiac related traumas (e.g. myocardial infarction, sudden cardiac arrest) and non-cardiac related traumas (e.g. sexual abuse, interpersonal violence).Results:10 patients met criteria for non-cardiac trauma and 18 patients met criteria for cardiacinduced trauma. There were no significant differences in HF aetiology or severity nor cardiac comorbidities. Time since PTSD, onset was significantly longer for those with non-cardiac PTSD. Among psychiatric comorbidities, alcohol and substance abuse disorders, as well as depression were more prevalent in patients with non-cardiac PTSD.Conclusion:Cardiac related PTSD was associated with less alcohol and substance abuse disorders, and depression by comparison to their non-cardiac induced PTSD counterparts. Ongoing research is required to establish if cardiac-induced PTSD truly reflects a unique subtype of PTSD, and whether there are different treatment needs and therapeutic approaches for this subtype.
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Affiliation(s)
- Phillip J. Tully
- Freemasons Foundation Centre for Men’s Health, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, Australia
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A Brief Interview to Detect Panic Attacks and Panic Disorder in Emergency Department Patients with Cardiopulmonary Complaints. J Psychiatr Pract 2018; 24:32-44. [PMID: 29320381 DOI: 10.1097/pra.0000000000000283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Patients with panic-related anxiety often initially present to the emergency department (ED) complaining of respiratory or cardiac symptoms, but rates of detection of panic symptoms by ED physicians remain low. This study was undertaken to evaluate the relevance of panic attacks and panic disorder in ED patients who present with cardiopulmonary symptoms and to determine whether a brief symptom-based tool could be constructed to assist in rapid recognition of panic-related anxiety in the ED setting. MATERIALS AND METHODS English-speaking adult ED patients with a chief complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic attacks and panic disorder with the Structured Clinical Interview for DSM-IV Axis I Disorders. Participants completed self-report measures to assess panic-related symptoms, comorbid psychiatric conditions, health-related disability, and health service use. RESULTS In this sample (N=200), 23.5% had panic attacks and 23.0% had panic disorder. Both groups reported higher rates of panic attack symptoms, greater psychiatric comorbidity, greater health-related disability, and higher rates of ED and mental health service use compared with those without either condition. A brief 7-item tool consisting of panic symptoms identified patients with panic attacks or panic disorder with 85% accuracy (area under the curve=0.90, sensitivity=82%, specificity=88%). CONCLUSIONS Patients with panic attacks or panic disorder commonly present to the ED, but often go unrecognized. A brief 7-item clinician rating scale accurately identifies these patients among those ED patients presenting with cardiopulmonary complaints.
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A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Srivastava S, Shekhar S, Bhatia MS, Dwivedi S. Quality of Life in Patients with Coronary Artery Disease and Panic Disorder: A Comparative Study. Oman Med J 2017; 32:20-26. [PMID: 28042398 DOI: 10.5001/omj.2017.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The quality of life (QOL) of patients with coronary artery disease (CAD) is known to be impaired. Non-cardiac chest pain referrals are often under-diagnosed and untreated, and there are hardly any studies comparing the QOL of CAD and panic disorder related (non-cardiac) chest pain referrals (PDRC). METHODS We assessed the psychiatric morbidity and QOL of patients newly diagnosed with CAD (n = 40) at baseline and six weeks post-treatment and compared their QOL with patients with PDRC (n = 40) and age- and gender-matched healthy controls (n = 57). Psychiatric morbidity in the CAD group was assessed using the General Health Questionnaire (GHQ12) item, Hamilton Anxiety Scores (HAM-A), and Hamilton Depression Scores (HAMD). QOL measures were determined by the World Health Organization QOL questionnaire (brief) and Seattle Angina Questionnaire. The CAD group was treated with anti-ischemic drugs (nitrates, betablockers), antiplatelet drugs (acetylsalicylsalicylic acid), anticoagulants (low molecular weight heparin, clopidogrel), and managed for risk factors. The PDRC group was treated with selective serotonin reuptake inhibitors and anxiolytics. RESULTS Patients with panic disorder had a worse QOL than those with CAD and healthy controls in the physical domain and psychological domain (PDRC vs. CAD vs. healthy controls, p < 0.001). In the CAD group, smoking was associated with change in angina stability (p = 0.049) whereas other tobacco products were associated with change in angina frequency (p = 0.044). Psychiatric morbidity was present in 40.0% of patients with CAD. In the PDRC group, a significant correlation of HAM-A scores was noted in the physical (p = 0.000), psychological (p = 0.001), social (p = 0.006), and environment (p = 0.001) domains of QOL. Patients with panic disorder had a significant improvement in anxiety scores after treatment compared to baseline (HAM-A scores difference 21.0 [16.5-25.6]; p < 0.001). CONCLUSIONS Patients in the PDRC group had a worse QOL than those in the CAD and healthy control groups. This highlights the need for careful diagnosis and prompt treatment of panic disorder in these patients to improve their QOL. Additionally, smoking, the use of other tobacco products, and hypercholesterolemia were associated with angina symptoms in patients with CAD.
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Affiliation(s)
- Shruti Srivastava
- Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Skand Shekhar
- Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Manjeet Singh Bhatia
- Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Shridhar Dwivedi
- Medicine/Preventive Cardiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India; National Heart Institute, East of Kailash, New Delhi, India
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Tully PJ, Turnbull DA, Horowitz JD, Beltrame JF, Selkow T, Baune BT, Markwick E, Sauer-Zavala S, Baumeister H, Cosh S, Wittert GA. Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial. Trials 2016; 17:18. [PMID: 26754447 PMCID: PMC4707770 DOI: 10.1186/s13063-015-1109-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/08/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Previous psychological and pharmacological interventions have primarily focused on depression disorders in populations with cardiovascular diseases (CVDs) and the efficacy of anxiety disorder interventions is only more recently being explored. Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in populations with CVDs. The aim of CHAMPS is to evaluate the feasibility of a unified protocol (UP) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs. The current study reports the protocol of a feasibility randomized controlled trial to inform a future trial. METHODS/DESIGN This is a feasibility randomized, controlled trial with a single-center design. A total of 50 participants will be block-randomized to either a UP intervention or enhanced usual care. Both groups will receive standard CVD care. The UP intervention consists of 1) enhancing motivation, readiness for change, and treatment engagement; (2) psychoeducation about emotions; (3) increasing present focused emotion awareness; (4) increasing cognitive flexibility; (5) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors (EDBs, including tobacco smoking, and alcohol use); (6) increasing tolerance of emotion-related physical sensations; (7) interoceptive and situation-based emotion-focused exposure; and (8) relapse prevention strategies. Treatment duration is 12 to 18 weeks. Relevant outcomes include the standard deviation of self-rated anxiety, depression and quality of life symptoms. Other outcomes include intervention acceptability, satisfaction with care, rates of EDBs, patient adherence, physical activity, cardiac and psychiatric readmissions. Parallel to the main trial, a nonrandomized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds. DISCUSSION CHAMPS is designed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population. The design will provide preliminary evidence of feasibility, attrition, and satisfaction with treatment to design a definitive trial. If the trial is feasible, it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress. TRIAL REGISTRATION ACTRN12615000555550 , registered on 29/05/2015.
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Affiliation(s)
- Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
- INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - John F Beltrame
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - Terina Selkow
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - Bernhard T Baune
- Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia.
| | - Elizabeth Markwick
- Department of Psychiatry, The Queen Elizabeth Hospital, Woodville West, Australia.
| | - Shannon Sauer-Zavala
- Center for Anxiety & Related Disorders, Department of Psychology, Boston University, Boston, USA.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
| | - Suzanne Cosh
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
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Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, Wittert GA. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events. Psychol Med 2015; 45:2909-2920. [PMID: 26027689 DOI: 10.1017/s0033291715000963] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD. METHOD Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases. RESULTS PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24-1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22-1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16-1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12-1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45-1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03-1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint. CONCLUSIONS Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.
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Affiliation(s)
- P J Tully
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - D A Turnbull
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - J Beltrame
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - J Horowitz
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - S Cosh
- Clinic of Psychiatry and Psychotherapy II,University of Ulm,Gunzburg,Germany
| | - H Baumeister
- Department of Rehabilitation Psychology and Psychotherapy,Institute of Psychology,University of Freiburg,Germany
| | - G A Wittert
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
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Baumeister H, Haschke A, Munzinger M, Hutter N, Tully PJ. Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review. Biopsychosoc Med 2015; 9:11. [PMID: 25969694 PMCID: PMC4427919 DOI: 10.1186/s13030-015-0039-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/10/2015] [Indexed: 02/03/2023] Open
Abstract
Background To systematically review in- and outpatient costs in patients with coronary artery disease (CAD) and comorbid mental disorders. Methods A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included which allowed a comparison of in- and outpatient health care costs (assessed either monetarily or in terms of health care utilization) of CAD patients with comorbid mental disorders (mood, anxiety, alcohol, eating, somatoform and personality disorders) and those without. Random effects meta-analyses were conducted and results reported using forest plots. Results The literature search resulted in 7,275 potentially relevant studies, of which 52 met inclusion criteria. Hospital readmission rates were increased in CAD patients with any mental disorder (pooled standardized mean difference (SMD) = 0.34 [0.17;0.51]). Results for depression, anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from −0.44 to 1.26. Length of hospital stay was not increased in anxiety and any mental disorder, while studies on depression reported heterogeneous SMDs ranging from −0.08 to 0.82. Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders. Results for invasive procedures were non-significant respectively inconclusive. Conclusions Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs. From a health care point of view, it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs.
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Affiliation(s)
- Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany ; Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Anne Haschke
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany
| | - Marie Munzinger
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany
| | - Nico Hutter
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany
| | - Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany ; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
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Tully PJ, Wittert GA, Turnbull DA, Beltrame JF, Horowitz JD, Cosh S, Baumeister H. Panic disorder and incident coronary heart disease: a systematic review and meta-analysis protocol. Syst Rev 2015; 4:33. [PMID: 25875199 PMCID: PMC4376084 DOI: 10.1186/s13643-015-0026-2] [Citation(s) in RCA: 9] [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: 11/15/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical presentation of panic disorder and panic attack overlaps many symptoms typically experienced in coronary heart disease (CHD). Etiological links between panic disorder and CHD are controversial and remain largely tenuous. This systematic review aims to pool together data regarding panic disorder with respect to incident CHD or myocardial infarction. METHODS/DESIGN Electronic databases (MEDLINE, EMBASE, PsycINFO and SCOPUS) will be searched using a search strategy exploding the topics for CHD and panic disorder. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows: POPULATION persons without CHD who meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; Comparison: persons without CHD who do not meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; OUTCOME verified fatal and non-fatal CHD at follow-up; including coronary revascularization procedure, coronary artery disease, and myocardial infarction. Studies adopting self-report CHD will be ineligible. Screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, risk ratios, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the CHD outcomes with Cochrane Review Manager 5.3. DISCUSSION This systematic review aims to clarify whether panic disorder is associated with elevated risk for subsequent CHD. An evaluation of the etiological links between panic disorder with incident CHD might inform evidence-based clinical practice and policy concerning triaging chest pain patients, diagnostic assessment, and psychiatric intervention with panic disorder patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014891 .
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Affiliation(s)
- Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany. .,Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, 254 North Terrace, Adelaide, Australia.
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, 254 North Terrace, Adelaide, Australia.
| | - Deborah A Turnbull
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, 254 North Terrace, Adelaide, Australia.
| | - John F Beltrame
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Adelaide, Australia.
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Adelaide, Australia.
| | - Suzanne Cosh
- Clinic of Psychiatry and Psychotherapy II, University of Ulm, Helmholtzstr, Gunzburg, Germany.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
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