Friday, July 27, 2012

Living with psychosis

Although this article mainly talks about the "schizophrenia", it will be useful to those seeking information about the "psychosis" in general.

Schizophrenia or schizophrenic disorders are the types of psychotic disorders ("psychosis"), and advice in relation to them (for example regarding methods of treatment, medication, and the origin of disorder) can be of great use to those suffering from other types of psychotic disorders (" psychosis "). So should not be confused by the term "schizophrenia" that is used here and can be broadly understood as "psychotic disorder". So if you're interested in "psychosis" - continue reading.

Schizophrenic disorders

We wish you further with this text acquainted with schizophrenia, explain their causes and highlight the treatment options. This article will encourage you and give you hope for this disease, despite a number of widespread prejudice, can be very successfully treated. In addition, it will show you how you can contribute to the patient as a significant improvement of the quality of their lives and for what patients can do as a family member.

Schizophrenic disorders are a collection of mental illness with similar symptoms and causes that require specific treatment.


In this chapter you will learn:

that schizophrenic disorders associated with disorders of brain function

that schizophrenic disorders are relatively common

that schizophrenic disorders are inherited only insofar as may be genetic predisposition (tendency to hypersensitivity)

that the disorder can not be proven by laboratory tests or X-ray

that the disorder is diagnosed only when symptoms manifest in sufficient number and severity

to the schizophrenic disorders may very well affect the consequent treatment

What is schizophrenic disorders?

Although science still can not answer all questions related to this disease, it is certainly the following: a disease called "schizophrenia" does not exist, only a disease unrelated to the splitting of the personality disordered.

In schizophrenic disorder leads to changes in certain brain functions. Consequently the changes of thought, perception and affect, then change the psyche.

It is not yet well understood why there is an imbalance of brain function. It is well known that the only thing some people are especially vulnerable, and that outbreaks can be caused by excessive stress or other mental burdens, drug abuse and hormonal disorders (pregnancy, menopause).

What we recognize a schizophrenic disorder?

The disease can manifest in different ways with very different signs (symptoms). In some individuals the symptoms can be very difficult, while in others insignificant, or not at all visible. There is only a vague feeling that "something is wrong."

In patients suffering from schizophrenic disorders usually present fear and a sense that they are required too. In schizophrenic disorder often leads to loss of their own peculiarities, its me and identity. Such a person feels between herself and the environment has no borders. The patient also believed that others took control over it, because it can not be protected (setting limits). In the specialized terminology of the "symptom" is called a disorder of the ego.

For better visibility of the symptoms are often divided into positive and negative symptoms. Some symptoms (positive) during certain phases of the disease occur in addition to the normal experience such as hallucinations or delusions, and other symptoms (negative) are reflected in the deficit compared to the period before the illness (eg, lack of enthusiasm, withdrawal).

The main symptoms are:



thought disorders

disorder will

social withdrawal


lack of sensitivity to disease

promenjenosti sense (sense of control from external / other)

The most positive symptoms


Our brain has a kind of filter to many stimuli in the environment that would otherwise be able to flood the brain. In schizophrenic disorders is abnormal function of the filter. Possible "defensive strategy" is a complete exclusion of external stimuli (like "putting a curtain") such as in a dream. Our brain, however, is still in dreaming sleep, occurs in patients some form of "waking sleep" - hallucinations. He hears voices (auditory hallucinations), smell (olfactory hallucinations) or see things that are not there (visual hallucinations) and such observations to be realistic.


Arise from a belief in a real patient reviews. He firmly believes he is being persecuted (persecution mania), that God (religious mania), or that everything related to it (the idea of ​​relations), holding fast to his convictions of which can not be deterred by any assurances or evidence that his ideas do not match reality. The reason for this lies in the fact that the patient withdrew into their inner world and that "pulled the curtain," much as we have seen in a hallucination. In this way, losing their ability to think, his own "reality" compared with the reality of the outside world.

Thought disorders

Especially in cases where the patient is emotionally excited or tired of his thought and speech becomes disjointed and hard to understand. The patient will interrupt a conversation in the middle of a sentence, or will completely lose the thread. Often feeling "invasion" of certain thoughts. These symptoms, however, have nothing to do with "maloumnošću".

In this disease intelligence is preserved!

The most important negative symptoms

In the group of negative symptoms is often difficult to distinguish whether a particular behavior or patient symptom is an attempt to overcome the disease - so it will be, for example, withdrawing protection from the onslaught of stimuli.

Lack of will

Patients emergence of the disease lose their usual enthusiasm and interest in all those things that were previously happy to deal with. This is why very hard for the fulfillment of the usual professional and other tasks.

Loss of feeling

The patient can not be happy, or to express their feelings in a way that it previously could.

Social withdrawal

Patients often withdraw into themselves and distance themselves from their family and other environments. I do not feel good to within a well-known person, and quite often express the fear of them.


In schizophrenic disorders may develop depression, especially if the affected person feel that the disease has greatly changed their lives.

Patients may be so desperate that they no longer see any output. About 10% of patients during illness and committed suicide!

Depressive behavior and thoughts of suicide should be taken very seriously. In such cases, should immediately contact a doctor!

How can a correct diagnosis of schizophrenia?

Picture of schizophrenic disorders can be manifold. Therefore, at the beginning of the disease is very difficult to make the diagnosis. Family and friends often do not find an explanation for the unusual behavior of the person suffering from schizophrenic disorders. Neither the patients themselves did not clearly suffering from a serious illness.

Schizophrenic disorders can be diagnosed by blood tests or other similar methods.

Diagnosis is based on conversations with the doctor takes a patient and his family and by observing the behavior of patients. While this is particularly important number, scope and duration of symptoms.

Early diagnosis increases the chances that treatment will be successful!

How often schizophrenic disorders?

Schizophrenic disorders occur relatively frequently. Scientific studies have proven that the disease sick about 1% of all people, regardless of the country in which they live, what race or culture they belong.

What causes this disease?

Causes of schizophrenic disorders have not been fully elucidated. All the facts, however, suggest that some people are sensitive to external influences and stimuli. Because of these vulnerabilities are particularly strong experience many things and are therefore less "resistant" to load, stress and internal conflict. They are therefore more sensitive than others. Such vulnerability is the professional language called vulnerability. If the load and the stress becomes too great, for such persons come to some kind of "nervous breakdown" and the appearance of symptoms.

The connection between | the vulnerability and disease outbreaks can be explained on the example of sensitivity to sun people who have fair skin. Skin type is a disposition, hereditary predisposition, as well as vulnerability. For those bright sun, the skin is just as dangerous as it is stress dangerous for people especially vulnerable. People light skin may be protected with sunscreen, but it should not stay too long in the sun. The protection of vulnerable people provide neuroleptics.

What does the dopamine hypothesis?

When the brain processes information you transmit nerve impulses on the nerve paths. Between individual nerve cells are the points of contact (synapses) in which the impulse for the further transfer of the necessary transmission of matter (transmitters). Scientific research has established that in schizophrenic disorder disrupted transmission of impulses in certain synapses, and the cause is too much of the transmission of matter called dopamine. Neuroleptics to block the reception of the cells (receptors) so that the excess dopamine can not reach an excessive stimulation of nerve cells.

Are schizophrenic disorders hereditary?

And in others the disease (cancer, heart attack) can inherit a tendency for a particular disease. The mere tendency can not, however, sufficiently explain the emergence of the disease. Persons in whose families appear schizophrenic disorders, need not themselves become ill. On the other hand, the disease can occur in cases when no one in the family does not suffer from schizophrenic disorders.

The risk in the general population is 1%

The risk for close relatives is approximately 10%

When the disease occurs?

The disease usually occurs the first time between | in puberty and the age of thirty, but in individual cases may start earlier or later. Before the actual onset of the disease is usually a period during which the patient is particularly vulnerable and live in constant tension, torn by his thoughts and feelings. In response to the often "beg" - withdrawing into themselves, seeking escape in alcohol and drugs or joining a cult. After these attempts to overcome neuspečnih disease symptoms described occur.

Prospects for treatment

The course of schizophrenic disorders can be very different. It may be that the disease occurs only once after which the affected person to be completely healthy again. This happens especially when the disorder occurs as a reaction to certain strokes of fate (reaction psychosis), at the time of hormonal changes (eg, immediately after delivery) or after using the drug. However, the person shall because of their particular vulnerability (vulnerability) to be particularly at risk of recurrence.

If the treatment is started early and continued long enough (prophylaxis of recurrences), the psychosis that is, in most cases, can be very convenient to operate. The risk of relapse (worsening) with 85% without treatment, decreasing to 15-20% with treatment. That for these patients means that with high probability be able to live without a relapse (worsening) - provided they are willing to accept the concept of medical therapy and to cooperate with him.

Schizophrenic disorders can be treated just as successfully as any other illness, such as diabetes.


In this chapter you will learn:

which therapeutic options

How long does treatment

Side effects that may occur during treatment

How to treat schizophrenic disorders?

The patient and his family have to learn that the patient is particularly sensitive, and should avoid all situations that might trigger the disease, such as excessive stress. In such cases, will be particularly important psychosocial therapy.

During psychosocial therapy patients and their families will learn how to cope with the disease and problems associated with it. That way you can reduce the burden of disease.

Talk to your doctor about which treatment is most appropriate in your particular case (additional psychotherapy, rehabilitation, family therapy, etc..). Especially if it occurs for the first time, it is important to participate in a psycho educational program. While working in groups of patients and their families will be informed in detail about the disease, its course and treatment options.

In order to restore disturbed balance transfer stimuli to the brain is needed with medication neuroleptics.

For the treatment of anxiety, depression and sleep disorders physician will be required, in addition to neuroleptics, sometimes prescribe other drugs.

Best results are achieved by a combination of pharmacological treatment of neuroleptics and psychosocial therapy.

Why do drugs?

Many people suspect that mental illness can be treated with medication. Drugs are, | however, the only option to treat acute symptoms of a psychosis, and the most successful protection against recurrence of the disease. Patient without the use of drugs in general will not be able to accept psychosocial treatment.

There are many reasons for taking drugs

Life becomes simpler again, and contacts with family, friends and colleagues much easier.

The patient will again start to be interested in different things and to engage in their hobbies.

They will be able to re-focus, and work will become easier. It will still be happy!

How to find the right medicine?

Given the fact that every body reacts differently to medication, the doctor will need to determine which and how neuroleptic dose is best for each individual patient. The goal of treatment is successful symptom control with the least possible side effects. It may be more neuroleptics It is necessary to try before you find most effective.

Patients starting treatment with often become impatient because the symptoms do not decrease immediately. It can happen that cause certain side effects of treatment before the eve of "good" effect of treatment. Patients because they think that their drug does not help. It is necessary, however, a certain amount of time before neuroleptics develop their full effect. The main symptoms (hallucinations, delusions) largely disappear in a period of several weeks of treatment.

What will happen if you take medication?

Without the use of pharmacological treatment occurs more frequently relapse (worsening), and requires more frequent and longer stays in hospital.

The incidence of relapse (worsening)

untar the first 2 years

Without treatment, about 85%

With long enough to treat about 10%

It is very important bolesinka intensive contact with the doctor in order to duly noted worsening of symptoms or side effects, to be able to immediately take appropriate countermeasures.

Why treatment should be continued, although the acute symptoms have disappeared?

Special sensitivity (vulnerability) of patients does not stop after the disappearance of symptoms. Because the patient still needs the protection that it provides neuroleptics. This prevents the recurrence of the disease.

Long-term treatment with low doses of neuroleptics can be achieved by reducing the sensitivity and thus preventing relapse (ie, deterioration of ours. Pominaće hereinafter only as "relapse"). Such an effect can be achieved only if patients improve after the acute symptoms are still taking neuroleptics.

Treatment of neuroleptics may decrease the risk of recurrence of 15-20%

How long does the treatment of neuroleptics?

To prevent recurrence of symptoms and outbreaks of new diseases should be taking neuroleptics for a long time, usually several years (prophylaxis of recurrences).

There are international guidelines that regulate the duration of treatment for prophylaxis of recurrence.

The first appearance of the disease: Treatment of neuroleptics and after the withdrawal symptoms should be continued for at least 1-2 years.

After a relapse: The risk of recurrence is still new, but the higher part of the first outbreak. Treatment should continue for at least 5 years.

In particularly severe relapse should protect neuroleptics carry a lifetime!

The physician should, in each case individually to determine the necessary duration of treatment, taking into account the previous course and severity of illness!

In which pharmaceutical forms are given neuroleptics?

Neuroleptics can be used in two ways: orally (by mouth) - in the form of drops, capsules or tablets, and intramuscular (injection into a muscle).

A special form of intramuscular administration is the depo-shot. A single injection of the patient will receive the amount of active ingredient which is sufficient for two to four weeks. For active substances stored intramuscularly is gradually released daily dose, so you do not need a daily intake, while improving tolerability.

There are short-term depot-injections with the actions of about 3 days, which is primarily used to treat acute illness.

Treatment can be initiated short-depot injections, eye drops or tablets. When the patient's condition stabilizes, therapy is based on tablets or depot injections.

What are the most common side effects of drugs?

Like all medications, and neuroleptics have a | woman side effects. The list of side effects that can be read in the instructions for use, it can sometimes be intimidating. However, it should be noted that the guidelines for the use of all drugs listed side effects were recorded anywhere in the world. Some "side effects" may actually be symptoms (such as fatigue, lack of will, disturbed concentration).

Individual susceptibility to side effects is very different. Therefore, we should, if they occur, always consult your physician. In many cases these unpleasant side effects can be mitigated or eliminated by changing doses, using any other medicines or taking additional medication. There are now a new generation of neuroleptics (atypical neuroleptics) that cause significantly fewer side effects.

If adverse effects persist, along with a doctor should assess whether the benefit of treatment is still greater than the inconvenience caused by these unwanted dejstima.

Neuroleptics not causing habit or addiction. It's certainly been proven!

Given that the symptoms and side effects adversely affect the ability of concentration and coordination, consult your doctor whether you may not drive or operate machinery.

In patients taking older neuroleptics may occur particularly unpleasant side effects, ie. late dyskinesias, which are reflected unconscious movements of the mouth, lips and tongue, and sometimes other muscles.Late dyskinesias are relatively rare - for many years taking neuroleptics occurs in 15-20% of cases. If there is suspicion of late dyskinesia, should immediately see a doctor and decide on further treatment.

Side effects

Muscle cramps (dyskinesia)

Anticholinergic drugs

Muscle rigidity, tremor, restlessness
Reduction of the dose, anticholinergic drugs, neuroleptics change

The need for constant movement (akathisia)

Change of neuroleptics

The reduction in blood pressure
Avoid overemphasised increasing doses, slowly get up, take the evening dose of the main

Dry mouth, constipation, visual disturbances
Dose reduction, the appropriate drugs (eg cleaning products) or change of neuroleptics

Increase in body weight

Diet, change of neuroleptics

Fatigue, drowsiness
Dose reduction does not operate motor vehicles, the main dose taken the evening

Hypersensitivity to sunlight
Avoid the sun, use sunscreen

Sexual disorders

Dose reduction, change of neuroleptics

Slowness of movement
Change neuroleptic dose reduction or anticholinergic drugs

Fault concentration

Dose reduction, change of neuroleptics

The unconscious muscle movements

Dose reduction, change of neuroleptics

In rare cases may occur, and other side effects!

What are atypical neuroleptics?

New piece. "Atypical" neuroleptics are drugs that are much better tolerated than the "classical" neuroleptics. When these products are very rare set of particularly bad side effects that include worsening of movement, walking with little steps and discomfort while sitting and standing. In addition, it appears that atypical neuroleptics are more favorable effect on negative symptoms such as lack of drive and social withdrawal.

Why some patients do not want to take medicine?

Lack of information

about the disease, treatment options and mode of action of drugs. Plays a major role and the basic attitude toward the disease and "chemical" treatment of mental disorders.

Get involved in a psycho educational group, ask your doctor with accurate information and read some manual like this.

Insufficient insight into disease

Affected people believe that the changed environment and that they themselves are not sick. Therefore, some of them do not understand that they need therapy.

Again, these measures should be taken.

The fear of the reality of everyday life

Fear of responsibility for their own life forces many patients to escape the "world of psychosis" from whom do not want to leave.

Psycho educational groups to help these individuals to share experiences on how to be a better way to combat the disease and normal lives.

Side effects of drugs

Often the fear of side effects generally cause for rejection drugs, or for taking them irregularly.

What can be done against the adverse effects see the previous section.

The fear of depending on drugs

Regular intake of neuroleptics, even over a long period, will not cause addiction!

Fear of change in personality

Patients are often afraid of taking drugs to lose their individuality and to be so controlled by their thoughts.

The truth is exactly the opposite - if the disease is left untreated, can lead to confusion of thought and the disintegration of personality!

Psychosocial therapeutic measures

The patient will often, in order to cope with the disease on the activities of private and professional life, need professional help. To this end, the good treatment showed the following forms:

Rehabilitation programs will help the patient to gradually fit back into normal life and working environment, it will provide advice and assistance on the issue of housing and vocational services, and will assist him in finding suitable work or with financial problems.

During family therapy to deal with family conflicts. The therapy can be implemented with a single family or multi-family together to form some kind of group therapy.

During behavior therapy and exercise in patients practicing social field behavior in the workplace and contact with other people, for example in role-play and learning in the model.

The psycho educational groups, patients and their families will learn how to better understand this disease, its effects and ways of its overcoming.

What is psycho educational groups?

In such groups in an easily understandable way explain the disease and its treatment methods.Participants will learn how to resolve social conflicts and help each other cope with the disease.

Such a treatment group of water a psychiatrist, psychologist, member of the medical staff or social worker. The program usually lasts eight to ten hours at intervals of two to three weeks. After that the group participants often continue to meet in the self-help groups.

Scientific research has shown that patients and their families who participated in a psycho educational group were better informed and are thus better able to cope with the disease. Therefore these patients reported significantly fewer relapses and hospitalization.

Avoiding relapse

In this section you will learn:

how to identify relapse

what can be done to prevent recurrence

What to do in case of crisis

why patients should avoid alcohol and drugs

Why is it so important to avoid recurrence?

Recurrences are a burden for all affected. The patient will need at least a year to recover from a relapse and be back fully fit for work. Sometimes it may happen that he never fully return to previous abilities.

Avoiding relapse is because the most important point in treatment.

How do we recognize threatening relapse? How can it be avoided?

Recurrence of the disease will always bring a lot earlier: anxiety, sleep disorders, or other signs. It is important to recognize these signs. If they occur, you should immediately see a doctor. The sooner you recognize threatening relapse and as soon as possible to take appropriate measures, to a greater chance of preventing recurrence of disease!

Any nervousness does not mean that really threatens a relapse. But it is better to consult a doctor sometimes without, but that the disease breaks out again.

In the next chapter you will find a list of symptoms that may signal impending relapse.

Early signs can be different in some patients. Therefore, we should pay attention not only typical but also the individual early warning signs.

I alone can make such a list in the table given below.

Typical early warning signs

nervousness, tension

restlessness, sleep disturbances

light excitation

concentration difficulties

apathy, depression


lack of appetite

loss of interest

feeling of worthlessness

memory difficulties

feeling that we all laugh and gossip about us

sound hallucinations

sudden loss of interest in listening to the radio or watching television

increased propensity to consume alcohol or smoke

avoidance of new, unusual situations

avoiding large groups of people (cinema)

If these signs persist for several days, be sure to visit the doctor!

My early warning signs:




Coping strategies:

help me: (eg, physical activity, withdrawal, peace, nature)




Damage to me (eg, travel, alcohol, watching too much television)




How to behave in a crisis?

The probability that the disease recurs not too high when applied satisfactory therapy. There is however some risk (15%), and therefore first need to make contingency plans.

While the patient is in a stable phase should be with the doctor and family arrangements that need to be treated if they appear above the early warning signs, for example, whether to increase the dose, or whether the patient may initially should stay home or go for treatment in a psychiatric hospital - if necessary, against his will - in order to preserve from further damage.

Are drugs or alcohol increases the risk of recurrence?

YES! Alcohol and drugs interfere with the metabolism of the nervous system, and is therefore extremely important that the patient avoids them.

Patients and their families

In this chapter you will learn:

what role does the social environment

why families must be included in the plan of treatment

what to look for in daily contact with patient

what are the needs of family members of patients

What are the prerequisites for successful treatment?

Schizophrenia is not just a "normal" crisis that will disappear by itself, but serious disease that needs treatment. If the patient and his family accept this fact, the first step to success has already been made.

Optimal treatment consists of medication and psychosocial therapy. Good chance that treatment will be successful only exist in those cases where the patients and their families are willing to cooperate with the doctor and follow the agreement. Treatment should never be interrupted without consulting a doctor!

How families can help in treatment?

In everyday life together should adhere to the following rules:

Affected individuals have a reduced work capacity and productivity. Always think that it is a consequence of disease and has nothing to do with laziness!

Patients need the possibility to withdraw at some lonely place. For the sake of their illness often do not distinguish between important and unimportant impressions. Therefore, they stress the excitement and very heavy.

Patients need regular daily schedule and the people who are reliable. It is very important that the ill family member speak clearly and simply without unnecessary criticism.

The patient must not overload the various activities and responsibilities. Its current capacity is, however, must not lose because of lack of exercise.

Patients and their families in times of stable disease with a doctor must agree on what to do in case the disease reappears (contingency plan).

Do not try to convince patients of the inaccuracy of his hallucinations or delusional ideas. For him they are a reality. Make sure that the patient receives medical attention.

People suffering from schizophrenic disorders and are looking forward to all the other people praise and awards! This is usually accomplished much more than criticism.

Do postaljvati unrealistic goals. Excessive pressure on the patients might lead to worsening of the disease.

Family members should try to keep yourself healthy. In addition, they must still go about their normal activities, and foster social contacts.

Only if you feel well, you will be able to help a sick family member!

Try it as a family member consciously live your own life!

The role of family

Support provided by family members or good friends to people suffering from schizophrenic disorders unusually important. Because of their illness is often restricted the ability of social contacts, and will live quite isolated and lonely for them if no one cares. In crisis situations and in solving everyday problems, they will need assistance.

With early detection of disease play an important role just people from the immediate vicinity of patients, because the patient often does not recognize the first signs of illness.

Family members of patients should therefore good to know all the facts about the disease. Necessary information, support and practical assistance will be given for example in the psihoedukativnih group for family members. In these groups will find people with similar problems, and already own and conversations with other people who are in similar situations, will contribute to successful coping with problems related to illness and tensions. This will help the patient, because the nervous overstrain and family to him is not any help. The aim of such psihoedukativnih group is to establish a constructive partnership between | the patients, families and physicians.


The rights of patients in psychiatric institutions

Legislation relating to the treatment can be found in several laws. The basic prerequisite for any treatment of the patients consent.

Patient's consent must be preceded by a conversation with the doctor. The doctor will be patients in a simple and easy to understand information about medical treatment, treatment effects and possible negative consequences. In this way the patient and the doctor comes to the conclusion of a kind "treatment contract" in which the patient may be terminated at any time.

These general rules apply to mental health treatment - for those patients who voluntarily go for treatment and can self-judgment |-operate and make decisions, or for those who do not need to restrict freedom of movement.

If, however, patients should be kept and treated against his will, which is permitted under certain circumstances, special rules apply. In such cases we talk about "placement in a psychiatric institution" which is regulated by special regulations.

If a patient is to be "placed in a psychiatric institution," that means you will be admitted to the closed department of the hospital and that his movements be restricted. When placing patients in a psychiatric hospital, the doctor may restrict the rights of another patient's contacts with people outside the hospital (visits, phone calls) and access to medical records. Other interventions in the personal rights of patients are not allowed.

For the patient against his will could be placed in a psychiatric hospital must meet the following prerequisites:

First There is a danger that the patient will harm himself or harm any any other ("significant threat to himself or others");

Second two psychiatrists must ascertain that there really is such a threat and that the patient is mentally ill;

Third there is no other treatment option.

The doctor has to prisutpačan way to explain why the patient is placed in the hospital (if such information to him in his current situation does not cause more harm than good). He must also placing the patient in a psychiatric institution inform the court, counsel patients and families.

If the patient because of his mental illness is not (more) I am able to take care of their affairs, he may be assigned a guardian. This will at the request of the patient, his family or others to do the court.

The patient can be placed in a psychiatric institution on its own request if it has the capacity to act. In this case, the patient must provide a statement that agrees with the treatment and restricting freedom of movement.

To learn more about the legislation and the rights of patients and family members in connection with placing patients in a psychiatric institution, contact a lawyer or social worker.

This text is izrađenen PRELAPSE within the program that the company "Lundbeck" launched in many countries. PRELAPSE means "Preventing Relapse in Schizophrenia", ie. Prevention of relapse in schizophrenia. This program recognized the World Health Organization (WHO) and the World Psychiatric Association (WPA).

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