Substance-induced psychosis and schizophrenia: the interaction point

Abstract

One of the most severe complications of narcotic drugs misuse are induced psychotic disorders. Their frequency is varies from 5.2 to 100% and depends on the type of drug. This review provides current data and discussion on the similarities and differences between induced psychosis and schizophrenia. Possible interaction of pathogenic pathways, the possibility of differentiation at the clinical level and the main difficulties in clear diagnostic are discussed. The problem of transformation of induced psychoses into schizophrenia and the significance of differentiated treatment are also considered.

Keywords

substance induced psychoses / schizophrenia / substance-related disorders

References

[1] World Drug Report 2020 (United Nations publication, Sales №E.20.XI.6). Available at: https://wdr. unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf Accessed: 2020 July 02.

[2] World Drug Report 2020 (United Nations publication, Sales №E.20.XI.6). Available at: https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf Accessed: 2020 July 02.

[3] European Drug Report 2020: Trends and Developments. Luxembourg: Publications Office of the European Union; 2020.

[4] Koshkina EA, Val’kova UV, Smirnovskaya MS. Sovremennyye trendy razvitiya narkologicheskoy situatsii. In: Psikhicheskoye zdorov’ye cheloveka i obshchestva. Aktual’nyye mezhdistsiplinarnyye problemy; 30 Oct 2017; Moscow. Moscow; 2018. (In Russ).

[5] Кошкина Е.А., Валькова У.В., Смирновская М.С. Современные тренды развития наркологической ситуации. В сб.: Психическое здоровье человека и общества. Актуальные междисциплинарные проблемы; 30 октября 2017; Москва. М.; 2018.

[6] Li EA, Koren SV. COVID-19 pandemic and drug users. Journal of Addiction Problems. 2020;(6):72-83. (In Russ).

[7] Ли Е.А., Корень С.В. Пандемия COVID-19 и наркопотребители // Вопросы наркологии. 2020. №6. С. 72-83.

[8] Vallersnes OM, Dines AM, Wood DM, et al. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry. 2016;16:293. doi:10.1186/s12888-016-1002-7

[9] Vallersnes O.M., Dines A.M., Wood D.M., et al. Psychosis associated with acute recreational drug toxicity: a European case series // BMC Psychiatry. 2016. Vol. 16. P. 293. doi:10.1186/s12888-016-1002-7

[10] Smith MJ, Thirthalli J, Abdallah AB, et al. Prevalence of psychotic symptoms in substance users:

[11] Smith M.J., Thirthalli J., Abdallah A.B., et al. Prevalence of psychotic symptoms in substance users: a comparison across substances // Comprehensive Psychiatry. 2009. Vol. 50, №3. P. 245-250. doi:10.1016/j.comppsych.2008.07.009

[12] a comparison across substances. Comprehensive Psychiatry. 2009;50(3):245-50. doi:10.1016/j.comp psych.2008.07.009

[13] Lecomte T., Dumais A., Dugré J.R., et al. The prevalence of substanceinduced psychotic disorder in methamphetamine misusers: A metaanalysis // Psychiatry Research. 2018. Vol. 268. P. 189-192. doi:10.1016/j.psychres.2018.05.033

[14] Lecomte T, Dumais A, Dugré JR, et al. The prevalence of substance-induced psychotic disorder in methamphetamine misusers: A meta-analysis. Psychiatry Research. 2018;268:189-92. doi:10.1016/j.psychres.2018.05.033

[15] Hobbs M., Kalk N.J., Morrison P.D., et al. Spicing it up - synthetic cannabinoid receptor agonists and psychosis a systematic review // European Neuropsychopharmacology. 2018. Vol. 28, №12. P. 1289-1304. doi:10.1016/j.euroneuro.2018.10.004

[16] Hobbs M, Kalk NJ, Morrison PD, et al. Spicing it up - synthetic cannabinoid receptor agonists and psychosis - a systematic review. European Neuro-psychopharmacology. 2018;28(12):1289-304. doi:10. 1016/j.euroneuro.2018.10.004

[17] Ragazzi T.C.C., Shuhama R., Menezes P.R., et al. Cannabis use as a risk factor for psychoticlike experiences: A systematic review of nonclinical populations evaluated with the Community Assessment of Psychic Experiences // Early Intervention in Psychiatry. 2018. Vol. 12, №6. P. 1013-1023. doi:10.1111/eip.12693

[18] Ragazzi TCC, Shuhama R, Menezes PR, et al. Cannabis use as a risk factor for psychotic-like experiences: A systematic review of non-clinical populations evaluated with the Community Assessment of Psychic Experiences. Early Intervention in Psychiatry. 2018;12(6):1013-23. doi:10.1111/eip.12693

[19] Roncero C., Abad A.C., Padilla-Mata A., et al. Psychotic Symptoms Associated with the use of Dopaminergic Drugs, in Patients with Cocaine Dependence or Abuse // Current Neuropharmacology. 2017. Vol. 15, №2. P. 315-323. doi:10.2174/1570159X14666160324144912

[20] Roncero C, Abad AC, Padilla-Mata A, et al. Psychotic Symptoms Associated with the use of Dopaminergic Drugs, in Patients with Cocaine Dependence or Abuse. Current Neuropharmacology. 2017;15(2):315-23. doi:10.2174/1570159X14 6661 60324144912

[21] Tatetsu S., Goto A., Fujiwara T. Psychostimulant toxicosis. Tokyo: Igakushoin; 1956.

[22] Tatetsu S, Goto A, Fujiwara T. Psychostimulant toxicosis. Tokyo: Igakushoin; 1956.

[23] Murray R.M., Paparelli A., Morrison P.D., et al. What can we learn about schizophrenia from studying the human model, druginduced psychosis? // American Journal of Medical Genetics. Part B: Neuropsychiatric Genetics. 2013. Vol. 162, №7. P. 661-670. doi:10.1002/ajmg.b.32177

[24] Murray RM, Paparelli A, Morrison PD, et al. What can we learn about schizophrenia from studying the human model, drug-induced psychosis? American Journal of Medical Genetics. Part B: Neuro-psychiatric Genetics. 2013;162(7):661-70. doi:10.1002/ ajmg.b.32177

[25] Ghose S. Substance-Induced Psychosis: An Indicator of Development of Primary Psychosis? // The American Journal of Psychiatry. 2018. Vol. 175, №4. P. 303-304. doi:10.1176/appi.ajp.2018.17121395

[26] Ghose S. Substance-Induced Psychosis: An Indicator of Development of Primary Psychosis? The American Journal of Psychiatry. 2018;175(4):303-4. doi:10.1176/appi.ajp.2018.17121395

[27] Менделевич В.Д. Психотические расстройства в результате употребления наркотиков: современное состояние проблемы // Наркология. 2014. Т. 13, №7. P. 93-100.

[28] Mendelevich VD. Psychotic disorders due to drug use: current state of the problem. Narcology. 2014; 13(7):93-100. (In Russ).

[29] Логутенко Р.М. Гетероагрессивное и суицидальное поведение больных параноидной шизофренией с бредом одержимости // Наука молодых (Eruditio Juvenium). 2015. №4. С. 104-110.

[30] Logutenko RM. Heteroaggressive and suicidal behavior of patients with paranoid schizophrenia with delusions of obsession. Nauka Molodykh (Eruditio Juvenium). 2015;(4):104-10. (In Russ).

[31] Fiorentini A., Volonteri L.S., Dragogna F., et al. Substance-Induced Psychoses: A Critical Review of the Literature // Current Drug Abuse Reviews. 2011. Vol. 4, №4. P. 228-240. doi:10.2174/18744 73711104040228

[32] Fiorentini A, Volonteri LS, Dragogna F, et al. Substance-Induced Psychoses: A Critical Review of the Literature. Current Drug Abuse Reviews. 2011;4 (4):228-40. doi:10.2174/1874473711104040228

[33] Howes O.D., Kambeitz J., Kim E., et al. The nature of dopamine dysfunction in schizophrenia and what this means for treatment // Archives of General Psychiatry. 2012. Vol. 69, №8. P. 776-786. doi:10. 1001/archgenpsychiatry.2012.169

[34] Howes OD, Kambeitz J, Kim E, et al. The nature of dopamine dysfunction in schizophrenia and what this means for treatment. Archives of General Psychiatry. 2012;69(8):776-86. doi:10.1001/archgen psychiatry.2012.169

[35] Kegeles L.S., Abi-Dargham A., Zea‐Ponce Y., et al. Modulation of amphetamine-induced striatal dopamine release by ketamine in humans: implica-tions for schizophrenia // Biological Psychiatry. 2000. Vol. 48, №7. P. 627-640. doi:10.1016/S0006-3223(00)00976-8

[36] Kegeles LS, Abi-Dargham A, Zea‐Ponce Y, et al. Modulation of amphetamine-induced striatal dopamine release by ketamine in humans: implications for schizophrenia. Biological Psychiatry. 2000;48 (7):627-40. doi:10.1016/S0006-3223(00)00976-8

[37] McCutcheon R.A., Krystal J.H., Howes O.D. Dopamine and glutamate in schizophrenia: biology, symptoms and treatment // World Psychiatry. 2020. Vol. 19, №1. P. 15-33. doi:10.1002/wps.20693

[38] McCutcheon RA, Krystal JH, Howes OD. Dopamine and glutamate in schizophrenia: biology, symptoms and treatment. World Psychiatry. 2020; 19(1):15-33. doi:10.1002/wps.20693

[39] Ham S., Kim T.K., Chung S., et al. Drug Abuse and Psychosis: New Insights into Druginduced Psychosis // Experimental Neurobiology. 2017. Vol. 26, №1. P. 11-24. doi:10.5607/en.2017.26.1.11

[40] Ham S, Kim TK, Chung S, et al. Drug Abuse and Psychosis: New Insights into Drug-induced Psychosis. Experimental Neurobiology. 2017;26(1):11-24. doi:10.5607/en.2017.26.1.11

[41] Khokhar J.Y., Todd T.P. Behavioral predictors of alcohol drinking in a neurodevelopmental rat model of schizophrenia and cooccurring alcohol use

[42] Khokhar JY, Todd TP. Behavioral predictors of alcohol drinking in a neurodevelopmental rat

[43] disorder // Schizophrenia Research. 2018. Vol. 194. P. 91-97. doi:10.1016/j.schres.2017.02.029

[44] model of schizophrenia and co-occurring alcohol use disorder. Schizophrenia Research. 2018;194: 91-7. doi:10.1016/j.schres.2017.02.029

[45] Brunette M.F., Mueser K.T., Babbin S., et al. Demographic and clinical correlates of substance use disorders in first episode psychosis // Schizophrenia Research. 2018. Vol. 194. P. 4-12. doi:10.1016/j. schres.2017.06.039

[46] Brunette MF, Mueser KT, Babbin S, et al.

[47] Martinotti G., De Risio L., Vannini C., et al. Substancerelated exogenous psychosis: a postmodern syndrome // CNS Spectrums. 2020. Vol. 1-8. doi: 10.1017/S1092852920001479

[48] Demographic and clinical correlates of substance use disorders in first episode psychosis. Schizophrenia Research. 2018;194:4-12. doi:10.1016/j. schres.2017.06.039

[49] Caton C.L.M., Drake R.E., Hasin D.S., et al. Differences Between Early-Phase Primary Psychotic Disorders With Concurrent Substance Use and SubstanceInduced Psychoses // Archives of General Psychiatry. 2005. Vol. 62, №2. P. 137-145. doi:10.1001/archpsyc.62.2.137

[50] Martinotti G., De Risio L., Vannini C., et al. Substance-related exogenous psychosis: a postmodern syndrome. CNS Spectrums. 2020;1-8. doi:10.1017/S1092852920001479

[51] Caton C.L.M., Hasin D.S., Shrout P.E., et al. Stability of earlyphase primary psychotic disorders with concurrent substance use and substanceinduced psychosis // The British Journal of Psychiatry. 2007. Vol. 190, №2. P. 105-111. doi:10.1192/bjp.bp.105.015784

[52] Caton CLM, Drake RE, Hasin DS, et al. Differences Between Early-Phase Primary Psychotic Disorders With Concurrent Substance Use and Substance-Induced Psychoses. Archives of General Psychiatry. 2005;62(2):137-45. doi:10.1001/archpsyc.62.2.137

[53] Mauri M., Di Pace C., Reggiori A., et al. Primary psychosis with comorbid drug abuse and drug-induced psychosis: Diagnostic and clinical evolution at follow up // Asian Journal of Psychiatry. 2017. Vol. 29. P. 117-122. doi:10.1016/j.ajp.2017.04.014

[54] Caton CLM, Hasin DS, Shrout PE, et al. Stability of early-phase primary psychotic disorders with con-current substance use and substance-induced psychosis. The British Journal of Psychiatry. 2007; 190(2):105-11. doi:10.1192/bjp.bp.105.015784

[55] Weibell M.A., Joa I., Bramness J., et al. Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area // BMC Psychiatry. 2013. Vol. 13. P. 319. doi:10.1186/1471-244X-13-319

[56] Mauri M, Di Pace C, Reggiori A, et al. Primary psychosis with comorbid drug abuse and drug-induced psychosis: Diagnostic and clinical evolution at follow up. Asian Journal of Psychiatry. 2017; 29:117-22. doi:10.1016/j.ajp.2017.04.014

[57] Crebbin K., Mitford E., Paxton R., et al. First episode druginduced psychosis: a medium term fol-low up study reveals a high risk group // Social Psychiatry and Psychiatric Epidemiology. 2009. Vol. 44, №9. P. 710-715. doi:10.1007/s00127-008-0490-2

[58] Weibell MA, Joa I, Bramness J, et al. Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry. 2013;13:319. doi:10.1186/1471-244X-13-319

[59] Fraser S., Hides L., Philips L., et al. Differentiating first episode substance induced and primary psychotic disorders with concurrent substance use in young people // Schizophrenia Research. 2012. Vol. 136, №1-3. P. 110-115. doi:10.1016/j.schres. 2012.01.022

[60] Crebbin K, Mitford E, Paxton R, et al. First episode drug-induced psychosis: a medium term follow up study reveals a high risk group. Social Psychiatry and Psychiatric Epidemiology. 2009;44(9):710-5. doi:10.1007/s00127-008-0490-2

[61] Пятаева И.В.Куташов В.А.Хабарова Т.Ю. Дифференциальная диагностика эндогенных и интоксикационных (солевых) психозовЦентральный научный вестник. 2016.

[62] Fraser S, Hides L, Philips L, et al. Differentiating first episode substance induced and primary psy-chotic disorders with concurrent substance use in young people. Schizophrenia Research. 2012;136(1-3): 110-5. doi:10.1016/j.schres.2012.01.022

[63] Дубатова И.В., Стоякин И.В., Карнаух К.А., и др. Анализ клинических проявлений и особенности терапии психотических расстройств у потребителей дизайнерских наркотиков // Главный врач Юга России. 2018. №1. С. 52-56.

[64] Piataeva IV, Kutashov VA, Khabarova TY. Differential diagnosis of endogenous and substance-induced (salt) psychosis. Central Science Bulletin. 2016;1(16):30-2. (In Russ).

[65] Quattrone D., Ferraro L., Tripoli G., et al. Daily use of highpotency cannabis is associated with more positive symptoms in firstepisode psychosis patients: the EU-GEI case – control study // Psychological Medicine. 2020. Vol. 1-9. doi:10.1017/ S0033291720000082

[66] Dubatova I, Stojakin I, Karnauh K, et al. The analysis of clinical manifestations and peculiarities of psychotic disorders therapy in consumers of designer drugs. Glavnyy Vrach Yuga Rossii. 2018;(1): 52-6. (In Russ).

[67] Martinotti G., Di Nicola M., Quattrone D., et al. Novel psychoactive substances and induced phenomena in psychopathology: the lysergic psychoma // Journal of Psychopathology. 2015. Vol. 21. P. 400-405.

[68] Quattrone D., Ferraro L., Tripoli G., et al. Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case – control study. Psychological Medicine. 2020;1-9. doi:10.1017/S0033291720000082

[69] Murray R.M., Quigley H., Quattrone D., et al. Traditional marijuana, highpotency cannabis and synthetic cannabinoids: increasing risk for psychosis // World Psychiatry. 2016. Vol. 15, №3. P. 195-204. doi:10.1002/wps.20341

[70] Martinotti G, Di Nicola M, Quattrone D, et al. Novel psychoactive substances and induced phenomena in psychopathology: the lysergic psychoma. Journal of Psychopathology. 2015;21: 400-5.

[71] Halpern J.H., Lerner A.G., Passie T. A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD // Current Topics in Behavioral Neurosciences. 2018. Vol. 36. P. 333-360. doi:10.1007/7854_2016_457

[72] Murray RM, Quattrone D, Natesan S, et al. Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? The British Journal of Psychiatry. 2016;209(5):361-5. doi:10.1192/bjp.bp.116.182683

[73] Litjens R.P.W., Brunt T.M., Alderliefste G.-J., et al. Hallucinogen persisting perception disorder and the serotonergic system: A comprehensive review including new MDMA-related clinical cases // European Neuropsychopharmacology. 2014. Vol. 24, №8. P. 1309-1323. doi:10.1016/j.euroneuro.2014.05.008

[74] Halpern JH, Lerner AG, Passie T. A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD. Current Topics in Behavioral Neurosciences. 2018;36:333-60. doi:10.1007/7854_2016_457

[75] Lev-Ran S., Feingold D., Rudinski D., et al. Schizophrenia and hallucinogen persisting perception disorder: A clinical investigation: Schizophrenia and HPDD: Clinical Characteristics // The American Journal on Addictions. 2015. Vol. 24, №3. P. 197-199. doi:10.1111/ajad.12204

[76] Litjens RPW, Brunt TM, Alderliefste G-J, et al. Hallucinogen persisting perception disorder and the serotonergic system: A comprehensive review including new MDMA-related clinical cases. European Neuropsychopharmacology. 2014;24(8):1309-23. doi:10.1016/j.euroneuro.2014.05.008

[77] Starzer M.S.K., Nordentoft M., Hjorthøj P. Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis // The American Journal of Psychiatry. 2018. Vol. 175, №4. P. 343-350. doi:10.1176/appi.ajp.2017.17020223

[78] Lev-Ran S, Feingold D, Rudinski D, et al. Schizophrenia and hallucinogen persisting perception disorder: A clinical investigation: Schizophrenia and HPDD: Clinical Characteristics. The American Journal on Addictions. 2015;24(3):197-9. doi:10.1111/ajad.12204

[79] Kendler K.S., Ohlsson H., Sundquist J., et al. Prediction of Onset of Substance-Induced Psychotic Disorder and Its Progression to Schizophrenia in a Swedish National Sample // The American Journal of Psychiatry. 2019. Vol. 176, №9. P. 711-719. doi:10.1176/appi.ajp.2019.18101217

[80] Starzer MSK, Nordentoft M, Hjorthøj P. Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis. The American Journal of Psychiatry. 2018; 175 (4):343-50. doi:10.1176/appi.ajp.2017.17020223

[81] Niemi-Pynttäri J.A., Sund R., Putkonen H., et al. Substance-Induced Psychoses Converting Into Schizophrenia: A Register-Based Study of 18,478 Finnish Inpatient Cases // The Journal of Clinical Psychiatry. 2013. Vol. 74, №1. P. e94-e99. doi:10.4088/JCP.12m07822

[82] Kendler KS, Ohlsson H, Sundquist J, et al. Prediction of Onset of Substance-Induced Psychotic

[83] Hjorthøj P., Starzer M.S.K., Benros M.E., et al. Infections as a Risk Factor for and Prognostic Factor After Substance-Induced Psychoses // American Journal of Psychiatry. 2020. Vol. 177, №4. P. 335-341. doi:10.1176/appi.ajp.2019.19101047

[84] Disorder and Its Progression to Schizophrenia in a Swedish National Sample. The American Journal of Psychiatry. 2019;176(9):711-9. doi:10.1176/appi.ajp.2019.18101217

[85] Murrie B., Lappin J., Large M., et al. Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Metaanalysis // Schizophrenia Bulletin. 2020. Vol. 46, №3. P. 505-516. doi:10.1093/schbul/sbz102

[86] Niemi-Pynttäri JA, Sund R, Putkonen H, et al. Sub-stance-Induced Psychoses Converting Into Schizophrenia: A Register-Based Study of 18,478 Finnish Inpatient Cases. The Journal of Clinical Psychia-try. 2013;74(1):e94-9. doi:10.4088/JCP.12m07822

[87] Gorelick D.A. Pharmacological Treatment of Cannabis-Related Disorders: A Narrative Review // Current Pharmaceutical Design. 2016. Vol. 22, №42. P. 6409-6419. doi:10.2174/1381612822666 160822150822

[88] Hjorthøj P, Starzer MSK, Benros ME, et al. Infections as a Risk Factor for and Prognostic Factor After Substance-Induced Psychoses. American Journal of Psychiatry. 2020;177(4):335-41. doi:10.1176/appi.ajp.2019.19101047

[89] Sulaiman A.H., Gill J.S., Said M.A., et al. A randomized, placebocontrolled trial of aripiprazole for the treatment of methamphetamine dependence and associated psychosis // International Journal of

[90] Murrie B, Lappin J, Large M, et al. Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis. Schizophrenia Bulletin. 2020;46(3):505-16. doi:10.1093/schbul/sbz102

[91] Psychiatry in Clinical Practice. 2013. Vol. 17, №2. P. 131-138. doi:10.3109/13651501.2012.667116

[92] Gorelick DA. Pharmacological Treatment of Cannabis-Related Disorders: A Narrative Review. Current Pharmaceutical Design. 2016;22(42):6409-19. doi:10.2174/1381612822666160822150822

[93] Kekelidze Z.I., Klimenko T.V., Kozlov A.A., et al. Differential approaches to the treatment of acute psychosis due to the use of synthetic cannabinoids // Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017. Vol. 117, №12. P. 21. doi:10.17116/jnevro201711712121-26

[94] Sulaiman AH, Gill JS, Said MA, et al. A randomized, placebo-controlled trial of aripiprazole for the treatment of methamphetamine dependence and associated psychosis. International Journal of Psychiatry in Clinical Practice. 2013;17(2):131-8. doi:10.3109/13651501.2012.667116

[95] Murray R.M., Quattrone D., Natesan S., et al. Should psychiatrists be more cautious about the longterm prophylactic use of antipsychotics? // The British Journal of Psychiatry. 2016. Vol. 209, №5. P. 361-365. doi:10.1192/bjp.bp.116.182683

[96] Kekelidze ZI, Klimenko TV, Kozlov AA, et al. Differential approaches to the treatment of acute psychosis due to the use of synthetic cannabinoids. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2017; 117(12):21. doi:10.17116/jnevro201711712121-26

[97] Schoeler T., Monk A., Sami M.B., et al. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and metaanalysis // The Lancet. Psychiatry. 2016. Vol. 3, №3. P. 215-225. doi:10.1016/S2215-0366(15)00363-6

[98] Murray RM, Quigley H, Quattrone D, et al. Traditional marijuana, high-potency cannabis and synthetic cannabinoids: increasing risk for psychosis. World Psychiatry. 2016;15(3):195-204. doi:10.1002/wps.20341

[99] Schoeler T., Monk A., Sami M.B., et al. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. The Lancet. Psychiatry. 2016;3(3):215-25. doi:10.1016/S2215-0366(15)00363-6

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