Schizophrenia
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Questions and Answers

What is the primary cause of premature death among individuals with schizophrenia?

  • Suicide (correct)
  • Heart disease
  • Substance abuse
  • Accidental injuries

Which of the following symptoms is considered a positive symptom of schizophrenia?

  • Cognitive impairment
  • Hallucinations (correct)
  • Temporal disorientation
  • Poverty of affect

What is the estimated concordance rate for schizophrenia in monozygotic twins?

  • 25%
  • 48% (correct)
  • 75%
  • 10%

Which drug treatment approach underlies the dopamine hypothesis associated with schizophrenia?

<p>Dopamine receptor antagonism (D)</p> Signup and view all the answers

What can complicate the treatment of schizophrenia?

<p>Wide variability in response to medications (B)</p> Signup and view all the answers

Which of the following factors has been indicated as a possible precipitant of schizophrenia?

<p>Stress (B)</p> Signup and view all the answers

What aspect of schizophrenia does the 'poverty of affect' refer to?

<p>Lack of emotional expression (C)</p> Signup and view all the answers

Genetic studies of schizophrenia suggest that the genetic basis is:

<p>Complex with multiple risk loci (D)</p> Signup and view all the answers

What is suggested about the causes of schizophrenia?

<p>They result from both genetic susceptibility and environmental factors. (C)</p> Signup and view all the answers

Which brain region is associated with positive symptoms of schizophrenia?

<p>Temporal lobe (D)</p> Signup and view all the answers

Which hemisphere of the brain is typically specialized for verbal functions in normal individuals?

<p>Left hemisphere (A)</p> Signup and view all the answers

What is considered a major site of dysfunction in schizophrenia?

<p>The dorsolateral prefrontal cortex (D)</p> Signup and view all the answers

Which neurotransmitters are indicated as being higher in the basal ganglia in relation to schizophrenia?

<p>Dopamine and glutamate (D)</p> Signup and view all the answers

What analogical description is used for schizophrenia in terms of brain function?

<p>An orchestra without a conductor (B)</p> Signup and view all the answers

Which symptom type of schizophrenia is primarily implicated with the prefrontal cortex?

<p>Negative symptoms (D)</p> Signup and view all the answers

Which drug is mentioned as an antipsychotic and supports the dopamine hypothesis?

<p>Reserpine (A)</p> Signup and view all the answers

What role does the DISC 1 gene play in the context of schizophrenia?

<p>It is involved in dopamine homeostasis. (A)</p> Signup and view all the answers

How can psychosocial factors contribute to the onset of schizophrenia in adolescents?

<p>Through stress that can precipitate illness. (C)</p> Signup and view all the answers

What structural brain damage finding has been noted in some schizophrenia studies?

<p>Enlargement of brain ventricles. (B)</p> Signup and view all the answers

What is a significant hypothesis regarding viral infection related to schizophrenia risk?

<p>Late winter or spring births increase the risk. (A)</p> Signup and view all the answers

What is the impact of the COMT gene on dopamine in schizophrenia?

<p>It is responsible for breaking down dopamine. (C)</p> Signup and view all the answers

What is indicated by the term 'cytoarchitectural abnormalities' in relation to the developing brain?

<p>Changes in the organization and structure of neuronal layers. (D)</p> Signup and view all the answers

How does a blunted cortisol response relate to schizophrenia?

<p>It suggests a disrupted stress response system. (C)</p> Signup and view all the answers

Which factor is associated with a higher rate of relapse in schizophrenia patients?

<p>Experiencing an emotionally charged home environment. (D)</p> Signup and view all the answers

What is one of the potential triggers of psychotic episodes as mentioned?

<p>L-DOPA (C)</p> Signup and view all the answers

What class of drugs is chlorpromazine categorized under?

<p>Antipsychotics (C)</p> Signup and view all the answers

What suggests that chlorpromazine acts as a dopamine receptor antagonist?

<p>Increase in dopamine metabolites in CSF (A)</p> Signup and view all the answers

What is a major limitation of typical antipsychotics?

<p>They may not be effective in all patients. (C)</p> Signup and view all the answers

What is a common side effect of typical antipsychotics?

<p>Sedation (C)</p> Signup and view all the answers

What is Tardive Dyskinesia characterized by?

<p>Chronic movement disorders (D)</p> Signup and view all the answers

According to the dopamine hypothesis, what is related to the symptoms of schizophrenia?

<p>Excess dopamine neurotransmission (B)</p> Signup and view all the answers

What does the literature indicate regarding dopamine release in schizophrenia?

<p>There is no consistent evidence for increased dopamine release. (B)</p> Signup and view all the answers

Which atypical antipsychotic is known for having fewer extra-pyramidal side effects?

<p>Clozapine (B)</p> Signup and view all the answers

What is the role of catechol-O-methyl-transferase (COMT) in relation to schizophrenia?

<p>It is a metabolic enzyme for dopamine. (B)</p> Signup and view all the answers

Which genetic factor has been implicated in familial cases of schizophrenia?

<p>Disrupted in Schizophrenia 1 (DISC1) (C)</p> Signup and view all the answers

Atypical antipsychotics are reportedly more effective against which type of symptoms?

<p>Negative symptoms (D)</p> Signup and view all the answers

What does the valine 108 allele of COMT indicate in relation to schizophrenia?

<p>Higher synaptic dopamine levels. (D)</p> Signup and view all the answers

What advancement is noted regarding D2 receptor hypersensitivity in the treatment of schizophrenia?

<p>It informs the development of antipsychotic drugs. (A)</p> Signup and view all the answers

Which of the following is NOT listed as an atypical antipsychotic?

<p>Haloperidol (D)</p> Signup and view all the answers

What is a common side effect found with the use of typical antipsychotics?

<p>Movement disorders (A)</p> Signup and view all the answers

What role does neuregulin play in relation to schizophrenia?

<p>It is a growth factor that regulates neuronal differentiation and migration. (D)</p> Signup and view all the answers

Which of the following is true regarding the role of DISC1 in schizophrenia?

<p>It is associated with aberrant neuronal migration. (C)</p> Signup and view all the answers

What is the current hypothesis about neuregulin's effect on the NMDA receptor?

<p>It reduces NMDA receptor function, raising schizophrenia risk. (D)</p> Signup and view all the answers

What is implicity suggested by the evidence of PFC involvement in schizophrenia symptoms?

<p>There is a neurodevelopmental defect affecting cortical neuron organization. (A)</p> Signup and view all the answers

How do antipsychotics function in treating schizophrenia?

<p>They block dopamine receptors. (A)</p> Signup and view all the answers

What is observed in post-mortem analyses of the brains of schizophrenia patients regarding neuregulin?

<p>Increased levels of neuregulin mRNA. (D)</p> Signup and view all the answers

Which region on chromosome 8 is associated with schizophrenia risk?

<p>It encodes neuregulin. (C)</p> Signup and view all the answers

What is the consequence of PFC hypofunctionality in the context of schizophrenia?

<p>It contributes to negative symptoms. (D)</p> Signup and view all the answers

Flashcards

Schizophrenia

A mental disorder characterized by a fragmentation of cognitive processes and personality, resulting in a complex array of symptoms.

Positive Symptoms

Symptoms that are present in individuals with schizophrenia, representing an excess or distortion of normal functions.

Negative Symptoms

Symptoms that are present in individuals with schizophrenia, representing a decrease or loss of normal functions.

Hallucinations

False perceptions that occur in the absence of an external stimulus.

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Thought Disorders

Disorganized thoughts, speech, and behavior patterns, which may be difficult to follow or understand.

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Stereotyped Behaviors

A range of behaviors that are repetitive, purposeless, and often unusual.

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Genetic Basis of Schizophrenia

The concordance rate for monozygotic twins is 48%, suggesting a strong influence of genetics in schizophrenia.

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Influence of Environment

The study of Tienari found that children adopted away from mothers with schizophrenia had an increased risk of developing the disorder, suggesting that environmental factors also play a role.

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DISC1 (Disrupted in Schizophrenia-1 Gene)

A scaffold protein implicated in the regulation of dopamine levels, a neurotransmitter crucial for motivation, reward, and behavior. Dysregulation of dopamine is linked to the development of schizophrenia.

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COMT (Catechol-O-Methyl Transferase Gene)

An enzyme responsible for breaking down dopamine. Abnormalities in its activity can lead to an imbalance in dopamine levels, contributing to symptoms of schizophrenia.

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Neuregulin

A family of cell signaling proteins involved in the growth and development of neurons and their connections. Their role in regulating neuronal activity is crucial for brain function.

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Adolescent Onset of Schizophrenia

The period during which the brain undergoes significant developmental changes, with a heightened vulnerability to environmental influences. Schizophrenia onset is often linked to adolescence.

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Stress and Schizophrenia

Stressful life events can trigger the development of schizophrenia or worsen existing symptoms. Particularly relevant are stressors during critical developmental periods.

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Blunted Cortisol Response

The brain's response to stress through the release of cortisol. Individuals with schizophrenia display atypical cortisol responses, with potentially lower levels in saliva.

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Ventricular Enlargement

An enlargement of the ventricles, fluid-filled spaces in the brain, is sometimes observed in individuals with schizophrenia. This may be related to developmental disruptions.

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Decreased Temporal Lobe Volume

A reduction in the size of the hippocampus, a brain structure crucial for memory and spatial navigation, is often seen in individuals with schizophrenia.

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Temporal Lobe

The brain structure involved in auditory processing and memory, which is smaller in individuals with schizophrenia.

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Dorsal-Lateral Prefrontal Cortex

A brain area that plays a crucial role in executive functions, planning, and decision-making. It is implicated in the negative symptoms of schizophrenia.

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Basal Ganglia

A group of brain structures that help to control movement and other functions, and are often targeted by antipsychotic medications. They are linked to the positive symptoms and motor problems in schizophrenia.

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Neurochemical Imbalance Theory

This theory suggests that schizophrenia is a result of a chemical imbalance in the brain, particularly concerning neurotransmitters like dopamine and glutamate.

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Positive Symptoms of Schizophrenia

A group of symptoms associated with abnormal increase in brain functions, such as hallucinations, delusions, and disorganized thinking.

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Negative Symptoms of Schizophrenia

A group of symptoms associated with reduced brain function, including flat affect, alogia, and avolition

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Synergy Between Genetics and Environment

The complex interaction between genetic predisposition and environmental factors in the development of schizophrenia.

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Antipsychotics and Dopamine

Drugs that work by blocking dopamine receptors, often used to treat positive symptoms of schizophrenia.

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Amphetamine-induced psychosis

A condition where individuals experiencing psychosis are prone to developing toxic psychosis as a result of amphetamine use.

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L-DOPA and psychosis

A medication used to treat Parkinson's disease that can trigger psychotic episodes in some individuals.

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Chlorpromazine's effect on dopamine

A drug that increases dopamine turnover in the brain, suggesting it acts as a dopamine receptor antagonist.

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Dopamine Hypothesis of Schizophrenia

The idea that schizophrenia arises from excessive dopamine activity in specific brain regions.

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No evidence for increased dopamine release

There is no consistent evidence supporting increased dopamine release in individuals with schizophrenia.

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Increased D2 receptors in schizophrenia

Studies on post-mortem brain tissue show increased D2 receptors in individuals with schizophrenia, possibly due to medication.

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No consistent D2 receptor increase in drug-naive patients

PET scans conducted on drug-naive patients with schizophrenia don't consistently reveal increased levels of D2 receptors.

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Debates surrounding dopamine hypothesis

Despite the dopamine hypothesis's prominence, conclusive evidence for increased dopamine signaling in schizophrenia remains elusive.

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DISC1

A gene implicated in schizophrenia, DISC1 is involved in neuronal migration and interacts with proteins mutated in lissencephaly, a condition characterized by a smooth brain surface.

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What does DISC1 disruption lead to?

The disruption of DISC1 leads to abnormal brain development, specifically affecting neuronal migration. This may be a contributing factor to schizophrenia.

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Neuregulin Hypothesis

This theory posits that an increase in neuregulin signalling contributes to schizophrenia, possibly by reducing the function of the NMDA glutamate receptor.

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Clozapine

Atypical antipsychotic medication, Clozapine is known to be effective in treating schizophrenia symptoms by potentially acting on NMDA receptor function.

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Prefrontal Cortex (PFC) in Schizophrenia

The brain's prefrontal cortex (PFC) is hypothesized to be hypofunctional in individuals with schizophrenia. This hypofunctionality is linked to negative symptoms.

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Subcortical Systems in Schizophrenia

Individuals with schizophrenia exhibit excessive activity in subcortical systems, potentially due to reduced inhibition from the hypofunctional prefrontal cortex. This is associated with positive symptoms.

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How do Antipsychotics work?

Antipsychotic medications work by blocking dopamine receptors, particularly in subcortical areas. This helps to reduce the excessive activity associated with positive symptoms of schizophrenia.

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What are atypical antipsychotics?

Atypical antipsychotics, also known as second generation antipsychotics, are a class of medications used to treat schizophrenia and other mental disorders. Compared to older typical antipsychotics, they have a lower incidence of extrapyramidal side effects (EPS) like tremors and muscle stiffness, and are considered more effective at reducing negative symptoms like social withdrawal and apathy.

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What is the significance of clozapine's receptor profile?

The receptor profile of a drug describes how it interacts with different receptors in the brain, influencing its effects and side effects. Clozapine, a typical antipsychotic, has a unique receptor profile with high affinity for serotonin receptors, which contributes to its lower EPS profile and efficacy in addressing negative symptoms.

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What is DISC1 and its role in schizophrenia?

DISC1 (Disrupted in Schizophrenia 1) is a gene implicated in schizophrenia. It's known to be a scaffold protein, meaning it interacts with other proteins to regulate their function.

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What is COMT and its significance in schizophrenia?

COMT (Catechol-O-Methyl Transferase) is an enzyme that breaks down dopamine, a neurotransmitter involved in motivation and reward. The COMT gene has two variants, Val108 and Met108, which affect the enzyme's activity. While the Val108 variant is associated with schizophrenia and impaired cognitive function, the Met108 variant is associated with higher dopamine levels.

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What is Neuregulin and its role in schizophrenia?

Neuregulin is a family of proteins involved in the development and function of neurons. Variations in Neuregulin genes have been linked to schizophrenia, suggesting they may contribute to the disorder's development.

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How do chromosomal microdeletion syndrome and familial schizophrenia contribute to our understanding of schizophrenia?

Association with chromosomal microdeletion syndrome, a condition characterized by the deletion of a small part of a chromosome, and the identification of rare familial variants of schizophrenia have provided valuable insights into the genetic underpinnings of schizophrenia.

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What is the dopamine hypothesis and its significance in schizophrenia?

The dopamine hypothesis suggests that imbalances in dopamine levels play a central role in schizophrenia. While this hypothesis is still being studied, it provides a framework for understanding the disorder's pathophysiology and targeted treatments.

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What is the role of genetics in schizophrenia?

Genetics is a complex area of study, and while it is clear that genetics plays a role, multiple genes have been linked to susceptibility to schizophrenia. This suggests that a combination of genetic factors contributes to the disorder's development.

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Study Notes

Schizophrenia Overview

  • Suicide is the leading cause of premature death among individuals with schizophrenia.
  • Estimates suggest 10% to 13% of deaths in this population are attributed to suicide.

Topics for Study

  • Symptoms and Causes
  • Antipsychotics and the Dopamine Hypothesis
  • Genetics and Beyond the Dopamine Hypothesis

Learning Outcomes

  • Critically assess neurobiological hypotheses for schizophrenia.
  • Discuss the difficulties in treating schizophrenia.
  • Describe the main drugs used to treat schizophrenia and their mechanisms of action.
  • Discuss the limitations of schizophrenia treatments.
  • Outline experimental approaches used to study the neurobiological basis of schizophrenia.
  • Comment on potential avenues for improving the understanding and treatment of schizophrenia in the future.

Schizophrenia Part 1: Symptoms and Causes

  • Swiss psychiatrist Eugen Bleuler (1908) described schizophrenia as a fragmentation of cognitive processes and personality.
  • Schizophrenia typically begins in adolescence.
  • The illness presents with a complex array of symptoms, often accompanied by stress.
  • The illness is typically episodic in nature.

Symptoms

  • Positive Symptoms: Hallucinations (primarily auditory, "inner speech"), thought disorders, and stereotyped behaviours.
  • Negative Symptoms: Poverty of affect, cognitive impairment, and temporal disorientation.

Time Course of Schizophrenia

  • The onset of schizophrenia is often variable and includes symptoms such as mood swings, anxiety or substance use.
  • Symptom severity, disability, and the course of the illness over time can vary greatly.

Incidence of Schizophrenia

  • Schizophrenia is thought to have a genetic component.
  • Studies show increased rates of schizophrenia among relatives of patients are consistent with a genetic component.

Causes of Schizophrenia

  • Genetic: High concordance rate for monozygotic twins (48%).
  • Genetic: Numerous susceptibility genes involved. Specific genes like DISC1, neuregulin, and COMT are associated with risk.
  • Environmental: The role of home environment as a potential factor in schizophrenia onset, especially stressful ones.
  • Environmental: Experiences such as exposure to viruses during pregnancy may be a contributing factor.

Structural Brain Damage

  • Some studies suggest ventricular enlargement and decreased volume of the temporal lobe, including hippocampus, in individuals with schizophrenia.
  • Neurodegenerative processes are not a primary factor.

Cytoarchitectural Abnormalities

  • Decreased numbers of small neurons in superficial layers, and increased numbers of large neurons in deeper layers, are observed in brain tissue with schizophrenia.
  • These abnormalities may indicate developmental problems.

Viral Infections

  • Higher incidence in those born during late winter or spring.
  • A hypothesis posits that maternal infection during pregnancy may increase schizophrenia risk in the child.

Summary of Causes

  • Schizophrenia is likely caused by a complex interplay of genetics and environmental factors.

Site of Brain Dysfunction

  • Limbic Structures: Temporal lobe reduced size and activity increases during auditory hallucinations in those with schizophrenia
  • Dominant Cerebral Hemisphere: Disruptions in the lateralisation of brain activity in verbal tasks is observed in people with schizophrenia.
  • Prefrontal Cortex: Hypo-functioning and lack of a "conductor" of the subcortical systems in people with schizophrenia.
  • Basal Ganglia: Site of action for antipsychotic medications.

Current Understanding

  • Genetic susceptibility plays a role, but environmental factors influence expression.
  • Positive symptoms are linked to temporal lobe dysfunction, while negative symptoms are associated with prefrontal cortex dysfunction.

Schizophrenia Part II: Neurochemical Imbalances

  • Dopamine and glutamate show higher activity in basal ganglia.
  • Reduced levels of dopamine, glutamate, and GABA are observed in frontal cortex.

Schizophrenia Part II: Antipsychotics and the Dopamine Hypothesis

  • Reserpine, a drug that decreases dopamine, has antipsychotic effects
  • Amphetamines induce toxic psychosis in vulnerable individuals
  • A drug like L-DOPA can provoke psychotic episodes

Dopamine Hypothesis

  • Indirect evidence supports the hypothesis that excess dopamine neurotransmission in the mesolimbic and mesocortical regions of the brain contributes to schizophrenia.

Antipsychotics (Neuroleptics)

  • Typical or first-generation antipsychotics include phenothiazines, thioxanthenes, and butyrophenones.
  • Effective against positive symptoms, but have limitations.

Side Effects of Typical Antipsychotics

  • Weight gain, sedation, postural hypotension, atropine-like side effects, hyperprolactinaemia, neuroleptic malignant syndrome, movement disorders (acute, chronic), and tardive dyskinesia.

Recent Advances in Antipsychotics

  • Atypical or second-generation antipsychotics, such as clozapine, quetiapine, olanzapine, risperidone, aripiprazole, asenafine, and paliperidone, exhibit less sedation and a lower incidence of movement disorders.

Clozapine

  • Clozapine is a relatively recent addition to the atypical antipsychotic class with reduced side effects compared to typical antipsychotics like haloperidol

Conclusions

  • Increased understanding of schizophrenia's genetic basis is crucial for understanding the underlying mechanisms.
  • Research should lead to better diagnostic tools and improved therapies for schizophrenia.
  • Addressing the interplay of environmental and genetic influences is essential.
  • Early and accurate diagnosis, and therapies are needed to lessen the impact on patients.

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Description

Test your knowledge about schizophrenia, including its symptoms, causes, and treatment approaches. This quiz covers various aspects such as genetic factors, brain regions affected, and treatment challenges. Perfect for students and professionals in psychology and mental health fields.

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