This essay is going to discuss the hypothesis ‘Taking Anti-psychotics drugs to will make you more likely to recover from Schizophrenia while living in India than living in Britain.’ and to consider how the country of residence affects how likely individuals are able to recover from Schizophrenia, with the aid of antipsychotics. A successful recovery from Schizophrenia has been known to be more likely in India due to their abundance of strong family networks. Adults who suffer from Schizophrenia in India are twice as likely to recover as sufferers in Britain, according to a report by the World Health Organisation (Whitaker, 2010). Twenty nine per cent of Schizophrenics living in Nottingham, United Kingdom would have a good recovery after two years of an attack, compared to fifty four per cent of those living in India. Stigma and lack of strong family networks mean that only fifteen per cent of schizophrenics in Britain are likely to have made a good recovery from the first attack of their illness compared with thirty-seven per cent of those in underdeveloped countries, such as India. In Britain, about one in four adults recover very well from a first attack of the illness and remain well for many years. Whereas in India, the outcome is conspicuously better; about one in two adults do well (Whitaker, 2010).
Although there is no known cause for Schizophrenia, one of the things that can trigger a psychotic episode that will lead to further diagnosis is an emotional and stressful life, which is more common in a more developed country such as Britain, hence why it is less likely for an individual to recover. High stress levels typically come with living in an affluent country such as Britain. This explains why negative emotions are more common for people living in Britain. Life in Britain is faster paced and people usually have more things to do; as well as higher expectations for themselves. This is mainly due to having more opportunities available to them, such as free education, university and a wide range of career paths. Trying to make the best choice as quickly as possible, stresses people out and causes high levels of anxiety, hence why Schizophrenia is more likely to be triggered in Britain than India (Blaszczak-Boxe, 2014).
According to (Staff, 2014) Schizophrenia refers to a disruption of the usual balance of thinking and emotions and a term used to describe a major psychiatric disorder (or clusters of disorders) that alters an individual’s perception, thoughts, affects and behaviour. Individuals who develop Schizophrenia will each have their own unique combination of symptoms and experiences, the precise pattern of which will be influenced by their circumstances and lifestyle.
Despite extensive research, scientists have yet to develop methods of lab diagnosis of Schizophrenia. However, in terms of non-diagnostic methods, most schizophrenic patients suffer from abnormalities in brain structure and diminished blood flow to the frontal lobe. This condition has become known as hypofrontality. People with schizophrenia often show reduced activation in frontal regions of the brain during tasks known to normally activate them. The brains of adults affected with Schizophrenia have far more neurotransmitters that are released between neurons, which are what causes the symptoms of Schizophrenia (Cazaban, 2017). The psychological diagnosis of Schizophrenia shows patients suffering from signs of attention deficit, weak memory, difficulty in adapting responses, and abnormal eye movements (Newsmax, 2011). There is no single test for Schizophrenia and the condition is usually diagnosed after assessment by a specialist in mental health (Acton, 2012).
Schizophrenia can usually be diagnosed if you have experienced symptoms for over a month. Symptoms can be categorised into positive, negative and behavioural disorganization symptoms. Positive symptoms include hallucinations, defined as perceptions in the absence of an external stimulus, and delusions, defined as unshakable false beliefs not explainable by religious or cultural background, hearing voices and incoherent speech.
The presence of severity of negative symptoms is more critical to the prognosis than hallucinations and delusions. Negative symptoms include suicidal thoughts, alogia (reduced amount of spontaneous speech), affective flattening (loss or lack of emotional expressiveness), avolition (reduced motivation) and anhedonia (loss of the ability to experience pleasure). Negative symptoms often persist to some degree even when positive symptoms have improved.
Positive formal thought disorder is another negative symptom. This involves the disruption of the normal grammatical and synaptic use of conversational language, such that statements become connected in unusual ways, words are used idiosyncratically (paraphasia) or are invented (neologism), or speech is rambling with the informational content (poverty of speech content). Bizarre behaviour is also displayed with people who have Schizophrenia. It refers to the socially inappropriate or disorganized behaviour frequently exhibited by adults with Schizophrenia (Buchanan & Lewis, 1998). Behaviour can be aggressive, childlike, exaggerated, emotive, or socially unacceptable. (Healthcommunities, 2001)
Behavioural disorganization is the disruption in the associations among mood and behaviour. For example, inappropriate affect- the loss of connection between affects and thought (Buchanan & Lewis, 1998). Adults with Schizophrenia are also affected by affective symptoms which refer to mood, emotions or feelings displayed by the person (Buchanan & Lewis, 1998). Anxiety, depression and mania may occur in addition to all other symptoms mentioned (John, 2015). Concisely, Schizophrenia has a significant impact on ability to work, study or perform daily tasks and can severely impair the way an adult lives their life, and inadvertently causing them to miss out on important opportunities if the illness if not managed properly. However, there are many useful medications available (Tracy, 2016). All these symptoms mentioned are more easily controlled for an adult living in India, than in Britain. This is due to the simple, less stressful lifestyle they live. Symptoms are triggered, as well as aggravated by stress, hence why symptoms will be less severe for an adult living in India, therefore easier to manage (Blaszczak-Boxe, 2014).
Treatment of Schizophrenia is a combination of counselling and medication. There is no cure for Schizophrenia and medication is not a cure. Medication is only used to manage and treat the symptoms of Schizophrenia. Schizophrenia drugs are a lifelong commitment; at best, they control the outbursts of psychosis, but do not stop them from reoccurring. An individual must go on taking the medication to stop the symptoms from coming back (Mind, 2017).
An imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters that brain cells use to communicate with each other, dopamine and glutamate, is seen in adults with Schizophrenia (National Institute of Mental Health, 2016). This is linked to why people with Schizophrenia show the symptoms they do.
There are two types of drugs given to adults with Schizophrenia to manage their symptoms; First or second-generation antipsychotics. Dopamine is the main neurotransmitter affected by antipsychotics. They affect the patient’s feelings and cause sufferers to feel motivated, satisfied and significant (Royal College of Psychiatrists’ Public Education Editorial Board, 2014). Dopamine is a neurotransmitter that helps control the brain’s reward and pleasure centres. Dopamine also helps regulate movement and emotional responses, and it enables us not only to see rewards, but to take action to move towards them. If parts of the dopamine system become overactive, they can produce hallucinations and delusions. The way that antipsychotic drugs work is by working as a selective dopamine receptor antagonist, as they have a high affinity to mesolimbic D2 and D3 dopamine receptors in the brain (D Hoyer, 1994). This temporarily alters the brain chemistry of the patient, as the drug is working alongside the dopamine neurotransmitter as an antagonistic pair (Gromisch, 2016). This blocks the dopamine receptors, to prevent them from becoming overactive and displaying positive symptoms. Antipsychotic Schizophrenia drugs have been used since the nineteen fifties to curtail psychosis and to deter relapses. All the drugs used to treat Schizophrenia are available in both India and Britain, although they are free in Britain, as they are prescribed through the National Health Service- a publicly funded national healthcare system for England, which allows everyone in Britain to receive free healthcare (Rouse, 2011). Whereas all antipsychotic drugs must be bought in India.
First generation antipsychotics block the action of dopamine receptors more strongly than others, although they include greater side effects than second generation antipsychotics; hence why there are used less commonly.
This makes it hard for adults in India to access medication, as it is a less developed country, and not everyone in need of medication may be able to afford it. This implies that medication may not actually be essential for a successful recovery from Schizophrenia, as people in India are more likely to recover.
First generation antipsychotics are notorious for their degenerative side effects, such as stiffness and shakiness, like Parkinson’s disease, uncomfortable restlessness (Akathisia), some can affect the blood pressure and make individual feel dizzy, problems with sex life and problems with breast swelling or tenderness. Some patients also need higher than normal doses to stay well, so the side effects can be controlled with anticholinergic drugs, Orphenadrine and Procyclidine are the two most commonly used anticholinergics in the United Kingdom (Royal College of Psychiatrists’ Public Education Editorial Board, 2014).
Due to these side effects, adults often come off their medication as they felt that the side effects outweighed the benefits, which would cause them to relapse and have another attack. Antipsychotic drugs must be taken on a long-term basis to successfully manage the symptoms of Schizophrenia. So, when adults come off their antipsychotic drugs, they are less likely to recover. Hence why second generation are more commonly used than First generation antipsychotic medication (Royal College of Psychiatrists’ Public Education Editorial Board, 2014).
Second generation antipsychotics drugs are used to calm disturbed patients whatever the underlying psychopathology which may be Schizophrenia. They are also used to alleviate severe anxiety, but this too will only be on a short-term basis; hence why drugs must be taken regularly, if not daily. Second generation antipsychotics also help alleviate ‘negative symptoms’ such as poor motivation, lack of interest, poor self-care; on which the older drugs have very little effect.
With Schizophrenia, the aim of treatment is to alleviate the suffering of the patient and to improve social and cognitive functioning. Many patients require life-long treatment with antipsychotic medication. Second generation antipsychotic drugs relieve positive psychotic symptoms such as thought disorder, hallucinations and delusions; and prevent relapse. They are usually less effective on negative psychotic symptoms apathy and social withdrawal. Patients with acute Schizophrenia generally respond better than those with chronic symptoms that have been reoccurring for a long period of time.
The most common Second Generation antipsychotic drugs given to Schizophrenia sufferers are Clozapine. Its usual daily dose is two hundred to four hundred and fifty milligrams a day, but its maximum daily dose is nine hundred milligrams (BNF.org, 2014). Clozapine is the only psychotic medication that works better than the others as it reduces suicidal feelings in adults with Schizophrenia. But sadly, it has more side effects than the other new antipsychotic drugs such as producing more saliva, affecting your bone marrow, leading to a shortage of white cells. This makes the individual more vulnerable to infection. If this happens, the medication is stopped at once so that the bone marrow can recover. It can also cause weight gain, constipation and make epileptic fits more likely. Another common antipsychotic is Amisulpride. Its usual daily dose is between fifty and eight hundred milligrams and its maximum daily dose is one thousand two hundred milligrams (BNF.org, 2014). Amisulpride controls acute psychotic episodes. Aripiprazole’s usual daily dose is ten to thirty milligrams a day and its maximum daily dose is thirty milligrams (BNF.org, 2014). This antipsychotic controls agitation and disturbed behaviour in adults with Schizophrenia and prevents recurrence of mania. Olanzapine is a monotherapy for mania and controls agitation and disturbed behaviour. Its daily dose is ten to twenty milligrams a day and its maximum daily dose is twenty milligrams (BNF.org, 2014). The last most common antipsychotic used for Schizophrenia is Risperidone which treats acute and chronic psychosis and mania and has a daily dose of between four to six milligrams. Its maximum daily dose is sixteen milligrams.
Most adults find that they feel well after their first dose of medication and stop taking the antipsychotic drugs. Even if the medication instantly helps, the symptoms may come back. This is much less likely to happen if the individual carry on taking medication daily (Royal College of Psychiatrists’ Public Education Editorial Board, 2014).
Looking at how severe the symptoms of Schizophrenia are, medication is a great way to manage them and psychotic episodes; although, medication is not available to all people in India. In both India and Britain, all drugs are available as generics (BNF.org, 2014), meaning that they go through the same detailed safety and quality requirements as the original branded product and are usually cheaper because there are fewer research and development costs, but they contain the same active ingredient as the branded products (NHS Choices, 2014). Also in Britain, all medication is provided, with no charge, by the National Health Service. In India, all antipsychotic drugs must be purchased as there is no healthcare system in place; Being a less developed country, this makes it hard for everyone to have access to the medication they need, unlike in Britain where everyone has access to the medication they need at all times. On average, the GDP per capita, PPP (current international £) is five thousand and sixty-four pounds (₹411589.16 Indian Rupee) and the GDP per capita growth (annual$) is six point two seven per cent as of 2015 (The World Bank Group, 2016). Despite the rising number of jobs India, the unemployment rate for India in 2017 is still three-point five per cent (Special Correspondent, 2017), and considering their high population of over one point three billion, many people are unemployed (Worldometers, 2017). Additionally, two-thirds of Indians live on less than two dollars (₹128.50) per day. So, for some of the poorest people in India, medication is not an option (Palmer, 2009).
The same drugs used to treat Schizophrenia in Britain are also available in India and the doses are also equivalent, such as Clozapine where an eighty-four-tab pack of a hundred milligram tablets costs thirty-three pounds eighty-eight pence. Also, Amisulpride costs forty pounds sixty-four for a sixty-tab pack of four hundred milligram tablets. Aripiprazole’s costs one hundred and ninety-two pounds and eight pence for a twenty-eight-tab pack of fifteen milligram tablets. Although Olanzapine and Risperidone are some of the cheapest antipsychotics in India for a twenty-eight-tab pack costing one pound nine pence and four pounds eight pence respectively (Medindia, 2016).
Having a low GDP and medication needed to be taken regularly causes this to be a problem as drugs become increasingly hard to afford. These statistics show medications is not necessarily essential for a good recovery from Schizophrenia, as adults in India are more likely to recover from a psychotic attack; but do not always have access to medication. Taking antipsychotics should make the individual more likely to recover from Schizophrenia in Britain than adults in India, as they have regular access to antipsychotic medication and free healthcare. But this is not the case as adults in India are shown to be more likely to recover from Schizophrenia. Therapy is also effective on reducing symptoms and leading to a successful recovery.
A new study published in The Lancet in February 2014, provides more concrete evidence for the effectiveness of treating schizophrenia patients with Cognitive Behavioural Therapy. Cognitive behavioural therapy is a talking therapy that can help and manage your problems, such as the symptoms of Schizophrenia, by changing the way you think and behave (Mind, 2017).
In trials at two different health centres in the United Kingdom, researchers at the University of Manchester conducted a study comparing the outcomes of schizophrenic patients who had received antipsychotic drugs with those who had received antipsychotics along with cognitive behavioural therapy. As a metric for outcomes, researchers used the Positive and Negative Syndrome Scale (PANSS), which is commonly used to assess Schizophrenia; the higher a patient’s PANSS score is, the more symptoms of Schizophrenia that the patient is experiencing. After the study, the researchers found that the mean PANSS scores for those who received Cognitive Behavioural Therapy was consistently lower than scores for the group that received antipsychotics (Pease, 2014).
The reason adults recover so well from Schizophrenia in India is due to the strong family links that they have. Although medication helps patients greatly, it is the mental wellbeing that primarily aids adult’s recovery from Schizophrenia. An example of how they do this is by being able to constantly be around their families. This is more common in India due to the small, close communities they have (Whitaker, 2010), and the high numbers of people, mainly family members, living in one household (Mind, 2017). This means that people with Schizophrenia in India are constantly receiving family intervention therapy and are more likely to recover from Schizophrenia.
Family intervention is known to be another effective form of therapy for people with psychosis (Mind, 2017). It is a way of helping both the individual and their family cope with their condition. After having an episode of psychosis, you may rely on your family members for care and support; and most family members are happy to help. Family therapy involves a series of discussions that take place over a period of three months or more. Discussions may include how to manage the condition and how it may progress, plus the available treatments, exploring ways of supporting the individual. Also, deciding how to solve practical problems caused by psychosis, such as planning how to manage future psychotic episodes, are discussed. Family intervention can improve relationships within the household as family members listen to each other and openly discuss problems and negotiate potential solutions together. This reduces the stress of the adult suffering from Schizophrenia as they do not have to deal with all their problems themselves (Mind, 2017).
Family intervention is more common in India as communities are close, hence why adults in India are more likely to recover from Schizophrenia and psychotic attacks. Unlike India, in Britain the living conditions are not as close. The large number of people in households in India means that there is a network of people who can share the responsibility for the patient’s care and recovery. There is a strong sense of duty and they all share the burden. Communities are smaller and closer together, in comparison to where communities are larger and less close together in Britain (Whitaker, 2010). Stigma related to Schizophrenia in Britain also damages family links between family members. In media reporting and in public opinion Schizophrenia has more negative associations than any other public health issue in the United Kingdom today (Living with Schizophrenia, 2017). Inevitably the negative beliefs and ideas that the public, the press, employers and health workers have around this condition impacts on the lives of those suffering from it, as well as their family members (Mind, 2017) (Kings College London, 2014).
An example of negative stigma is in the film, The Voices, which reinforces the stereotype that people with Schizophrenia are dangerous. The main character was portrayed as a murderer and instructed to kill by the voices in his head (Crepaz-Keay, 2015). This will cause family members in Britain to want to stay away from the Schizophrenia sufferer as in the media; people with Schizophrenia are branded as dangerous. This means only fifteen per cent of Schizophrenics in Britain and other Western countries are likely to have a good recovery from the first attack of their illness compared to thirty-seven per cent of those found in India and underdeveloped countries; due to the stigma of Schizophrenia and lack of family interventions (Whitaker, 2010).
Alternative, nonmedical methods are also used by people in India use to try and ‘cure’ Schizophrenia. Traditional healers are often used to try and expel the Schizophrenia from the patient. One hundred and twenty-nine inpatients with psychotic disorders on admission and discharge from the traditional healer’s centres were interviewed. There was significance reduction in the PANSS score after a mean period of stay of four and a half months. Meaning that symptoms were significantly reduced. The mean for the overall PANSS score was one hundred and eighteen point three six on admission and sixty nine point three six on discharge from the traditional healer’s centres (Sorketti, 2012). Traditional healing provides placebos to make the patient think they are receiving medication to help them recover from Schizophrenia. The reason this works is because it improves the mental wellbeing of the patient, which in turn reduces the signs and symptoms shown in Schizophrenia.
However, there are multiple factors which disprove the hypothesis “Taking Anti-psychotics drugs to will make you more likely to recover from Schizophrenia while living in India than living in Britain.”. One of these factors is the stigma associated with Schizophrenia in India is far superior to the stigma Schizophrenic’s receive in Britain. With people with Schizophrenia being referred to as witches or possessed.
A survey of consecutive psychiatric patients attending a hospital in Tamil Nadu, South India showed that fifty-eight per cent of psychotic patients saw a religious healer prior to psychiatric consultation (Sandeep Grover, 2014) . Alternative and traditional healings methods are common and popular especially for treating people with mental disorders, but only little information is available about the outcome of theses traditional healing approaches (Sorketti, 2012). At a small Hindu temple on the eastern outskirts of Rajasthan, India’s largest state, people labelled as ‘spiritually possessed’ come to have their demons expelled. Majority of people do not turn to medical help, even if they could afford the consultation or the medication, as members of the community brand them as possessed. Hence adults are more likely to get help from a spiritual healer, rather than a medical professional. These tags contribute greatly to the stigma associated with Schizophrenia in India (Sorketti, 2012).
Furthermore, India faces challenge of having too few trained psychiatric personnel to manage effectively the substantial burden of mental illness within their population (Jagadisha and Thirthalli, 2016). According to a recent study by the Indian Government, there is only one psychiatrist for every four hundred thousand people (Kennedy, 2010). Mental health sufferers in deprived environments such as the urban slum, alcoholism; domestic violence and suicidal behaviour go together. Children face violence from a young age which can affect them greatly as adults, and certain slums witness a free-flowing supply of drugs — triggers to mental illnesses, as it causes immense stress which is a large trigger of Schizophrenia (Chakrapani, 2017).
Additionally, India experiences extreme weather conditions such as floods, which greatly contribute to the mental health of its residents. Many residents living in the slums in Chennai suffered mental trauma after the two thousand and fifteen floods. Living in such poor conditions can put great stress on adults living in India as they may not be able to provide for themselves or their families, hence further triggering symptoms or even a psychotic episode (Chakrapani, 2017). The idea that where they are living is dangerous and that they are not guaranteed safety at all times puts unhealthy amounts of pressure and stress onto the individual. This will make them more likely to have an attack, and prolong the recovery process. This also makes recovery less likely to happen.
Although adults in India can recover from Schizophrenia more effectively, there are still many triggers for Schizophrenia there, as well as in Britain. To further disprove the hypothesis; over eight point seven million people in India have Schizophrenia compared to only two thousand five hundred people in Britain (Schizoprhenia.com, 2010)
Although if the medicine available in western countries could make it to the third world and all adults were able to afford the medication, then cultural concepts, values, beliefs, influence health-seeking pathways, and traditional healers would play an important role in the management of disease. In many cultures where ‘Western’ medicine, such as from Britain, is not available to all; people tend to view medication from foreign countries with scepticism, or use it in parallel with traditional treatment methods (Versola-Russo, 2006).
Although for people living in the most rural areas of India such as Rajasthan, this is the closest they will ever come to psychiatric care. Exorcisms are normally performed in a number of ways such as a strict diet over chanting Tantric hymns and also keeping the ‘possessed’ in shackles (Versola-Russo, 2006). These practices are as common as there is so little understanding of mental health disorders, especially in the rural north of India. Furthermore, most adults cannot afford the medication and have no choice but to result to non-medical interventions (Webster, 2011).
When exorcisms take place, screams and wails are often heard from miles around; which could last for multiple days. This does not help the person with Schizophrenia recover from the mental health disorder and just causes them great pain. They are also avoided by people in the community and less likely to recover from Schizophrenia, as they are seen as dangerous (Versola-Russo, 2006).
In summary, this essay has proved the hypothesis to be incorrect. This is as after exploring both sides of the argument, it has been proven that although antipsychotics are effective in managing the symptoms and psychotic episodes of Schizophrenia; there are factors within both countries that can hinder the recovery process. There are also effective and successful ways to recover in both India and Britain. Antipsychotics work by managing the amounts of dopamine released by the dopamine receptors in the brain (D Hoyer, 1994). If they become overactive, then positive symptoms such as hallucinations and delusions occur (Royal College of Psychiatrists’ Public Education Editorial Board, 2014). Taking antipsychotics prevents this from happening, and leads to a successful recovery from Schizophrenia.
Medication is always available in Britain due to the National Health Service, so this puts adults within Britain at an advantage, hence more likely to recover from Schizophrenia. This is not the case in India as adults only receive medication if they buy it. With India being a less economically developed country, not all people can afford medication.
This is also why in India, therapy and other psychological methods are much more common (Mind, 2017).
Traditional healers have been proven to reduce the PANSS scores of patients with Schizophrenia, meaning the symptoms the person displayed have successfully been reduced. This is due to the patients being given a placebo and believing they are being given medication to ‘cure’ their Schizophrenia; although the medication contains no active drugs (Sorketti, 2012).
Adults in India also have strong family links and neighbouring communities, so the burden of having Schizophrenia is shared between the family members of the person suffering from Schizophrenia. This means they are able to receive family intervention therapy and cognitive behavioural therapy, more regularly than someone in Britain. This reduces the stress, and consequently reduces the chance of having a psychotic attack and helps them to recover (Chakrapani, 2017). Stress is a big trigger for Schizophrenia (Blaszczak-Boxe, 2014) and should be minimised in order to recover from the mental disorder.
Adults in Britain can also receive family intervention therapy, but it is not as regular. This is because families and communities have been shown to be less close and family links are not as strong (Whitaker, 2010).
This essay has shown that taking antipsychotics does make you more likely to recover from Schizophrenia as they reduce the symptoms shown, despite the side effects being very severe and difficult to manage (Royal College of Psychiatrists’ Public Education Editorial Board, 2014). But therapy is also effective and does not involve taking medication.
Living in a close, friendly community and keeping in frequent contact with family members and people you are close to you also helps recovery. Sharing the burden of the mental disorder and talking to people who they trust can also help the individual to recover. The most effective way to treat a mental health issue is therapy due to it improving the mental wellbeing of the person and medication, as well as therapy can achieve this. Adults who receive, antipsychotic drugs along with Cognitive Behavioural Therapy have consistently less severe Schizophrenic symptoms that those who received medication alone (Pease, 2014).
In India, exorcisms are also performed to try and release the Schizophrenia from the Individual. This method has not been proven to be successful and just cause pain for the individual. It also singles them out from the community and makes them feel like an outsider, due to them being branded as ‘dangerous’ or ‘possessed’ (Chakrapani, 2017).
Adults living in Britain should also become closer with friends and family, so they have a network of people they trust to be able to share their problems related to Schizophrenia. This was they will able to find a solution and resolve the issue. This means that they will be more likely to make a recovery. Before trying to heal themselves with religious or spiritual healing methods, adults should seek medical attention or speak to a family member first, as this will give them the best chance of getting the help they need and eventually recovering from Schizophrenia.
It is also recommended that adults should not put too much pressure on themselves and try to live a less stressful life as this can also trigger stress and lead to developing Schizophrenia. An adult should not have unrealistically high expectations for themselves, as when the process to reaching their goals is much more stressful. Also when their goals are not met, it may cause them to go into a psychotic episode. This is unhealthy and could lead to Schizophrenia. If things do not go as planned, they should not worry and try not to let it take control of their life.
Adults should also not just rely on antipsychotics for recovery and try to get any sort of therapy where they are able to talk to people instead.
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