If you were treated with ECT, you would experience a n :. Which patient group was the first treated with ECT? ECT electroconvulsive therapy has changed over the years. Patients given this treatment now may receive:. One of the side effects of ECT is:. People who take MAO inhibitors and want to decrease the risk of negative side effects would make the greatest changes in which aspect of life? Corrina took an antidepressant and then ate a meal. Shortly thereafter her blood pressure skyrocketed and she felt faint.
Which of the following is MOST likely to be true? She ate something containing tyramine. MAO inhibitors work by:. Which of the following is MOST likely to elevate the mood in a depressed person? Researchers were searching for drugs to treat schizophrenia when they came across imipramine, which alleviated the symptoms of depression, although it was not effective against schizophrenia.
It became the first of a class of drugs, all sharing a similar molecular structure, called:. In order to effectively reduce the chances of relapse of depressive symptoms, patients should:.
Anafranil and Eldepryl. Which of the following best represents how tricyclics work? Second-generation antidepressants:.
Therapists who treat African American clients for depression need to be aware that their clients are:. How likely are Medicaid recipients to be prescribed antidepressant medication? Vagus nerve stimulation is MOST similar to:.
What do ECT, vagus nerve stimulation, and transcranial magnetic stimulation have in common? They suggest that brain stimulation is effective in treating severe forms of depression. Conclusions from extensive studies of the effectiveness of various forms of treatment for depression show that:.
The key to long-term treatment of depression is:. Recent research indicates that behavioral therapy is the treatment of choice only:. Your BEST advise to a friend who is experiencing severe depression would be:.
What would be your BEST recommendation i. Use a combination of drug therapy and cognitive therapy. Which of the following treatments produces the fastest results in the biological treatment for unipolar depression?
What is currently true about pharmaceutical companies regarding their ads for medications in the United States? They must recommend that patients consult with their doctors about taking the drugs in their ads. The effects of lithium were discovered during the investigation of:. A person with bipolar disorder is taking a commonly used drug to stabilize mood in the manic episodes.
What else might also happen as a result of taking this drug? The person might experience at least partial relief from depressive episodes. Lithium appears to affect:. You would expect to see the biggest impact of lithium on which part of the neuron? Which one of the following is the BEST example of adjunctive therapy? A patient is receiving both drug therapy and interpersonal therapy with his or her family.
Which one of the following is a likely reason for using adjunctive therapy to treat bipolar disorder? People stop taking lithium because they feel more productive and creative without taking it.
About how many suicides are committed annually in the United States? About how many suicides are attempted annually in the United States? Parasuicides are often included in the number of suicides. What is a parasuicide? The critical way in which the death seeker differs from the death darer, according to Edwin Shneidman, is:. Cecil and Jeanne, teenagers, made a love pact, jumping from a cliff in order to be with each other for eternity. Cecil and Jeanne are examples of what Edwin Shneidman refers to as:.
Ernest Hemingway was a physically strong, proud man who developed great concerns about his failing body. Depressed about his progressive illness, he intentionally ended his life. Edwin Shneidman would term Hemingway a:. According to Edwin Shneidman, how do death ignorers primarily differ from other categories? They believe death will not end their existance. According to Edwin Shneidman, people who are ambivalent about their intent to die and whose actions leading to death do not guarantee death e.
Knowing she was terminally ill, Bonnie swallowed a handful of barbiturates in order to save herself and her family from the final painful months of life. Bonnie is an example of what Edwin Shneidman refers to as a:. The self-inflicted burns would MOST likely be classified as:.
Retrospective analysis of suicide typically would include:. Which of the following is the BEST example of retrospective analysis? Therapists who had patients who committed suicide are interviewed to gain information on suicide.
One of the factors that is believed to account for differences in the suicide rates of different countries is:. Which of the following statements MOST accurately the relationship between religion and suicide? Which of the following statements is NOT true regarding gender and suicide? Women succeed at committing suicide more often than men. Which of the following would be the MOST surprising example of suicide because it does not fit into the pattern that current research results have identified?
According to current estimates, the suicide rate is highest in the United States among:. Native Americans. Assume that a community is made up of almost exactly equal numbers of these four groups: African Americans, Asian Americans, Hispanic Americans, and white Americans, and that everyone is of the same socioeconomic status. Approximately what percent of suicides would you expect to be committed by white Americans? How likely are women to use a gun to commit suicide?
About 40 percent of women who commit suicide use guns. Which of the following occupants has a particularly high rate of suicide? A person who sees life in "right or wrong," "all or none" terms is engaging in:. If you were assessing a person for suicidal potential, which of the following is MOST critical to notice since it is likely related to suicide risk? Which of the following is the BEST example of dichotomous thinking?
Based on the available research, we can conclude that:. About what percentage of people who commit suicides use alcohol just prior to the act? Which is TRUE about alcohol use and suicide? Which mental disorders have been found to contribute to the greatest number of suicides?
Based on the best available research, you reply,. Research indicates that suicides by people with schizophrenia are in response to:. Your BEST answer, based on research, is:. Which of the following is the BEST example of the social contagion effect? If you had a close relative or friend who committed suicide, your risk of committing suicide is greater. If a student at your school commits suicide, the staff might offer counseling sessions for the other students. If so, the staff is engaging in:.
The leading theories designed to explain suicide:. Research supporting a Freudian view of suicide has shown that later suicidal behavior is related to:. If the psychodynamic explanation for suicide is correct, then suicide rates should:. A society that loses its basic family and religious core values, experiences large-scale immigration of people with very different values, and fails to provide meaning for the life of its people is in danger of an increase in what Durkheim calls:.
Juan is an atheist, does what he wants, and is alienated from others. According to Emile Durkheim, he would be classified as an:. Carlos died by intentionally stepping in front of a bullet that was intended for another young man, for whom Carlos, as head of a platoon of soldiers in the Persian Gulf War, was responsible. Emile Durkheim would call this an example of:. A young man whose father and uncle committed suicide at about his age also commits suicide.
The strongest direct support for a biological explanation for suicide comes from:. Biological researchers have found a link between suicide and:. Of the following individuals, the one MOST likely to commit suicide would be a:. Based on the evidence about suicide rates, which of the following intervention strategies should prevent the MOST suicides? You should be sure to mention that suicide attempts by the very young often occur when they have:. Which of the following would you be MOST surprised to learn had committed suicide because his or her action is inconsistent with research results of studies of child suicide?
Which of the following represents the greatest risk of death to teenagers; in order from least concern to most concern? The other goal of IPT in grief management is to help the patient figure out relations which can act as a substitute for the lost person and lost relationship.
One way is to encourage patient to involve others in the process of remembering their lost one. The strategy that the therapist uses is to encourage patients to talk about their feelings. It is stressed that the expression of feelings does not make a person weak. Some people even fear that once they start expressing their feelings, they may become overwhelmed. Patients are encouraged to focus on the positive and negative aspects of the relationship with the loved one.
Death of a loved one often leaves a void in the patient's life, and it is important that this gap is filled up. Once the therapist has explored about the support system of the patient, important relationships in their life can be reestablished.
Patients can be encouraged to connect with important people in their life and share their feelings. The therapist must also encourage patients to engage in activities which they enjoyed before the death. This may be difficult for the patient, but still efforts must be made to engage in relationships.
Sometimes, patients may completely withdraw themselves from their social life and so, they must be told that they can just go out with a friend to see how things work. The end of the therapy includes termination sessions, focusing on consolidating the gains that occurred in the therapy and preparing patient to work outside the therapy in real-life situations.
For a healthy relationship, it is very important that both individuals have a sense of harmony, regard for each other's expectations, and have willingness to compromise for each other. Two people in a relationship may have different aspirations and perspectives, but when their expectations from each other become contrasting or different, it can result in strained relationship.
If they do not understand the needs and expectations of each other, it is very likely that disputes will result. If the patient presents with such complaints, the focus of the IPT will be directed toward resolving the role disputes.
Often, role transitions may lead to role disputes or the opposite situation. Like shifting to a new job or to a new place may change the expectations, two people in a relationship may have from each other. It can happen the other way around, where differing expectations can interfere with smooth transitions in the role changes one is expected to go through.
In either of the circumstances, depression may result from these situations or depression may interfere with the successful handling of these transitions. It is important for the therapist to identify these situations and identify whether role transition or role dispute is the important contributing factor in the initiation or maintenance of depression, and that particular area should be selected as the focus of the therapy.
After going through a long-standing role dispute, the patient starts believing that there is no way out and there is no benefit of initiating any therapy. Often, patients find themselves as the main reason behind the dispute and place the partner at a superior position.
Goals of the therapy include helping the patient find the dispute, identify it, and look for options to deal with it. The therapist helps to work out a plan of action. After going through the patient's history of presenting illness, the therapist needs to identify the area of dispute. Even though the patient reports that there is no possible solution, it needs to be reemphasized that no matter what the dispute is, some solution is always possible.
After having an agreement with the patient about the dispute area that will be targeted during the therapy, the therapist needs to explore various ways in which the relationship can be renegotiated. In cases when the renegotiation does not turn out to be successful, the patients at least learn to communicate their feelings more adequately.
Rectifying faulty expectations and facilitating better communication to resolve issues. The cause of many disputes is the contradictory expectations which two people in a relationship have from each other.
The goal of the therapy is to identify these faulty expectations and modify them in a better manner. It is better if the partner is also involved in the therapy, but it may not be possible in all cases when the therapist continues sessions with the patient.
The following steps are undertaken for dealing with role dispute in IPT:. The key to initiating any session is detailed exploration of the symptoms with which the patient has presented to us. This will be done in the initial sessions of IPT as described previously. The IP inventory also provides information about the IP issues. Once the depressive symptoms have been assessed, the next step is to draw relations between these symptoms and evident or covert dispute.
The IP formulation caters to this. Once the depressive symptoms have been assessed and their relation with the dispute has been drawn, the therapist tries to identify the stage at which the dispute currently is.
Often, patients may be aware of the differences in expectations but lack skills to express themselves. They consider their expectations as less important than the other person with whom the dispute is present. The communication between the two people has not stopped. The therapist helps the patient learn that even their expectations are genuine and they need to express it to the other person. In this stage, the relations have reached a point when conversation between the two people has stopped.
There are no more discussions and the patient feels that renegotiation is no more an option. Patients feel hopeless about any positive progress in the relationship. At such a stage, discussion can be brought forward clearly in the open. This stage is reached when either one or both the patient and partner are looking out ways and struggling to bring an end to the relation. This is usually not the first stage, but often, patients may report that they do not see a future ahead with their partner and are actively looking out ways to terminate the relationship.
At this stage, dissolution is advisable. It must be kept in mind that dissolution may lead to interference in role transition. Strategies that are used in dealing with role dispute are as follows:. Finding out options and deciding out a plan of action depending on the stage of the dispute. If the stage of impasse has been reached, the therapist encourages the patient to directly ask for the other person's expectations.
The disharmony may initially increase, but this opens a conversation between them which had stopped, and it helps the therapist understand the contradictory expectations better. Sometimes, it is better to go for dissolution of the relationship. This stage should be reserved for the point when all attempts to reestablish the relationship have been explored.
The strategy of role play is not only to give the patient a formal homework but also help the patient to do the conversations more easily in real life. This category is very wide and may include a large number of situations that one faces in day-to-day life. People who are depressed following role transition often report of difficulty adjusting to the new role and difficulty in giving up the old role.
Situations can be multiple, such as marriage, retirement, loss of job, becoming a parent, getting promoted, and getting diagnosed with a disease. Those who are vulnerable to depression have difficulty coping up with these changes, which, in turn, affects their mood and behavior. Sometimes, the changes are unexpected and sudden such as divorce or may be gradual. Sometimes, the transition may have been a desired one such as a planned pregnancy or desired promotion or unexpected such as financial loss.
Unexpected losses tend to have a greater impact on the patient. There can be two aspects to role transition. The goal in managing the problem of role transition will be to facilitate the mourning and explain the positive aspects of the transition. Depressed patients emphasize more on the positives of the old role. They consider the change as something that has added to the chaos in their lives.
Once an old role is lost, patients may have difficulty accepting the transition such as a divorce or an accident. It becomes important that the therapist facilitates the mourning process. The patients must express their feeling about the loss. They may feel sad or may express anger.
Some patients also report of not performing their old role adequately and express guilt. Some feel that they have no control over the situation now. The therapist helps the patients to express their feelings. Other important aspect of therapy would be that the patients acknowledge their lost role. Once they start doing that, the therapist helps patients to give up their old role. Patients may feel apprehensive about their new roles and the therapist tries to explain about all the positive aspects of being in the new role and that the new role is not as bad as the patient was expecting.
As patients start accepting new role, they gradually develop new skills. This adds to their confidence and helps in restoring their self-esteem. In the process, the patients build up their support group.
The entire process may proceed gradually and even if the patients at the end of therapy do not achieve full role transition, they have developed skills for that.
This helps in reduction of the depressive symptoms. Dealing with role transition may be challenging for the patient and may have been a trigger for their current depressive symptoms. The following aspects can be targeted while dealing with role transition:.
The first step would be to review the depressive symptoms. A detailed history provides important information about the sequence of events and what factors led to depression. What were the patient's expectations from the past role and what hurdles they face while dealing with the transition? Why they consider the previous role to be an ideal one. Exploration about the feelings associated with the change is also the part of therapy.
The therapist now tries to help by reviewing the merits and demerits of both the new and old roles. Good aspects of the new role and negative aspects of the old role are brought to the notice of the patient.
The therapist also helps patients to approach the situation in a more realistic way rather than in an ideal way. The most important aspect in helping patients deal with role transition is helping them acquire skills for the new role. Patients are encouraged to develop social support system which would be required for adjusting to the new role. This potentiates the patient's self-esteem, helping them handle the transition efficiently.
As therapy proceeds and patient develops these new skills, depressive symptoms begin to decrease. If after detailed exploration no other problem area is found, IP deficits may be chosen as a focus in IPT.
They include very few or no attachments, social isolation, or very few relationships. People who fall in this category have poor social skills and avoid IP contact.
Often, the results are not favorable when deficits are chosen as the focus in IPT. In addition, if in therapy the therapist feels that no or minimal response is happening, it is better to shift patient to other forms of psychological interventions such as cognitive behavioral therapy CBT. Individuals lacking close relations, those having difficulty sustaining relationships, or those who fear social relationships as in social phobia fall in this group.
The goal in the treatment is to decrease the isolation and promote the development of new relationships. There may be various reasons as to why the patient avoids interaction and prefers isolation. The causes need to be explored. The goal of IPT is to use strategies directed toward reducing the social isolation. In the therapy, efforts are made that patients involve themselves in developing new relations. Once the patient has given an adequate history, the therapist tries to build a relation between patient's isolation and emergence of depressive symptoms.
It becomes important to explore about the issues, patients had in the past relations and what stops them from indulging in new ones. What were the positive and negative aspects of the past relations they had? Is there a similar pattern in every significant relationship patient has had?
Is the patient anxious in making relations or approaching people? What is the fear they have? The therapist tries to encourage patient to get involved in relationships and approach people.
When the patient does so, details about how they felt while doing so, what problems they faced, did they like it or not etc. The therapist may even ask patients to tell about good and bad aspects of the current therapeutic relationships and draw parallels in other relations.
It must be noted that drawing parallels does not imply that the issue of transference is addressed, which is not a focus in IPT. Patients may be given tasks to analyze the past relationships, discuss its strength and weakness and discuss their feelings. Patient can be encouraged to contact old friends. The positive steps that the patient takes need to be encouraged.
Patient can also be encouraged to visit parties or events. Goals and strategies of different IPT techniques have been shown in Box 6. Besides the techniques discussed in specific focus areas targeting depression, we must be aware of the common techniques the therapist must follow while conducting IPT. Nondirective exploration: In IPT the therapist must present open ended questions to the patient and should not try to direct the questions to get specific answers.
This facilitates the discussion and helps in gaining more information about the patient and their circumstances. Direct elicitation: Sometimes, an open-ended question may not stress upon certain areas which need to be clarified and the patient may not express it overtly during the interview.
In these cases, the therapist may ask direct questions to elicit some details like asking how exactly the patient felt when husband's dead body was being taken away for funeral. Encouraging expression of affect: Therapist encourages the patient to express their feeling fully and without hesitation.
Patients may report that their strong negative feelings are markers of their incompetency in controlling their emotions.
The therapist in turn focuses on making the patient understand that emotions are not to be viewed as good or bad. Rather one should focus on proper communication of these emotions. A strong negative emotion can damage an already disturbed relationship. Patient's emotions need to be validated. The therapist may also contradict in between. Communication analysis: The therapist listens to the communication with the patient and then analyses the problems in it.
One has to look for the discrepancy between what patient is speaking and what they actually feel. It may not only help in identifying problems but also help in finding reasons for it and ways to deal with it.
Decision analysis: This helps patient to explore other available options and decide a course of action. This instills problem solving skills and can be used in any IP area. Like, asking patients if they have considered all options and do they feel there is an alternative solution. Role play: It is used in all the focus areas. An initial rehearsal with the therapist can prepare the patient to deal effectively the real-life situation. IPT although developed for depression can be used in other disorders as well.
Other indications of IPT are shown in Box 7. Depression occurring during pregnancy is referred to as peripartum depression. Postpartum depression is characterized by the onset of depressive symptoms within 4 weeks of delivery.
No major adaptations are required from routine IPT. Obtaining detailed pregnancy history including planned pregnancy and health status of the fetus. Grief may occur following a miscarriage. Difficulties in role transition may occur after shifting of role from an independent person to a mother with responsibilities and restrictions in previous lifestyle.
Role disputes occur when patients feel tired or feel that no one else is sharing the responsibilities of the child despite it being a planned pregnancy. During pregnancy, the female may require extra care and help which might be lacking, leading to IP deficits.
Depression leads to significant distress and dysfunction including academic dysfunction, suicide, missed school days, and substance abuse in children and adolescents. It often goes unnoticed. IPT can be delivered to adolescents and children, which has been found to be effective in reducing the depressive symptoms.
Depression in this age group may present with atypical features such as irritability instead of pervasive low mood and increased sleep and appetite. Various studies have found IPT to be effective in adolescents with depression. Different researchers have used different adaptations such as delivering in groups or in school-based clinics.
The basic structure and framework of IPT remains same with some adaptations. Some expected adaptations would include ability to communicate well with those in this age group and flexibility so as to adjust with the school schedule.
Telephonic sessions should also be considered as an option. The sick role allotted to the child should not be used as a reason to miss classes or extracurricular activities. It is advisable to involve parents in the sessions as they can help in facilitating the therapy. Collateral information from teachers, friends, and caretakers should also be obtained. If the problem areas are centered on the school settings, it is beneficial to obtain information from the teachers as well.
This should be done only after taking consent from the patient. For obtaining information about support system and IP context, a visual closeness circle can give more clarity to the patient about what is being asked and can provide more clarity to the therapist. Special issues including substance use, suicidal risk, learning disabilities, and school absenteeism need to be considered.
The basic structure of IPT remains same in managing elderly depression. Some adaptations may be required according to the belief system of the age group being targeted. Explaining depression using a medical model seems more relatable.
In addition, obtaining information about IP context may be difficult and focus should be on the current important relationships. Besides depressive symptoms, cognitive impairment can also be a problem in elderly patients and often they present with both the symptoms. Format of IPT: The patient as well as the caregiver needs to be involved.
Sessions can be taken individually with patient and if this is difficult, with the caregiver as well. It is important to hold problem-solving sessions jointly with both the patient and the caregiver.
Duration: Weekly sessions are preferred. A detailed assessment for cognitive impairment must be done. Adequate spacing of visits eases out the therapy. In dysthymia, symptoms remain less severe as compared to depression and never reach up to a syndromal level. Patients complain of feeling miserable during their entire life. Duration of 2 years is required to make a diagnosis.
Treatment is targeted toward decreasing symptoms which may not be as easy as in cases of acute depression. Adaptations in IPT for managing dysthymia include the use of iatrogenic role transition as the focus. Unlike the usual framework of IPT, it is difficult to draw a temporal correlation between patient's mood and IP issues due to the long duration of symptoms.
Hence, the concept of transition brought about by entering in therapy iatrogenic transition is used. Patients start realizing how depressive symptoms interfered with their normal functioning. Gradually, patients learn to handle the IP situations in a positive manner.
This builds up their confidence. The remaining structure of IPT remains same. Bipolar disorder is characterized by episodes of depression and mania or hypomania. The characteristic feature is the rhythmicity and disturbances in biological rhythm which paved the path toward the development of IP social rhythm therapy IPSRT for managing bipolar disorder.
It was seen that decreased sleep led to the emergence of manic symptoms and thus social rhythm regularization was targeted. Patients fill up a social rhythm metric including activities beginning from the day. This helps in regularizing the daily routine. IPT for depressive phase is delivered in the same manner as for unipolar depression. Disorders included are anorexia nervosa, bulimia nervosa, and binge eating disorder. The model often proposed for using IPT in eating disorders can be understood by the help of a flowchart as shown in Box 8.
The negative evaluation regarding one's social worth negatively affects the self-worth and esteem of individuals, which triggers eating disorders. IPT has been found to be useful in eating disorders to restore weight. There are mixed results, with a few studies showing positive outcome for IPT in anorexia nervosa and bulimia nervosa. Adaptations include providing sick role, restricting discussions, and redirecting them back to difficulties in IP relationships as a cause for eating disorders rather than discussing about eating and body image.
Thus, the focus is always centered on the social and IP context and related affective disturbances. The area of IP deficits is also addressed differently in eating disorders. Rather than initiating new relations as in managing depression, focus is on building satisfying relationships. The IPT model for eating disorders views symptoms as chronic and interrelated to IP issues which, in turn, act as triggers to maintain maladaptive eating habits. The therapist tries to draw a time line for the patient linking the IP events with the symptoms of eating disorder.
This helps to explain the patient how faulty eating habits are initiated and maintained. The overall structure almost remains same as in IPT for depression. Still, the role of IPT in eating disorders is not backed up by robust evidence. CBT still remains most effective.
It may be a valuable option, but results are slow to achieve. Anxiety disorders and symptoms are often comorbid with depression, and this has formed the background for exploring its role in anxiety spectrum disorders such as social anxiety disorder and panic disorder. Recent evidence comes from a meta-analysis which supports its efficacy for anxiety spectrum disorders. Hence, the same approach as in depression can be used without significant modifications.
The positive outcomes seen in previous studies encourage the use of IPT in these disorders but require more exploration for recommendations as first-line therapy. Significant modifications have not been suggested and exploration for other anxiety disorders is yet in a preliminary stage. IPT is conceptualized to work in posttraumatic stress disorder PTSD as initially it was considered to an anxiety spectrum disorder with the underlying role of stress diathesis model in the emergence and maintenance of symptoms.
With changes in the DSM-5, the category has now been shifted to trauma and stress-related disorders. The other accompanying disorder is adjustment disorder. The focus is not on the memories and traumatic events but on the impact it has had on the social and IP functioning of the patient.
Some evidence of its efficacy in PTSD exists. Adaptations made target the resulting negative emotions where the patient finds the world untrustworthy. The initial half of the therapy focuses on this aspect. Once the patients are able to handle their emotions better, they can eventually handle their interrelationships better.
In IPT, it is not required that the patients rethink of their traumatic events. Adjustment disorders are also responses to stressors, but the diagnostic threshold of depression is not met. The basic structure and model of IPT remains same as in depression. IPT has not been well researched for personality disorders.
Either the trials have been conducted on patients with comorbid mood disorders or have been confounded by small sample size and medication use.
The focus of therapy is the IP crisis that these patients go through. Initial sessions are targeted toward building therapeutic alliance and preparing a formulation. Telephonic conversations can be held in between for keeping a check on the patients. Another important aspect is monitoring patients for suicidality, commonly seen in patients with BPD. Substance use disorders SUDs have a significant impact on the IP and social relationships of the patients.
There is limited evidence to support its use in this subset of patients. However, once patients are out of their withdrawal and are not experiencing craving, IPT may be initiated for handling social and IP issues.
The research findings in support of this still remain scanty and can be an area of further research. It should not be used in psychotic depression or other psychotic disorders.
Adequate training is required for the therapist. Like any other psychotherapy, some understanding of the IP aspects of relationships and psychological sophistication is required in IPT.
Although IPT has been used in various other disorders, the underlying principles and techniques for the same have not been adequately and unanimously described as for depression. Thus, IPT is an evidence-based therapy for depression, which can improve outcomes in the patients.
IPT can be adapted for a wide range of conditions where interpersonnel problems exist. It has also been explored for other mood disorders and anxiety disorders with promising results. Modifications have also been made for delivery by nonmental health professionals such as medical nurses. It is delivered in a time-limited fashion and focuses on the current issues with IP functioning. It can be delivered as an individual therapy or in groups or to couples.
National Center for Biotechnology Information , U. Journal List Indian J Psychiatry v. Indian J Psychiatry. Published online Jan Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr.
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