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Hoebeke Y, Vanderhasselt MA, Carême M, Maurage P, Heeren A. No Impact of Tdcs on Stress-Induced State Rumination and no Influence of Executive Control and Trait Rumination: A Double-Blind Sham-Controlled Within-Subjects Study. CLINICAL NEUROPSYCHIATRY 2024; 21:99-109. [PMID: 38559434 PMCID: PMC10979793 DOI: 10.36131/cnfioritieditore20240107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective Rumination is conceptualized as a critical transdiagnostic vulnerability and maintenance factor for affective dysregulation and related emotional disorders. Recent research has pointed to transcranial direct current stimulation (tDCS) as a novel therapeutic tool for alleviating rumination, especially stress-induced rumination. However, the mechanisms of action underlying this effect remain unclear, particularly regarding the potential moderating role of executive control and trait-like rumination. Therefore, in this study, we investigated the impact of anodal tDCS on stress-induced rumination and the potential moderating influence of executive control and trait-like rumination on this efect. Method Forty participants from the general community (i.e., unselected sample) took part in a double-blind within-subjects design study wherein we compared anodal stimulation over the left dorsolateral prefrontal cortex(dlPFC) with a sham-stimulation procedure. Participants completed an N-back task, reflecting executive control, during tDCS stimulation, followed by a stress-induction protocol wherein we assessed stress-induced state rumination. Results We found no significant effect of tDCS on stress-induced state rumination and no modulation by executive control or trait rumination. Post-hoc Bayesian analyses corroborated these results and even supported the hypothesis that anodal tDCS does not impact stress-induced rumination. Conclusions From a clinical perspective, our results are at odds with the current outlook that tDCS is a viable tool for reducing rumination, particularly stress-induced rumination. However, we firmly believe that the results of null-finding studies, such as those from this study, are particularly valuable for future iterations and meta-researchon tDCS as a potential tool for targeting transdiagnostic processes, such as rumination. We also addressed methodological limitations and directions for future research in this area.
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Affiliation(s)
- Yorgo Hoebeke
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Marion Carême
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Pierre Maurage
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- National Foundation for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - Alexandre Heeren
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- National Foundation for Scientific Research (FRS-FNRS), Brussels, Belgium
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Spiller TR, Na PJ, Merians AN, Duek O, Ben-Zion Z, Tsai J, von Känel R, Harpaz-Rotem I, Pietrzak RH. Changes in mental health among U.S. military veterans during the COVID-19 pandemic: A network analysis. J Psychiatr Res 2023; 165:352-359. [PMID: 37595331 DOI: 10.1016/j.jpsychires.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
Increases of symptoms of posttraumatic stress disorder (PTSD), anxiety and depression have been observed among individuals exposed to potentially traumatic events in the first months of the COVID-19 pandemic. Similarly, associations among different aspects of mental health, such as symptoms of PTSD and suicidal ideation, have also been documented. However, studies including an assessment prior to the onset and during the height of the pandemic are lacking. We investigated changes in symptoms of PTSD, depression, anxiety, suicidal ideation, and posttraumatic growth in a population-based sample of 1232 U.S. military veterans who experienced a potentially traumatic event during the first year of the pandemic. Symptoms were assessed prior to (fall/winter 2019) and one year into the pandemic (fall/winter 2020). We compared changes in symptom interrelations using network analysis, and assessed their associations with pandemic-related PTSD and posttraumatic growth symptoms. A subtle increase in psychopathological symptoms and a decrease in posttraumatic growth was observed one year into the pandemic. The peripandemic network was more densely connected, and pandemic-related PTSD symptoms were positively associated with age, anxiety, worst-event PTSD symptoms, and pandemic-related posttraumatic growth. Our findings highlight the resilience of veterans exposed to a potentially traumatic event during the first year of a pandemic. Similarly, the networks did not fundamentally change from prepandemic to one year into the pandemic. Despite this relative stability on a group level, individual reactions to potentially traumatic events could have varied substantially. Clinicians should individualize their assessments but be aware of the general resilience of most veterans.
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Affiliation(s)
- Tobias R Spiller
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Addie N Merians
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Or Duek
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ziv Ben-Zion
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL, USA; School of Public Health, University of Texas Health Science Center at Houston, TX, USA
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ilan Harpaz-Rotem
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
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Poian LR, Chiavegatto S. Serotonin Syndrome: The Role of Pharmacology in Understanding Its Occurrence. Cureus 2023; 15:e38897. [PMID: 37309350 PMCID: PMC10257984 DOI: 10.7759/cureus.38897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
Serotonin syndrome (SS) is a potentially fatal adverse drug reaction characterized by an exaggerated increase in serotonergic activity in the central and peripheral nervous systems. It presents a constellation of signs and symptoms related to behavioral changes, neuromuscular excitability, and autonomic instability. These symptoms can occur in both mild and severe forms. SS can be triggered by the therapeutic use of a drug that increases serotonin (5-HT) availability in the synaptic cleft or by the co-administration of two or more drugs that provide this increase. With the escalating use of antidepressants by the world's population, this adverse reaction may be more recurrent. However, SS is often overlooked by patients or not diagnosed by doctors. This review aims to improve awareness about SS and provide a pharmacological perspective to explain its occurrence. Evidence shows that other neurotransmitters may also be involved with the pathology of SS. Furthermore, SS and neuroleptic malignant syndrome (NMS) seem to be part of the same pathological spectrum, especially in atypical NMS cases. The emergence of the syndrome's symptoms may be closely related to pharmacokinetic and/or pharmacodynamic polymorphisms that lead to an increase in the 5-HT available to or 5-HT signaling by specific receptors, thus constituting an important area for future investigations.
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Affiliation(s)
- Leila R Poian
- Department of Pharmacology, Biomedical Sciences Institute, University of Sao Paulo (ICB-USP), Sao Paulo, BRA
| | - Silvana Chiavegatto
- Department of Pharmacology, Biomedical Sciences Institute, University of Sao Paulo (ICB-USP), Sao Paulo, BRA
- Department of Psychiatry, Institute of Psychiatry, University of Sao Paulo Medical School (FMUSP), Sao Paulo, BRA
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Daouda CM, Blanchard MA, Heeren A. Is There an All-Embracing "Intolerance to Uncertainty" Construct? French Adaptation and Validation of the Intolerance to Uncertainty Scale-Revised. CLINICAL NEUROPSYCHIATRY 2023; 20:48-54. [PMID: 36936625 PMCID: PMC10016102 DOI: 10.36131/cnfioritieditore20230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objective Intolerance to uncertainty is a trait-like disposition largely studied in psychopathology and known to be involved in many psychological disorders. Yet, the very operationalization of this construct has prompted debate in the literature. Three different models have regularly been discussed: a correlated two-factor solution, a bifactorial solution, and a single-factor structure. A growing body of evidence suggests that the bifactorial model represents the adequate factorial solution; however, its validity has never been tested in a large French-speaking sample. Moreover, uncertainty remains regarding the associations between IUS-R and other psychological constructs, especially stress and depression. This project was designed to overcome these limitations. Method To do so, we translated the scale into French and tested (n = 728) via confirmatory factor analyses (CFA) whether the French version would better fit with a bifactorial-, correlated, or single-factor structure, as implied by previous works. We also examined the internal reliability of the IUS-R, as well as its associations with concurrent measures of stress, depression, anxiety, and worry. Results The results pointed to a bifactorial structure as the best-fitting model and provided evidence for a strong general intolerance of uncertainty factor that was more reliable and accounted for significantly more common variance than each subscale factor individually. Conclusions We discuss how this bifactorial structure impacts the conceptualization of IU.
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Affiliation(s)
| | - M Annelise Blanchard
- Psychological Sciences Research Institute, Université Catholique de Louvain, Belgium
| | - Alexandre Heeren
- Psychological Sciences Research Institute, Université Catholique de Louvain, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Belgium
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Heeren A, Mouguiama-Daouda C, McNally RJ. A network approach to climate change anxiety and its key related features. J Anxiety Disord 2023; 93:102625. [PMID: 36030121 DOI: 10.1016/j.janxdis.2022.102625] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/13/2023]
Abstract
Research has pointed to startling worldwide rates of people reporting considerable anxiety vis-à-vis climate change. Yet, uncertainties remain regarding how climate anxiety's cognitive-emotional features and daily life functional impairments interact with one another and with climate change experience, pro-environmental behaviors, and general worry. In this study, we apply network analyses to examine the associations among these variables in an international community sample (n = 874). We computed two network models, a graphical Gaussian model to explore network structure, potential communities, and influential nodes, and a directed acyclic graph to examine the probabilistic dependencies among the variables. Both network models pointed to the cognitive-emotional features of climate anxiety as a potential hub bridging general worry, the experience of climate change, pro-environmental behaviors, and the functional impairments associated with climate anxiety. Our findings offer data-driven clues for the field's larger quest to establish the foundations of climate anxiety.
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Affiliation(s)
- Alexandre Heeren
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience, UCLouvain, Brussels, Belgium; National Fund for Scientific Research (FRS-FNRS), Brussels, Belgium.
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Berto LF, Suemoto CK, Moreno AB, Fonseca MDJM, Nunes MAA, Molina MDCB, Barreto SM, de Fátima Haueisen Sander Diniz M, Lotufo PA, Benseñor IM, Brunoni AR. Increased Prevalence of Depression and Anxiety Among Subjects With Metabolic Syndrome in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Acad Consult Liaison Psychiatry 2022; 63:529-538. [PMID: 35718085 DOI: 10.1016/j.jaclp.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 04/05/2022] [Accepted: 06/09/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) and common mental disorders are prevalent conditions. However, the relationship of MetS and its components with depression, anxiety, and common mental disorders has not been sufficiently addressed in low-/middle-income countries. OBJECTIVE To investigate whether depression, anxiety, and common mental disorders are associated with MetS and its components in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS A cross-sectional analysis of the ELSA-Brasil baseline visit (2008-2010) was performed. Adults without cardiovascular diseases had their MetS status defined by the National Cholesterol Education Program's Adult Treatment Panel III criteria. We assessed mental disorders using the Clinical Interview Schedule-Revised. We employed multiple logistic regression models adjusted for sociodemographic and behavioral factors. The dependent variables were mental disorders, and the independent variables were MetS and its components. We also performed analyses stratified by age and gender. RESULTS Our sample included 12,725 participants (54.9% women, mean age of 51.8 ± 8.9 y). MetS and depressive disorders were significantly associated (odds ratio [OR] = 1.55, 95% confidence interval [CI] 1.30-1.85). Increased abdominal circumference (OR = 1.54, 95% CI 1.29-1.84), diabetes mellitus (OR = 1.24, 95% CI 1.02-1.50), hypertriglyceridemia (OR = 1.33, 95% CI 1.11-1.60), and low high-density lipoprotein cholesterol (only when adjusted for sociodemographic factors) (OR = 1.25, 95% CI 1.02-1.52) were also associated with depression. This association remained significant for all stratified analyses. Finally, MetS was also significantly associated with anxiety disorders (OR = 1.19, 95% CI 1.07-1.32) and common mental disorders (OR = 1.27, 95% CI 1.17-1.39). CONCLUSIONS Our cross-sectional findings suggested that depression, anxiety, and common mental disorder are associated with MetS. Depression was also associated with abdominal obesity, elevated blood glucose, elevated triglycerides, and reduced high-density lipoprotein cholesterol, but not with hypertension.
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Affiliation(s)
- Laura F Berto
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
| | - Claudia K Suemoto
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Arlinda B Moreno
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria de Jesus M Fonseca
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Angélica A Nunes
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Del Carmen B Molina
- Postgraduate Program in Public Health, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Sandhi M Barreto
- Department of Preventive and Social Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria de Fátima Haueisen Sander Diniz
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo A Lotufo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Orellana JDY, de Souza MLP. Excess suicides in Brazil: Inequalities according to age groups and regions during the COVID-19 pandemic. Int J Soc Psychiatry 2022; 68:997-1009. [PMID: 35621004 DOI: 10.1177/00207640221097826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic has already claimed more than six million direct deaths. Low-and middle-income countries, such Brazil, were severely hit, not only due to direct effects on mortality, but also for its indirect effects on other causes of deaths. AIMS The objective of this study was to estimate the excess suicides in Brazil and evaluate patterns within and between its regions during the COVID-19 pandemic in 2020. METHOD The observed suicides are gathered from the mortality information system of the Brazilian Ministry of Health. The estimates of expected suicides, according to sex, age group, bimonthly period and region, were reached through quasi-Poisson generalized additive models, with adjustment for overdispersion. The analyses were performed in R software, version 3.6.1 and RStudio, version 1.2.1335. RESULTS From March 2020 to December 2020, 10,409 suicides were observed in Brazil, resulting in an overall decrease of 13%, in comparison to the expected rate for the period. There were excess suicides of 26% in men from the Northern region in the 60 years and more age group, as well as in women from the Northern region in the 30 to 59 years age group in two consecutive bimonthly periods. Excess suicides of 40% was also observed in women in the 60 years and more age group from the Northeastern region. CONCLUSIONS Despite the overall decrease in suicides in Brazil over the period assessed, substantial excess suicides were observed in different age groups and sexes from the Northern and Northeastern regions of the country, which are regions that are historically more prone to health and socioeconomic inequalities.
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Trajectories of common mental disorders symptoms before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 Mental Health Cohort. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2445-2455. [PMID: 36114857 PMCID: PMC9483303 DOI: 10.1007/s00127-022-02365-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/02/2022] [Indexed: 11/02/2022]
Abstract
AIM Evidence indicates most people were resilient to the impact of the COVID-19 pandemic on mental health. However, evidence also suggests the pandemic effect on mental health may be heterogeneous. Therefore, we aimed to identify groups of trajectories of common mental disorders' (CMD) symptoms assessed before (2017-19) and during the COVID-19 pandemic (2020-2021), and to investigate predictors of trajectories. METHODS We assessed 2,705 participants of the ELSA-Brasil COVID-19 Mental Health Cohort study who reported Clinical Interview Scheduled-Revised (CIS-R) data in 2017-19 and Depression Anxiety Stress Scale-21 (DASS-21) data in May-July 2020, July-September 2020, October-December 2020, and April-June 2021. We used an equi-percentile approach to link the CIS-R total score in 2017-19 with the DASS-21 total score. Group-based trajectory modeling was used to identify CMD trajectories and adjusted multinomial logistic regression was used to investigate predictors of trajectories. RESULTS Six groups of CMD symptoms trajectories were identified: low symptoms (17.6%), low-decreasing symptoms (13.7%), low-increasing symptoms (23.9%), moderate-decreasing symptoms (16.8%), low-increasing symptoms (23.3%), severe-decreasing symptoms (4.7%). The severe-decreasing trajectory was characterized by age < 60 years, female sex, low family income, sedentary behavior, previous mental disorders, and the experience of adverse events in life. LIMITATIONS Pre-pandemic characteristics were associated with lack of response to assessments. Our occupational cohort sample is not representative. CONCLUSION More than half of the sample presented low levels of CMD symptoms. Predictors of trajectories could be used to detect individuals at-risk for presenting CMD symptoms in the context of global adverse events.
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