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Campbell K, Clarke KA, Massey D, Lakeman R. Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. Int J Ment Health Nurs 2020; 29:972-981. [PMID: 32426937 DOI: 10.1111/inm.12737] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
There is considerable controversy around psychiatric diagnosis generally and personality disorders specifically. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis. Both the DSM 5 and ICD-11 will be discussed; however, for the purposes of this paper, the DSM 5 will take the primary focus due to greater cultural significance. Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.
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Affiliation(s)
- Katrina Campbell
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Virginia, Queensland, Australia
| | - Karen-Ann Clarke
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Deb Massey
- School of Health sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Richard Lakeman
- School of Health sciences, Southern Cross University, Lismore, New South Wales, Australia
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2
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Affiliation(s)
- Selim R Benbadis
- University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, United States.
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Abd-Alrasool ZA, Gorial FI, Hashim MT. Prevalence and severity of depression among Iraqi patients with systemic lupus erythematosus: A descriptive study. Mediterr J Rheumatol 2017; 28:142-146. [PMID: 32185272 PMCID: PMC7046054 DOI: 10.31138/mjr.28.3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Systemic lupus erythematosus (SLE) patients have high risk for depression which is a potentially life-threatening disorder. OBJECTIVES: To evaluate the prevalence and severity of depression in a sample of Iraqi patients with SLE if present. PATIENTS AND METHODS: This cross-sectional study involved 60 patients with SLE diagnosed according to revised American College of Rheumatology (ACR) classification criteria. Demographics and clinical data were collected. All patients were screened for depression by using the diagnostic and statistical manual of mental disorders-5 (DSM5) diagnostic criteria of depression. Severity of their depression was determined by using the Beck Depression Inventory criteria. RESULTS: The prevalence of depression was 31.7%. A severe form of depression was observed in 13.3% of SLE cases, moderate depression in 10%, and a mild degree of depression was 8.3% of the cases. Patients with high SLE disease activity index (SLEDAI score >12) had an obviously higher rate of depression (40%) compared to 20% among those with mild or moderate disease. There was no important or statistically significant difference in median SLEDAI score between depression severity categories (p > 0.05). CONCLUSIONS: Prevalence of depression in SLE patients was relatively high. SLE disease activity increase depression rate.
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Affiliation(s)
| | - Faiq I Gorial
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Mushtaq T Hashim
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
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Komoto Y, Shoun A, Akiyama K, Sakamoto A, Sato T, Nishimura N, Shinohara K, Ishida H, Makino N. Development and validation of the Pachinko/Pachi-Slot Playing Ambivalence Scale. Asian J Gambl Issues Public Health 2017; 7:3. [PMID: 28573085 PMCID: PMC5429383 DOI: 10.1186/s40405-017-0023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/03/2017] [Indexed: 11/19/2022]
Abstract
Background A scale aimed at measuring ambivalence among people with pachinko/pachi-slot playing disorder, the Pachinko/Pachi-Slot Playing Ambivalence Scale (PPAS), was developed and its reliability and validity ascertained. Methods A total of 522 participants (average year: 48.0) who were residing in Tokyo Metropolitan Area, and had played pachinko within the previous year completed questions relating to demographics, four gambling-related scales (including South Oaks Gambling Screen) and two general ambivalence scales (including Ambivalence over Emotional Expressiveness Questionnaire). Results Internal consistency (α = 0.87) and test–retest reliability (r = 0.66) were confirmed. The PPAS’s score was associated with each related scale’s score (r = 0.37–0.62). Conclusions The PPAS was shown to be consistent with previous scales and useful in clinical settings.
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Affiliation(s)
- Yasunobu Komoto
- Yoshino Hospital, 2252, Zushi-tyo, Machida City, Tokyo 1940203 Japan
| | - Akiyo Shoun
- Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyō, Japan
| | - Kumiko Akiyama
- The Nikkoso Research Foundation for Safe Society, Tokyo, Japan
| | - Akira Sakamoto
- Department of Psychology, Ochanomizu University, Bunkyō, Japan
| | - Taku Sato
- Naruse Mental Clinic, Machida City, Japan
| | | | | | - Hitoshi Ishida
- The Nikkoso Research Foundation for Safe Society, Tokyo, Japan
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Lupien SJ, Sasseville M, François N, Giguère CE, Boissonneault J, Plusquellec P, Godbout R, Xiong L, Potvin S, Kouassi E, Lesage A. The DSM5/RDoC debate on the future of mental health research: implication for studies on human stress and presentation of the signature bank. Stress 2017; 20:95-111. [PMID: 28124571 DOI: 10.1080/10253890.2017.1286324] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social "signatures" of mental disorders. Along with this new "signature" approach to mental health disorders, modifications of DSM were introduced. One major modification consisted of incorporating a dimensional approach to mental disorders, which involved analyzing, using a transnosological approach, various factors that are commonly observed across different types of mental disorders. Although this new methodology led to interesting discussions of the DSM5 working groups, it has not been incorporated in the last version of the DSM5. Consequently, the NIMH launched the "Research Domain Criteria" (RDoC) framework in order to provide new ways of classifying mental illnesses based on dimensions of observable behavioral and neurobiological measures. The NIMH emphasizes that it is important to consider the benefits of dimensional measures from the perspective of psychopathology and environmental influences, and it is also important to build these dimensions on neurobiological data. The goal of this paper is to present the perspectives of DSM5 and RDoC to the science of mental health disorders and the impact of this debate on the future of human stress research. The second goal is to present the "Signature Bank" developed by the Institut Universitaire en Santé Mentale de Montréal (IUSMM) that has been developed in line with a dimensional and transnosological approach to mental illness.
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Affiliation(s)
- S J Lupien
- a Centre for Studies on Human Stress , CIUSSS Est , Quebec , Canada
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- c Department of Psychiatry, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - M Sasseville
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- c Department of Psychiatry, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - N François
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
| | - C E Giguère
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
| | - J Boissonneault
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
| | - P Plusquellec
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- d Department of Psychoeducation, Faculty of Arts and Sciences , University of Montreal , Montreal , Canada
| | - R Godbout
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- c Department of Psychiatry, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - L Xiong
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- c Department of Psychiatry, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - S Potvin
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- c Department of Psychiatry, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - E Kouassi
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
| | - A Lesage
- b Research Centre , Montreal Mental Health University Institute, CIUSSS Est , Quebec , Canada
- c Department of Psychiatry, Faculty of Medicine , University of Montreal , Montreal , Canada
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Sarkar S, Sakey S, Mathan K, Bharadwaj B, Kattimani S, Rajkumar RP. Assessing catatonia using four different instruments: Inter-rater reliability and prevalence in inpatient clinical population. Asian J Psychiatr 2016; 23:27-31. [PMID: 27969074 DOI: 10.1016/j.ajp.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS The present study aimed to assess inter-rater reliability and prevalence of catatonia according to four diagnostic methods: Bush Francis Catatonia Rating Scale (BFCRS) both screening and complete scale, Braunig's Catatonia Rating Scale (CRS), ICD 10 and DSM5. METHODS For inter-rater reliability, different raters evaluated patients using the definitions provides by the four scales: BFCRS Screen and Total, CRS, ICD10 and DSM5. Kippendorff'α was used to compute the inter-rater reliability. Concordance between different systems was assessed using spearman correlation. Prevalence of catatonia was studied using the four definitions in a clinical sample of consecutive adult admissions in a psychiatry ward of a tertiary care hospital. RESULTS The inter-rater reliability was found to be good for BFCRS Total (α=0.779), moderate for DSM5 and BFCRS screen (α=0.575 and α=0.514 respectively) and low for CRS and ICD10 (α=0.111 and α=0.018 respectively). BFCRS Total and DSM5 definitions of catatonia had highest concordance (rs=0.892 p<0.001). In the prevalence sample of consecutive hospital admissions, the prevalence was found to be highest with the definitions of BFCRS Screen and ICD 10 (10.3%, confidence intervals [CI] 3.9% to 16.7%), followed by BFCRS Total and DSM5 definitions 6.9%, CI 1.6% to 12.2%) and while CRS yielded the lowest prevalence rate (3.4%, CI 0% to 7.2%). CONCLUSION Different methods used to determine catatonia in the clinical sample yield different prevalence of this condition.
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Affiliation(s)
- Siddharth Sarkar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India; Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Sreekanth Sakey
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kaliaperumal Mathan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India; Department of Psychiatry, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Balaji Bharadwaj
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ravi P Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Fung LK, Reiss AL. Moving Toward Integrative, Multidimensional Research in Modern Psychiatry: Lessons Learned From Fragile X Syndrome. Biol Psychiatry 2016; 80:100-111. [PMID: 26868443 PMCID: PMC4912939 DOI: 10.1016/j.biopsych.2015.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
The field of psychiatry is approaching a major inflection point. The basic science behind cognition, emotion, behavior, and social processes has been advancing rapidly in the past 20 years. However, clinical research supporting the classification system in psychiatry has not kept up with these scientific advances. To begin organizing the basic science of psychiatry in a comprehensive manner, we begin by selecting fragile X syndrome, a neurogenetic disease with cognitive-behavioral manifestations, to illustrate key concepts in an integrative, multidimensional model. Specifically, we describe key genetic and molecular mechanisms (e.g., gamma-aminobutyric acidergic dysfunction and metabotropic glutamate receptor 5-associated long-term depression) relevant to the pathophysiology of fragile X syndrome as well as neural correlates of cognitive-behavioral symptoms. We then describe what we have learned from fragile X syndrome that may be applicable to other psychiatric disorders. We conclude this review by discussing current and future opportunities in diagnosing and treating psychiatric diseases.
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Affiliation(s)
- Lawrence K. Fung
- Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
| | - Allan L. Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
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Awad AG, Voruganti LLNP. Revisiting the 'self-medication' hypothesis in light of the new data linking low striatal dopamine to comorbid addictive behavior. Ther Adv Psychopharmacol 2015. [PMID: 26199720 PMCID: PMC4502591 DOI: 10.1177/2045125315583820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Persons with schizophrenia are at a high risk, almost 4.6 times more likely, of having drug abuse problems than persons without psychiatric illness. Among the influential proposals to explain such a high comorbidity rate, the 'self-medication hypothesis' proposed that persons with schizophrenia take to drugs in an effort to cope with the illness and medication side effects. In support of the self-medication hypothesis, data from our earlier clinical study confirmed the strong association between neuroleptic dysphoria and negative subjective responses and comorbid drug abuse. Though dopamine has been consistently suspected as one of the major culprits for the development of neuroleptic dysphoria, it is only recently our neuroimaging studies correlated the emergence of neuroleptic dysphoria to the low level of striatal dopamine functioning. Similarly, more evidence has recently emerged linking low striatal dopamine with the development of vulnerability for drug addictive states in schizophrenia. The convergence of evidence from both the dysphoria and comorbidity research, implicating the role of low striatal dopamine in both conditions, has led us to propose that the person with schizophrenia who develops dysphoria and comorbid addictive disorder is likely to be one and the same.
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Affiliation(s)
- A George Awad
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Humber River Hospital, 2175 Keele Street, Room 243A, Toronto, Ontario M6M 3Z4, Canada
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Grassi L, Caruso R, Sabato S, Massarenti S, Nanni MG, The UniFe Psychiatry Working Group Coauthors. Psychosocial screening and assessment in oncology and palliative care settings. Front Psychol 2015; 5:1485. [PMID: 25709584 PMCID: PMC4285729 DOI: 10.3389/fpsyg.2014.01485] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/02/2014] [Indexed: 11/28/2022] Open
Abstract
Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this, the many different variables, such as the factors affecting individual vulnerability (e.g., life events, chronic stress and allostatic load, well-being, and health attitudes) and the psychosocial correlates of medical disease (e.g., psychiatric disturbances, psychological symptoms, illness behavior, and quality of life) which are possibly implicated not only in “classical” psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools [e.g., and specific psychosocially oriented interview (e.g., the Diagnostic Criteria for Psychosomatic Research)] represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.
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Affiliation(s)
- Luigi Grassi
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy ; University Hospital Psychiatric Unit, Program of Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Drugs Abuse, S. Anna University Hospital and Health Authority Ferrara Italy
| | - Rosangela Caruso
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy
| | - Silvana Sabato
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy
| | - Sara Massarenti
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy
| | - Maria G Nanni
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy ; University Hospital Psychiatric Unit, Program of Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Drugs Abuse, S. Anna University Hospital and Health Authority Ferrara Italy
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Affiliation(s)
- Maree Teesson
- University of New South Wales, Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
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Abstract
Clinical and biological aspects of restrictive anorexia nervosa (R-AN) are well documented. More than 10,000 articles since 1911 and more than 600 in 2013 have addressed R-AN psychiatric, somatic, and biological aspects. Genetic background, ineffectiveness of appetite regulating hormones on refeeding process, bone loss, and place of amenorrhea in the definition are widely discussed and reviewed. Oppositely, constitutional thinness (CT) is an almost unknown entity. Only 32 articles have been published on this topic since 1953. Similar symptoms associating low body mass index, low fat, and bone mass are reported in both CT and R-AN subjects. Conversely, menses are preserved in CT women and almost the entire hormonal profile is normal, except for leptin and PYY. The aim of the present review is to alert the clinician on the confusing clinical presentation of these two situations, a potential source of misdiagnosis, especially since R-AN definition has changed in DSM5.
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Affiliation(s)
- Bruno Estour
- Service d’endocrinologie diabète et TCA, Centre Hospitalier Universitaire de Saint-Étienne, Saint Etienne, France
- *Correspondence: Bruno Estour, Service d’endocrinologie diabète et TCA, Hopital Nord Batiment A +1, CHU de Saint-Etienne, Saint Etienne Cedex 2 42055, France e-mail:
| | - Bogdan Galusca
- Service d’endocrinologie diabète et TCA, Centre Hospitalier Universitaire de Saint-Étienne, Saint Etienne, France
| | - Natacha Germain
- Service d’endocrinologie diabète et TCA, Centre Hospitalier Universitaire de Saint-Étienne, Saint Etienne, France
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