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Why was i misdiagnosed psychotic depressive?

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Posted

When i was admitted to a hospital after a nervous breakdown i could barely speak. i felt like i was trapped in my mind. i knew what i wanted to say to others but it took minutes for me to get out a thought as simple as "i'm feeling depressed."

I've been very curious about what this would be called as a symptom and why this apparently warranted a diagnosis of psychotic depression by the psychiatrist, even though i wasn't hallucinating or harboring paranoid delusions. are there exceptions to the usual conception of psychosis?

a few years later after that (now) i was diagnosed with asperger's because of the inattentveness which seems to have caused my social anxiety as well as the nervous breakdown/psychotic episode (from spending too much time inside my mind.) could it be that this kind of episode is typical of admitted aspies? could it be that psychosis or schizophrenia has simlarities to aspergers?

please help, i'm hoping to find a definitive answer to all this.

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Posted (edited)

Psychotic depression is usually diagnosed when there is the presence of hallucinations or delusions in congruence with depressive symptoms. If you were misdiagnosed, then my guess would be that the practitioner either did not know what they were doing (or didn't know the diagnosis), or misinterpreted them. If you did have a psychotic episode that was soley congruent with the depression, then I can see why someone would diagnose it.

How do you know that you were misdiagnosed?

Edited by Swamp56

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Posted

When i was admitted to a hospital after a nervous breakdown i could barely speak. i felt like i was trapped in my mind. i knew what i wanted to say to others but it took minutes for me to get out a thought as simple as "i'm feeling depressed."

I've been very curious about what this would be called as a symptom and why this apparently warranted a diagnosis of psychotic depression by the psychiatrist, even though i wasn't hallucinating or harboring paranoid delusions. are there exceptions to the usual conception of psychosis?

Catatonia or "quiet psychosis" is considered a form of psychosis.

(I would guess it has something to do with the disconnection between internal stimuli and external behavior.)

Ultimately the subcategories of diagnosis (type of depression, type of bipolar, etc.) are just labels that can help guide treatment, but any competent clinician is going to work on an individualized basis on the symptoms that you are dealing with. So having the word "psychotic" in there sounds scary, but it doesn't mean you're supposed to be in a straitjacket or hallucinating wildly. Just like not all people with bipolar disorder have massive manic episodes, the clinical expression of a diagnosis is going to vary in symptoms and severity.

I would speak to your current pdoc about this if you are concerned about whether you're getting the right treatment, but what you're describing is plausible (not qualified to say if it's correct for you; I'm just saying it's plausible; and I don't know enough about aspergers to speak to any connection/overlap therein).

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Posted

Psychotic depression is usually diagnosed when there is the presence of hallucinations or delusions in congruence with depressive symptoms. If you were misdiagnosed, then my guess would be that the practitioner either did not know what they were doing (or didn't know the diagnosis), or misinterpreted them. If you did have a psychotic episode that was soley congruent with the depression, then I can see why someone would diagnose it.

How do you know that you were misdiagnosed?

i'm basing my belief on the fact that psychosis involves hallucinations/delusions, which i did not have at the time i was admitted. however, my question is particularly about the symptom that i mentioned.

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Posted (edited)

When i was admitted to a hospital after a nervous breakdown i could barely speak. i felt like i was trapped in my mind. i knew what i wanted to say to others but it took minutes for me to get out a thought as simple as "i'm feeling depressed."

I've been very curious about what this would be called as a symptom and why this apparently warranted a diagnosis of psychotic depression by the psychiatrist, even though i wasn't hallucinating or harboring paranoid delusions. are there exceptions to the usual conception of psychosis?

Catatonia or "quiet psychosis" is considered a form of psychosis.

(I would guess it has something to do with the disconnection between internal stimuli and external behavior.)

i wasn't exactly mute, i could speak, but i stammered excessively when trying. i really didn't deal with much else other than that aside from depression/general anxiety and social anxiety. what sticks out most in my recollections of the hospital experience is that difficulty with speaking. i think i should mention that the difficulty with speech got better the more i spoke with someone, which tells me that the cause of it has more to do with internal preoccupation than any kind of "genetic predisposition to psychosis" (as the psych said) which tells me that this perhaps isn't uncommon among those with anxiety (or asperger's)

Edited by NullChamber

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Posted (edited)

i'm basing my belief on the fact that psychosis involves hallucinations/delusions, which i did not have at the time i was admitted. however, my question is particularly about the symptom that i mentioned.

One of the major components in diagnosing a patient is past history. If you reported having hallucinations or delusions previously, then the diagnosis could have been considered valid. Also, most people who suffer from delusions don't realize they are delusional.

By no means am I telling you that you are wrong, but usually there is some basis as to why someone is diagnosed with being psychotic; it is not something that is taken lightly by clinicians. I'm also guessing that you you (like the majority of people) don't have training in the diagnosis of psychiatric disorders (correct me if I am wrong).

Edited by Swamp56

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Posted

When i was admitted to a hospital after a nervous breakdown i could barely speak. i felt like i was trapped in my mind. i knew what i wanted to say to others but it took minutes for me to get out a thought as simple as "i'm feeling depressed."

That's psychosis, not autism:

-Disorganized or incoherent speech

-Confused thinking

-Slowed or unusual movements

-Cold, detached manner with the inability to express emotion

You may remember yourself as being perfectly coherent, but that doesn't mean you really were.

I've been very curious about what this would be called as a symptom and why this apparently warranted a diagnosis of psychotic depression by the psychiatrist, even though i wasn't hallucinating or harboring paranoid delusions. are there exceptions to the usual conception of psychosis?

It's called a symptom because it IS a symptom. "Psychosis" in the clinical sense does not require hallucinations or paranoid delusions. The public's "usual conception of psychosis" doesn't count.

a few years later after that (now) i was diagnosed with asperger's because of the inattentveness which seems to have caused my social anxiety as well as the nervous breakdown/psychotic episode (from spending too much time inside my mind.)

Asperger's isn't just social inattentiveness and doesn't cause nervous breakdowns or psychotic episodes. So, no, what you've described is NOT typical of aspies who do not also have a separate psychotic mood disorder. In fact, if you can pick up social cues when paying attention to what's going on around you (as opposed to what's going on inside your head), Asperger's Syndrome might be the misdiagnosis.

what sticks out most in my recollections of the hospital experience is that difficulty with speaking. i think i should mention that the difficulty with speech got better the more i spoke with someone,

You were also on at least one antipsychotic medication, weren't you? That probably had a LOT to do with easing your anxiety and combatting the other difficulties in communicating.

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Posted

i'm basing my belief on the fact that psychosis involves hallucinations/delusions, which i did not have at the time i was admitted. however, my question is particularly about the symptom that i mentioned.

One of the major components in diagnosing a patient is past history. If you reported having hallucinations or delusions previously, then the diagnosis could have been considered valid. Also, most people who suffer from delusions don't realize they are delusional.

By no means am I telling you that you are wrong, but usually there is some basis as to why someone is diagnosed with being psychotic; it is not something that is taken lightly by clinicians. I'm also guessing that you you (like the majority of people) don't have training in the diagnosis of psychiatric disorders (correct me if I am wrong).

i didn't tell them about any previous hallucinations or delusions (the only hallucinations i experienced were when i was subsequently put on abilify.) if there were any 'delusions' they probably were related to my social anxiety which i told them about, but as far as i'm aware anxious thoughts/worries aren't synonymous with delusions, if they were then psychosis would be much more diagnostically prevalent than it is.i may have told them about a depresive episode that i experienced when i was 11-12 yrs of age, but not certain about that. with all this in mind im pretty certain that the diagnosis had more to do with the speech/thought issue, the psych looked at me like i was a freak and after after he first saw me the diagnosis was given. but if so what does that symptom have to do with psychotic depresion?

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Posted (edited)

When i was admitted to a hospital after a nervous breakdown i could barely speak. i felt like i was trapped in my mind. i knew what i wanted to say to others but it took minutes for me to get out a thought as simple as "i'm feeling depressed."

That's psychosis, not autism:

-Disorganized or incoherent speech

-Confused thinking

-Slowed or unusual movements

-Cold, detached manner with the inability to express emotion

You may remember yourself as being perfectly coherent, but that doesn't mean you really were.

I've been very curious about what this would be called as a symptom and why this apparently warranted a diagnosis of psychotic depression by the psychiatrist, even though i wasn't hallucinating or harboring paranoid delusions. are there exceptions to the usual conception of psychosis?

It's called a symptom because it IS a symptom. "Psychosis" in the clinical sense does not require hallucinations or paranoid delusions. The public's "usual conception of psychosis" doesn't count.

a few years later after that (now) i was diagnosed with asperger's because of the inattentveness which seems to have caused my social anxiety as well as the nervous breakdown/psychotic episode (from spending too much time inside my mind.)

Asperger's isn't just social inattentiveness and doesn't cause nervous breakdowns or psychotic episodes. So, no, what you've described is NOT typical of aspies who do not also have a separate psychotic mood disorder. In fact, if you can pick up social cues when paying attention to what's going on around you (as opposed to what's going on inside your head), Asperger's Syndrome might be the misdiagnosis.

what sticks out most in my recollections of the hospital experience is that difficulty with speaking. i think i should mention that the difficulty with speech got better the more i spoke with someone,

You were also on at least one antipsychotic medication, weren't you? That probably had a LOT to do with easing your anxiety and combatting the other difficulties in communicating.

much of what you said here seems to make sense.

im not sure what gave you the idea that i can pick up social cues?

i was put on antipsychotics, but i noticed the subtle speech improvement even before that. i see how it was a psychotic episode, but im pretty sure anxiety contributed to it more than anything., im doubtful that a genetic predisposition has anything to do with it, but thats another issue.

Edited by NullChamber

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Posted

How did you end up in that situation Null? Have you always had problems with depression and it just got worse?

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Posted (edited)

much of what you said here seems to make sense.

im not sure what gave you the idea that i can pick up social cues?

You did, when you talked about being inattentive to them. When it's just a matter of whether you are directing your attention to others or not, that's not autism.

i was put on antipsychotics, but i noticed the subtle speech improvement even before that.

It's fairly standard to administer an antipsychotic to a patient who's freaking out before the patient ever makes it to the psych ward, so I find that hard to believe.

Edit: You may not remember it, though. I can't picture having a psychotic breakdown - even without hallucinations, etc. - being the sort of event that lends itself to keeping track of everything going on around you.

i see how it was a psychotic episode, but im pretty sure anxiety contributed to it more than anything.

It doesn't matter whether anxiety contributed or not, just that it got to the point where your brain and reality were no longer reading from the same page.

Edited by null0trooper

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Posted

It doesn't matter whether anxiety contributed or not, just that it got to the point where your brain and reality were no longer reading from the same page.

Exactly. Stress is usually a huge contributor to the symptoms of a psychotic disorder; it can help trigger episodes and/or cause a resurgence of symptoms.

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Posted (edited)

You did, when you talked about being inattentive to them. When it's just a matter of whether you are directing your attention to others or not, that's not autism.

It's fairly standard to administer an antipsychotic to a patient who's freaking out before the patient ever makes it to the psych ward, so I find that hard to believe.

Edit: You may not remember it, though. I can't picture having a psychotic breakdown - even without hallucinations, etc. - being the sort of event that lends itself to keeping track of everything going on around you.

sorry,i didn't elaborate on that: the key traits are present. the difficulty in empathizing with others and consequent issues with socializing. the inattention is just part of it [as far as i'm aware, add and social anxiety symptoms tend to overlap in the condition (in my case seems to be more along the lines of Add-Pi)]

nope i wasn't freaking out (nor did i ever freak out at the hospital, though the doctors/nurses seemed to be anticipating it which was confusing to me) i was extremely depressed, anxious and lost in thoughts (more or less not in tune with the present). again, what seems to have given others the idea that i was psychotic was that i had immense difficulty verbalizing my thoughts, i would stammer excessively when trying; when i tried to speak there seemed to a combination of hesitation about using appropriate words (some social anxiety) and a difficulty with tuning into the present because i had been so lost in my thoughts for an extended time. i may not remember everything but i remember the major events. i know for certain i wasn't delusional (mostly social anxious) on the other hand you may be right it may not have been a psychotic breakdown, hence my question

Edited by NullChamber

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Posted (edited)

How did you end up in that situation Null? Have you always had problems with depression and it just got worse?

i think the recent depression was caused by my social anxiety which was caused by my inattentiveness and general inability to relate to others or connect like most people. i think i always felt to some extent that i was "different" than most people; that and my academic underachievment probably mostly brought on the depressive episode that i experienced when i was 11 or 12. internalizing negative feedback and experiences and difficulties with school over time from there seems to have brought on the social anxiety and later depression. however, when i took otc stimulants because i thought they would help my inattentiveness (and thus social anxiety), probably sounds silly, but i felt like a completely different person. so after that gradually i came to give up many of my negative self-beliefs.i probably wouldnt be posting on forums or interacting or functioning like i do now if i didnt recognize my actual potential. right now im looking for at prescription stimulant thatl work for me since they interact with my antidepressant with my pdoc, so im sorry if some of what i say doesn't make sense because of careless text mistakes. i try to take into account many details when articulating my thoughts but at the same time sifting through all actual/potential details at the moment is almost exhausting.

Edited by NullChamber

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Posted

Nullchamber...

I see you building a wall of snowbricks in trying to justify your rejection of your recent illness and the professionals diagnosis.

You are stringing together unconnected symptoms in order to get an illness acceptable to you. ADD causes > Social Anxiety > GAD > Depression (with loss of memory, inability to communicate effectively, lost in internal thought) "all being logical and normal MI progression and symptoms which arent' Sz"

WRONG.

NUlloTrooper has excellent points that I would stand behind.

Not every symptom or distress deserves an official dx. There is overlap in symptoms and illnesses. Think horses not zebras in coming up with a dx. Finally, regardless of what dx you think you have, is the doctor treating your symptoms and getting you relief? That's what is important. ;)

best, a.m.

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Posted (edited)

Nullchamber...

I see you building a wall of snowbricks in trying to justify your rejection of your recent illness and the professionals diagnosis.

You are stringing together unconnected symptoms in order to get an illness acceptable to you. ADD causes > Social Anxiety > GAD > Depression (with loss of memory, inability to communicate effectively, lost in internal thought) "all being logical and normal MI progression and symptoms which arent' Sz"

WRONG.

NUlloTrooper has excellent points that I would stand behind.

Not every symptom or distress deserves an official dx. There is overlap in symptoms and illnesses. Think horses not zebras in coming up with a dx. Finally, regardless of what dx you think you have, is the doctor treating your symptoms and getting you relief? That's what is important. ;)

best, a.m.

okay, so it was a psychotic episode. i agree with much of what nullotrooper said. but i still reject the psychs notion that it's genetic. i was initially under the assumption that psychosis has no correlation with environmental factors swamp said that stress can cause a psychotic episode, and that seems plausible to me now. the doc gave me relief from depression and the psychotic episode, yes. but not from my attentional issues. subsquent docs/therapists failed to address the attentional issues which was quite obviously the reason social anxiety behavioral therapy wasn't working for me. i had to find that out and explain it to my current doc for myself. symptom relief is important, but at the same time id like to try and make sense of everything.

Edited by NullChamber

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Posted

At its' very worst, depression can and does have psychotic features.

Genes load the pistol, circumstances usually pull the trigger.

I could see how aspie misunderstanding could spiral into a really nasty depressive episode...

Glad you're doing a bit better.

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Posted

well, gave me useful stuff to mull over. i really appreciate all your feedback, thanks ;)

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Posted (edited)

Am I the only person here who thinks NullChamber may have a point that he may not have been psychotic? A psych hospital isn't the best place to get a diagnosis, it's a place to go to keep you safe and get you on enough meds that you're not a danger to yourself or others. I imagine there are a lot of us who have been misdiagnosed in an emergency setting.

It's altogether possible that the doctors made a wrong diagnosis, however, none of us here can really say for sure if that's the case. I would recommend working with both a therapist and a psychiatrist over an extended period of time to figure out your illness. If you're followed by the same person/people for a long time, over time they will be able to get your more definitive answers about your particular brand of crazy.

This.

And also, @OP, I never said that your issues aren't genetic. Psychosis is usually triggered through stress, but has been found to be of a genetic predisposition.

Edited by Swamp56

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Posted

Am I the only person here who thinks NullChamber may have a point that he may not have been psychotic? A psych hospital isn't the best place to get a diagnosis, it's a place to go to keep you safe and get you on enough meds that you're not a danger to yourself or others. I imagine there are a lot of us who have been misdiagnosed in an emergency setting.

It's altogether possible that the doctors made a wrong diagnosis, however, none of us here can really say for sure if that's the case. I would recommend working with both a therapist and a psychiatrist over an extended period of time to figure out your illness. If you're followed by the same person/people for a long time, over time they will be able to get your more definitive answers about your particular brand of crazy.

I had a similar thought as well, though I missed your first post. I know that when I was hospitalized the last time, the doctors weren't sure if it was more in the land of catatonic depression w/ some other issues that stemmed from trauma/anxiety or if it was more likely psychosis. And it sounds like some of hte symptoms were like that of NullChamber. Their conclusion was just to treat the symptoms for now, see what helps, and pay attention to if things get worse. If so, it'll likely fish out the diagnosis. If not, no worries.

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Posted (edited)

Am I the only person here who thinks NullChamber may have a point that he may not have been psychotic? A psych hospital isn't the best place to get a diagnosis, it's a place to go to keep you safe and get you on enough meds that you're not a danger to yourself or others. I imagine there are a lot of us who have been misdiagnosed in an emergency setting.

It's altogether possible that the doctors made a wrong diagnosis, however, none of us here can really say for sure if that's the case. I would recommend working with both a therapist and a psychiatrist over an extended period of time to figure out your illness. If you're followed by the same person/people for a long time, over time they will be able to get your more definitive answers about your particular brand of crazy.

This.

And also, @OP, I never said that your issues aren't genetic. Psychosis is usually triggered through stress, but has been found to be of a genetic predisposition.

so it's not plausible that a psychotic episode could happen without that predisposition?

is it true that those with psychotic depression tend to have experienced mild depressive episodes at a young age followed by a more severe one later on? this is something the psych seemed to suggest after i told him about my earlier depressive episode. if it's true could you supply information on that if possible?

Edited by NullChamber

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Posted

If you want a precise cause of your MI, that isn't going to happen.

It was established five years ago that MIT researchers could identify with 80% accuracy by looking at genes whether an individual had one of three MIs: Bipolar, SZ and I can't remember the other. The catch was they couldn't discern which illness the person had.

Your rembemberances of prior depressions is helpful to your pdoc in understanding and dxing. However, having childhood depressions is not diagnostic or predictive of being Sz or not Sz.

I do understand how frustrating the uncertaintity is. My pdoc first gave a dx, then made it tentative and it took another 1.5 years before she was convince I was bipolar.

Keep looking forward. a.m. ;)

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Posted (edited)

Mutism can be interpreted as a psychotic symptom. When in the context of catatonia this is a form of psychosis, though it is uncommon today. You may have been misdiagnosed. Autism can and has traditionally been confused with psychosis and schizophrenia. It is said that many of the childhood onset schizophrenics several decades ago would be recognized as autistic today. Many severe autistic people in the past may have been considered schizophrenic and lived in mental insitutions. Back a few decades ago, psychosis and schizophrenia were applied much more liberally to any odd behaviors and socially atypical behavior.

http://ccp.sagepub.c...stract/12/4/537

"All That Glitters Is Not Gold': Misdiagnosis of Psychosis in Pervasive Developmental Disorders — A Case Series

This is actually ironic, considering that some researchers hypothesize that autism and psychosis evolved from a dichotomous brain functions (psychosis being hyperfunction of the emotional/social brain, and autism being hyperfunction of the systemizing or mechanistic brain).

Although this is just a hypothesis. Other research shows that autism and schizophrenia/psychosis actually share simialr genes, so the relationship of autism to schizophrenia/psychosis is hardly a settled matter. Either way, it is definitely true that PDDs are often misdiagnosed as psychosis, in children and in adults, especially decades ago before PDDs were as widely recognized as they are now (and when schizophrenia was a "fad" diagnosis, back during the state institution days).

Edited by OscillateWildly

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Posted (edited)

Mutism can be interpreted as a psychotic symptom. When in the context of catatonia this is a form of psychosis, though it is uncommon today. You may have been misdiagnosed. Autism can and has traditionally been confused with psychosis and schizophrenia. It is said that many of the childhood onset schizophrenics several decades ago would be recognized as autistic today. Many severe autistic people in the past may have been considered schizophrenic and lived in mental insitutions. Back a few decades ago, psychosis and schizophrenia were applied much more liberally to any odd behaviors and socially atypical behavior.

http://ccp.sagepub.c...stract/12/4/537

"All That Glitters Is Not Gold': Misdiagnosis of Psychosis in Pervasive Developmental Disorders — A Case Series

This is actually ironic, considering that some researchers hypothesize that autism and psychosis evolved from a dichotomous brain functions (psychosis being hyperfunction of the emotional/social brain, and autism being hyperfunction of the systemizing or mechanistic brain).

Although this is just a hypothesis. Other research shows that autism and schizophrenia/psychosis actually share simialr genes, so the relationship of autism to schizophrenia/psychosis is hardly a settled matter. Either way, it is definitely true that PDDs are often misdiagnosed as psychosis, in children and in adults, especially decades ago before PDDs were as widely recognized as they are now (and when schizophrenia was a "fad" diagnosis, back during the state institution days).

i just don't understand why people are bring up mutism and catatonia; is it still considered mutism if the person *tries* to speak? because i really did, when asked. but that would seem contradictory to the term. as far as catatonia i really didn't have issues with physical movements, i mean i may have been slow moving, sorta.. but i wasn't immobile, or unresponsive

Edited by NullChamber

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Posted (edited)

If you want a precise cause of your MI, that isn't going to happen.

It was established five years ago that MIT researchers could identify with 80% accuracy by looking at genes whether an individual had one of three MIs: Bipolar, SZ and I can't remember the other. The catch was they couldn't discern which illness the person had.

Your rembemberances of prior depressions is helpful to your pdoc in understanding and dxing. However, having childhood depressions is not diagnostic or predictive of being Sz or not Sz.

I do understand how frustrating the uncertaintity is. My pdoc first gave a dx, then made it tentative and it took another 1.5 years before she was convince I was bipolar.

Keep looking forward. a.m. ;)

i dont think im looking for any kind of ultimate cause, just as many explanations as i can find.

Edited by NullChamber

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