Journal of child and adolescent psychopharmacology最新文献

{"title":"<i>Letter:</i> Fluoxetine for Behavioral Problems in an 8-Year-Old with Mucopolysaccharidosis IIIA.","authors":"Marta Abrantes, Tania Clemente","doi":"10.1177/10445463261422176","DOIUrl":"10.1177/10445463261422176","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"183-184"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Effects of Relative Fat Mass on Attention-Deficit/Hyperactivity Disorder: Insights from the 1999-2004 National Health and Nutrition Examination Survey.","authors":"Sitong Bi, Huijing Li, Xinyang Xu, Lihua Li","doi":"10.1177/10445463261416680","DOIUrl":"10.1177/10445463261416680","url":null,"abstract":"<p><strong>Background: </strong>Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Conventional adiposity indicators have been linked to ADHD. Relative fat mass (RFM), a novel adiposity measure, has demonstrated advantages in predicting metabolic and cardiovascular disease risk, conditions that share overlapping pathophysiological mechanisms with ADHD. This study aimed to investigate the association between RFM and ADHD, with a particular focus on sex-specific differences.</p><p><strong>Methods: </strong>Data were obtained from the 1999-2004 National Health and Nutrition Examination Survey, including 5089 children aged 6-14 years. RFM was calculated using height and waist circumference, and ADHD was defined based on physician diagnosis reported in the questionnaire. Multivariable logistic regression models were applied to assess the association between RFM and ADHD. Smooth curve fitting was conducted to validate the results, and subgroup analyses were performed separately for boys and girls.</p><p><strong>Results: </strong>A significant sex-specific association between RFM and ADHD was observed. Among boys, higher RFM levels were inversely associated with ADHD (Model 3: odds ratio [OR] = 0.967, 95% confidence interval [CI]: 0.946-0.989), whereas among girls, higher RFM levels were positively associated with ADHD (Model 3: OR = 1.043, 95% CI: 1.007-1.081). Smooth curve fitting confirmed these opposite linear trends in both sexes. Subgroup analyses further demonstrated that this sex-specific pattern was consistent across strata defined by age, health insurance status, maternal smoking during pregnancy, and birth weight.</p><p><strong>Conclusions: </strong>There is a significant sex-specific association between RFM and ADHD, showing an inverse relationship in boys and a positive association in girls. These findings suggest that the influence of adiposity distribution on ADHD differs by sex, highlighting the importance of considering sex differences when evaluating risk factors for ADHD.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"136-143"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methylphenidate and Psychotic Symptoms in Children and Adolescents: A Disproportionality Analysis on the WHO Safety Database (VigiBase).","authors":"Basile Chrétien, Camille Blouet, Joachim Alexandre, Renaud Jardri, Kazuki Nishida, Pierre Desaunay, Fabian Guénolé","doi":"10.1177/10445463261416450","DOIUrl":"10.1177/10445463261416450","url":null,"abstract":"<p><strong>Background: </strong>Methylphenidate (MPH) is widely used to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. However, concerns persist about its potential to induce psychotic symptoms, including hallucinations.</p><p><strong>Objective: </strong>This study aimed to evaluate the association between MPH exposure and psychotic symptoms in children and adolescents using VigiBase®, the World Health Organization global pharmacovigilance database.</p><p><strong>Methods: </strong>We conducted a retrospective, observational study using disproportionality analysis on reports from children and adolescents (5-17 years) exposed to MPH and other ADHD drugs (amitriptyline, atomoxetine, clomipramine, clonidine, desipramine, guanfacine, and nortriptyline). Multivariate logistic regression was used to calculate adjusted reporting odds ratios (aRORs) of psychotic symptoms in MPH-exposed children and adolescents.</p><p><strong>Results: </strong>Among 1,992 cases of psychotic symptoms, 1,232 were MPH-associated, with 51.7% classified as serious; significant disproportionalities were observed for the overall age range (aROR = 1.27; 95% confidence intervals [CI]: 1.15-1.40) and the 5-11 (children) age group (aROR = 1.35; 95%CI: 1.19-1.53). Of 1,250 hallucination cases, 809 were MPH-associated, with 59.2% serious; significant disproportionalities were found for the entire age range (aROR = 1.35; 95% CI: 1.19-1.52) and the children age group (aROR = 1.43; 95% CI: 1.23-1.67). The most common type of hallucination was visual (43.2%). MPH discontinuation or dose reduction led to a significantly higher rate of symptom abatement (88.6% of cases) compared to those without these measures (12.0%) (<i>p</i> < .001).</p><p><strong>Conclusions: </strong>These results suggest that MPH exposure in children is associated with an increased probability of serious psychotic symptoms, including hallucinations, which typically resolve with discontinuation or dose reduction. Further research is needed to better understand the MPH-induced psychotic symptoms.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":"36 3","pages":"121-127"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Study of Long-Term Associations of Behavioral Intervention Combined with Medications in Young Children with Attention-Deficit/Hyperactivity Disorder.","authors":"Taylor Price, Tanner J Bommersbach, Maria Saliba, Casey K Kelly, Allison LeMahieu, Idil Tarikogullari, Pravesh Sharma, Osama A Abulseoud, Magdalena Romanowicz","doi":"10.1177/10445463261426290","DOIUrl":"10.1177/10445463261426290","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine whether parent-child interaction therapy (PCIT), compared with other therapy modalities, was associated with differences in substance use and psychiatric outcomes in a cohort of children with attention-deficit/hyperactivity disorder (ADHD).</p><p><strong>Methods: </strong>This retrospective cohort study was conducted using medical record data from the Rochester Epidemiology Project (REP). The sample included 643 children aged ≤7 years who were diagnosed with ADHD and received either stimulant or nonstimulant medication, along with psychosocial therapy. Participants were categorized into two groups: those who documented exposure to PCIT versus other therapy modalities such as behavioral management, play therapy, cognitive behavioral therapy, parent management training, occupational therapy, speech therapy, parenting class, applied behavior analysis, and social skills training. Conditional logistic regression models were used to examine differences in baseline characteristics and outcomes between the two treatment groups.</p><p><strong>Results: </strong>Individuals in the PCIT group were more likely to have private insurance (66% vs. 57%; <i>p</i> = 0.016) and to fall into higher socioeconomic status quartiles (<i>p</i> = 0.024) at baseline. PCIT recipients also had a higher prevalence of emotional and behavioral disturbances at baseline (40% vs. 25%; <i>p</i> < 0.001). The median age of the participants at follow-up was 19.6 years, indicating a median follow-up period of approximately 13 years from the initiation of treatment. At follow-up, the PCIT group demonstrated higher rates of problematic alcohol (24% vs. 17%; HR = 1.50, 95% CI: [1.02, 2.20]; <i>p</i> = 0.038) and cannabis use (25% vs. 18%; HR = 1.48, 95% CI: [1.03, 2.15]; <i>p</i> = 0.037). However, after controlling for covariates in the adjusted model, no statistically significant differences emerged between the groups across any substance use outcome. No significant differences were observed in other psychiatric diagnoses or mental health service utilization.</p><p><strong>Conclusions: </strong>Findings indicate that individuals who documented exposure to PCIT demonstrated elevated rates of alcohol and cannabis use in young adulthood, but had no other differences in psychiatric outcomes. While this aligns with prior literature reporting increased substance use risk in ADHD populations, our study cannot confirm this association relative to non-ADHD controls because such a comparison was not included.These associations likely reflect underlying differences in clinical severity and clinical comorbidities at baseline, rather than a direct effect of PCIT. Further investigation is warranted to determine the treatment effects based on baseline risk factors.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"128-135"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapids Crisis Service for Children and Adolescents 2019-2024: 6-Year Changes in Crisis Service at Lambeth Children and Adolescent Mental Health Services in London, United Kingdom.","authors":"Gonzalo Salazar de Pablo, Claudia Aymerich, Lauren Burke, Steve Collier, Javier Torres-Cortes, Marina Cronin, Chia Lin-Li, Gabriella Maceiras, Hannah Osis, Elena Patel, Jasmine Ripa, Ruth Roseweir, Owen Spalding, Gavin Tucker, Jane Anderson, Celine Ryckaert","doi":"10.1177/10445463261425913","DOIUrl":"10.1177/10445463261425913","url":null,"abstract":"<p><strong>Objective: </strong>The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis intervention service developed within Lambeth Children and Adolescent Mental Health Services (CAMHS) at South London and Maudsley NHS Foundation Trust. The primary aim of this study was to examine how clinical presentations, risk profiles, and service outcomes changed over time among children and adolescents accessing Rapids over a 6-year period. We also aimed to describe the characteristics of individuals accessing Rapids.</p><p><strong>Methods: </strong>This service evaluation used routinely collected clinical data from all children and adolescents up to 18 years who accessed Rapids between January 1, 2019, and December 31, 2024. Sociodemographic, diagnostic, pharmacological, and risk-related variables were evaluated. Diagnoses were coded using International Classification of Diseases, 10th Revision (ICD-10) criteria. Descriptive and inferential analyses were conducted to assess changes in clinical presentations and service outcomes.</p><p><strong>Results: </strong>In total, 325 children and adolescents were included (mean age = 15.5 years, 61.8% females, 64.6% non-White). Anxiety disorders (29.5%), depressive disorders (42.2%), and autism spectrum disorder (33.5%) were the most common diagnoses. Inpatient admissions increased (1.5%-5.8%, <i>p</i> = 0.043), and high risk to self also rose notably (19.5%-31.7%, <i>p</i> < 0.001). Referrals accepted to adult services decreased significantly over time (38.5%-16.8%, <i>p</i> < 0.001). Diagnostically, eating disorders increased (3.7%-10.0%, <i>p</i> = 0.032), whereas emotionally unstable personality disorder traits decreased (14.1%-7.4%, <i>p</i> = 0.049).</p><p><strong>Conclusions: </strong>Rapids has evolved into an established model of crisis care within CAMHS, addressing acute needs through timely community-based interventions. We observed meaningful temporal changes in the clinical acuity, diagnostic profile, and service use outcomes of young people presenting to our community-based CAMHS crisis service. Our findings support the feasibility and scalability of intensive community-based crisis care and highlight the need for sustained investment in culturally responsive, multidisciplinary service models.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"155-163"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Letter:</i> Eye Movement Desensitization Reprocessing and Transcranial Magnetic Stimulation in an Adolescent with Comorbid Major Depression Disorder and Posttraumatic Stress Disorder: A Case Report.","authors":"Mehmet Karadag, Baran Calisgan, Gizem Yilmaz Saygili, Irem Erk","doi":"10.1177/10445463261424200","DOIUrl":"10.1177/10445463261424200","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"185-186"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Maladaptive Behaviors and Adjustment Disorders in Linking Separation Anxiety to Depression in Primary School Students.","authors":"Jing Zhang, Chanyuan Pan, Guankui Du","doi":"10.1177/10445463251407896","DOIUrl":"10.1177/10445463251407896","url":null,"abstract":"<p><strong>Objective: </strong>Children who experience prolonged separation anxiety may develop \"avoidance\" patterns of emotional regulation that manifest in stressful behavioral responses. This study tests whether maladaptive habits and adjustment disorders mediate the link between separation anxiety and depression in primary school students.</p><p><strong>Methods: </strong>In November 2022, we conducted a cross-sectional survey of 4474 students from elementary schools in Qionghai and Dongfang cities, Hainan Province, China, using stratified cluster sampling. Parents completed the Mental Health Rate Scale for Pupils. Data were analyzed with SPSS 22.0 (descriptive statistics, analysis of variance, correlations), AMOS 26.0 (structural equation modeling [SEM]), and Mplus 8.3 (latent class analysis).</p><p><strong>Results: </strong>SEM revealed that 12.2% of participants met criteria for depression. Students with separation anxiety had 4.5-5.0 times higher odds of depression compared to those without separation anxiety (95% confidence interval [CI]: 3.8-6.2). Mediation analysis indicated that maladaptive habits and adjustment difficulties partially mediated this association, with stronger indirect effects observed in older grades (Grades 5 and 6: β = 0.32, 95% CI: 0.24-0.41 vs. Grades 3 and 4: β = 0.21, 95% CI: 0.15-0.28).</p><p><strong>Conclusions: </strong>These findings suggest that early identification of maladaptive coping patterns in children with separation anxiety could improve mental health outcomes. We recommend integrating \"secure separation\" education strategies into teacher training programs and school counseling services, including structured transition activities and separation rituals, to support children's emotional adjustment during school transitions.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"174-182"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional Abuse as an Upstream Factor Influencing Non-Suicidal Self-Injury in Depressed Adolescents: A Network Analysis.","authors":"Lu Yueying, Liu Zheng, Li Na, Li Mengyan, Yu Xuezhu, Zhang Zhe, Wang Jianqiang, Li Youdong, Kong Lanlan","doi":"10.1177/10445463251405150","DOIUrl":"10.1177/10445463251405150","url":null,"abstract":"<p><strong>Objective: </strong>To construct a network model depicting non-suicidal self-injury (NSSI) and its influencing factors in adolescents diagnosed with depression, identify the core symptoms within this network, explore the potential causal pathways, and generate hypotheses for future research.</p><p><strong>Methods: </strong>A sample of 705 adolescent patients with depressive disorders was recruited and assessed using three standardized questionnaires, namely the Childhood Trauma Questionnaire, the Aggression Questionnaire, and the Adolescent Self-Injury Questionnaire. Undirected network analysis, coupled with directed Bayesian network analysis, was employed to elucidate the interrelationships among symptoms.</p><p><strong>Results: </strong>In the network of NSSI-related influencing factors in adolescents with depression, emotional abuse, hostility, sexual abuse, and emotional neglect are important influencing factors. Hostility and anger serve as bridges that connect NSSI to other influencing factors. In the Bayesian network, emotional abuse is shown to precede other symptoms, such as hostility and anger; conversely, NSSI and physical aggression were positioned at the periphery of the network, indicating a greater reliance on other symptoms for their occurrence. Emotional abuse demonstrated the strongest associations with the greatest number of other problems in the network, indicating that emotional abuse plays a crucial role.</p><p><strong>Conclusion: </strong>Emotional abuse plays an important role in the network model of NSSI of adolescent depression patients and its influencing factors.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"164-173"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Letter:</i> Response to the Letter to the Editor by Dr. Adler and Her Colleagues.","authors":"Ema Saito, Rumen Nikolov, Sarah Edwards, Rebecca Taylor","doi":"10.1177/10445463251414391","DOIUrl":"https://doi.org/10.1177/10445463251414391","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":"36 2","pages":"112"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Skills, Attitudes, and Perceived Barriers Related to Clozapine Use Among Child and Adolescent Psychiatry Professionals: A Cross-Sectional Survey.","authors":"Mustafa Tuncturk, Dila Mert Kilic, Celal Yesilkaya, Elif Akcay, Gulser Senses Dinc, Dicle Buyuktaskin, Cagatay Ermis, Esra Cop","doi":"10.1177/10445463261416453","DOIUrl":"10.1177/10445463261416453","url":null,"abstract":"<p><strong>Objectives/background: </strong>Clozapine is the treatment of choice for treatment-resistant schizophrenia (TRS), yet it remains underutilized in child and adolescent psychiatry. This study aimed to assess knowledge, clinical skills, attitudes, and perceived barriers related to clozapine use among child and adolescent psychiatry professionals in Türkiye.</p><p><strong>Methods: </strong>A cross-sectional online survey was distributed to child and adolescent psychiatry residents, specialists, and academics across Türkiye via professional email lists and messaging groups. The questionnaire assessed sociodemographic characteristics, clozapine prescribing experience, perceived barriers, self-rated competence, training exposure, and attitudes toward clozapine. Group comparisons were performed using chi-square tests.</p><p><strong>Results: </strong>A total of 517 professionals participated (180 residents, 212 specialists, and 125 academics). Only 30.0% had prescribed clozapine in the past 12 months, and 28.6% had received specific clozapine training. Barriers were common across all groups, with concerns about medication adherence (43.2%-58.0%), blood test compliance (56.8%-65.6%), and side effects being most frequently endorsed. A clear experience-related gradient emerged: residents reported significantly more barriers, lower self-rated competence, and greater reluctance to prescribe than specialists and academics. Clinicians without inpatient access reported more barriers and lower confidence and were less likely to have gained meaningful clozapine experience during residency (35.2% vs. 66.0%, <i>p</i> < 0.001) or to have observed clozapine's superiority firsthand (57.7% vs. 79.7%, <i>p</i> < 0.001). Despite these barriers, 92.3% of respondents acknowledged clozapine's superior efficacy compared with other antipsychotics.</p><p><strong>Conclusions: </strong>This nationwide survey, the largest to examine clozapine-related attitudes among child and adolescent psychiatry professionals globally, reveals substantial gaps in training, confidence, and service infrastructure in Türkiye. While efficacy is widely recognized, safety concerns and monitoring-related barriers, particularly among less experienced clinicians and those without inpatient access, limit appropriate prescribing. Findings underscore the unmet need for structured residency training programs, national clinical guidelines, and expanded service infrastructure to ensure equitable access to clozapine for youth with TRS.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":"36 2","pages":"81-88"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}