Personalized Medicine in Psychiatry最新文献

{"title":"Examining the influence of cognitive bias delaying the diagnosis and treatment of Anti-NMDA receptor encephalitis","authors":"Gary J. Iacobucci ,&nbsp;Raphael J. Leo ,&nbsp;Cynthia Pristach","doi":"10.1016/j.pmip.2025.100164","DOIUrl":"10.1016/j.pmip.2025.100164","url":null,"abstract":"<div><div>Anti-NMDAR encephalitis is an autoimmune condition that often mimics psychiatric conditions on first presentation. Although immunotherapy can be effective in treatment, delayed recognition and diagnosis prolongs the acute phase of illness which carries higher risk of morbidity. In addition to the complex and varied clinical manifestations, one overlooked factor that may influence clinical judgment, diagnosis, and treatment is a provider’s implicit biases, particularly as they pertain to sociocultural preconceptions of patients’ demographics. Here, we describe the clinical presentations, hospital courses, investigations, and treatment in two illustrative cases of anti-NMDAR encephalitis. We discuss the confluence of clinical factors that differentially confounded each clinical picture leading to delayed diagnosis. Additionally, we describe the possible influence of cognitive biases that perpetuated misdiagnoses. We emphasize that clinicians ought to be aware that bias takes different forms and can lead to delayed diagnosis or misdiagnosis resulting in significant morbidity. Consequently, we suggest simple strategies for mitigating the impact of specific biases both generally and specifically for encephalitis.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-regulatory contributions to depressive symptoms in a community sample of youth","authors":"Eleenor Abraham,&nbsp;Tara McAuley","doi":"10.1016/j.pmip.2025.100163","DOIUrl":"10.1016/j.pmip.2025.100163","url":null,"abstract":"<div><h3>Objective</h3><div>Depression is prevalent in youth, with concerning implications for their current and future function. Risk for depression is elevated pending how youth attempt to regulate their affective experiences (emotion regulation; ER) and the effectiveness with which they use higher-order cognitive abilities to work towards and attain their goals (executive functions; EF). According to the impaired disengagement hypothesis, depression may arise when ineffective EFs lead to reliance on maladaptive forms of ER—such as<!--> <!-->rumination. This study investigates rumination, other ER strategies, and EF challenges as correlated predictors of depressive symptoms in youth. Method: A community sample of 191 youth 11–18 years (<em>M</em> = 13.47,<!--> <em>SD</em> = 1.48, 108 females, 48 % White, 5 % Black, 5 % Hispanic, 42 % Other) completed self-report measures of their mental health, ER strategies, and ability to apply EF abilities in their everyday lives. Results: Depression was elevated in youth who identified as female and who endorsed higher levels of EF-challenge, greater dispositional use of maladaptive ER, and lesser dispositional use of adaptive ER. The association of youths’ EF challenges and depressive symptoms was attenuated and no longer significant in a multivariate model that considered the association between their depressive symptoms and<!--> <!-->use of self-blaming rumination, catastrophizing, expressive suppression, and positive reappraisal. Conclusions: Early identification of self-regulatory factors that increase youths’ risk of depression, including the experience of everyday EF challenges and reliance on maladaptive forms of ER, has potential to guide prevention and treatment efforts that mitigate the effects of depression in adolescence and adulthood.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-roe psychiatry: part I − A systematic review and multilevel meta-analysis investigating the impact of unwanted pregnancy and denied abortion on mental health","authors":"Debra P. Bruns ,&nbsp;Erika Botello ,&nbsp;Victoria L. King ,&nbsp;Natalie Remiszewski ,&nbsp;Laura Holland ,&nbsp;Linda L. Carpenter ,&nbsp;William M. McDonald ,&nbsp;Alik S. Widge ,&nbsp;Gerhard Hellemann ,&nbsp;Charles B. Nemeroff ,&nbsp;Nina V. Kraguljac","doi":"10.1016/j.pmip.2025.100159","DOIUrl":"10.1016/j.pmip.2025.100159","url":null,"abstract":"<div><h3>Objective</h3><div>To study the impact of unwanted pregnancies and abortion denials on maternal mental health and the mental health of children born from an unwanted pregnancy.</div></div><div><h3>Methods</h3><div>Using PRISMA guidelines, we performed a systematic search of PubMed up to June 2022. We grouped articles as follows: Unwanted pregnancies and maternal mental health, mental health of children born from an unwanted pregnancy, abortion denials and maternal mental health, mental health of children born after abortion denial. Where sufficient data were available, a random-effects multi-level <em>meta</em>-analysis using the natural logarithm of the odds ratio (logOR) was performed to measure the effect size.</div></div><div><h3>Results</h3><div>The logOR of overall negative maternal mental health outcomes with unwanted pregnancies compared to wanted or wanted/ unintended pregnancies was 0.50 (95 % CI: 0.39–0.61; p &lt; 0.01), corresponding to an odds ratio of 1.65. Data on mental health diagnoses of women denied an abortion or children born from unwanted pregnancies was scant. No studies were identified that investigated mental health of children born after abortion denial.</div></div><div><h3>Conclusions</h3><div>Data show that unwanted pregnancies significantly increase the risk of adverse mental health outcomes in the mothers (e.g. suicidality, depression, alcohol use). This is a major public health concern and will inevitably lead to additional demands on our already overwhelmed mental healthcare system. It is critical to provide access to the full spectrum of reproductive healthcare, strengthen our mental health care delivery system, and expand public health initiatives geared at primary prevention of unwanted pregnancies.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative social interactions on the relationship between ADD/ADHD and both anxious and depressive symptoms among Canadian adults","authors":"Ross D. Connolly ,&nbsp;Allyson Lamont ,&nbsp;David Speed","doi":"10.1016/j.pmip.2025.100165","DOIUrl":"10.1016/j.pmip.2025.100165","url":null,"abstract":"<div><h3>Objective</h3><div>The primary goal of the present research was to examine whether the associations that negative social interactions (NSIs) demonstrate with both anxiety and depression varied between adults with and without attention-deficit hyperactivity disorder (ADHD) in a Canadian sample.</div></div><div><h3>Method</h3><div>Data were obtained from the 2012 Canadian Community Health Survey–Mental Health (<em>N</em> ≥ 16,354). Presence of NSIs, diagnosis of generalized anxiety disorder (GAD), and experience of major depressive episodes (MDEs) were estimated in the self-report ADHD and non-ADHD groups.</div></div><div><h3>Results</h3><div>NSIs were positively associated with having GAD and experiencing an MDE. Self-reported ADHD was also positively associated with these diagnostic outcomes. Presence of self-reported ADHD did not significantly modify the associations between NSI and GAD or NSI and MDE.</div></div><div><h3>Conclusion</h3><div>The findings show that increased levels of NSIs are significant predictors of an increased risk of experiencing anxiety and depression, and that ADHD itself a corelate of anxiety and depression. However, the associations that NSIs demonstrate with anxiety and with depression do not significantly differ based on the presence or absence of an ADHD diagnosis.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurobiology and behavior associated with early neglect: An exploratory comparison of neglected US children and international adoptees","authors":"Eve G. Spratt ,&nbsp;Kathleen T. Brady ,&nbsp;O. Yaw Addo ,&nbsp;Carrie E. Papa ,&nbsp;Cynthia Cupit Swenson ,&nbsp;Bradley S. Miller ,&nbsp;James S. Contompasis ,&nbsp;Michael D. De Bellis","doi":"10.1016/j.pmip.2025.100155","DOIUrl":"10.1016/j.pmip.2025.100155","url":null,"abstract":"<div><h3>Objective</h3><div>This exploratory study investigates the effects of childhood neglect exposure within a family setting and in children adopted from Russian orphanages on markers of stress physiology as well as behavioral and emotional problems in pre-pubertal children.</div><div>Participants: Families of 17 U.S. children with a history of familial neglect (USN), 15 international adoptees from orphanages (IA), and 28 children living with biologic parents with no known history of maltreatment (controls).</div></div><div><h3>Methods</h3><div>Parents completed Child Behavior Checklists (CBCL) and demographic information. Morning salivary cortisol was collected at baseline before a blood draw (for serum biological markers) and at set intervals. The first morning urinary void was obtained to measure arginine vasopressin (AVP), oxytocin (OT), cortisol, and epinephrine levels.</div></div><div><h3>Results</h3><div>IA children had the lowest urinary AVP levels, highest urinary epinephrine, a higher cortisol peak and longer recovery. There were no OT differences between the three groups. The USN group had the lowest urinary epinephrine levels. Both neglect groups had higher behavior problem scores on the CBCL with the USN group having the highest scores. There was a strong consistent association between AVP and 4 out of 6 CBCL outcomes – but not with OT, cortisol or epinephrine.</div></div><div><h3>Conclusions</h3><div>In this study, there were significant differences in both biologic and psychosocial measures between the control group, the USN and the IA groups suggesting that the timing, type and context of neglect may impact biologic and psychosocial sequalae.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of patient expectation, motivation, and satisfaction on outcomes of neurosurgical deep brain stimulation in treatment-resistant depression and obsessive–compulsive disorder","authors":"Teodora Sabkova ,&nbsp;Volker A. Coenen ,&nbsp;Thomas E. Schläpfer","doi":"10.1016/j.pmip.2025.100162","DOIUrl":"10.1016/j.pmip.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Treatment-resistant major depressive disorder (MDD) and treatment-resistant obsessive–compulsive disorder (OCD) are the two main application areas of Deep Brain Stimulation (DBS) in psychiatry. DBS in treatment-resistant OCD patients is part of the guidelines, while this procedure in treatment-resistant depressive patients, is still being regarded as being under development.</div></div><div><h3>Objectives</h3><div>This study aimed to explore the role of patient-related factors—specifically, expectation, motivation, and satisfaction—in the context of DBS outcomes in patients with treatment-resistant depression and OCD. The focus was on descriptively examining how these factors present before and after the surgery, and how they may relate to patients’ perception of treatment efficacy.</div></div><div><h3>Methods</h3><div>A total of 58 patients participated in the study. Three measurement instruments were used for the investigation − the Client Motivation for Therapy Scale, the Stanford Expectancy Treatment Scale and the Credibility/Expectancy Questionnaire.</div></div><div><h3>Results</h3><div>Negative expectations decreased significantly, and realistic expectations increased postoperatively in both groups. Correlations between expectation levels and perceived treatment efficacy were observed at various time points. No significant differences in motivational behavior were found between the groups. Overall satisfaction with DBS was high across groups, with 81 % indicating they would choose the treatment again.</div></div><div><h3>Conclusions</h3><div>The findings highlight the relevance of patient factors such as motivation, expectation, and satisfaction in the treatment of psychiatric patients undergoing DBS. These aspects, while not predictive in a causal sense, offer valuable insights into patient engagement and perceived benefit. Managing patient expectations, as in many invasive therapies, remains a key component of therapeutic success.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiolytic, antidepressant, and hypnotic effects on the accuracy and speed of accessing information from episodic memory","authors":"Selene Cansino ,&nbsp;Frine Torres-Trejo ,&nbsp;Cinthya Estrada-Manilla ,&nbsp;Silvia Ruiz-Velasco","doi":"10.1016/j.pmip.2025.100161","DOIUrl":"10.1016/j.pmip.2025.100161","url":null,"abstract":"<div><div>The use of anxiolytics, antidepressants, and hypnotics to alleviate minor symptoms of anxiety, depression, and insomnia in the absence of any major disease has become extremely common. However, the effects of these medications are not completely understood. The aim of the present study was to examine the potential effects of these drugs on episodic memory, the ability to remember our personal experiences. In this study, we employed a computerized task that allowed us to measure recollection and recognition accuracy and speed within episodic memory. The participants’ ages ranged from 21 to 80 years; 87 of whom had taken exclusively anxiolytics, 94 had taken only antidepressants, and 36 had taken only hypnotics at some time in their lives but had not taken them for at least six months. These groups were compared with individuals who had never taken any of these medications and were matched by sex, age, and years of education. Recollection accuracy was lower in anxiolytics and antidepressants users compared with nonusers. In addition, we found that the longer and more frequently these drugs were taken, the worse recollection became. Recollection, one of the most essential memory processes to preserve autonomous everyday living, is affected by the consumption of anxiolytics and antidepressants, and this occurs across all ages in the adult life span.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144229953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What’s next for misophonia? Child and parent priorities for misophonia advocacy, treatment, and research","authors":"Katherine L. Abraham ,&nbsp;Catherine E. Rast ,&nbsp;Eric A. Storch ,&nbsp;Andrew G. Guzick","doi":"10.1016/j.pmip.2025.100160","DOIUrl":"10.1016/j.pmip.2025.100160","url":null,"abstract":"<div><h3>Background</h3><div>Misophonia is characterized by sensitivity to specific common sounds and associated visual stimuli. Despite a high estimated prevalence in the general population, “misophonia” as a term remains largely unknown by the general population, with research on misophonia treatment still in a nascent stage. This is especially the case in children and adolescents, despite misophonia most often beginning in this time. To guide the growing foundation of misophonia literature, this study seeks to inquire about advocacy, research, and treatment priorities from the perspective of youth with misophonia and their parents.</div></div><div><h3>Methods</h3><div>In this study, twenty youth with clinically significant misophonia (ages 10–17) and their parents engaged in semi-structured focused interviews. Interviews were transcribed and thematically analyzed using an inductive approach.</div></div><div><h3>Results</h3><div>Eight themes were identified, including <em>Advancing Awareness for Advocacy, Misophonia is Outside a Child’s Control, Practical and Misophonia-Specific Therapies Needed</em>, <em>Understanding the Neurobiology of Misophonia, Defining Misophonia Beyond Sound Triggers</em>, <em>Understanding the Daily Impact of Misophonia, Uncovering the Misophonia-Mental Health Connection</em>, and <em>Long-Term Prognosis.</em></div></div><div><h3>Discussion</h3><div>While some participants’ ideas were distinctive to their experience, several themes, described above, emerged across interviews. These findings propose paths forward for future advocacy, research, and treatment development.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of methamphetamine abstinence on social cognition and oxytocin regulation: A study in patients undergoing rehabilitation","authors":"Mariana Judith Ceja-Vega ,&nbsp;Yaveth Ruvalcaba-Delgadillo ,&nbsp;Fernando Jáuregui-Huerta","doi":"10.1016/j.pmip.2025.100156","DOIUrl":"10.1016/j.pmip.2025.100156","url":null,"abstract":"<div><div>Social cognition, essential for interpreting and responding to social cues, is often impaired by psycho-stimulants like methamphetamine, which disrupt neural pathways critical for social interaction and emotional processing. Oxytocin, a neuropeptide involved in social bonding and emotion regulation, is similarly impacted by substances that alter dopaminergic systems, influencing social behavior and cognitive functions. This study investigates the effects of methamphetamine abstinence on social cognition and serum oxytocin levels in individuals undergoing rehabilitation, aiming to understand the progression of cognitive deficits and neuroendocrine dysregulation over a six-month follow-up interval. Thirty-seven male participants, 25 of whom were methamphetamine users in a controlled rehabilitation environment and 12 matched healthy controls, were assessed. Social cognition was evaluated using Facial Emotion Recognition and Theory of Mind (ToM) tasks at early and late abstinence stages. Serum oxytocin levels were measured through ELISA at both stages, and statistical analyses examined group differences and within-group changes over time. Methamphetamine users exhibited significant declines in social cognition from early to late abstinence, with lower performance in ToM and facial emotion recognition (notably for anger, fear, and sadness) compared to controls. Additionally, oxytocin levels showed a significant decrease over the abstinence period, with methamphetamine users maintaining lower levels than controls. Findings suggest that cognitive impairments in social processing persist as abstinence progresses, accompanied by a parallel decline in oxytocin levels. These results underscore the need for targeted interventions to address the intertwined challenges of cognitive and hormonal dysregulation in methamphetamine recovery, highlighting oxytocin’s potential role in therapeutic strategies.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100156"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review on the relationship of asthma and mental disorders","authors":"João Freitas ,&nbsp;Filipa Novais","doi":"10.1016/j.pmip.2025.100157","DOIUrl":"10.1016/j.pmip.2025.100157","url":null,"abstract":"<div><div>Asthma is a complex, chronic condition affecting airway function, often accompanied by wheezing and breathlessness. Recent research has begun to explore the associations between asthma and mental disorders, particularly anxiety and depression. This review focuses on the emerging evidence suggesting a bidirectional relationship, where asthma may exacerbate mental health conditions and vice versa. Several hypotheses may explain these connections, including overlapping inflammatory pathways, altered interoceptive perception, and shared psychosocial stressors. We also explore how asthma phenotypes, different asthma treatment modalities, and breathing patterns may mediate the relationship between asthma and mental disorders such as anxiety and depressive disorders. Additionally, this review presents insights from the field of Psychoneuroimmunology and discusses the potential benefits of non-pharmacological approaches such as mindfulness, yoga, and breathing exercises. Overall, this narrative review emphasizes the need for an interdisciplinary approach to asthma management, stressing the importance of the biopsychosocial model in understanding shared pathogenic mechanisms across disorders involving psychoneuroimmunological pathways. Through this perspective, one can better understand the connections between respiratory and psychological health. This review also attempts to reveal some of the disagreements in the field, showing that more research is required to understand the risk profile that asthmatics carry when it comes to mental disorders.</div></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"51 ","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}