Psychiatry and Clinical Neurosciences最新文献

{"title":"Minocycline as a causative agent of manic episode: A case report and brief postmortem brain analysis.","authors":"Kazusa Miyahara, Atsuko Nagaoka, Hiroko Sato, Mizuki Hino, Hiroaki Tomita, Yasuto Kunii","doi":"10.1111/pcn.13862","DOIUrl":"https://doi.org/10.1111/pcn.13862","url":null,"abstract":"","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and symptom assessment in telepsychiatry vs. face-to-face settings: A systematic review and meta-analysis.","authors":"Mayu Fujikawa, Katsuhiko Hagi, Shotaro Kinoshita, Akihiro Takamiya, Mari Iizuka, Shota Furukawa, Yoko Eguchi, Shunya Kurokawa, Ryo Takemura, Taishiro Kishimoto","doi":"10.1111/pcn.13860","DOIUrl":"https://doi.org/10.1111/pcn.13860","url":null,"abstract":"<p><strong>Aim: </strong>Telepsychiatry is increasingly integral to psychiatric practice. However, few reviews have examined the concordance between assessments conducted in telepsychiatric and face-to-face settings. This systematic review and meta-analysis evaluated the agreement between telepsychiatric and face-to-face settings in the diagnosis and symptom assessment of various psychiatric disorders.</p><p><strong>Methods: </strong>A literature search was conducted using MEDLINE/PubMed, Cochrane Library, Scopus, EMBASE, CINAHL, and PsycINFO. Studies evaluating the concordance between telepsychiatric and face-to-face settings in the diagnosis and symptom assessment of various psychiatric disorders were included and analyzed.</p><p><strong>Results: </strong>Of the 6875 studies in the initial search, 22 studies that met the inclusion criteria were included in the analyses. The diagnostic concordance for 16 psychiatric disorders was \"almost perfect\" between the two settings (N = 16, n = 848, Cohen's κ = 0.824, confidence interval [CI] = 0.466 to 0.950, P < 0.001). Additionally, the concordance for the symptom rating scales between the two settings ranged from \"substantial\" in the Brief Psychiatric Rating Scale (N = 1, n = 533, Cohen's κ = 0.789, CI = 0.699 to 0.855, P < 0.001) to \"almost perfect\" in the Autism Diagnostic Observation Schedule (N = 1, n = 92, intraclass correlation coefficients = 0.943, CI = 0.798 to 0.985, P < 0.001).</p><p><strong>Conclusions: </strong>Telepsychiatry is highly concordant with face-to-face settings regarding psychiatric diagnoses and symptom assessment. In contrast, the present results also suggest that the suitability of telepsychiatry varies across disease types, specific symptoms, and assessment modalities. Although the present results must be interpreted with caution owing to the small number of studies for each assessment and disease, our findings suggest that telepsychiatry may have greater utility in psychiatric diagnostic assessment settings.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic cognitive differences between internal and external attention are associated with depressive and anxiety symptoms.","authors":"Taiki Oka, Yutaro Koyama, Akihiro Sasaki, Misa Murakami, Nao Kobayashi, Aurelio Cortese","doi":"10.1111/pcn.13859","DOIUrl":"https://doi.org/10.1111/pcn.13859","url":null,"abstract":"","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancement of the left frontoparietal network through real-time functional magnetic resonance imaging functional connectivity-informed neurofeedback and its impact on working memory in schizophrenia: A pilot study.","authors":"Yuko Kobayashi, Tomohisa Asai, Yujiro Yoshihara, Masahiro Yamashita, Hironobu Nakamura, Masaaki Shimizu, Takahiko Kawashima, Jun Miyata, Mitsuo Kawato, Toshiya Murai, Hiroshi Imamizu, Hidehiko Takahashi","doi":"10.1111/pcn.13849","DOIUrl":"https://doi.org/10.1111/pcn.13849","url":null,"abstract":"<p><strong>Aim: </strong>Cognitive impairment in schizophrenia shows limited improvement with pharmacotherapy, indicating a need for effective treatment. The frontoparietal network supports working memory, and a biomarker has successfully predicted performance in patients, with the left frontoparietal network contributing the most to working memory. We hypothesized that enhancing functional connectivity in this network through real-time neurofeedback (NF) will improve working memory in patients with schizophrenia.</p><p><strong>Methods: </strong>We conducted a two-arm, nonrandomized pilot study in patients with schizophrenia, with a NF group (N = 11) and a control N-back training group (N = 11). The NF training lasted 5 days (one session per day). The first session included baseline measurements, while the next four sessions involved training. The participants completed cognitive and clinical assessments and resting-state scans preintervention and postintervention. Our primary neural outcome was increased functional connectivity during NF, and the behavioral outcome was improvement in working memory, as indicated by scores on the digit-span backward task and working memory capability measured by the N-back task.</p><p><strong>Results: </strong>The NF group showed increased functional connectivity within the left frontoparietal network during the final session. A significant correlation existed between functional connectivity and the improvement in the mean N-back level, indicating that enhancing this network can boost working memory. A group-by-time interaction effect improved postintervention task score on the digit-span backward task in the NF group. In addition, post-NF scans indicated an enhanced resting-state functional connectivity within the left frontoparietal network.</p><p><strong>Conclusion: </strong>These results highlight the potential of functional connectivity-informed NF as a novel therapeutic approach for improving working memory in schizophrenia.</p><p><strong>Clinical trial registration: </strong>Japan Registry of Clinical Trials (UMIN000024831, jRCTs052180168, jRCTs032190244).</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health of sexual and gender minorities and its association with outings in Japan: A web-based cross-sectional study.","authors":"Yusuke Kanakubo, Yoshifumi Sugiyama, Eriko Yoshida, Takuya Aoki, Rieko Mutai, Takahiro Tabuchi, Masato Matsushima","doi":"10.1111/pcn.13858","DOIUrl":"10.1111/pcn.13858","url":null,"abstract":"<p><strong>Background: </strong>Sexual and gender minorities (SGMs) are known to experience mental health disparities. Outing, the non-consensual disclosure of one's sexual orientation or gender identity, has been suggested to exacerbate these issues. This study aimed to investigate the mental health status, outing experiences and their associations among SGMs in Japan.</p><p><strong>Methods: </strong>This cross-sectional study used data from 'the Japan COVID-19 and Society Internet Survey' conducted in September-October 2022, analyzing SGMs aged 18-79. Outing experiences were assessed across family, friends and school/workplace. Mental health was measured using the Kessler 6-Item Psychological Distress Scale (K6) and self-reported suicidal ideation within the past year. Modified Poisson regression was used to estimate prevalence ratios for mental health outcomes associated with outing experiences and the outing ranges within communities while adjusting for sociodemographic factors.</p><p><strong>Results: </strong>Of the 2596 SGM participants analyzed, 50.8% exhibited moderate-to-high K6 scores and 9.3% reported experiencing outings, with transgender and gender non-binary individuals being the most affected. Outing experience was significantly associated with moderate-to-high K6 scores (adjusted prevalence ratios [aPR], 1.43; 95% confidence interval [CI], 1.33-1.55), high K6 scores (aPR, 1.36; 95% CI, 1.10-1.68) and suicidal ideation within the past year (aPR, 1.39; 95% CI, 1.17-1.66). Additionally, experiencing outings within broader communities showed a dose-dependent association with higher levels of mental distress (aPR of moderate-to-high K6 for one to three communities: 1.31, 1.52 and 1.58, respectively).</p><p><strong>Conclusion: </strong>Outings can be a significant minority stressor among SGMs in Japan, contributing to elevated psychological distress and suicidal ideation.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimmune pathophysiology of long COVID.","authors":"Janna K Moen, Christopher A Baker, Akiko Iwasaki","doi":"10.1111/pcn.13855","DOIUrl":"https://doi.org/10.1111/pcn.13855","url":null,"abstract":"<p><p>Although COVID-19 was originally considered a respiratory illness, it is now well established that SARS-CoV-2 infection can have far-reaching impacts on the nervous system. Neurological symptoms such as chemosensory dysfunction are frequently observed during acute infection and approximately 10% of COVID-19 cases will go on to develop new or persistent long-term symptoms, a condition known in the literature as post-acute symptoms of COVID-19 (PASC) or by the patient-coined term Long COVID. Common neurological symptoms in Long COVID include new onset cognitive difficulties, dysautonomia, fatigue, and peripheral neuropathy. The emergence of Long COVID has prompted renewed interest in the study of post-acute infection syndromes (PAIS), particularly in the area of neuroimmune interactions. In this review we provide a comprehensive overview of the current body of literature on neurological manifestations of SARS-CoV-2 infection and Long COVID, with an emphasis on neuroimmune mechanisms drawn largely from autopsy studies and animal models. A more complete understanding of neuroimmune crosstalk in Long COVID will not only guide the development of therapies for this highly disabling condition but will also contribute to our general understanding of neuroimmune interactions in health and disease.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential placebo bias in current trials of delirium prevention: a network meta-analysis of 86 randomized controlled trials.","authors":"Bing-Yan Zeng, Chih-Sung Liang, Chih-Wei Hsu, Wei-Te Lei, Trevor Thompson, Yen-Wen Chen, Tien-Yu Chen, Ping-Tao Tseng, Yow-Ling Shiue","doi":"10.1111/pcn.13850","DOIUrl":"https://doi.org/10.1111/pcn.13850","url":null,"abstract":"<p><strong>Aim: </strong>Numerous network meta-analyses (NMAs) have reported inconsistent findings on the efficacy of various pharmacologic treatments for delirium prevention in high-risk patients. A potential confounder was the study design-using a placebo control or standard-of-care (SoC) control. We reexamined the incident delirium between SoC plus placebo and SoC alone in randomized controlled trials (RCTs) on delirium prevention.</p><p><strong>Methods: </strong>We systematically searched for relevant RCTs on pharmacotherapies for delirium prevention from the inception of electronic databases through 30 November 2023. The primary outcome was delirium incidence, with secondary consideration given to all-cause mortality. We conducted a frequentist NMA using risk ratios (RRs) with 95% confidence intervals (CIs) as the effect size.</p><p><strong>Results: </strong>The NMA results from 86 RCTs (19,889 participants, with a mean age of 68.5 years, and a mean female proportion of 44.0%) revealed that SoC plus placebo was associated with a lower risk of incident delirium than SoC alone (RR, 0.60 [95% CI, 0.41-0.88]). The RR of all-cause mortality was not significant between these two study designs.</p><p><strong>Conclusion: </strong>We found placebo effects on the incidence of delirium in RCTs involving high-risk patients. Further RCTs should consider a three-arm, parallel design including both a placebo group and an SoC group to replicate our study findings.</p><p><strong>Trial registration: </strong>CRD42023488481.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression, antidepressant use, and breast cancer incidence: results from the E3N prospective cohort.","authors":"Romain Colle, Eric Deflesselle, Océane Mohamed, Bruno Falissard, Gianluca Severi, Agnès Fournier, Marie-Christine Boutron-Ruault, Emmanuelle Corruble","doi":"10.1111/pcn.13852","DOIUrl":"https://doi.org/10.1111/pcn.13852","url":null,"abstract":"<p><strong>Aim: </strong>Depression and antidepressant drugs may both impact breast cancer incidence, potentially in opposite directions. The few epidemiological studies attempting to disentangle their effects have been inconclusive. We aimed to assess within the same prospective cohort the association between depression, antidepressant use, and breast cancer risk, while controlling for potential confounders.</p><p><strong>Methods: </strong>The study population included 47,791 women from the E3N (Etude Epidémiologique Auprès de Femmes de la Mutuelle Générale de l'Education Nationale) prospective cohort, born between 1925 and 1950 and followed for breast cancer incidence from 2005 to 2014. Depression was defined by a Center for Epidemiologic Studies-Depression Scale (CES-D) score ≥17. Exposure to antidepressants was identified from drug claims data available from 2004 onwards. Hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive breast cancer were calculated using Cox proportional hazards models adjusted for breast cancer risk factors. Antidepressant exposure was time-varying.</p><p><strong>Results: </strong>During a mean follow-up of 7.2 years, 1365 breast cancers occurred. Depression was associated with a higher incidence of breast cancer (HR, 1.14 [95% CI, 1.01-1.29]), while exposure to antidepressants was associated with a lower risk (HR, 0.85 [95% CI, 0.74-0.98]). No association was observed for treatment durations <6 months (HR, 1.02 [95% CI, 0.79-1.32]), while antidepressant use for at least 24 months was associated with an HR of 0.80 (95% CI, 0.64-0.99).</p><p><strong>Conclusion: </strong>These findings from a prospective cohort suggest that depression and antidepressant drugs exert opposing effects on breast cancer incidence. While these results require replication in future studies, they could help promote adherence to antidepressant drugs in women with depression.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-acting antipsychotics and mortality in patients with schizophrenia receiving homecare case management.","authors":"Wen-Yin Chen, Po-Yu Chen, Chih-Chiang Chiu, Chun-Hung Pan, Sheng-Siang Su, Chiao-Chicy Chen, Chian-Jue Kuo","doi":"10.1111/pcn.13853","DOIUrl":"https://doi.org/10.1111/pcn.13853","url":null,"abstract":"<p><strong>Aim: </strong>Long-acting injectable antipsychotics (LAIs) offer several advantages over oral antipsychotic medications for treating schizophrenia. However, whether the benefits of LAIs extend to patients receiving homecare case management (CM) remains unclear.</p><p><strong>Methods: </strong>This cohort study used Taiwan's National Health Insurance Research Database, enrolling 19,680 nationwide patients with schizophrenia who began homecare CM between January 1, 2000, and December 31, 2019. Each patient was followed for 5 years or to the data censored, with 30-day periods serving as follow-up units. We evaluated LAI and other medication usage during each period and their associations with mortality outcomes. Additionally, we investigated whether consistent users of homecare CM services (maintenance group) receiving specific LAI treatments had better prognoses.</p><p><strong>Results: </strong>In the cohort (n = 19,680), 6428 received first-generation antipsychotic long-acting injectables (FGA-LAIs) and 4954 received second-generation antipsychotic long-acting injectables (SGA-LAIs). The FGA-LAI group had a mean age of 39.27 years (55.13% male), while the SGA-LAI group had a mean age of 41.25 years (53.75% male). Of 1366 deaths within 5 years, 980 were from natural causes and 254 from suicide. FGA-LAIs reduced natural mortality (HR: 0.67, P = 0.001) but increased suicide risk (HR: 1.52, P = 0.01). SGA-LAIs lowered all-cause (HR: 0.53, P < 0.001) and natural mortality (HR: 0.42, P < 0.001) without affecting suicide mortality (HR: 0.82, P = 0.384). In the maintenance group, FGA-LAIs showed no mortality benefit and increased suicide risk (HR: 2.07, P < 0.001), while SGA-LAIs consistently reduced all-cause (HR: 0.39, P < 0.001), natural (HR: 0.31, P < 0.001), and suicide mortality (HR: 0.54, P = 0.034).</p><p><strong>Conclusions: </strong>SGA-LAIs could be a preferable treatment for reducing mortality in patients with schizophrenia receiving homecare CM, particularly for those in the maintenance group.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the Japanese-style diet and low prevalence of depressive symptoms: Japan Epidemiology Collaboration on Occupational Health Study.","authors":"Haruka Miyake, Akiko Nanri, Hiroko Okazaki, Toshiaki Miyamoto, Takeshi Kochi, Isamu Kabe, Aki Tomizawa, Shohei Yamamoto, Maki Konishi, Seitaro Dohi, Tetsuya Mizoue","doi":"10.1111/pcn.13842","DOIUrl":"https://doi.org/10.1111/pcn.13842","url":null,"abstract":"<p><strong>Aim: </strong>The Japanese diet, rich in fish, soy products, and green tea, is associated with better mental health. However, associations between Japanese dietary patterns and depressive symptoms remain inconsistent, with limited research on predefined patterns. This study developed scores for traditional and modified Japanese diets to explore their cross-sectional associations with depressive symptoms in a large working population.</p><p><strong>Methods: </strong>As part of the Japan Epidemiology Collaboration on Occupational Health Study, we conducted a survey between 2018 and 2021. Diet was assessed using a validated food frequency questionnaire. Scores were developed for the traditional Japanese diet (9 items: white rice, miso soup, soy products, cooked vegetables, mushrooms, seaweed, fish, salty foods, green tea) and its modified version (11 items: whole or minimally processed rice instead of white rice, reverse scoring for salty foods, and adding fruits, raw vegetables, dairy products). Depressive symptoms were assessed using the 11-item Center for Epidemiological Studies-Depression Scale (cutoff ≥9). Multilevel Poisson regression with robust variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for confounders and accounting for study site as a random effect.</p><p><strong>Results: </strong>Among 12,499 participants (76.8% participation), 30.9% reported depressive symptoms. The PRs of depressive symptoms across quartiles of the traditional Japanese diet score were 1.00 (reference), 0.94 (95% CI, 0.88-0.99), 0.91 (95% CI, 0.85-0.98), and 0.83 (95% CI, 0.80-0.86), and those for the modified version were 1.00 (reference), 0.94 (95% CI, 0.89-0.98), 0.83 (95% CI, 0.80-0.87), and 0.80 (95% CI, 0.76-0.83).</p><p><strong>Conclusion: </strong>Close adherence to the traditional and modified Japanese diet score is associated with fewer depressive symptoms among the working population.</p>","PeriodicalId":20938,"journal":{"name":"Psychiatry and Clinical Neurosciences","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}