What We Treat (select from dropdown)

At Eximious our providers are able to diagnose & treat most psychiatric conditions. Please chose from following if you have any questions.

At Eximious Integrated Health Solutions, we aim to provide the best possible service to our patients. Our providers strive everyday to serve you to satisfaction. We strive to develop a relationship with you rather than a transaction. To learn more about the issues are providers are dealing with and to join the Eximous community, please call us at 972-985-7499 and speak to us. You can also email us at [email protected].

Suboxone Therapy

Call office for details: (972) 985-7499 (Allen), (903) 892-6700 (Sherman)

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Couples counseling

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Have you ever walked into a social situation where a divorced couple is there, perhaps with new partners or even new spouses, and the tension is palpable, stress and discord so apparent that it makes you want to leave immediately?

Or perhaps it’s a close friend or family member that has gone through a divorce so filled with anger and hostility that the two individuals have become people you no longer recognize.

When encountering or experiencing these angst-filled divorces, one quickly realizes that the marriage is over, but the relationship, however contentious, continues.

Marriage and family therapists (MFTs) and other psychologists recommend divorce counseling or therapy, a relatively new therapeutic concept designed to re-structure relationships between partners and spouses. Professional counselors are trained to help couples shift their relationships from an emotional bloodbath to more of a non-emotional, practical relationship. These counselors or therapists are licensed mental health practitioners specializing in helping couples set ground rules for constructive ways to engage and get along – essential for creating a sense of peace and well being.

This is a type of peace that almost all professionals agree is imperative when children are involved. Children remember the pain and discord of acrimonious divorce battles long after the divorce – into their own adulthoods – sometimes necessitating later counseling or therapy to work through these troubling memories. And divorced parents who respect and treat each other well model a form of cooperation that teaches their children valuable life skills.

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MEDICATION MANAGEMENT

FOR ALL PSYCHIATRIC DISORDERS IN ALLEN, TX
THIS INCLUDES:

  • Selecting the right medication and treatment plan based on the individual’s needs.
  • Inform / educate the person involved in the action and effects of the prescribed drug.
  • Changes in medications prescribed based on unique causes if patients fail to adhere to the drug.
  • Side effects are addressed with full sympathetic attention when a person reports about them.

 

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Suicidal tendencies are the propensity for a person to have suicidal ideation or to make suicide attempts.

Couples Therapy

Making the choice to go to couples counseling can feel like a very big step. It involves admitting that things are not perfect in your partnership, which is often tough to do and scary to admit. And if you are not particularly familiar with what therapy is all about, it can feel mysterious and confusing, not to mention it can involve considerable effort — finding an appropriate provider, figuring out insurance and other financial aspects of the commitment, coming up with a time to fit into everyone’s schedule. Often, the idea of seeing a marriage or couples therapist sits on the back burner, with one or both parties thinking that it may be a good idea, but also feeling unsure of how to proceed — and of whether their specific problems can really be helped.

To help demystify the process, I’ve outlined some common issues that indicate that a couple could potentially benefit from seeing someone. It’s important to remember that most therapists, both for couples and individuals, offer some version of a free consultation to let you decide whether they might be a good fit for you. Don’t be afraid to reach out and ask questions — the earlier, the better — so that if it’s not a good match, you can move on.

Relationship Issues

Everyone’s relationships are different. But sometimes we face similar issues.

Whatever you’re going through in your relationship, it can be comforting to know that you’re not alone. Our counselors have put together some practical tips to help you with the most common relationship problems.

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Life Coaching is a profession that is profoundly different from consulting, mentoring, advice, therapy, or counseling. The coaching process addresses specific personal projects, business successes, general conditions and transitions in the client’s personal life, relationships or profession by examining what is going on right now, discovering what your obstacles or challenges might be, and choosing a course of action to make your life be what you want it to be.

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“Dysphoria” is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with your normal life, for instance at school or work or during social activities.

People who have gender dysphoria feel strongly that their gender does not match their biology.

For example, a person who has a penis and all other physical traits of a male might feel instead that he is actually a female. That person would have an intense desire to have a female body and to be accepted by others as a female. Or someone with the physical characteristics of a female would feel her true identity is male.

Feeling that your body does not reflect your true gender can cause severe distress, anxiety, and depression. “Dysphoria” is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with your normal life, for instance at school or work or during social activities.

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Physical therapy (PT), also known as physiotherapy, is one of the allied health professions that, by using mechanical force and movements (bio-mechanics or kinesiology), manual therapy, exercise therapy, and electrotherapy, remediates impairments and promotes mobility and function.

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Sex therapy is a type of psychotherapy — a general term for treating mental health problems by talking with a mental health professional. Through sex therapy, you can address concerns regarding sexual function, sexual feelings and intimacy, either in individual therapy or in joint therapy with your partner. Sex therapy can be effective for individuals of any age, sex or sexual orientation.

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Dialectical Behavior Therapy (DBT) 

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Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment developed by Marsha Linehan, PhD, ABPP. It focuses on individual psychotherapy and group skills to help people learn and acquire new skills and strategies to develop a life that they experience as worth living. DBT is inclusive of skills such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

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The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person be helped and “cured.”

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Sexual abuse is any form of sexual violence, including rape, child molestation, incest, and similar forms of non-consensual sexual contact. Most sexual abuse experts agree sexual abuse is never only about sex. Instead, it is often an attempt to gain power over others.

Immediate crisis assistance after sexual assault can prove invaluable and even save lives. A person can report sexual assault by calling local police. Survivors may also wish to get a physical exam at a hospital.

Therapy can also be helpful for those who experienced sexual abuse in the past. Some therapists specialize in addressing the trauma of sexual assault. Long-term assistance may be beneficial to some survivors of sexual abuse.

TYPES OF SEXUAL ASSAULT AND ABUSE

Sexual abuse is common, particularly for women and girls. Ninety percent of all rapes are committed against women. One in six women in America have experienced rape. One in five girls and one in 20 boys experience childhood sexual abuse.

Sexual abuse and sexual assault are umbrella terms used to refer to multiple crimes. These crimes include:

  • Rape: Forced sexual contact with someone who does not or cannot consent. Forcing sex upon someone who does not want it, who is intoxicated, or who is not legally old enough to give consent all count as rape. Date rapeis sexual assualt that occurs between people with an established relationship. A handful of states limit their definition of rape to forcible sexual intercourse. Yet any form of forcible sexual contact can have long-lasting effects on a person. Most states now recognize forced oral sex and similar forms of assault as rape.
  • Child molestation: Child molestation is any sexual contact with a child. Many children who are molested are too young to know what is happening and may not fight back. Some abusers use the child’s cooperation in these cases as “evidence” that no one was harmed. Examples of child molestation might include fondling or demanding sexual favors from a child.
  • Incest: Incestdescribes sexual contact between family members who are too closely related to marry. While incestuous sexual activity may occur between consenting adults, this is not common. Most reported incest occurs as child abuse. Over a third of American sexual assault survivors under the age of 18 are abused by a family member, according to latest statistics. However, incest is an underreported crime, so the actual number of incest survivors may be higher.
  • Non-consensual sexual contact: This category includes any unwanted sexual touching, such as groping or pinching. Attempted rape can also fall into this category.
  • Non-contact sexual abuse: Not all sexual abuse fits neatly into common legal or psychological definitions. For instance, parents who have sex in front of their children or who make sexually inappropriate comments to their children are engaging in sexual abuse. So-called revenge pornographysites, which publish nude photos of people without their consent, are another form of sexual abuse.

The laws governing sexual abuse are constantly changing. For this reason, most professionals who work with sexual abuse survivors rely on the person’s feelings, not the law, when determining whether a sexual assault has occurred. For example, marital rape can be deeply traumatic, especially in an otherwise abusive relationship. Yet marital rape did not become a crime anywhere until the 1970s. It is still a challenging crime to prosecute.

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Group therapy is a form of psychotherapy that involves one or more therapists working with several people at the same time.

Group therapy is a form of psychotherapy that involves one or more therapists working with several people at the same time. This type of therapy is widely available at a variety of locations including private therapeutic practices, hospitals, mental health clinics, and community centers. Group therapy is sometimes used alone, but it is also commonly integrated into a comprehensive treatment plan that also includes individual therapy and medication.

The Principles of Group Therapy

In The Theory and Practice of Group Psychotherapy, Irvin D. Yalom outlines the key therapeutic principles that have been derived from self-reports from individuals who have been involved in the group therapy process:

  1. The instillation of hope: The group contains members at different stages of the treatment process. Seeing people who are coping or recovering gives hope to those at the beginning of the process.
  2. Universality: Being part of a group of people who have the same experiences helps people see that what they are going through is universal and that they are not alone.
  3. Imparting information: Group members can help each other by sharing information.
  4. Altruism: Group members can share their strengths and help others in the group, which can boost self-esteem and confidence.
  5. The corrective recapitulation of the primary family group: The therapy group is much like a family in some ways. Within the group, each member can explore how childhood experiences contributed to personality and behaviors. They can also learn to avoid behaviors that are destructive or unhelpful in real life.
  6. Development of socialization techniques: The group setting is a great place to practice new behaviors. The setting is safe and supportive, allowing group members to experiment without the fear of failure.
  1. Imitative behavior: Individuals can model the behavior of other members of the group or observe and imitate the behavior of the therapist.
  2. Interpersonal learning: By interacting with other people and receiving feedback from the group and the therapist, members of the group can gain a greater understanding of themselves.
  3. Group cohesiveness: Because the group is united in a common goal, members gain a sense of belonging and acceptance.
  4. Catharsis: Sharing feelings and experiences with a group of people can help relieve pain, guilt, or stress.
  5. Existential factors: While working within a group offers support and guidance, group therapy helps member realize that they are responsible for their own lives, actions, and choices.
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Adolescent / Teen Issues

For most children, adolescence is a period of good physical health. The most common problems during adolescence relate to

  • Growth and development
  • School
  • Childhood illnesses that continue into adolescence
  • Mental health disorders
  • Consequences of risky or illegal behaviors (including injury, legal consequences, pregnancy, and infectious diseases)

Leading causes of death and disability among adolescents are:

  • Unintentional injuries resulting from motor vehicle crashes
  • Injuries resulting from interpersonal violence

During this phase of development, adolescents begin to transition from childhood to adulthood. Issues of independence, identity, sexuality, and relationships define this developmental stage. Mental health problems, such as mood disorders, anxiety disorders, and thought disorders (such as schizophrenia) as well as psychosocial disorders, may develop or first become apparent during adolescence. Suicide is a major cause of death for this age group. Other causes of death include accidents, unintentional injuries, and homicide.

Eating disorders, such as anorexia nervosa and bulimia nervosa, most commonly develop during adolescence and are more common among girls. Many unhealthy behaviors that start during adolescence, such as consuming a poor diet (see Obesity in Adolescents), smoking, substance use, and violence, can lead to immediate health problems, long-term disorders, or poor health later in life.

Analytical Therapy/Psychoanalysis

The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person be helped and “cured.”

Psychoanalysis was founded by Sigmund Freud (1856-1939).  Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining insight.

The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person be helped and “cured.”

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Even the best marriages need a little work now and then. No matter what facets of your marriage you need to work on, the caring therapists at Meier are there to help you along the journey. Pre-marriage counseling is actually something you and your future spouse may want to consider as part of your plan to build the strong marriage and life together that you’re so excited about. Think of it like this: you’ve just settled on your dream honeymoon location, you can see your toes in the sand of a five-star resort, but you’re not just going to end up there without a little planning and preparation to make sure everything goes just right. Instead, you’ll either take the time to painstakingly research places on your own or you could work with a travel professional who can help you through the process and ensure you’ll have the honeymoon of your dreams.

Professional premarital counseling is a bit like planning your honeymoon with a travel agent; while you’d most likely still have a great and successful marriage on your own, if you work with a professional premarital counselor then you can ensure you’re fully prepared for marriage to your partner and to tackle any lingering questions or issues you may struggle with.

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Alcoholism is the most severe form of alcohol abuse and involves the inability to manage drinking habits. It is also commonly referred to as alcohol use disorder. Alcohol use disorder is organized into three categories: mild, moderate and severe. Each category has various symptoms and can cause harmful side effects. If left untreated, any type of alcohol abuse can spiral out of control.

Individuals struggling with alcoholism often feel as though they cannot function normally without alcohol. This can lead to a wide range of issues and impact professional goals, personal matters, relationships and overall health. Over time, the serious side effects of consistent alcohol abuse can worsen and produce damaging complications.

You don’t have to suffer from alcohol addiction in silence. There are many treatment options available to help you overcome alcohol abuse and achieve long-term sobriety. We can help you find the right alcohol rehab facility that fits your needs.

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We know how difficult it can be to lose something or someone close to you: a friend or family member, a job, a home, or a sense of self-worth.

Grief is the normal internal feeling one experiences in reaction to a loss, while bereavement is the state of experiencing that loss. Although people often suffer emotional pain in response to loss of anything that is very important to them (for example, a job, a friendship or other relationship, one’s sense of safety, a home), grief usually refers to the loss of a loved one through death. Grief is quite common, in that three out of four women outlive their spouse, with the average age of becoming a widow being 59 years. More than half of women in the United States are widowed by the time they reach age 65. Every year in the United States, 4% of children under the age of 15 experience the loss of a parent through death.

Although not a formal medical diagnosis, prolonged grief, formerly called complicated grief, refers to a reaction to loss that lasts more than one year. It is characterized by the grief reaction intensifying to affect the sufferer’s close relationships, disrupting his or her beliefs, and it tends to result in the bereaved experiencing ongoing longing for their deceased loved one. About 15% of bereaved individuals will suffer from complicated grief, and one-third of people already getting mental-health services have been found to suffer from this extended grief reaction.

Anticipatory grief is defined as the feelings loved ones have in reaction to knowing that someone they care about is terminally ill. It occurs before the death of the afflicted loved one and can be an important part of the grieving process since this allows time for loved ones to say goodbye to the terminally ill individual, begin to settle affairs, and plan for the funeral or other rituals on behalf of the person who is dying.

We know how difficult it can be to lose something or someone close to you: a friend or family member, a job, a home, or a sense of self-worth.

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Even with the best intentions, it can be difficult to know when to draw the line in relationships. It is often helpful to work through these boundaries with a counselor in order to care for yourself.

Family/ Relationship issues

All relationships and families go through difficult times and experiencing occasional problems and conflict in personal relationships is normal. However, sometimes these problems can become overwhelming.

SIGNS OF FAMILY AND RELATIONSHIP PROBLEMS

  • Frequent arguing
  • Disagreements
  • Breakdown in communication
  • Angry outbursts
  • Avoidance
  • Physical conflict

TRIGGERS FOR FAMILY AND RELATIONSHIP PROBLEMS

  • Difference in opinions, personalities, beliefs, values or goals
  • Change in family circumstances e.g. new baby, divorce/separation, blending families
  • Financial problems
  • Stress
  • Issues relating to sexuality
  • Alcohol or drug use
  • Gambling problems
  • The onset of mental health problems
  • Bullying/harassment
  • Natural disasters
  • Lack of trust/respect in a relationship

THE IMPACT OF FAMILY AND RELATIONSHIP PROBLEMS

Often family are the most important people to you so relationship problems can be considerably distressing and can lead to:

  • Negative emotions – anger, sadness, anxiety
  • Stress
  • Exhaustion
  • Confusion
  • Feeling isolated, alone or withdrawn
  • Lack of concentration
  • Difficulty eating or sleeping
  • Problems with friends, colleagues or your children
  • Using alcohol or drugs to cope or escape

THINGS YOU CAN DO IF YOU ARE HAVING FAMILY/RELATIONSHIP PROBLEMS

  1. Talk– communication is the key and often the first step to finding solutions. Be calm and honest about your concerns when discussing your problems with a loved one.
  2. Accept your differences – it can help avoid unnecessary conflict if you can recognise that people have different ideas, opinions and beliefs and you may not always be in agreement.
  3. Have fun together – even when things are tough, it’s important to find the time to have fun with your loved ones.
  4. Make a plan – it can help reduce stress and give common goals to work towards. For example if you are having financial problems it can help to create a budget.
  5. Get help – you may not always be able to solve your problems yourself so you may need some external help.
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Are you feeling overwhelmed by life and the stresses that come with it? Are your responsibilities piling up to the point where you don’t think that you can handle it anymore? Let us give you practical coping tools to get you back on the path to peace. Stress management is a wide spectrum of techniques and psychotherapies aimed at controlling a person’s level of stress, especially chronic stress, usually for the purpose of improving everyday functioning. In this context, the term ‘stress’ refers only to a stress with significant negative consequences, or distress in the terminology advocated by Hans Selye, rather than what he calls eustress, a stress whose consequences are helpful or otherwise.

Stress produces numerous physical and mental symptoms which vary according to each individual’s situational factors. These can include physical health decline as well as depression. The process of stress management is named as one of the keys to a happy and successful life in modern society.[1] Although life provides numerous demands that can prove difficult to handle, stress management provides a number of ways to manage anxiety and maintain overall well-being.

Despite stress often being thought of as a subjective experience, levels of stress are readily measurable, using various physiological tests, similar to those used in polygraphs.

Many practical stress management techniques are available, some for use by health professionals and others, for self-help, which may help an individual reduce their levels of stress, provide positive feelings of control over one’s life and promote general well-being. Other stress reducing techniques involve adding a daily exercise routine, finding a hobby, writing your thoughts, feelings, and moods down and also speaking with a trusted one about what is bothering you. It is very important to keep in mind that not all techniques are going to work the same for everyone, that is why trying different stress managing techniques is crucial in order to find what techniques work best for you. An example of this would be, two people on a roller coaster one can be screaming grabbing on to the bar while the other could be laughing while their hands are up in the air (Nisson). This is a perfect example of how stress effects everyone differently that is why they might need a different treatment. These techniques do not require doctors approval but seeing if a doctors technique works better for you is also very important.

Evaluating the effectiveness of various stress management techniques can be difficult, as limited research currently exists. Consequently, the amount and quality of evidence for the various techniques varies widely. Some are accepted as effective treatments for use in psychotherapy, while others with less evidence favoring them are considered alternative therapies. Many professional organizations exist to promote and provide training in conventional or alternative therapies.

There are several models of stress management, each with distinctive explanations of mechanisms for controlling stress. Much more research is necessary to provide a better understanding of which mechanisms actually operate and are effective in practice.

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It’s normal to have days where you feel sad or extremely happy. As long as your mood swings don’t affect your personal life, they can be considered as healthy.

On the other hand, there could be a medical condition where you switch from extremely happiness to extreme depression frequently. In case of such a medical condition it is advisable to inform the doctor. They’ll have an answer to your volatile behavior.

It’s tough to go through the mood swings of bipolar disorder. Depression can make it hard to do the things you want and need to do. During manic periods, you may be reckless and volatile.

The best way to avoid mood swings is to get treatment. You may not be able to totally prevent bouts of mania or depression. Even people who always take their medication and take care of their health can still have mood swings from time to time. That’s why it’s important to catch changes in your mood, energy levels, and sleeping patterns before they turn into something serious.

Mood Swing Triggers in Bipolar Disorder

At first, mood swings may take you by surprise. But over time, you might start to see patterns or signs that you’re entering a period of mania or depression. Aside from a shift in your mood, look for changes in your:

  • Sleep patterns
  • Energy level
  • Alcohol or drug use
  • Sex drive
  • Self-esteem
  • Concentration

Mood Disorders

If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).

Anxiety disorders can also affect your mood and often occur along with depression. Mood disorders may increase your risk of suicide.

Some examples of mood disorders include:

  • Major depressive disorder— prolonged and persistent periods of extreme sadness
  • Bipolar disorder— also called manic depression or bipolar affective disorder, depression that includes alternating times of depression and mania
  • Seasonal affective disorder (SAD)— a form of depression most often associated with fewer hours of daylight in the far northern and southern latitudes from late fall to early spring
  • Cyclothymic disorder— a disorder that causes emotional ups and downs that are less extreme than bipolar disorder
  • Premenstrual dysphoric disorder— mood changes and irritability that occur during the premenstrual phase of a woman’s cycle and go away with the onset of menses
  • Persistent depressive disorder (dysthymia)— a long-term (chronic) form of depression
  • Disruptive mood dysregulation disorder— a disorder of chronic, severe and persistent irritability in children that often includes frequent temper outbursts that are inconsistent with the child’s developmental age
  • Depression related to medical illness— a persistent depressed mood and a significant loss of pleasure in most or all activities that’s directly related to the physical effects of another medical condition
  • Depression induced by substance use or medication― depression symptoms that develop during or soon after substance use or withdrawal or after exposure to a medication

For most people, mood disorders can be successfully treated with medications and talk therapy (psychotherapy).

When to see a doctor

If you’re concerned that you may have a mood disorder, make an appointment to see your doctor or a mental health professional as soon as you can. If you’re reluctant to seek treatment, talk to a friend or loved one, a faith leader, or someone else you trust.

Talk to a health care professional if you:

  • Feel like your emotions are interfering with your work, relationships, social activities or other parts of your life
  • Have trouble with drinking or drugs
  • Have suicidal thoughts or behaviors — seek emergency treatment immediately
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The defining feature of social anxiety disorder, also called social phobia, is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation. People with social anxiety disorder may worry about acting or appearing visibly anxious (e.g., blushing, stumbling over words), or being viewed as stupid, awkward, or boring. As a result, they often avoid social or performance situations, and when a situation cannot be avoided, they experience significant anxiety and distress. Many people with social anxiety disorder also experience strong physical symptoms, such as a rapid heart rate, nausea, and sweating, and may experience full-blown attacks when confronting a feared situation. Although they recognize that their fear is excessive and unreasonable, people with social anxiety disorder often feel powerless against their anxiety.

Social anxiety disorder affects approximately 15 million American adults and is the second most commonly diagnosed anxiety disorder following specific phobia. The average age of onset for social anxiety disorder is during the teenage years. Although individuals diagnosed with social anxiety disorder commonly report extreme shyness in childhood, it is important to note that this disorder is not simply shyness that has been inappropriately medicalized.

Social anxiety disorder can wreak havoc on the lives of those who suffer from it. For example, individuals may decline a job opportunity that requires frequent interaction with new people or avoid going out to eat with friends due to a fear that their hands will shake when eating or drinking. Symptoms may be so extreme that they disrupt daily life and can interfere significantly with daily routines, occupational performance, or social life, making it difficult to complete school, interview and get a job, and have friendships and romantic relationships. People with social anxiety disorder are also at an increased risk for developing major depressive disorder and alcohol use disorders.

Despite the availability of effective treatments, fewer than 5% of people of with social anxiety disorder seek treatment in the year following initial onset and more than a third of people report symptoms for 10 or more years before seeking help.

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A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes. A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Paresthesia (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself) Listen to this podcast.
  • Fear of losing control or “going crazy”
  • Fear of dying

Some people experience what is referred to as limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of fewer than four symptoms.

Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside. Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors’ offices, convinced they have a life-threatening issue.

Panic attacks can occur unexpectedly during a calm state or in an anxious state. Although panic attacks are a defining characteristic of panic disorder, it is not uncommon for individuals to experience panic attacks in the context of other psychological disorders. For example, someone with social anxiety disorder might have a panic attack before giving a talk at a conference and someone with obsessive-compulsive disorder might have a panic attack when prevented from engaging in a ritual or compulsion.

Panic attacks are extremely unpleasant and can be very frightening. As a result, people who experience repeated panic attacks often become very worried about having another attack and may make changes to their lifestyle so as to avoid having panic attacks. For example, avoiding exercise so as to keep their heart rate low, or avoiding certain places.

In the past it might have taken months or years and lots of frustration before getting a proper diagnosis. Some people are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac. Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful. Other people suffering from panic attacks don’t know they have a real and highly treatable disorder. It is our hope that through increased education, people will feel more empowered to discuss their symptoms with a healthcare professional and seek appropriate treatment.

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Trauma can be of various forms, some of which are to be worked with a thorough professional therapist. Post traumatic stress disorder is a form of anxiety disorder. It can occur after you’ve been traumatized after witnessing or experiencing a traumatic event that involved death or injury threat. o diagnose post-traumatic stress disorder, your doctor will likely:

  • Perform a physical exam to check for medical problems that may be causing your symptoms
  • Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
  • Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

  • You directly experienced the traumatic event
  • You witnessed, in person, the traumatic event occurring to others
  • You learned someone close to you experienced or was threatened by the traumatic event
  • You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:

  • Teaching you skills to address your symptoms
  • Helping you think better about yourself, others and the world
  • Learning ways to cope if any symptoms arise again
  • Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs
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Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable. Agitation can come on suddenly or over time. It can last for a few minutes, for weeks, or even months. Pain, stress, and fever can all increase agitation. Agitation by itself may not be a sign of a health problem. But if other symptoms occur, it can be a sign of disease. Agitated, aggressive, frustrated, angry, stubborn, restless – adjectives that are often used interchangeably to illustrate comparable clinical presentations, but words that can bear very different meanings to different people. It is well documented in the literature that individuals with cognitive disorders regularly suffer from a plethora of neuropsychiatric sequelae during their illness course. Syndromes such as depression, anxiety, and agitation are common, and agitation is frequently considered the most disruptive as it is often associated with increased rates of institutionalization. Specific diagnostic criteria for depression and anxiety in certain cognitive disorders such as Alzheimer’s disease have been outlined in the literature. However, agitation remains an ambiguously defined term that is often muddled by the individual’s, caretakers, or provider’s interpretation of the clinical manifestations. Creating a standardized, validated diagnostic definition of agitation in individuals with cognitive disorders could prove beneficial to clinical and research environments seeking to advance treatment options, as well as, facilitate accurate communication among clinicians and patients and their support.

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Evaluation by a child and adolescent psychiatrist is appropriate for any child or adolescent with emotional and/or behavioral problems. Most children and adolescents with serious emotional and behavioral problems need a comprehensive psychiatric evaluation.

Comprehensive psychiatric evaluations usually require a few hours over one or more office visits for the child and parents. With the parents’ permission, other significant people (such as the family physician, school personnel, or other relatives) may be contacted for additional information.

The comprehensive evaluation frequently includes the following:

  • Description of present problems and symptoms
  • Information about health, illness and treatment (both physical and psychiatric), including current medications
  • Parent and family health and psychiatric histories
  • Information about the child’s development
  • Information about school and friends
  • Information about family relationships
  • Interview of the child or adolescent
  • Interview of parents/guardians
  • If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation)

The child and adolescent psychiatrist then develops a formulation. The formulation describes the child’s problems and explains them in terms that the parents and child can understand. The formulation combines biological, psychological, and social parts of the problem with developmental needs, history, and strengths of the child, adolescent, and family.

Time is made available to answer the parents’ and child’s questions. Parents often come to such evaluations with many concerns, including:

  • Is my child normal? Am I normal? Am I to blame?
  • Am I silly to worry?
  • Can you help us? Can you help my child?
  • What is wrong? What is the diagnosis?
  • Does my child need additional assessment and/or testing (medical, psychological etc.)?
  • What are your recommendations? How can the family help?
  • Does my child need treatment? Do I need treatment?
  • What will treatment cost, and how long will it take?

Parents are often worried about how they will be viewed during the evaluation. Child and adolescent psychiatrists are there to support families and to be a partner, not to judge or blame. They listen to concerns, and help the child or adolescent and his/her family define the goals of the evaluation. Parents should always ask for explanations of words or terms they do not understand.

When a treatable problem is identified, recommendations are provided and a specific treatment plan is developed. Child and adolescent psychiatrists are specifically trained and skilled in conducting comprehensive psychiatric evaluations with children, adolescents, and families.

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Obsessive-compulsive disorder is a form of anxiety denoted by unnecessary and repetitive thoughts, feelings, ideas, sensations (obsessions), or behaviors that drive them to do something.  Mostly the person carries out the behaviors to avoid the obsessive thoughts, but this only provides with temporary relief. Obsessive-compulsive disorder (OCD) is an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.

Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and unwanted routines and behaviors are rigid and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsive actions.

A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function. About 1.2 percent of Americans have OCD and among adults slightly more women than man are affected. OCD often begins in childhood, adolescence or early adulthood; the average age symptoms appear is 19 years old.

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Autism is a lifelong, non progressive neurological disorder typically appearing before the age of three years. Autism is a spectrum disorder. The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. What Is Autism?

Autism is a complex neurobehavioral condition that includes impairments in social interaction and developmental language and communication skills combined with rigid, repetitive behaviors. Because of the range of symptoms, this condition is now called autism spectrum disorder (ASD). It covers a large spectrum of symptoms, skills, and levels of impairment. ASD ranges in severity from a handicap that somewhat limits an otherwise normal life to a devastating disability that may require institutional care.

Children with autism have trouble communicating. They have trouble understanding what other people think and feel. This makes it very hard for them to express themselves either with words or through gestures, facial expressions, and touch.

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Anxiety is denoted by excessive worrying, uneasiness, apprehension and fear about future uncertainties based on real or imaginary events, which might affect both psychological and physical health. Often, counseling is sufficient to help overcome your anxiety, but medication management is necessary if anxiety is of severe nature or biological factors are involved. But you may experience anxiety that is persistent, seemingly uncontrollable, and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

Anxiety disorders are real, serious medical conditions – just as real and serious as physical disorders such as heart disease or diabetes. Anxiety disorders are the most common and pervasive mental disorders in the United States.

The term “anxiety disorder” refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD),  panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective autism, separation anxiety, and specific phobias.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time as depression.

Irritable Bowel Syndrome, also called IBS, is characterized by abdominal pain, cramping, bloating, gas, constipation, and diarrhea

Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general for more than two weeks and when the feelings interfere with daily activities. Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. At any point in time, 3 to 5 percent of people suffer from major depression; the lifetime risk is about 17 percent.

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Depression is denoted by low esteem and low mood levels, and significant loss of interest or pleasure in normally enjoyable activities. Often, counseling is sufficient to help overcome your anxiety, but medication management is necessary if anxiety is of severe nature or biological factors are involved. Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

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Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People suffering from schizophrenia may feel like they have lost touch with reality. Although schizophrenia is not as common as other types of mental disorders, its symptoms can be hazardous.

Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too.

The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:

  • Hallucinations
  • Delusions
  • Thought disorders (unusual or dysfunctional ways of thinking)
  • Movement disorders (agitated body movements)

Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include:

  • “Flat affect” (reduced expression of emotions via facial expression or voice tone)
  • Reduced feelings of pleasure in everyday life
  • Difficulty beginning and sustaining activities
  • Reduced speaking

Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:

  • Poor “executive functioning” (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with “working memory” (the ability to use information immediately after learning it)
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Attention Deficit Hyperactivity Disorder is an ordinary condition that affects children, adolescents and adults. We have psychiatrists who offer medication management for ADHD treatment, and counseling is also advisable for the affected person/family. Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:

  • are more severe
  • occur more often
  • interfere with or reduce the quality of how they functions socially, at school, or in a job
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Addiction/Substance Abuse

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Drug addiction is a chronic disease denoted by drug seeking and use that is compulsive, or hard to control, despite unbearable outcomes. However, addiction can be treated and successfully managed. Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a “relapsing” disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It’s common for a person to relapse, but relapse doesn’t mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.

Most drugs affect the brain’s “reward circuit,” causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

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Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

  • Bipolar I Disorder—defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
  • Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
  • Cyclothymic Disorder (also called cyclothymia)—defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
  • Other Specified and Unspecified Bipolar and Related Disorders—defined by bipolar disorder symptoms that do not match the three categories listed above.
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Psychotherapy

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Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.

Problems helped by psychotherapy include difficulties in coping with daily life; the impact of trauma, medical illness or loss, like the death of a loved one; and specific mental disorders, like depression or anxiety. There are several different types of psychotherapy and some types may work better with certain problems or issues. Psychotherapy may be used in combination with medication or other therapies.

Psychotherapy is often used in combination with medication to treat mental health conditions. In some circumstances medication may be clearly useful and in others psychotherapy may be the best option. For many people combined medication and psychotherapy treatment is better than either alone. Healthy lifestyle improvements, such as good nutrition, regular exercise and adequate sleep, can be important in supporting recovery and overall wellness.

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A psychiatric consultation is a comprehensive evaluation of the psychological, biological, medical and social causes of emotional distress. Together, we will review your current stresses and problems and any past medical or psychiatric conditions. This information, as well as any necessary medical records and laboratory tests, will lead to the formulation of a comprehensive treatment plan.

A psychiatric consultation can help you understand the sources of problems from three points of view: biological (i.e. heredity, hormones, nutrition, and physical illness), psychological (i.e. current life stressors, childhood experiences), and social (i.e. cultural differences, family relationships, prejudice). It is this capacity to evaluate the causes of emotional distress from each of these perspectives that makes psychiatry unique. Many people find that a psychiatric consultation gives them a new perspective and hope for the future.

A simple psychiatric consultation takes two to three sessions. In order to make this short period of time as productive as possible, please gather together all of your records and recollections of previous treatments before the first session. Part of this process includes filling out a comprehensive patient survey.

A comprehensive psychiatric consultation takes at least four sessions. It may also involve time speaking with previous care providers or other clinicians at Eximous integrated health solutions. Generally, there is some staff time to gather medical records. Also, staff may chart this information graphically so that we can identify patterns of response or partial response (in a Life Chart). Gathering and analyzing this information may take many hours.

Generally two thirds of a consultation will be spent reviewing the nature of your problems, their origins, and the course of any previous treatment. The last third of a consultation is devoted to discussing the assessment of your difficulties, and any recommendations our doctors have for treatment.

Many patients are referred for psychiatric consultation by therapists who wonder if psychiatric medications might benefit their patients. A careful evaluation of this question is usually part of psychiatric consultation; however a consultation is much more than just an assessment for medications. Our commitment as your consultant is to review all the reasonable alternative treatments, their likely benefits and any possible risks associated with these treatments.A good psychiatric consultation requires expertise.

Medication Review

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Sleep problems

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Sleep problems, including snoring, sleep apnea, insomnia, sleep deprivation, and restless legs syndrome, are common. Good sleep is necessary for better health and can affect hormone levels, mood and weight. A sleep disorder is a condition that frequently impacts your ability to get enough quality sleep. While it’s normal to occasionally experience difficulties sleeping, it’s not normal to regularly have problems getting to sleep at night, to wake up feeling exhausted, or to feel sleepy during the day.

Frequently having trouble sleeping can be a frustrating and debilitating experience. You sleep badly at night which leaves you feeling dead-tired in the morning and whatever energy you have quickly drains away throughout the day. But then, no matter how exhausted you feel at night, you still have trouble sleeping. Therefore, the cycle begins again, taking a serious toll on your mood, energy, efficiency and ability to handle stress. Ignoring sleep problems and disorders can damage your physical health and lead to weight gain, accidents, impaired job performance, memory problems, and put a strain on your relationships. If you want to feel your best, stay healthy, and perform up to your potential, quality sleep is a necessity, not a luxury.

Even if you’ve struggled with sleep problems for so long that it seems normal, you can still learn to sleep better. You can start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine. If self-help doesn’t do the trick, you can turn to sleep specialists who are trained in sleep medicine. Together, you can identify the underlying causes of your sleeping problem and find ways to improve your sleep and quality of life.

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