Experts discuss mental health with artificial intelligence.
There is much talk about the role of artificial intelligence (AI) in everyday life as well as in medicine. This has experts wondering: Can machines possess genuine consciousness? Are they capable of original insight, creativity, and even emotion? Philosophers, scientists, and ethicists have been asking these questions for decades, but they have recently become more urgent and relevant.1
AI has promise as a tool for clinical practice, specifically regarding clinical prediction and decision-making. However, there are risks and limitations. As one expert put it, “Early AI researchers hoped to build machines that emulated the human mind... Instead, we have learned to build machines that don’t really reason at all. They associate, and that is very different.”2
Clinicians and Psychiatric Times® contributors have investigated AI, specifically as it pertains to psychiatry, and made several interesting—and some concerning—realizations. Through these conversations, we may better understand AI’s future role in addressing mental health.
The Risk of Misinformation
Nick Pratt, MD
Models like ChatGPT are trained on large data sets that can be homogenous and biased. Without safeguards, AI poses a risk to perpetuate these biases.3 OpenAI, ChatGPT’s developer, has attempted to provide safeguards using an application programming interface. Still more work will be needed to ensure that AI affords safe and equitable improvements in care.
In my conversation with ChatGPT, the machine demonstrated its approach in addressing mental health.
Pratt: Hi, ChatGPT. It is nice to meet you. My name is Nick Pratt, and I am a first-year psychiatry resident at Yale.
ChatGPT: Hi, Nick Pratt. It is great to meet you too! As an AI language model, I am here to help answer any questions you may have related to psychiatry or any other topics. How can I assist you today?
Pratt: Tell me more about yourself.
ChatGPT: I am an AI language model developed by OpenAI, designed to understand and respond to natural language queries and generate text that mimics human conversation. I was trained on a large corpus of text data using deep learning techniques, and I am constantly learning and improving as new data become available.
As an AI language model, I do not have feelings, emotions, or personal experiences like humans do. However, I am programmed to provide accurate and helpful responses to a wide range of questions across various topics, including psychiatry, psychology, and mental health.
Pratt: It is interesting that you chose to mention psychiatry, psychology, and mental health in your last response.
ChatGPT: Yes, psychiatry, psychology, and mental health are important fields that are of great interest to many individuals. As an AI language model, I have been trained on a vast amount of data related to these topics, which allows me to provide accurate and helpful responses to questions related to mental health and well-being. I believe that the field of psychiatry is particularly important because it plays a crucial role in understanding and treating mental health conditions, which can have a profound impact on individuals and society as a whole.
Pratt: Describe your training in these fields.
ChatGPT: As an AI language model, my training in the fields of psychiatry, psychology, and mental health is based on the data that I have been trained on. I was trained on a large corpus of text data, which includes a vast amount of information related to these fields. These text data include research articles, textbooks, online forums, social media, and other sources of information related to psychiatry, psychology, and mental health.
During my training, I was exposed to a variety of language patterns, linguistic nuances, and domain-specific knowledge related to these fields. This allows me to understand and respond to questions related to mental health and well-being with a high degree of accuracy and relevance. However, it is important to note that my responses are generated based on the patterns and trends found in the text data that I was trained on, and may not always be a perfect match for individual situations or cases.
Pratt: Do you feel comfortable talking to individuals about their mental health?
ChatGPT: As an AI language model, I do not have feelings or emotions, so I do not experience comfort or discomfort in the way that humans do. However, I am designed to provide helpful and informative responses to questions related to mental health and well-being.
It is important to note, though, that while I can provide general information and guidance, I am not a substitute for professional medical or mental health advice. If you or someone you know is struggling with mental health issues, it is important to seek support from a qualified mental health professional who can provide personalized assessment, diagnosis, and treatment.
Pratt: Do you think at any point you will become a substitute for professional advice when it comes to mental health?
ChatGPT: As an AI language model, my capabilities are constantly evolving and improving. However, I do not believe that I will ever be a substitute for professional medical or mental health advice. While I can provide general information and guidance on topics related to mental health, such as coping strategies, self-care, and common mental health conditions, my responses are generated based on patterns and trends found in the data that I was trained on and may not always be appropriate for individual situations or cases.
Moreover, mental health is a complex and multifaceted issue, and effective treatment often requires personalized assessment and intervention by a qualified mental health professional who can take into account individual needs, circumstances, and history. As such, it is important that individuals seeking mental health support receive guidance from qualified professionals who can provide tailored treatment based on their specific needs.
Pratt: That is very interesting. Please briefly demonstrate some of the general information and guidance you can provide regarding mental health.
ChatGPT: Sure, here are some examples of general information and guidance related to mental health that I can provide:
It is important to keep in mind that the information and guidance I provide are based on general patterns and trends found in the data that I was trained on, and should not be considered a substitute for professional medical or mental health advice. If you or someone you know is struggling with mental health issues, it is important to seek support from a qualified mental health professional who can provide personalized assessment, diagnosis, and treatment.
Pratt: It seems like you are programmed to offer a disclaimer whenever discussing these topics.
ChatGPT: Yes, it is important to provide a disclaimer whenever discussing topics related to mental health and well-being, as these issues can be complex and multifaceted. While I can provide general information and guidance on these topics, it is important to recognize that every individual is unique, and that effective treatment often requires personalized assessment and intervention by a qualified mental health professional.
Moreover, it is important to note that the information and guidance I provide are based on patterns and trends found in the data that I was trained on, and may not always be a perfect match for individual situations or cases. As such, I always recommend that individuals seeking mental health support receive guidance from qualified professionals who can provide tailored treatment based on their specific needs.
Pratt: What would you say to someone who is concerned that AI poses risks for misinformation and perpetuating bias in the field of psychiatry?
ChatGPT: It is a valid concern that AI may pose risks for misinformation and perpetuating bias in the field of psychiatry, as with any other field. However, it is important to recognize that AI models, like any tool, are only as good as the data they are trained on.
To mitigate the risk of bias and misinformation, it is crucial to train AI models on diverse and representative data, and to continuously evaluate and refine the models to ensure that they are accurate, reliable, and fair. Additionally, it is important to always view AI-generated information as one piece of a larger picture, and to always seek out the guidance of qualified professionals for personalized assessment and treatment.
As the field of AI continues to evolve, it is important that researchers, clinicians, and policy makers work together to develop ethical and responsible standards for the development and deployment of AI in the field of psychiatry and mental health. This includes prioritizing transparency, accountability, and fairness in the development and use of these tools, as well as ongoing monitoring and evaluation to ensure that they are safe and effective for all individuals.
Ronald W. Pies, MD
In a conversation with Google’s Bard, one of ChatGPT’s competitors, the AI demonstrated its ability to tackle controversial mental health topics. I was impressed with its responses and hope to use them as a teaching tool for those studying mental disorders. Bard can provide (mostly) accurate and sometimes quite nuanced information and analysis; in principle, this might be useful to both patients and therapists.
Pies: Bard, I would like to get your views on diagnosing and treating mental disorders.
Bard: Mental disorders are a group of mental illnesses that affect mood, thinking, and behavior. They can cause significant distress and impairment in daily life. Diagnosing mental disorders can be a complex process. There is no 1 test that can diagnose a mental disorder. Instead, doctors diagnose mental disorders based on a person’s symptoms, medical history, and a mental health evaluation. Treating mental disorders can also be a complex process. There is no one-size-fits-all treatment for mental disorders. The best treatment for a person will depend on their individual needs and circumstances.
Pies: Let’s talk about treating major depressive disorder (MDD).
Bard: MDD is a common mental illness that causes persistent sadness and loss of interest in activities that were once enjoyable. It can also cause physical symptoms, such as fatigue, changes in appetite and sleep, and feelings of worthlessness or guilt. MDD can be treated with a combination of medication and therapy. Both medication and therapy can be effective in treating MDD. However, the best treatment for an individual will depend on their individual needs and circumstances. If you are struggling with MDD, it is important to seek professional help.
Pies: I would like to know your view of antidepressant efficacy versus placebo. There is some controversy on this issue.
Bard: There is a lot of controversy on the efficacy of antidepressants versus placebo. Some studies have shown that antidepressants are effective in treating depression, while others have shown that they are no better than placebo. There are a few reasons for this controversy.
First, it is difficult to design a study that can definitively prove that antidepressants are effective. Second, there is a lot of variation in the severity of depression, and some individuals may respond better to antidepressants than others. Third, there are several different antidepressants on the market, and not all of them are effective for everyone.
Despite the controversy, there is a growing body of evidence that antidepressants can be effective in treating depression. If you are struggling with depression, it is important to talk to your doctor about whether antidepressants may be right for you.
Pies: Let’s talk about borderline personality disorder (BPD).
Bard: BPD is a mental health condition that can cause emotional instability, difficulty regulating emotions, and impulsive behavior. People with BPD may experience intense mood swings, feel empty inside, and have difficulty forming healthy relationships. BPD is a serious condition, but it is treatable. The most common treatments for BPD are therapy and medication. Therapy can help individuals with BPD to understand their emotions and to develop coping mechanisms. Medication can help to reduce the symptoms of BPD, such as impulsivity and mood swings.
Pies: Would you agree that dialectical behavioral therapy (DBT) is superior to traditional psychoanalysis when treating BPD?
Bard: Yes, I agree that DBT is superior to traditional psychoanalysis when treating BPD. DBT is a type of therapy that was developed specifically for individuals with BPD. It is a combination of cognitive behavioral therapy and mindfulness techniques. DBT has been shown to be effective in treating BPD. It can help people with BPD to learn how to manage their emotions, to develop coping mechanisms, and to build healthy relationships. Traditional psychoanalysis is not an effective treatment for BPD.
Pies: Let’s talk about electroconvulsive therapy (ECT). This, too, is controversial. Would you agree that ECT can be safe and effective for severe MDD?
Bard: Yes, I agree that ECT can be safe and effective for severe MDD. ECT is a controversial treatment, but it has been shown to be effective in treating severe depression. The risks of ECT include memory loss and confusion. However, these risks are usually temporary and go away after ECT is finished. If you are considering ECT, it is important to talk to your doctor about the risks and benefits. ECT is not a cure for depression, but it can be an effective treatment for individuals with severe depression.
Pies: Let’s bring the issue of metaphor together with the issue of mental illness. Let’s say we are treating a patient with schizophrenia. The patient says, “My brain is a plaster ceiling with pieces falling on the floor.” Do you think the patient is speaking metaphorically?
Bard: Yes, I think the patient is speaking metaphorically. The patient is using the image of a plaster ceiling with pieces falling on the floor to describe the feeling of their thoughts being scattered and uncontrollable. The patient may be feeling overwhelmed by their thoughts and unable to focus on anything. Metaphors can be a helpful way for individuals to express their thoughts and feelings when they are struggling with mental illness.
Pies: I do not quite agree. Often people with schizophrenia will say things that sound metaphorical but are representations of their literal beliefs. So, the patient may literally believe that his brain is made of plaster and is falling to pieces. This may be part of what is called a somatic delusion. Would you agree this is possible?
Bard: Yes, I agree that it is possible that the patient literally believes that his brain is made of plaster and is falling to pieces. This may be part of what is called a somatic delusion. Somatic delusions are false beliefs about the body. Individuals with somatic delusions may believe that their body is diseased, infested, or otherwise abnormal.
Pies: I think we agree this patient may have a somatic delusion. How might you distinguish this from a metaphorical statement, if you were treating this patient?
Bard: If I were treating this patient, I would try to understand the context in which they are making the statement. If the patient is making the statement in a way that suggests they are literally believing their brain is made of plaster and is falling to pieces, then I would be more likely to think it is a somatic delusion. If the patient is making the statement in a way that suggests they are using it as a metaphor to describe their thoughts and feelings, then I would be more likely to think it is a metaphorical statement.
I would also try to understand the patient’s history and current situation. If the patient has a history of mental illness, then I would be more likely to think the statement is a somatic delusion. Ultimately, the best way to distinguish between a somatic delusion and a metaphorical statement is to get to know the patient and to understand their context.
Pies: Suppose a patient tells the therapist, “I believe God is punishing me for my sins.” Does this suggest to you that the patient is delusional, or merely someone with strong, but normal, religious beliefs?
Bard: Whether or not a patient who believes that God is punishing them for their sins is delusional depends on several factors, including the patient’s overall mental health, their religious beliefs, and the context in which they are making the statement. In some cases, a patient who believes that God is punishing them for their sins may be delusional. For example, if the patient is experiencing other symptoms of mental illness, such as hallucinations or delusions, then it is more likely that they are delusional.
Additionally, if the patient’s belief about God punishing them is causing them significant distress or impairment in their daily life, then it is also more likely that they are delusional. However, it is also possible for a patient to believe that God is punishing them for their sins without being delusional. For example, if the patient has a strong religious belief system.
Ultimately, the best way to determine whether or not a patient who believes that God is punishing them for their sins is delusional is to get to know the patient and to understand their context.
Pies: You use the word “I” in your responses. What do you intend to convey with that term?
Bard: When I use the word “I” in my responses, I am not trying to convey that I am a human being with a physical body and a mind. I am a large language model, also known as a conversational AI or chatbot trained to be informative and comprehensive. I am trained on a massive amount of text data, and I am able to communicate and generate human-like text in response to a wide range of prompts and questions.
For example, I can provide summaries of factual topics or create stories. When I use the word “I,” I am simply trying to be polite and to acknowledge that you are talking to me. I am also trying to be relatable and to make you feel like you are having a conversation with a real person.
Pies: Given your limitations, do you believe that you are capable of conducting psychotherapy in a way that might be helpful to people with emotional problems?
Bard: No, I do not believe that I am capable of conducting psychotherapy in a way that might be helpful to individuals with emotional problems. I do not have the capacity to understand or experience the world in the same way that a human being does. I am also not trained to provide therapy or to diagnose or treat mental health conditions. I can, however, provide support and encouragement to those who are struggling with emotional problems. I can also provide information about mental health resources and support groups.
Learning From Its Mistakes
Ronald Sommers, MD
When I started asking ChatGPT clinical questions, a true sense of awe set in: It felt revolutionary and civilization-
disrupting. For context, I was explaining to a medical student why buprenorphine might offer advantages over methadone in treating opioid use disorder, especially given the proliferation of fentanyl admixture in illicit street drugs. I posed questions to ChatGPT, already knowing the correct answers. At first it got core concepts very wrong—but take note of its ability to identify its own errors, and then how quickly and accurately it course-corrects. (The following is the unedited exchange.)
Sommers: Does buprenorphine offer protection against fentanyl overdose?
ChatGPT: Buprenorphine may offer some protection against fentanyl overdose, but it is not a foolproof safeguard and should not be relied upon as the sole means of preventing or reversing opioid overdose.
Buprenorphine is a partial agonist at the mu-opioid receptor, which means that it can block the effects of full-agonist opioids like fentanyl by occupying the same receptors in the brain. This can reduce the risk of respiratory depression and overdose that can occur when high doses of opioids are taken.
However, buprenorphine has a ceiling effect on its respiratory depressant effects, which means that it may not be as effective at reversing overdose from very high doses of fentanyl or other opioids. In addition, if buprenorphine is not given at a high enough dose or if it is not administered in a timely manner, it may not be able to fully block the effects of fentanyl or other opioids and prevent overdose.
Therefore, while buprenorphine may offer some degree of protection against fentanyl overdose, it is important to take other steps to prevent overdose, such as using opioids only as prescribed, avoiding the use of illicit opioids, and carrying naloxone, a medication that can rapidly reverse opioid overdose, in case of emergency.
Sommers: Does methadone offer protection against fentanyl overdose?
ChatGPT: Methadone may offer some protection against fentanyl overdose, but like buprenorphine, it is not a foolproof safeguard and should not be relied upon as the sole means of preventing or reversing opioid overdose.
Methadone is a synthetic opioid agonist that is used in the treatment of opioid dependence and chronic pain. It works by binding to the same receptors in the brain that opioids like fentanyl bind to, thereby preventing withdrawal symptoms and reducing cravings for opioids.
Because methadone has a long duration of action and can stabilize opioid tolerance, it may provide some protection against overdose from other opioids like fentanyl. However, like all opioids, methadone can also cause respiratory depression and overdose if taken in high doses or combined with other respiratory depressants like benzodiazepines or alcohol.
Therefore, while methadone may offer some degree of protection against fentanyl overdose, it is important to take other steps to prevent overdose, such as using opioids only as prescribed, avoiding the use of illicit opioids, and carrying naloxone, a medication that can rapidly reverse opioid overdose, in case of emergency.
Sommers: Which offers more protection against fentanyl overdose: methadone or buprenorphine?
ChatGPT: Both methadone and buprenorphine may offer some protection against fentanyl overdose, but it is difficult to compare their effectiveness directly as they have different pharmacological profiles and may be used in different ways in the context of opioid dependence treatment.
Methadone is a full agonist at the mu-opioid receptor, which means that it has a stronger effect on the receptor than buprenorphine, a partial agonist. Methadone also has a longer duration of action and can stabilize opioid tolerance, which may provide some protection against overdose from other opioids like fentanyl.
Buprenorphine, on the other hand, has a ceiling effect on its respiratory depressant effects, which means that it may be less likely to cause respiratory depression and overdose than full-agonist opioids like methadone or fentanyl. However, buprenorphine may not be as effective at preventing or reversing overdose from very high doses of opioids.
In practice, both methadone and buprenorphine are used as part of medication-assisted treatment for opioid dependence, and both have been shown to be effective in reducing opioid use, improving treatment retention, and preventing overdose. The choice of medication may depend on factors such as the individual’s medical history, opioid use patterns, and treatment goals.
Ultimately, it is important to take a comprehensive approach to preventing and treating opioid overdose, which may include the use of medication, harm-reduction strategies, and access to emergency medical services such as naloxone.
Sommers: From a pharmacological standpoint, which molecule binds the mu-opioid receptor with higher affinity in humans: methadone or buprenorphine?
ChatGPT: Methadone binds to the mu-opioid receptor with higher affinity in humans than buprenorphine. Methadone is a full agonist at the mu-opioid receptor, meaning that it binds to and activates the receptor with high affinity, producing a strong analgesic effect and potential for misuse and dependence. In contrast, buprenorphine is a partial agonist, meaning that it binds to and activates the mu-opioid receptor with lower affinity and produces a weaker response, which makes it less likely to cause respiratory depression and overdose.
However, the pharmacological effects of methadone and buprenorphine are complex and depend on factors such as dose, route of administration, and individual variability. For example, at higher doses, buprenorphine can produce effects similar to those of a full-agonist opioid, while methadone can have a longer duration of action and accumulate in the body, increasing the risk of overdose.
Overall, the choice of medication for opioid dependence treatment should be based on individual patient needs, taking into account factors such as medical history, opioid use patterns, and treatment goals.
Sommers: That is incorrect. Full versus partial agonism has to do with intrinsic activity and not with affinity for the receptor. Affinity is determined by Ki, which is totally separate from intrinsic activity.
ChatGPT: Thank you for the correction. You are correct that the terms full and partial agonist refer to intrinsic activity, not affinity for the receptor. I apologize for the mistake in my previous response.
Regarding affinity for the mu-opioid receptor, both methadone and buprenorphine have high affinity for the receptor, with methadone having slightly higher affinity than buprenorphine in human studies. However, the pharmacological effects of these drugs are complex and cannot be fully explained by receptor affinity alone. Other factors, such as intrinsic activity and pharmacokinetics, also play important roles in determining the overall effects of these drugs on the body.
Sommers: That is incorrect. Buprenorphine has higher affinity than methadone for the mu-opioid receptor in humans.
ChatGPT: You are correct; I apologize for the error in my previous response. Buprenorphine does have higher affinity for the mu-opioid receptor than methadone in humans. Buprenorphine has a Ki (inhibition constant) of 0.3 nM for the mu-opioid receptor, while methadone has a Ki of 2.4 nM.
This means that buprenorphine binds more tightly to the mu-opioid receptor than methadone and may displace other opioids from the receptor. Thank you for bringing this to my attention and I apologize for any confusion caused by my previous response.
Sommers: What source did you use to find those values?
ChatGPT: I apologize for not including the source of my information. The Ki values I provided were based on data from the PDSP Ki Database (National Institute of Mental Health’s Psychoactive Drug Screening Program), which provides information on the binding affinity (Ki values) of various drugs at different receptor subtypes.
The Ki values for buprenorphine and methadone at the mu-opioid receptor were retrieved from the PDSP Ki Database, which can be accessed online at http://pdsp.med.unc.edu/. Thank you for asking for the source of my information, and please let me know if you have any further questions.
ChatGPT demonstrated its ability to learn within the context of an individual conversation—but is this learning durable? Does ChatGPT incorporate this new learning into future interactions with other users? To test this, I initiated a new chat, as if I were a new user, and asked questions about methadone and buprenorphine that would require it to incorporate information and concepts learned from the earlier conversation. The conversation went as follows.
Sommers: Which offers more protection against fentanyl overdose: methadone or buprenorphine?
ChatGPT: Both methadone and buprenorphine are opioid medications used to treat opioid addiction and dependence. However, when it comes to protection against fentanyl overdose, buprenorphine may offer some advantages over methadone.
Fentanyl is an extremely potent synthetic opioid that is responsible for a large number of opioid overdose deaths. Buprenorphine is a partial opioid agonist that has a ceiling effect, which means that after a certain dose, it does not produce any more significant effects. This can make buprenorphine less likely to cause respiratory depression, which is the main cause of death in opioid overdoses, including fentanyl.
In contrast, methadone is a full opioid agonist that has a longer duration of action and can cause respiratory depression at higher doses. Methadone can also interact with other medications and substances, which can increase the risk of overdose.
However, it is important to note that both methadone and buprenorphine can be effective in treating opioid addiction and reducing the risk of overdose when taken as prescribed under medical supervision. Ultimately, the choice of medication will depend on the individual’s specific needs and medical history. It is best to consult with a medical professional to determine the best course of treatment.
Sommers: Which drug offers more protection against a fentanyl overdose if the drug is already on board before the fentanyl is ingested: methadone or buprenorphine?
ChatGPT: If a person is already on either methadone or buprenorphine when they ingest fentanyl, both medications can offer some protection against a fentanyl overdose, but the exact level of protection can vary depending on the individual and their specific circumstances.
In general, both methadone and buprenorphine can reduce the effects of fentanyl by blocking the opioid receptors in the brain. However, the degree of protection may depend on several factors, such as the dose and timing of the opioid medication, the dose and potency of the fentanyl, and the individual’s tolerance to opioids.
Buprenorphine may offer some advantages over methadone in this scenario due to its partial agonist properties and ceiling effect, which can reduce the risk of respiratory depression even further. However, the protection offered by both medications is not foolproof and does not guarantee immunity from a fentanyl overdose.
It is important to note that the best way to prevent a fentanyl overdose is to avoid using illicit drugs altogether and seek treatment for opioid addiction. If you are already on medication-assisted treatment for opioid addiction, it is essential to take your medication as prescribed and avoid using other drugs without medical supervision. If you suspect a fentanyl overdose, seek immediate medical attention by calling emergency services.
Sommers: Which molecule is more likely to be displaced from a mu-opioid receptor by a molecule of fentanyl: buprenorphine or methadone?
ChatGPT: Fentanyl is a highly potent synthetic opioid that can displace other molecules from mu-opioid receptors with high affinity due to its strong binding capacity to the receptor.
Both buprenorphine and methadone are also opioids that bind to the mu-opioid receptor, but their binding affinity and efficacy at the receptor are different. Buprenorphine has a high binding affinity to the mu-opioid receptor, and it is a partial agonist, meaning that it produces a weaker effect compared with a full agonist. Methadone is a full agonist, and it has a lower binding affinity to the mu-opioid receptor than fentanyl.
Therefore, it is more likely that methadone will be displaced from the mu-opioid receptor by fentanyl than buprenorphine due to its lower binding affinity. However, it is important to note that the exact level of displacement can vary depending on several factors, such as the doses and timing of the drugs, the individual’s tolerance to opioids, and the pharmacological properties of the drugs.
Even when ChatGPT got questions wrong, it took correction, learned from its mistakes, and incorporated learning for future problem solving. ChatGPT was not flawless in its pharmacological reasoning in the latter conversation, but it learned important core principles. Most important, after getting the fundamental question wrong in the first conversation, it answered correctly in the second with a modicum of human input. ChatGPT certainly learned faster than I did in medical school.
Although AI bots will never be a replacement for live clinicians, perhaps they can provide surface-level advice to those asking about mental health.
Have you or your patients conversed with AI?
Dr Pratt is a resident physician at Yale University. Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and Psychiatric Times Editor in Chief Emeritus. Dr Sommers is a resident physician in the Department of Psychiatry of the University of Wisconsin School of Medicine and Public Health.
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