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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 10 to 34 of 34. Go back in thread:
Posted by Phillipa on October 4, 2006, at 23:14:38
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » Siouxgie, posted by Phillipa on October 4, 2006, at 22:18:18
Racer you too? I didn't know. Love Phillipa
Posted by sregan on October 5, 2006, at 15:53:02
In reply to Depression-Anxiety-Panic-I can't leave my house, posted by Siouxgie on October 4, 2006, at 19:06:42
> I have been suffering from depression for a while. In the past three weeks I have been suffering horribly. I've isolated myself alone in my house, have only been able to go to work 5 out of 10 days, and have started using ilicit drugs for the first time. What do I address first?
Do you feel better in the evening and worse in the morning? If anxiety your most prevalent symptom? Have you any benzos (Valium, Xanax, Klonopin?) if so they should/could help you sleep if taken before bed.
Posted by fca on October 5, 2006, at 18:17:43
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » Siouxgie, posted by Racer on October 4, 2006, at 22:41:25
the kind words. I am not sure if I am one "smart fellow: but I have surely paid my dues as patient, professional and father. I do try and think about what I say--I am way past writing to see my self in print. I only wish I knew more. There are some great posters on this Board.
BTW Siouxge, did you get out of the house today--I thought of you an several ocassions--Is your therapy CBT and just out of perverse curiousity what illegal drugs were you using. Have you given any thought to bipolar disorder (mixed or rapid cycling), I ask that because of insomnia, panic and anxiety. Do not take this as a dx--much to speculative at this point Thanks fca
Posted by Siouxgie on October 5, 2006, at 22:27:54
In reply to Re: Depression-Anxiety-Panic-I can't leave my house, posted by sregan on October 5, 2006, at 15:53:02
> > I have been suffering from depression for a while. In the past three weeks I have been suffering horribly. I've isolated myself alone in my house, have only been able to go to work 5 out of 10 days, and have started using ilicit drugs for the first time. What do I address first?
>
> Do you feel better in the evening and worse in the morning? If anxiety your most prevalent symptom? Have you any benzos (Valium, Xanax, Klonopin?) if so they should/could help you sleep if taken before bed.
>
> I don't really have worse or better times. Anxiety is the most prevalent symptom at this point. The Dr. prescribed Xanax when this all started. It didn't seem to work consistently. Sometimes I would take the prescribed dose and it wouldn't work-then I would double it - no effect. The next time I took it, it would make me sleep for 14 hours. So, I stopped taking it. I'm really at a loss about getting to sleep. I've cut out caffeine after 11 a.m., stopped watching TV before bed, tried baths, meditation tapes, etc. I think I am so worried about not sleeping that I don't.
Posted by Siouxgie on October 5, 2006, at 22:43:33
In reply to Re: Depression-Anxiety-Panic-Racer, Thanks for, posted by fca on October 5, 2006, at 18:17:43
> the kind words. I am not sure if I am one "smart fellow: but I have surely paid my dues as patient, professional and father. I do try and think about what I say--I am way past writing to see my self in print. I only wish I knew more. There are some great posters on this Board.
>
> BTW Siouxge, did you get out of the house today--I thought of you an several ocassions--Is your therapy CBT and just out of perverse curiousity what illegal drugs were you using. Have you given any thought to bipolar disorder (mixed or rapid cycling), I ask that because of insomnia, panic and anxiety. Do not take this as a dx--much to speculative at this point Thanks fca
>
> I did get out of the house today, but it was a close one. I managed 2 hours sleep, but woke up late...which turned into an anxiety episode.I don't know what CBT is, please explain.
I was smoking pot to try to make me sleep, but it didn't work. I know it's not what people consider a "hard" drug, but I stand to lose a lot if I am drug-tested.
I was "labeled" with Major Depressive Disorder. I've been doing a lot of reading in the past few days and bi-polar doesn't describe my behavior.
It's definitely depression that manifests in two different ways with one common factor - isolation. The first is sadness and sleeping (and when I say sleeping-I mean 48 hours at a rip of sleep, not laying around and napping on and off). It seems that if I can't resolve it during or right after the sleep stage, it turns into insomnia and not eating. I really think the anxiety/panic comes from the insomnia.I thought about this site many times today and am sure that the fact I got feedback without judgement was part of the reason I got the gumption to move on today. I'm at my wits end with not being able to help myself.
Posted by fca on October 6, 2006, at 12:31:40
In reply to Re: Depression-Anxiety-Panic-Racer, Thanks for, posted by Siouxgie on October 5, 2006, at 22:43:33
Siouxge--day by day huh. I do know how difficult it can be but you seem to be pulling an additional load. CBT stands for Cognitive Behavioral Treatment which is generally recognized as the most efficatious for anxiety disorders and depression. Involves very direct cognitive and behavioral restructuring. The anxiety and panic could certainly be aggravated by the insomnia. The only reson I mention the bipolar (mixed) is that it is aggravated by typical ADs which can easily lead to a type of hypomania. It is clear that any recovery plan has to forth rightly address the insomnia and sleeping patterns. No one knows better than you what you are experiencing. Please stay in touch and ask for any help we can offer. No one can be as helpful as a pdoc you trust. My Best fca
Posted by Squiggles on October 6, 2006, at 19:30:30
In reply to Re: Depression-Anxiety-Panic-I can't leave my house, posted by Siouxgie on October 5, 2006, at 22:27:54
I hope a dr. can give you an antidepressant;
i can tell you that Xanax is for panic attacks,
and only lasts for 2-4 hrs. max; i would ask
for a longer-life benzo to go along with
an antidepressant;good luck - hope you see a good dr.
Squiggles
Posted by Declan on October 6, 2006, at 22:16:01
In reply to Re: Depression-Anxiety-Panic-Racer, Thanks for, posted by Siouxgie on October 5, 2006, at 22:43:33
Isolation is for many the main feature of depression, IMO.
Posted by Phillipa on October 6, 2006, at 22:22:40
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » Siouxgie, posted by Racer on October 4, 2006, at 22:41:25
Declan do you leave yours? Love Phillipa
Posted by getinwl72 on October 7, 2006, at 21:01:52
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » Racer, posted by Phillipa on October 6, 2006, at 22:22:40
Posted by getinwl72 on October 7, 2006, at 21:12:00
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » Racer, posted by Phillipa on October 6, 2006, at 22:22:40
Hi, this is my first post. But I have been reading for months. I decided tonight I would join my fellow survivors and post. I, too have problems leaving the house. I want to, but I just cannot. I work from home and since I started a few years ago it has just made it worse for me. I have gotten dressed, gone to the mall, parked and just turned right around and not gone in. I once went to buy a television but was too afraid to ask someone for help to get it off the shelf for me, so I didn't buy it. I am avoiding all social situations. It has just gotten worse the older I get. It is a very sad way to live. I avoid all community and work functions because I feel different. I guess I just don't feel safe. I stopped walking in my neighborhood because I think my neighbors don't like me. But I shoudn't even care. I have gained weight as a result. I have just shut down. I wish I could find my way back to the world. I feel like I am just watching life happen for everyone else. I take Cymbalta 60mg, Topamax 100mg and Xanax 1mg for sleep(anxiety) in the evening. I also take Provigil for alertness as I have Multiple Scleroses and the Cymbalta makes me fatigue. I am actually going to start taking it at night. I refuse to take any medication that will cause weight gain. I have taken them all. I really feel like there are no options left for me. I do worry about my daily Xanax a little but I think with 1mg I am OK.
Posted by Phillipa on October 7, 2006, at 21:53:49
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous, posted by getinwl72 on October 7, 2006, at 21:12:00
I'm glad you posted maybe we can help each other. I do ride my bike when weather permits . But MS would hinder that wouldn't it? Babblemail me anytime and we can talk in private. Love Phillipa
Posted by Racer on October 8, 2006, at 1:51:58
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous, posted by getinwl72 on October 7, 2006, at 21:12:00
Welcome to Babble. I'm glad you came out of the shadows...
I've already posted that I have problems leaving the house, so this is offered as something that's helping me, not as a "well, it's easy" solution. I've started taking a few classes as a local junior college, as a reason to leave the house on a regular basis. I only take a couple of classes, but it does mean that a couple of times a week, I leave the house for a reason other than going to the doctor's or therapist's. That's reason enough for me to do it. It might help you, too. I'm taking maths classes, so I also have a reason to spend time in the math lab, which also helps keep me in contact with the world.
Something like that might be a good start for you, too. Aside from academic classes, you might consider things like ceramics -- which can sometimes be good for MS, I've heard. Then there are those classes like "film appreciation" which can be as demanding as you choose to make them.
Another thing that might help if you have the physical strength, is volunteering in an area that you feel strongly about. Volunteer at the local animal shelter, where you'd be interacting with humans secondarily to working with the beasties; volunteer at the local Boys and Girls club, helping with homework; be a docent at the local herpetological museum; be an usher at the opera (you get to see the opera, too!); there are as many opportunities for volunteering as there are interests.
Or, if that's too much, see if there are city walks in your area -- walking tours of sites of local interest. Those are one shot deals, which makes them easier.
Ah, I've got a million ideas -- none of which I have done anytime lately, but at least I've signed up for classes, and attend them...
Good luck to you, and welcome again to BabbleLand!
Posted by Squiggles on October 8, 2006, at 6:53:03
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » getinwl72, posted by Racer on October 8, 2006, at 1:51:58
I've been reading Robert Whitaker's book
"Mad in America" (a real test for
my drug), and have got to the point where
he criticizes Kraepelin in his categorization
of mental illness, by pointing to an
'epidemic' lasting about 20 years of
a condition called 'encephalitis lethargica'.This condition leads to organic brain
disease (a term i don't understand-- is
it different from inorganic brain disease for
example;). Anyway, this condition was around
Kraepelin's time and Whitaker's point is that
many of the patients Kraepelin studied were
not infact manics or schizophrenics, but
could have had this brain virus.As much as I appreciate his historical
description of mental health in America,
this point I think is dubious; and once again
Kraepelin did not distinguish schizophrenia
as unique from manic depression.
He thought schizophrenia was a species of paranoia
or extreme anxiety. I don't know who made
that distinction, but it was not him-- perhaps
it preceded him; maybe it was Freud.Squiggles
Posted by SLS on October 8, 2006, at 7:23:19
In reply to Encephalitis lethargica » Racer, posted by Squiggles on October 8, 2006, at 6:53:03
> As much as I appreciate his historical
> description of mental health in America,
> this point I think is dubious; and once again
> Kraepelin did not distinguish schizophrenia
> as unique from manic depression.
> He thought schizophrenia was a species of paranoia
> or extreme anxiety. I don't know who made
> that distinction, but it was not him-- perhaps
> it preceded him; maybe it was Freud.
Wikipedia is pretty cool, but it is a collaborative effort of the public, so you have to be careful."The term, dementia praecox, was first used to describe a psychotic disorder by the French physician Benedict-Augustin Morel in 1853,"
"Dementia praecox ("premature dementia") is a term popularized by German psychiatrist Emil Kraepelin (1856-1926) in 1896, to describe the condition that would eventually be labeled schizophrenia."
So now, I do understand that Kraeplin could have done anything he wanted to with this term. However, you are saying that he demoted it from being a separate disorder to being a part of a spectrum of some sort?
- Scott
Posted by SLS on October 8, 2006, at 7:44:12
In reply to Re: Encephalitis lethargica » Squiggles, posted by SLS on October 8, 2006, at 7:23:19
> > As much as I appreciate his historical
> > description of mental health in America,
> > this point I think is dubious; and once again
> > Kraepelin did not distinguish schizophrenia
> > as unique from manic depression.
> > He thought schizophrenia was a species of paranoia
> > or extreme anxiety. I don't know who made
> > that distinction, but it was not him-- perhaps
> > it preceded him; maybe it was Freud.
>
>
> Wikipedia is pretty cool, but it is a collaborative effort of the public, so you have to be careful.
>
> "The term, dementia praecox, was first used to describe a psychotic disorder by the French physician Benedict-Augustin Morel in 1853,"
>
> "Dementia praecox ("premature dementia") is a term popularized by German psychiatrist Emil Kraepelin (1856-1926) in 1896, to describe the condition that would eventually be labeled schizophrenia."
>
> So now, I do understand that Kraeplin could have done anything he wanted to with this term. However, you are saying that he demoted it from being a separate disorder to being a part of a spectrum of some sort?
Now, I am a bit confused. Encyclopedia Britannica got it wrong? I hate it when things I learned in college become worthless. Seems like most of it.
"Kraepelin, Emil(born Feb. 15, 1856, Neustrelitz, Mecklenburg-Strelitz-died Oct. 7, 1926, Munich, Ger.) German psychiatrist. He taught at the Universities of Heidelberg and Munich, where he developed an influential classification system for mental illness, the Psychiatric Compendium (nine eds., 1883–1926). He was the first to distinguish (in 1899) between manic-depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia), and the first to distinguish three clinical varieties of the latter: catatonia, hebephrenia, and paranoia. "
http://www.answers.com/topic/emil-kraepelin
http://www.britannica.com/eb/article-9046179/Emil-Kraepelin
- Scott
Posted by Squiggles on October 8, 2006, at 8:13:57
In reply to Re: Encephalitis lethargica » Squiggles, posted by SLS on October 8, 2006, at 7:23:19
....
> So now, I do understand that Kraeplin could have done anything he wanted to with this term. However, you are saying that he demoted it from being a separate disorder to being a part of a spectrum of some sort?
>
>
> - ScottIf i understand him correctly (i have not
read all he has to say on it), in Chapter VII
of "Manic Depressive Insanity and Paranoia",
he does make a distinction between schizophrenia (a kind of paranoia) and other kinds of paranoia.Here is the distinction, from p.273 [reprint
ed. Ayer Co. Pub., 1990]:"*Schizophrenia*:--....many cases of apparent paranoia might really be imperfectly developed schizophrenias. In the individual case it is not always easy to decide the question. The delusional system of the paranoiac is internally more closed, more rounded off, more thought out; it takes account up to a certain degree of objections, tries to explain difficulties, in contrast to the abrupt delusional ideas of the paranoid schizophrenics, which are often contradictory to each other and also change frequently. In the latter, moreover, the signs of emotional devastation will not be missed, the slight internal interest not only in the surroundings, but also in the delusion, which at most leads to occasional outbursts, but provides no permanent motives for activity. In the paranoiac, also we meet now and then a reserved, repellent manner, and peculiarities of many kinds in the conduct of life. But his conduct is invariably far more grounded on deliberation or emotional processes than the impulsive peculiarities of the schizophrenic."
Despite this distinction based on observation of the inner and outer emotional state of the patient, Kraepelin believes that the paranoias *are* a spectrum, and says that he has seen transitions between an underdeveloped and a full-blown state of paranoia, which we now call schizophrenia.
His archaic language (phrenia means skull, and maybe biological?) makes for difficult reading, but it is the meticulous, and empirical observation of his patients "inner life" that makes him a devoted doctor of mental illness.
As for medical certainty... he is very careful not to overdiagnose and researches the correlation with causes, according to the symptoms which observes. He offers many possibilites, based on statistics and his colleagues records and studies. One very interesting statistic about the paranoias (in which schizophrenia would fall) is found in Chapter V, "Frequency and Causes": p. 253
"The frequency of paranoia in my experience does not nearly amount to one per cent. of the admisssions, the reason of this probably being tha the majority of patients do not require institutional treatment or only require it temporarily.....
....half of the patients lived undisturbed for more than nine years in freedom, before they came into the hands of the alienist;" [heh!]
----------
btw, thank you for the info. on Morel.
Squiggles
Posted by Squiggles on October 8, 2006, at 8:26:50
In reply to Re: Encephalitis lethargica, posted by SLS on October 8, 2006, at 7:44:12
I'm not taking on the encyclopedias, no matter
what I understand from reading him; i certainly don't want to give up my position as a humble bipolar for a schizoid megalomaniac. :-)Squiggles
> Now, I am a bit confused. Encyclopedia Britannica got it wrong? I hate it when things I learned in college become worthless. Seems like most of it.
>
>
> "Kraepelin, Emil
>
> (born Feb. 15, 1856, Neustrelitz, Mecklenburg-Strelitz-died Oct. 7, 1926, Munich, Ger.) German psychiatrist. He taught at the Universities of Heidelberg and Munich, where he developed an influential classification system for mental illness, the Psychiatric Compendium (nine eds., 1883–1926). He was the first to distinguish (in 1899) between manic-depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia), and the first to distinguish three clinical varieties of the latter: catatonia, hebephrenia, and paranoia. "
>
> http://www.answers.com/topic/emil-kraepelin
>
> http://www.britannica.com/eb/article-9046179/Emil-Kraepelin
>
>
> - Scott
Posted by SLS on October 8, 2006, at 9:17:39
In reply to Re: Encephalitis lethargica » SLS, posted by Squiggles on October 8, 2006, at 8:26:50
> I'm not taking on the encyclopedias, no matter
> what I understand from reading him; i certainly don't want to give up my position as a humble bipolar for a schizoid megalomaniac. :-)
Even encyclopedias can be guilty of repeating historic errors for the sake of convenience, I guess. Perhaps your readings are uncovering new interpretations that more closely match the intended meanings of Kraepelin.Thanks for taking the time to put that stuff together.
Regarding the old dichotomy of "organic" versus "functional", I don't know what to tell you. When I was first diagnosed, affective disorders were considered functional, I think, because no structural pathology could be found nor was assumed. Similarly, no injury or other medical circumstance could be identified. I figured this was a good thing. I thought functional illness was just due to a problem with dysregulation of the system, but with fully intact hardware. My hopes were that this fully intact hardware would simply fire-up one day and be 100% ok. Now we know different regarding the hardware. Both bipolar and unipolar affective disorders show structural pathologies. Of course, we really don't know to what degree these are primary causes of the illness or secondary consequences to the illness, although I feel some of the new findings regarding bipolar disorder and abnormalities with myelination argue for the latter in that illness.
- Scott
Posted by getinwl72 on October 8, 2006, at 9:23:48
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » getinwl72, posted by Phillipa on October 7, 2006, at 21:53:49
> I'm glad you posted maybe we can help each other. I do ride my bike when weather permits . But MS would hinder that wouldn't it? Babblemail me anytime and we can talk in private. Love Phillipa
Hi, thanks for the response. My MS actually makes treating my BipolarII more difficult. Believe it or not, my BiPolar is what hinders my living much more than MS. Physically I am fine, other than fatigue and some cognitive issues. I am a little weak because I haven't gone out and exercised. Exercise is really good for me. I need to do more. Last year I was walking every day and doing great. Something happened and I just became agoraphobic. I would have anxiety at the thought of being around people. Hopefully, it will just pass. I see you post all the time. You have alot of interesting insight and give some great advice and support.
Posted by getinwl72 on October 8, 2006, at 9:30:23
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » getinwl72, posted by Racer on October 8, 2006, at 1:51:58
> Welcome to Babble. I'm glad you came out of the shadows...
>
> I've already posted that I have problems leaving the house, so this is offered as something that's helping me, not as a "well, it's easy" solution. I've started taking a few classes as a local junior college, as a reason to leave the house on a regular basis. I only take a couple of classes, but it does mean that a couple of times a week, I leave the house for a reason other than going to the doctor's or therapist's. That's reason enough for me to do it. It might help you, too. I'm taking maths classes, so I also have a reason to spend time in the math lab, which also helps keep me in contact with the world.
>
> Something like that might be a good start for you, too. Aside from academic classes, you might consider things like ceramics -- which can sometimes be good for MS, I've heard. Then there are those classes like "film appreciation" which can be as demanding as you choose to make them.
>
> Another thing that might help if you have the physical strength, is volunteering in an area that you feel strongly about. Volunteer at the local animal shelter, where you'd be interacting with humans secondarily to working with the beasties; volunteer at the local Boys and Girls club, helping with homework; be a docent at the local herpetological museum; be an usher at the opera (you get to see the opera, too!); there are as many opportunities for volunteering as there are interests.
>
> Or, if that's too much, see if there are city walks in your area -- walking tours of sites of local interest. Those are one shot deals, which makes them easier.
>
> Ah, I've got a million ideas -- none of which I have done anytime lately, but at least I've signed up for classes, and attend them...
>
> Good luck to you, and welcome again to BabbleLand!Hi there and thanks for the suggestions. These will undoubtedly sound like excuses... I work about 50-60 hours per week and am a single mother. My son is 16 and has some troubles. So, signing up for classes and doing anything extra is not anything I can do right now. I would really love to just get my sneakers on and walk around my neighborhood as I used to. It's so odd. I think I may force myself to start going into the office one day a week to interract with my co-workers in lieu of the above suggestions. I have just become so disconnected. I would say that working from home is not neccessarily a good thing for people with Depression/Anxiety as it enables us to isolate. I think maybe that's what has happened to me. I will try. Thanks for your welcome wishes and support!
Posted by Squiggles on October 8, 2006, at 9:39:03
In reply to Re: Encephalitis lethargica » Squiggles, posted by SLS on October 8, 2006, at 9:17:39
> Even encyclopedias can be guilty of repeating historic errors for the sake of convenience, I guess. Perhaps your readings are uncovering new interpretations that more closely match the intended meanings of Kraepelin.
>:-)
I see from surfing the net, that the term
has been bounced around; it seems to have
made its reappearance in the field, with the
biological school; but i also saw Freud using
it in completely different ways. The Ancient Greeks must have seen people who were loopy
and said "that guy's head is cracked" or
"sometimes he's happy, sometimes he's suicidal-- the guy's head is split" or something to that
effect as "schizo" means torn or split and
"phreno" means "skull". The historians can probably pin it down to whatever medical context
was the flavour of the era at the time.http://www.ajp.psychiatryonline.org/cgi/content/full/162/7/1393-a
>
> Regarding the old dichotomy of "organic" versus "functional", I don't know what to tell you. When I was first diagnosed, affective disorders were considered functional, I think, because no structural pathology could be found nor was assumed. Similarly, no injury or other medical circumstance could be identified. I figured this was a good thing. I thought functional illness was just due to a problem with dysregulation of the system, but with fully intact hardware. My hopes were that this fully intact hardware would simply fire-up one day and be 100% ok. Now we know different regarding the hardware. Both bipolar and unipolar affective disorders show structural pathologies. Of course, we really don't know to what degree these are primary causes of the illness or secondary consequences to the illness, although I feel some of the new findings regarding bipolar disorder and abnormalities with myelination argue for the latter in that illness.
>
>Personally, i would find a biological explanation
more comforting as there is hope of treatment with a structural or "organic" brain problem; but of course you cannot eliminate the functional aspect that necessarily comes with a "broken" brain.
I suppose the gross abnormalities are easier
to recognize, e.g. head injury. I wonder where
structural pathologies come from.Squiggles
> - Scott
>
Posted by Racer on October 8, 2006, at 12:36:20
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » Racer, posted by getinwl72 on October 8, 2006, at 9:30:23
You're welcome for the welcome.
I think your idea of going into the office once a week -- even once every two weeks, if that's better for you -- is a good one for your situation. The ideas I offered were just things I've thought of or done myself. Whatever works for you, right?
Good luck with it, whatever you do. Maybe Babble will help keep your spirits up enough to make it happen. I hope so.
Posted by Phillipa on October 8, 2006, at 17:25:01
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous, posted by getinwl72 on October 8, 2006, at 9:23:48
Thanks and I'm glad your MS doesn't hinder your physical activities. I was told start in baby steps. First day walk to the mailbox. Add a bit each day. Do you know what triggered the first episode of agoraphobia? Love Phillipa
Posted by Phillipa on October 8, 2006, at 17:30:03
In reply to Re: Depression-Anxiety-Panic-I can't leave my hous » getinwl72, posted by Phillipa on October 8, 2006, at 17:25:01
I agree I just finished the thread and if you can manage one day a week maybe a few hours at first would be ideal. And I believe you're right in that working from home doesn't help anxiety or depression. Love Phillipa
This is the end of the thread.
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