The DOI matches its Crossref record; 74 of the 74 references it cites were found in a registry or an index.
Prevalence of and Risk Factors for Medication Nonadherence in Patients With Schizophrenia: A Comprehensive Review of Recent Literature
Abstract
OBJECTIVE: Nonadherence to prescribed antipsychotic medications places patients with schizophrenia at a greatly increased risk of illness exacerbation and rehospitalization. Identification of risk factors for nonadherence is an initial step toward designing effective interventions. This article reviews recent literature on the prevalence of and risk factors for medication nonadherence in patients with schizophrenia. DATA SOURCES: We searched the MEDLINE/HealthSTAR and PsycINFO databases using combinations of the keywords risk factor(s), adherence, compliance, antipsychotic, neuroleptic, schizophrenia, and psychosis for articles published since 1980 that identified risk factors for medication nonadherence in schizophrenia patients. We included reports that (1) were published in English and (2) specifically examined risk factors for medication nonadherence. Thirty-nine articles met our selection criteria. DATA SYNTHESIS: Among the 10 reports that met a strict set of study inclusion criteria, we found a mean rate of nonadherence of 41.2%; the 5 reports that met a stricter set of inclusion criteria had a mean nonadherence rate of 49.5%. In the 39 articles reviewed, factors most consistently associated with nonadherence included poor insight, negative attitude or subjective response toward medication, previous nonadherence, substance abuse, shorter illness duration, inadequate discharge planning or aftercare environment, and poorer therapeutic alliance. Findings regarding an association between adherence and medication type were inconclusive, although few studies explored this relationship. Other factors such as age, gender, ethnicity, marital status, education level, neurocognitive impairment, severity of psychotic symptoms, severity of medication side effects, higher antipsychotic dose, presence of mood symptoms, route of medication administration, and family involvement were not found to be consistent predictors of nonadherence. Limitations of the published literature are discussed. CONCLUSION: Efforts to improve medication adherence in patients with schizophrenia should target relevant risk factors.
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“Disruption of treatment coverage has been associated with symptom relapse and increased risk of hospitalization [5–7].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [6]
In the citing paper
“Similarly, medication non-adherence is consistently associated with patients behavioral practices (e.g., substance abuse) [14, 74] and also patients’ socio-demographic characteristics (such as educational status, age, gender, and employment) [14, 72].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
In the citing paper
“In the present systematic review, medication non-adherence is associated with poor functioning of the health system such as lack of psychotherapy, lack of information, long treatment duration with little health personnel follow-up, inadequate discharge planning, increased hospitalizations, poor support and care environment, experiencing access barriers to high-quality care and health care”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
In the citing paper
“This systematic review of factors influencing psychotropic medication non-adherence which is consistent with other systematic reviews [14, 72, 73, 77] has shown that medication adherence is mainly affected by patients’ negative attitude toward their medication, lack of insight, negative health belief, and perceived stigma.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
In the citing paper
“The present systematic review and meta-analysis finding is consistent with a finding from a comprehensive systematic review on schizophrenia which reported that a mean rate of non-adherence was 41.2%.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
In the citing paper
“In addition, medication non-adherence is associated with clinical- or medication-related factors [14, 72–74, 77].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
In the citing paper
“The sub-group analysis indicated that a mean non-adherence rate was 49.5% [14]”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
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“Forty to 50% of individuals with schizophrenia do not adhere to their antipsychotic treatment (Lacro et al. 2002).”
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“Moreover, impaired insight poses a problem for adherence to treatment (Buckley et al., 2007; Lacro et al., 2002), prolongs duration of psychosis (Drake et al., 2000), and increases the risk for relapse, re-hospitalization (Drake et al., 2007) and involuntary status in the hospital (Kelly et al.,…”
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“Moreover, individual studies, as well as a meta-analysis, suggest that poor insight is associated with poor compliance or that higher levels of insight correlate with better compliance (Amador et al., 1991; Lacro et al., 2002).”
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“This low level of use has occurred despite the fact that up to half of patients with schizophrenia are noncompliant.(3) LAIs have instead become ‘‘niched’’ for patients who are at the later stages of schizophrenia (Figure 1), and LAI treatment has been stigmatized as well, since patients receiving LAIs are more likely…”
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Farooq, S., & Naeem, F. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s40777 · Cited by 75
“Some have examined a specific intervention, while others have examined the combination of two or more types of interventions.(3) The outcome measures of these interventions vary widely, and they include a variety of theoretical backgrounds, formats, and settings.”
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Improving Treatment Adherence in Bipolar Disorder
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Guideline-Concordant Antipsychotic Use and Mortality in Schizophrenia
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“2005) to compare atypical antipsychotics found that 74% of patients with a diagnosis of schizophrenia chose to discontinue their medication over 18 months and it is estimated that rates of medication non-compliance in schizophrenia can be as high as 40% to 50% (Lacro et al. 2002).”
Primary Nonadherence to Antipsychotic Treatment Among Persons with Schizophrenia
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“One report 32 suggested that 20%–56% of patients with schizophrenia were not adherent to their prescriptions.”
Peters-Strickland, T., Pestreich, L. K., Hatch, A., Rohatagi, S., Baker, R. A., Docherty, J. P., Markovtsova, L., Raja, P., Weiden, P. J., & Walling, D. P. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s116029 · Cited by 72
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“This leads to increased hospitalization, higher healthcare costs and is a predictor of poor outcomes like more relapses, suicide and overall mortality [30, 31].”
BackgroundCannabis use and adherence to antipsychotic medication: a systematic review and meta-analysis
Foglia, E., Schoeler, T., Klamerus, E., Morgan, K. D., & Bhattacharyya, S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000046 · Cited by 71
“5% among patients with psychosis (Cramer & Rosenheck, 1988; Lacro et al. 2002; Nosè et al. 2003),while theymaybeup to63%infirst-episodepsychosis (FEP) samples (Mojtabai et al.”
BackgroundMethodResultInfluentialPerspectives on reasons of medication nonadherence in psychiatric patients
Mert, D. G., Turgut, N. H., Kelleci, M., & Semiz, M. (2015) · Patient Preference and Adherence · doi:10.2147/ppa.s75013 · Cited by 70
“19 In our study, the ratio of medication nonadherence was found to be 24.2% in patients with schizophrenia.”
InfluentialSeale, C. F., Chaplin, R., Lelliott, P. T., & Quirk, A. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.03.047 · Cited by 70
Tranulis, C., GOFF, D. C., Henderson, D. C., & Freudenreich, O. (2011) · Psychiatric Services · doi:10.1176/ps.62.8.pss6208_0888 · Cited by 73
“5%, depending on the definition of adherence (2).”
Telemonitoring of Medication Adherence in Patients with Schizophrenia
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Risk profiles for non‐adherence to antipsychotic medications
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“Journal compilation © 2008 Blackwell Publishing Ltd have reported an inconsistent relationship between these variables (Dolder et al. 2002, Lacro et al. 2002).”
BackgroundMethodResultInfluentialDepp, C. A., Lebowitz, B. D., Patterson, T. L., Lacro, J. P., & Jeste, D. V. (2007) · Bipolar Disorders · doi:10.1111/j.1399-5618.2007.00397.x · Cited by 67
Self-citationNew generation antipsychotic drugs and compliance behaviour
Voruganti, L. P., Baker, L. K., & Awad, A. G. (2008) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3282f52851 · Cited by 67
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“Adherence is better if patients feel susceptible to the illness, believe that illness or its complications pose severe consequences for patients’ health and believe that the medical therapy will be effective and beneficial((40,44)).”
BackgroundMedication adherence and quality of life among Nigerian outpatients with schizophrenia
Adelufosi, A. O., Adebowale, T. O., Abayomi, O., & Mosanya, J. T. (2011) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2011.09.001 · Cited by 65
Treatment of Schizophrenia With Long-Acting Fluphenazine, Haloperidol, or Risperidone
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Medication adherence among patients with chronic diseases: a survey-based study in pharmacies
Jüngst, C., Gräber, S., Simons, S., Wedemeyer, H., & Lammert, F. (2019) · QJM: An International Journal of Medicine · doi:10.1093/qjmed/hcz058 · Cited by 69
Barkhof, E., Meijer, C. J., de Sonneville, L. M. J., LINSZEN, D. H., & de Haan, L. (2013) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt138 · Cited by 64
“Furthermore, there was a trend level interaction between the DAI score and age group: F(1,49) = 3.”
BackgroundInfluentialGäebel, W., Riesbeck, M., von Wilmsdorff, M., Burns, T., Derks, E. M., Kahn, R. S., Wulf Rössler, A., & Fleischhacker, W. W. (2010) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2010.02.001 · Cited by 66
“This corresponds to other studies, in which drug attitude was found as a predictor for drug non-adherence or discontinuation in unselected samples comprising of mainly multiple episode schizophrenia patients (Lacro et al., 2002) as well as in specific samples of first-episode patients (Kampman et al.”
BackgroundResultWobrock, T., & Soyka, M. (2008) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2008.02.008 · Cited by 64
Metacognition as a predictor of therapeutic alliance over 26weeks of psychotherapy in schizophrenia
Davis, L. W., Eicher, A. C., & Lysaker, P. H. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.02.026 · Cited by 63
“…of the alliance has been linked with reduced symptoms, improved quality of life, as well as performance in rehabilitation (Frank andGunderson, 1990; Neal and Rosenheck, 1995; Solomon et al., 1995; Lacro et al., 2002; Donnell et al., 2004; Davis and Lysaker, 2007; Smerud and Rosenfarb, 2008).”
BackgroundNon-Coding RNA as Novel Players in the Pathophysiology of Schizophrenia
Gibbons, A. S., Udawela, M., & Dean, B. (2018) · Non-Coding RNA · doi:10.3390/ncrna4020011 · Cited by 65
“Non-adherence to antipsychotic medication is a significant risk factor for relapse of psychotic episodes and is reported to be as high as 40–50% in people with schizophrenia [132].”
BackgroundJaeger, S., Pfiffner, C., Weiser, P., Längle, G., Croissant, D., Schepp, W., Kilian, R., Becker, T., Eschweiler, G., & Steinert, T. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0687-x · Cited by 63
Pharmacotherapy challenges in patients with first-episode psychosis
Abdel‐Baki, A., Ouellet‐Plamondon, C., & MALLA, A. K. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.02.029 · Cited by 63
Validation study of the Medication Adherence Rating Scale. Results from the FACE-SZ national dataset
Fond, G. B., Boyer, L., Boucékine, M., Aden, L. A., Schürhoff, F., Tessier, A., Andrianarisoa, M., Berna, F. S., Brunel, L., Capdevielle, D., et al. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.10.023 · Cited by 67
Cuevas, C. D. L., de León, J., Peñate, W., & Betancort, M. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s133513 · Cited by 70
“2 7 In the same way, the prevalence of anti-psychotic medication nonadherence in patients with schizophrenia has reached a mean rate of 50%–61%, 8,9 while estimates of nonadherence rates for long-term prophylactic pharmacotherapy for bipolar disorders range from 20% to 60%, with a median of 40%.”
InfluentialPrediction of medication noncompliance in outpatients with schizophrenia: 2-year follow-up study
Yamada, K., Watanabe, K., Nemoto, N., Fujita, H., Chikaraishi, C., Yamauchi, K., Yagi, G., Asai, M., & Kanba, S. (2005) · Psychiatry Research · doi:10.1016/j.psychres.2004.07.014 · Cited by 63
“It has been reported that the rate of noncompliance is 40% to 60% of patients with schizophrenia (Serban and Thomas, 1974; Kane and Borenstein, 1985; Weiden et al., 1994; Lacro et al., 2002; Novak-Grubic and Tavcar, 2002).”
BackgroundInfluentialSylvia, L. G., Hay, A., Ostacher, M. J., Miklowitz, D. J., Nierenberg, A. A., Thase, M. E., Sachs, G. S., Deckersbach, T., & Perlis, R. H. (2013) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3182900c6f · Cited by 62
Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review
Lanouette, N. M., Folsom, D. P., Sciolla, A., & Jeste, D. V. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.2.157 · Cited by 61
Self-citationOfford, S., Wong, B., Mirski, D., Baker, R. A., & Lin, J. (2013) · Journal of Medical Economics · doi:10.3111/13696998.2012.751025 · Cited by 62
Anosognosia in schizophrenia: hidden in plain sight.
Lehrer, D. S., & Lorenz, J. (2014) · PubMed Central · Cited by 63
Olivares, J. M., Peuskens, J., Pečeňák, J., Resseler, S., Jacobs, A., Akhras, K. S., & on behalf of the e-STAR study group (2009) · Current Medical Research and Opinion · doi:10.1185/03007990903149306 · Cited by 62
Staring, A., Mulder, C., Duivenvoorden, H., de Haan, L., & van der Gaag, M. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2009.05.022 · Cited by 63
Improving patient outcomes in schizophrenia: achieving remission
Nasrallah, H. A., & Lasser, R. (2006) · Journal of Psychopharmacology · doi:10.1177/1359786806071248 · Cited by 62
Brain, C., Allerby, K., Sameby, B., Quinlan, P. S., Joas, E., Karilampi, U., Lindström, E., Eberhard, J., Burns, T., & Wærn, M. (2013) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2013.09.001 · Cited by 62
“Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone.”
BackgroundComorbid Addiction and Major Mental Illness in Europe: A Narrative Review
Carrà, G., Bartoli, F., Brambilla, G., Crocamo, C., & Clerici, M. (2014) · Substance Abuse · doi:10.1080/08897077.2014.960551 · Cited by 60
“[6] Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV.”
BackgroundMcCutcheon, R. A., Beck, K., Bloomfield, M., Marques, T. R., Rogdaki, M., & Howes, O. D. (2015) · Journal of Psychopharmacology · doi:10.1177/0269881115576688 · Cited by 61
“Partial or non-adherence occurs in close to half of patients (Lacro et al., 2002) and patient self-report or clinician opinion tends to markedly overestimate adherence compared to more objective measures (Velligan et al., 2007, 2009).”
BackgroundKreyenbuhl, J. A., Slade, E. P., Medoff, D. R., Brown, C. H., Ehrenreich, B., Afful, J., & Dixon, L. B. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.04.028 · Cited by 60
Opjordsmoen, S., Friis, S., Melle, I., Haahr, U., Johannessen, J. O., Larsen, T. K., Røssberg, J. I., Rund, B. R., Simonsen, E., Vaglum, P., et al. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01536.x · Cited by 60
“Along with insight into the illness and knowledge of its social and psychological consequences, a good therapeutic alliance is beneficial for adherence (6).”
BackgroundFactors Associated with Medication Adherence Among Psychiatric Outpatients at Substance Abuse Risk
Magura, S. (2011) · The Open Addiction Journal · doi:10.2174/1874941001104010058 · Cited by 59
“It might be surprising that the intensity of substance use was not associated with medication adherence, but this is not necessarily inconsistent with prior research, which generally has found differences in adherence between those with and without substance use, rather than between those varying in degrees of use [3].”
BackgroundResultInfluentialAssessment of Medication Adherence in Patients With Schizophrenia
Kikkert, M., Barbui, C., Koeter, M. W. J., David, A. S., Leese, M., Tansella, M., Gieler, A., Puschner, B., & Schene, A. H. (2008) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31816a4346 · Cited by 58
“Lacro et al. (2002) in their systematic review found nonadherence rates ranging from 4% to 72% while others concluded that a mean of 40% to 60% of patients with schizophrenia are believed to not adhere to their prescribed medication regimen (Nose et al., 2003; Young et al., 1986).”
BackgroundMethodResultInfluentialIyer, S. N., Banks, N., Roy, M., Tibbo, P. G., Williams, R., Manchanda, R., Chue, P. S., & MALLA, A. K. (2013) · The Canadian Journal of Psychiatry · doi:10.1177/088740341305805s03 · Cited by 58
Antipsychotic medications: compliance and attitudes towards treatment
Awad, A. G. (2004) · Current Opinion in Psychiatry · doi:10.1097/00001504-200403000-00002 · Cited by 58
A question of choice: Compliance in medicine taking.
Carter, S., Taylor, D., & Levenson, R. W. (2003) · UCL Discovery (University College London) · Cited by 58
Cooper, R. E., Laxhman, N., Crellin, N. E., Moncrieff, J., & Priebe, S. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.05.020 · Cited by 62
Pharmacological long-term treatment strategies in first episode schizophrenia
Gäebel, W., Möller, H., Buchkremer, G., Ohmann, C., Riesbeck, M., Wölwer, W., von Wilmsdorff, M., Bottlender, R., & Klingberg, S. (2004) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-004-0509-y · Cited by 57
“…treatment program including psychoeducation –, these facts highlight the pressing need for developing strategies more acceptable to this particular group of patients, who often do not realize or accept the diagnosis of schizophrenia and its treatment options as yet available (Lacro et al. 2002).”
Buchman-Wildbaum, T., Váradi, E., Schmelowszky, Á., Griffiths, M. D., Demetrovics, Z., & Urbán, R. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113140 · Cited by 58
“Among the leading factors concerning non-adherence are poor insight, shorter illness duration, negative attitudes toward medication, lack of social support, and medication side-effects (Diaz et al., 2004; El-Mallakh, 2007; Lacro et al., 2002; Olfson et al., 2006).”
Gianfrancesco, F. D., Sajatovic, M., Rajagopalan, K., & Wang, R. (2008) · Clinical Therapeutics · doi:10.1016/s0149-2918(08)80062-8 · Cited by 56
Zhang, F., Si, T., Chiou, C., Harris, A. W. F., Kim, C. Y., Jahagirdar, P., & Ascher, S. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s77778 · Cited by 56
“6,8–10 Among patients recently diagnosed with schizophrenia, treatment discontinuity along with partial nonadherence 11 (ie, elapsed time of 1–10 days/year for prescribed antipsychotic therapy resumption) were observed to increase the risk of relapse, 12,13 and that of hospitalization (odds ratio =…”
Cuevas, C. D. L., y Revuelta, J. L. G. D. R., & Peñate, W. (2014) · Patient Preference and Adherence · doi:10.2147/ppa.s73029 · Cited by 56
Pharmacotherapy for schizophrenia and co-occurring substance use disorders
Noordsy, D. L., & Green, A. I. (2003) · Current Psychiatry Reports · doi:10.1007/s11920-003-0066-5 · Cited by 55
Metadata
- Authors
- Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V.
- Affiliations
- University of California San Diego (US)
- VA San Diego Healthcare System (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2002-10-15
- Volume
- 63
- Issue
- 10
- Pages
- 892-909
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2070893229
- Cited by
- 1,383
- References
- 74
- Citations by year
- 2026: 42 · 2025: 29 · 2024: 43 · 2023: 55 · 2022: 59 · 2021: 58 · 2020: 63 · 2019: 52 · 2018: 56 · 2017: 65 · 2016: 80 · 2015: 74 · 2014: 57 · 2013: 103 · 2012: 97
- FWCI
- 18.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r29mh056938-04)
- National Institute of Mental Health (MH49671, R01MH059101, MH-43693, MH56938, MH59101, P30MH049671, MH-19934, T32MH019934)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- medication non-adherence, schizophrenia, antipsychotic drugs, risk factors, prevalence, lack of insight, substance abuse, therapeutic relationship, aftercare planning, hospital readmission
- MeSH terms
- Adult, Ambulatory Care, Factor Analysis, Statistical, Female, Hospitalization, Humans, Male, Probability, Research Design, Risk Factors, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Prevalence, Treatment Refusal
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