Trastornos de personalidad en fumadores: una revisión Personality disorders in smokers: a review

Autores/as

  • Elena Fernández del Río Unidad de Tabaquismo, Universidad de Santiago de Compostela. Enviar correspondencia a: Elena Fernández del Río Universidad de Santiago de Compostela, Facultad de Psicología, Departamento de Psicología Clínica y Psicobiología, Campus Universitario Sur, 15782, Santiago de Compostela, A Coruña.
  • Elisardo Becoña Iglesias Unidad de Tabaquismo, Universidad de Santiago de Compostela.

DOI:

https://doi.org/10.20882/adicciones.207

Palabras clave:

fumar, dependencia de la nicotina, trastornos de personalidad, revisión smoking, nicotine dependence, personality disorders, review

Resumen

La relación entre psicopatología y dependencia de la nicotina en fumadores es un tema relevante en los últimos años. Sin embargo, poco se sabe acerca de los trastornos de personalidad en fumadores de cigarrillos. El objetivo de este artículo es revisar las investigaciones publicadas a escala nacional e internacional, que analizan la relación entre consumo de tabaco y trastornos de personalidad. La revisión realizada nos permite afirmar que la investigación sobre la presencia de trastornos del Eje II en fumadores de cigarrillos es realmente escasa. De los 12 estudios revisados se puede concluir que la prevalencia de trastornos de personalidad en fumadores es muy variable (entre el 9% y el 45%), y que el consumo de cigarrillos se asocia, en la mayoría de los estudios, en primer lugar con los trastornos del grupo C (dependiente, por evitación y obsesivo-compulsivo), y en segundo lugar con los trastornos del grupo B (histriónico, narcisista, límite y antisocial). Finalmente, se apuntan distintas limitaciones que existen en los estudios realizados hasta el momento y la necesidad de conocer mejor estos trastornos por su relevancia en el tratamiento de fumadores.
The association between psychopathology and nicotine dependence in smokers has been a relevant topic in recent years. Nevertheless, little is known about personality disorders in smokers. The aim of this article is to review research published nationally and internationally which analyzes the relation between tobacco use and personality disorders. Our review permits us to affirm that research on the presence of Axis II disorders in smokers is rather scarce. Of 12 studies analyzed, it can be concluded that the prevalence of personality disorders in smokers is highly variable (between 9% and 45%), and that, in the majority of the studies, smoking is associated first with the presence of cluster C disorders (dependent, avoidant and obsessive-compulsive), and second, with cluster B disorders (histrionic, narcissistic, borderline and antisocial). Finally, we note the various limitations of previous studies and stress the need to better understand these disorders, given their relevance to the treatment of smokers.

Biografía del autor/a

Elena Fernández del Río, Unidad de Tabaquismo, Universidad de Santiago de Compostela. Enviar correspondencia a: Elena Fernández del Río Universidad de Santiago de Compostela, Facultad de Psicología, Departamento de Psicología Clínica y Psicobiología, Campus Universitario Sur, 15782, Santiago de Compostela, A Coruña.

Citas

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: APA.

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.). Washington, DC: APA.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: APA.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. rev.). Washington, DC: APA.

Arent, M., Rosenberg, R., Foldager, L., Perto, G. y Munk-Jorgensen, P. (2007). Psychopathology among cannabis-dependent treatment seekers and association with later substance abuse treatment. Journal of Substance Abuse Treatment, 32, 113-119.

Bailey, E. L. y Swallow, B. L. (2004). The relationship between cannabis

use and schizotypal symptoms. European Psychiatry, 19, 113-114.

Barber, J. P., Frank, A., Weiss, R. D., Blaine, J., Siquel, L., Moras, K., et

al. (1996). Prevalence and correlates of personality disorder diagnoses among cocaine dependent outpatients. Journal of Personality Disorders, 10, 297-311.

Becoña, E. (2006). Tabaco. Prevención y tratamiento. Madrid: Pirámide.

Becoña, E. y Míguez, M. C. (2004). Consumo de tabaco y psicopatología

asociada. Psicooncología, 1, 99-112.

Becoña, E., Vázquez, F. L. y Míguez, M. C. (2002). Smoking cessation and anxiety in a clinical sample. Personality and Individual Differences, 32, 489-494.

Bellaire, W. y Caspari, D. (1992). Diagnosis and therapy of male gamblers in a university psychiatric hospital. Journal of Gambling Studies, 8, 143-150.

Black, D. W., Zimmerman, M. y Coryell, W. H. (1999). Cigarette smoking

and psychiatric disorder in a community sample. Annals of Clinical Psychiatry, 11, 129-136.

Blaszczynski, A. y McConaghy, N. (1994). Antisocial personality disorder and pathological gambling. Journal of Gambling Studies, 10, 129-145.

Bobo, J. K., McIlvain, H. E., Lando, H. A., Walder, R. D. y Leed-Kelly, A. (1998) Effect of smoking cessation counseling on recovery from alcoholism: Findings from a randomized community intervention trial. Addiction, 93, 877-887.

Bravo de Medina, R., Echeburúa, E. y Aizpiri, J. (2007). Características

psicopatológicas y dimensiones de personalidad en los pacientes dependientes del alcohol: un estudio comparativo. Adicciones, 19, 373-382.

Bravo de Medina, R., Echeburúa, E. y Aizpiri, J. (2008). Diferencias de

sexo en la dependencia del alcohol: dimensiones de personalidad, características psicopatológicas y trastornos de personalidad. Psicothema, 20, 218-223.

Breslau, N., Kilbey, M. y Andreski, P. (1991). Nicotine dependence, major depression, and anxiety in young adults. Archives of General Psychiatry, 48, 1069-1074.

Breslau, N., Kilbey, M. y Andreski, P. (1992). Nicotine withdrawal symptoms and psychiatric disorders: Findings from an epidemiological study of young adults. American Journal of Psychiatry, 149, 464-469.

Breslau, N. y Klein, D. F. (1999). Smoking and panic attacks : An epidemiologic investigation. Archives of General Psychiatry, 56, 1141-1147.

Breslau, N., Peterson, E., Schultz, L., Andreski, P. y Chilcoat, H. (1996).

Are smokers with alcohol disorders less likely to quit? American Journal of Public Health, 86, 985-990.

Breslau, N., Peterson, E., Schultz, L., Chilcoat, H. y Andreski, P. (1998).

Major depression and stages of smoking. Archives of General Psychiatry, 55, 161-166.

Brooner, R. K., King, V. L., Kidorf, M., Schimdt, C. W. y Bigelow, G. E.

(1997). Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Archives of General Psychiatry, 54, 71-80.

Caballo, V. (2004). Manual de trastornos de la personalidad: descripción, evaluación y tratamiento. Madrid: Síntesis.

Chabrol, H., Massot, E. y Mullet, E. (2004). Factor structure of cannabis

related beliefs in adolescents. Addictive Behaviors, 29, 929-933.

Chapman, L. J., Chapman, J. P., Kwapil, T. R., Eckblad, M. y Zinser, M. C.

(1994). Putatively psychosis-prone individuals ten years. Journal of Abnormal Psychology, 103, 171-183.

Claridge, G. S. y Broks, P. (1984). Schizotypy and hemisphere function I: Theoretical considerations and measurements of Schizotypy. Personality and Individual Differences, 5, 633-648.

Comptom, W. M., Thomas, Y. F., Conway, K. P. y Colliver, J. D. (2005).

Developments in the epidemiology of drug use and drug use disorders. American Journal of Psychiatry, 162, 1494-1502.

Covey, L. S., Hughes, D., Glassman, A. H., Blazer, D. y George, L. (1994).

Ever-smoking, quitting, and psychiatric disorders: Evidence from the Durham, North Carolina, Epidemiological Catchment Area. Tobacco Control, 3, 222-227.

Craig, R. J. (2000). Prevalence of personality disorders among cocaine and heroin addicts. Substance Abuse, 21, 87-94.

De Jong, C. A., Van den Brink, W., Harteveld, F. M. y Van der Wielen, E.

G. (1993). Personality disorders in alcoholics and drug addicts. Comprehensive Psychiatry, 34, 87-94.

Driessen, M., Veltrup, C., Wetterling, T., John, U. y Dilling, H. (1998).

Axis I and Axis II comorbidity in alcohol dependence and the two types of alcoholism. Alcoholism: Clinical and Experimental Research, 22, 77-86.

Echeburúa, E., Bravo de Medina, R. y Aizpiri, J. (2005). Alcoholism and personality disorders: An exploratory study. Alcohol & Alcoholism, 40, 323-326.

Echeburúa, E., Bravo de Medina, R. y Aizpiri, J. (2007). Comorbidity of

alcohol dependence and personality disorders: A comparative study. Alcohol & Alcoholism, 42, 618-622.

Echeburúa, E. y Fernández-Montalvo, J. (2008). Are there more

personality disorders in treatment-seeking pathological gamblers than in other kind of patients? A comparative study between the IPDE and the MCMI. International Journal of Clinical and Health Psychology, 8, 53-64.

Eysenck, H. J. y Eysenck, S. B. (1975). Manual of the Eysenck Personality

Questionnaire. London: Hodder and Stoughton Educational.

Fernández, J. J., González, M., Sáiz, P., Gutiérrez, E. y Bobes, J. (2001).

Influencia de los trastornos psiquiátricos en la efectividad de un programa de mantenimiento prolongado con metadona. Actas Españolas de Psiquiatría, 29, 228-232.

Fernández, J. J. y Gutiérrez, E. (2005). Trastornos de personalidad y dependencia de heroína: una relación por determinar. Adicciones, 17 (Supl.2), 95-110.

Fernández-Montalvo, J. y Echeburúa, E. (2004). Pathological gambling

and personality disorders: An exploratory study with the IPDE. Journal of Personality Disorders, 18, 500-505.

Fernández- Montalvo, J. y Echeburúa, E. (2006). Juego patológico y trastornos de personalidad: un estudio piloto con el MCMI-II. Psicothema, 18, 453-458.

Fernández-Montalvo, J., Lorea, I., López, J. J. y Landa, N. (2003). Trastornos de la personalidad en adictos a la cocaína: un estudiopiloto.

Análisis y Modificación de Conducta, 29, 79-98.

Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., et al. (2008). Treating tobacco use and dependence: 2008

Update. Rockville, MD: U. S. Department of Health and Human Services, Public Health Service.

First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. y Benjamin, L. S.

(1996). Structured Clinical Interview for DSM IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press.

First, M. B., Spitzer, R. L., Gibbon, M. y Williams, J. B. (1995). Structured

Clinical Interview for DSM-IV Axis I disorders. Patient edition (SCID-I/P. Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.

Gariti, P., Alterman, A., Mulvaney, F. y Epperson, L. (2000). The relationship between psychopathology and smoking cessation treatment response. Drug and Alcohol Dependence, 60, 267-273.

Goodwin, R. D., Keyes, K. y Simuro, N. (2007). Mental disorders and

nicotine dependence among pregnant women in the United States. Obstetrics and Gynecology, 109, 875-883.

Grant, B. F., Dawson, D. A. y Hasin, H. S. (2001). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSMIV version (AUDADIS-IV). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Grant, B. F., Moore, T. C. y Kaplan, K. (2003). Source and accuracy

statement: Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Grant, B. F., Hasin, D. S., Chou, P., Stinson, F. S. y Dawson, D. A. (2004).

Nicotine dependence and psychiatric disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61, 1107-1115.

Haas, A. L., Muñoz, R. F., Humfleet, G. L., Reus, V. I. y Hall, S. M. (2004).

Influences of mood, depression history, and treatment modality on outcomes in smoking cessation. Journal of Consulting and Clinical Psychology, 72, 563-570.

Heatherton, T. F., Kozlowski, L. T., Frecker, R. C. y Fagerström, K. O. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. British Journal of Addictions, 86, 1119-1127.

Hughes, J. R. (2007). Depression during tobacco abstinence. Nicotine

& Tobacco Research, 9, 443-446.

Hughes, J. R., Hatsukami, D. K., Mitchell, J. E. y Dahlgren, L. A. (1986).

Prevalence of smoking among psychiatric outpatients. American Journal of Psychiatry, 143, 993-997

Humfleet, G., Muñoz, R., Sees, K., Reus, V. y Hall, S. (1999). History of

alcohol or drug problems, current use of alcohol or marijuana and success in quitting smoking. Addictive Behaviors, 24, 149-154.

Hyler, S. (1994). Personality Diagnostic Questionnaire for DSM-IV (PDQ-4). New York: New York State Psychiatric Institute. Isensee, B.,

Wittchen, H. U., Stein, M. B., Höfler, M. y Lieb, R. (2003). Smoking increases the risk of panic: Findings from a prospective community study. Archives of General Psychiatry, 60, 692-700.

Johnson, J. G., Cohen, P., Pine, D. S., Klein, D. F., Kasen, S. y Brook, J.

S. (2000). Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. The Journal of the American Medical Association, 284, 2348-2351.

Kessler, R., McGonagle, K., Zhao, S., Nelson, C., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National

Comorbidity Survey. Archives of General Psychiatry, 51, 8- 19.

Khantzian, E. J. y Treece, C. (1985). DSM-III psychiatric diagnosis of narcotic addicts. Recent findings. Archives of General Psychiatric, 42, 1067-1071.

Kozlowski, L. T., Jelinek, L. C. y Pope, M. A. (1986). Cigarette smoking

among alcohol abusers: A continuing and neglected problem. Canadian Journal of Public Health, 77, 205-207.

Kranzler, H. R., Satel, S. y Apter, A. (1994). Personality disorders and associated features in cocaine-dependent inpatients. Comprehensive Psychiatry, 35, 335-340.

Lasser, K., Wesley, J., Woolhandler, S., Himmelstein, D., McCormick, D. y

Bor, D. (2000). Smoking and mental illness: A population-based prevalence study. Journal of the American Medical Association, 284, 2606-2610.

Lawn, S. J., Pols, R. G. y Barber, J. G. (2002). Smoking and quitting:

A qualitative study with community-living psychiatric clients. Social Science & Medicine, 54, 93-104.

Lenzenweger, M. F., Lane, M. C., Loranger, A. W. y Kessler, R. C. (2007).

DSM-IV personality disorders in the National Comorbidity Survey replication. Biological Psychiatry, 62, 553-564.

Liskow, B., Powel, B. J., Nickel, E. y Penick, E. (1991). Antisocial

alcoholics: Are there clinically significant diagnostic subtypes? Journal of Studies on Alcohol, 52, 62-69.

López, A. y Becoña, E. (2006a). Patrones y trastornos de personalidad

en personas con dependencia de la cocaína en tratamiento. Psicothema, 18, 578-583.

López, A. y Becoña, E. (2006b). Consumo de cocaína y psicopatología

asociada: una revisión. Adicciones, 18, 161-196.

López, A., Becoña, E., Casete, L., Lage, M. T., Díaz, E., García, J. M., et al.

(2007). Dependencia de la cocaína y trastornos de personalidad. Análisis de su relación en una muestra clínica. Trastornos Adictivos, 9, 215-227.

López, A., Becoña, E., Viéitez, I., Cancelo, J., Sobradelo, J. García, J. M., et

al. (2008) ¿Qué ocurre a los 24 meses de inicio del tratamiento en una muestra de personas con dependencia de la cocaína? Adicciones, 20, 347-356.

Mendoza, R., López Pérez, P. y Sagrera, M. R. (2007). Diferencias de

género en la evolución del tabaquismo adolescente en España (1986-2002). Adicciones, 19, 273-288.

Millon, T. (1999). MCMI-II. Manual (adaptación española de Ávila-Espada, A., director; Jiménez, F., coordinador). Madrid: TEA.

Ministerio de Sanidad y Consumo. (2008). Encuesta Domiciliaria sobre consumo de Alcohol y Drogas (EDADES) 2007-2008. Recuperado el 20 de noviembre de 2008, de http://www.msc.es/gabinetePrensa/notaPrensa/pdf/EncuestaDomiciliariaDrogasAlcohol(EDADES)MINISTRO.pdf.

Montes, A., Pérez, M. y Gestal, J. J. (2004). Impacto del tabaquismo

sobre la mortalidad en España. Adicciones, 16 (Supl. 2), 75-82.

Moran, P., Coffey, C., Mann, A., Carlin, J. B. y Patton, G. C. (2006).

Personality and substance use disorders in young adults. British Journal of Psychiatry, 188, 374-379.

Moreno, M. J. y Medina, A. (2006). Epidemiología y comorbilidad de los trastornos de personalidad. Recuperado el 21 de mayo de 2007, de http://www.psiquiatria.com.

Morgenstern, J., Langenbucher, J., Labouvie, E. y Miller, K. (1997). The

comorbidity of alcoholism and personality disorders in a clinical population: Prevalence rates and relation to alcohol typology variables. Journal of Abnormal Psychology, 106, 74-84.

Mykletun, A., Overland, S., Aaro, L. E., Liabo, H. y Stewart, R. (2008).

Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study. European Psychiatry, 23, 77-84.

Nieva, G., Gual, A., Ortega, Ll. y Mondón, S. (2004). Alcohol y tabaco.

Adicciones, 16 (Supl. 2), 191-199.

Nurnberg, H. G., Rifkin, A. y Doddi, S. (1993). A systematic assessment

of the comorbidity of DSM-III-R personality disorders in alcoholic outpatients. Comprehensive Psychiatry, 34, 447-454.

Organización Mundial de la Salud. (1992). CIE-10: Trastornos mentales

y del comportamiento. Descripciones clínicas y pautas para el diagnóstico. Madrid: Meditor.

Perea, J. M., Oña, S. y Ortiz, M. (2009). Diferencias de rasgos clínicos de

personalidad en el mantenimiento de la abstinencia y recaídas en tratamiento del tabaquismo. Psicothema, 21, 39-44.

Petry, N. M. (2005). Pathological gambling: Etiology, comorbidity and treatment. Washington, DC: American Psychological Association.

Pettinati, H, Pierce, J., Belden, P. y Meyers, K. (1999). The relationship

of axis II personality disorders to other known predictors of addiction treatment outcome. American Journal of Addictions, 8, 136-147.

Pilgrim, J. y Mann, A. (1990). Use of the ICD-10 version of the Standardized Assessment of Personality to determine the prevalence of personality disorder in psychiatric in-patients. Psychological Medicine, 20, 985-992.

Prochaska, J. O. y DiClemente, C. C. (1984). The transtheoretical approach: Crossing the traditional boundaries of therapy. Homewood, IL: Dow Jones/Irwin.

Ranney, L., Melvin, C., Lux, L., McClain, E. y Lohr, K. (2006). Systematic

review: Smoking cessation intervention strategies for adults and adults in special populations. Annals of Internal Medicine, 145, 845-856.

Regier, D., Farmer, M., Rae, D., Locke, B., Keith, S., Judd, L., et al. (1990).

Comorbidity of mental disorders with alcohol and other drug abuse. Journal of the American Medical Association, 264, 2511-2518.

Robins, L. N., Helzer, J. E., Croughan, J. y Ratcliff, K. S. (1981). National

Institute of Mental Health. Diagnostic Interview Schedule: Its history, characteristics and validity. Archives of General Psychiatry, 38, 381-389.

Robins, L. N., Wing, J. y Wittchen, H. U. (1988). The Composite International Diagnostic Interview: An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 12, 1069-1077.

Rodríguez-Llera, M. C., Domingo-Salvany, A., Brugal, M. T., Silva, T. C.,

Sánchez-Niubó, A, y Torrens, M. (2006). Psychiatric comorbidity in young heroin users. Drug and Alcohol Dependence, 84, 48-55.

Rubio, V. y Pérez, A. (2003). Trastornos de la personalidad. Madrid:

Elsevier España.

Samuels, J., Eaton, W. W., Bienvenu, O. J., Brown, C. H., Costa, P. T. y

Nestadt, G. (2002). Prevalence and correlates of personality disorders in a community sample. British Journal of Psychiatry, 180, 536-542.

Sanz, J. y Larrazabal, A. (2002). Comorbilidad de dependencia de cocaína y trastornos de personalidad. Implicaciones clínicas y pronósticas. En: III Congreso virtual de Psiquiatría, Interpsiquis 2002. Recogido el 3 de julio de 2008 en http://www.psiquiatria.com/articulos/adicciones/5592/

Schmitz, N., Kruse, J. y Kugler, J. (2003). Disabilities, quality of life, and mental disorders associated with smoking and nicotine dependence. American Journal of Psychiatry, 160, 1670-1676.

Specker, S. M., Carlson, G. A., Edmonson, K. M., Johnson, P. E. y Marcotte, M. (1996). Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies, 12, 67-82.

Stangl, D., Pfohl, B., Zimmerman, M., Bowers, W. y Corenthal, C. (1985).

A structured interview for the DSM-III-R personality disorders. Archives of General Psychiatry, 42, 591- 596.

Steel, Z. y Blaszczynski, A. (1998). Impulsivist, personality disorders

and pathological gambling severity. Addiction, 93, 895-905.

Sussman, S., McCuller, W. J. y Dent, C. W. (2003). The associations of

social self-control, personality disorders, and demographics with drug use among high-risk youth. Addictive Behaviors, 28, 1159-1166.

Tenorio, J. y Marcos, J. A. (2000). Trastornos duales: tratamiento y

coordinación. Papeles del Psicólogo, 77, 58-63.

Torgersen, S., Kringlen, E. y Cramer, V. (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58, 590-596.

Watzke, A. B., Schmidt, C. O., Zimmerman, J.y Preuss, U. W. (2008).

Personality disorders in a clinical sample of cannabis dependent young adults. Fortschritte der Neurologie-Psychiatrie, 76, 600-605.

Wilhelm, K., Wedgwood, L., Niven, H. y Kay-Lambkin, F. (2006). Smoking cessation and depression: Current knowledge and future directions. Drug and Alcohol Review, 25, 97-197.

Williams, J. H., Wellman, N. A., Allan, L. M. y Taylor, E. (1996). Tobacco

smoking correlates with schizotypal and borderline personality traits. Personality and Individual Differences, 20, 267-270.

Williams, J. H., Wellman, N. A. y Rawlins, J. N. (1996). Cannabis use correlates with schizotypy in healthy people. Addiction, 91, 869-877.

Wittchen, H. U., Fröhlich, C., Behrendt, S., Günther, A., Rhem, J.,

Zimmerman, P., et al. (2007). Cannabis use and cannabis use disorders and their relationship to mental disorders: A 10-year prospective-longitudinal community study in adolescents. Drug and Alcohol Dependence, 88 (Supl.), S60-S70.

World Health Organization (2008). WHO report on the global tobacco

epidemic. The MPower Packaged, 2008. Recuperado el 12 de diciembre de 2008, de http://www.who.int/tobacco/mpower/mpower_report_full_2008.

Zimmerman, M. y Coryell, W. (1989). DSM-III personality disorder diagnoses in a nonpatient sample: Demographic correlates and comorbidity. Archives of General Psychiatry, 46, 682-689.

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2010-06-01

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