Psychiatry

IMP.Psychiatric Topics.
1) "ANXIETY---anxiety is usually viewed as repressed or forgotten -fear ,features--hyperventilation,cold extremities,palpitations,pupillary dilatation,…..ANXIETY NEUROSIS---acute restlessness & fear of impending doom , anti -anxiety effect--chlorpromazine,TCA,BZD.,"------------((5))

2) "COCAINE---coined by FREUD.,jet black pigmentation of tongue with tactile hallucination ,creeping sensation,COCAINE-BUGS---sensation of bugs crawling all over the body"-----------((5))

3) "DELIRIUM---illusions with loss of consciousness,acute delerium-impaired consciousness, visual hallucination, hyperactivity& Fragmentary Delusions,"-------------((5))

4) "FREUD---introduced ---Cocaine , Psychoanalysis , concept of ""SUPER-EGO"" , free association , "" OEDIPUS COMPLEX""--by sigmund freund"----------((5))

5) "ANOREXIA NERVOSA---amenorroea-100%,phobic avoidance of normal wt.,wt.loss seen,over perception of body image,self induced vomiting ,excessive exercise,evident psychosis,least characteristic--decreased physical activity,false-decreased appetite,"-----------((4))

6) "CANNABIS---medical purposes/uses-in-Epilepsy ,glaucoma,nausea,Flash black phenomenon,.CANNABIS ADDICTION---symptomatic,Rx not req.,JHAGNAN phenomenon seen,"-------------((4))

7) "DEFENSE MECHANISIMS---MATURE defense mech.-->Projection & Altruism,IMP.defense mech.-->Repression,RATIONALIZATION-->drinks due to quarrel with wife ,"------------((4))

8) "DELIRIUM TREMENS---altered cons. ,tremors & visual hallucinations ,DOC.-diazepam."---------((4))

9) "EGO---works on realitiy principle , EGO DEFENSE MECHANISMS---""undoing""-seen in--OCN, Picasso synd.--Sublimation, Projection , Conversion,Reaction formation, "-----------((4))

10) "FUGUE---& DISOCIATIVE FUGUE--- seen in Schizophrenia , hysteria,epilepsy,wandering purposefully with some amnesia, "-----------((4))

11) "KORSAKOFF'S PSYCHOSIS---long term memory loss ,fes.--loss of Intellectual function but preservation of memory, lack of insight, unable to understand the disability, it is a REVERSIBLE state, CONFABULATION seen,Rx--VIT.B1(THIAMINE)"-------------((4))

12) "MENTAL RETARDATION---commonest cause--Birth Asphyxia ( Intellectual deficiency ),MENTALLY ILL---commonest mental illness in Chlidren --Neuroses,"------------((4))

13) "NEUROSIS---defective childhood experiences & adjustments & mild mental disorder , NEUROTIC DISORDERS---Anxiety, Hysteria, Phobia, OCN, "-------------((4))

14) "BULIMIA NERVOSA---episodes of excessive&uncontrolled eating , carries teeth , inducing vomiting,"----------((3))

15) "CATATONIA---FES.-automatic obedience,cataplexy,negativism,is seen in Schizophrenia,CATATONIA STUPOROUS---waxy flexibility is characteristic."---------((3))

16) "CONFABULATION---making stories to fill up gaps in memory loss , seen in alcoholism ,korsakoff psychosis"--------((3))

17) "FLASH BACK PHENOMENON---seen in Cannabis , Psilocybin , LSD.,"---------((3))

18) "HYPERKINETIC DISORDER---LOW I.Q., low Attention SPAN, poor impulse control, increase in Anger outburst, DOC-AMPHETAMINE.,"------------((3))

19) "LSD--Flash Blacks & Bad Trips , LSD Intoxication--> panic,confusion,Hyperreflexia, "------------((3))

20) "NOCTURNAL ENURESIS---DOC.-Imipramine, occurs in Stage IV sleep , "------------((3))

21) "OPIOID WITHDRAWAL---Rx nonaddicting drug -->Clonidine is used, OPIUM WTHDRAWAL---fes.-Lacrimation"---------((3))

22) "ORGANIC BRAIN SYND.---Visual Hallucination, Disorientation seen , bender gestalt test"---------((3))

23) "PANIC DISORDERS---DOC.--Diazepam, sudden attacks of anxiety with fear"-----------((3))

24) "PSYCHOANALYSIS---coined by Freud , this Tech. Used in Hypnosis,"-------------((3))

25) "SUICIDAL TENDENCIES---least in married person, Due to Withdrawal from Cocaine,Amphetamine,Alcohol, SUICIDE---most prone among -Adolecscent Girls,"-----------
Psychiatry-Topics Asked more than Twice
1) "AKATHISIA---restlessness/irresitible urge to move about & increased motor activity,Rx-amantadine,benzhexol,propranolol,"----------((2))

2) "ALZHEMER'S DISORDER---Ach.-biochemical cause ,predisposing factors--down's synd.,head trauma,low edu.group,"---------((2))

3) "ANTIPSYCHOTICS---longacting -Fluphenazin,"----------((2))

4) "BEHAVIOUR---TYPE A---time urgency ,impatiency,hard driving ,career orientation,ambitiousness, COINED BY friedman & rosenman ,"---------((2))

5) "BEHAVIOR THERAPY---indicated for Phobia,cardinal elements--Systemic desensitization & Flooding,"----------((2))

6) "BUSPIRONE---anti-anxiolytic,newer NONSEDATIVE ,non hypnotic axiolytic,"---------(2)

7) "CLOZAPINE---assosiated with agranulocytosis , causes sialorrhyroea,"-----------(( 2))

8) "EEG---alpha waves--> awake & eyes closed ( stage I sleep) ( ATKD'S-MNEMONIC-B,,,,A1,T1K2,D34(NREM),,,B-REMS)"-----------((2))

9) "FEAR---due to abnormal experiences of childhood , over consciousness & excess perception of danger , least common in depressive psychosis ,"-----------((2))

10) "FLUOXETINE---mech. of action--inhibition of serotonin uptake , side-effect--Anxiety,loose stools,Nause is troublesome"-----------((2))

11) "GPI(GENERAL PARESIS OF INSANE) ---fes. Confabulation, Grandiose, Delusions, Mental deterioration, "-----------((2))

12) "HALLUCINOGENS---Cocaine, Mescaline, LSD, Phencyclidine, "----------((2))

13) "HALOPERIDOL----acute drug dystonia after> 1day, causes Akathesia , used in BALLISMUS aswell,"---------((2))

14) "HYPOCHONDRIASIS---Preoccupation with body diseases, Over conscious about some illness, "----------((2))

15) "IMPOTENCE---it is also seen in D.M., diff. Between psy.Impotence & Organic I.--is diagnosed by monitoring of Penile TUMESCENCE during sleep ,"-----------((2))

16) "INTELLIGENCE QUOTIENT---I.Q.= (mental age X 100)/ chronological age (%), I.Q. Test = Binet Stanfort Test"------------((2))

17) "NEUROLEPTICS---blood levels checked for toxicity , commonest side-effect--Sedation , "---------((2))

18) "OEDIPUS COMPLEX---coined by sigmund Freud, seen in boys 3-5yrs of age,"------------((2))

19) "PHENOTHIAZINEs---involuntary perioral movement , used in Rx of depression , tardive dyskinesia is the side-effect,"------------((2))

20) POST-TRAUMATIC STRESS DISORDER---most common after major life threatening event/ e.g. any CAR accident,rape,earthquake,.. etc.-----------((2))

21) "PREMATURE EJACULATION --- Rx-SQUEEZE Technique, "------------((2))

22) "PSYCHONEUROSIS---diagnosis by VERBAL ACCOUNTS.,"------------((2))

23) "PSYCHOSOMATIC DISORDERS---e.g.--HTN,Peptic Ulcer disease, Bronchial Asthama, Hyperventilation"------------((2))

24) "THOUGHT---DISORDERS--loosening of Association, THOUGHT INSERTION---this is SCHEIDNER'S FIRST RANK SYMP."--------------((2))

25) "WITHDRAWAL SYMP.---PHYSICAL--absent-in Cannabis, Present in Pethidine,Opium,Haloperidol,Alcohol, Rx required in for withdrawal symp.--Cannabis, Cocaine,Alcohol,"-----


















1) ABREACTION---used in Rx of phobia,-----------((1))

2) "AFFECT---disorders of affect , disturbances of affect--panic , apathy , phobia,"---------((1))

3) "AFFECTIVE DISORDERS---depression ,reaction form'n ,adjustment reaction ,"-------((1))

4) "AGGRESSION ---PASSIVE AGG.--spills half,"-------((1))

5) "AGORAPHOBIA---fear of open spaces , DOC.--alprazolam,"-------((1))

6) "ALEXITHYMIA---inability to recognize & describe feelings,"--------((1))

7) "AMBIVALENCE---coined by EUGEN BLEULER,"---------(1))

8) "AMNESIA---anterograde amnesia--caused by giving ECT.,good prognostic indicator of head injury.,"---------((1))

9) "AMOTIVATIONAL SYNDROME---seen in cannabis,"------((1))

10) "AMOXAPINE---antidepressant with side effects like -tardive dyskinesia & neuroleptic malignant synd.,"-------((1))

11) AMPHETAMINES--- ,-----((1))

12) "ATTENTION DEFICIT DISORDER---seen with phenobarbitone ,"--------((1))

13) "AUTISTIC DISORDER---lesion is in Temporal lobe ,"-------((1))

14) "BALLISMUS---Rx haloperidol ,"-------((1))

15) "CHLORPROMAZINE---?rigidity,mask like face,tremors,(uses/side effects),"------(1))

16) "CLAUSTROPHBIA---fear of CLOSED spaces ,"-------((1))

17) "COGNITVE BEHAVIORAL THERAPY---is the Rx for Depression ,"-------((1))

18) "COPROLALIA---seen in TOURETTE'S SYND.,"-------((1))

19) CYCLOSERINE---anti -TB.-shows NeuroPsychiatric manifestation,--------((1))

20) "DÉJÀ VU---seen in normal persion ,temporal lobe epilepsy,psychosis,"--------((1))

21) DISORIENTATION---seen in Organic brain synd.,------------((1))

22) Diethyl Propion---1st. Choice in wt. reduction prog.,---------((1))

23) "DRUG DEPENDENCE---is due to withdrawal symptoms ,"---------((1))

24) "EXHIBITIONISM---shameless exposure of genitals ,"-------((1))

25) "FETISHISM---obtaining Sexual excitement with inanimate objects , "--------((1))

26) FREE ASSOCIATION---coined by FREUD.,------((1))

27) "GANSER'S SYND.---inappropriate answer...... , "--------------((1))

28) HASHISH---active substance—TetraHydroCannabinol,----------((1))

29) "HEROIN---withdrawal fes.--Yawing, muscle cramps, Hypersomnia, HTN.,"---------((1))

30) "HICCOUGH---Intractable--DOC-chlorpromazine/Largactil , "--------((1))

31) ILLUSIONS---,------((1))

32) "IMIPRAMINE---antidepressant ,DOC--in nocturnal enuresis , "--------((1))

33) INSOMNIA---Familial Fatal Insomnia--seen in PRION disease,-------((1))

34) KLEPTOMANIA---Irresistible ure to STEAL things of LITTLE value,---------((1))

35) "La Belle Indifference---seen in Dissociative disorders ,"--------((1))

36) LUCID INTERVAL---seen in INSANITY,------------((1))

37) least addictive---DihyroxyPropoxyphene,-----------((1))

38) MAOIS---induced hypertensive crisis-Rx-->reversed with Phentolamine,----------((1))

39) "MANDRAX---is combination of HYPNOTIC + ANTI-HISTAMINE,"----------((1))

40) "MASOCHISM---sexual partner are aroused & gratified by whipping ,"------------((1))

41) "MEMORY---RECENT--CENTRE--HIPPOCAMPUS ,"-------------((1))

42) "METHADONE---used in maintainance of Rx of opium dependence/ ?Withdrawal ,"-------------((1))

43) "MORPHINE---addiction , Withdrawal is done with Clonidine ,"---------------((1))

44) MYXEDEMA---ass. with depression ,-----------((1))

45) "MUNCHAUSEN SYND.---factitious disorder ,"---------((1))

46) "NARCOLEPSY---symp.--Cataplexy , Sleep acttacks, Sleep paralysis, "-----------((1))

47) "NIGHT TERRORS-seen in NREM sleep--TOC.-clonazepam,"-------------((1))

48) "NYMPHOMANIA---not a compulsive & habit forming disorder , "---------((1))

49) ORGANIC AMNESTIC SYND.---most common cause—Concussion,----------((1))

50) OTHELLO SYND.---Delusion of Infidelity on part of Sexual partner,-----------((1))

51) PARANOID DISORDER---Pseudocommunity,---------((1))

52) PERSONALITY DISORDERS---BORDERLINE-sucidal tendencies,--------((1))

53) PHENCYCLIDINE---ass. With DEPERSONALISATION,-----------((1))

54) "PICASSO SYND.---painter obsession developed into artistic painting, "--------((1))

55) PROJECTION---mature defense mech.,---?---------((1))

56) "PSYCHIATRIC MANIFESTATION---seen in Hypothyroidism, Hyperthyroidism, Acute Intermittent Porphyria, Inability for Erection, Inability to take deep breath , Pain,"--------((1))

57) "PSYCHOTHERAPY---PSYCHOANALYTICAL---Insight therapy, Behavioral therapy & SUPPORTIVE therapy, "--------------((1))

58) PUNISHMENT---inflicting pain to get rid of a bad habit ,--------------((1))

59) "PUNCH DRUNKENNESS ---is ass. With BOXING.,"--------------((1))

61) REINFORCEMENT---+ve R.-? Conditioned learning,----------------((1))

60) BRIEF REACTIVE PSYCHOSIS---after loss of loved-one's,--------------((1))

62) "SLEEP DEPRIVATION---leads to decreased mental altertness,"----------((1))

63) SLEEP-WALKING-somnabulism--seen in NREM STAGE 3/4 Sleep,-------(1))

64) "STUPOR---DEPRESSIVE--loss of power in all 4 limbs, Waxy Flexibility of muscle tone in limbs,"-------------((1))

65) "SUPERSTITION---a False belief unexplained by reality ( Shared by a number of persons/people ) ,"---------((1))

66) SUPER-EGO---coined by Sigmund Freund,--------((1))

67) "TARDIVE DYSKINESIA---due to Reserpine,HALOPERIDOL,"--------((1))

68) "THINKING---ABSTRACT--similarity between chair & table->both has 4 legs,"-------((1))

69) "THIORIDAZINE---side-effect--Pigmentary Retinopathy,"--------((1))

70) "THERMATIC PERCEPTION TEST---by Wechslers , "---------((1))

71) WERNICKE'S ENCEPHALOPATHY----Rx-Thiamine supplement,---------((1))

72) EIGHT STAGE CLASSIFICATION OF HUMAN LIFE---BY ERIKSON ,-------











3) "MOOD DISORDERS---seen in Schizoid state , MANIA---is a mood disorder, fes.--Mood Congruent delution, Delution of Grandeur, Neologism characteristic, Euphoria, Suicidal tendencies, pressure of Speech, Insomnia, Basic disturbance--ELATION, ass. With Good Humour, Physical Overactivity,

Rx of acute mania--is Lithium, drugs used--Haloperidol, Lithium,Carbamazepine,Chlorpromazine

4) "OBSESSIVE COMPULSIVE DISORDER/ NEUROSIS---characterised by Eleborate, checking, Repeated hand washing, Execessive Slowness, Irresistant Irrational behavior ,
Fixed at ANAL Stage, Persistance Irrational thought resisting the Data.
Mostcommon complication--is Depression

DOC.-Clomipramine, Rx-Dugs+Behavior therapy.
Rx of severe intractable OCN--is Cingulotomy, DOC.-Fluoxetine, DOC(OCN)--Imipramine"

5) "DELUSIONAL DISORDERS---DEF.-firm false /unshakeable belief ,seen in schizophrenia, mania, delirium, psychosis,psychotic depression ,it is comprehensible.
It is a Disorder of THINKING, MOOD CONGUENT DELUSIONS--MANIA & DEPRESSION ,DELUSION-OF-PERSECUTION---seen in schizophrenia.,"

6) "HALLUCINATIONS---disorder of false perception,
Visual hallucinations--seen in Alcoholism & Organic brain synd./lesion,
Auditory H.--seen in Schizophrenia, Mania, Amphetamine toxicity
Hypnagogic H.--arises when a pt. is falling a sleep"------------((12))

7) "ALCOHOL—
morbid jealously seen,ALCOHOL WITHDRAWAL SYND.
DOC.-chordiazepoxide,early morning drinking ,delirium,secretiveness about the amount taken,obessions,delusions,tremulousness,hallucination,hyperactive state,amnestic disorder,delirium tremens,epileptic seizures,
ALCOHOL ADDICTION---direct evidence-withdrawal symptoms,
ALCOHOLIC BLACK-OUTS-chare. by amnesia for events during drinking. ALCOHOLIC HALLUCINATIONS---occurs within 24hrs.of alcohol intake. ALCOHOLISM---auditory hallucinations,visual hallucinations,delirium ,&amnestic reaction."--------------((11))

8) "ECT / ELECTROCONVULSIVE THERAPY---
CI--in Brain Tumour ,Pergnancy ,Absolutely CI-in-increased ICT.
commonest side-effect--Amnesia,it is used in the Rx--of depression with sucidal - -tendencies, Req.>80Mvolts,
memory disturbance-recovers in few days to few wks.,antegrade amnesia of short duration occurs after ECT.
ECT is not useful in Rx of acute & chronic Schizophrenia, Unilateral ECT--less memory disturbance ,

9) "LITHIUM---Prophylactic Rx-MDP(manic depressive psychosis),used for Rx of Mood disorders,used in prophylaxis-Bipolar MDP,commonest symp.of lithium toxicity --is POLYURIA,chronic use of lithium--> HYPOTHYROIDISM, side-effects--hypothyroidism,Leucocytosis,Polyuria, Organs affected in Lithium toxicity--are Brain,Heart,Kidney(but not liver), Serum Li2+ levels=0.7-1.2meq/l , Lithium induced tremors--Rx Propranolol , "--------------((11))

10) "DEMENTIA---head injury, alzheimer's,huntington's chorea, multiple infarctions,deficiency of Niacin, Fes.--impaired memory, loss of judgment, loss of learned function,, Reversible cause--post encephalitis,Common in old age >60yrs. SUBCORTICAL DEMENTIA---Tactile agnosia,causes-parkinsonism,wilson's disease ,huntington's chorea,"-------------((10))

11) "PHOBIAS---is a type of neurosis, AGORAPHOBIA--Fear of OPEN Places, Animal Phobia--occurs at 8yrs. Of age, SOCIAL Phobia--Fear of public/seniors, IRRATIONAL Fear of Normal Instances,
Mx--Systemic Desensitization, Rx--Behavioural Therapy & Flooding , "-------------((10))

12) "PSYCHOSIS---Acute<2wks., auditory Hallucination seen, Major Psychosis--Endogeneous depression, Acceptance of other persons delusion-is the characteristis fes., ORGANIC Psychosis--Disorientation in time ,place,&person, Clouding of consciousness, Hallucination, Itellectual Impairment, Loss of insight, Rx-drugs used--Chlorpromazine,PUERPERAL Psychosis---, PSYCHOTIC DISORDERS---Schizophrenia, Mania, Psychotic depression"---------------((10))

13) "DISSOCIATIVE DISORDER---loss of Memory of all modalities , DISSOCIATION---seen in Fugue,Multiple personalities , Hysterical conversion, Somnabulism, dissociation hysteria leads to Amnesia , "----------((7))

14) "HYSTERIA---commonest symp.--motor or sensory phenomenon, Fixation of Hysteria--occurs at Phallic stage, uncommon symp.-Palpitation, Hysterical Somatization--Hemiplegia, Blindness, Fugue, Normal Intelligence, Rx--Psychoanalysis ,HYSTERICAL FITS---diff.fromm that of Epileptic Fits --Hyst.Fits occurs when people are Wachting , Incontinence of urine occurs,"--------------((7))

15) "TCA---ANTIDEPRESSANTS---TCA overdose-Rx-amitryptilline,safest TCA in HTN-Fluoxetine, TCA are CI. in angle closure glaucoma, Indications-gastric ulcer,depression,anxiety,…TCA adversly interact with Trnaylcypromine , TCA-causing Tardive dyskinesia-is-AMOXAPINE, side effects of TCA--metallic taste,dry mouth,epigastric discomfort,"

Acrophobia- Fear of heights. Hypsiphobia- Fear of height.
Agliophobia/Algophobia- Fear of pain.
Agoraphobia- Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place.
Automysophobia- Fear of being dirty.

Claustrophobia- Fear of confined spaces.
Cleptophobia- Fear of stealing.Kleptophobia- Fear of stealing.

Didaskaleinophobia- Fear of going to school.

Gerascophobia- Fear of growing old.
Glossophobia- Fear of speaking in public or of trying to speak.

Hydrophobia- Fear of water or of rabies.Hydrophobophobia- Fear of rabies.

Iatrophobia- Fear of going to the doctor or of doctors.

Kosmikophobia: Fear of cosmic phenomenon

Paraskavedekatriaphobia- Fear of Friday the 13th.
Phasmophobia- Fear of ghosts.

Sciophobia: Fear of shadows

Thanatophobia or Thantophobia- Fear of death or dying.

Xanthophobia- Fear of the color yellow or the word yellow

Zelophobia- Fear of jealousy.
Zoophobia- Fear of animals.
Most IMP. Psychiatry Topics
1) "SCHIZOPHRENIA(SP).----

Fes.--Thought Alienation, Thought Insertion & Broadcasting, Suspiciousness, Conspire against him, Hallucination of VOICES, Paranoid Delusion, Passivity, Delusions in CLEAR CONSCIOUSNESS, Los of insight occurs ,-ve Symp ,
Auditory H ,Visual H. ,Delusions of persecution, Increased Psychomotor activity,AMBIVALENCE-seen,Personality deterioration seen, Delusion of Presentation, Delusions of Reference, Delusion of Control,waxy flexibility,Fes. of Affect seen, NIHILISTIC IDEAS seen.

FIRST RANK SYMP.--Thought Insertion, Delusion of Perception, Hallucination, Thought Alienation phenomenon, ass. with ASTHENIC personalities

SP.is a side-effect of Amphetamine, Incidence in India 5-10 per1000,
Most common /Pathognomonic Hallucination--AUDITORY H., auditory H.-commanding the pt., Autism,Ass.Defect,Ambivalence,Cortisone,&ACTH-causes SP.

Prognosis of SP.is improved by/Good prognosis is due to->ATYPICAL SYMP.
Neurotransmittors involved are =PGE1,NorEpinephrine,5-HT, DOPAMINE is also found in increased quantity, Early SP.-resembles Anxiety neurosis, SP.is more common in low socioeconomic group/class, good prognosis is indicated by Early Onset, alsp good prognosis--is seen in Affective disorder, BLEULER'S Emphasis--is on Flattened affect, Loose associations, Ambivalence,

Rx of SP. ---DOC--FLUPHENAZINE, /Rx of Auditory H.-CLOZAPINE, /
Rx of Chronic Resistant SP.-CLOZAPINE,

CATATONIC SP. --- Grimacing , Defect in Conation, First symp. to disappear after Rx/Symp. with Best prognosis--Auditory H., C.SP.-mostly occurs in Adolescents, Fes.--Mannerism, Increased Psychomotor activity ,Rigidity, Negativism, Waxy flexibility,Echolalia is also seen,

HEBEPHRENIC SP--BAD/WORST Prognosis, Gross disorganiza/severe deterioration

PARANOID SP -Caused by Amphetamine, GOOD PROGNOSIS & LATE ONSET, Psychosis due to chronic amphetamine intake-resembles->SP."-----------((47))

2) "DEPRESSION---most common D.-post partum psychosis.
--pseudodementia seen in D by drugs --Methyldopa,Reserpine,O.C.pills,Propranolol,
Rx of acute D.->ECT.
Neurotransmittor Involved is =GABA & DOPAMINE,due to DEFICIENCY OF 5HT.

MAJOR D.-- death of loved person,UNIPOLAR MAJOR D.--more common in females, Lithium carbonate -least likely to cause serious D.

NEUROTIC D.-- commonest psychiatric illness in INDIA, Ravenous appetite , INCREASED libido , common risk is-Fatigablity ,NIHILISTIC DELUSIONS & early morning Insomnia
,
ENDOGENOUS D.---middle age 40-60 yrs.,sucidal tendecy most common,
Rx.of D.--Cognitive Theraphy ,DOC.-imipramine
DOC.for Rapid cyclers in Bipolar illness--valproic acid / Carbamazepine . DOC.for D.+CAD(coronary artery disease)--is-MIANSERIN."-------------((20))