therapy

Depression: How Does it Affect Relationships

GalleryJudy Gurfein Leave a comment
Depression: How Does it Affect Relationships

By: Jasmyn Cuate

Depression is one of the most common types of mental illness that Americans struggle with each day affecting approximately 1 in 6 Americans. Depression is characterized by feelings of sadness, emptiness, or hopelessness, irritability, angry outbursts, or low frustration tolerance, loss of interest in or ability to enjoy usual activities, sleep disturbance, fatigue and lack of energy, appetite disturbance, agitation, anxiety, feelings of worthlessness and guilt, difficulty concentrating, remembering things, making decisions, recurring thoughts of death, and thoughts of suicide.

Many individuals struggling with depression describe it as living in a heavy fog where you lose clarity about your life, start to have self-doubt, changing the way you view friends, family, and partners as well as how you think they view you.

Although many relationships experience problems, a partner dealing with depression or trying to help their partner overcome depression, may find themselves having more challenges to their relationship. Depression can cause overwhelming emotions such as detachment, distrust, and vulnerability. It can cause the partner to pay little attention to the other partner, be less involved, more irritable, start arguments, and have trouble enjoying time together. Factors such as high levels of conflict, lack of communication, difficulty resolving problems, and withdrawal can lead to depression.

Untreated depression can cause a cycle of self-destructive behaviors that can tear relationships apart. Research has shown that when one member of a couple has depression, there is an impact on the well-being of the other partner as well. In fact, BMC Public Health has found that partners of those with mental illnesses, show signs of anxiety and depression themselves.

If you or someone you know is seeking therapy for depression or experiencing relationship problems due to depression, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources: https://www.psychologytoday.com/us/basics/depression/signs-depression

https://blogs.scientificamerican.com/mind-guest-blog/the-warning-signs-that-depression-is-affecting-your-relationship/

Art Therapy: An Adjunct in the Therapeutic Process

GalleryJudy Gurfein Leave a comment

Art Therapy: An Adjunct in the Therapeutic Process

By: Julia Massa

Art therapy is defined as “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship.” Art therapy is used as an adjunct in the therapeutic process when working with diverse populations, but predominately children. This type of therapy can be exceptionally beneficial for parents of a child who has a medical illness or struggles with expressing or verbalizing their feelings or thoughts. Though this form of therapy is not commonly used when treating the adult population, it is frequently used diagnostically for those experiencing illness, trauma, or a mental health condition. For instance, art therapy can be an effective treatment for individuals diagnosed with cancer or traumatic brain injury.

Art therapists typically work in hospitals, psychiatric, and rehabilitation settings, as well as other clinical and community settings. In particular, art therapy can help support an individual’s ability to cope with certain medical challenges as well as long or short-term hospitalizations. This type of therapy can serve as an outlet for those who have difficulty expressing their daily thoughts. The creative process allows an individual to foster self-esteem as well as self-awareness.

Using a variety of forms of expressive art, such as dance, music, writing, visual arts, drama, etc. can allow an individual to not only express, but reflect on their own thoughts and emotions. In turn, an individual can explore and understand why they react to their experiences in a particular way and how they can initiate change.  Art therapy can be a key enhancer towards personal growth.

If you or someone you know is seeking therapy, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

About Art Therapy
https://www.atcb.org/what-is-art-therapy/

https://www.goodtherapy.org/learn-about-therapy/types/art-therapy

Anxiety: Generalized Anxiety Disorder (GAD): Signs, Symptoms, and Treatment

GalleryJudy Gurfein Leave a comment

Anxiety: Generalized Anxiety Disorder (GAD): Signs, Symptoms, and Treatment

By Celine Bennion

Generalized Anxiety Disorder (GAD) is a common anxiety disorder in the United States, currently impacting 3.1% of the population; as many as 5.7% of U.S. adults report experiencing this disorder at some point in their lives. GAD is characterized by feelings of excessive worry which have no particular trigger. This anxiety can be felt about school, work, social interactions, or even common, everyday events. These behavior patterns and cognitive issues become disordered when they begin to disrupt normal functioning.

Symptoms of GAD include the following: restlessness, being wound-up or on-edge, fatigue, trouble concentrating, irritability, muscle tension, and sleeping problems including difficulty falling/staying asleep or unsatisfying sleep. At least three of these symptoms must be present for at least six months for a patient to be diagnosed with GAD.

Treatment:

Cognitive Behavior Therapy (CBT) is a type of therapy that is particularly helpful in treating anxiety disorders, including GAD. This therapy involves teaching patients different ways to approach anxiety inducing situations by changing how they think, behave, and react to them. It also helps to implement social skills in patients.

Medications are another form of treatment for GAD. It should be noted, however, that medications are used to help decrease symptoms of a disorder and do not cure it entirely. Anti-anxiety and anti-depressant medications are commonly used to treat GAD. Anti-depressants work for both depression and anxiety by altering chemicals in the brain, specifically serotonin and norepinephrine. They help to regulate mood and relieve symptoms associated with these disorders. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are the most commonly used anti-depressants. Anti-anxiety medications, such as benzodiazepines, are effective in treating anxiety symptoms quickly. They are often used as a second option when anti-depressants are not enough to relieve symptoms.

If you or someone you know is seeking therapy for an anxiety disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://www.nimh.nih.gov/health/topics/anxiety-disorders

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

https://adaa.org/blog/category/generalized-anxiety-disorder-gad (photo)

ADHD in Girls: Suffering in Silence

GalleryJudy Gurfein Leave a comment

ADHD in Girls: Suffering in Silence

By: Stacey Rodriguez

Generally thought to be a disorder specific to school-aged boys, attention deficit disorder (ADHD) has shown to be relatively prevalent in girls as well. The disorder includes 3 subtypes: hyperactive and impulsive  (HI), inattentive, and combination. ADHD is commonly associated with the HI subtype, which is most commonly exhibited by boys. Contrastingly, girls tend to exhibit the inattentive subtype. By nature, inattentive features are not as overtly obstructive as that of hyperactivity and impulsivity, often causing them to go unnoticed. In fact, studies estimate that 75% of girls with attention deficit disorder never get diagnosed. Additionally, it is theorized that societal norms, such as gender roles, might also be a factor in this disparity; since many overt characteristics of ADHD do not align with female gender norms, such as the tendency to be disorganized or interrupt others speaking, girls with the disorder tend to suppress the tell tale signs. 

The result of undiagnosed attention deficit disorder can be detrimental, as it can lead to mental health consequences in adulthood. This is largely due to the fact that girls tend to internalize mistakes. This internalization leads to negative internal dialogues, which puts girls with ADHD at higher risk for eating disorders, anxiety disorders, and depression. It is imperative to be aware of the ways in which the disorder manifests differently in girls. For example,

A girl with ADHD might:

-be more more easily irritated, or sensitive to certain sounds/feelings

-talk significantly more than her peers and often interrupt others

-struggle to commit to completing tasks or activities

-often make “careless” errors

-seem to be especially disorganized

-tend to be forgetful

If you or someone you know is seeking therapy for attention deficit disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Source: https://www.cfpsych.org/blog/what-parents-need-to-know-about-adhd-in-girls/

Image Source: https://psychbc.com/blog/adhd-is-different-for-girls-what-families-need-to-know

Mental Health during Pride Month

GalleryJudy Gurfein Leave a comment
  • Mental Health During Pride Month

By Charlotte Arehart

With June finally starting, this means that it is officially Pride Month! Pride Month is celebrated in June in the USA and many other countries. During Pride Month, we celebrate and recognize the impact that  lesbian, gay, bisexual, transgender, queer LGBTQ+ individuals have on their communities. We celebrate their history, whether it be locally, nationally, or internationally. Unfortunately, there is a stigma surrounding the LGBTQ+ community regarding mental health. There are a plethora of statistics about LGBTQ+ individuals and mental health, including the fact that members of the community are less likely to seek treatment for mental health, substance abuse, and eating disorders. This is largely due to fear of being discriminated against because of their sexuality. Pride Month is the perfect opportunity to prioritize and learn more about mental health for LGBTQ+ individuals.

There are many barriers that LGBTQ+ individuals face when it comes to finding mental health treatment. Many mental health centers lack culturally-competent or diverse staff and/or treatment. It was not very long ago that homosexuality and bisexuality were themselves considered mental illnesses. This was thought to be true until the 1960’s. Gay men and lesbian women were frequently forced to undergo “treatment” for their sexuality against their will, such as aversion, conversion, and even shock therapies. Also damaging to mental health, LGBTQ+ individuals are at a higher risk for bullying, and sometimes even hateful violent crimes. The best way to help the LGBTQ+ community regarding mental health efforts is to support the community not only through words but through actions. By reducing the stigma around mental health and making LGBTQ+ individuals feel as comfortable as possible, hopefully we can make mental health treatment more accessible for everyone. Luckily, the vast majority of mental health professionals today are accepting and positive towards the LGBTQ+ community. Everyone deserves to have efficient, effective, and professional mental health no matter how they identify as individuals.

If you or someone you know needs mental health support, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

LGBTQ+ Mental Health Statistics
Gay Pride: LGTBQ+Mental Health Awareness

Image Source: https://lgbt-speakers.com/news/top-10-lists/10-lgbt-speakers-for-pride-month-2021

Physician Burnout during a Global Pandemic

GalleryJudy Gurfein Leave a comment

    By Eleanor Kim

    Physicians and nurses around the world have been at the front lines fighting the coronavirus and saving the lives of those infected. Now more than ever, citizens are coming to realize the importance of those within the medical field and the bravery that comes with entering medicine. That being said, there has been an immense amount of pressure placed upon healthcare workers, often causing stress, anxiety, and depression. At the end of the day, doctors, nurses, and other healthcare workers are humans and can feel the effects of burnout during such a heightened and high stakes moment in medical history.

    Burnout is when someone becomes overwhelmed by the demands of their daily life, becoming emotionally and physically exhausted and creating a sense of depersonalization and weakened personal accomplishments. Burnout is a common occurrence among physicians and nurses given the great amount of pressure that comes with saving lives. That being said, these feelings of burnout have skyrocketed given the additionally taxing nature of current frontline medical work such as the stress of isolating from friends and family, the extended hours of work, the tragic lack of medical supplies, and the fear of contracting or spreading the virus, to name a few. Physicians are also left to deal with the other struggles and anxieties that the past year has brought upon the general population regarding economic, political, racial, and other personal effects of the pandemic.

    During these elongated periods where healthcare workers are left sleep deprived, improperly fed, and overall anxious about the current status of the pandemic, they are exposed to both mentally and physically long lasting effects. In 2020, there have been a record number of physicians who have reported feelings of burnout and other mental health concerns since the start of the pandemic. Should these issues go untreated, there is an increased risk for depression, self-medication, substance abuse, and suicidal thoughts or attempts. Burnout is more than just stress; it is a mental health crisis and should be treated as such.

    If you or someone you know is feeling the effects of physician and healthcare worker burnout, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/.

    Resources:

    https://www.forbes.com/sites/lipiroy/2020/05/17/doctor-heal-thyself-physician-burnout-in-the-wake-of-covid-19/

    Image Source:

    More than a third of medical staff suffered insomnia during the COVID-19 epidemic in China

    Is an Emotional Support Animal Right for You

    GalleryJudy Gurfein Leave a comment

      By Eleanor Kim

      Pets have brought joy and comfort to pet owners for hundreds of years. The sheer presence of a happy-go-lucky dog or cat is enough to bring a smile to anyone’s face. The benefits of pet ownership can go beyond mere companionship or responsibility, in fact, emotional support animals are able to, as their name indicates, provide emotional support and other mental health benefits.

      Common ways in which emotional support animals could support their owners are:

      • Fostering emotional connectivity
      • Helping people during times of crisis
      • Lowering anxiety
      • Offering trauma support
      • Improving physical health (Lower blood pressure, decrease respiration rates, improve ability to cope with pain, etc.)
      • Lowering feelings of loneliness or depression
      • Reciprocating feelings of love and care

      It is important to indicate the difference between emotional support animals and service animals. Service animals also provide emotional support to their owners; however, service animals undergo intensive training to perform specific tasks necessary to aid their owners’ needs. In contrast, emotional support animals do not need formal training and simply need to receive a certification from the state registry. In order to qualify for an emotional service animal, individuals must acquire a prescription from a licensed mental health professional indicating that the presence of an emotional support animal is necessary for the mental health of the patient.

      In a time when all of us are at home and may be in need of more emotional support, emotional support animals may provide the help you need. If you are interested in receiving emotional support, whether that be through a support animal or through a mental health professional, we here at Arista Counseling are here to assist you.

      If you or someone you know is looking for emotional support, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/.

      References:

      Everything You Need to Know About Emotional Support Animals

      https://www.verywellmind.com/what-is-an-emotional-support-animal-4171479#definition

      Picture Source:

      https://figopetinsurance.com/blog/can-cats-dogs-live-together-peacefully

      ADHD and the 3 Types

      GalleryJudy Gurfein 1 Comment

      Mizuki Wada

      Known to be commonly diagnosed in children and adults, ADHD is a neurobehavioral disorder that is characterized by the patient’s inattentiveness and impulsivity. However symptoms can differ from patient to patient and can be categorized into three general types.

      The first type, primarily hyperactive also known as impulsive ADHD is generally linked with those who are restless. Some of the symptoms could include:

      • Restlessness
      • Impulsive speech and actions
      • Excessive talking
      • Overactive
      • Interruptive
      • Loud interactions

      Type two is primarily inattentive ADHD formerly called ADD. This type includes symptoms of inattentiveness and does not include hyperactive symptoms. Some common symptoms could be:

      • Trouble paying attention
      • Difficulty in following through tasks
      • Easily distracted
      • Shy
      • Disorganized
      • Careless
      • Slow in processing information

      The final type is a combination of these two types. This type is a mix of both hyperactive and impulsive behaviors.

      Although these symptoms are categorized into different types, they all fit under the general disorder, showing the depth of this disorder and how symptoms could differ depending on the individual.

      If you or someone you know is struggling with ADD/ADHD, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

       

      References

      https://www.psychologytoday.com/us/conditions/attention-deficithyperactivity-disorder-adult

      https://www.additudemag.com/3-types-of-adhd/#:~:text=What%20Are%20the%203%20Types%20of%20ADHD%3F%201,ADHD%20%28formerly%20called%20ADD%29%203%20Combined%20Type%2 0ADHD

      Borderline Personality Disorder: Misdiagnosed

      GalleryJudy Gurfein 4 Comments

      Borderline Personality Disorder: Misdiagnosed

      By Zoe Alekel

      When struggling with your mental health, the last thing you want to hear from a doctor or therapist is that they don’t think anything is wrong. It can leave you confused, lost, hopeless, and alone. Borderline Personality Disorder (BPD) often goes undiagnosed or misdiagnosed because of the disorder’s symptoms and stigma. According to the Mayo Clinic symptoms of borderline personality disorder include:

      • Intense fear of abandonment—including real or imagined separation/ rejection
      • Feelings of depression, anxiety, and hopelessness
      • Unstable relationships—idealizing someone one moment, then suddenly believing they don’t care or that they are cruel
      • Distorted view of self and self-image—including dissociation (feeling as if you don’t exist at all or if the moment in time isn’t real)
      • Impulsive and risky behavior—including rebellion, drug abuse, reckless driving, sudden decision making, unsafe sex and promiscuity, and sabotaging success or personal relationships
      • Suicidal thoughts, threats, or behavior or self-injury, often in response to fear of separation or rejection
      • Mood swings lasting from a few hours to a few days— including intense happiness, irritability, shame or anxiety
      • Inappropriate, intense anger—losing temper easily, acting out, intense irritability

      The symptoms for BPD often look like other mental health conditions—contributing to misdiagnosis or lack of diagnosis. Sometimes BPD has similar patterns and symptoms as bipolar disorder, which can also include severe mood swings. One study shows that 40% of people, who only met the criteria for BPD, were still misdiagnosed with Bipolar Type 2; which is likely due to the overlapping and similar symptoms of each disorder.

      Another reason why BPD can go undiagnosed or misdiagnosed is because of the myth that teens can’t have BPD. Many of the symptoms of BPD can be seen as “typical teenage behavior” as this is a crucial time in an adolescent’s life when they are developing personality and identity. Diagnosing younger adolescents with BPD is often avoided because of the stigma attached to the diagnosis. Some clinicians may fear that the client’s symptoms may only worsen with a BPD diagnosis. This can be very dangerous and harmful to the client who is not accurately being diagnosed, especially because it limits the resources they can receive for help.

      BPD does not only appear in a specific age group or gender, and sometime can mirror other diagnoses or the experience of a typical adolescent. Health professionals and advocates must continue to educate and understand the reality of BPD, and know when to properly diagnose so their client can receive the help they need.

      If you or someone you know is struggling with borderline personality disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

      Sources: https://nami.org/Blogs/NAMI-Blog/October-2017/Why-Borderline-Personality-Disorder-is-Misdiagnose

      https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

      Image source: https://wakeup-world.com/wp-content/uploads/2016/01/Genie-in-a-Bottle-The-Spiritual-Gift-of-Borderline-Personality-Disorder-1.jpg

      Bipolar Disorder: Loving someone with bipolar disorder, the ups and downs

      GalleryJudy Gurfein Leave a comment

      Bipolar Disorder: Loving someone with bipolar disorder, the ups and downs
      By Zoe Alekel

      Loving someone with bipolar disorder can be a challenge if you don’t have the right tools and knowledge to help both you and your loved one. The first step in loving someone with bipolar disorder would be to understand what it means to be bipolar. Although you may never know exactly how your loved one feels, it is important to understand and educate yourself about their behaviors and emotions. According to the Mayo Clinic, bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). To understand what your loved one is going through, it is key to remind yourself that your loved one can’t always control these emotional mood swings—and more importantly it is not a reflection of you or how they feel about you.

      It is understandable that it can be difficult to understand these seemingly sudden and intense mood swings, and your loved one struggling with bipolar disorder may already know this and feel bad about how it affects you. Make sure you approach them with kindness, and always ask them what you can do to help them. Sometimes space and understanding that the mood swing will pass is enough support for your loved one. No matter how involved or uninvolved they want you to be with their mental health, always respect their wishes.

      One thing you can do to help you cope with your loved one’s bipolar disorder is to find others that have loved ones with bipolar disorder as well. Additionally, you can reach out to a therapist to share your feelings and the struggles that you experience as someone who has a loved one diagnosed with bipolar disorder. A way you can further educate yourself on bipolar disorder is to visit the National Alliance on Mental Illness (NAMI) website. NAMI provides credible information for those with loved ones diagnosed with bipolar disorder, and suggests you can try the following to help a family member or friend with bipolar disorder:

      • Recognizing and preventing serious mood episodes/ mood swings
      • Being able to recognize the warning signs of mania and depression
      • Making sure your loved one is taking their medication regularly and consistently (as directed)
      • Communicating and making time to talk to your loved one about their feelings when they feel ready
      • Remaining calm and rational with your loved one
      • Keeping a positive attitude and a clear mind to help your loved one the best you can
      • Reaching out for psychological support for you and your loved one

      If you or someone you know is struggling with bipolar disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

      Sources: https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder/Support#:~:text=NAMI%20and%20NAMI%20Affiliates%20are%20there%20to%20provide,about%20bipolar%20disorder%20or%20finding%20support%20and%20resources.

      https://www.psychologytoday.com/us/blog/insight-is-2020/201206/bipolar-disorder-loving-someone-who-is-manic-depressive

      https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955#:~:text=Both%20a%20manic%20and%20a%20hypomanic%20episode%20include,sprees%2C%20taking%20sexual%20risks%20or%20making%20foolish%20investments

      Image Source: https://www.bing.com/images/search?view=detailV2&ccid=Yu1OAouO&id=1B4D516A8A17EF4EE248CCCBAD2EC46DA7E6585F&thid=OIP.Yu1OAouOT_6cQM6Ql4oDYQHaLW&mediaurl=https%3a%2f%2fi.pinimg.com%2foriginals%2f13%2fbb%2f82%2f13bb82bf3d3c1b28a560d610c2d17fad.jpg&exph=1128&expw=736&q=loving+someone+with+bipolar+disorder&simid=608040637685434558&ck=DC1BFB40548A0FA375883D67352A1C1F&selectedIndex=21&FORM=IRPRST&ajaxhist=0