Psychopathology
Appearance and behaviour
IMPORTANT FOR MENTAL STATUS EXAMINATIONÂ
go according to that ASEPTIC - learn that MHE history and examination first
1. General appearance
 => •A Self Neglect (dress, goom, hygiene)
* alcoholism
• drug addiction
• dementia
• schizophrenia
B Weightloss (build/demenour)
• Physical
disorder
• psychological
disorder
• social problems
C Apparent age?
2. Facial Expression
> Depression - vertical furrows, tearful, looks down, corner of mouth inverted. sighing
> Anxiety - hortizontal furrows, eyes wide open, mouth open, facial muscle tenseÂ
> Parkinsonian
Â
3. Posture and gait
-Â depressed sit forwards and looks down. Anxious biting finger nails, clinging to chair
Â
 4. Movement
>Stupor - pschomotor retardation like a statueÂ
>Tics - Irregular,
repeated
movements of
group of muscles
>Choreiform - Irregular,
repeated
movements of
group of muscles
>Dystonia - Muscle spasm ,
painful - can be due to meds like antipsychotics
Â
5. 5ocial Behaviour
>Disinhibited
>Impending violence - clench fist, abgry and hostile
Â
Behaviour
- Appropriate or not , motor activity -Â Motor retardation, motor restlessness, agitation
- Eye contact
- Accessibility – Readily accessible, Poorly accessible
Attitude towards examiner and examination
Co-operative
relaxed
anxious and tensed up
Reticent
Suspicious
Irritable
Hostile
Threatning
over familiar
Disinhibited
over confident
over-bearing,indifferent,apathetic
6. SpeecA
Quality (actually asessing thoughts)a – relevant , coherent, loosening of association, vague, i3cdiosyncratic thinking, flight of ideas
7. Mood
Mood vs affectÂ
A. Subjective Mood - how are you feeling tod
B. Objective Mood
> Nature – depression/ elation/ anger/anxiety/ suspicion/
perplexed
> Constancy – emotional lability/ emotional incontinence (cant control)/
(wont have lot) / flattening (wont show)
> Congruity – congruous (inline with thoughts) / incongruous (not in line -pscizophrenia and organic conditions like dementia)
>intensity
Nature. Intensity. Constancy. Congruity with affect/situation.
Any suicidal ideation or homicidal idealation.
8. Thoughts
* Accessed using speech, writing and Art(chidren)
A. Abnormalaties of stream
>pressure of thought ( a lot)
>Poverty of thought(little)
>blocking of though (dam in schizophrenia)
B. Abnormalaties of form (formal thought disorders)
>flight of ideas (usually in pressure of thoughts) (assessed using speech topics = mania)
>loosening of
associations (disconnected = cant understand despite langauge = incoherent) (knights move)
>perseveration (same thought always = same answer for all questions) = organic brain disease like dementia
Linea vs tangential vs circumferential
C. Abnormalaties of content
>delusions
>overvalued ideas
>obsessions
>Preoccupations
¨Worries
>Suicidal ideas and intentions (and homicidal etc)
>Phoobias
C1 Delusions (4 conditions)
>belief usually false
>firmly held on inadequate
grounds
>not amenable to reasoning
>not shared by the
sociocultural background
A Primary delusions
occurs suddenly without
any other abnormalh
mental event leading to it (without any other psychopathology without hallucinations, illusions, memory impairment)
Â
Delusion perception, idea, memory, mood
Â
g indications of schizophrenia)
> delusional mood - patient feels that
something sinister is
happening concerning
him, but unable to say
what it is
> sudden delusional idea - A patient may suddenly develop
the unshakable conviction that
he is changing sex
> delusional perception - A patient may suddenly be convinced he is a
homosexual when he sees the traffic lights turn red as
he approach it. Normal perception is given a delusional interpretation
B Secondary delusions
(mostly seen in practice because its a late presentation)
arise from some previous
abnormal idea or
experience
> hallucination
> mood
> another delusion (usual)
Delusional system or systemisized delusion - network of
inter-related
delusions
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F21a7bc6d-ab82-4f27-94ac-cd5b0c8d6621%2Fimage1.jpeg?table=block&id=2e18df46-8a1f-4cce-a883-a0583b6b2be3&cache=v2)
reference = everyone is talking about me
grandios = big shot
guilt = feeling guilty for something not done (depression)
nihilistic = nothing.
hypochondrical = something pathological in body
dysmorphohobic = fear of change in own body like nose, ear, hair
jealosy (morbid jealousy) = partner is unfaithful. Very common in sri lankan.
sexual = sex has change.
religious = deviating from sociocultural
control = controlled by someone, chipped inside brain
pocession of thoughts = someone control though
Thought withdrawal,
thought insertion = inserted though computer
thought broadcasting = thought known in village
hallcination?
interviewer has to decide 3 things:
1 Is the belief true?
2 How strongly are the beliefs held?
3 Are the beliefs culturally determined? (otherwise not thqat much of a delusion)
c2 OVERVALUED IDEA:Â
(one step before delusion)
because of its emotional
significance takes
precedence over other ideas
eg: emotional over famil members have cancer, they also think they have strongly cancer
C3 OBSESSIONS: (7 characteristics of an obsession)
repetitive
your own
thoughts
intrusive
resistance
distressing
dysfunctional
useless or purposeless
Types of obsessions:
thoughts ruminations(collection of thoughts) doubts
images impulses
phobias
and then nonsense
Themes of obsessions>
dirt &
contamination
aggressive
actions
orderliness
disease sex religion
Compulsions:
Behavioural rituals:
washing cleaning checking
counting dressing nonsense
Mental rituals: (occult obsession)
phrases, reassurance (3rd party needs to resolve)
Â
9. PERCEPTIONS:
process of becoming aware of what is presented
to the body through the sense organs
>Illusions
>Hallucinations
(frequently asked at exams)
>depersoanlization and derealization. > Passitivity experiences.
Illusions => (misinterpret)
Misperception
of a real
external
stimulus
Common when : sensory impairment (common in the night)
inattention
impaired consciousness (delirium)
emotional arousal
Hallucinations =>
Perception
experienced in
the absence of
an external
stimulus
(illusion you have a stimuli) (hallucination not0
Modalatities =>
auditory visual
smell taste
tactile
deep
sensation
Diagnostic Associations:
Visual => organic
disorders (delirum, alcohol withdrwa, drug withdrawal)
2nd person auditory => mood
disordersÂ
schizophrenia =>
3rd person Auditory. Running Commentry. Thought Echo (hearing your own thought aloud)
Â
10 Cognition
A CONSCIOUSNESS:
> clouding of
consciousness (delirium, organisc states, siwthdrawal and alcoholic states)
> stupor (disassociative, schizophrenia, depression)
> confusion (delirium)
B ORIENTATION:
> time
> place
> person
C ATTENTION & CONCENTRATION:
> serial 7s
test (subtract 7 from 100) 9repeat days of the week or months backward)
D Memory
> Assessment
assessment of immediate memory -
digit span test (hold 5 items)
assessment of recent memory -
name & address test / 5 item recall
assessment of long-term memory –
recall personal events / public events (weddings, birthdays, when is the inpedence day)
(important for exams)
>Disorders
1. retrograde amnesia:
Loss of memory for events before
the onset of unconsciousness
2 anterograde amnesia:
Loss of memory for events between the
ending of complete unconsciousness &
the restoration of full consciousness
(ECT, head injuries)
3 Confabulation :
reporting as memories of events
that did not take place to fill the
gaps in memory
E LANGUAGE: function tests
naming
verbal instructions (take piece of paper, fold it and place on the table)
written instruction (written instruction)
writing a sentence
Dysarthria, dysphasia, comprehension, writing, naming objects
F VISUOSPATIALÂ : functioning tests
copy simple line figures
draw a clock face (and mark the time)
trail making test (trail making)
G General information and ability to solve simple arithmetic problems,Judgment
COGNITIVE FUNCTION
ASSESSMENTÂ : special tests
mini mental state examination
Montreal cognitive assessment: MOCA (sinhala version) (good for earlier dementia)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fa29eb733-1af0-4319-b4ce-11f3990f46f1%2Fimage2.jpeg?table=block&id=22709876-541b-423f-8c4e-b3a8850b1c2f&cache=v2)
11. Insight
Extent to which the patient’s view of
their illness
>awareness that others consider oneself as
abnormal
>recognition that phenomena are
abnormal
>acceptance that these abnormal
phenomena are caused by mental illness
>awareness that treatment is required
>acceptance of specific treatment
recommendations
(sometimes can accept treatment but not accept something is wrong
psychotic illness feature)
Insight vs judgement
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F2f1c0eb0-d512-4d07-bd03-b0f2d56e85e7%2Fimage3.jpeg?table=block&id=5216bc8c-ffe0-4e7d-bda1-c2a0ee0bb79a&cache=v2)
Â
Systematised delusions?
Shared delusions?
Marrow
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fa7566d6c-423f-48e4-81dc-d4d13fc2c634%2FUntitled.png?table=block&id=ef376b36-d887-4a14-b5ba-30ad646490c7&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F1013f516-6ca8-451b-ae2f-7e3d4ca21f96%2FUntitled.png?table=block&id=04c7d14f-46c9-4f18-a01e-a9c8861323d1&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F19ac7aed-a4ec-4f74-9fa7-79680e9c3b8b%2FUntitled.png?table=block&id=25e805a2-025f-4b45-91dd-cc1b47dfe352&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Faacbfda5-6573-45f6-b184-a9bffe7244e9%2FUntitled.png?table=block&id=b1ef218d-5dc1-4272-a8bf-a133a9d02f5d&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fde40acac-2a73-4440-a5b7-ec7b8c1d1a33%2FUntitled.png?table=block&id=d9e50cf7-a033-4dc3-bd0b-641f5b3d036d&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fa076c96c-83ab-45c7-9194-3cd55dbbeea3%2FUntitled.png?table=block&id=b437b1be-5fe6-4729-b31a-6353f455c620&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F862d854c-3f69-4b8e-bfc7-68af844f45ba%2FUntitled.png?table=block&id=fad0293f-5df4-4041-80b8-f91ad59ae14e&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F5ab53433-ea30-4dad-bdf6-efaef1fd595c%2FUntitled.png?table=block&id=5788550c-fb0a-442f-9e37-bd841e285d2d&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F4c34bf67-085f-40fa-b534-52cfd631508f%2FUntitled.png?table=block&id=b8679e63-fe3c-4f95-a29b-b0f360dea2a9&cache=v2)
Â
PPT
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F55d88f19-b71d-43ad-bf2e-3a3d831015bc%2FUntitled.png?table=block&id=315e5ca5-e7c5-43c6-b6c3-ded32c170971&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F6c8cb304-8ad2-46e4-9d25-2839f88776bd%2FUntitled.png?table=block&id=afd33381-df4c-4d5e-b9b9-96df9ccd29c5&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fcade7361-7f62-42cc-8ef8-7d9147bd09bb%2FUntitled.png?table=block&id=25611de4-8307-4d46-b8d2-d2103b7938a4&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F62b0617a-9706-4f16-af1b-ac14768b9a4b%2FUntitled.png?table=block&id=164b85a6-8ada-440e-b921-9a6a9e88c21b&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fe7f00c7e-7d02-4044-a05d-25413a629250%2FUntitled.png?table=block&id=c8d2bed9-d3ad-44f9-ba94-0e75b153a801&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F55249006-382f-4cd3-bf03-21f6f1dc3d91%2FUntitled.png?table=block&id=e0d89f7a-7c92-4e8f-a256-d0a897c9fb47&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F5406f4f1-b726-437f-96de-f21637b66e71%2FUntitled.png?table=block&id=f5cc5622-23e0-4af6-b82d-5f9b7ad598dd&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F3ba8529c-4c99-4497-b4db-017572d0c8a2%2FUntitled.png?table=block&id=3524e36c-6909-4269-8d29-5588a97b0328&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F68ad5487-faba-488c-a43e-a0b1f9f0f674%2FUntitled.png?table=block&id=57b4f6f9-af45-4ca0-9f47-a573994bcd4e&cache=v2)
Â
Â
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fbdb926f9-e4ee-4140-86c4-4bc1e4349795%2FUntitled.png?table=block&id=57cc23ed-d1b9-4ce8-9c58-78510508fe29&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F79c9e3af-f5b2-4148-897f-477aab4e54cd%2FUntitled.png?table=block&id=0f87eedf-761b-480b-a2de-e64d5902ce4e&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fcc2076ac-454a-43cf-a7cf-9629b9e9055d%2FUntitled.png?table=block&id=08e6ebdd-7cdd-4163-b362-a2c66890f420&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F35e0554c-be62-45a5-9f57-578ad1aa8262%2FUntitled.png?table=block&id=d3660ceb-317e-48d8-a772-55cbb2d0abcf&cache=v2)
illusion vs minds eye vs hallucination
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fcc7d50d8-e230-4792-ad76-b4054440e3eb%2FUntitled.png?table=block&id=8f9b9dae-a9af-4006-b930-1fba94beb2f9&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Ff90ea5ff-06a1-49b7-b65b-a890c0ceeba3%2FUntitled.png?table=block&id=096db3ab-2494-4164-868c-52595de882e7&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fcc2d3f7b-7c53-4931-9d11-31069f8b24c1%2FUntitled.png?table=block&id=3b8b6554-e97e-4410-939c-dcf6e7cae55a&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fb53bd595-c9b0-49b8-b43b-5e704ee2fc4b%2FUntitled.png?table=block&id=fddd987c-8a01-4c54-94a5-a287507269e5&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F0fd1ac1f-9c5a-4ab7-9a4e-5cebd9383682%2FUntitled.png?table=block&id=1a65bdd5-6ad1-424f-a262-7933d63e5b2d&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fd10666f7-819a-4bfa-9d56-ef81e7f4c213%2FUntitled.png?table=block&id=e7abef37-93d3-458d-b443-45b79e211f5a&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F05593920-09a4-4bf2-8671-723c4904832a%2FUntitled.png?table=block&id=df18ffa4-a4e3-43ce-bf4e-0775d2f2e2aa&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fb3820aaa-8146-4621-95b3-31868b2761a1%2FUntitled.png?table=block&id=304ec2b9-98e9-4848-aeda-6d86567cbd88&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F43dea7b6-8ee9-4061-946c-d8736cf2f990%2FUntitled.png?table=block&id=cde53d14-8c3d-43e9-897d-1f9a6a138ec6&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fee55feab-ec20-4137-b2a4-e9dd54b1085c%2FUntitled.png?table=block&id=1b302496-61b2-41e0-b114-3418aff09bc4&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fdd12ecfc-b8b4-4aa6-84df-6c622715f560%2FUntitled.png?table=block&id=9211e2fb-73fa-45ce-aa17-4795551d9794&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F8008a37c-fe71-4e1d-8093-748732abdf1a%2FUntitled.png?table=block&id=a9be3d78-2674-43fa-ac62-243e23260155&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F64e696ae-2521-4ebb-97a0-7037fcb74b60%2FUntitled.png?table=block&id=d4993ae6-a77e-401d-8791-4497c6a44e75&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F6a029257-0df7-4752-bbc8-a4f93d390059%2FUntitled.png?table=block&id=134386cc-2ce7-46d4-bbd3-1eac20862985&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F1962f5b2-c12f-4487-b2dc-47825733472a%2FUntitled.png?table=block&id=9fb4d277-d826-451d-85bf-4b07ee0dac32&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F681540b4-de27-4f61-b412-259a723dc97f%2FUntitled.png?table=block&id=0deea76a-ceb3-4901-b289-d39a830a50cb&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F56d3c3ba-faaf-4e62-b603-41acb5fc6a5c%2FUntitled.png?table=block&id=30f76445-4680-4de5-acfe-8a993ab98fe8&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F5d38f550-338a-46b8-b12b-2d33b129020e%2FUntitled.png?table=block&id=da9d407f-39cd-4db0-a013-4e20a759bf97&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fdc19431e-ef2f-4108-b429-dbd74741f0fa%2FUntitled.png?table=block&id=fb847b66-7027-4044-afb6-cddb22c2ab98&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fb73e1d5c-5db0-41d6-9d56-b01ca8b3c489%2FUntitled.png?table=block&id=50e57deb-6780-4be3-99e0-54ff697b15da&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fee1a65e2-5225-456a-bbc9-d1ce5fb22777%2FUntitled.png?table=block&id=b3e20ec0-4943-47d9-af30-f32505736e0a&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F0bceaa95-a1b6-4aec-8dde-3e4e4b269bd9%2FUntitled.png?table=block&id=fee844dd-faba-4d07-b2b5-fc8c16310d3f&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F09d15292-47b4-482b-b9c9-6ab05291d4f5%2FUntitled.png?table=block&id=b1763c32-6a5c-45ba-95eb-db8a9c9965c7&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F1da4ae3a-86eb-406e-a59c-b5f1afd82e2c%2FUntitled.png?table=block&id=647e3b69-148b-4818-b7ff-952c3621ae4d&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F4ccd064a-f87b-482d-a6aa-cbed2b8537d5%2FUntitled.png?table=block&id=a5befd4f-8755-4991-87dd-d61987e44d68&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F1d1aaf8d-2e66-4f9c-8e07-d90b20047686%2FUntitled.png?table=block&id=093edf13-44c0-4d07-950c-a77434053e00&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fa16fcffb-f58d-48c0-8eac-6904cdeab404%2FUntitled.png?table=block&id=658b15ad-d7ea-4a33-8fd8-ffc8ecc5b98f&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F9397a409-2f23-49d6-83ad-d56978765b4e%2FUntitled.png?table=block&id=ea70825b-488a-427b-9638-a340af2fe09e&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Ff41c420c-1091-49d2-b1b4-49154d3c740a%2FUntitled.png?table=block&id=e3da8a2c-a230-48e8-b3cf-47d4399040d7&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F32c43e7d-cdfe-4ef2-97b1-5211cf5d289f%2FUntitled.png?table=block&id=2aaeb2ca-beee-4f94-8963-2e11b6162da0&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F8de0ccc1-b664-4b0c-94e1-31b71c4b7624%2FUntitled.png?table=block&id=30af8942-a5fd-4751-8b1c-43b5d9b0bc99&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fb5e8fb0e-995c-460f-8f8e-ffb654b10ddc%2FUntitled.png?table=block&id=8a25d9d7-ef89-40df-94d1-1ba204965b02&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fcba19b02-06a7-4d66-948c-61fba96638ec%2FUntitled.png?table=block&id=13b07727-c186-44b1-810f-f7cf5a6cdd57&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F7c12c623-17d4-43d1-a8f7-01266f383cb4%2FUntitled.png?table=block&id=1010cf69-d61d-437f-8d6c-20dde57cb43a&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F61b316b7-27f1-400d-aa02-f3f580d19408%2FUntitled.png?table=block&id=61fec22b-0617-441a-b814-ba58d152f53e&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F28241d37-e48a-486e-9372-f55510e8e124%2FUntitled.png?table=block&id=20ba10f2-31cf-4132-b71a-d45401d60363&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F7a0b11f0-e8be-490f-ac61-01fe4d2ef79f%2FUntitled.png?table=block&id=0db6cce0-3136-47d5-958a-fd642aa918d5&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F60a36cb4-6081-4f38-a4cf-778853d63533%2FUntitled.png?table=block&id=29e6e2aa-83bb-4088-bf17-9728eba61129&cache=v2)
Â
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F700ad3b1-7aac-4621-b5bc-7059694563eb%2FUntitled.png?table=block&id=07d3a5af-0f74-4e7b-9ce0-609ed1691d32&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fd1147646-aa8f-44ab-9e23-814fcea8ab06%2FUntitled.png?table=block&id=5aaea32a-4e26-4920-a87c-7f0488a535fd&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Fd7d8ba1e-99a6-4f4d-9a3e-283373ec5862%2FUntitled.png?table=block&id=09a33dad-f00d-455d-afaf-060d176aa2e7&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2Ffe482941-e754-4a92-bd02-2345203fa59c%2FUntitled.png?table=block&id=74436cad-db85-4d14-8b14-c8ebb3a17119&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F512fc04d-7866-4c91-8297-113f427ae078%2FUntitled.png?table=block&id=7ba0cb15-1758-464b-8add-40b66fa3fb24&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F40a376b4-ca64-4413-ba83-c850db77f549%2FUntitled.png?table=block&id=1463b497-35aa-4234-a210-60b833731fd8&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F71644f0f-1f6b-4d86-bd57-a3ef9bb6d343%2FUntitled.png?table=block&id=37930316-4c9a-4ec6-9842-b0d4d97d2fc2&cache=v2)
![notion image](https://www.notion.so/image/https%3A%2F%2Fs3-us-west-2.amazonaws.com%2Fsecure.notion-static.com%2F8956b887-7cc2-4fd9-ad69-b60a5d08b3d1%2FUntitled.png?table=block&id=18c8a360-ffc6-4003-8bf4-abf55cc3e915&cache=v2)