Euphoria

Playing can induce an intense state of happiness and contentment.

Euphoria ( /juːˈfɔːriə/) is an affective state in which a person experiences pleasure or excitement and intense feelings of well-being and happiness.[1][2] Certain drugs, many of which are addictive, can cause euphoria, which at least partially motivates their recreational use.[3] Similarly, certain natural rewards and social activities, such as aerobic exercise, laughter, listening to emotionally arousing music, music-making, and dancing, can induce a state of euphoria.[4][5] Euphoria is also a symptom of certain neurological or neuropsychiatric disorders, such as mania.[6] Romantic love and components of the human sexual response cycle are also associated with the induction of euphoria.[7][8][9]

According to Kent Berridge, an affective neuroscientist, intense euphoria occurs from the simultaneous activation of every hedonic hotspot within the brain's reward system.[10]

History of the term

The word "euphoria" is derived from the Ancient Greek terms εὐφορία: εὖ eu meaning "well" and φέρω pherō meaning "to bear".[11][12] It is semantically opposite to dysphoria.

A 1706 English dictionary defines euphoria as "the well bearing of the Operation of a Medicine, i.e., when the patient finds himself eas'd or reliev'd by it".[13]

In the 1860s, the English physician Thomas Laycock described euphoria as the feeling of bodily well-being and hopefulness; he noted its misplaced presentation in the final stage of some terminal illnesses and attributed such euphoria to neurological dysfunction.[14] Sigmund Freud's 1884 monograph Über Coca described (his own) consumption of cocaine producing "the normal euphoria of a healthy person",[15] while about 1890 the German neuropsychiatrist Carl Wernicke lectured about the "abnormal euphoria" in patients with mania.[16]

A 1903 article in The Boston Daily Globe refers to euphoria as "pleasant excitement" and "the sense of ease and well-being".[17] In 1920 Popular Science magazine described euphoria as "a high sounding name" meaning "feeling fit": normally making life worth living, motivating drug use, and ill formed in certain mental illnesses.[18] Robert S. Woodworth's 1921 textbook Psychology: A study of mental life, describes euphoria as an organic state which is the opposite of fatigue and "means about the same as feeling good."[19]

In 1940 The Journal of Psychology defined euphoria as a "state of general well being ... and pleasantly toned feeling."[20] A decade later, finding ordinary feelings of well being difficult to evaluate, American addiction researcher Harris Isbell redefined euphoria as behavioral changes and objective signs typical of morphine.[21] However, in 1957 British pharmacologist D. A. Cahal did not regard opioid euphoria as medically undesirable but an affect which "enhance[s] the value of a major analgesic."[22] The 1977 edition of A Concise Encyclopaedia of Psychiatry called euphoria "a mood of contentment and well-being," with pathologic associations when used in a psychiatric context. As a sign of cerebral disease, it was described as bland and out of context, representing an inability to experience negative emotion.[23]

In the 21st century, euphoria is generally defined as a state of great happiness, well-being and excitement, which may be normal, or abnormal and inappropriate when associated with psychoactive drugs, manic states, or brain disease or injury.[24]

Types

Many different types of stimuli can induce euphoria, including psychoactive drugs, natural rewards, and social activities.[1][25][5][6] Affective disorders such as unipolar mania or bipolar disorder can involve euphoria as a symptom.[6]

Exercise-induced

Runners can experience a euphoric state often called a "runner's high".

Continuous physical exercise, particularly aerobic exercise, can induce a state of euphoria; for example, distance running is often associated with a "runner's high", which is a pronounced state of exercise-induced euphoria.[26] Exercise is known to affect dopamine signaling in the nucleus accumbens, producing euphoria as a result, through increased biosynthesis of three particular neurochemicals: anandamide (an endocannabinoid),[27] β-endorphin (an endogenous opioid),[28] and phenethylamine (a trace amine and amphetamine analog).[26][29][30]

Music euphoria

Euphoria can occur as a result of dancing to music, music-making, and listening to emotionally arousing music.[5][31][32] Neuroimaging studies have demonstrated that the reward system plays a central role in mediating music-induced pleasure.[32][33] Pleasurable emotionally arousing music strongly increases dopamine neurotransmission in the dopaminergic pathways that project to the striatum (i.e., the mesolimbic pathway and nigrostriatal pathway).[31][32][33] Approximately 5% of the population experiences a phenomenon termed "musical anhedonia", in which individuals do not experience pleasure from listening to emotionally arousing music despite having the ability to perceive the intended emotion that is conveyed in passages of music.[33]

Drug-induced

A large dose of methamphetamine causes a drug-induced euphoria.[34]

A euphoriant is a type of psychoactive drug which tends to induce euphoria.[35][36] Most euphoriants are addictive drugs due to their reinforcing properties and ability to activate the brain's reward system.[6]

Stimulants

Dopaminergic stimulants like amphetamine, methamphetamine, cocaine, MDMA, and methylphenidate are euphoriants.[1][6] Nicotine is a parasympathetic stimulant that acts as a mild euphoriant in some people.[6]

Some textbooks state that caffeine is a mild euphoriant,[37][38][39] others state that it is not a euphoriant,[40][41] and one states that it is and is not a euphoriant.[42]

Chewing areca nut (seeds from the Areca catechu palm) with slaked lime (calcium hydroxide) – a common practice in South- and Southeast Asia – produces stimulant effects and euphoria.[43][44][45] The major psychoactive ingredients – arecoline (a muscarinic receptor partial agonist)[44][46] and arecaidine (a GABA reuptake inhibitor)[47][48] – are responsible for the euphoric effect.[49][50]

Depressants

Certain depressants can produce euphoria; some of the euphoriant drugs in this class include drinking alcohol (i.e., ethanol) in moderate doses,[51][52] γ-hydroxybutyric acid,[1] and ketamine.[1]

Some barbiturates and benzodiazepines may cause euphoria. Euphoriant effects are determined by the drug's speed of onset,[53] increasing dose,[54] and with intravenous administration.[55] Barbiturates more likely to cause euphoria include amobarbital, secobarbital and pentobarbital.[56][57] Benzodiazepines more likely to cause euphoria are flunitrazepam, alprazolam and clonazepam.[53][58][59] Benzodiazepines also tend to enhance opioid-induced euphoria.[60]

Pregabalin induces dose-dependent euphoria.[61][62] Occurring in a small percentage of individuals at recommended doses, euphoria is increasingly frequent at supratherapeutic doses (or with intravenous- or nasal administration).[63][62][61] At doses five times the maximum recommended, intense euphoria is reported.[61]

Opioids

µ-Opioid receptor agonists are a set of euphoriants[6] that include drugs such as heroin, morphine, codeine, oxycodone, and fentanyl. By contrast, κ-opioid receptor agonists, like the endogenous neuropeptide dynorphin, are known to cause dysphoria,[6] a mood state opposite to euphoria that involves feelings of profound discontent.

Cannabinoids

Cannabinoid receptor 1 agonists are a group of euphoriants that includes certain plant-based cannabinoids (e.g., THC from the cannabis plant), endogenous cannabinoids (e.g., anandamide), and synthetic cannabinoids.[6]

Inhalants

Certain gases, like nitrous oxide (N2O, aka "laughing gas"), can induce euphoria when inhaled.[6][64]

Glucocorticoids

Acute exogenous glucocorticoid administration is known to produce euphoria, but this effect is not observed with long-term exposure.[6]

Asphyxia-induced

Asphyxiation initially produces an extreme feeling of euphoria[65] leading some people to intentionally induce temporary asphyxiation. Erotic asphyxiation typically employs strangulation to produce euphoria which enhances masturbation and orgasm.[66] The choking game, prevalent in adolescents, uses brief hypoxia in the brain to achieve euphoria.[67][68] Strangulation, or hyperventilation followed by breath holding are commonly used to achieve the effects. Accidental deaths occur from both practices but are often mislabeled as suicide.[69][70][71]

Neuropsychiatric

Mania

Euphoria is also strongly associated with both hypomania and mania, mental states characterized by a pathological heightening of mood, which may be either euphoric or irritable, in addition to other symptoms, such as pressured speech, flight of ideas, and grandiosity.[72][73]

Although hypomania and mania are syndromes with multiple etiologies (that is, ones that may arise from any number of conditions), they are most commonly seen in bipolar disorder, a psychiatric illness characterized by alternating periods of mania and depression.[72][73]

Epilepsy

Euphoria may occur during auras of seizures[74][75] typically originating in the temporal lobe, but effecting the anterior insular cortex. This euphoria is symptomatic of a rare syndrome called ecstatic seizures,[76][77] often also involving mystical experiences.[78] Euphoria (or more commonly dysphoria) may also occur in periods between epileptic seizures. This condition, interictal dysphoric disorder, is considered an atypical affective disorder.[79][80] Persons who experience feelings of depression or anxiety between or before seizures occasionally experience euphoria afterwards.[81]

Migraine

Some persons experience euphoria in the prodrome – hours to days before the onset – of a migraine headache.[82][83][84] Similarly, a euphoric state occurs in some persons following the migraine episode.[82][84]

Multiple sclerosis

Euphoria sometimes occurs in persons with multiple sclerosis as the illness progresses. This euphoria is part of a syndrome originally called euphoria sclerotica, which typically includes disinhibition and other symptoms of cognitive and behavioral dysfunction.[85][86][87]

See also

References

  1. 1 2 3 4 5 Bearn J, O'Brien M (2015). ""Addicted to Euphoria": The History, Clinical Presentation, and Management of Party Drug Misuse". Int. Rev. Neurobiol. 120: 205–33. PMID 26070759. doi:10.1016/bs.irn.2015.02.005. Eating, drinking, sexual activity, and parenting invoke pleasure, an emotion that promotes repetition of these behaviors, are essential for survival. Euphoria, a feeling or state of intense excitement and happiness, is an amplification of pleasure, aspired to one's essential biological needs that are satisfied. People use party drugs as a shortcut to euphoria. Ecstasy (3,4-methylenedioxymethamphetamine), γ-hydroxybutyric acid, and ketamine fall under the umbrella of the term "party drugs," each with differing neuropharmacological and physiological actions.
  2. ↑ Alcaro A, Panksepp J (2011). "The SEEKING mind: primal neuro-affective substrates for appetitive incentive states and their pathological dynamics in addictions and depression". Neuroscience and Biobehavioral Reviews. 35 (9): 1805–1820. PMID 21396397. doi:10.1016/j.neubiorev.2011.03.002. Recent human data have demonstrated that the SEEKING brain circuitry, as predicted, is involved in the emergence of a characteristic appetitive affective state, which may be described as “enthusiastic positive excitement” or “euphoria” (Drevets et al., 2001; Volkow and Swanson, 2003) and that do not resemble any kind of sensory pleasure (Heath, 1996; Panksepp et al., 1985) ... However, in our view, cognitive processes, are only one “slice of the pie”, and gamma oscillations may be more globally viewed as the overall emotional–motivational neurodynamics through which the SEEKING disposition is expressed, accompanied by a feeling of excitement/eurphoria (not ‘pleasure’) that is evolutionarily designed to achieve a diversity of useful outcomes
  3. ↑ Johnson BA (2010). Addiction Medicine: Science and Practice. Springer Science & Business Media. p. 133. ISBN 9781441903389. It has been observed that drugs of abuse as diverse as alcohol, barbiturates, opiates, and psychomotor stimulants all share a profile of psychoactive effects characterized as euphoria. It is generally accepted that euphoria is at least a partial explanation why these drugs are abused.
  4. ↑ "Key DSM-IV Mental Status Exam Phrases". Gateway Psychiatric Services. Mood and Affect. Archived from the original on 2013-11-13. Retrieved 2014-02-17.
  5. 1 2 3 Cohen EE, Ejsmond-Frey R, Knight N, Dunbar RI (2010). "Rowers' high: behavioural synchrony is correlated with elevated pain thresholds". Biol. Lett. 6 (1): 106–8. PMC 2817271 Freely accessible. PMID 19755532. doi:10.1098/rsbl.2009.0670. This heightened effect from synchronized activity may explain the sense of euphoria experienced during other social activities (such as laughter, music-making and dancing) that are involved in social bonding in humans and possibly other vertebrates.
  6. 1 2 3 4 5 6 7 8 9 10 11 Malenka RC, Nestler EJ, Hyman SE (2009). Sydor A, Brown RY, eds. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 191, 350–351, 367–368, 371–375. ISBN 9780071481274. Changes in appetite and energy may reflect abnormalities in various hypothalamic nuclei. Depressed mood and anhedonia (lack of interest in pleasurable activities) in depressed individuals, and euphoria and increased involvement in goal-directed activities in patients, who experience mania, may reflect opposing abnormalities in the nucleus accumbens, medial prefrontal cortex, amygdala, or other structures. ... Although short-term administration of glucocorticoids often produces euphoria and increased energy, the impact of long-lasting increases in endogenous glucocorticoids produced during depression can involve complex adaptations such as those that occur in Cushing syndrome (Chapter 10). ... Exposure to addictive chemicals not only produces extreme euphoric states that may initially motivate drug use, but also causes equally extreme adaptations in reinforcement mechanisms and motivated behavior that eventually lead to compulsive use. Accordingly, the evolutionary design of human and animal brains that has helped to promote our survival also has made us vulnerable to addiction.
  7. ↑ Georgiadis JR, Kringelbach ML (July 2012). "The human sexual response cycle: brain imaging evidence linking sex to other pleasures" (PDF). Prog. Neurobiol. 98 (1): 49–81. PMID 22609047. doi:10.1016/j.pneurobio.2012.05.004. Strong feelings of pleasure and euphoria, as well as marked alterations in cognitive processing, self-referential thought, and physiological arousal are defining features of sexual consummation, especially during orgasm (Mah and Binik, 2001).
  8. ↑ Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar-Berman M, Gold M (March 2012). "Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms". J. Psychoactive Drugs. 44 (1): 38–55. PMC 4040958 Freely accessible. PMID 22641964. doi:10.1080/02791072.2012.662112. Early-stage romantic love can induce euphoria, is a cross-cultural phenomenon, and is possibly a developed form of a mammalian drive to pursue preferred mates. ... Under normal conditions, it is not surprising that sexual activity is physiologically regulated by the reward circuitry of the brain, specifically by dopaminergic pathways (see Figure 1). Moreover, the early stages of a new, romantic relationship can be a powerful and absorbing experience. Individuals in new romantic relationships report feeling euphoric and energetic. They also become emotionally dependent on, desire closeness with, and have highly focused attention on their partner (Reynaud et al. 2010; Young 2009). Human neuroimaging studies have shown that feelings experienced during the early stages of a romantic relationship are associated with neural activations in several reward-system and affect-processing regions of the brain (Young 2009; Aron et al. 2005; Bartels & Zeki 2000; Mashek, Aron & Fisher 2000).
  9. ↑ Jankowiak, William; Paladino, Thomas (2013). "Chapter 1. Desiring Sex, Longing for Love: A Tripartite Conundrum". In Jankowiak, William R. Intimacies: Love and Sex Across Cultures. Columbia University Press. p. 13. ISBN 9780231508766. These emotional states may also be manifested behaviorally as "labile psychophysical responses to the loved person, including exhilaration, euphoria, buoyancy, spiritual feelings, increased energy, sleeplessness, loss of appetite, shyness, awkwardness ... in the presence of the loved person" (Fisher 1998:32). The presence of similar neurological mechanisms and brain patterns may account for the ability to readily identify when someone is romantically involved or erotically excited (Fisher 1998:32; Fisher 1995).
  10. ↑ Kringelbach ML, Berridge KC (2013). "The Joyful Mind". From Abuse to Recovery: Understanding Addiction. Macmillan. pp. 199–207. ISBN 9781466842557. Retrieved 8 April 2016. Intense euphoria is harder to come by than everyday pleasures. The reason may be that strong enhancement of pleasure—like the chemically induced pleasure bump we produced in lab animals—seems to require activation of the entire network at once.
  11. ↑ Euphoria, Henry George Liddell, Robert Scott, A Greek-English Lexicon, at Perseus
  12. ↑ Online Etymology Dictionary
  13. ↑ Kersey J, Phillips E (1706). The new world of words: or, Universal English dictionary. London: Printed for J. Phillips. pp. EU–EU.
  14. ↑ Laycock T (4 January 1862). The Medical Times & Gazette. London: John Churchill. p. 1. Not unfrequently, indeed, the appearance of the patient is more diagnostic than his feelings. This is the case in some very grave diseases, in which that portion of the nervous system which subserves to the feeling of bodily well-being,—termed, in psychological phrase, euphoria—is morbidly modified as to function.
     • Laycock T (17 May 1864). The Medical Times & Gazette. London: John Churchill. p. 500. The morbid hopefulness of phthisis, physiologically termed euphoria, is seen more particularily in this class of patients. I have often called attention to it at the bedside, and shown that it ushers in the last stage. It is really a disease of the nervous system of a low type, a sort of insanity, and is of the worst significance.
  15. ↑ Freud S (1884). Über Coca., cited in, NIDA Research Monograph #13 Siegel RK (1977). "Chapter VI Cocaine: Recreational Use and Intoxication". In Petersen RC, Stillman RC. NIDA Research Monograph #13 (PDF). U.S. Government Printing Office. p. 130. The psychic effect (of cocaine) consists of exhilaration and lasting euphoria, which does not differ in any way from the normal euphoria of a healthy person.... One senses an increase of self-control and feels more vigorous and more capable of work; on the other hand, if one works, one misses the heightening of the mental powers which alcohol, tea, or coffee induce. One is simply normal, and soon finds it difficult to believe that one is under the influence of any drug at all.
  16. ↑ Miller R, Dennison J (2015). "Lecture 31". An Outline of Psychiatry in Clinical Lectures: The Lectures of Carl Wernicke. Springer. p. 216. ISBN 9783319180519 – via Google books. [R]ational judgment of actual ability is lost, and a feeling of increased capacity arises, … it induces feelings of happiness, to the point of abnormal euphoria; but here too, assuming that some degree of psychic ability prevails, self-awareness of the change in personality may be enabled—an autopsychic paraesthesia in the above sense. Consequently, the Affective state of abnormal euphoria which determines the clinical picture often shows up as transitions to autopsychic disarray.
  17. ↑ "Paris Doctors Say That Scorching is Like Effects of Drugs". Paris Herald. 1903 – via newspaperarchive.com. reprinted in The Boston Daily Globe, 13 May 1903. p. 6
  18. ↑ "Have You Euphoria?". Popular Science. New York: Modern Publishing Company. 97 (6): 79. December 1920 – via Google books. It takes a doctor to give a high-sounding name to a well known phenomenon. "Euphoria" means "feeling fit." It is as much a physiological fact as scarlet fever.
         Nature makes it worth while to be alive simply through euphoria. The joy of making a good tennis stroke, the delight that a Woodsman gets in the open air, the artist’s rhapsody—all are due to euphoria. Why do we drink alcohol—when we can get it or smoke tobacco? To affect euphoria. When a lunatic thinks that he is Napoleon and demands the homage due an emperor; he has euphoria in its worst form.
         Too little is known about euphoria. Since it can be affected by drugs and chemicals, who knows but it may have its seat in some gland?
  19. ↑ Woodworth, RS (1921). "Chapter VII: Emotion: Various organic states, and the conscious states that go with them". Psychology, a study of mental life. New York: Henry Holt and Company. pp. 119–120. Retrieved 16 April 2017 – via Internet archive. Something was said before about "organic states", under the general head of tendencies to reaction. Fatigue was an example. Now we could include fatigue under the term, "stirred-up state of the organism"; at least, if not precisely "stirred-up", it is uneasy. It is a deviation from the normal or neutral state. Also, it is often a conscious state, as when we speak of the "tired feeling"; not a purely cognitive state, either not simply a recognition of the fact that we are fatigued but a state of disinclination to work any longer. Though fatigue is thus so much like an emotion that it fits under our definition, it is not called an emotion, but a sensation or complex of sensations....
         Many other organic states are akin to emotion in the same way. The opposite of fatigue, the "warmed-up" condition, brought on by a certain amount of activity after rest, is a case in point. It is a deviation from the average or neutral condition, in the direction of greater readiness for activity. The warmed-up person feels ready for business, full of "ginger" or "pep" in short, full of life. The name "euphoria", which means about the same as "feeling good", is given to this condition. Drowsiness is another of these emotion-like states; but hunger and thirst are as typical examples as any.
  20. ↑ Bousfield WA (1940). "The Relation of the Euphoric Attitude to the Quality of Sleep". The Journal of Psychology. 9 (2): 393–401. doi:10.1080/00223980.1940.9917707. Euphoria is a term aptly denoting the state of general well being, and while it involves a relatively enduring and pleasantly toned feeling, its psychological significance derives primarily from its being a semi-emotional attitude of considerable determining power.
  21. ↑ Keats AS, Beecher HK (1952). "Analgesic activity and toxic effects of acetylmethadol isomers in man". The Journal of Pharmacology and Experimental Therapeutics. 105 (2): 210–215. ISSN 0022-3565. PMID 14928223. Retrieved 17 September 2016. [Footnote 3] Since matters of some interest hang upon the definition of 'euphoria', direct enquiry of Dr. Isbell brought the following comment (letter of November 1, 1951). 'I think it would be wise to exercise a certain degree of care in our use of the term "euphoria". We use it here in the sense of a train of effects similar to those seen after the administration of morphine. These effects include changes in behavior and objective signs, such as constriction of the pupil, depression of the respiratory rate and volume, drop in rectal temperature, etc. We do not use it in the sense of "feeling of well-being", as this is something that I have been utterly unable to evaluate.' The present authors prefer to limit the definition of euphoria to 'a sense of well-being'.
     • Isbell H, Vogel VH (1949). "The addiction liability of methadon (amidone, dolophine, 10820) and its use in the treatment of the morphine abstinence syndrome". The American Journal of Psychiatry. 105 (12): 909–914. ISSN 0002-953X. PMID 18127077. doi:10.1176/ajp.105.12.909. Retrieved 17 September 2016.
     • Jaffe JH, Jaffe FK (1989). "4. Historical Perspectives on the Use of Subjective Effects Measures in Assessing the Abuse Potential of Drugs". In Fischman MW, Mello NK. Testing for Abuse Liability of Drugs in Humans. National Institute on Drug Abuse Research Monograph Series. 92. Rockville, MD: National Institute on Drug Abuse.
  22. ↑ Cahal DA (1957). "Analgesic activity of dipipanone hydrochloride in student volunteers" (PDF). British Journal of Pharmacology and Chemotherapy. 12 (1): 97–99. ISSN 0366-0826. PMC 1509651 Freely accessible. PMID 13413158. doi:10.1111/j.1476-5381.1957.tb01368.x. Retrieved 17 September 2016. Not all of these effects can be regarded as undesirable. Drowsiness, euphoria, sleep, and 'detachment,' for instance, are effects which enhance the value of a major analgesic.
  23. ↑ Leigh D, Pare CM, Marks J (1977). A Concise Encyclopaedia of Psychiatry. Springer Science & Business Media. p. 152. ISBN 9789401159135 – via Google books. A mood of contentment and wellbeing. Euphoria in psychiatric terms always has a pathological connotation and is often an important early sign of organic cerebral disease. It differs from elation in subtle but important ways. It has no infectious quality and no element of gaiety, for its bland contentment is based on lack of awareness and inability to experience sadness or anxiety rather than on anything positive.
         It may be seen in any condition involving extensive cerebral damage, particularly if the frontal lobes are involved. It occurs sooner or later in senile and arteriosclerotic dementias (q.v.), in disseminated sclerosis and in Huntington’s chorea (q.v.) and is often seen also after severe head injury and old-fashioned forms of leucotomy (q.v.). Euphoria is sometimes seen in Addison's disease (q.v.).
  24. ↑ "definition of euphoria in English". Oxford Dictionaries. Retrieved 16 December 2016. a feeling or state of intense excitement and happiness
     • "definition of euphoria". Dictionary.com. Retrieved 16 December 2016. a state of intense happiness and self-confidence
         (psychology) a feeling of happiness, confidence, or well-being sometimes exaggerated in pathological states as mania
     • Sadock B, Sadock V (2009). Kaplan and Sadock's Comprehensive Textbook of Psychiatry (9th ed.). pp. 411–412, 923. Refers to a persistent and unrealistic sense of well-being, without the increased mental or motor rate of mania.
         Exaggerated feeling of well-being that is inappropriate to real events. Can occur with drugs such as opiates, amphetamines, and alcohol.
     • Mosby's Medical Dictionary (8th ed.). 2009. 1. a feeling or state of well-being or elation.
         2. an exaggerated or abnormal sense of physical and emotional well-being not based on reality or truth, disproportionate to its cause, and inappropriate to the situation, as commonly seen in the manic stage of bipolar disorder, some forms of schizophrenia, organic mental disorders, and toxic and drug-induced states
  25. ↑ Schultz W (2015). "Neuronal reward and decision signals: from theories to data". Physiological Reviews. 95 (3): 853–951. PMC 4491543 Freely accessible. PMID 26109341. doi:10.1152/physrev.00023.2014. The feeling of high that is experienced by sports people during running or swimming, the lust evoked by encountering a ready mating partner, a sexual orgasm, the euphoria reported by drug users, and the parental affection to babies constitute different forms (qualities) rather than degrees of pleasure (quantities).
  26. 1 2 Szabo A, Billett E, Turner J (2001). "Phenylethylamine, a possible link to the antidepressant effects of exercise?". Br J Sports Med. 35 (5): 342–343. PMC 1724404 Freely accessible. PMID 11579070. doi:10.1136/bjsm.35.5.342. The 24 hour mean urinary concentration of phenylacetic acid was increased by 77% after exercise. ... These results show substantial increases in urinary phenylacetic acid levels 24 hours after moderate to high intensity aerobic exercise. As phenylacetic acid reflects phenylethylamine levels3, and the latter has antidepressant effects, the antidepressant effects of exercise appear to be linked to increased phenylethylamine concentrations. Furthermore, considering the structural and pharmacological analogy between amphetamines and phenylethylamine, it is conceivable that phenylethylamine plays a role in the commonly reported "runners high" thought to be linked to cerebral β-endorphin activity. The substantial increase in phenylacetic acid excretion in this study implies that phenylethylamine levels are affected by exercise. ... A 30 minute bout of moderate to high intensity aerobic exercise increases phenylacetic acid levels in healthy regularly exercising men. The findings may be linked to the antidepressant effects of exercise.
  27. ↑ Tantimonaco M, Ceci R, Sabatini S, Catani MV, Rossi A, Gasperi V, Maccarrone M (2014). "Physical activity and the endocannabinoid system: an overview". Cell. Mol. Life Sci. 71 (14): 2681–2698. PMID 24526057. doi:10.1007/s00018-014-1575-6. The traditional view that PA engages the monoaminergic and endorphinergic systems has been challenged by the discovery of the endocannabinoid system (ECS), composed of endogenous lipids, their target receptors, and metabolic enzymes. Indeed, direct and indirect evidence suggests that the ECS might mediate some of the PA-triggered effects throughout the body. ... the evidence that PA induces some of the psychotropic effects elicited by the Cannabis sativa active ingredient Δ9-tetrahydrocannabinol (Δ9-THC, Fig. 1), like bliss, euphoria, and peacefulness, strengthened the hypothesis that endocannabinoids (eCBs) might mediate, at least in part, the central and peripheral effects of exercise [14]. ... To our knowledge, the first experimental study aimed at investigating the influence of PA on ECS in humans was carried out in 2003 by Sparling and coworkers [63], who showed increased plasma AEA content after 45 min of moderate intensity exercise on a treadmill or cycle ergometer. Since then, other human studies have shown increased blood concentrations of AEA ... A dependence of the increase of AEA concentration on exercise intensity has also been documented. Plasma levels of AEA significantly increased upon 30 min of moderate exercise (heart rate of 72 and 83 %), but not at lower and significantly higher exercise intensities, where the age-adjusted maximal heart rate was 44 and 92 %, respectively ... Several experimental data support the hypothesis that ECS might, at least in part, explain PA effects on brain functions, because: (1) CB1 is the most abundant GPCR in the brain participating in neuronal plasticity [18]; (2) eCBs are involved in several brain responses that greatly overlap with the positive effects of exercise; (3) eCBs are able to cross the blood–brain barrier [95]; and (4) exercise increases eCB plasma levels [64–67].
  28. ↑ Dinas PC, Koutedakis Y, Flouris AD (2011). "Effects of exercise and physical activity on depression". Ir J Med Sci. 180 (2): 319–325. PMID 21076975. doi:10.1007/s11845-010-0633-9. According to the 'endorphins hypothesis', exercise augments the secretion of endogenous opioid peptides in the brain, reducing pain and causing general euphoria. ... Based upon a large effect size, the results confirmed the endorphins hypothesis demonstrating that exercise leads to an increased secretion of endorphins which, in turn, improved mood states.
    β-Endorphin, an endogenous μ-opioid receptor selective ligand, has received much attention in the literature linking endorphins and depression or mood states. ... exercise of sufficient intensity and duration can increase circulating β-endorphin levels. ... Moreover, a recent study demonstrated that exercise and physical activity increased β-endorphin levels in plasma with positive effects on mood. Interestingly, the researchers reported that, independently of sex and age, dynamic anaerobic exercises increased β-endorphin, while resistance and aerobic exercises seem to only have small effects on β-endorphins. ... The results showed that mood tends to be higher in a day an individual exercises as well as that daily activity and exercise overall are strongly linked with mood states. In line with these findings, a recent study showed that exercise significantly improved mood states in non-exercises, recreational exercisers, as well as marathon runners. More importantly, the effects of exercise on mood were twofold in recreational exercisers and marathon runners.
  29. ↑ Lindemann L, Hoener MC (2005). "A renaissance in trace amines inspired by a novel GPCR family". Trends Pharmacol. Sci. 26 (5): 274–281. PMID 15860375. doi:10.1016/j.tips.2005.03.007. The pharmacology of TAs might also contribute to a molecular understanding of the well-recognized antidepressant effect of physical exercise [51]. In addition to the various beneficial effects for brain function mainly attributed to an upregulation of peptide growth factors [52,53], exercise induces a rapidly enhanced excretion of the main β-PEA metabolite β-phenylacetic acid (b-PAA) by on average 77%, compared with resting control subjects [54], which mirrors increased β-PEA synthesis in view of its limited endogenous pool half-life of ~30 s [18,55].
  30. ↑ Berry MD (2007). "The potential of trace amines and their receptors for treating neurological and psychiatric diseases". Rev Recent Clin Trials. 2 (1): 3–19. PMID 18473983. doi:10.2174/157488707779318107. It has also been suggested that the antidepressant effects of exercise are due to an exercise-induced elevation of [phenethylamine] [151].
  31. 1 2 Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ (2011). "Anatomically distinct dopamine release during anticipation and experience of peak emotion to music". Nat. Neurosci. 14 (2): 257–262. PMID 21217764. doi:10.1038/nn.2726. Music, an abstract stimulus, can arouse feelings of euphoria and craving, similar to tangible rewards that involve the striatal dopaminergic system. ... the caudate was more involved during the anticipation and the nucleus accumbens was more involved during the experience of peak emotional responses to music. ... Notably, the anticipation of an abstract reward can result in dopamine release in an anatomical pathway distinct from that associated with the peak pleasure itself.
  32. 1 2 3 Mavridis IN (March 2015). "Music and the nucleus accumbens". Surg Radiol Anat. 37 (2): 121–125. PMID 25102783. doi:10.1007/s00276-014-1360-0. The functional connectivity between brain regions mediating reward, autonomic and cognitive processing provides insight into understanding why listening to music is one of the most rewarding and pleasurable human experiences. Musical stimuli can significantly increase extracellular DA levels in the NA. NA DA and serotonin were found significantly higher in animals exposed to music. Finally, passive listening to unfamiliar although liked music showed activations in the NA. ... Music can arouse feelings of euphoria and craving, similar to tangible rewards that involve the striatal DAergic system [16]. Reward value for music can be coded by activity levels in the NA, whose functional connectivity with auditory and frontal areas increases as a function of increasing musical reward [19]. ... Listening to pleasant music induces a strong response and significant activation of the VTA-mediated interaction of the NA with the hypothalamus, insula and orbitofrontal cortex [1].
    Conclusions
    Listening to music strongly modulates activity in a network of mesolimbic structures involved in reward processing including the NA. Music, acting as a positive pleasant emotion, increases NA DAergic activity. Specifically the NA is more involved during the experience of peak emotional responses to music. Reward value of music can be predicted by increased functional connectivity of auditory cortices, amygdala and ventromedial prefrontal regions with the NA. Further research is needed to improve our understanding of the NA role in the influence of music in our lives.
  33. 1 2 3 Zatorre RJ (March 2015). "Musical pleasure and reward: mechanisms and dysfunction". Ann. N. Y. Acad. Sci. 1337: 202–211. PMID 25773636. doi:10.1111/nyas.12677. Most people derive pleasure from music. Neuroimaging studies show that the reward system of the human brain is central to this experience. Specifically, the dorsal and ventral striatum release dopamine when listening to pleasurable music, and activity in these structures also codes the reward value of musical excerpts. Moreover, the striatum interacts with cortical mechanisms involved in perception and valuation of musical stimuli. ... Development of a questionnaire for music reward experiences has allowed the identification of separable factors associated with musical pleasure, described as music-seeking, emotion-evocation, mood regulation, sensorimotor, and social factors. Applying this questionnaire to a large sample uncovered approximately 5% of the population with low sensitivity to musical reward in the absence of generalized anhedonia or depression. Further study of this group revealed that there are individuals who respond normally both behaviorally and psychophysiologically to rewards other than music (e.g., monetary value) but do not experience pleasure from music despite normal music perception ability and preserved ability to identify intended emotions in musical passages.
  34. ↑ Methamphetamine | InfoFacts | The National Institute on Drug Abuse (NIDA)
  35. ↑ Merrian-Webster definition
  36. ↑ "euphoriant". Memidex/WordNet Dictionary. Retrieved 2012-06-11.
  37. ↑ Kohn R, Keller M (2015). "Chapter 34 Emotions". In Tasman A, Kay J, Lieberman JA, First MB, Riba M. Psychiatry, 2 Volume Set. Volume 1. New York: John Wiley & Sons. pp. 557–558. ISBN 9781118845479. Table 34-12... Caffeine Intoxication - Euphoria
  38. ↑ Hrnčiarove J, Barteček R (2017). "8. Substance Dependence". In Hosák L, Hrdlička M, et al. Psychiatry and Pedopsychiatry. Prague: Karolinum Press. pp. 153–154. ISBN 9788024633787. At a high dose, caffeine shows a euphoric effect.
  39. ↑ Schulteis G (2010). "Brain stimulation and addiction". In Koob GF, Le Moal M, Thompson RF. Encyclopedia of Behavioral Neuroscience. Elsevier. p. 214. ISBN 9780080914558. Therefore, caffeine and other adenosine antagonists, while weakly euphoria-like on their own, may potentiate the positive hedonic efficacy of acute drug intoxication and reduce the negative hedonic consequences of drug withdrawal.
  40. ↑ Salerno, Bronwen Bryant ; Kathleen Knights ; Evelyn (2010). Pharmacology for health professionals (3rd ed.). Chatswood, N.S.W.: Elsevier Australia. p. 433. ISBN 9780729539296. In contrast to the amphetamines, caffeine does not cause euphoria, stereotyped behaviors or psychoses.
  41. ↑ Ivor Ebenezer (2015). Neuropsychopharmacology and Therapeutics. John Wiley & Sons. p. 18. ISBN 9781118385784. However, in contrast to other psychoactive stimulants, such as amphetamine and cocaine, caffeine and the other methylxanthines do not produce euphoria, stereotyped behaviors or psychotic like symptoms in large doses.
  42. ↑ Rang HP, Ritter JM, Flower RJ, Henderson G (2014). Rang & Dale's Pharmacology E-Book (8th ed.). Elsevier Health Sciences. pp. 453, 594. ISBN 9780702054976. By comparison with amphetamines, methylxanthines produce less locomotor stimulation and do not induce euphoria, stereotyped behaviour patterns or a psychotic state, but their effects on fatigue and mental function are similar. 
    Table 37.2 ... Psychomotor stimulants ... Drugs that cause wakefulness and euphoria ... Amphetamines, cocaine, methylphenidate, caffeine
  43. ↑ Cox S, Ullah M, Zoellner H (2016). "Oral and Systemic Health Effects of Compulsive Areca Nut Use". In Preedy VR. Neuropathology of Drug Addictions and Substance Misuse Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions. Academic Press. p. 791. ISBN 9780128006771. The areca nut is the fourth most used drug after nicotine, alcohol, and caffeine. The effects are described as pleasurable and generally stimulating, inducing a sense of well-being, euphoria, heightened alertness, a warm sensation throughout the body, and an increased capacity to work.
  44. 1 2 Garg A, Chaturvedi P, Gupta PC (June 2014). "A review of the systemic adverse effects of areca nut or betel nut". Indian Journal of Medical and Paediatric Oncology. 35: 3, 4. It is one of the most widely consumed addictive substances in the world after nicotine, ethanol and caffeine, and is consumed by approximately 10% of the world's population.... The users of areca nut believe that it is helpful for the digestive system and has mild euphoric effects. ...
         The major parasympathetic and muscarinic effects of areca nut are due to arecoline.
  45. ↑ Sharan RN, Mehrotra R, Choudhury Y, Asotra K (August 2012). "Association of Betel Nut with Carcinogenesis: Revisit with a Clinical Perspective". PLOS ONE. 7 (8): e42759. ISSN 1932-6203. PMC 3418282 Freely accessible. PMID 22912735. doi:10.1371/journal.pone.0042759.
  46. ↑ Riviere JE, Papich MG (2013). Veterinary Pharmacology and Therapeutics. John Wiley & Sons. p. 165. ISBN 9781118685907. Pilocarpine, arecoline and muscarine are rather selective parasympathetic agents; i.e., their cholinomimetic activity is exerted primarily at muscarinic sites with minimal nicotinic effects.
  47. ↑ Liu YJ, Peng W, Hu MB, Xu M, Wu CJ (November 2016). "The pharmacology, toxicology and potential applications of arecoline: a review". Pharmaceutical Biology. 54 (11): 2753. ISSN 1744-5116. PMID 27046150. doi:10.3109/13880209.2016.1160251.
  48. ↑ Peng W, Liu YJ, Wu N, Sun T, He XY, Gao YX, Wu CJ (April 2015). "Areca catechu L. (Arecaceae): a review of its traditional uses, botany, phytochemistry, pharmacology and toxicology". Journal of Ethnopharmacology. 164: 348. ISSN 1872-7573. PMID 25681543. doi:10.1016/j.jep.2015.02.010. Previous investigations indicated that the arecaidine and guvacine isolated from the A. catechu are effective antagonists of GABA, with IC50 values 122712 μM and 871 μM, respectively (Johnston et al., 1975; Lodge et al., 1977).
  49. ↑ Arif A, Westermeyer J (2012). Manual of Drug and Alcohol Abuse: Guidelines for Teaching in Medical and Health Institutions. New York: Springer Science & Business Media. pp. 159–160. ISBN 9781461595168.
  50. ↑ Aronson, J. K. (2009). Meyler's Side Effects of Herbal Medicines. Elsevier. p. 53. ISBN 9780444532695. The lime in the betel quid [areca nut, lime and Piper betle leaves] causes hydrolysis of arecoline to arecailide, a central nervous stimulant, which accounts, together with the essential oil of the betel pepper, for the eucphoric effects of chewing betel quid.
  51. ↑ Gilman JM, Ramchandani VA, Davis MB, Bjork JM, Hommer DW (2008). "Why we like to drink: a functional magnetic resonance imaging study of the rewarding and anxiolytic effects of alcohol". J. Neurosci. 28 (18): 4583–4591. PMC 2730732 Freely accessible. PMID 18448634. doi:10.1523/JNEUROSCI.0086-08.2008.
  52. ↑ Morgan, Christopher J.; Abdulla, A.-B. Badawy (2001). "Alcohol-induced euphoria: exclusion of serotonin". Alcohol and Alcoholism. 36 (1): 22–25. doi:10.1093/alcalc/36.1.22.
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  54. ↑ McCuistion LE, Kee JL, Hayes ER (2014). Pharmacology: A Patient-Centered Nursing Process Approach. Elsevier Health Sciences. p. 54. ISBN 9780323293488.
  55. ↑ Doweiko HE (2014). Concepts of Chemical Dependency. Cengage Learning. p. 79. ISBN 9781285457178.
  56. ↑ Galizio M, Maisto SA (2013). Determinants of Substance Abuse: Biological, Psychological, and Environmental Factors. Springer Science & Business Media. p. 205. ISBN 9781475799903.
  57. ↑ Psychotropic Agents: Part III: Alcohol and Psychotomimetics, Psychotropic Effects of Central Acting Drugs. Springer Science & Business Media. 2012. p. 420. ISBN 9783642677700.
  58. ↑ McCrady, Barbara S.; Epstein, Elizabeth E. (2013). Addictions: A Comprehensive Guidebook. OUP USA. p. 163. ISBN 9780199753666.
  59. ↑ Ruiz P, Strain EC (2011). Lowinson and Ruiz's Substance Abuse: A Comprehensive Textbook. Lippincott Williams & Wilkins. p. 258. ISBN 9781605472775.
  60. ↑ Staats PS, Silverman SM (2016). Controlled Substance Management in Chronic Pain: A Balanced Approach. Springer. p. 77. ISBN 9783319309644.
  61. 1 2 3 Martinotti G, Papazisis G, Santacroce R, Kouvelas D, Cinosi E, Lupi M, di Giannantonio M (2016). "Pregabalin Abuse and Addiction". In Preedy VR. Neuropathology of Drug Addictions and Substance Misuse Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions. London: Academic Press. pp. 948–949. ISBN 9780128006771. Exceeding the therapeutic doses, pregabalin is described as an 'ideal psychotropic drug' for recreational purposes, including alcohol/GHB/benzodiazepine-like effects, euphoria, entactogenic feelings, and dissociation. ...
         Up to 1200mg ... euphoria ... Over 1500mg ... intense euphoria
  62. 1 2 Schjerning O, Rosenzweig M, Pottegård A, Damkier P, Nielsen J (January 2016). "Abuse Potential of Pregabalin: A Systematic Review" (PDF). CNS drugs. 30 (1): 9. ISSN 1179-1934. PMID 26767525. doi:10.1007/s40263-015-0303-6. Pregabalin is, in some cases, used for recreational purposes and it has incurred attention among drug abusers for causing euphoric and dissociative effects when taken in doses exceeding normal therapeutic dosages or used by alternative routes of administration, such as nasal insufflation or venous injection.
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  74. ↑ Dahl J, Lundgren TL (2007). "Conditioning mechanisms, behavior technology, and contextual behavior therapy". In Holmes GL, Schachter SC, Kasteleijn-Nolst Trenite DGA. Behavioral Aspects of Epilepsy: Principles and Practice. Demos Medical Publishing. p. 248. ISBN 9781934559888. [S]eizures themselves may be stimulating or may induce euphoria. Dostoyevsky describes his seizure experience as follows 'the air was filled with a big noise and I tried to move. I felt the heaven was going down upon the earth and that it had engulfed me. I have really touched God. He came into me myself. Yes, God exists. I cried, and I don't remember anything else. You all, healthy people ... can't imagine the happiness we epileptics feel during the second before our fit ... I don't know if this felicity lasts for seconds, hours, or months but believe me, for all the joys that life may bring, I would not exchange this one'. [emphasis added]
  75. ↑ Kanner AM (2011). "Peri-ictal psychiatric phenomena". In Trimble MR, Schmitz B. The Neuropsychiatry of Epilepsy. Cambridge University Press. p. 57. ISBN 9781139497893. The classic expression of an ictal psychiatric symptom is an "aura," presenting as feelings of fear, sadness, or euphoria.
  76. ↑ Gschwind M, Picard F (January 2016). "Ecstatic Epileptic Seizures: A Glimpse into the Multiple Roles of the Insula". Frontiers in Behavioral Neuroscience. 10: 21. PMC 4756129 Freely accessible. PMID 26924970. doi:10.3389/fnbeh.2016.00021. In a table listing cases of ecstatic seizures reported in the literature, descriptions include: "Euphoric and talkative", "calm euphoria", "Pleasant feeling, euphoria", "Pleasant feeling, and feels euphoria", "short euphoric states"; others are within the definition of euphoria: "Sudden feeling of extreme well-being", "Ineffable joy. Intense pleasure without match in reality (perhaps music)", "Extreme happiness", "intense (non-sexual) pleasure", "Intense happy feeling", "Sudden indescribably pleasant and joyous feeling", "Sensation of intense well-being", "Intense pleasant feeling", "Intense feelings of bliss and well-being".
  77. ↑ Picard F, Friston K (September 2014). "Predictions, perception, and a sense of self". Neurology. 83 (12): 1117. ISSN 0028-3878. PMC 4166359 Freely accessible. PMID 25128179. doi:10.1212/WNL.0000000000000798.
  78. ↑ Devinsky O, Lai G (May 2008). "Spirituality and religion in epilepsy". Epilepsy & Behavior: E&B. 12 (4): 636–643. ISSN 1525-5050. PMID 18171635. doi:10.1016/j.yebeh.2007.11.011.
  79. ↑ Levenson JL, ed. (2011). "Neurology and Neurosurgery". The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill. American Psychiatric Publishing. p. 777. ISBN 9781585623792.
  80. ↑ Mulu M (2010). "The Interictal Dsyphoric Disorder of Epilepsy". In Miyoshi K, Morimura Y, Maeda K. Neuropsychiatric Disorders. Springer Science & Business Media. pp. 106–107. ISBN 9784431538714.
  81. ↑ Engel J (2013). Seizures and Epilepsy. Oxford University Press. pp. 332, 383. ISBN 9780195328547. Patients who are aware of increased depression or tension prior to generalized tonic-clonic or limbic seizures occasionally report a feeling of euphoria or release during the postictal period....
         [P]atients with interictal or preictal depression can report relief or euphoria postictally, which is consistent with the well-known beneficial effect of electroconvulsive shock therapy (ECT). Postictal hypomania can occur, particularly after repeated limbic seizures.
  82. 1 2 Dodick DW, Silberstein SD (2016). Migraine (3rd ed.). Oxford University Press. pp. 2, 15. ISBN 9780199793693. More than 70% of migraineurs experience premonitory phenomena hours to days before headache onset. Psychological symptoms include anxiety, depression, euphoria, irritability, restlessness, mental slowness, hyperactivity, fatigue, and drowsiness.
         Following the headache, the patient may have impaired concentration or feel tired, washed out, irritable, and listless. Some people, however, feel unusually refreshed or euphoric after an attack.     [emphasis added]
  83. ↑ Green MW, Colman R (2015). "6. Complicated Migraine". In Diamond S. Headache and Migraine Biology and Management. Academic Press. p. 51. ISBN 9780128011621. [P]remonitory symptoms can occur hours to a day or more prior to a migraine attack (with or without aura). Prodromal symptoms include various combinations of fatigue, stiff neck, sensitivity to light or sounds, difficulty in concentrating, depression or euphoria, cold hands and feet, blurred vision, yawning, nausea and pallor. [emphasis added]
  84. 1 2 Walling AD (2013). "63. Headache". In Taylor RB. Family Medicine: Principles and Practice (6th ed.). Springer Science & Business Media. p. 532. ISBN 9780387217444. Patients in the 'classic' subgroup (approximately 20% of all migrainers) experience a characteristic aura before the onset of migraine head pain.... A much larger proportion of patients describe prodromal symptoms, which may be visceral, such as diarrhea or nausea, but are more commonly alterations in mood or behavior. Food cravings, mild euphoria (conversely, yawning), and heightened sensory perception, particularly of smell, are surprisingly common....
         The attack often terminates with sleep.... Many patients report a 'hangover' on waking after a migraine, but others report complete freedom from symptoms and a sense of euphoria.     [emphasis added]
  85. ↑ Haussleiter IS, Brüne M, Juckel G (January 2009). "Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment". Ther. Adv. Neurol. Disord. 2 (1): 13–29. PMC 3002616 Freely accessible. PMID 21180640. doi:10.1177/1756285608100325.
  86. ↑ Romano S, Nocentini U (2012). "Euphoria, Pathalogical Laughing and Crying". In Nocentini U, Caltagirone C, Tedeschi G. Neuropsychiatric Dysfunction in Multiple Sclerosis. Springer Science & Business Media. ISBN 9788847026766.
  87. ↑ Duncan A, Malcolm-Smith S, Ameen O, Solms M (2016). "The Incidence of Euphoria in Multiple Sclerosis: Artefact of Measure". Mult. Scler. Int. Hindawi Publishing Corporation. 2016: 1–8. doi:10.1155/2016/5738425. Retrieved 13 June 2016.
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