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This implies both physical and mental stress

Psychiatry 130 HuK

doi: 10.1186/s12951-017-0252-y 257 HadjiHBouchemalK

In most of the reported cases, these events followed tonsillectomy and/or adenoidectomy, and many of the children had evidence of being ultra-rapid metabolizers of codeine (i.e., multiple copies of the gene for cytochrome P450 isoenzyme 2D6 or high morphine concentrations)