Placebo Flashcards
Placebo reaction
The sum of changes obtained in an individual as a consequence of placebo treatment
Placebo effect
Average changes in a given group
- Perceived placebo-effect
- True placebo-effect
Perceveied placebo effect
the sum of changes observed in a placebo-grouping during a clinical trial
True placebo effect
differences of parameter between a placebo-treated and a non-treated (control) group.
Placebo-reactor
A person who produces placebo-response in a study
- positive reactor: shows the expected response
- negative reactor: produces a response contrary to the expected direction (e.g. negative symptoms)
- non-reactor: produces no response
- Side effect produces: shows placebo side-effects
Reactor personality
a responder who produces placebo-reaction consistently or at least more than the probability of chance.
Concordance
co-operation with the physician in the therapy
What are probably not (only) placebo?
- psychotherapy
- hypnosis
- acupuncture
- phytotherapy (use plants)
What are those we don’t know whether placebo?
- homeopathy
- altenative therapies
- astrology
The most important factors of the placebo effect (physician characteristics)
- gender, status
- expectations and need of the physician
- therapeutic suggestion
- doctor patient relation
The most important factors of the placebo effect (patient characteristics)
- personality and psychological disposition of the patient
- doctor-patient relation
- previous experience, belief about the disease
- symptoms and severity of the disease
- adherence
The most important factors of the placebo effect (medicine)
- prestige
- form
- dosage
- shape/size
- color
How expectations work?
We attribute the effects to an external intervention; placebo takes over the attributes of the external factors; placebo alters the behavior; we feed back the outcome to the place;
PLACEBO BECOMES THE OBJECTIVATED FORM OF THE ANTICIPATION
Consciousness?
- conditioned experiences are unconscious
- expectations are frequently implicit, that is do not appear in the mind
- almost all elements of the placebo-effect maybe totally or partially unconscious
Culture
- biological elements (immune-adaptation to the local bacterial association)
- behavioral elements (feeding habits)
- psychological elements
- social elements (health care systems, education etc.)
Where evolution meets culture?
Sociability and group-formation on one hand, and system- formation (rules, traditions, meanings etc.) on the other hand.
Placebo therapy?
- replacement
- therapy on its own right
- balanced design
- add-on design (the ethically most acceptable design)
Nocebo
“negative placebo”
when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have.[1][2] For example, when a patient anticipates a side effect of a medication, they can suffer that effect even if the “medication” is actually an inert substance
Symptom report
Many frequent, everyday complaints (headache, dizziness, weakness etc.) are not necessarily pathological. Most healthy people may experience any of them temporarily, even if not taking any medicine. This is called SYMPTOM REPORT.
Factor predicting the number of side effects
Earlier personal experience, expectation, somatising tendency, somatosensory amplification.
Some important consequences
- placebo-treatment seems to be effective in disorders of psychological, but not of physiological origin.
- a crucial factor of the effect is patients compliance
- a nocebo-effect can be turned around by a placebo treatment
