placebo/nocebo

Question 1

define the placebo effect

Answer 1

when an inert substance or medical procedure produces a therapeutic effect because of the patients belief in the treatment

Question 2

how is the placebo effect generate

Answer 2

expectations

• expecting it to produce a beneficial effect
• believing
• expecting improvement motivates

classical conditioning

• previously experienced effectiveness
• associate +ve outcome with tx
• assume same experience will tx

Question 3

treatment factors affecting placebo

Answer 3

• two pills better than one
• known brand names
• larger pills
• colour (blue for sedation, pink for stimulant)
• sophisticated tx
• injection better than pills
• surgery better than other tx

Question 4

physician factors affecting placebo

Answer 4

• high status professional
• formal medical setting
• high credibility
• clear indication of expected response
• high confidence in tx
• warmth and empathy

Question 5

patient factors affecting placebo

Answer 5

• no consistent personality characteristics
• patient expectations important
• response may differ according to outcome measured
• response related to interaction between treatment and situational factors

Question 6

define nocebo effect

Answer 6

when an inert substance or medical procedure produces an adverse effect because the patient expects it

Question 7

how is the nocebo effect generated

Answer 7

expectations

• being informed of side effects
• expect so more focused on symptoms

misattribution
- misattribute pre-existing harmless, transient symptoms to a drug

classical conditioning

• side effects in past
• associate tx with unpleasant outcome

increased anxiety
- can produce physical symptoms

Question 8

treatment factors that increase nocebo effect

Answer 8

• given a large list of side effects
• communicating risk/likelihood of side effects
• generic vs branded medications

Question 9

physician factors causing nocebo effect

Answer 9

• unsure about expected response from tx
• low confidence in tx
• low competence
• low credibility
• lack of warmth and empathy

Question 10

patient factors causing nocebo effect

Answer 10

• negative patient expectations
• greater anxiety
• greater perceived sensitivity to medicines

Question 11

consequences of placebo vs nocebo

Answer 11

placebo

• aid the effect of a tx
• reduce experience of symptoms
• reduce anxiety, depression
• improve patient health outcome
• improve QOL

nocebo

• increase experience of side-effects
• non-adherence to tx
• increase patient distress
• lower QOL
• increase tx cost of patient and healthcare system