PSYC: Placebo/Nocebo Flashcards

1
Q
  • Define placebo and nocebo (using Latin roots).
  • Define the placebo and nocebo response.
    • Give an example of each.
A
  • Placebo = ‘to please’.
  • Nocebo = ‘to harm’.
  • Beneficial effect on disease resulting from accidental/intentional creation of positive expectancy or conditioning of positive belief.
    • Eg acupuncture, homeopathic therapy.
    • Psychotherapy = purest placebo.
  • Harmful effect resulting from accidental/intentional creation of negative expectancy or conditioning of negative belief.
    • Eg doctor handing out death sentence, patient believing that they are doomed.
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2
Q

For placebos to be more likely to work, which of the involved parties must believe in the therapy?

A
  • Patient.
  • Doctor AS WELL.
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3
Q

In DSM-IV, the previous terminology/classification of
‘Psychosomatic Disorders’ was replaced with
’Psychological Factors Affecting Medical Conditions’. Why?

A

Psychological/behavioral factors play a role in
almost every medical condition, whether that role is
in the initiation, progression, aggravation or
predisposition, and varies from disorder to disorder.

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4
Q

What are the five P factors when conceptualising an individual’s mental health?

A
  • Presenting problem(s)
  • Predisposing.
  • Precipitating.
  • Perpetuating.
  • Protective.
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5
Q

Differentiate between top-down and bottom-up causation (using examples) in the context of disease.

A

Any event at any level of organization of the human organism - from the symbolic to the molecular - may have repercussions at all the other levels.​

  • Top-down.
    • Social interactions → poor mental health → disease.
  • Bottom-up.
    • Underlying physical pathology → disease.
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6
Q

According to the DSM-IV/DSM V, what are the six psychological factors affecting medical conditions?

A
  • Axis I disorder (GAD, depression, schizophrenia, etc.)
  • Sub-syndromal symptoms (e.g. of anxiety, depression)
  • Personality traits or ‘coping style’
  • ‘Maladaptive’ life-style, health-related behavior
  • Stress-related physiological response
  • ‘Other’ (cultural, religious)
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7
Q

Placebo effect should be _____ from the ___ ______ effect.

A

Placebo effect should be subtracted from the net therapeutic effect.

  • All kinds of treatment, even active drugs
    and invasive surgery, produced powerful placebo
    effects in addition to their specific effects.
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8
Q

Name a factor that harms the placebo effect?

A

The patient guessing that the placebo is a placebo.

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9
Q

A clinical trial testing effects of a placebo vs no placebo requires how many arms?

  • What are these arms?
A

Four arms.

  • Experimental group.
  • No-treatment group.
    • Without a ‘no treatment group’ can’t comment reliably pm ‘placebo effect’ because factors such as natural remission, variation in symptoms, may be having effect.
    • No treatment groups are not included in most trials today.
  • ‘Pure’ placebo group.
  • ‘Active’ placebo group.
    • An active placebo is a placebo that produces noticeable side effects that may convince the person being treated that they are receiving a legitimate treatment, rather than an ineffective placebo.
    • Eg inert pure placebo and atropine (causes dry mouth) in studies of antidepressants.
    • Has side effects to convince the patients that they are receiving therapeutic benefit.
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10
Q

Trials with ____ placebo show much lower drug effects than those with ____ placebo.

A

Trials with active placebo show much lower drug effects than those with pure placebo.

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11
Q

There is strong evidence for the evidence of the placebo response in the treatment of what?

A

Pain.

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12
Q

The colours of tablets used to treat psychiatric disorders have been found to elicit placebo/nocebo effect. Which colours are most/least effective for anxiety/depression?

A
  • Green most effective for anxiety.
  • Yellow best for depression.
  • Red is least effective for anxiety and depression.
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13
Q

Give two examples of objective somatic changes that lead from placebo/suggestion.

A
  • Reduction in swelling and trismus with fake ultrasound treatment after dental surgery
  • Similar dopamine activation with apomorphine and placebo in Parkinson’s Disease.
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14
Q

What are the psychological manifestations of inflammation?

A

Sickness behaviour

  • Lethargy.
  • Apathy.
  • Loss of appetite.
  • Increased sensitivity to pain.
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15
Q
  • What is a theory regarding the mechanism of action of placebos?
  • There is evidence that _____ and _____ are involved as mediators of the placebo effect.
A
  • Different analgesics work by suppressing innate immune response (steroids, salicylates).
  • Evidence suggests placebos also suppresses innate immune response (less convincing effect on acquired/adaptive immune response).
  • 2002 study showed that a subset of brain regions was similarly affected by either a placebo intervention or treatment with the opioid agonist remifentanil.
  • 2001 study showed EXPECTATION of pain relief activates mu-opioid receptor signalling in the human brain.
  • Evidence that endorphins and dopamine are
    involved as mediators of the placebo effect.
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16
Q
  • What are the six suggested features of a personality that makes someone placebo prone?
  • What is the role of classical conditioning in placebo response?
A
  • Novelty seeking, reward responsiveness, altruism, optimism, empathy, spirituality.
    • NOTE: No clear placebo-prone personality type.
  • When active treatment replaced by inactive
    treatment, benefit of active treatment continues.
17
Q

Hidden application vs open application.

A
18
Q

What are the four conditions with poor placebo response?

A
  • Bacterial & viral infections.
  • Chronic degenerative diseases.
  • Cancer.
  • Schizophrenia.
19
Q
  • Describe the effect of the nocebo response in drug trials.
A
  • Nocebo effects are unwanted side effects (of placebo or medication) in drug trials.
  • Patients intensively informed about the potential side effects of medication report more symptoms than patients who were given limited information.
  • Theory: Expectation of symptoms (drug side effects) stimulates similar areas of the brain as the experience of symptoms.

NOTE: Nocebo effects are estimated to account for 72% of drop-outs in drug trials for fibromyalgia.