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The nocebo effect: a clinicians guide.
Aust N Z J Psychiatry 2013; 47(7):617-23AN

Abstract

OBJECTIVE

This paper aims to provide an overview on the nocebo effect, focusing on recognition - its phenomenology, at-risk demographic profiles, clinical situations and personality factors, as well as discriminating somatic symptoms in the general population from treatment-related adverse effects. Lastly, the paper addresses available evidence-based strategies for management and minimisation of the nocebo effect.

METHOD

Data for this paper were identified by searching PubMed using the search terms "nocebo" and "nocebo effect", augmented by a manual search of the references of the key papers and the related literature.

RESULTS

The nocebo effect refers to non-pharmacodynamic, harmful or undesirable effects occurring after inactive treatment, a phenomenon that also occurs in the context of active therapy. Known drivers include classical conditioning and negative expectations concerning treatment. Recent meta-analyses have reported a considerable prevalence, ranging from 18% in the symptomatic treatment of migraine, to more than 74% in multiple sclerosis. Recognition of the nocebo-driven adverse effects presents a challenge, especially because of its non-specific nature and the similarity to the active medication's expected profile. Traits such as neuroticism, pessimism and type A personalities may predispose individuals to this phenomenon. Clinical management of the nocebo effect includes awareness and recognition, changing the manner of disclosure of potential drug-related adverse effects, shaping patients' expectations and enhancing the treatment alliance.

CONCLUSION

The nocebo effect is a common, clinically significant, yet covert driver of clinical outcomes. Increased awareness of its features, as well as knowledge of strategies on how to manage it, are fundamental so that clinicians can mitigate its impact on clinical practice.

Authors+Show Affiliations

Psychiatric Department, Hospital Santa Maria, Lisbon, Portugal. joaodatafranco@gmail.comNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23093053

Citation

Data-Franco, João, and Michael Berk. "The Nocebo Effect: a Clinicians Guide." The Australian and New Zealand Journal of Psychiatry, vol. 47, no. 7, 2013, pp. 617-23.
Data-Franco J, Berk M. The nocebo effect: a clinicians guide. Aust N Z J Psychiatry. 2013;47(7):617-23.
Data-Franco, J., & Berk, M. (2013). The nocebo effect: a clinicians guide. The Australian and New Zealand Journal of Psychiatry, 47(7), pp. 617-23. doi:10.1177/0004867412464717.
Data-Franco J, Berk M. The Nocebo Effect: a Clinicians Guide. Aust N Z J Psychiatry. 2013;47(7):617-23. PubMed PMID: 23093053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The nocebo effect: a clinicians guide. AU - Data-Franco,João, AU - Berk,Michael, Y1 - 2012/10/23/ PY - 2012/10/25/entrez PY - 2012/10/25/pubmed PY - 2014/1/31/medline KW - Nocebo KW - adverse effects KW - placebo KW - treatment outcomes SP - 617 EP - 23 JF - The Australian and New Zealand journal of psychiatry JO - Aust N Z J Psychiatry VL - 47 IS - 7 N2 - OBJECTIVE: This paper aims to provide an overview on the nocebo effect, focusing on recognition - its phenomenology, at-risk demographic profiles, clinical situations and personality factors, as well as discriminating somatic symptoms in the general population from treatment-related adverse effects. Lastly, the paper addresses available evidence-based strategies for management and minimisation of the nocebo effect. METHOD: Data for this paper were identified by searching PubMed using the search terms "nocebo" and "nocebo effect", augmented by a manual search of the references of the key papers and the related literature. RESULTS: The nocebo effect refers to non-pharmacodynamic, harmful or undesirable effects occurring after inactive treatment, a phenomenon that also occurs in the context of active therapy. Known drivers include classical conditioning and negative expectations concerning treatment. Recent meta-analyses have reported a considerable prevalence, ranging from 18% in the symptomatic treatment of migraine, to more than 74% in multiple sclerosis. Recognition of the nocebo-driven adverse effects presents a challenge, especially because of its non-specific nature and the similarity to the active medication's expected profile. Traits such as neuroticism, pessimism and type A personalities may predispose individuals to this phenomenon. Clinical management of the nocebo effect includes awareness and recognition, changing the manner of disclosure of potential drug-related adverse effects, shaping patients' expectations and enhancing the treatment alliance. CONCLUSION: The nocebo effect is a common, clinically significant, yet covert driver of clinical outcomes. Increased awareness of its features, as well as knowledge of strategies on how to manage it, are fundamental so that clinicians can mitigate its impact on clinical practice. SN - 1440-1614 UR - https://www.unboundmedicine.com/medline/citation/23093053/The_nocebo_effect:_a_clinicians_guide_ L2 - http://journals.sagepub.com/doi/full/10.1177/0004867412464717?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -