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[安慰剂-反安慰剂现象的心理神经生理学基础:重视医患关系人性化的科学证据]

[Psiconeurophysiologic bases of the placebo-nocebo phenomenon: scientific evidences that value the humanization of the doctor-patient relationship].

作者信息

Teixeira Marcus Zulian

机构信息

Hospital das Clinicas da FMUSP - Servico de Clinica Medica Geral, Instituto Central, Predio dos Ambulatorios, Sao Paulo, Brazil.

出版信息

Rev Assoc Med Bras (1992). 2009 Jan-Feb;55(1):13-8. doi: 10.1590/s0104-42302009000100008.

Abstract

Aspect quite valued in the medical systems of all of the times, the doctor-patient relationship assumed secondary importance in the current biomedical model, depriving the modern therapeutic arsenal of a psyconeurophisiological intervention capable to complement the resolution of many organic disturbances. With the intention of rescuing this and other benefits, countless proposed by the humanization of the medicine have been appearing in the several sections of the health, remaining to scientific thought accept that this subjective relational increment can increase the effectiveness of the conventional treatments. Working as sensitization element, the recent experimental studies illustrate the possible benefits or harms that a doctor-patient relationship more or less humanized can provoke in the evolution of the diseases. Uniting the theories of classical conditioning and conscious expectation, the researches suggest that the doctor's posture, permeated by positive or negative manifestations (comments, suggestions, attitudes etc.), it can exercise similar influences in the patients' psyche, unchaining favorable or unfavorable neurophysiologic answers, acting as therapeutic or iatrogenic instrument, respectively.

摘要

医患关系在各个时代的医学体系中都备受重视,但在当前的生物医学模式中却被置于次要地位,使得现代治疗手段失去了一种能够辅助解决许多器质性疾病的心理神经生理干预方法。为了挽救这一关系及其他益处,医学人性化提出的无数建议已在健康领域的多个方面出现,科学思维仍有待接受这种主观关系的增强能够提高传统治疗的效果。作为一种敏感因素,最近的实验研究表明,医患关系或多或少的人性化在疾病发展过程中可能引发的益处或危害。结合经典条件反射理论和意识期望理论,研究表明医生的姿态,无论是积极还是消极的表现(评论、建议、态度等),都能对患者的心理产生类似影响,引发有利或不利的神经生理反应,分别起到治疗或医源性作用。

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