Psychiatric Department, Hospital Santa Maria, Lisbon, Portugal.
Aust N Z J Psychiatry. 2013 Jul;47(7):617-23. doi: 10.1177/0004867412464717. Epub 2012 Oct 23.
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.
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.
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.
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.
本文旨在概述“反安慰剂效应”，重点介绍其认知表现——包括其表现形式、高危人群特征、临床情况和人格因素，以及在普通人群中区分与治疗相关的不良反应的躯体症状。最后，本文将探讨针对反安慰剂效应的现有循证管理和最小化策略。
本文通过在 PubMed 中使用“反安慰剂”和“反安慰剂效应”这两个检索词进行搜索，并辅以对关键论文和相关文献的参考文献的手动搜索，来确定本文的数据。
反安慰剂效应是指在接受无效治疗后出现的非药效、有害或不良的影响，这种现象也发生在积极治疗的背景下。已知的驱动因素包括经典条件反射和对治疗的负面预期。最近的荟萃分析报告称，反安慰剂效应的发生率相当高，从偏头痛症状治疗中的 18%到多发性硬化症中超过 74%不等。由于其非特异性和与活性药物预期特征的相似性，识别反安慰剂驱动的不良反应具有挑战性。神经质、悲观主义和 A 型人格等特征可能使个体易受此现象影响。反安慰剂效应的临床管理包括意识和认知、改变潜在药物相关不良反应的披露方式、塑造患者的期望和增强治疗联盟。
反安慰剂效应是一种常见的、具有临床意义的、但隐蔽的临床结果驱动因素。提高对其特征的认识，以及了解如何管理它的策略，是至关重要的，以便临床医生能够减轻其对临床实践的影响。
