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1.
Nervenarzt ; 91(8): 708-713, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32691079

RESUMO

The efficacy of placebo effects is proven in experimental, clinical and meta-analytical studies. However, harnessing placebo effects in clinical treatment contexts is hampered legally and ethically, since it has been considered necessary to conceal the inert nature of a placebo application. Interestingly, the results of recently published small, randomized trials suggest that patients can experience symptom relief after taking pills that they know lack any medication. In particular, these so-called open-label placebos (OLP) improved strongly fluctuating and individually distressing complaints such as gastrointestinal, neurological, psychosomatic and pain symptoms. Although the mechanisms are largely unknown, the open-label placebo application might be a promising way of fostering placebo effects in clinical settings. Initial study protocols already provide schedules for OLP use as an additional treatment in opioid use disorders. Likewise, the reduction of side effects, conversion effects or withdrawal symptoms through OLP applications in pharmacologically active treatments appear to serve as appropriate therapy goals. Further mechanistic studies are urgently needed to investigate the thus far only hypothetically proposed underlying mechanisms of OLP.


Assuntos
Efeito Placebo , Projetos de Pesquisa , Humanos , Dor/tratamento farmacológico , Dor/prevenção & controle
2.
Support Care Cancer ; 28(10): 4667-4675, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31955277

RESUMO

PURPOSE: Patients with advanced cancer often receive suboptimal end-of-life (EOL) care. Particularly males with advanced cancer are more likely to receive EOL care that is more aggressive, even if death is imminent. Critical factors determining EOL care are EOL conversations or advance care planning. However, information about gender-related factors influencing EOL conversations is lacking. Therefore, the current study investigates gender differences concerning the content, the desired time point, and the mode of initiation of EOL conversations in cancer patients. METHODS: In a cross-sectional study, 186 female and male cancer patients were asked about their preferences for EOL discussions using a semi-structured interview, focusing on (a) the importance of six different topics (medical and nursing care, organizational, emotional, social, and spiritual/religious aspects), (b) the desired time point, and (c) the mode of discussion initiation. RESULTS: The importance of EOL topics differs significantly regarding issue (p = 0.002, η2 = 0.02) and gender (p < 0.001, η2 = 0.11). Males wish to avoid the engagement in discussions about death and dying particularly if they are anxious about their end-of-life period. They wish to be addressed regarding the "hard facts" nursing and medical care only. In contrast, females prefer to speak more about "soft facts" and to be addressed about each EOL topic. Independent of gender, the majority of patients prefer to talk rather late: when the disease is getting worse (58%), at the end of their therapy, or when loosing self-sufficiency (27.5%). CONCLUSION: The tendency of patients to talk late about EOL issues increases the risk of delayed or missed EOL conversations, which may be due to a knowledge gap regarding the possibility of disease-associated incapability. Furthermore, there are significant gender differences influencing the access to EOL conversations. Therefore, for daily clinical routine, we suggest an early two-step, gender-sensitive approach to end-of-life conversations.


Assuntos
Planejamento Antecipado de Cuidados/normas , Neoplasias/psicologia , Assistência Terminal/psicologia , Estudos Transversais , Feminino , Identidade de Gênero , Humanos , Masculino
3.
J Psychosom Res ; 111: 133-139, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29935747

RESUMO

OBJECTIVE: The main objective of this study was a detailed comparison of the level of anxiety about surgery and anesthesia. Other objectives included the assessment of the prevalence and intensity of preoperative anxiety. METHODS: This cross-sectional single-center survey used the validated Amsterdam anxiety and information scale (APAIS) and a modified numeric rating scale (mNRS) to assess preoperative anxiety, anxiety about surgery and anxiety about anesthesia. Prevalences and intensities of anxieties were predominantly analyzed descriptively. RESULTS: 3200 patients were enrolled and 3087 (57% females) were analyzed. 92.6% reported preoperative anxiety according to APAIS scores. The average total APAIS anxiety score (APAIS-A-T) was 9.9 (SD 3.6). 40.5% reported high anxiety (defined as APAIS-A-T > 10). Mean anxiety about surgery (APAIS-A-Su) was higher than mean anxiety about anesthesia (APAIS-A-An): 5.5 (SD 2.1) vs. 4.3 (SD 1.9), p < 0.0001. Accordingly, more patients were substantially more afraid (score difference > 2) of surgery (642, 20.8%, 95% CI 19.4-22.3) than of anesthesia (48, 1.6%, 95% CI 1.2-2.1). CONCLUSION: Preoperative anxiety is still very common among adult patients scheduled to undergo an elective procedure. Therefore, it should be evaluated routinely. Anxiety about surgery and anxiety about anesthesia differ in many patients. For this reason, anxiety about surgery and anxiety about anesthesia should be assessed separately. This would allow providing a more individualized support of patients to cope with their anxiety and could require particular attention by the surgeon or the anesthetist.


Assuntos
Ansiedade/epidemiologia , Ansiedade/psicologia , Cuidados Pré-Operatórios/psicologia , Inquéritos e Questionários , Adaptação Psicológica/fisiologia , Adulto , Idoso , Ansiedade/diagnóstico , Estudos Transversais , Medo/fisiologia , Medo/psicologia , Feminino , Objetivos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Prevalência
4.
Ann Oncol ; 27(10): 1909-15, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27551051

RESUMO

BACKGROUND: This study aims to determine the role of patient expectations as potentially modifiable factor of side-effects, quality of life, and adherence to endocrine treatment of breast cancer. PATIENTS AND METHODS: A 2-year prospective clinical cohort study was conducted in routine primary care with postoperative patients with hormone-receptor-positive breast cancer, scheduled to start adjuvant endocrine treatment. Structured patient-reported assessments of side-effects, side-effect expectations, quality of life, and adherence took place during the first week post-surgery and after 3 and 24 months of endocrine treatment. RESULTS: Of 111 enrolled patients, at 3 and 24 months, 107 and 88 patients, respectively, were assessed. After 2 years of endocrine treatment, patients reported high rates of side-effects (arthralgia: 71.3%, weight gain: 53.4%, hot flashes: 46.5%), including symptoms not directly attributable to the medication (breathing problems: 28.1%, dizziness: 25.6%). Pre-treatment expectations significantly predicted patient-reported long-term side-effects and quality of life in multivariate models controlling for relevant medical and psychological variables. Relative risk of side-effects after 2 years of endocrine treatment was higher in patients with high negative expectations at baseline than in those with low negative expectations (RR = 1.833, CI 95%, 1.032-3.256). A significant interaction confirmed this expectation effect to be particularly evident in patients with high side-effects at 3 months. Furthermore, baseline expectations were associated with adherence at 24 months (r = -0.25, P = 0.006). CONCLUSIONS: Expectations are a genuine factor of clinical outcome from endocrine treatment for breast cancer. Negative expectations increase the risk of treatment-specific side-effects, nocebo side-effects, and non-adherence. Yet, controlled studies are needed to analyze potential causal relationships. Optimizing individual expectations might be a promising strategy to improve side-effect burden, quality of life, and adherence during longer-term drug intake. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02088710.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Terapia de Reposição Hormonal/efeitos adversos , Tamoxifeno/administração & dosagem , Adolescente , Adulto , Idoso , Inibidores da Aromatase/administração & dosagem , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Estudos de Coortes , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Receptor alfa de Estrogênio/genética , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Qualidade de Vida , Tamoxifeno/efeitos adversos , Resultado do Tratamento
5.
J Psychosom Res ; 79(6): 492-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26553385

RESUMO

OBJECTIVE: The study investigates the association between somatosensory amplification and the reporting of side effects. It establishes a German version of the Somatosensory Amplification Scale and examines its psychometric properties in a representative sample of the German population. METHODS: Sample size was 2.469, with 51% taking any medication. Participants answered the Somatosensory Amplification Scale, Generic Assessment of Side Effects Scale, and indicated whether they were taking any medication and the type of medication. Correlational analysis and binary logistic regression were performed. RESULTS: When examining a subsample reporting both medication intake and general bodily symptoms, participants higher in somatosensory amplification rated more of their general bodily symptoms as medication-attributed side effects. However, somatosensory amplification scores were not associated with the intake of any type of medication. In the overall sample, higher somatosensory amplification scores were associated with an increased report of bodily symptoms. Additionally, participants with higher somatosensory amplification reported intake of a greater number of different medications. The psychometric properties of the translated scale were good, and previously established associations of somatosensory amplification with demographic variables (age, sex) were replicated. CONCLUSION: Results suggest a possible attributional bias concomitant to somatosensory amplification which in turn may increase the reporting of side effects after medication intake.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Córtex Somatossensorial/fisiopatologia , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Fatores de Risco
6.
Schizophr Res ; 96(1-3): 232-45, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17826034

RESUMO

Psychoeducation (PE) for schizophrenia and other psychotic disorders is widely adopted but insufficiently evaluated. So far, meta-analytic data has demonstrated efficacy for PE when interventions include family members. Whether PE directed solely at patients is also effective remains unclear. The current meta-analysis evaluates short- and long-term efficacy of PE with and without inclusion of families with regard to relapse, symptom-reduction, knowledge, medication adherence, and functioning. Randomized controlled trials comparing PE to standard care or non-specific interventions were included. A literature search in the Cochrane Library, PsycINFO and Medline retrieved 199 studies for closer examination, of which 18 studies, reporting on 19 comparisons, met the inclusion criteria. These studies were coded with regard to methodology, participants, interventions and validity. Effect sizes were integrated using the fixed effects model for homogeneous effects and the random effects model for heterogeneous effects. Independent of treatment modality, PE produced a medium effect at post-treatment for relapse and a small effect size for knowledge. PE had no effect on symptoms, functioning and medication adherence. Effect sizes for relapse and rehospitalization remained significant for 12 months after treatment but failed significance for longer follow-up periods. Interventions that included families were more effective in reducing symptoms by the end of treatment and preventing relapse at 7-12 month follow-up. Effects achieved for PE directed at patients alone were not significant. It is concluded that the additional effort of integrating families in PE is worthwhile, while patient-focused interventions alone need further improvement and research.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/terapia , Humanos , Seleção de Pacientes , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Recidiva , Sensibilidade e Especificidade , Resultado do Tratamento
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