The Journal of nervous and mental disease
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J. Nerv. Ment. Dis. · Jul 2013
ReviewThe medical alliance: from placebo response to alliance effect.
The natural human response to illness is to seek to understand what is happening and to look for help from others. In all cultures, one finds healers, who provide explanations and offer care. Their interventions often have a placebo effect through activation of natural healing processes in the patient. ⋯ We distinguish the alliance effect from the placebo effect. We develop a comprehensive model of the medical alliance, on the basis of the concept of concordance, and review its relevance for clinical practice and medical education. The alliance effect represents a professional and ethical way of activating a patient's natural healing mechanisms.
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J. Nerv. Ment. Dis. · Apr 2013
Consenting not to be informed: a survey on the acceptability of placebo use in the treatment of depression.
The aim of this study was to investigate the opinions of healthy students regarding the acceptability of placebo treatment if they were to experience depression. A survey was conducted among 344 students in five academic centers in Israel. After a thorough explanation of the placebo effect, its efficacy and limitations in the treatment of depression, the study participants completed a 32-item self-report questionnaire. ⋯ Eighty-eight percent (n = 297) of the subjects did not think that a physician who administered placebos was deceitful. Once aware of the possible benefits and limitations of placebo treatment, most of our study population was willing to accept placebo as a legitimate treatment of depression. Additional studies on the possible use of placebo as an effective, safe, and acceptable form of therapy are warranted.
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To characterize disclosures of conflicts of interest in review articles in psychiatry, we identified 285 reviews from 10 high-impact journals in psychiatry and 2 in general medicine. Disclosures were reliably coded as biotechnology/pharmaceutical/other material interests, nonprofit/government, communication companies, or other. The authors in both types of journals frequently reported industry ties. ⋯ The most common types of industry-related disclosures were for consulting, research support, and speaking fees. Disclosures seemed to be of limited utility in helping readers assess possible biases because the nature and the extent of the relationships being disclosed were often unclear. Efforts to screen out authors with significant financial relationships pertaining to the topic under review may be more effective than are disclosures in protecting the integrity of the medical literature.
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J. Nerv. Ment. Dis. · Dec 2012
Historical ArticleThree 20th-century multiauthored handbooks serving as vital catalyzers of an emerging specialization: a case study from the history of neurology and psychiatry.
Originating in the late 19th century, psychiatry and neurology emerged during a period of several decades as two distinct fields of medical inquiry, separate from the study and practice of internal medicine. Around 1900, the German-speaking countries in Europe played an important role in this development. In this article, the publication of three influential multivolume and multiauthor handbooks are studied. ⋯ Particular emphasis is placed on the preeminent role that Jewish clinical neurologists assumed in the editing of the respective handbooks, leading to the extraordinary breadth and wealth of these publications. A great number of doyens in the fields of neurology and psychiatry-among them numerous Nobel Prize laureates-were involved in the dissemination of contemporary knowledge, including diagnostic and therapeutic procedures, which testifies to the fundamental status that these handbooks held for training purposes for both undergraduate and postgraduate students. Finally, the volumes analyzed in this article (between 1911 and 2002) are representative of a shift in the dominant scientific language, from German to English, since the 1930s and the 1940s, as well as the change in geographical distribution of the leading scientific authors, from Central Europe (Germany, Austria, Holland, France, Italy, and Scandinavia) to North America (the United States).
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J. Nerv. Ment. Dis. · Jul 2012
Antipsychotic monotherapy and polypharmacy in the treatment of outpatients with schizophrenia in the European Schizophrenia Outpatient Health Outcomes Study.
This post hoc study used data from the naturalistic Schizophrenia Outpatient Health Outcomes study, assessing the factors associated with starting antipsychotic monotherapy and the annual rate and duration of antipsychotic monotherapy among patients initiating atypical antipsychotics (N = 6866). Descriptive and regression analyses were used. Factors associated with starting antipsychotic monotherapy at baseline were antipsychotic treatment for the first time, shorter duration of illness, less severe illness, and better social functioning. ⋯ The predicted mean number of days on baseline monotherapy was significantly longer for olanzapine than for risperidone, quetiapine, or amisulpride (all p < 0.01). Initiation of antipsychotic monotherapy at baseline is associated with select baseline patient characteristics. Olanzapine was found to have the highest monotherapy rate and the longest duration of maintained monotherapy, followed by risperidone, amisulpride, and quetiapine.