Psychogenic diseases are attributable to a variety of psychological and social factors
that may trigger the onset of symptoms and influence the course of the disease. Whenever
psychological factors are involved, both placebo effects and their evil twins, nocebo
effects, play an important role. These involve a number of mechanisms, ranging from
expectation, anxiety, reward to learning phenomena, such as Pavlovian conditioning,
cognitive and social learning. There is also some evidence of different genetic variants
in placebo responsiveness, and these give rise to high response variability. Overall,
the concept that is emerging today is that placebos and drugs share common mechanisms
of action. Therefore, the understanding of these mechanisms in placebo responders
and nonresponders has important clinical implications and applications, such as reduction
of drug intake and diagnosis and management of psychogenic diseases. Overall, exploring
placebo responsiveness through a neuroscientific approach gives us insights into the
biology of the human brain, better medical care, and better understanding of its impact
on society, particularly in those conditions in which the psychogenic nature of the
disease plays a key role.
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