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Placebo, nocebo, and psychogenic illness

      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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