Attitudes on Mind Over Matter: Physician Views on the Role of Placebo in Psychogenic Disorders

Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study

“…The overall threshold for prescribing may be lower as a result of the fewer treatment options (Richardson et al, 2001). A lack of evidence may also lead some clinicians to prescribe placebos (Rommelfanger, 2013), with attendant complex ethics (Shamy, 2010). On a systemic level, functional patients have increased contact with and referrals within mental and physical health services (McGorm et al, Barsky et al, 2005), which may lead to greater numbers of prescriptions and a cycle of medicalization may occur where patients require additional treatment to manage the side effects of a primary medication, for example requiring laxatives due to opioid analgesic prescriptions.…”

A comparative review on neuroethical issues in neuroscientific and neuroethical journals

“…The central focus of NS articles in this context is the under-representation of vulnerable social groups in medical trials ( Boden-Albala, 2022 ); see also Section “3.2.1. Bias and diversity.” NE articles, in contrast, address a broader range of issues, such as the moral justifiability of certain types of medical trials ( Hess, 2012 ; Gilbert et al, 2014 ; Hurst et al, 2015 ) and the ethical usage of placebos ( Rommelfanger, 2013 ). Other clinical-ethical issues addressed in NE articles include: personalized neurological medicine ( Walker et al, 2022 ), surrogate end-of-life decision-making through using neurotechnology ( Bendtsen, 2013 ; Fernández-Espejo and Owen, 2013 ; Schembs et al, 2021 ), ethical questions involved in diagnosis ( Brukamp, 2013 ; Rodrigue et al, 2013 ; Cratsley, 2019 ), and the ethically desirable treatment for patients with disorders of consciousness ( Brukamp, 2013 ; Farisco, 2013 ; Farisco et al, 2014 ; Lavazza and Reichlin, 2018 ; Peterson et al, 2021 ).…”

Stigma and functional neurological disorder: a research agenda targeting the clinical encounter

“…Other studies using the Illness Perception Questionnaire and Symptom Attribution Questionnaire found that the majority of neurologists, psychiatrists, and emergency medicine respondents attributed epilepsy to “physical” causes while functional seizures were often attributed to “psychological” causes. Studies interviewing neurologists and psychiatrists on attitudes on FND suggested a strategy of handling medical uncertainty by using psychological explanations and an age old stigma associated with an often oversimplification of the physical and psychologica 7 , 24 , 25 …”

“…The time from initial symptom onset to accurate diagnosis of an FND can take years 5 . Once a diagnosis is made, the label of FND on a patient’s medical record carries with it the potential to be stereotyped and treated differently as a result 6 , 7 . Prominent FND researchers have noted that how such a diagnosis is conveyed, and the biases that can be betrayed by an especially awkward delivery to patients—in contrast to a typical delivery of a diagnosis of a brain disorder such as epilepsy—, and can undermine patient care and recovery 8 , 9 …”