Summary and conclusions

Understanding the neurophysiological basis of placebo would be an important clue about change in both normal and pathological mood. There is some evidence that endorphins may be relevant, but a full discussion of the mechanism is beyond the scope of this chapter and the interested reader is referred to a review article by Benedetti and Amanzio.(64) It is clear that psychiatric disorders have a fluctuating course, that a phenomenologically based nosological system is inexact, and that the interaction between the two leads to a broad range in the proportion of patients in any sample who will have a placebo effect.

It may also be possible to identify patients whose improvement is a result of a placebo effect. This is at best an educated and inexact guess; however, under certain circumstances this may be an aid in planning the treatment of patients who have a contraindication to a continuing psychopharmacological regime.

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