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Efectos secundarios no específicos de la medicación y el fenómeno nocebo
Arthur J Barsky1, Ralph Saintfort, Malcolm P Rogers
1Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
JAMA
|February 7, 2002
Resumen
Los efectos secundarios no específicos de los medicamentos son comunes pero poco conocidos. Las expectativas del paciente, el acondicionamiento, los rasgos psicológicos y el contexto influyen en estos efectos adversos, que pueden ser manejados por los proveedores de atención médica.
Área de la Ciencia:
- Farmacología Farmacología.
- La medicina psicosomática es una medicina psicosomática.
- Investigación clínica La investigación clínica es la investigación clínica.
Sus antecedentes:
- Los pacientes a menudo experimentan efectos secundarios adversos y no específicos de los medicamentos activos, no relacionados con la acción específica del medicamento.
- Este fenómeno común, angustioso y costoso está poco estudiado y mal entendido.
- El fenómeno nocebo, donde los placebos causan efectos adversos, proporciona información sobre la notificación de efectos secundarios no específicos.
Objetivo del estudio:
- Revisar la literatura que identifica los factores asociados con el fenómeno nocebo y los informes de efectos secundarios no específicos en pacientes que toman medicamentos activos.
- Comprender las influencias psicológicas y contextuales en la notificación de eventos adversos de drogas.
- Informar estrategias para el manejo de efectos secundarios no específicos.
Principales métodos:
- Revisión enfocada de la literatura.
- Identificación de factores relacionados con el fenómeno nocebo y notificación de efectos secundarios no específicos.
- Análisis de las expectativas del paciente, el acondicionamiento, las características psicológicas y los factores situacionales.
Principales resultados:
- Las expectativas de los pacientes sobre los efectos adversos están asociadas con la notificación de efectos secundarios no específicos.
- El condicionamiento de experiencias anteriores que vinculan la medicación a los síntomas somáticos juega un papel.
- Los factores psicológicos (ansiedad, depresión, somatización) y el contexto situacional son importantes.
- El fenómeno nocebo ofrece un marco para comprender estos efectos.
Conclusiones:
- Los efectos secundarios no específicos están influenciados por las expectativas del paciente, el acondicionamiento, los rasgos psicológicos y el contexto.
- Los proveedores de atención médica pueden identificar a los pacientes en riesgo y utilizar relaciones de colaboración para manejar estos síntomas.
- Comprender y abordar estos factores puede ayudar a los pacientes a tolerar síntomas molestos pero no dañinos.
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