1
|
Alves RDB, de Rebouças CV, Yamada AMTD, Cruz FJSM. Prevalence of anticipatory nausea and vomiting in breast cancer patients undergoing highly emetogenic chemotherapy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230937. [PMID: 38716933 PMCID: PMC11068401 DOI: 10.1590/1806-9282.20230937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.
Collapse
Affiliation(s)
- Rafaela de Brito Alves
- Faculty of Medicine of ABC, Brazilian Institute for Cancer Control – Santo André (SP), Brazil
| | | | | | | |
Collapse
|
2
|
Jongerius C, Vermeulen L, van Egmond M, Evers AWM, Buffart LM, Lenos KJ. Behavioral factors to modulate immunotherapy efficacy in cancer. Front Immunol 2022; 13:1066359. [PMID: 36591246 PMCID: PMC9800824 DOI: 10.3389/fimmu.2022.1066359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Immune checkpoint inhibitors, including anti-PD-1 and anti-CTLA-4 therapies, are used to (re)activate the immune system to treat cancer. Despite promising results, a large group of patients does not respond to checkpoint inhibition. In the vulnerability-stress model of behavioral medicine, behavioral factors, such as stress, exercise and classical pharmacological conditioning, predict cancer incidence, recurrence and the efficacy of conventional cancer treatments. Given the important role of the immune system in these processes, certain behavior may be promising to complement immune checkpoint inhibition therapy. Here, we discuss the preliminary evidence and suitability of three behavioral mechanisms, i.e. stress modulation, exercise and classical pharmacological conditioning for the benefit of immunotherapy. It is crucial to study the potential beneficial effects of behavioral strategies that support immunotherapeutic anti-tumor effects with rigorous experimental evidence, to exploit behavioral mechanisms in improving checkpoint inhibition efficacy.
Collapse
Affiliation(s)
- C. Jongerius
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands,Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, Netherlands,Oncode Institute, Amsterdam, Netherlands,*Correspondence: C. Jongerius,
| | - L. Vermeulen
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands,Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, Netherlands,Oncode Institute, Amsterdam, Netherlands
| | - M. van Egmond
- Department of Molecular Cell Biology & Immunology, Amsterdam UMC, Location VU University, Amsterdam, Netherlands,Department of Surgery, Amsterdam UMC, Location VU University, Amsterdam, Netherlands
| | - A. W. M. Evers
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, Netherlands
| | - L. M. Buffart
- Department of Physiology, Radboudumc, Nijmegen, Netherlands
| | - K. J. Lenos
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands,Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, Netherlands,Oncode Institute, Amsterdam, Netherlands
| |
Collapse
|
3
|
Hadamitzky M, Lückemann L, Pacheco-López G, Schedlowski M. Pavlovian Conditioning of Immunological and Neuroendocrine Functions. Physiol Rev 2020; 100:357-405. [DOI: 10.1152/physrev.00033.2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The phenomenon of behaviorally conditioned immunological and neuroendocrine functions has been investigated for the past 100 yr. The observation that associative learning processes can modify peripheral immune functions was first reported and investigated by Ivan Petrovic Pavlov and his co-workers. Their work later fell into oblivion, also because so little was known about the immune system’s function and even less about the underlying mechanisms of how learning, a central nervous system activity, could affect peripheral immune responses. With the employment of a taste-avoidance paradigm in rats, this phenomenon was rediscovered 45 yr ago as one of the most fascinating examples of the reciprocal functional interaction between behavior, the brain, and peripheral immune functions, and it established psychoneuroimmunology as a new research field. Relying on growing knowledge about efferent and afferent communication pathways between the brain, neuroendocrine system, primary and secondary immune organs, and immunocompetent cells, experimental animal studies demonstrate that cellular and humoral immune and neuroendocrine functions can be modulated via associative learning protocols. These (from the classical perspective) learned immune responses are clinically relevant, since they affect the development and progression of immune-related diseases and, more importantly, are also inducible in humans. The increased knowledge about the neuropsychological machinery steering learning and memory processes together with recent insight into the mechanisms mediating placebo responses provide fascinating perspectives to exploit these learned immune and neuroendocrine responses as supportive therapies, the aim being to reduce the amount of medication required, diminishing unwanted drug side effects while maximizing the therapeutic effect for the patient’s benefit.
Collapse
Affiliation(s)
- Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Lückemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gustavo Pacheco-López
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Lenaert B, Boddez Y, Vlaeyen JW, van Heugten CM. Learning to feel tired: A learning trajectory towards chronic fatigue. Behav Res Ther 2018; 100:54-66. [DOI: 10.1016/j.brat.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
|
5
|
Efecto placebo y contexto terapéutico: un reto en investigación clínica. Med Clin (Barc) 2017; 149:26-31. [DOI: 10.1016/j.medcli.2017.03.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
|
6
|
Khairkar P, Reddy S, Agrawal A. Neuropsychiatric aspects of paediatric brain tumours: an update. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and neurobehavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. Childhood cancer remains the leading cause of illness-related death in childhood, but significant advances in survival have been made in the past 40 years. This review looks at the neuropsychiatric presentations, psychosocial and treatment-related issues that arise in children with brain tumors.
Collapse
|
7
|
Abstract
Placebo effects in clinical trials have sparked an interest in the placebo phenomenon, both in randomized controlled trials (RCTs) and in experimental gastroenterology. RCTs have demonstrated similar short-term and long-term placebo response rates in gastrointestinal compared to other medical diagnoses. Most mediators and moderators of placebo effects in gastrointestinal diseases are also of similar type and size to other medical diagnoses and not specific for gastrointestinal diagnoses. Other characteristics such as an increase in the placebo response over time and the placebo-enhancing effects of unbalanced randomization were not seen, at least in IBS. Experimental placebo and nocebo studies underscore the 'power' of expectancies and conditioning processes in shaping gastrointestinal symptoms not only at the level of self-reports, but also within the brain and along the brain-gut axis. Brain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias. These findings raise hope that sophisticated trials and experiments designed to boost positive expectations and minimize negative expectations could pave the way for a practical and ethically sound use of placebo knowledge in daily practice. Rather than focusing on a 'personalized' choice of drugs based on biomarkers or genes, it might be the doctor-patient communication that needs to be tailored.
Collapse
|
8
|
Abstract
UNLABELLED There is little information regarding changes in placebo responsiveness with age, although first predictors of placebo responders such as psychological and physiological processes have been identified. Reviews and meta-analyses indicate that placebo response rates in randomized controlled trials (RCTs) are higher in children and adolescents compared with adults. As these studies cannot control for age-dependent differences in the natural course of the disease, biases might contribute to different placebo rates in RCTs. To avoid these biases, this study investigated age-related differences in placebo responsiveness between children and adults in a well-established experimental model of placebo analgesia combining classic conditioning and expectation. Our data confirm placebo analgesic responses in children, which did not differ in magnitude from those of adults. The influence of previous experience on subsequent treatment outcome was stronger in children than in adults, indicating an increased relevance of learning processes for treatment outcomes in children. Further studies are needed to understand the influence of treatment-related learning processes in children and adolescents, which might critically determine treatment responsiveness during adulthood. PERSPECTIVE This study is the first to experimentally explore placebo analgesia and influences of previous experience on placebo responses in children compared with adults. We found comparable placebo responses in both groups and an increased relevance of learning processes for treatment outcomes in children.
Collapse
|
9
|
Dupuis LL, Robinson PD, Boodhan S, Holdsworth M, Portwine C, Gibson P, Phillips R, Maan C, Stefin N, Sung L. Guideline for the prevention and treatment of anticipatory nausea and vomiting due to chemotherapy in pediatric cancer patients. Pediatr Blood Cancer 2014; 61:1506-12. [PMID: 24753095 DOI: 10.1002/pbc.25063] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/18/2014] [Indexed: 11/06/2022]
Abstract
This guideline provides an approach to the prevention and treatment of anticipatory chemotherapy-induced nausea and vomiting (CINV) in children. It was developed by an international, inter-professional panel using AGREE II methods and is based on systematic literature reviews. Evidence-based recommendations for pharmacological and non-pharmacological interventions to prevent and treat anticipatory CINV in children receiving antineoplastic agents are provided. Gaps in the evidence used to support the recommendations are identified. The contribution of this guideline to anticipatory CINV control in children requires prospective evaluation.
Collapse
Affiliation(s)
- L. Lee Dupuis
- Department of Pharmacy; The Hospital for Sick Children; Toronto Ontario
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario
- Program in Child Health Evaluative Sciences; Research Institute, The Hospital for Sick Children; Toronto Ontario
| | | | - Sabrina Boodhan
- Department of Pharmacy; The Hospital for Sick Children; Toronto Ontario
- Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto Ontario
| | - Mark Holdsworth
- College of Pharmacy; University of New Mexico; Albuquerque New Mexico
| | - Carol Portwine
- Division of Hematology/Oncology, Department of Pediatrics; McMaster University; Hamilton Ontario
| | - Paul Gibson
- Pediatric Hematology/Oncology, Children's Hospital; London Health Sciences Centre; London Ontario
| | - Robert Phillips
- Regional Department of Haematology and Oncology; Leeds Children's Hospital; Leeds United Kingdom
- Centre for Reviews and Dissemination; University of York; York United Kingdom
| | - Cathy Maan
- Pediatric Hematology/Oncology, Children's Hospital; London Health Sciences Centre; London Ontario
| | - Nancy Stefin
- Division of Hematology/Oncology, Department of Pediatrics; McMaster University; Hamilton Ontario
| | - Lillian Sung
- Division of Haematology/Oncology; The Hospital for Sick Children; Toronto Ontario
- Program in Child Health Evaluative Sciences; Research Institute, The Hospital for Sick Children; Toronto Ontario
- Department of Paediatrics; University of Toronto; Toronto Ontario
| |
Collapse
|
10
|
Stockhorst U, Hall G, Enck P, Klosterhalfen S. Effects of overshadowing on conditioned and unconditioned nausea in a rotation paradigm with humans. Exp Brain Res 2014; 232:2651-64. [DOI: 10.1007/s00221-014-3998-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/16/2014] [Indexed: 12/13/2022]
|
11
|
Albring A, Wendt L, Benson S, Nissen S, Yavuz Z, Engler H, Witzke O, Schedlowski M. Preserving Learned Immunosuppressive Placebo Response: Perspectives for Clinical Application. Clin Pharmacol Ther 2014; 96:247-55. [DOI: 10.1038/clpt.2014.75] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/27/2014] [Indexed: 12/13/2022]
|
12
|
Yeh CH, Chien LC, Albers KM, Ren D, Huang LC, Cheng B, Margolis L, Liu R, Suen LKP. Function of Auricular Point Acupressure in Inducing Changes in Inflammatory Cytokines During Chronic Low-Back Pain: A Pilot Study. Med Acupunct 2014. [DOI: 10.1089/acu.2013.1015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Chao Hsing Yeh
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Lung Chang Chien
- University of Texas School of Public Health at San Antonio Regional Campus, San Antonio, TX
| | | | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | | | - Baoxia Cheng
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Leah Margolis
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Richard Liu
- Pain Management Clinic, Anesthesia, Walter Reed National Military Medical Center, Bethesda, MD
| | | |
Collapse
|
13
|
Ersche KD, Hagan CC, Smith DG, Abbott S, Jones PS, Apergis-Schoute AM, Döffinger R. Aberrant disgust responses and immune reactivity in cocaine-dependent men. Biol Psychiatry 2014; 75:140-7. [PMID: 24090796 PMCID: PMC3898808 DOI: 10.1016/j.biopsych.2013.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infectious diseases are the most common and cost-intensive health complications associated with drug addiction. There is wide belief that drug-dependent individuals expose themselves more regularly to disease-related pathogens through risky behaviors such as sharing pipes and needles, thereby increasing their risk for contracting an infectious disease. However, evidence is emerging indicating that not only lifestyle but also the immunomodulatory effects of addictive drugs, such as cocaine, may account for their high infection risk. As feelings of disgust are thought to be an important psychological mechanism in avoiding the exposure to pathogens, we sought to investigate behavioral, physiological, and immune responses to disgust-evoking cues in both cocaine-dependent and healthy men. METHODS All participants (N = 61) were exposed to neutral and disgust-evoking photographs depicting food and nonfood images while response accuracy, latency, and skin conductivity were recorded. Saliva samples were collected before and after exposure to neutral and disgusting images, respectively. Attitudes toward disgust and hygiene behaviors were assessed using questionnaire measures. RESULTS Response times to disgust-evoking photographs were prolonged in all participants, and specifically in cocaine-dependent individuals. While viewing the disgusting images, cocaine-dependent individuals exhibited aberrant skin conductivity and increased the secretion of the salivary cytokine interleukin-6 relative to control participants. CONCLUSION Our data provide evidence of a hypersensitivity to disgusting stimuli in cocaine-dependent individuals, possibly reflecting conditioned responses to noningestive sources of infection. Coupled with a lack of interoception of bodily signals, aberrant disgust responses might lead to increased infection susceptibility in affected individuals.
Collapse
Affiliation(s)
- Karen D. Ersche
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom,Address correspondence to Karen Ersche, Ph.D., Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge Biomedical Campus, Cambridge CB2 0SZ, United Kingdom
| | - Cindy C. Hagan
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Dana G. Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Sanja Abbott
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - P. Simon Jones
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Annemieke M. Apergis-Schoute
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Rainer Döffinger
- Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
| |
Collapse
|
14
|
Wendt L, Albring A, Schedlowski M. Learned placebo responses in neuroendocrine and immune functions. Handb Exp Pharmacol 2014; 225:159-181. [PMID: 25304532 DOI: 10.1007/978-3-662-44519-8_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The phenomenon of learned placebo responses in neuroendocrine and immune functions is a fascinating example of communication between the brain and both the endocrine and peripheral immune systems. In this chapter, we will give a short overview of afferent and efferent communication pathways, as well as the central mechanisms, which steer the behavioral conditioned immune response. Subsequently, we will focus on data that provides evidence for learned immune responses in experimental animals and learned neuroendocrine and immune placebo responses in humans. Finally, we will take a critical look at these learning protocols, to determine whether or not they can be considered a viable additional treatment option to pharmacological regimens in clinical routine. This is fundamental, since there are still a number of issues, which need to be solved, such as the potential reproducibility, predictability, and extinction of the learned neuroendocrine and immune responses. Together, these findings not only provide an excellent basis to increase our understanding of human biology but may also have far reaching clinical implications. They pave the way for the ultimate aim of employing associative learning protocols as supportive treatment strategies in pharmacological regimens. As a result, medication levels may be reduced, as well as their unwanted side effects, providing a maximized therapeutic outcome to the benefit of the patient.
Collapse
Affiliation(s)
- Laura Wendt
- Institute of Medical Psychology and Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | | | | |
Collapse
|
15
|
Jubb J, Bensing JM. The sweetest pill to swallow: How patient neurobiology can be harnessed to maximise placebo effects. Neurosci Biobehav Rev 2013; 37:2709-20. [DOI: 10.1016/j.neubiorev.2013.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022]
|
16
|
Weimer K, Gulewitsch MD, Schlarb AA, Schwille-Kiuntke J, Klosterhalfen S, Enck P. Placebo effects in children: a review. Pediatr Res 2013; 74:96-102. [PMID: 23598811 DOI: 10.1038/pr.2013.66] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/23/2012] [Indexed: 12/19/2022]
Abstract
Of more than 155,000 PubMed citations found with the search term "placebo," only ~9,000 (5.8%) included the terms "children" or "adolescents." When all these papers were screened, only ~2,000 of them investigated the placebo effect per se, and of those, only ~50 (2.5%) discussed the placebo effect in children and adolescents. In this narrative review, we explore four aspects of the placebo response in children and adolescents: (i) the legal and ethical limitations and restrictions for the inclusion of children in clinical trials as well as in experimental (placebo) research that may explain the poor knowledge base; (ii) the question of whether or not the placebo effect is larger in children and adolescents as compared with adults; (iii) whether the mechanisms underlying the placebo effect are similar between children and adults; and (iv) whether mediators and moderators of the placebo effect are comparable between children and adults. We finally discuss some of the consequences from the current placebo research in adults that may affect both experimental and clinical research in children and adolescents.
Collapse
Affiliation(s)
- Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | | | | | | | | | | |
Collapse
|
17
|
Weimer K, Schulte J, Maichle A, Muth ER, Scisco JL, Horing B, Enck P, Klosterhalfen S. Effects of ginger and expectations on symptoms of nausea in a balanced placebo design. PLoS One 2012; 7:e49031. [PMID: 23152846 PMCID: PMC3496739 DOI: 10.1371/journal.pone.0049031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 10/03/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Ginger effects on (experimental) nausea have been described, but also strong placebo effects and sex differences when nausea is involved. The "balanced placebo design" has been proposed to allow better separation of drug and placebo effects. METHODS Sixty-four healthy participants (32 women) were randomly assigned to receive an antiemetic ginger preparation or placebo, and half of each group was told to have received drug or placebo. They were exposed to 5×2 min body rotations to induce nausea. Subjective symptoms and behavioral (rotation tolerance, head movements) and physiological measures (electrogastrogram, cortisol) were recorded. Groups were balanced for sex of participants and experimenters. RESULTS Ginger and the information given did not affect any outcome measure, and previous sex differences could not be confirmed. Adding the experimenters revealed a significant four-factorial interaction on behavioral but not on subjective or physiological measures Men who received placebo responded to placebo information when provided by the male experimenter, and to ginger information when provided by the female experimenter. This effect was not significant in women. CONCLUSION The effects of an antiemetic drug and provided information interact with psychosocial variables of participants and experimenters in reports of nausea.
Collapse
Affiliation(s)
- Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jörg Schulte
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Annamaria Maichle
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Eric R. Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, United States of America
| | - Jenna L. Scisco
- Department of Psychology, Clemson University, Clemson, South Carolina, United States of America
| | - Björn Horing
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Sibylle Klosterhalfen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
18
|
Pacheco-López G, Bermúdez-Rattoni F. Brain-immune interactions and the neural basis of disease-avoidant ingestive behaviour. Philos Trans R Soc Lond B Biol Sci 2011; 366:3389-405. [PMID: 22042916 PMCID: PMC3189354 DOI: 10.1098/rstb.2011.0061] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Neuro-immune interactions are widely manifested in animal physiology. Since immunity competes for energy with other physiological functions, it is subject to a circadian trade-off between other energy-demanding processes, such as neural activity, locomotion and thermoregulation. When immunity is challenged, this trade-off is tilted to an adaptive energy protecting and reallocation strategy that is identified as 'sickness behaviour'. We review diverse disease-avoidant behaviours in the context of ingestion, indicating that several adaptive advantages have been acquired by animals (including humans) during phylogenetic evolution and by ontogenetic experiences: (i) preventing waste of energy by reducing appetite and consequently foraging/hunting (illness anorexia), (ii) avoiding unnecessary danger by promoting safe environments (preventing disease encounter by olfactory cues and illness potentiation neophobia), (iii) help fighting against pathogenic threats (hyperthermia/somnolence), and (iv) by associative learning evading specific foods or environments signalling danger (conditioned taste avoidance/aversion) and/or at the same time preparing the body to counteract by anticipatory immune responses (conditioning immunomodulation). The neurobiology behind disease-avoidant ingestive behaviours is reviewed with special emphasis on the body energy balance (intake versus expenditure) and an evolutionary psychology perspective.
Collapse
Affiliation(s)
- Gustavo Pacheco-López
- Physiology and Behaviour Laboratory, ETH (Swiss Federal Institute of Technology)-Zurich, Schwerzenbach 8603, Switzerland
| | - Federico Bermúdez-Rattoni
- Neuroscience Division, Cellular Physiology Institute, UNAM (National University of Mexico), Mexico City 04510, Mexico
| |
Collapse
|
19
|
Abstract
The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors.
Collapse
Affiliation(s)
- Brian P Kurtz
- Department of Psychiatry, Division of Pediatric Psychiatry, Tufts Medical Center and Floating Hospital for Children at Tufts Medical Center, 800 Washington Street #1007, Boston, MA 02111, USA
| | | |
Collapse
|
20
|
Roscoe JA, Morrow GR, Aapro MS, Molassiotis A, Olver I. Anticipatory nausea and vomiting. Support Care Cancer 2010; 19:1533-8. [PMID: 20803345 DOI: 10.1007/s00520-010-0980-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
A commonly reported consequence of post-treatment nausea or vomiting is the development of anticipatory nausea and vomiting (ANV). In most published work, nausea is reported to occur before chemotherapy drugs are administered by approximately 20% of patients at any one chemotherapy cycle and by 25-30% of patients by their fourth chemotherapy cycle. Most studies in adult patients strongly support the view that the development of ANV involves elements of classical conditioning. The best method to avoid development of ANV is to adequately prevent both vomiting and nausea from the first exposure to chemotherapy. If anticipatory side effects develop, behavioral treatment techniques, such as systematic desensitization, have been shown effective. Benzodiazepines used in combination with behavioral techniques or antiemetics may also be useful. The evidence on which these conclusions are based is reviewed in this article.
Collapse
Affiliation(s)
- Joseph A Roscoe
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | | | | | | | | |
Collapse
|
21
|
Hefner J, Klosterhalfen S, Martens U, Enck P. Psychische Faktoren gastrointestinaler Erkrankungen. PSYCHOTHERAPEUT 2010. [DOI: 10.1007/s00278-010-0744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Abstract
The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors.
Collapse
Affiliation(s)
- Brian P Kurtz
- Massachusetts General Hospital/McLean Hospital Child and Adolescent Psychiatry Residency Training Program, Boston, MA 02114, USA
| | | |
Collapse
|
23
|
Schedlowski M, Pacheco-López G. The learned immune response: Pavlov and beyond. Brain Behav Immun 2010; 24:176-85. [PMID: 19698779 DOI: 10.1016/j.bbi.2009.08.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 08/10/2009] [Accepted: 08/14/2009] [Indexed: 01/26/2023] Open
Abstract
The ability to associate physiological changes with a specific flavor was most likely acquired during evolution as an adaptive strategy aimed at protecting the organism while preparing it for danger. The behaviorally conditioned or learned immune response is an exquisite example of the bidirectional communication between the central nervous system (CNS) and the peripheral immune system. How is it possible that specific immuno-modulating properties of a drug or substance (unconditioned stimulus) can be re-enlisted just by the mere re-exposure to a particular taste, odor or environment (conditioned stimulus)? To answer this key question, we review the neurobiological mechanism mediating this type of associative learning, as well as the pathways and mechanisms employed by the brain to harness the immune system during the execution of the conditioned immune response. Finally, we focus on the potential therapeutic relevance of such learned immune responses, and their re-conceptualization within the framework of "learned placebo effects".
Collapse
Affiliation(s)
- Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Medical Faculty, 45122 Essen, Germany.
| | | |
Collapse
|
24
|
Teufel M, Biedermann T, Rapps N, Hausteiner C, Henningsen P, Enck P, Zipfel S. Psychological burden of food allergy. World J Gastroenterol 2007; 13:3456-65. [PMID: 17659692 PMCID: PMC4146781 DOI: 10.3748/wjg.v13.i25.3456] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
One fifth of the population report adverse reactions to food. Reasons for these symptoms are heterogeneous, varying from food allergy, food intolerance, irritable bowel syndrome to somatoform or other mental disorders. Literature reveals a large discrepancy between truly diagnosed food allergy and reports of food allergy symptoms by care seekers. In most studies currently available the characterization of patient groups is incomplete, because they did not distinguish between immunologic reactions and other kinds of food reactions. In analysing these adverse reactions, a thorough physical and psychological diagnostic approach is important. In our qualitative review, we present those diagnostic measures that are evidenced-based as well as clinically useful, and discuss the various psychological dimensions of adverse reactions to food. It is important to acknowledge the complex interplay between body and mind: Adults and children suffering from food allergy show impaired quality of life and a higher level of stress and anxiety. Pavlovian conditioning of adverse reactions plays an important role in maintaining symptoms. The role of personality, mood, or anxiety in food reactions is debatable. Somatoform disorders ought to be identified early to avoid lengthy and frustrating investigations. A future task will be to improve diagnostic algorithms, to describe psychological aspects in clearly characterised patient subgroups, and to develop strategies for an optimized management of the various types of adverse reactions to food.
Collapse
Affiliation(s)
- Martin Teufel
- Department of Internal Medicine VI-Psychosomatic Medicine and Psychotherapy, University of Tubingen, Osianderstrasse 5, D-72076 Tubingen, Germany.
| | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Nausea and/or vomiting are aversive gastrointestinal (GI) symptoms. Nausea and vomiting manifest unconditionally after a nauseogenic experience. However, there is correlative, quasiexperimental and experimental evidence that nausea and vomiting can also be learned via classical (Pavlovian) conditioning and might occur in anticipation of the nauseogenic event. Classical conditioning of nausea can develop with chemotherapy in cancer patients. Initially, nausea and vomiting occur during and after the administration of cytotoxic drugs (post-treatment nausea and vomiting) as unconditioned responses (UR). In addition, 20%-30% of cancer patients receiving chemotherapy report these side effects, despite antiemetic medication, when being re-exposed to the stimuli that usually signal the chemotherapy session and its drug infusion. These symptoms are called anticipatory nausea (AN) and/or anticipatory vomiting (ANV) and are explained by classical conditioning. Moreover, there is recent evidence for the assumption that post-chemotherapy nausea is at least partly influenced by learning. After summarizing the relevant assumptions of the conditioning model, revealing that a context can become a conditioned stimulus (CS), the present paper summarizes data that nausea and/or vomiting is acquired by classical conditioning and, consequently, may be alleviated by conditioning techniques. Our own research has focussed on two aspects and is emphasized here. First, a conditioned nausea model was established in healthy humans using body rotation as the nausea-inducing treatment. The validity of this motion-sickness model to examine conditioning mechanisms in the acquisition and alleviation of conditioned nausea and associated endocrine and immunological responses is summarized. Results from the rotation-induced motion sickness model showed that gender is an important moderator variable to be considered in further studies. This paper concludes with a review of the application of the demonstrated conditioning principles as interventions to ameliorate distressing AN/ANV in cancer patients undergoing chemotherapy, which is the second focus of our work.
Collapse
Affiliation(s)
- Ursula Stockhorst
- Institute of Psychology, General Psychology II and Biological Psychology, University of Osnabrueck, Osnabrueck, Seminarstrasse 20, D-49074 Osnabrueck, Germany.
| | | | | |
Collapse
|
26
|
Abstract
Research on gut-brain interactions has increased over the last decade and has brought about a number of new topics beyond "classical" subjects, such as "stress" and "personality", which have dominated the psychosomatic literature on gastrointestinal disorders over the past century. These novel topics include brain imaging of intestinal functions, placebo responses in gastroenterology, learning of gastrointestinal symptoms, quality of life in patients with intestinal complaints, and psychotherapy and familial aggregation of functional intestinal disorders. Currently, these new topics appear with a frequency of 1% to 3% in leading gastroenterological journals, either as data presentation or review papers. Increasing focus underlines the importance of enhancing our understanding on how the psyche and the brain communicate in order to better meet the needs of our patients.
Collapse
Affiliation(s)
- Paul Enck
- University Hospitals Tubingen, Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, Osianderstrasse 5, Tubingen 72076, Germany.
| | | | | |
Collapse
|
27
|
Stockhorst U, Steingrueber HJ, Enck P, Klosterhalfen S. Pavlovian conditioning of nausea and vomiting. Auton Neurosci 2006; 129:50-7. [PMID: 16949885 DOI: 10.1016/j.autneu.2006.07.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cancer patients undergoing cytotoxic drug treatment often experience side-effects, the most distressing being nausea and vomiting. Despite antiemetic drugs, 25-30% of the chemotherapy patients report these side-effects when being re-exposed to the stimuli that usually signal the chemotherapy session and its drug infusion. These symptoms are called anticipatory nausea and anticipatory vomiting. The present paper summarizes the evidence that anticipatory vomiting is acquired by Pavlovian conditioning, and, consequently, may be alleviated by conditioning techniques. To explore the mechanisms that induce and alleviate conditioned nausea and vomiting further, a conditioned nausea model was established in healthy humans using body rotation as the nausea-inducing treatment. The validity of this motion sickness model to examine conditioning mechanisms in the acquisition and alleviation of conditioned nausea was demonstrated. Cortisol and tumor-necrosis factor-alpha were elevated as endocrine and immunological correlates of nausea. Data in the rotation-induced motion sickness model indicated that gender is an important moderator variable to be considered in further studies. The paper concludes with a review of applications of the demonstrated conditioning principles as interventions to ameliorate distressing anticipatory nausea or anticipatory vomiting in cancer patients undergoing chemotherapy.
Collapse
Affiliation(s)
- Ursula Stockhorst
- Institute of Medical Psychology, Heinrich-Heine-University Duesseldorf, Germany.
| | | | | | | |
Collapse
|
28
|
Pacheco-López G, Engler H, Niemi MB, Schedlowski M. Expectations and associations that heal: Immunomodulatory placebo effects and its neurobiology. Brain Behav Immun 2006; 20:430-46. [PMID: 16887325 DOI: 10.1016/j.bbi.2006.05.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 05/29/2006] [Accepted: 05/29/2006] [Indexed: 12/28/2022] Open
Abstract
The use of placebo may have accompanied healing and medical practices since their origins (Plato; Charmides, 155-156). Recent experimental data indicate that we would be well advised to further consider placebo effects in future therapeutic strategies, with a better knowledge of their potency, psychological basis and underlying neurobiological mechanisms. Current research in the areas of pain, depression and Parkinson's disease has uncovered some of the potential neurobiological mechanisms of placebo effects. These data indicate that conscious expectation and unconscious behavioral conditioning processes appear to be the major neurobiological mechanisms capable of releasing endogenous neurotransmitters and/or neurohormones that mimic the expected or conditioned pharmacological effects. To date, research on placebo responses affecting immune-related diseases is scarce, but there are consistent indications that skin and mucosal inflammatory diseases, in particular, are strongly modulated by placebo treatments. However, the brain's capability to modulate peripheral immune reactivity has been impressively demonstrated by paradigms of behavioral conditioning in animal experiments and human studies. Thus, placebo effects can benefit end organ functioning and the overall health of the individual through positive expectations and behavioral conditioning processes.
Collapse
Affiliation(s)
- Gustavo Pacheco-López
- Chair of Psychology and Behavioral Immunobiology, Institute for Behavioral Sciences, ETH Zurich, 8092 Zurich, Switzerland
| | | | | | | |
Collapse
|
29
|
Klosterhalfen S, Enck P. Psychobiology of the placebo response. Auton Neurosci 2006; 125:94-9. [PMID: 16515893 DOI: 10.1016/j.autneu.2006.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Revised: 01/14/2006] [Accepted: 01/14/2006] [Indexed: 12/18/2022]
Abstract
The nature and determinants of the placebo response are widely unknown and are discussed controversially. This review presents a unifying concept for the understanding of the placebo response in clinical trials and practice based on three components: "Regression to the mean", "Pavlovian conditioning", and "Signal detection theory", and discusses the respective literature in light of experimental and clinical findings from psychology, psychiatry, neurology, and gastroenterology, with specific emphasis on "brain imaging" of the placebo response.
Collapse
|
30
|
Bovbjerg DH, Montgomery GH, Raptis G. Evidence for Classically Conditioned Fatigue Responses in Patients Receiving Chemotherapy Treatment for Breast Cancer. J Behav Med 2005; 28:231-7. [PMID: 16015457 DOI: 10.1007/s10865-005-4659-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2004] [Indexed: 11/26/2022]
Abstract
Fatigue is the most common side effect of chemotherapy for cancer. Not yet explored is the possibility that patients may develop conditioned fatigue responses to clinic cues as a result of the repeated pairing of the clinic environment (conditioned stimulus) with infusions of chemotherapy (unconditioned stimulus) that cause fatigue (unconditioned response). As a first critical test of this possibility, breast cancer patients (N = 82) were studied across their first four cycles of chemotherapy. Consistent with conditioning: (1) fatigue levels in the clinic environment significantly increased with repeated pairings of the clinic environment and chemotherapy administration; (2) fatigue responses in the clinic environment prior to the fourth infusion (CR) were predicted by patients' previous experiences of post-infusion fatigue (UR) above and beyond effects of concurrent emotional distress. These results provide the first evidence in the literature that fatigue can be conditioned. Additional research is warranted to determine the clinical importance of this source of fatigue in chemotherapy patients.
Collapse
Affiliation(s)
- Dana H Bovbjerg
- Department of Oncological Sciences, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029-6574, USA.
| | | | | |
Collapse
|
31
|
Klosterhalfen S, Kellermann S, Stockhorst U, Wolf J, Kirschbaum C, Hall G, Enck P. Latent inhibition of rotation chair-induced nausea in healthy male and female volunteers. Psychosom Med 2005; 67:335-40. [PMID: 15784802 DOI: 10.1097/01.psy.0000156930.00201.e0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pre-exposure to an environment in which a nausea-inducing body rotation will subsequently be given constitutes a latent inhibition procedure that might act to reduce anticipatory and postrotation nausea. METHODS This was tested in 24 healthy subjects randomly assigned to receive no pre-exposure (group 0), a single pre-exposure (group 1), or three pre-exposures (group 3). Rotation was standardized as 5 x 1 minute rotation, but the subjects could terminate it on request. Nausea was determined on a 7-item symptom rating scale before, during, and after rotation on days 3 and 4, whereas anticipatory nausea was measured before presumed rotation on day 5. Saliva cortisol and tumor necrosis factor alpha (TNF-alpha) levels were determined at baseline before, directly, and 15 and 30 minutes after rotation every day, and before presumed rotation on day 5. RESULTS Pre-exposure significantly reduced the degree of anticipatory nausea on day 5. Cortisol levels increased with rotation and were higher at baseline on days 4 and 5, but subjects habituated from day 3 to day 4; levels were lower in women than in men. In contrast, TNF-alpha decreased with rotation but showed no habituation. For both cortisol and TNF-alpha, no effects on postrotational nausea were found. CONCLUSION It is concluded that repetitive pre-exposure (latent inhibition) reduces anticipatory but not postrotation nausea; behavioral measures (rotation time) and measures of acute stress (cortisol, TNF-alpha) do not respond to latent inhibition. Thus, Pavlovian conditioning rules are effective in healthy humans with anticipatory nausea but not with postrotation nausea. Hormonal responses--TNF-alpha decrease with stress, compensatory cortisol increase--and gender-related effects on learning and habituation are discussed with regard to psychophysiological and psychoimmunological processes.
Collapse
Affiliation(s)
- Sibylle Klosterhalfen
- Institute of Medical Psychology, University Hospitals Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | |
Collapse
|
32
|
Aapro MS, Molassiotis A, Olver I. Anticipatory nausea and vomiting. Support Care Cancer 2004; 13:117-21. [PMID: 15599779 DOI: 10.1007/s00520-004-0745-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 11/02/2004] [Indexed: 02/06/2023]
Abstract
Anticipatory nausea and vomiting (ANV) is not only a learned response but can occur without prior exposure to chemotherapy depending on patient emotional distress and expectations. The best method to avoid development or reinforcement of ANV is to avoid both vomiting and nausea from the first exposure to chemotherapy. If ANV develops, benzodiazepines have been documented to help in adult patients, and several psychological techniques are also of help, including systematic desensitization. The evidence on which these conclusions are based is reviewed in this article.
Collapse
Affiliation(s)
- Matti S Aapro
- IMO Clinique de Genolier, CH-1272 Genolier, Switzerland.
| | | | | |
Collapse
|
33
|
Exton MS, von Auer AK, Buske-Kirschbaum A, Stockhorst U, Göbel U, Schedlowski M. Pavlovian conditioning of immune function: animal investigation and the challenge of human application. Behav Brain Res 2000; 110:129-41. [PMID: 10802310 DOI: 10.1016/s0166-4328(99)00191-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Pavlovian conditioning of immune functions provided early impetus to the rapidly expanding knowledge of bi-directional communication among the immune, endocrine, and central nervous systems. Since these early investigations, the phenomenology of this response has been well characterized. However the neural mechanisms and biological relevance of conditioned immunomodulation remain unclear. To this end, we present here data from our laboratories that have: (1) revealed some of the neural mechanisms and biological relevance of an animal model of conditioned immunomodulation; (2) demonstrated the conditionability and potential mechanisms of conditioned immune responses in healthy humans, and (3) investigated conditioned immunomodulation in a clinical sample. Together, these data demonstrate that animal models provide a basis for investigating mechanisms whereby conditioned changes in immune function may modulate health status in a clinical realm.
Collapse
Affiliation(s)
- M S Exton
- Institute for Medical Psychology, University of Essen, Hufelandstrasse 55, 45122, Essen, Germany.
| | | | | | | | | | | |
Collapse
|