ABSTRACT
The placebo effect can be defined as the improvement of symptoms in a patient after the administration of an innocuous substance in a context that induces expectations regarding its effects. During recent years, it has been discovered that the placebo response not only has neurobiological functions on analgesia, but that it is also capable of generating effects on the immune and endocrine systems. The possible integration of changes in different systems of the organism could favor the well-being of the individuals and go hand in hand with conventional treatment for multiple diseases. In this sense, classic conditioning and setting expectations stand out as psychological mechanisms implicated in the placebo effect. Recent advances in neuroimaging studies suggest a relationship between the placebo response and the opioid, cannabinoid, and monoaminergic systems. Likewise, a possible immune response conditioned by the placebo effect has been reported. There is evidence of immune suppression conditioned through the insular cortex and the amygdala, with noradrenalin as the responsible neurotransmitter. Finally, a conditioned response in the secretion of different hormones has been determined in different studies; however, the molecular mechanisms involved are not entirely known. Beyond studies about its mechanism of action, the placebo effect has proved to be useful in the clinical setting with promising results in the management of neurological, psychiatric, and immunologic disorders. However, more research is needed to better characterize its potential use. This review integrates current knowledge about the psycho-neuro-endocrine-immune basis of the placebo effect and its possible clinical applications.
Subject(s)
Analgesia , Placebo Effect , Endocrine System , Humans , Pain/drug therapy , Pain ManagementABSTRACT
La investigación describe el perfil neuropsicológico de un paciente con esquizofrenia en Cúcuta, Colombia. Se utilizó un diseño de investigación tipo ensayo clínico con fin diagnóstico y alcance descriptivo basado en un paciente de 52 años diagnosticado con esquizofrenia paranoide desde los 17 años, quien actualmente es tratado con antipsicótico atípico (risperidona 4,5 mg/día) y antidepresivo tricíclico (clorimipramina 300 mg/día). Se evaluó mediante un protocolo neuropsicológico conformado por Evaluación Cognitiva Montreal (MOCA, del acrónimo en inglés Montreal Cognitive Assessment), Test del Trazo (Trail Making, en inglés) A y B, subpruebas del Test Barcelona, curva de aprendizaje del Test Verbal de California, Figura Compleja de ReyOsterrieth, y subpruebas de WAIS III, cuyas respuestas generaron indicadores globales asociados con deterioro cognitivo leve, compromiso de la capacidad de atención alternante, memoria de trabajo, conversión acústico-fonológica y memoria declarativa de largo plazo, al igual que sus funciones ejecutivas.
This research aims to describe the neuropsychological profile in a patient with schizophrenia in the city of Cucuta, Colombia. A clinical trial type research design with a diagnostic purpose and descriptive scope was used in a patient aged 52 diagnosed with paranoid schizophrenia since age 17, currently being treated with atypical antipsychotic (Risperidone 4.5 mg/day) and tricyclic antidepressants (Clomipramine 300 mg/day). A neuropsychological protocol consisting of Montreal Cognitive Assessment (MOCA), Trail Making Test A and B, subtest of Barcelona Test, learning curve of the California Verbal Learning ââTest, ReyOsterrieth Complex Figure Test, and WAIS III subtests, recorded global indicators associated with mild cognitive impairment, commitment in the capacity of alternating attention, working memory, acoustic-phonemic conversion, and long-term declarative memory, as well as his executive functions.
Subject(s)
Humans , Male , Middle Aged , Schizophrenic Psychology , Executive Function/physiology , Cognitive Dysfunction , Neuropsychological TestsABSTRACT
El objetivo de esta investigación fue describir el desempeño cognoscitivo de un paciente de sexo masculino, de 51 años, con 9 años de evolución de Enfermedad de Parkinson (EP) y antecedentes de consumo de sustancias psicoactivas, para lo cual se utilizó un protocolo neuropsicológico encontrando en el test de trazados (TMT-A 24/24 y TMT-B 24/24), prueba de Denominación de Boston (58/60), F.A.S- COWAT (28), Curva de Memoria California (Ascendente), copia (34/36) y evocación (26/36) de la Figura Compleja de Rey Osterrieth, Torre de Londres, Stroop de Colores (C 16", P 31", C-P 57"). Adicionalmente se aplicaron subpruebas del Test de Inteligencia Wechsler para adultos (WAIS-III) (Retención de dígitos 9, sucesión letras-números 10, aritmética 11, dígito-símbolo 10, figuras incompletas 6, diseño con cubos 10, semejanzas 9), el perfil cognoscitivo se encuentra dentro de los parámetros normales para los procesos de lenguaje, memoria, praxias, y habilidades viso-construccionales; se evidencian leves alteraciones en atención, memoria de trabajo y funciones ejecutivas. El consumo prolongado de sustancias psicoactivas es un posible factor de riesgo en el desarrollo temprano de la EP, pero con un perfil cognoscitivo conservado que se puede explicar por su nivel académico previo y su continuo ejercicio intelectual en su profesión, que le exigen constantes actividades cognitivas.
The objective of this research was to describe the cognitive performance of a male patient, aged 51, with 9 years of evolution of Parkinson's disease (PD) and a history of psychoactive substance use, for which a protocol was used neuropsychological finding paths in the test (TMT-A 24/24 and TMT-B 24/24), Boston denomination (58/60), FAS-COWAT (28), Curve Memory California (ascending), copy (34 / 36) and evocation (26/36) of the Rey Osterrieth Complex Figure, Tower of London, Stroop Color (C 16 " W 31", CW 57 "). Additionally applied subtests Wechsler Intelligence Test for Adults (WAIS-III) (retention of digits 9, letter-number sequence 10, arithmetic 11, digit-symbol 10, incomplete figures 6, design with cubes10, similarities 9), cognitive profile is within normal parameters for the processes of language, memory, praxis, visual-constructional and skills, are demonstrated slight alterations in attention, working memory and executive functions. Prolonged use of psychoactive substances is a possible risk factor in early development of PD, but with preserved cognitive profile that can be explained by their prior academic and intellectual exercise continued in his profession, which require constant cognitive activities.
