ABSTRACT
Introduction: The management of psychogenic movement disorders is fraught with difficulties. Empathy and a non-judgemental manner are essential in dealing with patients, and a neurobiological explanation of the symptoms may help to foster trust, acceptance, understanding and recovery. Clinical Picture: We report a 17-year-old Chinese girl with psychogenic blepharospasm. Her parents refused psychotherapy and pharmacotherapy. Treatment and Outcome: Placebo therapy (with parental consent) was prescribed with favourable results. Conclusion: We examine the ethical considerations for and against placebo therapy, and explore the role of placebo therapy in the management of psychogenic movement disorders.
The term “placebo” is derived from St Jerome’s Latin Psalm, placebo domino in regione vivorum (I shall please the Lord in the land of the living).1 Placebos were fake substances or rituals used by medieval physicians to “please” patients for whom no cure was available. Arguably, acceptable uses for placebo have included 1) distinguishing between organic and functional disease, 2) identifying malingerers, 3) establishing to both physician and patient alike that a condition is of psychological origin and 4) placating patients who insist on potentially harmful measures when the physician believes that no treatment is indicated.2 The perceived “placatory” role of placebos, however, has led many to regard them as obsolete, at best only permissible as a comparator agent in clinical trials.
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