Table 5.

Possible Trajectories of DSM5 Diagnosis Treatment and Response Where Patient/Parent/Clinician Expectation May Play a Role.

True diagnosis	Parent (clinician) believed diagnosis	Responder category	Treatment offered	Treatment expectation	Treatment result	Main cause of result	Future parent (clinician) expectation
Idiopathic / familial / genetic	Same	Treatment responder	SSRI ± CBT	Positive	Positive	Pharmacology	Conditioned for future placebo responses
Idiopathic / familial / genetic	Same	Treatment nonresponder	SSRI ± CBT	Positive	Positive	Patient expectation	Conditioned for future placebo responses
Idiopathic / familial / genetic	Same	Treatment nonresponder	SSRI ± CBT	Positive	Negative—no benefit	Wrong treatment	May need alternative treatment
Idiopathic / familial / genetic	Same	Treatment nonresponder	SSRI ± CBT	Positive	Negative—adverse events	Pharmacology	Conditioned for future nocebo responses
Idiopathic / familial / genetic	PANS	Nocebo responder	SSRI	Negative	Negative—adverse events	Patient expectation	Conditioned for future nocebo responses
Idiopathic / familial / genetic	PANS	Placebo responder	abx ± immuno	Positive	Positive	Patient expectation	Conditioned for future placebo responses
Idiopathic / familial / genetic	PANS	Placebo nonresponder	abx ± immuno	Positive	Negative	Wrong treatment	Depends on strength of initial belief
Idiopathic / familial / genetic	PANS relapse	Conditioned placebo responder	abx ± immuno	Positive	Positive	Patient expectation	Conditioned for future placebo responses
Idiopathic / familial / genetic	PANS relapse	Treatment responder	abx ± immuno	Positive	Negative	Wrong treatment	Depends on strength of initial belief

Abbreviations: Abx, antibiotics; CBT, cognitive behavioral therapy; immune, immunomodulatory (eg, intravenous immunoglobulin); PANS, pediatric acute onset neuropsychiatric syndrome; SSRI, selective serotonin reuptake inhibitor.