Table 5.
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.