Setting, patient, and doctor effects on drug response in neurotic patients
Diazepam was compared to placebo and phenobarbital sodium in a double-blind study with 472 anxious psychoneurotic patients. Patients were treated in 3 settings — medical clinic, general practice, and private psychiatric practice. The treatment setting was found to be at least as important as the medication in producing a treatment response. Drug effects were pronounced. Compared to phenobarbital patients, diazepam patients more often completed the study, followed prescribed dosage, and reported fewer side reactions. Diazepam patients did not differ from placebo patients in dosage intake or side effects, only in higher completion rate. Population effects indicated clinic patients to drop out and deviate from dosage more than private patients. General practice patients reported the most and private psychiatric patients reported the least side effects. These differences are explained in terms of patient background and behavioral patterns and of a medical as opposed to a psychiatric orientation toward treatment.