263: Psychiatrist Effect in First-Episode Psychosis: HAMLETT Study, Antipsychotic Tapering, Dopamine Supersensitivity & Sex Differences with Franciska de Beer

[gentle music] All right.

Welcome back to the podcast.

Today I'm thrilled to be speaking with Franceska de Beer.

She is a talented researcher, soon to finish her PhD at the Center for Clinical Neuroscience and Cognition at the University Medical Center Groningen in Netherlands.

Franceska is the first author of multiple groundbreaking articles from the Hamlet-Thela Consortium, including key publications in JAMA Psychiatry, World Psychiatry, Psychological Medicine, Schizophrenia Research.

I first reached out to her after stumbling upon her article that she first authored called "Psychiatrist Effect on Positive Symptom Severity and Daily Functioning During Psychotherapy for First-Episode Psychosis Patients".

Many of you will know I often cite McKay's study on psychiatrist effect in depression, one of the only psychiatrist effect studies, so I was overjoyed to find a second study that looked at psychosis and the psychiatrist effect.

I've since learned more about her research interest and have been intrigued by her work on first-episode psychosis, and I think there's a, kind of an, a new question of when we should continue antipsychotics, when we should not continue antipsychotics, and so hopefully we'll have some of the new research on that discussed in this episode.

So welcome to the podcast.

Thank you for having me.

So maybe we could start with paper on psychiatrist effect and go from there.

So do you want to describe the, the basic findings of this, of this research?

Yeah, sure.

I love your, uh, introduction, and I think the McKay article, you, you love-- I love it so much as well.

So I think one of the main issues when we talk about psychiatry is that a- after all, we want to improve patients' recovery, right? And the main way we go about it is look, okay, how can we address patient characteristics like their, um, economic wellbeing, like their social functioning? And we tend, I think, to overlook that there is someone else across the table that also has an influence in these patients' outcomes, namely the psychiatrists.

And I think there is some literature or there is some decent literature about the psychotherapy and the effect of a therapist in psychotherapy, but the person also matters, the clinician matters when there is drugs prescribed in pharmaceutical and pharmacological therapies, and that is what we wanted to address.

What is the effect of the psychiatrist when patients who have recovered from a first psychosis in their treatment outcomes?