Psychiatrists effect on symptom severity during pharmacotherapy for first episode psychosis patients

Abstract Clinical outcome after a first episode psychosis (FEP) is heterogeneous. Many patient-related factors such as gender and comorbidity have been studied to predict outcome. However, psychiatrist-related factors, such as the therapeutic relationship and prescription behaviour, have received little attention. We assessed the psychiatrist effect on psychosis severity and daily functioning during one year, in 201 patients remitted from FEP, treated by 18 different psychiatrists. We controlled for baseline severity, dose and type of antipsychotic medication, frequency of visits, and patients’ education. Symptom severity, daily functioning and antipsychotic drug use were assessed at baseline and after 3, 6, and, 12 months follow-up. We found a psychiatrist effect of 9.1% explained variance on symptom severity and of 10.1% on daily functioning. These effects persisted even when controlling for factors such as baseline severity and the prescribed dose. The effect of prescribed dose differed between psychiatrists. Treatment centre, session frequency, and medication nonadherence were not related to symptom severity. Our results emphasize the importance of individual psychiatrist factors in symptomatic outcomes after FEP. Further identification of psychiatrist-related factors such as the quality of therapeutic alliances and shared decision making, may optimize psychiatrists’ training with the goal to improve patient outcomes.