de Beer Franciska, Koops Sanne, Schoevers Robert A, Veling Wim, van Beveren Nico, de Haan Lieuwe, Boonstra Nynke, Kikkert Martijn, Begemann Marieke J H
Department of Biomedical Sciences, University of Groningen, University Medical Centre Groningen, Antonius Deusinglaan 1, 9713 AW, Groningen, The Netherlands.
Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Sci Rep. 2024 Oct 2;14(1):22871. doi: 10.1038/s41598-024-72678-4.
Clinical outcomes after a first-episode of psychosis (FEP) are heterogeneous. Many patient-related factors such as gender and comorbidity have been studied to predict symptomatic outcomes. However, psychiatrist-related factors such as prescription behaviour and gender have received little attention. We assessed the relationship between patients' psychiatrists, psychosis severity and daily functioning in 201 patients remitted from an FEP for a duration of one year, 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 at 3, 6, and, 12 months follow-up. We found that psychiatrists accounted for 9.1% of the explained variance in patients' symptom severity and 10.1% of the explained variance in daily functioning.These effects persisted even when controlling for factors such as baseline severity and the prescribed dose. The effect of prescribed dose on symptom severity and daily functioning 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 an 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 of improving patient outcomes.
首次发作精神病（FEP）后的临床结局具有异质性。许多与患者相关的因素，如性别和共病情况，已被研究用于预测症状结局。然而，与精神科医生相关的因素，如处方行为和性别，却很少受到关注。我们评估了201例从FEP缓解一年的患者的精神科医生、精神病严重程度和日常功能之间的关系，这些患者由18位不同的精神科医生治疗。我们对基线严重程度、抗精神病药物的剂量和类型、就诊频率以及患者的教育程度进行了控制。在基线以及随访3个月、6个月和12个月时评估症状严重程度、日常功能和抗精神病药物的使用情况。我们发现，精神科医生占患者症状严重程度解释方差的9.1%，占日常功能解释方差的10.1%。即使在控制了基线严重程度和规定剂量等因素后，这些效应仍然存在。规定剂量对症状严重程度和日常功能的影响在不同精神科医生之间存在差异。治疗中心、就诊频率和药物不依从性与症状严重程度无关。我们的结果强调了个体精神科医生因素在FEP后症状结局中的重要性。进一步识别与精神科医生相关的因素，如治疗联盟的质量和共同决策，可能会优化精神科医生的培训，以改善患者结局为目标。
