Florence Thibaut is a psychiatrist and endocrinologist, currently professor of psychiatry at the University Hospital Cochin-Tarnier of Paris-Descartes University (France). Her research interests are varied and include addiction, schizophrenia genetics, and paraphilia. An investigator in many clinical and pharmaceutical studies, she is also past-president of both the French Association for Biological Psychiatry (AFPB) and the World Federation of Societies of Biological Psychiatry (WFSBP). She is president-elect of the International Association for Women’s Mental Health (IAWMH) and, since 2015, a member of the WHO expert panel on pharmacodependence. Professor Thibaut is author of 250 academic papers and has published five books and 70 books chapters.
In an interview with ECNP, she shared some insights into her career choices as well as her ongoing research work.
You completed your medical training and then went on to obtain a PhD in Parkinson’s disease research. Where did you go from there?
I then used my expertise in endocrinology and neurology in psychiatry. Psychiatric disorders are complex and multifactorial – much like, for example, diabetes. Diabetes is a multifactorial, complex disease in which medication is very important, and this was all being developed in endocrinology at that time. So that helped me a lot in psychiatry.
You then went on to develop a number of research interests. Could you describe how these came about?
Concerning genetics, I was working with neurologists and endocrinologists during an internship, and they were conducting the first genetic studies in diabetes and dementia. That was the reason I became interested in genetics. Then, with the same kind of model, we tried to find genes involved in schizophrenia.
Why were you interested in schizophrenia?
You recently published an issue of Dialogues on Clinical Neuroscience focused on addiction.1 You say in your editorial, “Surprisingly, DSM-5 no longer separates abuse from dependence.” Could you explain this point – is it so surprising?
Aside from pharmacologic treatments of addiction, how challenging is the psychological treatment aspect, i.e. engaging patients with themselves and developing their self-awareness and decision-making abilities?
You have also lately published on the importance of considering the impact of gender in research.2 Certainly, a decade ago, animal model research was predominantly conducted in males. How much has changed?
A Spanish member of the European Parliament, Beatriz Becerra Basterrechea, asked the parliament to be very forceful against the European Medicines Agency (EMA) and other medicines agencies, to impose upon them and pharmaceutical companies the requirement to conduct some studies in females, or at least to take gender into account in the statistical analysis of every drug appearing on the market from now on. Recently, and interestingly, the European Parliament urged the EMA to draw up separate guidelines for women as a specific population in clinical trials. The FDA in the US officially took some decisions in this way too. But we should follow up on this issue, because it ought to change.
Paraphilia is another of your research interests. Would you say that the lack of clinical research in this area motivates you especially?
The second reason is that each time I try to find grants to work in this field it is very, very difficult. We are trying to set up a cohort of sex offenders in Europe, but there are no grants in the European Commission. I have also tried another way of finding money, through the field of sexual violence and women, but also here there are no grants.
This is not a topic of interest in Europe. In addition, there are no pharmaceutical companies interested in it, although in fact 10 % of the population have been a victim of rape. A recent report concludes that, in 2012-13, the cost of child sexual abuse in the UK was 4.37 billion euros (including social, physical and mental consequences, as well as legal system expenses).4 This makes it a huge topic of interest. But it remains hidden.
A 2014 paper you co-authored on paraphilia pharmacologic treatment describes the treatment process.5 Could you describe how challenging it is to build trust between a physician and a patient, given the difficulty that many experience in coming forward for treatment at all?
To establish trust between the psychiatrist and a paraphiliac patient may take as long as three to five years. In fact, in severe cases, treatment may be lifelong, much like antipsychotics in severe forms of schizophrenia.
Could you summarise what the most pressing needs are in this field?
There are also some research studies being conducted with neuroimaging and genetics, trying to understand why these individuals are sex offenders, why they are paedophiles or exhibitionists or rapists. Rapists are more difficult to understand, because this is a very heterogeneous group. But if you don’t know the ‘why’, you cannot find the right treatment.
In 2017, Florence Thibaut was a chair and a speaker at one of the sessions S.18 (Behavioural addictions: diagnosis, co-morbidity and neurobiology) in the 30th ECNP Congress.
In this video, she talks about what ECNP Congress means to the scientific community. She also talks about her work in the field of schizophrenia for several years and her advice to junior scientists. She is a member of the Scientific Advisory Panel of ECNP.
This part of the website could either be in French or English, depending on the sources of the actualities.