'Our decision' to wean Bondi killer off psych meds

A psychiatrist who treated the Bondi Junction mass killer before his stabbing rampage has taken ownership over a decision to wean him off his medication.

Joel Cauchi, 40, was experiencing psychotic symptoms in April 2024 when he fatally stabbed six shoppers at Sydney's Westfield Bondi Junction and injured 10 others.

His Queensland psychiatrist was probed on Tuesday about a move in mid-2019 to completely stop the two antipsychotics Cauchi was taking.

"Do you take responsibility for the decision-making in removing Joel from Clopine and Abilify?" counsel assisting Peggy Dwyer SC asked, using brand names for clozapine and aripiprazole.

"It was my decision and (Joel's) decision," the psychiatrist told the NSW Coroners Court.

The doctor also testified she had never seen Joel "acutely unwell" nor any signs of "positive symptoms ... any relapse (or) any issues of safety".

However, she later admitted that his mother had raised concerns about a possible relapse after he stopped medicating in 2019.

This included that he was hearing voices, expressing sleeplessness, and experiencing extreme obsessive-compulsive disorder, the inquest was told previously.

The psychiatrist grew irritated with Dr Dwyer's questions around her initial diagnosis of Cauchi in 2012, telling the barrister to "move on".

She insisted she believed he had first-episode schizophrenia, rather than chronic schizophrenia, because he had remained symptom-free while medicated.

But a 2012 letter discharging Cauchi from the public system - which was shown to the court - appeared to contradict this.

"It appears that Joel may appear to experience some positive symptoms with fluctuating severity," it read.

"However Joel denies such symptoms."

The psychiatrist - who cannot be legally named - earlier issued a tearful apology to the families of the victims, Cauchi and those affected by the attacks.

Her life and health had also been personally impacted by the incident, she said.

"I offer my sincere apologies to you that this tragedy has happened," she said.

"I am aware that no words will ease the profound pain and suffering."

The psychiatrist gradually adjusted the dosage of his antipsychotics down every few months, aiming to reach a level where any negative side effects disappeared.

While at first she did not expect him to stop completely, his symptoms never reappeared and by July 2019 he was off both antipsychotics.

When she first assessed Cauchi in 2012, she listed his "over-religious" father's symptoms of schizophrenia as a vulnerability because the son's condition was "definitely genetic".

But she told the court that Cauchi was loved and accepted by his family who was a major stabilising factor in his life.

Cauchi's father was "adamant" about his son not resuming antipsychotics and said "he himself had been traumatised by demons when awake and hears voices and is not on medication," a nurse's note read to the coroner on Monday said.

Cauchi had been diagnosed with schizophrenia as a teen but was successfully treated for decades.

In early 2020, near the start of the COVID-19 pandemic, he moved to Brisbane when he was completely cut off from psychiatric care.

His rampage at the Westfield shopping centre in 2024 was brought to an end after he was shot dead by NSW Police Inspector Amy Scott.

The five-week hearing continues.

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