Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations - the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects - while assessing clinicians' adherence to guidelines. METHODS: A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A-F). Additionally, a review of multiple guidelines/guidance papers was performed. RESULTS: The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected. CONCLUSIONS: These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians' unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.
Source: European Psychiatry
Authors: Martina Rojnic Kuzman, Merete Nordentoft, Andrea Raballo, Pavel Mohr, Andrea Fiorillo, Geert Dom, Goran Mihajlovic, Tihana Jendricko, Egor Chumakov, Stojan Barjaktarov, Bernardo Carpiniello, Michal Patarák, Lorcan Martin, Dominika Dudek, Jerzy Samochowiec, Māris Taube, Philippe Courtet, Dragan Babic, Goran Racetovic, Kirsten Catthoor, Celso Arango, Nataliya Maruta, Koray Basar, Simavi Vahip, György Szekeres, Lars Lien, Ana Popova, Ruslan Zhelev, Erika Jääskeläinen, Mirjana Delic, Eka Chkonia, Jana Chichai, Diogo Telles-Correia, Doina Constanta Maria Cosman, Julian Beezhold, Peter Falkai
Institutions: University Hospital Centre Zagreb, University of Zagreb, University of Copenhagen, Organizzazione Sociopsichiatrica Cantonale, Università della Svizzera italiana, Charles University, National Institute of Mental Health, National Institute of Mental Health, National Institute of Mental Health, University of Campania "Luigi Vanvitelli", University of Antwerp, University of Kragujevac, St Petersburg University, Ss. Cyril and Methodius University in Skopje, University of Cagliari, Slovak Medical University, Trauma Hospital of Brno, Havlíčkův Brod Hospital, Midland Regional Hospital Mullingar, Jagiellonian University, Pomeranian Medical University, Riga Stradiņš University, Centre Hospitalier Universitaire de Montpellier, Hôpital Lapeyronie, University of Mostar, Ziekenhuis aan de Stroom, Universidad Complutense de Madrid, Instituto de Salud Carlos III, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Investigación Sanitaria Gregorio Marañón, Institute of Neurology, Psychiatry and Narcology, National Academy of Medical Sciences of Ukraine, Hacettepe University, Ege University, Semmelweis University, Innlandet Hospital Trust, University of Inland Norway, University of Oulu, University Psychiatric Hospital, Tbilisi State Medical University, Nicolae Testemițanu State University of Medicine and Pharmacy, University of Lisbon, Iuliu Hațieganu University of Medicine and Pharmacy, Norfolk and Suffolk NHS Foundation Trust, Northgate Hospital, Ludwig-Maximilians-Universität München
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,300
OpenAlex ID: W4412846213