Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective
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 –...
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Cambridge University Press
2025-01-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933825100722/type/journal_article |
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| author | 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 |
| author_facet | 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 |
| author_sort | Martina Rojnic Kuzman |
| collection | DOAJ |
| description | 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.
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| format | Article |
| id | doaj-art-adced7fe26bc497ba4e565811dbd3511 |
| institution | Kabale University |
| issn | 0924-9338 1778-3585 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj-art-adced7fe26bc497ba4e565811dbd35112025-08-20T03:44:13ZengCambridge University PressEuropean Psychiatry0924-93381778-35852025-01-016810.1192/j.eurpsy.2025.10072Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspectiveMartina Rojnic Kuzman0https://orcid.org/0000-0001-9646-0594Merete Nordentoft1Andrea Raballo2https://orcid.org/0000-0003-3709-4111Pavel Mohr3https://orcid.org/0000-0002-9851-3271Andrea Fiorillo4https://orcid.org/0000-0002-6926-0762Geert Dom5https://orcid.org/0000-0001-6492-0429Goran Mihajlovic6Tihana Jendricko7Egor Chumakov8https://orcid.org/0000-0002-0429-8460Stojan Barjaktarov9Bernardo Carpiniello10Michal Patarák11https://orcid.org/0000-0002-1036-4903Lorcan Martin12Dominika Dudek13https://orcid.org/0000-0001-6120-0506Jerzy Samochowiec14https://orcid.org/0000-0003-1438-583XMāris Taube15https://orcid.org/0000-0002-1144-8586Philippe Courtet16Dragan Babic17Goran Racetovic18Kirsten Catthoor19https://orcid.org/0000-0002-8738-8364Celso Arango20https://orcid.org/0000-0003-3382-4754Nataliya Maruta21https://orcid.org/0000-0002-6619-9150Koray Basar22https://orcid.org/0000-0003-4798-5305Simavi Vahip23https://orcid.org/0000-0003-0645-7098György Szekeres24https://orcid.org/0000-0003-1053-7592Lars Lien25Ana Popova26Ruslan Zhelev27Erika Jääskeläinen28https://orcid.org/0000-0001-5760-7389Mirjana Delic29Eka Chkonia30Jana Chichai31https://orcid.org/0000-0002-7720-5544Diogo Telles-Correia32Doina Constanta Maria Cosman33https://orcid.org/0000-0001-7102-2432Julian Beezhold34https://orcid.org/0000-0001-9857-1669Peter Falkai35Department of Psychiatry and Psychological Medicine Department of Psychiatry and Psychotherapy University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, CroatiaDepartment of clinical medicine, University of Copenhagen, Copenhagen, DenmarkFaculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland Cantonal Sociopsychiatric Organisation, Mendrisio, SwitzerlandClinical Department, National Institute of Mental Health, Klecany, Czechia Third School of Medicine, Charles University, Prague, Czech RepublicDepartment of Psychiatry, University of Campania “L. Vanvitelli”, Naples, ItalyCollaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, BelgiumDepartment for Psychiatry, Faculty of Medical Sciences, University Hospital, University of Kragujevac, Kragujevac, SerbiaUniversity Psychiatric Hospital Vrapce, Zagreb, CroatiaDepartment of Psychiatry and Addiction, Saint-Petersburg State University, Saint-Petersburg, RussiaFaculty of Medicine, University Clinic of Psychiatry, University “Ss. Cyril and Methodius”, Skopje, Republic of North MacedoniaSection of Psychiatry, Department of Medical Sciences and Public Health, University Hospital, University of Cagliari and Psychiatry Unit, Cagliari, Italy2nd Slovak Medical University Department of Psychiatry, F. D. Roosevelt University Hospital Banská Bystrica, SlovakiaSt. Loman’s Hospital, Mullingar, IrelandPsychiatry and Department of Adult Psychiatry, Collegium Medicum Jagiellonian University, Kracow, PolandDepartment of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, PolandDepartment of Psychiatry and Narcology, Rīga Stradiņš University, Rīga Centre of Psychiatry and Narcology, Rīga, LatviaDepartment of Emergency Psychiatry and Post Acute Care, Hôpital Lapeyronie, CHU Montpellier, FranceUniversity of Mostar, Mostar, Bosnia and HerzegovinaCommunity Mental Health Centre, Health Centre Prijedor, Prijedor, Bosnia and HerzegovinaCollaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium Psychiatric Hospital Stuivenberg, Ziekenhuis aan de Stroom, Antwerp, BelgiumDepartment of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, SpainState Institution “Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine”, Kharkiv, UkraineDepartment of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, TurkeyAffective Disorders Unit, Department of Psychiatry, Ege University Medicine Faculty, Izmir, TurkeyDepartment of Psychiatry and Psychotherapy, Semmelweis University, Budapest, HungaryFaculty of Health and Welfare, Inland University, Elverum, Norway Research Centre for Substance Use Disorders and Mental Illness, Innlandet Hospital Trust, NorwayCollege Private Psychiatry Association, Sofia, BulgariaCollege Private Psychiatry Association, Sofia, BulgariaResearch Unit of Population Health, University of Oulu, FinlandCenter for Treatment of Drug Addiction, University Psychiatric Clinic, Ljubljana, SloveniaDepartment of Psychiatry, https://ror.org/020jbrt22 Tbilisi State Medical University , Tbilisi, GeorgiaDepartment of Mental Health, Medical Psychology and Psychotherapy, State Medical and Pharmacy University “Nicolae Testemitanu” from Republic of Moldova, Chisinau, MoldovaClinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalIuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, RomaniaGreat Yarmouth Acute Service, Northgate Hospital/Norfolk & Suffolk NHS Foundation Trust, Great Yarmouth, UKDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilian University (LMU), Munich, GermanyAbstract 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. https://www.cambridge.org/core/product/identifier/S0924933825100722/type/journal_articleschizophreniaEuropeguidelinespsychopharmacologypsychotherapy |
| spellingShingle | 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 Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective European Psychiatry schizophrenia Europe guidelines psychopharmacology psychotherapy |
| title | Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective |
| title_full | Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective |
| title_fullStr | Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective |
| title_full_unstemmed | Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective |
| title_short | Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective |
| title_sort | schizophrenia treatment preferences of psychiatrists versus guidelines a european perspective |
| topic | schizophrenia Europe guidelines psychopharmacology psychotherapy |
| url | https://www.cambridge.org/core/product/identifier/S0924933825100722/type/journal_article |
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