TY - JOUR

T1 - Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective

AU - Rojnic Kuzman, Martina

AU - Nortertoft, Merete

AU - Raballo, Andrea

AU - Mohr, Pavel

AU - Fiorillo, Andrea

AU - Dom, Geert

AU - Mihajlovic, Goran

AU - Jendricko, Tihana

AU - Chumakov, Egor

AU - Barjaktarov, Stojan

AU - Carpiniello, Bernardo

AU - Patarák, Michal

AU - Martin, Lorcan

AU - Dudek, Dominika

AU - Samochowiec, Jerzy

AU - Taube, Māris

AU - Courtet, Philippe

AU - Babic, Dragan

AU - Racetovic, Goran

AU - Catthoor, Kirsten

AU - Arango, Celso

AU - Maruta, Nataliya

AU - Basar, Koray

AU - Vahip, Simavi

AU - Szekeres, György

AU - Lien, Lars

AU - Popova, Ana

AU - Zhelev, Ruslan

AU - Jääskeläinen, Erika

AU - Delic, Mirjana

AU - Chkonia, Eka

AU - Chichai, Jana

AU - Telles-correia, Diogo

AU - Cosman, Doina Constanta Maria

AU - Beezhold, Julian

AU - Falkai, Peter

PY - 2025/8/1

Y1 - 2025/8/1

N2 - 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.

AB - 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.

KW - Adult

KW - Antipsychotic Agents/therapeutic use

KW - Attitude of Health Personnel

KW - Cross-Sectional Studies

KW - Europe

KW - Female

KW - Guideline Adherence/statistics & numerical data

KW - Humans

KW - Male

KW - Middle Aged

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'/statistics & numerical data

KW - Psychiatrists

KW - Psychiatry/statistics & numerical data

KW - Schizophrenia/therapy

UR - https://www.mendeley.com/catalogue/1bc87fd7-96f0-3f73-9ba8-9492ba2c5b0b/

U2 - 10.1192/j.eurpsy.2025.10072

DO - 10.1192/j.eurpsy.2025.10072

M3 - Review article

C2 - 40745910

VL - 68

SP - e107

JO - European Psychiatry

JF - European Psychiatry

SN - 0924-9338

IS - 1

M1 - e107

ER -