European Psychiatry (Jan 2025)
Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective
- 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
Affiliations
- Martina Rojnic Kuzman
- ORCiD
- Department of Psychiatry and Psychological Medicine Department of Psychiatry and Psychotherapy University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
- Merete Nordentoft
- Department of clinical medicine, University of Copenhagen, Copenhagen, Denmark
- Andrea Raballo
- ORCiD
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland
- Pavel Mohr
- ORCiD
- Clinical Department, National Institute of Mental Health, Klecany, Czechia Third School of Medicine, Charles University, Prague, Czech Republic
- Andrea Fiorillo
- ORCiD
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
- Geert Dom
- ORCiD
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
- Goran Mihajlovic
- Department for Psychiatry, Faculty of Medical Sciences, University Hospital, University of Kragujevac, Kragujevac, Serbia
- Tihana Jendricko
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
- Egor Chumakov
- ORCiD
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint-Petersburg, Russia
- Stojan Barjaktarov
- Faculty of Medicine, University Clinic of Psychiatry, University “Ss. Cyril and Methodius”, Skopje, Republic of North Macedonia
- Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University Hospital, University of Cagliari and Psychiatry Unit, Cagliari, Italy
- Michal Patarák
- ORCiD
- 2nd Slovak Medical University Department of Psychiatry, F. D. Roosevelt University Hospital Banská Bystrica, Slovakia
- Lorcan Martin
- St. Loman’s Hospital, Mullingar, Ireland
- Dominika Dudek
- ORCiD
- Psychiatry and Department of Adult Psychiatry, Collegium Medicum Jagiellonian University, Kracow, Poland
- Jerzy Samochowiec
- ORCiD
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
- Māris Taube
- ORCiD
- Department of Psychiatry and Narcology, Rīga Stradiņš University, Rīga Centre of Psychiatry and Narcology, Rīga, Latvia
- Philippe Courtet
- Department of Emergency Psychiatry and Post Acute Care, Hôpital Lapeyronie, CHU Montpellier, France
- Dragan Babic
- University of Mostar, Mostar, Bosnia and Herzegovina
- Goran Racetovic
- Community Mental Health Centre, Health Centre Prijedor, Prijedor, Bosnia and Herzegovina
- Kirsten Catthoor
- ORCiD
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium Psychiatric Hospital Stuivenberg, Ziekenhuis aan de Stroom, Antwerp, Belgium
- Celso Arango
- ORCiD
- Department 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, Spain
- Nataliya Maruta
- ORCiD
- State Institution “Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine”, Kharkiv, Ukraine
- Koray Basar
- ORCiD
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Simavi Vahip
- ORCiD
- Affective Disorders Unit, Department of Psychiatry, Ege University Medicine Faculty, Izmir, Turkey
- György Szekeres
- ORCiD
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Lars Lien
- Faculty of Health and Welfare, Inland University, Elverum, Norway Research Centre for Substance Use Disorders and Mental Illness, Innlandet Hospital Trust, Norway
- Ana Popova
- College Private Psychiatry Association, Sofia, Bulgaria
- Ruslan Zhelev
- College Private Psychiatry Association, Sofia, Bulgaria
- Erika Jääskeläinen
- ORCiD
- Research Unit of Population Health, University of Oulu, Finland
- Mirjana Delic
- Center for Treatment of Drug Addiction, University Psychiatric Clinic, Ljubljana, Slovenia
- Eka Chkonia
- Department of Psychiatry, https://ror.org/020jbrt22 Tbilisi State Medical University , Tbilisi, Georgia
- Jana Chichai
- ORCiD
- Department of Mental Health, Medical Psychology and Psychotherapy, State Medical and Pharmacy University “Nicolae Testemitanu” from Republic of Moldova, Chisinau, Moldova
- Diogo Telles-Correia
- Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Doina Constanta Maria Cosman
- ORCiD
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Julian Beezhold
- ORCiD
- Great Yarmouth Acute Service, Northgate Hospital/Norfolk & Suffolk NHS Foundation Trust, Great Yarmouth, UK
- Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University (LMU), Munich, Germany
- DOI
- https://doi.org/10.1192/j.eurpsy.2025.10072
- Journal volume & issue
-
Vol. 68
Abstract
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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