Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Sep 5;65(1):e57.
doi: 10.1192/j.eurpsy.2022.2315.

European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia

Antonio Vita  1   2 , Wolfgang Gaebel  3   4 , Armida Mucci  5 , Gabriele Sachs  6 , Stefano Barlati  1   2 , Giulia Maria Giordano  5 , Gabriele Nibbio  7 , Merete Nordentoft  8   9 , Til Wykes  10   11 , Silvana Galderisi  5
Affiliations
Review

European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia

Antonio Vita et al. Eur Psychiatry. .

Abstract

Background: Although cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented.

Methods: The aim of the present guidance paper is to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia. The guidance is structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.

Results: Based on the reviewed evidence, this European Psychiatric Association guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive impairment in schizophrenia. In particular, second-generation antipsychotics are recommended for their favorable cognitive profile compared to first-generation antipsychotics, although no clear superiority of a single second-generation antipsychotic has currently been found. Anticholinergic and benzodiazepine burdens should be kept to a minimum, considering the negative impact on cognitive functioning. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. Noninvasive brain stimulation techniques could be taken into account as add-on therapy.

Conclusions: Overall, there is definitive progress in the field, but further research is needed to develop specific treatments for cognitive impairment in schizophrenia. The dissemination of this guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve recovery in this population.

Keywords: Cognitive enhancement; cognitive functioning; cognitive remediation; evidence-based; systematic review.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
See this image and copyright information in PMC

References

    1. First MB, Gaebel W, Maj M, Stein DJ, Kogan CS, Saunders JB, et al. An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry. 2021;20:34–51. doi:10.1002/wps.20825. - DOI - PMC - PubMed
    1. Green MF, Horan WP, Lee J. Nonsocial and social cognition in schizophrenia: current evidence and future directions. World Psychiatry. 2019;18:146–61. doi:10.1002/wps.20624. - DOI - PMC - PubMed
    1. Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, et al. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry. 2021;20:4–33. doi:10.1002/wps.20809. - DOI - PMC - PubMed
    1. Bleuler E. Dementia praecox, or the group of schizophrenias. New York: International Universities Press; 1969.
    1. Kraepelin E. Dementia praecox and paraphrenia, together with manic-depressive insanity and paranoia. Special edition. Birmingham, AL: Classics of Medicine; 1989.

MeSH terms