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Review
. 2025 Aug 1;68(1):e107.
doi: 10.1192/j.eurpsy.2025.10072.

Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective

Martina Rojnic Kuzman  1   2 , Merete Nordentoft  3 , Andrea Raballo  4   5 , Pavel Mohr  6   7 , Andrea Fiorillo  8 , Geert Dom  9 , Goran Mihajlovic  10 , Tihana Jendricko  11 , Egor Chumakov  12 , Stojan Barjaktarov  13 , Bernardo Carpiniello  14 , Michal Patarák  15 , Lorcan Martin  16 , Dominika Dudek  17 , Jerzy Samochowiec  18 , Māris Taube  19 , Philippe Courtet  20 , Dragan Babic  21 , Goran Racetovic  22 , Kirsten Catthoor  9   23 , Celso Arango  24 , Nataliya Maruta  25 , Koray Basar  26 , Simavi Vahip  27 , György Szekeres  28 , Lars Lien  29   30 , Ana Popova  31 , Ruslan Zhelev  31 , Erika Jääskeläinen  32 , Mirjana Delic  33 , Eka Chkonia  34 , Jana Chichai  35 , Diogo Telles-Correia  36 , Doina Constanta Maria Cosman  37 , Julian Beezhold  38 , Peter Falkai  39
Affiliations
Review

Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective

Martina Rojnic Kuzman et al. Eur Psychiatry. .

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.

Keywords: Europe; guidelines; psychopharmacology; psychotherapy; schizophrenia.

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Conflict of interest statement

Celso Arango has been a consultant to or has received honoraria or grants from Abbot, Acadia, Ambrosetti, Angelini, Biogen, BMS, Boehringer, Carnot, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plow, Sumitomo Dainippon Pharma, Sunovion, Takeda, and Teva.

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