Antonio Vita1,2, Wolfgang Gaebel3,4, Armida Mucci5, Gabriele Sachs6, Stefano Barlati1,2, Giulia Maria Giordano5, Gabriele Nibbio7, Merete Nordentoft8,9, Til Wykes10,11, Silvana Galderisi5. 1. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 2. Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy. 3. WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health DEU-131, LVR-Klinikum Düsseldorf, Düsseldorf, Germany. 4. Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany. 5. University of Campania "Luigi Vanvitelli", Naples, Italy. 6. University of Vienna, Wien, Austria. 7. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. 8. CORE - Copenhagen Research Centre for Mental Health, Copenhagen University Hospital, Copenhagen, Denmark. 9. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 10. Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 11. South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom.
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.
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.
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