European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia

被引:63
|
作者
Vita, Antonio [1 ,2 ]
Gaebel, Wolfgang [3 ,4 ]
Mucci, Armida [5 ]
Sachs, Gabriele [6 ]
Barlati, Stefano [1 ,2 ]
Giordano, Giulia Maria [5 ]
Nibbio, Gabriele [7 ]
Nordentoft, Merete [8 ,9 ]
Wykes, Til [10 ,11 ]
Galderisi, Silvana [5 ]
机构
[1] Univ Brescia, Dept Clin & Expt Sci, Brescia, Italy
[2] Spedali Civili Hosp, Dept Mental Hlth & Addict Serv, Brescia, Italy
[3] LVR Klinikum Dusseldorf, WHO Collaborating Ctr Qual Assurance & Empowermen, Dusseldorf, Germany
[4] Heinrich Heine Univ, Dept Psychiat & Psychotherapy, Dusseldorf, Germany
[5] Univ Campania Luigi Vanvitelli, Naples, Italy
[6] Univ Vienna, Vienna, Austria
[7] Univ Brescia, Dept Mol & Translat Med, Brescia, Italy
[8] Copenhagen Univ Hosp, CORE Copenhagen Res Ctr Mental Hlth, Copenhagen, Denmark
[9] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark
[10] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol, London, England
[11] South London & Maudsley NHS Fdn Trust, Maudsley Hosp, London, England
关键词
Cognitive enhancement; cognitive functioning; cognitive remediation; evidence-based; systematic review; DIRECT-CURRENT STIMULATION; NONINVASIVE BRAIN-STIMULATION; TRANSCRANIAL MAGNETIC STIMULATION; CONTEXT-RELATED FACTORS; QUALITY-OF-LIFE; SOCIAL COGNITION; EPA GUIDANCE; ANTICHOLINERGIC BURDEN; PSYCHOTIC DISORDERS; PERSONAL RESOURCES;
D O I
10.1192/j.eurpsy.2022.2315
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
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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页数:16
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