Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.
Eur Psychiatry. 2022 Sep 5;65(1):e57. doi: 10.1192/j.eurpsy.2022.2315.
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.
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.
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.
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.
认知障碍是精神分裂症的核心症状之一，与不同功能领域的预后较差有关，但它仍然是一个主要的治疗挑战。迄今为止，尚无针对精神分裂症认知障碍的综合治疗指南。
本指导文件的目的是对目前针对精神分裂症认知障碍的循证治疗方法进行全面的元综述。指导分为三个部分：药物治疗、心理社会干预和躯体治疗。
根据审查的证据，本欧洲精神病学协会指南建议适当的药物管理作为治疗精神分裂症认知障碍的基本起点。特别是，第二代抗精神病药因其与第一代抗精神病药相比具有更好的认知特征而被推荐，尽管目前尚未发现单一第二代抗精神病药具有明显优势。考虑到对认知功能的负面影响，应尽量减少抗胆碱能药和苯二氮䓬类药物的使用。在心理社会干预中，认知矫正和体育锻炼被推荐用于治疗精神分裂症的认知障碍。非侵入性脑刺激技术可以作为附加治疗。
总的来说，该领域已经取得了明确的进展，但仍需要进一步的研究来开发针对精神分裂症认知障碍的具体治疗方法。本指导文件的传播可能会促进有关治疗精神分裂症认知功能的共识指南的制定，以提高该人群的护理质量并实现康复。
