Diagnosis and management of cognitive impairment associated with schizophrenia: Real-world evidence from a cross-sectional survey of psychiatrists

Background: Cognitive impairment is a core feature of schizophrenia that can reduce functional capacity and quality of life in patients. However, it is unclear how physicians approach cognitive impairment associated with schizophrenia (CIAS) in real-world clinical practice. This study examines the knowledge, attitudes and practices of psychiatrists towards CIAS in patients. Methods: This non-interventional, cross-sectional study sampled psychiatrists across the US, UK and Germany with ≥36 months of clinical experience and who treated ≥5 patients with schizophrenia annually. Psychiatrists completed an online survey in December 2022 assessing their knowledge, attitudes and practices towards cognitive impairment in patients with schizophrenia. Outcome variables were analysed descriptively (patient estimates: median [IQR]; psychiatrist characteristics: n [%]). Results: Overall, 121 eligible psychiatrists completed the survey. Psychiatrists estimated that 50.0 % (28.0;80.0) of patients with schizophrenia exhibited cognitive impairment and diagnosed CIAS in 25.0 % (10.0;50.0) of patients. CIAS symptoms reportedly worsened over time and were transient in 50.0 % (30.0;70.0) and 20.0 % (10.0;30.0) of patients, respectively. Working and studying were ranked the activities of daily living most disrupted by CIAS by 48.8 % (n = 59) of psychiatrists. Only 18.2 % (n = 22) of psychiatrists were aware of effective CIAS treatments and 59.5 % (n = 72) did not administer medication for CIAS. Psychiatrists employed a watch-and-wait strategy in 50.0 % (20.0;70.0) of patients with CIAS. Conclusions: This study demonstrates limited consensus among psychiatrists regarding CIAS characterisation, diagnosis and management. These insights highlight an unmet need for effective diagnosis and treatment of CIAS, necessitating further research to improve the evidence base for clinical guidelines informing CIAS management.