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.

2nd Slovak Medical University Department of Psychiatry F D Roosevelt University Hospital BanskáBystrica Slovakia

3rd School of Medicine Charles University Prague Czech Republic

Affective Disorders Unit Department of Psychiatry Ege University Medicine Faculty Izmir Turkey

Cantonal Sociopsychiatric Organisation Mendrisio Switzerland

Center for Treatment of Drug Addiction University Psychiatric Clinic Ljubljana Slovenia

Clinica Universitária de Psiquiatria e Psicologia Médica Faculdade de Medicina Universidade de Lisboa Lisbon Portugal

Clinical Department National Institute of Mental Health Klecany Czechia

Collaborative Antwerp Psychiatric Research Institute Antwerp Belgium

College Private Psychiatry Association Sofia Bulgaria

Community Mental Health Centre Health Centre Prijedor Prijedor Bosnia and Herzegovina

Department for Psychiatry Faculty of Medical Sciences University Hospital University of Kragujevac Kragujevac Serbia

Department of Child and Adolescent Psychiatry Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón CIBERSAM ISCIII School of Medicine Universidad Complutense Madrid Spain

Department of clinical medicine University of Copenhagen Copenhagen Denmark

Department of Emergency Psychiatry and Post Acute Care Hôpital Lapeyronie CHU Montpellier France

Department of Mental Health Medical Psychology and Psychotherapy State Medical and Pharmacy University Nicolae Testemitanu from Republic of Moldova Chisinau Moldova

Department of Psychiatry and Addiction Saint Petersburg State University Saint Petersburg Russia

Department of Psychiatry and Narcology Rīga Stradiņš University Rīga Centre of Psychiatry and Narcology Rīga Latvia

Department of Psychiatry and Psychological Medicine

Department of Psychiatry and Psychotherapy Ludwig Maximilian University Munich Germany

Department of Psychiatry and Psychotherapy Semmelweis University Budapest Hungary

Department of Psychiatry and Psychotherapy University Hospital Centre Zagreb and School of Medicine University of Zagreb Zagreb Croatia

Department of Psychiatry Hacettepe University Faculty of Medicine Ankara Turkey

Department of Psychiatry https ror org 020jbrt22Tbilisi State Medical University Tbilisi Georgia

Department of Psychiatry Pomeranian Medical University in Szczecin Szczecin Poland

Department of Psychiatry University of Campania L Vanvitelli Naples Italy

Faculty of Biomedical Sciences University of Southern Switzerland Lugano Switzerland

Faculty of Health and Welfare Inland University Elverum Norway

Faculty of Medicine University Clinic of Psychiatry University Ss Cyril and Methodius Skopje Republic of North Macedonia

Great Yarmouth Acute Service Northgate Hospital Norfolk and Suffolk NHS Foundation Trust Great Yarmouth UK

Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

Psychiatric Hospital Stuivenberg Ziekenhuis aan de Stroom Antwerp Belgium

Psychiatry and Department of Adult Psychiatry Collegium Medicum Jagiellonian University Kracow Poland

Research Centre for Substance Use Disorders and Mental Illness Innlandet Hospital Trust Norway

Research Unit of Population Health University of Oulu Finland

Section of Psychiatry Department of Medical Sciences and Public Health University Hospital University of Cagliari and Psychiatry Unit Cagliari Italy

St Loman's Hospital Mullingar Ireland

State Institution Institute of Neurology Psychiatry and Narcology of the NAMS of Ukraine Kharkiv Ukraine

University of Mostar Mostar Bosnia and Herzegovina

University Psychiatric Hospital Vrapce Zagreb Croatia

Zobrazit více v PubMed

Solmi M, Seitidis G, Mavridis D, Correll CU, Dragioti E, Guimond S, et al. Incidence, prevalence, and global burden of schizophrenia – data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. Mol Psychiatry. 2023;28:5319–27. 10.1038/s41380-023-02138-4. PubMed DOI

van Os J, Rutten BP, Poulton R. Gene-environment interactions in schizophrenia: Review of epidemiological findings and future directions. Schizophr Bull. 2008;34:1066–82. 10.1093/schbul/sbn117. PubMed DOI PMC

Hemager N, Plessen KJ, Thorup A, Christiani C, Ellersgaard D, Spang KS, et al. Assessment of neurocognitive functions in 7-year-old children at familial high risk for schizophrenia or bipolar disorder. JAMA Psychiatry. 2018;75:844 10.1001/jamapsychiatry.2018.1415. PubMed DOI PMC

World Health Organization (WHO). International classification of diseases, eleventh revision (ICD-11) 2019/2021, 11th ed.; 2021. Available from: https://icd.who.int/browse11.

American Psychiatric Association. The diagnostic and statistical manual of mental disorders (5th ed.; DSM–5). 5th ed. Washington, DC: American Psychiatric Association; 2013.

Tsuang MT, Van Os J, Tandon R, Barch DM, Bustillo J, Gaebel W, et al. Attenuated psychosis syndrome in DSM-5. Schizophr Res. 2013;150:31–5. 10.1016/j.schres.2013.05.004. PubMed DOI PMC

Carpenter WT, van Os J. Should attenuated psychosis syndrome be a DSM-5 diagnosis? Am J Psychiatry. 2011;168:460–3. 10.1176/appi.ajp.2011.10121816. PubMed DOI

Yung AR, Phillips LJ, Yuen HP, McGorry PD. Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophr Res 2004;67:131–42. 10.1016/S0920-9964(03)00192-0. PubMed DOI

Yung AR, Yung AR, Pan Yuen H, PD McGorry, Phillips LJ, Kelly D, et al. Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry. 2005;39:964–71. 10.1080/j.1440-1614.2005.01714.x. PubMed DOI

Schultze-Lutter F. Subjective symptoms of schizophrenia in research and the clinic: The basic symptom concept. Schizophr Bull. 2009;35:5–8. 10.1093/schbul/sbn139. PubMed DOI PMC

Schultze-Lutter F, Ruhrmann S, Fusar-Poli P, Bechdolf A, Schimmelmann B G., Klosterkotter J. Basic symptoms and the prediction of first-episode psychosis. Curr Pharm Des. 2012;18:351–7. 10.2174/138161212799316064. PubMed DOI

Martínez-Cao C, de la Fuente-Tomás L, García-Fernández A, González-Blanco L, Sáiz PA, Garcia-Portilla MP, et al. Is it possible to stage schizophrenia? A systematic review. Transl Psychiatry. 2022;12:197 10.1038/s41398-022-01889-y. PubMed DOI PMC

McGorry PD, Nelson B, Goldstone S, Yung AR. Clinical staging: A heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders. Can J Psychiatry. 2010;55:486–97. 10.1177/070674371005500803. PubMed DOI

Berendsen S, van der Paardt J, van Bruggen M, Nusselder H, Jalink M, Peen J, et al. Exploring construct validity of clinical staging in schizophrenia spectrum disorders in an acute psychiatric ward. Clin Schizophr Relat Psychoses. 2018;CSRP.BEPA.061518: 10.3371/CSRP.BEPA.061518. PubMed DOI

Samara MT, Nikolakopoulou A, Salanti G, Leucht S. How many patients with schizophrenia do not respond to antipsychotic drugs in the short term? An analysis based on individual patient data from randomized controlled trials. Schizophr Bull 2019;45:639–46. 10.1093/schbul/sby095. PubMed DOI PMC

Scottish Intercollegiate Guidelines Network (SIGN). Management of schizophrenia. Vol. 131. Edinburgh; Scottish Intercollegiate Guidelines Network; 2013. Available from: http://www.sign.ac.uk.

National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: Prevention and management clinical guideline. 2014. Available from: www.nice.org.uk/guidance/cg178. PubMed

Correll CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: A large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16:163–80. 10.1002/wps.20420. PubMed DOI PMC

European Brain Council. Rethinking schizophrenia policy report. 2025. Available from: https://www.braincouncil.eu/wp-content/uploads/2024/04/Rethinking-Schizophrenia-Policy-Report.pdf.

Falkai P, Wagner E, John M, Yakimov V, Galderisi S, Bitter I, et al. Developing the EPA guidance of pharmacological treatment of schizophrenia – Results of a Delphi process. Eur Psychiatry. 2025;68:e26 10.1192/j.eurpsy.2024.1794. PubMed DOI PMC

Grol R, Grimshaw J. From best evidence to best practice: Effective implementation of change in patients’ care. Lancet 2003;362:1225–30. 10.1016/S0140-6736(03)14546-1. PubMed DOI

McIntyre JS. Usefulness and limitations of treatment guidelines in psychiatry. World Psychiatry. 2002;1:186–9. PubMed PMC

Forsner T, Hansson J, Brommels M, Wistedt AÅ, Forsell Y. Implementing clinical guidelines in psychiatry: A qualitative study of perceived facilitators and barriers. BMC Psychiatry 2010;10:8. 10.1186/1471-244X-10-8. PubMed DOI PMC

Rojnic Kuzman M, Padberg F, Amann BL, Schouler-Ocak M, Bajic Z, Melartin T, et al. Clinician treatment choices for post-traumatic stress disorder: Ambassadors survey of psychiatrists in 39 European countries. Eur Psychiatry. 2024;67:e24 10.1192/j.eurpsy.2024.19. PubMed DOI PMC

Rojnic Kuzman M, Slade M, Puschner B, Scanferla E, Bajic Z, Courtet P, et al. Clinical decision-making style preferences of European psychiatrists: Results from the ambassadors survey in 38 countries. Eur Psychiatry. 2022;65:e75 10.1192/j.eurpsy.2022.2330. PubMed DOI PMC

World Medical Association. World Medical Association Declaration of Helsinki. JAMA. 2013;310:2191 10.1001/jama.2013.281053. PubMed DOI

Evans SC, Roberts MC, Keeley JW, Blossom JB, Amaro CM, Garcia AM, et al. Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies. Int J Clin Health Psychol. 2015;15:160–70. 10.1016/j.ijchp.2014.12.001. PubMed DOI PMC

Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. Int J Surg. 2014;12:1500–24. 10.1016/j.ijsu.2014.07.014. PubMed DOI

Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020;177:868–72. 10.1176/appi.ajp.2020.177901. PubMed DOI

Vita A, Gaebel W, Mucci A, Sachs G, Barlati S, Giordano GM, et al. European psychiatric association guidance on treatment of cognitive impairment in schizophrenia. Eur Psychiatry. 2022;65:e57 10.1192/j.eurpsy.2022.2315. PubMed DOI PMC

Galderisi S, Kaiser S, Bitter I, Nordentoft M, Mucci A, Sabé M, et al. EPA guidance on treatment of negative symptoms in schizophrenia. Eur Psychiatry. 2021;64:e21 10.1192/j.eurpsy.2021.13. PubMed DOI PMC

De Hert M, Dekker JM, Wood D, Kahl KG, Holt RIG, H-J Möller. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European psychiatric association (EPA), Supported by the European Association for the Study of diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry. 2009;24:412–24. 10.1016/j.eurpsy.2009.01.005. PubMed DOI

Stubbs B, Vancampfort D, Hallgren M, Firth J, Veronese N, Solmi M, et al. EPA guidance on physical activity as a treatment for severe mental illness: A meta-review of the evidence and position statement from the European psychiatric association (EPA), supported by the International Organization of Physical Therapists in mental health (IOPTMH). Eur Psychiatry. 2018;54:124–44. 10.1016/j.eurpsy.2018.07.004. PubMed DOI

Maurus I, Wagner S, Spaeth J, Vogel A, Muenz S, Seitz V, et al. EPA guidance on lifestyle interventions for adults with severe mental illness: A meta-review of the evidence. Eur Psychiatry. 2024;67:e80 10.1192/j.eurpsy.2024.1766. PubMed DOI PMC

Schmidt SJ, Schultze-Lutter F, Schimmelmann BG, Maric NP, Salokangas RKR, Riecher-Rössler A, et al. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry. 2015;30:388–404. 10.1016/j.eurpsy.2015.01.013. PubMed DOI

Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2020;34:3–78. 10.1177/0269881119889296. PubMed DOI

McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017;31:519–52. 10.1177/0269881117699361. PubMed DOI

American Psychiatric Association. The practice of electroconvulsive therapy: Recommendations for treatment, training, and privileging. Washington, DC: APA; 2001. Available from: https://psychiatryonline.org/doi/epdf/10.1176/appi.books.9780890424841.

Hiemke C, Bergemann N, Clement H, Conca A, Deckert J, Domschke K, et al. Consensus guidelines for therapeutic drug monitoring in Neuropsychopharmacology: Update 2017. Pharmacopsychiatry. 2018;51:e1–1. 10.1055/s-0037-1600991. PubMed DOI

Szkultecka-Dębek M, Miernik K, Stelmachowski J, Jakovljević M, Jukić V, Aadamsoo K, et al. Treatment patterns of schizophrenia based on the data from seven central and eastern European countries. Psychiatr Danub. 2016;28:234–42. PubMed

Hamina A, Taipale H, Lieslehto J, Lähteenvuo M, Tanskanen A, Mittendorfer-Rutz E, et al. Comparative effectiveness of antipsychotics in patients with schizophrenia Spectrum disorder. JAMA Netw Open. 2024;7:e2438358 10.1001/jamanetworkopen.2024.38358. PubMed DOI PMC

Taipale H, Puranen A, Mittendorfer-Rutz E, Tiihonen J, Tanskanen A, Cervenka S, et al. Antipsychotic use among persons with schizophrenia in Sweden and Finland, trends and differences. Nord J Psychiatry. 2021;75:315–22. 10.1080/08039488.2020.1854853. PubMed DOI

Richards-Belle A, Launders N, Hardoon S, KKC Man, Bramon E, DPJ Osborn, et al. Prescribing of antipsychotics for people diagnosed with severe mental illness in UK primary care 2000–2019: 20-year investigation of who receives treatment, with which agents and at what doses. Br J Psychiatry. 2024;1–9. 10.1192/bjp.2024.186. PubMed DOI PMC

Definitive Healcare, 2022. Available at https://www.definitivehc.com/resources/healthcare-insights/top-antipsychotic-prescriptions, accessed August 2025

Højlund M, Köhler-Forsberg O, Gregersen AT, Rohde C, Mellentin AI, Anhøj SJ, et al. Prevalence, correlates, tolerability-related outcomes, and efficacy-related outcomes of antipsychotic polypharmacy: A systematic review and meta-analysis. Lancet Psychiatry. 2024;11:975–89. 10.1016/S2215-0366(24)00314-6. PubMed DOI

Rogers JP, Oldham MA, Fricchione G, Northoff G, Ellen Wilson J, Mann SC, et al. Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2023;37:327–69. 10.1177/02698811231158232. PubMed DOI PMC

Zaman H, Sampson SJ, Beck AL, Sharma T, Clay FJ, Spyridi S, et al. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2017;2023: 10.1002/14651858.CD003079.pub4. PubMed DOI PMC

Maric NP, Andric Petrovic S, Russo M, Jerotic S, Ristic I, Savić B, et al. Maintenance therapy of psychosis Spectrum disorders in a real-world setting: Antipsychotics prescription patterns and long-term benzodiazepine use. Front Psych. 2022;13 10.3389/fpsyt.2022.796719. PubMed DOI PMC

Bushnell GA, Stürmer T, Gaynes BN, Pate V, Miller M. Simultaneous antidepressant and benzodiazepine new use and subsequent long-term benzodiazepine use in adults with depression, United States, 2001-2014. JAMA Psychiatry. 2017;74:747. 10.1001/jamapsychiatry.2017.1273. PubMed DOI PMC

Benzodiazepines: The time for systematic change is now. Addiction. 2021;116:219–21. 10.1111/add.15095. PubMed DOI

Winkler P, Krupchanka D, Roberts T, Kondratova L, Machů V, Höschl C, et al. A blind spot on the global mental health map: A scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4:634–42. 10.1016/S2215-0366(17)30135-9. PubMed DOI

Arango C, Fagiolini A, Gorwood P, Kane JM, Diaz-Mendoza S, Sahota N, et al. Delphi panel to obtain clinical consensus about using long-acting injectable antipsychotics to treat first-episode and early-phase schizophrenia: Treatment goals and approaches to functional recovery. BMC Psychiatry. 2023;23:453 10.1186/s12888-023-04928-0. PubMed DOI PMC

Barnes TRE, Shingleton-Smith A, Paton C. Antipsychotic long-acting injections: Prescribing practice in the UK. Br J Psychiatry. 2009;195:s37–42. 10.1192/bjp.195.52.s37. PubMed DOI

Arango C, Baeza I, Bernardo M, Cañas F, de Dios C, Díaz-Marsá M, et al. Long-acting injectable antipsychotics for the treatment of schizophrenia in Spain. Rev Psiquiatr Salud Ment. 2019;12:92–105. 10.1016/j.rpsm.2018.03.006. PubMed DOI

Bunting SR, Chalmers K, Yohanna D, Lee R. Prescription of long-acting injectable antipsychotic medications among outpatient mental health care service providers. Psychiatr Serv. 2023;74:1146–53. 10.1176/appi.ps.20220586. PubMed DOI

Urkin B, Parnas J, Raballo A, Koren D. Schizophrenia Spectrum disorders: An empirical benchmark study of real-world diagnostic accuracy and reliability among leading international psychiatrists. Schizophr Bull Open. 2024;5:sgae012. 10.1093/schizbullopen/sgae012. PubMed DOI PMC

Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: A meta-analysis. Lancet. 2009;373:31–41. 10.1016/S0140-6736(08)61764-X. PubMed DOI

Artaloytia JF, Arango C, Lahti A, Sanz J, Pascual A, Cubero P, et al. Negative signs and symptoms secondary to antipsychotics: A double-blind, randomized trial of a single dose of placebo, haloperidol, and Risperidone in healthy volunteers. Am J Psychiatry. 2006;163:488–93. 10.1176/appi.ajp.163.3.488. PubMed DOI

Galling B, Roldán A, Hagi K, Rietschel L, Walyzada F, Zheng W, et al. Antipsychotic augmentation vs. monotherapy in schizophrenia: Systematic review, meta-analysis and meta-regression analysis. World Psychiatry. 2017;16:77–89. 10.1002/wps.20387. PubMed DOI PMC

Correll CU, Rubio JM, Inczedy-Farkas G, Birnbaum ML, Kane JM, Leucht S. Efficacy of 42 pharmacologic Cotreatment strategies added to antipsychotic Monotherapy in schizophrenia. JAMA Psychiatry. 2017;74:675. 10.1001/jamapsychiatry.2017.0624. PubMed DOI PMC

Helfer B, Samara MT, Huhn M, Klupp E, Leucht C, Zhu Y, et al. Efficacy and safety of antidepressants added to antipsychotics for schizophrenia: A systematic review and meta-analysis. Am J Psychiatry. 2016;173:876–86. 10.1176/appi.ajp.2016.15081035. PubMed DOI

Arango C, Garibaldi G, Marder SR. Pharmacological approaches to treating negative symptoms: A review of clinical trials. Schizophr Res. 2013;150:346–52. 10.1016/j.schres.2013.07.026. PubMed DOI

Galderisi S, Mucci A, Buchanan RW, Arango C. Negative symptoms of schizophrenia: New developments and unanswered research questions. Lancet Psychiatry. 2018;5:664–77. 10.1016/S2215-0366(18)30050-6. PubMed DOI

Fond G, Berna F, Boyer L, Godin O, Brunel L, Andrianarisoa M, et al. Benzodiazepine long-term administration is associated with impaired attention/working memory in schizophrenia: Results from the national multicentre FACE-SZ data set. Eur Arch Psychiatry Clin Neurosci. 2018;268:17–26. 10.1007/s00406-017-0787-9. PubMed DOI

Betcher HK, Montiel C, Clark CT. Use of antipsychotic drugs during pregnancy. Curr Treat Options Psychiatry. 2019;6:17–31. 10.1007/s40501-019-0165-5. PubMed DOI PMC

Park Y, Huybrechts KF, Cohen JM, Bateman BT, Desai RJ, Patorno E, et al. Antipsychotic medication use among publicly insured pregnant women in the United States. Psychiatr Serv. 2017;68:1112–9. 10.1176/appi.ps.201600408. PubMed DOI PMC

Howes OD, Vergunst F, Gee S, McGuire P, Kapur S, Taylor D. Adherence to treatment guidelines in clinical practice: Study of antipsychotic treatment prior to clozapine initiation. Br J Psychiatry. 2012;201:481–5. 10.1192/bjp.bp.111.105833. PubMed DOI

Agid O, Arenovich T, Sajeev G, Zipursky RB, Kapur S, Foussias G, et al. An algorithm-based approach to first-episode schizophrenia. J Clin Psychiatry. 2011;72:1439–44. 10.4088/JCP.09m05785yel. PubMed DOI

Farooq S, Choudry A, Cohen D, Naeem F, Ayub M. Barriers to using clozapine in treatment-resistant schizophrenia: Systematic review. BJPsych Bull. 2019;43:8–16. 10.1192/bjb.2018.67. PubMed DOI PMC

Tiihonen J, Haukka J, Taylor M, Haddad PM, Patel MX, Korhonen P. A Nationwide cohort study of Oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011;168:603–9. 10.1176/appi.ajp.2011.10081224. PubMed DOI

Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: A systematic review and network meta-analysis. Lancet Psychiatry. 2020;7:64–77. 10.1016/S2215-0366(19)30416-X. PubMed DOI PMC

Lorentzen R, Nguyen TD, McGirr A, Hieronymus F, Østergaard SD. The efficacy of transcranial magnetic stimulation (TMS) for negative symptoms in schizophrenia: A systematic review and meta-analysis. Schizophrenia. 2022;8:35. 10.1038/s41537-022-00248-6. PubMed DOI PMC

Laws KR, Conway W. Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis. World J Psychiatry. 2019;9:107–20. 10.5498/wjp.v9.i8.107. PubMed DOI PMC

Semrau M, Barley EA, Law A, Thornicroft G. Lessons learned in developing community mental health care in Europe. World Psychiatry. 2011;10:217–25. 10.1002/j.2051-5545.2011.tb00060.x. PubMed DOI PMC

Fiorillo A, Luciano M, Giacco D, Del Vecchio V, Baldass N, De Vriendt N, et al. Training and practice of psychotherapy in Europe: Results of a survey. World Psychiatry. 2011;10:238 10.1002/j.2051-5545.2011.tb00064.x. PubMed DOI PMC

Maric NP, Raballo A, Rojnic Kuzman M, Andric Petrovic S, Klosterkötter J, Riecher-Rössler A. European status and perspectives on early detection and intervention in at-risk mental state and first episode psychosis: Viewpoint from the EPA section for prevention of mental disorders. Eur Psychiatry. 2017;46. 10.1016/j.eurpsy.2017.08.003. PubMed DOI

Kotlicka-Antczak M, Podgórski M, Oliver D, Maric NP, Valmaggia L, Fusar-Poli P. Worldwide implementation of clinical services for the prevention of psychosis: The IEPA early intervention in mental health survey. Early Interv Psychiatry. 2020;14:741–50. 10.1111/eip.12950. PubMed DOI

National Clinical Audit of Psychosis & Royal College of Psychiatrists. National report for the early intervention in psychosis spotlight audit 2018/2019. 2019. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/ncap-eip-national-report---final-online-20190807.pdf?sfvrsn=166d7fe7_2.

National Institute for Health and Care Excellence N. Antenatal and postnatal mental health: Clinical management and service guidance. 2014. Available from: https://www.nice.org.uk/guidance/cg192. PubMed

Horakova A, Nemcova H, Hrdlickova K, Kalli S, Davletova A, Duarte MFRS, et al. State of perinatal mental health care in the WHO region of Europe: A scoping review. Front Psych. 2024;15:1350036 10.3389/fpsyt.2024.1350036. PubMed DOI PMC