The awareness, characterization, and burden of Cognitive Impairment Associated with Schizophrenia (CIAS) in clinical practice: Results from a nationwide survey in Italy

Introduction: Cognitive Impairment (CIAS) is a core aspect of schizophrenia and one of the main obstacles to clinical and functional recovery in patients. People with CIAS have difficulties with learning and using information in real world. Despite its well-recognized role, it is not yet a diagnostic criterion in DSM-5 and ICD system. The effective management of CIAS represents a critical unmet need of schizophrenia treatment. Methods: To evaluate the awareness of CIAS in the Italian landscape, we conducted a quantitative survey on psychiatrists highly specialized in schizophrenia, focused on its awareness, assessment, burden, and treatment. Results: Of 152 participants, 139 (91.4 %) consider CIAS assessment important. The terminology most frequently used to describe CIAS is 'cognitive impairment'. CIAS is assessed, clinically or with formal tools, in approximately 43 % of patients after stabilisation either during follow-up visits (N = 88, 67.7 %) or during hospital stay (N = 57, 43.8 %). 65 % of evaluated patients are considered affected by CIAS. Formal assessment tools (tests, questionnaires, interviews) are used in about 20 % of the centers. The Mini Mental State Examination (MMSE) (N = 75, 72.1 %) and the Wechsler Adult Intelligence Scale (WAIS) (N = 62, 59.6 %) are the most frequently used tools for CIAS evaluation. Conclusions: The clinical characteristics of the patient, structural barriers like the lack of trained personnel or inadequate economic resources, and organizational problems influence the assessment rate. Despite this awareness, greater effort must be made to overcome the barriers, especially economic and organizational ones, which prevent the assessment and treatment of CIAS from becoming established in routine clinical care.