Psychiatrists' and psychiatry trainees' perspectives of treatment priorities and the role of cognitive symptoms in supporting people with psychotic disorders.

The treatment focus in psychotic disorders, like schizophrenia, is often the remission of positive symptoms despite neurocognitive impairments better predicting long-term outcomes. Cognitive remediation has substantial evidence for supporting reliable improvements in cognition in people affected by schizophrenia, but it remains underutilised. Understanding the barriers for cognitive remediation and cognitive testing implementation is critical to improving treatment outcomes in psychotic disorders. To address this, an online survey of psychiatrists and psychiatry trainees in Australia was undertaken to explore treatment priorities, referral practices, and confidence in treating people diagnosed with psychotic disorders. Statistical analyses were conducted using chi-square analyses, logistic regression and analysis of variance. Clinicians (n = 96) expressed confidence in their ability to treat those with psychotic disorders but were not as confident with regard to their ability to identify/treat cognitive symptoms in people with psychotic disorders. Despite acknowledging that cognitive symptoms were most predictive of functional outcomes (>75%), clinicians believed that patient concerns were primarily positive symptoms (>60%). Accordingly, treating positive symptoms was the highest priority in managing early psychosis (~90%), with cognitive symptoms rated as the lowest. Referral rates for cognitive testing or cognitive remediation were low (both < 30%). Despite the acknowledged relationship between cognitive symptoms and functional outcomes, and the evidence base for cognitive remediation efficacy, access to cognitive testing and cognitive remediation referral rates appear far from optimal. These findings should motivate mental health services to better incorporate cognitive screening to support the identification and prioritisation of cognitive symptoms.