The Test Solution “Schizophrenia Spectrum Disorders – Neurocognitive Assessment” is intended to assess the cognitive functional profile of individuals with schizophrenia. The selection of dimensions is based on current research findings on cognitive changes associated with schizophrenia, as well as on the diagnostic standards DSM-5-TR (American Psychiatric Association, 2022), ICD-11 (WHO, 2022), and a comprehensive recommendation for the assessment of cognitive impairments in schizophrenia issued by the European Psychiatric Association (EPA) (Vita et al., 2022).
Schizophrenia is a severe and highly burdensome mental disorder. Individuals affected by schizophrenia are often confronted with difficulties in everyday functioning (Galderisi et al., 2014; Harvey & Strassnig, 2012), report reduced quality of life (Dong et al., 2019), and frequently show limited participation in social and personal life (Correll et al., 2022; Vita et al., 2022). Cognitive impairments represent a central component of the symptomatic profile of schizophrenia and contribute substantially to functional limitations (McCutcheon et al., 2023). Unlike, for example, depression, cognitive impairments are often present prior to the first episode and occur independently of it (McCutcheon et al., 2023). A recent meta-analysis further indicates that these impairments show high temporal stability (Ghanem et al., 2025), highlighting the clinical relevance of assessing individual cognitive deficits.
While ICD-11 (WHO, 2022) does not explicitly focus on cognitive impairments, it allows them to be considered as a relevant symptom domain that may complement severity assessment. In contrast, DSM-5-TR (American Psychiatric Association, 2022) explicitly describes cognitive functional impairments as central and clinically significant dimensions of the disorder. Although the introduction of a cognitive criterion as a formal diagnostic feature was considered during DSM-5 development, this was not implemented due to limited diagnostic specificity, for example in comparison with bipolar disorders (McCutcheon et al., 2023). Nevertheless, international guidelines, particularly the EPA Guidance (Vita et al., 2022), emphasize that cognitive performance impairments should be systematically assessed, as they affect key functional areas, contribute substantially to social and occupational participation, and provide important additional diagnostic information. The EPA identifies the following dimensions as relevant for cognitive assessment in schizophrenia: processing speed, attention and vigilance, working memory, verbal and visuospatial learning, memory, logical reasoning, and problem-solving ability.
The most frequently impaired cognitive domain in schizophrenia is processing speed, which has been identified as a fundamentally affected ability in numerous empirical studies (Gebreegziabhere et al., 2022; Morrens et al., 2008; Nuechterlein et al., 2004; Ojeda et al., 2012; Seitz-Holland et al., 2022). The umbrella review by Gebreegziabhere et al. (2022) identified processing speed, alongside memory, as the most frequently reported impairment in schizophrenia. A recent meta-analysis by Ghanem et al. (2025) demonstrated the temporal stability of cognitive deficits and reported significant differences between patients and control groups across all examined domains, including processing speed, attention, working memory, verbal and visual learning, verbal memory, verbal fluency, and logical reasoning (see Supplementary Table 5 in Ghanem et al., 2025). Ojeda et al. (2012) identified processing speed as the most important ability for differentiating healthy individuals from individuals with schizophrenia. Morrens et al. (2008) further showed slowed information processing in individuals with schizophrenia compared to healthy controls. In addition, Mahurin et al. (2006) demonstrated poorer performance of individuals with schizophrenia on Part A of the Trail Making Test compared with both healthy controls and individuals with depression.
Reviews by Osborne et al. (2020) and Morrens et al. (2007) indicate that psychomotor speed may also be impaired in individuals with schizophrenia. In the literature, this impairment is often referred to as psychomotor slowing. Osborne et al. (2020) further describe psychomotor slowing as a multidimensional construct and suggest that it may represent an important biomarker in schizophrenia diagnostics. These facets include response selection and motor planning, motor inhibition, volition, motor speed, and fine motor coordination. Van Beilen et al. (2004) likewise emphasize that psychomotor speed correlates with cognitive test performance. Morrens et al. (2008) confirmed the relevance of psychomotor speed and linked it to processing speed. Based on this evidence, it appears meaningful to assess psychomotor speed and interpret it in combination with processing speed.
Another central cognitive ability that may be impaired in schizophrenia is working memory. Ghanem et al. (2025) report medium to large effect sizes indicating lower working memory performance in individuals with schizophrenia compared with healthy individuals. A further meta-analysis (Lee & Park, 2005) suggests that these differences occur independently of test modality. Additional evidence from the umbrella review by Gebreegziabhere et al. (2022), as well as earlier findings by Forbes et al. (2009) and Ojeda et al. (2012), supports the relevance of working memory in schizophrenia and justifies its assessment alongside processing speed.
Nuechterlein et al. (2004) showed that attention and vigilance also represent relevant dimensions that may be impaired in schizophrenia. Differences in attentional performance between healthy individuals and individuals with schizophrenia were likewise reported by Ojeda et al. (2012).
Logical reasoning also shows significant and persistent impairment in schizophrenia (Ghanem et al., 2025; Nuechterlein et al., 2004). This domain is likewise identified by the EPA Guidance as relevant for cognitive assessment (Vita et al., 2022).
Within executive functions, a meta-analysis (Westerhausen et al., 2011) found that global executive dysfunctions may partly be explained by reduced inhibitory control. Bielecki et al. (2024) additionally demonstrated reduced cognitive and motor inhibition in patients with cognitive deficits or negative symptoms (according to the dimensional description in ICD-11). Mahurin et al. (2006) further showed that individuals with schizophrenia performed worse on Part B of the Trail Making Test, which assesses executive functions, compared with both healthy controls and individuals with depression.
In summary, the evidence indicates that processing speed, attention, psychomotor speed, inhibition, and working memory belong to the central and empirically well-supported functional areas that are typically impaired in schizophrenia. A structured assessment of these domains is therefore essential for clinical evaluation, treatment planning, and prognosis. The Test Solution “Schizophrenia Spectrum Disorders – Neurocognitive Assessment” therefore includes the following cognitive domains:
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Attention
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Processing speed (TMT-S, Part A)
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Selective attention (TACO)
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Motor and reaction speed (RT)
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Executive functions
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Cognitive flexibility (TMT-S, Part B)
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Verbal working memory (SPAN, digit span backward)
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Interference tendency and inhibition (STROOP)
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Learning and memory
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Verbal short-term memory (SPAN, digit span forward)
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Logical reasoning (BMT)
The Test Solution “Schizophrenia Spectrum Disorders – Neurocognitive Assessment” thus covers central cognitive domains that may be impaired in schizophrenia. However, some relevant domains are not included. Meta-analytic findings by Szöke et al. (2008), for example, identified semantic verbal fluency as one of the best predictors for differentiating individuals with schizophrenia from healthy controls, although this finding should be interpreted with caution due to the limited study quality noted by Gebreegziabhere et al. (2022). Verbal and visuospatial memory, as well as social cognition, are not included as standard components, although social cognition in particular is considered a relevant factor by the EPA Guidance.
Depending on the specific assessment question, additional procedures outside the SCHUHFRIED Selection may therefore be added to the Test Solution, for example to assess verbal fluency (WIWO), concretism (SMT; Barth, 2018; see Vita et al., 2022), verbal memory (AWLT), social cognition (TOM), or figural memory (FGT). Please note that when configuring the test sequence and adding tests that are not part of the SCHUHFRIED Selection, the combined results overview is no longer automatically available (see Notes on evaluation and interpretation ).
The test duration of the standard form is approximately 61 minutes.
References can be found here: Literature