Sun. Oct 13, 2019 2:50 PM - 4:30 PM Room 13 (501)

Organizer / Chair: Mitsuhiko YAMADA (Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan), Co-chair: Hisae ONO (Department of Integral Psychological Sciences, School of Humanities, Kwansei Gakuin University, Japan), Discussants: ‌Shih-Ku LIN (Taipei City Hospital and Psychiatric Center, School of Medicine, Taipei Medical University, Taiwan), Hiroyasu NARITA (Lundbeck Japan K.K.)

There has been a dramatic increase in the evidence base to improve mental health. Clinical guidelines had been expected to translate such best evidence into best practice. However, the poor uptake of these evidence-based practices has led us to investigate factors related to their successful dissemination and implementation. For example, greater “consumer” involvement would be expected in setting priorities. The consumer includes not only patients, but also clinicians, payers, and others. When planning and conducting clinical trials in psychiatry, it is very important to take account of these factors. For better generalizability and feasibility, well-designed, larger, simpler and pragmatic trials would be expected. The purpose of this symposium is to discuss the needs and future challenges of large pragmatic trials in psychiatry for effective discovery, dissemination and implementation of evidence-based practices. The first speaker will discuss the first- and second-line treatment strategies for untreated unipolar major depressive episodes, based on the results obtained from the SUN☺D study (Kato et al., BMC Medicine, 16, 103, 2018). SUN☺D study is a pragmatic, multi-centre, assessor-blinded randomised controlled trial (n=2,011). The second speaker will introduce an outline of the multi-centre randomised controlled trial (n=496) included in the precision medicine project in UK. The primary objective of the trial is to determine whether using the treatment algorithm to identify a “personalised” antidepressant results in an increased proportion of patients who keep taking the allocated treatment at 8 weeks, in comparison to usual care. Complex interventions are widely used in the mental health service and the number of trials to examine the effect of complex interventions are increasing. Recently, a multi-centre, randomised controlled trial (ACTION-J study) was conducted to examine the effect of assertive case management for people with mental health problems who had attempted suicide and were admitted to hospital emergency departments (Kawanishi et al., Lancet Psychiatry, 1: 193-201, 2014). ACTION-J study is a multi-centre, randomised controlled trial (n=914). The third speaker will introduce the ongoing projects for dissemination of the assertive case management in Japan. We hope that this symposium will help the audience to understand the essential steps needed to plan and conduct large pragmatic trials in the field of psychiatry for effective discovery, dissemination and implementation of evidence-based practices.