Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. Patients who have remitted from their psychotic symptoms and continue to use medication have a lower risk of relapse than individuals who reduce dosage or discontinue at an early stage. Most international guidelines recommend continuation with antipsychotic medication for at least one year. However, in clinical practice, we see that patients often have a strong wish to stop earlier due to side-effects that affect their everyday social functioning. Randomized intervention studies comparing the long-term effects of maintenance treatment versus early discontinuation are scarce and inconclusive. Psychiatrists, patients and family are therefore unsure which regime to follow: to continue or not to continue? That is the question.
The pressure to find answers has been felt worldwide and four independent currently address the topic of antipsychotic (dis)continuation: HAMLETT (www.hamlett.nl) covering the Netherlands, TAILOR in Copenhagen (Denmark), REDUCE in Melbourne (Australia) and RADAR throughout the United Kingdom. This international workshop brings together junior and senior researchers from different disciplines to better streamline our joint efforts on this important research topic and shape collaboration. Especially given the longitudinal nature of these studies, it is important to build a strong network together to facilitate international and interdisciplinary collaboration. Moreover, as these international results can actually impact patient care across the world, joint discussions on the interpretation of our future results is needed to translate these into health care guidelines. The organizing committee is determined to make this workshop an impactful and memorable event in September 2020.
Due to the COVID-19 circumstances part of the workshop will be online.
MONDAY (Dutch participants)
11.30 Welcome Staff Lorentz Center
11.45 Overview and what will everyone give & take Prof. Dr. Iris Sommer and Dr. Marieke Begemann
12.15 Opening lectures Moderator: Prof. Dr. Iris Sommer
HAMLETT OPHELIA Dr. Marieke Begemann Dr. Sanne Schuite-Koops
14:00 Lecture round Moderator: Prof. Dr. Lieuwe de Haan
WP1: Symptoms & relapse WP1: Cognition (BACS, PRAAT) WP1: Neuroimaging WP3: Prognostic modelling Prof. Dr. Lieuwe de Haan – psychiatrist and expert in early psychosis and schizophrenia Alban Voppel - PhD student investigating speech and cognition in psychosis Priscilla Oomen – PhD student specializing in MRI Dr. Joran Lokkerbol, Trimbos data scientist
15.00 Plenary discussion
15.15 Open space sessions Dr. Marieke Begemann
Today’s sessions will be about the presented outcome measures. Participants are invited to join the session(s) of their interest to discuss the possibilities of streamlining data processing and combining outcome measures in analyses. 1. How can inclusion rate be increased? 2. Symptom and relapse measurements 3. Cognition 4. Neuroimaging 5. Prognostic modelling 6. [Decided during meeting to leave room for input]
17.00 Plenary discussion: Recap day 1 Each session host presents a summary of key points resulting from their group session.
End product: Syntaxes will be written based on preliminary data in preparation of final data analyses.
17.30 Drinks and networking
19:30 End of day 1.
TUESDAY (Dutch participants)
9.30 Review day one, overview day two Moderator: Dr. Roberto Bakker-Doornebal
9.45 Lecture round 1: Moderator: Dr. Roberto Bakker-Doornebal
10.30 WP2: EMA WP2: BeHapp WP4: Blood-omics WP6: Gene-environment Discussion Prof. Dr. Wim Veling – expert in EMA Inge van der Heijden – PhD student BeHapp Karin Huizer, MD - finishing PhD Neuropathology Dr. Sinan Gülöksüz – genetic data analyst
10.45 Coffee/tea break
12.00 Lecture round 2: Moderator: Dr. Nynke Boonstra
WP5: Personal Recovery WP7: Implementation Patients & family members Dr. Nynke Boonstra & Bram-Sieben Rosema Dr. Martijn Kikkert Karin Groen - family organization Ypsilon
14.30 Open space sessions Moderator: Dr. Martijn Kikkert
Today’s session will be about the presented outcome measures. Participants are invited to join the session(s) of their interest to discuss the possibilities of streamlining data processing and combining outcome measures in analyses. 1. EMA 2. BeHapp 3. Blood-omics 4. Gene-environment 5. Personal Recovery 6. Implementation
16.30 Plenary discussion Each session host presents a summary of key points resulting from their group session.
End product: Syntaxes will be written based on preliminary data in preparation of final data analyses. A future plan will be made about how to sustain participation in this long-term HAMLETT/OPHELIA cohort
17.00 Evening program and dinner
WEDNESDAY (Dutch participants)
9.30 Optional: Time to meet with working groups
12.00 Review day two, overview today Prof. Dr. Filip Smit
12.15 Plenary lecture Moderator: Prof. Dr. Filip Smit
Instrumental Variables approach Dr. Joran Lokkerbol - Trimbos data scientist
14.00 Lecture round: Personalized medicine Moderator: Prof. Dr. Filip Smit
Gender Issues Norwegian dataset Selection bias Bodyl Brand Sanne Hoekstra Joelle Hoornaar
15.00 Open space sessions Moderator: Prof. Dr. Machteld Marcelis
Today’s session will be about the current trials. Participants are invited to join the session(s) of their interest to discuss common pitfalls and think about a general approach to handling them. 1. How to handle selection bias and dropouts? 2. Safety analyses: how may outcomes jeopardize your trial? 3. Cost effectiveness: what do we measure? 4. What gender issues can we expect and how do we handle this in our analyses? 5. [Decided during meeting to leave room for input]
17.00 Plenary discussion Each session host presents a summary of key points resulting from their group session.
End product: A summary describing the most important hurdles and difficulties encountered in HAMLETT/OPHELIA, together with the (joint) decisions that were made to overcome these issues, and identify common limitations of these kind of studies.
17.30 Evening program including dinner @ Van der Valk hotel Dutch participants
THURSDAY – all participants
8.15 Introduction participants Prof. Dr. Iris Sommer and Dr. Marieke Begemann
9.00 Lecture round 1: Current trials Moderator: Prof. Dr. Iris Sommer
RADAR REDUCE TAILOR HAMLETT Prof. Dr. Joanna Moncrieff & Dr. Jacki Stansfeld Prof. Dr. Eóin Killackey Dr. Helene Speyer Dr. Marieke Begemann
10.15 Coffee Break Coordinators of the different trials will be present in four different (digital) rooms, participants can digitally visit them to ask more detailed questions.
10.45 Lecture round 2: Previous trials Moderator: Prof. Dr. Lieuwe de Haan
The MESIFOS STUDY Prof. Dr. Lex Wunderink – PI of the first large-scale discontinuation RCT, performed in NL The Hui study Prof. Dr. Eric Chen – performed a large-scale longitudinal trial in Hong Kong 2018.
11.30 Open space sessions Moderator: Prof. Dr. Jim van Os
Today’s sessions will be about the current trials. Participants are invited to join the session(s) of their interest and are encouraged to discuss common pitfalls and think about a general approach to handling them. 1. What common pitfalls are shared between these international studies? 2. What common definitions can we use in the different trials? 3. What interim analyses are planned across trials, and how can we combine data? 4. Promoting individually adapted participation vs research protocol: tips and tricks 5. [To leave room for input for participants, this theme will be decided during the meeting]
12.30 Plenary discussion Each session host presents a summary of key points resulting from their group session.
13.00 Commitment session Moderator: Prof. Dr. Wim Veling
1. Discuss list of action and distribution of tasks across participants. 2. Which variables can be combined for a joint article? 3. Forming an author group that will be registered on Pubmed for joint publications 4. Which opportunities are there to organize joint symposia/meetings?
14.00 Plenary discussion
14.30 Closing remarks Prof. Dr. Iris Sommer
End product day 4: A summary describing common limitations of these kind of studies. These can be incorporated in the discussion section, when researchers will be writing up the results in the final research articles. Joint research article(s) will set up, authors group is registered on PubMed. Working groups for future collaborative topics, to streamline data analyses between the international studies as much as possible. Plan next meeting.
15.00 End of day 4.