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Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial.

Abstract

CONTEXT

The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including schizophrenia. Given that omega-3 PUFAs are generally beneficial to health and without clinically relevant adverse effects, their preventive use in psychosis merits investigation.

OBJECTIVE

To determine whether omega-3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents and young adults aged 13 to 25 years with subthreshold psychosis.

DESIGN

Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007.

SETTING

Psychosis detection unit of a large public hospital in Vienna, Austria.

PARTICIPANTS

Eighty-one individuals at ultra-high risk of psychotic disorder.

INTERVENTIONS

A 12-week intervention period of 1.2-g/d omega-3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months.

MAIN OUTCOME MEASURES

The primary outcome measure was transition to psychotic disorder. Secondary outcomes included symptomatic and functional changes. The ratio of omega-6 to omega-3 fatty acids in erythrocytes was used to index pretreatment vs posttreatment fatty acid composition.

RESULTS

Seventy-six of 81 participants (93.8%) completed the intervention. By study's end (12 months), 2 of 41 individuals (4.9%) in the omega-3 group and 11 of 40 (27.5%) in the placebo group had transitioned to psychotic disorder (P = .007). The difference between the groups in the cumulative risk of progression to full-threshold psychosis was 22.6% (95% confidence interval, 4.8-40.4). omega-3 Polyunsaturated fatty acids also significantly reduced positive symptoms (P = .01), negative symptoms (P = .02), and general symptoms (P = .01) and improved functioning (P = .002) compared with placebo. The incidence of adverse effects did not differ between the treatment groups.

CONCLUSIONS

Long-chain omega-3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states. Trial Registration clinicaltrials.gov Identifier: NCT00396643.

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  • Authors+Show Affiliations

    ,

    Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria. gpamminger@gmail.com

    , , , , , , ,

    Source

    Archives of general psychiatry 67:2 2010 Feb pg 146-54

    MeSH

    Adolescent
    Adult
    Diagnostic and Statistical Manual of Mental Disorders
    Dose-Response Relationship, Drug
    Double-Blind Method
    Fatty Acids, Omega-3
    Female
    Health Status
    Humans
    Male
    Patient Acceptance of Health Care
    Psychotic Disorders
    Risk Factors
    Schizotypal Personality Disorder
    Severity of Illness Index
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20124114

    Citation

    Amminger, G Paul, et al. "Long-chain Omega-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: a Randomized, Placebo-controlled Trial." Archives of General Psychiatry, vol. 67, no. 2, 2010, pp. 146-54.
    Amminger GP, Schäfer MR, Papageorgiou K, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010;67(2):146-54.
    Amminger, G. P., Schäfer, M. R., Papageorgiou, K., Klier, C. M., Cotton, S. M., Harrigan, S. M., ... Berger, G. E. (2010). Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Archives of General Psychiatry, 67(2), pp. 146-54. doi:10.1001/archgenpsychiatry.2009.192.
    Amminger GP, et al. Long-chain Omega-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: a Randomized, Placebo-controlled Trial. Arch Gen Psychiatry. 2010;67(2):146-54. PubMed PMID: 20124114.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. AU - Amminger,G Paul, AU - Schäfer,Miriam R, AU - Papageorgiou,Konstantinos, AU - Klier,Claudia M, AU - Cotton,Sue M, AU - Harrigan,Susan M, AU - Mackinnon,Andrew, AU - McGorry,Patrick D, AU - Berger,Gregor E, PY - 2010/2/4/entrez PY - 2010/2/4/pubmed PY - 2010/3/11/medline SP - 146 EP - 54 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 67 IS - 2 N2 - CONTEXT: The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including schizophrenia. Given that omega-3 PUFAs are generally beneficial to health and without clinically relevant adverse effects, their preventive use in psychosis merits investigation. OBJECTIVE: To determine whether omega-3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents and young adults aged 13 to 25 years with subthreshold psychosis. DESIGN: Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007. SETTING: Psychosis detection unit of a large public hospital in Vienna, Austria. PARTICIPANTS: Eighty-one individuals at ultra-high risk of psychotic disorder. INTERVENTIONS: A 12-week intervention period of 1.2-g/d omega-3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months. MAIN OUTCOME MEASURES: The primary outcome measure was transition to psychotic disorder. Secondary outcomes included symptomatic and functional changes. The ratio of omega-6 to omega-3 fatty acids in erythrocytes was used to index pretreatment vs posttreatment fatty acid composition. RESULTS: Seventy-six of 81 participants (93.8%) completed the intervention. By study's end (12 months), 2 of 41 individuals (4.9%) in the omega-3 group and 11 of 40 (27.5%) in the placebo group had transitioned to psychotic disorder (P = .007). The difference between the groups in the cumulative risk of progression to full-threshold psychosis was 22.6% (95% confidence interval, 4.8-40.4). omega-3 Polyunsaturated fatty acids also significantly reduced positive symptoms (P = .01), negative symptoms (P = .02), and general symptoms (P = .01) and improved functioning (P = .002) compared with placebo. The incidence of adverse effects did not differ between the treatment groups. CONCLUSIONS: Long-chain omega-3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states. Trial Registration clinicaltrials.gov Identifier: NCT00396643. SN - 1538-3636 UR - https://www.unboundmedicine.com/medline/citation/20124114/full_citation L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=20124114.ui DB - PRIME DP - Unbound Medicine ER -