20 Aug 2015 - Medscape - Omega-3 Treatment Shows Long-term Psychosis Prevention

Adolescents and young adults considered to be at high risk for psychosis show significant reductions in progression to psychotic disorder 7 years after a brief, 12-week intervention of omega-3 polyunsaturated fatty acids (PUFAs) compared with a group receiving placebo, a new study shows.

"This is the first study to show, to the best of our knowledge, that a 12-week intervention with omega-3 PUFAs prevented transition to full-threshold psychotic disorder and led to sustained symptomatic and functional improvements in young people with an at-risk mental state for [a median of] 7 years," the authors, led by G. Paul Amminger, MD, of the University of Melbourne, Australia, conclude.

The new research was published online August 11 in Nature Communications.

For the double-blind study, 81 patients (mean age, 16.5 years) who were considered to be at "ultra-high" risk for psychosis were treated for 12 weeks with daily supplementation of either fish oil capsules, providing omega-3 PUFAs of 700 mg of eicosapentaenoic acid (EPA) and 480 mg of docosahexaenoic acid (DHA) (n = 41), or placebo capsules matched in appearance and flavor with the active treatment (n = 40).

An earlier assessment of the patients at 12 months showed that those receiving the omega-3 intervention had a reduced risk for transition to psychotic disorder compared with those receiving placebo (P = .007).

In the new analysis, following up 71 of the original 81 patients at a median of 6.7 years from baseline, the cumulative conversion rate to psychosis was 9.8% in the omega-3 PUFA group, compared with 40% in the placebo group, with a more rapid conversion time in the placebo group among those who did develop psychosis (P < .0002).

Changes in scores on the Positive and Negative Syndrome Scale were significantly greater for the omega-3 PUFA group in the longer-term follow-up in terms of total scores (P = .003), positive and general scores (each P = .002), and, to a lesser degree, negative scores (P = .02).

Differences in the Montgomery-Åsberg Depression Rating Scale were not statistically significant (P = .117), and the omega-3 PUFA group had significantly higher functioning than the group receiving placebo, as reflected in Global Assessment of Functioning scores (P = .01).

The proportion of patients who reported being prescribed antipsychotic medication at the time of long-term follow-up was 29.4% in the omega-3 PUFA group, compared with 54.3% in the placebo group (P = .04).

Among those in the placebo group, 82.9% met the criteria for at least one DSM-IV Axis I disorder during the long-term follow-up period, compared with 52.9% in the omega-3 PUFA group (P = .008).

Even when ultra-high-risk patients do not convert to psychosis, research suggests their functioning outcomes can be poor. However, in looking at the patients with attenuated psychosis in the omega-3 PUFA group, only 6.7% had severe functional impairment, and as many as 70% were employed full-time, the authors note.

"The majority of the individuals from the omega-3 group did not show severe functional impairment, were employed full-time, and no longer experienced attenuated psychotic symptoms at follow- up," they note