Arch Gen Psychiatry. 2010 Feb;67(2):146-54
Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, Berger GE
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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Schizophrenia is a devastating mental illness that affects about 1.1 percent of people across the world in every culture.
The best that current antipsychotic medications can do in chronically ill patients is about a 4% reduction in the severity of symptoms on average. A 20% reduction in the severity of symptoms can be obtained if the illness is caught at first-break – if you are lucky. On whole, antipsychotic medications – the best treatment we have – only partially treats the illness, leaving the person still severely ill and disabled. The smaller number of cases where there is a spectacular effect gives the impression that they can work well. However, in the vast majority of people, this is not the case.
Schizophrenia is a complex illness with multiple pathophysiologies. Dopamine signaling problems – the primary target over the past 40 years – is only one contributing factor. The other contributing factors include problems with other neurotransmitters, hormones, proinflammatory cytokines, metabolism and nutrition. There are neurodegenerative aspects to the illness which make full recovery difficult since restoring neural circuitry is extremely difficult. But if we can identify and target the other contributing causes of schizophrenia, if we can develop treatments that restructure the brain and promote neurogenesis, and if we develop psychotherapies which can help the remaining brain compensate for the dysfunctional units in the brain, we can go a longer way toward improving outcome and mental health. Yes, psychotherapy is a huge component of treatment which is unfortunately often left out of consideration in mental health systems.
A contributing factor in schizophrenia are an increase in immune system proinflammatory activity.
There was one study demonstrating how augmenting treatment with ibuprofen can help reduce psychotic symptoms. This article demonstrates how omega-3 fatty acids – which also work through the COX-2 enzyme – can help not only prevent the development of psychotic symptoms (at least postpone it) but also reduce the severity of symptoms and improve functioning. Both of these interventions work by reducing pro-inflammatory cytokine signaling.
Of course, this begs the rhetorical question: Does poor nutrition (as exists with modern diets – with low-omega-3 content and multiple nutrient deficiencies) a contributing factor to the development of schizophrenia in susceptible individuals?