Omega-3 Fatty Acids in
Preventing Psychotic Disorders

Summary

This is a randomized, double-blind, placebo-controlled, 12-week trial of long-chain omega-3 polyunsaturated fatty acids (PUFAs) in adolescents and young adults aged 13-25 years with subthreshold psychosis. The study was conducted in Austria, and there was a 40-week monitoring period. The objective was to determine whether PUFAs reduce the rate of progression to first-episode psychotic disorder. Seventy-six of 81 participants (93.8%) completed the intervention. By study's end at 12 months, 2 of 41 individuals (4.9%) in the PUFA group and 11 of 40 (27.5%) in the placebo group had transitioned to psychotic disorder ( P = .007). The incidence of adverse effects did not differ between the treatment groups.

Viewpoint

Many patients who develop a psychotic disorder have a history of prior change in behavior, mood, cognition, and overall function. It is unknown how many adolescents and young adults actually present for treatment with subthreshold psychosis. When they do, we have limited means of treating them. More typically, patients come for psychiatric treatment once they have become psychotic. It would be ideal to be able to systematically identify patients at risk and prevent progression of illness, and several research groups have endeavored to do that.

That said, interventions typically employed are antipsychotics, antidepressants, and cognitive-behavioral therapy. The use of antipsychotics is particularly controversial because of their adverse-effect profile and the knowledge that a substantial proportion of patients in a pre-psychotic state never go on to develop psychosis. Amminger and colleagues proposed that PUFAs can be used and achieve similar effect sizes in the prevention of progression to psychosis compared to potentially more toxic agents. Number needed to treat to avoid an additional progression to psychosis was 5 (rounded up from 4.4) calculated from all randomly sampled patients (95% confidence interval, 3-14), putting it in the range of agents that are routinely accepted as efficacious for psychiatric disorders in general. The efficacy and effectiveness with long-term continued administration of PUFAs in this population remain unknown. Care must be taken to not generalize this outcome to the treatment of psychotic disorders in general, in which the utility of PUFAs, used as a monotherapy or adjunctively, remains unclear.

Authors and Disclosures

Leslie Citrome, MD, MPH

Professor, Department of Psychiatry, New York University School of Medicine, New York, NY; Director, Clinical Research and Evaluation Facility, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY Disclosure: Leslie L. Citrome, MD, MPH, has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Azur Pharma Inc.; Eli Lilly and Company; Forest Research Institute; GlaxoSmithKline; Janssen Pharmaceuticals Products, L.P; Merck & Co, Inc.; Pfizer Inc.; Vanda Pharmaceuticals Inc. Served as a speaker or a member of a speakers bureau: Abbott Laboratories; AstraZeneca Pharmaceuticals LP; Azur Pharma Inc.; Eli Lilly and Company; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc. Received grants for clinical research from: Abbott Laboratories; AstraZeneca Pharmaceuticals LP; Barr Laboratories, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; Janssen Pharmaceuticals Products, L.P; Pfizer Inc. Owns stock, stock options or bonds from: Abbott Laboratories; Bristol-Myers Squibb Company; Eli Lilly and Company; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Merck & Co., Inc.; Pfizer Inc.

-From: “ Omega-3 Fatty Acids in Preventing Psychotic Disorders”, Leslie Citrome, MD, MPH, Medscape Psychiatry & Mental Health : Viewpoints, posted: 03/01/2010, reviewing “Long-Chain Omega-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial”, Amminger GP, Schäfer MR, Papageorgiou K, et al,
Arch Gen Psychiatry. 2010;67:146-154. http://www.medscape.com/viewarticle/717514 retrieved 3/10/10.

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