Omega-3 vetzuren tegen Psychotische stoornissen*
Uit een kleine Oostenrijkse studie onder 80 personen in de leeftijd van 13-25 jaar, met een sterk verhoogde kans op een psychotische stoornis blijken
omega-3 vetzuren een psychose te kunnen voorkomen. Twaalf weken kreeg de helft van de deelnemers iedere dag een supplement van 1,2 gram omega-3 vetzuren, de andere helft kreeg een placebo. Daarna werden de deelnemers 40 weken lang gevolgd. Aan het eind van de studie bleek dat slechts 2 van de 41 personen in de omega-3 groep een psychotische stoornis had tegen 11 van de 40 personen in de placebogroep. De personen in de omega-3 groep voelden zich ook beter. Er was geen verschil in bijwerkingen bij personen in beide groepen.
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
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.
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.
PMID: 20124114 [PubMed - indexed for MEDLINE]
(Mei 2010)
