Omega-3 polyunsaturated fatty acids
may reduce the risk of psychotic disorders in high-risk individuals
Individuals at extremely high risk of developing psychosis
appear less likely to develop psychotic disorders following a 12-week course of
fish oil capsules containing long-chain omega-3 polyunsaturated fatty acids, according
to a report in the February issue of Archives of General Psychiatry, one of the
JAMA/Archives journals.
"Early treatment in schizophrenia and other psychoses
has been linked to better outcomes," the authors write as background information
in the article. "Given that subclinical psychotic symptoms may predict psychotic
disorder and psychosis proneness in a population may be related to the rate of
psychotic disorder, intervention in at-risk individuals holds the promise of even
better outcomes, with the potential to prevent full-blown psychotic disorders."
Long-chain omega-3 polyunsaturated fatty acids are a
promising intervention in individuals with schizophrenia, who may have an underlying
dysfunction in fatty acid metabolism, the authors note. G. Paul Amminger, M.D.,
of Medical University of Vienna, Austria, and Orygen Youth Health Research Centre,
Melbourne, Australia, conducted a randomized, double-blind, placebo-controlled
clinical trial of their effect on the risk of progression to psychosis in 81 individuals
at ultra-high risk. These individuals either had mild psychotic symptoms, transient
psychosis or a family history of psychotic disorders plus a decrease in functioning.
These criteria identify individuals whose risk of becoming psychotic may be as
high as 40 percent in a 12-month period.
For 12 weeks, 41 individuals were assigned to take daily
fish oil capsules containing 1.2 grams of omega-three polyunsaturated fatty acids
and 40 were assigned to take placebo; a total of 76 (93.8 percent) completed the
intervention. By the end of the study, two (4.9 percent) in the omega-3 group
and 11 (27.5 percent) in the placebo group had transitioned to psychotic disorder.
The difference between progression to psychosis was 22.6 percent.
Based on the results, the authors estimate that four
adults would need to be treated with omega-3 fatty acids to prevent one from developing
psychosis over a 12-month period. Polyunsaturated fatty acids also significantly
reduced symptoms and improved functioning compared with placebo. Rates of adverse
effects were minimal and similar between the two groups.
The potential effects of fatty acids on psychosis development
may result from changes to cell membranes and interactions with neurotransmitter
systems in the brain, the authors note. "The finding that treatment with a natural
substance may prevent or at least delay the onset of psychotic disorder gives
hope that there may be alternatives to antipsychotics for the prodromal phase,"
the authors write. "Stigmatization and adverse effects-which include metabolic
changes, sexual dysfunction and weight gain-associated with the use of antipsychotics
are often not acceptable for young people."
In contrast, omega-3 fatty acids may cause some digestive
complications but largely "are free of clinically relevant adverse effects. They
have the advantage of excellent tolerability, public acceptance, relatively low
costs and benefits for general health," the authors conclude. "Long-chain omega-3
fatty polyunsaturated fatty acids 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."
This study was supported by a grant from the Stanley
Medical Research Institute.
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