Amminger G Paul, Schäfer Miriam R, Papageorgiou Konstantinos, Klier Claudia M, Cotton Sue M, Harrigan Susan M, Mackinnon Andrew, McGorry Patrick D, Berger Gregor E
Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
Arch Gen Psychiatry. 2010 Feb;67(2):146-54. doi: 10.1001/archgenpsychiatry.2009.192.
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.
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.
Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007.
Psychosis detection unit of a large public hospital in Vienna, Austria.
Eighty-one individuals at ultra-high risk of psychotic disorder.
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.
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.
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.
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.
使用抗精神病药物预防精神障碍存在争议。长链ω-3（ω-3）多不饱和脂肪酸（PUFAs）可能对包括精神分裂症在内的一系列精神疾病有益。鉴于ω-3 PUFAs通常对健康有益且无临床相关不良反应，对其在精神病预防中的应用进行研究很有必要。
确定ω-3 PUFAs是否能降低13至25岁有阈下精神病的青少年和年轻人发展为首发精神病性障碍的发生率。
2004年至2007年进行的随机、双盲、安慰剂对照试验。
奥地利维也纳一家大型公立医院的精神病检测科室。
81名处于精神病性障碍超高风险的个体。
1.2克/天的ω-3 PUFA或安慰剂的12周干预期，随后是40周的监测期；总研究期为12个月。
主要结局指标是发展为精神病性障碍。次要结局包括症状和功能变化。红细胞中ω-6与ω-3脂肪酸的比例用于衡量治疗前与治疗后脂肪酸组成。
81名参与者中有76名（93.8%）完成了干预。到研究结束时（12个月），ω-3组41名个体中有2名（4.9%）发展为精神病性障碍，安慰剂组40名中有11名（27.5%）发展为精神病性障碍（P = 0.007）。两组在发展为完全阈上精神病的累积风险上的差异为22.6%（95%置信区间，4.8 - 40.4）。与安慰剂相比，ω-3多不饱和脂肪酸还显著减轻了阳性症状（P = 0.01）、阴性症状（P = 0.02）和一般症状（P = 0.01），并改善了功能（P = 0.002）。治疗组之间不良反应的发生率没有差异。
长链ω-3 PUFAs可降低发展为精神病性障碍的风险，并可能为有阈下精神病状态的年轻人提供一种安全有效的针对性预防策略。试验注册 clinicaltrials.gov标识符：NCT00396643。
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