Department of Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
J Child Psychol Psychiatry. 2018 Jun;59(6):628-636. doi: 10.1111/jcpp.12830. Epub 2017 Oct 24.
Improvements in executive functioning (EF) may lead to improved quality of life and lessened functional impairment for children with mood disorders. The aim was to assess the impact of omega-3 supplementation (Ω3) and psychoeducational psychotherapy (PEP), each alone and in combination, on EF in youth with mood disorders. We completed secondary analyses of two randomized controlled trials (RCTs) of Ω3 and PEP for children with depression and bipolar disorder.
Ninety-five youths with depression or bipolar disorder not otherwise specified/cyclothymic disorder were randomized in 12-week RCTs. Two capsules (Ω3 or placebo) were given twice daily (1.87 g Ω3 total daily, mostly eicosapentaenoic acid). Families randomized to PEP participated in twice-weekly 50-min sessions. Analyses assess impact of interventions on the Behavior Rating Inventory of Executive Functioning (BRIEF) parent-report Global Executive Composite (GEC) and two subscales, Behavior Regulation (BRI) and Metacognition (MI) Indices. Intent-to-treat repeated measures ANOVAs, using multiple imputation for missing data, included all 95 randomized participants. Trials were registered with www.clinicaltrials.gov, NCT01341925 & NCT01507753.
Participants receiving Ω3 (aggregating combined and monotherapy) improved significantly more than aggregated placebo on GEC (p = .001, d = .70), BRI (p = .004, d = .49), and MI (p = .04, d = .41). Ω3 alone (d = .49) and combined with PEP (d = .67) each surpassed placebo on GEC. Moderation by attention-deficit/hyperactivity disorder (ADHD) comorbidity was nonsignificant although those with ADHD showed nominally greater gains. PEP monotherapy had negligible effect.
Decreased impairment in EF was associated with Ω3 supplementation in youth with mood disorders. Research examining causal associations of Ω3, EF, and mood symptoms is warranted.
执行功能（EF）的改善可能会提高患有情绪障碍的儿童的生活质量并减轻其功能损伤。本研究旨在评估 ω-3 补充剂（Ω3）和心理教育心理疗法（PEP）单独和联合使用对情绪障碍青少年 EF 的影响。我们对两项关于 Ω3 和 PEP 治疗儿童抑郁症和双相情感障碍的随机对照试验（RCT）进行了二次分析。
95 名患有抑郁症或未特指的双相情感障碍/环性心境障碍的青少年被纳入为期 12 周的 RCT 中，并随机分为两组，每日两次服用 2 粒胶囊（Ω3 或安慰剂）（总剂量为 1.87g 的 Ω3，主要为二十碳五烯酸）。随机接受 PEP 的家庭参加每周两次的 50 分钟课程。分析评估干预措施对行为评定量表的执行功能（BRIEF）家长报告的综合执行功能（GEC）和两个子量表，行为调节（BRI）和元认知（MI）指数的影响。采用意向治疗重复测量方差分析，对缺失数据进行多重插补，包括所有 95 名随机参与者。这些试验已在 www.clinicaltrials.gov 上注册，NCT01341925 和 NCT01507753。
接受 Ω3（合并联合和单药治疗）的参与者在 GEC（p = 0.001，d = 0.70）、BRI（p = 0.004，d = 0.49）和 MI（p = 0.04，d = 0.41）上的改善显著大于安慰剂。Ω3 单独（d = 0.49）和与 PEP 联合（d = 0.67）均优于 GEC 上的安慰剂。注意缺陷多动障碍（ADHD）共病的调节作用无统计学意义，但 ADHD 患者的获益更大。PEP 单药治疗的效果可以忽略不计。
情绪障碍青少年中，EF 损伤减少与 Ω3 补充有关。有必要开展研究来检验 Ω3、EF 和情绪症状之间的因果关系。
