G Paul Amminger1, Barnaby Nelson2, Connie Markulev2, Hok Pan Yuen2, Miriam R Schäfer2, Maximus Berger2, Nilufar Mossaheb3, Monika Schlögelhofer3, Stephan Smesny4, Ian B Hickie5, Gregor E Berger6, Eric Y H Chen7, Lieuwe de Haan8, Dorien H Nieman8, Merete Nordentoft9, Anita Riecher-Rössler10, Swapna Verma11, Andrew Thompson2, Alison Ruth Yung12, Patrick D McGorry2. 1. Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia. Electronic address: amminger@unimelb.edu.au. 2. Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia. 3. Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria. 4. Department of Psychiatry, Jena University Hospital, Jena, Germany. 5. Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia. 6. Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland. 7. Department of Psychiatry, University of Hong Kong, Hong Kong, China. 8. Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands. 9. Psychiatric Centre Bispebjerg, Copenhagen, Denmark. 10. University Psychiatric Clinics Basel, Basel, Switzerland. 11. Institute of Mental Health, Singapore. 12. Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, United Kingdom.
Abstract
BACKGROUND: NEURAPRO was a multicenter, placebo-controlled trial of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) in 304 individuals at ultra-high risk for psychotic disorders. The study failed to show benefits of n-3 PUFAs over placebo. Although the randomized controlled trial design is placed at the top of the evidence hierarchy, this methodology has limitations in fish oil randomized controlled trials, as not only is the test agent present in the intervention group, but also n-3 fats are present in the diet and the body tissue of all participants. METHODS: Analysis of biomarker data (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA], n-3 index, EPA+DHA) collected as part of NEURAPRO was conducted on 218 participants with longitudinal biomarker data to determine if n-3 PUFAs measured in erythrocytes at baseline and month 6 predicted clinical outcomes. RESULTS: Increases of the n-3 index, EPA, and DHA predicted less severe psychopathology and better functioning at both follow-up time points. Higher baseline levels and increases of n-3 index also predicted overall clinical improvement at month 6 (n-3 index baseline: adjusted odds ratio [95% confidence interval (CI)] = 1.79 [1.30-2.48]; n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.43 [1.16-1.76]) and at month 12 (n-3 index baseline: adjusted odds ratio [95% CI] = 2.60 [1.71-3.97]; n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.36 [1.06-1.74]). CONCLUSIONS: These data suggest that n-3 PUFAs can exert therapeutic effects in ultra-high-risk individuals. This finding has implications for early intervention and treatment guidelines, as n-3 PUFA supplementation can easily and safely be used in a wide variety of settings, from primary care to specialist services.
RCT Entities:
BACKGROUND: NEURAPRO was a multicenter, placebo-controlled trial of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) in 304 individuals at ultra-high risk for psychotic disorders. The study failed to show benefits of n-3 PUFAs over placebo. Although the randomized controlled trial design is placed at the top of the evidence hierarchy, this methodology has limitations in fish oil randomized controlled trials, as not only is the test agent present in the intervention group, but also n-3 fats are present in the diet and the body tissue of all participants. METHODS: Analysis of biomarker data (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA], n-3 index, EPA+DHA) collected as part of NEURAPRO was conducted on 218 participants with longitudinal biomarker data to determine if n-3 PUFAs measured in erythrocytes at baseline and month 6 predicted clinical outcomes. RESULTS: Increases of the n-3 index, EPA, and DHA predicted less severe psychopathology and better functioning at both follow-up time points. Higher baseline levels and increases of n-3 index also predicted overall clinical improvement at month 6 (n-3 index baseline: adjusted odds ratio [95% confidence interval (CI)] = 1.79 [1.30-2.48]; n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.43 [1.16-1.76]) and at month 12 (n-3 index baseline: adjusted odds ratio [95% CI] = 2.60 [1.71-3.97]; n-3 PUFA increase: adjusted odds ratio [95% CI] = 1.36 [1.06-1.74]). CONCLUSIONS: These data suggest that n-3 PUFAs can exert therapeutic effects in ultra-high-risk individuals. This finding has implications for early intervention and treatment guidelines, as n-3 PUFA supplementation can easily and safely be used in a wide variety of settings, from primary care to specialist services.
Authors: Philip R Szeszko; Robert K McNamara; Juan A Gallego; Anil K Malhotra; Usha Govindarajulu; Bart D Peters; Delbert G Robinson Journal: Schizophr Res Date: 2021-01-11 Impact factor: 4.939
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Authors: David Mongan; Colm Healy; Hannah J Jones; Stan Zammit; Mary Cannon; David R Cotter Journal: Transl Psychiatry Date: 2021-05-31 Impact factor: 6.222
Authors: Barnaby Nelson; G Paul Amminger; Andrew Thompson; Stephen J Wood; Alison R Yung; Patrick D McGorry Journal: Front Psychiatry Date: 2020-05-27 Impact factor: 4.157
Authors: Dorien H Nieman; UnYoung Chavez-Baldini; Nienke C Vulink; Dirk J A Smit; Guido van Wingen; Pelle de Koning; Arjen L Sutterland; Roel J T Mocking; Claudi Bockting; Karin J H Verweij; Anja Lok; Damiaan Denys Journal: BMC Psychiatry Date: 2020-05-11 Impact factor: 3.630