Long-Chain ω-3 Fatty Acids for Indicated Prevention of Psychotic Disorders A Randomized, Placebo-Controlled Trial
Long-Chain ω-3 Fatty Acids for Indicated Prevention of Psychotic Disorders A Randomized, Placebo-Controlled Trial
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DOI：
10.1001/archgenpsychiatry.2009.192
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发表时间：
2010-02-01
影响因子：
--
通讯作者：
Berger, Gregor E.
中科院分区：
文献类型：
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作者：
Amminger, G. Paul;Schafer, Miriam R.;Berger, Gregor E.
背景：使用抗精神病药物预防精神障碍是有争议的。长链omega-3 （omega-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omega-3 PUFAs通常对健康有益且没有临床相关的不良影响，其在精神病中的预防应用值得研究。目的：确定omega-3 PUFAs是否能降低13 - 25岁阈下精神病青少年和年轻人的首发精神病进展率。设计：2004年至2007年间进行的随机、双盲、安慰剂对照试验。地点：奥地利维也纳一家大型公立医院的精神病检测部门。参与者：81名超高风险精神病患者。干预措施：12周的干预期为1.2g/d的omega-3 PUFA或安慰剂，随后是40周的监测期；总研究期为12个月。主要结局指标：主要结局指标为向精神障碍的过渡。次要结局包括症状和功能改变。红细胞中omega-6与omega-3脂肪酸的比例用于指标预处理与后处理脂肪酸组成。结果：81名参与者中有76人（93.8%）完成了干预。在研究结束时（12个月），41名omega-3组患者中有2人（4.9%）和40名安慰剂组患者中有11人（27.5%）转变为精神障碍（P=.007）。两组之间进展为完全阈值精神病的累积风险差异为22.6%（95%可信区间为4.8-40.4）。与安慰剂相比，omega-3多不饱和脂肪酸还能显著减轻阳性症状（P= 0.01）、阴性症状（P= 0.02）和一般症状（P= 0.01），并改善功能（P= 0.002）。不良反应的发生率在治疗组之间没有差异。结论：长链omega-3 PUFAs可降低进展为精神障碍的风险，并可能为具有阈下精神状态的年轻人提供安全有效的预防策略。
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 1.2g/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.