McGorry, Patrick D., Nelson, Barnaby, Markulev, Connie, Yuen, Hok Pan, Schäfer, Miriam R., Mossaheb, Nilufar, Schlögelhofer, Monika, Smesny, Stephan, Hickie, Ian B., Berger, Gregor Emanuel, Chen, Eric Y. H., de Haan, Lieuwe, Nieman, Dorien H., Nordentoft, Merete, Riecher-Rössler, Anita, Verma, Swapna, Thompson, Andrew David, Yung, Alison Ruth and Amminger, Paul (2017) Effect of ω-3 polyunsaturated fatty acids in young people at ultrahigh risk for psychotic disorders. JAMA Psychiatry, 74 (1). pp. 19-27. doi:10.1001/jamapsychiatry.2016.2902

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Abstract

Importance: A promising treatment to prevent onset and improve outcomes in patients at ultrahigh risk for psychosis is dietary supplementation with long-chain ω-3 polyunsaturated fatty acids (PUFAs).
Objective: To determine whether treatment with ω-3 PUFAs in combination with a high-quality psychosocial intervention (cognitive behavioral case management [CBCM]) is more effective than placebo plus CBCM.
Design, Setting, AND Participants: NEURAPRO, a double-blind, placebo-controlled, randomized clinical trial, was conducted from March 1, 2010, to September 30, 2014, in 10 specialized early psychosis treatment services in Australia, Asia, and Europe. The primary analysis used the intention-to-treat approach. INTERVENTIONS A daily dose of 1.4 g of ω-3 PUFAs or placebo (paraffin oil), plus 20 or fewer sessions of CBCM over the 6-month study period.
Main outcomes and measures: The primary outcome was transition to psychosis status at 6 months. The secondary outcomes were general levels of psychopathology and functioning, as assessed by the Brief Psychiatric Rating Scale (BPRS) (range, 24-168), Scale for the Assessment of Negative Symptoms (SANS) (range, 0-125), Montgomery-Åsberg Depression Rating Scale (MADRS) (range, 0-60), Young Mania Rating Scale (YMRS) (range, 0-44), Social and Occupational Functioning Assessment Scale (SOFAS) (range, 0-100), and the Global Functioning: Social and Role scale (range, 0-10). For SOFAS and Global Functioning: Social and Role scale, higher scores were better; for other measures, lower scores were better.
Results: In this study of 304 adults at ultrahigh risk for psychotic disorders, 153 (50.3%) received ω-3 PUFAs and 151 (49.7%) received placebo. In all, 139 (45.7%) were male; mean (SD) age was 19.1 (4.6) years. The Kaplan-Meier–estimated 6-month transition rates were 5.1% (95% CI, 1.3%- 8.7%) in the control group and 6.7% (95% CI, 2.3%-10.8%) in the ω-3 PUFA group. At 12 months, the rates were 11.2% (95% CI, 5.5%-16.7%) in the control group and 11.5% (95% CI, 5.8%-16.9%) in the ω-3 PUFA group. No significant difference was observed between the transition rates of both groups (hazard ratio, 1.1; 95% CI, 0.55-2.23; P = .76, stratified log-rank test).
Conclusions and relevance: This trial clearly failed to replicate the findings of the original single-center trial. The most likely explanation is that ω-3 PUFAs lack efficacy under these conditions. However, the lower-than-expected transition rate may have prevented a test of the main hypothesis. Given the substantial symptomatic and functional improvement in both groups, the other treatments received (ie, CBCM and antidepressants) likely produced a ceiling effect beyond which ω-3 PUFAs, even if effective, could not be shown to confer additional benefits. Nevertheless, the main conclusion is that ω-3 PUFAs are not effective under conditions where good quality, evidence-based psychosocial treatment is available.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Youth -- Psychoses -- Prevention, Omega-3 fatty acids
Journal or Publication Title:	JAMA Psychiatry
Publisher:	American Medical Association
ISSN:	2168-622X
Official Date:	January 2017
Dates:	Date Event January 2017 Published 23 November 2016 Available 14 September 2016 Accepted
Date of first compliant deposit:	16 January 2017
Volume:	74
Number:	1
Page Range:	pp. 19-27
DOI:	10.1001/jamapsychiatry.2016.2902
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	Stanley Medical Research Institute (SMRI), National Health and Medical Research Council (Australia) (NHMRC) , Colonial Foundation Trust
Grant number:	Grant 07TGF-1102 (SMRI), ID: 566529, ID: 1060996, ID: 1080963 ID: 566593, ID: 1027532 (NHMRC)
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 07TGF-1102 Stanley Medical Research Institute http://dx.doi.org/10.13039/100007123 566529 National Health and Medical Research Council http://dx.doi.org/10.13039/501100000925 1060996 National Health and Medical Research Council http://dx.doi.org/10.13039/501100000925 1080963 National Health and Medical Research Council http://dx.doi.org/10.13039/501100000925 566593 National Health and Medical Research Council http://dx.doi.org/10.13039/501100000925 1027532 National Health and Medical Research Council http://dx.doi.org/10.13039/501100000925 UNSPECIFIED Colonial Foundation Trust UNSPECIFIED
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