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Abstract
This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6–12. Mean time to follow-up was 3.4 (median = 3.3; SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11–13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the sample received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.
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Details
1 Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
2 Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Department of Psychiatry, Medical University of Vienna, Vienna, Austria
3 Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Department of Psychiatry, Medical University of Vienna, Vienna, Austria
4 Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
5 Department of Psychiatry, Medical University of Vienna, Vienna, Austria
6 University Hospital Jena, Jena, Germany
7 Brain and Mind Research Institute, University of Sydney, Sydney, Australia
8 Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
9 Department of Psychiatry, University of Hong Kong, Pokfulam, Hong Kong
10 Academic Medical Center, Amsterdam, The Netherlands
11 Psychiatric Centre Bispebjerg, Copenhagen, Denmark
12 Psychiatric University Clinics Basel, Basel, Switzerland
13 Institute of Mental Health, Singapore, Singapore
14 Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
15 Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK