{"id":21418,"date":"2012-03-20T22:37:51","date_gmt":"2012-03-21T02:37:51","guid":{"rendered":"http:\/\/1boringoldman.com\/index.php\/"},"modified":"2012-03-20T22:37:51","modified_gmt":"2012-03-21T02:37:51","slug":"early-intervention-studies","status":"publish","type":"page","link":"https:\/\/1boringoldman.com\/index.php\/early-intervention-studies\/","title":{"rendered":"early intervention studies&#8230;"},"content":{"rendered":"<ol>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12365879\" target=\"_blank\"><u><strong><font color=\"#200020\">Randomized   controlled trial of interventions designed to reduce the risk of   progression to first-episode psychosis in a clinical sample with   subthreshold symptoms<\/font><\/strong><\/u><\/a>.<br \/>               <sup>by McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, McDonald T, Blair A, Adlard S, and Jackson H.<\/sup><br \/>               <strong><font color=\"#200020\">Arch Gen Psychiatry<\/font><\/strong>. 2002 59(10):921-8. <\/p>\n<div align=\"justify\">[<a href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/content\/full\/59\/10\/921\" target=\"_blank\"><u><strong><font color=\"#200020\">full text on-line<\/font><\/strong><\/u><\/a>]<\/div>\n<ul>\n<div><sup><u><strong><font color=\"#200020\">BACKGROUND<\/font><\/strong><\/u>:  Most  disability produced by psychotic illnesses, especially  schizophrenia,  develops during the prepsychotic period, creating a case  for  intervention during this period. However, only recently has it  been  possible to engage people in treatment during this phase.<br \/>                       <u><strong><font color=\"#200020\">METHODS<\/font><\/strong><\/u>:  A  randomized controlled trial compared 2 interventions in 59 patients  at  incipient risk of progression to first-episode psychosis. We termed  this  group ultra-high risk to emphasize the enhanced risk vs  conventional  genetic high-risk studies. Needs-based intervention was  compared with  specific preventive intervention comprising low-dose  risperidone therapy  (mean dosage, 1.3 mg\/d) and cognitive behavior  therapy. Treatment was  provided for 6 months, after which all patients  were offered ongoing  needs-based intervention. Assessments were  performed at baseline, 6  months, and 12 months.<br \/>                       <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  By the end of treatment,  10 of 28 people who received needs-based  intervention progressed to  first-episode psychosis vs 3 of 31 from the  specific preventive  intervention group (P=.03). After 6-month  follow-up, another 3 people in  the specific preventive intervention  group became psychotic, and with  intention-to-treat analysis, the  difference was no longer significant  (P=.24). However, for risperidone  therapy-adherent patients in the  specific preventive intervention  group, protection against progression  extended for 6 months after  cessation of risperidone use.<br \/>                       <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>:  More  specific pharmacotherapy and psychotherapy reduces the risk of  early  transition to psychosis in young people at ultra-high risk,  although  their relative contributions could not be determined. This  represents at  least delay in onset (prevalence reduction), and possibly  some  reduction in incidence.<\/sup><\/div>\n<\/ul><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><u><strong><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12271805\"><font color=\"#200020\">Randomised   controlled trial of early detection and cognitive therapy for   preventing transition to psychosis in high-risk individuals. Study   design and interim analysis of transition rate and psychological risk   factors.<\/font><\/a><\/strong><\/u><br \/>               <sup>by Morrison AP, Bentall RP, French P, Walford L, Kilcommons A, Knight A, Kreutz M, and Lewis SW.<\/sup><br \/>               <strong><font color=\"#200020\">British Journal of Psychiatry<\/font><\/strong> Supplement 2002 43:s78-84.<\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">BACKGROUND<\/font><\/strong><\/u>:  There  is interest in the possibility of indicated prevention of  psychosis.  There is a strong case for using psychological approaches to  prevent  transition to psychosis in high-risk patients.<br \/>                                     <u><strong><font color=\"#200020\">AIMS<\/font><\/strong><\/u>:  To  identify individuals at high risk of transition to psychosis, and   psychological characteristics relevant to the development of psychosis   in this group.<br \/>                                     <u><strong><font color=\"#200020\">METHOD<\/font><\/strong><\/u>:  The design of a randomised  controlled trial of cognitive therapy for  the prevention of psychosis in  people at high risk (meeting operational  criteria of brief or  attenuated psychotic symptoms, or first-degree  family history with  functional decline) is outlined. The first patients  recruited are  compared with non-patient samples on cognitive and  personality factors;  an interim analysis of transition rate is  reported.<br \/>                                     <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  Cases  (n = 31) were recruited mainly from primary care. Of the 23  high-risk  patients monitored for 6-12 months, 5 (22%) made the  transition to  psychosis. The high-risk group scored significantly  higher than  non-patients on measures of schizotypy, metacognitive  beliefs and  dysfunctional self-schemas (sociotropy).<br \/>                                     <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>:  The  findings validate the methods of identifying individuals at high  risk  of experiencing a psychotic episode. Compared with non-patient  controls,  the cases showed dysfunctional metacognitive beliefs and  self-schemas. <\/sup><\/div>\n<\/ul>\n<div align=\"justify\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15458988\" target=\"_blank\"><u><strong><font color=\"#200020\">Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial.<\/font><\/strong><\/u><\/a><br \/>               <sup>by Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, Parker S, and Bentall RP.<\/sup><br \/>               <strong><font color=\"#200020\">British Journal of Psychiatry<\/font><\/strong> . 2004 185:291-7. <\/p>\n<div align=\"justify\">[<a href=\"http:\/\/bjp.rcpsych.org\/content\/185\/4\/291.long\" target=\"_blank\"><u><strong><font color=\"#200020\">full text online<\/font><\/strong><\/u><\/a>]<\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">BACKGROUND<\/font><\/strong><\/u>:  Advances  in the ability to identify people at high risk of developing  psychosis  have generated interest in the possibility of preventing  psychosis.<br \/>                                   <u><strong><font color=\"#200020\">AIMS<\/font><\/strong><\/u>: To evaluate the efficacy of cognitive therapy for the prevention of transition to psychosis.<br \/>                                   <u><strong><font color=\"#200020\">METHOD<\/font><\/strong><\/u>:  A  randomised controlled trial compared cognitive therapy with  treatment  as usual in 58 patients at ultra-high risk of developing a  first episode  of psychosis. Therapy was provided over 6 months, and all  patients were  monitored on a monthly basis for 12 months.<br \/>                                   <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  Logistic  regression demonstrated that cognitive therapy significantly  reduced  the likelihood of making progression to psychosis as defined on  the  Positive and Negative Syndrome Scale over 12 months. In addition,  it  significantly reduced the likelihood of being prescribed  antipsychotic  medication and of meeting criteria for a DSM-IV diagnosis  of a psychotic  disorder. Analysis of covariance showed that the  intervention also  significantly improved positive symptoms of psychosis  in this population  over the 12-month period<br \/>                                   <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>: Cognitive therapy appears to be an acceptable and efficacious intervention for people at high risk of developing psychosis.<\/sup><\/div>\n<\/ul><\/div>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16973786\"><u><strong><font color=\"#200020\">Three-year   follow-up of a randomized controlled trial of cognitive therapy for  the  prevention of psychosis in people at ultrahigh risk<\/font><\/strong><\/u><\/a>.<br \/>               <sup>by Morrison AP, French P, Parker S, Roberts M, Stevens H, Bentall RP, and Lewis SW.<\/sup><br \/>               <strong><font color=\"#200020\">Schizophrenia Bulletin<\/font><\/strong>. 2007 33(3):682-7. <br \/>     [<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2526150\/?tool=pubmed\" target=\"_blank\"><u><strong><font color=\"#200020\">full text online<\/font><\/strong><\/u><\/a>]<\/div>\n<ul>\n<div align=\"justify\"><sup>There  have been recent advances in the  ability to identify people at high  risk of developing psychosis. This  has led to interest in the  possibility of preventing the development of  psychosis. A randomized  controlled trial compared cognitive therapy  (CT) over 6 months with  monthly monitoring in 58 patients meeting  criteria for ultrahigh risk of  developing a first episode of psychosis.  Participants were followed up  over a 3-year period. Logistic  regression demonstrated that CT  significantly reduced likelihood of  being prescribed antipsychotic  medication over a 3-year period, but it  did not affect transition to  psychosis defined using the Positive and  Negative Syndrome Scale (PANSS)  or probable Diagnostic and Statistical  Manual of Mental Disorders,  Fourth Edition diagnosis. However,  exploratory analyses revealed that CT  significantly reduced the  likelihood of making progression to psychosis  as defined on the PANSS  over 3 years after controlling for baseline  cognitive factors.  Follow-up rate at 3 years was 47%. There appear to be  enduring benefits  of CT over the long term, suggesting that it is an  efficacious  intervention for people at high risk of developing  psychosis.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18055943\"><u><strong><font color=\"#200020\">Effects  of cognitive therapy on the longitudinal development of psychotic  experiences in people at high risk of developing psychosis.<\/font><\/strong><\/u><\/a><br \/>               <sup>by French P, Shryane N, Bentall RP, Lewis SW, and Morrison AP.<\/sup><br \/>                  <strong><font color=\"#200020\">British Journal of Psychiatry<\/font><\/strong> Supplement&nbsp; 2007 51:s82-7.<\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">BACKGROUND<\/font><\/strong><\/u>:  There  have been recent advances in the identification of people at  high risk  of psychosis and psychological treatments have shown promise  for  prevention.<br \/>                             <u><strong><font color=\"#200020\">AIMS<\/font><\/strong><\/u>:  To compare the longitudinal course of  psychotic experiences and  emotional dysfunction in high-risk  participants receiving cognitive  therapy with those receiving treatment  as usual.<br \/>                             <u><strong><font color=\"#200020\">METHOD<\/font><\/strong><\/u>:  Data from a recent randomised  controlled trial of cognitive therapy  for people at risk of developing  psychosis were utilised to examine  three different statistical models  that were based on 432 measurements  of psychotic experiences and 421 of  emotional dysfunction  (anxiety-depression) contributed by 57  participants across the 13  measurement occasions (monthly monitoring for  a year).<br \/>                             <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  Psychotic experiences and emotional  dysfunction were correlated and  decreased significantly over the course  of the study, with most  improvement in the early months. The reduction  in positive symptoms,  but not emotional dysfunction, was enhanced by  allocation to cognitive  therapy.<br \/>                             <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>:  Psychotic  experiences and emotional dysfunction appear to interact in  people at  risk of developing psychosis. There appears to be a specific  benefit of  cognitive therapy.<\/sup><\/div>\n<\/ul>\n<\/li>\n<li>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16504481\"><strong><font color=\"#200020\">Transition rates from schizotypal disorder to psychotic disorder for first-contact patients included in the OPUS trial.<\/font><\/strong><\/a><br \/>               <sup><em><strong><font color=\"#200020\">A randomized clinical trial of integrated treatment and standard treatment.<\/font><\/strong><\/em><\/sup><br \/>               <sup>by Nordentoft M, Thorup A, Petersen L, Ohlenschlaeger J, Melau M, Christensen T&Oslash;, Krarup G, J&oslash;rgensen P, and Jeppesen P.<\/sup><br \/>               <strong><font color=\"#200020\">Schizophrenia Research<\/font><\/strong>. 2006 83(1):29-40.<\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">BACKGROUND<\/font><\/strong><\/u>:  Only a few randomized clinical trials have tested the effect on  transition rates of intervention programs for patients with  sub-threshold psychosis-like symptoms.<br \/>                 <u><strong><font color=\"#200020\">AIM<\/font><\/strong><\/u>:  To examine whether integrated treatment reduced transition to psychosis  for first-contact patients diagnosed with schizotypal disorder.<br \/>                 <u><strong><font color=\"#200020\">METHODS<\/font><\/strong><\/u>:  Seventy-nine patients were randomized to integrated treatment or  standard treatment. Survival analysis with multivariate Cox-regression  was used to identify factors determinant for transition to psychotic  disorder.<br \/>                 <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  In the multivariate model, male gender increased risk for transition to  psychotic disorder (relative risk=4.47, (confidence interval  1.30-15.33)), while integrated treatment reduced the risk (relative  risk=0.36 (confidence interval 0.16-0.85)). At two-year follow-up, the  proportion diagnosed with a psychotic disorder was 25.0% for patients  randomized to integrated treatment compared to 48.3% for patients  randomized to standard treatment.<br \/>                 <u><strong><font color=\"#200020\">CONCLUSION<\/font><\/strong><\/u>: Integrated treatment postponed or inhibited onset of psychosis in significantly more cases than standard treatment.<\/sup><\/div>\n<\/ul>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16648318\" target=\"_blank\"><u><strong><font color=\"#200020\">Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis<\/font><\/strong><\/u><\/a>.<br \/>               <sup>by  by McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, Woods  SW, Hawkins KA, Hoffman RE, Preda A, Epstein I, Addington D, Lindborg S,  Trzaskoma Q, Tohen M, and Breier A.<\/sup><br \/>               <strong><font color=\"#200020\">American Journal of Psychiatry<\/font><\/strong>. 2006 163(5):790-9.<br \/>                      [<a href=\"http:\/\/ajp.psychiatryonline.org\/cgi\/content\/full\/163\/5\/790\" target=\"_blank\"><u><strong><font color=\"#200020\">full text online<\/font><\/strong><\/u><\/a>]<\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">OBJECTIVE<\/font><\/strong><\/u>:  This  study assessed the efficacy of olanzapine in delaying or  preventing  conversion to psychosis and reducing symptoms in people with  prodromal  symptoms of schizophrenia.<br \/>                          <u><strong><font color=\"#200020\">METHOD<\/font><\/strong><\/u>:  This randomized trial  occurred at four North American clinics in the  Prevention Through Risk  Identification, Management, and Education  project. Outpatients received  olanzapine (5-15 mg\/day, N=31) or placebo  (N=29) during a 1-year  double-blind treatment period and no treatment  during a 1-year follow-up  period. Efficacy measures included the  conversion-to-psychosis rate and  Scale of Prodromal Symptoms scores.<br \/>                          <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  During the  treatment year, 16.1% of olanzapine patients and 37.9% of  placebo  patients experienced a conversion to psychosis, a nearly  significant  difference. The hazard of conversion among placebo patients  was about  2.5 times that among olanzapine-treated patients, which also  approached  significance. In the follow-up year, the conversion rate  did not differ  significantly between groups. During treatment, the mean  score for  prodromal positive symptoms improved more in the olanzapine  group than  in the placebo group, and the mixed-model repeated-measures   least-squares mean score showed significantly greater improvement   between weeks 8 and 28 with olanzapine. The olanzapine patients gained   significantly more weight (mean=8.79 kg, SD=9.05, versus mean=0.30 kg,   SD=4.24).<br \/>                          <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>:  A significant treatment difference  in the conversion-to-psychosis rate  was not demonstrated. However,  these results may be influenced by low  power. The nearly significant  differences suggest that olanzapine might  reduce the conversion rate and  delay onset of psychosis. Olanzapine  was efficacious for positive  prodromal symptoms but induced weight  gain. Further treatment research  in this phase of illness is warranted.<\/sup><\/div>\n<\/ul>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19670055\" target=\"_blank\"><u><strong><font color=\"#200020\">Randomized  controlled trial of interventions for young people at ultra-high risk  of psychosis: study design and baseline characteristics. .<\/font><\/strong><\/u><\/a><br \/>               <sup>by  Phillips LJ, Nelson B, Yuen HP, Francey SM, Simmons M, Stanford C, Ross  M, Kelly D, Baker K, Conus P, Amminger P, Trumpler F, Yun Y, Lim M,  McNab C, Yung AR, McGorry PD.<\/sup><br \/>               <strong><font color=\"#200020\">Aust N Z J Psychiatry<\/font><\/strong>. 2009 43(9):818-29. <\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">OBJECTIVE<\/font><\/strong><\/u>:  Intervention during the pre-psychotic period of illness holds the  potential of delaying or even preventing the onset of a full-threshold  disorder, or at least of reducing the impact of such a disorder if it  does develop. The first step in realizing this aim was achieved more  than 10 years ago with the development and validation of criteria for  the identification of young people at ultra-high risk (UHR) of  psychosis. Results of three clinical trials have been published that  provide mixed support for the effectiveness of psychological and  pharmacological interventions in preventing the onset of psychotic  disorder.<\/sup>                           <\/div>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">METHOD<\/font><\/strong><\/u>:The  present paper describes a fourth study that has now been undertaken in  which young people who met UHR criteria were randomized to one of three  treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n =  43); cognitive therapy plus placebo (CogTher + Placebo: n = 44); and  supportive counselling + placebo (Supp + Placebo; n = 28). A fourth  group of young people who did not agree to randomization were also  followed up (monitoring: n = 78). Baseline characteristics of  participants are provided.<\/sup>                           <\/div>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">RESULTS AND CONCLUSION<\/font><\/strong><\/u>:  The present study improves on the previous studies because treatment  was provided for 12 months and the independent contributions of  psychological and pharmacological treatments in preventing transition to  psychosis in the UHR cohort and on levels of psychopathology and  functioning can be directly compared. Issues associated with recruitment  and randomization are discussed.     <\/sup>                           <\/div>\n<\/ul>\n<div align=\"justify\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21034687#\" target=\"_blank\"><u><strong><font color=\"#200020\">Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis.<\/font><\/strong><\/u><\/a><br \/>                                 <sup>by  Yung AR, Phillips LJ, Nelson B, Francey SM, PanYuen H, Simmons MB, Ross  ML, Kelly D, Baker K, Amminger GP, Berger G, Thompson AD, Thampi A, and  McGorry PD.<\/sup><br \/>                                 <strong><font color=\"#200020\">Journal of Clinical Psychiatry<\/font><\/strong>. 2011 72(4):430-40.<\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">OBJECTIVE<\/font><\/strong><\/u>:  Cognitive  therapy and\/or low-dose antipsychotic administered during  the prodromal  phase of schizophrenia may prevent or delay the onset of  full-blown  illness. However, it is unclear which of these treatments  are most  effective, how long treatment should be given, and whether  effects will  be sustained over a prolonged period.<\/sup>                           <\/div>\n<div align=\"justify\"><sup>  <u><strong><font color=\"#200020\">METHOD<\/font><\/strong><\/u>:  In order to  examine these issues, we conducted a randomized controlled  trial of  cognitive therapy + risperidone; cognitive therapy + placebo;  and  supportive therapy + placebo in young people at ultra high risk  for  developing a psychotic disorder (that is, putatively prodromal).  The  main outcome was transition to psychotic disorder, with level of   symptoms and functioning the secondary outcomes. This article reports   the interim 6-month follow-up results. The study was conducted from   August 2000 to May 2007.<\/sup>                           <\/div>\n<div align=\"justify\"><sup>  <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  Of a possible 464  eligible ultra high risk individuals, 115 were  recruited to the  randomized controlled trial (cognitive therapy +  risperidone, n = 43;  cognitive therapy + placebo, n = 44; and  supportive therapy + placebo, n  = 28). An additional 78 individuals  agreed to follow-up assessments but  not to randomization (&quot;monitoring  group,&quot; n = 78). At 6 months, 8 of  the  115 participants (7.0%) and 4 of the monitoring group (5.1%) had   developed psychotic disorder. There were no significant differences   between the 3 randomized groups (log rank test, P = .92) or between all 4   groups (log rank test, P = .93). There was also no difference between   the 4 groups in secondary measures, with all groups showing a reduction   in symptoms and increased functioning.<\/sup>                           <\/div>\n<div align=\"justify\"><sup>  <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>:  Rates  of transition to psychosis were lower than expected,  particularly in  the control supportive therapy + placebo group. This  may have accounted  for the negative finding, as the sample was  therefore underpowered to  find any difference between groups.  Alternatively, it may be that all  treatments were equally effective or  equally ineffective at 6 months.<\/sup><\/div>\n<\/ul>\n<\/li>\n<li>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20124114\"><u><strong><font color=\"#200020\">Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders:<\/font><\/strong><\/u><\/a><u><strong><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20124114\"><font color=\"#200020\"> a randomized, placebo-controlled trial<\/font><\/a>.<\/strong><\/u><br \/>              <sup>by Amminger GP, Sch&auml;fer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, and Berger GE.<\/sup><br \/>              <strong><font color=\"#200020\">Archives of General Psychiatry<\/font><\/strong>. 2010 67(2):146-54. <br \/>  [<u><strong><font color=\"#200020\">full text on-line<\/font><\/strong><\/u>]             <\/div>\n<ul>\n<div align=\"justify\"><sup><u><strong><font color=\"#200020\">CONTEXT<\/font><\/strong><\/u>:  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.<\/sup>            <\/div>\n<div align=\"justify\"><sup>     <u><strong><font color=\"#200020\">OBJECTIVE<\/font><\/strong><\/u>:  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.<\/sup>            <\/div>\n<div align=\"justify\"><sup>     <u><strong><font color=\"#200020\">DESIGN<\/font><\/strong><\/u>: Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007.<\/sup>            <\/div>\n<div align=\"justify\"><sup>     <u><strong><font color=\"#200020\">SETTING<\/font><\/strong><\/u>: Psychosis detection unit of a large public hospital in Vienna, Austria.<br \/>     <u><strong><font color=\"#200020\">PARTICIPANTS<\/font><\/strong><\/u>: Eighty-one individuals at ultra-high risk of psychotic disorder.<br \/>   <u><strong><font color=\"#200020\">INTERVENTIONS<\/font><\/strong><\/u>:  A  12-week intervention period of 1.2-g\/d omega-3 PUFA or placebo was   followed by a 40-week monitoring period; the total study period was 12   months.<\/sup>            <\/div>\n<div align=\"justify\"><sup>     <u><strong><font color=\"#200020\">MAIN OUTCOME MEASURES<\/font><\/strong><\/u>:  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.<\/sup>   <\/div>\n<div align=\"justify\"><sup>     <u><strong><font color=\"#200020\">RESULTS<\/font><\/strong><\/u>:  Seventy-six  of 81 participants (93.8%) completed the intervention. By  study&rsquo;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.<\/sup>            <\/div>\n<div align=\"justify\"><sup>     <u><strong><font color=\"#200020\">CONCLUSIONS<\/font><\/strong><\/u>:  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. Trial  Registration  clinicaltrials.gov Identifier: NCT00396643.<\/sup><\/div>\n<\/ul>\n<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. by McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, McDonald T, Blair A, Adlard S, and Jackson H. Arch Gen Psychiatry. 2002 59(10):921-8. 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