This Archives of General Psychiatry study was a randomized, double-blind, placebo-controlled, 12-week trial of long-chain omega-3 polyunsaturated fatty acids (PUFAs) in adolescents and young adults aged 13-25 years with subthreshold psychosis. The objective was to determine whether PUFAs reduce the rate of progression to first-episode psychotic disorder.
By study's end at 12 months, 2 of 41 individuals in the PUFA group and 11 of 40 in the placebo group had transitioned to psychotic disorder. The incidence of adverse effects did not differ between the treatment groups.
It is unknown how many adolescents and young adults actually present for treatment with subthreshold psychosis. When they do, we have limited means of treating them. Interventions typically employed are antipsychotics, antidepressants, and cognitive-behavioral therapy. The use of antipsychotics is particularly controversial because of their adverse-effect profile and the knowledge that a substantial proportion of patients in a pre-psychotic state never go on to develop psychosis. These researchers proposed that PUFAs can be used and achieve similar effect sizes in the prevention of progression to psychosis compared to potentially more toxic agents. Number needed to treat to avoid an additional progression to psychosis was 5 calculated from all randomly sampled patients, putting it in the range of agents that are routinely accepted as efficacious for psychiatric disorders in general.