Treatment of Schizophrenia With an Omega-3 Fatty Acid (EPA) and Antioxidants

A Multicentre, Placebo-controlled Trial of Eicosapentaenoic Acid (EPA) and Antioxidant Supplementation in the Treatment of Schizophrenia and Related Disorders

Diakonhjemmet Hospital, Stanley Medical Research Institute, Laxdale Ltd, Scandinavian Society for Psychopharmacology, Shipowner Emil Stray's legacy, Johanne and Einar Eilertsen's research fund, AstraZeneca, Solveig and Johan P. Sommer's foundation, Josef and Haldis Andresen's legacy, University of Oslo, Norwegian University of Science and Technology

The purpose of this trial is to study the effect of adding the omega-3 fatty acid EPA and/or Vitamins E + C to antipsychotic drugs in younger patients with schizophrenia and related psychoses.

Objective: Study the effect of adding Ethyl-EPA and/or Vitamins E + C to antipsychotic drugs in younger patients with schizophrenia and related psychoses. Methods and material: Design: Multicentre, randomized, double-blind, placebo-controlled, fixed dose, 2x2 factorial, add-on clinical trial. Sample: Patients with schizophrenia, schizoaffective disorder or schizophreniform disorder (DSM-IV); aged 18-40 years; less than 15 years since first psychotic symptoms;admitted to a psychiatric department within the previous 21 days before screening; speaks fluently a Scandinavian language;treated with antipsychotics; written informed consent;no known allergy to trial agents;no substance dependence (DSM-IV);no warfarin currently or anamnestic indicators of impaired haemostasis. Planned: 200 patients. Actually included: 99 intent-to-treat patients. Healthy controls: aged 18-40 years;no mental disorder (DSM-IV). Included: 20 persons. Clinical assessments: Positive and Negative Syndrome Scale (PANSS) (main outcome variable). Self-report questionnaire. Adverse effects (UKURS). Neurocognitive assessment battery. Niacin skin flush test. General medical assessment. Blood samples: RBC fatty acids, S-α-tocopherol, F2-isoprostane (kits), monocyte mRNA Phospholipase A22 (PLA2) Gr4a and 6a (RT-PCR method), RBC Gr4a PLA2 concentration (ELISA technique), a range of other biochemical tests. Experimental treatment over 16 weeks: Ethyl-EPA 2 g/d or Placebo EPA and Vitamin E 364 mg/d + Vitamin C 1000 mg/d or Placebo Antioxidants Statistics: Linear Mixed Model for longitudinal analyses of effects; other uni- and multivariate methods (SPSS 12.0 - PASW Statistics 18).

Schizophrenia, Schizophreniform disorders, Schizoaffective disorder, Psychotic disorders, Randomized Controlled Trials, Longitudinal Studies, Fatty Acids, Omega-3, Eicosapentaenoic Acid, Vitamins, Antioxidants, Ascorbic Acid, Alpha-Tocopherol, Placebos, Antipsychotic Agents, Oxidative Stress, Fatty Acids, Unsaturated, Phospholipases, Niacin, Adverse effects, Delusions, Hallucinations, Neuropsychological Tests, Attention, Memory, Hypertriglyceridemia, Models, Statistical

The concentrations of long-chain (C14-18) and very long-chain (C20-24)fatty acids in erythrocytes were measured. Fasting condition. We selected DGLA, AA, EPA, DHA, total omega-3 Polyunsaturated Fatty Acids (PUFA), total omega-6 PUFA, PUFA and LCPUFA (long-chain PUFA) as outcome measures.

Omitted from stastical analyses because of problems with the pre-analytic procedure (treatment the of blood)

Inclusion Criteria: Patients with schizophrenia, schizophreniform disorder or schizoaffective disorder (DSM-IV) Admitted to a psychiatric hospital/department within the previous twenty-one days before screening Less than fifteen years, in retrospect, since first psychotic symptoms (DSM-IV 295, criteria A,1-4) Age 18-40 years Speaks fluently a Scandinavian language A written informed consent must be obtained before any trial-related activities Exclusion Criteria: A diagnosis of substance dependence (DSM-IV) Known allergy to study medication Currently taking warfarin or having anamnestic indicators of impaired haemostasis (profuse bleeding, except epistaxis)