By Courtney Reyers, NAMI Publications Manager
A 2010 groundbreaking study by Paul Amminger and his team in Vienna, Austria found that fish oil (omega-3 can help prevent psychosis in individuals with schizophrenia. Two years later, researchers and mental health professionals around the world are starting to replicate that study to see if we can help prevent mental illness before it starts.
Today, there is a multi-country study going on in Europe looking at the effects that omega-3 fatty acids (found in fish oil, among other things) have on the brain when it comes to psychosis. Additionally, in the U.S. and Canada, Dr. Barbara Cornblatt (founder of the Recognition and Prevention Program (RAP) and a recipient of the 2003 NAMI Research Award) is collaborating with several other investigators to determine whether omega-3 fatty acids could potentially prevent onset of psychosis and improve clinical symptoms and functional outcome in youth and young adults who are at elevated risk for schizophrenia and other mental illnesses.
What Can Omega-3s Do for the Brain?
Omega-3 fatty acids (essential fatty acids, or EFAs) are thought to aid brain functioning in three possible ways: the assimilation of EFAs into brain cell membranes, EFA-induced alteration of neurotransmission and EFA caused reduction of oxidative stress. In separate studies, low levels of all three of these have been implicated in cases of schizophrenia.
Ethyl-eicosaptaenoic acid (E-EPA) is one of the fatty acids found in omega-3 that has been researched. Findings show that E-EPA might provide an increase in the antioxidant glutathione, which correlates with a reduction of oxidative stress in the hippocampus and lessened negative symptoms. Treatment seems to prevent further psychotic development by preventing further hippocampal damage, reiterating the importance of early treatment and preemptive intervention if possible.
Technicalities aside, fish oil looks promising because it can help prevent psychosis from developing in people who are at risk to develop it, while it has no side effects (and even some health benefits) for people who aren’t at risk. Essentially, it’s a benign preventative measure.
“There are people—30 to 35 percent of at-risk people—who have a higher chance for developing psychosis,” Dr. Cornblatt said. “We’re looking for a treatment that we can give everyone at risk—a treatment that can prevent psychosis in that 30 percent without harming the 70 percent of at-risk people who won’t go on to develop it. Fish oil seems to fit that bill.”
Stopping Mental Illness Before It Starts
A paradigm shift in the mental health field has been brewing for years—one that focuses on treating mental illness before it starts. The current team working on the DSM-5 (Diagnostic and Statistical Manual) is focusing on treating symptoms, not full-blown illnesses and many doctors, like Cornblatt, have been working with kids, teens and young adults to try approaching mental illness with foresight, rather than hindsight.
“[Early in my career] at Columbia University, I worked with genetically at-risk offspring of parents (mostly mothers) who lived with schizophrenia,” Cornblatt said. “We found several potential risk factors and I thought, ‘well now is the time to apply this in a real-world setting.’ I was fortunate in eventually moving to Zucker Hillside Hospital, where the potential of prevention in at-risk youngsters was immediately recognized, particularly because of the long history of research there focusing on patients in their initial episodes of psychosis. I received one of the first major grants in prodromal research in 2000, largely as a result of my prior experience researching risk factors in at-risk siblings and offspring.”
Armed with decades of experience and like-minded colleagues (such as Dr. Patrick McGorry and Dr. Alison Yung, as well as John Kane, head of Zucker), Cornblatt has focused on catching mental illness early. The grant allowed her to found the RAP Program, where she works with youth and their parents. At-risk teens and young adults are selected for the program if they meet specific entry criteria, as determined by an in-depth interview and system of symptom ratings. Youngsters are eligible for the RAP program is they display one or more symptoms (out of five) considered to be of medium to severe intensity (but not yet psychotic). This corresponds to getting between a three to five on a six-point scale on any one or more of the five symptoms. A score of six is too high, meaning the person is already displaying psychotic symptoms; below three is too low, meaning a person falls within the range typical of the general population. The five symptoms the RAP Program uses to determine if a teen or young adult is a good candidate for psychosis prevention are:
“The RAP program has a slightly different approach than many other at-risk studies—rather than basing prevention on treatment using anti-psychotic medication, we’ve been focused on risk factors and how to improve them,” Cornblatt said. “What we’re doing is prevention. We don’t really work with psychotic individuals, we work with people who have warning signs that suggest they could become psychotic. According to our criteria, the youngsters we work with display subtle, early forms of positive symptoms, but these are not yet considered psychotic because they are so mild.
Bottom line: If you can prevent early positive symptoms from increasing in intensity, you can prevent schizophrenia.
About the Study
In addition to Dr. Cornblatt's team, seven other centers are participating in the study: the University of California (San Diego), Yale University, Emory University, Harvard University, the University of North Carolina, the University of California (Los Angeles) and the University of Calgary in Alberta, Canada.
Eligible participants are treatment-seeking patients aged 12-30 who meet diagnostic criteria for a possible prodromal syndrome. The fish oil study is part of a larger multi-site project called the North American Prodrome Longitudinal Study (NAPLS), which has been ongoing for several years. The Zucker Hillside Hospital RAP program is just starting to recruit subjects for the fish oil study, and subjects will also be enrolled in the larger NAPLS program. The researchers expect to enroll 130 participants across all eight sites in the fish oil (omega-3) trial. Participants in the study will be randomly assigned to receive either two pills a day of pharmaceutical-level fish oil (for a total daily dose of 740 mg eicosapentaenoic acid combined with 400 mg docosahexaenoic acid) or matched placebos for six months, after which the participants will be followed for a period of 18 months.
The hypothesis is that by the end of the study, the rate of conversion to psychosis (the primary outcome) among prodromal patients randomly assigned to receive omega-3 fatty acids will be significantly lower and symptoms, in general, will be improved when compared to youngsters assigned to receive placebo. Results of this trial are expected in about two years.