Teenagers, Mood, Psychosis, and Omega 3s

AHS12 is next week!  In New England all the short-sleeved outdoor fun has to be squeezed into about 8 weeks of decent weather, so I'm taking it one day at a time at this point.  But I did manage to put together my presentation (which is on Friday at 4:15) over the weekend.  I swear when I looked at the schedule the first time I was directly opposite Mat LaLonde, but it turns out I'm just after Mat but in another room, so I'll stop grousing (though Maelen Fontes' antinutrients looks really interesting too.)

I don't have a lot of time, so I'll be looking at trans fats and carbohydrates and how they affect mental health.  It should be fun, and even if you follow my blog religiously you won't have seen all the stuff that will be covered.

But back to other interesting papers I've come across recently.  The first one is from the Archives in Feb 2010 (1).  These researchers randomized 81 people at ultra-high risk for psychosis aged 13-25 years to two groups.  The individuals had to have experienced a brief and mild psychotic symptoms already or have high genetic risk (typically a first degree relative with a psychotic disorder) and loss of social functioning.  Young people with these sorts of symptoms have about a 40% chance of developing a full blown psychotic disorder within the next 12 months when followed in previous research. 

Identifying and treating these ultra-high risk individuals is a hot topic in research today, since preventing schizophrenia, if possible, would obviously be a lot better than having someone suffer devastating psychotic episodes, hospitalizations, or having to drop out of college.  Defining the group of individuals to study has led to some misperception about the diagnostic category "psychosis risk syndrome" which to many seems like psychiatrists are trying to pathologize eccentricity among youth.  The category was developed to have consistent criteria for these preventative-style research projects, not to try to change every teen-ager with black-eyeliner and an interest in ESP into a polo-wearing business school student.

These caveats are not to say the research isn't controversial.  Sometimes it involves putting ultra-high risk kids on antipsychotics to see if it will prevent conversion to schizophrenia or other full-blown psychotic disorder later on.  Any time one treats generally healthy young people with drugs with lots of side effects, one had better be trepidatious.  However, the study I'm referring to took a much less aggressive approach.  The 81 young people either took an omega 3 fatty acid (700 mg EPA, 480 mg DHA, and some vitamin E as mixed tocopherols) supplement for 12 weeks or placebo (1.2g coconut oil and the same vitamin E).  Adherence was calculated by measuring RBC (red blood cell) membrane fatty acid content and by self-report.  No use of antipsychotics were permitted (or if full blown psychotic symptoms were present for more than a week, standard treatment was started and the individuals left the study), and both treatment and placebo groups had some standard psychosocial counseling sessions (helping cope with stress, learning life skills, etc.).

After the 12 week treatment period, the groups were followed closely for the next 9 months.  Among the placebo group, 11 of 40 (27.5%) developed full-blown psychosis during the 12 month study.   Only 2 of 41 (4.9%) in the treatment group developed psychosis.   The difference was statistically significant and comparable to similar studies using the far more toxic atypical antipsychotics.  That's an impressive result for a relatively simple intervention and it would be nice to see it repeated at different medical centers.

The next study (2) was published earlier this year and measured RBC membrane fatty acid content in 150 adolescents admitted to the hospital for treatment of depression vs. 161 controls.  Long chain omega 3 fatty acids play all sorts of important roles in the brain in membrane signalling, synapse formation, dendritic growth, and seem to help facilitiate communication and repair.  Low omega 3 levels in the red blood cell membranes correlate with sudden cardiac death and depression in adults, though supplement trials with omega 3 have had mixed results.  There were two major problems with the study--cases and controls were significantly different with respect to ethnic groups which might affect genetic differences in metabolism and conversion of dietary fatty acids to those incorporated into the membrane.  Also, no attempt at dietary measures were taken, so it is unclear whether differences are from metabolism or dietary differences.  

However, in the end, the lower the DHA in the cell membrane, the more likely a subject was to be in the depressed hospitalized group.  More to look into!