Gli omega-3 possono migliorare i disturbi psicotici

Neuroscienze e Nutrizione: gli omega-3 possono migliorare i disturbi psicotici - English/Italiano

Archives of General Psychiatry. 2010; 67:146-154

Long-Chain omega-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial

Amminger GP, Schafer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, Berger GE

ABSTRACT
The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain 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. 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. Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007. Psychosis detection unit of a large public hospital in Vienna, Austria. Eighty-one individuals at ultra-high risk of psychotic disorder. A 12-week intervention period of 1.2-g/d -3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months. 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. Seventy-six of 81 participants (93.8%) completed the intervention. By study'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. 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.

Commento
L’assunzione di integratori a base di olio di pesce, ricchi in acidi grassi omega-3 possono ridurre la probabilità di sviluppare disturbi psicotici in persone ad alto rischio. Si indica con alto rischio la probabilità di ammalarsi nel 40% dei casi in 12 mesi. E’ stato osservato che la supplementazione con olio di pesce, ricco di EPA e DHA, ha ridotto del 23% il rischio di progressione verso la psicosi conclamata (solo il 4,9% dei pazienti aveva sviluppato un disturbo psicotico). Il legame tra l’assunzione di omega-3 e funzioni cognitive e comportamentali è già stato osservato in passato e i dati più promettenti sono stati segnalati per il DHA, con miglioramenti a livello della memoria in adulti con declino delle funzioni cognitive legate all’età e ad alcune patologie, come il morbo di Alzheimer. Gli acidi grassi omega-3 possono produrre cambiamenti a livello delle membrane cellulari e interagire con i sistemi di neurotrasmissione nel cervello. Inoltre, hanno il vantaggio di essere tollerabili, ben accettati e di avere costi relativamente bassi, a differenza degli antipsicotici, che spesso non sono accettabili, soprattutto per i giovani.