Omega-3 Supplementation May Reduce Schizotypal Symptoms in At-Risk Youth

Children with schizotypal personality symptoms may benefit from dietary supplementation with omega-3 fatty acids, according to a report in Schizophrenia Bulletin. Schizotypal personality (or “schizotypy”) is marked by symptoms such as aggression, interpersonal difficulties, and cognitive problems that can be precursors to schizophrenia.

“Poor nutrition has long been associated with schizophrenia-spectrum disorders, including schizoid personality and schizotypal personality,” wrote Adrian Raine, D. Phil., the Richard Perry University Professor of Criminology, Psychiatry, and Psychology at the University of Pennsylvania, and colleagues. A 2003 study in the American Journal of Psychiatry by Raine and colleagues found that providing youth with a fish-rich dietary intervention could improve brain function and reduce schizotypy symptoms.

“Because the children in the intervention received 2.5 child portions of fish per week more than the control group, we hypothesized that omega-3 could be the active ingredient in the enrichment that reduced schizotypy,” Raine and colleagues wrote in the Schizophrenia Bulletin study.

In the study, 290 community-dwelling children aged 11 and 12 years were randomly assigned to receive three months of daily omega-3 supplementation alone, cognitive-behavioral therapy (CBT) alone, omega-3 supplementation plus CBT, or no intervention (control). All children met criteria for conduct disorder or oppositional defiant disorder or had higher-than-average scores on a standardized test for aggression.

The omega-3 supplement consisted of a daily 200 ml fruit-flavored drink containing 1,000 mg of various omega-3 fatty acids along with two chewable multivitamin tablets. CBT was delivered in 12 weekly one-hour sessions, supplemented with weekly home exercises. Schizotypy was assessed at baseline and at three, six, and 12 months using the self-report Schizotypal Personality Questionnaire-Child (SPQ-C19). It assesses the three key domains of schizotypy—interpersonal difficulties, cognitive and perceptual problems, and disorganized features like odd speech or behaviors.

In the omega-3 only and omega-3 plus CBT groups, total schizotypy was reduced by 28.0% and 21.3%, respectively, at three months (the end of treatment), and by 25.7% and 36.6%, respectively, at six months. Children in both groups showed greater symptom improvement than children in the control group at these time points.

The strongest improvements were seen for the interpersonal domain of the SPQ, which assesses such variables as discomfort in social situations and ability to establish close relationships.

But Raine and colleagues also noted that treatment effects for total schizotypy largely washed out nine months after supplementation was terminated, except for the interpersonal symptoms where reduction was sustained in both omega-3 groups at 12 months. Raine and colleagues suggested future studies that use larger doses of omega-3s and/or provide booster sessions may help produce longer-term reductions in schizotypy.

David Goldsmith, M.D., M.Sc., who is an assistant professor of psychiatry at Emory University and reviewed the report for Psychiatric News, said the study is a valuable one showing dietary supplementation may have “a measurable and clinically significant effect on schizotypal symptoms.” He noted that the study cohort—children with conduct disorder or oppositional defiant disorder—tend to have higher rates of schizotypy.

Goldsmith is also director of research at the Clinical and Research Program for Psychosis at Grady Health System and director of the Inflammation, Motivation, and Negative Symptoms of Schizophrenia Lab at Emory University School of Medicine.

“Finding nonmedication-based interventions is especially important in children,” he told Psychiatric News. “Moreover, the effects of omega-3 fatty acids … in this study may yield important insights into pathophysiological mechanisms underlying risk for schizotypy and perhaps later psychosis that will be interesting to follow up on.”

The Schizophrenia Bulletin study is not the first to show the beneficial effects of omega-3 fatty acids; a study by G. Paul Amminger, M.D., in 2010 and follow-up in 2015 showed that omega-3 supplementation reduced conversion to psychosis among youth with subthreshold psychosis. But Goldsmith noted that other studies were not able to replicate those findings.

He added that youth at high risk of psychotic disorders are highly heterogenous; some will benefit from omega-3 supplementation and others may not. “Given the mixed findings on omega-3 supplementation in the literature, I think it suggests that we really need to understand who may stand to benefit the most from these treatments,” Goldsmith said.

“For example, one potential mechanism by which omega-3 fatty acids may work is by reducing inflammation, but only a subset of individuals with psychotic illness appear to have evidence of chronic low-grade elevated inflammation,” he said.

Goldsmith concluded: “This study highlights diet as a possible intervention that is too often ignored in clinical practice. There are many reasons for psychiatrists to be talking to their patients, especially young patients, about the merits of a healthy diet and about regular exercise, and this study highlights another reason for psychiatrists to incorporate these conversations into practice.”

This study was funded by a grant from the Pennsylvania Department of Health with additional support from the Clinical & Translational Research Center at the University of Pennsylvania and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. ■