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    <recommendedItem id="20100101_19_359"
                     title="Fish Oil May Prevent Psychotic Episodes (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Psychiatry/Schizophrenia/tb/18242?impressionId=1265782371513"
                     
      &lt;p&gt;High-risk psychiatric patients were less likely to have psychotic episodes when they took daily doses of omega-3 (&amp;#969;-3) polyunsaturated fatty acids (PUFAs), according to results of a small, randomized clinical trial.&lt;/p&gt;
&lt;p&gt;Fewer than 5% of patients had psychotic episodes with &amp;#969;-3 PUFAs, versus more than 25% of patients given placebo (&lt;em&gt;P&lt;/em&gt;=0.007), investigators reported in the February &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The &amp;#969;-3 PUFAs, derived from fish among other sources, also reduced positive, negative, and general symptoms and improved functioning compared with placebo, the researchers found.&lt;/p&gt;
&lt;p&gt;&quot;The present trial strongly suggests that &amp;#969;-3 PUFAs may offer a viable prevention and treatment strategy with minimal associated risk in young people at ultra-high risk of psychosis, which should be further explored,&quot; G. Paul Amminger, MD, of the Medical University of Vienna in Austria, and co-authors concluded.&lt;/p&gt;
&lt;p&gt;Early treatment of schizophrenia and other psychotic conditions may lead to better outcomes, the researchers noted. Subclinical psychotic symptoms may predict psychotic disorder, and the propensity for psychosis in a particular population may influence the prevalence and incidence of psychotic disorders.&lt;/p&gt;
&lt;p&gt;Intervention in at-risk populations, therefore, may lead to even better outcomes, they asserted.&lt;/p&gt;
&lt;p&gt;Dysfunctional fatty acid metabolism has been proposed as a contributing factor in psychotic conditions, and several clinical trials have demonstrated beneficial effects of &amp;#969;-3 PUFA supplementation in patients with schizophrenia. Some studies, however, yielded negative results.&lt;/p&gt;
&lt;p&gt;Data from the schizophrenia studies, evidence of neuroprotective properties, and an absence of clinically relevant adverse effects make &amp;#969;-3 PUFAs &quot;an ideal candidate for indicated prevention in young people at risk of psychosis, in whom the use of antipsychotic medication is controversial, the authors wrote.&lt;/p&gt;
&lt;p&gt;To evaluate potential benefits of &amp;#969;-3 PUFAs in subclinical psychosis, investigators enrolled patients ages 13 to 25 who met criteria for one of three operationally-defined, high-risk groups: attenuated positive psychotic symptoms, transient psychosis, and genetic risk plus a decrease in functioning.&lt;/p&gt;
&lt;p&gt;&quot;These criteria comprise a combination of trait and state factors that identify people whose risk of becoming psychotic may approach 40% within a 12-month period,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The study included 81 patients, who were randomized to 1.2 g/d &amp;#969;-3 PUFA or matching placebo for 12 weeks, plus 12-months of follow-up.&lt;/p&gt;
&lt;p&gt;The authors reported that 76 patients (38 in each group) completed the 12-week intervention phase and 67 completed the 12-month follow-up. The primary outcome was conversion to a psychotic episode, defined by the Positive and Negative Syndrome Scale (PANSS) and sustained for one week.&lt;/p&gt;
&lt;p&gt;At 12 months, two of 41 patients assigned to &amp;#969;-3 PUFA therapy (4.9%) converted to psychotic episodes, compared with 11 of 40 (27.5%) in the placebo group.&lt;/p&gt;
&lt;p&gt;The &amp;#969;-3 group also had significantly lower PANSS positive, negative, general, and total scores at 12 weeks, six months, and 12 months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;=0.01). Patients in the &amp;#969;-3 group also had significantly better functioning (&lt;em&gt;P&lt;/em&gt;=0.002).&lt;/p&gt;
&lt;p&gt;Calculation of number needed to treat (NNT) showed that four at-risk patients would have to be treated to prevent one psychotic episode during one year, which the authors said is comparable to the NNT from trials of antipsychotic medications.&lt;/p&gt;
&lt;p&gt;The authors noted several limitations, including the relatively small size of the study and the fact that this was a highly selected population, so the results cannot be generalized.&lt;/p&gt;
&lt;p&gt;In addition, they pointed out that efficacy beyond the 12 month study period is unknown and it is possible that the transition to a first episode of psychosis may have been delayed rather than prevented.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Stanley Medical Research Institute.&lt;/p&gt;&lt;p&gt;The authors reported no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_356"
                     title="Exercise Builds Brain Volume in Schizophrenia (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Psychiatry/Schizophrenia/tb/18236?impressionId=1265782371513"
                     
      &lt;p&gt;Three months of aerobic exercise significantly increased the volume of the hippocampus in patients with chronic schizophrenia, researchers said.&lt;/p&gt;
&lt;p&gt;The increase was accompanied by &quot;modest&quot; increases in short-term memory and markers of neuron production, according to Frank-Gerald Pajonk, MD, of Dr K. Fontheim&apos;s Hospital for Mental Health in Liebenburg, Germany, and colleagues.&lt;/p&gt;
&lt;p&gt;But it&apos;s too early to say whether incorporating aerobic exercise into treatment programs might reduce the disability associated with schizophrenia, the researchers said in the February&lt;em&gt; Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Among schizophrenics, the hippocampus, which plays important roles in memory and spatial navigation, is known to be reduced in volume, Pajonk and colleagues noted.&lt;/p&gt;
&lt;p&gt;Unlike other forms of psychosis, they added in the journal, schizophrenia is characterized by persistent disability, perhaps because the production of new neurons is impaired.&lt;/p&gt;
&lt;p&gt;As well, they noted, in healthy humans it has been shown that exercise stimulates the production of new neurons.&lt;/p&gt;
&lt;p&gt;For those reasons, they speculated that aerobic exercise might increase the volume of the hippocampus in people with chronic schizophrenia, perhaps leading to clinical benefits.&lt;/p&gt;
&lt;p&gt;To test the idea, they enrolled 24 schizophrenia patients and eight healthy controls.&lt;/p&gt;
&lt;p&gt;Thirteen of the patients, selected randomly, were assigned to a three-month program of aerobic exercise  --  cycling three times a week for 30 minutes. The controls also took part in the cycling program.&lt;/p&gt;
&lt;p&gt;The remaining patients were assigned to play table soccer, again for 30 minutes three times a week.&lt;/p&gt;
&lt;p&gt;The primary endpoint was the change in hippocampal volume, assessed by magnetic resonance imaging, but the researchers also looked at changes in schizophrenia symptom scores, memory, and the ratio of N-acetylaspartate to creatine in the hippocampus. The latter is a regarded as a marker of neuron production.&lt;/p&gt;
&lt;p&gt;They found: &lt;ul&gt; &lt;li&gt;Compared to baseline, hippocampal volume increased 12% in the exercise group and 16% in the controls, changes that were significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/li&gt; &lt;li&gt;On the other hand, there was a nonsignificant 1% drop in volume among patients who did not take exercise.&lt;/li&gt; &lt;li&gt;The changes in hippocampal volume in the exercise group were significantly correlated (at r=0.71 and &lt;em&gt;P&lt;/em&gt;=0.003) with better aerobic fitness, as measured by change in maximum oxygen consumption.&lt;/li&gt; &lt;li&gt;Among patients in the exercise group, change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate to creatine ratio, which was significant (in a post-hoc analysis) at &lt;em&gt;P&lt;/em&gt;=0.04. There was no significant change in the healthy controls.&lt;/li&gt; &lt;li&gt;And short-term memory improvements among the patients were correlated (at r=0.51 and &lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) with changes in hippocampal volume.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The change in hippocampal volume was the &quot;most robust&quot; of the findings, Pajonk and colleagues said, and is roughly comparable with what is seen in other subcortical structures when schizophrenia patients switch from typical to atypical medications.&lt;/p&gt;
&lt;p&gt;The study was limited by its small size, they said, and the volunteers were selected for their willingness to take part in three months of an exercise program.&lt;/p&gt;
&lt;p&gt;As well, patients had to have chronic disease and be on stable medication programs, they said.&lt;/p&gt;
&lt;p&gt;They also noted that while the main finding was robust, the statistical significance of the secondary results would not have survived a correction for multiple testing.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers did not report any industrial support for the study. Pajonk reported financial links with AstraZeneca, Eli Lilly, Janssen, Novartis, Wyeth, Bristol-Myers Squibb, Pfizer, Sanofi-Synth&amp;#233;labo, and Merz.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_112"
                     title="Clozaril-Risperdal Duo Lacks Efficacy Against Schizophrenia"
                     score="-0.005"
                     href="