A Systematic Review of Effectiveness of Omega-3 Fatty Acid Supplementation on Symptoms, Social Functions, and Neurobiological Variables in Schizophrenia.

BACKGROUND: Disturbance of lipid, particularly omega-3 polyunsaturated fatty acid (PUFA), metabolism is associated with the etiology and symptoms of schizophrenia. Numerous clinical studies have tried to evaluate whether omega-3 PUFA supplementation can ameliorate the disorder, but the results are inconclusive. OBJECTIVES: This systematic review integrates and refines the research evidence of the effectiveness of omega-3 PUFA nutritional supplementation on schizophrenia during the different developmental phases of the disease (prodromal, first-episode, and chronic phases) and examines whether different developmental stages modulate the efficacy of omega-3 PUFA supplementation. DATA SOURCES: Scientific articles from 2000 to 2020 in PubMed/Medline, Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews guidelines. METHODS: A systematic review was performed. We reviewed electronic databases and identified 1,266 clinical studies. Of these, 26 met the inclusion criteria. RESULTS: The effectiveness of omega-3 dietary supplementation on symptoms varies among different phases of illness. Omega-3 supplementation significantly improves positive and negative symptoms at the prodromal phase, improves mainly the negative symptoms in patients with the first-episode, and effects symptoms partly in patients with chronic schizophrenia. DISCUSSION: The effectiveness of omega-3 PUFA dietary supplementation is modulated by age, duration of untreated psychosis and illness, baseline levels of omega-3 fatty acids, and status of antioxidant capacity of patients. The important implications for psychiatric research and clinical practice developments as well as nursing care are presented and discussed.

Beneficial effects of omega-3 fatty acid supplementation in schizophrenia: possible mechanisms.

BACKGROUND: Schizophrenia is a serious long-term psychotic disorder marked by positive and negative symptoms, severe behavioral problems and cognitive function deficits. The cause of this disorder is not completely clear, but is suggested to be multifactorial, involving both inherited and environmental factors. Since human brain regulates all behaviour, studies have focused on identifying changes in neurobiology and biochemistry of brain in schizophrenia. Brain is the most lipid rich organ (approximately 50% of brain dry weight). Total brain lipids is constituted of more than 60% of phospholipids, in which docosahexaenoic acid (DHA, 22:6n-3) is the most abundant (more than 40%) polyunsaturated fatty acid (PUFA) in brain membrane phospholipids. Results from numerous studies have shown significant decreases of PUFAs, in particular, DHA in peripheral blood (plasma and erythrocyte membranes) as well as brain of schizophrenia patients at different developmental phases of the disorder. PUFA deficiency has been associated to psychotic symptoms and cognitive deficits in schizophrenia. These findings have led to a number of clinical trials examining whether dietary omega-3 fatty acid supplementation could improve the course of illness in patients with schizophrenia. Results are inconsistent. Some report beneficial whereas others show not effective. The discrepancy can be attributed to the heterogeneity of patient population. METHODS: In this review, results from recent experimental and clinical studies, which focus on illustrating the role of PUFAs in the development of schizophrenia were examined. The rationale why omega-3 supplementation was beneficial on symptoms (presented by subscales of the positive and negative symptom scale (PANSS), and cognitive functions in certain patients but not others was reviewed. The potential mechanisms underlying the beneficial effects were discussed. RESULTS: Omega-3 fatty acid supplementation reduced the conversion rate to psychosis and improved both positive and negative symptoms and global functions in adolescents at ultra-high risk for psychosis. Omega-3 fatty acid supplementation could also improve negative symptoms and global functions in the first-episode patients with schizophrenia, but improve mainly total or general PANSS subscales in chronic patients. Patients with low PUFA (particularly DHA) baseline in blood were more responsive to the omega-3 fatty acid intervention. CONCLUSION: Omega-3 supplementation is more effective in reducing psychotic symptom severity in young adults or adolescents in the prodromal phase of schizophrenia who have low omega-3 baseline. Omega-3 supplementation was more effective in patients with low PUFA baseline. It suggests that patients with predefined lipid levels might benefit from lipid treatments, but more controlled clinical trials are warranted.

Efficacy of Electroacupuncture Combined with Methadone Maintenance Therapy: A Case-Control Study.

High compliance with methadone maintenance therapy (MMT) is crucial to successful opioid abstinence in addicts. However, MMT has numerous side effects, including reductions in quality of life and quality of sleep. Many studies have demonstrated that electroacupuncture relieves withdrawal symptoms in opioid addicts. The present study was a case-control study. From January 2015 to September 2016, 106 patients undergoing MMT at a medical center in central Taiwan were recruited and separated into an electroacupuncture treatment group and a control group. Electroacupuncture was performed for 15 minutes twice weekly for 4 weeks. The electroacupuncture treatment group was discovered to have improved quality of life, especially in terms of vitality and mental health. Although electroacupuncture did not significantly improve sleep quality, we found that sleep quality was significantly improved once methadone dosage had been reduced. Electroacupuncture can improve quality of life in patients undergoing MMT. If methadone dosage can be reduced and electroacupuncture can be employed, both sleep and life quality can be improved.

Attitudes toward and education about complementary and alternative medicine among adult patients with depression in Taiwan.

AIMS: To investigate patients' attitudes toward complementary and alternative medicine, the education nurses provided about complementary and alternative medicine for treating depression and to test whether such education mediates the effect of complementary and alternative medicine use and attitudes toward complementary and alternative medicine. BACKGROUND: Although we know that attitudes influence behaviour, very few studies simultaneously explore the relationship between attitudes, education and complementary and alternative medicine use. DESIGN: Survey. METHODS: This study was conducted as part of a larger survey, using face-to-face survey interviews with 206 adult patients aged 50 years or over and hospitalised in conventional hospitals in Taiwan for treatment of depression. The attitudes toward complementary and alternative medicine and patient education about complementary and alternative medicine instruments were specially developed for the study. RESULTS: Participants expressed slightly favourable attitudes toward complementary and alternative medicine. Many participants (50%) expressed that they were willing to try any potential treatment for depression. They believed that complementary and alternative medicine helped them to feel better and to live a happier life. However, 66.5% of participants reported that they had inadequate knowledge of complementary and alternative medicine. Participants with a higher monthly income, longer depression duration and religious beliefs hold more positive attitudes toward complementary and alternative medicine. Most participants were not satisfied with the education they received about complementary and alternative medicine. Patient education about complementary and alternative medicine was found to be a mediator for the use of complementary and alternative medicine. CONCLUSION: Patient education from nurses may predict patients' attitudes toward complementary and alternative medicine. Continuing nursing education is needed to enable nurses to respond knowledgeably to concerns patients may have about complementary and alternative medicine and treatment options. RELEVANCE TO CLINICAL PRACTICE: This study highlights the potential role of patient education about complementary and alternative medicine as an effective way of adjusting patients' attitudes toward complementary and alternative medicine and to link both patients' preferences for complementary and alternative medicine and health professionals' concerns about the proper use of complementary and alternative medicine for depression management and adverse drug interactions.

Use of antidepressants and complementary and alternative medicine among outpatients with depression in Taiwan.

Understanding use of complementary and alternative medicine (CAM) and antidepressants during patient's recovery for depression is important to enhance their psychological functioning and promote positive health care outcomes. This study investigated the use of antidepressant treatment and CAM in outpatients with depression 1 month after discharge from psychiatric hospitalization. Telephone surveys were conducted. Of the 201 participants, 50.2% reported using CAM 1 month after discharge. Nearly 41% (n = 82) used a combination of both antidepressant treatment and CAM after hospital discharge. The most commonly used CAMs were spiritual healing, relaxation techniques, and herbal medicine. Symptom relief was the top reason participants used CAM for depression. A number of factors were associated with higher odds of using CAM. CAM is often considered as a valued component of holistic care plan after discharge. It is important for nurses to identify the CAM approaches patients are using so that this information can assist in the education of patients and family about the benefits of contemporary treatments for depression, possible interactions when combining treatments, and the CAM and conventional medicine that can be helpful to relieve depression symptoms and psychological distress.

Use of Complementary and Alternative Medicine among adult patients for depression in Taiwan.

BACKGROUND: This descriptive exploratory study investigated the prevalence and type of Complementary and Alternative Medicine (CAM) use among older Taiwanese patients with a diagnosis of depression. METHOD: Self-report questionnaire. RESULTS: A convenience sample of 206 in-patients (98% response rate) completed the survey. Nearly 70% (69.9%) reported using at least one form of CAM in the past 12 months. Twenty-one kinds of CAM were identified in the treatment of depression, the most common being herbal medicines, spiritual healing, and folk remedies. Only one-third (35.4%, n=73) had discussed CAM use with their psychiatrists. Participants with mild to moderate depression tended to use more CAM than participants with severe depression (GDS-SF: Cramer's V=-.233; HDRS: Cramer's V=.201). CONCLUSIONS: This study confirms the high prevalence of CAM use among older adults with a diagnosis of depression in Taiwan. The popularity of CAM appears to be a consequence of people's preference for a more holistic approach to health care. CAM use needs to be explicitly discussed between patients and health professionals as part of ongoing assessment, patient education and management.