Clinical and treatment predictors of relapse during a three-year follow-up of a cohort of first episodes of schizophrenia.

Relapses are frequent in the first years following a first episode of schizophrenia (FES), being associated with a higher risk of developing a chronic psychotic disorder, and poor clinical and functional outcomes. The identification and intervention over factors associated with relapses in these early phases are timely and relevant. In this study, 119 patients in remission after a FES were closely followed over three years. Participants came from the 2EPS Project, a coordinated, naturalistic, longitudinal study of 15 tertiary centers in Spain. Sociodemographic, clinical, treatment and substance abuse data were analyzed. 49.6% of the participants relapsed during the 3-years follow-up. None of the baseline demographic and clinical characteristics analyzed showed a statistically significant association with relapses. 22% of patients that finished the follow-up without relapsing were not taking any antipsychotic. The group that relapsed presented higher mean antipsychotics doses (381.93 vs. 242.29 mg of chlorpromazine equivalent/day, p = 0.028) and higher rates of antipsychotic polytherapy (28.6% vs. 13%, p < 0.001), benzodiazepines use (30.8% vs. 8.5%, p < 0.001), side effects reports (39.2% vs. 25%, p = 0.022), psychological treatment (51.8% vs. 33.9%, p = 0.03), and cannabis consumption (93.2% vs. 56.7%, p < 0.001). Clozapine use was notably higher in the group that reminded in remission (21.7% vs. 8.2%, p < 0.019). These findings may guide clinicians to detect subgroups of patients with higher risk to present a second episode of psychosis, focusing on measures to ensure an adequate treatment or facilitating cannabis use cessation. This study supports future research to identify relapse prevention strategies for patients in early phases of schizophrenia.

Eficacia de los ácidos grasos omega-3 como tratamiento suplementario en la esquizofrenia / Efficacy of Omega-3 Fatty Acids as a Supplementary Treatment in Schizophrenia

La teoría de la membrana fosfolípidica en torno a la etiopatogenia de la esquizofrenia sostiene que una deficiencia en la composición de ácidos grasos poliinsaturados (PUFA) de los lípidos en la membrana neuronal es un factor relevante en la fisiopatología de este trastorno. Diversos ensayos clínicos evalúan el papel terapéutico de la suplementación con PUFA omega-3 en la esquizofrenia. Una revisión sistemática de la literatura publicada identificó siete ensayos clínicos realizados en condiciones de doble ciego y control con placebo que evaluaron la eficacia de dicha suplementación. Los resultados de estos estudios son heterogéneos. Parte de los datos indica una eficacia moderada de la suplementación con ácido eicosapentaenoico en dosis de 2 g/día en pacientes con esquizofrenia establecida. Dos estudios se centraron en psicosis incipiente, con resultados alentadores a corto plazo. Sin embargo, los estudios que reclutaron mayor número de pacientes no advirtieron diferencias respecto a placebo (AU)

The phospholipid membrane theory about the aetiopathogenesis of schizophrenia supports the idea that a deficiency in the polyunsaturated fatty acids (PUFA) of the lipids in the neuronal membrane is a significant factor in the pathophysiology of this disorder. Various clinical trials have evaluated the therapeutic role of omega-3 PUFA supplements in schizophrenia. A systematic review of the published literature was performed, identifying 7 double-blind, placebo controlled clinical trials that evaluated the efficacy of these supplements. The study results are heterogeneous. The data suggest that there is a moderate effect with supplements containing eicosapentaenoic acid in a dose of 2 g/day in patients with established schizophrenia. Two studies focused on incipient psychosis, with encouraging results in the short term. However, the studies that recruited a larger number of patients did not observe any differences compared to the placebo (AU)