Association between non-adherence to fish oil or placebo as a risk factor of transition to psychosis in ultra-high-risk individuals in the NEURAPRO study.
Monika Schlögelhofer, Ashleigh Lin, Connie Markulev, Miriam R Schäfer, Patrick D McGorry, Barnaby Nelson, Rebekah Street, Nilufar Mossaheb, Stefan Smesny, Ian B Hickie, Gregor Berger, Eric Yh Chen, Lieuwe de Haan, Dorien H Nieman, Merete Nordentoft, Anita Riecher-Rössler, Swapna Verma, Andrew Thompson, Alison R Yung, G Paul Amminger
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引用次数: 0
Abstract
Objective: Non-adherence is an important factor in clinical trials, which has not been investigated in people at ultra-high risk (UHR) of developing a first episode of psychosis.
Methods: Exploratory analysis of data from NEURAPRO, a multicenter, placebo-controlled trial of long-chain omega-3 polyunsaturated fatty acids (omega-3 PUFAs) in 304 individuals at UHR. We examined correlates of non-adherence with study medication (omega-3 PUFAs or placebo), including patient, illness and treatment factors, plus transition to psychosis. Non-adherence was defined as <75% study medication intake over 6 months and, post hoc, by the number of returned pills.
Results: Of 285 randomized participants with baseline fatty acid data, 163 (57.2%) were non-adherent. In univariate analyses, non-adherence was associated with baseline omega-3 index, pre-baseline duration of untreated symptoms, smoking, cannabis use, lower baseline Social and Occupational Functioning Assessment Scale, Global Functioning: Social and Role Scale scores and transition to psychosis. Transition to psychosis risk was significantly lower in the adherent than non-adherent group (4.2%, 95% CI = 0.7-7.7% vs 17.3%, 95% CI = 10.4-24.2%), Kaplan-Meier Log-rank test, chi-square = 10.675, p = 0.001), independent of omega-3 PUFA treatment status. Similarly, Cox regression analysis, covarying for the aforementioned factors significantly associated with non-adherence, also revealed non-adherence as an independent predictor of transition to psychosis (B = 1.452, p = 0.005). Finally, non-adherence was also significantly associated with transition to psychosis, even when defining non-adherence by number of returned pills.
Conclusion: Non-adherence predicted a higher risk of progressing to psychosis in UHR individuals. Further studies are needed to better understand factors contributing to non-adherence and how non-adherence is related to transition to psychosis.
期刊介绍:
Australian & New Zealand Journal of Psychiatry is the official Journal of The Royal Australian and New Zealand College of Psychiatrists (RANZCP).
The Australian & New Zealand Journal of Psychiatry is a monthly journal publishing original articles which describe research or report opinions of interest to psychiatrists. These contributions may be presented as original research, reviews, perspectives, commentaries and letters to the editor.
The Australian & New Zealand Journal of Psychiatry is the leading psychiatry journal of the Asia-Pacific region.