Review of: Raine A et al, Schizophr Bull 2024;50(5):1117–1126

Study Type: Single-blind randomized controlled community trial 

Traits associated with schizotypal personality disorder (SPD)—odd beliefs, social anxiety, and perceptual distortions—may precede SPD and schizophrenia-spectrum disorders. Interventions to reduce these traits may prevent severe outcomes later in life. Previous studies have suggested that omega-3 fatty acids could lower the risk of psychosis in at-risk adolescents. This study explored whether omega-3 supplementation could reduce schizotypal traits in a community sample of children.

This randomized, single-blind, controlled trial involved 290 children ages 11–12 from the community with traits of conduct disorder, oppositional defiant disorder, or elevated reactive or proactive aggression scores on the Reactive-Proactive Aggression Questionnaire. Participants were randomly assigned to four groups: omega-3 only, cognitive behavioral therapy (CBT) only, omega-3 + CBT, or control. Omega-3 supplementation consisted of 1000 mg daily (300 mg DHA, 200 mg EPA, 400 mg ALA, and 100 mg DPA). The CBT program focused on aggression and cognitive distortions. Schizotypal traits were measured at baseline, post-treatment (3 months), and at 6- and 12-month follow-up using a validated child schizotypy questionnaire.

Children receiving omega-3 supplementation, alone or with CBT, showed significant reduction in schizotypal traits compared to controls at 3 months (effect sizes: d = 0.56 for omega-3 only; d = 0.47 for omega-3 + CBT). Improvements were maintained at 6 months; by 12 months, most effects had diminished except for interpersonal schizotypy, which remained improved for the omega-3 groups. The reduction was most pronounced in children with higher baseline dietary intake of omega-3.

Carlat Take 
High-dose omega-3 supplementation moderately improved schizotypal traits, whether alone or with CBT. This ­suggests that omega-3 may help in ­prevention strategies for schizophrenia-spectrum disorders. Effects diminished after supplementation stopped, indicating that longer or higher dosing might be needed for sustained benefits, or the end of a placebo effect in a single-blind study. Clinicians might recommend increased dietary omega-3s for children at risk of developing schizotypal traits, but we need better studies to confirm long-term efficacy and safety.