JAMA / Archives - A moderate intake of omega-3 fatty acids from fish oil has shown yet another benefit for mental health. Young adults with symptoms indicating an extremely high risk of developing psychosis appear less likely to develop psychotic disorders following a 12-week course of fish oil capsules containing long-chain omega-3 polyunsaturated fatty acids, according to a report in the February 2010 issue of Archives of General Psychiatry.

“Early treatment in schizophrenia and other psychoses has been linked to better outcomes,” the authors write as background information in the article. “Given that subclinical psychotic symptoms may predict psychotic disorder and psychosis proneness in a population may be related to the rate of psychotic disorder, intervention in at-risk individuals holds the promise of even better outcomes, with the potential to prevent full-blown psychotic disorders.”

Long-chain omega-3 polyunsaturated fatty acids are a promising intervention in individuals with schizophrenia, who may have an underlying dysfunction in fatty acid metabolism, the authors note. G. Paul Amminger, M.D., of Medical University of Vienna, Austria, and Orygen Youth Health Research Centre, Melbourne, Australia, conducted a randomized, double-blind, placebo-controlled clinical trial of their effect on the risk of progression to psychosis in 81 individuals at ultra–high risk. These individuals either had mild psychotic symptoms, transient psychosis or a family history of psychotic disorders plus a decrease in functioning. These criteria identify individuals whose risk of becoming psychotic may be as high as 40 percent in a 12-month period.

For 12 weeks, 41 individuals were assigned to take daily fish oil capsules containing 1.2 grams of omega-three polyunsaturated fatty acids and 40 were assigned to take placebo; a total of 76 (93.8 percent) completed the intervention. By the end of the study, two (4.9 percent) in the omega-3 group and 11 (27.5 percent) in the placebo group had transitioned to a psychotic disorder. The difference between progression to psychosis was 22.6 percent.

Based on the results, the authors estimate that four adults would need to be treated with omega-3 fatty acids to prevent one from developing psychosis over a 12-month period. Polyunsaturated fatty acids also significantly reduced symptoms and improved functioning compared with placebo. Rates of adverse effects were minimal and similar between the two groups.

The potential effects of essential fatty acids on psychosis development may result from changes to cell membranes and interactions with neurotransmitter systems in the brain, the authors note. “The finding that treatment with a natural substance may prevent or at least delay the onset of psychotic disorder gives hope that there may be alternatives to antipsychotics for the prodromal [early symptomatic] phase,” the authors write. “Stigmatization and adverse effects - which include metabolic changes, sexual dysfunction and weight gain - associated with the use of antipsychotics are often not acceptable for young people.”

In contrast, omega-3 fatty acids may cause some digestive complications but largely “are free of clinically relevant adverse effects. They have the advantage of excellent tolerability, public acceptance, relatively low costs and benefits for general health,” the authors conclude. “Long-chain omega-3 fatty polyunsaturated fatty acids reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states” (Arch Gen Psychiatry. 2010;67[2]:146-154).

JAMA / Archives - A new study shows that moderate aerobic exercise three times per week is able to build up critical brain tissue and short-term memory in both normal controls and people with schizophrenia. Potentially beneficial brain changes (an increase in the volume of an area known as the hippocampus) occur in response to aerobic exercise both in patients with schizophrenia and healthy controls, according to a report in the February 2010 issue of Archives of General Psychiatry. The findings suggest that the brain retains some plasticity, or ability to adapt, even in those with psychotic disorders.

Schizophrenia is known to be associated with a reduced volume in the area of the brain known as the hippocampus, which helps regulate emotion and memory, according to background information in the article. “In contrast to other illnesses that may display psychotic features, such as bipolar disorder, schizophrenia is often characterized by incomplete recovery of psychotic symptoms and persistent disability,” the authors write. “These clinical features of illness may relate to an impairment of neural plasticity or mechanisms of reorganizing brain function in response to a challenge.”

The formation of new neurons is one component of plasticity; previous studies have shown that neuron growth in the hippocampus of healthy individuals can be stimulated by exercise. Frank-Gerald Pajonk, M.D., of The Saarland University Hospital, Homburg, and Dr. K. Fontheim’s Hospital for Mental Health, Liebenburg, Germany, and colleagues assessed changes in hippocampal volume in response to an exercise program in both male patients with schizophrenia and men who had similar demographics and physical characteristics but did not have the condition.

Eight participants with schizophrenia and eight controls were randomly assigned to exercise (supervised cycling) three times per week for 30 minutes, whereas an additional eight patients with schizophrenia instead played tabletop football for the same period of time. The game enhances coordination and concentration but does not affect aerobic fitness. All participants underwent fitness testing, magnetic resonance imaging of the hippocampus, neuropsychological testing and other clinical measures before and after participating in the program for 12 weeks.

Following exercise training, hippocampal volume increased 12 percent in patients with schizophrenia and 16 percent in healthy controls. “To provide a context, the magnitude of these changes in volume was similar to that observed for other subcortical structures when patients were switched from typical to atypical antipsychotic drug therapy,” the authors write. Conversely, patients with schizophrenia who played tabletop football instead of exercising experienced a 1 percent decrease in hippocampal volume.

Aerobic fitness also increased among all who exercised, and improvement in test scores for short-term memory was correlated with increases in hippocampal volume among patients and healthy controls.

“Further clinical studies are needed to determine if an incremental improvement in the disability related to schizophrenia could be obtained by incorporating exercise into treatment planning and lifestyle choice for individuals with the illness,” the authors conclude (Arch Gen Psychiatry. 2010;67[2]:133-143).

Dana-Farber.org - In a newly published clinical trial, patients with metastatic prostate cancer who received a vaccine of harmless poxviruses engineered to spur an immune system attack on prostate tumor cells lived substantially longer than patients who received a placebo vaccine, report researchers at Dana-Farber Cancer Institute and affiliated organizations. The findings of the placebo-controlled trial will be published by the Journal of Clinical Oncology on its Web site and later in a print edition.

The randomized phase II study involved the PROSTVAC-VF vaccine, a combination of two weakened poxviruses that have been genetically programmed to produce slightly irregular versions of prostate specific antigen (PSA) – a protein on the surface of prostate cells that is abnormal in many prostate cancers – and three costimulatory molecules that spur the immune system to a more vigorous attack on tumor cells. The double-blinded trial included 125 patients with metastatic prostate cancer who did not respond to standard, hormone-lowering therapy. Eighty-two of the participants received the vaccine, produced by BN ImmunoTherapeutics, Inc., of Mountain View, CA, and 40 received a placebo.

At the three-year point after the study, 30 percent of the PROSTVAC-VF patients were alive, versus 17 percent of the control group. The median survival of the vaccine group was 24.5 months, compared to 16 months for the control group, an 8.5-month increase. Patients tolerated the vaccine well; only a small number experienced side effects such as fatigue, fevers, and nausea.

“Although this study is relatively small, it offers encouraging evidence of a clinically meaningful benefit from this vaccine approach,” says principal investigator and lead author Philip Kantoff, MD, of Dana-Farber, who helped design the trial. Investigators are planning a phase III trial that will enroll about 600 patients to further evaluate the vaccine’s effectiveness.

The senior author of the study is Wayne Godfrey, MD, medical director of BN ImmunoTherapeutics. The study was supported by funding from the National Cancer Institute.

JAMA / Archives - Moderate or high physical activity appears to be associated with a lower the risk of developing age-related cognitive impairment in older adults after a two-year period. Thorleif Etgen, M.D., of Technische Universität München, Munich, and Klinikum Traunstein, Germany, and colleagues examined physical activity and cognitive function in 3,903 participants (older than 55) from southern Bavaria, Germany between 2001 and 2003.

At the beginning of the study, 418 participants (10.7 percent) had cognitive impairment. After two years, 207 (5.9 percent) of the remaining 3,485 unimpaired study participants developed cognitive impairment. “The incidence of new cognitive impairment among participants with no, moderate and high activity at baseline was 13.9 percent, 6.7 percent and 5.1 percent, respectively,” the authors write.

“Future large randomized controlled intervention trials assessing the quantity (e.g., no activity vs. moderate vs. high activity) and quality (aerobic exercise or any kind type of physical exercise, like balance and strength training or even integrated physical activities like dancing or games) of physical activity that is required to prevent or delay a decline in cognitive function are recommended,” they conclude regarding the anti-aging benefits of exercise in the brain (Arch Intern Med. 2010;170[2]:186-193).

JAMA / Archives - One year of once- or twice-weekly resistance training (weight training) appears to improve attention and conflict resolution skills among older women. Teresa Liu-Ambrose, Ph.D., P.T., of Vancouver Coastal Health Research Institute and University of British Columbia, Vancouver, Canada, and colleagues studied 155 women age 65 to 75. Participants were randomly assigned to participate in resistance training once (54 women) or twice (52 women) weekly, whereas 49 women in a control group participated in twice-weekly balance and tone training.

After one year, women in both resistance training groups significantly improved their cognition scores on tests of selective attention (maintaining mental focus) and conflict resolution. The program simultaneously improved muscular function in the women. Resistance training, or weight training, may soon become a common recommendation for those involved in women’s health, anti-aging public health and preventive medicine.

“This has important clinical implications because cognitive impairment is a major health problem that currently lacks a clearly effective pharmaceutical therapy and because resistance training is not widely adopted by seniors,” the authors write. “The doses of resistance training we used in this study fall within those recommended by the 2008 Physical Activity Guidelines for seniors” (Arch Intern Med. 2010; 170[2]:170-178).

JAMA / Archives - Women who regularly participated in physical activity during middle age appear more likely to be in better overall health when they reach 70 years of age and older. Qi Sun, M.D., Sc.D., of the Harvard School of Public Health and Harvard Medical School and colleagues analyzed data from 13,535 participants in the Nurses’ Health Study.

The women reported their physical activity levels in 1986, at an average age of 60. Among those who had survived to age 70 or older as of 1995 to 2001, those who had higher levels of physical activity at the beginning of the study were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments, testifying to the place of physical activity in women’ health and preventive medicine.

“Since the American population is aging rapidly and nearly a quarter of Americans do not engage in any leisure-time activity, our findings appear to support federal guidelines regarding physical activity to promote health among older people and further emphasize the potential of activity to enhance overall health and well-being with aging,” the authors conclude regarding the anti-aging benefits of exercise. “The notion that physical activity can promote successful survival rather than simply extend the lifespan may provide particularly strong motivation for initiating activity” (Arch Intern Med. 2010;170[2]:194-201).