The Vitamins in Psychosis Study: A Randomized, Double-Blind, Placebo-Controlled Trial of the Effects of Vitamins B12, B6, and Folic Acid on Symptoms and Neurocognition in First-Episode Psychosis

被引：33

作者：

Allott, Kelly ^{[1
,2
]}

McGorry, Patrick D. ^{[1
,2
]}

Yuen, Hok Pan ^{[1
,2
]}

Firth, Joseph ^{[1
,2
,4
]}

Proffitt, Tina-Marie ^{[1
,2
,5
]}

Berger, Gregor ^{[6
]}

Maruff, Paul ^{[3
]}

O'Regan, Michaels K. ^{[1
,2
]}

Papas, Alicia ^{[1
,2
]}

Stephens, Timothy C. B. ^{[1
,2
]}

O'Donnell, Colin P. ^{[7
]}

机构：

[1] Univ Melbourne, Natl Ctr Excellence Youth Mental Hlth, Orygen, Parkville, Vic, Australia

[2] Univ Melbourne, Ctr Youth Mental Hlth, Parkville, Vic, Australia

[3] Univ Melbourne, Dept Anat & Neurosci, Parkville, Vic, Australia

[4] Western Sydney Univ, NICM Hlth Res Inst, Sydney, NSW, Australia

[5] Univ Waikato, Sch Psychol, Hamilton, Waikato, New Zealand

[6] Psychiat Univ Clin, Dept Child & Adolescent Psychiat, Zurich, Switzerland

[7] Letterkenny Univ Hosp, Donegal Mental Hlth Serv, Dept Psychiat, Letterkenny, Donegal, Ireland

来源：

BIOLOGICAL PSYCHIATRY | 2019年 / 86卷 / 01期

基金：

澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;

关键词：

Attention; B vitamins; Early psychosis; Folic acid; Genetics; Homocysteine; BLOOD HOMOCYSTEINE LEVELS; YOUNG MALE-PATIENTS; L-METHYLFOLATE; METHYLENETETRAHYDROFOLATE REDUCTASE; COGNITIVE IMPAIRMENT; CLINICAL-TRIALS; RATING-SCALE; SCHIZOPHRENIA; SUPPLEMENTATION; DEPRESSION;

D O I：

10.1016/j.biopsych.2018.12.018

中图分类号：

Q189 [神经科学];

学科分类号：

071006 [神经生物学];

摘要：

BACKGROUND: Elevated homocysteine is observed in schizophrenia and associated with illness severity. The aim of this study was to determine whether vitamins B-12, B-6, and folic acid lower homocysteine and improve symptomatology and neurocognition in first-episode psychosis. Whether baseline homocysteine, genetic variation, sex, and diagnosis interact with B-vitamin treatment on outcomes was also examined. METHODS: A randomized, double-blind, placebo-controlled trial was used. A total of 120 patients with first-episode psychosis were randomized to an adjunctive B-vitamin supplement (containing folic acid [5 mg], B-12 [0.4 mg], and B-6 [50 mg]) or placebo, taken once daily for 12 weeks. Coprimary outcomes were change in total symptomatology (Positive and Negative Syndrome Scale) and composite neurocognition. Secondary outcomes included additional measures of symptoms, neurocognition, functioning, tolerability, and safety. RESULTS: B-vitamin supplementation reduced homocysteine levels (p = .003, effect size = -0.65). B-vitamin supplementation had no significant effects on Positive and Negative Syndrome Scale total (p = .749) or composite neurocognition (p = .785). There were no significant group differences in secondary symptom domains. A significant group difference in the attention/vigilance domain (p = .024, effect size = 0.49) showed that the B-vitamin group remained stable and the placebo group declined in performance. In addition, 14% of the sample had elevated baseline homocysteine levels, which was associated with greater improvements in one measure of attention/vigilance following B-vitamin supplementation. Being female and having affective psychosis was associated with improved neurocognition in select domains following B-vitamin supplementation. Genetic variation did not influence B-vitamin treatment response. CONCLUSIONS: While 12-week B-vitamin supplementation might not improve overall psychopathology and global neurocognition, it may have specific neuroprotective properties in attention/vigilance, particularly in patients with elevated homocysteine levels, patients with affective psychosis, and female patients. Results support a personalized medicine approach to vitamin supplementation in first-episode psychosis.

引用

页码：35 / 44

页数：10

共 56 条

[1]

A DEPRESSION RATING-SCALE FOR SCHIZOPHRENICS [J].