Advice

Intervention and alternatives

Intervention and alternatives

The omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential fatty acids. There are numerous products on the UK market that contain omega-3 fatty acids. Amongst them there are 14 that have a current licence as medicinal products. The majority of the oral formulations are indicated for use as adjuvant treatment in secondary prevention of myocardial infarction and for treatment of hypertriglyceridaemia when dietary measures are not sufficient.

Three other products with UK marketing authorisation contain named unsaturated fatty acids that belong to the group of omega-3 fatty acids (EPA and DHA).

Condition

Schizophrenia is a major psychiatric disorder, or cluster of disorders, characterised by psychotic symptoms that alter a person's perception, thoughts, affect, and behaviour. Each person with the disorder will have a unique combination of symptoms and experiences.

Typically, there is a prodromal period often characterised by some deterioration in personal functioning. This includes memory and concentration problems, unusual behaviour and ideas, disturbed communication and affect, and social withdrawal, apathy and reduced interest in daily activities. These are sometimes called 'negative symptoms'. The prodromal period is usually followed by an acute episode marked by hallucinations, delusions, and behavioural disturbances. These are sometimes called 'positive symptoms', and are usually accompanied by agitation and distress. After resolution of the acute episode, usually after pharmacological, psychological and other interventions, symptoms diminish and often disappear for many people, although sometimes a number of negative symptoms may remain. This phase, which can last for many years, may be interrupted by recurrent acute episodes, which may need additional intervention.

Alternative treatment options

Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary and secondary care (NICE clinical guideline 82) recommends the following:

Psychological interventions

  • Offer cognitive behavioural therapy (CBT) to all people with schizophrenia. This can be started either during the acute phase or later, including in inpatient settings.

  • Offer family intervention to all families of people with schizophrenia who live with or are in close contact with the service user. This can be started either during the acute phase or later, including in inpatient settings.

Pharmacological interventions

  • For people with newly diagnosed schizophrenia, offer oral antipsychotic medication. Provide information and discuss the benefits and side-effect profile of each drug with the service user. The choice of drug should be made by the service user and healthcare professional together, considering:

    • the relative potential of individual antipsychotic drugs to cause extrapyramidal side effects (including akathisia), metabolic side effects (including weight gain) and other side effects (including unpleasant subjective experiences)

    • the views of the carer if the service user agrees.

  • Do not initiate regular combined antipsychotic medication, except for short periods (for example, when changing medication).

Interventions for people with schizophrenia whose illness has not responded adequately to treatment

  • For people with schizophrenia whose illness has not responded adequately to pharmacological or psychological treatment:

    • review the diagnosis

    • establish that there has been adherence to antipsychotic medication, prescribed at an adequate dose and for the correct duration

    • review engagement with and use of psychological treatments and ensure that these have been offered according to this guideline. If family intervention has been undertaken suggest CBT; if CBT has been undertaken suggest family intervention for people in close contact with their families

    • consider other causes of non-response, such as comorbid substance misuse (including alcohol), the concurrent use of other prescribed medication or physical illness.

  • Offer clozapine to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs. At least 1 of the drugs should be a non-clozapine second-generation antipsychotic.

There is no reference to omega-3 fatty acid medicines in the NICE clinical guideline on schizophrenia.