Joseph Firth1; 1NICM Health Research Institute, University of Western Sydney, Sydney, Australia
Background: Extensive research has established that nutritional deficiencies are common in long-term schizophrenia. Randomised controlled trials (RCTs) also demonstrate that adjunctive nutritional interventions can improve outcomes in long-term schizophrenia. Therefore, we examined nutritional deficiencies and clinical correlates in first-episode of psychosis (FEP), in order to design a nutritional intervention for young patients in early stages of illness. Methods: We reviewed all studies examining blood nutrient levels and outcomes of supplementation in FEP: Meta-analytic techniques compared nutrient levels in FEP to healthy controls, and systematic synthesis was applied to all clinical correlates of nutritional deficiencies in FEP. Additionally, we conducted an independent systematic review of all nutrient-based treatment trials in FEP to date. Results: A total of 28 studies examined blood levels of six vitamins and ten dietary minerals in FEP, across 2,612 individuals. Random effects meta-analyses comparing FEP to healthy control groups showed large, significant deficits for Vitamin-D, Vitamin-C, and folate. Lower levels of folate and vitamin-D were associated with more severe symptoms in FEP. Our separate systematic review of 8 experimental studies indicated that supplementation with certain amino acids and antioxidants may also improve treatment outcomes in FEP. Conclusion: Our meta-analysis was the first to examine the extent and clinical correlates of nutritional deficits in FEP. Results showed that vitamin D and folate deficits exist from illness onset, even prior to antipsychotic treatment - and are associated with more severe psychiatric symptoms. Our upcoming RCT (the 'NATURE' trial) will assess if targeting these deficiencies can improve recovery in FEP.
