Effects of omega-3 polyunsaturated fatty acid supplementation on cognitive functioning in youth at ultra-high risk for psychosis: secondary analysis of the NEURAPRO randomised controlled trial

BACKGROUND: Cognitive impairments are well-established features of psychotic disorders and are present when individuals are at ultra-high risk for psychosis. However, few interventions target cognitive functioning in this population. AIMS: To investigate whether omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation improves cognitive functioning among individuals at ultra-high risk for psychosis. METHOD: Data (N = 225) from an international, multi-site, randomised controlled trial (NEURAPRO) were analysed. Participants were given omega-3 supplementation (eicosapentaenoic acid and docosahexaenoic acid) or placebo over 6 months. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Mixed two-way analyses of variance were computed to compare the change in cognitive performance between omega-3 supplementation and placebo over 6 months. An additional biomarker analysis explored whether change in erythrocyte n-3 PUFA levels predicted change in cognitive performance. RESULTS: The placebo group showed a modest greater improvement over time than the omega-3 supplementation group for motor speed (η$_{p}$$^{2}$ = 0.09) and BACS composite score (η$_{p}$$^{2}$ = 0.21). After repeating the analyses without individuals who transitioned, motor speed was no longer significant (η$_{p}$$^{2}$ = 0.02), but the composite score remained significant (η$_{p}$$^{2}$ = 0.02). Change in erythrocyte n-3 PUFA levels did not predict change in cognitive performance over 6 months. CONCLUSIONS: We found no evidence to support the use of omega-3 supplementation to improve cognitive functioning in ultra-high risk individuals. The biomarker analysis suggests that this finding is unlikely to be attributed to poor adherence or consumption of non-trial n-3 PUFAs

Distress in relation to attenuated psychotic symptoms in the ultra-high-risk population is not associated with increased risk of psychotic disorder.

AIM: The \u27ultra-high-risk\u27 criteria identify a clinical population at substantially increased risk for progressing to schizophrenia and other psychotic disorders. Although a number of clinical variables predictive of transition to psychotic disorder have been identified within this population, the predictive value of the level of distress associated with attenuated psychotic symptoms has not yet been examined. This was the aim of the present study. METHOD: The level of distress (0-100) associated with attenuated psychotic symptoms was recorded for 70 ultra-high-risk (UHR) patients using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Transition to psychosis was assessed over a 16-month follow-up period. RESULTS: Of the 70 UHR patients, 15 transitioned to psychosis (21.4%). Of the four CAARMS subscales measuring attenuated positive symptoms, Perceptual Abnormalities was rated as the most distressing. There were no differences in CAARMS scales rated as the most distressing between those who transitioned to psychosis and those who did not. There was also no association between higher levels of distress associated with attenuated psychotic symptoms and transition to psychosis. CONCLUSION: Although the findings require replication, they indicate that the degree of distress associated with attenuated psychotic symptoms should not be used as a criterion for enriching UHR samples for risk of frank psychotic disorder

Children's Judgements of Facial Hair are Influenced by Biological Development and Experience

Adults use features such as facial hair to judge others' social dominance and mate value, but the origin of these judgments is unknown. We sought to determine when these associations develop, which associations develop first, and whether they are associated with early exposure to bearded faces. We presented pairs of bearded and clean-shaven faces to children (2-17 years old; N=470) and adults (18-22 years; N = 164) and asked them to judge dominance traits (strength, age, masculinity) and mate choice traits (attractiveness, parenting quality). Young children associated beardedness with dominance traits but not mate choice traits. This pattern became more extreme during late childhood and gradually shifted toward adult-like responses during early adolescence. Responses for all traits were adult-like in late adolescence. Finally, having a bearded father was associated with positive judgments of bearded faces for mate choice traits in childhood and both mate choice and dominance traits in adolescence

Mothers are sensitive to men's beards as a potential cue of paternal investment

Mating strategy theories assert that women's preferences for androgen dependent traits in men are stronger when the costs of reduced paternal investment are lowest. Past research has shown that preferences for facial masculinity are stronger among nulliparous and non-pregnant women than pregnant or parous women. In two studies, we examine patterns in women's preferences for men's facial hair - likely the most visually conspicuous and sexually dimorphic of men's secondary sexual traits - when evaluating men's masculinity, dominance, age, fathering, and attractiveness. Two studies were conducted among heterosexual pregnant women, mothers, non-contractive and contraceptive users. Study 1 used a between-subjects sample (N = 2103) and found that mothers had significantly higher preferences for beards when judging fathering than all other women. Pregnant women and mothers also judged beards as more masculine and older, but less attractive, than non-contractive and contraceptive users. Parous women judged beards higher for age, masculinity and fathering, but lower for attractiveness, than nulliparous women. Irrespective of reproductive status, beards were judged as looking more dominant than clean-shaven faces. Study 2 used a within-subjects design (N = 53) among women surveyed during pregnancy and three months post-partum. Judgments of parenting skills were higher for bearded stimuli during pregnancy among women having their first baby, whereas among parous women parenting skills judgments for bearded stimuli were higher post-partum. Our results suggest that mothers are sensitive to beardedness as a masculine secondary sexual characteristic that may denote parental investment, providing evidence that women's mate preferences could reflect sexual selection for direct benefits

Subjective experience and meaning of delusions in psychosis : a systematic review and qualitative evidence synthesis

BACKGROUND: Delusions are a common transdiagnostic feature of psychotic disorders, and their treatment remains suboptimal. Despite the pressing need to better understand the nature, meaning, and course of these symptoms, research into the lived experience of delusional phenomena in psychosis is scarce. Thus, we aimed to explore the lived experience and subjective apprehension of delusions in help-seeking individuals with psychosis, regardless of diagnosis and thematic content of the delusion. METHODS: In our systematic review and qualitative evidence synthesis, we searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science for qualitative studies published in English from database inception, with the last search on Sept 9, 2021. Grey literature search and hand-searching of relevant journals were also done. Studies were eligible if they provided an analysis of lived experience of delusions or predelusional phenomena presented from the perspective of individuals (age 14-65 years) who had developed a clinical high-risk stage of psychosis, or a diagnosable affective or non-affective psychotic disorder (as clinically defined, self-reported, or assessed within the primary study). Studies with only a subset of relevant participants were eligible only if data for the population of interest were reported separately. Studies that did not discriminate between the experience of delusion and other positive symptoms (eg, hallucinations) were included only if data for delusions were reported separately or could be extracted. First-person accounts (and author interpretations) discussing changes in the sense of self, lived world, and meaning in relation to delusions were extracted and synthesised using a novel thematic synthesis approach informed by a critical realist stance and a phenomenological theoretical framework. Analytic themes were developed into a new overarching framework for understanding the emergence of delusional phenomena. The study was registered with PROSPERO, CRD42020222104. FINDINGS: Of the 3265 records screened, 2115 were identified after duplicate removal. Of these, 1982 were excluded after title and abstract screening and 106 after full-text eligibility assessment. Of the 27 studies entering quality assessment, 24 eligible studies were included in the qualitative evidence synthesis, representing the perspectives of 373 help-seeking individuals with lived experience of delusions in the context of psychosis. Gender was reported as male (n=210), female (n=110), transgender (n=1), or not reported (n=52). Only 13 studies reported ethnicity, with White being predominant. The age of most participants ranged from 15 to 65 years. We found no eligible studies investigating subclinical or predelusional experiences in at-risk mental state populations through qualitative methods. Most studies were undertaken in western, educated, industrialised, rich, and democratic (WEIRD) societies, and most included participants had received or self-reported a diagnosis within the schizophrenia spectrum. Studies differed in relation to whether they focused on one kind or theme of delusion or delusional phenomena more generally as a unified category. Three superordinate themes relating to experiential changes and meanings in delusion were identified: (1) a radical rearrangement of the lived world dominated by intense emotions; (2) doubting, losing, and finding oneself again within delusional realities; and (3) searching for meaning, belonging, and coherence beyond mere dysfunction. Based on the review findings and thematic synthesis, we propose the Emergence Model of Delusion to advance understanding of delusional phenomena in psychosis. INTERPRETATION: Delusions are best understood as strongly individualised and inherently complex phenomena emerging from a dynamic interplay between interdependent subpersonal, personal, interpersonal, and sociocultural processes. Integrative approaches to research on delusion, which consider their potential adaptiveness and favour explanatory pluralism, might be advantageous. Effective clinical care for individuals with psychosis might need adapting to match more closely, and take account of, the subjective experience and meaning of delusions as they are lived through, which might also help redress power imbalances and enduring epistemic injustices in mental health. FUNDING: Priestley Scholars, Wellcome Trust