Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomised Double Blind Placebo Controlled Pilot Study of Minocycline and/or Omega-3 Fatty Acids Added to Treatment as Usual for At Risk Mental States
Brief Summary: This is a randomized double-blind placebo controlled trial which aims to evaluate the efficacy and tolerability of minocycline and Omega-3 fatty acids for patients with ARMS. Specifically to determine whether the addition of minocycline and / or Omega-3 fatty acids to Treatment as Usual in an operationalized ARMS population in Pakistan:


Options:
A: Inclusion Criteria:

1. Male and female help seeking individuals aged between 16-35 years.
2. Meets at least one of the criteria for ARMS (see CAARMS Operationalized Intake Criteria section below).
3. Assessed as competent to provide informed consent.

Exclusion Criteria:

1. History ofpreviously experiencing a psychotic illness (treated or untreated).
2. IQ \< 70 and/or history of learning disability.
3. Any pre-existing inflammatory conditions e.g. rheumatoid arthritis.
4. Organic brain disease e.g. epilepsy.
5. treatment with an antipsychotic or mood-stabilising agent.
6. Prior history of intolerance or serious side effects (hepatotoxicity, photosensitivity, blood dyscrasias) to any of the tetracyclines or Omega-3 fatty acids.
7. Concomitant penicillin therapy or concomitant anticoagulant therapy.
8. Active substance abuse (except nicotine or caffeine) or dependence within the last three months, according to DSM-V criteria.
9. Treatment with warfarin or lamotrigine.
10. Current or previous treatment with tetracycline antibiotics or Omega-3 fatty acids in the preceding three months before study entry.
11. Current treatment with any anti-inflammatory medication.
12. Treatment with electroconvulsive therapy within the 12 weeks preceding the study.
13. Active expression of suicidal ideation (CAARMS item 7.3 severity score 6) or current aggression/dangerous behaviour (CAARMS item 5.4 severity score 6). 14. Relevant current or past hematologic, hepatic, renal, neurological or other medical disorder that in the opinion of the principal investigator may interfere with the study.

15. Pregnant or breastfeeding females.
B: Inclusion Criteria:

* Meets criteria from the Structured Interview of Prodromal Syndromes for the diagnosis of a prodromal syndrome
* Good general physical health
* English is first language
* Clinically stable (e.g., outpatient status for at least 8 weeks before study entry;on stable doses of medications for at least 1 month before study entry)

Exclusion Criteria:

* Confirmed neurological disorder
C: Inclusion Criteria:

* Age 18-40 yrs.
* Fulfill criteria for being at Ultra-High Risk of psychosis (defined by one or more of the following):

  * Vulnerability (Trait and State Risk Factor) Group: Individuals with a combination of a trait risk factor (schizotypal personality disorder or a family history of psychotic disorder in a first degree relative) and a significant deterioration in functioning, or sustained low functioning during the past year.
  * Attenuated Psychotic Symptoms (APS) Group: Individuals with sub-threshold (intensity or frequency) positive psychotic symptoms. The symptoms must have been present during the past year.
  * Brief Limited Intermittent Psychotic Symptoms Group (BLIPS): Individuals with a recent history of frank psychotic symptoms that resolved spontaneously (without antipsychotic medication) within one week. The symptoms must have been present during the past year.
* Provided informed consent.

Exclusion Criteria:

* Past history of a treated or untreated psychotic episode of one week's duration or longer
* Psychiatric symptoms that are explained by a physical illness with psychotropic effect or acute intoxication (e.g., cannabis use).
* Diagnosis of a serious developmental disorder, e.g,. Asperger's syndrome
* Currently receiving treatment with metylphenidate.
* Rejects providing informed consent.
D: Inclusion Criteria:

1. /written informed consent (for individuals under 18 written informed consent of at least one of the parents is required),
2. /age between 13 and 25 years,
3. /ARMS as classified by the PACE criteria (Yung et al., 1998)

PACE criteria for ARMS include one or more of following characteristics which must have occurred within the last 12 months:

* Frank psychotic symptoms \< 1 week (Transient psychosis group)
* Attenuated psychotic symptoms \> 1 week, \> 2 times per week
* Decline in global function (drop in GAF of \> 30%) plus family history of psychosis or individual has schizotypal personality disorder To operationalize PACE criteria duration and severity ratings of psychotic symptoms will be performed using the Positive and Negative Syndromes of Schizophrenia Scale (PANSS) (Kay et al., 1987) applying following cut-off scores, following Morrison et al (2002): Ad 1) Transient psychosis is defined with the presence of symptoms that score 4 or more on hallucinations, 4 or more on delusions, or 5 or more on conceptual disorganizations, last less than one week and resolve without antipsychotic medication. Ad 2) Attenuated psychotic symptoms are defined by the presence of symptoms that score 3 on delusions, 2-3 on hallucinations, 3-4 on suspiciousness or 3-4 on conceptual disorganization.

Exclusion Criteria:

1. /Acute suicidal behaviour, aggressive behaviour (PANSS hostility, suicidality = 7),
2. /Drug abuse that contributed decisively to the presentation of the index episode, (dependency on morphine, cocaine, amphetamine, but not THC),
3. /Alcohol abuse if considered as major problem,
4. /Epilepsy,
5. /Mental Retardation (IQ\<80),
6. /Pregnancy and lactation,
7. /Structural changes in MRI or CT scan (e.g., tumours), expect for enlargement of ventricles or sulci,
8. /Previous history of antipsychotic drug (\>1 week) or mood stabilizer treatment,
9. /Laboratory values more than 10% outside the normal range for transaminases, CRP or bleeding parameters,
10. /Individuals with organic brain syndrome,
11. /Individuals who are taking anticoagulants,
12. /Individuals who are taking omega 3 supplements, currently or within 8 weeks of being included in the trial,
13. /Individuals who have other, severe, intercurrent illness which in the opinion of the investigator may put them at risk or influence the results of the trial or affect ability to take part in the trial.

Answer: A