Minocycline and/or Omega-3 Fatty Acids Added to Treatment as Usual for At Risk Mental States

Study Overview
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Brief Summary
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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:

Detailed Description
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Primary hypothesis is that the persons with ARMS who are prescribed minocycline and / or Omega-3 fatty acids will have reduced transition rates to psychosis over a one year follow up period (from baseline) compared with Treatment-As-Usual (TAU). The transition rates will be lowest in the group receiving minocycline and Omega-3 fatty acids in combination. Secondary objective is to determine that the Persons with ARMS who are prescribed minocycline and / or Omega-3fatty acids in combination will have greatest symptom reduction compared with TAU. This study will be a six-month intervention of minocycline and/or Omega-3 fatty acids added to TAU in patients with ARMS, using a randomised, placebo-controlled, double-blind factorial design.The study will be a four-arm trial: one arm will receive minocycline with TAU; the second arm will receive Omega-3 fatty acids with TAU; the third arm will receive both minocycline and Omega-3 fatty acids with TAU; the fourth arm will receive placebo with TAU.

Official Title
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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

Conditions
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At Risk Mental State (ARMS), Psychosis

Intervention / Treatment
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* Drug: Minocycline
* Drug: Omega-3 fatty acids
* Drug: Placebo
* Drug: Minocycline Plus Omega-3 fatty acids


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female help seeking individuals aged between 16-35 years. Meets at least one of the criteria for ARMS (see CAARMS Operationalized Intake Criteria section below). Assessed as competent to provide informed consent. Exclusion Criteria: History ofpreviously experiencing a psychotic illness (treated or untreated). IQ < 70 and/or history of learning disability. Any pre-existing inflammatory conditions e.g. rheumatoid arthritis. Organic brain disease e.g. epilepsy. treatment with an antipsychotic or mood-stabilising agent. Prior history of intolerance or serious side effects (hepatotoxicity, photosensitivity, blood dyscrasias) to any of the tetracyclines or Omega-3 fatty acids. Concomitant penicillin therapy or concomitant anticoagulant therapy. Active substance abuse (except nicotine or caffeine) or dependence within the last three months, according to DSM-V criteria. Treatment with warfarin or lamotrigine. Current or previous treatment with tetracycline antibiotics or Omega-3 fatty acids in the preceding three months before study entry. Current treatment with any anti-inflammatory medication. Treatment with electroconvulsive therapy within the 12 weeks preceding the study. 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.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Minocycline<br>Minocycline added to TAU Minocycline will be administered in 200mg once daily dose | Drug: Minocycline<br>* Minocycline added to TAU Minocycline will be administered in 200mg once daily dose<br>|
| Active Comparator: Omega-3 fatty acids<br>Omega-3 fatty acids added to TAU Omega-3 fatty acids will be administered in 1.2mg once daily dose | Drug: Omega-3 fatty acids<br>* Omega-3 fatty acids added to TAU Omega-3 fatty acids will be administered in 1.2g once daily dose<br>|
| Active Comparator: Placebo<br>Placebo added to TAU | Drug: Placebo<br>* Placebo added to TAU<br>|
| Active Comparator: Minocycline Plus Omega-3 fatty acids<br>Minocycline+Omega-3 fatty acids added to TAU ,Minocyline will be administered in 200mg once daily dose and Omega-3 fatty acids 1.2 g taken as once daily dose | Drug: Minocycline Plus Omega-3 fatty acids<br>* Minocycline will be administered in 200mg once daily dose and Omega-3 fatty acid 1.2g taken as once daily dose<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Transition to psychotic disorder | Structure Clinical interview for DSM-IV(SCID) (Michael B et al,. 2002) to confirm the transition to psychosis. | 12 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measured severity ofAt Risk of Mental State ( ARMS) symptoms | Comprehensive Assessment of At-Risk Mental States (CAARMS) (Berger, GEet al2006).A semi-structured interview that assists in the identification of individuals at risk of developing a first-episode psychotic disorder and measured the severity of ARMS symptoms. | 12 Months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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At Risk of Mental State, Prodromal Phase, Psychosis