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Allott K, McGorry PD, Yuen HP, Firth J, Proffitt TM, Berger G, Maruff P, O'Regan MK, Papas A, Stephens TCB, O'Donnell CP. The Vitamins in Psychosis Study: A Randomized, Double-Blind, Placebo-Controlled Trial of the Effects of Vitamins B 12, B 6, and Folic Acid on Symptoms and Neurocognition in First-Episode Psychosis. Biol Psychiatry 2019; 86:35-44. [PMID: 30771856 DOI: 10.1016/j.biopsych.2018.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elevated homocysteine is observed in schizophrenia and associated with illness severity. The aim of this study was to determine whether vitamins B12, B6, and folic acid lower homocysteine and improve symptomatology and neurocognition in first-episode psychosis. Whether baseline homocysteine, genetic variation, sex, and diagnosis interact with B-vitamin treatment on outcomes was also examined. METHODS A randomized, double-blind, placebo-controlled trial was used. A total of 120 patients with first-episode psychosis were randomized to an adjunctive B-vitamin supplement (containing folic acid [5 mg], B12 [0.4 mg], and B6 [50 mg]) or placebo, taken once daily for 12 weeks. Coprimary outcomes were change in total symptomatology (Positive and Negative Syndrome Scale) and composite neurocognition. Secondary outcomes included additional measures of symptoms, neurocognition, functioning, tolerability, and safety. RESULTS B-vitamin supplementation reduced homocysteine levels (p = .003, effect size = -0.65). B-vitamin supplementation had no significant effects on Positive and Negative Syndrome Scale total (p = .749) or composite neurocognition (p = .785). There were no significant group differences in secondary symptom domains. A significant group difference in the attention/vigilance domain (p = .024, effect size = 0.49) showed that the B-vitamin group remained stable and the placebo group declined in performance. In addition, 14% of the sample had elevated baseline homocysteine levels, which was associated with greater improvements in one measure of attention/vigilance following B-vitamin supplementation. Being female and having affective psychosis was associated with improved neurocognition in select domains following B-vitamin supplementation. Genetic variation did not influence B-vitamin treatment response. CONCLUSIONS While 12-week B-vitamin supplementation might not improve overall psychopathology and global neurocognition, it may have specific neuroprotective properties in attention/vigilance, particularly in patients with elevated homocysteine levels, patients with affective psychosis, and female patients. Results support a personalized medicine approach to vitamin supplementation in first-episode psychosis.
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Affiliation(s)
- Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Joseph Firth
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Tina-Marie Proffitt
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; School of Psychology, University of Waikato, Hamilton, Waikato, New Zealand
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinic, Zurich, Switzerland
| | - Paul Maruff
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia
| | - Michaela K O'Regan
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia Papas
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Timothy C B Stephens
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Colin P O'Donnell
- Department of Psychiatry, Donegal Mental Health Service, Letterkenny University Hospital, Letterkenny, Donegal, Republic of Ireland.
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Verberk WJ, Kroon AA, Lenders JW, Kessels AG, van Montfrans GA, Smit AJ, van der Kuy PHM, Nelemans PJ, Rennenberg RJ, Grobbee DE, Beltman FW, Joore MA, Brunenberg DE, Dirksen C, Thien T, de Leeuw PW. Self-Measurement of Blood Pressure at Home Reduces the Need for Antihypertensive Drugs. Hypertension 2007; 50:1019-25. [DOI: 10.1161/hypertensionaha.107.094193] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (n=216) or office pressures (OPs; n=214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps;
P
<0.001) with lower costs ($3222 versus $4420 per 100 patients per month;
P
<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg;
P
=0.25/0.20), in changes in left ventricular mass index (−6.5 g/m
2
versus −5.6 g/m
2
;
P
=0.72), or in median urinary microalbumin concentration (−1.7 versus −1.5 mg per 24 hours;
P
=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (
P
<0.05) for systolic and 77.2 versus 76.1 mm Hg (
P
<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.
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Affiliation(s)
- Willem J. Verberk
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Abraham A. Kroon
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Jacques W.M. Lenders
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Alfons G.H. Kessels
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gert A. van Montfrans
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Andries J. Smit
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Paul-Hugo M. van der Kuy
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Patricia J. Nelemans
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Roger J.M.W. Rennenberg
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Diederick E. Grobbee
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Frank W. Beltman
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Manuela A. Joore
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Daniëlle E.M. Brunenberg
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Carmen Dirksen
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Theo Thien
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Peter W. de Leeuw
- From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
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