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| Name | Class |
|---|---|
| Baszucki Family Foundation | OTHER |
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This is a randomized, controlled clinical trial to assess the effects of the ketogenic diet in combination with treatment as usual on brain energy metabolism and psychiatric symptoms in individuals with first episode bipolar disorder and schizoaffective disorder.
Several lines of evidence show energy metabolism and redox dysregulation in bipolar disorder and psychotic disorders. Ketogenic interventions targeting energy metabolism are promising therapeutic approaches to improve mood and psychosis in bipolar disorder and other psychotic disorders. Early intervention is also critical to helping people achieve their goals for recovery after a first episode. Investigators aim to use multimodal imaging and metabolic measures to study the effects of a ketogenic diet intervention on energy metabolism and psychiatric symptoms in individuals with first episode bipolar disorder and schizoaffective disorder. This 12-week randomized controlled trial will assess the benefits of a ketogenic diet in combination with treatment as usual compared to a standard diet. Investigators will measure the effects of nutritional ketosis on brain redox and energy metabolism and other neurometabolic markers using magnetic resonance spectroscopy. Furthermore, investigators will measure the effects of the ketogenic diet on mood and psychotic symptoms and metabolic measures such as insulin resistance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ketogenic diet arm | Active Comparator | Eligible participants assigned to the ketogenic diet arm will be asked to follow the ketogenic diet (KD) for 12 weeks in addition to any ongoing medications (e.g., mood stabilizers and/or second-generation antipsychotics). Participants will receive weekly and as needed diet counseling from a registered dietician. Participants will be asked to monitor and report their blood ketone levels each day via a finger-prick device provided by the study team. Participants have the ability to opt into an optional open label phase where they can continue on the ketogenic diet with the daily finger pricks for another 12 weeks after the 12-week main study. |
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| Dietary Guidelines for Americans arm | Active Comparator | Eligible participants assigned to the Dietary Guidelines for Americans (DGA) arm will adhere to the Dietary Guidelines for Americans in addition to any ongoing medications (e.g., mood stabilizers and/or second-generation antipsychotics). Participants will receive weekly and as needed diet counseling from a registered dietician. Participants will be asked to monitor and report their blood ketone levels each day via a finger-prick device provided by the study team. Participants have the ability to opt into an optional open label phase where they can switch to the ketogenic diet with the daily finger pricks for 12 weeks after the 12-week main study. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ketogenic diet | Other | The ketogenic diet (KD) is a normo-caloric diet composed of high-fat, low carbohydrate, and adequate protein intake. The KD will consist of 3 meals a day plus snacks, targeting 75-80% fat, 13-18% protein, 7% carbohydrates. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in brain redox nicotinamide adenine dinucleotide metabolites ratio (NAD+/NADH) | Change from baseline to week 12 in NAD+/NADH as measured by in vivo phosphorus magnetic resonance spectroscopy (31P-MRS). | 12 weeks |
| Change in brain creatine kinase forward reaction rate (kf) | Change from baseline to week 12 in creatine kinase forward reaction rate (kf) as measured by 31P magnetization transfer (MT) MRS. | 12 weeks |
| Change in insulin resistance | Change from baseline to week 12 of insulin resistance measured using the homeostatic model assessment of insulin resistance (HOMA-IR) using fasting blood glucose and insulin levels. | 12 weeks |
| Change in psychotic symptoms | Change from baseline to week 12 in Positive and Negative Syndrome Scale (PANSS) total score. Scores range from 30-210; a higher score indicates a higher level of psychotic symptoms. | 12 weeks |
| Change in depressive symptoms | Change from baseline to week 12 in Hamilton Rating Scale for Depression (HAM-D) total score. Scores range from 0-52; a higher score indicates a higher level of depression. | 12 weeks |
| Change in mania symptoms | Change from baseline to week 12 in Young Mania Rating Scale (YMRS) total score. Scores range from 0-60. A higher score indicates a more severe illness. | 12 weeks |
| Change in Clinical Global Impression (CGI) Scale |
| Measure | Description | Time Frame |
|---|---|---|
| Change in body weight | Change from baseline to week 12 in participant body weight in kilograms, as measured using a standing scale. | 12 weeks |
| Change in glycated hemoglobin (Hemoglobin A1c) level |
| Measure | Description | Time Frame |
|---|---|---|
| Change in World Health Organization Disability Assessment Schedule (WHODAS) score | Change from baseline to week 12 in World Health Organization Disability Assessment Schedule (WHODAS) scale. Scores range from 0-144. A higher score indicates greater dysfunction and disability in major life domains. | 12 weeks |
| Change in World Health Organization Quality of Life (WHOQOL) score |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jacey Anderson, B.A. | Contact | 617-855-3988 | janderson75@mclean.harvard.edu | |
| Virginie-Anne Chouinard, MD | Contact | vchouinard@mclean.harvard.edu |
| Name | Affiliation | Role |
|---|---|---|
| Virginie-Anne Chouinard, MD | Mclean Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| McLean Hospital | Recruiting | Belmont | Massachusetts | 02478 | United States |
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| ID | Term |
|---|---|
| D011618 | Psychotic Disorders |
| D007333 | Insulin Resistance |
| D001714 | Bipolar Disorder |
| ID | Term |
|---|---|
| D019967 | Schizophrenia Spectrum and Other Psychotic Disorders |
| D001523 | Mental Disorders |
| D006946 | Hyperinsulinism |
| D044882 | Glucose Metabolism Disorders |
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| ID | Term |
|---|---|
| D055423 | Diet, Ketogenic |
| D018673 | Nutrition Policy |
| ID | Term |
|---|---|
| D050528 | Diet, Carbohydrate-Restricted |
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
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| Dietary Guidelines for Americans | Other | Dietary Guidelines for Americans diet is a normo-caloric diet consisting of 3 meals a day plus snacks, emphasizing nutrient dense foods to meet food group needs (85% of calories), and limits foods and beverages higher in added sugars and saturated fat (15% of calories). |
|
Change from baseline to week 12 in Clinical Global Impression (CGI) Scale. Scores range from 1-7; a higher score indicates higher severity of illness. |
| 12 weeks |
Change from baseline to week 12 in fasting Hemoglobin A1c level.
| 12 weeks |
| Change in triglyceride levels | Change from baseline to week 12 in fasting triglyceride levels. | 12 weeks |
| Change in low-density lipoprotein (LDL) levels | Change from baseline to week 12 in fasting LDL levels. | 12 weeks |
| Change in high-density lipoprotein (HDL) levels | Change from baseline to week 12 in fasting HDL levels. | 12 weeks |
| Change in high-sensitivity C-reactive protein (hs-CRP) levels | Change from baseline to week 12 in fasting hs-CRP levels. | 12 weeks |
| Change in brain gamma-aminobutyric acid (GABA) concentration | Change from baseline to week 12 in GABA concentration measured by proton magnetic resonance spectroscopy. | 12 weeks |
| Change in brain glutamate metabolite concentration | Change from baseline to week 12 in glutamate metabolite concentration measured by proton magnetic resonance spectroscopy. | 12 weeks |
| Change in brain glutathione (GSH) | Change from baseline to week 12 in brain GSH measured by proton magnetic resonance spectroscopy. | 12 weeks |
| Change in brain Phosphocreatine (PCr) | Changes from baseline to week 12 in PCr concentration as measured by in vivo 31P-MRS. | 12 weeks |
| Change in brain pH | Change from baseline to week 12 in pH as measured by in vivo 31P MRS. | 12 weeks |
| Change in brain inorganic phosphate concentration | Change from baseline to week 12 in inorganic phosphate (Pi) concentration as measured by in vivo 31P MRS. | 12 weeks |
| Change in adverse events | Change from baseline to week 12 from baseline to week 12 in adverse events. | 12 weeks |
| Change in anxiety symptoms | Change from baseline to week 12 from baseline to week 12 in Hamilton Anxiety Rating Scale (HAM-A) total score. Scores range from 0 - 56; a higher score indicates a higher level of anxiety. | 12 weeks |
| Change in stress symptoms | Change from baseline to week 12 in Depression Anxiety Stress Scales (DASS-42) Stress Subscale score. Scores range from 0-42; a higher score indicates a higher level of stress. | 12 weeks |
| Change in cognitive performance | Change from baseline to week 12 in Matrics Consensus Cognitive Battery (MCCB) Total Score. Scores range from 0.00% - 100.00%; a higher score indicates higher cognition. | 12 weeks |
| Change in Global Functioning Scale (GFS) - Social and Role total score | Change from baseline to week 12 in Global Functioning Scale (GFS) - Social and Role total score. Scores range from 6-60; a lower score indicates worse social and role functioning. | 12 weeks |
| Change in cell-free mitochondrial DNA (cf-mtDNA) | Change from baseline to week 12 in blood and saliva cf-mtDNA levels. | 12 weeks |
| Change in growth differentiation factor 15 (GDF15) | Change from baseline to week 12 in blood and saliva GDF15 levels. | 12 weeks |
| Change in blood NAD/NADH+ ratio | Change from baseline to week 12 in blood NAD/NADH+ ratio. | 12 weeks |
| Change in blood GSH/GSSH ratio | Change from baseline to week 12 in blood GSH/GSSH ratio. | 12 weeks |
Change from baseline to week 12 in World Health Organization Quality of Life (WHOQOL) scale. Scores range from 1-130. A lower score indicates lower perceived quality of life. |
| 12 weeks |
| Change in Extrapyramidal Symptom Rating Scale (ESRS) total score | Change from baseline to week 12 in Extrapyramidal Symptom Rating Scale (ESRS) total score. Scores range from 0-102; a higher score indicates more severe symptoms. | 12 weeks |
| Change in Pittsburgh Sleep Quality Index (PSQI) total score | Change from baseline to week 12 in Pittsburgh Sleep Quality Index (PSQI) total score. Scores range from 0-21; a higher score indicates worse sleep quality. | 12 weeks |
| Change in resting-state fMRI | Change within network positive correlations and between network negative correlations from baseline to week 12. | 12 weeks |
| Change in gray matter volume | Change in the gray matter volumes (cubic millimeters) of the frontal, parietal and temporal lobes as defined by Freesurfer's Desikan-Killiany Brain Atlas from baseline to week 12. | 12 weeks |
| Change in cortical surface area | Change in the cortical surface area (millimeters squared) of the frontal, parietal and temporal lobes as defined by Freesurfer's Desikan-Killiany Brain Atlas from baseline to week 12. | 12 weeks |
| Change in white matter fractional anisotropy (FA) | Change in fractional anisotropy (FA), a scalar measure of diffusivity, of water in the brain assessed by DTI at 3T from baseline to week 12. FA values range from 0 (isotropic, meaning diffusion is equally restricted in 3D space) to 1 (anisotrophic, meaning that diffusion is completely restricted to a single direction). | 12 weeks |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D000068105 | Bipolar and Related Disorders |
| D019964 | Mood Disorders |
| D004032 |
| Diet |
| D009747 | Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D006291 | Health Policy |
| D011640 | Public Policy |
| D011049 | Social Control Policies |
| D057766 | Policy |
| D004472 | Health Care Economics and Organizations |