Abstract
Cobalamin (Vitamin B12) has been linked to the development of certain mental illnesses. The psychological manifestations of vitamin B12 deficiency were variable in a survey of 19 patients (14 vegetarians) with confirmed vitamin B12 deficiency, with the majority showing no serious haematological or neurological symptoms.
When cells divide, cobalamin (Vitamin B12), a water-soluble vitamin, plays a crucial function in the creation of new DNA.
It's been connected to the production of dopamine and serotonin, two neurotransmitters thought to play a role in the aetiology of a wide range of psychiatric diseases, so it's not surprising that this factor is often considered as well.
2 Impaired transmethylation resulting to buildup of hazardous metabolites was the basis for the once-popular one-carbon hypothesis of schizophrenia. 3
Vitamin B12 deficiency has been linked to a wide range of mental health issues, yet the link between the two is generally disregarded. Depression, apathy, irritability, dementia, catatonia, delirium, and hallucinations are all possible psychiatric signs of vitamin B12 insufficiency. 4,5 A better prognosis in depressive disorders may be connected with higher vitamin B12 levels. 6 Researchers found that 4–6% of psychiatric inpatients had vitamin B12 deficiencies. 7 Up to 28% of individuals have reported neuropsychiatric problems without an increase in hematocrit values or red cell mean corpuscular volume (MCV); these are the markers typically tested for B12 insufficiency. Therefore, a determination of vitamin B12 levels is necessary under these circumstances.
Deficiencies in vitamin B12 occur when the vitamin is not consumed enough or is absorbed poorly. It is a by-product of bacterial synthesis and can only be found in foods that originated from animals, such as meat, eggs, and dairy products. Because of advances in nutrition, vitamin B12 insufficiency is uncommon in affluent nations but widespread in the poor world. In particular, it is widespread in India, where many people adhere to a strictly vegetarian diet. 8 Here, we provide a case series involving 19 patients who exhibited both vitamin B12 insufficiency and mental symptoms.
Continuing Case Studies
We found that psychosis was a prevalent diagnosis in many of our patients. Except for three individuals, all systemic exams were within normal ranges; one of these patients had sensory impairments in both lower limbs, and the other two showed pallor. The patients' clinical features who had normal serum B12 levels are listed in Table 1.
Among those diagnosed with psychosis, the vast majority had classic first-rank Schneiderian symptoms, including thought alienation phenomena, commenting and third-person aural hallucinations, delusions of persecution and reference, and passivity phenomena. Depressive thinking predominated, they didn't feel like doing anything, they were tired quickly, and they experienced physical symptoms. The person suffering from episodes of psychosis displayed severe psychotic symptoms but no typical first-rank symptoms. The bipolar patient exhibited typical manic symptoms.
Discussion
This study emphasises the need to test for vitamin B12 deficiency in people with mental disorder. No patient initially appeared with simply vitamin B12 insufficiency; rather, psychiatric symptoms were the initial focus of care until the underlying cause was determined. Of the 19 patients, 14 had adhered to a strict vegetarian diet, raising concerns about B12 deficiency. Given that Vitamin B12 is absent from plant products, it is well-documented that vegetarians often suffer from a functional B12 shortage. 1 The cross-sectional nature of our study makes it impossible to draw any firm conclusions about causation; rather, it is possible that the link between the two is perhaps coincidental or a result of some other factor unrelated to the psychiatric disease. However, vitamin B12 has been reported to significantly alleviate psychotic symptoms that were previously thought to be unresponsive to psychiatric medication. 4,9,10
Despite the fact that dementia-like syndrome has also been reported in the published literature, our middle-aged patient sample makes this a less likely outcome. An entirely distinct Geriatric Psychiatry clinic would serve our hospital's primarily older patient group.
Laboratory evaluations alone were sufficient to establish vitamin B12 deficiency in the vast majority of patients, who had no overt haematological or neurological symptoms. On physical examination, pallor was likewise absent in all but two cases. In other cases, B12 levels were also below the normal range, supporting previous reports that psychiatric symptoms sometimes precede neurological problems by months or even years. 11 It has also been suggested that the threshold be raised to 660 pg/L because psychiatric signs may appear before vitamin B12 levels fall to that low. 11 However, there may be an irreversible "window time" during which axonal demyelination and other degenerative alterations cannot be treated. 10
It has been recently suggested that all mental patients have their vitamin B12 levels checked, as a slight shortage in this nutrient may have been present for quite some time without being noticed.
8 Those at greater risk for developing a psychological disorder include the elderly, vegetarians, and people with gastrointestinal problems. 10 It is recommended to maintain a serum B12 level of at least 600 pg/ml, and this may be easily and accurately determined in a laboratory setting. 12 Non-vegetarian patients who are unresponsive to standard medical care may also benefit from a B12 test.
Although there were sufficient clinical grounds to consider a primary B12 insufficiency in isolation, this investigation was limited by the fact that we were unable to measure folic acid levels at the same time.
Conclusions
Patients in our study tended to be vegetarians and did not have any of the major physical conditions linked to low cobalamin levels. So, when dealing with vegetarian psychiatric patients who appear with symptoms unresponsive to standard psychotropics or antidepressants, a strong index of suspicion is warranted. Our findings also suggest that patients with a syndromal psychotic disease who are vegetarians should have their Vitamin B12 levels checked.
In conclusion, this paper stresses the significance of testing for vitamin B12 insufficiency in patients with psychiatric illnesses, particularly those in high-risk groups. Impairment in DNA synthesis may cause downstream alterations that contribute to the emergence of psychopathology, but these mechanisms remain unexplored. To further understand vitamin B12's function in the development of mental illness, more research is required.
Comments
Post a Comment