Elsevier

Clinical Nutrition

Volume 25, Issue 1, February 2006, Pages 60-67
Clinical Nutrition

ORIGINAL ARTICLE
Vitamin B12 and folate serum levels in newly admitted psychiatric patients

https://doi.org/10.1016/j.clnu.2005.08.014Get rights and content

Summary

Background & aims

Deficiencies of cobalamin and folate may play a causal role in the development or exacerbation of psychiatric illnesses. We compared cobalamin and folate levels in newly admitted psychiatric patients to mentally healthy controls and assessed their correlation with various psychiatric conditions.

Methods

All patients consecutively admitted to a psychiatric hospital were examined for serum cobalamin and folate levels. Controls were obtained from a population with no known mental illness. Values were considered to be below normal if cobalamin was <223 pg/ml and folate <3.1 ng/ml.

Results

The 224 newly admitted patients did not differ significantly from controls, both with regard to the mean cobalamin level and to the prevalence of lower than normal levels. About 30% of patients had low folate values compared to 2.5% in the control group (P<0.0001). Mean folate level in controls was significantly higher than in patients (P<0.0001), where a positive correlation was found between low folate levels and depression.

Conclusions

The results of our study suggest that folate levels be assessed in patients admitted to psychiatric wards, especially in those with depression. Further study is needed to evaluate the role of folate and cobalamin in psychiatric illness.

Introduction

The metabolism of vitamin B12 (cobalamin, Cbl) and folic acid (folate, FA) is interrelated and both are necessary in several pathways in the central nervous system.1, 2 Cobalamin and folate facilitate the production of S-adenosylmethionine (SAM)—the exceptional donor of a methyl-group for various reactions of methylation, by promoting the conversion of homocysteine (Hcy) into methionine. In cases of folate or cobalamin deficiency methionine synthetase activity may be severely impaired, resulting in an elevated plasma total Hcy level.3 However, a high Hcy level is not always related to vitamin deficiency.4 Folic acid also influences the rate of synthesis of the neurotransmitters dopamine, norepinephrine, and serotonin, and acts as a cofactor in the hydroxylation of phenylalanine and tryptophan.5, 6, 7 Disturbance of biogenic amine metabolism may lead to various psychiatric disorders.

Cobalamin and folic acid deficiency may contribute to the pathogenesis of neuropsychiatric disorders such as mental confusion, memory changes, cognitive slowing, mood disorder, violent behavior, fatigue, delirium, and paranoid psychosis. This relationship has been described by many investigators.6, 8, 9, 10, 11 Neuropsychiatric symptoms have been described as the presenting feature of cobalamin deficiency prior to the appearance of hematological findings.12, 13 The reported prevalence of a low serum cobalamin level among psychiatric inpatients is between 5% and 30% and that of a low serum folate level 10–33%.6, 7, 9, 14 These findings are in contrast with a nonpsychiatric population in which only 3–5% had low cobalamin levels and 5–8% low folic acid levels.15, 16, 17 Interestingly, it has been shown that there is a higher prevalence of low cobalamin levels among reportedly healthy individuals in Israel.18 Several studies have shown a higher incidence of cobalamin and folic acid deficiency in geriatric inpatients and outpatients, in acute geropsychiatric inpatients, and chronic psychiatric outpatients and inpatients.10, 14, 19, 20, 21, 22

The purposes of this study were: (1) To assess the serum levels of cobalamin and folate in newly admitted psychiatric patients. (2) To compare the serum level of both vitamins in newly admitted psychiatric patients to that of a control group of mentally healthy patients. (3) To compare the vitamin levels at the time of the first hospitalization with those at subsequent admissions. (4) To evaluate the correlation between various mental manifestations and the serum levels of both vitamins.

Section snippets

Subjects

During a period of 4 months, all consecutive admissions to a psychiatric hospital were evaluated, including patients with first hospitalizations as well as those returning for repeat admissions. Patients were evaluated only once during the study. The medical history and clinical status were assessed on admission, and laboratory investigations, including a complete blood count, blood chemistry, serum cobalamin and folate, were performed within 48 h of admission. The psychiatric diagnoses of

Results

We obtained blood samples from 237 newly admitted patients, of which thirteen were not analyzed due to technical reasons. The remaining 224 patients included 143 men and 81 women. The mean age of the study population was 39.4 years with a standard deviation of 13.3. Table 1 represents clinical and demographic characteristics of the study patients.

Almost half of the patients (44.7%) suffered from schizophrenia, 25.9% from mood disorders, 14.7% from schizoaffective disorder, 8% from organic

Discussion

We found a higher frequency of lower than normal levels of folate in newly admitted psychiatric patients compared to controls (30% vs. 2.5%). Also, although cobalamin deficiency was common in these patients (26%), the control group had a similar degree of deficiency (25%).

Our findings regarding folate deficiency in patients suffering from mood disorders are consistent with those of other recent studies.6, 13, 24, 25, 26, 27, 28, 29 A low folate level was found 3.5 times more frequently in

References (46)

  • H. Karabiber et al.

    Effects of valproate and carbamazepine on serum levels of homocysteine, vitamin B12, and folic acid

    Brain Dev

    (2003)
  • B. Shane et al.

    Vitamin B12–folate interrelationships

    Annu Rev Nutr

    (1985)
  • S.P. Stabler et al.

    Elevation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capillary gas chromatography-mass spectrometry

    J Clin Invest

    (1988)
  • D. Curtis et al.

    Elevated serum homocysteine as a predictor for vitamin B12 or folate deficiency

    Eur J Haematol

    (1994)
  • T. Bottiglieri et al.

    Folate deficiency, biopterin and monoamine metabolism in depression

    Psychol Med

    (1992)
  • T. Bottiglieri

    Folate, vitamin B12, and neuropsychiatric disorders

    Nutr Rev

    (1996)
  • D.L. Evans et al.

    Organic psychosis without anemia or spinal cord symptoms in patients with vitamin B12 deficiency

    Am J Psychiatry

    (1983)
  • M. Hector et al.

    What are the psychiatric manifestations of vitamin B12 deficiency?

    J Am Geriatr Soc

    (1988)
  • U.M. Skerritt

    A prevalence study of folate deficiency in a psychiatric in-patient population

    Acta Psychiatr Scand

    (1998)
  • V. Lerner et al.

    Acute dementia with delirium due to vitamin B12 deficiency: a case report

    Int J Psychiatry Med

    (2002)
  • J. Lindenbaum et al.

    Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis

    N Engl J Med

    (1988)
  • H. Silver

    Vitamin B12 levels are low in hospitalized psychiatric patients

    Isr J Psychiatry Relat Sci

    (2000)
  • P.J. Garry et al.

    Folate and vitamin B12 status in a healthy elderly population

    J Am Geriatr Soc

    (1984)
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