ORIGINAL ARTICLEVitamin B12 and folate serum levels in newly admitted psychiatric patients
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
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