Abstract
Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unremarkable with no substance use/exposure or infections. No stressors were present. The patient was not vegetarian. Past medical history and family history was normal. Neurological examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in the left elbow, bilateral problems of coordination in cerebellar examination, reduced swinging of the arms and masked face. Romberg’s sign was present. Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was suggestive of malabsorbtion. He was diagnosed with Mood disorder with Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone 0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along with referral for treatment of Helicobacter pylori. A visit on the second week revealed no psychotic features. Romberg’s sign was negative and cerebellar tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12 levels were elevated. Risperidone was stopped and parenteral Vitamin B12 treatment was continued with monthly injections for 3 months. Follow-up endoscopy and biopsy at the first month demonstrated eradication of H. pylori. He was followed monthly for another 6 months and psychiatric symptoms did not recur at the time of last evaluation. Despite limitations, this case may underline the observation that mood disorders with psychotic features especially with accompanying extrapyramidal symptoms lacking a clear etiology may be rare manifestation of vitamin B12 and/or folate deficiency in children and adolescents and be potentially amenable to treatment.
Highlights
Vitamin B12 is one of the essential vitamins affecting various systems of the body
This study aimed to report a case of vitamin B 12 deficiency in an adolescent who presented with mixed mood disorder symptoms with psychotic features
This study reports a case of vitamin B12 deficiency in an adolescent who presented with mixed mood disorder symptoms with psychotic features as well as extrapyramidal symptoms and its response to Vitamin B12 treatment
Summary
Vitamin B12 is one of the essential vitamins affecting various systems of the body. In case of deficiency; hematologic (megaloblastic, macrocytic anemia), neurologic (demyelinization, paresthesia), gastrointestinal (anorexia, glossitis) as well as psychiatric symptoms arise. This study aimed to report a case of vitamin B 12 deficiency in an adolescent who presented with mixed mood disorder symptoms with psychotic features. Case presentation A sixteen-year old male adolescent was brought to our department with complaints of “irritability, regressive behavior, apathy, crying and truancy”. Upon questioning of his parents it was learned that the complaints have been present for the past year. Speech was reduced and he became progressively isolated from his peers He refused to go to school and when sent became truant frequently. Premorbid personality of the adolescent was described as extrovert, euthymic and active He was well liked by his friends the academic staff reported problems in attention starting from the second grade. His teachers reported fidgetiness and impulsivity which was especially prominent in mathematics lessons
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
