Psychiatric Manifestations of Modern Scurvy: A Case Series and Literature Review

Abstract

Scurvy is often considered to be a historical disease that once affected sailors, and so its modern-day prevalence is underestimated. Scurvy can present in various ways, such as with mucocutaneous and/or hematological symptoms in classic scurvy or with isolated psychiatric symptoms in neuropsychiatric scurvy. We describe two patient presentations of scurvy with borderline-low vitamin C levels and neuropsychiatric symptoms. Patient 1 presented with an exacerbation of major depressive symptoms and classic physical symptoms of scurvy, while Patient 2 presented with new-onset psychotic symptoms and no physical symptoms. Both patients had significant improvement of symptoms with vitamin C supplementation. We also conducted a literature search of MED-LINE via PubMed, identifying 16 cases of patients who met criteria for a scurvy diagnosis and presented with psychiatric symptoms that responded to vitamin C supplementation. The cases and literature review revealed that patients with scurvy can have variable psychiatric symptoms with or without the presence of mucocutaneous signs. Therefore, to optimize detection of suspected cases, diagnostic guidelines for scurvy should include psychiatric symptoms in addition to classic signs. Patients with acute psychiatric symptoms and a history of malnutrition should be screened for hypovitaminosis C. An empirical trial of vitamin C supplementation may also be of value in some cases when borderline-low vitamin C levels are found in suspected neuropsychiatric scurvy. [ Psychiatr Ann . 2023;53(6):282–288.]