Psychosis as a symptom of Vitamin B12 deficiency. Report of one case

A Calle-Gonzalez,R Pinilla Zulueta,A Sotillos Gómez,A Hernández Mata,D Batet-Sanchez

doi:10.1192/j.eurpsy.2021.1126

A Calle-Gonzalez, R Pinilla Zulueta + Show 3 more

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https://doi.org/10.1192/j.eurpsy.2021.1126

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Abstract

IntroductionVitamin B12 deficiency may cause neurological and psychiatric symptoms, especially among elderly patients. Two clinical cases are presented of patients admitted to an Acute Inpatient Psychiatry Unit due to psychotic symptoms, being reported a B12 deficiency.ObjectivesReview clinical information about vitamin B12 deficiency as a factor involved in the development of psychiatric disorders, specifically psychotic symptoms, pointing out the peculiarities regarding clinical presentation, diagnosis, prognosis, and treatment management.MethodsSearch in the medical database PUBMED, MEDSCAPE and UPTODATE.ResultsVitamin B12 deficiency is associated with hematological, neuropsychiatric, and digestive disorders, is estimated that around 5-40% of the elderly population may present it. Neuropsychiatric syndromes may be the first, and sometimes sole, manifestation, related to a different etiological mechanism. Vitamine B12 deficiency implies enzymatic defects that cause an accumulation of methylmalonic acid and homocysteine, which is proportionally related to the severity of the neuropsychiatric symptoms. The range of clinical features includes psychotic and affective episodes, behavioral disorders, cognitive impairment, along with other neurological manifestations such as polyneuropathy and encephalopathy. The diagnosis delay is crucially important, as early detection could lead to reverse the neuropsychiatric symptoms and some of the neuroradiological alterations. Parenteral and oral vitamin B12 supplementation should be initiated, monitoring levels in plasma, together with psychiatric drugs until the symptoms are controlled.ConclusionsVitamin B12 deficiency is a factor that may be involved in the etiopathogenesis of psychiatric disorders. Thus, screening must be considered among the vulnerable population when presenting neuropsychiatric disorders as early diagnosis and treatment are key to clinical prognosis.

Highlights

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Summary

Introduction

The central effects of anticholinergic drugs can be marked in patients with dementia. Anticholinergics antagonise the effects of cholinesterase inhibitors, the main dementia treatment. Objectives: This study aimed to assess anticholinergic drug prescribing among dementia patients before and after admission to UK acute hospitals. Methods: 352 patients with dementia were included from 17 hospitals in the UK. An evidence-based online calculator was used to calculate the anticholinergic drug burden of each patient. 37.8% of patients had an anticholinergic burden score ≥1 and 5.68% ≥3. 43.2% of patients had an anticholinergic burden score ≥1 and 9.1% ≥3. The most common group of anticholinergic medications prescribed at discharge were psychotropics (see Figure 1). Among patients prescribed cholinesterase inhibitors, 44.9% were taking anticholinergic medications

Conclusions