Low serum vitamin B12 levels among psychiatric patients admitted in Butabika mental hospital in Uganda

BMC Research Notes

Seggane Musisi²  Henry Ddungu¹  Michael Ssonko³ 

[1] Uganda Cancer Institute, Mulago Hospital Complex, Kampala, Uganda;Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda;Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

关键词: Psychiatric Illness;    Vitamin B₁₂;    Low serum levels;   

Others  :  1134493
DOI  :  10.1186/1756-0500-7-90

 received in 2013-10-10, accepted in 2014-02-11,  发布年份 2014

【 摘 要 】

Background

Psychiatric manifestations have been noted in patients with low serum vitamin B₁₂ levels even in the absence of other neurologic and/or haematologic abnormalities. There is no literature on low serum B₁₂ prevalence among Ugandans with psychiatric illnesses. The aim of this study was to establish the prevalence, risk factors, and clinical manifestations of low serum vitamin B₁₂ among psychiatric patients admitted in a Mental Health Hospital in Uganda.

Method

Using a cross sectional descriptive study design, 280 in-patients selected by systematic sampling were studied using a standardized protocol. Low serum vitamin B12 was defined as a level < 240 pg /mL.

Results

We found a prevalence of low serum B₁₂ in 28.6% of the participants. Absent vibration sense which was significantly associated (58.3% Vs. 26.7%: OR = 3.84 (95% C.I. 1.18, 12.49); p-value = 0.025) with low vitamin B₁₂ was observed among 12 participants. Macro-ovalocytes present among 23 participants on peripheral film were significantly associated with low serum levels (73.9% Vs. 26.2%: OR = 7.99 (95% C.I. 3.01, 21.19) p-value < 0.0001). Factors significantly associated with low serum B₁₂ levels included psychiatric diagnosis of schizophrenia (AOR 1.74 (95% C.I. 1.00, 3.02); p-value = 0.049), duration of psychiatric illness > or = 3 years (AOR 2.27 (95% C.I. 1.29, 3.98); p-value = 0.004), and hospitalization < 3 weeks (AOR 4.01 (95% C.I. 1.02, 15.79); p-value = 0.047). Female participants were associated with protection from low serum levels (AOR 0.4 (95% C.I. 0.22, 0.73); p-value = 0.003).

Conclusion

Low serum B₁₂ is common among hospitalized psychiatric patients with the majority having no haematological findings. Associated risk factors included having a psychiatric diagnosis of schizophrenia, a shorter duration of hospitalization and longer duration of psychiatric illness. Female participants were less likely to have low serum vitamin B₁₂ levels. Routine screening for serum vitamin B₁₂ levels should be adopted by all hospitals for admitted psychiatric patients.

【 授权许可】

   
2014 Ssonko et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Zittoun J, Zittoun R: Modern clinical testing strategies in cobalamin and folate deficiency. Semin Hematol 1999, 36:35-46.
• [2]Herrmann W, Lorenzl S, Obeid R: Review of the role of hyperhomocysteinemia and B-vitamin deficiency in neurological and psychiatric disorders: current evidence and preliminary recommendations. Fortschr Neurol Psychiatr 2007, 75(9):515-527.
• [3]Carmel R, Gott PS, Waters CH, Cairo K, Green R, Bondareff W, DeGiorgio CM, Cummings JL, Jacobsen DW, Buckwalter G, et al.: The frequently low cobalamin levels in dementia usually signify treatable metabolic, neurologic and electrophysiologic abnormalities. Eur J Haematol 1995, 54:245-253.
• [4]O'Neill D, Barber RD: Reversible dementia caused by vitamin B12 deficiency [letter]. J Am Geriatr Soc 1993, 41:192-193.
• [5]Hector M, Burton JR: What are the psychiatric manifestations of vitamin B 12 deficiency? J Am Geriatr Soc 1988, 36:1105-1112.
• [6]Miller H, Golden RN, Evans DL: Mental dysfunction and cobalamin deficiency [letter]. Arch Intern Med 1990, 150:910-911.
• [7]Applebaum J, Shimon H, Sela BA, Belmaker RH, Levine J: Homocysteine levels in newly admitted schizophrenic patients. J Psychiatr Res 2004, 38:413-416.
• [8]Silver H: Vitamin B12 levels are low in hospitalised psychiatric patients. Isr J Psychiatry Relat Sci 2000, 37:41-45.
• [9]Fragasso A, Mannarella C, Ciancio A, Sacco A: Functional vitamin B12 deficiency in alcoholics: an intriguing finding in a retrospective study of megaloblastic anemic patients. Eur J of Int Med 2010, 21:97-100.
• [10]Verbanck PM, Le Bon O: Changing psychiatric symptoms in a patient with vitamin B12 deficiency. J Clin Psychiatry 1991, 52:182-183.
• [11]Hermesh H, Weizman A, Shahar A, Munitz H: Vitamin B12 and folic acid serum levels in obsessive compulsive disorder. Acta Psychiatr Scand 1988, 78:8-10.
• [12]Payinda G, Hansen T: Vitamin B12 deficiency manifested as psychosis without anemia [Letter]. Am J Psychiatry 2000, 157:660-661.
• [13]Tiong AC, Patel MS, Gardiner J, Ryan R, Linton KS, Walker KA, Scopel J, Biggs BA: Health issues in newly arrived African refugees attending general practice clinics in Melbourne. Med J Aust 2006, 185:602-606.
• [14]Cetinkaya F, Yildirmak Y, Kutluk G, Erdem E: Nutritional vitamin B12 deficiency in hospitalized young children. Pediatr Hematol Oncol 2007, 24(1):15-21.
• [15]Streiff RR: Anemia and nutritional deficiency in the acutely ill hospitalized patients. Med Clin North Am 1993, 77(4):911-918.
• [16]Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LJ, Kenler HA, Cody RP: Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg 1998, 2:436-442.
• [17]Remacha AF, Cadafalch J: Cobalamin deficiency in patients infected with the human immunodeficiency virus. Semin Hematol 1999, 36:75-87.
• [18]Semeere AS, Nakanjako D, Ddungu H, Kambugu A, Manabe YC, Colebunders R: Sub-optimal vitamin B-12 levels among ART-naïve HIV-positive individuals in an urban cohort in Uganda. PLoS One 2012, 7(7):e40072.
• [19]Tal S, Shavit Y, Stern F, Malnick S: Association between vitamin B12 levels and mortality in hospitalized older adults. J Am Geriatr Soc 2010, 58:523-526.
• [20]Karabiber H, Sonmezgoz E, Ozerol E, Yakinci C, Otlu B, Yologlu S: Effects of valproate and carbamazepine on serum levels of homocysteine, vitamin B12, and folic acid. Brain Dev 2003, 25:113-115.
• [21]Valuck RJ, Ruscin JM: A case–control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol 2004, 57(4):422-428.
• [22]Bhat AS, Srinivasan K, Kurpad SS, Galgali RB: Psychiatric presentations of vitamin B 12 deficiency. Indian Med Assoc 2007, 105(7):395-396.
• [23]Lernera V, Kanevskya M, Dwolatzkya T, et al.: Vitamin B12 and folate serum levels in newly admitted psychiatric patients. Clin Nutr 2006, 25:60-67.
• [24]Carmel R, Green R, Rosenblatt DS, Watkins D: Update on cobalamin, folate, and homocysteine. Hematology Am Soc Hematol Educ Program 2003, 2003:62-81. no. 1
• [25]Kish L: Survey Sampling. INC Wiley Classics Library Edition Published: John Wiley & Sons; 1995.
• [26]Shaffer D: A participant’s observations: preparing DSM-IV. Can J Psychiatry 1996, 41:325-329.
• [27]Ewing JA: Detecting alcoholism, The CAGE questionnaire. JAMA 1984, 252(14):1905-1907.
• [28]Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive stae of patients for the clinician. J Psychiatric Research 1975, 12:188-198.
• [29]Mini-Mental State Exam (MMSE): Tech-Administered. http://www.framinghamheartstudy.org/share/protocols/mm1_8s_protocol.pdf webcite
• [30]Information about NICE clinical guideline 42: National Institute for Health and Clinical Excellence. 2006, 19.
• [31]Shahar A, Feiglin L, Shahar DR, Levy S, Seligsohn U: High prevalence and impact of subnormal serum vitamin B12 levels in Israeli elders admitted to a geriatric hospital. J Nutr Health Aging 2001, 5(2):124-127.
• [32]Bell IR, Edman JS, Marby DW, Satlin A, Dreier T, Liptzin B, Cole JO: Vitamin B12 and folate status in acute geropsychiatric inpatients: affective and cognitive characteristics of a vitamin nondeficient population. Biol Psychiatry 1990, 27(2):125-137.
• [33]The United Nations University Food Nutr Bull 2008, 29:2.
• [34]Herr KD, Norris ER, Frankel BL: Acute psychosis in a patient with vitamin B12 deficiency and coincident cervical stenosis. Psychosomatics 2002, 43(3):234-236.
• [35]Bolander-Gouaille and Bottigglieri: Homocysteine, related vitamins and neuropsychiatric disorders. Prog Neuro-Psychopharmacol Biol Psychiatry 2005, 29:1175-1180.
• [36]Sánchez H, Albala C, Herlramp FE, Verdugo R, Lavados M, Castillo JL, Lera L, Uauy R: Prevalence of vitamin B-12 deficiency in older adults. Rev Med Chil 2010, 138(1):44-52.
• [37]Hao L, Ma J, Zhu J, Stampfer MJ, Tian Y, Willett WC, Li Z: Vitamin B-12 deficiency is prevalent in 35- to 64-year-old Chinese adults. J Nutr Health Aging 2007, 137(5):1278-1285.
• [38]Berenson AB, Rahman M: Effect of hormonal contraceptives on vitamin B12 level and the association of the latter with bone mineral density. Contraception 2012, 86(5):481-487.
• [39]Sütterlin MW, Bussen SS, Lorenz R: Serum folate and Vitamin B12 levels in women using modern oral contraceptives (OC) containing 20 μg ethinyl estradiol. Eur J Obstet Gynecol Reprod Biol 2003, 107:57-61.
• [40]Bickley LS, Szilagyi PG: Bates' Guide to Physical Examination and History Taking. 10th edition. Lippincott: Williams & Wilkins; 2007:584.
• [41]Abdalla SH, Corrah PT, Mabey DC: Severe megaloblastic anemia due to vitamin B12 deficiency in The Gambia. Trans R Soc Trop Med Hyg 1986, 80:557-562.